CORRELATIVE ASSOCIATION OF OXYGENATION AND SEPSIS PANELS WITH THE USE OF ACE2 INHIBITORS AND WITHOUT IT IN THE CONDITIONS OF SEPTIC SHOCK IN COVID-19-INFECTED AND NON-INFECTED PATIENTS (COHORT STUDY).

Sepsis-associated hyperlactatemia (SAHL), Lactic acidosis, is a common problem in critically ill patients. The prevalence of Lactic acidosis is estimated to be approximately 1% of all hospitalized nonsurgical patients. The purpose of our study was to reveal possible associations between the level of Lactate with sepsis biomarkers: PCT, IL 6, and PO2 in the presence of ACE 2 inhibitors in Covid-19 infected and non-infected patients with Septic Shock. We conducted a cohort study, comparing outcomes of 212 critically ill patients with Septic shock, who were treated in the intensive care unit of First University Clinic of Tbilisi State Medical University during the 2020-2021 years. Inclusion criteria for the study were: Age>40ys; COVID-19 and other respiratory diseases associated with Septic shock, with respiration dysfunctions with prior exposure to ACE2 inhibitors o no history of treatment with the ACE2 inhibitors. Patients enrolled in the study were individuals who were diagnosed with COVID-19 infection and septic shock, and who were undergoing treatment with ACE2 inhibitors/not taking ACE2 inhibitors; patients with septic shock who were not infected with COVID-19, and who were undergoing treatment with ACE2 inhibitors/not taking ACE2 inhibitors. According to lactate level, the studied patients were divided into subgroups: lactate <3 mMol/l, and lactate > 3 mmol/l. In patients with septic shock who were not infected with COVID-19 the main Causative microorganisms were gram-negative bacteria. In patients' blood the Interleukin-6 (IL-6), lactate, procalcitonin (PCT), pO2, and pulmonary pressure were investigated. Results of the study show that the rise in lactate levels in COVID-19-infected and non-infected patients was accompanied by an increase in PCT content and a decrease in pO2 level in blood. Therefore, serum lactate levels can be used as a prognostic marker of the severity of septic shock in COVID-19-infected and noninfected patients. In COVID-19-infected patients together with the increased lactate level, increases the level of IL-6, which indicates the important link between the quality of immunological disorders, inflammation, and COVID-19 infection in patients with ARDS and sepsis. These alterations were not prevented by the prior use of the ACE2 inhibitors. In COVID-19-infected and noninfected patients who didn't use ACE2 inhibitors, high lactate levels were accompanied by decreased pulmonary pressure which was normalized in patients who prior used ACE2 inhibitors.

IMPACT OF THE ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS ON THE COURSE OF THE SEPTIC SHOCK DEVELOPED DURING COVID-19 AND OTHER SEVERE RESPIRATORY INFECTIONS IN PRESENCE OF HYPERFERRITINEMIA.

SARS-CoV-2 can cause sepsis regardless of the presence of secondary bacterial or fungal infections. The virus itself likely causes sepsis through a variety of possible mechanisms, including immune dysregulation, with respiratory dysfunction, which as a result of circulatory dysfunction leads to hypoxemia and metabolic acidosis. We conducted cohort study, comparing outcomes of 212 critically ill patients with Septic shock (134 men (63.3%) and 78 women (36.7%), with a mean age between 40-70 years) were evaluated, who were treated in the intensive care unit of First University Clinic during 2020-2021 years. All four groups had documented Hyperferritinemia (HF). Patients were divided according to ferritin concentrations: moderate HF (ferritin <1500ng/ml) and severe HF (ferritin >1500ng/ml). The study aimed to reveal the impact of the Angiotensin-Converting enzyme -2 (ACE2) inhibitors on the course of the Septic shock developed during COVID-19 and other severe respiratory infections in conditions of hyperferritinemia (HF). Study results show that severe HF in patients with Septic shock is associated with a high risk of mortality and can be considered an indicator of the severity of the disease. The consumption of ACE2 inhibitors plays an important role in the regulation of inflammatory processes in both COVID-19-infected and non-infected patients with Septic shock: ACE2 inhibitors reduce the levels of Ang II and C reactive protein (CRP) in the blood in both COVID-19-infected and non-infected patients with Septic shock in conditions of moderate and severe HF; regulate the activity of leukocytes and the blood pro-coagulation system in both COVID-19-infected and non-infected patients with Septic shock in conditions of moderate HF; reduce the expression of pro-inflammatory cytokines (IL-6), decrease the level of D dimer in СOVID-infected patients in conditions of moderate HF; Procalcitonin levels do not differ between COVID-19 infected and non-infected patients with Septic shock. Based on our study, we can assume that there is the important link between elevated Ang 2 and the quality of immunological disorders and inflammation. The consumption of ACE2 inhibitors plays an important role in the regulation of inflammatory processes in both COVID-19-infected and non-infected patients with Septic shock.

EFFECTIVE TREATMENT OF CHRONIC HEPATITIS C VIRUS INFECTIONS WITH DIRECT ACTING ANTIVIRALS IN PRISONS SYSTEM.

