Ioana Mihaiela Ciuca, Liviu L. Pop, Bogdan Guta-Almajan, Florina Ardelean and Alexandru Florin Rogobete
Țica Ovidiu, Otilia Anca Țica, Adrian Hatos, Larisa Roșan and Mircea Ioachim Popescu
Introduction: Atrial fibrillation (AF) is the most frequent cardiac rhythm disorder, considered until recently benign. Due to its major complications (cardio-embolic episodes) patients need to be anticoagulated. Aim: To assess the quality of life (QOL) in patients with new oral anticoagulants (NOAC) versus those using classical anticoagulants (VKA). Methods: A total of 483 patients admitted consecutively in our clinic were evaluated during hospitalization and after discharge. Follow-up visits were conducted: at baseline, 6, 12, 18 and 24 months; the quality of life (QoL) was measured by a specific questionnaire (EQ-5D-3L), and the results were assessed. Patients were divided in two groups considering their anticoagulant use: NOAC or VKA. Baseline characteristics, clinical outcomes as well as QoL indices were compared between the two groups The current research has been conducted in accordance with the ethical prin ciples set out in the Helsinki Declaration and Good Clinical Practice Recommendations and was approved by our hospital Ethics Committee. Results: The mean age of our studied group (374 eligible patients) was 64.7 ± 8.2 years (p=0.220); 116 patients (31.01%) used NOAC. Patients with NOAC obtained better results in all domains: physical (57.0±8.9 vs. 51.1±12.5 vs. 42.0±6.2; p<0.001), social (62.6±19.8 vs. 52.5±20.0 vs. 45.7±16.0; p=0.019) and environmental (62.9±12.7 vs. 52.7±7.6 vs. 60.7±3.6; p =0.018). Compared to VKAs, NOACs were more commonly prescribed in patients with a history of stroke or with a higher thromboembolic risk (p<0.001). EQ-5D-3L total score: 75.6 ± 20.9; visual analogue scale: 63.1 ± 20.6. Conclusion(s): Satisfaction and QoL with oral anticoagulants were high, although they were both better with NOACs. A worse QoL was associated with comorbidities, polypragmasy, and previous treatment with VKA. Patients strongly expressed their desire to improve their QoL.
Annabella Benedek, Diana Opincariu, Imre Benedek, Ionuț Ferenț, Roxana Hodaș, Emese Marton and Theodora Benedek
Acute coronary syndromes are usually triggered by the erosion or rupture of a vulnerable coronary plaque. A vulnerable plaque (VP) is an atheromatous plaque which, after suffering different transformations, is prone to rupture causing an acute coronary event. Such a VP carries inside several biomarkers considered as “signatures of vulnerability”, which, if identified, can prompt timely initiation of therapeutic measures in order to prevent the development of an acute myocardial infarction. The most freqeuntly used techniques for identification of vulnerability markers are computed tomographic angiography (CTA), intravascular ultrasound and optical coherence tomography. Endothelial shear stress (ESS) represents a new promising biomarker associated with plaque vulnerability. Determination of ESS is nowadays possible using noninvasive imaging techniques, based on complex computational post-processing of multiple datasets extracted from CTA images and advanced computational fluid dynamics technologies. The aim of this systematic review was to evaluate the role of the coronary ESS, determined using advanced computational techniques for image post-processing, as a feature associated with CTA-derived biomarkers of atheromatous plaque vulnerability, underlining the conceptual differences between high ESS and low ESS as promotors of vulnerability.
Gergana N. Sandeva, Rositsa P. Deliradeva and Pavlina L. Gidikova
Assessment of work ability is an important aspect of occupational medical services, the main goal being to maintain employees’ health, well-being and efficiency. The aim of the study was to evaluate and compare the work ability of workers employed by two machinery factories. We used the Work Ability Index (WAI) questionnaire to assess 165 workers of an iron casting factory A and 166 workers in a press-forging plant B. The data obtained were evaluated and compared based on gender, age, length of service and occupation. Mean WAI for the two factories were almost identical (43.3±4.9 for Factory A and 43.3±4.6 for Factory B), both indicating good overall work ability. The lowest mean WAI (37.7) was registered for the crane operators from Factory B, and the highest (47.2) - for the molders in Factory A. The female production workers in Factory A had a significantly lower WAI as compared to their male counterparts (p=0.001). WAI also varied significantly between different age groups and occupations in the two plants. Significant negative correlations were found between work ability and length of service, as well as between psychological resources and gender (Factory A) and the length of service (Factory B). WAI is a useful tool in finding vulnerable workers who need more attention from occupational health specialists.
