Cystic echinococcosis of the liver in Kazakhstan: The effectiveness of the PAIR method in comparison with laparoscopic and «open¼ surgical methods.

BACKGROUND: One of the urgent problems of surgical parasitology in the Republic of Kazakhstan is liver cystic echinococcosis. The study aimed to analyze the effectiveness and safety of the percutaneous treatment with different techniques in comparison with the results of laparoscopic and "open" surgical methods. METHODS: Retrospectively, we analyzed the outcome of 485 patients with active echinococcal cysts in the period from January 2017-July 2023. Indications for surgical treatment and the choice of the intervention method were based on this classification. Patients were conditionally divided into 3 groups: Laparoscopy-33, Laparotomy-319, PAIR-133. RESULTS: The duration of the operation in the PAIR was significantly shorter compared to the Laparotomy and Laparoscopy groups (55.4vs.225.2 and 215.3, p = 0.0001). There was no intraoperative blood loss in PAIR, whereas in Laparotomy and Laparoscopy there were 146.0 and 111.0. The postoperative stay of patients in PAIR is significantly shorter than in Laparotomy and Laparoscopy (3.8 compared to 7.5 and 6.4, p = 0.0001). The follow-up time averaged 39.8 months ± 21. There were no statistically significant differences in relapses. Laparotomy and PAIR groups had 11 (3.5 %) and 6 (4.5 %) relapses, respectively. CONCLUSION: In cystic echinococcosis of the liver types CE1, CE3a regardless of the localization, the optimal volume is a PAIR is characterized by a shorter postoperative stay of the patient, early recovery and cure. In the CE2, CE3b stages, laparoscopic pericystectomy is the most effective and safe in individual patients. In case of an intimate arrangement of cysts to tubular structures, the safest method is laparotomy.

Assessment of hypercholesterolemia prevalence and its demographic variations in the Republic of Kazakhstan.

Hypercholesterolemia is a major risk factor for cardiovascular disease, the leading cause of death in Kazakhstan. Understanding its prevalence is vital for effective public health planning and interventions. This study aimed to assess the scale of hypercholesterolemia in the Republic of Kazakhstan and to identify differences among distinct population groups. A cross-sectional study involving 6720 participants (a nationally representative survey.) aged 18-69 was conducted from October 2021 to May 2022 across all 17 regions of Kazakhstan. The magnitude of hypercholesterolemia was 43.5%. Cholesterol levels were determined through blood biochemical analysis. Age, sex, geographic location, and ethnicity served as covariates. The majority of participants (65.49%) were from urban areas with an almost equal gender distribution (50.07% male and 49.93% female). The predominant age groups were 18-29 years (25.71%) and 30-39 years (25.12%), and 65.09% identified as Kazakh. The prevalence increased with age, with the 60-69 age group showing the highest rate at 71.14%. Women had slightly higher rates than men. Geographical differences were evident, with regions like Astana city and Almaty region showing significant disparities. Kazakhs had a lower rate compared to other ethnicities. Age, region, and BMI were significant predictors for hypercholesterolemia in both binary and multivariate logistic regression analyses. The study revealed a significant prevalence of hypercholesterolemia in Kazakhstan, with increasing age as a major determinant. Women, especially those over 50, and certain regions showed higher cholesterol levels. The disparities observed across regions and ethnicities suggest the need for targeted public health interventions to address this pressing health concern.

Evaluating the Effectiveness of a Modified Colorectal Cancer Screening Program in Almaty, Kazakhstan.

