Original articles 2011

ARCHIVE

1/2011
DEVELOPMENT AND VALIDATION OF HPLC METHOD FOR DETERMINATION OF 4-METHYLBENZYLIDENE CAMPHOR UV-FILTER IN SUNSCREENS (SINGULARLY AND IN COMBINATION WITH OCTOCRYLENE, OCTYL METHOXYCINNAMATE AND OCTYL SALICYLATE CHEMICAL UV FILTERS AS WELL AS WITH PHYSICAL UV FILTERS ZINC OXIDE AND TITANIUM DIOXIDE)
A. Tachev, D. Chohadzhieva and N. Vasileva
National Center of Public Health Protection – Sofia


Summary: So far, no referent method has been reported for determination of 4-methylbenzylidene camphor UV filter in sunscreens. The aim of this study is to develop and validate an HPLC method for determination of 4-methylbenzylidene camphor UV filter in sunscreen formulations (singularly and in combination with octocrylene, octyl methoxycinnamate and octyl salicylate chemical UV filters as well as with physical UV filters zinc oxide and titanium dioxide). HPLC method has been developed and subsequently validated for determination of 4-methylbenzylidene camphor UV filter in sunscreen products, which is applied both singularly and in combination with octocrylene, octyl methoxycinnamate and octyl salicylate chemical UV filters as well as with physical UV filters zinc oxide and titanium dioxide. The method is based on the effective chromatographic separation of UV filters according to their retention times, at combined presence in the cosmetic product and following quantitation of each UV filter versus calibration curve of certified referent substance by the method of external standard. A total of 58 tests were carried out, on which the following parameters were examined: linear range from 0,25 μg/cm3 to 100 μg/cm3 (from 0,13 to 50,00%); limit of detection (LOD) – 0,05%; limit of quantitation (LOQ) – 0,15%; working range from 0,30 μg/cm3 to 100 μg/cm3 (0,15 to 50,00%); repeatability – in 3% 4-methylbenzylidene camphor – standard deviation (SD) – 0,0602%; reproducibility – in 3% 4-methylbenzylidene camphor – relative standard deviation (RSD) – 2,10%, under conditions of repeatability; analytical yield of 1% 4-methylbenzylidene camphor concentration in the cosmetic product – 1% – 98,20% (95,00-106,00%), at 2% – 99,00% (95,00-103,00%), and at 3% – 97,90% (95,00-103,30%). The proposed HPLC method development and validation are rapid, precise and accurate, which is useful for the routine determination of 4-methylbenzylidene camphor UV filter in sunscreen products.
Key words: ultra-violet (UV) filters, sunscreens, validation, concentration
Address for correspondence: Anton Kolev Tachev, Naional Centre of Public Health Protection – Sofia,
15 Ivan Evst. Geshov blvd, Bg-1431 Sofia, е-mail: а.tachev@ncphp.government.bg

PERFORMANCE OF THE T SPOT TB – EFFICIENCY CRITERION OF ANTITUBERCULOSIS THERAPY
S. Velizarova and A. Spasova
University Children's Clinic of Pulmonary Diseases, SHATPD “Sv. Sofia”


Summary: The purpose of this study was to determine the effectiveness of the T SPOT TB in children with different forms of tuberculosis in the course of tuberculostatic therapy. At the University Children's Clinic of Pulmonary Diseases, there were followed 40 children with different forms of primary tuberculosis. Children were tested with TST and T SPOT TB at baseline and after three months of tuberculostatic therapy. Before treatment 7.5% of children had a negative TST, 22.5% were with normergic and 72.5% with hyperergic reactions. In the second test, there were no negative, but normergic increased to 47.5% and hyiperergic declined to 52.5 percent, which conclusively proves that antituberculosis treatment leads to desensitization of the body. The first T SPOT TB test showed negative resuls in 25% and positive in 75%, while in the second test 27.5 percent were negative against 72.5 percent positive. T SPOT TB test showed no distinct difference before and after therapy, which corresponds to its higher specificity.
Key words: TB in children, treatment of tuberculosis, T SPOT TB, IGRAs tests, TST, normergy, hyperergy, kappa non parametric analysis for correlation between both tests
Address for correspondence: S. Velizarova, MD, University Children's Clinic of Pulmonary Diseases,
SHATPD “Sv. Sofia”, 17 Akad. Ivan Geshov blvd., tel.: 8054299, Bg-1431, Sofia, GSM: 0899423231, e-mail: velizarovasv@gmail.com

EPIDEMIOLOGICAL INVESTIGATION OF MUMPS
M. Karcheva
Department of Epidemiology, Parasitology and Tropical Medicine, Medical University – Pleven, Bulgaria


