Introduction. Urolithiasis may be complicated by infected obstruction requiring timely treatment. Factors associated with this complication and prolonged hospitalization remain insufficiently studied. Aim. To identify clinical, laboratory, and radiological factors associated with infected upper urinary tract obstruction and prolonged hospitalization in patients with urolithiasis. Materials and methods. A single-center retrospective observational study was conducted among patients with urolithiasis admitted to the Department of Urology of the Central City Clinical Hospital in Almaty in 2025. The analysis was based on data obtained from medical records and the hospital medical information system. A total of 471 hospital admissions were included. The primary outcomes were infected obstruction and prolonged hospitalization, defined as a hospital stay exceeding 4 bed-days. Binary logistic regression was used to assess the associations. Results. The median age of the patients was 46 years (36-61), and men accounted for 57.7% of the study population. The most common diagnosis was a ureteral stone, accounting for 66.9% of cases. Infected obstruction was identified in 40 patients (8.5%), while prolonged hospitalization was recorded in 225 patients (47.8%). Patients with infected obstruction had larger stones, a higher frequency of body temperature ≥38 °C and pyuria, and higher blood leukocyte counts. In the multivariable model, the independent factors associated with infected obstruction were body temperature ≥38 °C (OR 16.26; 95% CI 7.35-35.98; p<0.001), blood leukocyte count (OR 1.15 per 1×10⁹/L increase; 95% CI 1.07-1.24; p<0.001), and stone size (OR 1.09 per 1-mm increase; 95% CI 1.00-1.18; p=0.040). Male sex was the only statistically significant factor associated with prolonged hospitalization (OR 1.48; 95% CI 1.01-2.18; p=0.045). Conclusion. Among hospitalized patients with urolithiasis, infected obstruction has a distinct clinical and laboratory profile and is associated with fever, leukocytosis, and larger stone size. These indicators may be used for the early identification of patients at risk of a potentially complicated clinical course and for determining the need for timely urological assessment.

Introduction. Premium intraocular lenses (IOLs) enable presbyopia correction during cataract surgery. Multifocal IOLs create discrete foci, while extended depth of focus (EDOF) lenses provide a continuous range through aberration modification. Direct comparison is needed to guide clinical choices regarding effectiveness, safety, and visual phenomena (halos, glare). Aim. To systematically compare visual functions, quality of vision, and safety of multifocal versus EDOF IOLs in age-related cataract. Materials and Methods. A systematic search was conducted in PubMed/MEDLINE and Google Scholar (January 2020 – April 2025). Inclusion criteria: adults with age-related cataract undergoing bilateral phacoemulsification with implantation of a premium IOL (multifocal, trifocal, EDOF, or hybrid), with direct comparison against another premium or monofocal IOL type and reporting quantitative postoperative visual outcomes. Studies without direct comparative data or with unilateral implantation were excluded. Methodological quality was assessed using the Jadad scale (RCTs) and the Newcastle-Ottawa Scale (observational studies). Fourteen primary comparative studies met inclusion criteria. Pooled meta-analysis was applied to extractable comparable outcomes using a random-effects model; remaining outcomes were narratively synthesized. Results. EDOF and hybrid EDOF-multifocal IOLs showed advantages for intermediate visual acuity and broader functional range. Trifocal IOLs remained superior for near vision and spectacle independence. Distance vision was comparable across types. Photic phenomena frequency varied by design, but definitions were inconsistent. Conclusion. Each type of premium IOL possesses a unique efficacy profile. The choice between multifocal and EDOF lenses should be based on an individual analysis of the patient's visual needs: a priority for near vision favors trifocal IOLs, while an emphasis on intermediate vision and visual quality in mesopic conditions favors EDOF IOLs.

Introduction. Drug-coated balloons (DCB) deliver an antiproliferative agent to the vessel wall during a single balloon inflation without leaving a permanent implant. Real-world data from Kazakhstan and Central Asia remain limited. Aim. To assess the procedural safety and mid-term clinical outcomes of DCB angioplasty in a consecutive real-world cohort with de novo coronary lesions and in-stent restenosis treated at a single interventional cardiology centre in Kazakhstan. Materials and Methods. This retrospective, single-centre observational study included 102 consecutive patients treated with the MagicTouch™ sirolimus-coated balloon (Concept Medical) between August 2024 and May 2025 (data cut-off 31 May 2026). The cohort comprised de novo lesions, in-stent restenosis, small-vessel disease (<2.5 mm), distal and bifurcation lesions, and hybrid procedures. Clinical outcomes were assessed at 3, 6 and 12 months. The primary endpoint was major adverse cardiovascular events (MACE): cardiac death, non-fatal myocardial infarction and clinically driven target lesion revascularization. Results. Mean age was 63.2 ± 9.4 years; 66.7% were male; 37.3% had diabetes and 21.6% chronic kidney disease. A bail-out stent was required in 17.6%. Procedural success was achieved in 97.1%. At 12 months, MACE occurred in 5 of the 92 patients with complete follow- up (5.4%); all events were clinically driven target lesion revascularization (5/92; 5.4%), with no non-fatal myocardial infarction (0/92) and no cardiac death (0/92). Freedom from angina (CCS class 0) was documented in 66/92 (71.7%) and CCS class 0–II in 85/92 (92.4%). No vessel thrombosis was recorded. Conclusion. In this observational cohort, DCB angioplasty was associated with high procedural success, progressive symptomatic improvement and no observed vessel thrombosis across small-vessel disease, in-stent restenosis, and distal and bifurcation lesions. As a single- arm study, it cannot establish comparative safety or efficacy versus drug-eluting stents; prospective multicentre studies with angiographic endpoints are warranted.

Introduction. AI-enabled nutrition includes predictive dietary personalisation, digital lifestyle programmes and generated dietary advice. Aim. To assess clinical outcomes of AI-enabled personalised nutrition in adults with cardiometabolic risk and the accuracy and safety of generated dietary advice. Materials and Methods. Five bibliographic databases and two trial registries were searched from inception to August 2026, with supplementary searches in Semantic Scholar, medRxiv and selected web sources. Eligible interventions were digital tools in which artificial intelligence, machine learning, a large language model or a conversational agent generated individualised dietary, menu or meal recommendations. Clinical outcomes and generated- advice accuracy were synthesised separately. Risk of bias was assessed using RoB 2, ROBINS- I and an adapted QUADAS-2 instrument; certainty was evaluated with GRADE. Results. The final working evidence inventory comprised 62 studies (64 reports): 26 in the clinical domain and 36 in the accuracy domain. A machine-learning-guided diet reduced HbA1c by 0.08 percentage points more than a Mediterranean diet at six months (95% CI, −0.14 to −0.02), whereas a separate personalised-diet trial did not improve six-month weight loss over a low-fat diet (difference +1.05 percentage points of baseline weight; 95% CI, −0.40 to 2.50). Personalised LLM prompting improved weight loss compared with manual ChatGPT prompting, while an AI-based sodium programme did not improve salt intake or blood pressure. A 368-participant trial met its prespecified noninferiority criterion for referral to an AI-led rather than human-coached diabetes-prevention programme. Generated-advice studies reported favourable expert ratings alongside nutrient and guideline discrepancies; complex profiles were more challenging in an exploratory chatbot comparison. Conclusion. Selected interventions improved specific outcomes, but a class-wide benefit remains unestablished. Programme effects do not isolate the AI component, and favourable content ratings do not establish nutritional adequacy or patient safety.

Introduction. Ischemic heart disease (IHD) remains a leading cause of mortality and disability among the elderly. Beyond clinical characteristics, self-reported healthcare system factors may be associated with quality of life, but Kazakhstan evidence is limited. Aim. To assess the relationship of self-reported healthcare system factors and quality of life in elderly patients with IHD in Almaty and Almaty Region. Materials and Methods. The cross-sectional pilot study included 75 elderly patients with a verified IHD from four facilities. Data were collected via questionnaires and medical records. Healthcare system factors and quality of life were self-assessed using a 5-point Likert scale, angina functional class by CCS (Canadian Cardiovascular Society). Spearman's correlation, multiple linear regression (unadjusted/adjusted for sex, age, CCS class) were used; significance – p < 0.05 (SPSS 26.0). Results. Mean age was 66.6 years, 53.3% were female, and 54.7% had CCS class III. Mean body mass index – 30.1 ± 5.4 kg/m², total cholesterol – 5.86 ± 1.48 mmol/L. Among self- reported healthcare system factors, screening participation (64.0%) and healthcare accessibility (61.3%) were most often rated as High. Self-reported medication availability was more often rated "low" (40.0%). Quality of life correlated with several self-reported healthcare system factors, including screening participation (ρ=0.496; p < 0.001), cardiovascular risk-factor awareness (ρ=0.464; p < 0.001), treatment adherence (ρ=0.355; p = 0.002), and healthcare accessibility (ρ=0.338; p = 0.003). However, self-reported risk-factor awareness was the only independently associated factor (B = 1.655; p = 0.012), remaining significant after adjustment (B = 1.395; p = 0.035). Conclusion. In elderly IHD patients, quality of life was associated with self-reported healthcare system factors. Self-reported risk-factor awareness was the only independently associated factor, remaining significant after adjustment. Prospective studies exploring the implications of findings for patient education are warranted.

Introduction. Secondary prevention of coronary artery disease requires not only evidence-based pharmacological and non-pharmacological interventions but also effective organization of their delivery in routine clinical practice. Different healthcare systems use different models of care integrating patient follow-up, risk-factor management, medication management, rehabilitation, and coordination across levels of care. Aim. To systematically identify implemented models for organizing secondary prevention of coronary artery disease, characterize their key organizational components, and summarize their reported outcomes. Materials and methods. A systematic review of studies identified in PubMed, Scopus, and Web of Science was conducted. Studies involving patients with established coronary artery disease were included if they described an implemented secondary-prevention model incorporating structured follow-up and coordination of care. Results. 51 publications representing 42 unique models of care were included. 6 major types were identified: nurse-led or nurse-coordinated care (11; 26.2%), telehealth or hybrid care (11; 26.2%), shared cardiology-primary care (7; 16.7%), comprehensive cardiac rehabilitation (6; 14.3%), integrated or multidisciplinary care (4; 9.5%), and coordinated post-myocardial infarction pathways (3; 7.1%). Despite differences in organizational architecture, recurring components included care coordination, planned follow-up, medication management, risk- factor monitoring, lifestyle support, and mechanisms for referral or escalation to specialist care. Improvements were most consistently reported for cardiovascular risk-factor control, treatment adherence, and lifestyle-related outcomes. Findings for mortality, cardiovascular events, and hospitalizations were less consistent. Conclusion. No single organizational model of secondary prevention for coronary artery disease was identified as predominant across different healthcare systems. Despite differences in care structure and delivery, the models shared similar organizational components, including coordination and continuity of follow-up, risk-factor management, medication management, and support for lifestyle modification. These components may inform the development of secondary prevention models adapted to the specific characteristics of individual healthcare systems.

Introduction. Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disease of the central nervous system characterized by demyelination and neuroinflammation. Aim. This study investigates the prevalence and demographics of MS in the northern regions of Azerbaijan, providing insights for targeted healthcare strategies. Materials and Methods. This was a prospective, single-center, registry-based observational study involving patients referred from regional clinics or those presenting directly. The study was conducted at the Neurology Center of the Ministry of Health of Azerbaijan, from 01.01.2013, to 31.12.2022. Newly diagnosed or follow-up MS cases were included, with referrals from neurologists across the republic or self-referral to the center. Diagnostic protocols followed the Ministry of Health's "Clinical Protocol for the Diagnosis and Treatment of MS". Prevalence rates per 100,000 population were calculated and standardized using international and local demographic benchmarks. Statistical analysis included Pearson’s chi-square, Student’s t-tests, and Mann-Whitney U-tests, with significance set at p<0.05. Results. In 2022, MS prevalence in the northern region of Azerbaijan was 18.25±1.25/100,000 (95% CI: 15.80–20.70), higher in urban (28.27±2.80/100,000, 95% CI: 22.78–33.75) than in rural areas (13.76±1.31/100,000, 95% CI: 11.20–16.32) (p<0.0001). The mean diagnosis age was 35.39±8.65 years (95% CI: 34.23–36.54), disease onset at 29.89±8.57 years (95% CI: 28.74–31.03), and the diagnostic delay was 5.50±4.24 years (95% CI: 4.93– 6.07). Among living registered patients included in the point–prevalence analysis, women accounted for 63.4% of cases (135/213). The prevalence was significantly higher among women than men (23.10±1.99 vs. 13.38±1.51 per 100,000; p<0.001). Conclusion. MS prevalence in northern region Azerbaijan is lower than in most European regions but comparable to neighboring countries. Findings highlight the need for better diagnostics in rural areas and establish a baseline for studying environmental and other risk factors.

Introduction.The quality of an autologous bone marrow-derived cellular product in chronic disease depends on culture conditions, phenotypic composition and morphological maturation, not only on the cellular source. Aim. To evaluate the generation and laboratory characterization of an autologous composite bone marrow-derived cellular product obtained from patients with chronic diseases. Materials and methods. A laboratory-based translational study was conducted at the National Scientific Medical Center. The manufacturing cohort included 132 patients with cardiovascular, autoimmune, metabolic and hepatobiliary diseases. Bone marrow aspirates were processed to obtain a composite cellular fraction. Culture conditions with and without L- glutamine, automated cell counting, flow cytometry, light microscopy and electron microscopy were assessed. Results. Final post-culture cell concentration was higher in L-glutamine-supplemented cultures: median 4.01×106 cells/ml versus 2.30×106 cells/ml without L-glutamine (p=0.036). Median fold expansion was 37.9 and 10.8, respectively (p=0.095). Flow cytometry demonstrated a heterogeneous product containing MSC-associated, hematopoietic/progenitor and immunoregulatory populations. The most favorable morphological features were observed on culture days 21-23. Conclusion. The optimized culture protocol increased cell yield and supported morphological maturation of the composite bone marrow-derived product. Further standardization of release, safety and potency criteria is required before clinical translation.

Introduction. Stroke remains a leading cause of death and disability, with rising global burden. Transient ischemic attack (TIA) is often overlooked despite requiring urgent care. Evidence on stroke awareness, intended action, and access to acute care in Kazakhstan is limited. Aim. To assess public stroke awareness and its sociodemographic distribution, test whether knowledge predicts appropriate intended action, describe barriers in the acute stroke pathway, and identify targets for system improvement. Materials and Methods. Two independent cross-sectional online surveys (StrokeTimeBrain v1.4) were conducted in February–April 2026. Module A included community adults aged ≥18 years (n=383), and Module B included patients and caregivers with a suspected stroke/TIA care contact within the previous 24 months (n=397). Outcomes included a composite knowledge score (0–15), three symptom vignettes, and a four-item care-experience scale. Analyses used χ2 tests, nonparametric comparisons, and logistic/Poisson regression adjusted for age, sex, education, residence, and region. Results. Overall knowledge was modest (mean 6.5/15). Only 20.4% identified the ≤4.5- hour thrombolysis window, and reperfusion-treatment awareness was low, although 94.5% knew the emergency number. Knowledge increased with age, while the youngest respondents were least informed. Appropriate “call EMS” responses declined from 83.6% for slurred speech to 60.8% for transient/TIA symptoms (p<0.001). Correct intended action was associated mainly with urban residence (aOR 3.22), not with total knowledge score. Willingness to use telestroke was high (78.1%). Among care users, satisfaction was high (7.9/10), and imaging delay was the main bottleneck (42.1%). Conclusion. Stroke awareness in Kazakhstan was modest and unevenly distributed. Education should emphasize urgency and TIA, while system improvement should prioritize EMS, imaging, and telestroke capacity, especially in weaker regions.

