Translational and Clinical Medicine - Georgian Medical Journal
Biannual Medical Journal of Ivane Javakhishvili Tbilisi State University and Georgian Medical Association link gacor rokokbet https://pafikopadang.org/ toto 4d slot88 slot 200 slot qris https://rrijm.com/ rokokbet rokokslot link gacor slot dana situs gacor rokokbet rokokbet rokokbet slot88 slot777 slot gacor
Ivane Javakhishvili Tbilisi State University
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Exploring EEG Changes in Video Game Players A Study on Behavioral Addiction
Background: Internet Gaming Disorder (IGD) is increasingly seen as a behavioral addiction, partially due to the way its neurological features resemble those that are found in substance-use disorders. To improve our methods in the diagnostics and treatment of IGD, a better understanding of the effects and influences of excessive gaming on the brain is crucial. Aim: This review aims to explore the neurophysiological characteristics of IGD by examining findings from electroencephalography (EEG) studies, focusing on resting-state activity and event-related potentials (ERPs) as potential biomarkers of the disorder. Methods: A range of peer-reviewed EEG studies on individuals diagnosed with IGD were reviewed. The studies included assessments of resting-state brainwave activity and ERP components, particularly those associated with attention and cognitive control. Results: The reviewed studies consistently report altered EEG patterns in individuals with IGD. At rest, there is a notable increase in theta activity and a decrease in beta activity, indicating possible deficits in arousal and cognitive engagement. In ERP studies, IGD participants frequently exhibit reduced P300 amplitudes during cognitive tasks, suggesting impairments in attentional processing and executive function. Conclusions: EEG research reveals distinct neurophysiological patterns in individuals with IGD, reinforcing its classification as a behavioral addiction. The observed changes in brainwave activity and ERP responses may serve as reliable markers for the disorder. These findings highlight the potential of EEG-based measures to enhance diagnostic accuracy and support the development of targeted interventions, including neurofeedback and cognitive-behavioral therapies.
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Artificial Intelligence and Telemedicine in Gerodontology and Improving Oral Health and Quality of Life in Older Adults
The world's population is aging. According to the World Health Organization's forecast, by 2050 the number of people aged 60 and older will double. Along with the increase in life expectancy, it is natural that the risk of chronic diseases and oral health-related problems also increases, which may have a significant impact on a person's overall condition and quality of life.[i] The proportion of individuals aged 65 years and older is rapidly increasing worldwide, caring for the oral health of older adults has become a pressing public health issue. In elderly patients, oral conditions such as edentulism, as well as damage to the hard and soft tissues of the teeth, are common and are often associated with the presence of comorbid general systemic diseases. At the same time, elderly patients may have limited mobility, which further complicates access to dental services.[ii] [iii] In this article, we will discuss ways to assist the elderly population throughქ the help of telemedicine and artificial intelligence models, which have already been created in several countries around the world and are actively undergoing a period of development.[iv] By using artificial intelligence and telemedicine, it is possible to improve the dental status of elderly patients, as these are tools that can replace the consultation provided by a doctor, identify diagnoses, and outline ways for the prevention of various types of diseases. These means can be considered as instruments for improving access to dental services, which will be used in the future to strengthen disease prevention.[v] [vi] With the help of artificial intelligence models, a patient can detect oral diseases at an early stage, regardless of their ability to visit a clinic for professional consultation and early diagnosis based on their socio-economic status. Today, it is already possible to receive a doctor's advice without leaving home and monitor the treatment process; this will especially help rural residents and beneficiaries of nursing homes.[vii] This literature review relies on the latest studies, which discuss the use of artificial intelligence and telemedicine in gerodontology (geriatric dentistry). The aim of the research is to explore how these innovations can improve oral health outcomes and, ultimately, enhance the quality of life for older adults.[viii] Oral health underpins full nutrition, speech, and social confidence. Its neglect contributes to the development of such serious systemic diseases, including heart disease, diabetes, and respiratory infections.[ix]
Hypothyroidism can be considered a causative factor of heart failure and is associated with left atrial myopathy [1–3]. Introduction In recent years, there has been growing recognition of the intricate relationship between metabolic disorders and cardiovascular health. Among these, hypothyroidism—a condition characterized by insufficient thyroid hormone production—has increasingly been linked to various cardiac abnormalities, including those affecting the left atrium [1,4,5]. This connection not only highlights the physiological complexities underlying both conditions but also underscores the importance of recognizing this interplay in clinical practice. Left atrial function and size serve as critical indicators of cardiovascular health, and alterations in these parameters may predispose individuals with hypothyroidism to adverse outcomes such as arrhythmias, heart failure, and stroke [2,6]. By examining the mechanisms through which thyroid dysfunction impacts left atrial dimensions and functionality, clinicians can better understand the broader implications