Georgian medical news最新文献

Background/introduction: Heart failure with reduced ejection fraction (HFrEF) represents a major global health burden, accounting for approximately half of all heart failure cases and characterized by high mortality, frequent hospitalizations, and progressive cardiac remodeling. Angiotensin-converting enzyme (ACE) inhibitors constitute a foundational cornerstone in the therapeutic management of HFrEF. Perindopril is a long-acting ACE inhibitor with a highly favorable safety profile; however, robust clinical data evaluating its specific efficacy in HFrEF cohorts remain scarce.

Aim: To evaluate the therapeutic efficacy, reverse cardiac remodeling, and clinical outcomes of perindopril versus sacubitril/valsartan in patients with HFrEF in routine clinical practice.

Methods: This retrospective cohort study included 214 HFrEF patients (LVEF<40%, mean age 64.8±11.0 years) treated at Tbilisi Heart Center between 2018 and 2025. Patients received GDMT and were divided into two groups: Perindopril (n=118) and Sacubitril/Valsartan (n=96). Clinical, echocardiographic, and biochemical metrics were assessed at baseline (Visit 1), 2-3 weeks (Visit 2), and 3-6 months (Visit 3). Primary endpoints included changes in LVEF and NYHA functional class.

Results: • Both treatment strategies significantly improved LVEF, reduced left ventricular dimensions (LVEDD, LVESD), and decreased pulmonary artery systolic pressure (ANOVA p < 0.01), with major reverse remodeling occurring between Visits 1 and 2. • LVEF increased from 34.3±3.9% to 41.3±7.4% in the perindopril group and from 30.8±5.2% to 33.8±8.1% in the sacubitril/valsartan group. • In multivariable linear regression analysis, treatment group (B=-3.170, p=0.004), baseline LVEF (B=0.381, p=0.005), and de novo heart failure (B=2.966, p=0.005) were independent predictors of follow-up LVEF. • Both cohorts showed significant longitudinal optimization in NYHA functional class (p<0.001). No significant changes in serum potassium or renal function were observed. One-year all-cause mortality did not differ significantly between groups (33.1% vs. 22.9%, p=0.103).

Conclusion: Perindopril therapy is associated with significant clinical improvement, LVEF recovery, and positive reverse cardiac remodeling in patients with HFrEF. Both perindopril and sacubitril/valsartan demonstrate comparable efficacy in reducing cardiac dimensions and optimizing NYHA functional status. Furthermore, perindopril maintains a favorable safety profile with low nephrotoxicity, confirming its potential as an effective therapeutic option in HFrEF management.

Maxillary transverse deficiency (MTD) in adults is difficult to treat due to partial or complete fusion of the midpalatal suture and the limited effectiveness of conventional orthodontic expansion techniques. Traditional methods often lead mainly to dentoalveolar changes and may cause tooth inclination, periodontal complications, and instability of treatment outcomes. The purpose of this study was to analyze morphometric changes of the maxillary complex in adult patients after treatment with standard and individualized MARPE appliances using cone beam computed tomography (CBCT) and to compare their effectiveness in achieving skeletal expansion. Adult patients with diagnosed maxillary transverse deficiency were treated with either a standard MSE-type Microimplant-Assisted Rapid Palatal Expander (MARPE) or a customized MARPE appliance developed using digital planning. CBCT examinations were performed before treatment and after the expansion phase as part of clinically indicated diagnostic and treatment monitoring protocols. Morphometric analysis included measurements of transverse parameters of the maxillary complex. Statistical analysis was conducted using paired t-tests, the Mann-Whitney U-test, and analysis of variance (ANOVA) with a significance level of p<0.05. Both appliances provided effective maxillary expansion and significant increases in transverse parameters of the upper jaw. However, the individualized MARPE demonstrated greater effectiveness compared to the standard MSE-type appliance in terms of intermolar width gain (4.8±1.5 mm versus 3.4±1.2 mm) and the frequency of midpalatal suture opening (85% versus 60%). CBCT enabled accurate three-dimensional visualization of skeletal changes and objective monitoring of treatment outcomes. The study provides a comparative evaluation of standard and customized MARPE appliances in adult patients based on CBCT morphometric data, emphasizing the advantages of individualized appliance design. Both MARPE systems are effective for treating maxillary transverse deficiency in adults. However, customized MARPE appliances provide more precise positioning, better anatomical adaptation, and potentially greater long-term stability of expansion results.

