Vascular-ventricular coupling is a major determinant of left ventricular load. The aim of our study was to assess non- invasively left ventricular load and its dependency on central hemodynamics. Sixty-five healthy and gender-matched individuals were divided in two groups according to their age: 20y/o and 50y/o. Applanation tonometry was performed using the Sphygmocor device. Central pressures and pulse wave analysis indices were computed. Central systolic (120±3 vs. 98±2 mm Hg) and pulse pressures (43±3 vs. 29±1 mm Hg) as well as the augmentation index (AIx75) (23±3 vs. 6±2%) were significantly higher in the 50y/o group (p<0.01). These parameters are relevant markers of arterial stiffness and evidenced the development of central arterial morphological and functional alterations in the older subjects. The time-tension index (TTI) computed from the systolic pressure area was significantly higher in the 50y/o subjects as compared to the 20y/o group (2378±66 vs. 1954±73 mmHg×s, p<0.01). Moreover, we have shown the presence of significant correlation between TTI and AIx75 (p<0.01) in both age groups. This finding confirmed the contribution of arterial stiffness for the impaired vascular-ventricular coupling. In conclusion, applanation tonometry might be utilized for non-invasive evaluation of the left ventricular load, which is an important parameter of cardiovascular risk.
Polina P. Vasileva, Angel D. Yordanov, Valentina I. Mazneykova, Adelaida L. Ruseva and Dobromir D. Dimitrov
Preeclampsia (PE) is characterized by hypertension and proteinuria after the 20th gestational week (GW). It is a significant cause of maternal and fetal perinatal morbidity and mortality during pregnancy. There is increasing evidence suggesting that PE is due to an impaired balance between maternal placental angiogenic and antiangiogenic factors that harm maternal vascular endothelium. The study aimed to assess the clinical and financial aspects of introducing into practice the soluble fms-like tyrosine kinase (sFlt-1) to placental growth factor (PlGF) ratio test to improve the management of preeclampsia and adverse pregnancy outcome, intrauterine growth retardation, iatrogenic prematurity, and placental abruption.
We report a case study in which we used the sFlt-1/PlGF ratio in the management of a high-risk pregnancy. Unnecessary hospitalization was avoided, and the patient was managed appropriately.
We aimed to compare results between patients with early- stage prostate cancer who underwent robot-assisted and open radical prostatectomy. We examined preoperative and postoperative data, early and late complications, and analysed oncological and functional outcomes (continence and erectile function) during follow-up.
We studied the data of 123 patients with localized prostate cancer, operated with nerve-sparing retropubic radical prostatectomy, divided into two groups. Group 1 included 70 patients who underwent robot-assisted radical prostatectomy (RARP). Group 2 included 53 patients, on whom open retropubic radical prostatectomy (RRP) was performed. We compared preoperative data, complications rate, oncological, and functional outcome (continence and erectile function) during the follow-up period.
Operative time was significantly lower in the RRP group. Blood loss and earlier removal of the urinary catheter were significantly lower in the RARP group. The percentage of significant postoperative complications (Clavien-Dindo III-IV) was 0% in the first group and 3% in the second group. During follow-up, the improvement in the functional outcome - continence and erectile function was significantly better in the robot-assisted surgery patients.
There were statistically significant better functional outcomes in patients operated on using the robot-assisted technique. The operating time was shorter in the classic radical prostatectomy. The application of robot-assisted radical prostatectomy may help achieve earlier recovery, as compared to open radical prostatectomy.
Victoria A. Georgieva, Sevdalina M. Marinova, Nikola K. Popovsky, Stefan I. Ivanov and Lyuben V. Georgiev
We studied the incidence and causes of transition disturbances in the first 30 minutes of life in full-term newborns. This one-year study was retrospective and included 1147 full- term live-born neonates without life-threatening congenital anomalies and surgical complications. They were divided into four groups: 0 (with normal transition), 1 (resuscitated without endotracheal intubation), and 2 (intubated); A (without underlying maternal, obstetric or fetal/neonatal problem, with adequate for GA eight and from single birth) and B (with one or more of following: underlying maternal, obstetric or fetal/neonatal problem, SGA or LGA, from multiple pregnancies).
