Original articles 2010

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1/2010

THE ROLE OF LOW MOLECULAR ANTIOXIDANT N-ACETYL-L-CYSTEINE ON THE PHOSPHOLIPID COMPOSITION OF THE ALVEOLAR SURFACTANT IN SEPTIC RESPIRATORY DISTRESS SYNDROME CAUSED BY EXPERIMENTAL FECАL PERITONITIS
S. Lazarov1, R. Nicolov2, E. Yanev1, A. Momtchilova3 and R. Pankov4
1Department of Pathophysiology, Medical Faculty – Sofia
2Department of Pharmacology and Toxicology, Medical Faculty – Sofia
3Institute of Biophysics, Bulgarian Academy of Sciences
4Department of Biology, Sofia University “Sv. Kliment Ohridski”

Summary: The acute fecаl (bacterial) peritonitis represents a major problem in the clinical practice. It causes Gram-negative sepsis, resulting in septic shock and multiple organ dysfunction syndrome leading to death in 40-45% of hospitalized patients. It is due to the respiratory distress syndrome in adults (ARDS) in over 90% of the patients. It is developed because of irreversible structural and functional injuries in the lung surfactant system and meanly in the alveolar surfactant (AS). Despite of serious improvements in both the therapy and the intensive care for patients with ARDS, the mortality is about 50-60% for the last ten years. Different antioxidants are between the most studied drugs for the treatment of ARDS. In the present study, we investigated the АS of rats in experimental model of sepsis ARDS, treated by a low molecular non-enzyme antioxidant N-acetyl-L-cysteine. We studied the total quantity and the percent ratio of the surfactant phospholipids and the quantity ratio between the main phospholipid fractions in the AS. We found statistically significant favorable changes in the studied indicators of the treated with N-acetyl-L-cysteine.
Key words: acute fecаl peritonitis, sepsis, septic shock syndrome, adult respiratory distress syndrome, alveolar surfactant, surfactant phospholipids, lipid transfer proteins, N-acetyl-L-cysteine
Address for correspondence: Simeon Lazarov, MD, Department of Pathophysiology, Group of Lung Pathology and Survactants, Medical Faculty, Medical University – Sofia, 1 Sv. G. Sofiyski str., Bg-1431 Sofia, GSM: 0897 75 14 93

ALTRATIONS IN INTESTINAL PERMEABILITY IN PATIENTS WITH LIVER CIRRHOSIS AND PORTAL HYPERTENSIVE GASTROPATHY
V. Gerova1, D. Svinarov2, S. Stoinov1, B. Vladimirov1 and D. Katsarov2
1Clinic of Gastroenterology, University Hospital “Queen Joanna” – Sofia
2Central Laboratory of Therapeutic Drug Monitoring and Clinical Pharmacology, University Hospital “Alexandrovska” – Sofia

Summary: Studied is the relationship between intestinal barrier function and portal hypertensive gastropathy (PHG) in patients with liver cirrhosis (LC) by assessment of intestinal permeability (IP). The study included 31 patients with LC and 25 healthy controls. The diagnosis was made on the basis of commonly accepted criteria. IP was assessed using a contrast medium iohexol (Omnipaque), which was administered orally (25 ml, 350 mg/ml) 2 hours after breakfast. Three and six hours later serum iohexol concentrations (SIC) were determined by a validated high-performance liquid chromatography technique. In the sub-group of patients with PHG (n = 18), the median SIC at 3 (2,67 ± 1.90 mg/l) and at 6 h (2,54 ± 2,02 mg/l) after its ingestion were significantly higher in comparison to the patients without PHG (1.15 ± 0.71 mg/l, respectively 1.24 ± 0.79 mg/l) and to the controls (1.25 ± 1.40 mg/l and respectively 1,11 ± 1,10mg/l) (p < 0,05). Abnormal IP was found in 33.3% of pt with PHG, 7.7% in cases without PHG and in 8% of the controls. Increased IP to iohexol in patients with LC and PHG was found more frequently, probably related to structural changes in small/large intestinal mucosa as a part of spectrum of microcirculatory alterations in gastrointestinal tract secondary to portal hypertension.
Key words: liver cirrhosis, portal hypertensive gastropathy, intestinal permeability, iohexol
Address for correspondence: V. Gerova, MD, Clinic of Gastroenterology, UMBAL “Tsaritsa Yoana”, 8 Byalo more str., Bg-1527 Sofia, GSM: 0898 65-31-84

IMMUNOMODULATORY AND ANTITUMOR EFFECTS OF PROBIOTICS AND RECOMBINANT HUMAN ERYTHROPOIETIN
I. Pashalieva and Zl. Stoyanov
Department of Physiology and Pathophysiology, Medical University – Varna

Summary: Treatment of cancer patients remains a serious medical problem and the development of alternative treatment strategies is therefore of great importance. The article summarizes the findings on the possible mechanisms of action of some nutritional components such as probiotics in the treatment and prevention of cancer. Evidence from the literature supports the antineoplastic effect of recombinant human erythropoietin (rEPO). rEPO might be used as an adjunct immune treatment in various malignant diseases in addition to the current regimen and chemotherapeutic protocols.
Key words: cancer, probiotics, erythropoietin, biotherapy
Address for correspondence: Irina Pashalieva, MD, Department of Physiology and Pathophysiology, 55 M. Drinov str., Bg-9000 Varna, tel. +359 67 70 50, 2630, е-mail: ipashalieva@yahoo.com

DISTRIBUTION OF CТ1-СТ2 STAGE PROSTATE CARCINOMA IN THE PERIPHERAL ZONE OF THE PROSTATE GLAND AND OPTIMIZATION OF THE PROTOCOL FOR TRANSRECTAL PROSTATE BIOPSY
N. Smilov1, E. Aleksandrov1, I. Lozev2 and P. Lozev1
1Urology Ward, Medical Institute – Ministry of Interior – Sofia
2Clinic of Surgery, Medical Institute – Ministry of Interior – Sofia

