International University of Kyrgyzstan

BACKGROUND Triple-negative breast cancer (TNBC) is an aggressive subtype with limited therapeutic options, primarily relying on chemotherapy, yet often leading to recurrence due to chemoresistance. Cancer stem cells (CSCs) contribute to tumor heterogeneity, resistance, and poor prognosis, but data in Pakistani populations are scarce. This study hypothesizes that a positive CSC phenotype independently predicts reduced pathological complete response (pCR) and inferior survival outcomes. AIM To investigate CSC markers' association with chemotherapy response and survival in Pakistani TNBC patients. METHODS Retrospective cohort study at Institute of Radiotherapy and Nuclear Medicine, Peshawar, Pakistan, including 256 women with TNBC from January 2015 to December 2022. CSC markers (CD44 high, CD24 low, aldehyde dehydrogenase 1 positive) were assessed via immunohistochemistry on pre-treatment biopsies. Outcomes: pCR to neoadjuvant chemotherapy, overall survival, disease-free survival. Data were analyzed with multivariable logistic regression and Cox proportional hazards models, adjusting for age, tumor grade, and stage. RESULTS The CSC-positive phenotype was identified in 26 patients (10.2%). Compared to negative cases, positive cases had lower pCR rates [5.0% vs 51.8%; adjusted odds ratio = 0.05, 95% confidence interval (CI): 0.01-0.39, P = 0.004]. The positive phenotype was associated with poorer overall survival (adjusted hazard ratio = 4.35, 95%CI: 2.43-7.79, P < 0.001), with a median overall survival of 19 months vs 27 months. No association with disease-free survival was observed (hazard ratio = 0.86, 95%CI: 0.43-1.73, P = 0.675). CONCLUSION CSC markers are associated with reduced chemotherapy response and inferior overall survival in Pakistani TNBC patients. These findings suggest their potential as prognostic biomarkers and highlight the need for future research into targeted strategies, such as proteomic profiling and Proteolysis Targeting Chimeras technology, to overcome chemoresistance in this population.

AIM:ST-segment elevation myocardial infarction (STEMI) remains a major contributor to global cardiovascular morbidity and mortality, with outcomes varying considerably between high-income and low- and middle-income countries (LMICs). Although advances in reperfusion therapy and improvements in hospital-based performance have decreased in-hospital delays, pre-hospital delay remains one of the largest components of total ischemic time, thereby restricting the survival benefit of timely reperfusion. METHODS:This narrative review synthesizes evidence on pre-hospital delay in STEMI and interprets delay through a health-system performance and equity lens rather than viewing it only as an individual behavioral issue. Relevant studies were identified through a search of PubMed, Embase, and Scopus (2000-2025). Evidence was interpreted using a conceptual framework comprising four pathways through which pre-hospital delay is produced: recognition, decision-making, access, and system readiness. RESULTS:Across multiple observational studies and registry reports, median symptom onset-to-first medical contact intervals in high-income countries are typically 60-120 min, supported by organized STEMI networks and higher EMS utilization, although inequities persist among vulnerable population. In several LMIC settings, symptom onset-to-FMC delays frequently exceed 300 min and may extend beyond 480 min, driven by limited EMS coverage and fragmented referral pathways. CONCLUSION:Overall, pre-hospital delay in STEMI is a multidimensional and inequitable phenomenon suggesting the need for integrated approaches beyond awareness campaigns, including EMS strengthening, coordinated referral networks, early diagnostic capacity, financing protections, and governance and accountability mechanisms. Positioning emergency cardiac care within universal health coverage and national non-communicable disease strategies may reduce avoidable STEMI mortality and narrow global inequities.

This article analyzes the social and psychological impact of congenital auricular deformities on the quality of life of children and their families. The medical, emotional, and economic consequences of this pathology are examined, including issues of social adaptation, stigma, the child's self-esteem, and the financial burden on the family. Particular attention is paid to the role of timely surgical correction and comprehensive rehabilitation in improving quality of life. Based on an analysis of clinical and socioeconomic data, the need for an interdisciplinary approach to providing medical and social care to this category of patients is substantiated.

The article examines medical and social assessment procedures and disability determination in children with congenital deformities of the auricle, including microtia and anotia. These conditions often combine anatomical defects with functional hearing impairment, resulting in complex medical, psychological, and social consequences. The study analyzes the clinical criteria, functional limitations, and social adaptation challenges that may justify disability status within national healthcare and social protection systems. Particular attention is given to the role of hearing loss, communication difficulties, and psychosocial vulnerability in shaping long-term outcomes. The paper discusses the necessity of a comprehensive evaluation approach that integrates clinical diagnostics, audiological assessment, psychological analysis, and socio-economic factors. The findings highlight the importance of individualized assessment models and interdisciplinary collaboration to ensure fair disability determination and effective rehabilitation planning. The study concludes that medical and social expertise in cases of congenital auricular deformities should move beyond purely anatomical evaluation and incorporate functional and quality-of-life indicators to provide balanced and evidence-based decisions.

Examines the theoretical and methodological aspects of the efficiency of management of the tourism industry, which requires the analysis and assessment of key economic indicators that make it possible to determine the level of competitiveness, sustainability and profitability of tourism enterprises. Particular attention is paid to the main groups of indicators used to assess the effectiveness of management in the tourism sector are indicators of profitability, costs, investment attractiveness, employment level and the multiplier effect of tourism on the country's economy. As a result of the study, it was noted that the experience of foreign countries shows that successful strategies for state support of tourism are based on an integrated approach, including tax incentives, investment programs, marketing campaigns and infrastructure development.