Georgian medical news最新文献

The working conditions of healthcare professionals are constantly exposed to excessive physical and emotional overload and stress. the dynamics of the level of job satisfaction play an important role, directly affecting labor efficiency. Aim: The paper aims to determine the level of satisfaction of medical staff with the state program of universal health care in Tbilisi and its regions. Methods: the study was conducted in outpatient and hospital institutions of Tbilisi and the regions, 207 randomly selected medical personnel aged 18 to 70 were interviewed. The interviewees were from the clinics in Tbilisi and the medical staff employed in both the outpatient and inpatient sectors of the "Regional Health Center Results: When asked whether there are factors that hinder the implementation of the public health program in terms of impeccable patient care, the vast majority of medical personnel employed in both sectors, 89% responded that they do exist and are due to the inferiority of the public health care program (exceptional diagnoses, lack of laboratory and instrumental research). On the question of which component, you think needs to be improved/changed following the universal healthcare program, most of the medical staff employed in the outpatient clinic (60%) consider the simplification of the payment procedures, while the hospital sector considers more awareness about the services and procedures. 40% of the medical staff employed in the outpatient clinic indicated that the relationship with private insurance companies is more useful and easier, and 71% of the medical staff employed in the hospital sector considered cooperation with the state program of universal health care to be preferable Conclusion: • Implementation of a universal healthcare system improved access to medical services and satisfaction of medical personnel. • Medical staff satisfaction is significantly higher in the hospital sector than in the outpatient sector. • The research outcomes can be used to increase the job satisfaction of doctors in medical institutions.

Objective: To investigate the spectrum of neurological disorders in children with juvenile localized scleroderma (JLS) on face and JLS without plaques on face and head.

Materials and methods: 156 children with JLS were examined were with a neurological examination MRI, EEG, genetic thrombophilia markers detection.

Results: Neurological disorders (ND) were found in 56 from 114 (49%) of the patients with scleroderma of head and face (LSH)(group1) and in 30% (13 from 42) with JLS without plaques on face (Group 2). Headaches were detected in Group 1 in 43,8%, in Group 2-in30%. In Group 1 other disorders were detected: epileptic seizures (in 25%), cranial nerve involvement (12.5%), stroke (5.3%), tics (5.3%), none of named in Group 2. Out of 56 children with ND changes on brain magnetic resonance imaging (MRI) were detected in 47 (84%). white matter lesions and less commonly gliotic changes in the periventricular area. Electroencephalography (EEG) monitoring revealed typical patterns of epileptiform activity in the majority of cases. These three cases of ischemic stroke in children with LSH are the first to be presented. All patients with stroke were diagnosed with genetic thrombophilia, two had cerebral vascular malformations, and one had antiphospholipid syndrome.

Conclusion: Our data suggest that sclerodermic vasculopathy, cerebral vascular anomalies and genetic thrombophilia are rick factors for stroke in children with LSH. Mandatory MRI angiography and screening for genetic thrombophilia could identify risk group for stroke in children with LSH.

This study aims to summarize the evidence of the effectiveness of xylitol toothpastes with a focus on caries, namely on its prevention and reduction. Materials and methods: A thorough literature review was performed after conducting an electronic search through Medline, PubMed (Central), Scopus, Web of Science (Scielo), Google scholar, and the Cochrane Library (from 2000 to November 2022) to identify studies relevant to the effectiveness of xylitol toothpastes in caries prevention. Results: The number of studies that have been found in the literature to meet the criteria for inclusion in this article has been limited. Number of studies have analyzed the effect of xylitol on vehicles such chewing gums, gummy bears, lozenges or candies and not on toothpastes. Eight papers have been found that have met the criteria for inclusion in this article so that their results could be compared and discussed. The results of these studies regarding the effectiveness of xylitol toothpastes in oral health were quite convenient Conclusion: Positive proven properties of xylitol such as: biocompatibility with oral tissues, anti-caries effect, antibacterial effect, demineralization inhibitor and remineralization enhancer, makes xylitol an effective caries preventive and cariostatic agent and it should be part of a comprehensive strategy to prevent caries. Clearly can be concluded that xylitol should be consider as the most suitable sugar substitute in toothpastes.

Background and objectives: The prevalence of osteoporosis among patients with rheumatoid arthritis (RA) in the Duhok governorate of Iraqi Kurdistan underscores a significant health concern that intersects autoimmune and bone health. The present study aimed to assess the prevalence of osteoporosis among patients with rheumatoid arthritis (RA) in the Duhok governorate.

