Background/Aims: There has been a paucity of published data on the epidemiology of inflammatory bowel disease (IBD) in Central Asia and Kazakhstan. Therefore, we aimed to study IBD prevalence and patient awareness among adults in Kazakhstan. Methods: The cross-sectional study was carried out among subjects of both sexes aged 18 years and older using IBD Alert Questionnaire (CalproQuest), single fecal calprotectin test, and endoscopy with biopsy to verify IBD from January to December 2017, across regions of Kazakhstan. All participants were included in the study after providing informed consent.Results: Out of 115,556 subjects, there were 128 confirmed IBD cases, in which 36 Crohn’s disease (CD) and 92 ulcerative colitis (UC) cases identified. The age and sex-adjusted IBD prevalence were 113.9 (95% confidence interval [CI], 69.0–158.9) per 100,000 population. The age- and sex-adjusted prevalence for UC were 84.4 (95% CI, 44.8–123.9) and for CD were 29.5 (95% CI, 8.2–50.9) per 100,000 population.Conclusions: This is the first report on the prevalence of IBD with a verified diagnosis in the Central Asia and could be used to better plan and allocate healthcare resources for IBD management program.

Introduction. Coronavirus infection is an acute viral disease with a primary lesion of the upper respiratory tract, caused by an RNA-virus of the Betacoronavirus genus of the Coronaviridae family. The course of a viral infection varies from asymptomatic to a wide range of clinical manifestations, including fever, chills, gastrointestinal manifestations, pneumonia, respiratory distress, and death. Ulcerative colitis (UC) and Crohn's disease (CD) are chronic immune-mediated diseases with intestinal and systemic symptoms, which are based on an impairment of the intestinal microbiota and dysregulation of the immune system in genetically predisposed individuals. In the Kazakh population, risk factors also include irregular food intake (p=0.043; OR=3.61 [95% CI: 1.04–12.51]), consumption of fish and seafood (p=0.000; OR= 15.77 [95% CI: 4.56-54.59]), consumption of frozen processed foods (p = 0.018; OR = 4.62 [95% CI: 1.3-16.4]), diet based on meat dishes (p=0.029; OR=3.2 [95% CI: 1.13-9.2]), use of NSAIDs other than aspirin (p=0.031; OR=3.79 [1.13-12.69 ]) and smoking (p=0.008; OR=4.93 [95% CI: 1.52-15.98]). The suppression of the immune response is associated with the risk of infection with viral or bacterial pathogens, including potentially the SARS-CoV-2 virus. On the other hand, SARS-CoV-2 infection as a potential trigger factor for de novo occurrence of inflammatory bowel disease is currently being discussed. The aim of this study was to assess the characteristics of the course of COVID-19 during the treatment of inflammatory bowel diseases (IBD), risk factors and outcomes of COVID-19, as well as the activity of IBD before and after a coronavirus infection. Materials and methods. A longitudinal descriptive study included 158 patients with IBD who applied on an outpatient basis (including via remote consultation) or inpatient with SARS-Cov2 or COVID-19 infection in the academic centers of Almaty (Kazakhstan) n=54 and St. Petersburg (Russia), n= 104. The observation period was from May 2020 to May 2022. The median and interquartile range were used to describe quantitative data (age), and absolute frequencies and percentages were used for qualitative data. The Mann-Whitney U-test was used for intergroup comparison of quantitative data (age), for the remaining indicators, the likelihood ratio test (Likehood ratio test), and in the case of 2X2 tables, Fisher's exact test. Results. There was no association between IBD type/activity or drugs taken and the severity of COVID-19. However, the severity of COVID-19 affected the activity of IBD. We`ve identified the same risk factors for the development of a more severe course of COVID-19 were as in the world literature: cardiovascular pathology, arterial hypertension and chronic liver pathology. Conclusion. Thus, inflammatory bowel disease and current therapy do not affect the risk of SARS-Cov-2 infection and/or the severity of COVID-19, while infection associated with severe COVID-19 affects the activity or outcomes of IBD. Актуальность.Коронавирусная инфекция – острое вирусное заболевание с преимущественным поражением верхних дыхательных путей, вызываемое РНК-геномным вирусом рода Betacoronavirus семейства Coronaviridae. Заражение вирусом варьируется от бессимптомного до широкого спектра клинических проявлений, включая лихорадку, озноб, желудочно-кишечные проявления, пневмонию, респираторный дистресс и смерть. Язвенный колит (ЯК) и болезнь Крона (БК) – хронические иммуноопосредованные заболевания с кишечной и системной симптоматикой, в основе которых лежат нарушение микробиоты кишечника и дисрегуляция иммунной системы у генетически-предрасположенных лиц. У лиц казахской популяции к факторам риска также можно отнести нерегулярный прием пищи (р=0,043; ОШ=3,61 [95% ДИ: 1,04-12,51]), потребление рыбы и морских продуктов (р=0,000; ОШ=15,77 [95% ДИ: 4,56-54,59]), потребление замороженных полуфабрикатов (р=0,018; ОШ=4,62 [95% ДИ: 1,3-16,4]), питание, основанное на мясных блюдах (р=0,029; ОШ=3,2 [95%ДИ: 1,13-9,2]), применение НПВС, кроме аспирина (р=0,031; ОШ=3,79 [1,13-12,69]) и курение (р=0,008; ОШ=4,93 [95% ДИ: 1,52-15,98]) [25] Подавление иммунного ответа ассоциировано с риском инфицирования вирусными или бактериальными патогенами, в том числе, потенциально вирусом SARS-CoV-2. С другой стороны, в настоящее время обсуждается SARS-Cov2 в качестве триггера de-novo ВЗК случаев [22]. Цель проведенного исследования: оценить особенности течения COVID-19 на фоне терапии воспалительных заболеваний кишечника, факторы риска и исходы COVID-19, а также активность ВЗК до и после перенесенной КВИ. Материалы и методы.Продольное описательное исследование включало 158 пациентов с ВЗК, обратившихся амбулаторно (в том числе посредством...

