Comparative Effectiveness and Safety of Cryoablation Versus Radiofrequency Ablation Treatments for Persistent Atrial Fibrillation.

The purpose of this study was to compare the effectiveness and safety of 2 strategies for catheter treatment of patients with persistent atrial fibrillation in the long-term period, using cardiac implantable loop recorders. The research is a prospective, randomized, controlled study designed to compare the results of modern catheter technologies in patients with persistent atrial fibrillation. The study included 127 patients with persistent atrial fibrillation in the last 6 months before inclusion in the study, for whom at least 2 antiarrhythmic drugs of class I to III were not effective. By random distribution, 50 patients were included in group 1; they underwent cryoballoon ablation, using a cryoballoon of the second generation. Group 2 also included 50 patients who underwent radiofrequency ablation, where a catheter was used to control the contact force. Cardiac implantable loop electrocardiogram recorders were implanted in all patients after surgery. The average duration of follow-up was 36 months. The primary end point of efficacy occurred in 15 patients in the group with cryoballoon ablation and 14 patients in the group with radiofrequency ablation. In conclusion, the primary effectiveness was relatively the same in the groups; yet, in the long-term period, the superiority of radiofrequency ablation using catheters with pressure control was noted, but the difference in results was statistically insignificant (p <0.672) and there was no significant difference between the 2 methods in terms of overall safety.

Efficacy and Safety Results of Different Ablation Technologies for Persistent Atrial Fibrillation Treatment.

INTRODUCTION: Pulmonary vein isolation is the primary goal in treating patients with paroxysmal atrial fibrillation using catheter ablation. This study's purpose is a comparative assessment of the efficacy and safety of two strategies for catheter treatment in patients with persistent atrial fibrillation. PATIENTS AND METHODS: The study included 127 patients with persistent atrial fibrillation during the last six months before inclusion in the study. The average follow-up period was 24 months. RESULTS: The primary efficacy endpoint (death, cerebrovascular event, or serious complications associated with treatment) occurred in 15 patients in the cryoballoon ablation group and 14 patients in the radiofrequency ablation group. The Kaplan-Meier survival estimates were 30% and 28%, and the risk ratio   0.96 and 95% of the confidence interval. CONCLUSIONS: The treatment in patients with persistent atria fibrillation, using catheter ablation with contact force control catheter treatment with the pulmonary vein isolation, was more efficient.

Prevalence of refractive errors and risk factors for myopia among schoolchildren of Almaty, Kazakhstan: A cross-sectional study.

INTRODUCTION: Very little is known about the prevalence of refractive errors among children in Kazakhstan. The aim of this study was to investigate the prevalence of refractive errors and risk factors of myopia among schoolchildren in Almaty, Kazakhstan. METHODS: In the cross-sectional study of 2293 secondary school students (age 6-16), we examined cycloplegic autorefraction and offered a questionnaire in three age groups: 1st grade (N = 769), 5th grade (N = 768) and 9th grade (N = 756). The questionnaire covered main risk factors such as parental myopia, screen time, time outdoors, sports activities, near work, gender, grade, and school shift. Adjusted logistic regression analysis was applied to test the association of risk factors with myopia. RESULTS: The mean spherical equivalent (SER) was -0.54 ± 1.51 diopters (D). The overall prevalence of refractive errors was 31.6% (95% confidence interval (CI) 29.7; 33.5); myopia 28.3% (95% CI 26.5; 30.1); hyperopia 3.4% (95% CI 2.7-4.1) and astigmatism 2.8% (95% CI 2.1; 3.5). In the multivariate adjusted regression analysis, higher class level (5th grade (odds ratio (OR) 1.78; 95% CI 1.26; 2.52) and 9th grade (OR 3.34; 95% CI 2.31; 4.82)) were associated with myopia, whereas outdoors activity more than 2 hours a day (OR 0.64; 95% CI 0.46; 0.89) and sports (OR 0.70; 95% CI 0.52; 0.93) were associated with a lower incidence of myopia. CONCLUSIONS: Myopia is a leading refractive error in schoolchildren in Almaty, Kazakhstan. Myopia prevention measures, including more time outdoors, should guide public health interventions in this population.

Occupational burn-out, fatigue and stress in professional rescuers: a cross-sectional study in Kazakhstan.

