Kiril K. Karamfiloff, Zhivka D. Stoykova, Petya G. Georeva, Diana K. Trendafilova and Julia B. Jorgova
The main objective of this analysis was to define the influence of multivessel disease involvement compared to single vessel disease on mortality rates in STEMI patients. The retrospective study included 549 patients, hospitalized with STEMI in St. Ekaterina University Hospital (age - 62.66±12.56; women - 31.3%) from 01.06.2008 to 30.06.2011. One-vessel disease was found in 232 patients (44%) as compared to two-vessel disease in 165 patients - 31% and multivessel disease in 130 patients - 25%. There was LM stenosis (>30) in 11 patients (2%); ostial lesion in 33 patients (6.3%); presence of Ca in 37 patients (7%). A stent was implanted in 484 patients (91.8%), and GP IIb/IIIa was used in 400 patients (75.9%). There was significant increase in mortality rates in patients with multivessel disease: 15.6% - 46 patients, compared to one-vessel disease - 6.5% (15 patients) (p<=0.01). Both early (30 days) and late mortality (one year) rates were higher in the multivessel group (6.8% vs. 2.6%, p<=0.05 and 10.2% vs. 3.9% (p<=0.0510), respectively. Multivessel disease is associated with higher mortality rates in STEMI patients, which may further alter clinical course and decision making.
Daniela Y. Arabadzhieva, Zhaneta T. Georgieva, Ara G. Kaprelyan and Zdravko D. Slavov
The aim of the investigation was to analyze the correlation between myocardial infarction and ischemic heart disease, on the one hand, and acute ischemic stroke (AIS), on the other hand. We studied 258 AIS patients (mean age 70.9±7.22 years, range 49-92 years) hospitalized in 2007-2013 in the First Clinic of Neurology, St. Marina University Hospital of Varna. The diagnosis of acute ischemic stroke was confirmed by Doppler sonography and computed tomography of the cerebral circulation. Data were statistically processed by variation and correlation analysis. Our results proved a relatively strong correlation between effort angina pectoris and ischemic heart disease (Pearson's coefficient: r=0.643) as well as a weak correlation between ischemic heart disease and myocardial infarction (Pearson's coefficient: r=0.243) among acute ischemic stroke patients. The well-known risk factors for these cardiovascular diseases such as obesity, tobacco smoking, low physical activity and alcohol abuse were common among the patients with acute ischemic stroke, too. In conclusion, both myocardial infarction and ischemic heart disease are strongly associated with the development of acute ischemic stroke. Such patients require strict and regular control by general practitioners. They should observe an appropriate diet and adhere to a healthy life-style.
Slavcho T. Tomov, Grigor A. Gortchev, Latchesar S. Tantchev, Todor I. Dimitrov, Chavdar A. Tzvetkov and Savelina L. Popovska
Selection of an appropriate surgical method for hysterectomy in an individual patient is currently an issue that remains open and debatable. This study aimed to analyze perioperative outcomes in gynecologic patients who underwent laparoscopic hysterectomy at a single institution during a 6-year period and to compare the data for simple hysterectomy patients treated with different surgical approaches. The study included a retrospective analysis of demographics, pre- and post-operative characteristics of 1,023 patients, operated on using four types of simple hysterectomy approaches: 635 laparoscopic hysterectomies (62.1%), 289 total abdominal hysterectomies (28.3%), 45 total vaginal hysterectomies (4.4%) and 54 robotic-assisted hysterectomies (5.3%). For the laparoscopic hysterectomy group, the mean operative time was shorter as compared to the abdominal and vaginal hysterectomy groups (p<0.05), as well as a significantly shorter hospital length-of-stay when compared to the abdominal, robotic or vaginal hysterectomy groups (p<0.05). Regression analysis revealed significant linear correlation between operative time and body-mass index of laparoscopic hysterectomy patients (R2 =0.008; p=0.026). Complications emergence and hemotransfusion often prolonged the mean operative time significantly by 17.8 min (p=0.002) and 15.5 min, respectively (p<0.001). The rate of major complications was significantly higher in the laparoscopic vs. abdominal groups (p<0.05). Clinical outcomes in patients operated on with laparoscopic hysterectomy were better than in those operated with total abdominal and vaginal hysterectomy in terms of operative time and hospital length-of-stay. Prospective randomized multi-center studies would be desirable to further define the place of the modern minimally invasive hysterectomy approaches.
