Showing papers by "Medical University of Varna published in 2016"

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years.

Abstract: Background—Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no glob...

Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project

Abstract: Over 14 000 patients aged 15-24 are estimated to be diagnosed with cancer in the European Union (EU) each year. Teenagers and young adults (TYA) often fall down gaps between children's and adults cancer services. The specific challenges of providing optimal care to them are described, but we present a summary of recent progress. Progress to overcome these challenges is happening at different rates across Europe. We summarise the European national projects in this field but more recently we have seen the beginnings of European coordination. Within the EU 7th Funding Programme (FP7) European Network for Cancer Research in Children and Adolescents programme (ENCCA), a specific European Network for Teenagers and Young Adults with Cancer has held a series of scientific meetings, including professionals, patients and caregivers. This group has proposed unanswered research questions and agreed key features of a high-quality service that can improve outcomes for TYA with cancer, including the primacy of collaboration between adult and paediatric services to eliminate the gap in the management of TYA with cancer.

Current models of care for disorders of sex development - results from an International survey of specialist centres.

Abstract: To explore the current models of practice in centres delivering specialist care for children with disorders of sex development (DSD), an international survey of 124 clinicians, identified through DSDnet and the I-DSD Registry, was performed in the last quarter of 2014. A total of 78 (63 %) clinicians, in 75 centres, from 38 countries responded to the survey. A formal national network for managing DSD was reported to exist in 12 (32 %) countries. The paediatric specialists routinely involved in the initial evaluation of a newborn included: endocrinologist (99 %), surgeon/urologist (95 %), radiologist (93 %), neonatologist (91 %), clinical geneticist (81 %) and clinical psychologist (69 %). A team consisting of paediatric specialists in endocrinology, surgery/urology, clinical psychology, and nursing was only possible in 31 (41 %) centres. Of the 75 centres, 26 (35 %) kept only a local DSD registry and 40 (53 %) shared their data in a multicentre DSD registry. Attendance in local, national and international DSD-related educational programs was reported by 69, 78 and 84 % clinicians, respectively. Participation in audits/quality improvement exercises in DSD care was reported by 14 (19 %) centres. In addition to complex biochemistry and molecular genetic investigations, 40 clinicians (51 %) also had access to next generation sequencing. A genetic test was reported to be more preferable than biochemical tests for diagnosing 5-alpha reductase deficiency and 17-beta hydroxysteroid dehydrogenase 3 deficiency by 50 and 55 % clinicians, respectively. DSD centres report a high level of interaction at an international level, have access to specialist staff and are increasingly relying on molecular genetics for routine diagnostics. The quality of care provided by these centres locally requires further exploration.

Diet quality in European pre-schoolers : evaluation based on diet quality indices and association with gender, socio-economic status and overweight, the ToyBox-study

Abstract: OBJECTIVE: To study diet quality among pre-schoolers using the Diet Quality Index (DQI) and to investigate differences according to gender, socio-economic status (SES) and overweight/obesity status. DESIGN: Kindergarten-based cross-sectional survey within the ToyBox-study. A standardized protocol was used and parents/caregivers self-reported sociodemographic data and a semi-quantitative FFQ. A total DQI and its four subcomponents (diversity, quality, equilibrium and meal index) were calculated based on this FFQ. High total DQI scores indicate better diet quality than low scores. Results of the total DQI and the subcomponents were reported as percentages of maximum scores (100 %). SETTING: Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). SUBJECTS: European pre-schoolers (aged 3·5-5·5 years) and their parents/caregivers (n 7063). RESULTS: The mean total DQI score was 68·3 %. Mean scores of the subcomponents were 61·7 % for diversity, 56·5 % for quality, 65·4 % for equilibrium and 89·7 % for the meal index. Pre-schoolers of lower-SES backgrounds had lower scores on the total DQI and all its subcomponents. No clear differences were found by gender and overweight status. Results differed slightly according to country. CONCLUSIONS: Pre-schoolers scored low on the total DQI and especially on dietary quality, as energy-dense, low-nutritious food items were more often consumed than highly nutritious food items. Furthermore, already in pre-schoolers lower-SES mothers were less likely to provide a good diet quality and this was consistent for all four subcomponents of the total DQI. Food intake in pre-schoolers should be enhanced, especially in pre-schoolers of lower-SES backgrounds.

Effect and Process Evaluation of a Cluster Randomized Control Trial on Water Intake and Beverage Consumption in Preschoolers from Six European Countries: The ToyBox-Study.

