Tatul Saghatelyan

Biomedical Engineering (BME) is a modern and dynamic specialty that is predicted to grow over the next decades, partly due to increasing penetration of technological processes and devices into the healthcare system and medical practice, education and research. BME education is regarded as an important tool to support development of healthcare systems and medical industry. BME education in Armenia has been present at certain higher education institutions (HEIs) for some period of time, however the existing study programs need to be updated according to modern standards and practices, and the capacity of the institutions delivering the program needs to be expanded. The 3-year curriculum development project ”Biomedical Engineering Education Tempus Initiative in Eastern Neighboring Area” (BME-ENA) financed through the EU’s Tempus IV funding instrument, involves 17 institutions from 11 EU and ENA countries and is aimed primarily at development and implementation of an innovative joint MSc program in BME amongst the participating universities. Armenia is represented by two leading HEIs – the State Engineering University of Armenia (SEUA), and the Russian-Armenian (Slavonic) University (RAU), and an NGO working in the field of medical technologies – Armenian Association of Telemedicine (AATM). The project team from Armenia has by now held several working meetings locally and with the international partners, which have resulted in development of the new curriculum outline for the joint BME program, incorporating approaches and recommendations of the European project partners. The BME-ENA project is expected to provide an important platform for modernizing BME education in Armenia and bringing it in accordance with current European standards.

Cancer is the second leading cause of death in Armenia. Over the past two decades, the country has seen a significant rise in cancer morbidity and mortality. This review aims to provide up-to-date info about the state of cancer control in Armenia and identify priority areas of research. The paper analyzes published literature and local and international statistical reports on Armenia and similar countries to put numbers into context. While cancer detection, diagnosis, and treatment are improving, the prevalence of risk factors is still quite high and smoking is widespread. Early detection rates are low and several important screening programs are absent. Diagnosis and treatment methods are not standardized; there is a lack of treatment accessibility due to insufficient government coverage and limited availability of essential medicines. Overall, there is room for improvement in this sector, as research is limited and multidisciplinary approaches to the topic are rare.

BACKGROUND Central nervous system (CNS) tumors are the second most common malignant neoplasms among children worldwide. The current paper aims to analyze the situation in pediatric neuro-oncology in Armenia from the neurosurgical perspective. METHODS We have collected data of pediatric patients with CNS tumors treated in the Neurosurgery department of “Surb Astvasamayr” Medical Center from 01.01.2010 till 01.12.2019. Incidence by gender, age at diagnosis, and histopathology results were calculated. Survival rates were calculated based on the follow-up results performed until 30.12.2019. RESULTS Hospital-based data showed that during the previous 10 years 47 patients with CNS tumors received neurosurgical treatment in the unit, among them 66% were females. 38.3%, 31.9% and 29.8% of diagnosed patients were aged 0–4, 5–9, and 10–18 respectively. In 41 cases, the disease was not disseminated at diagnosis. The most common observed malignancies were low-grade gliomas (21.3%) and embryonal...

BACKGROUND Central nervous system (CNS) tumors are the second most common malignant neoplasms among children worldwide. The current paper aims to analyze the situation in pediatric neuro-oncology in Armenia from the neurosurgical perspective. METHODS We have collected data of pediatric patients with CNS tumors treated in the Neurosurgery department of “Surb Astvasamayr” Medical Center from 01.01.2010 till 01.12.2019. Incidence by gender, age at diagnosis, and histopathology results were calculated. Survival rates were calculated based on the follow-up results performed until 30.12.2019. RESULTS Hospital-based data showed that during the previous 10 years 47 patients with CNS tumors received neurosurgical treatment in the unit, among them 66% were females. 38.3%, 31.9% and 29.8% of diagnosed patients were aged 0–4, 5–9, and 10–18 respectively. In 41 cases, the disease was not disseminated at diagnosis. The most common observed malignancies were low-grade gliomas (21.3%) and embryonal...

Purpose. The purpose of the current study was the analysis of the role of localization of the primary tumour for overall survival in patients with bone metastases from solid tumours treated with palliative radiotherapy.
Materials and methods. The data of 515 patients with bone metastases from solid tumour treated with palliative radiotherapy in 2007-2011 in the National Center of
Oncology: Survival analyses were performed using Kaplan-Meier method, and Log rank test was used for comparisons between groups. An univariate risk analysis using Cox proportional hazards model was performed for breast and lung cancer patients.
Results. The mean survival for the whole group was 21.5 months and the median was 10 months: 6-months, 1-, 2- and 5-year overall survival rates were 70%, 46%, 28% and 15%, respectively. Significant differences of overall survival parameters were observed between the subgroups of patients with various primary localizations.
Conclusion. The primary tumour localization
is an important factor affecting overall survival of patients treated with palliative radiotherapy for bone metastases from solid tumours which can be included in predictive models for overall survival.

