Plan de internacionalización de Wanna: estudio de mercado y método de entrada

En este trabajo se tratará de realizar un plan de internacionalización de una PYME española que fabrica un producto innovador y exclusivo, un plato amoldable denominado Wanna. Para el desarrollo de este proyecto se han abarcado diversas materias relacionadas con el Máster en Comercio Exterior. En primer lugar, se ha analizado la situación del fabricante y se han estudiado los posibles países para efectuar la primera entrada internacional. En segundo lugar, se ha profundizado en el examen del mercado objetivo y las estrategias de entrada. Al final se elabora el método de venta, transporte y promoción en el mercado exterior. Los aspectos no abarcados en el proyecto quedan como pendientes para futuros trabajos.Máster en Comercio Exterio

Predictive Role Of Neutrophil Gelatinase-Associated Lipocaline As An Early Marker For Kidney Injury In Patients With Diabetes Mellitus

Diabetic kidney disease (DKD) is a chronic complication of diabetes mellitus leading to increased cardiovascular morbidity and mortality, and a risk of developing an end-stage renal disease (ESRD). Diabetic nephropathy is a disease affecting mainly the glomerulus, however, a number of studies indicate the predictive role of tubulo-interstitial lesions in the development and the progression of diabetic nephropathy. Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most promising tubular biomarkers in the diagnosis of kidney disease. The data in the literature determine NGAL as a marker with a good diagnostic profile in the diagnosis of DKD.  Neutrophil gelatinase-associated lipocalin values correlate with the progression of the albumin excretion, with the decrease in the glomerular filtration rate and with the severity of renal impairment.  Neutrophil gelatinase-associated lipocalin is defined as an early marker of DKD, which establishes the development of renal dysfunction before the increase in albumin excretion. The evaluated cut-off values demonstrate good to high efficacy of NGAL in discriminating DKD patients with normal albumin excretion from healthy individuals. Several studies have indicated NGAL as an indicator of DKD progression, stratifying the risk of developing ESRD, patients with diabetes with higher NGAL levels have a faster and earlier decline in renal function. However, NGAL is a modulator of insulin signalling and its levels are elevated in patients with diabetes without DKD. Elevated levels of NGAL may be the result of common concomitant diseases of diabetes—cardiovascular disease and urinary tract infections. Additional studies are needed to assess the clinical applicability of NGAL in the diagnosis of DKD

Tuberculosis as a potential pitfall on FDG PET/CT in patients with Hodgkin`s lymphoma - a case report

FDG-PET is an essential diagnostic tool in the management of Hodgkin's lymphoma (HD). However, a lot of benign conditions are well-known to present with high FDG uptake thus mimicking malignant activity. Tuberculosis (TBC) is an infection with known high FDG accumulation and should be suspected in patients with lymphoma and those treated with chemotherapy.CASE REPORT: We present a 19-year old female with mediastinal Hodgkins lymphoma who had discrete lung changes on presentation. After initial chemotherapy, patients status worsened, with CT scan showing complete resolution of the mediastinal mass along with progression in the lung. Patient was restaged and mediastinal and lung involvement was proven. Therapy was escalated with further worsening and newly found liver lesions. TBC was clinically suspected although not objectively proven. FDG PET scan revealed high activity infiltrative lung changes, diffuse pleural activity, active liver lesions and celiac lymph nodes. However, changes could not be addressed as malignant, due to TBC or to both. Pleural biopsy revealed TBC. Patient received anti-TBC treatment only. The follow-up FDG PET scan revealed almost complete resolution of all the changes consistent with complete remission of the lymphoma and good treatment response of TBC.CONCLUSION: Based on initial CT report we consider this case a coexistence of TBC and HD at initial presentation with further worsening rather than a newly-developed TBC on an immunosupressed ground. FDG PET is an excellent tool in HD management, but falsely positive results from TBC should be kept in mind, especially when lung in involved.Scripta Scientifica Medica 2013; 45(1): 82-84

Osteоcalcin, BAP and Vitamin D - specific bone markers in CKD and hemodialysis patients

