Experimental and Clinical Medicine Georgia
By the dissertation councils journal is included in a list of scientific editions recommended for publishing of the dissertation fragments. Journal DOI: https://doi.org/10.52340/jecm Google Scholar IF - 0.075 (2023) SJIF - 6.191 (2023) Cosmos IF - 5.556 (2019) ISSN: 1512-0392 E-ISSN: 2667-9736
CONGENITAL PULMONARY ARTERY STENOSIS DIAGNOSED AFTER COVID-19-ASSOCIATED PNEUMONIA IN AN ELDERLY PATIENT WITH MULTIVALVULAR PATHOLOGY AND SUBSEQUENT SUCCESSFUL SURGICAL TREATMENT
Congenital pulmonary artery stenosis is predominantly caused by genetic factors and embryonic developmental defects. Due to its association with other congenital heart anomalies, clinical manifestations are often complex and typically present during childhood or adolescence. Diagnosis at an advanced age is extremely rare. Contributing factors such as viral infections can provoke symptom onset. This paper presents the clinical case of a 69-year-old male patient diagnosed with congenital pulmonary artery stenosis following COVID-19-associated pneumonia. The case was further complicated by comorbidities including combined valvular defect, ischemic cardiomyopathy, essential hypertension, atherosclerotic heart disease, secondary pulmonary hypertension, stage III chronic kidney disease, obesity caused by excessive caloric intake, and type 2 diabetes mellitus. The patient underwent surgical treatment including bioprosthetic replacement of the aortic and pulmonary valves, transannular patch enlargement of the right ventricular outflow tract, and mitral valve annuloplasty. Despite the initially unfavorable prognosis, symptom severity decreased and the patient's condition improved significantly during follow-up.
Exercise-induced anaphylaxis (EIA) is a disorder in which anaphylaxis occurs in response to physical exertion. In the majority of patients, symptoms only develop if exercise takes place within a few hours of eating a specific food to which the patient is allergic, but the food allergy is asymptomatic unless there is associated exertion. This is called food-dependent EIA (FDEIA). A more accurate term for FDEIA would be "cofactor-dependent food allergy" because research has demonstrated that there are cofactors other than exercise that can lower a patient's threshold for developing symptoms. Typical manifestations of EIA and FDEIA include generalized pruritus, warmth, flushing, urticaria and angioedema, and sudden fatigue, progressing to gastrointestinal symptoms, upper airway obstruction, and collapse in some cases. Symptoms usually begin during exercise or just after stopping exercise. The diagnosis of EIA/FDEIA is usually based upon the clinical history and exclusion of other disorders. The prognosis of patients with EIA and FDEIA is generally favorable once the diagnosis has been clarified, especially if a food allergy can be identified.
FOLATE RECEPTOR ANTI-AUTOANTIBODIES (FRAAS): DAMAGING EFFECTS IN DIFFERENT AGE GROUPS, WAYS TO OVERCOME
Folate Receptor Autoantibodies (FRAAs) are antibodies produced by the body’s immune system that are directed against its own folate receptors. These receptors are responsible for transporting folate into cells, including those in the brain and placenta. FRAAs interfere with the normal absorption of folate, causing a functional folate deficiency even when folate supplementation is adequate and blood folate levels appear normal. This article reviews several aspects of FRAAs, including their causal factors, characteristics across different age groups, associations with other autoimmune diseases, and their impact on gestational and perinatal outcomes. It also discusses pathologies that may raise suspicion for FRAAs, laboratory methods for diagnosis, and treatment strategies, including the indications for using folic acid and folinic acid.
CEREBRAL VENOUS THROMBOSIS IN PREGNANCY: CURRENT PERSPECTIVES ON DIAGNOSIS AND MANAGEMENT (LITERATURE REVIEW)
This paper presents a literature review examining the clinical presentation, traditional and innovative diagnostic methods, and surgical treatment methods presented in the works of Russian and international authors. Long-term study of neurological and neurosurgical conditions in women during pregnancy has left many unanswered questions due to the low prevalence of these conditions in pregnant women and women in labor. The specificity and uniqueness of each clinical case of these conditions opens a wide range of discussions regarding the choice of pregnancy and childbirth management strategies. These conditions pose a significant risk to the life of not only the mother but also, consequently, the fetus. Therefore, the study of this problem is crucial for approaches to diagnosis, timely prognosis, and the selection of pregnancy and childbirth management strategies for patients with such extragenital comorbidities.
MODIFICATION OF THE FUNCTIONAL IMPRESSION TECHNIQUE FROM THE EDENTULOUS UPPER AND LOWER JAWS IN COMPLETE EDENTULISM
The issue of impression-taking from edentulous jaws remains a challenge in prosthetic dentistry to this day. Numerous methods for obtaining anatomical and functional impressions have been developed and introduced. Although certain positive outcomes have been achieved, optimal fixation of complete removable dentures on edentulous jaws, especially the lower jaw, is sometimes still unattainable. In cases of complete edentulism, dentures fabricated using our modified method of taking functional impressions from the edentulous upper and lower jaws in the occlusal position demonstrated a high degree of fixation on both jaws. The results of prosthetic treatment were satisfactory in all cases. The adaptation period to removable dentures was short (7–12 days), while the masticatory efficiency of the dentures, due to their secure fixation on the jaws, was high (45–60%).
