ONYCHOLYSIS AS A COMPLICATION OF TAXANE-BASED CHEMOTHERAPY WITH CONCOMITANT CRYOTHERAPY IN BREAST CANCER PATIENTS: TWO CASE REPORTS.

Nail changes are a common side effect of taxane chemotherapy, although onycholysis is quite a rare complication the correct management of which is poorly standardized. These case reports provide a description and analysis of onycholysis, a rare but noteworthy complication observed during taxane-based chemotherapy with concomitant cryotherapy in two patients with breast cancer. Despite prophylactic measures, both cases experienced nail complications during Paclitaxel treatment, underlining the complex nature of onycholysis during taxane therapy and highlighting the critical role of nail assessment and infection screening.

EPIDEMIOLOGICAL STUDY OF INJURIES IN THE EMERGENCY DEPARTMENT OF THE UNIVERSITY HOSPITAL OF GEORGIA.

Injuries represent a significant burden on societies, resulting in deaths and health care costs incurred during Emergency Department visits and hospitalizations. This research aimed to estimate the burden of traumatic injury of patients treated and evaluated in the Emergency Department of the University Hospital in Georgia. A retrospective study was conducted at the University Hospital of Georgia for all trauma patients from January 1, 2018 to June 30, 2018. Visits were identified from existing electronic medical records, using the iCREATE Registry as a model. Data collected included patient demographics, injury characteristics, and injury costs. To estimate the direct costs of trauma treatment, data were obtained from the cost accounting database. A total of 2445 injured patients aged 0 to 91 years were medically examined during the study period and about 65% of them were male. Most of the injured patients were school-age children (31%). The leading mechanism of injury in the Emergency Departments were falls (45%). Most of the patients (78%) suffered from moderate injuries and needed only outpatient treatment. The total direct costs for all patients were $248 628. Fall-related injury costs accounted for most direct medical costs (51%), followed by road traffic crashes related costs (23%). Road traffic injured patients had the highest total mean costs ($269). Injuries result in a substantial number of Emergency Department visits and significant medical costs in Georgia. Understanding the characteristics of these injuries is essential for targeting injury prevention.

A RETROSPECTIVE STUDY OF THE MAXILLOFACIAL INJURIES IN TWO EMERGENCY DEPARTMENTS IN TBILISI, GEORGIA.

Maxillofacial injuries are a global problem in our modern society. It can be a major cause of increased morbidity and mortality. Maxillofacial trauma can lead to scar distortion accompanied by emotional and psychological problems. The epidemiology of facial fractures varies in terms of trauma type, the extent of injury, and severity. The main aim of this research is to explore the scope, the burden, and the etiology of maxillofacial injuries in Tbilisi, Georgia. Data was retrospectively collected from two large emergency departments in Tbilisi, Georgia using a cross-sectional design. Inclusion criteria was patients admitted in hospitals during one year with diagnosis maxillofacial injury. SPSS 21 software was used for statistical analysis. Differences in categorical variables were assessed with Chi-square tests of independence. This research shows that men are still the most frequent victims of maxillofacial injuries. Out of 598 patients, whose age ranged from 1month to 87 years - 67% were males, and 33% patients were females, including both, maxillofacial trauma alone and also combined injuries. With only maxillofacial injuries, the male patients were still leading, with 51% (307) and female patients were 28% (167), these results gave us a statistically significant difference (p=0.026). The main causes of maxillofacial injuries were falls, which equaled to 63% (378 patients) from total recorded data, as in many other countries. The results of this research provide really important information about future preventive interventions in the country. It also shows us that educating the public with prevention strategies is substantial.

FALL RELATED GERIATRIC TRAUMA TRENDS IN GEORGIA.

