Clinical factors and ancillary tests used in modern clinical practice for diagnosing brain death

Nowadays, brain death is an issue causing a number of controversies in modern society. Its medical definition and the criteria for its diagnosis have undergone many changes over the years. However, the process of proving it has always followed a series of definite steps. An important condition before performing the clinical examination of the patient and the use of certain instrumental studies is knowledge of the etiology and pathogenesis of the process, as well as the exclusion of certain factors that could influence the clinical diagnosis

Impact of hypernatremia on liver graft function in brain-dead organ donors

Hypernatremia is a common condition in brain-dead patients, and its correction is a key point in their conditioning as organ donors. Controlling it poses a challenge for medical professionals, and it is believed to impact liver graft function. The purpose of this review is to summarize the available results describing the relationship between hypernatremia in brain-dead organ donors and the success of liver transplantation. It is believed that it can lead to a high incidence of liver graft rejection. Other studies have shown that donor serum sodium levels do not affect clinical outcomes. There is a lack of definitive literature data fully supporting one of these two theses

Accesibilidad de las playas de Barcelona

Màster Oficial en Disseny Urbà: Art, Ciutat, Societat. Facultat de Belles Arts de la UB, curs: 2011-2012, Tutor: Tomeu Vidal MorantaLas grandes transformaciones que sucedieron en la ciudad de Barcelona a lo largo de las últimas décadas dieron lugar a lo que hoy es conocido como Modelo Barcelona. Se trata de un proceso largo, influido por los cambios en las diferentes esferas de la vida social, económica y política de la ciudad. En éste trabajo se tienen en cuenta los cambios de carácter urbanístico, explorando las características más relevantes y el conjunto de factores que han contribuido al desarrollo de dicho modelo. De una ciudad en crisis, Barcelona logró llegar al punto de convertirse en un ejemplo mundial, por lo cual fue y sigue siendo objeto de varios estudios e investigaciones, incluso a ser referencia para diferentes proyectos en otras ciudades. El Modelo Barcelona nos permite observar el nivel que ha alcanzado la accesibilidad y el proceso de desarrollo que ha tenido en la ciudad como uno de sus aspectos más relevantes. Esta investigación estudia la accesibilidad de las playas como parte del espacio público, y resalta el derecho a acceder y disfrutar de ellas por todos los ciudadanos, ya que hasta hace poco no eran un espacio abierto o accesible para los usuarios. Durante el proceso de recopilación de información no se encontró ningún estudio exhaustivo de la accesibilidad a las playas, de aquí parte la importancia de realizar ésta investigación, resaltando al mismo tiempo, la importancia de las diferentes intervenciones de diseño urbano realizadas en las playas de Barcelona y que sirvieron de referencia en el análisis a continuación presentado. El resultado de ésta investigación es un estudio bastante preciso de la situación actual de las playas barcelonesas, que puede servir como punto de partida para la optimización total de dichas playas y posiblemente aplicable a otras partes del mundo

FT-IR spectral analysis for a newly obtained structure analog of bexarotene

INTRODUCTION: Retinoids are natural and synthetic compounds part of the family of polyisoprenoid lipids. These compounds are involved in several important physiological processes in the human body because of their ability to bind to different nuclear receptors. Retinoids are used in the therapy of some precancerous lesions, the treatment of acute promyelocytic leukemia (APL), T-cell lymphoma, and the prevention of malignancies in high-risk cancer groups. In this work we discuss the possibilities for analysis of the newly synthesized hydrazone of the retinoid bexarotene.  AIM: The purpose of this study is to conduct FTIR spectral analysis of newly synthesized hydrazone of bexarotene.MATERIALS AND METHODS: Infrared spectra 500-4000 cm-1 were taken on a Bruker FTIR spectrometer using ATR - a plug with Smart iTR adapter.RESULTS: The infrared spectra of the newly synthesized compound were strikingly similar in the relative positions and intensities of the resulting peaks, confirming its close structural relationship with bexarotene. Despite the structural similarity, there were significant differences that point to the introduction of a substituent and the formation of a new hydrazone derivative.CONCLUSION:  In order to confirm the data obtained by FTIR spectroscopy, a further reversed-phase HPLC-UV analysis of the new hydrazone derivative should be performed

