EXPERIMENTAL & CLINICAL MEDICINE
2007, ¹ 3
1. GOTUA T., PAVLENISHVILI I., PARULAVA TS., TABUTSADZE D.
LATE-ONSET SEPSIS CAUSED BY MULTIRESISTANT MICROBS FROM FAMILY ENTEROBACTERIACEAE IN LOW BIRTH WEIGHT PREMATURE NEONATES
J. Experimental and Clinical Medicine, 2007, 3, pp. 9-11.
Tbilisi state Medical University, Georgia
Late-onset sepsis continues to be an important cause of morbidity and mortality, although advances in neonatal intensive care have led to improved survival of low (LBW) and very low birth weight (VLBW) premature neonates [3].
Microbs of family Enterobacteriaceae have an outer membrane that contains, among other things, lipopolysaccharides from which lipid-A plays a major role in sepsis. Lipid-A, also known as endotoxin, is the major stimulus for the release of cytokines which are the mediators of systemic inflammation and its complications.
To study late-onset sepsis caused by Enterobacteriaceae, risk factors for disease, antibiotic therapy, prevention strategies, we evaluated 76 LBW and 18 VLBW premature neonates with proven late-onset sepsis admitted from January 2006 till February 2007 to Tbilisi State Medical University Pediatric clinic’s NICU and department of pathology for premature neonates. Sepsis caused by Serratia marcescens was in major cases (51%), Klebsiella spp. in 42.5%, E.coli in 6.3%, Salmonella in 2.1%. Clinical manifestations and laboratory parameters did not differ from the other gram- negative bacilli sepsis, but in VLBW neonates it had severe, fulminant duration, prolonged hospitalization with complications and mortality (27.7%). Birth weight and gestational age were srongly associated with risk of late -onset sepsis. Serratia and Klebsiella were multiresistant to many antibiotics, but sensitive to carbapenems, aminoglycosides, chinolons.
These data suggest that empiric antibiotics selected for treatment of suspected sepsis of infants >3 days old need to effectively treat Gram-negative pathogens, particularly Serratia marcescens, Klebsiella spp., Escherichia coli, Salmonella, because these organisms are strongly associated with fulminant Late-onset sepsis and with complications and mortality.
Late-onset sepsis among LBW and VLBW premature neonates underscores the importance of serious complications and mortality and suggests that strategies to reduce infections in this neonates and their social and economic toll are needed urgently. Successful interventions should improve survival and shorten hospital stay, decrease antibiotic usage and reduce the high cost of caring for this infants.
Analysis of indexes of coagulation stage of hemostasis in patients with severe cerebrocranial trauma and lung complications
J. Experimental and Clinical Medicine, 2007, 3, pp. 11-15.
Chair of Internal Diseases and Reanimatology of AMU, Department of Surgery Reanimation of Clinical Medical Centre, Baku, Azerbaijan
Severe cerebrocranial trauma is still one of the most important problems of medicine. The objective of this study was to review the dynamics of indexes of the coagulation stage of hemostasis in patients with severe cerebrocranial trauma and complicated pneumonia. In the period of 2000 to 2006 in the Clinical Medical Centre we observed 60 patients aged 15 to 60 years. Patients were devided into 2 groups. The I group included 30 patients with severe cerebrocranial trauma and complications developed in the lungs. The II group included 30 patients with severe cerebrocranial trauma without lung complications. Researches showed that in the patients with severe cerebrocranial trauma the content of fibrinogen increases in arterial and venous blood, assisting to the development disseminated intravascular coagulation.
3. JAVAKHADZE M., BUBASHVILI M., RIGVAVA S.
IMMUNITY AFTER VACCINATION AGAINST DIPHTHERIA AND TETANUS IN DIFFERENT AGE GROUPS
J. Experimental and Clinical Medicine, 2007, 3, pp. 15-18.
Tbilisi State Medical University;
G. Eliava Institute of Bacteriophagy, Microbiology and Virology, Tbilisi, Georgia
By the method of random selection there were studied 1425 healthy persons, who hadn’t had diphtheria. They were vaccinated against diphtheria and tetanus.
Blood serum (0.1 ml) was taken as research material, and antibody titers against diphtheria and tetanus were studied by the method of passive hemagglutination. Age of the persons being researched ranged between 1-60, and they were divided into the following age groups: <1 year old; 1-3 years old; 4-8; 8-11; 12-14; 15-20; 21-30; 31-40; 41-50; 51 years old and over.
