Showing papers by "Medical University of Varna published in 2014"

Reliability of primary caregivers reports on lifestyle behaviours of European pre-school children : the ToyBox-study

Abstract: Reliable assessments of health-related behaviours are necessary for accurate evaluation on the efficiency of public health interventions. The aim of the current study was to examine the reliability of a self-administered primary caregivers questionnaire (PCQ) used in the ToyBox-intervention. The questionnaire consisted of six sections addressing sociodemographic and perinatal factors, water and beverages consumption, physical activity, snacking and sedentary behaviours. Parents/caregivers from six countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain) were asked to complete the questionnaire twice within a 2-week interval. A total of 93 questionnaires were collected. Test-retest reliability was assessed using intra-class correlation coefficient (ICC). Reliability of the six questionnaire sections was assessed. A stronger agreement was observed in the questions addressing sociodemographic and perinatal factors as opposed to questions addressing behaviours. Findings showed that 92% of the ToyBox PCQ had a moderate-to-excellent test-retest reliability (defined as ICC values from 0.41 to 1) and less than 8% poor test-retest reliability (ICC < 0.40). Out of the total ICC values, 67% showed good-to-excellent reliability (ICC from 0.61 to 1). We conclude that the PCQ is a reliable tool to assess sociodemographic characteristics, perinatal factors and lifestyle behaviours of pre-school children and their families participating in the ToyBox-intervention.

Extensive clinical, hormonal and genetic screening in a large consecutive series of 46,XY neonates and infants with atypical sexual development

Abstract: Background One in 4500 children is born with ambiguous genitalia, milder phenotypes occur in one in 300 newborns. Conventional time-consuming hormonal and genetic work-up provides a genetic diagnosis in around 20-40% of 46,XY cases with ambiguous genitalia. All others remain without a definitive diagnosis. The investigation of milder cases, as suggested by recent reports remains controversial.

Parvalbumin-immunoreactive neurons in the human claustrum

Abstract: The morphology and distribution of parvalbumin-immunoreactive neurons (PV-ir) were studied in the human claustrum. PV-ir neurons were observed throughout the claustrum, with the highest numbers noted in the central (broadest) portion as compared with the dorsal and ventral aspects. Reaction product was evident in the neuronal perikarya, dendritic processes, and spines. In the majority of these labeled neurons, the cytoplasm was devoid of lipofuscin pigment. Cell bodies varied widely in both shape and size, ranging from oval and small, to multipolar and large. PV-ir neurons were classified into two groups, primarily based on dendritic morphology: spiny neurons with long and straight dendrites, and aspiny neurons with thin and curving dendritic processes. PV-ir fibers were seen throughout the neuropil, with many immuno-positive puncta noted.

Applying the Intervention Mapping protocol to develop a kindergarten-based, family-involved intervention to increase European preschool children's physical activity levels: the ToyBox-study.

Abstract: Although sufficient physical activity is beneficial for preschoolers' health, activity levels in most preschoolers are low. As preschoolers spend a considerable amount of time at home and at kindergarten, interventions should target both environments to increase their activity levels. The aim of the current paper was to describe the six different steps of the Intervention Mapping protocol towards the systematic development and implementation of the physical activity component of the ToyBox-intervention. This intervention is a kindergarten-based, family-involved intervention implemented across six European countries. Based on the results of literature reviews and focus groups with parents/caregivers and kindergarten teachers, matrices of change objectives were created. Then, theory-based methods and practical strategies were selected to develop intervention materials at three different levels: (i) individual level (preschoolers); (ii) interpersonal level (parents/caregivers) and (iii) organizational level (teachers). This resulted in a standardized intervention with room for local and cultural adaptations in each participating country. Although the Intervention Mapping protocol is a time-consuming process, using this systematic approach may lead to an increase in intervention effectiveness. The presented matrices of change objectives are useful for future programme planners to develop and implement an intervention based on the Intervention Mapping protocol to increase physical activity levels in preschoolers.

