Hypersensitivity pneumonitis is a chronic immune-mediated inflammatory lung disease that develops as a result of repeated exposure to inhaled organic or inorganic antigens. This article presents an analysis of current data on etiological factors, pathogenetic mechanisms, and regional features of disease distribution. The key elements of immunopathogenesis are discussed, including the role of T-cell-mediated immune responses, cytokine regulation, and fibrogenesis. The significance of genetic factors, such as HLA polymorphisms and telomere shortening, which determine individual susceptibility and disease severity, is highlighted. Particular attention is given to the study of potential biomarkers reflecting the activity of inflammation and fibrotic remodeling. The article emphasizes the challenges of late diagnosis and the difficulties in identifying causative antigens. Local factors, including climatic and occupational exposures, influence the risk of sensitization and disease development. A comprehensive understanding of the etiology, pathogenesis, and molecular mechanisms of hypersensitivity pneumonitis contributes to improving approaches for early detection, differential diagnosis, and prognostic assessment.

In addition, the review summarizes the results of recent studies demonstrating the overlap between fibrotic hypersensitivity pneumonitis and idiopathic pulmonary fibrosis, particularly in molecular and histopathological patterns. These findings underline the need for timely recognition of fibrotic transformation and the integration of molecular biomarkers into clinical practice. Given the lack of large-scale national studies, further research focusing on local environmental and occupational factors in Kazakhstan is crucial for clarifying regional patterns of antigen exposure and disease progression.

The review provides an analysis of the role of the activity of the enzyme diamine oxidase in the diagnosis of urticaria in children. The authors conducted a traditional search for sources in the databases PubMed, Web of Science, ScienceDirect, Google Scholar in Kazakh, Russian and English, which are in open full-text access and contain statistically confirmed conclusions, the search depth was from 1990 to 2024. The initial literature search revealed 413 articles from the PubMed database, Google Scholar 104 articles, Web of Science 10 articles, ScienceDirect 312 articles. Seventy one sources were selected as analytical materials. Summary reports, newspaper articles, and personal messages were excluded from the review.

In recent years, there has been an increase in allergic diseases among children, urticaria is caused by food allergens, is the most common. Histamine is one of the important mediators of urticaria and belongs to biogenic amines. Eating foods rich in histamine can cause symptoms of allergic reactions. The main enzyme of histamine metabolism is diamine oxidase, which is mainly present in intestinal epithelial cells. Measurement of serum diamine oxidase is used as the main diagnostic test and the usefulness of measuring serum diamine oxidase activity in the diagnosis of histamine intolerance has been confirmed in scientific studies, although conflicting results have been reported in scientific literature on the usefulness of measuring diamine oxidase in the diagnosis of histamine intolerance.

The enzyme diamine oxidase provides new opportunities in the diagnosis of urticaria. In this regard, this problem requires more careful study in relation to children, since it is very difficult for them to recognize this disease and prevent its further development.

The analysis of modern organizational and methodological approaches to early rehabilitation after hip replacement was carried out.

A systematic literature review on the organization of early postoperative rehabilitation after hip joint arthroplasty was conducted. Various rehabilitation models in different countries, their effectiveness, economic aspects, and the impact of digital technologies on the recovery process were analyzed.

The implementation of Enhanced Recovery After Surgery (ERAS) programs has reduced the average length of hospitalization by 2 times without increasing the frequency of complications, while the probability of rehospitalization decreased by more than 60%. Economic analysis showed a reduction in total treatment costs per patient by $4,000 with an additional gain of 0.08 QALY in Denmark. The effectiveness of using telemedicine technologies and mobile applications in the rehabilitation process was revealed. Comparative analysis of national models showed that the Scandinavian and British models demonstrate the highest economic efficiency with comparable functional results.

Proteins of the HP1 family (Heterochromatin Protein 1) play a key role in the organization of the three-dimensional structure of the genome, participating in the stabilization of heterochromatin and the formation of spatial compartments of the nucleus. For a long time, it was believed that HP1 realizes its functions through the mechanisms of liquid-phase separation (LLPS), but recent data indicate a more relevant role of microphase separation leading to the formation of heterochromatin nanodomains.