Summary: Over the past decade many countries with specific immunoprophylaxis against mumps register upsurge of the morbidity. The aim of this study is to identify and analyse epidemiological characteristics in the course of mumps in several areas in northern Bulgaria in the period 2000-2008. For the period studied mumps reserved cyclic pattern of the epidemic process. In interepidemic period for the country of low mumps incidence, morbidity in the studied area corresponded to the average values for the country – the period between 2002 and 2004. During the epidemic rise in the country, in some areas there was an increase in morbidity above the average (in 2005). While the country's average morbidity was 7.8‰оо the morbidity in Lovech was 154.4‰оо) and in other cities it was lower than average (in 2007 at an average morbidity of 69.2‰оо for the country, in Silistra district it was 1.3‰оо). Epidemic process took place with greater intensity in the cities – 67% of registered cases. From clinically manifested forms of the disease suffered mostly men – 64%. Morbidity by age groups shifted to the higher ones. The most affected age group for totally surveyed areas was 10-14 with a total number of diseased – 840 (42%), followed by age group 15-19 – 698 (34%). Trends are similar to epidemiologic situation in other European countries.
Key words: mumps, epidemic process, dynamic
Adress for correspondence: Milena Karcheva, MD, Department of  Epidemiology, Parasitology and Tropical Medicine,
Medical University, 1 Sv. Kl. Ohridski, str. ,Bg- 5800 Pleven, tel.: +35964884269, e-mail: milena_karcheva@abv.bg

ON THE PROGRAMME FOR LIQUIDATION OF MEASLES IN BULGARIA
B. Halova1, Y. Mitova2, K. Batserova3 and P. Georgiev2
1RICPРH – Sofia
2Department of Epidemiology, Medical University of Sofia
3RICPРH – Plovdiv

Summary:
In the late 20th century, European Regional Office of WHO advised all countries to include in their national programs the task of liquidation of measles disease by 2010. Theoretical basis of this scientific and practical formulation stems from the facts that the disease is anthropogenic with universal distribution, no healthy people carry the virus, it has 100% contagious index and builds lifelong natural immunity. In these characteristics, a specific mass prophylaxis can eliminate the third unit in the epidemic process (i.e. susceptible population) worldwide. The expected results were obtained in all countries, including ours.
Key words:
measles, epidemiology, anti-epidemic measures, mass immunization against measles, National program for the liquidation of measles and congenital rubeolla
Address for correspondence:
Prof.  P. Georgiev, Department of Epidemiology, Medical University, SBALAG "Maychin dom",
2 Zdrave str., Bg-1431 Sofia, tel.: 9523844

TRANSURETHRAL RESECTION IN MUSCLE-INVASIVE UROTHELIAL BLADDER CANCER
Ts. Genadiev
Clinic of Urology, University Hospital Lozenetz – Sofia

Summary: We analyse the results of twelve patients with muscle-invasive urothelial bladder cancer staging T2a to T4N0M0 treated with transurethral resection. Age of the patients was 62 to 78 years. All of them received adjuvant radiotherapy and some cases chemotherapy too. We present surgical results and a 5-year survival of patients.
Key words: transurethral resection, muscle-invasive urothelial bladder cancer, urinary bladder, adjuvant therapy
Address for correspondence: Assoc. Prof. Tsvetin Genadiev, MD, Clinic of Urology, University Hospital Lozenetz,
1 Koziak str. Bg-1407 Sofia, e-mail: genadievi@abv.bg

ANALYSIS OF THE PRESENCE OF ACRYLAMIDE IN FOOD
T. Vrabcheva1, V. Hristova-Bagdasarian1, J. Tishkova1, H. Petkova-Henaui1 and L. Dimitrova2
1National Center for Public Health Protection – Sofia
2RICPPH – Plovdiv


Summary: Acrylamide (AA) may be formed in food during the processing in the Maillard reactions.The most important precursor is the free amino acid asparagine which reacts with reducing sugars in the Maillard reactions that also form color and flavor. Although trace amounts of acrylamide can be formed by boiling or frying, significant formation generally requires a processing temperature of 120ºC or higher. It is classified as potential carcinogen by IARC (group 2A). It is offered a GC/MS method for determination of AA, based on its extraction by water from different kinds of homogenised foods. After bromination, the obtained 2,3-dibrompropanamide was extracted with ethyl acetate and after being concentrated, was determinated by GC/MS. The method of the external standard was used. The linear range was 170 – 5000 µg/kg, LOD – 100 µg/kg, LOQ – 170 µg/kg. The method was used for determination of AA in 10 groups of various foods (overall 45 samples ). The lowest recovery was received from powder products (e.g. cocoa, ground coffee) – approximately 51%. The highest recovery was received from chips – 92%. The RSD was between 5,2% and 17,6% depending on the matrix. The presence of AA was detected in 18 samples (40 %). The highest results were discovered in chips (620-2384 µg/kg), fried potato balls – 652 µg/kg and fried potatoes – 410 µg/kg. The level of AA in samples of bread, biscuits, crackers, grain children food were from < 100 µg/kg to 200 µg/kg. There was no content over the LOD in various types of bread, macaroni, couscous, children mashes and milk pap, blanched potatoes, different kinds of coffee. It was gained high value of AA in remedial barley coffee-substitute (887 µg/kg). After undergoing high temperature processing, certain products such as fried potatoes, chips, etc. showed high levels of AA, which correspond to the WHO reports for the same kinds of products.
Key words: acrylamide, crisp, biscuits, bread sticks, coffee, food contaminants, GC/MS method
Address for correspondence: As. Prof. eng. V. Bagdassarian, PhD, Laboratory “Chemical Contaminants and Food Additives”, National Center for Public Health Protection, 15 Akad. Ivan Geshov blvd., Bg-1431 Sofia,
tel.: +359 2 8056375, GSM: +359 898 56 42 85, e-mail: v.hristova@ncphp.government.bg

