Drug-Resistant Tuberculosis, Georgia, Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, 2017-2022.

In 2021, the World Health Organization recommended new extensively drug-resistant (XDR) and pre-XDR tuberculosis (TB) definitions. In a recent cohort of TB patients in Eastern Europe, we show that XDR TB as currently defined is associated with exceptionally poor treatment outcomes, considerably worse than for the former definition (31% vs. 54% treatment success).

Menopausal Status Impact on the Quality of Life in Kazakhstani Healthcare Workers: A Cross-sectional Study.

BACKGROUND: Menopausal quality of life (MenQoL) is a common concern that primary healthcare workers often encounter. Menopause has a significant impact on women's health, but studies examining its effect on the MenQoL of menopausal healthcare employees have produced conflicting results. OBJECTIVE: The aim of this study was to compare the quality of life related to menopausal status (pre-, peri-, or postmenopausal) in healthcare workers from various clinical settings in Kazakhstan. DESIGN: This was a cross-sectional study. PARTICIPANTS: In total, 222 menopausal healthcare workers (physicians, nurses/midwives, administrative staff, and cleaners) were enrolled from hospitals affiliated with the University Medical Center (UMC) in Kazakhstan. MAIN MEASURES: The outcome variable was assessed using the Menopausal Quality of Life Questionnaire (MENQOL), which evaluates MenQoL across four domains of menopausal symptoms: physical, psychological, vasomotor, and sexual. KEY RESULTS: The most frequently reported menopausal symptoms were physical ones, such as feeling tired or worn out (70.7%), followed by feeling a lack of energy (65.3%) and dry skin (64.1%). The postmenopause group had the highest mean MenQoL score in the vasomotor domain (mean 3.46 ± 1.84). There was a borderline statistical significance when comparing postmenopause and perimenopause groups in the physical domain. The pairwise comparison of mean sexual scores revealed that postmenopause women had the highest average score (3.3 ± 2.36) compared to both premenopause (mean 2.3 ± 1.82) and perimenopause (mean 2.22 ± 1.58) groups (p < 0.05). CONCLUSIONS: Menopausal status has influence on the MenQoL of healthcare workers. The study findings could have important implications for policymakers as they provide insight into the factors influencing the quality of life of menopausal healthcare employees. Creating a more menopause-friendly work environment may not only enhance the well-being of healthcare personnel but also improve their overall job satisfaction and performance.

Predictors associated with night sleep disturbance among breastfeeding women.

OBJECTIVE: The aim of this study was to investigate the incidence of somnological disorders among Kazakhstani women who breastfeed and to assess the association of this phenomenon with some medical and social characteristics. METHODS: The authors used the standardized questionnaire of A.M. Vein and Y.I. Levin to assess nocturnal sleep among 1101 breastfeeding women in the Republic of Kazakhstan, applied Pearson's chi-square test to study the correlation between sleep disturbances and duration of breastfeeding, and multiple logistic regression to assess the influence of various medical and social factors on somnological disorders. Data collection occurred in February 2023. RESULTS: On average, 80% of breastfeeding women (ranging from 79% to 85.9%) experienced some form of nocturnal sleep disorders, with no significant association found between these disorders and breastfeeding duration (p = 0.234), while urban residence, history of operative delivery, child's health issues, and low satisfaction levels with various aspects were associated with over twofold increased odds of experiencing sleep disorders (p ≤ 0.05). CONCLUSIONS: The elevated prevalence of nocturnal sleep disorders among breastfeeding Kazakhstani women serves as a risk indicator for adverse health outcomes, with predictors including place of residence, obstetric complications, child health issues, and satisfaction levels with social conditions and personal expression opportunities.

Genetic markers of cardiac autonomic neuropathy in the Kazakh population.

