The Bonebridge system – Our clinical experience /Case report/

Introduction: Bone conduction implants are a standard treatment option for patients with conductive or mixed, hearing loss. The Bonebridge system was introduced by MED-EL in 2012, and two years after its debut, it was used in more than 200 centers worldwide (6). For the first time the Bonebridge system was implanted in Bulgaria in 2015 by associated professor P. Rouev. The main audiological criteria for placement is conductive hearing loss, which is caused by atresia of the auditory canal or diseases of the middle ear with preserved bone conduction (below 45 dB), as well as unilateral hearing loss above 70 dB (contralateral hearing loss not more than 20 dB). The system does not penetrate the skin and consists of an internal part - an implant, which is placed completely under the skin, and an external part - a processor. The acoustic signal from the environment is transformed into mechanical vibrations that are transmitted to the mastoid bone. The expected results are an improved hearing threshold and better hearing in noisy environments.Methods: Our clinical experience with the Bonebridge system is based on three operated patients aged between 56 and 73 years. All three patients had evidence of bilateral conductive hearing loss. Here we present one of these cases.Results: Test results showed significant improvement in hearing sensitivity especially in frequencies round 1000 Hz.Conclusions: Bone conduction implants such as the Bonebridge system are an excellent treatment option for patients with bilateral conductive deafness. Bonebridge has good hearing results, relative simplicity, and low rate of complications. Experience has shown that the Bonebridge system is easy to use and highly reliable. The use of Bonebridge conduction implant system leads to a significant improvement in the quality of life

Immunodetection of chitinase-like and beta-1,3-glucanase-like proteins secreted in vitro by embryogenic and non-embryogenic cells of grapevines

Research NoteEmbryogenic and non-embryogenic cell lines were obtained from the rootstock 41B (Vitis vinifera cv. Chasselas x V. berlandieri). A few extracellular proteins from culture media of embryogenic and non-embryogenic grapevine cell lines during multiplication showed a positive reaction with anti-chitinase antibodies (embryogenic cell lines) and anti-β-1,3-glucanase antibodies (non-embryogenic cell lines)

Surgical approach for borderline „giant“ osteoma in the frontal sinus. Clinical case. Literature review

Introduction: Osteomas are benign tumors, with slow growth and a long period of asymptomatic development. The paranasal sinuses are often involved, the most affected one being the frontal sinus, followed by the ethmoid, maxillary and sphenoid sinuses. Etiologically, theories of inflammatory, traumatic, genetic genesis should be introduced, but the issue still remains unclear. The diagnosis is very often accidental, when performing radiography or computed tomography (CT). Clinically manifested osteomas with headache, facial deformity, mucocele, intracranial complications are subject to timely surgical intervention. The choice of surgical approach depends on the size of the osteoma and the location, as well as on the professional and technical capabilities given the more specific requirements for the instrument.Materials and methods: We present a clinical case of a 28-year-old man with complaints of headache in the frontal facial area. An X-ray revealed an osteoma in the area of the left frontal sinus, involving more than 2/3 of its cavity. CT was performed and a discussion of the possibilities of endoscopic endonasal surgery, given the borderline „giant“ osteoma with a diagonal size of about 2.75 cm (> 3 cm). An endoscopic endonasal approach was applied.Results: Endoscopic endonasal surgery was performed. The chosen surgical approach was Draf 3 type frontotomy with osteoma extirpation. In early postoperative period– 5 days, there aren’t registreted complications. The patient was followed endoscopically in the second week, first month, sixth month. A month later, a control CT scan was performed with data on residuality on the anterior wall of the frontal sinus, without drainage disturbance. Clinically, the patient has no complaints. There are no late postoperative complications.Conclusion: Symptomatic osteomas of the paranasal sinuses require timely surgery. The choice of surgical approach (open with osteoplastic flap, endonasal or combined) depends on the anatomical location, the size of the tumor, as well as the experience of the surgeon and the technical capabilities of the hospital. Endoscopic endonasal surgery is popular, with highly valued capabilities over time, but in „giant“ osteomas it is debatable given the risk of residuality

Necrotising sinusitis with orbital complication in patient with macrophage activation syndrome (MAS)

