Age Characteristics and Concomitant Diseases in Patients with Angioedema

BACKGROUND: Angioneurotic oedema (AE) is an unpredictable and dangerous disease directly threatening the patient's life due to a sudden onset of upper respiratory tract obstruction. The disease is associated with various causes and triggering factors, but little is known about the conditions that accompany AE. AIM: The study aims to determine the age-specificities and the spectrum of concomitant diseases in patients with AE. MATERIAL AND METHODS: The subjects of observation were 88 patients (53 women and 35 men) with angioneurotic oedema who underwent diagnostics and treatment in the Department of Occupational Diseases and Clinical Allergology of University hospital “Saint Georgeâ€-Plovdiv. RESULTS: The highest level of disease prevalence was found in the age group over 50 years, both in males (45.71%) and females (54.72%). We found that the most often concomitant diseases in our patients with AE are cardiovascular (33%). On second place are the patients with other accompanying conditions outside of the target groups (27.3%). Patients with AE and autoimmune thyroiditis were 14.8%, and those with AE and skeletal-muscle disorders-10.2%. Given the role of hereditary factors in this disease, the profession of the patients is considered insignificant. CONCLUSION: Angioedema occurs in all age groups, but half of the cases are in people over 50 years of age. The most common concomitant diseases in angioedema are cardiovascular diseases

Contemporary Therapeutic Options In Carbapenem-Resistant Non-Fermenters In Bulgaria

Резюме:Въведение: Неферментиращите бактерии с клинично значение Acinetobacter baumannii и Pseudomonas aeruginosa, обичайно считани за опортюнистични патогени, днес заплашват да се превърнат в едни от най-проблемните причинители на инфекции. Терапевтичните рестрикции от една страна се дължат на тяхната вродена резистентност към широк набор от антибиотици, a от друга на все по-нарастващата придобита резистентност.Цел: Да се анализират най-честите механизми на карбапенемна резистентност сред неферментиращите бактерии в страната и да се препоръчат опции за справяне с терапевтичните рестрикции.Методи: Обикновено се използват както фенотипни, така и генетични методи за определяне на резистентност към карбапенеми. Най-чести фенотипни методи за детекция на карбапенемази при неферментиращите бактерии са Модифицираният Ходж тест и Carba NP-тестът. Класически PCR се използва за доказване на гени, кодиращи карбапенемази, a qRT-PCR за оценка на експресията на ключови ефлукс помпи, вродената AmpC и трансмембранния OprD рецептор при Pseudomonas.Резултати и обсъждане: Две независими проучвания в България доказаха, че свръхекспресията на MexXY-OprM ефлукс помпата е главна причина за карбапенемна резистентност при изолатите P. aeruginosa. При A. baumannii продукцията на OXA-23 карбапенемази е основен фактор за този тип резистентност. Най-новите терапевтични стратегии включват използването на сулбактам при лечение на инфекции, причинени от OXA-23 продуциращи A. baumannii, поради липсата на активност на тези карбапенемази към сулбактам, както и поради вроден ефект на този бета-лактамен инхибитор при род Acinetobacter. На базата на анализирания опит в страната и света, както и на собствени проучвания, считаме, че антибиотични комбинации с колистин, рифампицин и фосфомицин могат да бъдат подходяща алтернатива при инфекции, причинени от двата микроорганизма: Pseudomonas and Acinetobacter.Introduction: The non-fermenters of clinical significance Acinetobacter baumannii and Pseudomonas aeruginosa, usually considered as opportunistic pathogens, nowadays emerge to evolve in some of the most problematic causative agents of infections. The therapeutic restrictions are determined on one hand due to their intrinsic resistance to a great variety of antibiotics and on the other, due to the arising acquired resistance.Aim: The aim of this article is to analyze the most often detected mechanisms of carbapenem resistance among non-fermenters in the country and to recommend options to manage the therapeutic restrictions.Methods: Both methods - phenotypic and genetic, are usually combined to evaluate the mechanisms of resistance to carbapenems. As phenotypic tests for detection of common carbapenemases a Modified Hodge test and a Carba NP-test are used. A classical PCR investigation is used to detect the most frequent carbapenemases for both microorganisms and a qRT-PCR to assess the expression of main efflux pumps, the intrinsic AmpC and the transmembrane receptor OprD in Pseudomonas.Results and Discussion: Two independent studies proved that in Bulgarian clinical isolates P. aeruginosa, the increased expression or overexpression of MexXY-OprM efflux pump, is the main mechanism of determining carbapenem resistance. The main reason for carbapenem resistance in A. baumannii isolates is the production of OXA-23 carbapenemases. The newest therapeutic strategies include the use of sulbactam for infections provoked by OXA-23 producing A.baumannii due to the lack of activity of these carbapenemases against it and the intrinsic effect of this beta-lactamase inhibitor against Acinetobacter spp. Antibiotic schemes including colistin, rifampicin and phosphomycin could be an appropriate alternative for infections provoked by both Pseudomonas and Acinetobacter

