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 Original papers

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Volume 50, 2014

 

 

bullet 6'2014

 

Prevalence of asymptomatic heart failure: an epidemiologic study – Medical Review (Meditsinski pregled), 50, 2014, № 6, 29-33.
T. Vekov (1) and E. Grigorov(2)

(1)Faculty of Public Health, Medical University  --  Pleven, (2)Department of Pharmacy, Sofia Health Insurance Fund
Summary: The aim of this epidemiologic study is to establish the prevalence of asymptomatic heart failure (HF) among patients between 65 and 75 years of age, who have arterial hypertension or ischemic heart disease and who have not been previously diagnosed with heart failure due to lack of clinical symptoms. Measurement of N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) was used as an appropriate screening tool for timely diagnosis of HF. A total of 3348 out-patients with arterial hypertension, HF and/or ischemic heart disease, examined at 11 medical centres, were included in the study. Patients were divided in two groups: an experimental group including 1842 patients with arterial hypertension and/or ischemic heart disease and no symptoms of or diagnosis of HF, and a control group, including 1506 patients, diagnosed with HF. The study was undertaken during February 2012-November 2013 year. Out of 1842 patients without symptoms of HF, 212 (11.5%) were positive for NT-proBNP (> 125 pg/ml), revealing asymptomatic HF in these patients. The sensitivity, specificity, positive and negative predictive value of the test showed that it was a reliable screening tool for establishing asymptomatic heart failure. These findings give us the reason to recommend the routine measurement of NT-proBNP in all patients with multiple risk factors, regardless of the finding on echocardiography.
Key words: asymptomatic heart failure, screening, NT-proBNP, epidemiologic study
Address for correspondence: Prof. Toni Vekov, Faculty of Public Health, Medical University, 1, Sv. Kl. Ohridski St., Bg -- 5800 Pleven, e-mail: t.vekov.mu.pleven@abv.bg

 

 

Mild cognitive impairment of Huntington disease – Medical Review (Meditsinski pregled), 50, 2014, № 6, 34-38.
М. Petrova, I. Petrova, Ya. Zhelev, К. Stoyanova, О. Grigorova and L. Traykov

Clinic of Neurology, University Hospital “Alexandrovska”, MU -- Sofia
Summary: Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder clinically characterized by progressive involuntary movements, psychiatric disturbances and cognitive impairment. Impaired self-awareness of cognitive, emotional and functional abilities in HD patients is associated with global cognition and deficits in executive functioning and memory. However, the specific profile of mild cognitive impairment (MCI) and the relationships between MCI and other clinical features of Huntington’s disease (HD-MCI) are not fully established. The aim of this study was to examine in detail the clinical and cognitive functions in HD-MCI patients in order to define the cognitive profile of HD-MCI and its relationship to other clinical aspects. We investigated 19 patients with HD-MCI and 20 controls. All subjects underwent a comprehensive neuropsychological and clinical assessment. Relative to controls, HD-MCI group showed significant deficits on immediate and delayed free and total recall of the Free and Cued Selective Reminding Test (FCSRT), digit span, TMTA, TMTB, MCST, Stroop test and verbal fluency. In addition, motor subscale of UHDRS showed tendency for significant correlation with phonemic fluency and Stroop test part 1. In conclusion, our study demonstrates unambiguously the important role of the detailed neuropsychological examination in the diagnosis of HD-MCI, even in earlier stages of the disease. This ability of early diagnostics is very important having in mind the new therapeutical strategies for treatment of the disease and also the association between the impaired self-awareness and the deficiency of executive functions and memory.
Key words: diagnosis, mild cognitive impairment, Huntington disease
Address for correspondence: М. Petrova, M. D., Clinic of Neurology, University Hospital “Alexandrovska”, 1 Sv. G. Sofiyski Blvd., Sofia, Bg -- 1431, tel. +359 2 92 30 468, е-mail: dr.mpetrova@mail.bg

 

 

Hepcidin in the diagnosis of anemia in rheumatoid arthritis tools – Medical Review (Meditsinski pregled), 50, 2014, № 6, 39-42.
V. Manolov(1), V. Paskaleva-Peycheva(2), M. Velizarova(1), S. Hadjidekova(1), V. Vasilev(3) and K. Tzatchev(3)

(1)Department of Medical Genetics, Medical University -- Sofia, (2)Department of Internal Diseases, Medical University -- Sofia, (3)Department of Clinical Laboratory and Clinical Immunology, Medical University -- Sofia
Summary: Anemia in rheumatoid arthritis (RA) is related to the chronic inflammatory nature of the disease. It includes iron deficiency, mainly due to gastrointestinal bleeding caused by the ongoing therapy and redistribution into the inflamed joint structures. The discovery of iron deficiency in patients with anemia of chronic disease (ACD) is of clinical importance because of the following factors: 1) iron-deficiency anemia (IDA) is curable; 2) diagnosis may suggest the need for further research into the cause of anemia, and 3) can prevent unnecessary prescribing of preparations containing iron. We determined the serum hepcidin levels (an iron metabolism regulating hormone) through immunosorbent ELISA assay in patients with rheumatoid arthritis. A total of 43 patients diagnosed with RA in the Rheumatology Clinic of University Hospital "St. Ivan Rilski" during 2013-2014 year were included in the study. Activity of the disease was determined by Disease Activity Score calculator for RA [DAS 28-CRP]. Patients were divided into four groups: RA without anemia; RA with iron deficiency anemia (IDA); RA with anemia of chronic disease (ACD) and RA with a combination of IDA and ACD. We found statistically significant differences in serum hepcidin levels in three of the study groups: RA without anemia -- 14 +/- 8.4 mcg/L; RA with IDA and with a combination of IDA and ACD -- 0.8 +/- 0.4 mcg/L and 1.9 +/- 0.3 mcg/L, respectively; RA with ACD -- 98.7 +/- 9.8 mcg/L. These results may support the preferred choice of a therapeutic approach particularly in patients with anemia and rheumatoid arthritis.
Key words: anemia, rheumatoid arthritis, hepcidin
Address for correspondence: Victor Manolov, M. D., UMHAT „Аleksandrovska”, 1, “Sv. Georgi Sofiiski” St., Bg -- 1431 Sofia, tel.: +359 2 9230 928, fax +359 2 9230 922; GSM +359 887 222 069, e-mail: victhedoc2@yahoo.com

 

 

Treatment of patients with polytrauma and indications for intensive orthopaedic surgery – Medical Review (Meditsinski pregled), 50, 2014, № 6, 43-50.
V. Spasov and A. Baltov

First Traumatology Clinic, Emergency Hospital “N. I. Pirogov” -- Sofia
Summary: Major aetiological factor for traumatic disease is a mechanical trauma with great force. The aggregate effects that appear mediators of injury form a syndrome of systemic inflammatory response. In recent decades, in an era of high speed, technological progress and demographic transition, pathology has evolved, in particular the cause of death has changed. And as evidenced by clinical experience, this picture is due to the fact that multiple and combined injuries account for a large preponderance of patients with traumatic shock and massive blood loss. Therefore, an important task is to remove life-threatening violations and reduce the likelihood of disability of the victim.
Key words: polytrauma, blood loss, stabilization of fractures
Address for correspondence: Viktor Spasov, M. D., First Traumatology Clinic, Emergency Hospital
“N. I. Pirogov”, 21, Gen. Totleben Blvd., Bg -- 1606 Sofia, tel. +359 2 91 54 457


 