Background: Macrophage activation syndrome (MAC) is a potentially fatal clinical-laboratory syndrome of uncontrolled hyperinflammation arising as a result of hereditary or acquired immune-mediated processes of cellular overactivation and nonmalignant proliferation of tissue macrophages/histiocytes, which can cause multiorgan failure.Case report: We present a clinical case of 15-years old child, who was diagnosed with juvenile idiopathic arthritis in 2019. The disease started with macrophage activation syndrome. In the next years the child had multiple hospitalizations in the Pediatrics clinic, but in the course of the disease it developed the picture of severe necrotic pansinuitis with an orbital complication, which required an immediate surgical intervention. Ever since the child had an ongoing necrotizing process in the area of the nasal passages, sinuses, upper jaw and hard palate. Other complications were breakthrough of the hard palate, loss of healthy teeth from the upper dentition and creation of direct communication between the oral cavity and the left maxillary sinus.Conclusions: The diagnosis of MAS is difficult to make, but increased awareness of this disease is an essential for its recognition. The struggle with autoimmune diseases often lasts for years with periods of exacerbation and remission of symptoms. Complications related to them can affect different organs and systems and require interdisciplinary approach

Clinical aspects of satellite diseases and cricoarytenoid joint involvement. Arthritis of the cricoarytenoid joint. Clinical case.

Introduction: Laryngeal involvement in rheumatoid arthritis is a rarely mentioned complication in clinical practice. In the literature over the last 10 years, single articles on the subject have been published, presenting a small number of clinical cases. Cricoarytenoid arthritis is a life-threatening condition requiring timely anesthesia and otorhinolaryngological intervention, where the tracheostomy has an important therapeutic place.Aim: With the presentation of our clinical case we aim to expand the knowledge about systemic diseases and their possible acute manifestation in otorhinolaryngological practice. Materials and methods: We present a clinical case of patient M.S., 63 years old, female, with a long medical history of rheumatoid arthritis. She was admitted to the clinic with a tracheostomy cannula placed for acute laryngeal dyspnea. Physical examination with a fibrolaryngoscope revealed bilateral paresis of the vocal folds, in a medial position, without phonatory and respiratory activity. Computer tomography of the neck, chest, with a focus on the mediastinum – without clinical data on tumor processes. Laboratory tests reveal a repeatedly elevated rheumatoid factor.Results: MRI revealed a collapse of the larynx, with pronounced fatty degeneration of the thyroarytenoid and cricoarytenoid muscles. The patient was referred to a rheumatologist to control the chronic exacerbation process, with a definitive tracheostomy cannula.Conclusion: Pathological changes in the cricoarytenoid joint in patients with rheumatoid arthritis, as well as scleroderma, lupus, Felty’s syndrome, Tiez syndrome and other systemic diseases, are a common finding, although diagnosed in the past at autopsy. It can be acute, subacute and chronic, but in otorhinolaryngological practice it occupies an important clinical place in emergencies

Value-semantic motivational characteristics of the popptional choice of students of medical university

The article reveals the value-semantic motivational characteristics of the professional choice of medical students. Presents the results of the survey. The study was attended by first-year students of treatment-and-prophylactic, pediatric, and dental faculties of the Ural State Medical University.В статье раскрываются ценностно-смысловые мотивационные характеристики профессионального выбора студентов медицинского вуза. Представлены результаты анкетирования. В исследовании приняли участие студенты-первокурсники лечебно-профилактического, педиатрического, стоматологического факультетов Уральского государственного медицинского университета

Seismic activity in Turkey. Earthquake in Elazing (turkish eastern province) on january 24, 2020

The article provides an analysis of the earthquake that occurred in the Turkish province of Elazig on January 24, 2020, as one of the largest earthquakes of the past year, seismic activity in Turkey and its features.В статье приведён анализ землетрясения, произошедшего в турецкой провинции Элязыге 24.01.2020, как одно из наиболее крупных землетрясений прошедшего года, сейсмическая активность в Турции и её особенност

The importance of pathogenicity factors of some Streptococcus spp. and Klebsiella spp. in determining their etiological role in the inflammatory processes of the respiratory tract

