Consequences of medical drugs use have been a subject of scientific research, both in terms of long-term effect on the gene pool of populations and immediate effects on human health. Drug-drug interactions (DDI) is an important and still insufficiently recognized cause of medical errors and costs for the healthcare system. We have studied the prevalence and structure of DDI in hospitals of West Kazakhstan. We performed a retrospective analysis of pharmacotherapy in a systematic sample of 730 patients with cardiovascular diseases treated in the hospitals of Aktobe, Uralsk, Atyrau cities in 2014. Potentially dangerous DDI were identified using Drug Interaction Checker source (FDA). The prevalence of major and moderate potential DDI and their structure were studied. Associations between DDI and other studied variables were estimated using odds ratios (OR) and chi-squared tests. For all estimates 95 % confidence intervals (CI) were calculated. We found a high prevalence of major and moderate DDI (53,8 (95 % CI 50,9-58,3) % and 88,1 (95 % CI 85,590,3) %, respectively. We found out that 53,8 % of patients were treated with at least one potentially inappropriate combination. The effect of age (OR 1,8, p 0,001, 95 % CI 1,4-2,5) and polypragmasy (OR 6,0, р 0,001, 95 % CI 2,7-13,1) on potentially dangerous DDI were revealed. Adverse drug effects were diagnosed in 4,1 % of patients, they were more frequently observed in patients with more prescriptions (р = 0,001). The most frequent drugs creating a dangerous combination were spironolactone, ACE inhibitors, enoxaparinm sodium, fondaparinux sodium, clopidogrel, potassium chloride, sartana.
Introduction: Stomach cancer is the fourth most common cancer worldwide. Although there is a lot of international evidence on survival of stomach cancer patients, the data from Central Asia is still scarce. Aims: To study one-and five-years survival of stomach cancer patients and its correlates in Western Kazakhstan. Methods: All histologically confirmed cases of stomach cancer (ICD10 code: C16) registered from 2015 to 2019 in the Aktobe region, Western Kazakhstan, were included in a registry-based historical cohort study. One-and five-years survival with 95 % confidence intervals (CI) was calculated by life tables method. Independent associations between survival and its correlates were studied using Cox regression and presented as crude and adjusted hazard ratios (HR). Results: Altogether, there were 793 new cases of and 587 deaths from stomach cancer in the Aktobe region over the study period. Sixty-five percent of cases were diagnosed at stage III or IV. The overall one-and five-year survival was 33.1 % and 8.4 %, respectively. Significant differences in survival functions across categories were observed for cancer stage (p < 0.001), morphological type (p < 0.001) and ethnic background (p = 0.017). After adjustment, only stage and morphological type of tumor remained significantly associated with the out come. Stage III (HR = 2.3, 95 % CI: 1.5-3.6) and stage IV (HR = 4.4, 95 % CI: 2.8-6.9) were associated with shorter survival compared to the reference category. Patients with intestinal type of cancer were more likely to survive longer (HR = 0.7, 95 % CI: 0.6-0.8). Conclusions: High proportion of cases diagnosed at advance stage and low survival warrant urgent measures on both population and institutional levels. Preventive activities, increased awareness of the population and implementation of routine screening should be among the priority actions to improve survival of stomach cancer patients and decrease cancer mortality in Western Kazakhstan.
Background: Cardiovascular diseases (CVD) are the main causes of death worldwide. The incidence of and mortality from CVD in Kazakhstan is greater than in most neighboring countries warranting urgent public health measures related to both primary, secondary and tertiary prevention. Aims: To assess whether a newly developed 6-months public health rehabilitation program for patients with acute myocardial infarction (AMI) with home visits performed by physician assistants is superior to the standard rehabilitation of these patients in Western Kazakhstan. Methods: A randomized controlled study. A total of 75 AMI patients were enrolled after discharge form the hospital and 72 completed the trial. The control group (n = 34) participated in the standard rehabilitation program while the intervention group (n = 38) underwent and experimental rehabilitation program with home visits in addition to the standard program. Body mass index, waist circumference, blood pressure, heart rate, blood lipids, smoking and compliance to the treatment were assessed at the enrollment and after 6 months of the follow-up. Differences between the changes in the intervention and in the control group were compared using Mann-Whitney tests. Results: The experimental program was superior to the standard program in reducing systolic-(-22.5 vs. -2.9 mm Hg, p < 0.004) and diastolic (-6.3 vs. -0.6 mm Hg, p = 0.032) blood pressure, body mass index (-0.99 vs. 0.53 kg/m 2 , p < 0.001), waist circumference (-3.0 vs. 1.7 cm, p < 0.001) and the number of smoked cigarettes (-12 vs. -3, p = 0.002). Blood lipid profiles improved in both groups. Although slightly more pronounced changes were observed in the intervention group, the differences did not reach the level of statistical significance. Conclusions:The program was more effective on blood pressure, smoking and obesity-related indicators than the standard rehabilitation. Larger studies are warranted to corroborate our findings prior to implementation of the program in practice.
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