The Mask of Orthorexia – Two Cases from Medical Practice

Introduction: Eating disorders (EDs) are common, often chronic, and potentially life-threatening conditions affecting predominantly adolescents and young people. An especially common problem in the latest years is orthorexia nervosa (ON). Often the symptoms of ON are well disguised and the condition is not included in the differential diagnosis of most medical professionals.Materials and Methods: Two case studies are presented from the practice of a medical specialist in nutrition and dietetics: women with ON. Both patients received nutritional training and specific nutritional instructions. The motivation to change their dietary habits and create new ones was maintained through regular communication with the physician, and in some cases - through regular meetings with a clinical psychologist. Both women were encouraged to participate in group psychotherapy sessions under the guidance of a clinical psychologist.Interpretation: These clinical cases demonstrate that when diagnosing ON there are not always large deviations in the clinical and laboratory indicators. Only the careful recording of the anamnesis and the in-depth conversation with the patient allows the correct diagnosis to be made. Insufficient awareness among medical staff (including doctors and nurses) about symptoms and diagnosis of eating disorders requires further training on this issue

Rare Anatomic Variations of the Female Reproductive System Published in Bulgarian Medical Literature in Late XIX. Century

Periodic medical press in Bulgaria dates back to 80s of the XIX century, when the first scientific medical journals have been published. A sample of publications devoted to a specific medical problem, i. e. of the rare variations of the female reproductive system was studied by means of a detailed analysis of the literature from this period. In this paper the articles concerning the description of variations, journals containing them and their authors along with a short biographic data were presented. The results showed a high professionalism and desire for research of these authors

Diverticular Disease (DD) of the Digestive Tract. Classification, Types of Complications, and Treatment

IntroductionDiverticular disease (DD) of the digestive system is a common disease with an increasing incidence recorded. The most frequently affected anatomical areas are the distal sections of the large intestine, namely the distal colon and sigmoid colon.AimThe aim of this article is to investigate the frequency of DD, the position of the diverticula, the types of complications and treatment.Material and MethodsThe study was single-center, retro- and prospective, covering 1,879 patients hospitalized at the General Hospital in Pleven for the period 01.01.2022–01.06.2023. A total of 66 patients (3.5%) were diagnosed with DD. Both sexes were affected equally.ResultsThe complications were as follows: bleeding in 39 (59%) patients, and 12 (18%) had the presence of an inflammatory process. Eleven of the patients (16.6%) were operated on. In 27% Hartmann’s resection was performed, in 72%—partial resection or hemicolectomy with primary anastomosis. We have no lethal outcomes in the studied patient group. The operated patients were evaluated according to CDD, Modified Hinchey and Hansen-Stock classifications.ConclusionThe most frequent factors affecting the incidence of DD are the increased survival rate of the population, inadequate prevention of gastrointestinal tract (GIT) diseases, constipation, disturbances in the dietary regimen. The GIT parts affected by DD in the group of patients was of the Western type, i.e., mainly on the left. The most common complication is bleeding, which in most cases is controlled with medication. Operative treatment was applied in cases of diagnosed peritonitis and/or unsatisfactory result of antibiotic treatment

Multimedia Assessment of Pollutant Pathways in the Environment, European Scale Model (MAPPE-EUROPE)

The report documents the structure, functions and algorithms used for the modeling of pollutant pathways in air, soil sediments and surface and sea water at the European continental scale. The algorithms are implemented in an extension for ESRI ArcGIS 9.2 a popular geographic information system (GIS) software widely used within the European Commission and in the research, environmental assessment, planning communities. The software is called MAPPE after Multimedia Assessment of Pollutant Pathways in Environment of Europe; the acronym is also the Italian word to denote maps. The purpose of the software is to provide a user-friendly way to convey the wealth of geographic data available to model the fluxes and concentrations of chemical pollutants emitted by industrial activities and other point emissions, and widespread use within households, urban environments or agriculture. The intended use is for organic contaminants such as pesticides, pharmaceuticals, VOCs, and other industrial chemicals. The output of the model, i.e. maps of concentration and chemical fluxes, can be used for the screening of hot spots at continental scale, the assessment of risk for human health and ecosystems, the evaluation of policies and scenarios with reference to the ¿big picture¿ of the continental scale. However this does not avoid the need to use more detailed, site specific assessment procedures for single problems, but provides a tool for decision support in contexts such as the management of priority substances of concern for soil, water and air quality, the control of effects of environmental pollution on human health and ecosystems, and the sustainable management of agro-chemicals, etc. by making available a geographic representation available of the consequences of emissions to air, soil and water compartments.JRC.DDG.H.5-Rural, water and ecosystem resource

