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Objective: The objective of this paper is to review experience in prevention of mother-to-child transmission (PMTCT) of HIV in Georgia.Background: PMTCT is one of the strategic priorities in Georgia. The first case of HIV infection in pregnant women was reported in 1999. Starting 2005 the National Programme on PMTCT became operational.Materials and Methods: One hundred sixteen HIV voluntary counselling and testing (VCT) centers operate throughout the country at antenatal clinics. According to the National PMTCT protocol, all first time attending pregnant women are offered Voluntary Counselling and Testing (VCT). Testing on HIV/AIDS is based on identification of HIV antibodies by screening method and all positive results are referred to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) for the further investigation (confirmation by Western Blot assay) and further management. Data collection was made retrospectively, using information from IDACIRC National HIV/AIDS Data Base, VRF for the period 1999-2007.Results: Prevalence of HIV among pregnant women availing VCT services in 2006 was 0.03%. As of December, 2007 total 69 pregnancies of 64 women were registered at the IDACIRC. Fifty eight women (90.6%) acquired infection through heterosexual contact. None of the HIV positive women reported intravenous injection of illicit drugs. The majority of the HIV infected pregnant women had one sexual partner (90.6%). Of children delivered by 51 positive partners 41(80%) were infected through injecting drugs intravenously and 10 (20%) persons through heterosexual contacts. Throughout the period 1999-2007 14 pregnant women received PMTCT services only partially. In 2 cases children were HIV-infected. In 12 pregnancies women received AZT in about the 28th week of pregnancy. No case of HIV transmission to child was recorded in this group. In 32 cases pregnant women received full prophylaxis therapy and all children were negative for HIV infection. Among 6 pregnant women admitted at IDACIRC later than the 28th week of pregnancy only 1 child was infected. As of December 2007, 5 women are still pregnant. Three of them receive antiretroviral drugs (ARV) prophylaxis with AZT+3TC+SQV/r. Two women are under 28 weeks of gestational age.Conclusion: Over the last several years the national response to AIDS in Georgia achieved significant progress. The provision of comprehensive packages of PMTCT services in Georgia has been shown to minimize the risk of vertical transmission. As described above none of the women completing full course of ARV prophylaxis, combined with appropriate infant feeding, transmitted HIV to their children. PMTCT programmes are indisputably the main entry point not only for HIV related care and treatment for women, but also for other comprehensive care and prevention. [ABSTRACT FROM AUTHOR]

Apoptosis plays one of the major roles in the progression of human cancers including cervical carcinoma. The aim of our study was to analyse the expression of Cas3, Bax and their correlation with the proliferation index and ER expression status during the progression of cervical intraepithelial neoplasia (CIN). Study included altogether 140 specimens, divided into two major groups, such as: cervical lesions without co-infections and with co-infections. Standard immunohistochemistry was used to detect antigens: Ki67, Cas3, Bax and ER. The study results showed that the expression of Cas3 is significantly decreased whilst the expression of Bax is significantly increased during the progression of CIN in both groups with and without co-infections. The expression of Bax negatively correlates with the expression of Cas3 (r=-42.4, p<0.05) and ER (r=-33.4, p<0.05) and positively correlates with the expression of proliferation marker Ki67 (r=56.3, p<0.05). The results indicate that the deregulated apoptosis measured as increased expression of Bax and Cas3 loss, as well as the increase in proliferation index measured as Ki67 expression is significantly related to the progression of CIN into cervical carcinoma. Therefore, the measuring of mentioned protein expression could be used as the markers of the CIN progression.

Stem cells represent the small subpopulation of healthy and cancerous tissues, which are characterised with increased proliferation and self-renewal properties. From the many different markers of stem cells, we have investigated the stem cell index during the progression of cervical intraepithelial neoplasia (CIN), based on the immunohistochemical expression of CD44 in total of 140 tissue samples from uterine cervix. In addition, we have performed the profound correlation analysis of CD44 with different epithelial-mesenchymal, proliferation, apoptosis and hormonal markers at both protein and mRNA level. The results of our study indicated that, stem cell index based on the CD44 detection is significantly increased with the progression of cervical intraepithelial neoplasia. In addition, CD44 expression significantly correlates with the epithelial-mesenchymal transition, proliferation-apoptotic features and ER status in both protein and mRNA level. Two, groups of cervical intraepithelial lesions as well as carcinoma can be identified based on the expression of CD44, Ki67, Cas3 and ER. To the best of our knowledge we are first to demonstrate such findings in CIN and cervical carcinoma and identified characteristics could be used for the early assessment of CIN patient prognosis and for the relevant clinical management.

