Relevance. Breast cancer is characterized by substantial heterogeneity in clinical course and outcomes, which is largely determined by the biological diversity of tumors. Molecular biological markers, including receptor status and the Ki-67 proliferation index, play a key role in disease prognosis; however, their significance may vary across populations.

Objective: To evaluate the prognostic significance of receptor status (ER, PR, HER2) and the Ki-67 proliferation index in the risk stratification of mortality among patients with breast cancer based on the results of univariate analysis.

Materials and Methods. A retrospective cohort analysis was performed, including 729 patients with primary breast cancer registered between 2018 and 2022 according to the Almaty Cancer Registry. The primary endpoint was mortality. Statistical analysis included the chi-square test, logistic regression, and ROC analysis.

Results. ER and PR status demonstrated a statistically significant association with mortality risk (p < 0,001): negative receptor status was associated with a higher risk of death. Logistic regression revealed a protective effect of ER (Exp(B) = 0,883) and PR (Exp(B) = 0,424) expression. ROC analysis showed moderate discriminative ability for ER (AUC = 0,614) and PR (AUC = 0,622). HER2 status was not significantly associated with mortality (p = 0,531). The Ki-67 index was significantly associated with increased mortality risk (Exp(B) = 1,015 for each 1% increase; p < 0,001), demonstrating moderate prognostic accuracy (AUC = 0,606). The integrated molecular-biological phenotype was also significantly associated with outcomes (p < 0,001): the luminal A subtype showed the most favorable prognosis, whereas the triple-negative phenotype was associated with the poorest outcomes.

Conclusion. ER  and PR receptor status, as well as the Ki-67 index, are significant prognostic factors for mortality risk in breast cancer. HER2 status did not demonstrate prognostic significance in this cohort

Relevance. Persistent elevation of portal venous pressure, most commonly resulting from viral- or alcohol-related liver cirrhosis, leads to the development of esophageal varices due to dilation of the submucosal venous plexus in the distal esophagus. Acute esophageal variceal bleeding is a life-threatening condition and remains one of the major challenges in modern gastroenterology and surgery.

Objective. To evaluate the clinical, demographic, laboratory, and endoscopic characteristics of patients with esophageal bleeding associated with liver cirrhosis and to assess hospitalization outcomes.

Materials and Methods. A retrospective analysis was conducted on the clinical and demographic data of 158 patients with portal hypertension and symptoms of esophageal bleeding. The study evaluated demographic characteristics, cirrhosis etiology, Child–Pugh class, the Model for End-Stage Liver Disease (MELD) score, severity of blood loss, presence of active bleeding on admission, laboratory findings, endoscopic characteristics of esophageal varices, and hospitalization outcomes.

Results. Esophageal bleeding occurred more frequently in men than in women, with more than 90 %of cases observed in patients older than 40 years. Esophageal varices were most commonly located in the lower third of the esophagus (63.9%), while severe blood loss was documented in 75.3 % of patients.

Conclusions. The findings have important clinical implications for prognostic assessment and the selection of optimal treatment strategies for patients with esophageal bleeding associated with liver cirrhosis.

Relevance. Chronic limb-threatening ischemia is the most severe manifestation of peripheral artery disease, carrying high rates of amputation and mortality. Structured patient education programs have demonstrated benefit in other chronic diseases, yet remain largely unevaluated in peripheral artery disease, particularly chronic limb-threatening ischemia.

Objective. To evaluate the effectiveness of a structured multimodal educational program (CLTI School) compared with standard care on clinical outcomes and quality of life in patients with peripheral artery disease.

Materials and Methods. Parallel-group randomized controlled trial conducted in Astana, Kazakhstan. A total of 184 patients with peripheral artery disease (Rutherford categories 2-5) were randomized 1:1 and followed for 12 months. The program comprised eight vascular surgeon-led group sessions, a digital platform, peer support groups, and smoking cessation counseling. Per-protocol analysis included 81 experimental and 78 control participants. Co-primary outcomes were health-related quality of life (SF-12) and peripheral artery disease -related hospitalization rate.

Results. At 12 months, the experimental group showed significantly higher SF-12 Physical Component Summary (44.76 vs. 35.08; p < 0.001) and Mental Component Summary (43.42 vs. 35.90; p < 0.001) scores. Hospitalizations (14.8 % vs. 20.5 %; p = 0.346) and amputations (4.9 % vs. 7.7 %; p = 0.476) were numerically lower but did not reach statistical significance. Smoking cessation was threefold higher (25.0 % vs. 8.5 %; p = 0.026), pain declined significantly (median VAS 3 vs. 5; p < 0.001), and QALYs were higher (0.67 vs. 0.60; p < 0.001). No adverse events attributable to the program were recorded.