Abstract: Background Within the ToyBox-study, a kindergarten-based, family-involved intervention was developed to prevent overweight and obesity in European preschoolers, targeting four key behaviours related to early childhood obesity, including water consumption. The present study aimed to examine the effect of the ToyBox-intervention (cluster randomized controlled trial) on water intake and beverage consumption in European preschoolers and to investigate if the intervention effects differed by implementation score of kindergartens and parents/caregivers. Method A sample of 4964 preschoolers (4.7±0.4 years; 51.5% boys) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain) was included in the data analyses. A standardized protocol was used and parents/caregivers filled in socio-demographic data and a food-frequency questionnaire. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and for the six country-specific samples. Based on the process evaluation questionnaire of teachers and parents/caregivers, an implementation score was constructed. To assess differences in water intake and beverage consumption by implementation score in the total sample, multilevel repeated measures analyses were performed. Results Limited intervention effects on water intake from beverages and overall beverage consumption were found. However, important results were found on prepacked fruit juice consumption, with a larger decrease in the intervention group compared to the control group. However, also a decline in plain milk consumption was found. Implementation scores were rather low in both kindergartens and parents/caregivers. Nevertheless, more favorable effects on beverage choices were found in preschoolers whose parents/caregivers and kindergarten teachers had higher implementation scores compared to those with lower implementation scores. Conclusion The ToyBox-intervention can provide the basis for the development of more tailor-made interventions. However, new strategies to improve implementation of interventions should be created.

Long-term outcomes of children treated for Cushing's disease: a single center experience.

Abstract: Pediatric Cushing’s disease (CD) is rare and there are limited data on the long-term outcomes. We assessed CD recurrence, body composition, pituitary function and psychiatric comorbidity in a cohort of pediatric CD patients. Retrospective review of 21 CD patients, mean age at diagnosis 12.1 years (5.7–17.8), managed in our center between 1986 and 2010. Mean follow-up from definitive treatment was 10.6 years (2.9–27.2). Fifteen patients were in remission following transsphenoidal surgery (TSS) and 5 were in remission following TSS + external pituitary radiotherapy (RT). One patient underwent bilateral adrenalectomy (BA). CD recurrence occurred in 3 (14.3 %) patients: 2 at 2 and 6 years after TSS and 1 7.6 years post-RT. The BA patient developed Nelson’s syndrome requiring pituitary RT 0.6 years post-surgery. Short-term growth hormone deficiency (GHD) was present in 14 patients (81 % patients tested) (11 following TSS and 3 after RT) and 4 (44 % of tested) had long-term GHD. Gonadotropin deficiency caused impaired pubertal development in 9 patients (43 %), 4 requiring sex steroid replacement post-puberty. Four patients (19 %) had more than one pituitary hormone deficiency, 3 after TSS and 1 post-RT. Five patients (24 %) had long-term psychiatric co-morbidities (cognitive dysfunction or mood disturbance). There were significant long-term improvements in growth, weight and bone density but not complete reversal to normal in all patients. The long-term consequences of the diagnosis and treatment of CD in children is broadly similar to that seen in adults, with recurrence of CD after successful treatment uncommon but still seen. Pituitary hormone deficiencies occurred in the majority of patients after remission, and assessment and appropriate treatment of GHD is essential. However, while many parameters improve, some children may still have mild but persistent defects.

Vitamin K2 Improves Anxiety and Depression but not Cognition in Rats with Metabolic Syndrome: a Role of Blood Glucose?

Abstract: Background The metabolic syndrome is a socially important disorder of energy utilization and storage, recognized as a factor predisposing to the development of depression, anxiety and cognitive impairment in humans. Aim In the present study we examined the effects of vitamin K2 on the behavior of rats with metabolic syndrome and looked for relationships with the effects on blood sugar. Materials and methods Male Wistar rats were divided in four groups: a control group on a regular rat chow, a metabolic syndrome (MS) group fed a high-fat high-fructose diet, a control group treated with vitamin K2 and a MS group treated with vitamin K2. Vitamin K2 was given by gavage. At the end of the study (after 10 weeks) behavioral tests were performed and fasting blood glucose was measured. Anxiety was determined using the social interaction test and depression was assessed by the Porsolt test. Memory effects were estimated by the object recognition test. Correlations between fasting blood glucose and behavioral performance were analyzed. Results The rats from the MS group had elevated blood glucose. They had anxiety, depression and memory deficit. Vitamin K2 normalized blood glucose, reduced anxiety and depression, but did not improve memory. Time of social interaction (inverse index of anxiety) and memory recognition were negatively correlated with blood glucose in the untreated rats but the immobility time (measure of depression) was not. When vitamin K2-treated rats were added, the correlation of blood glucose with the time of social interaction was kept, but the one with the recognition memory was lost. It might be that the anxiolytic effect of vitamin K2 in this setting is at least partly due to its effects on blood glucose, while the anti-depressant effect is glucose-independent. Conclusion The present study demonstrated that vitamin K2 prevented the development of anxiety and depression, but did not improve the memory deficit caused by the dietary manipulation in an experimental model of metabolic syndrome. It might be that the anxiolytic effect of vitamin K2 is at least partly due to its effects on blood glucose, while the antidepressant effect is glucose-independent.

