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 Original papers

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Volume 53, 2017

 

 

 

bullet 6'2017

Carbapenem-non-susceptible nosocomial isolates of Acinetobacter baumannii with multidrug resistance (2014-2016): Antimicrobial resistance surveillance and treatment recommendations – Medical Review (Medicinski pregled), 53, 2017, № 6, 27-36.
T. Strateva(1), T. Stoeva(2), E. Savov(3), Y. Marteva-Proevska(4), A. Trifonova(3), A. Stratev(5), Ts. Velinov(4) and I. Mitov(1)
(1)Department of Medical Microbiology, Faculty of Medicine, Medical University -- Sofia,
(2)Department of Microbiology and Virology, Medical University -- Varna,
(3)Laboratory of Microbiology, Department of Military Epidemiology and Hygiene, Military Medical Academy -- Sofia,
(4)Central Laboratory of Microbiology, UMHAT “Alexandrovska”, Medical University -- Sofia, (5)Department of Anaesthesiology and Intensive Care, UMHAT “Alexandrovska”, Medical University -- Sofia
Abstract: A total of 226 carbapenem-non-susceptible nosocomial isolates of Acinetobacter baumannii (AB) with multidrug resistance (MDR), identified by the gyrB polymerase chain reaction, was collected during the period 2014-2016 from four university hospitals in Bulgaria. The aim of this study was to assess their levels of antimicrobial susceptibility, according to the EUCAST-2016 criteria, and to ensure appropriate recommendations for the treatment. The antibiotic resistance rates were: to imipenem -- 90.7%, meropenem 98.3%, doripenem 100%, amikacin 92.8%, gentamicin 87.2%, tobramycin 55.6%, levofloxacin 98.2%, trimethoprim-sulfamethoxazole 86.2%, tigecycline (TGC) 22.1%, colistin (COL) 0% and ampicillin-sulbactam (SAM) 41.6% (interpreted according to the CLSI-2016 guideline). Twenty-eight isolates out of the tested strains (12.4%) were extensively drug-resistant (XDRAB), susceptible only to COL. Carbepenems have been regarded as effective antimicrobial agents to treat AB infections. The carbapenem resistance and the MDR necessitate the use of other classes of antibiotics and combination therapies. Usually, the choices of antimicrobial treatment for MDRAB and XDRAB are severely limited. There are only a few effective options available, including COL, TGC and SAM.
Key words: nosocomial isolates of Acinetobacter baumannii, multidrug resistance, antimicrobial resistance surveillance, treatment recommendations
Address for correspondence: Assoc. Prof. Tanya Strateva, MD, 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

 

 

sIgA levels, measured in unstimulated saliva and taste disorder in end-stage chronic kidney disease patients – Medical Review (Medicinski pregled), 53, 2017, № 6, 37-40.
D. Konstantinova(1), A. Nenova-Nogalcheva(2) and P. Pechalova(3)
(1)Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University -- Varna,
(2)Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Medical University -- Varna,
(3)Department of Oral Surgery, Faculty of Dental Medicine, Medical University -- Plovdiv
Abstract: The aim of the present study was to investigate the correlation between sIgA levels and taste disorder in patients suffering from end-stage chronic kidney disease (CKD) as a support of the hypothesis that high levels of sIgA could be used as a criterion in the planning of invasive dental manipulations. Study design: The clinical study targeted 70 patients suffering from end-stage CKD, undergoing renal replacement therapy. The participants included 32 male patients (45.71%) and 38 female patients (54.29%) with a mean age of 58.9 years (SD = 14.46). The data was collected through a questionnaire, comprising questions related to the subjective sense of taste disorder, and quantification of sIgA levels from the salivary liquid medium using radial immunodiffusion (or Mancini method). Results: The results revealed that 30.0% of respondents (21 patients) had a loss of taste. The patients, who had not reported any taste alteration, exhibited higher levels of immunoglobulin A (p = 0.050). There was no statistical correlation between gender and the subjective complaints of taste alteration. Conclusion: The levels of sIgA, measured in total unstimulated saliva, are proportional to the lack of taste changes in patients with end-stage CKD.
Key words: CKD, chronic dialysis, taste disorder, sIgA
Address for correspondence: Anna Nenova-Nogalcheva, MD, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Medical University, 84, Tsar Osvoboditel Blvd., Bg -- 9000 Varna, e-mail: anenova@yahoo.com

 

 

Comorbidity and functional consequences after operative treatment of malignancies in head and neck area. Part I: Comorbidity and sensory function, pain, speech and swallowing – Medical Review (Medicinski pregled), 53, 2017, № 6, 41-46.
E. Aleksiev(1, 2), M. Nikolova(3), M. Kondeva(1, 2), L. Videnova(1, 2) and P. Stanimirov(1, 2)
(1)Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Medical University -- Sofia,
(2)Department of Maxillofacial Surgery, University Hospital “Aleksandrovska”, Medical University -- Sofia,
(3)Department of Internal Medicine, Medical University -- Sofia
Abstract: The patients with neoplastic conditions affecting the maxillofacial area (MFA) and the neck often have serious comorbidities that affect the therapeutic and rehabilitation period. The aim of this research was to evaluate the effect of comorbid conditions on the development of functional consequences after operative treatment for neoplastic processes in the MFA and the neck. We investigated the sensorial function, pain, speech and swallowing before and 30 days after surgical intervention in 165 patients operated for malignancies in the MFA and the neck. We found no correlation between the comorbid status and the severity of postoperative functional impairment of the sensorial function, the pain, the speech and the swallowing.
Key words: comorbidity, functional consequences, surgical treatment, malignancy, maxillo­facial area
Address for correspondence: Evgeniy Aleksiev, DD, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Medical University, 1, Sv. Georgi Sofiyski St., Bg -- 1431 Sofia, e-mail: dr_aleksiev@yahoo.de

 

 

