Talshyn Ukybassova

Introduction. Cervical cancer is still one of the pressing problems in medicine and public health in Kazakhstan. Infection with high-risk human papillomavirus (HPV) is a key cause of precancerous changes development, which suggests the need to find new ways of diagnosing and assessing risk factors. Aim. To develop an integrated algorithm for evaluation and diagnosis of the risk of precancerous cervical changes caused by HPV, considering the features of modern diagnostic methods and the healthcare system of Kazakhstan. Methods. According to the WHO recommendations and up-to-date literature, an algorithm has been developed for women aged 18 to 70 years. The algorithm includes initial screening for high-risk HPV infection and cytology, and then stratification of patients based on test results. In cases of abnormal cytology and/or high-risk HPV infection, the algorithm includes colposcopy, targeted biopsy, and histopathological confirmation of the results. In addition, vaginal microflora and sexually transmitted infections are assessed, especially in patients who test positive for human papillomavirus. Results. The described algorithm makes it possible to divide patients into groups with low, medium, and high risk, taking into account the presence of HPV, HPV type, cytological and colposcopic manifestations, as well as the presence of STIs and dysbiosis. High-risk status is determined by the detection of HPV-16, cytological changes, and an abnormal colposcopic pattern. Histopathological examination is used to determine the next steps in the treatment of CIN I-III and in situ cancer. Conclusion. The proposed algorithm combines HPV diagnostics, cytology, colposcopy, histology and microbiological studies. This approach may yield better results in terms of early detection of precancerous changes and optimization of patient referrals. It can also be used to prevent cervical cancer. Further study is required to evaluate the diagnostic performance of the algorithm. Keywords: cervical cancer, diagnostics, HPV, algorithm, cytology.

Introduction. This study aims to investigate the distribution of high-risk HPV genotypes in different cervical pathology and identify the diagnostic agreement between colposcopy and cervical biopsy in Kazakhstan. Methods. This is a cross-sectional cohort study that was conducted in a tertiary care hospital in Astana, Kazakhstan from November 2024 to March 2026. Women of reproductive age aged 18–45 years underwent HPV testing, a video-colposcopy and colposcopy-guided cervical biopsy. Results. The study included 483 participants who were not previously vaccinated from HPV. Colposcopy was done for 285 women. 48.5% of participants had normal colposcopic impression, 40.1% had abnormal grade I impression, and 10.6% had abnormal grade II impression. Among these 285 patients, cervical biopsy results were available for 127 participants and the distribution of biopsy results varied significantly among three colposcopic impressions. The agreement percentage between colposcopic impressions and biopsy results is 37.5%, unweighted Cohen's κ = 0.083 (bootstrap CI -0.097-0.269) indicating weak and the quadratic-weighted κ = 0.342 (bootstrap CI [0.178, 0.477]) indicating a moderate degree of agreement. Conclusion. Although discordance was present between colposcopy and cervical pathology, our results demonstrated that colposcopy has potential to increased diagnostic value in detection of high grade cervical changes. Key words: cervical precancerous lesions, colposcopy, human papillomavirus, cervical biopsy, cervical cancer.

Ntroduction. This studyaimed to assess the level of knowledge, the attitude, and practices of physicians from Kazakhstan on topics related to cervical cancer and Human Papillomavirus (HPV), and to find their associations with socio-demographic variables.Methods. A 41-item questionnaire was distributed online through the snowballing method, which was completed by 389 participants. Any physician who practiced or is practicing in Kazakhstan was eligible for participation. The Poisson test with robust error variances was used for statistical model building. Results. Approximately half of the physicians had appropriate knowledge (score > 70%) on topics of cervical cancer and HPV. Seventy-one percent of physicians expressed intention to vaccinate their own children against HPV. Lessthan half (44.41%) have recommended the HPV vaccine to their patients previously. Younger physicians, pediatricians, and general practitioners had a lower prevalence of appropriate knowledge, a supportive attitude towards the HPV vaccine, and actively recommended the HPV vaccine.Conclusion. Knowledge of physicians regarding cervical cancer and HPV could be improved. Improvement in the attitudes and practices of physicians could positively influence the uptake of cervical cancer screening and HPV vaccine in Kazakhstan.Key words:human papillomavirus, vaccination, cervical cancer, knowledge, physician, Kazakhstan.

