Risk factors and algorithms to identify hepatitis C, hepatitis B, and HIV among Georgian tuberculosis patients

SummaryObjectivesTo determine prevalence, risk factors, and simple identification algorithms for HIV, hepatitis B, and hepatitis C co-infection; factors that may predispose for anti-tuberculosis therapy-induced hepatotoxicity.MethodsWe recruited 300 individuals at in-patient tuberculosis hospitals in three cities in Georgia, administered a behavioral questionnaire, and tested for antibody to HIV, hepatitis C (HCV), hepatitis B core antigen (anti-HBc), and the hepatitis B surface antigen (HBsAg).ResultsOf the individuals tested, 0.7% were HIV positive, 4.3% were HBsAg positive, 8.7% were anti-HBc positive, and 12.0% were HCV positive. In multivariable analysis, a history of blood transfusion, injection drug use, and prison were significant independent risk factors for HCV, while a history of blood transfusion, injection drug use, younger age at sexual debut, and a high number of sex partners were significant risk factors for HBV. Three-questionnaire item algorithms predicted HCV serostatus 74.1% of the time and HBV serostatus 85.2% of the time.ConclusionsTreatment of tuberculosis patients in resource-limited countries with concurrent epidemics of HCV, HBV, and HIV may be associated with significant hepatotoxicity. Serologic screening of tuberculosis patients for HBV, HCV, and HIV or using behavioral algorithms to identify patients in need of intensive monitoring during anti-tuberculosis therapy may reduce this risk

Genomic analyses of Mycobacterium tuberculosis from human lung resections reveal a high frequency of polyclonal infections

Polyclonal infections occur when at least two unrelated strains of the same pathogen are detected in an individual. This has been linked to worse clinical outcomes in tuberculosis, as undetected strains with different antibiotic resistance profiles can lead to treatment failure. Here, we examine the amount of polyclonal infections in sputum and surgical resections from patients with tuberculosis in the country of Georgia. For this purpose, we sequence and analyse the genomes of Mycobacterium tuberculosis isolated from the samples, acquired through an observational clinical study (NCT02715271). Access to the lung enhanced the detection of multiple strains (40% of surgery cases) as opposed to just using a sputum sample (0-5% in the general population). We show that polyclonal infections often involve genetically distant strains and can be associated with reversion of the patient's drug susceptibility profile over time. In addition, we find different patterns of genetic diversity within lesions and across patients, including mutational signatures known to be associated with oxidative damage; this suggests that reactive oxygen species may be acting as a selective pressure in the granuloma environment. Our results support the idea that the magnitude of polyclonal infections in high-burden tuberculosis settings is underestimated when only testing sputum samples

Impact of the COVID-19 pandemic on tuberculosis national reference laboratory services in the WHO European Region, March to November 2020.

We assessed the impact of COVID-19 on diagnostic services for tuberculosis (TB) by national reference laboratories in the WHO European Region. Of 35 laboratories, 30 reported declines in TB sample numbers, amounting up to > 50% of the pre-COVID-19 volumes. Sixteen reported reagent or consumable shortages. Nineteen reallocated ressources to SARS-CoV-2 testing, resulting in an overall increase in workload, largely without a concomitant increase in personnel (n = 14). This poses a risk to meeting the 2025 milestones of the End TB Strategy

Site Characterization for Critical Infrastructure

Using the H/V spectral ratio method, various regions of Georgia were studied and the dominant frequencies characterizing each region were assessed

Molecular patterns of multidrug resistance of Mycobacterium tuberculosis in Georgia

Background: Tuberculosis (TB) infections caused by multidrug-resistant Mycobacterium tuberculosis (MDR MTB) remain a significant public health concern worldwide. Georgia has a high prevalence of MDR MTB. The genetic mechanisms underlying the emergence of MDR MTB strains in this region are poorly understood and need to be determined for developing better strategies for TB control. This study investigated the frequency of major drug resistance mutations across rpoB, katG and inhA loci of Georgian MDR MTB strains and explored differences between new and previously treated patients. Methods: A total of 634 MTB strains were examined for which an MDR phenotype had been previously determined by the proportions method. The GenoType®MTBDRplus system was applied to screen the strains for the presence of rpoB (S531L, H526D, H526Y, and D516V), katG (S315T) and inhA promoter region (C15T and T8C) mutations. The target loci were amplified by PCR and then hybridized with the respective site-specific and wild type (control) probes. Results: Out of the 634 isolates tested considered by phenotypic testing to be resistant to RIF and INH, this resistance was confirmed by the GenoType®MTBDRplus assay in 575 (90.7%) isolates. RIF resistance was seen in 589 (92.9%) and INH resistance was seen in 584 (92.1%); 67.2% and 84.3% of MDR strains harbored respectively rpoB S531L and katG S315T mutations (generally known as having low or no fitness cost in MTB). The inhA C15T mutation was detected in 22.6% of the strains, whereas rpoB H526D, rpoB H526Y, rpoB D516V and inhA T8C were revealed at a markedly lower frequency (≤5.2%). The specific mutations responsible for the RIF resistance of 110 isolates (17.4%) could not be detected as no corresponding mutant probe was indicated in the assay. There was no specific association of the presence of mutations with the gender/age groups. All types of prevailing mutations had higher levels in new cases. Conclusions: A great majority of the Georgian MDR MTB strains have a strong preference for the drug resistance mutations carrying no or low fitness cost. Thus, it can be suggested that MDR MTB strains with such mutations will continue to arise in Georgia at a high frequency even in the absence of antibiotic pressure

