This study examines the development and competitiveness of tourism clusters in Kazakhstan?s Turkestan region, one of the key Silk Road destination. It also explores the perceptions of tourists, local residents, and stakeholders on the development of a tourism cluster in this selected region. Cluster analysis revealed distinct visitor segments, with cultural and ecotourism as dominant demand types, alongside the differences in income, stay duration, and spending. Using Porter?s Diamond Model, the study identified challenges such as poor sectoral coordination, limited promotion, and weak institutional support. Regression analysis showed income-related variation in preferences, while SWOT analysis underscored the need for improved infrastructure, digital marketing, and service integration. Although sustainability outcomes were not empirically measured, the findings contribute to understanding the economic dimension of sustainability by examining stakeholder views on clustering and competitiveness. The results offer strategic guidance for policy and tourism development, emphasizing Turkestan?s cultural and ecological value within the Silk Road corridor. While sustainability was not directly measured, the outcomes offer strategic direction for enhancing the region?s competitiveness and advancing its role as a vital destination along the Silk Road.

Background/Objectives: Acute coronary syndrome (ACS) remains a leading cause of sudden cardiac death worldwide; however, limited data exist regarding the relationship between coronary arterial and coronary venous dynamics in this context. The present study aimed to evaluate whether coronary sinus flow (CSF) dynamics obtained via transthoracic echocardiography (TTE) are associated with the long-term risk of ACS and cardiovascular events. Methods: This retrospective observational cohort study included 100 patients who underwent elective coronary angiography and had their CSF parameters assessed via TTE. All participants were followed up for a duration of up to 48 months. The primary endpoint was cardiovascular mortality, while secondary endpoints comprised the occurrence of ACS, refractory angina pectoris, and cerebrovascular events. Study endpoints were evaluated by dichotomizing the population into two groups using the median CSF value as the cutoff (low: CSF ≤ median; high: CSF > median). Results: The primary endpoint did not differ significantly between the two groups; however, refractory angina was significantly more common in the high CSF group [4 (8.2%) vs. 12 (24.5%), p = 0.029]. Similarly, the high CSF group exhibited a significantly higher rate of the composite endpoint than the low CSF group [13 (26.5%) vs. 25 (51.0%), p = 0.013]. In multivariate Cox analysis, CSF was an independent predictor of the composite endpoint (HR: 1.50; 95% CI: 1.11–2.02, p = 0.009). Conclusions: Baseline CSF measured by TTE was independently associated with the composite endpoint, whereas its association with isolated ACS was limited. CSF assessment may provide incremental prognostic information alongside conventional arterial and microvascular evaluation.

Introduction: Strain analysis with 2D speckle tracking echocardiography could be used in the diagnosis of severe coronary artery disease. The aim of this study is to evaluate the effectiveness of 2D speckle tracking echocardiography in a group of patients with positive myocardial Perfusion Scintigraphy (MPS) but without severe coronary artery disease (CAD). Methods: Forty (25 female, age: 58.85±9.73) patients with the of angina pectoris and ischemia was found in MPS but non-obstructive CAD (0.05). In subgroup analyzes based on gender, hypertension, diabetes mellitus, hyperlipidemia, and hypertriglyceridemia, no difference was observed between ischemic and non-ischemic segments in terms of longitudinal strain. Conclusion: In the patient group without severe coronary artery disease, no difference was observed between the staining parameters in the left ventricle 2D longitudinal strain analysis in terms of MPS positive segments and MPS negative segments. Considering previous studies, by using 2D strain analysis in combination with MPS, we can avoid unnecessary coronary artery angiography in special cases such as kidney failure, suspected MPS positivity.

Aim: Thyrotoxicosis is a clinical state of inappropriately high levels of free T4 (thyroxine) and/or free T3 (tri-iodothyronine) in the body caused by distinct etiologies including Graves’ disease (GD), subacute thyroiditis (SAT), toxic adenoma and toxic multinodular goiter (TMNG). Simple hematologic indices such as neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) have increasingly been mentioned as measures of presence and severity of thyrotoxicosis. In this study, we aimed to analyze whether there is a link between these peripheral blood parameters and the presence of thyrotoxicosis. Material and Methods: A total of 46 GD, 46 TMNG, 39 TA and 45 SAT patients and 45 control subjects were studied. Laboratory parameters in all patients were recorded and NLR, PLR and MPV values were recorded from peripheral blood complete blood cell counts. Results: This study showed that NLR and PLR levels are elevated in patients with SAT in comparison with other thyrotoxic patient groups and controls. The post hoc analysis of comparison of NLR and PLR in each study groups revealed that NLR and PLR were statistically different in the SAT group in comparison to the GD, TMNG, TA, and healthy controls. A significant decrease in the level of MPV was demonstrated in thyrotoxicosis patients (p

Aim: This study aimed to examine the retinal layer before and after treatment in patients with hypothyroidism with vitamin D deficiency, since the vitamin also protects the retinal cells against inflammatory damage. Material and methods: The free T3, free T4, and vitamin D levels of 104 patients with no ocular disease were first measured. Ophthalmological examinations of these patients, who were divided into three groups, were performed by specialist ophthalmologists, while retinal findings were examined using optical coherence tomography (OCT) and recorded. The first group was given vitamin D for three months, the second levothyroxine, and the third vitamin D + levothyroxine. After three months repeat OCT was performed, and the results were compared with the previous values. Results: The thickness of the left inner nuclear cell layer of the patients in the vitamin D group increased significantly compared to pre-treatment. Post-treatment right central macular thickness, right nerve fiber layer, right outer nuclear cell layer, right pigment epithelial layer, left central macular, and left inner nuclear cell layer thicknesses were all significantly higher compared to pre-treatment in the patients in the levothyroxine + vitamin D group, while right outer retinal layer and left retinal nerve fiber thicknesses decreased (p<0.05). Conclusion: A greater increase in cell layer thickness was observed in the group using vitamin D and levothyroxine together compared to those in which vitamin D and levothyroxine were employed alone. However, further studies on the effect of vitamin D on retinal cell development and protection against injury are now needed.

Introduction: This study aimed to investigate the relationship between left ventricular ejection fraction (LVEF) measured on preoperative transthoracic echocardiography (TTE) and peak systolic velocity (PSH) and resistance index (DI) calculated on postoperative renal Doppler ultrasonography. Methods: The study retrospectively included 68 renal transplant patients. TTE measurements were taken for all patients, and LVEF was recorded. Renal Doppler ultrasonography recorded PSH and DI. Patients were divided into two groups based on LVEF below 55% (group 1, n=24) and above (group 2, n=44). Results: Of the patients participating in our study, 21 (30.8%) were female and 47 (69.2%) were male. The mean age of the patients in the study was 53.2±9.27 years. Urea was significantly lower in patients with LVEF values above 55% (85.9±31.5 vs. 103.3±35.2; p=0.02). On the other hand, PSV and RI were significantly lower in the group with LVEF values above 55% (188.2±33.1 vs. 238.7±40.2; p=0.02; 0.64±0.15 vs. 0.78±0.19; p=0.04, respectively). A negative correlation was also found between LVEF values and PSV and RI (r= -0.731, p=0.007; r= -0.602, p=0.01, respectively). Conclusion: In this study, renal transplant patients with echocardiographic LVEF greater than 55% had significantly lower RI and PSV determined by renal Doppler ultrasonography.