STUDY ON NUTRITIONAL BEHAVIOR OF PREGNANT WOMEN
P. Gatseva1, S. Harisanova1, V. Atanasova1, R.Vasileva1, A. Alexandrova1, E. Dimitrakova2
and B. Komitov2

1Department of Hygiene, Ecology and Epidemiology
2Clinic of Obstetrics and Gynaecology
Medical University – Plovdiv


Summary: A study on nutritional behavior of 40 pregnant women from Plovdiv and district of Plovdiv was carried out. An original author’s questionnaire was used for the purpose of the study. The results show that omissions in the nutrition of pregnant women are available. The unhealthy nutrition is a risk factor for their health and for the normal fetus development. Concrete recommendations for improvement of nutritional behavior during pregnancy and prevention of unfavorable consequences for the fetus were made.
Key words: nutrition, pregnant women, nutritional behavior
Address for correspondence: Assoc. Prof. P. Gatseva, MD, Department of Hygiene, Ecology and Epidemiology, Medical University, 15A V. Aprilov blvd., Bg-4000 Plovdiv, tel.: +359 32/602-543, e-mail: gatseva_p@mail.bg

EARLY POSTOPERATIVE RESULTS AFTER ENDOSCOPICALLY ASSISTED CYSTECTOMY VERSUS CONVENTIONAL CYSTECTOMY IN RADICULAR CYSTS OF THE JAWS
P. Pechalova1 and A. Bakardjiev2
1Department of Maxillofacial Surgery, Faculty of Dental Medicine, Medical University – Plovdiv
2Department of Oral Surgery, Faculty of Dental Medicine, Medical University – Plovdiv


Summary: The study was conducted over 80 patients with radicular cysts of the jaws, arranged in two groups. The first group comprised 46 persons who received conventional treatment by Partsch ІІ method. The second group included 34 persons treated by endoscopically assisted cystectomy. Pain and swelling were observed 24, 72 hours and between 7-th and 10-th day postoperatively. The endoscopically assisted cystectomy was a less traumatic operative method versus Partsch ІІ method.
Key words: endoscopy, radicular cyst, early results
Address for correspondence: Petya Pechalova, MD, Maxillofacial Surgery Clinic, UMHAT „Sv. Georgi”, Medical University,
66 Peshtersko shose str., Bg-4000 Plovdiv, GSM: +359 898 468 498, e-mail: pechalova@abv.bg

2/2011
ARDUOUS STRUGGLE AGAINST MEASLES
H. Odiseev1, T. Dimitrova2 and V. Doycheva2
1National Center of Infectious and Parasitic Diseases – Sofia
2Department of Epidemiology, Medical University – Sofia 

Summary: Vaccines against measles, vaccinal strategies in the struggle with measles and the idea of global eradication of measles are discussed. A special attention is paid to the epidemiologic phenomenon of “import-related cases of measles”, which in last years affected Bulgaria as well. Main reason for the emergence or re-emergence of measles in some European countries is the low immunologic status of their populations. A significant part of the affected individuals is not immunized against measles, while the percentage of affected individuals after a single vaccination is lower and this of double vaccinated affected individuals is the lowest. Non-traditional characteristics of the epidemiologic process of import-related measles has been established. WHO urgently requests the state institutions to provide financial, personnel and organizational assistance for implementing the global program for eradication of measles.
Key words: measles, vaccinal strategies, measles eradication, import-related measles
Address for correspondence: Prof. T. Dimitrova, M.D., D.M.Sc., Department of Epidemiology, University Hospital of Obstetrics and Gynecology “Maychin dom”, 6th floor, Room 668, 2 Zdrave Str., Bg – 1431 Sofia, tel.: (+359 2)952 38 44, e-mail: tod.dimitrova@mail.bg

EPIDEMIOLOGY AND PREVENTION OF PERTUSSIS IN BULGARIA (1921-2010)
Y. Mitova1, N. Ribarova1 and B. Halova2
1Department “Epidemiology”, Medical University – Sofia
2RIPСРH – Sofia

