MEDICO-LEGAL APPLICATIONS OF FRACTURE HEMATOMA: REVIEW.

This review aimed to elucidate the critical role of fracture hematoma in forensic medicine, with a specific focus on its utility in differentiating antemortem from postmortem fractures. The study seeks to provide a comprehensive synthesis of current knowledge on the subject, highlighting the biological and medico-legal implications of fracture hematoma analysis in forensic investigations. A systematic review of literature was conducted, encompassing various scientific databases including PubMed, Scopus, and Web of Science, focusing on studies published from 2000 to 2024. The search employed keywords such as "fracture hematoma," "antemortem fractures," "perimortem fractures" and "postmortem fractures," among others, to explore relevant data. Selected studies were scrutinized based on their relevance, the presence of substantial data on fracture hematoma, and their contribution to forensic analysis. The review underscores the significance of fracture hematoma as an indicator of antemortem injuries, revealing that active blood circulation at the time of injury facilitates hematoma formation. Detailed analyses within the selected studies illustrate the interplay of cellular and molecular dynamics within fracture hematomas, emphasizing the roles of cytokines, particularly IL-6, and cellular constituents in the healing process. Fracture hematoma analysis emerges as a vital forensic tool in establishing the vitality of bone fractures, enhancing the accuracy of forensic assessments. However, the review also acknowledges the challenges posed by individual healing variability and postmortem changes, suggesting a need for further research to refine the interpretative frameworks used in forensic hematoma analysis.

NEEDS ASSESSMENT FOR EFFECTIVE CONTINUOUS PROFESSIONAL DEVELOPMENT OF PHYSICIANS IN GEORGIA.

At all levels--from individual to national- Continuing medical education (CME,) competency-based continuing professional development (CPD) planning should incorporate objectively determined quality, program utilization, and other objective data as well as more subjectively determined needs as perceived by individual physicians. The study aims to conduct self-recognized/perceived needs assessment for CME/CPD among certified physicians working at TSMU University Clinics and TSMU affiliated clinics different regional cities of Georgia: Kutaisi, Batumi, Kareli; Provide quantitative and qualitative analysis of the completed questionnaires to identify discrepancies and find the differences between forecasts and actual data, recognize their causes and devlop recommendations for clinical skills development, new knowledge dissemination, and barrier avoidance. Medical Doctors were interviewed by specially designed on-line surveys in various regions of Georgia, including the capital. The answers provided by respondents indicate, that clinicians today are responsive to activities that are practice-relevant, efficient, effective, rewarding, and more personalized. Physicians prefer evidence-based, clinical CME topics that address a major aspect of their practice and that potentially provide an opportunity to learn new skills.

CONTINUOUS PROFESSIONAL DEVELOPMENT OF HEALTHCARE WORKERS - ANALYSIS OF THE CURRENT STATE.

Nowadays Continuous medical education means motivated continuous professional development based on competencies of medical workforce and other healthcare professionals. Its purpose is to identify and fill a gap in knowledge and practical skills that is determined by the development of technologies and changes, which occur in the healthcare system, the regulatory environment, and society in general. Result of good quality can be achieved with close collaboration of stakeholders and high-quality programs based on the competence, of which basis shall be a solid legislative framework and a relevant motivational environment as for professionals also employers. A new phase in the continuous professional training of medical staff started in Georgia 2018. Forms of Continuing Medical Education, Accreditation Procedure and Criteria were approved by the Order №01-3/N of the Minister of Labor, Health and Social Affairs of Georgia. The old orders were invalidated which made difficulties for CPD as a professional development mechanism. Professional preparedness and competency of health workforce, effective evaluation of productivity and quality of continuous medical education are particularly important in the Healthcare system of Georgia for achieving sustainable development goals supplied by World Health Organization with a view to better responding to the health needs of people, taking into account the special needs of country.

PROLIFERATIVE/STEM CELL INDEX AND PHENOTYPIC CHARACTERISTICS OF PROLIFERATIVE PROCESSES IN ENDOMETRIUM.