Establishing a method to estimate the cost‐effectiveness of a kindergarten‐based, family‐involved intervention to prevent obesity in early childhood. The ToyBox‐study

Abstract: Overweight and obesity in children are recognized as a major health problem. The ToyBox-intervention was developed with the aim of preventing obesity in pre-schoolers. Because it is increasingly important to inform policy makers not only on the effects of prevention interventions, but also on their costs and cost-effectiveness, our purpose was to establish a method to estimate the cost-effectiveness of the ToyBox-intervention. In order to estimate the long-term impact of the ToyBox-intervention on health and societal costs, extrapolations of the intervention effect will be conducted to predict children's weight status (based on the body mass index) at adult age. Effects of the adult weight status on the prevalence of obesity-related complications will be modelled through a Markov model, with a total time horizon of 70 years and a cycle length of 1 year. The model will be conducted in six European countries participating in the ToyBox-intervention, based on country-specific economic and epidemiological data. This study describes the methodological rationale and implementation of an analytic model to examine the cost-effectiveness of the ToyBox-intervention for six European countries, in order to inform decision-makers on the value for money of this intervention in the prevention of obesity in pre-schoolers.

The Role of 3-D Endorectal Ultrasound in Rectal Cancer: Our Experience

Abstract: In the last 20 years, endorectal ultrasound (ERUS) has been one of the main diagnostic methods for locoregional staging of rectal cancer. ERUS is accurate modality for evaluating local invasion of rectal carcinoma into the rectal wall layers (T category). Adding the three-dimensional modality (3-D) increases the capabilities of this diagnostic tool in rectal cancer patients. We review the literature and report our experience in preoperative 3-D ERUS in rectal cancer staging. In the group of 71 patients, the staging of preoperative 3-D endorectal ultrasonography was compared with the postoperative morphologic examination. Three-dimensional ERUS preoperative staging was confirmed with morphologic evaluation in 66 out of 71 cases (92.9%). The detection sensitivities of rectal cancer with 3-D ERUS were as follows: T1, 92.8%; T2, 93.1%; T3, 91.6%; and T4, 100.0%; with specificity values of T1, 98.2%; T2, 95.4%; T3, 97.8%; and T4, 98.5%. Three-dimensional ERUS correctly categorized patients with T1, 97...

Composition and antioxidant activity of aronia melanocarpa fruit juice

Abstract: Aronia melanocarpa is a woody shrub of the Rosaceae family. Its fruits are used for consumption either fresh, or as juice, jam and wine. The aim of the present study was to measure the concentration of some biologically active substances and the antioxidant activity of two samples of Aronia melanocarpa fruit juice (AMFJ). The juice was prepared from fresh fruits. One of the samples was produced using a juice centrifuge and was preserved with potassium sorbate (1.0 g/l). The other sample was produced by crushing and squeezing of fruits after which the juice was filtered and sterilized at 100 °C for 10 min. The contents of biologically active substances in the juice samples were measured by spectrophotometric and high-performance liquid chromatography methods. The antioxidant activity of the two juice samples was measured by the ORAC (oxygen radical absorbance capacity) and HORAC (hydroxyl radical аverting capacity) methods. The results showed that both samples were extremely rich in polyphenolic substances, amongst which the highest was the concentration of procyanidins followed by phenolic acids (chlorogenic and neochlorogenic) and anthocyanins. Sample 1 had higher concentration of total phenolics and contained higher quantities of most polyphenolic substances with the exception of anthocyanins. It also contained micro-quantities of cyanogens. The variations in the composition of the two samples could be attributed to the different methods of juice production and conservation. Both juice samples showed very high ORAC and HORAC values which were higher for sample 1 (the sample with the higher concentration of polyphenolic substances). The high antioxidant activity of the two AMFJ samples could be attributed to their polyphenolic ingredients.

Endoscopic diagnosis of intramural hematoma in the colon sigmoideum in a child with high titer inhibitory hemophilia A.

