Juvenile nasopharyngeal angiofibroma is the most common benign tumor of the nasopharynx in adolescent males, often presenting with aggressive local invasion and severe, potentially life‑threatening epistaxis. Its highly vascular nature complicates surgical resection, making preoperative transarterial embolization an important step to reduce intraoperative blood loss and improve outcomes. Evaluating the effectiveness of different embolization techniques is critical for optimizing endoscopic surgical treatment and minimizing complications. This study was driven by an ongoing need to improve surgical safety and efficiency, especially as endoscopic approaches become the standard of care in managing this challenging tumor.

The purpose of the study. Тo determine the effect of preoperative transcatheter arterial embolization on intraoperative blood loss and surgery time for endoscopic transnasal resection of juvenile nasopharyngeal angiofibroma.

Methods and materials. A retrospective analysis was conducted on thirty adolescent male patients who received surgical treatment at the University Medical Center from February 2014 to December 2023. The cohort was divided into two groups: those who underwent preoperative transcatheter arterial embolization (n = 19) and those who did not (n = 11). The characteristics compared included blood loss and the duration of surgery.

Results. Patients who underwent preoperative transcatheter arterial embolization experienced a significant reduction in intraoperative blood loss across all stages of juvenile nasopharyngeal angiofibroma. Although preoperative transcatheter arterial embolization reduced the time required for surgery, the results were not statistically significant.

Conclusions. Preoperative transcatheter arterial embolization significantly enhances surgical outcomes by effectively reducing intraoperative bleeding during the resection of juvenile nasopharyngeal angiofibroma.

Existing data on the follow-up of children with SARS-CoV-2-associated Multisystem Inflammatory Syndrome are limited.

The purpose of this study. To investigate the medium and long-term consequences of Multisystem Inflammatory Syndrome in children who had Multisystem Inflammatory Syndrome associated with SARS-CoV-2.

Methods and materials. A retrospective study was conducted that included 93 children with a history of SARS-CoV-2-associated Multisystem Inflammatory Syndrome. The analysis included monitoring the health status of the study group of children using data from the Damumed medical information system. Identified changes were categorized into the following periods: occurring within the first 6 months, 1 year, 2 years, and more than 2 years post-illness.

Results: Diseases identified during outpatient monitoring in the follow-up included pneumonia (9.6 %), vegetative-vascular dystonia (11.8 %), vision deterioration (7.5 %), joint damage (6.6 %), metabolic disorders (2.2 %), and recurrence of Multisystem Inflammatory Syndrome (2.2 %). Cardiovascular system assessment revealed changes unusual for the acute period of MIS: regression of symptoms of the inflammatory process of the heart in the form of cardiomegaly, left ventricular dysfunction, pericarditis, pulmonary arterial hypertension, coronary artery disease, mitral regurgitation, and an increase in valvular disease of the right heart chambers (regurgitation of the pulmonary and tricuspid valves), arrhythmias compared to the acute period (p<0.005). These changes were predominantly observed during the first year of follow-up.

Conclusions: Children who had Multisystem Inflammatory Syndrome associated with SARSCoV-2 exhibited various somatic disorders during long-term monitoring. The majority of patients (64.1 %) continued to have subclinical signs of myocardial damage within the first year of observation.

Post-COVID syndrome in elderly patients with arterial hypertension remains insufficiently studied, particularly in terms of autonomic dysfunction. The systemic effects of SARS-CoV-2 and its influence on cardiovascular regulation make the identification of such disorders a relevant issue in modern medicine.

Objective of the Study. To investigate autonomic nervous system dysfunction in elderly patients with arterial hypertension and post-COVID syndrome.

Materials and мethods. As part of outpatient follow-up at the clinical bases of the Kazakhstan Russian Medical University, a study was conducted to assess autonomic dysfunction in elderly patients with arterial hypertension and post-COVID syndrome. The examination included interviews, physical examinations, and assessment using Wayne’s scale, and heart rate variability analysis using the «CardioVisor» module. Time and frequency domain parameters were evaluated: SDNN, rMSSD, pNN50, LF, HF, LF/HF, the stress index, and the regulatory systems activity index.

