The impact of COVID-19 pandemic on the 2020 hepatitis C cascade of care in the Republic of Georgia.

OBJECTIVES: In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN: Retrospective analytic study. METHODS: We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS: In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.

BLOODSTREAM INFECTIONS ASSOCIATED WITH INTENSIVE CARE UNIT AT A MULTIPROFILE HOSPITAL, TBILISI, GEORGIA.

Bloodstream infections (BSIs) are associated with a high mortality rate, additional hospital days and excess hospital costs. Intensive Care Unit (ICU) patients are at high risk of nosocomial BSIs because of their weakened condition caused by underlying disease, frequent invasive diagnostic and therapeutic procedures. Catheterization is the most common cause of hospital-acquired BSIs. The major causes of catheter-related BSI (CRBSI) are microorganisms from the patient's and medical personnel's skin and contamination of the catheter hub. From July 1, 2015 through June 30, 2016, were collected blood cultures from patients fulfilling the criteria for systemic inflammatory response syndrome in a tertiary care hospital ICU in Tbilisi. Blood culturing procedures and techniques and antimicrobial susceptibility testing, following methods set out by EUCAST. From microbiologically studied 84 blood samples 21 (25%) were positive for growth, 19 (90.5%) samples were monomicrobial, whereas 2 (9.5%) samples were polymicrobial. On the basis of microbiological, clinical and epidemiological data 21 patients were diagnosed as ICU associated BSI. Among them 16 (76.2%) patients were diagnosed primary BSI and CLABSI, four (23.8%) patients - secondary BSI; three of them were caused with ventilator-associated pneumonia, one - with catheter-associated urinary tract infection. The most common microorganism isolated from ICU associated BSI cases were Coagulase-negative staphylococci (30,4%), A. baumannii (21.7%) and K. pneumoniae (17.4%). Preventing BSIs should be a priority for hospitals and for this they must be introduced to modern methods infection prevention and control.

EPIDEMIOLOGY OF CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE IN INTENSIVE CARE UNITS OF MULTIPROFILE HOSPITALS IN TBILISI, GEORGIA.

Klebsiella pneumoniae is one of the most frequent cause of health care associated infections. Dissemination of carbapenem-resistant (CR) K. pneumoniae infections significantly trend toward patient morbidity, length of stay and mortality. The aim of this research was to study prevalence and risk-factors of CR K. pneumoniae in Georgia. To identify risk factors for hospital-acquired carbapenem-resistant (CR) K. pneumoniae, from January 1, 2017 through February 28, 2018, an observational case-control study was performed in the ICUs of two tertiary-care hospitals in Tbilisi (High Medical Technology Centre and Ghudushauri National Medical Centre). All isolated K. pneumoniae cultures were tested on antibiotic susceptibility tests (AST). AST was performed by disk diffusion methods and E-test for MIC detection. For the first time CR K. pneumoniae isolates were screened for the presence of KPC, VIM, IMP, NDM and OXA carbapenemase in a PCR. Totally, 46 cultures of K. pneumoniae were isolated. Among them 20 (43.5%) were resistant to carbapenems. Most frequently CR K. pneumoniae cultures were isolated in patients with ventilator associated pneumonia (75%). Main risk factors of carbapenem-resistant from invasive procedures were: mechanical ventilation (OR 30.4, 95% CI 3.504-263.752, p=0.0003), nasogastric tube (OR 17.0, 95% CI 3.202-90.257, p=0.0002), central venous catheter (OR 10.06, 95% CI 1.152-87.849, p=0.028) and previous use of antibiotics (OR 10.059, 95% CI 1.152-87.849, p=0.028), especially carbapenem and 3rd generation cephalosporin. Predominant is OXA-producing K. pneumoniae, NDM-producing K. pneumoniae is relatively rare. To control dissemination of CR K. pneumoniae infection prevention and control should be toughened in medical facilities, and screening for early detection of patients with CR K. pneumoniae should be done.

[Urgent problems of occupational diseases in Georgia in the junction of XX-XXI centuries].

The radical reform of health care system in Georgia after the collapse of the Soviet Union negatively affected the occupational medicine, environmental medicine, occupational health services, and preventive measures. The level of medical assistance to people suffering from harmful industrial factors decreased, which is a serious danger for the health of the workers and for the next generations. The aim of the article is to protect the right to means for adequate health and suggest effective ways for health care improvement. In order to reconstruct the system of Occupational and Environmental Medicine, it is necessary to create a network of occupational healthcare. We strongly believe investment in preventive health is vital to safeguard and improve the health of the community. The Center of Occupational Medicine and the Institute of Labor Medicine and Ecology with corresponding financing, educational programs for medical students and continuous practice of physicians in occupational medicine, enhancing the number of the scientific research designed to discover the early forms of occupational pathologies and timely prevention of the disease is vital to protect the right to means for adequate health, to advance the professional development of physicians, nurses, research scientists, and allied health professionals in order to diminish general and occupational diseases in Georgia.

[Occupational medicine -- past, present and the future trends].

State of the occupational medicine in Georgia -- performing investigations in the field of occupational illnesses, providing workers with the occupational health services, training of the medical staff in higher educational institutions, perspectives of occupational health services for workers and personnel, having professional contact with hazardous factors were discussed. The major stages of the development of occupational medicine, since the foundation of the occupational health services in Georgia, till today, were presented. The principal mistakes made in organizational -- practical, educational, methodical, research practices in public institution managing the training of the scientific and practical personnel of occupational medicine were evaluated. On the basis of the present state of occupational medicine in the country some principal conclusions were made. These conclusions state that immediate measures should be taken for the development of the modern occupational health services. It is necessary to work out some new strategies and to restore old and proved actions.

[The characteristic state of health of ammonia nitrate producing workers].

The workers producing ammonia nitrate have professional contact with ammonia nitrate aerosol and nitrogenous gases. The state of health of ammonia producing workers has been examined. The morbidity, the therapeutic, neurological and laryngeal status have been inspected. Electrocardiography and examination by peak flow meter by Wotchall has been conducted. Peripheral blood test and radiography of backbone has been carried out as been required. It has been estimated that the illnesses of respiratory apparatus and musculoskeletal system predominate in the morbidity structure. The clinical examination of the workers with basic professions of the production of ammonia nitrate shows the frequent cases of chronic bronchitis and radiculoneuropathy. The results of function study show the damage of airways, the myocardiodystrophy and the changes of T wave. The nitrogen containing particulate pollutants that irritate respiratory systems and hard manual labor at these working places determine these illnesses. This fact corresponds with the hygiene and sanitary conditions of labor at major working places of production. This confirms the major role of occupational-productional factors in the etiology of these pathological conditions. In order to prevent the remote structural lesion of respiratory and cardiovascular systems it is required to amend the functional damage. On the basis of carefully performed study a complex of recreation measures has been carried out in order to improve the service conditions.

[The efficiency of low-intensity laser radiation in the treatment of arterial hypertension complicated by ischemic heart disease]. / Effektivnost' ispol'zovaniia nizkointensivnogo lazernogo izlucheniia pri lechenii arterial'noi gipertonii i ee sochetaniia s ishemicheskoi bolezn'iu serdtsa.

The efficiency of low-intensity laser radiation (LILR) was studied in the treatment of 291 patients with arterial hypertension and ischemic heart disease. Clinical grounds are given for use of LILR red and infrared rays in rehabilitation of hypertensive patients with ischemia. The rehabilitation regimens can be differentiated according to the disease severity, type of hemodynamics, state of cerebral circulation.