PRELIMINARY STUDY OF SOME PLANTS DISTRIBUTED AND CULTIVATED IN GEORGIA ON THE CONTENT OF BIOLOGICALLY ACTIVE SUBSTANCES
Preliminary studies were conducted on 74 analytical samples of 11 families, 25 genera, and 34 species of the Georgian flora on the content of biologically active compounds - flavonoids and triterpene secondary metabolites. The preliminary analysis of the objects revealed that most of them contain flavonoids in the above-ground organs. Datisca cannabina L. was a rare exception, the presence of flavonols was confirmed in its underground parts. The following species were distinguished by their flavonoid content: Polygonatum glaberrimum, Echium vulgare, Cerinthe minor, Datisca cannabina, Rhododendron brachycarpum, Rhododendron delavayi, Rhododendron ungernii, Astragalus brachycarpus, Cercis siliquastrum, Cytisus caucasicus, Cytisus hirsutissimus, Onobrychis kachetica, Genista patula, Vaccaria segetalis, Hypericum perforatum, Stachys iberica, Satureja laxiflora, and Clematis orientalis. The flavonol glycoside 2´, 3, 5 - tri-hydroxy - 7 - methoxy - flavone - 3 - O - [O - α - L - rhamnopyranosyl - (1→6) - β - D - glucopyranoside (datin-3-rutinoside or datinoside) has been isolated and identified from the roots of Datisca cannabina. The following species are distinguished by the content of triterpene secondary metabolites: Astragalus brachycarpus, Cerinthe minor, Echium vulgare, Datisca cannabina, Rhododendron brachycarpum, Rhododendron delavayi, Rhododendron ungernii, Cercis siliquastrum, Cytisus caucasicus, Cytisus hirsutissimum. From the analysed samples, the following species, common in Georgia were studied for the first time on the content of triterpene compounds: Argyrolobium biebersteinii, Astragalus brachycarpus, Datisca cannabina, Cerinthe minor, Echium vulgare, Polygonatum glaberrimum, Rhododendron brachycarpum, Rhododendron delavayi, Spartium junceum, Vaccaria segetalis, Rhododendron ungernii, Genista patula, and Clematis orientalis.
ASSESSMENT OF PSYCHO-EMOTIONAL STATUS IN A POPULATION OF CHILDREN WITH JAW-TEETH ANOMALIES
Introduction: Jaw and dental anomalies rank third in prevalence among oral pathologies in children, following caries and periodontal diseases. These conditions significantly affect adolescents’ psycho-emotional status, self-esteem, and social adaptation. Methods: The study was conducted at the pediatric dental clinic “Family Dent” in Kutaisi. A total of 125 patients aged 10–16 years were assessed using the modified Lavrentieva & Titarenko anxiety questionnaire and an anonymous self-assessment survey. Results: Various degrees of anxiety were identified in all patients; Emotional restlessness, irritability, fear of starting new activities, and tearfulness were statistically more prevalent in girls; Self-esteem was particularly low before treatment though after the treatment, the vast majority of patients reported significantly higher self-esteem. Conclusion: Jaw and dental anomalies cause not only esthetic and functional, but also significant psycho-social problems. The findings highlight the necessity of an interdisciplinary approach, combining orthodontic treatment with psychological support to enhance patient motivation and reduce anxiety factors.
THE TH1/TH2 CYTOKINE PROFILE PARADIGM IN THE IMMUNOPATHOGENESIS OF PSORIASIS
Psoriasis is a chronic inflammatory disease characterized by the presence of erythematous papules and plaques on the skin. T cell autoreactivity to a still unknown antigen plays a leading role in the pathogenesis of psoriasis. These immune cells migrate from the dermis to the epidermis and secrete chemical mediators of inflammation - proinflammatory cytokines. The aim of our study was to study the activity of Th1/Th2 cytokine profiles in the immunopathogenesis of psoriasis. According to the obtained results, IL-2 levels are significantly increased in psoriasis patients compared to healthy and allergic groups, indicating activation of the Th1 immune line, and the low levels of IL-33 in both the psoriasis and allergy groups reflect its non-dominant role. According to the results of our study, the significantly elevated levels of IL-2 and the relatively low levels of IL-33 in patients with psoriasis indicate a shift in the Th1/Th2 immune balance towards Th1, which increases the diagnostic and immunotherapeutic value of this cytokine.
MENOPAUSE AND METABOLIC HEALTH: THE HIDDEN RISKS PRESENT IN GEORGIA
Menopause represents a natural biological transition characterized by declining estrogen levels and profound metabolic changes. Estrogen deficiency contributes to insulin resistance, dyslipidemia, and visceral fat accumulation, increasing the risk of type 2 diabetes and cardiovascular disease. In Georgia, these risks often remain unrecognized due to the lack of targeted prevention and screening programs. This article discusses the physiological mechanisms underlying menopausal metabolic alterations, presents local epidemiological data, and outlines public-health strategies for early detection and prevention.