MANAGEMENT IN HEALTHCARE

Comparative analysis of the budgetary impact of the targeted drug therapies for treatment of non-small cell lung cancer in Bulgaria about two alternative approaches for referral reimbursement – Medical Review (Medicinski pregled), 53, 2017, № 6, 53-60.
T. Vekov
Faculty of Pharmacy, Medical University -- Pleven
Abstract: The aim of the study was to make a comparative analysis of the budgetary impact of targeted therapies for the treatment of patients with non-small cell lung cancer in two scenarios. The first reflects the real normative practice of pricing based on a reference value calculated for INNs and a drug form in which the analyzed drug therapies does not refer to each other. The second predicts the amount of public spending on pricing based on a reference value calculated for incremental cost-effectiveness ratio (ICER) of the analyzed target therapies. On the basis of the comparative analysis, it was intended to establish the impact of the ICER mutual reference on the value of public expenditure over a five-year period. The benchmarking of bevacizumab (BEV), erlotinib (ERL), afatinib (AFA), gefitinib (GEF), crizotinib (CRI) healthcare technology was based on a network meta-analysis of health technology assessments conducted in other countries. For the calculation of the value of the annual public expenditure, reference prices for medicinal products from the Positive Drug List were used as of August 2017. The results of the mutual referral of BEV, ERL, AFA, GEF, CRI were calculated on the basis of model prices for target medicinal products, referenced to the best incremental cost-benefit ratio. Modern approaches to value-based pricing (VBP) at disease level and patient group are a real opportunity to manage public spending on generic-free drugs. In this group of medicinal products, the use of INN reference cost-based pricing (CBP) is inapplicable as there are no alternative competitive therapies. In the present study, the modeling of ICER referral (VBR) in the target drug group for non-small cell lung cancer compared to INN referral achieved a reduction in public spending by BGN 18 million over a five-year time horizon.
Key words: non-small cell lung cancer, target drug therapies, budget impact, reference reimbursement
Address for correspondence: Prof. Tony Vekov, e-mail: t.vekov.mu.pleven@abv.bg

 

 

Maxillofacial surgery: prevalence and considerations – Medical Review (Medicinski pregled), 53, 2017, № 6, 61-64.
R. Kolarov
Executive Agency “Medical Audit” -- Sofia
Abstract: Maxillofacial surgery is a medical science with a multi-disciplinary profile. Into its coverage included are different types of diseases: inflammatory, traumatic, oncologic, inherited and acquired defects. It requires broad range of medical knowledge, as well as practical skills. However patient care delivery in the clinics is organized in pathways within the discipline itself. Presented is an analysis of the clinical pathways structure.
Key words: maxillofacial surgery, clinical pathways, patient flow, prevalence, surgical treat­ment, inflammatory diseases, traumas, oncology, malformations
Address for correspondence: Assoc. Prof. Rosen Kolarov, Executive Agency „Medical Audit“, 3, Sv. G. Sofiyski St., Bg -- 1606 Sofia, е-mail: rossen_kolarov@mail.bg

 

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bullet 5'2017


Evaluation of peripheral arterial stiffness in patients with prediabetes and type 2 diabetes
– Medical Review (Medicinski pregled), 53, 2017, № 5, 35-38.
S. Nacheva(1), Ts. Gatev(2), Ya. Assyov(2), Z. Kamenov(2) and J. Petrova(1)
(1)Clinic of Neurology, UMHAT “Aleksandrovska”, MU -- Sofia, (2)Clinic of Endocrinology, UMHAT “Aleksandrovska”, MU -- Sofia
Abstract: Type 2 Diabetes is one of the major diseases spread worldwide. Vascular impairment occurs in patients with prediabetes and type 2 diabetes and leads to premature development of cerebrovascular, cardiovascular and peripheral-nerve dysfunction. Ultrasound markers have been studied in order to evaluate the vascular impairment in glycemic disorders. Intima Media Thickness (IMT) di­rectly measures atherosclerotic transformation of the vessel, as for Ankle-Bra­chial Index (ABI) is a marker of abnormal vascular function or vascular obstruction in later stage of its development. The current study presents the first results from evaluating the beta-index -- new ultrasound marker for early vascular disease and its progression in the glycemic impairment.
Key words: prediabetes, diabetes type 2, neuropathy, vascular damage, markers
Address for correspondence: Silvia Nacheva, M.D., e-mail: drSylvi87@gmail.com

 

 

Destructive gunshot colon injury – Medical Review (Medicinski pregled), 53, 2017, № 5, 39-42.
K. Kostov, Yu. Vanev and K. Petrov
3rd Surgical Clinic, UMHATEM “N. I. Pirogov” -- Sofia
Abstract: Gunshot colon injuries are characterized by destructive localized or multiple lesions, and a number of aggravating the general condition factors. Therefore, they are problematic in diagnostic and therapeutic treatment. Treatment includes general physiological support and stabilization, and a choice of operating approach for elimination of local damage and restoration of the damaged colon segment. Objective: To analyze the clinical and pathological characteristics of patients with destructive colon injuries and their influence on the choice of surgical approach and its outcomes. Material and methods: Collected and stored data from a study of patients in the Section of General, Visceral and Emergency Surgery UMHATEM "N. I. Pirogov" for the period from 1 January 2005 to 31 December 2014 were used. Clinical, laboratory and surgical results were analyzed in 22 patients with gunshot injuries. Results: Isolated lesions of the colon were noted in 4 patients (18.2%). In all other cases the abdominal injuries are multiple and combined, as the combined ones include two or more organs in the abdominal cavity or other body regions (11 patients, 50%). Multiple lesions (two or more lesions) of colon were recorded in 7 patients (31.8%). In three patients the lesions are localized, but destructive because of extensive complex damage of the wall of the bowel. In a stable condition there are admitted 6 of the patients (27.2%), in serious condition -- 4 (18.2%), in critical condition -- 8 (36.4%). In extremely critical condition is 18.2% -- 4 patients. With traumatic shock are five of them (22.7%), with diffuse peritonitis -- 7 (31.8%). One-stage procedure was performed in 8 (36%) patients, a multi-stage procedure -- in 8 patients -- suture is provided with a proximal colostomy, resection of the intestine with colostomy was performed in 5 patients. In 1 patient there was primary suture of the hepatic flexure with protective ileostomy. Septic complications were registered in 12 (54.5%) patients. The total number of deceased patients was 5 (23%). Conclusion: Despite the justified pursuit of one-stage procedure, the multi-stage procedure remains indicated in patients with severe status, diffuse peritonitis or technical difficulties. Patients with massive (more than one quadrant) fecal contamination, systolic blood pressure below 90 mm Hg at admission, perioperative needs for blood transfusion, severe comorbidity and left-sided location of colonic injury, are not indicated to the one-stage procedure. Overall burden of trauma and shock condition are the main predictors of death, compliance and operational approach can prevent some complications and to contribute to improving the prognosis.
Key words: Trauma, gunshot colon injuries, single-stage and multi-stage procedure
Address for correspondence: Konstantin Kostov, MD, 3rd Surgical Clinic, UMHATEM “N. I. Pirogov”, 21, Totleben Blvd., Bg -- 1606 Sofia, e-mail: dr.k.kostov@gmail.com