Background: Post-traumatic epilepsy (PTE) is a delayed complication of traumatic brain injury (TBI), but its biological predictors remain insufficiently defined. This study evaluated the dynamic profile of serum biomarkers of neuroinflammation, neuroimmune activation and neuronal injury after moderate TBI, as well as their predictive value for late post-traumatic seizures and PTE during 12 months of follow-up.

Materials and methods: This prospective observational study included 126 patients with moderate TBI, who were classified at 12 months into patients without late post-traumatic seizures (n=113) and patients with late post-traumatic seizures or PTE-spectrum outcomes (n=13). The biomarker panel included interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL) and high-mobility group box 1 (HMGB1), measured at 24-48 hours, 7-10 days, 30±7 days and 3 months after injury. ROC analysis was used to determine clinically informative thresholds, and a composite BioIndex was calculated from IL-6, HMGB1 and NfL.

Results: Patients who developed late post-traumatic seizures or PTE-spectrum outcomes had significantly higher levels of inflammatory, neuroimmune and neuroinjury biomarkers throughout follow-up. IL-6, TNF-alpha and IL-1beta remained elevated from the acute phase to 3 months; GFAP and NfL indicated persistent astroglial and axonal injury; and HMGB1 reflected sustained neuroimmune activation. Clinically significant thresholds were IL-6≥10 pg/mL, IL-1beta≥2.0 pg/mL, TNF-alpha≥7.5 pg/mL, HMGB1≥6.0 ng/mL and NfL≥35 pg/mL. BioIndex≥2 was associated with an increased 12-month risk of late seizures or PTE-spectrum outcomes.

Conclusion: Late post-traumatic seizures and PTE after moderate TBI are associated with a persistent biomarker signature of neuroinflammation, neuroimmune activation and glial-axonal injury. A simple BioIndex based on IL-6, HMGB1 and NfL may serve as a practical laboratory tool for early risk stratification and individualized follow-up after moderate TBI.

Background: Successful apicoectomy relies on effective bone healing at the resected root apex. Platelet-rich fibrin (PRF) and bone graft materials have been proposed to enhance regeneration, yet comparative evidence using both two-dimensional (2D) and three-dimensional (3D) imaging remains limited.

Objective: To compare bone regeneration following apicoectomy using PRF, PRF combined with Bio-Oss, and conventional technique, and to evaluate postoperative pain and edema.

Material and methods: Thirty patients undergoing apicoectomy were randomly assigned to three groups (n=10 each): PRF, PRF + Bio-Oss, and control (NaCl 0.9%). Linear defect measurements were obtained from standardized periapical radiographs, while volumetric analysis was conducted using CBCT segmentation software at baseline and 3, 6, and 12 months postoperatively. Regeneration percentage was calculated based on defect reduction. Postoperative pain (VAS 0-10) and edema (0-3 scale) were recorded for 7 days. Data were analyzed using paired t-tests and repeated-measures ANOVA (p<0.05).

Results: All groups showed significant defect reduction (p<0.001). PRF-based treatments achieved greater regeneration than control (2D: F(2,27)=12.41, p<0.001; 3D: F(2,27)=18.93, p<0.001), with the PRF+Bio-Oss group showing the highest percentages (2D: 82.6%±7.2; 3D: 90.4%±4.8). CBCT analysis demonstrated greater sensitivity and effect size than 2D radiography. No significant differences were observed in postoperative pain or edema.

Conclusion: PRF enhances bone regeneration after apicoectomy, especially when combined with Bio-Oss, without increasing postoperative morbidity. CBCT volumetric assessment provides superior evaluation of regenerative outcomes.

Aim of the study: To analyze current mental health problems, assess the prevalence of mental disorders, identify key determinants, and evaluate access to mental health care in different countries.

Material and methods: A narrative analytical review with a comparative synthesis of international and national data on mental health for 2019-2025 was conducted, including scientific publications, reports and estimates from the World Health Organization, Global Burden of Disease, World Mental Health, the Organization for Economic Co-operation and Development, and national data from Ukraine.