THE IMPORTANCE AND ROLE OF NON-INVASIVE PRENATAL TESTING (NIPT) IN THE PRENATAL SURVEILLANCE SYSTEM
The issues regarding the practical application of cf DNA testing are discussed. cf DNA is mainly used for screening chromosomal and monogenic aberrations. The advantages of cf DNA testing compared with combined screening (biochemical markers + ultrasound) should be noted, including detection rate, frequency of false-positive results, and positive predictive value. The benefits of amniocentesis compared with chorionic villus sampling (CVS) in cases of confined placental mosaicism (CPM) are demonstrated. The importance of chromosomal microarray analysis (CMA) in detecting microdeletions and microduplications, as well as in the genetic evaluation of abortuses and stillbirths, is emphasized. Additionally, the application of cf DNA testing in cases of congenital adrenal hyperplasia (CAH), autosomal dominant, autosomal recessive, and X-linked disorders, as well as for the determination of the fetal RhD genotype, is presented.
AI-BASED ALGORITHM ENCEVIS PERFORMANCE IN THE EPILEPSY MONITORING UNIT: A MULTIFACTORIAL ANALYSIS
Objective: To evaluate the performance of the ENCEVIS AI-based seizure detection algorithm in long-term EEG recordings and to identify seizure characteristics - specifically localization, rhythmicity, and duration - that influence detection sensitivity. Methods: This prospective study included 267 prolonged EEG recordings (>3 hours) collected from 2019 to 2023 at Khechinashvili University Hospital. Seizures were visually evaluated by experts, and onset zone, rhythmicity, and duration were defined. ENCEVIS detections were considered true positives if they occurred within 30 seconds before to 60 seconds after expert-defined seizure boundaries. Detection sensitivity was calculated and analyzed using multivariate logistic regression with interaction terms for rhythmicity × duration and localization × rhythmicity. Results: A total of 114 seizures were identified, of which 65 were correctly detected by ENCEVIS (overall sensitivity: 57.0%). Temporal lobe seizures were detected with the highest sensitivity (71.0%, p < 0.05), while generalized tonic seizures showed the lowest (35.1%). Rhythmic seizures had significantly better detection than arrhythmic seizures (71.4% vs. 22.7%, p < 0.0001). Peak sensitivity was observed for seizures lasting 38–68 seconds. In logistic regression, rhythmicity was the strongest independent predictor of detection (OR = 2.13), with a positive interaction observed between rhythmicity and seizure duration (OR = 1.61). Duration alone and localization alone showed limited predictive value. Significance: Seizure detection by ENCEVIS is primarily driven by rhythmicity and moderately long duration, particularly in temporal lobe seizures. Arrhythmic, short, and generalized tonic seizures remain underdetected, underscoring the need for algorithmic refinement. Enhancing detection performance for underrepresented seizure types will be essential for AI seizure detection model implementation in clinical practice.
THE IMPACT OF UNWANTED PREGNANCY ON THE DEVELOPMENT OF CHILDS MENTAL HEALTH
In the case of unwanted or unplanned pregnancy, the majority of women (18-40 years old) develop mental problems. Which in most cases leads to the development of certain types of mental, behavioral and cognitive problems in children aged 0-3 years. Studies confirm that the issue is quite relevant in Georgia and requires professional attention. Through the implementation of certain targeted health or social measures, it is possible to delay negative processes and take care of their improvement. In the direction of public health and the formation of a healthy population, unwanted pregnancy is one of the important psycho-social determinants. It also represents a severe stressor that negatively affects both the mental health of the mother and the mental development of the infant. The aim of the study is to determine how important a role the mother's predisposition to pregnancy and her subsequent well-being plays. In addition, the impact of the material situation on the mother's psyche in the case of a family income below the average, while it is necessary to mobilize quite large finances. The problem is discussed from a public health perspective and aims to raise awareness regarding these issues.
SONOGRAPHIC SHORT CERVIX - CLINICAL MANIFESTATION OF SUBCLINICAL INTRA-AMNIOTIC INFECTION: A COMPREHENSIVE REVIEW
A sonographic short cervix in the mid-trimester is a powerful predictor of spontaneous preterm delivery and may represent the only clinical manifestation of subclinical intra-amniotic infection or inflammation. This review examines the relationship between cervical shortening and intra-amniotic pathology, diagnostic approaches, treatment strategies, and long-term outcomes. Evidence demonstrates that 9-10% of asymptomatic women with sonographic short cervix (<25 mm) have microbial invasion of the amniotic cavity (MIAC), while sterile intra-amniotic inflammation occurs in an additional 10-22% of cases. Biomarkers including interleukin-6 (IL-6) and matrix metalloproteinase-8 (MMP-8) show promise for rapid diagnosis. Targeted antibiotic therapy with ceftriaxone, clarithromycin, and metronidazole has demonstrated success in eradicating intra-amniotic infection in selected cases, potentially allowing term delivery. However, the association with adverse neurodevelopmental outcomes, including cerebral palsy, underscores the importance of early recognition and intervention.