Summary: The objective of the study was to investigate the distribution of prostate carcinoma in the peripheral zone in order to optimize the protocols for diagnosis of сТ1-сТ2 stage carcinoma at first biopsy. We studied the results from 385 biopsies under TRUS guidance performed in the 7-year period between 2002 and 2009 to patients suspected for harboring prostate carcinoma. Secondary and third biopsy was performed to 106 and 16 patients respectively. The applied biopsy protocols were 6-, 10-, 12-core biopsies, 15-core i.e. 5-regional model and saturation biopsy with 18 and more cores. At first biopsy to all patients with a gland up to 30 cc the systematic Stamey protocol was applied, for patients with prostate volume 30-50 cc the 10-core protocol was used, while to those with glands bigger than 50 cc – the chosen protocol was the 12-core biopsy by Gore. The protocol used for secondary biopsy was 5-regional by Eskew while saturation protocol was used in the cases of third biopsy. In total, 4080 punctures were performed at first biopsy, 1590 punctures at second and 351 at third biopsy. Prostate carcinoma was diagnosed in 119 (30,9%) patients. The diagnostic rate out of all patients with carcinoma at first biopsy was 85,8% (102 patients), at second biopsy – 11,7% (14 patients), and at third biopsy – 2,5% (3 patients). The punctures of the prostate base are with the biggest contribution to cancer detection followed by those laterally directed in the middle part of the gland; then the punctures directed at the anterial horn of the peripheral zone (in the cases of glands bigger than 50 cc) and those in the apex. The sextant model even in glands smaller than 30 сс omits considerable number of carcinomas in Т1-Т2 stage. The 12-core biopsy does not show an advantage over the 10-core protocol in glands up to 50 сс. In prostates with volume > 80 сс, it is necessary to apply additional punctures (5-region model).
Key words: prostate carcinoma, prostate biopsy, transrectal ultrasound
Address for correspondence: N. Smilov, MD, Medical Institute – Ministry of Interior, 79 Skobelev blvd., Bg-1606 Sofia, GSM 0888 763 674, e-mail: smilov_nencho@yahoo.com

PRIMARY SPONTANEOUS PNEUMOTHORAX – YES OR NO ALFA-1 ANTITRYPSIN DEFICIENCY
I. Novakov1, G. Paskalev1 and D. Terzieva2
1Department of Thoraco-Abdominal Surgery, Medical University – Plovdiv
2Central University Laboratory, Medical University – Plovdiv
Summary:
Primary spontaneous pneumothorax is a frequent pathology for thoracic surgeons. Mechanisms of its origin are still discussed. The aim of this study was to establish if there is a correlation between primary spontaneous pneumothorax and serum activity of alfa-1 antitrypsin. 34 patients with recurrent primary spontaneous pneumothorax were included in the study. Chest radiograph, computed tomography and medical thoracoscopy were used to determine the group of patients. The level of serum alfa-1 antitrypsin was determined by imunoturbidimetry. The cause of primary pneumothorax in 25 (73,5%) of patients was rupture of subpleural blebs. For 11 of them, there were established blebs onto the lung surface without rupture. For 9 of patients (26,5%), no defects of the lung surface were established. Serum levels of alfa-1 antitrypsin were in the referent interval [mean – 1, 51 g/L; SD – 0,28; sem – 0,04] in all patients. There is no correlation between serum levels of alfa-1 antitrypsin and primary spontaneous pneumothorax. The lack of alfa-1 deficiency in patients with primary pneumothorax, reject the need of their clinical observation.
Key words: primary spontaneous pneumothrax, alfa-1 antitrypsin
Address for correspondence: Ivan Novakov, Department of Thoraco-Abdominal Surgery, Medical University, 54 Petrova niva str., Bg-4004 Plovdiv, e-mail: inovakov2003@yahoo.com
VIRAL MENINGITIS AND MENINGOENCEPHALITIS IN CHILDREN TREATED IN THE HOSPITAL OF INFECTIOUS DISEASES – SOFIA (1996 -2008)
A. Mangarov¹, Sv. Alexieva¹, N. Korsun², R. Kotseva², D. Ilieva¹ and M. Slavova¹
¹Hospital of Infectious Diseases – Sofia
²National Centre of Infectious and Parasitic Diseases – Sofia

