Original articles 2009

ARCHIVE

 

1/2009
CHICKENPOX – PRESENT AND FUTURE PROBLEMS

H. Odiseev2, T. Dimitrova1, V. Doycheva1 and T. Kuzmova1

1Medical University – Sofia
2National Center of Infectious and Parasitic Diseases – Sofia

Summary: Chickenpox, a highly contagious disease caused by varicella-zoster virus, is one of the most commonly reported childhood diseases. Airborne transmission is possible through sneezing and coughing. The greatest number of cases occur in winter and early spring. In 1995, the Federal Food and Drug Administration in USA approved a vaccine for protection of children and other susceptible individuals from chickenpox. The vaccine has been proven to be 85% effective in preventing the disease and 95% effective in preventing severe from of the disease.

Key words: chickenpox (varicella), varicella-zoster virus, varicella vaccine

Address for correspondence:
Assoc. Prof. Dr. Todorka Dimitrova, MD, DMSc, 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
ASEPTIC MENINGITIS OUTBREAK IN WEST BULGARIA, 2004

R. Komitova1,3, P. Petrov1, N. Korsun2, S. Gurova2, А. Nikolova1, Z. Georgieva1, M. Russinova1 and L. Panchev1

1University Hospital „Sv. Anna” – Sofia
2National Center  of Infectious and Parasitic Diseases – Sofia, Bulgaria
3Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Мedicine,
Medical University – Pleven (current affiliation)

Summary:  Aseptic meningitis is the most common infectious syndrome affecting the central nervous system. Non-polio human enterovuruses are the leading cause of aseptic meningitis in children. A retrospective study was conducted to determine the epidemiological, clinical and  laboratory characteristics of aseptic meningitis outbreak in West Bulgaria, 2004. A total of 50 patients, median age 8,7 years, admitted to Infectious Diseases Department, University Hospital “Sv. Anna”, Sofia, were studied. The dominant clinical symptoms were fever (96%), headache (96%) and vomiting (100%). The signs of meningeal irritation were moderate expressed in 94%.Twelve patients  had contact with ill children. The mean number of cell count in cerebrospinal fliud was 161.106/L with mononuclear predominance in 91% of the cases. Non-polio enteroviruses (Coxsackie B4, echovirus type 4, 6, 14 and 25) were cultured in CSF and/or feces of 16 (32%). All patients received empirical antibiotic regime and supportive therapy. The rational assessment of the combined information from epidemiologic, clinical and laboratory data should facilitate the diagnosis of aseptic meningitis, even when the infectious agent was not identified at the time of clinical presentation.

Key words: enteroviruses, aseptic meningitis

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
CLINICAL AND EPIDEMIOLOGICAL STUDY OF MUMPS INFECTION

M. Karcheva1, M. Atanasova2 and P. Ilieva1

1Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Medical University – Pleven
2Department of Anesthesiology, Military Medical Academy – Sofia

Summary: Mumps infectioun draws scientists’ attention at present because it has easy transmission mechanism and insufficient immunization ratio. In the period from 2000 to 2008 (1st six months), we established increasing incidence in 2001 and 2005 and lower morbidity in 2002, 2003 and 2004. Similar problems were observed in other districts in Bulgaria. We investigated 130 patients treated in the Clinic of Infectious Diseases in Pleven. The results showed mumps orchitis in 40% of patients, pancreatitis in 45% and aseptic meningitis in 8% of patients. We observed swelling of the parotid glands in all patients and other localizations of mumps infection in several cases. The patients with complications should stay under observation for a long period of time.

Key words: mumps infection, morbidity, complications

Address for correspondence:
Milena Karcheva, MD, Section of Epidemiology, Parasitology and Tropical Medicine,
Medical University, Bg-5800 Pleven, 1 Sv. Kliment Ohridski, str., tel. 064/884-269, e-mail: milena_karcheva@abv.bg

CONTEMPORARY CLINICO-EPIDEMIOLOGICAL CHARACTERISTICS OF SCARLET FEVER

T. Petkova1, O. Boykinova2, S. Pachkova3 and B. Bonev4

1Section „Epidemiology, Parasitology and Tropical Medicine”, Medical University – Pleven
2Clinic of Infections Diseases, University Hospital “Sveti Georgi” – Plovdiv
3Department “Microbiology, Virusology and Medical Genetics”, Medical University – Pleven
4Regional Inspection for Prevention and Control of Public Health – Pleven

Summary: Main feature of contemporary scarlet fever during the last 4-5 decades is its milder form. Nevertheless, scarlet fever keeps its main clinical characteristics. The objective of this study is to find out the changes in the epidemical process. An epidemiological analysis of scarlet fever incidence in Bulgaria and the region of Pleven has been done. Data of  Regional Inspection for Prevention and Control of Public Health – Pleven, and the National Centre of Infectious and Parasitic Diseases annual analysis of the illness were used. A retrospective research of documental data of 102 patients with diagnosis scarlet fever was also done. These patients were treated in the Clinic of Infectious Diseases at the University Hospital “Sv. Georgi” in Plovdiv during the period 2000-2007. The conclusion was that the scarlet fever epidemiological process during the last 10 years had a tendency to decrease its intensity but the typical cyclic recurrence of uncontrollable infections is not changed. The disease predominates in childhood – over 90% are up to 14 years of age. The proportion town/village is the same – the incidence is considerably higher in towns. Con­temporary scarlet fever is characterized by its milder form. Mild forms account for 14,71%, moderate forms for 81,37%, and the severe ones for 3,92% of the cases. Complications among hospitalized patients were found in 9,8%.