The main of the study was to examine the overall trends and epidemiologic characteristics of fall-related hospitalizations in the population aged 65 years and above in Georgia. For this observational study Hospital database was used. Data were collected from all hospitalized patients aged 65 years and above during 2015-2021 in the country. The number of geriatric patients hospitalized with fall-related injuries increased in 2021 compared with 2015. The upward trend in hospitalizations from 2015 to 2021 was reversed only during the Covid-19 pandemic in 2020. Fall-related hospitalizations are more frequent in women (p<0.001), the women-to-men ratio is 2:1. The highest hospitalization rate of 23% (n=6768) was in the 80-84 age group, followed by the 75-79 and 65-69 age groups at 22% (n=6517) and 21% (n=6146), respectively. The frequency of hospitalizations increases with age (p<0.001). In all other age groups except for the 65-69 age group (OR 0.99; 95% CI, 0.94-1.04, p=0.747) the number of fall-related hospitalizations was significantly higher in women than in men. During the study period about half of hospitalizations (51%) were caused by hip injuries. According to age groups, the longest average hospital stay was recorded in the 85+ and 80-84 age groups (5.6 ± 4.5 and 5.3 ± 5.1days, respectively). The number of male fatalities was higher than that of female fatalities (OR 2.57; 95% CI, 2.23 - 2.97). The highest in-hospital mortality was in the 85+ age group (5%). Falls presented the leading mechanism for hospitalization of elderly patients admitted with geriatric trauma. The key epidemiologic characteristics identified in the 7-year study of fall-related geriatric trauma trends provide an evidence-based framework for the development of more effective patient management strategies and appropriate preventive interventions among the population aged 65 years and above.

[Primary hyperaldosteronism: indications for screening].

The review discusses the current state of the problem of screening patients for early detection of primary hyperaldosteronism (PHA) as a potential cause of arterial hypertension (AH). The features of screening, methodological errors that make it difficult to interpret the results of the study are considered. The screening criteria are analyzed, based on which it is possible to assess the probability of diagnosis of PHA and judge its prevalence in various populations of patients with AH categories of high risk for the development of PHA. Attention is drawn to the low level of screening in patients with AH in order to detect PHA , and to the need for wider familiarization of doctors with the methods of screening and diagnosis of PHA as the cause of uncontrolled AH. The importance of timely diagnosis of PHA and its targeted treatment to reduce the risk of cardiovascular complications associated with hypersecretion of aldosterone is emphasized.

TRACKING PREGNANCY OUTCOMES: DATA FROM BIRTH REGISTER OF GEORGIA.

Reliable and high quality data are critical to identify issues related to maternal health and factors affecting the reproductive health as well as to measure progress towards the Sustainable Development Goals. In 2016, an electronic case-based system for antenatal and obstetric services, so called "Georgian Birth Registry" (GBR), which provides continuous monitoring of pregnant women from the first antenatal visit until childbirth, was introduced in Georgia. GBR gave the possibility to describe maternal and child health, as well as reproductive health issues in correlation with different social factors, which influenced the fertility and pregnancy outcomes. In Georgia there is a lack of study addressing pregnancy outcomes. The aim of the research is to study influence of education, employment status and place of residence on pregnancy outcomes among women in Georgia. Methods. GBR data from 2018 has been used for this study. Results. The most important overall findings are: pros - high percent of timely initiation of first visit (from 70% to 80% and more) for all observed women, cons - the high rates of unplanned pregnancies (52%), particularly in adolescents (47%), high rates of abortions (31%), high percent of C-Sections, without indication in adolescents (25%). Tracking pregnancies and their outcomes trough registry system is an innovative approach for LMICs, which gives an opportunity to correlate some social-economic and behavioral characteristics in female population that can help in determining the preventive interventions aimed to reduce maternal and perinatal morbidity and mortality in LMICs.

[Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management].

The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

TRAUMATIC BRAIN INJURIES IN CHILDREN IN PRACTICE OF PEDIATRIC HOSPITAL IN GEORGIA.

