Original articles 2012




A. Mircheva and B. Deseva
Clinic for Physical Medicine and Rehabilitation at the University Multiprofile Hospital
for Active Treatment “Dr. G. Stranski” – Pleven

Summary: The purpose of this article is to examine, follow up and report on the recovery of the volume of actions in the shoulder joint among patients, who have developed “shoulder-arm” syndrome complication after distal radius fracture. Materials and methods: In the survey 22 patients with “shoulder-arm” syndrome complication after distal radius fracture have been included. All patients have undergone measurements and tests, which have been noted down in personal cards. The rehabilitation program included: underwater gymnastics – local bath (forearm, wrist and fingers), kinesitherapy (for the entire upper limb), cryotherapy (for the shoulder joint), labour therapy, low frequency impulse magnetic field, ultraphonophoresis – daily, 10 procedures per rehabilitation course. Results and discussion: The results of the conducted goniometry of the shoulder joint proved statistically significant improvement towards the end of the rehabilitation process, but the recovery among patients with complication requires a longer period and more rehabilitation courses.
Key words: rehabilitation, shoulder-arm syndrome, goniometry, distal radius fracture
Address for correspondence: Anitsa Mircheva, Clinic for Physical Medicine and Rehabilitation, Medical University, MHAT “Dr

B. Halova1, P. Georgiev2 and Y. Mitova2
1Metropolitan RHI – Sofia
2Department of Epidemiology, Medical University of Sofia

Summary: Factors that influence the strength and duration of the epidemic process directly depend on the possibility of active intervention by the people for elimination and eradication of communicable diseases. Analysis of the dynamics of distribution and opportunities for prevention and control of infectious diseases in the two examined regions − Sofia and the rest of Bulgaria, is in support of the main and decisive role of social factors that can be successfully guided in the presence of good government policy of understanding, consent and protection of public health.
Key words: immunoprophylaxis, immunomodulators, social factors, natural focality of infections, epiziootic process
Address for correspondence: Y. Mitova, Department of Epidemiology, Medical University, SHATOG “Maychin Dom”, 2 Zdrave str., Bg – 1431 Sofia, tel.: +359 2 9523844

M. Karcheva and G. Gancheva
Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine,
Medical University – Pleven

Summary: Measles is an acute infectious disease with high infectivity. In Bulgaria the specific immunoprophylaxis led to the epidemic process in 2000-2006. However, in 2009-2010 there was an epidemic of measles, analogous to the increased incidence noted in other European countries. The aim of this study was to present epidemiological and clinical aspects of measles infection in Pleven for the period 2000-2010. Material and methods: Data were collected from reports and analyses from the Regional Health Inspection of Pleven. Clinical laboratory data on patients hospitalized at the Clinic of Infectious Diseases, University Hospital “Dr. G. Stranski” − Pleven were obtained from our previous studies. Results: The highest incidence of measles was registered in 2010 − 162.43 per 100 000 population. People of all ages were affected, the highest incidence being registered in children under 1 years of age − 3506.7. Ethnicity was mostly Romany (95%). There was a winter-spring seasonal pattern with a peak in April. Both sexes were equally affected in a ratio of 1.02: 1.00. Clinical and laboratory studies of the 455 hospitalized patients were focused on two age groups in the two extremes (under 1 and over 20 years) and demonstrated intoxication, catarrhal and skin rash syndrome. Two cases of encephalitis and two of acute respiratory failure were observed. All had a favorable outcome. Conclusions: The temporary reduction of morbidity and disruption of the epidemic process have led to the accumulation of susceptible population and an epidemic rise in 2010. In recent years people from all age groups are being affected. The disease has not changed its clinical course.
Key words: мeasles, epidemic process, clinical course
Address for correspondence: Dr. Milena Karcheva, MD, Department of Epidemiology, Parasitology and Tropical Medicine Medical University, 1 “St. Kl. Ohridski” str., Bg – 5800 Pleven, e-mail: milena_karcheva@abv.bg

