Epidemiology of HPV Infection and HPV-Related Cancers in Kazakhstan: a Review

Background: Cancer is one of the most prevalent causes of mortality worldwide. In the cervix it is considered to be caused by different high-risk human papillomavirus (HPV) types. Although many studies have already been conducted worldwide on the epidemiology of HPV infection and their oncogenic properties, limited data are available on HPV prevalence, incidence and genotype specific dissemination in Kazakhstan. Methods: To review the distribution of HPV infection, electronic databases (e.g. PubMed, Web of Science and Google Scholar) were searched for peer reviewed articles in English. The study was performed during June-July 2017 with a review of 39 relevant articles, published up to July 31, 2017. The following inclusion criteria were applied: general population data, cytology results available, and use of polymerase chain reaction (PCR) and/or Hybrid Capture® 2, Digene Corp., USA for HPV detection. Results: As reported in limited studies, the prevalence of HPV infection in Kazakhstan ranges from 43.8% to 55.8%. However, the scenario with regard to epidemiology of HPV related cancers in Kazakhstan is not very clear. One study reported a decline of laryngeal cancer observed during the recent years, whereas cervical cancer incidence has increased to about 3000 new cervical cancer cases, and about 1,000 cervical cancer deaths each year. Conclusion: The high incidence of cervical cancer with a significant mortality rate in Kazakhstan is evidence of HPV infection abundance despite an absence of HPV screening and low public awareness of the problem. Having a well-informed understanding of the role of HPV infection could enhance the public’s acceptance of screening and intervention programs to reduce morbidity and mortality in the country due to HPV infection. Thus, the purpose of this review article is to summarize the existing data, identifying directions for future research on HPV epidemiology and HPV-related diseases in Kazakhstan

Application of molecular genotyping to determine prevalence of HPV strains in Pap smears of Kazakhstan women

Objectives: Human papillomavirus is themain causative agent for cervical cancer. However, few data are available about HPV prevalence in Kazakhstan. The aims of this study were to genotype HPV DNA in Pap smear samples of women to determine prevalence of carcinogenic HPV types in Astana, Kazakhstan and to analyze the association between HPV positivity and the cytology results of patient samples. Methods: Pap smear materials were obtained from 140 patients aged 18-59, who visited the outpatient gynecological clinic. Microscopic examination was done to detect dysplasia, and HPV genotyping was done using real-time multiplex PCR. Results: HPV testing showed that among 61 HPV positive patients, the most prevalent types were 16 and 18. Microscopic examination showed that 79% of the samples had normal cytology, while 13% had CIN grade I, 5% had CIN grade II, and 3% had CIN grade III. The analysis revealed that 12% of the samples had CIN cytology and presence of HPV. Approximately 31% had HPV without cervical dysplasia, while 8% of samples were CIN positive without HPV infection. A statistically significant relationship between HPV 16 and HPV 33 positive samples and CIN grade II and III was found. Conclusions: Overall, this study will help to strengthen and guide health policy implementation of primary and secondary cervical cancer prevention strategies in Kazakhstan.2016 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync nd/4.0/)

Application of molecular genotyping to determine prevalence of HPV strains in Pap smears of Kazakhstan women

Abstract ObjectivesHuman papillomavirus is the main causative agent for cervical cancer. However, few data are available about HPV prevalence in Kazakhstan. The aims of this study were to genotype HPV DNA in Pap smear samples of women to determine prevalence of carcinogenic HPV types in Astana, Kazakhstan and to analyze the association between HPV positivity and the cytology results of patient samples. MethodsPap smear materials were obtained from 140 patients aged 18-59, who visited the outpatient gynecological clinic. Microscopic examination was done to detect dysplasia, and HPV genotyping was done using real-time multiplex PCR. ResultsHPV testing showed that among 61 HPV positive patients, the most prevalent types were 16 and 18. Microscopic examination showed that 79% of the samples had normal cytology, while 13% had CIN grade I, 5% had CIN grade II, and 3% had CIN grade III. The analysis revealed that 12% of the samples had CIN cytology and presence of HPV. Approximately 31% had HPV without cervical dysplasia, while 8% of samples were CIN positive without HPV infection. A statistically significant relationship between HPV 16 and HPV 33 positive samples and CIN grade II and III was found. ConclusionsOverall, this study will help to strengthen and guide health policy implementation of primary and secondary cervical cancer prevention strategies in Kazakhstan

