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Original Article. Open Retropubic and Robot-Assisted Radical Prostatectomy in Prostate Carcinoma: Advantages of Methods

Summary

Prostate cancer (PC) is the most common type of cancer in men inanumber of countries. The choice of surgical technique for radical prostatectomy (RP) concerns both patients and urologists. The choice is not easy to make, since data is still limited due to the lack of large multicentric randomized research trials. For three years (2011-2014), 244 patients with limited prostate cancer were operated in the Urology Clinic of the University Hospital in Pleven. Robot-assisted radical prostatectomy (RARP) was performed on 35 patients (14%), open retropubic radical prostatectomy (ORP) - on 199 patients (81%), and laparoscopic RP - on 12 patients (5%). The preoperative and post-op results from the first two groups were compared. For the follow-up period of 12 months, functional results in 82 patients of the ORPgroup were compared to the results in the 35 patients of the RARPgroup. The operative time was significantly longer in the RARPgroup, and blood loss was lower. The catheter stay was shorter in patients with RARP. The percentage of significant postoperative complications was 0%in the patients with RARPand 3%in the patients with an ORP. RARPpatients demonstrated better continence: 91%vs. 87%and erectile function46%vs.40%at 12 months.

Open access
Original Article. Prevalence of HPV16 IgG Antibody and Rt-Pcr DNAdetection in Patients with Laryngeal Carcinoma and Cervical Dysplasia

Summary

Human papillomaviruses (HPVs) are associated with the most common sexually transmitted infections. It is well documented that high-risk (HR)-HPVtypes are etiologically associated with some cancers. The aim of the study was to investigate HPV16-DNApositivity and prevalence of Ig Gantibody against HPV16 in patients with laryngeal carcinoma and precancerous lesions of cervix uteri in Pleven region, Bulgaria. Material/Methods: We performedacross-sectional study and investigated clinical materials. Attached is real-time PCR-analysis for detection of HPV16-DNA. HPVspecific antibody response by enzyme-linked immunosorbent assay (ELISA) test for detection and quantification of specific Ig Gantibodies in serum were used. Results: For the six-month period, 30 samples were collected and tested. Fourteen of them were found in patients with carcinoma of the larynx and sixteen - in patients with various lesions of cervix uteri.We found that six patients (42.8%) in the first group and eight patients (50%) in the second group were HPV16-DNA-positive. Different age groups were affected. The sera analyzed in this study showed that seven patients (50%) with carcinoma of the larynx were seropositive of whom four (57%) were males. Fourteen of the females with dysplasia (88%) were seropositive. Matching DNApositivity and antibody response were found in 29%of the patients with laryngeal cancer. The match was found in 50%of the females with cervical dysplasia. Conclusions: Real-time PCRisarapid, cost-effective method for detection of HPVs.Ahigh level of seropositivity was found in the two groups of patients.

Open access
Original Article. Sensitization to Aeroallergens in Pediatric Patients with Allergic Rhinitis and Asthma

Summary

Asthma and allergic rhinitis are common in childhood. Establishing sensitization to aeroallergens is crucial to effectively prevent exacerbation of these respiratory allergic diseases. The study aimed to evaluate sensitization to the most common aeroallergens in children with asthma and allergic rhinitis.We establishedacorrelation between patients sensitized to indoor, outdoor and simultaneously to both allergens. The study population consisted of 276 patients (168 boys and 108 girls) ages 4 to 16 years with asthma (A) and allergic rhinitis (AR). Skin prick tests were performed with 21 commercial allergen extracts: pollens, mites, epithelia and insects, and molds. We found that 217 patients were sensitized to at least one aeroallergen: 117 patients hadapositive result to mites, 92 to pollens, 72 to epithelia and insects, and 63 - to mold allergens. Dermatophagoides pteronyssinus was the most prevalent aeroallergen. Sensitized only to indoor allergens were 104 patients, 60 - only to outdoor allergens, and 53 were sensitized to both. Mites were the most frequent aeroallergens in children with Aand AR. Lately there has been foundasignificant increase in rates of sensitization to mold allergens, especially to Alternaria alternata. Our study has confirmed the dominant role of indoor allergens in children with respiratory allergic diseases.

Open access
Original Article. Urinary Tract Desobstruction in Patients with Malignant Neoplasms of the Uterine Cervix

Summary

Cancer of the cervix causes internal, external compression or both of the upper urinary tract in 50-60%of patients in advanced stages. Retrograde stenting is the most widely used technique for desobstruction of the upper urinary tract in urology practice. Diversion of urine flow is an alternative, achieved by nephrostomy of one or both kidneys.We studied retrospectively 33 women with upper urinary tract obstruction caused by carcinoma of the uterine cervix operated on between March 2014 and March 2015 in the urology clinic at the University Hospital in Pleven, Bulgaria. Apercutaneous nephrostomy (PNS) was placed in 17 patients, and 11 patients hadaretrograde catheterization with ureteral stent type JJ. Five patients were treated with both methods. Placement ofa JJstent was the first choice procedure for all patients since it providesabetter quality of life. PNSimproves renal function faster than retrograde JJstenting. Therefore, the first method of choice for patients with an untreated primary cervical, uterine cancer is the placement of PNS. Retrograde JJstenting is the method of choice in patients who undergo surgery and radiation therapy withoutarelapse of the disease.