 

 

Risk exposure and application of personal protective equipment in the practice of dental students – Medical Review (Medicinski pregled), 53, 2017, № 5, 43-48.
А. Kevorkyan(1), R. Raycheva(2), Y. Stoilova(1) and Sv. Dermendzhiev(3)
(1)Department of Epidemiology and Disaster Medicine, Faculty of Public Health, MU -- Plovdiv, (2)Department of Social Medicine and Public Health, Faculty of Public Health, MU -- Plovdiv, (3)Section of Occupational Diseases and Toxicology, IInd Department of Internal Medicine, Faculty of Medicine, MU -- Plovdiv
Abstract: In dental medicine field the risks of infection spread by microorganisms through the blood-borne, airborne and the waterway of the dental unit transmissions have been documented in numerous studies. Despite the limited clinical experience the risk for dental students still exists. Objective: To study the risk exposures and use of personal protective equipment in dental students practice in order to assess the knowledge for infection control measures when dealing with patients. Materials and Methods: We conducted an anonymous, confidential survey among 93 dental students trained at the Medical University of Plovdiv. All of them are undergraduates in courses that met a graduation requirement -- fourth year students with one-year dental practice experience. Results: The use of disposable gloves was confirmed in all (100%) cases, but only 68.81% (64/93) (p < 0.05) of respondents put safety glasses when working. The change of gloves between patients was declared by 96.77% (90/93). We report high proportion of students who have suffered exposure while working with a patient as needle stick or sharp injuries -- 46.24% (43/93), the students with ≥ 2 injuries were 55% compared to those with one -- 45% (p = 0.373). Pre-procedural use of an antiseptic mouth rinse of patients was confirmed by 36.56% of the students. Conclusion: Our study demonstrates that the education of dental students should focus on continuous motivation of the routine and proper implementation of infection prevention and control measures, followed by strict monitoring.
Key words: dental students, personal protective equipment, risk exposures, infection prevention and control measures
Address for correspondence: Assoc. Prof. Ani Kevorkyan, Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University, 15A, Vasil Aprilov Blvd., Bg -- 4002 Plovdiv, tel. +359 32 602 855, e-mail: ani _kevorkian@mail.bg

 

MANAGEMENT IN HEALTHCARE

Assessment of intraoperative medical imaging technologies for safe radical resection of brain tumors -- cost-effectiveness analysis in Bulgaria, 2017 – Medical Review (Medicinski pregled), 53, 2017, № 5, 52-56.
T. Vekov(1), N. Raynov(2) and G. Slavchev(3)
(1)Faculty of Pharmacy, Medical University -- Pleven, (2)Faculty of Medicine, Ludwig-Maximilians-Universität, München, (3)Health Technology Assessment OOD
Abstract: The aim of the study is to identify and analyze published data from assessments of intraoperative medical imaging technologies for safe radical resection of brain tumors, which are performed in different countries; modeling of costs and health benefits of health technology of intraoperative MRI (ioMRI) in comparison with the used in clinical practice intraoperative ultrasound system (ioUS). It was performed literature search of published data from assessments of intraoperative medical imaging technologies for safe radical resection of brain tumors in the period January 2013-July 2017. For the forecast of health costs and benefits of ioMRI versus ioUS there is used the model of Markov with five health conditions. Time horizon of the model is 5 years. The type of used economic method is cost/effectiveness. There are selected a perspective of healthcare and the view of payer. Costs and benefits are discounted with 5% annually. In conclusion of the cost-effectiveness analysis it can be summarized that ioMRI is a cost-effective medical imaging technology compared to ioUS for safe total resection of brain tumors (ICER BGN 19,279/QALY). Calculated incremental ratio is under threshold of the acceptable level of cost effectiveness WTP </= BGN 40,000/QALY.
Key words: brain tumors, intraoperative medical imaging technologies, cost-effectiveness analysis
Address for correspondence: Prof. Tony Vekov, e-mail: t.vekov.mu.pleven@abv.bg

 

 

Methods to develop a personal work time budget for Rehabilitation, Wellness, SPA and Balneotherapy Master Program students – Medical Review (Medicinski pregled), 53, 2017, № 5, 57-60.
M. Tarnovska(1) and G. Petrova(2)
(1)Department of “Health Care Management”, Faculty of Public Health, Medical University -- Plovdiv,(2)Department of “Nursing”, Faculty of Public Health, Medical University -- Plovdiv
Abstract: The article introduces training methods for preparation of a personal work time ‘budget’, which are applied to practical trainings of Rehabilitation, Wellness, SPA and Balneotherapy Master Program students at the Medical University -- Plovdiv. The main steps, set out in exercise methodic plan, on the basis of which each student prepares an individual work day budget have been described. Budget structure includes any activities and physiotherapeutic procedures of work schedule with their specific description, the necessary and the actual time needed to perform each one of them, as well as their arrangement based on the priorities. Methods illustrate one of the classic techniques for time expense research -- preparation of work time log by means of the so-called time somatography. The methods applied favor the establishment of a connection between theory and practice, teaches students how to acquire knowledge independently on the basis of their professional experience and in the particular work environment.
Key words: time management, work time budget, training, students, „Rehabilitation, Wellness, SPA and Balneotherapy“ Master Program
Address for correspondence: Miglena Tarnovska, MD, PhD, Section of Medical Ethics and Law, Department of “Health Care Management”, Medical University, 15A, Vasil Aprilov Blvd., Bg -- 4000 Plovdiv, e-mail: miglena_tarnovska@abv.bg