Hepatitis C is a widespread infectious disorder, accounting for chronic hepatic inflammatory condition - hepatitis, hepatic cirrhosis and hepatocellular carcinoma throughout the world. In Georgia, where the incidence of HCV infection in population is highest among eastern European countries, hepatitis C represents one the most actual problems of healthcare system. The aim of the study was to identify the efficacy of antiviral therapy and management of side effects in HCV infected patients. In the patients under observation with type I genotype, the rapid viral response (RVR) was negative in 100%. End of treatment response (EOT) was negative in 100%, and stable viral response (SVR) was negative in 99.3%. In patients with type II genotype the rapid viral response (RVR) was negative in 100%, end of treatment response (EOT) was negative in 100% and stable viral response (SVR) was negative in 100%. In patients with type III genotype: the rapid viral response (RVR) was negative in 100%. End of treatment response (EOT) was negative in 100% and stable viral response (SVR) was negative in 97%. Thus, HCV infection is widespread in correction department institutions. According to our study results, the final outcomes of antiviral treatment completed within the frames of this program, side effects developed during the course of treatment and their management are not significantly different from the results of antiviral treatment conducted in other population. Regardless of different psychological setting present in this type of institutions, this program is ongoing successfully and the observed results indicate on the importance of its continuation.

EPIDEMIOLOGY OF CLINICALLY MANIFESTED ACUTE HEPATITIS C CASES IN GEORGIA.

Hepatitis C virus is responsible for the majority of persistent viral infections of the liver, chronic hepatitis, liver cirrhosis and/ or hepatocellular carcinoma. Two strategies are important to curtailing the rising prevalence of disease: efficient diagnosis of acute hepatitis and identification of the likely mode of transmission. The aim of this study was to identify the clinical and epidemiological hallmarks of acute hepatitis C. During 2013-2015, 31 patients were hospitalized with a diagnosis of acute C hepatitis. According to epidemiological data, the primary mode of transmission is during medical procedures, responsible for 14 (45.16%) of cases, followed by injection drug use 3 (9.7%) of cases and sexual transmission - 2 (6.43%) of cases. However, in 12 (38.71%) of cases the infected individual was unable identify the likely source of infection. Given that nearly half of all cases arise from nosocomial infection, it is imperative that infection control practices be reviewed and resources provided to prepare a sterile environment for patients and health care providers.

EPIDEMIOLOGY, CLINICAL AND LABORATORY FEATURES OF CRIMEAN-CONGO HEMORRHAGIC FEVER IN GEORGIA.

Crimean-Congo hemorrhagic fever virus transmitted to humans by Hyalomma ticks or by direct contact with the blood of infected humans or domestic animals. The most common clinical signs of CCHF are fever, nausea, headache, diarrhea, myalgia, petechial rash, and bleeding. CCHF is a severe disease in humans with a fatality rate up to 15-85%. This study was undertaken to determine the predictors of fatality among patients with CCHF based on epidemiological, clinical, and laboratory findings. 34 patients were enrolled in the study, aged 4 to 77; 17 - male and 17 female. 3 of them were fatal cases. All of them were from Shua Kartli: Khashuri, Gori and Kaspi districts, involved in farming/handling livestock and the history of tick bite was present in most of patients. Evaluation of the epidemiological characteristics of this cases showed that the female to male ratio was nearly similar. The disease is common in the rural areas of the region, mostly in the actively working age group and almost all patients were farmers. The results of our study show that the most cardinal clinical and laboratory features of Crimean-Congo hemorrhagic fever are - acute beginning of disease, high fever, intoxication and hemorrhagic symptoms, thrombocytopenia, high level of aminotransferases and creatine. Predictors of fatality are: an altered mental status, in early stage of disease dramatic decreased thrombocytes count and significantly high level of aspartate aminotransferase, also longer the mean prothrombin time and INR.

The role of interleukin-10 in patients with HCV infection.

The aim of investigation was to study cytokine-producing ability of blood immune cells in type of viral hepatitis C, correlation with the degree of hepatic lesion and liver cirrhosis. 130 patients were investigated: 72 with cirrhosis: among them 10 - with stage A, 14 - with stage B and 48 - with stage C. The study demonstrates significant changes of cytokine-producing ability of blood immune cells type of viral hepatitis C, correlation with the degree of hepatic lesion and liver cirrhosis. The results showed that various types of chronic viral hepatitis C and stages of cirrhosis were associated with misbalance in production of anti-inflammatory cytokine, i.e. a significant rise of interleukin-10 concentration, which were the most prominent in cases of severe hepatic lesion.

The serum level of interleukin-12 among patients with HCV infection.

The aim of investigation was to study cytokine-producing ability of blood immune cells in type of viral hepatitis C, correlation with the degree of hepatic lesion and liver cirrhosis. 130 patients were investigated: 20 with acute hepatitis C; 38 with chronic hepatitis C; 72 with cirrhosis: among them 10 with Stage A, 14 with Stage B and 48 with Stage C. Also we used 30 healthy people as the controls. The study demonstrates significant changes of cytokine-producing ability of blood immune cells type of viral hepatitis C, correlation with the degree of hepatic lesion and liver cirrhosis. The serum contents of IL-12 in chronic HCV patients is higher than in patients with acute HCV infection and in patients with liver cirrhosis The results showed that various types of acute, chronic viral hepatitis C and stages of cirrhosis were associated with misbalance in production of proinflammatory cytokine, i. e. a rise of interleukin-12 concentration versus the controls., which were the most prominent in cases of severe hepatic lesion.

[Use of polypeptide growth factors for the acceleration of vascular prosthesis healing]. / Ispol'zovanie polipeptidnykh faktorov rosta dlia uskoreniia prizhivleniia sosudistykh protezov.

The authors describe results of experimental investigations proving the possibility to use polypeptide growth factors from the brain of animals for the stimulation of neogenesis of the vascular wall cells. The method was used for plasty of the vessels with biological and artificial prostheses. Patency of the prostheses in experiment was noted in observations during 180 days.