Статьи

• 1. Acute Liver Failure On The Background Of Chronic Liver Disease Due To Hepatitis Virus Reactivation

  Bolatbek Baimakhanov, Shokan Kaniyev, Maxat Doskhanov, Almagul Jumabaeva, Zhambyl Ospan, Milliyenium Maulen, Ainur Aftandilkyzy, Magzhan Tursynbay

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  4–9

  Abstract

  Today, hepatitis B virus-associated acute liver failure remains the leading cause of liver failure (44% mortality in Asia and 41% in the United States). Studies show that among patients with hepatitis B-associated cirrhosis, acute liver failure develops in 10-20% of cases. Acute liver failure on chronic liver disease is a potentially reversible syndrome that occurs in patients with cirrhosis or chronic liver disease and is characterized by acute decompensation, organ failure, and high short-term mortality. Chronic hepatitis B virus infection is a leading cause of liver morbidity and mortality worldwide. When we talk about hepatitis B, there is a high risk of developing super infection hepatitis D, since hepatitis D remains infectious and can reactivate at very low titers that are not detected using modern analysis methods if HBsAg remains in the blood serum. The interaction of these viruses leads to accelerated progression of fibrosis and cirrhosis of the liver, which significantly increases the risk of developing acute liver failure against the background of chronic.

  In our case, a patient diagnosed with liver cirrhosis as a result of viral hepatitis B with delta agent, class C according to Child–Pugh–Turcotte, MELD-36 points, the patient developed a severe form of acute renal failure, which required emergency intervention, so he was not included in the waiting list for a transplant from a cadaveric donor. His wife became the donor, which is an example of living donation, which provides higher chances of successful recovery due to a shorter waiting time and a lower risk of graft rejection. Timely examination of the donor and recipient, as well as prompt liver transplantation, contributed to a favorable outcome of the disease.

  Keywords

  viralre activation, acute-on-chronic liver failure, liver transplantation

• 2. A Rare Case Of Congenital Portosystemic Shunt (Abernethy Malformation Type II) In A Child. Diagnosis, Endovascular Interventional Strategy, And Follow-Up

  Kozhamkul Alisher, Bolatkan Arlan, Abilkhanov Yerzhan, Onlasynov Aziz, Sapunov Alexander, Pazilov Sabit, Saduakas Almas, Zhakubayev Manat, Matkerimov Askar, Oraqbai Ernur

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  10–17

  Abstract

  Congenital portosystemic shunt, also known as Abernethy malformation, is a rare vascular anomaly in which portal venous blood partially or completely bypasses the liver and enters the systemic circulation. This condition can lead to severe complications such as hepatopulmonary syndrome, hepatic encephalopathy, hypoxemia, and hyperammonemia. This article presents the first clinically confirmed and successfully treated case of Abernethy type II malformation in a child in Kazakhstan, who developed severe hepatopulmonary syndrome. A detailed description is provided of the diagnostic algorithm, angiographic evaluation, the endovascular intervention technique, and the patient’s clinical course over a five-year follow-up period. Shunt closure resulted in marked clinical improvement, including normalization of oxygen saturation (from 60% to 98%), reduction in blood ammonia levels, increased exercise tolerance, and enhanced quality of life. The findings support the effectiveness of an individualized, stepwise approach in the management of type II CPSS. The importance of early recognition of this condition is emphasized, particularly in pediatric patients presenting with unexplained cyanosis, hypoxemia, or signs of hepatic dysfunction. Endovascular techniques, due to their minimally invasive nature and high clinical efficacy, represent an optimal therapeutic strategy in pediatric practice.

  Keywords

  transcatheter shunt closure, congenital portosystemic shunt (CPSS), hepatopulmonary syndrome, Abernethy malformation

• 3. Clinical And Prognostic Significance Of Intra-Abdominal Pressure In Choosing A Surgical Strategy For Gastroschisis In Newborns

  N. Bissaliyev Bauyrzhan, A. Tsap Natalya, V. Sarsenova Valentina, B. Tussupkaliev Assylbek, T. Baubekov Zhenysbek, Z. Abdullayeva Gulzhamal, V. Li Dmitriy, Nurbakyt Zh. Zhaksybayeva

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  18–24

  Abstract

  Background. Gastroschisis is a congenital defect of the anterior abdominal wall in newborns, characterized by the evisceration of bowel loops without a protective sac. Timely and appropriate abdominal wall closure is essential for favorable outcomes.