Results. The study included 141 patients divided into two groups. The mean age in the main group was 70.81 ± 5.36 years, compared to 74.00 ± 6.06 years in the control group (p = 0.003). The proportion of patients aged 60-74 years was higher in the main group (p = 0.006). Grade 1 arterial hypertension was more common in patients with post-COVID syndrome, while grades 2 and 3 were more frequent in the control group (p = 0.042). Patients with post-COVID syndrome more often reported fatigue (38.36 %), anxiety (19.18 %), memory impairment (21.92 %), and excessive sweating (26.03 %) (p ≤ 0.001). According to the Wayne scale, respiratory symptoms were more prevalent during emotional stress (p = 0.014). Among heart rate variability indicators, a significant difference was observed in the LF/HF ratio (1.8 vs 1.5; p = 0.049).

Conclusion. In elderly patients with arterial hypertension, post-COVID syndrome is accompanied by characteristic complaints and signs of autonomic dysfunction, highlighting the need for further investigation into its impact on chronic conditions.

Myofunctional disorders and dentoalveolar anomalies in children after surgery for adenoid hypertrophy are an important problem. There is information in the literature that the most common dentoalveolar anomaly in children with adenoid hypertrophy is distal occlusion. In the presence of distal occlusion, it is necessary to study the state of the dentoalveolar system after adenotomy and identify myofunctional disorders.

The purpose of this study: to analyze the condition of children after adenotomy from an orthodontic point of view.

Materials and methods: We examined 80 patients with distal occlusion who required orthodontic dental care after surgery for adenoid hypertrophy.

Results: The diagnostics (functional tests and X-ray examination) revealed that the majority of patients had myofunctional disorders, including oral or mixed breathing, and a dentoalveolar anomaly, specifically a distal bite.

Discussion: The results of our studies are of significant scientific and practical interest and require further in-depth study. The authors hope that the above will facilitate the early diagnosis of myofunctional disorders and dentoalveolar anomalies in children after adenotomy for specialists of various profiles.

Conclusions: The study of the condition of children after adenotomy from the orthodontic point of view revealed the predominance of distal bite (2 skeletal class, posterior position of the apical base of the lower jaw (along the sagittal plane) relative to the anterior segment of the base of the skull) and oral or mixed breathing. The conducted studies will contribute to the development of a comprehensive, interdisciplinary approach to managing patients with such conditions.

In the current healthcare context, the moral and psychological climate within nursing teams is becoming a critical factor influencing job satisfaction, staff retention, and the quality of healthcare services. However, these aspects remain insufficiently explored in the Republic of Kazakhstan.

Objective: To analyze the impact of organizational and psychological factors on the moral and psychological climate in the nursing staff of a medical facility in Almaty.

Materials and Methods. A cross-sectional survey was conducted with the participation of 281 nurses. The research instrument included demographic questions and scales for assessing job satisfaction, communication traits, and moral climate. Data were analyzed using the chi-square (χ²) test, regression analysis, and Cronbach's alpha coefficient.

Results: A statistically significant association was identified between a high moral and psychological climate and indicators such as team cohesion, trust, constructive criticism, freedom of expression, and positive emotional background. Nurses who positively assessed the workplace climate were more likely to choose cooperation and compromise strategies in conflict situations.

Conclusions: Establishing a sustainable moral and psychological environment through improved internal communication and staff support should become a priority in healthcare human resource policy.

Myasthenia is a classic autoimmune disease, the clinical manifestations of which, in the form of weakness and pathological muscle fatigue, are caused by the phenomenon of autoaggression with the formation of antibodies directed against various antigen targets of the peripheral neuromotor apparatus. In addition to somatic manifestations, more and more attention of researchers is attracted by concomitant mental disorders, primarily depressive states, which can significantly aggravate the course of the underlying disease and reduce the effectiveness of complex therapy.

The purpose of this study is to assess the frequency and relationship of depression in patients with myasthenia.

Methods and Materials. Forty patients with myasthenia were examined (14 men and 26 women, the average age of patients was 48.6 ± 12.95 years). The severity of depression was determined using the Beck Depression Inventory (BDI). The relationship between these indicators and gender, age, disease duration, and myasthenia severity, as measured by the MGFA scale, was clarified.

Results. The results indicate a high prevalence of depressive symptoms among patients with myasthenia, with mild and moderate depressive disorders being the most common. For patients with myasthenia, the level of depression according to the Beck Depression Inventory was significantly higher than in healthy subjects. In patients with myasthenia, the value was 16.62 ± 8.15, and in healthy volunteers, it was 8.25 ± 5.06 (p < 0.01).

