Abstract Gingival recession is a common dental condition causing esthetic and functional problems to the patients. In the present case report gingival recession Miller class III is treated with bilaminar technique and subepithelial connective tissue graft where the tooth root surface is modified by Er:YAG laser and the case is observed for 5 months. There were no complications or side effects during the surgery and the healing period. The patient was stable after 5 months of follow-up. It could be concluded that the Er:YAG laser could be used in addition to mucogingival surgery, but longer observation and more studies are needed to clarify and prove its adjunctive application.
{"title":"Er:Yag Laser Root Modification for Single Root Recession Class III Coverage – Case Report","authors":"B. Yaneva","doi":"10.2478/amb-2021-0033","DOIUrl":"https://doi.org/10.2478/amb-2021-0033","url":null,"abstract":"Abstract Gingival recession is a common dental condition causing esthetic and functional problems to the patients. In the present case report gingival recession Miller class III is treated with bilaminar technique and subepithelial connective tissue graft where the tooth root surface is modified by Er:YAG laser and the case is observed for 5 months. There were no complications or side effects during the surgery and the healing period. The patient was stable after 5 months of follow-up. It could be concluded that the Er:YAG laser could be used in addition to mucogingival surgery, but longer observation and more studies are needed to clarify and prove its adjunctive application.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"34 - 37"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41366088","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. Gulubova, M. Hadzhi, L. Hadzhiilieva, D. Chonov, M. M. Ignatova
Abstract Nonalcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are associated with steatosis, inflammation and fibrosis. Liver dendritic cells (DCs) are usually tolerogenic in the sinusoidal milleu composed of immunosuppressive cytokines. In NAFLD and NASH, DCs become pro-inflammatory and modulate hepatic immune response. Murine liver DCs are three major subtypes: classical (lymphoid) cDC1 or the crosspresenters (CD8α+CD103+), classical (myeloid) cDC2 (CD11b+) and plasmacytoid pDCs (PDCA-1+Siglec-H+) and two additional subtypes or lymphoid + myeloid DCs and NKDCs. Similarly, human liver DCs are three subtypes or CD141+CLEC9A+, CD1c+ (BDCA1+) and pDCs (CD303+BDCA2+). Compared to blood human hepatic DCs are less immature and predominantly induce regulatory T cells (Tregs) and IL-4 secreting T cells (Th2). DCs polarize T cells into different Th types that are in interrelations in NAFLD/NASH. T helper 1 (Th1) (T-bet) cells are associated with adipose tissue inflammation. The differentiation of Th2 (GATA3) cells is induced by IL-4 DCs, increased in NAFLD. Similarly, Th17 cells (RORγt/ RORc) are increased in NAFLD and NASH. Tregs (FoxP3) are increased in the liver in steatosis and Th22 cells (AHR) are elevated in diabetes mellitus 2 (DM2) and adiposity. CD8+ T cells γδT cells and MAIT cells also contribute to liver inflammation.
{"title":"Dendritic Cells and T Cell Subsets in the Development of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis","authors":"M. Gulubova, M. Hadzhi, L. Hadzhiilieva, D. Chonov, M. M. Ignatova","doi":"10.2478/amb-2021-0037","DOIUrl":"https://doi.org/10.2478/amb-2021-0037","url":null,"abstract":"Abstract Nonalcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are associated with steatosis, inflammation and fibrosis. Liver dendritic cells (DCs) are usually tolerogenic in the sinusoidal milleu composed of immunosuppressive cytokines. In NAFLD and NASH, DCs become pro-inflammatory and modulate hepatic immune response. Murine liver DCs are three major subtypes: classical (lymphoid) cDC1 or the crosspresenters (CD8α+CD103+), classical (myeloid) cDC2 (CD11b+) and plasmacytoid pDCs (PDCA-1+Siglec-H+) and two additional subtypes or lymphoid + myeloid