CHARACTERISTICS OF DRUG RESISTANT TUBERCULOSIS IN GEORGIA (2015-2020).

The aim of the study was to assess general characteristics of drug resistant tuberculosis and its association with treatment outcomes in Georgia. A retrospective cohort study was conducted among 1581 DR-TB adult (18+) patients, from 2015 - 2020 cohorts, whose anti-tuberculosis treatment outcomes was known. Adjusted analysis of the study participants data [1581 (100%)] shows significant association of a successful TB treatment outcome with the "Female gender" (adjusted OR 1.78, 95% CI: 1.33 - 2.39, p<0.001), "New TB case" (adjusted OR 2.34, 95% CI: 1.88-2.91, p<0.001) and with "HIV negative status" (OR 2.33; 95% CI 1.53-3.55; p<0.001). Based on bivariate and multivariate analysis of the study data, the significant association of a treatment outcome with other key factors, including "New drugs in the regimen" was not found. Since the programmatic using of the new effective DR-TB regimens are widely recommended only from 2019, the treatment outcomes of all patients on these regimens are still not defined. Further studies are necessary to assess complete data of the patients on new DR-TB regimens and its association with the treatment outcomes.

THE EFFICACY OF ENDOBRONCHIAL VALVE THERAPY IN COMPLEX TREATMENT OF BRONCHO-PLEURAL FISTULAS.

The aim of our investigation was the assessment of the efficacy of endobronchial valve (EBV) therapy in the complex treatment BPF. The presented study has been carried out in several centers of Georgia (basically in the National Center for Tuberculosis and Lung Diseases). The study group was selected from 30 patients with BPF, who underwent endobronchial valve therapy and signed the informed consent to participate in the study. The corresponding control group was selected from 28 patients with BPF, who underwent conservative therapy by multiple thoracocentesis, chest tube insertion and also surgery and signed the informed consent to participate in the study. EBV therapy has been carried out by combined using the rigid (Friedel) and flexible (Olympus and Pentax) bronchoscopes. EBV therapy has been performed by valves of Medlung Ltd.The quality of life in study and control groups has been studied by the Saint George Respiratory Questionnaire (SGRQ). Statistical analysis performed by software SPSS 22.0. BPF closure after EBV intervention in the study group was in 28 cases from 30 and in 19 cases from 28 in the control group. Respectively the relapse cases after EBV intervention or surgery showed that 2 cases (6.7%) were identified in the study group and 9 cases (32.14%) - in the control group. Difference between groups was statistically significant (χ2=6.1163; p=0.0134). The duration of the pre-surgery period in the study group was significantly lower, 0.89 (SD - 1.45) days compared to the control group, 11.04 (SD -17.0) days. The mean value of hospital delay after EBV intervention was 8.0 (SD - 14.1) days, the corresponding value in the control group was 36.9 (SD - 47.4) days (the difference was significant p=0.0023). The mean duration of the chest tube insertion in the study group after EBV therapy - 2.6 (SD - 1.7) days. Analogous values in control group was 18.4 (SD - 20.2) days (p=0.0001). The assessment of the quality of life by SGRQ in study and control groups showed that the total SGRQ score was decreased significantly during 6 months from 65.4 to 42.3 (p<0.001), i.e. by 23.1. The total SGRQ score in the control group was not decreased significantly during 6 months (from 63.6 to 58.4, p=NS). The dynamics for symptom domain was also significant -27.6 (p=0.008), for activity domain -31.5 (p<0.001), for impact domain -17.0 (p=0.011). EBV therapy revealed high efficacy in the treatment of BPF. Compared to traditional methods, such as conservative therapy (thoracentesis, chest tube insertion) and surgery it was expressed by significantly lower frequency of relapses, lower duration of chest tube insertion, and lower duration of hospital delay.

