COVID-19-Associated Nephropathy

The renal involvement in the inflammatory process of SARS-CoV-2 infection worsens the course and prognosis of the disease. Some common clinical features of COVID-19-associated nephropathy are the proteinuria and acute kidney injury (AKI).The article explains the pathophysiological mechanisms, the characteristic pathomorphological changes in the kidneys, and the clinical manifestation of COVID-19-associated nephropathy

Renal Disorders In Laurence-Moon-Bardet-Biedl Syndrome Patients

Laurence-Moon-Bardet-Biedl Syndrome, also known as Bardet-Biedl Syndrome, falls under the category of hereditary cil-iopathies. This rare genetic disorder is associated with multiple organ impairments. The aim of the article is to characterize the syndrome and explain the pathogenetic mechanisms of the renal disorders along with their clinical manifestations

Renal Hemodynamics In Patients With Beta-Thalassemia Major

Introduction: Chronic anemia and hypoxia in patients with β-thalassemia major (β-ТМ) lead to disorders of renal hemodynamics. Renal blood flow and eGFR are increased. Hyperfiltration contributes to the progression of CKD.Aim: The aim of this article is to measure the glomerular filtration and to find a correlation between eGFR, ferritin levels and the age of patients with β-ТМ.Materials and Methods: The study includes 44 patients with β-ТМ aged from 7 to 57 years, with an average of 24.3±12.71 years, of whom 18 childrеn and 26 adults. Glomerular filtration is estimated by Schwartz formula for children from 1 to 17 years and MDRD for adults.Results: It was proved that the patients in the study to have a hyperfiltration (mean GFR—151.25 mL/min ±41.18880 SD) and CKD G1. A positive correlation was found between eGFR and ferritin levels and between eGFR and the age of patients with β-TM

Urinary neutrophil gelatinase-associated lipocalin—an early biomarker for renal injury in patients with beta-thalassemia major

INTRODUCTION:The iron overload and the development of secondary hemosiderosis in patients with β-thalassemia major (β-TM) lead to organ damages, including kidney disorders from early childhood. Contemporary urinary markers such as neutrophil gelatinase-association lipocalin (NGAL), β2-microglobulin (β2-MG), and N-acetyl-β-D-glucosaminidase (NAG) could be a useful tool for clinicians in diagnosis of early tubular lesions.AIM: The aim of this article is to make an assessment of contemporary urine biomarkers β2-microglobulin, neutrophil gelatinase-associated lipocalin, and N-acetyl-beta-D-glucosaminidase in the diagnosis of early renal injury in patients with β-TM.MATERIALS AND METHODS: The current study was conducted by examining 44 patients with β-thalassemia major and 30 controls. All participants were tested for NGAL, β2-MG, and NAG in the first sample morning urine using ELISA method.RESULTS: The results show statistically significant differences between the two examined groups in urinary NGAL.CONCLUSION: Urinary NGAL indicates subclinical kidney injury when the tubular reabsorption of molecules is impaired

Hepcidin and beta-thalassemia major – diagnostic and therapeutic aspects

Iron overload is one of the major pathophysiological mechanisms of organ damages in the transfusion-dependent anemia to which β-thalassemia major belongs. The accumulated free intracellular iron as a result of increased intestinal absorption, the frequent hemotransfusions and the premature death of erythrocytes leads to secondary hemosiderosis and tissue hypoxia. Hepcidin is a regulator of the iron metabolism. The article reviews the effects of hepcidin in maintaining iron homeostasis, as well as new diagnostic and therapeutic aspects in patients with β-thalassemia major

Tubulopathy in Patients with Beta Thalassemia Major

The iron overload and the development of secondary hemosiderosis in patients with β-thalassemia major lead to organ damages, including kidney disorders from an early childhood. Contemporary urinary markers such as neutrophil gelatinase-association lipocalin, β2-microglobulin, and N-acetyl-β-D-glucosaminidase could be a useful tool for clinicians in diagnosing early tubular lesions. The current study was performed in 44 patients with β-thalassemia major and 30 controls. All participants were tested for NGAL, β2-MG, and NAG in the first sample morning urine using the ELISA method. The results showed statistically significant difference in urinary NGAL between the two examined groups. This marker indicates very early damage to the proximal tubule before cell death occurs