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bullet 4'2017

 

 

MANAGEMENT IN HEALTHCARE

A cost-effectiveness analysis of Venetoclax for treatment of refractory/relapsed chronic lymphocytic leukemia with or without 17p deletion in march 2017 in Bulgaria – Medical Review (Medicinski pregled), 53, 2017, №4, 38-45.
N. Veleva(1), D. Tsanova(2), T. Vekov(1)
(1)Faculty of Pharmacy, Medical University -- Pleven, (2)Faculty of Public Health, Medical University -- Pleven
Abstract: The study aim is to analyze published data from assessments of health technologies for treatment of relapsed/refractory chronic lymphocytic leukemia (R/R CLL) +/- del 17p/TP53 mut. Indirect comparison through network meta-analysis was made, including: Venetoclax (VEN), best supportive care (BSC), ibrutinib, rituximab, bendamustine, idelalisib, ofatumumab. Costs and health benefits are modeled. It is found that VEN is a cost-effective drug product in comparison with therapeutic alternatives for treatment of CLL in the presence of del 17p/TP53 mut in adult patients, who are not eligible or failed with BCRSP-i. VEN is a cost-effective therapy for treatment of CLL without del 17p/TP53 mut in adult patients, who failed with both chemoimmunotherapy and BCRSP-i.
Key words: refractory/relapsed chronic lymphocytic leukemia, Venetoclax, network meta-analysis, cost-effectiveness
Address for correspondence: Prof. Toni Vekov, e-mail: t.vekov.mu.pleven@abv.bg

 

 

Quality indicators in oral and maxillofacial surgery – Medical Review (Medicinski pregled), 53, 2017, №4, 46-51.
R. Kolarov.
Executive Agency „Medical Audit“ -- Sofia
Abstact: Quality of the health services is a right for any patient and is a priority for every state. Its maintenance is defined by actions headed towards a provision and establishment of standards. The objective assessment is hard because of the specific and complex nature of the health product. The development of particular indicators is a dominant goal for many scientists. Oral and maxillofacial surgery is a medical science with multidisciplinary profile. Development of specific quality indicators should take into consideration all the different approaches -- some of them valid for other medical specialties. Discussed is also the need for behavioral algorithms in oral and maxillofacial surgery.
Key words: quality in health care; oral and maxillofacial surgery; indicators for health; behavioral algorithms
Address for correspondence: Ass. Prof. Rossen Kolarov, Executive Agency „Medical Audit“, 3, Sv. G. Sofiyski St., Bg -- 1606 Sofia

 

 

An economic analysis and assessment of the value of parallel exports of drug products for treatment of oncological diseases in Bulgaria in 2016 – Medical Review (Medicinski pregled), 53, 2017, №4, 52-57.
T. Vekov(1) and Zh. Kolev(2)
(1)Faculty of Pharmacy, Medical University -- Pleven, (2)Faculty of Pharmacy, Medical University -- Varna
Abstract: The aim of the study is the analysis and assessment of parallel exports from Bulgaria of drug products for treatment of oncological diseases with annual sales of more than BGN 3 million in 2016. Documentary method and analysis comparing the quantity and value of sold oncological drug products in Bulgaria in 2016, which are registered by two independent sources -- IMS Health and the National Health Insurance Fund. The present study does not find data for deficit of analyzed drug products or restricted patient access to treatment due to lack of accessibility to drug therapy.
Key words: parallel exports, drug products for oncological diseases, Bulgaria
Address for correspondence: Prof. Toni Vekov, e-mail: t.vekov.mu.pleven@abv.bg

 

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bullet 3'2017


Hepatitis E virus infection in Northeastern Bulgaria – Medical Review (Medicinski pregled), 53, 2017, №3, 30-34.
Zh. Stoykova(1, 3), L. Ivanova(1, 3), D. Tsaneva-Damyanova(1) and Ts. Kostadinova(2)
(1)Department of Microbiology and Virology, Medical University -- Varna, (2)Education and Research Sectors of Medical Laboratory Assistant, Medical College, Medical University -- Varna, (3)Laboratory of Clinical Virology, University Hospital „Sv. Marina” -- Varna
Abstract: Hepatitis E virus (HEV) is the most important cause of acute hepatitis in many countries in Asia, the Middle East and North Africa considered as endemic regions. Although most disease cases were imported from these countries, recent studies have shown that hepatitis E occurs also in patients who has never been abroad. HEV infection has not been considered a major health problem in Europe, but recent studies show that seroprevalence to HEV increases in different European countries. The aims of our study are to investigate the possible role of HEV in causing acute hepatitis in Northeastern Bulgaria and to estimate the laboratory data of the previous infection. Single serum samples of 325 patients were tested from January 2012 to August 2016. Four of these patients had travelled to areas with high HEV endemicity. The study population is divided into two groups. Group A includes 287 hospitalized patients with clinical data of acute hepatitis and group B -- 38 outpatients with laboratory data of liver dysfunction. Commercial ELISA test kits were performed for detection of specific IgM and IgG antibodies for hepatitis A, B, C and E, according to the manufactures recommendations. Our data indicated that 43/325 patients (13.2%, CI 95% [3.1-23.3%]) were associated with acute HEV infection as shown by positive anti-HEV IgM test. The other causes of acute hepatitis were excluded as a reason for the condition. Positive anti-HEV IgG only were 68 of all 325 tested patients (20.9%, CI 95% [11.2-30.6%]) cases, showing past infection. Our data indicated that sporadic HEV infection is present in Northeastern Bulgaria as a cause of acute hepatitis. The preliminary data about seroprevalence to HEV is estimated as 20.9% in the investigated population.
Key words: acute hepatitis, seroprevalence, hepatitis E virus (HEV), ELISA
Address for correspondence: Zhivka Soykova, Department of Microbiology and Virology, Medical University, 55 “Marin Drinov” St., Bg -- 9002 Varna, e-mail: jivita77@abv.bg

