Anemia is an important public health problem worldwide. Although iron (Fe) deficiency is considered the main factor in the pathogenesis of anemia, only 40-60% of anemia cases are responsive to Fe supplementation. Considerable data exist that other micronutrient deficiencies, such as selenium (Se), could be possible causes of anemia. The issue of Se deficiency as a risk factor for the development of anemia is of particular interest to our country since the Balkan region is known by a low Se content of soils. The aim of the study was to examine the contemporary conception of the influence of Se deficiency on the development of anemia by a review of the scientific literature. Most animal studies have shown a significant relation between Se deficiency and anemia, but one study indicates that there is no impact of Se deficiency on the hematological parameters. Associations of low serum Se with anemia have been found in a number of human studies including subjects of various age groups and pathological conditions. Three possible biological mechanisms have been suggested for the involvement of Se deficiency in the development of anemia: increased oxidative stress, modulation of inflammation through induction of interleukin-6, and increased expression of heme oxygenase-1. A more categorical clarification of the relationships between Se deficiency and development of anemia is needed with respect to appropriate trace element supplementation in cases of anemia with insufficient or absent therapeutic response to Fe treatment.
A Transient Ischemic Attack (TIA) is a state of emergency and an independent risk factor for ischemic stroke. The social significance of the disease is determined, based on the probability of occurrence of subsequent cerebrovascular incidents and their frequency among groups. The purpose of the present study was to perform a comparative analysis of clinical features and outcome in patients with TIA for at least 24 months after onset had been registered, according to the pathogenesis and to ABCD (2) score. Two hundred and fifty-seven patients were monitored at the Neurology Clinic, First MHAT – Sofia after suffering an initial TIA. All subjects were studied using a clinical evaluation of pathogenetic mechanisms and an ABCD (2) algorithm. A diagnosis of TIA was confirmed by neuroimaging. The comparison between specific pathogenetic mechanisms demonstrated a statistically significant difference. Two TIA subgroups were involved – thromboembolic and cryptogenic (p<0.05). Also, according to the ABCD (2) score results, significant differences were found between groups at low (1-3) and high (6-7) risk, and those at intermediate (4-5) and high risk (p<0.01). Detailed investigation and assessment of patients with TIA are important concerning the prognostic outcome.
Acne vulgaris is among the commonest inflammatory skin diseases affecting pilosebaceous units. It occurs mainly in puberty and affects adolescents at the age of 14-19 years both females and males, in relation to sebum production of hair follicles under the action of sex hormones. Clinically the disease is presented with comedones, papules, pustules, nodules and scars in some cases. Seborrheic areas face, chest and back are affected. Recent epidemiologic studies have shown significant number of female patients aged over 25 years with acne and the term Adult onset acne (AOA)was established.The latter is manifested clinically in the lower third of the face. Primary etiological cause of AOAisahormonal imbalance, mainly hyperandrogenemia. Acase ofa25-year-old woman with adult acne and elevated levels of testosterone and prolactine is presented in this paper.
Acute appendicitis due to Enterobius vermicularis, usually known as pinworm, is very rare and affects mostly children.According to different authors, it is controversial whether pinworms cause inflammation of the appendix or appendiceal colic only.We presentacase ofa14-year-old female with three subsequent hospitalizations in 1 month due to abdominal pain in the right lower abdomen, with rebound tenderness, normal CTscan and laboratory findings. During the last hospitalization, laparoscopic appendectomy was performed. Intraoperatively multiple pinworms were found in the appendix. These were trapped byastercolith in the appendicular base inanoninflamed and histologically normal appendix. Two oral doses of mebendazole were administered postoperatively. Uneventful postoperative period and postoperative follow-up showed lack of symptoms six months after the operation. Despite the widespread idea that acute appendicitis due to Enterobius vermicularis is very rare, it should always be considered in young female patients with repeated abdominal pain in the right lower abdomen with normal laboratory and radiologic findings.
In the past two decades, the demographic crisis in Bulgaria has been widely debated. According to the National Statistical Institute (NSI), the proportion of people aged 65 and over is increasing, despite the general population decline in the country. To investigate whether the age structure of patients operated on has changed during the past 10 years and assess the need to reorganize the training of anesthetists,aretrospective study in the anesthesia electronic database of the University Hospital in Rouse was carried out. The data of anesthesia performed by anesthesiologists in 2005, 2010 and 2015 in patients aged 65 and over were summarized. The distribution of these patients by ASA Physical Classification System and frequency of complications during anesthesia were analyzed. The average annual number of anaesthesias for the three years was almost unchanged and amounted to about 5500. The proportion of patients aged 65 and over increased from 30.54%in 2005 to 35.72%in 2010, and 37.81%in 2015. The distribution of patients in according to the ASA Classification changed significantly: the percentage of patients ASAI-IIdropped from 36.19%in 2005 to 11.85%in 2015. The patients in the ASA III-IVgroups for the three analyzed years was 41.86%, 58.66%and 65.30%, respectively, and this was mainly due to the increase in the ASAIVpatients. It is necessary to build multidisciplinary teams and prepare specialized protocols for behavior in geriatric patients. It is imperative that anesthesiologists possess specialized knowledge about age-related organ changes and their effects on anesthesia.
