DENTAL FLUOROSIS PREVALENCE, SEVERITY AND ASSOCIATED RISK FACTORS IN PRE-SCHOOL AGED CHILDREN RESIDING IN FLUORIDE DEFICIENT REGIONS OF GEORGIA.

The aim of study was to assess prevalence, severity, and associated risk-factors for Dental Fluorosis in Pre-School children (1-6 years) in Fluoride deficient regions (1) Tbilisi (F=0.08-0.22 mg/l) and (2) Akhaltsikhe, (F<0.4 mg/l) Georgia, having different geographic location and socio-economic conditions. A cross-sectional study was carried out on 570 pre-school aged children (1-6 years) attending public kindergartens of Tbilisi and Akhaltsikhe region. Descriptive analysis was performed for Dental Fluorosis prevalence and severity using Thylstrup-Fejerskov Index (TFI). Correlative analysis was done to assess information about possible acquired risk-factors through questionnaire including biological and social variables. To differentiate genuine Dental fluorosis from other non-carious resembling defects ECEL method was introduced. For Fluoride concentration determination in potable water (2) ISO 10359-1:1992 Electrochemical probe as ion-selective electrode method was used. Information about F concentration in Tbilisi tap water (1) was obtained by GWP. (Georgian Water and Power, 2019). The overall Prevalence of Dental Fluorosis in study group was 6.3% (36 Children) (95% CI;(4.3 - 8.3)). There was no statistically significant difference in the level of Dental Fluorosis prevalence between rural and urban residents (P>0.05). Dental Fluorosis prevalence was similar in both gender groups. 6.0% of girls had dental fluorosis (95% CI 2.2% - 8.8%), whereas DF prevalence in boys was 6.5% (95% CI3.7% - 9.3%), respectively. Regular brushing and dentifrices ingestion were not effecting DF prevalence and severity (p>0.05). Indoor coal-burning environment increasing airborne Fluoride absorption during pregnancy was recognized as a risk-factor for dental fluorosis occurrence in children (OR=5.8 (95% CI; 2.1-15.9)). High tea consumption (≥2 cups/day) was increasing Odds of DF occurrence (OR=17.3 (95% CI; 7.4-40.7)). Exposure to diverse fluoride sources like indoor coal-burning and high tea consumption in non-fluoridated areas is a risk-factor of Dental Fluorosis in study community.

IMPACT OF BIOMEDICAL AND BEHAVIORAL FACTORS ON PRETERM BIRTH.

Preterm birth, in a long-term perspective, is a priority for medicine and public health, as it is directly associated with health index of the population. Georgian clinical management guidelines for preterm birth is based on non-Georgian experience, due to lack of population-based research in Georgia. For this purpose, it was implemented Cause-effect epidemiological study with the purpose on risk factors of preterm birth. Study based on 2018 Georgian Birth Registry (GBR) with registered 50468 childbirth cases, data was conducted for total Georgian single-fetus (n=49762) population according to known biomedical and behavior-related expositions based on a review of the scientific literature from 1999-2020. Target variable was divided into two sub-variables (dichotomy variable), according to which, pregnancy term of 258 days including was determined as preterm, while 259 and above was considered as timely. Study of risk factors of preterm birth was implemented using stages of backward selection modelling of analysis, while possible expositions linked to preterm birth was included in logistic regression model. According to the final model, male gender and fetus of less than 2,500 grams are statistically relevant factors for the outcome of preterm birth. Also mother's age below 18 and above 35. Severe anemia remains a risk factor on the final model with and diabetes during pregnancy. Small increase of body mass index (BMI<5) is a reliable risk factor for the preterm birth, and increases risk for interesting outcomes by 1.3 (95% CI 1.1-1.5). According to regression analysis, out of behavior expositions, inducted abortions during previous pregnancies ensure statistically reliable increase of premature termination of future pregnancies. Insufficient antenatal care (≤4 visits) are statistically reliable risk factors for premature termination of pregnancy. Results of study based on population registry enable to conclude that biomedical and behavior factors, as proven by evidence, are important for prevention of preterm birth. This process requires shared responsibility between medical personnel, pregnant woman and environment. Prevention should be ensured through effective use of medical technologies, formulation of interventions of different levels on behavior-related factors: public awareness, education, active interventions.

IMPACT OF ACCESS TO DENTAL SERVICES ON DENTAL CARIES RISK IN ADULT POPULATION OF GEORGIA.

The objectives of the present paper are to outline the oral disease burden globally and to describe the influence of major socio-behavioral risk factors and the deficit of dental services, associated with the oral health in Georgian population. One thousand and twenty-seven subjects from 6 regions of Georgia were examined. Caries prevalence and oral hygiene status was assessed among the five age groups: I- (35-44), II-(45-54), III-(55-64), IV- (65-74), V- (75-84). A questionnaire was used to evaluate general health condition, alcohol and tobacco consumption, oral hygiene habits and dental service accessibility. High prevalence (100%) of the dental caries and intensity of DMF=10.96 were recorded. There is high prevalence of the dental caries in the investigated areas of Georgia. Positive correlation between the dental caries and accessibility to dental services was noted.

