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CURRENT ISSUE /1-2014

ASSESSMENT OF BETA-CELL FUNCTION DURING PREGNANCY AND AFTER DELIVERY
M. P. Genova(1), K. Todorova-Ananieva(2), B. Atanasova(1) and K. Tzatchev(1)
(1)Department of Clinical Laboratory and Clinical Immunology, Medical University,
University Hospital “Alexandrovska”, Sofia, Bulgaria
(2)University Clinic of Endocrinology, Medical University, Pleven, Bulgaria

Summary. The aim of the present study was to assess beta-cell function using homeostasis model (HOMA-B) and disposition index (DI) in pregnant women with/without gestational diabetes, and after delivery. A total of 102 pregnant women between 24-28 gestational weeks (53 with gestational diabetes mellitus (GDM) and 49 with normal glucose tolerance (NGT) and 22 GDM postpartum women (8-12 weeks after delivery) were included in the study. All postpartum women had a history of GDM. HOMA indexes (insulin resistance – HOMA-IR and HOMA-B for assessing beta-cell function) were calculated from fasting glucose and insulin concentrations. To estimate insulin secretion independent of insulin sensitivity, DI was calculated using glucose and insulin levels at 0 and 60 min during the course of a 2 h 75g oral glucose tolerance test (OGTT). In GDM pregnant women HOMA-B was significantly lower compared to NGT women (p = 0.017), but there was no significant difference compared to women after birth (NS). There was difference between NGT and postpartum women (p < 0.05). DI was significantly lower for GDM pregnant women in comparison to NGT and postpartum women (p < 0.0001; p = 0.011), between NGT and women after birth (p < 0.04). In our study, comparison of НОМА-В in NGT and GDM pregnant women demonstrated that the OR of developing GDM was 0.989 (95% CI, 0.980-0.998, P = 0.013), and comparison of DI in healthy pregnant and GDM showed that the OR of developing GDM was 0.967 (95% CI, 0.947-0.988, P = 0.002). Therefore, HOMA-B and DI appear to be protective factors in the risk of developing GDM. According to our results, assessment of beta-cell function, using HOMA-B and DI, showed that they are lower in GDM than NGT group and postpartum women. It is important to note that HOMA-B did not show significant difference between GDM pregnant and women after delivery with a history for GDM. We assume that pregnant women with GDM have a pancreatic beta-cell defect that remains after birth. These women are at increased risk for developing diabetes mellitus, the most frequent type 2 diabetes, in the future after birth.
Key words: gestational diabetes mellitus, beta-cell function, homeostasis model assessment, disposition index

 

PROINSULIN IN HEALTHY PREGNANCY, PREGNANCY WITH GESTATIONAL DIABETES AND AFTER DELIVERY
M. P. Genova(1), K. Todorova-Ananieva(2), B. Atanasova(1) and K. Tzatchev(1)
(1)Department of Clinical Laboratory and Clinical Immunology, Medical University,
University Hospital “Alexandrovska”, Sofia, Bulgaria
(2)University Clinic of Endocrinology, Medical University, Pleven, Bulgaria

Summary. The aim of the present study was to evaluate the levels of pro-insulin and pro-insulin/ insulin ratio (PIR) in pregnant with normal glucose tolerance (NGT), pregnant with gestational diabetes mellitus (GDM) and women after delivery with GDM history. Normal pregnancy is characterized by progressive insulin resistance, which is physiologically compensated by an increase in insulin secretion. The higher secretion of the insulin precursor pro-insulin has been associated with beta-cell dysfunction. A total of 102 pregnant women between 24-28 gestational weeks (53 GDM pregnant, 49 with NGT) and 22 post partum with GDM history, as assessed by a 2h oral glucose tolerance test, were included in the study. Fasting plasma insulin and pro-insulin (PI) concentrations at the basal state were measured in all women. The ratio pro-insulin/insulin was calculated. BMI was significantly higher in GDM pregnant compared to NGT weight-matched group (30.56 ± 6.9 vs. 30.56 ± 6.9; p < 0, 011) and compared to the levels after delivery (30.56 ± 6.9vs. 27.9 ± 6, 27; p < 0, 001). Significant differences in the levels of PI between NGT and GDM pregnant (3.94 ± 2.78 vs. 7.59 ± 5.27; p = 0.006), between GDM and post partum women (7.59 ± 5.27 vs. 4.46 ± 1.14; p = 0.022) were established. No significant difference in the level of PIR between two pregnant groups was observed. Separately NGT and GDM showed significant difference compared to young mothers (0.41 ± 0.14 vs. 0.148 ± 0.031, p < 0.02; 0.46 ± 0.16 vs. 0.148 ± 0.031, p = 0.009). Fasting insulin was statistically higher in GDM pregnant compare to NGT and women after delivery (13.84 ± 8.43 vs. 11.35 ± 7.38, p = 0.02; 13.84 ± 8.43 vs. 10.60 ± 7.53, p < 0.01). The correlation between PIR and BMI in the three groups studied were r = 0.416; r = 0,741; r = 0,556 (with statistical significance p = 0.01 between NGT and GDM pregnancy, p = 0.02 between GDM pregnancy and post-partum, p < 0.0001 between NGT pregnancy and young mother with GDM history). In our study, comparison of PI levels between pregnant with NGT and GDM demonstrated that the OR of developing GDM was 1.194 (95% CI, 1.028-1.329, P = 0.001). Increasing the value of PI with 10 pmol/l increases the risk for development of GDM with 19.4%. According to our results, pregnant with GDM have elevated levels of pro-insulin and PIR which could serve as a markers for this condition. These results support our findings about relationship and influence of BMI on β-cell functions, established in this study with normotolerant, gestational diabetes pregnant and women post partum with GDM history. These results demonstrate that gestational diabetics have abnormalities in pancreatic beta-cell secretion, which are likely to be important both in the etiology of gestational diabetes and non-insulin dependent diabetes.
Key words: body mass index, gestational diabetes mellitus, pro-insulin, PIR