for patient management and treatment strategies. Ultimately, unraveling this relationship is vital for developing a holistic approach to both hypothyroidism and its cardiovascular consequences. Early detection of cardiac functional or structural changes is crucial for timely intervention [5]. Based on the key roles of thyroid hormones in the cardiovascular system, hypothyroidism is known to be associated with the development or progression of various cardiovascular diseases [1,4,7]. Although several previous studies have reported the association between hypothyroidism and heart diseases, a comprehensive analysis of the relationship between hypothyroidism and the left atrium—one of the most important cardiovascular parameters—has not yet been performed. There are small studies indicating a linear relationship, but most were conducted in populations with other risk factors for left heart disease, such as hypertension or diabetes, which can confound results [8]. Some studies have aimed to comprehensively analyze whether hypothyroidism is associated with left atrial disease. One systematic review of 11 studies found that 10 reported hypothyroidism to be associated with a larger left atrium, while one showed no association. Data quality in all studies was moderate [8]. The association was significant in both Western and Asian populations, and findings remained significant even after rigorous adjustment for hypertension. However, only population-based studies consistently showed a significant association, indicating that more research is needed to confirm this relationship [8,9]. Furthermore, many studies did not include advanced left atrial functional assessment tools, such as left atrial strain and phasic function evaluation (conduit, reservoir, and pump functions). Currently, assessment of left atrial function is incomplete without these parameters [10]. Left atrial (LA) strain assessment is an important tool in evaluating cardiac function, particularly in patients with atrial fibrillation, heart failure, or other cardiovascular diseases [10–12]. LA strain refers to the measure of how much the left atrium stretches and returns to its normal size after each heartbeat. It serves as a marker of LA stiffness, which can indicate cardiac disease. Methods for left atrial strain assessment include: Speckle-tracking echocardiography (STE): Ultrasound imaging tracks the movement of speckles in the myocardium to estimate LA strain. Tissue Doppler imaging (TDI): Measures the velocity of tissue displacement in the LA to estimate strain. Cardiac magnetic resonance (CMR) imaging: Provides detailed images of LA structure and function for direct strain measurement. Studies demonstrate that left atrial strain assessment is valuable for predicting cardiovascular outcomes and guiding management of patients with cardiac disease [11–13]. Background In recent years, there has been growing recognition of the relationship between metabolic disorders and cardiovascular health, but studies remain inconclusive and yield varying results [1,4,8]. By examining the mechanisms through which thyroid dysfunction impacts left atrial dimensions and functionality, clinicians can better understand the broader implications for patient management and treatment strategies [5,8]. Early recognition of dysfunction is crucial for effective treatment and prevention strategies [6,8]. Subclinical abnormalities in structural or functional parameters can help identify populations at risk or those already in the early stages of heart disease [9,10]. Aim The aim of this study was to perform a systematic literature review on the historical perspective and current evidence regarding hypothyroidism and left atrial dysfunction [1,4,8]. Methods The literature review was performed using the PubMed, Cochrane Library, Embase, CNKI, and Sinomed databases to identify clinical studies on the effects of hypothyroidism on cardiac function. The search was limited to articles published in English within the last five years. Methods The literature review was performed using the PubMed, Cochrane Library, Embase, CNKI, and Sinomed databases to identify clinical studies on the effects of hypothyroidism on cardiac function. The search was limited to articles published in English within the last five years. Overview of hypothyroidism and its systemic effects A deficiency in thyroid hormones, as seen in hypothyroidism, leads to systemic effects extending beyond metabolic dysfunction, often impacting cardiovascular health [1,4,6]. The interplay between thyroid hormones and cardiovascular function is particularly critical; low thyroid hormone levels can result in dyslipidemia, endothelial dysfunction, and diminished cardiac contractility, increasing the risk of coronary artery disease and heart failure [2,4,6,14]. Research indicates that patients with hypothyroidism often experience symptoms such as fatigue and weight gain, which can further contribute to cardiovascular disorders. Addressing these complications through appropriate therapy—such as levothyroxine (LT4) replacement—is vital. LT4 not only normalizes thyroid hormone levels but also improves lipid metabolism and enhances cardiac performance, demonstrating the importance of thyroid regulation in promoting cardiovascular health [14]. Without timely intervention, the systemic consequences of hypothyroidism can lead to significant complications, particularly affecting cardiac structure and function. Hypothyroidism is also linked to worse outcomes in patients with diagnosed heart failure [15]. The largest study examining the thyroid–heart disease connection was conducted in Denmark and included 216,894 patients with no known thyroid or heart disease at baseline, each with at least one serum thyroid-stimulating hormone (TSH) measurement between 1995 and 2011 [15]. Data collected over a 7-year period showed that untreated mild hypothyroidism (average TSH 5.5 mIU/L) was associated with an 83% increased risk of developing heart problems compared with individuals with normal thyroid function or treated hypothyroidism. Over a