OBJECTIVE: This study aimed to evaluate the effectiveness of a modified colorectal cancer (CRC) screening program, incorporating culturally tailored strategies to increase screening uptake and compliance, in Almaty, Kazakhstan. METHODS: A cross-sectional study was conducted in Almaty between 2019-2022, involving 5370 participants aged 50-70 from diverse settings. Participants were assigned to the main (modified method) and comparison (standard method) groups based on the parity of their ID number digits. Variables of interest included demographics, somatic comorbidities, disability degree, and CRC screening results. The modified screening emphasized healthcare prioritization, optimized nursing resources, enhanced accessibility, and preparedness for the second screening stage. RESULTS: In the study 2702 patients in the main group (modified method), and 2668 patients in the comparison group (standard method). Comorbidity data showed that the majority of participants in both groups had between 1-10 comorbidities, with an average of 8.2 in the main group and 8.1 in the comparison group. Screening response rates at stage I were higher in the main group, with 82.6% of subjects undergoing screening, compared to 78.9% in the comparison group (χ2=12.12, p=0.001). The response rates were higher among females in both groups, and no significant differences were found across age groups. At stage II, the response rate was again higher in the main group (56.2%) than in the comparison group (47.2%) (χ2=4.217, p=0.040), with no significant differences noted in relation to sex or age. However, the main group showed a higher response rate at stage I among respondents with 6-10 comorbidities (87.1% vs 82.5%, χ2 =7.820, p=0.009). CONCLUSION: The study demonstrates that the modified program significantly outperformed the traditional one, achieving higher response rates at both the initial and subsequent stages of screening. These findings emphasize the value of revisiting and refining current CRC screening methods to maximize early detection rates.

Prevalence of chronic kidney disease in Kazakhstan: evidence from a national cross-sectional study.

To date, there have been no large-scale national studies of the prevalence of chronic kidney disease in Kazakhstan. It includes the research based on the analysis of the estimated glomerular filtration rate (eGFR). The aim of this study was to investigate the population prevalence of CKD and associated risk factors in Kazakhstan. The cross-sectional study consisted of a nationally representative sample of n = 6 720 adults aged 18 to 69 from 14 regions and 3 major cities in Kazakhstan. The study covered the period from October 2021 to May 2022. The WHO STEPS questionnaire was used for the survey. For the diagnosis of CKD, creatinine levels in collected blood samples were measured to assess eGFR. Demographic characteristics were collected and studied. The total and adjusted prevalence of factors associated with the presence of CKD were calculated and analysed using logistic regression. 73.5% (n = 4940) of participants had normal eGFR, while 25.2% (n = 1695) had mild CKD (eGFR = 60-89 mL/min/1.7 m2). The overall prevalence of CKD with eGFR < 60 ml/min/1.7 m2 was 1.3% (n = 85), of which 0.2% (n = 15) had eGFR < 45 ml/min/1.7 m2. A mild degree of CKD was most often determined in residents of the East Kazakhstan region in 10.4%, and in 7.8-8.0% of cases. The majority of CKD patients was detected in the East Kazakhstan region and Almaty city, 15.3% and 10.6% of cases respectively. In mild and CKD with GFR < 60 ml/min/1.7 m2, the age of participants was 50-69 years in 61.5% and 78.8% of cases, respectively (p < 0.001). In addition to the association with the place of residence, a statistically significant relationship was found between the risk of developing CKD and underweight (OR 1.43, 95% CI (1.09-1.88), p < 0.001), as well as the presence of obesity (OR 1.24, 95% CI (0.99-1.53), p = 0.04). We observed the prevalence of CKD with eGFR < 60 ml/min/1.7 m2 at the level of 1.3%. However, a fairly large part of study participants had a mild CKD (25.2%). The results of this study can be used for the optimization of the doctors workload and the timely provision of care to patients with CKD.

Epidemiological Analysis of HIV/AIDS in Kazakhstan During 2018-2020.

BACKGROUND: The human immunodeficiency virus (HIV) is a severe threat to public health everywhere, including the Central Asian region and Kazakhstan. The aim of the study was to conduct an epidemiological analysis of newly diagnosed cases of HIV infection during 2018-2020. STUDY DESIGN: A case series study. METHODS: A descriptive analysis of national data on registered cases of HIV in Kazakhstan was conducted, and demographic information was collected and studied accordingly. The analysis of the influence of age, period, and cohort was performed using the age-period-cohort method. RESULTS: Based on the results, men prevailed (68.5%) among all cases of HIV infection (n=1235). Sexual transmission during heterosexual contact was higher in females (88.9%, P=0.005), and the number of new cases as a result of homosexual contact was higher in men (23.0%, P=0.087). In addition, the parenteral route of HIV transmission cases prevailed among men (27.5%, P=0.001), and intravenous drug administration was more common among males (27.4%, P=0.01). Moreover, 68.5% of men and 33.2% of women had a low therapy adherence. In men, the risk of HIV prevalence increased after 32.5 years (deviation [Dv]: 0.134, 95% confidence interval [CI]=0.096 to 0.364). At the age of 37.5 years, there was an increase (Dv: 0.852, 95% CI=0.626 to 1.079) in HIV prevalence. However, no peaks were observed in women. CONCLUSION: Our findings indicated a rise in the prevalence of HIV infection in Kazakhstan. Men aged 37 and older were identified as the risk category. Eventually, inadequate adherence to treatment was observed in HIV/acquired immunodeficiency syndrome patients.

