BACKGROUND: The issues of the pathogenetic relationship of thyroid-adrenal disorders in diabetes mellitus (DM) remain relevant, despite certain advances in the study of the pathogenesis and the clinic of DM. These issues are especially actual in the case of a combination of DM with ischemic heart disease (IHD) and obesity. AIM: The aim was to reveal the pathogenetic mechanisms of the relationship between metabolic and morphofunctional thyroid-adrenal disorders in DM and obesity. METHODS: The study included 395 patients with type 1 and 2 diabetes. The diagnosis of DM was verified in accordance with International Programs and was based on WHO criteria. The glycemic level of patients was determined using a One Touch® basic glucometer (Johnson&Johnson, USA). The degree of carbohydrate metabolism compensation was assessed by the level of glycated hemoglobin (HbA1c), determined using a laboratory analyzer DCA-2000 MT (BAYER, Germany). The concentration of C-peptide in the blood serum was determined by the method of immunoluminometric analysis “Immunotech” (Czech Republic). Caro and HOMA-IR indices were calculated to identify and assess the insulin resistance (IR). The indices of hormone metabolism were determined by ELISA using DSL kits (USA) with subsequent measurement of optical density on a Spectra Classic reader from Tecan (Austria): Corticotropic hormone, adrenaline, noradrenaline, cortisol, free hydrocortisone; 17-ketosteroids, 17-oxycorticosteroids, glucogone, insulin, somatotropic hormone (STH); thyroid-stimulating hormone (TSH); thyroxine (T4); and thyroxine (T3). Instrumental-functional and radiation research methods. Ultrasound examination of the adrenal glands, thyroid gland, lungs, liver, and kidneys was performed in all patients. Morphological changes were assessed using histological and morphometric methods. RESULTS: Disorders of carbohydrate metabolism in diabetic patients were revealed by increased glycemic parameters – in 2.14 times, immunoreactive insulin (IRI) – in 2.8 times, HbA1c – in 1.85 times, and HOMA – in 5.3 times compared with the control group. The following indicators were significantly higher in patients with combination of DM, IHD, and obesity: Glycemia – in 2.29 times (p < 0.05), IRI – in 3.81 times, HbA1c – in 2.01 times, and HOMA – in 7.76 times compared with Co and CIHD groups. An increase in the content of pyruvate and lactate and the ratio in the DM2o and DM2IHDo groups indicate an acceleration of glycolysis and the degree of pyridine nucleotides reduction, as well as excessive lipolysis and progression of tissue hypoxia. Thus, the rate of glucose oxidation in patients of DM2o subgroup is reduced in 3.02 times, in patients of DM2IHDo subgroup (p < 0.05) – in 3.18 times compared with Co group. Computed tomography (CT) revealed an increase in the volume of adipose tissue in relation to muscle and bone tissue in patients of DM2o and DM2IHDo subgroups. Abdominal obesity type is expressed in these patients. An increase of glucose promotes its conversion into triglycerides (TG) of adipose tissue under the condition of hyperinsulinemia. Lipogenesis in the body of patients with DM and coronary heart disease increases, and obesity develops. The increase of cortisol and TSH (p < 0.01) levels was observed in patients of DM2o, DM2IHDo groups compared with the control groups. In patients of DM1 group, the parameters of norepinephrine were increased in 2.23 times, TSH (p < 0.01) – in 3.15 times, and the content of STH was reduced in 3.76 times and the content of cortisol – in 1.5 times significantly (p < 0.01) compared to C1 group. Ultrasound and CT with contrast revealed diffuse adrenal hyperplasia, signs of a decrease in the size of the thyroid gland with a medium-grained structure, areas of its cystic degeneration in the form of hypoechoic zones with a medium-grained echo structure. Thus, the expressed atrophic processes in the lobes of the thyroid gland were observed in 27 (15.4%) patients of DM2 group and in 13 (13%) patients of DM2CHDo group. Analysis of spectral characteristics during Doppler ultrasonography of the thyroid gland vessels made it possible to determine low peak systolic blood flow velocities in CIHD group. Pathomorphological examination of the adrenal glands on electronograms recorded that the porosity of the walls of the sinusoidal capillaries increased primarily within the bundle zone of the cortex. Corticocytes of the fascicular and reticular zones underwent degenerative and necrotic changes. Along with this, some of the epithelial cells contained the usual number of light and an increased number of dark fat droplets. The study of the sectional material revealed signs of suppression of the function of the thyroid gland, dystrophic changes in the cells increased, which contributed to a decrease in the functional capabilities of the follicular epithelium, destruction of individual thyrocytes, and substitutional sclerosis with an increase in the exchange surface area in the blood-tissue barriers. CONCLUSION: The main pathogenetic mechanism of suppression of the structural and functional state of the adrenal and thyroid glands is due to dystrophic changes in the microvasculature. With the addition of ischemic heart disease, the oppression of their functions of the glands develops, which leads to destruction, an increase in vascularization, porosity of the capillary walls, and tissue hardening. There is a further aggravation of hormonal and metabolic disorders in patients with DM with coronary heart disease. It is confirmed by a significant increase in the lactate/pyruvate index and the index of IR. The volume of adipose tissue in relation to muscle and bone tissue on CT was significantly higher (p < 0.05) compared to the control groups. The predominance of the abdominal type of fat deposition is expressed.