Summary: Pertussis (whooping cough) is an acute infectious disease, caused by B. pertussis. Since the beginning of the XX century, there has been a marked and continuous drop in death rate of whooping cough. Since it became vaccine preventable around 1960 (1957 in Bulgaria), the number of cases and deaths has dropped dramatically. In Bulgaria, there is a marked decline of pertussis from 1960 to 2010. During 1950 incidence (per 100 000 population) was about 175,9, whereas during 1990 it was 0,74%ooo. During 2001-2010, the annual incidence of pertussis is about 2,45 per 100,000. The highest incidence is found below the age of 9 years.
Key words: pertussis, period before immunization, vaccination, incidence
Address for correspondence: Y. Mitova, MD, Department “Epidemiology”, Medical University – Sofia, 2 Zdravе Str., University Obstetrics and Gynecology Hospital “Maychin Dom”, fl. 6, 670, Bg – 1431 Sofia, e-mail: drmitova@mail.bg

EPIDEMIOLOGICAL AND CLINICAL STUDIES OF SCARLET FEVER IN THE REGION OF PLEVEN (BULGARIA)
T. Petkova1, Ts. Doichynova1, D. Shalamanov1, S. Kozarova2 and B. Bonev2
1Department of Infectious Diseases, Epidemilogy, Parasitology and Tropical Medicine,
Medical University – Pleven

2RIPPH – Pleven 

Summary: Scarlet fever is characterized by a mild clinical course and lower intensity of the epidemic process in the last few decades. For the purpose of the study, a retrospective analysis of documentary data of 49 patients, hospitalized in the Clinic of Infectious Diseases in the University Hospital "Dr. Georgi Stranski" – Pleven, Bulgaria was performed. The period includes the years 2000-2010. The results show that scarlet fever like the rest of respiratory infections affects mainly the childhood; 84,34% of hospitalized patients are aged up to 14 years. The distribution by months shows two peaks in the incidence – in October, when the students begin the new school year and in March. The latter is a new tendency during the last years. Contemporary scarlet fever is characterized by the following: mild cases (30,61%) and moderate cases (55,10%) are predominant, severe cases are 14,29%. Complications are found in 10,20% of hospitalized patients – bronchopneumonia in 6,12%, bronchitis in 4,08%.
Key words: scarlet fever, streptococcal infections
Address for correspondence: Tanja Petkova, MD, Section “Epidemiology, parasitology and tropical medicine”, Medical University, 1  Sv. Kliment Ohridski str., Bg – 5000 Pleven, GSM 0885 33 87 74, e-mail: tanja_1973@abv.bg

EVALUTION OF THE UNCERTAINTY OF THE ANALYSIS WITH ROTATION THROMBELOSTOMETRY
ANALYZER ROTEM®

A. Stancheva1, L. Lambreva2 и K. Tsachev2
1University Hospital "Lozenets”, Central Clinical Laboratory – Sofia, Bulgaria
2Department of Clinical Laboratory and Immunology, Medical University – Sofia, Bulgaria 

Summary: The rotation thrombelastometry method ROTEM gives the possibility for hemostatic monitoring of the coagulation and fibrinolytic activities. The assessment of the analytical reliability of the rotation thrombelastometry is extremity important for the adequate interpretation of the results and their clinical application. Aim of the studiy was to perform an evaluation of the uncertainty of the analyses performed with rotation thromelastometry analyzer ROTEM®. The assignment of the imprecision in series with citrated blood for tests INTEM, EXTEM and FIBTEM (CT, CFT, MCF and α-angle) performed on one detecting channel, on four detection channels and on three analyzers ROTEM, assessed insignificant differences (p < 0,05) and CV ≤ 7,9%. It was determined significantly better imprecision in series with citrated blood (CV ≤ 5,9%) in comparison with series with citrated plasma (CV ≤ 15,6%). Good uncertainty was found in assessing the span of indetermination. The control materials indicate good imprecision in series (CV ≤ 11,4%). The imprecision is good to the sixth hour after taking the blood assay. The determined analytical characteristics of the rotation thrombelastograph ROTEM®, when using citrated blood, enables its application for clinical, scientific and investigative purposes.
Key words: rotation thrombelastometry ROTEM®, analytical reliability
Address for correspondence: Assya Stancheva, MD, Central Clinical Laboratory, University Hospital “Lozenets”, 1 Koziak str., Bg – 1407 Sofia, e-mail: assiastancheva@yahoo.com

COMPLEX FUNCTIONAL ASSESSMENT OF THE RECOVERY OF PATIENTS
WITH DISTAL RADIUS FRACTURE

D. Vacheva1 and A. Mircheva2
1Clinic for Physical Medicine and Rehabilitation, University Multiprofile Hospital for Active Treatment
„Dr. G. Stranski” – Pleven

2Faculty for Physical Medicine, Rehabilitation, Ergotherapy and Sports, Medical University – Pleven

