DEMOGRAPHIC AND CLINICAL FACTORS ASSOCIATED WITH INCREASED IL-6 LEVELS IN AMBULATORY PATIENTS WITH CHRONIC HEART FAILURE.

IL-6 promotes T cell activation and production in acute inflammatory conditions, initiates B cell differentiation, regulates liver production of acute phase reactants, and stimulates hypothalamus-pituitary-adrenal system, which is important in acute inflammation. Nevertheless prolonged IL-6 exposition activates apoptosis. According to recent studies increased levels of IL-6 increase cardiovascular disease risks. The aim of the study was to explore IL-6 basic levels in chronic congestive heart failure patients, as in risk group in COVID-19, and various factors (demographic or clinical) in various groups of IL-6 basic levels. We used consecutive sampling approach to recruit 96 congestive heart failure patients and 34 persons without the condition as controls. Hematologic, biochemical and immunologic parameters were measured using conventional methods. We used descriptive statistics for demographic parameters. We compared mean values of hematologic and biochemical parameters in cases and controls using independent sample t test and explored differences within the congestive heart failure group (further separated in 3 groups according to IL-6 levels) using one way ANOVA test, with further post-hoc analysis. Levels of IL-6 are statistically significantly higher in CHF patients; groups differ in co-morbidity, also abdominal obesity is more prevalent in diseased group. Difference between groups is significant in a number of pro-inflammation, coagulation, hematology parameters. It is also important to note that the CHF group showed a number of differences in sub-groups according to IL-6 levels, risks of CHF and comorbidity deterioration risks therefore are suggested to be different.

USE OF INTRAOSSEOUS ACCESS IN PEDIATRIC EMERGENCY CARE IN GEORGIA.

Intraosseous Access (IO) has obtained an increasingly valued place in emergency medical care cases when peripheral access venous access in not possible. This has also been demonstrated in pediatric settings. The method though has never been applied in Georgia, let alone pediatric emergencies. Therefor we conducted the study to access opportunities for IO use introduction in pediatric emergency care in Georgia. A quasi experimental study was conducted with 24 patients undergoing IO and further 40 receiving central venous access for their condition management. A number of parameters were monitored and reported. Additionally, a pre- and post-test was used to assess the specially trained medical personnel. The study groups outcomes were described, while personal assessment was analyzed. The study demonstrates that with proper training and in certain indications, the internationally approved method can be safely used in Georgian healthcare settings, including pediatric emergency management. The method should be included into the Georgian patient management guidelines, provided proper training is delivered to the personnel.

USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN GEORGIA.

In Georgia, like in most countries globally, people commonly resort to complementary and alternative medicine (CAM). However, not much is known about CAM practices there. The aim of the study was to document common practices of CAM in Georgia and related patient attitudes. We collected data from peoples who commonly use CAM at 20 service provision centers in Georgia using cluster sampling from 300 patients. We admininstered a cross-sectional survey and conducted descriptive statistical analyses. People in Georgia use CAM either for prevention to improve general health (33%) or to treat chronic conditions (36%), spending about 25 Euros per month out of pocket. Most (77%) get their knowledge about CAM from family or friends , less than half (44%) from books or media, and 11% from medical providers. A close person's advice or experience was the most common rationale given for CAM use (54%). In our sample, 17% either don't trust or are unsatisfied with conventional medicine, 29% found CAM treatment "very effective" and 61% "quite/partially" effective; only 5% not effective. Conventional treatment was stopped in half of the cases. 35% of respondents informed their physicians of their CAM use, while about half did not. Public mistrust towards conventional medicine, CAM user high satisfaction, relatively low cost of such services in Georgia - are the factors letting us to suggest that CAM use will further increase. Frequent self taking decisions made by patients to stop physician prescribed treatment, not informing physicians on CAM use, as well as other factors put patients health at risk. Further research and capacity building in practice, education and other related aspects are needed to establish evidence-based regulation and standards for CAM in Georgia that ensure informed decision making and patient safety.

COMPLEMENTARY AND ALTERNATIVE MEDICINE AND MEDICAL EDUCATION IN GEORGIA: STATE OF THE ART AND FURTHER PERSPECTIVES.

Aim - complementary and alternative medicine (CAM) is popular in Georgia, but providers' training not well understood or regulated. The aim of this mixed-methods study was to inform the process of implementing quality CAM curricula in Georgia and strategies for the inclusion of effective CAM curricula into medical education in Georgia. We analyzed existing medical curricula. We conducted a contextual analysis based of qualitative data collected from relevant medical education experts, qualified physicians, CAM practitioners and other stakeholders; and administered a quantitative MD students' survey to MD students. CAM components are currently not represented in medical curricula in Georgia. Physicians largely lack adequate knowledge of CAM and its practice. All stakeholders supported that it would be beneficial to develop CAM educatory courses, both to future practitioners (medical students, initially as an elective subject) and practicing physicians (through CME). We recommend development/integration of an elective subject and/or a curricular component as a first step of CAM integration into the medical curricula in Georgia for MD students and CME courses for physicians. Interdisciplinary and international collaborations may help achieve best outcome, and safe practice of CAM in Georgia, forming a base for physician - CAM practitioner collaborations for quality care for patients in Georgia.