  Objective: To evaluate the clinical and prognostic significance of intra-abdominal pressure monitoring for determining the optimal surgical strategy in newborns with gastroschisis.

  Materials and Methods. A retrospective cohort study was conducted on 32 newborns with gastroschisis treated in two tertiary centers in Kazakhstan and Russia from 2015 to 2025. Patients were allocated into two groups based on intraoperative intra-abdominal pressure values: Group 1 (n=21) underwent primary fascial closure using the Elective Delayed Midgut Reduction technique; Group 2 (n=11) received staged silo-assisted closure. intra-abdominal pressure was measured intravesically, and a threshold of 22–24 cm H₂O was used to guide the surgical decision. Clinical outcomes included duration of mechanical ventilation, total parenteral nutrition, ICU stay, hospital stay, complication rate, and mortality. Statistical analysis was performed using the Mann–Whitney U test (p < 0.05).

  Results. Group 1 had significantly better outcomes, including shorter durations of mechanical ventilation (6 vs. 13 days, p = 0.01), ICU stay (12 vs. 20 days, p = 0.01), parenteral nutrition (14 vs. 22 days, p = 0.04), and lower mortality (4.8% vs. 27.3%, p = 0.03). Group 2 showed a higher complication rate, especially adhesive obstruction and sepsis.

  Conclusion. Intraoperative intra-abdominal pressure measurement is a valuable tool for guiding surgical strategy in gastroschisis. An individualized approach based on physiological parameters improves safety and outcomes in neonatal surgical care.

  Keywords

  gastroschisis, intra-abdominal pressure, infant, newborn, surgical wound closure, abdominal compartment syndrom

• 4. Improving The Organization Of Early Diagnosis Of Manifestations Of Microangiopathy To Prevent The Risk Of Complications

  B. Sandybek Alibek, I. Akhmetov Ualikhan, B. Popova Tatyana

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  25–31

  Abstract

  Background. Microangiopathy is a heterogeneous group of pathological conditions characterized by damage to small-caliber blood vessels, leading to impaired microcirculation and subsequent disruption of trophic, gas exchange, detoxification, and immune functions. It frequently develops in diabetes mellitus, arterial hypertension, systemic autoimmune, infectious, and neurodegenerative diseases. Untimely detection of microangiopathic changes significantly increases the risk of severe complications such as diabetic retinopathy, nephropathy, neuropathy, cognitive impairment, stroke, and dementia.

  Material and methods. A retrospective analysis was conducted using brain magnetic resonance imaging data obtained on a 1.5 Tesla General Electric scanner at Clinical Hospital No. 5 in Almaty from 2022 to 2024. Patient records were evaluated for the presence and severity of microangiopathic changes according to the Fazekas scale.

  Results. Among 1,814 patients who underwent brain magnetic resonance, pathological changes were detected in 58% of cases, of which 79% were of a microangiopathic nature. Early-stage changes (Fazekas 1) accounted for 57% of cases, suggesting that detection often occurs before severe structural damage develops. Advanced microangiopathy (Fazekas 2–3) was observed in the remaining cases, indicating the need for closer clinical monitoring and targeted intervention.

  Conclusion. The findings demonstrate the high prevalence of microangiopathy among patients undergoing brain magnetic resonance in Almaty. Early detection through neuroimaging provides an opportunity for timely preventive and therapeutic measures, potentially reducing the risk of severe neurological complications and improving patient outcomes.

  Keywords

  —

• 5. The Radicality Of Pituitary Adenoma Removal In The Republic Of Kazakhstan

  A. 0XVWDɐQ+, A. Doskaliyev, A. Yelyubayev, A. Teltayev

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  32–36

  Abstract

  Background. Pituitary adenoma is a common tumor of the chiasmosellar region. By hormonal activity, pituitary adenoma’s are classified as somatotropinomas, non-functioning, prolactinomas, corticotropinomas, and mixed types. Treatment tactics vary by type. Objective: To assess radicality of removal of different pituitary adenoma types in patients operated.

  Materials and methods. Retrospective analysis of 929 patients (721 — endoscopic transnasal approach) treated at JSC "National Centre for Neurosurgery" between 2010–2022. Clinical data and magnetic resonance imaging findings were evaluated.