DCs and NKDCs. Similarly, human liver DCs are three subtypes or CD141+CLEC9A+, CD1c+ (BDCA1+) and pDCs (CD303+BDCA2+). Compared to blood human hepatic DCs are less immature and predominantly induce regulatory T cells (Tregs) and IL-4 secreting T cells (Th2). DCs polarize T cells into different Th types that are in interrelations in NAFLD/NASH. T helper 1 (Th1) (T-bet) cells are associated with adipose tissue inflammation. The differentiation of Th2 (GATA3) cells is induced by IL-4 DCs, increased in NAFLD. Similarly, Th17 cells (RORγt/ RORc) are increased in NAFLD and NASH. Tregs (FoxP3) are increased in the liver in steatosis and Th22 cells (AHR) are elevated in diabetes mellitus 2 (DM2) and adiposity. CD8+ T cells γδT cells and MAIT cells also contribute to liver inflammation.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"49 - 55"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48297169","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 Introduction: Azacitidine is one of the hypomethylating agents available for the treatment of elderly patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). It is also used as an appropriate treatment of chronic myelomonocytic leukemia (CMML) in the real life setting. As treatment of AML and CMML is not curative, and allogeneic stem cell transplantation (allo-SCT) remains traditionally the only option, significant clinical benefits by hypomethylating agents have been reported. According to the available data, 16% of subjects with MDS who received azacitidine had a complete or partial normalization of blood cell counts and bone marrow morphology, while two-thirds of patients who required blood transfusions no longer needed them. Nevertheless, it can also be hepatotoxic in patients with severe liver impairment and extensive liver tumors. Aim: to summarize the effect of azacitidine treatment in patients in the light of their general condition, blood count parameters, toxicity (general and hematologic), as well as the presence of cytogenetic aberrations. Materials and Methods: Twenty-seven patients of which 15 patients with MDS, 9 patients with CMML and 3 patients with AML received azacitidine treatment. The blood count levels and toxicity were followed for a period of twelve months. Results: 22.2% of our patients (6 of 27) of different hematologic diagnoses showed genetic aberrations in their DNA. All they showed quick disease progression and fatal outcome, four of them also developed hematologic toxicity. The remaining 77.8% had no cytogenetic findings. Of all the cohort, 19.05% developed toxicity during the course of the treatment, 38% – decreased leucocyte levels, 14.3% – decreased thrombocyte levels and 18.2% – decreased hemoglobin level. The erythrocyte levels were not substantially influenced by the treatment. The majority of the patients sustained stable levels of red blood cells, as well as of platelets and hemoglobin without remarkable changes between month 0 and month 6 of the treatment. Conclusion: Our results showed, that the main disadvantage of azacitidine treatment in our patients were progressive leucopenia (in 10/27 patients or 37% of cases) and toxicity (8/27 or 29.6% of cases).
{"title":"Azacitidine Treatment in Patients with Myelodysplastic Syndrome, Chronic Myelomonocytic Leukemia Type 2 and Acute Myeloid Leukemia According to their Cytogenetic Findings","authors":"D. Nikolova, A. Yordanov, A. Radinov","doi":"10.2478/amb-2021-0030","DOIUrl":"https://doi.org/10.2478/amb-2021-0030","url":null,"abstract":"Abstract Introduction: Azacitidine is one of the hypomethylating agents available for the treatment of elderly patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). It is also used as an appropriate treatment of chronic myelomonocytic leukemia (CMML) in the real life setting. As treatment of AML and CMML is not curative, and allogeneic stem cell transplantation (allo-SCT) remains traditionally the only option, significant clinical benefits by hypomethylating agents have been reported. According to