Nowadays, there is a high rate of exposure to diphtheria and tetanus in all age groups. The highest indicator of exposure is among the IV group (9-11), VIII (31-40) and X groups (51 years and over). The best protected were the V (12-14), VI (15-20) and III (4-8) groups. The most unprotected were the persons of the V group (15-20). During the last epidemic in Georgia, people of this age were taken ill with diphtheria most frequently, but after booster immunization (after getting over diphtheria were inoculated) the level of protection improved. At present, a high indicator of exposure to the diseases is registered at the age of 9-11 and 51 and over.
4. TURMANIDZE K., CHIKVILADZE D., GACHECHILADZE KH., MIKELADZE M., METREVELI D.
ALTERNATION OF STRUCTURAL COMPONENTS IN MIXED SALIVA DURING TREATMENT OF APICAL PERIODONTITIS WITH DIFFERENT ANTISEPTICS
J. Experimental and Clinical Medicine, 2007, 3, pp. 18-23.
Tbilisi State Medical University, Department of Microbiology and Immunology;
Stomatologic Clinic “G&N-dent”, Tbilisi, Georgia
Investigation of the dynamics of structural components alternation in the mixed saliva during treatment of apical paradontitis with various antiseptics was provided among 58 patients with chronic apical periodontitis: 22 of them had chronic fibroses and 36 - chronic granulomatous periodontitis (28 men - 16 to 45 age group and 36 women - 18-65 age group) and 15 were practically healthy (control). The study of such individuals carried out before treatment and at different time (7, 90, 180, 360 days) revealed that Ca level in the saliva is normal during the whole period of control. During control period was used 3% solution of Na hypochloride and dicamphen. However, the usage of 3% solution of hydrogen peroxide caused changing Ca level. Activity of alkali phosphatase was maximal by the 90th day of treatment with 3% solution of Na hypochloride and dicamphen. Level of sialic acids decreases on the 7th and 90th days, only with dicamphen, these is related with active regenerative processes, when root channels were treated with 3% solution of Na hypochloride and dicamphen. Moreover, marked increased correlation of links during usage of 3% solution of Na hypochloride confirms its influence on the intensity of reparative processes in bone marrow.
The results of structural components alternation in the mixed saliva during treatment of apical periodontitis and later after treatment enable selecting of antiseptics with maximal therapeutic effect. Our investigation showed that the most effective during treatment of different forms of apical periodontitis is 3% Na hydrochloride and dicamphen.
IMMUNE CHANGES AFTER SPLENECTOMY
J. Experimental and Clinical Medicine, 2007, 3, pp. 23-26.
Batumi Central Clinical Hospital, Georgia
The present article researches immune changes occurring after splenectomy. There was researched the immune status of 55 patients. 15 patients out of 55 were almost healthy, and the research results formed the basis for a control data sheet. 40 out of 55 patients had had splenectomy at different ages. The researched data show that splenic injury occurs mostly at the age of 26-35, and it is twice more often in males rather than in females.
Post-splenectomy syndrome (general disability, decreased physical and working ability, periodic and weak pain passing over without any medical help) was revealed in 4 patients (44.4%) - 3 out of 4 were males and 1 was a female, age range - 20 to 45. The researched 4 patients underwent surgery 3-12 years ago.
A post-splenectomy picture clearly shows total decrease in general immune status, i.e. immunodeficiency. That proves the vital importance of spleen shielding operations.
6. JAVELIDZE N., NATRIASHVILI M., ABULADZ T., BERIDZE M., BREGADZE T.,
EREMENKO N.
MODERN ASPECTS OF “GLOSSALGI SYNDROME” TREATMENT
J. Experimental and Clinical Medicine, 2007, 3, pp. 26-29.
TSMU Parodontology Clinic, Tbilisi, Georgia
During complex treatment of the disease we were using Mexidol a synthetic antioxidant.
The medicine is to be used according to the following scheme: Locally – application of 5% Mexidol solution 3 times a day; Generally – tablets of Mexidol (0.125mg twice a day for two weeks’ time); Physiotherapy – electrophoresis - 5% solution of Mexidol (10 times); Prophylactics – hygienic means – tooth-paste Mexidol Phyto. As a result of using the above-mentioned medicine, the duration of the disease treatment is shortened and positive results are present in 80%.
