Clinical and echocardiographic features of scleroderma patients with pulmonary hypertension - 42, 2006, No 4, 44-47.
K. Yablanski(1) and Zl. Kolarov(2)
(1)Clinic of Rheumocardiology, Medical University - Pleven
(2)Clinic of Rheumatology, Medical University - Sofia
Summary: Pulmonary hypertension is recognized as an important complication of both limited and diffuse systemic sclerosis. It is difficult to treat and is associated with high mortality. Patients were classified as having secondary pulmonary hypertension (SPH) if there was evidence of pulmonary fibrosis. In the absence of this finding, the patients were classified as having isolated (primary) pulmonary hypertension РРН. The study included 69 patients (63 women and 6 men) with progressive systemic sclerosis. In the study, we found a prevalence of PPH of 5,8% and SPP of 17,4% among the patients. The prevalence of pulmonary hypertension in this patients cohort was similar to that of other catheter based studies. Methods based on the use of clinical examination and electrocardiography are insensitive in the detection of early stages of pulmonary hypertension.
Key words: pulmonary hypertension, systemic sclerosis
Address for correspondence: K. Yablanski, M. D., Clinic of Rheumocardiology, Medical University, 1, Kl. Ohridski Str., Bg 5800 Pleven
Overlapping neuropsychiatric manifestations in patients with systemic lupus erythematosus erythematosus – 42, 2006, No 4, 48-52.
Clinic of Rheumatology, Medical University – Sofia
Summary: The systemic disorders of the connective tissue are a heterogenous group of rheumatic diseases that may at certain developmental stage exhibit an overlap of clinical and laboratory manifestations. Different variants and degrees of overlap are possible – between the particular nosological entities as well as between the clinical manifestations associated with injury of some body system.In the present study, 162 patients with systemic lupus erythematosus were investigated, of whom 104 were with clinically manifested impairment of the nervous system and 58 had incomplete systemic lupus.A complex of investigation methods was used for diagnosing as well as for establishment of nervous system injuries. An overlap of neuropsychiatric manifestations was found in 93 (89,42%) of the patients with clinically manifested?nervous system involvement, and in 24 (41,38%) of the patients in the second group. In both groups, the cognitive and autonomous disorders mostly overlapped the other neuropsychiatric manifestations.
Key words: systemic lupus erythematosus, overlap syndromes, neuropsychiatric systemic lupus erythematosus
Address for correspondence: Simeon Monov, M.D., Clinic of Rheumatology, Medical University, 13, Urvitch Str., Bg 1612 Sofia, tel. +359 2 958-29-27
Secondary hemorrhagical complications in the myocardium in patients with acute myocardial infarction with ST segment elevation and the risk of mechanical heart complications – 42, 2006, No 4, 53-58.
J. Uzunangelov(1), T. Vesselinovà(2), R. Ivanova(2) and À.Velkovà(3)
(1)Clinic of Cardiology and Intensive Treatment, UMHAT – Pleven
(2)Centre of Common and Clinical Pathology, UMHAT – Pleven
(3)Department of Public Health, Medical University Pleven(3)
Summary: The aim of this study is to evaluate the frequency, clinical course and outcome in patients with STEMI, treated or not with thrombolysis (ÒRL) with proven at authopsy secondary hemorrhagical complications in the myocardium leading to cardiac rupture (ÑR). We analysed retrîspectively the data of 1440 patients with STEMI divided into 2 groups – treated or not with ÒRL. We followed up the patients with mechanical complications during the acute phase of the infarction from hospitalization to hospital discharge or to the appearance of infarct complications (operation or death). These data àre collected by clinical, non-invasive (2D-echocardiography) and pathoanathomical methods and calculated with standard statistical methods. We found mechanical complications in 8 (2.2%) of the patients with STEMI treated with ÒRL (n = 366). In the group without ÒRL (n = 1074), we detect similar complications in 14 patients (1.3%). Total mortality in the investigated groups was 14.9% (n = 214), ànd the mortality due to mechanical complications???95% (n = 21). The mechanical complications accounted for 8.9% of all deaths. One of the patients with SR treated surgically was alive at the end of the investigation. Secondary hemorrhagical complications in the myocardium were rare in patients with STEMI treated or not with ÒRL. Cardiac rupture in patients with STEMI and TRL was significant higher than in those without TRL. Using more frequent echocardiographic investigation in cases with pericardial effusion and hemodynamic unstability or repeated chest pain will help the physicians early to find CR and to treat the patients surgically.
Key words: acute myocardial infarction, thrombolysis, secondary hemorrhagical complications, cardiac rupture
Address for correspondence: Jordan Uzunangelov, M. D., Clinic of Cardiology and Intensive Treatment, UMHAT „Dr. Georgi Stranski”, Bg 5800 Pleven, tel./fax +359 64 886-227, e-mail: email@example.com
The ratio of early mitral flow velocity to flow propagation velocity E/Vp – prognostic index of heart failure development – 42, 2006, No 4, 59-62.
E. Kinova, N. Zlatareva and A. Goudev
Department of Cardiology, University Hospital “Tzaritza Ioanna” – Sofia
Summary: Left ventricular (LV) diastolic dysfunction is related to clinical signs and symptoms of heart failure and has prognostic value in heart diseases. The aim is to assess the relationship between LV diastolic function in acute phase of myocardial infarction (MI) and development of in-hospital heart failure using flow propagation velocity (Vp). Two-dimensional, PW- and color M-mode Doppler echocardiography were performed during 72 hours of a first MI in 119 patients. Patients were divided into two groups according to E/Vp ratio (early diastolic peak-E velocity to Vp ratio): group 1 – with E/Vp < 1.5 (35 patients) and group 2 – with E/Vp >= 1.5 (84 patients). During hospitalization, heart failure (Killip >= ІІ class) was followed-up. Sixty patients developed heart failure and 51 of them were from group 2. Multiple logistic regression analysis identified E/Vp ratio >= 1.5 (RR 4, CI 95% 1.6-9.9, p = 0.002) to be the most powerful independent predictor of development of in-hospital heart failure. The second predictor was Wall Motion Index = 1.7 (RR 2.5, CI 95% 1.1-5.5, p = 0.02). Conclusions: Е/Vр ratio >= 1.5 in the acute phase of MI is the best predictor of in-hospital congestive heart failure and allows early detection of patients at risk.
Key words: acute myocardial infarction, left ventricular diastolic function, heart failure, flow propagation velocity, echocardiography
Address for correspondence: E. Kinova, M. D., Department of Cardiology, University Hospital “Tzaritza Ioanna”, 8, Bialo more Str., Bg 1527 Sofia
Are metoprolol succinate with controlled release and metoprololtartrate retard in a dose ratio 1:2 equipotent regarding their antihypertensive effect? - 42, 2006, No 4, 63-65.
D. Raev(1), Ml. Grigorov(2), St. Milanov(3), M. Tsekova(4) and L. Mihov(5)
(1)MI-MIA Sofia, (2) ІІ МHAT - Sofia, (3)MHATEM “N. I. Pirogov” - Sofia, (4)MHAT - Pleven, (5)MHAT - St. Zagora
Summary: The study aimed at comparing the efficiency of two slow-release forms of metoprolol – 50 mg metoprolol succinate controlled release tablets (MSCR) and 100 mg metoprolol tartrate retard (MTR) regarding the 24-hour arterial blood pressure control (ABP) in patients with non-optimally controlled light or moderate essential hypertension treated with MSCR 50 mg (monotherapy or combined therapy). The observation was multi-centered, prospective, crossed, open, held with 78 (51 men) ambulatory patients, average age 48.2 +/- 7.2, ABP 147.4 +/- 8.4/95.0 +/- 4.3 mmHg and heart rate (HR) 78,5 +/- 8.1 b.p.m. Before beginning the observation, a 24-hour ambulatory blood pressure monitoring (ABPM) was made on basis of the regular therapy, including MSCR 50 mg/day; then MSCR 50 mg was substituted by MTR 100 mg daily for 8 weeks; at the end of the period a second ABPM was held. The ABP and HR 24 hours after the MTR 100 mg dose had considerably lower rates than the ones with MSCR 50 mg (138.9 +/- 7.0/86.6 +/- 5.6 mm Hg, compared to 147.4 +/- 8.4/95.0 +/- 4.3 mm Hg and 72.4 +/- 7.4 compared to 78.5 +/- 8.1 b.p.m., p < 0.001). During all time intervals (24-hour, day, night, morning and the last 4 hours of the dose period), MTR 100 mg realized a more significant reduction of ABP and HR compared to MSCR 50 mg. Regarding their antihypertensive effect, MSCR and MTR in a dose ratio 1:2 are not equipotent. Their effect on ABP and HR is dose-dependant. Our results show that even the better way of releasing the active substance (zero-order kinetics) cannot compensate the insufficient effect of its lower dose.
Key words: ambulatory blood pressure monitoring, metoprolol tartrate retard, metoprolol succinate controlled release
Address for correspondence: D. Raev, M. D., Medical Institute of Ministry of Internal Affairs, 79A Skobelev Blvd., Bg 1606 Sofia
Importance of the ECG phase at hospitalization for the prognosis of patients with acute myocardial infarction, treated without fibrinolysis – 42, 2006, No 4, 68-73.
Internal Diseases Clinic, University Hospital “Sv. Anna” – Sofia
Summary: A comparison has been made between the near and distant prognosis of patients with acute and sub-acute myocardial infarction with ST-elevation. Two groups of patients have been formed according to the ECG and clinical criteria. ECG group 1 is comprised of patients, hospitalized during the acute phase – with elevation of the ST-segment, without complete Q-waves, with positive biochemical markers for fresh myocardial necrosis, and time offset of less than 12 hours since the beginning of the infarction pain; ECG group 2 is comprised of patients in sub-acute phase: ECG with stretched image of MI but still positive or normalized biochemical characteristics for fresh myocardial necrosis. Offset from the beginning of infarction pain of more than 12 hours renders, the patients not eligible for fibrinolysis. The patients from both groups present without statistically significant difference regarding sex, age and heaviness of the risk profile for IHD, and they have been treated in like manner.
Key words: acute myocardial infarction, acute ECG phase, sub-acute ECG phase, pre-hospital delay, complications during acute phase, clinical decease rate, progression of IHD, distant survival rate
Address for correspondence: Tatyana Taseva, M. D., Internal Diseases Clinic, University Hospital “Sv. Anna”, 1, D. Mollov Str., Bg – Sofia, tel. +359 2 9759213, GSM +359 888 97 33 05, e-mail: firstname.lastname@example.org
Polymorphisms in the vitamin D-receptor gene and bone mineral density in men of Bulgarian population – 42, 2006, No 4, 74-80.
