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CURRENT ISSUE /1-2010

PERIARTICULAR CALCIFICATIONS IN NORMOCALCEMIC PRIMARY HYPERPARATHYROIDISM
M. Panchovska(1), E. Firkova(2), H. Georgiev(1), A. Gosmanov(1) and R. Makuleva(1)
(1)Clinic of Internal Diseases, Military Hospital – Plovdiv, Bulgaria
(2)Department of Periodontology and Oral Diseases, Medical University – Plovdiv, Bulgaria

Summary. We report the case of a 63-year-old female patient referred to the clinic for further diagnostic specification. The patient had complained of periodically increasing pain in the left knee joint and thigh muscles for a year and a half. The X-rays studies of both knee joints revealed degenerative changes consistent with those of osteoarthritis. There were calcifications in the patellar tendons and in m. quadriceps femoris sin. The lab studies and imaging techniques showed that the patient had increased levels of blood ionised calcium (with total calcium within norm), increased concentrations of parathyroid hormone and hyperplasia of one of the parathyroid glands. Extended investigations found generalised osteoporosis, bilateral renal microlithiasis and cholelithiasis. The case of primary hyperparathyroidism we report excited our inte­rest because of the endocrine disorder diagnosed in connection with the pain in the soft tissues caused by the periarticular calcifications established in the X-ray study.
Key words: periarticular calcification, primary hyperparathyroidism, chondrocalcinosis

 

DEANXIT SELF-POISONING IN A PATIENT WITH FACIOSCAPULOHUMERAL
MUSCULAR DYSTROPHY – A CASE REPORT

A. Loukova(1) and J. Radenkova-Saeva(2)
(1)Sector of Psychiatry,
(2)Toxicology Clinic,
Emergency Hospital “N. I. Pirogov” ― Sofia, Bulgaria

Summary. The authors report a case of deanxit self-poisoning in a 18-year-old female with accompanying hereditary degenerative disease – facioscapulohumeral muscular dystrophy, confirmed by molecular genetic investigation in the mother and the grandmother of the patient. It was to lay great emphasis on the necessity of interdisciplinary approach and utilization of means and instruments by different clinical specialists in examination of rarities in medical practice.
Key words: deanxit, self-poisoning, hereditary degenerative disease

 

PSEUDOEXFOLIATION SYNDROME AND GLAUCOMA
H. Blagoeva(1,3), Ch. Balabanov(2) and D. Petrov(1)
(1)“Sv. Sofia” Hospital, Sofia
(2)Medical University – Pleven, Eye Clinic
(3)Tsaritsa Joanna University Hospital – Sofia

Summary. The aim of this study is to describe the epidemiological characteristics, physical findings and morphological signs of pseudoexfoliative glaucoma. This is a prospective, observational case-control study, which includes a 7-year period of observation of 893 patients (1786 eyes) with pseudoexfoliation glaucoma (PeG) and 52 patients with Primary Open Angle Glaucoma (POAG). Color Doppler Ultrasonogrphy (CDU) of carotid and ophthalmic artery of 18 eyes with PeG was performed. Peak systolic and end diastolic velocities were measured. Mean flow velocities, resistive and pulsative indices were calculated. Transmission electron microscopic (TEM) study of 24 eyes with PeG and 12 eyes with POAG was performed. Specimens from conjunctiva, trabecular meshwork and iris were obtained during surgery. The results show high prevalence of PeG (37,19% of all glaucoma types). The patients were predominantly men and the recessive type of inheritance was proposed. PeG was diagnosed more frequently in elderly (60-80 years). CDU showed that the hemodynamic parameters were altered. It was observed by TEM that all cell types are involved in the pathological process.
Key words: pseudoexfoliation syndrome, glaucoma

 

HE-NE LOW LEVEL LASER THERAPEUTIC APPLICATIONS FOR TREATMENT OF ACUTE IRIDOCYCLITIS
K. Koev(1), E. Borisova(2) and L. Avramov(2)
(1)Clinic of Ophthalmology, University Hospital “Alexandrovska” – Sofia
(2)Institute of Electronics, Bulgarian Academy of Sciences

