K. Papadakis, T. Handjieva-Darlenska, R. Tafradjiiska-Hadjiolova, H. Nocheva
Abstract Atopic dermatitis (AD), or eczema, is a common skin disease that is often associated with other atopic disorders, such as allergic rhinitis and asthma. The disease can develop both in infancy and adulthood, and characterizes with recurrent episodes impairing the quality of life. The review аnalyzes the genetical, immunological, and environmental factors in the pathogenesis of AD. The role of the skin barrier function is also considered in regard of the main hypotheses for AD development. Further elucidation of the mechanisms involved in the pathogenesis of AD could give interesting and useful clues for therapeutic protocols and prophylactic approaches.
{"title":"Insights Into Atopic Dermatitis – From Pathogenesis to Therapy","authors":"K. Papadakis, T. Handjieva-Darlenska, R. Tafradjiiska-Hadjiolova, H. Nocheva","doi":"10.2478/amb-2023-0022","DOIUrl":"https://doi.org/10.2478/amb-2023-0022","url":null,"abstract":"Abstract Atopic dermatitis (AD), or eczema, is a common skin disease that is often associated with other atopic disorders, such as allergic rhinitis and asthma. The disease can develop both in infancy and adulthood, and characterizes with recurrent episodes impairing the quality of life. The review аnalyzes the genetical, immunological, and environmental factors in the pathogenesis of AD. The role of the skin barrier function is also considered in regard of the main hypotheses for AD development. Further elucidation of the mechanisms involved in the pathogenesis of AD could give interesting and useful clues for therapeutic protocols and prophylactic approaches.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"73 - 80"},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46806907","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 worldwide distribution of the HBV infection has usually been estimated by the prevalence of hepatitis B surface antigen (HBsAg) among the general population. Total antibodies for hepatitis B core antigen (anti-HBc) are the most important diagnostic marker for proving prior exposure to HBV. Aim The aim of this study was to determine the prevalence of Hepatitis B virus (HBV) infection among Bulgarian population. Reliable epidemiologic data is needed to estimate the prevalence of Hepatitis B in order to determine the actual burden of the infection and to plan prevention and control measures. Materials and methods A total of 2140 serum samples were tested for major serological markers of HBV (HBsAg and anti-HBc) for a period of two years (2018-2019). Results We established an intermediate prevalence of HBsAg (5.1%) and high prevalence of anti-HBc (27%) among HBsAg negative individuals. Conclusion In conclusion, the prevalence of Hepatitis B is much higher among those born before the introduction of universal hepatitis B vaccination in Bulgaria (1992).
{"title":"Prevalence of Hepatitis B in Random Bulgarian Blood Samples – A Single-Site Experience","authors":"A. Gotseva, E. Naseva","doi":"10.2478/amb-2023-0013","DOIUrl":"https://doi.org/10.2478/amb-2023-0013","url":null,"abstract":"Abstract The worldwide distribution of the HBV infection has usually been estimated by the prevalence of hepatitis B surface antigen (HBsAg) among the general population. Total antibodies for hepatitis B core antigen (anti-HBc) are the most important diagnostic marker for proving prior exposure to HBV. Aim The aim of this study was to determine the prevalence of Hepatitis B virus (HBV) infection among Bulgarian population. Reliable epidemiologic data is needed to estimate the prevalence of Hepatitis B in order to determine the actual burden of the infection and to plan prevention and control measures. Materials and methods A total of 2140 serum samples were tested for major serological markers of HBV (HBsAg and anti-HBc) for a period of two years (2018-2019). Results We established an intermediate prevalence of HBsAg (5.1%) and high prevalence of anti-HBc (27%) among HBsAg negative individuals. Conclusion In conclusion, the prevalence of Hepatitis B is much higher among those born before the introduction of universal hepatitis B vaccination in Bulgaria (1992).","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"5 - 9"},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43911722","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}
P. Velikov, N. Kapincheva, I. Trifonova, V. Velev, M. Popov, I. Ivanov, R. Chipeva, T. Valkov, R. Yordanova, G. Dimitrov, N. Korsun, T. Tcherveniakova, Dr. Petar Krasimirov Velikov
