With the progress of tissue engineering technologies, the use of biomaterials in reconstructive surgery has become a new stage of development. It should be noted, that the existing clinical and experimental studies aimed at finding high-tech materials "similar" to the tissue of the tympanal membrane to close the defects of the eardrum, do not completely solve the problems of otosurgery. The aim of this study was to use of the decellularized bovine-derived peritoneum matrix as a reconstructive biological material in operative otorhinolaryngology. Over the past 20 years in the available literature, the authors did not find data of the use of the decellularized bovine-derived peritoneum matrix for myringoplasty.

In this review, the spectrum of pathogens isolated from patients before and after upper urinary tract stenting was evaluated based on literature data from foreign sources. Analysis of the literature data revealed that the most frequent microorganisms isolated from urine samples and stents are E. coii, P. mirabiiis, P. aeruginosa, S. epidermidis and E. faecium. Many of these microorganisms are resistant to antibacterial drugs, which is an urgent problem, as it leads to an increase in the length of hospitalization, increased mortality and increased medical costs. Despite the fact that at the moment there are foreign works confirming the effectiveness of antibacterial prevention and therapy for urinary tract stenting, there is still no local data on the spectrum of microorganisms and their sensitivity to antibacterial drugs, which determines the relevance of future research.

The working population is regarded as an economically significant basis of the state, being an important core for the innovative and industrial development of the country. The psychosocial work environment consists of a culture of work organization, as well as the relationships of people, their spiritual values, beliefs and daily activities in the enterprise. Together, these factors affect the mental and physical condition of workers. Factors that can cause emotional or mental stress are often referred to as stress factors. In this regard, there is a need to study the psychosocial working environment as a component of healthy jobs. Objective: to study the psychosocial production environment for the management of occupational risks in the workplace.

Pupils spend a long time at school, where improved water, sanitation and hygiene services can improve health by decreasing diseases, such as diarrhea, respiratory infections, and soil-transmitted helminths. Recent studies showed that improved school WASH services have a positive influence on decreasing illnesses; for instance, in beneficiary schools, diarrhea was 29% lower. Symptoms of respiratory infections were 25% lower than in comparison schools. The aim of the study: to assess the access to the sanitation in rural schools. Material and methods: the study was carried out using the face to face interview with the administration of the school, observation checklist, and a questionnaire for the pupils. Results and discussion: 13.3% of pupils reported that the toilets are locked, and the key is not available in the schools. 20.5% of students reported the absence of separation of toilets by gender. 46.4% of them were girls. Additionally, 29.5% of students characterized as a problem of the separation absence by gender. 57.1% of them were female. 20.23% of pupils reported that the youngest pupils could not use the toilet without any help. Conclusions: analyzing the situation, we can conclude that access to sanitation is provided in schools, unfortunately, the conditions of their maintenance are ignored.

An analysis of occupational traumatism and professional morbidity in the Republic of Kazakhstan for a depth of 10 years is carried out, data on industries with adverse and harmful working conditions are presented. The dynamics of the total number of incidents among men and women (including group) are shown, data on the number of victims and deaths from industrial accidents are given. The data on occupational traumatism and professional morbidity by certain types of economic activity and by the level of accidents in various regions of the Republic of Kazakhstan are reflected. The aim of the study: analysis of occupational traumatism and professional morbidity in the Republic of Kazakhstan for a depth of 10 years, from 2008 to 2018. Materials and methods: a review of occupational traumatism and professional morbidity in the Republic of Kazakhstan is based on the analysis of statistical data from the Agency of the Republic of Kazakhstan on Statistics. Results and discussion: the analysis of the level of accidents showed that occupational traumatism in all regions of the republic has a general tendency to decrease. So, when comparing the indicators for 2008 and 2018, the following is observed: in the Karaganda region - a decrease of 54.2%; in the East Kazakhstan region - a decrease of 43.6%; in Pavlodar region - a decrease of 43.6%; in the city of Astana - a decrease of 55.9%; in Almaty - a decrease of 44%. Although the overall level of occupational traumatism and professional morbidity in the country remains high, it requires special attention and implementation of measures based on the assessment of working conditions. Conclusions: analyzing the situation of traumatism and professional morbidity in the whole country, we can conclude that every accident that occurs, except for social damage, causes the state large material losses. The analysis revealed that the largest number of victims of accidents and, accordingly, the largest material losses are observed in regions with worn-out fixed assets, a spent raw material base, which also has industry-specific consequences.

