Hyperglycemia, characteristic of diabetes mellitus, contributes to the production of oxidative stress agents that cause impaired immune function and the development of a chronic inflammatory process. These factors underlie the development of late complications of diabetes mellitus, such as coronary heart disease, unstable angina pectoris, myocardial infarction, peripheral microangiopathy and other articular diseases that worsen the prognosis for diabetic foot syndrome. Inflammatory processes and disorders of the immune system contribute to an imbalance of tissue homeostasis, are associated with the appearance of chronic ulcers and the need for amputation of the lower extremities. The consequences of chronic wounds create an unfavorable reality of disability and mental stress for patients. Both patients and medical staff will undoubtedly benefit from a deeper understanding of the pathogenesis and pathophysiology of various non-healing ulcers. New knowledge was acquired by comparing the similarities between chronic wounds of different natures with their differences from acute wounds.

Gingival recession is a widely spread pathology of the oral cavity. Prevalence rates vary from 15 to 99.7%. Gingival recession often leads to serious aesthetic problems. It can also lead to additional complaints of increased sensitivity and the formation of cervical caries. Many factors contribute to the development of gingival recession: unhealthy habits, bad oral hygiene, iatrogenic factors, the consequences of orthodontic treatment, etc.

Treatment of gingival recession should begin with the elimination of etiological factors. However, with an already formed defect, these actions are not able to solve the problem. The gold standard in eliminating recession is surgical treatment. The choice of surgical method is determined by the number of defects, anatomical conditions in the oral cavity, etc.

Aging is an inevitable stage of life, a natural process that we all experience and often strive to slow down. As life expectancy on Earth continues to rise, the quest for longevity and vitality becomes increasingly significant. However, alongside this increase in lifespan, we face the emergence of diseases associated with aging and genetic mutations that can lead to various health complications. This dual challenge has long been a concern for researchers and healthcare professionals.

To mitigate the negative impact of aging on health, it is crucial to explore ways to slow down this process. This article discusses several promising options that suggest their effectiveness against aging, potentially acting as geroprotectors. Among these, antioxidants are perhaps the most popular choice due to their ability to reduce oxidative stress caused by free radicals—unstable molecules that can damage cells and contribute to aging.

In addition to traditional antioxidants, synthetic antioxidants such as enzyme mimetics are becoming a focal point of therapeutic research. These compounds aim to replicate the action of natural enzymes that combat oxidative stress, offering a novel approach to age-related health issues. Furthermore, polyphenols, naturally occurring compounds found in various fruits, vegetables, and beverages like tea and red wine, have garnered attention for their potential health benefits.

Together, these compounds may contribute to new research opportunities aimed at combating age-related pathology and improving overall health outcomes. By understanding and harnessing the power of antioxidants, enzyme mimetics, and polyphenols, we may pave the way for innovative interventions that not only extend lifespan but also enhance the quality of life for individuals as they age. The pursuit of effective geroprotectors represents a vital frontier in promoting healthy aging and preventing age-related diseases.

Background. Adipose-derived tissues and platelet-rich plasma (PRP) have emerged as promising agents in regenerative medicine and aesthetic surgery due to their ability to stimulate tissue repair, enhance angiogenesis, and reduce inflammation. Their combined use has gained increasing attention in reconstructive and plastic surgical practices.

Aim. This review aims to evaluate the biological functions and clinical potential of adipose tissue derivatives and PRP in surgical applications, particularly in enhancing fat graft survival and promoting tissue regeneration.

A systematic review of scientific literature was performed using databases such as PubMed, Scopus, and Web of Science, following PRISMA guidelines. The selection criteria included original studies, reviews, and clinical trials focused on the biological properties, therapeutic mechanisms, and surgical outcomes associated with the use of adipose tissue and PRP. Adipose tissue contains multipotent mesenchymal stem cells that contribute to neovascularization, immune modulation, and extracellular matrix remodeling. PRP is rich in growth factors that support cellular proliferation, tissue integration, and inflammation control. The co-administration of PRP with fat grafts improves graft retention and healing outcomes. Several clinical studies demonstrate enhanced aesthetic and functional results in procedures involving facial reconstruction, wound healing, and breast surgery.