Summary. This investigation is carried out in two groups of patients with acute anterior uveitis (acute iridocyclitis). In every group, there were included 20 eyes. In the first group, eyes were irradiated every day during a ten-day-period with He-Ne low level laser (Mediray 04, Optella Ltd., Sofia, Bulgaria) at emission wavelength of 632 nm and power density 0,1 mW/cm2. Second group was used as a control. In both groups, there was applied standard anti-inflammatory treatment of iridocyclitis in equal number of applications of the following: Tobradex, Ophthalar, Midrum, antibiotics drugs per os and non-steroid anti-inflammatory drugs per os, Dexamethazone para bulb. We observed significant suppression of the inflammatory reaction, stronger decrease of the ciliary flush, photophobia, epiphora, faster disappearance of the fibrinous exudate and posterior synechiae in the anterior chamber, as well as faster disappearance of the keratic precipitates, in the treated by low-level laser therapy (LLLT) eyes. For irradiated eyes by LLLT, we have found that the healing period is shortened significantly by 40 % (p<0,001). Our results revealed that LLLT application is appropriate and perspective for acute iridocyclitis treatment.
Key words: low level laser therapy, acute iridocyclitis, inflammatory reaction, eyes


PREGNANCY OUTCOMES IN NORMOGLYCEMIC WOMEN WITH HYPERINSULINEMIA TREATED
WITH METFORMIN BEFORE AND DURING PREGNANCY – A CASE-CONTROL STUDY BIGUANID
IN PREGNANCY OF HYPERINSULINEMIC WOMEN

K. Todorova – Ananieva(1), E. Konova(2), D. Iafusco(3), O. Palaveev(5),
Al. Emin(2), M. Atanasova(1) and M. Guenova(4)
(1)High Risk Pregnancy Department, Specialized Hospital of Obstetrics and Gynecology, Medical University Sofia, Bulgaria
(2)Clinical Institute for Reproductive Medicine, Pleven, Bulgaria
(3)Department of Pediatrics, Second University of Naples, Naples, Italy
(4)Central Department Clinical Laboratory and Clinical Immunology, Medical Faculty, Sofia, Bulgaria
(5)Unipharm AD, Sofia, Bulgaria

Summary. The aim of this study was to evaluate the effects of metformin on maternal and neonatal pregnancy outcome among normoglycemic hyperinsulinemic women with one previous spontaneous abortion (SA). A prospective, two-year case-control study was performed including sixty-six pregnant women with normal carbohydrate tolerance before pregnancies and one SA. A 75-gram Oral Glucose Tolerance Test (OGTT) was performed before pregnancy. The levels of blood glucose (BG) and immunoreactive insulin (IRI) were measured at 0 min, 60 min and 120 min. Women with hyperinsulinemia were treated with metformin (0.75 g/day) before and during pregnancy. OGTT was repeated at 12 and 36 gestational weeks (g.w.) in all pregnant women. Pregnant women were divided into two groups: non-treated with metformin (Group 1; n1 = 32) and treated with metformin (Group 2; n2 = 34). The changes in BG, IRI levels during OGTT, live births and SA rates and newborn’s body weight were recorded. Statistical comparison was performed between treated and non-treated pregnant women. Logistical regression analysis was used to assess the effect of hyperinsulinaemia and metformin on the risk of pregnancy loss. No statistically significant differences in the mean values for age, body mass index (BMI) and BG levels were found. The IRI was significantly higher in women of n1 compared to n2 in early and in late pregnancy. Eleven (34.4%) pregnant women of n1 and five (14.7%) of n2 presented impaired glucose tolerance (IGT) at late pregnancy (P=0.03). There was no case of gestational diabetes (GD) in n2, whereas four (12.5%) of n1 developed GD in late pregnancy. There were no maternal complications and no birth defects in the group of patients treated with metformin. The body weight of the newborns was similar for both groups. The rate of miscarriage was 18.7% in Group 1, and 8.8% in Group 2. Pregnant women with IRI levels over 50 mIU/ml at 12 g.w. showed a significantly higher risk for SA in comparison with those with normal level of IRI, proved by the model of logistic regression (OR = 4.9; CI. 2.1-19.3). There was no statistically significant effect of metformin on the logistic regression model. Conclusion of our study was that the treatment with metformin during pregnancy was safe, improved metabolic markers and significantly reduced spontaneous miscarriage rates.
Key words: hyperinsulinemia, insulin resistance, gestational diabetes, metformin, pregnancy outcome, spontaneous abortion


