The authors presented a literature review on the directions of modern adjuvant therapy for breast cancer. The use of adjuvant chemotherapy, targeted and hormone therapy increases the rates of relapse-free and overall survival of patients with breast cancer. The literature data indicate the feasibility of co-prescribing chemotherapy and targeted or chemotherapy and hormone therapy in patients with locally advanced breast cancer. The authors believe that adjuvant therapy is an achievement in the treatment of patients with breast cancer, its optimal use significantly increases the overall and relapse-free survival rates. Despite the standard chemotherapy regimens that have proven to be highly effective, relapse-free, and stable survival rates, medicine does not stand still, and scientists each year try to develop new chemotherapy-targeted drugs with less toxicity, which will soon become a priority in the adjuvant treatment.

In the present review of the literature, an analysis of modern ideas about iron metabolism is carried out. As promising areas of research are a detailed study of signaling mechanisms leading to hepcidin activation. The current direction is the definition and study of the regulatory relationships between systemic and cellular iron metabolism. The mechanisms of iron transport through the membranes of intracellular organelles are also not fully understood. Research in this direction has not only biological, but medical value. So, the axis hepcidin-ferroportin is positioned as an attractive target for drug development. It is assumed that IRP1 and IRP2 are involved not only in the regulation of iron metabolism, but also play an independent role in the mechanisms of cancer development.

The urgency of the problem of complications in acute impaired mesenteric blood flow due to high mortality rates and difficulties in early diagnosis. The main pathogenetic factor in acute mesenteric ischemia (AMI) is the phenomenon of microbial translocation. The article provides an overview of publications by Russian and foreign researchers on the problem of bacterial translocation in acute mesenteric ischemia over the past 10 years. This phenomenon is studied by various methods, the priority and universality of which are currently not established.

The article analyzes the literature data on the study of the prevalence of HIV infection in the world and in the Republic of Kazakhstan. An analysis of UNAIDS data on new cases of infection of children in the world from 0 to 14 years from 2000 to 2017 showed that the peak of the incidence was registered in 2000, and since 2017 there has been a downward trend in the detected cases. Kazakhstan is in a concentrated stage of the HIV epidemic. Despite the small number of HIV-infected children and adolescents, this problem requires special attention and the implementation of important measures to prevent and combat HIV infection.

According to official data of experts of the world health organization, every year 3.5 million people died from domestic injuries, as a result of road accidents-about 1.35 million people. Although more than 90% of road traffic deaths occur in almost half of the world's transport modes, these events are common in low-and middle-income countries. The problem of road traffic injuries is relevant for many countries of the world.

Objective: to determine the relationship between psychoemotional stress and periodontal disease in students Materials and methods: a medical and social survey of 300 students was conducted. Age of students from 17 to 27 years. Results and discussion : The prevalence of periodontal disease among students is high and amounts to 94.3%. Students have a direct correlation between psycho-emotional stress and periodontal disease, the Pearson correlation coefficient was 0.511. The correlation is significant at the 0.01 level. Conclusion: psychoemotional stress is one of the factors leading to the development of periodontal disease in students.

When providing medical assistance either in terms of the medical institution or outside, there are always certain risks posing a threat to the patients and personnel health. According to the patients opinions, those risks are linked closely to medical practitioners professionalism level, their compliance with disinfection and sterilization regimes, proper hands decontamination, wearing gloves, availability of the disposable sterile equipment/instruments. It was established that most health workers have disorders in microbiocenosis because of the increase in the total microbial number of conditionally pathogenic microorganisms. This article provides the qualitative composition of microbial environment of the large intestine and the pharynx mucosa in 20 surgical hospital personnel and 30 obstetric medical staff was investigated. The study revealed the decrease in the detection rate of indigenous microflora of pharynx microbiocenosis and colonization of the mucous membranes with opportunistic microorganisms.

According to literary data, congenital malformations of the gastrointestinal tract in the world and in the Republic of Kazakhstan occupy the third place in the frequency of occurrence among all congenital malformations. The frequency of congenital malformation occurrence has no tendency to decrease. Wherein, the congenital malformations diagnosis of the gastrointestinal tract is possible already in the antenatal period, the accuracy of which depends on the use of highly specialized expert diagnostic devices, the level of specialists' qualification as well as the type of defect. Early diagnoses, and consequently, the early start of specialized care, both neonatal and surgical in perinatal centers, excluding transportation as well as the form of congenital malformations of gastrointestinal tract and its combination with other congenital malformations, have a direct impact on the children's survival prognosis with congenital malformations of gastrointestinal tract. This work presents a review of literature data on the frequency of occurrence, various methods of timely diagnosis of gastrointestinal atresia, specialized surgical care and neonatal care for this group of children.