Human Papillomavirus Infection and Cervical Cancer: Epidemiology, Screening, and Vaccination-Review of Current Perspectives

https://www.hindawi.com/journals/jo/2019/3257939/Viral infections contribute as a cause of 15–20% of all human cancers. Infection by oncogenic viruses can promote different stages of carcinogenesis. Among many types of HPV, around 15 are linked to cancer. In spite of effective screening methods, cervical cancer continues to be a major public health problem. There are wide differences in cervical cancer incidence and mortality by geographic region. In addition, the age-specific HPV prevalence varies widely across different populations and showed two peaks of HPV positivity in younger and older women. There have been many studies worldwide on the epidemiology of HPV infection and oncogenic properties due to different HPV genotypes. However, there are still many countries where the population-based prevalence has not yet been identified. Moreover, cervical cancer screening strategies are different between countries. Organized cervical screening programs are potentially more effective than opportunistic screening programs. Nevertheless, screening programs have consistently been associated with a reduction in cervical cancer incidence and mortality. Developed countries have achieved such reduced incidence and mortality from cervical cancer over the past 40 years. This is largely due to the implementation of organized cytological screening and vaccination programs. HPV vaccines are very effective at preventing infection and diseases related to the vaccine-specific genotypes in women with no evidence of past or current HPV infection. In spite of the successful implementation of the HPV vaccination program in many countries all over the world, problems related to HPV prevention and treatment of the related diseases will continue to persist in developing and underdeveloped countries

Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods-UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques

Unveiling the Role of the Work Environment in the Quality of Life of Menopausal Physicians and Nurses

Background: There is a lack of scientific evidence regarding the specific challenges faced by menopausal medical professionals in different work settings. This study aims to investigate the relationship between work environment and the menopausal quality of life (QoL) in physicians and nurses. Methods: This survey was conducted using the Menopausal Quality of Life Questionnaire (MENQOL) with a sample of 35 menopausal physicians and 95 nurses employed in health facilities in Astana and Kyzylorda cities, Kazakhstan. Results: Physicians reported a higher frequency of menopausal symptoms compared to nurses. The difference was statistically significant (p < 0.05) for symptoms such as decreased productivity (60.00% vs. 38.20%), flatulence or gas pains (71.43% vs. 48.39%), weight gain (79.41% vs. 61.80%), changes in skin appearance (79.59% vs. 50.00%), and changes in sexual desire (58.82% vs. 33.70%). Physicians with managerial duties had a significantly higher occurrence of vasomotor symptoms compared to non-managerial physicians (mean 3.35 ± 2.14 vs. 1.69 ± 0.89) and also had a higher mean psychological score (mean 3.26 ± 1.28 vs. 2.29 ± 1.19). Conclusions: These findings reflect differences between the menopause effects related to work environment for doctors and nurses, and shed light on the specific challenges faced by them during menopause. In addition, it is important to consider socio-demographic and workplace-related factors in investigating their impact on the QoL

HUMAN PAPILLOMAVIRUS VACCINATION: PAST, PRESENT AND FUTURE

The link between human papillomavirus (HPV) infection and different diseases has been well-established since more than four decades ago [1,2]. Moreover, high-risk HPV types were confirmed as causative agents for a variety of malignant conditions, including oropharyngeal, anogenital, and cervical cancer