7. ZAMANOV N., ALEKPEROVA G.
STUDY OF THICKNESS OF CAROTID ARTERIES INTIMA-MEDIA COMPLEX IN PATIENTS WITH RHEUMATOID ARTHRITIS
J. Experimental and Clinical Medicine, 2007, 3, pp. 29-32.
Azerbaijan Medical University, ¹1 Department of Internal Diseases and Reanimatology, Baku
There were surveyed 68 patients with rheumatoid arthritis (RÀ) - 20 men (29.4 %) and 48 women (70.6 %). Patients’age ranged from17 to 57 years (on average – 38.7±10.5 years); the disease duration – 0.25 to 28 years, on average – 15.7±9.4 years.
There were revealed direct positive correlations (RÀ) between the thickness of the intima-media complex (ÒIMC) of the patients’ carotids and lipid–protein spectrum parameters.
In the patients with RÀ, between ÒIMC of the carotids and some indexes of EchoCG (end- diastolic volume LV, end-systolic volume LV, speed of early diastolic fillings LV, E/A) a direct positive correlation has been revealed, and with other indices (fraction of ejection LV, speed late diastolic fillings LV) - negative correlation.
There was observed an average positive correlation between the duration of RÀ and ÒIMC of carotids. In the process of RÀ activity increasing of, an increase of ÒIMC (direct, average and high correlation) was marked.
ÒIMC of carotids more than 1 mm in thickness was marked basically in the patients with RÀ of seropositive form, with a high concentration of C–reactive protein, expressed anemia and significant EchoCG changes.
8. BERIDZE M., NATRIASHVILI M., ABULADZE T., JAVELIDZE N., GOLOVACHEVA A.
ACTUAL TREATMENT OF LOCAL PARODONTITIS WITH CYCLOPHERONE 5% LINEMENT AND “MIL” THERAPY
J. Experimental and Clinical Medicine, 2007, 3, pp. 32-35.
TSMU Parodontology Department, Tbilisi, Georgia
The usage of the mentioned method in the treatment of Local Parodontitis has obtained positive results: the treatment period reduced; theoretical effect increased that is confirmed by clinical diseases and on the basis of the research.
9. KHIZANISHVILI I., BARABADZE K., VEKUA M., PAPAVA M.
CONDITION OF CHILDREN’S HEALTH IN THE REGION OF CATASTROPHE
J. Experimental and Clinical Medicine, 2007, 3, pp. 35-37.
I.Pagava Research Institute of Pediatry, Tbilisi, Georgia
In the village Ninotsminda, Sagarejo district, an important environmental pollution was caused by an oil well explosion.
The research results given in the work show intoxication of children’s breathing system with gases accompanying oil.
420 children residing at the polluted village Ninotsminda and 50 children residing at the nearby ecologically clear village Badiauri (at a distance of 6km) were examined and investigated.
An observation has been carried out quarterly and it covered a repeated clinical-laboratory research in both zones.
As a result of the research performed, it was determined that the frequency of children’s illnesses had sharply increased in the zone of catastrophe in comparison with the control zone, but domination of the upper breathing system diseases was revealed in the nozologic structures of the diseases.
10. PARULAVA T., PAVLENISHVILI I., GOTUA T., MACHATADZE D.
PAINFUL FUNCTIONAL DISORDERS OF THE GASTROINTESTINAL TRACT IN CHILDREN
J. Experimental and Clinical Medicine, 2007, 3, pp. 37-40.
TSMU Pediatric Clinicl; Central Pediatric Hospital, Tbilisi, Georgia
Functional disorders of the gastrointestinal tract (clinical signs and symptoms without structural or biochemical changes in this system) are rather often among children and adults. Such disorders are explained by dysadaptation of psychosocial and regulation mechanisms.
The Committee on Childhood Functional Gastrointestinal Disorders (Rome II) suggests the following clinical forms of functional disorders:
1. Functional disorders with vomiting;
2. Functional disorders with abdominal pain;
3. Functional disorders with defecation problems.
We observed 122 children 5 to 15 years old, who had persistent abdominal pain during 12 weeks in last 12 month. We learned detailed history, CBR, results of ultrasound screening and endoscopy of the upper or lower gastrointestinal segments. In the majority of cases (64%) there was not enough data for organic disorders.