Целью исследования была оценка удовлетворенности студентов процессом обучения в онлайн-формате. Материалы и методы. В исследовании прияли участие 160 студентов 3 курса бакалавриата образовательной программы «General medicine» международного медицинского факультета Медицинского университета Караганды. Оценивали удовлетворенность студентов процессами преподавания, оценивания, формирования навыков и опыта получения знаний после изучения дисциплины «Биостатистика в медицине» в онлайн-формате. Для оценки удовлетворенности студентов процессом обучения использовали опросник «Measuring student satisfaction from the Student Outcomes Survey». Результаты и обсуждение. 79 % студентов, принимавших участие в исследовании, в целом были удовлетворены процессом обучения в онлайн-формате. Вместе с тем, около 30 % студентов либо сомневались, либо были не согласны с утверждением о том, что преподаватель их заинтересовал и увлек во время преподавания дисциплины. Такое же количество студентов были не удовлетворены временными интервалами, через которые происходил контроль знаний и умений. Заключение. Результаты исследования показали, что вынужденный переход на онлайн-обучение в целом не повлиял на удовлетворенность студентов такими составляющими процесса обучения, как преподавание, оценивание, формирование навыков и опыта получения знаний. Выводы. Для достижения качественных результатов обучения и повышения удовлетворенности студентов процессом обучения необходимо пересматривать и корректировать методы преподавания и оценивания знаний и навыков студентов в зависимости от формата обучения (онлайн или офлайн).

The distribution of the health workforce affects the availability of health service delivery to the public. In practice, the demographic and geographic maldistribution of the health workforce is a long-standing national crisis. In this study, we present an approach based on Functional Principal Component Analysis (FPCA) of data to identify patterns in the availability of health workers across different regions of Kazakhstan in order to forecast their needs up to 2033. FPCA was applied to the data to reduce dimensionality and capture common patterns across regions. To evaluate the forecasting performance of the model, we employed rolling origin cross-validation with an expanding window. The resulting scores were forecasted one year ahead using Autoregressive Integrated Moving Average (ARIMA) and Long Short-Term Memory (LSTM) methods. LSTM showed higher accuracy compared to ARIMA. The use of the FPCA method allowed us to identify national and regional trends in the dynamics of the number of doctors. We identified regions with different growth rates, highlighting where the most and least intensive growth is taking place. Based on the FPSA, we have predicted the need for doctors in each region in the period up to 2033. Our results show that the FPCA can serve as a significant tool for analyzing the situation relating to human resources in healthcare and be used for an approximate assessment of future needs for medical personnel.

