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 Original papers

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Vol. 47, 2011

 

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4'2011

Glomerular damage in patients with psoriasis - 47, 2011, № 4, 41-44.
R. Robeva(1), M. Yordanov(1), A. Kostadinova(1) and T. Todorov(2)
(1)Department of Internal Diseases, МU -- Sofia, (2)Department of Pathoanatomy, МU -- Sofia
Summary: The combination of immune related diseases is well known. The renal damage is not frequent in patients with psoriasis, but cases of IgA, membranous, membranoproliferative glomerulonephritis and FSGS are described. We present five cases of this association: two mesangioproliferative GN with and without IgA deposition, one membranous GN, one FSGS and one lupus nephropathy. All of them were treated with immunomodulatory therapy with good results in 4 patients concerning renal injury and amelioration of skin damages in all. Because of restricted number of cases and lack of specific histological manifestations, the existence of psoriatic nephropathy remains uncertain. In view of the large he­terogeneity in our material and in the literature, we are more likely to assume that this is a more frequently association of immune diseases with link points in their immune pathogenesis.
Key words:  psoriasis, glomerulonephritis
Address for correspondence: Assoc. Prof. R. Robeva, Clinic of Therapy of Internal Diseases, Nephrology, Dyalisys and Clinical Pharmacology, UMHAT “Sv. Iv. Rilski”, 15, Acad. Iv. Geshov Blvd., Bg -- 1431 Sofia, tel. +359 2 8510846

 

 

Individual approach in immunosuppressive therapy after kidney transplantation - 47, 2011, №  4, 45-48.
E. Paskalev
Department of Nephrology and Kidney Transplantation, University Hospital “Alexandrovska” -- Sofia
Summary:  Kidney transplantation is an optimal treatment of chronic renal failure. There is a significantly prolonged survival of both allograft and patient in result of advances in immunology and immunosuppressive therapy. The goal of the study is to characterize the individual approach in immunosupressive treatment in renal transplanted patients. We tested 445 renal transplants and their immunosuppressants. A characterization of all immunosuppressive regimens was made. Immunosuppression after kidney transplanation is characterized by use of all contemporary immunosuppressants and their combinations in order to decrease the frequency of rejections, increase allograft survival, reduce side effects, and optimize immunosuppressive regimens for prevention of posttransplant cancers. Immunosuppression is presented with many combinations whichis very important for individual approach in imminosuppressive treatment.
Key words:  kidney transplantation, immunosuppression, individual approach
Address for correspondence: Assoc. Prof. Emil Palkalev, M. D., Department of Nephrology and Kidney Transplantation, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg -- 1431 Sofia, tel. +359 2 9230 333, e-mail: emilpaskalev@abv.bg

 

 

Anemia correction in predialysis patients with chronic renal failure with CERA (Mircera) administered once monthly - 47, 2011, № 4, 49-52.
M. Lubomirova(1), I. Asenova(2) and Kr. Ashikova(3)
(1)Clinic of Nephrology, UMHAT “Aleksandrovska” -- Sofia, (2)MHAT -- Моntana, (3)MHAT „ Sv. Аnna ‘’ -- Sofia
Summary: The aim of the study is to follow up the hemoglobin (Hb) levels when CERA (Mircera) was administered once monthly for correction of renal anemia. 29 patients, 11 M and 18 F, average age 64.68 +/- 12,94 years, mean duration of chronic renal failure 2.89 +/- 1,47 years and anemia duration 1.60 +/- 0.85 years were examined. Renal function was assessed by Cockcroft-Gault formula. Mean serum creatinine was 210 +/- 64.39 mcmol/l. The mean dose of Mircera was 100 mcg monthly (1,2 mcg/kg monthly) administered once per month. The mean hemoglobin level before treatment was 9,91 g/dl, at the 6th month of treatment it was 11,83 g/dl. CERA (Mircera) was well tolerated, when administrated once monthly. Based on this regime, target levels of Hb were reached and they were stable.
Key words:  chronic renal failure, anemia, long-acting erythropoietic stimulant, CERA, Mircera
Address for correspondence: Mila Lubomirova, M. D., Clinic of Nephrology, UMHAT “Aleksandrovska”, 1, Sv. G. Sofiiski Str., Bg -- 1431 Sofia, tel. +359 2 9230229, e-mail: Mljubomirova@yahoo.com

 

 

Study of the economic results of pharmaceutical policy on cancer in 2011 - 47, 2011, № 4, 53-60.
T. Vekov
Commercial League National Pharma Center
Summary:  The article discusses results of the change (at the end of 2010) made by the decision of the Ministry of Health (letter 91-00-229/23.12.2010 to directors of hospitals) in the way of negotiation, supply and use of medicinal products intended to treat cancer (regulation by Decree № 34/25.11.2005). Provided is a comparative cost analysis. A warrant disturbing fact to note is that due to implementation of changes all the controls to ensure effectiveness are removed -- limited drug quantities consistent with the budget, reference price (based on the lower price of eight reference countries and the price of the previously negotiated and legislated specification products through Ordinance № 34/25.11.2005). As a result of the reforms on oncology anticancer drug prices increased by an average of 68.64%. Direct consequence of the increased prices is the increased value of the same quantities of medication in 2011 compared to 2010 by approximately BGN 12.5 million (16.17%). It should be noted that for the increase of prices in 2011 there are some additional factors as the inclusion of new proprietary and expensive products to the specifications of the hospitals, as well as mostly overall replacement in therapeutic protocols with similar proprietary therapeutic products from the same pharmaceutical manufacturers, whose prices are much higher.
Key words:  medicines for cancer/drug supply, regulatory changes, negotiation
Address for correspondence:  Assoc. Prof. Toni Vekov, Commercial League National Pharma Center, 1, G. M. Dimitrov Str., Bg -- 1172 Sofia, tel. +359 2 962 54 54, fax +359 2 962 50 59, e-mail: t.vekov.hq@comleague.com

