Original articles 2008

ARCHIVE

 

2/2008
CYTOLOGIC AND MICROBIOLOGIC INVESTIGATION OF SPUTUM IN CHILDREN WITH CHRONIC PULMONARY DISEASES
G. Petrova1, P. Perenovska1, T. Strateva2 and I. Mitov2


1Pediatric Clinic, UMHAT “Alexandrovska” – Sofia
 2Chair of Microbiology, Medical University – Sofia

Summary: Objective monitoring of the respiratory tract in children with chronic pulmonary diseases, besides bronchoscopy, which is invasive and costly, is needed. In the last decades, numerous scientists pull out sputum investigation as a tool that could be as informative and more suitable than examination of bronchioalveolar lavage. Neutrophil-dominated endobronchial inflammation is a major characteristic of cystic fibrosis and non-CF bronchiectasis. Sputum eosinophilia as a test for asthma (defined by a consistent history and clinical presentation) gives a sensitivity of  80% and a specificity of 95%. We investigated sputum samples from forty two children (21 with asthma, 5 with bronchiectasis and 16 with cystic fibrosis) aged 7-18 yrs, admitted to the clinic for acute exacerbation. Sputum was expectorated spontaneously or induced by 20-min inhalations of 0,9% saline. There were no side effects and adverse reactions during the sputum collection. All sputum fractions were investigated cytologically and microbiologically and the results were in concordance with studies with similar design. In conclusion, sputum investigation is a noninvasive monitoring for prediction and intervention in children with chronic pulmonary disease.

Key words: cystic fibrosis, asthma, bronchiectasis, sputum examination

Address for correspondence:
Gergana Perova, MD, Clinic of pediatrics, UMBAL “Aleksandrovska”, 1 Sv. G. Sofiyski str., Bg – 1431 Sofia,
gsm: ++359 889 75 11 65, e-mail: gal_ps@yahoo.co.uk
SYSTEMIC VASCULITIDES WITH PULMONARY INVOLVЕMENT
E. Petrova


Centre of Occupational Diseases, Clinic of Occupational Diseases, University Hospital “Sv. Ivan Rilski”

Summary: An analysis of the characteristics of the basic systemic vasculitides with pulmonary involvement was performed. We discussed and summarized the existing information from 75 publications during the last 13 years. The statements about the etiology, pathogenesis, pathology, clinical characteristics, x-ray findings, disease development, and treatment strategies in the basic vasculitides with lung involvement (Wegener’s granulomatosis, allergic granulomatosis (Churg-Strauss Syndrome), microscopic polyangiitis, рolyarteriitis nodosa, necrotizing systemic sarcoidosis, Takayasu arteriitis, temporal giant cell arteriitis, Behçet's disease, essential mixed cryoglobulinemic vasculitis, Henoch-Schönlein purpura, leucoclastic vasculitis) were summarized.

Key words: systemic vasculitides, lung, etiology, pathogenesis, clinical signs, treatment

Address for correspondence:
Prof. Elisaveta Petrova, DSc, Clinic of Occupational Diseases, Centre of Occupational Diseases, University Hospital “Sv. Ivan Rilski”, 15 Akad. Iv. Evst. Geshov bl., Bg - 1431 Sofia, e-mail: mdepetrova@yahoo.com
SOME ASPECTS OF CHRONIC HCV PERSISTENCE AFTER ACUTE HEPATITIS C
O. Boykinova1, N. Popivanova1 and P. Georgiev2


1Department of Infectious Diseases, Medical University – Plovdiv
2Anti-Narcotics Association – Sofia

Summary: The virus–host interaction determines the outcome of the disease and is responsible for the high rate of chronic HCV persistence. The percentage of chronicity and associated cell-mediated immunity, as well as the prevailing genotypes were followed up 5 years after acute viral hepatitis C. The rate of chronicity was estimated at 63.33% of the investigated population. They showed decreased cell-mediated immunity of T cell subpopulations including decreased MHC non-restricted and restricted natural killer cells CD8+CD56+ and decreased total killer cells CD56+.

Key words: acute hepatitis C, chronic hepatitis, cell-mediated immunity

Address for correspondence:
O. Boykinova, MD, Department of Infectious Diseases, Medical University – Plovdiv, 15A V. Aprilov str., Bg – 4000 Plovdiv;
tel.: 032/60-29-33, GSM: 0899069747
CHEMOTHERAPY AS ALTERNATIVE IN PULMONARY ECHINOCOCCOSIS
K. Vutova and T. Todorov


Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University – Sofia

Summary: One hundred twenty six patients with lung echinococcosis were reated with albendazole or mebendazole. The cysts were located only in the lungs in 50 of them and in 76 – besides the lungs in other organs (liver, spleen, brain, abdomen and other). Eight of patients were treated with mebendazole (30-70 mg/kg/day for 3-6 months) and 118 received albendazole (10 mg/kg/day for four courses of 30 days with 14 days drug-free intervals). The evaluation of treatment response was based on objective criteria, provided by imaging methods – X-ray and computed tomography. In the treatment of pulmonary cysts, cure was achieved in 96,03% and improvement – in 3,97%. Patients were observed for 2 to 25 years by X-ray and serological methods. No serious side effects were seen after treatment with these drugs. The efficacy of chemotherapy is high in lung echinococcosis, and is an alternative for patients both with multiple and single cysts.

