Saliva application in oral and systemic diseases

Saliva is a noninvasive and accessible biofluid that permits early detection of oral and systemic diseases. Changes in saliva reflect the alterations in the blood and thus making saliva a suitable diagnostic tool. The use of saliva has many advantages, including simple and non-invasive sampling and easy, low-cost storage.Today salivary diagnostics is a promising tool for diagnostic processes and clinical monitoring. Saliva is used to detect illicit drugs, alcohol, to measure hormone levels, and in the diagnosis of wide range systemic diseases such as cardiovascular, infectious, renal, endocrine diseases, some types of cancer as well as nonsystemic oral diseases.The current review presents a critical overview of saliva as a promising tool for the development of valuable salivary biomarkers, their relevance to the prognosis, diagnosis and management of systemic and oral diseases. Development of point-of-care testing based on saliva samples as a screening tool will also support the diagnostic process in near future

Radiological impact of surface water and sediment near uranium mining sites

The aim of this study is to assess the radiological impact of surface water and sediment around uranium mining sites 20 years after their closing. The areas under observations are 31 former classical underground uranium mining and exploratory sites in Bulgaria, named as objects. The extraction and processing of uranium ores in the Republic of Bulgaria were ended in 1992. To assess the radiological impact of radionuclides field expeditions were performed to sample water and bottom sediment. The migration of uranium through surface water was examined as one of the major pathways for contamination spread. The range of uranium concentration in water flowing from the mining sites was from 0.012 to 6.8 mgU l −1 with a geometric mean of 0.192 mgU l . The uranium concentrations in water downstream the mining sites were approximately 3 times higher than the background value (upstream). The concentrations of U nat , 226 Ra, 210 Pb, and 232 Th in the sediment of downstream river were higher than those upstream by 3.4, 2.6, 2, and 1.7 times, respectively. The distribution coefficient of uranium reflects its high mobility in most of the sites. In order to evaluate the impact on people as well as site prioritization for more detailed assessment and water management, screening dose assessments were done

Radiotherapy. stages of planning of the radiotherapy process. TNM classification

В лъчелечението днес се използват две основни групи йонизиращи лъчения - фотони и заредени частици. Фотони са рентгеновите, гама и високоенергийното спирачно лъчение (Х-лъчите), a частици - бета-лъчите, ускорените електрони, протоните, пи-мезоните и тежките йони. До скоро рентгеновата и телегаматерапията бяха водещи в България. С въвеждане на линейните ускорители най-широко е приложението на Х-лъчите и ускорените електрони. Рентгеновата терапия се прилага при кожни лезии с малки размери.Процесът на планиране на лъчелечението е труден, съдържа много стъпки и високорискови дейности, тъй като включва използването на много източници на информация и взаимодействието на различни специалисти, участващи в лъчелечебния процес. TNM класификацията се използва за определяне индикациите за лъчелечение.При всички болни, които се облъчват с линейни ускорители, се прилага триизмерно планиране. Основното е, че облъчваният обем и критичните органи се задават в поредица от срезове с дебелина, по-голяма от 0,5 см. По този начин значително се повишава точността и качеството на планираното лъчелечение. Техниките на облъчване, прилагани с линеен ускорител, са изоцентрични и налагат маркиране на изоентъра на кожата на пациента или на имобилизиращите устройства. Изоцентърът се поставя при първото облъчване на терапевтичния апарат в присъствието на лекар и физик-дозиметрист, изготвил индивидуалния план.Ако всеки лъчетерапевтичен център разполага с пълен набор от лъчетерапевтична апаратура, това дава възможност за адекватно и съвременно облъчване на всички локализации на злокачествени и доброкачествени новообразувания, с индикации за лъчелечение. В онкологичната информационна система се съхраняват: личните данни на пациента, клиничната информация относно заболяването и вида лечение, дозиметричният план на облъчването, както и подробна информация за проведеното лъчелечение. Информацията се архивира с възможност за справка на броя на извършените сеанси и облъчвани обеми, както и статистически анализ на множество данни, отнасящи се до цялостния лъчетерапевтичен процес.In modern radiotherapy two main groups of ionizing radiation are used - photons and charged particles. The photons consist of orthovoltage x-rays, gamma rays and high-energy x-rays, and the particles are beta-rays, accelerated electrons, protons, pi mesons and heavy ions. Until recently orthovoltage and telegamatherapy have been the main types of radiotherapy in Bulgaria. Now with the installation of linear accelerators, x-rays, and accelerated electrons are most commonly used. Orthovoltage radiotherapy is used for small skin lesions.The planning process of radiotherapy is difficult and contains many steps and high-risk activities as it includes the use of many sources of information and the collaboration of different specialists participating in the radiotherapy process. TNM classification is used to define the indication for radiotherapy. Three-dimensional planning is applied to all patients that are treated at a linear accelerator. The main issue here is that the target volume and the critical organs are defined as a series of consecutive CT scans with thickness of less than 0.5 cm. Thus, the accuracy and the quality of the planned radiotherapy are significantly improved. Isocenter irradiation techniqes are used with linear accelerators and this requires marking the isocenter on the patient`s skin or on the immobilization devices.The isocenter is marked during the first irradiation at the treatment machine in the presence of a physician and a physicist-dosimetrist who has developed the individual plan.If a single radiotherapy department is equiped with the full set of radiotherapy machines, this will provide adequate and modern irradiation of all malignant tumors and benign conditions requiring radiotherapy. The oncology information system stores the demographic data of the patient, the clinical information about the disease and treatment methods, the treatment as well as detailed information about the radiotherapy course . The information is archived and allows the checking of the number of performed fractions, the irradiated volumes as well as the performing of a statistical analysis of multiple data related to the entire radiotherapy process

