Original articles 2013

ARCHIVE

1/2013

EPIDEMIOLOGICAL INDICES OF ASTHMA IN BULGARIA
G. Christoff1, E. Karova2 and I. Stoeva3
1Department “Health Еconomics”, Faculty of Public Health, Medical University – Sofia,
2Department “Conservative Dentistry”, Faculty of Dental Medicine, Medical University – Sofia
3Department “Allergology, Physiotherapy and Clinical Radiology”, Faculty of Dental Medicine,
Medical University – Plovdiv


Summary: The objective of the study was to examine the prevalence of asthma in Bulgaria with regard to different definitions of the disease used. Adapted International Study of Allergy and Asthma in Children (ISAAC) and European Community Respiratory Health Survey (ECHRS) questionnaires were used to address the specific needs of the study. Prevalence of asthma (95% CI)  14.9% (13.5-16.2) was high, but was lower than that of eczema (atopic dermatitis)  17.9% (16.5-19.4) and allergic rhinitis 39.3% (37.5-41.1).

Key words: asthma, allergic rhinitis, atopic dermatitis, allergic diseases, prevalence

CYTOGENETIC AND HEMATOLOGIC CHARACTERISTICS OF 8 CASES WITH HEMATOLOGIC NEOPLASMS
AND STRUCTURAL ABNORMALITIES
OF CHROMOSOME 1

L. Mitev1, M. Velizarova2, V. Uzunova1, Y. Rainov3, I. Gigov3 and R. Stanchev3
1Катедра „Клинична лаборатория и имунология“, Военномедицинска академия – Sofia
2Катедра по клинична лаборатория и клинична имунология, Medical University – Sofia
3Клиника по хематология и онкология, Военномедицинска академия – Sofia


Summary: Structural aberrations of chromosome 1 were described in different myeloproliferative neoplasms, non-Hodgkin’s lymphoma (NHL) and multiple myeloma (MM). Eight patients with hematologic neoplasms and structural anomalies of chromosome 1, detected by conventional cytogenetic, were included in our study. We found diverse aberrations in 1р22 (3 cases), 1q23 (2 cases) and 1p36, 1p32, 1q10, 1q12, 1q21 chromosome regions (each one on a case). There were established an i(1)(q10) and “giant” chromosome 1- idic(1;1) in one patient; +del(1)(p22) in one case, dup(1)(p36)- in one case. Structural aberrations of chromosome 1 were combined in complex karyotype in 3 of patients. We found association of cytogenetic findings with morphologic data in 4 of patients: 1 case with t(1;9;22) and lymphoblast proliferation, 1 case with t(1;15;17) and promyelocytic proliferation, 2 cases with del(1)(p22) and bone marrow eosinophilia and megaloblastoid changes. We present the first in our country MM case with a rare der(Y)t(Y;1)(q12;q12) translocation, which was a part of multiple chromosomal aberration in complex karyotype.

Key words: chromosome 1, hematologic neoplasms, multiple myeloma, acute myeloid leukemia

IN VITRO STUDY OF THE BACTERICIDAL ACTIVITY OF THREE HERBAL INFUSIONS AGAINST 44 CLINICAL STRAINS
OF HELICOBACTER PYLORI, INCLUDING DOUBLE AND TRIPLE ANTIBIOTIC RESISTANT STRAINS

L. Boyanova, G. Gergova and I. Mitov
Department Medical Microbiology, Medical University -- Sofia

Summary: The aim of the study was to assess the killing of Helicobacter pylori strains by peppermint, chamomile and lime flower, which have not been studied or have been a topic of single reports. Bactericidal activities of 3 herbal infusions at concentrations used for herbal teas/tisanes were evaluated against 44 clinical H. pylori strains. The strongest bactericidal activity within 2 h was found by peppermint (56.8%), followed by chamomile (40.9%) and lime flower (20.4%). Peppermint, chamomile and lime flower killed 25.8%, 12.9% and 3.2% of 31 H. pylori strains resistant to one or more antibiotics within 1h, and 54.8%, 45.2% and 16.1% within 2h, respectively. To our knowledge, this is the first study which provides data about bactericidal effects of the chamomile and lime flowers as aqueous extracts at concentrations used for herbal teas/tisanes against H. pylori. Only the peppermint exhibited bactericidal activity against >1/2 of the strains, although with non-significant differences vs. the activity of the chamomile. Lime flower was not active against the bacteria.

