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Vol. 54, 2018

 

1'/2018

C O N T E N T S 

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V. Boeva-Bangyozova, M. Muhtarov, K. Eneva and M. Panajotova. Zoonotic aspects of human ascariasis – Medical Review (Medicinski pregled), 54, 2018, №1, 5- 9.
Kr. Koev. Contemporary aspects and ocular manifestations in Goldenhar syndrome – Medical Review (Medicinski pregled), 54, 2018, №1, 10-13.
D. Dimitrova, T. Stoeva and R. Markovska. Enterobacter cloacae: mechanisms of antimicrobial resistance – Medical Review (Medicinski pregled), 54, 2018, №1, 14-22.
B. Borisov, St. Linkova and K. Nedyalkov. Stenosis of the arterio-venous anastomosis – Medical Review (Medicinski pregled), 54, 2018, №1, 23-28.

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ORIGINAL ARTICLES

T. Valkov, Zh. Hristova, K. Kalinov, I. Elenkov and M. Tiholova. Clinical manifestation and etiological diagnosis of acute CNS infections – Medical Review (Medicinski pregled), 54, 2018, №1, 29-33.
E. Aleksiev, M. Nikolova, M. Kondeva, L. Videnova and P. Stanimirov. Comorbidity and functional consequences after operative treatment of malignancies in head and neck area. Part II: Comorbidity, musculo-skeletal function and mental status – Medical Review (Medicinski pregled), 54, 2018, №1, 34-40.
T. Vekov. Pharmacoeconomic analysis of administration of atypical antipsychotics for treatment of schizophrenia in Bulgaria – Medical Review (Medicinski pregled), 54, 2018, №1,  41-45.
L. Pekova, P. Parusheva, Sv. Tchakarov and M. Fartunova. Psycho-emotional profile of people living with HIV/AIDS – Medical Review (Medicinski pregled), 54, 2018, №1, 46-50.
N. Dzhermanova-Temelkova, K. Peycheva-Tsoncheva, P. Popivanov, E. Naseva, G. Achzet and T. Tankova. EMPA-THY Bulgaria I  – Medical Review (Medicinski pregled), 54, 2018, №1, 51-60.

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CASE REPORTS

M. Nikolova, D. Vasileiou, J. Hristova, L. Shemelekova, Tz. Vasileva, M. Krupev, Al. Kirilov, R. Krasteva and B. Bogov. Acute renal failure after the intake of non-steroid anti-inflammatory drugs -- the importance of the team work for the diagnosis and the treatment – Medical Review (Medicinski pregled), 54, 2018, №1, 61-64.
P. Krastev, Hr. Angelov, F. Abedinov, P. Nikolov, D. Trendafilova, Ju. Jorgova and G. Nachev. Rupture of coronary artery in an adult male patient under the conditions of STEMI – Medical Review (Medicinski pregled), 54, 2018, №1, 65-69.
V. Velev. Family sporademia of imported trichocephalosis – Medical Review (Medicinski pregled), 54, 2018, №1, 70-72.


razdelitel

 

bullet REVIEWS

 

Zoonotic aspects of human ascariasis – Medical Review (Medicinski pregled), 54, 2018, №1, 5- 9.
V. Boeva-Bangyozova(1), M. Muhtarov(2), K. Eneva(3) and M. Panajotova(4)
(1)Medical University -- Sofia, (2)Gastroenterology Ward, Multi-Profile Hospital for Active Treatment -- Kardzhali, (3)Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University -- Plovdiv, (4)Department of Pediatrics, Trakia University -- Stara Zagora
Abstract: Ascariasis is the most common geohelminthosis and affects 0.8-1.22 billion people in the world. It is caused by one of the two intestinal nematodes -- Ascaris lumbricoides in humans and Ascaris suum in pigs. Morphologically (both very similar) can cause cross-infection in hosts and that is the reason for active discussion about their taxonomic validity. Ascariasis may exist as a zoonotic parasitosis associated with using of pig manure in plant growing, but in most endemic areas it is most likely to be transmitted from humans. With the development of molecular-epidemiological methods new data have been gathered in recent years about the zoonotic aspects of human ascariasis. In this paper the authors reviewed the world publications for cases of zoonotic ascariasis in humans. In Bulgaria there are no data about the cases of zoonotic ascariasis in humans.
Key words: ascariasis, ascaris, zoonosis, infestation
Address for correspondence: Assoc. Prof. Violina Genova Boeva-Bangyozova, MD, PhD, e-mail: violin1987@abv.bg

