Social determinants of infectious diseases in diverse age groups in Varna region, Bulgaria

During the first years as a member to the European Union the healthcare system of Republic of Bulgaria faced many challenges: declining demographic tendencies, poverty with notice ably expressed age dimensions and limited resources for health care. The aim of this study is to reveal some social determinants and risk factors in the vulnerable groups of elderly people and breast-fed infants with communicable diseases. Specially designed questionnaires were used to study the socioeconomic and other risk factors in patients over 60 years and mothers accompanying their infants with infectious diseases. Analyses of the demographic indicators of Varna region and disease incidence correspond to the trends of the national level. Infectious diseases most commonly observed among the aged population are shigelloses, salmonelloses and other gastroenterites, mediterranean spotted fever, lymeborreliosis, acute viral hepatitis and neuroinfections. Gastroenteritesin breast-fed infants are the most common cause for hospitalization.The risk factors influencing patients of 60+ suffering from infectious diseases are poverty, unhealthy and inadequate nutrition, smoking, alcohol consumption, insuf icient physical activity and high levels of stress. Socially significant in communicable diseases are the common terrain on which the infectious process takes place. Risk factors influencing infants with infectious diseases are similar and sometimes derived from the factors influencing the adult population. More detailed and wider span studies of the social determinants of comunicable diseases in Bulgaria are needed to estimate the situation in other risk groups.Scripta Scientifica Medica 2010;42(2):115-12

Modeling language learning using specialized Elo ratings

Automatic assessment of the proficiency levels of the learner is a critical part of Intelligent Tutoring Systems. We present methods for assessment in the context of language learning. We use a specialized Elo formula used in conjunction with educational data mining. We simultaneously obtain ratings for the proficiency of the learners and for the difficulty of the linguistic concepts that the learners are trying to master. From the same data we also learn a graph structure representing a domain model capturing the relations among the concepts. This application of Elo provides ratings for learners and concepts which correlate well with subjective proficiency levels of the learners and difficulty levels of the concepts

EPIDEMIOLOGICAL ASPECTS OF ANTHROPOGENIC INFLUENCE TO LEPTOSPIROSIS EVOLUTION

Abstract. It has been shown that practical activity of people during the last several decades exerts significant influence not only for frequency of population’s contacts with leptospirosis foci, but also for changes of mammalian types which are reservoirs and sources of infection. The last ones in significant proportion determined etiological structure of human diseases, mechanisms of infection transmission, social and professional groups, who have highest risk to be infected, and also incidence rates and changes in clinical course of infection and its outcomes. The evolution of leptospirosis is characterized by cyclic changes of epidemiological and clinical indices

Multivisceral ‘en-bloc` resections of colorectal tumours - milestones in the surgical techniques

Purpose: Colorectal tumours (CRT) consisting mainly of colorectal cancer (CRC) are diagnosed sometimes at an advanced T4 stage, i. e. local involvement of neighbouring organ/organs and anatomical structure/ structures. Aggressive surgical approach preceded and/or followed by neo-adjuvant/adjuvant therapy is advocated because of proven benefit for the patient. The aim of this study was to carry out a literature survey, on the one hand, and to analyze the cases from the authors` institutional experience, on the other hand, in an attempt to submit for consideration the milestones of the multivisceral en-block resections in cases of locally advanced CRTs, i.e. to describe the specific surgical approaches depending on different tumour location and peritumoural involvement of adjacent structures and organs.Material and methods: A retrospective analysis of 154 cases of CRT was performed, all of them operated in the Clinic of Liver, Biliary, Pancreatic and General Surgery, Tokuda Hospital of Sofia, from January 1, 2007 to March 31, 2013. All the patients were diagnosed in an advanced T4-stage and received multivisceral en-bloc resections. Three main groups of methods that had been used were analyzed: 1) preoperative diagnosis, giving a hint of multivisceral en-bloc resection; 2) intraoperative assessment - gross tumour appearance, frozen sections (?), final histological examinations, and 3) surgical methods.Results: Early morbidity and mortality rates were 22,6% and 5,8%, respectively, without any significant difference when compared with ‘simple` colon and rectum resections and with literature data available.Conclusion: Multivisceral en-bloc resection for CRCs has been performed in more than 10% of the cases. It benefits the long-term prognosis. Tumour location and number of resected organs are essential characteristics of these procedures and they are independently associated with the quantity of intraoperative blood loss, higher early morbidity rates and more frequent local recurrence