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.

Screening for Breast, Cervical and Prostate Cancers in Kazakhstan: Key Factors and Psychological Aspects.

OBJECTIVE: Screening is the main method for early detection and reduction of cancer mortality in all countries, including Central Asia and Kazakhstan. However, there is no official data on the awareness of the population about cancer screening in Kazakhstan. In addition, there were no studies on the psycho-emotional state of the patients during the screening procedure conducted yet. The purpose of the study was to assess the potential factors of awareness and psycho-emotional state during screening for breast (BC), cervical (CC), and prostate cancers (PC) in Kazakhstan (using the example of Almaty city). METHODS: This cross-sectional study was conducted in the period from 01/01/2017 to 05/31/2017. The study was carried out at six polyclinics in Almaty (Kazakhstan). 1 625 volunteers took part in the study. The special questionnaires were employed to assess awareness of the screening procedure and subjective feelings during screening. The survey was conducted on patients who were screened for BC (n=674  or 41.5%), CC (n=565  or 34.8%) and PC (n=386 or 23.8%). Demographic data (age, education, marital status, preferred language of communication, etc.) were collected from participants using in-depth interviews. The internal consistency of the questionnaires was analysed by determining the reliability index (Cronbach's alpha). RESULTS: The mean age of screening participants was 54.6 ± 3.3 years (BC), 49.2 ± 7.3 years (CC), and 56.6 ± 5.1 years (PC) (p = 0.001). Participants in BC and CC screening had a general knowledge of the procedure (45.1 % and 59.8 % of cases, respectively). Men had no information about PC screening (76.4 % of cases, p = 0.001). On the other hand, women had no sufficient knowledge about mammography (46.4 %) and Papanicolaou (Pap)  test (51.2% of cases). In 40.1 % (BC) and 41.1 % (CC) of cases, the fact of having the test was an unpleasant circumstance. However, in 59.6 % (PC) of cases, men did not have any discomfort associated with undertaking the test (p = 0.001). PC screening participants experienced no discomfort in 58.3 % of cases. At the same time, participants in BC and CC screenings experienced discomfort in 38.1 % and 42.5 % of cases, respectively (p = 0.001). Analysis of internal consistency on the questionnaire on awareness of the screening procedure showed the value of Cronbach's Alpha 0.693. The scores of subjective feelings during screening were 0.702. CONCLUSIONS: The study's results revealed the reliability and applicability of the questionnaires on awareness of the screening procedure and assessment of subjective feelings. Knowledge of general information about the screening program differed depending on the type of screening. Participants in BC and CC screening were more likely to be aware of the screening program than participants in PC screening. An unpleasant circumstance associated with screening test is most often considered the very fact of having the test, especially for participants in BC and CC screening. The results of this study highlight the importance of providing an information campaign to raise awareness about screening tests. In addition, the results indicate the need to provide patients with full information about the screening process, and possible risks and benefits.

Assessment of the levels of interleukin-17 and interleukin-38 in thyroid-associated ophthalmopathy patients.