Summary: Viral infections of the central nervous system occupy a considerable place in the infectious pathology of childhood. The aim of the study is to provide a retrospective analysis of the etiological structure, clinical course, laboratory findings, and the consequences of the viral infections of the central nervous system in 111 children treated in the Pediatric Ward with ICU of the Hospital of Infectious Diseases in Sofia for the period 1996-2008 (13 years) with viral meningitis or meningoencephalitis. Diagnosis in all patients was confirmed by spinal tap. 85 of the patients were tested in the reference laboratories of the National Centre for Infectious and Parasitic Diseases – Sofia. The most frequently confirmed agent was influenza – 20 – Н3N2, 1 – type B, 1 – A + B. 51 (45,95%) had no causative agent confirmed. 26 (23,44%) had no material sent for virology testing. Most of the patients were over 5-year-old. Infants were least affected. Males were affected twice more than females. Most of the cases were in the summer months – 44 (39,64%), and least in the winter months – 18 (16,22%). In influenza cases, the picture was reversed – cases were evenly scattered throughout the year with least cases in summer. The average hospital stay was 13,68 ± 8,75 days. 27 of the patients (24,32%) were CT scanned, 13 of them had abnormalities. Typical profile of a pediatric patient with viral meningitis treated in the Hospital of Infectious Diseases in Sofia for the last 13 years is presented. Most severe and with most complications were the cases caused by influenza viruses.
Key words: viral meningitides, spinal fluid, influenza, enteroviruses
Address for correspondence: Dr. Atanas Mangarov, Hospital of Infectious Diseases, Pediatric Ward with ICU, 17 Akad. Ivan Geshov str., Bg-1606 Sofia, e-mail: amangarov@gmail.com
DIAGNOSTIC VALUE OF T SPOT TB IN CHILDREN WITH LATENT TUBERCULOSIS INFECTION
S. Velizarova
University Clinic of Pulmonary Diseases in Children
University Hospital of Pulmonary Diseases, “Sv. Sofia”
Summary:
In the University Clinic of Pulmonary Diseases in Children – Sofia, there were studied 38 children with LTBI. It was found that hyperergy increases with age – 46,7 were aged 0-3 year, 73,4 – 4-7, and 93,8 – over 8 years. T SPOT TB test was negative in 80-100% of the children. Following conclusions can be made: 1. Hyperergy proportion of TST increases with age, the most prominent are children over 8 years of age. 2. T SPOT TB is dominantly negative in all age groups – 80-100%. 3. Negative T SPOT TB is not an argument for rejection of LTBI. 4. In children with positive T SPOT TB, chemoprophylaxis is especially important, since they are more likely to develop disease. 5. There is no Correlation dependence between both tests – kappa – 0.055. 6. TST has a leading role in the diagnosis of LTBI.
Ключови думи: tuberculosis in children, diagnostic test for TB, IGRAs tests, LTBI
Address for correspondence: S. Velizarova, MD, Child Clinic, Sv. Sofia University Hospital of Pulmonary Diseases, 17 Acad. Iv. Geshlov blvd., Bg-1606 Sofia, tel. 359 2 80-54-299
MANAGEMENT OF THE ALCOHOL DEPENDENCE SYNDROME IN TOXICOLOGICAL PRACTICE
A. Loukova and M. Gesheva
Toxicology Clinic, MHATEM "Pirogov"
Summary: We are presenting a systematic study over 108 patients dependent on alcohol. Algorithm is discussed for the­rapeutic behavior. The study presented a comprehensive intervention program of medical, social and administrative activities, enabling to overcome behavioral dependency, improve the health and mental condition of patients, enabling selection of the next stage of treatment, family and social reintegration of the patient.
Key words: alcohol dependence, complex treatment
Adress for correspondence: Anelia Loukova, MD, Toxicology Clinic – Psychiatry Sector, MATHEM „Pirogov”, 21 Totleben blvd., Bg-1606 Sofia, tel. 9154409, е-mail: aloukova@yahoo.com
ДИАГНОСТИЧНА СТОЙНОСТ НА T SPOT TB ПРИ ДЕЦА С ЛАТЕНТНА ТУБЕРКУЛОЗНА ИНФЕКЦИЯ
С. Велизарова
Университетска детска клиника по белодробни болести,
СБАЛББ ”Света София”
Резюме: В Университетската детска клиника за белодробни болести са проучени 38 деца с LTBI. Установено е, че хиперергията при изследване с туберкулинов тест на Манту се увеличава с възрастта – 46,7% на 0-3 години, 73,4% на 4-7-годишна възраст и 93,8% над 8-годишна възраст. T SPOT TB е отрицателен при 80-100% от децата и само при 15,7% е позитивен. Могат да се направят следните изводи. Хиперергията се увеличава синхронно с възрастта, като най-изявена е след 8-годишна възраст. TB SPOT TB e позитивен само при 15,7% от случаите, което показва дискусионната му роля при деца с ЛТБИ. Негативният резултат на T SPOT TB не е основание за отхвърляне на ЛТБИ. При децата с положителен за туберкулоза T SPOT провеждане на химиопрофилактика е особено важно, тъй като те са по-склонни да развият болестта. Липсва корелационна зависимост между двата теста – капа – 0,055, което е резултат на многото хиперергични проби, част от които са резултат на кръстосана чувствителност с BCG щама. TST има водеща роля при диагностицирането на ЛТБИ.
Ключови думи: туберкулоза при децата, диагностичен тест за туберкулоза, IGRAs тестове, ЛТБИ
Адрес за кореспонденция: Д-р С. Велизарова, Детска клиника, СБАЛЛБ „Св. София”, бул. „Акад. Ив. Гешов” 17,
1606 София, тел. 80-54-299
2/2010

ВАЛИДИРАНЕ НА СПЕКТРОФОТОМЕТРИЧEН МЕТОД ЗА ОПРЕДЕЛЯНЕ НА 2-PHENYLBENZIMIDAZOLE-5-SULFONIC ACID В СЛЪНЦЕЗАЩИТНИ КОЗМЕТИЧНИ ПРОДУКТИ ПРИ САМОСТОЯТЕЛНО И ПРИ СЪВМЕСТНО ПРИСЪСТВИЕ С ДРУГИ ХИМИЧНИ УЛТРАВИОЛЕТОВИ (UV) ФИЛТРИ И С ФИЗИЧНИ UV ФИЛТРИ ZINC OXIDE И TITANIUM DIOXIDE

