Abstract Background There is a lack of upper-limb organ specific patient-reported questionnaires that are linguistically validated and culturally adapted for the Bulgarian population. The Liverpool Elbow Score (LES) is a mixed elbow-specific score with excellent psychometric properties of the patient-answered questionnaire (PAQ). There is no Bulgarian version. The aim of this study was to perform a linguistic validation and cultural adaptation of the LES−PAQ in Bulgarian, and to test the validity and reliability of the Bulgarian version. Materials and Methods The study was conducted in a single institution. Participant selection criteria were defined – included were mentally healthy adult patients with a diagnosis of osteochondritis dissecans of the radiocapitellar joint, elbow arthritis, lateral epicondylitis and elbow contracture. Excluded were patients with coexisting upper limb conditions, illiterate and non-native Bulgarian speakers. The Bulgarian LES−PAQ was created. The process consisted of forward translation, reconciliation and backward translation. An expert committee agreed upon a pre-final Bulgarian version. A final version was decided after cultural adaptation. The psychometric properties and reliability of the Bulgarian LES−PAQ was tested. Results 101 patients were included in this study. We did not observe a ceiling or floor effect. Cronbach’s α coefficient was 0.858. Intraclass correlation coefficient was 0.864 (95% CI 0.77 to 0.92; p < 0.05). A moderate negative correlation was revealed between the LES-PAQ and the DASH (r = -0.591, p < 0.05), and a high positive correlation with SF-12 (r = 0.867, p < 0.001). Conclusion The Bulgarian LES−PAQ is a reliable and valid instrument for assessing elbow conditions such as osteochondritis dissecans of the radiocapitellar joint, elbow arthritis, lateral epicondylitis and elbow contracture. It may assist Bulgarian healthcare professionals in both research and daily work.
{"title":"Linguistic Validation, Adaptation, and Reliability of the Liverpool Elbow Score’s Patient-Answered Questionnaire in Bulgarian the Bulgarian Les-Paq Questionnaire","authors":"Tsvetan Tsenkov, S. Slavchev, N. Dimitrov","doi":"10.2478/amb-2023-0040","DOIUrl":"https://doi.org/10.2478/amb-2023-0040","url":null,"abstract":"Abstract Background There is a lack of upper-limb organ specific patient-reported questionnaires that are linguistically validated and culturally adapted for the Bulgarian population. The Liverpool Elbow Score (LES) is a mixed elbow-specific score with excellent psychometric properties of the patient-answered questionnaire (PAQ). There is no Bulgarian version. The aim of this study was to perform a linguistic validation and cultural adaptation of the LES−PAQ in Bulgarian, and to test the validity and reliability of the Bulgarian version. Materials and Methods The study was conducted in a single institution. Participant selection criteria were defined – included were mentally healthy adult patients with a diagnosis of osteochondritis dissecans of the radiocapitellar joint, elbow arthritis, lateral epicondylitis and elbow contracture. Excluded were patients with coexisting upper limb conditions, illiterate and non-native Bulgarian speakers. The Bulgarian LES−PAQ was created. The process consisted of forward translation, reconciliation and backward translation. An expert committee agreed upon a pre-final Bulgarian version. A final version was decided after cultural adaptation. The psychometric properties and reliability of the Bulgarian LES−PAQ was tested. Results 101 patients were included in this study. We did not observe a ceiling or floor effect. Cronbach’s α coefficient was 0.858. Intraclass correlation coefficient was 0.864 (95% CI 0.77 to 0.92; p < 0.05). A moderate negative correlation was revealed between the LES-PAQ and the DASH (r = -0.591, p < 0.05), and a high positive correlation with SF-12 (r = 0.867, p < 0.001). Conclusion The Bulgarian LES−PAQ is a reliable and valid instrument for assessing elbow conditions such as osteochondritis dissecans of the radiocapitellar joint, elbow arthritis, lateral epicondylitis and elbow contracture. It may assist Bulgarian healthcare professionals in both research and daily work.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"35 ","pages":"33 - 36"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139016429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract At the beginning of 2023 we carried out a survey among active athletes asking about their attitude towards dietary supplements. Aim The aim of the study was to evaluate the attitude of athletes towards dietary supplements using a survey method. The objective of the study was to determine whether active athletes use dietary supplements. Materials and methods The participants in the study were asked to anonymously complete a survey consisting of 16 questions. In January 2023, we surveyed 50 active athletes from the „Vasil Levski” National Sports Academy (35 men and 15 women). Forty-six of the participants were between 18 and 22 years old and 4 were between 23 and 27 years old. Results The majority (94%) of the surveyed athletes trusted the advertisement of a particular dietary supplement. Ninety per cent had complete trust in the pharmacists’ advice. Pharmacists played a significant role in the choice of dietary supplements. A high percentage (60%) of the respondents who used dietary supplements had not sought medical advice prior to their use. Ninety per cent of the respondents used dietary supplements for weight loss in order to fit in a particular category; 78% indicated that they used dietary supplements for improvement of their sports achievements; 72% used supplements to increase their stamina and 46% – to shorten their time for recovery. A campaign should be initiated to encourage the use of dietary supplements only when they are prescribed by physicians.