Implanted electrhydraulic artificial heart

The problem of full-featured, high-efficiency replacement of the heart’s pumping ability with an artificial analog is urgent all over the world. The most promising model of an implanted artificial heart is now the model with the elecrohydraulic principle of operation. In the weight and overall dimensions and in the efficiency, this model can compete with the most popular Abiokor model of the artificial heart

Remediation of landfill sites using Georgian zeolite (80% clinoptilolite)

კვლევაში განხორციელდა საქართველოს ზოგიერთ რეგიონში განლაგებული სტიქიური ნაგავსაყრელების ინვენტარიზაცია. შესწავლილ იქნა მათი ტერიტორიების (ასევე მიმდებარე ტერიტორიების) ნიადაგის დაბინძურების ხარისხი ისეთი მძიმე ლითონებით როგორებიცაა Cu, Zn, Pb, Cd, Hg. ქართული ცეოლიტის გამოყენებით ჩატარდა კვლევა მოცემული დაბინძურებული ნიადაგების ხარისხის გაუმჯობესების მიმართულებით (კერძოთ სორბენტის შერევით მოსუფთავებული ნაგავსაყრელის ტერიტორიაზე). შედარებითი ანალიზის საფუძველზე დადგინდა რომ ქართული ცეოლიტი (80% კლინოპტილოლიტი) ახდენს დადებით გავლენას ჩვენს მიერ შესწავლილი ნიადაგების ხარისხზე და შესაბამისად საგრძნობლად ამცირებს მათში ზემოთ ჩამოთვლილ მძიმე ლითონების შემცველობებს.in the study, an inventory of natural landfills located in some regions of Georgia was carried out. The degree of soil contamination of their territories (as well as adjacent territories) with such heavy metals as Cu, Zn, Pb, Cd, Hg was studied. Using Georgian zeolite, a study was conducted in the direction of improving the quality of given contaminated soils (in particular, in the area of a landfill cleaned by mixing a sorbent). Based on a comparative analysis, it was found that Georgian zeolite (80% clinoptilolite) has a positive effect on the quality of the soils we studied and, therefore, significantly reduces the content of the heavy metals listed above in them

Dynamics of TB mixed infections through space and time

Abstract de la comunicación oral presentada al Scientific Meeting on Mycobacteria. MycoPORTO 2019 Porto (Portugal), 19-20 de septiembre de 2019Pág. 25 del libro de abstracts que se adjunta. Mixed infections happen when at least two unrelated strains of the same pathogen can be detected in an individual. This has been linked to worse clinical outcomes in tuberculosis infections, as undetected strains presenting different antibiotic resistance profiles can lead to treatment failure. Here, we present a study of the extent of mixed infections in Georgia, a high-burden setting in which up to 11% of new TB cases are MDR/RR-TB. We obtained NGS data from cultures derived from surgery and sputum samples from 20 patients. Combined with a customized bioinformatics pipeline we enhanced the detection of multiple strains as opposed to just using a clinical sputum sample, identifying an unprecedented number of mixed infection cases of up to 40% of the patients analyzed. We also characterized transmission using 358 clinical samples and detected transmission clusters, several of which contained a sample from our surgery patients¿ dataset, allowing us to trace the history of several mixed infections. Our results suggest that the magnitude of mixed infections in highburden settings is likely to be underestimated when only using sputum samples and they can be behind discrepancies between DST and WGS predictions if not properly assessed

Study of Hydrochemical Composition of Natural Waters of Racha-Lechkhumi and Kvemo Svaneti Region in 2023

