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Original papers

Volume 40, 2004

4/2004

Blastocystis hominis as a causative agent in acute and chronic urticaria – 40, 2004, No 4, 53-58.
A. Galev(1), M. Kadurina(2), J. Dimova(3), P. Chobanova(3) and B. Dimitrov(2)

(1)Clinic of Infectious Diseases
(2)Clinic of Dermatology and Venereology
(3)Centre of Military Epidemiology and Hygiene - Military Medical Academy - Sofia
Summary: We present the first clinical trial in Bulgaria that defines Blastocystis hominis as a causative agent in patients with acute and chronic urticaria. The study followed 32 immunocompetent patients suffering acute and chronic urticaria. The laboratory testing did not show any microorganisms related to the urticaria etiology. Treatment with metronidazole or co-trimoxazole was applied. The symptoms diminished in 2,68 +/- 1,96 days. The follow-up parasitological testing revealed a 100% negative result for Blastocystis hominis. A month later, relapse of the disease was registered in four patients (12,5%). Two of them were treated with metronidazole (7,4%); the rest with co-trimoxazole (40%). In comparison, better results were achieved when the patients were treated with metronidazole than co-trimoxazole. Our observations showed the need for including parasitological testing for Blastocystis hominis in the schedule for urticaria patients handling. We think it would be lucrative, Blastocystis hominis to be taken into consideration when there are undiagnosed cases with skin, allergic and enteric symptoms.
Key words:  urticaria, Blastocystis hominis, metronidazole, co-trimoxazole
Address for correspondence:
  Andrey Galev, M. D., Department of Infectious Diseases, Military Medical Academy, 3 Sv. G. Sofiiski Str., Bg - 1606 Sofia, тел. + 359 2 922-55-52, e-mail: cveh@abv.bg
 



HLA antigen predisposition to osteoarthritis of the hip joint and psoriatic arthritis
– 40, 2004, No 4, 59-62.
V. Trankova(1), A. Toncheva(2) and F. Martinova(1)
(1)Unit of Hemotransfusion and Immunogenetics, MHATEM “N. I. Pirogov
(2)Clinic of Cardiology and Rheumatology, NMTH “Tzar Boris III” - Sofia
Summary: This research aims at allocation of HLA antigens in patients with psoriatic arthritis and osteoarthritis. There were examined 100 patients with psoriatic arthritis and 125 patients with osteoarthritis of the hip joint. The results were compared to a healthy control group. This research could be used to define the risk groups, which would help the timely prevention.
Key words:  HLA antigens, correlation, psoriatic arthritis, osteoarthritis
Address for correspondence: V. Trankova, M. D., Unit of Hemotransfusion and Immunogenetics, MHATEM “N. I. Pirogov”, 21, Totleben Blvd., Bg -1606 Sofia


Estimation of high intensity signals  in patients with valve prostheses – 40, 2004, No 4, 63-66.
M. Staneva(1), J. Petrova(2), T. Donova(3) and P. Shotekov(2)
(1)UMHAT “Lozenetz” - Sofia
(2)Clinic of Neurology, University Hospital “Alexandrovska” - Sofia
(3)Department of Propedeutics of Internal Diseases, Medical University - Sofia
Summary: Transcranial Doppler sonography monitoring (TDSM) is an easyly applicable mode to estimate the blood flow for a longer period and to assess brain autoregulation observing High Intensity Signals (HITS). Fifteen patients underwent TDSM of a. cerebri media during cardiopulmonary bypass (CPB). In 8 of them, mechanical mitral valve prostheses (in 4 – aortal and in 4 – mitral and aortal) were implanted. In all patients HITS were registered during the cannulation of the aorta and CPB. The number of HITS is different during the particular stages of the heart operation. The most risky moments are the aorta declamping (4,4 HITS/min), inserting CPB (2,76 HITS/min) and of aorta clamping (1,4 HITS/min). The patients were observed HITS for a year after the operation. In 5 of them, HITS (at the rate of 0,49 HITS/min) were found. They had subjective complaints, without focal neurological symptomatic. After the operation, HITS were registered in patients with normal function of the valve prosthesis without thrombotic masses in the heart cavities and during optimal anticoagulation therapy.
Key words: valve prostheses, Doppler sonography monitoring, high intensity signals
Address for correspondence:
  M. Staneva, M.D., e-mail: staneva-milena@hotmail.com


Decrease of microalbuminuria in patients with type 2 diabetes mellitus treated with sulodexide – 40, 2004, No 4, 67-71.
Vl. Christov(1), Z. Kamenov(1), M. Genova(2) and M. Todorova(3)
(1)Clinic of Endocrinology, University Hospital “Alexandrovska”, Medical University - Sofia
(2)Department of Clinical Laboratory, Medical University - Sofia
(3)Department of Pathophysiology, Medical University - Sofia
Summary: Diabetes mellitus (DM) is the most frequent cause for end stage renal insufficiency. Both precise glycemic control, which is difficult to be achieved and sustained and is often associated with an increased risk of hypoglycemia and the use of ACE inhibitors and angiotensin receptor blocking agents can postpone and delay, but not stop the progression of diabetic nephropathy. Other medications with renoprotective effect are searched for. The aim of the study was to evaluate the effect of sulodexide (Vessel Due F), administered orally for 3 months at a daily dose of 500 LRU on microalbuminuria in patients with type 2 DM. The effects of the drug on glycemic control and blood pressure (BP) were estimated as well. Twenty five subjects were included in the study. Out of the whole group, twenty finished the course of treatment and were followed for HbA1c and BP control. Fourteen of them met the inclusion criteria for measurement of microalbuminuria (did not show significant changes in glycemic control, BP and administration of other drugs). In the course of treatment with sulodexide, microalbuminuria decreased compared with baseline levels (p < 0.05). Sulodexide did not affect glyce­mic control and BP. No significant side effects were observed. Sulodexide exerts a favorable specific early effect, decreasing microalbuminuria in patients with type 2 DM. This effect is not associated with alterations of the glycemic control and BP.
Key words: type 2 diabetes mellitus, microalbuminuria, sulodexide
Address for correspondence:
Zdravko Kamenov, M. D., Clinic of Endocrynology, UMHAT “Alexandrovska”, Medical University, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, tel. + 359 2 92-30-244

 

