Introduction. Pelvic venous varicosities (PVV) in women with liver cirrhosis are rare but clinically significant. Portal hypertension and impaired gonadal venous outflow contribute to reflux, dilation, and chronic pelvic pain. In reproductive-age women, PVV may be linked to infertility and adverse obstetric outcomes, emphasizing the importance of timely diagnosis and treatment. Aim. To evaluate the prevalence, clinical characteristics, and surgical outcomes of pelvic venous varicosities in women of reproductive age with liver cirrhosis. Materials and Methods. A retrospective study included 344 women with liver cirrhosis treated at the National Scientific Center of Surgery named after A.N. Syzganov (Almaty, Kazakhstan) between 2019 and 2024. Of them, 61 were of reproductive age (18-45 years), and PVV was diagnosed in 9 patients (2.6%) using Doppler ultrasonography, CT venography, and phlebography. All underwent endovascular ovarian vein embolization with coils and sclerosants. Pain severity was assessed using the visual analogue scale (VAS); reproductive outcomes were also analyzed. The Wilcoxon signed-rank test was applied to compare pre- and post-procedure data. Differences were considered statistically significant at p < 0.05. Results. Mean age was 38.2 ± 6.1 years. Esophageal varices were present in 6 women (66.7%), ascites in 3 (33.3%), and splenomegaly in 5 (55.6%). Portal hypertension-related complications were more common in Child–Pugh classes B–C (77.8% vs. 33.3% in class A; p = 0.04). Obstetric complications were reported in 3 patients (42.8%), and secondary infertility in 2 (28.6%). Severe PVV (Hiromura II–III) was more frequent in multiparous women (71.4% vs. 33.3%; p = 0.048). VAS decreased from 6.8 at baseline to 3.2 on day 3, 2.8 at 1 month, and 2.4 at 3 months (p < 0.001). Clinical improvement included reduced pelvic pain (77.8%), dyspareunia (66.7%), normalization of cycles (22.2%), and one pregnancy. No major complications were observed; one patient required re-embolization. Overall effectiveness reached 88.9%. Conclusions. PVV in women with cirrhosis is uncommon but impactful. Ovarian vein embolization is a safe and effective treatment method for PVV, providing sustained pain relief, improved quality of life, and partial restoration of reproductive potential. Введение. Тазовые венозные варикозы (ТВВ) у женщин с циррозом печени являются редкой, но клинически значимой патологией. Портальная гипертензия и нарушение оттока по гонадным венам способствуют развитию венозного рефлюкса, дилатации сосудов и формированию хронического тазового болевого синдрома. У женщин репродуктивного возраста ТВВ могут быть связаны с бесплодием и неблагоприятными акушерскими исходами, что подчёркивает важность своевременной диагностики и лечения. Цель. Оценить распространённость, клинические особенности и результаты хирургического лечения тазовых венозных варикозов у женщин репродуктивного возраста с циррозом печени. Материалы и методы.Ретроспективное исследование включало 344 женщин с циррозом печени, проходивших лечение в Национальном научном центре хирургии имени А.Н. Сызганова (г. Алматы, Казахстан) в период с 2019 по 2024 годы. Из них 61 пациентка находилась в репродуктивном возрасте (18–45 лет), у 9 (2,6%) были диагностированы ТВВ с использованием допплеровского ультразвукового исследования, КТ-венографии и флебографии. Всем пациенткам выполнена эндоваскулярная эмболизация яичниковых вен с применением спиралей и склерозантов. Интенсивность болевого синдрома оценивалась по визуально-аналоговой шкале (ВАШ), также анализировались репродуктивные исходы. Для сравнения показателей до и после вмешательства использовался критерий Уилкоксона. Статистически значимыми считались различия при p < 0,05. Результаты. Средний возраст пациенток составил 38,2 ± 6,1 года. Варикозное расширение вен пищевода выявлено у 6 пациенток (66,7%), асцит — у 3 (33,3%), спленомегалия — у 5 (55,6%). Осложнения портальной гипертензии достоверно чаще наблюдались у пациенток с циррозом класса Child–Pugh B–C по сравнению с классом A (77,8% против 33,3%; p = 0,04). Акушерские осложнения отмечены у 3 пациенток (42,8%), вторичное бесплодие — у 2 (28,6%). Тяжёлые формы ТВВ (II–III степень по Hiromura) чаще встречались у многорожавших женщин (71,4% против 33,3%; p = 0,048). Показатель ВАШ достоверно снизился с исходного уровня 6,8 до...

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 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.