Metastatic bone (MB) disease is a common manifestation of advanced cancer. Although bone metastases can be asymptomatic, in more than two thirds of patients they cause pain, as well as a wide spectrum of complications, including pathological fractures, spinal cord and nerve root compressions, hypercalcaemia and mobility impairment; greatly reducing the patients' quality of life. Radiotherapy has since long proved to be an effective modality for treatment of bone metastases, resulting in palliation in up to 80% patients. Despite the extensive research in this area, many controversial issues still remain. The authors conducted a critical review of the publications on several of these issues, including the mechanisms of action of radiotherapy, dose-response relationship, optimal fractionation regimens, irradiation techniques, response assessment. The conclusion was drawn that in line with the current clinical evidence, there are no substantial differences between various fractionation schedules in terms of analgesic effect. However, in consideration of other endpoints, MF regimens may provide better effect than SF; this is a subject for future clinical research. Currently, besides the clinical evidence, the routine practice in radiotherapy departments is strongly influenced by other disease-non-specific factors, including the factors that are physician-related (country of training, location, and type of practice, professional membership affiliation, etc.) and policy/community-related (type of reimbursement, available recourses). A brief description of the practice in palliative radiotherapy for bone metastases in the Radiotherapy Department of the National Center of Oncology is presented.

Новые технологические развития в радиотерапии создают широкие воз-можности для улучшения качества и повышения эффективности лечения рака предстательной железы. Имеющиеся данные доказывают значительное преимущество новых методик перед конвенционными и подтверждают целесообразность усилий и финансовых затрат направленные к внедрению и применению современных технологии в радиотерапии РПЖ.

Abstract: Armenian Association of Telemedicine (AATM) successfully completed two pilot telemedicine projects in 2010. The first one, funded by the United States Agency for International Development (USAID) within the framework of Primary Health Care Reform (PHCR) program, was titled “Capacity building of the Armenian Association of Telemedicine to result in improved primary health care services in Armenia”. The project consisted of four major segments: capacity building and expansion of the Association; research on the role of Telemedicine and eHealth in improving quality, accessibility and costeffectiveness of health care system in Armenia; demonstrational telemedicine model system; evaluation and dissemination of the outcomes, including public awareness campaign. The most important part of the project was establishment of a fully functional model of telemedicine network consisting of two PC-based stations (the referral station at a rural primary care center in northern region, and...

The first international meeting on Healthcare ICT took place on October 14-16 in Yerevan, Armenia, and was co-hosted by Armenian Association of Telemedicine (AATM), Russian-Armenian (Slavonic) University (RAU) and Union of Information Technology Enterprises (UITE), under the auspices of the Ministry of Health of Armenia, and the two principal global NGOs in the field of telemedicine and eHealth: the International Society for Telemedicine and eHealth (ISfTeH) and the American Telemedicine Association (ATA). As evidenced by feedback from the faculty, participants and guests, the event met its major objectives and marked an historical milestone in development of Healthcare Information and Communication Technologies in Armenia and in the region of South Caucasus. The congress program featured: four plenary sessions incorporating keynote presentations on virtually all current issues in Health ICT, delivered by leading telehealth experts from around the globe; a scientific session; an Exp...

To assess resources and management strategies for the use of radiotherapy (RT) in the treatment of lung cancer in developing Central and Eastern European countries. Questionnaires on patterns of care of NSCLC and SCLC were sent to radiation oncologists of Central and Eastern Europe. Comparisons were made between two groups of countries-ex-USSR states and other Eastern and Central European countries. Twenty-four out of twenty-eight surveyed countries responded. There were significant differences in access to modern treatment facilities (3D planning systems, number of linear accelerators), percentage of patients with lung cancer receiving radiotherapy, schedules of palliative RT, use of postoperative RT for early stages between both analysed groups of countries. 3D systems were in use in 25% of centres for an entire treatment, in 28% for a part of the treatment, and in 47% curative RT was 2D planned. Sequential chemo-RT was the most common approach to radical management of NSCLC, followed by RT alone and concomitant chemo-RT; median percentages of patients receiving respective treatments per centre were 57%, 30%, and 10%. For SCLC, the concurrent approach was declared by 56%, and the sequential approach by 42% of responders. Patterns of care of lung cancer in the analysed countries differed in some part from existing, evidence-based data on lung cancer. In particular, this difference was observed between ex-USSR countries and the rest of European developing countries in the equipment available and specific diagnostic and treatment parameters in radiotherapy of lung cancer, the latter group's practices more resembling those of developed European countries.

Radiochemotherapy has become a standard approach in locally advanced non-small cell lung cancer and limited disease small cell lung cancer. Most of the data supporting this observation come from the developed world and only extremely rarely have good-quality clinical trials been carried out in developing countries. It is therefore of paramount importance to put the experience of the developed world into the context of the limited resources and other health care problems of developing countries. In this overview, the problems with the implementation of such data are discussed. The necessity of carrying out clinical trials specifically designed to address the needs of developing countries is emphasised. The research on cheaper ways of radiochemotherapy combination should be encouraged. The specific national guidelines for local needs should be created and followed. The availability of radiotherapy equipment is of major importance, as radiotherapy has a pivotal role in non-surgical treatment of lung cancer, especially in the developing world.