The review presents current concepts of the mechanisms of chromatin compartmentalization with the participation of HP1, including its binding to H3K9me2/3-modified nucleosomes , the ability to dimerize and form stable internucleosomal interactions. Particular attention is paid to heterochromatin nanodomains as structural units of microphase separation, their initiation by ATRX, PAX3/9 and ADNP proteins, as well as the thermodynamic parameters regulating their size and stability. The differences between the microphase separation and collapsed globule models , the role of HP1 in embryonic development and cell differentiation, and the involvement of histone H1 and other factors in the maintenance of B-compartments are discussed. The presented data highlight the importance of HP1 in shaping the nuclear epigenetic landscape and open up prospects for further biophysical and biomedical research in the field of regulation of genomic architecture.

Hearing loss is the most common form of sensory disability among children worldwide. Normal hearing is essential for the full social and linguistic development of children corresponding to their ageappropriate characteristics. Successful auditory and verbal rehabilitation is defined as the restoration or acquisition of hearing and speech by a patient. As an interdisciplinary task, auditory and verbal rehabilitation of children who have undergone cochlear implantation (CI) includes a number of specific aspects.

A thorough understanding of these aspects improves not only the accuracy of medical prognosis, but also helps to identify factors that need to be corrected to achieve optimal results of auditory and verbal rehabilitation in the future. The aim of this study is to analyze potential factors that may influence the results of auditory and verbal rehabilitation of children who have undergone CI.

The aim of this study was to conduct a comprehensive analysis of the adaptive responses of the cardiorespiratory and psychophysiological systems in young athletes of various specializations. The research assessed functional indicators of external respiration, cardiovascular activity, cognitive status, and anxiety levels, taking into account age, somatotype, training experience, and sport profile.

The study involved adolescent males engaged in mini-football, volleyball, swimming, boxing, and track and field. It was found that athletes with long-term training experience demonstrated significantly higher values of vital lung capacity, minute ventilation, and ventilatory power, indicating a well-developed respiratory adaptation. Psychophysiological testing revealed statistically significant advantages in memory, attention, and stress resilience among trained participants (p<0.05).

Special attention was given to the diagnosis and prevention of overtraining syndrome, which manifests through reduced ventilatory efficiency, autonomic imbalance, emotional instability, and signs of functional exhaustion. A direct relationship was established between the functional state of the cardiorespiratory system and the level of long-term adaptation to specific muscular activity.

As a promising direction for future research, the study proposes investigating the role of myokines – biologically active molecules synthesized by muscle tissue – as potential markers of adaptation, recovery, and overtraining. Their integration into diagnostic protocols may enhance the accuracy of functional assessments in athletes.

The findings of this study can be applied in sports medicine to develop individualized training programs, guide athlete selection, and monitor the physiological condition of young athletes.

The article addresses proactive management of work-related health hazards in the mining and metallurgical sector. This study applies an integrated risk assessment approach to form the foundation of a risk-oriented health management model. The analysis was conducted at a full-cycle gold mining and processing plant (open-pit mine, beneficiation, and hydrometallurgical units), using comprehensive hygienic evaluation of physical, chemical, and ergonomic factors.

Results identified the most significant health hazards: whole-body vibration and intense noise (class 3.2), high levels of respirable silica dust (class 3.2-3.3), and exposure to toxic chemicals (cyanide, class 3.3). Elevated physical workload and work intensity (class 3.2-3.3) were also found among operators and managers. Multiple exceedances of hygiene standards confirm a high risk of occupational diseases (vibration syndrome, hearing loss, silicosis, etc.).

Based on the integrated risk assessment, a prioritized register of occupational risks was compiled. Key practical measures are recommended: enhanced cyanide control (sealed processing systems, automated reagent dosing, continuous air monitoring), dust suppression and improved ventilation, reduction of noise and vibration exposures, ergonomic changes to ease heavy labor, and stress-management programs for staff. These interventions are proposed within a continuous improvement framework.