Key words: Helicobacter pylori, bactericidal, chamomile, peppermint, lime flower, antibiotic resistance, multidrug resistance

EPIDEMIOLOGICAL ANALYSIS OF EPIDEMIOLOGICAL OUT BREAK OF VIRAL HEPATITIS A IN SOFIA-REGION
V. Doycheva1, T. Dimitrova1, Y. Mitova1, G. Kanzov2, G. Kamenov2, M. Borisova2,
J. Donkov2 and D. Arsova2

1Department of Epidemiology, Medical University – Sofia
2Regional Health Inspection, Sofia-region


Summary: The aim of this study was to clarify the characteristics of an outbreak of viral hepatitis type A, recorded in 2012 in Ihtiman – Iztok, Sofia region, the Roma ethnic population with 363 ill persons. Outbreak has high intensity and incidence reaching 2779.63%ooo. The results of epidemiological analysis of the outbreak warrant a critical assessment of the ongoing anti-epidemic measures in outbreaks of viral hepatitis type A. It is remedial social policies of our society, as well as the discussion and integration of immunization against hepatitis A Immunization calendar of Bulgaria, with priority for Roma in Bulgaria.

Key words: viral hepatitis type A, outbreak, epidemiological analysis, hepatitis A vaccine

APLICATION OF LASER DOPPLER FLOWMETRY IN OCCUPATIONAL PATHOLOGY
Zl. Stoyneva
Clinic of Occupational Diseases, UMHAT “Sv. Ivan Rilski”  Sofia

Summary. The aim of this work was to present the principles and clinical application of laser Doppler flowmetry (LDF) in occupational pathology by assessment of the available literature and our own experience. LDF is based on Doppler principle using laser-generated monochromatic light beam, transducer with optic fibers and sensitive photo-detectors. The number of moving blood cells, their velocity and perfusion, which is the product of them both, are being monitored. The accuracy and sensitivity of LDF in clinical practice have been improved by applying standardized functional tests – orthostatic, heating, cooling, venoarteriolar reflex, Valsalva maneuver, reactive hyperaemia, etc., for analyzing skin microvascular reactivity, which is a reproducible parameter of sympathetic vasomotor control. Disorders of autoregulation and autonomic function were established in occupationally induced distal autonomic neuropathy of the limbs, radiculopathies, neuropathies, polyneuropathies, secondary Raynaud’s phenomenon due to exposure to vibration, cold, overstrain, toxic agents, and electromagnetic fields in the conditions of work. In conclusion, LDF is a contemporary non-invasive easy to apply diagnostic tool. It investigates the blinded sphere in ultrasonography – microcirculation and its autoregulation. The method is valuable for objectifying microcirculatory and autonomic disorders in different occupational and environmental diseases, for their expertise and dynamic follow-up.

Key words: laser Doppler flowmetry, diagnostic tool, occupational diseases, microcirculation, autonomic disorders

2/2013

BACTERIAL SPECTRUM OF ETIOLOGY OF THE COMMUNITY-ACQUIRED RESPIRATORY INFECTIONS IN CHILDHOOD
AND ANTIMICROBIAL RESISTANCE

R. Gergova1, 2, P. Minchev3, M. Dikova4, S. Gergov5, C. Jurova6, 7, T. Ilieva1, 2 and I. Mitov1
1Department of Medical Microbiology, Medical University – Sofia,
2Diagnostic Medical Laboratory “Medirs”
3Clinic of Pediatric Pulmonology, University Hospital “Sv. Sofia”
4Pediatric Clinic, University Hospital of Orthopedy and Traumatology
5National Oncologic Medical Center
6Pediatric Department, Hospital of Pirdop
7Individual Medical Practice


