The relationship between vitamin D and adolescents' parathyroid hormone and bone mineral density.

Introduction: To detect the relationship between 25-hydroxy vitamin D (25(OH)D) and adolescents' parathyroid hormone (PTH) and bone mineral density (BMD). Material and methods: Two hundred adolescent girls were recruited for this cross-sectional comparative study. After detailed evaluation, a pelvic sonography was performed for the studied adolescents to rule out any pelvic pathology. Adolescents' blood samples were collected to measure the thyroid stimulating hormone, prolactin, glycosylated haemoglobin (HbA1C), PTH, and 25(OH)D. The studied adolescents' BMD and the T-score were evaluated at 2 anatomical sites. The studied adolescents were classified according to their serum 25(OH)D into 2 groups: a 25(OH)D-deficient group (study group; 25(OH)D < 20 ng/ml) and normal controls (25(OH)D > 30 ng/ml). Student's t-test was used for analysis of the studied adolescents' variables, and correlation analysis (Pearson`s correlation) was used to detect the relationship between 25(OH)D and adolescents' PTH and BMD. Results: The parathyroid hormone was statistically higher in the 25(OH)D-deficient group than in the normal controls (41.3 ±3.4 pg/ml vs. 21.1 ±2.8) (p = 0.02), and the BMD was statistically lower in the 25(OH)D-deficient group than in the normal controls (-1.25 ±0.5 vs. 0.3 ±0.4) (p = 0.01). The 25(OH)D had a significant negative correlation with the adolescents' PTH (r = -0.9175; p < 0.00001) and a significant positive correlation with the adolescents' BMD (r = 0.756; p < 0.00001). The parathyroid hormone had a significant negative correlation with the adolescents' BMD (r = -0.7006; p < 0.00001). Conclusions: The parathyroid hormone in this study had significant negative correlations with both 25(OH)D and BMD. The 25(OH)D had a significant positive correlation with the studied adolescents' BMD.

Maternal and fetal outcomes after bariatric surgeries.

Introduction: Obesity is the most common medical problem affecting reproductive-age women. To detect the prevalence of obesity, and bariatric surgeries (BSs) in reproductive-age women, and the impact of obesity vs. BSs on the subsequent pregnancy outcomes. Material and methods: Obese-pregnant women, and women underwent BSs before the current pregnancy, with complete antenatal, and delivery records were included in the current study. Collected data were analyzed using MedCalc 20.106 to calculate the odd ratio (OR), and relative risk (RR) of adverse maternal, and fetal outcomes in relation to maternal obesity vs. BSs. Results: Data of 14,474 pregnant women were collected during this study; 33.94% (4912/14474) of them were obese, and 3.8% (546/14474) of them had previous BSs before the current pregnancy. The obese group has significantly higher odds, and RR of gestational diabetes mellitus (GDM) [OR 1.9 (p = 0.0001), and RR 1.79 (p = 0.0001)], gestational hypertension [OR 1.7 (p = 0.0002), and RR 1.6 (p = 0.0003)], and preeclampsia (PE) [OR 1.7 (p = 0.0001), and RR 1.6 (p = 0.0001)] compared to BSs group. The obese group has also significantly higher odds, and RR of cesarean sections (CSs) [OR 1.3 (p = 0.008), and RR 1.25 (p = 0.01)], and large for gestational age [OR 1.39 (p = 0.01), and RR 1.3 (p = 0.02)] compared to BSs group. Conclusions: About 33.94% of the reproductive-age women in Kuwait are obese, and 3.8% of them had previous BSs. Obese-pregnant women are at increased risks of GDM, gestational hypertension, PE, and CSs. Bariatric surgeries reduced the rates of GDM, gestational hypertension, PE, and CSs significantly.

Epidemiology of Breast Cancer Mortality in Kazakhstan, trends and Geographic Distribution.