five-year period, untreated mild hypothyroidism tripled the risk of heart problems, while treated hypothyroidism with low TSH had a 2.1-fold increased risk, and treated hypothyroidism with normal TSH had a 1.8-fold increased risk [15]. The highest risk was observed in untreated hypothyroid patients over 65 years of age. The Relationship Between Hypothyroidism and Cardiac Function Seeking a deeper understanding of how hypothyroidism impacts cardiac function reveals significant insights into the physiological adaptations of the heart in this condition. Research indicates that hypothyroidism can lead to alterations in various cardiac parameters, such as reduced left ventricular ejection fraction and cardiac index, demonstrating that cardiac efficiency is compromised in these patients [16]. Furthermore, the geometric relationship between the left atrium and left ventricle is critical for optimal diastolic filling. In heart transplant patients, for instance, an enlarged left atrium resulting from surgical techniques can lead to impaired diastolic filling due to a negative atrioventricular area difference, revealing how structural changes can detrimentally affect cardiac function [17]. These findings underscore the need for effective treatment strategies, such as aggressive levothyroxine replacement therapy, to restore cardiac performance and enhance overall patient outcomes in those with hypothyroidism or to initiate early treatment for subclinical heart failure. Low levels of thyroid hormones can negatively affect myocardial morphology and physiology, largely compromising diastolic function [8]. Nevertheless, the degree of dysfunction has not been associated with the development of heart failure but rather exacerbates and worsens this condition [8,18]. A historical cohort study by Ro et al. over 25 years with 52,856 patients found that individuals with hypothyroidism and congestive heart failure had a significantly higher risk of hospitalization due to exacerbation than euthyroid individuals (hazard ratio 1.86) [18]. In addition, a prospective cohort in the USA with 1365 patients with pre-existing heart failure found that higher TSH levels were associated with more severe heart failure and increased rates of heart transplantation, ventricular assist device placement, and mortality compared to euthyroid patients [19]. The authors concluded that hypothyroidism portends a poorer prognosis in patients with pre-existing heart failure [19]. Atrial Fibrillation and Hypothyroidism Atrial fibrillation (AFib) is a common arrhythmia in individuals with hypothyroidism. The prevalence of AFib varies based on age, severity of hormone deficiency, and comorbidities. Research indicates hypothyroidism may increase AFib risk, especially in older or untreated patients [20–23]. Regular monitoring and effective management of thyroid hormone levels can reduce this risk [20–23]. Impact of Hypothyroidism on Heart Rate and Rhythm The relationship between hypothyroidism and cardiovascular function is complex, particularly regarding heart rate and rhythm. Hypothyroid patients often exhibit bradycardia, leading to impaired cardiac output and increased morbidity. Additionally, hypothyroidism can exacerbate rhythm abnormalities, including atrial fibrillation [24,25]. Changes in left atrial strain correlate with heart rate increases, reflecting the importance of left atrium–left ventricle coupling in cardiovascular stability [24]. Interventions like thoracoscopic radiofrequency fragmentation can improve outcomes in atrial fibrillation and heart failure [25]. Structural Changes in the Left Atrium Due to Hypothyroidism Hypothyroidism can cause structural changes such as fibrosis and atrial remodeling in the left atrium, contributing to arrhythmia development [26,27]. Advanced imaging, including cardiac magnetic resonance, reveals fibrotic lesions correlated with arrhythmic risk [26,27]. Understanding these changes is crucial for targeted therapeutic strategies. Analysis of Left Atrial Size and Function and Its Implications Left atrial enlargement (LAE) affects patient prognosis and treatment outcomes. Non-linear associations exist between LA diameter and mortality or heart failure hospitalization, with enlargement correlating with increased risks [28]. Low-voltage areas in the left atrial anterior wall can be substrates for arrhythmias, complicating hypothyroid patients’ management [29]. Both under- and overtreatment of hypothyroidism may increase heart disease risk, warranting further study [15]. Results and Discussion Studies show hypothyroid patients have an increased risk of heart problems compared with euthyroid individuals, regardless of treatment status. Those treated to achieve normal TSH levels have the lowest risk compared to untreated patients or those with low TSH levels. Both undertreatment and overtreatment may be linked to higher cardiac risk, suggesting a need for careful therapy management [15]. Conclusions Endocrine dysfunction in hypothyroidism significantly complicates cardiovascular outcomes. Thyroid hormones play pivotal roles in cardiac physiology and vascular dynamics [1,2,30]. Proper monitoring is essential in congenital heart disease patients, such as those with transposition of the great arteries, to reduce postoperative complications related to thyroid dysfunction [30]. Emerging therapies like photobiomodulation may help mitigate age-related cardiac deterioration in hypothyroid patients [1]. Routine cardiac evaluation in hypothyroid patients is recommended to manage increased risks of atrial fibrillation and other complications [20–23]. Future research should focus on mechanisms linking thyroid hormone deficiency to left atrial remodeling and the long-term impact of treatment [4]. Early detection of subclinical heart disease induced by hypothyroidism could become a compelling indication for levothyroxine therapy [15]. Hypothyroidism may affect cardiac function as an adaptation that could progress to myocardial damage if untreated. Cardiac function often improves with aggressive levothyroxine replacement [8,15].
