COMPARISON OF THE OSCILLOMETRICALLY MEASURED AORTIC PULSE WAVE VELOCITY, AUGMENTATION INDEX AND CENTRAL SYSTOLIC BLOOD PRESSURE BETWEEN PATIENTS WITH ACUTE CORONARY SYNDROME AND CHRONIC CORONARY SYNDROME

Recent studies have revealed a strong association between Coronary Artery Disease (CAD) severity and arterial stiffness parameters, such as Pulse Wave Velocity (PWV). The majority of studies mainly using carotid-femoral PWV (cfPWV) or brachial-ankle PWV (baPWV). The emerging data have indicated that oscillometrically PWVao proved to be an independent marker of atherosclerotic cardiovascular disease (ASCVD), as well. The main goal of the present study has been to compare the oscillometrically measured parameters of aortic stiffness between patients with Acute Coronary Syndrome (ACS) and patients with stable ischemic heart disease (SIHD). In 100 patients with Acute Coronary Syndrome (Group 1) and 91 patients with Chronic Coronary Syndrome (Group 2) arterial stiffness was assessed by oscillometrically measured complex arterial function. The highest strength of the association revealed between Aortic Pulse Wave Velocity, PWVao (m/s), and incidence of Acute Coronary Syndrome (ACS) with Odds Ratio (OR) of 9.41; 95% CI (4.86, 18.2). Next was Augmentation Index, AIx (%) with OR=5.11; 95% CI (2.65, 9.86), and last Central Systolic Blood Pressure SBPao (mmHg) with OR=3.15; 95% CI (1.63, 6.1). An oscillometrically measured parameters of arterial stiffness, such as Aortic Pulse Wave Velocity (PWVao), Augmentation Index (AIx), and Central Systolic Blood Pressure (SBPao) may be useful in terms of early risk stratification and prevention of Acute Coronary Syndrome (ACS).

ASSESSMENT OF EFFECTS OF NON-FUNCTIONAL OVERREACHING AND OVERTRAINING ON RESPONSES OF SKELETAL MUSCLE AND CARDIAC BIOMARKERS FOR MONITORING OF OVERTRAINING SYNDROME IN ATHLETES

The aim was to study the effects of non-functional overreaching and overtraining on responses of biomarkers of the skeletal muscle cell (CK-NAC) and cardiomyocyte injury (cTnI and CK-MB) and their use in monitoring OTS. In 43 athletes with non-functional overreaching (NFO)/overtraining syndrome (OTS) and 40 athletes without NFO/OTS -control athletes (CA) off-season measurements of creatine kinaze (CK-NAC and CK-MB) were performed, followed by peak-season evaluation of the dynamic of CK-NAC, CK-MB and cardiac troponin I (cTnI) changes. CK and cTnI levels were obtained 24 hrs before the strenuous exercise appropriate to the sport-specific peak-season intensity, immediately after completion of the work-load, after 6, 48, and 72hrs. Baseline and post-exercise clinical assessment and echocardiography were performed in 6 and 48 hrs after strenuous session. Similar rising trend of CK-NAC, CK-MB, and cTnI levels was observed immediately after exercise, reaching peak values after 6 hours in all athletes, though, significantly greater in NFO/OTS athletes than in controls. After 48 hours of recovery in athletes with NFO/OTS CK-NAC, CK-MB, and cTnI values were significantly higher than on entry, showing slower recovery. CK-NAC fell within the "possible overtraining and muscle damage" levels in OTS athletes, even after 72 hours of recovery. Most of the athletes noted continuous trauma during game/combat contact events, though, mostly recovered after 48 or 72 hours. Two year follow-up showed no signs of full recovery in the OTS athletes. Echocardiography didn't reveal any sustained alterations of systolic and diastolic functions, or clinically threatening myocardial damage, only minor diastolic changes due to adaptation to the post-exercise haemodynamic. Elevated values of cardiac markers after strenuous exercise can be linked to increased cellular permeability and cardiac troponin leakage, amplified by oxidative stress existent in OTS athletes. In our study sport-specific intensive exercise caused mild injury to skeletal muscle and transient increase of the CK-MB and cTnI, without irreversible pathophysiological and clinical consequences, suggesting mostly benign cardiac involvement, though amplified by existent oxidative stress in athletes with OTS. Monitoring responses via alterations of biochemical parameters can be helpful to guide athletic training, and prevent OTS or interrupt NFO to OTS progression.