 

 

Evaluation of the serum hepcidin and VEGF levels in patients with ischemic stroke – Medical Review (Medicinski pregled), 53, 2017, №3, 35-37.
J. Petrova(1), V. Manolov(2), S. Hadjidekova(3), V. Vasilev(4), K. Tzatchev(2), M. Petrova(1), L. Traykov(1), B. Marinov(5), I. Bogov(6), G. Gentchev(7) and R. Emilova(8)
(1)Department of Neurology, Medical University -- Sofia, (2)Department of Clinical Laboratory and Clinical Immunology, Medical University -- Sofia, (3)Department of Medical Genetics, Medical University -- Sofia, (4)University Hospital „Aleksandrovska”, Clinical Laboratory and Clinical Pharmacology, (5)Clinic of General and Pathological Pregnancy, UOGH “Maichin Dom”, Medical University -- Sofia, (6)HAT NCH -- Sofia, (7)Department of Health Management, Faculty of Public Health, Medical University -- Sofia, (8)NCCPD -- Sofia
Abstract: Oxidative stress plays an important role in pathogenesis of cerebral ischemia. Elevated free iron levels result in formation of free radicals. We searched for correlation between the peptide that regulates iron homeostasis -- hepcidin, and vascular endothelial growth factor, an angiogenesis inducer in patients with destabilized atherosclerotic plaques and ischemic stroke. 73 patients with ischemic stroke (before stenting) were measured for serum hepcidin and VEGF concentrations (60% males); middle age 61.5 (54-69). Established results were compared to 73 age- and gender matched healthy volunteers. We found significantly elevated serum hepcidin levels in the patients with ischemic stroke (95.4 +/- 17.3 mcg/L) compared to control group (19.9 +/- 3.9 mcg/L) (P < 0.001). VEGF concentrations in serum in patients with ischemic stroke were considerably increased (68.8 +/- 8.1 pg/ml) compared to healthy controls (36.2 +/- 3.3 pg/ml); Р < 0.005. Hepcidin correlates positively to VEGF levels in patients with ischemic stroke (r = 0.719, P < 0.005). The serum VEGF and hepcidin levels are increased in patients with atherosclerotic changes, leading to ischemic stroke. Our results show the important role of hepcidin in iron overload in cerebral ischemia.
Key words: hepcidin, stroke, VEGF, iron, ferritin
Address for correspondence: Victor Manolov, MD PhD, Department of Clinical Laboratory and Clinical Immunology, Medical University, Bg -- 1431 Sofia, 1 “Sv. Georgi Sofiyski” St., tel.: +359 2 9230 928, e-mail: victhedoc2@yahoo.com

 

 

Economic non-medical losses due to human cystic echinococcosis in Bulgaria – Medical Review (Medicinski pregled), 53, 2017, №3, 38-42.
M. Muhtarov¹, G. Gachev² and T. Tsvetanova³
¹Gastroenterology Ward, Multi-Profile Hospital for Active Treatment -- Kardzhali, ²Institute of Mathematics and Informatics, Bulgarian Academy of Sciences -- Sofia, ³Certified public accountant -- Sofia
Abstract: Cystic echinococcosis is a parasitic zoonosis caused by infestation with tapeworm Echinococcus granulosus. The study presents an analysis of economic non-medical losses among people caused by human cystic echinococcosis in Bulgaria. That kind of analysis has not been done before, as Echinococcosis has not been registered in the information database of the state social security system in the past. We calculated the amount of non-medical losses during the period 2009-2013 up to BGN 7,874,492.38 (EUR 4,026,021.64) on the basis of the method created by us. Their structure included direct costs of benefits paid for temporary disability -- BGN 745,015.66, indirect losses from unrealized gross domestic product (GDP) based on the total number of working days -- BGN 1,269,810.03 and potential losses of unrealized GDP caused by premature death from cystic echinococcosis -- BGN 5,859,666.68. Research on economic losses caused by cystic echinococcosis prove that funds invested in the creation and implementation of control programs can bring substantial anticipated return on the invested funding.
Key words: cystic echinococcosis, economic losses, temporary disability, unrealized gross domestic product
Address for correspondence: e-mail: mukhtarov@abv.bg

 

 

Nonsurgical rejuvenation of the middle third of the face with hyaluronic acid fillers – Medical Review (Medicinski pregled), 53, 2017, №3, 43-48.
Y. P. Yordanov(1) and A. Shef(2)
(1)Department of Plastic Reconstructive and Aesthetic Surgery, Uni Hospital -- Panagyurishte, (2)Department of Dermatovenereology and Allergology, Military Medical Academy -- Sofia
Abstract: Facial aging is one of the most complex issues to deal with in the field of the aesthetic medicine. A hallmark of facial aging is loss of subcutaneous volume and the midface is one of the most affected and most difficult areas. From the other hand a substantial number of injectable dermal fillers are now available for soft-tissue augmentation being the hyaluronic acid one of the most preferable worldwide. The aim of the present study was to demonstrate the authors’ experience of using a non-animal synthetized hyaluronic acid filler for the rejuvenation of the middle third of the face. A brief retrospective study was conducted analyzing clinical outcomes of 112 patients treated with hyaluronic acid because of facial deflation. This nonsurgical approach has shown to be safe, effective and satisfying for both doctors and patients.
Key words: hyaluronic acid, midface, filler
Address for correspondence: Yordan P. Yordanov MD, PhD, Department of Plastic Reconstructive and Aesthetic Surgery, MHAT “Uni Hospital” -- Panagyurishte, 100, Georgi Benkovsky St., Bg -- 4500 Panagyurishte, e-mail: yordanov_vma@abv.bg

 

 