Conclusion. The integration of PRP and adipose-derived therapies offers significant advantages in surgical regenerative strategies. However, heterogeneity in preparation methods and application protocols limits comparability across studies. Further research is necessary to standardize techniques, validate outcomes, and broaden the clinical applicability of these regenerative modalities.

Aim. The main idea of the study is to assess the impact of night shift work on the quality of life of nurses.

Materials and methods. The quality of life of 175 nurses working in shifts at the Multidisciplinary regional children's hospital PUE was studied. The study involved 31 (17.7%) male nurses and 144 (82.3%) female nurses. Using descriptive statistics from the WHOQOL-BREF questionnaire, the average values and standard deviations of the assessment of the quality of life of nurses of the regional children's clinical hospital were calculated and presented by age, gender, length of service and the indicators of fashion, median, minimum and maximum were calculated.

Results and discussion. The average indicator of general physical health is 54.22, which is an average indicator of quality of life. Mental health – 63.47; social relations – 68.61; environment – 65.37. This shows that the quality of life of nurses is above average in these three areas.

Conclusions. The quality of life of nurses working the night shift at the multidisciplinary regional children's hospital shows a level from average to above average. Working the night shift has a significant impact on nurses' quality of life, including sleep, rest, pain and ability to work, as well as the ability to perform their daily duties.

This article presents a comprehensive analysis of the sanitary and hygienic working conditions at a mining and processing complex (MPC) in the Karaganda region and the associated occupational morbidity. The main occupational risk factors—dust, gas contamination, noise, vibration, and microclimate—were studied across four production units (Gold Recovery Plant – GRP Phase 3, Gold Recovery Plant – GRP Phase 1, open-pit mine, and auxiliary sections). Concentrations of harmful substances in the workplace air, as well as equivalent levels of noise and vibration, were determined. It was found that dust concentration at GRP Phase 1 (8.0 mg/m³ versus the maximum permissible concentration (MPC) of 4.0 mg/m³) and hydrogen cyanide vapors (0.46–2.75 mg/m³ versus the standard of 0.3 mg/m³) significantly exceed permissible limits. The average equivalent noise level at GRP Phase 1 was 92 dBA, at GRP Phase 3-88 dBA, and in the open-pit mine – 82 dBA, with heavy dump truck noise levels reaching up to 88 dBA. Exceedances in whole-body vibration levels were recorded at open-pit workstations (adjusted level: 120.5 dB). The calculation of permissible work duration based on dust exposure showed significant limitations in highly dusty areas (less than 30 years of service). Analysis of temporary disability morbidity in 2023 revealed a predominance of respiratory diseases, musculoskeletal disorders, and injuries: at GRP Phase 3, respiratory diseases ranked first (4.8 cases and 33.3 lost workdays per 100 employees), followed by injuries (2.5 cases and 39.5 lost workdays). Statistically significant differences were identified between production units: the incidence rate at GRP Phase 1 was significantly higher than at GRP Phase 3 (χ² = 9.83, p = 0.0017). Based on the findings, a risk management model and recommendations for reducing occupational risks were developed (improving ventilation, regulating noise exposure, limiting service duration, etc.).

Introduction. The article presents a retrospective analysis conducted over the period from 2010 to 2023 among the able-bodied adult population of the Republic of Kazakhstan registered for arterial hypertension. The study examined the frequency and dynamics of this disease, its prevalence among men and women, as well as comparative data between urban and rural residents with the identification of characteristic features.

Aim. To characterize the factors that increase the incidence of blood pressure among people of working age in the Republic of Kazakhstan.

Materials and methods. The research material is a database of people of working age who are registered for hypertension at the Republican Center for Electronic Health of the Ministry of Health of the Republic of Kazakhstan for 2010-2023. The research method was statistical processing using Microsoft Excel and analyzed using the statistical program SPSS.