{"title":"Attitude of Athletes Towards Dietary Supplements","authors":"I. Miteva, T. Kundurdzhiev, V. Valchev","doi":"10.2478/amb-2023-0041","DOIUrl":"https://doi.org/10.2478/amb-2023-0041","url":null,"abstract":"Abstract At the beginning of 2023 we carried out a survey among active athletes asking about their attitude towards dietary supplements. Aim The aim of the study was to evaluate the attitude of athletes towards dietary supplements using a survey method. The objective of the study was to determine whether active athletes use dietary supplements. Materials and methods The participants in the study were asked to anonymously complete a survey consisting of 16 questions. In January 2023, we surveyed 50 active athletes from the „Vasil Levski” National Sports Academy (35 men and 15 women). Forty-six of the participants were between 18 and 22 years old and 4 were between 23 and 27 years old. Results The majority (94%) of the surveyed athletes trusted the advertisement of a particular dietary supplement. Ninety per cent had complete trust in the pharmacists’ advice. Pharmacists played a significant role in the choice of dietary supplements. A high percentage (60%) of the respondents who used dietary supplements had not sought medical advice prior to their use. Ninety per cent of the respondents used dietary supplements for weight loss in order to fit in a particular category; 78% indicated that they used dietary supplements for improvement of their sports achievements; 72% used supplements to increase their stamina and 46% – to shorten their time for recovery. A campaign should be initiated to encourage the use of dietary supplements only when they are prescribed by physicians.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"325 ","pages":"37 - 40"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139025336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Mesechkova, A. Kavrakova, E. Todorova, B. Georgieva, I. Sigridov, V. Mitev, A. Todorova
Abstract Aim To investigate the potential role of the following bacterial/viral panel (Chlamydia trachomatis, Ureaplasma urealyticum/parvum, Mycomplasma hominis/genitalium, Gardnerella vaginalis, HSV1/2, EBV, CMV, VZV, HHV6, HHV7, HHV8) as causative factors for miscarriages in women by testing endometrial biopsies. Anaerobic and aerobic microorganisms causing dysbiosis and endometrial bacterial colonization by unbalanced growth were additionally tested. Materials and methods In total, 65 patients with a history of early and late miscarriages were analyzed. DNA extractions, real-time qPCR, agarose gel-electrophoresis were applied. Comparative analysis of the current with previously obtained data on the described panel in menstrual tissue samples was performed. Results In 64,6% of all tested endometrial biopsies bacterial and/or viral pathogens were detected. In 49,23% of all tested samples we found bacterial, while in 15,3% – viral pathogens. These results are similar to our previous data on menstrual tissue samples of infertile women – 61,1% infected, as 48,8% had bacterial and 22,2% had viral pathogens. Gardnerella vaginalis and Ureaplasma parvum were detected in 31,25% and 3,12% of all bacterial infected endometrial biopsies, significantly lower in comparison to the estimated rate of 69,31% and 61,36% on menstrual tissue. Anaerobic and aerobic dysbiosis were detected in 53,33% and 27% of the bacterial infected endometrial samples. In 13,33% a dysbiosis with a mixed etiology was found, while in 7% a dysbiotic condition with a totally absent findings of targeted bacteria and Lactobacillus was observed. EBV, CMV, HHV6 and HHV7 were detected in 30%, 30%, 20% and 20% of the positive for viral factors endometrial biopsies and in 40%, 7,5%, 10% and 42,5% in menstrual tissue samples. In the current study 62,5% bacterial co-infection and 12,5% bacterial/viral co-infection variants were found. Infections with the rest of the target pathogens were not detected in the endometrial biopsies. In contrast to the endometrial biopsy results, Mycomplasma hominis, Ureaplasma urealyticum and HSV2 were detected in our previous research on menstrual tissue samples. Conclusions Our research suggests a possible dysbiosis as a consequence of bacterial/viral endometrial colonization, associated with miscarriages. We prove that menstrual tissue, containing parts of the functional endometrial layer, is a reliable and accurate noninvasive sample for infectious screening of the upper genital tract.