Can Parenting Practices Explain the Differences in Beverage Intake According to Socio-Economic Status: The Toybox-Study.

Abstract: Previous research indicated that preschoolers of lower socioeconomic status (SES) consume less healthy beverages than high SES preschoolers. The purpose of this study is to investigate the mediating role of parenting practices in the relationship between SES and plain water, soft drink and prepacked fruit juice (FJ) consumption in European preschoolers. Parents/caregivers of 3.5 to 5.5 years old (n = 6776) recruited through kindergartens in six European countries within the ToyBox-study completed questionnaires on socio-demographics, parenting practices and a food frequency questionnaire. Availability of sugared beverages and plain water, permissiveness towards sugared beverages and lack of self-efficacy showed a mediating effect on SES-differences in all three beverages. Rewarding with sugared beverages significantly mediated SES-differences for both plain water and prepacked FJ. Encouragement to drink plain water and awareness significantly mediated SES-differences for, respectively, plain water and prepacked FJ consumption. Avoiding negative modelling did not mediate any associations. Overall, lower SES preschoolers were more likely to be confronted with lower levels of favourable and higher levels of unfavourable parenting practices, which may lead to higher sugared beverage and lower plain water consumption. The current study highlights the importance of parenting practices in explaining the relation between SES and both healthy and unhealthy beverage consumption.

MECHANICAL PROPERTIES OF DENTAL Co-Cr ALLOYS FABRICATED VIA CASTING AND SELECTIVE LASER MELTING

Abstract: The aim of the present paper is to investigate the mechanical properties (hardness and tensile strength) of dental Co-Cr alloys fabricated via casting and selective laser melting (SLM). Two groups of metallic specimens (four-part dental bridges and standard tensile test specimens) made of Co–Cr dental alloys were produced by lost-wax casting and SLM processes. Vickers hardness distribution along the depth of the dental bridges as well as the Rockwell hardness and tensile strength of the samples were studied out. The hardness of Co–Cr dental alloys are dependent on the manufacturing technique employed. It was established that the average Vickers hardness of the samples, produced by SLM, was higher than that of the cast samples 382 HV and 335 HV respectively. The nearly even hardness distribution in the bridges, produced by SLM, and fluctuations of the hardness values along the depth of the cast bridges were observed. The Rockwell measurements confirmed the higher hardness of the SLM samples – 39 HRC in comparison with that of the cast ones – 33 HRC. The tensile strength is in good agreement with the hardness values. Due to the unique microstructure, the yield strength and tensile strength for the SLM samples were higher than those of the as-cast alloy.

Tinea profunda of the genital area. Successful treatment of a rare skin disease

Abstract: We present a rare case of 36-year-old female patient, who developed a severe Majocchi granuloma in the pubis after waxing, with isolated causative agent Trichophyton mentagrophytes. The condition was initially misdiagnosed as a bacterial folliculitis and treated unsuccessfully with topical corticosteroids and antibiotics. After the adequate diagnose was confirmed by mycological examination, followed by histopathological verification, complete remission of the symptoms was achieved at the 4th week after initiating 6 weeks course of antifungal therapy with Terbinafine 250 mg/daily dose, while good therapeutic response was observed even in the 10th day. The etiopathogenesis of the disease, as well as its current treatment options are considered, in respect to the rare occurrence of this condition in the pubic area and its frequent misdiagnosis.

Eyelid Reconstruction with Full Thickness Skin Grafts After Carcinoma Excision.

