OCCUPATIONAL EXPOSURE TO BLOOD AND BODY FLUIDS IN HOSPITAL HEALTHCARE WORKERS AND PERCEPTION OF INFECTIOUS RISK

Introduction and aim: Injuries with sharps in healthcare are associated with a risk of infection with blood-borne pathogens that is significant due to the high incidence of injury. Each year, 3 million healthcare workers worldwide experience percutaneous exposure to blood-borne pathogens.The aim was to summarize the results of occupational exposure to blood and body fluids, immunization status and perception of infection risk among hospital-based healthcare workers, and to assess progress in the implementation of blood-borne infection prevention measures.Contingent and methods: 2744 healthcare workers from 19 hospitals in the city of Sofia were studied, 87.3% women, average age 48.08 ± 11.9 years, average work experience 24.8 ± 12.6 years: 763 doctors, 1427 nurses, 208 laboratory assistants , 176 midwives, 77 rehabilitators, 93 nurses. A standardized blood exposure questionnaire “Exposure of hospital personnel to blood and blood-borne infections” was completed anonymously.Results and discussion: 63.2% of healthcare workers had an incident of contact with blood/biological fluids during their work experience, and 45% in the previous year. Unvaccinated against hepatitis B were 41.6%. The probability of infection with blood-borne pathogens from contaminated blood after a needle stick was predominantly rated as high, with equal risk for HBV and HCV. The highest proportion of health care workers reported a 100% probability of HIV infection.Conclusion: The frequency of injuries with sharp objects during work experience and in the previous year was high. Healthcare workers had an inaccurate perception of the risk of infection in the event of an incident involving contaminated blood. Hepatitis B vaccination coverage was low

Inhibition of zymosan-induced kidney dysfunction by tyrphostin AG-490

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Pilomatrix carcinoma in the presternal region. Very rare or very often misdiagnosed malignancy?

Pilomatrix carcinoma is a very rarely diagnosed malignancy. There are around 150 cases reported in the literature. In the very past this type of carcinoma was considered as a low-grade, non-metastasizing tumor. Nowadays with its high potential of recurrence and metastasizing the approach to this type of neoplasm should always be careful and multidisciplinary. The first line of therapy is wide surgical excision, followed by adjuvant radiotherapy. If there is observation of lymph node metastases they should be surgically or radiotherapeutically treated.  In the present case report, we present a 46-year-old patient with pilomatrix carcinoma in the presternal region

Disseminated superficial actinic porokeratosis, Bowen's disease and basal cell carcinoma. Coincidence or rare double malignant transformation?

Disseminated superficial actinic porokeratosis (DSAP) is a skin condition that consist of multiple annular, hyperkeratotic lesions. They are usually distributed bilaterally and mostly affect the extremities. DSAPs have a wider distribution than the porokeratosis of Mibelli and usually appears between the age of 40 and 50. Squamous cell carcinoma, Bowen’s disease, and basal cell carcinoma that arises in the classical type of porokeratosis of Mibelli is well-documented, but there are not many reported cases of Bowen’s disease and basal cell carcinoma arising in DSAP. We present a 77-year-old woman in whom the two– Bowen’s disease and Basal cell carcinoma develop in a histologically proven DSAP.

The Prognostic Impact of Time Interval Between Hysterectomy and Initiation of Adjuvant Radiation Treatment in Women With Early-Stage Endometrial Carcinoma