{"title":"Role of Bacterial and Viral Infections and Co-Infections in Miscarriages","authors":"K. Mesechkova, A. Kavrakova, E. Todorova, B. Georgieva, I. Sigridov, V. Mitev, A. Todorova","doi":"10.2478/amb-2023-0037","DOIUrl":"https://doi.org/10.2478/amb-2023-0037","url":null,"abstract":"Abstract Aim To investigate the potential role of the following bacterial/viral panel (Chlamydia trachomatis, Ureaplasma urealyticum/parvum, Mycomplasma hominis/genitalium, Gardnerella vaginalis, HSV1/2, EBV, CMV, VZV, HHV6, HHV7, HHV8) as causative factors for miscarriages in women by testing endometrial biopsies. Anaerobic and aerobic microorganisms causing dysbiosis and endometrial bacterial colonization by unbalanced growth were additionally tested. Materials and methods In total, 65 patients with a history of early and late miscarriages were analyzed. DNA extractions, real-time qPCR, agarose gel-electrophoresis were applied. Comparative analysis of the current with previously obtained data on the described panel in menstrual tissue samples was performed. Results In 64,6% of all tested endometrial biopsies bacterial and/or viral pathogens were detected. In 49,23% of all tested samples we found bacterial, while in 15,3% – viral pathogens. These results are similar to our previous data on menstrual tissue samples of infertile women – 61,1% infected, as 48,8% had bacterial and 22,2% had viral pathogens. Gardnerella vaginalis and Ureaplasma parvum were detected in 31,25% and 3,12% of all bacterial infected endometrial biopsies, significantly lower in comparison to the estimated rate of 69,31% and 61,36% on menstrual tissue. Anaerobic and aerobic dysbiosis were detected in 53,33% and 27% of the bacterial infected endometrial samples. In 13,33% a dysbiosis with a mixed etiology was found, while in 7% a dysbiotic condition with a totally absent findings of targeted bacteria and Lactobacillus was observed. EBV, CMV, HHV6 and HHV7 were detected in 30%, 30%, 20% and 20% of the positive for viral factors endometrial biopsies and in 40%, 7,5%, 10% and 42,5% in menstrual tissue samples. In the current study 62,5% bacterial co-infection and 12,5% bacterial/viral co-infection variants were found. Infections with the rest of the target pathogens were not detected in the endometrial biopsies. In contrast to the endometrial biopsy results, Mycomplasma hominis, Ureaplasma urealyticum and HSV2 were detected in our previous research on menstrual tissue samples. Conclusions Our research suggests a possible dysbiosis as a consequence of bacterial/viral endometrial colonization, associated with miscarriages. We prove that menstrual tissue, containing parts of the functional endometrial layer, is a reliable and accurate noninvasive sample for infectious screening of the upper genital tract.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"20 10","pages":"13 - 18"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139023544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Dimitrova, R. Hristov, A. Djemadan, I. Gaytandzieva
Abstract Introduction Decentralized clinical trials are a new approach in health technology research and development that take advantage of innovative digital technologies in data collection for clinical trial purposes. Decentralized clinical trials achieve shorter participant recruitment periods, better adherence to assigned therapy, lower drop-out rates and shorter trial duration overall. Participants reported greater convenience compared to traditional clinical trials due to the studies being conducted at home and the removal of transport and time barriers. Materials and methods A literature review was conducted using the Scoping Review methodology defined by Arskey and O’Malley in 2005 and further updated in 2010 and 2014. PubMed, Scopus, and Google Scholar scientific databases were searched using predefined inclusion and exclusion criteria and keywords: virtual clinical trials, and/or decentralized clinical trials and barriers and challenges. Results The literature review found 40 articles that met the specified inclusion and exclusion criteria. The results of the different studies in this area show that decentralized clinical trials achieve shorter recruitment periods, better adherence to assigned therapy, lower dropout rates from trials, and shorter trial duration overall. Participants reported greater convenience compared to traditional clinical trials due to the studies being conducted at home and the removal of transport and time barriers. Major challenges with this type of trial is the difficulty in conducting physical examinations, invasive therapies by the investigators, and privacy protection. Conclusion The adoption of a regulatory framework for digital healthcare, education of medical professionals and patients about innovative technologies are necessary, especially in countries from Central and Eastern Europe.