J. Ivanova(1), P. Doukova(1), M. Boyanov(2) and P. Popivanov(2)
(1)Chair of Clinical Laboratory and Clinical Immunology, University Hospital “Alexandrovska”, Medical University - Sofia
(2)Endocrinology Clinic, University Hospital “Alexandrovska”, Medical University???Sofia
Summary: Bone mineral density (BMD) is a major determinant of fracture risk. The gene for the vitamin D receptor (VDR) is the first one distinguished to contribute to BMD. Assessment of the association between BMD and FokI and BsmI polymorphisms in the VDR gene is performed in a case-control study on 74 unrelated men (30 controls and 44 cases with low BMD). BMD is measured at lumbar spine by DXA. PCR is used to amplify exon 2 and intron 8. PCR products are digested and electrophoresed through an agarose gel. The association we find between f allele (FokI) and B allele (BsmI) and low BMD confirm the contribution of the VDR gene to osteoporosis. The relative risk (RR) calculated for low BMD is higher for the BsmI marker (4,84) compared to the FokI marker (2,97). The etiological factor which reflects the association between the investigated polymorphisms and the illness on populational level is assessed as EF=0.53 for FokI marker and EF=0.69 for BsmI marker. On account of this, we conclude that the FokI and BsmI polymorphisms are closely related to low BMD at lumbar spine and both are useful genetic determinants of BMD and osteoporotic risk.
Key words: osteoporosis, low bone mineral density, biochemical markers of bone turnover, genetic markers, polymorphisms, vitamin D receptor
Address for correspondence: Mihail Boyanov, M.D., Endocrinology Clinic, University Hospital "Alexandrovska", 1, Sv. G. Sofiiski Str., Bg 1431 Sofia, tel. +359 2 9230 784, e-mail: email@example.com
Lipid profile, HOMA index and fibrinogen in healthy late postmenopausal women, treated with tibolone – 42, 2006, No 4, 81-86.
M. Todorova(1), Z. Kamenov(2) , V. Christov(2) and M. Baleva(3)
(1) Department of Pathophysiology, Medical University - Sofia
(2) Clinic of Endocrinology, Hospital “Alexandrovska”, Medical University - Sofia
(3) Clinic of Allergology, Hospital “Alexandrovska”, Medical University - Sofia
Summary: The aim of the study was to investigate glucose, lipid metabolism and fibrinogen in healthy postmenopausal women in the course of tibolone administration. Twenty seven clinically healthy postmenopausal women were included in the study and were divided into two groups: control group (n = 11, mean age 54.8 +/- 4.0 years) and a treatment group (n = 16, mean age 56.4 +/- 4.6 years) who were allocated to tibolone at a dose of 2.5 mg/d for 6 months. Both groups did not differ significantly in mean age, years of amenorrhea, BMI and BP. Lipid profile, fasting blood glucose (BG), immunoreactive insulin (IRI), HbA1c and HOMA index were determined at entry and on the sixth month. Fibrinogen was determined at baseline, 1, 3 and 6 months after treatment. Triglycerides (TG), VLDL-C and HDL-C significantly decreased in the tibolone group (p < 0.01 vs baseline) and (p < 0.05 vs controls). Total cholesterol (TC) and LDL-C remained unaffected. BG and HbA1c did not change, and both IRI and HOMA index significantly decreased at the sixth month (p < 0.05). Fibrinogen did not change during tibolone treatment. These data indicate that tibolone had beneficial effect on TG, VLDL and insulin sensitivity. It did not change fibrinogen. These favorable effects may counterbalance the adverse influence on HDL-C and tibolone may be considered a good alternative of HRT.
Key words: menopause, tibolone, lipids, HOMA index, inflammatory activity
Address for correspondence: Zdravko Kamenov, M. D., Clinic of Endocrinology, Alexandrovska Hospital, Medical University, 1, Sv. G. Sofiiski Str., Bg 1431 Sofia, tel. +359 2 9230 244, GSM +359 887 726683
Rosiglitazone in the treatment of type 2 diabetes mellitus – 42, 2006, No 4, 87-90.
Clinic of Endocrinology, Medical University - Plovdiv
Summary: The phenomenon of insulin resistance is observed in the majority of patients with type 2 diabetes. Great expectations in the treatment of type 2 diabetes have been entrusted in the glitazones, such as rosiglitazone (Avandia) that are aimed at decreasing insulin resistance. The aim of our study was do evaluate the efficacy of rosiglitazone as monotherapy and in combination with other antidiabetic drugs in patients with type 2 diabetes. We investigated 102 patients divided in four therapeutic groups: on rosiglitazone monotherapy, on combined treatment with rosiglitazone + metformin, rosiglitazone + sulphonylurea, rosiglitazone + acarbose. We observed а significant decrease in prandial glycaemia in the first group, followed by the groups on combined treatment with sulphonylurea and acarbose. The largest decrease of hemoglobin A1c levels (1.2%) was observed in patients on rosiglitazone + metformin. We also observed decrease in HDL-cholesterol and triglyceride levels, but these changes did not reach statistical significance. In conclusion, rosiglitazone, as monotherapy or in combination with the traditional oral antidiabetic medications, achieves the target goals in the treatment of type 2 diabetes.
Key words: type 2 diabetes mellitus, rosiglitazone, metformin, sulphonylurea, acarbose
Address for correspondence: Stefka Vladeva, MD, Clinic of Endocrinology, Medical University, 15a Vasil Aprilov Str., Bg???4000 Plovdiv, e-mail: firstname.lastname@example.org
Utility of homocysteine determination in cardiovascular disease: a randomized trial of folic acid effect on serum homocysteine levels – 42, 2006, No 4, 91-93.
I Boncheva, A. Stancheva, V. Koleva and K. Lazarova
University Hospital “Lozenetz” - Sofia
Summary: The results from a prospective study showed that serum homocysteine levels were significantly higher in men who died of ischaemic heart disease (IHD) than in men who survived. Thus lowering serum homocysteine with folic acid is expected to reduce mortality from IHD. The homocysteine reduction is known to be maximal at a folic acid dose of 1 mg/day but the effect of lower doses (relevant to food fortification) is unclear, particularly in diseased subjects. 114 patients with IHD were randomised to one of five doses of folic acid (0.2 mg, 0.4 mg, 0.6 mg, 0.8 mg, 1.0 mg per day) or placebo. Fasting blood samples for serum homocysteine and serum folate analysis were taken initially and after three months supplementation, and three months after folic acid was discontinued. Serum homocysteine was determined by a fluorescence polarization immunoassay (FPIA, AxSYM Homocysteine). Serum homocysteine decreased with increasing folic acid dose, up to a maximum of 0.8 mg folic acid/day when the homocysteine reduction was 3.07 mcmol/L (27 %) similar to the known effect of folic acid doses of 1 mg/day and above. The higher a person’s initial homocysteine level was the greater was the response to folic acid, but there was a statistically significant reduction in homocysteine regardless of the initial level. About 70% of the effect were attained with a dose of 0,4 mg/day but a dose of 0.8 mg/day was needed for full effect at low initial serum homocysteine levels. Serum folate increased approximately linearly (5,08 nmol/L for every 0.1 mg folic acid). Conclusion: A dose of 0.8 mg/day folic acid appears necessary to achieve the maximum reduction in serum homocysteine across the range of homocysteine levels in this patient population.
Key words: homocysteine, ischaemic heart disease, folic acid
Address for correspondence: Margarita Boncheva M.D., Phd, University Hospital Lozenetz, 1 Koziak Str.,Bg - Sofia 1407, e-mail: email@example.com
Experimental study for effects of 17-beta-estradiol on pituitary
T. Shumkova-Tucheva and N. Boyadjieva
Department of Pharmacology and Toxicology, Medical Faculty, Medical University – Sofia
Summary: Tumors of the pituitary are one of the most frequent tumors in the brain. The etiology of these tumors is not known. In vivo and in vitro experiments on pituitary of Wistar rats demonstrated that 17-beta-estradiol activates the proliferation of lactotropic cells and cause development of prolactinoma. The results also demonstrated that 17-beta-estradiol stimulates the secretion of prolactin from cultured pituitary cells. The data suggest that estrogens activate tumorogenesis in anterior pituitary of Wistar rats.
Key words: 17-beta-estradiol, pituitary, tumor
Address for correspondence: Teodora N. Shumkova, Medical Faculty, Medical University, 2, Zdrave Str., Bg 1431 Sofia, e-mail: firstname.lastname@example.org tel.: +359 887 349 268
Inhibitory effect of Bulgarian propolis on clinical isolates of Prevotella and Porphyromonas strains – 42, 2006, No 4, 98-102.
L. Boyanova(1) , R. Kolarov(2) , G. Gergova(1) and I. Mitov(1)
(1)Department of Microbiology, Medical University – Sofia
(2)University Hospital of Maxillo-Facial Surgery - Sofia
Summary: The aim of the study was to evaluate the effect of Bulgarian propolis (EEP, 30% ethanolic extract) on 25 Prevotella and Porphyromonas clinical strains. The strains were tested by both agar-well diffusion (wells, 7 mm diameter) and disk-diffusion (disk diameter, 6 mm) methods. Most (88%) of the strains were inhibited by 30 mcL propolis extract per well and almost all strains (96%) were inhibited by 90 mcL propolis extract per well. Propolis extract was significantly more active than the solvent of ethanol (P < 0.02). By 30 mcL extract per well, the mean inhibitory diameter of the strains was 11.7 mm, and that by 90 mcL was 15.2 mm, respectively. Mean inhibitory diameters of the strains by 30 and 90 mcL ethanol were only 8 and 8.3 mm. Moist propolis disks inhibited 23 (92%) of the strains. The propolis exhibited some activity against a multi-drug resistant Prevotella oralis strain. In conclusion, the propolis extract was highly active against most strains of the genera Prevotella and Porphyromonas. The results could focus on a higher interest in the use of the Bulgarian propolis for prophylaxis or supplementary treatment of some anaerobic infections, e.g. oral and orofacial infections, involving anaerobes from the genera Prevotella and Porphyromonas.
Key words: anaerobic bacteria, Prevotella, Porphyromonas, propolis, inhibition, activity
Address for correspondence: Assoc. Prof. Ludmila Boyanova, Department of Microbiology, Medical University, 2 Zdrave, Str., Bg - 1431 Sofia, tel. +359 2 91-72-730, e-mail: email@example.com
Comparison of clinical laboratory parameters performed by two clinical chemistry analyzers – 42, 2006, No 4, 103-105.