 

 

Integral health evaluation of children living in an environment with different level of air pollution and socioeconomic conditions - 47, 2011, №  4, 61-65.
T. Turnovska(1), B. Marinov(2) and S. Mandadzhieva(2)
(1)Department of Hygiene, Ecology and Epidemiology, (2)Department of Pathological Physiology, Medical University -- Plovdiv
Summary: In the recent years, during the transition to market economy, the ecological conditions in Bulgaria were alleviated due to the reduction and shutting down of a number of productions polluting the environment. Several trials showed marked improvement of health indices in children living at reduced levels of air pollution. The socioeconomic situation at that time was characterized by higher rate of unemployment, deficient nutrition and a lot of stress. Having in mind that cardiopulmonary exercise test gives integral evaluation of the functional reserve, we aimed at measuring the functional capacity of two groups of children living in an environment with different level of air pollution and socioeconomic conditions, assessed by parents’ education. The first group, constituted of 66 clinically healthy children, aged 13.30 +/- 0.46 y. (X +/- SD), was living at a higher level of air pollution than the second group (61 clinically healthy children aged 13.41 +/- 0.50 y.) belonging to families in which the parents had lower level of education. The cardiopulmonary test was carried out on tradmill TrackMasterTM (Jass Fitness Systems, USA). The results showed that the children in the second group had lower functional capacity in spite of better ecological conditions for them. This corresponds to the lower level of their parents’ education. Concluded is that low level of socioeconomic status among teenagers is of decisive importance for their functional capacity towards negative influence of low level of air pollution.
Key words:  air pollution, cardiopulmonary exercise test, socioeconomic conditions
Address for correspondence: Assoc. prof. T. Turnovska, M. D., 24, Lozengrad Str., Bg -- 4000 Plovdiv, е-mail: turnovt@yahoo.com

 

 

Influence of artificial perfluorocarbon blood FC-43 emulsion on gross morphological, histologic and cellular structure of the lung, on arterial blood gases and acid-base balance in rabbits - 47, 2011, № 4, 66-72.
E. Yanev(1), S. Lazarov(1), M. Balutsov(1), A. Momchilova(2) and R. Pancov(3)
(1)Department of Pathophysiology, Medical University -- Sofia, (2)Institute of Biophysics, BAS -- Sofia, (3)Biological Faculty, University of Sofia “Sv. Kl. Ohridski”
Summary: Artificial blood, containing perfluorocarbon substances, is a preferable means for complete or partial substitution of the circulating blood in case of a lack of whole blood or erythrocyte mass. It is used for perfusion of organs in case of acute hemorrhages. Perfluorocarbon substances are excreted and released from the human body through the lungs. Two or three weeks are needed for their complete elimination. There is a possibility for structural and functional injury of the alveolar surfactant. That’s why we investigated the АS of rabbits, perfused by artificial perfluorocarbon blood FC-43 emulsion. We studied the gross morphological, histologic and cellular structure of the lung, blood acid-base and arterial blood gas balance. No statistically significant alterations have been observed in the investigated parameters between control and experi­men­tal values.
Key words:  Lung parenchyma, pulmonary surfactant system, artificial perfluorocarbon blood FC-43 emulsion, acid-base аnd arterial blood gas balance
Address for correspondence: Simeon Lazarov, M.D., Ph.D., Department of Pathophysiology, Medical Faculty, Medical University, 1, Sv. G. Sofiiski Str., Bg -- 1431 Sofia, tel. +359 897 751 493, е-mail: maks2000@abv.bg

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3'2011

Survey of registered regional cancer incidence in two settlements in the Plovdiv region for 15 years 47, 2011, 3, 27-33.
R. Dimova(1), N. Ananoshtev(2), R. Dimov(3) and T. Apostolova(2)
(1)Department of Healthcare Management, Health Economic and Primary Care, Medical University -- Plovdiv, (2)Regional Cancer Centre -- Plovdiv, (3)ІІІth Surgery, Medical University -- Plovdiv
Summary: The aim of the study was to analyse the cancer incidence in two villages with approximately the same demographic characteristics (number of inhabitants and age structure). Analysed were registered cancer diseases from two villages for 15 years. Used were statistical analyses: variational, alternative, nonparametric, graphical, direct method of standardization, survival analysis and analysis of dynamic changes. A higher cancer incidence in persons over 60 years old for the village Trud compared with Parvenets was registered. The study revealed a statistical significant difference between locoregional cancer incidence in both settlements, which is higher for village Trud. The absolute growth of new registered cases of cancer for a 15-year period, based on 1994, shows an increase only of colorectal carcinoma, cancers of the male reproductive system and breast cancer. Results show an average five-year survival rate of 45% in women with breast cancer.
Key words: locoregional incidence, cancer diseases, survival
Аddress for correspondence: Rositsa Dimova, M. D., Ph. D., Department of Healthcare Management, Health Economic and Primary Care, Medical University, 15A, Vasil Aprilov Str., Bg -- 4000 Plovdiv, tel. +359 32 60 20 39, GSM +359 887 36 30 22

