An economic impact of incorrect referrals for MRI and CT scans. A retrospective analysis

Background and aims: Up to date, no research on the economic efficacy of diagnostic modalities, such as magnetic resonance imaging (MRI) and computerized tomography (CT), has been done in Central Asia. The aim of this study was to analyse the inappropriate appointments of MRI and CT scanning procedures in Kazakhstan. Methods: We used the imaging diagnostic reports and medical records from 9725 planned outpatient CT and MRI exams performed in two major hospitals in Almaty. The study period was for the period 2014-2019. The independent experts-radiologists evaluated the MRI and CT exams for validity using the ACR® compliance standards and RCR recommendations. Results: The results showed that the combined costs of MRI and CT scans increased by $17.982 between 2014 ($22.537) and 2019 ($40.519), p = 0.002. The highest rate of MRI examinations was observed in 2019, with a rate of 6.9 per 10,000 people. It was determined that in 2019 the highest rate for men who undertook CT was equal to 12.4 per 10,000 people, while for women it was equivalent to 5.7 per 10,000 patients. The majority of non-corresponding imaging examinations (n = 1304) were referred for MRI and CT scans by general practitioners. We detected the irrational referrals for head and neck radiological examinations in n = 178 (13.7%) cases, and the abdominal cavity checks in n = 249 (19.1%) cases (p = 0.001). The main portion of erroneously unreasonable referrals for examination of the abdominal organs was made by surgeons in n = 43 (3.3%) cases. Conclusion: The findings indicated an increase in the number of referrals for unnecessary CT and MRI tests over the research period (2014-2019). It had a substantial impact on the rise in healthcare system expenses. The results demonstrate the need for the education of GPs and improving the approaches for diagnostics

Prevalence of chronic kidney disease in Kazakhstan: evidence from a national cross-sectional study

Abstract To date, there have been no large-scale national studies of the prevalence of chronic kidney disease in Kazakhstan. It includes the research based on the analysis of the estimated glomerular filtration rate (eGFR). The aim of this study was to investigate the population prevalence of CKD and associated risk factors in Kazakhstan. The cross-sectional study consisted of a nationally representative sample of n = 6 720 adults aged 18 to 69 from 14 regions and 3 major cities in Kazakhstan. The study covered the period from October 2021 to May 2022. The WHO STEPS questionnaire was used for the survey. For the diagnosis of CKD, creatinine levels in collected blood samples were measured to assess eGFR. Demographic characteristics were collected and studied. The total and adjusted prevalence of factors associated with the presence of CKD were calculated and analysed using logistic regression. 73.5% (n = 4940) of participants had normal eGFR, while 25.2% (n = 1695) had mild CKD (eGFR = 60–89 mL/min/1.7 m2). The overall prevalence of CKD with eGFR < 60 ml/min/1.7 m2 was 1.3% (n = 85), of which 0.2% (n = 15) had eGFR < 45 ml/min/1.7 m2. A mild degree of CKD was most often determined in residents of the East Kazakhstan region in 10.4%, and in 7.8–8.0% of cases. The majority of CKD patients was detected in the East Kazakhstan region and Almaty city, 15.3% and 10.6% of cases respectively. In mild and CKD with GFR < 60 ml/min/1.7 m2, the age of participants was 50–69 years in 61.5% and 78.8% of cases, respectively (p < 0.001). In addition to the association with the place of residence, a statistically significant relationship was found between the risk of developing CKD and underweight (OR 1.43, 95% CI (1.09–1.88), p < 0.001), as well as the presence of obesity (OR 1.24, 95% CI (0.99–1.53), p = 0.04). We observed the prevalence of CKD with eGFR < 60 ml/min/1.7 m2 at the level of 1.3%. However, a fairly large part of study participants had a mild CKD (25.2%). The results of this study can be used for the optimization of the doctors workload and the timely provision of care to patients with CKD

Study of Kazakhstan inpatient childhood asthma: assessment of prevalence and factors influencing treatment adherence