Summary: The community-acquired respiratory infections among children are the most common reason for the morbidity and antimicrobial therapy in this age. Our research during fifteen years period considers the etiological structure of these infections and the growing resistance in the most common respiratory pathogens. We studied 4528 children aged 1-15 years who have treatment ambulatory or were hospitalized for community-acquired infections of upper (URTIs) or lower respiratory tract (LRTIs) in the period of 1997-2011. The samples from children were subjected to quantitative and qualitative microbiological examination for detection of the etiological bacterial agents. The antimicrobial resistance was determined by a diffusion disc method and minimal inhibitory concentrations (MICs) according criteria CLSI. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus were the most common bacterial pathogens in children with URTIs and LRTIs. Very often were isolated in polymicrobial combinations. Streptococcus pyogenes was the predominant bacterial pathogen in pharyngitis and tonsillitis. In recent years was observed the dramatic increasing resistance among each of these respiratory pathogens – beta-lactamase production in near 100% of isolates M. catarrhalis and S. aureus, macrolide resistance about 30% among all isolates S. pneumoniae, S. pyogenes and S. aureus. This study suggests that penicillins with inhibitor of beta-lactamase, including amoxicillin/clavulan acid, ampicillin/sulbactam and the some of third generation cephalosporins, still retain good activity against the major respiratory bacterial pathogens in childhood as: S. pneumoniae, H. influenzae, M. catarrhalis, S. pyogenes and S. aureus. The exploration of the etiology of the respiratory infections and the mechanisms of resistance among the most common respiratory pathogens can help in the correct choice of empiric antimicrobial therapy.

Key words: childhood, respiratory infections, etiology, antimicrobial therapy, resistance

A STUDY ON THE DYNAMICS OF THE EPIDEMIC PROCESS OF NOSOCOMIAL INFECTIONS IN PLEVEN DISTRICT
FOR THE PERIOD 2007-2012

S. Angelova, Ts. Mincheva, Y. Mitova, V. Doycheva and E. Edinakova
Department “Epidemiology”, Medical University – Sofia

Summary: Nosocomial infections (NIs) are one of the major causes of morbidity and mortality in modern society, not only in the developing, but also in developed countries. The NIs rate is different in hospitals, outpatient practices, medical facilities for extended medical care and homes for medical and social care for children (infant homes). The purpose of the present study is to outline the dynamics of the etiological structure, the percentage of the leading clinical forms, the level of etiological diagnosis, as well as the morbidity caused by NIs in the hospitals in Pleven District. The epidemiological analysis uses official data from the automated information system “Nosocomial infections”. The complex epidemiological method (also including the method of epidemiological analysis) has been employed to process the aforementioned data. For the period 2007-2012, the total morbidity caused by NIs in hospitals in Pleven was 13.3‰. 40% of the NIs were registered in the homes for medical care for children and 48% were recorded in high-risk units, mostly in the University Hospital. About 45% of the advertised nosocomial infections are micro-biologically unconfirmed. This group includes acute catarrh of the upper respiratory tract. More than 65% of nosocomial infections are caused by Gram-negative microorganisms, where the leading strains are E. coli – isolated annually in approximately 20% of the total number of micro-biologically documented infections.

Key words: nosocomial infections, medical facilities, etiological structure, common morbidity, structure in clinical localization

DISTRIBUTION OF Q-FEVER IN BULGARIA (1961-2012)
E. Edinakova1, Y. Mitova1, V. Dojcheva1, R. Filipova2 and S. Angelova1
1Department of Epidemiology, Medical University – Sofia
2Ministry of Health


Summary: Q-fever is an infectious zoonotic disease, caused by Coxiella burnetii, described for the first time in Bulgaria by A. Mitov in 1949. Over the past, more than 50 years in the country have been observed multiple sporadic cases and smaller or larger outbreaks, involving hundreds infected individuals. Incidence (per 100,000 population in Bulgaria) of Q fever in the periods from 1961 to 1980, 1981-2000 and 2001-2012 was accordingly from 0 to 1.5%ooo, from 0.01 to 5.64%ооо for the second period, and between 0,16%ооо and 3,74%ooo in recent years. Epidemiological studies shown cattle and sheep cattle as the main source of infection for Q-fever in humans in Bulgaria and leadership respiratory and alimentary (milk consumption) route of transmission. Severe endocarditis is the most common form of chronic Q-infection.