Introduction.Metabolic dysfunction-associated fatty liver disease (MAFLD) is a widespread pathology requiring effective treatment approaches. One promising direction is the use of a complex of carnitine orotate and biphenyl dimethyl dicarboxylate (COC and BDD), which possess antioxidant and hepatoprotective properties. Materials and methods. As part of the observational, non-interventional, prospective cohort study KASVM-01 [NCT06078722], the impact of COC and BDD on the progression of MAFLD in patients in the Republic of Kazakhstan was investigated. From February 2023 to July 2024, a total of 121 participants from Almaty and Almaty Region were enrolled in the study and received COC and BDD. The observation period lasted 12 months, with an interim analysis conducted on 78 participants who completed a 24-week treatment course. Anthropometric parameters (BMI, waist circumference), liver steatosis, and fibrosis levels measured via transient elastography (FibroScan) with CAP, ALT, AST, total cholesterol, triglycerides, and FIB-4 (a non-invasive fibrosis marker) were assessed at baseline and after completing 24 weeks of therapy with COC and BDD. Results.The interim analysis revealed a statistically significant reduction in ALT levels (from 32.4 to 20.1 U/mL, p<0.001), triglycerides (from 1.4 to 1.3 mmol/L, p=0.007), steatosis grade (from 304 to 283 dB/m, p<0.001), and fibrosis level (from 6.5 to 6.0 kPa, p=0.022). The prevalence of severe steatosis (S3) decreased from 52.7% to 45.7%, whereas mild steatosis (S1, S0) increased to 21.4% and 10%, respectively (p=0.001). The proportion of patients with F3 fibrosis declined from 8.1% to 1.4%, while F2 fibrosis decreased from 27% to 21.4% (p=0.022), indicating an improvement in fibrosis markers. During the observation period, BMI decreased (from 30.4 to 29.8 kg/m²), although the changes were not statistically significant (p=0.214). No significant changes were observed in total cholesterol and FIB-4 levels. Conclusion.The interim analysis confirmed the effectiveness of COC and BDD in the treatment of MAFLD, demonstrating improvements in biochemical parameters as well as regression of liver steatosis, and fibrosis. Further research and validation of these findings in later stages of observation are necessary to assess the final efficacy and long-term safety of the therapy. Введение. Метаболически-ассоциированная жировая болезнь печени (МАЖБП) является распространённой патологией, требующей эффективных методов терапии. Одним из перспективных направлений является использование комплекса карнитин-оротата и бифенилдиметилдикарбоксилата (КОК и BDD), обладающего антиоксидантными и гепатопротекторными свойствами. Материалы и методы. В рамках обсервационного неинтервенционного проспективного когортного исследования КАСВМ-01 [NCT06078722] изучалось влияние КОК и BDD на течение МАЖБП у пациентов в Республики Казахстан. С февраля 2023 года по июль 2024 года в исследовании в Алматы и Алматинской области приняли участие 121 участник, принимавшие КОК и BDD. Длительность наблюдения составила 12 месяцев, а промежуточный анализ проведён на 78 участниках, завершивших 24-недельный курс лечения. Антропометрические данные (ИМТ, окружность талии), уровни стеатоза и фиброза печени, измеренные с помощью транзиторной эластографии (FibroScan) с CAP, АЛТ, AСТ, общий холестерин, триглицериды и FIB-4 (неинвазивный маркер фиброза), оценивались во время исходного визита и после завершения терапии КОК и BDD на 24-й неделе. Результаты. По данным промежуточного анализа, отмечено статистически значимое снижение уровня АЛТ (с 32,4 до 20,1 ЕД/мл, p<0,001), триглицеридов (с 1,4 до 1,3 ммоль/л, p=0,007), степени стеатоза (с 304 до 283 дБ/м, p<0,001) и уровня фиброза (с 6,5 до 6,0 кПа, p=0,022). Частота выраженного стеатоза (S3) уменьшилась с 52,7% до 45,7%, тогда как легкие степени стеатоза (S1, S0) возросли до 21,4% и 10% соответственно (p=0,001). Доля пациентов с фиброзом F3 снизилась с 8,1% до 1,4%, а с F2 – с 27% до 21,4% (p=0,022), что свидетельствует об улучшении показателей фиброза. За время наблюдения ИМТ снизился (с 30,4 до 29,8 кг/м²), но статистически значимых различий не выявлено (p=0,214). Существенных изменений общего холестерина и FIB-4 не зафиксировано. Заключение. Промежуточный анализ подтвердил эффективность применения КОК и BDD в терапии МАЖБП, продемонстрировав улучшение биохимических показателей, а также регрессию стеатоза и фиброза печени....