Andrey V. Grek, Lyudmyla N. Prystupa and Tatiana V. Sytnik
Cardiovascular diseases (CVD) of atherosclerotic origin and accompanying complications are a major cause of mortality in the world and Ukraine, in particular. Endothelial dysfunction is the key cause of atherosclerosis and atherothrombosis. One of the causes of endothelial dysfunction is hyperhomocysteinemia that may occur on the background of MTHFR (methylenetetrahydrofolate reductase) mutation.
Thus, the goal of the study was to investigate the interrelation between homocysteine (Hc) level and MTHFR polymorphism in patients with acute coronary syndrome (ACS).
161 patients with ischemic heart disease and ACS have been examined. The control group comprised 87 healthy individuals. Homocysteine level was the highest in the patients having ACS with ST-segment elevation and complicated course, and was 1.8 times higher than Hc level in the control group. The patients with the most severe ACS course comprised 27 % of homozygotes for the major allele C and 41 % of homozygotes for the minor allele T. Comparing the distribution of MTHFR gene C677T polymorphism in patients with ACS that were stratified by plasma Hc level, we observed a statistically significant association, P < 0.030 by chi-square test. We confirmed that these patients had a high T/T genotype frequency of MTHFR C677T polymorphism. The obtained data proved the association of T/T genotype of MTHFR C677T polymorphism with increased Hc level as well as ACS severity.
Parental alcohol drinking is associated with an increased risk of alcohol consumption in adolescents and social drinking is often the first step to regular alcohol consumption. The purpose of the study was to investigate the association between social drinking in adolescence and parental alcohol consumption. We conducted a survey, using a self-completed questionnaire about alcohol drinking habits. Of 903 students (aged 15-19), 279 (30.9%) were found to be abstainers (NDA) and 455 (50.39%) were social drinkers (SDA). These two groups were statistically compared for drinking patterns of their parents. It was found that SDA are fourfold less likely than NDA to have two alcohol abstaining parents (OR=0.26, 95%CI =0.19-0.37) and fourfold more likely to have two alcohol drinking parents (OR=3.89, 95%CI =2.77-5.45). There were no significant differences between SDA and NDA regarding probability to have one abstaining and one socially drinking parent, and SDA were less likely to have one abstaining and one regularly drinking parent (OR=0.54, 0.37-0.8). The social learning theory explains well adolescent drinking patterns when there is no contradiction in parental modeling. It seems, however, that the presence of contradicting patterns of parental alcohol drinking needs another explanation. Since contradicting parental modeling prevents adolescents from social drinking, it could be considered in health prevention intervention.
Kameliya T. Tsvetanova, Dobromir D. Dimitrov, Hyuliya E. Feradova, Vasil Nanev, Tsvetomir M. Ivanov and Todor Iv. Dimitrov
Colon cancer is one of the most common malignant diseases with high grade of malignancy and mortality at high rate. Approximately one million people are diagnosed with colorectal cancer each year. Metastases affect mostly the liver, followed by the lungs. Here is a rare case of a patient with rectal cancer without disease progression or recurrence who underwent surgery due to a trans-stomal hernia, combined with high transstomal fistula of the ileum. Acute respiratory failure developed in the postoperative period and led to fatal deterioration as a result of enlarged metastatic mediastinal lymph nodes, which was very difficult to diagnose.
Rumyana N. Kuzmanova, Irina Z. Stefanova, Irena V. Velcheva and Katerina I. Stambolieva
The aim of the study is the translation, adaptation and validation of Side effects of antiepileptic drugs questionnaire in Bulgarian language (SIDAED-BG) in order to use it for objective monitoring of patients with epilepsy. One hundred and thirty one patients (mean age 40.13±13.37 years) took part in the investigation. The internal consistency and test-retest reliability were tested by Cronbach's α and ICC estimations. The convergent construct validity was evaluated by estimating the correlation of SIDAED-BG with the QOLIE-89 and the discriminant validity - by evaluation of the difference between SIDAED-BG scores and clinical parameters such as type of epilepsy using Kruskal-Wallis ANOVA. The Cronbach's α of the total scale was 0.93. The test-retest reliability was higher and determined the strong positive correlations between the first and second examination. The SIDAED-BG questionnaire showed good internal consistency (Cronbach's alpha ranged from 0.37 to 0.86) and the scores significantly correlated with other questionnaires such as QOLIE-89 and showed a good discriminative validity between groups with different levels of self-assessed adverse effects of antiepileptic drugs. The Bulgarian version of SIDAED is a reliable and valid tool in assessing the patient-reported adverse effects of antiepileptic drugs and their impact on the patient's outcome.