Air pollution is one of the most important tasks in the field of public health protection. In large cities, air pollution is mainly caused by stationary sources (industrial and fuel and energy enterprises). Purpose: to assess the state of atmospheric air in an industrial city in Central Kazakhstan. Materials and methods, environmental, retrospective and statistical research methods were used. Statistical analysis was performed using Statistica 8, descriptive statistics. Results and discussion: in terms of the volume of emissions of pollutants into the atmospheric air, the city of Temirtau took the second place in the republic with the volume of pollutants in 2018 - 587 thousand tons. The emissions from the metallurgical industry are dominated by solid particles of various diameters, hydrocarbons, nitrogen oxides, heavy metal salts, sulfur-containing compounds. All these toxic substances, when exceeding their permissible concentrations, negatively affect the health of the population. Conclusion, many sources of air pollution cannot be controlled by individuals and require consolidated action by the authorities at the local, national and international levels.

Concomitant dry eye disease exacerbates the course of chronic dystrophic diseases of the cornea and worsens the results of corneal transplantation. Keratoplasty for corneal transplant disease without effective relief of xerosis results in transparent engrafment in only 30% of cases. Aim: in clinical study to establish the effectiveness of the hyaluronic acid with a molecular weight of 500-700 kDa implementation in the corneal transplant disease treatment. Materials and methods: the study included 19 patients (20 eyes) aged 24 to 87 years, who developed transplant disease after keratoplasty because of chronic dystrophic corneal diseases. The dynamics of the severity of symptoms during treatment was evaluated weekly during the course of therapy using the OSDI (Ocular Surface Disease Index). To assess the dynamics of objective signs of Dry eye disease visometry, biomicroscopy, Schirmer's test, LIPCOF test were performed weekly before the next injection. A control study of the patient was carried out a week after the last injection. Results: changes in objective indicators of the eye surface state were characterized by positive dynamics during therapy. The Schirmer test (p<0.00001) increased most rapidly and significantly with a lasting effect for a month. A decrease in the OSDI index was noted after the first injection and continued to decrease progressively during the course and after its completion until the control one month after the last injection (p <0.00001). Conclusion: complex treatment with the inclusion of weekly subconjunctival administration of sodium hyaluronate (500-700 kDa) positively affects the condition of the graft, potentially extending its lifespan.

Materials and methods: the study involved 79 children. 6 main groups were formed depending on the level of glycosylated hemoglobin. The control group consisted of 52 children. Finally, refractometry was examined with the equipment «Auto Ref/Keratometer Huvitz» (HRK-7000A), for the quantitative analysis we calculated the spherical equivalent of eye refraction. Results and discussion: among children of the main groups, simple myopic (21.5%) and mixed astigmatism (36.7%) were most common in comparison with patients in the control group, 5.8% and 5.76%, respectively. The level of clinical refraction with the calculation of the spherical equivalent in patients with astigmatism and diabetes mellitus differs from the control group by some «myopization» in one of the study meridians. Determination of the level of clinical refraction in patients of the main groups, depending on the level of glycated hemoglobin, showed some variability in values from -0.76 D in the III and V groups to +0.5 D in groups VI and VII. Conclusions: among patients with diabetes mellitus type 1, refractive errors were more common (76%) than in children of the control group (38.5%). Among children of the main groups, simple myopic (21.5%) and mixed astigmatism (36.7%) were most common, in comparison with patients in the control group 5.8% and 5.76%, respectively. The level of clinical refraction with the calculation of the spherical equivalent in kids with diabetes mellitus differs from the control group by some «myopization» in one of the study meridians. Determination of the level of clinical refraction in patients of the main groups depending on the level of glycated hemoglobin showed some variability in values from -0.76 D in the III and V groups to +0.5 D in VI and VII groups.

Deficiency of the active form of vitamin D calcitriol is determined in the early stages of chronic kidney disease and progresses as the glomerular filtration rate decreases due to a decrease in its synthesis in the proximal tubules. A decrease in calcitriol level is a consequence of chronic kidney disease and at the same time accelerates its progression. This article presents literature data and the results of our own research on the analysis of the relationship between chronic kidney disease and vitamin D provision in children from 1 to 17 years old. Objective was to establish the level of Vitamin D in children with different stages of chronic kidney disease. Between January 2020 and September 2020 we examined 40 children (16 boys and 24 girls). The patients' age ranged from 1 to 17 years inclusive. Vitamin D deficiency was found in 62.5% of children with chronic kidney disease. Vitamin D deficiency was noted in 25% of cases. The prevalence of vitamin D deficiency correlates with a decrease in glomerular filtration rate. Determination of vitamin D level in children with chronic kidney disease is important for timely correction and prevention of further progression of chronic kidney disease. Timely substitution therapy will improve the quality of life of a child with chronic kidney disease and prevent the development of complications.

