IMPACT OF SOME ENVIRONMENTAL FACTORS ON HUMAN HEALTH.

This paper presents statistical data of 2012-2015 on the diseases caused by the atmospheric air and water pollutions in Ajara region. The research on the content of dust, sulfur dioxide and nitrogen dioxide as well as carbon monoxide in the atmospheric air was held together with the National Environment Agency Ajara Monitoring Service. The results of the research have shown that the average content of the dust reached its maximum in 2012 (0.60 mg/m3) and it dropped to the minimum in 2015 (0.441 mg/m3). As for average content of carbon monoxide the maximum was observed in 2013 (3.1 mg/m3) and minimum in 2015 (2.1 mg/m3). Average content of the sulfur dioxide was at maximum in 2015 (0.159 mg/m3) and at minimum in 2012 (0.07 mg/m3). The average content of nitrogen dioxide reached its maximum in 2015 (0.153 mg/m3) and was found to be at its minimum in 2012 (0.13 mg/m3). In parallel statistical research of the registered diseases (chronic and undetermined bronchitis, asthma, allergic rhinitis and trachea/bronchi/lung malignant cancer) in Ajara during 2012-2015 has been performed. These diseases were especially common among the population over the age of 40. It may be concluded that in 2015 the cases of diseases caused by the atmospheric air pollution in Ajara have become more frequent compared to the previous years. Therefore, it is evident that monitoring of atmosphere air should be improved and corresponding preventive measures should be undertaken.

Identification, management and complications of intra-abdominal hypertension and abdominal compartment syndrome in neonatal intensive care unit (a single centre retrospective analysis).

The abdominal compartment syndrome (ACS) is a result of increased intra-abdominal pressure (IAP) due to tissue edema or free fluid collecting in the abdominal cavity. Elevated pressure in the abdomen is referred to as intra-abdominal hypertension (IAH). The end result of ACS, if undetected and untreated, is multisystem organ failure and patient death. Intra-abdominal pressure monitoring should be strongly considered in all patients with this clinical presentation. Normal intra-abdominal pressure is 0-5 mm Hg. Physiologic compromise begins when the pressure rises above 8-10 mm Hg. Once the pressures increase beyond 20 mm Hg irreversible tissue injury occurs, ultimately resulting in ACS and multiple organ failure. Early recognition of rising abdominal pressure is critically important, because it allows prompt intervention which will prevent ACS from developing, leading to a much better prognosis for the patient. The purpose of the research was to: 1) Detect abdominal compartment syndrome in newborns with clinically suspicious intra-abdominal hypertension; 2) Identify intra-abdominal pressure numbers presented with clinical manifestation; 3) Measure and detect intra-abdominal pressure numbers presented with abdominal compartment syndrome; 4) Find correlation between intra-abdominal hypertension grade and patient outcome. For completion of our goal we selected and reviewed medical records of 155 neonatal patients from 2008 to 2010, who stayed in surgical neonatal intensive care unit for more than 7 days. We monitored IAP in patients with suspected ACS and different clinical presentation. According to our research we may come to the following conclusion: Intra-abdominal hypertension was confirmed in most suspected cases. Intra-abdominal pressure of >10 mmHg in patients with clinical suspicion may be considered as intra-abdominal hypertension. Intra-abdominal hypertension is in close correlation with presence of fluid in abdominal cavity proved by ultrasound investigation. Intra-abdominal pressure of ≥20 mmHg can be considered as a point of development of abdominal compartment syndrome. The grade of hypertension is in close correlation with patient outcome.

[Changes of redox processes in liver under pv-88 at experimental hemorrhagic shock].

