ANTIRETROVIRAL THERAPY RESISTANCE MUTATIONS AMONG HIV INFECTED PEOPLE IN KAZAKHSTAN

In Kazakhstan, the number of people living with HIV (PLHIV) has increased steadily by 39% since 2010. Development of antiretroviral therapy (ART) resistance mutations (ARTRM) is a major hurdle in achieving effective treatment and prevention against HIV. Using HIV pol sequences from 602 PLHIV from Kazakhstan, we analyzed ARTRMs for their association with factors that may promote development of ARTRMs. 56% PLHIV were infected with HIV subtype A6 and 42% with CRF02_AG. The ARTRM Q174K was associated with increased viral load and decreased CD4+ cell count, while infection with CRF02_AG was associated with a lower likelihood of Q174K. Interestingly, CRF02_AG was positively associated with the ARTRM L10V that, in turn, was observed frequently with darunavir administration. Infection with CRF02_AG was positively associated with the ARTRM S162A that, in turn, was frequently observed with the administration of nevirapine, also associated with lower CD4 counts. Zidovudine or Nevirapine receipt was associated with the development of the ARTRM E138A, that, in turn, was associated with lower CD4 counts. Determination of a patient’s HIV variant can help guide ART choice in Kazakhstan. For example, PLHIV infected with CRF02_AG will benefit less from darunavir and nevirapine, and emtricitabine should replace zidovudine

Antiviral activities of extremophilic actinomycetes extracts from Kazakhstan’s unique ecosystems against influenza viruses and paramyxoviruses

Commercially available antiviral drugs, when used in the treatment of viral infections, do not always result in success. This is an urgent problem currently that needs to be addressed because several viruses including influenza and paramyxoviruses are acquiring multi-drug resistance. A potential solution for this emerging issue is to create new antiviral drugs from available compounds of natural products. It is known that the majority of drugs have been developed using compounds derived from actinomycetes, which are naturally occurring gram-positive bacteria. The purpose of this study was to investigate the antiviral properties of extremophilic actinomycetes extracts from strains that were isolated from extreme environments in Kazakhstan

KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARD COVID-19 VACCINATION IN KAZAKHSTAN: A CROSS-SECTIONAL STUDY

Background: There are several COVID-19 vaccines available and many are under different stages of development. However, vaccine hesitancy, including vaccination delays and refusals, represents a major hurdle for achieving herd immunity. The current study aims to evaluate COVID-19 vaccine hesitancy and the associated factors. Method: This is a cross-sectional survey-based study that was conducted between Aug and Nov 2020. Results: There were 417 respondents with nearly 61% females, more than 65% fall between the ages of 18 and 29 years, three-quarters holding a university degree, with more than 63% identified as single, and those who have no children represented more than 67% of the respondents. More than 36% of the respondents considered themselves COVID-19 vaccine hesitant. COVID-19 vaccine hesitancy appeared to be high among female respondents (p = .02), aged 30 years old and above (p < .001), widowed or divorced (p < .001) and those who have a child (p < .001). One of the most vaccine hesitancy influencing factors is the vaccines’ country of origin. Conclusion: There appears to be a high COVID-19 vaccine hesitancy among the participants with several associated factors. The current finding provides a knowledge base for policymakers for communication improvement and confidence-building in relation to COVID-19 vaccines and vaccination

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

Validating a Minimally Invasive Tissue Sampling (MITS) Method in Determining Cause of Death in Stillbirths and Neonates

Complete diagnostic autopsy (CDA) remains the gold standard and a valuable technique for determining cause of death. It is a source of health statistics that can be used to measure health care services&rsquo; quality, unraveling important information on disease processes, particularly in emerging and unknown diseases. It can also be a vital tool for medical education and biomedical research. However, autopsy rates have been declining globally. There is an urgent need to develop and validate alternative methods in different settings to provide reliable information on cause of death. In this study, we aimed to determine cause of death (KazCoDe) in neonates and infants using minimally invasive tissue sampling (MITS), and to compare these results with those of CDA. We conducted MITS and CDA sequentially on 24 deceased children at the Pathological Bureau of the Akimat of the city of Nur-Sultan. Clinical data of the study subjects were extracted from their clinical records. During both procedures, brain, liver and lung tissues were collected for pathological diagnosis. Fifteen (62.5%) and nine (37.5%) were stillbirths and neonates, respectively. Eight (33.3%) were females and 16 (66.7%) were males. MITS diagnosis of cause of death was concordant with CDA diagnosis in 83.3% out of the 24 cases when considering the immediate and underlying causes of death and reviewing all the clinical and laboratory test results as part of the diagnostic evaluation to arrive at a cause of death (ICD-PM). We concluded that MITS is a valuable and reliable method for cause of death diagnosis in stillbirths and neonates, which can contribute vital mortality statistics in children in the absence of CDA

