THE TRAINING OF GERIATRIC SPECIALISTS IN MEDICAL COLLEGE AT TRAKIA UNIVERSITY, STARA ZAGORA, BULGARIA - IMPORTANT TOOL OF SOCIAL POLICY FOR ACHIEVING BETTER QUALITY OF LIFE FOR OLD PEOPLE

Demographic indicators of are dynamic and reported an increase in the length of human life and the aging the world population. This has emerged as an irreversible process, which is particularly valid for Bulgaria, because it ranks fifth in the world in pace of aging of the population.The purpose of this research is to determine the role and place of the new geriatric specialists from the Medical College of Trakia University, Stara Zagora, for improving the quality of life of elderly and old people.Materials and Methods: Documentary, counterfactual analysis, monitoringResults: Medical College at Trakia University set up and accredits new for the country specialty "Geriatric Care" for which is approved administration of 60 students state order. Based on the analysis and comparison of the competencies of geriatric specialists with fundamental targets set at national level thus improving the quality of life of adults and older people from Bulgaria in the part of delivery of quality long-term care are made conclusions about the geriatric specialists as important tool of social policy in achieving high quality life of life in geriatric age..Demographic indicators of are dynamic and reported an increase in the length of human life and the aging the world population. This has emerged as an irreversible process, which is particularly valid for Bulgaria, because it ranks fifth in the world in pace of aging of the population.The purpose of this research is to determine the role and place of the new geriatric specialists from the Medical College of Trakia University, Stara Zagora, for improving the quality of life of elderly and old people.Materials and Methods: Documentary, counterfactual analysis, monitoringResults: Medical College at Trakia University set up and accredits new for the country specialty "Geriatric Care" for which is approved administration of 60 students state order. Based on the analysis and comparison of the competencies of geriatric specialists with fundamental targets set at national level thus improving the quality of life of adults and older people from Bulgaria in the part of delivery of quality long-term care are made conclusions about the geriatric specialists as important tool of social policy in achieving high quality life of life in geriatric age.

Heart failure treatment in patients with thalassemia major

Съвременното лечение на сърдечната недостатъчност при пациентите с талсемия започва с профилактиката на сърдечните увреждания при тези пациенти. Кардиомиопатията в резултата от натрупване на желязо е най-тежкото и животозасташяващо усложнение на трансфузионно завиимата таласемия, но поради връзката му с отлагането на желязо е обратима. Лечението се провежда с хелатори, както и с конвенционални лекарства за сърдечна недостатъчност. Тежко декомпенсирани форми се лекуват в специализирани центрове.The modern treatment of heart failure (HF) in patients with thalassemia is based on the prevention of cardiac impair- ment. Iron overload cardiomyopathy is the most serious and life-threatening complication of transfusion-dependent thalassemia, but due to its association with iron deposition it is reversible. Treatment includes chelation therapy and conventional medication for HF. Severely decompensated cases are treated in specialized centers

The challenge to manage a patient with advanced heart failure and necrotizing vasculitis - a clinical case

Пациентите с напреднала сърдечна недостатъчност много често имат и придружаващи заболявания, които повлияват и ограничават избора на лечение както за сърдечната недостатъчност, така и за придружаващото заболяване. Предствяме мъж, на 64години, с механична клапна протеза на аортно място, с високостепенна трикуспидална регургитация и високостепенна пулмонална хипертония, с тотална сърдечна недостатъчност, захарен диабет, периферна артериална болест и некротизиращ васкулит. Лечението, което бе предприето е напълно съобразено с препоръките за лечение на сърдечна недостатъчност на Европейското дружество по Кардиология от 2016 год., както и съвременните препоръки за лечение на захарен диабет и васкулити.Patients with advanced heart failure are patients with a lot of comorbidities that have important influence on the options of treatment - both for heart failure and the concomitant diseases. Here we present a 64-year-old man with mechanical aortic valve prosthesis, severe tricuspid regurgitation, severe pulmonary hypertension and total heart failure, diabetes mellitus type 2, peripheral artery disease and necrotizing vasculitis. The management of heart failure is according to the guidelines for the treatment of patients with heart failure of the European Society of Cardiology 2016; the treatment of the diabetes mellitus and the necrotizing vasculitis is also in accordance with the latest recommendations

