Abstract We present a case of a male patient who underwent right-sided pneumonectomy due to central low-grade squamous cell carcinoma of the right lung, chemo-, radio-, and immunotherapy. However, the disease progressed. In addition the patient got SARSCoV-2 pneumonia in the left lung, followed by postpneumonectomy empyema. Right-sided uniportal video-assisted thoracoscopy, debridement, and definitive drainage of the pleural cavity were performed.
{"title":"Postpneumonectomy Empyema Following SARS-CoV-2 Infection in a Patient with Metastatic Lung Cancer","authors":"G. Yankov, M. Alexieva, S. Yankova, E. Mekov","doi":"10.2478/amb-2022-0018","DOIUrl":"https://doi.org/10.2478/amb-2022-0018","url":null,"abstract":"Abstract We present a case of a male patient who underwent right-sided pneumonectomy due to central low-grade squamous cell carcinoma of the right lung, chemo-, radio-, and immunotherapy. However, the disease progressed. In addition the patient got SARSCoV-2 pneumonia in the left lung, followed by postpneumonectomy empyema. Right-sided uniportal video-assisted thoracoscopy, debridement, and definitive drainage of the pleural cavity were performed.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"39 - 42"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43312102","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 Radical surgery for gastric cancer remains the only reliable therapeutic tool and cornerstone for definitive treatment. With improving resectability, patients are given a better opportunity for long-term survival. Indocyanine green (ICG) is able to define more precisely the boundaries of the tumor in early and advanced gastric cancer. In addition, it can noticeably improve lymph node dissection and reduce the risk of subsequent complications. In this paper we present our experience with laparoscopic gastrectomy together with a review of the available literature.
{"title":"Laparoscopic Gastrectomy with ICG Guided D2 Lymph Node Dissection – A Case Report and Review of the Literature","authors":"A. Arabadzhiev, Ts. Popov, M. Sokolov","doi":"10.2478/amb-2022-0019","DOIUrl":"https://doi.org/10.2478/amb-2022-0019","url":null,"abstract":"Abstract Radical surgery for gastric cancer remains the only reliable therapeutic tool and cornerstone for definitive treatment. With improving resectability, patients are given a better opportunity for long-term survival. Indocyanine green (ICG) is able to define more precisely the boundaries of the tumor in early and advanced gastric cancer. In addition, it can noticeably improve lymph node dissection and reduce the risk of subsequent complications. In this paper we present our experience with laparoscopic gastrectomy together with a review of the available literature.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"43 - 47"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42535102","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}
R. Robeva, N. Arnaudova, G. Kirilov, A. Elenkova, S. Zacharieva
Abstract Aims: The present study aims to investigate the association between catecholamine metabolites (normetanephrine [NMN] and metanephrine [MN]) and polycystic ovarian syndrome (PCOS) and its clinical manifestations. Materials and methods: A total of 60 female patients (18-37 years) were included in the study. Twenty-five healthy women and 35 patients with PCOS provided blood and urine samples. Anthropometric, biochemical, and hormonal parameters, e.g. immunoreactive insulin, total testosterone, gonadotropins, and dehydroepiandrosterone-sulfate (DHEAS) have been investigated. Twenty-four-hour urinary metanephrines (MN and NMN) were measured by radioimmunoassay technique. Results: MN and NMN showed a strong positive correlation (r = +0.645, p < 0.001) in women with PCOS, but nephrines were not significantly associated with the hormonal, anthropometric, and metabolic parameters of the patients (p > 0.05 for all). No differences in urinary nephrines concentrations between women with PCOS and healthy individuals after adjustment for age and BMI were established. However, lower 24-hour urinary MN levels predicted the development of menstrual irregularity after adjustment for age and BMI (OR = 1,015 [95% CI 1,001-1,029], p = 0,036). Conclusions: Adrenomedullary dysfunction might influence the development of chronic anovulation in young women.