BACKGROUND: According to the International Agency for Research on Cancer, ongoing demographic changes will lead to an increase in the number of deaths from breast cancer (BC) per year in the vast majority of regions. In 2040 it is expected that 1.04 million people worldwide will die from this malignancy, including 2,380 women in Kazakhstan. METHODS: The retrospective study (2009-2018) was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. RESULTS: During 10 years 12,958 women died from BC. An average age of the death was 61.6 years (95%CI=60.6-62.6) and tended to increase (APC=+0.6%, R2=0.6117). Age-specific rates had a bimodal increase with peak rates at 70-74 years - 76.7±5.5 (APC=+3.4%, R2=0.2656) and 80-84 years - 78.0±9.1 (APC=+3.7%, R2=0.0875). The age-standardized rate was 13.9 per 100,000 of female population, and the trend has decreased. When compiling thematic maps, mortality rates were determined on the basis of standardized indicators: low - up to 12.5, average - from 12.5 to 15.2, high - above 15.2 per 100,000. The results of the spatial analysis showed the regions with a higher levels of BC mortality rate per 100,000: Pavlodar (16.9), Almaty (19.2) and Astana cities (19.3). CONCLUSIONS: Age-standardized mortality rates had a strong downward trend (APC=-4.0%, R2=0.9218). The decrease mostly is due to a large coverage of the population by mammography screening and to an improvement in the effectiveness of breast cancer treatment.

Epidemiology of spontaneous pregnancy loss in Kazakhstan: A national population-based cohort analysis during 2014-2019 using the national electronic healthcare system.

INTRODUCTION: Spontaneous pregnancy loss (SPL) is a common health problem that affects 1:10 of childbearing women, and is linked with physical and psychological complications. As the number of nationwide studies on the incidence of SPL is few, especially from middle-income countries, in this study we investigated the epidemiology, complications and outcomes of SPL before 22 weeks of gestation by analyzing large-scale healthcare data from the Unified Nationwide Electronic Healthcare System (UNEHS) in Kazakhstan. MATERIAL AND METHODS: A population-based study among women who experienced SPL in any healthcare setting of the Republic of Kazakhstan during the period of 2014-2019. The International Classification of Diseases (ICD) 10th edition and ICD 9th edition's procedural codes were utilized to retrieve data using relevant diagnostic and procedural codes. RESULTS: In total, 207 317 records of women who have experienced an SPL before 22 weeks of gestation were analyzed from all Kazakhstani regions. The estimated prevalence of SPL was 8.7%, with a 20% decline over a 6-year period. The SPL cases ratio comprises on average 6.2 per 1000 reproductive-age women. Incomplete miscarriage (ICD-10 code "O03.4") was the most common type (37.8%), followed by blighted ovum (ICD-10 code "O02.0"; 34.1%) and missed abortion (ICD-10 code "O02.1"; 13.5%). The most common management methods were dilation and curettage of the uterus (ICD-9 code "69.0"; 84.7%) and aspiration curettage of the uterus (ICD-9 code "65.0"; 15%), whereas medical management was rarely performed (2.6%). CONCLUSION: The information available in UNEHS adequately identifies types of miscarriages and treatment methods. Although the prevalence of SPL before 22 weeks of gestation is decreasing, management of miscarriages requires closer attention.

Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box.

Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are accepted for recurrent pregnancy loss but the types of pregnancy and gestational age at miscarriage. Due to the heterogeneity of definitions and criteria applied by international guidelines for recurrent pregnancy loss, the true incidence of recurrent miscarriage, which is reported to range from 1% to 5%, is difficult to estimate. Moreover, the exact etiology of recurrent pregnancy loss remains questionable; thus, it is considered a polyetiological and multifactorial condition with many modifiable and non-modifiable factors involved. Even after thoroughly evaluating recurrent pregnancy loss etiology and risk factors, up to 75% of cases remain unexplained. This review aimed to summarize and critically analyze accumulated knowledge on the etiology, risk factors, relevant diagnostic options, and management approach to recurrent pregnancy loss. The relevance of various factors and their proposed roles in recurrent pregnancy loss pathogenesis remains a matter of discussion. The diagnostic approach and the management largely depend on the etiology and risk factors taken into consideration by a healthcare professional as a cause of recurrent miscarriage for a particular woman or couple. Underestimation of social and health consequences of recurrent pregnancy loss leads to compromised reproductive health and psychological well-being of women after miscarriage. Studies on etiology and risk factors for recurrent pregnancy loss, especially idiopathic, should be continued. The existing international guidelines require updates to assist clinical practice.