Purpose/Objective(s): Adjuvant radiation therapy (ART) is indicated for women with endometrial carcinoma (EC) who are at high risk for recurrence. However, due to various reasons, some patients do not receive ART in a timely manner. In this study, we evaluated the prognostic impact of the time interval (TI) between hysterectomy and starting date of ART. Materials/Methods: After institutional review board approval, we queried our prospectively-maintained institutional database for women with uterine endometrioid EC of 2009 FIGO stages I-II who received ART without chemotherapy after surgical staging. The patients were classified into two groups, based on whether they received ART ≤8 weeks (group A) or \u3e8 weeks (group B) after hysterectomy. We then compared the two groups with regards to the following survival endpoints: recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS). Univariate and multivariate analyses were also performed. Results: A total of 460 patients were identified. Median follow-up duration was 70.5 months. The median age for the entire cohort was 66.0 years. The cohort consisted of 176 patients with FIGO stage IA (38%), 207 (45%) with stage IB and 77 (17%) with stage II. Group A consisted of 354 (77%) patients, and group B had 106 (23%). The median TIs from hysterectomy to ART were 6 weeks and 10 weeks for groups A and B, respectively. There was no statistically significant difference between the groups in terms of baseline demographic and disease characteristics including age, race, grade, FIGO stage, extent of myometrial invasion, presence of lymphovascular space invasion and radiation treatment modality. A total of 52 patients experienced recurrences. Patients in group A (vs. group B) experienced significantly less recurrences overall (9% vs. 18%; p = 0.01). Rate of vaginal recurrence was significantly lower in group A (9% vs. 42%, p = 0.01). Univariate analysis showed that having RT ≤8 weeks was associated with significantly improved 5-year RFS rate, which was 89% and 80% for groups A and B (p = 0.04), respectively. The rates of 5-year OS (86% vs. 85% for groups A and B, respectively) and 5-year DSS (93% vs. 93% for groups A and B, respectively) were similar. In addition, multivariate analysis showed a statistical trend for improved 5-year RFS when receiving RT ≤8 weeks (p = 0.07). Conclusion: Our study suggests that delaying adjuvant radiation treatment beyond 8 weeks post-hysterectomy is associated with significantly more cancer recurrences for women with early-stage endometrial cancer

Burning mouth syndrome and squamous cell carcinoma: Coincidence or a new disease association

Burning mouth syndrome (BMS) is described as a burning feeling or sensation in the mouth in the absence of specific oral mucosa lesions. Patients with BМS often complain of paraesthesia (tingling sensation in the mouth), xerostomia (dry mouth sensation), changes in sense of taste and smell. In the past two decades, significant research of this condition has been conducted. Psychological, systemic and local factors probably play a role in the pathogenesis of BMS. We present a case of an 82-year-old female with burning sensation in the mouth and a coexisting growing lesion on her lower lip

BIOLOGICAL ACTIVITY OF BULGARIAN FOLIA BETULAE DRY EXTRACT

Objective: The aim of this study was to investigate the biological activity of dry Folia Betulae (FB) extract.Methods: Extracts from birch leaves were obtained by different technological methods–maceration and percolation, extraction with different concentrations of ethanol, changes in temperature regimen. The influence of the technological factors on the content of the biologically active substances (BAS) was examined. A phytochemical characterization of the extracts and their standardization were made, according to important groups of BAS–flavonoids (rutin, quercetin) and terpenes (betulin and betulinic acid), by means of HPLC methods for detection and quantitative determination. A model extract, with optimal content of BAS was chosen for subsequent in vitro investigation of its biological activity. Antimicrobial activity was studied via in vitro tests using bacterial isolates–Staphylococcus aureus, Escherichia coli and Candida albicans. The physiological activity was investigated by using in vitro test with smooth muscle strips. The antiproliferative activity of FB extract on eukaryotic cells was examined on cell cultures in vitro. Two cell cultures were used: the mouse lymphoma cell line L5178Y and the serum-free McCoy-Plovdiv cells.Results: The dry extract from FB has a dose–dependent antibacterial effect. The bactericidal effect on Staphylococcus aureus is stronger than the one on Escherichia coli. Results prove that adding the extract leads to stimulating effect on muscle contractility. It demonstrates biological activity, expressed as changes in cell morphology, proliferation and vitality as well as initiation of apoptosis.Conclusion: The results obtained largely overlap with literature data and explain some of the applications of this plant in traditional medicine.Â

Intense pulsed light (IPL): An innovative method for the treatment of Meibomian gland dysfunction in patients with dry eye disease

