TOPICAL ISSUES OF COPD MANAGEMENT IN GEORGIA.

Chronic obstructive pulmonary disease (COPD) is the major cause of chronic morbidity and mortality throughout the world. USAID Health Care Improvement Project (HCI) had collaborated with the Ministry of Labor, Healthcare and Social Affairs of Georgia in 2012-2014 to improve quality of care for high-burden and under-diagnosed diseases, including asthma and COPD. The Aim of the study was to evaluate the effectiveness (quality, consistency and continuity) of medical care in COPD patients in one of the regions of Georgia after 5 years from the ending of the project. The received results of our research were compared to the data from USAID HCI Project. In order to evaluate the effectiveness of medical care, 7 rural primary care units and 1 hospital have been selected. Information was gathered with standardized questionnaires: from providers, patients and medical records: 42 physicians and 83 patients were interviewed, 152 medical records were reviewed. Research period was defined from March 2017 till March 2019. Research protocol is approved by an Ethical Committee Review Board at ATSU. All indicators showing the quality and effectiveness of COPD management (prescription of COPD controller medications, bronchodilators, documented procedures, etc) are improved. Improvement tendency is obvious in all aspects of treatment/management, except spirometry results recorded, which is 4% less compared to the project results. Documentation from the primary care units showed decreased indicator of counseling provided for smoking cessation by 9%. Based on our data the sustainability in the treatment and management of COPD is still in progress. Two main areas need to be paid special attention to: patient consultation/education and timely diagnosis of the disease.

MONITORING THE EFFICACY OF MONTELUKAST USED IN CHILDREN WITH RISK OF ASTHMA.

The aim of the study is to evaluate the effect of Montelukast - leukotriene inhibitor in children population with risk of bronchial asthma. The research was conducted at LTD. Kutaisi Children primary care unit #3. The data were collected from January 2013 till January 2016. 104 patients (5-18 year, 43 girl, 61 boy), with potential risk of bronchial asthma were involved into the research, 47 (45%) patients out of 104 were considered as a real risk for asthma, based on Peak Expiratory Flow (PEF) and spirometry results. Patients with risk of asthma were grouped according to the method of treatment (monotherapy with inhaled glycocorticoid and inhaled glycocorticoid combined with leukotriene inhibitor). Descriptive statistics methods were used to characterize each variable. Our results indicate on positive influence of montelukast - selective leukotrien inhibitor in treatment of children with various forms of asthma.

Role of Montelukast in treatment of mild and severe forms of asthma.

The aim of the study was to evaluate the effect of Montelukast - leukotriene inhibitor in longitudinal treatment of mild and severe forms of asthma. The research was conducted at LTD Kutaisi Nazarishvili Regional center of Family Medicine. Retrospect analysis of 187 patients histories were carried out. Patients histories were grouped according to the severity of the disease, method of treatment (monotherapy with inhaled glycocorticoid and inhaled glycocorticoid combined with leucotriene inhibitor) in different age groups. The results of measurements of lung function - especially spirometry (FEV1 - Forced Expiratory Volume1 sec and PEF- Peak Expiratory Flow) were studied. Descriptive statistics methods were used to characterize each variable. Our results indicate on positive role of montelukast - leukotrien inhibitor in the treatment of severe and mild forms of asthma.

Comparison of intravenous pantoprazole with intravenous ranitidine in peptic ulcer bleeding.

Following successful endoscopic therapy in patients with peptic ulcer bleeding, rebleeding occurs in 4% to 30% of cases. Rebleeding remains the most important determinant of poor prognosis. The aim of our study is to compare the efficacy of intravenous pantoprazole and ranitidine for prevention of rebleeding of peptic ulcers following initial endoscopic hemostasis. In our study patients who had gastric or duodenal ulcers with bleeding received combined endoscopy therapy with injection of epinephrine and thermocoagulation. Patients with initial hemostasis were randomly assigned to two groups. One group (45 patients) was treated with intravenous pantoprazole, with an initial dose of 40 mg and subsequently with 40 mg every twelve hours during the first three days, followed by 40 mg a day orally. The other group (44 patients) was treated with intravenous ranitidine, with an initial dose of 50 mg and subsequently every eight hours during the first three days, followed by 150 mg ranitidine every 12 h. In all case of rebleeding repeated endoscopy was performed. One patient (2,2%) had rebleeding in pantoprazole group. Bleeding could not be blocked by repeated endoscopic intervention, thus the patient underwent emergency surgery. 6 patients (13,6%) from ranitidine group had recurrence of bleeding. Repeated endoscopy was performed in all these patients: bleeding was stopped in 3 cases endoscopically, other 3 patients were surgically treated urgently as endoscopic hemostasis was not successful. None of the patients died of uncontrolled rebleeding. The frequency of rebleeding was significantly low in the group of pantoprazole compared to ranitidine group (2,2% vs 13,6% P=0,046). There were no statistically significant differences between the groups with regard to need for emergency surgery (2,2% vs 6,8%), the length of hospital stay (6,7±3,3 vs 7,4±4,3 d) and mortality (0%vs 0%). After endoscopic treatment of bleeding peptic ulcers, intravenous pantoprazole is more effective than ranitidine for the prevention of rebleeding.

The efficacy of topical drugs in treatment of noninflammatory acne vulgaris.

Treatment of Acne Vulgaris still remains as an actual problem. The purpose of the research was to study the curing process and side effects of topical drugs - Diacneal and Skinoren in patients with non-inflammatory acne vulgaris. The results of the research has confirmed the swift and stable treating effect of both preparations, that expressed in decrease in number and size of comedonal and papulo-comedonal formations, actually without side effects. Thus, in spite of divergence of either chemical composition or mechanism of action, both, Diacneal and Skinoren, may be recommended as a very good choice for monotherapy of non-inflammatory acne vulgaris.

Study of distribution of the vitamin A after overdose feeding along the digestive tract of rats intestine by LIFS.

UNLABELLED: Distribution of vitamin A after overdose feeding along the digestive tract of rat's intestine was studied by LIFS. Purpose of our pilot study was to investigate possible usage of LIFS for real time monitoring of vitamin A digestion and storage in intestine as in liver and to identify regions of intestine where vitamin A droplets are formed. ANIMALS: normal male Wistar rats (250-300 g, n=5) were fed on vitamin A enriched diet during the experimental 21 days' period (totally -82.56 mg. vitamin A). The control group (250-300 g, n=5) was maintained by ordinary diet. All rats used in our studies were sacrificed in the morning between 9:30 and 11:30 a.m. Liver and intestinal regions of duodenum, jejunum, ileum and cecum were examined in this experiment. LIF spectra in all parts of intestine as well as in liver demonstrates characteristic fluorescence peaks at approximately 390 nm and at 470 nm. It is clearly demonstrated, that after overdose feeding rats on vitamin A, retinol-rich regions can be found in all, but in cecum part of rat intestine. Obtained results demonstrate that LIFS can be used for study of metabolism and real-time monitoring of intratissue retinol.