Abstract Introduction. Psoriasis is a systemic immuno-inflammatory disease associated with metabolic syndrome (MS), abdominal obesity, insulin resistance, and atherogenic dyslipidemia. Current diagnostic criteria identify already established metabolic disorders, whereas early risk stratification in patients with psoriasis and excess weight remains a practical priority. Objective. To assess the informative value of clinical and laboratory parameters for stratifying obesity-associated metabolic risk in patients with psoriasis. Materials and Methods. A single-centre observational study included 150 adult patients with confirmed psoriasis and BMI > 28 kg/m² (Dermatology and Venereology Clinic, Almaty). Eleven parameters were assessed: sex, age, PASI, blood pressure, waist circumference, cholesterol, triglycerides, LDL-C, HDL-C, fasting glucose, and glycated hemoglobin (HbA1c). Obesity was defined as BMI ≥ 30 kg/m². Cut-off values were determined by ROC analysis using the Youden index. The Integral Screening Index (ISI) was calculated as the arithmetic mean of empirical obesity probabilities across seven selected parameters. Results. Seven parameters demonstrated statistically significant discriminatory ability: waist circumference area under curve (AUC) = 0.975; p < 0.001; cut-off 99 cm), HbA1c (AUC = 0.684; p < 0.001), triglycerides (AUC = 0.684; p < 0.001), fasting glucose (AUC = 0.650; p = 0.001), age (AUC = 0.643; p = 0.002), HDL-C (AUC = 0.628; p = 0.005), and LDL-C (AUC = 0.607; p = 0.021). PASI, blood pressure, cholesterol, and sex showed no significant association. A three-tier stratification was proposed: ISI < 0.4 – low risk; 0.4–0.6 – moderate risk; > 0.6 – high risk. Conclusion. Waist circumference was the strongest marker of obesity-associated metabolic risk in patients with psoriasis and BMI > 28 kg/m². The ISI may serve as a preliminary screening tool for selecting patients requiring in-depth endocrinological evaluation, but does not replace standard MS diagnostic criteria. Further validation is warranted.

Introduction. Acid-base balance disorders are critical conditions in intensive care units requiring rapid and accurate management. The study explores the potential of large language models to serve as accessible clinical decision support systems to reduce iatrogenic errors. Aim. To compare the accuracy of diagnosing acid-base balance disorders and the rationality of therapeutic recommendations proposed by artificial intelligence based on ChatGPT and by intensive care physicians. Materials and Methods. Study design: retrospective, single-center, comparative study. The analysis included 302 clinical and laboratory cases of patients treated in an intensive care unit between 2024 and 2025. Using prompt engineering techniques, an adapted ChatGPT model named “ReanimatorKZ” was developed. A comparative expert evaluation was conducted to assess the conclusions of ChatGPT and intensive care physicians regarding acid–base disorders. Statistical analysis was performed using StatTech v.4.12.7 and SPSS Statistics 27.0.1. Results. In the group of doctors, diagnostic accuracy was 71.2% correct, 24.8% partially correct, and 4.0% incorrect conclusions. The AI demonstrated a lower rate of completely incorrect diagnostic conclusions (2.0%), while completely correct diagnoses accounted for 64.9%. The physicians’ treatment strategies were completely correct in 60.9% of cases, whereas the AI’s recommendations were completely correct in 89.7% of cases, with no completely incorrect therapeutic recommendations classified for the AI. Statistically significant differences were confirmed using paired tests (p < 0.05). Conclusion. An adapted version of ChatGPT demonstrated a high level of diagnostic accuracy in identifying acid–base disorders, comparable to that of intensive care physicians, and superior accuracy in formulating therapeutic recommendations for these conditions. Our study supports the potential for developing effective and readily scalable clinical decision support systems based on widely available artificial intelligence models. However, additional prospective validation is required before such systems can be implemented in routine clinical practice.

Introduction. Induced pluripotent stem cells (iPSCs) hold promises for disease modelling and regenerative medicine, but reprogramming efficiency and safety depend on the method used to deliver Yamanaka factors (OCT4, SOX2, KLF4, c-MYC). Lentiviral vectors offer high efficiency yet risk insertional mutagenesis, while non-integrating Sendai virus systems provide transient transgene expression. Aim. This study aimed to compare these two commonly used delivery strategies by reprogramming primary human lung fibroblasts using both doxycycline-inducible lentiviral vectors and a non-integrating Sendai virus system. Materials and Methods. Primary human fetal lung fibroblasts (20–21 weeks of gestation) were isolated via explant culture and reprogrammed using either doxycycline- inducible lentiviral vectors encoding OKSM factors or a Sendai virus-based kit (CytoTune 2.0). Emerging iPSC colonies were expanded and characterized by immunofluorescence for pluripotency markers (SSEA4, OCT4, TRA-1-60) and alkaline phosphatase (ALP) activity. Results. Both methods generated iPSC colonies with typical morphology (compact structure, high nucleus-to-cytoplasm ratio). Colony emergence occurred on days 15-20 in both lentiviral and Sendai virus reprogramming systems. Immunofluorescence confirmed expression of SSEA4, OCT4, and TRA-1-60 in colonies from both approaches, and ALP staining was positive. Conclusion. Primary human fetal lung fibroblasts can be reprogrammed into iPSCs using both integrating lentiviral and non-integrating Sendai virus systems. Both methods yield stable iPSC lines with proper characteristics. The choice of method depends on the required balance between efficiency and genomic safety.

Introduction. Loss of professional working capacity (LPWC) reflects the severity of the consequences of diseases and injuries among workers. This issue is particularly relevant for Kazakhstan because of the important role of mining and processing industries, where workers may be exposed to harmful occupational factors. Aim. To analyze factors associated with the LPWC level among workers in Kazakhstan, including age, sex, cause of disability, disease class, and region of observation. Materials and Methods. The study included data on 476 registered LPWC cases for 2021–2024. The percentage of LPWC, age, sex, cause of disability, disease class, and region were analyzed. Descriptive statistics, contingency tables, Pearson’s chi-square test, Cramér’s V, the Kruskal-Wallis test, Dunn’s pairwise comparisons with Holm correction, and linear regression were used. Results. The highest number of cases was observed in the 50–59 age group, whereas the highest median LPWC level was found among workers under 40 years of age. Injuries predominated in the younger group, while pneumoconioses predominated in older age groups. The structure of disease classes differed statistically between age groups, with a moderate association. The cause of disability was associated with LPWC level: higher median values were observed for work-related injuries and general diseases compared with occupational diseases, although the effect was small. Regional differences persisted after adjustment for covariates. In the regression model, Pavlodar Region and Astana city were associated with higher expected LPWC values compared with the reference region. Conclusion. Interpretation of LPWC indicators requires consideration of the age, nosological, and regional structure of cases. More accurate risk assessment requires data on industry, work experience, working conditions, and the number of workers in risk groups.

Introduction. Heavy episodic drinking is a harmful pattern of alcohol use that may differ from the overall prevalence of alcohol consumption. In Kazakhstan, national survey data allow separate assessment of current alcohol use and riskier drinking patterns among those who drink. Aim. To examine heavy episodic drinking among current alcohol consumers in Kazakhstan, with emphasis on urban-rural differences and clustering of behavioural and metabolic risk indicators. Materials and Methods. This cross-sectional secondary analysis used data from a national World Health Organization STEPwise survey among adults aged 18–69 years. Of 6712 records available after verification, 1737 respondents reported alcohol use during the previous 30 days. The primary analytical sample included 1591 current drinkers with valid information on heavy episodic drinking. Heavy episodic drinking was defined as consumption of six or more standard drinks on at least one occasion during the previous 30 days. Associations were examined using chi-square tests and multivariable logistic regression. Results. Among current drinkers, 642 of 1591 participants reported heavy episodic drinking (40.4%). Urban adults were more likely than rural adults to report alcohol use during the previous 30 days (31.2% vs 17.1%; p<0.001). In contrast, heavy episodic drinking among current drinkers was more frequent in rural than urban areas (56.6% vs 35.1%; p<0.001). In the fully adjusted model, rural residence (adjusted odds ratio 2.42; 95% CI 1.88–3.11), male sex (1.58; 1.25–1.99), and current smoking (1.77; 1.41–2.22) were independently associated with heavy episodic drinking. A graded association was observed for risk-factor clustering, with adjusted odds ratio 2.93 (95% CI 1.94–4.43) among participants with three or more risk indicators compared with those with none. Conclusion. In Kazakhstan, urban adults reported alcohol use more often, but rural current drinkers had a substantially higher probability of heavy episodic drinking. These findings support the need to distinguish overall alcohol use from harmful drinking patterns in public health surveillance and prevention.

Introduction. Aminopropylimidazole derivatives, which potentially can have various pharmacological activities and have a wide range of applications in pharmacochemistry, were selected as the object of study. Aim. The study aimed to investigate some biological effects of new aminopropylimidazole derivatives. In this study, we investigated the acute toxicity and local anesthetic activity in an experiment on laboratory animals. Materials and Methods. The study of the acute toxicity of the compounds was conducted on healthy, sexually mature, non-linear mice. The study of local anesthetic activity during infiltration anaesthesia was carried out using the method of Bulbring and Wajda on male guinea pigs. The tail flick method was used for the experimental study of local anesthetic activity during conduction anaesthesia. Results. The compounds showed low toxicity, as well as a positive effect of varying degrees of expression during the study of local anesthetic activity in models of conduction and infiltration anaesthesia, exceeding the indicators of novocaine. Conclusion. The obtained results may become the basis for further in-depth study of these compounds within the framework of expanded preclinical trials, including the study of chronic toxicity and the determination of optimal therapeutic doses, with the aim of creating new local anesthetic agents.

Introduction. Ischemic cardiomyopathy with reduced left ventricular ejection fraction (LVEF) is associated with limited functional reserve despite guideline-directed medical therapy. Intracoronary autologous bone marrow-derived cell therapy is considered an adjunctive regenerative strategy in patients with ischemic myocardial injury and chronic heart failure. Aim. To evaluate technical feasibility, 6-month safety, and exploratory functional changes after intracoronary autologous bone marrow-derived cell therapy in patients with ischemic cardiomyopathy and LVEF ≤40%. Methods. This single-center pilot-controlled cohort study included 20 patients with ischemic cardiomyopathy and LVEF ≤40%. Ten received intracoronary autologous bone marrow-derived cell therapy plus medical therapy, and 10 received medical therapy alone. Results. Of 27 screened patients, 20 were included, 10 in each group. At 6 months, mean LVEF changed from 30.2 ± 7.6% to 40.4 ± 10.0% in the cell therapy cohort and from 32.2 ± 9.9% to 28.5 ± 6.7% in controls. NT-proBNP changed from 686.4 ± 358.6 to 381.7 ± 168.1 pg/ml and from 1134.2 ± 1939.5 to 1242.6 ± 1737.4 pg/ml, respectively. Six-minute walk distance increased by 96.7 m and 33.2 m, respectively. NYHA class decreased from 2.7 ± 0.5 to 1.8 ± 0.6 in the cell therapy cohort and remained unchanged in controls. No serious clinical events were reported. Conclusion. Intracoronary autologous bone marrow-derived cell therapy was feasible and was not associated with reported serious adverse events over 6 months. Favorable cardiac and functional changes were observed, but findings remain exploratory and do not support definitive efficacy claims. Further randomized studies with complete product characterization, patient-level data and rigorous safety assessment are required.

Introduction. A favorable professional environment is a key factor influencing advanced practice nurses’ (APNs) efficiency, motivation, and job satisfaction. Working conditions also affect their autonomy and willingness to report adverse events, which are essential for patient safety. Aim. To assess APNs’ attitudes toward their professional clinical environment and to examine the association between working conditions and their readiness to report adverse events. Materials and Methods. A descriptive cross–sectional study was conducted among 77 APNs working in municipal polyclinics in Almaty. Data were collected using the Revised Professional Practice Environment (RPPE) and Reporting of Clinical Adverse Events Scale (RoCAES). Statistical analysis was performed using SPSS 29.0 with Chi–square (χ²) and Fisher’s exact tests at a significance level of p < 0.05. Results. Overall, respondents evaluated their professional environment positively. The highest scores were observed for Leadership and Professional Autonomy in Clinical Practice (mean = 3.0) and Intrinsic Motivation (mean = 3.0). Lower scores were found for Teamwork (mean = 2.5) and Conflict Management (mean = 2.7), indicating challenges in interprofessional collaboration. Most nurses demonstrated a positive attitude toward adverse event reporting, particularly regarding procedural clarity and managerial support (mean = 2.9). A statistically significant association was identified between Clinical Communication with Patients and adverse event reporting (p = 0.046), with lower communication scores associated with more frequent reporting. Conclusion. A supportive professional environment is associated with higher levels of motivation, autonomy, and leadership among APNs. However, only limited associations were found between environmental factors and reporting behavior. Key challenges include weaknesses in teamwork, communication, and concerns about negative consequences of reporting. Strengthening interprofessional collaboration and non–punitive reporting culture may improve patient safety.

Introduction. Neovascular age–related macular degeneration, diabetic macular edema, and macular edema secondary to retinal vein occlusion are leading causes of persistent central vision loss. Faricimab is the first bispecific intravitreal agent targeting both VEGF–A and Ang– 2, potentially providing meaningful early anatomical and functional benefits in real–world practice. Aim. To assess the real–world effectiveness and safety of faricimab (6 mg/0.05 mL) in patients with neovascular age–related macular degeneration (nAMD), diabetic macular edema (DME), and macular edema secondary to central retinal vein occlusion (CRVO). Materials and Methods. Twelve treatment–naïve patients who had not previously received intravitreal therapy with vascular endothelial growth factor (VEGF) inhibitors were included: 4 patients in each cohort (nAMD, DME, and CRVO). All patients received four monthly intravitreal injections of faricimab (6 mg), with assessment of best–corrected visual acuity (BCVA) and central retinal thickness (CRT). Results. OCT demonstrated a reduction in the severity of macular edema in all patients across all cohorts after the loading phase. In the overall group, BCVA improved from 0.23 ± 0.22 to 0.56 ± 0.34 (p = 0.016). CRT decreased from 503 ± 129 μm to 328 ± 76 μm (p = 0.003). No serious injection–related complications were observed. Conclusion. After the loading phase, faricimab showed early signs of functional and anatomical improvement with a favorable safety profile.

Introduction. In cases of acute poisoning, effective emergency medical care requires accurate identification of the cause of intoxication. Within the framework of chemical and toxicological analysis, the identification of toxic substances in biological matrices such as blood plasma and urine are of key importance. One of the most critical stages of the analysis is their isolation from the studied matrices. Aim. To develop a method for the extraction of pregabalin from biological fluids (blood plasma and urine). Materials and Methods. The extraction of pregabalin from aqueous solutions was studied using the liquid–liquid extraction method with standard pregabalin solutions at a concentration of 100 µg/mL. To develop an optimal method for isolating pregabalin from biological fluids, a series of extraction experiments from an aqueous medium under various conditions was conducted. The effect of organic solvent properties on extraction efficiency was evaluated using solvents of different polarities, as well as the influence of pH on pregabalin recovery. Experiments aimed at developing a method for isolating pregabalin from blood plasma and urine were carried out using model mixtures with pregabalin concentrations of 1, 10, and 100 µg/mL. A butanol–ethyl acetate mixture (1:1) was tested as the extraction solvent. Results. The results showed that the highest extraction efficiency of pregabalin was achieved by triple extraction from the aqueous medium using a butanol–ethyl acetate mixture (1:1) at pH 5.5. These conditions were considered optimal and were applied for the isolation of pregabalin from blood plasma and urine samples. Conclusion. An optimal method for the liquid–liquid extraction of pregabalin from blood plasma and urine was developed for its quantitative determination by high–performance liquid chromatography with ultraviolet detection. The method was validated in terms of recovery from urine 63.15%, from blood plasma – 53.40%, linearity (1–100 µg/mL), relative standard deviation (2.98% for blood plasma and 2.06% for urine), limit of detection (LOD: 0.3 µg/mL for both matrices), and lower limit of quantification (LLOQ: 1 µg/mL). It was established that the optimal conditions for isolating pregabalin from biological fluids involve triple extraction with a butanol – ethyl acetate mixture (1:1) at pH 5.5.

