Pancreatic fat accumulation is associated with age, obesity, and metabolic abnormalities. The contributions of individual metabolic and inflammatory measures after mutual adjustment remain unclear.

Objective: To assess associations of a calculated semiquantitative pancreatic MRI fat index with clinical, anthropometric, metabolic, and inflammatory measures in adults with metabolic risk factors.

Materials and Methods: This cross-sectional analysis used prospectively collected data from 150 adults aged 30–60 years examined in Astana between 25 October 2025 and 30 April 2026. The MRI fat index was calculated from dual-echo chemical-shift images and was not equivalent to standardized MRI-PDFF. Analyses included Kruskal–Wallis tests, Spearman correlations, multivariable gamma regression, and sensitivity analyses. Multiple comparisons were adjusted using the Benjamini–Hochberg method.

Results: The median index was 5.70 [2.60–9.83] %. The strongest positive correlations were with age (ρ=0.445), BMI (ρ=0.426), HbA1c (ρ=0.400), HOMA-IR (ρ=0.385), interleukin-6 (ρ=0.368), and insulin (ρ=0.354); HDL cholesterol was inversely correlated (ρ=−0.240). In the full gamma model, only age remained statistically significant, with a mean ratio of 1.510 per standard deviation (95 % CI 1.254–1.818; p<0.001). Associations with sex, BMI, and interleukin-6 reached statistical significance only in the additional linear model.

Conclusion: In unadjusted analyses, the MRI fat index was associated with several anthropometric, metabolic, and inflammatory measures. After mutual adjustment, the association with age was the most consistent. The semiquantitative nature of the index and the dependence of other associations on model choice limit the clinical interpretation of these findings.

Introduction. International experience shows that school nurses spend 36% of their working time working directly with children and 64% on other duties. Administrative tasks account for 22.1%, while preventive activities involving children and parents represent only 2.8%. As only 72% of these professionals are employed on a permanent basis, approaches to workload standardization need to be reconsidered. The workload structure of nurses in rural schools in Kazakhstan remains insufficiently studied, highlighting the need for a comprehensive analysis of working time allocation.

Objective: to evaluate the work time structure and the ratio of core activities among school nurses in rural schools.

Materials and methods. A secondary statistical analysis of time-motion observation data on the work activities of 14 nurses from 9 rural schools was conducted. For each nurse, 10 observation days were analyzed, yielding a total of 140 nurse-day observations and 14,112 consecutive records with a total duration of 76,389 minutes. The proportions of working time allocated to different activities were calculated using interval duration as a weight. Cluster bootstrap, permutation tests, Spearman’s correlation coefficient, and mixed-effects models accounting for repeated observations were used to assess differences and uncertainty. Statistical analysis was performed using R version 4.5.2.

Results. The median duration of the observed working day was 540 [540-595] minutes. The largest proportion of time was spent on paper-based administrative work (32.3 %), followed by personal breaks (19.5 %), clinical work (11.6 %), and work in information systems (10.2 %). The administrative proportion varied between schools from 32.2 % to 62.3 %, while the clinical and preventive proportion ranged from 9.5 % to 32.9 %. Parallel work was recorded in 27.7 % of intervals, and the median frequency of switching between activities was 2.93 per hour.

Conclusions. Administrative workload, broadly defined, accounted for 47.75% of school nurses’ working time. The median proportion of time spent in direct contact with children was 14.9% [5.9–26.7], while clinical and preventive activities accounted for approximately one fifth of the total observed time. No statistically significant differences were found between schools with one and two nurses. Workforce planning should consider not only the number of students but also the task structure and administrative workload.

Background. Cardiovascular diseases remain a major public health challenge. In predominantly rural regions, the geographical distribution of healthcare resources may limit access to specialist care.

Objective. To assess trends in registered cardiovascular morbidity and cardiology service capacity in the Almaty Region and estimate cardiologist workforce requirements for 2026.

Materials and methods. A retrospective population-based analytical study used aggregated administrative data. Regional morbidity was assessed for 2019–2024; territorial morbidity, workforce, and bed capacity for 10 territorial units during 2022–2024; and urban and rural hospitalizations for 2022–2025. Surgical and high-technology care indicators were assessed for the available periods. Analyses included descriptive statistics, coefficients of variation, and Pearson correlations. Workforce requirements were estimated using the 2024 dispensary-registered patient population, annual growth, and a planning assumption of one cardiologist per 2,000 patients.