Abstract Compared to other respiratory viruses, the proportion of hospitalizations due to SARS-CoV-2 among children is relatively low. While severe illness is not common among children and young individuals, a particular type of severe condition called multisystem inflammatory syndrome in children (MIS-C) has been reported. The aim of this prospective cohort study, which followed a group of individuals under the age of 19, was to examine the characteristics of patients who had contracted SARS-CoV-2, including their coexisting medical conditions, clinical symptoms, laboratory findings, and outcomes. The study also aimed to investigate the features of children who met the WHO case definition of MIS-C, as well as those who required intensive care. A total of 270 patients were included between March 2020 and December 2021. The eligible criteria were individuals between 0-18 with a confirmed SARS-CoV-2 infection at the Infectious Disease Hospital “Prof. Ivan Kirov” in Sofia, Bulgaria. Nearly 76% of the patients were ≤ 12 years old. In our study, at least one comorbidity was reported in 28.1% of the cases, with obesity being the most common one (8.9%). Less than 5% of children were transferred to an intensive care unit. We observed a statistically significant difference in the age groups, with children between 5 and 12 years old having a higher likelihood of requiring intensive care compared to other age groups. The median values of PaO2 and SatO2 were higher among patients admitted to the standard ward, while the values of granulocytes and C-reactive protein were higher among those transferred to the intensive care unit. Additionally, we identified 26 children who met the WHO case definition for MIS-C. Our study data supports the evidence of milder COVID-19 in children and young individuals as compared to adults. Older age groups were associated with higher incidence of both MIS-C and ICU admissions.
{"title":"SARS-COV-2 Infection in Children and Young People in Bulgaria – A Prospective, Single-Center, Cohort Study","authors":"P. Velikov, N. Kapincheva, I. Trifonova, V. Velev, M. Popov, I. Ivanov, R. Chipeva, T. Valkov, R. Yordanova, G. Dimitrov, N. Korsun, T. Tcherveniakova, Dr. Petar Krasimirov Velikov","doi":"10.2478/amb-2023-0014","DOIUrl":"https://doi.org/10.2478/amb-2023-0014","url":null,"abstract":"Abstract Compared to other respiratory viruses, the proportion of hospitalizations due to SARS-CoV-2 among children is relatively low. While severe illness is not common among children and young individuals, a particular type of severe condition called multisystem inflammatory syndrome in children (MIS-C) has been reported. The aim of this prospective cohort study, which followed a group of individuals under the age of 19, was to examine the characteristics of patients who had contracted SARS-CoV-2, including their coexisting medical conditions, clinical symptoms, laboratory findings, and outcomes. The study also aimed to investigate the features of children who met the WHO case definition of MIS-C, as well as those who required intensive care. A total of 270 patients were included between March 2020 and December 2021. The eligible criteria were individuals between 0-18 with a confirmed SARS-CoV-2 infection at the Infectious Disease Hospital “Prof. Ivan Kirov” in Sofia, Bulgaria. Nearly 76% of the patients were ≤ 12 years old. In our study, at least one comorbidity was reported in 28.1% of the cases, with obesity being the most common one (8.9%). Less than 5% of children were transferred to an intensive care unit. We observed a statistically significant difference in the age groups, with children between 5 and 12 years old having a higher likelihood of requiring intensive care compared to other age groups. The median values of PaO2 and SatO2 were higher among patients admitted to the standard ward, while the values of granulocytes and C-reactive protein were higher among those transferred to the intensive care unit. Additionally, we identified 26 children who met the WHO case definition for MIS-C. Our study data supports the evidence of milder COVID-19 in children and young individuals as compared to adults. Older age groups were associated with higher incidence of both MIS-C and ICU admissions.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"10 - 19"},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42965976","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 There is conflicting literature evidence regarding the independent effects of insulin resistance and concomitant hyperinsulinemia on bone mineral density. In addition, it is still under debate whether the net effect is favorable or unfavorable for the fracture risk. Therefore, we conducted a cross-sectional study. Aim To assess the correlation between bone mineral density and fracture risk with insulin resistance and circulating insulin levels in non-diabetic postmenopausal women. Materials and methods The study analyzed 84 women. The mean age of the participants was 60.54 ± 7.07 years, and the mean postmenopausal period was 11.45 ± 6.62 years. A standard oral glucose tolerance test was performed with measurement of blood glucose and insulin levels at 0 and 