Time from the first examination of an AMI patient to the admission to hospital - analysis of the problem for the district of Sofia during the period 1996-2003 – 40, 2004, No 4, 72-80.
T. Taseva and Tch. Natchev
Clinic of Internal Diseases, University Hospital “Sv. Anna” - Sofia
Summary: The publication presents a retrospective analysis of the time interval between the point, when medical assistance was first sought and the hospitalization at the Coronary Care Unit of the University Hospital “Sv. Anna” - Sofia. The study regards patients from the Sofia district, discharged from the Cardiology Department at the University Hospital “Sv. Anna” with diagnosis of AMI for the period 1996-2003. The two subintervals have been reviewed separately. They are as follows: from the first examination by a physician to the time, when the patient enters the Emergency Department of the Emergency Medical Care Center - Sofia and from the leaving of the Emergency Department to the entrance into the Coronary Care Unit. A comparison has been made for most of the indications in the periods 1996-2000 and 2001-2003, because the latter coincides with the beginning of the Bulgarian health system reform. Suggestions have been made about the possibilities of optimizing this interval of the prehospital therapeutical care.
Key words: acute miocardial infarction, time delay, prehospital stage, emergency medical care, optimisation
Address for correspondence:
Tatiana Taseva, M. D., Internal Diseases Clinic, University Hospital “Sv. Anna”, 1, D. Mollov, Bg - 1756 Sofia, GSM +359 888-97-33-05

 

Urine strip testing automation - experience and reflections – 40, 2004, No 4, 81-83.
M. Shishenkov
Clinical Laboratory of the Fifth Multiprofile Hospital - Sofia
Summary: Urine analyses amount to 1/10 of the total parameters investigated in a hospital laboratory. The research targets the working process in regard to urine test strips. During manual testing and visual readings, the staff fails to comply with the instruction sheet accompanying the test strips (the elapsed reaction time shows significant variations - ?CV > 20%). Therefore, our recommendation is to standardize strip testing by analyzing urine samples in series of 5 (five). On the other hand, use of the strip reader AUTION-MINI - Kyoto - Japan enables us to automatically standardize the process while increasing the productivity. By using AUTION-MINI reader under heavy work load, in 80% of the cases, the strip reader reaches its maximum capacity.
Key words:  urine analyses, automation, standardization, test-strips
Address for correspondence:
  M. Shishenkov, M. D., Clinical laboratory, Fifth Multiprofile Hospital, 67-A, Stoletov Blvd., Bg - 1233 Sofia, tel. +359 2 926-81-23


Career-path dynamics of female dentists: actual status and trends – 40, 2004, No 4, 84-89.
L. Katrova(1) and Zh. Surcheva(2)
(1)Department “Social Medicine and Public Dental Health”, Dental Faculty, Medical University - Sofia
(2)Central Medical Library, Medical University - Sofia
Summary: This study aims at demonstrating the changes in the socio-professional status of female dentists in Bulgaria during last years. It compares differences by gender in the career paths of female and male dentists. Employment opportunities, practice patterns, attitude toward the continuing dentistry education and job satisfaction are discussed. An analysis of the future plans and personality traits of Bulgarian female dentistry students revealed some future trends of this profession.
Key words: female dentists, dental practice - management, healthcare reform, dental students - motivation, location professional practice, continuing dental education, social values
Address for correspondence:
Lidia Katrova, M. D., Department “Social Medicine and Public Dental Health”, Dental Faculty, 1, Sv. G. Sofiisku Str., Bg - 1431 Sofia


Fatty acid determination in a lipid component of serum and liver after external gamma irradiation – 40, 2004, No 4, 90-94.
P. Petrunov, M. Aliakov and A. Milanova
Department of Radiobiology and Radiation Protection, Military Medical Academy - Sofia
Summary: Aim of the study was to follow the changes in the quantity of 6 unsaturated fatty acids in serum and liver after influence of ionizing irradiation as a possible criterion for assessing the injuring effect and for determining the potentialities of different drug approaches. The alterations in quality and quantity composition of the following fatty acids: palmitinic, stearinic, oleinic, linolic, linolenic, arahidonic after external gamma irradiation with 7 Gy in experimental model upon 90 “Vistar” male rats with 150-160 g body weight have been determined. For establishing fatty acid existence, a gas-сhromatographic method has been used. Dynamic alterations in the quantity of fatty acids have been registered. It was shown that irradiating with 7 Gy reduces the activation of the enzyme systems of the antioxidant defense (more strongly in the serum) that leads to increase of the quantity of the unsaturated fatty acids. The data received can be used as criterion for the injuring effect of different factors on the organism and the abilities for antioxidant therapy.
Key words:
 Fatty acids, radiation, antioxidant therapy
Address for correspondence:  Plamen Petrunov, M. D., Department of Radiobiology and Radiation Protection, Military Medical Academy, 3 ”Sv. G. SofiiskiStr., Bg - 1431 Sofia, tel. 922-64-74, e-mail: p_petrunov@yahoo.co.uk


3/2004

Priorities in infectious diseases in the bulgarian army - analysis for the period 1998-2003 – 40, 2004, No 3, 35-42.
G. Popov and K. Plochev

Clinic of Infectious Parasitic and Tropical Diseases, MMA - Sofia
Summary: The purpose of the present research is to analyse the spread of infectious diseases in the Bulgarian army over a six-year period. From 01.01.1998 to 31.12.2003 a total of 5092 military personnel suffering from infectious diseases in the Bulgarian army were registered. We studied the dynamics of the most frequent infectious diseases in the Bulgarian army. The priorities were established on the basis of various indications (morbidity rate, average increase in number of infected persons, epidemiological trends of morbidity, mortality rate etc.). According to these priorities, infectious diseases in the Bulgarian army are: intestinal infections caused by an unknown agent (25.0%); food toxicoinfections (3.1%); shigellosis (2.3%); salmonellosis (2.0%); viral hepatitis (23.8%); upper respiratory tract infections (11.1%); tick born infections (9.3%); varicella (3.8%); rubella (3.2%) and mumps (2.4%). In addition to these 10 priority infectious diseases in the Bulgarian army, Lyme disease, mononucleosis infectiosa, tularemia and trichinosis account for over 1% each. It was concluded that there is a tendency for an increase in the number of military personnel suffering from infectious diseases and from less frequent occurring infectious diseases in the past – tick born infections, viral hepatitis C etc. An explicit cyclicity in the progress of the infectious process is observed.
Key words: infectious diseases, Bulgarian army
Address for correspondence: Georgi Popov, M. D., Clinic of Infectious Parasitic and Тtropical Diseases, Military Medical Academy, 3, Sv. Georgi Sofiiski Str., Bg – 1431 Sofia, e-mail: popovg@abv.bg


Drug-induced lupus – 40, 2004, No 3, 43-45.
R. Rashkov, (1), D. Ianeva(2), S. Monov(1), M. Baleva(3) and K. Nikolov(4)