Key words: scarlet fever, streptococcal infections, epidemic process

Address for correspondence:
Tanya Petkova, MD, Section “Epidemiology, Parasitology and Tropical Medicine”, Medical University,
1 Sv. Kliment Ohridski str., Bg-5800 Pleven, tel. 064/ 884 269, GSM 0885 33 87 74, e-mail: tanja_1973@abv.bg

DIFFERENTIAL DIAGNOSIS OF LUNG TUBERCULOSIS FROM OTHER INFECTIOUS DISEASES

I. Dikov and G. Popov

Clinic of Infectious, Parasitic and Tropical Diseases, MМА – Sofia

Summary: Lung involvement is common in the course of an infectious disease. It can be primary or secondary, as a complication of a particular infection. Infectious diseases included in differential diagnosis of TB are: Q fever, Legionella pneumonia, Chlamydia pneumonia, mycoplasma pneumonia, tularemia, adenovirus pneumonia, influenza, HIV/AIDS, actinomycosis, abdominal typhus. The broad differential diagnosis of TB from other infectious diseases, necessitates in medical practice always to consider them a potential cause and to perform respective microbiological, virological and parasitological examinations.

Кey words: tuberculosis, infectious diseases, differential diagnosis

Address for correspondens:
Prof. Iv. Dikov, MD, Clinic of Infections, Parasitic and Tropical Diseases, Military Medical Academy,
3 Sv. G. Sofiyski str., Bg-1431 Sofia, tel. 922-61-67, GSM 0877-16-55-80, e-mail: popovg@abv.bg
COGNITIVE IMPAIRMENT AND QUALITY OF LIFE IN PATIENTS WITH MALIGNANT SUPRATENTORIAL BRAIN TUMORS

Е. Enisheynova1, Yu. Ilieva2 and I. Hadjiangelov3

1Neurological Clinic, Military Medical Academy – Sofia
2Section of Biostatistics and Medical Informatics, Chair of Social Medicine, Medical University – Sofia
3Clinic of Neurosurgery – Military Medical Academy – Sofia

Summary: Health-related quality of life has become an increasingly important measure in studies of brain tumor patients. Assessment of quality of life in glioma patients is particularly relevant, as these patients cannot be cured. Quality of life of patients with brain tumors is often impaired by a decreased general and neurologic performance status and decreased cognitive functioning. Modern radiotherapy to moderate doses does not lead to significant cognitive impairment within a median of 3 years of treatment. Тherefore, cognitive disturbances should probably be attributed to damage by the tumor or surgical procedures or to psychological effects.

Key words: cognitive disturbance, quality of life, brain tumors

Address for correspondence:
Elisaveta Enisheynova, MD, Clinic of Neurology, Military Medical Academy, 3 Sv. G. Sofiiski str., Bg-1431 Sofia, e-mail: eli_eni@abv.b
RETROPERITONEOSCOPIC RENAL OPERATIONS

Ts. Genadiev

Clinic of Urology,
University Hospital “Lozenetz” – Sofia

Summary: Retroperitoneoscopic approach is widely used in urological practice. We analyse and report our first results. Between March and December 2008, we have done 4 retroperitoneoscopic pyelolithotomies and 1 retroperitoneoscopic kidney tumor resection. Patients were 4 men and one woman, mean age 64 years. Mean operative time was 180 min. Conversion was performed in two cases – in intrarenal calculus and in tumor resection case. There were no serious complications. We conclude that retroperitoneoscopic approach is a safe, simple, and effective, minimally invasive procedure, a feasible option that can be recommended for management of renal disease.

Key words: retroperitoneoscopic renal operations

Address for correspondence:
Tsvetin Genadiev, Clinic of Urology, University Hospital “Lozenetz”,
1 Kozyak str., Bg-1407 Sofia, tel. 9607669, e-mail: genadievi@abv.bg
RETINITIS PIGMENTOSA – USHER SYNDROME IN TWO CASES WITH AUTOSOMAL-RECESSIVE FORM OF INHERITANCE

K. Koev1, S. Cherninkova2, R. Georgiev1 and I. Kamenov1

1Clinic of Ophthalmology, University “Alexandrovska” Hospital – Sofia
2Clinic of Neurology, University “Alexandrovska” Hospital – Sofia

Summary: Retinitis pigmentosa (RP) is a heritable group of genetic diseases that is characterized by degeneration of the retinal pigment epithelium due to loss of photoreceptors, primary rods and secondary cones. We present 2 familial cases, brother and sister, with Usher syndrome. The visual acuity of the brother was pplc of both eyes, while the visual acuity of the sister was 0,1 of both eyes. Fundoscopically we observed osteoclast-like pigmentations in the posterior pole of the retina and in and around the macula lutea – mainly in the macula of the brother. The ERG of the brother had micropotentials with lack of flicker response; the ERG of the sister – micropotentials without flicker response. The FA of both siblings – revealed dense osteoclast-like pigment in the posterior pole and the macula area.The presented two cases of Usher syndrome are a significantly rarer form of RP with probable autosomal-recessive form of inheritance. Blood for DNA analysis has been taken to confirm the diagnosis.

