Hybrid versus traditional method closure of ventricular septal defects in children.

Objective: The aim of our study was to evaluate the safety and effectiveness of the hybrid method off-pump for closure of isolated ventricular septal defect (VSD) compared with the traditional method of on-pump of children. Methods: This research was a retrospective cohort study. Data were collected from 500 patients with isolated VSD (or residual VSD after a previous repair) who underwent surgery at the National Scientific Medical Center from May 2016 to December 2020. Patients were operated with 1 of 2 methods of surgery: the traditional method of on-pump or the hybrid method of off-pump. This study assessed the safety and efficacy of the hybrid method by comparing it with the traditional method for the treatment of patients with isolated VSD. Results: The procedural success rate reached 93.2% in the hybrid method, with a 6.4% conversion rate to the traditional method and 0.4% hospital mortality. The mean operation time was 84 minutes (31; 160 minutes) in the hybrid group (n = 250) and 168 minutes (70; 300 minutes) in the traditional group (n = 250) (P = .000). Hospital mortality was 0.43% in the first group and 1.5% in the second group (P = .000). Conclusions: The hybrid method of VSD closure is safe and effective in a selected group of patients. The advantages of the hybrid method are improved cosmetics and shorter operation time and overall hospital stay.

Epidemiology of Lung Cancer in Kazakhstan: Trends and Geographic Distribution.

OBJECTIVE: The aim is to study the trends of lung cancer (LC) incidence in the regional context in Kazakhstan. METHODS: The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. RESULTS: Over the 10 years under study, 36,916 new cases of LC were registered in the country (80.5% - in men and 19.5% - in women). During the studied years the average age of patients was 64.2±0.1 years (95%CI=63.9-64.4). The highest incidence rates per 100,000 in the entire population were found in the age groups 65-69 years (147.6±2.7), 70-74 years (159.3±2.5), and 75-79 years (147.1±3.2). The incidence of LC tended to increase only at the age of 80-84 years (APC=+1.26) and the most pronounced average annual decline rates were observed in the age groups of 45-49 years (APC=-4.09), 50-54 years (APC=-4.20) and 85+ years (APC=-4.07). The average annual standardized incidence rate was 22.2 per 100,000, and in dynamics tended to decrease (APC=-2.04). There is a decrease in incidence in almost all regions, with the exception of the Mangystau region (APC=+1.65). During the compilation of cartograms, incidence rates were determined on the basis of standardized indicators: low - up to 20.6, average - from 20.6 to 25.6, high - above 25.6 per 100,000 for the entire population. CONCLUSION: The incidence of lung cancer in Kazakhstan is decreasing. The incidence among the male population is six times higher than among the female, while the rate of decline is more pronounced. The incidence tends to decrease in almost all regions. High rates were found in the northern and eastern regions.

Trend in Gastric Cancer Mortality in Kazakhstan.

OBJECTIVE: The aim is to study the trends in gastric cancer (GC) mortality in Kazakhstan. METHODS: Data on those who died from GC and on the annual population were obtained from the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan. A retrospective study was carried out for the period 2009-2018 using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific mortality rates are determined according to the generally accepted methodology used in sanitary statistics. RESULTS: GC mortality in Kazakhstan is considered to be decreasing. It was determined that during the studied period 19,672 died of this cancer. The mean of death was 67.8 with 95% CI of 67.6 to 68.0. The highest mortality rates per 100,000 in the entire population were found in the age groups 75-79 years (145.9±24.1), 80-84 years (161.0±11.0), and 85+ years (116.5±16.4). Trends in age-related mortality rates had a pronounced tendency to increase in 70-74 years (T=+4.3%, R2=0.1924) and to decrease in the age of up to 30 (T=-8.7%, R2=0.2426). The average annual standardized mortality rate was 13.2 per 100,000, and in trends   tended to decrease (T=-5.8%; R2=0.9763). In all regions, there is a decrease in mortality, except for the city of Astana. During categorization mortality rates were determined on the basis of standardized indicators: low - up to 12.9, average - from 12.9 to 15.1, high - above 15.1 per 100,000 for the entire population. CONCLUSION: The mortality rates from GC tend to decrease, while the downward trends and the degree of their approximation are expressed in almost all regions. The study of regional mortality has theoretical and practical significance for monitoring and evaluating the effectiveness of early detection and treatment. Health authorities should take into account the results obtained when organizing antitumor measures.