Open access
Recurrent Arterial and Venous Thrombotic Events in a Patient with Psoriasis. Impact of PAI-1 Polymorphism: A Case Report

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
Review. Approaches for Health Technology Assessment in Europe: Situational Analysis

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
Alterations in Platelet Activity and Elastic Modulus of Healthy Subjects, Carriers of G20210A Polymorphism in the Prothrombin Gene

Summary

Platelet activation is a complex process in which platelet reorganization takes place associated with changes in the cell shape, topology, membrane elasticity and microparticle production. The aim of this study was to investigate the changes/aberrations in the platelet activity, elasticity and morphology in healthy subjects, carriers of A allele of prothrombin G20210A polymorphism. Blood samples from 18 healthy subjects were used for platelet analysis by force-mode atomic force microscopy. Restriction analysis was used to investigate the carriage of G20210A polymorphism in the prothrombin gene. Flow- cytometry was applied to evaluate platelet activation. Young’s modulus of the plasma membranes of platelets derived from healthy subjects, carriers of variant A allele of prothrombin 20210G>A polymorphism (407±69 kPa) is two times higher than the one determined for non­carriers (195.4±48.7 kPa; p<0.05). The background activity of platelets measured as an interrelation of Cd41/Cd61 and CD62 by flow cytometry was also higher in carriers of variant A allele of prothrombin 20210G>A polymorphism (5.0%) than in non-carriers (1.3%). Platelets isolated from healthy carriers of variant A allele of prothrombin 20210G>A polymorphism exhibited a higher level of activity and a higher degree of stiffness at the stage of spreading as compared to platelets from non­carriers.

Open access
Biobanks and Public Health: A New Challenge for Public Engagement and Trust

Summary

Modem biobanks should be considered as important structural platforms for sharing samples and data, providing benefits that go beyond those of a single study. To increase the impact of biobanking on feasible strategies to protect and improve peoples’ health, it could be useful to increase awareness about biobank research potential in the scientific community, as well as to promote collaboration among different fields of expertise. The basis for involvement of biobanks in public health has already been partly built up, emphasising the synergy in organising efforts and the openness to infrastructure collaboration, to ensure reliable long-term funding and resource sharing to the benefit of all. To obtain the maximum benefits possible from biobanks, which currently constitute a set of heterogeneous structures, a strategy of coordinated governance is needed, based on harmonisation of different aspects, built on the consensus of all stakeholders involved and society in general. It is important that researchers strive to understand public attitudes in this biobanking involvement so that the relationships between public trust in biobanking, donors’ behaviours and support for public-health involvement in the health-care system can be better understood.

Open access
Genetic Polymorphisms, Plasma Levels of Lipoprotein (A) and its Possible Links with Degenerative Aortic Stenosis

Summary

Degenerative aortic stenosis is the second most common acquired valvular heart disease in adults (after mitral insufficiency) and the second most common cause for cardiac surgery (after coronary heart disease). The reasons for the occurrence of these diseases (congenital abnormality of the valve: bicuspid aortic valve disease, advanced renal failure, impaired calcium-phosphorus metabolism) have been established only in a small portion of these patients. The absence of a specific reason, causing calcification and narrowing of the aortic valve in recent years has challenged researchers to start investigating genetic factors that may correlate with the development of degenerative aortic stenosis. Regardless of the conducted studies, knowledge and identification of predictive genetic factors in the occurrence and progression of aortic stenosis are still insufficient. It is assumed that a specific genetic variant in the Lipoprotein (a) locus (LPA locus), reflected by the Lipoprotein (a) [Lp(a)] plasma levels, is connected to the pathology of aortic stenosis in multiethnic groups. The study of the genetic nature of aortic stenosis and significance of Lp( a) plasma levels and genetically determined variations of its structure associated with the manifestation and progression of valvular calcification in the future might provide predictive intervention. Similar studies relating to genetic polymorphisms in LPA locus, plasma concentrations of Lp(a) and their correlation with aortic stenosis have not beenconducted in Bulgaria so far.

Open access
Hypothermia in a Patient Treated with Antipsychotics

Summary

We present a case of 58-year-old female patent with a long-term history of paranoid schizophrenia treated with different antipsychotics. She died with sign and symptoms of hypothermia. Autopsy revealed an ischemic stroke. We could not exclude involvement of antipsychotic medications as culprits.

Open access