Methods: Detailed questionnaire to collect demographic data, essential for identifying factors influencing BMD, such as age, sex, and lifestyle were used. Participants then underwent Dual-energy X-ray Absorptiometry (DXA) scans, a precise imaging technique for measuring BMD.

Results: The study involved middle-aged adults with an average age of 57.6 years, primarily females (91.5%), who had rheumatoid arthritis (RA) for about 15 years. Most participants were non-educated (71.5%) and lived in urban areas (77.1%). The majority worked in moderately heavy jobs (58.6%) and were married (98.5%). Most patients did not engage in exercise (84.3%), were non-smokers (77.1%), and alcohol-free (100%). Nearly half had a family history of RA, and all were tuberculosis-free. Clinically, most patients were obese, with 65.7% having comorbidities like hypertension and diabetes. A significant proportion tested positive for rheumatoid factors (74.3% for Rheumatoid factor and 84.3% for Anti-CCP) but were negative for DAS28-ESR. None had subcutaneous nodules, erosions, or joint surgeries. Regarding treatment, 65.7% used one DMARD, while 34.3% used two, and only 5.7% were on biologics; 80% also used corticosteroids. Osteoporosis was prevalent, with 80% showing signs (34.2% with osteopenia and 45.8% with osteoporosis).

Conclusion: Such efforts should focus on integrating routine bone health evaluations into RA care protocols, necessitating collaborative endeavors among rheumatologists, endocrinologists, and primary care professionals. This interdisciplinary model aims not only at early diagnosis but also at formulating comprehensive management plans tailored to the unique needs of this demographic within Iraqi Kurdistan's healthcare framework.

Intraoperative blood loss management is a critical concern in orthopaedic surgeries, particularly in trauma and complex elective procedures. Traditionally, allogeneic blood transfusions have been used to manage significant blood loss, but they carry risks such as transfusion reactions, infections, and increased healthcare costs. Cell salvage, or autotransfusion, offers a safer alternative by collecting, processing, and reinfusing the patient's own blood during surgery. This article explores recent trends in the use of cell salvage in orthopaedic trauma and elective surgeries, highlighting its growing adoption in high-blood-loss procedures such as pelvic fractures, long bone injuries, and revision arthroplasties. We discuss the indications, including use in patients with rare blood types, religious objections to donor blood, and pre-existing anaemia. The advantages of cell salvage, such as reducing dependency on allogeneic transfusions, minimizing transfusion reactions, and providing cost-effectiveness, are weighed against its limitations, including high initial costs, contraindications in certain procedures, and the need for specialized training. Recent advances in cell salvage technology, which enhance the safety and efficiency of the process, are also examined. As orthopaedic practices evolve toward more patient-centered, cost-effective care, the role of cell salvage is expected to grow, making it a valuable tool in modern blood management strategies.

Background: Asthma is a prevalent chronic respiratory disease that significantly impacts the quality of life. Genetic factors, particularly single nucleotide polymorphisms (SNPs), play a crucial role in asthma susceptibility. This study investigates the genetic determinants associated with asthma in the Kazakh population, focusing on SNPs within the ACTN3 and TSBP1 genes.

Materials and methods: A case-control study was conducted involving 600 participants, with 300 diagnosed with asthma and 300 healthy controls. Participants were recruited from 17 regions across Kazakhstan. Genomic DNA was extracted, and 120 SNPs were selected for analysis. Genotyping was performed using the QuantStudio 12K Flex Real-Time PCR System. Statistical analyses included the Mann-Whitney U test, χ2 tests, and calculation of odds ratios (OR) to evaluate the association between SNPs and asthma.

Results: Significant associations were found between asthma and two SNPs: rs540874 in the ACTN3 gene and rs3132954 in the TSBP1 gene. The G allele of rs540874 (MAF 0.71 in cases vs. 0.30 in controls, p-value = 4.78×10^-14) and the G allele of rs3132954 (MAF 0.54 in cases vs. 0.10 in controls, p-value = 1.33×10^-12) were associated with increased asthma susceptibility. The findings suggest a potential protective role of the A/A genotype in asthma.

Conclusion: This study identifies significant genetic markers associated with asthma in the Kazakh population, highlighting the complex interplay between genetic and environmental factors in the disease's pathogenesis. The results contribute to the understanding of asthma's genetic underpinnings and may inform the development of personalized medical interventions tailored to genetic profiles, advancing the field of precision medicine for asthma management.