V. L. Hristova-Bagdasaryan, Zh. A. Tishkova and T. M. Vrabcheva
National Centre for Public Health and Analysis – Sofia
Summary: Acrylamide (AA) is defined by the International Agency for Research on Cancer (IARC, 1994) [17] as possibly carcinogenic to humans (Group 2A). Formation of acrylamide in foods is a consequence of the reaction between asparagine and sugars or reactive carbonyls, which occurs during frying or baking goods. Due to the large number of heat treatments, coffee is a potential source of acrylamide. Depending on the age of the population, food habits and preferred way of processing, the contribution of coffee to the total dietary acrylamide exposure can reach nearly 40%. GC-MS method with solid-extraction and derivatization was developed for determination of AA in coffee, coffee substitutes and cocoa. The linear range was 100 – 5000 µg/kg, LOD – 40 µg/kg, LOQ – 100 µg/kg. The recovery ranged from 68% to 86% and relative standard deviation (RSD) was between 4.5% and 12.5%, depending on the matrix. The additional SPE-procedure was introduced for elimination of residual staining of the extract due to the matrix. The ratio signal/noise was effectively improved, the interfering components were removed. The method developed was applied to analyze samples of 22 types of coffee, coffee substitutes and cocoa, and a content of AA was found in 59% of the analyzed samples. Acrylamide content in coffee varies from < 100 μg/kg to 486 μg/kg, in coffe substitutes – from < 100 μg/kg to 887 μg/kg., and in cocoa – from < 100 μg/kg to 422 μg/kg. The results obtained for the content of acrylamide in coffee products correspond to the EU reports for the same kinds of products.
Key words: Acrylamide, coffee, coffee products, food contaminants, GC/MS method, SPE
Address for correspondence: Chief ass. eng.V. Bagdassarian, PhD, Department “Food Contact Materials”, National Center for Public Health and Analysis, 15 Akad. Ivan Geshov blvd., Bg – 1431 Sofia, tel: +359 2 8056375; +359 2 8056323, mobile: +359 898 56 42 85, e-mail: v.hristova@ncpha.government.bg


V. Atanasova1, N. Donchev2 and P. Gatseva1
1Department of Hygiene, Ecology and Epidemiology, Faculty of Public Health, Medical University – Plovdiv
2Pathоhistological Laboratory of former National Center of Hygiene, Medical Ecology and Nutrition – Sofia

Summary: A six-month experiment was carried out with white male Wistar rats in order to estimate the effect of black chokeberry (aronia) juice on tumor formation under the influence of diethylnitrosamine (DENA). Model of DENA tumorigenesis, modified by Donchev and Borov, 1995, was used in the experiment. The experimental group was treated with DENA and black chokeberry juice (black chokeberry – Aronia Melanocarpa Elliot), administered perorally for 6 months with drinking water. It was established that 96% of all tumors were localized in the rats’ livers. The bits of precisely coded sections of the rats’ livers from the experimental and control groups were investigated by electron microscopy. The results of the study showed that the ultrasructural changes in the hepatocytes were markedly more vived in the rats from the DENА control group in comparison with the group treated with DENА and aronia juice. The observed hyperplasia of the smooth endoplasmic reticulum (SER) was a sign of regenerative processes in the liver cells. In conclusion, the observed changes under the influence of aronia juice were associated with adaptation and regenerative changes in hepatocytes. The findings of the ultrastructural analysis revealed that black chokeberry juice could cause apoptosis in tumor cells in the applied model of experimental diethylnitrosamine − induced carcinogenesis.
Key words: diethylnitrosamine (DENА), electron microscopy, black chokeberry juice, rats
Address for correspondence: Dr. Victoria Atanasova, MD, Head Assistant Professor, Department of Hygiene, Ecology and Epidemiology, Medical University, 15-A Vasil Aprilov blv., Bg – 4002 Plovdiv, office tel. (032) 602-543, e-mail: victoria321@ abv.bg