摘要目的:本研究旨在探讨儿茶酚胺代谢物(去甲肾上腺素[NMN]和去甲肾上腺素[MN])与多囊卵巢综合征(PCOS)及其临床表现的关系。材料与方法:共纳入60例女性患者，年龄18-37岁。25名健康女性和35名多囊卵巢综合征患者提供了血液和尿液样本。人体测量、生化和激素参数，如免疫反应性胰岛素、总睾酮、促性腺激素和硫酸脱氢表雄酮(DHEAS)已被调查。用放射免疫法测定24小时尿中肾上腺素(MN、NMN)。结果:MN和NMN在PCOS患者中呈强正相关(r = +0.645, p < 0.001)，而肾素与患者的激素、人体测量和代谢参数无显著相关性(p < 0.05)。经年龄和BMI调整后，PCOS女性与健康个体尿肾素浓度无差异。然而，在调整年龄和BMI后，较低的24小时尿MN水平预示着月经不规律的发生(OR = 1,015 [95% CI 1,001-1,029]， p = 0,036)。结论:肾上腺髓质功能障碍可能影响年轻女性慢性无排卵的发展。
{"title":"Metanephrine and Normetanephrine Urine Excretion in Patients with PCOS","authors":"R. Robeva, N. Arnaudova, G. Kirilov, A. Elenkova, S. Zacharieva","doi":"10.2478/amb-2022-0012","DOIUrl":"https://doi.org/10.2478/amb-2022-0012","url":null,"abstract":"Abstract Aims: The present study aims to investigate the association between catecholamine metabolites (normetanephrine [NMN] and metanephrine [MN]) and polycystic ovarian syndrome (PCOS) and its clinical manifestations. Materials and methods: A total of 60 female patients (18-37 years) were included in the study. Twenty-five healthy women and 35 patients with PCOS provided blood and urine samples. Anthropometric, biochemical, and hormonal parameters, e.g. immunoreactive insulin, total testosterone, gonadotropins, and dehydroepiandrosterone-sulfate (DHEAS) have been investigated. Twenty-four-hour urinary metanephrines (MN and NMN) were measured by radioimmunoassay technique. Results: MN and NMN showed a strong positive correlation (r = +0.645, p < 0.001) in women with PCOS, but nephrines were not significantly associated with the hormonal, anthropometric, and metabolic parameters of the patients (p > 0.05 for all). No differences in urinary nephrines concentrations between women with PCOS and healthy individuals after adjustment for age and BMI were established. However, lower 24-hour urinary MN levels predicted the development of menstrual irregularity after adjustment for age and BMI (OR = 1,015 [95% CI 1,001-1,029], p = 0,036). Conclusions: Adrenomedullary dysfunction might influence the development of chronic anovulation in young women.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"5 - 10"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46081969","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}
T. Taseva, Y. Koycheva, S. Simeonova, E. Nikolova, M. Krasteva
Abstract Background and objectives. Though glyceraldehyde-3-phosphate dehydrogenase (Gapdh) is one of the most commonly used housekeeping genes for comparison of gene expression data, studies have revealed that Gapdh expression is not constant at different developmental stages, and is modulated by many factors including ethanol. In view of this, in the present study, we investigated the effect of ethanol on Gapdh stability and expression levels in different model systems. Methods. Evaluation of Gapdh stability was determined by comparison with three commonly used housekeeping genes in alcohol-exposed and control mouse blastocysts, embryos, and placentas (ActB, Hsp90ab1, and Atp5b), and in alcohol-dependent and healthy humans (ACTB, ATP5B, and HSPCB), and was ranked by the software program RefFinder. To detect the Gapdh expression patterns as a target gene, qRT-PCR analysis was applied. Results. The order of expression stabilities obtained by the RefFinder ranked Gapdh as the most unstable reference gene in studied groups. The study of the expression dynamics of Gapdh showed significant upregulation in ethanol-exposed mouse blastocysts and embryos (FC = 1.56, p = 0.05 and FC = 6.0, p = 0.01) and downregulation in placentas (FC = 0.60, p = 0.01). Conclusions. Our results revealed that the expression of Gapdh can vary in different model systems under ethanol exposure and imply the need for caution when using it as an internal control. This is the first report for statistically significant change in Gapdh expression after ethanol exposure during preimplantation mouse development.