EVALUATION OF RESIDUAL LESIONS FOLLOWING CONSERVATIVE TREATMENT OF HIGH GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA.

The purpose of this study was to determine the diagnostic value Pap smear test and colposcopy in Georgian National Screening Center, evaluation of efficiency of the excisional treatment and determining the main risk factors for prediction of residual/recurrent disease in patients with high-grade cervical intraepithelial neoplasia. We retrospectively analyzed 613 patients, who underwent excisional treatment of the cervix (LEEP). Follow-up was performed by Pap smear test, colposcopy and histamorphological examinations. Accuracy of Pap smear test and colposcopy prior to the the excisional treatment revealed Pap: Se 83.4%; Sp 76.4%; PPV 72.6%; NPV76.8%; Colposcopy: Se 83.4%; Sp 69.4%; PPV 69.3%; NPV 80.6%; After the excisional treatment: Pap: Se 82.8%; Sp 92.3%; PPV 61.5%; NPV 97.3%; Colposcopy: Se 62.1%; Sp 80.4%; PPV 32.1%; NPV 93.4%. After LEEP colposcopy is less sensitive than before LEEP. After LEEP sensitivity of the Pap smear test exceeds the sensitivity of the colposcopy. Forty one (18.4%) of 223 patients had residual/recurrent lesion during follow-up. According to univariate analysis the patient's age ≥40 years (p<0.01) OR 3.2 (95% CI 1.3-8.4), transformation zone type III (p<0.01) OR 5.0 (95% CI 2.1-11.5), endocervical gland involvement (p<0.01) OR 6.2 (95% CI 2.7 - 15.1 ), smoking status (p<0.001) OR 7.7 (95% CI 3.336-17.8), major abnormal cytology (p<0.05) OR 2.72 (95% CI 0.963-9.512) were significant risk factors for residual/recurrent disease. However, gravidity, parity, severity of disease and positive margins were not relevant factors for the residual/recurrent disease (P>0.05). Consideration and implementation of these predictive factors in patient surveillance protocol will allow avoiding delayed treatment or overtreatment.

Geographic peculiarities of endometrial and cervical cancer incidence in five continents (review).

The review of references and data on endometrial and cervical cancer incidence in five continents (1970, 1976, 1982, 1987) are presented. The increase in cervical cancer rates in the developing countries of Asia, Africa and Latin America has been recorded. The hormonedependent tumours (endometrial, breast cancer) prevail in the economically developed countries of Europe and North America. They have shown a tendency to increase since the end of the 70's. The possible causes of peculiarities in oncogynecological incidence have been discussed.

Myoma uterus as a marker of oncogynecological pathology in pre- and post-menopause.

Development and (or) growth of myoma uteri in pre- and post-menopause is accompanied by hyperestrogenia which is shown by histological investigation of the endometrium and the ovaries. A comparative clinical and morphological study of 853 patients with myoma uteri, 996 patients with glandular, atypical hyperplasia and endometrial carcinoma was carried out. Benign tumors of the ovaries were revealed in 9.5% of patients with myoma, 12.7% of patients with atypical endometrial hyperplasia and 19.8% of patients with endometrial cancer. A significant increase of the occurrence of endometrial cancer in postmenopausal patients with myoma, in comparison with patients in the reproductive period was determined, 13.4% and 1.1% respectively, P = 0.01. In postmenopause "growth" of the tumor was more often and significantly simulated by malignant disease of the uterus and adnexa. In postmenopausal patients with myoma and uterine bleeding, endometrial carcinoma was 5.5 times more often revealed in comparison with the analogous group of patients in the reproductive period. The "relative risk" of the development of endometrial cancer, sarcoma uteri and ovarian tumors was calculated. The "relative risk" was shown to increase in the postmenopausal period. In the processes of observation of patients with myoma in postmenopause, cytological investigation of endometrial aspirates, ultrasound and mammographic screening should be carried out.

[Planning of the treatment of atypical hyperplasia of the endometrium in patients with uterine myoma]. / Planirovanie lecheniia atipicheskoi giperplazii éndometriia u bol'nykh miomoí matki.

The results of a two-stage hormonal treatment of 62 cases of atypical hyperplasia of the endometrium were analysed. Within the first 6 months, patients received 24.0-28.0 g of hydroxyprogesterone capronate each. Six courses of steroid contraceptives such as non-ovlon and bisecurin were given during the second stage when regression of endometrial precancer had already been registered. The results proved hormonal therapy to be highly effective in managing atypical hyperplasia of the endometrium. Complete response was observed in 67.7% of patients. Coexistent uterine myoma affected the efficacy of treatment adversely: only 4 out of 14 patients with atypical hyperplasia of the endometrium with concomitant myoma were good responders. Hormonal treatment was ineffective mainly in cases of myoma of sizes exceeding 8 weeks of gestation and in pre- and postmenopausal patients. This makes the case for surgery.