120 min. Dual-energy X-ray absorptiometry was used to determine bone mineral density at lumbar spine and proximal femur. Fracture risk was calculated using the Fracture Risk Assessment Tool. Results We found that in non-diabetic postmenopausal women lower basal insulin levels (fasting insulin) were associated with a higher 10-year risk of major osteoporotic fracture when insulin sensitivity was preserved (HOMA-IR index < 2). Fasting insulin levels under 6.15 μIU/ml were considered high-risk regarding the fracture risk. On the other hand, higher stimulated insulin levels at 120 min (post-load insulin) were associated with a higher 10-year risk of major osteoporotic fracture at HOMA-IR index greater than 2. Stimulated insulin levels above 39.7 μIU/ml were considered high-risk regarding the fracture risk. Conclusion Our results revealed a negative relationship between stimulated insulin levels at HOMA-IR index above 2 and bone integrity in postmenopausal age. On the other hand, higher basal insulin levels at HOMA-IR index lower than 2 were associated with better parameters of postmenopausal bone health.
{"title":"Association of Insulin Resistance with Bone Mineral Density and Fracture Risk in Non-Diabetic Postmenopausal Women","authors":"R. Dimitrova, K. Hristozov","doi":"10.2478/amb-2023-0016","DOIUrl":"https://doi.org/10.2478/amb-2023-0016","url":null,"abstract":"Abstract There is conflicting literature evidence regarding the independent effects of insulin resistance and concomitant hyperinsulinemia on bone mineral density. In addition, it is still under debate whether the net effect is favorable or unfavorable for the fracture risk. Therefore, we conducted a cross-sectional study. Aim To assess the correlation between bone mineral density and fracture risk with insulin resistance and circulating insulin levels in non-diabetic postmenopausal women. Materials and methods The study analyzed 84 women. The mean age of the participants was 60.54 ± 7.07 years, and the mean postmenopausal period was 11.45 ± 6.62 years. A standard oral glucose tolerance test was performed with measurement of blood glucose and insulin levels at 0 and 120 min. Dual-energy X-ray absorptiometry was used to determine bone mineral density at lumbar spine and proximal femur. Fracture risk was calculated using the Fracture Risk Assessment Tool. Results We found that in non-diabetic postmenopausal women lower basal insulin levels (fasting insulin) were associated with a higher 10-year risk of major osteoporotic fracture when insulin sensitivity was preserved (HOMA-IR index < 2). Fasting insulin levels under 6.15 μIU/ml were considered high-risk regarding the fracture risk. On the other hand, higher stimulated insulin levels at 120 min (post-load insulin) were associated with a higher 10-year risk of major osteoporotic fracture at HOMA-IR index greater than 2. Stimulated insulin levels above 39.7 μIU/ml were considered high-risk regarding the fracture risk. Conclusion Our results revealed a negative relationship between stimulated insulin levels at HOMA-IR index above 2 and bone integrity in postmenopausal age. On the other hand, higher basal insulin levels at HOMA-IR index lower than 2 were associated with better parameters of postmenopausal bone health.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"26 - 32"},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42563003","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 Background Symptoms of depressive disorder have been found to be particularly common among employees in the private administration, public, and industrial sectors. Aims This study aimed to assess the prevalence of depression among the specified groups of workers and to identify the main stressors that lead to symptoms of this condition. Materials and methods A self-administrated questionnaire was completed by respondents comprised of three groups of workers in the Republic of North Macedonia – Skopje. The survey assessed the sociodemographic characteristics and mental health (Patient Health Questonnaire-9). Logistic regression models were used to estimate associations between depressive symptoms and demographics, working environment and lifestyle parameters. Results The analysis of the total PHQ-9 score divided into two groups (≤ 10 and ≥ 10) indicated that 89% of the respondents had minimal/mild depression and 11% had moderate/severe depression. We have found a significant association between the group to which the respondent belongs and the degree of depression. Severe depression was significantly associated with work in public institutions. Conclusion Screening for depression among workers is necessary because of its high prevalence and high rates of underdiagnosis in the workplace. Early diagnosis and appropriate interventions are recommended, including actions focused on the risk factors for depression at the workplace.