PHARMACOECONOMIC ANALYSIS FOR THE FUTURE TREATMENT OF DIABETES MELLITUS
AFTER GESTATIONAL DIABETES

Katya Todorova-Ananieva
Specialized Hospital of Obstetrics and Gynecology, Medical University – Sofia, Bulgaria

Summary. The research aims to outline the risk of developing diabetes mellitus (DM) during the first year after giving birth for women with previous gestational diabetes mellitus (GDM), as well as to estimate the social efficiency value of the applied prophylactic method. A study has been performed among 50 women, with GDM for one year after delivery. During that period, a prophylactic program has been applied for DM prevention. The social efficiency of the applied prophylactic method is presented using the “decision tree” model. All indirect costs for future DM treatment are presented, as well as calculations are given for the added years of life with invalidity (DALY). DM has been observed at 13 (or 26%) out of 50 women with previous GDM in the first year after birth delivery. The total costs per women for the applied prevantive programme have been calculated at 12.1€. The total annual expenses for treatment and control of a women with Т2 DM and good metabolic control are 98.9€, for satisfying metabolic control – 122.1€ and for bad metabolic control – 241.8€. The total annual expenses for treatment and control of one women with Т1 DM and good metabolic control are 241.8€, for satisfying metabolic control – 303.7€, and for bad metabolic control – 119.5€. The social cost of late diagnosed or complicated Т2 DM is 10,994.80€. The cost for the complicated Т1 DM treatment is 20,979.38 € at 5% discount. The rate of DALY also varies according to the rate of diabetic complications. The calculated DALY for women with DM at stage of disability are: – 10.1 year for women with DM with no complications, 12.1 years for women with DM and a mild rate of complications, 13.6. г. – years for women with DM and with moderate complications and 15.1 years for women with DM and a severe rate of complications. Future DM treatment costs depend entirely on the extent of metabolic compensation, probability for later complications and the method of treatment. However, the prophylactic screening of the women with previous GDM can considerably save these costs.
Key words: pharmacoeconomy, gestational diabetes, pregnancy, DALY


LASER-INDUCED AUTOFLUORESCENCE SPECTROSCOPY OF BASAL CELL CARCINOMA AND PAPILLOMA
OF EYELIDS AND COMPARISON WITH THE RESULTS FROM THE HISTOLOGICAL INVESTIGATION

K. Koev(1), E. Borisova(2) and L. Avramov(2)
(1)Alexandrovska University Hospital – Sofia
(2)Institute of Electronics, Bulgarian Academy of Sciences – Sofia

Summary. Aim of the study was investigation and differentiation of normal eyelid skin and basal cell carcinoma and papilloma of eyelids with the method of laser-induced autofluorescence spectroscopy, and comparison with the results from the histological analysis of the tissues. 18 patients with basal cell carcinoma of eyelids and 12 patients with papilloma of eyelids were investigated. The method of laser-induced autofluorescence spectroscopy (LIAFS) was applied. Spectrometer S2000 produced by the company Ocean Optics was used. Nitrogenous laser with wavelength 337 nm was used for fluorescence excitation. Following the excision of the tumors, the materials were investigated histologically by standard methods. Two maximums of autofluorescence were observed from the normal eyelid tissue, respectively at 440 and 490 nm, due to the respective emission from the basic endogenous fluorophores in the skin: NADH and collagen. We ascertained identity between the clinical diagnoses of basal cell carcinoma and papilloma of the eyelid and the histological tests made after the extirpation. We registered increase of the intensity of the fluorescent signal in the sections affected by basal cell carcinoma and papilloma of the eyelid. In all cases of basal cell carcinoma of the eyelid, we established a new spectral component in the 400 nm range, and increase of the amplitude of fluorescence. There was a good correlation between the results from the histological analysis and the changes in the fluorescence spectra in cases of basal cell carcinoma and papilloma of eyelids. The potentials of fluorescence spectroscopy as a method for early diagnostic of tumor growths were demonstrated.
Key words: laser-induced autofluorescence spectroscopy, basal cell carcinoma and papilloma of eyel

 