А. Тачев, С. Узунова и Н. Василева

Национален център по опазване на общественото здраве към МЗ – София

Резюме: За ултравиолетовия (UV) филтър 2-Phenylbenzimidazole-5-Sulfonic Acid като съставка в козметичните продукти в законодателството e посочена максимално допустима концентрация до 8% (изразено като киселина). Необходим е контрол за спазване на тази норма. От друга страна, установяването на по-ниско фактическо наличие на UV филтъра от обявеното в рецептурата на козметичния продукт е показателно, че не се осигурява обявената върху етикета защита срещу UV лъчи. Отсъства референтен метод за определяне на UV филтър 2-Phenylbenzimidazole-5-Sulfonic Acid в слънцезащитни козметични продукти. Целта на проучването е разработване и валидиране на достъпен спектрофотометричен метод за неговото определяне. Разработен и валидиран е спектрофотометричен метод за определяне на UV филтъра 2-Phenylbenzimidazole-5-Sulfonic Acid в слънцезащитни козметични продукти, който е приложим както при самостоятелно, така и при съвместно присъствие с други химични UV филтри и с физични UV филтри Zinc Oxide и Titanium Dioxide. Методът се основава на способността на разтвори на 2-Phenylbenzimidazole-5-Sulfonic Acid в 0,05 М воден разтвор на натриев хидроксид да поглъщат ултравиолетови лъчи с дължина на вълната 310 nm. Стойността на светлинната абсорбция, измерена при тази дължина на вълната, е пропорционална на концентрацията на 2-Phenylbenzimidazole-5-Sulfonic Acid. Проведени са общо 313 изпитвания, на базата на които са изведени параметрите на метода: селективност – специфична абсорбция при 310 nm; линейност – от 1,25 до 25 μg/cm3 (от 0,625 дo 12,5%); устойчивост за 24 h престой на концентрация на 2-Phenylbenzimidazole-5-Sulfonic Acid 10 μg/cm3 – RSD = 0,13%; повторяемост – при 3% на 2-Phenylbenzimidazole-5-Sulfonic Acid – SD – 0,0413%; възпроизводимост – при 3% на 2-Phenylbenzimidazole-5-Sulfonic Acid – RSD в условия на повторяемост – 1,46%; аналитичен добив при концентрация на 2-Phenylbenzimidazole-5-Sulfonic Acid в козметичния продукт 2% – 91,32% (88,15-95,68%), при 4% – 94,76% (91,71-97,86%). За различните видове козметични продукти са установени: работен обхват – от 0,09 до 12,5%, граница на откриване (LOD) – от 0,07 до 0,75%, граница на определяне (LOQ) – от 0,09 до 0,82%. Разработеният и валидиран спектрофотометричен метод за определяне на UV филтър 2-Phenylbenzimidazole-5-Sulfonic Acid в слънцезащитни козметични продукти е бърз, с добра чувствителност, точност и възпроизводимост и не изисква сложна и скъпа апаратура. Той може лесно да бъде използван при контрола на слънцезащитните козметични продукти.

Ключови думи: ултравиолетови филтри, слънцезащитни козметични продукти, валидиране, 2-phenylben­zimida­zole-5-sulfonic Acid

Адрес за кореспонденция: Антон Колев Тачев, бул. „Иван Евст. Гешов” № 15, 1431 София, България, е-mail: A.Tachev@ncphp.government.bg

ДИСТРОГЛИКАНОПАТИИ
М. Станчева
Детска клиника, УМБАЛ „ Александровска” – София

Резюме: Дистрогликанопатиите са група наследствени мускулни дистрофии, които се дължат на хипогликозилирането на екстрацелуларния рецептор – алфа-дистрогликан. Те се отличават с клинична хетерогенност, която варира от тежки форми с мозъчни и очни аномалии, като Walker-Warburg синдром, мускул-око-мозък синдром, до леки форми, като мускулна дистрофия тип пояс-крайник без засягане на централната нервна система. В обзора се разглеждат известните до момента дистрогликанопатии и ролята на алфа-дистрогликана при някои инфекциозни и злокачествени заболявания.

Ключови думи: дистрогликанопатии

Адрес за кореспонденция: Д-р  М. Станчева, Детска клиника, УМБАЛ „Александровска”, ул. „Св. Г. Софийски” № 1, 1431 София, България

РАК НА МЛЕЧНАТА ЖЛЕЗА И ПЪРВИЧНА ОНКОЛОГИЧНА ИНВАЛИДНОСТ ПРИ ЖЕНИТЕ В БЪЛГАРИЯ
М. Николов
СБАЛ по онкология

Резюме: Злокачествените новообразувания заемат първо място по тежест в нозологичната структура на класовете болести, водещи до инвалидизация. Ракът на млечната жлеза е най-често срещаното онкологично заболяване при жените и обхваща близо една четвърт от всички злокачествени новообразувания. Направен е подробен анализ на мястото, ролята и значението на рака на млечната жлеза в структурата на първичната онкологична инвалидност. Проучени са 52 431 жени с различни по локализация онкологични заболявания, които са се явили пред ТЕЛК в цялата страна за времето от 2001 до 2008 г. и са оценени с 50 и повече процента трайно намалена работоспособност. Получените резултати доказват, че ракът на млечната жлеза предизвиква значително по-голяма инвалидизация в сравнение с останалите злокачествени новообразувания при пациентките в България и е основното онкологично заболяване, водещо до инвалидизация на жените.

Ключови думи: инвалидност, онкологични заболявания, рак на млечната жлеза, жени

Адрес за кореспонденция: Д-р Манаси Николов, дм, СБАЛ по онкология, ул. „Пловдивско поле” № 6, 1756 София, тел.: 02/ 8076250, GSM: 0888408089, e-mail: mdn@mail.bg

ЛЕЧЕНИЕ НА НЕАЛКОХОЛНАТА СТЕАТОЗНА БОЛЕСТ НА ЧЕРНИЯ ДРОБ
М. Боянов1 и В. Грозева2
1Клиника по ендокринология, УМБАЛ „Александровска”,
2Катедра по вътрешни болести, Медицински университет – София

Резюме: Неалкохолната стеатозна болест (НАСБ) на черния дроб заема важно място в диференциалната диагноза на хроничните чернодробни заболявания, особено при пациентите с данни за затлъстяване, инсулинова резистентност и хипертриглицеридемия. НАСБ сама по себе си повишава сърдечно-съдовия риск и смъртност, както и риска от поява на хепатоцелуларен карцином или терминално чернодробно увреждане. В практиката са тествани различни терапевтични принципи, но нито един от тях не показва неоспоримо превъзходство над останалите. Основният и най-ефективен терапевтичен подход е повишената физическа активност успоредно със спазване на диета с нисък гликемичен и липемичен индекс. Медикаментозното лечение има подкрепяща роля и не бива да се прилага самостоятелно. Най-голяма вероятна комбинирана полза се очаква по отношение на приложението на метформин и може би – на глитазони. При склонност към фиброза вероятно е уместно приложение и на урзодезоксихолева киселина.