Key words: Q-fever, morbidity, forms of intensity of the epidemic process, areas of distribution

SURVEILLANCE OF FUNGEMIA IN A UNIVERSITY HOSPITAL: ETIOLOGICAL SPECTRUM AND ANTIFUNGAL SUSCEPTIBILITY
T. Stoeva, K. Bojkova and M. Bojkova
Department of Microbiology and Virology, Medical University – Varna

Summary: Aims: The study aim was to determine the rates of fungemia, the etiological spectrum of pathogenic fungi and their susceptibility to antifungal agents for the period 2007-2011 in the University Hospital “St. Marina” - Varna. Materials and methods: A total of 18 246 blood samples were tested, from which 38 non-duplicate isolates of Candida spp. and non-Candida spp. were isolated. The susceptibility to 5-fluorocytosine, amphotericin B, fluconazole and itraconazole was tested. Results: The rates of fungemia for the studied period are as follows: 0.02/1000 hospital admissions in 2007, 0.12 – in 2008, 0.044 – in 2009, 0.268 – in 2010, and 0.40 during 2011. C. albicans is the dominant species among all isolates (36.8%). Candida non-albicans are presented in 57.7%. Candida parapsilosis is the second most common species (28.9%), followed by Candida glabrata (21%). C. albicans is the most commonly isolated species (52.6%) among the isolates from the Intensive Care Units (ICUs). In the non-ICUs, the highest rates of isolation are detected for C. parapsilosis (42%) and C. glabrata (26.3%). The susceptibility of C. albicans to the tested agents is fully preserved. The resistance rates in C. non-albicans isolates to fluconazole is 7.1% (n = 1), to amphotericin B – 21.4% (n = 3); no isolates resistant to 5–fluorocytosine are detected. Conclusions: Constantly increasing rates of fungemia are found. The etiological spectrum is shifted to Candida non-albicans species with C. parapsilosis being the most common one. The activity of fluconazole stays high during the studied period both in the group of C. albicans and Candida non-albicans isolates.

Key words: fungemia, C. albicans, Candida non-albicans, fluconazole

PATIENT, HOSPITAL AND ORGAN TRANSPLANTATION
R. Krumova-Pesheva, L. Spasov and V. Milhaylova
University Hospital “Lozenets” – Sofia

Summary: To a certain extent organ transplantation is a new procedure in Bulgaria. It is the only alternative for treatment and life extension for a vast number of patients. Over the past years, liver and kidney transplantations are among the most important medical procedures in University Hospital “Lozenets”. The psychological work has a major role in all stages of the transplantation procedure. The psychological work consists of psychological evaluation and psychological consulting during the pre-transplantation period and psychotherapeutical work in the post-transplantation period. The goal of this paper was to address the specific difficulties and psychotraumatic moments to which the patients are exposed during the pre- and post- transplantation periods.

Key words: transplantation, psychotherapy

3/2013

TESTING AND PREMEDICATION IN SELECTED PATIENTS WITH ALLERGIES
IN THE STUDY WITH IODINATED CONTRAST MEDIA

L. Terziev, V. Tzvetkova-Vicheva, M. Nenova and C. Dardanova
Department of Allergology, University Multiprofile Hospital for Active Treatment “Dr. G. Stransky” – Pleven

Summary: Seventy-one patients, undergoing testing with ionic iodinated media were reported. They were divided into two groups: group I, which includes selected 51 patients with a history of drug allergy, and group II including 20 patients without such history, used as controls. All patients had skin-scarification sample with contrast media reported on the 20th minute. Six patients (11.8%) of the first group and one (5%) of the controls were tested positive. All of them were excluded from the study and offered alternative research methods. The rest patients received premedication between one and three days before the study, including the combined administration of a corticosteroid agent, and H-1 blocker, antihistamine. None of these patients developed adverse reaction to the used ionic iodine containing contrast media. We believe that a detailed history of pre-existing risk factors for adverse reactions to contrast media and pre-testing of patients with contrast medium will allow for the exclusion of risk and premedication with steroids and H-1 antihistamines will minimize the possible development of side reactions.