MANAGEMENT IN HEALTHCARE

Infectious diseases specialization: present and future – Medical Review (Meditsinski pregled), 50, 2014, № 6, 51-60.
M. Baymakova(1), M. Pishmisheva(2) and K. Plochev(1)
(1)Department of Infectious Diseases, Military Medical Academy -- Sofia, (2)Department of Infectious Diseases, Hospital of Pazardjik
Summary: Тraining in any medical specialty is a long and complex process. The educational program is based on improving the knowledge and acquiring new practical experience. In Bulgaria the period of training of infectious diseases is four years. In Western Europe, this period varies from 5 to 7 years. In 2008, in order to improve the mobility of health professionals in the EU and better management of clinical activity, Union Européenne des Medécins Spécialistes (UEMS) has produced a curriculum for specialization in infectious diseases. The total duration of the specialization is six years, which contains two main modules: Internal Medicine (2 years) and Infectious Diseases (4 years). The required knowledge and skills are the following: HIV-infection, tuberculosis, malaria, viral hepatitis, community-acquired infections, hospital-acquired infections, vaccine and antibiotic therapy. It was emphasized that a close and daily interaction between microbiologists and ID specialists was required, as good collaboration is the base for improving the quality of care. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) is also interested in the development of a specialty. To our days ESCMID conducted three workshops to discuss the problems of the educational program of ID and microbiology. The decisions are concerning both the present and the future of specialties.
Key words: infectious diseases, specialization, UEMS, ESCMID, educational program
Address for correspondence: Magdalena Baymakova, MD, Department of Infectious Diseases, Military Medical Academy, 3 Georgi Sofiyski St., Bg -- 1606 Sofia, e-mail: dr.baymakova@gmail.com

 

 

Toxicological analysis guidance for organ transplantation from deceased and living donors tools – Medical Review (Meditsinski pregled), 50, 2014, № 6,61-64.
V. Atanasov and K. Kanev
Clinic of Urgent Toxicology, Military Medical Academy -- Sofia
Summary: The progress in transplant activity in the country requires continuous improvement of the criteria and standards in this area. The establishment of brain death and the expertise of donor organs require conducting a specialized toxicology testing. This paper presents a comparative evaluation of the regulatory framework in the country and relevant practices in other countries and provides a protocol for toxicological analysis. Toxicological testing should include general screening for unknown toxic substances and analysis of psychoactive drugs that could mimic brain death. The proposed protocol is implemented in the practice of the Military Medical Academy.
Key words: toxicological analysis, brain death, transplantation
Address for correspondence: Assoc. Prof. Vasil Atanasov, M. D., Clinic of Urgent Toxicology, Military Medical Academy, 3, G. Sofiyski St., Bg -- 1606 Sofia, e-mail: vatanasov@vma.bg

 

 

ACTUALITY

Ebola hemorrhagic fever – Medical Review (Meditsinski pregled), 50, 2014, № 6, 65-68.
N. Kalvachev

 

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bullet 5'2014

Analysis of the relationship between urinary tract infections and chronic kidney disease in kidney transplant patients – Medical Review (Meditsinski pregled), 50, 2014, 5,  30-37.
B. Zlatkov(1), Zh. Filipov(1), E. Paskalev(1), B. Markova(2), U. Marteva-Proevska(2) and A. Kolevski(2)

(1)Nephrology and Transplantation Clinic, (2)Central Microbiological Laboratory, UMHAT “Aleksandrovska” -- Sofia
Summary:  Urinary tract infections (UTIs) are amongst the most common infections, caused by microorganisms -- 30-80%, and acute pyelonephritis is one of the most serious infections of the urogenital tract. The risk of progression to chronic kidney disease (CKD), caused by UTIs in non-transplanted patients is low -- 3-4% as reported by different authors. The aim of the study is to examine the relationship between UTIs and CKD in kidney transplant recipients. A sample of 453 kidney transplant patients was studied during a twelve-month follow-up at the Nephrology and Transplantation Clinic. We found that the average values of serum creatinine in kidney transplant recipients have increased with statistical significance during an active UTI -- from 118 +/- 34 to 153 +/- 54 mcmol/L. After a full course of treatment the values decreased but remained higher than the initial values -- 120 +/- 37 mcmol/L. We proved that the average values of serum creatinine for the 12 month period of the study of the group with acute pyelonephritis were higher -- 165 +/- 38 mcmol/L, compared to kidney transplant patients with UTIs other than acute pyelonephritis -- 153 +/- 33 mcmol/L. Kidney transplant recipients without UTIs had lower average creatinine values than both other groups -- 134 +/- 24 mcmol/L. The average values of creatinine clearance in kidney transplant recipients with acute pyelonephritis were lower -- 39.5 ml/min/1.73 m2 compared to the values of creatinine clearance in transplanted patients with UTIs but without acute pyelonephritis -- 54.6 ml/min/1.73 m2, which in turn were lower compared to transplanted patients without UTIs -- 57.2 ml/min/1.73 m2. UTIs have a negative influence on the progression of CKD in kidney transplant recipients which is significantly stronger than the influence of UTIs on non-transplanted patients. Effective diagnostic procedures and antimicrobial therapy are necessary for early diagnosis and treatment of infectious diseases of the urinary tract which can prevent the decline in kidney function.
Key words:  kidney transplantation, urinary tract infections, chronic kidney disease
Address for correspondence:  Borelli Zlatkov, M. D., Nephrology and Transplantation Clinic, UMHAT “Aleksandrovska”, 1 Sv. G. Sofiyski St., Bg -- 1431 Sofia, tel. +359 2 9230233, e-mail: dok_zlatkov@abv.bg

 

 

Depression during pregnancy and postpartum -- clinical and biological characteristics – Medical Review (Meditsinski pregled), 50, 2014, № 5, 38-44.
R. Vladimirova, V. Stoyanova, S. Krastev and V. Milanova
Clinic of Psychiatry, UMHAT “Аleksandrovska”, Medical University -- Sofia
Summary: The purpose of this study was to analyze risk factors for depression during pregnancy and after delivery, as well as to assess clinical symptoms and their severity, and the effects of the administered therapy. Participants were divided into two groups -- pregnant women (61%) and mothers (39%) (up to three months after birth). The average age of women was 25 years (SD +/- 1.8). A significant level of correlation was found between family history of depression and postpartum depression (p = 0.043). More than half of the women had a history of a depressive episode experienced in the past (65%). The periods in risk of development of depression in pregnant women are the first and the third trimester, while for the women in the postpartal period -- the risk is up to the 3rd month after delivery. The clinical presentation of a depressive disorder in the peripartal or the puerperal period is characterised by some specific symptoms -- muscular and neural tension, depressive delusions and hallucinations, subjectively lowered functioning. Pregnant women respond much better to the treatment with electroconvulsive therapy (ECT) (p < 0.05). Existence of severe depression symptoms during pregnancy or after birth require prompt treatment and intensive care.
Key words:  pregnancy, puerperium, delusions, hallucinations, electroconvulsive therapy
Address for correspondence: R. Vladimirova, M. D., Clinic of Psychiatry, UMHAT “Аleksandrovska”, Medical University, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia

 

 

Assessment of echogenicity of substantia nigra in patients with early Parkinson's disease – Medical Review (Meditsinski pregled), 50, 2014, № 5, 45-47.
D. Kochev, Yu. Petrova, M. Petrova and L. Traykov
Department of Neurology, MU -- Sofia
Summary:  Parkinson's disease (PD) is a neurodegenerative disease for which timely and accurate clinical diagnosis is still difficult to be made. We examined 65 patients with newly diagnosed PD (probable PD). Clinical status of patients was assessed according to the modified scale of Hoehn and Yahr (including grade 2). Out of all clinically diagnosed 65 patients, 65.5% were men and 34.5% were women of mean age 63.8 +/- 10.1 yrs. Of these, 10.7% did not participate in the study due to lack of temporal window. Changes in patients were identified in 91.3%. In patients with initial PD dominated ipsilateral changes (probably the beginning of the disease). Simultaneously, in 9.4% of the patients a bilateral change of echogenicity was seen, probably as a marker of more rapid onset of the disease. In 5 patients (8.6%) echogenicity of substantia nigra was not changed. Degree of echogenicity was assessed as mild in 43 patients (81.1%) and moderate in 10 pts (18.9%). First degree in Hoehn and Yahr had 28 pts (48.2%), 1.5 degree -- 14 pts (24.1%) and second degree -- 16 pts (27.6%). No statistical significance was found between altered echogenicity and gender, and between the degree of altered echogenicity and the result from Hoehn and Yahr modified scale for clinical evaluation, and between age and changed echogenicity. Transcranial ultrasound of the midbrain, especially the substantia nigra, may allow early diagnosis of PD.
Key word:  early Parkinson’s disease, ultrasound, substantia nigra
Address for correspondence: D. Kochev, M. D., Department of Neurology, MU, Sv. G. Sofiyski St., Bg -- 1431 Sofia

 

 

