Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan

Background

According to the World Stroke Organization, there was a significant increase in stroke cases, stroke deaths, and the DALY rate in low- and middle-income countries in 2022. The number of stroke cases rose by 70.0%, stroke deaths reached 86.0%, and the DALY rate reached 89.0%. Among cerebrovascular diseases, ischemic stroke accounts for 62.0% of all strokes, with more than 7.6 million cases reported annually.Kazakhstan, with a population of 19,832,737, is the largest country in Central Asia in terms of territory. In Kazakhstan, the incidence of cerebrovascular disease has risen from 258.4 cases per 100,000 population in 2015 to 433.7 cases per 100,000 population in 2020. Official statistics indicate that the average inpatient mortality rate from stroke in the country is 16.2%, and the average time for patients to be delivered to the hospital after an ambulance call is 40 min (83.2%).Our study findings reveal that in the regions of Kazakhstan, the main contributors to the high morbidity and mortality rates in stroke are a shortage of doctors, inadequate primary healthcare, insufficient follow-up and treatment, and delayed hospitalization. Consequently, this study has helped fill knowledge gaps regarding the epidemiological situation in these regions and underscores the need for training doctors in managing high-risk patients, establishing multidisciplinary home visit teams, and establishing "Stroke Schools" to enhance public awareness of early stroke signs and the fundamentals of a healthy lifestyle. Future research endeavors should consider these study results as valuable contributions towards addressing the existing problems.

Aim

To study the prevalence and mortality of acute cerebral circulation impairment in the population within multidisciplinary hospitals in the cities of Nur-Sultan and Almaty, Republic of Kazakhstan, for the period of 2018-2020.This retrospective study was conducted in two stages. In the first stage, an analysis of morbidity, prevalence, and mortality was conducted for the population of Nur-Sultan and Almaty cities, as well as for the overall population of Kazakhstan. This analysis was based on data from the "Electronic Register of Discharged Patients" (IS ERDB) and the annual collection "Health of the Population of the Republic of Kazakhstan and the Activities of Health Organizations in 2015-2020". In the second stage, we examined the care provided to patients with acute impaired cerebral circulation in a multidisciplinary hospital in these two cities. The analysis was based on data regarding the sex and age composition of treated patients in hospitals across the Republic of Kazakhstan, categorized according to the ICD-10 code "Acute Impaired Cerebral Circulation" (I60-I64). We investigated the methods of patients' delivery to medical organizations, types of hospitalization, and outcomes of treated patients. The sample of patients was selected using data from the "Electronic Register of Dispensary Patients" of the Ministry of Health of the Republic of Kazakhstan, along with the statistical collection "Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations". Between January 1, 2018, and December 31, 2020, a total of 5965 patients were diagnosed with a cerebrovascular event and admitted to a general hospital in Nur-Sultan city, while 13,498 patients were diagnosed and admitted in Almaty city.

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.

Availability of General Practice Workforce and Basic Health Indicators in the Republic of Kazakhstan: 2015-2019

Фон . Республика Казахстан уделяет особое внимание развитию кадров общей практики (ВОП) за последние три десятилетия. Это исследование было направлено на предоставление описательного распределения врачей общей практики между различными административными единицами Казахстана по основным показателям здоровья за период 2015-2019 гг. Методы . Это было ретроспективное перекрестное исследование, основанное на данных, полученных из реестра медицинских кадров. Данные о смертности от всех причин, смертности от сердечно-сосудистых заболеваний, материнской и младенческой смертности получены из ежегодных статистических отчетов, выпускного министерства здравоохранения. Полученные результаты .В настоящее время врачи общей практики составляют основную часть медицинского персонала в Казахстане. В Казахстане наблюдается стабильное снижение показателей сердечно-сосудистой, материнской и младенческой смертности в период 2015-2019 гг. Заключение . Врачи общей практики - передовые деятели казахстанской системы здравоохранения. Необходимо изучить другие факторы, способствующие улучшению основных показателей здоровья в Казахстане.

Practice of Surgical Treatment for Patients with Combined Echinococcosis of Chest and Abdominal Organs

BACKGROUND

Epidemiological significance of echinococcosis is determined by the severe clinical progression leading to disability, incapacitation and death, a wide range of hosts, and formation of synanthropic and mixed lesions. The aim of the work was to analyze cases of combined echinococcosis of the chest and abdominal organs and the results of its surgical treatment in clinics of Almaty (Kazakhstan) from 1997 to 2019.

MATERIALS AND METHODS

In 413 patients, 534 lesions of echinococcosis were revealed: single and multiple cysts. Concurrent echinococcectomy of 2-3 organs was performed in 261 patients; meanwhile phased echinococcectomy was performed in several organs in 152 patients.

RESULTS

Performed surgical interventions in more than 70% of cases had a favorable outcome.

