COMPARATIVE ANALYSIS OF THE EFFICACIES OF BOTULINOTOXIN A THERAPY AND FRACTIONAL RADIO-FREQUENCY-LIFTING IN THE TREATMENT OF PRIMARY HYPERHYDROSIS.

Hyperhydrosis (HH) is a pathology of eccrine gland which is manifested by excessive sweating on the skin. It has a significant negative impact on an individual's quality of life (QoL). Primary HH is the most common idiopathic condition which is mostly localized. Botulinum toxin A therapy (BTX) treatment is one of the proven, minimally invasive methods for HH treatment; however, minimally invasive fractional RF-lifting with microneedles for primary HH is of great interest of researchers. The aim of our study was to compare the effectiveness of fractional RF-lifting with microneedles and botulinum toxin-A treatment methods in people with primary HH and to determine the role of these methods in HH management tactics based on the analysis. After signing the consent agreement 60 patients with HH participated in the study. 30 patients were selected for BTX (group 1), another 30 participants - for RF-lifting with microneedles (group 2). Target areas of treatment were the armpit, palm, and sole. The assessment of treatment efficacy was performed by the questionnaires of the Dermatology Patient Quality of Life Index (DLQI) and Hyperhidrosis Severity Score (HDSS). Mean value of DLQI-score before treatment in group 1 was 18.1±4.3, and in in group 2 - 13.3±5.6 (the difference was significant - p<0.001). After treatment these scores were 8.3±5.5 and 6.6±5.3, respectively (the difference was not significant - p=0.228). As for intragroup difference of DLQI-scores before and after treatment, they were decreased significantly (p<0.001 for both groups). Moreover, the percentages of the patients with high degree HH were significantly decreased in both groups. However, the difference between the DLQI-scores of groups both before and after treatment was not significant. Both methods proved to be significantly effective for all three locations, especially for the armpit. However, no significant differences were observed when comparing the methods. The results of the study based on the DLQI-questionnaire indicate that application of both methods improved QoL of HH patients and decreased the degree of severity significantly. Both methods may be applied in the tactics of HH treatment with equal success rates. Additional randomized trials are needed to make evidence-based conclusions.

RECOMMENDATIONS BY GEORGIAN ASSOCIATION OF SKELETAL METABOLIC DISEASES ON THE INITIATION OF TREATMENT WITH USE OF AGE-DEPENDENT INTERVENTION THRESHOLD BASED ON FRAX IN PATIENTS WITH OSTEOPOROSIS.

Treatment criteria based only on bone mineral density do not reflect completely the likelihood of fractures. We reviewed the studies and recommendations on different types of intervention thresholds for the initiation of treatment in patients with osteoporosis. Georgian Association of Skeletal Metabolism Diseases recommends to use age dependent intervention threshold based on 10-year probability of osteoporotic fractures calculated by FRAX algorithm as a diagnostic and treatment criteria for patients with osteoporosis.

THE IMPACT OF 12-MONTH GROWTH HORMONE REPLACEMENT THERAPY ON LIPID METABOLISM AND ADIPOSE TISSUE DISTRIBUTION IN GEORGIAN PATIENTS WITH ADULT GROWTH HORMONE DEFICIENCY.

Growth hormone deficiency (GHD) is one of the reasons of significant metabolic morbidities inchildren and adults. The aim of our study was to evaluate the impact of growth hormone (GH) replacement therapy on lipid profile and adipose tissue distribution in adults with GHD. Twenty hypopituitary adults, aged 40.75±2.2 years (mean ± SE, range 20.5-60), with adult onset GHD (aGHD) were enrolled in a randomized, double blind, placebo-controlled study. 10 patients received recombinant growth hormone injection once weekly for 12 months, and the rest 10 patients (as control group) received placebo. The patients were selected from the basis of National Institute of Endocrinology. After 12 months of treatment mean values of low density lipoprotein cholesterol (LDL-CH), total cholesterol (CH) and triglycerides (TG) were increased in GH treated patients, compared to the control group (median increase in LDL-CH, CH and TG were 0.1 mmol/l, 0.1 mmol/l and 0.3mmol/l, respectively). In contrast, the favorable effect was seen in high density lipoprotein cholesterol (HDL-CH) levels with the median increase of 0.2 mmol/l). Furthermore, there was an increase in adipose tissue distribution percentages, in GH treated patients (DXA: Legs +10.22%, Trunk: +7.43%, Android: +5.59%, Gynoid: +10.59%, Total body: +7.6%), compared to the control group, in which adipose tissue distribution was slightly improved or remained unchanged. Since the results of 12-month growth hormone treatment therapy did not show any improvements in lipid profile and adipose tissue distribution, the decision was made to prolong the study for the next 12 months.

[The role and place of helical ct for preporative diagnosis of acute appendicitis].

The goal of our study was to ascertain the role and place of helical CT for preoperative diagnosis of acute appendicitis. Our study relied upon the results of helical CT scans of 60 patients, which were diagnosed probable acute appendicitis based upon clinical signs. Of these 60 patients 49 (81,6%) were female, 11 (18,4%) male. For all patients laboratory studies of blood were made, 31 patients were examined by ultrasonography. Among this group the diagnosis of acute appendicitis was verified by CT scan in 41 patients. In the case of 5 patients the scan was equivocal because of smaller amount of omentum; in this subgroup of 5 patients (5% overall) three were given radiocontrast dye, and two (3,3% overall) were not. In 11 (18,3%) cases the diagnosis of acute appendicitis was not verified, and in three cases the diagnosis was incorrect. According to data of our study and intraoperative data analysis, sensitivity of this method approaches 93% and the specificity - 92%, and overall diagnostic accuracy 93%. Helical CT may be stated as diagnostic method of choice in the diagnosis of acute appendicitis. It is helpful in clinical decision making, and reducing the amount of false appendectomies.