PV-88 is the Ca2+ L channel blocker from pyrrole compounds, that has been used at hemorrhagic shock - HS (model of Shock was created by the method of (Wiggers-Feine) on 60th minute (intravenous administration, 3 mg/kg). Mean arterial pressure was 40 mmHg. Effects were studied on 80th minute after blood letting. Blood was exfused 40 ml/kg. Effect of PV-88 on redox processes in liver was studied. Experiments were carried out on male cats. Right lobe of the liver and the metabolic indices: ATP, CO, NAD, NADP, ALP, SDH, LDH were studied with the use of histochemistry (Pearse). Investigations have shown that on 80th minute after PV-88 administration CO (p<0.05), NADP (p<0.05), ALP (p<0.001), SDH (p<0.05), and LDH (p>0.05) were increased, while ATP (p<0.001) and NAD (p<0.001) were decreased. Increase in LDH was not statistically significant. According to the results of investigations, after administration of PV-88 at HS 60 on 80th minute, in liver increases oxygen concentration and aerobic process respectively.

The role of permanent invasive monitoring of intracranial pressure in the treatment of infants with posthaemorrhagic ventricular dilatation after intraventricular haemorrhage (case report).

Posthaemorrhagic ventricular dilatation (PHVD) is a major complication of intraventricular haemorrhages in very preterm infants. Posthaemorrhagic ventricular dilatation is associated with a high rate of disability, multiple impairments and adverse effects of shunt surgery for hydrocephalus. It may lead to an impaired neurological prognosis, caused by a raised intracranial pressure (ICP) and concomitant decreased cerebral blood perfusion. Therefore, early intervention to decrease the ICP may improve the long term outcome. Different treatment modalities have been studied, of which repetitive removal of cerebrospinal fluid (CSF) seems to be the only effective one. Studies performed in several institutions showed, that intermittent CSF drainage in very preterm infants with PHVD is an effective way to treat increased ICP and its negative effect on cerebral blood perfusion. The cut off point for CSF drainage is about 6.0 cm H(2)O ICP, as drainage below that level no longer results in improvement in perfusion. From this single case study it can be concluded, that in preterm infants with PHVD, repetitive CSF tapping from a ventricular access device guided by ICP measurements and ICP targeted treatment strategy is a useful technique for determining the frequency and volume of CSF removal. In neonatal intensive care units with poor capabilities and resources this is possible even by placing the simple intravenous single lumen catheter.

Incidence and risk factors of nosocomial infections after cardiac surgery in Georgian population with congenital heart diseases.

Nosocomial infections still remain a serious problem in patients undergoing open heart surgery. The aim of the study was to determine the incidence, etiology and main risk factors of nosocomial infections (NI) following cardiac surgery in congenital heart diseases population. Retrospective case study was conducted. 387 patients with congenital heart disease (CHD), who underwent cardiac surgery from January 2007 to December 2008 were studied. The age of the most patients varied between 1 day to 15 years, 73 patients (18,8%) were older than 15 years. All 387 patients underwent cardiac surgery. The rate of NI was 16%. The most common infections were bloodstream infections (BSI) (7,75%) and respiratory tract infections (7%) respectively. The rate of NI was higher in patients under 1 year of age, after urgent surgery and urgent reoperation, long cardiopulmonary bypass (CPB) and aortic cross-clamp time, also in patients with prolonged mechanical ventilation, massive haemotransfusion, with open heart bone after surgery, reintubation, hospitalization in another hospital during last three month. It was concluded that the most common nosocomial infection after cardiac surgery congenital heart diseases in Georgian population was blood stream infection. The main risk factors of NI in the same setting were age under 1 year, urgent surgery, urgent reoperation, long CPB and aortic cross-clamp time, long duration of mechanical ventilation, massive haemotransfusion, open heart bone after surgery, reintubation, hospitalization in another hospital during last three month.

[The dynamics of infectious disease in Adjara Autonomous Republic in 2008].

15-16 nosologies are registered on Adjarian territory annually, among which the most frequently registered infections are - the diarrhea of infectious origin, other bacterial infection of guts, viruse hepatitis and by air-drop transmission of such diseases as flue and respiratory infections. 22681 cases of infectious diseases are registered in 2008. If we compare with the results of the last year, the number has increased by 979 cases. There are 60-65% of population of 0-14 years old in the age spectrum of the disease. Among other bacterial infections of guts, there are 170 cases of esherikhosis col proved laboratorially. This is 75% of infections registered by other bacterial infection diagnosis of the gut. In 2008 there were 508 cases of A+other cases of viruse hepatitis included in the epidemy controlling system. The index of flue and acute infectious diseases of upper inhalant has risen several times compared with the last years. 450 cases of flue were registered in 2008, from the observed the virus is identified in 22 cases, 16491 cases of acute virus infection of upper inhalant, 15 cases of hospitalization with the flue like disease. Within the 28 year dynamics of the flue and upper inhalant acute infections, the data of 2005-2008 years gets closer to the data of the 80s.