Conclusions. The Chronic limb-threatening ischemia School significantly improved patient-reported outcomes and smoking cessation in patients with peripheral artery disease. Structured educational programs should be considered an integral component of comprehensive peripheral artery disease management.

Relevance. Adhesive small bowel obstruction is a common surgical emergency associated with substantial morbidity and frequently requires operative treatment. Although multi-port laparoscopy is widely accepted, evidence regarding the safety and feasibility of single-port laparoscopic surgery remains limited.

Objective: To evaluate the feasibility, safety, and perioperative outcomes of single-port laparoscopic surgery in the management of adhesive small bowel obstruction.

Materials and Methods. This was a retrospective, multicenter, single-arm observational study conducted from April 2018 to October 2025 and included 91 patients with adhesive small bowel obstruction. All patients were operated on by one surgeon laparoscopically using the single-port technique (single-port laparoscopic surgery). The effectiveness of single-port laparoscopic surgery was assessed by analyzing operative time, intraoperative and postoperative complications, length of hospital stay, incision length, and intraoperative blood loss.

Results. In this selected cohort, all 91 patients underwent SPLS without conversion to multi-port laparoscopy or open surgery. Postoperative complications occurred in 5 patients, corresponding to an incidence of 5.5 % (95 % CI: 1.8–12.4).  Favorable outcomes were likely associated with careful patient selection and surgeon expertise, despite the technical challenges of the single-port approach. These findings suggest that SPLS may be a feasible minimally invasive approach in selected ASBO patients when performed by an experienced surgeon.

Conclusions. The findings suggest that SPLS is technically feasible and potentially safe in carefully selected patients with ASBO when performed by an experienced surgeon. However, prospective comparative studies are required to confirm its advantages over conventional laparoscopic or open approaches.

Relevance: Chronic heart failure remains a major public health challenge worldwide, characterized by increasing incidence and significant morbidity and mortality. Understanding epidemiological trends and changes associated with the COVID-19 and post-COVID-19 period is essential for optimizing healthcare strategies.

Aim: To analyze the dynamics of CHF incidence and mortality in Almaty city and Almaty oblast during the pre-COVID-19 and COVID-19/post-COVID-19 periods, and to assess future trends up to 2030.

Methods: A retrospective descriptive and analytical study was conducted using official statistical data from 2012 to 2025. Indicators of CHF incidence and mortality were analyzed in the general population and by sex. The study period was divided into pre-COVID-19 period (2012-2019) and COVID-19/post-COVID-19 period (2020-2025) phases. Absolute and relative changes were calculated, and time series analysis was performed. Forecasting was carried out using linear regression and ARIMA (0,0,0) models.

Results: Chronic heart failure incidence increased in both regions. In Almaty city, the chronic heart failure incidence rate increased from 1,217.3 to 1,552.2 per 100,000 population (+27.5 %), while in Almaty oblast it increased from 145.7 to 755.1 per 100,000 population (+418.4 %). The most pronounced growth was observed after 2019. Incidence increased in both sexes, with a higher growth rate among men. Mortality declined in both regions over the study period. Comparison of the pre-COVID-19 and COVID-19/post-COVID-19 periods demonstrated higher incidence rates in both regions, whereas mean mortality rates decreased. Forecasting indicates a continued increase in incidence through 2030, with relatively stable or gradually decreasing mortality.

Conclusion: The study demonstrates a growing burden of chronic heart failure, particularly in Almaty oblast, with increasing incidence and declining mortality. These findings highlight the need for strengthening early detection, preventive strategies, and long-term management of chronic heart failure, especially in regional healthcare settings.

Relevance. Chronic postoperative hypoparathyroidism is a rare complication of thyroidectomy. It needs lifelong therapy. But reports of decompensation caused by a combination of thyrotoxicosis, COVID-19, and long-term use of outdated drugs like dihydrotachysterol are few.

Objective. To describe a case of decompensated chronic postoperative hypoparathyroidism in a patient with Graves' disease - and to analyse what led to the decompensation, how we diagnosed it, and how we treated it.

