[CEFTRIAXONE-INDUCED GALLBADDER LITHIASIS IN CASE OF INTENSTINAL BACTERIAL INFECTIONS (CASE REPORTS)].

Ceftriaxone is a third generation cephalosporin antibiotic and is one of the most often applicable parenteral drug, which has wide antimicrobial activity range. According to the literature gall bladder lithiasis is a complication which is described in the first days of the treatment with this antibiotic. The cases are seen mostly as undergdiagnosed conditions when ultrasound examination is performed due to the abdominal colics. The aim of the study was to observe Cholelithiasis in ceftriaxone-treated patients. Last year few cases of Cholelithiasis were observed in Children's Infectious Diseases Hospital. All of them were related to the dysentery treatment with ceftriaxone. All of the cases of Cholelithiasis were diagnosed at the beginning of the antibiotic therapy (in first 2-3 days of hospitalization). Gall bladder concernments/sludge were found accidentally. Cholelithiasis in these cases was transitory and in 2 weeks ultrasound investigation revealed no calculi/sludge in the gall bladder. Further findings are supposed to be analyzed on a bigger number of the patients. It is necessary to follow up with gall bladder concernments till their absolute resolution.

Correspondence of treatment of acute diarrhea to who recommendations in georgia.

The aim of this study was to analyze Georgian health care practitioners' knowledge on management of acute diarrhea and its adherence to WHO treatment guidelines. A questionnaire-based, cross-sectional survey was carried out in hospitals and out-patient clinics of Georgia. 350 anonymously filled questionnaires were analyzed (27% - hospitals, 73% - out-patient clinics). Majority (65%) of interviewees defined diarrhea correctly, 74% correctly named main signs of dehydrations and classified severity of dehydration, 26% mixed up signs of moderate and severe dehydration. About 90% uses ORS during diarrhea, but only 51% follow WHO recommendations about fast rehydration. The most of responding staff (78%) don't know the benefits of low osmolarity ORS. 42% pediatricians who work at the hospital use IV rehydration in case of moderate dehydration. 78% of medical staff named recommended IV fluids either Ringer lactate solution or Normal saline, but 22% still choose 5-10% Dextrose solution. Almost all doctors (94%) use probiotics, either as monotherapy (22%) or in combination (78%). 35% of physicians prescribe antiemetics, 27% antidiarrheals, 45% antimicrobial drugs, from those 65% uses antibiotics only in case of presence of blood in stool. The majority of medical staff don't use Zinc. Study revealed that most respondents advise continuation of breastfeeding, in case of bottle feeding 32% prescribe lactose free formula, while others continue normal diet. In elder children some restrictions in diet is still in practice. The study revealed that primary level health care representatives adhered to the WHO recommendations better, than hospital doctors, that was statistically significant. The findings show a moderate adherence to standard treatment guidelines of diarrhea. The recommendations on using ORS and continuation of breast-feeding are most followed. The most problematic issues are excessive use of antibiotics and IV fluids, no use of zinc, unnecessary use of antidiarheals and antiemetics. To improve case management of acute diarrhea, continuing professional development program targeting the practitioners is necessary.

[Functional status of haemostasis system in patients with visceral leishmaniasis].

During the last decades in Georgia was observed significant increase of cases of visceral leishmaniasis and fight against this disease became important problem as far as the management of this disease is rather problematic. According to references and our clinical experience patients with visceral leishmaniasis are predisposed to bleeding. The objective of our study was the assessment of functional status of hemostasis related to the degree of clinical severity. We have studied platelet count, activated partial thromboplastin time (APTT), prothrombin time, thrombin time, plasma concentration of fibrinogen, the soluble fibrin-monomeric complexes (SFMC), fibrinogen/fibrin degradation products (D-dimer) and anticoagulant protein C. Haemostatic functional tests were studied in 45 patients with visceral leishmaniasis before and after treatment (with 20-25 day intervals). Before treatment the reduction of platelet count was observed in 95%. Prolonged APTT and prothrombin time was found in severe forms of the disease. Thrombin time prolonged in 45.7%, SFMC level was increased in 80% (p=0.003) and D-dimer level in 95.6% (p=0.023). Protein C was in normal value in 73%. The results indicate that leishmania infection affects primary haemostasis, coagulation and fibrinolysis and these alterations are related to the severity of clinical symptoms. Investigation of SFMC and D-dimer showed that in case of visceral leishmaniasis activation of intravascular coagulation takes place, particularly during the severe forms of the disease, study of these markers is of the diagnostic and prognostic importance and the treatment at an early stage of infection may potentially avoid the possibility of developing an uncompensated DIC.

[Study of intravascular coagulation activation markers in patients with visceral leishmaniasis].

During last decades significant attention has been paid to the increase of protozoal infections including leishmaniasis. The management of this disease is rather problematic. Significant increase of cases of this disease was observed in Georgia as well. The problem of visceral leishmaniasis is very important nowadays. According to references and our clinical experience patients with visceral leishmaniasis are predisposed to bleeding. The objective of our study was the assessment of functional status of hemostasis in patients with visceral leishmaniasis. We have studied the intravascular activation markers of blood coagulation -- the soluble fibrin-monomeric complexes (SFMC) and fibrinogen/fibrin degradation products (D-dimer) in order to reveal the disorders of hemocoagulation. SFMC and D-dimer we studied in 45 patients with visceral leishmaniasis before and after treatment (with 20-25 day intervals). One patient with severe generalized bleeding died within 72 hours of admission. SFMC measurements were conducted by the orthophenantroline test (Renam, Russia). D-dimer level was measured using FDP-Slidex Direct kit (Bio-Meriou, France). Especially high levels of SFMC and D-dimer have been revealed in cases of severe form of visceral leishmaniasis. SFMC level was increased by 80% (p=0,003), and D-dimer level by 95,6% (p=0,023). There was correlation between numbers of platelets and intravascular blood coagulation markers. Investigation of SFMC and D-dimer showed that in case of visceral leishmaniasis activation of intravascular coagulation takes place, particularly during the severe forms of the disease. Study of these markers is of the diagnostic and prognostic importance and for the initiation of treatment at an early stage of infection, which may potentially avoid the possibility of developing an uncompensated DIC.

[An immunoenzyme method for determining IgA antibodies to lipopolysaccharide in secretions in the diagnosis of shigellosis]. / Immunofermentnyi metod opredeleniia v sekretakh IgA-antitel k lipopolisakharidu v diagnostike shigelleza.

IgA antibodies to S. sonnei and S. flexneri lipopolysaccharides (LPS) in secretions, as well as Escherichia coli LPS in coprofiltrates of children with acute diarrhea, were determined with the use of enzyme immunoassay (EIA). In adult patients with dysentery serum and salivary anti-LPS antibodies were assayed. The results of EIA showed that children aged up to 18 months had an elevated level of LPS of the causative agent in their coprofiltrates. The specificity of this assay permitted its use for finding out the agent of acute enteric infection. In adults, the levels of salivary anti-LPS antibodies in dysentery patients and in healthy persons significantly differed, which might also be regarded as a sign of Shigella infection. No significant difference in the levels of IgG antibodies to LPS in the saliva of sick and healthy persons was registered. IgA antibodies were found to be active mainly against common determinants of S. sonnei and S. flexneri LPS and thus not suitable for the differentiation of the causative agents of dysentery. For this purpose, the levels of serum IgG antibodies to LPS of different Shigella species should be determined.