On January 25, 2024, a group of specialists/experts set up by the Public Defender of Georgia made another visit to the VivaMedi clinic to assess the condition of Mikheil Saakashvili.

It is known to the public that, in accordance with the mandate of the Public Defender, the purpose of the visits of the medical group, from the day of its creation, has been to monitor the medical services provided to the patient. The group is not involved in the treatment of the patient.

Members of the January 25 group physically examined Mikheil Saakashvili, read the relevant part of the medical materials and talked to the medical staff of the clinic.

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

Conclusion of the medical experts:

Complaints/anamnesis

General weakness, loss of balance, feeling of numbness in the limbs, decreased energy, decreased concentration, deterioration of memory.

As for the laboratory tests, microcytic anemia Hb 9.9g/l, leukopenia 3300 are noteworthy.

The patient takes Secita, Trittico, Valsacor, Nebilet, Atarax, Tamsulosin, several supplements, symptomatically non-steroids.

Examination results

The patient is mostly lying down, feels weak, is reluctant to answer questions, cognitive functions were assessed by the MMSE scale - 21 points (N≥25), the Generalized Anxiety Disorder Rating Scale (GAD-7) - 18 points, indicating severe anxiety, the PHQ-9 depression questionnaire - 21 points, which also indicates severe depression. During bilateral abduction, unstable end gaze nystagmus can be observed, knee reflexes are sluggish (1 point), Achilles is not triggered bilaterally, the nasopharyngeal reflex is triggered, the abdominal skin reflex is sluggish on the right, it is not triggered on the left, the strength in the limbs is diffusely reduced symmetrically ( 4 points). The patient performs nose tests bilaterally with dysmetria, alternative movement tests in the lower limbs are impaired (due to weakness), knee tests are also performed with dysmetria due to weakness. The patient is unstable in the Romberg position, tandem walking is impossible, he moves with short, low steps. Distal vibration sensitivity on bilateral lower limbs, including in the ankles, is severely impaired, the tingling sensation in the upper extremities from the wrist down, in the lower extremities from the upper third of the thigh down, is also worsened. Decreased skin turgor, decreased subcutaneous fat and evident muscle atrophy can be observed.

Orthostatic test was performed, horizontal pressure 150/80, pulse 64', vertical pressure after 3 minutes 140/90, pulse 74'. The test is negative.

Patient's weight: 77 kg, (BMI-20.5), shoulder circumference D-25.5, S -26 cm, triceps skinfold thickness (TSF) 1.2 cm (shoulder muscle area was calculated by the formula [(25,5-π*1.2)^2] /4π -10 = 27.6 (N-54±11), which is one of the markers of muscle development), thigh circumference D-44cm, S-43cm, tibia circumference D-35, S -35, muscle tone decreased.

Conclusion:

Currently, there is a positive dynamic, which can be seen in the weight gain and negative orthostatic test. However, cognitive impairment, muscle hypotrophy, neuropathy, anxiety, and depression persist. According to the group of doctors, the patient needs close medical supervision and psychological intervention.

According to the group, the current positive dynamics is due to the fact that the patient has been under the supervision and treatment of highly professional doctors in a multi-professional clinic for more than a year and a half. However, all psychoneurological pathologies are still of the same quality.

Accordingly, the group considers that the patient's condition does not allow solid positive forecasts to be made yet.

The group of doctors will make another visit to the patient as needed.

Members of the group of specialists/experts:

/Tengiz Tsuladze/

/Giorgi Kacharava/

/Nino Zavrashvili/

/Giorgi Grigolia/

/Grigoli Khurtsidze/

/Giorgi Papiashvili/

/Aida Gozalova/