Results and discussion. In the territory of the Republic of Kazakhstan, all registered cases of high blood pressure among the adult population were analyzed. Statistical studies have been conducted taking into account gender and age characteristics and the place of residence of patients. During the analysis of the prevalence of this disease among urban and rural residents, it was found that it is more common among the adult population in cities.

Conclusions. The main reasons why blood pressure is more common among urban residents of working age are the following factors: high stress levels among the urban population compared with the rural population. Arterial hypertension is indeed more common among the able-bodied urban population than in rural areas. Thus, the development of arterial hypertension is influenced by a combination of many factors that are more often inherent in the urban environment.

Introduction. Congenital fetal developmental anomalies are one of the pressing issues in healthcare due to the prevalence of numerous risk factors, the increase in stressful situations, the uncontrolled intake of medications by pregnant women, as well as the widespread occurrence of bad habits and infectious diseases among the population.

Aim. To study the factors influencing the occurrence of congenital fetal anomalies.

Materials and methods. During the study, we analyzed data from 697 women who underwent outpatient ultrasound examination during pregnancy. We analyzed the data of 697 women, who were divided into two groups based on the presence of signs of congenital fetal developmental anomalies. The main group included 466 women whose newborns exhibited congenital developmental anomalies either during pregnancy or in the early postnatal period, while the control group consisted of 231 women whose children showed no signs of congenital developmental anomalies either during pregnancy or in the early neonatal period.

Results. According to the obtained results, the earliest detection period for congenital fetal anomalies was 24.7±0.9 weeks of pregnancy, which was observed in cases of combined anomalies and central nervous system defects. The earliest detection period for these congenital anomalies was 11.5 weeks, which was the minimum for the entire studied group. Next in order of detection were congenital anomalies of the urinary system at 26.3±1.7 weeks, digestive system anomalies at 27.1±2.0 weeks, and heart and major blood vessel anomalies at 27.7±1.0 weeks of pregnancy. Musculoskeletal system anomalies were detected at 28.1±1.9 weeks, while chromosomal anomaly signs were identified the latest at 29.4±3.2 weeks of pregnancy.

Conclusion. Thus, the gestational age at which severe developmental anomalies are detected plays a crucial role in further pregnancy management.

Introduction. The new coronavirus infection (COVID-19), which led to the development of a global pandemic in 2020, is characterized not only by a high risk of pneumonia and multiple organ failure, but also by manifestations of the central nervous system (CNS). The relevance of the article is due to the lack of research and the high frequency of damage to the circulatory system in the brain.

Aim. To study the parameters of electroencephalography in the post–cortical period according to the reactions of the cerebral vessels of students, depending on the severity of the disease.

Materials and methods. At the 1st stage of the study, a questionnaire dynamic examination of 48 students of the 1st-2nd year of the medical university of the specialty «General Medicine» was conducted and their physiological state after the coronavirus infection and 10 students who were not sick with coronavirus as a control group were analyzed. The age of the study participants ranged from 17 to 19 years, the average age was 18.37+0.44 years, which generally corresponded to the indicators of the main group. The majority of students 37 (77%) lived in a family, and 23% in a dormitory (11 people), as they came from other regions of Kazakhstan. There were no disability limitations in the study participants. The majority of the 30 students tested (62.5%) were right-handed.

Results and discussion. The method of analyzing EEG microstates turned out to be the most indicative, which allowed us to identify specific and quantitative characteristics of changes in the bioelectric activity of the brain, recorded on a routine electroencephalogram only within the framework of general diffuse changes in the bioelectric activity of the brain in the beta activity range. The functional restructuring of the neuronal macro-networks of the brain, regardless of the severity of COVID, was characterized by dynamic changes that make it possible to trace the characteristic adaptation of the organism. However, the brain activity of students with a moderate degree compared with the pronounced form of COVID was characterized by more pronounced changes in the duration of the 1st and 4th grades of EEG microstates, which was clinically manifested by impaired perception of new information and difficulties in decision-making.