Relevance. Reproductive medicine is still faced with a significant problem of recurrent pregnancy loss (RPL), with over half of diagnoses unexplained. Vitamin D deficiency is linked with poorer pregnancy outcomes and polymorphisms in the vitamin D receptor (VDR) gene can affect reproductive health. Evidence from various populations is not uniform; however, no studies have yet been conducted among women in Central Asia. Objective. The aim of the present study was to examine whether ten common polymorphisms found in the multi-locus haplotypes of the vitamin D receptor (VDR) gene predicted the risk of recurrent pregnancy loss among Kazakhstani women. Materials and methods.These include 200 women with RPL and 200 multiparous healthy controls of the population from the Republic of Kazakhstan. Genotyping of polymorphisms rs739837, rs7975232, rs1544410, rs7975128, rs2228570, rs731236, rs7967152, rs2238140, and rs2853564 was carried out via high-precision real-time PCR. Results. All SNPs analyzed were at Hardy–Weinberg equilibrium among healthy controls. No SNPs indicated associations were found between increased or decreased risk of RPL and minor allele frequencies were not different in RPL cases and controls. Genotype frequencies were also comparable across groups in all conditions (codominant, dominant, recessive, overdominant, log-additive). Using the most common GCCGGAAGA haplotype as a reference (OR = 1.00), haplotype analysis showed a negative association between the TATAGGCAG haplotype and RPL (P = 0.001) at baseline, which was held constant after correcting for major covariates (P = 0.006). In an experimental study, after Bonferroni correction, however, the association was less significant (P = 0.059). Conclusion. We established no significant association between VDR gene polymorphisms and recurrent pregnancy loss among Kazakhstan women. Актуальность. Привычное невынашивание беременности (ПНБ) признано серьезной проблемой в области репродуктивного здоровья, более половины случаев имеют неизвестные причины. Плохой статус витамина D у матери связан с неблагоприятным течением беременности, а мутации в гене VDR могут изменять репродуктивную функцию. Однако доказательства различий между популяциями непоследовательны, и исследования в контексте женщин Центральной Азии еще не проводились. Цель. Данное исследование направлено на оценку потенциальных ассоциаций между десятью общими полиморфизмами и многолокусными гаплотипами гена рецептора витамина D (VDR) и материнским риском повторной потери беременности среди женщин, проживающих в Казахстане. Материалы и методы. Исследование было проведено на основе выборки включавший 200 женщин с ПНБ и 200 многорожавших женщин, составивших контрольную группу из населения Республики Казахстан. Генотипирование полиморфизмов rs739837, rs7975232, rs1544410, rs7975128, rs2228570, rs731236, rs7967152, rs2238140 и rs2853564 проводилось с использованием высокоточной ПЦР в реальном времени. Результаты. Однонуклеотидные полиморфизмы (SNPs) у здоровых женщин в контрольной группе находились в равновесии Харди-Вайнберга. Ни один из исследованных SNPs не был связан с более высоким или низким риском ПНБ, и частоты минорных аллелей (MAF) не различались у женщин с ПНБ и здоровых женщин. Аналогично, частоты генотипов всех SNPs не варьировались между двумя группами, с учетом соответствующих модификаторов и независимо от используемой генетической модели (кодоминантной, доминантной, рецессивной, сверхдоминантной или лог-аддитивной). Для наиболее распространенного гаплотипа GCCG-GAAGA (OR = 1.00) анализ гаплотипов предполагал отрицательную связь между гаплотипом TATAGGCAG и ПНБ (P = 0.001) изначально, которая сохранялась с учетом важных ковариант (P = 0.006). Однако при контроле на множественные сравнения, проведенные методом Бонферрони, эта ассоциация стала статистически незначимой (P = 0.059). Заключение. Полученные данные демонстрируют, что полиморфизмы гена VDR не были статистически значимо связаны с восприимчивостью к привычному невынашиванию беременности у женщин Казахстана. Өзектілігі. Қайталамалы жүктіліктің үзілуі (ҚЖҮ) — репродуктивті денсаулық саласындағы өзекті мәселелердің бірі болып...