Conclusion. Thus, depression in patients with myasthenia gravis is a common and often underestimated clinical problem that requires a comprehensive and systematic approach to diagnosis and therapy. The introduction of timely depression screening into standard clinical algorithms for the management of patients with myasthenia gravis facilitates more timely detection of affective disorders, increases treatment adherence, and improves the overall prognosis of the disease. An interdisciplinary approach, involving interaction between specialists in neurology and psychiatry, is optimal, ensuring more effective management of this patient group.

The heterogeneity of neuroendocrine tumors not only in their localization, but also in their clinical manifestations, the lack of clear criteria and algorithms for their diagnosis, as well as the low alertness of doctors in the general clinical network regarding the timely detection of this group of tumors, in most cases leads to their late diagnosis, resulting in only the palliative stage of their treatment. A clinical case is presented to demonstrate the relevance of the problem.

A clinical case. Since March 2020, the patient has been periodically bothered by loose, mushy stools. During an examination in the clinic, according to computed tomography of the abdominal organs from 02/20/2021, a neoplasm of the head and body of the pancreas with invasion of the portal and splenic veins, subtotal lesion of the pancreas with vascular invasion) and multiple liver metastases was detected, taking into account the results of computed tomography studies, pancreatic malignancy, T3NxM1, multiple metastases in the liver.

Conclusions. The variety of clinical manifestations of neuroendocrine tumors complicates their early diagnosis and treatment, which requires high oncological alertness, effective interaction of specialists and the creation of national protocols for early detection and therapy.

The relevance of the presented clinical observation is due to the rarity of the combination of extragenital endometriosis with chronic infectious diseases, in particular brucellosis. Brucellosis, which has an immunomodulatory effect, can contribute to impaired immune surveillance and support chronic inflammation, creating conditions for the progression or atypical course of endometriosis. The number of descriptions of cutaneous forms of endometriosis in the background of chronic infections is extremely limited in the available literature, which makes the presented cases a valuable contribution to clinical practice and deepens the understanding of the immunopathogenesis of the disease.

A series of clinical cases:

Diagnosis of 1 case. The diagnosis is primary chronic brucellosis. Subcompensation. Osteochondrosis, spinal spondyloarthritis of the cervical, thoracic and lumbosacral spine with radicular syndrome. Osteoarthritis of the knee, small hands and feet, talus-calcaneus-navicular joints. Spastic colitis. Uterine fibroids. Extragenital endometriosis.

Diagnosis of the second case. Primary-chronic brucellosis, subcompensation. Small-focal myocarditis. Degenerative-dystrophic changes of the lumbar spine. L2-L4 spondylosis. L1 spondylitis with a small leak. Osteochondritis L2-L3, L3-L4, L4-L5, L5-S1. Osteoarthritis of the knee and small bones of the joints. Phlebitis. Vegetative vascular dystonia. Polyarthroneuromyalgia. Endometriosis. Salpingooophoritis. Ovarian cyst on both sides.

Concusions. The presented clinical cases demonstrate the development of external extragenital endometriosis. The leading clinical syndrome was pain syndrome, manifested as secondary dysmenorrhea.

The chronic infectious process led to a dysfunction of the immune system, resulting in the dissemination of endometriodic heterotopias into various organs.

Quality healthcare is the primary objective of any healthcare system. An effective electronic health record system is a crucial tool for achieving this goal. Its objectives are to improve the quality of medical care by automating the work of doctors and medical personnel in all areas of activity.

The purpose of this study. To explore the impact of electronic health records systems in primary health care facilities on improving the quality of care to ensure a sustainable organizational structure as an essential public healthcare function.

Materials and methods. The search was conducted in the MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. The search strategy was based on the PICO Framework. The studies selected for the meta-analysis were published between January 1, 2010, and May 1, 2023. Two authors independently reviewed article titles and abstracts for eligibility. Information from the search was deduplicated using EndNote X9 and imported into the Covidence Systematic Review for review. Statistical processing was performed in RStudio 2023.03.1 Build 446 (Posit Software, PBC).

Results. A literature search identified 640 publications; 11 of them were included in the review. Meta-analysis showed that the use of electronic health records (EHRs) helps to reduce the time to complete medical records by 33.4 % (95% CI = 0.8 % to 1.2 %; p < 0.007), promotes adherence to clinical recommendations (RR 1.30; 95 % CI = 1.04 to 1.79; p = 0.05) and reduces prescribing errors (RR 0.44; 95 % CI = 0.34 to 0.53; p < 0.001), which undoubtedly improves the quality of medical care.