Key words: pulmonary echinococcosis, chemotherapy, аlbendazole, мebendazole, alternative

Address for correspondence:
Assoc. Prof. Kamenna Vutova, MD, PhD, Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University – Sofia, 15 “Acad. I. Geshov”, Bg – 1431 Sofia, tel.: 0888 381 600, e-mail: К_Vutova@abv.bg
ABOUT EPIDEMIOLOGY AND PROPHYLACTICS OF MUMPS
T. Dimitrov, Y. Mitova, V. Doycheva and P. Georgiev


Department of Epidemiology, Medical University – Sofia

Summary: The authors analyze the incidence of mumps during the 1969-2007 immunization period. The epidemic years and the inter-epidemic periods with low disease rate are pointed out. It is established that the index of vaccine complications is many times lower compared to the complications of the natural mumps infection. The immunization policy of the country is evaluated as inconsistent. The authors give recommendations in accordance with the position of the WHO.

Key words: mumps, mumps vaccine, immunogenicity, reactogenicity, vaccine complications

Adress for correspondence:
Assoc. Prof. Todorka Dimitrova, MD, Department of Epidemiology, Medical University – Sofia, Maychin dom,
2 Zdrave str., fl. 13, Bg – 1431 Sofia, tel. 9520304

CLINICAL FEATURES, DIAGNOSIS AND PREVENTION OF ROTAVIRUS GASTROENTERITIS
T. Chervenyakova and B. Panova

Hospital of Infectious Diseases “Prof. Iv. Kirov" – Sofia

Summary: In 80% of the cases, viral gastroenteritis is etiologically connected with rotaviruses (RV). They are the most common cause for hospitalization due to gastroenteritis worldwide. In most cases it affects children under 5 years of age, especially at risk are the infants. In developing countries, mortality remains high. In Europe, rotaviruses are the leading cause for children’s nosocomial diarrhea in intensive care units and newborn departments. In Bulgaria, the frequency of RV gastroenteritis among hospitalized children is nearly 30,2%. The most reliable method for prevention of this infection is the usage of  the recently introduced into practice rotaviral vaccines.

Key words: gastroenteritis, rotavirus, vaccines

Adress for correspondence:
T. Cherveniakova, MD, Hospital of Infectious Diseases ”Prof. Iv. Kirov”, 17 Iv. Geshov blvd. 1431 Sofia,
tel.: 9520101, e-mail: taniacher@abv.bg

POTENTIAL OF DUAL-PHASE SCINTIGRAPHY WITH 99mTc-MIBI IN PATIENTS WITH HYPERPARATHYROIDISM
N. Mlachkov and Y. Palashev


Department of Nuclear Medicine, University Hospital “Sv. Ivan Rilski” – Sofia

Summary: The aim of the study was to evaluate the potential of dual-phase scintigraphy for visualization of enlarged parathyroid glands in patients with hyperparathyroidism. Thirty six patients – 30 women and 6 men, aged from 32 to 68 years (mean age 49 years) with clinical evidence of hyperparathyroidism and parathyroid hormone levels between 70 pg/ml and 1035 pg/ml were included in the study. Twenty-eight patients (26 women and 2 men) were with severe osteoporosis, 6 (4 women and 2 men) with chronic renal failure and 2 men with recurrent renal calculosis The scintigraphy was performed by means of gamma camera Starcam 4000i GE in 2 phases. The first phase consisted of serial scintigraphy with 16 one-minute frames after bolus injection of 740 MBq of 99m-Tc-MIBI (methoxyisobutyl-isonitrile). The second phase consisted of one static image 1.5 hour post injection. Fourteen patients were MIBI-positive and 22 – MIBI-negative. All MIBI-positive patients were with parathyroid hormone levels above 160 pg/ml. In 6 patients, we obtained false-negative results. Visualization of hyperfunctioning parathyroid glands on 99mTc-MIBI scintigraphy correlated directly with parathyroid hormone level, and was more likely with higher serum parathyroid hormone levels. False-positive results could be avoided with combination of scintigraphy and ultrasound of the thyroid gland. False-negative results were more frequent and in these cases we recommended searching with other imaging modalities.

Key words: dual-phase scintigraphy, MIBI, hyperparathyroidism

Address for correspondence:
N. Mlachkov, MD, Department of Nuclear Medicine, University Hospital “Sv. Ivan Rilski”, 15 “Akad. I. Geshov” str., Bg - 1431 Sofia,
tel. 8510819, e-mail: izotopna@yahoo.com
CLINICO-EPIDEMIOLOGIC CHARACTERISTICS OF THE ACUTE EXOGENOUS INTOXICATIONS
FOR THE PERIOD 2002-2004 IN PLOVDIV REGION
S. Tufkova¹, E. Karaslavova² and M. Dyakova3


¹Toxicological Clinic, University Multiprofile Hospital for Active Treatment ”Sv. Georgi” – Plovdiv
²Social Medicine and Healthcare Management Faculty,
Section Medicine in Disastrous Situations, Medical University – Plovdiv
3Faculty of Public Health, Medical University – Sofia

Summary: The acute intoxications continue to play a considerable role in the pathogenesis of human organism disorders, and constitute a contemporary medical, ecological and social problem. The global trends reveal that the incidence of acute intoxications is seriously increasing in all countries. The few epidemiological studies, conducted in Bulgaria, show that structure and dynamics of the characteristics of these common causes of death follow the trends in the developed countries.

