Journal of Biomedical and Clinical Research Feed

50 Years of Antenatal Corticosteroids: A Systematic Review

Mon, 11 Dec 2023 00:00:00 GMT

The administration of antenatal corticosteroids (ACS) to accelerate fetal lung maturation is considered one of the most valuable antenatal therapies in preterm labour. Although early indications that administering antenatal corticosteroids has a positive impact on fetal lung maturation and despite the widespread recommendations to use this treatment in women at risk of preterm birth, there is still some uncertainty regarding its effectiveness, particularly in lower-resource settings and in high-risk groups such as women with hypertension or multiple pregnancies. The optimal timing of administration has not improved in over 50 years. This assessment aimed to evaluate the effects of administering a course of corticosteroids to women before anticipated preterm birth (before 37 weeks of pregnancy) on fetal and neonatal morbidity and mortality, maternal mortality and morbidity, and the child’s health later in life. It is advised that clinicians only administer a single course of ACS in high-risk cases of preterm birth likely to occur within the next seven days, and the gestational age is between 22+0 and 33+6 weeks. The diagnosis of preterm labour should be made based on available resources and expertise and supported by comprehensive protocols in the relevant setting.

Predictors for Gangrene and Perforation of Gallbladder Wall in Patients with Acute Cholecystitis

Mon, 11 Dec 2023 00:00:00 GMT

Perforation of the gallbladder wall leads to a local perivesical abscess or progression to biliary peritonitis. The study aimed to analyse clinical, laboratory, and imaging indicators that have the strongest relationship with the presence of gangrenous cholecystitis and perforation of the wall and to design a predictive scoring system that highlights the risk of developing gangrenous cholecystitis with perforation. We performed a retrospective analysis of a total of 331 patients operated for five years (2016-2020) at the Department of Surgical Diseases” of Medical University - Pleven, with histologically verified chronic cholecystitis (120 patients; 36.4%), acute cholecystitis (100 patients; 30.1%), and destructive cholecystitis (111 patients; 33.5%). The statistical analysis identified nine main factors with the most substantial statistical significance in patients with gangrene and perforation of the gallbladder wall: age >65, male gender, diabetes mellitus, cardiovascular pathology, tachycardia>90 bpm, WBC>14.109, the thickness of gallbladder wall > 4 mm with pericholecystic fluid, ASAT and ALAT > 40 UI, CRP>150 ng/l. The total possible score was 11 points. The positive predictive value of the scale was 96% and identified the cases with micro-perforation and perivesical abbesses among the group with the highest total score.

Porcine or Bovine Tissue Valves: Which are Better for Surgical Aortic Valve Replacement?

Mon, 11 Dec 2023 00:00:00 GMT

The choice between mechanical and bioprosthetic aortic valve implants is affected by relatively clear criteria. However, the choice between porcine or pericardial valve is more complex regarding bioprosthetic devices. We aimed to elucidate any hemodynamic and clinical difference between two widely used bioprosthetic valves: the Sorin Mitroflow bovine pericardial valve and the St. Jude Medical Epic Supra porcine valve. We retrospectively studied 71 consecutive patients separated into two groups based on the valve they received. Clinical outcomes included patient survival and hemodynamic performance of the implanted prostheses. Patients were assessed at one and five years postoperatively. Mean transprosthetic pressure gradients were used as a marker of hemodynamic performance. The Mitroflow valve exhibited lesser mean transvalvular gradients than the Epic valve for all labelled sizes at one and five years postoperatively. The 5-year survival was equal between groups. Both prostheses demonstrated a small but significant increase in mean pressure gradients in the fifth year. Most patients enjoyed significant clinical improvement as assessed by NYHA functional class. Both bioprostheses performed very well with excellent hemodynamic parameters. The pericardial valves are a safe and appropriate choice for surgical bioprosthetic aortic valve replacement.

Introduction of Stereotactic Vacuum-Assisted Breast Biopsy in Bulgaria

Mon, 11 Dec 2023 00:00:00 GMT

Breast cancer is the most common cancer in women worldwide. The gold standard for biopsy is core needle biopsy. However, in certain cases, core needle biopsy cannot be applied, and the method of choice is vacuum-assisted biopsy. It is a minimally traumatic and precise method for diagnosing microcalcifications and small breast lesions. We aimed to present the initial experience with stereotactic vacuum-assisted biopsy in breast diseases at the Department of Surgical Oncology. We show indications and contraindications for this kind of biopsy and present our initial experience. From February 2020 to December 2022, 29 stereotactic vacuum-assisted biopsies were performed. Benign histology was found in 9 cases, malignant – in 15, and 5 cases were precancerous. Therefore, being an innovative, minimally invasive, and highly accurate method for diagnosing breast lesions with a good cosmetic effect, it allows early diagnosis of breast cancer, and, last but not least, the procedure can be curative for benign lesions.