The study demonstrates that this comprehensive, risk-oriented model provides a fuller understanding of workplace conditions and focuses preventive efforts on critical hazards. Such a model forms a reliable foundation for a «healthy workplace» environment and significantly enhances actual worker protection.

Aim. To determine the nature of the relationship between the nutrient composition of the diet and biochemical indicators of nutritional status in men and women aged 60 – 90 years with nutrition-related diseases, identifying gender-specific features of these correlations.

Materials and methods. A cross-sectional study was conducted involving 350 participants aged 60 to 90 years, including elderly individuals (60 – 74 years) and senile individuals (75 – 90 years). The following indicators of nutritional status were assessed: аnthropometry (body weight, height, and body mass index); dietary assessment (analysis of the average daily diet with determination of macro- and micronutrient intake); biochemical analysis (determination of blood glucose, cholesterol, creatinine, urea, and triglyceride levels); statistical analysis (Spearman’s rank correlation coefficient was used to assess the relationships). Correlation strength was interpreted as weak (r = 0.1 – 0.3), moderate (r = 0.3 – 0.5), and strong (r > 0.5). The significance level was set at p < 0.05.

Results and discussion. In men, body mass index showed a positive correlation with glucose, cholesterol, and triglyceride levels. Protein, fat, and vitamins A, E, and B1 intake were associated with increased creatinine and urea levels, reflecting active metabolic processes.

In women, the correlations between nutrients and biochemical indicators were weaker and multidirectional: glucose levels were negatively correlated with carbohydrate intake and dietary energy value, while urea levels were positively associated with calcium and tocopherol intake.

Thus, men demonstrated more pronounced and systemic relationships between nutrient composition and metabolic indicators, indicating gender-specific metabolic regulation features.

Conclusions. Elderly men exhibited stronger correlations between nutrient composition and biochemical indicators than women. In women, these correlations were weaker and multidirectional, likely due to physiological and hormonal characteristics of aging. The findings confirm the importance of considering gender differences when assessing nutritional status and developing personalized dietary recommendations for the prevention of nutrition-related diseases.

Aim. Evaluation of the impact of dust load on the function of external respiration in coal miners.

Materials and methods. Hygienic, analytical, evaluation of the function of external respiration.

Results and discussion. The characteristics of air dustiness in workplaces in underground mines were obtained and analyzed, dust loads were calculated for workers of the main professional groups, the function of external respiration taking into account the length of service and age of workers.

Conclusions. The effect of length of service on the reduction of external respiration function indicators is shown.

Aim. To conduct a retrospective analysis of the dynamics of meningococcal infection morbidity in the Republic of Kazakhstan from 2010 to 2022 and to identify factors influencing the activation of the epidemic process.

Materials and methods. The epidemiological study was based on data from forms No. 1 and No. 2 of the epidemiological department of the branch of the Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring under the National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan. Statistical analysis was conducted on morbidity data from 2010 to 2022.

Results and discussion. Although the incidence rate has decreased in recent years, the transmission routes, serological diversity of the pathogen, and asymptomatic carriage continue to pose a risk for new outbreaks. Certain periods with increased morbidity were identified, linked to regional specifics and migratory flows.

Conclusion. Retrospective analyses play a key role in managing the epidemic process of meningococcal infection. The findings can be used to enhance preventive measures and reduce the risk of disease spread.

Aim. To study the avoidable mortality from respiratory disease in Aktobe region in 2019 – 2023.

Materials and methods. To calculate avoidable mortality we used the methodology suggested by OECD and the Eurostat working group. The data collected from the National Research Center for Health Development in the Aktobe region. The data included number of deaths using International Classification of Diseases 10, also gender, and area as urban and rural. The preventable and treatable mortality, as well as absolute and relative changes and the average annual percentage change were included in analysis.

Results and discussion. Between 2019 and 2023, avoidable mortality from respiratory diseases showed a decline, with a notable decrease in urban areas and a slight increase in rural areas. Preventable mortality was higher in males than females, with chronic lower respiratory diseases being the leading cause, and rural areas experiencing significantly higher rates than urban areas. The trends in treatable mortality showed a consistent decline, particularly in urban areas, with rural females seeing the largest decrease. Preventable mortality from COVID-19 was higher in males overall, however in rural areas, females had higher rates.