P. Tokov, E. Zhivkov, L. Simonova, N. Popadiyn, V. Popov, T. Frangov and V. Dimitrova
Clinic of General and Liver-Pancreatic Surgery, “Aleksandrovska” Hospital − Sofia
Summary: Background: Insulinomas are the most common endocrine neoplasm of the pancreas. In female patients they occur with higher frequency. They are located predominantly in the pancreatic tail, less commonly in the pancreatic body, and extremely rarely in the head of the gland. The clinical symptoms are various. They include disorientation, amnesia, confusion, loss of consciousness, nervosity, sweating, tachycardia, gain of weight. The Whipple`s triad is common. Time to correct diagnosis is usually between 1.5 and 3 years. Visualization of the tumor can be achieved with CT or MRI examination. Surgical resection is the most successful treatment. Aim: The aim of the current publication is to make a brief review of the world experience in the diagnosis and treatment of pancreatic insulinomas and compare it with our results, reviewed retrospectively. Methods: Between 1997 - 2008, in the Clinic of General and Liver-Pancreatic Surgery 12 patients with pancreatic insulinomas, verified histologically, were operated. Results: Eight distal resections of the pancreas, 4 of which being “blind resections”, with no possible visualization of the tumors despite the CT and MRI examinations, were performed. Furthermore, 2 enucleations, 1 duodenohemipancreatectomy and 1 resection of the corpus of the pancreas were made. Conclusions: Conclusions have been made based on our and the world experience.
Key words: pancreatic insulinoma, distal resection, endocrine neoplasm
Address for correspondence: Assoc. Prof. Petyo Tokov, MD, Head of Section of General and Liver-Pancreatic Surgery, Clinic of General and Liver-Pancreatic Surgery, UH “Alexandrovska”, 1 “Sv. G. Sofiyski” str., Bg – 1431 Sofia, tel.: +359 888 67-50-10, e-mail: george25mh@hotmail.com

Е. Arabadzhieva, S. Bonev, P. Tokov and V. Dimitrova
Clinic of General and Liver-Pancreatic Surgery, “Alexandrovska” Hospiral − Sofia
Summary: Introduction: Diverticulosis is one of the most common diseases of the gastrointestinal tract in Western countries. However, about 10 to 25% will develop symptoms and only 20% of these patients will undergo surgery. AIM: The aim of the study was to analyze possible operative management of complicated diverticulosis of the gastrointestinal tract and to determine the most suitable surgical approach according to the stage of the disease and the type of the developed complication. Methods and materials: Between 2009 and March 2012, 150 patients with diverticulosis of the digestive tract were diagnosed in the Department of General and Hepatopancreatic Surgery of the University Hospital “Alexandrovska”. Seventeen of them underwent surgical treatment because of the development of complicated forms of the disease: perforation and diffuse peritonitis (7), intraabdominal abscess which was a result from covered perforation (2), obstruction symptoms (6), bleeding from the GI tract (1) and inflammation of Meckel diverticulus (1). Statistical analysis was performed with SPSS-19 according to localization of the process, stage of the disease, Hinchey classification, type of the developed complication, applied surgical treatment and following morbidity and mortality. Results: Seventeen patients with complicated diverticulosis were operated – 11 women (64, 71%) and 6 men (35, 29%) between 26 и 84 years. Four intestine resections, 3 Hartmann procedures, 2 right и 5 left hemicolectomies were performed. Resection of the sigmoid colon was performed in 2 cases, and 2 other patients underwent suture and proximal diversion. Insuficiency of primarily performed anastomoses were not observed. Two patients underwent relaparotomies because of wound dehiscence in one of the cases and forming of intraabdominal abscesses in the other one. Wound complications were observed in 1 patient (5, 88%). Mortality rate was 11, 76% (2 patients). Conclusion: Surgical treatment of complicated diverticulosis, especially in cases with peritonitis, remains a challenge not only because of the high morbidity and mortality rates, but also because of the trends towards improvement of long-term quality of life. In recent years primary resection and anastomosis with or without proximal diversion became alternatives to Hartmann’s procedure. Till now there are not clearly defined criteria and statistically based guidelines for the best operative strategy in cases with complicated diverticulosis.
Key words: complicated diverticulosis, perforation of a diverticulus, bleeding, Hartmann procedure, primary resection and anastomosis
Address for correspondence: Assoc. Prof. Petyo Tokov, MD, Head of Section of General and Liver-Pancreatic Surgery, Clinic of General and Liver-Pancreatic Surgery, UH “Alexandrovska”, 1 “Sv. G. Sofiyski” str., Bg – 1431 Sofia, tel. +359 888 67-50-10,
e-mail: george25mh@hotmail.com



