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.

OVARIAN CANCER TREATMENT OPTIMIZATION: THE COMPLEX ANALYSIS OF THE RESULTS OF CYTOREDUCTIVE SURGERY, MICROSCOPIC MALIGNANCY AND T-LYMPHOCYTIC INFILTRATION OF THE TUMOR.

The paper discusses 64 cases of ovarian cancer (observed in 2016-2019). Patients underwent cytoreductive surgery. Both Shimizu/Silverberg system and the "Two-tier" system were used to grade the tumor differentiation of serous carcinomas. The grade of the differentiation was specified by expression of oncoprotein p53. The tumor infiltrating lymphocytes (TILs) labeled with immunohistochemical markers - CD2, CD3, CD4, CD8 - were evaluated for the intensity of expression in both - the ovarian tumor parenchyma and stroma. Quantitative assessment of expression was performed by a computer program ImageJ. The survival of patients with ovarian cancer was examined by using the Kaplan-Meier curves and calculations of Cox Hazard Ratio (HR). Multiple regression analyses of factors influencing surgical intervention was performed by a logarithmic regression method. According to the obtained data, the carcinogenesis of high-grade and low-grade serous ovarian carcinoma is different: low-grade forms are always preceded by serous cystadenoma and/or serous cystadenofibroma, which progresses to borderline serous carcinomas and then to low-grade invasive carcinoma; high-grade serous carcinomas are not developed from the progression of low-grade invasive carcinomas and are the product of the de novo formation. p53 may be used as an additional molecular-biological feature for specifying the grade of microscopic malignancy of the tumor in the cases, when the moderate differentiation is established by Shimizu/Silverberg system. The antineoplastic and/or prognostic role of the tumor-infiltrating T lymphocytes is not fully evident and needs further investigation. High-grade (G3) of ovarian carcinoma and the neoadjuvant chemotherapy are the factors having a significant impact in defining the effectiveness of the surgical treatment of ovarian cancer.

THE PREVALENCE OF HIRSUTISM AND ETHNICAL PECULIARITIES OF HAIR DISTRIBUTION IN GEORGIAN ADOLESCENT POPULATION IN TBILISI.

Objective - the purpose of the study is evaluation of the Hirsutism prevalence and ethnical peculiarities of the hair distribution in Georgian female adolescents of Tbilisi, Georgia. 2592 randomly selected female adolescents of Tbilisi were included in the study. They completed standard questionnaires consisted of questions about the existence of hirsutism and its locations. For clinical assessment 2 groups were selected from them: group 1 - 117 adolescents with hirsutism and 178 without it. For clinical evaluation of hirsutism modified Ferriman-Gallwey score was used. Based on the self-estimation the hirsutism prevalence was 26.62% (690 out of 2592), while clinically established prevalence of hirsutism was 20.61%. The most prevalent areas of hair distribution by self-estimation were the face and the abdomen. Clinical assessment of patients with hirsutism showed that mean value of Ferriman-Gallwey Score was 12.87±5.94. Hair distribution by clinical assessment was most significantly observed in the lower abdomen (78.33%), upper lip (76.67%) and chest (68.33%). This is the first study of hirsutism prevalence in ethnically Georgian adolescent female population. The study has shown that the value of prevalence by self-estimation exceeds analogous value established clinically, and the sites with hair excess are lower abdomen, upper lip and the chest.

[The relation of the activity of postheparin lipoprotein lipase with the CBC parameters in patients with acute coronary syndrome].

The aim of presented investigation was to study of the relation of the activity of postheparin lipoprotein lipase (LPL) with the blood test parameters in patients with acute coronary syndrome(ACS) during first 6-12 hours after appearance of acute anginous pain. 47 patients with the disease of coronary arteries (DCA) have been investigated. Acute form of ACS was revealed in 27 patients (mean age--62.9+/-11.7 years), chronic form--in 20 patients (mean age 67.9+/-14.0 years). The study was carried out in the first 6-12 hours after appearance of acute anginous pain. Control group consisted of 23 healthy subjects (mean age--37.5+/-8.9 years). Postheparin activity of LPL has been determined in whole cohort by potentiometric method. Blood test was carried out by standard method. The acute coronary syndrome was confirmed by electrocardiographic findings. In ACS group the activity of LPL significantly correlated inversely with the value of leukocytes (r=-0.4022, p=0.038), stab (r=-0.4808, p=0.011) and segmental leukocytes (r=-0.5853, p=0.001), erythrocyte sedimentation rate (r=-0.4188, p=0.030). Corning to the comparative analysis of chronic and acute forms of DCA, the activity of LPL was significantly lower in patients with chronic form compared to the acute form (p=0.043). Therefore, based on the obtained data it should be concluded that in 6-12 hours after development of acute coronary syndrome during worsening the inflammatory reaction (which reflected on the parameters of blood test) together with endothelial dysfunction it is expressed the decrease of the activity of endothelial enzyme LPL.

[Relation of serum uric acid levels with basic metabolic parameters in patients with metabolic syndrome during insulin-sensitizing therapy].