Tangram based technology for clothing design

The trends in the society regarding environment protection and more optimized production are reason for the research of the author in this direction. The technology of the item connect with the stamina of the product. Within the report, there is an author’s development for series of clothing presented in the context of the steady design. Using zero-waste technology aims the improvement of the functional characteristics, as it is being experiment with different textile materials like artificial leather, cotton, wool, spandex and others. The design through transformation of square into other figure through cutting connect with the Chinese tangram game. Problems are included, such as construction, functional, and aesthetic character, as well social and ecological aspect

Genetic features and treatment of pulmonary diseases

Introduction: Development of medical genetics and technologies has a great impact on genetic dis­eases diagnostics. According to different researches, hereditary pulmonary diseases are a significant part, between 30-50%, of all respiratory problems in patients. The recognition of these conditions and their pathophysiology may facilitate the choice of treatment and its efficiency.Materials and methods: This report represents three clinical cases of patients, diagnosed with hered­itary pulmonary diseases, admitted to the Respiratory Intensive Care Unit at University Hospital `St. Marina` (Varna, Bulgaria). All of them have been hospitalized several times in different pulmonary clinics with complaints of fever, cough and different degree of dyspnea.Results: Present complaints of the patients were the same as the ones mentioned during the prior hospitalization. Patient no.1 was referred to a Computed Tomography (CT) scan which revealed tra­cheobronchomegaly. Although Alpha-1 antitrypsin deficiency test showed negative results, the work­ing diagnosis was Mounier-Kuhn syndrome. Having in mind this, he was prescribed a course with two antibiotics - Cefadime and Ciprinol, in combination with Methylprednisolone and Ventolin. The symptoms of patient no. 2 started when she was 7. Suspicion of Cystic Fibrosis was confirmed by ge­netic analysis of the CFRT gene. Sputum culture tests yielded Pseudomonas aeruginosa in 2016. The patient received treatment with Piperacillin/Tazobactam, Colistin, Bromhexine, Pulmozyme and Kreon. After physical examination and a CT scan of patient no.3, pectus carinatum and multiple cysts distributed in both lungs were found. Negative sweat test results confirmed the diagnosis - mul­tiple cystic lung disease. A scheme of Cefadime, Metronidazole, Levofloxacin and Bromhexine was prescribed. All three patients were discharged with improvement after the treatment.Conclusion: These cases studies showed that knowing the symptoms of hereditary diseases can con­tribute to treatment of patients with respiratory tract diseases in order to increase their quality of life

CARDIAC GASTRIC CANCER IN A PATIENT WITH A BLADDER NEOPLASM: CASE REPORT

Introduction: The incidence of cardiac gastric cancer is increasing with a general tendency of reducing the severity of gastric cancer in the world. The risk factors for cancers of the cardia are also different; the role of genetic factors of Barrett`s esophagus and smoking is being discussed, while Helicobacter pylori infection is established as not being a carcinogen.Materials and Methods: The aim of this report is to present a case of synchronous development of gastric adenocarcinoma and transitional cell carcinoma of the bladder.Results: A 71-year-old man was admitted at the Department of Gastroenterology with complaints of progressive loss of appetite and asthenoadynamia, abdominal pain in the left hypochondrium and postprandial epigastric fullness. Recently, the condition has started to present also with dysphagia to solids and quickly after that to liquid foods. The patient has a history of Barrett`s esophagus and moderately differentiated papillary transitional cell carcinoma of the bladder (T1N1M0, G2), managed with surgery and 2 courses of chemotherapy in the summer of 2016. Laboratory tests showed hypochromic microcytic anemia (Hb 108 g/l), a tendency to thrombocytosis and elevated CA 19-9 (4x the upper limit of normal). An abdominal ultrasonography found: gastric wall (high part of the stomach body) - 6 mm, rough and focal bladder wall thickening with polypoid masses. Contrast-enhanced ultrasonography and computed tomography didn`t register liver metastases. During the upper endoscopy a carcinoma of the gastroesophageal junction was established: infiltration near the Z-line of a tumor formation, which causes incomplete obturation, and in retroflexed view was seen an oval tumor formation in cardia, histologically confirmed as highly to moderately differentiated adenocarcinoma. Following a decision of an Oncology Commission, the patient was referred for surgical treatment.Conclusion: We analyzed the current recommendations for the behavior of cardia carcinoma of the stomach and the gastroesophageal junction and the mechanisms for synchronous development of gastric adenocarcinoma and transitional cell carcinoma of the bladder