Beyond Gout: The Cardiovascular Impact of Hyperuricemia and Its Role in Atherogenesis
Background: Atherosclerosis is a chronic inflammatory disease of the arterial wall and remains a leading cause of morbidity and mortality. Hyperuricemia-defined as elevated serum uric acid-has recently been implicated as a potential independent contributor to atherosclerotic cardiovascular disease (ASCVD). Objective: This narrative review aims to explore the interrelationship between hyperuricemia and atherosclerosis by examining shared mechanisms of vascular injury, epidemiological evidence, and implications for management. Methods: A comprehensive computer-based literature search was conducted using PubMed, Scopus, Web of Science and the Cochrane Library from January 2005 to September 2025. Keywords included atherosclerosis, hyperuricemia, gout, peripheral artery disease, and coronary artery disease. No restrictions were placed on language or study design. Reference lists of retrieved articles were manually screened for additional studies. In total, 36 articles met the inclusion criteria for this review. Results: The evidence supports multiple mechanistic links: elevated uric acid promotes endothelial dysfunction, oxidative stress, nitric oxide depletion, activation of urate transporters (e.g., URATv1), and xanthine oxidase–mediated reactive oxygen species generation. Epidemiologic studies demonstrate associations between higher serum uric acid and increased risks of coronary heart disease incidence and mortality, stroke, and peripheral arterial disease; some data suggest stronger associations in women. Therapeutic interventions (e.g., xanthine oxidase inhibitors) may confer vascular benefit beyond urate lowering. Conclusion: Hyperuricemia and atherosclerosis are inter-related through overlapping molecular and inflammatory pathways. Considering serum uric acid as a modifiable cardiovascular risk factor may yield opportunities for earlier detection and prevention of ASCVD. Further prospective trials are needed to determine whether urate-lowering therapy directly reduces atherosclerotic events.
Artificial intelligence in general medicine and dermatology: a comprehensive review
Background: Artificial intelligence (AI) has rapidly transitioned from a conceptual innovation to a practical tool across multiple areas of clinical medicine. Dermatology, in particular, has emerged as a leading specialty for AI integration due to its strong reliance on visual pattern recognition and image-based diagnostics. Aim: This review aims to summarize fundamental concepts of AI, outline its applications across general medicine, and provide an in-depth analysis of current and emerging AI applications in dermatology. Methods: A narrative review of the contemporary literature was performed, focusing on AI applications in clinical medicine and dermatology, including diagnostic support, treatment planning, telemedicine, education, and regulatory considerations. Results: AI systems have demonstrated diagnostic performance comparable to clinicians in selected tasks, particularly in dermatological imaging and skin cancer detection. Applications extend beyond oncology to inflammatory skin diseases, dermatopathology, teledermatology, and clinical decision support. However, challenges remain regarding data bias, interpretability, real-world validation, ethical concerns, and clinical workflow integration. Conclusions: AI represents a transformative technology in general medicine and dermatology, with the potential to enhance diagnostic accuracy, efficiency, and access to care. Responsible implementation, rigorous clinical validation, and attention to ethical and equity considerations are essential for safe and effective clinical adoption.