Ocular and Visual Discomfort Epidemic Amid COVID-19 Pandemic: A Sample of Medical Students in Bulgaria

Mon, 11 Dec 2023 00:00:00 GMT

The purpose of оur research was to evaluate the effect of remote education on ocular health among medical students during the current COVID-19 pandemic. The students included in the study were 219 in total, all from Medical Universities in Bulgaria. They were asked about their eye health and comfort during the distance-learning semester. They were interviewed anonymously, with an online questionnaire, between April 1-30, 2021. The findings of the study highlighted that digital learning increases screen time, at potentially dangerous for eye health levels. The most common presenting complaints were eye fatigue (83.1%), tearing (epiphora) (58.9%), dry eyes (58.4%), blurred vision (40.2%), photophobia (37.4%), itchiness (34.7%) etc. Regarding the longest uninterrupted time spent working on a computer, 32% of the students reported 1-2 hours without a break, 57.1% - more than 2 hours, and only 3.7% spent less than 20 min before taking a break. As the conclusion of this study, it was observed that distance learning during the pandemic and social isolation adversely affected eye health and eye fatigue among medical students. Increased screen time during online semester causes digital eye strain, which interferes with the quality of life and is an emerging public health issue.

Diagnostic Utility of Endocan and Interleukins for Late-Onset Neonatal Sepsis

Mon, 11 Dec 2023 00:00:00 GMT

The aim of this study was to determine the potential of early inflammatory markers to diagnose late-onset neonatal sepsis – interleukin 6 (IL-6), interleukin 8 (IL-8) and endocan (ESM-1), and to compare them with routinely used markers like C-reactive protein (CRP) and procalcitonin (PCT). A prospective (January, 2022 – January, 2023) clinical-epidemiological study was conducted in a third level NICU in Pleven, Bulgaria. Patients with suspected nosocomial infection and healthy controls were tested. A sandwich ELISA method was used to measure the serum concentrations. Sixty newborns with an average gestational age of 29.75±3.61 gestational weeks were included, of which 35% were symptomatic and infected, 33.3% were symptomatic but uninfected, and 31.7% were asymptomatic controls. The mean values of PCT and IL-6 differ significantly in the three groups. For ESM-1, IL-8 and CRP, the difference was statistically insignificant. The best sensitivity (78%) and negative predictive value (84%) was found for IL-6. The introduction into routine practice of indicators such as PCT and IL-6 may provide an opportunity to promptly optimize the diagnostic and therapeutic approach to LOS.

Japanese Quince Fruit Juice Exerts a Cardioprotective Effect in a Model of Diet-Induced Metabolic Syndrome in Rats

Mon, 11 Dec 2023 00:00:00 GMT

The current study aimed to evaluate the influence of Japanese quince (Chaenomeles japonica) fruit juice (JQFJ) on the myocardium and on the coronary arteries of rats with diet-induced metabolic syndrome (MS). Male Wistar rats (n=50) were divided into 5 groups: Control, MS, MS+JQFJ2.5, MS+JQFJ5 and MS+JQFJ10. MS was induced with a high-fat high-fructose diet for 10 weeks. During that period, all animals were daily orally treated with distilled water (Control and MS groups) or with JQFJ at doses of 2.5 ml/kg, 5 ml/kg and 10 ml/kg (the other three groups, respectively). At the end of the experiment, the myocardium and coronary arteries were examined histopathologically. In group MS, necrotic endothelial cells and exposed basal membrane were observed. JQFJ at 2.5 ml/kg reduced the impairment but activated endothelial cells were still found. JQFJ at 5 ml/kg and 10 ml/kg prevented coronary artery endothelium damage, preserving the normal morphology. The myocardium in MS group presented with cardiomyocyte degeneration and increased distance between the cells. In group MS+JQFJ2.5, the degeneration was decreased. In groups MS+JQFJ5 and MS+JQFJ10, the histology of the myocardium resembled that of the control group. In the current histopathological evaluation, JQFJ prevented the MS-induced impairment of myocardium and coronary arteries.