Introduction. According to the classification of the World Health Organization, the Crimean–Congo hemorrhagic fever (CCHF) virus is classified as a high–priority pathogen due to its high mortality rate, the absence of licensed vaccines, and the lack of specific antiviral therapy. In the Republic of Kazakhstan, natural foci of CCHF are located in the Kyzylorda, Zhambyl, and Turkestan regions, where cases are reported annually. Aim. To conduct a genetic characterization of CCHF virus RNA isolates detected in Hyalomma asiaticum ticks in the Turkestan region in 2025 and to determine their phylogenetic position. Materials and Methods. Sequencing of four CCHF virus RNA samples was performed, followed by nucleotide sequence analysis using the GenBank (NCBI) database and phylogenetic analysis methods. Results. Of the four samples studied, amplification was observed in three. Phylogenetic analysis of the S and L genome segments of the CCHF virus showed that all isolates identified in the Turkestan region belong to the Asia 2 genotype. Analysis of the S segment revealed a high degree of nucleotide homology (up to 97.9%) with strains circulating in Kazakhstan and Tajikistan. The phylogenetic tree of the L segment demonstrated clustering of one isolate with Kazakh strains, with the highest identity (up to 98.2%) observed with a strain from Tajikistan. Pairwise comparative analysis showed 100% identity between isolates No. 20 and No. 21, whereas isolate No. 22 was characterized by greater divergence (up to 2.6%) and relative genetic distance from the other samples. The cluster of the studied isolates had high statistical support (95–98%). Conclusion. The obtained results confirm that the studied isolates belong to the Central Asian lineage Asia 2 of the CCHF virus and indicate the circulation of this genotype in the natural focus of the Turkestan region. No evidence of the presence of other viral genotypes was detected among the studied samples. The findings are consistent with previously published data on the predominance of the Asia 2 genotype in the Central Asian region. The study highlights the importance of molecular genetic methods and sequencing for clarifying the phylogenetic affiliation of the virus and monitoring its genetic diversity in natural foci.

Introduction. In pharmaceutical science, medicinal plants are prioritized as valuable sources of biologically active substances. According to the DataHorizon Research forecast, the global phytopreparations market will grow from 192,6 billion in 2022 to 357,1 billion dollars by 2032 (representing an annual growth rate of 6,5%). This study investigated the pharmaceutical–technological and quantitative parameters of three Polygonum (P. acerosum, P. argyrocoleon, P. aviculare) and two Achillea (A. salicifolia, A. setacea). Aim. The aim is to determine the pharmaceutical–technological parameters of Polygonum and Achillea raw materials by evaluating their physicochemical properties, which are necessary for the efficient extraction of active substances and phytopreparation development. Materials and methods. A comparative study was conducted using plant material collected in East Kazakhstan (June–August 2024). We determined density, porosity, free layer volume, absorption coefficient (water, 30–90% ethanol), moisture content, ash content, and extractive substance yield. All measurements were performed in three independent series (n=3), with results presented as X\pm SD. Results. Among Polygonum, P. aviculare exhibited the highest porosity (0,890±06001) and free layer volume (0,910±0,001), while the minimum extractant absorption coefficient was noted in P. acerosum (1,00±0,01 ml/g for water). A. setacea demonstrated a maximum Kn with 70% ethanol (7,54±0,01 ml/g). The maximum extractive yield for P. aviculare was 25,3% (30% ethanol), and for A. salicifolia it was 27,2% (aqueous extraction). Mass loss on drying was 6,01–6.73%, and hydrochloric acid ash was 4,72–8,51%. Conclusion. Interspecific differences directly impacted the sorption properties and extraction efficiency of the samples. High porosity and pronounced sorption were recorded in specific Polygonum and Achillea representatives. For most species, aqueous and 30–50% ethanol solutions provided the maximum yield of extractive substances. These data serve as a foundation for scaling up extraction processes and further phytochemical studies.

Introduction. Patient Support and Internal Expertise Services play a central role in translating patient complaints into managerial decisions. In practice, day–to–day work may be constrained by high workloads, multiple intake channels, and fragmented information systems. Aim. To assess organizational and digital barriers perceived by Patient Support and Internal Expertise Services specialists, and to evaluate the association between root–cause recording and accounting for repeated complaints. Materials and Methods. A cross–sectional empirical observational descriptive– analytical study was conducted using an online questionnaire (Google Forms). Data were collected between November 26, 2025, and January 21, 2026. A 16–item questionnaire was used. The sample comprised 35 employees of medical organizations performing Patient Support and Internal Expertise functions. Descriptive statistics were calculated; associations were assessed using Fisher’s exact test (p<0.05). Results. The main complaint channels were telephone and walk–in complaints, each accounting for 37.1%. Working across multiple information systems was considered inconvenient by 97.1% of respondents. The most common difficulties were the lack of data export functions for reporting (42.9%) and overload due to task concentration on a single specialist (34.3%). Recording the root cause of a complaint in the system was noted in 97.1% of responses (predominantly in free–text form), while accounting for repeated complaints in reporting was noted in 65.7%. An association was identified between recording the root cause and accounting for repeated complaints (OR=6.67, p=0.038). Conclusion. Digital barriers, high workload, and limited standardization in complaint analytics were identified as key perceived constraints on the work of Patient Support and Internal Expertise Services specialists. A unified approach to recording root causes and monitoring recurrence together with improved data export and analytics functions may strengthen the operational capacity of these services, while training needs were also identified by respondents as an area requiring further attention.

Background. Occupational dust-related lung diseases are associated with reduced exercise tolerance, dyspnea, limitations in daily activities, and impaired quality of life. Evidence on the effectiveness of pulmonary and multicomponent rehabilitation in these patients remains limited and heterogeneous. Aim. To systematize the evidence on the effectiveness of pulmonary and multicomponent rehabilitation in adult patients with occupational dust-related lung diseases, with a focus on exercise tolerance, dyspnea, pulmonary function, quality of life, and occupational outcomes. Materials and methods. This systematic review was conducted in accordance with PRISMA 2020. The literature search was performed in PubMed/MEDLINE, Scopus, Web of Science Core Collection, and the Cochrane Library from inception to November 30, 2025, with additional manual searching. A total of 348 records were identified; after duplicate removal and study selection, 12 primary studies were included in the qualitative synthesis. Studies involving adult patients with pneumoconiosis, silicosis, occupational COPD, and other chronic occupational dust-related lung diseases were eligible if they evaluated a rehabilitation intervention and reported at least one relevant outcome. Results. The included studies generally indicate a beneficial effect of pulmonary and multicomponent rehabilitation on exercise tolerance and quality of life. Several studies also reported reductions in dyspnea and improvements in selected pulmonary function parameters, although these findings were less consistent. The most pronounced effects were observed in programs that included inspiratory muscle training. Occupational outcomes were rarely assessed in the available studies. Conclusions. Pulmonary and multicomponent rehabilitation in patients with occupational dust-related lung diseases is primarily associated with improved exercise capacity and quality of life. The main limitations of the current evidence base are clinical and methodological heterogeneity, the small number of studies, and the lack of data on long-term occupational prognosis.

Introduction. Crimean–Congo hemorrhagic fever (CCHF) remains a high-fatality tick- borne zoonosis with expanding endemicity in Kazakhstan, driven by climate-related shifts in Hyalomma tick distribution and animal movement; therefore, rapid laboratory confirmation is critical, and this study evaluates a newly developed real-time reverse transcription polymerase chain reaction (RT-PCR) primer–probe set for sensitive and specific detection of CCHF virus RNA in biological samples. Aim. To develop, optimize, and evaluate the diagnostic performance of a primer–probe system for the detection of CCHF virus RNA using real-time reverse transcription polymerase chain reaction (RT-PCR). Materials and Methods. Based on the nucleotide sequences of CCHF virus available in the GenBank database and using the Gen Runner software, primers and a probe were designed to flank a highly conserved 138 bp region within the 5′ untranslated region (UTR) of the viral S-segment. The limit of detection (LOD) was determined using tenfold serial dilutions of plasmid DNA containing the target fragment, ranging from 106 to 100 copies per reaction. The amplification efficiency was 98.6% (R2 = 0.998), and the coefficient of variation between replicates did not exceed 3.5%, indicating high reproducibility of the method. Specificity was assessed using RNA samples from non-target viruses (acute respiratory viral infections and tick-borne encephalitis virus) and field material (118 tick specimens and clinical samples from two patients). The results were compared with the commercial test kit “AmpliSens® CCHFV-FL”, demonstrating a κ = 1.0 level of agreement (complete concordance). Results. The developed system exhibited a high sensitivity, with a detection limit ranging from 100 pg to 10 fg, corresponding to 102–104 copies per reaction. No cross-reactivity with non- target viruses was observed. Field sample testing detected CCHFV RNA in two pools of Hyalomma scupense ticks from the Kyzylorda region and in two clinical samples from patients in the Zhambyl region. Conclusion. The proposed primer–probe system demonstrates high sensitivity, specificity, and reproducibility, confirming its potential use in the development of a domestic diagnostic test kit and for monitoring CCHF virus circulation in natural foci across Kazakhstan.

Introduction. Decarbonization is important for public health, because CO₂ emissions and air pollutants, including PM2.5, are associated with increased cardiovascular and respiratory morbidity and premature mortality. Aim. To compare the dynamics of CO2 emissions from the health-care system and Bitcoin mining in Kazakhstan and to assess trajectories through 2030 under different scenarios. Materials and methods. A retrospective ecological time-series analysis covered 2016–2022 and included deterministic scenarios through 2030. National fossil CO₂ and energy indicators were obtained from official statistics (Form 1-TEB). Health-care emissions were estimated top-down as 3.65% of national fossil CO₂, calibrated using the Kazakhstan Health Sector Emissions Fact Sheet. Mining emissions were calculated from annual electricity consumption and the power-system emission factors. Results. National fossil CO2 increased from 211.5 to 245.9 Mt. Health-care emissions rose from 7.71 to 8.96 Mt CO2e at a share of 3.64–3.65%. The trend was significant: β=+0.158 Mt/year, p=0.031, R2=0.64. Bitcoin-mining emissions increased from 0.82 to 7.50 Mt CO2e: β=+1.187 Mt/year, p<0.001, R2=0.96. Mining electricity consumption grew from 1,234 to 11,234 GWh, and its share in national electricity use increased from 1.66 to 10.13%. The mining/health ratio increased from 10.7 to 83.7%: β=+0.133/year, p<0.001, R2=0.97. In 2021, the health-care emissions structure comprised Scope 1 67% (5.76 Mt), Scope 2 5% (0.43 Mt), and Scope 3 28% (2.40 Mt). Heating and fuel combustion accounted for 57% of the total. The resulting structure indicates that the main mitigation potential in health care is related to building energy retrofits, a transition to clean heat, and improved efficiency of on-site equipment in care delivery settings. Through 2030 under BAU, health care reaches 9.5 Mt and mining 10.4 Mt. Under Health-only, health care decreases to 5.2 Mt, while mining remains 10.4 Mt. Under Joint action, 5.2 Mt for health care and 3.5 Mt for mining are achieved. Conclusion. Moderate growth in health-care emissions is accompanied by rapid growth in Bitcoin-mining emissions, which by 2022 nearly matched the sector’s carbon footprint. The maximum effect is achievable by reducing health-care emissions, primarily Scope 1, and by decarbonizing or restricting mining.

Introduction. Kazakhstan belongs to countries with a medium-high level of suicidal mortality, while data on presuicidal states and psychosocial determinants of suicidal behavior among young people are limited. Objective. To determine how social environment factors, traumatic events, and intrapersonal characteristics are associated with the risk of suicidal behavior among young people aged 18–40 years in the Republic of Kazakhstan. Materials and Methods. An applied comparative non-randomized study with data de- identification was conducted, including 100 participants aged 18–40 years who sought care at the Republican Scientific and Practical Center for Mental Health of the Ministry of Health of the Republic of Kazakhstan and the Almaty Mental Health Center (January–June 2025). The first group (n=30) comprised individuals with suicidal tendencies (suicidal thoughts and/or attempts), the second group (n=70) comprised individuals at risk (depression, anxiety, stress, substance abuse, personality disorders). The following tools were used: an author-designed sociological-clinical questionnaire, the DASS-21 scale, and the Paykel Suicidal Risk Questionnaire. Statistical analysis included Pearson’s χ² test, Fisher’s exact test, and Spearman’s rank correlation (α=0.05). Results. Participants with suicidal tendencies more often had a lower level of education and an unfavorable employment situation (p<0.05), maladaptation in the family sphere, lack of a sense of happiness and security in the parental family, a tense family atmosphere, and a deficit of trusting relationships (a number of associations p<0.05). In this group, computer addiction (36.6% versus 15.7%; p<0.05), severe bullying, violence and disruption of life plans, as well as pronounced mood swings and intrusive thoughts (p<0.01) were recorded significantly more often. The risk group was characterized by a higher prevalence of substance dependence (60% versus 16.7%; p<0.001). According to DASS-21, moderate and high levels of depression, anxiety, and stress were found in both groups; at the same time, in the first group, the mean DASS scores and Paykel questionnaire score (8.56 points) showed a strong positive correlation (Rs up to 1.0; p<0.05), while in the second group a moderate and high correlation was observed (Rs up to 0.61; p<0.05). Conclusion. The risk of suicidal behavior among young people is associated with a combination of unfavorable social determinants (low level of education, unemployment, family dysfunction, psychotraumatic life events) and intrapersonal factors (depression, anxiety, stress, mood swings, intrusive thoughts, addictive behavior). The obtained data confirm the feasibility of using DASS-21 and the Paykel questionnaire for early screening of suicidal risk and substantiate the need for a large-scale population study in key regions of Kazakhstan.

Abstract Introduction. Adolescence is characterized by a shift in circadian phase, an increase in academic workload, and chronic sleep deprivation, which may reduce cognitive efficiency, especially under conditions of early school start times. Aim. To assess the structure of chronotypes and sleep characteristics in adolescents aged 15–16 years and to analyze their association with memory, attention, and self-esteem indicators during morning testing under conditions of an early start to the school day. Materials and Methods. A cross-sectional observational study was conducted among 100 schoolchildren in grades 9–10 (15–16 years) from a general education school in the city of Atyrau. Participants were selected using simple random sampling. Sociodemographic characteristics, sleep–wake parameters, chronotype (adapted adolescent version of the Horne Östberg Morningness–Eveningness Questionnaire), cognitive functions and attention, and level of self-esteem were assessed. Examinations were conducted in person at school during the first half of the day (09:30–12:00). Results. Mean nocturnal sleep duration was 6.32 ± 1.14 h, with a mean bedtime of 23:47 and wake time of 06:55. Self-esteem was high in 59.6% of adolescents. Chronotype distribution was shifted toward non-morning types: morning type – 3.8%, intermediate – 69.8%, evening – 26.4%. Indicators of visual and digit memory, memory span, and integral indices of performance and accuracy of visuomotor reaction were statistically significantly below the “NS-Psychotest” normative values, whereas the number of errors significantly exceeded the recommended level (several indicators demonstrated large effect sizes). A later chronotype was associated with reduced visual (ρ = –0.41; p < 0.01) and digit memory (ρ = –0.38; p < 0.01) and an increased number of reaction errors (ρ = +0.44; p < 0.001). The association between chronotype and self-esteem was weak and not statistically significant (ρ = +0.12; p = 0.21). Conclusion. Under conditions of an early school start time, adolescents demonstrated a combination of shortened sleep duration and a predominance of intermediate and evening chronotypes, along with an objective decline in memory, attention, and visuomotor reaction accuracy in the morning hours. The evening chronotype is associated with a more pronounced reduction in cognitive efficiency while maintaining high self-esteem, which allows adolescents of the evening type to be considered a higher-risk group and supports the need for prevention of chronic sleep deprivation and revision of the school schedule.