{"title":"Prevalence of Depression Among Employees in the Public Administration, Private and Industrial Sectors","authors":"N. Stancheva-Pargov, V. Stoyanova","doi":"10.2478/amb-2023-0018","DOIUrl":"https://doi.org/10.2478/amb-2023-0018","url":null,"abstract":"Abstract Background Symptoms of depressive disorder have been found to be particularly common among employees in the private administration, public, and industrial sectors. Aims This study aimed to assess the prevalence of depression among the specified groups of workers and to identify the main stressors that lead to symptoms of this condition. Materials and methods A self-administrated questionnaire was completed by respondents comprised of three groups of workers in the Republic of North Macedonia – Skopje. The survey assessed the sociodemographic characteristics and mental health (Patient Health Questonnaire-9). Logistic regression models were used to estimate associations between depressive symptoms and demographics, working environment and lifestyle parameters. Results The analysis of the total PHQ-9 score divided into two groups (≤ 10 and ≥ 10) indicated that 89% of the respondents had minimal/mild depression and 11% had moderate/severe depression. We have found a significant association between the group to which the respondent belongs and the degree of depression. Severe depression was significantly associated with work in public institutions. Conclusion Screening for depression among workers is necessary because of its high prevalence and high rates of underdiagnosis in the workplace. Early diagnosis and appropriate interventions are recommended, including actions focused on the risk factors for depression at the workplace.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"42 - 48"},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42233817","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}
Z. Gospodinova, G. Antov, M. Novaković, V. Tešević, N. Krasteva, D. Pavlov, S. Valcheva-Kuzmanova
Abstract Background and objective Cotinus coggygria Scop. is a valuable medicinal plant species with pronounced pharmacological potential due to its numerous biological activities. The herb is characterized by a high content of polyphenols among which is fustin. The anticancer activities of fustin, however, are extremely weakly studied. The aim of the present study was to investigate the in vitro antiproliferative potential of fustin isolated from the heartwood of C. coggygria against cell lines originating from two of the most common cancer types – breast (MDA-MB-231 and MCF7), and colon cancer (Colon 26). Materials and methods Cell growth inhibitory properties of fustin were examined by MTT assay. Subsequently, phase-contrast and fluorescence microscopy analysis as well as colonyforming assay were carried out on the most sensitive to the cytostatic action of the fustin cell line. Results The obtained results showed that fustin reduced the proliferation of all studied cell lines. The highest cytostatic effect was registered towards breast cancer MDA-MB-231 cells with a half maximal inhibitory concentration (IC50) value of 56.02 μg/ml followed by colon cancer cells with an IC50 of 78.07 μg/ml. MCF7 cell proliferation was least affected with a calculated IC50 of 187.8 μg/ml. Further investigations on breast cancer MDA-MB-231 cells indicated decreased density of cell monolayer and some morphological alterations, significant attenuation in the number of viable cells, and diminished clonogenic ability of cells after fustin exposure. Conclusion It could be concluded that fustin isolated from the heartwood of medicinal plant C. coggygria possesses marked antiproliferative properties against breast cancer cell line MDA-MB-231 which will be a subject of our more detailed future investigations.