{"title":"Decentralized Clinical Trials – Current Environment, Potential Barriers and Facilitators for Implementation and Risk Mitigation: A Review of the Literature","authors":"M. Dimitrova, R. Hristov, A. Djemadan, I. Gaytandzieva","doi":"10.2478/amb-2023-0047","DOIUrl":"https://doi.org/10.2478/amb-2023-0047","url":null,"abstract":"Abstract Introduction Decentralized clinical trials are a new approach in health technology research and development that take advantage of innovative digital technologies in data collection for clinical trial purposes. Decentralized clinical trials achieve shorter participant recruitment periods, better adherence to assigned therapy, lower drop-out rates and shorter trial duration overall. Participants reported greater convenience compared to traditional clinical trials due to the studies being conducted at home and the removal of transport and time barriers. Materials and methods A literature review was conducted using the Scoping Review methodology defined by Arskey and O’Malley in 2005 and further updated in 2010 and 2014. PubMed, Scopus, and Google Scholar scientific databases were searched using predefined inclusion and exclusion criteria and keywords: virtual clinical trials, and/or decentralized clinical trials and barriers and challenges. Results The literature review found 40 articles that met the specified inclusion and exclusion criteria. The results of the different studies in this area show that decentralized clinical trials achieve shorter recruitment periods, better adherence to assigned therapy, lower dropout rates from trials, and shorter trial duration overall. Participants reported greater convenience compared to traditional clinical trials due to the studies being conducted at home and the removal of transport and time barriers. Major challenges with this type of trial is the difficulty in conducting physical examinations, invasive therapies by the investigators, and privacy protection. Conclusion The adoption of a regulatory framework for digital healthcare, education of medical professionals and patients about innovative technologies are necessary, especially in countries from Central and Eastern Europe.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"40 12","pages":"73 - 78"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139017012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Popovski, A. Nikolov, Ts. Lukanov, S. Blazheva, T. Totev
Abstract Introduction Women who suffered preeclampsia (PE) have two to four times higher risk for development of cardiovascular disease (CVD) compared with women with a history of normotensive pregnancy. Microvascular and endothelial dysfunction, mediated by different vasoactive factors have been suggested as attainable pathophysiological pathways. The study aimed to: (1) determine changes in circulating levels of key vasoactive peptides in sera of women with history of PE and in women who had a normal pregnancy 1 year after delivery and (2) investigate whether an association exists between these molecules and cardiovascular risk factors. Materials and methods The current research examined 32 women one year after preeclampsia (mean age 25.3 ± 6.3 years) and control group of 20 women one year after normal pregnancy (mean age 25.6 ± 5.6 years). The enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of angiotensin II (AngII), angiotensin-(1-7) [Ang-(1-7)] and pro-endothelin-1 (Pro-ET-1). Results We found that at 1 year after delivery 38.46% of women who suffered PE have developed hypertension and 5.77% have developed diabetes mellitus. Women who had normal pregnancy developed neither hypertension, nor diabetes mellitus 1 year after delivery. Serum AngII levels in women one year after PE were statistically significantly lower than in women one year after normotensive pregnancy 0.9 (0.55÷1.7) vs. 2.3 pg/ml (2.0 ÷ 2.9) (KW = 20.849; p = 0.0001). Ang-(1-7) concentrations in women one year after PE were lower than in women one year after normal pregnancy, but not significantly 1.7 (0.3÷4.5) vs. 3.2 ng/ml (0.2÷8.0) (p>0.05). Levels of serum Pro-ET-1 in women one year after PE were statistically significantly higher than in women one year after normal pregnancy 322.65 (261.75÷391.85) vs. 248.7 pmol/L (231.05÷282.15) (KW = 6.639; p = 0.009). AngII showed correlation with AH grade (r = -0.33; 0.02), Ang-(1-7) (r = 0.27; 0.05), DBP (r = -0.28; p = 0.04), mean arterial pressure (r = -0.43; p = 0.002), pulse pressure (r = -0.28; p = 0.04), BMI (r = -0.30; p = 0.03), TC (r = -0.31; p = 0.03) and LDL (r = -0.30; p = 0.03). Pro-ET-1 correlated with age (r = 0.30; p = 0.03), mean arterial pressure (r = -0.25; p = 0.05) and pulse pressure (r = 0.41; p = 0.003). Conclusion Our data showed an association between key vasoactive peptides and major CVD risk factors in women one year after PE. We suggest that imbalance between AngII, Ang-(1-7) and Pro-ET-1 could have a potential imply on the vascular wall after PE, reflecting persistent microvascular and endothelial injury/dysfunction postpartum. Further studies are warranted to clarify these vasoactive peptides’ role in the ongoing vascular endothelial function after delivery and the pathogenic mechanisms determining development of CVD in previously PE women.
