THE STUDY OF VDR FOKI RS2228570 SNP IN AUTOIMMUNE THYROIDITIS.

Autoimmune thyroid disease (AITD) is a common organ-specific autoimmune disease. A strong influence of genetic and epigenetic modifications has been demonstrated to take part in the development and progression of autoimmune thyroid diseases. The linkage between the Vitamin D receptor (VDR) polymorphism and several autoimmune disorders, including the AITD. In this article, we aim to investigate the Frequency of VDR Fokl (rs2228570) genotypes (CC, CT, TT) and alleles (C,T) in autoimmune thyroiditis. The investigation of VDR Fokl (rs2228570) was conducted on 150 samples (control (75 healthy women) and diseased women (75 diseased with autoimmune thyroiditis)) patients from the Adjara (Georgia) Population. It also examined some clinical and laboratory characteristics of the study population. Autoimmune thyroiditis's disease was diagnosed by measuring blood antibodies, determining the level of thyroperoxidase, and conducting an ultrasound examination. Anti-TPO and TSH were studied using the ELISA method. The genomic DNA was extracted from the peripheral blood. The polymerase chain reaction was evaluated to examine the VDR Fokl rs2228570 SNP polymorphism. According to VDR Fokl (rs2228570) genotypes (CC; CT, TT) frequency, in the control group, the Frequency of CC-genotype is 48%, CT-heterozygous genotype is 29.33%, and TT-genotype is 22.67%; in the diseased population, the Frequency of CC-genotype is 57.33%, CT-genotype is 34.67%, and TT-genotype is 8%. According to VDR Fokl (rs2228570) alleles (C, T), the Frequency of the C-allele is high, and the Frequency of the T-allele is low in both populations. The Frequency of the CC and CT genotypes of VDR Fokl (rs2228570) is high in the population with autoimmune thyroiditis compared to the control group; the TT genotype is relatively low in the population suffering from autoimmune thyroiditis; According to VDR Fokl (rs2228570) alleles (C, T), the Frequency of C-allele is high both population.

EVALUATION OF SOME LABORATORY PARAMETERS IN PATIENTS WITH MORBID OBESITY AFTER BARIATRIC SURGERY.

Obesity is a global challenge of the 21st century, both in terms of morbidity and mortality worldwide. In this article, we studied the effect of surgical treatment on glycemic indicators within morbid obesity patients, therefore assessing the glucose and glycosylated hemoglobin in blood serum. Also, we evaluated the hormonal background associated with Obesity - by measuring the insulin level in patients. This study included 40 patients who underwent bariatric surgery in the period 2017-2021; the above laboratory parameters were assessed before and after surgery. The control group consisted of 40 patients with morbid Obesity planning bariatric surgery in the future. Thus, we investigated three groups: I - control group - 40 patients with morbid Obesity who planning bariatric surgery in the future, Group II - 40 patients with morbid Obesity immediately before bariatric surgery and group III - the same 40 patients as in the second group, but after bariatric surgery performed between 2017 and 2021. It should be noted that the glucose level is ⁓1.4 times higher in patients immediately before bariatric surgery (group II) compared to the control group (group I) and ⁓1.19 times lower in the postoperative period (group III) according to compared with the control group. The insulin level is ⁓1.4 times higher in patients immediately before bariatric surgery (group II) compared to the control group (p=0.0066) and ⁓2.5 times lower in the postoperative period (group III) compared to the control group (p=0.0001). According to the results, the insulin level after surgery decreases by ⁓3.7 times compared to the preoperative group (p=0.0001). The glycated hemoglobin level in bariatric patients is lower (slightly) than in the control group (⁓1.01 times), which is explained by the preoperative preparation of the patient at least several months before surgery. In postoperative patients, it decreased by ⁓1.06 times compared to preoperative patients. Thus, today, bariatric surgery is undoubtedly a very effective method of radical treatment of morbid Obesity, which we can consider to be one of the most essential parts of the holistic model of obesity treatment.