Abstract: Background Various techniques have been proposed for reconstruction of the eyelid anterior lamella after carcinoma excision: among these are the transposition of skin flaps, and full-thickness skin grafts or combination of these two. Aim To present our experience in eyelid reconstruction with full-thickness skin grafts and to assess the aesthetic and functional outcomes. Patients and methods The present retrospective study included 39 patients (20 males, 19 females, mean age 71 yrs) with surgically excised eyelid carcinoma, followed by reconstruction using full-thickness skin grafts. The patients were treated between 2005 and 2014. Parameters recorded were patient demographics, histological classification of malignancy, tumor localization and size, postoperative defect size. In cases of large full-thickness lower lid defect Hughes tarsoconjunctival flap was used for reconstruction of posterior lamella. Full-thickness skin grafts donor sites included upper eyelid, preauricular area and inner brachial area. We appraised the grafts viability one week after surgery and the aesthetic results - 6 months after surgery by the graft colour and lid position. Results In 95% of the cases the skin grafts were viable. The full-thickness skin graft (FTSG) failed in two patients because of subcutaneous haematoma. There were a few early postoperative complications including graft hypertrophy, graft contraction, and partial graft failure, which were managed without additional surgery. All 39 patients had normal postoperative lid function. All 39 had either good (14) or excellent (25) cosmetic results. Conclusions Our findings suggest that full-thickness skin graft is a good choice in periocular reconstructive surgery after carcinoma excision. The surgical technique is easy to perform producing proper functional and aesthetic results.

Immunophenotypic Modulation of the Blast Cells in Childhood Acute Lymphoblastic Leukemia Minimal Residual Disease Detection.

Abstract: UNLABELLED Early clearance of leukemic cells during induction therapy of childhood acute lymphoblastic leukemia (ALL) is a basis for treatment optimization. Currently, the most widely used methods for the detection of minute residual malignant cells in the bone marrow and/or peripheral blood, minimal residual disease (MRD), are PCR and flow cytometry (FCM). Immunophenotypic modulation (IM) is a well known factor that can hamper the accurate FCM analysis. AIM To report the IM detected by 8-color FCM during the BFM-type remission induction in 24 consecutive MRD-positive samples of children with B-cell precursor ALL and the possible implications for MRD detection. PATIENTS AND METHODS Between 2010 and 2012 we prospectively followed up the MRD on days 15 and 33 of induction treatment in bone marrow (BM) samples and on day 8 in peripheral blood (PB). The IM was assessed by comparative analyses of the changes in the mean fluorescence intensity of 7 highly relevant antigens expressed by the leukemic cells and normal B-lymphocytes. RESULTS IM occurred, to different extents, in all analyzed day 15 BM and in most day 33 BM samples. Statistically significant changes in the MFI-levels of four CDs expressed by the leukemic blasts were observed: downmodulation of CD10, CD19 and CD34 and upmodulation of CD20. No changes in the expression of CD38, CD58 and CD45 were noticed. CONCLUSIONS Measuring the MRD by standardized 8-color flow cytometry helps improve the monitoring of the disease, leading to better therapeutic results. However, the IM of the different antigens expressed by the leukemic blasts should be taken into consideration and cautiously analyzed.

Accuracy of polymeric dental bridges manufactured by stereolythography

Abstract: Purpose: Purpose of this paper is to investigate the accuracy of dental bridges produced via digital light projection stereolithography process. Design/methodology/approach: 3D printer Rapidshape D30 was used for manufacturing of two groups of samples – temporary four-part bridges and cast patterns for permanent bridges. The temporary bridges were made of NextDent C+B polymer, while the cast patterns of NextDent Cast. The samples were manufactured with different layer’s thickness (0.035 mm and 0.050 mm). The geometrical and adjusting accuracy were investigated by measuring of the samples’ dimensions and silicone probe, while the surface roughness was studied out by profile meter and optical microscopy. Findings: It was established that the dimensions of the temporary bridges and the cast patterns, printed with layer thickness 50 μm, are larger than that of the virtual 3D model with 0.1-0.3 mm. Decreasing the layer thickness to 35 μm leads to 0.29%-1.10% smaller sizes of dental bridges and cast patterns in comparison to that of the virtual 3D model. The average roughness deviation Ra of the 3D printed temporary bridges and cast patterns is larger than that of the initial model. As the surface roughness depends on the layer’s thickness, the samples with 0.035 mm layer characterize with lower Ra values. The silicone probe shows that the temporary bridges as well as the cast patterns need additional adjusting in the dental office or corrections during design of the virtual 3D model and 3D printing process in the dental laboratory. Practical implications: The stereolithography as part of CAD/CAM manufacturing process characterizes with high accuracy as a whole. But present study reveals that additional adjusting or preliminary corrections of the design of 3D printing process are needed for dental constructions produced by SLA. Originality/value: The geometrical and fitting accuracy as well as the surface roughness of dental bridges, produced by stereolithography were evaluated. The data, shown in the present study, will help dentists and dental technicians to precise the manufacturing regimes for production of dental constructions with high accuracy.