the available data, 16% of subjects with MDS who received azacitidine had a complete or partial normalization of blood cell counts and bone marrow morphology, while two-thirds of patients who required blood transfusions no longer needed them. Nevertheless, it can also be hepatotoxic in patients with severe liver impairment and extensive liver tumors. Aim: to summarize the effect of azacitidine treatment in patients in the light of their general condition, blood count parameters, toxicity (general and hematologic), as well as the presence of cytogenetic aberrations. Materials and Methods: Twenty-seven patients of which 15 patients with MDS, 9 patients with CMML and 3 patients with AML received azacitidine treatment. The blood count levels and toxicity were followed for a period of twelve months. Results: 22.2% of our patients (6 of 27) of different hematologic diagnoses showed genetic aberrations in their DNA. All they showed quick disease progression and fatal outcome, four of them also developed hematologic toxicity. The remaining 77.8% had no cytogenetic findings. Of all the cohort, 19.05% developed toxicity during the course of the treatment, 38% – decreased leucocyte levels, 14.3% – decreased thrombocyte levels and 18.2% – decreased hemoglobin level. The erythrocyte levels were not substantially influenced by the treatment. The majority of the patients sustained stable levels of red blood cells, as well as of platelets and hemoglobin without remarkable changes between month 0 and month 6 of the treatment. Conclusion: Our results showed, that the main disadvantage of azacitidine treatment in our patients were progressive leucopenia (in 10/27 patients or 37% of cases) and toxicity (8/27 or 29.6% of cases).","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"19 - 25"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48812265","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}
A. Nikolov, M. Tzekova, K. Kostov, A. Kostadinovska, S. Blazheva
Abstract Introduction: Angiotensin II (AngII) and angiotensin-(1-7) [Ang-(1-7)] are key components of the renin angiotensin system (RAS). They exhibit counter-regulatory effects in the systemic circulation, as well as in tissues important for cardiovascular regulation. Aim: To investigate the association between the AngII/Ang-(1-7) balance and left ventricular hypertrophy (LVH) in patients with heart failure and mid-range ejection fraction (HFmrEF). Material and methods: 56 patients with HFmrEF were included, with a mean age of 65.62 ± 9.69 years and 22 age- and sex-matched healthy subjects, their mean age - 56.4 ± 5.53 years. The patients were divided in two subgroups: subjects with left ventricular hypertrophy (n = 32); (HFmrEF+LVH) and subjects without left ventricular hypertrophy (n = 24); (HFmrEFLVH). AngII and Ang-(1-7) levels were measured with an ELISA kit. Results: Patients with HFmrEF+LVH showed significantly higher levels of AngII: 8.53 pg/mL (1.47 ÷ 13.0) than HFmrEF-LVH – 1.33 pg/mL (0.47 ÷ 6.93) and healthy controls – 1.53 pg/mL (0.27 ÷ 5.21); (KW = 3.48; p = 0.04). There was no significant difference between Ang-(1-7) levels in all patients compared to controls (p > 0.05). AngII/Ang-(1-7) ratio was significantly higher in all patients than controls: 3.81 (2.03 ÷ 6.66) vs. 1.5 (0.93 ÷ 2.06) (KW = 18.68; p < 0.001). Patients with HFmrEF+LVH showed statistically higher AngII/Ang-(1-7) ratio compared with controls (4.7 vs. 1.5). Moreover, subjects with LVH showed the highest AngII/Ang-(1-7) ratio among all particpants in the study. The AngII/Ang-(1-7) ratio correlated with LVH (r = -0.39; p = 0.03), DBP (r = 0.25; p = 0.04), HDL (r = 0.33; p = 0.01), SBP (r = 0.34; p = 0.01). Conclusion: Our study showed an association between AngII/Ang-(1-7) ratio, blood pressure and LVH. The imbalance between Ang-II and Ang-(1-7) could contribute to the mechanisms determining LVH in HFmrEF. Further studies are warranted to clarify whether evaluation of serum Ang-II/Ang-(1-7) ratio could predict LVH development in patients with HFmrEF.
