TEMPORAL TRENDS OF CERVICAL CANCER MORTALITY IN GEORGIA, 2011-2018.

Cervical cancer is the fifth most common cancer diagnosed in Georgia, after breast, thyroid, colorectal, and uteri cancers. During 2015-2018 cervical cancer incidence composed 17.9, 19.6, 15.0 and 14.3 per 100000 female population accordingly. The study aims to describe cervical cancer (CC) mortality in Georgia during the period of 2011 and 2018. Descriptive analysis was conducted using mortality data during the period of 2011-2018 from the National Statistics Office of Georgia. To estimate time trends of CC mortality study period was divided into two groups - 2011-2014 and 2015-2018 years. For data analysis, descriptive statistics was performed, in which the mortality rates, age-specific mortality rates per 100,000 female population and other statistical measurements - median, the first quartile (Q1), the third quartile (Q3), and interquartile range (IQR) of age at death from Cervical cancer were estimated. Statistical analysis was completed by using the programs of EpiInfo version 7 and Statistical Package of the Social Science (SPSS) version 23 for Windows. The statistical significance tests - p value, and 95% of Confidence Interval (95% CI) were used in order to estimate statistical reliability of the results. The number of annual deaths varied between 121 and 185 cases that composed variation of mortality rates from 6.1 to 9.5 per 100,000 women. According to the 95% of CI the difference between mortality rates according to calendar years is not statistically significant. Mean mortality rates for the periods 2011-2014 and 2015-2018 were 7.1(SD=0.7) and 8.7 (SD=0.5) accordingly and presented a slight increase. Taking into consideration that during 2005-2010 annual number of registered deaths from cervical cancer in Georgia was quite low and varied between 50 and 60, it is likely that this increase is related to the improvement in registration and is not a true increase. Therefore, the second period (2015-2018) of the study represents more real data, then the first (2011-2014). Cervical cancer mortality increases with age, which indicates that advanced age is a predictor factor. The age effects for almost all calendar years included in analysis (2011-2018) presented an increasing trend with age from 25 to 59, while a moderate decrease was shown within the age group from 60-64 to 65-69 and over 80 years of old. The median age of deaths from CC fluctuated inconsistently between 57 and 62 years; Interquartile range in different calendar years composed: 47-67, 52-72, and 52-67 years. Comparatively stable median age of deaths, indicates that, there is no tendency of cervical cancer early mortality reduction. The study revealed a slight increase in CC mortality, which could be related to the improvement of death registration.

SURVEY OF PRACTICES, KNOWLEDGE AND ATTITUDE CONCERNING ANTIBIOTICS AND ANTIMICROBIAL RESISTANCE AMONG MEDICAL UNIVERSITY STUDENTS.

Antimicrobial resistance (AMR) has become a global problem and is considered an emerging threat to public health worldwide. Aim - to assess knowledge, attitude and practice (KAP) regarding antimicrobial resistance and antibiotics among medical students in Georgia. KAP questionnaire containing 50 questions was developed in English and Georgian. Sampling frame consisted of students of the 4th year of the Tbilisi State Medical University (TSMU). Random cluster sampling was used and total number of participants was 212 (31.13% - International Faculty of Medicine, 45.75% - Faculty of Medicine, 23.11% - Faculty of Public Health). Mean age 22.95 (sd=0.52) with almost equal gender distribution. Cross-sectional study was performed. The survey was anonymous and self-administered. Principles of Declaration of Helsinki were followed. Data analysis was done in Stata 14.0. 79.25% think that antibiotics can cure bacterial infections, 57.08% think that antibiotics can not cure viral infections (statistically significant difference by faculties p<0.0001). 34.43% think that bacteria cause common cold and influenza (by gender p=0.01 and by faculties p=0.03). 83.02% have heard of antibiotic resistance (by faculties p<0.0001). 83.96% agree that antibiotics resistance has become a problem. 75.00% agree that the abuse of antibiotics has become the main cause leading to bacterial resistance. 60.38% consider that antibiotic resistance affects them and their family's health. 93.40% agree that it is necessary to get more education about antibiotics. 31.61% of the students in Georgia always and often stop taking antibiotics if they start feeling better. 43.40% never keep the remaining antibiotics. Obtained results are in line with the international findings. There was seen a statistically significant difference between public health and medical faculties (both English and Georgian) in responses on knowledge. In the attitude and practical behaviour sections all three groups provided similar results, only some questions were provided significantly different responses by faculties.