MEDICAL MANAGEMENT

Analysis of disease-related costs, paid by the NHIF on ambulatory care visits -- Part 2 – Medical Review (Meditsinski pregled), 50, 2014, 5, 56-61.
A. Zlatareva(1), S. Sopotenski(2), M. Grozdanova(3) and G. Petrova(4)
(1)Medical Centеr “Health BG” Ltd., (2)University Hospital “N. I. Pirogov”, (3)National Health Insurance Fund, (4)Faculty of Pharmacy, Medical University -- Sofia
Summary: The purpose of this study is to perform a comparative analysis of the cost of pharmacotherapy paid by the National Health Insurance Fund (NHIF) for ambulatory care visits of patients with chronic conditions in 2012 and 2013. Official data were collected through the NHIF databases that were systematized and analyzed by INN, ICD code and therapeutic groups. For the analyzed period from January 2013 to December 2013, a process of increasing the amount, paid by the NHIF, was observed and this trend was noted until the end of 2013. The reason for this is the inclusion of new medicines and the increase in the number of patients with one or more resource consuming diagnoses for which treatment NHIF pays. With the largest share arel CD codes E11, ”Non-insulin-dependent diabetes mellitus” -- 15%, followed by ”Hypertension” codes -- 11%, third place is occupied by J44 “Chronic obstructive pulmonary disease” -- 9%, the disease “Arthritis” is the fourth highest share of expenditure with 7% and the fifth one is J45 „Asthma” by 6%. The dynamics in the expenditures is a results of the influence of two main forces, which are the inclusion of new INN in the therapy and changes in the reference reimbursement value.
Key words: NHIF, costs, reimbursement amount, medicines, diagnoses, Public Fund
Address for correspondence: Albena Zlatareva, M.D., е-mail: azlatareva@gmail.com

 

 


Geriatric medicine. Elements of the concept – Medical Review (Meditsinski pregled), 50, 2014, № 5, 62-68.
I. H. Petrov

Clinical Center of Endocrinology and Gerontology, MU -- Sofia
Summary: Gerontology and geriatrics are closely interrelated. Geriatrics is a principal branch of the modern gerontology. At the same time, it is a part of the clinical medicine. Geriatrics (or geriatric medicine) has been developed in the middle of the 20th century. Since 1947, it was recognized in many European countries as an independent (primary) medical specialty. The development of the Bulgarian gerontology and geriatrics is uneven. The Bulgarian Centre of Gerontology and Geriatrics (CGG) was founded in 1963, but afterwards it was sacrificed. An obligatory student’s education in gerontology and geriatrics has not been introduced at Bulgarian medical schools up to now. At the CGG a post-graduate education was carried out, and the specialty in gerontology and geriatrics was officially recognized, however only for a short period of time. Later it was cancelled, and then restored again, but true conditions for clinical geriatric work did not ensue. The clinical geriatrics has its specific methodical approach and characteristics. An attempt to summarize them is one of the aims of this paper. We also would like to stress on the need of future clinical and educational geriatric units.
Key words:  geriatrics, geriatric medicine, teaching gerontology/geriatrics, specifics of the geriatric work
Address for correspondence: Assoc. Prof. Ignat H. Petrov, M. D., Clinical Center of Endocrinology and Gerontology, MU -- Sofia, tel. +359 888 35 39 37  

 

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bullet 4'2014

Laser treatment of angiokeratomas of Fordyce in the genital area – Medical Review (Meditsinski pregled), 50, 2014, 4, 18-22.
A. Shef and M. Kadurina

Department of Dermatovenereology and Allergology, Military Medical Academy -- Sofia
Summary: The aim of the present study is to demonstrate the effectiveness and safety of 1064 Nd:YAG laser for the treatment of angiokeratomas of Fordyce. Seventeen patients were treated with above mentioned devise in three to five sessions with an interval of one month between each session. The authors independently assessed improvement of the lesion based on digital photographs taken before treatment and three months after the end of it. Good to excellent improvement was registered in all of the patients and 100% of them were completely satisfied with the obtained result. In conclusion, 1064 Nd:YAG laser is a highly effective and safe treatment for angiokeratomas of Fordyce. No permanent side effects were observed.
Key words: angiokeratomas of Fordyce, laser treatment, long-pulse Nd:YAG laser
Address for correspondence: Aylin Shef, MD, Military Medical Academy, Department of Dermatovenereology and Allergology, 3, Georgy Sofiyski Blvd, Bg -- 1606 Sofia, e-mail: ailinshef@abv.bg

 

 

Single stage scalp reconstruction with local flaps – Medical Review (Meditsinski pregled), 50, 2014, № 4, 23-29.
Y. P. Yordanov
Unit of Plastic Surgery and Burns, Military Medical Academy -- Sofia
Summary: Scalp reconstruction is often challenging to surgeons because of its specific structure and low laxity. Anterior and middle scalp defects require special attention and often multiple stage surgeries are needed for functional reconstruction and aesthetic hairline recreation to be achieved. The aim of the present study is to demonstrate the preliminary experience of the author in using local flaps as a single stage method of scalp reconstruction. Seven patients who had scalp defect of varying etiology were presented. The defects were located on the parietal area of the scalp in 4 patients, frontoparietal area, frontotemporal area and on the temporal area in the rest of the patients. Single rotation flaps were used in all the cases except one who was reconstructed with a complex plasty with transposition flaps. All the flaps survived and excellent functional and aesthetic results were obtained. Based on his experience, the author suggests that with proper planning scalp defects located on the anterior two thirds of the hair-bearing scalp can be reconstructed with pivotal scalp flaps in one stage without the need for multiple surgeries including preceding expansion.
Key words: scalp reconstruction, local plasty, rotation flaps, transposition flaps
Address for correspondence: Yordan P. Yordanov, MD, PhD, Unit of Plastic Surgery and Burns, Military Medical Academy, 3, Sv. G. Sofiyski Blvd. Bg -- 1606 Sofia, e-mail: yordanov_vma@abv.bg

 

 

Registered diseases during preventive medical examinations – Medical Review (Meditsinski pregled), 50, 2014, № 4, 30-35.
E. Petrova, G. Simeonov, A. Ivanova, T. Mauromatis, S. Tancheva, L. Nikolcheva, N. Dobrev, R. Krasteva, I. Dobrinova, R. Lipeva, M. Apostolova, R. Radenkov and E. Dobreva
Tokuda Medical Center -- Sofia
Summary:
The aim of the study was to outline the activities of Preventive Medicine (PM) in Tokuda Medical Center, as well as to analyze the structure of the registered diseases during a four-year period of medical prevention check ups, and to outline future steps for improvement the quality of medical care. A retrospective cross sectional study of the activity and of the registered diseases during four years screening period in PM were performed. The trends of registered diseases were analyzed. The number of outpatient and preventive medical examinations in the PM department for the period 2010-2013 ys. was 135,610, as well as the number by years was 27,371 -- in 2010, 31,340 -- in 2011, 39,811 -- in 2012, and 37,088 -- in 2013 y, respectively. The predominant portion of examined individuals were healthy subjects -- 50,254 (70.7%), followed by people with visual disabilities -- 8,684 (12.2 %), as well as diseases of the female reproductive system (2,641 -- 3.7% ), hypertensive diseases -- 2,372 (3.3%), joint disorders, spinal and systemic autoimmune diseases -- 1,032 (1.4%), kidney stones -- 529 (0.7%), diseases of the upper respiratory tract -- 527 (0.74%), gastrointestinal, hepatic, and pancreatic diseases -- 506 (0.7%), benign tumors -- 456 (0.6 %), endocrine disorders, malnutrition, obesity, and disorders of metabolism -- 361 (0.5%), blood diseases -- 356 (0.5%), and chronic diseases of the lower respiratory tract. Fifty (0.07 %) malignant neoplasms were registered. Among malignant diseases, breast cancer was the most common one, registered in 14 women (0.019%), followed by carcinoma of the cervix and the uterus body -- 4 women (0.006%), and prostate cancer or testicular cancer -- 3 men (0.004%). In conclusion, we established a relatively low number of registered chronic diseases, ischemic heart disease, and cerebrovascular disease, due to the relatively young age of the examined population. However, during the four year period of the study some diseases occurred more frequently. These include ocular injuries and diseases of the female genital organs, joint and spinal diseases, hypertension, thyroid gland diseases, gastrointestinal diseases, and others. Further efforts should be directed towards early detection of different diseases in the predisposed groups, including malignant neoplasm through the application of genetic markers.
Key words: prevention, registration, socially significant diseases
Address for correspondence: Prof. Elisaveta Petrova, M.D., DSc, Head of Sector on Preventive Medicine, Tokuda Medical Center, 51B Nikola Vaptsarov Blvd., Bg -- 1407 Sofia

