Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 422
Filtrar
1.
Allergol. immunopatol ; 48(1): 73-77, ene.-feb. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-186595

RESUMO

Background and objective: A recent survey in Batumi, Georgia showed a low prevalence of asthma in children (1.8%). A potential explanation is underdiagnosis of asthma. To investigate this, we conducted a follow up to the survey with the objective of estimating the level of childhood asthma underdiagnosis and to describe factors related to it. Methods: Subjects included 437 survey participants who had a history of asthma-like symptoms and no diagnosis of asthma. All children underwent clinical examination (spirometry, skin prick tests, FeNO measurement) to identify new cases of asthma. The distribution of host and environmental factors was compared between the group with newly identified asthma and a group of 59 children with previously known asthma (diagnosed asthma). Results: Clinical investigation identified 107 cases of undiagnosed asthma. The corrected asthma prevalence estimate was 5.1% (95%CI: 4.4%-5.9%) suggesting that 65% of asthma cases were undiagnosed. Compared to children with diagnosed asthma, children with undiagnosed asthma were younger (8.2 ± 1.6 vs. 9.3 ± 2.1; p = 0.0005), had less frequent history of allergic disorders (38.3% vs. 64.4%; p = 0.001), and a lower prevalence of parental asthma (1.8% vs. 8.4%; p = 0.04). The groups did not differ in terms of environmental characteristics except for more exposure to passive smoking in the undiagnosed asthma group (p = 0.01). Multivariate analysis confirmed results of simple analyses. Conclusion: In Batumi, 65% of children with asthma remain undiagnosed. Older age of a child, coexisting allergic disorders, and parental asthma seem to facilitate diagnosis. Implementation of current diagnostic guidelines should improve diagnostic accuracy of pediatric asthma in Batumi


No disponible


Assuntos
Humanos , Criança , Adolescente , Asma/epidemiologia , Fatores de Risco , Asma/diagnóstico , Espirometria , Testes Cutâneos , Análise Multivariada , República da Geórgia/epidemiologia , Inquéritos e Questionários , Asma/tratamento farmacológico , Análise de Dados
2.
BMC Infect Dis ; 20(1): 30, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924172

RESUMO

BACKGROUND: Georgia has one of the highest HCV prevalence in the world and launched the world's first national HCV elimination programs in 2015. Georgia set the ambitious target of diagnosing 90% of people living with HCV, treating 95% of those diagnosed and curing 95% of treated patients by 2020. We report outcomes of Sofosbuvir (SOF) based treatment regimens in patients with chronic HCV infection in Georgia. METHODS: Patients with cirrhosis, advanced liver fibrosis and severe extrahepatic manifestations were enrolled in the treatment program. Initial treatment consisted of SOF plus ribavirin (RBV) with or without pegylated interferon (INF). Sustained virologic response (SVR) was defined as undetectable HCV RNA at least 12 weeks after the end of treatment. SVR were calculated using both per-protocol and modified intent-to-treat (mITT) analysis. Results for patients who completed treatment through 31 October 2018 were analyzed. RESULTS: Of the 7342 patients who initiated treatment with SOF-based regimens, 5079 patients were tested for SVR. Total SVR rate was 82.1% in per-protocol analysis and 74.5% in mITT analysis. The lowest response rate was observed among genotype 1 patients (69.5%), intermediate response rate was achieved in genotype 2 patients (81.4%), while the highest response rate was among genotype 3 patients (91.8%). Overall, SOF/RBV regimens achieved lower response rates than IFN/SOF/RBV regimen (72.1% vs 91.3%, P < 0.0001). In multivariate analysis being infected with HCV genotype 2 (RR =1.10, CI [1.05-1.15]) and genotype 3 (RR = 1.14, CI [1.11-1.18]) were associated with higher SVR. Patients with cirrhosis (RR = 0.95, CI [0.93-0.98]), receiving treatment regimens of SOF/RBV 12 weeks, SOF/RBV 20 weeks, SOF/RBV 24 weeks and SOF/RBV 48 weeks (RR = 0.85, CI [0.81-0.91]; RR = 0.86, CI [0.82-0.92]; RR = 0.88, CI [0.85-0.91] and RR = 0.92, CI [0.87-0.98], respectively) were less likely to achieve SVR. CONCLUSIONS: Georgia's real world experience resulted in high overall response rates given that most patients had severe liver damage. Our results provide clear evidence that SOF plus IFN and RBV for 12 weeks can be considered a treatment option for eligible patients with all three HCV genotypes. With introduction of next generation DAAs, significantly improved response rates are expected, paving the way for Georgia to achieve HCV elimination goals.


Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Interferons/uso terapêutico , Programas Nacionais de Saúde , Ribavirina/uso terapêutico , Sofosbuvir/uso terapêutico , Adolescente , Adulto , Quimioterapia Combinada , Feminino , Seguimentos , Genótipo , República da Geórgia/epidemiologia , Hepacivirus/genética , Hepatite C Crônica/virologia , Humanos , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/virologia , Perda de Seguimento , Masculino , Pessoa de Meia-Idade , RNA Viral/genética , Resposta Viral Sustentada , Adulto Jovem
3.
Georgian Med News ; (295): 42-47, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31804197