Changes in the vascular wall in patients with prediabetes are currently poorly understood, however even at the stage of prediabetes and diabetes risks, endothelial dysfunction occurs. Objective: to study the relationship between the endothelial dysfunction marker - Endocan-1, intima media thickness and insulin resistance indicators in patients with prediabetes. Materials and methods: an observational cross-sectional study was conducted, including 133 individuals, aged from 18 to 65 years. After clinical assessment, study participants were divided into 2 groups: Group I (n=55) - patients with prediabetes, Group II (n=78) - patients without prediabetes. HbA1c levels from of 5.7 to 6.4% were considered as a prediabetes. Ultrasound measured of the right and left intima media thickness of common carotid artery value >0.9 mm was considered as a marker of atherosclerosis. Results: significant differences the Endocan-1 levels were found between Group I (Mean±SD: 1787,18±435,1 pg/ml) and Group II (626,19±118,1 pg/ml; p=0,01). Also significant differences were found during study of intima media thickness with a predominance it in Group I, so the right common carotid artery intima media thickness: comprised 0,85±0,18 mm, the left common carotid artery intima media thickness 0,96±0,22 mm (p=0,03) in patients with prediabetes. Correlation analysis found relationships between Endocan-1, the right common carotid artery intima media thickness (r=0,62; р=0,005), the left common carotid artery intima media thickness (r=0,86; р<0,001), and also presence of an atherosclerosis (r=0,86; р<0,001). These findings indicate that in patients with prediabetes the elevation of the Endocan-1 level is associated with common carotid artery intima media thickness increase. Moreover, an elevation of Endocan-1 level has impact on the development of subclinical atherosclerosis in these patients. Endocan-1 showed significant correlation with insulin (r=0,27; р=0,03), IR-HOMA index (r=0,37; р=0,02), С-peptide (r=0,23; р=0,03), fasting glucose (r=0,22; р=0,05). Conclusions: we found the association of the Endocan-1 biomarker, Intima media thickness and insulin resistance indicators in patients with prediabetes. We suggest that rising of insulin resistance leads to Endocan-1 elevation, Intima media thickness and thereby to increase endothelial dysfunction and cardiovascular risk in these patients.

The article analyzes the main clinical manifestations of hemorrhagic disease of newborns and children of the first months of life. The issues of the course of the disease and measures for the prevention of hemorrhagic disease are also considered.

Purpose of the work: to research clinical and laboratory parameters, the proportion of concomitant pathology and complications that affect the severe course of COVID-19 in people over 60 years old. Materials and methods: a retrospective analysis of medical documents of 134 patients over 60 years old with COVID-19, proceeding with concomitant pathology and complications, was carried out. The patients were divided into two age categories: elderly people (from 60 to 74 years old) - 89 patients, as well as elderly people (from 75 to 90 years old) - 45 patients. Results and discussion: the severe unfavorable course of COVID-19 was associated with the presence of concomitant diseases from the cardiovascular system (coronary heart disease, arterial hypertension, myocardial infarction) - 115 (85.8%). Concomitant pathology of the respiratory system was noted in 16 (11.9%) cases, the presence of type 2 diabetes mellitus - in 36 (26.9%), oncopathology - in 8 (5.9%) cases. The development of complications also influenced the course of the disease, the most common manifestation was pneumonia, leading to DN and ARDS. According to the existing classification, lung damage according to CT data ranged from 10 to 90%. Persistent leukopenia, which was observed in patients transferred to the ICU, was a formidable sign of a severe course of the disease. Valuable laboratory criteria were neutrophilia, lymphocytopenia, increased levels of D-dimer, C-reactive protein.

The article describes the clinical manifestations and features of the course of coronavirus infection in children hospitalized in the children's hospital in Karaganda. The ages of the hospitalized children ranged from 6 months to 15 years. CVI was more often diagnosed in children under the age of 2 years than in older age groups. The disease was mainly mild to moderate. Kawasaki syndrome was diagnosed in 5 patients.

The authors proposed a new biological material for the tympanic membrane plastic surgery - the decellularized matrix of xenoperitoneum. The objective of the work was the quantitative assessment of hearing sense presence after myringoplasty using decellularized xenoperitoneal matrix in an experiment. A comparative characteristic of hearing sense was performed after myringoplasty with decellularized xenoperitoneal matrix and canned cadaver pachymeninx using the method of brainstem auditory evoked response (BAER-test), based on the assessment of the total length of three more expressed peaks in the audiogram. There were no statistically significant differences between a healthy ear and an operated ear with a new biological implant according to the results of the average values of the sum of the three peaks in the audiogram (53.2±13.55 mm and 40.6±9.77 mm, respectively (p>0.05). Hearing acuity after myringoplasty with decellularized matrix of xenoperitoneum was significantly restored to original values.