(1)Clinic of Rheumatology, Medical University - Sofia
(2)UMHAT “Sv. Anna”
(3)Clinic of Allergology and Clinical Immunology, Medical University - Sofia
(4)Clinic of Dermatology and Venereology, Medical University - Sofia
Summary: In patients with drug related lupus (DRL), there is a relationship between a definite medicine and the appearance of lupus like syndrome. There are several groups of drugs, which are responsible for the appearance of DRL: antiarrythmics, beta blockers, antibiotics, vaccines. In this study, we describe the clinical and immunological characteristics of patients with DRL. There are pointed out the main clinical features and those predicting poor prognosis.
Key words: drug induced lupus, clinical manifestations, immunologic findings
Address for correspondence:
Ass. Prof. Rasho Rashkov, M. D., Clinic of Rheumatology, Medical University, 13, Urvitch Str., Bg - 1612 Sofia, tel. +359 2 958-29-27

 

Cell-mediated and humoral immunity in patients with malignancies and impaired nutritional status subjected to surgical treatment – 40, 2004, No 3 – 40, 2004, No 3, 46-50.
K. Ikonomova, (1), B. Miteva(1) and B. Borisov(2)

(1)National Transport Hospital “Tzar Boris III” – Sofia
(2)National Drug Agency
Summary: Surgical interventions combined with malignancies and malnutrition influence the immune system increasing the risk for sepsis, metastases progression and impaired postoperative survival. Aim of the study was to examine perioperative changes in some indexes of cell-mediated and humoral immune response in patients with malignancies and impaired nutritional status. Seventeen patients (10 males, 7 females, mean age 60 ± 1,89 years) with impaired nutritional status were examined. The patients were divided as follows: 9 patients with stomach cancer, 8 patients with duodenal ulcer and 21 healthy volunteers. Before operation and on 96 hour after operation, blood was taken for examination of lymphocyte subpopulations and immunoglobulins (IgG, IgA IgM). The determination of lymphocyte subpopulations (CD2, CD19, CD4+, CD8+) was made using FITC conjugated monoclonal antibodies on fluorescent microscope. Immunoglobulins were detected by immunodiffusion method. Nutritional status was determined by anthropometric and biochemical indexes. Total T lymphocyte count (CD2+ cells) was decreased in patients with impaired nutritional status both with cancer and with ulcers compared with controls (p < 0,02). The changes were more pronounced in patients with stomach cancer. Postoperative CD2+ lymphocytes increased to normal ranges in patients with duodenal ulcer but remained decreased in patients with cancer. Helper/inducer cells (CD4+ cells) were decreased in patients with stomach cancer compared to the controls (p < 0,02). Postoperative CD4+ cell count remained low in cancer patients. CD4+/CD8+ ratio was decreased in patients with stomach cancer comparing both with ulcer patients and control ones (p < 0,02). In cancer patients in the early postoperative period, serum immunoglobulin concentrations were decreased. The variations were significant (p < 0,05) but in the reference range interval. Both, operation and malignancy together and independently exerted metabolic and immunosuppressive effects. Studying the immune changes during the operative intervention is of a great importance for improvement of postoperative survival.
Key words: malignancies, nutritional status, humoral and cell immunity
Address for correspondence:
K. Ikonomova, M. D., National Transport Hospital "Tzar Boris III", 108, Maria-Luiza Blvd., Bg - 1202 Sofia

 


Rotative coronary atherectomy – opportunities and methods – 40, 2004, No 3, 51-54.

Vl. Grigorov
Hospital “Glynwood” - Johannesburg, SAR
Summary: Rotative coronary atherectomy (rotablation) of coronary stenoses with a length above 1.5 cm and with a great number of calcium plaques, as well as of other stenoses, is a method not yet widely applied in interventional cardiology. The author presents considerable experience in 50 patients with rotablation with a 95% success rate and a low profile of complication. In 6 of them, the rotablation was the only procedure (ostial stenoses), in all the rest rotablation ended with percutaneous coronary intervention. A detailed description of methods of rotablation is presented and very good obtained results are reported.
Key words: coronary stenosis, interventional cardiology, rotablation
Аddress for correspondence:
Vladimir Grigorov, M. D., FESC, Hospital “Glynwood” - Johannesburg, SAR

 

Renoprotective effect of enalapril in chronic allograft nephropathy – 40, 2004, No 3, 55-59.
E. Paskalev

Clinic of Nephrology and Transplantation, University Hospital “Alexandrovska” - Sofia
Summary: Chronic allograft nephropathy is a major therapeutic problem in renal transplants. The data about the renoprotective effect of ACE inhibitor enalapril in chronic allograft nephropathy (CAN) are scarce so far. The goal of the study is to estimate retrospectively the effect of enalapril in CAN. Thirty two kidney grafts recipients with CAN, divided into two groups, were included in the study. The patients of the group A (16 patients) had never been given ACE inhibitors. 16 patients (group B) were treated with enalapril (5-30 mg/d). Hypertension was treated with calcium-channel blockers and/or beta-blockers and/or adrenergic modulators. The follow-up was 36 ± 9 months. Evolution of hypertension and proteinuria, as well as the time elapsed from CAN diagnostics (the starting point) and development or renal function were evaluated. According to base line proteinuria levels (over or below 0.5 g/d), both groups were divided into two subgroups. In the subgroup A-1, moderate hypertension [mean blood pressure (BP) 110 mm Hg (105-115)] remained stable during the follow-up, and proteinuria showed an increase from 0.9 to 1.4 g/d (p < 0.01). In comparable subgroup A-2, mean BP decreased from 115 (105-120) to 105 (100-110) mm Hg (p < 0.05), and proteinuria did not changed: 0.35 to 0.4 g/d (p - n.s.). The index of 36-month sCr doubling in the subgroup A-2 was 18.7% (n = 3) versus 37.5% (n = 6) in the subgroup A-1 (p < 0.01). In patients of subgroup B-1, stable marked hypertension [mean BP 110 mm Hg (105-120)] remained during the follow-up, but in the subgroup B-2 mean BP decreased from 120 (115-125) to 105 (100-115) mm Hg (p < 0.05). This was accompanied by the decrease of proteinuria in 68.7% (n = 11) of patients, while in the subgroup B-1 it increased in 43.7% of patients (p < 0.01). The index of 36-month sCr doubling was 18.7% (n = 3) in the subgroup B-2 versus 31.2% (n = 5) in the subgroup B-1. These results demonstrate renoprotective efficacy of enalapril in CAN independently of the level of proteinuria, and suggest that renoprotective effect of enalapril in CAN is associated with its antihypertensive effect as well.
Key words: kidney transplantation, chronic allograft nephropathy, enalapril
Address for correspondence:
Ass. 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, e-mail: emilpaskalev@abv.bg

 