RESUMO

The aim of the study was to study the current problems of non-carious dental lesions in residents of Penza, depending on the influence of production factors. In the structure of non-carious lesions, there is a large group of diseases (and injuries) of the hard tissues of the teeth (enamel, dentin, cement), which have their various clinical manifestations, the occurrence and development of which is not directly related to the microbial factor, unlike carious lesions. Such diseases are enamel and dentin hypoplasia, fluorosis, wedge-shaped defect, etc. All these diseases can be manifested by spotting, expressed to varying degrees on permanent and temporary teeth, which sometimes complicates the differential diagnosis with the initial stages and causes a significant aesthetic defect. Thus, the identification and treatment of non-carious lesions in practical dentistry is undoubtedly an urgent task. The team of authors conducted a dental examination of 350 patients from among adult residents of Penza and the Penza region aged from 20 to 60 years of the main professional groups of the region (working at enterprises of heavy and medium machinery, in the timber processing industry, engaged in agriculture). As a result of the study it was revealed that the Penza region is endemic for fluorosis, in connection with which there are high prevalence rates of fluorosis and hypoplasia of teeth. At the same time, respondents working in the machine-building and timber processing industries have a slightly lower prevalence, which is associated with large proportions of the foreign population (persons born and raised in other regions). At the same time, the influence of production factors on the incidence of different types of non-carious dental pathology in respondents working in the machine-building and timber processing industries of the Penza region was established. This mainly concerned non-carious diseases that occur after teething-pathological abrasion of teeth, wedge-shaped defect, multiple cracks of enamel.


Assuntos
Cárie Dentária , Hipoplasia do Esmalte Dentário , Fluorose Dentária , Dente , Adulto , Cárie Dentária/epidemiologia , Esmalte Dentário , Hipoplasia do Esmalte Dentário/epidemiologia , Dentina , Fluorose Dentária/epidemiologia , República da Geórgia/epidemiologia , Humanos , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
4.
Georgian Med News ; (292-293): 72-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560667

RESUMO

The aims of our study were to determine antibiotic prescribing rates for prevention and treatment of infections in pediatric units, to evaluate the number and type of antimicrobial agents and administration route, reveal commonly used antibiotic subgroups and identify targets for improving the quality of antimicrobial prescribing. A 1-day PPS (Point Prevalence Study) on antibiotic use in hospitalized children was performed in Georgia from 2015 to 2019. 18 clinics in different regions of Georgia were included in the survey. Antimicrobial prevalence rates increased over the years from 60.1% in 2015 to 92.6% in 2018. The most commonly, antibiotics were prescribed for lower respiratory tract infections (LRTI). In 2015 25.1% of LRTI were treated by ampicillin-sulbactam but the next year it replaced with ceftriaxone (37.1% in 2017 and 38.2% in 2018). In pediatric surgical ward, the antibiotics were commonly prescribed for surgical prevention (54.1% in 2015, 32.3% in 2018). The most common conditions treated with antibiotics in neonates were sepsis (30.1%) and LRTI (45.3%). The most used antibiotic was ceftriaxone (33.3% in 2015). Ampicilin-sulbactam was prescribed in 28.1% of pneumonia case in neonates in 2018. In 2015 antibiotics were mainly prescribed empirically (98.0%). In 2018 resistance of MRSA was 8.1%, and resistance to the third-generation cephalosporin 17.3%. Prevalence rate of antibiotics for prevention and treatment of infection disease in pediatric units increased in 2018. Main feasible targets for optimization of antibiotic prescribing have been identified: high use of broad-spectrum antibiotics in hospitals, high frequency of empirical treatment, rarely performed culture tests, prolonged antibiotic prophylaxis in surgery patients and an alarming raise of resistant strains. The implementation of disease-specific clinical pathways associated with annual PPSs could be a good way to monitor and improve antibiotic prescription patterns in neonatal and pediatric inpatients over time.


Assuntos
Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Farmacorresistência Bacteriana , Uso de Medicamentos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Feminino , República da Geórgia/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Masculino , Pediatria , Prevalência , Inquéritos e Questionários
5.
Zoonoses Public Health ; 66(7): 835-841, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31338987

RESUMO

Zoonotic diseases are endemic in the country of Georgia. Using the non-linear canonical correlation (NCC) method, the aim of this study was to examine the relationship between thirteen epidemiological risk factors and seropositivity to five zoonotic infections (anthrax, Q fever, tularemia, leptospirosis, and Crimean-Congo hemorrhagic fever [CCHF]) among Georgian military recruits during 2014-2016. According to this multivariate statistical technique, which is suitable for the analysis of two or more sets of qualitative variables simultaneously, two canonical variables were identified. These variables accounted for 68% of the variation between the two sets of categorical variables ("risk factors" and "zoonotic infections"). For the first canonical variable, there was a relationship among CCHF (canonical loading, which is interpreted in the same way as the Pearson's correlation coefficient, [cl] = 0.715), tick bites (cl = 0.418) and slaughter of animals (cl = 0.351). As for the second canonical variable, Q fever (cl = -0.604) and leptospirosis (cl = -0.486) were related to rodents inside and outside home (cl = -0.346) and sweeping in or around home (cl = -0.317). The NCC method allows researchers to obtain additional insights into the complex relationship between epidemiological risk factors and multiple zoonotic infections.


