Background and objective: Virtual reality is a promising pain control strategy for various pain conditions. This umbrella review of systematic reviews and meta-analyses aims to evaluate the analgesic effects of virtual reality.Methods: We searched for the relevant reviews in Scopus, PubMed and Cochrane library. Our primary outcome was pain, with secondary outcomes including disability, general health status, patient satisfaction, depression, balance, fear of movement, and adverse events. The quality of included articles was evaluated using the AMSTAR-2 tool.Results: 21 systematic reviews and meta-analyses with 274 studies and 17,680 patients were included in this review. All the reviews concluded benefits of virtual reality in managing pain conditions, including chronic and pain.Discussion and conclusions: This umbrella review demonstrates successful application of virtual reality in pain control, including perioperative, periprocedural, and chronic pain settings. Virtual reality can be used as an alternative therapy for pain management in children and adults.

Background: Regional anesthesia is increasingly used in acute postoperative pain management. Ultrasound has been used to facilitate the performance of the regional block, increase the percentage of successfully performed procedures and reduce the complication rate. Artificial intelligence (AI) has been studied in many medical disciplines with achieving high success, especially in radiology. The purpose of this review was to review the evidence on the application of artificial intelligence for optimization and interpretation of the sonographic image, and visualization of needle advancement and injection of local anesthetic.Methods: To conduct this scoping review, we followed the PRISMA-S guidelines. We included studies if they met the following criteria: (1) Application of Artificial intelligence-assisted in ultrasound-guided regional anesthesia; (2) Any human subject (of any age), object (manikin), or animal; (3) Study design: prospective, retrospective, RCTs; (4) Any method of regional anesthesia (epidural, spinal anesthesia, peripheral nerves); (5) Any anatomical localization of regional anesthesia (any nerve or plexus) (6) Any methods of artificial intelligence; (7) Settings: Any healthcare settings (Medical centers, hospitals, clinics, laboratories.Results: The systematic searches identified 78 citations. After the removal of the duplicates, 19 full-text articles were assessed; and 15 studies were eligible for inclusion in the review.Conclusions: AI solutions might be useful in anatomical landmark identification, reducing or even avoiding possible complications. AI-guided solutions can improve the optimization and interpretation of the sonographic image, visualization of needle advancement, and injection of local anesthetic. AI-guided solutions might improve the training process in UGRA. Although significant progress has been made in the application of AI-guided UGRA, randomized control trials are still missing.

Objective: This umbrella review aims to analyze the effectiveness of exercise therapy for low back pain through an analysis of systematic reviews that evaluate pain reduction, quality of life improvement, and functional outcomes. Methods: This review adhered to PRISMA guidelines and systematic review of review recommendations by searching across PubMed, Scopus, and the Cochrane Library. This study searched for systematic reviews alongside meta-analyses that evaluated exercise interventions in treating low back pain (LBP). This study included reviews that examined exercise therapy for LBP patients and presented data regarding their pain intensity, disability, and quality-of-life outcomes. Data extraction and quality assessment were performed independently by several reviewers. The methodological quality of the included systematic reviews was assessed using the AMSTAR 2 tool. Results: This research yielded 88 systematic reviews from 997 evaluated records. Reduction of pain emerged as the primary measured outcome in systematic reviews (81.8%, n = 72), and these studies showed significant improvement rates of 83.0%. The proportion of studies that concluded no change was 9.1%. The most frequently studied exercises were strengthening, aerobic, and mind–body exercises. The reviews reported quality of life improvements in 27.3% (n = 24), but most reviews (68.2%) did not assess this outcome. No studies indicated worsening outcomes. Exercise interventions demonstrated various forms that effectively contribute to LBP management, according to the study results. Conclusions: This umbrella review of 88 systematic reviews highlights that exercise therapy is a safe, effective, and commonly used strategy for managing low back pain. However, key limitations include the low methodological quality of several included reviews, risk of bias, imprecision, limited reporting of adverse effects, and confounding from multicomponent interventions. While there is limited certainty that any one type of exercise is more effective than others, individualized approaches and patient adherence appear to be critical factors in optimizing outcomes.

Background/Objectives: Effective management represents a real opportunity to reduce the economic burden of focal epilepsy, which leads to the withdrawal of at least 0.7% of the working-age population from the labor force. The aim of this retrospective observational cross-sectional study is to identify barriers that limit access to surgical treatment for epilepsy among patients with focal epilepsy in Kazakh population. Methods: Medical reports from epileptologists on 3112 patients of the Epilepsy Center (Astana) in 2024 were reviewed. The study included original information on 1361 patients with a confirmed diagnosis of focal epilepsy, in accordance with ICD-10 codes G40.0–G40.2. Results: Timely detection of focal epilepsy was not associated with socio-demographic or regional factors in our sample. Logistic regression analysis showed that sex and social status did not affect whether patients underwent surgery. However, marital status, employment, and region were significant factors. Married and employed patients had higher odds of remaining non-operated. Among candidates for surgical treatment, 38.68% underwent surgery. Conclusions: The markedly higher odds of remaining non-operated outside Astana point to gaps in referral pathways and service availability, emphasizing the need for a comprehensive approach to managing focal epilepsy in countries undergoing rapid technological development.

