Original articles 2/2014

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MICROSURGICAL RECONSTRUCTION OF EXTENSIVE ABLATIVE DEFECTS, AFFECTING THE SKULL BASE
Y. P. Yordanov
Unit of Plastic Surgery and Burns, Military Medical Academy – Sofia
Summary. Ablative and traumatic defects in the skull base region produce complex reconstructive problems with a high risk of significant postoperative morbidity and mortality. Over the past two decades, microvascular free tissue reconstruction following open conventional resections has been shown to improve outcomes and reduce complication rates when compared to the traditional use of pedicled flaps. The increasing use of free tissue transfer has been further strengthened by improved technical expertise and high flap success rates.This study was designed to demonstrate the free flap reconstruction of extensiveskull base defects, applying different microvascular flaps. All extensive anterior skull base penetrating tumor resections with microvascular reconstruction made in the plastic surgery unit of the General University hospital Gregorio Mrañón in Madrid (Spain) between September 2009 and December 2012 were reviewed. Seventeen patients with mean age 51.6 y were included in the study. Nineteen free microvascular flaps were used in total being the rectus abdominis flaps the most commonly used. However, four different types of flaps were applied. Two infectious complications were observed (11.7%), two cases of CSF leak (11.7%), one case of wound dehiscence (5.9%) and one case of partial distal necrosis of the flap (5.9%) were observed. Total flap necrosis was not registered in the study. Two latissimus dorsi donor site haematomas were observed (11.7%). Microvascular free tissue transfer is a safe and reliable method of anatomical reconstructing skull base defects while offering favorable cosmetic and functional results.
Key words: microsurgery, skull base reconstruction, free flaps, complications
Address for correspondence: Yordan P. Yordanov, MD, PhD, Unit of Plastic Surgery and Burns, Military Medical Academy, 3, Sv. G. Sofiyski St., Bg – 1606 Sofia, tel. +359 887 56 00 54, e-mail: yordanov_vma@abv.bg

CLINICAL AND ETIOLOGICAL STRUCTURE OF NOSOCOMIAL INFECTIONS
IN BULGARIA FOR THE PERIOD 2011 TO 2013

Y. Mitova, V. Dojcheva and S. Angelova
Department “Epidemiology”, Medical University – Sofia
Summary. Despite the partial diagnostics and registry, nosocomial infections in Bulgaria are widespread and have a great significance on health, as well as social and economic impact. Statistical estimates of official data for the 2011-2013 period show that the frequency of registered nosocomial infections among hospitalized patients is under 1%. Within the clinical structure of nosocomial infections in Bulgaria during the discussed peroid leading part take pneumonia and other lower respiratory tract infections, with a 21,22% share. Their leading etiological agents in Bulgaria are Acinetobacter spp. and Pseudomonas spp. Infections of the urinary tract take 15,65% of the clinical structure of nosocomial infections. They are mostly caused by E. coli (29,68%). During the etiological decoding of the surgical site infection, the highest frequency of isolation is due to S. aurevs (20,67%) and E. coli (20,18%). As for the bloodstream infections the isolated agent in 29,55% of the cases is coagulase negative staphylococcus (primarily S. epidermidis).
Key words: nosocomial infections, distribution, clinical structure, etiological agents
Address for correspondence: Yordanka Mitova-Mineva, MD, PhD, Department of Epidemiology, Medical University, 2 Zdrave st., Bg – 1431, Sofia, e-mail:drmitova @mail.bg

COMPETENCE OF HEALTH CARE WORKERS WITH RESPECT TO STANDARD PRECAUTIONS FOR INFECTION CONTROL
M. Karcheva1, S. Mihaylova1,2, I. Makaveev3, A. Dimitrova3 and L. Mihaylova2
1Medical University – Pleven
2Pleven University Hospital
3Military Medical Academy – Hospital Facility for Active Treatment – Pleven