Introduction. Palliative care quality is a critical determinant of end-of-life experience for both patients and their families. Family satisfaction reflects not only clinical outcomes but also communication, accessibility, and psychosocial support. Validated instruments, such as FAMCARE, allow standardized measurement across domains of care. Aim. The aim of the study was to evaluate family caregivers’ satisfaction with the quality of palliative care in a hospice setting using the validated RU/KZ version of the FAMCARE questionnaire, and to examine its association with health literacy and organizational factors. Materials and methods. A cross-sectional study was conducted among 100 family caregivers of hospice patients. The RU/KZ version of FAMCARE (20 items, 4 domains) was applied after forward–backward translation and expert panel adaptation. Additional items assessed health literacy (3 questions). Data analysis included descriptive statistics, Cronbach’s alpha, χ² tests, Mann–Whitney U test, and Spearman correlations. Results. Internal consistency of FAMCARE was high (α=0.86 RU, α=0.82 KZ). The overall mean satisfaction score was 3.28±0.77 for the Russian version and 3.34±0.72 for the Kazakh version (out of 5). Family members with low health literacy (56%) reported higher satisfaction compared to those with adequate literacy (3.45±0.6 vs. 2.95±0.6; p=0.004). The greatest differences were observed in the domains of information (3.4±0.8 vs. 2.9±0.7; p=0.018) and accessibility/coordination (3.5±0.7 vs. 3.0±0.7; p=0.015). Correlation analysis demonstrated significant associations: physician response time (ρ=–0.48; p=0.002), nurse response time (ρ=–0.41; p=0.006), and bed waiting time (ρ=–0.36; p=0.011). Conclusion. The RU/KZ FAMCARE demonstrated high reliability and feasibility for evaluating family satisfaction in hospice care. Family members with higher health literacy tended to assess care more critically, highlighting gaps in information and psychosocial support. Reducing response times and improving communication should be priorities for quality improvement in palliative services.

Introduction. Interest in non-pharmacological modalities for health promotion is growing globally. Shungite, a carbon-rich mineral, is increasingly used in complementary therapy settings (e.g., shungite rooms), yet empirical data regarding its immediate physiological and psychological effects remain scarce. Aim. To evaluate the immediate impact of a single session in a shungite room on self- reported quality of life and perceived stress levels in adults. Materials and Methods. This observational study included a final sample of 36 participants. The intervention consisted of a single 20 to 25-minute relaxation session in a specialized shungite room. Outcome measures included the EuroQol-5D (EQ-5D-3L) to assess health-related quality of life and the Perceived Stress Scale (PSS-10) to measure stress levels. Assessments were conducted immediately before and after the session. Statistical analysis utilized the Wilcoxon signed-rank test and Stuart-Maxwell test for paired data. Results. No statistically significant shifts were observed in the five categorical dimensions of the EQ-5D (Mobility, Self-Care, Usual Activities, Pain/Discomfort, Anxiety/Depression) (p > 0.05), with a high prevalence of "no problems" at baseline. However, the EQ-5D Visual Analog Scale (VAS) demonstrated a statistically significant improvement in self-rated health, with mean scores increasing from 70.77 ± 11.76 to 75.09 ± 11.63 (p = 0.002). Regarding the PSS-10, no significant changes were found in the total stress scores (16.16 ± 5.00 vs. 16.53 ± 5.02; p = 0.527) or individual item distributions following the intervention. Conclusion. A short-term stay in a shungite room significantly improves immediate subjective health perception, but does not acutely alter specific health dimensions or perceived stress levels. The findings suggest that while the intervention may enhance momentary well- being, it does not immediately impact the cognitive appraisal of stress. Further research with longitudinal designs is warranted.

Introduction. Type 1 and type 2 diabetes mellitus remain among the leading causes of morbidity and mortality, and a substantial proportion of patients do not achieve target HbA1c levels even with modern pharmacotherapy. Perinatal mesenchymal stromal cells (MSCs) and their cell- free derivatives have pronounced immunomodulatory and trophic effects and are considered a promising approach to modifying the course of diabetes. Aim. To systematize clinical data on the use of perinatal MSCs in T1DM and T2DM and to summarize preclinical results on perinatal cell-free MSC products (exosomes, small extracellular vesicles, secretome, conditioned medium) in diabetes and its complications. Materials and Methods. This systematic review was conducted in accordance with PRISMA 2020 recommendations. A search was performed in major international biomedical databases for the period from January 2000 to 3 October 2025 without language restrictions. We included clinical studies of T1DM/T2DM using perinatal MSCs or their cell-free derivatives with diabetes-oriented outcomes, as well as preclinical studies in diabetes models using perinatal exosomes, extracellular vesicles, secretome, or conditioned medium. Results. Fourteen studies (6 clinical, 8 preclinical) were included in the review. Meta- analyses of randomized trials showed that MSC therapy, including perinatal sources, reduces HbA1c by ~1 percentage point, decreases insulin dose, and increases C-peptide without increasing the incidence of serious adverse events. Clinical studies of perinatal MSCs in T2DM demonstrate a 1–3% reduction in HbA1c and a 30–50% decrease in insulin requirements, along with improvement in insulin resistance parameters. Preclinical studies have shown that perinatal exosomes, small extracellular vesicles, and secretome improve insulin resistance, protect β-cells, accelerate healing of diabetic wounds, and provide nephro- and retinoprotective effects. No clinical studies of perinatal cell-free products in diabetes were identified at the time of the search. Conclusion. Perinatal MSCs, primarily UC-MSCs, in clinical studies provide a moderate but clinically meaningful improvement in glycemic control in T1DM and T2DM with favorable short- term safety. Preclinical data on perinatal cell-free derivatives confirm the key role of paracrine mechanisms and the promise of standardized cell-free preparations, which requires confirmation in randomized clinical trials.

Introduction. Cell products are increasingly being introduced into clinical practice for the treatment of severe immune-inflammatory, vascular, neurological, and other diseases. Despite their significant therapeutic potential, biosafety issues related to cell therapy – especially at the early stages of clinical development – remain poorly understood and require comprehensive analysis. Aim. To systematically review data from early-phase (I–II) clinical trials assessing the biosafety of various cell products. Materials and Methods. The systematic review was conducted in accordance with the PRISMA 2020 guidelines. A literature search was performed in PubMed/MEDLINE, Web of Science Core Collection, Scopus, and Cochrane CENTRAL. The review included phase I–II clinical trials that evaluated the safety of cell products. Data were extracted on adverse and serious adverse events, infectious and thrombotic complications, mortality, and other potential risks. Results. The review included 18 publications, predominantly phase I clinical trials. The vast majority of safety data concerned mesenchymal stromal cells; information on other classes of cell products was limited. In most studies, the safety profile was characterized by a predominance of mild to moderate adverse effects. Serious adverse events were rare and were generally related to the severity of the underlying disease and the clinical condition. A key safety signal was a fatal opportunistic infection (Pneumocystis jirovecii pneumonia) in a patient with severe immunosuppression. Assessment of long-term risks, including tumor formation and genetic instability, was limited in many studies due to short follow-up periods. Conclusion. Available evidence from early-phase clinical trials – primarily involving mesenchymal stromal cells – suggests a favorable short-term safety profile for cell products. However, limitations in study design and follow-up duration do not allow definitive conclusions regarding long-term biosafety. The findings highlight the need for larger, methodologically rigorous studies and the implementation of long-term safety monitoring systems for cell therapy.

Introduction. Pharmacoresistant epilepsy and epileptic syndromes in children remain a pressing clinical problem. The ketogenic diet (KD), a high-fat and low-carbohydrate metabolic intervention, is considered an effective method to reduce seizure frequency and improve neurocognitive status. Aim. The aim of this study was to evaluate the efficacy and tolerability of KD in children with pharmacoresistant epilepsy in a rehabilitation setting. Materials and Methods. A prospective observational study was conducted at the National Center for Child Rehabilitation (Astana, Kazakhstan) from January 2022 to March 2025. The study included 30 patients aged 1 to18 years (median age – 8 years) with confirmed pharmacoresistant epilepsy or epileptic syndromes. KD was applied in the classic ratio of 2:1, 3:1, and 4:1 alongside antiepileptic therapy. Effectiveness was assessed by reduction in seizure frequency at 4, 6, 12, and 12–18 months of therapy. Additionally, EEG dynamics, cognitive status, and adverse effects were evaluated. Statistical analysis was performed in SPSS 25. Results. After 4 months of therapy, a clinically significant response (≥50% reduction in seizure frequency or remission) was observed in 22 patients (73.3%). At 6 months, positive dynamics persisted in 13 patients (56.5%), at 12 months – in 7 of 15 (46.7%), and at 12–18 months – in 7 of 17 (41.2%). The presence of pronounced cognitive impairment was associated with lower KD effectiveness (p=0.04). Completion of the full course of the diet was significantly more frequent among patients with a positive effect (p=0.006). Adverse effects were more common in the non-responder group (p=0.03); no severe complications were recorded. Conclusion. The ketogenic diet is an effective and safe method of treating pharmacoresistant epilepsy in children, including patients with severe neurodevelopmental disorders. High adherence and multidisciplinary support contribute to clinical improvement. Controlled studies with larger samples are needed to confirm long-term efficacy.

Introduction. Chronic non-communicable diseases (NCDs) remain the leading cause of morbidity and mortality worldwide. Family history is an independent risk factor reflecting both genetic and environmental influences. However, in preventive medicine it is often underestimated despite its simplicity and low cost as a risk assessment tool. Aim. To assess the prevalence of family history of selected NCDs and analyze its demographic determinants in a nationally representative sample of adults in Kazakhstan. Materials and Methods. A nationally representative cross-sectional study was conducted between April and July 2025. The sample included 6,720 adults aged 18–69 years, selected by multistage cluster sampling stratified by sex and age. Data were collected using the WHO STEPS methodology and included demographic characteristics, behavioral factors, and self-reported family history of NCDs. Statistical analysis was performed in SPSS, applying logistic regression models. Results. Family history was most common for cardiovascular diseases: hypertension (43.8%) and myocardial infarction (14.2%). For malignant and mental disorders, prevalence was lower but epidemiologically important: breast cancer in 8% of women, tuberculosis in 7.4% of respondents, and schizophrenia in 2.4%. Age was the main determinant, with higher prevalence of hypertension and infarction in older groups. Education and smoking showed weak associations, while sex and region were more significant. Tuberculosis was more frequent in southern regions, whereas cardiovascular diseases predominated in metropolitan areas and in the east. Conclusion. Family history of NCDs is widespread among adults in Kazakhstan and shows clear demographic variation. These findings emphasize the need to systematically include this factor in preventive and screening programs. Combining personal and family morbidity data in epidemiological studies can improve risk assessment, particularly for cardiovascular and metabolic diseases. Future studies should specify degrees of kinship and integrate family history with genetic and environmental markers to strengthen risk prediction.

Introduction. Mortality from emergencies remains a significant source of preventable losses with marked interregional variability. In large countries, such heterogeneity may result from both long-term trends and short-term shocks; however; in Kazakhstan, formal panel studies have rarely been conducted. Aim. To analyze the temporal dynamics of mortality from emergencies and individual risk across the administrative units of Kazakhstan during 2013–2023, quantify interregional inequality, and identify long-term trends and short-term fluctuations using fixed-effects panel regression. Materials and Methods. A retrospective ecological panel study was conducted, covering all regions of Kazakhstan, including the newly established Abai, Zhetysu, and Ulytau regions formed after the 2022 reform. Annual data on mortality from emergencies and population size were used to calculate risks (per 10,000 population). Inequality was assessed using variance, coefficient of variation, the share of the top three regions, and the Herfindahl–Hirschman, Gini, and Theil T indices. Dynamics were analyzed with region-level fixed-effects regressions. Results. Between 2013 and 2019, mortality and risk steadily declined (−6.3 cases and −0.07 risk units per year). In 2020, a sharp increase was recorded (+126 cases; +1.14 risk units), followed by partial reduction in 2021–2023; however, indicators did not return to the pre- pandemic level. Interregional inequality peaked in 2020 (Gini index=0.459; Theil T=0.356; HHI=0.112), reflecting systemic overload and spatial concentration of risk. By 2023, inequality decreased but remained above early-decade levels. Metropolitan areas experienced short-term peaks with rapid recovery, while several regions showed local extremes and slower decline. Conclusion. In Kazakhstan, 2013–2019 were marked by decreasing emergency mortality, followed by a surge in 2020 and incomplete recovery by 2023. This shock intensified interregional disparities, concentrating mortality in limited areas. Civil protection planning should integrate long-term prevention with local mechanisms for rapid response.

Introduction. Aging is characterized by cellular decline driven by hallmark processes such as loss of proteostasis and mitochondrial dysfunction. These impairments contribute to toxic protein accumulation, oxidative stress, and tissue degeneration. While transient expression of reprogramming factors (Oct4, Sox2, Klf4, and c-Myc; OSKM) has been proposed to reverse age-associated dysfunction, the precise temporal dynamics of rejuvenation remain unclear. Aim. The study aims to determine the temporal windows of proteostasis and mitochondrial function restoration in senescent human fibroblasts during partial OSKM reprogramming. Materials and Methods. Senescent human lung fibroblasts were engineered to express OSKM under doxycycline control. Restoration of proteostasis was assessed using the Proteasome-Glo™ Cell-Based assay to measure chymotrypsin-like, trypsin-like, and caspase- like proteasomal activities. Mitochondrial activity was evaluated through measurement of reactive oxygen species using MitoSOX Red dye and flow cytometry. Data were analyzed by comparing induced and senescent control cells, with statistical testing to establish significance. Results. OSKM induction led to a time-dependent restoration of proteostasis. By day 5, proteasomal activities were significantly elevated in OSKM-induced cells compared to senescent controls (chymotrypsin-like activity increased from 48,976 to 128,078 RLU; trypsin- like activity from 12,222 to 42,333 RLU; caspase-like activity from 32,614 to 126,628 RLU). Mitochondrial rejuvenation occurred later, with ROS levels significantly reduced by day 10, reaching values comparable to young fibroblasts (p < 0.001). These results highlight distinct temporal windows for the recovery of proteostasis and mitochondrial function. Conclusion. Partial reprogramming via transient OSKM expression can effectively reverse key hallmarks of aging in senescent fibroblasts. Proteostasis is restored within 5 days, followed by mitochondrial functional recovery at 10 days, suggesting a sequential rejuvenation process. These findings provide critical temporal insights for optimizing reprogramming-based interventions and support the development of clinically translatable rejuvenation strategies.

