Аim. To identify the immunological features of out-of-hospital pneumonia in vaccinated children, to assess their impact on the severity of the disease.
Materials and methods. The study was conducted in 2017-2019. 85 children with various degrees of severity were hospitalized in Karaganda from 2 months to 3 years. They were divided into 2 groups: the first included vaccinated children (n=45), the second included children with impaired vaccination (n=40). The control group consisted of 20 children.
The calculation and evaluation of the results obtained was carried out on an IBM compatible computer with the Windows XP operating system using the MS Excel 2017 (Microsoft), SPSS 12.0.2 and Statistica 20 software package. Statistical analysis was carried out using the STATISTICA package. Numerical data is represented by indicators such as Me (median), Q1 (L-quartile or lower quartile point) and Q3 (U-quartile or upper quartile point). Kruskall-Wallace criterion calculated [Kruskall W., Walles W. A.]. The differences were considered statistically significant at p < 0.05.
Results and discussion. The quantitative indicator of anti-inflammatory MCP-1 cytokines in vaccinated children with severe nosocomial pneumonia in early childhood is 7.21 [5.25; 9.03] pg/ml Me [Q1; Q3], and in children with immunization disorders-15.18 [6.13; 50.11] pg/ml Me [Q1; Q3] (Kruskal criteria-Wallis p<0.05). In children aged 2 months to 3 years, the quantitative indicator of anti-inflammatory cytokines MCP-1 in vaccinated children with mild nosocomial pneumonia is 2.13 [0.01; 3.02] pg/ml Me [Q1; Q3], and in children with immunization disorders –3.46 [0.04; 6.74] pg/ml Me [Q1; Q3].

Introduction.Myasthenia gravis is a chronic autoimmune disease that manifests itself as a syndrome of pathological muscle fatigue. Epidemiological studies show a change in the course of the disease due to the COVID-19 pandemic.
The purpose of the study. Analysis of features of cohort of patients with myasthenia gravis in Central Kazakhstan.
Materials and methods. A retrospective analysis of case histories of 98 patients with myasthenia gravis treated from January 2020 to December 2022 in the neurological departments of Karaganda region (Central Kazakhstan) was carried out.
Results. The ratio of men and women was 1:2.2. 46% of patients had onset of the disease aged 18 to 39 years. In the debut of disease, the ocular and generalized forms are presented in an equal ratio. Comorbidity prevails in the elderly. CT-signs of thymoma were detected in 23% of patients. All the studied patients received therapy with pyridostigmine bromide, glucocorticoids; cytostatic therapy – 1 patient; immunoglobulin G – 1 patient; there were no patients with therapy with monoclonal antibodies.
Conclusions. There are gender and age characteristics, differences in the course of the disease and comorbidity in patients with myasthenia gravis in Central Kazakhstan, in comparison with other countries. Improvements are needed in the field of immunological diagnostics and, according to indications, the introduction of international treatment regimens.

The article presents the results of a study of 62 patients with bronchial asthma (ВА), which were divided into 2 groups: the first group included patients (n = 34) with moderate severity of asthma, the second group included patients (n = 28) with severe asthma. The worsening of the course of bronchial asthma in the examined patients is due to the duration of the disease, the presence of harmful risk factors, among which adverse living conditions with the development of sensitization to them are of the greatest importance. In severe bronchial asthma, an uncontrolled course of the disease prevails with a 1.8-fold decrease in asthma-control test values (p<0.05). With an increase in the severity of the inflammatory process in the airways, the level of AOРP in the blood plasma increases. In patients with bronchial asthma, the following features of oxidative metabolism were established: in the blood plasma and erythrocytes of patients with bronchial asthma of varying severity, a tendency to an increase in reactive carbonyl derivatives of proteins, malondialdehyde, AOPP compared with the control was observed, which indicates an increase in oxidative metabolism with the development of pathology.