The aim of our investigation was to study the peculiarities of serum uric acid (UA) levels in patients with metabolic syndrome (MS) during 6 month therapy with metformin (MF), Rosiglitazone (RG) and their combination. 30 patients with MS (10 males, 20 females, mean age - 35,5+/-9,7 years) have been investigated by all parameters of MS and serum UA levels. Investigated group was divided into 3 subgroups of 10 patients: group 1 - patients on RG; group 2 - patients on MF; group 3 - patients on RG + 850-1000 mg of MF. Results of investigation showed that UA serum levels did not decrease significantly. However, the frequency of hyperuricemia decreased significantly. PPG, basal C-peptide, and HOMA-% IR also decreased significantly. Despite percentage reduction of BMI in group 3 (7,6%), decrease of UA and HOMA-IR was significantly higher in group 1 (18,2% and 37.0%, respectively). Correlation analysis showed that decrease of UA significantly correlated with BMI and HOMA-IR in the whole group (r=0.5674, p=0.001; r=0.5437, p=0.002; respectively); in group 1 - with HOMA-IR (r=0.5753, p=0.016); in group 3 - with BMI (r=0.7821, p<0.001). Obtained results showed that UA levels and hyperuricemia cases significantly decreased during insulin sensitizing therapy.

[The dependence of changes of parameters of metabolic syndrome features on the reduction of degree of insulin resistance during lifestyle intervention].

The aim of our investigation was to study the dependence of changes of parameters of metabolic syndrome (MS) features on the reduction of degree of insulin resistance during lifestyle intervention--balanced diet and moderate exercise. 33 patients with MS have been investigated (mean age--49.1+/-8.7 years). MS was confirmed by WHO definition of 2002. All parameters of MS features have been determined baseline and after 6 months of study initiation. Balanced diet (restriction of easy-digestible carbohydrates and lipids and consumption of products with high cellulose content) and moderate exercise (60 min. walking three times per week) have been prescribed to all patients. After 6 months IR index was decreased from 3.6+/-0.7 to 2.6+/-0.4 (p<0.001). Investigated subjects were divided on two groups: I group consisted of patients HOMA-IR index of whom after 6 months decreased by magnitude less than 1.0 (n=19); and II group--patients HOMA-IR index of whom after 6 months decreased by magnitude greater or equal 1.0 (n=14). In spite of similar reduction of body mass and waist circumference, the parameters of carbohydrate and lipid metabolism in II group decreased significantly sharply than in I group. The more positive changes of metabolic parameters of MS features during lifestyle intervention strongly depend on the degree of reduction of insulin resistance which has to become the main strategic target during MS treatment.

Comparative analysis of blood redox parameters according thyroid function of patients with autoimmune thyroid diseases.

Little is known about various blood parameters of oxidative stress and antioxidant defence patients with various thyroid functional states in autoimmune diseases (ATD). To clarify influence of thyroid metabolic status on blood redox parameters, we performed a complex estimation of patients with ATD (Graves' disease and chronic autoimmune thyroiditis). 50 patients with ATD have been studied: 16 - with hyperthyroidism; 20 - euthyroidism; and 14 - with hypothyroidism. 10 healthy subjects were selected as a control group. In patients with hyperthyroidism has been only observed inverse correlation between ceruloplasmin (CP) and thyroid volume (r= -0,5177, p<0,001); in patients with euthyroidism only inverse correlation between CP and FT4 (r= -0,4970, p<0,001). But in patients with hypothyroidism inverse correlation between Fe(3+)-transferrin and TSH levels (r= -0,6501, p<0,001) and direct correlation between nitric oxide and FT4 (r= 0,5657, p<0,001), and lipid peroxyradicals and FT4 (r= 0,5620, p<0,001) have been established. Thus, according to obtained results oxidative stress occurs at ATD in spite of thyroid status. Our findings about association of the thyroid function and REDOX-system should be considered in the treatment of ATD.

[Levels of uric acid in serum in patients with metabolic syndrome].

The aim of our investigation was to study the peculiarities of serum uric acid (UA) levels in patients with metabolic syndrome (MS) and without it, also correlations between UA and parameters of MS features. 41 patients (mean age - 37,8+/-13,7 years) have been investigated. MS was defined by definitions of WHO (2002), ATPIII and Society of Georgia Endocrinologists (SGE). Exclusion criterion served the gout. Levels of all parameters of MS features and serum UA have been determined. MS was diagnosed in 48,7% of cases. Study group consisted of these patients, and control group - patients without MS. Serum UA levels were significantly higher in the study group in comparison with the control (6,6+/-1,4 vs. 5,4+/-1,3 mg/dl, p=0,007; respectively). In main group the cases of hyperuricemia have been documented significantly frequently than in control (65,0% vs. 33,3%, p=0,043; respectively). Obtained results shown that UA levels significantly higher and hyperuricemia cases significantly frequent at MS, which have to be taking into account during symptomatic treatment of patients.

[Peculiarities of postprandial activity of lipoprotein lipase in coronary heart disease].