PHYSIOLOGICAL MECHANISMS CONTROLLING CARDIOVASCULAR RESPONSES TO MUSCULAR STATIC LOAD
R. Nikolova(1), E. Vodenitcharov(2) and N. Tzacheva(3)
(1)National Center of Public Health Protection, Laboratory for Work Physiology and Psychology ― Sofia
(2)Medical University, Faculty of Medicine, Department of Hygiene, ― Sofia
(3)University Hospital “Tzaritza Joanna”, Faculty of Public Health,
Department of Occupational Medicine ― Sofia

Summary. A review synopsis of physiological mechanisms controlling cardiovascular responses to muscular static (isometric) load is presented. Muscular static load during work activity is associated with development of disorders of the musculoskeletal system known as repetitive strain injuries, cumulative trauma disorders or activity and work-related musculoskeletal disorders. One of the basic topics of occupational and physiological research is investigation of the mechanisms underlying induced cardiovascular responses to muscular static load. Static muscular load might affect most of the physiological cardiovascular responses, such as heart rate, cardiac cycle length, arterial pressure. Cardiovascular responses vary with the intensity of muscular exertion and contraction, and are part of processes that occur to adapt the circulation to the skeletal muscles’ need of blood. Reflex mechanisms that mediate circulatory changes during static muscular contraction, stimuli that initiate the reflex mechanism, and nerve structures which compose the reflex arc are indicated.
Key words: static load, isometric contraction, cardiovascular responses, reflex mechanisms, musculoskeletal disorders, health risk

 

COST-EFFECTIVENESS OF CELECOXIB IN PATIENTS WITH FAMILIAL ADENOMATOUS
POLYPOSIS: A BULGARIAN SCENARIO

G. Petrova, A. Stoimenova and M. Manova
Faculty of Pharmacy, Department of Social Pharmacy, Medical University – Sofia

Summary. Familial adenomatous polyposis (FAP) is a genetic disease, characterized by development of hundreds to thousands of intestinal polyps in the affected patients who are exposed nearly to 100% chance of developing colorectal cancer in their earlier ages. COX-2 selective inhibitors have been found to be effective in reduction of the number of adenomatous polyps in FAP-patients, as a secondary therapy to surgery, and additional endoscopic surveillance. The aim of this study was to assess the cost-effectiveness of the COX-2 inhibitor celecoxib in patients with FAP in Bulgaria. The non-selective non-steroidal anti-inflammatory medicines (NSAIDs) were selected as therapeutic alternative for celecoxib. Evidences for the final outcome in life years saved were derived from published studies after searching databases PubMed, Cochrane library, HTA, and NICE. There were selected 1 large-scale epidemiological study, 7 placebo-controlled randomized trials, and 5 pharmacoeconomic studies. The time horizon was for 1 year and point of view was for the health care system. It was considered the pharmacotherapy cost only. The total cost of therapy with celecoxib was calculated as 335 800 Bulgarian leva (BGN), while the lowest possible cost of therapy with non-steroidal anti-inflammatory drugs is 168 937 BGN. Data from the RCT showed, that 40 people more could be saved annually if they were treated with celecoxib instead of acetysal, and the loss for the society is 10 times higher. Thus the cost per life year saved using celecoxib instead of acetysal is 4172 BGN. Our results confirmed those from the international pharmacoeconomic studies, showing that celecoxib use is cost-effective also for Bulgaria because the cost per LYS is less than the yearly GDP per capita.
Key words: COX-2 inhibitors, celecoxib, cost-effectiveness, CRC, familial adenomatous polyposis

 

FOOD SUPPLEMENTS IN CENTRAL AND EASTERN EUROPEAN COUNTRIES
A. Stoimenova
Faculty of Pharmacy, Department of Social Pharmacy, Medical University – Sofia