{"title":"Changes of Serum Angiotensin Peptides, Pro-Endothelin-1 Levels in Women One Year After Preeclampsia and their Association with Cardiovascular Risk Factors","authors":"N. Popovski, A. Nikolov, Ts. Lukanov, S. Blazheva, T. Totev","doi":"10.2478/amb-2023-0038","DOIUrl":"https://doi.org/10.2478/amb-2023-0038","url":null,"abstract":"Abstract Introduction Women who suffered preeclampsia (PE) have two to four times higher risk for development of cardiovascular disease (CVD) compared with women with a history of normotensive pregnancy. Microvascular and endothelial dysfunction, mediated by different vasoactive factors have been suggested as attainable pathophysiological pathways. The study aimed to: (1) determine changes in circulating levels of key vasoactive peptides in sera of women with history of PE and in women who had a normal pregnancy 1 year after delivery and (2) investigate whether an association exists between these molecules and cardiovascular risk factors. Materials and methods The current research examined 32 women one year after preeclampsia (mean age 25.3 ± 6.3 years) and control group of 20 women one year after normal pregnancy (mean age 25.6 ± 5.6 years). The enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of angiotensin II (AngII), angiotensin-(1-7) [Ang-(1-7)] and pro-endothelin-1 (Pro-ET-1). Results We found that at 1 year after delivery 38.46% of women who suffered PE have developed hypertension and 5.77% have developed diabetes mellitus. Women who had normal pregnancy developed neither hypertension, nor diabetes mellitus 1 year after delivery. Serum AngII levels in women one year after PE were statistically significantly lower than in women one year after normotensive pregnancy 0.9 (0.55÷1.7) vs. 2.3 pg/ml (2.0 ÷ 2.9) (KW = 20.849; p = 0.0001). Ang-(1-7) concentrations in women one year after PE were lower than in women one year after normal pregnancy, but not significantly 1.7 (0.3÷4.5) vs. 3.2 ng/ml (0.2÷8.0) (p>0.05). Levels of serum Pro-ET-1 in women one year after PE were statistically significantly higher than in women one year after normal pregnancy 322.65 (261.75÷391.85) vs. 248.7 pmol/L (231.05÷282.15) (KW = 6.639; p = 0.009). AngII showed correlation with AH grade (r = -0.33; 0.02), Ang-(1-7) (r = 0.27; 0.05), DBP (r = -0.28; p = 0.04), mean arterial pressure (r = -0.43; p = 0.002), pulse pressure (r = -0.28; p = 0.04), BMI (r = -0.30; p = 0.03), TC (r = -0.31; p = 0.03) and LDL (r = -0.30; p = 0.03). Pro-ET-1 correlated with age (r = 0.30; p = 0.03), mean arterial pressure (r = -0.25; p = 0.05) and pulse pressure (r = 0.41; p = 0.003). Conclusion Our data showed an association between key vasoactive peptides and major CVD risk factors in women one year after PE. We suggest that imbalance between AngII, Ang-(1-7) and Pro-ET-1 could have a potential imply on the vascular wall after PE, reflecting persistent microvascular and endothelial injury/dysfunction postpartum. Further studies are warranted to clarify these vasoactive peptides’ role in the ongoing vascular endothelial function after delivery and the pathogenic mechanisms determining development of CVD in previously PE women.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"622 ","pages":"19 - 27"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139021983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Ivanov, S. Mihailova, R. Bilyukov, C. Popov, T. Kundurzhiev, E. Naumova
Abstract COVID-19 has proven to be a disease that affects not only the respiratory tract but also leads to a state of generalized systemic hyperinflammation and overall immune dysregulation. An important role in its pathogenesis is the disturbance of many cytokines – a condition which, in its most pronounced form, is also called a „cytokine storm“. Objective To evaluate the serum cytokine levels during COVID-19 infection as potential biomarkers for the severity and course of infection. Materials and methods By design, the study is a retrospective cross-sectional, in which the serum concentrations of 10 pro- and anti-inflammatory cytokines (IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF-α, and GM-CSF) were investigated in 36 individuals (divided into 3 groups by severity – with a mild form of the infection/presymptomatic, moderately severe and severe/critical) within two periods – before and after the second week from the onset of symptoms of the disease. Results In the period up to the 2nd week, the serum concentrations of IFN-γ (p = 0.029), IL-1β (p = 0.017), and IL-5 (p = 0.014) showed a statistically significant correlation with the disease severity, however in the later stage of the disease the cytokine levels did not show any clinical value. Conclusion Cytokine testing could be used to predict the severity of COVID-19 infection which could support individual therapeutic decisions. Analysis of a larger group of patients is needed to unfold the full potential of such testing.