Conclusion. Adaptive reactions of hypotonic-type cerebral vessels with gender differences were revealed: in students, we identified changes that can be interpreted as «compensatory», allowing the examined to restore their «social status», but at the same time maintain a number of subjective manifestations that gradually regressed by the end of the 5th month of recovery. The results can be used by medical professionals and physiologists.

Aim. To evaluate the effectiveness of telerehabilitation using the Inventivo platform and the MedQuest mobile application after hip replacement in comparison with traditional rehabilitation.
Materials and methods. A prospective comparative study was conducted with the participation of 50 patients who underwent primary total hip replacement. The patients were randomized into two groups: experimental (n=25, telerehabilitation) and control (n=25, standard rehabilitation). The assessment was carried out using the SF-12 questionnaires, the Bartel index, the MRC scale, the visual analog pain scale, the scale of subjective assessment of the limitation of pain movements and goniometry.
Results and discussion. The experimental group demonstrated a statistically significant improvement compared to the control group in terms of quality of life (SF-12), pain intensity (VAS) and muscle strength (MRC) (p < 0.05). Using MedQuest reduced the survey time by an average of 16 minutes and reduced the use of paper media by 70%. The use of artificial intelligence has made it possible to use a larger number of ICF codes.
Conclusions. Telerehabilitation using the Inventivo platform and the MedQuest application showed higher efficiency compared to traditional rehabilitation after hip replacement. Digital technologies have optimized the process of collecting and processing clinical data, opening up new opportunities for the use of artificial intelligence in rehabilitation. Mass implementation of telerehabilitation can increase the availability and quality of medical care, especially in remote areas. 

Aim. Evaluation of the effectiveness of occupational therapy methods in the rehabilitation of patients with cerebral stroke.

Materials and methods. The study included patients with cerebral stroke aged 42 to 69 years (mean age 58±3.2 years) undergoing rehabilitation. The condition was assessed using the following scales: the HDRS scale, the Rivermead mobility Index, the modified Rankin scale, and the NIHSS stroke assessment scale. Statistical data processing was performed using the Statistica 10.0 program (StatSoft, Inc., USA). For quantitative variables, the mean (M), standard deviation (σ), and standard error of the mean (m) were calculated; The results are presented as M±σ±M. The Student's t-test and Pearson's χ2-test were used to assess the differences between the groups. The differences were considered statistically significant at p<0.05.

Results and discussion. As a result of the conducted occupational therapy, a significant improvement was observed in all evaluated parameters from the 3rd to the 30th day. Patients showed increased balance, hand sensitivity, joint activity, pain sensitivity, and improved skills needed to perform daily activities. In the main group, there was a significant decrease in the severity of neurological deficit on the NIHSS scale (by 2 times, p<0.05), the level of depression on the HDRS (by 1.4 times, p<0.05), the degree of disability on the Rankin scale (by 1.5 times, p<0.05), as well as an increase in the level of mobility on the Rivermead index (by a factor of 2, p<0.05).

Conclusions. The use of occupational therapy methods in the rehabilitation of patients with cerebral stroke contributes to a significant recovery of motor functions, reducing the severity of neurological deficits and increasing activity in everyday life. The data obtained confirm the high clinical effectiveness of occupational therapy in the early recovery period of stroke.

Introduction. Septic complications following orthopedic procedures remain a pressing challenge in modern surgical practice, contributing significantly to patient morbidity, prolonged hospital stays, increased healthcare costs, and, in severe cases, long-term disability. One of the modifiable but often overlooked risk factors is preoperative anemia, which is frequently underdiagnosed and undertreated. Existing evidence indicates that allogeneic blood transfusions, commonly used to correct anemia, are independently associated with a higher risk of postoperative infections. This underscores the urgent need to explore alternative, safer strategies for perioperative management, particularly those targeting the correction of anemia prior to surgery.

Aim. To evaluate the effectiveness of perioperative intravenous iron supplementation with ferric carboxymaltose in reducing the incidence of periprosthetic joint infections and improving clinical outcomes in patients undergoing elective orthopedic surgery.

