On October 19, 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, 3^rd President of Georgia.

It is known to the public that, in accordance with 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.

On October 19, the members of the group physically examined Mikheil Saakashvili, checked the medical materials and talked to the medical staff of the clinic.

Neurologist Tengiz Tsuladze, cardiologist Giorgi Kacharava and endocrinologist Nino Zavrashvili took part in the visit. Cardiologist/arrhythmologist Giorgi Papiashvili, anesthesiologist-reanimatologist Giorgi Grigolia, therapist, internal disease and hospital medicine specialist Grigoli Khurtsidze and hematologist, clinical oncologist, internist and palliative medicine specialist Aida Gozalova 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, worsened memory.

Microcytic anemia Hb 9g/l, leukopenia 3200 are worth noting from the laboratory tests results. Electromyographically, sensory axonal polyneuropathy is also evident, which has somewhat deepened.

He takes Secita 10 mg/day, Trittico 150 mg/day, which has improved his sleep, and he no longer has nightmares.

Symptomatic treatment continues.

Check-up results

The patient mostly lies down, feels weak, answers questions reluctantly; cognitive functions were assessed by MOCA scale - 13 points (N≥26), knee reflexes are sluggish (1 point), Achilles cannot be activated bilaterally, larynx reflex is strengthened, abdominal skin reflexes cannot be activated. Strength in the limbs is diffusely impaired symmetrically (4 points), the finger-nose test was performed with dyssymmetry, alternate movement tests in the lower limbs were impaired (due to weakness), the knee tests were also performed dissymmetrically due to weakness, the patient is unstable in the Romberg position, failed in tandem walk test, moves with short low steps, distal vibrating sensation of bilateral lower limbs, including the ankles, is significantly impaired, and tingling sensation is also impaired from the upper third of the tibia downwards.

Skin turgor is weakened, subcutaneous fat is decreased and muscle atrophy is evident.

An orthostatic test was performed; pressure in horizontal position 140/90, pulse 78', while standing up 120/80, pulse 100'; vertically, after 3 minutes, pressure 140/90, pulse 100'. The test should be considered negative, regardless of the tachycardia developed.

Patient's weight: 70 kg, (BMI-18.6), shoulder circumference D=S 23.5 cm, triceps skinfold thickness (TSF) 0.8 cm (shoulder muscle area was calculated by the formula [(23.5-π*0.8)^2]/4π - 10 = 25 (N-54±11), which is one of the markers of muscle wasting), hip circumference D-39cm, S-39cm, tibia circumference D-32, S-33, muscle tone is decreased.

Thus, there are some positive dynamics, although the basic picture: muscle atrophy, neuropathy, cognitive deterioration remains unchanged. The patient needs close medical supervision.

Members of the specialist/expert group:

/Tengiz Tsuladze/

/Giorgi Kacharava/

/Nino Zavrashvili/

/Giorgi Grigolia/

/Grigoli Khurtsidze/

/Giorgi Papiashvili/

/Aida Gozalova/