{"title":"Changes in the Cytokine Profile in Patients During COVID-19 Infection","authors":"N. Ivanov, S. Mihailova, R. Bilyukov, C. Popov, T. Kundurzhiev, E. Naumova","doi":"10.2478/amb-2023-0036","DOIUrl":"https://doi.org/10.2478/amb-2023-0036","url":null,"abstract":"Abstract COVID-19 has proven to be a disease that affects not only the respiratory tract but also leads to a state of generalized systemic hyperinflammation and overall immune dysregulation. An important role in its pathogenesis is the disturbance of many cytokines – a condition which, in its most pronounced form, is also called a „cytokine storm“. Objective To evaluate the serum cytokine levels during COVID-19 infection as potential biomarkers for the severity and course of infection. Materials and methods By design, the study is a retrospective cross-sectional, in which the serum concentrations of 10 pro- and anti-inflammatory cytokines (IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF-α, and GM-CSF) were investigated in 36 individuals (divided into 3 groups by severity – with a mild form of the infection/presymptomatic, moderately severe and severe/critical) within two periods – before and after the second week from the onset of symptoms of the disease. Results In the period up to the 2nd week, the serum concentrations of IFN-γ (p = 0.029), IL-1β (p = 0.017), and IL-5 (p = 0.014) showed a statistically significant correlation with the disease severity, however in the later stage of the disease the cytokine levels did not show any clinical value. Conclusion Cytokine testing could be used to predict the severity of COVID-19 infection which could support individual therapeutic decisions. Analysis of a larger group of patients is needed to unfold the full potential of such testing.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"67 22","pages":"5 - 12"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138988707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Latifi, E. Moudi, F. Abesi, A. Minouei, M. Hozouri, A. Bijani
Abstract Background To date, few studies have compared the accuracy of cone-beam computed tomography (CBCT) and ultrasonography in measuring the soft tissue thickness of the maxillary and mandibular gingiva. Aims To compare the accuracy of ultrasonography and CBCT in measuring the soft tissue thickness of the maxillary and mandibular gingiva in a sheep model. Materials and Methods In this study, 38 different landmarks (26 points from the upper jaw and 12 points from the lower jaw) were evaluated. The gingival soft tissue thickness was measured using a digital caliper, ultrasonography, and standard and high-resolution CBCTs. The measurements were finally compared with each other. Results Regarding the thicknesses < 2 mm, no significant difference was seen between the measurements of the digital caliper and ultrasonography (mean difference < 0.1 mm, p = 0.140). Conversely, data analysis indicated significant differences between CBCTs measurements and digital caliper and ultrasonography measurements. Regarding thicknesses > 2 mm, digital caliper measurement was not significantly different from ultrasonography and high-resolution CBCT measurements (mean differences < 0.1 mm) but differed from the standard CBCT measurement. Also, a significant difference was observed between ultrasonography and standard CBCT measurements but not between ultrasonography and high-resolution CBCT (mean differences < 0.1 mm). Finally, mean differences between standard and high-resolution CBCT measurements were statistically significant. Conclusion According to the results, ultrasonography can be a reliable option for measuring gingival soft tissues regardless of their thickness, while CBCT may be more suitable for thicker gingival tissues. Clinicians should carefully consider the measurement accuracy of different imaging methods when planning dental procedures.