Summary. Aim: To study the competence of health care workers with respect to standard precautions for infection control. Material and methods: One hundred and thirty-one health care workers (nurses and midwives) aged from 24 to 60 years with work experience between 1 and 40 years were subject of investigation. A self-reported questionnaire was used. Data were processed by the program IBM SPSS Statistics 20.0. Results: The majority of health care workers indicated the aim of standard precautions (n = 93, 71.0%) and all possible cases in which they have to be applied (n = 109, 83.2%); identified the wrong answers connected with medical waste separation (n = 115, 87.8%) and personal protective equipment (n = 118, 90.1%); answered correctly the questions concerning mask usage (n = 109, 83.2%), working clothing (n = 112, 85.5%) and gloves (n = 113, 86.3%). A lower proportion of nurses and midwives recognized the necessary time for hand washing with soap and water (n = 47, 35.9%); knew permissible volume for filling containers with used needles and syringes (n = 67, 51.1%) and were informed that the front of protective glasses is considered contaminated (n = 89, 67.9%). Conclusion: Medical specialists demonstrate high levels of knowledge with respect to standard precautions. These results reflect the adaptation and introduction of internationally approved regulations and requirements in practice in Bulgarian hospitals. The gaps found could provide insight for choosing the topics for periodic instructions connected with infection control. In this way, a high quality of health care, safety, as well as protection of the rights of health care workers, patients and third parties will be provided.
Key words: competence, health care workers, standard precautions
Address for correspondence: Assoc. Prof. Milena Karcheva, MD, PhD, Section “Epidemiology, parasitology and tropical medicine”, Medical University, 1 Sv. Kliment Ohridski St., Bg – 5800 Pleven, e-mail: milena_karcheva@abv.bg

CAMPYLOBACTERIOSIS AND SALMONELLOSIS – DIFFERENTIAL DIAGNOSIS STUDIES IN CHILDREN
V. Velev1.2, N. Durvenyashka1,2, N. Naydenova1,2, V. Ilchova2, I. Tomova2, S. Aleksieva1,2 and M. Tiholova1,2
1Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical Universisty – Sofia
2SHATIPD “Prof. Iv. Kirov” – Sofia

Summary. The aim of the study was to investigate the differences in the clinical course of salmonellosis and campylobacteriosis in children. Diagnosed and treated were a total of 27 children, 15 with campylobacteriosis and 12 with salmonellosis – an average age of 3.9 years. The study included only children with culture proven cause for the period March 2012 – August 2013 from SHATIPD "Prof. Ivan Kirov". Used were clinical, epidemiological and lab methods of investigation. Salmonellosis occurred significantly more frequently with low-grade febrile values in comparison to Campylobacter disease (42% to 2.22%), but the difference in high febrile cases no longer exists (58% to 58.33%). In Campylobacter disease defecation varies between 3 and 5 times, at a 10 times over salmonellosis. In both diseases defecation occurs most frequently between 5 and 10 times (46% for Campylobacter to 50% of salmonellosis). In salmonellosis the impurity of mucus (67%) is frequent, while campylobacteriosis mucus and blood is frequent (73.33%). In salmonellosis vomiting ocurrsis frequenly more than 5 times (16.66% to 0%). Campylobacteriosis and salmonella as typical bacterial zoonoses have similar moments of course – diarrhea pathological impurities; upper dyspeptic syndrome and abdominal pain. Leading in campylobacteriosis is high febrile temperature in most cases, which is an expression of a more severe intoxication. In the majority of stool present both pathological impurity – mucus and blood. In salmonellosis are more pronounced incidence of upper and lower dyspeptic syndromes and impurities of mucus in the stools.
Key words: campylobacteriosis, salmonellosis, differential diagnosis
Address for correspondence: V. Velev, MD, Department of Infectious Diseases, Parasitology and Tropical Medicine, MU, 17 Akad. Ivan Geshov bvl., Bg – 1431 Sofia