Key words: computed perimetry, Usher syndrome, fluorescein angiography

Address for correspondence:
Krassimir Koev, MD, Clinic of Ophthalmology, UMBAL “Alexnadrovska”, 1 Sv. G. Sofiyski str., Bg-1431 Sofia, tel. +3592 8365504
2/2009

MUMPS IN SOFIA REGION, 2007
 R. Кomitova1,4, Z. Mihneva2, P. Petrov1, A. Nikolova1, Z. Georgieva1, M. Rusenova1, L. Panchev1,
E. Badalanova1, M. Todorova1 and M. Borisova3

1University Hospital “Sv. Anna” – Sofia
2National Center of Infectious and Parasitic Diseases – Sofia
3Regional Inspectorate for Control and Protection of Public Health
4Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Мedicine,
Medical University – Pleven (current affiliation)
Summary: Mumps is a common childhood infection and its hallmark is swelling of the parotid glands. It is vaccine-preventable and routine vaccination has proven highly effective in reducing its incidence. However, there have been outbreaks of the disease in vaccinated populations recently. During 2007, Bulgaria experienced the third mumps outbreak after introduction of mumps vaccine. Here we report epidemiological, clinical and serological features of 37 hospitalized patients in Department of Infectious Diseases, ar “Sv. Anna” University Hospital, Sofia. Diagnosing mumps is problematic in vaccinated persons. Virus-specific IgM antibodies were measured positive in 49% of acute serum samples, while all acute and convalescent serum samples were IgG positive. To minimize the risk of future outbreaks, measles/mumps/rubella (MMR) vaccine coverage with two doses must be improved and maintained.

Key words: mumps, epidemic, vaccine failure

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. + 359 64/884 385

SOME AESTHETIC AND ONCOLOGYCAL PROBLEMS IN ONCOLOGICAL PROBLMES IN ONCOPLASTIC SURGERY
FOR BREAST CANCER OF THE INFERIOR QUADRANTS

V. Molov1, Iv. Traikov1, R. Romanski2 and K. Ianev1
1Clinic of Plastic, Reconstructive and Aesthetic Surgery,
Medical University – Plovdiv
2Clinic of Plastic, Reconstructive and Aesthetic Surgery,
Medical University – Sofia
Summary: As an advanced method the oncoplastic surgical model is an well-accepted approach for breast cancer treatment in worldwide surgical practice. Some real problems appeared in close connection with its innovative nature. The aim of this study is to assess early technical, oncological and aesthetic problems during the introduction of inverted T-reduction mammaplasty with areolar recentralisation for inferior quadrants breast tumors. Because of tumor formation of the left breast a 60-years old patient was referred to the authors for diagnosis and treatment. During the preoperative assessment, informed consent for breast conserving surgery was obtained – quadrantectomy through inverted T-reduction mammaplasty and axillary dissection by separate incision. Seven months postoperatively the patient was referred again to the authors with local recurrence suspicion. This was rejected by histological examination. Wedge shaped glandular excision was interpreted as a tumor decay/inflammatory infiltration without any clinical evidence of decay or inflammation. The model of breast conserving surgery through the inverted T-reduction mammaplasty meets the requirements of oncology and aesthetic surgery. Postoperative follow-up requires calculation of the specific features of surgical technique chosen. More researches are needed on oncological safety of oncoplastic surgery.

Key words: oncoplastic surgery, reduction mammaplasty, breast conserving surgery

Address for correspondence: V. Molov, MD, Clinic of Plastic, recoNstructive and Esthetic Surgery, Medical University – Plovdiv,
76 Al. Stamboliyski blvd, Bg  4000 Plovdiv, e-mail: oneoplasticsg@abv.bg

TRANSOBTURATOR  SLING  TECHNIQUE TO TREAT INCONTINENCE IN MEN AFTER PROSTATE OPERATIONS. MODIFICATION OF MALE SLING I-STOPTM B. BRAUN - TECHNICAL AND OPERATIVE ASPECTS
Kr. Yanev, M. Georgiev, D. Ormanov, P. Simeonov, Pl. Dimitrov, V. Vassilev, V. Mladenov, Al. Timev, S. Kirilov and P. Panchev
Department of Urology, University Hospital „Akeksandrovska – Sofia
Summary: Postoperative incontinence in operations of the prostate is a significant problem that worsensed significantly the quality of life of patients. We present our initial experience with the male perineal sling using polypropylene mesh and transobturator needles – modified sling system I-STOP, TOMS, B.Braun Company. For a period of three months, modified  I-STOP transobturator  perineal sling was installed to three patients. All patients were with postoperative incontinence – two after a radical prostatectomy and one after suprapubic adenomectomy. The average age of patients was 71.6 years (60 to 74 y). The degree of incontinence before placing the sling could be defined as moderately severe – two cases, and severe – one case. In one case, there was a significant detrusor hyperactivity. The mean operative time was 49.62 min (55 to 75 min). Average bloodloss was 86 ml (from 50 ml to 90 ml). In two cases, the urethral  catheters were pulled out on the second postoperative day and in one – on the third postoperative day. We accept for success the carrying of one or less pads per day, postoperatively. Two of the three cases, were considered socially continent. Patients were followed up to 30-th postoperative day. The male perineal sling is accepted as an efficient method for treatment of urinary stress incontinence in men.

Key words: postoperative incontinence, male transobturator perineal sling , artificial urethral sphincter

Address for correspondence: Krassimir Yanev, MD, Clinic of Urology, MHAT „Aleksandrovska”,
1 Sv. G. Sofiyski Str., Bg 1431 Sofia, GSM: +359 888 68-63-27, e-mail: dr_kyanev@yahoo.com