Clinical Case. A 58-year-old woman presented in November 2023 with limb cramps, tachycardia, and tremor. She had a history of subtotal thyroidectomy for Graves' disease (1991), followed by hypoparathyroidism treated with dihydrotachysterol for over 30 years - without adequate control. In 2022, she had COVID-19 pneumonia (60 % lung involvement) and then a stroke, which left her with left-sided hemiparesis. On admission: total calcium 1.57 mmol/L, ionized calcium 0.61 mmol/L, phosphorus 1.64 mmol/L, PTH 6.78 pg/mL, plus decompensated thyrotoxicosis (free T4 29.45 pmol/L, TSH receptor antibodies 13.5 IU/L), a prolonged QT interval, and a cataract. We started alfacalcidol 1 μg/day, calcium carbonate 2000 mg/day, and thiamazole 30 mg/day. Over 15 months, her calcium normalised to 2.35 mmol/L, TSH receptor antibodies fell to 4.61 IU/L, and she became euthyroid. But then she stopped alfacalcidol on her own - because she felt well - and her calcium dropped again.

Conclusion. This case shows three things. First, dihydrotachysterol is outdated and should be replaced with active vitamin D metabolites. Second, COVID-19 can trigger calcium-phosphorus decompensation. Third, thorough biochemical monitoring is essential - and patients need to be warned not to stop alfacalcidol even when they feel completely well.

Relevance. In recent years, there has been an increase in nontuberculous mycobacteriosis, including cases combined with pulmonary tuberculosis. Diagnosis of co-infection is challenging due to the similarity of clinical and radiological findings, while treatment presents a complex task because of the heterogeneous drug susceptibility of the pathogens.

Case Description. We present a case of a 49-year-old female patient with recurrent drug-resistant pulmonary tuberculosis, chronic obstructive pulmonary disease, and severe underweight (Body Mass Index 15.0). Examination using the GenoType® Mycobacterium CM method confirmed co-infection with M. tuberculosis and M. avium complex. The patient was prescribed an individualized chemotherapy regimen including bedaquiline, linezolid, clofazimine, levofloxacin, cycloserine, and clarithromycin.

Results. After 8 months of treatment, sputum conversion was achieved (negative sputum smear microscopy and culture), with favorable radiological changes and clinical improvement.

Conclusion. This case demonstrates the fundamental possibility of successful treatment of drug-resistant pulmonary tuberculosis and nontuberculous mycobacteriosis co-infection using a combination of reserve anti-tuberculosis drugs and macrolides, despite diagnostic limitations, the complexity of selecting a chemotherapy regimen, and challenges in patient routing for those with co-infection.

Relevance. Prosthetic rehabilitation of patients after total maxillectomy remains one of the most challenging problems in maxillofacial prosthodontics because of extensive postoperative defects, communication between the oral and nasal cavities, and insufficient retention of obturator prostheses.

Objective. To develop and evaluate the clinical effectiveness of a technique for improving the retention of resection obturator prostheses following total maxillectomy.

Materials and Methods. Two clinical cases of prosthetic rehabilitation after total maxillectomy using the proposed obturator retention technique are presented. The technique involves creating a trapezoidal recess on the vestibular surface of the obturator and placing a medical foam insert or a dental cotton roll as an additional retentive element.

Results. The proposed technique provided satisfactory retention and stability of the obturator prosthesis, reliable separation of the oral and nasal cavities, and improvement of mastication, swallowing, and speech. The presented clinical cases demonstrated the practical applicability of the proposed design.

Conclusions. The proposed technique is a simple, accessible, and effective method for improving the retention of resection obturator prostheses and may be recommended for prosthetic rehabilitation of patients after total maxillectomy.

Relevance. Population growth in urban agglomerations creates a quantifiable gap between the demand for medical care and the availability of personnel, medicines, financial resources, and logistical support. The Almaty agglomeration is home to approximately 3.5 million residents, with a projected population of 4.5 million by 2030. According to the Ministry of Health of the Republic of Kazakhstan, in 2023, the shortage of physicians amounted to 4,864 positions, and the concurrent employment rate reached 1.4, reflecting systemic staff overload. 

Objective. To analyze current models for forecasting healthcare resource needs in urban agglomerations, with a focus on machine learning tools, and to assess their applicability to the conditions of the Almaty agglomeration.

Materials and methods: A literature search was conducted in the PubMed, Scopus, Web of Science Core Collection, and WHO IRIS databases for the period from January, 2010 to March, 2026. The review included original studies, systematic reviews, and WHO/OECD methodological reports containing quantitative predictive models with accuracy metrics (MAE, RMSE, MAPE, AUROC, R²) at the level of urban agglomerations or regions with an urbanization rate ≥ 50 %. Of the 1,286 records identified, 57 publications were included in the review. 