{"title":"Antiproliferative Activity of Natural Flavonoid Fustin Isolated from the Heartwood of Cotinus Coggygria Scop. Against Breast and Colon Cancer Cell Lines","authors":"Z. Gospodinova, G. Antov, M. Novaković, V. Tešević, N. Krasteva, D. Pavlov, S. Valcheva-Kuzmanova","doi":"10.2478/amb-2023-0004","DOIUrl":"https://doi.org/10.2478/amb-2023-0004","url":null,"abstract":"Abstract Background and objective Cotinus coggygria Scop. is a valuable medicinal plant species with pronounced pharmacological potential due to its numerous biological activities. The herb is characterized by a high content of polyphenols among which is fustin. The anticancer activities of fustin, however, are extremely weakly studied. The aim of the present study was to investigate the in vitro antiproliferative potential of fustin isolated from the heartwood of C. coggygria against cell lines originating from two of the most common cancer types – breast (MDA-MB-231 and MCF7), and colon cancer (Colon 26). Materials and methods Cell growth inhibitory properties of fustin were examined by MTT assay. Subsequently, phase-contrast and fluorescence microscopy analysis as well as colonyforming assay were carried out on the most sensitive to the cytostatic action of the fustin cell line. Results The obtained results showed that fustin reduced the proliferation of all studied cell lines. The highest cytostatic effect was registered towards breast cancer MDA-MB-231 cells with a half maximal inhibitory concentration (IC50) value of 56.02 μg/ml followed by colon cancer cells with an IC50 of 78.07 μg/ml. MCF7 cell proliferation was least affected with a calculated IC50 of 187.8 μg/ml. Further investigations on breast cancer MDA-MB-231 cells indicated decreased density of cell monolayer and some morphological alterations, significant attenuation in the number of viable cells, and diminished clonogenic ability of cells after fustin exposure. Conclusion It could be concluded that fustin isolated from the heartwood of medicinal plant C. coggygria possesses marked antiproliferative properties against breast cancer cell line MDA-MB-231 which will be a subject of our more detailed future investigations.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"27 - 33"},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48841090","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. Boyanov, D. Zamfirova, D. Bakalov, V. Karamfilova, A. Gateva, Y. Assyov, E. Zaharieva, K. Atanassova, G. Sheinkova, A. Tsakova, Z. Kamenov
Abstract Hypoparathyroidism (hypoPT) is a relatively rare endocrine disease, mainly due to thyroid surgery. The classical supplementation with calcium and active vitamin D may represent a challenge to the clinician. Objective To describe the level of biochemical control in patients with chronic hypoPT and to look for differences between postsurgical and non-surgical cases referred between 2006 and 2020. Materials and Methods This was a retrospective cross-sectional study with data review from the database of a tertiary endocrine clinic from the last 15 years. Cases with hypocalcemia not related to PTH were excluded. The patients’ medical history was reviewed as well as concomitant diseases and medications. Serum calcium (total, albumin-corrected and ionized; sCa, corrCa, iCa+) and phosphates (P), magnesium, creatinine, alkaline phosphatase together with 24hr urinary calcium and phosphate were measured. The intact parathyroid hormone (iPTH) was determined by electro-hemi-luminescence (Elecsys, Roche Diagnostics). Thyroid and abdominal ultrasound (US) were both performed. Results Seventy-eight patients met the study criteria – 69 were females. Most of them were between 30 and 60 years (mean age 50.6 ± 14.5 years). Albumin-corrected calcium was in target in 20.5% of the patients, ionized calcium – in 36.5%, serum phosphate – in 46.3%, serum magnesium – in 87.9%. When all four parameters were taken together, less than 20% were in target. Hypercalciuria was registered in 11.8%, while 57.1% of the patients had nephrolithiasis and 27.3% had CKD grade 3-4. Thus, a high proportion of patients with kidney involvement was identified. Calcium carbonate and calcitriol were the preferred replacement choices. Comparing patients with post-surgical and non-surgical hypoPT significant differences were found only for age, total serum calcium, serum magnesium and TSH. Conclusion Our study is the first of its kind in our country during the last two decades describing the contemporary clinical and biochemical picture of chronic hypoPT in patients referred for specialized care. Low supplementation doses leading to hypocalcemia and hyperphosphatemia were a common finding. Low patient’s adherence may be just one possible explanation. Non-surgical cases tend to have even lower calcium and magnesium levels. The patients, their families and treating physicians should be better informed about up-to-date management of chronic hypoPT and the possible impact of suboptimal treatment on morbidity and mortality of the affected subjects.
