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Open access

N. Yancheva, N. Temelkova, D. Strashimirov, I. Gabarska and T. Tchervenyakova


Objective: To determine the incidence of osteopenia and osteoporosis in Bulgarian human immunodeficiency virus (HIV)-infected patients.

Methods: Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry in 41 Bulgarian HIV-infected patients.

Results: Overall, 27% of patients had reduced BMD (7% osteoporosis and 20% osteopenia). There was a significant correlation between low BMD and increasing age and between low BMD and duration of antiretroviral therapy (ART) but no correlation with gender, therapy regimen or serum calcium or phosphate levels. Seventy-one percent had elevated serum cystatin C levels but there was no correlation between BMD and cystatin C levels. Serum calcium, phosphate, cystatin C and creatinine levels and the T- and Z-scores were tested for dependence on duration of therapy. Dependence was found for T- and Z-scores, (p = 0.048 and p = 0.038) but not for calcium, phosphate, cystatin C or creatinine levels. These variables were subsequently tested by means of cross-tabulation tables for correlations between pairs of parameters; no significant correlation was found between any pairs (R > 0.5 for all comparisons).

Conclusions: Significant correlations were observed between low BMD and increasing age and longer duration of ART but no relationship was observed with gender or therapy regimen.

Open access

V. Ilieva, T. Mihalova, Yo. Yamakova, R. Petkov and B. Velev


Introduction: In the light of constant pressure for minimizing healthcare costs we made a cost-minimization analysis comparing invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) as treatment for hypoxemic acute respiratory failure (ARF).

Aim: The primary objective was to estimate the direct medical costs generated by a patient on IMV and NIV. A secondary objective was to identify which aspect of the treatment was most expensive.

Material and Methods: This is a single center retrospective study including 36 patients on mechanical ventilation due to hypoxemic ARF, separated in two groups – NIV (n = 18) and IMV (n = 18). We calculated all direct medical costs in Euro and compared them statistically.

Results: On admission the PaO2/FiO2 and SAPS II score were comparable in both groups. We observed a significant difference in the costs per patient for drug treatment (NIV: 616.07; IQR: 236.68, IMV:1456.18; IQR:1741.95, p = 0.005), consumables (NIV: 16.47; IQR: 21.44, IMV: 98.79; IQR: 81.52, p < 0.001) and diagnostic tests (NIV: 351; IQR: 183.88, IMV: 765.69; IQR: 851.43, p < 0.001). We also computed the costs per patient per day and there was a significant difference in the costs in all above listed categories. In both groups the highest costs were for drug treatment – around 61%.

Conclusions: In the setting of hypoxemic ARF NIV reduces significantly the direct medical costs of treatment in comparison to IMV. The decreased costs in NIV are not associated with severity of disease according to the respiratory quotient and SAPS II score.

Open access

Vasil Sveshtarov, S. Nencheva-Sveshtarova, R. Grozdanova and K. Prodanova


The aim of this study is to compare the pain intensity reduction between the mean radiation doses per session of gallium-aluminum-arsenide (GaAIAs) laser with superluminous diodes (SLD) in four of the most common pain-related chronic temporomandibular disorders (TMD) - local myalgia, myofascial pain, myofascial pain with a referral, and arthralgia. This study was implemented on 124 patients with pain-related temporomandibular disorders according to the DC/TMD criteria. We applied trigger point oriented near-infrared laser (785 nm, 100 s, 8 J/cm2) and SLD cluster sessions (the cluster is composed of 49 SLDs with a combination of visible red (633 nm) and infrared (880 nm) diodes, 200 mW, 300 s, 8 J/cm2) for the temporomandibular joints and the affected muscles. Patients were evaluated at the start of the treatment, and after the 6th session of combined phototherapy. The pain intensity scores were measured according to the Visual Analogue Scale (VAS). Our results show that the most statistically manifested pain reduction is found for the SLD dose, р = 0,000118, followed by the overall dose (laser plus SLD); р = 0,001031, and the laser dose; р = 0,030942 (ANOVA dispersion analyses). Consequently, it can be concluded that myalgia is better treated through lower doses of red light compared to infrared laser doses because SLDs combine the prooxidative effect of photons with 633 nm wavelength, a large area of exposure, sufficient tissue penetration, and some positive warming thermal impact of the SLD clusters.