Traumatic brain injury (TBI) is a leading cause of death and permanent disability in children and adolescents. Study of TBI with reliable and high-quality data represents the basis for effective strategies for injury prevention. The database of the National Center for Disease Control and Public Health of Georgia for 2018 was studied to identify TBI cases treated at the largest children's hospital in Georgia. Cases were included based on the S06 diagnosis coded of ICD-10. Descriptive statistics were used to describe traumatic brain injuries. М. Iashvili Childrens'hospital treated 296 pediatric brain injuries in 2018. TBIs were more common in boys (n=180, 61,1%) than in girls (n=116, 38,9%), and patients aged 10 -14 were most frequent. 8 (4,4%) of male patients and 2 (1,7%) of female patients required more than 15 days of in-patient treatment. More than two thirds of children had suffered TBI due to falling 198 (66.6%), followed by road traffic injuries 56 (18.9%) and other type of blunt force 42 (14.2%). 54.3% of all TBI patients required at least one day of hospital stay. Most of the TBI patients 220 (74,3%) were brought to the hospital by private transportation. In-patient treatment was completed in 293 (98.9%) of cases, three (1%) male patients died. In all three cases of lethal outcome, the cause of injury wasroad traffic. Based on existing data, it was possible to study just part of TBI epidemiological properties. TBI national reporting formats do not cover information about location and time of injuries, place of occurrence, therapeutical treatment and severity of the illness. To study the full epidemiological picture of TBI, retrospective studies based on the medical history in hospitals are needed.

PERCEPTION OF ORAL PROBLEMS IN PATIENTS WITH ADVANCED CANCER.

The results of the previous research, aimed to study the per-ception of and attitude to the end-of-life in the incurable cancer patients as well as the elderly aged 85 and older, revealed that independently from the cause of the life limitation, perceptions of and attitudes to the end-of-life are mainly similar. Moreover, it must be highlighted that the complaints on oral cavity were stated only by the single patients from the sample. We aimed to verify if the less attention from the sides of pa-tients towards the oral cavity symptoms/complaints were caused by the "poor" format of semi-structured interviews that were not focused on the oral status. The sample of the research included 50 advanced cancer pa-tients aged 20 to 75, under integrated palliative treatment (care). We applied for two-part questionnaire in the first part of which the patients had to choose one out of the alternative answers to the concrete questions related to oral cavity problems. The sec-ond part of the questionnaire was filled by the researcher/dentist based on the information obtained through examination of the patient's oral cavity. Based on the results of the data processing it was concluded that conditions recorded by a dentist were more severe and seri-ous in comparison to what the patients stated. Furthermore, it must be taken into consideration that the con-ditions and pathologies of oral cavity registered during our re-search are subject to improvement and treatment and, relevant-ly, their correct management has potential to improve the quality of life for incurable cancer patients.

Digital cognitive behavioral therapy for insomnia - The first Georgian version. Can we use it in practice?

Insomnia is a common sleep disorder which has a 5-6% prevalence rate and shows high social impact. At least 10% of patients with insomnia will see a medical specialist. Hence, 20,000-40,000 people in Georgia require medical help for insomnia. Treatment of insomnia is very effective. Pharmacotherapy is common, but it is recognized that cognitive behavioral therapy (CBT) is a better choice, since it is safe for patients and shows sustainable improvement. CBT of insomnia is not currently available in Georgia. The aim of our study was to evaluate a Georgian version of an innovative, internet-delivered digital CBT (dCBT) for insomnia in terms of therapeutic efficacy, adherence, and ease of handling. The Georgian digital cognitive behavioral therapy for insomnia was developed as an analogue of Dutch dCBT "i-Sleep." All online materials were made applicable for the Georgian population through translation, validation by translation back to the original language, and adaptation to the Georgian reality, in order to avoid linguistic, cultural, and social pitfalls. Fifty-two adult patients with insomnia were recruited for the study: 34 women and 18 men, aged 18-64 years (mean: 33.5 years). Inclusion criteria included: age over 18, access to internet, and sufficient skills to use electronic devices. The patients who were treated pharmacologically continued their usual medication and received dCBT in addition to this treatment. DCBT was guided by a therapist. Clinical efficacy was evaluated on the basis of Insomnia Severity Index (ISI), measured before the dCBT and one month after its completion. 25 out of 52 patients (48%) completed a full dCBT course. Mean ISI in this group dropped from 22.88 to 8.24 (P < 0.01), showing significant therapeutic effect one month after CBT completion. 27 patients (52%) stopped treatment for various reasons at different stages of dCBT. Sixteen patients dropped out from the first module (31%). 7 patients older than 50 years encountered problems with handling electronic devices and the platform itself. 9 patients stopped therapy, showing bad adherence for different reasons, mostly related to finding the sessions time-consuming and being disappointed by the absence of immediate therapeutic effect. Eleven more patients (21%) stopped at sleep restriction, finding it difficult to accomplish sleep restriction-related tasks. In general, patients found dCBT quite comprehensive and easy to handle. This data suggests that the Georgian version of dCBT for insomnia is a promising therapeutic tool, comparable with international analogues in terms of efficacy and adherence. Further studies, involving a greater number of patients and long-term follow-up are required for the final assessment of therapeutic efficacy and sustainability of results.