{"title":"Biochemical Control of 78 Patients with Chronic Hypoparathyroidism Referred between 2006 and 2020 – Where do We Actually Stand?","authors":"M. Boyanov, D. Zamfirova, D. Bakalov, V. Karamfilova, A. Gateva, Y. Assyov, E. Zaharieva, K. Atanassova, G. Sheinkova, A. Tsakova, Z. Kamenov","doi":"10.2478/amb-2023-0001","DOIUrl":"https://doi.org/10.2478/amb-2023-0001","url":null,"abstract":"Abstract Hypoparathyroidism (hypoPT) is a relatively rare endocrine disease, mainly due to thyroid surgery. The classical supplementation with calcium and active vitamin D may represent a challenge to the clinician. Objective To describe the level of biochemical control in patients with chronic hypoPT and to look for differences between postsurgical and non-surgical cases referred between 2006 and 2020. Materials and Methods This was a retrospective cross-sectional study with data review from the database of a tertiary endocrine clinic from the last 15 years. Cases with hypocalcemia not related to PTH were excluded. The patients’ medical history was reviewed as well as concomitant diseases and medications. Serum calcium (total, albumin-corrected and ionized; sCa, corrCa, iCa+) and phosphates (P), magnesium, creatinine, alkaline phosphatase together with 24hr urinary calcium and phosphate were measured. The intact parathyroid hormone (iPTH) was determined by electro-hemi-luminescence (Elecsys, Roche Diagnostics). Thyroid and abdominal ultrasound (US) were both performed. Results Seventy-eight patients met the study criteria – 69 were females. Most of them were between 30 and 60 years (mean age 50.6 ± 14.5 years). Albumin-corrected calcium was in target in 20.5% of the patients, ionized calcium – in 36.5%, serum phosphate – in 46.3%, serum magnesium – in 87.9%. When all four parameters were taken together, less than 20% were in target. Hypercalciuria was registered in 11.8%, while 57.1% of the patients had nephrolithiasis and 27.3% had CKD grade 3-4. Thus, a high proportion of patients with kidney involvement was identified. Calcium carbonate and calcitriol were the preferred replacement choices. Comparing patients with post-surgical and non-surgical hypoPT significant differences were found only for age, total serum calcium, serum magnesium and TSH. Conclusion Our study is the first of its kind in our country during the last two decades describing the contemporary clinical and biochemical picture of chronic hypoPT in patients referred for specialized care. Low supplementation doses leading to hypocalcemia and hyperphosphatemia were a common finding. Low patient’s adherence may be just one possible explanation. Non-surgical cases tend to have even lower calcium and magnesium levels. The patients, their families and treating physicians should be better informed about up-to-date management of chronic hypoPT and the possible impact of suboptimal treatment on morbidity and mortality of the affected subjects.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"5 - 12"},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43357399","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 Aortic dissections occur as a result of a tear in the intimal layer, continued longitudinal splitting within the intima and media, and formation of false lumen. This could lead to sudden death or severe aortic regurgitation and cardiogenic shock. The presented case here describes a patient with acute anterior ST-elevation myocardial infarction due to acute Stanford type A ascending aortic dissection. Case presentation A 55-year-old male presented with severe chest pain, radiating into the back, jaw, and left arm, and signs of cardiogenic shock. Electrocardiography showed acute anterior ST-elevation myocardial infarction and echocardiography confirmed that there was a reduced left ventricle ejection fraction (38% calculated using the Simpson method), severe aortic regurgitation, and wall motion abnormalities. Based on these findings, we made a diagnosis of acute myocardial infarction. In accordance with the current guidelines, we opted for an interventional therapeutic approach. Angiography showed left main trunk dissection extending to the left anterior descending coronary artery caused by ascending aorta dissection. This finding altered the diagnosis and treatment plan and the patient was immediately sent to the operating room for emergency surgery. Conclusions Aortic dissection should be suspected in patients presenting with acute anterior ST-elevation myocardial infarction, severe aortic regurgitation, and cardiogenic shock. Involvement of the left main trunk and left anterior descending artery occurs much more rarely than that of the right coronary artery, which causes inferior myocardial infarction.