Assuntos
Infecções Bacterianas/epidemiologia , Febre Hemorrágica da Crimeia/epidemiologia , Militares , Zoonoses/epidemiologia , Adulto , Animais , República da Geórgia/epidemiologia , Humanos , Masculino , Análise Multivariada , Fatores de Risco , Testes Sorológicos
6.
Przegl Epidemiol ; 73(1): 61-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31134775

RESUMO

OBJECTIVES: There is currently an urgent need to harmonize hepatitis standards of care for HIV-positive patients across Europe. The HIV epidemic in Central and Eastern Europe has often been driven by injecting drug use, therefore a higher rate of co-infection with HCV and HBV is expected in this region. We have investigated the epidemiological prevalence and treatment availability for end-stage liver disease in HIV/HCV/HBV coinfections in countries represented in the ECEE Network Group. METHODS: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care regarding HIV infection in the region. Information about HIV/HCV/HBV co-infections and the availability for end-stage liver disease treatment for HIV-positive patients were collected through on-line surveys. The respondents were ECEE members from 16 countries of the region. The information on co-infection prevalence was sourced from WHO, national HIV programmes, articles published in international journals, single clinic reports, and personal information in ten of the participating countries (62.5%). RESULTS: The HIV/HCV co-infection rate was from 3% to 99%. The range of reported of HIV/HBV coinfection percentages was 2.3% to 40%. HIV/HCV/HBV co-infection ranged from 0% to 9%. Regarding treatment for end-stage liver disease, liver transplantation was an available option for HIV-positive patients in only three countries (19%). CONCLUSION: Our findings revealed only a limited number of treatment options for the end-stage liver disease in HIV-positive patients for the vast majority of Central and Eastern European countries. There are gaps in epidemiological surveillance in this region. It appears there are many differences in the number of co-infected patients among Central and Eastern European and neighboring countries, but there is no unification of information sources.


Assuntos
Doença Hepática Terminal/terapia , Infecções por HIV/complicações , Acesso aos Serviços de Saúde , Hepatite B/complicações , Hepatite C/complicações , Coinfecção , Doença Hepática Terminal/complicações , Doença Hepática Terminal/epidemiologia , Europa Oriental/epidemiologia , República da Geórgia/epidemiologia , Grécia/epidemiologia , Humanos , Turquia/epidemiologia
7.
PLoS One ; 14(5): e0215228, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048838

RESUMO

INTRODUCTION: Anthrax is considered endemic in livestock in Georgia. In 2007, the annual vaccination became the responsibility of livestock owners, while contracting of private veterinarians was not officially required. Six years later, due to increase in human outbreaks associated with livestock handling, there is a need to find out the risk factors of livestock anthrax in Georgia. OBJECTIVE: To identify exposures and risk factors associated with livestock anthrax. METHODS: A matched case-control study design was used to recruit the owners of individual livestock anthrax cases that occurred between June 2013 and May 2015, and owners of unaffected livestock from within ("village control") and outside the village ("area control"). We collected data about the case and control livestock animals' exposure and risk factors within the one-month prior to the disease onset of the case livestock (or matched case for the controls). We used logistic regression analysis (univariate and multivariable) to calculate the odds ratios of exposures and risk factors. RESULTS: During the study period, 36 anthrax cases met the case definition and were enrolled in the study; 67 matched village control livestock and 71 matched area control livestock were also enrolled. The findings from multivariable logistic regression analysis demonstrate that vaccination within the last two years significantly reduced the odds of anthrax in cattle (OR = 0.014; 95% Confidence interval = <0.001, 0.99). The other factors that were significantly protective against anthrax were 'animals being in covered fence area/barn' (OR = 0.065; p-value = 0.036), and 'female animal being pregnant or milking compared to heifer' (OR = 0.006; p-value = 0.037). CONCLUSIONS: The information obtained from this study has involved and been presented to decision makers, used to build technical capacity of veterinary staff, and to foster a One Health approach to the control of zoonotic diseases which will optimize prevention and control strategies. Georgia has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock, to which primary emphasis of the anthrax control program will be given. Education of livestock keepers in Georgia is an overriding priority.


Assuntos
Antraz/epidemiologia , Surtos de Doenças , Animais , Antraz/diagnóstico , Antraz/veterinária , Estudos de Casos e Controles , Bovinos , Feminino , República da Geórgia/epidemiologia , Cabras , Humanos , Gado , Modelos Logísticos , Masculino , Fatores de Risco , Ovinos , Zoonoses/diagnóstico , Zoonoses/epidemiologia
8.
PLoS One ; 14(4): e0216123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31034530

RESUMO

Hepatitis C virus (HCV) infection is a significant public health concern worldwide. Georgia is among the countries with a high burden of HCV infection. People who inject drugs (PWID) have the highest burden of infection in Georgia. In 2015, the Government of Georgia, with partners' support, initiated one of the world's first Hepatitis C Elimination Programs. Despite notable progress, challenges to achieving targets persist. This qualitative study is aimed to better understand some of the barriers and facilitators to HCV testing and treatment services for PWID to inform HCV treatment policies and practices. The study instrument examined social, structural, and individual factors influencing HCV testing and treatment practices. We started with key informant interviews to guide the study instrument development and compare the study findings against health care planners' and health care providers' views. Forty PWID with various HCV testing and treatment experiences were recruited through the snowball method. The study found that along with structural factors such as political commitment, co-financing of diagnostic and monitoring tests, and friendly clinic environments, knowledge about HCV infection and elimination program benefits, and support from family and peers also play facilitating roles in accessing testing and treatment services. On the other hand, inability to co-pay for diagnostic tests, fear of side effects associated with treatment, poor knowledge about HCV infection, and lack of social support hampered testing and treatment practices among PWID. Findings from this study are important for increasing the effectiveness of this unique program that targets a population at high risk of HCV infection.