{"title":"Association Between the Angiotensin II/Angiotensin (1-7) Imbalance and Left Ventricular Hypertrophy in Patients with Heart Failure","authors":"A. Nikolov, M. Tzekova, K. Kostov, A. Kostadinovska, S. Blazheva","doi":"10.2478/amb-2021-0029","DOIUrl":"https://doi.org/10.2478/amb-2021-0029","url":null,"abstract":"Abstract Introduction: Angiotensin II (AngII) and angiotensin-(1-7) [Ang-(1-7)] are key components of the renin angiotensin system (RAS). They exhibit counter-regulatory effects in the systemic circulation, as well as in tissues important for cardiovascular regulation. Aim: To investigate the association between the AngII/Ang-(1-7) balance and left ventricular hypertrophy (LVH) in patients with heart failure and mid-range ejection fraction (HFmrEF). Material and methods: 56 patients with HFmrEF were included, with a mean age of 65.62 ± 9.69 years and 22 age- and sex-matched healthy subjects, their mean age - 56.4 ± 5.53 years. The patients were divided in two subgroups: subjects with left ventricular hypertrophy (n = 32); (HFmrEF+LVH) and subjects without left ventricular hypertrophy (n = 24); (HFmrEFLVH). AngII and Ang-(1-7) levels were measured with an ELISA kit. Results: Patients with HFmrEF+LVH showed significantly higher levels of AngII: 8.53 pg/mL (1.47 ÷ 13.0) than HFmrEF-LVH – 1.33 pg/mL (0.47 ÷ 6.93) and healthy controls – 1.53 pg/mL (0.27 ÷ 5.21); (KW = 3.48; p = 0.04). There was no significant difference between Ang-(1-7) levels in all patients compared to controls (p > 0.05). AngII/Ang-(1-7) ratio was significantly higher in all patients than controls: 3.81 (2.03 ÷ 6.66) vs. 1.5 (0.93 ÷ 2.06) (KW = 18.68; p < 0.001). Patients with HFmrEF+LVH showed statistically higher AngII/Ang-(1-7) ratio compared with controls (4.7 vs. 1.5). Moreover, subjects with LVH showed the highest AngII/Ang-(1-7) ratio among all particpants in the study. The AngII/Ang-(1-7) ratio correlated with LVH (r = -0.39; p = 0.03), DBP (r = 0.25; p = 0.04), HDL (r = 0.33; p = 0.01), SBP (r = 0.34; p = 0.01). Conclusion: Our study showed an association between AngII/Ang-(1-7) ratio, blood pressure and LVH. The imbalance between Ang-II and Ang-(1-7) could contribute to the mechanisms determining LVH in HFmrEF. Further studies are warranted to clarify whether evaluation of serum Ang-II/Ang-(1-7) ratio could predict LVH development in patients with HFmrEF.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"12 - 18"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41709309","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 The COVID-19 pandemic caused by the SARS-CoV-2 has increased the burden on healthcare system. Despite some progress in its diagnostics has been made, effective prevention and treatment are still insufficient. Since SARS-CoV-2 infections often cause systemic inflammation and multiple organ failure, the therapeutic options aimed at modulating the host immune responses to prevent subsequent systemic complications are demanding. The review provides a summary of the SARS-CoV-2 virus infection and underlines the current perception of pulmonary host’s immune response and its contributions to disease severity and systemic inflammation. Signaling pathways which have the potential to manipulate host immunity and improve clinical outcomes are also presented.
{"title":"Infection, Inflammation and Immunity in Covid-19 Infection","authors":"R. Cherneva, Z. Cherneva","doi":"10.2478/amb-2021-0040","DOIUrl":"https://doi.org/10.2478/amb-2021-0040","url":null,"abstract":"Abstract The COVID-19 pandemic caused by the SARS-CoV-2 has increased the burden on healthcare system. Despite some progress in its diagnostics has been made, effective prevention and treatment are still insufficient. Since SARS-CoV-2 infections often cause systemic inflammation and multiple organ failure, the therapeutic options aimed at modulating the host immune responses to prevent subsequent systemic complications are demanding. The review provides a summary of the SARS-CoV-2 virus infection and underlines the current perception of pulmonary host’s immune response and its contributions to disease severity and systemic inflammation. Signaling pathways which have the potential to manipulate host immunity and improve clinical outcomes are also presented.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"77 - 82"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69120620","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 Malignant tumors of the heart are rare. Even rarer, however, are metastases to the heart from cancers originating from the gastrointestinal tract. This case report involves a 63-year-old patient who presented into the clinic with a gastric ulcer and subsequent haemorrhage, and who died after sudden cardiac arrest. Autopsy revealed a metastatic involvement of the heart muscle from low-grade carcinoma of the stomach, as well as many other organ metastases.
