Clinical cases of pulmonary tuberculosis as a result of TNF antagonist therapy

През последните 12 години антагонистите на TNF са били успешно използвани за лечение на много пациенти страдащи от хронични възпалителни заболявания. Това лечение увеличава риска от туберкулоза до 25 пъти. Дължи се на факта, че TNF и TNF-рецепторите играят важна роля в медиирането на имунния отговор при остри и хронични възпаления. Ето защо всички пациенти, на които предстои подобно лечение трябва да бъдат подложени на стриктна оценка за изключване на активна и латентна туберкулозна инфекция. През 2010 г. беше публикуван консенсус на TBNET, озаглавен „Рискът от туберкулоза, свързан с лечение с TNF антагонисти`.В изложението са представени два случая на белодробна туберкулоза, които са наблюдавани в хода на провеждано лечение с TNF антагонисти при болни с доказани възпалителни заболявания на червата.During the past 12 years TNF antagonists have been successfully used for the treatment of many patients suffering from chronic inflammatory diseases. This treatment increases the risk of tuberculosis up to 25 times. This is due to the fact that TNF and TNF-receptors play an important role in mediating the immune response in acute and chronic inflammation. Therefore all patients undergoing such treatment should be subject to rigorous assessment to exclude active and latent tuberculosis infection. In 2010 a TBNET consensus was published entitled "The risk of tuberculosis related to TNF therapies." In this article we present two cases of pulmonary tuberculosis, which were observed in the course of an ongoing treatment with TNF antagonists in patients with proven inflammatory bowel disease

Strategic Priorities for Transport Development in Economic Growth and Integration in the Common Transport System of Europe

The state analysis and the outlined main strategic priorities for development have important significance for overcoming the crisis in the transport industry. This task is coordinated with the tendencies towards dynamic development of the national economy and the European transport policy. The main concept in priorities development is the confirmed position that the transport is a structure determining industry with extremely important social function and role for the development of the whole economy. The transport development has a determining significance also for successful integration of Bulgaria to the common European economic, infrastructural, market and social environment. The objective integration processes impose the necessity for technological, organizational and economic compatibility of the national transport with the European transport structures. The main strategic priorities are developed based on a study in the following directions: economic and production-technological specifics of the transport as a factor for accelerated development and international integration; main directions of the European transport policy and necessity for coordination of the strategy for transport development in Bulgaria with the European standards; state, priorities and main factors for development of transport and transport infrastructure. The strategic tasks are concretization of the strategic tasks by types of transport and common transport processes. The state analysis and the outlined priorities for transport development are basis for further research studies and effective management decision making at all levels. Thus an accelerated development of the transport can be guaranteed as well as opportunities for it to correspond to the increasing needs of transport services.

Role of some biomarkers in determining the risk of mortality of hospitalized patients with community- acquired pneumonia

Introduction: Various biomarkers are used to determine the severity and risk of mortality in community-acquired pneumonia (CAP). The aim of this article is to evaluate the prognostic value for in-hospital mortality of leukocyte count (Leuk), C-reactive protein (CRP), procalcitonin (PCT), and mid-regional proadrenomedullin (MR-proADM) in CAP patients.Materials and Methods: This was a prospective study including a total of 92 CAP patients hospitalized in the Clinic of Pneumology and Phthisiatry at St. Marina University Hospital of Varna. Biomarkers were determined at hospitalization, Leuk - by automated methodology, CRP - by latex-enhanced immuno-turbidimetric method, and both MR-proADM and PCT - by standard ELISA. CAP severity was estimated by Pneumonia Severity Index (PSI) and CURB-65.Results: The patients were at a mean age of 59.2±16.8 years, 68.5% were men. In-hospital mortality was 7.6%. The optimal cut-off value of MR-proADM for in-hospital mortality was 0.88 ng/mL (sensitivity 85.7% and specificity 85.8%). The positive predictive value was 33.3% and the negative predictive value was 98.6%. The optimal cut-off value of PCT was 1.84 ng/mL (sensitivity 71.4% and specificity 81.1%). The positive predictive value was 23.8% and the negative predictive value was 97.1%. Cut-off values for CRP and Leuk could not be established. By performing ROC curves, MR-proADM, PSI, PCT and CURB-65 were good predictors for in-hospital mortality (AUC 0.91, 0.90, 0.89, and 0.86, respectively).Conclusion: MR-proADM and PCT are promising markers in predicting CAP prognosis. Their predictive value for mortality is similar to that of PSI and CURB-65. CRP and Leuk cannot serve as predictors