Билиарные осложнения после трансплантации печени

Ambulatory cardiac monitoring is a rapidly expanding field of functional diagnostics. Today, the main direction of cardiac monitoring is outpatient monitoring of the electrocardiogram, an important diagnostic tool that is used daily by doctors in many specialties. Therefore, both wearable and subcutaneous technologies of electrocardiographic monitoring are now widely used. A number of devices can be placed under the patient’s skin and have the ability to wirelessly transmit data to home transmitters, which, in turn, then transmit data to the doctor via cloud interfaces, so that, they allow remote monitoring and monitoring of the patient’s condition. Such systems are widely used in various countries of the world, approved in the USA, and are also used for remote monitoring of patients in Europe and Kazakhstan, where their implementation is gaining momentum. This review presents the technical aspects of subcutaneous monitoring, provides a schematic representation of the operation of systems existing on the market, discusses the advantages of this method, as well as the disadvantages of existing implantable cardiac monitors. The issues of the future development of this technology and indications for the use of existing devices approved by the professional cardiological communities are considered.

Background/Objectives: Malignant distal biliary obstruction (MDBO) is a frequent complication of pancreatic cancer and often leads to obstructive jaundice, impaired liver function, and delayed oncologic treatment. Endoscopic biliary drainage using endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the standard minimally invasive approach for restoring biliary flow. However, clinical outcomes and complication rates vary across studies depending on stent design, placement technique, and patient characteristics. The aim of this systematic review was to evaluate the clinical outcomes and complications associated with endoscopic biliary stenting in pancreatic cancer-related MDBO. Methods: A systematic literature search was performed in PubMed/MEDLINE, ScienceDirect, Web of Science, and the Cochrane Library for studies published between January 2016 and January 2026. Studies evaluating ERCP-guided biliary stenting in adult patients with pancreatic cancer-related malignant distal biliary obstruction were included. Study selection followed PRISMA 2020 guidelines, and methodological quality was assessed using the Newcastle–Ottawa Scale. Clinical outcomes including technical success, clinical success, stent patency, recurrent biliary obstruction, and procedure-related complications were analyzed. Results: Eighteen studies involving a total of 3291 patients were included in the qualitative synthesis. Technical success rates were consistently high, reaching up to 100% in several studies, while clinical success rates generally exceeded 90%. Median time to recurrent biliary obstruction ranged from approximately 102 to 541 days depending on stent type and placement technique. Recurrent biliary obstruction was the most frequently reported complication, occurring in 30.7% of patients. Stent migration occurred in 14.9% of cases, while post-ERCP pancreatitis was reported in approximately 4.2% of patients. Several studies demonstrated longer patency with self-expandable metal stents compared with plastic stents. Conclusions: Endoscopic biliary stenting performed during ERCP is an effective and safe strategy for the management of malignant distal biliary obstruction in pancreatic cancer. Self-expandable metal stents provide more durable biliary drainage and reduce the need for repeat interventions. Nevertheless, recurrent biliary obstruction remains a common limitation, highlighting the need for further improvements in stent technology and optimized placement strategies.

Background: Outpatient drug provision is a critical component of primary healthcare systems and a key determinant of treatment continuity, adherence, and equity, yet the effectiveness of publicly funded outpatient drug programs often depends on how policies are implemented at the point of care. This study examined physician awareness, practical experience, and perceived barriers related to outpatient drug provision and drug cost compensation mechanisms in urban primary care settings in Kazakhstan. Methods: A descriptive cross-sectional survey was conducted between September and December 2024 among 380 physicians working in all 33 state-owned urban polyclinics in Almaty, using a structured author-developed questionnaire. Descriptive statistics and Pearson’s chi-square tests were applied to assess associations between physician characteristics and awareness levels. Results: Only 44.0% of physicians confirmed the existence of outpatient drug cost compensation mechanisms in their polyclinics, while 26.0% believed that no such mechanisms existed and 30.0% were unable to provide a definitive answer, indicating that 56.0% lacked accurate awareness. Limited medicine availability and recurrent shortages were frequently reported, with half of physicians advising patients to purchase medicines out of pocket. Physician awareness was significantly associated with professional experience and specialty (p < 0.001). Conclusions: These findings indicate a substantial physician-level implementation gap in outpatient drug provision, suggesting that organizational and informational barriers—rather than insufficient public financing—are the primary drivers, highlighting the need for strengthened governance.