Introduction. Anemia comprises heterogeneous disorders that share reduced hemoglobin yet differ by etiology and morphology. Routine hematology analyzers generate rich, time- varying signals that remain underused for differential diagnosis. Aim. To formalize and test mathematical models and rule-based/algorithmic workflows that discriminate major anemia types using routinely available laboratory data, and to outline a tractable pathway for clinical implementation. Materials and Methods. We analyzed routine hemograms on Sysmex XE-2100 and KX- 21N with HGB, HCT, RBC, MCV, MCH, MCHC, RDW, PLT, WBC, and reticulocyte indices Ret%, Ret, IRF%, LFR%, MFR%, HFR%, RET-Y, Ret-He. We modeled treatment dynamics in iron-deficiency and vitamin B12–deficiency anemia using a generalized S-function. Fit metrics were not reported in the sources. Algorithmic differential diagnosis covered normocytic and other forms using WHO thresholds, ferritin, and vitamin B12. Results. In the microspherocytosis study 41 patients were examined, 17 men and 24 women, age 23 to 61 years. RDW was 13.6±0.5% in controls and 17.6±3.9% in the main group with p=0.0001. Thickness of microerythrocytes was 2.3±0.2 µm in controls and 2.9±0.2 µm in the main group with p=0.001. Mean erythrocyte thickness was 2.1±0.2 µm and 2.6±0.3 µm with p=0.005. Microcell sphericity index was 2.8±0.2 and 2.2±0.2 with p=0.003. Erythrocyte sphericity index was 3.7±0.3 and 2.3±0.1 with p=0.005. Mean erythrocyte diameter was 7.5±0.2 µm and 6.6±0.2 µm with p=0.005. The share of microcytes was 12.6±6.7% and 68.7±16.9% with p=0.005. Normocytes were 72.9±7.3% and 30.4±16.5% with p=0.005. Macrocytes were 14.5±11.8% and 1.9±1.2% with p=0.005. In the retrospective routine dataset 364 of 400 records were retained, which is 91%, with 11 hematological indicators. Conclusion. A combined modeling-plus-algorithmic framework built on routine laboratory data can structure differential diagnosis of anemia and prioritize confirmatory tests. The approach is implementable on existing analyzers and amenable to software deployment.

Background. Non-pharmacological sanatorium-climatic approaches (aquatic therapy, climate-/balneotherapy, speleo-/halotherapy) are considered as adjuncts to standard pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), but the evidence base remains fragmented. Aim. To evaluate the impact of sanatorium-climatic and related interventions on lung function, exercise tolerance, and quality of life in patients with stable COPD. Materials and Methods. Systematic review according to PRISMA 2020. Databases searched: PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library; no year restrictions; last search the year 2025. Included RCTs, controlled, and prospective pre-/post- studies in stable COPD; interventions: aquatic therapy/exercise in water, mountain climate therapy/sanatorium programs, speleo-/halotherapy; comparators: standard therapy/rehabilitation or none. Primary outcomes: FEV1, 6MWT/equivalents, SGRQ/CAT/SF- 36. Risk of bias: RoB-2/ROBINS-I. Results. A total of 316 records were identified; 9 studies included: 4 RCTs, 3 controlled (including semi-randomized/pilot), 2 quasi-experimental; locations: Slovakia (3), Brazil (2), Russia (2), Sweden (1), Iran (1). FEV1: improvement in 3 studies (one with effect size η2=0.218; one p<0.001); no effect in 1 RCT; in 2 studies FEV₁ was measured but results not reported. 6MWT/equivalents: improvement in 6 studies (one η2=0.771; several p≤0.05); in 2 studies data not presented. Quality of life: improvement in 7 studies (SGRQ/SF-36), neutral CAT result in 1 RCT. Achievement of MCID for SGRQ reported in 1 study: 81.1% (MCID 4) and 72.2% (MCID 7). Reporting of adverse events and exacerbations was absent or sporadic. Main sources of bias: small sample sizes, incomplete randomization/blinding, incomplete reporting of baseline and post-intervention values. Conclusions. Sanatorium-climatic and aquatic programs in stable COPD consistently improve exercise tolerance and quality of life; effects on FEV₁ are less stable and may require longer intervention protocols. Key gaps include outcome standardization, effect sizes/MCID, and safety (adverse events, exacerbations). Large, well-designed RCTs with ≥6–12 months follow-up and standardized endpoints are needed.

Introduction. Endovascular stenting for atherosclerotic stenosis in the intra- and extracranial arteries is a minimally invasive procedure, but comprehensive studies on long-term complications following COVID-19 infection are lacking. Given the potential for increased rates of stent thrombosis, stroke, myocardial infarction, and mortality among COVID-19 patients, understanding the long-term outcomes of stenting for extra- and intracranial atherosclerotic stenosis is crucial for public health. This study addresses the dearth of extensive research on the long-term adverse outcomes associated with endovascular stenting procedures in patients who have experienced atherosclerotic stenosis in intracranial and extracranial arteries following COVID-19 infection. Materials and methods. This retrospective study analyzed data from a tertiary hospital database, focusing on individuals who underwent extracranial or intracranial atherosclerotic stenting procedures at the Central Clinical Hospital JSC, Department of Neurosurgery, between 2016 and 2017, before the COVID-19 pandemic. The primary outcome measures evaluated were the incidence of stent thrombosis, ischemic stroke, myocardial infarction, and all-cause mortality. Results. This study consisted of 81 participants, of whom 32 had a prior COVID-19 infection confirmed by PCR, antigen, and antibody testing, forming the COVID-19 group, while the remaining 49 comprised the control group. The analysis revealed no statistically significant differences in mortality, stroke, and myocardial infarction rates between the COVID-19 and control groups. However, high blood pressure was found to be a significant predictor of mortality and stroke. The binary logistic regression analysis indicated a trend toward increased cardiovascular risk with smoking, but the association did not reach statistical significance. While smoking remains a major modifiable risk factor for vascular disease, further studies with larger sample sizes are needed to confirm its specific impact in post-stenting patients. Conclusion. While COVID-19 infection did not significantly influence long-term mortality, stroke, or myocardial infarction rates, elevated blood pressure, smoking, and high stress levels were associated with worse outcomes. These findings highlight the importance of managing cardiovascular risk factors in patients undergoing endovascular stenting

Introduction. Mentha asiatica Boriss. is a member of the mint genus (Mentha L.) known for its antiseptic, anti-inflammatory and antispasmodic properties. The pharmacological activity of this plant is associated with a high content of biologically active compounds, including monoterpenes (menthol, menthone, pulegone), sesquiterpenes (β-caryophyllene) and flavonoids, which have a complex effect on physiological processes in the body. Despite the positive effects of pharmacological properties, some studies show that phenolic compounds and terpenoids can cause nephro- and hepatotoxicity with prolonged use or high doses. Animal experiments have shown that extracts Mentha asiatica Boriss. in high concentrations can lead to dystrophic changes and necrosis of liver, kidney and stomach tissues. At long-term use in high doses, changes in mitochondrial activity of liver cells are observed, which may indicate mechanisms of damage to this organ. Objective. To evaluate the safety, acute and chronic toxicity of peppermint extract Mentha asiatica Boriss. Materials and methods. The study was conducted on white albino male mice (♂) weighing 20-30 g and aged 8-10 weeks. The animals were kept in standard vivarium conditions and were quarantined for 10 days before the experiment. The extract was administered orally via a probe for 14 days. At the end of the experiment, the animals were killed by decapitation, after which morphological and histological studies of liver, kidney and stomach tissues were performed, with hematoxylin-eosin staining according to generally accepted methods. Results. No significant changes in the structure of organs of the control group were observed. In the group that received a dose of 500 mg/kg, edema of the renal stroma and parenchymatous dystrophy of the epithelium of the glands of the stomach were detected. At a dose of 2000 mg/kg, foci of necrosis, flattening of renal tubule epithelium, and oedema of gastric tissue were observed in the liver. At a dose of 5000 mg/kg, extensive necrosis in the liver, abnormalities of the gastric mucosa and pronounced dystrophic changes in the kidneys were detected. Conclusion. The data obtained confirm the dose-dependent nature of toxicity of the extract of Mentha asiatica Boriss. Morphological changes in organs as the dose increases indicate a progressive nature of the lesion, which means the potential hepatotoxicity and nephrotoxicity of the plant at high doses.

Introduction. In recent years, various methods for labor preparation have been used in obstetrics and gynecology. Each method has its own advantages and disadvantages. Comparing these methods is very important since the planned mode of delivery directly affects the woman’s health, the condition of the newborn, and the overall birth outcomes. Objective. To compare and evaluate the effectiveness of preinduction methods used for cervical ripening at 37–41 weeks of pregnancy, including mechanical (Foley catheter) and pharmacological (prostaglandins E1 and E2) methods. Materials and Methods. The study included 107 pregnant women who underwent preinduction and induction of labor in accordance with the clinical protocol of the Ministry of Health of the Republic of Kazakhstan (2023), between October 2024 and February 2025, at the clinical base of the department – Maternity Hospital No. 5, Almaty. The study was conducted as a prospective cohort study. The time interval was measured from the beginning of labor preparation to the moment of delivery (in days and hours). Some indicators were recorded in weeks of gestation. No difficulties or limitations arose during the study. The women were divided into three groups: Group I – prostaglandin E1 (misoprostol) orally (n=44); Group II – prostaglandin E2 (dinoprostone gel) applied to the posterior vaginal fornix (n=33); Group III – Foley catheter inserted into the cervical canal (n=30) (These three methods are applied in the maternity hospital in accordance with the clinical protocol.) Results. Key indicators of labor preparation were as follows: tendency for post-term pregnancy (41 weeks ± days): Group I – 57%, Group II – 76%, Group III – 66.6% (*p<0.05); hypertensive conditions during pregnancy: Group I – 32%, Group II – 15%, Group III – 23.3% (*p<0.05); intrauterine growth restriction: Group I – 7%, Group II – 6%, Group III – 6.67% (*p<0.05); oligohydramnios: Group I – 4%, Group II – 3%, Group III – 3.4% (*p<0.05). (*Note: *p<0.05 was considered statistically significant). Effectiveness rates were: misoprostol – 86.4%, dinoprostone – 88%, Foley catheter – 90%, and the combination of Foley catheter + misoprostol showed 100% effectiveness. The highest rate of complications was observed in the misoprostol group: fetal distress (6.8%), postpartum hemorrhage (9%), and weak labor activity (6.8%). Conclusion. This study demonstrated the safety and effect The study demonstrated the safety and effectiveness of prostaglandin E2 (dinoprostone) and Foley catheter methods for cervical ripening. These methods positively contribute to increasing the rate of vaginal deliveries and are considered effective approaches to reducing the frequency of cesarean sections.

Introduction. The morbidity of healthcare workers and associated days of temporary disability have a significant impact on workforce stability and the overall efficiency of the healthcare system. Objective. The aim of this study was to assess the influence of professional, socio- demographic, and behavioral factors on the frequency of temporary disability among healthcare workers. Methods. A cross-sectional study was conducted involving 1211 healthcare professionals. Gender, age, work experience, work schedule, unhealthy habits, and the number of disability days over the past year were assessed. Descriptive statistics, t-test, ANOVA, and multiple linear regression were applied. Results. The mean number of disability days was 3.51 per year (SD = 1.72). Comparative analysis revealed a statistically significant increase in disability days with longer work experience (p = 0.0027) and the presence of unhealthy habits (p < 0.0001). Gender and night shifts had no statistically significant effect. In the regression model, work experience (β = 0.14; p = 0.0001) and unhealthy habits (β = 0.19; p < 0.0001) maintained an independent association with the number of disability days. Conclusion. The results show that among the factors studied, work experience and unhealthy habits make the most significant contribution to the formation of temporary disability among healthcare workers. These findings may be considered in the development of preventive and organizational measures for occupational health among medical personnel.

Abstract Introduction. Cognitive development in children and adolescents is increasingly recognized as sensitive to nutritional status, especially during critical periods of brain maturation. While numerous randomized controlled trials (RCTs) and cohort studies have examined the effect of micronutrients on cognitive performance, their findings remain inconsistent due to heterogeneity in populations, intervention types, baseline deficiencies, and assessment tools. Aim. This meta-analysis aims to synthesize current evidence on the cognitive impact of nutritional interventions in school-aged populations. Methods. A systematic search was conducted across PubMed, Cochrane Library, Embase, Scopus, and Google Scholar from 2007 to 2024, using PRISMA 2020 guidelines. Eligible studies included RCTs and prospective cohorts targeting children up to 18 years, evaluating the effects of dietary supplementation, fortified foods, or modified diets on validated cognitive outcomes. The Risk of Bias was assessed using the ROB-2 tool. Meta-analysis was performed using a random-effects model (DerSimonian–Laird) to calculate pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were conducted; publication bias was examined using funnel plots and Egger’s test. Results. Sixteen studies (13 RCTs, 3 cohort/combined designs) were included in the final analysis. Interventions ranged from single-nutrient supplementation (e.g., vitamin D, omega-3) to multi-micronutrient formulas. Cognitive outcomes included memory, executive function, attention, and processing speed. The pooled effect was statistically significant (SMD = 0.34; 95% CI: 0.18–0.50; p < 0.001), with moderate heterogeneity (I² = 52.7%). Subgroup analysis revealed stronger effects in children with ADHD/ASD (SMD = 0.48), in younger schoolchildren (SMD = 0.36), and in low-nutrition regions (SMD = 0.41). Most included studies (n = 10) showed low risk of bias; three had high risk due to unclear randomization or outcome assessment. Conclusion. Nutritional interventions show a modest but consistent benefit on cognitive functioning of children of preschool and school age, especially among vulnerable subgroups. Results highlight the relevance of targeted strategies and combined interventions (e.g., with behavioral therapy) to optimize cognitive outcomes. However, variability in study design and the limited duration of interventions indicate a need for long-term, context-sensitive research.

Introduction. Medical confidentiality is one of the key elements in protecting patients' personal data and ensuring their right to privacy. In the context of healthcare digitalization and the expanding powers of government authorities in Kazakhstan, new challenges arise concerning the confidentiality of medical information. Aim. This article aims to analyze the legal regulation of medical confidentiality in the Republic of Kazakhstan, identify existing legislative gaps and threats to medical data confidentiality, and develop proposals for improving law enforcement practices. Materials and methods. The study employs methods of comparative legal analysis, systemic and normative approaches, allowing an assessment of the compliance of current regulations with international standards (GDPR, HIPAA). Additionally, content analysis of Kazakhstan’s regulatory legal acts and judicial practice was conducted. Results. It has been established that Kazakhstan’s legislation formally ensures the protection of medical confidentiality; however, it contains several exceptions that allow government agencies to request personal medical data without patient consent. Significant issues include the vagueness of national security criteria, insufficient regulation of access to digital medical databases, and the lack of effective mechanisms for monitoring and notifying patients about the transfer of their data to third parties. Risks of data leaks have been identified due to the inadequate level of cybersecurity in medical information systems and the low awareness of patients about their rights. Conclusion. To enhance the protection of medical confidentiality in Kazakhstan, reforms are needed in several areas: strengthening judicial oversight over requests for medical data disclosure, tightening criminal and administrative liability for unlawful dissemination, implementing transparency mechanisms and patient notifications, and improving cybersecurity standards. The development of educational programs for medical personnel and increasing patients' legal awareness are also crucial steps toward strengthening the institution of medical confidentiality and adapting it to the digital era.