Abstract: Lower gastrointestinal bleeding is a rare condition in childhood pathology. The incidence of this disorder in the general population of Bulgarian children is unknown. We report a case of a 7-year-old child with diagnosed hemophilia A and high titer of factor VIII inhibitor; the patient was admitted into the Department of Pediatrics and Medical Genetics for rectorrhagia after falling onto his buttocks while playing. Colonoscopy showed submucosal hematoma 25 cm from the anocutaneous line occluding the intestinal lumen with a lesion of the overlying mucosa as long as 20 mm. If a patient presents with rectorrhagia, timely and carefully planned colonoscopy could identify the source of bleeding, determine the severity of bleeding and the size of hematoma, and assess the need for surgical intervention. The reported case supports the modern view that patients with inhibitor hemophilia should not be denied interventional procedure or surgical intervention for fear of uncontrolled bleeding.

Publication bias in clinical research sponsored by pharmaceutical industry

Abstract: An increasing number of clinical trials are funded by the pharmaceutical industry, and the industry as strong commercial interests in research publications that present their products positively and enhance their sales. As main sponsor of clinical trials, the pharmaceutical industry has gained unprecedented control over the evaluation of its own products and communication of research results. There is mounting evidence that industry-sponsored trials are biased in favor of the sponsor`s products. Various potential ways have been described in which pharmaceutical concerns exert influence on the outcome of a study and its communication, however, publication bias proved to be a major cause for bias in industry-funded trials. Pharmaceutical industry and its sponsored investigators selectively report favorable outcomes, fail to publish whole studies with unfavorable results, or publish studies with favorable results multiple times. Such manipulation of research communication might greatly jeopardize the scientific basis for good clinical practice. This article explores the aspects of clinical trial performance that can be affected by pharmaceutical company sponsorship, particularly emphasizing on results dissemination and publication. It is aimed at describing the relationship between pharmaceutical industry sponsorship and bias in research publication. By revealing the scope of the problem and its essence - it attempts to sensitize the scientific, professional and publishing societies and provoke

Kobophenol A inhibits sodium nitroprusside-induced cardiac H9c2 cell death through suppressing activation of JNK and preserving mitochondrial anti-apoptotic Bcl-2 and Mcl-1.

Abstract: Sodium nitroprusside (SNP) releases nitric oxide (NO), a powerful vasodilator, and thus widely used in intensive care unit for treating hypertension emergency. However, cardiac toxicity after SNP administration is a clinical problem. For finding a natural compound that suppressing SNP-induced cardiac toxicity, we tested the protective potential of kobophenol A (Kob A), purified from the root of Caragana sinica, against the toxic effects of SNP. The severe cardiac H9c2 cell death was induced by SNP (2 mM) treatment. Kob A ameliorated SNP-induced cardiac H9c2 cell death, and this protective effect of Kob A may be related to the inhibition of c-Jun NH2-terminal kinase (JNK) and p38 mitogen-activated protein (MAP) kinase activation following SNP administration. In addition, the downregulation of cellular Bcl-2 and Mcl-1 levels by SNP exposure was strongly abrogated in the presence of Kob A. These biological properties of Kob A might provide insights into developing new cardioprotectant against SNP-induced cardiac cell death.

Mechanism of TiO2 Nanotubes Formation on the Surface of Pure Ti and Ti-6Al-4V Alloy

Abstract: The present paper deals with the investigation of the mechanisms of TiO2 nanotubes formation on titanium surfaces during anodization process. The samples were made of pure Ti Grade-2 and Ti-6Al-4V alloy. They were grinded, etched with 0,5 wt. % HF acid and anodized. The anodization was done in electrolyte containing 0,5 wt. % HF acid using DC power supply with graphite electrode as cathode. The samples were investigated by SEM, EDAX and XRD analysis. The results show two different mechanisms of formation of TiO2 nanotubes on the surfaces of both materials. During the anodization process the oxide formations, obtained on the pure Ti surface after etching, are oxidized to nanorods; the area between them is also oxidized and connects them. This thin oxide layer grows in the metal depth while the nanorods are dissolved thus forming the porous sponge-like structure which is further transformed in tubular. While on the surface of Ti-6Al-4V alloy oxide nanonuclei originate which transform their shape from nanoseed to bowl-like with clearly pronounced bottom and walls, growing in tubular structures. The type of the material defines the surface morphology after etching. Thus obtained morphology influences on the processes running rate in different micro-regions determining origination of the titanium nanotubes on different stage as well as by different mechanism. The field-enhanced oxidation and field-enhanced dissolution are the main processes for formation of TiO2 nanotubes during anodization. In the regions with prevalent oxidation processes the TiO2 nanotubes are formed earlier while in the regions with dominant dissolution processes the TiO2 nanotubes are formed on the later stage.