MANAGEMENT IN HEALTHCARE


A cost-effectiveness analysis of idelalisib for treatment of patients with follicular non-Hodgkin's lymphoma – Medical Review (Medicinski pregled), 53, 2017, №3,  56-61.
T. Vekov(1), D. Canova(2) and N. Veleva(1)
(1)Faculty of Pharmacy, (2)Faculty of Public Health Medical University -- Pleven
Abstract: The aim of presented study is prognostication through modeling health expenses and benefits from administration of idelalisib (IDE) for treatment of patients with follicular non-Hodgkin's lymphoma (FNHL) in Bulgaria. The published data from assessments of IDE for treatment of FHNL in other countries are analyzed and modeled results for cost effectiveness are validated for Bulgaria. Depending on the length of time horizon, ICER of IDE varies within the range of BGN 386,115/QALY -- BGN 772,230/QALY, compared to the therapeutic alternatives for treatment of patients with FNHL. IDE is an effective therapeutic option for third-line therapy of the patients with FNHL in Bulgaria.
Key words: follicular non-Hodgkin's lymphoma, idelalisib, therapeutic alternatives, cost-effectiveness analysis
Address for correspondence: Prof. Toni Vekov, e-mail: t.vekov.mu.pleven@abv.bg

 

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bullet 2'2017

Influence of volume overload on arterial stiffness usinig a brachial oscillometric monitor in hemodialysis patients – Medical Review (Medicinski pregled), 53, 2017, №2, 37 – 43.
T. Velikov(1), E. Kinova(1), N. Georgieva(1), Al. Popov(2) and A. Goudev(1)
(1)Department of Cardiology, University Hospital "Queen Joanna" -- ISUL -- Sofia, (2)Department of Hemodialysis, University Hospital "Queen Joanna" -- ISUL -- Sofia
Abstract: Background: Patients undergoing hemodialysis are characterized by an in­crea­sed risk of cardiovascular complications and death. The risk assessment in these patients is difficult due to the dynamic changes in preload and afterload. Aim: Therefore, we aimed to study the vascular stiffness in patients undergoing hemodialysis before, immediately after and at the 24th hour after the procedure with a brachial oscillometric monitor. Methods: We examined 51 patients with chronic renal failure undergoing he­mo­dialysis at mean age 57 +/- 15 years (68.6% men, 31.4% women) and ana­ly­zed the brachial pulse wave through the brachial ambulatory monitor Mobil-O-Graph at three points of times -- before and after hemodialysis and 24th hour after the procedure. Results: When examining the pulse wave velocity, we found a significant decrease following hemodialysis (8.95 +/- 1.85 m/s versus 8.09 +/- 3.37 m/s, p = 0.03). The augmentation pressure followed the same trends as the differences reached significance between the second and third measurement (6.88 +/- 1.00 mmHg vs. 4.94 +/- 0.90 mm Hg, p = 0.04). The measurement of augmentation index tended to increase following hemodialysis and to decrease significantly at the 24th hour (24.21 +/- 15.15%, 17.49 +/- 14.38%, p = 0.04).The values of central systolic and diastolic aor­tic pressure measured before hemodialysis (130.42 +/- 23.16 mm Hg, 97.69 +/- 17.35 mm Hg, respectively) decreased following hemodialysis (126.11 +/- 26.89 mm Hg, 94.00 +/- 18.04 mm Hg, resp.), and this trend continued at the 24th hour (122.00 +/- 22.58 mm Hg, 92.04 +/- 16.99 mm Hg, resp.) without reaching significance. Re­gardless of loading condition we found significant correlations between the central aortic systolic pressure and the augmentation pressure and between augmentation pressure and the pulse wave velocity. Conclusion: The surrogate markers of vascular stiffness measured in different time points help us monitor more accurately and entirely patients with dynamic loading condition as it is in hemodialysis. In our study population undergoing hemodialysis volume reduction lowered blood pressure and peripheral vascular resistance leading to a reduction in indicators of vascular stiffness.
Key words: vascular stiffness, hemodialysis, pulse wave velocity, augmentation index, augmentation pressure, central aortic pressure
Address for correspondence: е-mail: toni_velikov@abv.bg

 

 

Instrumental methods and diagnostic autoantibodies in patients with progressive systemic sclerosis to optimize an early diagnosis – Medical Review (Medicinski pregled), 53, 2017, №2, 44 – 52.
Tsv. Yoneva(1), E. Krasimirova(2), D. Kalinova(1), E. Ivanova-Todorova(2), Tsv. Velikova(2), Y. Zdravkova(1), I. Sheytanov(1), D. Kyurkchiev(2) and R. Raskov(1)
(1)Clinic of Rheumatology, University Hospital "Sv. Ivan Rilski”, Department of Internal Medicine, Medical University -- Sofia, (2)Laboratory of Clinical Immunology, University Hospital "Sv. Ivan Rilski”, Department of Clinical Laboratory and Clinical Immunology, Medical University -- Sofia
Abstract: The aim of this study was to optimize the early diagnosis of progressive systemic sclerosis (SSc) and to propose an algorithm for management in these patients by studying a wide panel of autoantibodies and through instrumental methods. The study included 10 female patients -- 7 with suspected early SSc and 3 newly diagnosed with SSc patients who had clinical and instrumental data (capillaroscopy, pulmonary function tests, computed tomography) and immunoassays (determination of antinuclear antibodies, ANA, by indirect immunofluorescence and immunoblotting 13 typical SSc antigens). We found that all patients exhibited at least one of the morphological markers of disorganization of the microcirculation. In patients with a history of systemic autoimmune disease, the most common pattern is the early scleroderma model -- half of the patients. In 9 patients we found features of lung injury, 4 of them -- with restrictive changes. In 8/10 patients we found the presence of ANA, where in 6/10 -- the presence of antibodies against specific antigens for scleroderma: against RNA polymerase III (3 patients) against centromere-associated protein (CENP) (2 patients) and Ro-52 (2 patients ), against Th/To (1 patient). Even in early SSc, there are many organ damages and we found associations between them and scleroderma specific antibodies. Our data confirm that abnormal capillaroscopy picture, changes in lung function in combination with SSc-specific antibodies indicates a high probability of developing clinically definite SSc while lacking of antibodies rather decreases this opportunity.
Key words: progressive systemic sclerosis, autoantibodies, capillaroscopy, pulmonary func­tion, early diagnosis
Address for correspondence: е-mail: katty_iv@yahoo.com