Summary: In respect to the investigation and reporting on the effect of applying labour activities when rehabilitating patients recovering after a distal radius fracture, we compiled a test that included all known and routine researches of the upper limb’s functional condition: Visual Analogue Pain Scale, goniometry, MMT (manual muscle testing), types of grasps and daily life activities, and the total number of points (the maximum is 100) gives an objective idea of the recovery of patients with traumas and upper limb troubles. In our research we included 106 patients with distal radius fracture (divided into two groups – a control one of 43 patients and an experimental one of 63 patients), who were undergoing a complex rehabilitation program that included: underwater gymnastics, kinesitherapy, labour therapy, low frequency impulse magnetic field and interference currents. The patients from the control group did not undergo any treatment with labour activities. Patients with complications from all groups when commencing the rehabilitation had low functional results, just a little above satisfactory level, while patients without complications were in good functional condition. Best functional recovery could be seen among patients from the experimental group without complications with injured dominant limbs, just a little below the excellent recovery line. The most significant was the improvement in the results of patients with complications from both experimental and control groups with injured dominant limbs, which could be explained with their much harder condition just after removing the immobilization (the beginning of the rehabilitation).
Key words: distal radius, rehabilitation, fracture, functional assessment
Address for correspondence: Danelina Vacheva, Ph. D., Clinic for Physical Medicine and Rehabilitation, University Hospital “Dr. Georgi Sranski” in Pleven, tel.: +359 64/ 886-186; +359 888 77 03 55, е-mail: danelina@abv.bg

DETECTION AND QUANTITATIVE DETERMINATION OF ALLANTOIN IN COSMETIC PRODUCTS
A. Tachev
National Center of Public Health Protection – Sofia

Summary: Allantoin is widely used in different cosmetic products – regenerative and skin protection creams, toilet milks and emulsions, shampoos and conditioners, preparations against sweating, lotions and aftershaves etc. It keeps the water balance of the skin. It helps the regeneration of the skin cells after prolonged sun exposure. It is renowned for its ability to soothe, heal and regenerate skin cells. Allantoin enhances the radiant complexion making it more flawless and looking healthier. Allantoin content, which is easily absorbed through the skin, gives pleasant cooling sensation. It provides perfect care after sunbath, tightens pores, makes the skin soft, silky and smooth. Allantoin restores elasticity and hydration to skin, giving it a more youthful appearance. In referent methods published for checking the composition of cosmetic products (Annex No.10 of the Ordinance No.36), no methods have been found for determination of allantoin in cosmetic products. Therefore, the necessity of developing a method for the needs of control has been arisen. An easy spectrophotometric method for determination of allantoin in cosmetic products has been developed, which was based on the interaction of allantoin with phenylhydrazine hydrochloride; thus phenylhydrazone was formed. It was oxidized by potassium ferrycyanide and the compound formed has purple-red colour, which is spectrophotometrised at 520 nm wavelength. A total of 28 studies were performed on the basis of which the parameters drawn were as follows: limit of detection (LOD) – 0, 01%; limit of quantification (LOQ) – 0,02%; repeatability – by 0,30% addition of allantoin in basic cosmetic product with homogenic viscous consistency – SD – 0,0082%; reproducibility – by 0,30% addition of allantoin in basic cosmetic product with homogenic viscous consistency – RSD under the conditions of repeatability – 2,86%; analytical yield at allantoin concentration of 0,20% in the cosmetic product –94,20% (90,00-100,00%); at 0,40% – 97,08% (95,00-100,00%). The developed spectrophotometric method for determination of allantoin in cosmetic products is quick, sensitive, accurate and reproducible, and does not require any sophisticated and expensive equipment; for that reason it can be used in the control of cosmetic products.
Key words: cosmetic products, repeatability, reproducibility, allantoin
Address for correspondence: Anton Kolev Tachev, 15 Ivan Evst. Geshov Blvd., Bg – 1431 Sofia, е-mail: a.tachev@ncphp.government.bg

CONTEMPORARY ACCENTS OF OCCUPATIONAL MEDICINE SIGNIFICANCE OF THE STUDY OF FUNCTIONAL STATE FOR WORK HEALTH AND SAFETY
R. Nikolova1 and S. Danev2
1Laboratory for Physiology and Psychology, National Center of Public Health Protection – Sofia
2Medeia Inc. – Sofia  

Summary: The interaction of components health and safety at work depends on functioning of the system – optimal functional state and prevention of health status, and effective performance of work activity composed of differentiated job tasks. Besides the European strategy in the field of functioning of the system on health and safety which ensures optimal functional state and health status, preservation of work safety and maintenance of adequate performance for task execution, institutions working in this field of research put an accent on preventive strategies necessary for optimizing the functional state and health status, improvement of working conditions for performing work activity and enhancement of culture of the employees as a result of implementing the training for optimization of health status and preservation of work safety.
Key words: functional state, health and safety at work, performance, functional diagnostics, prevention
Address for correspondence: Assoc. Prof. Dr. Ruzha Nikolova, MD, National Center for Public Health, Department of Physiology and Psychology, 15 Acad. Ivan Geshov  blvd., Bg – 1431 Sofia, tel.: 8056 207