An Integrated View: Neuroadipocrinology of Diabesity

Abstract: 2 1 Laboratorija za biologiju celije, Katedra za anatomiju i histologiju, Medicinski Univerzitet, Varna, Bugarska 2 Institut za biologiju celije i neurobiologiju, Nacionalni istraživacki centar, Rim, Italija 3 Katedra za histologiju i embriologiju, Medicinski fakultet, Univerzitet u Nisu, Srbija 4 Katedra za patofi ziologiju, Medicinski Univerzitet, Lublin, Poljska 5 Katedra za fi ziologiju, Medicinski fakultet, Univerzitet Eskisehir Osmangazi, Eskisehir, Turska ABSTRACT Today's achievements in systems biology and -omics sciences have facilitated a shift from studying individual molecules and tissues to characterising molecules and cells holistically. In this article, we attempt to discuss the sta- tus of a much-needed coherent view that integrates stud- ies on neurobiology and adipobiology, as well as those on diabetes and obesity. Globally, cardiometabolic diseases (atherosclerosis, hypertension, type 2 diabetes mellitus, obesity, diabesity, and metabolic syndrome) are the most prevalent pathologies. In 2000, Astrup and Finer (Obes Rev 1: 57-59) wrote the following: "Since type 2 diabetes is obesity dependent, and obesity is the main aetiogical cause of type 2 diabetes, we propose the term 'diabesity' should be adopted." Arguably, the research field of adipo- biology has witnessed three major paradigm shifts since the discovery of leptin, an adipose-derived hormone, in 1994. Various neuroendocrine and neurotrophic factors are included in the growing list of endocrine and paracrine adipose-secreted signaling proteins collectively designated adipokines. These findings open a novel field of research known as neuroadipocrinology, a component of neuroen- docrinology. Adipokines, including nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), mediate multiple biological processes, such as food intake, immunity, inflammation, memory, mood, and metabo- lism. The effects on metabolism involve the maintenance of glucose, lipid and energy homeostasis as well as cardio- protection, neuroprotection, and aging. In this article, we highlight the role of metabotrophic factors (MTF) and the adipose- and nonadipose-derived biomolecules that me- diate these effects. Recent results demonstrate that circu- lating and tissue levels of certain MTFs, e.g., adiponectin, NGF, BDNF, glucagon-like protein-1, sirtuin-1, interleu- kin-10, and aquaporin-7, are altered in cardiometabolic diseases, including diabesity. Overall, this may cultivate

Lumbar Intraforaminal Synovial Cyst in Young Adulthood: Case Report and Review of the Literature

Abstract: Study Design Case report. Objective Lumbar juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Most patients with lumbar cysts are in their sixth decade of life and have significant facet joint and disk degeneration. Lumbar synovial cysts (LSCs) are extremely rare in adolescence and young adulthood, and to our knowledge, only two pediatric cases of LSC have been reported in the literature. We aim to prove the existence of LSC in adolescent patients as a real entity that causes low back and radicular complaints and to discuss the possibility of traumatic injury as a pathogenic cause of LSC formation in adolescence. A case of an 18-year old patient with LSC is presented. We report the clinical presentation, management, outcome, and review of the literature, focusing on issues that remain debatable. Methods The case is presented together with its clinical course, the diagnostic techniques, the surgical findings, histologic results, and the treatment outcome. Results After surgical treatment, the patient's complaints were alleviated and almost no complaints were registered during the next 6 months' follow-up. Conclusions LSCs are extremely rare in adolescence, but they could be considered in the differential diagnosis in adolescent patients with low back pain and radiculopathy. Surgical removal of LSC could be considered as a treatment option to provide immediate and safe symptomatic relief.