Objectives: to study the relationship between the eruption of permanent teeth and indicators of physical development Material and methods: in the course of the study, a dental examination of 1 456 children and adolescents of both sexes aged from 5 to 14 years old was conducted in the schools of the city of Karaganda and Temirtau. Anthropometric measurements were carried out: length and body weight, the BMI was determined. Statistical processing was performed using IBM SPSS Statistics 23 for OS Windows Results and discussions: there was no significant relationship between the level of body length and the number of permanent teeth in the oral cavity. There was also no significant correlation between the level of body weight and the number of permanent teeth in the oral cavity. There is a direct correlation between the level of BMI and the number of permanent teeth in the oral cavity. The Pearson correlation coefficient was 0.071, with a bilateral significance of 0.008. Conclusion, teething is in close connection with the general state of health, and the length and body weight separately are not indicative.

Introduction: inflammatory processes of the maxillofacial area and neck are accompanied by the mobilization and activation of protection factors, both in the infection zone and in the organism as a whole, mechanisms of local and general resistance are involved. The purpose of the study was to analyze the changes in the immune status of patients with infectious diseases of the maxillofacial area and neck depending on the process spreading. Objects and methods: a comprehensive survey of 198 patients with maxillofacial infection was conducted in the department of maxillofacial surgery of the Vitebsk Regional Clinical Hospital from 2010 to 2018. The group of patients was divided into 4 subgroups: 1 subgroup (40 people) - patients with acute purulent odontogenic jaw periostitis, 2 subgroups (96 people) - patients with acute purulent odontogenic jaw osteomyelitis complicated by phlegmon of one cellular space, 3 subgroups (36 people) - patients with acute purulent odontogenic osteomyelitis of the jaw, complicated with phlegmon of 2-4 cellular spaces, 4 subgroup (26 people) - patients with acute purulent odontogenic osteomyelitis of the mandible, complicated with phlegmon of the mouth floor. A comprehensive assessment of the immune status was carried out on the basis of the results of a blood immunogram performed twice: on the first day and at the end of patient treatment. Results: when comparing immunogram indices of patients with acute odontogenic infectious diseases of different spreading and healthy individuals, significant differences were found both at the beginning and at the end of treatment. At the same time, more evident deviations from the parameters of healthy people were noted in the subgroups of patients with more spread processes.

The article presents the comparative aspects of intensive therapy of diabetes mellitus type II complications depending on the rate of insulin therapy and the volume of infusion therapy. The dynamics of the main vital functions is evaluated during the whole period of critical state therapy. The causal relationship between the development of complications and the premorbid state is analyzed.

In modern pancreatology, the problem of diagnosing acute pancreatitis is one of the most complex and urgent. The use of modern methods of radiation diagnosis in patients with acute pancreatitis and pancreatonecrosis allows determining the form of the disease and identifying its complications. This article presents an analysis of literature data on the diagnosis and prognosis of pancreatitis and clarifying the role of ultrasound and computed tomography as the main diagnostic methods, their importance in planning treatment tactics in patients with acute pancreatitis.

Material and methods. We analyzed the results of the observation of 223 persons aged 25 to 65 years (177 women, 46 men) from May 2014 to December 2018. The study included socio-demographic, anthropometric data, blood pressure measurement, the study of cholesterol, glucose, chemokine CXCL16. For the cardiovascular event took the development of acute cerebrovascular accident, acute coronary syndrome, transient ischemic attack, first diagnosed angina. Data analysis was performed using the SPSS 22 statistical software package. Results and discussion. The frequency of cardiovascular events was 15.7%. Differences were found between groups depending on age (p=0.002), systolic blood pressure level (p=0.029), waist size (p=0.003), risk degree on a SCORE scale (р=0,002), and CXCL16 chemokine level (p=0.009). Conclusion. The relationship between the SCORE scale, the CXCL 16 chemokine level and the development of cardiovascular events has been found. Findings. Further research is needed on the prognostic evaluation of biomarkers.