Introduction. Currently, the occupational etiological factors of vibration disease are well studied, but the management of this group of patients against the background of comorbid pathology, the impact on the quality of life of patients and the long-term prognosis of the disease remains an urgent problem.
Aim. Study of nutritional and metabolic status in patients with vibration disease in combination with arterial hypertension.
Materials and methods. A survey of 336 patients with vibration disease in combination with arterial hypertension was conducted in the conditions of the regional center of occupational pathology on the basis of a specialized department of occupational pathology. A comprehensive assessment of the clinical, nutritional and metabolic status of patients with vibration disease in combination with hypertension was carried out, including the study of clinical parameters, the daily profile of blood pressure, protein, lipid and carbohydrate metabolism, the component composition of the body of patients and the assessment of the profile of adipokines and cytokines.
Results and discussion. Insufficient reduction of pressure at night (non-dippers) was revealed, an increase in fat mass and extracellular fluid was determined against the background of lean mass deficiency and a decrease in phase angle, proatherogenic dyslipidemia, protein deficiency, impaired carbohydrate metabolism, high levels of adipokine and cytokine activity.
Conclusion. As a result of the study, additional markers for the diagnosis of nutritional disorders in the combined course of vibration disease and arterial.
Conclusions. As an early diagnosis of nutritional and metabolic disorders in vibration disease in combination with arterial hypertension, the most informative integral indicators characterizing nutritional and metabolic disorders in this phenotype were identified – the waist circumference/hip circumference index and active cell mass.

There was a paradigm shift in the treatment of type 2 diabetes mellitus after 2015, which now implies not only the control and achievement of target levels of glycemia, but also takes into account the comorbidity of patients, the risks of MACE. The approach has become more individualized. In accordance with the consensus of 2022, patients with ASCVD, CKD, CHF are recommended to use at the start of therapy, in addition to lifestyle modification, metformin, drugs of the group of glucose-sodium co-transporter type 2 inhibitors with cardio- and nephroprotection.
This article studied the efficacy of prescribing empagliflozin in addition to the already existing hypoglycemic therapy with metformin in a group of people in the amount of 30 people with morbid obesity, coronary artery disease, arterial hypertension for 12 months.
Based on the results of the study, it was drawn that through the administration of empagliflozin, the following metabolic effects can be achieved: 1) achievement and maintenance of target levels of glycemia, 2) decrease in the level of glycated hemoglobin up to 1.7% maximum, 3) loss of weight, 4) improvement of the lipid profile.

This article is aimed at discussing prenatal diagnosis of fetal genetic abnormalities as an important step in the detection and prevention of birth defects and genetic syndromes. The authors show the multi-vector nature of this problem, which requires an integrated approach and the participation of a multidisciplinary team of specialists, such as gynecologists, radiologists, neonatologists, clinical geneticists, and pediatricians. Among the many methods that allow diagnosing congenital genetic pathology, this publication highlights fluorescent hybridization in situ. In comparison with other immunogenetic methods, this technique allows assessing the genetic status of an individual cell and detecting several etiopathogenetically significant abnormal cells among thousands of others with a normal genotype. This is its advantage over PCR, in which the DNA of all cells is mixed and the result is averaged. The article provides indicators for the selection of patients for screening for fetal pathology. Prenatal screening pathways, as nowadays in most countries consist of similar tests. This article is meant to be an introduction into more detailed ethical discussions about prenatal screening. A new approach of prenatal testing (PNT) will be useful given the currently available diagnostic tests. Genetic tests and general trend of individualization in healthcare policies are directions for establishing prenatal diagnosis with consideration of ethical policies.

The introduction of modern effective technologies and teaching methods is an urgent problem in the training of pharmaceutical personnel. Unfortunately, the main directions of the pharmaceutical industry, such as management, development and quality assurance of medicines, especially the development of technologies for industrial pharmaceutical production, are currently significantly ahead of the pace of development of pharmaceutical education. It should be noted that the purpose of higher and postgraduate education is not only the training of in-demand personnel, but also a look into the future, research and technology transfer, knowledge about the future. In order to bring together the content of the training program and the modern requirements of the pharmaceutical industry for graduates, it is necessary to search and implement effective approaches in training. To this end, in our work we present the experience of implementing project-oriented and dual training in different courses for students of the pharmaceutical training program. The discussion presents the results of the analysis of the implementation processes, the analysis of the problems encountered in the work.