Pharmacoeconomic analysis of medical abortion in Bulgaria

The drug treatment for interrupting early pregnancy begins with the identification of prostaglandins. In the 1970s, many developed countries legalized abortion, which led to the development and active application of this healthcare technology worldwide.The cost-effectiveness method was used in the pharmacoeconomic analysis by comparing the costs of abortion of two of the most popular protocols and dosage regimens with the medicines available at the time of the study on the Bulgarian market and the costs of classic abortion. The eventual complications were also noted. Because of the equivalent efficiency of the two procedures, cost-effectiveness analysis is simplified to cost-minimization analysis (CMA).The analysis shows that the drug termination of pregnancy under the EMA protocol is with a slightly higher cost per patient compared to the surgical abortion if the procedure is performed during the first trimester of pregnancy (∆ Costs = + 10,61 BGN) and leads to cost savings for the patient during the second trimester of pregnancy (∆ Costs = - 90,96 BGN).Medication termination of pregnancy under the WHO protocol results in cost-savings per patient compared to surgical abortion, regardless of the period of pregnancy during which the procedure is performed (∆ Cost = - 50,43 BGN in the first trimester and ∆ Cost = - 156,60 BGN in the second trimester).Drug termination is non-invasive, highly effective, and safe, resembling the natural mechanism of spontaneous abortion. In most cases, medical abortion is saving costs and can be considered as a reasonable alternative to surgical abortion

Scenario analysis of pollutants loads to European regional seas for the year 2020. Part II: Assessment of priority chemicals – an example with three pilot substances

In order to support the implementation of the Marine Strategy Framework Directive, DG Environment and the Joint Research Centre joined to carry out a study on the expected cumulative impact of existing EU environmental legislation on the quality of the marine environment, with specific reference to the case of aquatic discharges to the European seas. The report describes a few scenario analyses affecting emissions to the European regional seas up to 2020 for Lindane, Trifluralin and Perfluorooctane sulfonate (PFOS) taken as pilot substances. The scenarios developed are agreed with stakeholders at DG ENV following some preparatory meetings. The scenarios do not intend be exhaustive, but examples of what can be further achieved making use of the modelling and database development made in the different phases of the project. For Lindane, the model estimated European sea load of 745 tons per 1995, based on the official emission data provided by EMEP, appears to be reduced by 98.3% in 2005, ten years after the start of the EU regulations for γ-HCH. Besides, under the BAU scenario, a Lindane sea load of ca.12.5 tons per year should be expected. The trend and ban scenarios support, respectively, a reduction of the load to the European seas in 2020 by 74% and 95% when compared to the BAU estimate. Aimed at Trifluralin, according to the BAU scenario, an annual load of ca.61.7 tones is estimated in 2020. However, this is an overestimation, because the aggregated emission data of EUROSTAT for the agriculture use of the entire group of dinitroaniline herbicides in for EU25 have been considered as model input data. The complete ban scenario forecasts ca. 0.07 t/y and in practice eliminates the concern about loads of Trifluralin to European seas to a negligible level in a time-frame of one year due to degradation in soil. Considering PFOS under BAU scenario conditions the total sea load from all European contries is estimated to be 5.8 tons per year. The model forecasts approximately a half of this amount when a 50% reduction of emissions takes place.JRC.H.1-Water Resource

Assessment of Persistent Organic Pollutants load to marine environment by MAPPE-Global model focusing on European regional seas

MAPPE-Global modeling tool belongs to the group of the global box models for environmental fate and transport of POPs. The estimated error level of MAPPE-Global is about a factor of two, which suggests that the model could be considered as a tool for a screening or initial evaluation of chemical risk for POPs at global scale. The verified MAPPE-Global is applied in practical assessments of chemical loads to the European regional seas. The PCBs case study relates to a sum of 22 congeners and considers two emission scenarios: first - the current status relative to the 2010 year; second – a future projection corresponding to the 2020 year. The total amount of 22PCBs released to air equals to 101.03 t for year 2010 and to 50.2 t for year 2020, respectively. The Baseline scenario for Lindane assumes, for the reference year 2005, 86.6 t atmospheric emissions only from European sources and omits the impact of the long range atmospheric transport. The second scenario for Lindane aims to targeting the situation in the year 2020. This scenario (denoted as LRT) suggests no emissions to atmosphere from any European origin due to the banning of this substance but admits that Europe is affected by an unavoidable „import” of 5.4 t Lindane through trans-continental air transport. According to the MAPPE-Global model, the extended European area is exporting to the marine water 3.7 t of 22PCBs in 2010 and 1.9 t in 2020, respectively. In both scenarios, the most affected seas are the Mediterranean Sea (ca.35% from the total) followed by Northern (ca. 21.5%) and Black sea (ca. 19%). It was estimated that the European seas receive by atmospheric deposition about 7.9 t of 22PCBs in 2010 and ca. 4t in 2020. This is two times more when comparing to the entire riverine discharge of 22PCBs for these years. MAPPE-Global forecasts 10.1 t riverine sea load of Lindane under the Baseline scenario and 0.26t in the case of LRT meaning 97% reduction compared to the baseline option. The highest discharges are observed for Atlantic Ocean – in Baseline scenario 2.2t (21.8% from the total) and for LRT 0.06t (23%); and Mediterranean Sea - Baseline 3.5t (34.7%) and LRT 0.04t (15.4%). For the gamma-HCH, likewise for the PCBs, it is found that the atmospheric deposition over the European seas dominate the river input to the coastal zone. Under the Baseline scenario, the total air deposition (50.2t/y) is about 5 times higher than the riverine component of the sea load. Potentially the outcome of MAPPE-Global model could serve in the assessments of different policy options related to the EU Water Framework Directive (WFD) or Marine Strategy Framework Directive (MSFD) as well as to support the implementation of the European sea conventions as HELCOM (Baltic Sea), OSPAR (North-East Atlantic), MEDPOL (Mediterranean Sea) and BSC (Black Sea).JRC.H.1-Water Resource