Key words: iodinated contrast media, testing, premedication
Address for correspondence: Lyudmil Terziev, MD, PhD, Medical University, 1 Kliment Ohridski St., Bg ― 5800 Pleven,
е-mail: luterzi@mail.bg

FLUORESCENCE SPECTROSCOPY IN DIAGNOSTICS OF SQUAMOUS CELL CARCINOMAS OF THE SKIN
E. Pavlova1, P. Troyanova2 and E. Borisova3
1Medical-Dental Center “Tsaritsa Yoanna – ISUL”
2University Multiprofile Hospital for Active Treatment “Tsaritsa Yoanna – ISUL”
3Institute of Electronics – Bulgarian Academy of Sciences


Summаry: Fluorescence spectroscopy is a modern diagnostic technique based on the fluorescence emission – the property of substances and tissues to emit light upon their excitation with light. Due to the altered metabolism of tumour cells and the specific concentrations of certain substances in the  tumour cells, their fluorescence spectra differ considerably from the fluorescence spectra of the healthy tissue. The purpose of this study is to analyze the possibilities for application of autofluorescence spectroscopy for diagnosis of squamous cell skin carcinomas (SCCs). This study included 37 cases of SCCs wherein spectral measurement was performed, and fluorescence spectra were determined. It compares the measured parameters characterizing the spectra of normal skin and basal cell carcinoma (BCC) as well. Analysis of the fluorescence spectra did not find any significant changes of the shape but there are changes of the intensity of the fluorescent signal of SCC relative to healthy skin and to BCC. SCCs, regardless of the degree of differentiation, are characterized by a high fluorescence intensity and a green light added peak. In SCCs there is a high intensity of fluorescent signal, even higher than that of the surrounding healthy skin. The obtained results show a statistically significant correlation between non-melanoma skin cancer and the characteristics of their fluorescence spectra. There are significant differences between the spectral characteristics of SCCs, of BCC and normal skin. Therefore, fluorescence spectroscopy can be used to diagnose SCCs and to distinguish them from the BCC.

Key words: fluorescence spectroscopy, autofluorescence spectra, squamous cell carcinoma, basal cell carcinoma
Address for correspondence: Assoc. Prof. P. Troyanova, DM, UMHAT “Tsaritsa Yoanna – ISUL“, 8 Byalo more St., Bg ―1527 Sofia,
tel.: +359 888 876 482,  fax: +359 2 9432144

DIAGNOSTIC VALUE OF SERUM ECP AS A MARKER OF ALLERGIC INFLAMMATION IN CHILDREN WITH RESPIRATORY ALLERGOSES
А. Spasova
Specialized Hospital for Active Treatment of Pulmonary Diseases "Sv. Sofia"

Summary: Early diagnosis and treatment are very important in children with allergic rhinitis (AR) in order to provide them with a higher life quality and to stop the progress of their illness to asthma. This study aimed to investigate the usefulness of determination of serum ECP levels in children with respiratory allergies. Materials and Methods: In our study 50 patients with rhinitis were divided into the following 3 groups: Group 1 (n = 15, 30%) included children with allergic rhinitis, Group 2 (n = 12, 24%) ― children with nonallergic rhinitis and group 3 (n = 23, 46%) ― nonallergic rhinitis with eosinophilia syndrome. Every subject underwent the serum ECP levels, skin prick test, eosinophil count in nasal smear and total IgE. Serum ECP levels were measured by the commercially available immunoassay technique (Pharmacia CAP). Results: Studies have indicated that patients with asthma and rhinitis had higher IgE values than those with rhinitis alone. No statistically significant difference was found between ECP levels in patients with rhinitis and rhinitis plus asthma groups, although mean ECP was higher in the latter group. We conclude that the extent of allergic inflammation in mucosal surfaces such as allergic rhinitis plus asthma, might influence serum ECP levels.

