BIOELECTRICAL IMPENDANCE ANALYSIS OF BODY COMPOSITION IN PATIENTS WITH CHRONIC HEART FAILURE.

Evaluation of body composition is important in countries of different populations and morbidities. One of the groups of morbidity consists of patients with chronic heart failure, where the body fat mass as well as fat-free mass and several other parameters are likely to have an impact on severity and/or outcome of the disease and patient's quality of life. The purpose of the study was to analyze the parameters of body composition in patients with chronic heart failure. Study included 86 patients, fit for the purpose of the study, and 30 practically healthy individuals. Body mass and other measurement data (height, waist circumference, hip circumference and waist-to-hip ratio, anthropometric measurements) were evaluated. Bioelectrical impedance (BIA) was analyzed by BIA 450, BIODYNAMICS (USA) in accordance with standard procedures that are widely accepted. Fat free mass (FFM) was determined by the BIA method. This index was also calculated by prediction equation based on BIA and anthropometric parameters: FFM (kg) = 11.78 + (0.499 x H2/R) + (0.134 x Weight) + (3.449 x gender), where H stands for height in cm, R represents resistance in Ω, Weight is measured in kg and "gender" equals to 0 for females and 1 - for males (3). FFMI equals to the ratio of FFM (kg) to the square of the height; Ratio of FMI - FM (kg) to the square of the height. Study showed that in both patients' and control groups, underweight, as well as overweight individuals are present; also, in both groups, obesity, as BMI category, is most common. Groups (patients vs control) differed in Reactance and FFM (kg) (P<0.009). There was no statistically significant difference between male subgroups of patient and control groups; Valid differences in resistance, lean body mass and fat free mass (kg) were observed between female subgroups. Analysis of body composition characteristics in patients with chronic heart failure revealed that functional classes of heart failure differ in several BIA data, including resistance, Lean body mass (kg) and Fat Free Mass (%).

; ASPECTS OF NUTRITION IN PATIENTS WITH CONGESTIVE HEART FAILURE.

Congestive heart failure (CHF) is a significant healthcare problem, and is associated with high levels of morbidity and mortality. The majority of patients have poor quality of life in spite of the modern evidence-based treatment. Malnutrition is more common in patients with HF, especially at the severe stage of HF, and is associated with the risk of complications and mortality. Consequently, evaluation of malnutrition in patients with HF, monitoring of patients in this regard, and identifying the right assessment tools are the basis for developing of an effective nutritional strategy that can have a significant impact on the treatment and management of such patients.; Our aim was to study the prevalence of different markers of malnutrition, their association with nutrient indices, and their correlation with CHF in Georgian population.; The total of 96 patients relevant to the research objective (43 female and 53 male with average age 69.85) were enrolled in the study. Nutritional screening was performed using the GNRI, which was calculated as follows: GNRI=14.89× serum albumin (g/dL) +41.7*body weight÷ideal body weight. Ideal body weight=22* square of height in meters and PNI was calculated as follows: PNI=10* serum albumin (g/dL) +0.005*total lymphocyte (count per mm3) and The Controlling Nutritional Status (CONUT) score was calculated by serum albumin score plus total cholesterol score and total lymphocyte score. Peripheral venous blood was tested for acute phase reactant (hsCRP, Interleukin-6, fibrinogen, acid glycoprotein) and for protein-energy malnutrition (prealbumin, albumin, lymphocytes, lipid profile and transferrin).; By examining the correlation between the CONUT, GNRI and PNI indices, a significant negative correlation was found between CONUT and PNI. We quantitatively compared results obtained using CONUT, GNRI and PNI scale risk groups, as the primary picture suggested it in our study group (ambulatory, quite compensated CHF). CONUT and PNI represent best option.; Prealbumin, lipid profile data, transferrin decreases with increasing risk for CONUT and PNI, with Interleukin-6 increasing on both calculators. Changes in other data are not correlated.