Cost-effectiveness of evolocumab in treatment of heterozygous familial hypercholesterolaemia in Bulgaria: measuring health benefit by effectively treated patient-years*

Background: An elevated level of low-density lipoprotein cholesterol (LDL-C) constitutes one of the most important modifiable risk factors for cardiovascular disease (CVD). Individuals with heterozygous familial hypercholesterolaemia (HeFH) are particularly vulnerable to CVD events. The addition of evolocumab to statins has shown marked reductions in LDL-C levels. The objective of this analysis is to demonstrate the clinical and economic value of LDL-C lowering with evolocumab from the Bulgarian public health care perspective. Methods: A disease-specific measure of health benefit was devised: Effectively treated patient-years (ETPYs) combine length of life with the likelihood of attaining best-practice recommendations on LDL-C lowering. “Effective treatment” was defined as a reduction in LDL-C levels of ≥50%. A Markov cohort state-transition model was adapted, considering a life-long treatment duration. Demographics, baseline characteristics and efficacy data were taken from the RUTHERFORD-2 trial. The model uses the relationship between LDL-C lowering and reduced CVD event rates observed in the meta-analyses conducted by the Cholesterol Treatment Trialists’ Collaboration. Outcomes and costs (from year 2015) were discounted at an annual rate of 5%. Sensitivity analyses were conducted to assess uncertainty surrounding the results. Results: The total incremental costs of evolocumab added to statins versus statins alone are BGN 120,329 while adding 9.30 ETPYs over lifetime. These results imply an incremental cost per ETPY of BGN 12,937 (US$ 7,215; € 6,604). The use of evolocumab is associated with a relative reduction in the CVD event rate by 38% (18% per 1 mmol/L). Conclusions: Adding evolocumab to statins may be considered cost-effective in light of an additional expense per patient-year gained in which individuals with HeFH receive effective treatment under the terms of international prevention guidelines. ETPYs are an intuitive and clinically meaningful measure of patient benefit that, in relation to costs, can support health care decision-making that considers quality of care

EARLY DISTRIBUTION OF SQUAMOUS PENILE CARCINOMA

Introduction: Penile carcinoma is mostly a squamous cell carcinoma (SCC), usually originating from the epithelium of the inner prepuce or the glans. At least one third of the cases can be attributed to HPV-related carcinogenesis. The incidence of penile cancer increases with age, peaking during the sixth decade of life. However, the disease does occur in younger men.Materials and Methods: This abstract features case reports of two patients, aged 44 and 54, respectively, admitted for the first time at the Clinic of Urology at St. Marina University Hospital (Varna, Bulgaria) with similar complaints of non-healing tender lesions in the region of the penis, lasting more than one year.Results: After taking into consideration these complaints, patient no.1 (aged 44) was hospitalized and referred to a CT scan. The CT scan revealed a tumor formation in the corpus of the penis, as well as multiple swollen lymph nodes bilaterally. After the diagnostics an operative intervention - penile amputation and lymphadenectomy was chosen as treatment. Incision biopsy of the operative material revealed a highly differentiated penile squamous cell carcinoma - T2, N0, Mx, G1 (low-grade).Patient no. 2 (aged 54) was admitted into the Clinic of Urology with highly differentiated invasive penile squamous cell carcinoma, diagnosed a month prior. A CT scan of the abdomen and the lesser pelvis was made with the intention of staging the tumor. The scan confirmed an infiltration of the scrotum and the testes. Packages of lymph nodes were visible bilaterally as well as along the iliac blood vessels. Emasculation and lymphadenectomy were chosen as treatment. The incision biopsy confirmed the diagnosis - T3, N3, Mx, G1 (low-grade).Conclusions: The presented case reports prove that the lack of timely consultation with a specialist can lead to radical operative interventions on the male reproductive system, leading to psycho-social discomfort