GENETIC VARIATIONS INFLUENCING GLUCOSE HOMEOSTASIS AND INSULIN SECRETION AND THEIR ASSOCIATIONS WITH AUTISM SPECTRUM DISORDER IN KAZAKHSTAN

There is a complex interaction between glucose and insulin homeostasis pathways, diabetes and autism spectrum disorder (ASD). It is known that neuronal migration pathways may be interrupted by intrauterine hyperinsulinemia and hyperglycemia. Moreover, neonatal hypoglycemia which is related to mitochondrial dysfunction has a potential role that influences ASD pathogenesis [6,7]. We present here a preliminary case-control study on children and adolescents (8 – 15 years old) with and without autism spectrum disorder examining the association between genetic polymorphisms impacting glucose and insulin homeostasis and autism spectrum disorder in Kazakhstan..

Arsenic in Drinking Water and Urinary Tract Cancers : A Systematic Review Update

Problem: There remains uncertainty around cancer risk at lower levels of arsenic in drinking water. This study updates evidence from our previous review on the relationship between arsenic in drinking water and urinary bladder and kidney cancers (updated search January 2013 to February 2023). Method: Thirty-four studies were retained for review; six met criteria for inclusion in meta-analysis. Risk estimates for bladder and kidney cancer incidence and mortality were analyzed separately using Bayesian multilevel linear models. Results: For bladder cancer incidence, the estimated posterior mean relative risks (RRs) were 1.25 (0.92–1.73), 2.11 (1.18–4.22) and 3.01 (1.31–8.17) at arsenic concentrations of 10, 50 and 150 μg/L, respectively, with posterior probabilities of 92%, 99% and 100%, respectively, for the RRs to be >1. The corresponding RRs for kidney cancer were 1.37 (1.07–1.77), 1.95 (1.44–2.65) and 2.47 (1.74–3.52), with posterior probabilities of 100%. For bladder cancer, the posterior mean mortality ratios were 1.36 (0.35–6.39), 2.92 (1.24–7.82) and 4.88 (2.83–9.03) with posterior probabilities of 72%, 99% and 100%, respectively. Conclusions: The findings show increased bladder and kidney cancer risks at lower levels of arsenic in drinking water. Given that many people worldwide are exposed to lower levels of arsenic in drinking water, the public health impacts are substantial.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacultyResearcherGraduat

TRENDS OF HIV/AIDS KNOWLEDGE AND ATTITUDES AMONG NIGERIAN WOMEN BETWEEN 2007 AND 2017 USING MULTIPLE INDICATOR CLUSTER SURVEY DATA

Background: Globally, Nigeria ranks third among the countries with the highest number of People Living with HIV (PLHIV). Given that HIV/AIDS knowledge is a key factor that determines the risk of transmission and certain attitudes towards PLHIV, there is a need to understand the trend of HIV knowledge within the population for the purpose of assessing the progress and outcome of HIV prevention strategies. The aim of the study was to understand the trends of HIV/AIDS knowledge and attitude towards PLHIV between 2007 to 2017 among Nigerian women, and to investi gate change in the factors associated with HIV/AIDS knowledge and attitude towards PLHIV over years. Methods: Data were derived from three Nigerian Multiple Indicator Cluster Surveys (2007, 2011 and 2016–2017) among women aged 15–49 years old from each geo-political zone (South South, South East, South West, North East, North West, North Central) in Nigeria. Participants who did not answer questions related to HIV/AIDS knowledge and attitude were excluded from the study. The fnal sample sizes were 17,733 for 2007, 26,532 for 2011 and 23,530 for 2017. In descriptive statistics, frequencies represented the study sample, while percentages represented weighted estimates for the population parameters. Rao-Scott chi-square test for complex survey design studies was used to assess bivariable associations. Factors associated with outcome variables were examined using the survey-weighted multivariable logistic regression models for the complex survey design while controlling for potential confounding variables. Results: There was a relatively high level of HIV/AIDS knowledge level in 2007 and 2016–2017 surveys (64.6 and 64.1%, respectively), however a decrease in HIV/AIDS knowledge trend was observed in 2011 (45.6%). The positive attitude towards PLHIV progressively increased across the years (from 40.5 to 47.0% to 53.5%). Multivariable analysis revealed that women who had a higher educational level, higher wealth index, and lived in urban areas had higher odds for HIV/AIDS knowledge and positive attitude towards PLHIV across the years. In addition, the Northern zones had predominantly higher knowledge and attitude levels. Conclusions: Our study found increasing tendency for high HIV/AIDS knowledge and positive attitude towards PLHIV over the years. Women’s age, wealth index, education level and residence were consistently associated with knowledge and attitude over the years. There is a need for more pragmatic HIV/AIDS-related knowledge action plan to target to cover all age groups, all geo-political zones while paying close attention to the rural areas and the less educated women. In addition, more replicative studies of HIV/AIDS knowledge and attitude trends is crucial in monitoring of the progress of HIV interventions in the country in the coming years

