National Scientific Center for Surgery named after A.N. Syzganov

BACKGROUND: One of the most important tasks and challenges of modern vertebrology is determining optimal approaches to the surgical treatment of children with congenital spinal deformities. The relevance of this issue is associated with characteristic features of the disease, including the formation and progression of pathological curvature, rapid and steady deterioration of the spinal column during the child's growth and development, formation of compensatory counter-curves, and a substantial reduction in quality of life and life expectancy in this category of patients. AIM: This work aimed to evaluate the efficacy and accuracy of patient-specific 3D-printed guide templates in the surgical correction of congenital thoracic and lumbar spinal deformities in preschool-aged children. METHODS: A comparative analysis of surgical outcomes was performed in 40 patients (aged 3–7 years) with isolated vertebral formation defects. The patients were divided into two groups: the main group (n = 20), in which pedicle screws were inserted using patient-specific 3D-printed guide templates, and the control group (n = 20), in which the freehand technique was used. The following parameters were assessed: operation duration, extent of fixation, accuracy of screw placement according to the Gertzbein–Robbins scale, and the degree of deformity correction measured using the Cobb method. RESULTS: In the main group, a significant reduction was observed in the time required for pedicle canal preparation (29.7 ± 4.2 s vs. 72.4 ± 6.8 s; p = 0.027) and screw insertion time (36.3 ± 3.5 s vs. 49.2 ± 5.2 s; p = 0.039), as well as a reduction in the extent of fixation (1.4 vs. 2.05 segments; p = 0.013). Accurate pedicle screw placement (grade 0) was achieved in 64.6% of cases in the main group and 23.3% in the control group (p 0.0001). Correction of kyphotic deformity was significantly greater when guide templates were used (p = 0.024). CONCLUSION: The use of patient-specific 3D-printed guide templates improves the accuracy of pedicle screw placement, reduces operation time and the extent of fixation, and ensures the safety and reproducibility of surgical correction of congenital spinal deformities in young children.

IntroductionInfectious bovine rhinotracheitis (IBR), caused by bovine herpesvirus type 1 (BoHV-1), remains endemic in Kazakhstan. Despite the absence of vaccination, comprehensive multi-year data on the virus circulation have been limited.MethodsA three-year surveillance between 2023 and 2025 was conducted in unvaccinated cattle from all 17 administrative regions a total of 8,590 serum samples and 4,795 nasal swabs. Serological monitoring was performed using two validated ELISA systems (IDEXX IBR gE Ab Test and ID Screen® IBR Indirect ELISA). Molecular detection employed real-time PCR on nasal swabs, and virus-isolation attempts were carried out on Vero cell monolayers. National reference serum panels were developed and externally validated at the Friedrich-Loeffler-Institut (Germany).ResultsSerological testing revealed consistently high antibody prevalence—69.13% (2023), 80.64% (2024), and 82.79% (2025)—with marked regional variation. PCR positivity was 11.2% (280/2,500) in 2024 but only 0.43% (10/2,295) in 2025, indicating subclinical circulation and intermittent viral shedding. All virus-isolation attempts were negative, consistent with low viral loads and latent infection. The validated serum panels achieved > 95% concordance with international reference sera and were successfully implemented for national QA/QC.ConclusionThese findings confirm persistent BoHV-1 endemicity in Kazakhstan and highlight the diagnostic and epidemiological framework necessary for harmonized surveillance, DIVA-compatible vaccination (Differentiating Infected from Vaccinated Animals), and progressive alignment with WOAH eradication programs.

In memory of L.I. Kurmanseitova, the initiator of this patient registry In 2016, an initiative group, in coordination with the leadership of the Hepato-Pancreato-Biliary Association of Commonwealth of Independent States, established the "Registry of Patients with Post-Traumatic Bile Duct Strictures" with the aim of assessing long-term treatment outcomes and developing unified approaches to the management of patients with benign bile duct strictures and biliodigestive anastomoses. The registry was officially registered as a federal database. From 2016 to 2024, data on 426 patients were entered into the registry. In 72.8% of patients, the stricture developed after surgeries on the gallbladder and bile ducts. According to the registry data, 33.2% of patients underwent surgical treatment, 33.9% received interventional radiology procedures, 14.4% were treated endoscopically, and 17.8% underwent combined treatment methods. Long-term outcome data were available for 47.3% of patients. This work presents an analysis of treatment outcomes in this patient population based on the registry data. Further development of the registry with an expanded and more detailed database is planned, which will enable more in-depth and high-quality analysis, including the use of artificial intelligence.