Background: Central nervous system (CNS) tumors during pregnancy are rare but present significant diagnostic, therapeutic, and ethical challenges. These include both primary and metastatic lesions, which share overlapping clinical features and management complexities. Their clinical course is influenced by gestational physiological changes, which can mask symptoms and delay diagnosis, thereby increasing maternal and fetal risks. Objective: This review aims to synthesize current evidence on the epidemiology, pathophysiology, clinical presentation, diagnostic strategies, treatment options, prognosis, and ethical considerations related to CNS tumors in pregnant patients. Methods: A comprehensive literature review was conducted, including retrospective and prospective studies, clinical guidelines, and systematic reviews focusing on brain and spinal tumors diagnosed during pregnancy. Particular attention was given to the impact of gestational age, tumor histology, and maternal condition on treatment outcomes. Results: Hormone-sensitive tumors such as meningiomas and prolactinomas may exhibit accelerated growth during pregnancy due to elevated progesterone and prolactin levels. Diagnosis is often delayed due to symptom overlap with normal gestational changes. MRI without contrast remains the imaging modality of choice. Glucocorticoids and selected chemotherapy agents can be cautiously used depending on gestational age. Surgical resection, particularly in the second trimester, has been shown to be safe and effective in appropriate clinical scenarios. Multidisciplinary coordination is essential. Prognosis varies based on tumor type and timing of intervention, with maternal survival prioritized in high-risk situations. Ethical management hinges on patient autonomy, informed consent, and proportionality of medical interventions. Conclusions: CNS tumors during pregnancy require early recognition, individualized treatment planning, and ethical vigilance. Multidisciplinary collaboration is vital to optimizing outcomes for both mother and fetus. Future efforts should focus on developing standardized protocols and expanding evidence through multicenter studies.

Background/Objectives: Cervical cancer is one of the most frequent malignancies among women in Kazakhstan, where human papillomavirus (HPV) vaccination was initiated in 2024. Despite the implementation of vaccination and cytology-based screening programs, diagnostic limitations remain, and local evidence linking HPV infection to clinical outcomes is scarce. This study aimed to evaluate the correlation between HPV status, cervical cytology results, colposcopic impression, and biopsy results in a non-vaccinated female population. Methods: A cross-sectional study was conducted at the University Medical Center, Astana, between November 2024 and March 2025. A total of 396 women of reproductive age were enrolled. Cervical samples underwent liquid-based cytology and high-risk HPV testing with the RealBest assay. Colposcopy was performed following abnormal cervical cytology results, and colposcopy-guided biopsies were obtained where indicated. Sociodemographic characteristics were assessed, and associations between HPV genotype and clinical outcomes were analyzed using descriptive and inferential statistics. Results: HPV infection was detected in 140 women (35.4%). HPV-16 was the most common genotype (11.4%), followed by HPV-52 (6.6%) and HPV-33 (5.3%). Among 198 women evaluated by colposcopy, abnormal findings were observed in 72.2%, with HPV-16 showing a significant association with higher-grade abnormalities (p < 0.001). Biopsies were available for 40 participants: 12 had CIN I, 12 had CIN II, 10 had CIN III, and 4 had carcinoma in situ. HPV-16 was the only genotype significantly linked to CIN II/III lesions. Conclusions: HPV-16 was strongly associated with abnormal colposcopic findings and high-grade histology, underscoring its oncogenic importance. The prevalence of HPV-52 and HPV-33 further supports the need for HPV nonavalent vaccination. These findings highlight the importance of HPV-based screening, genotype-specific triage, and expanded vaccination to reduce cervical cancer incidence in Kazakhstan.

Introduction: Vaginal microbiota has emerged as an important factor influencing human papillomavirus (HPV) persistence and host immunity. While HPV infection is often transient, persistent infections with high-risk HPV genotypes significantly increase the risk of cervical carcinogenesis. Thus, this study aims to investigate the association between microflora/sexually transmitted infections (STIs) and HPV infection, with a focus on the prevalence of coinfection and the potential role of genital tract microecological disorders. Methods: A prospective cohort study was conducted at a tertiary care center in Astana, Kazakhstan, between November 2024 and March 2025. A total of 396 non-pregnant women aged 18–45 years were enrolled during routine gynecological screening. Cervical samples were collected for high-risk HPV genotyping and the detection of 11 other vaginal microorganisms using real-time PCR. Results: HPV-positive women were significantly younger and more likely to be single compared to HPV-negative participants. They also had fewer pregnancies and deliveries and were more likely to use barrier contraception. Among STIs, Mycoplasma hominis demonstrated a significant association with HPV infection (adjusted OR = 2.16, 95% CI: 1.15–4.05, p = 0.017). Overall STI presence (adjusted OR = 2.16, p = 0.017) and STI multiplicity (adjusted OR = 1.36 per additional STI, p = 0.017) were also significantly associated with HPV positivity. Correlation analysis revealed a moderate association between Chlamydia trachomatis and Trichomonas vaginalis (ϕ = 0.39, p < 0.001), suggesting shared ecological or transmission pathways. Conclusion: The findings highlight the relevance of specific vaginal pathogens, particularly Mycoplasma hominis, and co-infection patterns in increasing the risk of HPV infection. These results underscore the importance of comprehensive STI screening and microbial profiling in cervical cancer prevention strategies, especially in populations with limited access to HPV vaccination. Further longitudinal and mechanistic studies are warranted to elucidate causal pathways and progression to cervical neoplasia.