Ключови думи: неалкохолна стеатозна болест, затлъстяване, метформин, глитазони

Адрес за кореспонденция: Доц. д-р Михаил Боянов, дмн, Клиника по ендокринология, УМБАЛ „Александровска”,
ул. „Св. Г. Софийски” № 1, Bg-1431 София, GSM: 0888 971 203, e-mail: boyanov@alexandrovska-hospital.bg

ЗАВРЪЩАНЕ НА БРУЦЕЛОЗАТА В БЪЛГАРИЯ
Р. Комитова1, Р. Ненова2, И. Томова2, С. Иванова3 и И. Бойковски4
1Медицински университет – Плевен
2Национален център по заразни и паразитни болести – София
3Регионална инспекция за контрол и опазване на общественото здраве – Хасково
4Национална вeтеринарномедицинска служба – София

Резюме: В България, свободна от бруцелоза повече от 40 години, е регистриран местен взрив в област Хасково, 2007 г., в резултат на нелегално внесени животни. Целта на настоящата публикация е да се анализират епидемиологичните и клиничните характеристики, лечението, усложненията и изходът на бруцелозата при хора през последните 3 години. Проведено е ретроспективно проучване за периода август 2007-декември 2009 г. Диагнозата се основава на клинични признаци, съответни на заболяването, и серологични данни за бруцелна инфекция. Включени са 55 случая, отговарящи на критериите на проучването. Основният път на заразяване е консумация на непастьоризирано мляко и млечни продукти. Асимптомната инфекция преобладава. При повечето клинично изявени случаи заболяването протича в подостра форма. Мултидисциплинарният подход от комплекс мерки, насочени към животни и хора, допринася за контрола на инфекцията през 2009 г.

Ключови думи: бруцелоза, стандартен аглутинационен тест, доксициклин

Адрес за кореспонденция: Доц. д-р Р. Комитова, дм, Катедра по инфекциозни болести, епидемиология, паразитология и тропическа медицина, Медицински университет, ул. “Климент Охридски“ № 1, 5800 Плевен, тeл.: 064/884 385

РАЗВИТИЕ НА ДОБРОВОЛНОТО ЗДРАВНО ОСИГУРЯВАНЕ В БЪЛГАРИЯ ПРЕЗ 2009 Г. И АНАЛИЗ НА УДОВЛЕТВОРЕНИЕТО НА ОСИГУРЕНИТЕ ГРАЖДАНИ
Т. Веков
ЗОФ DallBogg: Живот и Здраве

Резюме: В представеното изследване са анализирани финансовите резултати на първите десет дружества чрез коефициентите за рентабилност, ликвидност и задлъжнялост (към 2009 г.), както и удовлетвореността на пациентите (чрез анонимна анкета на 1530 доброволно осигурени граждани). Отбелязва се, че общата рентабилност на сектора за доброволно здравно осигуряване към ноември 2009 г. е негативна, което е резултат на финансови загуби на здравноосигурителните дружества през последните две години, и се представят основните причини за тези резултати. Авторът констатира, че финансовите резултати и политиката на управление оказват влияние върху удовлетворението на пациентите. Анализът установява обратнопропорционална зависимост между нивата на печалба и удовлетворението на пациентите.

Ключови думи: здравно осигуряване, доброволно допълнително здравно осигуряване, здравноосигурителни дружества

Адрес за кореспонденция: Тони Веков, Изпълнителен директор на ЗОФ DallBogg: Живот и Здраве, бул. “Г. М. Димитров” № 1, 1172  София, тел.: 02/962 54 54, факс: 02/962 50 59, email: t.vekov.hq@comleague.com

ИДЕИ ЗА ОПТИМИЗИРАНЕ НА ЛАБОРАТОРНАТА ДЕЙНОСТ В УНИВЕРСИТЕТСКИТЕ БОЛНИЦИ
С. Танчева, Й. Радков и К. Ненов
УМБАЛ „Св. Марина”, МУ – Варна

Резюме: Както е известно, лабораторията не работи сама за себе си, а обслужва всички клинични специалности. Тя е много скъпо, но в същата степен е доказала, че може да бъде и много печелившо звено. Нашата работа има за цел да посочи потребността от нова стратегия в управлението на болничните университетски клинични лаборатории (УКЛ) и да отбележи актуалността на тази тема. Визирайки болничната лабораторна полипрагмазия, искаме да насочим вниманието към нов тип мениджиране на лабораторната дейност в болниците. Интересът към темата бе затвърден от една справка за общия брой анализи на изследвани електролити (K; Na; Cl) в рамките на произволен месец в университетската болница, отнесени към броя на патологичните резултати на същите параметри, получени за същия месец. Броят изследвания на тези показатели за проследения период бе 5231, докато резултатите извън референтните граници бяха 240, т.е. лабораторно констатираната патология бе в границите на 4,588%. За представяне на нашите резултати използвахме алтернативен, непараметричен и графичен анализ. Множеството лабораторни анализи, които съпътстват диагностицирането на едно заболяване, невинаги облекчават работата на клинициста и подпомагат неговата диагностика и терапия, но винаги струват пари (които някой плаща). Като цяло се оказа, че моделът на „клиничните пътеки”, прилаган в сегашния му вид, е една твърде ригидна форма, която от гледна точка на клиниколабораторните анализи е доста нерентабилна. Стандартите, които тя налага, невинаги са диагностично обосновани и често са финансово неоправдани. Необходимо е прецизно вътрешно остойностяване на отделните параметри на „клиничната пътека” (или каквато и да е друга формулировка на медицинската болнична дейност), което би довело до по-добра отчетност и рационализиране на финансирането. В това отношение клиничната лаборатория може да бъде използвана като пилотен проект, тъй като голяма част от лабораторните анализи са остойностени. Проектът първоначално без обструкции може да бъде приложен към УКЛ в университетските болници, тъй като при тях контактът между лабораторните специалисти и клиниките е лесно осъществим, а и се предполага, че в тези лаборатории работят висококвалифицирани лабораторни специалисти, които имат широк клинико-лабораторен поглед. Необходим е нов, по-адекватен икономически модел за използване на потенциала на УКЛ.