Background: Up to date, the assessment of adherence to the treatment of children with asthma in Kazakhstan has not been carried out yet. Objective: The study aimed to evaluate the level of therapeutic adherence of paediatric patients with asthma in urban and rural areas of Kazakhstan. In addition, the validity and reliability of a structured scale for assessing adherence in patients with asthma was also scrutinized. Methods: A prospective study of verified cases of bronchial asthma of 518 children in the dispensary control in the Children’s City Clinical Hospital N2 (Almaty, Kazakhstan) was conducted in the period from 2018 to 2020. Children with asthma were sub-divided into 2 groups: urban and rural residents. The demographic and clinical characteristics, external and social factors of the patients were analysed. Patient adherence to treatment was assessed using the Lebanese Medication Adherence Scale-14(LMAS-14). The reliability was tested using the measure of internal consistency (Cronbach’s alpha). Data were collected after the discharge from the hospital (T1) and after 6 months (T2). Results: Urban and rural patients made up 81.3% vs. 18.7% respectively. Children aged 5-12 years accounted for 70.6%. Male gender was predominant in all groups (p=0.73). Better financial situation, education were noted by 90.5% and 95.5% of urban parents (p=0.001). The influence of external factors (dampness, coal heating and possession of pets) was higher in rural areas (p=0.001).The results of study based on the LMAS-14 questionnaire (T1 period) showed no significant differences. However, in the T2 period, the adherence of urban children was higher than rural ones (p=0.001). The Cronbach’s α was 0.606 for the total score. According to the results of a survey after 18 months, a significant relationship was found between the levels of adherence and the frequency of asthma attacks (p=0.001). Conclusion: In 2018-2020, a low therapeutic adherence of children with asthma, especially in a rural area, was detected in the territory of the Republic of Kazakhstan. Our findings indicate the necessity to develop effective measures to regulate and increase adherence to treatment of patients, especially those living in rural areas

Sero‐prevalence of SARS‐CoV‐2 in certain cities of Kazakhstan

Abstract Background and Aims Seroprevalence studies are needed to determine the cumulative prevalence of SARS‐CoV‐2 infection and to develop pandemic mitigation strategies. Despite the constant monitoring and surveillance, the true level of infection in the population of Kazakhstan remains unknown. The aim of this study was to determine the sero‐prevalence of SARS‐CoV‐2 in the main cities of Kazakhstan. Methods The research was conducted as a cluster‐randomized cross‐sectional national household study in three cities of Kazakhstan. The study covered the period: from October 24, 2020, to January 11, 2021. A total of 5739 people took part in the study. All participants agreed to be tested for antibodies to IgM/IgG. Demographic characteristics were analyzed. The presence of symptoms of respiratory diseases and the results of polymerase chain reaction (PCR) testing were determined. The antibodies to the SARS‐CoV‐2 virus were detected using the method of enzyme‐linked immunosorbent assay (ELISA). Results There was significant geographic variability with a higher prevalence of IgG/IgM antibodies to SARS‐CoV‐2 in Almaty 57.0%, in Oskemen 60.7% than in Kostanay 39.4%. There were no significant differences in prevalence between men and women (p ≥ 0.05). In Almaty, only 19% of participants with antibodies reported the presence of respiratory symptoms during a pandemic. At the same time, the percentage of patients with antibodies who had respiratory symptoms was 36% in Oskemen and 27% in Kostanay. Conclusion The findings indicate that despite reasonable level of seroprevalence, the country has not yet reached the baseline minimum of herd immunity scores. The prevalence estimates for asymptomatic or subclinical forms of the disease ranged from 64% to 81%. Thus, given that almost half of the population of Kazakhstan remains vulnerable, the importance of preventive strategies such as social distancing, the use of medical masks, and vaccination to protect the population from the transmission of SARS‐CoV‐2 is highly critical

Prognostic value of serum soluble ST2 in professional athletes.

