Opinion survey among patients regarding the provided rehabilitation programmes in specialised rehabilitation hospitals

Медицинската рехабилитация е процес, насочен към цялостното лечение на пациента и към превенция на инвалидността. Колкото по-рано се приложи тя, толкова по-бързо и качествено е възстановяването. Липсата на навременна и дългосрочна рехабилитация води до влошаване качеството на живот и социална изолация. Настоящата статия има за цел да проучи мнението на пациентите за предлаганите ре-хабилитационни програми чрез пряка индивидуална анкета. В съвременните условия на живот те имат възможност търсят и получават информация за заболяването, диагнозата и възможностите за лечение. Необходимо е качеството на рехабилитационните процедури да отговаря на очакванията на пациента и неговите потребности. Медицинската рехабилитация е с голямо медико-социално и икономическо значение. Мнението, оценката и удовлетвореността на пациентите са важен показател за качеството и ефективността на здравното обслужване.Rehabilitation is a process aiming at the comprehensive treatment of patients and the prevention of physical disability. The earlier this process starts, the quicker and more satisfactory the recovery is. The lack of prompt and long-term rehabilitation leads to patients` social isolation and deterioration of their quality of life. The purpose of this article is to analyse the patients` opinion regarding the provided rehabilitation programmes through a personal survey. Nowadays, patients have an access to information about the disease they suffer from, the diagnosis and the treatment options. It is necessary that the rehabilitation procedures meet the patients` expectations and needs. The opinion, assessment and satisfaction of the patients are key quality and effectiveness indicators of the health services provided

Obesity in Pregnancy – Implications on Pregnancy Events

BACKGROUND: Overweight and obesity are serious health problems in most developed countries. The percentage of young women with excessive weight who get pregnant continues to grow every year. This raises a concern about the risks of the mother and the baby during pregnancy and after birth. AIM: This study aims to determine health risk for overweight mothers and especially the risk for preterm birth. MATERIALS AND METHODS: This is a prospective and retrospective study taking place in the outpatient clinic of the University Hospital “Maichin Dom”. Our study included 105 pregnant women with BMI ≥25 kg/m2 as a case group and 91 pregnant women with BMI within normal limits as a control group. RESULTS: Mean BMI in the case group was 34.79 ± 3.71 kg/m2 and 20.20 ± 2.24 kg/m2 in the control group. Among 105 women in the case group, we registered 24.8% (n = 26) who gave birth before term. Preterm births among 91 women in the control group were registered in 17.6% (n = 16) patients. We found a significant correlation between increased BMI and the risk of increased systolic and diastolic blood pressure. Moreover, we found comorbidities in 43.8% of cases and 24.2% of controls. CONCLUSION: Maternal overweight and obesity during pregnancy are associated with increased risks of preterm delivery and complications of pregnancy. Extra efforts should be made to help women lose weight before this important period of life

SQUAMOUS CELL CARCINOMA OF THE SKIN: A STUDY OF CLINICOHISTOPATHOLOGICAL CORRELATIONS PREDICTIVE FOR RECURRENCE, METASTASIS AND MORTALITY

Introduction: The incidence of Squamous cell carcinoma of the skin (SCCs) increases annually, and this process will likely be continued because of sun exposure, outdoor activities and the aging population. Objectives: The aim of our study is to analyse clinicohistopathological features, recurrence, metastasis and mortality rates of SCCs in Pleven, Lovech region, Bulgaria. Methods: We investigated 355 patients with histologically confirmed SCCs for the period 2016 – 2022 and carried out a detailed histopathological analysis of 100 tumors. They were divided into two groups according to their macroscopic diameter: with low risk for recurrence and metastases (20mm). We studied the localisation, histological subtype, tumor cell differentiation, microscopic depth of invasion, perineural and lymphovascular invasion, stromal lymphocyte infiltration. Results: We revealed that 73,3% of the patients with SCCs reported severe sunburns, and 1,13% of them underwent immunosuppressive treatment. Head and Neck localisation is the most common – 72,7%. We established a mean histological depth of SCCs of 5,92mm, lymphovascular invasion in 7% and perineural invasion in 5% of the cases. We found that tumors with a macroscopic diameter >20mm have a greater depth of invasion in comparison to SCCs with a smaller diameter. We found an incidence of local recurrence of 4,8%, lymph node metastases at 5,1%, far metastases in internal organs at 2,25% and mortality at 1,97%. Conclusion: Clinicohistopathological features of SCCs with related to recurrence, metastasis and mortality are localisation on the scalp, ears or lips, tumor size >20mm, depth of invasion >6mm, poor tumor cell differentiation, perineural and lymphovascular invasion, low or absent stromal lymphocyte infiltration

Level of hypertension treatment adherence during pandemic

Adherence to antihypertensive medications is the cornerstone for achieving metabolic syndrome control. The aim of this study was to explore how the pandemic has affected the adherence of patients with high BP to prescribed antihypertensive drugs. This multicentre observational study utilized self-completed questionnaires among patients between June and November 2020. Overall, 842 patients were included in the study. The likelihood of adherence was assessed using the 5‐item version of the Medication Adherence Report Scale (MARS-5Professor Rob Horne). The average MARS score of the sample was 16.81, the median was 4.162, and the most common value was 3 (24.5% of respondents) for the patients treated during the pandemic. The study suggests that several sociodemographic factors but not the COVID pandemic play a role in treatment adherence

Past decade above-ground biomass change comparisons from four multi-temporal global maps