 

 

Trichinellosis -- clinical and epidemiological data concerning an outbreak in Sofia - 47, 2011, 3, 34-36.
K. Vutova(1), A. Gotseva(1), M. Tiholova(1), I. Atanasova(2), R. Chipeva(1), V. Velev(3), Z. Sabit(3) and S. Petkova(4)
(1)Department of Infectious, Parasitic and Tropical Diseas es, MU -- Sofia, (2)RIPCPH -- Sofia, (3)Department of Biology, MU Sofia, (4)Institute of Experimental Morphology, Pathology and Anthropology with Museum -- BАS
Summary: Eight cases from one family with trichinosis were treated. The diagnosis was made based on clinical symptoms, hematological, serological and epidemiological data. All patients were hospitalized in serious condition with high fever up to 40°C, myalgia, neck oedema, swelling of the face, skin rash. Leucocytosis (from 16.8 to 32.6 G/l), eosinophilia (from 0.20 to 0.46), elevated creatinine phosphokinase (up to 5028 U/l) and liver transaminases (AST up to 433 U/l, ALT up to 476 U/l) were established. Positive serological methods -- hemagglutination test (HAT) titer up to 1:25 600. After treatment with Albendazole (Zentel) 10 mg/kg for 7-10 days, corticosteroids, antihistamines and intravenous infusions, the patient's condition improved. There was consumed infected meat of domestic pig, reared in the courtyard that was not tested for trichinosis, but in the wild rats caught nearby Trichinella invasion was found.
Key words: trichinellosis, fever, myalgia, eosinophilia, leukocytosis, creatine-phospho­ki­nase, albendazole, domestic pig, rodents
Address for correspondence: V. Velev, M. D., Department of Biology, Medical University, 2, Zdrave Str., Bg -- 1431 Sofia, е-mail: velev_md@mail.bg

 

 

Genetic heterogeneity of rotavirus strains circulating in Bulgaria over the period 2005-2009 - 47, 2011, 3, 37-42.
N. Korsun(1), Z. Mladenova(1), I. Aleksiev(1) and A. Steyer(2)
(1)National Centre of Infectious and Parasitic Diseases -- Sofia, (2)Medical Faculty -- Lubliana, Slovenia
Summary: Group A rotaviruses are the most common causes of severe gastroenteritis in children aged < 5 leading to hospitalization. During the period 2005-2009, a total of 4640 stool specimens were collected from children hospitalized with acute diarrhea. Group A rotaviruses were identified in 1604 (34,5%) of these specimens. The most common rotavirus strains were G1P[8], G2P[4], G4P[8] and G9P[8]. The VP7 (G) and VP4 (P) genes were sequenced and 38 sequences were analysed. Genetic analysis of some uncommon human strains exhibited the highest nucleotide identity with another human strains. Sequence data of few strains revealed the closest identity with animal rotavirus strains.This study presents close evolutionary links between rotavirus strains, circulating in Bulgaria and contemporary human and animal rotaviruses, detected in other countries.
Key words: rotavirus, genotype, diarrhea, vaccine, sequence
Address for correspondence: Assoc. Prof. Neli Korsun, M. D., Department of Virology, National Centre of Infectious and Parasitic Diseases, 44A Stoletov Blvd, Bg -- 1233 Sofia, tel. +359 2 931 81 32, e-mail: neli_korsun@abv.bg

 

 

Epidemiological trends of respiratory diseases among workers in brown coal mines and led-zinc ore mining - 47, 2011, 3, 43-49.
E.  Petrova
Tokuda Medical Center -- Sofia
Summary: A cross-sectional case-control study of dust exposed and non-exposed workers (1538 p. -- from brown coal mining, 291p. -- from led-zinc ore mining, and 92 p. -- from construction materials mining) was performed. An anamnesis for occupational risk factors, for subjective symptoms, alcohol drinking, and to­bacco-smoking, as well as physical examination, chest radiography, spirometry, and electrocardiography were performed. A statistical analysis was done. The aim was to establish the epidemiological trends of respiratory diseases among coal and ore miners and to preparе a program for early diagnostics by respiratory screening and surveillance. Borderline 0/1, 1/0 р, q pneumoconiosеs among 805 (52.2%) coal miners, 188 (61.4%) ore miners, and 33 (36.3%) mi­ners of construction materials were detected. 1/1+р, q manifest pneumo­coniosеs and welders' pneumoconiosеs were established among 19 (1.2%) brown coal miners and 6 (0.4%) welders. High shares of chronic bronchitis (46 -- 3,0%) among mine workers from brown coal mining and from orе mining were found. Toxic pulmonary fibrosis in 2 (0.1%) workers from brown coal mining was found. Single cases of basal pulmonary fibrosis, bronchial asthma, and pulmonary embolism were detected in brown coal and ore miners. The established trend of high share of borderline pneumoconiosis, manifest pneumoconiosis, and COPD among Bulgarian coal and ore miners requires systematic screening and surveillance over an one-year period, including anamnesis, physical examination, chest radiography, spirometry, and electrocardiography.
Key words: mining, dust exposure, epidemiology, pneumoconiosis, COPD
Address for correspondence: Prof. Elisaveta Petrova, M. D., Ph. D., DSC, Tokuda Medical Center, 51B, Nikola Vaptsarov Blvd., Bg -- 1407 Sofia