OBJECTIVES: To find predictors of burn-out in a cohort of rescuers. DESIGN: Cross-sectional study. SETTING: Republican Rescue Squad (N=105) and Republican Mudslide Rescue Service under the Ministry of Emergency Situations (N=480) in Almaty, Kazakhstan. PARTICIPANTS: In total, we included 268 (80% men, median age 38 (IQR 22) years) rescuers from both organisations. PRIMARY AND SECONDARY OUTCOME MEASURES: We offered a questionnaire to rescuers, which included Maslach Burnout Inventory, quantifying emotional exhaustion (EX), cynicism (CY) and professional efficacy (PE) along with fatigue, stress and health-related quality of life (HRQL) tools. RESULTS: Lower scores of HRQL (Physical Component Score (PCS) beta -0.04 (95% CI -0.06 to -0.02); Mental Component Score beta -0.03 (95% CI -0.05 to -0.01)), higher fatigue (Fatigue Severity Scale (FSS) score beta 0.03 (95% CI 0.03 to 0.04)) and stress (Perceived Stress Score-10 beta 0.04 (95% CI 0.02 to 0.06)) independently predicted greater EX. Lower PCS (beta -0.03 (95% CI -0.06 to -0.01)) and FSS (beta 0.02 (95% CI 0.01 to 0.03)) could predict more CY burn-out. In addition to stress, higher education (beta 0.86 (95% CI 0.40 to 1.32)) was positively associated with lower burn-out severity in PE domain. CONCLUSIONS: Fatigue, stress and HRQL were associated with burn-out in rescuers. Addressing these predictors may help guide further interventions to reduce occupational burn-out.

The efficacy and safety of cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation.

BACKGROUND: Electrical isolation of pulmonary vein ostia is an established therapy for paroxysmal atrial fibrillation. AIMS: The purpose of this study is to evaluate the long-term efficacy and safety of cryoballoon catheter ablation in paroxysmal atrial fibrillation with normal anatomy of the left atrium. METHODS: Two hundred fifteen consecutive patients were included in the study (from November 2014 to November 2016). All the patients had symptoms of paroxysmal atrial fibrillation resistant to antiarrhythmic drugs and underwent pulmonary vein cryoisolation using second-generation cryoballoons. Standard "single-shot" cryoballoon exposures were used alternately for each of the four pulmonary veins. The endpoint of the ablation procedure was the electrical isolation of each pulmonary vein. RESULTS: Sixty-nine patients had stable atrial fibrillation recurrences and left atrial flutter with 30 of 69 patients having atrial fibrillation paroxysms during the first year after primary ablation. Repeated ablation was performed within 6-12 months after the first ablation. In 39 of 69 cases, arrhythmia recurrences were registered during the second and third year after the first ablation. These patients underwent repeated ablation within 12-36 months after the first ablation. In 98% of the patients, no disease progression with a transition to a persistent form of atrial fibrillation was observed. During the mean 5-year follow-up period, no disease progression with the transition to persistent forms of atrial fibrillation was observed. CONCLUSIONS: It was concluded that in patients with paroxysmal atrial fibrillation, with normal left atrium anatomy and no risk factors, it can be controlled with single pulmonary vein isolation without additional atrial substrate modification.

Prevalence and patient awareness of inflammatory bowel disease in Kazakhstan: a cross-sectional study.

BACKGROUND/AIMS: There has been a paucity of published data on the epidemiology of inflammatory bowel disease (IBD) in Central Asia and Kazakhstan. Therefore, we aimed to study IBD prevalence and patient awareness among adults in Kazakhstan. METHODS: The cross-sectional study was carried out among subjects of both sexes aged 18 years and older using IBD Alert Questionnaire (CalproQuest), single fecal calprotectin test, and endoscopy with biopsy to verify IBD from January to December 2017, across regions of Kazakhstan. All participants were included in the study after providing informed consent. RESULTS: Out of 115,556 subjects, there were 128 confirmed IBD cases, in which 36 Crohn's disease (CD) and 92 ulcerative colitis (UC) cases identified. The age and sex-adjusted IBD prevalence were 113.9 (95% confidence interval [CI], 69.0-158.9) per 100,000 population. The age- and sex-adjusted prevalence for UC were 84.4 (95% CI, 44.8-123.9) and for CD were 29.5 (95% CI, 8.2-50.9) per 100,000 population. CONCLUSIONS: This is the first report on the prevalence of IBD with a verified diagnosis in the Central Asia and could be used to better plan and allocate healthcare resources for IBD management program.