Ethical and regulatory aspects of clinical trials in paediatric population in the Republic of Macedonia

Clinical trials in children should be carried out to provide adequate protection whilst recognising the right to benefit from research. Their vulnerability emphasizes the responsibility to ensure parental permission and assent of able children, assurance of direct benefit for the child with the particular condition, minimization of risk, and scientific necessity of the research. Although there may be ethical concerns about conducting paediatric trials, this has to be balanced by the ethical concerns about giving medicines to a population in which they have not been tested. Specific clinical trials in paediatric populations are required due to age-related differences in the drug handling or drug effects which may lead to different formulation or dose requirements to achieve efficacy or to avoid adverse effects

Kidney stone disease (Nephrolithiasis) - Pathogenesis, types of imaging diagnostic methods in contemporary medicine

Рискът от развитие на нефролитиаза в развитите страни е около 12% при мъжете и 6% при жените. Бялата раса е по-засегната от черната. Честотата на заболяването се увеличава правопропорционално на увеличената честота на захарен диабет тип ІІ и наднорменото тегло. Съотношението мъже / жени е 1,3:1. Честотата се увеличава във възрастта над 20 години, a пикът на патологията е във възрастовата група между 40-60 години, след което намалява и остава константа. Нефролитиазата е известна още като бъбречно-каменна болест и се развива при пациенти с генетична предиспозиция, при широк спектър от метаболитни заболявания, a също и при множество коморбидни състояния. Повечето камъни са изградени от калциев оксалат и пикочна киселина, струвит (амониево-магнезиев сулфат), цистин, амониев урат. Напоследък се повишава честотата на лекарствено индуцираната нефролитиаза, която се наблюдава при имобилизирани пациенти.Образнодиагностичните методи започват с ултразвуковото изследване на пикочо-отделителната система. То открива голям процент от всички конкременти, както и паренхимни процеси, които биха могли да имитират ренална колика. Обзорната рентгенография на бъбреци, уретери, пикочен мехур (БУМ) представлява рентгеново изследване на отделителната система, което демонстрира конкременти с калциево съдържимо; обикновено предшества венозната урография и други рентгенови изследвания. Венозна урография - методът дава информация както за позицията и размера на конкремента, така и за състоянието на бъбречната функция. Методът обаче има риск от известна нефротоксичност. Компютърна томография без използване на контрастна материя демонстрира конкременти във всяка една част от отделителната система.Има редица заболявания, които могат да имитират симптомите на БКБ и поради тази причина е необходимо те да бъдат изключени в хода на диагностичния процес. Днес развитието на науката допринесе за по-задълбочено разбиране на причините и механизмите за образуване на камъни и съответно - за много по-ефективно клинично диагностициране и лечение. Необходимо е периодично да се следи здравословното състояние чрез редовни консултации с нефролог или уролог, който да извършва ехографско изследване.The risk of nephrolithiasis in developed countries is roughly 12% in men and 6% in women. Caucasians are more likely to form kidney stones than black people. The frequency of this pathology increases proportionally to the rising frequency of type II diabetes mellitus and obesity. The ratio of male to female sufferers is 1.3:1. The disease is mostly observed in individuals over the age of 20, while the pique is between 40 and 60 years. Nephrolithiasis