3D-printing in contemporary prosthodontic treatment

Abstract: The purpose of the present paper is to make a review of the applications for 3D-printing in contemporary prosthetic treatment as this modern technology has become widely spread not only in the industry but in medicine and dentistry, too. It is a form of additive manufacturing technology where a three-dimensional object is created by laying down successive layers of material.

JC polyomavirus in the aetiology and pathophysiology of glial tumours

Abstract: Glial brain tumours with their poor prognosis, limited treatment modalities and unclear detailed pathophysiology represent a significant health concern. The purpose of the current study was to investigate and describe the possible role of the human polyomavirus JC as an underlying cancerogenic or co-cancerogenic factor in the complex processes of glial tumour induction and development. Samples from 101 patients with glial tumours were obtained during neurosurgical tumour resection. Small tissue pieces were taken from several areas of the histologically verified solid tumour core. Biopsies were used for DNA extraction and subsequent amplification reactions of sequences from the JC viral genome. Real-time polymerase chain reaction was used for detection and quantification of its non-coding control region (NCCR) and gene encoding the regulatory protein Large T antigen (LT). An average of 37.6% of all patients was found to be LT positive, whereas only 6.9% tested positive for NCCR. The analysis of the results demonstrated significant variance between the determined LT prevalence and the rate for NCCR, with a low starting copy number in all positive samples and threshold cycles in the range of 36 to 42 representing viral load in the range from 10 to 1000 copies/μl. The results most probably indicate incomplete JC viral replication. Under such conditions, mutations in the host cell genome may be accumulated due to interference of the virus with the host cell machinery, and eventually malignant transformation may occur.

Bad breath and its association with age and gender

Abstract: Halitosis is a health condition associated with an unpleasant odor from the oral cavity. The origin of bad breath may be related to systemic and oral conditions, but the large percentage of cases (about 85%) are related to oral factors. Our aim was to investigate the presence and degree of halitosis in healthy patients and to compare it accordance with age and gender. We examined 79 healthy patients with an apparatus to measure bad breath - HC-212SF FitScan Breath Checker of Tanita Corporation of America, Inc. We obtained a result of 0.87 for the group under 18 years old, 1 for the group 19-51 years old and 1.5 for the group over 51 years. In our study the average value was 0.88 for men and 1.39 for women. Of all tested persons about one-third did not show any bad smell, while 77 percent have some degree of positive result. Considering the condition in relation to gender, we observed that 43% of men and 25% of women do not have a bad odor from the mouth. About 29% had the lowest positive value (1), value 2 about 28% and only 1.3% had a very high degree of halitosis. This study indicates augmentation of the values of bad breath with the increasing of age. Women have a bad smell from the mouth more often. In all age groups we observed higher degree of bad breath in women.

Serum levels of RIPK3 and troponin I as potential biomarkers for predicting impaired left ventricular function in patients with myocardial infarction with ST segment elevation and normal troponin I levels prior percutaneous coronary intervention.

Abstract: The current study examined the serum levels of receptor-interacting protein kinase 3 (RIPK3) in 51 patients with New York Heart Association (NYHA) class III-IV heart failure, 53 patients with myocardial infarction with ST elevation (STEMI), and 19 healthy subjects serving as a control group. An enzyme-linked immunoadsorbent assay (ELISA) was used to measure the levels of RIPK3 expression in serum. The area under the receiver operating characteristic curve (AUC) was then used to evaluate the predictive performance of RIPK3 and troponin I in patients with STEMI. In patients with normal levels of troponin I prior to percutaneous coronary intervention (PCI), serum levels of RIPK3 and troponin I after PCI were sufficient to differentiate patients with a preserved left ventricular ejection fraction (LVEF) from those with impaired left ventricular function after PCI (AUC = 0.780 (95% CI: 0.565-0.995, p = 0.043) with a sensitivity of 76.9% and a specificity of 71.4% vs. AUC = 0.735 (95% CI: 0.530-0.941, p = 0.038) with a sensitivity of 88.2% and a specificity of 63.6% at the optimal cutoff values, respectively). Moreover, elevated levels of troponin I after PCI were associated with an increased risk of an LVEF < 50% prior to discharge (odds ratio, 1.014; 95 % CI, 1.001 to 1.027; p = 0.03), while elevated levels of RIPK3 were not associated with such a risk. The current findings suggest that in patients with normal levels of troponin I prior to PCI, serum levels of RIPK3 and troponin I can serve as a potential marker to identify patients with a decreased LVEF, thus possibly allowing an early shift to more intensive therapy.