PUBLIC ATTITUDES TOWARDS THE USE OF ANIMALS IN BIOMEDICAL RESEARCH IN GEORGIA.

In different societies there are different opinions about moral and ethical aspects of animal testing in biomedical research. Many studies have been conducted worldwide since 1980s to evaluate public perception and attitude towards the animal research. In EU Eastern Neighboring Countries, including Georgia, ethical aspects of animal usage for biomedical experiments have not been well emphasized. There are no ethical-legal regulations on animal use for biomedical research in Georgia neither on national nor on institutional level. At the same time, public attitude concerning the animal testing for scientific research is unclear. The aim of the study has been to explore public attitudes towards the animal research for the first time in Georgia. In this survey quantitative and qualitative research methods had been used. A special questionnaire was developed and an individual interview method was utilized. Totally 750 interviews were conducted and 715 questionnaires were used for analysis. Codified questionnaires were included in the database and then analyzed with SPSS 27 software. The technique of cross-tabulation was used for the bivariate analysis. For most respondents (68.0%) animal use in Biomedical research is acceptable. 82,0% of respondents fully or partly agreed with the concept, that involvement of animals in experiments which comply to the principles of international norms and regulations (reduction of the number of animals, improving the experiment/lowering pain for animals, and using alternative methods) is acceptable. The results of the study have demonstrated that the attitude of the study sample towards the animal testing in biomedical research is influenced by age (Pearson Chi-Square=32.479, df=8, p<0.05; p=0.000), education (Pearson Chi-Square=27.850 df=12, p<0.05; p=0.006) and occupation (Pearson Chi-Square = 37.767 df=16, p<0.05; p=0.002). Gender, place of residence and experience with owning the pet/animal doesn't have statistically significant influence on the public attitude.  The results of our study highlight that animal testing in biomedical research is acceptable for the respondents involved in the study. However, most of the respondent's consider use of International regulations highly important.

[24-hour systolic wave increment index monitoring in patients with low-renin arterial hypertension].

AIM: To analyze the circadian rhythm of blood pressure (BP) and daily reflected wave values in patients with low-renin hypertension with normal and elevated aldosterone production. SUBJECTS AND METHODS: The investigation included 66 patients. 24-hour BP monitoring was carried out and arterial wall rigidity and reflected wave values were assessed in all the patients. RESULTS: The patients with hyperaldosteronemia were found to have not only statistically significant severer hypertension, impaired circadian rhythms of BP, but also impaired augmentation index (Aix)--mainly its nocturnal increase. A positive correlation was found between nocturnal Aix and resting plasma aldosterone concentrations (r = -0.31; p = 0.002). CONCLUSION: The findings suggest the expediency of 24-hour systolic wave increment index monitoring in hypertensive patients ofthis category.

[Changes in orthogonal ECG in hypertensive patients taking different antihypertensive therapy].