Conclusion. The avoidable and preventable mortality from respiratory diseases declined overall from 2019 to 2023, though with significant regional and gender disparities. Urban areas had more improvements, while rural areas experienced slower progress and higher mortality rates, particularly among males. Continued targeted interventions, especially in rural areas, are necessary to reduce these disparities and improve health outcomes.

Aim. To analyze the trends in the incidence of acute cholecystitis in the Akmola region from 2009 to 2022.

Materials and methods. The study is based on a retrospective analysis of data from the Ministry of Health of the Republic of Kazakhstan using the International Classification of Diseases, 10th Revision (ICD10), code K81. To assess incidence dynamics, methods of health statistics and time series analysis were applied.

Results and discussion. Between 2009 and 2022, a total of 12,538 patients were hospitalized with acute cholecystitis in the Akmola region. The hospital-based incidence rate decreased from 136.3±4.3 to 106.7±3.8 per 100,000 population (p24 hours after symptom onset) decreased from 68.9 to 36.9 per 100,000, reflecting improved early access to care.

Conclusions. The study highlights the need to improve medical approaches to the treatment of acute cholecystitis in the Akmola region. The results indicate the critical importance of early diagnosis and timely hospitalization to reduce complications. There is currently a need for additional research to review existing and develop more effective clinical protocols.

Introduction. Magnetic resonance radiation and ultrasound are the most common types of nonionizing radiation (NIR). Existing data on the biological effects of these types of non-ionizing radiation on the cardiovascular system and nervous system are of an ambiguous nature. There are no universal tools for assessing the long-term biological effects of NIR.

Aim. To investigate the relationship between heart rate variability indicators and depression among healthcare professionals based on their professional exposure to various types of non-ionizing radiation: ultrasound and magnetic fields.

Materials and methods. The study included 60 healthcare workers from magnetic resonance imaging (n=22), ultrasound (n=20) and ophthalmology (n=18) rooms. All medical workers had professional contact only with one type of NIR. The level of depression in all subjects was assessed using the PHQ-9 scale and the heart rate variability (HRV) indicators.

Results and discussion. 60% of the medical workers had various levels of depression. In the group of ultrasound room workers, 60% had mild depression and 25% had moderate to severe depression. When assessing intergroup differences using the Mann-Whitney criterion, statistically significant differences were found in depression (p=0.0001) and HF (p=0.001). In conducting multiple multivariate logistic regression (control group – medical staff of ophthalmological rooms), depression lost its significance, and only HF in the group of MRI room medical workers retained statistical significance (p=0.049)

Conclusions. Overall, our results demonstrate a high level of depression among medical workers, and HRV serves as an objective indicator reflecting a decrease in vagus nerve tone associated with depression symptoms. Further research is needed to assess the biological effects of ultrasound and radiation from MRI devices on the health of medical workers, which will help develop preventive measures.

Aim. To study the features of the work of nurses during the coronavirus pandemic.

Materials and methods. A retrospective study was conducted, the main method of which was a questionnaire. 90 nurses working in three different medical organizations in Karaganda took part in the survey: City Center for Primary Health Care, Multidisciplinary Hospital No. 1 and Multidisciplinary Hospital named after Professor Kh. Zh. Makazhanov.

Results and discussion. Absolutely all respondents had to master certain new skills and perform an increased amount of work, study and improve various types of activities, often with a shortage of medical products/consumables. Nursing staff often faced negativism and stigmatization. The most resistant to these situations were respondents who were engaged in increasing the level of their emotional intelligence. The overwhelming majority of respondents consider vaccination the main measure to combat the coronavirus pandemic. Since the beginning of the pandemic, at the City Center for Health Care in Karaganda, more than 90 thousand doses of vaccines have been used in immunization against coronavirus, and vaccination was carried out by nursing staff.