 

ELISA METHOD FOR SERUM HEPCIDIN QUANTIFICATION IN BULGARIAN POPULATION
V. Manolov, B. Atanasova, V. Vasilev, K. Tzatchev and M. Velizarova
Department of Clinical Laboratory and Clinical Immunology, Medical Faculty, Medical University, Sofia, Bulgaria

Summary. Hepcidin is a 25-aminoacid cysteine-rich iron regulating peptide. Hepcidin quantification in human blood may provide further insights for the pathogenesis of disorders of iron homeostasis and might prove a valuable tool for clinicians for the differential diagnosis of anaemia. This study describes ELISA immunoassay for hepcidin quantification in human serum. We used a sandwich ELISA method from USCN Life Science inc., that consists of ready to use, pre-coated 96-well strip plate with 2 antihepcidin-25 monoclonal antibodies. A recombinant hepcidin in 16 μg/l concentration is used as a standard; it reconstitutes with 1.0 ml standard diluent to prepare a stock solution. We correlated ELISA results of hepcidin-25 measurements in healthy population with hemodialysis patients. The sandwich ELISA was highly specific for hepcidin-25, having a low limit of quantification of 0.020 mcg/l. Hepcidin-25 concentrations were increased in hemodialysis patients (median 33.05 mcg/l, range 22.31-60.98 mcg/l, n = 10) compared with healthy individuals (median 12.41 mcg/l, range 6.05-18.53 mcg/l, n = 40). The use of 2 monoclonal antibodies in a sandwich ELISA format provides a robust, convenient and not very expensive method for measuring concentrations of the active form of hepcidin. It should help to improve our understanding of the role of hepcidin in regulating iron metabolism.
Key words: hepcidin, quantification, ELISA, hemodialysis, iron metabolism

 

CONTINUED PROFESSIONAL EDUCATION OF BULGARIAN PHARMACISTS: SECOND REGISTRATION PERIOD
G. Petrova(1,2), I. Nikolov(2), Z. Ivanova(2), Tz. Decheva(2), Tz. Valchanova(2), G. Draganov(1,2),
T. Naydenov(3) and A. Stoimenova(1)
(1)Department of Social Pharmacy, Faculty of Pharmacy, Medical University – Sofia, Bulgaria
(2)Quality Commission, Bulgarian Pharmaceutical Union, Sofia, Bulgaria
(3)Management Board of Bulgarian Pharmaceutical Union

Summary. The continuing professional education prepares the pharmacists for the requirements of the changed role of pharmacists in the society. Different approaches to continuous professional education ranging from lectures to peer-mentoring work shops and web tools have been developed throughout the last 25 years. The goal of the current analysis is to systematize the trends in accredited education events for pharmacists by the Quality Committee of the BPhU during 2010-2013. This study is a retrospective database analysis. The information concerning the accredited forms of continuing education of pharmacists as well as other activities related to continuing education was extracted from the official protocols, issued by the Quality Commission of the Bulgarian Pharmaceutical Union (BPhU). The continuing postgraduate education of pharmacists in Bulgaria is developing with new elements which allow competence development through individual forms of self-development such as publication activities, delivering presentations, individual training, etc. In the educational programs accredited during the second registration period, still prevailed the short courses, with focus on the new medicinal products.
Key words: pharmacists, continued education, Bulgaria