 

Contemporary aspects and ocular manifestations in Goldenhar syndrome – Medical Review (Medicinski pregled), 54, 2018, №1, 10-13.
Kr. Koev
Clinic of Ophtalmology, Department of Emergenci Medicine, Medical University -- Sofia
Abstract: The review presents the Goldenhar syndrome, which features asymmetric malformations of the face, eyes and ears, as well as vertebral anomalies. Data refer to a frequency between 1 in 3000 and 1 in 25 000 live births. Eye malformations, epibulbar dermoid, coloboma, microphtalmia are presented. Heartburn, renal, neurological, anal, spinal defects are observed in patients with Goldenhar syndrome. In 85% of cases, face, eye and ear malformations are unilateral, but in patients with bilateral anomalies, their severity is clearly asymmetric. The etiology of this syndrome remains obscure and appears sporadic. Treatment requires an individual approach to each individual patient and the involvement of a team of different scientists.
Key words: epibulbary dermoid, coloboma, eye malformations, ear anomalies, facial abnormalities, vertebral anomalies
Address for correspondence: Assoc. Prof. Kr. Koev, MD, Department of Emergenci Medicine, Medical University, 8, Bialo more St., Bg -- 1527 Sofia, tel. +359 896291020, е-mail: k00007@abv.bg

 

Enterobacter cloacae: mechanisms of antimicrobial resistance – Medical Review (Medicinski pregled), 54, 2018, №1, 14-22.
D. Dimitrova(1), T. Stoeva(1) and R. Markovska(2)
(1)Department of Microbiology and Virology, Medical University -- Varna, (2)Department of Medical Microbiology, Medical University -- Sofia
Abstract: During the last years the clinical significance of Enterobacter cloacae as a causative agent of nosocomial infections is constantly growing. As an opportunistic pathogen, it is associated with a variety of infections predominantly in immunocompromised patients (bacteremia, pneumonia, incl. VAP, skin and soft tissue infections, intraabdominal and urinary tract infections). During the last decade in parallel with the increased scientific interest in E. cloacae, a trend of growing levels of acquired resistance to clinically used antimicrobial agents in this bacterial species has been detected. In this review the genetic mechanisms of resistance in E. cloacae to most commonly used antimicrobial agents (beta-lactams, quinolones, aminoglycosides, glycylcyclines) are presented in details, as well as data regarding their distribution in different geografic regions.
Key words: Enterobacter cloacae, antimicrobial agents, mechanism of resistance
Address for correspondence:
D. Dimitrova, MD, Department of Microbiology and Viro­logy, Medical University, 55, Marin Drinov St., Bg -- 9001, tel. +359 52 978 615, e-mail: dobromira.dimitrova.9@gmail.com

 

Stenosis of the arterio-venous anastomosis – Medical Review (Medicinski pregled), 54, 2018, №1, 23-28.
B. Borisov(1), St. Linkova(1) and K. Nedyalkov(2)
(1)Clinic of Nephrology and Dialysis, Medical University -- Pleven, (2)Department of Surgery, Medical University -- Pleven
Abstract: The arterio-venous anastomosis (AVA) is the main permanent vascular access used for hemodialysis treatment in patients with terminal renal failure. The aim of this review is to summarize the views of various authors related to changes in vascular hemodynamics following the construction of anastomosis, pathogenesis of vascular stenosis and thrombosis in this area. We reviewed the modern methods for the treatment of fistulous stenosis and shared our views on some aspects of this serious problem.
Key words: arterio-venous anastomosis, stenosis, thrombosis, treatment
Address for correspondence: Biser Borisov, MD, Clinic of Nephrology and Dialysis, UMBAL “Dr Georgi Stranski”, 8A, “Georgi Kochev” St., Bg -- 5800 Pleven, e-mail: Biserugo@abv.bg
 