BACKGROUND: Cardiac autonomic neuropathy (CAN) is a complication of diabetes mellitus (DM) that increases the risk of morbidity and mortality by disrupting cardiac innervation. Recent evidence suggests that CAN may manifest even before the onset of DM, with prediabetes and metabolic syndrome potentially serving as precursors. This study aims to identify genetic markers associated with CAN development in the Kazakh population by investigating the SNPs of specific genes. MATERIALS AND METHODS: A case-control study involved 82 patients with CAN (cases) and 100 patients without CAN (controls). A total of 182 individuals of Kazakh nationality were enrolled from a hospital affiliated with the RSE "Medical Center Hospital of the President's Affairs Administration of the Republic of Kazakhstan". 7 SNPs of genes FTO, PPARG, SNCA, XRCC1, FLACC1/CASP8 were studied. Statistical analysis was performed using Chi-square methods, calculation of odds ratios (OR) with 95% confidence intervals (CI), and logistic regression in SPSS 26.0. RESULTS: Among the SNCA gene polymorphisms, rs2737029 was significantly associated with CAN, almost doubling the risk of CAN (OR 2.03(1.09-3.77), p = 0.03). However, no statistically significant association with CAN was detected with the rs2736990 of the SNCA gene (OR 1.00 CI (0.63-1.59), p = 0.99). rs12149832 of the FTO gene increased the risk of CAN threefold (OR 3.22(1.04-9.95), p = 0.04), while rs1801282 of the PPARG gene and rs13016963 of the FLACC1 gene increased the risk twofold (OR 2.56(1.19-5.49), p = 0.02) and (OR 2.34(1.00-5.46), p = 0.05) respectively. rs1108775 and rs1799782 of the XRCC1 gene were associated with reduced chances of developing CAN both before and after adjustment (OR 0.24, CI (0.09-0.68), p = 0.007, and OR 0.43, CI (0.22-0.84), p = 0.02, respectively). CONCLUSION: The study suggests that rs2737029 (SNCA gene), rs12149832 (FTO gene), rs1801282 (PPARG gene), and rs13016963 (FLACC1 gene) may be predisposing factors for CAN development. Additionally, SNPs rs1108775 and rs1799782 (XRCC1 gene) may confer resistance to CAN. Only one polymorphism rs2736990 of the SNCA gene was not associated with CAN.

Epidemiology of pediatric hematological malignancies in Kazakhstan: Data from Unified National Electronic Healthcare System 2014-2021.

We aimed to describe incidence and all-cause mortality of hematological pediatric malignancies (leukemia and lymphomas) in Kazakhstan based on nationwide large-scale healthcare data from the Unified National Electronic Healthcare System (UNEHS) for the 2014-2021 year period. The cohort included data of patients less than 18 years old with the diagnosis of hematological malignancies registered in the UNEHS (inpatient and outpatient registries) for the year period 2014-2021. Descriptive statistics were conducted to indicate socio-demographic characteristics of the cohort. Incidence and all-cause mortality were calculated per 100,000 population. Cox proportional hazard regression analysis was performed to investigate the association between determinants with the all-cause mortality. The total cohort consisted of 3357 children with leukemia and 1474 children with lymphomas. The mean age at diagnosis of leukemia and lymphomas was 7.3 ± 4.7 and 9.9 ± 4.9 years, respectively. The incidence rate of hematological malignancies was 6.8 per 100,000 in 2021. Patients with ALL had a higher incidence rate than patients with AML (3.4 and 1.2 per 100,000 in 2021, respectively). The incidence rate of HL and NHL was relatively similar which varied from 0.6 to 2.6 per 100,000 in 2014-2021. All-cause mortality of pediatric hematological malignancies varied from 1.1 to 1.5 per 100,000 in 2014-2021, with the peak in 2016 (1.7 per 100,000). Younger age is significantly associated with increased risk of all-cause mortality in children with AML. CONCUSION: Patients with ALL had a higher incidence rate than patients with AML. The incidence rate of HL and NHL was relatively similar. All-cause mortality rates for leukemia and lymphomas were quite stable during the study period. Younger age is significantly associated with increased all-cause mortality among AML patients. However, there is no significant association of age with all-cause mortality among ALL, HL and NHL. In order to obtain more reliable data and analysis on pediatric (hematological) malignancies, specific registries for childhood tumors (including detailed information on relapses, treatments, short and long-term side effects, and specific death causes) should be implemented. WHAT IS KNOWN: • Leukemias and lymphomas together account for around 45% of all pediatric malignancies. • Lymphoma accounts for 12% of all childhood malignancies; non-Hodgkin's lymphomas (NHL) are more frequent than Hodgkin's lymphomas (HL). WHAT IS NEW: • The incidence rate of ALL was higher than the incidence rate of AML throughout the whole study period, whereas all-cause mortality of ALL and AML was quite stable. • According to Cox PH analysis, younger age (0-5 years old) was associated with a higher risk of death among AML children compared to older children, and no significant association of age was observed with all-cause mortality among ALL and lymphomas.