Total phenolic compounds and tannins content of Bancha green tea (Camellia Sinensis) depending on extraction conditions

Abstract: The effect of different extraction conditions of prepared infusions on the content of bioactive compounds of Bancha green tea ( Camellia sinensis L. ) were investigated. The content of total phenols, tannins and methylxanthines were determined spectrophotometrically. The highest content of total phenolic compounds and tannis were determined on the 30th minute of infusion - 7,71% and 4,49% respectively. The conditions with the most valuable (higher content of polyphenols) and the most healthy (lowest of tannins) combination is in the 10th minute of extraction - 7.47% and 3,84%. The tea also contained low percentages of methylxanthines (0,66%) and caffeine (0,09%).

Autism spectrum disorders: neurotrophins enter the dance

Abstract: Autism spectrum disorders (ASD) is a group of lifelong neurodevelopmental disorders characterized by impairment in social interaction and communication, delayed and disordered language, restricted and stereotypic patterns of behaviour, interests and activities, and onset before 3 years of age.

Trends in registered blindness in eastern Bulgaria

Abstract: Purpose : The purpose of the study was to evaluate the incidence and causes of registered blindness and low vision in Eastern Bulgaria. Methods : Documentation per each included patient based on archives of the Expert Disability committee was evaluated and divided in two intervals. The cumulative incidence per 100 000 was calculated in 3 severity groups for bilateral and monocular blindness and by residence. Results : The incidence of binocular blindness decreased from 63.79 to 41.61 for males and from 64.21 to 41.14 for females during the second period. Meanwhile, monocular blindness increased from 41.14 to 65.14 for males and from 33.01 to 48.83 for females. It rapidly increases after 60 years of age and is the highest for those over 80. Patients with visual acuity (VA) below 0.05 comprise 40-35%, between 0.06 and 0.1 - 22- 35%, and 0.15 to 0.3 - 38-34%. The proportion and incidence of patients with VA below 0.05 have decreased two times during the second period among residents of cities and remained high - 42-48% in the rural population. Severe monocular blindness was significantly higher among males across the whole population. In the age group below 19 years, the leading causes of binocular blindness were retinopathy of prematurity (ROP), congenital glaucoma, microphthalmos and congenital cataract and for monocular impairment - trauma and amblyopia. For those above 20, the main causes were glaucoma, end-stage diabetic retinopathy, cataract - both with significant reduction in the incidence, AMD and trauma. Conclusions : Systematic evaluation of the deteriorated quality of life and estimation of the cost of vision loss and eye diseases to individuals and their families as well as extended family caregivers and thirdparty payers, the health care system and Bulgarian society is essential in the development of evidence-based interventions that translate research into enhanced clinical and community practice and prevention of unnecessary visual impairment.

Relevance of pharmaceutical higher education to the labor market: a study of pharmacists' attitudes

Abstract: The role and responsibilities of pharmacists are developing and increasingly expanding. University programs need to guide pharmacists into becoming leaders of change. The objective of the following survey is to examine the attitudes among pharmacy graduates as to the level of relevance of their higher education studies to the requirements of the pharmaceutical practices and the labor market. The overwhelming share of the participants in the survey believes higher education training is relevant to pharmaceutical practices. Nevertheless, a mere 6% state that the knowledge, skills and competences acquired in the course of higher education training relate completely to those required in the professional practice.

Molecular epidemiology of multidrug resistant acinetobacter baumannii clinical isolates from two bulgarian hospitals

Abstract: Objectives : To investigate the molecular epidemiology of multidrug resistant (MDR) Acinetobacter baumannii isolates collected from patients in two Bulgarian Hospitals (H1, H2) during the period 2005-2012. Materials and Methods : A total of 93 nonduplicate MDR A. baumannii isolates collected from Intensive care units (ICUs) and surgical wards were studied. Antimicrobial susceptibility was tested by VITEK 2 (bioMA©rieux, Marcy l`Etoile) and Phoenix (BD) and the results were interpreted according to the current CLSI guidelines. Detection of carbapenemase encoding genes was performed by PCR. Isolates were genotyped by PFGE and rep-PCR DiversiLab system (bioMerieux) and compared against a library of A. baumannii strains representing the international clones (IC) 1-8. Results : Twenty seven isolates were carbapenem resistant and were associated with OXA-23 and OXA-58 enzymes. The majority of the investigated isolates (n=65) clustered with ICs 1, 2 and 8. Twenty five isolates from H2, collected during the period 2005-2007, did not cluster with any of the representative strains for the ICs 1-8 and formed a separate unique clone, which was found to persist in 2012. Conclusions : Our results reveal the epidemic and endemic potential of A. baumannii as well as persistence of clones over time. Multidrug resistance in A. baumannii from the investigated Bulgarian hospitals was associated with intrahospital dissemination of IC1, 2 and 8 and with unique local clones.