Tantalum, known for its superior mechanical properties and biocompatibility, has revolutionized the field of acetabular reconstruction, especially in revision total hip arthroplasty (rTHA). This review explores the clinical indications, biomechanical and biological properties, benefits, risks, and outcomes associated with tantalum acetabular components, particularly in managing complex cases of acetabular deficiencies. Extensive research has highlighted tantalum's ability to promote osseointegration, provide high survivorship rates, and maintain mechanical stability even in the most challenging cases, such as pelvic discontinuity and severe bone loss. However, challenges remain, including high costs and the need for long-term studies in primary total hip arthroplasty (THA). This article aims to provide a comprehensive overview of tantalum's current role in THA, discussing the potential for broader applications in primary surgeries and the implications of its high cost on healthcare systems.

Rotation advancement flaps are a challenge for dermatosurgery and in particular the severe clinical cases, mainly affecting skin tumors in the facial area or the so-called ˝high risk areas˝. The proximity of these areas to important vital structures (such as nerves and blood vessels) also determines the need for more precision when performing this type of manipulation. Teamwork and preoperative planning are crucial and provide a number of advantages in terms of the timely achievement of the therapeutic endpoints. We present two cases of patients with squamous cell carcinomas in the periocular and periorbital areas treated by rotation advancement flaps. The problems that may arise within these interventions and the prerequisites for the latter to be successful are discussed.

Background: The lateral indirect decompression shows many advantages over the posterior approach for patients with low-grade spondylolisthesis or mild canal stenosis. While the minimally invasive surgery - transforaminal lumbar interbody fusion (MIS TLIF) was considered a favourable approach for most surgeons, it can also archive nerve release without exposure, especially with the use of intraoperative neuromonitoring which provides safer and fewer complications.

Materials and methods: From 2022 to March 2024, 20 single-level lumbosacral spondylolisthesis was performed MIS TLIF technique, in which, the superior-articular process was removed only to enlarge the Kambin's triangle without exposure to nerve structure. Intraoperative neuromonitoring was followed in every single step during surgery. Patient information was recorded during pre-, intra-operation, and follow-up at 6- and 12-months post-operation; we also collected demographic data, operation time, blood loss, VAS, ODI, modified MacNab criteria, radiographic evaluation including x-ray and MRI pre-, post-operation, and complications.

Results: 20 patients were followed up for more than 12 months. Mean age: 52,1 and mean follow-up 15,2 months. VAS back pain: 7,4 preoperatively and 0.8 at the final. VAS of leg pain was 7,1 preoperatively and 0,9 at the final. ODI was 52,4% preoperatively and 15,6% at the final. The mean operation time is 80,7 mins, blood loss is less than 100 ml. The average ambulation is 1,2 days, and the hospital stay is 4,7 days. MIS TLIF was associated with a very good reduction of spondylolisthesis, an increase in disc height (+6 mm), foraminal height (+3,1 mm), and segmental lordosis (+4,8°). The correction to normal of the listhesis was 85%. Pelvic parameters were not significantly changed. According to the modified MacNab criteria: 75% excellent, 20% good, and 5% fair. There was no complication was recorded.

Conclusions: The indirect decompression using MIS TLIF seems to be a safe, effective, and favourable technique in management for patients with single-level lumbosacral spondylolisthesis.

This study analyzes Emergency Medical Services (EMS) call trends and demographic changes from 2020 to 2024. During this period, a total of 2,469,283 EMS calls were registered, with sharp increases in 2021 and subsequent stabilization in later years. The number of daily calls rose by 52% in 2021 compared to 2020, with smaller growth in 2022 and 2023. A notable decline of 12.7% was observed in the first half of 2024. Response times also lengthened across the study period, increasing from 15.05 minutes in 2020 to 16.56 minutes in 2024. Time spent from request to completion decreased initially in 2021 but increased again in 2023 and 2024, with the longest average time of 1:16:46 in 2024. The study also found that call patterns fluctuated by day of the week, with Mondays consistently showing the highest call volumes and Fridays the lowest. Gender analysis revealed that both the male and female populations grew, with men increasing by 80.6% and women by 61.1% between 2020 and 2023. Although women initially outnumbered men, the gender gap narrowed over time. The 7-18 age group saw the most significant growth, especially in 2021-2022. The findings highlight a significant strain on EMS services due to increasing demand and worsening response times, exacerbated by the COVID-19 pandemic. These insights can guide resource allocation and service improvements to meet the growing healthcare demands.