The relationship between Toll-like receptor-4 genes and preeclampsia outcomes.

PURPOSE: The study aimed to analyse the relationship of the rs4986790 locus of the TLR4 gene with the overall risk of preeclampsia, including both its early and late forms. METHODS: The study used standard genetic analysis methods such as DNA extraction, PCR amplification, and genotyping of the rs4986790 locus of the TLR4 gene to assess the association with the development of preeclampsia and peripartal stroke in 207 pregnant women from the southern regions of Kazakhstan from 2016 to 2022, of whom 103 had peripartal stroke on the background of preeclampsia (the main group) and 104 preeclampsia (comparative group). RESULTS: The results of the study demonstrate that the AG and AG + GG genotypes at the rs4986790 locus of the TLR4 gene are significantly associated with an increased risk of developing an early form of preeclampsia. This opens up a new perspective in the identification of genetic markers that can serve as indicators of a tendency to develop preeclampsia in earlier periods of pregnancy. CONCLUSION: It was noted that the rs4986790 locus did not show a statistically significant association with the risk of late preeclampsia. An important aspect of the study revealed the relationship of genotypes with the development of peripartal stroke on the background of preeclampsia. This study offers practical insights for creating targeted genetic screening and personalised treatments for preeclampsia, aiming to improve patient outcomes. To fully understand the molecular mechanisms underlying the identified association, additional research is required to identify deeper molecular pathways and relationships, and to develop new strategies for the prevention and treatment of preeclampsia.

Analysis of chronic kidney disease epidemiology in Kazakhstan using nationwide data for 2014-2020 and forecasting future trends of prevalence and mortality for 2030.

According to the Global Burden of Disease (GBD) study, chronic kidney disease (CKD) was prevalent in 697.5 million individuals worldwide in 2017. By 2040, it is anticipated that CKD will rank as the fifth most common cause of death. This study aims to examine the epidemiology of CKD in Kazakhstan and to project future trends in CKD prevalence and mortality by 2030. The retrospective analysis was performed on a database acquired from the Unified National Electronic Health System for 703,122 patients with CKD between 2014 and 2020. During the observation period, 444,404 women and 258,718 men were registered with CKD, 459,900 (66%) were Kazakhs and 47% were older than 50. The incidence rate notably decreased: 6365 people per million population (PMP) in 2014 and 4040 people PMP in 2020. The prevalence changed from 10,346 to 38,287 people PMP, and the mortality rate increased dramatically from 279 PMP to 916 PMP. Kazakhstan's central regions, Turkestan and Kyzylorda were identified as the most burdensome ones. The ARIMA model projected 1,504,694 expected prevalent cases in 2030. The predicted mortality climbed from 17,068 cases in 2020 to 37,305 deaths in 2030. By 2030, the prevalence and mortality of CKD will significantly increase, according to the predicted model. A thorough action plan with effective risk factor management, enhanced screening among risk populations, and prompt treatment are required to lessen the burden of disease in Kazakhstan.