The change of resting metabolic rate in treatment of obese patients with diet and sibutramine hydrochloride (reductil) – 40, 2004, No 3, 60-64.
Zh. Boneva(1) and Vl. Christov(2)

(1)Department of Endocrinology, Medical Institute, Ministry of Internal Affairs - Sofia
(2)Clinic of Endocrinology, University Hospital “Alexandrovska” – Sofia
Summary: The weight loss induces normally a decline in the sympathetic nervous system activity and respectively of the resting metabolic rate (RMR) as a result of food restriction and the reduction of lean body mass accompanying the loss of fat mass. The aim of the present study was to compare the decrease of RMR in treatment of obese patients with diet alone and with diet and sibutramine (reductil). Two groups of patients with overweight and obesity were enrolled in this prospective 12-week open study. Group I – 35 patients were treated with reductil 15 mg per day and diet with 600 kcal deficiency of daily energy needs; group II – 15 patients treated with diet alone. RMR was assessed with bioimpedance “Tanita“ body composition analyzer TBF–215 at the beginning and the end of the study. The average decrease in body weight at the end of the first month in the first group was 4,22 +/- 2,2 kg and 9,46 +/- 4,2 kg at the end of the third month respectively. For group II, this reduction at the end of the first month was 3.0 +/- 1.2 kg and at the end of the third month – 5.3 +/- 2.4 kg (p < 0.001). The reduction of RMR at the end of the third month in group I was from 1865.51 +/- 304.6 to 1760.14 +/- 287.3 kcal, in group II – from 1940 ± 258.3 to 1751.5 +/- 293.3 kcal. The change of RMR was 105.37 +/- 43.49 kcal for group I versus 189.20 +/- 51.53 kcal for group II (p < 0.0001). It is concluded that sibutramine (reductil) contributes to a lower decline of RMR in weight loss and a better maintenance of the treatment results.
Key words: obesity, resting metabolic rate, sibutramine hydrochloride
Address for correspondence: Zhivka Boneva, M. D., Department of Endocrinology, Medical Institute, Ministry of Internal Affairs, 79, Skobelev Blvd., Bg - 1606 Sofia, tel. +359 2 51-57-351, e-mail: zhbonevaa@abv.bg

 

Treatment of hyperphosphatemia - a significant symptom of renal osteodystrophy with RenaGel in dialysis patients – 40, 2004, No 3, 65-68.
D. Ionova and V. Papazov.

Clinic of Dialysis, University Hospital “Alexandrovska” , MU Sofia
Sevelamer hydrochloride, a non-aluminium- and non-calcium-containing hydrogel, is an effective phosphate binder in dialysis patients, and may produce favourable changes in the lipid profile. To determine the effectiveness of sevelamer hydro-chloride firstly introduced in our clinic in Bulgaria, we performed a 10-month clinical trial in 22 adult patients with end-stage renal disease on hemodialysis. Drug-related changes in the concentrations of serum phosphorus, calcium, calcium х phosphate product, parathyroid hormone, and low- and high-density lipoprotein cholesterol concentrations, some hemocoagulation parameters, bicarbonates and chlorides were the major outcomes of interest. Treatment with sevelamer was associated with a mean change in serum phosphorus of -0.85 ± 0.76 mmol/l, serum calcium of-0.14 ± 0.26 mmol/l, and calcium х phosphate product of-1,46 ± 1.78 mmol/l (p < 0.01 for all comparisons). There were no significant overall treatment-related changes in parathyroid hormone in 12 patients with constant calcitriol dose and a significant change in the other 10 (p < 0.05), for whom the dose of calcitriol was increased one month after the start of sevelamer. Serum levels of LDL cholesterol decreased by 0.81 ± 0.75 mmol/l (mean -30%, р < 0.01) and HDL choles­terol did not change significantly. Coagulation status was not sizably disturbed and no elevation of Weeding episodes was registered. Changes of magnesium, bicarbonates and chlorides was among the referent values. Drug-related adverse events were infrequent and most of them were of mild intensity.
Key words: hemodialysis, mineral metabolism, hyperphosphatemia, sevelamer (RenaGel)
Address for correspondence: Diana Ionova, M.D., Clinic of Dialysis, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, tel. +359 2 923-04-63; +359 2 923-05-15, e-mail: drjonova@em3il.com

 

Measurеment of the nose with acoustic rhinometry – 40, 2004, No 3, 69-73.
D. Vicheva

Department of Otorhinolaryngology, Medical University - Plovdiv
Summary: The aim of our study was to investigate both nasal cavities before and after the application of the topical decongestant xylomethazoline through analysis of the acoustic rhinometry curves. We investigated 24 patients - 13 women and 11 men aged between 18 and 42 years. A wide-band noise acoustic rhinometer SRE 2100 (Rhinometrics, Denmark) was used. After the clinical examination, the changes in nasal geometry before and after decongestion after dropping 3 drops of xylomethazoline 0.01% in each nasal cavity were investigated. 15 minutes later we registered the changes, which took place after decongestion with xylomethazoline. Our data showed that decongestion with xylomethazoline increases nasal volume by approximately 35% in MCA = 1.3 cm, CA = 3.3 cm; 4 cm and 6.4 cm.
Key words: acoustic rhinometry, nasal cavities, decongestion
Address for correspondence: Dilyana Vicheva, M. D., Department of Otorhinolaryngology, Medical University, 81A, Il. Makariopolski Str., Bg - 4000 Plovdiv, e-mail: dilyanav@yahoo.com

 

Some problems of medical care of patients with Sjogren’s syndrome – 40, 2004, No 3, 74-78.
R. Kolarov

Specialized Hospital of Maxillo-Facial Surgery – Sofia
Summary: Some problems of medical care of 45 patients with primary Sjogren’s syndrome is analyzed. There were found some omissions and failures in the quality of medical care: late diagnosis, many unnecessary examinations and consultations, long and difficult patient’s route through different structures of the healthcare system, lack of multidisciplinary approach, etc. Algorithms of observed and of desirable medical care of patients with Sjögren’s syndrome are presented.
Key words: Sjogren’s syndrome, medical care, healthcare quality
Address for correspondence: Rosen Kolarov, M.D., Specialized Hospital of Maxillo-Facial Surgery, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia.

