Effectiveness of Tocilizumab in the Treatment of a Recent Kidney Transplant Recipient With COVID-19.

The coronavirus disease 2019 (COVID)-19 pandemic significantly affected transplantation care strategies due to the heightened vulnerability of transplant recipients to severe illness. We present a unique case of a 31-year-old female with COVID-19 pneumonia following a recent kidney transplant managed with immunosuppressant reduction and tocilizumab therapy. The patient underwent live donor kidney transplantation and was considered a low immunologic risk recipient. Following surgery, she presented with fever, headache, and fatigue, and subsequent testing confirmed active COVID-19 infection. Imaging revealed characteristic pneumonia features. Standard approaches, including immunosuppressant reduction and antibiotic therapy, initially failed to halt clinical deterioration. Progressive radiological findings and increasing inflammatory markers raised concerns of impending graft failure and cytokine storm. Considering the severity of the condition, tocilizumab, an interleukin-6 (IL-6) receptor antagonist, was administered alongside continued supportive care and adjusted immunosuppression. Within a day post-tocilizumab infusion, the patient showed significant improvement in clinical parameters, with resolution of respiratory distress and systemic symptoms. Laboratory markers gradually normalized, and subsequent lung imaging showed improvement. The patient was discharged with follow-up recommendations. Managing COVID-19 in postoperative transplant patients requires nuanced approaches due to immunosuppression-related complexities. Despite limited guidance, our case highlights the successful use of tocilizumab in treating COVID-19 pneumonia shortly after transplantation, showcasing its potential effectiveness and safety in this context. Reporting such experiences is crucial for refining management strategies for immunocompromised transplant recipients facing COVID-19 complications.

Recognizing vaccine wastage in Georgia.

The COVID-19 vaccination program in the country of Georgia began on March 15, 2021, and reached its peak in the summer of 2021. Throughout the process, individuals had access to over 5.3 million doses of COVID-19 vaccines which were acquired from various sources as reported by the National Center for Disease Control and Public Health (NCDC). Factors such as widespread vaccine hesitancy and low demand led to reduced vaccine uptake, low vaccination rates, and vaccine wastage. As of August 2022, a total of 2,922,000 doses have been administered with less than 35% of the Georgian population, or 1,276,000 people, fully vaccinated with at least two doses. Over 400,000 doses have expired at NCDC's storage facilities due to low demand. Many more doses have been wasted at administration points, and there is a risk of wasting more in the future. The key reasons for wastage are widespread public hesitancy toward the newly developed vaccines, inconsistent policies and communication from government officials, rampant disinformation, and ambiguity from influential bodies in Georgian society. Despite certain limitations, logistics is not among the leading causes of wastage, as Georgia was able to develop a strong cold-chain and vaccine administration infrastructure through years of international cooperation that allowed for efficient management of the COVID-19 vaccination process. Lastly, in addition to establishing a robust reporting system and ensuring transparency of vaccine wastage data, relevant studies based on original data are required to better understand the problem. Conducting studies on health literacy in the country as a baseline for long-term interventions, as well as research that will increasingly evidence-inform further pandemic response are being recommended.

Regulatory environment for complementary and alternative medicine in Georgia-a health policy analysis.

International bodies such as the WHO call on member states to regulate and, where possible, integrate Complementary and Alternative Medicine (CAM) into health systems, to the benefit and safety of patients. Research on CAM regulations in the Republic of Georgia has been limited. The aim of this study was to identify key actors and analyse the regulatory environment for CAM in Georgia in its local and international contexts. We conducted a health policy analysis using a triangle framework of content, context and processes. We used data from national government, professional associations and academia; and drew from primary qualitative data of stakeholders' perspectives and needs regarding CAM in Georgia. The several CAM associations we identified have limited capacities for self-regulation. CAM practices are currently not effectively regulated in Georgia, while the government has no expressed intention to develop regulatory frameworks. Georgia's CAM health policy is currently not compliant with WHO and European directives and recommendations. Government, lawmakers, public administration, academia, physicians, non-physician CAM practitioners and other actors should constitute a national working group dedicated to CAM regulations in Georgia to identify, classify CAM practices; and develop core principles for policy making for safe and effective CAM practiced in Georgia's health system.

Georgia's healthcare system and integration of complementary medicine.

BACKGROUND: An increasing number of people in the Republic of Georgia use complementary and alternative medicine (CAM). CAM has long been practiced in the country, but is not currently part of the formal medical system. The aim of this study was to explore patients' CAM use and their perspectives of CAM complementation of existing services in Georgia's health care system. METHODOLOGY: We conducted a qualitative study exploring patient needs and wants by performing in-depth, contextual interviews with patients using CAM. We recruited participants at CAM clinics and collected data until we reached saturation. A thematic analysis involving line by line coding explored perspectives and allowed us to formulate recommendations of CAM integration in Georgia. RESULTS: Study participants voiced that they pursued cure beyond symptom relief; their disappointment in that regard with conventional medicine in Georgia directed them towards CAM as a safe and effective care setting. Most sought natural approaches as a sustained approach to their health and perceived CAM as empathetic therapeutic and preventive space. Participants were in favor of integration of CAM with conventional health services through government support and regulation. They saw coverage of payments for CAM visits and treatments as important aspect for an effective and sustainable integration. CONCLUSION: Patients favor an integration of CAM into Georgia's current healthcare systems to ensure CAM's broad availability as well as effective regulation and financing, including coverage by health insurance.