P. Jordanova-Laleva(1) , A. Ruseva(1) , V. Petkova(1) , A. Velkova(2) and I. Gencheva(1)
(1)Clinical Laboratory, University Hospital ”G. Stranski - ”Pleven
(2)Faculty of Public Health, Medical University - Pleven
Summary: Biochemical investigations of enzymes ASAT, ALAT, AP, GGT, CK and substrates urea, creatinine, total protein, albumin, cholesterol, triglycerides, glucose and total bilirubin, performed on biochemical analyser Pentra 400, are compared to those performed on the analyser Cobas Integra 400. Fifty serums for each parameter were assayed with reagentsand materials provided by the producers of the two systems, respectively Horiba ABX and Roche Diagnostics. The CV and Bias values of the utilized control materials of both analysers for the month in which the analysis was performed are presented. The correlation coefficients for all parameters showed a significant correlation, r > 0.9. This makes it possible to perform and observe the laboratory tests of each patient regardless of the biochemistry analyser used.
Key words: clinical laboratory parameters: enzymes, substrates; biochemical analyzers: Pentra 400, Cobas Integra 400
Address for correspondence: P. Jordanova-Laleva, M. D., Clinical Laboratory, University Hospital "G. Stranski", Bg - 5800 Pleven
HISTORY OF MEDICINE
Rene Laennec (1781 - 1826): a prominent physician and pathologist – 42, 2006, No 4, 112-116.
D. Paskalev(1), A. Kircheva(2) and D. Radoynova(3)
(1)Clinic of Nephrology and Dialysis, University Hospital “Sv. Marina” - Varna
(2)Department of Clinical Epidemiology, Multi-Profile Hospital for Active Therapy “Sv. Anna” – Varna
(3)Chair of Forensic Medicine, University Hospital “Sv. Marina” - Varna
Summary: Rene Laennecwas born in Quimper, in Brittany, in the far west of France, on February 17, 1781, in the family of lawyer. His mother died of tuberculosis when he was a few years old. The young Renе was placed in the care of his uncle, Guillaume Laennec, a physician in Nantes. In 1795, Rene Laennec began his study in medicine under his uncle in a hospital in Nantes. In 1801, he went to Paris in order to contunue his medical education at L’Ecole de Medicine. There his teacher was Jean-Nicolas Corvisart, the physician who revived Auenbrugger’s technique of percussion (described in 1761). In 1803, R. Laennec made a classical description of atrophic cirrhosis of the liver. Between 1803 and 1804, after more than a thousand autopsies, he was able to bring great order to the contemporary clinical thinking about the tuberculosis. Laennec demonstrated that tubercles serving as typical pathological lesions of the disease could be find in every tissue of the body. Laennec pointed out also that the term “phthisis pulmonum”, often applied to an undifferentiated group of pulmonary diseases, was in fact tuberculosis of the lungs. In 1816, he invented a new instrument called “stethoscope” for the purpose of auscultation of the heart and the lungs. Using the stethoscope in the clinical practice, Laennec described many pulmonary symptoms such as rales, pectoriloquy and egophony. He also described cardiac sounds and murmurs. In 1819, Laennec published his famous book “Trate de l’auscultation mediate”. In 1826, he died of tuberculosis.
Key words: history of medicine, Rene Laennec, stethoscope
Address for correspondence: Assoc. Prof. Dobrin Paskalev, MD, PhD, Clinic of Nephrology and Dialysis, University Hospital “Sv. Marina”, Medical University, 55, Marin Drinov Str., Bg - 9002 Varna, tel. +359 52 302 851, ext. 296, e-mail: firstname.lastname@example.org
revascularization in conditions of "beating heart" - 42, 2006, No 3, 32-36.
L. Spasov, V. Pushev
and G. Georgiev
University Hospital "Lozenets" - Sofia
Summary: The complications observed in the coronary bypass operations
under conditions of extracorporeal circulation (EC) prompt the authors
to adopt the coronary revascularizations on "beating heart"
without EC. In the period May 2000 - December 2004, the authors made 151
coronary revascularizations on "beating heart". They emphasize
the low diagnostic value of EKG in patients at rest. Of greatest significance
are the selective coronarography, echocardiography
and exercise-test. The authors consider the indications and contra-indications
for coronary operations under the conditions of "beating heart".
The technical problems facilitating the operative intervention are considered:
undulating sternotomy, mechanical stabilization of the heart ventricles,
fixing the electrodes for electrostimulation,
endoscope techniques for taking the autovenous
grapht. Intraoperatively, in 19
patients the operation of "beating heart" without EC had to
be changed by operation with EC. Coronary operations without EC under
conditions of "beating heart" are followed by an easier postoperative
period, lesser need of hemotransfusion, early
extubation, fewer postoperative complications
and lowering of the postoperative lethality to 2.17%.
Key words: coronary surgery, conditions of beating
heart, operative techniques, postoperative period, complications, mortality
Address for correspondence: Lubomir Spasov, M. D., University Hospital "Lozenets",
1, Koziak Str., Bg
- 1407 Sofia, e-mail: email@example.com
between angiographic coronary lesion morphology and different clinical
manifestation in patients with angina - 42, 2006, No 3, 37-42.
I. Manoukov(1), J. Jorgova(1) and A. Djurdjev(2)
of Invasive Cardiology, University Hospital "Sveti
of Cardiology, University Hospital "Sveti
Summary: Patients with acute coronary syndromes often have complex
morphology of coronary stenoses at angiography.
We evaluated the association between different qualitative angiographic
types of coronary stenoses and clinical forms
of angina. A total of 112 patients with single vessel coronary artery
disease were divided into two groups: a control group with simple coronary
stenosis (n = 46) and a group with complex coronary stenosis (n = 66). Qualitative analysis of coronary angiograms
was performed using a modified Ambrose classification. Both groups were
compared according to the manifestation and distribution of different
clinical forms of angina. Both groups have similar severity of coronary
stenoses (79.8% +/- 10.7% vs. 82.7% +/- 8.2%, > 0.1). The
extent of effort angina was similar between the groups (89.47% +/- 4.97%
vs. 91.67% +/- 3.56%), but the amount of cases with variable threshold
of angina was higher in the group with complex stenosis.
There was a prevalence of rest angina, angina after emotion, as well as
at cold or wind exposure in the group with complex stenosis.
The coronary stenosis complex morphology is
associated mainly with stable angina modified by vascular spasm, and thus
provoked by mental stress, cold or wind exposure, as well as rest angina.
Key words: angina, vascular spasm, complex stenosis, Ambrose classification
Address for correspondence:
Clinic of Invasive Cardiology, University Hospital "Sveti
Georgi", 66, Peshtersko
shose Blvd., fl. 8, Bg - 4000 Plovdiv,
tel. +359 32 602925 , GSM +359 888 986 892, 5-mail: firstname.lastname@example.org
stroke in patients with acute myocardial infarction with ST segment 5levation and thrombolytic treatment - 42, 2006, No 3, 42-46
J. Uzunangelov(1), P. Tzvetanov(2) and A. Velkova(3)
of Cardiology and Intensive Treatment, UMHAT Pleven
(2)IIrd Clinic of Neurology, UMHAT Pleven
of Health Management, Medical University - Pleven
Summary: The aim of this study is to estimate the frequency of
the haemorrhagic stroke in patients with STEMI who underwent treatment
with thrombolytic agents, and to analyse the
most important risk factors. The current retrospective study comprises
1440 patients with STEMI (mean age 61 +/- 11; 34-81; 985 males) admited to ICCU 0t the Clinic of
cardiology of UMHAT Pleven during the last 6
years (2000-2005). Diagnosis haemorrhagic stroke was established by clinical
and CSF examination and confirmed by CT scan. Brain haemorhage
in the acute phase of myocardial infarction was observed in 6 patients
(0,4%), 4 underwent TRL (1,0%) and 2 without TRL (0,2%). Haemorhagic strokes were most frequent in patients taken rPA - 2 (1.2%), rarely in these with
Streptokinase - 1 (1%) and tPA
- 1 (0.75%). The mean age was significantly higher
in patients with haemorhagic stroke compared
with those without stroke (p < 0.001); they had more frequent high
blood pressure at hospital admission (p < 0.01) as well as low levels
of fibrinogen (p < 0.05). Fatal outcome was found in 4 patients (66,7%). The frequency of haemorhagic
stroke in patients with STEMI treated with TRL is rare. The more frequent
risk factors for this complication are not assotiated
as much with the presence of high blood pressure, as with prolonged 0PTT, low levels of serum fibrinogen and their combination.
Key words: acute myocardial infarction, thrombolysis, haemorrhagic stroke
Address for correspondence: Jordan Uzunangelov,
M. D., Clinic of Cardiology and Intensive Treatment, UMHAT "Dr. Georgi Stranski", Bg - 5800 Pleven, tel./fax +359
64 886-227, 5-mail: email@example.com
control in urban and rural populations of Varna region - 42, 2006, No 3, 47-51.
K. Dokova(1), K. Stoeva(1), N. Feschieva(1), Ph. Kirov(2), S. Petrova(3), J. Jotov(2), A. Sanz(4) and J. Powles(5)
of Social Medicine and Healthcare Organization, MU - Varna
Hospital "Sv. Marina" - Varna
Healthcare Centre - Sofia
of Preventive Medicine and Public Health, University of the Basque Country
- Bilbao, Spain
of Public Health and Primary Care, Institute of Public Health - Cambridge,
Summary: Few studies have reported on the effectiveness
hypertension control in Bulgaria. 80 rural and 80 urban residents aged
from 45 to 74 took part in the study. Blood pressure was measured with
a standard mercury sphygmomanometer in the subjects' home twice daily
in 2 cycles (in the winter and in the summer) each lasting 8 days. Hypertension
was defined as a mean systolic blood pressure (SBP) higher than 140 mm
Hg or a mean diastolic blood pressure (DBP) higher than 90 mm Hg or verified
drug treatment for hypertension. Hypertensives
were classified as "aware", "treated" or "controlled",
if mean pressure values were below 140/90 mm Hg. Urban women had the best
experience of hypertension control while rural men had the worst. Of 41
women 30 were hypertensive and of these 29 were "aware", 28
were "treated" and 15 were controlled. Among rural men, 30 of
37 were hypertensive and of these, 23 were "aware", 18 were
"treated" but none were controlled. The effectiveness of blood
pressure control is poor - especially in the rural areas where stroke
risks are highest. Development of strategies to improve the cost-effectiveness
of hypertension control is a public health priority in Bulgaria.
words: hypertension, awareness, treatment, control, Bulgaria
Address for correspondence: Klara Dokova, M. D., Department of Social Medicine and Healthcare
Organization, Medical University, 55, M. Drinov
Str., Bg - 9002 Varna
circumference - predictor of insulin sensitivity in patients with type
2 diabetes mellitus - 42, 2006, No 3, 52-57.