Surgical Sepsis of Hepatobiliary Origin: Cоmplications and Prognosis

Mon, 11 Dec 2023 00:00:00 GMT

Hepatobiliary sepsis and biliary septic shock are defined as a group of purulent-inflammatory diseases of the biliary tract which, in their progression, lead to sepsis in case of delayed diagnosis and treatment. The study aimed to analyse all the cases of hepatobiliary sepsis treated at the Clinic of Surgery, Dr G. Stranski University Hospital – Pleven, from 2016 to 2020 and create a reliable prognostic score for surveillance for patients with hepatobiliary sepsis. Retrospectively, we analysed the records of 697 patients (81%) with a hepatobiliary tract infection, including 79 (11.3%) diagnosed with hepatobiliary sepsis and six fatal cases (1.3%). We evaluated all statistically significant factors that affected mortality: immune deficiency comorbidity (р<0.005), pathogenesis-related to trauma and ascending biliary tract infection (p<0.005), positive hemoculture (p<0.001), length of hospital stay, the need of treatment in intensive care unit and all septic complications. We designed four different prognostic indices based on calculated individual SOFA scores and factors that significantly affected mortality in the high SOFA score patients: immune deficiency, pathogenesis-related risks of sepsis or positive blood culture. The newly designed indices for the outcome are original and have 80% sensitivity and 87% specificity, compared with a simple SOFA score.

Contact Allergy in Atopic Patients

Mon, 11 Dec 2023 00:00:00 GMT

Atopic dermatitis (AD) is a chronic inflammatory disease based on genetic and immune alterations and is part of the atopic symptom complex, including allergic rhinitis, allergic conjunctivitis, and bronchial asthma. A disturbed barrier function facilitates antigen penetration through the skin, with the subsequent development of allergic contact dermatitis (ACD). The gold standard for diagnosing ACD is epicutaneous (patch) testing, also applied to objectify contact sensitization in AD. This study aimed to determine the frequency of contact allergy (CA) among individuals with atopic history and the allergens that caused ACD in those cases. We studied 453 individuals tested in the period 2009-2022. Of these, a subpopulation of 189 individuals with atopic diathesis was identified. A retrospective analysis was used. Using clinical and allergological methods, we divided the tested patients according to sex, age, professional occupation, and areas of the body affected by dermatitis and identified the most common contact allergens that cause positive reactions and ACD. In conclusion, our results highlight the possibility of developing ACD in people with atopic diathesis. As far as we know, our study is the first one in Bulgaria to examine the frequency of contact sensitization in AD patients.

Study on 25 (OH) Vitamin D Status in Hospitalizied Children with Acute Respiratory Infections: Preliminary Results

Mon, 11 Dec 2023 00:00:00 GMT

Our study aimed to determine and analyze the serum levels of 25 (OH) vitamin D and parathyroid hormone (PTH) to assess vitamin D deficiency as a risk factor for increased morbidity of acute respiratory infections (ARI) in childhood. The changes in the serum parathormone level were used as a criterion for vitamin D sufficiency since an optimal level of 25 (OH) vitamin D is required for normal PTH values. The study included 87 children divided into four subgroups, respectively – children with acute bronchopneumonia (n=49), children with acute laryngotracheitis (n=11), children with acute bronchiolitis (n=16), and a control group (n=11). Subnormal Vit. D levels were found in the individual groups: in the bronchopneumonia group, 18 children showed evidence of insufficiency; in the group of children with laryngotracheitis, five children showed insufficiency, and one child had Vit.D deficiency; children with acute bronchiolitis showed abnormalities in vit. D levels: seven children with insufficiency and two children - with deficiency. The preliminary results showed that Vit. D status deviations are more common in children with acute respiratory infections than in healthy children.

Serum Erythropoietin in Patients with Chronic Renal Failure in the Predialysis Stage

Mon, 11 Dec 2023 00:00:00 GMT

A prospective study was carried out of serum erythropoietin levels in patients with chronic renal failure/chronic kidney disease in the predialysis period. The study is part of scientific project № 2/2022, financed by Medical University-Pleven. Fifty patients were tested – 22 males and 28 females (average age 63.7±13.0), with average serum creatinine 253±127 mcmol/l and average glomerular filtration rate of 22.6±11.8 ml/min/1,72 m2. The results showed that the serum erythropoietin level varied from 1.86 to 48.50 U/l and was below the borderline in only three patients. There were no significant differences between serum erythropoietin and haemoglobin values in both genders. No differences were found between the average haemoglobin values of patients with different values of serum erythropoietin. Non-significant differences were found in the values of serum erythropoietin in patients with different haemoglobin values. A statistically significant difference between the average value of serum erythropoietin was seen in the group of patients who were not undergoing treatment for anaemia with recombinant erythropoietin (8.5±5.9 U/l) and the groups treated with a dose above 3000 UI/weakly (from 18.6±11.3 to 19.7±8.8 U/l).