AIM: To ascertain changes in orthogonal ECG in hypertensive patients taking different antihypertensive treatment. MATERIAL AND METHODS: Orthogonal ECG parameters and those of 24-h blood pressure monitoring (BPM) were examined before and after antihypertensive treatment with different drugs in 95 hypertensive patients aged 47 +/- 1 years. Of them, 14 patients received trandolapril+verapamil SR for 2 months, 13 patients--candesartan for 3 months, 25 patients--ramipril for 5 months, 26 patients--carvedilol for 4 months, 10 patients--atenolol for 8 months, 7 patients--doxasozine for 5 months. RESULTS: 24-h BPM parameters improved in all the groups. Initially, conventional ECG evidence on left ventricular hypertrophy was not seen in 86% patients. Dynamics of orthogonal ECG showed that parameters which increase in left ventricular hypertrophy decrease in response to treatment in patients with baseline values above the median. Parameters G and Gx, which in left ventricular hypertrophy diminish, rise significantly in patients with baseline values under median due to therapy. Treatment with impact on renin-angiotensin system reduced voltage parameters of orthogonal ECG, improved G characterizing repolarisation. Treatment with adrenoreceptors blockers reduced IADI. CONCLUSION: The analysis of parameters of orthogonal ECG reveals positive dynamics in response to treatment in patients with insignificant changes on ECG in short follow-up. Drugs of different groups change different parameters of orthogonal ECG.

Human rights for better quality of life.

This article reviews problems of pain relief for incurable patients, in the context of human rights and international standards in this field. In respect to international and national humans and patients rights, regarding to achieve better quality of life, the governments should identify and determine the problems and obstacles that impede opioid use for medical purposes, in aim rich adequate pain relief for incurable patients. Implementation of newly adopted legislation in Georgia into practice will enable to overcome existing barriers; hence these patients will be able to pass their last path of life under care, as much as possible without pain and with dignity.

[Comparative genetic analysis of different forms of low-renin arterial hypertension].

High level of clinical and genetic heterogeneity is a characteristic of arterial hypertension (AH) that is one of the most wide-spread cardiovascular diseases. In most cases (excluding a few monogenic forms), AH is a polygenic disease and genes of renin-angiotensin-aldosterone system play an important role in AH predisposition. 20-25% AH cases occur during low activity of renin in blood plasma (low-renin form of AH) while aldosterone production can be increased (hyperaldosteronism, HA) or normal. We examined polymorphism of genes that code the renin-angiotensin-aldosterone system components in the groups of low-renin forms of AH, namely, primary HA, idiopathic HA and AH with normal level of aldosterone. For all HA cases, the absence of chimeric CYP11B2/CYP11B1 gene that is a cause for monogenic disease--amilial HA of first type, was shown. A comparison of distributions of alleles and genotypes of polymorphous regions of genes: CYP11B2 (C-344T), REN (C-5434T, C-5312T and A BglI G), AGT (Thr174Met), ACE (I/D), CMA (G-1903A), AT2R1 (A1166C) and of their combinations is the groups described above was done. The analysis of carriership of the alleles and genotypes combinations of the polymorphous regions has shown that genes CYP11B2, REN, ACE, CMA andA T2R1 participate in development of low-renin HA. The results are evidence of similarities and some definite differences in genetic nature of the different forms of low-renin AH and, to say more widely, argue that the investigation of genetic predisposition for clinically heterogeneous forms of polygene diseases by comparison of groups of patients, separated in accordance with peculiarities of disease course, holds much promise for their hereditary background understanding.

[The role of tissue myocardial dopplerechocardiography in early detection of structural-functional changes in the myocardium of patients with mild and moderate arterial hypertension].