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ORIGINAL ARTICLES


Clinical manifestation and etiological diagnosis of acute CNS infections infections – Medical Review (Medicinski pregled), 54, 2018, №1, 29-33.
M. Nikolova, D. Vasileiou, J. Hristova, L. Shemelekova, Tz. Vasileva, M. Krupev, Al. Kirilov, R. Krasteva and B. Bogov
(1)Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University -- Sofia, (2)SHIPD “Prof. Iv. Kirov” -- Sofia, (3)Department of Clinical Laboratory and Clinical Immunology, Faculty of Medicine, Medical University -- Sofia, (4)New Bulgarian University -- Sofia, (5)Executive Agency "Medical Audit"
Abstract: Aim: Data analysis of main clinical and laboratory characteristics of hospitalized patients with CNS infections and etiological diagnosis confirmation in CSF samples. Materials and methods: The main clinical and laboratory characteristics of 116 patients with neuroinfections admitted to the National Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, were analyzed and summarized and subsequently observed for a period of 5 years from 2011 to 2016. We used laboratory, serological and molecular biological techniques. Results: Significant initial toxic-infectious syndrome was observed in 107 patients (92.2%) as a background of the most common neurological disturbances: neck stiffness in 100 patients (86.2%), Kernig’s sign in 72 patients (61.1%), and deep tendon reflexes exaggeration in 113 patients (97.4%). The conscious state was evaluated according to Glasgow Coma Scale (GCS). Etiology is confirmed in 59 patients (51%) and in 57 patients (49%) the causative agent remained undefined. S. pneumoniae was isolated in 10 (10.8%) of the patients with bacterial CNS infections. The most common viral CNS infections were caused by Herpes Virus Group -- 14 patients (18.7%), followed by Enterovirus -- 12 patients (16%) and Influenza Virus -- 10 patients (13.3%). Discussion and conclusion: Herpes Virus Group etiology was the most common causer of viral infections, as for bacterial CNS infections it was S. pneumoniae. We consider the combination of acute onset of the disease, febrility, headache, and neck stiffness is imperative for a diagnostic spinal tap performance. The leading criteria which marks the severity of the disease was the GCS score. Bacterial meningitis was characterized with more severe clinical course. Among the viral neuroinfections Influenza Group meningoencephalitis was related to the gravest presentation, followed by Herpes Virus Group CNS infections. Recent diagnostic criteria demand microbiological diagnosis only in CSF samples in cases of neuroinfections. Conclusion: Despite the vast advantages in diagnostic and treatment aspects, a number of issues remain unsolved.
Key words: neuroinfections, meningitis, meningoencephalitis, cerebrospinal fluid diagnostic tests
Address for correspondence: Trifon Vаlkov, MD, e-mail: trifon_heim@abv.bg

 

Comorbidity and functional consequences after operative treatment of malignancies in head and neck area. Part II: Comorbidity, musculo-skeletal function and mental status – Medical Review (Medicinski pregled), 54, 2018, №1, 34-40.
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 per se on the development of functional consequences after operative treatment for malignancies in the MFA and the neck. We investigated the musculo-skeletal function and the mental status before and 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 musculo-skeletal system. We found positive correlation between the presence of comorbidities and the levels of postoperative mental morbidity.
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. G. Sofiyski St., Bg -- 1431 Sofia, e-mail: dr_aleksiev@yahoo.de

 

Pharmacoeconomic analysis of administration of atypical antipsychotics for treatment of schizophrenia in Bulgaria – Medical Review (Medicinski pregled), 54, 2018, №1, 41-45.
T. Vekov
Faculty of Pharmacy, Medical University -- Pleven
Abstract: Literature search of published data from pharmacoeconomic assessments of drug the­rapies for treatment of schizophrenia, including the period January 2006-De­cem­ber 2017, was made with the aim to model future expenses and health benefits of atypical antipsychotics, which are used in the clinical practice in Bulgaria, and in­di­rect comparison of therapeutic and cost effectiveness of alternatives for treatment of schi­zophrenia based on network meta-analysis. The results from the phar­ma­co­eco­no­mic analysis are presented as incremental ratio (ICER) of additional costs (delta costs) and additional health benefits (delta QALY) of alternative atypical antipsychotic the­rapies. The analysis leads to conclusions that olanzapine (OLA) and quetiapine (QUE) dominate aripiprazole and risperidone with better therapeutic efficacy and lo­wer costs of annual therapy. Cariprazine is a cost-ineffective therapy in comparison to all other alternatives from the group of atypical antipsychotics for treat­ment of schizophrenia in Bulgaria, with ICER varying within the range of BGN 41,760-157,190/QALY. OLA and QUE have similar therapeutic and cost effectiveness.
Key words: schizophrenia, atypical antipsychotics, pharmacoeconomic assessments, cost-effectiveness analysis
Address for correspondence: Prof. Tony Vekov, e-mail: t.vekov.mu.pleven@abv.bg

 

