A narrative review of visceral leishmaniasis in Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan, the Crimean Peninsula and Southern Russia.

There is an extensive body of medical and scientific research literature on visceral leishmaniasis (VL) in the Caucasus, Central Asia, the Crimean Peninsula and the southern part of The Russian Federation that is written in Russian, making it inaccessible to the majority of people who are interested in the leishmaniases in general and VL in particular. This review and summary in English of VL in what was Imperial Russia, which then became the Soviet Union and later a number of different independent states intends to give access to that majority. There are numerous publications in Russian on VL and, mostly, those published in books and the main scientific journals have been included here. The vast geographical area encompassed has been subdivided into four main parts: the southern Caucasus, covering Armenia, Azerbaijan and Georgia; Central Asia, covering Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan; the Crimean Peninsula and the northern Caucasus, which is part of The Russian Federation. Only rare cases of VL have been recorded in the northern Caucasus and Crimean Peninsula. In the other countries mentioned, human VL has been more intense but epidemics like those associated with L. donovani in India and East Africa have not occurred. For most of the countries, there are sections on the distribution, clinical aspects, the causative agent, the reservoirs and the vectors. Serological surveys and research into therapy are also covered. Recent studies on VL in Uzbekistan covered the application of serological, biochemical and molecular biological methods to diagnose human and canine VL, to identify the leishmanial parasites causing them in Uzbekistan and neighbouring Tajikistan and the epidemiology of VL in the Namangan Region of the Pap District, Eastern Uzbekistan. More recently, two studies were carried out in Georgia investigating the prevalence of human and canine VL, and the species composition of phlebotomine sand flies and their rates of infection with what was probably L. infantum in Tbilisi, eastern Georgia and Kutaisi, a new focus, in western Georgia. Though published in English, summaries of this information have been included where relevant to update the parts on VL in Uzbekistan and Georgia.

Gestational diabetes in Turkmenistan: implementation of a screening program and first results.

PURPOSE: Data on the prevalence of gestational diabetes (GDM) is not available for Turkmenistan or any other central Asian country with large energy resources and rapidly increasing wealth and rates of obesity. We initiated a screening program to determine the prevalence of and the risk factors for GDM in Turkmenistan. METHODS: Between March 2008 and March 2011, all pregnant women presenting to the Ene-Maehri-Merkezi perinatal center in Ashgabat before week 34 of pregnancy received a glucose screening test (after 26 weeks of pregnancy; 50 g glucose). If 60-min glucose was ≥7.8 mmol/l, an oral glucose tolerance test (oGTT) (75gr) was performed. GDM was diagnosed if ≥1 glucose values were abnormal (≥5.0, ≥10.0, ≥8.0 mmol/l at 0-, 60-, 120-min, respectively). Birth weight, 30 min glucose, and APGAR (1, 5, and 10 min) were recorded for all newborns. RESULTS: Of 1,738 women, 22.7 % had a pathological screening test. 70 % of these, underwent an oGTT and of these, 39.5 % had GDM (overall prevalence 6.3 %). Age, BMI, parity, and blood pressure were associated with screening glucose (all p < 0.001). In a multivariate analysis, age, BMI, and family history for diabetes were associated with GDM. Newborns from affected mothers were heavier (3,622 ± 435 vs. 3,480 ± 464 g, p = 0.007) and developed postnatal hypoglycaemia more often (21.6 vs. 9.3 %, p = 0.001), while there was no difference in APGAR. CONCLUSIONS: GDM is a relevant problem in Turkmenistan and probably also in other central Asian countries. The prevalence is similar to other developing countries such as India or China. Risk factors are comparable to those determined in other parts of the world.

[Structural and clinical characteristics of elderly and senile patients' treatment in regional surgical hospital].

Treatment results of 1219 patients of elderly and senile age, hospitalized in surgical departments of Turkestan during 2001-2008 were analyzed. Demographic characteristics, spectrum of profile pathology as well as concurrent diseases were given. Operative activity and average hospital stay, hospital lethality and complication rates were defined.