Functional disorders of the gastrointestinal tract represent a common reason for abdominal pain in childhood, and are more often among preschool and early school age children, predominantly girls. Biliary tract dysfunction is the most frequent reason for functional abdominal pain in children.
11. DUNDUA T., SUMBADZE TS., JOJUA T., PAPAVA M.
C-PEPTIDE LEVEL IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES MELLITUS AND DIABETIC RETINOPATHY
J. Experimental and Clinical Medicine, 2007, 3, pp. 40-42.
Al. Natishvili Institute of Morphology ;
Research Institute of Medical Radiology, Tbilisi, Georgia
The level of C-peptide was measured in the blood plasma of patients with non-insulin-dependent diabetes mellitus and diabetic retinopathy (DR). There were examined 62 patients (28 males and 34 females) aged 50 to 70. They were divided into two groups. The first group included 31 patients (14 males and 17 females) with non-insulin-dependent diabetes mellitus without DR. The second group included the same number of patients with non-insulin-dependent diabetes mellitus complicated by DR. The control group included 31 healthy persons.
C-peptide concentration was increased in patients suffering from non-insulin-dependent diabetes mellitus without DR. It was also increased in the patients with non-insulin-dependent diabetes mellitus complicated by DR.
12. TSISKARISHVILI N., TSISKARISHVILI N.
Up-to-date method for prophylaxis of cervix uterI cancer in women infected by papilloma virus
J. Experimental and Clinical Medicine, 2007, 3, pp. 42-45.
Department of Dermatology and Venereology, Tbilisi State Medical University, Georgia
A new, pathogenetically proved method comprising Colomack Solution (for external application) and preparation Gold-Ray (has antioxidative and antitumoral properties) is offered for combined treatment of women infected by human papilloma virus.
In 94% of patients the regress of skin eruption was observed. There were not revealed any complications during the treatment. In subsequent 6 months of medical observations, none of the patients complained about eruption relapse.
The method requires neither expensive equipment nor anesthetization, results in a high percentage of recoveries, and may be recommended for wide application.
IMMUNO-BIOLOGICAL PROPERTIES OF ANTHRAX VACCINE STRAINS OF PANTHRACIS
J. Experimental and Clinical Medicine, 2007, 3, pp. 45-46.
G.Eliava Institute of Bacteriophagy, Microbiology and Virology, Tbilisi, Georgia
Some bacterial, serological and genetic properties of Anthrax vaccine strains such as STI-1, 55, I-17, 34F2 and 71/12 – the second vaccine of Tsenkovski - have been studied. The nutrient medium is sensitive to specific bacteriophages – Gamma and Fah. By means of a serologic method – passive hemagglutination reaction - Anthrax antibodies (soporiferous and vegetative forms, toxins) were revealed in the blood serum of patients suspected with Anthrax, in soil and animal debris. Genetic indicators were studied. It was determined that vaccines are characterized by a high polymorphism. Each of them belongs to various genotypes. Nevertheless, their relationship with vaccine 34F2 was verified.
14. GABUNIA L., PETRIASHVILI S., RATIANI L., VADACHKORIA D., CHACHUA M., KHUCISHVILI G.
COMPARATIVE INFLUENCE OF DILATREND, INHIBACE AND THEIR COMBINATIONS UPON LIPID SPECTRUM, HEMOCOAGULATION SYSTEM, QUANTITATIVE AND QUALITATIVE PLATELET INDEXES OF EXPERIMENTAL RATS
J. Experimental and Clinical Medicine, 2007, 3, pp. 46-49.
Tbilisi State Medical University, Georgia
The present work is devoted to the study of a comparative influence of AGF–inhibitors - Dilatrend, Inhibace and their combinations (the firm Hoffmann-LaRoche, Switzerland) upon lipid spectrum in blood, hemocoagulation system, quantitative and qualitative platelet indexes of experimental rats against the background of electronic stress.
Based on the investigation results, a positive influence upon hemocoagulation system indexes and lipid spectrum was noticed in III, IV and V series, but the greater part of changes caused by stress developed against the background of Inhibace and Dilatrend used in combination.