Social anxiety of the citizens of Kazakhstan: The dynamics of change and its impact on public consciousness.

The purpose of the study is to analyze the factors associated with the formation of social anxiety and to explore trends in their impact on society in the Republic of Kazakhstan. The authors have used comparative, descriptive, and deductive methods to achieve the research goals. The results of the study determined that anxiety phenomena have become increasingly common over time and social anxiety is one of the most dangerous due to its degree of limitation. The vast majority of people experience some form of social anxiety, which occurs when distorted reality intervenes and certain moments signalize as dangerous. As a product of individual experience and sociopolitical construct, fear becomes the element organizing the state order. The social aspects are notably relevant to the process when the common sense of public consciousness puts security in the foreground as a matter of the greatest importance and urgency.

The Assessment of the Nutritional Status among the Young-Old and Old-Old Population with Alimentary-Dependent Diseases.

Background and Objectives: Unhealthy nutrition can contribute to the development or progression of various alimentary-dependent diseases, including obesity, type 2 diabetes mellitus, metabolic syndrome, anaemia, and arterial hypertension. Young-old and old-old individuals often have diets deficient in essential vitamins, minerals, and macronutrients, characterized by high consumption of carbohydrate-rich foods and insufficient intake of plant-based products like vegetables and fruits. This study aims to identify key parameters of nutritional status among the young-old (aged 60-74 years) and old-old (aged 75-90 years) populations in central Kazakhstan, particularly in relation to specific alimentary-dependent diseases. Materials and Methods: The study involved 300 participants aged 60-90 years. The study incorporated a dietary questionnaire, food consumption records (such as 24 h recalls), and measurements of anthropometric indicators including weight and skinfold measurements. Results: Residents in the surveyed regions typically consumed food 3-4 times daily, with breakfast, lunch, and dinner being eaten at consistent times. A significant proportion of individuals, especially older adults, followed this meal schedule. About one-third ate before bedtime, and more than half believed they adhere to a specific diet. The mean BMI for men aged 60-74 years was 28.3 (95% CI: 20.1-43.2) and, for those aged 75-90 years, it was 29.0 (95% CI: 22.1-40.8). Caloric intake among individuals aged 60-74 was higher compared to those aged 75-90, with males consuming an average of 2372.7 kcal and females consuming 2236.78 kcal versus 2101.5 kcal for males and 2099.9 kcal for females in the older age group. Conclusions: The dietary patterns observed among old-old individuals were marked by excessive calorie intakes and imbalances in macronutrient composition, with a predominant emphasis on high-carbohydrate foods at the expense of essential nutrients like proteins, fats, and key vitamins (such as C, E, B vitamins) and minerals (such as potassium, calcium, and iron).

Risk factors of cognitive impairment in elderly people in the Republic of Kazakhstan.

OBJECTIVE: To study the risk factors of cognitive impairment in elderly people in the Republic of Kazakhstan. METHODS: Study design - cross - sectional. 385 elderly people randomly selected from all over Kazakhstan took part in the survey. The questionnaire for the elderly included socio-demographic data and a small test that determines the absence or the risk of developing cognitive impairment. RESULTS: Incomplete secondary education increases the risk of developing CI 4.92 times, secondary education 1.24, secondary special education 2.25 times compared to higher education. The absence of work at this time increases the risk of cognitive impairment compared to those who continue to work 2.24 times, being retired 0.42 times. Smoking increases the risk of developing CI compared to those who do not smoke 2.51 times, smoking history 0.86 times. Alcohol consumption increases the risk of developing CI compared to those who do not drink alcohol 1.62 times, other (on holidays) 0.31 times    . CONCLUSION: Prevention of dementia does not exist today, but it is possible to reduce the risk of its development. Risk factors increase the chances of getting sick but also serve as guidelines that can be influenced (Tab. 3, Ref. 17).

Predictors of Job Satisfaction and Association with Psychological Distress Among Academic Medicine Faculty in Kazakhstan.