  Results. Significant differences in “Extent of Resection” were found among pituitary adenoma types. The highest rate of total resection occurred in mixed tumors compared to prolactinomas (76.5% vs 50%). Subtotal removal was seen in 23.5% of mixed tumors, none had partial resection. Prolactinomas showed total removal in 50%, subtotal in 41.9%, partial in 8.1%. Conservative resection of prolactinomas is linked to their high sensitivity to medical therapy, enabling full recovery with dopamine agonists postoperatively. More radical removal of mixed pituitary adenoma’s is justified by their aggressive behavior and relative drug resistance.

  Conclusion. Extent of resection correlates with pituitary adenoma type. Lower radicality in prolactinomas reflects their benign course and responsiveness to drugs, whereas mixed pituitary adenoma’s require aggressive surgery due to severe hormonal disturbances. Greater radicality should be pursued when possible while preserving quality of life. The transnasal endoscopic approach remains the safest and most effective surgical method for pituitary adenoma’s in Kazakhstan, as confirmed by high total resection rates and low postoperative complications.

  Keywords

  pituitary adenoma, transnasal, endoscopic surgery, Kazakhstan, neurosurgery

• 6. An Optimized Approach To The Formation Of The Upper Eyelid Among Euroasians

  Muradov Mismil, Abdukarimova Aidana, Zagainova Maria, Dzhamaldinov Timur

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  37–42

  Abstract

  Background. Blepharoplasty of the Asian eyelid is a variant of operation in which a fold of the eyelid is created. The Asian upper eyelid is characterized by a low, absent, or variable skin fold, a fuller eyelid with a smaller orbit, and a medial epicanthal fold. The presence of this fold is explained by a different attachment of the muscle that raises the upper eyelid.

  Material and methods. In the conditions of the NSCS named after Syzganov, between 2020–2024, we operated on 127 patients. In 101 cases, blepharoplasty was performed separately, in 26 cases in combination with other operations.

  Results. In the postoperative period, no general surgical complications were observed in patients, in 2 cases there was an inconsistency of the formed fold.

  Conclusions. Our method is a proven choice for the Europeanization of Asian eyelids, in which the postoperative scar does not extend beyond the cutout of the eyes. Low injury rate of the operation. Indirect epicanthoplasty is the method of choice for oriental blepharoplasty, since this method does not require additional incisions, therefore, the duration of rehabilitation, the number of possible complications, and the time of surgery are reduced. Only 2% of patients had an unsatisfactory result. The economic validity of this methodology: no need to stay in the hospital for a long time. This minimizes the costs of the medical facility and reduces the burden on medical staff.

  Keywords

  upper eyelid, Oriental blepharoplasty, epicanthu

• 7. Features Of Risk Factors For The Development Of Atherosclerosis-Associated Cardiovascular Diseases In The Kazakhstani Population. Ethnonational Aspect

  Makhabbat Bekbossynova, Tatyana Ivanova-Razumova, Aliya Sailybayeva, Management Board, Kamila Akzholova

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  43–55

  Abstract

  Background. Atherosclerosis-associated cardiovascular diseases exhibit significant ethnic and regional variability in risk factors. Kazakhstan’s high cardiovascular disease mortality rates necessitate population-specific profiling, particularly given urban-rural disparities and lifestyle differences unique to Central Asia.

  Methods. This cross-sectional study (2023–2024) analyzed 368 Kazakhstani adults stratified by European Atherosclerosis Society risk tiers: low (n=67), high (n=127), and very high risk (very high-risk group, n=174). Assessments included lipid profiles (low density lipoprotein, high density lipoprotein, and apolipoprotein B to apolipoprotein A ratio), lifestyle factors (smoking, diet, physical activity), and residence (urban/rural). Statistical analyses employed multiclass logistic regression (MNLogit) with FDR-adjusted p-values.

  Results. Age (OR=8.01, 95% CI:4.40–14.58, p<0.001), male sex (OR=3.27, CI:1.82–5.88), and smoking (OR=7.19, CI:1.52–34.15) were strongly associated with very high-risk group. Rural residents faced 2.6-fold higher very high-risk group odds (CI:1.52–5.68, p=0.002) versus urban counterparts. Protective effects emerged for physical activity (OR=0.03, CI:0.004–0.32) and female sex (High-Density Lipoprotein: +8.1 mg/dL vs. males, p<0.001). No alcohol association was observed (p=0.836).

  Conclusion. A thorough study of the gender aspect of the development of atherosclerotic pathology is required. Physical activity has a strong protective effect. It is interesting that, according to the comparative analysis of binary variables, rural residents have a higher risk of developing atherosclerosis.