Dangerous food-drug interactions

Abstract: Aim: To increase patients` awareness of the health risks of certain drug-food interactions and to present their competence in the problem. Materials and methods: Systematic approach of available scientific literature on the problem and specially designed questionnaire. Results: Interactions between food and drugs may affect treatment results and be the reason of undesirable side effects. The clinical significance of this type of cooperation is varied. Some foods may sensitively influence the rate and extent of absorption of the active substance. That in turn could cause serious side effects, toxicity or treatment failure. In other cases, the food-drug interaction could have a favorable aftereffect by increasing the drug efficacy or reducing the side effects. Our dynamic present offers increasingly wide range of medicines. This requires the study of precisely these two types of interactions with food before the release of a drug on the market Conclusions: The results of the survey should reflect on patients` general health culture and their awareness of proper drug intake

Diagnostics of liver hydatid disease

Abstract: E. granulosis is the species that prevails in most countries around the world and especially in the Mediterranean region. It is one of the most severe infestations in humans. Biological diagnosis is based on serological tests. Eosinophily is considered variable because it does occur in cases of hydatid cyst disease but its absence does not exclude the possibility of hydatid cyst existence. Imaging diagnostics is important for the classification of the hydatid cysts. Ultrasound is a noninvasive, widely available method with high sensitivity for the diagnosis of hepatic echinococcosis and low price and is a method of choice. CT is the method of а doubt for suppuration of hydatid cyst. MRI with high contrast resolution of T1 and T2 images demonstrated better pericyst , daughter cysts and matrix. We reviewed the current trends in the diagnosis of liver cystic echinococcosis.

Night manometry of the upper airway in snoring and obstructive sleep apnea

Abstract: The present survey systematizes the most recent scientific literature devoted to the issues of the topic diagnostic significance of night pressure measurements of the upper airway. The contributions of the eminent researchers who have elaborated both Reggie® and АpneaGraph® systems are indicated. The role of the differentiation between the ‘upper’ and ‘lower’ upper airway obstructions are emphasized. The clinical importance of the night manometry is juxtaposed to that of the druginduced videoendoscopy during sleep.

New approach in the treatment of ophthalmic neovascular disorders: using fusion protein aflibercept

Abstract: The aim of this review is to appraise the usage of a newly approved anti-vascular endothelial growth factor (anti-VEGF) fusion protein, aflibercept, in ocular neovascular disorders such as diabetic retinopathy and age-related macular degeneration. Aflibercept is a soluble fusion protein, which combines ligand-binding elements taken from the extracellular domains of VEGF receptors 1 and 2 fused to the Fc portion of IgG. This protein contains all human amino acid sequences, which minimizes the risk for immunogenicity in human patients. In this short review we investigate the available literature and data from clinical studies on the efficacy, pharmaceutical and pharmacological properties of aflibercept, and identify its possible advantages over commercially available anti-VEGF drugs. Biomedical Reviews 2014; 25: 59-65.

To Screen or Not to Screen for Prostate Cancer

Abstract: Golden standard for prostate cancer screening are digital rectal examination, PSA screening and transrectal ultrasound. The recommendations of U.S.Preventive Services Task Force (USPSTF) are based on review of medical literature which conclude that PSA screening leads to unnecessary treatment- related complications which are not justified by the number of the saved lives because: Low specifity of PSA-screening for cancer detection Medical complications, caused by unnecessary procedures, because of false-positive PSA. Increasing pressure to reduce the rate of growth of health care The end point of evaluation of the effect of the screening is decreasing of cancer-specific mortality and evaluation of the quality of life of the saved men.