Determination of the content of macro- and microelements in hair is an important forensic diagnostic feature. The article presents the materials of the study of the elemental composition of the hair of the population of Central Kazakhstan. The analysis of the content of Cu, Zn, Co, Fe, Cr, Mn, Cd, As, Pb, Ni, P, Ca, K and Mg in the hair by the method of atomic emission spectrometry with inductively coupled plasma was carried out. The features of the receipt, distribution and deposition of these elements in living people and corpses, depending on the place of residence, gender, age, place of work and professional experience, are considered. Differences in the macro- and microelement composition of residents living in urbanized and rural areas were established. The analysis of microelement imbalance in persons working at industrial enterprises of regions and persons not employed in the production sphere is presented. At the same time, a significant excess of the concentration of toxic chemical elements in the hair was revealed in people who work for a long time in production, against the background of a significantly lower supply of the body with macronutrients. Differences related to the age index and gender were found. The most characteristic indicator indicators of the levels of accumulation of elements in the hair, formed under the influence of regional industrial complexes, were revealed. The issues of choosing optimal criteria for human identification during forensic medical examinations are considered

Objective: a comparative study of the macroscopic features of the placenta from pregnancies with preeclampsia and the placenta in the physiological course of pregnancy. Material and methods: based on the data on the course of pregnancy and the state of health of the mother, 355 placentas were selected in 2 groups: a group of pregnant women with preeclampsia and a group of pregnant women with a physiological course of pregnancy. The macroscopic features of the placenta in preeclampsia were analyzed. Results and conclusions: Preeclampsia is associated with lower weight (379.0±78.9 versus 439.0±53.1, (p<0.0001) and height (8.3 (3.5-11.7) versus 7.8 (5,1-9.9) (p<0.0001) of the placenta, but with an increased fetoplacental index of 7.3 (3.5-11.7), umbilical cord tortuosity other than normal, as well as combined cord injuries, including more one of the structural features of the umbilical cord, different from the norm (141 (76.6%) versus 67 (45.0%) (p<0.0001) compared with placentas from physiological pregnancy.

The aim of the study was to assess the effectiveness of the implementation of elements of virtual technologies in the educational process in the discipline «Fundamentals of General Medical Practice». The research material was a developed electronic clinical scenario (case) based on a virtual patient. We applied the PBL (Problem-based Learning) method using a clinical scenario (case) with the problem of «Acute abdomen» of a virtual patient, adapted to a real case and implemented into the independent work with a teacher of the discipline «Fundamentals of General Medical Practice» for 5^th year students of the specialty «General Medicine» in 86 students studying in the Kazakh language, 45 students in Russian. The script was developed using a special computer program Open Labyrinth. To assess the implementation of elements of virtual technologies in active teaching methods (PBL) aimed at teaching bachelors to prevent medical errors in practice and develop students' professional competencies aimed at communicative, diagnostic, therapeutic, preventive, rehabilitation, research activities, we have developed «PBL Implementation Questionnaire - Virtual Patient». Experience shows that the introduction of clinical scenarios on a virtual patient into active teaching methods (PBL) allows you to bring students closer to real practice, avoid medical errors, as well as develop professional competencies aimed at communicative, diagnostic, therapeutic, preventive, rehabilitation, and research activities. The results of the survey showed that the majority of students prefer conducting independent work with a teacher using cases with a virtual patient - 81 (94%) students in the Kazakh language, 43 (96%) - students in Russian. Also, according to the survey data, 88% of students in the Russian and 92% of students in the Kazakh department note that this form of education develops students' professional competencies aimed at communicative, diagnostic, therapeutic, preventive, rehabilitation, research activities. So among them, communication skills developed in 86%, clinical skill in diagnosing the most common diseases at the primary health care level - in 88%, clinical skill in treatment activities - 78%, clinical skill in preventive activities -80%, clinical skill in rehabilitation activities - 52%, clinical skill in research activities - 52%.

This article presents medical errors in pediatrics for teaching senior students in order to determine the type of medical error and make the optimal decision on the tactics of patient management. The study of these clinical cases will allow students to record important information and be prepared to avoid medical errors in their future professional activities.