CARDIOVASCULAR EVENT ASSESSMENT IN PATIENTS WITH NONOBSTRUCTIVE CORONARY ARTERY DISEASE UNDERGOING DUAL ANTIPLATELET TREATMENT

The aim of our study was to learn the differences in baseline presentation between NObCAD and obstructive coronary artery disease (ObCAD) subjects, to compare the likelihood of several clinical outcomes and the rate of primary endpoints between this groups. Out study included 165 patients: 115 patients with NObCAD ACS, 50 - with ObCAD ACS. Inclusion criteria: age >18 year; Presence of any atherosclerotic stenosis greater than 20% but less than 50% in the left main coronary artery, and greater than 20% but less than 70% in any other major epicardial coronary artery. Рatients with NObCAD ACS were randomly assign in an 1:1 ratio in 2 group: Group A (n=55) received dual antiplatelet treatment with aspirin 100-160 mg once daily and clopidogrel 75 mg once daily for three months. Group B (n=60) received only aspirin 100-160 mg once daily for three months. 50 patients with ObCAD ACS entered in group C - controlled group, patients were treated according appropriate treatment guidelines. Clinical, demographic and treatment data were investigated. Demographic variables included age and gender. Comorbidities included smoking, diabetes, hyperlipidemia, hypertension, obesity, and prior history of heart disease (angina, heart failure, myocardial infarction, coronary artery bypass grafting, and percutaneous coronary intervention), renal and liver disease. ECG changes and initial laboratory data were recorded. Laboratory analyses: CBC, urine test, serum lipid profile, fasting blood glucose and HbA1C, creatinine and eGFR, liver enzymes were provided. All patients underwent coronary angiography. Data describing patient management included use of β-blockers, aspirin, ACE inhibitors or angiotensin receptor blockers, lipid-lowering agents. We categorized each patient by CAD extent. To accomplish this, we categorized each patient by CAD severity in a single, double, or triple-vessel distribution. Follow-up evaluations were performed at one, two and three months and 1 year. At these visits was assessed primary endpoints - MACE (Major adverse cardiac events): 1year hospitalization for Myocardial infarction or other cardiovascular causes after index angiography, cardiovascular death, revascularization, survival. We studied type and frequency of bleeding during treatment and follow up period. After data assessment we can tell, that the combination of clopidogrel and aspirin was not significantly more effective than aspirin alone in reducing the rate of myocardial infarction, but there was significant difference between groups regarding the CVD event rates, revascularization frequency and bleeding rate.

WEB-BASED 5-DIMENSIONAL ELECTRONIC PORTFOLIO (5DEP) AS A COMPETENCY-BASED ASSESSMENT TOOL IN POST-GRADUATE MEDICAL TRAINING

Background. New challenges of permanently changing context of healthcare system requires new methods of medical education and new assessment tools, as well. Competency-based Medical Education (CBME), framework which has been adopted as a new approach in medical education, needs appropriate assessment tool such as portfolio. Portfolio is learner-centered assessment instrument which evaluates learner’s progression towards outcomes and enables both residents and teachers to engage in a process of learning through assessment. Objective. In this paper we aim to share our successful experience of an effective use of web-based 5-Dimensional Electronic Portfolio (5DeP) as an assessment tool in the Pilot Group. Methods. Pilot Group of sixteen residents (six first year residents of Obstetrics/Gynecology and ten first year residents of Internal Medicine. Tbilisi State Medical University Institute of Postgraduate Medical Education and Continuous Professional Development) and twelve mentors (four Obstetrics/Gynecology mentor and eight Internal Medicine mentors) reported some feedback about 5-Dimensional Electronic Portfolio (5DeP) as a new assessment tool. Results. Feedback about 5-Dimensional Electronic Portfolio (5DeP) as a new assessment tool from mentors and students demonstrated efficiency of the program. It enables assessment within a framework of transparent and declared criteria and learning objectives; provides a model for lifelong learning and continuing professional development; increases competence in a wider context with benefits to both professional and personal roles; improves organizing skills. Conclusions. 5DeP have been recognized as an extremely effective assessment tool.