Psycho-emotional profile of people living with HIV/AIDS – Medical Review (Medicinski pregled), 54, 2018, №1, 46-50.
L. Pekova(1, 2), P. Parusheva(1, 2), Sv. Tchakarov(2) and M. Fartunova(2)
(1)Department of Hygiene, Infectious Diseases and Epidemiology, Faculty of Medicine, Trakian University -- Stara Zagora, (2)Clinic of Infectious Shades with HIV/AIDS, University Hospital "Prof. Stoyan Kirkovich” -- Stara Zagora
Abstract: People living with HIV/AIDS (PLWHA) are under the influence of psychological stress due to the nature of their illness. They change their behavior and thinking because of isolation and misunderstanding on the part of society. The aim of the present study is to make a literary review of the psycho-emotional profile of PLHIV and to compare the level of awareness of the disease, psychological state, expectations and personality change of 17 HIV/AIDS patients aged 35 to 57, who are treated in the Clinic of Infectious Diseases with HIV/AIDS activities at the University Hospital "Prof. Stoyan Kirkovich -- Stara Zagora. The following methods were used: a literature review, a questionnaire consisting of 12 questions, discriminative statistics. The results show that the studied PLHIV suffer from stigma, believe they can be useful and want to find their own places in society. Patients are satisfied with the medical service. In conclusion, PLWHA deserve particular attention. Thanks to the modern ART methods and the support of the whole society, they can overcome their sense of total inferiority.
Key words: people with HIV/AIDS, psycho-emotional profile, stigma
Address for correspondence: Prof. Liliya Pekova, MD, е-mail: pe_kova@abv.bg

 

EMPA-THY Bulgaria I – Medical Review (Medicinski pregled), 54, 2018, №1, 51-60.
N. Dzhermanova-Temelkova(1), K. Peycheva-Tsoncheva(2), P. Popivanov(1), E. Naseva(3), G. Achzet(4) and Ts. Tankova(5)
(1)Department of Clinical Densitometry and Bone Metabolic Diseases, UMHAT “Aleksandrovska” -- Sofia, (2)Medical Department, Boehringer Ingelheim, Bulgarian Branch, (3)Faculty of Public Health, Medical University -- Sofia, (4)Medical Department, Boehringer Ingelheim, Regional Center Vienna, (5)Department of Diabetology, Cinical Center of Endocrinology and Gerontology, Medical University -- Sofia
Abstract: EMPA-THY Bulgaria is a part of the International project EMPA-THY (EMbra­cing PATients and pHYsicians perception of type 2 diabetes -- an evaluation of disease risks, treatment goals and expectations from modern oral antidiabetic medications). In Bulgaria EMPA-THY was conducted as two separate projects: EMPA-THY Bulgaria I and II with internal registration numbers 170326 and 170705, and involved only physicians. In EMPA-THY Bulgaria I, performed du­ring the period May 2017-June 2017, 83 specialists in endocrinology were surveyed. The project was conducted as non-trial activity (NTA) performed through completing of a questionnaire. Awareness and perceptions of Bulgarian endocrinologists regarding type 2 diabetes were evaluated, including assessments of risks associated with type 2 diabetes, and expectations from modern oral antidiabetic medications. Statistical analysis was performed using SPSS, version 20. The project EMPA-THY Bulgaria I showed that: 1) Bulgarian endocrinologists consider type 2 diabetes as a cardiovascular risk factor; 2) their primary therapeutic strategy is disease control aiming at prevention of diabetes-related complications; 3) in Bulgaria 67% of type 2 diabetes patients on oral therapy, seen by an endocrinologist within a month, have established cardiovascular disease; 4) type 2 diabetes management involves management both glycaemic control and cardiovascular risk factors (81.9% of respondents); 5) the endocrinologists in Bulgaria are well informed, convinced and motivated to use empagliflozin in the therapy of type 2 diabetes (96.4% of respondents).
Key words: EMPA-THY Bulgaria, empagliflozin, type 2 diabetes, cardiovascular risk
Address for correspondence: Assoc. Prof. Plamen Popivanov MD, PhD, Department of Clinical Densitometry and Bone Metabolic Diseases, UMHAT “Aleksandrovska”, 1, Sv. G. Sofiysky Blvd., Bg -- 1431 Sofia, tel. +359 2 9230 528, e-mail: ppopivanov@abv.bg