 

 

Correlation of hepcidin with some iron metabolism parameters in patients with chronic hemodialysis – Medical Review (Meditsinski pregled), 50, 2014, 4, 36-38.
V. Manolov(1), D. Yonova(2), E. Vazelov(2), M. Velizarova(1), V. Vasilev(1) and K. Tzatchev(1)

(1)Department of Clinical Laboratory and Clinical Immunology, Medical University -- Sofia, (2)Dialysis Center, University Hospital “Aleksandroska”, Medical University, Sofia -- Sofia
Summary:
Hepcidin is a 25-amino acid peptide, playing an important role as a key regulator of iron homeostasis. We studied its serum level and looked for a correlation with some clinical and biochemical parameters in patients on chronic hemodialysis. We found a correlation between serum hepcidin levels and some parameters of iron homeostasis in chronic dialysis patients. We used a sandwich ELISA method to quantificate serum hepcidin levels in healthy control group (n = 65) and patients on chronic dialysis (n = 40). Inclusion criterion for the control group was no evidence of iron metabolism disorders. The sandwich ELISA was highly specific for hepcidin-25. We found that serum hepcidin levels correlated significantly between the two groups -- 14.4 +/- 8.1 mcg/L (control group) to 279.5 +/- 203.0 mcg/L (chronic dialysis group). Transferrine levels showed negative and no significant correlation to hepcidin in serum (r = -0.119). In conclusion, the use of sandwich ELISA method for the quantitative determination of serum hepcidin level is a step forward in the diagnosis and treatment of iron metabolism disorders in patients receiving chronic dialysis.
Key words: hepcidin, iron deficiency anemia, reference range, chronic dialysis
Address for correspondence: Victor Manolov, M. D., Department of Clinical Laboratory and Clinical Immunology, Medical University, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, tel. +359 2 9230 928, fax +359 2 9230 922; GSM +359 887 222 069, e-mail: victhedoc2@yahoo.com

 

 

Homocysteine and post-stroke cognitive impairment in Bulgarian patients – Medical Review (Meditsinski pregled), 50, 2014, 4, 39-44.
N. Petrova(1), S. Меhrabian(2), M. Raycheva(2) and L. Traykov(2)

(1)Clinic of Neurology, “MHAT Ruse” -- Ruse, (2)Clinic of Neurology, University Hospital “Aleksandrovska” -- Sofia
Summary: The objective of this study was to determine the association between homocysteine level and cognitive decline in first-ever post-stroke patients with cognitive impairments one year after onset. Eighty-five first-ever stroke inpatients (mean age 65.6 +/- 5.6) without previous cognitive complaints were prospectively evaluated with a comprehensive neuropsychological battery at fifth day and at first, sixth and twelfth month thereafter. A wide range of demographic, clinical, radiological, and laboratory variables were examined. Our results showed that out of the 85 participants, 67 (78.8%) had hyperhomocysteinаemia (Hcy > 14 mcmol/L). Higher Hcy levels at 5th day after stroke were significantly associated with executive dysfunction and memory impairment of executive type. Repeated measures analysis of variance (rANOVA) showed significantly worse performance on immediate recall, delayed recall and TMT-B in patients with high Hcy levels in each follow-up exam. In multiple regression analysis, we found that the Hcy level significantly contributed to the attention and executive functions, and memory. In conclusion, the results of this study establish a direct association between elevated homocysteine ​​levels and cognitive impairment one year after stroke. Hyperhomocysteinаemia is a potentially reversible risk factor and can be identified early. In establishing such a relationship, it is assumed that lowering homocysteine levels by vitamin supplementation will reduce the incidence and progression of cognitive decline after stroke.
Key words: post-stroke dementia, ischemic stroke, vascular cognitive impairment, risk factors, homocysteine
Address for correspondence: Neli Petrova, MD, Clinic of Neurology, MHAT Ruse, e-mail: npetrova27@yahoo.com


 

MANAGEMENT IN HEALTHCARE

Cost analysis of the pharmacotherapy of most resource consuming diseases paid by the NHIF -- Part I – Medical Review (Meditsinski pregled), 50, 2014, 4, 45-52.
A. Zlatareva
(1), S. Sopotenski(2), M. Grozdanova(3) and G. Petrova(4)
(1)Medical Centre “Health BG” EOOD, (2)“UHAT “N. P. Pirogov”, (3)National Health Insurance Fund, (4)Faculty of Pharmacy, Medical University -- Sofia
Summary:
The goal of this study is to analyze the expenditures for medicines for the therapy of most resource consuming ambulatory diseases paid by the public fund (NHIF) in Bulgaria. Officially published data was collected and analyzed by ATC groups, including types of diseases, as well as the cost of rare diseases, the cost of cancer diseases, expenditures for the treatment of organ transplant patients for home treatment, and the cost of common diseases in outpatient care, paid by NHIF for 2013 in Annex 1 of the in the Positive Drug List (PDL). Reimbursement paid by the Public Fund for the different positions is constantly changing, owing to the said Annex № 1 of the PDL, which in turn is due to the price reduction and entry of generic products, and also because medications that previously determined the referent in a group drop down. According to the performed analysis for the period from January 2013 to December 2013, a process of increasing the payment by the NHIF is observed and this trend is continuing until the end of 2013. The reason for this is the inclusion of a large number of new and expensive medicines and made amendments to Ordinance № 38 with new diseases whose home treatment becomes paid by the NHIF. From the analyses we can conclude that the main factors influencing the expenditures growth are the increasing number of patients and inclusion of new INN in the PDL.
Key words: NHIF, expenditures for medicines, reimbursement rate, Public Fund
Address for correspondence: Albena Zlatareva, M.D., е-mail: azlatareva@gmail.com

 

 

MEDICAL ETHICS

Compatibility between ethics and drug policy: is there a chance? – Medical Review (Meditsinski pregled), 50, 2014, 4, 53-57.
T. Vekov

Faculty of Public Health, Medical University -- Pleven
Summary:
Financial targets of the pharmaceutical industry often differ from public policy and health objectives. The study aimed at identifying the factors, which influence institutional corruption and unethical practices incorporated in drug policy. Analyzed data from literature sources and summarized data from the conducted study were discussed under five main headings: systemic problems, clinical trials, medical competence and practice, pharmaceutical marketing and patient advocacy organizations.
Key words: drug policy, institutional corruption, systemic problems, clinical trials, medical competence, pharmaceutical marketing, patient advocacy organizations
Address for correspondence: Prof. Toni Vekov, Faculty of Public Health, Medical University, 1, Sv. Kl. Ohridski, St., Bg -- 5800 Pleven, e-mail: t.vekov.mu.pleven@abv.bg

 

 

Ethical aspects of advertising in respect to public health – Medical Review (Meditsinski pregled), 50, 2014, 4, 58-62.
S. Aleksandrova-Yankulovska and T. Vekov
Faculty of Public Health, Medical University -- Pleven
Summary: Advertising can influence people in different ways -- it changes their convictions or their desires and emotions. Advertisements can send strong messages, introduce new symbols, values, standards and ideals for good life. The aim of this paper is to examine the potential of advertisement for positive and negative influence on the consumers with respect to its effects on public health. Through the example of Benetton’s unusual campaigns, the possibilities of shockvertising to communicate social messages are considered. Advertising possess powerful means of influence, which can be employed not only for marketing purposes, but also for the purpose of improving public health and achieving change in attitude towards social problems.   
Key words: advertisement, shockvertising, effects on public health, social messages
Address for correspondence: Assoc. Prof. Silvia Aleksandrova-Yankulovska, DM, Faculty of Public Health, Medical University, 1, Kliment Ohridski, St., Bg -- 5800 Pleven, tel: +359 64884196, e-mail: silviya_aleksandrova@hotmai.com/dean-ph@mu-pleven.bg

 

 