Results. Statistical models were the most common (40.4 %), followed by supervised machine learning methods (34.0 %), hybrid models (17.0 %), and unsupervised machine learning methods (4 publications, or 8.5 %). Only 3 validated models (6.4 %) used data from Kazakhstan and cover the human resources category exclusively. No model covered all four resource categories simultaneously. 

Conclusions. The methodological findings of this review justify the development of an integrated forecasting model based on unsupervised machine learning for the Almaty metropolitan area, covering at least three resource categories and a 5-10-year forecast horizon in accordance with national planning documents.

 Introduction: Obesity is an established independent risk factor for hepatocellular carcinoma (HCC), the third leading cause of cancer-related mortality worldwide. In Kazakhstan, where obesity affects over 20% of the adult population and liver cancer incidence has risen steadily, this association carries urgent public health significance. Despite a well-documented epidemiological link, the mechanisms by which obesity undermines antitumor immunity and reshapes the hepatic microenvironment remain incompletely characterized. This review analyses how innate and adaptive immune populations are remodeled across the NAFLD-to-HCC continuum under chronic metabolic stress.

Objective: Analysis of current scientific evidence on the role of immune and inflammatory mechanisms in the development of liver cancer in the context of obesity, and systematization of data on how metabolic disturbances influence antitumor immune responses and the hepatic microenvironment.

Materials and methods:  A systematic literature search was conducted across PubMed, Google Scholar, Scopus, and Web of Science databases, covering international and domestic publications from 2000 to 2026.

Results and discussion: Obesity-associated HCC develops through a progressive immunometabolic cascade in which visceral adipose tissue assembles an immunosuppressive microenvironment – via expansion of myeloid-derived suppressor cells (MDSC), NK cell dysfunction, and CD8⁺ T cell exhaustion – before malignant transformation occurs. Tregs are depleted in obese adipose tissue yet accumulate in HCC; NK cell activation in NASH drives hepatocyte damage rather than tumor protection. Functional polarisation state, not cellular abundance, determines the pathological outcome.

Conclusions: Obesity promotes HCC through chronic adipose inflammation, insulin resistance, and metabolic reprogramming of the tumor microenvironment, exhausting cytotoxic CD8⁺ T cells and NK cells while expanding immunosuppressive Tregs and MDSCs. Liver cancer progression is driven not only by viral or toxic factors but by obesity-induced immune imbalance in which systemic metabolic stress becomes a key enabler of tumor immune evasion.

Relevance. The mining industry is one of the most hazardous sectors and is characterized by high occupational risks. It accounts for up to 8 % of fatal occupational injuries. The prevalence of pneumoconiosis among miners is 3.7 %, while that of silicosis is up to 8 %. In some regions, a high level of comorbidity is observed, including the «triple burden of disease». These factors indicate the need for further research and improvements in workers’ medical care systems.

Objective: to analyze modern scientific data and international experience in the organization of medical care for workers in the mining industry

Materials and Methods. An analysis of scientific publications from 2010 to 2025 was conducted, focusing on workers’ health status, occupational risks, and the organization of medical care in the mining industry. The literature search was performed using the PubMed, Scopus, Web of Science, and Google Scholar databases. The review included studies published in Russian and English that were relevant to the research topic. The obtained data were systematized according to the main areas of the study.

Results. Workers are exposed to a complex of harmful factors (dust, noise, vibration, and chemical agents), which can lead to occupational diseases, including pneumoconiosis and silicosis. In some regions, a «triple burden of disease» (silicosis, tuberculosis, infectious diseases) is observed. A high prevalence of mental health disorders and the impact of shift work on injury risk were also identified. Traditional models of medical care were found to be insufficient and require a transition to preventive approaches.

Conclusions. Improving the organization of medical care for mining workers requires a shift toward preventive approaches, using digital technologies and artificial intelligence to predict risks and detect disease early.

Introduction. Frailty is a common geriatric syndrome associated with decreased functional capacity and a high risk of adverse outcomes. According to studies, its prevalence among individuals aged 50 years and older averages 17.4 %, while pre-frailty prevalence reaches 49.3 %. In the Republic of Kazakhstan, the issue of frailty remains insufficiently studied despite the growing proportion of older adults and the high prevalence of chronic diseases.

Objective: analysis of current data on frailty in older adults.

Materials and Methods. A review of the scientific literature on the prevalence, risk factors, and diagnostic methods of frailty in older adults was conducted. The search was performed in the databases PubMed, Scopus, Web of Science, and Google Scholar for the period 2010-2025. Articles in Russian and English focusing on frailty in older adults were included; irrelevant and duplicate publications were excluded.