Clinical Center of Endocrinology, Medical University - Sofia
Summary: Aim of the present study was to establish easily applicable
in clinical practice predictor of insulin sensitivity, determining highest
percent of it's variance in patients with type 2 diabetes mellitus. 63 patients of
mean age 52 +/- 8.7 yrs., with good glycaemic
control of glycosylated hemoglobin
(HbA1c) 6.38 +/- 0.58%, participated in the study. The diabetic men were
with the following anthropometric parameters: BMI 28.86 +/- 4.94 kg/m(2), waist circumference (WC) 101.5 +/- 13.6 cm and the diabetic
women were with BMI 33.81 +/- 6.53 kg/m(2), WC 102.1 +/- 15.8 cm. Insulin
sensitivity (IS) was measured with a manual hyperinsulinaemic
euglycaemic clamp technique and expressed as
an amount of glucose utilized by the tissues, mainly skeletal muscles
(M). Statistical analysis included analysis of variance, Pearson correlation
analysis with p value = 0.05 considered significant and multiple linear
regression analysis. The diabetic men with visceral obesity according
to the WC >/= 102 cm were characterized by a significantly lower IS
(M) - 2.371 +/- 1.370 in comparison to that of men without visceral obesity
- M 6.703 +/- 3.386 mg/kg/min, p < 0.001.The diabetic women with visceral
obesity according to the WC ³ 88 cm were characterized by a significantly lower IS (M) - 2.834 +/-
1.453 in comparison to that of women without visceral obesity - M 5.514
+/- 1.678 mg/kg/min, p < 0.01. They were also notified by a significantly
higher level of uric acid and arterial blood pressure. The waist circumference
was an independent predictor of IS in female sex, determining 50.5% of
it's variance. Independent predictors of insulin sensitivity
in male sex were waist circumference and diastolic blood pressure, defining
60.4% of it's variance. In conclusion, waist
circumference is an easily applicable in clinical practice predictor of
insulin sensitivity. The simple measurement of waist circumference would
be useful to the physicians for screening and early treatment of the patients
with insulin resistance.
Key words: type 2 diabetes mellitus, insulin
resistance, waist circumference, visceral obesity, cardiovascular risk
Address for correspondence:
Petya Kamenova, M.
D., Clinical Center of Endocrinology, 6, D.
Gruev str., Bg -1303 Sofia, e-mail: firstname.lastname@example.org
study and changes of lymphocyte receptors in patients with acute exogenous
intoxications - 42, 2006, No 3, 58-61.
J. Radenkova-Saeva(1) and A. Mihova(2)
Hospital "N. I. Pirogov", (2)NCIPD -
Summary: The authors have carried out a study on somatic damages and changes
of lymphocyte receptors/markers in a group of patients with acute heroin
poisoning and associated with other psychoactive substanses
intoxications. The study involved 7 patients (5 men and 2 women), long-standing
heroin abusers, treated in the Clinic of Toxicology, MHATEM "N.
I. Pirogov", Sofia. Clinical studies
revealed polyorganic damages and post-intoxication complications. By
laser flowcytometry with monoclonal antibodies,
CD markers of the basic lymphocyte populations and subpopulations were
determined. The study of the lymphocyte receptors demonstrated a decreased
level of NK cells (CD3- CD56+), as well as tendency to a decreased level
of T-helper lymphocyte population (CD3+ CD4+). The data show, that the
immune system is sensitive to psychoactive substances, including opiates.
It is possible that the immune system is included in the pathogenesis
of polyorganic damages.
Key words: heroin, psychoactive substances, lymphocyte
Address for correspondence: J. Radenkova-Saeva,
M. D., Clinic of Toxicology, MHATEM "N. I.
Pirogov", 21, Totleben
Blvd., Bg - 1606 Sofia, tel. +359 2 91-54-346,
cell cycle and malignant melanoma - 42, 2006, No 3, 62-71.
3), N. Tsankov(2) and C. E. Orfanos(1)
of Dermatology and Allergy, Skin Cancer Cente,
Charite-Universitaetsmedizin, Campus Benjamin Franklin, Berlin
of Dermatology and Venereology, University Hospital Alexandrovska,
of Dermatology and Immunology, Municipal Hospital Dessau,
Academic Educational Hospital of the Martin-Luther-University, Halle-Wittenberg, Germany
Summary: Apoptosis is a form of programmed cell death with typical
morphological signs. It has an important role in physiological conditions
during the embryonic period for supporting the cell homeostasis. Apoptosis
is regulated by many genes and gene products which are in complicated
interrelations. In malignant melanoma, there is a disturbed cell control
because of reduced apoptosis and uncontrolled cell proliferation. Immunohistological investigations in melanoma determine decreased
or increased expression of proapoptotic proteins
like Bax and Bak in
correlation with the stage of tumor growth.
Occurrence and progress of malignant melanoma are connected with genetic
changes in the processes of apoptosis and proliferation. Beside the main
suppressor genes p53 and p16, the proteins Rb,
p21 and p27 participate in the disturbed regulation of the cell cycle.
The immunohistochemical determination of the
expression of inhibitors and regulators of cell cycle in malignant melanoma
is of considerable meaning for the prognosis of the disease. The processes
of tumorigenesis, programmed cell death (apoptosis),
and the control of cell cycle are intertwined in a "disentangled
net" and cannot be considered separately. The simultaneous immunohistochemical
examination of a larger number of marker molecules characterizing these
processes (programmed cell death, cell cycle) provides more precise information
compared to the detection of 1 or 2 markers in a larger number of patients.
Key words: apoptosis, cell cycle, malignant melanoma,
tumor growth regulation
Address for correspondence: Georgi Tchernev, M.D., Department
of Dermatology and Immunology, Municipal Hospital, Academic Educational
Hospital of the Martin-Luther-University, Halle-Wittenberg,
Auenweg 38, 06847 Dessau,
tel. 0049 340 501 4050/4056, 5-mail: email@example.com
of the apolipoprotein E epsilon4 allele on the efficacy of donepezil in the treatment of Alzheimer's disease - 42, 2006, No 3, 72-75.
L. Traykov(1, 2), F. Latour(2), F. Moulin(2) and A-S. Rigaud(2)
of Neurology, University Hospital "Alexandrovska",
Medical University - Sofia
(2)Broca Hospital, Paris - France
Summary: In the past ten years or so, there have been several advances
in the therapy of Alzheimer's disease (AD) and some medications are already
available to produce some symptomatic improvements in selected patients.
From all data available, it became evident that certain patients respond
better to the treatment than others. However, factors that can predict
a response to acetylcholinesterase (AChE) inhibitors have not been yet established. Some authors
showed a negative effect of the apolipoprotein
(ApoE) epsilon4 allele on the response to acetylcholinesterase inhibitors, while others did not. Our
objective was to evaluate the effects of the E (ApoE)
genotype and gender on the response to donepezil
treatment in AD. We analysed the ApoE genotype
of 86 mild to moderate AD patients who took part in a 36-week open label
trial of donepezil therapy. Patients were treated blindly in relation
to ApoE phenotype with incremental donepezil dosages. The cut-off point for being considered
a responder to treatment was a 4-point decrease in the ADAS-Cog score.
The results clearly show lack of tendency for the epsilon4- carriers to
respond better than the epsilon4+ carriers. When patients were stratified
by gender, no differences were found between the effects of the treatment
on men and women. In conclusion, the results of the present work do not
support the hypothesis that the ApoE phenotype
and gender are predictors of the response to AChE
inhibitors in AD patients.
Key words: Alzheimer's disease, dementia, apolipoprotein E, epsilon4 allele, donepezil
Address for correspondence: Assoc.
Prof. Latchezar Traykov,
M. D., Clinic of Neurology, University Hospital "Alexandrovska",
1 "Sv. G. Sofiski"
Str., Bg - 1431 Sofia, e-mail: firstname.lastname@example.org
in orbital fracture reconstruction - 42, 2006, No 3, 76-79.
Central Clinic - Augsburg, Germany
Summary: Orbital fractures take a highly significant share in facial
traumatism, especially after the introduction of a series of extreme kinds
of sport. Among 3438 patients treated for a 6-year period, we observed
554 cases of orbital fractures comprising 12% of the total number of patients.
Improper reposition of these fractures may lead to significant deformities
occurring after incorrect adaptation of fragments and leading later on
to very unpleasant esthetic defects in the area
of the facial skeleton. This from the very beginning made us use new osteosynthetic
means for reconstruction of the fractures before callus formation.
Key words: orbital fractures, reposition, osteosynthesis
Address for correspondence: E. Zenev,
M. D., Central Clinic - Augsburg, Germany
bacteriology in 55 patients with cellulitis
of the mouth floor - 42, 2006, No 3, 80-85.
L. Boyanova(1), R. Kolarov(2), E. Deliverska(2), G. Gergova(1), P. Sapundjiev(2),
J. Madjarov(2), M. Marinov(2) and I. Mitov(1)
of Microbiology, Medical University - Sofia
Hospital of Maxillo-Facial Surgery - Sofia
Summary: The aim of the study was to evaluate the prevalence of
anaerobes in 55 patients with cellulitis of
the mouth floor as well as the susceptibility of the isolates to penicillins (amoxicillin), clindamycin,
ampicillin/sulbactam and metronidazole.
Isolates were identified by Crystal anaerobes identification system, API
System rapid ID 32A, and routine methods. Totally 93 strains of anaerobic
bacteria were found in 81.8% of all patients with approximately 2.1 anaerobic
isolates per positive specimen. The predominant isolates were Prevotella
(32), Eubacterium (11), Actinomyces
(10), Fusobacterium species (8) and Gram-positive
anaerobic cocci (7). Three B. fragilis
group strains were detected (in 5.4% of all specimens) and one Clostridium
tertium was found in one case. All anaerobic isolates were
susceptible to ampicillin/sulbactam. Metronidazole, clindamycin and penicillin
were active against 100, 85 and 67.4% of Gram-negative strains and 41.5,
90 and 87.8% of Gram-positive anaerobes respectively. Low rate of double
resistance to penicillins + metronidazole
was found in 3.2% of all strains. The results highlight the role of anaerobic
microbiology in cases of deep-space head and neck infections. The involvement
of B. fragilis group in severe orofacial
infections should be considered.