Open access

R. Gancheva, A. Kundurdjiev, T. Kundurdjiev and Zl. Kolarov


Aim: To study the differences in cardiovascular risk between type 2 diabetic and non-diabetic patients with asymptomatic hyperuricemia and gout using the Framingham Risk Score (FRS) and complex multimodal ultrasonography.

Patients and methods: A total of 201 patients participated, divided into two groups: 1/ patients with asymptomatic hyperuricemia (n = 52), and 2/ patients with gout (n = 149). FRS was determined as well as ultrasound parameters, independent predictors of cardiovascular risk: left atrial size (LA), intima-media thickness (IMT) and common carotid artery resistive index (CCARI).

Results: The patients in the two groups were age-matched and conventional cardiovascular risk factors were equally distributed. In the asymptomatic hyperuricemia group, 12 patients (23.1%) had diabetes. In this group, there was no difference in FRS between diabetic and non-diabetic individuals. However, diabetic patients had larger LA, thicker intima-media and higher CCARI. In the gout group 18 subjects (12%) had diabetes, but the FRS, LA, IMT and CCARI values were similar among diabetic and non-diabetic patients. Furthermore, when gout subjects were subdivided according to the presence of tophi, we found that the subgroup having gouty tophi and diabetes had larger LA (p = 0.014) compared to those with gouty tophi without diabetes.

Conclusion: In diabetic patients with asymptomatic hyperuricemia and gouty tophi, a more complex approach for estimation of cardiovascular risk is needed. Our work suggests that diabetes and tophi might potentiate their action on the cardiovascular system.

Open access

M. A. Boyanov, E. Czerwinski, A. Shinkov, V. Palička, P. Lakatos, C. Poiana, J. Payer, Z. Killinger, T. Kocjan, O. Lesnyak, G. Holzer and H. Resch


To assess the current practice patterns in the diagnosis and treatment of male osteoporosis based on questionnaires. Questionnaires were presented and filled out by osteoporosis experts from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, Slovenia and Russia. The questions included focused on the proportion of male referrals to DXA, the main reasons for referral, the preferred measurement sites and reference database, the definition of male osteoporosis, needed laboratory investigations, data on calcium and vitamin D supplementation as well as on treatment modalities and their reimbursement rate. Men comprised 5 to 10% of all DXA referrals. The main reasons for referral were low back pain and fractures. Most of the respondents used the International male reference database. The diagnosis of osteoporosis was based mainly on a T-score below −2.5 after the age of 50, but a few respondents added fractures as a necessary condition. Only 1/3 of men visiting DXA sites are expected to have normal BMD. A consensus for the use of laboratory investigations in male osteoporosis is practically lacking. Treatment modalities include alendronate, risedronate, zoledronate, denosumab, rhPTH and strontium (with some restrictions for the latter three). Data on treatment adherence and persistence are generally lacking except for Austria, Romania and Slovakia. The levels of reimbursement vary a lot across countries. Osteoporosis in men is an under-recognized problem in CEE countries, leading to a tremendous gap in the diagnosis and treatment.

Open access

F. Al-Obaidi, T. Al-Kinani, M. H. Al-Ali and M. H. Al-Myahi

, Rencuzogullari I, Cagdas M, et al. Association between BNP levels and new-onset atrial fibrillation : A propensity score approach. Herz. 2017. 27. Topaz G, Flint N, Steinvil A, et al. Long term prognosis of atrial fibrillation in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention. Int J Cardiol. 2017;240:228-33. 28. Podolecki T, Lenarczyk R, Kowalczyk J, et al. Significance of Atrial Fibrillation Complicating ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017;120(4):517-21. 29. Rencuzogullari I, Cagdas M