PURPOSE: The objective of the study was to analyse the levels of IL-17 and IL-38 in the samples of unstimulated tears, orbital adipose tissues, and sera of patients diagnosed with active forms of TAO. The correlation of the levels of IL-17 and IL-38 with clinical activity score (CAS) was scrutinized. METHODS: A study was conducted at the Kazakhstan Scientific Research Institute of Eye Diseases (Almaty city, Kazakhstan). Study participants (n = 70) were sub-divided into 3 groups: (1) a group of patients diagnosed with active TAO (n = 25), (2) a group of patients with an inactive form of TAO (n = 28), and (3) a "control group" (patients diagnosed with orbital fat prolapse, n = 17). All patients underwent a clinical assessment and diagnostics. The activity of the disease and its severity were assessed using the CAS and NOSPECS scales. Thyroid function tests were performed, including the study of the levels of thyroid-stimulating hormone, triiodothyronine, free thyroxine, and antibodies to the thyroid-stimulating hormone receptor. IL-17 and IL-38 levels in non-stimulated tear samples, orbital tissue, and patients' sera were measured using commercial ELISA kits. RESULTS: The results showed that the number of former smokers prevailed among patients with active TAO (48%) in comparison with patients with inactive TAO (15.4%), p = 0.001. The concentration of IL-17 significantly increased in the samples of non-stimulated tears, adipose tissues of the orbit and sera of patients with active forms of TAO. The level of IL-38 was reduced in all types of samples (p ≤ 0.05). The results of a histological study of orbital adipose tissues in the group of patients with an active form of TAO showed the presence of focal infiltration with lymphocytes, histiocytes, plasma cells, severe sclerosis and vascular plethora. We observed an association between the CAS of patients with active TAO and the level of IL-17 in sera (r = 0.885; p = 0.001). On the contrary, a negative correlation was detected for the level of IL-38 in sera. CONCLUSIONS: The results highlighted the systemic effect of IL-17 and the local effect of IL-38 in TAO. We observed a significant increase in the production of IL-17, and a decrease in IL-38 in samples of sera and unstimulated tears (the active form of TAO). Our data indicate a correlation of IL-17 and IL-38 levels with the clinical activity of TAO.

Evaluation of the sexual function of men in Kazakhstan during 2021-2022: A cross-sectional study.

Background and Aims: Assessing male sexual function is an important public health issue in every country. In Kazakhstan, there are currently no reliable statistics on male sexual function. The study aimed at the assessment of sexual function in men in Kazakhstan. Methods: Men between the ages of 18 and 69 from Astana, Almaty, and Shymkent, three of Kazakhstan's biggest cities, were included in the cross-sectional study in 2021-2022. A standardized and modified Brief Sexual Function Inventory (BSFI) tool was used for participants' interviews. The World Health Organization STEPS questionnaire was employed to gather sociodemographic information, including smoking and alcohol use. Results: Respondents from three cities: n = 283 from Almaty, n = 254 from Astana, and n = 232 from Shymkent were interviewed. All participants' average age was 39.2 ± 13.4. Kazakhs made up 79.5% of the respondents by nationality; 19.1% who answered questions on physical activity verified that they were involved in high-intensity labor. According to the BSFI questionnaire, the respondents from Shymkent had an average total score of 2.82 ± 0.92, (p ≤ 0.05), which was higher than the total scores of respondents from Almaty (2.69 ± 0.87) and Astana (2.69 ± 0.95). A relationship was found between sexual dysfunction and age indicators over 55 years. Participants with overweight had a relationship with sexual dysfunction with an odds ratio (OR): 1.84 (p = 0.01). According to the smoking factor, in study participants with sexual dysfunction, a relationship was also determined, OR: 1.42; 95% confidence interval (CI): 0.79-1.97 (p = 0.001). The presence of high-intensity activity (OR: 1.58; 95% CI: 0.04-1.91), and physical inactivity (OR: 1.49; 95% CI: 0.89-1.97) were associated with the presence of sexual dysfunction, p ≤ 0.05. Conclusions: Our research indicates that men over 50 who smoke, are overweight, and are physically inactive are at risk for sexual dysfunction. Early health promotion may be the most effective method to reduce the negative effects of sexual dysfunction on the health and wellbeing of men over 50.

An economic impact of incorrect referrals for MRI and CT scans: A retrospective analysis.