 

 

Effects of ambroxol on the phospholipid composition of the alveolar surfactant in septic respiratory distress syndrome caused by an experimental fecаl peritonitis - 47, 2011, 3, 50-54.
S. Lazarov(1), A. Momchilova(2), R. Pankov(3), R. Nikolov(4) and E. Yanev(1)
(1)Department of Pathophysiology, Medical University -- Sofia, (2)Institute of Biophysics, Bulgarian Academy of Science -- Sofia, (3)Faculty of Biology, University ”Sv. Kliment Ohridski“ -- Sofia, (4)Department of Pharmacology and Toxicology, Medical University -- Sofia
Summary: The respiratory distress syndrome in adults (RDS) is developed by irreversible structural and functional injuries in the lung surfactant system (LSS) mainly in the alveolar surfactant (AS). ARDS may occur as serious complication of the Gram-negative sepsis and septic shock in patients with acute peritonitis. The most studied adjuvant drugs for the treatment of ARDS are different antioxidants. In the present study, we investigated the effects of low molecular antioxidant ambroxol on the phospholipid composition of the АS in experimental model of septic RDS in rats. We studied the total phospholipids and quantity of the main phospholipid fractions in the AS, percent distribution of the phospholipid fractions, and ratio between surfactant phospholipids. Intraperitoneal administration of ambroxol in rats with experimental model of septic respiratory distress syndrome caused increasing of the total phospholipids, as well as favourable change in the phospholipid fractions of the alveolar surfactant.
Key words: adult respiratory distress syndrome, alveolar surfactant, аcute fecаl peritonitis, ambroxol, sepsis, surfactant phospholipids
Address for correspondence: Simeon Lazarov, M.D., Ph.D., Department of Pathophysiology, Medical Faculty, Medical University, 2, Zdrave Str., Bg -- 1431 Sofia, tel. +359 897 751 493

 

 

Informal patient payments under conditions of a financial crisis -- Bulgaria, 2011 - 47, 2011, 3, 55-59.
T. Vekov
Faculty of Public Health, Medical University -- Pleven
Summary: This article presents the results of a survey of patient opinion on informal payments for medical care. The results of the survey conducted for the period January-March 2011 show that in times of financial crises, the pressure of unacceptable informal payments exerted on patients by doctors is increasing. Ve­ry often, particularly in major surgery, the amount of informal patient payments exceeds clinical pathway costs, reimbursed to the hospital by the compulsory health insurance fund. This is a real barrier to health care access. Patients with additional voluntary health insurance are more rarely exposed to informal payment pressure.
Key words: health, health insurance, informal patient payments, financial crisis
Address for correspondence: Assoc. Prof. Toni Vekov, Bulgarian Cardiac Institute, 1, G. M. Dimitrov Str., Bg -- 1172 Sofia, tel. +359 2 962 54 54, fax +359 2 962 50 59, e-mail: t.vekov.hq@comleague.com

 

 

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HELPING PRACTICE

Quick methods for detection of vitamins A, C and E in cosmetic products - 47, 2011, 3, 70-72.
A. Tachev
National Center of Public Health Protection -- Sofia
Summary: The most effective influence of vitamins A, C and E on the skin is achieved by combining them in special complexes; as a result of this their increased optimal application results have been observed. The combination of vitamins A, C and E normalizes the process of removal of dead cells from the skin’s surface, stimulates the regeneration of the epidermis and restores the natural water-lipid balance of the skin. Combining vitamins A, C and E in one preparation can guarantee maximum protection against free radical damage. In referent methods published for checking the composition of cosmetic products (Annex No.10 of the Ordinance No.36), no methods have been found for detection of vitamins A, С and Е in cosmetic products. Therefore, the necessity of developing a method for the needs of control has arisen. Simple and good qualitative methods for quick detection of vitamins A, C and E have been developed, which can be used in the control of cosmetic products.
Key words: cosmetic products, free radicals, vitamins A,C, E
Address for correspondence:
Аnton Tachev, National Center of Public Health Protection, 15, Iv. Geshov Blvd., Bg -- 1431 Sofia, е-mail: a.tachev@ncphp.government.bg

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2'2011

Parenterally transmissible hepatitis viruses in clinically diagnosed cases of acute hepatitis and chronic liver diseases - 47, 2011, № 2, 24-31.
L. Ivanova(1), I. Kotsev(2), D. Radkova(3), M. Atanasova(2) and Zh. Stoykova(1)
(1)Laboratory of Clinical Microbiology and Virusology, UMHAT “Sv. Marina”, (2)Clinic of Gastroenterology, UMHAT “Sv. Marina”, (3)Clinic of Infectious Diseases, Medical University -- Varna
Summary: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are among the most prevalent in humans worldwide. Hepatitis D virus (HDV) infection occurs either as a coinfection or superinfection in HBV positive persons. The aim of the study is to determine the relative deal of parentally transmissible hepatitis viruses in clinically diagnosed cases of acute hepatitis and chronic liver disease patients in North Eastern Bulgaria during the period 2002-2009. A total of 2250 clinically diagnosed acute hepatitis patients and 1648 chronic liver disease patients were investigated. The serum samples were tested for the various HBV markers, anti-HCV and anti-HDV, using separate ELISA kits. Of the 2250 acute hepatitis patients investigated, the relative deal of HBV was 14.66%, and of HCV -- 3.28%. Coinfection or superinfection with HDV was confirmed in 7.57% and with HCV -- in 4.8% of the HBV positive cases. Triple infections were proved in 1.8% of them. Of the 1648 chronic liver disease patients, HBV positive were 26.57% and anti-HCV 13.8% of the patients. Dual HBV/HDV infection was proved in 10.7% of the HBV positive cases and with HCV -- in 3.4%. Four (0.91%) of the HBV positive patients were positive for HBV, HCV and HDV. HBV is the more common causative agent of acute viral hepatitis than HCV (p < 0.01). HBV infection is the main cause of chronic liver diseases in North- Eastern Bulgaria. Screening of the clinically diagnosed patients for all viral causes of hepatitis is essential for establishing diagnosis and permitting detection of the co/superinfected.
Key words: HBV, HCV, HDV, acute viral hepatitis, chronic liver diseases
Address for correspondence: L. Ivanova, M. D., UMHAT “Sv. Marina”, MU, 1, Hristo Smirnenski Blvd., Bg -- 9010 Varna, e-mail: liivanova @abv.bg