The aim of investigation was to study the peculiarities of activity of lipoprotein lipase (LPL) and serum lipid spectrum after fat test meal in patients with coronary heart disease (CHD). 42 persons have been investigated. The main group consisted of 27 patients with CHD (13 males, 14 females). 15 almost healthy subjects (5 males, 10 females) were unified in control group. Parameters of lipid metabolism have been studied by biochemical technique both in basal state and at 3 hours after standard test meal. In parallel, the levels of LPL activity have been investigated by potentiometric method. The values of LPL activity in patients with CHD both in basal and in postprandial states were significantly lower in comparison with analogous values of control subjects. Its postprandial level in CHD patients did not change significantly (percentage increment was 1,0+/-0,9%), but in control group - was increased by 22,3+/-4,4%. Obtained results suggest that LPL activity is not increased at increased postprandial atherogenic lipemia in patients with CHD. LPL activity should be considered as a metabolic marker of atherogenesis and CHD.

[The status of redox system in patients with chronic autoimmune thyroiditis].

The aim of present investigation was to study redox processes and to establish state of blood oxidative and antioxidant systems in patients with chronic autoimmune thyroiditis (CAT). 19 patients with CAT (2 males, 17 females; mean age 35,3+/-14,8 years) have been randomly investigated, of which 3 patients (15,8%) had hypothyroidism, 11 (57,9%) - euthyroidism and 5 (26,3%) - hyperthyroidism. Control group consisted of 10 practically healthy subjects (2 males, 8 females; mean age 41,1+/-11,7 years). The parameters of blood redox-system were investigated by electron-paramagnetic resonance method (EPR). The value of ceruloplasmin in patients with CAT was significantly higher than in control group (20,0+/-2,0 mm/mg vs. 16,0+/-1,1 mm/mg, p<0,001); EPR-signal of Fe3+ - transferrin in main group was also significantly higher (18,5+/-1,3 mm/mg vs. 22,0+/-0,9 mm/mg, p<0,001); values of nitric oxide in both groups were almost identical. EPR-signals of methemoglobin significantly correlated with thyroid volume (r=0,5421, p=0,016). These changes demonstrate possible relationship between CAT and blood redox system. It should be supposed that the introduction of antioxidant preparations will improve CAT pathogenetic therapy.

[The status of redox system in patients with Graves' disease].

The aim of our investigation was studying the redox processes, the establishment of state of blood oxidative and antioxidant systems in patients with Graves' Disease (GD). 19 with diffuse-toxic goiter have been investigated. Control group included 10 practically healthy subjects. The parameters of blood redox-system were investigated by electron-paramagnetic resonance method (EPR). In GD group hypothyroidism was diagnosed in 7 patients (36,8%), euthyroidism - in 7 patients (36,8%) and hypothyroidism - in 5 (26,3%). The value of ceruloplasmin in main group was significantly higher than in the control (18,6+/-1,3 mm/mg vs. 16,0+/-1,1 mm/mg, p<0,001); EPR-signal of Fe(3+)-transferrin in main group was also significantly higher (19,2+/-1,2 mm/mg vs. 22,0+/-0,9 mm/mg, p<0,001); values of nitric oxide in both groups were almost identical. EPR-signals of Mn(2+) ions significantly correlated with thyroid volume (r=0,5461, p=0,016), NO - with antibodies to thyroglobulin (r=0,5750, p=0,010). These changes demonstrate possible relationship between autoimmune diseases and redox-system.

[Some peculiarities of the activity of postheparin lipoprotein lipase and parameters of lipid metabolism at ischaemic heart disease].

The study of the relation of atherosclerosis with lipid metabolism (LM) remains still very important. The aim of presented work was the investigation of peculiarities of lipoprotein lipase (LPL) and LM at IHD in different age and sex groups; also the search of possible relation of LPL activity changes with myocardial contractility function and coronarography data at IHD. 47 patients (15 females, 32 males) with IHD were investigated. They were divided on 3 groups: 1 -<50 years (n=14); 2 - 50-59 years (n=14); 3 - >/=60 years (n=19). Patients were investigated by coronarography and echocardiography. Main parameters of LM were determined by enzyme-linked immunoassay. LPL activity was defined by potentiometric method. It was observed significant difference between levels of LPL activity of different age groups (p(1-2)=0,027, p(1-3)<0,001, p(2-3)=0,035). Significant difference in this parameter by sex feature did not observed. The degree of damage in anterior descending branch of left coronary artery negatively correlated with LPL activity (r=-0,5598, p<0,001). Ejection fraction (EF) revealed positive correlation with LPL activity (r=0,4362, p=0,002). The degree of damage of left coronary artery, in particular, medial segment of circumflex branch correlated with LM parameters. EF positively correlated with high-density lipoprotein cholesterol blood level (r=0,3548, p=0,036). LPL activity in patients with IHD significantly decreased with aging. From obtained results it will be supposed that LPL activity and LM parameters influences on the damage degree, basically, left coronary artery.