ROLE OF OCCUPATIONAL RISK FACTORS IN THE DEVELOPMENT OF SOME AUTOIMMUNE DISEASES
E. Petrova
Centre of Occupational Diseases, Medical Faculty, Medical University,
Clinic on Occupational Diseases, University Hospital “Sv. Ivan Rilski” – Sofia
Summary: The aim of the paper is to study and to analyze the literature data, characterizing the etiological role of the non-organic dusts and other professional factors in some autoimmune diseases. Dta of 37 publications and reviews from the last 30 – 40 years were studied. The occupational risk factors (quartz, asbestos, silicates, metal dusts as well as organic solvents, and UV radiation) etc. play an important etiological role in formation of some autoimmune diseases (Caplan’s syndrome – CS, progressive systemic sclerosis – SSc, Erasmus syndrome – ES, systemic lupus erythematosus – SLE, Wegener’s granulomatosis – WG, polyarteritis nodosa – PAN, Goujerot-Sjögren syndrome – SGS). The biological reactions due to silica are connected to stimulation of the immune system, but the molecular mechanisms of the system autoimmunity are not definitely clear. Investigators consider silica a pathogen related molecular model, which plays an important role in presence of genetic predisposition. HLA-A2-A31, HLA-B51-B18 and HLA-DR3-DR11haplotypes are found in quartz exposed individuals. A part of individuals reveal predisposition to autoimmune diseases. The macrophages play a key role in the pathogenesis of the quartz induced diseases. The silica particles influence macrophages, and they release active oxygen radicals and inflammatory cytokines, which provoke immunological mechanism. Initially quartz induces stimulation of the macrophages, and later provokes their death; they produce cytokines IL-1 and TNF, following by activation of the fibroblasts, and fibro-hyaline tissue formation. Genetic factors and immune mechanisms play an important role in CS in quartz exposed individuals. Experimental studies investigating SLE established that quartz provokes parallel adjuvant effect and generates apoptotic material. A case report reveals a relationship between SLE and pesticide exposure. In genetic predisposed quartz exposed individuals, there have been found high production of oxygen radicals, as well as inflammatory cytokines, induction of immune reaction, exocytose of proteinase-3 and appearance of myeloperoxidase antigens on the surface of the polynuclear neutrophils. The occupational risk factors (quartz, asbestos, other silicates, metal particles, organic solvents, UV radiation etc) play an important role as etiological factor in patients with different autoimmune diseases (CS, SSc, ES, SLE, WG, PAN, and SGS). In cases with SSc, some authors suspect influences of plastics, vibrations and welders’ fumes as well. It is necessary to be done a deeper analysis on the occupational risk factors’ exposure, as well as on epidemiology and pathogenesis of the autoimmune diseases for assessment their occupational etiology. The role of the occupational factors in patients with autoimmune diseases should be a study object of epidemiologists, geneticists, rheumatologists and experts in occupational diseases.

Key words: quartz, asbestos, organic solvents, pesticides, autoimmune diseases

Address for correspondence: Prof. Elisaveta Petrova, MD, PhD, DSc, Clinic on Occupational Diseases,
University Hospital “Sveti Ivan Rilski”, 15 Acad. Ivan Geshov Blvd., Bg 1431 Sofia, е-mail: mdepetrova@ yahoo.com

UNIVERSAL COMPONENTS OF QUALITY MANAGEMENT SYSTEM APPLIED IN HOSPITAL PHARMACIES
D. Shopov
MBAL – Haskovo
Summary: A review has been made of the recommendations in the consensus document HS10 -A2, CLSI, USA, about the specific requirements in introducing a quality management system for inpatient medication use. The critical assessment shows that some of the recommendations in the document are known and implemented in Bulgarian hospital pharmacies by accreditation procedure and regulations. However, the document  shows how by implementing a policy, processes and procedures of the universal quality management system in health establishments into a policy, procedures and processes of specific workflow, the hospital pharmacy can achieve the desired level in medication quality, reduce the error possibilities, harms to patients and wastes of resources. The document organizes in a new way the specific information in inpatient medication use, which allows monitoring of activities, identification of problems and their solutions. With desire, comprehension and efforts for better structuring of the quality do­cu­mentation and more objectivism in assessments, the inpatient medication  in hospitals can be harmonized with this international document and the medication service quality – considerably improved.

Key words: Quality managements system, impatient medication quality, document of CLSI, HS10-A2

Address for correspondence: Dimitar Shopov, MD, managing director for MHAT AD – Haskovo,
49 Saedinenie Blvd., Bg- 6300 Haskovo, tel. +359 38/606999, е-mail: shopov_d@abv.bg

3/2009

ISOELECTRIC FOCUSING OF SERUM TRANSFERRIN IN BULGARIAN PEDIATRIC PRACTICЕ
M. Stancheva¹, M. Apostolova², N. Ivanova² and I. Kremenski³
¹Pediatric clinic, University Hospital “Alexandrovska”
²Laboratory of Medico-biological Research, Institute for Molecular Biology, Bulgarian Academy of Science
³National Genetic Laboratory
Summary: Isoelectrofocusing of serum transferrin (IEF) is a routine screening method in most of the European countries for diagnosis of congenital disorders of glycosylation. Our aim was the introduction of the method into Bulgarian clinical practice for diagnosis of these complex multiorgan disorders with predominant involvement of the central nervous system leading to mental retardation and invalidization. In the investigation participated 85 children with symptoms of metabolic disease. Here we present an overview of the applied individualized protocol for IEF of serum transferrin, and our experience with diagnostics of congenital disorders of glycosylation. The authors recommend to include the method in the diagnostic algorithm of mental retardation and/or liver failure.
Key words: isoelectric focusing, transferrin, congenital disorders of glycosylation
Address for correspondence: Malina Stancheva, MD, Pediatric clinic, University Hospital “Alexandrovska”,
1, St. G. Sofiiski, str., Bg-1431, Sofia, Bulgaria, tel. 0359 2 9230 640

PERSPECTIVES FOR HEPATITIS B ERADICATION
A. Kevorkian1, N. Petrova2, Y. Stoilova1 and E. Kuncheva3
1Department of Preventive Health, Ecology and Epidemiology, Medical University – Plovdiv
2Department of Social Medicine and Public Healthр Medical University – Plovdiv
3Department of Infectious Diseases Suveillanceр Center for Disease Control – Plovdiv