AIM: To study structural and functional changes in left ventricular myocardium (LVM) of patients with mild and moderate arterial hypertension (AH) with application of tissue myocardial dopplerechocardiography (TMD), correlation between these changes and parameters of electrophysiological remodeling and circadian profile of blood pressure. MATERIAL AND METHODS: Forty-give hypertensive patients were divided into two groups: the study group 2A consisted of 28 patients with mild AH (144.2 +/- 5.8/89.4 +/- 6.6 mm Hg), group 2B - of 17 patients with moderate AH (160.5 +/- 9.1/101.3 +/- 10.2 mm Hg). The control group consisted of 10 normotensive subjects. All the patients were examined using standard echocardiography with assessment of transmitral blood flow, tissue doppler investigation, circadian monitoring of blood pressure, electro-, vector- and decartocardiography. RESULTS: No significant differences in standard doppler, electro- and vectorcardiographic parameters between the patients with mild and moderate hypertension were found. LVM mass index and LV wall relative thickness significantly increased both in 2A and 2B groups vs controls (p < 0.05). Most patients of group 2A and 50% patients of group 2B had no alterations in LV geometry. Lower blood pressure was associated with LV concentric remodeling, higher - with concentric and excentric hypertrophy. In the presence of LV remodeling hypertensive patients developed more pronounced disorders of diastolic function according to TMD compared to hypertensive patients with normal LV geometry (p < 0.05). TMD detected LV diastolic disorders in 82% patients of group 2A and in 94% - of group 2B, while transmitral doppler study detected diastolic dysfunction only in 14 and 29% patients, respectively. A significant difference by Em/Am was registered between patients with mild and moderate AH only in the area of the mitral ring at the side of LV posterior wall (p < 0.05). CONCLUSION: TMD is able to detect earleast structural-functional myocardial changes in hypertensive patients and to determine significant differences in LV diastolic disorders in patients with mild and moderate AH. No significant differences in LVM mass, standard doppler, electro- and vector-cardiographic parameters were found between AH patients' groups.

[Changes in parameters of orthogonal ECG in hypertensive patients given combined antihypertensive treatment].

AIM: To evaluate changes in parameters of orthogonal ECG in hypertensive patients on trandolapril+verapamil combination. MATERIAL AND METHODS: Eighteen patients before and after 8-week therapy were examined using orthogonal ECG and 24-h monitoring of blood pressure. Computer processing of orthogonal ECG was made with calculation of some vectorcardiography (VCG) and d mapping parameters. Also, 24-h blood pressure monitoring was made. RESULTS: 8-week therapy significantly reduced mean diurnal and nocturnal systolic and diastolic blood pressure (SBP, DBP), improved their variability. In patients with VCG signs of left ventricular hypertrophy the treatment significantly diminished some VCG parameters. A direct correlation was found between initial diurnal SBP variability and SQRSxyz, SQRSxz; dynamics of nocturnal SBP variability and dynamics of SQRSxyz, SQRSxz and Rx+Sz (r = 0.7; p < 0.05). A direct correlation was between dynamics of SBP and IADI (r = 0.7; p < 0.05). CONCLUSION: Hypertensive patients treated with a fixed combination trandolapril/verapamil exhibit a positive trend not only in parameters of 24-h monitoring of blood pressure but also in parameters of orthogonal ECG.

[Contribution of CYP11B2, REN and AGT genes in genetic predisposition to arterial hypertension associated with hyperaldosteronism].

We carried out comparison of distribution of alleles and genotypes of polymorphic loci of renin-angiotensin-aldosterone system genes: CYP11B2 (C-344T), AGT (Thr174Met) and REN (C-5434T, C-5312T, and A BglI G) and their combinations in two groups of patients with low renin forms of arterial hypertension (AH). Group 1 included 59 patients with low renin hyperaldosteronism (HA) at the background of glomerular zone adenoma and hyperplasia of adrenal cortex. Group 2 included 28 patients with low renin hypertensive disease characterized by normal level of aldosterone. Complex analysis of carriership of allele and genotype combinations evidence for the difference in genetic nature of two forms of low renin AH. Participation of CYP11B2 and REN and possibly AGT genes in development of low renin AH was convincingly shown.

[Capacities of computed tomographic angiography in the diagnosis and estimation of the site, pattern, and degree of vascular bed lesion in nonspecific aortoarteritis].

Nonspecific aortoarteritis (NAA) is a chronic inflammatory disease that affects the aorta and its branches. The clinical manifestations of this disease are of a great variety and depend on the site of a lesion and the stage of the disease. A wide range of highly informative noninvasive imaging techniques, such as duplex scanning (DS), magnetic resonance imaging (MRI), and computed tomography (CT) of the aorta and its branches, are used to make a more accurate diagnosis and to determine the site and extent of a vascular bed lesion. The given clinical example suggests that CT angiography of the aorta and its branches is a high-precision technique in determining the site of vascular bed lesion in patients with NAA and the pattern and extent of arterial involvement and that it may be used for both the diagnosis of the disease at its developmental stages and the monitoring of the vessels during pathogenetic therapy.