Assuntos
Erradicação de Doenças , Hepatite C/epidemiologia , Pesquisa Qualitativa , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Custos e Análise de Custo , Utilização de Instalações e Serviços , Feminino , República da Geórgia/epidemiologia , Hepatite C/economia , Hepatite C/prevenção & controle , Hepatite C/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação e Adesão ao Tratamento
9.
Georgian Med News ; (287): 105-110, 2019 Feb.
Artigo em Russo | MEDLINE | ID: mdl-30958299

RESUMO

Objective - according to WHO, acute poisoning is one of the important public health global problems. At the same time, each geographic region is characterized by a unique epidemiological situation on acute poisoning. The aim of this study was to investigate and compare the main toxic-epidemiological parameters of the two largest cities of the South Caucasus - Baku and Tbilisi, and on the basis of the obtained data to develop a program on chemical safety and prevention of acute poisoning among population of the region. Data on all acute poisoned patients undergoing in-patient treatment in the hospitals of Baku and Tbilisi in 2009-2016 were placed in the standard forms and subjected to a comparative analysis. Diagnoses of toxicological patients were unified in accordance with ICD-10 (T36-T65). The total number of patients in this study was 13,292 in Baku and 14,229 in Tbilisi. The results of the study showed that in the both cities among toxicological hospitalizations dominated by cases of toxic effects of substances chiefly nonmedicinal as to source (62.13% in Tbilisi and 53.75% in Baku). However, with a detailed analysis of individual nosological units, we found significant and fundamental differences in the toxic-epidemiological profile of non-medicinal chemical poisoning in two capitals. For example, acute alcohol poisoning in Tbilisi was accounted for 24.26% of all intoxications, or 39,865 cases per 100,000 population. At the same time, alcohol intoxications in Baku were significantly less frequent, amounting to 4,454 hospitalizations per 100,000 population or 5.73% of all poisoning cases. Corrosive substances poisoning in Baku amounted 10.77% of all intoxication, while in Tbilisi it was significantly less - 3.86%. In Baku, the hospitalizations rate of acetic acid poisoning was 5.724 cases per 100.000 population, while in Tbilisi it was only 0.023 cases per 100.000 inhabitants. Toxic effects of carbon monoxide in Baku occupied 24.36% and in Tbilisi - 4.53% of all poisoning cases, which was 18.951 and 7.449 hospitalizations per 100.000 population, respectively. According to pesticide poisoning, hospitalization rates in Baku was 2,710 and in Tbilisi 6,906 cases per 100,000 population. Hospitalization of patients with envenomation in Tbilisi amounted to 5,901; and in Baku - 2,622 cases per 100,000 residents, respectively. In general, the hospitalization rate of intoxication with substances chiefly nonmedicinal as to source use in Tbilisi was 102,088 cases per 100,000 population, and in Baku - 41,817 cases per 100,000 residents respectively. This prospective toxic-epidemiological study revealed a significant incidence of acute intoxication in the two largest cities in the South Caucasus. However, there are considerable differences in the comparative profile and frequency of hospitalizations in patients with acute poisoning in Baku and Tbilisi over the period 2009-2016. The observed cases of mass and unusual intoxication during the study period make it necessary to create the unified network for the monitoring toxic-epidemiological situation and rapid information exchange on emerging toxicological risks in the South Caucasus region.


Assuntos
Intoxicação Alcoólica/epidemiologia , Hospitalização/estatística & dados numéricos , Envenenamento/epidemiologia , População Urbana/estatística & dados numéricos , Cidades , República da Geórgia/epidemiologia , Humanos , Incidência , Estudos Prospectivos
10.
PLoS One ; 14(4): e0214785, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964906

RESUMO

INTRODUCTION: In order to determine the impact of HIV prevention and care programs, it is essential to look at both HIV incidence and prevalence estimates and trends over time. We estimated the HIV incidence and prevalence and assessed the trend using data from three cross-sectional surveys of men who have sex with men (MSM) in two cities in Georgia. METHODS: Using respondent-driven sampling strategy, a total of 796 eligible MSM (18 years or older men with self-reported oral or anal sex with another man in past 12 months) were recruited in Tbilisi in 2010, 2012 and 2015 and 115 in Batumi 2015 into behavioral surveys and HIV testing. To estimate the HIV incidence, we divided the number MSM tested positive for HIV to the time at risk. We calculated the time at risk as years since age at first anal intercourse to the age at last HIV-negative test or the age at first HIV-positive test, accounted for the interval censorship. We calculated the respondent-driven sampling adjusted estimates for HIV prevalence and assessed the trend in Tbilisi by Chi2 test for trend. For HIV incidence rate, we used Kaplan Meier method to estimate the rates and assessed the subgroup differences by log-rank test. RESULTS: The HIV prevalence was 14.9% in Batumi in 2015; it significantly increased in Tbilisi from 6.2% in 2010 to 14.1% in 2012, and to 19.6% in 2015 (p-value for trend < 0.001). Likewise, the HIV incidence rate in Tbilisi significantly increased form 0.45 per 100 person-years (PY) in 2010 to 0.98 per 100 PY in 2012 (p-value 0.01), and to 1.63 per 100 PY in 2015 (p-value < 0.001). HIV incidence rate was 1.37 per 100 PY in Batumi in 2015. In 2015, young MSM (Tbilisi: 3.71, Batumi: 3.92 per 100 PY, p-value< 0.008), single MSM (Tbilisi: 1.99, per 100 PY, p-value 0.03) and less educated MSM (Batumi: 1.86 per 100 PY, p-value 0.03) had higher HIV incidence than other MSM. CONCLUSION: Our findings suggest the continuous transmission of HIV among MSM in Tbilisi and a high prevalence of HIV among MSM in Batumi and the critical need for scaling up the coverage and accessibility of combination prevention packages including rapid HIV diagnosis and treatment.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Adulto , Estudos Transversais , República da Geórgia/epidemiologia , HIV/patogenicidade , Homossexualidade Masculina , Humanos , Incidência , Masculino , Prevalência , Assunção de Riscos , Comportamento Sexual
11.
Zoonoses Public Health ; 66(3): 276-287, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30724030