The present article is concerned with the descriptive tools used in the process of teaching Kazakh as a foreign language. The authors of the article define the main provisions that must be taken into account at the application the tools of representational use of visual methods as well. Special emphasis is given to the didactic and functional potential of using infographics in the classroom when working with international students focused on developing the speaking ability. The authors unlock the linguistic and methodological potential of infographics as a tool of teaching in the framework of the implementation the basic didactic principle of use of visual methods in the lessons of the Kazakh language as a foreign language. The article highlights the undeniable advantages of use of visual methods, including infographics, in teaching foreign students productive language activities. Among the advantages of such tools are authenticity, the ability to use ready-made materials without prior adaptation, and the fact that they are the means of incresing motivation to learn a language.

Our aim was to explore the effect of the uncertainty of some parameters on total General Practitioner supply in Kazakhstan to 2030. System dynamics simulation was used to develop model for General Practitioner workforce forecasting. Sensitivity analysis (Monte Carlo method) was performed to account for changes in the number of General Practitioners as each and set of model parameters is varied. Three key input parameters were explored: retirement rate, attrition rate, recruitment rate. For each parameter relative sensitivity was calculated. Created model is the least sensitive to the parameter of the retirement rate, but is very sensitive to attrition rate. Staff turnover is one of the main problems of primary health care. The attrition rate parameter has great potential for controlling the flow of labor. The level of recruitment (other than new General Practitioners) is another factor that has a significant impact on forecasting General Practitioners. The sensitivity to this parameter is comparable to the sensitivity to the rate of depletion. We believe that measures taken to reduce dropouts will simultaneously increase recruitment. We also evaluated the effect of all three parameters simultaneously. If the most likely scenario is realized, then the proposal of a General Practitioner will almost completely cover the needs with a small deficit of 68 to 305 doctors. If the high limit or low limit scenarios in the labor market are implemented, Healthcare Ministry will face serious problems.

Today, there is a tendency towards an increase in the prevalence of diabetes insipidus with the same frequency, both in women and in men. The main peak of morbidity was in the second - third decade of life. The problem of diabetes insipidus is associated with impaired synthesis, secretion or action of vasopressin, manifested by the excretion of large quantities of urine with low relative density, dehydration and thirst. Vasopressin is secreted by the neurohypophysis, the most important biological effect of which is the preservation of water in the body by reducing urine excretion by increasing water reabsorption in the distal renal tubules, where it increases the hydroosmatic permeability of the tubular membrane. The article presents a clinical case from the nephrological department of pediatrics, in which a male patient, at the age of 15 years, was diagnosed with diabetes insipidus. From the anamnesis it is known that the manifestations of the disease were noted from the age of 3. The department carried out a diagnostic search to determine the genesis of diabetes insipidus. At the first stage, a fluid restriction test was performed, the results of which excluded primary polydipsia. At the second stage of diagnosis, a desmopressin test was performed to separate the genesis of diabetes insipidus. According to the results of which, an increase in the relative density of urine by more than 50% was not observed. In this connection, therapy with hypothiazide and indomethacin was prescribed, with a positive effect.

The survival rate of patients with uveal melanoma depends on many factors: the patient's age, the timeliness of seeking medical help, the stage of the process, the size of the tumor, its location, and treatment methods. According to literature data, brachytherapy has a more effective effect on the life expectancy of patients. In the presented clinical case, the duration of the disease was traced for more than 11 years.

Today, the prevalence of Covid-19 has reached 62 million people. Currently, there are 130 thousand infected people in Kazakhstan. The numbers change daily, as the number of cases is constantly growing. Coronaviruses are a family of viruses that do not have DNA, but their genome is contained in RNA macromolecules. However, also on the territory of Kazakhstan, children had another complication - Kawasaki syndrome. So, in total, the number of people who showed this syndrome reached 14. The article presents a clinical case from the cardiology department of the city children's hospital of Karaganda, in which a male patient at the age of 10 was diagnosed with mucosal lymphonodular syndrome (Kawasaki) Multisystem inflammatory syndrome (Kawasaki-like syndrome) associated with COVID-19. From the anamnesis, it is known that he was ill for several days, there was an increase in temperature to febrile numbers, abdominal pain, and loose stools. Further, a laboratory diagnostic study and an instrumental study were conducted, as well as a consultation with other specialists. Based on the results of these studies, the conclusion was made Multisystem inflammatory syndrome (Kawasaki-like syndrome) associated with Covid-19. Treatment tactics: receiving complex therapy, pulse therapy with corticosteroids, as well as kiovig - human immunoglobulin, which helps to fill the antibody deficit. Against the background of the introduction of this drug, the patient has a positive dynamics.