MEDICAL BASIS OF DIABETIC NEUROPATHY FORMATION (REVIEW).

Nowadays, chronic diseases are leading cause of death worldwide. One of popular chronic disease of 21 century is Diabetes Mellitus (DM) that affected 422 million people around the world in 2014; its prevalence is expected to increase to 592 million by the year 2035. Diabetic neuropathy (DN) seems to be the most common and least understood complication being present in over 50% of chronic diabetics. As the latest date explain the pathogenesis of DN is not fully understood. Therefore, considering the widespread of DN, severity of its consequences, it is vital to investigate details of its pathophysiology and find therapeutic strategies to improve patients' condition. Generally two mechanisms have been suggested to be involved in the pathogenesis of diabetic neuropathy. The first mechanism is the activation of the Renin Angiotensin Aldosterone System (RAAS) in the presence of hyperglycemia with increased tissue level of Angiotenzin II (Ang II). Ang II stimulates Nicotin Adenine Dinucleotide (Phosphate) (NAD (P)) oxidase which enhances oxidative stress and vascular damage and leading to DN. The other mechanism is linked with disturbance in the metabolism and vasculature of nerve tissue in the presence of excessive uptake of glucose. Conclusion: In our review we have discussed different mechanisms involved in formation of DM and DN. Based on the latest research studies the main component in the big picture of DN formation is hyperglycemia.The list of mechanisms are associated with high glucose level leading inflammation, oxidative stress, hypoxia and apoptosis through the activation of several pathogenic pathways induced by Tumor Necrosis Factor alfa (TNFa), AgII, (pro)renin, Protein Kinase C (PKC), glycolysis intermediated products, Cyclooxygenase 2 (COX2) and reactive nitrogen species (RNS). Therefore to use drugs linked with above discussed pathological processes would be effective solution in the treatment of DM and its complications.

[The characteristics of various forms of complicated surgery infections of the diabetic foot syndrome and their antibacterial treatment].

In case of neuropathic forms, infection is the cause of tissue nekros, while - in case of neuroischemic forms, it's critical ischemia. Antibacterial therapy is present in all cases of neuroischemic form, not dependent on the signs of infection, Though, in case of neuropathic forms, a course of antibiotics is prescribed only in case of the attachment of infection. Infected neuroischemic ulcer is characterized of acube development (infection+ischemia), unlike infections neuropathic, ulces. The researches showed that 42 patients (40%) suffered from neuropathic form and 63(60%) - from neuroischemic form. In purulent zones anaerobic flora was revealed in 77.3%, aerobic flora - 17.7%, the rise of microflora was not indicated in 5% of cases. Most often, with 43.6% St. aureus was found out, and from the association of microbes - st. aureus + Str. pyogenes - 8.7%. Was the level of bacterial pollution and varied from 105 to 10(12). The highest sensibility was shown towards Tienam (98.9%). The most acceptable and productive form of treatment turned our to be the following combination phtorchinolyns+aminoglycosides. Out of 105 patients 34 amputations were done + 6 tall, 10 large (more than a half) and 18 small (up to the middle of the foot). In 71 cases we successfully managed to stop infections processes and get rid of amputations.

[Indices of the bone mineral density in the female population of Adjara].

The aim of the presented research is to study the indices of the bone mineral density among female population of the high mountainous Adjara (Georgia) and reveal risk factors which affect the process of mineralization in females. The research is based on the analyses of special questionnaire filled in by 422 ethnic Georgian females, natives of Adjara highlands (Khulo, Shuakhevi, Keda), from 18 to 82 years old, which underwent medical examination. Characteristic of the bone mineral density was obtained by a densitometric method of investigation. It was found that female population from the high mountainous areas of Adjara were under the impact of factors provoking the osteoporosis (in 40 % of cases osteoporosis was revealed; in 24 % of cases--osteopenia). Investigation showed that 60 % of the breakages occur among females above 35 years old. The females above 50 years old suffer from breakages of lower limbs. The coefficient of the gender-related problems (late menarche, early menopause, long-term lactation) influencing the bone mineralization among the female population of the high mountainous Adjara is very high. The latter fact indicates the necessity of package correction of the bone mineral density among the female population of the high mountainous Adjara.

The densitometry survey of osteoporosis in young population in Ajaria (Georgia).

There is currently great interest in identifying factors that are associated with bone mineral density (BMD) in younger individuals because these factors may be important for attainment of peak bone mass and risk of osteoporosis development. The aim of the survey was to examine the bone mineral density practically in healthy young people in Ajara region. To obtain epidemiologic data on osteoporosis in the young Ajarian (Georgia) population, 90 (58 women and 32 men) residents average age 24.75+/-2.04 were the investigated. Determination of change in bone mineral density (BMD) was conducted using densitometry technique. The index of bone mineral density in young people in Ajara region is decreased; Out of 90 examined only 48 (53.33%) had normal index of bone mineral density. The index of bone mineral density in the group of young men showed better results comparing to the women group.

Inhibitors of the kinin system as an alternative method of prevention or reduction reperfusive damages within thrombolytic therapy in patients with acute myocardium infarction.

The aim is to show the effectiveness of inhibitors of the kallikrein-kinin system (KKS) to avoid early microcirculation impairment and low reperfusion damages in the ischemic area during systemic thrombolysis (T) in order to achieve optimal results of thrombolytic therapy (TLT) in patients with acute myocardium infarction. Patients (n=104) with acute myocardium infarction were divided into 4 groups: treatment with early TLT infusing Contrycal (Aprotinin) and Heparin (CH) during the first 2 hrs from the onset of disease (Gr. 1); treatment for isolated T at an early stage (Gr. 2); TLT with late T (in 3-6 hrs) (Gr. 3); and conventional therapy (Gr. 4). The dynamics of clinical and ECG data were evaluated for each of the groups. Before the clinical study was fully evaluated, an experimental-morphological, controlled study was carried out on dogs. These results showed improved retrograde blood flow of the acute ischemized myocardium and decrease in ischemia level, together with reduction of frequency and area of reperfused intramiocardial haemorrhages (RPIMH) in infarction areas under the TLT and CH infusion. When CH was infused a significant advantage was revealed in early T that showed high antianginal and antiarrhythmic effect, while no Q wave was observed or it was deepened non-significantly. More clinical dynamic problems with extrasystols and significant deepening of Q wave were seen in the earlier isolated T (Gr. 2) that were worse than those seen in Gr. 1 conditions, but the problems were more negative in the patients from Gr. 3 and 4. CH optimizes the situation causing suppression of the pathological activation of KKS, decreasing vessel permeability, and reducing reperfusion damage. The latest thrombolytic drugs ensure faster thromb lysing but do not prevent the reperfusion damage, as higher fibrinolytic activity at the moment of T causes enhanced activation of KKS and RPIMH development and prevents peroxide oxidation of the lipids but this may result in higher affectivity of antioxidant use. Earlier administration of KKS inhibitors optimizes the affectivity of TLT and widens the indication to the systemic and intracoronary T, minimizes complications, and may cause higher affectivity of coronary angioplasty (CAP) and aorta-coronary shunting in patients with acute myocardium infarction.