Key words: epidemiology, acute exogenous intoxication

Address for correspondence:
Stoilka Tufkova, MD, Clinic of toxicology, UMBAL “Sv. Georgi”, 29 Dame Gruev str., Bg – 4000 Plovdiv, GSM: 0889/302-953, tel.: 032/ 602-406, е-mail: tuffi_med@yahoo.com
VERAPAMIL POISONING: APPEARANCE AND DYNAMICS OF THE CLINICAL SYMPTOMS AND ECG CHANGES.
CLINICAL
EXPERIENCE

S. Zlateva, P. Marinov, M. Yovcheva and M. Asparuchova


Department of Toxicology, BBAL – Varna, Military Medical Academy – Sofia

Summary: Verapamil poisonings occur often in the last years and quite frequently they end fatally. We have made a clinical observation of 27 suicidal cases, patients, who have swallowed 600 to 8000 mg verapamil. The symptoms of different organs and systems have been described, from the moment of hospitalization to the end of the toxic process. The influence on the symptoms from the applied medical means and methods has been reported. The toxicity of verapamil leads to a wide variety of manifestations of the cardiovascular system like hypotension, shock, bradycardia, conduction and rhythm disturbances and depression of the contractility. There have been observed disturbances of the central nervous system, of the pulmonary (ARDS) and endocrine-metabolic system as well as gastrointestinal disturbances. We define clinically three typical stages during the course of the verapamil intoxication – early phase, crucial phase (it lasts 24 hours on an average), and a phase of later complications (after the 48th hour) with a cardiac failure and congestive edema (late phase). The therapeutical management includes early gastrointestinal decon­tamination and long lasting gastric lavage. We have treated hypotension and shock with α- and β- adrenergic drugs such as dopa­mine and dobutamine, haemodex, plasma; bradyarrythmias – with calcium gluconicum, atropine, pacemaker. Charcoal hemo­perfusion cannot be useful in overdose.

Key words: verapamil, poisoning, shock, A-V blockage, coma, pulmonary edema, ARDS, hyperglycemia, metabolic acidosis, charcoal hemoperfusion

Address for correspondence:
Snezha Zlateva, MD, Mladost bl. 141, entr. 7, et. 10, app.25, Bg – 9020 Varna, tel.: 052 73 58 72,
GSM: 0887 41 45 97, e-mail: snezhazlateva@abv.bg
AVAILABILITY OF ANTI-HCV ANTIBODIES AMONG BLOOD DONORS IN SOME REGIONS OF BULGARIA
T. Petkova1 and K. Terzieva2


1Section „Epidemiology, Parasitology and Tropical Medicine” Medical University – Pleven
2Regional Centre of Transfusional Hematology – Pleven

Summary: The aim of this work was to summarize the results from the screening for anti-HCV antibodies among blood donors in six regions of Bulgaria – Pleven, Russe, Veliko Turnovo, Gabrovo, Lovech and Razgrad. Blood testing was done in Regional Center of Transfusion Haematology – Pleven in 2006. Testing for anti-HCV antibodies was done by using the available ELISA system (Dia Sorin). The average percentage of the anti-HCV antibody carriers was 0,25%, whereas the lowest percent – 0,15%, was found in Gabrovo region and the highest – 0,62%, in Lovech and Razgrad. The research shows that prevalence of anti-HCV antibodies among blood donors is characterized by a relative stability, and Bulgaria is in the zone of low prevalence of HCV infection.

Key words: anti-HCV antibody, blood donors

Address for correspondence:
Tanya Petkova, MD, Section „Epidemiology, parasitology and tropical medicine”, Medical University,
1 Sv. Kliment Ohridski str., 5800 Pleven, e-mail: tanja_1973@abv.bg,  tel.: 064/ 884 269, GSM: 0887 60 54 71
3/2008

PROPROLIFERATIVE ROLE OF PROTEIN KINASE Ca AND PROTEIN KINASE Ce THROUGH DOWNREGULATION
OF ERK1/2 ACTIVITY IN HUMAN EPIDERMAL KERATINOCYTES

P. Ivanova1, N. Ishkitiev1, G. Kosekova1, Y. Poumay2 and V. Mitev1

1Department “Chemistry and Biochemistry”, Medical University – Sofia
2Cell and Tissues Laboratory, URPHYM, University of Namur (FUNDP), Belgium