RESUMO

BACKGROUND: In the Mediterranean and Black Sea Region, arbovirus infections are emerging infectious diseases. Their surveillance can benefit from one health inter-sectoral collaboration; however, no standardized methodology exists to study One Health surveillance. METHODS: We designed a situation analysis study to document how integration of laboratory/clinical human, animal and entomological surveillance of arboviruses was being implemented in the Region. We applied a framework designed to assess three levels of integration: policy/institutional, data collection/data analysis and dissemination. We tested the use of Business Process Modelling Notation (BPMN) to graphically present evidence of inter-sectoral integration. RESULTS: Serbia, Tunisia and Georgia participated in the study. West Nile Virus surveillance was analysed in Serbia and Tunisia, Crimea-Congo Haemorrhagic Fever surveillance in Georgia. Our framework enabled a standardized analysis of One Health surveillance integration, and BPMN was easily understandable and conducive to detailed discussions among different actors/institutions. In all countries, we observed integration across sectors and levels except in data collection and data analysis. Data collection was interoperable only in Georgia without integrated analysis. In all countries, surveillance was mainly oriented towards outbreak response, triggered by an index human case. DISCUSSION: The three surveillance systems we observed prove that integrated surveillance can be operationalized with a diverse spectrum of options. However, in all countries, the integrated use of data for early warning and inter-sectoral priority setting is pioneeristic. We also noted that early warning before human case occurrence is recurrently not operationally prioritized.


Assuntos
Infecções por Arbovirus/veterinária , Saúde Única , Animais , Infecções por Arbovirus/epidemiologia , Infecções por Arbovirus/virologia , Mar Negro , Doenças Transmissíveis Emergentes , República da Geórgia/epidemiologia , Humanos , Região do Mediterrâneo , Vigilância da População , Sérvia/epidemiologia , Tunísia/epidemiologia
12.
J Med Virol ; 91(2): 235-240, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29905958

RESUMO

Human immunodeficiency virus (HIV) drug resistance is a major threat to the sustained impact of antiretroviral therapy (ART). We studied the epidemiology of drug resistance in the country of Georgia. The study included all adult patients who experienced virologic failure on first line ART and received HIV drug resistance testing between 2005 and 2016. The Stanford HIV Sequence Database was used for interpretation of the resistance data. Patient-level data were extracted from the national AIDS health information system. Of the 447 patients included, 85.5% harbored the subtype A6 virus, 8.0% - subtype B, 2.9% - subtype G, and other subtypes were <1%. The most frequent first-line regimens were Tenofovir/Emtricitabine/Efavirenz (28.4%), Zidovudine/Lamivudine/Efavirenz (28.4%), and Abacavir/Lamivudine/Efavirenz (15.9%). A total of 85.0% of the patients with treatment failure developed at least one drug resistance mutation affecting their susceptibility to ART. The most frequent nucleoside reverse transcriptase inhibitor mutations were M184V (65.3%), K65R (19.7%) and L74V (17.0%). At least three thymidine analogue mutations were detected in 6.3% of the patients. From non-nucleoside reverse transcriptase inhibitor mutations, G190S was shown to be the most prevalent (49.4%), followed by K101E (27.10%) and K103N (24.4%). G190S and K101E were more common in subtype A as compared with non-A viruses (G190S: 54.9% vs 11.3%, P < 0.0001; K101E: 29.8% vs 11.3%, P = 0.005). On the other hand, K103N was more frequent in non-A subtypes (43.4%) compared with subtype A (22.2%), P = 0.0008. A majority of persons failing on ART had HIV drug resistance. Drug resistance patterns may vary by subtype. K65R mutation remains below 20%, but given the high use of Tenofovir in the country, continuing surveillance of drug resistance is needed.


Assuntos
Farmacorresistência Viral , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Técnicas de Genotipagem , República da Geórgia/epidemiologia , HIV/genética , HIV/isolamento & purificação , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Prevalência , Estudos Retrospectivos , Falha de Tratamento , Adulto Jovem
13.
Georgian Med News ; (283): 97-103, 2018 Oct.
Artigo em Russo | MEDLINE | ID: mdl-30516502