Introduction. A decrease in testosterone negatively affects the functions of many organs and systems in men, impairing quality of life and life expectancy. For older men with hypogonadism, visceral obesity is characteristic. This is the excessive accumulation of fat in the torso and abdominal cavity area. An increase in visceral fat is a provoking factor for the dysfunction of sex hormones and lipid metabolism. In combination, this leads to the early development and progression of age-related hypogonadism in men. Objective. To assess the relationship between testosterone fraction levels and lipid metabolism markers in Kazakh men with excess weight. Materials and Methods. A total of 417 individuals participated in the study. Among them, 135 patients had hypogonadism, and 282 were healthy men. A statistically significant increase in triglycerides (p < 0.001), and a decrease in LDL (p < 0.001) and albumin (p = 0.001) were noted in patients with hypogonadism. There was also a noticeable increase in triglycerides above the reference value (1.7-2.25 mM/L). Hormonal status assessment among men with hypogonadism showed a decrease in total testosterone (p < 0.001) and SHBG (p < 0.001) compared to the control group. A decrease in free testosterone (p = 0.3), bioavailable testosterone (p = 0.1), and LH (p = 0.6) was also observed compared to the control group, but without statistical significance. Results. Excess weight and obesity contribute to a decrease in testosterone fraction levels. In our study, a decrease in total testosterone (p < 0.001) and SHBG (p < 0.001) was observed compared to the control group. There was also a decrease in free testosterone (p = 0.3), bioavailable testosterone (p = 0.1), and LH (p = 0.6) compared to the control group. Correlation analysis showed that triglyceride levels were negatively associated with androgen status indicators (a weak negative correlation with total testosterone (p = 0.001), SHBG (p = 0.014)). Conclusions. In older men, abdominal obesity is a cause of decreased testosterone levels and lipid metabolism disorders. Obesity and dyslipidemia are more common causes of low testosterone levels than chronological age itself. Based on these data, we should pay increased attention to the symptoms of hypogonadism in older men with dyslipidemia and excess weight.

Introduction. Atopic dermatitis belongs to a group of allergic diseases, including food allergies, allergic rhinitis, and asthma. Atopic dermatitis is a common chronic heterogeneous inflammatory skin disease characterized by relapses. The main factors contributing to its development include genetic predisposition, epidermal barrier disruption, and immune system dysfunction. The aim of this study is to investigate the polymorphisms of atopic dermatitis genes among the population of Kazakhstan. Materials and methods. Our case-control study involved 322 people with atopic dermatitis and 328 healthy controls. 120 SNPs were selected and genotyped using a Quant Studio 12K Flex real-time PCR system. Results. Significant associations were identified between eight single nucleotide polymorphisms (SNPs) (rs79497729, rs12144049, rs2321443, rs3091307, rs3208007, rs10995245, rs56302621, rs72823628) and atopic dermatitis. Conclusion. Our data confirm and expand the current understanding of the influence of SNPs on atopic dermatitis. Importantly, this study is unique in focusing on the Kazakhstani population, providing valuable insights into Central Asia, where research data are scarce or absent for this region.

Introduction. Chimeric Antigen Receptor T-cell (CAR-T) therapy represents a breakthrough in the treatment of relapsed and refractory hematologic malignancies. However, its application is limited by high production costs and technical complexity. In Kazakhstan, approximately 180–240 patients annually require this type of therapy, yet access remains virtually unavailable. Aim. This study aimed to develop a localized and standardized protocol for the production of CD19-specific CAR-T cells using an automated manufacturing system. Materials and methods. The CliniMACS Prodigy platform was used for T-cell isolation, activation, and lentiviral transduction with vectors encoding the CD19 CAR construct. Functional activity of CAR-T cells was assessed via flow cytometry using CD19-positive (Raji) and CD19-negative (K562) target cell lines. Quality control included sterility testing, verification of replication-competent lentivirus absence, and phenotypic analysis of the cell product. Results. The resulting CAR-T cell products met international quality standards in terms of sterility, lack of replication-competent virus, and CD3+CAR+ cell content (75.18%). In vitro experiments demonstrated high specific cytotoxicity against CD19+ targets (Raji) with minimal nonspecific lysis of CD19− cells (K562). The developed and validated protocol enables standardized CAR-T cell manufacturing and has the potential to significantly improve therapy accessibility in Kazakhstan. The data support the feasibility of localized production of effective CAR-T cell products, which could greatly enhance treatment outcomes for patients with severe hematologic malignancies in the region. Conclusion. The proposed protocol for the production of CD19-specific CAR-T cells using the CliniMACS Prodigy platform meets international standards and allows for the generation of high-quality cellular products for B-cell hematologic cancer therapy.

Введение. Корь у беременных представляет значительную угрозу для здоровья матери и плода. Снижение коллективного иммунитета и отказ от вакцинации приводят к вспышкам заболевания даже в развитых странах, а физиологические изменения в иммунной системе увеличивают риск осложнений, таких как выкидыши, преждевременные роды и врожденные аномалии. Цель исследования. Описать клинические особенности течения кори у беременных в период эпидемического подъема. Материалы и методы исследования. В исследовании проанализированы медицинские карты 63 беременных пациенток, госпитализированных в Областную клиническую инфекционную больницу во время подъема заболеваемости корью в Актюбинской области. Анализ включал данные о жалобах, клинических проявлениях, лабораторных и инструментальных исследованиях с расчетом процентных соотношений по каждому показателю. Результаты. Распределение по возрасту показало: 46% – от 20 до 30 лет, 46% – старше 30 лет и 8% – младше 20 лет. Все пациентки были привиты против кори в детстве, однако данные о повторной вакцинации во взрослом возрасте отсутствовали. Тяжёлые формы – 30%, средние – 67%, лёгкие – 3%. Большинство пациенток (76,2%) находились в стационаре 6–8 дней, остальные – менее 5 или более 8 дней. Классические симптомы кори: высокая температура (38,5–40°C) на 3–5 дней, ярко выраженный катаральный период с кашлем, ринитом, конъюнктивитом, пятна Бельского-Филатова-Коплика (100%) и типичное распространение сыпи. Бронхит выявлен у 12,7% (из них с обструктивным типом у 37,5%), пневмония – у 11,1% (с одышкой и риском дыхательной недостаточности), диарея – у 4,8%, выкидыш – в 1 случае, энцефалит не зарегистрирован. Отмечены лейкопения (23,8%), относительный лимфоцитоз (74,6%), нейтрофилез (79,4%), повышенная СОЭ (84,1%), анемия (92,1%) и тромбоцитопения (14,3%). При тяжёлом течении – выраженные изменения печеночных ферментов. Выводы. Корь у беременных протекает тяжело, с 30% случаев характеризующихся выраженной интоксикацией и высокой лихорадкой. Наблюдались признаки выраженного воспалительного процесса – лейкопения, анемия и цитолиз гепатоцитов.

Введение. Хронические неинфекционные заболевания являются основной причиной смертности в мире. Эффективная профилактика на уровне первичной медико- санитарной помощи может значительно снизить преждевременную смертность и улучшить качество жизни, особенно среди лиц старших возрастных групп. Однако доступные данные о реализации профилактической деятельности в ПМСП Казахстана ограничены. Цель исследования: изучить текущие практики и потребности медицинских работников, а также ожидания и поведение пациентов в сфере профилактической помощи в учреждениях ПМСП г. Алматы. Материалы и методы. Данное описательное поперечное исследование было проведено в 10 учреждениях ПМСП Алматы в 2024 году. Результаты. Проводились анкетные опросы среди 240 медицинских работников и 360 пациентов старше 50 лет с хроническими заболеваниями. Результаты исследования показали, что в профилактической деятельности участвовали 94,2% медработников, однако 32,9% не проходили специализированного обучения. Нехватку информационных материалов отметили 50,8%. Среди пациентов 86,9% демонстрировали приверженность к гипотензивной терапии, но только 60,6% соблюдали рекомендации полностью. Около 21% не знали свой уровень артериального давления. Высокую удовлетворенность профилактикой отметили 56,7% пациентов. Заключение. Несмотря на активность медицинских работников, имеются недостатки в подготовке и ресурсном обеспечении. Пациенты демонстрируют готовность к профилактике, но нуждаются в лучшей информированности. Результаты подчеркивают необходимость системного укрепления профилактической помощи в ПМСП, особенно с учётом потребностей целевых групп.

Oral diseases such as periodontal disease, dental caries, and oral cancer are significant public health problems that affect not only oral health but also the entire body. Traditional diagnostic methods often detect these diseases only at late stages, which limits treatment options and outcomes. The advent of biomarkers, biological molecules found in biological fluids such as saliva and gingival crevicular fluid (GCF), offers promising opportunities for early non- invasive diagnosis, prognosis, and personalized treatment. This review examines the role of biomarkers in the diagnosis of oral diseases, focusing on their ability to detect pathologies at early stages. Salivary biomarkers such as proline-rich proteins (PRPs) and microRNAs (miRNAs) have already shown promise in identifying the risk of dental caries and early oral squamous cell carcinoma (OSCC). GCF biomarkers such as RANKL/OPG ratio and cytokines enable clinicians to monitor periodontal disease progression and customize treatment plans. The integration of high-throughput technologies and artificial intelligence in biomarker research further enhances diagnostic accuracy and personalized care. The aim of this review is to analyse and discuss in detail the use of modern biomarkers of oral diseases. Particular attention is paid to salivary and gingival crevicular fluid (GCF) biomarkers, which are promising tools for the diagnosis of various pathologies, including cancer. These biomarkers have high potential for early detection, monitoring of disease progression, and evaluation of the effectiveness of therapeutic interventions.

Abstract Introduction. Idiopathic scoliosis is a common form of spinal deformity, the cause of which is unknown. Despite widespread use, there is no systematic method of treatment accepted by doctors. The aim. Demonstration of the results of using the navigation system in combination with intraoperative computer tomography, used in surgical correction of deformities in patients with 3-4 degrees of scoliosis of the thoracic and lumbar spine. Materials and methods. During the study, medical documents were analyzed, including the protocol of operations and the results of diagnostic measures. The obtained data were presented using descriptive statistical methods. Patients with 3-4 degrees of scoliosis or kyphoscoliosis of the spine according to the Cobb classification took part in the study. When selecting patients, only patients with idiopathic deformation of the spine were included, and patients with other deformations were excluded from the study. Written informed consent was obtained from all patients (their parents or legal guardians). Results and discussion. An analysis of the results of operations performed on 37 people aged 11 to 20 years with scoliosis of the spine was carried out. According to the location of the scoliosis arch of the spine, thoracic deformity was detected in 21 patients, thoracic-lumbar in 10, and lumbar in 6. The average age of patients was 16.3±2.3 years. 456 transpedicular screws were installed. Conclusion. The use of navigation systems integrated into intraoperative computer tomography during the installation of transpedicular screws in the correction of scoliosis (kyphoscoliosis) deformation of the spine has a great future and potential. However, due to the high cost of the method, it is impossible to implement it throughout the country.

Introduction. Fractures of the foot bones account for about 10% of all skeletal bone fractures in pediatric practice. Radiography remains the main method of diagnosing foot fractures in children, however, for an accurate interpretation of the X-ray picture, it is necessary to take into account the peculiarities of skeletal development in order to minimize the risk of diagnostic errors and timely identify possible complications. The aim of the study is to study the features of fractures of the foot bones in children and adolescents according to X-ray examination. Methods. The results of X-ray examinations and medical documents of 1159 patients admitted to the emergency of Children's City Clinical Hospital No. 2 in Almaty with an acute foot injury in the period from 01.09.2023 to 31.12.2023 were studied. The criteria for inclusion in the study were the age of patients from 1 to 18 years; history of acute foot injury. Results. Of the studied results of radiological data, fractures of the foot bones were revealed in 471 (40.6%), contusion of the soft tissues of the foot in 674 (58.2%), open laceration of the soft tissues of the foot in 12 (1.0%), post-traumatic infiltration of soft tissues feet – in 2 (0.2%) cases. It was found that the main causes of foot fractures were household, sports, and traffic accidents. By location, fractures of the bones of the foot before the age of 18 were most often visualized in 462 (98%) cases of the forefoot, in the middle section (7 - 1.6%) and 2 (0.4%) cases in the hindfoot. The most frequently visualized fractures on radiographs of the feet were oblique fractures (42.7%), “green stick” fractures (32.7%) and epiphysiolysis (11.5%). An analysis of complications of fractures of the foot bones revealed that an intra- articular fracture (172 - 36.5%) was often observed in acute foot trauma, in contrast to displacement of fragments in 17 (3.6%) cases. Conclusions. These studies show that the majority of fractures of the foot bones in children occur in the age period from 7 years to 14 years, among them there is a significantly higher risk of fractures in boys compared to girls. Also, according to the results of the study, the anterior part of the foot is the most vulnerable localization in fractures of the foot. The findings highlight the importance of radiography for the correct diagnosis and treatment of foot fractures in children, as well as the need for preventive measures to reduce injuries in this age group.

Introduction. Breast cancer is one of the leading causes of mortality among women worldwide, and its early diagnosis plays a crucial role in improving clinical outcomes and reducing mortality. We aimed to assess the effectiveness of artificial intelligence (AI) methods in breast cancer diagnosis and conduct a meta-analysis of diagnostic accuracy based on data from multiple studies published from 2010 to 2023. Methods. A systematic review was conducted in accordance with PRISMA guidelines. Literature searches were performed in PubMed, Scopus, and Web of Science databases using combinations of keywords and MeSH terms covering the topics "breast cancer," "artificial intelligence," "machine learning," and "deep learning." A total of 24 studies evaluating the diagnostic accuracy of AI methods using sensitivity, specificity, and area under the ROC curve (AUC) metrics were included in the meta-analysis. Statistical analysis was performed using a random-effects model, and the quality of studies was assessed using the QUADAS-2 tool. Results. The range of AUC values for AI methods was from 0.80 to 0.96, indicating high diagnostic accuracy. The highest scores were demonstrated in studies by McKinney et al. (2020) (AUC = 0.95, 95% CI: 0.92–0.98) and Ribli et al. (2018) (AUC = 0.95, 95% CI: 0.93– 0.98). Convolutional neural networks (CNN) showed the highest accuracy among all methods. There was significant heterogeneity between studies, necessitating sensitivity analysis and meta-regression analysis to identify sources of heterogeneity. Conclusion. AI methods have significant potential in breast cancer diagnosis, demonstrating high sensitivity and specificity. However, further research should focus on improving reproducibility of results, standardizing approaches, and increasing the transparency of algorithms for their safe and effective application in medical practice.

Introduction. Extensive abdominal alveococcosis of the liver, in the treatment of which the autotransplantation method was used, has not been described in modern domestic literature. We present our experience of a successful operation in a patient with extensive abdominal alveococcosis with invasion into the inferior vena cava. Case presentation. a patient (woman, 64 years old) diagnosed with "alveococcosis of the liver with metastases to the lungs and brain". From the anamnesis: in 2021, alveococcosis of the brain was detected, in 2023, alveococcectomy from the left frontal lobe was performed and alveococcosis of the liver was diagnosed. When performing contrasting computed tomography of the abdominal organs, retroperitoneal space, chest and mediastinum: cystic formation of the right lobe of the liver of parasitic genesis, formations of the lower lobes of both lungs. Surgical treatments: Laparotomy. Left hemihepatectomy with resection of the inferior vena cava ex vivo, with plastic surgery of the inferior vena cava with a synthetic prosthesis, with orthotopic transplantation of the remnant right lobe of the liver. Results. The postoperative period was uneventful. In the postoperative period, empirical antibacterial therapy was started: meropenem 1000 mg 3 times a day (10 days). Gastroprotective therapy with omeprazole 40 mg once a day (14 days). Clexane was administered subcutaneously at 0.2 ml once a day (2 days), then 0.4 ml once a day (10 days). Transfusion of 20 doses of fresh frozen plasma, 7 doses of red blood cell suspension, 2 doses of platelet mass, daily administration of 100 ml of 10% albumin for 14 days were performed. Drainage systems were removed on the 9th day. On the 12th day, the patient was transferred from the intensive care unit to the ward, and on the 20th day after the operation she was discharged with improvement. The patient is currently in the 12th month of outpatient observation. According to the abdominal CT scan, no relapse was observed. Conclusion. Radical surgical treatment for extensive hepatic alveolar echinococcosis, even in cases of invasion into the bifurcation of the portal vein, inferior vena cava, and hepatocaval confluence, is a preferable therapeutic strategy and feasible in specialized institutions.