Tribo corrosion behavior of cast and selective laser melted Co Cr alloy for dental applications

Abstract: Cobalt-chromium based alloys are widely used in dental applications due to their excellent mechanical properties, high corrosion resistance and good biocompatibility. Although they are generally fabricated by casting for dental restorations, recently selective laser melting (SLM) has become an attractive production method since it allows complex geometries. Recent studies revealed that Co-Cr alloys formed by SLM, provided better corrosion resistance as well. In this study, tribo-corrosion behavior of a Co-Cr-Mo alloy produced by casting (Biosil-Degudent) was compared with the one (Co212-f ASTM F75) produced by SLM. The wear properties were investigated by tribo-corrosion tests in a Fusayama-Meyer artificial saliva solution using a “ball-on-disc” type tribometer. Polished surfaces were tested against zirconia balls at the same sliding speed, distance and load. Friction coefficient values were determined and the worn surfaces were evaluated using microscopes to compare the wear and tribo- corrosion resistance through wear tracks. SLM proved to be a promising manufacturing method for dental applications.

Does Driver Suicide Occur in Iran

Abstract: Background: Iran has a relatively low suicide rate and the highest road death rate in the world. Objectives: To explore the possibility that driver suicide occurs in Iran. Methods: Examination of the relevant suicide and road traffic literature. Results: Suicide in Iran includes self-immolation, hanging and other violent methods. It is stigmatized and suicidal intent and actions may be denied. The choice of suicide method depends on availability and culture. Driver suicide is reported in many countries and represents a small percentage of the total number of suicides. It is a method which may hide the fact of suicide and suggest accident. We could find no report of driver suicide from Iran. Conclusions: There is great interest in reducing the road toll in Iran. Driver suicide may be occurring but not being reported. If driver suicide has a role in the road deaths of Iran, identification and quantification would be helpful.

Possibilities of 3D printer Rapidshape D30 for manufacturing of cubic samples

Abstract: The purpose of the present paper is to establish experimentally the possibilities of the 3D printer Rapidshape D30 for the manufacturing of standard cubic samples from different types of monomers and to evaluate their geometrical accuracy and roughness. Standard cubic samples with dimensions 5mm х 5mm х 5mm were printed from all the materials, given by the producer, in two ways of dimensional orientation according to the base – horizontally and inclined at 45о. They were manufactured with 3D printer Rapidshape D30, working on a stereolithography principle with LED light. It was established that: ❖❖ The samples, made of NextDent Surgical Guide, have the highest dimensional accuracy and the lowest deviation interval in both ways of placement. This polymer is characterized with the highest thickness of the polymerization layer – 0.100 mm, but it is transparent, thus ensuring the entire polymerization throughout the depth of the whole layer. NextDent C+B, intended for manufacturing of temporary crowns and bridges, occupies a middle position in comparison to the other 6 materials. ❖❖ Nearly in all the materials the surface roughness of the cube with horizontal placement is lower than that of the cube printed inclined (average values of Ra 0.46-2.69μm and Ra 1.74-2.77, respectively). ❖❖ In 3D printing the surface roughness depends on the thickness of the polymerization layer and the inclination to the printing direction. The thicker the polymerization layer and the larger the slope, the higher the surface roughness.

Conceptual and methodological approaches to quality of life - a public health perspective

Abstract: Quality of life is a major goal in the context of public health. It is important, both as a needs assessment tool and as an outcome measure in health promotion interventions. QoL has been frequently measured but seldom explicitly defined. The aim of this article is to discuss a wide range of conceptual and methodological issues related to QoL. The classical Being-Belonging-Becoming approach is presented. Further, the methodology for QoL assessment covers a wide range of topics. It involves the taxonomy of QoL definitions, a classification of QoL instruments, and recommendations how to choose the right questionnaire with the relevant psychometric properties. There is a need for more research based on carefully selected measures of QoL chosen as being of particular importance to individuals and to the hypotheses being tested. Measuring health rather than disease is a methodological challenge which has recently received more attention and should be further explored in target-setting exercises at a community level.