{"title":"“The Rhythm of Cancer” – Unexpected Autopsy Finding in a Patient with Gastric Ulceration","authors":"J. Ananiev, M. Hadzhi, K. Ivanova","doi":"10.2478/amb-2021-0034","DOIUrl":"https://doi.org/10.2478/amb-2021-0034","url":null,"abstract":"Abstract Malignant tumors of the heart are rare. Even rarer, however, are metastases to the heart from cancers originating from the gastrointestinal tract. This case report involves a 63-year-old patient who presented into the clinic with a gastric ulcer and subsequent haemorrhage, and who died after sudden cardiac arrest. Autopsy revealed a metastatic involvement of the heart muscle from low-grade carcinoma of the stomach, as well as many other organ metastases.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"38 - 40"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42500962","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 Objectives: The aim of this study was to determine the role of the patient’s point of view when assessing health technologies as well as the patients’ willingness to participate in this process in our country. Methods: A pilot study included 165 patients across Bulgaria recruited from December 2019 to March 2020. Appropriate descriptive and statistical methods were used. Results: The patient’s point of view was an essential element in HTA. Patients in Bulgaria have the desire and willingness to share their personal experience with institutions, but insufficient knowledge of the process hinders their full participation in HTA. Our results showed that the need for higher awareness in the field and familiarity with HTA methodology are critical factors for the inclusion of patients in the HTA procedures in Bulgaria. Conclusion: This study was one of the few ones focused on the impact of patient participation in HTA in Bulgaria. The patient’s role in the development of medical technology must be recognized and considered a critical factor in the future of HTA.
{"title":"Role of the Patient‘s Viewpoint in Health Technologies Assessment in Bulgaria","authors":"C. Georgieva, A. Yanakieva","doi":"10.2478/amb-2021-0028","DOIUrl":"https://doi.org/10.2478/amb-2021-0028","url":null,"abstract":"Abstract Objectives: The aim of this study was to determine the role of the patient’s point of view when assessing health technologies as well as the patients’ willingness to participate in this process in our country. Methods: A pilot study included 165 patients across Bulgaria recruited from December 2019 to March 2020. Appropriate descriptive and statistical methods were used. Results: The patient’s point of view was an essential element in HTA. Patients in Bulgaria have the desire and willingness to share their personal experience with institutions, but insufficient knowledge of the process hinders their full participation in HTA. Our results showed that the need for higher awareness in the field and familiarity with HTA methodology are critical factors for the inclusion of patients in the HTA procedures in Bulgaria. Conclusion: This study was one of the few ones focused on the impact of patient participation in HTA in Bulgaria. The patient’s role in the development of medical technology must be recognized and considered a critical factor in the future of HTA.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"5 - 11"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42548802","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 Erythema multiforme (EM) is an acute immune-mediated disease with multifactor etiology, which presents with symmetric target-like lesions on the skin. Probably the most common etiological factor of EM is viral infections, particularly herpes simplex virus (HSV). Herpes-associated erythema multiforme (HAEM) is an acute exudative dermatosis, caused mostly by HSV-1 and much rarely by HSV-2. A 44-year-old female patient with herpes associated erythema multiforme was consulted with initial appearance of typical target lesions on the dorsal surface of both hands, after long history of labial herpes episodes. The diagnostic algorithm included routine laboratory tests, histological examination and serologic test for HSV-1 and 2. Our first choice of treatment was acyclovir 5 x 200 mg/24 h and dexamethasone 4 mg/24 h, however due to increased anxiety and tachycardia reported by patient the corticosteroid therapy was discontinued and promethazine was initiated. The patient responded well to the therapeutic regimen and at the follow-up visit was in clinical remission. In conclusion, the diagnosis of HAEM is mainly clinical, when the patient develops target lesions and coexisting HSV infection is detected.