Methods. The IRON study is a prospective, single-center, randomized, open-label, controlled clinical trial. A total of 170 adult patients scheduled for elective orthopedic interventions will be enrolled and randomized to receive perioperative intravenous ferric carboxymaltose at a dose of 15 mg/kg (up to a maximum of 1000 mg).

Primary endpoint. The incidence of periprosthetic joint infections within the postoperative follow-up period.

Secondary endpoints. 28-day all-cause survival, duration of stay in the intensive care unit and in the hospital, achievement of target hemoglobin levels (≥120 g/L in women, ≥130 g/L in men), number of vasopressor-free days, reduction in the frequency and volume of intraoperative and postoperative blood transfusions, and decreased utilization of the Cell Salvage System.

Expected Results: Although patient enrollment is ongoing, it is hypothesized that intravenous iron therapy will reduce the rate of infectious complications and the need for allogeneic transfusions, while improving postoperative recovery and hematologic parameters.

Aim. To study the features of morphological changes in the lungs in children with congenital pneumonia of various etiologies.

Materials and methods. A retrospective study of the lungs of children of the pathoanatomic department of the Regional Children's Clinical Hospital (Karaganda, Republic of Kazakhstan) from 2020 to 2023 was conducted. Protocols of pathoanatomic autopsies of 18 corpses under the age of 1 month who died of congenital pneumonia were analyzed.

Results and discussion. It was found that the macroscopic signs of pneumonia are a mottled appearance of the lungs, alternating dark areas of atelectasis and light swollen emphysematous fields in the dead during the first 1-3 days of life are poorly expressed, but increase by 5-7 days, when more significant lesions of the lung tissue are observed. Microscopically, the most common changes include circulatory disorders, the formation of foci of distelectases, lymphocytic infiltration, often with an admixture of erythrocytes, the presence of fibrin, the formation of hyaline membranes and edematous hemorrhagic syndrome, especially in premature infants with gestational immaturity of the lungs.

Conclusions. Macro- and micro-preparations of lung tissue obtained during autopsy indicate serious changes in the lung tissue and circulatory system, which can have significant clinical consequences for the health of newborns.

A particularly difficult environmental situation in the Aral Sea region poses a direct threat to public health. The decrease in the quality of health is directly related to sand dust rising from the bottom of the Aral Sea, which includes pesticides and heavy metals used in the processing of crops.

The study of the molecular mechanisms of the influence of various factors on the body is one of the fundamental tasks of modern medicine. Exposure to harmful environmental factors can cause changes at the cellular and molecular levels.

Scientists focus their attention on the study of extracellular nucleic acids and histone proteins to assess the extreme nature of external factors in ecological monitoring of the environment. Therefore, an experimental study of the influence of the dust-salt aerosol of the Aral Sea on epigenetic mechanisms, structural disturbance of chromatin is an urgent problem.

We recorded changes in the indicators of acid-soluble fractions, extracellular nucleic acids and histone proteins in the blood of rats exposed to dust-salt aerosols of the Aral Sea: extracellular CRF, DNA, RNA and histone proteins increased compared to the control group.

The results of the study of the role of extracellular nucleic acids and histone proteins are prognostic in order to assess the degree of metabolic disorders, understand the molecular basis of pathogenesis, diagnose various types of cancer and assess the risk of harmful factors.

Introduction. Staphylococcus aureus demonstrates sufficient adaptive potential under external stress conditions, which may determine its key role in the etiology of hospital-acquired infections. The observed exponential growth of strains with multiple antibiotic resistance over the past decades indicates that adaptation mechanisms contribute to the survival and spread of S. aureus under conditions of intensive hospital exposure to antimicrobial agents. This phenomenon significantly complicates the clinical treatment of infections and poses a serious threat to the healthcare system. Despite the active study of changes in the activity of genes associated with antibiotic resistance under various stress conditions, the role of phenolic compounds in the regulation of gene expression in MRSA has been insufficiently studied. In particular, there are practically no data on the effect of phenolic compounds and borneol on the expression of the MecA and YycFG genes, which determines the relevance of this work.

