The Role of Climatic, Environmental and Socioeconomic Factors in the Natural Movement of Urban Populations in Kazakhstan, 2012-2020: An Analysis from a Middle-Income Country in Central Asia.

BACKGROUND: This study addresses the importance of identifying key characteristics influencing demographic indicators for urban populations, emphasizing the need to consider regional climatic features and ecological factors. The research utilized data from ten main regional cities across the Republic of Kazakhstan. METHODS: This study involved a retrospective analysis based on secondary data from official sources spanning 2012-2020. We employed correlation analysis and multidimensional regression models. RESULTS: Noteworthy predictors for crude birth rate included the influence of effective temperature (ß = 0.842, p < 0.0001), marriage rate (ß = 0.780, p < 0.0001), Gini coefficient (ß = -27.342, p = 0.020) and divorce rate (ß = -2.060, p < 0.0001), with overall strong model performance (R2 = 0.940). The degree of atmospheric pollution (ß = -0.949, p = 0.044), effective temperature (ß = -0.294, p < 0.0001) and Gini coefficient (ß = 19.923, p = 0.015) were the predictors for crude mortality rate, with a high model fit (R2 = 0.796). CONCLUSIONS: The study unveils significant relationships between demographic indicators (crude birth rate, mortality rate) and variables like effective temperature, marriage rate, divorce rate, Gini coefficient, physician density and others. This analysis of climatic, environmental, and socioeconomic factors influencing demographic indicators may help in promoting specific measures to address public health issues in Kazakhstan.

Heart transplantation of patients with ventricular assist devices: impact of normothermic ex-vivo preservation using organ care system compared with cold storage.

BACKGROUND: Organ Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Impact of normothermic ex-vivo preservation using OCS compared with cold storage (CS) for prolonged heart preservation especially beneficial for high-risk recipients bridged to transplantation with Mechanical Circulatory Support (MCS). METHODS: Between 2012 and 2018, we performed a retrospective single-center review of prospectively collected data. All patients who underwent heart transplantation with MCS using the OCS Heart (n = 25) versus standard cold storage (n = 10) were included in this study. RESULTS: During this period, 353 patients were implanted with left ventricular assisted device (LVAD) and 35 (10%) were bridged to heart transplantation. There was no significant difference in donor and recipient characteristics and risk factors. The Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was a trend towards higher estimated risk of death at 1y in the OCS group (14.2 vs. 10.8% p = 0.083). Mean total ischemic time during preservation was statistically significantly longer in CS vs OCS group (210 (23) Vs 74.6 (13) min p = 0.001). Median ex vivo normothermic heart perfusion time in OCS was 348.4(132; 955) min. There was significant difference in total out of body time between OCS group 423(67) Vs CS group 210(23) min p = 0.002). All patients were alive on the 30th days post implant in CS groups and 96% in OCS group (p = 0.5). CONCLUSION: Normothermic ex-vivo preservation of the allograft during transportation with the organ care system might be beneficial for long-time out of body organ preservation in comparison of cold storage especially for recipients on mechanical circulatory support.

Comparison of Custodiol vs warm blood cardioplegia and conditioning of donor hearts during transportation with the organ care system.

OBJECTIVES: Cold crystalloid cardioplegia for donor heart harvesting and cold ischemic storage conditions during the transportation is the standard of care during heart transplantation procedure. Organ care system (OCS) was introduced for more prolonged and reliable ex vivo organ management. This study evaluated the two different techniques used for myocardial preservation during the procurement and transportation of the heart using the OCS. METHODS: We performed prospective analysis of 43 patients with heart failure undergoing heart transplantation and using the OCS for donor organ transport. Donor hearts were arrested using blood cardioplegia and conditioning (n = 30) or standard Custodiol (SC) solution ( n = 13). Perfusion and cardiac function parameters were continuously monitored while the donor hearts were perfused in the OCS. Impact of preservation techniques on biochemical parameters and clinical outcomes were evaluated. RESULTS: All donor hearts had stable perfusion and lactate characteristics in the OCS, with similar measures between the two groups at the beginning of the ex vivo perfusion. Ex vivo heart perfusion mean ending concentration of Interleukin (IL)-6 and IL-8 was significantly lower in the blood cardioplegia group compared to the standard care group. Clinical outcomes were comparable between the two groups of patients. CONCLUSIONS: The use of blood cardioplegia and conditioning could be a safe method for myocardial protection in distant procurement and preservation of donor hearts in the OCS.

Repeated pulmonary embolism with cardiac arrest after uterine artery embolization for uterine arteriovenous malformation: A case report and literature review.

OBJECTIVE: Uterine arteriovenous malformation (AVM) is an abnormal and nonfunctional communication between uterine arteries and veins, currently managed by uterine artery embolization (UAE). Pulmonary embolism (PE) is the most severe and life-threatening complication of this procedure. CASE REPORT: We report a case of 27 year-old woman with heavy vaginal bleeding and abdominal pain caused by AVM. UAE was performed uneventfully, but 2 h after the procedure the first attack of pulmonary embolism occurred, treated by anticoagulation therapy. Second attack happened on the third postinterventional day. Considering vaginal bleeding, continued extracorporeal membrane oxygenation (ECMO), and suspicion of embolic particles arising from uterus, a subtotal hysterectomy was done. Patient was discharged two weeks following surgery, after complete recovery. CONCLUSION: Although AVM is managed by UAE, clinicians must be aware of complications. To avoid PE, we suggest only large sized microspheres for carefully selected patients.