{"title":"Herpes Simplex Associated Erythema Multiforme: A Case Report and Review of the Literature","authors":"G. Dzhelyatova, L. Miteva, L. Dourmishev","doi":"10.2478/amb-2021-0036","DOIUrl":"https://doi.org/10.2478/amb-2021-0036","url":null,"abstract":"Abstract Erythema multiforme (EM) is an acute immune-mediated disease with multifactor etiology, which presents with symmetric target-like lesions on the skin. Probably the most common etiological factor of EM is viral infections, particularly herpes simplex virus (HSV). Herpes-associated erythema multiforme (HAEM) is an acute exudative dermatosis, caused mostly by HSV-1 and much rarely by HSV-2. A 44-year-old female patient with herpes associated erythema multiforme was consulted with initial appearance of typical target lesions on the dorsal surface of both hands, after long history of labial herpes episodes. The diagnostic algorithm included routine laboratory tests, histological examination and serologic test for HSV-1 and 2. Our first choice of treatment was acyclovir 5 x 200 mg/24 h and dexamethasone 4 mg/24 h, however due to increased anxiety and tachycardia reported by patient the corticosteroid therapy was discontinued and promethazine was initiated. The patient responded well to the therapeutic regimen and at the follow-up visit was in clinical remission. In conclusion, the diagnosis of HAEM is mainly clinical, when the patient develops target lesions and coexisting HSV infection is detected.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"46 - 48"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69120427","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. Yordanov, F. Rushidova, M. Hrincheva, J. Ananiev
Abstract Lupus nephropathy is a glomerular lesion and one of the most severe organ localizations of systemic lupus erythematosus (SLE). Diabetic nephropathy, on the other hand, is a major cause for chronic kidney disease (CKD) as well as for end stage kidney disease (ESKD). We present the case of a 51-year-old woman with nephrotic syndrome diagnosed 4 months previously. Since the diagnosis was made, a rapid decline in renal function was observed – serum creatinine rose from 159 to 200 and to 462 μmol/l. Arterial hypertension was present for 2 years with BP values up to 200/90 mm Hg, as well as newly diagnosed diabetes mellitus which was insulin-treated due to the low renal function. The test for anti-dsDNA-63.3 was positive and ANA titers were 1: 320. The renal biopsy revealed a combination of lupus nephropathy and a nodular variant of diabetic nephropathy. Treatment with methylprednisolone, cyclophosphamide and heparin was initiated. This was followed by improvement in serum creatinine and proteinuria, by reduction of edema, decreased titers of anti-dsDNA and by improvement of the general well-being. A few months later, in the course of another intermittent infection, the patient’s condition deteriorated sharply, necessitating hemodialysis. Nephropathy secondary to lupus erythematosus is rarely seen in combination with diabetic nephropathy, but once they co-occur, a complicated course of the disease will eventually lead to serious kidney damage. The morphological examination of the renal biopsy aspirate is the only reliable mean to assess the nature of the glomerular changes and to make adequate therapeutic decisions.
狼疮肾病是一种肾小球病变，是系统性红斑狼疮(SLE)最严重的器官定位之一。另一方面，糖尿病肾病是慢性肾脏疾病(CKD)和终末期肾脏疾病(ESKD)的主要原因。我们提出一个51岁的妇女与肾病综合征诊断4个月前的情况。自确诊以来，肾功能迅速下降，血清肌酐从159 μmol/l上升到200 μmol/l，再上升到462 μmol/l。动脉高血压存在2年，血压值高达200/90 mm Hg，以及新诊断的糖尿病，由于肾功能低下而接受胰岛素治疗。抗dsdna -63.3检测阳性，ANA效价为1:20 20。肾活检显示狼疮肾病和结节型糖尿病肾病合并。开始使用甲基强的松龙、环磷酰胺和肝素治疗。随后是血清肌酐和蛋白尿的改善，水肿的减少，抗dsdna滴度的降低以及总体幸福感的改善。几个月后，在另一次间歇性感染的过程中，病人的病情急剧恶化，需要进行血液透析。继发于红斑狼疮的肾病很少与糖尿病肾病合并，但一旦合并，复杂的病程最终会导致严重的肾脏损害。肾活检抽吸物的形态学检查是评估肾小球改变性质和作出适当治疗决定的唯一可靠手段。
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S. Chattopadhyay, U. Roy, S. Biswas, P. Roy, P. Mandal
Abstract Background The antipsychotic olanzapine is a first-line drug in the treatment of schizophrenia while blonanserin is indicated in resistant cases of schizophrenia when the first line antipsychotics have failed. There are very limited studies available world-wide as well as in India that compare blonanserin with other antipsychotics in the setting of schizophrenia. Aims To study the efficacy, safety and tolerability of olanzapine and blonanserin in Schizophrenia. Settings and Design: The study was a prospective, observational, parallel group study done on schizophrenia patients aged between 18-50 years of both sexes at an outpatient Department of Psychiatry, in a tertiary medical college. The study was conducted from February 2015 to October 2016, with follow ups at weeks 4, 8 and 12. Materials and Methods The efficacy parameters were measured by the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression (CGI) rating. The safety parameters included the vital signs, haematological profile, lipid profile, blood sugar monitoring. Adverse drug reactions and compliance to therapy was observed through-out the study period. Appropriate statistical tests were applied to detect any significant within and between group differences using Microsoft Excel 2007 and SPSS version 17. Results There was significant decrease in the mean total score on the BPRS and CGI-S in the blonanserin arm at the 2nd and last follow up visit (p value < 0.001). Compliance was good in both groups (≤ 20% missed pills). Overall, 77 treatment-emergent adverse events were present from 56 patients. Twenty three subjects of the blonanserin arm and 33 subjects in the olanzapine arm at least experienced one adverse event (p = 0.006), metabolic adverse effects were more common with olanzapine, whereas insomnia, headache and somnolence were more often seen with blonanserin. Conclusions In the present study, blonanserin provided significantly better outcomes than olanzapine with respect to BPRS, CGI-S scores.