DEMOGRAPHIC AND CLINICAL FACTORS ASSOCIATED WITH INCREASED IL-6 LEVELS IN AMBULATORY PATIENTS WITH CHRONIC HEART FAILURE.

IL-6 promotes T cell activation and production in acute inflammatory conditions, initiates B cell differentiation, regulates liver production of acute phase reactants, and stimulates hypothalamus-pituitary-adrenal system, which is important in acute inflammation. Nevertheless prolonged IL-6 exposition activates apoptosis. According to recent studies increased levels of IL-6 increase cardiovascular disease risks. The aim of the study was to explore IL-6 basic levels in chronic congestive heart failure patients, as in risk group in COVID-19, and various factors (demographic or clinical) in various groups of IL-6 basic levels. We used consecutive sampling approach to recruit 96 congestive heart failure patients and 34 persons without the condition as controls. Hematologic, biochemical and immunologic parameters were measured using conventional methods. We used descriptive statistics for demographic parameters. We compared mean values of hematologic and biochemical parameters in cases and controls using independent sample t test and explored differences within the congestive heart failure group (further separated in 3 groups according to IL-6 levels) using one way ANOVA test, with further post-hoc analysis. Levels of IL-6 are statistically significantly higher in CHF patients; groups differ in co-morbidity, also abdominal obesity is more prevalent in diseased group. Difference between groups is significant in a number of pro-inflammation, coagulation, hematology parameters. It is also important to note that the CHF group showed a number of differences in sub-groups according to IL-6 levels, risks of CHF and comorbidity deterioration risks therefore are suggested to be different.

ASSESSMENT OF NUTRITIONAL STATUS AND MALNUTRITION RISK IN HEALTHY ELDERLY GEORGIANS.

The aim of the research was: evaluation of nutritional status and malnutrition risks of Georgian healthy elderly, to use modern assessment methods according to our research goal, development and adaptation of adequate approach considering specificity of Georgian population. Our research is the first study of nutritional status in Georgian elderly. Study group ≥ 60 y (n=75): men (n=14), women (n=61); Subgroup <75 y (n=64): men (n=9), women (n=55); Subgroup 75+ y (n=11): men (n=5), women (n=6). We first time used the standard and alternative anthropometric measurements, SF-BIA and validated equations for FFM (Kyle et al.) and TBW (Vache et al.); clinical, laboratory and dietary (adapted questionnaire) assessment. Estimated energy requirement (EER) was calculated using validated equation, research group was divided into 4 subgroups based on the diet energy intake to EER ratio (over 100%, >75 and ≤100%, >50 and ≤ 75%, ≤ 50%.). The findings of our study have shown the number of research participants with malnutrition according to different indicators: BMI - 0; MUAC - 0; AMA - 4; FFMI - 1; Albumin - 12; TLC - 38. Independet samples T test and ANOVA, Multiple Comparisons, Bonferroni, Paired Samples T test were used to compare variables. The difference between four subgroups was not revealed, except for nutrients and energy consumption indicators. Although there is the undernutrition of protein and energy in certain groups of participants, neither malnutrition screening tool (MNA-SF score 12-14) nor BMI and FFMI as the highest trustworthy diagnostic criteria do not reflect real condition. Predictively significant malnutrition can be left unattended, overlooked and undiagnosed without of energy intake assessment in practically healthy elderly. Therefore, he comparison of recent energy intake and estimated energy requirement is the best criterion for defining malnutrition.

DEVELOPMENT AND ADAPTATION OF DIETARY ASSESSMENT TOOLS FOR ELDERLY IN GEORGIA.