BACKGROUND: The growing concern for the faculty's well-being is allied with the emotionally demanding nature of teaching, which has an adverse effect on physical and mental health. There is abundant evidence that academic medicine faculty are subjected to high rates of dissatisfaction, distress, burnout, and turnover among medical educators. This study is dedicated to the exploration of the association between job satisfaction and psychological distress among academic medicine faculty in Kazakhstan. METHODS: The observational cross-sectional study was conducted among medical educators in Kazakhstan between 1 October and 25 December. The survey was completed by 715 representatives of academic medicine staff. The sample size was calculated by Epi Info Sample Size Calculator, version 7.0. Multinomial logistic regression analysis using the forced entry procedure was applied to identify the factors associated with job satisfaction. RESULTS: The prevalence of job satisfaction, depression, anxiety, and stress was 19.2%, 40.6%, 41.3%, and 53%, respectively. Three variables were significantly associated with job satisfaction: having a partner (AOR=0.79; 95% CI 0.38-1.659), having work experience of 5-10 years (AOR=0.32; 95% CI 0.14-0.74), and holding a Ph.D. degree (AOR=0.40; 95% CI 0.18-0.91). Job satisfaction was significantly associated with depression (p=0.005) and stress (p<0.001). CONCLUSIONS: Compared to previous research in this area, our findings reported a higher prevalence of psychological distress and dissatisfaction. Potential reason for higher rates of dissatisfaction may be the global disruption due to COVID-19 pandemic.

Trends in the dynamics of morbidity and mortality from hypertension in the Republic of Kazakhstan from 2010 to 2019.

OBJECTIVE: Aim: The purpose of the research is to study trends in the dynamics of morbidity and mortality from arterial hypertension in the Republic of Kazakhstan for 2010-2019. PATIENTS AND METHODS: Materials and Methods: Due to the interdisciplinary nature of the study, a set of methods was used: analytical, graph-analytical, statistical, sociological, clinical and economic analysis, organizational experiment. RESULTS: Results: The survey of 318 hypertension patients highlighted a common profile: hypertensive men aged 45-59, smokers, alcohol drinkers, urban dwellers, married with children, industrially employed, physically active at their country house, and facing stress. Gender differences showed 74.4% of hypertensive women were over 50, while a fifth of men were under 45, with higher risk factors in men: smoking (1.87), alcohol (2.53), occupational hazards (2.76), and harsh climates (2.54). CONCLUSION: Conclusions: The analysis findings reveal noteworthy trends within the hypertension patient population in Kazakhstan. Despite a decline in hypertension prevalence and initial occurrences, along with reduced relative hospitalization rates between 2010 and 2019, mortality linked to hypertension-related causes and the occurrence of heart attacks have remained relatively steady in recent times.

Cardiology Service of Kazakhstan Today: Acute Coronary Syndrome, Chronic Heart Failure, Atherosclerosis.

The article focuses on the prevalence of circulatory diseases, organization and implementation of new programs in the system of cardiological care services in the Republic of Kazakhstan. Currently, three key programs are functioning at the republican level: "Acute coronary syndrome", "Chronic heart failure", and "Atherosclerosis and dyslipoproteinemia". The National Scientific Cardiac Surgery Center (Astana) is the coordinator of all these programs.

GIS TECHNOLOGIES IN THE STUDY OF NATURAL RESULTS ESPECIALLY DANGEROUS DISEASES IN KAZAKHSTAN.

