Annals of Clinical Medicine and Health Research
Annals of Clinical Medicine and Health Research (ACMHR) is an international, open-access, peer-reviewed journal dedicated to advancing the science and practice of clinical medicine and health research. The journal serves as a rigorous academic platform for clinicians, researchers, public health professionals, and biomedical scientists to disseminate original research, critical reviews, and evidence-based findings that improve patient outcomes and inform healthcare policy worldwide. ACMHR is committed to publishing high-quality work that bridges the gap between laboratory discovery and clinical application, with a particular emphasis on research that is translatable, reproducible, and relevant to real-world healthcare settings. The journal welcomes submissions from all regions of the world and actively encourages contributions from emerging economies and under-represented research communities. Title: Annals of Clinical Medicine and Health Research Frequency: Twice a year ISSN: Applied Owner: Magnus Scientific Publishing Company, Kazakhstan Publisher: Magnus Scientific Publishing Company, Kazakhstan Executive Editor: Dr. Galina Fedotovskikh, MD, Doctor of Medical Sciences, Department of Pathology, Syzganov National Research Surgery Center, Almaty (Kazakhstan), editor@acmhr.com Copyright: Author Starting year: 2025 Subject: Medicine Language: English Publication format: Online/Print journal Email ID: editor@acmhr.com, info@magscipublishing.com Website: https://acmhr.com/index.php/acmhr Address: Magnus Scientific Publishing Company, Valikhanova Str.7, Astana, Almaty District, Nur-Sultan, Kazakhstan, 010000 Year of Starting: 2025 Periodicity: Bi-Annual (2 issues in a year) Language: English
Minimally Invasive Surgery: Transforming Modern Surgical Practice
Background. Minimally invasive surgery (MIS)—encompassing laparoscopic, thoracoscopic, endoluminal, and robotic-assisted techniques—has reshaped operative practice across virtually every surgical specialty since the late 1980s. By accomplishing through small incisions or natural orifices what once required large open exposures, MIS aims to reduce surgical trauma while preserving therapeutic efficacy. Objective. This narrative review traces the development of MIS, summarises the comparative evidence on clinical outcomes, surveys the rise of robotic-assisted surgery, and considers the limitations, costs, and future trajectory of minimally invasive practice. Methods. We undertook a structured narrative review of peer-reviewed literature, systematic reviews and meta-analyses, and contemporary procedural and industry data, prioritising high-level comparative evidence and primary reporting. Results. Across multiple specialties, MIS is consistently associated with reduced intraoperative blood loss, shorter hospital stay (commonly 20–30% shorter than open surgery for colorectal procedures), less postoperative pain, and lower wound-related morbidity, with broadly equivalent long-term oncological and functional outcomes in appropriately selected patients. Robotic-assisted surgery has expanded rapidly: da Vinci systems alone have now been used in more than 20 million procedures worldwide. Evidence is not uniformly favourable, however; in early-stage cervical cancer, MIS radical hysterectomy has been associated with worse oncological outcomes than open surgery, underscoring the importance of procedure-specific appraisal. Conclusion. MIS has transformed modern surgery and is now the standard of care for many procedures. Its benefits are substantial but not universal, and must be weighed against cost, the learning curve, and procedure-specific evidence. Rigorous trials, structured training, and equitable access will determine the next phase of its evolution.
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc-nd/4.0
Quality of Life Among Patients with Chronic Diseases in General Medical Practice
Background. As chronic diseases become the dominant reason for consultation in general medical practice, the goals of care increasingly extend beyond survival and biomarker control to the preservation of health-related quality of life (HRQoL). HRQoL captures the patient’s own experience of physical, psychological, and social functioning, and is a central—if often under-measured—outcome of chronic-disease care in primary settings. Objective. To synthesise current evidence on HRQoL among patients with chronic diseases in general practice: its conceptual basis and measurement, the impact of single and multiple chronic conditions, the determinants of HRQoL, and the implications for primary-care management. Methods. We conducted a structured narrative review of peer-reviewed literature and validated instrument documentation, prioritising primary-care and general-population studies and systematic reviews of multimorbidity and HRQoL. Results. Generic instruments—notably the SF-36 and the EuroQol EQ-5D (with dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression)—are the most widely used measures, complemented by disease-specific tools. Chronic conditions consistently reduce HRQoL, with anxiety/depression and chronic pain among the largest decrements (each around −0.19 on the EQ-5D index in one general-population study), and multimorbidity produces a graded, cumulative reduction (around −0.12 EQ-5D index) alongside roughly double the odds of hospitalisation. Older age, female sex, lower education and income, unemployment, and conditions such as heart failure and joint disease are associated with poorer HRQoL. Enhanced, team-based primary-care management can improve HRQoL. Conclusion. HRQoL is a meaningful, measurable outcome that should be integrated into routine chronic-disease care in general practice. Person-centred, multimorbidity-aware management—attentive to mental health, pain, and social circumstances—offers the most realistic route to preserving quality of life.
