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Open access

Rumyana N. Kuzmanova, Irina Ts. Stefanova and Katerina I. Stambolieva

Summary

In recent years focus has been increasingly placed on impulse control disorders (ICDs) in patients with Parkinson’s disease (PD). ICDs include pathological attraction to gambling, compulsive shopping, compulsive eating and compulsive sexual behaviour and are associated mostly with the intake of dopamine agonists. Another impulsive and compulsive behaviour in PD is the dopamine dysregulation syndrome, which is associated with compulsive intake of L-dopa, and short-acting dopamine agonists. Diagnostics and prevention of this group of disorders is essential, considering the difficulties related to their treatment and their negative impact on the patients themselves as well as on their relatives.

Open access

Tatyana M. Betova, Savelina L. Popovska, Radoslav G. Trifonov, Konstantina S. Karakadieva, Genoveva B. Valcheva and Lachezar S. Tanchev

Summary

Desmoid-type fibromatosis is a rare mesenchymal neoplasm with locally aggressive, infiltrating and destructive growth that is not characterized by a metastatic potential. According to their anatomical position, desmoid-type fibromatoses can be divided into three groups: extra-abdominal, intra-abdominal, and fibromatoses of the abdominal wall. Mesenteric fibromatoses account for 8% of the intra-abdominal ones. The latter are characterized by myofibroblastic proliferation and infiltration of both the pelvic and abdominal organs. We report a 26-year-old woman who complained of abdominal enlargement, feeling of heaviness, discomfort and reflux, which symptoms dated back 1-2 months prior to hospitalization. The patient underwent laparotomy due to subocclusive symptoms. Intraoperatively, a tumor sized 30 cm in diameter was found. The tumor originated from the mesentery and infiltrated in the jejunum, the entire ileum, and part of the caecum with perforation towards the abdominal cavity. The histological and immunohistochemical examinations are important for clarification of the diagnosis. The treatment requires a multidisciplinary approach, in which the surgical method has the key role.

Open access

Iliya. V. Valkov and Rositza D. Dimkova

Summary

Eleven retired sportsmen, who had a career in contact sports (three boxers, four footballers, four wrestlers) and one cyclist with a history of several falls from a bicycle and had been diagnosed with a cerebrovascular trauma, were investigated with auditory cognitive P300. The age range was aged between 26 and 63 years. Ten out of the twelve presented cognitive wave latency between 512 msec and 928 msec. This finding made us conclude that repetitive minor head injuries (mHI) that they inevitably had experienced during their carrier has led to cognitive problems in older age.

Open access

Armine V. Grigoryan, Aneliya A. Dimitrova, Krasimir G. Kostov, Adelaida L. Russeva, Milena A. Atanasova, Alexander B. Blagev, Tatyana M. Betova and Radoslav G. Trifonov

Summary

Osteoporosis is a systemic skeletal disease characterized by decreased bone mass, destruction of the microarchitectonics of bone structure and a high risk for fracture. One of the criteria for altered bone homeostasis includes the changes in serum levels of alkaline phosphatase (ALP) and the activity of matrix metalloproteinases (MMPs). The purpose of this study was to determine the serum concentrations of calcium (Ca2+), phosphorus (P), magnesium (Mg2+), alkaline phosphatase (ALP) and MMP-9 in ovariectomized rats. We used 35 female Wistar rats at reproductive age (2 months) divided into 2 groups: a control group (G1-SHAM) – 20 animals subjected to “false” ovariectomy and placebo-operation, and an ovariectomized group (G2-OVX) – 15 animals subjected to bilateral ovariectomy. Blood was collected from the abdominal aorta for testing levels of Ca2 +, P, Mg2+, ALP and MMP-9. No statistically significant differences in serum concentrations of Ca2+, P and Mg2+ were found between G2 and G1 (p>0.05). The values of ALP and MMP-9 in rats of G2 were statistically significantly increased, as compared to G1 (p<0.05). The serum activity of ALP, which is a marker for bone formation, was increased in OVX-induced osteoporosis. Elevated serum MMP-9 levels in G2 confirmed the hypothesis that it is a marker for osteoclast activity.

Open access

Joana I. Simeonova, Snejanka T. Tisheva-Gospodinova, Yoana M. Todorova, Petkana A. Hristova, Asia N. Yanakieva and Martin I. Hristov

Summary

The aim of the cross-sectional study was to estimate the absolute 10-year risk for fatal cardiovascular disease (CVD) in patients with hypertension by Systematic Coronary Risk Estimation (SCORE). The study was carried out in 2016 as part of Project No 4/2016. Ninety-one patients aged 40-89 years were included. The mean age of the sample was 66.0±11.0, and 44.0% were males. Information of the patients’ risk profile included about age, gender, blood pressure, smoking and total cholesterol. The patients with hypertension were stratified according to a 10-year absolute risk of CVD. Data were processed by Statistical Package for Social Science versions 19.0 (SPSS.v.19.0). Over two-thirds of the patients had 1 stage hypertension (31.9%) and 2 stage hypertension (37.4%). Median systolic blood pressure on admission to the clinics was 160 mg Hg, and median diastolic blood pressure was 90 mm Hg. Total serum cholesterol values exceeded 4.9 mmol/L in 64.0% of the patients. Smokers accounted for about one-fourth of the patients, most of them having smoked for 40 years. The mean number of risk factors for CVD was 3.0. Over 65% of the patients were found to be at a very high 10-year absolute risk of fatal CVD by SCORE. Cardiovascular risk assessment has important role in prevention of morbidity, premature death and disability of CVD.