Factors associated with HIV status disclosure among people living with HIV in Georgia
Background HIV status disclosure plays a critical role in reducing stigma, improving treatment adherence, and enhancing social support for people living with HIV (PLHIV). Despite its importance, disclosure remains a complex process influenced by individual, relational, and systemic factors. The Eastern Europe and Central Asia region, including Georgia, faces high levels of stigma, making HIV status disclosure particularly challenging. This study explores factors associated with HIV status disclosure among Georgian PLHIV to inform interventions and policies. Aim To examine the sociodemographic and healthcare-related factors associated with HIV status disclosure among PLHIV in Georgia. Methods This secondary data analysis utilized the PLHIV Stigma Index 2.0 survey conducted in Georgia in 2022, which included 765 participants recruited through peer-to-peer interviews in Tbilisi and three additional regions. Data on demographics, stigma, discrimination, and healthcare interactions were collected following standardized methodologies developed by UNAIDS. Statistical analysis included chi-square tests to explore univariate associations and multivariate logistic regression to adjust for potential confounders and identify significant predictors of disclosure. Results Of the 765 participants, 67.4% were male, most of them aged 30–49 years (61.3%). Lower education levels were reported by 64.2%, while 39.6% were unemployed. HIV status disclosure to at least someone from their social and healthcare environment was reported by 86.9% of participants, with 13.1% not disclosing to anyone. Multivariate analysis identified significant predictors of disclosure. Participants aged 30–39 were less likely to disclose than those aged 18–29 (aOR=0.39, 95% CI: 0.16–0.93). Disclosure was more likely among those in intimate relationships (aOR=3.93, 95% CI: 2.42–6.40) and those diagnosed with alcohol or substance use disorder (aOR=4.53, 95% CI: 1.04–19.75) or mental health disorders (aOR=6.86, 95% CI: 1.61–29.24). Conclusions This study highlights the significant influence of demographic, relational, and health-related factors on HIV status disclosure in Georgia. Age, relationship status, and co-occurring conditions were key predictors of disclosure. The findings underscore the need for targeted interventions to address stigma, promote safe disclosure, and improve healthcare engagement for PLHIV. Future research should focus on understanding the mechanisms through which these factors influence disclosure to enhance policy and practice in the region.
Impact of conception mothod on the risk of preeclamsia
Abstract Background Hypertensive disorders are one of the leading causes of maternal and perinatal morbidity and mortality worldwide. (1) It is responsible for around 16% of maternal deaths globally, in 2023 this was the equivalent to around 42 000 deaths (2, 3). Aim To define the impact of conception method on the risk of preeclampsia. Methods A prospective observational study was conducted at the Zurab Sabakhtarashvili Reproductive Clinic on the pregnant women from 2021 (january)-2025 (november). All of the participants of the study underwent preeclampsia first-semester screening test. 537 pregnant women, who were conceived with artificial reproductive technology (In vitro fertilization and Ovarian stimulation) were selected as group l. In addition to that, 407 woman who had a spontaneous pregnancy were chosen as a control group (group II). Logistic regression was used to exclude confounding factors. Results: In 01.01.2021 – 31.11.2025, 988 preeclampsia screening tests were performed at Zurab Sabakhtarashvili Reproductive Clinic. In 520 cases were confirmed a high risk (52.63%). Group 1 was seperated into three subgroups. Subgroup 1 – method of conception in vitro fertilization and frozen embryo transfer (240 women). Subgroup 2 - method of conception in vitro fertilization and fresh embryo transfer (149 women). Subgroup 3 - method of conception – ovulation drugs (148 women). For control group were selected women with spontaneous pregnancy (407 women). The difference in subgroup 1 and subgroup 2 was not significant (p value = 0.47). The difference between group 1 and group 2 (Assisted reproductive technology vs spontaneous pregnancy) was significant (p value = 0.002). Conclusion: Absence of corpus luteum in frozen embryo transfer regimen is considered to be a key point of increasing risks of Preeclampsia during pregnancy. The mechanism, however is unknown and the results from different studies are controversial. In our study no statistical difference was found between frozen embryo transfer and embryo transfer (p = 0.47). In contrast, statistical difference was found between spontaneous and assisted reproductive technology pregnancy groups (p value = 0.002). According to the results of our study we conclude that, frozen embryo transfer regimen does not make a difference for risk of preeclampsia, but assisted reproductive technology does make a difference. Keywords: Preeclampsia risk factors; Infertility; ART; spontaneous pregnancy