Geographic Variability of Gastric Cancer Incidence in Kazakhstan.

OBJECTIVE: The article studies the geographical features of the incidence of gastric cancer (GC) in Kazakhstan. METHODS: The retrospective study was done for the period 2009-2018. Descriptive and analytical methods of oncoepidemiology were used. Crude (CR), age-specific (ASIR), age-standardized (ASR), equalized incidence rates and approximation were calculated. The dynamics of indicators was investigated using component analysis according to methodological recommendations. The method of drawing up a cartogram based on the determination of the standard deviation (σ) from the mean (x) was applied. RESULTS: During the study period, 27,467 new cases of GC were registered. The incidence rate increased from 16.80 (2009) to 15.10 in 2018 and the overall decline was 1.70 per 100,000 population, including due to the age structure - ∑ΔA=+1.51, due to the risk of acquiring illness - ∑ΔR=-2.91 and their combined effect - ∑ΔRA=-0.31. The component analysis revealed that the increase in the number of patients with GC was mainly due to the growth of the population (ΔP=+651.8%), changes in its age structure (ΔA=+433.9%) and changes associated with the risk of acquiring illness (ΔR=-832.1%). The cartograms were allocated according to the following criteria: low - up to 14.80/0000, average - from 14.8 to 19.20/0000, high - above 19.20/0000. The results of the spatial assessment showed the highest levels of GC incidence in following regions: Akmola (22.20/0000), North Kazakhstan (22.30/0000), and Pavlodar (23.20/0000). CONCLUSION: Thus, as a result of the epidemiological analysis, the role of the influence of demographic factors and the risk of acquiring illness on the formation of the number of patients and the incidence of GC was evaluated, while sex differences and geographical variability were established.

Colorectal Cancer Mortality in Kazakhstan: Spatio-Temporal Epidemiological Assessment.

OBJECTIVE: The aim is to study the trends in colorectal cancer (CRC) mortality in Kazakhstan. METHODS: The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific mortality rates are determined according to the generally accepted methodology used in sanitary statistics. RESULTS: CRC mortality in Kazakhstan is considered to be increasing. Therefore, this study (for the period 2009-2018) was undertaken to retrospectively evaluate data across the country available from the central registration bureau. Age standardized data for mortality was generated and compared across age groups. It was determined that during the studied period 15,200 died of this pathology. During the studied years an average age of the dead made 69.8 years (95%CI=69.5-70.0). The average annual standardized mortality rate was 10.2 per 100,000, and in dynamics tended to decrease. Peak of mortality was noted in aged 60-84 years. Trends in age-related mortality rates had a pronounced tendency to increase in 30-34 years (T=+11.7%, R2=0.7980) and to decrease in 75-79 years (T=-16.4%, R2=0.8881). In many regions, there is a decrease in the number of deaths. During the compilation of cartograms, mortality rates were determined on the basis of standardized indicators: low - up to 8.9, average - from 8.9 to 11.5, high - above 11.5 per 100,000 for the entire population. In addition, all calculations were made taking into account age-sex differences. CONCLUSION: Trends in mortality from CRC in recent years have decreased from 11.2 to 7.7 per 100,000 of the total population, while the trend is stable (T=-3.6%, R2=0.8745). The study of regional mortality has theoretical and practical significance: monitoring and evaluation of the effectiveness of early detection and treatment of detected pathology. Health authorities should take into account the results obtained when organizing anti-cancer measures.

Inflammatory Biomarkers as Predictors of Infected Diabetic Foot Ulcer.