Background and Aims: Up to date, no research on the economic efficacy of diagnostic modalities, such as magnetic resonance imaging (MRI) and computerized tomography (CT), has been done in Central Asia. The aim of this study was to analyse the inappropriate appointments of MRI and CT scanning procedures in Kazakhstan. Methods: We used the imaging diagnostic reports and medical records from 9725 planned outpatient CT and MRI exams performed in two major hospitals in Almaty. The study period was for the period 2014-2019. The independent experts-radiologists evaluated the MRI and CT exams for validity using the ACR® compliance standards and RCR recommendations. Results: The results showed that the combined costs of MRI and CT scans increased by $17.982 between 2014 ($22.537) and 2019 ($40.519), p = 0.002. The highest rate of MRI examinations was observed in 2019, with a rate of 6.9 per 10,000 people. It was determined that in 2019 the highest rate for men who undertook CT was equal to 12.4 per 10,000 people, while for women it was equivalent to 5.7 per 10,000 patients. The majority of non-corresponding imaging examinations (n = 1304) were referred for MRI and CT scans by general practitioners. We detected the irrational referrals for head and neck radiological examinations in n = 178 (13.7%) cases, and the abdominal cavity checks in n = 249 (19.1%) cases (p = 0.001). The main portion of erroneously unreasonable referrals for examination of the abdominal organs was made by surgeons in n = 43 (3.3%) cases. Conclusion: The findings indicated an increase in the number of referrals for unnecessary CT and MRI tests over the research period (2014-2019). It had a substantial impact on the rise in healthcare system expenses. The results demonstrate the need for the education of GPs and improving the approaches for diagnostics.

Study on Breast Cancer in Kazakhstan Using the Functional Time Series.

AIM: In Kazakhstan and Central Asia, breast cancer (BC) is the most common malignancy among women. However, no large-scale study on breast cancer using the functional time series approach has been carried out in Kazakhstan. METHODS: A functional assessment of the age-period-cohort model (APC) and the survival rate (period 2017-2021) was used in the retrospective study. Clinical and demographic information on patients was analysed, including age, gender, region of residence, kind and stage of tumour, occupation, socioeconomic standing, nationality, and specifics of treatment and its outcomes. Additionally, the relationship between nationality, stage, and residency region and the survival rate of breast cancer patients was investigated too. RESULTS: The data of n=22,736 breast cancer patients were analysed. The highest number of breast cancer cases reported was 4,945 (21.7%), in 2019. In 2021, n =4,939 (21.7%) cases were detected, while in 2020, n=4,222 (18.6%) cases were observed. The patients with breast cancer in stages I and Ia were recognized in 6,585 (29% of cases), while those in stages Ib and Ic were confirmed in 8687 (38.2% of cases). In n=10,147 (44.6%) cases, a malignant tumour of the upper outer quadrant of the breast (C50.4) was predominant. Kazakhs made up the majority (n=10,939, 48.1%) of patients with a primary validated diagnosis of breast cancer, followed by Russians (n=7527, 33.1%). Germans had the lowest survival rate overall (11.4 ± 1.7 months) (p ≤ 0.05) (95% CI: 8.0-14.7 months). Uzbeks showed relatively high survival rates of 18.3 ± 1.6 months (95% CI: 15.1-21.5 months) (p ≤ 0.05). The Aktobe region had the lowest breast cancer survival rates, measuring 12.1±0.9 months (95% CI: 10.3-13.9 months) (p ≤ 0.05). The highest survival rates, 18.0±1.3 months (95% CI: 15.5-20.5 months) and 17.9±1.4 months (95% CI: 15.3-20.7 months), were seen in Shymkent and Zhambyl regions (p ≤ 0.05), respectively. The prevalence of breast cancer increases after 37.5 years, according to the results of the APC analysis, with an indicator of 0.572 (95% CI: -0.41 - 1.56), maintaining a steady upward trend in the age range from 42.5 years to 62.5 years. CONCLUSIONS: Despite a slight drop in the disease's frequency, the incidence of breast cancer in women 37.5 years and older has been stable over the past five years. Additionally, it was shown that the country's northern regions had a higher incidence of breast cancer cases than the southern and western regions. Our results show the significance of demographic characteristics such as age and location for the development of preventive measures and effective treatment.

The Study of the Outbreak of Coronavirus Infection in a General Hospital in Almaty.

The study aimed to identify the possible causes of COVID-19 outbreak and its development in a general hospital in Almaty (from April 11 to May 6, 2020), where 682 persons were identified with a COVID-19. 546 were hospital employees (48.9%), including doctors (57.8%), nurses (53.4%), junior medical personnel (54.4%) and other personnel (23.3%), and also among 136 patients. The attack rate among women was 50.0%, and incidence rate was higher amongst young employees < 30 years old (57.0%). The analysis showed that there was a failure of the management of the medical personnel in such critical situation.

