Study of the Major Risk Factors Associated with Bronchial Asthma in Children in Georgia

Bronchial asthma is an important health problem worldwide. Identification of asthma risk factors is important in asthma management. A better study of risk factors provides an opportunity for primary prevention of asthma. Assessment of the symptoms, severity, and control of bronchial asthma in children living in different regions of Georgia, identification of the risk factors and their relationship to asthma severity, and asthma control. Observational, cross-sectional study. Data were collected in 2017 - 2020 from M. Iashvili Children's Central Hospital, as well as from Batumi and Zugdidi Referral Hospitals. In the research participated 507 children aged 2 to 18 diagnosed with asthma. The research tool was a set of questionnaires consisting of the following questionnaires: 1) General questionnaire - a basic, general questionnaire that included information about the asthma of the participants; 2) The Pediatric Quality of Life Inventory TM (Peds QL), Asthma Module (Version 3.0, Short Form (SF 22)). Pediatric Quality of Life Inventory (Peds QL), Asthma Module (Version 3.0, Short Form (SF 22)); 3) The Peds QL Multidimensional Fatigue Scale; 4) The Peds QLTM Family Impact Module; 5) Asthma control test (ACT) or the childhood Asthma-Control Test (C-ACT); Asthma severity and control are significantly associated with a genetic factor. Children whose mothers had bronchial asthma (31.6%) had a severe form of asthma, and children whose fathers had bronchial asthma made up 57.1%. Being overweight is associated with both, asthma severity and asthma control. 1/3 of the overweight children had severe (18%) and moderate (12.6%) asthma. As for asthma control, 13.2% of the overweight patients had uncontrolled and 4.4% had partially controlled asthma. In children with a smoking mother the incidence of a severe form of asthma is 6.25 times higher than in the case of a non-smoking mother. In smoking father, the incidence of severe asthma was 9.9 times higher than in the case of a non-smoking father. 33.7% of children of smoking mothers and 19% of smoking fathers were diagnosed with severe forms of asthma. As for asthma control, 17.3% of the children of smoking mothers had uncontrolled asthma, while the children of smoking fathers made up 16, 15%. 41.3 % had severe asthma with concomitant allergic diseases (4.9% of children with concomitant allergic rhinitis, 14.7% with food allergies, and 21.7% with mixed allergies). Uncontrolled forms were most often detected in children with concomitant mixed allergies (30.4%). Home humidity, type of flooring, and type of fuel used were also associated with asthma severity and its control; the presence of dampness was strongly correlated with both severe forms of asthma as well as poor control. The presence of carpet was associated with more severity than control, and the presence of linoleum was associated with both severity and control. Severe asthma was correlated with firewood use. Severe and uncontrolled forms of asthma were correlated with family income as well as parental education. Child asthma is a family burden; 100% of the parents of the participants said that they had difficulties in the family due to the child's asthma, such as anxiety and depressive mood (63%), financial (12%), and other difficulties (25%). Finally; Identification of risk factors plays an important role in controlling asthma. Correctly managed bronchial asthma ensures a reduction in the impact of asthma on the quality of life of both the child and the entire family

Prognostic value of TH1/TH2 cytokines in infants with wheezing in a three year follow-up study