HISTORY OF MEDICINE

History of contraceptive methods in the ancient world: Egypt, Greece and the Roman empire – Medical Review (Meditsinski pregled), 50, 2014, 4, 63-67.
V. Belcheva(1) and E. Grigorov(2)

(1)Faculty of Public Health, MU -- Sofia, (2)Faculty of Pharmacy, MU -- Sofia
Summary:
The practice of contraception or preventing pregnancy is supposed to be as old as human existence. For centuries, humans have relied upon their imagination to avoid pregnancy. Since the first described methods for contraception, the history started to be full of curious information and sometimes bizarre facts for its practice. The topic is also known to be clouded by innuendo for centuries. Since ancient times, many women practiced different methods of birth control. Religious and civil authorities are often not able to intervene in this process. Women have done this, especially as they used their knowledge of the properties of some plants and animal products. Egyptian ancient writings dating back to 1800 BC, refer to techniques using a device placed in a woman’s vagina made of crocodile dung and sour milk. The Greeks used Silphium, a plant known to have contraceptive and abortifacient properties. Another plant used in was the Pennyroyal. Today, the voluntary control of fertility is of paramount importance to modern society. The different methods for contraception have become very safe and effective. From a global perspective, we can say that countries currently face the crisis of rapid growth of the human population, so that has begun to threaten human survival and the birth control is essentially important.
Key words: history, methods, contraception, Ancient world
Address for correspondence: Valentina Belcheva, Faculty of Public Health, MU, 8, Bialo more St., Bg -- 1527 Sofia, e-mail: valentina.belcheva@gmail.com

 

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Registered morbidity from urogenital system diseases in the emergency room at the Aleksandrovska University Hospital – Medical Review (Meditsinski pregled),  50, 2014, № 3, 19-23.
N. Houbanov(1), B. Zlatkov(2) and J. Filipov(2)
(1)Emergency Room, Alexandrovska University Hospital, (2)Nephrology and Transplantation Clinic, Alexandrovska University Hospital, Medical University -- Sofia
Summary: The diseases of the urogenital system represent a significant part of the hospitalized morbidity rate in hospitals. A total of 151 670 patients were hospitalized in 2012 with the fraction of the diseases of the urogenital system ranking fourth in terms of cause for admission to hospital. The objective of this survey is to describe and analyze data related to the registered and hospitalized patients in The Emergency Room at The Alexandrovska University Hospital. The survey was based on a descriptive and correlation analysis of statistical data related to the registered morbidity rate of diseases of the urogenital tract with registered and examined in the ward patients. Part of the data has been compared with past periods. There have been established similarities and differences in the statistical parameters in comparison to a previous period. There have been identified cyclicity and seasonality in some of the researched parameters. The registered morbidity rate among patients of the Emergency Room at the Alexandrovska University Hospital is substantially formed by diseases and symptoms related to the urogenital system representing 30.05% of the examined patients and 60.61% of all hospitalized patients in the ward. Throughout the analyzed period of 2013, there was established a disappearance of the seasonal and monthly variations in the registered incidence of patients suffering from diseases of the urogenital system.
Key words: urogenital system diseases, incidence rate, seasonality
Address for correspondence: Nikolay Houbanov, M. D., Emergency Room, Alexandrovska University Hospital, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia

 

 

Species-specific identification of clinically significant Enterococcus spp. strains -- application of microbiological and molecular-genetic methods in the laboratory practice – Medical Review (Meditsinski pregled),  50, 2014, 3, 24-30.
T. Strateva(1), D. Atanasova(1), S. Dimov(2), K. Bojkova(3), S. Raycheva(4), A. Katrandjieva(5), A. Dimitrova(6), I. Ivanova(7) and I. Mitov(1)
(1)Department of Medical Microbiology, Faculty of Medicine, Medical University -- Sofia, (2)Department of Genetics, Faculty of Biology, Sofia University “Sv. Kliment Ohridski”, (3)Department of Microbiology, Medical University -- Varna, (4)PMDL “Mikro-2” -- Kurdzhali, (5)MHAT “Dr. Tota Venkova” -- Gabrovo, (6)MHAT “Sv. Panteleymon” -- Yambol, (7)MDL “Medilab” -- Blagoevgrad
Summary: One hundred ninety-two clinical strains belonging to the genus Enterococcus were identified to a species level by both microbiological and molecular-genetic methods. The microbiological methods included cultivation on a chromogenic selective medium, biochemical tests and commercial kits/systems, while molecular-genetic ones were based on the use of polymerase chain reaction primers especially designed to hybridize to genus- and species-specific genomic DNA sequences -- within the 16S ribosomal RNA genes or within genes encoding enzymes participating in different metabolitic pathways. From the total number of strains, 135 were identified as Enterococcus faecalis, 48 as Enterococcus faecium, 6 as Enterococcus durans, and 3 as Enterococcus gallinarum. While the molecular techniques showed the advantages to be fast and giving clear results, the classical ones, despite of being more time-consuming and presenting ambiguity in some cases, revealed to possess some advantages when non-faecalis/non-faecium species had to be identified. A good fit between the two groups of methods, ranging from 85.6% to 94.7%, was observed, however the differences suggest their complex application for the species identification in the laboratory practice.
Key words: genus Enterococcus, species identification, conventional biochemical tests, commercial kits and systems for identification, polymerase chain reaction, chromogenic cultural method
Address for correspondence: Assoc. Prof. Dr. Tanya Strateva, PhD, Department of Medical Microbiology, Faculty of Medicine, Medical University, 2 Zdrave Str., Bg -- 1431 Sofia, tel. +359 2 9172750, e-mail: dr.strateva@abv.bg

 

 

Expression of costimulatory receptors in chronic lymphocytic leukemia -- relationship with progression of disease – Medical Review (Meditsinski pregled), 50, 2014, № 3, 31-36.
R. Vladimirova, D. Popova, E. Vikentieva, I. Galabova, L. Mitev, I. Gigov and J. Rainov

Military Medical Academy -- Sofia
Summary: Chronic lymphocytic leukemia (CLL) results not only from impaired apoptosis, but also from microenvironment-induced cellular proliferation. The aim of this study was the search for correlations between the expression of costimulatory molecules, such as CD40, CD80, CD86, their ligands CD28, CD154, migration-related chemokine receptor CD197 and cellular activation and proliferation. Peripheral blood from 55 patients with CLL was collected. Mononuclear cells were stained for 7-color flow cytometry. Sera were tested with radioenzyme assay for the in vitro determination of sTK1 enzyme activity. CLL patients showed increased expression of CD40, CD86, sTK1 and decreased CD80. All investigated CLL markers exhibited changes in their expression and in the correlation between expression levels with risk progression. In conclusion, low expression levels of CD28 and CD197 on Т cells enhance the role of the activation signal, mediated via CD86 pathway, and are prerequisite for B cell proliferation.
Key words: chronic lymphocytic leukemia, costimulatory molecules, sTK1, proliferation
Address for correspondence: Rositsa Vladimirova, MD, Laboratory of Cytogenetics and Immunology, Military Medical Academy, Sofia, Bg -- 1606, 3 Sv. G. Sofiyski Blvd., tel. +359 888 351 777, e-mail: rossy_vladimirova@yahoo.com

 

 

Seasonal variations of 25-hydroxyvitamin D in Bulgarian kidney transplant recipients – Medical Review (Meditsinski pregled), 50, 2014, № 3, 37-41.
J. Filipov(1), B. Zlatkov(1), E. Paskalev(1), N. Houbanov(2) and D. Svinarov(3)