EVALUATION OF HEALTH STATUS OF WORKERS IN TOBACCO PROCESSING AND CIGARETTE INDUSTRY BASED ON ANALYSIS OF MORBIDITY WITH TEMPORARY DISABILITY
M. Lyapina and E. Vodenitcharov
Department of Hygiene, Medical Ecology and Nutrition, Medical University – Sofia

Summary: The aim of the present study is to evaluate the health status of the workers in tobacco processing and cigarette industry based on the analysis of the main indices of morbidity with temporary disability (MTD) for 2008 and 2009. The indices of the morbidity with temporary disability were evaluated as very high no matter the trend for decrease in 2009. The delineated contingents at risk are women, the group of workers below the age of 45, the group of workers involved in tobacco processing and cigarette production, chronically ailing workers. The most important groups of diseases that had determined the structure of MTD are respiratory, diseases of nervous and musculoskeletal system, cardiovascular and digestive system. The role of the specific factors of working environment is considered important determinant for structure of MTD, but more prolonged investigatins are needed for a definite statement.
Key words: health status, workers, tobacco processing and cigarette industry, morbidity with themporary disability
Address for correspondence: Ch. Prof. Dr. M. Lyapina, Department of Hygiene, Medical Ecology and Nutrition, Medical University – Sofia, 15 Academic Ivan Evst. Geshov Blvd., tel.: +359 2/9152109

3/2011

SUSCEPTIBILITY OF CLINICAL HELICOBACTER PYLORI STRAINS TO METRONIDAZOLE, TINIDAZOLE, CLARITHROMYCIN AND AZITHROMYCIN
L. Boyanova, G. Gergova and I. Mitov
Department of Medical Microbiology, Medical University of Sofia, Bulgaria

Summary: The aim of the present study was to evaluate Helicobacter pylori susceptibility to two macrolides and two nitroimidazoles. The susceptibility of 19 H. pylori strains to Metronidazole, Tinidazole, Clarithromycin and Azithromycin was evaluated by agar dilution method (ADM) and that of 134 strains to the macrolides was assessed by breakpoint susceptibility testing method (BST). By ADM, resistance to the nitroimidazoles was detected in 26.3% of the 19 strains. Although similarities between the results of the categories by Metronidazole and Tinidazole were 100%, these between the MIC results were lower (73.7%). Clarithromycin MICs were lower than that of Azithromycin in 6 (31.6%) strains. The results showed a slightly higher MIC90 of Azithromycin (2 mg/l) compared to those of Clarithromycin (0.5 mg/l). The macrolide Clarithromycin had a slightly better activity than Azithromycin, expressed as lower MICs against 16% of the strains as well as according to the categories against 11.9% of the strains by BST. In conclusion, H. pylori resistance to Azithromycin was higher by about 5-8% compared to that to Clarithromycin by both ADM and BST. The difference, although small, is important for the eradication success. The results show a similar to slightly better activity of Tinidazole compared to that of Metronidazole and a slightly higher activity of Clarithromycin than that of Azithromycin, the latter confirmed by suboptimal eradication rates by Azithromycin in two our studies.

Key words: Helicobacter pylori, resistance, Clarithromycin, Azithromycin, Metronidazole, Tinidazole

Address for correspondence: Assoc. Prof. Lyudmila Boyanova, M.D., Ph. D., Department of Medical Microbiology, Medical University, 2 Zdrave street, Bg – 1431 Sofia, phone numbers: (+359 2) 91 72 730, е-mail: l.boyanova@hotmail.com; l.boyanova@lycos.com

NEW ASPECTS IN THE ANTIBIOTIC TREATMENT OF SURGICAL INFECTIONS
Ts. Velinov1, D. Bulanov2 and T. Kantarjiev1
1National Center of Infectious and Parasitic Diseasse, Department of Microbiology – Sofia
2Department of General and Operative Surgery, Medical University – Sofia

Summary: Daptomycin is a cyclic lipopeptide with potent activity and broad spectrum against Gram-positive bacteria currently used for the treatment of complicated skin and skin appendages infections and bacteremia, including right sided endocarditis. We evaluated the in vitro activity of this compound against clinical strains of staphylococci and enterococci collected from Bulgarian medical centers in the National Reference Laboratory for “Control and Monitoring of Antimicrobial Resistance” at the NCIPD. A total of 100 non-duplicate clinical strains from different medical centers were tested for susceptibility by reference agar microdilution methods according to Clinical and Laboratory Standards Institute guidelines and interpretative criteria. All S. aureus strains were inhibited at a daptomycin MIC of ≤1 mg/l. Among tested E. faecium strains the highest daptomycin MIC value was 2 mg/l (MIC50 under 0.5 mg/l), while among E. faecalis and Е. аvium the highest MIC value was 1 mg/l. Daptomycin showed excellent in vitro activity against staphylococci and enterococci collected in the National Reference Laboratory for “Control and Monitoring of Antimicrobial Resistance” and appears to be an excellent therapeutic option for serious infections caused by methicillin-resistant staphylococci and vancomycin-resistant enterococci. Currently, in Bulgaria 50% of bacterial infections of the skin and soft tissue, infections of surgical wounds, and the most serious infections – those of the cardiovascular system, are caused by Gram-positive organisms. Leading pathogens are Staphylococcus aureus, coagulase-negative staphylococci and enterococci. Surgical site infections are the third most common nosocomial infections, Daptomycin is active against a broad spectrum of poly-resistant microorganisms (MRSA and VRE), for which there are few alternatives for treatment.

