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Objective: This review aims to analyse and systematise the ethical and legal aspects of implementing artificial intelligence (AI) in the diagnosis of cardiovascular diseases within the framework of primary health care.

Materials and methods: The review was conducted in accordance with established scientific standards for writing review articles. A comprehensive literature search was performed using databases such as PubMed, Scopus, Web of Science, and Google Scholar. Key search terms included: «artificial intelligence», «primary health care», «cardiovascular diseases», «ethics», «legal aspects», «data protection», and «medical AI». The review included publications from 2005 to 2025, with a focus on peer-reviewed articles and reports addressing the ethical and/or legal application of AI in healthcare.

Results: The findings of the review indicate that despite the high potential of artificial intelligence (AI) to improve diagnostic accuracy, expand access to medical care, and reduce the burden on healthcare professionals, its implementation in primary health care is accompanied by a range of ethical and legal challenges. These include ensuring data privacy, obtaining informed consent, promoting equitable access to AI technologies, addressing legal uncertainty, and clarifying liability in cases of AI-related errors. Particular attention must be paid to vulnerable and rural populations to prevent digital inequality. Although AI holds promising applications-such as remote monitoring of cardiovascular health and intelligent decision support-the level of trust among healthcare providers in these algorithms remains limited. This highlights the need for a comprehensive regulatory and educational framework to ensure the safe and ethical integration of AI into clinical practice.

Conclusion: Artificial intelligence (AI) holds significant potential for improving the quality of cardiovascular disease diagnosis in primary health care. However, its effective and safe implementation is possible only when supported by a well-defined ethical and legal framework. To minimise risks related to data privacy, algorithmic bias, legal liability, and unequal access, collaboration is essential among physicians, developers, legal experts, ethicists, and patient representatives. This collaboration should focus on developing unified regulatory policies, patient-centred technologies, and practical ethical guidelines. Future research should prioritise empirical evaluation of AI integration outcomes in cardiovascular diagnostics, as well as cross-cultural analyses. Such efforts will help shape a sustainable and adaptable global policy for the ethical use of AI in primary cardiology practice.

Segmental bone defects represent one of the most demanding challenges in trauma and orthopaedic surgery. These defects commonly result from high-energy trauma, tumour resection, infection, or non-union, often compounded by soft tissue loss and systemic comorbidities. A broad range of reconstructive strategies is available, including autologous grafting, vascularized fibular grafts, allografts, distraction osteogenesis, and the Masquelet induced membrane technique. Treatment selection depends on defect size, host biology, and soft tissue condition, with classification systems such as Ferreira and Tanwar offering structured guidance. While traditional methods remain essential, recent advances are reshaping the reconstructive landscape. Biologics, synthetic bone substitutes, and 3D printing technologies are expanding the armamentarium, though their roles in routine care remain under evaluation. Despite these innovations, complications such as infection, prolonged treatment, and graft failure persist. This review synthesizes current concepts in bone defect management, including established and emerging techniques. It emphasizes that success depends not only on surgical method but also on host optimisation, early soft tissue reconstruction, and multidisciplinary collaboration. Future progress will require robust multicenter trials and incorporation of patient-reported outcomes to refine treatment algorithms and validate novel approaches.

Introduction: Papillary thyroid carcinoma (PTC) accounts for nearly 85% of all thyroid malignancies worldwide. Molecular profiling continues to demonstrate that the BRAF V600E mutation is the dominant oncogenic alteration, identified in approximately 40-60% of PTC cases. Recent meta-analyses confirm that BRAF V600E is significantly correlated with tumor aggressiveness and resistance to radioiodine therapy, though regional variations exist.

Objective: To investigate the BRAF V600E mutation in patients with neoplasms and to assess its association with clinical and cytological characteristics in indigenous people living in the territory of the former Semipalatinsk Nuclear Test Site (SNTS) across three generations.