Of the newborns, 9.1% of required resuscitation and 1.6% - extensive resuscitation with intubation. The groups significantly differed in the incidence of underlying maternal, obstetric, or fetal/neonatal problems. Resuscitated babies were born via Caesarean section (CS), in abnormal presentation (PaN) and by vacuum extraction or forceps (V/F) predominantly. The highest incidence of the small for gestational age (GA) babies – SGA, was detected in Group 2. Twins and large for GA (LGA) had prevalence in Group 1. Resuscitation was necessary for 18.1% of CS-delivered babies. V/F and PaN lead to the highest need for intubation. According to our data, every 10th of the full-term neonates required assistance in the fetal-to-neonatal transition. The causes could be diseases of the mother or fetus/newborn, multiple births, SGA, or LGA. A compromised medical decision about the time and way of delivery may result in iatrogenic transition disturbances.
Total extraperitoneal hernioplasty (TEP) has become increasingly used by surgeons. The TEP procedure is technically more challenging due to space constraints and has a higher learning curve. Chronic groin pain after inguinal hernia repair has become the dominant outcome investigated rather than recurrence. We aimed to evaluate the rate of chronic groin pain after TEP inguinal hernia repair performed at the Department of Surgical Oncology in G. Stranski University Hospital – Pleven. The procedures performed totaled 36. There was one conversion, and the patient was excluded from the study because the procedure performed was not laparoscopic. Distribution according to inguinal hernia type was: 41.7% - indirect hernia (15), 36.1% - direct hernia (13), 13.9% combined (5), and 8.3% femoral (3). Twenty-eight of the patients (80%) had preoperative pain. Two of the patients with chronic groin pain had had their meshes fixed with tacks (14.3% from the tack group with p=0.7). Our study showed that the TEP procedure is a safe, feasible operation with minimal risk for complications. Using tacks for mesh fixation is associated with higher rates of chronic groin pain, but it does not affect the recurrence rate, which correlates with the literature review data.
Tatyana D. Itova, Victoria A. Georgieva and Vanya N. Nedkova
It is believed that 98% of newborns have elevated serum bilirubin levels, but only about 60% have clinic of jaundice. Severe late neurological effects should not be observed if the serum bilirubin levels are well controlled. To follow-up the motor and mental development during the first year of life in infants suffered from neonatal jaundice. The study includes 92 term babies, divided in four groups: A – without jaundice, B – with jaundice treated by phototherapy in the 1st week , C - intensive jaundice during the first 14 postnatal days , D – intensive prolonged jaundice . Studied indicators: birth weight , gestational age, sex, delivery mode, Apgar score, maternal age and education, domicile, bilirubin serum levels during hospital stay, transcutaneous bilirubin levels ambulatory. Neuro-psychological development was assessed monthly until the 1-year-age.We found that groups were comparable across the all indicators except for residence, with significant difference for groups B and D. There was a statistically significant development delay in the Group D compared to the other three groups in the all studied age periods. All the cases of prolonged jaundice were resolved until the age of 3rd month. According to our data, prolonged jaundice compromises the first-year-psychomotor- development of the infants.
Veselin P. Penkov, Katya S. Kovacheva, Georgi M. Golemanov, Galia A. Georgieva, Peter D. Ivanov, Regina S. Komsa-Penkova and Olamide Ajewole
The present study aimed to evaluate the impact of factor V Leiden (FVL) polymorphism within the reproductive problems encountered by patients with polycystic ovary syndrome (PCOS). A total of 92 female patients with PCOS and 101 healthy controls were included in the study. Clinical and laboratory parameters were examined. The full history of each patient was taken. Single nucleotide polymorphism rs6025 in F5 was genotyped in PCOS patients and compared to the genotype frequency of the healthy controls. The data were analysed for correlation with infertility and pregnancy loss in PCOS patients. The prevalence of FVL polymorphism was higher, however not significantly, in PCOS patients compared to that of the control group (respectively OR=2.238, 95 % CI 0.777±6.449, p=0.104). The carriers of FVL polymorphism showed a higher rate of primary infertility (30.0% versus 12.5%, OR=3.143, 9 % CI 0.686±14.388, p=0.047) and their total reproductive failure rate was higher (60.5% versus 47.2%, OR=1.819, 95% CI 0.632±9.259, p=0.117). Carriage of FVL polymorphism in PCOS patients is associated with primary infertility and a presumed cause of the further investigations needed to understand the impact of FVL on PCOS. Carriage of FVL polymorphism in PCOS patients is associated with a higher rate of primary infertility, which draws attention to the role of this factor in the aetiology of the PCOS-related subfertility. Further investigations are needed to understand the impact of FVL on PCOS.