Diabetic foot ulcer infection is a crucial complication associated with lower-limb amputation and postoperative mortality in individuals with diabetes mellitus. Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Early detection of infected diabetic foot ulcers can reduce the frequency of hospitalizations, the occurrence of disability, and chances of mortality. Inflammatory biomarkers are predictors of infected diabetic foot ulcers and lower-limb amputation. Procalcitonin, CRP, pentraxin-3, interleukin-6, and calprotectin may help distinguish uninfected from mildly infected diabetic foot ulcers and diagnose soft tissue infections, bone lesions, and sepsis in diabetic patients. Moreover, these biomarkers may be predictors of lower-limb amputation and postoperative mortality. The current management of infected diabetic foot ulcers is disappointing and unsatisfactory, both in preventing its development and halting and modifying its progression. The use of new (molecular) techniques for the identification of the IDFU has not yet to be proven superior to classic cultural techniques for the management of such patients. For clinicians, if the risk stratification of DFU can be obtained earlier in diabetic patients, the hospitalization, disability, and mortality rate will be reduced. For the practical application of these biomarkers, it is important to correlate these quantitative parameters with clinical symptoms. Based on clinical observations and inflammatory biomarker evaluation, it can be used to guide clinical treatment methods. This review details clinical information published during the past several decades and discusses inflammatory biomarkers that may determine the risk and level of infection of diabetic foot ulcers.

Trends of Colorectal Cancer Incidence in Kazakhstan.

AAMC: Background and objective: Colorectal cancer (CRC) remains one of the most widespread human malignancies. The aim of this study was to study trends of the incidence of CRC in Kazakhstan. Materials and Method: This retrospective study was done using descriptive and analytical methods of oncoepidemiology. Results: During the study period from 2009 to 2018, 28,950 new cases of CRC were recorded, 13,779 (47.6%) cases were allocated to men and 15,171 (52.4%) to women. It was found that the incidence rate of CRC increased from 14.79 (2009) to 17.72 in 2018 and the overall growth was 2.93 cases per 100,000. This increase was due to the age structure ­ ΣΔA=+1.42, the risk of acquiring illness ­ ΣΔR=+1.31, and their combined effect ­ ΣΔRA=+0.20. The component analysis results revealed that the increase in the number of patients with CRC was mainly due to the growth of the population (ΔP=+37.7%), changes in age structure (ΔA=+26.6%), and changes associated with the risk of acquiring illness (ΔR=+24.6%). The number of patients (both sexes) was increasing in many regions largely due to the influence of the age structure of the population. In addition, it was found that growth in the number of patients in most regions, both men and women, was associated primarily with the risk of acquiring illness. Conclusion: The findings of the current study showed increasing trends in the incidence of CRC in all regions of the country. These changes were mainly influenced by demographic factors (population size and age structure), risk of acquiring the disease, and their combined effect.^ieng

Efficacy of erythropoietin for wound healing: A systematic review of the literature.

OBJECTIVES: To systematically review the available literature on the efficacy of erythropoietin for wound healing in human patients. DESIGN: The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A descriptive-analytical method was used to analyse and integrate review findings. DATA SOURCES: A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: 'efficacy', 'erythropoietin' and 'wound healing'. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers. RESULTS: Seven distinct studies involving 150 patients met the inclusion criteria for the review. The included studies suggest that topical and subcutaneous application of erythropoietin improves the wound healing process via faster re-epithelialization and reducing wound area and depth. CONCLUSIONS: There were a limited number of studies and a great degree of heterogeneity of evidence due to differences in the course of concomitant illness, wound aetiology, and the time and dosing regimens adopted. Further research adopting validated and consistent outcome measures is recommended to determine the efficacy and safety of erythropoietin for wound healing.

New Trends of Cervical Cancer Incidence in Kazakhstan.

OBJECTIVE: The epidemiological features of the cervical cancer (CC) incidence and its spatial and temporal assessment in Kazakhstan were studied. METHODS: The retrospective study was done for the period 2009-2018. Descriptive and analytical methods of oncoepidemiology were used. RESULTS: During the study period, 16,441 new cases of CC were registered. The average annual crude and age-standardized incidence rate were 18.6±0.5 and 17.7±0.4 cases per 100,000 population of female, respectively, and their trends tended to increase (Тup=+2.3%; R2=0.708 and Тup=+1.9%; R2=0.615, respectively). The analysis of ASIR showed unimodal growth with a peak at 50-54 years - 45.3±1.1 cases per 100,000 population of female. Trends of ASIR decreased up to 30 years (Tdown=-1.8%; R2=0.111) and 35-59 years (Tdown=-0.9%; R2=0.103), in other age groups the trends increased, and were most pronounced in 40-44 (Тup=+4.1%; R2=0.878) and 65-69 years (Тup=+4.4%; R2=0.537). Trends in ASR of СС tended to grow in almost all regions, with higher levels in Mangystau (Тup=+4.1%; R2=0.482) and Aktobe (Тup=+6.3%; R2=0.846) regions. The cartograms of ASR per 100,000 population of female were allocated according to the following criteria: low - up to 16.3, average - from 16.3 to 19.2, high - above 19.2. The results of the spatial analysis showed the regions with a higher levels of CC incidence rate per 100,000 population of female: East Kazakhstan (19.8), Aktobe (20.0), Almaty (20.1), Kostanay region (20.9), Atyrau (21.7) regions and Almaty city (22.0). CONCLUSION: The study of trends of the cervical cancer incidence has the theoretical and practical value:  monitoring and evaluation of screening programmes, which are implemented in the country, and conduction of secondary prevention of cervical pathology. Health authorities should consider the obtained results in the in the organization of anti-cancer activities.