Objective: To evaluate the impact of disease duration of pharmacoresistant focal epilepsy and type of antiepileptic therapy on intraoperative infusion therapy parameters. Materials and Methods: A retrospective cohort study was conducted involving 102 patients (2019–2024) who underwent neurosurgical intervention for pharmacoresistant focal epilepsy. Patients were stratified by disease duration (≤15 years and >15 years) and therapy type (monotherapy and polytherapy). The following parameters were evaluated: infusion volume, infusion therapy composition, fluid balance, urine output, blood loss, extubation time, and length of stay in the intensive care unit. Results: Polytherapy was associated with significantly higher fluid balance and greater crystalloid volume compared to monotherapy (p15 years) was accompanied by a tendency toward increased fluid balance and significantly prolonged time to extubation (p<0.05). Hemodynamic parameters remained stable across all groups. Conclusion: The type of antiepileptic therapy and disease duration are significant factors influencing infusion therapy volume. A personalized approach to infusion management in patients with pharmacoresistant epilepsy may enhance safety and improve outcomes.

Background: Drug-resistant epilepsy (DRE) remains a serious clinical challenge, especially in settings with limited access to specialized care. A significant proportion of patients in Kazakhstan do not receive timely diagnosis or referral to specialized centers. Objective: The aim of this study is to identify, using the example of the Epilepsy center’s work, the barriers that limit access to specialized treatment, particularly the timely establishment of a diagnosis of drug-resistant epilepsy. Materials and methods: This retrospective observational study included 560 Kazakh patients with DRE who presented to the Center between 2017 and 2023. Clinical and demographic data, social status, place of residence, and access to specialized care were analyzed. Statistical processing was performed using non-parametric methods and the χ² test, with a significance level of p < 0.05. Results: In the overall patient group, delayed identification of drug resistance was associated with marital status and region of residence. Among patients whose diagnosis was first established at the Epilepsy center, unmarried individuals predominated (p < 0.006). A statistically significant predominance of individuals from Astana who received specialized care was observed (p < 0.0001). Examination of the association between DRE diagnosis and different epilepsy duration groups revealed no significant relationship in any group. Analysis of factors contributing to delayed DRE diagnosis in patients with disease duration over 20 years showed that men were almost 1.5 times more likely to experience delayed diagnosis compared to women (OR, 95% CI: 1.12 (1.02–1.31), p = 0.02), and lack of social protection reduced the likelihood of receiving specialized care (OR, 95% CI: 0.65 (0.54–0.79), p < 0.0001). Conclusions: Timeliness of DRE diagnosis in Kazakhstan is determined by a combination of sociodemographic and regional factors. Patients from Astana and those with social support have better access to specialized care. Systemic measures are needed to improve patient referral pathways, reduce regional disparities, and combat stigmatization. Введение. Фармакорезистентная эпилепсия (ФРЭ) остаётся серьёзной клинической проблемой, особенно в условиях ограниченного доступа к специализированной помощи. Значительная часть пациентов в Казахстане не получает своевременную диагностику и направление в специализированные центры. Целью данного исследования является на примере работы Центра выявить барьеры, ограничивающие доступ к специализированному лечению, в частности своевременное установление диагноза фармакорезистентной эпилепсии. Материалы и методы. Ретроспективное наблюдательное исследование включало 560 пациентов казахской национальности с ФРЭ, обратившихся в Центр с 2017 по 2023 гг. Анализировались клинико-демографические данные, социальный статус, место проживания и доступ к специализированной помощи. Статистическая обработка данных проводилась с использованием непараметрических методов и χ²-теста, уровень значимости p < 0,05. Результаты. В общей группе пациентов с несвоевременным выявлением фармакорезистентности были связаны семейное положение и регион проживания пациента. Среди пациентов, у которых диагноз впервые установлен в Центре эпилепсии, преобладали неженатые/незамужние (р<0,006). Наблюдается статистически значимое преобладание лиц в Астане, получивших специализированную помощь (р<0,0001). Изучение ассоциации с диагнозом фармакорезистентности в разных группах в зависимости от продолжительности эпилепсии не показала значимой связи ни в одной из групп. Анализ факторов несвоевременной постановки диагноза фармакорезистентности в группе пациентов с длительностью заболевания более 20 лет показал, что среди мужчин почти в 1,5 раза была вероятность несвоевременного диагностирования по сравнению с женщинами (OR, 95% CI: 1,12 (1,02-1,31), р=0,02) и отсутствие социальной защиты уменьшает шансы на получение специализированной помощи (OR, 95% CI: 0,65 (0,54-0,79), р<0,0001). Выводы. Своевременность диагностики ФРЭ в Казахстане определяется сочетанием социально-демографических и региональных факторов. Пациенты из Астаны и социально защищённые лица обладают более высокой доступностью специализированной помощи....