is more commonly known as kidney stone disease and develops primarily in genetically predisposed patients, patients with metabolic disorders, and multiple comorbidities. Most stones are made up of calcium oxalate and uric acid, struvite (magnesium ammonium phosphate), cystine, ammonium urate. Recently there has been an increase in medicamentation-induced nephrolithiasis, observed in immobilized patients.The imaging diagnostics begins with abdominal ultrasonography - it can find a large percentage of all calculi, as well as parenchymal processes which could simulate a renal colic. Plain abdominal radiographs can demonstrate calcium-containing stones, and usually precedes venous urograms and other exams. Venous urograms provide insight into a calculus position, as well as regarding renal function. It is, however, associated with potential nephrotoxicity. Computed tomography can natively (without contrast material) demonstrate virtually all stones in every part of the excretory system.There are several conditions which mimic the symptoms of kidney stone disease, and must therefore be exlcuded along the diagnostic pathway. Currently, advanced understanding of the reasons and mechanisms of calculus formation have contributed to more effective diagnostic and treatment methods. Periodic consultations and ultrasonographies with a nephrologist or urologist are advisable

Imaging diagnostic methods for colorectal cancer in contemporary medicine. Types and prevention

INTRODUCTION: Colon cancer (colorectal carcinoma) is a malignant tumor, stemming from the wall of the colon. It is the second most common carcinoma in men (after pulmonary and before stomach cancers) and the third most common in women (after breast and uterine carcinomas). Its frequency has been increasing steadily in the last years. It most often affects people past 50 years of age, but about 20% of cases occur before that point. Histologically, 80% of cases are of adenocarcinoma and about 20% - mucinous. Carcinomas generally develop on the basis of adenomas.AIM: To examine the types, the prevention and the imaging diagnostic methods for the cancer of the large intestine and of the colon of modern medicine.MATERIALS AND METHODS: This research applies statistical methods. The data was processed through statistical and graphical analyses.RESULTS: Screening methods applied with success are as follows: rectoromanoscopy, fibrocolonoscopy, irigography, computed tomographic colonography, magnetic resonance tomography. The most frequently used two are irigography with a barium enema and fibrocolonoscopy. The former allows for a thorough radiological topographical analysis of the whole colon, while the latter allows for direct mucosal visualization and biopsy (both cytological and histological) without radiation by means of a flexible metallic tube inserted retrogradely. Fibrocolonoscopy enables minor minimally invasive surgery such as polyp and small tumor removal. Rectoromanoscopy is a dated method, solely with historical significance. The latest imaging diagnostic methods are the tomographic ones - computed tomography, computed tomography virtual colonoscopy, and magnetic resonance tomography. They are highly informative for all diseases of the colon, contributing considerably to tumor staging, and to preoperative assessment.CONCLUSIONS: Screening programs, timely consultations with specialists and the increasing availability of imaging diagnostic equipment lead to a marked tendency of decreasing colorectal carcinoma mortality in Bulgaria

The effect of X-ray radiation on the human body - pros and cons. Radiation protection in medical imaging and radiotherapy

