Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus.

The purpose of this article is to investigate the common facilitators and barriers associated with the implementation of hospital-based health technology assessment (HB-HTA) across diverse hospital settings in seven countries. Through a two-round Delphi study, insights were gathered from a panel of 15 HTA specialists from France, Hungary, Italy, Kazakhstan, Poland, Switzerland, and Ukraine. Experts initially conducted a comprehensive review of the HB-HTA implementation in their respective countries, identifying the barriers and facilitators through descriptive analysis. Subsequently, panel experts ranked these identified barriers and facilitators on a seven-point Likert scale. A median agreement score ≥ 6 and interquartile range (IQR) ≤ 1 was accepted as reaching a consensus. Out of the 12 statements categorized as external and internal barriers and facilitators, the expert panel reached consensus on six statements (two barriers and four facilitators). The external barrier, which achieved consensus, was the lack of the formal recognition of the role of HB-HTA in national or regional legislations. The internal barrier reaching consensus was the limited availability of human resources dedicated to HB-HTA. This qualitative study indicates that HB-HTA still has progress to make before being formally accepted and integrated across most countries, although by building on the facilitating factors we identified there may be an opportunity for the implementation of internationally developed strategies to strengthen HB-HTA practices.

Photodynamic therapy of cervical cancer: a scoping review on the efficacy of various molecules.

Background: Cervical cancer poses a considerable worldwide health issue, where infection with the human papillomavirus (HPV) plays a vital role as a risk factor. Photodynamic therapy (PDT) is a minimally invasive treatment for HPV-related cervical lesions, which uses photosensitizers and light to selectively destroy abnormal cells. Objectives: Our objective is to present a comprehensive overview of the different types of molecules employed in PDT to reduce the occurrence and fatality rates associated with cervical cancer. Design: Scoping review and bibliometric analysis. Methods: The article explores clinical trials investigating the efficacy of PDT in treating low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion, as well as preclinical approaches utilizing various molecules for PDT in cervical cancer. Furthermore, the article sheds light on potential molecules for PDT enhancement, examining their properties through computer modeling simulations, molecular docking, and assessing their advantages and disadvantages. Results: Our findings demonstrate that PDT holds promise as a therapeutic approach for treating cervical lesions associated with HPV and cervical cancer. Additionally, we observe that the utilization of diverse dye classes enhances the anticancer effects of PDT. Conclusion: Among the various molecules employed in PDT, functionalized fullerene exhibits a notable inclination toward overexpressed receptors in cervical cancer cells, making it a potential candidate for intensified use in PDT. However, further research is needed to evaluate its long-term effectiveness and safety.

Using light to treat cervical cancer: what you need to know Cervical cancer is a significant global health concern, often linked to the human papillomavirus (HPV). There is a less invasive treatment called photodynamic therapy (PDT), which employs light and special substances to target and destroy abnormal cells related to HPV. In this review, we aim to give you a comprehensive look at the different substances used in PDT to reduce the occurrence and severity of cervical cancer. We have examined clinical trials focusing on treating specific types of cervical lesions and explored preclinical approaches using various substances. We have also delved into computer simulations and molecular docking to understand the strengths and weaknesses of these substances. Our findings show that PDT has potential as a treatment for HPV-related cervical lesions and cancer. Different dye classes used in this therapy enhance its effectiveness against cancer. Notably, a substance called functionalized fullerene stands out for its tendency to target receptors overexpressed in cervical cancer cells. It looks promising, but more research is necessary to ensure its long-term effectiveness and safety.

Evaluation of the effectiveness and safety of photodynamic therapy in the treatment of precancerous diseases of the cervix (neoplasia) associated with the human papillomavirus: A systematic review.

This study provides an overview of the effectiveness and safety of PDT for the treatment of HPV-associated precancerous cervical conditions and contains recent findings from relevant research studies. A comprehensive literature search of MEDLINE/PubMed, Cochrane Central Library, and Google Scholar was conducted, including analytic epidemiological studies, and 11 papers were included. The narrative synthesis approach was used to summarize the results of the included studies. Studies were critically appraised using The Joanna Briggs Institute (JBI) tool for assessing the risk of bias. The results of the study demonstrate that CRR for HPV remission ranges from 66.7 % to 92.73 %, whereas for CIN1 it fluctuates from 57.1 % to 83.3 %. The frequency of recurrence of the disease ranged from 3.3 % to 8.9 % during the follow-up period of up to 2 years. Adverse events were observed in 8 (66 %) studies and the most common were cervical stenosis, abdominal pain, vaginal pain, and focal edema. Five types of topical and intravenous applications along with lasers of various wavelengths and intensities were mostly used. However, all studies demonstrated relatively similar results. According to the results, PDT has demonstrated favorable outcomes, but no impressive effect on the treatment of CIN. It should be emphasized, that the effectiveness of PDT for the treatment of HPV-associated CIN may vary depending on some variables, including the kind of PDT agent used, the dosage, duration and frequency of PDT administration, the severity and location of the lesions, and the host immunological response.