THE GLOBAL POINT PREVALENCE SURVEY (PPS) OF ANTIMICROBIAL USE AND ANTIMICROBIAL RESISTANCE AMONG HOSPITALIZED CHILDREN IN GEORGIA.

The aims of our study were to determine antibiotic prescribing rates for prevention and treatment of infections in pediatric units, to evaluate the number and type of antimicrobial agents and administration route, reveal commonly used antibiotic subgroups and identify targets for improving the quality of antimicrobial prescribing. A 1-day PPS (Point Prevalence Study) on antibiotic use in hospitalized children was performed in Georgia from 2015 to 2019. 18 clinics in different regions of Georgia were included in the survey. Antimicrobial prevalence rates increased over the years from 60.1% in 2015 to 92.6% in 2018. The most commonly, antibiotics were prescribed for lower respiratory tract infections (LRTI). In 2015 25.1% of LRTI were treated by ampicillin-sulbactam but the next year it replaced with ceftriaxone (37.1% in 2017 and 38.2% in 2018). In pediatric surgical ward, the antibiotics were commonly prescribed for surgical prevention (54.1% in 2015, 32.3% in 2018). The most common conditions treated with antibiotics in neonates were sepsis (30.1%) and LRTI (45.3%). The most used antibiotic was ceftriaxone (33.3% in 2015). Ampicilin-sulbactam was prescribed in 28.1% of pneumonia case in neonates in 2018. In 2015 antibiotics were mainly prescribed empirically (98.0%). In 2018 resistance of MRSA was 8.1%, and resistance to the third-generation cephalosporin 17.3%. Prevalence rate of antibiotics for prevention and treatment of infection disease in pediatric units increased in 2018. Main feasible targets for optimization of antibiotic prescribing have been identified: high use of broad-spectrum antibiotics in hospitals, high frequency of empirical treatment, rarely performed culture tests, prolonged antibiotic prophylaxis in surgery patients and an alarming raise of resistant strains. The implementation of disease-specific clinical pathways associated with annual PPSs could be a good way to monitor and improve antibiotic prescription patterns in neonatal and pediatric inpatients over time.

PREVALENCE OF CLEFT LIP AND PALATE IN GEORGIA.

Cleft lip and palate take significant place in congenital malformations. We aimed to study epidemiological peculiarities of these pathologies in Georgia for 2006-2015. We compared magnitude of its distribution with the data from 1981-1990. Prevalence of cleft lip and palate in Georgia in 2006-2015 was 0.95±0.04 per 1000 live births, while in 1981-1990- it was 1.05, i.e. in contrast to 1980's frequency of these pathological conditions decreased to some extent. Distribution of cleft lip and palate varies across the country regions. The most intensive spread has been observed in Mtskheta-Mtianeti region, where prevalence composed 2.28/1000. In the rest of the regions frequency of these pathologies is significantly lower. For instance, in Kakheti the rate is equal to 1,87/1000, in Kvemo Kartli - 1.56/1000, in Shida Kartli - 1.55/1000. In the rest of the regions prevalence rate is lower than the country average. It should be noted that in Tbilisi the rate is as low as 0.80/1000. The lowest level has been reported in Guria - 0.56/1000. Currently cleft lip with palate is the most frequently occurring anomaly in Georgia accounting for 39.8% of all congenital malformations. Cleft lip alone ranks the second - 36.1%, followed by cleft palate (24.1%). These pathologies are more frequent in boys than in girls. 60.3% of the cases are reported in males, in contrast to girls - 39.7% (p<0.01). Usually, cleft palate is the most common among girls, but in our case, it had higher prevalence among boys, 53.6% vs. 46,4%. Thus cleft lip and palate distribution in Georgia is characterized by epidemiological peculiarities, which should be considered in implementation of preventive measures.