SYSTEMIC OXIDATIVE STRESS AS A SURROGATE OF CORONARY ATHEROSCLEROTIC PLAQUE INSTABILITY AND RUPTURE PREDICTOR

Background. Oxidative stress is crucial in developing broad spectrum of diseases, including atherosclerosis and related life-threatening conditions, such as acute coronary syndrome (ACS) mainly caused by atherosclerotic plaque vulnerability. Objective. To clarify the relation between oxidative stress and plaque instability we decided to compare oxidative profiles of patients with acute coronary syndrome (ACS) and with chronic coronary syndrome (CCS), evaluated at admission to the coronary care unit (CCU) of LTD Clinic-LJ (Kutaisi, Georgia) in April 2018 - June 2019, who underwent successful primary percutaneous coronary intervention (PCI). Methods. 191 patients were enrolled (100 patients with ACS in Group 1 and 91 patients with CCS in Group 2) into the study. Using the CR3000 FORM PLUS (Callegari Srl, Catellani Group, Italy) – Callegari Point of Care instrument we evaluated free oxygen radical test (FORT), free oxygen radicals defense (FORD), calculated REDOX Index and the overall Profile of oxidative stress. Results. The mean/median concentration of Free Oxygen Radicals was significantly higher in the patients with ACS (404.37±9.83 Fort units/2.36 mmol/l H2O2 eq. vs 282.34±9.83 Fort units/2.36 mmol/l H2O2 eq., p<0.0001). Significant correlation was found between advanced oxidative stress and acute coronary syndrome (OR 14.42 95% CI (7.08-29.4), RR 3.26 95% CI (2.31-4.60) with high diagnostic characteristics (sensitivity of 82% and specificity of 92.3%; positive predictive value of 92% and positive likelihood ratio of 11). Conclusion. Oxidative stress is crucial in life-threatening acute coronary events. Measurement of overall oxidative stress profile, as a surrogate of plaque instability and rupture predictor, could help the clinicians in risk stratification and prevention of acute coronary syndrome (ACS).

IMPLICATION OF RELATIONSHIP BETWEEN OXIDATIVE STRESS AND ANTIOXIDANT STATUS IN BLOOD SERUM

Aim of the study was to examine the relationship between oxidative stress and overtraining syndrome in athletes by evaluation in serum oxidative and antioxidant status. In 43 athletes with non-functional overreaching (NFO)/overtraining syndrome(OTS) and 40 athletes without NFO/OTS -control athletes (CA), diacron-reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) in serum, as well as ratio of d-ROMs and BAP test measurements - marker of oxidative stress, were assessed. Baseline data collection performed in both groups of athletes - with NFO/OTS and CA, followed by data collection in athletes with NFO/OTS after 28 days of rest. In athletes suspicious for OTS all measurements were performed after 2 more months of rest. Results of the study showed higher baseline d-ROMs in NFO/OTS athletes than in athletes without NFO/OTS, whereas antioxidant potential in CA was significantly higher, than in NFO/OTS athletes, After 28 days of rest there was significant decrease in d-ROM values in both: athletes with NFO and with OTS, as well as normalization of antioxidant status in athletes with NFO. Total 3 month of rest showed improvement in the oxidative status of athletes with OTS, reaching normal values, though antioxidant status remained without significant improvement, showing subnormal BAP values and decreased BAP/d-ROM ratio. The results demonstrate increased oxidative stress in overtraining state, creating disbalance between d-ROM production and antioxidant capacity. Thus, prolonged imbalance between oxidant production and antioxidant protection via attenuation of antioxidant capacity can be a cause of overtraining in highly trained athletes. In this study most frequently NFO and OTS were seen in wrestling, which needs further investigation and regular medical monitoring.

THE EFFECTS OF NON-FUNCTIONAL OVERREACHING AND OVERTRAINING ON AUTONOMIC NERVOUS SYSTEM FUNCTION IN HIGHLY TRAINED ATHLETES

