AWARENESS OF CANCER SCREENING AMONG GEORGIAN PRIMARY CARE PHYSICIANS.

Despite the development of new diagnostic and treatment tools, cancer remains one of the leading public health challenges of developed and developing countries. According to the National Center for Disease control and Public Health (NCDC), incidence of all cancer cases in 2018 was 258.6 per 100.000 in Georgia. However, the national cancer screening program (available since 2006) has a low participation rate. In 2018, only 11.2% of eligible women were screened for cervical cancer and 8.6% had a mammogram. The coverage is even lower for colorectal cancer screening (1.5%). In 2019, NCDC launched an awareness campaign for cancer screening aiming to inform citizens about the importance of cancer screening and to provide updated information to primary care physicians to promote the cancer screening among their patients. Primary care workers (PCW) from three regions of Georgia were surveyed to assess their awareness regarding cancer and the cancer screening program before and after the educational courses. Data were collected using a self-administered questionnaire with 27 questions. The statistical software package, SPSS version 23, was used for data processing and analyses. A total of 129 primary care workers were enrolled, of whom 55.1% did not know that breast cancer screening is offered every two years by the national screening program. Only 61.1% correctly identified the eligible age groups for colorectal cancer screening. Almost half of PCWs (46.0%) did not know that low-risk HPV strains are associated with genital warts. Low engagement of PHC workers in cancer screening may explain the low participation rate in the state cancer screening program. Even though baseline knowledge was significantly improved after training courses, follow-up knowledge and practice surveys are needed to understand the long-term impact of training on the rate of referrals for cancer screening by PHC providers.

Tularemia transmission to humans: a multifaceted surveillance approach.

Tularemia has sustained seroprevalence in Eurasia, with estimates as high as 15% in endemic regions. The purpose of this report is to characterise the current epidemiology of Francisella tularensis subspecies holarctica in Georgia. Three surveillance activities are summarised: (1) acute infections captured in Georgia's notifiable disease surveillance system, (2) infectious disease seroprevalence study of military volunteers, and (3) a study of seroprevalence and risk factors in endemic regions. Descriptive analyses of demographic, exposure and clinical factors were conducted for the surveillance studies; bivariate analyses were computed to identify risk factors of seropositivity using likelihood ratio χ2 tests or Fisher's exact tests. Of the 19 incident cases reported between 2014 and August 2017, 10 were confirmed and nine met the presumptive definition; the estimated annual incidence was 0.12/100 000. The first cases of tularemia in Western Georgia were reported. Seroprevalences of antibodies for F. tularensis were 2.0% for military volunteers and 5.0% for residents in endemic regions. Exposures correlated with seropositivity included work with hay and contact with multiple types of animals. Seroprevalence studies conducted periodically may enhance our understanding of tularemia in countries with dramatically underestimated incidence rates.

ROTAVIRUS VACCINE IMPLEMENTATION IN GEORGIA - IMPACT OF KNOWLEDGE, APPROACH, AND PRACTICES OF HEALTH CARE WORKERS.

Rotavirus (RV) is the most common cause of severe gastroenteritis in infants and young children worldwide. RV causes approximately half a million deaths each year among children aged <5 years. According to WHO estimates for 2008, there were approximately 10 to 50 deaths annually in young children due to rotavirus diarrhea in Georgia. The purpose of this study was to assess the knowledge, attitudes, and practices related to rotavirus diarrhea and the rotavirus vaccine among health care workers (HCWs). The National Center for Disease Control and Public Health (NCDC) conducted a cross-sectional survey of HCWs involved in the expanded program of immunization (EPI). The HCWs were selected by simple random sampling using employee lists, and questionnaires were hand-delivered to selected HCWs during working hours. The majority of HCWs (67.9%) recognized diarrhea as a frequent health-related problem in children under 2 years of age. However, 53.9% partially disagreed with the statement that rotavirus is the most common cause of all forms of diarrhea. Multivariable analysis revealed that the following perceptions among HCWs more than doubled the likelihood that they would not support adoption of the RV vaccine: no perception of need for this vaccine in Georgia specifically (OR=2.54, CI: 1.46-4.42), no perception of need to address burden of disease in developing countries (OR=2.75, CI: 1.59-4.75), and concerns about the vaccine's safety (OR=2.51, CI: 1.56-4.02). Concerns about vaccine safety, low awareness about the RV disease burden and the effectiveness of the RV vaccine, combined with a lack of communication skills represented the main predictors of RV vaccine uptake among HCWs. Intensive vaccine promotion interventions that focus on the epidemiology of disease and vaccine effectiveness are urgently needed.