Chemical Composition of Carduus candicans ssp. globifer and Carduus thoermeri Essential Oils

Abstract: Chemical composition of the essential oils from flower heads of Carduus candicans W.&K. ssp. globifer (Vel.) Kazmi and Carduus thoermeri Weinm., collected from Bulgaria, was determined by GC-MS. The main components of Carduus candicans ssp. globifer essential oil were benzaldehyde (22.1 %), palmitic acid (8.9 %), methyl salicylate (7.3 %), heptacosane (6.3 %), tricosane (6.1 %), pentacosane (5.6 %), Z-12-pentacosene (3.5 %) and β-caryophyllen (3.2 %). The oil of Carduus thoermeri contained mainly palmitic acid (17.9 %), methyl salicylate (14.8 %), benzaldehyde (13.2 %), trans-nerolidol (4.7 %), p-cymen-8-ol (4.5 %) and tricosane (2.7 %).

Evaluation of some parameters of copper metabolism and leipzig scoring system in the diagnosis of wilson disease

Abstract: PURPOSE: Wilson disease (WD) is an autosomal recessively inherited disorder of copper accumulation and toxicity. Its recognition is easy in the presence of typical clinical presentations. Unexplained liver test abnormalities are a diagnostic challenge and require more examinations. The objective of this study is to assess the diagnostic value of ceruloplasmin, 24-hour urine copper excretion and Leipzig scoring system in WD. MATERIAL AND METHODS: Sixty-five patients with WD (22 females and 43 males) and control group of 17 patients with other chronic liver diseases (CLD) were analyzed. The values of the parameters of copper metabolism and Leipzig scoring system were evaluated. RESULTS: Average ceruloplasmin level was under 0,2 g/L and 24-hour urinary copper concentration was increased. D-penicillamine challenge test showed a mean value of 17,4 µmol/24 hours of urinary copper excretion in WD patients versus 5,46 µmol/24 hours in CLD ones. According to the Leipzig scoring diagnostic criteria, 58 WD patients (89,23% of the cases) presented with a score ≥4 (maximal value of 12). Score 3 was found out in seven patients, however, the exclusion of other etiology and the clinical course of the disease confirmed the diagnosis. The control subjects presented with a score ≤3 as it was ≤2 in 76,5% of the cases. CONCLUSION: Our results confirm the diagnostic value for WD of the Leipzig scoring system combined with clinical symptoms, laboratory parameters of copper metabolism, genetic testing and liver biopsy in clinical practice.

Retrobulbar optic neuritis and cystoid macular edema as a first manifestation of lyme disease

Abstract: Lyme disease is a multi-system disorder caused by the spirochete Borrelia burgdoferi. Eye manifestations are a rare involvement. We report two cases of patients who developed a retrobulbar optic neuritis and a cystoid macular edema as a sole clinical presenting in Lyme disease. A 42-year-old female presented with left eye decreased visual acuity and painful ocular movement. Dilated funduscopy and neurological examination were normal. A diagnosis of left eye retrobulbar optic neuritis was made. The brain and spinal cord MRI showed typical lesions characteristic of MS. Serological tests for Lyme disease revealed positive results for IgM ELISA and Western blot. The possible serologically proven Lyme disease was diagnosed. Visual acuity returned to normal following a course of high-dose steroids and intravenous antibiotic, after by oral antibiotic. A 28-year-old male presented with left eye blurred vision and intermittent blurring vision in his right eye. Dilated funduscopy revealed bilateral cystoid macular edema (left more than right). He was positive for Lyme serology, IgM ELISA and Western blot, and intravenous antibiotic therapy was commenced, followed by oral antibiotic. Visual acuity was restored and fuduscopy was normal. In summary, although Lyme disease is an uncommon cause of these neuro-ophthalmic complications, our two patients highlight the importance of considering this disorder as a differential diagnosis and to initiate an early adequate therapy.