 

2/2004

Gender differences in characteristics and prognosis in patients survived acute myocardial infarction in a 5-year follow up study - 40, 2004, № 2, 43-49.
K. Vitlianova
(1), N. Feschieva (2), E. Shipkovenska (3) and R. Tzrancheva (1)
(1)II Clinic of Internal Medicine, University Hospital “Alexandrovska” - Sofia
(2)Department of Social Medicine, Biostatistics and Medical Informatics, Medical University - Varna
(3)Department of Preventive Medicine, Faculty of Public Health, Medical University - Sofia
Summary: The aim of study is to explore and assess the differences by gender, if any, in characteristics and prognosis of reinfarction in patients survived acute myocardial infarction (AMI) over a five-year follow up. Assessment of prognosis was done in a retrospective cohort study on 241 cases, survived AMI between 06/1994 to 01/1995. Number of the followed cases at the fifth year of the study was 190 (78.8%). Univariate and multiple regression values of relative risks of reinfarction of the characteristics studied were calculated by using the Cox regression models and stratification by age and gender. Females developed AMI on average 4 years later than men. Differences between sexes in distribution of the prognostic factors studied were statistically not-significant. Females were also less likely to report angina before MI, had lower rates of therapy with beta blockers and acetysal and also lower frequency of hypercholesterolemia. Patients of male gender more frequently reported arterial hypertension and smoking. Heart failure and LFEF < 50 % have been more often observed among men. In the higher age groups, the risk of reinfarction at the fifth year of the follow up did not differ between sexes. In younger ages, however, the relative risk for females was higher than for males (RR 1.50; 95% CI 0.58-3.96). In conclusion, the observed sex specific differences depend on the effect of age. In higher age groups, differences by gender disappeared after controlling for age. There is a need for conduction of prospective study with a long follow up period to answer the questions of the observed by some authors worst prognosis in females survived AMI.
Key words: gender, myocardial infarction, prognosis
Address for correspondence:
K. Vitlianova, M. D., II Clinic of Internal Medicine, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, e-mail: k.vitlianova@abv.bg

 

Perioperative changes in immunoglobulins and acute phase proteins in patients with different extend of surgical intervention and impairment of nutritional status - 40, 2004, № 2, 50-54.
K.
Ikonomova (1), B. Miteva (1) and B. Borissov (2)
(1)National Transport Hospital “Tzar Boris III” – Sofia
(2)National Drug Agency
Summary: The aim of the study was to explore the perioperative changes in acute phase proteins, IgG, IgA, IgM in patients with different extend of surgical intervention and changes in nutritional status. Thirty six patients (26 males and 10 females, mean age 57,4 +/- 2,2 years) were divided into three groups. First group – 16 patients, undergoing major abdominal or chest-abdominal operations and impaired nutritional status. Second group – 9 patients, undergoing major abdominal or chest-abdominal operations and unimpaired nutritional status. Third group – 11 patients, undergoing minor surgical operations and unimpaired nutritional status. Before operation on the 12, 24, 48 and 96 hours, blood was taken for biochemical and immunological examinations. The nutritional status was determined using anthropometric methods and biochemical indexes – albumin and transferrin. Immunological parameters – alpha-1-antitripsin, alpha-1-acid glycoprotein, alpha-2-macroglobulin, ceruloplasmin, haptoglobin, C-reactive protein (CRP), IgG, IgA, IgM, were determined by radial immunodiffusion method. In patients with major abdominal or chest-abdominal operations and impaired nutritional status, CRP, alpha-1-antitripsin, alpha-1-acid glycoprotein were increased significantly in the postoperative period. IgG dropped in the middle of the postoperative period but at the end reached the initial values. Similar changes were detected in the patients with major abdominal or chest–abdominal operations and unimpaired nutritional status. In patients with minor surgical operations and unimpaired nutritional status, CRP elevation was established in the postoperative period. At the end of the period, CRP concentration dropped to the normal ranges. Changes in acute phase proteins were determined by the extend of the surgical intervention and the main surgical disease. They are stronger stimulants for the acute phase response than the changes in nutritional status.
Key words: surgical operations, nutritional status, acute phase proteins and immunoglobulins
Address for correspondence: K. Ikonomova, M. D., National Transport Hospital “Tzar Boris III”, 108, Maria Luiza Blvd., Bg - 1202 Sofia

 

Erythropoietin treatment of renal transplant patients in early posttransplant period - 40, 2004, № 2, 55-60.
E.
Paskalev
Clinic of Nephrology and Transplantation, University Hospital “Alexandrovska - Sofia
Summary: The use of recombinant human erythropoietin (rhEPO) for treatment of anemia in the first days after kidney transplantation is of great clinical importance. The goal of the study is to assess the effect of treatment with rhEPO on renal transplant patients in the early postoperative period. The study includes 27 renal transplant patients, which were treated with rhEPO in the early postoperative period. Doses were individually determined and were between 1000 to 5000 UI every day or every second day. Treatment was combined with intravenous iron supplementation. We analyzed the utilized doses and determined mean daily dose of 1715 UI and mean duration of treatment on 7 days (4 to 14). Lasting tendency to attain optimal high levels of hemoglobin we achieved when serum creatinine decreased under 180 mcmol/l or creatinine clearance increased over 32 ml/min. We attained these results most rapidly (for 4 to 9 days) in patients, which normalized fully renal function in the first 3-5 days, and slowly overcome anemia (for 9 to 14 days) patients with bleeding or infections. We made a comparison between the frequency of hemotransfusions in the study group – 22.2% with the frequency in an other group renal transplanted at one year before study period – 31.4%. The frequency in the second group was significantly higher (p < 0,05). The difference between both groups consists in rarely use of rhEPO treatment in the second group. We made a second comparison between the study group and a group (n = 10) of renal transplanted in the same period without rhEPO treatment. We achieved optimal hemoglobin levels in this group in mean 11.5 days. When we treated with rhEPO, the period of attaining optimal hemoglobin levels was reduced by 40% (p < 0.05). Treatment with rhEPO in early postoperative period is of great clinical importance and it is a necessary moment in the complex therapy of renal transplant patients.
Key words: renal transplantation, human recombinant erythropoietin, early postoperative period
Address for correspondence: Ass. 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, e-mail: emilpaskalev@abv.bg

 

Effect of supplementation with essential aminoacids and their ketoanalogues in patients on a continuous ambulatory peritoneal dialysis treatment - 40, 2004, № 2, 61-64.
L. Kambova, A. Koteva and Z. Kraev

Clinic of Dialysis, University Hospital “Alexandrovska”, Medical University - Sofia
Summary: Malnutrition is common in continuous ambulatory peritoneal dialysis (CAPD) patients and closely related to morbidity and mortality. The aim of the present study is to evaluate the influence of the supplementation with essential aminoacids and their ketoanalogues in patients with end stage renal disease on CAPD treatment. Twelve patients were investigated – average age of 52.01 years, average duration of dialysis treatment – 37.03 months, average duration of CAPD - 22.03 months. All patients were receiving epoetin at individual doses. In the group, there was a significant rise in the levels of albumin, total protein (p < 0.01) and significant decreased epoetin doses (p < 0.01). The results demonstrate improvement of the quality of life of patients on CAPD.
Key words: CAPD treatment, essential aminoacid, ketoanalogues, epoetin
Address for correspondence: Liliana
Kambova, M. D., Clinic of Dialysis, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, tel. + 359 2 923-04-63, e-mail: dr_kambova@abv.bg