  Keywords

  preventive cardiology, lipid metabolism, urban-rural disparities, Kazakhstan, cardiovascular risk factors, atherosclerosis

• 8. Periodontitis As A Possible Cause Of Chronic Heart Failure

  Dana Yessimgalikyzy, R. Aipov Baurzhan, R. Kassiyet Nurlan, Aldanysh Zhumazhan, T. Taukelova Ainur, K. Saltanat, Islambek Laiskanov, Aliya Sailybayeva, S. Bekbosynova Makhabbat, R. Kushugulova Almagul

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  56–63

  Abstract

  Background. The objective of this study was to investigate the prevalence of periodontitis in patients with chronic heart failure, as well as to characterize the microbiological profile of periodontitis across different chronic heart failure phenotypes. The objective is to analyze the link between oral health and heart disease.

  Materials and Methods. A cohort of 98 chronic heart failure patients (mean age 62.22 ± 8.62 years, 69 men) was assessed through comprehensive cardiological and periodontal examinations. Patients were categorized into heart failure with reduced ejection fraction, mildly reduced ejection fraction, and preserved ejection fraction. Periodontal parameters, including probing pocket depth, clinical attachment loss, and bleeding on probing were evaluated. Microbiological and statistical analyses were conducted.

  Results. Severe periodontitis (Stage C) was identified in 30% of patients, while 48% had moderate periodontitis (Stage B). Patients with chronic heart failure with reduced ejection fraction exhibited the highest prevalence of severe periodontitis, with a significant correlation between increased probing pocket depth and reduced ejection fraction. Candida species abundance was associated with lower ejection fraction (p≤0.0Y) and advanced periodontitis (p≤0.0X). Elevated NT-proBNP levels (1121.00–7611.00 pg/mL) correlated with Streptococcus mitis prevalence, while C-reactive protein levels (up to 2.35 mg/dL) were highest in patients with Klebsiella pneumoniae.

  Conclusion. The study highlights a strong association between periodontal disease, microbial dysbiosis, and CHF. Findings suggest that oral microbial imbalances, particularly involving Candida, Streptococcus mitis, and Klebsiella pneumoniae, contribute to systemic inflammation and cardiovascular complications.

  Keywords

  dental health surveys, gingiva pathology, heart failure, inflammation, periodontal index

• 9. Six-Minute Walk Test As A Tool For Assessing Physical Activity In Patients With Heart Failure

  S. Bekbossynova Makhabbat, R. Kushugulova Almagul, K. Jetybayeva Saltanat, T. Tauekelova Ainur, S. Duisenbina Zhadyra, Aida Zholdybaeva

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  64–72

  Abstract

  Background. Heart failure is one of the most significant medical problems of our time, which is associated with the increase in the prevalence of the disease over the past decade. The six-minute walk test is a simple, accessible, and informative tool for assessing the physical activity of patients with heart failure. The test results correlate with peak oxygen consumption and can be used to monitor the effectiveness of rehabilitation programs. The aim of the study is to evaluate the effectiveness of the six-minute walk test as a tool for measuring the level of physical activity and functional status in patients with heart failure, and to determine its correlation with clinical indicators and quality of life in this category of patients.

  Materials and methods. In this study, conducted on the basis of the UMC "Heart Center" Astana, Kazakhstan, private institution "National Laboratory Astana", data of patients with heart failure of class I-IV according to a special classification were analyzed. The main objective of the study was to evaluate the effectiveness of the test as a tool for monitoring physical activity and functional status of patients.

  Results. The results showed that the test is a reliable method for assessing the dynamics of physical capabilities and can be used to individualize rehabilitation programs.

  Conclusion. The 6MWT remains an important component of clinical practice, helping to optimize functional outcomes and improve the quality of life of patients with heart failure.

  Keywords

  functional status, quality of life, cardiac rehabilitation, physical activity, six-minute walk test (6MWT), heart failure

• 10. Comparative Analysis Of Bisoprolol Efficacy In Patients With Normal And Altered Cardiac Anatomy In The Postoperative Period After Catheter Ablation Of Atrial Fibrillation

  Adil Baimbetov, Karlygash Kissikova, Madi Tokhtarov, Omirzhan Rysbayev, Ilinara Akhmetzhan, Moldir Seitbek, Alexander Sapunov, Rzaev Farkhad

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  73–83

  Abstract

  Background. The aim of this study was to evaluate the effectiveness of the β-adrenergic blocker bisoprolol in maintaining sinus rhythm in patients with atrial fibrillation following catheter ablation of the pulmonary vein ostia, considering the anatomical condition of the left atrium.