COVID-19 Outbreak in Post-Soviet States: Modeling the Best and Worst Possible Scenarios

Background: COVID-19 pandemic has presented extreme challenges to developing countries across the world. The aim of this paper was to provide estimates for current development COVID-19 pandemic in the Post-Soviet states and forecast potential best and worst scenarios for spread of this deadly infection. Methods: The data on COVID-19 cases extracted from official governmental sources until April 18, 2020. A modified SEIR (Susceptible-Exposed-Infected-Recovered) modelling was used to plot the pandemic outbreak in 10 Post-Soviet states and forecasting over the period of 10, 30 and 60 days. The optimal measures (best-scenario) and suboptimal measures (worst-scenarios) of potential spread of COVID-19 in these countries were estimated. Results: It was estimated that Armenia and Azerbaijan have reached their peaks, Kazakhstan, Kyrgyzstan, Moldova, and Uzbekistan are expected to reach their peaks in the early May-2020), with comparatively low cases of COVID-19 in the best-case scenario. In contrast, Belarus, Russia, and Ukraine would likely see the outbreaks with the largest number of COVID-19 cases amongst the studied Post-Soviet States in the worst-scenario during the next 30 and 60 days. Conclusion: Governmental response was shown to be as an important determining factor responsible for the development of COVID-19 epidemic in Post-Soviet states. The current protection rates should be maintained to reduce active cases during upcoming 30 and 60 days. The estimated possible scenarios based on the proposed model can potentially be used by healthcare professionals from each studied Post-Soviet States as well as others to improve plans to contain the current and future epidemic

OUTCOME PREDICTORS OF STROKE MORTALITY IN THE NEUROCRITICAL CARE UNIT

Background: Risk factors for medium to long-term mortality after stroke are well-established but predictors of in-hospital stroke mortality are less clearly characterized. Kazakhstan has the highest age-standardized mortality rate from ischemic stroke in the world. Methods: We performed a retrospective analysis of patients with stroke who were admitted over a 3.5-years period to the neurocritical care unit of a tertiary care hospital in Nur-Sultan, Kazakhstan. Results: In total, 148 critically ill patients were included in the analysis (84 ischemic stroke, 64 hemorrhagic stroke). The mean age was 63 years, 45% were male and the mean Glasgow Coma Score (±SD) at baseline was 10.3 (±3.4). The in-hospital mortality rate was similar in patients with ischemic (36%) and hemorrhagic (39%) stroke (HR 0.88, 95%CI 0.48–1.60). Median survival was 38 days (range: 1–89 days) in patients with ischemic stroke and 39 days (range: 1–63 days) in patients with hemorrhagic stroke. Univariable analysis found that patients who had a lower Glasgow Coma Scale, were in coma and who had cerebral edema were more likely to die in-hospital (P = 0.04, 0.02, <0.01, respectively). Conclusions: Our analysis showed that mortality risk in critically ill patients with hemorrhagic stroke was closer to mortality risk in patients with ischemic stroke than has been reported in other analyses. Hypertension, chronic heart failure, ischemic heart disease and atrial fibrillation were the most frequent comorbidities in patients who developed severe (life-threatening) stroke. Coma and cerebral edema on admission appear to be associated with poor outcome. This is the first publication of in-hospital stroke mortality from a Central Asian population and could form the basis for future research including development of risk scores and identifying modifiable risk factors