Conclusions. A sociological study was conducted among nursing staff of various medical organizations. The study found that nursing staff during the coronavirus pandemic were forced to work under excessive loads and high psycho-emotional stress. The study found that nurses faced many challenges, such as negativism and stigmatization from the public.

Aim. Study of possible problems of online sales of pharmaceutical goods in the Republic of Kazakhstan and identification of the main reasons for their occurrence.

Materials and methods. Databases of the Information System of Labeling and Traceability of Goods (markirovka.ismet.kz) for studying the unified scheme of turnover of pharmaceutical goods, the Information and Legal System of Regulatory Legal Acts of the Republic of Kazakhstan (Adilet.zan.kz) for analysis of regulatory documents in the field of circulation of medicines and medical devices of the Republic of Kazakhstan, as well as official websites of state bodies of the Republic of Kazakhstan, RSCI, Scopus, Pubmed databases.

Results and discussion. A comparative analysis of the pharmaceutical e-commerce market in the Republic of Kazakhstan was carried out, focused on the retail sale of medicines. In addition, a comparative analysis of the obtained data with the database of regulatory legal acts of the Republic of Kazakhstan was carried out. As a result, the main problems arising in the sale of medicines through online platforms, such as online pharmacies and marketplaces, were identified.

Conclusions. Online sale of medicines in Kazakhstan is associated with many problems related to quality control, compliance with regulatory requirements and maintaining the confidentiality of buyers' data. The main risks include difficulties in checking permits, control of the authenticity and quality of products, violation of storage and transportation conditions, as well as problems with the return of goods and price regulation. In addition, significant attention is required to ensure the security of patient data and the accuracy of the translation of information about products.

Aim. To test the performance and assess the feasibility of spirometric quality criteria of ATS/ERS2019 protocol in an epidemiological study.

Materials and methods. Spirometry was completed in 989 adults (18 years old and older, median age 42 (interquartile range (IQR) 25;55) years), residents of Shymkent selected from the general population after training. Spirometry quality was assessed with a range of criteria, including the difference in forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC) between attempts, whereas the predictors of criteria attainment were tested in adjusted regression models.

Results and discussion. Total number of attempts varied from 3 to 23 (median 4, IQR 3;6) and it was independently associated with age, FEV₁%, smoking status and educational level. ΔFEV₁ median equaled 0.05 l (IQR 0.03;0.09), whereas ΔFVC median was 0.06 (IQR 0.03;0.10). Back extrapolation volume median was 0.07 (IQR 0.05;0.11). End-expiratory flow (EEF) median was 0.16 (IQR 0.09;0.33) l, and was independently associated with age, FEV₁, FVC and their ratio, as well as diagnosed COPD. The target EEF value of 0.025 l/s could be attained in only 13 subjects (1%) out of 989.

Conclusions. Overall, high standard of spirometry could be attained with the majority of indicators after the relevant training; however, keeping the expiration till the target end-expiratory flow of 25 ml/s is the greatest challenge and hard to achieve.

Aim. To consider the legal and ethical aspects of DNA identification and theft of genetic information, to study the opinions of students of Toraigyrov University about the possible risks of theft of genetic information.

Materials and methods. A questionnaire was compiled for the study. This survey was conducted to study the awareness and opinions of students regarding the topic. Questions include determining the level of knowledge about DNA identification methods, assessing the fears and concerns of intruders about the theft or abuse of genetic information, understanding public opinion regarding genetic privacy protection measures and legislation. These questions helped determine not only the respondents’ knowledge and understanding of genetic concepts, but also their attitude to the issues of privacy, ethics and regulation of the use of genetic information.

The survey on the topic «DNA identification and theft of genetic information» involved 103 respondents. Of these, 96% are students, and the remaining 4% are graduates of Toraigyrov university, that is, employees who currently work in various institutions of the city.

Results and discussion. The results show that, firstly, there is a high level of awareness about the possible risks of DNA theft, which indicates the urgency of this problem in society. Secondly, half of the respondents expressed concern about the possibility of abuse of their genetic information and supported the introduction of strict security measures to protect their privacy. The third result indicated that most respondents were willing to take precautions, such as protecting personal information and using safe methods to store DNA samples.