Above-ground biomass (AGB) is considered an essential climate variable that underpins our knowledge and information about the role of forests in mitigating climate change. The availability of satellite-based AGB and AGB change (Delta AGB) products has increased in recent years. Here we assessed the past decade net Delta AGB derived from four recent global multi-date AGB maps: ESA-CCI maps, WRI-Flux model, JPL time series, and SMOS-LVOD time series. Our assessments explore and use different reference data sources with biomass re-measurements within the past decade. The reference data comprise National Forest Inventory (NFI) plot data, local Delta AGB maps from airborne LiDAR, and selected Forest Resource Assessment country data from countries with well-developed monitoring capacities. Map to reference data comparisons were performed at levels ranging from 100 m to 25 km spatial scale. The comparisons revealed that LiDAR data compared most reasonably with the maps, while the comparisons using NFI only showed some agreements at aggregation levels <10 km. Regardless of the aggregation level, AGB losses and gains according to the map comparisons were consistently smaller than the reference data. Map-map comparisons at 25 km highlighted that the maps consistently captured AGB losses in known deforestation hotspots. The comparisons also identified several carbon sink regions consistently detected by all maps. However, disagreement between maps is still large in key forest regions such as the Amazon basin. The overall AAGB map cross-correlation between maps varied in the range 0.11-0.29 (r). Reported AAGB magnitudes were largest in the high-resolution datasets including the CCI map differencing (stock change) and Flux model (gain-loss) methods, while they were smallest according to the coarser-resolution LVOD and JPL time series products, especially for AGB gains. Our results suggest that AAGB assessed from current maps can be biased and any use of the estimates should take that into account. Currently, AAGB reference data are sparse especially in the tropics but that deficit can be alleviated by upcoming LiDAR data networks in the context of Supersites and GEO-Trees

Management of old flexor tendon injury in ‘no man`s land zone` using two-stage Hunter`s rod technique: case report

Introduction: Flexor tendons of the wrist are divided into five anatomical zones. Zone II has the poor­est prognosis and highest probability of adhesions after repair, especially when there is significant la­tency between the trauma event and the medical help provided. Therefore, management of old full-width flexor tendon lesions are a significant orthopaedic problem.Materials and methods: A 32 years old man sustained a cutting trauma with a knife two months be­fore visiting a specialist. The patient complains of inability to flex his fifth finger on the right hand. During the physical examination it was determined that (flexor digitorum profundus) FDP tendon was lacerated. Considering the time of the event, a decision for a two-staged reconstruction with au­tograft was taken.Results: For the first stage of the operation, a zigzag operative approach was used. A solid silicon rod was inserted in the place of the lacerated tendon. The rod was then attached to the distal phalanx, thereafter the wound was closed and the finger left the extension. Two months later on the second stage, a tendon autograft from the patient`s palmaris longus muscle was used to take the place of the rod and reattached to the distal fifth phalanx and FDP on the fourth finger. The patient followed a re­habilitation programme for 3 months, until observing a good functional outcome.Conclusion. Dealing with old flexor tendon lesions in ‘no man`s land zone` can be notoriously diffi­cult and leading to poor functional outcome. In this case, the technique gave a good chance of regain­ing satisfactory function, considering the time passed since the trauma and the tendons` status. Con­clusively we can way this operative treatment offers significant benefits over the non-operative alter­natives

Comparative analysis of newer classes of antidiabetics and the concept of pharmaceutical care – dealing with therapeutic problems

The prevalence of obesity is increasing rapidly. The latest World Health Organization – WHO report declares the disease as an epidemic. After pharmacodynamic, pharmacokinetic, clinical and pharmacoepidemiologic data analysis and comparison of the three classes of antidiabetic medicinal products: GLP-1 receptor agonists, DPP-4 inhibitors and SGLT2 inhibitors, a literature review of the topic, patient education and the concept of pharmaceutical care emerged as methods for dealing with the most common adverse drug reactions, safety concerns, and drug interactions

Extemporaneous preparation of paediatric oral formulations with sildenafil citrate

The paediatric population is composed of several very different subgroups, each with its own specific characteristics. For this reason, children cannot be considered “small adults”. The development of formulations suitable for children is a complex process, as it must consider the physiological changes that occur during childhood and the impact they have on the absorption of drugs. Sildenafil citrate is a drug with a narrow therapeutic index used in paediatrics to treat pulmonary hypertension. In the present work, technological approaches for extemporaneous preparation of paediatric oral forms containing sildenafil citrate for personalized therapy in children were studied. The prepared formulations were tested for physical and microbiological stability, in-use stability, and determination of active substance content. All tested oral formulations remained unchanged in terms of appearance during the entire period of stability monitoring at the selected storage conditions – room temperature 25 °C ± 5 °C and in a refrigerator at 5 °C ± 2 °C. The established pH values suggest that the formulations remained chemically stable during the stability study. The content of sildenafil citrate in all prepared oral formulations remained above 95% w/v. The microbiological quality of the prepared compositions was confirmed. Rational strategies for preparation of extemporaneous formulations were proposed based on the analysis of experimental data

The era of digital pharmacy. 3D printing - realities and perspectives

3D printing is an innovative technology for building three-dimensional objects by laying down successive layers of material under the control of a computer software. It is entering pharmacy mainly because of its revolutionary potential to provide individualized dosage forms that meet the needs of each patient, due to the possibility to produce objects of many different sizes and shapes. An important aspect of personalized 3D tablets is the possibility to include several active substances in one dosage form, which would reduce the daily number of medications and the frequency of their administration and improve patient compliance. Another advantage of 3D printing is the possibility of producing small batches or even individual drugs for each patient. Despite the many advantages, 3D printing has several technological challenges to overcome before it becomes widely applicable in pharmacy. Five basic technologies are currently applied in pharmaceutical practice: powder-based printing, selective laser sintering, stereolithography, extrusion moulding printing, and electrohydrodynamic 3D printing. This article reviewed development, research focus, and prospects of each technology respectively