Public Health Challenges in the Prevention and Management of Urinary Tract Infections in Nigeria
Background. Urinary tract infections (UTIs) are among the most common bacterial infections in Nigeria, yet their prevention and management are undermined by a distinctive set of public-health challenges—weak diagnostic capacity, widespread self-medication and over-the-counter antibiotic sales, and escalating antimicrobial resistance (AMR). Objective. To synthesise the public-health challenges in the prevention and management of UTIs in Nigeria, encompassing the burden and microbiology of disease, the drivers of antimicrobial resistance, health-system barriers, and the policy response, and to identify priorities for action. Methods. We conducted a structured synthesis of published Nigerian and West African evidence, including hospital-based microbiological studies, national surveillance and policy documents (notably the National Action Plan on AMR), and the international literature. Results. Escherichia coli is consistently the predominant uropathogen across Nigerian studies (often around 50–62% of isolates), with women disproportionately affected. Resistance to commonly used oral agents—ampicillin, co-trimoxazole, and increasingly fluoroquinolones—is high and rising, while nitrofurantoin retains comparatively better activity in several settings. Key drivers include very high rates of self-medication (a 2024 national survey reported around 48%), an estimated 60% of antibiotic prescriptions being inappropriate, and widespread over-the-counter sales despite prescription-only regulation. Antimicrobial stewardship programme coverage remains low (around 23% of facilities). Conclusion. Effective UTI control in Nigeria requires strengthened diagnostic and surveillance capacity, enforcement of prescription-only antibiotic sales, scaled-up antimicrobial stewardship, public education to curb self-medication, and improved water, sanitation, and hygiene—delivered within the One Health framework of the National Action Plan on AMR.
Clinical Characteristics and Health Outcomes of Working-Age Adults (18–64 Years) in General Medical Practice: A Synthesis of Primary-Care Evidence
Background. Chronic disease and multimorbidity are usually framed as problems of old age, yet a large and growing share of the burden falls on working-age adults (18–64 years), in whom illness intersects with employment, income, and family responsibility. General practice is the principal setting in which this population is managed, but its distinctive clinical profile is comparatively neglected. Objective. To synthesise published evidence on the clinical characteristics, prevalent conditions, and health outcomes of working-age adults in general practice, with particular attention to multimorbidity, mental–physical comorbidity, the social gradient, and the consequences for work and productivity. Methods. We conducted a structured synthesis of peer-reviewed primary-care epidemiology and population studies, prioritising analyses that disaggregate the working-age group, including large electronic-health-record and community cohorts and productivity-cost studies. Results. Although multimorbidity prevalence rises with age, in absolute numbers more people with multimorbidity are below 65 than above it. Prevalence among middle-aged adults (45–64) is substantial—around 30% in Scottish primary-care data—and in deprived areas multimorbidity appears 10–15 years earlier, so that disadvantaged working-age adults carry a burden equivalent to affluent people a decade or more older. Depression and anxiety are especially prominent in this group, particularly among the unemployed, and musculoskeletal conditions are common. Multimorbidity in employed adults is associated with markedly increased work absence—rising from around 5–6 days a year with no or one condition to over 30 days with four or more. Conclusion. Working-age adults in general practice represent a large, socially patterned, and economically consequential group in whom early, equity-focused, and work-aware chronic-disease care could yield substantial individual and societal benefit.
Prevalence and Management of Chronic Non-Communicable Diseases in Adult Patients
Background. Chronic non-communicable diseases (NCDs)—principally cardiovascular disease, cancer, chronic respiratory disease, and diabetes mellitus—are the leading cause of death and disability worldwide, accounting for roughly three-quarters of all deaths. Their rising prevalence among adults, driven by ageing populations and modifiable behavioural and metabolic risk factors, poses a defining challenge for health systems. Objective. To synthesise current evidence on the prevalence, burden, risk factors, and management of the major chronic NCDs in adult patients, with emphasis on cost-effective, scalable approaches to prevention and care. Methods. We conducted a structured narrative review of peer-reviewed literature, World Health Organization (WHO) surveillance and policy documents, and international epidemiological data, prioritising guideline-level evidence and large datasets. Results. NCDs cause approximately 41 million deaths annually (around 74% of global mortality); cardiovascular diseases account for the largest share (around 17.9 million deaths), followed by cancers (around 9.3 million), chronic respiratory diseases (around 4.1 million), and diabetes (around 2.0 million). About 77% of NCD deaths and 86% of premature NCD deaths occur in low- and middle-income countries. Four shared behavioural and metabolic risk factors—tobacco use, harmful alcohol use, unhealthy diet, and physical inactivity, operating through raised blood pressure, obesity, hyperglycaemia, and dyslipidaemia—drive most disease. WHO has identified a set of cost-effective “Best Buy” interventions whose full implementation could, by 2030, save an estimated 12 million lives at a cost of around US$3 per person per year. Conclusion. Most NCD burden in adults is preventable or manageable through known interventions. The central challenge is implementation—integrating cost-effective prevention and primary-care management, particularly of hypertension and diabetes, within a multisectoral, whole-of-society response.