Results. Regional registered cardiovascular morbidity increased from 2,319.7 to 2,497.3 per 100,000 population (+7.7%), with the largest increase observed for ischemic heart disease. In 2024, the mean rate across the 10 territories was 5,101.4 per 100,000, with a coefficient of variation of 65.3%. Rural hospitalizations increased from 1,756 to 2,325 (+32.4%). None of the three correlations reached statistical significance (p > 0.05). The projected requirement for 2026 was 84 cardiologists compared with 71 reported in 2024, yielding a net model-based gap of 13.

Conclusions. Registered cardiovascular morbidity increased, and substantial territorial variability was observed. Correlations remain exploratory. The workforce projection is a planning estimate rather than a confirmed future shortage. Further assessment of workforce distribution, referral pathways, and access to specialist care is warranted.

Introduction. Post-intubation cicatricial laryngeal stenosis in young children is a clinically significant condition, particularly among patients who have undergone intensive care and prolonged intubation. In Kazakhstan, most children with this condition are treated at the University Medical Center, while data on their nutritional status remain limited. Chronic upper airway obstruction may increase energy expenditure, impair swallowing, and reduce food intake, potentially increasing the risk of undernutrition. This study aimed to evaluate anthropometric indicators of nutritional status in young children with post-intubation cicatricial laryngeal stenosis.

Materials and methods. A single-center retrospective descriptive study was conducted using medical records of 95 children under 5 years of age with post-intubation cicatricial laryngeal stenosis treated at the University Medical Center. Physical development was assessed according to the 2006 WHO Child Growth Standards using anthropometric Z-score indices: weight-for-age, height-for-age, and weight-for-height. Z-score values below −2 SD were considered indicative of nutritional impairment.

Results. Underweight according to weight-for-age was identified in 27.4 % of children, while linear growth delay according to height-for-age was found in 23.2 % of patients. Signs of acute nutritional impairment according to weight-for-height were recorded in 28.4 % of children. Additional enteral nutrition was administered to 20.0 % of patients. These findings indicate that a substantial proportion of young children with post-intubation cicatricial laryngeal stenosis demonstrate anthropometric signs of both acute and chronic nutritional impairment.

Conclusion. Young children hospitalized with post-intubation cicatricial laryngeal stenosis showed a high frequency of impaired nutritional status, including underweight, wasting, and linear growth delay. The results support the need for routine nutritional screening, early identification of at-risk patients, and further prospective studies evaluating the role of nutritional support in the comprehensive management of children with chronic upper airway obstruction.

Relevance. Circulating microRNAs are promising minimally invasive biomarkers for the diagnosis of non-small cell lung cancer. However, their biological origin remains insufficiently understood. If the primary tumor represents their principal source, surgical tumor resection would be expected to reduce their plasma levels.

Objective. To determine whether plasma levels of previously identified diagnostic miRNAs decrease following surgical tumor resection in patients with non-small cell lung cancer.

Materials and methods. The study included 18 patients with histologically confirmed non-small cell lung cancer and 41 healthy controls who participated in our previous study. Paired patient plasma samples were collected before surgery and 14–119 days after surgery, prior to adjuvant therapy. The experimental workflow included magnetic bead-based RNA isolation, reverse transcription, TaqMan-based real-time PCR, and normalization to the exogenous spike-in control ath-miR-159a. Statistical analyses included correction for multiple comparisons.

Results. Seven miRNAs (miR-130b-3p, miR-1-3p, miR-423-5p, miR-200a-3p, miR-154-5p, miR-376a-3p, and miR-18b-5p) were significantly elevated in preoperative plasma compared with healthy controls. Five remained significantly elevated after surgery. No statistically significant postoperative decrease in NSCLC-associated candidate miRNAs was detected after correction for multiple comparisons. Three miRNAs (miR-495-3p, miR-191-5p, and miR-543) showed postoperative decreases at nominal p < 0.05, but these differences did not remain significant after correction. Their preoperative levels did not differ significantly from those of healthy controls. No statistically significant correlation was detected between postoperative miRNA levels and the time from surgery to postoperative blood sampling in this sample.

Conclusions. No statistically significant postoperative decrease in non-small cell lung cancer-associated candidate miRNAs was detected after correction for multiple comparisons. These findings do not establish their cellular origin or validate their utility for postoperative disease monitoring. Larger prospective studies are required.

Relevance. Direct compression enables lozenge manufacturing without wet granulation and drying. However, variability in the properties of herbal extracts may affect the reproducibility of critical quality attributes. Quality risk management within the Quality by Design framework supports systematic identification of variability sources and justification of a control strategy.

Objective. To identify and assess quality risks during the development of a direct compression technology for lozenges containing dry Ajania fruticulosa (Ledeb.) Poljak extract.