Epidemiology of Lung Cancer in Kazakhstan: Trends and Geographic Distribution.

OBJECTIVE: The aim is to study the trends of lung cancer (LC) incidence in the regional context in Kazakhstan. METHODS: The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. RESULTS: Over the 10 years under study, 36,916 new cases of LC were registered in the country (80.5% - in men and 19.5% - in women). During the studied years the average age of patients was 64.2±0.1 years (95%CI=63.9-64.4). The highest incidence rates per 100,000 in the entire population were found in the age groups 65-69 years (147.6±2.7), 70-74 years (159.3±2.5), and 75-79 years (147.1±3.2). The incidence of LC tended to increase only at the age of 80-84 years (APC=+1.26) and the most pronounced average annual decline rates were observed in the age groups of 45-49 years (APC=-4.09), 50-54 years (APC=-4.20) and 85+ years (APC=-4.07). The average annual standardized incidence rate was 22.2 per 100,000, and in dynamics tended to decrease (APC=-2.04). There is a decrease in incidence in almost all regions, with the exception of the Mangystau region (APC=+1.65). During the compilation of cartograms, incidence rates were determined on the basis of standardized indicators: low - up to 20.6, average - from 20.6 to 25.6, high - above 25.6 per 100,000 for the entire population. CONCLUSION: The incidence of lung cancer in Kazakhstan is decreasing. The incidence among the male population is six times higher than among the female, while the rate of decline is more pronounced. The incidence tends to decrease in almost all regions. High rates were found in the northern and eastern regions.

Factors Influencing Antibiotic Consumption in Adult Population of Kazakhstan.

Poor or suboptimal knowledge of appropriate antibiotic use is a cause for global concern and little is known about Central Asian countries. Therefore, this survey is aimed at evaluating awareness about antibiotic use and resistance among the adult population of Kazakhstan. A cross-sectional study of a random sample was conducted between October 2021 and February 2022 among 727 individuals without medical education and followed the methodology described in the WHO report "Antibiotic Resistance: Multi-country public awareness survey". Half of the respondents (50.4%) received antibiotic therapy within the last 12 months, 40.1% had no prescription for this and 40.4% received no advice from a medical professional. Nearly two-thirds of respondents (65.3%) never heard about antibiotic resistance and 57.2% believed that it is worth requesting the same antibiotic if it helped to treat a similar condition previously. In general, knowledge about antibiotic use proved to be low in 82.1% of respondents and 91.9% agreed with the statement that a common cold requires antibiotics. There is a need for awareness-raising campaigns to improve the knowledge about antibiotic use and resistance in the population of Kazakhstan.

Corpus Uteri Cancer in Kazakhstan: Recent Incidence Trends.

BACKGROUND: Endometrial cancer is the fifteenth most common malignant disease in the world. It is estimated that 417,367 new cases of this malignant neoplasm are diagnosed annually and 97,370 women die from it. OBJECTIVE: The epidemiological features of the corpus uteri cancer (CUC) incidence and its spatial and temporal assessment in Kazakhstan were studied. METHODS: The retrospective study was done for the period 2009-2018. Descriptive and analytical methods of epidemiology were used. Crude, age-specific, age-standardized, equalized incidence rates and approximation were calculated. The method of drawing up a cartogram based on the determination of the standard deviation (σ) from the mean (x) was applied. RESULT: During the study period, 10,522 new cases of CUC were registered. The average annual age-standardized incidence rate was 11.1±0.2 cases per 100,000 population of female, (Т=+0.6%; R2=0.083). The analysis of ASIR showed unimodal growth with a peak at 65-69 years - 58.8±3.6 cases per 100,000 population of female. The most pronounced downward trend was revealed in the age group < 30 years (T=-2.6%), and the most pronounced annual average upward rates was in 80-84 years (T=+6.4%). The results of the spatial analysis showed regions with a higher levels of CUC incidence rate per 100,000 population of female: Pavlodar, Kostanay, Karaganda, Almaty city, North Kazakhstan and Astana city. CONCLUSION: In recent years, CUC incidence in Kazakhstan has been increasing. High incidence rates were found in the northern regions of the country, and the trend of incidence growth was more pronounced in the western and eastern regions.

