On April 2, 2023, the group of specialists/experts set up by the Public Defender of Georgia made another visit to the VivaMedi clinic in order to assess the condition of Mikheil Saakashvili.

Taking into account the mandate of the Public Defender, the purpose of the visits of the expert group, from the day of its creation, has been to monitor the medical services provided to the patient. The group has not been involved in the patient's treatment process.

Doctors examined the patient on April 2. Unfortunately, due to the visit being made on a non-working day, it was not possible to interview the doctor treating Saakashvili or review the medical documentation on the spot.

The following experts participated in the visit: Tengiz Tsuladze (neurologist), Giorgi Kacharava (cardiologist), Giorgi Grigolia (anesthesiologist-reanimatologist) and Aida Gozalova (hematologist, clinical oncologist, internist, palliative medicine specialist). Nino Zavrashvili (endocrinologist), Giorgi Papiashvili (cardiologist/arrhythmologist) and Grigoli Khurtsidze (therapist, internal diseases/hospital medicine) participated in the online discussion after the visit.

Conclusion:

Patient’s condition:

Aggravation after February 19 (the day of the previous visit).

By objective examination:

Severe sarcopenia is evident.

The patient has lost another 4 kilograms at the expense of significant muscle wasting. Movement is significantly limited due to weakness.

When standing up, he is experiencing a sharp drop in blood pressure from 120/90 to 78/40, which is accompanied by loss of balance and noticeable disruption of coordination. A significant decrease in mental functions and depression are also evident.

Impression:

1. Sarcopenia, muscle wasting, severe cachexia stage 4.
2. Critical drop in orthostatic pressure with loss of coordination.

Prognosis and risks:

1. The patient has entered the phase of active catabolism.

As a result of further weight loss, he will become bedridden, as his lower limb muscles will be completely wasted and he will not be able to move due to weakness.

The critical weight for him is 52-53 kilograms, after which irreversible changes will begin in the body.

2. Peripheral and autonomic neuropathy can still be observed, which causes a critical drop in blood pressure when standing up.

Currently, unsupervised movement is dangerous for the patient, as the risks of falling down and sustaining body injuries/fractures are very high. In case of the latter, the resource of the cachexic body to heal the wound or fracture is very low, which will lead to the cascading development of other critical complications (hemorrhage, infection, deep vein thrombosis, etc.) with a high probability of lethal outcome.

Members of the group of specialists/experts:

/Giorgi Grigolia/

/Grigoli Khurtsidze/

/Giorgi Kacharava/

/Giorgi Papiashvili/

/Tengiz Tsuladze/

/Nino Zavrashvili/

/Aida Gozalova/