Association of Gene Polymorphisms with Breast Cancer Risk in the Kazakh Population.

OBJECTIVE: The research aim is analyzing and identify reliable genetic markers of breast cancer risk in the Kazakh population. METHODS: The databases were analyzed with the selection of polymorphisms associated with the development of breast cancer and further genotypic study of a group of women with a confirmed diagnosis of breast adenocarcinoma (group No. 1) and a group of relatively healthy women (group No. 2). RESULT: The research presents the results of a study on the frequency of certain single-nucleotide polymorphisms in patients with breast cancer in the Republic of Kazakhstan. The frequency of single-nucleotide polymorphisms rs4646, rs1065852, rs4244285, rs67376798, rs6504950, rs2229774, rs1800056, rs16942, rs4987047 is statistically significant compared to the control group of patients. These polymorphisms in the Kazakh population have a direct association with an increased risk of breast cancer in women and may be used as cancer indicators during the genetic screening of patients with a complicated family history. Single-nucleotide polymorphisms such as rs55886062, rs3918290, rs12721655, rs4987117, rs2229774, rs11203289, rs137852576, rs11571833, rs80359062 and rs11571746 were found in more than 40. Zero percent of patients with breast cancer may be used as markers for detecting patients at increased risk of breast malignancy in the Kazakh population without a history of poor family history. CONCLUSION: The usage of the data obtained in a set of state programs for early screening of patients will improve the rates of early breast tumor detection, form groups of patients with a high risk of disease development and improve the quality and expectancy of life.

Review of prognostic factors for kidney transplant survival.

Transplantation is the most effective treatment for end-stage chronic kidney disease, as this procedure prolongs and improves the patient's quality of life. One of the key problems is the risk of graft rejection. The purpose of this research was to identify and analyse prognostic factors that will prevent rejection. In particular, the prognostic factors grouped by methods of synthesis, generalisation and statistical processing with calculation and graphical representation of hazard ratio and correlation coefficient were grouped, namely: age of donor and recipient, time of cold kidney ischaemia, duration of preoperative dialysis, body mass index, presence of concomitant diseases (diabetes mellitus, hypertension), primary causes causing transplantation. Several molecular genetic and biochemical prognostic markers (transcription factors, immunocompetent cell signalling and receptors, cytostatin C, creatinine, citrate, lactate, etc.) are annotated. It has been demonstrated that creatinine reduction rate determines the risk of rejection, displaying the dynamics of cystatin C and creatinine changes in the postoperative period. Young recipients who underwent prolonged preoperative dialysis were identified as having the highest risk of rejection. Diabetes and hypertension bear a non-critical but commensurately equal risk of rejection. The survival rate of the graft is better when transplanted from a living donor than from a deceased donor. A correlation between cold ischaemia time, body mass index and the probability of graft failure has been proven, namely, the greater the donor and recipient body mass index and the longer the cold ischaemia time, the lower the chance of successful long-term organ acclimation. The data obtained can be used as prognostic factors for graft accommodation at different intervals after surgery.

Clinical-biochemical and Fibroelastometric Results of the Mare's Milk Application in Non-Alcoholic Steathepatitis / Resultados clínico-bioquímicos y fibroelastométricos de la aplicación de la leche de yegua en la esteatohepatitis no alcohólica

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world, representing the hepatic component of metabolic syndrome, and currently affects an average of 20-33 percent of the adult population. Non-alcoholic steatohepatitis (NASH) is a severe form of NAFLD and is a consequence of overweight, obesity, and metabolic syndrome. Objective: The study aimed to evaluate the effectiveness of the use of freeze-dried mare's milk in NASH. Methods: Clinical-biochemical, ultrasound, and fibroelastometric research methods were used in NASH patients receiving mare's milk in comparison with the control groups. Results: The result of the study demonstrates noticeable gain not only in the clinical symptoms of the disease but also in the laboratory and instrumental indicators, as well as health improvement and a decrease in symptoms of concomitant pathology. Taking mare's milk not only normalized liver biochemical parameters but also decreased cholesterol metabolism (total cholesterol, LDL, TG), the degree of liver steatosis, and existing hepatomegaly declined too. This pleiotropic effect of mare's milk points to the pathogenetic feasibility for the use of Saumal in NAFLD, including NASH. Conclusions: Addressing the problems of healthy nutrition in NASH, mare's milk can be considered as a pathogenetically justified, highly effective, and affordable natural therapeutic and prophylactic agent. The value of the product is determined by its multicomponent balanced qualitative composition. Hepatoprotective, hypocholesterolemic, and lipotropic properties of mare's milk in this pathology are marked(AU)