RESUMO

The purpose of our study was to identify the nature of the cause-effect relationship between the risks of developing of Chronic Obstructive Pulmonary Disease (COPD) and Cardio-vascular Disease (CVD) in patients residing in the villages of Chiatura district, characterized by varying degrees of environmental stress. The residents (n=400) of the Chiatura district living in the villages, Khreiti, Perevisa and Rgani were examined. The villages are characterized by different degrees of ecological tension (the villages differ both in their remoteness from sources of environmental pollution - manganese mining quarries and the scale of its extraction, which allows them to rank according to the degree of environmental tension: Khreiti - low, Perevis - medium, Rgani - high). In the patients the blood general redox balance and genetic parameters (the number of micronuclei in the scrapings of the oral mucosa) were studied. In the zone of moderate environmental stress (the village of Perevisa), a significant increase in the indicator of the total antiradical activity of blood plasma and an increase in the frequency of micronucleated buccal cells were revealed in comparison with the zone of low environmental stress (the village of Khreiti). In residents of the village of Rgani, characterized by the highest level of pollution, the indicator of the total antiradical activity of blood plasma decreases sharply, the number of micronuclei decreases, the presence of various types of damage to the nucleus is noted, which is characteristic of intensive apoptosis. Under the conditions of moderate air pollution, observed mobilization of protective anti-radical and replication mechanisms in the body are aimed at preserving the stability of the somatic cell genome. Identified oxidative stress can also act as mediators of secondary alteration and the development of the inflammatory process in the circulatory bed, resulting in an increased risk of arterial hypertension (AH) against the background of a relatively high risk of chronic nonspecific obstructive pulmonary diseases (COPD). High level of environmental pollution contributes to the development of permanent intense oxidative stress in the affected tissues of the respiratory tract. That contributes to the development of predominantly nonreparable changes in the cell genome, apoptosis and intensification of secondary oxidative stress, which, under conditions of depletion of antiradical protection, causes preferential defeat of the microenvironment of apoptotic cells, the development of local effects, reflected in a sharp increase in the risk of COPD.


Assuntos
Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/etiologia , Micronúcleos com Defeito Cromossômico/induzido quimicamente , Estresse Oxidativo/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/etiologia , Poluição do Ar/análise , Antioxidantes/metabolismo , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/metabolismo , Doença Crônica , República da Geórgia/epidemiologia , Humanos , Mineração , Estresse Oxidativo/genética , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/genética , Doença Pulmonar Obstrutiva Crônica/metabolismo , Risco
14.
Georgian Med News ; (283): 123-129, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30516507

RESUMO

Shiga toxin-producing Escherichia coli (STEC) causes illness ranging from mild diarrhea to bloody diarrhea, to the hemolytic uremic syndrome (HUS), which manifests with a triad of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Surveillance of HUS and bloody diarrhea is not performed in Georgia. The primary objective of our study was to determine the annual incidence of diarrheal diseases. The secondary objective was to assess epidemiological characteristics, etiology and risk factors of diarrhea and HUS in Georgia among children under 15. We collected a retrospective data on diarrheal diseases particularly bloody diarrhea and HUS among children in Georgia in 2009-2016 years. Laboratory, clinical and epidemiological data was entered into electronic database. Descriptive statistics, proportions, incidence rates, means and medians were calculated in R statistical language using statistical package R for windows v 3.4.3. A total of 316 cases of bloody diarrhea including 64 (20.2%) cases complicated with HUS under age 15 were identified from 2009 until 2016. From 316 patients 5 (1.6%) have died, all of them with diagnosis and severe complications of HUS. Average rate of HUS per 100,000 populations during 2009-2016 was 0.3 and for bloody diarrhea 2 per 100,000. High RR for food products consumed by children with bloody diarrhea either complicated with HUS or not were various ice-creams produced locally (RR 4.23 P<0.001), dairy products (RR 2.79 P = 0.01), ground beef products (RR 4.52 P<0.001). The another highest attack ratio was identified for fruits (RR 6.19 P<0.001) and vegetables (RR 3.45 P < 0.001). Different enteric pathogens including shiga toxin producing E. coli was detected as etiology of diarrheal diseases and HUS. Epidemiological data suggests that inadequately washed fruits, vegetables and eating undercooked food and ice-cream could be a possible risk factors of exposure with enteric pathogens and developing diarrhea and HUS among children. Further investigations of food products are required to determine epidemiology and source food products of bloody diarrhea and HUS among children in Georgia.


Assuntos
Diarreia/epidemiologia , Infecções por Escherichia coli/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Escherichia coli Shiga Toxigênica/isolamento & purificação , Adolescente , Criança , Pré-Escolar , Diarreia/complicações , Diarreia/microbiologia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Feminino , República da Geórgia/epidemiologia , Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco
15.
Georgian Med News ; (283): 129-133, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30516508

RESUMO

The analysis of prevalence of each specific subtypes of the ductal invasive breast carcinoma according to age group categories showed that Luminal A subtype is observed in every age group as dominant subtype, although in different intensity: two peaks were demonstrated in group III and group IV, and in relatively less amount, in V group as well. Its considerable that Her2(+)/ER subtype was second most prevalent subtype in almost all age groups. It also must be noted that there was no direct correlation found between pre- or post-menopausal period and HER2+ state, except for group IV (60-69 year old range), where it was almost 2 times less frequently found than Basal-like subtype. The frequency of Her2(+)/ER tumor subtype was identical to Luminal A subtype frequency. In age group I (30-39 year old) and all others its frequency was found to be markedly decreasing along with the frequency of Luminal A subtype (if in age group I their frequency was 1.2, in the age group IV it accounted for 9.4, which means that Her2(+)/ER subtype prevalence decreases with increasing age until the age group V (70-79 year old), after which it increases again (age group V and VI demonstrated the frequency of 2.0 and 5.0 respectively). Basal-like tumor was not found in age groups I and VI, and its frequency was gradually increasing except for age group II, where it was approximately 1.5 less frequent than in other age group categories. Triple-negative subtype was not found in age groups I and VI, however, its frequency was gradually increasing with increasing age. The prevalence of triple-negative tumor in age group V was 4.5 times higher than in age group II. The frequency of Luminal B subtype tumor was almost 2 times decreased in age group III, while in age group V it was almost 3 times increased. However, it disappeared in age group VI completely. Consideration of the age-related specificities of ductal invasive breast carcinoma subtypes (phenotypes) is important both for diagnostic aspect and treatment strategy selection, as well as adequate planning of breast cancer screening programs. Thus, in all age groups of the studied population, IIIA and B stages of tumor were identified, with tumor sizes ranging between 2.8-4.7mm. There was no stable direct correlation between breast cancer and family history, as the presence of such data requires additional research with more focus on anamnesis details.