Ключови думи: лабораторен мениджмънт, университетска клинична лаборатория

Адрес за кореспонденция: Д-р С. Танчева, Университетска клинична лаборатория, 9010 Варна, тел.: 052 302851, 1224,
e-mail:Tanq_Tancheva@abv.bg

СПЕЦИФИКА НА ТЪРСЕНЕТО И ПРЕДЛАГАНЕТО НА ПАЗАРА НА БОЛНИЧНИ УСЛУГИ
Л. Иванов и Ст. Спиридонов
МБАЛ „Хигия” – Пазарджик

Резюме: В статията се анализира спецификата на търсенето и предлагането на пазара на болнични услуги. Тъй като средствата на НЗОК, държавата и общините за заплащане на здравни услуги са ограничени, а натискът върху разхода за здравеопазване се увеличава, политиците на национално ниво са принудени да разработват стратегии за решаване на този проблем. Налице са две основни и често пъти взаимно допълващи се възможности.

Ключови думи: пазар, търсене, предлагане, болнични услуги

Адрес за кореспонденция: Д-р Стайко Спиридонов, дм, изпълнителен директор на МБАЛ “Хигия”, ул. “Св. Иван Рилски” № 3, 4400  Пазарджик, тел./факс: 034 / 443 306, e-mail: office@higia-bg.com

3/2010

EPIDEMIOLOGICAL STUDY OF STREPTOCOCCAL CARRIAGE
IN CHILDREN GROUPS

T. Petkova1, S. Pachkova2, A. Decheva3 and A. Velkova4
1Section „Epidemiology, Parasitology and Tropical medicine”, Medical University – Pleven
2Department „Microbiology, Virusology and Medical Genetics”, Medical University – Pleven
3NRL “Streptococci and diphtheria”, NCIPD – Sofia
4Department „Social and preventive medicine, medical statistics, pedagogy,and psychology”,
Medical University – Pleven

Summary: The aim of this study is to identify the rate, characteristics and epidemiological importance of carriage of beta-hemolytic streptococci in the most affected of streptococcal infections groups (3 to 16 years). For this purpose we observed for half a year (December 2009-May 2010) 156 children from two collectives in Pleven region. Our study showed the average prevalence of carriage in non epidemical year of scarlet fever to be 30,15%, ranging from 20 to 43,24% in various studies. The duration of carriage was over 24 weeks in 4,49% (± 3,32%) of children. The highest proportion of isolated beta-hemolytic streptococci were group A (25,63%), down to minor percentages group C (4,02%) and group G (0,50%). During the period, circulation of four different M serotypes (М11, М12, М14 and M49) in Pleven region was determined. M14 serotype (48,04%) was dominant. Two T serotypes in the study groups were established (T11 and T14). T14 serotype (70,59%) was dominant. The results show a high level of streptococcal carriers in children's groups, indicating the need for advisable screening program as part of the surveillance of streptococcal infections and their complications.
Key words: beta-hemolytic streptococci, Streptococcus pyogenes, infection carriage
Address for correspondence: Dr. Tanja Petkova, Medical University, 1  Sv. Kliment Ohridski str., Bg-5000 Pleven, GSM 0885 33 87 74, e-mail: tanja_1973@abv.b

 

DIAGNOSIS OF NONSPECIFIC GRANULOMATOUS PROSTATITIS IN PATIENTS UNDERGOING PROSTATE BIOPSY UNDER TRANSRECTAL ULTRASOUND GUIDANCE
N. Smilov, N. Koleva and I. Lozev
Medical Institute – Ministry of Interior

Summary: The aim of the current study is to evaluate retrospectively the data from digital rectal examination (DRE) and transrectal ultrasound (TRUS) examination and the PSA levels in 12 patients with nonspecific granulomatous prostatitis (NSGP) diagnosed histologically. The results of 486 patients from prostate biopsy under TRUS guidance were studied. All patients underwent DRE, transrectal core biopsy of the prostate under TRUS guidance and PSA test. Nonspecific granulomatous prostatitis was found in 12 patients (2,5%). The level of the serum PSA varied from 2,8 to 18,4 ng/ml. The digital rectal examination found 3 patients with local asymmetrical and dense prostate and 9 patients with prostate nodule/s. In 3 patients, the TRUS findings were normal while single or multiple nodules were found in 9 patients. Currently, there is no clinical, biochemical or imaging method capable of diagnosing with sufficient probability the condition of NSGP. This diagnosis can be defined with certainty with histological test after transrectal core biopsy of the prostate. It is necessary these patients to be followed up in order not to omit the presence or the eventual development of prostate cancer.
Key words: nonspecific granulomatous prostatitis, prostate biopsy, transrectal ultrasound, prostate cancer
Address for correspondence: N. Smilov, MD, Medical Institute Ministry of Interior, 79 Skobelev blvd., Bg-1606 Sofia,
tel.: 0888 763 674, e-mail: smilov_nencho@yahoo.com