Кіріспе: Жүрек-қан тамырлары аурулары бүкіл әлемде өлімнің негізгі себебі болып табылады. Жүрек-қан тамырлары ауруларын емдеуде имплантацияланатын кардиовертер дефибрилляторы (ИКД) сияқты технологиялық жетістіктер де маңызды рөл атқарады. ИКД аномалиялық жүрек ырғағын түзете алады. Зерттеудің мақсаты - жүрек ауруларындағы ИКД тиімділігін зерттеу. Әдіс-тәсілдер::PubMed, Cochrane Library кітапханаларында әдебиеттерді іздеу жүргізілді. Іздеу келесі кілт сөздер кірді: implantable cardioverter defibrillator, efficiency, or effectiveness, quality of life, sudden cardiac death. Әдістемелік сүзгілерге метаанализ және систематикалық зерттеулер кірді. Іздеу 2011 жылдың қаңтары мен 2021 жылдың сәуірі аралығында жарияланған ағылшын және орыс тілдерімен шектелді. Қосу критериі: 1) мәліметтер базасында бар толық мәтіндер; 2) ағылшын немесе орыс тілдеріндегі мәтіндер; 3) соңғы онжылдықта (2011-2021) жүргізілген немесе жарияланған зерттеулер; 4) метаанализ және систематикалық зерттеулер. AMSTAR 2 бақылау тізімінің көмегімен енгізілген зерттеулердің сапасы талданды. Нәтижелер: Жүргізілген зерттеулер кенеттен жүрек өлімінің, жүректің ишемиялық артерия ауруы жоқ және жүректің ишемиялық ауруы бар сол жақ қарыншалық дисфункцияның алдын-алу үшін ИКД тиімділігін зерттеуді, гипертрофиялық кардиомиопатия және қарыншалық аритмиямен ауыратын науқастардың клиникалық нәтижелері мен асқынуларын қамтиды. Қорытынды: Қазіргі уақытта қол жетімді деректер альтернативті терапиямен салыстырғанда ИКД қолдану емдеудің маңызды нұсқасы екендігін көрсетеді. Introduction: Cardiovascular disease is the leading cause of death worldwide. Technological advances such as the implantable cardioverter defibrillator (ICD) also play a key role in the treatment of cardiovascular disease. An ICD can correct an abnormal heart rhythm. The aim is to study the effectiveness of ICD in heart disease. Methods: Literature search was carried out in databases: PubMed, the Cochrane Library. The search strategy included the following keywords: implantable cardioverter defibrillator, efficiency, or effectiveness, quality of life, sudden cardiac death. Methodological filters included systematic reviews and meta-analyzes. The search was limited to English and Russian, published between January 2011 and April 2021. Inclusion criterion: 1) full texts available in databases; 2) texts in English or Russian; 3) research carried out or published over the past decade (2011-2021); 4) systematic reviews and meta-analyzes. Quality of the included studies was analyzed using the AMSTAR 2 checklist. Results: The studies included the effectiveness of ICD for the prevention of sudden cardiac death, left ventricular dysfunction without coronary artery disease and with ischemic heart disease, with cardiac resynchronization therapy, clinical outcomes and complications in patients with hypertrophic cardiomyopathy and ventricular arrhythmia. Conclusions: Currently available data demonstrate that the use of ICD is an important treatment option in comparison with the alternative therapies. Введение:Сердечно-сосудистые заболевания являются ведущей причиной смерти во всем мире. Технологические достижения, такие как имплантируемый кардиовертер-дефибриллятор (ИКД), также играют ключевую роль в лечении сердечно-сосудистых заболеваний. ИКД позволяет исправить нарушение сердечного ритма. Целью исследованияявляется изучить эффективность ИКД при заболеваниях сердца. Методы: Поиск литературы проводился в базах данных: PubMed, the Cochrane Library. Стратегия поиска включала ключевые слова: implantable cardioverter defibrillator, efficiency, or effectiveness, quality of life, sudden cardiac death. Методологические фильтры включали cистематические обзоры и метаанализ. Поиск был ограничен английским и русским языками, опубликованными в период с января 2011 года по апрель 2021 года. Критерий включения: 1) полные тексты, имеющиеся в базах данных; 2) тексты на английском, или русском языках; 3) исследования, выполненные или опубликованные за последнее десятилетие (2011-2021 гг.); 4) cистематические обзоры и...