 

 

A method for fixation of mandibular fractures which does not require intermaxillary immobilization – Medical Review (Medicinski pregled), 53, 2017, №2, 53 – 61.
А. Dzhorov
Maxillofacial Surgery Department, Tokuda Hospital Sofia
Abstract: The lower jaw has anatomically weak spots which are prerequisites for fractures. On the other side there are areas with increased resistance. Such are the buttresses, which together with the proper occlusion are criteria for reposition and places of fixation. The treatment methods of mandibular fractures are conservative (closed) and surgical (open) ones. In the ‘closed’ methods the immobilization is commonly achieved through mandibulo-maxillary fixations by standard splints or screws. They are used to treat almost all types of mandibular fractures and to provide intraosseous fixation. The titanium plates and screws are approved in cases of surgical treatment and at present time there are two basic principles for osteosynthesis: absorbing or distributing the stress. Based on biomechanical studies, current tools and principles of fixation, we present a method of treatment of fractures of the lower jaw using titanium plates and screws which does not require an intermaxillary immobilization. We used the method in 23 patients with almost all cases of mandibular fractures and describe the surgical access and technique of osteosynthesis. Clinically and radiologically we reported correct repositions and normal consolidations between the fragments. The achieved results confirm that the fractures of the lower jaw can be successfully treated by fixation on mandibular buttresses, which are the “ideal places for osteosynthesis” and do not require postoperative intermaxillary immobilization. We believe that the fixation with titanium plates and screws should be a standard for the treatment of mandibular fractures and be reimbursed by NHIF. Their price will be compensated by the small number of complications, shorter hospital stay, functional and social comfort of patients, as well as earlier employment.
Key words: mandibular fractures, fixations, immobilizations, osteosynthesis, screws
Address for correspondence: Assoc. Prof. Anton Djorov, DD, „Tokuda Hospital”, MDC „AMA”, Sofia, James Baucher Blvd., block 122, tel.: +359 888 778284, tel.: +359 2/9625579, e-mail: dzhorov4@abv.bg


 

MANAGEMENT IN HEALTHCARE

Network meta-analysis of cost-effectiveness of palbociclib for treatment of HR+/HER2- advanced/metastatic breast cancer in Bulgaria, 2017 – Medical Review (Medicinski pregled), 53, 2017, №2, 62 – 67.
D. Tsanova(1), Zh. Kolev(2) and T. Vekov(3)

(1)Faculty of Public Health, Medical University -- Pleven,
(2)Faculty of Pharmacy, Medical University -- Varna,
(3)Faculty of Pharmacy, Medical University -- Pleven
Abstract: The aim of the study is after analysis of published data from the assessments of the health technologies for treatment of HR+/HER2- advanced/metastatic breast cancer to perform modeling of expenses and health benefits of palbociclib (PAL) in Bulgaria in comparison to therapeutic alternatives based on indirect comparison. Modeled data in the performed network meta-analysis prove that: 1. PAL/LET (FUL) demonstrates significantly increased therapeutic effectiveness in comparison with monocomponent therapies LET (FUL) for treatment of HR+/HER2- advanced/metastatic breast cancer; 2. PAL/LET is cost-effective therapy for treatment of such patients in comparison with EVE/EXE (ICER 22,012 Levs/QALY) and dominates alternative therapies BEV/PAC and BEV/CAP with better therapeutic activity and lower expenses.
Key words: breast cancer, treatment, cost-effective therapies
Address for correspondence: Prof. Toni Vekov, e-mail: t.vekov.mu.pleven@abv.bg


 

DRUG INFORMATION



A new pharmaceutical form of metamizol: dialgin – Medical Review (Medicinski pregled), 53, 2017, №2, 70 – 72.
V. Vlahov
Chemax Pharma Ltd. -- Sofia
Abstract: The comparative bioavailability of the pharmacologically active metabolite of metamizole, 4-methyl-amino-antipyrine (4-MAA), after the single oral application of 1000 mg metamizole in form of Novalgin (Sanofi Aventis) tablets and a 1000 mg Dialgin (Chemax Pharma) sachet containing metamizole in the form of powder for obtaining water solution, was investigated on healthy volunteers. The confidential interval of the indices AUClast and Cmax between Dialgin and Novalgin satisfied the international established intervals for bioequivalence of both products. The blood plasma concentrations of 4-MAA 15 minutes after the application of Dialgin were higher in comparison with those after Novalgin application in 74% of the volunteers.
Key words: metamizole, Dialgin, Novalgin, bioequivalence
Address for correspondence:vlahovv@gmail.com


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bullet 1'2017


Surveillance of antimicrobial resistance in clinical Enterococcus spp. isolates from Bulgarian hospitals, 2012-2015 – Medical Review (Medicinski pregled), 53, 2017, №1, 23 - 32.
T. Strateva1, D. Atanasova1, A. Trifonova2, E. Savov2, S. Dimov3 and I. Mitov1
1Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia
2Laboratory of Microbiology, Department of Military Epidemiology and Hygiene, Military Medical Academy – Sofia
3Department of Genetics, Faculty of Biology, Sofia University “Sv. Kliment Ohridski
Abstract: A total of 450 clinically relevant isolates of Enterococcus spp. (325 Enterococcus faecalis and 125 Enterococcus faecium) was collected during the period 2012-2015 from seven large hospitals in Bulgaria, to assess the current levels of antimicrobial susceptibility, according to the Clinical and Laboratory Standards Institute  2014 criteria. Approximately one-third (32.7%) of the studied isolates showed resistance to aminopenicillins, 52.4% were determined as isolates with high-level aminoglycoside resistance (HLAR) and 4.2% were vancomycin-resistant (VRE). 25% of all strains were multidrug resistant (MDR) and it was recorded significant augmentation (p < 0.05) in their prevalence – from 13.7% in 2012 to 45% in 2015. Higher resistance (p < 0.001) was established among E. faecium isolates than that in E. faecalis to the following antimicrobial agents: ampicillin, gentamicin (HLAR), quinolones, erythromycin, nitrofurantoin, and vancomycin. The increase in the incidence of enterococcal isolates with HLAR, with MDR, and the increasing isolation of VRE, combined with their rapid spread in Bulgarian hospitals, justify: continuous antimicrobial resistance surveillance, detailed study of the mechanisms involved and optimizing of the ongoing antibiotic policy in the treatment of infections caused by problematic Enterococcus spp.
Key words: Enterococcus faecalis, Enterococcus faecium, clinical isolates, antimicrobial resistance, surveillance
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 917275,; e-mail: dr.strateva@abv.bg