Background. Pulmonary vein isolation is the cornerstone of catheter-based treatment for atrial fibrillation. Cryoballoon ablation offers an effective and reproducible method for pulmonary vein isolation, yet recurrence of arrhythmias remains a challenge. Despite advances in catheter technologies, the role of altered pulmonary vein anatomy as a factor for atrial fibrillation recurrence is poorly studied. Materials and Methods. This prospective study included 465 patients with paroxysmal atrial fibrillation who underwent cryoballoon ablation. Pulmonary vein and left atrial anatomy were evaluated using multislice computed tomography. Patients were followed for 24–48 months to assess atrial fibrillation recurrence and anatomical risk factors. Cox proportional hazard modeling and Kaplan-Meier analysis were used to evaluate predictors of arrhythmia recurrence. Results. Complete Pulmonary vein isolation was achieved in all patients. During follow-up, 38% of patients experienced atrial fibrillation recurrence. Patients with altered pulmonary vein anatomy, particularly a left common pulmonary vein and additional pulmonary veins, showed a higher rate of recurrence. Cox regression analysis identified left atrial volume index >50 mL/m² and pathological pulmonary vein anatomy as independent risk factors for atrial fibrillation recurrence. Conclusion. Altered pulmonary vein anatomy is a significant risk factor for atrial fibrillation recurrence following cryoballoon ablation. Comprehensive imaging of the left atrial and pulmonary vein using multislice computed tomography can improve patient selection, reducing the recurrence risk and improving long-term outcomes.

Introduction. In the Republic of Kazakhstan, the problem of Helicobacter pylori (H. pylori) is of particular importance due to the high incidence of gastrointestinal diseases and limited access to modern diagnostic and therapeutic methods in some regions. Despite the availability of international clinical guidelines, implementing these approaches in clinical practice requires not only technical and organizational support but also a high level of awareness and commitment from primary care and specialized physicians. The purpose of the study. To assess the level of awareness among physicians in the Republic of Kazakhstan regarding current approaches to the diagnosis and treatment of H. pylori infection, as well as to the symptomatic management of dyspeptic disorders, and to identify key barriers that hinder the prevention and treatment of this infection. Materials and Methods. This descriptive observational study involved interviewing 175 general practitioners (GPs) and 35 gastroenterologists from 6 regions of Kazakhstan. Results. The study showed that gastroenterologists generally have a higher level of awareness of modern approaches to the diagnosis and treatment of H. Pylori compared to GPs. Recommendations of clinical protocols remain the most important criterion for both gastroenterologists and GPs when choosing a treatment regimen for H. pylori infection. The primary reasons for the failure of eradication therapy, according to both groups of specialists, are bacterial resistance to antibiotics, insufficient patient awareness of the risks associated with H. pylori persistence, and the importance of completing treatment. Conclusions. Gastroenterologists have a higher level of awareness than GPs; they also more often use modern diagnostic methods and focus on local antibiotic resistance when choosing treatment regimens. Primary care physicians remain a key link in patient routing; however, their needs for additional training and support are more pronounced.

Relevance. High-altitude work involves exposure to hypobaric hypoxia and risks of altitude illness, sleep and cognitive disturbances, and cardiovascular complications. Differences in national regulatory requirements hinder harmonisation of workers’ medical assessments. Objective. To compare selected Russian, Kazakhstani and Kyrgyz regulatory acts relevant to medical examinations for high-altitude work and assess their concordance with international guidance and scientific evidence. Materials and Methods. Three national regulatory acts and three international clinical documents from the Wilderness Medical Society, European Society of Cardiology and British Thoracic Society were analysed. A structured narrative review using Scopus and Web of Science included 23 scientific publications in the qualitative synthesis. Results. The Russian document addresses reduced pressure and reduced oxygen partial pressure in technologically maintained environments, but its applicability to natural high-altitude settings is not explicitly defined. The Kazakhstani document does not identify hypobaric hypoxia as a distinct harmful occupational factor. The Kyrgyz document covers selected occupations in high-altitude and remote areas. Within the provisions reviewed, no integrated system of altitude-specific risk stratification, validated occupational fitness criteria and explicit categories of restriction was identified. International clinical guidance addresses relevant risks but does not constitute an occupational fitness regulatory standard. Selected forms of haemorrhoids and hernias are included in the Kazakhstani and Kyrgyz documents; their regulatory context must be distinguished from contraindications specifically attributable to hypobaric exposure. Conclusion. National requirements would benefit from clearer definitions of occupational exposure to hypobaric hypoxia and individual, task-specific fitness assessment. International guidance may inform regulatory revision when adapted to occupational settings.