Atrial fibrillation (AF) is the commonest type of arrhythmia seen in everyday clinical practice, which leads to a significant increase in both morbidity and mortality. Its incidence increases with age and tends to turn into an epidemic. The cause of AF in 10-20% of cases remains unknown. Several mutations and polymorphism that might be responsible for the development of AF have been found, including single nucleotide polymorphisms (SNPs) - rs2200733 and rs10033464 in the long arm of the fourth chromosome. These polymorphisms are selected o the basis of genome- wide association study in Iceland from 2007, the results from which were later confirmed in 4 other large populations. The rs2200733 is a common noncoding polymorphism, described in National Center for Biotechnology Information (NCBI) database dbSNP like NC_000004.12:g.110789013C>T, with a frequency of the less common allele between 0.1 and 0.24. In order to investigate the association between the rs2200733 polymorphism in chromosome 4q25 and the development of AF, we studied the frequency of this polymorphism in patients with heart diseases from the Pleven region, and thus evaluate the relationship between the individual genotype and the clinical condition of the patients. We carried out a case-control study on 80 patients: 40 with AF and 40 without AF- from the Pleven region. None of these had structural heart disease. The study was conducted between November 2015 and November 2017. With deoxyribonucleic acid (DNA) analysis, we determined rs2200733 polymorphism, using a TaqMan-based polymerase chain reaction (PCR). The Cochran-Armitage trend test, the Chi-Squared Pearson correlation, Fisher test we used confirmed the statistically significant association between the rs2200733 polymorphism in chromosome 4q25 and the development of AF. In the population examined, the genotypic frequencies were as follows: CC - 45 (56.2%), CT - 19 (23.8%), TT - 16 (20%), with value of Chi-Square (χ2) 24.496, df=2, p<0.001. Screening for SNPs could be a useful marker for the detection of patients predisposed to AF.
Basal cell carcinoma (BCC) is the most frequent non-melanoma skin cancer. Only 5-15% of BCC cases can be found in patients aged 20-40 years (so-called early onset). The early onset BCC is characterized by active and aggressive tumour growth, clinically presenting in most of the cases as a morpheaform, locally infiltrating or recurrent BCC. Despite the advances in the study of the pathogenesis of this tumour, surgery remains the most used, most effective and most suitable treatment modality. We describe a case of a 39-year-old woman who developed an early onset BCC of the nasolabial fold. After the subsequent surgical excision an excellent cosmetic result was achieved.
Food allergy is an immunoglobulin E-meditated reaction, to which the organism’s immune system reacts to a food allergen, recognizing it as harmful. The study aimed to establish at what age cow’s milk protein allergy is manifested and determine the values of immunoglobulin E (IgE) and hemoglobin(Hb) in children with CMPA in Pleven region, Bulgaria. The study included 94 infants presenting with clinical manifestations of food allergy (age range 0 to 12 months) from Pleven and Pleven region, consulted in 2017 by a pediatrician at the University Hospital Consulting Center in Pleven. Venous blood was collected to determine the IgE and Hb values. Chronic iron-deficiency anemia could be the only clinical manifestation in children with CMPA. Out of all the children with CMPA, 17% had a pronounced anemic syndrome. The rest had normal Hb values. Anemic syndrome could have severe consequences for a growing child. Elevated IgE values were found in 73% of the children tested. CMPA is frequently seen in infants. Early diagnosis of clinical manifestations and diet could prevent severe complications of allergy such as chronic diarrhea, chronic urticaria, and asthma.
HPV infection is involved in the etiology of a number of nonmalignant, premalignant and malignant cutaneous lesions. One of them is the so-called giant condyloma of Buschke-Löwenstein type (Buschke-Löwenstein tumor, BLT), which sometimes can imitate clinically other tumors or tumor-like conditions. Clinicians face a particular challenge in cases of BLT where, clinically, the lesions demonstrate a permanent brown hyperpigmentation in parallel with the dermatoscopic lack of the characteristic melanocytic network, globules or regression zones. There are uncommon clinical presentations with solitary, sharply demarcated pigmented lesions. In these cases the histopathological verification of the lesion is obligatory and the most efficient treatment method in the early period of the disease is the complete surgical excision. We report a case of a 74-year-old man who was admitted to the University Hospital “Lozenetz” in connection with profuse variceal bleeding of the esophagus associated with liver cirrhosis of unknown etiology. He underwent a consultative examination at the department of dermatology because of suspected advanced stage melanoma of the prepuce. Computed tomographic analysis indicated diffuse bone metastases located in the small pelvis and femur, as well as metastatic disease in the left inguinal lymph nodes. However, the subsequent histopathologic examination of the lesion, rather than showing melanoma, confirmed the presence of HPV-associated giant condyloma of Buschke and Löwenstein in initial stage, without histopathological evidence for invasive and destructive tumor growth. After his death, the patient’s relatives did not give consent for an autopsy, and therefore the genesis of the metastases, demonstrated by nuclear magnetic resonance imaging (NMR), remained unclear. In some cases, the clinical picture of the malignant and premalignant cutaneous lesions in the genital area could be problematic. The complete surgical excision with a subsequent histopathological verification is the best way to find out the exact diagnosis
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.
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.
AIM: To compare spectral-domain optical coherence tomography (SD-OCT) with fluorescein angiography (FA) in detecting macular edema in patients with uveitis and analyse discrepancies in the findings obtained by the two methods. METHODS: The study included 133 eyes from 117 patients with uveitis that had SD-OCT (RTVue-100/ Optovue) and FA (Topcon TRC 50DX) scans performed to detect or rule out macular edema. RESULTS: Macular edema was found in 57 (42.9%) of the 133 surveyed eyes. In 37 eyes (27.8%) macular edema was confirmed by both imaging methods. In 17 eyes (12.8%) macular edema was detected on SD-OCT but not on FA;in 15 eyes of these the edema was diffuse, and in 2 eyes - serous retinal detachment was verified in the macular area. Focal macular edema was detected on FA in three eyes (2.3%) in which SD-OCT showed normal finding. In 76 eyes (57.1%) no pathological changes in the macula were observed on both SD-OCT and FA. Kappa coefficient was 0.675 at p < 0.001. The agreement rate between the two methods calculated using Kendall’s tau-b was 0.693 at p < 0.001. CONCLUSION: Fluorescein angiography and spectral domain optical coherence tomography are highly sensitive methods used in detecting macular edema in patients with uveitis, but they might fail to be efficient in this if used independently. Optical coherence tomography is a more informative method, especially in diagnosing diffuse macular edema.
Rhabdomyolysis (RM) is defined as striate muscle-cell damage with disintegration of skeletal muscles and release of intracellular constituents to the circulation, with or without subsequent kidney injury. RM is one of the leading causes of acute kidney injury and is associated with substantial morbidity. The major signs of acute kidney injury in rhabdomyolysis are: pain, weakness and swelling of the injured muscle or muscle groups and myoglobinuria with reddish discoloration of the urine and decrease in urine output to anuria. The authors describe three cases of rhabdomyolysis with acute renal injury and discuss the current knowledge on the etiopathogenesis, clinical manifestations, diagnosis and treatment of this condition.