EARLY CLINICAL EFFECTIVENESS OF ER:YAG LASER IN ASSOCIATION WITH THE RED COMPLEX OF BACTERIA IN THE
INITIAL TREATMENT OF MODERATE CHRONIC PERIODONTITIS

Bl. Yaneva(1), E. Firkova(1) and E. Karaslavova(2)
(1)Department of Periodontology and Oral Diseases, Faculty of Dental Medicine,
Medical University ― Plovdiv
(2)Faculty of Biology, Plovdiv University “Paisii Hilendarski”

Summary. Chronic periodontitis is a result of polymicrobial infection and its treatment aims removal of dental calculus and biofilm from the periodontal pocket. Many hand and power-driven instruments are created for this purpose. In recent years, lasers are widely discussed tools for periodontal therapy. The aim of the present study is to evaluate the early microbiological and clinical effectiveness of the Er:YAG laser in the treatment of chronic periodontitis. 30 patients with moderate chronic periodontitis were enrolled in the study. Using a split-mouth design they were treated either with Er:YAG laser (chisel tip, 100 mJ, 15 Hz, 5-6 water spray)-test group or with Gracey curettes-control group. Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), bleeding on probing and plaque presence were evaluated at baseline and one month after the therapy. Microbiological samples were taken from the deepest four pockets of each quadrant from 20 randomly selected patients (n = 80). They were evaluated using real time PCR for periodontal pathogens from the red complex (Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia). One month after therapy in the control group PPD decreased from 4.59 mm to 3.36 mm, the CAL gain was 1.09 mm and the reduction of bleeding and plaque – from 87.9% to 33.7% and from 75.9% to 40.9%, respectively. In the test group PPD decreased from 4.58 mm to 3.15 mm, the CAL gain was 1.37mm and the reduction of bleeding and plaque was from 85.6% to 25.9% one month after the treatment. The results were statistically significant in favour of the laser group (p < 0.05). Microbiological analysis revealed that the pathogens from the red complex decreased 3 times in the control and 6 times in the test group. Therefore, the Er:YAG laser demonstrate pronounced early effectiveness in chronic periodontitis treatment and would be appropriate alternative of the conventional periodontal therapy.
Key words: periodontitis, Er:YAG laser, clinical effectiveness


RESECTION OF THE TOOTH APEX WITH DIODE LASER
Tz. Uzunov(1), P. Uzunova(2), T. Uzunov(1) and R. Grozdanova(1)
(1)Faculty of Dental Medicine, Medical University – Sofia
(2)Faculty of Medicine, Medical University – Sofia

Summary. An “in vitro” experimental study has been carried out on 70 extracted teeth. A laser resection of the root apex has been carried out with diode laser beam with a wavelength of – 810 ± 10 nm. Sequentially a radiation with increasing power has been applied, as follows: 1,3 W, 2W, 3W, 4W, 5W, 6W, 7W, in electro surgery mode. Successful resection of the tooth apex has been performed at: 3W; 4W; 5W; 6W and 7W power. It was established that when laser resected the tooth apex carbonizes.
Key words: diode laser, apical osteotomy, "Denlase"

 

STRESS, VISUAL AND MUSCULOSKELETAL COMPLAINTS IN OPEN PLAN OFFICE STAFF
K. Vangelova and V. Stanchev
National Center of Public Health and Analyses, Sofia, Bulgaria

Summary. The aim of the study was to identify the main ergonomic and organizational risks contributing to stress, visual and musculoskeletal disorders in open plan office workers. A total of 73 subjects of mean age 28.3 ± 4.7 years were studied. Measurements of salivary cortisol and self-ratings for strain, fatigue, stress symptoms, visual and musculoskeletal complaints were performed. The work places were organized well, but the studied staff reported high work load and time pressure. The data showed higher cortisol levels during the workday under time pressure. High incidence of visual and musculoskeletal complaints mainly in the region of the back and the neck were found, associated with flickering and blinks on the screen monitors and overtime. Optimizing workplace organization could help reduce stress and health complaints of office staff.
Key words: ergonomics, cortisol, fatigue, visual complaints, musculoskeletal complaints


HYPERTROPHIC SCARS AND KELOIDS – CONTEMPORARY CONCEPTS AND TREATMENT OPTIONS
Y. P. Yordanov(1) and A. Shef(2)
(1)Unit of Plastic Surgery and Burns, Military Medical Academy, Sofia
(2)Department of Dermatovenereology and Allergology, Military Medical Academy, Sofia