Aim. To evaluate the dynamics of MecA and YycFG gene expression in methicillin-resistant Staphylococcus aureus (MRSA) under the influence of phenolic compounds (rosmarinic, chlorogenic and ferulic acids), borneol and Salvia Stepposa Des. -Shost leaf extract.

Materials and methods. The MICs of the studied compounds were determined using the serial dilution micromethod. To evaluate the effect of the studied compounds, daily MRSA cultures were additionally incubated with the studied compounds at subinhibitory concentrations (1/2 MIC) for 4 hours. Changes in MecA and YycFG expression were analyzed by quantitative PCR (ΔΔCt, log2 Fold Change). GyrB expression was assessed as an endogenous control. Statistical processing included the Kruskal-Wallis, Wilcoxon and Mann-Whitney tests (p=0.05).

Results and discussion. The results showed that phenolic compounds, borneol and Salvia stepposa leaf extract reduced MecA expression by 2.17-5 times (p=0.043) and increased YycFG by 1.84-2.45 times (p=0.043). Rosmarinic and chlorogenic acids showed the greatest activity towards MecA.

Conclusion. Chlorogenic and rosmarinic acids have significant potential to suppress MecA expression in MRSA. Rosmarinic acid reduces MecA expression by 5 times, chlorogenic acid by 4 times. These results allow us to consider the studied compounds as promising candidates for the development of new antimicrobial drugs or adjuvants that enhance the effect of antibiotics. In the future, the synergistic combination of rosmarinic and chlorogenic acids with β-lactams may become an effective tool for overcoming MRSA resistance.

Aim. Comparative morphometric, histological, and histochemical evaluation of the efficacy of combined application of stromal vascular fraction (SVF) and platelet-rich plasma (PRP) in the treatment of long non-healing wounds in an experi- mental model.

Materials and methods. A randomized experimental study was conducted on 32 rabbits. Excisional wounds with a diameter of 2 cm were created on the animals' backs. The animals were randomly divided into four groups: control group (standard treatment), group with preoperative treatment using physiological saline, group with preoperative PRP+SVF injection, and group with both preoperative and postoperative PRP+SVF injections. The effectiveness was assessed using morphometric, histological, and histochemical methods.

Results. The combined use of PRP and SVF enhanced angiogenesis, stimulated collagen synthesis, and reduced inflammatory cell infiltration.

Conclusion. The combined use of PRP and SVF significantly improves tissue regeneration quality and may be an effective method for the treatment of chronic wounds.

Aim. To evaluate CHROMagar™ Orientation Chromogenic Medium for isolation and differentiation of pathogenic urinary tract microorganisms.

Materials and methods. A prospective study was conducted, which included 147 consecutive urine samples from patients with clinically suspected UTIs of Karaganda city (Republic of Kazakhstan) in 2019. The presumptive microorganisms’ identification was carried out at CHROMagar™ Orientation in accordance with morphology, colony color on the characteristics recommended by the manufacturer. The final identification of isolates to species was performed by matrix-associated laser desorption/ionization – time-of-flight mass spectrometry (MALDI-TOF MS) using the Microflex LT system and the MALDI Biotyper Compass v.4.1.80 software (Bruker Daltonics, Germany). The recommended values of Score ≥2.0 were used as a criterion for reliable species identification.

Results and discussion. 55 (37.4%) of 147 urine cultures gave a positive growth of bacteria, 86 (58.5%) did not give a growth, 6 samples were regarded as contaminated material. Comparative results of using CHROMagar™ Orientation for identification of the claimed microorganisms reached 100% sensitivity and specificity compared to mass-spectrometry. Excellent species identification was for E. coli – colonies were stained in dark pink, but there are some limitations for the rest microorganisms – Klebsiella, Enterobacter, Citrobacter, Serratia, respectively, in such cases, further species identification with additional tests is necessary.

Conclusions. The results of the study showed that the chromogenic environment of CHROMagar™ Orientation can be used to isolate and differentiate urinary tract microorganisms. This is a reliable identification of relevant uropathogens, cultures differentiation, saving time and research costs.