Unilateral unique Lupus tumidus: pathogenetic mystery and diagnostic problem

Abstract: Lupus tumidus is a rare immunological disorder whose pathogenesis is not fully understood. Although on the one hand there are some differences in (1) the clinical morphology of lesions, (2) the histopathology picture, as well as in (3) serological profile of lupus tumidus patients at the current moment, the disease is regarded as a subform of chronic cutaneous lupus erythematosus. Differential diagnosis requires the exclusion of many diseases such as Jessner Kanoff lymphocytic infiltration, polymorphous light eruption, and reticular erythematous mucinosis. Differentiation between them is not always easy. The standard treatment regimen of patients with lupus tumidus is based on local and systemic application of corticosteroids, azathioprin, dapsone, mepacrine, chloroquine, and hydroxychloroquine. Modern treatment options include the use of pulsed dye laser, tacrolimus 0.1 % ointment and photophoresis. We present a 42-year-old patient with unilateral atypical form of lupus tumidus who was successfully treated with systematically administration of hydroxychloroquine in combination with sunscreen SPF 50. After a 2-month course of treatment with hydroxychloroquine dosage of 200 mg per day and a break of 3 months between courses, we observed a complete remission.

Association between vitamin D status and obesity in Bulgarian pre-pubertal children: a pilot study

Abstract: Background: It is considered that obesity and metabolic syndrome are accompanied with vitamin D deficiency. We aimed to examine the interrelations between vitamin D status and biomarkers for metabolic syndrome in Bulgarian pre-pubertal children. Methods: The study enrolled 51 pre-pubertal children (29 boys, 22 girls) examined for serum 25-xydroxyvitamin D, and routine parameters for metabolic syndrome. Obesity was evaluated by body mass index and waist circumference. Results: More than half (57.1%) of the studied children were vitamin D deficient, prevalent in girls than in boys (65.0% vs. 51.7% respectively). A tendency for worse metabolic status in the vitamin D-deficient group, expressed by higher fasting insulin, total cholesterol, total cholesterol/HDL-ratio and Homeostasis Model Assessment (HOMA)-index was observed. A trend for negative correlation was established between 25-xydroxyvitamin D and waist circumference, HOMA-index, and fasting insulin. Conclusions: Vitamin D deficiency and inverse relationships between 25-xydroxyvitamin D and waist circumference, HOMA-index, and insulin were found amongst studied children.

Vitamin D status in patients with psoriasis

Abstract: Introduction : Vitamin D may act as immune modulator in psoriasis and be related with disease characteristics. Our study aimed to evaluate the vitamin D status in patients admitted for diagnostics or exacerbation of psoriasis. Material and methods : 92 patients (50 male, 42 female, mean age 55 years) were included in analysis. Disease severity was assessed by Psoriasis Area and Severity Index (PASI). Type of disease was classified according to age at presentation as early (up to 40 years) and late (above 40 years). Serum levels of 25-hydroxyvitamin D, 25(OH)D, were tested with immune fluorescent method (ADVIA Centaur Vitamin D Total, Siemens). Results : The mean level of 25(OH)D in psoriatic patients was 12.07 ng/ml (30.18 nmol/l), found at low limit of insufficiency; related 95% CI range was 10.55 - 13.60 ng/ml (26.38 - 33.99 nmol/l). A total of 45 of 92 patients (48.9%) had vitamin D insufficiency (defined as 25 (OH) D level of 10 to 30 ng/ml), 44 patients (47.82%) had deficiency (< 10 ng/ml) and only in 3 patients 25(OH)D was assessed at level of sufficiency. Vitamin D level correlate with PASI (r=-0.508), but does not correlate with C-reactive protein. No significant difference in vitamin D status was observed in patients with obesity and early type 1 psoriasis. Conclusion : High prevalence (47.83%) of vitamin D deficiency in patients with moderate and severe psoriasis suspects the role of vitamin D in pathogenesis of disease exacerbation. Vitamin D therapeutic supplementation needs to be clarified by further studies.