Aim. To identify the conditions that enhance the effectiveness of mentorship at the Department of Pediatrics and Neonatology among seventh-year medical interns specializing in General Medicine within the training program of General Medical Practice.

Materials and methods. An assessment was conducted involving 87 medical interns majoring in General Medicine during General Medical Practice.

Results and discussion. The mentor formulated the learning objectives and consistently obtained feedback from the trainees. Using the mentorship-based learning model, the mentor, in accordance with their specialization and adhering to proper teaching techniques, explained the tasks to the trainee, step by step and then asked questions to ensure that the intern had understood the material. When the mentor emphasized the practical aspects of knowledge transfer, the skills or information were assimilated more effectively, as the interns began to perform the procedures independently and developed critical thinking in nonstandard situations.

Conclusion. Mentorship, as an indisputable factor in the formation of a young specialists, largely determines the quality of their training and provides the correct direction for the professional development of future doctors.

The experience of using the patient-centered counseling method in the educational process to develop communicative competence among future doctors is presented.

Aim. The aim was to analyze the effectiveness of teaching 5th-year students of the School of Medicine complementary communication with patients within the framework of the international educational project FOR21 of the Erasmus+ CBHE program.

Materials and methods. 36 students of the General Medicine specialty took part in training in the technology of the best interviews with patients. The first stage of the training took place in the classroom using the «flipped» classroom technology, the Padlet visual board, and the Open Labyrinths Internet resource. At the second stage, at the Center for Simulation Technologies, the Calgary-Cambridge version of the interview with a standardized patient was used. The third stage took place in the clinic. At each stage of training, debriefing was conducted among students, including questionnaires.

Results and discussion. The debriefing showed that 100% of students demonstrated active listening; critical thinking and effective learning skills – 50% of students. 70% of students demonstrated critical selfassessment skills during communication. 40% of individuals emphasized that the “script case” and “university walls” did not allow them to fully use their newly acquired communication skills. Some fifth-year students experienced stress during an interview with a standardized patient. More than 80% of listeners rated mental stress a 7 out of 10. All 100% of participants noted the high demand for training, 40% saw their own problems in communication.

Conclusions. Was found that thanks to patient-centered interview technology, students developed the best communication skills.

The aim of the study was to ensure logical and consistent implementation of training, as well as effective organization of the educational process.

The study employed methods of system analysis, pedagogical design, and a modular approach. The materials included theoretical developments in the fields of didactics, pedagogy, and information technology, as well as practical experience in creating electronic educational courses. To implement the structuralmodular approach, the following stages of course design were developed: conceptual, technological, operational, and implementation. During the design process, multimedia technologies, interactive elements, and testing systems for knowledge assessment were applied.

As a result of the study, the structure of an electronic educational course was developed, comprising three interconnected subsystems: content, information-navigation, and diagnostic. The content subsystem provides the theoretical foundation of the course, the information-navigation subsystem ensures convenient access to materials, and the diagnostic subsystem enables the monitoring and assessment of students' knowledge. The modular approach allowed the educational material to be divided into autonomous blocks, each aimed at achieving specific educational goals. This ensures the flexibility of the course, its adaptability to different levels of student preparation, and simplifies the process of updating content. Particular attention was paid to interactive elements, such as forums, assignments, tests, and multimedia materials, which contribute to increased motivation and engagement among learners. The developed course design methodology was tested in the educational process, confirming its effectiveness in improving the quality of learning.

The structural-modular approach to designing electronic educational courses allows for the systematization of educational material, ensuring its logical sequence and accessibility.

The main idea of the study is to strictly limit the expert concept of «affect» within Complex Forensic Psychological and Psychiatric Examination to the culminating type, characterized by a total disruption of voluntary regulation, in order to ensure its correct legal application as «sudden strong emotional turmoil» (Articles 101 and 111 of the Criminal Code of the Republic of Kazakhstan).