[Comparison of PIM and SOFA scoring systems for mortality risk prognosis in critically ill children with sepsis].

The task of the study was the comparison of 2 scoring systems SOFA and PIM for mortality risk assessment in intensive care units. SOFA score is evaluated on admission and thereafter 72 and 120 h until ICU discharge in Children's Central Clinical Hospital from 2001 to 2005 years. Total 200 patients were studied. Mean age was 234.5+/-14.5. Mortality rate was 54 (27%). 89 (44.5%) were females and 111 (55.5%) were mails. Mechanical ventilation was performed in 72 (36%) patients. Septic shock was developed in 39 (19.5%) cases. Diagnose was confirmed by bacteriology in 68 (34%) cases. Higher score was in 93 (46.5%) cases, middle scores in 94 (47%) cases and low in 13 (6.5%) cases at the first day of admission. After 72 h. higher score was in 33 (16.5%) cases, middle in 113 (56.5%) cases and low in 54 (27.5%) cases. By evaluation with PIM--Higher score was in 58 (29%) cases, middle scores in 51 (25.5%) cases and low in 91 (45.5%) cases at the first day of admission. There is a correlation between the SOFA and PIM scores and paediatric mortality. Sofa scores predict mortality in ICU better then PIM scoring system. Kendall's tau of SOFA 0.64+/-0.3. Kendall's tau of PIM 0.45+/-0.2. Sofa scores is an excellent tool to describe the extent of organ dysfunction in critically ill patients.

[Effect of toluene on stability of chromatin of white rat hippocampus and olfactory bulb in vivo. Microcalorimetric study].

The denaturation heat parameters of hippocampus and olfactory bulb nodulus tissues were determined. The total denaturation heat calculated from the areas of endotherms I-IX onto which the dependence deltaH = f(T) is factorized equals to 13.03 +/- 1.3 J/g for bulb nodules and 9.91 J/g for the hippocampus. It was shown that chromatin in the composition of tissues had two stages of denaturation with the following parameters: for bulb nodules: Td(VIII) = 99.4 degrees C, Qd(VIII) = 62.3 +/- 0.8 J/g DNA, Td = (IX) = 106 degrees C, Qd = 28.8 ; 0.4 J/g DNA; and for hippocampus: Td(VIII) = 95 degrees C; Qd(VIII) = 62.0 +/- 9 J/g. Td(IX) - 107 degrees C; Qd(IX) = 29.0 +/- 4.5 J/g DNA. It was established that, along with denaturation of cytoplasmatic structures, nonhistone, nuclear proteins and damage to the nuclear matrix, toluene caused the redistribution of heat between endotherms IX, VIII, VIII(I) connected with the infolding of chromatin loops and 30-nm fibers. It is supposed that toluene causes the damage to the genetic material due to not only its oxidative influence on chromatin DNA but also the disturbance of nuclear matrix structural organization and partial denaturation of nuclear proteins of non-histone origin.

[Features of regeneration of joint cartilage during osteoarthritis].

In order to define the features of regeneration of joint cartilage during osteoarthritis, morphological study of surgical material, obtained from 50 patients, has been performed with the help of histological, histochemical and morphometric methods. In the joint cartilage, alongside with the alteration, there is also the cellular regeneration expressing in the intensive proliferation of cartilaginous cells. However, maturing of the regenerated cells proceeds defectively and consequently regenerate loses ability to be differentiated in hyaline, joint cartilage that specifies the phase of differentiation. Hence, the specified process should be qualified as not reparation, but as a pathological regeneration. Cartilaginous regenerate is not capable to carry out amortization and protective functions of an articulate cartilage and is exposed to secondary alteration. The last, in turn, aggravates arthroses changes and causes progressing disease.