А. Gladilova¹ and N. Ribarova²
¹University National Cardiology Hospital – Sofia
²Department of Epidemiology, Medical University – Sofia

Summary: In relation to the incidence of nosocomial infections, their severe course and sometimes adverse prognosis, neonatal wards are defined as high risk wards. The nosocomial infections in these wards represent 4.88% of all hospital infectious  disease pathology. Annually, about 2% of the newborns develop nosocomial infection (according to the official register) and 1/3 of them require antibiotic therapy. This indicator increases in recent years. The etiologic structure of nosocomial infections is characterized predominantly with circulation of conditional – pathogenic microorganisms.The nosocomial structure is not so variable and includes clinical forms such as infections of the sensory organs, respiratory and gastrointestinal tract and sepsis.
Key words: nosocomial infection, newborns, neonatal wards, distribution, etiologic structure, clinical forms
Address for correspondence: Prof. N. Ribarova, MD, PhD, Department of Epidemiology, Medical University  Sofia, Bulgaria,
GSM: 0889 735 127, e-mail: nribarova@abv.bg

T. Petkova1, S. Pachkova2 and A. Decheva3
1Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine,
Medical University – Pleven
2Department of Microbiology, Virology and Medical Genetics, Medical University – Pleven
3NRL of Streptococci and Corynebacteria, NCIPD – Sofia

Summary: A comparative epidemiological typing of strains of Streptococcus pyogenes (GAS), isolated from children with acute tonsillopharyngitis was performed. The prospective study was conducted during October 2010 – October 2011 in the city of Pleven. We have studied 726 children with sporadic forms of tonsillopharyngitis and 339 children belonging to organized groups. Lancefield group of the isolated Streptococci in pure culture was determined using the latex agglutination test (Slidex Strepto Plus, Company Bio Merieux, France). Of the isolated GAS, identification of M- and T-serotype and testing for production of serum opacity factor (SOF) were carried out by conventional methods. The results showed predominance of GAS and negligible role of group C and group G Streptococci in the etiology of acute tonsillopharyngitis. The study of 66 (9.09%) strains GAS, isolated from children with sporadic tonsillopharyngitis established circulation of sixteen M-serotypes, with  M25, M6 and M12 being the most common. The epidemiological typing of 85 (25.07%) strains of GAS, isolated from children, belonging to organized groups, showed that the disease was caused by four M-serotypes, with a leading role of M14. The epidemiological typing confirmed the hypothesis that in organized groups the majority of diseases are caused by a limited number of M-serotypes. The typing method allows determining the likely source of infection and the circulation of common virulent strains in the region.
Key words: group A Streptococci (GAS, Streptococcus pyogenes), M-serotype
Address for correspondence: Tanya Petkova, MD, Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Medical University, 1 St. Kliment Ohridski str., Bg-5800 Pleven, GSM: +359 885 33 87 74, e-mail: tanja_1973@abv.bg


N. Korsun1, R. Kotseva1, A. Teodosieva1, A. Kurchatova2, P. Genova-Kalou1 and M. Kozhuharova2
1Department of Virology, National Laboratory “Influenza and ARD” – Sofia
2Department of Epidemiology and Сommunicable Disease Surveillance, NCIPD – Sofia