 

Application of HSA 20% in the urgent toxicology practice - 40, 2004, № 2, 65-68.
J.
Radenkova-Saeva, F. Martinova, V. Trankova and A. Hubenova
Department of Hemotransfusion and Immunogenetics, Clinic of Toxicology, MHATEM “N. I. Pirogov
Summary: The authors studied the therapeutic effect of HSA 20% on 19 patients (7 men and 12 women), treated in the Clinic of Toxicology at MHATEM “N. I. Pirogov”. The patients were divided into 5 groups according to toxic substance (drugs, corrosive matters, mixed intoxications, Lyell’s syndrome etc.). The dose of HSA 20% was determined in accordance with the degree of intoxication, the patient’s condition, the value of total proteins, the complications. By use of human albumin, it was achieved correction of the hypoproteinemia, the protein balance normalized, exotic shock, septic state, lung edema were overcome. The preparation HSA 20% is indispensable for the therapeutic approach in substitutive way to acute poisonings, which are marked by extremely severe complications and protein disbalance.
Key words: HSA 20%, sepsis, intoxication, Lyell’s syndrome
Address for correspondence: Julia Radenkova-Saeva, M. D., Department of Hemotransfusion and Immunogenetics, Clinic of Toxicology, MHATEM "N. I. Pirogov", 21, Totleben Blvd., Bg - 1606 Sofia, tel. +359 2 91-54-346,
e-mail: jrsaeva2@yahoo.co.uk

 

Treatment of chronic lymphocytic leukemia with bendamustine hydrochloride - 40, 2004, № 2, 69-72.
G.
Arnaudov
National Center of Haematology and Transfusiology
Summary: Bendamustine hydrochloride is a new antineoplastic agent with alkylating effects. The medicine was tested in 15 patients with chronic lymphocytic leukemia (CLL) stage B and C after Binet resistant to treatment with leukeran. Three different ways have been used: 100, 110 and 120 mg/m2/d on two consecutive days every 4 weeks. DLT was observed in 5 cases: increased bilurubin – three cases, thrombocytopenia - one and diarrhea - one. No DLT was observed at a dose of 100 mg/m2. Response rate up to the sixth cycle of the treatment was: 40% complete remission and 20% partial remission. Bendamustine showed the least cross-resistance with leukeran and is fit for second line treatment of CLL.
Key words:   chronic lymphocytic leukemia/chemotherapy, bendamustine hydrochloride
Address for correspondence: Georgi Arnaudov, M. D., National Center of Haematology and Transfusiology, 6, Plovdivsko pole Str., Bg - 1756 Sofia, tel. +359 2 969-00-21

 

Some cardiovascular effects of Catha edulis - an amphetamine-like product widespread in Yemen - 40, 2004, № 2, 73-76.
M. Al-Saadi
(1) and M. Grigorov (2)
(1)
Clinic of Cardiology, Department of Medicine, Medical University – Plovdiv
(2)Clinic of Cardiology, II MHAT - Sofia
Summary:
The chewing of Khat (Cathа Edulis Forskal), a widespread plant in Yemen and East Africa, is a serious medicosocial problem. The amphetamine-like alkaloids cathinone and cathine, present in the plant are the main psychoactive substances, responsible for the sympathicomimetic effect of CE. 60 normal subjects were studied by recording 24 h - Holter ECG. The investigated subjects were divided into 2 groups. While the first group involved subjects, who tookkhat” for first time, in the second group were chronic consummators. The results of the investigations of the two groups demonstrated a sinus tachycardia and occurrence of supraventricular extrasystoles during chewing of Khat. In contrast with the chronic group, the increase of the heart rate in the first group was greater and with early appearance (1-2 h after starting of chewing in first group; 3-4 h in the second group).
Key words: Cathа edulis, cathinone, amphetamine, holter ECG
Address for correspondence: Mohamed Al-Saadi, M. D., Department of Medicine, Faculty of Medicine, Aden University, Yemen, e-mail: 30112000@maktoob.com

 

Investigations on serum levels of some placental angiogenic proteins in pre-eclampsia - 40, 2004, № 2, 77-80.
E. Dimitrakova
(1) and D. Dimitrakov (2)
(1)Chair of Gynecology and Obstetrics, Medical University - Plovdiv
(2)Department of Internal Diseases, Medical University - Plovdiv
Summary: A number of circulating placenta-produced factors has been implicated in causing the endothelial dysfunction and the clinical phenotype characteristic of pre-eclampsia. Aim was to determine the serum levels of placental soluble fms-like tyrosine-kinase-1 (sFlt-1) and placental growth factor (PLGF) in pre-eclamptic pregnant women. Twenty two preeclamtic pregnant women and 18 healthy pregnant women (controls) were included in the study. Determination of sFlt-1 and PLGF was done with ELISA. The mean serum sFlt-1 levels of pre-eclamptic pregnant women were seven folds as high as that of normal pregnant women. Parallel with the increase in the sFlt-1 level, there are decreases in the free PLGF levels (r = -0,673). sFlt-1 and PLGF to be involved in the pathogenesis of pre-eclampsia and their serum levels can be used as a diagnostic marker of pre-eclampsia.
Key words: pre-eclampsia, sFlt-1, PLGF
Address for correspondence:
E. Dimitrakova, M. D., Chair of Gynecology and Obstetrics, Medical University, 15A V. Aprilov Blvd., Bg - 4002 Plovdiv

 

1/2004

Importance of the human immunodeficiency virus (HIV) as a factor driving the evolution - 40, 2004, № 1, 38-42.
R. Аrgirova
Laboratory for Retroviruses, National Center of Infectious and Parasitic Diseases - Sofia
Summary: Twenty years of HIV/AIDS research is being widely commemorated in 2003. The great achievement in diagnosis and therapy of HIV infection transformed it into a chronic disease. Today, under the conditions of effective etiological treatment but no virus eradication and anti-HIV vaccine, we should be clear about the short-term and long-term consequences of HIV-pandemic on medical science. The paper enlightens a number of short-term consequences – concerning mainly the HIV-infected individual – as emerging and transmission of drug resistant mutants, as well as of some long-term impacts - jumping the species, sometimes even class-barriers by so far non-human agents, acquiring at the same time increased virulence and pathogenicity. The impact of immuno-compromised by HIV terrain for the success of immunization programmes is also described, actualization of legislation on diagnosis and treatment of HIV/AIDS is recommended.
Key words: HIV infection, cross-species barriers, emerging infectious agents
Address for correspondence: Prof. Radka Argirova, M.D., Laboratory for Retroviruses, 44-A Stoletov Blvd., Bg - 1233 Sofia; e-mail: argirovaradka@hotmail.com