 

 

Orbital and periorbital metastatic lesions. Surgical treatment of 34 cases - 47, 2011, 2, 32-39.
Chr. Tsekov(1), T. Spiriev(1), S. Kondov(1), S. Cherninkova(3), L. Laleva(1), A. Tsekov(1), T. Zlatareva(1), V. Busarski(2), K. Romanski(2) and O. Kalev(2)
(1)Department of Neurosurgery, Tokuda Hospital -- Sofia, (2)Clinic of Neurosurgery, University Hospital “Sv. Ivan Rilski” -- Sofia, (3)Department of Neurology, University Hospital “Alexandrovska” – Sofia
Summary: The orbit is a size-resticted anatomical compartment, but its extensive blood-supply is a factor favoring the development of metastatic lesions from different primary sources. Their treatment is a difficult task, having in mind оn the one hand, the aim of maximal cytoreduction and on the other, preservation of visual functions, ocular muscle integrity, and good cosmetic effect. Multiple approaches are developed and some authors report the use of neuronavigation in the management of these lesions. Thirty four patients (16 men, 18 women) were operated between 1995-2009 at the University Hospital “Ivan Rilski” and Tokuda Hospital Sofia, Bulgaria. Retrospective analysis based on medical documentation and follow up data was done. The mean age of the patients (pts) was 56.2 years (range 4-72 years). The neoplasm was localized in the left orbit in 13, in the right orbit in 18 and in both orbits in 3 of the patients. Bone structures were invaded in 20 pts and purely intraorbital localization was reported in 11 pts. In 12 cases, an extraconal metastasis invaded the orbital wall, and in the rest 22 cases, the process was located in the soft intraorbital structures. The most common symptoms were exophthalmus (61.7%), visual deficit (47%) and ocular muscle dysfunction (29%), local deformity (26.4%), pain (20%). The average time from the onset of symptoms till hospitalization was 12.4 weeks. The primary sources of metastasis were lungs 35%, breasts 26%, kidneys 6%, skin 6%, neuroblastoma 6%, uterus 3%, bone tumor 3%, of unknown origin 15%. All patients were operated using the following approaches: cranio-orbital (transciliary superolateral) in 19 pts; lateral in 5 pts; pterional in 6 pts, anterior orbitotomy in 2 pts; trans-maxillar in 1 pt; orbito-zygomatic in 1 pt. Gross-total resection was achieved in 15 cases (44%), partial in 19 pts (56%). All patients were referred for postoperative radio- and chemotherapy. The mean survival rate was 11 months. Orbital metastatic lesions are relatively rare (1-13%) but represent a major surgical challenge, because of the vital structures involved in this anatomical region. The radical surgical removal is not always possible, and not always necessary, having in mind the aggressive nature of the disease and the desire of the surgeon to preserve intact patient’s neurologic functions. Preference is given to the cranio-orbital approach which ensures enough working space. Neuronavigation is a valuable tool in selected cases with large displacement of orbital structures.
Key words: orbital metastatic lesion, neurosurgery, results
Address for correspondence: Assoc. Prof. Christo Tzekov, M.D. Ph.D., Department of Neurosurgery, Tokuda Hospital, 51, N. Vaptsarov Blvd., Bg -- 1407 Sofia, tel. +359 888 924203, е-mail: tzekovchr@abv.bg

 

 