Summary: The aim of the present study was to perform а comparative analysis of influenza epidemics in Bulgaria during the seasons 2010/2011 and 2011/2012  and the circulating at that time influenza viruses characterized. During the period October 2010 – April 2011, 818 nasopharyngeal swabs of patients with influenza-like illness from different regions of the country were tested for influenza viruses, and 578others – during the period October 2011 – April 2012. Real Time RT-PCR kits with specific primers and probes for detection and typing/subtyping of influenza viruses, donated by the CDC Atlanta, USA, were used. The isolation of influenza viruses was performed in embryonated hen’s eggs and cell culture MDCK-SIAT. Antigen characterization of the isolates was carried out by the haemagglutination inhibition assay. The sensitivity of the viruses to the neuraminidase inhibitors Oseltamivir and  Zanamivir was determined by a phenotypic method using fluorescent substrate MUNANA. Sequencing of haemagglutinin and neuraminidase genes of two pandemic virus А(Н1N1)2009 isolates was performed. The data on influenza and acute respiratory diseases (ARD) incidence rate during the seasons 2010/2011 and 2011/2012 were obtained from the web-based information system for sentinel surveillance of these infections in Bulgaria. In the first post-pandemic influenza season co-circulation of the pandemic subtype А (Н1N1)2009 and type B viruses was demonstrated, while in the second season subtype А (Н3N2) were the predominat influenza virus. There were differences in the dynamics, intensity and age structure of influenza cases during both epidemic seasons. Clinical influenza activity during the first season was higher. In season 2010/2011 cases of pneumonia were predominantly associated with А (Н1N1)2009 viruses, while cases of neuroinfections – with type B viruses (p < 0, 05). Influenza viruses of the pandemic subtype А(Н1N1)2009 were cultivated well in embryonated hen’s eggs and proved by haemagglutination with avian erythrocytes, while the isolation of subtype А(Н3N2) viruses was successful only in cell culture MDCK-SIAT and the proving – by use of guinea pig erythrocytes. All tested pandemic А(Н1N1)2009 viruses were sensitive to the antiviral drugs oseltamivir and zanamivir. Sequencing analysis of haemagglutinin and neuraminidase genes of two isolates of the pandemic virus А (Н1N1)2009 showed 9 and 4 amino-acid substitutions, respectively, in comparison with the vaccine virus A/California/7/2009. The National laboratory “Influenza and ARD” successfully deciphered the circulation of influenza viruses during the first two influenza seasons of the post-pandemic period. There were differences in the biological properties, epidemiology and clinical activity of the influenza viruses, responsible for two consecutive influenza epidemics in Bulgaria. Our virological and epidemiological data complement the information on the spread of influenza viruses in Europe.
Key words: pandemic influenza virus А(Н1N1)2009, influenza virus А(Н3N2), post-pandemic period, resistance
Address for correspondence: Assoc. Prof. Neli Korsun, MD, PhD, NRL of Influenza and Acute Respiratory Diseases, Department of Virology, National Center of Infectious and Parasitic Diseases – Ministy of Health, 44A General Stoletov blvd., Bg-1233 Sofia, tel.: +359 2 931 81 32, e-mail: neli_korsun@abv.bg


A. Gladilova¹ and N. Ribarova²
¹University National Cardiology Hospital – Sofia
²Epidemiology Department, Medical University – Sofia

Summary: The children’s wards are among the most risky hospital wards in relation to nosocomial infections. During the last years the nosocomial pathology in children’s wards constitutes 21.6% of the total number of all registered nosocomial infections in the hospitals around the country. The relative portion of nosocomial infections in hospitalized children is 3.03%, averagely. Out of the total 4,344 patients registered yearly to have a nosocomial infection, 2/3 remain etiologically unclear or simply not examined at all. Annually, near 3/4 of the hospitalized children are treated with antibiotics. The etiological structure of nosocomial infections in children is characterized with circulation of conditional – pathogenic microorganisms: Klebsiella pneumoniae, Staphylococcus spp, E.coli, etc. The most common clinical forms of nosocomial infections are: respiratory infections, sepsis, intestinal infections, etc.
Key words: nosocomial infections, children’s wards, dynamics of distribution, etiological structure, clinical forms
Address for correspondence: Prof. N. Ribarova, MD, PhD, Department of Epidemiology, Medical University – Sofia, Bulgaria,
GSM: 0889 735 127, e-mail: nribarova@abv.bg

R. Popov1, N. Petrov2 and V. Vaseva2
1Haematology and Blood Transfusion Center, Military Medical Academy – Sofia
2Department of Anesthesiology and Critical Care, Military Medical Academy – Sofia