Key words: Daptomycin, MIC, surgical infections, sepsis, MRSA, VRE

Address for correspondence: Tsvetan Velinov, M.D., PhD., National Reference Laboratory “Control and Monitoring of Antimicrobial Resistance”, Department of Microbiology, National Center of Infectious and Parasitic Diseases, 26 Yanko Sakazov blvd., Bg – 1504 Sofia, tel: +359 2 / 944 69 99 ext. 312, e-mail: tzv@mail.bg

NOSOCOMIAL PNEUMONIA IN INTENSIVE CARE UNITS AND SURGICAL WARDS IN BULGARIA (2000-2010)
Y. Mitova1, N. Ribarova1 and M. Minev2
1Department “Epidemiology”, Medical University – Sofia
2Second Surgical Ward, 5th MBAL – Sofia

Summary: Nosocomial pneumonia (NP) is the second most common nosocomial infection overall and the most common in intensive care units (ICUs). Non-fermentative Gram-negative bacteria - Pseudomonas spp. and Acinetobacter spp. are the leading agensts of nosocomial pneumonia in surgical wards and in ICUs in Bulgaria for 2000-2010 period. The incidence of NP is 20 to 25 cases per 1000 hospital admissions in ICUs and 1 per 1000 admissions in surgical wards. In ICUs pseudomonas aeruginosa is the most common pathogen in adults with NP (30,67%), as well as in surgical wards (20,24%). In ICUs in Bulgaria the diagnosis of pneumonia was confirmed by microbiological tests in 96,81% of the patients. The identification of causative microorganisms allowed the physicians to confirm the diagnosis and select appropriate antibiotic therapy.

Key words: nosocomial pneumonia, surgical wards, intensive care, unitsetiological structure, diagnosis

Address for correspondence: Y. Mitova, MD, Department “Epidemiology”, Medical University, 2 Zdrave str., University Obstetrics and Gynecology Hospital “Maychin Dom”, fl. 6, 670, Bg – 1431 Sofia, e-mail: drmitova@mail.bg

THE ROLE OF MORAXELLA CATARRHALIS IN THE ETIOLOGY OF RESPIRATORY TRACT INFECTIONS IN BULGARIA
R. Gergova1, P. Minchev2, M. Dikova3, S. Gergov4, R. Melamed4 and I. Mitov1
1Department of Medical Microbiology, MU – Sofia
2Clinic of Pediatric Pulmonology, SHATPD – Sofia
3Pediatric Clinic, SHATIN Orthopedics “B. Boychev” – Sofia
4Clinic “Head and Neck”, SHAT in Oncology – Sofia

Summary: To determine the role of M. catarrhalis in the etiology of respiratory infections in Bulgaria over a 15-year period (1996-2010) we analysed the results from the studies of 4060 patients, stratified by age, gender, healthy subjects and patients with different sites of infection. M. catarrhalis was confirmed as a causative agent over 30% of children aged 0-7 years and in nearly 26% of adults older than 60 years. The carrier rate in healthy preschool children was about 20%, while in healthy adults M. catarrhalis was hardly isolated. It was proved mainly in sick children with the following diagnoses: rhinosinuitis, rhinopharyngitis, adenoiditis. It was often involved (65%) in the etiology of chronic obstructive pulmonary disease in adults. Two thirds of the sufferers were men. There was a fall-winter seasonality. In more than half of the cases, M. catarrhalis was the only etiologic agent. When Moraxella was in microbial association, it was most often in cooperation with H. influenzae, and more rarely with any of the species S. pneumoniae, S. aureus, S. pyogenes. The prevalence of beta-lactamases-producing M. catarrhalis in Bulgarian isolates is nearly 100% and the infection requires treatment to be carried out with enzyme-resistant beta-lactam agents.

Key words: Moraxella catarrhalis, respiratory infections, virulence, resistance

Address for correspondence: Raina Gergova, MD, Department of Medical Microbiology, MU, 2 “Zdrave” str., Bg – 1431 Sofia, GSM: +359887 940 996, e-mail: renigergova@mail.bg

CURRENT TREATMENT OF TUBERCULOUS MENINGOENCEPHALITIS IN CHILDHOOD
S. Velizarova and A. Spasova
University Children’s Clinic of Pulmonary Diseases,
SHATPD “Sv. Sofia”

Summary: Tuberculous meningoencephalitis is the most debilitating form of extrapulmonary tuberculosis. It is a specific inflammatory process affecting the meninges of the brain and spinal cord. For the period 2005-2010 year the clinic treated 10 children with tuberculous meningoencephalitis, including 7 girls and 3 boys. Of these, 5 children were aged 0-3 years, 1 child was in age group 4-7 years and 4 children were in the 8-16 years age group. Four of the children had a close household contact with culture-conformed tuberculosis. Outcome of the disease in 2 children of the observation group was exitus, 5 children had rigidity, trophic skin disorders and inability to swallow, 3 children were discharged with improvement and slightly delayed in her neuropsychological development. The success of the treatment of tuberculous meningoencephalitis depends on the early etiological diagnosis, the proper treatment conducted no later than 21 days after the establishment of the symptoms and the qualification and experience of the physician in a specialized hospital.