Атрофический гастрит — это хроническое заболевание желудка, характеризующееся прогрессирующей атрофией слизистой оболочки, что значительно увеличивает вероятность развития рака. Это исследование посвящено анализу современных знаний и методов диагностики, мониторинга и лечения атрофического гастрита, а также оценке их применимости в условиях Республики Казахстан с целью разработки актуализированных рекомендаций для клинической практики. В рамках исследования был проведен всесторонний анализ существующих доказательств, представленных в научной литературе, с учётом мнений экспертов в области гастроэнтерологии. Для разработки рекомендаций Best Practice Advice использовался системный подход, который включал обзор актуальных литературных источников с применением научных баз данных PubMed, Scopus и Web of Science. Второй этап работы заключался в проведении Экспертного совета, в ходе которого были обсуждены ключевые аспекты диагностики и терапии атрофического гастрита, а также специфические особенности его течения в Казахстане. Полученные данные позволили сформулировать обновленные рекомендации Best Practice Advice, которые будут полезны для практикующих врачей в улучшении диагностики и лечения этого заболевания, а также для формирования стратегий профилактики и своевременного вмешательства в клинической практике, что способствует снижению рисков возникновения рака желудка и улучшению качества жизни пациентов.

CT perfusion (CTF) is currently considered to be the most relevant method for assessing cerebral blood flow. CT extends the importance of X-ray computed tomography in the diagnosis of ischemic stroke. CT perfusion is now becoming a clinically available method of examining patients with suspected acute cerebrovascular accident and provides functional data on cerebral blood flow, which allows making treatment decisions for a particular patient. The purpose of our study is to review in this review the current state of evidence underlying various imaging paradigms for the diagnosis and treatment of acute ischemic stroke, including current recommendations from scientific studies and major reviews. We also review recent advances in neuroimaging and ongoing trials in key therapeutic areas, as well as imaging selection criteria, to inform possible future approaches to using neuroimaging for stroke diagnosis and treatment decisions.

Chimeric antigen receptor T-cell (CAR-T) therapy represents a transformative advancement in the treatment of relapsed or refractory hematological malignancies such as leukemias, lymphomas, and multiple myeloma. Despite its remarkable efficacy in clinical trials, challenges remain in integrating CAR-T into routine healthcare systems. This systematic review examines key aspects of CAR-T implementation, including manufacturing logistics, economic evaluations, infrastructural readiness, regulatory frameworks, patient-reported outcomes (PROMs), and long-term follow-up strategies. Data from 25 studies highlight that while CAR-T has shown significant therapeutic potential, logistical barriers such as lengthy production timelines and specialized facility requirements hinder its scalability. Economic analyses reveal high upfront costs, with limited accessibility in low-resource settings. PROM data emphasize meaningful improvements in patient quality of life, though these findings are predominantly short-term. Adverse events, including cytokine release syndrome and neurotoxicity, necessitate rigorous safety protocols and specialized care teams. Long-term follow-up remains underexplored, with few studies providing insights into survivorship care. To address these challenges, the review identifies potential solutions, including decentralized manufacturing, innovative reimbursement models, and enhanced patient selection criteria. Collaborative efforts between stakeholders, robust policy frameworks, and patient-centered approaches are crucial for successful CAR-T integration. Future research should focus on longitudinal studies, real-world applications, and tailored survivorship protocols to optimize CAR-T delivery and outcomes.

Introduction. Acute ischemic stroke remains one of the leading causes of disability and mortality worldwide. Non-contrast computed tomography (NCCT) is the standard primary imaging method, but early ischemic changes (“subtle” tissue density reduction) may be difficult to detect visually. The goal of this study was to develop and evaluate an automated system for detecting regions of reduced density in CT images, based on deep neural network models, and integrated into the «Cerebra» platform. Materials and Methods. The study included 246 patients (127 males and 119 females) with a confirmed diagnosis of acute ischemic stroke. The mean age for males was 58.96 ± 8 years, for females—62.15 ± 8 years. All CT scans were performed on multislice scanners (Fujifilm, GE, Hitachi, Siemens, UIH) using standard protocols. Cascading U-Net-based models (in particular, with an EfficientNet B6 encoder), trained on annotated data verified by three independent radiologists, were used for automatic segmentation of areas with reduced density. Performance was evaluated using Accuracy, Precision, Recall, F1-Score, and Cohen’s Kappa. Results. During 2022–2024, a stepwise improvement in accuracy was observed. In 2024, the Accuracy reached 92.3%, F1-Score was 96.0%, Recall 92.3%, and Precision reached 100%. In 2023, Cohen’s Kappa was 0.80, indicating high agreement with expert assessments. Analysis on different CT scanner models showed the algorithm maintained high reproducibility (F1- Score from 88.8% to 100%) under varying technical conditions. Discussion. These findings confirm that the combined use of image normalization (MNI space), cascading deep neural networks, and consensus annotation by three experts enhances early detection of ischemic changes. Improvements over the years were associated with expansion of the training dataset and regular updating of the model architecture. The “Cerebra” system has demonstrated versatility due to stable results on scanners from different manufacturers. Conclusion. The developed automated system for detecting reduced tissue density can significantly improve diagnostic accuracy in acute ischemic stroke and reduce decision-making time. Further dataset expansion and multicenter validation will enable this solution to be scaled up for widespread clinical use.

Introduction. Hemorrhagic stroke is characterized by high mortality and severe outcomes. According to the World Health Organization, strokes rank second among the leading causes of death worldwide and are a leading cause of permanent disability among adults. Aim. The aim of this study is to identify factors influencing the likelihood of mortality in patients with hemorrhagic stroke admitted to a multidisciplinary clinic. Materials and methods. Data from 200 patients with hemorrhagic stroke admitted to City Clinical Hospital No. 7 in Almaty between January 2018 and December 2023 were analyzed. A retrospective cohort study was conducted, including an analysis of demographic data, clinical indicators, surgical interventions, and outcomes. Statistical analyses were performed using the χ² test, Student's t-test, Mann-Whitney test, and logistic regression. Results. The mean age of patients in the mortality group was significantly higher compared to the discharge group (69 vs 58 years, p = 0.02). The presence of arterial hypertension nearly doubled the risk of death (OR = 1.717, p = 0.049), and low consciousness level at admission (GCS) significantly increased the risk of mortality (OR = 0.705, p < 0.001). Neurological deficit at admission was associated with a 3.6 times higher risk of death (OR = 3.595, p = 0.005). The volume of surgical intervention was also a significant factor, increasing the risk of mortality by 1.5% for each additional milliliter (OR = 1.015, p = 0.003). The length of hospital stay did not have a significant effect on outcomes (p = 0.221). Conclusion. Age, presence of arterial hypertension, consciousness level at admission, neurological deficit, and the volume of surgical intervention are key factors influencing the likelihood of mortality in patients with hemorrhagic stroke. These findings can be used to improve prognosis and management of such patients.

Настоящая обзорная статья посвящена анализу текущих данных по респираторным проявлениям постковидного синдрома, представляющими собой одно из значимых последствий перенесенной COVID-19. В работе рассматриваются основные клинические проявления, патогенетические механизмы и подходы к лечению постковидного синдрома. На основе анализа современной литературы выделены ключевые направления для дальнейших исследований и даны рекомендации для клинической практики. Полученные данные подчеркивают важность комплексного подхода к диагностике и лечению данного состояния, что может значительно улучшить качество жизни пациентов.

Введение. В последние годы в судебно-медицинской практике участились случаи дорожно-транспортных происшествий (ДТП) с участием моторизированных средств передвижения: мотоциклов, мопедов, электросамокатов, скутеров и т.п. При этом виновниками ДТП являются как водители автотранспорта, так и водители мототранспортных средств. Последствия таких происшествий варьируются от легких телесных повреждений до летальных исходов. В случаях со смертельным исходом следственные вопросы к судебно-медицинскому эксперту включают и установление механизма травмы, и данные о транспортном средстве, о приблизительной скорости его движения. Бывают необходимость определения последовательности повреждений, непосредственной причины смерти, возможности пострадавшего после получения травмы совершать активные действия и т.д. Можно с уверенностью заметить, что каждая экспертиза так или иначе пополняет пока еще недостаточно богатую практику по методике осмотра места происшествия, осмотра мототранспорта, дорожного покрытия, самого трупа, и, наконец, экспертизы с использованием всех возможных дополнительных методов исследований. Материалы и методы. Материалы: 1) Архивные материалы танатологического отдела г. Алматы Центра Судебных экспертиз, по мотоциклетной травме за последние 2 года. 2) Собственные исследования – экспертизы, проведенные авторами. Методы исследования касательно архивных материалов – статистическая обработка по показателям: а) возраста, пола и других данных о водителе (пассажирах) мототранспорта; б) механизма травмы; в) характера и локализации повреждений; г) непосредственная причина смерти; д) использованных методик секционного исследования; е) использованных дополнительных методов исследований. Методы исследования касательно собственных судебно-медицинских экспертиз трупов: изучение материалов следствия, исследование одежды трупа, наружное и внутреннее исследование трупа, дополнительные лабораторные исследования по материалам изъятых от трупа. Результаты. Определены показатели статистики ДТП с участием мототранспорта, выявлена тенденция роста общего количества происшествий, в том числе со смертельным исходом, даны рекомендации по методике осмотра места происшествия, а также наружного и внутреннего исследования трупов. Обсуждение. Получить объективные данные о наиболее вероятных механизмах мототравм о характерной локализации повреждений у водителей и пассажиров, обозначить вопросы следствия, подлежащие разрешению при экспертизе трупов и освидетельствовании пострадавших. Выводы. Учитывая актуальность и особенности мототравм, а также их относительно малоизученность, полагаем, что исследование данной темы является востребованным и требует от судебных медиков восполнения существующего научного пробела в исследовании этого вида транспортной травмы.

Introduction. Telemedicine is a type of use of telecommunication technologies to provide remote medical advice. The most intensive development of teleconsultations began during the COVID-19 pandemic, when face-to-face consultations became difficult. Previously, the experience of teleconsultation in psychiatric practice has not been analyzed on the territory of the Republic of Kazakhstan. Aims. For the first time, a study of the experience of telemedicine consultation was conducted at the “Republican Scientific and Practical Center for Mental Health” of the Ministry of Health of the Republic of Kazakhstan (RNPCPZ MOH RK), to improve the treatment and diagnostic service of a psychiatric profile. Materials and Methods. 53 protocols of telemedicine calls from 13 regions of the country were studied. The socio-demographic and clinical indicators of patients who underwent telemedicine consultation were studied. Absolute numbers and percentages are given, average values and deviations are calculated using the Student's method. Results. It was found that the number of online consultations increased annually and the vast majority of which were initial requests (n=48 - 90.6%). The age range of consulted patients ranged from 3 to 74 years, with a mean age of 26±3.6. The vast majority of those consulted were adolescents and young adults aged from 13 to 28 years with an average age of 19±3.4. The range of established diagnoses was quite wide and corresponded to mental disorders from the neurotic to the endogenous level. Along with this, the most common reason for contact was the question of verification of diagnosis and correction of therapy (n=39 - 73.6%). Conclusion. A growing need for the development of remote consultation and the interest of regional doctors in telemedicine technologies have been identified.

Введение. Скрининговые программы на рак молочной железы, шейки матки и предстательной железы играют ключевую роль в раннем выявлении онкологических заболеваний и снижении смертности. Однако эффективность этих программ во многом зависит от уровня информированности пациентов, качества медицинских услуг и организационных мер, предпринимаемых в ходе скрининга. Цель. Данное исследование направлено на выявление проблемных аспектов информирования пациентов о результатах скрининга, а также разработку стратегий для повышения участия населения и оптимизации проведения скрининга. Методы. В рамках исследования были проведены глубинные интервью с ответственными за организацию скрининга (категория A) и медицинскими работниками, выполняющими скрининг (категория B). Собранные данные были проанализированы с целью выявления ключевых проблем и предложений по улучшению программ скрининга. Были разработаны и предложены меры по улучшению информирования, обучения медицинского персонала, а также повышения координации между медицинскими учреждениями. Результаты. Анализ данных глубинных интервью выявил несколько ключевых проблем: низкий уровень доверия пациентов к результатам скрининга, недостаточная персонализация подхода к информированию, а также организационные и технические барьеры, такие как хранение данных и доступ к результатам. Для решения этих проблем были предложены меры, включая проведение информационных кампаний, регулярное обучение медицинского персонала, улучшение координации между учреждениями и введение системы персонального поощрения. Заключение. Для повышения эффективности скрининговых программ необходимо принять комплексные меры, включающие повышение кадровой стабильности, проведение информационных кампаний для населения и обучение медицинских работников. Реализация предложенных мер может значительно повысить эффективность скрининговых программ, что приведет к улучшению уровня участия населения и снижению заболеваемости и смертности от онкологических заболеваний. Для достижения этих целей необходим комплексный подход, включающий как организационные улучшения, так и повышение уровня информированности и доверия среди населения.

В настоящее время изучены различные методы для рецессии десны. В большинстве современных процедур используются аутогенные трансплантаты мягких тканей, что связано с болезненностью донорских участков. Целью исследования являлось оценить доказательства эффективности альтернативы аутогенной соединительной ткани при использовании в качестве трансплантатов для увеличения мягких тканей. Были изучены статьи, находящиеся в открытом доступе, с использованием следующих баз данных научных публикаций и специализированных поисковых систем глубиной за последние 10 лет: PubMed, Scopus, Web of Science. Критериями включения были публикации уровня доказательности А, В: мета-анализы, систематические обзоры, рандомизированные контролируемые исследования, когортные исследования, поперечные исследования. Критериями исключения были мнение экспертов в виде коротких сообщений, рекламные статьи. За последние 10 лет, с учетом исключения дубликатов было найдено 430 статьи, из которых 88 соответствовало критериям включения. Субэпителиальные соединительнотканные трансплантаты являются лучшим выбором в случаях покрытия корней. Однако хирургам-стоматологам требуются дополнительные научно обоснованные варианты для ситуаций, в которых золотой стандарт не идеален, например, в случаях с финансовыми ограничениями, в случаях, когда доступно ограниченное количество донорской ткани для множественных рецессий. Свободный десневой трансплантат позволяет сохранить первоначальный вид мягких тканей неба на месте реципиента, но может привести к плохой эстетической интеграции и текстуре, напоминающей рубцовую ткань. Аутологичный богатый тромбоцитами фибрин отличался от золотого стандарта лишь по количеству ороговевшей слизистой оболочки. Из-за вопроса об истинной важности кератинизированной слизистой оболочки для здоровья зубов и периимплантатов, отсутствие статистических различий между методами лечения по другим параметрам (глубина зондирования, уровень клинического прикрепления и рецессия десны) предполагает многообещающее будущее использования мембран АБТФ в качестве альтернативы субэпителиальным СТТ в процедурах закрытия открытых корней. В настоящее время субэпителиальные соединительнотканные трансплантаты являются золотым стандартом в случаях покрытия корней, однако аутологичный богатый тромбоцитами фибрин по многим параметрам не отличался от него и может служить альтернативным методом в случаях, ограничивающих применение соединительнотканного трансплантата, свободный десневой трансплантат.