Thyroid Cancer in Kazakhstan: Component Analysis of Incidence Dynamics.

Background: The International Agency for Research on Cancer (IARC) reports that 567,000 new cases of thyroid cancer (TC) were registered in the world in 2018, and the age-standardized incidence rate was 6.7 per 100,000. The Global Cancer Observation forecasts a 35% growth in the number of new cases worldwide by 2040. The number of patients with TC in Kazakhstan is also increasing steadily. This investigation was the first epidemiological study of TC trends by component analysis among the population of Kazakhstan. This paper presents the results of the component analysis of TC incidence trends in Kazakhstan. Methods: The study covers primary data of TC cases (ICD 10 ­ C73) registered throughout Kazakhstan from 2009 to 2018. TC incidence trends were evaluated using component analysis according to the methodological recommendations. Results: 5,559 new TC cases were registered during the 10-year study period. The average age of patients was 52.0±0.2 years, the average annual age-standardized rate in 2009-2018 was 3.3±0.20/0000, with a constant upward trend (Т=+6.6%). According to the component analysis results, the increase in incidence was mainly due to the combined effect of the two factors: the increased disease risk (ΔR=+61.7%), and the population growth (ΔP=+15.4%). Conclusion: The noted increase in incidence was mainly caused by the changes in risk factors, such as the worsening environmental aspects and the increase in detection of clinically non-manifesting cases. The results of the study shall be taken into account when planning anticancer activities for TC.

Epidemiology of esophageal cancer in Kazakhstan.

The incidence of esophageal cancer in Kazakhstan was analysed for the period of 1989-2010 years, with a focus on trends by age, gender and region. The highest rates of incidence were evident in the Western regions. The dynamics for cancer of the esophagus in the Republic demonstrated decrease, except in the Karaganda region, where a tendency for increase was noted. Considerable variation between regions pointed to differences in risk factor exposure which need to be targeted for future control efforts.

Age characteristics of incidences of prevalent cancers in the Aral Sea area of Kazakhstan.

The aim of the research was to examine age-specific features of incidence of cancer of the esophagus, lung, stomach, breast, cervix and thyroid gland in the Aral Sea area in Kazakhstan. A retrospective study of 11 years (1999-2009) was conducted using descriptive and analytical methods with calculated age incidence rates. The average age of patients with esophageal cancer and lung cancer had a tendency for increase with "aging", while in other cases "juvenation" was noted. The peak incidence of malignant tumors in general, and in the studied forms of cancer was found at 70 years of age or older, except for breast cancer and cervical cancer, where the peak incidence was found at 60-69 years. Trends in age-varied incidence rates had different tendencies in particular organ sites.

Trends of prevalent cancer incidences in the Aral-Syr Darya ecological area of Kazakhstan.

The aim of this research was to examine the incidence of major forms of cancer in the Aral-Syr Darya ecological area of Kazakhstan. The present retrospective study of 11 years (1999-2009) was therefore conducted using descriptive and analytical methods. Incidence rates (crude and standardized) of 11 leading cancer sites were calculated and trends determined. The result of analysis demonstrated the most common neoplams in the study region to be esophageal cancer, carcinoma of lung, stomach cancer, and breast cancer. Trends in incidence of cancers under study were different, the most marked reduction in cancer of esophagus is established (T=-6.1%) and revealed the high increase in breast cancer (T=+6.7%). In the dynamics the trend of malignant disease in general tended to decrease (T=-0.5%).