{"title":"Comparison of Ultrasonography and Cone-Beam Computed Tomography Accuracy in Measuring the Soft Tissue Thickness of Maxillary and Mandibular Gingiva in a Sheep Model","authors":"S. Latifi, E. Moudi, F. Abesi, A. Minouei, M. Hozouri, A. Bijani","doi":"10.2478/amb-2023-0042","DOIUrl":"https://doi.org/10.2478/amb-2023-0042","url":null,"abstract":"Abstract Background To date, few studies have compared the accuracy of cone-beam computed tomography (CBCT) and ultrasonography in measuring the soft tissue thickness of the maxillary and mandibular gingiva. Aims To compare the accuracy of ultrasonography and CBCT in measuring the soft tissue thickness of the maxillary and mandibular gingiva in a sheep model. Materials and Methods In this study, 38 different landmarks (26 points from the upper jaw and 12 points from the lower jaw) were evaluated. The gingival soft tissue thickness was measured using a digital caliper, ultrasonography, and standard and high-resolution CBCTs. The measurements were finally compared with each other. Results Regarding the thicknesses < 2 mm, no significant difference was seen between the measurements of the digital caliper and ultrasonography (mean difference < 0.1 mm, p = 0.140). Conversely, data analysis indicated significant differences between CBCTs measurements and digital caliper and ultrasonography measurements. Regarding thicknesses > 2 mm, digital caliper measurement was not significantly different from ultrasonography and high-resolution CBCT measurements (mean differences < 0.1 mm) but differed from the standard CBCT measurement. Also, a significant difference was observed between ultrasonography and standard CBCT measurements but not between ultrasonography and high-resolution CBCT (mean differences < 0.1 mm). Finally, mean differences between standard and high-resolution CBCT measurements were statistically significant. Conclusion According to the results, ultrasonography can be a reliable option for measuring gingival soft tissues regardless of their thickness, while CBCT may be more suitable for thicker gingival tissues. Clinicians should carefully consider the measurement accuracy of different imaging methods when planning dental procedures.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"427 13","pages":"41 - 46"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138991219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. K. Kavaldzhieva, D. K. Dimitrova-Dikanarova, K. S. Mladenova, V. Lazarov, N. Y. Mladenov
Abstract A major factor affecting male fertility is excessive death of germ cells, both immature germ cells and mature spermatozoa. It can be due to various factors causing testicular and/or post-testicular damage, such as infections, obstructive conditions, toxins, oxidative stress, hormonal imbalance, hyperthermia, and anti-sperm antibodies. Massive death of spermatozoa leads to a high proportion of dead sperm cells in the ejaculate (necrozoospermia or necrospermia) while death of immature germ cells can lead to low sperm count (oligozoospermia or oligospermia). Cell death can occur both by necrosis and by apoptosis; in recent decades, it has been found that apoptosis of mature spermatozoa is not only possible but quite common, and can contribute to infertility. Treatment approaches are primarily directed to the underlying condition, i.e. removing the cause(s) of sperm cell death whenever possible, but include also attempts to bypass the cell death event by intracytoplasmic sperm injection with testicular spermatozoa.
{"title":"The Death of Sperm Cells","authors":"K. K. Kavaldzhieva, D. K. Dimitrova-Dikanarova, K. S. Mladenova, V. Lazarov, N. Y. Mladenov","doi":"10.2478/amb-2023-0046","DOIUrl":"https://doi.org/10.2478/amb-2023-0046","url":null,"abstract":"Abstract A major factor affecting male fertility is excessive death of germ cells, both immature germ cells and mature spermatozoa. It can be due to various factors causing testicular and/or post-testicular damage, such as infections, obstructive conditions, toxins, oxidative stress, hormonal imbalance, hyperthermia, and anti-sperm antibodies. Massive death of spermatozoa leads to a high proportion of dead sperm cells in the ejaculate (necrozoospermia or necrospermia) while death of immature germ cells can lead to low sperm count (oligozoospermia or oligospermia). Cell death can occur both by necrosis and by apoptosis; in recent decades, it has been found that apoptosis of mature spermatozoa is not only possible but quite common, and can contribute to infertility. Treatment approaches are primarily directed to the underlying condition, i.e. removing the cause(s) of sperm cell death whenever possible, but include also attempts to bypass the cell death event by intracytoplasmic sperm injection with testicular spermatozoa.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"1551 ","pages":"69 - 72"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139018676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Active moderate-to-severe TAO is a disease, the treatment of which requires a multidisciplinary team, an individualized approach and strict follow-up, yet it is often suboptimal. Recent knowledge about the pathogenesis of the disease and the randomized controlled trials conducted in recent years made it possible to use new therapeutic combinations and biological agents. The currently recommended first-line therapy for active moderate-to-severe TAO is the combination of intravenous glucocorticoids (GCs) in moderate doses and mycophenolate or, in more severe cases, a high-dose GC treatment alone. There are several options for second-choice therapy, if needed: a new course with GCs, combination of orbital radiotherapy and GCs (preferably intravenous), cyclosporine and oral GCs, azathioprine and oral GCs, rituximab, tocilizumab or teprotumumab. The clinical manifestations of TAO should also be considered when choosing second-line treatment. Thus, for example, teprotumumab best affects diplopia, orbital radiotherapy – visual disturbances and diplopia, while intravenous GCs, mycophenolate, cyclosporine, rituximab and tocilizumab – the inflammatory manifestations of TAO. However, the question of the availability of the new drugs in routine clinical practice remains unsolved.