INTRODUCTION: The immune system is known to play a key role in the development of viral-induced wheeze, but the pattern of cytokine response is not clear. The aim of the study was to determine whether plasma cytokine levels during the acute wheezing illness in infants are associated with the subsequent development of persistent recurrent wheezing (PRW). MATERIAL AND METHODS: 43 infants admitted to Iashvili Central Children Hospital, Tbilisi, Georgia, were selected. The concentrations of IFN-g, TNF-a and IL-6 were determined by enzyme-linked immunosorbent assay (ELISA). Total serum IgE level was also determined. IgM and IgG antibodies to RSV, Chlamydophila pneumonia and Mycoplasma pneumonia were tested by ELISA. All children were followed-up during 3 years period. RESULTS: There was no significant association with PRW and atopy in the infant or parental atopy, low maternal age, low birth weight, serum level of IL-6, serum level of IFN-g, serum level of total IgE and the particular pathogen. There was a tendency for the association with male sex, bottle feeding and household cigarette smoking, although the relation was not significant. There was just TNF-a which was strongly associated with the risk of PRW after three years of follow up. CONCLUSION: We have identified TNF-a, as a biomarker, which can be detected in children under 3 years of age and may be useful in the prediction of development of persistence of wheezing later. To further evaluate the usefulness of this and other markers and establish cutoff levels for prediction and use in clinical practice, a larger prospective follow-up study is needed.INTRODUCTION: The immune system is known to play a key role in the development of viral-induced wheeze, but the pattern of cytokine response is not clear. The aim of the study was to determine whether plasma cytokine levels during the acute wheezing illness in infants are associated with the subsequent development of persistent recurrent wheezing (PRW). MATERIAL AND METHODS: 43 infants admitted to Iashvili Central Children Hospital, Tbilisi, Georgia, were selected. The concentrations of IFN-g, TNF-a and IL-6 were determined by enzyme-linked immunosorbent assay (ELISA). Total serum IgE level was also determined. IgM and IgG antibodies to RSV, Chlamydophila pneumonia and Mycoplasma pneumonia were tested by ELISA. All children were followed-up during 3 years period. RESULTS: There was no significant association with PRW and atopy in the infant or parental atopy, low maternal age, low birth weight, serum level of IL-6, serum level of IFN-g, serum level of total IgE and the particular pathogen. There was a tendency for the association with male sex, bottle feeding and household cigarette smoking, although the relation was not significant. There was just TNF-a which was strongly associated with the risk of PRW after three years of follow up. CONCLUSION: We have identified TNF-a, as a biomarker, which can be detected in children under 3 years of age and may be useful in the prediction of development of persistence of wheezing later. To further evaluate the usefulness of this and other markers and establish cutoff levels for prediction and use in clinical practice, a larger prospective follow-up study is needed

Znaczenie prognostyczne cytokin TH1/TH2 u małych dzieci ze świszczącym oddechem w trzyletnim prospektywnym badaniu obserwacyjnym

WSTĘP: Układ immunologiczny odgrywa ważną rolę w powstawaniu świstów w przebiegu infekcji wirusowych, choć profil cytokinowy odpowiedzialny za to zjawisko nie został dotychczas ustalony. Celem badania było ustalenie czy stężenie cytokin w surowicy podczas ostrego epizodu świstów u małych dzieci wiąże się z późniejszym rozwojem przetrwałego nawrotowego świszczącego oddechu (PRW, persistent recurrent wheezing). MATERIAŁ I METODY: Do badania włączono 43 dzieci w wieku od 3 miesięcy do 3. roku życia, leczonych w Centralnym Szpitalu Dziecięcym im. M. Iashvili w Tbilisi (Gruzja). Stężenia IFN-g, TNF-a i IL-6 oznaczono za pomocą testu ELISA (enzyme-linked immunosorbent assay). Oznaczono również całkowite stężenie IgE w surowicy. Przeciwciała klasy IgM i IgG przeciwko wirusom RSV, Chlamydophila pneumonia i Mycoplasma pneumonia oznaczono przy pomocy testu ELISA. Wszystkie dzieci poddano prospektywnej obserwacji przez okres 3 lat. WYNIKI: Nie potwierdzono związku pomiędzy rozwojem przetrwałego nawrotowego świszczącego oddechu a występowaniem atopii u dzieci lub ich rodziców, młodym wiekiem matki, niską masą urodzeniową, stężeniem w surowicy IL-6, IFN-g, stężeniem całkowitego IgE i rodzajem patogenu. Wykazano tendencję do związku z płcią męską, sztucznym karmieniem i paleniem papierosów w domu, choć związki te nie były istotne statystycznie. Tylko stężenie TNF-a było silnie związane z ryzykiem przetrwałego nawrotowego świszczącego oddechu po trzech latach obserwacji. WNIOSKI: TNF-a może służyć jako prognostyczny biomarker dla przyszłego rozwoju przetrwałego nawrotowego świszczącego oddechu u dzieci poniżej 3. roku życia. W celu pełnej oceny przydatności TNF-a i innych biomarkerów w praktyce klinicznej oraz określenia wartości odcięcia konieczne jest przeprowadzenie większego badania prospektywnego.WSTĘP: Układ immunologiczny odgrywa ważną rolę w powstawaniu świstów w przebiegu infekcji wirusowych, choć profil cytokinowy odpowiedzialny za to zjawisko nie został dotychczas ustalony. Celem badania było ustalenie czy stężenie cytokin w surowicy podczas ostrego epizodu świstów u małych dzieci wiąże się z późniejszym rozwojem przetrwałego nawrotowego świszczącego oddechu (PRW, persistent recurrent wheezing). MATERIAŁ I METODY: Do badania włączono 43 dzieci w wieku od 3 miesięcy do 3. roku życia, leczonych w Centralnym Szpitalu Dziecięcym im. M. Iashvili w Tbilisi (Gruzja). Stężenia IFN-g, TNF-a i IL-6 oznaczono za pomocą testu ELISA (enzyme-linked immunosorbent assay). Oznaczono również całkowite stężenie IgE w surowicy. Przeciwciała klasy IgM i IgG przeciwko wirusom RSV, Chlamydophila pneumonia i Mycoplasma pneumonia oznaczono przy pomocy testu ELISA. Wszystkie dzieci poddano prospektywnej obserwacji przez okres 3 lat. WYNIKI: Nie potwierdzono związku pomiędzy rozwojem przetrwałego nawrotowego świszczącego oddechu a występowaniem atopii u dzieci lub ich rodziców, młodym wiekiem matki, niską masą urodzeniową, stężeniem w surowicy IL-6, IFN-g, stężeniem całkowitego IgE i rodzajem patogenu. Wykazano tendencję do związku z płcią męską, sztucznym karmieniem i paleniem papierosów w domu, choć związki te nie były istotne statystycznie. Tylko stężenie TNF-a było silnie związane z ryzykiem przetrwałego nawrotowego świszczącego oddechu po trzech latach obserwacji. WNIOSKI: TNF-a może służyć jako prognostyczny biomarker dla przyszłego rozwoju przetrwałego nawrotowego świszczącego oddechu u dzieci poniżej 3. roku życia. W celu pełnej oceny przydatności TNF-a i innych biomarkerów w praktyce klinicznej oraz określenia wartości odcięcia konieczne jest przeprowadzenie większego badania prospektywnego