The maintenance of health, functional independence and quality of life in elderly requires adequate understanding of nutrition needs of older people. The aim of our study was to search and analyze dietary assessment tools existing in modern medical literature intended to evaluate the nutritional status, in order to compile and develop adapted adequate questionnaires for elderly people of Georgian population. Our research is the first study of the elderly nutrition in Georgia. We have analyzed more than 150 questionnaires of 15 types and selected the standard methods for daily and usual eating assessment, also, Mini Nutritional Assessment Short Form (MNA-SF). For final adaptation purpose of selected and compiled/developed questionnaires we have used the study group formed for the nutritional status assessment in Georgian healthy elderly (Study group ≥ 60 y (n=75) - men (n=14) and women (n=61); Subgroup <75 y (n=64) - men (n=9) and women (n=55); Subgroup 75+ y (n=11) - men (n=5) and women (n=6)). The compiled/developed questionnaire consists of 3 parts: 1. Historical Data - includes elements of Health/Medical, Social-Economic, Drug/Medication and Diet histories; 2. Multiple-Pass approach 24-hour Recall (5 steps, 4 nonconsecutive days); 3. Adapted Food Frequency Questionnaire - 42 item non-quantitative or semi-quantitative, open-ended, "face-to-face" interviewer-administered questionnaire. Compiled and developed adequate questionnaire for elderly people of Georgian population allows Georgian medical professionals to use of ready-made reliable/relevant dietary assessment tools in practice. Adaptation of the adequate approach considering specificity of Georgian population is the successful experience for farther studies, also, the best motivation for Georgian practitioners or researchers on proceed to develop these tools.

DIRECT MEASURED AND ALTERNATIVE ANTHROPOMETRIC INDICES IN GEORGIAN HEALTHY ELDERLY POPULATION: RELIABILITY/VALIDITY OF ASSESMENT TOOLS.

The aim of the research was standard and alternative measurement of anthropometric indices in Georgian healthy elderly population for determining the reliability/validity of the widely used and recognized assessment tools. Our research is the first study of the anthropometry as the part of of nutritional status assessment in Georgian elderly. For anthropometric assessment we first time used 1. Standard measurements (weight, height, WC, HC, MAC /MUAC, TSF, BMI, WHR, AMA using standard methods and tools for measurable values and standard formulas for calculating values), and 2. Alternative measurements (demispan, demispan equivalent height and BMI (DEH, DE BMI), Mindex for women, Demiquet for men. using Bassey's equations). Our study group formed for the nutritional status assessment in Georgian healthy elderly (Study group ≥ 60 y (n=75): men (n=14); women (n=61). Subgroup <75 y (n=64): men (n=9); women (n=55); Subgroup 75+ y (n=11); men (n=5); women (n=6)). Based on BMI range, the data from 78.7% of participants' were above the norm, 21.3% - normal and 0 - below the norm. The findings of our study have shown that BMI is not height-dependent variable, moreover, BMI as mindex and demiquet is a mass/weight-dependent anthropometric characteristic. BMI, demiquet and mindex had nearly same correlation with other anthropometric parameters (especially for women). High correlation between direct measured/calculated BMI and DE BMI were confirmed by Pearson coefficient 0.979 (p<0.01). The Cohen's Unweighted Kappa index was 0.8518 (0.81 - 1.00 almost perfect or perfect agreement). According to the Paired Samples Test results, there were no difference between BMI and DE BMI. Statistically significant difference between the BMI and DE BMI was determined only for men (0.003 - difference is significant at p<0.05). However, there were only 14 men in our research group and the use of this method recommended in a larger group. Graphical Bland and Altman agreement analysis demonstrated the absence of the trends in differences between BMI and DE BMI. The findings of our research confirm that Demi-span is a reliable measure of stature in Georgian healthy elderly. Demiquet and Mindex are useful indices for our population and suitable for use in clinical practice and in the study of the Georgian elderly when the use of standard weight to height indices may be questionable. Considering to results of statistical analysis, strength of correlation and agreement between direct measured BMI and alternative BMI confirms that the Bassey's equation is valid for Georgian healthy elderly, Demispan equivalent height and BMI is reliable and, accordingly, useful in case of lack of standard calculations or to avoid errors of direct measurements. However, further studies with higher subject numbers are needed to confirm our findings. Additional studies covering other communities in Georgia with different socioeconomic and ethnic composition, also, with different diseases would be necessary to obtain a better anthropometric characterization of the Georgian elderly.

USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN GEORGIA.

In Georgia, like in most countries globally, people commonly resort to complementary and alternative medicine (CAM). However, not much is known about CAM practices there. The aim of the study was to document common practices of CAM in Georgia and related patient attitudes. We collected data from peoples who commonly use CAM at 20 service provision centers in Georgia using cluster sampling from 300 patients. We admininstered a cross-sectional survey and conducted descriptive statistical analyses. People in Georgia use CAM either for prevention to improve general health (33%) or to treat chronic conditions (36%), spending about 25 Euros per month out of pocket. Most (77%) get their knowledge about CAM from family or friends , less than half (44%) from books or media, and 11% from medical providers. A close person's advice or experience was the most common rationale given for CAM use (54%). In our sample, 17% either don't trust or are unsatisfied with conventional medicine, 29% found CAM treatment "very effective" and 61% "quite/partially" effective; only 5% not effective. Conventional treatment was stopped in half of the cases. 35% of respondents informed their physicians of their CAM use, while about half did not. Public mistrust towards conventional medicine, CAM user high satisfaction, relatively low cost of such services in Georgia - are the factors letting us to suggest that CAM use will further increase. Frequent self taking decisions made by patients to stop physician prescribed treatment, not informing physicians on CAM use, as well as other factors put patients health at risk. Further research and capacity building in practice, education and other related aspects are needed to establish evidence-based regulation and standards for CAM in Georgia that ensure informed decision making and patient safety.

ECHOCARDIOGRAPHIC CHARACTERISTICS OF DIFFERENT WHO/ISH CARDIOVASCULAR DISEASE RISK GROUPS.

The objective of the study was to analyze association of echocardiographic TOD variables with the CVD risk groups defined by WHO/ISH. A cross-sectional study was conducted between (September 2008 - December 2010) Consecutive sample of 146 participants were enrolled in the study, 97 (66.4 %) women and (49) 33,6 % men, mean age. Study population was categorized in three groups according to WHO/ISH risk categories: Group 1 included population with risk less than 10% according to WHO/ISH, in Group 2 there were united two WHO/ISH risk categories (10-10.9% and 20-29.9%) and Group 3 represented population of 30-39.9% and more than 40% of CVD risk. Routine Echocardiography was conducted. The data was analyzed using SPSS, version 21. The distribution of echocardiography characteristics in WHO/ISH groups was statistically different for LA, PSP and EF (P<0.05). In groups I and II LA were only mildly dilated, while in group III was revealed moderate LA enlargement. The mean PSP was in normal range in groups I and II and mildly to moderate elevated in group III. The mean EF was in normal range for all the groups with tendency of reduction from group I to group III. Unlike this we have not found statistically significant differences in other echocardiographic variables, as IVS, PWT, LVD and LVEDV and they were in normal range for all risk groups. According to the findings of our study and considering that our study population is without any clinical presentation of cardiovascular disease and still have statistically significant tendency toward increase in LA and PSP we argue that those variables can be considered as early predictors of cardiovascular disease. Furthermore, it is recommended to include echocardiographic examination as part of the CVD risk evaluation protocol in selected population.

[EPIDEMIOLOGY, STRUCTURE AND ALGORITHM OF MANAGEMENT OF PREGNANT WOMEN WITH EXTRAGENITAL PATHOLOGY OF THERAPEUTIC PROFILE].