Cardiovascular causes of death in breast cancer patients: analysis of the Georgia Cancer Registry (2020–2021)
Background: Cardiovascular disease (CVD) has emerged as a major non-cancer cause of mortality among breast cancer (BC) patients, driven by shared risk factors and cardiotoxic effects of anticancer therapies. Objective: To evaluate cardiovascular causes of death among breast cancer patients who underwent anticancer treatment using data from the Georgia Cancer Registry Methods: A retrospective analysis was conducted on 522 deceased BC patients recorded between January 1, 2020, and January 1, 2021. Among them, 344 (65.9%) had received anticancer therapy. Cardiovascular causes of death and contributing conditions were analyzed by age group. Proportions were compared using Pearson’s chi-square test. Results: Cardiovascular causes accounted for 15.1% of deaths among treated patients. Ischemic heart disease was the leading cause (36.5%), followed by cerebrovascular events (19.2%) and pulmonary embolism (11.5%). Heart failure (HF) was identified in 6.7% of patients. including unspecified HF (1.5%). Additional contributing conditions included, hypertension (9 cases,2.6%), valvular disease (3 case, 0.9%), and atrial fibrillation (2 cases, 0.6%). The highest proportion of cardiovascular deaths occurred in patients aged 25–49 years (24.3%), although differences were not statistically significant (p>0.05). Cardiotoxicity-related cardiomyopathy (ICD-10 I42.7)was not reported. Conclusions: CVD constitutes a significant cause of mortality among breast cancer patients in Georgia. The absence of documented cardiotoxic cardiomyopathy suggests underdiagnosis, emphasizing the need for improved cardio-oncology integration
Diabetic Dyslipidemia in Georgian Children with Type 1 Diabetes
Background: Diabetes mellitus in children and adolescents increases the risk of developing dyslipidemia. The aim of our study is to determine the relationship between HbA1c and lipid profile indicators in a Georgian population of children with type 1 diabetes. Methods The study was based on biochemical data obtained from 230 children and adolescents with type 1 diabetes and 383 age-comparable controls from the Megalab clinic population. The participants were 9 to 18 years old; the mean age in the T1D group was 13.22±2.82 years. Biochemical assessment was performed after a 12-hour overnight fast. We studied: Serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), glycated hemoglobin (HbA1c). The following lipid indices were assessed: non-HDL-C, TG/HDL-C, log10(TG/HDL-C), HDL-C/LDL-C, TC/HDL-C, LDL-C/HDL-C, and non-HDL-C/HDL-C. Statistical analysis was performed using SPSS - 23. Results: A statistically significant positive correlation was observed between HbA1c and the following indicators: Total cholesterol (TC): r=0.527; LDL-C: r=0.441; triglycerides (TG): r=0.446; non-HDL-C: r=0.522**; HbA1c also showed a low-significant positive correlation with atherogenic indices -TC/HDL-C: r=0.321, LDL-C/HDL-C: r=0.256, non-HDL-C/HDL-C: r=0.321, TG/HDL-C: r=0.369, log(TG/HDL-C): r=0.328, LDL-C–HDL-C: r=0.385**. ( p<0.001)This indicates that an increase in HbA1c in children with type 1 diabetes is associated with a worsening of the atherogenic profile. In the case of HDL-C: r=−0.009; p=0.895 - a statistically significant relationship was not observed. In the T1DM group, significantly increased compared to controls - TC: 153.15 vs 175.92 mg/dL, LDL-C: 89.83 vs106.99 mg/dL; TG: 71.15 mg/dL vs 119.28 mg/dL HDL was reduced in the T1D group by 45.07 mg/dL vs: 49.09 mg/dL. Non–HDL-C -104.06 vs 130.84 mg/dL reflects an increase in atherogenic fractions. In all cases (p<0.001). All indices were significantly higher in the T1D group: TC/HDL-C: 3.16 vs 4.14; LDL/HDL-C: 1.87 vs 2.55; Non-HDL/HDL-C: 2.16 vs 3.14; TG/HDL-C: 1.47 vs 2.95; log(TG/HDL): 0.16 vs 0.38, indicating a markedly atherogenic profile, LDL-C–HDL-C: 40.75 vs 61.92 mg/dL increase reflects a strengthening of the atherogenic imbalance. Conclusions Glycemic control in children with type 1 diabetes mellitus has a significant impact on lipid metabolism and determines the formation of an atherogenic lipid profile. In Georgian children with type 1 diabetes, the lipid profile is significantly more atherogenic than in healthy controls and is characterized by higher total cholesterol, LDL-C, triglycerides, and non-HDL-C, lower HDL-C, and increased atherogenic indices. The TC/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C, and TG/HDL-C indices are all significantly higher in the diabetes group. Changes in the lipid spectrum indicate early cardiovascular risk formation and justify active prevention and monitoring already in childhood. These data indicate the early formation of cardiovascular risk and emphasize the importance of preventive measures in childhood.