[Detection of Anopheles artemievi Gordeev et al. (Diptera, Culicidae) in Turkmenistan].

Anopheles artemievi (a member of An. maculipennis complex species) described from the Transfergana region (South Kyrgyzstan) in 2004 was first found in the Lebap veloyat (Eastern Turkmenistan). A single larva of this species was collected together with An. superpictus in the irrigation channel of a rice field. Species affiliation has been proven by a polymerase chain reaction-restriction fragment length polymorphism method. This species is to be included into a list of Anopheles species of Turkmenistan.

Contextual factors influencing HIV risk behaviour in Central Asia.

Central Asia has experienced a rapid increase in HIV. HIV interventions and prevention programmes are needed that adequately appreciate and account for the ways that ongoing cultural, political and economic changes in this region affect HIV risk reduction efforts. Drawing on relevant literature, this paper provides a contextual foundation to better understand the impact of context on HIV risk behaviour in the countries of Central Asia and to begin the conversation on the contextual factors of Islam and polygamy.

[Milestones and major results of studies on leishmaniasis and sand fly fevers in Turkmenistan].

Among the countries endemic for tropical diseases, Turkmenistan along with Uzbekistan has a special role to play in having basic scientific knowledge of leishmaniasis. This article summarizes the principal scientific findings in the course of the 20th century in respect of leishmaniasis and sand fly fevers. The most important results of studies on cutaneous and visceral leishmaniasis are cited. The role of different researchers in the epidemiology, epizootology, natural focality of these diseases, their clinical aspects, diagnosis, treatment, and prevention are described in detail. The paper gives information obtained by the latest studies on the etiology of leishmaniasis. The most important publications on this topic are assessed. Particular emphasis is laid on the results of the Anti-Leishmaniasis Expedition carried out by the researchers of the E.I. Martsinovsky Institute of Medical Parasitology and Tropical Medicine to the Tedjen oasis of Turkmenistan.

[Prevalence of type III secretion system genes in cholera vibrios from different serogroups].

Prevalence of vcs genes coding the type III secretion system (T3SS) in cholera vibrios of different serogroups isolated in Russia and neighboring countries was studied for the first time. Virulent strains of O1 and O139 serogroups as well as toxigenic Vibrio cholerae strains of other serogroups contained no T3SS genes. Unlike mentioned strains, 29.2% of atoxigenic non O1/non O139 cholera vibrios isolated from patients in Russia and neighboring countries contained the T3SS genes cluster, which might contribute to the pathogenic properties of these strains.

[Landscape-epidemiological zoning of Turkmenistan by leishmaniasis].

Based on the long-term (1961-1992) study of the parasitic systems of zoonotic cutaneous and visceral leishmaniasis in the context of a landscape, the authors made an epidemiological regional and typological zoning of Turkmenistan. Regional zoning identified 13 districts by zoonotic cutanenous leishmaniasis and 6 districts by visceral leishmaniasis. While typologically zoning according to the human hazard ofzoonotic cutaneous leishmaniasis, the authors divided the landscapes of Turkmenistan into 5 groups: hyperendemic; mesoendemic; hypoendemic; enzootic by cutaneous leishmaniasis, but not dangerous to man; nonenzootic by cutaneous leishmaniasis and not dangerous to man. While typologically zoning with respect with visceral leishmaniasis, the authors divided them into 4 groups: epidemically hazardous landscapes of sandy deserts and semisavanna low-mountain of South-Eastern Turkmenistan; epidemically hazardous landscapes of foothills, low-mountains, and middle mountains of Kopetdag; epidemiologically potentially dangerous landscapes of the piedmont plain of Kopetdag and the valley of the Murgab river; nonenzootic landscapes in terms of visceral leishmaniasis, and those not dangerous to man.

Characterization of hepatitis E virus from outbreak and sporadic cases in Turkmenistan.