Костните и минерални нарушения (КМН) при ХБЗ са все по-задълбочено проучвани, профи-лактирани и лекувани, но въпреки това си остават едни от най-тежките системни и прогреси-ращи заболявания при пациентите с хронични бъбречни заболявания. Вторичният хиперпаратиреоидизъм (ВтХПТ) е едно от честите усложнения на ХБЗ (хронично бъбречно заболяване), което променя минералния баланс с развитие на костно-минерални нарушения (КМН) и мекотъканни калцификати. При намаляване на гломерулната филтрация (GFR<60 ml/min) фосфорният клирънс се понижава значимо и това води до ретенция на фосфор, стимулиране на синтеза и секрецията на ПТХ (8). Диализното лечение е бъбречнозаместващ метод, който продължава живота на болните с ХБЗ, временно подобрява наличната костна патология, но по-често ускорява прогресирането й. Ето защо симптомите, развитието и усложненията на КМН - ХБЗ, се демонстрират и изявяват при пациентите на екстракорпорално лечение. Лечението на костно-минералните нарушения изисква постоянно мониториране на Са-Р обмяна, PTH (паратиреоиден хормон), серумните нива на Вит. D и белтъчните костни маркери - остеокалцин, костна алкална фосфатаза - ВАР. Системното приложение на активните метаболити на витамин D, фосфат-свързващи ве щества и калцимиметици при много от пациентите с ВтХПТ променят биохимичния контрол. В Клиниката по диализа в УМБАЛ „Св. Марина` ЕАД се проследиха и сравниха серумните нива на биомаркерите - ВАР, Osteocalcin, Vit D, при две групи болни - на ХД и ХБЗ - 2 / 3 стадий с ВтХПТ. Резултатите показват статистически значими разлики между двете групи в изследваните серумни нива на показателите.Bone and mineral disorders (BMD) in chronic kidney disease (CKD) are more thoroughly studied, prevented, and treated, but remain among the worst systematic and progressive diseases in patients with CKD. Secondary hyperparathyroidism (sHPT) is one of the common complications of CKD. It changes the mineral balance with the development of BMDs or soft tissue calcifications. In the reduction of glomerular filtration (GFR <60 mL/min), phosphorus clearance is significantly reduced and this results in phosphorus retention, stimulation of parathyroid hormone (PTH) synthesis and secretion. Dialysis treatment is a renal replacement method that prolongs the life of patients with CKD. It temporarily improves the existing bone pathology, but more often accelerates the progression. That is why symptom development and complications of BMD in CKD demonstrate and manifest in the patients` extracorporeal treatment. The treatment of bone mineral disorders requires continuous monitoring of the Ca-P exchange, PTH, vitamin D serum levels and the protein bone markers - osteocalcin, bone alkaline phosphatase (BAP). The systemic use of active metabolites of vitamin D, phosphate binders, and calcimimetics in many patients with sHPT alters the biochemical control. At the Clinic of Dialysis of St. Marina University Hospital, Varna, the serum levels of biomarkers - BAP, osteocalcin, vit D were followed and compared in two groups of patients - on hemodialysis and with CKD - 2/3 stage with sHPT. The results showed statistically significant differences between the two groups in the tested serum levels of the indicators

Tracing and comparing serum, specific, bone biomarkers in patients with secondary hyperparathyroidism

Bone and mineral disorders (BMDs) in chronic kidney disease (CKD) are increasingly being studied, and prophylaxis and treatment are conducted, but they still remain one of the most severe systemic illnesses in patients with CKD.In patients with end-stage CKD and secondary hyperparathyroidism, accompanying metabolic disorders of calcium and phosphorus homeostasis may lead to pathological changes in bone and blood vessels, which increase the risk of bone fractures and cardiovascular (CV) events. High levels of parathyroid hormone (PTH), calcium and phosphorus are associated with increased morbidity and mortality in dialysis patients.Dialysis treatment is a renal replacement method that continues the life of patients with CKD, temporarily improving existing bone pathology, but it more often accelerates its progression. Therefore, the symptoms, developmental and complications of BMD-CKD are demonstrated and manifested in patients with extracorporeal treatment.Treatment of BMD requires constant monitoring of Ca-P exchange, PTH, serum of Vitamin D levels and the protein bone markers - osteocalcin, bone alkaline phosphatase.Despite the systemic use of active metabolites of vitamin D, phosphate binders and calcimimetics, in many patients with secondary hyperparathyroidsm, inadequate biochemical control has been observed.In the Dialysis Clinic at St. Marina University Hospital, Varna, two groups of patients on hemodialysis (HD) and with CKD - 2/3 stage with secondary hyperparathyroidism, were followed and had their serum biomarker levels compared - PTH, bone alkaline phosphatase (BAP), osteocalcin, and vitamin D. The results showed statistically significant differences between the two groups in the investigated serum levels of the indicators