背景抗精神病药物奥氮平是治疗精神分裂症的一线药物，而布兰色林则适用于一线抗精神病药物无效的精神分裂症耐药病例。在世界范围内，以及在印度，比较blonanserin与其他抗精神病药物在精神分裂症治疗方面的研究非常有限。目的探讨奥氮平与布朗那色林治疗精神分裂症的疗效、安全性和耐受性。背景和设计:本研究是一项前瞻性、观察性、平行组研究，研究对象为一所三级医学院精神科门诊的18-50岁男女精神分裂症患者。该研究于2015年2月至2016年10月进行，并在第4、8和12周进行随访。材料与方法采用精神病学简易评定量表(BPRS)和临床总体印象量表(CGI)评定疗效。安全参数包括生命体征、血液学、血脂、血糖监测。在整个研究期间观察药物不良反应和治疗依从性。采用Microsoft Excel 2007和SPSS version 17进行适当的统计检验，以检测组内和组间是否存在显著差异。结果两组患者第2次和最后一次随访时BPRS和CGI-S平均总分均显著降低(p值< 0.001)。两组依从性均较好(漏服药≤20%)。总的来说，56例患者中出现了77例治疗后出现的不良事件。布隆那色林组23名受试者和奥氮平组33名受试者至少经历一次不良事件(p = 0.006)，代谢不良反应奥氮平组更常见，而布隆那色林组更常见失眠、头痛和嗜睡。结论在本研究中，blonanserin在BPRS、CGI-S评分方面明显优于奥氮平。
{"title":"Comparative Efficacy, Safety and Tolerability of Olanzapine and Blonanserin in Patients with Schizophrenia: A Parallel Group Study","authors":"S. Chattopadhyay, U. Roy, S. Biswas, P. Roy, P. Mandal","doi":"10.2478/amb-2021-0023","DOIUrl":"https://doi.org/10.2478/amb-2021-0023","url":null,"abstract":"Abstract Background The antipsychotic olanzapine is a first-line drug in the treatment of schizophrenia while blonanserin is indicated in resistant cases of schizophrenia when the first line antipsychotics have failed. There are very limited studies available world-wide as well as in India that compare blonanserin with other antipsychotics in the setting of schizophrenia. Aims To study the efficacy, safety and tolerability of olanzapine and blonanserin in Schizophrenia. Settings and Design: The study was a prospective, observational, parallel group study done on schizophrenia patients aged between 18-50 years of both sexes at an outpatient Department of Psychiatry, in a tertiary medical college. The study was conducted from February 2015 to October 2016, with follow ups at weeks 4, 8 and 12. Materials and Methods The efficacy parameters were measured by the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression (CGI) rating. The safety parameters included the vital signs, haematological profile, lipid profile, blood sugar monitoring. Adverse drug reactions and compliance to therapy was observed through-out the study period. Appropriate statistical tests were applied to detect any significant within and between group differences using Microsoft Excel 2007 and SPSS version 17. Results There was significant decrease in the mean total score on the BPRS and CGI-S in the blonanserin arm at the 2nd and last follow up visit (p value < 0.001). Compliance was good in both groups (≤ 20% missed pills). Overall, 77 treatment-emergent adverse events were present from 56 patients. Twenty three subjects of the blonanserin arm and 33 subjects in the olanzapine arm at least experienced one adverse event (p = 0.006), metabolic adverse effects were more common with olanzapine, whereas insomnia, headache and somnolence were more often seen with blonanserin. Conclusions In the present study, blonanserin provided significantly better outcomes than olanzapine with respect to BPRS, CGI-S scores.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"45 - 52"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45047409","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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