Surgical complications and unwated events in the modern percutaneous vertebroplasty treatment

Abstract: Aim and object of the study. The modern spinal surgery accepts the percutaneous vertebroplasty (PV) with polymethylmethacrylate(PMMA) as routine procedure for treatment of painful osteoporotic, neoplastic and traumatic compression fractures in the thoracic and lumbar region of the spinal column. Although considered to be minimal invasive and safe procedure, it could be complicated with severe disabling and even life-threatening complications. The aim of the present study is to evaluate the different potential complications with their clinical presentation, diagnostics and different treatment options. Methods : The study analyzes a cohort of 56 consecutive patients (66 levels) treated with PV in our clinic for the period January 2008 - July 2012. Of them 31(55,4%) are women and 25(44,6%) are men with mean age of 61,7 (23 - 80) years. The osteoporotic and traumatic compression fractures subgroup comprises of 44 (78,6%) patients, while the patients with neoplastic fractures are 12(21,4%). All the fractures are classified as A1 Magerl`s fractures with no neurologic deficit. Results : Complications and unwanted events are registered in 9(16,1%) patients. Of them 2 experienced transient increased pain syndrome intensity, one of the patients presented with index level radiculopathy, 2 patients were diagnosed with extravertebral leakage of the cement in the spinal canal with compression of the neural structures and subsequently operated, 1 patient had cement leak in the adjacent disk, 2 patients cement leak in the paravertebral soft tissues and the paravertebral venous system and one with cement pulmonary embolism. Conclusion : PV is minimal invasive and effective procedure that is used in the treatment of the painful osteoporotic, traumatic and neoplastic compression fractures on neurologically intact patients. The clinically significant complications and unwanted events are relatively rare encounter and in the majority of the cases are treatable with conservative measures. The epidural cement migration with neural elements compression is the only one indication for surgical decompression and removal of the compressing cement.

SPAs and wellness – a new philosophy for harmony in life

Abstract: The article reveals the development of spa therapy through the years and centuries and its revival by receiving renewed attention from many medical specialties and health tourists. According to their character spas nowadays reflect the progress of science and culture of mankind. The accent is on the contemporary understanding of spa which is based on health promotion and prevention of illnesses. The idea for health prophylaxis has reached a higher level which serves as a base for thefoundations of wellness conception. The idea of this conception is aspiration for achieving complete prosperity of the human personality by synergy of all aspects of health - physical, mental, intellectual, emotional and social.

Types of caregivers

Abstract: Поради голямото многообразие от извършвани дейности, място на работа и квалификация, болногледачите са известни с различни наименования по света. Общото, което ги свързва, е полагането на подкрепящи грижи за болен или недееспособен човек. Те подпомагат работата на медицинския персонал и освен това са източник на подкрепа както за нуждаещите се лица, така и за техните семейства. Болногледачите изпълняват своите задължения с непрестанна всеотдайност и съпричастие към физическото и емоционално състояние на пациента. Работата им в домашни условия често е гаранция за поддържане на добрите взаимоотношения в семействата. Изпълнителите на подкрепящи грижи придобиват все по-голяма актуалност поради нарастващата необходимост от надежден човек, който да полага грижи за болен роднина, инвалид или дете в семейството. Настоящата статия разглежда разновидностите на тези здравни професионалисти и техните специфични задължения.

Botulinum neurotoxin – Biochemical aspects and mechanism of action (Review)

Abstract: Ботулиновият невротоксин (BoNT) е една от най-силните биологични субстанции, познати на човечеството. Продуцира се от спорообразуващи анаеробни бактерии Clostridium botulinum, които причиняват заболяването ботулизъм. BoNT блокира освобождаването на невротрансмитера ацетилхолин, провеждащ нервните импулси до мускулните влакна. По този начин токсинът косвено предизвиква мускулна парализа. Тази негова животозастрашаваща способност обаче се оказва изключително ефективна при терапия на редица заболявания, свързани с абнормна хиперактивация на мускули и жлези, естетически корекции на глаберални бръчки и други. Известни са девет серотипа на BoNT, наименовани с латинските букви от А-Н (BoNT-C е разделен на два типа), като типовете А, B, E и F причиняват ботулизъм при човека. Според някои автори са изследвани и изолати от хора, съдържащи BoNT-G. Изследват се и редица нови направления в медицинската практика, където BoNT може да се приложи ефективно - детска церебрална парализа, хронични анални фисури, урологични смущения и други.

Some aspects of the conservative treatment and prevention of lumbar disc disease

Abstract: INTRODUCTION : Lumbar disc disease is a degenerative disease of the intervertebral discs of the spine. It usually affects the lower portion of the spine. AIM : To summarize the main physiotherapeutic approaches for prophylactic and treatment of the lumbar disc disease. MATERIALS AND METHODS : Analysis of literary sources. RESULTS : There is a significant link between disc degeneration and lower back pain. The first group of com­plaints is more and more common in young people between 20 and 30 years of age. CONCLUSION : An adequately conducted treatment and prophylactic measures have a big impact when it comes to improving the quality of life of the patients.