The current pandemic situation in the world has led to the need to study information technologies of all layers of infrastructure, especially in education. For this reason, the discipline «Information and Communication Technologies» (ICT) was introduced everywhere, including in medical universities. The aim of the work is to improve the motivation of students to learn using available resources in accordance with the realities of the current educational context without the use of expensive, off-the-shelf GIS technologies that are currently used to process and visualize data on COVID 19, as well as a mobile application. «Symptomate», which is freely available. The result of the study is the defense of the project on morbidity chosen by the student, which involves an in-depth study of the topic itself, work with the database, statistical processing, its visualization using 3D maps, calculations, passing an online survey with a diagnosis and paperwork rules.

Goal. To consider the possibility of introducing the methodology for calculating avoidable mortality in the educational process by the example of determining the indicators of avoidable mortality from cervical cancer.
Materials and methods. The data are based on criteria and indicators developed by experts from the Organization for Economic Cooperation and Development (OECD) countries. A comparative analysis of the indicators of avoidable mortality due to cancer in the OECD countries and other countries was carried out. Statistical data for 2015-2021 were obtained from the National Statistical Bureau of the Agency of the Republic of Kazakhstan for Strategic Planning and Reforms (https://stat.gov.kz).
Discussion. Evaluation of the effectiveness of health systems is becoming increasingly important in the OECD and EU countries (European Union). Avoidable mortality indicators serve as a starting point for assessing the effectiveness of public health and health policy in preventing premature mortality from preventable and treatable causes of death. Acquisition of skills in calculating avoidable mortality and interpretation of the results of calculations of indicators of avoidable mortality from diseases within the framework of the development of an educational program (areas of training – Management in healthcare, MBA, EMBA and Global Health and Healthcare) are necessary for future specialists in practice, in particular when conducting a comparative assessment of indicators of the effectiveness of the healthcare system with OECD countries. Effective activities of the health system in the field of public health protection carried out in different countries have a great impact on the spread and control of diseases. For example, the reduction in the level of avoidable mortality from cervical cancer in several regions of Kazakhstan (Akmola region, Zhambyl region, Shymkent city, Turkestan region) in the period from 2015 to 2021 proves the effectiveness of preventive measures implemented in these regions. At the same time, in some regions of Kazakhstan (West Kazakhstan region, Kyzylorda region, Mangystau region, Pavlodar region, Kostanay region, East Kazakhstan region), mortality rates from cervical cancer have increased and there is a need to strengthen measures at the level of primary and secondary prevention and treatment. Thus, the definition and study of the regional heterogeneity of indicators of avoidable mortality will allow us to identify the weaknesses and strengths of the implemented strategies for the protection of the health of the female population.
Results. The methodology for calculating avoidable mortality is a key element for achieving the Third Sustainable Development Goal (SDG). Future masters of educational programs Management in Healthcare, MBA, EMBA and Global Health and Healthcare need to master the methodology for calculating avoidable mortality, as well as clearly understand the concepts and concepts of preventive and treatable mortality, which will allow them to carry out timely assessment of implemented programs in the future and will contribute to the adoption of decisive and more targeted, effective measures to reduce avoidable mortality.
Conclusions. As a result of the inclusion of the methodology for calculating avoidable mortality in the educational program of the master's degree, students are given the opportunity to master new terminology related to the concepts of avoidable mortality, acquire skills in calculating indicators of avoidable mortality, as well as conducting a comparative analysis of the causes of mortality, which can mainly be prevented by effective public health measures and primary prevention, as well as the causes of mortality, which can be cured with the help of timely and effective health measures, including secondary prevention and treatment (i.e. after the onset of diseases, to reduce mortality).

Nephroblastoma (Wilms tumor) is one of the most common malignant embryonic tumors in children. Nephroblastoma accounts for 5-11% of all childhood tumors, and its frequency is 0.4 to 1 per 10,000 live births. It is most common in children under the age of 5 years, rarely in newborns and adults. We have presented our own clinical observation of a premature newborn girl, starting from the 1st day of life, the dynamics of the disease, comprehensive examination and treatment, including highly specialized care, are reflected. There was an unfavorable prognosis with a fatal outcome at the age of 13 days, taking into account risk factors: early age, antenatal realization in the form of nephromegaly in the neonatal period with diffuse anaplasia. The causes of death were cardiopulmonary insufficiency and progressive renal insufficiency.