Relationship between routine urinary catheterization and postoperative urinary symptoms and urinary tract infections in women undergoing elective caesarean section.

Introduction: The aim of the study was to detect the relationship between routine urinary catheterization and postoperative urinary symptoms and urinary tract infections (UTIs) in women undergoing elective caesarean sections (ECSs). Material and methods: One hundred women undergoing ECSs were included in this observational study and randomized into a catheterized (C) group, including women who underwent ECS after insertion of indwelling Foley's catheter, and a non-catheterized (NC) group, including women who underwent ECS without Foley's catheter. The Foley's catheters were removed from all participants in the C group once they were freely ambulant and had recovered from the effect of the spinal anaesthesia. Participants were asked about any abnormal postoperative urinary symptoms (dysuria, frequency, urgency, and/or urinary retention), and to collect urine samples (mid-stream) once they were freely ambulant for urine cultures. Results: The postoperative dysuria, frequency, and urgency were significantly higher in the C group compared to the NC group [36% (18/50), 40% (20/50), and 34% (17/50) vs. 8% (4/50), 6% (3/50), and 6% (3/50), respectively], (p = 0.006, 0.001 and 0.004, respectively). The urinary tract infections and the postoperative antimicrobials used were significantly higher in the C group compared to the NC group [40% (20/50) and 40% (20/50) vs. 6% (3/50) and 6% (3/50), respectively], (p = 0.001 and 0.001, respectively). The postoperative hospital-stay after the ECSs was significantly higher in the C group compared to the NC group (5.4 ±1.8 days vs. 3.8 ±1.15, respectively), (p = 0.001). Conclusions: Routine urinary catheterizations in women undergoing ECS significantly increase the odds of postoperative dysuria, frequency, urgency, UTIs, and the postoperative antimicrobials used.

The effect of vitamin D on adolescents' primary dysmenorrhea.

Vitamin D receptor (VDR) expression in the female reproductive tract explains the regulatory role of vitamin D on inflammatory cytokine and prostaglandin (PGD) synthesis. This study aimed to evaluate the effect of vitamin D on adolescents' primary dysmenorrhea and the relationship between Vit. D and adolescents' primary dysmenorrhea. Eighty-five adolescents were included in the current study. After a detailed evaluation, pelvic sonography was performed for all participants to rule out any pelvic pathology. Blood samples were collected to measure thyroid stimulating hormone (TSH), prolactin, glycosylated hemoglobin (HbA1C), and 25-hydroxyvitamin D (25[OH]D). Participants were administered vitamin D (50,000 IU weekly for five months), and their dysmenorrhea symptoms were evaluated before and after this period using the Visual Analog Scale (VAS) and the Verbal Multidimensional Scoring (VMS). The mean VAS and VMS scores of dysmenorrhea statistically decreased from 8.7±0.91 and 2.65±0.93 to 4.8±0.75 and 0.80±0.75, respectively, after vitamin D intake (p=0.03 and 0.025, respectively). Significant negative associations between 25(OH)D and VAS (R = -0.886; p<0.00001) and VMS of dysmenorrhea (R = -0.885; p<0.00001) were detected in this study. Vit. D could be a useful therapeutic option to reduce the severity of primary dysmenorrhea and could limit the use of non-steroidal anti-inflammatory drugs.