{"title":"Gapdh Shows Altered Gene Expression in Alcohol Models","authors":"T. Taseva, Y. Koycheva, S. Simeonova, E. Nikolova, M. Krasteva","doi":"10.2478/amb-2022-0014","DOIUrl":"https://doi.org/10.2478/amb-2022-0014","url":null,"abstract":"Abstract Background and objectives. Though glyceraldehyde-3-phosphate dehydrogenase (Gapdh) is one of the most commonly used housekeeping genes for comparison of gene expression data, studies have revealed that Gapdh expression is not constant at different developmental stages, and is modulated by many factors including ethanol. In view of this, in the present study, we investigated the effect of ethanol on Gapdh stability and expression levels in different model systems. Methods. Evaluation of Gapdh stability was determined by comparison with three commonly used housekeeping genes in alcohol-exposed and control mouse blastocysts, embryos, and placentas (ActB, Hsp90ab1, and Atp5b), and in alcohol-dependent and healthy humans (ACTB, ATP5B, and HSPCB), and was ranked by the software program RefFinder. To detect the Gapdh expression patterns as a target gene, qRT-PCR analysis was applied. Results. The order of expression stabilities obtained by the RefFinder ranked Gapdh as the most unstable reference gene in studied groups. The study of the expression dynamics of Gapdh showed significant upregulation in ethanol-exposed mouse blastocysts and embryos (FC = 1.56, p = 0.05 and FC = 6.0, p = 0.01) and downregulation in placentas (FC = 0.60, p = 0.01). Conclusions. Our results revealed that the expression of Gapdh can vary in different model systems under ethanol exposure and imply the need for caution when using it as an internal control. This is the first report for statistically significant change in Gapdh expression after ethanol exposure during preimplantation mouse development.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"16 - 21"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43640462","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. Kirilova-Doneva, M. Kamusheva, N. Gerasimov, G. Petrova
Abstract Background: Hernia surgery procedures are among the most frequently performed in Bulgaria. An open, mesh-based repair is a standard method for hernia repair. From a societal perspective, a cost-utility analysis of open hernia surgical procedures performed in Bulgaria is necessary in light of the economic and social burden that poses this health issue. The aim of the study was to perform an economic evaluation of the quality of health results after a conventional elective hernia operation with implanted light and standard meshes. Methods: The cost of elective hernia operation with standard and light meshes was calculated as a sum of direct and indirect costs. Incremental cost-effectiveness ratio (ICER) for conventional hernia operation was calculated as health improvement was measured in quality-adjusted life years (QALY) reported in a previous study. Deterministic sensitivity analysis was applied to evaluate the changes in the ICER values in case of planned inguinal hernia operation. Results: The cost of operation with standard meshes is less than operation with light meshes. The difference is in the range 55-200 EUR. The additional costs per one QALY gained for light meshes are far below the recommended threshold values which identified these meshes as cost-effective. Conclusions: The study presents evidence for cost-effectiveness of light meshes.