Summary. The consumption of food supplements, functional foods and beve­rages is constantly increasing. The increase of the different segments of the market varies from 5 to 15%. Worldwide, the most dynamic food supplement markets are the ones in United States, European Union (EU), China, India and Japan. In recent years, the economics of Central and Eastern European countries (Russia, Poland, Ukraine, Bulgaria, Romania, Czech Republic, Slovakia, Slovenia and Croatia) have shown significant development which also reflects the food supplement market. The article outlines the main tendencies in the development of food supplement markets in Central and Eastern European countries as one of the most dynamic segments of the EU food supplements market. Market drivers, business trends in the industry and market prospects are discussed. The food supplement market in Eastern European countries is dominated by the multivitamin market and mineral supplement. Other food supplements with significant consumption are various combination products, vitamin C, vitamin B, tonics and child-specific preparations. Plant-based food supplement are less used. The common interest for development of regulated and stable markets of food supplements with the efforts of regulators, manufacturers, distributors, medical specialists and consumers would further develop food supplements markets for the benefit of the consumers. Consumer and medical specialists’ education is needed in order to balance the safety of food supplements with the free market concept.
Key words: food supplement, dietary supplement, vitamins, market, Eastern Europe, Bulgaria

 

QUALITY OF LIFE AND AGE AT ONSET IN PATIENTS WITH PARKINSON’S DISEASE
A. Todorova
University Hospital for Neurology and Psychiatry “Sv. Naum” – Sofia, Bulgaria

Summary. The impact of Parkinson’s disease (PD) on the lives of young patients differs significantly from the impact the disease has on the lives of older patients. In this study, we investigated 35 patients with early onset of PD and 81 with late onset. For assessing the severity of PD we used Hoehn and Yahr scale and for clinical evaluation – Unified Parkinson’s Disease Rating Scale (UPDRS). Beck Depression Inventory (BDI) was used for assessing the presence and severity of depression. For measuring quality of life, the three disease-specific quality of life questionnaires – PDQ-39, PDQL and PIMS, were used. The patients with early onset of PD had worse results for the summary index score PDQ-39Bg-Si. Still, among some of the subscales of the questionnaire – “mobility”, “daily activities”, and “social support”, there was a statistically significant difference between the two groups, and the patients with early onset reported worse quality of life. Young onset patients had also worse results on the stigma subscale and were more frequently depressed. Moderate to severe depression, defined as such by BDI scores above 20, was present in a significantly high percentage of the patients within the group with early onset of the disease (43%) in comparison to those with late onset (34%). In conclusion, the impact of PD on the life of the patients is more expressed when the disease starts at a younger age which could partially be due to the differences in the Parkinsonian symptoms or the more frequent occurrence of levodopa related dyskinesias.
Key words: Parkinson’s disease, quality of life, young onset, late onset, depression

 

A COMPARISON OF REMISSION IN BIPOLAR AND RECURRENT DEPRESSIVE DISORDERS:
CLINICAL AND SOCIO-DEMOGRAPHIC CHARACTERISTICS

V. Stoyanova(1), S. Krastev(1), R. Vladimirova(1), G. Genchev(2) and V. Milanova(1)
(1)Psychiatric Clinic – University Hospital “Alexandrovska”
(2)Department of Medical Information and Biostatistics, Medical University – Sofia

Summary. Even in periods of remission, affective disorders are illnesses with hidden morbidity and serious implications on both the family and society. During the last years, the problem of reccurence has been emerging as the leading in diagnosis, treatment and prognosis of these conditions. The aim of this study was to evaluate some important socio-demographic and clinical characteristics during the period of remission in patients with uni- and bipolar course of the affective disorders. The design of the study was naturalistic, the data processing used the statistical software package SPSS 17.0.1 and the study sample comprised 37 patients with bipolar affective disorder (BAD) and 28 patients with recurrent depressive disorder (RDD). The mean illness duration for the patients with BAD significantly exceeded that for the patients with RDD (р=0.003), as the number of episodes and the number of hospitalizations were also higher for the patients with BAD (р<0.001). The presence of psychotic symptoms during an episode was mainly characteristic for the patients with BAD (р=0.003), while more residual depressive symptoms during a remission were observed in the patients with RDD (р=0.023). The number of individuals with high educational status was significantly higher for the patients with BAD (р<0.001). Social dysfunctions were manifested to a greater degree in the patients with RDD, reaching, however, the cut-off value of significance (р=0.097). Conclusions: The period of remission is a part of the illness history, as some important characteristics, such as educational status, residual symptoms and functioning, may serve as predictors for the remission stability and course of the disease.
Key words: recurrent depressive disorder, bipolar affective disorder, clinical characteristics, quality of remission

 
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