Discussion and management of incontinence in a patient with spina bifida by four international experts followed by a literature review.

To review the existing experience in prevention of Mother-To-Child Transmission (PMTCT) of HIV in Georgia the comprehensive PMTCT state program was started in 2005. Georgia was the first among the former Soviet Countries that ensured the universal access to PMTCT throughout the Country. According to the National PMTCT protocol, all pregnant women are offered Voluntary Counseling and Testing for HIV infection at Women Health Centers, maternity hospitals, and regional hospitals of Georgia. Positive results are referred to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) for the confirmation and management that implies: antiretroviral therapy, caesarean section, infant feeding by formula and PCP prophylaxis by TMP-CTX. Data were collected using National HIV/AIDS Data Base. Prevalence of HIV among pregnant women attending VCT services in 2005-2008 years was 0.03%. Throughout the period 1999-2008 total 84 pregnancies were registered at the IDACIRC, among them 77 pregnancies were monitored by IDACIRC. Prophylactic strategy was tailored individually according to the national acting guideline, women gestation age, HIV disease stage, ARV's availability, etc. Totally 36 pregnant women received full PMTCT service. In this group no vertical transmission of HIV infection was recorded. 33 pregnant women received partial PMTCT service. The reasons were: late HIV diagnosis, limited access to ARV (from 1999 till 2004), refusal by pregnant woman. Number of HIV transmission cases was 3 in this group. As of November, 2008 eight women are still pregnant. Since 2005 Georgia ensured comprehensive and sustainable PMTCT service throughout the Country and universal access for all pregnant women. Provision of full package of this service minimized the risk of vertical transmission.

Aim of the study was to evaluate effect of sublingual misoprostol given prior to manual vacuum termination (MVA) of gestation. 349 healthy women with a normal intrauterine pregnancy at 8 and 12 weeks of gestation were studied. 175 women were randomly allocated to misoprostol group and 174 women to placebo group. The patients received 400 microg misoprostol sublingually or the same amount placebo approximately one hour before the procedure. The mean gestational age were 9,9 (SD 1,4) in the intervention group and 9,8 weeks (SD 1,3) in the control group. The mean age of patients was 27,3 years in both groups. The parity and abortion frequency were 5,7 (SD 4,3) and 3,2 (SD 3,8) in the intervention group and 4,9 (SD 2.8) and 2,5 (SD 2,4) in the control group respectively. The preoperative cervical dilatation were 8,9 mm (SD 1,8) in misoprostol group vs. 6,2 mm (SD 1,5) in placebo group (p<0,001). The amount of blood loss were - 95,0+/-89,3 in misoprostol group vs. 149,0+/-82,1 in placebo group (p<0,001). Need for oxytocin was less common in misoprostol group - 29 (16,6%) vs. 63 (36,2%). The duration of the procedure - 7,3 min (SD 2,7) in misoprostol group vs. 7,7 min (SD 2,2) in placebo group (p=NS). There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, and rate of side effects among the groups. Obtained results has shown that sublingual administration of 400 microg misoprostol at least an hour before MVA for termination of pregnancy facilitates the abortion procedure by decreasing the need for cervical dilatation, reducing blood loss and need for oxytocin use. However there was no significant difference in operating time between the two groups. Sublingual misoprostol has the advantage of being more convenient to administer and may be more suitable for day surgery. Further studies could assess optimal route, dose, time interval of misoprostol administration which would provide a faster and a higher effect required for blood loss decrease and cervical priming before abortion.

Cross-sectional study was performed in all maternity units of Tbilisi, Georgia, with delivering 18,554 women between 1 January 2004 and 1 January 2005. There were 267 cases of severe obstetric morbidity giving a prevalence of 14,2 per 1000 deliveries (95% CI 12,6-16,0). During the study there were 3 maternal deaths. Disease specific morbidities per 1000 deliveries were: severe pre - eclampsia - 5,0 (95% CI 4,1-6,2); hysterectomy during 24 hours after delivery - 4,5 (95% CI 3,6-5,6); hemorrhage - 2,3 (95% CI 1,7-3,1), sepsis 1,3 (95% CI 0,9-2,0); eclampsia - 0,74 (95% CI 0,44-1,25); uterine rupture - 0,16 (95% CI 0,05-0,47); HELLP-syndrome - 0,11 (95% CI 0,03-0,39). Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone and allows for an effective audit system of maternal care.