Anemia, heart failure and treatment with erythropoiesis-stimulating agents

Aнемията е често съпътстващо заболяване при пациентите със сърдечна недостатъчност и причина за влошаване на прогнозата и лошия изход от болестта. Aнемия сред популацията на пациентите със сърдечна недостатъчност е много по-често срещана от колкото в останалото население. Счита се, че тя варира между 17и 70% в зависмост от това дали става въпрос за хоспитализирани или амбулаторни болни. Честотата на анемията сред български пациенти, хоспитализирани за остра сърдечна недостатъчност, според едно проучване е 32,7%. Лечението на тази съпътстваща коморбидност се определя от етиологията , като чести причини са желязо-дефицитната анемия, анемията при хронично заболяване, наличие на хронично бъбречно заболяване. Лечението на анемия с еритропоетинови препарати, първоначално е било обещаващо, но последващите резултати се оказват разочароващи. Еритропоеза-стимулиращите агенти увеличават тромемболичния риск, честотата на инсултите, макар да се наблюдава покачване в стойността на хемоглобина.Anemia is a common concomitant disease in patients with heart failure and is a cause for deteriorating prognosis and poor outcome of the disease. Anemia in the population of patients with heart failure is much more common than in the general population. It is estimated that it varies between 17 and 70% depending on whether the patients are hospitalized or not. The incidence of anemia among the hospitalized for acute heart failure patients in one Bulgarian study is 32.7%. The treatment of this concomitant state is defined by its etiology. The most common causes of anemia in heart failure are iron defficiency, chronic inflamation and chronic kidney disease. The treatment of anemia with erythropoiesis-stimulating agents was initially promising, but the results that came out later showed disappointing data. Erythropoiesis-stimulating agents increase the thrombotic risk, the incidence of stroke, although an increase in the level of hemoglobin is found

A clinical case of a patient with subclinical hypothyroidism and newly diagnosed diabetes mellitus and arterial hypertension

Захарният диабет и хипотиреоидизмът са двете най-често срещани ендокринни нарушения, който при съчетанието си при един и същи пациент биха могли да протекат с различен ход от колкото изолирано. Инсулинът и тиреоидните хормони са тясно свързани в клетъчния метаболизъм и техния ексцес или дефицит взаимно се повлияват. Познаването на връзките между тях е полезно в клиничната практика за скрининга и управлението на тези заболявания. Добре известно е, че хормоналните отклонения при една ендокринна жлеза могат да повлияят функцията и на другите жлези. Така например, хипотиреоидизма и хипертиреоидизма променят стойностите на кръвната захар и трябва да се имат предвид при интерпретацията на лабораторните резултати. От друга стана наличието на захарен диабет, особенно автоимунната форма, става често причина да се търси асоциирано автоимунно заболяване като тиреоид на Хашимото. Представяме клиничен случай на пациентка с хипертонична криза, без известнa до този момент артериална хипертония, която става повод да се диагностицират редици други заболявания, като тиреоидна дисфункция и захарен диабет. Представяме подхода при диагнозата, оценката на таргетните увреди и избора на терапия в светлината последните съвременните ръководства.Diabetes mellitus and hypothyroidism are the most common endocrine disorders and when concomitant in the same patient can change the course of each conditions in a rather different way than when running their course on their own. Both hormones - insulin and the thyroid hormone, act on cell metabolism and the excess or insufficient secretion of any of them affects the function of the other. In clinical practice, it is very useful to be familiar with the interaction between these two hormones for better screening and management of the diseases. It is well known that a single hormone dysfunction can change other hormone activity. It is the situation in hyper- or hypothyroidism, both influence blood glucose level and that should be taken into account when biochemistry is analyzed. On the other hand, diagnosing diabetes mellitus, especially the autoimmune form of the disease, directs our attention toward searching for another autoimmune disorder like Hashimoto thyroiditis. Here, we present a clinical case of a female patient with hypertensive crises with unestablished arterial hypertension, in whom additional concomitant disorders - thyroid dysfunction and diabetes mellitus, were diagnosed simultaneously. We discuss the approach to the diagnosis and target organ evaluation, as well as the management of the diseases in the light of the newest guidelines

The challenge to manage a patient with advanced heart failure and necrotizing vasculitis - a clinical case

Пациентите с напреднала сърдечна недостатъчност много често имат и придружаващи заболявания, които повлияват и ограничават избора на лечение както за сърдечната недостатъчност, така и за придружаващото заболяване. Предствяме мъж, на 64години, с механична клапна протеза на аортно място, с високостепенна трикуспидална регургитация и високостепенна пулмонална хипертония, с тотална сърдечна недостатъчност, захарен диабет, периферна артериална болест и некротизиращ васкулит. Лечението, което бе предприето е напълно съобразено с препоръките за лечение на сърдечна недостатъчност на Европейското дружество по Кардиология от 2016 год., както и съвременните препоръки за лечение на захарен диабет и васкулити.Patients with advanced heart failure are patients with a lot of comorbidities that have important influence on the options of treatment - both for heart failure and the concomitant diseases. Here we present a 64-year-old man with mechanical aortic valve prosthesis, severe tricuspid regurgitation, severe pulmonary hypertension and total heart failure, diabetes mellitus type 2, peripheral artery disease and necrotizing vasculitis. The management of heart failure is according to the guidelines for the treatment of patients with heart failure of the European Society of Cardiology 2016; the treatment of the diabetes mellitus and the necrotizing vasculitis is also in accordance with the latest recommendations

Results of the COVID-19 mental health international for the general population (COMET-G) study.

INTRODUCTION: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. MATERIAL AND METHODS: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. CONCLUSIONS: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them