Results: Mental health significantly affects quality of life, productivity, and social stability. The COVID-19 pandemic, military conflicts, and economic instability have increased the prevalence of depressive, anxiety, and stress-related disorders worldwide. A high global burden of mental disorders and major regional differences were identified. The treatment gap remains especially high in low- and middle-income countries, where less than 10% of the population receives adequate care. In developed countries, coverage reaches 20-40%, although inequalities, long waiting times, and stigmatization persist. In Ukraine, the prevalence of mental disorders is estimated at 31-36% due to socio-economic instability and military conflict.

Conclusions: The findings highlight the need to integrate mental health services into primary health care, expand community-based support models, and implement comprehensive policies to reduce the global burden of mental disorders.

Myocardial injury is largely the result of oxidative stress, which alters the structure and function of the heart's cardiomyaceous and conduction cells. The purpose of this investigation is to determine the relative effects of Vitex agnus-castus, a plant that is known to contain anti-inflammatory and antioxidant properties, upon the histology of the hearts of mice exposed to oxidative stress. Histological examinations were performed on the cardiac tissues of experimental groups of mice that were subjected to oxidative stress, either with or without treatment with V. agnus-castus extract. Whereas oxidative stress alone caused cardiomyocyte swelling, interstitial expansion, loss of striation, Purkinje fiber degeneration, and early necrotic alterations, control groups showed normal architecture with maintained muscle striations and centrally placed nuclei. By preserving nuclear morphology, reducing cytoplasmic degeneration, and maintaining intercalated discs and striations, treatment with V. agnus-castus, on the other hand, lessened these changes, indicating reduction of both cellular and conduction system damage. These results are in line with recent observations that phytochemicals from V. agnus-castus stabilize cellular membranes and scavenge reactive oxygen species (ROS) to produce cardioprotective effects. In conclusion, V. agnus-castus supplementation considerably reduced the cardiac damage caused by oxidative stress in rats, indicating that it may be a natural cardioprotective agent and indicating the need for additional mechanistic and translational research.

Regional intra-arterial delivery of cytotoxic drugs into bronchial arteries (bronchial artery infusion - BAI; bronchial arterial chemoembolization - BACE; drug-eluting bead BACE - DEB-BACE) aims to maximize local tumor exposure while minimizing systemic toxicity. Recent single-center series suggest potential for symptom control, local tumor downstaging and conversion to resectability in locally advanced NSCLC, but evidence remains heterogeneous.

Objective: To systematically review and critically appraise the clinical and methodological literature (2015-2025) on selective bronchial artery chemoinfusion (BAI, BACE, DEB-BACE) for locally advanced NSCLC, focusing on anatomical/technical prerequisites, pharmacokinetic rationale, oncologic efficacy (RECIST response, conversion to resectability, PFS, OS) and safety.

Methods: A targeted literature search of PubMed/MEDLINE (supplemented with PMC, Scopus and Cochrane checks) was conducted for publications from 1 January 2015 to 1 December 2025. Primary clinical studies (prospective/retrospective cohorts), case series and systematic reviews reporting outcomes after BAI/BACE/DEB-BACE in NSCLC were included. Data extraction addressed cohort characteristics, technical parameters, objective response (RECIST 1.1), conversion to surgery, survival outcomes, and complications. The review followed PRISMA 2020 guidelines. Quality was assessed using adapted Newcastle-Ottawa Scale and JBI checklists. Due to methodological heterogeneity, a narrative synthesis with subgrouping by technique and clinical context was performed.

Results: Available evidence is largely retrospective and single-center, with heterogeneous technical protocols. DEB-BACE series (notably with CalliSpheres®) report favorable local control and objective responses (ORR up to ~50-60% in selected series), symptomatic relief (including hemostasis), and occasional conversion to radical resection, with acceptable safety and low rates of severe systemic toxicity. Comparative and combination studies (DEB-BACE±microwave ablation; DEB-BACE±PD-1 inhibitors) show encouraging signals for prolonged PFS/OS and improved local control but are limited by nonrandomized designs. Major complications are uncommon when superselective approaches and vascular mapping are applied. Quality assessment revealed moderate risk of bias in most studies (57.1%), with only 21.4% low risk.