Summary: In our previous research, knockdown of PKD1 (protein kinase D1), using antisense oligonucleotide and siRNA, led to significant inhibition of keratinocyte proliferation caused by increase in ERK1/2 (extracellular signal-regulated kinase 1/2) phosphorylation (activity). The established effects were followed by increased expression of early markers of differentiation–involucrin and keratin 10. The obtained results led us to the conclusion that high activity of ERK1/2 in human keratinocytes leads to cell differentiation, whereas lower ERK1/2 activity promotes their proliferation. In the present study, we decided to use antisense oligonucleotides for gene knockdown of PKCα (protein kinase Cα) and PKCε (protein kinase Cε) in order to explore their effects on keratinocyte proliferation and ERK1/2 activity. Knockdown of the two PKCs led to significant reduction of thymidine incorporation in keratinocyte DNA. Transient transfection of PKCα antisense oligonucleotide increased markedly ERK1/2 phosphorylation (activity), whereas silencing of PKCε led to lower increase of ERK1/2 phosphorylation. The obtained results suggest proproliferative role of the two PKCs isoforms in human epidermal keratinocytes through down-regulation of ERK1/2 activity. To examine a putative role of the high activity of ERK1/2 in keratinocyte differentiation, ERK1/2 phosphorylation and expression were detected in cultured keratinocytes at different cell confluency. Cultured human keratinocytes showed increased expression and activity of ERK1/2 during differentiation in postconfluent state, compared to the subconfluent proliferating cells, suggesting a possible role for these MAPK (Mitogen-activated protein kinases) members in keratinocyte differentiation. Here we showed for the first time that ERK1/2 are inducible enzymes in human keratinocytes, and probably the initiation of keratinocyte differentiation is the signal for their increased expression. 

Keywords: PKCα, PKCε, ERK1/2, MAPK, human keratinocytes, proliferation

Address for correspondence:
Petya Ivanova, Department of Chemirty and Biochemistry, Mеdical University – Sofia, 2 Zdrave str., Bg1431 – Sofia,  
tel.: 029172-656, fax: +359-2-9520345, e-mail: pvivanova@gmail.com

DEFICIT OF ATPase SUBUNIT 8: CONTRIBUTION WITH TWO NEW CASES
M. Stancheva¹, B. Radeva², E. Naumova³ and S. Mihaylova³

¹University Children`s Hospital ”Alexandrovska” – Sofia, Bulgaria
²University Children`s Hospital “Sv. Evdokiya” – Sofia, Bulgaria
³Central Laboratory of Clinical Immunology, University Hospital ”Alexandrovska”

Summary: In two consanguineous children – brother and sister, there was reported a rare mitochondrial disorder caused by mutation of the gene of MT-ATP 8: base change T8412C, with aminoacid change: methionin–threonine which caused a decreased activity of the synthesized protein (enzyme) and dysfunction of the central nervous system and muscles of the affected children. These cases gave us the reason to recommend the children with muscle hypotonia, mental retardation with unknown cause to be hospitalized in “Clinical genetics unit” for confirmation of the diagnosis and careful genetic consultation. The establishment of a new rare mitochondrial disease of ATP synthase subunit 8 deficiency is a contribution in pediatrics and enables treatment and prenatal diagnosis of the family.

Key words: mitochondrial diseases, ATP-ase subunit 8 deficit, mitochondrial DNA mutation

Address for correspondence:
Malina Stancheva, MD, Pediatric clinic, UMBAL „Alexandrovska”, boul. “Sv. G. Sofiiski” № 1, Bg-1431 Sofia, GSM: 0886 913 222

THE EXPERIENCE OF BULGARIAN PEDIATRICIANS IN THE DIAGNOSISOF MORQUIO DISEASE TYPE IVB
M. Stancheva3, B. Radeva2, E. Paschke1, I. Kremenski4, I. Sinigerska4 and R. Petkov5

1Laboratory of Metabolic Diseases, Department of Pediatrics, University of Graz
2Clinical genetics, University Children`s Hospital “Sv. Evdokiya”
3Pediatric clinic, University Hospital ”Alexandrovska“
4National Genetic Laboratory, “Maichin dom”
5Center for MRI, University hospital “Alexandrovska”

Summary: The authors report two cases with Morquio type IVB. The first child presents with typical clinical mauitestation – normal intelligence, dysostosis multiplex. DMB test showed increased level of MPS. Electrophoresis showed chondroitin sulfate. The diagnosis was confirmed by low beta-galactosidase in leucocytes. DNA analysis showed the most common in Europe mutation W273L/W273L. The second child presents with skeletal anomalies, coarse facial features, astigmatism, myopia, joint hyperflexibility, dyslalia, cortical atrophy with enlarged subarachnoidal spaces on the convex, ventricles and basal cisterns, and slightly expressed hypotonia. Electrophoresis showed unidentified oligosaccharides. The enzyme assays revealed low beta galactosidase in leucocytes and fibroblasts. The DNA analysis showed two nonpathogenic polymorphisms c.29C > T (heterozygote), c.34T > C (homozygote), a heterozygous state for a common mutation R201H in exon 6 of GLB1 gene and a novel mutation P597S in exon 16 of GLB1 gene. A genetic counseling and carrier testing were performed on the parents and the brother of the one child.