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CASE REPORTS


Acute renal failure after the intake of non-steroid anti-inflammatory drugs -- the importance of the team work for the diagnosis and the treatment – Medical Review (Medicinski pregled), 54, 2018, №1, 61-64.
M. Nikolova, D. Vasileiou, J. Hristova, L. Shemelekova, Tz. Vasileva, M. Krupev, Al. Kirilov, R. Krasteva and B. Bogov
Clinic of Nephrology, University Hospital Aleksandrovska, Medical University -- Sofia
Abstract: Acute renal failure (ARF) is among the rare complications of the intake of non-steroid anti-inflammatory drugs (NSAID) in therapeutic doses. In such patients, usually an acute allergic tubulointerstitial nephritis or latent and undiagnosed myeloma is present. The joint diagnostic and therapeutic efforts of clinicians, radiologists and laboratory physicians are crucial for the early diagnosis and the timely treatment of such patients. We present a case of myeloma diagnosed during the investigation of acute renal failure developing during NSAID treatment in low therapeutic doses for arthralgiae and bone pain.
Key words: acute renal failure, NSAID, myeloma, diagnosis, treatment
Address for correspondence: Milena Nikolova, MD, Clinic of Nephrology, University Hospital Aleksndrovska, Medical University, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, e-mail: milena_i_dani@abv.bg

 

Rupture of coronary artery in an adult male patient under the conditions of STEMI – Medical Review (Medicinski pregled), 54, 2018, №1, 65-69.
P. Krastev(1), Hr. Angelov(1), F. Abedinov(2), P. Nikolov(3), D. Trendafilova(1), Ju. Jorgova(1) and G. Nachev(1)
(1)Cardiology Clinic, University Hospital “Sv. Ekaterina” -- Sofia, (2)Clinic of Anesthesiology and Intensive Care, University Hospital “Sv. Ekaterina” -- Sofia, (3)Cardiology Clinic, University Hospital “Sv. Georgi” -- Plovdiv
Abstract: Coronary artery rupture (perforation) is a rare life threatening condition during percutaneous coronary intervention that can lead to hemodynamically significant pericardial effusion. The frequency of this complication is 0.2% to 0.5%. Standard therapy for coronary perforation is urgent surgical treatment -- drainage of the pericardial effusion with pericardial drain. With the development and advancement of new technologies in interventional cardiology such as coated stents and embolization coils, many cases of coronary perforation were treated in the catheterization laboratory without need for surgical intervention. Therefore, in any catheterization laboratory, especially without the presence of a cardiac surgical center, it is necessary to have needed materials and an experienced operator ready to deal with this type of complication. In the next clinical case, we present and analyze the incidence, causes, clinic and method of interventional treatment for coronary perforation. By the implantation of polytetrafluoroethylene stent-graft, the perforation was successfully covered and sealed.
Key words: coronary artery rupture, coated stent, interventional treatment, polytetrafluoro­ethylene stent-graft
Address for correspondence: P. Krastev, MD, Cardiology Clinic, University Hospital “Sv. Ekaterina”, 52A, P. Slaveykov Blvd., Bg -- 1431 Sofia, e-mail: plamenkr@mail.bg

 

Family sporademia of imported trichocephalosis – Medical Review (Medicinski pregled), 54, 2018, №1, 70-72.
V. Velev
Clinic of Children, Hospital for Infectious and Parasitic Diseases “Prof. Iv. Kirov”, Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University -- Sofia
Abstract:
Trichocephalosis is anthroponotic geohelminthosis; it is caused by nematodes Trichocephalus trichiurus, which are widespread, both in tropics and subtropics as well as in temperate climates. The disease in the five-member family was studied -- two parents, a 1-year-old girl and two twin girls at 3 years of age because of diagnostic difficulties and failed treatment after returning from Italy. Macroscopic and microscopic parasitological diagnostic methods were used, blood sample with blood film. It was macroscopically found that the imaginary forms were of Trichocephalus trichiurus, later diagnosis was confirmed by enrichment methods. All three children had mild hypochromic anemia, and the youngest child had 9% eosinophilia. Treatment with Albendazole at 10 mg/kg was administered for 5 days for all family members. Any suspected intestinal infection should also be accompanied by a parasitological feces test, and each parasitological study of intestinal parasites should be done three times, combining native and enrichment methods.
Key words: Trichocephalosis, intestinal parasites, Albendazole
Address for correspondence: Valeri Velev, MD,e-mail: velev_md@abv.bg

 

 

 

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