摘要 活动性中重度 TAO 是一种疾病，其治疗需要多学科团队、个体化方法和严格的随访，但治疗效果往往不尽如人意。近年来，对该病发病机制的最新认识以及随机对照试验的开展，使得使用新的治疗组合和生物制剂成为可能。目前推荐的活动性中重度 TAO 的一线疗法是静脉注射中等剂量的糖皮质激素（GCs）和霉酚酸酯联合治疗，或在更严重的病例中单独使用大剂量 GCs 治疗。如果需要，有几种第二选择治疗方案：使用糖皮质激素的新疗程、眼眶放疗与糖皮质激素（最好是静脉注射）联合、环孢素与口服糖皮质激素、硫唑嘌呤与口服糖皮质激素、利妥昔单抗、妥西珠单抗或替普妥单抗。在选择二线治疗时，还应考虑 TAO 的临床表现。例如，替普鲁单抗对复视的影响最大，眼眶放疗--视觉障碍和复视，而静脉注射 GCs、霉酚酸酯、环孢素、利妥昔单抗和托珠单抗--TAO 的炎症表现。然而，新药在常规临床实践中的可用性问题仍未解决。
{"title":"Current Therapeutic Options in Active Moderate-to-Severe Thyroid-Associated Ophthalmopathy","authors":"M. Stoynova, A. Shinkov, R. Kovatcheva","doi":"10.2478/amb-2023-0045","DOIUrl":"https://doi.org/10.2478/amb-2023-0045","url":null,"abstract":"Abstract Active moderate-to-severe TAO is a disease, the treatment of which requires a multidisciplinary team, an individualized approach and strict follow-up, yet it is often suboptimal. Recent knowledge about the pathogenesis of the disease and the randomized controlled trials conducted in recent years made it possible to use new therapeutic combinations and biological agents. The currently recommended first-line therapy for active moderate-to-severe TAO is the combination of intravenous glucocorticoids (GCs) in moderate doses and mycophenolate or, in more severe cases, a high-dose GC treatment alone. There are several options for second-choice therapy, if needed: a new course with GCs, combination of orbital radiotherapy and GCs (preferably intravenous), cyclosporine and oral GCs, azathioprine and oral GCs, rituximab, tocilizumab or teprotumumab. The clinical manifestations of TAO should also be considered when choosing second-line treatment. Thus, for example, teprotumumab best affects diplopia, orbital radiotherapy – visual disturbances and diplopia, while intravenous GCs, mycophenolate, cyclosporine, rituximab and tocilizumab – the inflammatory manifestations of TAO. However, the question of the availability of the new drugs in routine clinical practice remains unsolved.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"1248 ","pages":"59 - 68"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139018985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Primary precursor B-lymphoblastic lymphoma/leukemia (B-LBLL) of bone is uncommon neoplasm that accounts for less than 1% of primary bone tumors. It has been commonly reported in pediatric population but is rare in adults. We present a case of a 20-year-old man with multiple osteolytic lesions as sole presentation of acute lymphoblastic leukemia, whose diagnosis was established by bone biopsy. A peripheral blood smear and the bone marrow aspirate showed no blast cells. The patient received treatment according to BFM 99 protocol and achieved complete response confirmed by F-FDG-PET/CT.
{"title":"A Rare Case of Adult Precursor B-Cell Lymphoblastic Lymphoma/Leukemia Presenting with Multiple Osteolytic Bone Lesions as Sole Manifestation","authors":"I. Micheva, S. Dimitrova","doi":"10.2478/amb-2023-0044","DOIUrl":"https://doi.org/10.2478/amb-2023-0044","url":null,"abstract":"Abstract Primary precursor B-lymphoblastic lymphoma/leukemia (B-LBLL) of bone is uncommon neoplasm that accounts for less than 1% of primary bone tumors. It has been commonly reported in pediatric population but is rare in adults. We present a case of a 20-year-old man with multiple osteolytic lesions as sole presentation of acute lymphoblastic leukemia, whose diagnosis was established by bone biopsy. A peripheral blood smear and the bone marrow aspirate showed no blast cells. The patient received treatment according to BFM 99 protocol and achieved complete response confirmed by F-FDG-PET/CT.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"33 ","pages":"55 - 58"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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