METHOD FOR ENDOSCOPICALLY ASSISTED CYSTECTOMY IN RADICULAR
CYSTS OF THE JAWS

P. Pechalova
Department of Maxillo-facial Surgery, Faculty of Dental Medicine,
Medical University – Plovdiv

Summary: Radicular cysts are the main reason for jaw bone loss. The aim of this study was to present a method for endoscopically assisted cystectomy in radicular cysts of the jaws. We designed two operative approaches: When the teeth in radicular cyst were preserved, we prepared triangle muco-periostal flap, performed one or two (in large cysts) fenestrations on vestibular compact jaw bone up to 1 cm in diameter per which removed the cyst and did apical resection of the teeth, swabbed the cavity with hemostatic sponge and stitched up. When the teeth were removed, operative approach was assumed per alveolas. More researches are needed to specify the advantages and the potential of the method.
Key words: radicular cysts, extirpation, endoscopy
Address for correspondence: Petia Pechalova, Department and Clinic of Maxillo-facial Surgery, Sv. Georgi Hospital, Medical University, 66 Peshtersko shose blvd., Bg-4000 Plovdiv, GSM: 0898 468 498, e-mail: pechalova@abv.bg

4/2010

TRANSRECTAL PUNCTION BIOPSY OF PROSTATE – OPERATIVE TECHNIQUE AND RESULTS FROM 320 CASES
Ts. Genadiev, V. Veleva, D. Gaydarov, P. Petrov, P. Deliyski, M. Kaytsanov and S. Manchev
Clinic of Urology
University Hospital “Lozenetz” – Sofia

Summary. Transrectal ultrasound guided biopsy of the prostate is a main method for diagnostics of prostate cancer. The aim of this study is to evaluate the results of transrectal ultrasound prostatic biopsy in our clinic according to the indications, operative technique, postoperative complications. Between 2001 and 2010, 320 transrectal sextant punction prostate biopsy under transrectal ultrasound control have been made in our Clinic. Median age of patients was 63 years (range from 49 to 89). Median prostate specific antigen (PSA) total was 12 ng/ml (1,5-500). Median time of biopsy was 10 minutes (range from 5 to 20 min). There was no case with anesthesia. Мedian number of punctures was 6 (range from 4 to18). The size of biopsy needle was 18 gauge and length of materials – 1.5 and 2.2 cm. The patient was placed in lithotomy position. Pain was evaluated with a pain level scale. Many of patients found the pain small or medium. Ciprofloxacin was administered for 10 days prophylactically in all of patients after the biopsy. The postoperative results showed 2 cases (0.7%) of hospitalizations due to fever. There were intermittent hematuria, rectorrhagia and hematospermia in over 50%. No major complications were observed.
Key  words: transrectal ultrasound biopsy of prostate, prostate cancer, operative resuts
Address for correspondence: Tsvetelin Genadiev, MD, Clinic of Urology, UMHAT “Lozenets”, 1 Koziak str., Bg-1407 Sofia, e-mail: genadievi@abv.bg

 

INVESTIGATION OF GENETIC MARKERS RELATED TO OVARIAL RESPONSE AFTER STIMULATION OF BULGARIAN WOMEN WITH REPRODUCTIVE PROBLEMS
A. Savov(1), L. Dimitrova(2), S. Bichev(1), A. Todorova(3), T. Todorov(3) and I. Vladimirov(2)
(1)Medical University – Sofia, Hospital of Obstetrics and Gynecology, National Genetics Laboratory, Bulgaria
(2)Center for Reproductive Medicine and in vitro Fertilization “Sofia”, Bulgaria
(3)Genetic Medico-diagnostic Laboratory Genica – Sofia

Summary. Recent studies showed a relation of the genetic polymorphisms in ESR1 and FSH receptor with ovarian response during in vitro fertilization. However a population and ethnic specificity have been described. The aim of this study is to investigate these polymorphisms in a cohort of Bulgarian patients with reproductive problems and to evaluate a possibility for their use as predictive markers in clinical practice.
Key words: reproductive problems, ovarian response, genetic markers, gene of estrogen receptor alpha, gene of follicle-stimulating hormone receptor
Address for correspondence: Assoc. Prof. Alexey Savov, PhD, University Hospital of Obstetrics and Gynecology “Maychin dom”, 2 Zdrave str., 1431 Sofia, Bulgaria, e-mail: Alexey.Savov@abv.bg

 

ORBITAL PHLEGMONA OF SINONASAL ORIGIN – DIAGNOSTICS AND OPERATIVE TREATMENT
K. Dzhambazov1, N. Traykova(2) and A. Hilendarov(3)
(1)Department of ENT Diseases, MU – Plovdiv
(2)Department of Radiology, MU – Plovdiv
(3)Center of Diagnostic Imaging, University Hospital „Sv. Georgi” – Plovdiv

Summary. In the etiology of the orbital phlegmona, the initial focus originates most frequently in the sinuses – ethmoidal sinuses and very rarely in frontal and sphenoidal sinuses. We present our five-year experience in 10 patients (14-76 years old) with orbital complications from paranasal origin. Two patients had orbital periostitis with eyelid edema because of affect of ethmoidal and frontal sinuses. One of the patients was with orbital phlegmone and meningitis from isolated sphenoidal sinusitis, and seven patients were with orbital phlegmona – five from ethmoidal sinusitis, one from pansinuitis and one from frontal sinusitis. In all patients, we performed microendoscopic endonasal sinus surgery with decompression of medial orbital wall and optic nerve. Direct after the operation and orbital decompression, in all of patients we observed quick regress of the inflammatory process. The absence of external incision and unnecessary operation trauma allowed the discharge of the patients.
Key words: orbital phlegmona, sinus diseases, sinus surgery
Address for correspondence: Assoc. Prof. N. Traykova, MD, Center for Diagnostic Imaging, University Hospital “Sv. Georgi”, 66 Peshtersko shose blvd., 4000 Plovdiv, GSM: 0888272765