Paulina Tr. Vladova, Sergey D. Iliev and Savelina L. Popovska
According to the consensus and the recommendations of the European Neuroendocrine Tumor Society (ENETS), the frequency of appendicular neuroendocrine tumors (NETs) is 0.15-0.6/100 000 a year. They are found a little more often in women aged between 40 and 50. Neuroendocrine neoplasms of the appendix are about 30 to 80% of all appendicular tumors. Their evolution is usually asymptomatic. They are diagnosed accidentally during a conventional or laparoscopic appendectomy. In the past, the surgical approach used to depend on the localization of the tumor. Currently, its localization is not a significant factor in the choice of a surgical approach. Our purpose wass to present the consensus guideline and the recommendations of ENETS 2017 for surgical procedures in neuroendocrine neoplasms of the appendix and analyze the difference in the survival rate in different surgical interventions. The literature overview includes studies on surgical treatment of neuroendocrine neoplasms of the appendix and takes into consideration the last consensus guideline of ENETS 2017 on the topic. ENETS recommends a simple appendectomy in well- differentiated appendix tumors smaller than 2 cm, regardless of their localization. Right hemicolectomy is performed for in tumors sized between 1 cm and 2 cm with positive resection lines, with deep mesoappendiceal invasion, high proliferation activity (G2) and vascular invasion. For tumors over larger than 2 cm – right hemicolectomy is recommended. Although current studies have pointed out no significant differences in survival rates between appendectomy for neuroendocrine neoplasms of the appendix and right hemicolectomy, ENETS 2017 suggests that the latest consensus guidelines should be followed.
Vanya S. Popova, Svetla O. Blajeva, Margarita L. Alexandrova, Tsvetan H. Lukanov, Silvia Y. Naneva and Nikolay T. Tzvetkov
Chronic lymphocytic leukemia is one of the most common types of leukemia in adults. It belongs to the group of indolent lymphoproliferative disorders and has a slow clinical course. Approximately 50% of newly diagnosed patients do not require treatment for years. A better understanding of the pathophysiology of the disease has led to the development of models for assessment of the risk.
Our study aimed to evaluate the prognostic significance of the serum marker beta-2 microglobulin (82M) and the flow cytometric marker CD49d in patients with early-stage of B-chronic lymphocytic leukemia (B-CLL) as well as look for a correlation between CD 49d and the early stages of the disease. For this purpose, analysis of 30 untreated patients with known and newly diagnosed B-CLL was carried out. The following methods were used: documentary, flow cytometric analysis of peripheral blood, Rai staging system and chi-square test of independence (Fisher’s Exact Test). The results from our study showed that a small number of patients in the early stage of the disease have high levels of CD49d expression and beta-2 microglobulins. In eight of 29 patients, the flow cytometric marker was higher than 30%, and in ten out of 29 patients, the B2M was above the reference range. No significant correlation between the two markers in early stage B-CLL patients was found.
Savelina L. Popovska, Tereza B. Dineva and Polina D. Damyanova
Lung cancer is still the leading cancer-related cause of death with a high incidence rate in the whole world. Treatment options – surgery, radiotherapy, and chemotherapy, depending on the stage of the disease. During the last decade, many molecular alterations were discovered that led to impressive changes in treatment. Personalized approaches, including target therapies with specific inhibitor drugs, became a part of the standard therapies. This article reviews current molecular biomarkers used in clinical practice to treat lung cancer patients.