Open access

O. S. Barylo, S. S. Polishchuk, R. L. Furman, T. R. Zakalata and A. M. Yur


The objective of this study was to perform a comprehensive evaluation of major indices of pain syndrome in patients with mandibular fractures accompanied by damage of inferior alveolar nerve using conventional therapeutic regimen supplemented by the administration of drug product Nucleo CMP Forte. Operative and postoperative treatment of 50 patients with angular fractures of the mandible, accompanied by clinical manifestations of inferior alveolar nerve damage, was performed. The severity of pain syndrome and neuropathy symptoms was evaluated using the LANSS pain scale, DN4 questionnaire, the Visual Analogue Scale (VAS) and Neuropathy Total Symptom Scores (NTSS-9). Decrease of pain syndrome was revealed in both groups but with different dynamic pattern. In the treatment group pain syndrome manifestations and neuropathy symptoms decreased quicker than in the comparison group. As LANSS, DN4, VAS and NTSS-9 scales characterize pain syndrome from various perspectives, the results were different but similar tendency was shown. At the beginning of the study LANSS scale indices were nearly identical in both groups, while on the 7th and 14th day they were 1.35 and 2.03 times lower, respectively, in the treatment group compared to the control group. On the first day NTSS-9 scale values did not practically differ in between the studied patients, being somewhat higher in the treatment group. On the 7th and 14th day the values increased 1.24 and 3.82 times, in the treatment group and in the group of comparison, respectively. Thus, the patients in the treatment group showed significantly greater pain relief than those in the comparison group. The analysis of dynamic pattern of complaints as well as the objective findings in angular fractures of the mandible, accompanied by the damage of inferior alveolar nerve, demonstrated that the administration of drug product Nucleo CMP Forte led to a more pronounced improvement of pain syndrome in the course of treatment. Because of the fact that neuropathic pain can develop in orthodontic treatment, as well as when partial and complete removable dentures are used, the administration of drug product Nucleo CMP Forte is warranted in combined therapy of both mandibular fractures followed by the clinical manifestations of inferior alveolar nerve damage, and neuropathic pain management in orthodontics and orthopedic stomatology.

Open access

R. Mihaylov, B. Pencheva, D. Stoeva and A. Ruseva

: 10.1186/1471-230X-12-14 26. Zaman A, Rosen HR, Ingram K et al. Assessment of FIBRO Spect II to detect hepatic fibrosis in chronic hepatitis C patients. Am J Med, 120, 2007, № 3, 280-291. 27. Salkic NN, Jovanovic P, Hauser G, et al. FibroTest/Fibrosure for significant liver fibrosis and cirrhosis in chronic hepatitis B: a meta-analysis. Am J Gastroenterol, 109, 2014, № 6, 796-806. 28. Lichtinghagen R, Pietsch D, Bantel H, et al. The Enhanced Liver Fibrosis (ELF) score: Normal values, influence factors and proposed cut-off values. J Hepatology, 59

Open access

Z. Gospodinova, N. Bózsity, M. Nikolova, M. Krasteva and I. Zupkó

proliferation and induces apoptosis via Bcl-2 and Bax regulation. Mol Med Rep, 2012;5(6):1453-1456. 8. Ferrazzano GF, Roberto L, Catania MR et al. Screening and scoring of antimicrobial and biological activities of Italian vulnerary plants against major oral pathogenic bacteria. Evid Based Compl Alternat Med, 2013;2013:316280. 9. Georgieva L, Mihaylova D. Screening of total phenolic content and radical scavenging capacity of Bulgarian plant species. Int Food Res J, 2015;22(1):240-245. 10. Gospodinova Z, Antov G, Christova R, Krasteva M. Extracts from

Open access

A. Shariat, Sh. Bahri Mohd Tamrin, M. Arumugam, M. Danaee and R. Ramasamy

Proceedings of Economics Development & Research, 42, 2012. 11. Janwantanakul, P., Pensri, P., Moolkay, P., Jiamjarasrangsi, W. Development of a risk score for low back pain in offi ce workers-a cross-sectional study. BMC musculoskeletal disorders. BioMed Central Ltd, 12, 2011, 23-29 12. Miranda, H., Kaila-Kangas, L., Heliövaara, M., Leino-Arjas, P., Haukka, E., Liira, J., Viikari-Juntura, E. Musculoskeletal pain at multiple sites and its effects on work ability in a general working population. Occupational and environmental medicine. BMJ