RISK FACTORS OF CLEFT LIP AND PALATE IN GEORGIA.

A case-control study was conducted to reveal risk factors for cleft lip and palate. The main group consisted of 41mothers of infants with orofacial clefts (cleft lip and/or palate) who were born in Tbilisi maternity houses during 2015-2016. The control group was composed of 61 mothers who have given birth to healthy babies in the same maternity houses. Information on possible risk factors was collected using a special form. In order to evaluate a role of these risk factors, bivariate analysis was conducted at the first stage of the study. Odds ratio (OR) was calculated for each factor, significance of the results was evaluated by calculating 95% confidence intervals (95% CI). At the next stage of the study the factors significantly correlated with the development of orofacial clefts were identified and multivariate analysis was performed using a multiple logistic regression model. According to the study results stressful situations in the families of pregnant women play the most significant role in the development of cleft lip and palate with standardized (adjusted) OR=7.76, 95% CI: 1.93-31.33. Other risk factors such as contracting infectious or noncommunicable diseases during the first trimester of pregnancy as well as use of medications during this period have some impact on the development of these malformations (OR=2.10, 95% CI: 0.77-5.70; OR=2.88, 95% CI: 0.83-9.97 and OR=2.22, 95% CI: 0.77-10.41, correspondingly).

[ANTIBIOTIC SENSITIVITY/RESISTANCE OF MICROBIAL STRAINS ISOLATED IN TRAUMATOLOGICAL DEPARTMENT].

In this article, there are given data of study for antibiotic sensitivity/resistance of gram-positive and gram-negative representatives of different microbial species, isolated from patients after primary hip replacement and osteosynthesis of long bones, which had post operative infectious complications, and also isolated from samples of traumatology department environment. Identification of sensitivity/resistance to antibiotics was performed with use of two methods - disc diffusion and serial dilution on solid nutrient media. It was found, that gram-positive, as well as gram-negative microorganisms had high level of resistance to several penicillins and aminoglycosides. Gram-positive microorganisms had high level of sensitivity to vancomycin, ciprofloxacin, amikacin, amoxiclav, cefazoline, cefuroxim, cefotaxim and cefepim. Gram-negative microorganisms had high level of sensitivity to representatives of ftorhinolones, carbapenems and several cephalosporins. Strains of Candida albicans, showed 100% resistance to nistatine and comparatively high level of sensitivity to such antifungal drugs as diflucan, ketakonasol and amphotericin B. Performed studies once more confirmed significance of microbiological laboratories, which have to be main components of infectious control to dial with infectious complications - performance of permanent microbiological monitoring in separately taken hospitals, that in particular enables effective rotation of antibacterial drugs in that hospitals.

[ETHIOLOGY OF LEPTOSPIROSIS IN GEORGIA].

Investigation of leptospirosis was initiated in 1950s, when the first cases in humans were detected in Gudauta rayon. Serology test confirmed the diagnose. High level of antibodies to serogroup Pomona was revealed in all cases. Later on the infection encountered as sporadic cases, the exception was 1986, when a large outbreak was reported in Sukhumi. At present leptospirosis is widely spread in the country, especially in Ajara region, where indicators of morbidity recently reached 11.4 per 100 thousand population. It is likely that warm humid climate creates exceptionally favorite conditions for spreading of Leptospira. In order to determine the true magnitude of the infection in the country a seroprevalence study was carried out in 50-60-ies of the past century in humans, agricultural animals and rodents. It was found that serotgroups Pomona, Icteroheamorrhagiae and Grippothypos prevailed in humans, Serogroup L. Pomona - dominated in animals, while in rodents the dominated serotgrouo was L. Icteroheamorrhagiae. Similar study, conducted by us in 1990-2005 showed that L.Pomona and L. Icteroheamorrhagiae prevailed in humans and rodents while L. Icteroheamorrhagiae was the only serogroup isolated in gray rats, trapped in Tbilisi. Infectivity of rodants composed 70%. Currently lesptosirosis is caused by a new serogroups of Leptospira - L. Sejroe, namely by serotypes Wolfii and Hardjo, L. Australis (serotype Bratislava) and L. Autumnalis along with the previously occurring serogroups L. Icteroheamorrhagiae, L. Bataviae, L. Hebdomadis. In our opinion the recent increase in leptospirosis in the country is attributable to the improvements in diagnostics of the infection as well as to the emergence of new serogroups of Leptospira, which in turn is a result of intensive migration processes in the country.