Locally advanced adenocarcinoma of the supramesocolic part of the colon . Feat ures of surgical treatment and challenges

Purpose: The objective of the present study was to analyze the early results from the surgical treatment of locally advanced carcinoma of the colon in its transverse section and the two flexures.Material and methods: The study covered 36 patients with locally advanced colonic carcinoma, 19 males and 17 females at a mean age of 65,6 years, treated in the Clinic of Liver, Biliary, Pancreatic and General Surgery, Tokuda Hospital of Sofia during the period from January 2007 to March 2013. Any necessary diagnostic and surgical methods were applied.Results: Multivisceral resections were commonly performed in order to achieve a radical surgery in cases of locally advanced disease. Great surgeon`s experience in liver, biliary and pancreatic interventions is obligatorily required. In this paper we share our experience in the treatment of this disease for a period of 6 years.Conclusion: Our application of the multivisceral resections results in surgical radicality along with acceptable levels of perioperative morbidity and mortality rates when compared to other studies in in the foreign literature available

Early perioperative res ults in 53 cases of locally rec urrent colorectal cancer

Purpose: The objective of this study was to analyze retrospectively the early perioperative results in a cohort of 53 patients with localy reccurent colorectal cancer (CRC).Material and methods: The study covered 53 patients with CRC 21 males and 32 females at a mean age of 62 years treated in the Clinic of Liver, Biliary, Pancreatic and General Surgery, Tokuda Hospital of Sofia, during the period from January 2007 to March 2013. Any necessary diagnostic and surgical methods were applied.Results: The locally recurrent CRC is a challenge for the surgeon because of the fact that in most cases it engages adjacent anatomical structures and organs, on the one hand, and it is accompanied by complications, on the other hand.Conclusion: Achievement of good late results in patients with recurrent CRC is due to radicality of the interventions. Most often, they should be multivisceral resections. The presence of intestinal obstruction of varying degree and of synchronous peritoneal and liver metastases commonly limit the possibilities for surgical interference with the disease. Particular attention should be paid to possible neoadjuvant treatment capable of reducing the stage of diasease and improving the perioperative outcomes. Therapeutic behaviour should be strictly individual and consider any possible options. The experience of the surgical team is extremely important, too

‘Down with communism – Power to the people’: The legacies of 1989 and beyond

This special issue brings together reflections on the thirtieth anniversary of the revolutions of 1989 and considers their consequences for our understandings of European and global society. What seemed for some at least the surprising and rapid collapse of Eastern European state socialism prompted rethinking in social theory about the potential for emancipatory politics and new modes of social and political organization. At the same time, there was increased reflection on the nature of varieties of capitalism and the meaning of socialism beyond the failure of at least its etatist and autarkic mode. The five articles here and the editors’ introduction address themes such as utopian hopes, civil society, the transformation of Europe, the world beyond 1989, and new configurations of power and conflict

Betriebliche Bewirtschaftungsindikatoren für Biodiversität im Ökologischen Landbau und in extensiven Anbausystemen in Europa

Farming practices are the key to maintaining and restoring farmland biodiversity. Selected farm management indicators, regarded as scientifically sound, practicable and attractive to stakeholders, were tested against species indicators in various farm types in 12 case studies across Europe. A set of eight farm management indicators is recommended, reflecting the pressure on biodiversity by farm management via energy and nutrient input, mechanical operations, pesticide use and livestock