This study explores the application of GIS technologies in analyzing and visualizing spatial structures of especially dangerous infections (EPI) in Kazakhstan. International collaborations have facilitated projects studying the focal patterns of diseases, improving data analysis and visualization. Extensive electronic databases resulting from field research on EPI foci have elevated the study's depth. The dynamics of natural foci, influenced by intraspecific structures of infection carriers, are impacted by industrial and agricultural developments, urban expansions, and climate change. The study notes changes in the enzootic territory, affecting mammal migration and consequently altering natural focus boundaries. Industrial activities, rotational methods, and habitat changes contribute to the increased epidemic potential in enzootic areas. Despite anthropogenic and climatic influences, the prevalence of plague remains high in Kazakhstan, with a trend towards expanding enzootic territories. Unified electronic databases on plague, tularemia, anthrax, and other zoonoses, developed for GIS analysis, enable mapping and visualization of natural foci. Electronic maps aid in determining enzootic territory boundaries, assessing infectious disease activity, and planning preventive measures based on risk assessment. ESRI's ArcGIS Desktop 10.8 with Arc Toolbox modules facilitated data processing in the geoinformation environment. Data includes epidemiological examination results, species composition of carriers, and laboratory test outcomes, enhancing comprehensive analysis and decision-making for anti-epidemic measures. The study in Kazakhstan identifies and details six natural and twenty autonomous plague foci, categorizing them by main carriers and observing an expansion of natural hotspots. The enzootic territory is classified into four geographic zones, further divided into 105 landscape-epidemiological regions. Laboratory studies inform electronic maps for analyzing plague's dynamic situation. Anthrax prevalence, primarily in chernozem and chestnut soils, is assessed, revealing 1,778 unaffected settlements and spatially clustered points. An epidemiological index aids in zoning for anthrax trouble. Tularemia's landscape occurrence is classified into four types, with spatial analysis revealing clusters and potential epidemic danger in specific regions. Geographic information technologies highlight high-risk areas, justifying preventive measures for dangerous infections. The results obtained serve as a scientific justification for the priority of preventive measures within the boundaries of administrative territories characterized by a high degree of potential epidemic danger and objectively indicate the prospects for the introduction of GIS technologies into the practice of epidemiological surveillance of particularly dangerous infections.

ANALYSIS OF RISK FACTORS FOR ISCHEMIC STROKE IN RURAL RESIDENTS OF THE AKTOBE REGION.

Stroke continues to be a major global health concern, accounting for the fifth highest death rate and a sizable portion of the world's disability burden. Over 40,000 stroke cases are reported annually in the Republic of Kazakhstan, of which 5,000 people die within the first 10 days and an additional 5,000 within a month after discharge. Even with the establishment of regional stroke centers, a state anti-stroke program, and substantial efforts, rural communities still experience higher rates of stroke-related morbidity and mortality. The purpose of this research is to examine the complex factors, such as disparities in emergency care and elevated risk factors, that contribute to the variation in the incidence of stroke between rural and urban areas. Rural inhabitants' lesser knowledge of stroke symptoms is a result of educational and socioeconomic differences, which causes systemic delays in care. Just 1% of rural residents live within 60 minutes of a primary stroke center, indicating a lack of access to specialized stroke care. In terms of intravenous thrombolysis performed, urban hospitals perform better than rural ones. The study shows that the mean age of the patients is 62.2±11.9 years, confirming the presence of an average age in the group. Women make up 40.2%, men - 59.8%. An average BMI of 27.6±4.5 may indicate a predominance of excess weight. The NIHSS score decreases from admission (7.64±4.85) to discharge (5.98±6.02), which may indicate a positive effect of treatment. A decrease in MRS reflects improvement in disability after treatment. Analyzing the dependence on place of residence, it was revealed that the largest number of patients came from districts 5 and 10. Analyzing the NIHSS and MRS indicators, statistically significant differences were identified depending on the presence of diabetes, arrhythmia and atherosclerosis. The rate of stroke severity and disability on admission is significantly higher in patients who die. A model for predicting unfavorable outcome was developed, which showed the statistical significance of the factors of cardiac arrhythmia and NLR.

ANALYSIS OF ANTIDIABETIC THERAPY FOR TYPE 2 DIABETES IN PRIMARY HEALTH CARE (WESTERN KAZAKHSTAN).