Key words: Morquio IVB type, beta-galactosidase

Address for correspondence:
Malina Stancheva, MD, Pediatric clinic, UMBAL „Alexandrovska”, boul. “Sv. G. Sofiiski” № 1, 1431 Sofia, GSM: 0886 913 222

ASPECTS OF PRESENT INTEREST IN THE ETIOLOGY OF DIABETES MELLITUS
K. Todorova-Ananieva1, K. Petkova2 and M. Stamenova2

1SBALAG “Maychin dom” – Sofia
2Institute of Biology and Immunology of Reproduction “Acad. K. Bratanov” – Bulgarian Academy of Science

Summary: The present review analyses the participation of genetic factors in the etiology of type 1 (T1) and type 2 (T2) diabetes mellitus (DM). Over 20 regions of human genome are switched on in the genetic predisposition to T1DM but a direct link with a risk of arising of T1DM isn’t demonstrated. Such link is proved only in the case of genes, that are localized in HLA-region of the sixth chromosome. The genetic predisposition to T2DM is proved by identification of different genes, that are fused in two big groups – genes influencing β-cellular function, insulin activity and glucose metabolism and genes, responsible for other metabolic disorders. These genes contribute to the onset of T2DM. At this moment, there are described over 50 such genes with probable influence to the onset of DM. The phenotype of their action depends on other combination of factors – race’s affiliations, the influence of environmental factor, interactions between genes. It is expected, the genes associated with increased risk of development of every of the types of DM to be fully identified.

Key words: diabetes mellitus, Type 1 DM, Type 2 DM, MODY, genetic factors

Address for correspondence:
K. Todorova-Ananieva, MD, SBALAG “Maychin dom”, 2 Zdrave str., Bg-1431 Sofia, tel.: 851-72-22

SPECTRUM AND ANTIMICROBIAL RESISTANCE OF PATHOGENS CAUSING PYELONEPHRITIS IN DIABETICS
P. Yovchevski1, E. Keuleyan2, R. Hristov1, Zh. Boneva3, T. Anakieva2 and Sh. Tete-Nicolova2

1Department of Nephrology
2Department of Clinical Microbiology
3Department of Endocrinology
Medical Institute – Ministry of the Interior, Sofia

Summary: Among patients with diabetes mellitus (DM), urinary tract infections are more common and more severe, than in non-diabetic patients. We studied retrospectively 205 patients with DM type 2 and chronic pyelonephritis, treated in the hospital during three three-year periods, each five years apart from the other: 62 patients were treated between 1989 and 1991, 75 patients during 1997-1999 and 70 patients – 2005-2007. We found a small decrease in the relative rate of Escherichia coli as opposed to the increase of Pseudomonas spp. and Enterococcus spp. in etiological spectrum of infections. In E. coli, a high resistance to aminopenicillins was maintained, while 9.7% of strains resistant to aminopenicillins/inhibitor occurred during the third period. The resistance to acylureidopenicillins was doubled in each period and reached 22%; the resistance to third generation cephalosporins during 1997-1999 was 5.7%. The strains resistant to Ciprofloxacin reached very high rate – 17.1% during the third period. Nitrofurantoin, first choice therapy for non-complicated urine-infections, according to the European guidelines, showed again a good activity against enterobacteriae, causing pyelonephritis in patients with diabetes mellitus. Fam. Enterobacteriaceae strains, producing extended-spectrum beta-lactamases, from 0% at the beginning of study, increased to 6.6 % during the period from 2005 to 2007, presenting challenges to the therapy.

Key words: urinary tract infections, pyelonephritis, diabetes mellitus, antibiotic resistance, antibacterial treatment

Address for correspondence:
Plamen Yovchevski, MD, PhD, Department of Nephrology, Medical Institute – Ministry of the Interior, 79 Skobelev Blvd, Bg-1606 Sofia, tel. 02 98 21 435, e-mail: nephro@dir.bg

CLINICAL FEATURES, DIAGNOSIS AND PREVENTION OF ROTAVIRUS GASTROENTERITIS
T. Chervenyakova and B. Panova

Hospital of Infectious Diseases “Prof. Iv. Kirov" – Sofia

Summary: In 80% of the cases, viral gastroenteritis is etiologically connected with rotaviruses (RV). They are the most common cause for hospitalization due to gastroenteritis worldwide. In most cases it affects children under 5 years of age, especially at risk are the infants. In developing countries, mortality remains high. In Europe, rotaviruses are the leading cause for children’s nosocomial diarrhea in intensive care units and newborn departments. In Bulgaria, the frequency of RV gastroenteritis among hospitalized children is nearly 30,2%. The most reliable method for prevention of this infection is the usage of  the recently introduced into practice rotaviral vaccines.

Key words: gastroenteritis, rotavirus, vaccines

Adress for correspondence:
T. Cherveniakova, MD, Hospital of Infectious Diseases ”Prof. Iv. Kirov”, 17 Iv. Geshov blvd. 1431 Sofia,
tel.: 9520101, e-mail: taniacher@abv.bg

DEATH RATE IN ACUTE POISONINGS IN VARNA REGION FOR A 15-YEAR PERIOD
P. Marinov1and M. Jovcheva2

1Department of Toxicology, BBAL – Varna
2Military Medical Academy – Sofia

Summary: The death rate of the acute poisonings in Varna region for a 15-year period (1991-2005) was analyzed. The study included 12 565 cases, 163 of which with lethal outcome. The death rate was 1,3% and was higher in male patients than in female patients as the ratio men:women was 1,86:1. Most of the fatal accidents were in the age over 45 years – almost 3/4. The main cause of death was acute pesticide intoxication (mainly organophosphates) – 27,61%, followed by alcohols – 24,54%; drugs – 20,24%; Amanita phalloides poisonings – 14,11%. 