As for the quantitative and qualitative platelet indexes, a positive influence on them was almost identical in the III and IV series of the experiment, which will evidently make for the high effectiveness of Inhibace and Dilatrend preparations (and especially their combined use) in pharmacotherapy for cardiovascular diseases.
15. SHAVDIA M., JINCHARADZE M., KACHAKHIDZE G., SHAVDIA N., METIVISHVILI G.
REASONS FOR INCORRECT MANAGING OF ADVANCED CANCER PAIN
J. Experimental and Clinical Medicine, 2007, 3, pp. 49-53.
Palliative Care Clinic of Cancer Prevention Center, Batumi, Georgia;
High Medical Shcool “Aieti”, Tbilisi, Georgia
Objective: During last years (2000-2006) in Georgia over 50% of oncologic patients have been diagnosed with IV stage cancer. Taking this fact into account, the number of incurable patients is too large and they need palliative care. Having studied 638 incurable cancer patients, we found out that the most marked characteristic of them are asthenia (85.1%) and pain (78.5%). The frequency of pain syndrome in growing according to the increase of ECOG which reaches 85.3% at the IV stage. So it is most important to examine Georgian doctors’ qualification, their ability to manage modern principles of chronic pain control. Methods: In May and September 2006, at Tbilisi “Palliative care clinic” 98 general practitioners from different regions of Georgia were questioned during the current training. The total number of questions concerning the basic principles of cancerous pain control was 6. The answers were to be “yes” and “no”. The results were treated via the ordinary statistical method. Results: After questioning general practitioners working in different regions of Georgia, it was found out that: 1. 91.8% did not know the half-value period of concrete opioids; 2. 50% were unaware of rational use of the three-stage system of pain control recommended by WHO; 3. 100% could not estimate pain intensity (by visual analogy scale); 4. 89.8% prescribed opioids without isolation of the pain provoking cause which was often the reason for an inadequate pain control; 5. 95.9% were completely unable to choose an adequate dose of analgetics (neither in ampoules nor in tablets), and did not know their replacement factor; 6. 53.1% were unaware of a considerable part of side effects of opioids and could not control them adequately. Conclusion: To adequately manage incurable cancer patients’ chronic pain syndrome, doctors working in the public health system of Georgia require an appropriate education. Therefore, it is necessary to launch an education program on modern principles of an adequate control of pain, the aims of which will be: 1. To determine pain intensity; 2. To describe the components of pain estimation; 3. To estimate destructive influence of pain; 4. To describe the reasons for an inadequate pain control; 5. Basic reasons provoking tumor pain; 6. Indications, dosage, side effects of opioids; 7. Control realization on basic principles of pain estimation.
16. RIGVAVA S., NATIDZE M., NATIDZE T.
METHODOLOGY FOR IMMUNOLOGIC DIAGNOSIS OF INFECTIOUS DISEASES
J. Experimental and Clinical Medicine, 2007, 3, pp. 53-54.
G.Eliava Institute of Bacteriophage, Microbiology and Virology, Tbilisi, Georgia
Modern science possesses various means for etiologic diagnosis of the diseases induced by microbes, viruses, helminthes. The first of these methods is isolation and identification of an infectious agent; the second – provides for recording of an immune response; the third method allows isolation of the infectious agent-antigens from pathological material of a patient. The optimal way of diagnostics should be developed with consideration of existing regularities. The topmost condition implies application of modern methods of diagnosis for infectious diseases.
J. Experimental and Clinical Medicine, 2007, 3, pp. 54-57.
N. Kipshidze Central University Clinic, Department of Ophthalmology, Tbilisi, Georgia
The history of cataract surgery shows that there is a tendency of diminution of the incision size. Surgeons began to make intra and extracapsular extraction with an incision of 10-12 mm, because of which they had a big postoperative astigmatism and other complications. Later on ophthalmologists used the coaxial phacoemulsification with possibility to make an incision just of 3 mm. Actually, the modern cataract operation is bimanual phacoemulsification with two incisions of 1.5 mm.