PERCEIVED CLIMATE-RELATED SKIN CHANGES AND SUN-PROTECTION BEHAVIORS AMONG ADULTS IN TBILISI, GEORGIA: A CROSS-SECTIONAL SURVEY-BASED STUDY
Adults in urban settings may experience skin changes related to climate and adjust their protection behaviors accordingly. This cross-sectional online survey of adults living in Tbilisi, Georgia (final sample n = 296), explored sun-protection routines, perceived climate-related skin changes and dermatology service use. The questionnaire assessed sociodemographic characteristics, dermatology visits and complaints, changes in sun-protection behavior over the past 5 years, perceived climate-related skin changes and interest in information on climate and skin. Most participants were middle-aged women; almost half had never visited a dermatologist. About two-thirds reported increasing their sun-protection routine, mainly using SPF creams, and 60% perceived climate-related skin changes, predominantly dryness, sensitivity, acne flares and pigmentary changes. In multivariable analyses, increased protection independently predicted perceived climate-related changes, while both perceived changes and frequent dermatology visits independently predicted greater protection. These findings suggest that climate-related skin concerns are common and that risk perception and dermatology contact may be important levers for strengthening preventive skin-health behaviors in a warming urban environment.
AWARENESS, KNOWLEDGE AND ATTITUDES TO CARDIOPULMONARY RESUSCITATION (CPR) IN GEORGIAN POPULATION
Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Bystander immediate cardiopulmonary resuscitation (CPR) is critical for increasing survival rates. The aim of study was to assess CPR awareness, knowledge, and attitudes as well as their correlation with regular first aid training in Georgian population. Methods: Data on CPR knowledge was collected from 572 volunteers residing in Tbilisi. SPSS (Statistical Package for the Social Sciences) 16.0 for analysis and Χ2 - Pearson's chi-squared test (p-value) for statistical significance were used. Results: Out of the study objects, 301 (52.6%) were familiar with CPR, while 271 (47.4%) had no information about it. Most volunteers 215/301(71.4%) gained CPR knowledge through first aid training, and 86/301 (28.6%) from other sources (TV, social media, educational booklets, media, etc.) Among those who received first aid training regularly (124/215 or 57.7%), 92% confirmed willingness for CPR performance. In contrast, among those who took first aid training once (91/215 or 42.3%), only 43% confirmed preparedness for CPR performance. Conclusions: The CPR awareness level in Georgian population is low. The most effective way to increase both awareness and willingness for CPR performance is the implementation of regular first aid training courses in all community settings.
THE STAGES OF DEVELOPMENT AND RISKS ASSOCIATED WITH SYPHILIS IN PREGNANCY AND CONGENITAL SYPHILIS
Syphilis is an infectious disease characterized by a chronic and relapsing course. It is primarily transmitted sexually. It can also be transmitted from mother to child during the pregnancy. Therefore, early detection of the disease is crucial to prevent complications that may arise from syphilis infection in pregnant women, which would consequently lead to fetal infection and the development of a range of pathological changes.
SEX DIFFERENCIES IN PATIENTS WITH GASTRIC CANCER IN GEORGIA, 2015-2022
The study aimed to estimate the sex-specific characteristics of invasive gastric cancer morbidity and mortality in patients diagnosed in Georgia between 2015 and 2022. We conducted cancer population registry-based study. Between 2015 and 2022, the age-standardized incidence rate (ASIR) of gastric cancer in Georgia decreased from 12.0 to 11.5 in men and from 5.9 to 4.3 in women. However, across all calendar years included in the analysis, ASIR was approximately twice as high in men as in women. During this period, the age-standardized mortality rate decreased from 10.5 to 7.3 in men and from 5.8 to 3.0 in women. No trend of stable reduction in morbidity and mortality was observed throughout the observation period. The univariate Cox regression analysis confirmed that men diagnosed with gastric cancer have a slightly higher risk of mortality than women, although multivariate analysis did not confirm that patient gender is an independent determinant of mortality. During planning preventive activities for gastric cancer, the disease gender characteristics should be considered.
IMPACT OF TOBACCO SMOKING ON RUN OF RHEUMATIC DISEASES
Introduction: The global prevalence of Rheumatic diseases is steadily increasing, presenting a significant public health concern. Among various environmental risk factors, tobacco use is one of the most strongly associated with the development and progression of autoimmune diseases. Smoking-related illnesses account for over 8 million deaths annually, with more than 7 million due to direct tobacco use and the remainder caused by exposure to second-hand smoke. In patients with Rheumatic diseases Smoking has been linked not only to the onset of diseases such as Rheumatoid arthritis and Systemic Lupus Erythematosus but also to increased disease severity, higher inflammatory markers, and reduced treatment efficacy. For instance, a population-based study found that current smokers with rheumatoid arthritis exhibited higher disease activity and lower health-related quality of life compared to non-smokers, while early smoking cessation was associated with improved outcomes. This contributes to a greater health burden through increased morbidity, diminished quality of life, and higher healthcare costs. Addressing tobacco use is therefore essential in the prevention and management of Rheumatic diseases. Aim of study: The study aimed to assess the impact of tobacco consumption on the prevalence and run of Rheumatic diseases, providing valuable insights into the role of smoking in the progression of these conditions. Materials and methods: Research was conducted in 2025 at “Solomed” Clinic in Batumi, Georgia, involving 131 patients