{"title":"Cost-Utility Analysis of Open Hernia Operations in Bulgaria","authors":"M. Kirilova-Doneva, M. Kamusheva, N. Gerasimov, G. Petrova","doi":"10.2478/amb-2022-0015","DOIUrl":"https://doi.org/10.2478/amb-2022-0015","url":null,"abstract":"Abstract Background: Hernia surgery procedures are among the most frequently performed in Bulgaria. An open, mesh-based repair is a standard method for hernia repair. From a societal perspective, a cost-utility analysis of open hernia surgical procedures performed in Bulgaria is necessary in light of the economic and social burden that poses this health issue. The aim of the study was to perform an economic evaluation of the quality of health results after a conventional elective hernia operation with implanted light and standard meshes. Methods: The cost of elective hernia operation with standard and light meshes was calculated as a sum of direct and indirect costs. Incremental cost-effectiveness ratio (ICER) for conventional hernia operation was calculated as health improvement was measured in quality-adjusted life years (QALY) reported in a previous study. Deterministic sensitivity analysis was applied to evaluate the changes in the ICER values in case of planned inguinal hernia operation. Results: The cost of operation with standard meshes is less than operation with light meshes. The difference is in the range 55-200 EUR. The additional costs per one QALY gained for light meshes are far below the recommended threshold values which identified these meshes as cost-effective. Conclusions: The study presents evidence for cost-effectiveness of light meshes.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"22 - 27"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45733114","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}
G. Tchernev, N. Oliveira, L. Kandathil, I. Terziev, I. Lozev, S. Chernin, I. Pidakev, J. Patterson
Abstract One step melanoma surgery (OSMS) is an innovative, personalized approach to the surgical treatment of cutaneous melanoma, which not only follows the total resection fields recommended by AJCC and EJC, but also has a significant advantage over these guidelines; namely, conduction of the procedure within a single surgical session. Guidelines for personalized surgical treatment of cutaneous melanoma can be used at any stage of the disease. The ideal purposes/goals of these newly introduced guidelines are to reduce the number of locoregional and distant recurrences and to stop the advancement of melanomas in a subsequent stage. In contrast to the histology, which under AJCC/EJC guidelines determines the extent of the subsequent or second surgical intervention, the leading starting points for personalized one step melanoma surgery are completely different and based on a complex final assessment, including: 1) clinical and dermatoscopic characteristics in favor of cutaneous melanoma, 2) preoperative ultrasound determination of tumor thickness, and, if possible, 3) the conduction of confocal microscopy. Another important and innovative proposal of the newly created OSMS guidelines is the requirement of absolute reciprocity between the preoperatively measured and subsequent histopathologically established surgical margins. The lack of such reciprocity under previously established guidelines (AJCC/EJC) till the present moment seriously calls into question the reliability of the data shared in the medical field concerning the size of resection fields. Three patients with suspected melanocytic lesions are presented and the applicability, advantages, and disadvantages of the personalized one step melanoma surgery versus two step melanoma surgery (AJCC/EJC) are discussed.
{"title":"Personalised Оne Step Melanoma Surgery and the Outdated/Current Guidelines for Surgical Treatment of Cutaneous Melanoma: Facts and Controversies","authors":"G. Tchernev, N. Oliveira, L. Kandathil, I. Terziev, I. Lozev, S. Chernin, I. Pidakev, J. Patterson","doi":"10.2478/amb-2022-0021","DOIUrl":"https://doi.org/10.2478/amb-2022-0021","url":null,"abstract":"Abstract One step melanoma surgery (OSMS) is an innovative, personalized approach to the surgical treatment of cutaneous melanoma, which not only follows the total resection fields recommended by AJCC and EJC, but also has a significant advantage over these guidelines; namely, conduction of the procedure within a single surgical session. Guidelines for personalized surgical treatment of cutaneous melanoma can be used at any stage of the disease. The ideal purposes/goals of these newly introduced guidelines are to reduce the number of locoregional and distant recurrences and to stop the advancement of melanomas in a subsequent stage. In contrast to the histology, which under AJCC/EJC guidelines determines the extent of the subsequent or second surgical intervention, the leading starting points for personalized one step melanoma surgery are completely different and based on a complex final assessment, including: 1) clinical and dermatoscopic characteristics in favor of cutaneous melanoma, 2) preoperative ultrasound determination of tumor thickness, and, if possible, 3) the conduction of confocal microscopy. Another important and innovative proposal of the newly created OSMS guidelines is the requirement of absolute reciprocity between the preoperatively measured and subsequent histopathologically established surgical margins. The lack of such reciprocity under previously established guidelines (AJCC/EJC) till the present moment seriously calls into question the reliability of the data shared in the medical field concerning the size of resection fields. Three patients with suspected melanocytic lesions are presented and the applicability, advantages, and disadvantages of the personalized one step melanoma surgery versus two step melanoma surgery (AJCC/EJC) are discussed.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"51 - 58"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45959988","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. Atemin, T. Todorov, I. Tourtourikov, V. Mitev, A. Todorova
Abstract NARS1-related neurodevelopmental disorder is caused by pathogenic variants in the NARS1 gene. The aim of the present study was to determine the genetic reason for the epilepsy and microcephaly, observed in the tested patient. Using whole exome sequencing two novel heterozygous variants c.676G>C, p.Val226Leu and c.986G>A, p.Arg329Gln in the NARS1 gene were detected. The obtained results from the molecular-genetic analysis can enrich the spectrum of epilepsy related variants and can explain the genetic etiology of a severe epileptic disease.