Introducción: La enfermedad del hígado graso no alcohólico es la enfermedad hepática más común en el mundo, representa el componente hepático del síndrome metabólico y actualmente afecta a un promedio de 20 a 33 por ciento de la población adulta. La esteatohepatitis no alcohólica es una forma grave de hígado graso no alcohólico y es una consecuencia del sobrepeso, la obesidad y el síndrome metabólico. Objetivo: Evaluar la efectividad del uso de leche de yegua liofilizada en hígado graso no alcohólico. Métodos: Se utilizaron métodos de investigación clínico-bioquímicos, ecográficos y fibroelastométricos en pacientes con hígado graso no alcohólico que recibieron leche de yegua en comparación con los grupos de control. Resultados: El resultado del estudio demuestra una ganancia notable no solo en los síntomas clínicos de la enfermedad, sino también en los indicadores de laboratorio e instrumentales, así como una mejora de la salud y una disminución de los síntomas de la enfermedad concomitante. La ingesta de leche de yegua no solo normalizó los parámetros bioquímicos del hígado, sino que también disminuyó el metabolismo del colesterol (colesterol total, LDL, TG), el grado de esteatosis hepática y la hepatomegalia existente también disminuyeron. Este efecto pleiotrópico de la leche de yegua apunta a la viabilidad patogénica del uso de Saumal en hígado graso no alcohólico, incluida la esteatohepatitis no alcohólica. Conclusión: Al abordar los problemas de una nutrición saludable en la enfermedad hígado graso no alcohólico, la leche de yegua se puede considerar como un agente terapéutico y profiláctico natural patogénicamente justificado, altamente efectivo y asequible. El valor del producto está determinado por su composición cualitativa equilibrada multicomponente. Las propiedades hepatoprotectoras, hipocolesterolémicas y lipotrópicas de la leche de yegua en esta enfermedad son marcadas(AU)

Tumor progression mechanisms: Insights from the central immune regulation of tissue homeostasis.

Knowledge of the mechanisms underlying the spread of cancer at the cellular and molecular levels is expanding rapidly. However, the central regulators governing the initiation and the rate of tumor growth remain poorly established. The fundamental principles of innate and adaptive immunity may explain how immune cells generate a specific response to tumor tissue. In the current review, the functional features of the immune system that contribute to the maintenance of normal tissue homeostasis, as well as their disruption in malignant transformations, were analyzed. Experimental and clinical studies previously demonstrated the involvement of regulatory T-cells in the process of tumor metastasis in a tissue-specific manner. An understanding of the cross talk between lymphoid and tumor cells may provide an insight into cancer evolution in terms of the mechanisms of T-cell competency formation. Elucidating the mechanisms of tumor progression via central immune regulation has implications for the development of novel therapeutic agents that target immune checkpoints.

Hospital-based Health Technology Assessment in Kazakhstan: 3 years' experience of one unit.

OBJECTIVES: The aim of this study was to describe the development and activities of the Hospital-Based Health Technology Assessment (HB-HTA) Unit in the Hospital of the President's Affairs Administration, one of the first examples of the implementation of HB-HTA into the practice of Kazakhstani hospitals. METHODS: Details of the development of the Unit were obtained from the hospital's administrative records. The Unit's own records were used to describe the reports prepared and the clinical areas that were covered. Responses to recommendations in the Unit's reports were obtained from hospital administration and individual departments. Estimates of savings and payback periods were based on data from the hospital information system, and data submitted by manufacturers and distributors of medical equipment. RESULTS: Fifty-one rapid- and mini-HTA reports were prepared by the Unit from 2015 to 2017. Seventeen health technologies (33 percent) were not recommended for implementation in hospital practice. Refusal to implement sixteen of these technologies saved approximately 1,053,500 USD. Of the thirty-four recommended health technologies, twenty-four were implemented to treat or diagnose 1,376 patients, and eight others were included in plans for 2018-20. Of the twenty-four implemented health technologies, twelve did not require additional investments. The payback period of investments for the other twelve implemented technologies is not more than 3 years for six, less than 5 years for four, and more than 10 years for two technologies. CONCLUSIONS: Establishment of the HB-HTA Unit in the hospital created the basis for making informed managerial decisions; identifying key directions for strategic development; and improving hospital management.