The aim of the study was to explore and identify the relationship between endometrial proliferative/stem cell index and phenotypic characteristics under proliferative processes of endometrium using statistical correlation analysis. The study represents a retrospective research. The coded and depersonalized material data from Acad. N. Kipshidze Central University Clinic was used in the study. 5 study groups (83 cases) were selected from routine histopathology tissue specimens of uterus. Hematoxilyn-eosin technology and immunohistochemistry with markers ki67, CD146, PTEN was performed. The proliferative/stem cell index (PR/ST index) was calculated by the ratio of Ki67-positive cell percentage value divided by CD146-positive cell percentage value. PTEN expression score was evaluated by next scheme - PTEN positive cell numbers <10% - conditional negative, PTEN positive cell numbers 10-50 % - heterogenic, PTEN positive cell numbers >50% - conditional positive. The study showed that, PR/ST index in 1st study group Endometrial Hyperplasia ranges within the interval 15-23, PTEN is diffusely positive with focal heterogeneity 11.1%. 2nd study group Endometrial Dysplasia, the PR/ST index ranges within the interval 16.5-23.3. PTEN heterogeneity is 18.3%, negativity - 6.3%. 3rd study group Endometrioid Carcinoma Grade 1, the PR/ST index ranges between 21.7 and 25.5. PTEN is heterogenic in 35.7% of cases, negative in 14.3% of cases. 4th study group Endometrioid Carcinoma Grade 2, the PR/ST index ranges within the interval 23.2-27.8. PTEN is heterogenic in 43.5% of cases, negative in 30.4% of cases. 5th study group Endometrioid Carcinoma Grade 3, the PR/ST index ranges within the interval 25.8-29.4. PTEN is heterogenic in 33.3% of cases, negative in 41.7% of cases. It was found that, in endometrial hyperplasia and dysplasia cases the PR/ST index do not correlate with phenotypic characteristics, while in the cases of endometrial carcinoma different degrees of malignancy the PR/ST Index and phenotypic characteristics intensely and directly correlates. The high attention should be given to the fact that heterogeneity peak of PTEN expression takes place in the cases of endometrial carcinoma G2, but the negativity of PTEN protein is increasing in parallel with the malignancy increasing process and reaches peak performance in cases of endometrial carcinoma G3.

SPECIFICITIES OF ENDOMETRIAL PROLIFERATION/STEM CELL INDEX DISTRIBUTION IN ENDOMETRIOID CARCINOMA OF DIFFERENT GRADE OF MALIGNANCY.

Endometrial neoplasia is the most common malignant tumor of female genital system in developed countries. The incidence of endometrial cancer has increased in the last years and despite advances in diagnosis and treatment, the death rates have steadily been increasing over the past 20 years. Therefore aspects of endometrial cancer development, pathogenesis and effective treatment is especially urgent to this day, as much of the risk for endometrial cancer development is influenced by the environment and lifestyle. Endometrial stem cells take the special place among somatic stem cells of female reproductive system-the detection of them and identification of their location in the complex cellular hierarchy still remains challenging. Further study of endometrial stem cells will clarify their role in gynecologic pathologies associated with hyper-proliferative states of endometrium. The aim of our study was to explore the specificities of endometrial proliferative/stem cell index distribution under endometrioid carcinoma of different grade of malignancy. The study represents a retrospective research. The coded and depersonalized material data from Acad. N. Kipshidze Central University Clinic was used in the study. 3 study groups - 1st study group "Endometrioid Carcinoma Grade 1" (14 cases), 2nd study group "Endometrioid Carcinoma Grade 2" (23 cases) and 3rd study group "Endometrioid Carcinoma Grade 3" were selected from routine histopathology tissue specimens of uterus. Hematoxilyn-eosin technology and immunohistochemistry with proliferation marker ki67 and stem cell marker CD146 was performed. The proliferative/stem cell index was calculated by the ratio of Ki67-positive cell percentage value divided by CD146-positive cell percentage value. The study showed that in the 1st study group labeled as "Endometrioid Carcinoma Grade 1", the proliferative/stem cell index ranges between 21.7 and 25.5. Its mean average value in the age distribution subgroups accounts for: 1.1) reproductive age - 22.4; 1.2) menopause - 23.5; 1.3) post-menopause - 24.8. Proliferative/stem cell index reaches its maximum in the samples retrieved from post-menopause age, and decreases significantly in reproductive age individuals. In the 2nd study group labeled as "Endometrioid Carcinoma Grade 2", the proliferative/stem cell index increases and ranges within the interval 23.2-27.8. Its mean average value in the age distribution subgroups accounts for: 2.1) reproductive age -23.7; 2.2) menopause - 24.2; 2.3) post-menopause - 25.8. In the 3rd study group labeled as "Endometrioid Carcinoma Grade 3", the proliferative/stem cell index markedly increases and ranges within the interval 25.8-29.4. Its mean average value in the age distribution subgroups accounts for: 3.1) reproductive age - 28.4; 3.2) menopause - 28.5; 3.3) post-menopause - 28.5. It was found that average value of proliferative/stem cell index in the 1st and 2nd study groups (EC Grade 1/2) keeps the same tendencies of increase in age subgroups as well as at endometrial hyperplasia conditions - in particular in both study groups increase in value of the proliferative/stem cell index in age subgroups makes about 1% (1st study group-0,97%, 2nd study group-0,96%). What about 3rd study group (EC Grade 3) average value of proliferative/stem cell index in age subgroups is almost the same. It was found that average value of proliferative/stem cell index in endometrioid carcinoma most markedly differs from the norm in post-menopause period. The study showed that average value of proliferative/stem cell index in endometrioid carcinoma cases (EC Grade 1/2) tends to increase with age like endometrial hyperplasia conditions, in contrast with the norm, where it is observed to progressively decrease with aging. The attention should be given to the fact that the mean average value of proliferative/stem cell index in endometrioid carcinoma Grade 3 is almost constant.