with different Rheumatic diseases (82 women and 49 men). An anonymous survey was used to assess tobacco use and its impact on disease progression. Results: Among the 131 patients, 42% (n=55) were active smokers, 31.3% (n=41) passive smokers, and 26.7% (n=35) non-smokers. The highest prevalence of smoking was observed in the 55-65 age group. Rheumatic disease distribution by smoking status included Ankylosing Spondylitis (n=41), Psoriatic Arthritis (n=31), Rheumatoid Arthritis (n=26), Metabolic Arthropathies (n=14), Osteoporosis (n=8), and other joint diseases (n=11). Active smokers were predominantly male. A majority of patients 58.78% (n=77) identified as physically active. Most patients (87.8%, n=115) were receiving treatment for their rheumatic conditions, with 64.89% (n=85) on biological therapy. Notably, 87.1% (n=114) of respondents observed symptom improvement after quitting or attempting to quit smoking. Disease severity was highest among active smokers and lowest among non-smokers. When all groups were combined, 28.3% of patients had mild disease, 31.7% had moderate disease, and 40.0% had severe disease, indicating a clear trend of increasing severity with greater tobacco exposure. These percentages were obtained from data collected through a custom-designed questionnaire, patient anamnesis, laboratory findings, and treatment response, allowing a comprehensive assessment of disease severity across different levels of smoking exposure. Conclusion: Our study demonstrates that Rheumatic diseases generally require ongoing or long-term medical management, Tobacco use is more prevalent among older adults. The highest number of passive smokers also in this age group. The findings suggest a positive impact of smoking cessation on the run of Rheumatic diseases, highlighting the importance of strengthening preventive measures for this patient population. Disease severity was greatest among smokers and mildest among non-smokers. By our findings, every second individual is classified as an active smoker, every third individual as a passive smoker. Our results highlight the urgent need to raise awareness among patients about the harmful effects of tobacco use and the benefits of smoking cessation.
EFFECTS OF NICOTINE ON GLUTAMAT-GLUTAMINE CYCLE AND PURINE METABOLISM IN A MOUSE MODEL OF PARKINSON’S DISEASE
Parkinson's disease is a neurodegenerative disorder characterized by the progressive loss of dopaminergic neurons and metabolic imbalances. This study aimed to determine whether nicotine modulates MPTP-induced parkinsonism in mice. BALB/c mice were divided into four groups: control, nicotine-only, MPTP-treated, and MPTP+nicotine. Analysis of substantia nigra tissue revealed that MPTP caused dopaminergic deficits and disrupted glutamate and purine metabolism, while nicotine treatment normalized these alterations. In conclusion, nicotine exhibits a protective effect against glutamate and purine metabolic disturbances associated with Parkinson's disease.
SOME ASPECTS OF THE USE OF OSTEOMODIFIERS IN ONCOLOGY PATIENTS
During the use of the osteomodifier denosumab in oncology patients of various ages and diagnoses, a complication in the oral cavity-necrosis of the jaw bone was recorded in 3.5% of cases. No other changes and acute reactions in the oral cavity were detected against of taking the drug.
DIGITAL VERSUS CONVENTIONAL REMOVABLE DENTURES IN GERIATRIC PATIENTS: A COMPARATIVE LITERATURE REVIEW OF CLINICAL EFFICIENCY, MATERIAL BIOCOMPATIBILITY, AND PATIENT-REPORTED OUTCOMES
This literature review provides a comparative analysis of digital versus conventional fabrication methods for removable complete dentures, with a specific focus on their application in the geriatric population. The conventional workflow, while established, presents significant burdens for elderly patients, including numerous, lengthy appointments. Digital workflows, utilizing CAD/CAM (milling) and additive manufacturing (3D-printing), offer a profound advantage in clinical efficiency, reducing the fabrication process to as few as two or three visits. This review synthesizes recent systematic reviews and clinical trials to compare these modalities across three critical domains for geriatric care: (1) clinical efficiency and process benefits, (2) patient-reported outcome measures (PROMs), and (3) material science, specifically biocompatibility and suitability for high-risk patients. Evidence confirms the digital workflow is unequivocally superior in efficiency. Furthermore, the ability to archive the definitive prosthesis as a "digital duplicate" file represents a paradigm shift for providing rapid replacements for frail or institutionalized patients. While broad systematic reviews suggest patient satisfaction is often comparable between methods, high-evidence crossover trials where patients use both types report a significant preference for the fit, comfort, and retention of digital dentures. The most critical divergence, however, is in material properties. CAD/CAM milled PMMA demonstrates superior flexural strength, the lowest surface roughness, and significantly lower Candida albicans adhesion compared to conventional acrylic. Conversely, 3D-printed resins currently show the highest surface roughness and microbial adhesion. Furthermore, milled PMMA is the most hydrophilic, making it a physiologically targeted solution for geriatric patients with xerostomia. We conclude that while 3D-printing offers speed, the superior material properties of milled dentures make them the optimal clinical choice for high-risk geriatric patients.
CRITERIA FOR THE DIAGNOSIS AND TREATMENT OF SYPHILIS IN PREGNANCY AND CONGENITAL SYPHILIS
The increasing incidence of congenital syphilis over the past decades poses a serious public health problem. Consequently, great importance is placed on the diagnosis of syphilis in pregnant women and routine antenatal screening for the infection. Timely detection and adequate treatment of both the mother and the neonate are crucial for preventing a wide range of complications during pregnancy, as well as for the ultimate goal of eliminating congenital syphilis.