Key words: acute poisonings, death rate

Address for correspondence:
Petko Penkov Marinov, MD, Evrohospital, 2A Nayden Raykov, Bg-9022 Varna,
tel.: 052 387 918, GSM 0899 982 700, е-mail: eurohospital.bg@abv.bg

REGARDING DRUG PANDEMIA AND THE SCIENTIFIC PRINCIPLES OF PSYCHOSOCIAL REHABILITATION
P. Georgiev2 and E. Nikolova1

1Department of Epidemiology, MU – Sofia
2Center For Psycho-Social Rehabilitation of Drug Addicts – Sofia

Summary: The authors analyze the drug addiction incidence and present the scientific principles of contemporary psychosocial rehabilitation. They point out the basic postulates from which the programs of the third generation therapeutic community are taken out. The authors give recommendations to the rehabilitation institutions that are established in Bulgaria. They call to society and the state power to help the establishment of a national system for psychosocial rehabilitation of drug addicts.

Key words: drug pandemic, narcotic dependence, therapeutic community, psychosocial rehabilitation, drug addiction situation, institutional responses

Address for correspondence:
Prof. P. Georgiev, Department of Epidemiology, Medical University – Sofia, 2 Zdrave str., Bg-1431 Sofia, GSM: 0888 469 786

IONIZING RADIATOIN AND ITS INFLUENCE ON HUMANS Part II. MEDICAL SECURITY AND RADIATION DEFENCE
E. Karaslavova

Department of Social Medicine, Medical University – Plovdiv

Summary: The health security of the population in radiation incidents requires knowledge in radiology and preliminary training of the entire medical personnel, the civil defence force, police and army as well as the citizens. In the present work, there are described the types and volume of medical help in radiation incidents. Radiation defence is a complex of activities for restricting people and staff members’ radiation to the lowest levels ever possible attainable with acceptable for the society means. Calculations and emergency plans (on national, district and company levels) are regularly worked out with providing for individual and collective protection.

Key words: ionizing radiation, medical security, radiation defence, emergency plans

Address for correspondence:
Emilia Karaslavova, MD, Department of Social Medicine, Section Medico-biological protection,
Medical University, 15A V. Aprilov bul., 4000 Plovdiv, GSM: 0896/651-274, e-mail: e_karaslavova@yahoo.com

TRENDS AND PERSPECTIVES IN THE EDUCATION OF NURSES AND NURSE-MIDWIVES
E. Dimitrova1 and M. Mitova2

1Department “Nurse care”, Medical University – Pleven
2Department “Medical pedagogy”, Medical University – Sofia

Summary: An increase of needs of health care as well as its quality was identified in the end of 20th century. Increasing the quality of health care implies improvement of the quality of the education of those who enter the profession of nurse and nurse midwife as well as continuous education of those who already are practicing. Taking into account the role of these specialists, in 1995 WHO came up with strategy for their education. The purpose of this material is to present the trends and the perspectives in the education of nurses and nurse-midwives in Bulgaria based on the European strategy of WHO for education of these medical specialists in the period of pre-accesion and accesion of Bulgaria to the European Union in 2007.

Key words: education, nurses, nurse-midwives, trends, perspectives

Address for correspondence:
Evgenia Kuncheva Dimitrova, Medical College, 38 Russe blvd., Bg-5800 Pleven,
tel. home: 064/801319, tel. off.: 064/ 830813, e-mail: nia62@abv.bg

4/2008

EXTRAPULMONARY COUGH – ETIOPATHOGENESIS AND CLINICAL CHARACTERISTIC
A. Balanova


Department of Propedeutics of Internal Diseases
Medical University – Sofia

Summary: Coughing is always suspected as a symptom related to some respiratory disorder. In their practice physicians often meet a patient with persistent, irresponsive to therapy cough that does not correspond to any objective abnormalities in the lungs. The reason for such a condition is often outside the lungs. The pathophysiology of the coughing reflex and the reflexion bow that is responsible for it let us know that there are receptors situated in other organs such as uterus, ovary, stomach, diaphragm, mediastinum, pericard, oesophagus, oto-rhinolaryngeal region. This explains that a local process of irritation of the before mentioned organs could provoke cough, without affecting the lungs. Here we present 43 patients (25 women and 18 men), aged between 57-81 years. We proved that there is an extrapulmonary reason for coughing: cardiac diseases, gastrointestinal disorders, neurogenic conditions. Having in mind this, should we reconsider the definition of Thompson et Kazenii from 1987? According to it, “coughing is one of the commonest symptoms in pulmonary diseases and it is determined as a strong explosive expiration, whose function is the removal of the secretion, foreign bodies and other irritants in respiratory airway.“

Key words: coughing reflex, pathophysilogy, irritation out of the lung

Address for correspondence:
Assoc. Prof. Anna Balanova, MD, Department of Propedeutics of Internal Diseases, Medical University,
1 Sv. G. Sofiyski str., Bg – 1431 Sofia, tel.: 92-30-604/470

EPIDEMIOLOGIC EVALUATION OF PREVENTIVE AND ANTIEPIDEMIC MEASURES AGAINST MARSEILLES FEVER IN BULGARIA
D. Mitov1 and T. Dim
itrova2

1Medical University – Pleven
2Medical University – Sofia

Summary: Morbidity and antiepidemic measures against Marseilles fever in Bulgaria for the period 1948-2006 are analyzed by the authors. The natural-geographic characteristics of the endemic zone in Southern Bulgaria are described. Dynamics of Marseilles fever epidemic process in eight historically developed endemic natural foci is studied. Conclusions about morbidity dynamics in 217 nosoareals (villages) are drawn. A critical analysis of the existing control system of the disease, emphasizing on numerous details related to parasiticidal and socio-ecologic systems is made in order to improve the preventive measures.