CHANGES OF LIPOPEROXIDATION AND ANTIOXIDATIVE ENZYMES DURING CRUSH-SYNDROME MODELLING.

Crush-syndrome (CS) is characterized by numerous pathological deviations due to the soft tissue damage and their further reperfusion. The aim of the study was to investigate pro- and antioxidative processes during different regimens of crush syndrome. The experiment was carried out on randomly selected 200-250gr. mass 50 laboratory rats using crush syndrome modeling classical method. Investigations were conducted at various stages of compression and decompression period. Activity of antioxidant enzymes - total ceruloplasmin, oxidized ceruloplasmin was determined in blood serum. LOO. and free oxygen species were as well determined with the use of relevant methods. According to our findings we can conclude that: - Lipoperoxidation intensity increases in compliance with crush syndrome duration; - Short-term (3-hour) compression causes enhancement of lipoperoxidation however, in further 1 hour decompression there is revealed a trend toward normalization of processes. Lipoperoxides and free oxygen species content decreases and the antioxidant enzymes activity is almost restored; - Long lasting compression (6 hours) leads to severe disorders in the body (total ceruloplasmin impaired production and after 6 hours from decompression antioxidant enzymes inactivation).

[The role of apoptosis in the development of virus hepatitis].

In present review hepatocyte apoptosis is presented as universal defensive reaction of liver, to the damages. Hepatocyte apoptosis may be caused by hepatotropic virus's direct affection, or by the immune reactions initiated by viruses. Apoptosis development caused by virus direct affection varies and contains at lest two mechanisms: production of specific proteins: B virus - X protein and C virus - core-protein; expression of the receptors leading the induction of this process on the hepatocyte membrane, for example, increasing of Fas-receptor and cell sensation to apoptosis stimulus. In apoptosis induced by immune reaction T-lymphocytes could trigger off apoptosis in two principal ways: by releasing perporines that produce holes through hepatocyte membrane and according to this process granzyms are permetted inside the cells. By destroying of caspases by proteases that initiate apoptosis cascade. In this article molecular mechanisms of the processes mentioned above are also discussed.

[Clinical value of changes in red blood cell ultrastructure and energy metabolism in children with cystic fibrosis].

In 42 patients of various age (from 1 month to 14 years) with cystic fibrosis were analyzed ultra structure, level of adenylnucleotides and activity ATP-ase of erythrocytes, in order to characterize their membrane and energy metabolism. The studies revealed the changes in erythrocytes in the cases of cystic fibrosis. In the cases of broncho pulmonary form of cystic fibrosis were detected I and II row echinocytes, cone-shaped erythrocytes, also erythrocytes with reach-through hole in center. At mixed form of cystic fibrosis were detected more changes in erythrocytes than in other forms of this disease. Both cone-shaped erythrocytes were more than in other forms of cystic fibrosis. Also there were detected erythrocytes with holes (round, polygonal) in their center. The results of the study provide a more precise diagnosis, in time correction of disorders and a comprehensive assessment of multiple-modality treatment of cystic fibrosis.

Barriers to hepatitis B vaccine coverage among healthcare workers in the Republic of Georgia: An international perspective.