Purpose: The Successive Approximation Model (SAM) provides an iterative framework for developing digital learning resources, while artificial intelligence (AI) may enhance personalization and cognitive support. However, empirical evidence on the combined implementation of SAM and AI in medical education remains limited. This study aimed to evaluate the acceptability and perceived educational effectiveness of a biostatistics e-course developed using the SAM model and supplemented with an AI-supported component. Materials and Methods: A mixed-perspective descriptive study was conducted following the development and implementation of a modular biostatistics e-course based on the SAM at Karaganda Medical University. The course was developed through iterative prototyping, stakeholder feedback, and progressive refinement consistent with the SAM framework. Participants included 215 undergraduate medical students, 73 students involved in the needs assessment phase, and course developers. Questionnaires and descriptive analysis were used to gain staff perceptions of the SAM model of course development, student use of AI, and student evaluation of the quality of the course. Results: Across key evaluation domains, 64.7% of students reported positive perceptions of the course, including improved understanding of biostatistics and greater convenience compared with traditional learning formats, while negative responses remained below 12%. The AI component was used by 56.9% of students, primarily for explanation of theoretical material and analysis of statistical concepts. Among AI users, 82.1% reported improved understanding, and 53.7% reported increased motivation. However, 57.7% encountered errors, and trust in AI remained moderate. Developers positively evaluated the SAM model, particularly its iterative design and flexibility, while highlighting the need for methodological training and institutional support. Conclusion: The integration of SAM-based instructional design and AI-supported learning represents a feasible and acceptable approach to developing adaptive digital courses in medical education. Effective implementation depends on the balanced integration of instructional design, AI-mediated support, and institutional readiness.

Background: A good understanding of the demand for health services requires not only an analysis of the current and historical volume of health care provided but also relies on accurate forecasting of trends in the future. Such trends provide invaluable information for needs assessment, resource planning, facility evaluation and policy formulation. We set the task of assessing the load on the healthcare system of Kazakhstan in the next decade using indicators of general morbidity, outpatient visits, the need for medical personnel and financial costs of medical care. Methods: This study applies a dynamic Markov chain model to forecast population dynamics and ARIMAX method for healthcare demand forecasting. Results: In the next decade, the population of Kazakhstan is expected to grow by an average of 1.4% per year, reaching 23,334,397 people by 2033. The population growth will lead to an increase in the overall morbidity of the population in absolute values. The growth rate for children will be 1.6%, for adults - 0.8% per year. In this regard, the number of visits to medical specialists will increase by approximately 1.5% per year. Therefore, the demand for internists will increase by an average of 4.7% per year. The need for labour and material resources will entail an increase in financial costs. Total costs by 2033 will increase by 11.6% compared to 2023. Conclusions: Understanding the demand for health services requires not only the analysis of past and current health data but also relies on accurate forecasting of future trends. Assessing such trends provides invaluable information for identifying needs, planning resources, evaluating facilities, and formulating policies.

Background and Objectives: Purine-metabolism profiles across distinct thyroid phenotypes remain poorly characterized despite the recognized redox imbalance associated with thyroid dysfunction and autoimmune thyroiditis (AIT). We compared plasma and erythrocyte purine-metabolite profiles, derived purine ratios, and their associations with lipid peroxidation across four thyroid-disease phenotypes and healthy controls. Materials and Methods: This single-center cross-sectional study included 164 participants: hypothyroidism without AIT (n = 31), AIT with hypothyroidism (n = 30), nontoxic nodular goiter with euthyroidism (n = 42), euthyroid AIT (n = 37), and healthy controls (n = 24). Purine metabolites were assessed by direct UV spectrophotometry and expressed in relative extinction units; thiobarbituric acid-reactive substances (TBARS)-derived malondialdehyde (MDA) equivalents were measured in plasma and erythrocytes. Results: Plasma guanine and hypoxanthine were lower in AIT with hypothyroidism than in hypothyroidism without AIT and in euthyroid AIT than in nontoxic nodular goiter. Plasma X/HX and UA/HX were higher in both AIT groups than in controls. Plasma MDA was elevated in all thyroid-disease groups, whereas erythrocyte MDA was highest in hypothyroidism without AIT. Plasma UA/X correlated positively with both plasma and erythrocyte MDA, and plasma UA/HX with plasma MDA, with phenotype-dependent heterogeneity in stratified analyses. Conclusions: Thyroid phenotypes showed distinct compartment-specific purine and lipid-peroxidation patterns rather than a uniform AIT-dependent shift. Purine ratios should be interpreted as indirect, method-specific indices rather than direct measures of metabolic flux or XOR/XO/XDH activity.