Validation of the Georgian version of stress in children questionnaire: translation equivalence and psychometric properties among orphaned children
Background: The Stress in Children is a short, easily administered, self-reported questionnaire, constructed to assess stress in younger children. Aim: The purpose of this study was to validate a Georgian version of The Stress in Children questionnaire and to assess its psychometric qualities in a Georgian sample of Children from orphanages and the surrounding area. Methods: The cross-sectional study was carried out in several orphanages of Georgia. A total of 116 orphaned children aged of 7 to 18 years from 11 orphanages (study group). An equal number of schoolchildren from nearby communities were selected as a comparison group. Translation and adaptation of The Stress in Children was carried out by forward-backward translation method. Pilot test-retest study (time interval between test and retest was 7 days) with 30 bilingual children age of 7 to 18 years. Association of responses considered acceptable if Pearson’s R≥0.7. Based on this pilot study translated version The Stress in Children -Georgia was adapted by correct comprehension, grammar correctness and comprehensibility. Results: Final stage showed acceptable association of test and re-test responses was R=0.769. The association of Test and Re-Test responses on The Stress in Children original and translated versions was significant for all questions, and internal consistencies for both methods were acceptable. Cronbach’s alpha for internal consistency of test responses was 0.883 (95%CI – 0.796-0.970). The comparison of mean total and subscale scores of The Stress in Children -Georgia in the study group (orphaned children) were significantly higher compared to control group – for factor 1 (distress) - 19.8 ± 4.3 vs. 13.9 ± 3.1, respectively, p<0.001; for factor 2 (wellbeing) - 15.2 ± 3.8 vs. 10.0 ± 2.3, respectively, p<0.001; for factor 3 (social support) - 9.3 ± 2.9 vs. 6.1 ± 1.6, respectively, p<0.001; Total - 48.1 ± 8.7 vs. 33.1 ± 6.1, respectively, p<0.001. Conclusions: The Georgian version of The Stress in Children Questionnaire used in the present study, demonstrated satisfactory psychometric properties (content validity, internal reliability) that support its use as a valid screening measure for childhood stress. This easily administered tool could be used in future studies of childhood stress in Georgia.
Psychodermatology across the lifespan: Case-based insights into cognitive decline, somatic preoccupations, and factitious dermatitis
Background: Psychodermatology examines the complex bidirectional relationship between the skin and the mind. This interaction becomes particularly significant in vulnerable populations such as older adults with cognitive decline and younger individuals with psychosocial or developmental vulnerabilities. Aim: To illustrate the heterogeneity of psychodermatological presentations across the lifespan and highlight the role of cognition, insight, and psychosocial context in clinical manifestations. Methods: We present a case-based analysis of three patients with distinct psychodermatological conditions: (1) delusional parasitosis associated with cognitive decline, (2) somatic preoccupation with mild neurocognitive impairment, and (3) factitious dermatitis in a young adult with intellectual disability. Clinical, neuropsychological, and contextual factors were analyzed comparatively. Results: Older patients demonstrated dermatological symptoms linked to cognitive impairment and altered insight, including delusional infestation and psychosomatic skin complaints. In contrast, the younger patient exhibited self-inflicted lesions consistent with factitious disorder, driven by psychosocial stress and limited coping capacity. Insight varied across cases and was closely associated with cognitive status and psychosocial environment. Conclusions: Psychodermatological conditions differ significantly across age groups but share a common biopsychosocial foundation. Early cognitive screening, careful psychiatric assessment, and interdisciplinary collaboration are essential for accurate diagnosis and effective management.
Actinic Keratosis of the Scalp Initially Diagnosed as Psoriasis: A Case Report
Background: Actinic keratosis (AK) is a common premalignant skin lesion that develops on chronically sun-exposed areas, particularly in elderly individuals. Due to overlapping clinical features, AK may be misdiagnosed as inflammatory dermatoses, including psoriasis. Aim: To highlight the potential for misdiagnosis of scalp actinic keratosis as psoriasis and to emphasize the diagnostic value of dermoscopy and histopathology. Methods: A 79-year-old man with persistent scalp lesions previously diagnosed as psoriasis was clinically evaluated. Dermoscopic examination was performed, followed by histopathological assessment of a skin biopsy. Results: The patient showed no significant improvement after one year of topical corticosteroid therapy. Dermoscopic findings suggested actinic keratosis, which was subsequently confirmed by histopathology. No evidence of psoriasis was identified. Conclusions: Diagnostic reassessment is essential in persistent scalp lesions. Dermoscopy and histopathological examination are valuable tools for accurate diagnosis and timely management of actinic keratosis.