Key words: allergic rhinitis in children, asthma in children, bronchial hyperreactivity, bronchospasm
Address for correspondence: A. Spasova, SHATPD Sveta Sofia, 17 Acad. Iv. Geshov, Bg ― 1431 Sofia

LIVER HEMANGIOMAS – CLASSIFICATION
A. Taseva and V. Tasev
Department of General and Liver-Pancreatic Surgery,
University Multiprofile Hospital for Active Treatment “Alexandrovska”,
Medical University – Sofia


Summary: Hepatic haemangiomas are the most common benign hepatic tumours. The developing process of the imaging methods in recent years makes the diagnostic easier and more specific. This poses the question about the surgical treatment of liver haemangiomas in a more specific way. The absence of clear criteria for quality assessment of the pathological process makes the decision „What is the proper behaviour?” harder. The aim of the present study is to form, according to our experience,criteria for a clinical-anatomical classification, which could be helpful for making the decision for the type of treatment of liver haemangiomas. The analyses and the conclusions, that we made and suggest are based on the experience at the Department of General and Liver-Pancreatic Surgery, University hospital “Alexandrovska”, Sofia. The conclusions are based not only on our study for the period – January 1995 – March 2013, 101 patients, but also on the information from other authors. The suggested criteria have indexes and groups, respectively, which are united in a new classification system. The proposed classification is simple and gives a chance to systemize the clinical cases in one system. It is strongly connected to the indications for the treatment – conservatively or surgical.

Key words: haemangioma, liver, classification
Address for correspondence: Dr. Anna Taseva, Department of General and Liver-Pancreatic Surgery, UH “Alexandrovska” – Medical University, 52 "Pencho Slaveykov" blvd., Bg ― 1431 Sofia, tel.: +359 2 9230 262, e-mail: annnataseva85@gmail.com

CELLS ISOLATED AND CULTURED FROM GLIOBLASTOMA MULTIFORME POSSESS SIMILARITIES WITH MESENCHYMAL STEM CELLS
K. Tumangelova-Yuzeir1, Е. Naydenov3, E. Ivanova-Todorova1, Тs. Mladenova1, S. Nachev4,
M. Murdjeva2 and D. Kyurkchiev1

1Medico-Diagnostic Laboratory of Clinical Laboratory and Immunology, University Hospital “Sv. Ivan Rilski”, Department of Clinical Laboratory and Clinical Immunology, Medical University – Sofia
2Section of Molecular Immunology, Institute of Biology and Immunology of Reproduction,
Bulgarian Academy of Sciences
3Clinic of Neurosurgery; 4Laboratory of Clinical Pathology, University Multiprofile Hospital for Active Treatment
“Sv. Ivan Rilski”, Department of Neurosurgery, Medical University – Sofia


Summаry: Glioblastoma multiforme is the most common and aggressive brain tumour. Recent observations suggest that gliomas can originate from neural stem cell populations which can be transformed in cancer stem cells. These cancer stem cells are able to induce suppression in the immune system. Mesenchymal stem cells are multipotent fibroblast-like cells and they have the possibility of self-renewal and differentiation in mesodermal cell lines. It is also known that mesenchymal stem cells have immunosuppressive effect affecting not only the effector cells of the immune system, but also cells which are known as regulators of the immune response. Using methods for cell culturing, flowcytometry and ELISA our results demonstrated the similarities between mesenchymal stem cells and cellular cultures from glioblastoma regarding their marker expression and cytokine secretion which give us opportunity to speculate that the similarities regarding immunosuppressive function between both kinds of cells are also possible.

Key words: glioblastoma multiforme, immune regulation, mesenchymal stem cells, neural stem cells, cancer stem cells
Address for correspondence: Kalina Tumangelova-Yuzeir, MDL of Clinical laboratory and immunology, UMHAT “Sv. Ivan Rilski” , 15 Acad. Ivan Geshov St., 1431 Sofia, tel.: +359 2 8527046, e-mail: kullhem000@gmail.com


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