Allergic Contact Dermatitis to Acrylates: A Study Among Manicurists and Clients

Mon, 11 Dec 2023 00:00:00 GMT

The study aimеd to investigate the association between the professional environment and hypersensitivity reactions to various contact allergens, features of the clinical course, and types of allergic contact dermatitis (ACD) in 34 manicurists and ten service users. The analysis was based on the data on length of professional experience, localisation of rashes, clinical diagnoses and allergens, and the cause of positive reactions in epicutaneous testing. Pathological skin changes most often affected the upper limbs (hands, palms, fingers). As a diagnosis, the frequency of ACD was the highest – 79.4%, followed by that of dyshidrotic eczema (DE) – 17.6%, which also determines the highest percentage of dermatitis on the upper limbs (97%). Of the patients, 47.1% had a history of the disease for up to one year. For manicurists, the results of patch tests with the specialised MH-1000 series showed the highest frequency of positive reactions to 2-Hydroxyethyl methacrylate (2-HEMA) and 2-Hydroxypropyl methacrylate (2-HPMA) – 88.88% each, Ethylene glycol dimethacrylate (EGDMA) – 83.33% and 2-Hydroxyethyl acrylate (2-HEA) – 61.11%. After combining data for manicurists and clients, correlation analysis found a significant effect on the development of ACD to 2-HPMA (p=0.003) and EGDMA (p=0.005), as well as for hand dermatitis to 2-HEMA (p=0.05) and 2-HEA (p=0.044).

Depression in Parkinson’s Disease – Profile and Assessment

Mon, 11 Dec 2023 00:00:00 GMT

Depression and anxiety are the most common nonmotor symptoms in Parkinson‘s disease-NMSPD in the department of the neuropsychiatric disorders. Depression is present in all stages of PD - early and advanced even in premorbid stage of PD. The incidence of depression in PD varies in large limits according of used methods and criterions. Some somatic symptoms are part of the depression syndrome. At the presence no consensus exists about the etiology of depression in PD. The concomitant occurrence of depression and PD and the overlapping symptomatology of PD and depression usually lead to the terminological discussion and discrepancy. To explain the high prevalence of depression in PD some hypotheses have been proposed. Many scales were used for assessment of depression in PD. The properties and critique of nine scales was discussed.

Chronic Kidney Disease - Peridialysis Period: Predialysis, Dialysis Preparation, and Initial Dialysis Prescription

Mon, 11 Dec 2023 00:00:00 GMT

Two periods adjacent to starting dialysis are called “chronic kidney disease - peridialysis.” The predialysis period is of varying duration, while the dialysis period lasts up to 3 months after the first dialysis session. During the peridialysis period of chronic kidney disease, complications, mortality, and treatment costs increase significantly. The rate of glomerular filtration rapidly decreases, which requires intensive treatment. Management of the peridialysis period is a challenging clinical problem. This review aims to acquaint all working with patients with chronic kidney disease with the novelties published in the medical literature in recent years about the principle of work in patients with glomerular filtration below 15 ml/min per 1.73 m².

Squamous Cell Carcinoma of the Skin: Epidemiology, Diagnosis, Management, Recurrence and Mortality Rates for the Bulgarian Population

Mon, 11 Dec 2023 00:00:00 GMT

Squamous cell carcinoma of the skin (SCCs) accounts for 20-30% of non-melanoma skin cancers, resulting in 1 million cases in the United States annually. The risk of developing SCCs increases annually, and this process will likely be continued because of the aging population. We investigated 355 patients with histopathologically confirmed SCCs. We rated the age- and sex-related incidence, risk factors, localisation, pathological features, staging systems and treatment, and the recurrence and mortality rates of the tumours. Staging and risk stratification for recurrence and metastases is significant. Most SCCs are successfully treated surgically, with a small subset of carcinomas leading to recurrence, metastasis, and death. Patients with advanced and metastatic disease are often inappropriate for surgical and radiation therapy. We present the first study on squamous cell carcinoma of the skin conducted for the population of the Pleven and Lovech regions of Bulgaria.