Prevalence of and factors influencing smoking among medical and non-medical students in Tbilisi, Georgia

OBJECTIVE: Smoking is a serious problem that has a devastating impact on health. The objective of this study was to describe the prevalence of and factors influencing smoking among medical and non-medical students in Tbilisi, Georgia, as well as to determine whether medical education has an impact on smoking. METHODS: A cross-sectional study was carried out at Tbilisi State Medical University and Tbilisi State University, both of which are located in Tbilisi, Georgia. A total of 400 4th-year students (200 students at each university) were asked to complete standardized questionnaires. RESULTS: Of the sample as a whole, 48.75% were identified as smokers and 51.25% were identified as nonsmokers. The mean age was 20.24 years among smokers and 20.26 years among nonsmokers. Of the medical students, 49.5% were smokers, as were 48.0% of the non-medical students. The male-to-female ratio in the study population was 0.9:1.1. Smoking was found to have a strong relationship with gender, males accounting for 65% of all smokers. Of the smokers, 56.9% stated that they would like to quit smoking (for health or financial reasons). Of the medical students, 59.5% expressed a willingness to quit smoking, as did 54.2% of the non-medical students. CONCLUSIONS: There is a need to improve smoking education for undergraduate students. Special attention should be given to the inclusion of anti-smoking education in undergraduate curricula, as well as to the implementation of smoking prevention campaigns at institutions of higher education. However, such measures will be effective only if tobacco control policies are strictly enforced on the national level as well

Injuries due to foreign body aspirations in Georgia: A prevention perspective

Background: Suffocation due to foreign bodies (FB) is a leading cause of death in children aged 0-3. No data from the former U.S.S.R. are available in the international scientific literature. Methods: Consecutive patients admitted at the Iashvili Central Children Hospital in Tbilisi, Georgia from 1989 to 2011 were analyzed. Injuries in the upper airways due to foreign bodies' inhalation were collected and compared with the Susy Safe Registry and the pooled estimates of the meta-analysis. Results: 2896 cases were collected. Distribution of injuries in children younger than 3 years was significantly higher than in the Susy Safe Registry and in the "High-Income" countries in the meta-analysis. Percentage of injuries due to organic objects (86%) was significantly higher than in published data. Conclusions: Since Georgia is not showing any substantial difference, both in epidemiology and treatment of foreign bodies injuries, as compared to the other case series, translation of public health initiatives from other most advanced prevention experiences is possible and it is likely to be effective. Level of evidence: Level V, Epidemiological case series. \ua9 2015 Elsevier Ireland Ltd

Factors affecting development of Clostridium difficile infection in hospitalized pediatric patients in the country Georgia