Immune thrombocytopenia (ІTP) is one of the most common causes of clinically overt hemorrhage. Despite the progress made in recent years in clarifying the pathogenesis of the disease, the exact unlockmechanisms still remain unclear. The aim of the study was to correlate the oxidative stress markers and the severity of immune thrombocytopenia in adults and to investigate their predictive value of transforming the acute formof ITPinto chronicІTP.We studiedatotal of 58 subjects (14 patients with newly diagnosedІTP, 13 patients with chronic form ofІTR, and 31 controls). The plasma levels of human pantetheinase ( vanin-1) and lipid hydroperoxides were measured using commercial assay kits.We found that the form of the disease was not significantly related to the plasma vanin-1 levels (p=0.120). Asignificant difference in the vanin-1concentrations was observed between newly diagnosed IPTand the controls (p=0.046). Further studies with larger and more homogenous groups of patients and including more indicators of oxidative stress are needed to be able to draw statistically valid conclusions about the role of oxidative biomarkers in diagnosing and treatment ofІTP.
Breast cancer is the most common cancer in women worldwide. The standard for detecting it includes clinical exam, mammography and fine-needle aspiration cytology. Our aim was to establish the role of the tru-cut biopsy in the diagnosis of malignant breast lesions. We provideatwo-year retrospective clinical study defining 98.67%sensitivity, 100%specificity, 100%positive predictive value, 80%negative predictive value and an overall diagnostic accuracy of 98.73%. In 89.1%of the malignant lesions, the sample was adequate to define the receptor status. Therefore, tru-cut biopsy is an easy, cheap, safe and accurate alternative to fine-needle aspiration cytology in the diagnosis of breast lesions.
The study aimed to assess the inhalation technique of patients with bronchial asthma/chronic obstructive pulmonary disease (COPD) via an objective method and to evaluate the effect of training in patients with incorrect technique. Тhe inhalation technique of 120 patients with obstructive pulmonary disease was tested. The patients were divided into two groups: using metered dose inhalers (MDI) - 34 patients (28%) and dry powered inhalers (DPI) - 86 patients (72%). The most frequent mistakes in the MDIgroup were short duration of the inhalation (55.88%) and bad synchronization between activating the canister and the inhalation (29.41%). For the DPIgroup, the inhalation was not forceful enough (48.84%) and the short duration of the inhalation (12.79%). Patients claiming to have good inhalation technique accounted for 97%of those in the MDIgroup, and 96.5%of those in the DPIgroup. There were two patients (5.88%) with correct inhalation technique in the MDIgroup at their first attempt, and 31 patients (36.05%) in the DPIgroup. We found that in the MDIgroup there wasasignificant reduction in the number of mistakes (p<0.001). In the DPIgroup, such correlation was not found but during visit 2 there were no patients with more than 1 mistake. Correcting poor inhalation technique led to reduction of the number of mistakes during inhalation.
Matrix metalloproteinases (MMPs) areagroup of proteases containing Zn ions asacofactor, which are involved in degrading ofalarge number of extracellular matrix proteins, and bioactive molecules. They also playamajor role in processes such as cell proliferation, cell migration, differentiation and apoptosis. Very little is known about the expression and function of MMPs in the male reproductive tract. Occurrence of MMP-2 and MMP-9 activity in human seminal plasma has been previously reported but their origin and function are still not fully understood. The aim of this study was to examine the presence of MMP-2 and MMP-9 in normal and abnormal human sperm samples and find if any correlation existed between the levels of expression of MMPs and fertilization potential of the spermatozoa. Human spermsamples were examined for the presence of MMP-2 and MMP-9 by gel zymography and western blot analysis. A DNAfragmentation test was performed. The samples were divided into two groups - samples with normozoospermia and teratozoospermia. The gelatin zymography showed gelatinolytic bands with molecular weight 64 and 72 k Da corresponding to active and inactive form of MMP-2. MMP-9 was not detected. The MMP-2 enzymatic activity appeared to be much higher in samples with compromised sperm morphology as compared to the normozoospermic samples. The mean DNAfragmentation index (DFI) of the group with teratozoospermia was relatively higher (22.16%) and over the upper reference limits, compared to the normozoospermic group, in which it was within the normal range (17.26%).