Study of the use of herbal products with anxiolytic effect in Bulgaria in 2016

Увод: Валерианата (Valeriana officinalis) е много популярна билка за лечение на безсъние и безпокойство. Пасифлора (Passiflora), растение, което не е много популярно в България, също се използва при тревожност и безсъние. Златен корен (Rhodiolarosea), нововъведена в България билка, се препоръчва при стрес, изтощение и тревожност. Целта на настоящото изследване е да се проучат наличните на фармацевтичния пазар в България лекарствени продукти и хранителни добавки, съдържащи валериана, пасифлора и златен корен, и да се анализира употребата на такива продукти през 2016 година. Материал и методи: Проучването е направено чрез събиране на данни от 19 аптеки в гр. Варна за продажбите на продукти, съдържащи трите билки с анксиолитичен ефект. Резултати и обсъждане: В аптечната мрежа в България има разнообразни валериана-съдържащи монопродукти и комбинирани проду кти. Лекарствените продукти са два, a хранителните добавки са над 35. Пасифлора се предлага под формата на хранителни добавки, които са монопродукти и комбинирани продукти. Три от пасифлора-съдържащите хранителни добавки са с най-голяма употреба. В България златен корен е наличен под формата на един лекарствен продукт и няколко хранителни добавки, които са предимно монопродукти. Данните за аптечните продажби на опаковки, съдържащи една от трите билки, показват, че валериана-съдържащите продукти заемат 87.9% от продажбите, пасифлора-съдържащите са 11.5% и съдържащите златен корен са 0.6%. Средната цена на търговец на едро на продадена опаковка за валериана-съдържащ продукт е 3 пъти по-ниска от тази на пасифлора-съдържащ продукт и 12 пъти по-ниска от тази на съдържащ златен корен продукт. Преобладаващата употреба на валериана-съдържащи продукти може да се обясни с голямата популярност на билката и ниската цена на продуктите. Заключение: Трите най-широко използвани в България билки с анксиолитичен ефект са валериана, пасифлора и златен корен. Най-голяма е употребата на валериана-съдържащи продукти, докато пасифлора и златен корен са по-непознати в България и вероятно в бъдеще ще добиват все по-голяма популярност и употреба.Introduction: Valerian (Valeriana officinalis) is a very popular herb used to treat insomnia and anxiety. Passion flower (Passiflora), not very popular in Bulgaria, is also used in anxiety and insomnia. Golden root (Rhodiola rosea), a newly introduced herb in Bulgaria, is recommended for stress, exhaustion and anxiety. Aim: The aim of this study was to examine the available on the pharmaceutical market in Bulgaria pharmaceutical products and dietary supplements containing valerian, passion flower and golden root and to analyze the use of such products in 2016. Materials and Methods: The study was conducted by collecting sales data from 19 pharmacies in Varna for products containing the three herbs with anxiolytic effect. Results and Discussion: There is a great variety of valerian-containing monoproducts and combined products in Bulgaria. The pharmaceuticals are two, and the dietary supplements are above 35. Passiflora is available in the form of several dietary supplements (monoproducts and combined), three of which are mostly used. In Bulgaria, golden root is available as one pharmaceutical product and several dietary supplements, which are predominantly monoproducts. The sales data of packages containing one of the three herbs in the investigated pharmacies showed that valerian-containing products comprised 87.9%, 11.5% were passion flower-containing and 0.6% were golden root-containing. The average wholesale price of a sold valerian-containing package was respectively 3 and 12 times lower than that of a passion flower-containing one and a golden root-containing one. The predominant use of valerian-containing products might be explained by the great popularity of the herb and the low price of the products. Conclusion: The three most frequently used in Bulgaria anxiolytic herbs are valerian, passion flower and golden root. The highest is the use of valerian-containing products while passion flower and golden root are quite unfamiliar and probably will gain increasing popularity and use in the future

Colorectal resections - clinical and immunological results

INTRODUCTION: Surgery induces a generalized state of postoperative immunosuppression responsible for a lot of complications in postoperative period. Magnitude and type of the intraoperative injury depend on the extent and duration of postoperative immune suppression. This study compared clinical outcomes and immune changes after minimally invasive and open colorectal resections in patients with colorectal cancer (CRC).MATERIAL AND METHODS: Study included 40 patients with CRC who underwent colorectal resections in our clinic last year. Twenty one of them underwent minimally invasive surgery, with a mean age of 64.8 years (49-86). The rest 19 patients underwent conventional surgery, with a mean age of 66.2 years (56-84). Blood tests were performed 24 hours prior to surgery, 24 hours and 7 days after surgery. Analysis included full blood count, total protein, albumin and markers of inflammation (CRP, ESR, fibrinogen). T- (CD3+), B- (CD19+) and NK-cell lymphocyte populations were studied by means of flow cytometry, as well as activation of leucocytes, according to the expression of HLA-DR, CD38, CD279, CD163 and some clinical parameters. All data were analyzed using SPSS version 21.RESULTS: There was no significant difference in preoperative results between minimally invasive group and conventional group. At 24 hours after surgery there were significant decrease in lymphocyte percentages and increased leucocyte count, granulocyte percentages and CRP levels in conventional group. This ratio maintained at 7 days after surgery. Activated monocyte (CD 163+), total protein and albumin, eosinophiles, percentage of monocytes, lymphocytes and NKT-cells (CD3+ CD16/CD56+) were significant decrease in conventional group compared with minimally invasive group at first postoperative day.CONCLUSIONS: Minimally invasive colorectal cancer resection is a technically feasible option, with comparable results in terms of oncologic clearance, lesser degrees of tissue injury, surgical metabolic stress, and immunosuppressive response to conventional open surgery. Patients undergoing minimally invasive resections demonstrated improved clinical recovery and shorter hospital stay than patients undergoing open surgery. 

TRANSANAL ENDOSCOPIC MICROSURGERY IN THE MANAGEMENT OF RECTAL CARCINOID.

AIMS: Carcinoid tumors, a type of neuro-endocrine tumors (NETs), comprise a heterogeneous group of neoplasms arising from cells of the neuro-endocrine system. Rectal carcinoid tumors are relatively uncommon, representing 1,1% to 1,3% of all rectal neoplasms. Their incidence is dramatically increasing. The aim of this study was to review our department`s experience and assess the efficacy of transanal endoscopic microsurgery (TEM) in the management of rectal carcinoid tumor.METHODS: Between 2013 and 2015, four patients with rectal carcinoid underwent TEM, and their clinical data were reviewed retrospectively. RESULTS: Two patients (50%) were identified as high-risk patients and underwent TEM, full-thickness excision and two ones (50%) were identified as low-risk patients and underwent TEM, submucosal resection. One patient from the high-risk group was referred to us by gastroenterologist from another hospital for complete surgery after endoscopic polypectomy with microscopically tumor positive resection margin. Tumor size was bigger in high-risk patients than in low-risk ones (14 and 20 mm versus 7 and 9 mm). There was no lymphovascular invasion in both groups. The operation time was longer in the full-thickness excision than in the submucosal resection group (45 and 55 min versus 27 and 33 min). One patient with full-thickness excision was complicated with acute urinary retention. There was neither local recurrence, nor distant metastasis in our patients during the follow-up period. CONCLUSIONS: Our data suggest that TEM is a safe, minimally invasive approach for local excision of rectal carcinoid tumors and, generally, leads to good oncological and surgical outcomes. Furthermore, for patients with microscopically positive margins after endoscopic polypectomy, TEM can be an effective surgical option for complete residual tumor removal