Viral load and lymphocyte subpopulations in newly diagnosed patients with chronic Hepatitis B

INTRODUCTION: The immune response against Hepatitis B virus (HBV) represents a key factor for infection outcome. However, the relation between viral replication and host immune reactivity is still a matter of investigation. AIM: To investigate whether the cellular immune response of newly diagnosed treatment naïve chronic hepatitis B (CHB) patients may be influenced by the replicative status of HBV.MATERIALS AND METHODS: A total of 45 (17 female and 28 male) newly diagnosed untreated CHB patients aged 42.48±13.19 years (19÷71 years) were enrolled in this study. The patients were divided in two groups according to the viral load: >0÷≤104 copies/ml (n=25) and >10 4÷<108 copies/ml (n=17). Flowcytometric immunophenotyping was performed for evaluation of the cellular immunity. Serum HBV DNA load was assessed by quantitative real-time polymerase chain reaction.RESULTS: Similar alterations were observed in both patients` groups in comparison with healthy controls which could be summarized as follows: decreased total T cells (CD3+) due to low helper-inducer (CD3+CD4+) and suppressor-cytotoxic (CD3+CD8+) subpopulations; reduced effector cytotoxic (CD8+CD11b-; CD8+CD28+) and activated (CD3+HLA-DR+, CD8+CD38+) T-cell subsets; increased CD57+CD8- cells; elevated percentage of B lymphocytes. No significant differences in the studied immune parameters were detected between both patients` groups except the significantly elevated CD4/CD8 ratio in individuals with higher in comparison to those with lower HBV DNA levels.CONCLUSION: Alterations in the cellular immune repertoire of CHB patients were observed resulting mainly in significantly decreased T-cell subpopulations, particularly those with effector cell immune phenotype regardless of the viral load

C-peptide levels and glycemic indices in COVID-19 patients

AbstractType 2 diabetes (T2DM) is a common comorbidity in COVID-19 patients, which could favor disease progression. Our study aimed to evaluate the impact of some glycemic biomarkers on characteristic features of COVID-19. Electronic medical records of patients consecutively admitted to a COVID-19 ward were analyzed. Demographic and anthropometric as well as clinical and laboratory parameters were obtained. T2DM was present in 47% of the patients, with 22.58% of diabetic patients being newly diagnosed at admission. The most important predictors of severe COVID-19 were age (OR 1.214 [1.078-1.366], p = 0.001), creatinine levels (OR 1.018 [1.003-1.034], p = 0.017), glucose above 7.0 mmol/L at admission (OR 7.800 [2.232-27.255], p = 0.001) and HbA1c ≥ 6.5% (OR 4.840 [1.428-16.405], p = 0.011) irrespective of the presence of DM. C-peptide levels correlated positively with age, creatinine level, the severity of hypoxia and ferritin levels of patients (p < 0.05 for all) and appeared to be a significant predictor of leukocytosis. Suboptimal glycemic indices and impaired kidney function might predict COVID-19 disease worsening. Early detection of DM and optimization of glycemic control in diabetic patients should be among the priorities of the public health systems during COVID-19 pandemics