Aim. Evaluation of the effectiveness of the introduction of elements of dual education among students of the specialty

«Public Health» when mastering the discipline «Occupational Hygiene» by studying and analyzing the degree of student satisfaction with changes in the educational process.

Materials and methods. The continuous cross-sectional study was conducted among 3rd and 4th year students of the specialty «Public Health».

The study of students' satisfaction with dual education during the course of the discipline «Occupational Hygiene» included two stages. The first stage is an anonymous online survey using a specially designed questionnaire. At the second stage, an interview was conducted with students in an offline format, which clarified the attitude towards dual education.

Results and discussion. The results of the survey on satisfaction with the development of practical skills in occupational hygiene at the scientific research sanitary and hygienic laboratory were distributed as follows: 86.5% of respondents were completely satisfied with the development of practical skills, 10.8% of respondents noted partial satisfaction with the development of practical skills, as they would like to hone their practical skills directly in the workplace, 2.7% of students are completely dissatisfied with the development of practical skills on the basis of the scientific research sanitary and hygienic laboratory, without explaining the weighty reason for this answer.

92% of students are satisfied with the socio-psychological climate when studying theoretical issues of occupational health and on a practical basis. At the same time, during the interview, students noted the lack of allocated hours in the discipline for detailed study of questions with a teacher and mentor.

Aspergillosis of the lungs is an infectious disease caused by fungi of the genus Aspergillus, which can affect lung tissue, causing inflammation, necrosis and loss of function. This disease is becoming increasingly relevant due to the increasing number of patients with weakened immune systems, such as patients with chronic respiratory diseases (for example, COPD, asthma, etc.). The disease can occur in various forms, from acute and subacute to chronic and invasive, which makes diagnosis difficult and requires an individualized approach to treatment. Differential diagnosis of the pulmonary form of aspergillosis should be performed with tuberculosis, sarcoidosis, pneumonia (destructive forms), tumor processes and their metastases.

The article presents a clinical case of disseminated pulmonary aspergillosis in a woman, in which it became difficult to clinically diagnose the pathological process without morphological verification.

This clinical case shows that a pathologist should carry out a thorough morphological verification of the granulomatous process, taking into account clinical and laboratory data, radiation diagnostics and additional research methods, taking into account the peculiarities of the histological picture in each granulomatous disease. Differential diagnosis of granulomatous formations makes it possible to exclude other types of granulomatosis, in particular in tuberculosis, during histological examination of thoracobiopsy material. Timely morphological verification of the clinical diagnosis will make it possible to choose an adequate treatment strategy and assess the prognosis of the disease. Aspergillosis worsens the course of the underlying pathological process.

Aspergillosis of the lungs is a serious threat to health, especially among patients with weakened immune systems.

Early detection and accurate diagnosis of the disease play a key role in its successful treatment.

Aim. Demonstration of a clinical case of radioiodine resistance highly differentiated thyroid cancer and discussion of current diagnostic methods: the role of PET-CT with 18F-FDG.

Materials and methods. The study design is a retrospective study. A database of patients who underwent treatment in the radionuclide therapy department of the Centre for Nuclear Medicine and Oncology of the Abay Regional Healthcare Institution was formed. This clinical case was taken from this database.

Results and discussion. The clinical case we reviewed confirms the presence of a flip-flop phenomenon in the radioiodine resistance course of thyroid cancer. PET-CT with 18F-FDG is an important component in the diagnostic algorithm of patients with highly differentiated thyroid cancer, suspected or confirmed radioiodine resistance. The method provides visualization of metabolically active tumor foci due to the accumulation of fluorodeoxyglucose in tissues with increased glycolysis.

Conclusions. PET-CT using 18F-FDG occupies an important place in the diagnosis of radioiodine resistance differentiated thyroid cancer. The method makes it possible to identify metabolically active tumors and metastases that do not accumulate radioactive iodine and indicates the aggressiveness of the process. Despite the existing limitations, PET-CT with 18F-FDG remains an effective tool for making decisions about the expediency of radioiodine therapy and the choice of further treatment tactics.