DIFFERENTIAL DIAGNOSIS BETWEEN VITILIGO AND OTHER SKIN HYPOMELANOSES
We present here comparative characteristics of vitiligo and the most common hypomelanotic skin conditions. Also, we describe clinical features of secondary leukoderma in patients with various forms of chronic dermatoses, skin infections, congenital diseases, and traumatic skin lesions. Criteria for differential diagnosis of vitiligo and other hypomelanotic skin conditions have been developed
DYSREGULATION OF THE RECEPTOR PROFILE OF MONOCYTES IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA
Chronic lymphocytic leukemia (CLL) is characterized by profound immune dysregulation, leading to an increased susceptibility to infectious complications. As key components of the phagocytic system, monocytes play an essential role in modulating innate immune responses. This study analyzed the expression of CD180 and TLR4 receptors on peripheral blood monocytes in 17 newly diagnosed CLL patients and 9 age- and sex-matched healthy controls. Using flow cytometry, we observed a significant reduction in CD180 expression in CLL patients (51.2±7.6) compared with healthy individuals (75.9±7.1; p=0.0273). TLR4 expression also showed a decreasing tendency in CLL patients (72.4±6.3 vs. 86.4±4.9 in controls), although the difference did not reach statistical significance (p=0.0877). These findings indicate impaired monocyte activation and altered inflammatory signaling in CLL, potentially contributing to increased susceptibility to infections and facilitating leukemic progression. The study highlights the importance of monocyte receptor deregulation in the immunopathogenesis of CLL and underscores the need for timely antimicrobial support in disease management.
Necrobiosis lipoidica is a rare, chronic, idiopathic granulomatous disorder of the skin, often associated with type 1 diabetes mellitus. Its exact etiology remains unknown; however, vascular disturbances involving immune complex deposition and microangiopathy are considered important contributing factors. Diagnosis is primarily clinical, although a skin biopsy may be performed to differentiate it from granuloma annulare, sarcoidosis, or necrobiotic xanthogranuloma. Management includes topical or intralesional corticosteroids for active lesions, wound care, and surgical excision for ulcers. Ulceration and scarring are common complications, and lesions should be monitored over time. We report a clinical case that highlights the importance of clinical recognition, dermoscopy, and histopathologic confirmation of necrobiosis lipoidica in patients with diabetes mellitus, facilitating early intervention and prevention of complications.
BROCQ’S PSEUDOPELADE DEVELOPED AFTER CHILDBIRTH – CLINICAL CASE
Pseudopelade of Brocq (PPB) or Brocq’s alopecia is an uncommon and somewhat enigmatic form of scarring (cicatricial) alopecia primarily the scalp. Occasionally isolated “islands” of hair persist within these patches, accentuating the irregular, “footprint in the snow” appearance commonly described in pseudopelade. This is a specific diagnosis reached after excluding known causes of patchy scarring alopecia (pseudopelade) such as lichen planopilaris and discoid lupus erythematosus.
Devergie’s disease (pityriasis rubra pilaris – PRP) is an idiopathic inflammatory, papulosquamous dermatosis. Clinically, it is characterized by disordered keratinization and the formation of hyperkeratotic follicular papules that coalesce into the orange-red plaques, between these areas the skin is not changed “islands of sparing” - are observed. Possible associations include infectious diseases, autoimmune processes, medication-induced reactions, and malignant neoplasms. The article describes a clinical case of Devergie’s disease. Patient S.E., 56 years old. 26.04.25, “Kani Clinic.” The patient complained of a generalized skin rash. General condition: satisfactory. On the trunk, upper, and lower extremities, numerous, separately distributed, orange-colored hyperkeratotic follicular papules were noted. On the extensor surface of the upper extremity, a solitary plaque was present.
Hypomelanosis of Ito (HOI), also known as pigmentary mosaicism, is a rare, sporadic neurocutaneous disorder characterized by linear hypopigmented patches distributed along the lines of Blaschko and involving at least two body segments. Cutaneous changes are typically evident at birth or in early childhood. HOI is marked by multisystem involvement, most commonly affecting the central nervous system and the musculoskeletal system. The diagnosis is primarily clinical and is based on recognizing the characteristic cutaneous morphology as well as identifying associated systemic manifestations such as intellectual disability, epilepsy, hypotonia, scoliosis, limb asymmetry, strabismus, coloboma, and dental anomalies. When necessary, diagnostic clarification may be supported by chromosomal studies, including karyotyping of peripheral blood lymphocytes or genetic analysis of fibroblasts obtained from affected skin. This article presents a clinical case of Hypomelanosis of Ito in a 6-year-old child who is a carrier of thalassemia, further highlighting the multifactorial nature of the condition and its diagnostic significance.
BULLOUS LICHEN PLANUS SECONDARY TO AUTOIMMUNE HYPOTHYROIDISM – CLINICAL CASE
Bullous lichen planus is a rare variant of lichen planus. It is characterized by vesicles or bullae, which usually develop in the context of pre-existing LP lesions. The clinical features of bullous lichen planus include typical lichen planus lesions, accompanied by the formation of bullae on the affected or perilesional skin. The clinical features of bullous lichen planus include typical lichen planus lesions, accompanied by the formation of bullae on the affected or perilesional skin.