Key words: Marseilles fever, natural focus, nosoareals, prevention, epidemiologic control

Address for correspondence:
Assoc. Prof. Todorka Dimitrova, MD, DMSc, Department of Epidemiology, SBALAG “Maychin dom”, fl. 6,
2 “Zdrave” Str., Bg-1431 Sofia, e-mail: tod.dimitrova@mail.bg

VACCINAL PROPHYLAXIS OF EPIDEMIC PAROTITIS IN BULGARIA
H. Odiseev1, T. Dimitrova2, I. Haydushka3 and Y. Stoilova3


1Department of Virology, National Centre for Infectious and Parasitic Diseases – Sofia
2Department of Epidemiology, Medical University – Sofia
3Medical University – Plovdiv

Summary: In 1967, a cell culture vaccine of the Bulgarian strain Sofia 6 was obtained. During the period from 1972 to 1976, a staged administration of the vaccine in the whole population was undertaken and the vaccine was included in the National Immunization Calendar. During that period, a combined measles-mumps vaccine of Leningrad 16 measles strain and Sofia 6 parotid strain was obtained and the mono-vaccine was gradually replaced. The mumps vaccine, as an individual or combined product, exhibits good tolerance, immunogenicity and efficacy. The parotitis incidence has slumped. The incidence of isolated meningeal reactions has been considered as an inevitable minimal risk compared to the effects of natural infection. In 1982, for an observed slight incidence increase, complete revaccination of the paediatric population aged 6-12 years was undertaken. Following this large-scale (412 312 doses) short-term administration, 78 cases of meningeal reactions were observed, which resulted in cessation of revaccinations and regular vaccinations and rejection of Sofia 6 reaction-genicity. The perspective for creating a Bulgarian three-in-one MMR (measles-mumps-rubella) vaccine has failed. For four more years, the vaccination has not been performed and in 1986 this resulted in an epidemic peak unknown in the history of parotitis in Bulgaria. The country was condemned to use imported foreign vaccines, which have also caused meningeal reactions. The justice requires a renewal of Bulgarian vaccine (Sofia 6 vaccinal strain) prestige.

Key words: parotitis, vaccinal prophylaxis, Bulgarian and foreign parotitis vaccines, vaccination and revaccination, reaction-genicity, immunogenicity and epidemiologic efficacy of vaccines

Address for correspondence:
Assoc. Prof. Dr. Todorka Dimitrova, PhD, Department of Epidemiology, MU – Sofia, SBALAG “Maychin dom”,
2 “Zdrave” Str., Bg-1431 Sofia, tel.: (+359 2) 952 03 04, e-mail: tod.dimitrova@mail.bg

MONITORING OF THE TREATMENT OF INTERSTITIAL BACTERIAL NEPHRITIS BY FOLLOWING THE LEVELS
OF THE ACUTE-PHASE REAGENT C-REACTIVE PROTEIN

S. Tancheva, D. Bliznakova, B. Boychev and Al. Stoyanov


UMBAL “Sv. Marina” – Varna

Summary: Bacterial infections of the kidneys and urinary tract often manifest clinically with vague symptoms. That is why they are diagnosed with difficulties and relatively late in their course or are overdiagnosed. The aim of our study was to follow the levels of the acute-phase reagent CRP during the treatment of infectious tubulointerstitial nephritis and to compare these values with the changes in urinary sediment. 54 children from the Pediatric Nephrology of the University Hospital "Sveta Marina" – Varna, have been studied. They had clinico-laboratory diagnosis acute pyelonephritis. The serum level of CRP was determined and the urine was studied biochemically and its sediment was investigated on the admission and on the fifth day of the start of treatment. The investigation showed that CRP can be used for follow-up the effect of treatment of renal infections. As a factor used to monitor the treatment of pyelonephritis, CRP is an index which is highly informative. CRP is more sensitive than urine sediment for determining the effect of treatment of infectious tubulointerstitial nephritis. It is legislatively allowed CRP to be examined outside hospitals which is suitable for monitoring the outdoor treatment of pyelonephritis.