Anemia, heart failure and treatment with erythropoiesis-stimulating agents

Aнемията е често съпътстващо заболяване при пациентите със сърдечна недостатъчност и причина за влошаване на прогнозата и лошия изход от болестта. Aнемия сред популацията на пациентите със сърдечна недостатъчност е много по-често срещана от колкото в останалото население. Счита се, че тя варира между 17и 70% в зависмост от това дали става въпрос за хоспитализирани или амбулаторни болни. Честотата на анемията сред български пациенти, хоспитализирани за остра сърдечна недостатъчност, според едно проучване е 32,7%. Лечението на тази съпътстваща коморбидност се определя от етиологията , като чести причини са желязо-дефицитната анемия, анемията при хронично заболяване, наличие на хронично бъбречно заболяване. Лечението на анемия с еритропоетинови препарати, първоначално е било обещаващо, но последващите резултати се оказват разочароващи. Еритропоеза-стимулиращите агенти увеличават тромемболичния риск, честотата на инсултите, макар да се наблюдава покачване в стойността на хемоглобина.Anemia is a common concomitant disease in patients with heart failure and is a cause for deteriorating prognosis and poor outcome of the disease. Anemia in the population of patients with heart failure is much more common than in the general population. It is estimated that it varies between 17 and 70% depending on whether the patients are hospitalized or not. The incidence of anemia among the hospitalized for acute heart failure patients in one Bulgarian study is 32.7%. The treatment of this concomitant state is defined by its etiology. The most common causes of anemia in heart failure are iron defficiency, chronic inflamation and chronic kidney disease. The treatment of anemia with erythropoiesis-stimulating agents was initially promising, but the results that came out later showed disappointing data. Erythropoiesis-stimulating agents increase the thrombotic risk, the incidence of stroke, although an increase in the level of hemoglobin is found

A clinical case of a patient with subclinical hypothyroidism and newly diagnosed diabetes mellitus and arterial hypertension

Захарният диабет и хипотиреоидизмът са двете най-често срещани ендокринни нарушения, който при съчетанието си при един и същи пациент биха могли да протекат с различен ход от колкото изолирано. Инсулинът и тиреоидните хормони са тясно свързани в клетъчния метаболизъм и техния ексцес или дефицит взаимно се повлияват. Познаването на връзките между тях е полезно в клиничната практика за скрининга и управлението на тези заболявания. Добре известно е, че хормоналните отклонения при една ендокринна жлеза могат да повлияят функцията и на другите жлези. Така например, хипотиреоидизма и хипертиреоидизма променят стойностите на кръвната захар и трябва да се имат предвид при интерпретацията на лабораторните резултати. От друга стана наличието на захарен диабет, особенно автоимунната форма, става често причина да се търси асоциирано автоимунно заболяване като тиреоид на Хашимото. Представяме клиничен случай на пациентка с хипертонична криза, без известнa до този момент артериална хипертония, която става повод да се диагностицират редици други заболявания, като тиреоидна дисфункция и захарен диабет. Представяме подхода при диагнозата, оценката на таргетните увреди и избора на терапия в светлината последните съвременните ръководства.Diabetes mellitus and hypothyroidism are the most common endocrine disorders and when concomitant in the same patient can change the course of each conditions in a rather different way than when running their course on their own. Both hormones - insulin and the thyroid hormone, act on cell metabolism and the excess or insufficient secretion of any of them affects the function of the other. In clinical practice, it is very useful to be familiar with the interaction between these two hormones for better screening and management of the diseases. It is well known that a single hormone dysfunction can change other hormone activity. It is the situation in hyper- or hypothyroidism, both influence blood glucose level and that should be taken into account when biochemistry is analyzed. On the other hand, diagnosing diabetes mellitus, especially the autoimmune form of the disease, directs our attention toward searching for another autoimmune disorder like Hashimoto thyroiditis. Here, we present a clinical case of a female patient with hypertensive crises with unestablished arterial hypertension, in whom additional concomitant disorders - thyroid dysfunction and diabetes mellitus, were diagnosed simultaneously. We discuss the approach to the diagnosis and target organ evaluation, as well as the management of the diseases in the light of the newest guidelines

Genetic diversity of Microsporidia in the circulatory system of endemic amphipods from different locations and depths of ancient Lake Baikal