It is well known that some psychological features of adolescents as extraversion, risk-taking and impulsivity positively associate with substance abuse. The aim of the study was a description of psychological features of adolescents associated with regular alcohol drinking. We conducted a survey using an original questionnaire, classifying alcohol drinking as regular, social (incidental) and abstinence. The adolescents were asked to evaluate their own patterns of drinking. Of the 903 investigated students (aged 15-19), 169 identified themselves as regular alcohol drinkers (RDA), and 279 – as abstainers (NDA). These two groups were compared statistically in terms of a wide range of self-described psychological features. It was found that RDA were more likely to strive for dominant positioning in intersubjective relations (OR 1.8, 95%CI 1.22-2.65), more likely to avoid academic obligations (OR 1.61, 95%CI 1.08-2.39), and more likely to postpone their duties in everyday life (OR 1.81, 95%CI 1.23-2.67). It seems that regular drinking positively associates with egocentric personality traits and help is needed in personality development that could have a positive secondary effect on alcohol prevention.
Daniela Y. Arabadzhieva, Ara G. Kaprelyan, Zdravko D. Slavov, Zhaneta T. Georgieva and Aleksandra Zh. Tsukeva
The objective of this study was to analyze the association between some cardiovascular diseases and acute ischemic stroke. A total of 258 acute ischemic stroke patients (mean age 70.59±7.22 years) were examined. The presence of eight cardiovascular diseases and pathological conditions was analyzed: arterial hypertension, hypertensive heart, atrial fibrillation, myocardial infarction, ischemic heart disease, effort angina pectoris, coronary atherosclerosis, and heart failure. Data were statistically processed by variation and correlation analysis. Most male and female patients presented with four accompanying cardiovascular diseases (27 or 20.93% and 31 or 24.03% of the cases, respectively). There were two groups of four variables each - with a relatively strong and a moderate, as well as with a weak correlation (r<0.4), to the presence of acute ischemic stroke in the corresponding patients. Ischemic heart disease was strongly associated with effort angina pectoris (r=0.667) and to a lesser extent - with coronary atherosclerosis (r=0.470), whereas myocardial infarction was associated with coronary atherosclerosis (r=0.604) and ischemic heart disease (r=0.378), respectively. Arterial hypertension was moderately related to hypertensive heart (r=0.300). In conclusion, there were relatively close associations between acute ischemic stroke and these heart diseases. These patients should strictly and regularly be followed up by general practitioners.
The purpose of the study was to present the ability of Drusen analysis software tool to measure drusen area and volume in patients with dry age-related macular degeneration (AMD). Eleven patients with confirmed dry AMD aged 59-74 years were scanned with 3D OCT-2000 Topcon 3D Macula scanning protocol by a single operator. All subjects underwent a complete ophthalmologic examination including best corrected visual acuity, indirect biomicroscopy, tonometry, fluorescein angiography and OCT. Drusen analysis was performed on the macula with 6.0 × 6.0 mm volume cube scans and 512×128 pixels scan resolution. The results were presented along with calculated values in two clearly arranged reports. Mean follow-up period was 19 months (6-40). Count, area occupation, volume of the drusen and 3D retinal pigment epithelium (RPE) elevation map were presented in a Macula drusen analysis report. Drusen count and volume in 6 patients were increased at the end of follow-up period. There were 5 patients with regression in drusen count and area and volume of the drusen in 3 of them were higher than on previous examination. Another 2 were with regression not only in drusen count but also in their area and volume. With this software tool the status of RPE can be objectively and automatically examined in detail and can be followed up over time. OCT allows for precise quantitative evaluation and study of microstructural changes in patients with dry AMD and provides three-dimensional information of macular pathology in situ and in real time. This could be useful for determining stages and monitoring the progression of AMD.