The research methodology relies on a multi-factor theoretical and practical analysis of the legal and psychological basis of the concept of «affect» within the framework of forensic expertise. The study involved a thorough literature review covering methodological and organizational-legal foundations of Complex Forensic Psychological and Psychiatric Examination and the conceptual discrepancies of affect between general psychology and criminal law. The core analytical approach utilized was socio-psychological modeling of the individuals involved in the forensic assessment to evaluate the examinee's capacity for conscious action regulation.

The study confirms a crucial conflict: the concept of «affect» differs significantly among general psychology, forensic psychology, and criminal law (Articles 101/111 of the Criminal Code of the Republic of Kazakhstan, referring to «sudden strong emotional turmoil»). The primary issue identified is the absence of a systemic approach in Complex Forensic Psychological and Psychiatric Examination to accurately link psychological findings to the specific legal criterion, leading to the potential confusion of true affect with other strong emotional states (stress, fear).

For the effective application of Complex Forensic Psychological and Psychiatric Examination results and their correct correlation with the legal concept of «sudden strong emotional turmoil» (as per Articles 101 and 111 of the Criminal Code of the Republic of Kazakhstan), the expert concept of «affect» must be strictly limited to the culminating type, characterized by a total disruption of the voluntary regulation of behavior and temporary narrowing of consciousness, thereby eliminating the ambiguity resulting from the varying conceptual scopes in psychology and law and significantly increasing the objectivity and legal validity of the expert conclusion.

In recent years, there has been an increase in the number of patients with urolithiasis, which is associated with changes in lifestyle and nutrition. A clinical case of a 60-year-old patient with bilateral ureteral stones against the background of chronic calculous pyelonephritis and concomitant diseases demonstrates an effective approach to treating this problem. In 2024, a simultaneous operation was performed in the urology department of the State Budgetary Institution on the Right of Economic Management «City Multidisciplinary Hospital No. 2»: mini-percutaneous nephrolithotripsy on the left and ureteroscopy on the right using laser lithotripsy. The operation lasted 130 minutes, and despite the presence of bilateral stones, blood loss was only about 50 ml. No complications were observed, which corresponds to level 0 according to the Clavien-Dindo classification. The patient was discharged on the 6th day after the intervention, which indicates high efficiency and safety of the performed surgery.

A review of the literature shows that simultaneous interventions such as mini-percutaneous nephrolithotripsy and ureteroscopy can significantly reduce the overall cost of treatment. They reduce the number of anesthesia and hospitalization time, which is also important for elderly patients with comorbidities. This approach not only minimizes surgical risks, but also increases patient satisfaction, as they can return to their normal life faster.

The clinical case emphasizes that simultaneous mini-percutaneous nephrolithotripsy and ureteroscopy are a safe and cost-effective method for treating bilateral urolithiasis in elderly patients. This solution allows for effective management of the disease, improving the quality of life of patients and reducing the burden on medical institutions.

Purulent sternomediastinitis is a severe complication of open cardiac surgery. Although the incidence of postoperative sternomediastinitis is 1-3%, mortality from this condition is high, and its course is complicated by concomitant diseases. In addition, the effectiveness of treatment of purulent sternomediastinitis varies depending on the approach used, and is also determined by the individual characteristics of the patient.

A clinical case of successful treatment of chronic purulent-destructive sternomediastinitis in a 53-year-old patient, which developed after aortocoronary bypass surgery from a sternotomy approach and lasted for one year, is presented. Physiotherapy procedures based on ultraviolet irradiation, laser therapy and intravenous laser blood irradiation in combination with antibacterial therapy were used for treatment, since there was prolonged suppuration of the wound in the postoperative period. The characteristics and sequence of the applied effects during the procedures are described in detail.

After three courses of combined physiotherapy procedures, the patient's wound was cleared of pathogenic microflora, suppuration ceased, swelling and wound size decreased, and the wound healed.

The results obtained in this study show that the combined use of ultraviolet irradiation, laser therapy and intravenous laser blood irradiation leads to rapid healing of the sternum wound in the treatment of complex purulent-destructive sternomediastinitis. The effectiveness and advantages of such combined physiotherapy procedures over invasive treatment methods should be studied in more detail.