Human papillomavirus (HPV) is a well-established etiological factor in the development of precancerous cervical lesions and cervical cancer. This narrative review synthesizes current evidence on the global prevalence, genotype distribution, and pathophysiological mechanisms of HPV infection, emphasizing regional epidemiological variations that influence prevention and treatment strategies. Particular attention is given to high-risk HPV genotypes, their role in carcinogenesis, and the impact of co-infections and the cervicovaginal microbiota on infection persistence and disease progression. Advances in diagnostic methodologies, including E6/E7 oncoprotein detection, DNA methylation, and microRNA-based assays, are examined in the context of improving screening accuracy and early detection. Furthermore, the review explores the psychological implications of HPV diagnosis and underscores the importance of integrating psychosocial support into clinical management. Given the challenges associated with screening coverage, the potential of self-sampling techniques, particularly in resource-limited settings, is discussed as a means to enhance accessibility and participation in cervical cancer prevention programs. By providing a comprehensive overview of these interrelated factors, this review highlights the necessity of a multidisciplinary approach that integrates novel diagnostic strategies, targeted prevention efforts, and supportive care to mitigate the burden of HPV-associated diseases.

Background/Objectives: Persistent high-risk human papillomavirus (HPV) infections are the leading cause of cervical cancer. Developing evidence suggests that the cervicovaginal microbiome plays a significant role in modulating HPV persistence and progression to cervical neoplasia. This review synthesizes the current knowledge on the interplay between the cervicovaginal microbiome and local immunity in HPV infections, emphasizing microbial diversity, immune responses, and potential therapeutic implications. Methods: A thorough review of the literature was performed using Embase, PubMed, Scopus, and Google Scholar, encompassing studies published between 2000 and 2024. Studies examining the composition of the microbiome, immune responses, and HPV-related outcomes were evaluated and synthesized into a comprehensive review. Results: A Lactobacillus-dominant microbiome, particularly with L. crispatus, creates a protective environment through lactic acid production, maintenance of low pH, and anti-inflammatory immune modulation, facilitating HPV clearance. Dysbiosis, often characterized by a dominance of L. iners and overgrowth of anaerobic bacteria, fosters chronic inflammation, cytokine imbalance, and a microenvironment conducive to HPV persistence and progression. Hormonal changes and menopause exacerbate these microbial shifts, increasing the risk of cervical lesions. Studies suggest that cytokine profiles and antimicrobial peptides significantly influence local immune responses, further modulating infection outcomes. Conclusions: The cervicovaginal microbiome is a critical determinant in HPV infection outcomes, with therapeutic potential for modulating the microbiome to enhance immune responses and prevent cervical cancer. Personalized microbiome-targeted therapies may offer a novel avenue for managing HPV and reducing cervical cancer incidence.

Cervical cancer is a largely preventable malignancy of the uterine cervix. The tendencies in cervical cancer morbidity and mortality have remained similar for the past decade, albeit with increasing frequency in low- and middle-income countries (LMICs). Moreover, in the majority of LMICs, cervical cancer is the second most prevalent cancer and the second most common cause of cancer-related death among reproductive-age women. High-risk human papillomavirus (HR-HPV) infections have been proven to be associated with up to 95% of cervical cancer cases, with HPV-16 and HPV-18 types being responsible for approximately 70% of all cervical cancers, with the other high-risk HPV types accounting for up to a further 25%. More recently, the latest data appear to confirm there is a change in the frequency of HR-HPV occurrence, especially HPV-16 and HPV-18, as a reflection of the implementation of preventive vaccination programs. Owing to the growing incidence of cervical cancer among reproductive-age women and with the development of cancer management approaches, fertility-sparing options have been proposed for early-stage cervical cancer management as an option for young women, especially those with unaccomplished reproductive desires. However, methods applied for this purpose (cold-knife conization, loop electrosurgical excision, trachelectomy) have variable outcomes and do not prevent risks of relapse. Multiple factors are involved in cervical cancer recurrence, even in cases treated at the early stage of the disease. In this review, the authors unveil whether HPV infection and virus type could be one of the key factors associated with cervical cancer recurrence after fertility-sparing surgery. Reviews of the literature reveal that recurrent and persistent HR-HPV infection is a strong predictor of cervical lesions’ relapse. In particular, HPV-16 and HPV-18 infections and their persistence have been reported to be associated with cervical cancer recurrence. HR-HPV genotyping before and after fertility-sparing surgery for cervical cancer could facilitate a personalized approach and improve the overall survival rate. Screening for HR-HPV is essential during the follow-up of cervical cancer-treated women and will help to predict possible cancer recurrence.