BACKGROUND: While the Republic of Georgia has a high prevalence of hepatitis B virus (HBV) infection (3.4% of blood donors tested positive for HBV surface antigen [HBsAg]), relatively few healthcare workers (HCWs) are thought to be immunized. OBJECTIVE: To measure rates of HBV vaccination coverage and identify predictors of vaccine acceptance among HCWs. DESIGN: Cross-sectional survey. METHODS: A study was conducted among full-time physicians and nurses at 2 large hospitals. Self-administered questionnaires included questions about demographic characteristics, HBV vaccine status, willingness to recommend vaccination to other HCWs, and barriers to vaccination. Laboratory tests were conducted for identification of HBsAg and antibody to hepatitis B core antigen. RESULTS: A total of 297 (91%) of 325 randomly selected HCWs provided information for the study (124 physicians and 173 nurses). The rate of HBV vaccination coverage was 12%, and 54% of respondents indicated that they would recommend vaccination to other HCWs. Perception of vaccine safety was identified as the most important predictor for acceptance (prevalence ratio [PR], 3.3 [95% confidence ratio {CI}, 1.2-8.9]) and for willingness to recommend HBV vaccination to other HCWs (PR, 5.5 [95% CI, 3.1-9.4]). Vaccinated HCWs were more likely to recommend vaccination to other healthcare personnel (PR, 1.7 [95% CI, 1.5-2.1]), as were those younger than 40 years of age (PR, 6.0 [95% CI, 2.8-12.6]). Multivariate analyses identified 2 additional factors associated with vaccine acceptance and willingness to recommend vaccination: the hospital at which the HCW was employed and the perception of risk of infection for HCWs. CONCLUSION: Georgia plans a major HBV vaccination campaign for HCWs in 2009. The campaign's success will depend on addressing vaccine safety concerns identified in this study and educating HCWs about risk factors for infection and benefits of immunization.

[Molecular mechanisms of apoptosis].

Apoptosis is the vital issue of Biology and Medicine. Recent concept of molecular and cellular mechanisms of apoptosis--a well-controlled form of cell death was reviewed. The aim of a review was to broaden knowledge of apoptosis mechanism and to reveal molecular targets for the modulation of these processes. The data on the apoptosis was analyzed. The biological role of physiological cell death in normal state and in different human pathologies is described. The literature data showed that many molecular mechanisms of apoptosis are still unknown. Three mechanisms are actually known to be involved in the apoptotic process: a receptor-ligand mediated mechanism, a mitochondrial pathway and a mechanism in which the endoplasmic reticulum plays a central role. Morphological and biochemical definitions of poptosis are presented. An original scheme of apoptosis mechanisms is constructed. The term "mediators of poptosis" is introduced. Extra cellular and intracellular mechanisms of apoptosis are examined. The special attention is paid to mitochondrial factors of apoptosis, Ca(2+)-ions, and proteins (Bcl-2, Bax, p-53).

[The role of changes in tissue redox-status in mechanism of paraneoplasia].

To specify mechanisms of paraneoplastic alterations of redox-status of tissues in experimental malignant tumor growth, we investigated electronic paramagnetic centers of blood, skeletal muscle and liver with electronic paramagnetic resonance (EPR) method. We also studied the concentration and activity of antioxidant enzymes. Our experiments on adult white male rats of mixed population with sarcoma C-45 and mice with Ehrlich carcinoma have shown that malignant tumor growth leads to enhanced lipid peroxidation (LPO): production of potent LPO promoters - Fe2+, Mn+2+, NO, ubiquinone; depression of antioxidant defence - reduced production of total ceruloplasmin, elevated blood levels of oxidized ceruloplasmin and enhanced catalase activity. It is suggested that malignant tumor growth is associated with marked paraneoplastic shifts in tissue redox-potential. These alterations are involved in mechanisms of paraneoplastic changes of red cells, microhemocirculation and circulation intensity. All these interrelated processes result in generalized paraneoplastic hypoxia of the organs and tissues. Basing on our and literature data, we propose an original scheme of the mechanisms of paraneoplastic disorders of tissue redox-status, microcirculation and erythrocytes.

[Role of peroxidation processes and nitric oxide in mechanisms of paraneoplastic alterations of hemocirculation].

The present work was aimed to study mechanisms of paraneoplastic alterations of tissue redox-status, intensity of local blood flow in liver and their possible interrelations in case of malignant tumor growth. It has been investigated the electronic paramagnetic centres of blood and liver using the electronic paramagnetic resonance (EPR) method and intensity of local hemocirculation with the use of H(+) clearance polarography method. Experiments have been carried out on adult white rats of mixed population with carcinoma Walker and mice -- with carcinoma Ehrlich. It has been shown that malignant tumor growth displays conditions that lead to exaggerated lipid peroxidation (production of POL promoters -- Fe(2+), Mn(2+), NO, ubiquinone) and suppression of antioxidant protection of organism (reduction of total ceruloplasmin concentration in blood and increased concentration of oxidized ceruloplasmin). It has been suggested that in case of malignant tumor growth sharp paraneoplastic alterations of redox-status plays essential role in mechanisms of paraneoplastic disorders of tissues blood supply. All of these interrelated processes result in generalized paraneoplastic hypoxia in organs and tissues.