Specific Combinations of Erythrocyte Group Antigens in Blood Donors.

Blood groups are inherited biological characteristics that do not change throughout life only in healthy people. Blood group antigens determine the adaptation of a human, as a biological species, to the surrounding environment. Our goal was to study the combination and frequency characteristics of three group systems (ABO, RH, KELL) in blood donors. The blood of 743 donors (aged ≥ 18 years) has been investigated on erythrocyte blood group antigens (521 male and 222 female). The sample has been provided from diagnostic laboratory of "Health Centre Medina Ltd" of Batumi. Research was agreed with hematology department of the clinic. Blood typing of the sample has been carried out on the basis of immunogenetic laboratory of Batumi Shota Rustaveli State University. The express method with universal mono-clone antibodies was used in order to reveal blood group system antigens. ABO blood group are distributed the following order: O > A > B > AB. We allocated 16 phenotypic groups. O, Rh+, K- (38.62 ± 1.7%) are represented with the highest percentage among donors and a rather large number of the investigated donors (287 donors) is the carrier of this phenotype. A frequency distribution of the A, Rh+, K- phenotype group 10% (28.93 ± 1.6) was less. 215 donors carry A, Rh+, K- phenotype combination. O, Rh+, K+ and A, Rh+, K+ variations of the phenotype are represented with an equal percentage (3.23 ± 0.4%). 7.94 ± 0.9% donors are characterized by features of the O, Rh-, K- Erythrocyte group. A frequency distribution of B, Rh+, K- phenotype is slightly less - 6.86 ± 0.9%. A, Rh-, K combination of phenotype occurs with a frequency of 4.97 ± 0.7%, and AB, Rh+, K- occurs with a frequency of 2.28 ± 0.5%. I n the donor population there were only single cases of B, Rh-, K+ (0.13 ± 0.01); AB, Rh+, K+ (0.13 ± 0.01); AB, Rh-, K- (0.40 ± 0.2); B, Rh+, K+ (0.26 ± 0.1); O, Rh-, K+ (0.40 ± 0.2); A, Rh-, K+ (0.67 ± 0.2) combination of phenotype. The phenotype AB, Rh-, K+ was not identified. The existence of this database will increase the safety level of transfusion, widen donors database and allow the clinics to find quickly the rare combination of blood group for transfusion and decrease of the risk of post-transfusion complications.

MANAGEMENT OF MEDIASTINAL-ABSCESS-INDUCED SEPSIS AND SEPTIC SHOCK (CLINICAL CASE REPORT).

Infection of the mediastinum is typically polymicrobial in nature resulting from a disruption of normal mucosal and tissue barriers. Infection may result from a rupture of the esophagus or trachea or from surgical intervention. Medaistinal abscess is the most lethal form of mediastinitis. A case report is presented: sepsis - induced polyorganic insufficiency with underlying severe somatic pathological condition and violation of hemodynamics. Clinically the insufficiency of all the organic systems developed at the background of cardio-respiratory-cerebral insufficiency, with functional insufficiency of all the organ systems and violation of buffer system. With reasonable pathognomic and symptomatic treatment eradication of vicious circle was possible. The patient was discharged from the clinic with positive clinical-laboratory recovery. The condition was stable. Neurological status -contacted, adequate, with high capacity to work. The fistula on the anterior wall of the trachea as well as stoma were removed.

VERY LATE STENT THROMBOSIS 2 YEARS AFTER IMPLANTATION OF A DRUG-ELUTING STENT (CASE REPORT).

A serious long-term complication of drug-eluting stent (DES) implantation is the occurrence of very late stent thrombosis (VLST) beyond 1 year after implantation. While VLST has been observed as late as 1 year following the initial procedure, it remains unknown whether DES thrombosis is a finite phenomenon that abates over time or is a risk that persists indefinitely. Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of a 40-year-old man who sustained an ST-segment-elevation myocardial infarction 2 years after initial paclitaxel-eluting stent implantation. Focal incomplete endothelialization of the stent struts is the likely cause of VLST; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. According to the current guidelines 12 months of dual antiplatelet therapy (DAPT) is recommended following DES implantation. However, there are uncertainties surrounding the optimal duration of dual antiplatelet therapy in patients who suffer from drug-eluting very late stent thrombosis. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of dual antiplatelet therapy.