ნაშრომში განხილულია 2023 წლის რაჭა-ლეჩხუმი და ქვემო სვანეთის რეგიონის დარიშხანის გადამამუშავებელი საწარმოების მიმდებარე ტერიტორიებზე არსებული მდინარეების (ლუხუნი და ცხენისწყალი), არტეზიული და წყაროს წყლების ჰიდროქიმიური დახასიათება. ბუნებრივი წყლის სინჯებში, მდინარის შეწონილი ნაწილაკებისა და ფსკერული ნალექების ნიმუშებში განისაზღვრა ჰიდროქიმიური მაჩვენებლები და დარიშხანის შემცველობა. გამოვლენილია სხვადასხვა ინგრედიენტებით დაბინძურებული მდინარეები და არტეზიული წყლები. მიღებული შედეგები წარმოდგენილია დასკვნების სახით. ანალიზები ჩატარდა თანამედროვე მეთოდებისა და აპარატურის გამოყენებით, რომლებიც შეესაბამება ევროპულ სტანდარტებს. მდინარის წყლებში, როგორც ფონური, ისე დაბინძურებულ ადგილებიდან აღებულ სინჯებში არც ერთი განსაზღვრული კომპონენტი არ აღემატება ზღვრულად დასაშვებ კონცენტრაციას (ზდკ) და ნორმის ფარგლებშია. მდინარეების წყალის მინერალიზაცია მიეკუთვნება მცირედ და საშუალოდ მინერალიზირებული წყლების კატეგორიას; არტეზიული და სასმელი წყაროს წყლები მიეკუთვნება ზომიერი მინერალიზაციის მქონე წყლებს; განსაკუთრებით გამოირჩევა მჟავე წყაროს წყალი, სადაც აღინიშნება წყლის სიხისტის (18.57 მგ.ექვ/ლ) მატება ზდკ-თან მიმართებაში და მისი მინერალიზაცია მიეკუთვნება მაღალ მინერალიზირებული წყლების კატეგორიას; დამაბინძურებელი ინგრედიენტებიდან შეიძლება გამოვყოთ აზოტის მინერალური ფორმებიდან ამონიუმის იონები, რომელთა შემცველობა აჭარბებს ზდკ-ს დაახლოებით -1.2-ჯერ, ნიტრიტების შემცველობა კი - 132 -ჯერ, ნიტრატების და ფოსფატების რაოდენობა არც ერთ შემთხვევაში არ აღემატება ზდკ-ს; ზედაპირულ წყლებში (მდინარე ლუხუნი და ცხენისწყალი) დარიშხანის საშიშროების ინდექსი 1-ზე ნაკლებია (HQsw <1) და მათ საფრთხე არ ემუქრებათ; არტეზიულ და სასმელ წყლებში დარიშხანის საშიშროების ინდექსი 1-ზე მეტია (HQdw>1), ეს წყლები რისკის ქვეშ არიან; მდინარეების შეწონილ ნაწილაკებსა და ფსკერულ ნალექებში აღინიშნება დარიშხანის მაღალი კონცენტრაციები.The paper discusses the hydrochemical characterization of the rivers (Lukhuni and Tskhenistskali), artesian and spring waters in the areas adjacent to the arsenic processing enterprises of the Racha-Lechkhumi and Kvemo Svaneti regions in 2023. Hydrochemical indicators and arsenic content were determined in natural waters, river suspended solids and bottom sediment. Rivers and artesian waters contaminated with various ingredients have been identified. The obtained results are presented in the form of conclusions. Analyzes were carried out using modern methods and equipment that correspond to European standards. In the river waters, in both the background and polluted samples, none of the determined components exceed the maximum allowable concentration (MPC) and are within the norm. Mineralization of river water belongs to the category of slightly and moderately mineralized waters; Artesian and drinking spring waters belong to waters with moderate mineralization; Acidic spring water is especially distinguished, where there is an increase in water hardness (18.57 mg.eq/l) in relation to MPC, and its mineralization belongs to the category of highly mineralized waters; Among the polluting ingredients, we can single out ammonium ions from mineral forms of nitrogen, the content of which exceeds the MPC by about -1.2 times, and the nitrite content - 132 times, the amount of nitrates and phosphates does not exceed the MPC in any case; In surface waters (river Lukhuni and Tskhenistskali) the arsenic hazard index is less than 1 (HQsw <1) and they are not in danger; In artesian and drinking waters, the arsenic hazard index is greater than 1 (HQdw>1), these waters are at risk; High concentrations of arsenic are noted in the suspended solids and bottom sediments of rivers