CONCLUSION

The choice of rational surgical tactics for combined echinococcosis should be based on an individual approach, taking into account the general condition of the patient, risk analysis and the likelihood of complications.

RECENT TREATMENT RESULTS OF LIVER ECHINOCOCCOSIS BY PAIR METHOD (PUNCTURE, ASPIRATION, INJECTION, REASPIRATION)

The development of new technologies in medicine lead to creating an optimal treatment methods of cystic liver echinococcosis, based on minimally invasive technologies, such as percutaneous puncture-aspiration echinococcectomy (PAIR) under ultrasound (US) guidance. Aim of this study is to analyze and evaluate the efficiency of PAIR treatment. The study material included a retrospective analysis of 33 patients who underwent PAIR from December 2017 to December 2019. Of them, 25 (75%) patients with primary CLE, 8 (24%) patients with recurrent cystic liver echinococcosis. Cystic liver echinococcosis was staged according to WHO classification by US images. All patients pre- and postoperatively received therapy with Albendazole. The mean duration of surgery was 41 (30-70) min. Hospital stay times were ranged from 2 and 16 days (mean 4,8 days) in all patients. The conversion to laparotomy during the procedure was not necessary. Operation was finished in 3 cases due to developing anaphylactic shock during operation. There was no fatal outcome in any cases. One patient developed bilio-cystic communication, resolved spontaneously without additional treatment. The use of minimally invasive PAIR intervention followed by Albendazole therapy has a positive effect on reducing the patient's hospital stay.

BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

The aim of our research is to perform a retrospective analysis of all cases involving biliary complications after liver transplantation in two transplant centers of Kazakhstan. In the period from December 2011 and December 2019, 106 adult patients underwent LT at Syzganov's National Scientific Center of Surgery and City Clinical Hospital №7, Almaty, Kazakhstan. Eighty-nine (84%) patients underwent living donor liver transplantation (LDLT) from an adult donor, while 17 (16%) patients underwent deceased donor liver transplantation. The graft types were as follows: whole liver (n=17; 16%), right lobe (n=82; 77.3%), left lobe (n=6; 5.6%), and right posterior section (n=1; 0.9%). Duct-to-duct anastomosis was performed in 102 cases, the types of which were as follows single duct-to-duct anastomosis (n=95; 93.1%), double duct-to-duct anastomosis (n=5; 4.9%), combined-type anastomosis (duct-to-duct anastomosis and roux-en-Y hepaticojejunostomy [n=2; 1.9%]). Roux-en-Y hepaticojejunostomy was performed in 3 cases. A biliary splint was used in 53 (52%) cases; biliary splints were not used in 49 (48%) cases. Preoperative and intraoperative methods of investigating (MRC, IOC) the biliary tracts can reveal the types of biliary tracts and are useful for planning the type of biliary reconstruction. Various types of biliary reconstruction are associated with a high risk of biliary complications after liver transplantation. Biliary splinting in duct-to-duct anastomosis reduces the incidence of biliary complications.

Role of metabolism during viral infections, and crosstalk with the innate immune system

Viruses have been for long polemic biological particles which stand in the twilight of being living entities or not. As their genome is reduced, they rely on the metabolic machinery of their host in order to replicate and be able to continue with their infection process. The understanding of their metabolic requirements is thus of paramount importance in order to develop tailored drugs to control their population, without affecting the normal functioning of their host. New advancements in high throughput technologies, especially metabolomics are allowing researchers to uncover the metabolic mechanisms of viral replication. In this short review, we present the latest discoveries that have been made in the field and an overview of the intrinsic relationship between metabolism and innate immunity as an important part of the immune system.

Career intentions and dropout causes among medical students in Kazakhstan

BACKGROUND AND OBJECTIVE

The number of new entrants to higher medical schools of Kazakhstan increased by 1.6 times from 2007 to 2012. However, it is not known how it will affect the shortage of human resources for health. Additionally, human resources for health in rural areas of Kazakhstan are 4 times scarcer than in urban areas. The aim of the present study was to investigate the intentions of students toward their professional future and readiness to work in rural areas, as well as to determine the causes for dropping out from medical schools.

MATERIAL AND METHODS

A cross-sectional survey was conducted in 2 medical universities in Almaty during the academic year 2011-2012. The study sample included medical students and interns. In total, 2388 students participated in the survey. The survey tool was an anonymous questionnaire.

RESULTS

The students of the first years of studies compared with those of later years of studies were more optimistic about the profession and had more intentions to work in the medical field. Only 8% of the students reported a wish to work in rural localities. On the other hand, 4% of the students did not plan to pursue the profession. On the average, every third medical student dropped out on his/her own request.

CONCLUSIONS

Associations between intentions to work according to the profession and the year of studies, faculty, and residence area before enrolling in a medical school were documented. The majority of the students who came from rural areas preferred to stay and look for work in a city, which might contribute to an unequal distribution of physicians across the country.