Materials and methods. Potential sources of variability were structured using an Ishikawa cause-and-effect diagram. Risks were ranked using Failure Mode and Effects Analysis. Severity, occurrence, and detectability were assessed using five-point scales, and Risk Priority Numbers (RPNs) were calculated. Residual risks were predicted by expert reassessment of occurrence and detectability under the proposed mitigation scenario, while severity scores remained unchanged.

Results. Thirty-six potential variability factors were identified, and seven priority failure modes were selected for Failure Mode and Effects Analysis. Initial RPNs ranged from 18 to 48. Powder blend segregation during feeding into the hopper zone had the highest initial RPN. Under the proposed mitigation scenario, predicted residual RPNs ranged from 6 to 24. Six of the seven failure modes were classified as low risk, including five initially classified as medium risk. Powder blend segregation remained a medium risk requiring continued monitoring.

Conclusions. The proposed control strategy provides a basis for further process development, technology transfer, and scale-up. Risk reduction represents an expert prediction and requires experimental confirmation through measurement of the corresponding critical quality attributes.

Relevance. Genetic factors play an important role in determining individual susceptibility to pancreatic diseases. Variants in SPINK1, PRSS1, and CFTR are associated with different forms of pancreatitis, whereas BRCA1 and BRCA2 are primarily relevant in the context of hereditary cancer predisposition. Evaluation of molecular genetic testing results in clinical practice may help characterize the spectrum of genetic findings and inform future clinical genetic research.

Objective. To describe the spectrum and frequency of molecular genetic testing results for SPINK1, PRSS1, CFTR, BRCA1, and BRCA2 in a pilot clinical series, with separate analyses at the level of unique patients and individual genetic tests.

Materials and Methods. A pilot retrospective descriptive study was conducted among patients evaluated at Medcenter-Rakhat LLP, Almaty, Republic of Kazakhstan, in 2021-2022. The analysis included 14 unique patients and the results of 16 molecular genetic tests: SPINK1, n = 5; PRSS1, n = 2; CFTR, n = 5; and BRCA1/BRCA2, n = 4. Analyses were performed separately at the patient and individual-test levels. Categorical variables are presented as n (%). Exact two-sided 95 % confidence intervals (CIs) for proportions were calculated using the Clopper–Pearson method. Statistical analyses were performed using R version 4.5.2.

Results. Findings interpreted in the original laboratory reports as being associated with increased susceptibility to pancreatitis were identified in 2 of 14 patients (14.3 %; 95 % CI, 1.8–42.8 %). In both cases, a heterozygous SPINK1 p.Asn34Ser (N34S) variant was identified. Among the five SPINK1 tests, this variant was detected in 2 cases (40.0 %; 95 % CI, 5.3–85.3 %). No other risk-associated findings were reported for PRSS1, CFTR, or BRCA1/BRCA2 according to the original laboratory interpretations.

Conclusions. In this pilot clinical series, the heterozygous SPINK1 p.Asn34Ser variant was the only risk-associated genetic finding identified. The small sample size and heterogeneity of genetic testing limit the generalizability of the findings and support the need for larger studies using standardized genetic testing and systematic evaluation of genotype–phenotype associations.

Relevance. Milk provision to employees exposed to hazardous working conditions remains a large-scale social guarantee in Kazakhstan. However, a universal food product does not account for differences in toxicant properties, exposure intensity, occupational risk, nutritional status, or individual contraindications.

Objective. To formulate a two-component framework for risk-oriented occupational nutrition that preserves workers’ statutory and contractual guarantees, and to specify its implementation and evaluation requirements.

Materials and Methods. This was a critical secondary documentary analysis and conceptual policy study, not a systematic review. The documentary corpus comprised statistical, regulatory, organizational, economic and biomedical materials available to the authors, together with accessible public primary sources used to verify legal and statistical claims. No comprehensive bibliographic search, formal study-selection flow or risk-of-bias assessment was undertaken. Narrative synthesis distinguished externally reported observations, authors’ arithmetic calculations and conceptual proposals.

Results. The analysis produced a two-component framework linking preservation of existing guarantees with exposure-specific nutritional assessment and product evaluation. It specified a staged decision process covering exposure characterization, individual suitability, product documentation, worker participation and controlled evaluation. Official statistics record 325,429 recipients of milk or equivalent products in the surveyed enterprise population in 2025. Organizational material identifies implementation issues, while the economic analysis specifies the inputs required for a reproducible future full-cost comparison. Incomplete enterprise documentation limits assessment of implementation outcomes. Historical biomonitoring values attributed to the Kola Mining and Metallurgical Company were excluded from quantitative analysis because the original report and essential methodological information were unavailable.