Open access

Slaveyko N. Djambazov and Toni Y. Vekov

Summary

Health technology assessment (HTA) isaprocess, which should answer the question“Isagiven health technology/medication worth its price for the value it provides?” In the spirit of the amendments to the Bulgarian Health Insurance Act and institutionalization of HTA, our team prepared this situational evaluation aiming to throw light on the practices and approaches to HTAin European countries. As awhole,we can identify two types of agencies that perform it: those servicing the population of an entire nation oraregion, and those working at the level of hospitals oranetwork of hospitals. All the agencies studied have two common characteristics. First, they were created withanon-profit purpose and second, all of them are financed by public funds inavariety of ways. It also becomes clear from the comparative analysis performed that the ways HTAis conducted in Europe differ from country to country. Irrespective of the variations, the common aspiration is that the value forapatient, to which the approved health technologies contribute, should be greater than the price to be paid for them. Bulgaria is may be the last EUstate to implement HTAin its domestic legislation and this also gives the advantage of having and using the experience of the other countries. Establishing an independent structure, which is appointed to prepare local health technologies assessment would result in transparent decision-making, participation of all concerned parties and optimization of the budget for medicines regarding the effectiveness/benefit ratio, as well as expenses.

Open access

Péter Halász

Summary

Introduction. Medial temporal lobe of epilepsy (MTLE) is considered as local/regional epilepsy. However, as was discussed in Part I of this review (Halász, 2016a) there is more evidence regarding the involvement of both temporal lobes so as to consider MTLE as one of the typical bilateral system epilepsies.

Aim. To provide contemporary review of MTLE in relation to the declarative memory system and the newly recognized hippocampo-frontal memory consolidation during slow wave sleep.

Methods. A review of the available literature on experimental and clinical data and also the authors own studies in MTLE patients.

Review, discussion and results. New experimental and clinical neurophysiological data have shown that MTLE is closely linked to the hippocampal memory system. It is likely that hippocampal spiking is the epileptic variations of the normal sharp wave ripple events mediating the encoding and consolidation of memory engrams by a hippocampo-frontal dialogue during slow wave sleep.

Conclusions. The source of memory impairment in MTLE patients is not merely the cell loss and synaptic transformation of the hippocampal structure, but the every night interference with memory consolidation due to interictal spiking.

Open access

Borislav T. Dimitrov, Veronika H. Gincheva, Iva G. Simeonova, Anika I. Ivanova, Maria P. Petkova, Dimitar K. Gospodinov and Regina Komsa-Penkova

Summary

Psoriasis isachronic autoimmune multisystem disease, mainly affecting the skin and joints. Its origin is related to both environmental and genetic factors. The condition affects 1-3%of the population worldwide. Psoriasis is also associated with cardiovascular risk factors, atherothrombotic events, and markers of hypercoagulation (platelet activation and hyperhomocysteinemia). Venous thromboembolism (VTE) isawidespread severe disease. Both VTEand psoriasis are connected with risk factors for cardiovascular disorders (obesity and hypertension). The incidence of VTEevents in patients with psoriasis is higher. Patients with psoriasis should be checked for risk factors (metabolic disorders and cardiovascular diseases).We reportacase of a 53-year old man, diagnosed with plaque psoriasis 20 years ago, andafive year history of hypertension. In 2006, he hadastroke, and in 2011 ‒aheart attack. In 2013 he was diagnosed with thrombophlebitis. The patient was recently diagnosed with Type IIdiabetes, dyslipidemia and metabolic syndrome. The DNAanalysis revealed that the patient wasahomozygous carrier of 4G/4G (rs1799889) polymorphism in plasminogen activator inhibitor 1 (PAI-1) -a risk factor for thrombophilia. This case is important because of the major comorbidities, more particularly thrombotic events in combination withaprothrombotic mutation.

Open access

Dorota Talarska, Michał Michalak and Patrycja Talarska

Summary

Background. Every chronic illness, including epilepsy, has a negative effect on both the quality of life of the sufferer as well as on their relationship with their surroundings.

Aims. To investigate the quality of life of children suffering from epilepsy and analyse how they assessed and scored their experiences compared to their parents.

Materials and methods. The study included 209 children with epilepsy and their parents. The research tool was a questionnaire for gathering demographic and clinical data as well as the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL 4.0) questionnaire in two versions, one for 8–12 year olds and one for 13–18 year olds and their parents.

Results. Cronbach’s alpha coefficient for the entire PedsQL 4.0 questionnaire was 0.91 and 0.93 for children with epilepsy and their parents respectively. Children rated their Total Scale Score higher (67.5 points) than their parents (62.5 points). Whilst analyzing children’s functioning in different areas it was observed that girls’ assessments were higher than boys’, except for Emotional Functioning. Both parents and children scored School Functioning the lowest. The greatest agreement of responses was observed in the domain of Physical Functioning, the smallest in the domain of Emotional Functioning.

Conclusions. Quality of life was rated higher by both age groups of children suffering from epilepsy than by their parents. A statistically significant difference was found when comparing the assessment scores of children and parents in light of the following variables; child age, gender, illness duration, seizure frequency and treatment effectiveness.