INTRODUCTION: The discovery of X-rays in November 1895 by Roentgen opened a new chapter in the scientif­ic development and pretty soon it became clear that these rays can be useful for diagnostics and treatment. The most frequent use of X-rays is related to their ability to pass through matter. The main fields of application of the rays are medicine, industry, checks of goods and packages and scientific studies. Modern medicine consti­tutes approximately 80% of the overexposure. The contribution of diagnostic radiology is approximately 22% of the total exposure of Bulgarian population. The quality of the medical services depends to a great extent on the accurate and timely diagnoses set through different methods using also ionizing radiation. The exposure of the patient should be reasonably justified and optimized but cannot be limited. The risk of exposure to high doses of radiation is justified only if this is appropriate for the diagnosis or the treatment. Each overexposure, including medical irradiation, is related to certain radiation risk. Radiation protection is a means to apply the measures intended to protect the health from ionizing radiation-related risks. It is essential to know the bene­fits and risks of the medical procedures.AIM: To investigate radiation protection means, and the benefits and risks of medical procedures.MATERIALS AND METHODS: An analysis of literature sources was conducted.RESULTS: The medical control of the radiation protection divides exposure into three categories: professional exposure, medical exposure and exposure of the population. Irradiation by any source should be conducted by optimizing the protection and the safety, maintaining the size of the individual dose, the number of exposed persons and the exposure at levels as low as reasonably achievable considering the social and economic factors. This is the so-called optimization of the protection

Gallstone disease (Cholelithiasis) - pathogenesis, prevention and contemporary methods of imaging diagnostics

INTRODUCTION: Cholelithiasis is a metabolic disorder, leading to stone formation in the bile ducts and gall­bladder. The stones are classified by their composition as cholesterol, pigment, and mixed. The condition is more frequent in overweight individuals, with a stationary way of life, diabetics, and women on oral contracep­tives. There is a female predilection with a 3.5:1 ratio. The disease has several forms. The latent one is devoid of complaints - stones are an incidental finding. The acute form manifests with right upper quadrant pain. Bili­ary colic is typical - it comes in fits of right subcostal pain, nausea, and frequently - vomiting. Complications are frequent - gallbladder and bile duct inflammation, biliary obstruction, gallbladder perforation, and bili­ary peritonitis.AIM: To analyze the pathogenesis, the prevention and the modern medical imaging methods related to the gallstones disease.MATERIALS AND METHODS: This research applied statistical methods. The data was processed through sta­tistical and graphical analysis.RESULTS: Accurate diagnosis requires a compound approach. Anamnesis of biliary colic initiates it. Abdomi­nal ultrasonography is the fastest and most accessible imaging method for finding gallstones. It can also pres­ent the gallbladder itself - whether it is enlarged, inflamed, or folded. Additional methods include magnetic resonance imaging (MRI), computed tomography (CT), and some hybrid techniques. If the data of cholelithi­asis is ambiguous, the latter can be confirmed by endoscopic retrograde cholangiopancreatography (ERCP) - an endoscope is introduced to the level of the papilla of Vater, and contrast is injected into it. The biliary path­ways also used to be imaged by percutaneous transhepatic cholangiography, which now is a dated technique.CONCLUSIONS: Prophylaxis includes avoiding risk factors of alimentary nature and undergoing periodic con­trol ultrasonographies, especially in individuals with a family history of gallstones. This is crucial, as chroni

MEASUREMENTS OF RADON CONCENTRATION IN SOIL GAS OF URBAN AREAS, BULGARIA

These work present results of preliminary study of radon concentration in soil gas at 64 locations within 13 urban areas of Bulgaria using AlphaGuard equipment. The measuring period was from 2008 to 2012. The temperature and humidity has been measured as well, including the gamma dose rate. The radon concentration in soil gas was found to be log-normally distributed within the range from 3-97 kBq.m −3 , with arithmetic mean of 26 kBq.m −3 . The influence of the meteorological and geological factors in relation to radon measurements was examined. Correlation between radon in soil gas and gamma dose rate was also present