Purpose of the study - the study of the extragenital pathology (EGP) structure in pregnant women according to the requests for medical help. The screening survey was attended by 742 pregnant women. Average age was 28,4±5,5 years. A retrospective analysis of the causes of calls to pregnant ambulance carriages was carried out for 2012-2013. On the basis of obtained data was suggested an algorithm of pregnant women with EGP management. In the structure of EGP in one profile led hematology - 306 cases (41.2%), followed by nephrology - 290 (39.1%) and gastroenterology (38.8%) - 288 cases, respectively. In the structure of requests for emergency medical care for pregnant first place occupied by respiratory diseases (2012 r - 28%, 2013- 30%), followed by urinary system diseases (2012 - 19.6% 2013 - 17.2% r ). Obtained data formed the basis for the algorithm to identify risks and provide medical care for pregnant women with extragenital pathology. In the structure of the screening study prevailed hematology profile diseases, and respiratory system diseases often were the reason for emergency medical care. The result of this study became the creating of the algorithm for medical care delivery.

COMPLEMENTARY AND ALTERNATIVE MEDICINE AND MEDICAL EDUCATION IN GEORGIA: STATE OF THE ART AND FURTHER PERSPECTIVES.

Aim - complementary and alternative medicine (CAM) is popular in Georgia, but providers' training not well understood or regulated. The aim of this mixed-methods study was to inform the process of implementing quality CAM curricula in Georgia and strategies for the inclusion of effective CAM curricula into medical education in Georgia. We analyzed existing medical curricula. We conducted a contextual analysis based of qualitative data collected from relevant medical education experts, qualified physicians, CAM practitioners and other stakeholders; and administered a quantitative MD students' survey to MD students. CAM components are currently not represented in medical curricula in Georgia. Physicians largely lack adequate knowledge of CAM and its practice. All stakeholders supported that it would be beneficial to develop CAM educatory courses, both to future practitioners (medical students, initially as an elective subject) and practicing physicians (through CME). We recommend development/integration of an elective subject and/or a curricular component as a first step of CAM integration into the medical curricula in Georgia for MD students and CME courses for physicians. Interdisciplinary and international collaborations may help achieve best outcome, and safe practice of CAM in Georgia, forming a base for physician - CAM practitioner collaborations for quality care for patients in Georgia.

ASSOCIATION OF ECHOCARDIOGRAPHIC CHARACTERISTICS WITH CARDIOVASCULAR RISK FACTORS IN ADULTS WITHOUT CLINICAL MANIFESTATION OF HEART FAILURE.

The objective the study was to assess the association between echocardiographic parameters and established cardiovascular risk factors in adults without clinical manifestation of heart failure (HF). A cross-sectional study was conducted between (September 2008 - December 2010) Consecutive sample of 177 participants were enrolled in the study. We performed routine Transthoracic Echocardiography and evaluated several well established cardiovascular risk factors. The data was analyzed using SPSS, version 16. LA was significantly correlated with age (r 0.396, p<0.000), WC (r 0.291, p<0.005), BMI (r 0.233, p<0.005), SBP (r 0.208, p<0.012) and TCH (r 0.163, p<0.049); IVS - with age (r 0.318, p<0.000), WC (r 0.259, p<0.002), BMI (r 0.178, p<0.032), TCH (r 0.191, p<0.022); PWT - with age (r 0 313, p<0.000), WC (r 0.270, p<0.001), BMI (r 0.204, p<0.013), TCH (r 0.168, p<0.042); LVD - WC (r 0.201, p<0.015) and BG (r 0.176, p<0.034); with LVEDV - WC (r 0.240, p<0.004); with EF - SBP (r- 0.202, p<0.015), DBP (r -0.171, p<0.015) and with PSP - age (r 0.286, p<0.000), SBP (r-0.243, p<0.003), DBP (r 0.254, p<0.002). As echocardiography characteristics are independent risk factors for Heart Failure development and progression and as most of them are correlated the age and obesity variables it should be appropriate to conduct routine echocardiography in aged and obese patients even in low CVD risk group. This statement particularly relevant for Georgia as the frequency of obesity is very high in the Georgian population.