Nina P. Ayvazova, Lyubomira O. Ilieva, Emiliana I. Konova and Milena A. Atanasova
Recently, the important role of matrix metalloproteinases (MMPs) has been identified in follicular development and subsequent ovulation. Although the role of MMP in ovarian tissue remodeling during folliculogenesis has been well studied, the relationship between matrix protease activity and their inhibitors - Tisue inhibitors of matrix metalloproteinases (TIMP) and aging of the oocytes is still unclear. The present study aimed to establish the probable relationship between the expression levels of MMP-2 and TMP-1 and TIMP-2 in follicular fluid with the degree of oocyte maturity and quality. Follicular fluids from 20 women collected on the day of follicular puncture were tested for the presence of MMP-2, TIMP-1, and TIMP-2 using enzyme-linked immunosorbent assay (ELISA). The oocytes obtained were described in terms of maturity, morphology, and fertilization, as well as the embryo’s quality and rate of development. MMP-2 was significantly higher in follicular aspirates in the first prophase of meiosis - germinal vesicle (GV), compared to aspirates with first metaphase (MI) (p=0.011) and second metaphase (MII) of mature oocytes (p=0.010). The MMP-2/TIMP-1 ratio was significantly higher for GV compared to M1 (p=0.011), M2 (p=0.006) and atretic oocytes (p=0.032); (F(3, 71)=2.909, p=0.040). Based on our results, we can conclude that MMP-2 concentration in follicular fluids during the IVF / ICSI procedure had a significant relationship to oocyte maturation levels. It was significantly higher in the case of immature oocytes. On the other hand, oocytes with normal morphology were associated with a significantly higher MMP-2 concentration in follicular fluids.
Irena R. Hristova, Joana I. Simeonova, Nadezdha H. Hinkova and Slavcho T. Tomov
The aim of the study was to develop the norms for physical growth (birth weight-, birth height- and head circumference- for age) of the full-term babies born from singleton pregnancy in UMHAT „Dr. G. Stranski” – Pleven (total, by gender and gestational age at birth). A cross-sectional study was carried-out in 2017; 1092 live infants born from singleton pregnancy between 38 and 42 weeks were included in the study. We obtained information about three anthropometric measurements (birth weight-, birth height- and head circumference-for age). Data were processed by SPSS v.24.0. Norm group ranges (3, 5 and 7 groups) were developed for three indicators using percentile methods. Kruskal-Wallis test was used. The mean birth weight- and height-for age were higher for baby boys (P50, 3280 g and 50 cm) compared with baby girls (P50, 3150 g and 49 cm). Baby boys and girls weighed <2570 g at birth fell into the group ,,very slow growth” (P3). A ,,very fast growth” (P97) was found in baby boys weighed >4120 g at birth (vs. >3870 g for baby girls). Norm group ranges allow to identify the newborns with a higher risk and to focus efforts and health resources to them; it should be updated periodically.
Ivanka I. Veleva, Maya J. Stoimenova, Petranka G. Chumpalova, Kaloyan R. Stoychev, Lyudmil Z. Tumbev and Mirena P. Valkova
Schizophrenia is associated with basic neurocognitive deficit- ineffective space-time information assessment, leading to ineffective judgment and planning of behaviour. Our study aimed to examine and compare the psychomotor speed and number of errors in patients with paranoid schizophrenia (PS), first-degree relatives (FDR) and healthy controls (HC). One-hundred-eight patients with PS, 58 with FDR and 60 HCs were examined via Trail Making Tests (TMT) A and B. The influence of other additional factors as The Positive and Negative Syndrome Scale (PANSS), demographics and education were additionally assessed for PS. Statistical analysis was done using Excel 2010, Statgraphics 5.0+ and SPSS 20. All results were interpreted at 95% confidential level. PS showed most unsatisfactory performances on TMT A and B, as compared to others (p=0.0001). However, FDR differed from HC only in TMTB performance (p=0.0241). The most significant impact in PS group included ageing, education, PANSS and negative syndromes, and syndromes of disorganization. PS showed a significant decline of psychomotor speed and executive functioning, although FDR had average results in TMTB, compared to PS and HC. The above results determined both detentions as endophenotype markers for PS. Additional risk factors for decline include ageing, low education and high PANSS results.