Changes in sex and non-sex hormones and distribution of erythrocyte antigens in reproductive age women with tumors of body of uterus in Adjara.

The aim the research was to study the hormonal state of reproductive age women with tumors of body of uterus. The quantitative changes of sex steroid hormones: progesterone (P), estradiol (E), testosterone (T), gonadotropine -Luteinizing hormone (LH) and Follicle-stimulating hormone (FSH) were investigated. Distribution of ABO blood group antigens and Rh-Hr systems genetic variants in the blood of women living in Adjara Region was also studied. For study was used reproductive age women's blood with benign (fibromioma) and malignant (endometrial cancer) tumors of body of uterus (the middle age was 20-45 years). The determination of hormones was made by the enzymatic analysis method (ELAIZA). For the research of blood groups, were used the immunoserologic methods. The study have revealed that in blood of reproductive age women with benign and malignant tumors of body of uterus, level of estradiol was increased while levels of progesterone and testosterone were sharply reduced. Amount of Follicle-stimulating hormone and Luteinizing hormone were also increased. It's significant that, both hormones were sharply increased in case of cancer of body of uterus, in comparison with control group and benign tumor. According to distribution of ABO blood group phenotypes - O (I) phenotypic group of ABO system has its highest frequency in blood of women with cancer of body of uterus. Cancer of body of uterus is associated with O (I) phenotypic groups; benign tumor of body of uterus - with A(II) and AB(IV) phenotypic groups. Women with cc and EE genetic variants of Rh-Hr system have sensitivity to the development of benign and malignant tumors of body of uterus; women with ee genetic variant have lower sensitivity towards body of uterus cancer and sharply expressed sensitivity to uterus benign tumors. In women with malignant tumors of body of uterus the frequency of distribution of Rh-Hr system CC genetic variant was sharply reduced.

[Protocol of the management of patients with severe sepsis and septic shock].

Severe sepsis and septic shock remains the most urgent problem. In severe sepsis and septic shock should be early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition; -appropriate diagnostic studies to ascertain causative organisms before starting antibiotics; -early administration of broad-spectrum antibiotic therapy; -reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate; -a usual 7-10 days of antibiotic therapy guided by clinical response; -source control with attention to the method that balances risks and benefits; -equivalence of crystalloid and colloid resuscitation; aggressive fluid challenge to restore mean circulating filling pressure; -vasopressor preference for norepinephrine and dopamine; -cautious use of vasopressin pending further studies; -avoiding low-dose dopamine administration for renal protection; consideration of dobutamine inotropic therapy in some clinical situations; -stress-dose steroid therapy for septic shock; use of recombinant activated protein C in patients with severe sepsis and high risk for death; -with resolution of tissue hypoperfusion and in the absence of coronary artery disease or acute hemorrhage, targeting a hemoglobin of 7-9 g/dL; -a low tidal volume and limitation of inspiratory plateau pressure strategy for acute lung injury and acute respiratory distress syndrome; -application of a minimal amount of positive end-expiratory pressure in acute lung injury/acute respiratory distress syndrome; -protocols for weaning and sedation, using either intermittent bolus sedation or continuous infusion sedation with daily interruptions/lightening; -avoidance of neuromuscular blockers, if at all possible; -maintenance of blood glucose <150 mg/dL after initial stabilization.

Distribution of erythrocyte phenotypic groups in women with benign tumors of the uterus in Adjara Oncology Centre.