Summary. Wound reparative process after surgery, burns, injuries, and inflammatory processes results in a spectrum of scar formation ranging from nearly scarless healing to excessive fibrosis or atrophy. Scarring is considered a major medical problem that leads to aesthetic and functional sequelae. Scar tissue is clinically distinguished from normal skin by an aberrant color, rough surface texture, increased thickness (hypertrophy), occurrence of contraction, and firmness. In the last decade, the concept of wound healing kinetics has been developed to describe the delicate balance of cell activity involved in scar formation and remodeling. Hypertrophic scars and keloids are formed as a result of the process of abnormal wound healing. Despite all that has been written on improving the appearance of these types of scars, there are no definitive management protocols. The aim of the present article is to make a brief review of the basic wound healing, while focusing on medicine’s latest understanding of the development and treatment of keloids and hypertrophic scars.
Key words: wound healing, scar assessment, hypertrophic scars, keloids, treatment

 

TOXOPLASMOSIS AND ITS OCULAR MANIFESTATIONS
Kr. Koev
Department of Urgency Medicine
Medical University – Sofia

Summary. The present review provides general information about the parasitic infection of toxoplasmosis and describes the ways of its transmission. It outlines the importance of the consequences of toxoplasmosis infection and the methods of its prevention. The review traces the harmful effects of the disease on human and animal organisms, the causes and stages of development of the disease. The review specifically focuses on the ocular manifestations of toxoplasmosis which can cause ocular lesions, inflammation and scarring. Herein are described the ways toxoplasmosis can damage the eyes causing chorioretinitis, nystagmus, microphthalmia, etc. Furthermore, the review addresses the problem of how congenital and acquired toxoplasmosis affects eyes. The ocular symptoms of toxoplasmosis include weakened or blurred vision, eyeballs pain, ocular sensitivity to light, etc. The harmful effects of toxoplasmosis to pregnant women and immunocompromised patients have been delineated. Some of the disease manifestations include jaundice, rash, asphyxia, etc. The review traces the diagnostic work-up and comments on common tests for toxoplasmosis, such as taking of blood serum samples. The review ends with the treatment of the disease and of its ocular manifestations in particular, for example application of intravitreous injection. The prevention of the infection is extremely important for pregnant women, immunocompromised patients and patients with AIDS.
Key words: toxoplasmosis, ocular manivestations

 

EARLY ONSET BASAL CELL CARCINOMA: SURGICAL APPROACH
M. Betekhtin(1), J. Ananiev(2), G. Tchernev(3), L. Zisova(4), S. Philipov(5) and R. Hristova(4)
(1)Moscow Medical Multidisciplinary Center, Moscow, Russia
(2)Department of General and Clinical Pathology, Medical Faculty, Trakia University,
Stara Zagora, Bulgaria
(3)Polyclinic for Dermatology and Venereology, “St. Kliment Ohridski" University,
University Hospital Lozenetz, Sofia, Bulgaria
(4)Dermatology and Venereology Department, Medical University, Plovdiv, Bulgaria
(5)Department of General and Clinical Pathology, Medical Faculty, “St. Kliment Ohridski" University, Sofia, Bulgaria

Summary. Basal cell carcinoma (BCC) is the most frequent non-melanoma skin cancer. Only 5-15% of BCC cases can be found in patients aged 20-40 years (so-called early onset). The early onset BCC is characterized by active and aggressive tumour growth, clinically presenting in most of the cases as a morpheaform, locally infiltrating or recurrent BCC. Despite the advances in the study of the pathogenesis of this tumour, surgery remains the most used, most effective and most suitable treatment modality. We describe a case of a 39-year-old woman who developed an early onset BCC of the nasolabial fold. After the subsequent surgical excision an excellent cosmetic result was achieved.
Key words: Basal cell carcinoma, early onset, surgery, excision

 

HPV-ASSOCIATED PENILE PIGMENTED LESION
J. Ananiev(1), G. Tchernev(2), S. Philipov(3), C. Guarneri(4), J. W. Patterson(5), L. Zisova(6), R. Hristova(6), M. Betekhtin(7) and U. Wollina(8)
(1)Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora
(2)Polyclinic for Dermatology and Venerology, University Hospital Lozenetz,
"Saint Kliment Ohridski University", Sofia
(3)Department of General and Clinical Pathology, Medical Faculty, "Saint Kliment Ohridski University",
(4)Assistant Professor of Dermatology and Venereology, Department of Social Territorial Medicine,
Section of Dermatology, University of Messina, Italy
(5)Division of Surgical Pathology and Cytopathology, University of Virginia, USA
(6)Department of Dermatology and Venerology, Plovdiv Medical University, Bulgaria
(7)Medical center, Moscow, Russia
(8)Department of Dermatology & Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse, Dresden, Germany