Introduction: Meibomian gland dysfunction (MGD) is a leading cause of dry eye syndrome. They produce lipids that contribute to the integrity of the tear film and slow down its evaporation. When these glands become blocked, they can lead to symptoms associated with dry eye disease. Until recently, only tear substitutes containing lipid components, omega-3 fatty acids, warm compresses, and topical anti-inflammatory agents were used for treatment. Intense pulsed light (IPL) therapy is a new treatment option for dry eye syndrome due to meibomian gland dysfunction.Aim: The aim of our study was to evaluate the efficacy and safety of IPL for the treatment of dry eye syndrome due to meibomian gland dysfunction in patients of different age groups by examining the non-invasive tear breakup time (NITBUT) and Schirmer’s test measured before IPL treatment and their change after two IPL procedures.Material and Methods: ANTARES corneal topographer (CSO, ANTARES-2017) was used to measure the indicators. Intense pulsed light treatment was given to 61 patients in both eyes. Each patient had a second-degree MGD and underwent two procedures at an interval of two weeks. The tear breakup time (TBUT) and Schirmer’s test were assessed at baseline and two weeks after the last treatment. The analysis, by which the data were processed, is GLM Repeated Measures.Results: The majority of tests documented an improvement in the clinically relevant parameters, including the tear breakup time, Schirmer’s test, meibum quality, and Standard Evaluation of Eye Dryness Questionnaire. Side effects were relatively rare, but included discomfort and skin erythema. Age, gender and the application of artificial tears did not have a significant effect on the described results.Conclusion: Intense pulsed light shows therapeutic potential for MGD treatment, improving the quality of the tear film and reducing the symptoms of dry eye syndrome

A Multi-Institutional Analysis of Adjuvant Chemotherapy and Radiation Sequence in Women With Stage IIIC Endometrial Cancer

PURPOSE: Our purpose was to evaluate the effect of sequence and type of adjuvant therapy for patients with stage IIIC endometrial carcinoma (EC) on outcomes. METHODS AND MATERIALS: In a multi-institutional retrospective cohort study, patients with stage IIIC EC who had surgical staging and received both adjuvant chemotherapy and radiation therapy (RT) were included. Adjuvant treatment regimens were classified as adjuvant chemotherapy followed by sequential RT (upfront chemo), which was predominant sequence; RT with concurrent chemotherapy followed by chemotherapy (concurrent); systemic chemotherapy before and after RT (sandwich); adjuvant RT followed by chemotherapy (upfront RT); or chemotherapy concurrent with vaginal cuff brachytherapy alone (chemo-brachy). Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by the Kaplan-Meier method. RESULTS: A total of 686 eligible patients were included with a median follow-up of 45.3 months. The estimated 5-year OS and RFS rates were 74% and 66%, respectively. The sequence and type of adjuvant therapy were not correlated with OS or RFS (adjusted P = .68 and .84, respectively). On multivariate analysis, black race, nonendometrioid histology, grade 3 tumor, stage IIIC2, and presence of adnexal and cervical involvement were associated with worse OS and RFS (all P \u3c .05). Regardless of the sequence of treatment, the most common site of first recurrence was distant metastasis (20.1%). Vaginal only, pelvic only, and paraortic lymph node (PALN) recurrences occurred in 11 (1.6%),15 (2.2 %), and 43 (6.3 %) patients, respectively. Brachytherapy alone was associated with a higher rate of PALN recurrence (15%) compared with external beam radiation therapy (5%) P \u3c .0001. CONCLUSIONS: The sequence and type of combined adjuvant therapy did not affect OS or RFS rates. Brachytherapy alone was associated with a higher rate of PALN recurrence, emphasizing the role of nodal radiation for stage IIIC EC. The vast proportion of recurrences were distant despite systemic chemotherapy, highlighting the need for novel regimens

Septicaemia models using Streptococcus pneumoniae and Listeria monocytogenes: understanding the role of complement properdin

Streptococcus pneumoniae and Listeria monocytogenes, pathogens which can cause severe infectious disease in human, were used to infect properdin-deficient and wildtype mice. The aim was to deduce a role for properdin, positive regulator of the alternative pathway of complement activation, by comparing and contrasting the immune response of the two genotypes in vivo. We show that properdin-deficient and wildtype mice mounted antipneumococcal serotype-specific IgM antibodies, which were protective. Properdin-deficient mice, however, had increased survival in the model of streptococcal pneumonia and sepsis. Low activity of the classical pathway of complement and modulation of FcγR2b expression appear to be pathogenically involved. In listeriosis, however, properdin-deficient mice had reduced survival and a dendritic cell population that was impaired in maturation and activity. In vitro analyses of splenocytes and bone marrow-derived myeloid cells support the view that the opposing outcomes of properdin-deficient and wildtype mice in these two infection models is likely to be due to a skewing of macrophage activity to an M2 phenotype in the properdin-deficient mice. The phenotypes observed thus appear to reflect the extent to which M2- or M1-polarised macrophages are involved in the immune responses to S. pneumoniae and L. monocytogenes. We conclude that properdin controls the strength of immune responses by affecting humoral as well as cellular phenotypes during acute bacterial infection and ensuing inflammation