ARTIFICIAL INTELLIGENCE IN DERMATOLOGY: CURRENT STATE, CHALLENGES AND FUTURE PERSPECTIVES
Artificial intelligence has become a crucial tool in modern dermatology, enhancing diagnostic accuracy for skin neoplasms, reducing overdiagnosis, and providing standardized assessments. CNN-based models perform at or above dermatologist level in detecting melanoma and other malignancies (AUC > 0.94). AI platforms such as PhotoFinder and Doctorium help decrease unnecessary biopsies by 20–30%, significantly enhances diagnostic yield, achieving a validated diagnostic accuracy of 90% or greater. AI is widely applied in dermoscopy, histopathology, and trichoscopy, enabling automatic structure recognition, mitotic count analysis, and classification of hair loss disorders. Despite its significant potential, challenges remain, including data heterogeneity, algorithm transparency, and ethical considerations. The future of AI in dermatology lies in multimodal models, real-time risk prediction, and the integration of locally developed Georgian AI systems into clinical practice.
WHEN AND FOR WHAT PURPOSES COMBINED ALLERGIC DIAGNOSTIC TESTING SHOULD BE EMPLOYED IN CHILDREN
In pediatric practice, the issue of allergic diseases has become particularly prominent in recent years. For the purposes of prevention and treatment of these conditions, the identification of allergens is of significant importance. The aim of our study was to assess the immunological status of children with allergic diseases. Quantitative levels of IgE were measured, and a comprehensive mixed allergen panel was evaluated. Result: An open observational study was conducted from 2022 to 2025 at the G.Zhvania University Clinic of Pediatrics, the study included 59 children aged 3 to 13 years. The highest IgE were observed in patients with recurrent bronchitis and bronchial asthma, in whom hypersensitivity to respiratory allergens was detected. In cases of allergic urticaria, where IgE levels were moderately elevated, sensitization was observed to plant pollens as well as animal dander. Patients with allergic rhinitis and conjunctivitis exhibited moderately increased IgE levels, with hypersensitivity primarily associated with seasonal allergens. Patients with normal IgE levels predominantly showed hypersensitivity to food allergens. Conclusion: The implementation of these findings in clinical practice will enable the rational and timely diagnosis of allergic diseases. From a cost-effectiveness perspective, it is preferable to prioritize the diagnostic assessment of allergens.
CLINICAL CASE: THE USE OF FEMORAL AND SCIATIC NERVE BLOCK COMBINATION IN PAIN MANAGEMENT AFTER TOTAL KNEE ARTHROPLASTY
Total knee arthroplasty (TKA) is frequently associated with significant postoperative pain, which can impair early rehabilitation and increase opioid consumption. Femoral nerve block (FNB) is widely used to manage anterior knee pain but may cause quadriceps weakness and does not reliably cover posterior knee innervation. The addition of a sciatic nerve block (SNB) may enhance analgesic efficacy by targeting posterior knee structures. However, concerns remain regarding potential motor deficits, including foot drop. This case report presents two patients who underwent unilateral TKA and received a combined femoral and sciatic nerve block after confirming full return of motor function, aiming to optimize postoperative analgesia while minimizing neurological risks. Unlike traditional protocols in which nerve blocks are performed preoperatively or immediately at the end of surgery, these cases utilized a delayed block technique - administering FNB and SNB after confirmation of restored foot motor function. This approach allows early detection of surgical nerve injury and reduces the risk of masking postoperative complications such as foot drop.
MODERN APPROACHES TO OSTEOPOROSIS REHABILITATION: ANALYSIS OF CONSERVATIVE TREATMENT EFFECTIVENESS
Osteoporosis is a major public health concern characterized by reduced bone mineral density, increased bone fragility, and a heightened risk of fractures. The condition is particularly prevalent among postmenopausal women and commonly presents with fractures of the femoral neck, spine, and shoulder. The underlying mechanism involves the loss of bone mass and disturbances in mineral homeostasis, leading to decreased mechanical strength of the skeleton. Management and rehabilitation remain significant challenges from both medical and socio-economic perspectives. Modern therapeutic approaches emphasize the integration of pharmacological treatment and rehabilitation strategies aimed at strengthening bone tissue, restoring functional capacity, and preventing complications. Physiotherapy, therapeutic exercises, balance training, and balneological interventions play a central role in improving mobility and overall quality of life. According to contemporary research, integrated rehabilitation programs — including ROPE-type resistance-reactive exercises, sensorimotor and balance training, physiotherapeutic modalities (such as magnetotherapy and electrotherapy), and balneotherapy — result in an average increase in bone mineral density, up to a 40% reduction in pain intensity, and a 23–30% decrease in fall risk. Studies also demonstrate that comprehensive rehabilitation significantly improves muscular strength, proprioception, and functional performance, thereby reducing the likelihood of fractures in high-risk populations. This article reviews modern rehabilitation approaches for osteoporosis, presents clinical examples, and highlights the crucial role of physiotherapy in disease management and prevention.