 

US TOMOGRAPHY IN THE MONITORING AND THERAPY OF PLEURAL FLUID COLLECTIONS IN TERMS OF EMERGENCY
A. Hilendarov, K.Velkova, N. Traikova and A. Nedeva
Department of Diagnostic Imaging, University Hospital „Sv. Georgi” – Plovdiv

Summary. In the past 20 years, the use of US tomography in terms of urgency for the diagnosis of free and incapsulated fluid collections in the abdominal and pleural cavity is validated as a method of choice for major trauma patients in serious condition. Aim was to provide our expertise in diagnosis, monitoring and planning of therapeutic behavior in free and encapsulated pleural fluid collections in polytrauma patients in emergency conditions. For a period of three years in 125 patients (89 men and 36 women), conventional US examinations of the chest to establish pleural fluid collections were performed. Fifty-four fine-needle aspirations (FNA) under US control were performed for diagnostic reasons. Ultrasonic equipment and 16-slice MDCT scanner for examination and guidance of the interventional procedures were used. All examinations and invasive manipulations were performed with the informed consent of patients. We classified the performed imaging examinations of the emergency patients as: 1. Diagnostic non invasive – in 102 (86.44%) of all 118 included patients under US investigation positive results of pleural fluid were obtained. 2. Diagnostic invasive procedures – fifty-four fine-needle aspirations (FNA) under US control were performed for diagnostic reasons. There were 99 true positives, 14 true negatives, one false positive and four false negative results. The obtained results demonstrated that ultrasonography had a sensitivity 96.11%, specificity 93.33%, accuracy 95.76%, and PPV – 99%, and NPV – 75%. Our experience and literature reports support the opinion that US tomography should be used as a prime method in diagnosis and monitoring of pleural liquid collections in polytrauma patients and patients with complicated clinical condition as well as a control of the invasive diagnostic procedures.
Key words: pleural fluid, US control, CT control, invasive procedures
Address for correspondence: Assoc. Prof. N. Traykova, Center of medical imaging, “Sv. Georgi”, 66 blvd. Peshtersko shosse, Bg-4000, Plovdiv, GSM: 0888 27-27-65

FUNCTIONAL SIGNIFICANCE OF JOB ANALYSIS FOR HEALTH AND SAFETY AT WORK
R. Nikolova(1), N. Tzacheva(2) and S. Danev(3)
(1)Department of Physiology and Psychology, National Center of Public Health Protection – Sofia;
(2)Department of Occupational Medicine, Faculty of Public Health, Medical University – Sofia
(3)”Medeia”

Summary. As an occupational medicine method, job analysis defines the basic work tasks, and studies the effect of physical, cognitive, and psychological work demands, automated systems, and work environment on operator’s functional state. Determining the dependence on health and safety at work, demonstrates its functional role and significance. The aim of our study is to determine the significance of job analysis for health and safety at work of sound-recording operators. Research results showed basic work tasks, work environment conditions, workplace assessment, mental and physical demands of job, exposure of occupational risk factors. Risk factors might generate disturbance in functional state and affect health: central nervous system, visual and auditory sensory system, cardiovascular and respiratory system, musculo-skeletal system, psychic activity; safety at work: failures, accidents; social activity. Job analysis contributes to specifying the influence of work demands on functional state, identifying workplace occupational risk factors, and determining the dependence on health and safety at work.
Key words: job analysis, health and safety at work, sound-recording operators, functional state
Address for correspondence: Assoc. Prof. Ruja Nikolva, MD, National Center for Public Health, Department of Physiology and Psychology of Labor, 15 Blvd. Acad. Ivan Geshov, tel.: 8056 207

 

HEMORRHAGIC FEVER WITH RENAL SYNDROME IN SOUTH BULGARIA
R. Komitova(1)*, G. Katsarov(2), М. Karagyaurova(3), S. Senkova(3), М. Marinova(4) and I. Boev(5)
(1)University Hospital „G. Stranski” – Pleven
(2)National Center of Infectious and Parasitic Diseases – Sofia
(3)District Hospital – Smolyan
(4)District Hospital – Kardzhali
(5)University Hospital “Sv. Georgi” – Plovdiv
*current affiliation: University Hospital “Sv. Georgi” – Plovdiv

Summary. Hemorrhagic fever with renal syndrome (HFRS) is an endemic zoonosis in Europe caused by Hantaviruses, which affect mainly the human kidneys. Our aim was to characterize clinical course and therapy of HFRS cases. This retrospective study was carried out in patients with HFRS between 2001-2010, in South Bulgaria. Diagnosis was confirmed by complement fixation test. Twelve patients were included in the study and in 5 of them the diagnosis was laboratory confirmed. All had potential rodent exposure. Most of them were initially misdiagnosed. Half of the patients underwent hemodialysis for treatment of acute oliguric renal failure. Majority had mild hemorrhagic manifestations. All had initial thrombocytopenia and/or proteinuria. All recovered. More than half of the patients were misdiagnosed not only as a result of nonspecific initial clinical manifestation but also due to unavailability of serological tests. Early thrombocytopenia and proteinuria and potential rodent exposure would facilitate diagnosis.
Key words: hemorrhagic fever with renal syndrome, hantaviruses
Аddress of correspondence: Radka Komitova, MD, PhD, Infectious Diseases Clinic, University Hospital, Plovdiv, 66 Peshtersko Road, 032/602 933


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