18. NATIDZE M., RIGVAVA S., NATIDZE T.
CURRENT BACTERIOLOGIC METHODS FOR DIAGNOSIS OF INFECTIOUS DISEASES AND PHAGODIAGNOSIS
J. Experimental and Clinical Medicine, 2007, 3, pp. 57-58.
G. Eliava Institute of Bacteriophagy, Microbiology and Virology;
Ltd “Immunogen”, Tbilisi, Georgia
In diagnosis of infectious diseases the newest immunologic methods – immune-enzymatic analysis, chain reaction of polymerase etc. are successfully used. Along with bacteriologic and serologic methods, phagodiagnosis seems to be a promising one. According to the our investigations, the reaction of a phage titer elevation which belongs to diagnostic express-methods and is characterized by specificity and high sensitivity, allows rapid diagnosis – within 18-36 hours – of salmonellosis. This finding was verified via the parallel bacteriologic examination.
DIAGNOSIS AND CONSERVATIVE TREATMENT OF GASTRO-DUODENAL PEPTIC ULCER BLEEDING
J. Experimental and Clinical Medicine, 2007, 3, pp. 58-59.
Borjomi Hospital, Georgia
A balloon probe with the olive-shaped tip has been offered for the compression of duodenal ulcer hemorrhage. To approach the goal, a special tube with the metallic olive-shaped tip was constructed. Bile and blood outflow from the tube testified that the olive-tip was properly located. Then, cold liquid in the balloon was heated to 10oC.
Ceasing of hemorrhage or its recurrence was defined by controlling the probe canal. Hemorrhage was stopped in 40 patients (of 45), but in 5 cases this method didn’t help, and a special operation became inevitable. The use of a balloon probe allows simultaneous direct compression and hypothermia of duodenal ulcer, helps hemostasis. This method should be included in complex measures for the accomplishment of hemostasis in juxtapyloric ulcer hemorrhage.
The results of our assessment indicate that the observed method has a marked therapeutic effect and diagnostic value as well.
SONOHYSTEROSALPINGOGRAPHY: SAFETY AND INFORMATIVITY
J. Experimental and Clinical Medicine, 2007, 3, pp. 61-64.
Obstetric-Gynecological Clinic Ltd “Bibida”;
Clinic “Healthy World” for Endoscopy and Plastic Surgery, Tbilisi, Georgia
Objectives: To compare the diagnostic accuracy of hysterosalpingography and sonohysterosalpingography in detecting tubal and uterine abnormalities. Methods: In a prospective study for the evaluation of uterine and tubal pathologies, 86 patients with primary and secondary infertility rates (54% and 46%, respectively) underwent sonohysterosalpingography. Tubal pathologies, as well as intracavitary and/or structural uterine abnormalities, detected with this procedure were compared with preoperative hysterosalpingography and operative procedures. Results: With surgical findings as the gold standard, sonohysterosalpingography had a sensitivity of 78.2%, a specificity of 93.1%, a positive predictive value of 82.7%, and a negative predictive value of 91%. For total tubal and uterine pathologies, the findings for the same parameters using HSG were 76.3%, 81.8%, 90.9%, and 59.2%, respectively. Sonohysterosalpingography was more accurate than hysterosalpingography for detecting intrauterine adhesions and various forms of uterine anomalies. Conclusions: Sonohysterosalpingography is a safe, easy, accurate, and promising procedure for the detection of female upper genital tract pathologies, especially because it can differentiate specific uterine anomalies.
RADIOSURGERY FOR TREATMENT OF BACKGROUND DISEASES OF CERVIX UTERI
J. Experimental and Clinical Medicine, 2007, 3, pp. 64-66.
D.Koridze Maternity Hospital, Tbilisi, Georgia
Radio-wave treatment was provided to 100 women suffering from background diseases of cervix of the uterus complicated with ectopia, condylomatosis, and condylomatosis against the background of ectopia.
Treatment of background diseases of the cervix uteri was provided to 60 patients via the radiosurgical method, and 40 patients were treated by the radio-wave method against the background of T-activin, ginilaki, and magnetic-laser therapy.
Comparing the results achieved after providing radio-wave surgical treatment, we could come to the conclusion that radio-wave excision can be considered as a highly effective method for treatment of background diseases of the cervix uteri. A positive side of the above-mentioned method is atraumatization of the cervix uteri tissues that does not cause stenosis of the cervical canal which might have further negative effect on the woman’s reproductive function, and combined application of radio-waive excision together with T-activin and magnetic-laser therapy that is rather more effective for the treatment of pathologies of the cervix uteri.