Coinfection of the intestinal tract with Aeromonas hydrophila, Clostridium difficile and Rotavirus - a case report

Most cases of acute diarrhea in adults are of infectious etiology, likely viral and self-limited. Among those with severe diarrhea, however, bacterial causes are responsible for most cases.Apart from the standard stool cultures, to increase the positive yield a novel multiplex molecular test can be performed simultaneously. The authors present a patient with recurrent diarrhea and detection of Aeromonas hydrophila by culturing and Rotavirus and Clostridioides difficile by multiplex molecular test. They discuss and justify which is the most likely actionable pathogen. Good communication between the physicians and interpretation on the multiple positive results in the context of clinical picture and the test employed were important for a better management and favourable outcome of the patient

Study on anti-inflammatory and immunomodulatory effects of fluoxetine in rat models of inflammation

The aim of the present study was to evaluate the anti-inflammatory effect of fluoxetine in carrageenan- and lipoplysaccharide-induced models of inflammation by investigating the changes in serum levels of pro-inflammatory cytokine TNF-α and anti-inflammatory cytokines IL-10 and TGF-β after single and repeated administration of the drug. To study the effect of a single and repeated dose fluoxetine on carrageenan-induced paw edema male Wistar rats were divided into five groups (n = 8): control group; positive control group; and three experimental groups treated with 5, 10, and 20 mg/kg bodyweight (bw) fluoxetine, respectively. To study the effect of a single and repeated dose of fluoxetine on serum cytokine levels, the animals were divided in four groups (n = 8): two control groups treated with saline and two experimental groups treated with fluoxetine 20 mg/kg bw. Carrageenan and LPS were injected immediately after fluoxetine or saline injection. Serum cytokine concentrations were tested by enzyme immunoassay. In single administration only the highest dose used inhibited carrageenan-induced inflammation. Edema inhibition was seen with 10 and 20 mg/kg bw fluoxetine after repeated administration. At 24 h a statistically significant effect on inhibition of carrageenan edema was found only in rats treated with 20 mg/kg bw fluoxetine In carrageenan-induced inflammation, fluoxetine significantly increased Il-10 and decreased TNF-α after repeated administration. Surprisingly, in single-dose treated animals an increase in TNF-α values upon fluoxetine administration was observed in this model of inflammation. In LPS-induced inflammation, fluoxetine significantly decreased TNF-α after single and repeated treatment. Fluoxetine has anti-inflammatory and immunomodulatory effect in the carrageenan-induced model of exudative inflammation. In LPS-induced inflammation it showed an immunomodulatory effect manifested with a decrease in pro-inflammatory cytokine TNF-α

Beneficial Effect of Chronic Treatment with Extracts from Rhodiola Rosea L. and Curcuma Longa L. on the Immunoreactivity of Animals Subjected to a Chronic Mild Stress Model

Background: Recent studies have suggested increased levels of pro-inflammatory cytokines in depression. Aim: The present study aimed to evaluate the effect of extracts from Rhodiola and Curcuma on immunoreactivity of animals subjected to a chronic mild stress (CMS) model followed by lipopolysaccharide-induced inflammation. Materials and methods: Male Wistar rats (n=56) divided in 7 groups were treated orally with: distilled water 10 ml/kg (control and CMS model groups); Rhodiola 250 mg/kg; Rhodiola 500 mg/kg; Curcuma 250 mg/kg; Curcuma 500 mg/kg, Rhodiola 250 mg/kg and Curcuma 250 mg/kg. All groups except the control were stressed daily according to a CMS protocol. Changes in glucose preference, weight gain and locomotor activity were recorded. In the sixth week the animals were challenged with LPS and rats’ sera were obtained for ELISA evaluation of TNF-α and IL-6 levels. Results: The animals from the model group decreased their weight gain, glucose preference and locomotor activity compared to controls. The groups exposed to stress and treated with Rhodiola 500 mg/kg, Curcuma 500 mg/kg and their combination increased their locomotor activity compared to the model group. High expression of the pro-inflammatory cytokines TNF-α and IL-6 were found in all groups exposed to CMS and challenged by LPS. Conclusions: The groups exposed to the stress procedure showed a variety of depression-like behavioral changes. In addition, ELISA tests showed that CMS is affecting rats’ immunity by increasing the cytokines’ levels. These changes could be reversed by administration of Rhodiola and Curcuma in combination suggesting synergic interaction regarding their anti-inflammatory and anti-stress effects