{"title":"A Rare Case of Acute Stanford Type a Aortic Dissection Presenting with Anterior St-Elevation Myocardial Infarction","authors":"N. Ivanova","doi":"10.2478/amb-2023-0011","DOIUrl":"https://doi.org/10.2478/amb-2023-0011","url":null,"abstract":"Abstract Introduction Aortic dissections occur as a result of a tear in the intimal layer, continued longitudinal splitting within the intima and media, and formation of false lumen. This could lead to sudden death or severe aortic regurgitation and cardiogenic shock. The presented case here describes a patient with acute anterior ST-elevation myocardial infarction due to acute Stanford type A ascending aortic dissection. Case presentation A 55-year-old male presented with severe chest pain, radiating into the back, jaw, and left arm, and signs of cardiogenic shock. Electrocardiography showed acute anterior ST-elevation myocardial infarction and echocardiography confirmed that there was a reduced left ventricle ejection fraction (38% calculated using the Simpson method), severe aortic regurgitation, and wall motion abnormalities. Based on these findings, we made a diagnosis of acute myocardial infarction. In accordance with the current guidelines, we opted for an interventional therapeutic approach. Angiography showed left main trunk dissection extending to the left anterior descending coronary artery caused by ascending aorta dissection. This finding altered the diagnosis and treatment plan and the patient was immediately sent to the operating room for emergency surgery. Conclusions Aortic dissection should be suspected in patients presenting with acute anterior ST-elevation myocardial infarction, severe aortic regurgitation, and cardiogenic shock. Involvement of the left main trunk and left anterior descending artery occurs much more rarely than that of the right coronary artery, which causes inferior myocardial infarction.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"67 - 71"},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45312174","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}
H. S. Fayazi, A. Naeimi, M. Yaseri, S. S. M. Khatibani
Abstract Objective In the Coronavirus 2019 (COVID-19) global pandemic, various studies on the target communities of this virus were widely started and rapidly progressed. Smokers and opioid consumers are one of the virus targets since they have a vulnerable respiratory system. Due to the contradictory results in previous studies and the lack of similar investigations in this area, we aimed to perform this study to investigate the effect of smoking and opioid consumption on the consequences of the COVID-19 disease. Materials and Methods In this retrospective study, the required information was collected and analyzed from the archives of Razi Hospital, Rasht, Iran. Study variables included age, sex, the need for intubation, hospital length of stay, history of current smoking or opioid consumption, and intensive care unit (ICU) admission, ICU length of stay, admission oxygen saturation, disease severity, and the outcome of death or recovery. Data were collected and divided into the case (including current cigarette smokers, opioid consumers, and cigarette-opioid consumers) and control (non-smokers and non-opioid-consumers) groups. Out of 986 patients, 489 patients met the criteria for inclusion and subsequent analysis. The average age was 69.79 ± 16.06, and 294 (60.1%) patients were male. The median age of the case group (65.15 ± 42.41) was older than the control group (57.45 ± 15.71, P = 0.001). The case group consisted of more male patients than the control group (P = 0.001). Results The adjusted regression models demonstrated that current cigarette smoking, opioid, and cigarette-opioid consumption did not significantly predict hospital and ICU length of stay, ICU admission, disease severity, and mortality outcomes (P > 0.05). Current cigarette smoking and opioid consumption could not be an independent predictor for the consequences of ICU admission, hospital and ICU length of stay, the need for intubation, disease severity, and mortality in COVID-19 patients.
