SOCIO-ECONOMIC FEATURES OF SEXUALLY TRANSMITTED INFECTIONS AMONG MSM IN GEORGIA.

The aim of our study was to investigate correlation between socio-Economic conditions and prevalence of Sexually Transmitted Infections among gay individuals (men who have sex with men, MSM) in Georgia. The study was conducted in 5 main cities in different regions of Georgia (Tbilisi, Batumi, Kutaisi, Zugdidi, and Telavi). During 2015-2019, social workers, LGBT community and non-governmental organizations (NGOs), conducted screening of MSM for STI, which was achieved by disseminating required information through electronic and print media, resulting in maximum involvement of MSM in screening programs for STI disseminating. A specially designed questionnaire/survey has been used to investigate the correlations between the following parameters, such as: age, educational attainment (non-completed secondary, secondary, non-completed High School, completed High School), economic income (extremely low, low, middle, high), awareness of STI (yes/no), sources of information (healthcare worker, internet/media, sex partner, social workers and/or NGOs (supporters of LGBT community, others), residence type (urban/rural); frequency of safe sex (using condoms for the last 6 months), number of sexual partners (>3) and etc., among the persons involved in the study. The following prevalence rates of STIs among the MSM population in Georgia during 2015-2019 were defined: for syphilis it appeared to be approximately 25.76%; for gonorrhea - 18.63%, and for chlamydia - 21.98%, respectively. The results of current study indicated that low-income levels and educational attainment are the key socioeconomic risk factors leading to high rates of STI prevalence among MSM. On the contrary, STI rates were inversely correlated with the level of education of the studied population. The odds ratio (OR) for syphilis between with the low and high incomes groups was 1.18 (p=0.023); for gonorrhea, the OR between the above stated groups s was 1.32 (p=0.001); for chlamydia OR was not significant - 0.89 (p=0.118). OR for syphilis between informed and uninformed about STI groups was 1.92 (p<0.001); the OR between the same groups was 2.24 (p<0.001), and in the case of chlamydia - 1.59 (p<0.001). Analysis of information obtained MSM from the selected sources over years showed that the contribution of the social and electronic media was decreased (50.5% to 38.1%, p<0.001) as well as the contribution of the social workers and/or non-governmental (LGBT community supporters) organizations (24,2% to 15.5%, p<0.001); that was mainly due to the acquisition of qualified information from medical workers (from 12.0% to 25.0%, p<0.001) and the high level of reliability of sexual partnership (from 13.2% to 21.1%, p<0.001). The OR for syphilis cases between the Rural/Urban groups was OR=1.60 (p=0.002); for gonorrhea, the OR between the same groups was 1.74 (p<0.001); and for chlamydiosis, the OR was 1.80 (p<0.001). Low-income levels and educational attainment are considered as main socio-economic risk-factors for high STI prevalence observed among the MSM. Healthcare workers and sexual partners are viewed as the main and reliable sources of sexual health information in MSM group. Although the obtained findings need further investigation and confirmation, preliminary results show that screening and prevention programs together with extensive dissemination of sexual health information may decrease prevalence of STI among MSM. And all are of great importance.

Prevalence and risk factors of tinea pedis in Georgian Defense Forces.

INTRODUCTION: Tinea pedis is a widely spread infection among military personnel. The aim of the research was to determine the prevalence of tinea pedis and its associated risk factors in Georgian Defense Forces. METHODS: A cross-sectional study including interviews and clinical and laboratory examination was performed among randomly selected Georgian soldiers and civilians, after getting the signed consent form from them. In the selected population with clinical evidence of tinea pedis, scrapings were taken for direct microscopic examination. Statistical Package for Social Sciences V.22.0 was used for ststistical analysis. RESULTS: Out of 729 soldiers, tinea pedis was clinically observed in 46.64% (n=340) and laboratory-confirmed in 25.24% (n=184) of cases, while out of 279 civilians, tinea pedis was found in 21.86% (n=61) and approved in 13.98%(n=39). Multivariate analysis demonstrated that tinea pedis is correlated with the age and military ranks but is not associated with the length of military service. Using a communal shower (OR=1.04, 95% CI 1.01 to 1.07) and having tinea pedis before military service (OR=3.27, 95% CI 1.79 to 5.96) increase the chances of tinea pedis development, though using two or more pairs of the military boots interchangeably decreases the spread of disease (OR=0.21, 95% CI 0.15 to 0.29). CONCLUSIONS: According to our research analysis, the prevalence of tinea pedis among Georgian militaries is significantly higher than that in the civilians. It is necessary to develop a large-scale strategy and to implement appropriate preventive measures to minimise the discomfort caused by this disease.