Introduction: identification of the toxicity of any chemical agent is carried out taking into account its effect on the reproductive system. Objective: to assess the structural changes in the corpus luteum of the ovaries of mature female rats when exposed to dust-salt aerosols of the Aral Sea. Materials and methods: the object of study - females of white mongrel rats with an initial weight of 150-170 g (n=20). The first group is control, the second is experienced. Inhalation exposure was carried out for 30 days. The material of the study was the ovaries of animals. Histological examination was according to the standard technique with hematoxylin - eosin staining. Results: when morphological assessment of the size of the ovaries, we found a significant difference in the studied groups. Morphometric studies showed that in the experimental group of animals, compared with the control, there is a decrease in the number of menstrual corpus luteum in the ovary and their area, respectively, by 21.7% (p<0.05 ), 10.49% (p<0.05) Conclusions: when the inhalation effect of the salt - salt aerosols of the Aral Sea, there is a change in the qualitative and quantitative characteristics of the structure of the corpus luteum of the ovary, and as a result, we believe that there is insufficient secretion of progesterone, insufficient luteal phase, preimplantational and preplacental losses.

The aim of the study was to study the value of nitric oxide in the blood of white mongrel rats exposed to dust-salt aerosols of the Aral sea. According to the study, we found that in the experimental groups the value of nitric oxide is higher than in the control group and there is no increase in the concentration on the 14th day of pregnancy, also in the experimental groups there is a tendency only to decrease. In chronic hypoxia, the concentration of nitric oxide increases, which explains their important role in the case of hypoxic stress. Thus, nitric oxide plays an important role in the regulation of many physiological and pathophysiological processes in the body, including the reproductive system.

This article discusses the role of the International Classification of Diseases of the 10 revision, the purpose of which is to provide a unified standard language and define a framework for describing health indicators and health-related indicators. It introduces definitions of the components of health and some of the health-related components of well-being (training, education, labor, etc.), that is, the domains found in the International Classification of Diseases can be considered as health domains and health-related domains. The authors of the article come to the conclusion that the use of the International Classification of Diseases in the practical activity of doctors allows: 1) to conduct a comprehensive analysis of the existing life limitations; 2) to change the level and vector of building programs not only medical, but also social and environmental rehabilitation; clarify the sequence of the complex of rehabilitation measures; 4) assess the effectiveness of the rehabilitation.

The article discusses the methods of problem-based teaching of the discipline «biochemistry» as a value innovative technology in the educational process of a medical university. Ways of creation are analyzed and directions for solving problem situations proposed in the process of studying and mastering new knowledge by students are suggested.

This article presents the experience of distance learning technologies using in a medical university on the example of the disciplines «Psychiatry and Narcology» for students of the 5^th year of study in the specialty «General Medicine». The authors of the article share the principles and values of teaching medical students, they also note the possibility of using distance learning technologies in the process of acquiring knowledge. The article presents the experience of using distance learning technologies in the discipline «Psychiatry and Narcology» based on the Moodle educational environment.

The main trends in the development of modern biology, requirements for university graduates are described. The problems of teaching disciplines of the mathematical cycle among students-biologists are analyzed. The place and role of courses on mathematical statistics in personnel training, shortcomings of the available educational literature, requirements to the modern textbook on mathematical statistics are described.

The authors, in order to determine the competence of future doctors in the new innovative conditions, analyzed the methods of assessing the knowledge of medical students, with various training models tested in the management of pediatric surgery, taking into account the concept of the pedagogical process, built by an individual teacher. Applied assessment methods revealed new needs for students, in the form of «hidden desires» (90 -34.6%), start-up ideas (25-133.3%) corresponding to modern realities, where the proposal to transfer business technology in conjunction with possession of the skills of scientific competence, received confirmation in 80% of cases. An analysis of the applied methods for assessing the knowledge of medical students has shown that the development of clinical thinking takes place within the core competencies of the university, but in order for it to meet the new realities, changing the orientation of students, responding to them and the university's expectations, it must be confirmed by an innovator.

Premacular hemorrhage is a pathology of the fundus of the eye, as a result of detachment of the vitreous body from the retina and accumulation of blood in the cavity have formed in connection with rupture of the retinal vessels. This disease has polyetiologic and retinovasculitis reasons. When the process have localized in the macular area, vision have suddenly sharply decreased. Existing treatment methods of premacular hemorrhage do not have a clear dosage and the timing of initial and repeated treatment is not determined. Such as expelling blood from the macula by introducing an expanding gas, pharmacological lysis of the clot with recombinant tissue plasminogen activator, anti-vascular endothelial growth factor (antiVEGF) agents. One of the simplest and safest methods of treating pre-acuclear hemorrhage is laser hyalo-acupuncture on the Nd:YAG-laser. The article presents a clinical case with premacular hemorrhage and a good outcome as a result of the use of high modern technologies - treatment with Nd: YAG-laser.