Smart Surgical Systems and the Future of Minimally Invasive Interventions
Background. Minimally invasive surgery has been progressively augmented by “smart” technologies—artificial intelligence (AI), machine learning, computer vision, augmented reality, and increasingly autonomous robotics—that aim to enhance perception, decision-making, and precision within the operating room. Collectively termed smart surgical systems, these technologies are reshaping the trajectory of minimally invasive intervention. Objective. This narrative review surveys the current landscape of smart surgical systems, examines the evidence for intraoperative AI, augmented reality guidance, and autonomous robotics, and considers the technical, ethical, and regulatory challenges that will shape their clinical future. Methods. We undertook a structured narrative review of peer-reviewed literature, systematic reviews, and landmark preclinical studies, prioritising high-level syntheses and primary reports of clinically relevant advances. Results. Intraoperative AI has demonstrated promising performance in surgical-phase recognition (reported accuracy approximately 81–93%) and anatomical-structure identification (approximately 71–98%), supporting applications such as real-time anatomy delineation and intraoperative decision support. Augmented reality and image guidance increasingly overlay preoperative imaging onto the operative field. In preclinical work, the Smart Tissue Autonomous Robot (STAR) performed autonomous laparoscopic intestinal anastomosis in a porcine model, producing results comparable or superior to expert surgeons. Persistent challenges include limited and biased training data, the “black-box” nature of many models, absence of validation and regulatory frameworks, and unresolved questions of liability and accountability. Conclusion. Smart surgical systems hold substantial promise for the next era of minimally invasive surgery, moving from task-assisting tools toward context-aware, partially autonomous platforms. Realising this potential safely will require rigorous prospective validation, transparent and interpretable models, robust regulation, and clear governance of accountability. For the foreseeable future these systems augment rather than replace the surgeon.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc-nd/4.0
Early-Onset Type 2 Diabetes Mellitus Among Adolescents and Young Adults: Clinical Profiles and Risk Factors
Background. Type 2 diabetes mellitus (T2DM), historically a disease of middle and older age, is increasingly diagnosed in adolescents and young adults. This shift carries disproportionate clinical consequences: youth-onset T2DM follows a more aggressive course than adult-onset disease, with rapid loss of beta-cell function and early onset of complications. Objective. This review synthesises current evidence on the epidemiology, pathophysiology, clinical profile, risk factors, and complication burden of early-onset T2DM in adolescents and young adults, and considers the implications for screening and management. Methods. We undertook a structured narrative review of peer-reviewed literature, landmark cohort and intervention studies (notably SEARCH for Diabetes in Youth, TODAY, and RISE), and contemporary international reviews and guidelines. Results. In the US SEARCH study, the prevalence of youth T2DM rose from 0.34 per 1,000 in 2001 to 0.67 per 1,000 in 2017—a relative increase of roughly 95% over 16 years—with the burden concentrated in Black, American Indian, Hispanic, and Asian/Pacific Islander youth. The TODAY study found that approximately half of participants failed metformin-based therapy within a few years, driven by beta-cell decline of roughly 20–35% per year; any microvascular complication reached a cumulative incidence of 80% by 15 years of disease duration. Obesity, family history, ethnicity, intrauterine exposure to maternal diabetes, and markers of insulin resistance are principal risk factors. Conclusion. Early-onset T2DM is a rising global problem with a distinctly aggressive phenotype and an early, heavy complication burden. Earlier and more intensive intervention, targeted screening of high-risk youth, and attention to the psychosocial and reproductive dimensions of care are urgently needed.