Summary. HPV infection is involved in the etiology of a number of nonmalignant, premalignant and malignant cutaneous lesions. One of them is the so-called giant condyloma of Buschke-Lцwenstein type (Buschke-Lцwenstein tumor, BLT), which sometimes can imitate clinically other tumors or tumor-like conditions. Clinicians face a particular challenge in cases of BLT where, clinically, the lesions demonstrate a permanent brown hyperpigmentation in parallel with the dermatoscopic lack of the characteristic melanocytic network, globules or regression zones. There are uncommon clinical presentations with solitary, sharply demarcated pigmented lesions. In these cases the histopathological verification of the lesion is obligatory and the most efficient treatment method in the early period of the disease is the complete surgical excision. We report a case of a 74-year-old man who was admitted to the University Hospital “Lozenetz” in connection with profuse variceal bleeding of the esophagus associated with liver cirrhosis of unknown etiology. He underwent a consultative examination at the department of dermatology because of suspected advanced stage melanoma of the prepuce. Computed tomographic analysis indicated diffuse bone metastases located in the small pelvis and femur, as well as metastatic disease in the left inguinal lymph nodes. However, the subsequent histopathologic examination of the lesion, rather than showing melanoma, confirmed the presence of HPV-associated giant condyloma of Buschke and Lцwenstein in initial stage, without histopathological evidence for invasive and destructive tumor growth. After his death, the patient’s relatives did not give consent for an autopsy, and therefore the genesis of the metastases, demonstrated by nuclear magnetic resonance imaging (NMR), remained unclear. In some cases, the clinical picture of the malignant and premalignant cutaneous lesions in the genital area could be problematic. The complete surgical excision with a subsequent histopathological verification is the best way to find out the exact diagnosis.
Key words: HPV, papillomatosis, malignant melanoma, differential diagnosis, koilocytosis

 

SUBCONJUNCTIVAL DIROFILARIA REPENS
I. Neichev(1), K. Slaveykov(1), K. Trifonova(1) and B. Chakarova(2)
(1)Department of Ophthalmology and General Medicine, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
(2)Department of Parasitology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria

Summary. Dirofilariasis is a relatively rare zoonotic disease that affects mainly dogs. The two most common representatives are Dirofilaria immitis and Dirofilaria nochtiella. Studies have documented the spread of the disease across Central and Eastern Europe in recent years due to global changes. In Bulgaria since 2001 there are around 20 cases of dirofilariasis in dogs registered yearly. We report a case of subconjuctival dirofilariasis in a 47-year-old woman living in Southwestern Bulgaria. The infection manifested as a painful, inflamed nodule in the left eye, containing a vital parasite. Morphological analysis aroused suspicion for a filarial worm belonging to the genus Dirofilaria. Subsequent analysis confirmed suspicions and identified the parasite as Dirofilaria repens. After removal, the subconjunctival nodule completely resolved and the patient was successfully cured.
Key words: ophthalmology, dirofilariasis

 

CARDIAC GLYCOSIDE PLANTS SELF-POISONING
J. Radenkova-Saeva(1) and P. Atanasov(2)
(1)Clinic of Toxicology, UMHATEM “N. I. Pirogov”, Sofia, Bulgaria
(2)Clinic of Internal Medicine, UMHATEM “N. I. Pirogov”, Sofia, Bulgaria

Summary. Cardiac glycosides are found in a diverse group of plants including Digitalis purpurea and Digitalis lanata (foxgloves), Nerium oleander, Convallaria majalis (lily of the valley), Strophanthus gratus, etc. Nerium Oleander is an indoor and ornamental plant of an evergreen shrub. It’s widespread in countries with a Mediterranean climate. Oleander is one of the most poisonous plants known to humans. All parts of the nerium oleander are poisonous, primarily due to the contained cardiac glycosides – oleandrin, nerin, digitoxigenin, and olinerin of which oleandrin is the principal toxin. The bark contains the toxic substances of rosagenin which causes strychnine-like effects. Signs of poisoning appear a few hours after the adoption of the parts of the plant. Two cases of Nerium Oleander poisoning were presented. Clinical picture included gastrointestinal, cardiovascular and central nervous system effects. The clinical symptoms were characterized by nausea, vomiting, salivation, colic, diarrhoea, ventricular tachycardia, dysrhythmia, heart block, ataxia, drowsiness, muscular tremor. Treatment included administration of activated charcoal, symptomatic and supportive care.
Key words: toxic plants, oleander, poisoning, glycosides, oleandrin

 
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