AGE-RELATED SPECIFICITIES OF ENDOMETRIAL PROLIFERATION/STEM CELL INDEX DISTRIBUTION.

Endometrial stem cells take the special place among somatic stem cells of female reproductive system, since their essence and nature still remains unclear - cellular complexity of endometrium, its hormone-dependence and cycling remodeling makes the study of endometrial stem cells exclusively complicated. Consequently, the detection of endometrial stem cells and identification of their location in the complex cellular hierarchy still remains challenging. The aim of our study was to explore the age-related specificities of endometrial proliferative / stem cell index distribution under normal and hyperplasia conditions. The study represents a retrospective research. The coded and depersonalized material data from Acad. N. Kipshidze Central University Clinic was used in the study. 2 study groups - 1st study group "Norm" (12 cases) and 2nd study group "Endometrial Hyperplasia" condition (18 cases) were selected from routine histopathology tissue specimens of uterus. Hematoxilyn-eosin technology and immunohistochemistry with proliferation marker Ki67 and stem cell marker CD146 was performed. The proliferative/stem cell index was calculated by the ratio of Ki67-positive cell percentage value divided by CD146-positive cell percentage value. The study showed that in the 1st study group labeled as "norm", the proliferative/stem cell index ranges between 8 and 16.5. Its mean average value in the age distribution subgroups accounts for: 1.1) reproductive age - 10.6; 1.2) menopause - 4.5; 1.3) post-menopause - 1. In the 2nd study group labeled as "endometrial hyperplasia", the proliferative/stem cell index markedly increases and ranges within the interval 15-23. Its mean average value in the age distribution subgroups accounts for: 2.1) reproductive age - 18; 2.2) menopause - 18.2; 2.3) post-menopause - 18.5. It was found that proliferative/stem cell index in the 1st study group labeled as "Norm" progressively decreases with aging, while in the 2nd study group labeled as "Endometrial Hyperplasia" it behaves opposite and increases with age. Moreover, it must be noted that proliferative/stem cell index in endometrial hyperplasia cases with regard to norm increases significantly, namely in the subgroups 1.1/1.2 (which is reproductive age) it increases 1.5 times, and in the subgroups 1.2/2.2 (which is menopause age) it increases 2.5 times, while in the subgroups 1.3/2.3 (which is post-menopause age) it increases 18.5 times. The high attention should be given to the fact that the mean average value of proliferative/stem cell index in endometrial hyperplasia most markedly differs from the norm in post-menopause period.

Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel, inhuman or degrading treatment or punishment.

In some jurisdictions attempts have been made to limit or deny access to medical records for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance of full disclosure of all medical and other health records, as well as legal documents, in any case in which an individual alleges that they have been subjected to torture or other forms of cruel, inhuman or degrading treatment of punishment. A broad definition of what must be included in the terms medical and health records is put forward, and an overview of why their full disclosure is an integral part of international standards for the investigation and documentation of torture (the Istanbul Protocol). The fact that medical records may reveal the complicity or direct participation of healthcare professionals in acts of torture and other ill-treatment is discussed. A summary of international law and medical ethics surrounding the right of access to personal information, especially health information in connection with allegations of torture is also given.

Pancreatic D-cells in aging and intraislet effects of pancreatic somatostatin.

In old organisms pancreatic D-cells are not changed in number. During the aging in mentioned cells takes place the intensification of secretory and extrusive functions, which are more prominent in old organisms than in young ones. Peripherally situated D-cells are vascularly ineffective within the pancreatic islet and do not suppress locally B- and A-cells. D-cells' major target tissue may be pancreatic acinar cells. Functionally activated D-cells in old organisms may play the main role in the development of involutive processes in exocrine pancreas and in its atrophy. Stagnation of the secretory granules in pancreatic A- and B-cells in old ages could not be caused by influence of paracrine effect of somatostatin. The given process could be considered as a result of reduction of energopotentials and suppression of signal ways for initiation of insulin and glucagon secretion. Respectively, extrusion impediment of secretory granules resulted in their stagnation could be explained by suppression of exocytosis as an energy- and signal-dependent process. We suppose that cytotopographic and microvascular peculiarities of pancreatic islets in human beings and rodents is a reflection of intensification of insulin apparatus and is directed to loose the B-cells from the local (microvascular or paracrine) influences (effects of D- or A-cells). The mentioned is of high physiological importance (especially in the process of aging) for the organisms of above-presented taxonomic groups due to rich amount of carbohydrates in their food ration. The above-mentioned fact gains the special importance in human beings, where evolutionary "solitary" (represented by single B-cells) insulin apparatus is faced with evolutionary "rooted" strong and diverse contrainsulin apparatus, leading to development of diabetes mellitus (type 2) in late ages.