Assuntos
Carcinoma Ductal de Mama/epidemiologia , Neoplasias de Mama Triplo Negativas/epidemiologia , Adulto , Fatores Etários , Idoso , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patologia , Feminino , República da Geórgia/epidemiologia , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Neoplasias de Mama Triplo Negativas/metabolismo , Neoplasias de Mama Triplo Negativas/patologia
16.
Virol J ; 15(1): 190, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30547827

RESUMO

BACKGROUND: African swine fever virus (ASFV) causes an acute hemorrhagic infection in suids with a mortality rate of up to 100%. No vaccine is available and the potential for catastrophic disease in Europe remains elevated due to the ongoing ASF epidemic in Russia and Baltic countries. To date, intra-epidemic whole-genome variation for ASFV has not been reported. To provide a more comprehensive baseline for genetic variation early in the ASF outbreak, we sequenced two Georgian ASFV samples, G-2008/1 and G-2008/2, derived from domestic porcine blood collected in 2008. METHODS: Genomic DNA was extracted directly from low-volume ASFV PCR-positive porcine blood samples and subjected to next generation sequencing on the Illumina Miseq platform. De novo and mapped sequence assemblies were performed using CLCBio software. Genomic illustrations, sequence alignments and assembly figures were generated using Geneious v10.2.4. Sequence repeat architecture was analyzed using DNASTAR GeneQuest 14.1.0. RESULTS: The G-2008/1 and G-2008/2 genomes were distinguished from each other by coding changes in seven genes, including MGF 110-1 L, X69R, MGF 505-10R, EP364R, H233R, E199L, and MGF 360-21R in addition to eight homopolymer tract variations. The 2008/2 genome possessed a novel allele state at a previously undescribed intergenic repeat locus between genes C315R and C147L. The C315R/C147L locus represents the earliest observed variable repeat sequence polymorphism reported among isolates from this epidemic. No sequence variation was observed in conventional ASFV subtyping markers. The two genomes exhibited complete collinearity and identical gene content with the Georgia 2007/1 reference genome. Approximately 56 unique homopolymer A/T-tract variations were identified that were unique to the Georgia 2007/1 genome. In both 2008 genomes, within-sample sequence read heterogeneity was evident at six homopolymeric G/C-tracts confined to the known hypervariable ~ 7 kb region in the left terminal region of the genome. CONCLUSIONS: This is the first intra-epidemic comparative genomic analysis reported for ASFV and provides insight into the intra-epidemic microevolution of ASFV. The genomes reported here, in addition to the G-2007/1 genome, provide an early baseline for future genome-level comparisons and epidemiological tracing efforts.


Assuntos
Vírus da Febre Suína Africana/genética , Febre Suína Africana/epidemiologia , DNA Viral/sangue , Genoma Viral/genética , Polimorfismo Genético/genética , Animais , Sequência de Bases , DNA Viral/genética , Surtos de Doenças , República da Geórgia/epidemiologia , Sequenciamento de Nucleotídeos em Larga Escala , Alinhamento de Sequência , Análise de Sequência de DNA , Suínos , Proteínas Virais/genética
17.
Georgian Med News ; (282): 50-52, 2018 Sep.
Artigo em Russo | MEDLINE | ID: mdl-30358540

RESUMO

The epidemiological research was conducted among school children of 6-7, 12, 15 ages (According to the WHO nomenclature) in the municipalities of Kobuleti and Khelvachauri of Ajara region in order to study the spread of major dental diseases and determine further prophylactic measures. The research involved 246 children, of whom 129 were residents of Kobuleti and 117 residents of Khelvachauri. Studies have shown that in all age groups the level of caries distribution is high; the median intensity index is also high in all age groups compared to the median indexes established for residents of Georgia. A particularly difficult situation was observed when reviewing the components of the DMFT structure. The number of teeth damaged by caries was prevailing in all age groups and the number of filled teeth was insignificant. The study of the hygiene skills of the research target group revealed a low sanitary culture. Consequently, in order to improve the dental status in the target group of the research, the following was determined: 1. Need to increase the scope and quality of dental care; 2. Necessity of implementing sanitary-educational works for increasing sanitary culture and the motivation of oral hygiene.