Materials and methods: A cross-sectional study was conducted to determine the frequency of the BRAF V600E mutation in thyroid nodules using fine-needle aspiration biopsy (FNAB) material. The study included 157 FNAB samples obtained under ultrasound guidance from first-, second-, and third-generation residents of the SNTS high-radiation-risk zone. All samples were subjected to molecular genetic analysis for BRAF V600E using the PCR-RFLP method.

Results: The study analyzed 157 fine-needle aspiration biopsy (FNAB) samples. Patient ages ranged from 31 to over 87 years, with a mean age of 68 ± 6.5 years. Women comprised 63% of the cohort and men 37%, yielding a female-to-male ratio of 1.7:1. All biopsies were performed under ultrasound guidance, and needle washings were used for molecular genetic analysis. Among the 157 samples, the following cytological diagnoses were made: papillary carcinoma - 97 cases (56.2%), benign tumors - 18 cases (13.1%), follicular neoplasia - 15 cases (10.9%), suspected carcinoma - 15 cases (10.9%), follicular carcinoma - 8 cases (5.8%), poorly differentiated carcinoma - 2 cases (1.5%), and malignant lymphoma - 1 case (0.72%). The BRAF V600E mutation was detected exclusively in papillary carcinoma samples.

Conclusion: The analysis revealed an association between the BRAF V600E mutation and papillary thyroid cancer in patients exposed to radiation from nuclear testing at the former SNTS. These findings offer new prospects for targeted therapy and early diagnosis of malignant thyroid neoplasms. Following the closure of the test site, positive developments in public health have been observed: radiophobia has decreased and the population's quality of life has improved. Furthermore, the adoption of iodine prophylaxis legislation and the country's industrial growth have contributed to improved well-being and better epidemiological outcomes for thyroid cancer in subsequent generations.

Introduction: The pharmacokinetics, metabolism, and bioavailability of local anesthetics are well established to date. However, in individuals with concomitant systemic diseases, these parameters may undergo significant alterations.

Aim: To analyze the influence of hepatic, renal, cardiovascular, and endocrine comorbidities on the bioavailability, metabolism, and pharmacokinetics of local anesthetics used in dental practice.

Materials and methods: A narrative review was conducted using relevant data from electronic databases including PubMed, Google Scholar, and the Cochrane Library, from 2019 to 2025.

Discussion: Hepatic dysfunction and Gilbert's syndrome reduce the activity of hepatic microsomal enzymes, leading to elevated plasma concentrations of active metabolites and increased systemic toxicity. In renal disease, elevated levels of alpha-1-acid glycoprotein decrease the concentration of unbound local anesthetics, thereby reducing anesthetic efficacy while promoting drug accumulation and systemic toxicity. Cardiovascular disorders impair hepatic perfusion and cardiac output, prolonging the elimination half-life and increasing the risk of cardiotoxicity. Hyperthyroidism accelerates metabolism and shortens the duration of anesthetic action, whereas hypothyroidism and diabetes mellitus slow drug clearance, alter plasma protein binding, and enhance systemic toxicity.

Conclusion: Since systemic diseases can significantly modify the bioavailability, metabolism, and pharmacokinetics of local anesthetics, anesthetic protocols should be individualized for each patient based on their specific comorbid condition and metabolic status.

Background and objectives: Paraproctitis is a common proctological condition that can present in acute or chronic forms, each requiring distinct diagnostic and therapeutic approaches. However, there is limited comparative data on the clinical and organizational characteristics of these forms. The purpose of this study is to conduct a retrospective analysis of medical care for patients with paraproctitis in the Abay region.

Materials and methods: A retrospective cross-sectional study was conducted using data from 453 patients treated for paraproctitis at the University Hospital of NAO "MUS" from 2019 to 2024. Patients aged 18 years and older were included, with diagnosis confirmed by clinical, laboratory, and instrumental methods. Exclusion criteria were age under 18, presence of other diseases. Statistical analysis was performed using SPSS 24.0, with p<0.05 considered significant.