Study of Morphological Changes in Rat Liver Caused by Occlusion of Inferior Vena Cava.

Background/objectives: Up to date, there are no reports on animal survival rate and morphological changes in the liver caused by the impairment of blood outflow from the liver and its time dependence. Moreover, the impact of duration and degree of occlusion of inferior vena cava on pathological changes was not investigated yet. This study aimed at the assessment of the survival rate and morphological changes in the liver with varying degrees of occlusion of inferior vena cava. The exact timing of the reversibility of pathological processes was determined. Methods: Rats (n = 160) were randomly divided into five groups: I - control group (CG) (n = 20); II - sham group (SG) (n = 20); III - intervention group (IG-1) (narrowing of the lumen of the inferior vena cava by 25%) (n = 40); IV intervention group (IG-2) (narrowing by 50%) (n = 40); and intervention group V (IG-3) (narrowing by 75%) (n = 40). The level of postoperative pain, the body and liver weight of the animals, histological examination, morphometry, and macroscopic evaluation of abdominal organs were carried out on the 1, 3, 7, 14, and 30 days following the surgical intervention. The survival rate of animals was assessed using the Kaplan-Meier method. Results: On the 30th day, the rat grimace scale indices in the IG-1 (P ≤ 0.05), IG-2, and IG-3 (P ≤ 0.001) groups were higher. By body weight, this indicator on the 30th day was lower in the IG-1 (P ≤ 0.05), IG-2, and IG-3 (P ≤ 0.001) groups compared to the CG and SG groups. In the IG1 and IG2 groups, the survival rates were 72.5% and 65.0%, respectively. The lowest survival rate was observed in the IG3 group (22.5%). Conclusions: Compression of the inferior vena cava by 75% led to an increase in animal mortality and the development of persistent morphological changes in the liver. At the same time, the survival rate of animals and the extent of changes in the liver with narrowing of the inferior vena cava by 25% and 50% had similar results. The results acquired possess scientific and practical importance.

The Recent Advances of Mobile Healthcare in Cardiology Practice.

Background: Digitalization of healthcare led to the optimization of monitoring, diagnostics, and treatment of the range of disorders. Taking into account recent situation with COVID-19 pandemics, digital technologies allowed to improve management of viral infections via remote monitoring and diagnostics of infected patients. Up to date, various mobile health applications (apps) have been proposed, including apps for the patients diagnosed with cardiovascular pathologies. Objective: The presented review aimed at the analyses of a range of mHealth solutions used to improve primary cardiac care. In addition, we studied the factors driving and hindering the wide introduction of mHealth services in the clinics. Methods: The work was based on the guidelines of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The publication search was carried out using PubMed, Web of Science, Cochrane Library, Scopus, and Google Scholar databases. Studies published during the period from 2014 until January 2022 were selected for the analysis. The evaluation of risk of bias for the included studies was conducted using the Cochrane Collaboration Risk of Bias tool. Results and Discussion: An overall 5513 studies were assessed for eligibility after which 39 studies were included.. The main trend in the mobile health for cardiological applications is the use of different types of wearable devices and Artificial Intelligence-platforms. In fact, mobile technology allows remotely to monitor, interpret, and analyze biomedical data collected from the patient. Conclusion: The results of this literature search demonstrated that patients diagnosed with cardiovascular disorders can potentially benefit from the application of mHealth in cardiology. However, despite the proven advantages of mHealth for cardiology, there are many challenges and concerns regarding effectiveness, safety, reliability and the lack of official regulation and guidelines from official organizations. Such issues require solutions and further work towards a wide implementation of mHealth technologies in cardiac practice.

Evaluation of the Effectiveness of the Mobile Application on Adherence of Patients With Arterial Hypertension.