Background/Objectives: To evaluate an exploratory ordinal transabdominal ultrasonography score against a study-defined semiquantitative two-echo chemical-shift MRI pancreatic fat index ≥ 5%. Methods: This prospective paired diagnostic accuracy study included 150 adults aged 30–60 years with metabolic abnormalities or risk factors and technically adequate ultrasonography. A score ≥ 1 was the primary positive index-test result. Diagnostic accuracy, ROC AUC, and ordinal correspondence were evaluated. Results: After nine clinical exclusions, pancreatic ultrasonography was technically evaluable in 150 of 170 participants (88.2%; 95% CI, 82.5–92.3%). For the study-defined MRI index ≥ 5%, sensitivity was 76.8% (95% CI, 66.6–84.6%), specificity was 77.9% (95% CI, 66.7–86.2%), accuracy was 77.3% (95% CI, 70.0–83.3%), and AUC was 0.812 (95% CI, 0.748–0.876). Exact four-category agreement was 45.3%, and quadratically weighted kappa was 0.504 (95% CI, 0.387–0.612). Conclusions: These estimates describe agreement and discrimination relative to the study-defined two-echo MRI index in selected adults with metabolic risk and technically adequate ultrasonography. They should not be interpreted as diagnostic accuracy for histologically confirmed pancreatic steatosis or standardized MRI-PDFF-defined disease. The exploratory score is not a quantitative substitute for MRI and requires reproducibility assessment and external validation.

Background/Objectives: Sports medicine systems require evidence-informed prioritization of medical, rehabilitation, preventive, and organizational interventions. This study aimed to assess and rank stakeholders’ perceived importance of proposed development domains for sports medicine in Kazakhstan, rather than the current performance or quality of the existing system. Methods: An anonymous cross-sectional survey was conducted between December 2025 and January 2026 among 100 stakeholders involved in medical care, rehabilitation, diagnostics, coaching and training, athletic participation, or sports administration. Twelve development domains were rated on a five-point priority scale, followed by a Top-5 selection task. Because the survey form did not technically enforce selection of exactly five options, the primary Top-5 analysis was restricted to the 47 respondents who completed the task as instructed. Results: Among these 47 respondents, rehabilitation and recovery programs were selected by 30/47 (63.8%), injury prevention by 26/47 (55.3%), and both accessibility of medical support and financing/sustainability by 24/47 (51.1%). The all-questionnaire sensitivity ranking (N = 100) showed strong but incomplete agreement with the primary exact-five ranking (Spearman’s ρ = 0.889; Kendall’s τ = 0.762). The 12-domain ratings showed a pronounced ceiling/invariant-response pattern, and subgroup analyses were treated as exploratory because of small and compositionally unequal subgroups. Conclusions: The findings describe perceived priorities within the surveyed non-probability stakeholder sample. Given the purposive, snowball-assisted recruitment strategy and the lack of full psychometric validation of the study-specific questionnaire, they should not be interpreted as nationally representative estimates of service quality, current shortages, or national policy priorities.

Individualized regulation of training load may help characterize athlete-specific responses during competitive swimming. This controlled longitudinal pilot study evaluated metabolic and perceptual responses to an individualized, biochemically guided interval-swimming protocol. Twelve competitive swimmers were included (experimental group, n = 5; control group, n = 7) and completed six serial assessments (T0–T5). Group allocation was non-randomized. In the experimental group, work-bout duration was progressively modified using repeated biochemical and perceptual information, whereas the control group followed a predominantly fixed-duration protocol. The principal outcome analyzed in this report was blood lactate measured 1 min after exercise. Post-exercise blood lactate decreased from 11.78 to 7.94 mmol/L in the experimental group and from 12.19 to 11.43 mmol/L in controls. The T0–T5 reduction was greater in the experimental group (−3.84 vs. −0.76 mmol/L), with a between-group difference in change of −3.08 mmol/L (95% CI, −3.72 to −2.45; p < 0.001). Ammonia showed a supportive longitudinal difference, whereas uric acid was exploratory because it guided load adjustment. Perceived exertion showed a supportive but borderline change after multiplicity adjustment. Recorded interval pace remained broadly stable while work-bout duration increased substantially in the experimental group; however, no standardized time-trial or competitive-performance outcome was assessed. These preliminary findings support further evaluation of individualized, biochemically guided interval-training protocols in larger, prospectively standardized studies.

Morbidity from acute intestinal infections exhibits a seasonal pattern and is associated with climatic factors. Assessing changes in these indicators and the influence of weather conditions in the Kyzylorda region is relevant. This study provides a basis for effective epidemiological monitoring and preventive measures. Objective: to determine the seasonal characteristics of acute intestinal infections in the Kyzylorda region and to assess the impact of climatic factors (temperature and rainfall) on morbidity. Materials and methods: A total of 492 observations were analyzed. The data were complete and reliable. Statistical analysis was performed using the Kruskal-Wallis test and various regression models (linear, quadratic, exponential, and composite). Results: morbidity levels were low in winter, gradually increased in spring, peaked in summer, and declined gradually in autumn. Rising temperature contributed to an exponential increase in morbidity, while higher rainfall reduced it. The linear model indicated that seasonal variation accounted for 95.5 % of the changes in morbidity. Conclusion: The study allows effective planning of epidemiological monitoring and preventive measures and confirms the significant impact of seasonal factors on morbidity.