Conclusion. This study validates the positive influence of EHRSs on enhancing care quality in PHC settings, primarily by streamlining documentation, reducing prescription errors, and aligning workflow with clinical guidelines. These findings can help healthcare and public health professionals make informed decisions about EHRS adoption.

Being one of the most common types of cancer, prostate cancer requires a specific diagnostic approach, using modern, highly sensitive, and specific diagnostic methods. An analysis of existing methods will allow us to determine the most effective strategies for early detection and control of the disease.

The purpose of this study. To summarize existing data on the diagnostic algorithm for prostate cancer, identify the strengths and weaknesses of each of the procedures used, and evaluate the impact and effectiveness of modern diagnostic methods.

Methods and materials. Information was searched and analyzed in Google Scholar, PubMed, Elsevier, Web of Science, and Medline databases. The review includes data from meta-analyses, randomized controlled trials, systematic reviews, and clinical trials. Duplicate articles have been deleted, information verified, and irrelevant works excluded. As a result, 75 full-text documents and abstracts were selected, providing a comprehensive analysis of the problem under consideration.

Conclusion. Combined approaches increase the accuracy of pancreatic cancer diagnosis. PSMA-PET improves the detection of metastases, but remains expensive and difficult to access in developing countries. A liquid biopsy has potential, but requires improved sensitivity. Transrectal ultrasound examination remains an important tool, but its diagnostic value is limited. A magnetic resonance imaging-targeted biopsy reveals more clinically significant prostate cancer than a systematic biopsy. Artificial intelligence in diagnostics requires development, but its use should be regulated.

Cirrhosis of the liver is often accompanied by portal hypertension, which causes dangerous varicose veins of the esophagus and stomach. Untimely stop of bleeding leads to high mortality. Nonselective betablockers and somatostatin are actively used in therapy.

The purpose of the study. Тo analyze the combined treatment of nonselective beta-receptor blockers and somatostatin in the treatment of bleeding from varicose veins of the esophagus and stomach in cirrhosis of the liver.

Мaterials and Methods: A literature review conducted over the past 25 years in Google Scholar, PubMed, and other databases revealed 20 relevant sources. The selected sources meet the inclusion criteria.

Results: NSB, like propranolol, reduces portal pressure, heart rate, and cardiac output. Somatostatin reduces visceral blood flow and inhibits vasodilation, helping to stop bleeding. The combined use of these drugs reduces the risk of recurrent bleeding and the development of hepatorenal syndrome more effectively than monotherapy.

Conclusions: The combined use of NSB and somatostatin increases the effectiveness of the treatment of varicose veins in cirrhosis of the liver and reduces the risk of complications

Today, digitalization is one of the important trends that affects all aspects of modern healthcare, including ophthalmology. The rapid development of technologies creates new opportunities to improve the accessibility and quality of medical care.

Ophthalmology faces numerous global challenges, including an increasing number of patients with eye diseases, a shortage of specialized physicians, and a growing burden on the healthcare system. An aging population and the prevalence of a large number of chronic diseases also exacerbate these challenges. For example, diabetes mellitus is a leading cause of vision loss. In this context, digitalization can be an important tool to overcome existing barriers.

The purpose of this study. To investigate the current state of digitalization in ophthalmic care, to identify the main barriers and prospects.

Materials and methods. The study analyzed scientific literature, reports from international organizations, and practical examples of digitalization in ophthalmology. Methods of comparative analysis and data systematization, including international experience and the current situation in our country, were employed.

Results. The analysis revealed that digitalization in ophthalmology encompasses the utilization of technologies such as telemedicine, artificial intelligence, electronic medical records, and mobile applications. The primary barriers to digitalization include inadequate infrastructure, a lack of qualified personnel, financial constraints, and cybersecurity concerns. Prospects include the widespread use of telemedicine technologies and the automation of diagnosis and treatment with artificial intelligence, which can significantly improve the accessibility of ophthalmic care in remote areas.

Conclusions. The digitalization of ophthalmic care will address the primary challenges of these sectors, including a shortage of specialists and high treatment costs. Successful implementation requires investment in infrastructure, training of medical staff, and active government support.