Background: An assessment of the level of adherence of patients diagnosed with hypertension to therapy has not been conducted in Central Asia yet. It includes the lack the information on the impact of digital technologies on hypertension management. Objective: The study aimed at the evaluation of the effect of using a mobile application on adherence to therapy in patients with diagnosed arterial hypertension. Methods: A multi-centre randomized controlled study was conducted on 517 patients with diagnosed arterial hypertension (in the out-patient clinic, Almaty, Kazakhstan). Patients were randomly assigned to intervention (IG) and control (CG) groups. IG patients used a mobile application, which allowed creating an individual schedule for taking medications, including visual and audio notifications. The assessment of adherence to antihypertensive treatment was carried out using the Lebanese Medication Adherence Scale-14 (LMAS-14), consisting of 14 items. Data were collected before therapy (T1), 3 months (T2), 6 months (T3) and 12 months (T4) followed the first dose. Adherence was assessed on 101 patients in the CG group and 165 respondents in the IG group. Results: In the period T1 in both groups CG and IG, a moderate adherence to treatment was recorded with indices equal to 35.9 ± 1.2 and 35.9 ± 1.3, respectively (p ≤ 0.05). A decrease in adherence in the CG group was determined after 3 months (35.9 ± 1.2) (p ≤ 0.05) and six months later (36.5 ± 3.2) in comparison with relatively high adherence among respondents in the IG group in periods T2 (39.5 ± 1.2) and T3 (40.5 ± 1.2) (p ≤ 0.001). After 12 months (T4) on the adherence scale in patients who used the mobile application "MyTherapy" (IG), despite a slight decrease in scores, the results were relatively higher (40.3 ± 1.3) compared with the CG group (33.6 ± 1.9) (p ≤ 0.001). Conclusion: The analysis of adherence of patients with primary health care in Almaty (Kazakhstan) with chronic arterial hypertension showed the effectiveness of using the 'MyTherapy' mobile application in increasing patient adherence. The obtained data on the positive effect of the use of digital technologies require further research to assess the possibility of wider implementation in healthcare.

Prevalence of Viral Hepatitis B, C, and D in Kazakhstan.

Background: Viral hepatitis is a major burden for the healthcare system worldwide. Up to date, a comprehensive analysis of the prevalence of viral hepatitis in Kazakhstan and Central Asia has not been carried out yet. Our epidemiological study aimed at investigating the frequency and spread of viral hepatitis B, C, and D depending on age and sex in Kazakhstan (5-year period). Materials and Methods: We utilized the data from the primary registration of the incidence of hepatitis B, C, and D in 18 regions of Kazakhstan (period: from 2015 to 2020). Age indicators, gender, and territorial characteristics of registered cases were determined and analysed. The data were obtained from the state information system "Electronic Register of Dispensary Patients", based on the International Classification of Diseases-10 for coding diseases. Results: During the period studied, 268 975 cases of hepatitis B, C, and D were detected in Kazakhstan. Hepatitis B was registered in n = 109 734 cases. In women, the incidence rate was 40.6% of all cases (n = 44545), and in men it was 59.4% (n = 65189) of all cases (p ≤ 0.01). Hepatitis D was detected in 8 656 cases, of which 58.3% (n = 5049) were in men and 41.7% (n = 3607) in women (p ≤ 0.01). Hepatitis C was registered in n = 159 585 cases. The rate was higher in the male population (54.6%; n = 82 203) compared to women 45.4% (n = 68382) (p ≤ 0.01). In 2020 (in comparison with 2015), there was a significant increase in the incidence of hepatitis D by 68.3%, hepatitis B by 49.8%, and hepatitis C by 46.4%. The largest prevalence of hepatitis D was recorded in 2016 which is 22.3% higher compared to 2020. A significant increase in hepatitis C was recorded in 2019 compared to 2015, where indicators were 49.2% higher. Conclusion: An analysis of the prevalence of hepatitis B, C, and D showed an increase in new cases in Kazakhstan. These findings indicate the need to develop effective preventive measures and screening strategies among people in a high-risk group. The results of the study can be used for the development of a national program to combat the spread of viral hepatitis.

Sero-prevalence of SARS-CoV-2 in certain cities of Kazakhstan.