{"title":"Neurodevelopmental Disorder in a Bulgarian Patient Caused By Novel Mutations in the NARS1 Gene","authors":"S. Atemin, T. Todorov, I. Tourtourikov, V. Mitev, A. Todorova","doi":"10.2478/amb-2022-0020","DOIUrl":"https://doi.org/10.2478/amb-2022-0020","url":null,"abstract":"Abstract NARS1-related neurodevelopmental disorder is caused by pathogenic variants in the NARS1 gene. The aim of the present study was to determine the genetic reason for the epilepsy and microcephaly, observed in the tested patient. Using whole exome sequencing two novel heterozygous variants c.676G>C, p.Val226Leu and c.986G>A, p.Arg329Gln in the NARS1 gene were detected. The obtained results from the molecular-genetic analysis can enrich the spectrum of epilepsy related variants and can explain the genetic etiology of a severe epileptic disease.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"48 - 50"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45720324","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. Mekov, R. Petkov, A. Tsakova, M. Genova, D. Kostadinov
Abstract Two-year mortality in patients with COPD is expected to be between 10% and 49% depending on the investigated subgroup and specific patients’ characteristics. Aim: To assess the two-year mortality in COPD patients following hospitalization for severe exacerbation and to describe the prognostic value of comorbidities and specific patients’ characteristics. Materials and methods: We included 152 consecutive patients hospitalized for COPD exacerbation and signing informed consent. The Metabolic syndrome (MS), diabetes mellitus (DM), and hypovitaminosis D were diagnosed according to international guidelines. Demographic parameters (age, sex, smoking status, and the number of pack-years) were recorded. Quality of life was examined using CAT and mMRC questionnaires. The lung function was assessed by spirometry. Two-year mortality was determined according to data extracted from the national death register. Results: Two-year mortality rate was 11.8%. The investigated comorbidities – DM, MS, arterial hyper-tension (AH) and vitamin D status were no predictors of the two-year mortality. Mortality was increased in patients with mMRC ≥ 2 (17.2 vs. 1.9%, p = 0.005) and CAT score ≥ 10 (14.2 vs. 0%, p = 0.045). Severe exacerbation during the previous year was a risk factor for the registered two-year mortality (17.5% vs 5.6%, p = 0.021). The two-year mortality was increased in the group with FEV1 < 50%, compared to FEV1 > 50% (18.0 vs. 7.7%, p = 0.049). Cox regression analysis showed a 3.0% increase in the mortality rate for each 1% decrease in FEV1, 6.2% for each 1% decrease in PEF, 7.8% for one year of increasing age, 4% for 1% decrease in the FEV1/FVC ratio and 7.1% for each 1 point increase of CAT (all p-values < 0.05). Conclusions: The two-year mortality of COPD patients following a severe exacerbation was relatively low. Chronological age, FEV1, history for severe exacerbation during the previous year, reduced quality of life, and low BMI were all associated with increased mortality. Disease Grade C, mMRC < 2, and CAT score < 10 were associated with a favourable prognosis.