Spontaneous puberty in an adolescent girl with a combined structural anomaly of the X chromosome
Background Structural anomalies of the X chromosome represent a significant cause of reproductive dysfunction and primary amenorrhea. The coexistence of large-scale deletion and duplication within the same X chromosome is rare and associated with marked clinical variability. In this context, spontaneous pubertal development represents an unusual and rarely reported finding. Advances in cytogenetic and molecular techniques, particularly chromosomal microarray analysis, have improved the detection of combined of chromosomal rearrangements and are essential for accurate diagnosis. Case Presentation We report a 16-year-old adolescent girl presenting with primary amenorrhea and spontaneous but incomplete pubertal development. Physical examination revealed height 152 cm, with minor dysmorphic features, including a low posterior hairline and high-arched palate. Tanner staging corresponded to B4P4Ax3Me0, with normal female external genitalia. Hormonal evaluation demonstrated hypergonadotropic hypogonadism with elevated FSH and LH and low estradiol levels. Pelvic ultrasound revealed a hypoplastic uterus and small ovaries without visible follicles. Cytogenetic analysis identified a structural anomaly of the X chromosome (46,X,del(X)(q21)). Chromosomal microarray analysis confirmed a combined rearrangement consisting of a heterozygous ~70 Mb deletion at Xq21.2–q28 and a heterozygous ~51 Mb duplication at Xp22.33–p11.2. Despite the presence of a terminal Xq deletion, height delay was not observed, as the patient’s stature was consistent with familial height. Conclusion This case highlights the importance of integrated cytogenetic and molecular analysis in patients with DSD. Combined X chromosome copy number variations can result in diverse clinical phenotypes, requiring careful genetic counseling, evaluation of X chromosome inactivation, and multidisciplinary management. Early diagnosis and comprehensive care may improve outcomes, while ongoing advances in genetic research will further refine understanding and guide targeted diagnostic strategies.
Integrating Alcohol Use Disorder Interventions into HIV and Harm Reduction Programs: A Narrative Review
Background: Alcohol use disorder (AUD) is highly prevalent among people who inject drugs (PWID) and it significantly hinders the effectiveness of HIV treatment. Hazardous drinking is mostly associated with viral non-suppression, poor antiretroviral therapy (ART) adherence, and poor retention to care, especially in Eastern Europe and Central Asia (EECA), where structural barriers, fragmented health systems, and stigma limit access to integrated services. Despite the combined burden of HIV and AUD, the utilization of alcohol treatment services among PWID is critically low in Georgia. Aim: To synthesize regional and global evidence on the relationship between alcohol use disorder and HIV-related outcomes, identify determinants and barriers of AUD service utilization among PWID, and evaluate opportunities for integrating AUD interventions into HIV and harm-reduction programs in Georgia and the EECA region. Methods: We conducted a narrative review of regional and global literature published between 2000 and 2025, using Scopus, PubMed and Google Scholar. Study eligibility was based on whether selected studies examined the relationship between alcohol use and HIV-related outcomes and/or determinants of alcohol treatment utilization, with focus on PWID. Andersen’s Behavioral Model of Health Services Use, complemented by the Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework, was used to thematically synthesize the evidence. Findings were triangulated with unpublished Georgian quantitative data (IBBS 2017–2022). Results: Perceived need for treatment emerged as the strongest predictor of AUD service utilization across studies, exceed ing clinical and demographic factors. Dominant barriers were criminalization, stigma, denial, limited behavioral health capacity and poor service integration. Consistent evidence indicates that alcohol use was associated with a double risk of ART non adherence and viral non-suppression. Evidence supports the feasibility and effectiveness of integrating SBIRT and task shifted, peer-led interventions into HIV and harm-reduction services. Conclusions: AUD substantially compromises HIV care outcomes among PWID; however, it remains underdiagnosed and undertreated. Integrating alcohol screening and intervention into HIV and harm-reduction programs, reducing stigma, and strengthening the behavioral health workforce are essential system-level priorities. In Georgia and across EECA, embedding SBIRT within routine HIV services could significantly improve ART adherence, viral suppression, and progress toward UN-AIDS 95-95-95 targets.