ABO blood groups antigens have biological and clinical significance. The ABO blood groups antigens has been associated with many diseases, though the explanation between ABO blood groups and disease is still unclear. The aim of this study is to investigate the presence of a possible association between benign tumors of the utesus with blood ABO, RhD, Kell and MN groups in women in reproductive periods. In diseased population (60 subject) was investigated for Erythrocyte phenotypic groups antigens. Immunoserological methods have been used to identify the antigens. The obtained results were statistically processed. High frequencies of A (43,3±3,2%), D(91,6±3,5%) and Kell (+) (26.66±5.7 %) antigens were found in diseased of benign tumors of uterus comparison with donor. The researches shows, that is increased risk of disease development in carriers of these phenotypes. In summary, according our research we've thought, that blood groups may be a marker for bening tomors of the uterus. Based on these data, these could be used as prognostic factor for bening tomors of the uterus. The study of Erythrocyte group antigens in diseased we may to identify "high risk" individuals, that help to find ways, which help to control of disease.

Frequencies of erythrocyte blood groups alleles and haplotyphes in women with benign tumors of the uterus.

The erythrocyte blood groups antigens are associated with risk of certain malignancies though the correlation between blood groups and diseases is still unclear. The investigation is aimed at determining the correlation between benign tumors of the uterus and erythrocyte blood groups alleles and haplotyphes in patients of Adjara Oncology Centre. Blood of 60 women with benign tumors of the uterus and of 60 healthy women of reproductive age were investigated for ABO and Rh system alleles and haplotypes. Immunoserological methods have been used to identify the antigens. The obtained results were statistically processed. The ABO system gene alleles' frequency was computed by the formula proposed by F. Bernstein and used in investigation of three-allele genetic systems. The frequency of Rh-system genes, Rh-haplotypes is computed by the formula proposed by A. E. Mourant. According to ABO systems in women with benign tumors of the uterus high frequencies of p (0,12) and q (0,21) alleles are found. When studying individual alleles of the Rh system in women with benign tumors, high frequency of D was noticed (0.8). In women with benign tumor of the uterus RhD allele frequency is statistically different to healthy women. ABO systems gene alleles' significantly differ in healthy and diseased women. In women with benign tumor of the uterus only three Rh-system haplotypes have been found: CDe, cDe, cde haplotypes.

Erythrocyte group antigens and women's reproductive system organs.

The aim of this study is to investigate the presence of a possible association between breast and uterus cancer with blood ABO groups in women of reproductive, menopausal and post-menopausal age. Following information was recorded: patient age, stage of cancer, ABO blood group. In diseased population (120 subject) was investigated for ABO red cell blood groups antigens. Immunoserological methods have been used to identify the antigens. The obtained results were statistically processed. High frequency of A antigen is found in uterus cancer diseased, on the thirst stage, in the reproduction age (65±10,6%). High frequency of O antigen was found on the first stage, of the aid in the post-reproductive (55±11,1%) and in the postmenopausal periods (60±10,9%). ABO blood group antigens have been studied in breast cancer diseased, on the second and third stages, postmenopausal women, in which high frequency of A antigen is found.

[Clinical trials and intensive therapy of the swine flu (H1N1)].

During the recent years there's a high index of the swine flu А (H1N1) disease in the whole world. In Georgia it began to spread at the end of Autumn 2009. The aim of our study was to define clinical trials of the swine flu (H1N1) in patients of Republic Clinical Hospital in Batumi from 2009 to 2011 and to generalize the methods of treatment. In the hospital there were 94 patients suffering from the swine flu (H1N1) disease, 20 of which due to their critical situation of the disease were treated in the department of the intensive therapy. We studied case histories of 20 patients, who were undergoing treatment in the department of the intensive therapy by the generally acknowledged programme of study and monitoring due to their hard disease. Among these 20 patients 10 were women and 10 men. 10 patients died. The programme of intensive treatment consisted of infusive-transfusive therapy by the negative water balance, antivirus treatment (Tamiflu/Relenza), de-escalation antibiotic therapy, mechanic ventilation of lungs, aerosol therapy, plus symptom treatment. In 2011 there were fewer cases of the swine flu and the death rate compared to the earlier years. In 2011 of 25 patients only one patient died, but in 2009-2010 of 69 patients 7 patients died), which was conditioned by immunity development. The most frequently used regime of lung mechanic ventilation was BIPAR. In the first days antibiotic therapy is not defining. It is necessary to find more effective method of antivirus treatment.