Background and Aims: Seroprevalence studies are needed to determine the cumulative prevalence of SARS-CoV-2 infection and to develop pandemic mitigation strategies. Despite the constant monitoring and surveillance, the true level of infection in the population of Kazakhstan remains unknown. The aim of this study was to determine the sero-prevalence of SARS-CoV-2 in the main cities of Kazakhstan. Methods: The research was conducted as a cluster-randomized cross-sectional national household study in three cities of Kazakhstan. The study covered the period: from October 24, 2020, to January 11, 2021. A total of 5739 people took part in the study. All participants agreed to be tested for antibodies to IgM/IgG. Demographic characteristics were analyzed. The presence of symptoms of respiratory diseases and the results of polymerase chain reaction (PCR) testing were determined. The antibodies to the SARS-CoV-2 virus were detected using the method of enzyme-linked immunosorbent assay (ELISA). Results: There was significant geographic variability with a higher prevalence of IgG/IgM antibodies to SARS-CoV-2 in Almaty 57.0%, in Oskemen 60.7% than in Kostanay 39.4%. There were no significant differences in prevalence between men and women (p ≥ 0.05). In Almaty, only 19% of participants with antibodies reported the presence of respiratory symptoms during a pandemic. At the same time, the percentage of patients with antibodies who had respiratory symptoms was 36% in Oskemen and 27% in Kostanay. Conclusion: The findings indicate that despite reasonable level of seroprevalence, the country has not yet reached the baseline minimum of herd immunity scores. The prevalence estimates for asymptomatic or subclinical forms of the disease ranged from 64% to 81%. Thus, given that almost half of the population of Kazakhstan remains vulnerable, the importance of preventive strategies such as social distancing, the use of medical masks, and vaccination to protect the population from the transmission of SARS-CoV-2 is highly critical.

Radio-Protective effect of aminocaproic acid in human spermatozoa.

BACKGROUND: The negative effects of ionizing radiation on organs and the reproductive system are well known and documented. Exposure to gamma radiation can lead to oligospermia, azoospermia and DNA damage. Up to date, there is no effective pharmaceutical compound for protecting the male reproductive system and sperm. OBJECTIVE: This study aimed at investigating the ability of Ɛ-aminocaproic acid (EACA) to prevent the damage of human spermatozoa and DNA induced by ionizing radiation. MATERIALS AND METHODS: Sperm samples were obtained from healthy volunteers (35 men; 31.50 ± 7.34 years old). There were four experimental groups: (1) control group (CG), (2) group exposed to maximal radiation dose 67.88 mGy (RMAX), (3) low-dose radiation (minimal) 22.62 mGy (RMIN), and (4) group treated with radiation (67.88 mGy) and EACA (dose 50 ng/mL). Sperm motility, viability, and DNA damage were assessed. RESULTS: We observed a significant decrease in total sperm motility of the RMAX group compared to CG (p < .05). Sperm viability in the RMAX group was also reduced in comparison to the control (p < .05). A significant increase in DNA fragmentation was detected in the RMAX group. The results demonstrated that the treatment of sperm with EACA led to a decrease in the fragmentation of the sperm DNA (compared to the RMAX group) (p < .05). CONCLUSION: The results indicate that EACA effectively protects human spermatozoa from DNA damage induced by ionizing radiation. Treatment of spermatozoa with EACA led to the preservation of cell motility, viability, and DNA integrity upon radiation exposure.

Synthetic Amphoteric Cryogels as an Antidote against Acute Heavy Metal Poisoning.

The effectiveness of an amphoteric cryogel (AAC) as an oral sorbent (enerosorbent) for the treatment of acute poisoning of small animals (rats) with heavy metals (HMs) was studied in in vivo experiments. The morphological structure of the cryogel was examined using scanning electron microscopy/energy-dispersive X-ray analysis and confocal microscopy. The use of the cryogel in the treatment of rats administered an LD50 dose of Cd(NO3)2, CsNO3, Sr(NO3)2, or HgCl2 in aqueous solution showed their high survival rate compared to the control group, which did not receive such treatment. The histological and chemical analysis of internal tissues and the biochemical analysis of the blood of the experimental animals showed the effectiveness of the cryogel in protecting the animals against the damaging effect of HMs on the organism comparable with unithiol, a chelating agent based on 2,3-dimercapto-1-propane sulfonic acid sodium salt (DMPS) approved for the treatment of acute poisoning with some heavy metals.