Review of the 1st Watch List under the Water Framework Directive and recommendations for the 2nd Watch List

The surface water Watch List (WL) under the Water Framework Directive (WFD) is a mechanism for obtaining high-quality Union-wide monitoring data on potential water pollutants for the purpose of determining the risk they pose and thus whether Environmental Quality Standards (EQS) should be set for them at EU level. According to the EQS Directive (article 8b) , this list should be updated every 2 years. The main objectives of this report are: • To present an overview of the data gathered during the 1st year of monitoring of the 1st WL (also called WL dataset in this report), • To assess whether this WL dataset is sufficient to determine the risk posed by the WL substances, and consequently to determine whether any of these substances can be taken out of the WL, • To propose new substance(s) to be included in the second WL, using the information and results from the latest review of the list of priority substances, as well as any other relevant information available at the time of this report. The executive summary first explains the context for the assessment. Then, mirroring the report itself, it presents an overview of the WL dataset for the different WL substances, it specifies the criteria for taking substances out of the WL and the substances proposed on the basis of these criteria, and finally it presents the criteria for including new substances in the WL and the new proposed WL candidates.JRC.D.2-Water and Marine Resource

The last option for pain management - combined cryo-technique in blind eyes with absolute glaucoma

AIM: To evaluate the efficiency and safety of simultaneous, combined cryotherapy and alcohol injection in cases of secondary neovascular glaucoma with absolute vision loss and intolerable pain syndrome. Ocular pain due to glaucoma can be complex and difficult to treat. Therapy consists of topical and systemic pres­sure lowering agents, anti-inflammatory drugs, analgesics, surgical procedures - cyclocryotherapy, retro­bulbar alcohol injection, enucleation or evisceration.MATERIALS AND METHODS: We present 35 patients diagnosed with absolute glaucoma and treated with a combined technique - cyclocryotherapy and retrobulbar alcochol 96% 1ml injection. Verbal Analog Score (VAS) was used to evaluate the pain.RESULTS: All of the patients (100%) were pain-free 12 months after the procedure. No significant long-term complications were observed.CONCLUSION: This case study highlights that cyclocryotherapy combined with retrobulbar alcohol can play a significant role in the management of pain in patients with absolute glaucoma

Multimedia assessment of pollutant pathways in the environment: a Global scale model

The report describes the assumptions, equations and a few examples of preliminary applications of a global spatial steady-state box model entitled Multimedia Assessment of Pollutant Pathways in the Environment (MAPPE-Global). The model grounds on the concept of already developed European version of MAPPE chemical fate model. MAPPE-Global computes the removal rates of a substance with given physical-chemical properties in an evaluative environment for the Globe with a resolution of 1x1 degree considering atmosphere, land (natural and agriculture soils, forests, impervious surfaces, frozen territories), surface water (including lakes, inland wetlands and reservoirs) and oceans and seas. MAPPE-Global is able to consider chemical emissions in one or more of the environmental compartments and estimates chemical concentrations and fluxes accounting chemical partitioning (gas, liquid or solid), degradation, advective and diffusive transport. At this stage, MAPPE Global does not explicitly compute chemical transport in space, but only the fate of a substance at each location in space. However, the model estimates for each grid cell the mass fluxes of chemical that are available for transport inside or outside of the cell, in addition to concentrations from local emissions. Thus, MAPPE Global is developed specifically to respond questions as: • How will a chemical spread across different media in the different climatic and landscape settings? • How important is the variability of environmental processes in determining the fate of chemicals across the globe? In addition, the model enables estimating, for virtually any location in the world, representative parameters of the environmental removal rates that determine the fate of a contaminant. These rates may be used to feed a zero-dimensional time-dependent model that allows computing the main receptors of the chemical emissions. Besides, in order to evaluate the performance of the MAPPE-Global model a comparison with established models, such as Impact World and USEtox was made by crosschecking of the intermedia removal rate coefficients. Finally, MAPPE-Global was used to quantify for a set of 34 representative pollutants at global scale the range of variability of chemical removal rates for the different environmental compartments and to identify the fate patterns of flyers, swimmers, soil-bound and multimedia chemical substances.JRC.H.5-Rural, water and ecosystem resource