Investigating the importance of additional factors related with the effectiveness of a complex rehabilitation program in patients with distal radius fracture - 47, 2011, № 2, 40-45.
D. Vacheva
Clinic for Physical Medicine and Rehabilitation, UMHAT Dr. G. Stranski -- Pleven
Summary: In respect to investigating and reporting on the effect of applying labour activities when rehabilitating patients after distal radius fracture, we paid attention to the importance of additional factors and circumstances that refer to effectiveness of the applied PhTR program: gender, age, injured limb -- dominant (active) or non-dominant, complications after the fracture (M. Zudeck), favourite occupation (hobby). In our research we have included 106 patients with distal radius fracture (divided into two groups -- a control one of 43 patients and an experimental one of 63 patients), who are undergoing a complex rehabilitation program that includes: underwater gymnastics, kinesitherapy, labour therapy, low frequency impulse magnetic field and interference currents. The patients of the control group did not undergo any treatment with labour activities. The initial tests and measurements show that here are no significant differences in the functional state of patients from all age groups. In the end of the rehabilitation, the patients of the experimental group show better recovery in comparison to those from the control group, and the improvement among all age groups is essential. Patients with injured dominant limbs show in the beginning of the rehabilitation process lower results, but in the end of the treatment their improvement is substantial. Patients with complications recover more slowly. Recovery among men and women has more or less the same results. Patients who have favourite occupation (hobby) recover better and more quickly. In order to discuss the obtained results we have used the results from the test for a complex functional assessment of the upper limb that includes visually analogue pain scale, goniometry, manual muscle test, types of grasps and daily life activities, and the total number of scores (the maximum is 100) gives an objective idea of the recovery of patients with traumas and upper limb troubles.
Key words: fracture, distal radius, rehabilitation, functional assessment
Address for correspondence: Danelina Vacheva, Clinic оf Physical Medicine and Rehabilitation at University Multiprofile Hospital for Active Treatment Dr. G. Stranski, 8 А, G. Kochev Str., Bg -- 5800 Pleven, tel. +359 64 886-186; +359 888 77 03 55, е-mail: danelina@abv.bg

 

 

Development and validation of HPLC method for determination of octyl methoxycinnamate UV filter in sunscreens (singularly and in combination with 4-methylbenzylidene camphor, octocrylene and octyl salicylate chemical UV filters as well as with physical UV filters zinc oxide and titanium dioxide) - 47, 2011, № 2, 46-51.
A. Tachev, D. Chohadzhieva and N. Vasileva
National Center of Public Health Protection -- Sofia
Summary: So far, no referent method has been reported for determination of Octyl Methoxycinnamate UV filter in sunscreens. The aim of this study was to develop and validate an HPLC method for determination of UV filter in sunscreen formulations (singularly and in combination with 4-Methylbenzylidene Camphor, Octocrylene and Octyl Salicylate chemical UV filters as well as with physical UV filters Zinc Oxide and Titanium Dioxide). The HPLC method was been developed and subsequently validated for determination of Octyl Methoxycinnamate UV filter in sunscreen products, and was applied both singularly and in combination with 4-Methylbenzylidene Camphor, Octocrylene and Octyl Salicylate chemical UV filters as well as with physical UV filters Zinc Oxide and Titanium Dioxide. The method is based on the effective chromatographic separation of UV filters according to their retention times, at the combined presence in the cosmetic product followed by quantitation of each UV filter versus the calibration curve of a reference substance by certified the method of external standard. A total of 58 tests were carried out and the following parameters were examined: linear range from 0,25 ncg/cm3 to 100 ncg/cm3 (from 0,13% to 50,00%); limit of detection (LOD) 0,05%; limit of quantitation (LOQ) 0,15%; working range from 0,30 ncg/cm3 to 100 ncg/cm3 (0,15% до 50,00%); repeatability in 5% Octyl Methoxycinnamate; standard deviation (SD) 0,0377%; reproducibility in 5% Octyl Methoxycinnamate relative standard deviation (RSD) 0,77%, under con­ditions of repeatability; analytical yield of 1% Octyl Methoxycinnamate con­cen­tration in the cosmetic product 99,80% (96,00-104,00%), at 2% -- 99,00% (97,00-101,00%) and at 5% -- 99,90% (98,00-102,00%). The so developed and validated HPLC me­thod is rapid, precise and accurate, and is useful for routine determination of Octyl Methoxycinnamate UV filter in sunscreen products.
Key words: ultraviolet filters, sunscreens, validation, concentration
Аddress for correspondence: Аnton Tachev, National Center of Public Health Protection, 15, Iv. Geshov Blvd., Bg -- 1431 Sofia, е-mail: a.tachev@ncphp.government.bg


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HELPING PRACTICE

Doctors’ errors -- a current medical or communication problem between patients and physicians - 47, 2011, 2, 67-70.
T. Vekov
Faculty of Public Health, MU -- Pleven
Summary: Physicians’ demotivation related with progressively decreasing incomes and nebulous professional and research expectations affects directly both patient-doctor communication and the quality of medical service delivery. Between February 2010 and February 2011, a sociologic study with standardized questionnaires was conducted in two patient and one physician’s groups. In the first group, 2580 randomly chosen patients were interviewed to establish doctors’ errors; 368 (14.26%) of them asserted they had become victims of doctors’ errors. The second group involved 1643 patients hospitalized in four cardiologic clinics. They were interviewed to establish their degree of satisfaction with received medical assistance. The standardized questionnaire among physicians included questions about physicians’ opinions on what the patients were mostly interested in and what impacted greatly on patients' satisfaction with medical services. The analysis showed that patients’ complaints with doctors’ errors were rather due to incorrect or missing patient-doctor communication than to real medical errors.
Key words: quality of medical assistance, doctors’ errors, patient-doctor communication, sociologic study
Address for correspondence: Assoc. Prof. Toni Vekov, Bulgarian Cardiac Institute, 1, G. M. Dimitrov Str., Bg -- 1172 Sofia, tel. +359 2 962 54 54, fax +359 2 962 50 59, e-mail: t.vekov.hq@comleague.com

 