The Comparison Of Automated Urine Analysis With Manual Microscopic Examination For Urinalysis

Увод: Уринният анализ е един от най-често извършваните в клиничната лаборатория. Той дава важна информация за заболявания на отделителната система. Микроскопското изследване на седимент отнема време и няма възможност за стандартизация.Цел: Целта на изследването е да се съпоставят резултатите за уринен седимент от автоматичен анализатор и микроскопски анализ.Материали и методи:Уринни проби (n = 92) бяха изследвани на уринен анализатор за определяне на уринен седимент FUS–100 и на камера на Fuchs-Rosenthal. Сравнени бяха резултатите за еритроцити и левкоцити.Резултати: За изследваната група уринни проби бяха изчислени: средна стойност за левкоцити за автоматичен анализатор 163 ±77/μl, а за левкоцити на микроскоп 201 ± 45/μl. Средната стойност за еритроцити на автоматичен анализатор е 47 ±48,5/μl, а за еритроцити на микроскоп 22 ± 13,5/μl.След статистически анализ на резултатите с T-test на Student (p < 0.05) се установи статистически значима разлика при изброяване на левкоцити (p = 0.04) и еритроцити (p = 0.00081) посредством двата изследвани метода.Обсъждане:Автоматизираните системи имат значение от гледна точка на стандартизация и бързина. Необходимото време за провеждане на микроскопско изследване на патологична проба урина, съдържаща голям брой клетки е около 20 минути. С производителност около 50 урини на час автоматичните анализатори успешно се използват за скрининг на пробите. Засичането на резултатите от тест лента и апаратния седимент е достатъчно на обучения лаборант да определи суспектните за неточен резултат проби, чиито брой клетки да бъде определен с последващо микроскопско изследване. Автоматичният анализатор оптимизира работния процес в клинично-лабораторната практика, като осигурява значително walk-away време за включване в други дейности.Изводи: FUS–100 разполага със софтуер за идентификация и високоспециализираната технология тип „изкуствен интелект“. Системата позволява автоматична калибрация и контрол на качеството. Методът позволява стандартизация и се характеризира с много добра възпроизводимост и точност.Introduction: Urinalysis is one of the most commonly performed tests in the clinical laboratory. It is an indicator of the status of urinary tract. Manual microscopic sediment examination is time-consuming and lacks standardization.Aim: In this study the results from manual microscopic examination and automated urine analysis were compared. Materials and Methods: A total of 94 urine samples were analyzed by Dirui FUS – 100 automatic urine sediment analyzer and by manual microscopic method using Fuchs – Rosenthal’s counting chamber. The results for leucocytes and erythrocytes were compared.Results: Within the tested urine samples the average value for leucocytes counted by the automated analyzer was calculated as 163 ± 77 / microl, for leucocytes counted using counting chamber – 201 ± 45 / microl.For erythrocytes counted by the automated analyzer the average value was calculated as 47 ± 48.5/microl and for the erythrocytes counted using counting chamber - 22 ± 13.5 / microl.Statistical analyses were performed by the T Student’s Test (p < 0.05) and statistically significant difference was determined for the leucocyte count (p = 0.04) and for the erythrocyte count (p = 0.00081) using both methods.Discussion: Automated systems are important in terms of standardization of measurement and speed of the analysis performance. The microscopic analysis of a pathological sample requires approximately 20 min. FUS – 100 Urine Sediment Analyzer is able to analyze 50 samples per hour. The automated analyzers are successfully used for screening urine samples. When combined with urine chemistry analysis the well trained staff can easily recognize the samples suspect for inaccurate result and to analyze them microscopically. The automated analyzers optimize the work process, providing significant amount of walk-away time for the laboratory staff.Conclusion: Dirui FUS – 100 uses artificial intelligence identification technique. The system performs automated calibration, provides standardization of the measurement and repeatability and accuracy of the analysis