Results: A total of 453 patients were included in the study, of whom 68% had acute paraproctitis and 32% had chronic forms. Males predominated in both groups (83.8%), and most patients were aged 18-44 years. Urban residents accounted for the majority of hospitalizations (77.9%). All patients underwent surgical treatment; abscess drainage prevailed in acute cases (91.2%), while reconstructive procedures were more frequent in chronic cases. Conservative therapies such as physiotherapy, strengthening treatment, and diet No. 3 were significantly more common in chronic cases (p<0.0001). Complications occurred more frequently in acute cases, especially wound infections (74.9%) and bleeding (42.3%), while fecal incontinence and rectovaginal fistulas were more common in chronic disease. The mean hospital stay did not differ significantly between groups; however, mortality was observed only in the acute group (1.6%, p<0.0001). Full recovery was more frequent in chronic cases (53.1%), whereas clinical improvement prevailed in acute cases (83.8%).

Conclusion: Acute and chronic paraproctitis differ significantly in clinical presentation, treatment approaches, complication rates, and outcomes. These findings emphasize the importance of tailored treatment strategies and early intervention to reduce complications and mortality.

Objective: This review aims to examine the current diagnostic and therapeutic challenges associated with endometriosis in women of reproductive age in Kazakhstan and globally. The goal is to identify existing gaps in care and propose improvements in diagnosis, treatment, and health policy.

Materials and methods: A comprehensive literature review was conducted using English-language studies published up to July 2025. Databases such as PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched using keywords: «infertility», «epidemiology», «prevalence», «Kazakhstan», and «endometriosis». Only peer-reviewed studies were included.

Results: The global prevalence of endometriosis is estimated at approximately 10%, yet data from Kazakhstan's national electronic health system shows a significantly lower rate of 0.12%, indicating underdiagnosis. Delays in diagnosis, often reaching several years, are linked to insufficient awareness, lack of non-invasive diagnostic tools, and limited access to specialised care, especially in rural regions. Diagnostic laparoscopy remains the gold standard, but its invasive nature restricts widespread use. Recurrence rates of up to 67% are reported, often due to incomplete lesion removal. Hormonal therapy remains the mainstay of treatment, although it does not offer a definitive cure. Promising innovations, including cytokine biomarker panels, nanotechnology, and stem cell therapy, are being explored. A multidisciplinary, patient-centered approach is essential for long-term disease management.

Conclusion: Endometriosis in Kazakhstan remains underdiagnosed and undertreated. Systemic healthcare reforms, improved awareness among both healthcare professionals and the public, and investment in research and technology are critical. Early diagnosis and personalised, multidisciplinary care can significantly improve outcomes and quality of life for affected women.

Introduction: Respiratory diseases remain one of the leading causes of morbidity and mortality among children worldwide, particularly in low- and middle-income countries where access to quality healthcare and trained professionals is limited. Nurses working in primary healthcare (PHC) settings play a pivotal role in caring for children with respiratory diseases, including initial contact, early symptom detection, and organizing preventive measures. However, despite the growing need for quality care, nursing education programs and training standards for managing pediatric respiratory diseases in Kazakhstan still require significant improvement and systematization. The aim of this review is to conduct a systematic analysis of international studies on the knowledge and best practices of nurses in managing pediatric respiratory diseases in primary healthcare settings.

Search strategy: A literature search was conducted in electronic databases including PubMed/Medline, Cochrane Database of Systematic Reviews, and Scopus for the period from 2014 to 2024. The search terms used were «nursing», «knowledge», «practice», «competence», «primary health care», «pediatric respiratory diseases», «asthma», «children», «evidence-based nursing practice». Relevant publications in Russian and English describing the knowledge and practical approaches of PHC nurses in pediatric respiratory care, as well as barriers in this field, were included. Out of 1156 articles identified, 46 were selected after removing duplicates and those not meeting inclusion criteria. Exclusion criteria included publications older than 10 years, theses, abstracts.