(1)Department of Nephrology and Transplantation, University Hospital "Alexandrovska" -- Sofia, (2)Emergency Unit, University Hospital "Alexandrovska" -- Sofia, (3)Laboratory of Therapeutic Drug Management & Clinical Pharmacology, University Hospital “Alexandrovska" -- Sofia
Summary: Almost 90% of total body vitamin D (VD) is synthesized in the skin after exposure to direct sunlight. This explains the marked seasonal variations of VD. VD insufficiency however is frequently detected in the so called “sunny” regions of the world due to different factors -- style of clothing, cultural characteristics, etc. The aim of our study was to assess the seasonal changes in 25-hydroxyvitamin D (25VD) in kidney transplant recipients, followed-up in our transplant center. The patients were tested for 25VD during two intervals May -- November 2012 and January -- April 2013. Patients within 6 months of transplantation, performed parathyroidectomy, unstable kidney function, concomitant intake of calcineurin inhibitors (CNI) and mTOR inhibitors, advanced liver disease and VD supplemen­tation were excluded from the study. Statistical analysis included descriptive sta­tistics, univariate and multivariate loglinear regression, paired samples T-test (SPSS 11.5, adopted level of significance p < 0.05). Determination of total 25 VD was performed by a validated LC-MS/MS method. A total of 232 patients we­re selected according to the above-mentioned criteria. Statistically significant dif­ference in mean 25VD was detected for May-November 2012 and January-Ap­ril 2013 (61.06 +/- 22.31 nmol/L vs. 39.19 +/- 18.89 nmol/L, respectively, p < 0.001). Seasonal drop of 25VD was influenced by VD testing in July, August, September, March, April, as well as male gender and body mass index. A marked seasonal variation in 25VD was detected in our cohort of patients. The changes were linked not only to seasonal factors, bat also male gender and body mass index.
Key words: seasonal variations, 25-hydroxyvitamin D, kidney transplantation
Address for correspondence: J. Filipov, M. D., Clinic of Nephlology and Haemodyalisis, University Hospital “Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia

 

 

HELPING PRACTICE

Need for interpretation and adaptation of pharmacoeconomic evaluations for the introduction of a positive drug list – Medical Review (Meditsinski pregled), 50, 2014, № 3, 51-54.
T. Vekov
Faculty of Public Health, Medical University -- Pleven
Summary: The study aimed at analyzing the requirements needed when presenting or adapting data from pharmacoeconomic evaluations. Another aim of the study was to outline a model of formal requirements of the National Council on prices and reimbursement for data reporting after these have been transferred from other countries and adapted according to local pharmacoeconomic evaluations. Differences in the availability of therapy, relative prices, treatment recommendations and individual clinical practice styles, together with the lack of motivation for health professionals and institutions, pose the need for a scientific translation of pharmacoeconomic evaluations into local health-economic environment.
Key words: reimbursement, pharmacoeconomic evaluations, health-economic environment
Address for correspondence: Prof. Toni Vekov, Faculty of Public Health, Medical University, 1, Sv. Kl. Ohridski St., Bg -- 5800 Pleven, e-mail: t.vekov.mu.pleven@abv.bg

 

 

MEDICAL ETHICS

Contraception -- ethical, religious and financial aspects – Medical Review (Meditsinski pregled), 50, 2014, № 3, 55-60.
N. Shtereva-Nikolova

Faculty of Public Health, Medical University -- Sofia
Summary: The application of contraceptives is a conscious intervention in the natural process of fertility. They are widespread across the global community. Different methods of contraception allow people to exercise full control over their reproductive ability and family size without prejudice to their sex life. The purpose of this paper is to consider contraception as a method to prevent pregnancy and discuss the resultant ethical, religious and financial issues. In this paper issues related to contraception were presented in three aspects: ethical, religious and financial. The debate generally takes place between opponents and supporters of birth control. The ethical issues associated with the use of contraceptives by adolescent boys and girls were described. Ethical problems arising from contraception are in no way limited to the health status of individuals. Increased use of contraceptives has contributed to a new understanding of sexual contact, family, and the idea of responsible parenthood. These are factors that are important to the economic stability of every family and social development of society and the state.
Key words: ethical aspects, contraception, family, sexual life, planned reproduction
Address for correspondence: N. Shtereva-Nikolova, M. D., Faculty of Public Health, Medical University, Bg -- 1527 Sofia, 8, Bialo more St., е-mail: nshtereva@gmail.com

 

 

Is the revised Helsinki Declaration new? – Medical Review (Meditsinski pregled), 50, 2014, № 3, 61-64.
S. Aleksandrova-Yankulovska
Faculty of Public Health, Medical University -- Pleven
Summary: Scientific research lays the foundation of human knowledge and understanding of natural processes. At the same time, research projects present serious challenge to bioethics in relation to the inevitable involvement of human beings as subjects of experiments. Since its adoption in 1964, the Declaration of Helsinki becomes a cornerstone ethical document in biomedical research. This is the most frequently revised ethical document, which has undergone 8 revisions until October 2013, when the latest, 9th revision has been adopted at the 64th General Assembly of the World Medical Association in Brazil. . The aim of this paper is to compare the last two revisions of the Declaration, analyze the changes that have been made and assess their effect on the organization of research with human beings.
Key words: scientific research, Declaration of Helsinki, research with human beings
Address for correspondence: Assoc. Prof. Silvia Aleksandrova-Yankulovska, DM, Faculty of Public Health, Medical University, 1, Kliment Ohridski, St., Bg -- 5800 Pleven, tel: +359 64884196, e-mail: silviya_aleksandrova@hotmail.com / dean-ph@mu-pleven.bg

 

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Comparative pharmacoeconomic study of the drug asenapine for the treatment of bipolar disorder type 1 in Bulgaria   - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 29-34.
E. Grigorov
Faculty of Pharmacy, MU -- Sofia
Summary: The aim of this study was to perform a comparative pharmacoeconomic analysis assessing the drug Sycrest® (asenapine), used in the treatment of bipolar affective disorder type 1. The primary endpoint of the study was to analyse the cost of therapy with asenapine compared with the most commonly used alternative treatment strategy for the treatment of bipolar affective disorder type 1 at the present time in the country, using the method "cost of illness". Additionally, as a secondary endpoint a budget impact analysis was performed over a five-year period based on the assumption that the rate of increase of patients treated with asenapine would be proportional to the growth rate of the market utility of the drug, reflecting the rate of morbidity. The pharmacoeconomic analysis was based on the clinical experience of Bulgarian psychiatric practice, as well as on the Standard of Care in Psychiatry, adopted by the Ministry of Health.
Key words: bipolar disorder type 1, pharmacotherapy, pharmacoeconomics
Acknowledgments: This study was funded by Lundbeck Bulgaria.
Address for correspondence: Evgeni Grigorov, Faculty of Pharmacy, Medical University, 2 Dunav St., Bg -- 1000 Sofia, e-mail: evgeni.grigorov@gmail.com

 

 

Use of Renohelp M in patients with recurrent urinary tract infections infections - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 35-39.
B. Zlatkov(1), Zh. Filipov(1), E. Paskalev(1), B. Markova(2), Yu. Marteva-Proevska(2) and A. Kolevski(2)
(1)Clinic of Nephrology and Transplantation, UMHAT “Aleksandrovska” -- Sofia, (2)Central Laboratory of Microbiology, UMHAT “Aleksandrovska” -- Sofia
Summary: Urinary tract infections (UTIs) are one of the most common infections in the human population. Patients who underwent renal transplantation represent a group with very high risk for UTIs with a much higher incidence been reported -- 30% to 80%. The purpose of this study was to determine the effect of the product “Renohelp M” in patients with recurrent UTIs, as well as in renal transplant recipients with UTIs caused by Gram-negative and Gram-positive bacteria, who were treated with an appropriate antibacterial therapy. A total of 70 patients with recurrent UTIs treated at the Clinic of Nephrology and Transplantation have been observed in the study. They were divided into two groups -- 35 renal transplant recipients and 35 non-transplant patients. All patients received appropriate antibiotic therapy according to microbiological results. After patients have completed the antibiotic course, treatment with Renohelp M was initiated for a period of three months. The frequency of UTIs was followed-up. In a large proportion of the patients we found that the preparation "Renohelp M" exhibited antibacterial and antiseptic effects and assisted in the treatment of UTIs. Renohelp M reduced the recurrence rate of UTIs during the reference period in 83% (58/70) of all patients. In the group of renal transplants the recurrence rate of UTIs was reduced with 80% (28/35 patients) and in the non-transplant group with 86% (30/35 patients). The use of Renohelp M results in increased cleaning function of the renal transplant, a significant decrease of serum creatinine and urea, and increase of creatinine clearance. Moreover, we established a significant decrease in the level of uric acid (from 514 +/- 16 mmol/L at baseline to 439 +/- 15 mmol/L in men and from 408 +/- 12 mmol/L to 324 +/- 11 mmol/L in women, p < 0.05), along with some increase in urine output. The results allow us to conclude that Renohelp M could be successfully applied in patients who underwent renal transplantation and in non-transplant patients with recurrent UTIs.
Key words: Renohelp M, urinary tract infections, creatinine clearance, uric acid
Address for correspondence: Prof. Emil Paskalev, M. D., Clinic of Nephlology and Haemodyalisis, University Hospital “Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, tel. +359 2 9230 539, e-mail: emilpaskalev@abv.bg