{"title":"Two-Year Mortality Following a Severe COPD Exacerbation in Bulgarian Patients","authors":"E. Mekov, R. Petkov, A. Tsakova, M. Genova, D. Kostadinov","doi":"10.2478/amb-2022-0017","DOIUrl":"https://doi.org/10.2478/amb-2022-0017","url":null,"abstract":"Abstract Two-year mortality in patients with COPD is expected to be between 10% and 49% depending on the investigated subgroup and specific patients’ characteristics. Aim: To assess the two-year mortality in COPD patients following hospitalization for severe exacerbation and to describe the prognostic value of comorbidities and specific patients’ characteristics. Materials and methods: We included 152 consecutive patients hospitalized for COPD exacerbation and signing informed consent. The Metabolic syndrome (MS), diabetes mellitus (DM), and hypovitaminosis D were diagnosed according to international guidelines. Demographic parameters (age, sex, smoking status, and the number of pack-years) were recorded. Quality of life was examined using CAT and mMRC questionnaires. The lung function was assessed by spirometry. Two-year mortality was determined according to data extracted from the national death register. Results: Two-year mortality rate was 11.8%. The investigated comorbidities – DM, MS, arterial hyper-tension (AH) and vitamin D status were no predictors of the two-year mortality. Mortality was increased in patients with mMRC ≥ 2 (17.2 vs. 1.9%, p = 0.005) and CAT score ≥ 10 (14.2 vs. 0%, p = 0.045). Severe exacerbation during the previous year was a risk factor for the registered two-year mortality (17.5% vs 5.6%, p = 0.021). The two-year mortality was increased in the group with FEV1 < 50%, compared to FEV1 > 50% (18.0 vs. 7.7%, p = 0.049). Cox regression analysis showed a 3.0% increase in the mortality rate for each 1% decrease in FEV1, 6.2% for each 1% decrease in PEF, 7.8% for one year of increasing age, 4% for 1% decrease in the FEV1/FVC ratio and 7.1% for each 1 point increase of CAT (all p-values < 0.05). Conclusions: The two-year mortality of COPD patients following a severe exacerbation was relatively low. Chronological age, FEV1, history for severe exacerbation during the previous year, reduced quality of life, and low BMI were all associated with increased mortality. Disease Grade C, mMRC < 2, and CAT score < 10 were associated with a favourable prognosis.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"33 - 38"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42979916","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}
D. Guleva, M. Balabanova, L. Miteva, L. Dourmishev
Abstract Lupus erythematosus is an autoimmune connective tissue disorder showing a broad spectrum of clinical manifestations. The aim of this study was to assess the correlation of skin histology and different types of lupus erythematosus. Materials and methods: Fifty-one skin specimens were assessed from 39 female and 12 male patients with acute, subcutaneous and chronic lupus erythematosus, diagnosed and treated in the Department of Dermatology and Venereology, Alexandrovska University Hospital for a 4-year period. Results: Follicular hyperkeratosis, epidermal atrophy, vacuolar degeneration and interface dermatitis were the most frequently observed lesions in chronic cutaneous lupus erythematosus while diffuse hyperkeratosis, epidermal atrophy and indistinct interface dermatitis in the dermis were predominant in subacute cutaneous lupus erythematosus. Lupus tumidus, a rare intermittent variant of cutaneous lupus erythematosus, showed almost no epidermal involvement and mucin deposition in the dermis. However, in one of our lupus tumidus patients the disease progressed to a systemic form with histological changes of acute cutaneous lupus erythematosus including atrophy, dermal-epidermal smoothing and lymphocytic infiltration in the dermis. Of note, a few patients showed histological changes of urticarial vasculitis-like and rheumatic-like patterns. Conclusion: The correlation of clinical course, histopathological findings and immunological tests are of vital importance for the correct diagnosis and follow up of patients with lupus erythematodes, thus preventing complications and improving their quality of life.