Results and conclusion: Respiratory diseases place a significant burden on primary healthcare systems, highlighting the need to improve nurse training. International experience emphasizes the importance of implementing specialized educational programs, clinical protocols, and multidisciplinary collaboration to enhance the effectiveness of care for children. Adapting such best practices in Kazakhstan could significantly improve the quality of pediatric healthcare and patient satisfaction.

Background: Acute pancreatitis (AP) is an inflammatory disorder with an unpredictable course, ranging from mild self-limiting forms to necrotizing pancreatitis with multiple organ failure. Despite advances in imaging and scoring systems, early severity prediction remains a major challenge. Circulating biomarkers have gained attention as tools for improving diagnostic precision and patient risk stratification.

Aim: To summarize and сcomprehensively evaluate current literature on serum biomarkers used or proposed for predicting acute pancreatitis severity and complications, and to determine their prognostic and clinical value for potential integration into existing scoring systems.

Materials and methods: A comprehensive search of PubMed, Scopus, Google Scholar, and The Cochrane Library identified retrospective and prospective studies assessing diagnostic and prognostic performance of biomarkers - C-reactive protein (CRP), procalcitonin, lipase, angiopoietins (ANG-1, ANG-2), fibrinogen-like proteins (FGL1, FGL2) and interleukins (IL-6, IL-38).

Results: Classical biomarkers (CRP, procalcitonin, nitrogen, protein, and electrolyte indicators) retain diagnostic relevance but show limited specificity. Emerging markers (angiopoietin-2, FGL1, FGL2, cytokines, D-dimer) demonstrate higher sensitivity and prognostic accuracy for organ failure and necrosis, though clinical use remains limited by cost and lack of multicenter validation.

Conclusion: Serum biomarkers hold significant potential for improving early severity prediction in AP. Integrating novel and traditional markers with scoring systems may enhance diagnostic accuracy and guide timely intervention. Further multicenter studies are required for clinical validation and implementation.

Research objective: This research aims to examine the association between labor participation and mental health of older adults, particularly depressive symptoms, and to investigate the extent to which this relationship varies across gender and socioeconomic backgrounds. Based on data from the China Longitudinal Aging Social Survey (CLASS), the research examined the mechanisms through which labor participation influenced the mental health of older adults and provided theoretical support and practical guidance for policymakers.

Materials and methods: This research utilized data from the 2023 China Longitudinal Aging Social Survey (CLASS), involving 10,366 older adults aged 60 and above. Employing a cross-sectional design, the research assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). Labor participation was measured through the questionnaire item, "whether engaged in paid work." Descriptive statistics, univariable analysis, and multiple linear regression analysis explored the relationship between labor participation and mental health of older adults. Gender-stratified analyses were conducted to examine potential heterogeneity, and further heterogeneity analysis based on job types was performed to examine employment quality.

Results: Labor participation showed a significant association with depressive symptoms among older adults, with those engaged in labor exhibiting lower levels of depressive symptoms than their non-working counterparts. Gender analysis revealed that labor participation exerted a significantly greater association with depressive symptom among women than men. Heterogeneity analysis further revealed that a significant negative association with depressive symptoms was strongest only for work characterized by high autonomy and low physical demands. Additionally, factors such as educational attainment, health status, and marital status significantly influenced depressive symptoms. Labor participation interacted with these factors, jointly influencing the mental health of older adults.

Conclusion: A significant association was found between labor participation and reduced depressive symptoms, particularly among women. Furthermore, this relationship varied by job type, showing the strongest association in high-autonomy, low-physical-demand positions. Policy interventions should not only encourage labor participation-particularly among women-but also prioritize job quality by creating positions with greater autonomy and manageable physical demands. Enhancing these job characteristics can strengthen social participation and self-efficacy, thereby maximizing the mental health benefits of working in later life.