OVERALL MIGRATION FROM FOOD CONTACT MATERIALS – FIRST SURVEY OF THE ITEMS FROM THE BULGARIAN MARKET
T. Vrabcheva, J. Tishkova, T. Barakova and V. Christova-Bagdassarian
Food Contact Materials Department, National Center of Public Health and Analyses – Sofia
Summary. Food contact materials are used along the whole chain of food supply, processing, storage and consumption. These materials are insufficiently studied source of exposure. In this connection, surveys for overall migration from commercially available food contact plastics were conducted for the first time in Bulgaria. For this purpose, standard European methods were verified. The test conditions of the items are selected according to the relevant guidelines of the European Reference Laboratory for food contact materials. The results obtained for 68% of samples were below the limit of detection of the method. For 9.8% of the samples noncompliance with the regulations was found. The results obtained were stratified according to type of the polymer and intended use. The item’s groups, indicating a risk to human health have been established. Attention was focuses to the materials and articles showing the results significantly above the limit on overall migration (color masterbatch and polyamide articles).
Key words: food contact materials, plastics, overall migration
Address for correspondence: Chief Assistant Eng. Valentina Christova-Bagdassarian, PhD, Food Contact Materials Department, National Center of Public Health and Analyses, 15, Akad. Iv. Ev. Geshov Blvd., Bg – 1431 Sofia, Phone number: +359 2 80 56 375, е-mail: v.hristova@ncpha.government.bg

SOCIOLOGICAL STUDY OF DENTAL MEDICINE PRACTICIONERS’ KNOWLEDGE AND ATTITUDE FOR APPLYING THE METHOD BIOLOGICAL TREATMENT
OF THE PULP

V. Stefanova1, S. Tzanova2, M. Manolova1 and D. Dimitrova2
1Department of Operative Dentistry and Endodontics, Faculty of Dental Medicine
2Department of Health Management, Economics of Health Care and General medicine,
Faculty of Public Health, Medical University – Plovdiv

Summary: Aim: This study aims to investigate the information and attitude of dental medicine practitioners towards the new materials and technologies in biological treatment of the pulp. Methods: An inquiry sociological study addressed to the dental medical practitioners, members of the Regional Body of the Bulgarian Dental Association in Plovdiv was made. The respondents filled an original anonymous inquiry paper. The analyses of data and graphical visualization of results were performed by statistical software SPSS 13.0. Results: The mean age of the respondents is 43.8 years. Men are 32.2%, women – 83.7%. The average length of working is 19.0 years. 31.2% are specialists in General Dental Medicine, 55.4% are without specialty. 83.7% of the respondents have a contract with the National Health Insurance Fund. In this investigation women with a longer working length prevail (p < 0.05, х2 = 10.269). With statistical significance it was proved (p < 0.01; х2 = 18.332) that dental medical practitioners at the age under 40 and those over 51 apply biological treatment to people not older than 35 years and those who apply the method only to patients under the age of 18 are in the age group 41-50. With the increase of age of the practitioners the usage of local anesthesia during this method is decreasing (p < 0.05; х2 = 8.354). In between groups connections investigation proved (p < 0.01; х2 = 24.948) that dental medicine practitioners who choose tricalcium silicate cement as their favorite pulp capping material consider the dental laser the most atraumatic in caries lesion excavation in biological treatment of the pulp. Conclusion: Dental medicine practitioners know the new pulp capping materials for biological treatment of the pulp but a small part use them in their everyday practice. Although practitioners are familiar with the advantages of dental laser in dental caries excavation their application is limited. The common level of knowledge of the method of biological treatment of the pulp in the studied contingent may be considered high.
Key wоrds: biological treatment of the pulp, vital pulp therapy, pulp capping materials, dental lasers
Address for correspondence: Vesela Stefanova, Chief Assistant Professor, Department of Operative Dentistry and Endodontics, Faculty of Dental Medicine, Medical University, 3 Hristo Botev blvd., Bg – 4000 Plovdiv, tel.: +359 888656232, vesela_st@yahoo.com

STUDY OF THE PROMOTION REGULATION AND THE DRUG ADVERTISING IN THE EUROPEAN UNION
Т. Vekov1 and Zh. Kolev2
1Public Health Faculty, Medical University – Pleven
2Pharmaceutical Faculty, Medical University – Varna

Summary. The focus of our study is about the comparative analysis of the normative requirements for marketing, promotion and advertising of the drugs in European Union. The aim is to evaluate the regulatory normative mechanisms in Bulgaria. Having in mind the increase of the expenditures for medicines and the chronic deficit of public financial resources for reimbursement it is necessary the good European practices to be implemented. Thus the modulation of the prescription model will be possible.
Кey words: drugs, marketing, promotion, commercials, normative requirements, Еuropean Union
Address for correspondence: Prof. T. Vekov, DSci, Faculty of Public Health, Medical University, 1, Sv. Kliment Ohridski, st., Bg ― 5800 Pleven


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