Epidemiological Profile of Tuberculosis Patients in Kazakhstan: A Synthesis of National Surveillance Data
Background. Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and disproportionately affect women across the life course. Rising antimicrobial resistance in key uropathogens—chiefly Escherichia coli—threatens the effectiveness of standard empirical therapy, making local and regional epidemiological data essential for rational management. Objective. To synthesise the epidemiological patterns of UTIs in women—burden, risk factors, causative organisms, and antimicrobial-resistance profiles—with particular attention to evidence from Kazakhstan and the surrounding region, set within the wider international literature. Methods. We conducted a structured synthesis of published evidence, prioritising large narrative reviews, multicentre surveillance studies (notably the DARMIS-2018 study spanning Russia, Belarus, and Kazakhstan), and regional cohort analyses, supplemented by international epidemiological data. Results. Approximately 40–60% of adult women experience at least one UTI in their lifetime, of whom 30–44% experience recurrence; annual incidence of physician-diagnosed UTI in women exceeds 10%, and prevalence in women over 65 is roughly double the overall female rate. E. coli predominates, causing around 75–90% of uncomplicated community-acquired UTIs. In the regional DARMIS-2018 surveillance, Enterobacterales comprised about 89% of isolates and E. coli about 69% among adults, with fosfomycin and nitrofurantoin retaining the highest activity. Resistance to older first-line agents (ampicillin, co-trimoxazole, fluoroquinolones) is high and rising. Conclusion. UTIs impose a large, gendered burden on women, compounded by escalating antimicrobial resistance. Regional surveillance from Kazakhstan and neighbouring countries supports nitrofurantoin and fosfomycin as preferred empirical agents for uncomplicated infection and underscores the need for continued local resistance monitoring and antimicrobial stewardship.
Lifestyle, Hygiene, and Behavioural Risk Factors for Urinary Tract Infections and HIV Among Women in Central Asia
Background. Women in Central Asia bear a substantial burden of two distinct infectious conditions: urinary tract infections (UTIs), the most common bacterial infection in women, and HIV, in a region where the epidemic continues to grow. The two have fundamentally different transmission routes and risk factors, yet both are shaped by gendered social and structural determinants. Objective. To synthesise the lifestyle, hygiene, behavioural, and structural risk factors for UTIs and for HIV among women in Central Asia, treating each condition according to its own biology while examining the shared determinants and the implications for prevention. Methods. We conducted a structured synthesis of published evidence, prioritising regional surveillance and cohort studies—including the DARMIS-2018 uropathogen study and Central Asian HIV cohorts—alongside UNAIDS regional estimates and the international literature. Results. For UTIs, lifetime risk in adult women is approximately 40–60%, with hygiene- and lifestyle-related factors (sexual activity, voiding behaviour, contraceptive method, post-menopausal changes) and Escherichia coli predominance (around 75–90% of uncomplicated cases). For HIV, the Eastern Europe and Central Asia region recorded an estimated 140,000 new infections in 2023—a 20% rise since 2010—driven historically by injection drug use and increasingly by sexual transmission; women are most often infected through their own injecting or that of male partners, with HIV prevalence reported as high as 30% among female partners who inject drugs in one Almaty study. The risk factors for the two conditions are largely non-overlapping. Conclusion. UTIs and HIV in Central Asian women require distinct, biologically appropriate prevention strategies—hygiene, behavioural, and stewardship measures for UTI; harm reduction, condom access, testing, and treatment for HIV—linked by attention to the shared social determinants of women’s vulnerability. Conflating the two, or attributing HIV to hygiene, is both scientifically incorrect and stigmatising.
Trauma-Related Mental Health Disorders: Diagnosis, Treatment, and Rehabilitation
Background. Exposure to potentially traumatic events is a near-universal human experience, yet only a minority of those exposed develop a clinically significant disorder. Trauma-related mental health disorders—principally post-traumatic stress disorder (PTSD), acute stress disorder, complex PTSD, and adjustment disorders—carry substantial individual and societal burden and are frequently under-recognised in routine clinical care. Objective. This narrative review synthesises current epidemiological, diagnostic, therapeutic, and rehabilitative evidence on trauma-related mental health disorders, with emphasis on translating evidence into practical clinical pathways. Methods. We conducted a structured narrative review of peer-reviewed literature, international epidemiological surveys, and contemporary clinical practice guidelines, prioritising large multinational datasets and guideline-level evidence. Results. Across the WHO World Mental Health Surveys, approximately 70% of respondents reported lifetime trauma exposure, while the cross-national lifetime prevalence of PTSD was 3.9% overall and 5.6% among trauma-exposed individuals. Trauma-focused psychotherapies—including trauma-focused cognitive behavioural therapy, cognitive processing therapy, prolonged exposure, and eye movement desensitisation and reprocessing—are consistently recommended as first-line treatment, with selective serotonin reuptake inhibitors and venlafaxine as principal pharmacological options. Rehabilitation increasingly emphasises functional recovery, social reintegration, and management of frequent comorbidity. Conclusion. Trauma-related disorders are common, disabling, and treatable. Early identification, evidence-based trauma-focused intervention, and a recovery-oriented rehabilitative framework are central to improving outcomes. Persistent gaps in access, particularly in low- and middle-income settings, remain a global priority.