COMPLIANCE OF INITIALLY PRESCRIBED ANTI-TUBERCULOSIS TREATMENT REGIMENS WITH COMPLETE DRUG SUSCEPTIBILITY TEST RESULTS AND ITS ASSOCIATION WITH TREATMENT OUTCOMES IN GEORGIA (2015-2020).

Georgia has countrywide access to the genotypic and phenotypic drug susceptibility testing (gDST and pDST), however identification of susceptibility to the different anti-Tuberculosis (TB) drugs in different time period, not in all cases gives us opportunity to simultaneously know susceptibility to the all anti-TB drugs and to build an appropriate treatment regimens based on complete individual DST profile in timely manner. Initial TB treatment regimen prescribed based on gDST results not in all cases may be compliant with complete DST profile, which may be detected based on pDST results within eight weeks only. It's important to know proportion of TB patients, who in period between gDST and pDST results are treated with regimens which is non-compliant with complete individual DST profile and how the use of these inappropriate treatment regimens may affect TB treatment outcome. The aim of the study was to assess compliance of anti-TB treatment regimens with complete DST profile in period between gDST and pDST results and its association with treatment outcomes among patients who initially was registered as drug sensitive TB (DS-TB) cases in Georgia. A retrospective cohort study was conducted among 8468 patients initially registered as DS-TB adult (18+) cases, from 2015 - 2020 cohorts, whose DST profiles and anti-TB treatment outcomes was known. Adjusted analysis of the study participants data [8468 (100%)] shows significant association of a successful TB treatment outcome with the "appropriate treatment regimen" (adjusted OR 3.3, 95% CI: (2.43-4.48), p<0.001), "female gender" (adjusted OR 1.69, 95% CI: 1.47 - 1.94, p<0.001) and with "new TB case" (adjusted OR 2.15, 95% CI: 1.91-2.42, p<0.001). From 184 patients, for whom between gDST and pDST results an inappropriate 2 month treatment was used, in 171 (93%) cases the resistance to the Isoniazid was detected (Rifampicin resistance in 52 (28%), Ethambutol resitance in 44 (24%) and Ofloxacin rsistance in 16 (9%) cases was detected). Based on study data discordance between Xpert MTB/RIF and culture tests were revealed. From all 7221 (85.3%) Xpert (MTB+) cases, only 5915 cases were culture positive too. All 400 (4.7%) patients with Xpert (MTB-) results were Culture positive. In 664 cases with Xpert (MTB+) results, Culture was negative. For successful outcomes, all efforts should be done to have the individual and complete DST profiles of all patients at initial stage of TB diagnosis. Otherwise, in case of delayed DST results anti-TB treatment for a certain period maybe inappropriate and can raise the risk of non-successful outcome.

[RISK FACTORS AND SPECIAL ASPECTS FORGENITAL TUBERCULOSIS DIAGNOSTICS].

Was examined 453 women, who applied to National Center for Tuberculosis and Lung Diseases for genital tuberculosis diagnostics. GTB was detected in 289 cases, in 164 cases GTB results was negative (control group). In 10 cases GTB was combined with pulmonary tuberculosis (OR-1,13). Risk factors are previous diseases of female reproductive organs- intracellular infection (OR-1,08), sexually transmitted diseases (OR-1,25), nonspecific inflammatory diseases (OR-1,009), interruption of pregnancy (OR-1,26), artificial abortions (OR-1,11), the most specific signs of Genital Tuberculosis is a pain in the stomach area (P-0,023), dysmenorrhoea (P-0,00001), intestinal obstruction (P-0,0006), heat (P-0,00001), liquid presence in posterior vault (P-0,007), hydrosalpinx (P-0,00001), Fallopian tubes deformation (P-0,000003), oophoritic cyst (P-0,067), adhesive process in small pelvis (P-0,0006). Lab tests used to study material showed high specificity of cytological (Sp - 78,05%), bacteriological (Sp - 96.4%) and morphological (Sp - 98.78%) methods, as a result of their low sensitivity (Se - 28.03%, 96.4%, 98.78%, respectively). As for PCR diagnostics, in this case both the sensitivity and specificity is of high level (Se - 77.98%, Sp - 82.11%).