Large outbreaks and sporadic cases of hepatitis E have been reported in Central Asia. We assessed the genetic relatedness of hepatitis E virus (HEV) strains from outbreak and sporadic cases in Turkmenistan. Specimens from outbreak and sporadic cases of acute hepatitis non-A, non-B were tested by reverse transcription (RT)-polymerase chain reaction (PCR) to identify the presence of HEV RNA; nucleotide sequences were analyzed. HEV RNA was detected from 23/156 (15%) outbreak cases and 2/23 (9%) sporadic cases. The HEV outbreak isolates represented 14 unique sequences with genetic distances varying between 0.3% and 8.6%, 12 of which were closely related, with distances between 0.3% and 5.6%. Two unique sequences from outbreak cases 32 and 42 were closely related (99.7%) and shared 91.8-93.4% of sequence with the other 12 strains. The two strains were closely related to the previously published isolates from Burma (99.7-100%) and India-Madras (95.7-96.1%). The two 1994 sporadic HEV strains were 97.4% distinct, wile revealing 91.4-94.1% homology to 1985 strains, and 94.4-94.7% to HEV from the neighboring China and Pakistan. Genetic diversity of HEV that caused the hepatitis E outbreak in Turkmenistan in 1985 suggests heterogeneity of viral sources. Sporadic hepatitis E that occurred in 1994 was caused by viral strains genetically distinct from those causing the outbreak in 1985, yet closely related to HEV from neighboring countries. The study suggests that circulation of a broad variety of strains of HEV may occur in Central Asia, regardless of international borders, presenting a significant public health threat to the population of the region.

The effects of dictatorship on health: the case of Turkmenistan.

BACKGROUND: There is a health crisis in Turkmenistan similar to, but more severe than, in other Central Asian countries. This paper asks whether the health crisis in Turkmenistan is attributable to the consequences of the dictatorship under president Niyazov, who died in 2006. METHODS: The basis for this paper was a series of semi-structured in-depth interviews with key informants complemented by an iterative search of internet sites, initially published as a report in April 2005, and subsequently updated with feedback on the report as well as a comprehensive search of secondary information sources and databases. RESULTS: This paper describes in depth three areas in which the dictatorship in Turkmenistan had a negative impact on population health: the regime's policy of secrecy and denial, which sees the "solution" to health care problems in concealment rather than prevention; its complicity in the trafficking of drugs from Afghanistan; and the neglect of its health care system. CONCLUSION: The paper concludes that dictatorship has contributed to the health crisis facing Turkmenistan. One of the first tests of the new regime will be whether it can address this crisis.

Multidrug-resistant tuberculosis in central Asia.

Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major threat to TB control, particularly in the former Soviet Union. To determine levels of drug resistance within a directly observed treatment strategy (DOTS) program supported by Médecins Sans Frontières in two regions in Uzbekistan and Turkmenistan, Central Asia, we conducted a cross-sectional survey of smear-positive TB patients in selected districts of Karakalpakstan (Uzbekistan) and Dashoguz (Turkmenistan). High levels of MDR-TB were found in both regions. In Karakalpakstan, 14 (13%) of 106 new patients were infected with MDR-TB; 43 (40%) of 107 previously treated patients were similarly infected. The proportions for Dashoguz were 4% (4/105 patients) and 18% (18/98 patients), respectively. Overall, 27% of patients with positive smear results whose infections were treated through the DOTS program in Karakalpakstan and 11% of similar patients in Dashoguz were infected with multidrug-resistant strains of TB on admission. These results show the need for concerted action by the international community to contain transmission and reduce the effects of MDR-TB.

[Effect of heliogeophysical factors on epizootic activity of a native focus of visceral leishmaniasis]. / Vliianie geliogeofizicheskikh faktorov na épizooticheskuiu aktivnost' prirodnogo ochaga vistseral'nogo leishmanioza.

Visceral leishmaniasis (VL) morbidity in the population of the south-eastern Turkmenistan and the epizootic activity of a natural focus were studied. A definite cyclic recurrence of the processes occurring in the natural focus of VL, which was associated with solar activity changes was found. The regularities found make it possible to predict the increase in the epizootic tension of a natural focus of VL in this region and the incidence of this disease among the population in 2002-2004.