Summary: Viral B hepatitis (VBH) is undergoing a gradual eradication process worldwide. This task was set as a priority by WHO in 1988. The availability of a highly effective recombinant vaccine, the anthroponosis character of the disease and its remote relation to other microbial species made this process possible. According to world experts, eradication is real, when there is a complete vaccine coverage of the susceptible population. Bulgaria is among the first countries, that have joined this process. The aim of the present study was to establish the trend in the epidemiological prevalence of viral hepatitis B in the region of Plovdiv and to assess the rate of disease eradication due to the undertaken complex preventive measures. Hepatitis B prevalence rate in Plovdiv over the period 1982-2009 was analyzed. Data on vaccine coverage of the population were evaluated. Method used were: complex epidemiological methods, method of least squares, correlation analysis, mathematical and statistical methods to assess the effectiveness of vaccinations. It was established that vaccination coverage is relatively high: 93% average for the country and 95% average for Plovdiv region. From 1982 through 2008, prevalence rates dropped three times – 38,41%ооо to 11,49%ооо. In the prevaccination period, the prevalence curve shows an upward tendency whereas in the vaccination period it demonstrates a sharp decline – the average annual decrease rate is 1,32%ооо, average morbidity rate is 32,21%ооо. Determination coefficient is high (75%), as well as correlation coefficient – 0,86. R (vaccine effectiveness) is 0,8. We consider that the eradication process is difficult and slow as only 13% of the region’s population are vaccinated.
Key words: viral hepatitis B, eradication, recombinant vaccine, epidemiological effectiveness
Address for correspondence: Ani Kevorkian, MD, Department of Preventive Health, Ecology and Epidemiology, Medical University, 15A “V. Aprilov” str., Bg-4000 Plovdiv, tel. +359 32 602-931, в. 245, 251, е-mail: ani_kevorkian@mail.bg

APPLICATION OF MODIFIED TRANSOBTURATOR SLING TECHNIQUE FOR TREATMENT OF INCONTINENCE AFTER PROSTATE SURGERY – EARLY RESULTS
Kr.Yanev, M. Georgiev, D. Ormanov, Pl. Dimitrov, V. Vassilev, V. Mladenov, Al. Timev, P. Simeonov,
S. Kirilov and P. Panchev

Clinic of Urology, University Hospital "Aleksandrovska” – Sofia
Summary: The postoperative incontinence after prostate surgery is a troublesome complication decreasing the quality of patients’ life. We present our early experience with modified male perineal sling, using the propylene mash and transobturator needles as the sling I-STOP, TOMS of B. Braun. For the period of four months, transobturator perineal sling, a modification of the sling I-STOP, was put in four patients. All of them were with postoperative incontinence due to: radical prostatectomy in two, and adenomectomy in the other two cases. Mean age was 65,25 (from 60 to 74). Тhe degree of incontinence before surgery was classified as mild in one patient, moderate in two and severe in one patient. Mean operative time was 60 min (from 50 to 75). Mean blood loss was 62,5 ml (from 50 to 90 ml). Drainage was not used in any of the four cases. Mean follow up was 4,5 months (from 3 to 6). Success was defined as using one or less pad per day. In three of the four cases, the patients were socially continent. Postoperatively, only one patient was completely continent and incontinence persisted in one case. The male perineal sling is an effective method for treatment of incontinence in men who underwent prostate surgery.
Key words: AUS-artificial urethral sphincter, transobturator sling technique, postoperative incontinence
Address for correspondence: Krassimir Yanev, MD, Clinic of Urology, UMHAT „Aleksandrovska”,
1 Sv. G. Sofiyski Str., Bg-1431 Sofia, GSM: 0888 68-63-27, e-mail: dr_kyanev@yahoo.com

CLINICAL INVESTIGATION OF COMBINED INFLUENCE OF THE LOW INTENSITY LASER THERAPY WITH MEDYRAY 04, ACYCLOVIR AND IOD-DESOXYURIDIN IN PATIENTS WITH KERATITIS HERPETICA DENDRITICA
K. Koev1, V. Tanev1, L. Avramov2 and E. Borisova2
1Clinic of Ophtalmology, UMHAT “Alexandrovska” – Sofia
2Institut of Electronics, BAS – Sofia

Summary: The investigation of the treatment effect with combined therapy of the keratitis herpetica dendritica: He-Ne laser, iod-desoxyuridin (ID), Acycovir. The survey was conducted to 64 eyes with keratitis herpetica dendritica divided in three groops. The first group of 20 eyes is treated with Acycovir. The  second group of 21 eyes is treated with ID and Acycovir. In the third group of 23 eyes besides the abovementioned combination was apllied He-Ne laser every day – wave leught 632 nm and power densisty 0,3 mw/cm2 in exposure 3 minutes.The flourescein reaction was monitored every day. We observed earlier answer of the inflammatory and the perifocal edema in the group treated with He-Ne laser, ID and Acycovir. Treated eyes with Acycovir presented mean time of improvement (MTI) of the keratitis for 9,2±0,3  days. Similar results were obtained on the eyes treated with double combination, ID and Acycovir, MTI – 8,3 ± 0,6 days. The best effect was obtained by the triple combination: ID, Acycovir and He-Ne laser (statistically proved),  MTI – 6,3 ± 0,4 days. The combined treatment  shows marked additional effect. It is concluded that combined treatment with He-Ne laser, ID and Acycovir is an efficient method for treating patients with keratitis herpetica dendritica.
Key words: He-Ne laser, Acycovir, ID, keratitis herpetica dendritica, regeneration
Address for correspondence: Krassimir Koev, MD, Clinic of Ophthalmology, UMHAT “Alexandrovska”,
1 Sv. G. Sofiyski Str., Bg-1431 Sofia, tel. +359 2 8365504