Together with the known pathogens of inflammatory processes of the respiratory tract in clinical practice are often found representatives of Streptococcus and Klebsiella, previously considered commensals of the mucous membranes of the upper respiratory tract. The exchange of genetic information facilitates the transfer of virulence factors between strains not only within the species but also within the genus. In such cases, the acquisition of virulence genes by nonpathogenic species from representatives of pathogenic species contributes to the manifestation of previously not typical properties. Therefore, the aim of the research was to study the virulence of opportunistic Streptococcus spp. and Klebsiella spp. in inflammatory processes of the respiratory tract and substantiate their etiological role in the development of the disease. We studied 220 strains of Streptococcus spp. and 97 strains of Klebsiella spp., isolated from patients with inflammatory processes in the respiratory tract and from healthy individuals. Strains of Streptococcus spp. were investigated for the presence of virulence genes: sagA, lmb, fapl, ply, lytA. Strains of Klebsiella spp. were examined for the presence of virulence genes: MrkD, magA, kfu. The phenotypic marker of lmb gene expression in Streptococcus and MrkD gene in Klebsiella was the indicator of adhesion of isolated strains to buccal epithelial cells. Expression of the fapl gene was evaluated in a phenotypic biofilm formation test. In individuals with upper respiratory tract inflammation, the most common types of strepto -cocci were: S. mitis, S. anginosus, and S. oralis. Strains of these species isolated from inflammatory processes in the upper respiratory tract had 2—4 times greater adhesiveness than strains isolated from healthy individuals. Phenotypic determination of the ability to biofilm formation showed that strains of Streptococcus containing the fapl gene formed a dense biofilm in contrast to strains without the fapl gene. K. oxytoca strains isolated from people with sinusitis had mrkd, magA, and kfu virulence genes that are characteristic of K. pneumoniae strains. In phenotypic tests, it was found that the value of the adhesion index in K. oxytoca strains isolated from patients is 4 times higher than in strains of this species isolated from healthy individuals. Thus, to confirm the etiological role of an opportunistic microorganism in the development of the infectious process, it is necessary to be guided by data on the genetic and phenotypic markers of virulence of the isolated strain

Assessing <i>Serratia</i> spp. pathogenic potential from cryogenic habitats

The genus Serratia are opportunistic bacteria widely spread in natural environment. At the same time, this bacterial genus consists of the species associated with outbreaks of nosocomial infections. Serratia species are found in extreme habitats, but pathogenic potential of polyextremophilic strains in this genus remains unexplored. The aim of this study was to compare the genomes of two Serratia strains isolated in polar regions, primarily examining genetic factors of virulence and adaptation to cryogenic environment. During the 56th Russian Antarctic Expedition the Serratia liquefaciens 72 strain was isolated from a guano sample of the Adelie Penguin (Pygoscelis adeliae) colony on Tokarev Island (Haswell Archipelago, East Antarctica). The Serratia fonticola 5l strain was isolated from the frozen carcass of moose (Alces alces) fossils found on the Buor-Khaya Peninsula near the Laptev Sea coast (Yakutia Region, Russia). The whole-genome sequencing of such strains allowed to reveal genetic structures evidencing about their successful adaptation to low temperatures. Thus, it was found that both genomes contain genes encoding the main cold shock proteins, phylogenetically close to the corresponding genes in the hypobarotolerant Serratia liquefaciens strain ATCC 27592. Furthermore, both strains bear a cluster of tc-fABCD genes determining the bacterial adhesion to epithelial tissues, and the genes for RTX toxins — adhesins, crucial factors of biofilm formation in pathogenic Gram-negative bacteria. Experimental studies confirmed the ability of Serratia liquefaciens 72 and Serratia fonticola 5l to actively form biofilms in a wide temperature range (from 6°C to 37°C). The results obtained indicate that the examined genus Serratia strains isolated in Arctica and Antarctica exert overall similar adaptation strategies to polar climate, including the ability to produce pili, show active adhesion, and biofilm formation under low temperatures. Genetic adaptive factors may also act as pathogenicity factors allowing extremotolerant Serratia strains to exert traits of opportunistic and nosocomial pathogens and spread via chilled food-borne transmission. The wide use of food technologies, such as cooling and vacuum sealing, can potentially create a new ecological niche favourable for selection of psychrotolerant and hypobarotolerant pathogens. The data obtained allow to raise a question about necessity of further studies to monitor genetic diversity among psychrophilic hypobarotolerant microbial populations possessing pathogenic and epidemic potential