Key words: CRP, pyelonephritis

Address for correspondence:
Stoyanka Tancheva, MD, Clinical Laboratory, UMBAL “Sv. Marina”,
1 Hr. Smirnenski blvd., Bg-9010 Varna, tel. 052 302851 (60) 1224, e-mail: Tanq_Tancheva@abv.bg

ACUTE ENTEROCOLITIS IN CHILDREN LESS THAN 5 YEARS OF AGE – EPIDEMIOLOGICAL, CLINICAL AND DIAGNOSTIC STUDY
R. Komitova1, V. Nedkova2, V. Popova3, Hr. Hitkova3, Z. Mladenova4, N. Korsun4, Ts. Petkova2 and R. Stoyanova2


1Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Medical University – Pleven
2Department of Pediatrics, Medical University – Pleven
3Department of Microbiology, Virology and Medical Genetics, Medical University – Pleven
4National Reference Laboratory of Enteroviruses, National Center of Infectious and Parasitic Diseases, Sofia – Bulgaria

Summary: Infectious enterocolitis is one of the most common diseases in humans, with particular high morbidity in children. To clarify the infectious etiology of diarrhea in children less than 5 years of age, we conducted an 8-month study of all children admitted to the Pediatric Clinic, University Hospital, Pleven, during the period from June 2007 through January 2008. Stools from 207 children were examined. Rotavirus antigen was detected by enzyme-immunoassay (ELISA), Salmonella, Shigella, E. coli, thermotolerant Campylobacter and Yersinia were detected by standard methods. Stool samples from a small number of patients were tested for Clostridium difficille toxins A & B. Rotavirus was by far the most common pathogen detected. Fifty two (25%) of 207 stool samples tested contained bacterial pathogens. Salmonella spp. and Shigella spp. were the most common bacterial pathogens. Overall, 55% of specimens that underwent complete testing yielded at least one pathogen. Improved specimens sampling had increased the yield of bacterial isolation. We suggested that routine rotavirus examination of stool samples should be included when managing a child under 2 years of age with infectious diarrhea.

Key wоrds: infectious diarrhea, rotaviruses, Salmonella, Shigella

Address for correspondence:
Assoc. Prof. R. Komitova, PhD, Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Мedicine,
Medical University, 1 Kliment Ohridski Str., Bg-5800 Pleven, tel.: 064/884-385

INFLUENCE OF THE SOCIAL ENVIRONMENT ON CHILDREN’S ALCOHOL CONSUMPTION
A. Loukova


MHATEM “Pirogov”

Summary: The use of alcohol is one of the most important (connected with the life style) behavior risk factors which influences the health and causes different somatic and psychological damages to children. The increasing rate of alcohol abuse and alcoholic intoxication in children with its complexity and versatility provokes high interest in different circles of politicians, economists and scientists. The family environment, as well as the school- and social environment are of  fundamental importance for personality formation and its behavior reactions. That is the reason why, against the background of our social and economic reality, more efforts are necessary to prevent this type of unhealthy behavior among the coming generations.

Key words: family environment, education, school environment, society, prevention

Adress for correspondence:
Anelia Loukova, MD, Toxicology Clinic – Psychiatry Sector, MHATEM Pirogov,
21 Totleben Blvd., Bg-1606 Sofia, tel.: 9154409, е-mail: aloukova@yahoo.com

ANALYSIS OF INJURIES IN A SEVERE ROAD TRAFFIC ACCIDENT WITH AUTOBUS
W. Dokov1, I. Stoyanov², V. Dokov³ and St. Churov²


1Department of Forensic Medicine and Deontology, Medical University – Varnа
2Department of Forensic Medicine, Multiprofile Hospital for Active Treatment – Ruse
3Department of General and Clinical Pathology, Medical University – Varna

Summary: The injuries of 28 killed have been studied, of whom 19 (65.87%) males of average age 37, and 9 (32.14%) females of average age 39, the ratio between them being 3.11:1. The most common injuries were broken ribs 20 (17.25%), drowning 17 (15.17%), and lacerations and contusions of the lungs 13 (11.6%). The analysis of the injuries of 12 wounded, whose average age was 28, showed a ratio between the genders of 1:1. Among the injuries in the wounded persons, the most common were broken ribs: 4 (16%), contusion-laceration wounds: 4 (16%), and broken humeri: 3 (12%). Severe bodily injuries were the largest number: 5 cases (41.66%), light bodily injuries were observed in 4 cases (33.33%), and average bodily injuries in 3 cases (25%). The ratio between killed and wounded was 2.33:1.

Key words: road traffic accident, traffic injuries

Address for correspondence:
W. Dokov, MD, Department of Forensic Medicine, Medical University – Varna,
55 Marin Drinov Str., Bg-9002 Varna, e-mail: Dokov@seznam.cz

RETROPERITONEOSCOPIC UROLOGICAL OPERATIONS – INITIAL EXPERIENCE
Ts. Genadiev, D. Gaydarov, V. Veleva and P. P
etrov

Clinic of Urology
University Hospital “Lozenets” – Sofia

Summary: Retroperitoneoscopic urological procedures are widely used in the world urological practice. We analyze and present our first retroperitoneoscopic operations. There were endoscopic extraperitoneal radical prostatectomy – 4 cases, one of them nerve sparing, retroperitoneoscopic pyelolithotomy – 1 case, kidney tumor resection – 1 case. The patients were five men, mean age 64 years and one 64-year-old woman. Mean operative time on radical prostatectomy was 300 minutes. There was one case of intraoperative conversion due to adhesions in the kidney tumor resection case. No blood transfusion was performed. It is concluded that the retroperitoneoscopic access is a method of choice in urological endoscopic procedures.

Key words: urological retroperitoneoscopic operation

Address for correspondence:
Tzvetin Genadiev, MD, Clinic of Urology, University hospital “Lozenetz”,
Kozyak str. 1, Bg-1407, Sofia,  tel. 9607669, e-mail: genadievi@abv.bg


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