Aim of the study was to compare the ANS functioning, as measured by heart rate variability (HRV), in athletes with non-functional overreaching (NFO) and overtraining syndrome (OTS) and in athletes without NFO/OTS. In 43 athletes with NFO/OTS, 40 athletes without NFO/OTS, as well as in 35 sedentary subjects the ANS function was evaluated with the Autonomic Balance Test, based on the HRV analysis of resting heart rate recordings. Results of the study show lower HRV and lower vagal influence along with increased sympathetic cardiovascular control in athletes with non-functional overreaching and particularly in athletes with overtraining, than in highly trained athletes without NFO/OTS. "Stress Response" in athletes with NFO, as well as in some athletes with OTS, showing sympathetic dominance, considered as a sign of physical or mental fatigue and chronic stress, whereas "Total Autonomic Dystonia" in most of the athletes with OTS (67%) reflects more advanced stage of maladaptation associated with depressed regulatory function of the ANS, both sympathetic, as well as vagal influences. Most frequently NFO and OTS were seen in wrestling, which needs further investigation and regular medical monitoring. Thus, results of the study show progression of autonomic imbalance and depression of regulatory function of the autonomic nervous system in athletes with OTS. The cardiac autonomic imbalance observed in overtrained athletes implies changes in HRV and therefore would consider that heart rate variability may provide useful information in detection of overtraining in athletes and can be a valuable adjacent tool for optimising athlete's training program as well as for timely diagnosis and prevention of progression of NFO/OTS.

HYPOGENESIS OF RIGHT LOBE OF LIVER ACCOMPANIED BY PORTAL HYPERTENSION AND ESOPHAGOGASTRIC VARICEAL BLEEDING; A RARE ANOMALY: A CASE REPORT

Hypo-agenesis of the right lobe of the liver is an extremely rare finding. It is defined as the complete or partial absence of liver tissue on the right side without previous disease or surgery. It is usually an incidental finding. A 32-year-old female patient came to Emergency Department of TSMU the First University Clinic 22.10.2015 with an initial diagnosis of upper gastrointestinal bleeding. Her medical history showed no previous diseases of the liver or episodes of hemorrhage. Dizziness, nausea, vomiting with red blood, melena was presented on admission. Esophagogastroduodenoscopy revealed III degree varicose of veins from middle part of the esophagus to cardiofundal part of the stomach. Hemorrhage was observed from cardial part of the stomach. Control of bleeding was not achieved endoscopically. Sengstaken-Blakemore tube was used to stop bleeding temporarily. Computed tomography with angiography was performed. Right lobe of the liver was presented with VII and VIII segments. Medial edge of the left lobe of the liver is located near the spleen. Liver parenchyma is homogenous. No thrombosis of the portal or hepatic veins was revealed. Gallbladder was dislocated laterally and cranially without pathological changes. Extra- and intrahepatic biliary ducts were not dilated. There was colonic interposition between the liver and diaphragm. Diagnosis was established - hypogenesis of right lobe of liver, atrophy-hypertrophy complex, portal hypertension, varicose of the veins of the esophagus and cardiofundal part of the stomach, hemorrhage from variceal vein of the cardial part of the stomach, acquired coagulation factors deficiency, functional hypersplenism, posthemorrhagic anemia. In our case there was congenital hypogenesis of the right lobe of the liver. Five months follow-up showed no recurrent bleeding.

[Effects of combined administration of ripronat and rotavit royal on the working capacity of the young football players]

The goal of the study was evaluation of the impact of the pharmaceutical preparations Ripronat and Rotavit Royal on the physical working capacity and psychomotor performance of the young football players during their basic preparatory period of physical conditioning. Blinded placebo controlled study was performed on 50 male football players (mean age 19,8 ± 3,2 years). The football players were divided into three groups: study group (n=30), placebo group (n=10) and control group (n=10). Study group in turn were divided in two subgroups: subgroup A (n=15, receiving ripronat and rotavit royal) and subgroup B (n=15, receiving only ripronat). In all groups following tests were performed before and after four weeks of the medical administration: 1.Watt max bicycle test. 2. Wingate cykletest. 3. Psychomotor performance including reaction time and relaxation abilities. Results of our study allow us to conclude that ripronat increase the aerobic capacity and psychomotor performance of football players, and it would be recommended for administration during early stages of training, when main emphasis is made on aerobic performance.

Antibacterial therapy of acute infectious exacerbation of chronic obstructive pulmonary disease

This article reviews the role of antibiotic therapy in the management of patients with acute infectious exacerbation of chronic obstructive pulmonary disease (COPD). Papers relevant to the issue are included in the review. Current antibiotic therapy of acute infectious exacerbation of COPD is directed at the most common pathogens, including Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Mild to moderate exacerbations of COPD are usually treated with broad-spectrum antibiotics such as doxycycline, trimethoprim-sulfamethoxazole and amoxicillin-clavulanate potassium. Treatment with augmented penicillins, fluoroquinolones, third-generation cephalosporins or aminoglycosides may be considered in patients with more severe exacerbations.