Stenting of the left main bronchus in cicatrical post-TB bronchial stenosis (case report).

The primary treatment of endobronchial tuberculosis complicated by bronchial stenosis is antituberculous chemotherapy. Surgical resection and bronchoplastic reconstruction has long been the standard treatment. However, bronchoscopic intervention is essential to restore the patency of the involved bronchus and controlling TB. To our best knowledge this is a first report of bronchial stenting in Georgian Republic. We performed this procedure in cooperation with interventional cardiologists from Cardiac Catheterization Laboratory "HELSY T.E." Ltd. which have wide experience in stenting manipulations. A 24-year-old woman, after treatment with antituberculous medications for pulmonary tuberculosis, suffered by cough, dyspnea, wheezing. CT scan showed stricture of the left main bronchus starting from bifurcation to the end and having a lumen diameter 2mm. Bronchoscopic examination revealed focal narrowing to pinhole size to the left main bronchus with severe fibrotic changes. We decided to perform endobronchial stenting. Under general anesthesia, balloon-expendable, metallic, non-covered stent (Medtronic) was inserted across the stenotic lesion and was expanded under the pressure of 9 atmospheres using Indeflator Perouse Medical. Bronchography, taken immediately after stent insertion, showed an expanded left main bronchus. Postoperatively the patient did well. Chest radiographs taken after 6 days demonstrating a fully expanded stent, mediastinal repositioning towards the midline and normal aeration of the left lung. Patient's dyspnea was much improved. The patient has now been asymptomatic for 3 months. In conclusion, this case describes a patient with a cicatrical post-TB bronchial stenosis that was effectively treated by bronchoscopic stenting, which is alternative to surgical resection thus avoiding unwarranted thoracotomies and providing quality of life.

[Study of epidemiological situation of HIV associated TB in Georgia].

The goal of the work is to study epidemiological situation of TB/HIV coinfection in Georgia. The research was based on the study of TB prevalence among 766 HIV/AIDS patients registered at the National Centre of Infections Diseases, AIDS and Clinical Immunology in 1989-2004; determining of HIV status among 3084 patients with active TB, treated in the hospital of the National Centre of TB and Lung Diseases, Abastumani TB-hospital and Ksani prison Analysis of the obtained data showed that dynamic of TB/HIV coinfection in the period of 2000-2004 varied from 2,1% to 3,8%. Results show low indicators of HIV associated TB prevalence in Georgia. Taking into account slow but stable increase of HIV/AIDS new cases and complicated, but manageable epidemiological situation in regard to TB, increasing of the cases of HIV associated TB can be expected.

Argyrophilic nucleolar organizer regions in benign and malignant mesothelial lesions.

The aim our study was to assess the usefulness of AgNOR stain in distinguishing between benign and malignant mesothelial lesions. The patients were divided into three groups: group I -- reactive mesothelium (71 cases), group II -- hyperplastic mesothelium (66 cases), group III -- epithelial type mesothelioma (52 cases). Smears were stained by Pap and AgNOR methods. After staining, all cases were randomized for blind evaluation. Each case was viewed independently by two observers. AgNORs were identified as black, usually spheric particles observed within the nucleolus. For each cell, the number of AgNOR-positive cells and the number of AgNOR-dots per nucleus were counted. Our results show that AgNOR staining is useful to differentiate epithelial type mesothelioma and benign mesothelial lesions such as reactive and hyperplastic mesothelium. This differentiation is based primarily on the mean number of AgNOR-dots per cell rather than number of AgNOR-positive cells. AgNOR is highly sensitive, specific and cost-effective technology which can be used as an ancillary diagnostic approach for distinguishing between reactive and/or hyperplastic changes of mesothelium as well as in differential diagnosis of epithelial type mesothelioma.