PREVALENCE OF PAH MUTATIONS IN GEORGIAN PKU PATIENTS COMPARED TO MOST FREQUENT PAH MUTATIONS IN EUROPEAN POPULATIONS.

The aim of the study was to compare Georgian PAH mutation spectrum to the most frequent European mutations. Population study publications were reviewed and 20 most frequent European PAH mutations were determined. Mutations were detected in 40 Georgian PKU patients using Sanger sequencing. PAH mutations were detected on all 80 alleles, clinical diagnose of PKU was confirmed in all 40 patients. Detected mutations in Georgian population was: P281L in 37.5%, IVS10-11G>A in 17.5%, R261X in 10%, L48S in 8.75%, E280K in 5%, R270K in 3.75%, E390G in 3.75% and mutations R252W, IVS12+1G>A, R243Q, R261Q, 1089delG, Y387H, EX5del, IVS7-5T>C, IVS12+1G>A, G171R, IVS2+5G>C each in 1.25%. Study revealed that the most common Georgian PAH mutations spectrum differs from the European one. 9 out of 18 detected mutations coincide with the European panel. At the same time more than half (55%) of the mutations found in Georgians were not identified as the most common mutations in Europe. These findings may indicate the necessity for the development of diagnostic panels specific to the Georgian population, including both 9 frequent European PAH mutations and 9 mutations more common for the Georgian population, which will significantly improve the quality of PKU diagnostics in Georgia. The results have been obtained are of an intermediate nature, which propose to continue and complete this research by studying the entire Georgian PKU population.

[Analysis of spreading the sexually transmitted disorders in Georgia].

According statistical data in Georgia sexually transmitted disorders represent one of the most important medical and social problems. Main causes of this are hard social and economic condition of the country, changing sexual-behavioral stereotypes, drugs and alcohol abuse, political perturbation, as well as unprecedented decrease in financing prevention programs of STD by government. The purpose of given research is statistical analysis of spread of sexually transmitted disorders in Georgia, in particular, among the people included in risk group; finding trends and in accordance with this, working out recommendations for improvement of situation in given field of medicine. Essays showed that through 2000-2012 years among STD revealed in the group of increased risk chlamidiosis was the most common. There is an objective trend of increasing the level of morbidity with chlamidiosis and trichomoniasis, however the speed of increasing morbidity with trichomoniasis probably does not correspond the reality. In the same time morbidity with gonorrhea and syphilis is decreasing, however in the result of significant decrease in STD prevention program scale data validity concerning syphilis might be doubtful. Coming out of this in the field of health care related to STD optimization of laboratory diagnostics management is essential; perfection of methods of epidemiologic control; increasing the scales of prevention programs as well as initiation of researches related to antimicrobial resistance of gonococci. Authors consider essential taking steps for optimization of management of laboratory diagnostics and perfection of methods of epidemiologic control and increasing scales of preventive programs.

The characteristics of human papillomavirus expression and cell proliferation in actinic keratosis and Bowen's disease of the skin.

The aim of our study was to elucidate the characteristics of HPV expression and cell proliferation in actinic keratosis and Bowen's disease of the skin. We examined immunocompetent patients with premalignant lesions of the skin such as actinic keratosis and Bowen's disease. 10 patients were involved in each group. Clinical study included gross features of lesion, growth rate, colour, size. Paraffin sections from biopsy specimens were were stained by hematoxylin-eosin and von Gieson. Immunohistochemistry was performed using monoclonal antibodies against HPV, oncoprotein p53, anti-apoptotic protein Bcl-2, proliferation marker PCNA. Strongly, moderately and weakly positive cells were counted. Actinic keratosis and Bowen's disease failed to show the specific clinical features, therefore, they can not be diagnosed based on clinical signs only and morphological examination seems to be mandatory. The immunohistochemical study has showed that in both actinic keratosis and Bowen's disease HPV was positive in 60%, and 40% were HPV-negative suggesting the similar incidence of HPV infection in these premalignant lesions. Our results suggest that HPV(+)/p53(+) types of actinic keratosis and Bowen's disease are characterized by higher proliferation activity in comparison to HPV(-)/p53(+) types, and expression of Bcl-2 is associated with HPV-negativity, therefore, these premalignant lesions of the skin require immunohistochemical examination with evaluation of expressions of human papillomavirus, proliferation marker PCNA and anti-apoptotic protein Bcl-2. The differential diagnosis of actinic keratosis and Bowen's disease should be based on the following immunohistochemical criteria: incidences of positivity for p53, Bcl-2 and PCNA are similar, but expression intensity and anatomical localization are different: their expressions are higher in Bowen's disease, positive cells are found primarily in upper epidermis in actinic keratosis, while whole epithelium is involved in Bowen's disease.