Diabetes Mellitus Type 2 (T2D) represents a significant global health challenge, with increasing prevalence and the need for effective management strategies. Despite the widespread nature of the disease, there is disagreement regarding the optimal glycemic targets for patients with Type 2 diabetes. The American Diabetes Association recommends aiming for an HbA1C level of less than 7% (53 mmol/mol). About 50% of diabetes patients do not meet their glycemic targets, leading to an increased risk of chronic complications associated with diabetes. Although lifestyle modifications are crucial for prevention and management, most T2D patients eventually need pharmacotherapy to maintain control over their blood glucose levels. In Western Kazakhstan, a study was conducted to evaluate the efficacy of antidiabetic therapy in primary healthcare settings. Aim - to assess the proportion of patients with uncontrolled glycemia among adult patients with T2D, and to analyze antidiabetic therapy in the primary health care (Western Kazakhstan). The cross-sectional study involved 96 participants, divided into two groups based on their HbA1c levels: 32 patients with an HbA1c <7%; 64 patients with an HbA1c >7%. In the study 58 patients (60,6%) were female and 38 patients (39,4%) were male. Data analysis was performed using IBM SPSS 26 and GraphPad, employing Kolmogorov-Smirnov and Shapiro-Wilk tests for distribution, medians and interquartile ranges for non-normal variables, Chi-squared and Fisher's Exact tests for nominal variables, and representation of nominal data in absolute and percentage values. The study found that 66.67±5.89% of participants had unsatisfactory glycemic control at enrollment, with only 33.33±8.33% achieving the desired HbA1c level of <7% (p<=0.005; t=3.26). Statistical analysis showed a significant association between higher glucose levels and the type of therapy, with insulin therapy more common in patients with glucose levels >7 (χ²=5.500, df = 1, p <0.05) and a similar correlation with SGLT-2 inhibitors (Fisher's Exact Test, p<0.01). Analysis of the data collected from urban polyclinics in Aktobe highlighted a troubling fact: two-thirds of the participants (66.67%) had unsatisfactory glycemic control. This is considerably lower than the 45% to 60% control rates reported internationally, indicating an area for significant improvement in the regional management of T2D. The study underscores the importance of a tailored therapeutic approach, balancing drug efficacy, patient response, and individual healthcare needs. Higher variability and blood sugar peaks were observed in patients with HbA1c levels above 7%. In the Western region of Kazakhstan, metformin was the most commonly prescribed antidiabetic drug, consistent with its first-line therapy status. Patients with HbA1c >7% were more likely to receive insulin therapy and SGLT-2 inhibitors, indicating their role in more intensive treatment strategies. Less use of incretins and sulfonylureas was noted among patients with HbA1c <7%, possibly due to their efficacy, safety profiles, or availability of newer alternatives. The findings call for enhanced strategies to improve diabetes management and increase the percentage of patients achieving their glycemic targets, aiming for a more personalized, patient-centered care model in Kazakhstan and potentially similar healthcare settings.

Prevalence and genotypes distribution of virus hepatitis B and hepatitis delta virus in chronic liver diseases in Kazakhstan.

BACKGROUND: The geographical distribution of hepatitis B virus (HBV) and hepatitis D virus (HDV) genotypes is uneven and has its own clinical and organizational implications for health systems. Despite the introduction of vaccination and successful antiviral therapy the prevalence of chronic hepatitis B (with or without delta agent) increased over the past 5 years. This study aimed for the first time to investigate the molecular epidemiology of HBV and HDV in Kazakhstan. METHODS: Total 834 chronic hepatitis B (with or without delta agent) patients were included to the study from November 2017 to June 2019. The material was collected from the regional hepatological сenters from 13 cities of Kazakhstan. Genotyping of HBV/HDV isolates was carried out using phylogenetic analysis of null-binary sequences of Kazakhstani isolates, in comparison with the reference sequences. Nucleotide sequence alignment was performed using the ClustalW algorithm, the "neighbor-joining" method was used for the construction of phylogenetic trees and subsequent analysis. RESULTS: Overall 341 samples were PCR-positive and genotyped for HBV. Comparison and phylogenetic analysis of nucleotide sequences of HBV isolates showed that they were represented by genotypes HBV-D (95.9%), HBV-A (3.5%) and HBV-C (0.6%). At the same time, the identity of the nucleotide sequences of Kazakhstani isolates were: HBV-D (95-100%); HBV-A (97.2-100%) and HBV-C (99%). 256 samples were PCR positive and genotyped for HDV, all of them belonged to genotype 1. CONCLUSION: This study describes for the first time the molecular epidemiology of HBV and HDV in Kazakhstan. The data obtained expand the knowledge of the global epidemiology of viruses; have potential implications for public health policy and for further clinical research on chronic hepatitis in Kazakhstan. TRIAL REGISTRATION: ClinicalTrials.gov NCT05095181 (registered on 27/10/2021).