The increasing incidences of antibiotic-resistant infections is a significant concern in managing complicated wound healing. This study examines the trends and microbiological profiles of infected wounds treated surgically at the National Research Center for Traumatology and Orthopedics named after Academician N.D. Batpenov in Astana, Kazakhstan, from 2021 to 2023. A retrospective analysis was conducted on patients who underwent surgical wound closure between 2021 and 2023. Data on patient age, length of hospital stay, comorbidities, type of trauma, chronicity of the condition, affected body part, initial diagnosis, and microbiological culture results were collected. The study assessed the frequency and patterns of antibiotic resistance among isolated pathogens. In 2021, 56 patients were included, with an average age of 43±14.7 years and an average hospital stay of 22.25±11.6 days. Trauma types varied, with a significant proportion resulting from traffic accidents and burns. In 2022, 21 patients (average age 43.9±12.2 years) had longer hospital stays (37.5±23.4 days). The primary diagnoses included osteomyelitis and acute injuries. In 2023, 33 patients were studied, with a mean age of 42.5±27 years and an average stay of 12.6±11 days. Notably, the proportion of patients with osteomyelitis increased over the 3 years. Microbiological analysis revealed a growing presence of antibiotic-resistant pathogens. Staphylococcus aureus (24%) and Pseudomonas aeruginosa (12%) were the most commonly isolated bacteria, with a significant increase in resistance to beta-lactams and other antibiotic groups. The emergence of multi-drug resistant Klebsiella pneumoniae and Acinetobacter species was also observed. The study highlights a concerning trend of increasing antibiotic resistance in pathogens isolated from infected wounds. This underscores the need for ongoing surveillance, updated treatment protocols, and the judicious use of antibiotics to manage such infections effectively. Further research is required to develop strategies to combat the rise of antibiotic-resistant infections.

Aim: The aim of the present study is to analyse and summarize the experience of the Department of Reconstructive and Plastic Microsurgery of the National Scientific Center of Surgery named after A.N. Syzganov in the field of treatment of hand injuries.. Materials and Methods: The study sample included 295 patients who applied to the Department of Reconstructive and Plastic Microsurgery of the National Scientific Center of Surgery named after A.N. Syzganov from the beginning of 2021 to the end of 2022, in relation to which general clinical methods of research, including the method of dynamic observation and innovative microsurgical techniques, were applied. Innovative minimally invasive surgical techniques were developed and successfully applied to the flexor tendons of the fingers, ensuring precise juxtaposition of tendon ends, reducing tissue trauma, and facilitating smooth passage of the repaired tendons in bone-fibrous canals. Results: The application of the developed methods demonstrated high clinical efficacy, as evidenced by the high percentage of good and satisfactory treatment results - 98.8% in one group and 93.7% in the other. Nevertheless, in 3.4% of cases, the development of flexion contractures of fingers of different severity was observed, which was associated with insufficient intensity of rehabilitation, lack of proper dynamic control and indiscipline of some patients. Conclusions: The result of the work was a comprehensive analysis of the experience of microsurgery of the hand obtained in the Republic of Kazakhstan during the study period.

BACKGROUND Minimally invasive pancreatectomy has become the standard practice for the management of benign and malignant pancreatic tumors. Techniques such as robotic and laparoscopic approaches are known to reduce morbidity by offering benefits such as less blood loss, reduced pain, shorter hospital stays, and quicker recovery times. The indication for repeated minimally invasive pancreatectomy for recurrent or de novo pancreatic neoplasm after primary pancreatic surgery remains debated. CASE REPORT A 50-year-old woman was admitted to our hospital with a diagnosis of an intraductal papillary mucinous neoplasm in the pancreatic head. In 2010, she underwent laparoscopic single-branch resection for a branch-type tumor in the pancreatic uncinate process. During a 5-year follow-up, a de novo intraductal papillary mucinous neoplasm was detected, showing gradual growth and the presence of a mural nodule over the next 7 years. The patient's CEA level was elevated to 7.0 ng/mL. Considering the tumor's progression and the appearance of a mural nodule, we recommended a robot-assisted Whipple procedure. The operation began with laparoscopic adhesiolysis. After detachment of the adhesions and remobilization of the duodenum using the Kocher maneuver, the operation continued with the Da Vinci surgical system. The postoperative period was uneventful, and the patient was discharged on postoperative day 20. Pathological examination revealed intraductal papillary mucinous carcinoma in situ with negative resection margins. CONCLUSIONS This case verifies the safety and feasibility of performing a robotic Whipple procedure for a newly diagnosed pancreatic neoplasm in patients who have previously undergone minimally invasive pancreatic surgery.