 

 

The effect of the antioxidant drug “U-74389G” on chloride levels during ischemia-reperfusion injury in rats rats - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 40-44.
C. Τsompos(1), C. Panoulis(2), K. Τοutouzas(3), G. Ζografos(4) and A. Papalois(5)
(1)Department of Obstetrics & Gynecology, Messolonghi County Hospital -- Etoloakarnania -- Greece, (2)Department of Obstetrics & Gynecology, Aretaieion Hospital, Athens University, Attiki Greece, (3)Department of Surgery, Ippokrateion General Hospital, Athens University -- Attiki, Greece, (4)Department of Surgery, Ippokrateion General Hospital, Athens University -- Attiki, Greece, (5)Experimental Research Center ELPEN Pharmaceuticals, S.A. Inc., Co.
Summary: The aim of this experimental study was to examine the effect of the antioxidant drug “U-74389G” on rat model and particularly in an ischemia-reperfusion (IR) protocol. The beneficial effect or non-effectiveness of that molecule was studied biochemically using mean blood chloride levels. Materials and methods: 40 rats of mean weight 231.875 g were used in the study. Chloride levels were measured 60 min (groups A and C) and 120 min (groups B and D) after reperfusion. The drug U-74389G was administered only in groups C and D. Results: U-74389G administration non-significantly decreased the chloride levels by 1 mmol/l (-2.074727 mmol/l ÷ -0.0747266 mmol/l, p = 0.0673). This finding was in accordance with the results of paired t-test (p = 0.1085). Reperfusion time non-significantly decreased the chloride levels by 0.9 mmol/l (-1.984218 mmol/l ÷ -0.1842178 mmol/l, p = 0.1011), also in accordance with paired t-test (p = 0.1105). However, U-74389G administration and reperfusion time together produced a significant combined effect in decreasing the chloride levels by 0.7818182 mmol/l (-1.408963 mmol/l ÷ -0.1546735 mmol/l, p = 0.0159). Conclusion: Results of this study indicate that U-74389G administration, reperfusion time and their interaction have a decreasing short-term effect on chloride levels within the context of a 2-hour experimental period. Either significant or not, this decrease has an immediate impact on serum osmotic pressure, blood pH and other physiological states.
Key words: U-74389G, chloride levels, reperfusion
Address for correspondence: Tsompos Constantinos, Mesologi County Hospital, 11-1-2014 Nafpaktou street, 30200 Etoloakarnania, Greece, Tel: 00302631360237, Fax: 00302106811215

 

 

Effects оf sodium valproate on hyperthermic reaction in experimental serotonin syndrome - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 45-48.
R. Nikolov
Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University -- Sofia
Summary: Serotonin syndrome is likely to be observed as a result of an overdose of serotoninergic drugs or interactions related to the combined administration of two or more drugs that increase the intrasynaptic concentration of serotonin (5-hydroxytryptamine). The aim of this study was to establish the effects of sodium valproate (300 mg/kg i.p.) on the hyperthermic response to experimental serotonin syndrome in rats. Administration of 5-hydroxy-L-tryptophan and clorgyline induced the serotonin syndrome in rats. The body temperature of the animals was measured with thermistor probes (TX-8) inserted rectally, and monitored on multichannel recorder Iso-Thermex 16. Pretreatment with sodium valproate decreased hyperthermic reaction in an experimental model of the serotonin syndrome.
Key words: serotonin, sodium valproate, serotonin syndrome, hyperthermia, rats
Address for correspondence: Assoc. Prof. Rumen Nikolov, MD, PhD, Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University, 2 „Zdrave“ St., Bg -- 1431 Sofia, tel. +359 2 91 72 621, e-mail: ru_nikolov@abv.bg

 

 

The frequency of cognitive impairment and dementia one year after ischemic stroke in Bulgarian patients   - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 49-53.
N. Petrova(1), S. Mehrabian(2), M. Raycheva(2) and L. Traykov(2)
(1)Clinic of Neurology, MHAT -- Ruse, (2)Clinic of Neurology, University Hospital “Aleksandrovska” -- Sofia
Summary: The aim of the study was to determine the relative frequency of first-ever post-stroke dementia and cognitive impairments (one year after onset) in consecutive hospitalized Bulgarian patients. Eighty-five first-ever stroke inpatients (mean age 65.6 +/- 5.6) without previous cognitive complaints were prospectively evaluated with a comprehensive neuropsychological battery at 5th day, 1st, 6th and 12th month after the cerebrovascular event. At one-year follow-up, the results revealed that 15 patients (20%) had no cognitive impairment (NCI), 30 patients (41%) had mild cognitive impairment (MCI) and 29 patients (39%) were with dementia. In the dementia patient group, 4 patients improved their cognitive status afterwards -- reversion to MCI level was observed in 3 patients and to NCI - in one patient. In the MCI patient group, no further changes occurred in 27 patients, 18 patients went on to develop dementia, and 12 patients reversed to NCI. Baseline impairments in attention/executive functions and memory were associated with development of dementia in post-stroke patients. In conclusion, cognitive decline is common after stroke. Better knowledge of the early neuropsychological markers for delayed post-stroke dementia should increase the effectiveness of preventive strategies in patients with this condition.
Key words: post-stroke dementia, ischemic stroke, vascular cognitive impairment, risk fac­tors, neuropsychological assessments
Address for correspondence: Neli Petrova, M. D., e-mail: npetrova27@yahoo.com

 

 

MANAGEMENT IN HEALTHCARE

Appication of pharmacoeconomic evaluations and value-added for the patient in drug policy   -Medical Review (Meditsinski Pregled), 50, 2014, No 2, 58-62.
T. Vekov
Faculty of Public Health, Medical University -- Pleven
Summary: As a result of the widely recognized benefits pharmacoeconomic evaluations are applied in a number of EU countries. They give answers to questions such as: Is there a therapeutic and social need for the medicinal product? Is it necessary the medication to be paid with public funds and could the payer of public money afford it? To what extend is society willing to pay extra for the new therapy compared to existing drug alternatives? Should the pre-existing drug alternatives to be excluded from the reimbursement system, if they are less economically efficient? The decision to pay for a drug with public funds should be transparent and based on relevant criteria, and such decisions should be subject to review.
Key words: drug policy, pharmacoeconomic evaluations, value-added, European practices
Address for correspondence: Prof. Toni Vekov, Faculty of Public Health, Medical University, 1, Sv. Kl. Ohridski St., Bg -- 5800 Pleven, e-mail: t.vekov.mu.pleven@abv.bg

 

 

HELPING PRACTICE

Right patient selection -- a main precondition for successful practice in aesthetic surgery   -Medical Review (Meditsinski Pregled), 50, 2014, No 2, 63-68.
Y. P. Yordanov(1), A. Shef(2) and V. Donkina(3)
(1)Unit of Plastic Surgery and Burns, Military Medical Academy -- Sofia, (2)Department of Dermatovenereology and Allergology, Military Medical Academy -- Sofia, (3) Center for Mental Health and Prevention, Military Medical Academy -- Sofia
Summary: Patient consultation and selection for aesthetic plastic surgery goes well beyond assessment of anatomical indications. Patient selection involves an understanding of the patient's motivations for the procedure, expectations for the surgical outcome, and ego strength for tolerating the stress of operative intervention. The patient interview preoperatively must be structured to give the surgeon ample information in order to determine the psychological and emotional stability of the candidate. The aim of the present article was to stress on the importance of the adequate patient selection as a key first step toward a successful outcome from a proposed procedure and avoiding complications of medical, medico-legal and emotional entities. Basic principles of patient selection for aesthetic plastic surgery were reviewed. Special emphasis was placed on some common conditions and personality disorders that will guarantee a dissatisfied and ungrateful patient who will be difficult to manage. Predicting the future is part of the plastic surgeon's valued armamentaria but even experienced and astute physician cannot always make the perfect decision.
Key words: patient selection, aesthetic plastic surgery, preoperative consultation, difficult patient, personal disorder
Address for correspondence: Yordan P. Yordanov, MD, PhD, Unit of Plastic Surgery and Burns, Military Medical Academy, 3, Sv. G. Sofiyski St., Bg -- 1606 Sofia, tel.: +359 887 56 00 54, e-mail: yordanov_vma@abv.bg