  Material and methods. A total of 50 patients were enrolled and divided into two groups: those with normal left atrial anatomy (n = 25) and those with pathologically altered anatomy (n = 25). All patients received bisoprolol at a dose of 10 mg/day for 12 months post-ablation.

  Results. Within the first 6 months of follow-up, no atrial fibrillation recurrences were observed in the group with normal left atrium anatomy (100%), whereas 92% of patients in the altered anatomy group experienced recurrences. In the second half of the follow-up period (months 6–12), differences between the groups were no longer statistically significant. Statistical analysis confirmed a highly significant difference in recurrence rates during the early postoperative period (p < 0.001) and no significant difference in the late period (p > 0.3).

  Conclusion. The effectiveness of bisoprolol in maintaining sinus rhythm is highly dependent on the anatomical condition of the left atrium in the early period following ablation. The results highlight the importance of individualizing antiarrhythmic therapy based on morphofunctional characteristics.

  Keywords

  atrial fibrillation, catheter ablation, bisoprolol, β-adrenergic blockers, left atrial anatomy

• 11. Cardiorespiratory Fitness And Its Role In Managing Atrial Fibrillation. A Literature Review

  A. Beisenbayeva, M. Bekbossynova, F. Bekmetova, U. Aleushinova, A. Abdrakhmanov, Ayan Abdrakhmanov

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  84–95

  Abstract

  Background. Atrial Fibrillation is a prevalent cardiac arrhythmia associated with irregular heartbeats, posing significant health risks. The purpose of the study is literature review seeks to explore the intricate relationship between cardiorespiratory endurance and Atrial Fibrillation, shedding light on how cardiorespiratory parameters can serve as essential markers for assessing physical activity levels.

  Materials and methods. The search was conducted using electronic databases, particularly PubMed, Google Scholar, and Scopus. Titles and abstracts of identified studies were screened for relevance, and full-text articles were reviewed for eligibility. The following keywords were used in the search: atrial fibrillation, cardiorespiratory fitness, maximal oxygen consumption, cardiovascular mortality. The search depth is 25 years.

  Results. Physical activity adherence lowers overall and cardiovascular mortality in Atrial Fibrillation patients. Tailored exercise regimens alleviate Atrial Fibrillation symptoms, improve heart rate control, and enhance well-being. Standardizing cardiorespiratory testing protocols is crucial for consistent comparisons. Various testing methods, including treadmill protocols and cycle ergometers, offer insights into Cardiorespiratory fitness. Differences between treadmill and cycle ergometer outcomes warrant careful interpretation. Normative values vary across populations, influenced by physical activity, geography, genetics, and testing modalities.

  Conclusions. Integrating cardiorespiratory testing into AF management enhances diagnosis and personalized interventions, contributing to a nuanced approach in addressing this prevalent cardiac condition.

  Keywords

  Atrial fibrillation, Cardiorespiratory fitness, Maximal oxygen consumption, Cardiovascular mortality, Ventilatory anaerobic threshold

• 12. Bile Duct Atresia. Literature Review

  Biliary atresia, Z.U. diagnosis, Bakhytzhan Shirtayev, Kurbanov Doniyor, Azadbekova Zarnigora, Subhash Gupta

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  96–114

  Abstract

  Biliary atresia is a rare but severe congenital disease characterized by progressive obstruction of the extrahepatic and intrahepatic bile ducts and leading to cholestasis, fibrosis and cirrhosis of the liver in newborns. Epidemiological data demonstrate the variability of prevalence in different regions, which indicates the possible influence of genetic and environmental factors. The pathogenesis of the disease remains the subject of active study and includes the interaction of immune, viral and molecular mechanisms leading to damage to the bile ducts. Clinical diagnosis is difficult due to non-specific symptoms such as jaundice, light feces, and dark urine, which makes early detection critical to improve outcomes. Surgical intervention, known as Kasai surgery, remains the main treatment method and is aimed at restoring bile outflow, however, a significant proportion of patients eventually require liver transplantation. Current research focuses on the search for biomarkers for early diagnosis, the study of molecular targets, and the development of innovative therapeutic approaches, including immunomodulation and cellular technologies. The literature data emphasize the need for an integrated approach to disease management and further scientific research to improve clinical outcomes.

  Keywords

  Biliary atresia, diagnosis, screening, cytomegalovirus, portoenterostomy, Kasai, liver, transplantation, immunology, immunosuppression