QUALITY MANAGEMENT SYSTEM IN EMERGENCY WARD
D. Shopov
MHAT – Haskovo
Summary: Presented are the results of a two-year period of activities at Emergency Ward of MHAT – Haskovo and the acquired experience of the model introduction of a Quality Management System in the same ward. It has been established that the systematic presentation of the activities in proper tables and diagrams gives good opportunities for analysis and evaluation, and the presentation of the processes with the supporting procedures, instructions and persons in charge in the course of the work implements two important components of the Quality Management System – control and improvement. It is outlined that the lack of normative documented indicators for the professional quality in emergency wards impedes the objective assessment of the effect of the model introduction.
Key words: health establishments, emergency, quality management
Address for correspondence: Dimitar Shopov, MD, MHAT,
49 Saedinenie Blvd., Bg-6300 Haskovo, tel. +359 38 606999, е-mail: shopov_d@abv.bg
POSSIBLE CONSEQUENCES FOR BLACK SEA REGION IN CASE OF PROBABLE TERRORIST ACTION WITH DEPLETED URANIUM 
Hr. Romanova1, D. Tomov1 and N. Popov2
1Department of Hygiene and Disaster Medicine, Medical University – Varna
2“Nikola Vaptsarov” Naval Academy - Varna

Summary: In the article, the possible consequences for Black sea region in case of probable terrorist actions with depleted uranium are viewed. The detonations with depleted uranium hide serious danger of pollution for the environment and man. The possible medical consequences of the effect of depleted uranium are insignificant in case of external irradiation and severe in case of internal one, even after decades. For the time being, there are no data for registered pollution of air, water, soil, animals and man, but the presence of contemporary weapons with depleted uranium and the military-strategic significance of Black sea region make the question of possible consequences substantial.
Key words: depleted uranium, terrorist actions, medical consequences
Address for correspondence: Assoc. Prof. Hristianna Romanova, MD, Head of Department of Hygiene and Disaster Medicine, Medical University, 55 “Marin Drinov” Str., Bg-9002 Varna, tel. 0878 568 448, e-mail: romanova_hr@abv.bg
4/2009

DEVELOPMENT AND VALIDATION OF SPECTROPHOTOMETRIC METHOD FOR DETERMINATION OF OCTYL METHOXYCINNAMATE IN COSMETIC PRODUCTS FOR SUN PROTECTION AT INDIVIDUAL AND COMBINED PRESENCE WITH PHYSICAL ULTRAVIOLET FILTERS ZINC OXIDE AND TITANIUM DIOXIDE
A. Tachev, S. Uzunova and N. Vasileva
National Center of Public Health Protection, Ministry of Health – Sofia

Summary: There is no available referent method for determination of UV filter Octyl Methoxycinnamate in cosmetic products for sun protection. The aim of the study is to develop and validate a comprehensible spectrophotometric method for its determination. A spectrophotometric method for determination of UV filter Octyl Methoxycinnamate in cosmetic products for sun protection is developed. It is applicable at both individual and combined presence with physical UV filters Zinc Oxide and Titanium Dioxide. The method is based on the ability of Octyl Methoxycinnamate solutions in ethyl alcohol to absorb UV rays with wavelength of 308 nm. The value of light absorption measured at that wavelength is proportional to the concentration of Octyl Methoxycinnamate. A total of 443 tests were conducted to derive the method parameters: selectivity – specific absorption at 308 nm; linearity – from 2,5 to 30 μg/cm3 (from 1,2 to 15%); stability for 24-h stay of Octyl Methoxycinnamate concentration 10 μg/cm3 – RSD = 0,40%; repeatability – at 4% Octyl Methoxycinnamate – standard deviation (SD) – 0.030%; recovery – at 4% Methoxycinnamate – relative standard deviation (RSD) – 0,77%, in conditions of repeatability; analytical recovery at Octyl Methoxycinnamate concentration in the cosmetic product of 2% – 88,28% (72,68-94,82%), at 4% – 96,62% (88,35-99,16%). For the various cosmetic products, there were determined: scope of the method, Limit of detection (LOD) and Limit of quantification (LOQ). For a cosmetic product with homogeneous creamy consistency, emulsion type water in oil: operation range of the method – 0,09-15% (0,18 μg/cm3-30 μg/cm3); LOD – 0,05%; LOQ – 0,09%. For a cosmetic product with milky consistency, emulsion type water in oil: operation range of the method – 0,84-15% (1,69 μg/cm3-30 μg/cm3); LOD – 0,68%; LOQ – 0,84%. For a cosmetic product with creamy consistency, emulsion type oil in water: operation range of the method – 0,11-15% (0,21 μg/cm3-30 μg/cm3); LOD – 0,06%; LOQ – 0,11%. The developed and validated spectrophotometric method for determination of UV filter Octyl Methoxycinnamate in sunscreens is rapid, with good sensitivity, accuracy and recovery, does not require complex expensive equipment and can be easily implemented for control of cosmetic products for sun protection.
Key words: ultraviolet filters, ultraviolet A rays, ultraviolet B rays, solarprotection cosmetic products, absorption, concentration
Address for correspondence:  Anton Kolev Tachev,15, Ivan Geshov Blvd., Bg –1431 Sofia, е-mail: A.Tachev@ncphp.government.bg