Joana I. Simeonova, Snejanka T. Tisheva-Gospodinova, Yoana M. Todorova, Petkana A. Hristova, Asia N. Yanakieva and Martin I. Hristov
A cross-sectional study was carried out in 2016 in the research project No 4/2016. We selected 98 patients aged 40-89 and diagnosed with hypertension. The patients were admitted to Cardiology Clinic One of the University Hospital in Pleven. The study aimed to measure and compare direct and indirect costs of hypertensive patients aged 40-89 years, who were treated with lisinopril and perindopril. We estimated the total and average costs of 50 (51.0%) patients treated with lisinopril and 48 (49.0%) treated with perindopril. Males were 46.4%, and the mean age of the sample was 65.9.0±11.2 years. Data were processed by Statistical Package for Social Science version 19.0 (SPSS.v.19.0). Total costs exceeded amount reimbursed for the clinical path (BGN 420.00) in 64.6% of the patients treated with perindopril and 48.0% of the patients treated with lisinopril. We found that treatment costs within 6-months after discharge were BGN 673.82 in patients treated with lisinopril, as compared to BGN 171.92 reimbursed by the National Health Insurance Fund (NHIF), and BGN 781.18 for those treated with perindopril, compared to BGN 216.33 reimbursed by NHIF. The NHIF reimbursement rate for antihypertensive treatment is insufficient to cover all direct costs. Increased hospital costs and out-of-pocket payments present a significant restriction on access to treatment for arterial hypertension.
Dobromir D. Dimitrov, Tsvetomir M. Ivanov, Tashko S. Deliyski, Sergey D. Iliev, Emil T. Filipov, Martin P. Karamanliev, Tatqna M. Betova, Savelina L. Popovska, Nataliya P. Chilingirova, Izabela P. Georgieva, Slavcho T. Tomov and Grigor A. Gortchev
Total mesorectal excision (TME) is a standard surgical procedure for rectal cancer. Robotic surgery has the potential to minimize the disadvantages of laparoscopic rectal resection. Circumferential margin and macroscopic quality assessment of the resected specimen are the major prognostic factors for local recurrence of the disease. The aim of this study was to research the macroscopic assessment of the quality of TME after robotic-assisted rectal resections for rectal cancer performed in a single center. Data was prospectively collected about macroscopic assessment of the quality of TME in thirteen patients after robotic-assisted rectal resections for rectal cancer between 09.04.2014 and 31.12.2016. After all robotic TMEs, a pathologist made macroscopic assessment of the completeness of the mesorectal excision. The quality of TME was complete in 12 cases and nearly complete in one case. The circumferential and distal resection margins were negative in all cases. The mean number of harvested lymph nodes was nine. This study indicated that using robotic surgery for rectal cancer does not lead to worsening the quality of TME. Further studies in this field are necessary.
Boyan A. Stoykov, Nikolay H. Kolev, Rumen P.Kotsev, Fahd Al-Shargabi, Pencho P. Genov, Aleksandar Vanov, Jitian A. Atanasov, Manish Sachdeva, Pencho T. Tonchev and Maria I. Koleva
The experience accumulated with low-intensity extracorporeal shock wave therapy (LI-ESWT) from international clinical trials has demonstrated its safety, efficacy and good tolerance in treatment of erectile dysfunction (ED). The aim of this retrospective study was to investigate the effect of LI-ESWT in patients with ED after bilateral nerve sparing radical surgery for prostate cancer. Twenty-seven patients underwent bilateral nerve sparing radical retropubic prostatectomy (BNSRRP) at the clinic of urology of the university hospital in Pleven between January 2016 and December 2016. Twenty-one of these patients had pre-operative preserved erectile function (EF), as reported according to the International Index of Erectile Function (IIEF-5). Postoperatively, these 21 patients experienced a mild (18-21 points) impairment of EF. In 10 patients (group 1), LI-ESWT was performed. The procedure was performed once a week for 6 weeks with a LI-ESWT (BTL 6000 SWT Topline) instrument. The reading was obtained with IIEF-5 on the third and sixth month after the end of therapy. The other 11 patients (group 2) were used as a control group and did not receive treatment. In 5 patients in group 1, a recovery of EF (> 21 points) as per IIEF-5 was recorded at the third month after treatment. In two patients, the same score was recorded at the sixth month. No improvement was seen in three men in group 1. In the controls (group 2), a spontaneous EF improvement in four patients at sixth month was registered. Despite the small number of patients and their short-term follow-up, our initial results indicate that LI-ESWT is effective, safe and well-tolerated. It could be an alternative for early penis rehabilitation in patients who have undergone BNSRRP.