What Factors Are Associated with Attitudes towards HPV Vaccination among Kazakhstani Women? Exploratory Analysis of Cross-Sectional Survey Data

Background. The high prevalence of HPV infection among Kazakhstani women and the absence of an HPV vaccination program are directly reflected in increasing rates of cervical cancer incidence and mortality. Kazakhstan made its first attempt at introducing the HPV vaccine in 2013, but was unsuccessful due to complications and low public acceptance. The attitudes of Kazakhstani women towards the vaccine were never measured. Therefore, this study aims to investigate the attitudes of women towards the HPV vaccine and determine factors associated with positive, negative, or neutral attitudes. Methods. A 29-item survey consisting of 21 demographic and contextual questions and 8 Likert-scale questions was distributed among women attending gynecological offices in four major cities of Kazakhstan from December 2021 until February 2022. Attitudes of women were measured based on their answers to the eight Likert-scale questions. Ordinal logistic regression was built to find associations between demographic characteristics and attitudes of women. Results. Two hundred thirty-three women were included in the final analysis. A total of 54% of women had positive attitudes towards the vaccine. The majority of women did not trust or had a neutral attitude towards the government, pharmaceutical industry, and traditional and alternative media. However, the trust of women was high in medical workers and scientific researchers. Women’s age, education, number of children, effect of the 2013 HPV program, and trust in alternative medicine were included in the ordinal logistic model. Women with a low level of education, a high number of children, who believe in alternative medicine, and who were affected by the failed 2013 vaccination program were less likely to have a positive attitude towards the vaccine. Conclusions. Contrary attitudes towards HPV vaccination exist among Kazakhstani women, with approximately half having positive and almost half having negative or neutral attitudes towards the vaccine. An informational campaign that takes into consideration women’s levels of trust in different agencies, as well as targets those who are the most uninformed, might help in a successful relaunch of the HPV vaccination program. However, more studies that cover a higher number of women are required

COMPARISON OF TWO INVASIVE NON-SURGICAL TREATMENT OPTIONS FOR UTERINE MYOMAS: UTERINE ARTERY EMBOLIZATION AND MAGNETIC RESONANCE GUIDED HIGH INTENSITY FOCUSED ULTRASOUND— SYSTEMATIC REVIEW

Background: Uterine Artery Embolization (UAE) and Magnetic Resonance guided High Intensity Focused Ultrasound (MRgHIFU) are two noninvasive treatments for uterine leiomyoma. Methods: This systematic review, following PRISMA guidelines, analyzed the efectiveness of two treatments by comparing percent fbroid volume shrinkage immediately after the procedure and after 3, 6, 12 and 24 months of follow-up and also assessed and compared common complications following treatment. The search utilized Science Direct, PubMed, MEDLINE, Google Scholar and BioMed Central databases, selecting manuscripts published during the period 2000 and 2020. Studies with premenopausal patients with previous treatments for uterine leiomyoma and/or with other pelvic diseases were excluded. Results: Twenty-nine papers satisfed inclusion and exclusion criteria. Results were pooled and stratifed by treatment and follow-up time. Weighted fbroid volume percent shrinkage after UAE was statistically signifcantly greater than MRgHIFU at 6, 12, and 24 months follow-up times. However, UAE had statistically signifcantly more complications, such as pain, nausea and vomiting. However, this study cannot conclude that UAE is more efective than MRgHIFU due to confounding factors

EVIDENCE-BASED INPATIENT POSTNATAL CARE AMONG WOMEN IN A NATIONAL HOSPITAL IN KAZAKHSTAN: A BEST PRACTICE IMPLEMENTATION PROJECT

Improvements in reducing maternal and infant mortality in Kazakhstan have been noted over the past 2 decades. However, recent studies have indicated that care given to women during the perinatal period, which includes the postnatal period, is unsatisfactory. In addition, service delivery remains unstandardized, while outdated and inconsistent application of practice guidelines are observed in the clinical setting