{"title":"The Effect of Smoking and Opioid Consumption on the Severity of the Disease and Duration of Hospitalization in COVID-19 Patients","authors":"H. S. Fayazi, A. Naeimi, M. Yaseri, S. S. M. Khatibani","doi":"10.2478/amb-2023-0005","DOIUrl":"https://doi.org/10.2478/amb-2023-0005","url":null,"abstract":"Abstract Objective In the Coronavirus 2019 (COVID-19) global pandemic, various studies on the target communities of this virus were widely started and rapidly progressed. Smokers and opioid consumers are one of the virus targets since they have a vulnerable respiratory system. Due to the contradictory results in previous studies and the lack of similar investigations in this area, we aimed to perform this study to investigate the effect of smoking and opioid consumption on the consequences of the COVID-19 disease. Materials and Methods In this retrospective study, the required information was collected and analyzed from the archives of Razi Hospital, Rasht, Iran. Study variables included age, sex, the need for intubation, hospital length of stay, history of current smoking or opioid consumption, and intensive care unit (ICU) admission, ICU length of stay, admission oxygen saturation, disease severity, and the outcome of death or recovery. Data were collected and divided into the case (including current cigarette smokers, opioid consumers, and cigarette-opioid consumers) and control (non-smokers and non-opioid-consumers) groups. Out of 986 patients, 489 patients met the criteria for inclusion and subsequent analysis. The average age was 69.79 ± 16.06, and 294 (60.1%) patients were male. The median age of the case group (65.15 ± 42.41) was older than the control group (57.45 ± 15.71, P = 0.001). The case group consisted of more male patients than the control group (P = 0.001). Results The adjusted regression models demonstrated that current cigarette smoking, opioid, and cigarette-opioid consumption did not significantly predict hospital and ICU length of stay, ICU admission, disease severity, and mortality outcomes (P > 0.05). Current cigarette smoking and opioid consumption could not be an independent predictor for the consequences of ICU admission, hospital and ICU length of stay, the need for intubation, disease severity, and mortality in COVID-19 patients.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"34 - 40"},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44548849","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}
E. Arabadzhieva, S. Bonev, D. Bulanov, L. Simonova, E. Zhivkov, G. Korukov, Z. Shavalov, M. Velizarova, D. Svinarov, A. Yonkov
Abstract Introduction Liver resection is widely accepted as a treatment option for primary liver cancer and metastases. The goal of surgery is to resect all tumours with negative histological margins while preserving sufficient functional hepatic parenchyma and reducing postoperative complications. The use of Indocyanine green (ICG) for liver function assessment and fluorescence image-guided surgery could be used to achieve that goal. Clinical Case Description We present the case of a 62-year-old female patient with diagnosed sigmoid colon cancer with four bilobar liver metastases who underwent a simultaneous sigmoid resection and ICG fluorescence image-guided liver resection 3 days after preoperative ICG liver function assessment. We decided to perform liver-sparing resection having in mind the liver metastases’ number, size and location and the slightly impaired liver function (ICG retention rate 15 – ICGR15 was 14,02%). All liver tumours were removed without complications, and the resected margins were all microscopically free of tumour tissue (R0 resection). The postoperative period was uneventful, without any signs of postoperative liver failure. Conclusions ICGR15 can be considered a safe and informative marker for liver function and indirectly for the degree of portal hypertension. ICG fluorescence provides an additional method to assist intra-operative tumour identification. The best timing of injection requires further study.
{"title":"Indocyanine Green Fluorescence for Liver Assessment and Imaging-Guided Resection of Colorectal Metastases: A Case Report","authors":"E. Arabadzhieva, S. Bonev, D. Bulanov, L. Simonova, E. Zhivkov, G. Korukov, Z. Shavalov, M. Velizarova, D. Svinarov, A. Yonkov","doi":"10.2478/amb-2023-0008","DOIUrl":"https://doi.org/10.2478/amb-2023-0008","url":null,"abstract":"Abstract Introduction Liver resection is widely accepted as a treatment option for primary liver cancer and metastases. The goal of surgery is to resect all tumours with negative histological margins while preserving sufficient functional hepatic parenchyma and reducing postoperative complications. The use of Indocyanine green (ICG) for liver function assessment and fluorescence image-guided surgery could be used to achieve that goal. Clinical Case Description We present the case of a 62-year-old female patient with diagnosed sigmoid colon cancer with four bilobar liver metastases who underwent a simultaneous sigmoid resection and ICG fluorescence image-guided liver resection 3 days after preoperative ICG liver function assessment. We decided to perform liver-sparing resection having in mind the liver metastases’ number, size and location and the slightly impaired liver function (ICG retention rate 15 – ICGR15 was 14,02%). All liver tumours were removed without complications, and the resected margins were all microscopically free of tumour tissue (R0 resection). The postoperative period was uneventful, without any signs of postoperative liver failure. Conclusions ICGR15 can be considered a safe and informative marker for liver function and indirectly for the degree of portal hypertension. ICG fluorescence provides an additional method to assist intra-operative tumour identification. The best timing of injection requires further study.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"50 1","pages":"54 - 58"},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44579333","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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