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Increased inherited platelet aggregation  as a risk factor for venous thrombosis  - 50, 2014, № 1,33-37.
P. Ivanov(1), P. Laleva(2), M. Ivanov(1), R. Komsa-Penkova(1), A. Izmailov(1) and L. Beshev(3)

(1)Department of Biochemistry, Medical University -- Pleven, (2)Clinical Laboratory, UMBAL “Dr. G. Stranski”, Medical University -- Pleven, (3)Vascular Surgery Unit, UMBAL “Dr. G. Stranski”, Medical University -- Pleven
Summary: Alone or as a complication of other diseases, deep venous thrombosis (DVT) frequently occurs without a well-established direct cause. Besides the well-known provoking factors, DVT could be related with inherited impaired coagulation. Along with typical thrombophilic factors like Factor V Leiden (FVL) and prothrombin 20210 G>A mutation (FII 20210 G>A), there are also other inherited factors predisposing to thrombosis development. The aim of this study was to assess the role of polymorphism A2 (PL A1/A2) in platelet glycoprotein IIb/IIIa in the development of DVT and the contribution of this polymorphism to the clinical manifestation of the disease when in combination with other thrombophilic factors. Eighty patients with DVT and 103 health control subjects were tested for PL A1/A2, FVL and FII 20210 G>A. There was a significantly higher occurrence of PL A1/A2 in patients with DVT compared to controls, 41.3% and 17.5%, respectively (OR: 3.5; 95% CI 1.7-7.4, p = 0.001). A significantly higher number of patients  --  carriers of PL A1/A2 in combination with FVL or FII 20210 G>A had their first DVT event before 45 years as compared to carriers of single FVL or FII 20210 G>A (p = 0.022). The mean age of onset of first episode of DVT was 36.4 and 47.2 years, respectively, for combined PL A1/A2 -- FVL and PLA2 -- FII 20210 G>A carriers, as compared to FVL or FII 20210 G>A carriers alone. This study demonstrated an impact of PL A1/A2 for the development of DVT. Combined carriage of PL A1/A2 with other thrombophilic factors lead to early thrombotic events. The result encouraged PL A1/A2 testing in DVT patients for better risk assessment and prevention of recurrent thrombosis by applying proper prophylaxis.
Key words: polymorphism A1/A2, platelet glycoprotein IIb/IIIa, deep venous thrombosis, early onset
Address for correspondence: Petar Ivanov, M. D., Ph. D., Department of Biochemistry, Medical University, 1, Sv. Kliment Ohridski St., Bg  --  5800 Pleven, tel. +359 897899583, e-mail: mdivanov@gmail.com

 

 


K. Tzonkov, S. Asyov and V. Tzanov
. Basic problems of interlocking intramedullary nailing of proximal tibial fractures  - 50, 2014, № 1,38-41.
K. Tzonkov, S. Asyov and V. Tzanov
.
Second Clinic of Traumatology, UMHATEM "N. I. Pirogov" -- Sofia
Summary:
The goal of this study was to disscus the problems arising with the treatment of the proximal tibial fractures with interlocking intramedullary nailing without reaming and to present decision of preventing complications. Thirty-five patients with extraarticular fractures of the proximal tibia were treated with those method in Second Traumatologic Clinic of Emergency Hospital „Pirogov” for a period of 7 years. There were 4 open and 31 closed fractures. All patients were treated with interlocking intramedullary nailing without reaming of the medullar chanel. Open reduction was performed in 5 patients. The results obtained were as follow: 60% -- with anterior angulation, 28% with more than 5 degree angulatin in the frontal and sagital planes, and 14% -- delayed union. Anterior angulation occurred in 21 patients (60%). Rotatory deviation of 8-10 degree was found in 2 patients (6%). The anterior angulaton and the valgus deformation were the most common complications after intramedullary nailing of the tibia. Based on these findings, the authors consider that this method of treatment of proximal tibial fractures should not be recommended and should be avoided. But when the intramedullary nailing is compulsory, it has to be done in semiextended position of the leg and with lateral parapatellar entry hole, situated cranially as much as possible.
Key words: proximal tibial fractures, treatment, interlocking intramedullary nailing, problems
Address for correspondence: Konstantin Tzonkov, M. D., Second Clinic of Traumatology, UMHATEM "N. I. Pirogov", 21, Totleben Blvd., Bg -- 1606 Sofia

 

 


Conservative treatment by physical means of arthritis of the temporomandibular joint  - 50, 2014, № 1,42-46.
Kr. Kazalakova(1), G. Georgiev(2) and A. Bayraktarova(3)
.
(1)Department of „Physical Medicine and Rehabilitation”, UMHATUM „Pirogov” -- Sofia, (2)Clinic of „Physical Medicine and Rehabilitation”, MMA -- Sofia, (3)Department of Medical Rehabilitation and Occupational Therapy, Faculty of Medicine, Medical University -- Sofia
Summary: Arthritis and osteoarthritis of the temporomandibular joint are a group of disorders known to be inflammatory in nature. Temporomandibular disorders cause severe pain and discomfort. In the literature it is considered that more women than men are affected, aged between 20 and 40 years. In this paper we propose the use of conservative therapy with preformed physical factors intended to influence the pathophysiological mechanisms that affect this small joint.
Key words: temporomandibular joint, preformed physical factors, traumatic injury, rheu­ma­toid arthritis
Address for correspondence: Krasimira Kazalakova, M. D., Department of Physical Medicine and Rehabilitation, UMHATUM „Pirogov”, 21, Totleben Blvd., Bg -- 1606 Sofia, tel. +359 887 39 69 06

 

 

MANAGEMENT IN HEALTHCARE


The missed opportunities for management
of the expenditures for medicinal products in Bulgaria  - 50, 2014, № 1,59-63.
T. Vekov.
Faculty of Public Health, Medical University  --  Pleven
Summary: Current understanding of European health policy makers and managers is that, through appropriate regulation of the pharmaceutical market, savings can be made without this being associated with a worsening of the quality of health care.Bulgaria has the highest (35.3%) relative proportion of expenditures for medicinal products out of the total health care spending. Therefore, we have a reason to assume that, in our country, drug policy that favours the rational use of medicines and the control of public expenditure, based on pharma­co­eco­no­mic evaluations, is simply lacking.
Key words: medicinal products, expenditures, economic efficiency, management and control approaches
Address for correspondence: Prof. Toni Vekov, Faculty of Public Health, Medical University, 1, Sv. Kl. Ohridski St., Bg -- 5800 Pleven, e-mail: t.vekov.mu.pleven@abv.bg

 

 The role of Bulgarian media and internet networks in the formation of public perceptions and evaluations of the moral image of the physician  - 50, 2014, № 1,64-68. 
Pl. Popivanov
.
Department of Internal Medicine, Faculty of Medicine, Medical University -- Sofia
Summary: Print and electronic media, websites and social networks not only reflect but also significantly influence the formation of attitudes, opinions and evaluations about physicians and health care. The aim of the study was to assess the role of the Bulgarian media and Internet publications in shaping the notion of ​​the moral image of the physician. Publications with keywords Hippocrates and/or Hippo­cratic Oath in the database of CROSS Agency for 2010-2012 were exa­mined with media, graphic, alternative and Groundswell analyzes. А con­ti­nuous and sustainable interest of the media and internet networks to physicians' morale was established. The ratio between the number of positive and negative assessments was found to be about 1:9. Positive materials were always per­sonified, and negative -- generalized to the whole medical profession. Media and In­ternet publications have significant influence in shaping public perceptions of the physician’s moral image. The unbalanced, biased and often manipulative materials have turned the painful issue of the physicians’ morale into a “social outlet”.
Key words: media, social networks, physician’s morale
Address for correspondence: Plamen Popivanov, M. D., Department of Internal Diseases, Medical University, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, e-mail: ppopivanov@abv.bg

 

Last update of the page: 02.02.2015.

 

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