Results. Frailty is a syndrome with a staged and dynamic course. Three stages are distinguished: robust, pre-frailty, and frailty. The prevalence of the syndrome varies from 10 % to 24 % depending on the population, reaching about 20 % in Asian countries and decreasing to 7-8 % in some countries. Pre-frailty is more common and may reach 40-50 %. The highest prevalence is observed among individuals with multimorbidity and in low- and middle-income countries. The main risk factors include advanced age, multimorbidity, low physical activity, poor nutrition, cognitive impairment, and social isolation.

Conclusions. Frailty is a common and clinically significant syndrome that has a substantial impact on the health and quality of life of older adults. The high variability in prevalence and the multifactorial nature of its development require a comprehensive approach to diagnosis and prevention.

Relevance. Metabolic syndrome is a cluster of interconnected metabolic abnormalities characterized by central obesity, hypertension, dyslipidemia, and impaired glucose metabolism. One important but under-studied factor influencing the development and severity of metabolic syndrome is mineral metabolism, including calcium, magnesium, and phosphorus levels. An imbalance of these minerals can disrupt insulin sensitivity, promote inflammatory processes, and affect lipid and carbohydrate metabolism.

Objective. To summarize and critically evaluate current evidence on the relationship between mineral metabolism (calcium, magnesium, phosphorus, parathyroid hormone, and vitamin D) and the clinical and metabolic manifestations of metabolic syndrome in adults.

Materials and methods. A structured literature search was conducted in PubMed, Scopus, and Google Scholar. The review primarily included studies published between January 2018 and March 2026, while earlier landmark publications were included when necessary to provide physiological background.

Нәтижелері. Әдебиеттерді талдау минералдық алмасу бұзылыстарының метаболизмдік синдромның дамуы және оның клиникалық-метаболикалық көріністерімен тығыз байланысты екенін көрсетті. Ең сенімді деректер магний тапшылығына, сондай-ақ кальций, фосфор, паратиреоидты гормон және D витамині алмасуының бұзылыстарына қатысты алынды, олар инсулинге төзімділікпен және басқа да метаболикалық бұзылыстармен байланысты болды.

Conclusions. The literature review confirms that mineral metabolism disorders, including serum calcium, magnesium, and phosphorus levels, are closely related to the clinical and metabolic manifestations of metabolic syndrome.

Introduction. This review article examines the role of myofunctional disorders and dentomaxillary anomalies in the development of adenoid hypertrophy, including recurrence after adenotomy. The relevance of this problem is supported by quantitative evidence: a systematic review reported a worldwide prevalence of malocclusion of 56 %, while malocclusions were associated with poorer oral health-related quality of life (RR/PR = 1.15; 95 % CI: 1.12–1.18; 3672 participants). In pediatric samples, malocclusion was found in 49.1 % of children aged 8–10 years, and mouth breathing was associated with transverse malocclusion (PR = 6.15; 95 % CI: 2.96–12.80).

Objective: To analyze literary sources on the role of myofunctional disorders and dentomaxillary anomalies in the development of hypertrophy of the pharyngeal tonsil.

Materials and methods: We conducted an analytical review of sources from Google Scholar, Scopus, Web of Science, PubMed, and eLIBRARY scientific databases for 2019–2024. Key classical sources outside this period were also included. The final review included 92 publications that met the predefined eligibility criteria.

Results. The reviewed evidence indicates that adenoid hypertrophy, impaired nasal breathing, mouth breathing, myofunctional disorders, and dentomaxillary anomalies are closely interrelated. Hypertrophy of the pharyngeal tonsil is a common disease of the ear, nose and throat among children aged 6 years; in frequently ill children, it is reported in 70ө90 % of cases. Oral or mixed breathing associated with adenoid hypertrophy may be accompanied by articulation disorders, with speech defects reported in 81.7 % of children with breathing disorders. Although recurrent surgery is relatively uncommon, one large retrospective study reported a revision adenoidectomy rate of 0.55 %, and 21 % of revision cases were associated with tubal tonsil hyperplasia rather than true adenoid regrowth.

Conclusions: The conducted analysis of literary data provides grounds for concluding that preventing recurrence after adenotomy is clinically important and should include an interdisciplinary, comprehensive approach to postoperative management. Such an approach should combine otorhinolaryngological follow-up, early orthodontic assessment, correction of persistent mouth breathing and dentomaxillary anomalies, and myofunctional or speech therapy when indicated.