Assuntos
Cárie Dentária/epidemiologia , Adolescente , Criança , Cárie Dentária/prevenção & controle , República da Geórgia/epidemiologia , Humanos , Higiene Bucal
18.
Eur J Heart Fail ; 20(11): 1570-1577, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30225878

RESUMO

AIMS: The impact of frailty on outcomes in randomized heart failure with preserved ejection fraction (HFpEF) trials has not been previously reported. This analysis sought to characterize frailty in a large contemporary HFpEF clinical trial cohort and to evaluate its impact on patient relevant outcomes. METHODS AND RESULTS: Using data from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, a frailty index (FI) was constructed at baseline using 39 clinical, laboratory, and self-reported variables. The relationship between frailty and outcomes and the role of frailty in modulating the benefits of spironolactone were examined in a subset of 1767 TOPCAT patients. For the cohort as a whole (mean age 71.5 years, 49% female), the mean FI at baseline was 0.37 ± 0.11. Four frailty classes were defined ranging from FI < 0.3 to FI ≥ 0.5. Overall, 94% of subjects were considered frail (defined as a FI > 0.21). Mean age was lowest for the most frail class (69 ± 9 years for Class 4; 73 ± 10 years for Class 1; P < 0.001). Body mass index, systolic blood pressure, and pulse pressure all increased as FI increased. Both primary and secondary outcomes increased as frailty severity increased. There was no interaction between frailty class and treatment effect of spironolactone. CONCLUSIONS: Frailty was very common in TOPCAT HFpEF participants. Greater frailty was associated with a higher risk of cardiovascular outcomes and mortality. The benefit of spironolactone on outcomes in TOPCAT was not attenuated by frailty class.


Assuntos
Idoso Fragilizado , Fragilidade/complicações , Insuficiência Cardíaca/tratamento farmacológico , Espironolactona/uso terapêutico , Volume Sistólico/fisiologia , Idoso , Américas/epidemiologia , Método Duplo-Cego , Feminino , Fragilidade/mortalidade , Fragilidade/fisiopatologia , República da Geórgia/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Federação Russa/epidemiologia , Taxa de Sobrevida/tendências , Resultado do Tratamento
19.
Georgian Med News ; (280-281): 64-68, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30204097

RESUMO

Objective - the purpose of the study is evaluation of the Hirsutism prevalence and ethnical peculiarities of the hair distribution in Georgian female adolescents of Tbilisi, Georgia. 2592 randomly selected female adolescents of Tbilisi were included in the study. They completed standard questionnaires consisted of questions about the existence of hirsutism and its locations. For clinical assessment 2 groups were selected from them: group 1 - 117 adolescents with hirsutism and 178 without it. For clinical evaluation of hirsutism modified Ferriman-Gallwey score was used. Based on the self-estimation the hirsutism prevalence was 26.62% (690 out of 2592), while clinically established prevalence of hirsutism was 20.61%. The most prevalent areas of hair distribution by self-estimation were the face and the abdomen. Clinical assessment of patients with hirsutism showed that mean value of Ferriman-Gallwey Score was 12.87±5.94. Hair distribution by clinical assessment was most significantly observed in the lower abdomen (78.33%), upper lip (76.67%) and chest (68.33%). This is the first study of hirsutism prevalence in ethnically Georgian adolescent female population. The study has shown that the value of prevalence by self-estimation exceeds analogous value established clinically, and the sites with hair excess are lower abdomen, upper lip and the chest.


Assuntos
Cabelo/fisiopatologia , Hirsutismo/epidemiologia , Adolescente , Grupos Étnicos , Feminino , República da Geórgia/epidemiologia , Hirsutismo/etnologia , Humanos , Prevalência , Adulto Jovem
20.
Georgian Med News ; (280-281): 68-75, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30204098

RESUMO

Cardiovascular diseases (CVD) continue to be the leading cause of death and disability worldwide, representing 30% of all death. In Georgia 36% of all death caused by ischemic heart disease and 23% caused by stroke. There is a limited data on association between socioeconomic status (SES) and CVD risk in Georgia. Our study aims at assessing association between SES and CVD risk factors in a cohort of adult Georgians. A cross-sectional study was conducted in the region of Western Georgia between June 2007 - June 2008. 1196 individuals aged 40-70 years were enrolled in the study. To assess SES we collected information about education, income, ownership of a private transport, and employment. CVD risk was assessed by the WHO/ISH risk classification scale. In addition, anthropometric measurements were conducted in each study participant. Low education level (adjusted odds ratio (aOR) 2.85; 95% confidence interval (CI), 1.57-5.17), obesity (aOR 2.13, 95% CI 1.16 -3.92) and abdominal obesity (aOR 2.21, 95% CI 1.26 -3.87) were statically significantly associated with more than 10% 10 year risk of a fatal or non-fatal cardiovascular event. Lower education level (not finished high school -aOR 2.21 95% CI 1.44 - 3.38, undergraduate - aOR 1.52, 95% CI 1.12 - 2,05), income 120 USD or more (aOR 0.73, 95% CI 0.54 -1.00), overweight (aOR 1.68, 95% CI 1.07 - 2.63), obesity (aOR 1.58, 95% CI 1.04 - 2.41), and abdominal obesity (aOR 1.43, 95% CI 1.01 - 2.03) were found to be statistically significant predictors of CVD in our study population. We found that education level, income, body mass index and waist to hip ratio are CVD risk factors. Public health authorities, as well as clinicians should consider this finding in primary and secondary prevention and organize multidisciplinary teams to address those risk factors.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fatores Socioeconômicos , Adulto , Idoso , Estudos Transversais , Feminino , República da Geórgia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Risco , Classe Social
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA