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

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

FALL RELATED GERIATRIC TRAUMA TRENDS IN GEORGIA.

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

TRACKING PREGNANCY OUTCOMES: DATA FROM BIRTH REGISTER OF GEORGIA.

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

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

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

[THE COMPARATIVE STRUCTURE OF ACUTE POISONINGS IN TWO CAPITAL CITIES OF THE SOUTH CAUCASUS REGION].

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.

EFFECT OF SELECTED PROGNOSTIC AND RISK FACTORS ON SURVIVAL OF WOMEN WITH BREAST CANCER IN GEORGIA.

According to the population-based cancer registry data in Georgia, the incidence rate of breast cancer per 100000 women was 90.6 in 2016. The aim of this study is to explore the effects of risk and prognosis factors on survival of female invasive breast cancer patients in Georgia. Cancer survival analysis was conducted, it is based on retrospective study of Georgian cancer registry data. Almost all breast cancer cases who were diagnosed and histologically confirmed during the period of 2006-2015 and are recorded in the cancer registry system, were included in the study. From factors, associated with prognosis of disease and are considered as risk and prognosis factors, demographic (age at diagnosis, place of residence) and histopathology factors (stage at diagnosis and tumor cell differentiation grade) were included in the study. Survival status (alive, dead or censored) was used as the dependent (response) variable. As the starting point of time for estimating survival of patients was defined the date of diagnosis. Patients' observation period included the time from the date of diagnosis to the last follow-up (31ST December 2016) for those who was alive by the end of the study, and the date of death (end-point) for those who died during the study period. Any cause of death of cancer patients was considered as the end point. That means the overall (and not breast cancer specific) survival rate response to predictor factors was estimated in the study. Cox proportional hazard regression model was constructed to analyze the effect of all risk and prognosis factors and calculate the hazard ratio (HR) for mortality and 95% Confidence Interval (95% CI). A p value < 0.05 was considered as statistically significant. Total number of breast cancer cases enrolled in the study is 3852, age range from 21 to 80 years. We have found that cancer diagnosed between 41-59 years of age had a lower death hazard (HR=1.45, p=0.04) compared to cancer detected over 60 years of age (HR=2.40, p<0.01). There were significant differences (p<0.01) in terms of survival between patients, detected at different stages: the hazard ratio of death for cancer patients diagnosed at the second, third and fourth stages was 2.25, 4.04, and 10.43 accordingly. The study results showed that the moderately differentiated tumor had better survival chance (HR=1.35, p=0.44), than those with poorly differentiated (HR=2.37, p=0.03), and undifferentiated cancers (HR=5.19, p=0.01). Patients living in regions of Imereti (HR=1.40, p=0.02), Adjara (HR=1.37, p=0.07), and Guria (HR=1.30, p=31), had higher risk of mortality than residents of Tbilisi, while living in Shida Kartli (HR=0.59, p=0.01) region had statistically significant effect on better survival. Breast cancer survival dissimilarities among the regions of Georgia could be explained by detection of cancer at different stages and non-standard approaches to cancer management. Some risk and prognosis factors, such as the demographic (age and place of residence) and histopathology (stage at diagnosis and tumor cell differentiation grade) factors have impact on survival of the female invasive breast cancer patients, moreover, this effect mainly is statistically significant.

FACTORS AFFECTING SURVIVAL OF WOMEN DIAGNOSED WITH BREAST CANCER IN GEORGIA.

Breast cancer is the most frequently diagnosed cancer in women worldwide with nearly 2.4 million new cases diagnosed in 2015, In Georgia survival from breast cancer is lower than in many developing countries. The goal of the study was to identify predictors for low survival of disease in the country. Data from population-based cancer registry was used in order to estimate 1-year and 5-years relative survival rates for breast cancer. To identify predictors for low survival time, was performed bivariate analysis. Statistical analyses looked at correlations between possible predictors and survival period. From the cancer registry database 190 breast cancer cases, whose diagnosis were conformed histologically and died in 2015 were included in a statistical analysis. All analyses were performed using Epi Info version 7. According to population-based cancer registry, breast cancer is the most common form of  cancer among women in Georgia. In 2015 1838 breast cancer new cases were detected in the country, incidence rate composed 94.7 per 100000 population. Based on 190 breast cancer patients' data, that died during 2015, one-year and 5-year survival rate composed 69% and 26% in accordance. The results of bivariate analysis, show that late stage at diagnosis (OR=1.89, 95%CI=0.74-4.68), a young age of patients at diagnosis (OR=1.89, 95%CI=0.50-7.17), highly differentiated histological grade (OR=1.21, 95%CI= 0.44 - 3.54), is positively correlated with low survival period (less than 5 years), while having mastectomy (OR=0.52, 95%CI=0.27-0.89), adjuvant chemotherapy (OR=0.38, 95%CI=0.20-0.74), and a radiotherapy (OR=0.62, 95%CI=0.31-1.25), have statistically significant positive association with high (more than 5 years), survival period. A young age of patients at diagnosis, highly differentiated histological grade and late stage at diagnosis were possible predictors for low survival time (less than 5 years) in Georgia. Breast cancer survival can be extended by using complex methods of treatment and implementation of standardized approaches to management of diseases throughout the country.

The relation between the general intellect of schizophrenic patients and psychopathological deterioration.

The aim of the study was to examine whether the postpsychotic decline in IQ during schizophrenia are due to a dementing process and psychopathological deterioration or this is a state independent premorbid impairment. The IQ score of 32 schizophrenic patients and 25 normal comparison subjects were evaluated three times during an average of 4,5 years, after short (mean 2,3 years) and long (mean 4,6) follow-up periods. The regression analysis was used to evaluate the association of clinical symptoms and IQ scores at the different period of time. The results were examined and related to changes of negative and positive symptoms of the illness. The schizophrenic group had low IQ score at baseline than the normal comparison subjects but showed comparable stability over time. The raw IQ score slightly increased in both groups in follow-up period. The regression analyses revealed that low IQ score especially in the block design (MT) and non-verbal reasoning (LPS3) subtests could be additional predictors for deterioration of negative symptoms. The IQ score of patients with schizophrenia appears to remain stable regardless of psychopathological decline, and even could be improved by learning and rehearsal.

Methicillin-resistant Staphylococcus aureus in hospitals in Tbilisi, the Republic of Georgia, are variants of the Brazilian clone.

The purpose of this study was to characterise methicillin-resistant Staphylococcus aureus (MRSA) isolates from the Republic of Georgia, part of the former Soviet Union. Thirty-two non-duplicate MRSA isolates were collected in the period from May 2006 to February 2007. The patient data were analysed and the isolates were characterised by staphylococcal protein A (spa) typing, staphylococcal chromosome cassette mec (SCCmec) typing, multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) and the detection of Panton-Valentine leukocidin (PVL) genes. Only two closely related spa types were found; 29 isolates were of spa type 459 and three were t030. The spa types belonged to sequence type (ST) 239, clonal complex (CC) 8. All isolates were multiresistant, PVL-negative and harboured SCCmec type IIIA. Based on the molecular findings and PFGE, the isolates most closely resembled the pandemic Brazilian clone (ST239-IIIA).

[Possibilities of colposcopy in the diagnostics of cervical Chlamydia-mycoplasmatic infections (population prospective study)].

Possibilities of colposcopy in the diagnostics of cervical chlamydia-mycoplastic infections are less investigated. The aim of given work was the study of this problem. Colposcopic examination was performed in 952 women (age - from 16 to 67) asked to clinics for examination and more precise definition of diagnosis because of different complaints. It was revealed specific colposcopic features of chlamydia-mycoplastic genital infections, which were compared with the results obtained from "gold standard" methods - direct immunofluorescence method and bacteriological analysis of cervical smears. High sensitivity (Se) - 0,96, specificity (Sp) - 0,79 and diagnostic effectiveness (De) - 0,93 of colposcopy were established. Authors conclude that the application of colposcopy for diagnostics of chlamydia-mycoplastic genital infection is particularly important: during urgent cases; during the case, when it is impossible to carry out the deep diagnostics of the sexually transmitted infections; for optimization of the diagnostics of the sexually transmitted infections.