Conclusions. The framework provides a structured basis for developing and testing differentiated occupational nutrition while maintaining mandatory provision. It links legal guarantees with requirements for product selection and evaluation. Preventive efficacy, safety, acceptability and cost-effectiveness require prospective assessment.

Relevance: The COVID-19 pandemic exposed organizational weaknesses in health systems, disrupting workforce capacity, hospital services, supply chains, and routine care. Lessons from these disruptions may inform preparedness for future public health emergencies in Kazakhstan.

Objective: To synthesize evidence on the organizational consequences of COVID-19, distinguish emergency adaptations from persistent gaps, and consider the applicability of international preparedness lessons to Kazakhstan.

Methods: A narrative review was conducted using PubMed/MEDLINE, Web of Science, and Google Scholar. The search covered publications first published between January 2020 and July 2026; the last search was performed on 26 August 2026. Citation searching, targeted searches, and institutional reports supplemented the database searches. The review drew on 90 publications, including three conference abstracts, and five additional institutional reports. Findings were synthesized by thematic domain.

Results: A meta-analysis estimated burnout prevalence among healthcare workers at 52 % (95 % CI 40-63 %). Burnout was associated with intention to leave, whereas actual workforce departures were reported mainly in national surveys. A global modelling study projected that 28.4 million elective operations would be cancelled or postponed during 12 weeks of peak disruption in 2020. Supply-chain studies identified concentrated manufacturing, low contingency stocks, and limited supply-chain knowledge as potential contributors to shortages. Organizations adapted through staff redeployment, bed conversion, centralized supply coordination, and telemedicine, but evidence on the long-term sustainability of these measures was limited.

Conclusion: The evidence supports considering workforce protection, surge-capacity planning, supply-chain diversification, and institutional learning within routine health-system operations. The comparative effectiveness and long-term sustainability of specific measures remain uncertain. Evidence from Kazakhstan is limited, and proposed measures require local evaluation.

Occupational work in high-altitude environments presents a complex array of physiological challenges and health risks due to chronic exposure to hypobaric hypoxia. Prolonged or intermittent stays at altitudes above 2,500 meters place workers at risk of acute mountain sickness, sleep and cognitive disturbances, cardiovascular stress, and long-term complications, including chronic mountain sickness and pulmonary hypertension. Despite shared physiological risks, normative regulatory acts remain heterogeneous across countries and often lag behind contemporary scientific evidence. This variability creates gaps in worker protection, complicates cross-border operations, and hampers surveillance.

Objective. To conduct a comparative analysis of the NLAs of Russia, Kazakhstan, and Kyrgyzstan regulating medical examinations of workers in high-altitude environments, and to assess their concordance with international guidelines and recent evidence.

Materials and Methods. This comparative analysis was conducted through a comprehensive review of national and international normative frameworks, alongside scientific literature and clinical guidelines related to occupational work under hypobaric hypoxia in high-altitude environments. 

Results. The analysis revealed discrepancies between formal lists of contraindications in NLAs and the current evidence based on work under conditions of hypobaric hypoxia. Russia explicitly lists hypobaric hypoxia as a harmful factor but provides general contraindications. Kazakhstan omits hypobaria, while Kyrgyzstan recognizes reduced atmospheric pressure but includes nonspecific contraindications such as hemorrhoids and hernias. International evidence emphasizes cardiovascular, respiratory, hematological, neurological, and ophthalmological risks, while conditions like hemorrhoids lack evidence-based justification.

Conclusion. It is advisable to update the NLAs by highlighting hypobaria as a separate factor and specifying contraindications based on international clinical guidelines. Harmonization with international clinical guidelines (Wilderness Medical Society, ESC, BTS) is necessary to ensure safety and avoid both over-restriction and under-protection.

The analysis of modern literature data shows that in recent years there has been a significant increase in the number of children worldwide suffering from autism spectrum disorders. This trend raises concerns among mental health professionals and highlights the need for further research into the etiology and pathogenesis of these disorders. To date, issues related to diagnostic criteria for these developmental disorders remain controversial and continue to provoke debates among scientists and practitioners. The analytical literature review presented in this article makes it possible to trace the historical stages of the formation of clinical criteria for these disorders, which form the basis for developing assistance measures for this population. The historically accumulated knowledge about autism spectrum disorders can serve as a foundation for further research in this field, contributing to the improvement of diagnosis and therapy.