Adherence to Acromegaly Treatment and Analysis of the Related Factors&mdash;A Real-World Study in Bulgaria

The purpose was to assess the level of medication adherence (MA) and related factors among individuals with acromegaly. The secondary goal was to assess the quality of life of patients and whether and how it correlates with the level of adherence. A prospective one-year study was conducted among patients with acromegaly diagnosed, treated, and monitored in the reference center for rare endocrine diseases in Bulgaria in 2021. Clinical data, patients reported outcomes, and health economics data were collected to define the predictors of non-adherence to medicines. Medication adherence level was assessed through a free Morisky&ndash;Green 4-item questionnaire. A total of 179 patients with acromegaly were observed. Approximately 62% were female, 50% were between 41 and 60 years, and the mean age at diagnosis was 40.4 years. The response rate to the questionnaires was 53% (n = 95; mean age 53.5 years, 73% female and 26% male). Patients with high levels of MA reported higher median values for the 36-Item Short Form Health Survey (SF-36) in comparison with those with low levels: 65.5 vs. 48.5 (p = 0.017). Similar results for EQ-5D-3L (3-level EuroQol 5D version) values and the level of MA were found: 0.656 vs. 0.796 (p = 0.0123). A low level of adherence was revealed in 34.7% of the patients, with no difference among different age groups. A significant positive determinant for adherence was years lived with acromegaly (OR = 5.625, 95% CI 1.7401&ndash;18.1832, p = 0.0039), as shorter duration was related to higher odds for high level of adherence. The current study demonstrates the importance of &#1052;&#1040; assessment for patients with acromegaly in Bulgaria. The medication adherence to the prescribed therapy among the observed group of patients with acromegaly varied as the percentage of adherent patients was around 65%. Still, there are low-adherent patients, and the responsible factors should be further investigated

Adherence to Acromegaly Treatment and Analysis of the Related Factors—A Real-World Study in Bulgaria

The purpose was to assess the level of medication adherence (MA) and related factors among individuals with acromegaly. The secondary goal was to assess the quality of life of patients and whether and how it correlates with the level of adherence. A prospective one-year study was conducted among patients with acromegaly diagnosed, treated, and monitored in the reference center for rare endocrine diseases in Bulgaria in 2021. Clinical data, patients reported outcomes, and health economics data were collected to define the predictors of non-adherence to medicines. Medication adherence level was assessed through a free Morisky–Green 4-item questionnaire. A total of 179 patients with acromegaly were observed. Approximately 62% were female, 50% were between 41 and 60 years, and the mean age at diagnosis was 40.4 years. The response rate to the questionnaires was 53% (n = 95; mean age 53.5 years, 73% female and 26% male). Patients with high levels of MA reported higher median values for the 36-Item Short Form Health Survey (SF-36) in comparison with those with low levels: 65.5 vs. 48.5 (p = 0.017). Similar results for EQ-5D-3L (3-level EuroQol 5D version) values and the level of MA were found: 0.656 vs. 0.796 (p = 0.0123). A low level of adherence was revealed in 34.7% of the patients, with no difference among different age groups. A significant positive determinant for adherence was years lived with acromegaly (OR = 5.625, 95% CI 1.7401–18.1832, p = 0.0039), as shorter duration was related to higher odds for high level of adherence. The current study demonstrates the importance of MA assessment for patients with acromegaly in Bulgaria. The medication adherence to the prescribed therapy among the observed group of patients with acromegaly varied as the percentage of adherent patients was around 65%. Still, there are low-adherent patients, and the responsible factors should be further investigated