Aldosterone And Renin - Indications For Testing And Pre-Analytical Requirements

Въведение: Според данни на СЗО хипертонията е най-често срещаното хронично заболяване, което причинява 7,5 милиона или 12,8% от всички смъртни случаи годишно. Централно място в регулирането на обмяната на соли и течности в организма заема ренин-ангиотензин-алдостероновата система (RAAS).Цели: Ренинът се изследва основно за откриване причината за увеличеното артериално налягане, при недостатъчен отговор на антихипертензивното лечение и ниски нива на калий в кръвта. Измерванията на алдостерон са предназначени за диагностика и лечение на първичен хипералдостеронизъм; резистентна хипертония, хипоалдостеронизъм, едематозни състояния и други състояния на електролитен дисбаланс. За оценка на РААС изследването на алдостерон се съчетава с определянето на плазмена ренинова активност и определяне на съотношението алдостерон/ренин.Материали и методи: Нивата на ренин и алдостерон в клинична лаборатория към УМБАЛ „Св. Марина“ се изследват с автоматичен имунохимичен анализатор LIASON®, DIASORIN, прилагащ технологиятa на хемилуминисцентен имунеоанализ (CLIA). Материал за изследване са ЕДТА плазма и 24-часова диурезна урина.Резултати: Референтните стойности за ренин и алдостерон зависят от положението на тялото при венепункцията, съдържанието на натрий в диетата, прием на медикаменти, физиологичното състояние на пациента – стрес и бременност. На резултатите се отразява приемът на кортикостероиди, естрогени, аспирин, кофеин, бета-блокери, диуретици, ACE-инхибитори. Референтните стойности за алдостерон в плазма са: 0,6-0,98 nmol/l в изправено положение и 0,03-0,65 nmol/l за легнало положение; алдостерон в урина – 1,19-28,1 µg/24 ч. Референтните стойности за ренин в плазма са: 4,4-46,1 u IU/ml в изправено положение, 2,8-39,9 u IU/ml – легнало положение.Заключение: Изследването на ренин и алдостерон се използва като скринингов тест за диагностика на първичен хипералдостеронизъм и високо артериално налягане. Резултатът в референтни граници не изключва наличието на заболяване и трябва да бъде интерпретиран съвместно с клиничната картина на пациента и с други диагностични процедури. За постигане на надеждни резултати е необходима прецизна техника и стриктно спазване на преданалитичните изисквания.Introduction: According to WHO data, high blood pressure is the most common chronic disease that causes 7.5 million or 12.8% of all deaths yearly on a global scale. The renin-angiotensin-aldosterone system (RAAS) plays a significant role in preserving hemodynamic stability in response to the loss of blood volume, salt and water.Aim: A blood renin test is usually ordered to detect the cause of increased blood pressure, insufficient response to antihypertensive therapy and low blood potassium levels. Indications for aldosterone measurements are intended for use in the diagnosis and treatment of primary aldosteronism, hypertension caused by primary aldosteronism, selective hypoaldosteronism, edematous states and other conditions of electrolyte imbalance. Since renin and aldosterone are so closely related, both substances are often tested together as aldosterone-to-renin ratio (ARR).Materials and Methods: The levels of renin and aldosterone are being tested in the Clinical Laboratory at the St. Marina University Hospital, with an automated immunochemical analyzer LIASON®, DIASORIN, which uses chemiluminescent immunoassay (CLIA) technology. For screening renin and aldosterone levels EDTA plasma and 24-hour urine collection are used.Results: Reference ranges of renin and aldosterone tests can be affected by body position when blood is drawn, salt intake, stress, pregnancy,variety of prescribed medications and supplements – corticosteroids, estrogens, caffeine, beta blockers, vasodilators, diuretics, ACE inhibitors. The normal value range for aldosterone in plasma is: 0.6-0.98 nmol/L for upright position, and 0.03-0.65 nmol/L – in a lying down position; aldosterone in the urine - 1.19-28.1 μg/24h. The normal value range for plasma renin is: 4.4-46.1 in IU/mL – upright position and 2.8-39.9 in IU/mL – in a lying down position.Conclusion: Measuring renin and aldosterone levels is used as a screening test for diagnosis and treatment of hyperaldosteronism and hypertension. A score within a reference range does not exclude the presence of a disease and it should be interpreted in conjunction with the patient's clinical picture and other diagnostic procedures. In order to achieve reliable results, precise technique and strict observance of the pre-analytical requirements are required