Key words: cellulitis
of the mouth floor, anaerobic, susceptibility, incidence
Address for correspondenAe: Assoc. Prof.
Ludmila Boyanova, M. D., Department
of Microbiology, Medical University, 2, Zdrave
Str., Bg - 1431 Sofia,
tel. +359 2 91-72-730, e-mail: email@example.com
image and prognosis of the pneumoconioses in
fundamental industries in Bulgaria - 42, 2006, No 3, 86-90.
E. Petrova and Ch. Nachev
Center of Occupational Diseases, Medical University - Sofia
Summary: The object of the study were the lung X-ray
findings and lung diseases in 480 quartz exposed miners and 120 asbestos
exposed workers. We have used the ILO-80 radiological classification for x-ray findings assessment and for
dust diseases diagnostics. The X-ray findings were assessed in 28 individuals
of non exposed control group. The nestled screening cross sectional
case control study, including posterior-anterior chest radiographs and
summarizing of information for dust exposure levels in work environment
air were done. The software SPSS was used, and Pearson Chi-Squar5,
Likelihood Ratio and significance ( ) were calculated. 16 cases with @1/1
initial silicosis from mane mines in Bulgaria due to quartz
dust exposure, 4 @1/1 mixed pneumoconiosis from KZM "Plovdiv",
43 manifested asbestoses from the Steam power plant, and from production
of the asbestos brakes with average exposure length 16 y. and 17 y. average
latency were detected. 15 were the cases with asbestos induced pleural
fibrosis and asbestos pleural plaques; 90, resp.
116 were the boundary pneumoconioses @0/1 and
@1/0. 36, resp. 30 were s0/1-s and the t0/1 boundary asbestoses. The
asbestos induced pleural fibrosis, fibrous and calcified plaques predominated.
The high dust levels in the mines,and
the asbestos exposure, as well as the dose/effect studies, and the dynamics
of the dust lung diseases allow to prognosticate a growth of the silicosis
incidence, as well as of asbestosis and asbestos induced pleural diseases
in the future 10-15-20 years.
Key words: dust, ILO-80,
chest radiography, silicosis, asbestosis, mixed pneumoconiosis
Address for correspondence:
Assoc. Prof. Elisaveta Petrova,
M. D., Clinic of Occupational Diseases, University Hospital "Sv. Ivan Rilski",
15 Akad. Ivan Geshov
Blvd., Bg - 1431 Sofia,
growth factor-beta1 in pleural empyema progression
- experimental study - 42, 2006, No 3, 91-95.
I. Novakov(1), G. Ivanov(2) and V. Hodgev(3)
of Thoraco-Abdominal Surgery, Medical University
of General and Clinical Pathology, Medical University -
of Pulmonology, Medical University - Plovdiv
Summary: Pleural empyema progresses into three phases
acute (exudative), transitional (fibrinopurulent)
and chronic (phase of organization). The final result of empyema
progression is development of fibrothorax. It
is thought, that the process of pleural fibrosis is stimulated by transforming
growth factor-beta1 (TGF-beta1). It is a cytokine and an important mediator
of inflammation and angiogenesis. The aim of our study was to demonstrate
the role of TGF-beta1 in empyema progression
and development of pleural fibrosis. Our hypothesis was that TGF-beta1
levels in effusion correlate with the degree of fibroblast proliferation,
increased collagen production and pleural visceral thickness. It was used
a model of empyema in rabbits. TGF-beta1-levels were measured on days
2nd, 4th, 6th and 8th. Cell-surface localization of TGF-beta1 was determined
by immunohistochemistry staining. TGF-beta1
levels in pleural effusion correlated with fibroblast count in empyema
progression. TGF-b1 is localized on macrophages. In conclusion, TGF-beta1
is responsible for empyema progrresoin
and development of pleural fibrosis.
Key words: empyema,
pleural fibrosis, cytokines, transforming growth factor-beta1
Address for correspondence: Ivan
Novakov, M. D., Department of Thoracoabdominal
Surgery, Medical University, 54 "Petrova
Bg - 4004 Plovdiv,
DISCUSSIONS IN SCIENCE
Milchev. Therapeutic cloning
or umbilical cord blood banking - 42, 2006,
- 3, 103-105.
in Medicine and Biotechnology: Eureth.net
- European Information Network
provides practical assistance for Bulgarian health professionals - 42, 2006, No 3, 106-109.
Zh. Surcheva(1), I. Alexandrov(1), L. Tacheva(1) and S. Tomova(2)
Medical Library, MU - Sofia
(2)Rectorate, MU -
Summary: An overview was made on the structure and basic functions
of the Eureth.net - Euroethics Information Network
"Ethics in Medicine and Biotechnology".
Short instructions for searching in the database Euroethics
are given. A representation of the Bulgarian web-site - a part of the
project - and it elements, are given too.
Key words: bioethics, medical ethics, databases
-organization and administration; documentation - standards, internet,
interdisciplinary communication, international cooperation
Address for correspondence: Zh. Surcheva, Central Medical Library, Medical University- Sofia, 1, "Sv.
G. Sofiiski" Str., Bg 1431, Sofia, tel. +359 2 952-62-60; e-mail: firstname.lastname@example.org
for evaluation of primary information in Bulgarian medical web-sites - 42, 2006, 3, 110-115.
J. Vinarova, P. Pencheva
and I. Penjurov
Department of Biomedical Sciences, NBU Sofia
Summary: In the course of time Internet acquires leading significance
as a mass media between the professional users, because it is the most
powerful information source for references and research needs. Leaded
by the ambition to propose a standardized method for content evaluation
of the Bulgarian health and medical sites, we would like to present an
original tool, which is influenced by a well-adopted and good working
standard and it's completely conformable to the Bulgarian conditions and
Key words: medical information, web site evaluation,
Internet-searching, reference investigation
Address for correspondence: J. Vinarova, Department "Biomedical sciences", NBU,
21 Montevideo Str., Bg
- 1618, Sofia, e-mail: email@example.com
between forearm bone mineral density and body composition - 42, 2006, № 2, 53-57.
Endocrinology Clinic, University Hospital “Alexandrovska”,
Medical University Sofia
Summary: Bone mineral density (BMD) is the major determinant
of fracture risk. The idea to predict BMD from body weight seems very
attractive. We conducted a bone densitometry study including 78 female
patients (52 were menopausal) aged 30-65 years. BMD was measured at the
distal and ultra-distal forearm by dual X-ray absorptiometry (Hologic QDR 4500
A). Body composition (fat mass, fat-free mass and total body water) was
measured by bio-impedance on a Tanita TBF-215
device. BMD and age-matched Z-score data as dependent variables were then
regressed on weight and body composition indices as dependent variables.
In the majority of cases, we did not find any model.
When a model was found, it was quadratic or linear with a low correlation
R (R < 0,40) and statistical significance
(p > 0,05). For practical purposes, a model including body weight might be sufficient. In conclusion,
it is impossible to screen patients at risk of forearm osteoporosis based
solely on body weight. More sophisticated models including other important
risk factors are needed.
Key words: forearm
bone densitometry, body weight, body composition,
Address for correspondence: Mihail
Boyanov, M. D., Endocrinology Clinic, Alexandrovska
Hospital, 1, G. Sofiiski Str., Bg 1431 Sofia, tel. +359 2 9230-528, e-mail: firstname.lastname@example.org
diagnostic methods for community acquired pneumonia caused by Chlamidophila
- 42, 2006, № 2, 58-60.
T. Kantardjiev, N. Braneova,
E. Dobreva, S. Panaiotov
and V. Levterova
Department of Microbiology, NCIPD Sofia
Summary: C. pneumoniae and M. pneumoniae cause
acute respiratory tract infections such as atypical community-acquired
pneumonia, chronic bronchitis, asthma and less frequently upper respiratory
tract infections. The investigation presents the application of modern
methods for detection of C. pneumoniae and M. pneumoniae in
respiratory tract specimens, based on species-specific omp1 and P1 genes.
All clinical specimens were examined with PCR method. Epidemic outbreaks
among children in Kliuch village (2002) and
town of Pavlikeni (2005) of atypical pneumonia caused by M. pneumoniae
were confirmed. The positive results were obtained from nasopharyngeal
specimens and sputums. The PCR methods have high specificity and sensibility
and can be used as reliable methods in the routine laboratory diagnostics
for C. pneumoniae and M. pneumoniae.
Key words: Chlamydophila
pneumoniae, Mycoplasma pneumoniae,
acquired community pneumonia, PCR
Address for correspondence: Nadia Brankova,
Department of Microbiology, NCIPD, 26 Janko Sakasov Blvd., Bg1504
Sofia, e-mail: email@example.com
natriuretic peptide and tumor necrosis factor-alpha
in the prognostic evaluation of patients with heart failure - 42, 2006, № 2, 61-65.
N. Stancheva(1), Sn. Tischeva(1), St. Cholakov(2), St. Kurkchiev(3) and A. Goudev(4)
(1)Clinic of Cardiology and Rheumatology,
UMHAT “G. Stranski” – Pleven
(2)Department of Functional Diagnosis,
UMHAT “G. Stranski” – Pleven
(3)Institute of Biology and Immunology
of Reproduction, Bulgarian Academy of Sciences – Sofia
(4)Clinic of Cardiology with Intensive
Care Unit, UMHAT “Tsaritsa Ioanna”
Summary: The relationship of neurohormones
and cytokines with poor prognosis in chronic heart failure (HF) has already
been established. The aim of this study was to evaluate the role of plasma
concentration of N-terminal proBNP (NTproBNP) and tumor necrosis factor (TNF-alpha)
as predictors of outcome in HF. One hundred and twenty-seven patients
with symptomatic HF ranging from II to IV NYHA functional class were included,
of them 69 males (57%) with mean age 61.9 +/- 8.4 years. The patients
were consecutively hospitalized due to exacerbated HF. On the day of discharge,
standard laboratory samples were obtained, echocardiography was performed
and venous plasma for NTproBNP and TNF-alpha was collected.
The primary endpoint was defined as rehospitalization for exacerbated HF within 6 months after
discharge, more than 2 hospitalizations in 1 year or cardiac death. One
hundred and twenty-one (95.3%) patients were followed for a mean of 387
+/- 117 days. Fifty-four (44.6%) of them reached at least one of the endpoints.