Abstract Objective Main aims of our study were to investigate occurrence of Clostridium difficile among hospitalized pediatric patients in Georgia and examine risk factors for the development of C. difficile infection. During our study we tested and piloted the real-time PCR diagnostic systems for rapid and simultaneous identification of C. difficile and number of other pathogens in our facility settings. A cross-sectional study has been performed in children less than 18 years of age in two pediatric hospitals in Georgia, between May 2016 and December 2017. Stool specimens negative by the conventional bacteriology analysis were analyzed for the presence of C. difficile and several viral and protozoa pathogens using enzyme immune assay and polymerase chain reaction. In total samples from 220 hospitalized children with gastroenteritis symptoms were analyzed in this study. Results The average age of the study participants was 4.7 years. Overall 23 children were identified positive for C. difficile (10.5%). Antibiotic exposure within 2 months preceding the onset of diarrhea was associated with an increased risk of C. difficile infections. The risk was greatest with cephalosporins, followed by penicillins, carbapenems and macrolides. Clostridium difficile is an important cause of healthcare-associated diarrhea in pediatric population of Georgia

Nedraugiška ugnis: kaip tabako pramonė griauna mūsų vaikų ateitį

Tobacco has long been known to be one of the greatest causes of morbidity and mortality in the adults, but the effects on the foetus and young children, which are lifelong, have been less well appreciated. Developing from this are electronic nicotine delivery systems or vapes, promulgated as being less harmful than tobacco. Nicotine itself is toxic to the foetus, with permanent effects on lung structure and function. Most vapes contain nicotine, but they also contain many other compounds which are inhaled and for which there are no toxicity studies. They also contain known toxic substances, whose use is banned by European Union legislation. Accelerating numbers of young people are vaping, and this does not reflect an exchange of vapes for cigarettes. The acute toxicity of e-cigarettes is greater than that of tobacco, and includes acute lung injury, pulmonary haemorrhage and eosinophilic and lipoid pneumonia. Given the worse acute toxicity, it should be impossible to be complacent about medium and long term effects of vaping. Laboratory studies have demonstrated changes in lung proteomics and the innate immune system with vaping, some but not all of which overlap with tobacco. It would be wrong to consider vapes as a weaker form of tobacco, they have their own toxicity. Children and young people are being targeted by the vaping industry (which is largely the same as the tobacco industry), including on-line, and unless an efficient legislative program is put in place, a whole new generation of nicotine addicts will result

Feasibility of a pulmonary rehabilitation programme for patients with symptomatic chronic obstructive pulmonary disease in Georgia:a single site, randomized controlled trial from the Breathe Well Group

OBJECTIVES: To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT). DESIGN: A two-arm, randomised feasibility trial with a mixed-methods process evaluation. SETTING: Secondary care setting in Georgia, Europe. PARTICIPANTS: People with symptomatic spirometry-confirmed chronic obstructive pulmonary disease recruited from primary and secondary care. INTERVENTIONS: Participants were randomised in a 1:1 ratio to a control group or intervention comprising 16 twice-weekly group PR sessions tailored to the Georgian setting. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility of the intervention and RCT were assessed according to: study recruitment, consent and follow-up, intervention fidelity, adherence and acceptability, using questionnaires and measurements at baseline, programme end and 6 months, and through qualitative interviews. RESULTS: The study recruited 60 participants (as planned): 54 (90%) were male, 10 (17%) had a forced expiratory volume in 1 second of ≤50% predicted. The mean MRC Dyspnoea Score was 3.3 (SD 0.5), and mean St George’s Respiratory Questionnaire (SGRQ) 50.9 (SD 17.6). The rehabilitation specialists delivered the PR with fidelity. Thirteen (43.0%) participants attended at least 75% of the 16 planned sessions. Participants and rehabilitation specialists in the qualitative interviews reported that the programme was acceptable, but dropout rates were high in participants who lived outside Tbilisi and had to travel large distances. Outcome data were collected on 63.3% participants at 8 weeks and 88.0% participants at 6 months. Mean change in SGRQ total was −24.9 (95% CI −40.3 to –9.6) at programme end and −4.4 (95% CI −12.3 to 3.4) at 6 months follow-up for the intervention group and −0.5 (95% CI −8.1 to 7.0) and −8.1 (95% CI −16.5 to 0.3) for the usual care group at programme end and 6 months, respectively. CONCLUSIONS: It was feasible to deliver the tailored PR intervention. Approaches to improve uptake and adherence warrant further research. TRIAL REGISTRATION NUMBER: ISRCTN16184185