[The condition of oxidation-antioxidation balance of kidney and suprarenal tissue in experimental traumatic shock with white rats and the influence of Plaferon LB].

The aim of the work is the study of the oxidation-ant oxidation balance of kidney and suprarenal tissue and the influence on them of Plapherone LB preparation. The objects for experiment were 30 white rats which weigh was about 200gr. The traumatic shock was reproduced according to Kennon. White rats were divided into two groups. In 15 minutes after shock intraperitonealy were made: first group - 0,3 ml of physiologic solution, second group - Plapherone LB 0,06 mg on 0,3 mg of physiologic solution. Separately was studied control group of animals. The tissues were studied by the method of electronic paramagnet resonance on RE-1304 radiometer (Russia). The rough upset of oxidation-antioxidation balance was revealed. The use of Plapherone LB in this case promotes the optimization of these changes.

[Influence of antioxidants under polytrauma during traumatic sickness].

To study protective effect of Plapheron LB during grave traumatic sickness. Studied 94 patients with grave polytrauma, who were divided in to two groups of 47 patients. To I-st group was prescribed ordinary program of intensive therapy and to the II-nd group of patients additionally to the ordinary program of intensive therapy was made Plapheron LB in dose of 0.028 mg/kg two times a day sublingually during ten days. Grave condition of the patient was fixed by RTS scale and grave of shock by Skinner scale. Stated that each group was different in grave traumatic and shock conditions. Separately was studied group of health patients. The study was held by the method of electro-paramagnetic resonance of venous blood to admitted to hospital patients and on fifth day of intensive therapy. Noted: NO, FeS-NO, Fe(3+)-transpherin, Fe(2+) and Met-Hb. From immunology cytokin TNF-alpha was studied by the method of immunopherment. Results of study and discussion: Plapheron LB promotes decrease of the process of peroxide oxidation of lipids, increases activation of antioxidant ferments, stimulates production of nitric oxide and decreases the quantity of pyoinflammatory complication from those organs and systems which has no frequent effect of medical manipulation.

[The changes of content of TNF-alpha, nitric oxide and FeS-NO in patients blood with traumatic shock under Plaferon LB influence].

There were examined 40 patients with traumatic shock and 10 healthy blood-donor (1-st group). The patients were divided into two groups: patients with traumatic shock based on standard program of intensive therapy and patients with traumatic shock based on standard program of intensive therapy plus Plaferone LB. The blood test was made on 1st and 5th day of stationary treatment. TNF-alpha was examined in blood plasma by immunophermetic method and NO, FeS-NO by electro-paramagnetic resonance method. It was revealed, that Plapherone LB has no affect on TNF-alpha concentration, but it modulates NO concentration.

[Manifestations of oxidative stress and its correction in traumatic shock]. / Proiavleniia oksidantnogo stressa i ego korrektsiia pri travmaticheskom shoke.

The case study purpose was to investigate the oxidation-antioxidation process in the affected organism after traumatic shock and under the impact of Plapherone LB. A randomized experiment involved 94 patients who were shared between 2 groups: group 1--routine intensive therapy, group 2--it received additionally Plapherone LB (sublingually, 2 mg protein/day). Ten persons of the control group were investigated separately. It was found by the method of electron paramagnet resonance that the antixidant system became weaker (in patients with traumatic chock), the lipoid oxidants got more intensified, the activity of their oxidant enzymes went up and the concentration of free radical got to be higher. Finally, Plapherone LB was found to promote the optimization of such systemic changes, since it normalized the xanthine oxidase activity in experimental traumatic shock.