Serum homocysteine and high-sensitive C-reactive protein levels and cardiovascular disease in patients with diabetes mellitus type 2

PURPOSE: Hyperhomocysteinemia and hs-CRP are non-classical risk factors independently associated to the development of cardiovascular disease. The increased coronary heart disease (CHD) risk in subjects with type 2 diabetes mellitus (DMT2) can be in part explained by the classical risk factors like hypertension, hyperlipidemia and obesity. There is no sufficient data about the importance of homocysteine (Hcy) and hs-CRP levels in DMT2 patients without CHD in predicting the macroangiopathic complications. The aim of this study was to determine the association between plasma homocysteine and hs-CRP concentrations in DMT2 patients with and without CHD.MATERIAL AND METHODS: Fifty patients hospitalized in the Clinic of Endocrinology at St. Marina University Hospital of Varna were divided into three groups: group one, 20 DMT2 patients without any evidence of CHD; group two, 20 DMT2 patients with history of CHD and group three, 10 healthy controls matched to these groups in terms of age and classical risk factors for CHD.RESULTS: Serum hs-CRP concentrations were significantly higher in DMT2 patients than in healthy controls as well as in DMT2 patients with CHD than in CHD-free DMT2 ones. Serum Hcy concentrations were significantly higher in DMT2 patient with CHD than in controls. Both markers were elevated in group two presenting with the highest risk for CHD.Scripta Scientifica Medica 2013; 45(1): 58-61

Non-rigidity induced by luminance gratings in structure-from-motion displays

An illusory motion between the brightest and darkest strips of luminance gratings used as texture over a slanted plane and rotating around a vertical axis was observed. This effect could not be expected from the theoretical analysis of structure-from-motion displays. The conditions for the perceived non-rigidity produced by the luminance gratings were evaluated in Experiment 1.  The results showed that the symmetry of the luminance profile, the slant of the planes and the motion direction modified the perceived orientation only of the brightest stripes. The effect is not due to the interpretation of the brightness variation of the moving gratings as caused by a stationary light source (Experiment 2) or by motion sharpening of the blurred edges in the gratings (Experiment 3). Potential explanations of the observed effect based on interaction between the processes of brightness filling-in and the motion information processing are discussed.Durant la rotation d’un plan oblique autour d’un axe vertical un mouvement illusoire est observé entre les bandes claires et sombres d’une grille lumineuse utilisée comme texture.  Un tel effet ne pouvait être prévu par l’analyse théorique de l’établissement de la structure à partir du mouvement. Les conditions pour cette non-rigidité perçue, produite par grilles lumineuses sont examinées dans la première étude.  Les résultats montrent que la symétrie du profile lumineux, la pente des plans et la direction du mouvement modifient l’orientation perçue uniquement des plus claires bandes. L’effet n’est pas dû à l’interprétation des bandes claires des grilles mouvantes comme dans le cas de source lumineuse stationnaire (Etude 2) ou dans celui de l’augmentation de la netteté du mouvement du flou des bords de la grille perçues (Expérimente 3). Des explications alternatives de l’effet observé sont discutées, basées sur les interactions entre les processus du remplissage de la luminosité et du mouvement