 

 

Levels of „rewarding“ dopamine and „stress“ prolactin in alcohol-dependent patients – Medical Review (Medicinski pregled), 53, 2017, №1, 33-44.
L. Neykova-Vasileva
Clinic of Emergency toxicology – Military Medical Academy, Sofia
Abstract: In this paper, we analyze the clinical data and laboratory abnormalities of the neurotransmitters dopamine and prolactin in the early detoxification among alcoholdependent patients. The purpose of this article is from the analysis of the clinical data and the neurotransmitter levels of dopamine and prolactin, in early detoxification therapy, to define and individualize the diagnostic – therapeutic approach and to make a predictive assessment of the risk for recurrence of the abuse of alcohol. The target group consisted of patients with alcohol dependence, treated by detoxification in the Emergency Toxicology Clinic at the Military Medical Academy in Sofia. The methods used were documentary, clinical and laboratory studies (including radio-immunoassays) and statistical methods. The patients were of both sexes, with a preponderance of men. In terms of duration of the alcohol dependence both groups according to the type of alcohol abuse (daily abuse and alcohol spree), more numerous were patient with abuse between 0 and 5 years. In the patients with daily alcohol abuse, clinical symptoms of pre-delirium or delirium tremens were found three times more often compared to those with spree type of abuse. The identified higher levels of dopamine in the beginning of the detoxification in alcohol-dependent patients were considered a sign of a lesser unpleasant symptoms of withdrawal of alcohol. The high levels of prolactin acted as a marker for higher intensity of the stress reactions in detoxification and corresponded to the negative sides of the mood in alcohol-dependent patients, which increased the risk of alcohol recidivism. So more intensive clinical observation by medical personnel and dynamism in the correction of therapeutic methods is required. The analysis of the results helps increase the effectiveness of treatment to predict risk of alcohol abuse recurrence and to make a medical recommendation for its prevention. A relevant and (positive) economic impact is achieved.
Key words: alcohol abuse, abstinence alcohol, dopamine, prolactin, detoxification
Address for correspondence: e-mail: lussi66@abv.bg

 

 

Probability of cholecystitis development in periampullary duodenal diverticulum – a mathematical model – Medical Review (Medicinski pregled), 53, 2017, №1, 45-48.
S. Dineva1, P. Getsov2, B. Vladimirov3 and K. Prodanova4
1Department of Diagnostic Imaging, Medical Institute of Ministry of Interior – Sofia
2Department of Diagnostic Imaging at University Hospital „Tsaritsa Ioanna“ – Sofia
3Clinical Center of Gastroenterology at University Hospital „Tsaritsa Ioanna“ – Sofia
4Technical University – Sofia
Abstract: The periampullary location of the diverticula is of special interest because the complications are not uncommon here. The most common are the obstruction, bleeding and perforation, and their frequency reaches 75% of all complications. There are also recurrent episodes of pancreatitis, cholecystitis, and choledocholithiasis, including and after cholecystectomy. The observations on the link between periampullary duodenal diverticula (PDD) with cholelithiasis and cholecystitis are relatively incomplete. The frequency of calculous cholecystitis is significantly higher in patients with PDD compared to patients without such diverticula. The use of logistic regression analysis procedure allows for the construction of mathematical models to predict the likelihood of these complications.
Key words: рeriampullary duodenal divurticul, cholecystitis, cholelitiasis, mathematical model
Address for correspondence: Stoyanka Dineva, MD, Department of Diagnostic Imaging, Medical Institute of Ministry of Interior, 79 Skobelev St., Bg – 1606 Sofia, e-mail: dineva_g@abv.bg


 

MANAGEMENT IN HEALTHCARE


A cost-effectiveness analysis of four-component combination antiretroviral therapy for treatment of HIV-1 positive patients in Bulgaria (July 2016) – Medical Review (Medicinski pregled), 53, 2017, №1, 59 - 64.
T. Vekov¹ and S. Dzhambazov²
¹Faculty of Pharmacy, Medical University – Pleven
¹Faculty of Public Health, Medical University – Pleven
Abstract: The additional costs, additional health benefits and their incremental ratio (ICER) of four-component combination antiretroviral therapy (cART) as ECETAF (elvitegravir/ cobicistat/emtricitabine/tenofovir alafenamide) and ECETDF (elvitegravir/cobicistat/ emtricitabine/tenofovir disoproxil fumarate) in comparison to the most commonly used treatment alternatives in the clinical practice in treatment of HIV-1 positive patients in Bulgaria by 2016 are analyzed. A systematic analysis of the data from analyses of cost effectiveness of cART for treatment of HIV-1 positive patients, which are published in MEDLINE, EMBASE, Web of Science, and Cochrane Library in the period January 2010 – June 2016, was done. Data for health benefits expressed as  QALY are directly transferred for the requirements of the present analysis. Data for expenses for cART are based on local reference prices in Bulgaria, which are published in Positive Drug List by July 2016. In conclusion, the four-component cART, ECETDF and ECETАF, are cost-effective in comparison to the commonly used in Bulgaria treatment alternative ABA/LAM/LOP and are recommended as first choice.
Key words: HIV-1 positive patients, four-component antiretroviral therapy, evaluations of health technologies, transferring and adapting data
Address for correspondence: Prof. Toni Vekov, Faculty of Pharmacy, Medical University, 1, Sv. Kl. Ohridski St., Bg – 5800 Pleven, e-mail: t.vekov.mu.pleven@abv.bg

 

 

 

Last update of the page: 24.11.2017

 

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