The ESPE e-learning webportal: A global tool for instruction and formative assessment of pediatric endocrinology

Abstract: The ESPE e-learning portal (http://www.espe-elearning.org) aims at supporting the learning of cognitive objectives, competencies and skills at two levels: core (medical students) and advanced (fellow/postdoc). It provides a rich source of up-to-date information on various Pediatric Endocrinology topics. The ESPE elearning webportal offers a set of functionalities consisting of a general learning content (chapters, problem solving cases, self-tests, glossary, community) and the option to construct specific courses for an event (ESPE school) or organization: a client, university or institution. Moreover, a set of question types has been developed allowing scoring and assessment of competencies. The content is being expanded and includes chapters and/or cases on the topics of growth, puberty, DSD, calcium and bone, diabetes, hyperinsulinism, thyroidal disorders, adrenal disorders, dis-electrolytemia. Since the portal has been moved to its definite address the global use of the portal has increased: during the period September – December 2013 there were 1264 visits; during the period January-April 2014 there were 2393 visits. The availability of the portal for members and non-members of ESPE needs to be emphasized and needs to be made public widely. Moreover, relevant feedback from users should be translated by the editorial board to make practical improvements. As demonstrated during two courses held in Varna, Bulgaria the portal facilitates the combination of online learning and face-to-face instruction: blended learning. Finally, the next step in extending the impact of the e-learning portal is the further development of learning and competency assessment tools. Furthermore, in demonstrating its applicability at a global level, regional and cultural aspects should be fully recognized.

Dynamics of oxidative status in patients with paroxysmal atrial fibrillation

Abstract: Introduction : Studies have established oxidative disorders in persistent and permanent atrial fibrillation. Our aim was to investigate oxidative status still in the early hours of paroxysmal atrial fibrillation (PAF) and monitor its changes after sinus rhythm (SR) restoration. Material and Methods : Levels of malondialdehyde and total glutathione were determined in plasma (Pl-MDA; Pl-GSH) and erythrocytes (Er-MDA; Er-GSH) together with erythrocyte glutathione peroxidase activity (GSH-Px) in 51 patients (59.84±1.6 years, 26 males). Markers were investigated upon hospital admission, 24 hours and 28 days after SR restoration. They were also determined in 52 healthy subjects (59.50±1.46 years, 26 males). Results : Mean AF duration prior to hospitalization was 8.14±0.76 hours. Upon admission, Pl-MDA and Er-MDA were significantly increased (p 0.05). Conclusion : Disorder of oxidative status is detected in the early hours of PAF, which persists after SR restoration. Oxidative balance is restored slowly with time. This specific dynamics of oxidative status is most likely related to AF clinical course, namely to its manifestation and recurrences.

Clinical Investigations: Somatosensory Evoked Potentials in Full-Term Neonates With Perinatal Asphyxia

Abstract: OBJECTIVE To explore the capacity of somatosensory evoked potentials (SEP) to assess maturation processes in the development of the nervous system, and the characteristics of SEP in healthy full-term infants and full-term newborns with perinatal asphyxia and their follow up until the age of 14 months. MATERIALS AND METHODS SEP were studied in 21 healthy full-term infants and 38 full-term newborns with perinatal asphyxia. The children with asphyxia were studied longitudinally until they were 14 months old. To assess the SEP we measured the latency of the P15, N20 and P25 components, the amplitude ratio N20/P25 and inter-peak intervals P15-N20 and N20-P25. RESULTS The component that was most typically always found in the SEP recordings of both healthy infants and those with perinatal asphyxia was N20. The mean latency values of P15, N20 and P25 were higher in the children with perinatal asphyxia (p < 0.001). The SEP amplitude was highly variable (CoV% = 76.6%). The latencies became shorter with age in asphyxia patients aged 0 to 14 months, the shortening being the greatest in the first trimester, while they showed no statistically significant differences in infants aged 6 to 12 months. CONCLUSIONS SEPs in the neonatal period differ considerably from those of adults and older children in the morphology and longer potential latency, which can be accounted for by the incomplete myelination of nerve fibers. The changes in SEP latency in patients with HIE stages I and II follow the same pattern found in healthy children--latency became shorter with increasing age, which was most pronounced in the first 3 months. SEP latency was found to be correlated with height and age. No differences were found in the latency of potentials between healthy infants and infants with brain hemorrhage. Recording SEP is a sensitive method to assess the CNS in children with perinatal asphyxia and to monitor the maturation of the somatosensory pathway.