Hallux valgus (HV) is a common foot deformity that manifests with increasing age, especially in women. The associated foot pain causes impaired gait and decreases quality of life. Moderate and severe HV is a deformity that is characterized by the involvement of lesser rays and requires complex surgical treatment. In this study, we attempted to develop a procedure for this condition. To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity. We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor's bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems. This method included a modified Lapidus procedure, M2M3 tarsometatarsal arthrodesis, intermetatarsal fusion of the M4 and M5 bases, and the use of an original external fixation apparatus to enhance correction power. Preoperative, postoperative, and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared, and P values < 0.05 were considered to indicate statistical significance. The study included 28 females (93.3%) and 2 males feet (6.7%), 20 (66.7%) of whom had a moderate degree of HV and 10 (33.3%) of whom had severe deformity. M2 and M3 metatarsalgia was observed in 21 feet, and 9 feet experienced pain only at M2. The mean follow-up duration was 11 months. All patients had good correction of the HV angle [preoperative median, 36.5 degrees, interquartile range (IQR): 30-45; postoperative median, 10 degrees, IQR: 8.8-10; follow-up median, 11.5 degrees, IQR: 10-14; P < 0.01]. At follow-up, metatarsalgia was resolved in most patients (30 vs 5). There was a clinically negligible decrease in the corrected angles at the final follow-up, and the overall AOFAS score was significantly better (median, 65 points, IQR: 53.8-70; vs 80 points, IQR: 75-85; P < 0.01). The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up. Randomized clinical trials with larger samples, as well as long-term outcome assessments, are needed in the future.

BackgroundThe geographical distribution of hepatitis B virus (HBV) and hepatitis D virus (HDV) genotypes is uneven and has its own clinical and organizational implications for health systems. Despite the introduction of vaccination and successful antiviral therapy the prevalence of chronic hepatitis B (with or without delta agent) increased over the past 5 years. This study aimed for the first time to investigate the molecular epidemiology of HBV and HDV in Kazakhstan.MethodsTotal 834 chronic hepatitis B (with or without delta agent) patients were included to the study from November 2017 to June 2019. The material was collected from the regional hepatological сenters from 13 cities of Kazakhstan. Genotyping of HBV/HDV isolates was carried out using phylogenetic analysis of null-binary sequences of Kazakhstani isolates, in comparison with the reference sequences. Nucleotide sequence alignment was performed using the ClustalW algorithm, the “neighbor-joining” method was used for the construction of phylogenetic trees and subsequent analysis.ResultsOverall 341 samples were PCR-positive and genotyped for HBV. Comparison and phylogenetic analysis of nucleotide sequences of HBV isolates showed that they were represented by genotypes HBV-D (95.9%), HBV-A (3.5%) and HBV-C (0.6%). At the same time, the identity of the nucleotide sequences of Kazakhstani isolates were: HBV-D (95–100%); HBV-A (97.2–100%) and HBV-C (99%). 256 samples were PCR positive and genotyped for HDV, all of them belonged to genotype 1.ConclusionThis study describes for the first time the molecular epidemiology of HBV and HDV in Kazakhstan. The data obtained expand the knowledge of the global epidemiology of viruses; have potential implications for public health policy and for further clinical research on chronic hepatitis in Kazakhstan.Trial registrationClinicalTrials.gov NCT05095181 (registered on 27/10/2021).

Up to date, no research on the economic efficacy of diagnostic modalities, such as magnetic resonance imaging (MRI) and computerized tomography (CT), has been done in Central Asia. The aim of this study was to analyse the inappropriate appointments of MRI and CT scanning procedures in Kazakhstan. We used the imaging diagnostic reports and medical records from 9725 planned outpatient CT and MRI exams performed in two major hospitals in Almaty. The study period was for the period 2014-2019. The independent experts-radiologists evaluated the MRI and CT exams for validity using the ACR® compliance standards and RCR recommendations. The results showed that the combined costs of MRI and CT scans increased by $17.982 between 2014 ($22.537) and 2019 ($40.519), p = 0.002. The highest rate of MRI examinations was observed in 2019, with a rate of 6.9 per 10,000 people. It was determined that in 2019 the highest rate for men who undertook CT was equal to 12.4 per 10,000 people, while for women it was equivalent to 5.7 per 10,000 patients. The majority of non-corresponding imaging examinations (n = 1304) were referred for MRI and CT scans by general practitioners. We detected the irrational referrals for head and neck radiological examinations in n = 178 (13.7%) cases, and the abdominal cavity checks in n = 249 (19.1%) cases (p = 0.001). The main portion of erroneously unreasonable referrals for examination of the abdominal organs was made by surgeons in n = 43 (3.3%) cases. The findings indicated an increase in the number of referrals for unnecessary CT and MRI tests over the research period (2014-2019). It had a substantial impact on the rise in healthcare system expenses. The results demonstrate the need for the education of GPs and improving the approaches for diagnostics.