Morphological characteristics of tissue damages from electrical contact.

The purpose of the study was to reveal the morphological pattern of different tissues mostly vulnerable to electric contact injury from domestic electrical appliances and to determine the possible diagnostic criteria of this damage. The matter is of particular importance as domestic electrical appliances are widely used in torture and other cruel, inhuman and degrading treatment or punishment. The pilot part of the study was experimental and as the material of study have been used adult Wistar white rats. The microscopic study of slides taken from tissues damaged by electricity and dyed by routine Hematoxilin-Eosin reveals general structural changes that does not represent characteristic morphological pattern sufficient for forensic diagnosis of electric injury. The electricity damage of kidney and adrenal glands reflects the morphological pattern of stress that allows complex evaluation of damage but could have only orientating value for the estimation of cause of injury. Due to results obtained from pilot part of the study there is considered in regard to determine the possible diagnostic criteria for electrical injury of tissues the experimental morphological study must continue on skin and myocardial material using routine Hematoxilin-Eosin as well as other classical and modern morphological methods of study.

Assessment of physicians awareness of patient's rights in Georgia.

Georgian Parliament adopted the law on Patients' Rights in 2000. The Georgian legislation on Patients' rights covers most of the universal European principles of patients' rights. The overall purpose was to determine the level of physicians' knowledge and understanding of patient's rights from the point of physicians' view. 200 physicians from 12 medical institutions were surveyed by method of interview. During the process of surveying the respondents mostly indicate to necessity of expanded information of patients in terms of payment for medical services, information dealing with test results, diagnosis and treatment, prognosis of disease. According to physician's view, the patients are less informed that reflects in delayed visit to physician. Data from the surveyed physicians shows that one of the most significant problems is related to informed consent on medical manipulations. As it was revealed most of them did not require informed consent during their practice. The authors of study come to a decision, that the need to adopt new instruments for protection of patients' rights during and after medical care and elimination of any violence of rights is of the highest importance and one of the main priorities for national health care.

Morphological pre-conditions of diabetes mellitus' development under chronic lipid-loading during aging.

Chronic lipid loading in pancreatic beta-cells of young and old animals causes the intensification of secretion the morphologic equivalents of which are revealed by elevation of number and sizes of mitochondria, granular endoplasmatic reticulum and Golgi apparatus of beta-cells with the quantitative increase of intraorganelle ultrastructures and decrease of volume share and number of secretor granules, which are more prominent in old animals. After definitive period following the chronic lipid loading the secretor processes in young age are normalized (organelles turn back to their initial volume state and consist of the same initial number of intraultrastructures), whereas in old age -- are markedly lower compared with the norm (size and number of organelles and their inner structures are decreased; volume part of secretory granules is increased); in some part of beta-cells complete block of secretion takes place (in the part of beta-cells the irreversible changes are developed; stagnation of secrete is prominent). Therefore any metabolic disease or syndrome running on the background of chronic lipidemia, seems to be a risk-factor for development of Diabetes Mellitus in organisms of old age.

Stereometrical peculiriaties of energy-forming ultrastructures of pancreatic beta -cells under lipid loading during aging.

Chronic lipid loading in pancreatic beta -cells mitochondria of young and old animals causes the activation of ATP generation necessary for insulin secretion, activation of signalling system necessary for initiation of insulin secretion (the morphologic equivalents of which are revealed by elevation of volume share of mitochondrial matrix and increase of volume and number of crysts in the beta -cells), more prominent in old organisms. After loading with lipids in the certain term in young age mitochondrial processes are normalized (matrix turns back to initial volume, the crysts - to initial size and number), whereas in old age in comparison with the norm the activity of ATP-synthesis and signalling system are markedly impaired (significant decrease of matrix volume part and number of crysts, very marked elevation of volume part of aggregative-destructive sites, most important widening of intramembranous space); in some part of mitochondria complete energetic lack and blockage of signalling system take place (in some mitochondria the destructive-disorganization processes are markedly evident).