Summary: From a clinical perspective the ABO system is the most important blood group antigen system and the system Rh is one of the most complicated isoserological systems. The survey was performed in order to determine the distribution of blood groups of the ABO system and the prevalence of A1, A2 and Rh (D) antigens in patients and donors of whole blood at the Military Medical Academy (MMA). A total of 21,568 blood samples, of which 11,168 from patients and 10,400 whole blood samples from donors were studied. The distribution of blood groups according to the Rh (D) antigen and the prevalence of A1 and A2 subgroups were also determined. The prevalence of blood groups of the ABO system was as follows: А – 43.2%, В – 16.11%, О – 32.6% and  АВ – 8.1%. The prevalence of Rh (D) antigen was 86.8%. The distribution of A1 and A2 subgroups was 90.2% and 9.8%, respectively. These results support and complement the pre-existing knowledge about the distribution of ABO blood system antigens among the Bulgarian population.
Key words: blood groups, ABO blood group system
Address for correspondence: R. Popov, MD, Haematology and Blood Transfusion Center, Military Medical Academy, 3 Sv. G. Sofiyski blvd., Bg-1606 Sofia, tel. +359 2 922-55-06, e-mail: rumenpopov2002@yahoo.com

V. Hristova-Bagdassarian, Zh. Tischkova and I. Topalov
National Center of Public Health and Analysis -- Sofia, Bulgaria
Summary: In cosmetic products, which are proposed for prolonged sun exposure and in products for daily use, manufacturers start adding different UV filters for combined protection of UVB and UVA radiation – chemical and physical (two and more), aiming at maximal skin protection. The UV filters content in cosmetic products is strictly regulated in the European legislation (Directive76/768/EEC and its amendments), as well as in the Bulgarian legislation, harmonized with the European legislation, Regulation № 36/ 2005 and its amendments – “Requirements to the cosmetic products”. The regulation defines maximal admissible levels for all authorized cosmetic UV filters. Consequently, it emerges a need for strict observational control of these regulation levels. On the other hand, insufficient concentration of UV filters in cosmetic products, lower than the labeled levels, leads to adverse health effects, caused by the UV rays and insufficient sun protection. The aim of this study was to determine the real UV filter content of ten different cosmetic products and to compare the established results with the content information, declared by the manufacturer, as well as with the maximal admissible levels, regulated by the law, and with the declared recipe content. The study was conducted with ten sunscreen cosmetic products of six Bulgarian brands, with and without solar protection product information on the labels. In the investigation highly sensitive, accurate and validated methods were used – high performance liquid chromatography (HPLC), complexometry and weight analyses. Forty-one determinations of seven UV filters in ten cosmetic products were carried out. In five (12. 20%) of the samples, coincidence between the determined results data and the declared by the manufacturer data was established. In twenty-two (53.66%) sample determinations, the measured concentrations were below those announced in the producer recipes, in 19 (46.34%) of them the deviation was within the allowable percentage (10%) of the input quantities, and in the remaining three (7.32%) the deviation was greater than 11.11% (from 11.11 to 14.00%). In 14 (34.15%) samples the determined concentrations were higher than the announced in the recipes and for twelve determinations (29.27%) the deviation of the added quantity was in the allowable range (10%), and only in two (4.88%) samples the deviation was outside the allowable range – 12.50% and 14.30%, respectively. In three of the investigated cosmetic products, one of the added UV filters was established to have a concentration close to the maximal admissible levels, and for other three UV filters minimal deviations above the maximal admissible concentrations, according to the regulation levels, were established. This study proves the necessity of preliminary studies for the establishment of the real content of UV filters in the cosmetic sunscreen products, their stability and compatibility, of which the real skin protection from UVB and UVA rays depends. For this purpose, suitable determination methods are HPLC, complexometry and weight analyses. The study shows that non-compliance between legislation levels and declared by the manufacturer levels of UV filters in cosmetic products is unacceptable.
Key words: UVB and UVА rays, sunscreen cosmetic products, UV filters
Address correspondence: Valentina Hristova-Bagdassarian, National Center of Public Health and Analysis, 15,  Ivan Evst. Geshov blvd., Bg-1431 Sofia, е-mail: v.hristova@ncpha.government.bg