CLINICAL MANIFESTATIONS OF ALLERGIC DISEASES AND THEIR EPIDEMIOLOGICAL INDICATORS IN GEORGIA
The aim of the study was to study the epidemiological characteristics of various allergic diseases, including food allergy, atopic dermatitis, allergic rhinitis and bronchial asthma, in our clinics, according to the outpatient visit, in the children and adult population. As a result of the epidemiological study, the diagnosis of allergic diseases in the children's population: atopic dermatitis, food allergy, allergic rhinitis and bronchial asthma was based on the clinical picture of the disease. Patients were assessed using special standardized questionnaires. Great importance was attached to the symptoms of this population, where there is practically no laboratory test that would independently determine the presence of this allergic atopy. Thus, the significance of the impact of each factor and its relationship with morbidity in the population were analyzed. According to the data obtained, the proportion of controllable risk factors is high, which can serve as a basis for developing targeted and effective preventive measures for allergic diseases in the child population.
REPRODUCTIVE LOSSES OF THE FETUS IN MODERN OBSTETRICS-GYNECOLOGY AND REPRODUCTOLOGY
The issue of reproductive losses remains a firmly established and pressing concern in modern obstetrics–gynecology and reproductive medicine. Among obstetric pathologies, one of the least studied yet most significant due to the severity of its consequences is fetal antenatal loss, caused by genetic, endocrine, anatomical abnormalities, and infection-related changes. To this list have been added pathologic conditions associated with coagulation disorders, including congenital and acquired thrombophilia and the complications arising from it: recurrent pregnancy loss, gestosis, preeclampsia/eclampsia, premature detachment of a normally implanted placenta, Intrauterine Growth Restriction (IUGR), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), and Disseminated Intravascular Coagulation (DIC). Since hereditary thrombophilia represents a group of genetic disorders that promote thrombosis and contribute to a hypercoagulable state, and despite the fact that hereditary thrombophilia accounts for 20–30% of venous thromboembolism cases, universal screening does not exist; however, testing is essential in individuals with high-risk profiles (burdened family history of thrombosis, recurrent venous thromboembolism, pregnancy, or planned surgical intervention). Furthermore: Factor V Leiden mutation (resistance to activated protein C) is the most common form of hereditary thrombophilia (5–7% in Caucasians). A mutation in the F5 gene renders coagulation factors resistant to protein C. Prothrombin gene mutation (G20210A) has a prevalence of 2–3% in Caucasians. The F2 gene mutation increases prothrombin levels and the risk of hypercoagulation. Protein C deficiency is a rare form of hereditary thrombophilia (0.2–0.5%). Protein C inactivates factors Va and VIIIa; deficiency leads to excessive activity of clotting factors and thrombus formation. Protein S deficiency is also rare (0.1–0.7%). Protein S functions as a cofactor for protein C; its deficiency increases the risk of thrombosis. Antithrombin deficiency is another rare inherited thrombophilia (0.02–0.2%). Antithrombin inhibits thrombin and factors Xa, IXa, and XIa; deficiency leads to excessive activity of these factors and development of hypercoagulation. Rare forms include dysfibrinogenemia and hyperhomocysteinemia. Clinical manifestations involve venous thromboembolism (pulmonary embolism, deep vein thrombosis). Thrombosis may also develop in unusual sites—cerebral veins, or veins of internal organs. Thrombophilia is frequently associated with recurrent pregnancy losses at various gestational ages. It is noteworthy that hereditary thrombophilia tends to manifest at a younger age compared with acquired forms. Our aim was to discuss this issue: 1. By reviewing our own retrospective cases (women treated in our clinic during 2023–2025); 2.By summarizing the positive outcomes in the management of relatively complex cases and assessing treatment effectiveness: a. Based on the obtained results, abnormalities of the coagulation–vascular and fibrinolytic systems were identified, requiring treatment both during preconception planning and b. Throughout pregnancy, childbirth, and the postpartum period, with dynamic monitoring of hemostasis markers until full correction; 3. Mathematical modeling of the data was performed using the three-component inclusion–exclusion principle known in combinatorial analysis.
AUTOINFLAMMATORY DISEASES IN CHILDREN: NEW CHALLENGES
Autoinflammatory diseases are a significant challenge for pediatricians due to polymorphic clinical manifestations and complex pathogenesis. Autoinflammatory diseases are characterized by fever attacks of varying duration, and clinical manifestations such as abdominal pain, lymphadenopathy, polyserositis, arthritis, etc. Despite the variety of clinical manifestations, there are several common characteristics, similarities to clinical symptoms, which complicate the differential diagnosis of autoinflammatory diseases. Diagnosing autoinflammatory diseases such as PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) and FMF (Familial Mediterranean Fever) in children presents significant difficulties due to overlapping symptoms and variability of genetic mutations.
THE IMPACT OF A VEGAN DIET ON ORAL HEALTH
Veganism is a philosophy that seeks to eliminate the exploitation of animals for various purposes. During a vegan diet, patients have removed both meat, dairy products and eggs from their diet, which has a negative impact on both general and oral health. The oral health of 10 vegan patients (age range 25-45) was assessed by both clinical examination and orthopantomography. Each patient completed a dietary questionnaire over the past 48 hours. The study showed that 8 out of 10 patients had increased tooth sensitivity, 4 patients had erosive lesions in the area of ​​several teeth. The intensity of caries was 11.5. After studying their diet, it was determined that all patients had a deficiency of vitamin B12 and vitamin D. Cholesterol levels were low, but the content of organic acids, mono- and disaccharides was high, and vitamin C was also increased.