Prevalence of viral hepatitides in the Bulgarian army - clinicаl and epidemiological analysis for the period 1996-2002- 40, 2004, № 1, 43-49.
G. Popov
Clinic of Infectious, Parasitic and Тropical Diseases, Military Medical Academy - Sofia
Summary: The prevalence of viral hepatitidеs in the relatively closed army staff has some specifities. The purpose of the present research is to analyse the spread of viral hepatitides in Bulgarian army for the period of seven years. From 01.01.1996 to 31.12.2002, we registered 2020 cases of viral hepatitides. We studied the etiological characterization, seasonal dynamics and age structure. We analysed the incidence by army contingents. There is emphasized on the characteristic of the epidemic process in hepatitis A with outbreaks through 1996/1997 and 2001. It is concluded that is a tendency to increased number of military personnel suffering from viral hepatitides, shift in the most often affected by the di-seases age group from the first to the second and third decade, shift of the peak of the most common incidence towards winter-spring season. There is discussed the necessity of introducing obligatory immunoprophylaxis by vaccination against hepatitis A virus of the recruits.
Key words: viral hepatitis, Bulgarian army
Address
for correspondence: Georgi Popov, M. D., Clinic of Infectious, Parasitic and Тropical Diseases, Military Medical Academy, 3, Sv. Georgi Sofiiski Str., Bg – 1431 Sofia, e-mail: popovg@abv.bg

Treatment of renal anemia in chronic renal failure: Is there a relationship between therapeutic result and administering mode of erythropoietin? - 40, 2004, № 1, 50-54.
V. Todorov(1), P. Stavrev(2), P. Martev(3), P. Shikov(4) and A. Mincheva(5)

(1)Clinic of Nephrology and Dialysis, UMHAT – Pleven
(2)Clinic of Nephrology and Hemodialysis, UMHAT – Plovdiv
(3)Center of Hemodialysis, MHAT - Asenovgrad
(4)Center of Hemodialysis, MHAT – Pazardgik
(5)Center of Hemodialysis, MHAT – Targovishte
Summary: The aim of this study is to evaluate the causal connection of subcutaneous (s.c.) and intravenous (i.v.) application of erythropoetin with correction of renal anemia in patients undergoing chroniohemodialysis treatment. 108 patients were divided into two groups and were followed for a period of 12 weeks. All patients have been treated before with epoetin for a time more than 6 months. During the first 6 weeks, they were treated with epoetin beta injected s.c. During the last 6 weeks, they were treated with epoetin alfa injected i.v. The dose of epoetin, administered i.v. was rised by 25,3 UI/kg BW/per week, or by 1692 UI/patient/per week, or by 30,6% in the first group. The dose of epoetin administered IV has not been changed in the second group. The differences between average hemoglobin and hematocrit levels during the periods of s.c. and i.v. epoetin treatment in the first group were not significant. It has been registered a significant fall of the same indices at the end of the second period in the second group. The average cost of the epoetin treatment calculated on the basis of the epoetin dosage in the first group is 5276 ± 1980 leva/patient/year in s.c. treatment and 6891 ± 2455 leva/patient/year in i.v. treatment. The results of the study confirm the rule that s.c. application of epoetin is significant more effective and economiccally more profitable than i.v. application.
Key words: chronic renal failure, hemodialysis, renal anemia, erythropoietin
Address
for correspondence: Ass. Prof. Vasil Todorov, Clinic of Nephrology and Dialysis, University Hospital, 8A, G. Kochev Str., Bg - 5800 Pleven, tel. +359 64 21023, e-mail: vastod@abv.bg

Clinical experience in the treatment of early glotтic carcinoma - 40, 2004, № 1, 55-57.
L. Popov, K. Kunev, S. Raikov and S. Valcheva

I ENT Clinic, University Hospital "Tzaritza Ioanna" – Sofia
Summary: The aim of this article is to prеsent the therapeutic experience of the team of I ENT Clinic at the University Hospital "Tzaritza Ioanna" - Sofia, in patients with primary early laryngeal squamous cell carcinoma (T1-2N0M0) according to the AJCC - 1987. We analyzed the period between 1990-2000. The number of the hospitalized patients with primary laryngeal squamous cell carcinoma in early stage was 89. The correlation between T1 and T2 was 1:20. The patients aged between 50 and 60 years most frequently were affected. 86 of them were men - tobacco smokers and/or regularly alcohol users. Only 3 of the patients were females. The period between the onset of the complaints and the pathohistological verification was about three months, unfortunately with a tendency to increasing.
Key words: early laryngeal carcinoma, surgery, retrospective analysis
Address for correspondence: Liuben Popov, M. D., ENT Clinic of Children, University Hospital "Tzaritza Ioanna", Bg - 1527 Sofia, tel. + 359 943-25-92, е-mail: liubenp@yahoo.com

Lipid profile in hemodialysis patients on erythropoietin treatment** - 40, 2004, № 1, 58-60.
D. Yonova(1), R. Garsia(2) and F. Valderrabano(2)

(1)Dialysis Clinic, University Hospital "Alexandrovska" - Sofia, Bulgaria
(2)Nephrology, Dialysis and Transplantation Clinic, General University Hospital "G. Maranjon" - Madrid, Spain
Summary: The points of view on the influence of human recombinant erythropoietin (Epo) on lipid profile in patients on HD are controversial. This retrospective study offers a comparison of this profile at the beginning of Epo and HD treatment with the later phases when the red blood parameters are reaching normal leves. Target Hb values have been 110-120 g/l and Htc 0.35-0.40 IU/l. Serum levels of T-C, Tg, LDL-C, HDL-C, Apo-A1, Apo-B, Lp(a) were followed before start of Epo treatment and yearly in 34 patients (each of them started HD and Epo in different months and years) during a 3-year period. Hb, Htc, ferritin (F) and Kt/V (kept > 1.2) have been registered monthly. The results showed significant elevation of Apo-A1 and no other changes in lipid parameters. Hb and Htc increased after the 4th month of Epo treatment. According to the study, Epo does not affect lipid profile in HD patients during the treatment and maintaining period and is not substantial in the control of lipid status in these patients.
Key words: haemodialysis, erythropoietin, lipid profile
Address for correspondence: Diana Ionova, M. D., Clinic of Dialysis, University Hospital "Alexandrovska", 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, tel. + 359 923-04-63, 923-05-15, e-mail: dr_ionova@email.com