Sv. Dermedjiev¹, Zl. Stoyneva² and T. Kuneva²
1Medical University – Plovdiv,
2 Medical University - Sofia

Summary: The present study aimed to follow up the number of hospitalized patients from a huge local factory KCM Corp. – Plovdiv for production and processing of non-ferrous metals during a five-year period (2005-2009) and to assess the severity of their toxic lead and cadmium induced damages by means of the approved principles and criteria in toxicological practice. Significant decrease of the exposed workers and hospitalized patients in the Clinic of Occupational Diseases during the last year of the investigated period was found with reliable correlation (p < 0.01). The stage and severity of the objectified disorders in patients, occupationally exposed to lead and cadmium for each year of the period were mainly preclinical forms of exposure with a single case of mild poisoning. Dynamic check-ups of the exposed to lead and cadmium persons is necessary for biomonitoring of the contingent at risk and for early diagnosis.
Key words: contemporary exposure, lead, cadmium, poisoning
Address for correspondence: Ass. Prof. Svetlan Dermendzhiev, MD, PhD, Section for Occupational Diseases and Toxicology, Medical University  15A Vasil Aprilov blvd., Bg-4020 Plovdiv, tel.: 032/602 488, е-mail: svetlan_d@yahoo.com

S. Bonev, P. Tokov, E. Arabadzhieva and V. Dimitrova
Clinic of General and Hepatopancreatic Surgery,
University Hospital “Alexandrovska”  Sofia

Summary: Tumors of the exocrine pancreas have extremely poor prognosis because of the fact that the 5-year survival after the moment of diagnosis is less than 5%. Over the past two decades many advances in the diagnosis, therapy and palliation of pancreatic cancer have taken place, although the overall survival of affected patients has not improved significantly, and even in the leading clinics the 5-year survival after radical resection is less than 30%. AIM: The aim of this study is to review the experience of the clinic in the management of pancreatic cancer, and based on the available literature, to compare it to the worldwide experience and determine the predictors of survival after radical and palliative surgical treatment. Between 1999 and 2011, 919 patients with pancreatic cancer were surgically treated in the Department of General and Hepatopancreatic Surgery of University Hospital “Alexandrovska” – 270 radical resections, 591 palliative procedures and 58 exploratory laparotomies with biopsy. Clinicopathological data was analyzed with different statistical methods included in SPSS-19 in order to determine the prognostic importance of a variety of factors: age, sex, tumor stage, performed treatment and morbidity after it, preoperative values of tumor markers and presence of pain. The statistical analysis shows that the tumor stage and the type of treatment (radical or not) are significant prognostic factors influencing the long-term postoperative results. The higher preoperative values of tumor markers and the presence of pain symptoms are related with poor prognosis. Surgical resection is the only potentionally curative treatment for pancreatic cancer. The exact diagnosis and the aggressive surgical strategy are related with increased resectability rate, which is the most important predictor of survival.
Key words: pancreatic cancer, radical resections, prognostic factors, staging, survival
Address for correspondence: S. Bonev, MD, Clinic of General and Hepatopancreatic Surgery, University Hospital “Alexandrovska”, 1 “G. Sofiyski” str. , Bg-1431, Sofia

K. Mitov and A. Savova
Department “Organization and Economics of Pharmacy”, Faculty of Pharmacy,
Medical University – Sofia

Summary: The current work represents the methodology for data submission to the Ministry of Education Register with the web-application “Adminrhe”. The methodology that has been developed is based on the consequence of work when submitting data to the register and the differences in the possible ways of submitting data, with the universities being the starting points. It describes in a logical way 7 main stages of data verification, correction and submission to the web application “Adminrhe”. Complying with the methodology saves time, decreases the risk of errors, and improves the efficacy of the administrative staff. The methodology is accepted and routinely applied in the practice of the Medical University of Sofia.
Key words: students registers, education, student’s graduation
Address for correspondence: K. Mitov, Department “Organization and Economics of Pharmacy”, Faculty of Pharmacy, Medical University – Sofia, тel.: (02) 9236 508, е-mail: kmitov@pharmfac.net


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