Prevalence of Self-Medication with Antibiotics in Europe: A Scoping Review

Thu, 10 Aug 2023 00:00:00 GMT

The most common cause of antibiotic resistance is the irrational use of antibiotics. Most of the irrational use of antibiotics is related to use in the community and the prevalence of self-medication in different populations. This review aimed to explore the prevalence of self-medication with antibiotics in European countries and the main sources of antibiotics. An online search of Pubmed and Scopus was conducted to identify relevant studies. A two-phase mapping approach was used. All steps in this scoping review were carried out using the Covidence® software. A total of 22 studies were included. The prevalence of self-medication with antibiotics is greater in Southern European countries than in Northern and Western European countries. The main sources of over-the-counter antibiotics are community pharmacies and leftovers from previous courses. Targeted communication strategies and interventions are needed to reduce the overuse of antibiotics and to slow down the spread of antibiotic resistance until new classes of effective antibiotics are developed.

Assessment of the Measures Implemented in Bulgarian Legislation to Reduce the Content of Nitrates in Groundwater Used for Public Water Supply

Thu, 10 Aug 2023 00:00:00 GMT

The article analyzes the application of the current documents related to reducing nitrate pollution of groundwater bodies used for public water supply in the Pleven administrative region. The requirements of the European legislation are fully implemented in the Bulgarian legislation, but the legislative measures have not led to quick and permanent results, i.e., small drinking water sources contaminated with nitrates still exist. Special attention should be paid to the diffusive sources of pollution (mineral fertilization of soils) since they are of the most significant importance in groundwater contamination with nitrates. For settlements with permanently elevated nitrate content (over 50 mg/L), it is necessary to consider the application of an individual approach in dealing with this long-standing problem: changing the water source, mixing the water from two neighboring water sources or implementing specific purification methods (biological denitrification, ion exchange resins, etc.). We analyzed the data from the monitoring of drinking water carried out by the Regional Health Inspectorate – Pleven and found that in the Pleven region, there are 17 towns or villages (out of a total of 123) for which some of the listed measures should be foreseen. The district’s relative share of the exposed population is 3.2%, comparable to the country’s exposed population for 2004-2007.

Clinical Case of a Patient with Extranodal Diffuse Large B-Cell Lymphoma and Surgical Complications

Thu, 10 Aug 2023 00:00:00 GMT

Diffuse large B-cell lymphoma (DLBCL) is one of the most common types of non-Hodgkin lymphoma in adults. In most of the cases a complete remission is possible to obtain by applying conventional immunochemotherapy (rituximab in combination with cyclophosphamide, doxorubicin, vincristine, methylprednisolone or R-CHOP). Its effect depends on some risk factors, cellular origin of the lymphoma and to some extend – the localization when extranodal involvement is confirmed.We present the case of a patient with DLBCL of small intestine and non-specific clinical manifestation. Following treatment with standard therapy R-CHOP patient fail to achieve disease response and gastrointestinal track (GIT) complications were registered.

Aortic Dissection Type a in Combination with Acute Anterior Myocardial Infarction. Myocardial Protection

Thu, 10 Aug 2023 00:00:00 GMT

Acute aortic dissection is an extremely serious condition with a high mortality risk. Symptoms may mimic other emergencies such as myocardial ischemia, often leading to misdiagnosis. A combination between coronary hypoperfusion and aortic dissection is relatively rare, but when present it could be fatal. Early diagnosis and correct surgical approach are essential to success in those patients and the high mortality rate requires improvement of myocardial protection. Development of acute cardiac ischemia on top of mandatory global ischemia is a serious precondition for a severe postcardiotomy syndrome, and only excellent cardiac protection can lead to successful surgical intervention.

Diabetic Foot: Old Disease, New Challenges

Thu, 10 Aug 2023 00:00:00 GMT

Diabetes is a socially significant disease that brings a significant burden to healthcare systems worldwide. The vicious nature of the disease affects almost all of the systems and organs of the body. The foot is one of the most important and clinically significant areas where these complications are manifested. Diabetic foot gangrene is a leading cause of non-traumatic foot loss worldwide. Although the disease has been known for over a decade, understanding it has gone through highs and lows, leading to suboptimal results in many cases. In this review article, we focused on diabetic foot and the methods for evaluation and assessment of the condition to properly initiate adequate treatment.