Conclusions: BAI/DEB-BACE are promising regional strategies for selected patients with locally advanced or refractory NSCLC - especially for central, hypervascular tumors and for palliation of hemoptysis - and may be integrated into multimodal protocols in investigational settings. High-quality randomized, multi-center trials and procedural standardization are required to define their role relative to current systemic and combined modality treatments.

Cervical cancer is one of the leading causes of death from malignant neoplasms among women in Ecuador, a problem influenced by social and health determinants. The objective of this study is to analyze the trends and magnitude of inequalities in cervical cancer mortality among mestizo and indigenous women in Ecuador during the period 2010-2024. The study design is observational, retrospective, and ecological, using a time-series approach. A total of 6,090 deaths of women aged 20 years and older recorded by the National Institute of Statistics and Census (ICD-10 code: C53) were included. Age-standardized mortality rates were calculated. Joinpoint regression models were used to assess trends. Risk gaps were quantified using the mortality rate ratio (MRR) by comparing the three-year periods 2010-2012 and 2022-2024. Mestizo women accounted for 87.8% of deaths, and indigenous women for 6%. The trend among the mestizo population remained stable (APC: 0.8%), while the indigenous population increased (APC: 3.3%). A statistically significant increase was observed in the indigenous cohort aged 20 to 44 (APC 11.2%). In the 2010-2012 period, indigenous women aged ≥65 had lower mortality than mestizo women (MRR 0.64); however, in 2022-2024, a numerical trend toward risk reversal was observed (MRR 1.13; 95% CI: 0.82-1.55), without reaching statistical significance. Cervical cancer mortality in Ecuador follows divergent trajectories depending on ethnicity. The increase among young indigenous women and the shift in risk among older women highlight profound structural inequities in access to prevention.

A cutaneous horn is a conical keratinous projection that may develop on various parts of the body, most commonly in sun-exposed areas. These lesions are of considerable clinical significance because they may be associated with premalignant or malignant conditions. Histologically, cutaneous horns consist of hyperkeratotic material and resemble animal horns; however, they lack the central bony core characteristic of true animal horns. We present the case of a male patient with a giant cutaneous horn located on the skin of the right cheek. The lesion was managed by wide local excision followed by reconstruction of the resulting defect. Histopathological examination revealed an underlying malignant process, specifically squamous cell carcinoma. The standard treatment for a cutaneous horn is complete surgical excision with adequate margins, followed by histopathological evaluation to determine the need for further management and appropriate therapeutic strategies.

Background: Surgical treatment of tumours of the maxilla and hard palate is often associated with persistent functional and psychosocial impairment, making quality-of-life assessment an important component of rehabilitation evaluation. The objective of the present study was to assess the applicability and psychometric characteristics of an adapted bilingual (Russian-Kazakh) version of the UW-QOL v4.1 questionnaire in patients after surgical treatment of tumours of the maxilla, hard palate, and adjacent anatomical regions, as well as to analyse quality-of-life outcomes depending on the method of functional rehabilitation.

Materials and methods: A cross-sectional study included 104 patients after surgical treatment of maxillary and hard palate tumours. Translation and cultural adaptation were performed using forward translation, expert consensus, and pilot testing. Internal consistency, test-retest reliability, and construct validity were assessed using standard psychometric methods. Statistical analysis was performed using IBM SPSS Statistics 26.0.

Results: The overall Cronbach's α coefficient for the 14 questionnaire domains was 0.878, indicating high internal consistency. Test-retest reliability demonstrated strong correlations across all domains (r=0.904-0.983; p<0.001). The lowest quality-of-life scores were observed in the "Saliva" (41.3±21.2) and "Taste" (43.6±21.5) domains. Patients with advanced-stage disease and those who underwent multimodal treatment had significantly lower Physical Function and Social-Emotional Function scores compared with patients with early-stage disease and monotherapy (p≤0.001). Patients using obturator prostheses demonstrated significantly higher quality-of-life scores than patients without prosthetic rehabilitation (p<0.001). Financial limitations were the most common reason for refusal of obturator rehabilitation (55.6%).

Conclusions: The adapted bilingual version of the UW-QOL v4.1 questionnaire used in the present study demonstrated good psychometric properties and may be applied for quality-of-life assessment in patients after surgical treatment of maxillary and hard palate tumours in the Republic of Kazakhstan. The findings also highlight the importance of accessible functional rehabilitation in this patient population.