Введение: Актуальность исследования подчеркивается необходимостью поддержки грудного вскармливания как ключевого аспекта здоровья и развития ребенка. Работа основана на рекомендациях Всемирной организации здравоохранения и Детского фонда Организации Объединенных Наций, подчеркивающих значимость грудного вскармливания в первые годы жизни. В контексте здравоохранения Казахстана недостаточно исследованы причины отказа от грудного вскармливания. Исследование направлено на выявление этих причин и разработку рекомендаций для улучшения ситуации. Цель исследования заключается в выявлении причин отказа от грудного вскармливания и препятствий для пропаганды и консультирования по грудному вскармливанию в сети ПМСП в Алматы, на базе ГП № 11, а также для разработки рекомендаций для улучшения вскармливания грудных детей Материалы и методы исследования. Исследование было проведено в несколько этапов. На первом этапе мы провели поиск в базах данных PubMed, Scopus, Google scholar, Cochrane Library, Scopus, Cyberleninka, e-library, UpToDate. В анализ взято 19 источников из 57, найденных по ключевым словам: “human milk”, “breasfeeding”, “lactation”, “pregnancy”, “breast rejection”, “newborn”, “lactostasis”. Глубина поиска – 5 лет (2018-2023 гг.). На втором этапе нами был проведен опрос матерей детей до 2 лет, прикрепленных к ГП № 11 города Алматы, по разработанной анкете, которая включала в себя 15 вопросов. Для выявления причин гипогалактии, мамам указавшим недостаток молока была предоставлена дополнительная анкета, включающая 7 вопросов открытого и закрытого типа. Результаты. Всего было опрошено 112 респондентов. Основной причиной прекращения грудного вскармливания была гипогалактия– 28,57%. Среди обследованных родильниц первичная гипогалактия была отмечена у 25%, вторичная – у 75%. Среди причин гипогалактии следует отметить: – наличие трещин, мастита, что составляет 50%, стресс - 50% случаев, позднее прикладывание новорожденных к груди матери – 25%, сахарный диабет и гестозы в единичных случаях. Заключение. Полученные результаты помогли разработать информационные материалы и стратегии для поддержки грудного вскармливания в медицинских учреждениях и среди общества в целом.

Введение: Элективная медицинская помощь является основой эффективно функционирующих систем здравоохранения. Однако пандемия COVID-19 вызвала значительное снижение приоритетов и доступности выборных процедур, что привело к увеличению нагрузки на системы здравоохранения. Цель: Оценить текущее состояние элективной медицинской помощи в Казахстане на примере пластики паховой грыжи. Методы: Проведено национальное многоцентровое проспективное когортное исследование пациентов, перенесших операцию по поводу паховой грыжи. Данные были собраны в период с 30 января по 21 мая 2023 года. Были собраны рутинные анонимные данные без изменения существующих схем клинической помощи. Основные показатели включали частоту экстренных операций, частоту резекций кишечника, время ожидания, использование сетчатых имплантов, частоту дневных операций и послеоперационные осложнения. Результаты: В исследовании приняли участие 48 пациентов из двух больниц Казахстана. Частота экстренных операций составила 8,3%, частота резекций кишечника — 2,1%. Среднее время ожидания плановой операции составило 7,5 месяцев. Сетчатые импланты использовались во всех плановых операциях. Частота дневных операций была низкой — 29,2%. Послеоперационные осложнения возникли у 16,7% пациентов и были более частыми после экстренных операций (75,0%). Заключение: Исследование показало, что элективная медицинская помощь в Казахстане сталкивается с существенными проблемами в доступности и качестве. Высокая частота экстренных операций и послеоперационных осложнений, а также длительное время ожидания плановых операций указывают на необходимость улучшения организации и проведения выборных процедур. Полученные результаты могут служить основой для разработки стратегий по улучшению элективной медицинской помощи в Казахстане.

Introduction. Left-sided pneumonectomy, a surgical intervention for treating severe lung conditions, requires significant bodily adaptation to maintain lung function. Understanding the adaptive processes based on morphometric studies of lung tissue can help develop new treatment and rehabilitation strategies to improve outcomes and quality of life for patients undergoing this surgery. The aim. This study aims to analyze morphometric changes in lung tissue in rabbits following left-sided pneumonectomy using standard methods, and to explore the compensatory and adaptive processes occurring in the remaining lung tissue. Materials and Methods. Thirty adult, mixed-breed rabbits of both sexes, weighing between 2 to 4 kg, were divided into two experimental series. Series I involved standard left- sided pneumonectomy on 10 rabbits, while Series II involved left-sided pneumonectomy with pre-arteriovenous shunting of the small circulation on 15 rabbits. A control thoracotomy was performed on 5 rabbits for comparison. Morphometric analysis of alveoli, capillaries, terminal arterioles, and precapillaries was conducted at various time points: 1, 3, 6, 12 hours, and 1, 3, 7, 15, and 30 days post-operation. Results. Significant morphometric changes were observed in the alveoli, capillaries, terminal arterioles, and precapillaries of the remaining lung tissue. In the first hours after pneumonectomy, there was a notable increase in the true size of alveoli and specific alveolar area, indicating compensatory hyperinflation. Capillary diameter and cross-sectional area significantly increased within the first 12 hours post-surgery, suggesting compensatory vasodilation. Terminal arterioles exhibited increased outer radius, lumen radius, and vessel diameter, indicating active vasodilation and improved perfusion. Precapillary changes were most significant in the first hours and days, stabilizing by 30 days post-operation. Conclusion. The study demonstrates that left-sided pneumonectomy in rabbits leads to significant morphometric changes in the remaining lung tissue, driven by compensatory and adaptive processes aimed at maintaining adequate ventilation and perfusion. These findings contribute to a better understanding of lung tissue adaptation mechanisms and may inform the development of new therapeutic and rehabilitative strategies for patients undergoing pneumonectomy.

Introduction. Bronchial asthma (BA) is one of the most frequently identified pathologies is childhood. Assessing adherence and monitoring is over a long period of observation and treatment of the patient will reduce the frequency of exacerbations of the disease and improve the patients quality of life. The purpose of the work is to assess the level of adherence to treatment in children with asthma. Material and methods. A retro-prospective study of verified cases of bronchial asthma was conducted in 518 children receiving inpatient treatment (urban patients accounted for 81.3%, and rural residents 18.7%). Information was taken after the discharge from the hospital (within 6-12 days) (T1), and after 6 months (T2) after the hospital discharge. All data were summarized using descriptive statistics methods. The Chi-square test was employed to compare categorical indicators. Corresponding confidence intervals of 95 % (95 % CI) were also calculated. Results. Compared to children with BA living in rural areas (17.5%), families of children living in the city (90.5%) had a relatively good financial situation. In terms of education, 95.5% of urban children's parents were educated, while the figure in rural areas was 12.4%. At the time of discharge of urban children from the hospital, the adherence rate was 40.1. This was higher compared to the adherence results of children with bronchial asthma in rural areas - 38.9. After 6 months, the level of adherence to therapy of children in rural areas decreased to 33.3, compared to the adherence of children living in urban areas -38.1. Discussion and conclusion. There is low therapeutic adherence of children with asthma, especially those living in rural areas. These results on children's commitment find a correlation with a relatively low level of quality of life of villagers with the presence of difficult socio- economic and housing conditions. Often, children were admitted in a moderate to severe condition upon initial admission to the hospital, which is explained by late diagnosis and low adherence to treatment. Increasing adherence to therapy in children with asthma should be carried out using mobile applications with the function of reminding and auto-calling patients about the need to take inhaled glucocorticoids inhaled glucocorticoids in patients with bronchial asthma.

Annotation The state of children's mental health in modern living conditions is one of the most important problems that worries not only psychiatrists, but also specialists of other profiles. The development and mental state of a child is influenced by many factors, one of which is the mental state of parents and other important people for him, as well as family relationships and the influence of their lifestyle and work in the family. A systematic review of studies to identify the relationship between family relationships and parental work and children's mental health has shown that there are direct links between these factors. To achieve the result, the external and internal behavior of the child was evaluated. The analysis of the data obtained allows us to talk about a direct connection between the work of parents, the atmosphere in the family and the mental health of children, but the static significance of the facts is not enough to form clear conclusions. However, it can be said that the activities of parents directly affect the position of children in the family. Such studies help to provide recommendations on possible actions aimed at improving the mental health of children, affecting the family, in particular the work of parents.

. Введение: Повторная беременность (ПБ) характеризуется высоким риском возврата перипартальной кардиомиопатии или ухудшения течения заболевания. Однако у некоторых больных повторная беременность протекает благоприятно. Предикция факторов риска ухудшения течения является важным для клинического применения у этих больных. Цель: Изучить влияние повторной беременности на течение и прогноз жизни больных с перипартальной кардиомиопатией Материалы и методы: Представлены данные 11 пациентов ПКМП. Для наглядной оценки пациенты были разделены на 2 группы в зависимости от исходной ФВЛЖ. Были оценены прогноз жизни, ухудшение течение сердечной недостаточности или выздоровление. Результаты: В группе с низкой ФВЛЖ отмечено большее количество неблагоприятных событий: 1 летальный исход (ФВ менее 30%), в 4х случаях (ФВ менее 50%) наблюдалось прогрессивное ухудшение сердечной недостаточности и снижение ФВЛЖ ниже 30% с потерей плода. Клинические симптомы и признаки ХСН характерные II-III классу по NYHA сохранялись у троих женщин, роды прошли успешно. Женщины с ФВ более 50% находились в стабильном состоянии всю беременность, ФВ ЛЖ не снижалась ниже 50%. Выводы: ФВЛЖ является одним из основных предикторов неблагоприятного течения беременности и течения перипартальной кардиомиопатии.

. К основным перинатальным сосудистым осложнениям, наиболее часто встречающимися в практике акушер-гинекологов, относятся венозные тромбоэмболические осложнения и послеродовые кровотечения. Цель исследования - обзор данных о хирургической профилактике и лечении данных патологий. Проведен поиск данных в таких базах как Pubmed, Medline, Cyberlinka, клинических протоколах лечения. Глубина поиска – 13 лет. Критерии включения – мета-анализы, литературные обзоры, контролируемые и оригинальные исследования, систематические обзоры, клинические протокола лечения. В работу включены 50 источников. После проведенного литературного обзора, были описаны методы диагностики венозных тромбоэмболических осложнений, методы их хирургической профилактики, а также описаны этапы хирургической остановки послеродового кровотечения. Главную роль в обнаружении тромбозов вен нижних конечностей играет дуплексное сканирование вен, а диагностика тромбоэмболии легочных артерий, в свою очередь, имеет свою иерархию. Что касается хирургической профилактики ТЭЛА, то с этой целью используются различные виды оперативных вмешательств, имеющие свои особенности. В остановке послеродового кровотечения имеется иерархия в применении хирургических методов деваскуляризации матки. При угрозе возникновения ТЭЛА используются ряд хирургических методов профилактики, выбор которых зависит от наличия определённых показаний. При остановке послеродового кровотечения необходимо учитывать своевременность и последовательность использования перечисленных методов.

Abstract Introduction: Mitosis is an essential process influenced by age, occurring across various tissues and regulated by different mediators. Substances such as cytokines and hormones are currently utilized in therapeutic interventions for conditions like cancer and graft-versus-host disease. Aim: This study aims to critically evaluate existing literature on age-dependent mitoses, cytokines, and hormones within lymphatic fluid, particularly thoracic duct lymph (TDL), under normal physiological conditions. The insights gathered will be leveraged for novel drug design and development. Materials and methods: An extensive review was conducted using databases such as PubMed/Medline, WorldCat, Google Scholar, and Index Copernicus, focusing on publications from the last forty years. Results: Three studies highlighted specific morphological attributes and quantitative shifts in age-associated mitoses within normal TDL. Another investigation detailed the quantitative and morphological properties of TDL lymphocytes in healthy individuals and those treated with thyroxin. Additional research delved into the physiological roles of angiotensins, insulin, and steroid hormones. Recent studies have increasingly focused on the mediators of proliferation and mitosis, with interleukins being examined for their antigenstimulating properties and other effects. Notably, age-related variations in immune system functionality, particularly mitosis, have been identified. Despite significant advancements in drug design, certain challenges persist, often due to oversimplified approaches. Conclusion: The evidence suggests that the immune system undergoes age-related changes, both under normal conditions and when influenced by external factors. However, the specific differences in TDL mitosis mediators between immature (neonatal) and mature (adult) organisms remain understudied. There is a critical need for the development of new drug components. The observed variations in TDL mitosis mediators between healthy neonates and adults present a promising avenue for creating innovative treatments for cancer, graft-versus-host disease, and other conditions.

Введение: Послеоперационные спайки являются значимой клинической проблемой, вызывая осложнения, такие как кишечная непроходимость и хронические боли. Цель: Оценка эффективности и безопасности различных барьерных средств, применяемых для профилактики послеоперационных спаек. Материалы и методы: Для проведения систематического обзора и мета-анализа были использованы три основных источника данных: PubMed, Scopus и Google Scholar. Поиск литературы был проведен с использованием комплексных поисковых стратегий, разработанных для выявления релевантных исследований, касающихся профилактики послеоперационных спаек с использованием различных барьерных средств. Отобранные исследования соответствовали критериям включения: рандомизированные контролируемые испытания, использующие барьерные средства для профилактики послеоперационных спаек в абдоминальных хирургических вмешательствах. Результаты: В анализ были включены 7 исследований. Использованные барьерные средства включали гидрогель, гиалуроновую кислоту/карбоксиметилцеллюлозу, аланилглутамин и другие. Результаты показали, что применение барьерных средств значительно снижает частоту и тяжесть послеоперационных спаек по сравнению с контрольной группой. Также было отмечено снижение частоты осложнений, связанных со спайками, таких как кишечная непроходимость и хронические боли. Заключение: Применение барьерных средств является эффективным и безопасным методом профилактики послеоперационных спаек. Дальнейшие исследования должны быть направлены на определение оптимальных барьерных средств и методик их применения.

Введение: В настоящее время, Казахстан по официальной статистике, при сравнении с другими государствами мира имеет более высокий уровень суицида. В связи с этим, возникает необходимость выявления маркеров суицидального поведения для выработки эффективных программ по профилактике самоубийств. Определенные биологические характеристики также могли бы помочь специалистам проводить дифференциальную диагностику истинной суицидальной настроенности с демонстративно-шантажным поведением. Цель: Тезиограмма дает возможность визуально рассмотреть и изучить изменения состава крови. Ранее тезиографическое исследование крови не проводилась на пациентах данного контингента. Материалы и методы: Объектами исследования являются: контрольная группа, состоящая из здоровых людей в количестве 10 человек, а также экспериментальная группа, которая составляла 30 человек, после совершения ими суицидальных попыток. Использовался метод клиновидной дегидратации В.Н. Шабалина и С.Н. Шатохиной. Клинические методы, применявшиеся в данном исследовании, включают в себя психиатрическое интервью с оценкой психического статуса пациента и суицидального риска. Результаты: Изучая тезиографические картины плазмы крови, выделили 3 группы, соответствующие трем морфотипам и имеющих характерологические клинические признаки. Таким образом, отмечается тенденция к отсутствию липидного кольца у большинства образцов, сочетающееся с образованием липидно – белковых структур, что свидетельствует об изменениях обмена в этих группах. Мы предполагаем некоторое соотношение между морфотипом тезиограммы и клинической характеристикой пациентов после совершения суицидальных попыток. Так, например, пациенты, тезиографическая картина которых соответствовала третьему морфотипу имеют более высокий суицидальный риск, когда как пациенты первого морфотипа более низкий.