At univariate analysis, NTproBNP proved
to be significant predictor of outcome (chi square = 32.93, ? < 0.0001)
while TNF-alpha did not (chi square = 1.17, ? = 0.76).
In hospitalized patients with HF, plasma concentration of NTproBNP
at discharge is predictive of outcome in HF.
Key words: brain natriuretic
peptide, tumor necrosis factor, heart failure, prognosis
Address for correspondence: Nadia Stancheva,
M. D., Clinic of Cardiology and Rheumatology, UMHAT “G. Stranski, 8 Georgi Kochev Str., Bg
– 5800 Pleven
index as a predictor of renal transplant survival - 42, 2006, № 2, 66-72.
Clinic of Nephrology and Transplantation, University Hospital “Alexandrovska”
Summary: Chronic allograft nephropathy is a main cause
of the loss of renal allograft function and the decrease of its survival.
There is no reliable factor predicting long-term outcome of renal transplantation
yet. The goal of the study is to determine whether renal arterial resistance
index over 0,80 is predictive of shorter allograft survival. We tested
renal resistance index (segmental arteries) by Doppler ultrasonography
in 260 patients at least three months after renal transplantation between
2002 and 2006. End points of the study were a decrease of 50% or more
in the creatinine clearance rate, allograft failure, indicated by
the need of dialysis, or death. A total of 52 patients (20%) of all 260
had resistance index of 0,80 or more. Nineteen
of these patients (36,5%) had a decrease of 50% or more in creatinine
clearance rate, as compared with sixteen (7,7%)of the 208 patients
with resistance index of less than 0,80 (p < 0.001). Eleven patients
with higher resistance index (21,1%) required
dialysis, as compared with twelve (5,8%) patients with lower resistance
index (p < 0.001). Five patients with higher resistant index (9,6%)
died, as compared with six patients (2,9%) with lower resistance index
(p < 0.001). A total of 45 patients (67,3%)
with higher resistant index reached the end point of the study, as compared
with 34 patients (14,4%)of those with lower resistance index (p
< 0.001). These results showed the importance of renal arterial resistance
index of 0,80 or more, measured at least three months after transplantation,
as a predictor of shorter survival of renal allograft as compared with
a resistance index of less than 0,80.
Key words: kidney
transplantation, survival of renal transplant, arterial resistance index
Address for correspondence: Assoc. Prof. Emil Paskalev,
M. D., Clinic of Nephrology and Transplantation, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg – 1431 Sofia, tel. +359 2 923-02-40,
of fosinopril on C-reactive protein and blood
pressure in post-menopausal women - 42, 2006, № 2, 73-75.
A. Goudev(1), A. Elenkova(2) and N. Koycheva(3)
(1)Department of Cardiology, University
Hospital “Tsaritsa Ioanna”
Hospital “Akad. Ivan Penchev”
(3)Department of Clinical Chemistry,
Medical University Sofia
Summary: Arterial hypertension is a complex clinical syndrome
and is a well recognized atherosclerotic risk factor. The current understanding
is that atherosclerosis is a low-grade inflammation. Activation of renin-angiotensin
system evokes induction of redox sensitive genes
and activation of immune mechanisms in arterial wall. In the present study,
we tested the effect of fosinopril on the concentration
of C-reactive protein in postmenopausal women with arterial hypertension
for three months. At the end of the study, the blood pressure was significantly
reduced. There was a trend to decrease of CRP levels, which was not statistically
Key words: arterial hypertension, C-reactive
Address for correspondence: Assoc. Prof. Asen
R. Goudev, Department of Cardiology, University
Hospital "Tsaritsa Ioanna",
8, Bialo more Str.,
Bg 1527 Sofia, e-mail: firstname.lastname@example.org
of the transforming growth factor-beta1 in progression of pleural empyema
- 42, 2006, № 2, 76-79.
I. Novakov(1) and D. Terzieva(2)
(1)Department of Thoraco-Abdominal
Surgery, Medical University – Plovdiv
(2)Central Clinical Laboratory, Medical UniversityPlovdiv
Summary: Transforming growth factor (TGF)-beta1
is a cytokine, which is an important mediator of inflammation and angiogenesis.
TGF-beta1 stimulates pleural exudation and the process of pleural fibrosis
in the course of pleural inflammation. The aim of our study was to demonstrate
the role of TGF-beta1 in pleural empyema progression. We hypothesized that TGF-beta1 is a local
mediator in pleural inflammation, produced by cells of inflammation. The
study was performed with 19 patients with parapneumonic
pleural empyema. For every patient, there was
established pleural fluid analysis and were determined: total protein,
glucose, lactatdehydrogenase, total leukocyte
and differential cell count. Concentration of TGF-beta1 in pleural effusion
and serum was measured using ELISA-kit. Our results have shown that TGF-beta1
is a cytokine with local action in pleural space. TGF-beta1-levels in
pleural effusions correlate with severity of pleural inflammation. The
levels of TGF-beta1 in the pleural effusion can be accepted as a diagnostic
marker for pleural empyema progression.
Key words: pleural empyema, cytokines, transforming growth factor-beta1, pleural
Address for correspondence: Ivan Novakov,
M. D., Department of Thoracoabdominal Surgery,
Medical University, 54, Petrova niva
Str., Bg - 4004 Plovdiv, e-mail: email@example.com
and functional respiratory impairments in workers exposed to mineral work
environment dust -
42, 2006, № 2, 80-85.
A. Petrova and
Center of Occupational Diseases, Medical University – Sofia
Summary: Subject of the study are the clinical and functional
impairments in 480 miners, in 120 workers, exposed to asbestos containing
dust in different industrial branches, and in 121 non-exposed to dust
individuals. A cross sectional case control study of the subjective complaints,
physical respiratory examination, and spirometry
(VC, FVC, FEV1, FEV1/VC, FEF25%, FEF50%, FEF75%)
were done. There were formed four types ventilatory insufficiency
(restrictive, obstructive, mixed insufficiency, and small airway obstruction).
The subjective symptoms predominated in asbestos exposed workers, followed
by workers from steam power plant without statistical significance. The
subjective complaints predominated amongst asbestos exposed workers in
comparison with non-exposed individuals in control group (?
< 0.0001). More intensive respiratory complaints were found
in tobacco smokers. Subjective complaints were found in 239 (96.4%) workers
with proven lung disease, and in 9 (3.6%) with acute respiratory disease.
Subjective symptoms were present in 33.3% new registered pneumoconiosis,
as well as in 34.6% workers with borderline pneumoconioses.
80.0% of the patients with chronic bronchitis had chronic cough with varying
expectoration, fatigue, breathlessness during physical efforts. The obstructive
ventilatory insufficiency was rarer than the
small airways’ obstruction (SAO). Restrictive and mixed ventilatory
insufficiency predominated amongst the control group, in comparison to
the group of asbestos exposed workers. Asbestos exposed individuals were
with predominating obstructive ventilatory insufficiency
and SAO. It is concluded that the subjective symptoms dominated in the
group of asbestos exposed workers, as well as in the group of the coal
miners due to the irritative effect of the dust.
Mixed ventilatory insufficiency
and SAO predominated in the miners’ group, and
the obstructive ventilatory insufficiency and
SAO were found amongst asbestos exposed
workers. Respiratory questionnaire, as well as spirometry
(FEF25%, FEF50%, FEF75%) are the most useful
screening methods in dust exposed workers, as well as in early diagnostics
of the occupational dust diseases. An active compaign
against tobacco smoking in dust exposed individuals is necessary.
Key words: screening, mineral dusts, subjective
respiratory complaints, spirometry
Address for correspondence: Assoc. Prof.
M.D., PhD, Clinic of Occupational Diseases, University Hospital “Sv.
Ivan Rilski”, Medical University, 15
Akad. I. Geshov
– 1431 Sofia, e-mail: firstname.lastname@example.org
care anti-asthmatic treatment: types of medication, expenditures of the
health insurance system and the patients - 42, 2006, № 2, 86-92.
Clinical Centre of Allergy, Medical University – Sofia
Summary: Asthma is one of the most common chronic diseases
in the world. Its rate, prevalence and incidence are associated with constant
increase. The social and economic burden of asthma in many countries is
of sufficient magnitude to warrant its recognition as a priority disorder
in government health strategies. The expenses that the health insurance
system incurs providing outpatient health services for asthmatics are
of considerable interest. The published data in the
annual reports of the NHIF for 2003 and 2004 are used to analyze the structure
of the primary care antiasthmatic treatment
programmes as well as the expenditures of the
health insurance system and the patients.
Key words: bronchial asthma, NHIF, statistical
and economic indices, antiasthmatic medication
Address for correspondence: George Christoff,
MD, PhD, Clinical Centre of Allergy, Medical University, 1, “Sv. G. Sofiiski” str., Bg 1431 – Sofia, tel. +359
2 9230-612, e-mail: email@example.com
interstitial pneumonia. Contemporary clinical-roentgenologic-pathologic classification - 42, 2006, № 2, 114-122.
of cardiovascular incidents with fenofibrate
in patients with type 2 diabetes: results from FIELD Study -
42, 2006, № 2, 123-125.
Vl. Hristov and V.
parameters and exercise capacity in COPD patients with frequent and infrequent
exacerbations - 42, 2006, № 1,
V. Hodgev(1) and S. Kostianev(2)
(1)Department of Pulmonology,
(2)Department of Pathophysiology,
Medical University – Plovdiv
Summary: The objective of
this study was to compare symptoms, functional parameters and exercise
capacity between COPD patients with frequent exacerbations and those with
infrequent exacerbations. The study population included 101 stable COPD
patients: age = 59.1 +/- 8.6 год.;
FEV1% = 36 +/- 15%; BMI = 23.7 +/- 5.6 kg.m2. The patients were divided into those
who had presented with three or more episodes in previous 12-month period (frequent
exacerbatorsn = 50) and those who had suffered two or less exacerbations
(infrequent exacerbatorsn = 51). We found statistically significant differences between
frequent and infrequent exacerbators with respect to chronic symptoms: cough (2.6 +/- 0.8 vs. 2.1 +/- 0.9; Р =
0.001), sputum production (2.3 +/- 0.8 vs. 1.8 +/- 0.8; Р = 0.002), wheeze (1.8 +/-
0.9 vs. 1.3 +/- 1.1; Р = 0.018) and dyspnea (2.9 +/- 0.7 vs. 2.4 +/- 0.6; Р < 0.001); PImax (44 +/- 22 vs. 57
+/- 19 cm H2O; Р = 0.005) and exercise capacity (6MWТ, 6-minute walk test) (345
+/- 131 vs. 410 +/- 93 m; Р = 0.005). There were no differences in age, BMI, packs/yearly of smoking, lung function
indices (FEV1%, VC%, TL,CO/VA%, RV/TLC%) and
blood gases. It was concluded that: COPD patients who experienced frequent
exacerbations in previous year have significantly more severe chronic
symptoms, lower PImax and 6MWT, than those who experience infrequent exacerbations.
words: chronic obstructive pulmonary disease, exacerbation, 6-minute walk test
D.M., Department of Pulmonology,
Medical University, 15A Vasil Aprilov Blvd., Bg – 4002 Plovdiv, tel. +359 32 4-41-70/486, e-mail:
pulmonale and silent myocardial ischemia - 42, 2006, № 1, 59-64.