{"title":"Histology of Skin Alterations in Lupus Erythematosus","authors":"D. Guleva, M. Balabanova, L. Miteva, L. Dourmishev","doi":"10.2478/amb-2022-0016","DOIUrl":"https://doi.org/10.2478/amb-2022-0016","url":null,"abstract":"Abstract Lupus erythematosus is an autoimmune connective tissue disorder showing a broad spectrum of clinical manifestations. The aim of this study was to assess the correlation of skin histology and different types of lupus erythematosus. Materials and methods: Fifty-one skin specimens were assessed from 39 female and 12 male patients with acute, subcutaneous and chronic lupus erythematosus, diagnosed and treated in the Department of Dermatology and Venereology, Alexandrovska University Hospital for a 4-year period. Results: Follicular hyperkeratosis, epidermal atrophy, vacuolar degeneration and interface dermatitis were the most frequently observed lesions in chronic cutaneous lupus erythematosus while diffuse hyperkeratosis, epidermal atrophy and indistinct interface dermatitis in the dermis were predominant in subacute cutaneous lupus erythematosus. Lupus tumidus, a rare intermittent variant of cutaneous lupus erythematosus, showed almost no epidermal involvement and mucin deposition in the dermis. However, in one of our lupus tumidus patients the disease progressed to a systemic form with histological changes of acute cutaneous lupus erythematosus including atrophy, dermal-epidermal smoothing and lymphocytic infiltration in the dermis. Of note, a few patients showed histological changes of urticarial vasculitis-like and rheumatic-like patterns. Conclusion: The correlation of clinical course, histopathological findings and immunological tests are of vital importance for the correct diagnosis and follow up of patients with lupus erythematodes, thus preventing complications and improving their quality of life.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"28 - 32"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41588878","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 Ischemic heart disease (IHD) affects > 110 million individuals worldwide and represents an important contributor to the rise in the prevalence of heart failure and the associated mortality and morbidity. Despite modern therapies, up to one-third of patients with acute myocardial infarction would develop heart failure. IHD is a pathologic condition of the myocardium resulting from the imbalance in a given moment between its oxygen demands and the actual perfusion. Acute and chronic forms of the disease may potentially lead to extensive and permanent damage of the cardiac muscle. From a clinical point of view, determination of the still viable extent of myocardium is crucial for the therapeutic protocol – since ischemia is the underlying cause, then revascularization should provide for a better prognosis. Different methods for evaluation of myocardial viability have been described – each one presenting some advantages over the others, being, in the same time, inferior in some respects. The review offers a relatively comprehensive overview of methods available for determining myocardial viability.
{"title":"Myocardial Viability – An Important Decision Making Factor in the Treatment Protocol for Patients with Ischemic Heart Disease","authors":"V. Grigorov, M. Grigorov, E. Grigorov, H. Nocheva","doi":"10.2478/amb-2022-0022","DOIUrl":"https://doi.org/10.2478/amb-2022-0022","url":null,"abstract":"Abstract Ischemic heart disease (IHD) affects > 110 million individuals worldwide and represents an important contributor to the rise in the prevalence of heart failure and the associated mortality and morbidity. Despite modern therapies, up to one-third of patients with acute myocardial infarction would develop heart failure. IHD is a pathologic condition of the myocardium resulting from the imbalance in a given moment between its oxygen demands and the actual perfusion. Acute and chronic forms of the disease may potentially lead to extensive and permanent damage of the cardiac muscle. From a clinical point of view, determination of the still viable extent of myocardium is crucial for the therapeutic protocol – since ischemia is the underlying cause, then revascularization should provide for a better prognosis. Different methods for evaluation of myocardial viability have been described – each one presenting some advantages over the others, being, in the same time, inferior in some respects. The review offers a relatively comprehensive overview of methods available for determining myocardial viability.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"59 - 64"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41800992","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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