The role of the plant Catha edulis in the occurrence of dilated cardiomyopathy - cases in Yemen - 40, 2004, № 1, 61-64.
M. Al-Saadi(1) and M. Grigorov(2)

(1)Clinic of Cardiology, Department of Internal Medicine, Medical University – Plovdiv
(2)Clinic of Cardiology, II MHAT – Sofia
Summary: Catha edulis is a plant, whose leaves are chewed in East Africa and Arab peninsula for their psychostimulant effect. Among the various compounds present in the plant, the phenylalkylamines cathinone and cathine are the main sympathomimethic ingredients. The study included 50 Yemeni patients and was conducted by using clinical, radiological, electrocardiographic, echocardiographic and histopathological methods. We investigated the role of different risk factors like catha chewing, alcohol consumption, family history for heart failure, hypertension, I.H.D, diabetes mellitus etc. The study revealed that catha chewing is a significant risk factor in the younger patients (20-50). The clinical and the echo-manifestations showed various forms. The histopathological investigation showed a myocyte hypertrophy and interstitial fibrosis. The study concluded that the consumption of "Chat" contributes to the occurrence of D.C.M. in the young patients with inherited predisposition.
Key words: Catha edulis, dilated cardiomyopathy, risk factors
Address for correspondence: Mohamed Al-Saadi, M. D., Department of Medicine, Faculty of Medicine, Aden University, Yemen, e-mail: 30112000@maktoob.com

Clinical and electromyographic investigations in patients with neuropathy and chronic obstructive pulmonary disease - 40, 2004, № 1, 65-68.
J. Petrova
Clinic of Neurology, University Hospital "Alexandrovska" – Sofia
Summary: We investigated 36 patients with COPD. Reflexes of upper extremities were normal in all patients. The changes in lower extremities were: Reduced knee reflexes – in 16.67% and Achilles’ reflex – in 24.97%; the muscle tonus of upper and lower extremities was normal in all the patients. The distal muscle strength of upper and lower extremities was reduced in 2 patients (5.56%). Hypesthesia was found in 9 patients (25%) for upper and lower extremities. EMG investigations showed involved sensitivity almost equally for n. ulnaris (17%) and n. medianus (15%). N. suralis didn’t respond in 14% of patients and was with abnormal parameters in 14%. MCV for lower extremities had abnormal parameters in 15% for n. fibularis and 13% for n. tibialis. It was found a correlation between the MCV and the functional parameters of COPD. These data give an opportunity to determine the pathophysiological profile of the neuropathy as sensory and sensory-motor.
Key words: chronic obstructive pulmonary disease, neuropathy, pathophisyological profile, EMG
Address for correspondence: Julia J. Petrova, Laboratory of Vegetology and Doppler Sonography, Clinic of Neurology, University Hospital "Alexandrovska", 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia

Laboratory involvement in three priority programs of the National Health Insurance Fund: theory and realization - 40, 2004, № 1, 68-74.
V. Tsoneva, R. Katsarova, D. Bekiarov, J. Krusteva and N. Atanasov

University Hospital, Thracian University – Stara Zagora
Summary: The prophylactic programs with laboratory involvement are often budgeted separately to assess their effectiveness. In 2001, National Health Insurance Fund (NHIF) financed laboratory tests for patients and priority programs (PP), which imposes a delicate balance between both health services without providing clear information on their effectiveness. Goal of our study was a critical appraisal of the laboratory results in three PP of NHIF, 2001. Methods applied were: SWOT-analysis, based on the number of tested individuals, the results beyond the cutoff values defined by NHIF, reference intervals, central 95% interval and costs. Following results were obtained in PP "Healthy Individuals Aged over 65" 2,225 analyses were performed on 341 persons for 1956.80 leva. Total cholesterol (TC) over 5.0 mmol/l (NHIF) was found in 252 out of 334 individuals (75.4%), anemic syndrome (AS) in 81 out of 340 (23.8%) and glycemia (g) over 6.1 mmol/l (NHIF) in 17 out of 310 (5.5%). In PP "Arterial Hypertension", 1,649 analyses were performed on 247 individuals for 1468.70 leva. TC over 5.0 mmol/l was found in 213 out of 247 individuals (86.2%), AS in 23 out of 245 (9.4%) and g over 6.1 mmol/l in 20 out of 245 (8.2%). In PP "Diabetes Mellitus", 961 analyses were performed on 144 persons for 851 leva. TC over 5.0 mmol/l was found in 109 out of 142 individuals (76.8%), AS in 21 out of 204 (10.3%) and g over 7.0 mmol/l (NHIF) in 109 out of 144 (75.7%). It is concluded that a misfit with theoretical requirements may be the possible cause for the unbelievable high number of individuals with obscure follow-up or treatment, as well as for the dubious effectiveness of the performed PP.
Key words: prophylactic programs, laboratory results, screening
Address for correspondence: Vania Tsoneva, M. D., Central clinical laboratory, University Hospital, 11, Armeyska Str., Bg - 6000 Stara Zagora

Comparative study of the efficacy, tolerability and adverse effects of voltaren 50 mg tablets, diclac 75 mg and diclofenac duo 75 mg in the treatment of patients with osteoarthritis - 40, 2004, № 1, 75-79.
A. Toncheva
(1) and B. Bochev(2)
(1)Clinic of Cardiology and Rheumatology - NMTH "Tzar Boris III" - Sofia
(2)Clinic of Orthopaedy - NMTH "Tzar Boris III" – Sofia
Summary: Here we present the results of the research on the effect, tolerability and adverse effects in three groups of patients suffering from osteoarthritis, who received during a ten-day period 150 mg voltaren, diclac or diclofenac duo, respectivelly. With all three drugs, we observed good therapeutical effect. With reference to the side effects, the most cases (7) occured in the group of patients treated with voltaren, the most severe unwanted drug reactions were obseved in the group treated with diclac. The smallest number of adverse effects (2) had the patients treated with diclofenac duo. One hundred per cent of the patients treated with diclofenac duo gave excellent and very good evaluation of the drug against 90% in the other two groups. Only one patient of those treated with diclofenac duo stopped his treatment due to unwanted side effects against 3 patients from the other two groups. These results make diclofenac duo the drug of proper choice for symptomatic treatment of patients with osteoarthritis.
Key words: diclofenac natrium, osteoarthritis, tolerability, side effects
Address for correspondence: Antoaneta Toncheva, M. D., Clinic of Cardiology and Rheumatology, NMTH "Tzar Boris III", 108, Maria-Luiza Blvd., Bg - 1202 Sofia

 

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