(1)Department of Propedeutic
of Internal Diseases
(2)Central Clinical Laboratory
(3)Clinic of Allergology
and Clinical Immunology
Hospital “Alexandrovska”, Medical University – Sofia
Summary: The long development of chronic obstructive
pulmonary disease (COPD) with respiratory failure leads to disorders in
lung circulation and hemodynamics. It seems to play an important role
in the pathogenesis of cor pulmonale and of right heart failure. Secondary
changes in the left ventricular function develop in these patients. The
effect of changed pulmonary hemodynamics and chronic progressive hypoxemia
on myocardial dysfunction is still under debates. The aim of the study
was to follow-up changes in left ventricular and myocardial function in
COPD pa-tients with cor pulmonale. 96 COPD patients with moderate and
severe respiratory and right heart failure were investigated. They were
divided into two groups ac-cording to the degree of respiratory failure.
The following investigations were carried out: spirometry, arterial blood
gases analysis, electrocardiogram (ECG), 24 hours Holter-ECG monitoring,
and two- dimensional echocardiography. In 8 of them, rest myocardial scintigraphy
was realized. The data obtained significant disorders in lung hemodynamics,
and in right ventricular heart function: significantly higher mean pulmonary
arterial pressure values, right ventricular dilatation and right ventricular
wall hypertrophy. There was a relationship between the degree of respiratory
failure and changed hemodynamic parameters. In 32 (33.3%) COPD patients,
left ventricular hypertrophy was detected. 28.1% (27) of COPD patients
were with diastolic heart dysfunction. 28.1% (21) of COPD patients were
with left sistolic heart dysfunction. ECG, Holter ECG, ultrasound and
myocardial scintigraphy data for myocardial perfusion were found in 41
(42.7%) patients. Only 7 of them were with moderate respiratory failure.
In 68.75% (66) of all the patients with COPD, different forms of rhythmic
disturbances were established, while in 12.5% (12) of them atrial fibrillation
was observed. The progressive disorders in lung circulation and right
heart failure and chronic hypoxemia in COPD patients with cor pulmonale
lead to secondary myocardial ischemia and left ventricular heart dysfunction,
often without clinical symptoms. These processes worsen the prognosis
of COPD. Their early diagnosis and treatment are of essential importance
for improvement of the prognosis of the disease and the survival of these
words: chronic obstructive pulmonary disease, respiratory failure, left
ventricular dysfunction, arrythmia
correspondence: Daniela Petrova, M. D., Clinic of Pulmonology, University Hospital "Alexandrovska",
1, "Sv. G. Sofiiski" Str., Bg – 1431 Sofia, tel. +359 2 92 30 656, e-mail:
Nosocomial infections in
intensive care patients - 42, 2006, № 1,
A. Kircheva and D. Paskalev
Department of Clinical Epidemiology, MHAT “Sv. Anna” – Varna
Clinic of Nephrology and Dialysis, MHAT “Sv. Marina” – Varna
Summary: Nosocomial infections
are unavoidable consequence of medical manipulations worldwide, discrediting
the success of treatment and prolonging hospital stay. It is generally
acknowledged fact that these infections most commonly occur in patients
that have undergone intensive treatment: 5 to 88% according to the information
of the World Health Organization and 11 to 20% in this country. The report
makes a comparative review and assessment of the most frequently registered
nosocomial infections in this country and abroad and the etiologically
connected bacterial flora. Underlined is the leading role of nosocomial
pneumonia and the risk factors that need to be controlled and prevented.
The knowledge of the pathological mechanisms for the occurrence of this
infection is also a necessary prerequisite to reassess the routine practices
and to develop principles for monitoring and control of nosocomial infections
in every hospital. First step in this direction is the observance of the
medical standards developed for the respective profiles of medical services
in this country.
words: nosocomial infections; nosocomial pneumonia; risk factors;
Address for correspondence: Anna Kircheva, M. D., Department of Clinical Epidemiology,
MHAT “Sv. Anna” , 100, Tzar Osvoboditel blv., Bg – 9000 Varna, e-mail:
changes in acute pancreatitis - 42, 2006, № 1,
of Emergency Surgery, Third Surgical Clinic, MHATEM “N. I. Pirogov” –
Summary: In this study, there are presented data about
the frequency and type of the electrocardiographic (ECG) changes in 67
patients with cardiac dysfunction among a total of 114 patients with acute
pancreatitis, and potential relations between ECG changes and the course
of the acute pancreatitis are analyzed. 50 of the patients were treated
inoperativelly, and in 17 cases, single- or multiple-stage surgical procedures
were performed. At admission to the hospital, ECG changes were found in
78% of the patients, and during the follow up ECG examinations – in 44%
of the inoperativelly treated patients and in 50% of the patients operated
on – during the postoperative course. Most common were sinus tachycardia
and ST-segment changes. ECG changes were similar in frequency and type
among the patients with a history of cardiac diseases and in those without
such a history. However, ECG changes were more frequent in patients with
severe forms of acute pancreatitis. The analyses of the data enable us
to conclude that ECG changes are causally related with the systemic physiological
changes and the acute inflammatory response, and that the consideration
and the monitoring of the ECG changes are a prerequisite for the prognose
and the successful management.
words: electrocardiographic changes, acute pancreatitis, cardiovascular
Address for correspondence: Maria Milanova, M. D., Section of
Emergency Surgery, MHATEM “N. I. Pirogov”,21, Totleben Blvd.,
Bg – 1606 Sofia, tel. +359 2 915-43-13
Thrombophilic genetic factors in patients with
pulmonary embolism - 42, 2006, № 1,
P. Ivanov(1), K. Kovacheva(2), R. Komsa-Penkova(1), Y. Ivanov(3), P. Pavlov(3) and V. Nojarov(3)
(1)Department of Biochemistry,
(2)Department of Medical Genetics, Medical University Pleven,
University Lung Diseases Hospital - Pleven
Summary: Pulmonary embolism (PE) is a state started
with deep venous thrombosis followed by embolisation and rethrombosis
of pulmonary artery. The impairment of coagulation resulting in formation
of thrombus (thrombophilic state) has an important role in pathogenesis
of PE. Factor V Leiden (FVL), G20210A prothrombin gene mutation (PTM),
genetic variant C677T in methylenetetrahydrofolate reductase (MTHFR) gene
and PA1/PA2 polymorphism in platelet Glycoprotein IIb/IIIa (PlA2) are
more common genetic factors predisposing to thrombotic state. The aim
of the study was to estimate frequency of thrombophilic genetic factors
among patients with PE and contribution of these factors for recurrent
development and onset of thrombotic incidences in carriers of the factors.
Thirty two patients with PE and 25 healthy controls were tested with DNA
analysis. Eighteen patients (56%) with PE were carriers of at least one
thrombophilic factor compared to 4 (16%) in controls (р = 0.0005).
FVL was the most common genetic defect found in 25% of patients, versus
8 % in controls, (р = 0.04). Carriers of at least one thrombophilic
factor were 65% of patients with recurrent incidences of PE and 74% of
patients with onset of the first PE incidence under 45 years. The frequency
of FVL and G20210А prothrombin mutation in these subgroups was significant
higher compared to controls which emphasizes
the clinical importance of genetic defects for development of PE. Testing
for thrombophilic genetic factors allows an early detection of patients
at high risk for PE as well as individualizing of therapy and prevention
of recurrent incidence of PE.
Key words: pulmonary embolism, genetic
factors, predisposition, thrombophilia
Address for correspondence: P. Ivanov, M. D., Department of Biochemistry, Medical University, 8A G. Kochev
Str., Bg – 5800 Pleven
Analysis of pleural exudate: role
in the diagnosis and predicting the outcome of treatment of complicated
parapneumonic effusions - 42, 2006, № 1,
Novakov(1) and R. Ivantcheva(2)
(1)Department of Thoraco-abdominal Surgery, Medical University – Plovdiv
(2)Department of Pulmonology,
Medical University – Plovdiv
Summary: From 20 to 57% of patients with pneumonia develope
effusions in the course of disease. The presence of complicated parapneumonic
effusion is indication for its drainage. The aim of our study was to evaluate
the role of some characteristics of pleural fluid as well as for establishing
the complicated parapneumonic effusion as for predicting the outcome of
effusional drainage. Forty-three patients with complicated parapneumonic
effusion were included in the study. Visual, laboratory and microbiology
methods were used for pleural fluid analysis. We established large size
effusions in all patients with pleural loculation in 14 (32,56%).
The data from laboratory fluid analysis were with low sensitivity – 12%
for LDH and 23% for glucose. The size of effusion is the main factor to
select the patients with complicated parapneumonic effusion, while the
results of laboratory fluid analysis have no important role. We also prove
that pleural loculation is the only predicting factor for poor outcome
of effusional drainage.
words: complicated parapneumonic effusion, pleural loculations, predicting
Address for correspondence: Ivan Novakov, M. D. Department of Thoracoabdominal
Surgery, Medical University – Plovdiv, 54 “Petrova niva” Str., Bg
– 4004, e-mail: firstname.lastname@example.org
Role of oxidized LDL for coronary
artery disease in patients with diabetes mellitus type 2 - 42, 2006, № 1,
N. Doncheva(1), P. Holvoet(2), M. Todorova(3), Z. Kamenov(4), V. Christov(4) and Z. Kuneva(5)
(1)Department of Clinical Lipidology, Medical Institute of MIA – Sofia
of Experimental Surgery and Anesthesiology, Catholic University of Leuven – Belgium
(3)Department of Pathophysiology, Medical University – Sofia
(4)Clinic of Endocrinology, Alexandrovska Hospital, Medical University – Sofia
(5)Clinic of Cardiology, Alexandrovska Hospital, Medical University – Sofia
Summary: The impоrtance of oxidative stress for the development of diabetic complications
is well known. Oxidized LDL (OxLDL) is one of the most atherogenic fractions of LDL. The aim of the study was to
make a comparative analysis of the lipid prophile,
plasma levels of OxLDL and the atherogenic marker
TC/HDL-C in three groups of patients: 1) with coronary artery disease
(CAD); 2) with type 2 diabetes mellitus (DM2); 3) combined CAD + DM2. In the study, 68 subjects below 50 years were included:
11 clinically healthy volunteers without laboratory evidence for carbohydrate
or lipid metabolic disturbances or cardiovascular disease; 24 patients
with CAD; 15 patients with DM2 without evidence for CAD, and 15 patients
with DM2 + CAD. The results showed that TC, LDL,
TG and the ratio TC/HDL-C were significantly higher in the three groups
of patients compared with the controls, the highest values found in DM2 + CAD. The levels of HDL were significantly lower in the three
groups, as compared with the control group, and the lowest values were
found in the group DM2
+ CAD. The values of OxLDL in all patient
groups were significantly higher compared to the controls. The values
of OxLDL were highest in the group with CAD, but the difference between
the patient groups was not significant. In conclusion, the ratio TC/HDL-C
has a stronger informative and prognostic value for the risk of CAD in
patients with DM2 compared with OxLDL.