ON THE ROLE OF SOCIAL FACTORS IN COMMUNICABLE DISEASES
V. Doycheva1, T. Dimitrova1 and T. Petkova2
1Department of Epidemiology, Medical University – Sofia
2Department of Epidemiology, Parasitology and Tropical Medicine, Medical University – Pleven

Summary: Contemporary evolution of communicable diseases requires concrete analysis of phenomena, such as demographic changes, urbanization, population migration, changes in social ecosystems, etc. Its complexity includes multiple subsystems with specific mechanisms of self-development, self-regulation and self-maintenance. Regional specificity of social policies in prevention of and fight against communicable diseases is particularly well-represented by the evaluation of epidemiologic situation in the different countries. In Bulgaria, the social policy is based on the dominant influence of social factors on epidemiology-related issues. Social factors have their significant role in the three stages of the epidemic process as well as in the specificity and distribution of the infectious process.
Key words: social factors, social policy, communicable diseases, epidemic process, infectious process, demographic parameters
Address for correspondence: Dr. Viktoriya Doycheva, PhD, Department of Epidemiology, Medical Universiti – Sofia, SBALAG "Maichin dom" room 669, tel. +359 2  952 38 44, e-mail: v.doycheva@mail.bg

A NEW ABOUT NOSOCOMIAL INFECTIONS
W. Monev
Summary:
During the last years on the basis of development of biotechnologies and improved isolation and identification of microbiological agents, in the fore ground comes more and more the polybacterial infectious process which, plays a greater role in nosocomial infections (NI). To avert exogenous NI there are appropriate hygienical and control measures because the success or unsuccess depend of available corresponding resources. In endogenous infections, the patients themselves are source of infection. In these cases, control measures have little potentialities because etiopathogentical dispositions often can not be influenced. The early identification of agents of NI is of exclusive importance. Recently revealed mechanisms of peculiarities of collective behaviour of microorganisms ("quorum sensing") and of relationship between microbial species between and host (“cross-talk”) have their epidemiological dimemsions, that should be use in prevention of NI.
Key words: infections, nosocomial infections, pathogenetical and diagnostic aspects
Address for correspondence: Prof. W. Monev, 19 Yurii Venelin str. 19 entr. 1, Bg  1142 Sofia, tel. +359 2 898-83-98

CHROMAGEN CONTACT LENS – A NEW METHOD FOR CORRECTION OF COLOR DISRUPTION
K. Koev, R. Georgiev and E. Trendafilova
Clinic of Ophtalmology, UMBAL “Alexandrovska” – Sofia

Summary: The first case in Bulgaria is presented of applied ChromaGen contact lens for correction of color disruption produced by CANTOR+NISSEL Company exclusively represented here by SMI company. The patien D.D., 22-years old has normal visual acuteness and innate color abnormalitydischromatopsia .A deiteranomaly was found during the color vision examination with HUE – 28, Fornsworth 100, Anomaloscop JF-2, ATL (Album Tritan Lantony) and color tables Ishihara and Rabkin. It was found by tests which is the non-dominant eye – in our case the right one – which received the ChromaGen lens. After the application of the ChromaGen lens on the non-dominant eye, a normal trichromasia was reported, found out by the above-mentioned methods, During an anomaloscopie we found that the patient is color normal with his right, non-dominant eye, with values within the referent limits from AQ = 1,04; B = 15 to AQ = 0,75; B = 14. During an examination with anomaloscope of each eye separately, it was found that the dominant eye sees the colors in the way it has seen them before the color anomaly.
Key words: dischromatopsia, ChromaGen contact lens, anomaloscope JF-2, color tables
Address for correspondence: Krassimir Koev, M. D., Clinic of Ophthalmology, UMBAL “Aleksandrovska”, 1, Sv. G. Sofiiski Str., Bg – 1431 Sofia, tel. +359 2 8365504, е-mail: sofia56@abv.bg

INTRAOPERATIVE USING OF A HIGH-FREQUENCY LINEAR TRANSDUCER IN INTRAMYOCARDIAL SITUATED CORONARY VESSELS
Z. Vazhev, K. Stanev, K. Hadzhihristev, G. Nedyalkov, N. Dodenov, H. Rahman and G. Nachev
Cardiosurgery Clinic,UMBAL “Sv. Georgi” – Plovdiv

Summary: Some patients’ coronary arteries are situated deeply under fatty tissue and the myocardium. Thus, it is hard to find and reach an intramuscular located coronary artery. In these cases, it is reasonable to use a high-frequency linear transducer to visualize and display the intramyocardial coronary artery. We represent the opportunities of the used instrument and our modest experience with two patients who underwent coronary artery bypass grafting.
Key words: high-frequency linear transducer, intramyocardial coronary artery
Address for correspondence: Z. Vazhev, MD, Cariosurgery Clinic, UMBAL “Sveti Georgi”, 66 Peshtersko shosse blvd., Bg-4000 Plovdiv, tel./fax +359 32/602 800

ЕNDOSCOPIC RENAL CYST RESECTION – TRANSPERITONEAL AND RETROPERITONEAL ACCESS
Ts. Genadiev
Clinic of Urology
University Hospital Lozenets – Sofia