Background: The predictive value of serum soluble ST2 (sST2) biomarker for diagnostics of cardiovascular pathologies is still poorly understood as well as the role of psychological stress on the risk of heart disease. Aim: This study aimed at determining the diagnostic significance of the sST2 level in athletes involved in speed-strength sports. In addition, stress as a risk factor for the development of cardiovascular pathology was assessed and analysed as well. Methods: A prospective study on Greco-Roman wrestlers was carried out at the Centre for Sports Medicine and Rehabilitation (Almaty, Republic of Kazakhstan). All participants (n = 30) were males aged 20 to 34 years. The control group consisted of volunteers (VO) (n = 30). Anthropometric and hemodynamic parameters of athletes were studied along with electrocardiography (ECG) and ECG tests. The sST2 level was determined before (BT) and immediately after (AT) training. The stress level was determined using The Perceived Stress Scale-10 (PSS-10). Results: The average age of the athletes was 26.57 ± 3.6 years. The total training experience was 14.57 ± 4.02 years. According to the ECG data, minor deviations from the norm (13.3%) and an abnormal ECG (33.3%) were identified. Echo-CG data showed "moderate" and "pronounced changes" in 23.3% and 53.3% of cases, respectively. The sST2 level of VO (337.1 ± 61.8 pg / mL) was lower than that of BT (548.1 ± 32.6 pg / mL) (p ≤ 0.001). The sST2 level of AT, it was significantly higher (830.01 ± 71.6 pg / mL) than BT (p ≤ 0.001). The average and high level of stress among athletes was in 43.3% and 56.7% of cases, respectively. Stress increased the likelihood of developing distinctly abnormal ECG (OR = 1.06, 95% CI 1.01–1.08; p = 0.02). The stress level showed a positive correlation with the sST2 level (r = 0.752, p = 0.01). The sST2 concentration and categorical echocardiography data demonstrated a dependent positive correlation (r = 0.6, p = 0.01). Conclusions: Athletes' sST2 levels exceeded thresholds both before and after training. Moreover, the relationship between an increase in sST2 levels and abnormal ECG abnormalities and a high level of stress in athletes was determined. sST2 concentration was associated with cardio-pulmonary stress triggered by the cumulative exercise dose as well as with lifelong psychological stress. Our findings indicate that the elevated sST2 concentrations in athletes could be used as the predictive value. However, clinical relevance and results validity require further intensive studies.Antecedentes: El valor predictivo del biomarcador ST2 soluble en suero (sST2) en la enfermedad cardiovascular aún no se conoce bien, así como el papel del estrés psicológico en el riesgo de enfermedad cardiovascular. Objetivos: Este estudio tuvo como objetivo determinar la importancia diagnóstica del nivel de sST2 en atletas involucrados en deportes de velocidad-fuerza. Además, también se evaluó y analizó el estrés como factor de riesgo para el desarrollo de patología cardiovascular. Métodos: Se llevó a cabo un estudio prospectivo sobre luchadores grecorromanos en el Centro de Medicina y Rehabilitación del Deporte (Almaty, República de Kazajstán). Todos los participantes (n = 30) eran hombres de entre 20 y 34 años. El grupo de control estaba formado por voluntarios (VO) (n = 30). Se estudiaron los parámetros antropométricos y hemodinámicos de los atletas junto con las pruebas de electrocardiografía (ECG). El nivel de sST2 se determinó antes (BT) e inmediatamente después (AT) del entrenamiento. El nivel de estrés se determinó utilizando la Escala de Estrés Percibido-10 (PSS-10). Resultados: La edad promedio de los deportistas fue de 26,57 ± 3,6 años. La experiencia de formación total fue de 14,57 ± 4,02 años. Según los datos del ECG, se identificaron desviaciones menores de la norma (13,3%) y un ECG anormal (33,3%). Los datos de Echo-CG mostraron cambios "moderados" y "pronunciados" en el 23,3% y el 53,3% de los casos, respectivamente. El nivel de sST2 del grupo VO (337,1 ± 61,8 pg / mL) fue menor que el de BT (548,1 ± 32,6 pg / mL) (p ≤ 0,001),). El nivel de sST2 en AT fue significativamente mayor (830.01 ± 71.6 pg / mL) que en BT (p ≤ 0.001). El nivel medio y alto de estrés entre los deportistas fue del 43,3% y el 56,7% de los casos, respectivamente. El estrés aumentó la probabilidad de desarrollar un ECG claramente anormal (OR = 1,06; IC del 95%: 1,01-1,08; p = 0,02). El nivel de estrés mostró una correlación positiva con el nivel de sST2 (r = 0,752, p = 0,01). La concentración de sST2 y los datos de la ecocardiografía categórica demostraron una correlación positiva dependiente (r = 0,6, p = 0,01). Conclusión: Los niveles de sST2 de los atletas excedieron los umbrales tanto antes como después del entrenamiento. Además, se determinó la relación entre un aumento en los niveles de sST2 y anomalías anormales del ECG y un alto nivel de estrés en los atletas. La concentración de sST2 se asoció con el estrés cardiopulmonar desencadenado por la dosis acumulativa de ejercicio, así como con el estrés psicológico de por vida. Nuestros hallazgos indican que las concentraciones elevadas de sST2 en los atletas pueden usarse como valor predictivo. Sin embargo, se requieren más estudios

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)