Key words: dyslipidemia,
coronary artery disease, diabetes mellitus 2, OxLDL
Address for correspondence: Zdravko Kamenov,
M. D., Clinic of Endocrinology, MHAT “Alexandrovska”, 1, “Sv. G. Sofiiski”
Str., Bg – 1431 Sofia, tel. +359 2 92-30-244, e-mail: email@example.com
OCULAR changes in patients with systemic lupus
erythematosus and clinically manifested nervous system disorders - 42, 2006, № 1,
S. Monov(1), R. Toncheva(2), R. Rashkov(1), I. Altankova(3) and A. Ivanov(4)
(1)Clinic of Rheumatology,
Medical University – Sofia
(2)Ophthalmology, MHAT “Sv. Iv. Rilski ”Sofia
MHAT “Sv. Iv. Rilski ”Sofia
(4)Military Medical Academy Sofia
Summary: Systemic lupus erythematosus (SLE) is
an autoimmune multisystem disease affecting the retinal vessels in 3 to
29% of the cases. Ocular injuries in SLE may be associated with the disease
itself as well as with the therapy performed with corticosteroids and
antimalarials. Ocular symptoms manifesting the systemic character of SLE
are: retinal changes, atrophy of the optic nerve and cataract. Subject
of this study were the ocular changes in 104 patients with SLE and clinically
manifested disorders of the nervous system. The most frequently established
pathology at investigation with direct ophthalmoscopy was vasculitis of
the retinal vessels (32,69%). Papilledema was diagnosed in 26,92%.
Retinopathy was found in 54% of the patients with neuropsychiatric SLE
(NPSLE) and positive anticardiolipin antibodies, in 53,57%
of those with NPSLE and kidney injuries and in 52,38% of the patients
with NPSLE and positive data at MRI (magnetic resonance imaging) for disorders
of the central nervous system. Investigation of fundus oculi is necessary
in all patients with SLE, as it is an indicator not only of the systemic
character of SLE but of its activity as well.
systemic lupus erythematosus, ophthalmoscopy, retinopathy, optic
Address for correspondence: Simeon
Monov, M. D., Clinic of Rheumatology, Medical University, 13, Urvitch Str., Bg
– 1612 Sofia, tel. +359 2 958-29-27
Comparative evaluation of two immunometric
methods for detection of antinuclear antibodies - 42, 2006, № 1,
I. Manolova(1), V. Tsoneva(2)
and M. Ivanova(3)
(1)Laboratory of Clinical Immunology, University Hospital –
(2)Central Clinical Laboratory, University Hospital –
(3)Clinic of Rheumocardiology, University Hospital – Stara Zagora
Summary: The standard method for detecting antinuclear antibodies
(ANA) is by indirect immunofluorescence assay (IIF) on HЕp-2 cells
as substrate. A more recent approach
to ANA screening is the use of enzyme immunoassays (EIA). The aim of our
study was to compare BINDAZYME ANA Screen EIA test (Binding Site, UK)
with IIF in view of their performances in the detection of ANA. The study
was performed on 90 serum samples: 49 specimens were positive by both
assays, 27 were negative by both assays, 12 were positive by IIF only,
and 2 were positive by EIA only. There was an overall good concordance
of 84.4% between both assays. In conclusion, BINDAZYME ANA Screen is a
suitable alternative test for ANA screening. However, IIF on HЕp-2 is still a
more reliable method for ANA detection.
words: antinuclear antibodies, enzyme immunoassay,
Address for correspondence: Irena Manolova, MD, PhD, Laboraroty of Clinical
Immunology, University Hospital, 11 Armeiska Str., Bg
– 6000 Stara Zagora, tel. +359 42 664 385, e-mail: firstname.lastname@example.org
Lung emphysema in individuals exposed
to mineral dust and in patients
with pneumoconioses and relation with some risk factors and FEF50% -
42, 2006, №
Е. Petrova and Ch. Nachev
Center of Occupational Diseases, Medical University – Sofia
Summary: The object of the study is the X-ray estimated compensatory lung emphysema (еm – according to ILO’80)
in 480 underground miners and in 120
asbestos exposed workers. The average age
of all the investigated dust exposed individuals was 41.38 years, and the average length of the dust exposure in the group of
the miners was 11.32 y. The average asbestos exposure was 16.5 y and the average latent period was 17.45 years.
All workers were exposed in their work places in the period from
1985 to 2003. The X-ray emphysema
findings (еm) were evaluated by two experts using the ILO International
Classification of ten Radiographs of Pneumoconioses, Geneva, 1980 (ILO’80)
in the conditions of a nestled case control study. A spirometry with an
accent to FEF50% was done. The levels of the dust in the work
environment air, tobacco smoking habit and alcohol abuse were accounted.
A compensatory emphysema (em – by ILO’80) without/with presence of a boundary
(0/1,1/0) or initial pneumoconiosis (1/1) was found in 75 (69.4%) asbestos
exposed workers, 62 (54.9%) miners from black coal mining, 49 (42.2%)
miners from brown coal mining, in 19 (35.8%) underground miners from anthracite
coal mining and in 42 (34.1%) miners from lead-zinc mining (Р <
0.0001). Em X-ray findings were established in 91 (31.5%) workers with
10-year mineral dust exposure, 159 (55%) with 11+ years exposure, and
in 39 (13.5%) non-exposed controls. We did not detect em in 76 (22.4%)
controls, in 154 (45.4%) exposed to 10-year dust exposure, and in 109
(32.2%) workers with 11+ years mineral dust exposure. The absolute number
and the relative share of the group of the individuals with 10 years dust
exposure without еm findings were 154 (58.6%), and the number and
the share of the 11+ years exposure group were 109 (41.4%). The number
and the share of em findings in the workers’ group with alcohol abuse
were 235 (81.3%); respectively, there were 54 (18.7%) in individuals non-using
alcohol. The individuals with alcohol abuse without em findings were 229
(67.6%) against 110 (32.4%) workers non-using alcohol without em X-ray
findings (Р < 0.0001). Em was found in 203 (70.2%) workers without
data for previous lung diseases, and the individuals with a history of
pulmonary diseases with concomitant emphysema (em) were 86 (29.8%) – Р
= 0.035. The average value of FEF50% diminished due to appearance
of compensatory emphysema in dust exposed workers and in patients with
boundary and manifested initial pneumoconioses. Roentgenologically confirmed
compensatory emphysema (em) dominated in asbestos exposed workers, followed by
miners from the black coal, the brown coal, and the anthracite coal mining, as well as
from the lead-zinc ore mining. The em X-ray
findings were significantly influenced by the dust exposure length,
as well as by the alcohol abuse in workers exposed to mineral dust.
There was a lack of influence of previous lung and
pleural diseases on the em X-ray findings. This fact confirms the thesis for
the multifactorial etiopathogenesis of compensatory emphysema
the proved effect of tobacco smoking.
Key words: еmphysema,
mineral dust, FEF50%
Address for correspondence: Assoc. Prof. Elisaveta Petrova,
M.D., PhD, Clinic of Occupational Diseases, University Hospital “Sv. Ivan
Rilski”, Medical University, 15 Akad. I. Geshov Blvd., Bg
– 1431 Sofia, e-mail: email@example.com
Sodium hyaluronate 500-730 кDa
(Hyalgan®) intra-articularly after treatment of synovitis in primary active
osteoarthritis of the knee joint with betamethasone - 42, 2006, № 1, 109-113.
S. Kuzmanova and P. Solakov
Clinic of Rheumatology, University Hospital – Plovdiv
Summary: Sodium hyaluronate
(HA) may be a useful additional therapy of symptomatic OA. It has a long
duration of action, and demonstrated a good safety profile. Therapeutic
efficacy of HA lies in its different mechanisms of action as: unique viscoelastic
properties and lubricant abilities, as well as ability to retain fluid
in the joint cavity. Objective of the study was to compare efficacy and
tolerability of HA intraarticularly (i.a.) in two groups of patients with
OA of the knee joint. The 1st group of15 patients with active
primary symptomatic knee OA with synovitis and intraarticular effusion
was treated prior to therapy with HA with Betamethasone i.a., and 2nd
group including 13 patients with primary symptomatic knee OA without clinically
active synovitis received intraarticularly weekly injections of HA (2
ml of 20 mg/ml) for 5 weeks. First group patients were with contraindications
for immediately HA treatment as per manufacturers
instruction of Hyalgan®. They received Betamethasone i.a. as the first
step of treatment. After decreasing the signs of joint inflammation, these
patients were treated for five weeks with HA i.a. (Hyalgan®). We demonstrate
the advantages of the treatment of active synovitiis of the knee in OA
with Betamethasone i.a. before injections of HA. The inhibition of joint
inflammation with corticosteroid as first step enabled a better effect
of HA on the pain and the functional impairment. In summary: in cases of active OA of the knee with manifested synovitis and
intraarticular hydrops, it is recommended before treatment with HA i.a.
to provide treatment with Betamethasone i.a.
words: sodium hyaluronate, Betamethasone, osteoarthritis,
knee joint, synovitis
Address for correspondence: Assoc. Prof. Stefka Kuzmanova, M.D., DSc, Clinic of Rheumatology,
University Hospital, 15A V. Aprilov Blvd., Bg – 4002 Plovdiv, tel./fax:
+359 32 602 532, e-mail: firstname.lastname@example.org
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