Summary: We compared the transperitoneal and retroperitoneoscopic endoscopic renal cyst resection according to technique of the procedures, operative time, complications and postoperative early results. Between 2004 and 2009, 15 patients underwent endoscopic cyst resection. The patients were 10 women and 5 men. Mean age was 48 years (range 28-63). Patients were divided into 2 groups: group A (n = 10) – transperitoneal approach with pneumoperitoneum and 3 to 4 ports, and group B (n = 5) – retroperitoneal approach with retroperitoneal balloon dissection with 3 to 5 ports. There were one case of peripelvical symptomatic cyst and one case of renal polycystosis. Transperitoneal operations in group A were successful with mean operating time 60 min (50-110 min). Retroperitoneoscopic renal cyst decortication was successfully performed in all 5 patients on group B, no conversion was needed. The mean operative time was 70 min (50-90 min) in patients with parenchymal and peripelvic cysts. There was minimal operative blood loss in both groups. Mean lenght of hospital stay was 3 days (2-5 days). Laparoscopic transperitoneal and retroperitoneoscopic renal cyst resections are a safe procedures. The choice of method depends on location of the cyst – ventral or dorsal, upper or down pole, and peripelvical, polycystic or parenchymal. In cases of peripelvical cyst and polycystic kidney, the best approach is the transperitoneal one because of the large operative space and possibility to operate both kidneys.
Key words: renal cyst, laparoscopic and retroperitoneoscopic renal cyst resection, solitary cortical cyst, simple parenchymal cyst, peripelvic renal cyst, renal polycystosis
Address for correspondence: Tzvetin Genadiev, MD, Clinic of Urology, University Hospital Lozenetz, 1 Kozyak str., Bg – 1407 Sofia, tel. +359 2 9607752, e-mail: genadievi@abv.bg

BACTERIAL INFECTIONS OF CENTRAL NERVOUS SYSTEM IN NEWBORNS AND CHILDREN UP TO 1 YEAR
Ts. Doychinova1 and R. Rosmanova2
1Clinic of Infectious Diseases
2Clinic of Neopathology
UMBAL – Pleven

Summary: The aim of this study is to compare etiological agent, clinical course, laboratory and liquor data and the outcome of the disease among newborns and children up to 1 year with bacterial meningitis. It presents a retrospective analysis of the progress of the disease in 9 newborns and 9 children up to 1 year. Respiratory, cardiovascular, renal and hemorrhagic complications are more frequent in newborns, also proteinorachy is more pronounced, the disease shows high lethality and neurological complications. In children under 1 year, meningo-radicular syndrome is established in 77%, proteinorachy is pronounced, PMN’s pleocytosis is at higher level, the outcome of disease is favorable without neurological complications.
Key words: bacterial meningitis, newborns
Address for correspondence: Tsetsa Doychinova, MD, Clinic for Infectious Diseases, UMBAL, 8a G. Kochev bvld., Bg  5800 Pleven, tel. +359 888 729 532, e-mail: doichinova@abv.bg

INTESTINAL PERMEABILITY IN PATENTS WITH ULCERATIVE COLITIS AND ITS ASSOCIATION WITH THE DISEASE CHARACTERISTICS
V. Gerova1, D. Svinarov2, S. Stoinov1 and D. Katsarov2
1Clinic of Gastroenterology, UMBAL “Tsaritsa Yoanna” – Sofia
2Central Laboratory of Therapeutic Drug Monitoring and Clinical Pharmacology,
UMBAL “Alexandrovska” – Sofia

Summary: Aim of the work was to study the alterations in intestinal barrier function in patients with active ulcerative colitis (UC) by assessment of intestinal permeability (IP) and to assess its association with the disease characteristics (extent, severity, endoscopic activity). The study included 26 patients with active UC and 25 healthy controls. The diagnosis was made on the basis of commonly accepted criteria. IP was assessed using of a contrast medium iohexol (Omnipaque), which was administered orally (25 ml, 350 mg/ml) 2 hours after breakfast. Six hours later, serum iohexol concentrations (SIC) were determined by a validated high-performance liquid chromatography technique. In patients with active UC, the median SIC (2,49 ± 2,80 mg/l) were significantly higher in comparison to the controls (1,11 ± 1,10 mg/l), (p = 0.023). Abnormal IP was found in 8% of the controls and in 30, 8% of UC patients. The alteration of IP were 2-fold more frequently in the cases with pancolitis (41.7%) than in distal and left side UC (21.4%). There was no relationship between IP parameters and UC severity. Median SIC of the patients with severe endoscopic activity (3.68 ± 3.18 mg/l) were significantly higher compared to patients with mild to moderate activity (0.91 ± 0.69 mg/l), (р = 0.009). The alterations of IP were found in about 1/3 of UC patients, more frequently in the cases with pancolitis, but not related to the disease severity. Serum concentrations of iohexol appear to be a reliable disease marker in patients with active UC as they reflect the activity of mucosal inflammation in the colon.
Key words: ulcerative colitis, intestinal permeability, iohexol
Address for correspondence: V. Gerova, MD, Clinic of gastroenterology, UMВAL “Tsaritsa Yoanna”, 8 Bialo more str., Bg  1527 Sofia, tel. +359 2 92-30-305

OPTICAL COHERENCE TOMOGRAPHY APPLICATION IN ANTERIOR EYE SEGMENT DISORDERS
H. Blagoeva
MBAL “Sv. Sofia” – Sofia
Summary:
Anterior segment imaging is a rapidly advancing field of ophthalmology. The aim of the study is to represent the basic clinical applications of optical coherence tomography (OCT) in anterior eye segment disorders. Data, impressions and results are shown concerning usage in: LASIK, phakic IOL implantation, corneal disorders, cataract surgery, glaucoma, trauma, other disorders of the anterior segment. OCT is a fast, reproducible, in real time, non-contact method for evaluation of the structures of anterior eye segment.
Key words: optical coherence tomography, anterior eye segment
Address for correspondence: Hristina Blagoeva, MD PhD, Department of Ophthalmology, UMBAL “Sv. Sofia”, 104 Bulgaria blvd., tel. +359 2 818 46 23, GSM: +359 888 46-28-90, e-mail: ch_blagoeva@abv.bg

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