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1'2011

Mumps specific IgG antibodies in an age group till 18 years - 47, 2011, № 1, 41-45.
M. Karcheva(1), M. Atanasova(2) and I. Makaveev(3)
(1)Department of Epidemiology, Parasitology and Tropical Medicine, MU -- Pleven, (2)Department of Anatomy, Histology, Cytology and Biology, MU -- Pleven, (3)Section of Prevantive Medicine, Applied Science Center for Military Epidemiology and Hygiene -- Pleven, MMA -- Sofia
Summary: The incidence of mumps in Bulgaria in recent years shows predominantly affected age groups 10-14 and 15-19. The displacement of morbidity in older age groups questioned the status of immunity in this age. The aim of this study is to establish prevalence of mumps antibodies in subjects up to 18 years. There was used enzyme immunoassay method (EIA) for indirect evidence of specific IgG antibodies in serum. The results showed that 41% of the surveyed were negative in terms of mumps IgG antibodies, 11% had borderline values and the remaining approximately 48% were tested positive. In immunization age non-immune population occurs, which is susceptible to mumps infection. This requires strengthening the control of ongoing immunization and expanded research on the immunogenicity of the vaccine.
Key words: mumps, mumps IgG antibodies, immunoprophylaxis
Address for correspondence: Milena Karcheva, M. D., Department of Epidemiology, Parasitology and Tropical Medicine, MU, 1, Sv. Kl. Ohridski Str., Bg -- 5800 Pleven, e-mail: milena_karcheva@abv.bg

 

 

l Surgical treatment of spheno-orbital meningiomas - 47, 2011, № 1, 46-51.
Chr. Tsekov(1), T. Spiriev(1), S. Kondov(1), L. Laleva(1), A. Tsekov(1), V. Busarski(2), K. Romanski(2), K. Minkin(2), E. Naydenov(2), V. Pelinkov(1), I. Angelov(1) and Ya. Enchev(2)
(1)Department of Neurosurgery -- Tokuda Hospital -- Sofia, (2)Clinic of Neurosurgery -- University Hospital “Sv. Ivan Rilski” -- Sofia
Summary: Spheno-orbital meningiomas are 9-18% of all intracranial meningiomas. They engage the greather and lesser sphenoidal wing, the orbit, and the neighboring neurovascular structures: cavernous sinus, carotid artery, optic nerve, oculomotor muscles. Their invasive nature to the dura, bone structures and the orbital content make their radical removal difficult, and the end surgical treatment results -- unsatisfactory. Radiotherapy and chemotherapy are often discussed. Aim is to analyze the experience of the Tokuda hospital neurosurgical department and of the hospital Sv. Ivan Rilski with the diagnostics and treatment of this pathology and to compare our results with the literature. The nature of the study is retrospective. For the years 1995-2009, in the above mentioned clinics 59 patients (40 female, 19 male) with the diagnosis spheno-orbital meningiomas were treated. The mean patient’s age was 52 years. The diagnosis was established with the aid of computed tomography (CT), magnetic resonance imaging (MRI). Pre- and postoperatively all patients had neuro-ophthalmological examination. All patients were operated with pterional approach as primary one, extended when necessary to modified orbito-zygomatic approach. Gross total resection was achieved in 68% of cases, subtotal in 10%, partial in 22%. In 71 % of cases, visual improvement compared to preoperative status was established. Reduction of the exophtalmos was achieved in 78% of patients. Twenty eight patients (47%) were re-operated. Radical removal of the tumor was achieved in patients with relatively restricted tumor size, or with limited invasion of the lesion. The early diagnosis is extremely important for the correct planning of the operative intervention on the basis of the CT/MRI, especially in en plaque meningiomas. The main treatment is operative, but radiotherapy comes into consideration in selected tumors.
Key words: orbital metastatic lesion, neurosurgery, results
Address for correspondence: Assoc. Prof. Christo Tsekov, M.D. Ph.D. Department of Neurosurgery, Tokuda Hospital, 51, N. Vaptsarov Blvd., Bg -- 1407 Sofia, tel. +359 888 924203, е-mail: tzekovchr@abv.bg

 

 

In  vitro activity of Tigecycline against multidrug-resistant isolates of Acinetobacter baumannii - 47, 2011, № 1, 52-56.
T. Stoeva and K. Bozhkova
Department of Microbiology and Virology, Medical University -- Varna
Summary: Our оbjective was to study the activity of the novel antimicrobial agent tigecycline against selected multidrug resistant strains Acinetobacter baumannii, isolated from patients in intensive and non-intensive care units during the period 1999-2007. A total of 49 strains A. baumannii (36 carbapenem-susceptible and 13 carbapenem-resistant) are studied. E test is used to determine the Minimal Inhibitory Concentration (MIC) of tigecycline. Susceptible to tigecycline (МIC <= 1 mg/L) are 34.7% (n = 17) of all isolates, 53% (n = 26)demonstrate intermediate susceptibility (МIC = 4 mg/L), 4.08% (n = 2) are resistant to tigecycline (МIC >= 8 mg/L). The level of tigecycline resistance among the carbapenem-resistant isolates is 7.7% (n = 1), while in the group of carbapenem-susceptible ones, it is 2.7% (n = 1). Our results show the susceptibility of strains A. baumannii, isolated before the introduction of tigecyclinе in the clinical practice in Bulgaria. A high level of tigecycline nonsusceptible isolates of A. baumannii is detected, that is higher than in other similar studies. Considering that tigecycline is a novel therapeutic alternative in the treatment of A. baumannii infections, in vitro testing of susceptibility to tigecycline before starting the therapy is highly re­commended.
Key words: A. baumannii, tigecycline, multidrug resistance
Address for correspondence: Temenuga Stoeva, M. D., Department of Microbiology and Virology, Medical University, 55, Marin Drinov Str., Bg -- 9001 Varna, tel. +359 887 614 008, e-mail: temenuga.stoeva@abv.bg