Endemic amphipods (Amphipoda, Crustacea) of the most ancient and large freshwater Lake Baikal (Siberia, Russia) are a highly diverse group comprising >15% of all known species of continental amphipods. The extensive endemic biodiversity of Baikal amphipods provides the unique opportunity to study interactions and possible coevolution of this group and their parasites, such as Microsporidia. In this study, we investigated microsporidian diversity in the circulatory system of 22 endemic species of amphipods inhabiting littoral, sublittoral and deep-water zones in all three basins of Lake Baikal. Using molecular genetic techniques, we found microsporidian DNA in two littoral (Eulimnogammarus verrucosus, Eulimnogammarus cyaneus), two littoral/sublittoral (Pallasea cancellus, Eulimnogammarus marituji) and two sublittoral/deep-water (Acanthogammarus lappaceus longispinus, Acanthogammarus victorii maculosus) endemic species. Twenty sequences of the small subunit ribosomal (SSU) rDNA were obtained from the haemolymph of the six endemic amphipod species sampled from 0–60 m depths at the Southern Lake Baikal’s basin (only the Western shore) and at the Central Baikal. They form clusters with similarity to Enterocytospora, Cucumispora, Dictyocoela, and several unassigned Microsporidia sequences, respectively. Our sequence data show similarity to previously identified microsporidian DNA from inhabitants of both Lake Baikal and other water reservoirs. The results of our study suggest that the genetic diversity of Microsporidia in haemolymph of endemic amphipods from Lake Baikal does not correlate with host species, geographic location or depth factors but is homogeneously diverse

THE TRAINING OF GERIATRIC SPECIALISTS IN MEDICAL COLLEGE AT TRAKIA UNIVERSITY, STARA ZAGORA, BULGARIA - IMPORTANT TOOL OF SOCIAL POLICY FOR ACHIEVING BETTER QUALITY OF LIFE FOR OLD PEOPLE

Demographic indicators of are dynamic and reported an increase in the length of human life and the aging the world population. This has emerged as an irreversible process, which is particularly valid for Bulgaria, because it ranks fifth in the world in pace of aging of the population.The purpose of this research is to determine the role and place of the new geriatric specialists from the Medical College of Trakia University, Stara Zagora, for improving the quality of life of elderly and old people

The role of abdominal Doppler ultrasonography in diabetic nephropathy diagnostics

Diabetes mellitus is the most common chronic disorder of carbohydrate metabolism, which leads to progressive atherosclerosis and failure of multiple internal organs, which in turn results in an early and severe disability. Diabetic nephropathy is one of the main microvascular complications of this disease. The article explores the usefulness of abdominal Doppler ultrasonography to validate the early changes of renal hemodynamics in patients with diabetes mellitus

Microsporidian Parasites Found in the Hemolymph of Four Baikalian Endemic Amphipods.

At present, approximately 187 genera and over 1300 species of Microsporidia have been described, among which almost half infect aquatic species and approximately 50 genera potentially infect aquatic arthropods. Lake Baikal is the deepest and one of the oldest lakes in the world, and it has a rich endemic fauna with a predominance of arthropods. Among the arthropods living in this lake, amphipods (Crustacea) are the most dominant group and are represented by more than 350 endemic species. Baikalian amphipods inhabit almost all depths and all types of substrates. The age and geographical isolation of this group creates excellent opportunities for studying the diversity, evolution and genetics of host-parasite relationships. However, despite more than 150 years of study, data investigating the microsporidia of Lake Baikal remain incomplete. In this study, we used molecular genetic analyses to detect microsporidia in the hemolymph of several endemic species of amphipods from Lake Baikal. We provide the first evidence that microsporidian species belonging to three genera (Microsporidium, Dictyocoela and Nosema) are present in the hemolymph of Baikalian endemic amphipods. In the hemolymph of Eulimnogammarus verrucosus, we detected SSU rDNA of microsporidia belonging to the genus Nozema. In the hemolymph of Pallasea cancellous, we found the DNA of Microsporidium sp. similar to that in other Baikalian endemic amphipods; Dictyocoela sp. was found in the hemolymph of Eulimnogammarus marituji and Acanthogammarus lappaceus longispinus

The SSU rDNA sequences of microsporidia used for phylogenetic analysis.

<p>‘*’—the species of microsporidia founds in endemic amphipod of Lake Baikal (GenBank data).</p><p>The SSU rDNA sequences of microsporidia used for phylogenetic analysis.</p