Study of seroprevalence of SARS-CoV-2 in Kazakhstan.

This study aimed to analyse the seroprevalence of SARS-CoV-2 in Kazakhstan. This is a cross-sectional study of adult population in Kazakhstan for the period from October 2021 to May 2022. For the study, 6 720 people aged 18 to 69 were recruited (from 17 regions). The demographic data were collected and analysed. Gender was evenly distributed (males 49.9%, females 50.1%). Women exhibited a higher seroprevalence than men (IgM 20.7% vs 17.9% and IgG 46.1% vs 41.5%). The highest prevalence of IgM was found in the age group of 30-39. However, the highest prevalence of IgG was detected in the age group of 60-69. The seroprevalence of IgG increased across all groups (from 39.7% in 18-29 age groups to 53.1% in 60-69 age groups). The odds for a positive test were significantly increased in older age groups 50-59 (p < 0.0001) and 60-69 (p < 0.0001). The odds of a positive test were 1.12 times higher in females compared to males (p = 0.0294). The odds for a positive test were significantly higher in eight regions (Astana, Akmola, Atyrau, Western Kazakhstan region, Kostanai, Turkestan, Eastern Kazakhstan region, and Shymkent) compared to Almaty city. The odds of a positive test were three times higher in Astana and the Western Kazakhstan region than in Almaty city. In urban areas, the odds of a positive test were 0.75 times lower than in rural areas (p < 0.0001). The study's results showed an adequate level of seroprevalence (63%) that exceeds the essential minimum of herd immunity indicators in the country. There was significant geographic variability with a higher prevalence of IgG/IgM antibodies to SARS-CoV-2 in rural areas.

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.

Trends in the incidence of musculoskeletal diseases in Kazakhstan in 2011-2020: an information-analytical study.

According to the World Health Organization, there is an increase in the incidence of musculoskeletal diseases worldwide. The problem of this group of diseases is that they are associated with the onset of temporary and permanent disability. A number of studies have demonstrated an increase in the incidence of musculoskeletal diseases in the US, Canada, Australia, and European countries. The current informational and analytical study was aimed to reflect on related morbidity trends in Kazakhstan. We analyzed data on the incidence of diseases of the musculoskeletal system in 2011-2020. Ten annual statistical yearbooks of the Ministry of Health of Kazakhstan were used to obtain data. The results showed an increase in the total incidence of musculoskeletal diseases of 304,492 cases between 2011 and 2020. Primary incidence of musculoskeletal disorders in the whole population increased by a factor of 1.5. The incidence rate of musculoskeletal diseases increased in the age group over 18 years and in the 0-14 years' child group. A comparative analysis of morbidity figures for rural and urban populations was also presented. An increase in the incidence of musculoskeletal diseases in both populations was observed. Finally, comparative data analysis on morbidity across Central Asian countries was provided. This information-analytical study shows that the incidence of musculoskeletal disorders is steadily increasing in Kazakhstan. The scientific community should pay attention to this trend to prevent further increases in the incidence of musculoskeletal disorders.