 

 

Study on the changes of the levels of OPG, sRANKL, total alkaline phosphatase, serum calcium and leucocytes in patients with radicular jaw cysts - 47, 2011, № 1, 57-62.
P. Pechalova(1), P. Pavlov(2), A. Bakardzhiev(3), D. Terzieva(2) and A. Boyadzhieva(2)
(1)Maxillofacial Surgery Department, Faculty of Dental Medicine, Medical University -- Plovdiv, (2)Central Clinical Laboratory, UMHAT “Sveti Georgi” -- Plovdiv, (3)Oral Surgery Department, Faculty of Dental Medicine, Medical University -- Plovdiv
Summary: Periapical (radicular) cysts cause limited bone loss in the jaws. The aim of this study was to specify the connection between bone loss and some changes in bone metabolic markers and white blood cells. Sixty five volunteers were included in this study -- 35 patients with radicular cysts (target group) and 30 healthy persons (control group). We determined that level of alkaline phosphatase was increased in a target group (210,51 +/- 55,58 U/l) in comparison with a control groupe (159,7 +/- 37,64 U/l) and that level of calcium was decreased in a target group (2,31 +/- 0,14 mmmol/ l) compared with a control group (2,39 +/- 0,13 mmol/ l).
Key words: radicular cyst, OPG, sRANKL, alkaline phosphatase, calcium
Address for correspondence: Petya Pechalova, M. D., Maxillofacial Surgery Department, UMHAT „Sv. Georgi”, Medical University, 66, Peshtersko shose Str., Bg -- 4000 Plovdiv, GSM +359 898 468 498, e-mail: pechalova@abv.bg

 

 

Chronic administration of caffeine and desipramine in experimental model of depression in rats: effects on body temperature in norm and stress 47, 2011, № 1, 63-69.
R. Nikolov(1), Ya.
Chekalarova(2), D. Pehlivanova(2), K. Stanoeva(1), V. V. Petkov(2) and K. Yakimova(1)
(1)Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University -- Sofia, (2)Institute of Neurobiology, Bulgarian Academy of Sciences
Summary: Many neurotransmitters are involved in thermoregulation of the mammals, including serotonin, norepinephrine, acetylcholine, dopamine, prostaglandins, gamma-aminobutyric acid (GABA), glutamate, and beta-endorphin. Recent experimental data showed involvement of purinergic mechanisms in the regulation of body temperature. Acute administration of caffeine produced dose-dependent changes in the body temperature of rats. We suggest a modulating role of caffeine after acute and chronic administration in the changes, associated with the thermoregulatory mechanisms in rats with model of depression. This study investigated effect of caffeine, a nonselective adenosine receptor antagonist, and desipramine, a tricyclic antidepressant on the body temperature in male Wistar rats after systemic (p.o. or i.p.) chronic administration. The rats were divided into two randomized groups: normal rats and rats with model of depression. As an experimental model of depression we used chronic unpredictable stress (Chronic Unpredictable Stress, CUS). The core temperature of the experimental animals was measured with thermistor probes inserted rectally and monitored on multichannel recorder with computing program. The results of the present study demonstrate hyperthermic effects after chronic administration of caffeine in both non-stressed and stressed group of rats. Desipramine reduced the core temperature in rats of non-stressed group. The hyperthermic response observed in the stressed group of rats was reduced by desipramine. These data suggest involving of purinergic system in the processes of thermoregulation, as well as a specific modulating role of caffeine in the thermoregulatory responses to chronic unpredictable stress.
Key words: caffeine, desipramine, chronic unpredictable stress, body temperature, rats
Address for correspondence: Rumen Nikolov, M. D., Ph. D., Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University, 2 „Zdrave“ Str., Bg -- 1431 Sofia, tel. +359 2 91 72 621, e-mail address: ru_nikolov@abv.bg

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HELPING PRACTICE

Pharmacoeconomic evaluation of Poractant alfa in preterm children with respiratory distress syndromе - 47, 2011, № 1, 70-76.
A. Stoimenova(1), V. Tsankova(2), А. Savova(1), М. Маnova(1) and G. Petrova(1)
(1)Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University -- Sofia, (2)Department of Pharmacology and Toxicology, Faculty of Pharmacy, Medical University -- Sofia
Summary: The aim of this publication is to perform pharmacoeconomic evaluation of therapy of respiratory distress syndrome with poractant alfa in preterm children. A cost-minimization analysis from the hospital perspective was conducted. The analysis includes direct pharmacotherapy costs only. Рoractant alfa is a low-cost treatment of preterm children with respiratory distress syndrome, and achieves similar clinical outcomes in regard to short-term results -- a reduction of oxygenation and respiratory requirements. In terms of mortality indicators, clinical trials show that poractant alfa is associated with a significantly lower mortality (3.0% in poractant alfa group and 11-12.5% in beractant group), therefore it can be considered a dominant alternative compared to beractant.
Key words: pharmacoeconomics, cost-minimization analysis, poractant alfa, beractant
Address for correspondence: А. Stoimenova, Department of Social Pharmacy and Pharmacoeconomics, 2, Dunav Str., Bg -- 1000 Sofia, e-mail: assena_stoimenova@mail.bg

 

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