[Leptospirosis in Georgia].

The aim of the article was to study epidemiological patterns of leptospirosis in Georgia from 2001 to 2011. The investigation revealed that formal registration of the infection began in 1950s. Single cases were reported annually in the country with the exception of 1986, when water-borne outbreak broke out in Sukhumi with 21 detected cases. Low morbidity level of disease was reported during 2001-2005. Since 2006 significant increase of leptospirosis has been observed. The highest incidence was reported in 2011-1.81 per 100 000 population. The increase is likely to be mainly attributed to the improvements in diagnostics of the infection. Young and middle-age persons are more frequently vulnerable to leptospirosis in Georgia, 54.8% of the cases are reported among age group of 30-59. Incidence of the infection is the highest in males - 60-65% of the detected cases. In addition, leptospirosis is characterized by high case-fatality rate - 8.7 ± 3.6% (95% CI=5.7-11.7). Case fatality is especially high in persons over 60 and over reaching 24.3 ± 8.1%. Only single cases are observed in children under 14. In 21st century ethiological structure of leptospirosis has being changed somehow. By contrast, in the earlier period the disease was mainly caused by L. icterohaemorrhagiae and L.grippotyphosa, nowadays we encounter such causative agents which were not observed in 20th century - L. autunnalis, L. mankarso, L. wolffii and others. Water is mainly implicated as a risk factor in the infection transmission. Finally, to study of epidemiological characteristics of leptospirosis in Georgia, identified that, the infection is widely distributed in the country, has an increasing tendency and duration of the disease frequently is a severe.

[Epidemiology of meningococcal infection in Georgia].

Epidemiology of meningococcal infection in Georgia was studied for 2009-2011. As the official surveillance data shows, morbidity with the infection is characterized by a downward trend. During the analyzed period the morbidity level declined by 2,4 times. The average incidence rate for the period composed 0,95 ± 0,12 per 100 000 population. The infection is unequally spread throughout the country. High incidence is indicated in Tbilisi city and the regions: Ajara and Kvemo Kartli. Children are the most vulnerable population. 81,3% of all the cases fell on the children' population. High incidence rate in children of the age under 1 year is especially alarming, composing 11,52 per 100 000 population. Irrespective of the downward trend meningococcal infection in Georgia remains as a severe disease, high level of lethal outcome (lethality 18,6±3,0%) is the confirmation of that. Lethality is even higher in small children under 1 year - 27,7 ± 7,4%. The study of the isolated N. meningitides from patients with meningococcal meningitides as well as with meningococcemia showed that N. meningitides of the serosgoups B and C are being circulated in Georgia. Epidemiological investigation of the infection foci in terms of medical examination of contact persons of the cases indicated that the causative agents of the same serogroups are also widely circulated among contact subjects. Along of the passive surveillance data on the meningococcal disease, results of active investigation of epidemiological foci of the infection may serve as valuable information for planning of specific prevention measures against the infection.

[Contamination of some food products with Salmonella in Georgia].

Salmonella infections in Georgia are usually caused by S. enderitidis and S. typhimurium. Food products represent a leading vehicle in transmission of S. enderitidis, which predominates over other serotypes. The goal of our research was to study contamination of chickens and chicken eggs with S. enderitidis and S. typhimurium. Overall 90 chicken eggs, obtained from various poultries, 100 eggs, sold by peasant and 30 chicken and their excrements were tested. Cer Test Salmonella-immunchromatography one stage analysis were employed for detecting of salmonella microbe. Chickens and chicken eggs were contaminated with bacteria S. Enteritidis. The microbe isolation rate from eggs was 4.2±1.4%. It was 1.1 for eggs from poultries and 7.0±2.5 for eggs from peasant vendors. Chicken's contamination was found to be high--26.7±8.1%. The research data showed the prevalence of S. Enteritidis in etiology of salmonella infections in Georgia.