Key words: tuberculous meningoencephalitis, children, treatment

Address for correspondence: S. Velizarova, MD, University Children’s Clinic of Pulmonary Diseases, SHATPD “Sv. Sofia”, 17, Akad. Ivan Geshov blvd., tel.: +359 8054299, GSM: +359 899423231, e-mail: velizarovasv@gmail.com

CLINICAL PROFILE OF NON-PROGRESSIVE CONGENITAL STATIONARY
NIGHT BLINDNESS WITHOUT PIGMENT IN A FAMILY WITH AUTOSOMAL DOMINANT INHERITANCE

K. Koev1, S. Cherninkova2, I. Turnev1, R. Gerogiev1 and R. Kuneva3
1Clinical Centre of Emergency Medicine, Medical University – Sofia
2University Department of Neurology, UMHAT “Alexandrovska” – Sofia
3Department of Medical Chemistry and Biochemistry and Molecular Medicine Centre, Medical University – Sofia

Summary: Purpose was to examine the clinical profile of 13 patients with non-progressive CSNB without pigment who were members of a single family. The following methods were used: best corrected visual acuity; Computed perimetry with Humphrey perimeter, ERG; Fluorescein angiography; Farnsworth Hue-28 test; anomaloscopy with anomaloscope IF-2 Tommey. In all 12 patients, we found the following symptoms: bilateral symmetrically reduced visual acuity up to 0.1; bilateral tunnel visual field; normal retinas without forming pigment accumulations. In all 13 patients, the ERG showed residual bioelectrical activity (20-30 μV); lack of bio-potentials under red filtered and reduced answer under blue filter; no activity during rhythmic Flicker stimulation on 4Hz. Fluorescein angiography showed no pathological signs. The tritanopia was diagnosed with the use of Farnsworth Hue-28 test and an anomaloscopy. CSNB without pigment is a variant of retinitis pigmentosa which is a hereditary disorder. The inheritance can be Schubert–Bornschein type, autosomal dominant, autosomal recessive and X-linked. We present a family composed of 13 patients with autosomal dominant form of CSNB without pigment followed up in three generations. The form described here first appeared shortly after birth and did not progress in time.

Key words: retinitis pigmentosa, congenital stationary night blindness, fluorescein angiography, computed perimetry, visual acuity

Address for correspondence: Assoc. Prоf. Krasimir Koev, Clinical Centre of Emergency Medicine, MU, 1 Sv. G. Sofisky str., Bg – 1431 Sofia

EFFICACY OF AMNION MEMBRANE TRANSPLANTATION ON CORNEAL SURFACE IN ANNULAR ABSCESS AND ANTERIOR UVEITIS
K. Koev1 and R. Georgiev2
1Clinical Centre of Emergency Medicine, Medical University – Sofia
2Clinic of Ophthalmology, UMHAT “Alexandrovska” – Sofia

Summary: Objectives: To determine the effect of amniotic membrane transplantation (AMT) on a patient with an annular abscess with a stromal defect of the cornea and anterior uveitis. In May 2010 a transplantation of amniotic membrane was performed on a patient suffering from an annular abscess with a stromal defect of the cornea and anterior uveitis. On examination objective findings showed a mixed hyperemia with conjuctival chemosis and corneal opacifications, a hypopyon reaching a level of 4 mm and the presence of posterior synechiae, as well as opacities in the vitreous body. We also established corneal epithelial disruption, detected with fluorescein staining of the eye. One month after the AMT a significant improvement was established. We observed epithelization of the cornea, disappearance of the ciliary hyperemia, closure of the stromal defect, resorption of the hypopyon, and the corneal opacifications and opacities in the vitreous body. There was a partial presence of posterior synechiae. The inflammatory process was overcome. Three months after the AMT a semi-transparent leucoma was observed and an increased visual acuity was registered. We inspected solitary posterior synechiae. The AMT was efficient, had manifestivе anti-inflammatory effects and could be successfully applied to cases of sever inflammatory processes, annular abscess, corneal defects and anterior uveitis.

Key words: amniotic membrane transplantation, annular abscess, stromal defect, anterior uveitis

Address for correspondence: Assoc. Prof. Krasimir Koev, MD, Clinical Centre for Emergency Medicine, UMHAT “Tsaritsa Yoanna”, 8 Byalo more str., Bg – 1527 Sofia, e-mail: k0007@abv.bg


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