Medical history among Bulgarian patients with fever of unknown origin and low-grade fever

Въведение: Персистиращият фебрилитет с неизвестен произход е предизвикателство пред медицинската общност. Целта на тази статияе да се представят анамнестичните данни при български пациенти с неясно фебрилно състояние (НФС) и субфебрилна температура.Материали и методи: За периода от 01.02.2012г. до 01.08.2015г. в Клиниката по инфекциозни болести към ВМА-София се проведе проспективно проучване на пациенти с НФС и субфебрилитет. Изследвани бяха общо 117 пациенти, от тях с НФС - 88 човека, със субфебрилитет 29 човека. В настоящата работа са използвани следните методи: библиографски метод, метод на сравнението и клинични методи.Резултати: Основните анамнестични данни, имащи принос към поставянето на окончателната диагноза при всички проучени пациенти, са следните - умора, изпотяване, втрисане, главоболие и артралгия.Заключение: Анамнезата е от съществено значение за крайния успех в диагностиката на фебрилитета с неизвестен произход. Тя се явява първа стъпка в диагностичния алгоритъм при НФС.Introduction: The persisting fever of indeterminate genesis is a challenging for the medical society. The aim of this paper was to present the medical history of Bulgarian patients with fever of unknown origin (FUO) and low-grade fever (non-FUO).Materials and methods: A prospective study of patients with FUO and non-FUO was done at the Department of Infectious Diseases, Military Medical Academy (Sofia, BG) for the period: 1st February 2012 - 1st August 2015. A population of 117 patients were analyzed, 88 - FUO, 29 - non-FUO. The following methods were applied: literature review, a method of comparison and clinical evaluation.Results: The main historical data which are leading to the final diagnosis in the whole analyzed group were: fatigue, sweats, chills, headache and arthralgia.Conclusion: The medical history is a basic key in the diagnostic pathway to the final diagnosis in case of fever of undetermined origin. This is the first step in the diagnostic algorithm

Congenital and Acquired Interferonopathies: Differentiated Approaches to Interferon Therapy

This chapter reviews various interferon (IFN) system disturbances—interferonopathies. The authors describe clinical specifics of type I interferonopathy associated with overexpression of IFNα—which is a rare Mendelian genetic disease. Certain autoimmune diseases (systemic lupus erythematosus (SLE), vasculitis, immune dysregulation syndrome, etc.) are also characterized by overproduction of IFNα. Furthermore the most common interferonopathies are described—deficiencies of IFN, congenital or acquired IFNα/IFNβ and IFNγ deficiencies in children and adults. Deficiency of IFNα/IFNβ associated with severe recurrent viral infections and deficiency of IFNγ cause mycobacterial infection. Interferon-corrective therapy methods are described. The target therapy of type I interferonopathies (biologics) binds IFNα and normalizes the high level of IFNα. From the other side, patients with congenital IFNα deficiencies are needed in replacement IFN therapy. In case of acquired IFNα deficiency, the differentiated interferon-corrective therapy is performed. In both replacement and interferon-corrective therapies, recombinant human IFNα2b in complex with antioxidants (Viferon®) can be used, because their application is safe and has good clinical efficiency and no side effects

Mathematical tools for updating the value profile of environmental university programs’ students

The article presents a mathematical tool of the value profile of students studying at environmental university programs in Russia. A theoretical review of modern literature confirmed the special relevance of the formation of the value profile of future environmentalists and defined a theoretical model of values for the development of indicators of empirical research. On the basis of a random sample we developed and conducted a survey of 1127 people studying in the areas of “Ecology”, “Ecology and Nature Management”, “Environmental Monitoring” in regional universities of Russia. The questionnaire database was processed in the SPSS program (version 26). Respondents evaluated the list of values of personal development and values in terms of life and positioning themselves in society during the survey. A structural mathematical model of the value profile of future environmentalists was performed by Rotation Method: Varimax with Kaiser Normalization. We identified five structural elements of the current value model of environmentalists of Russia. The results are important for the subsequent analysis and adjustment of university educational programs and the achievement of strategic professional tasks facing future environmentalists in accordance with the goals of national development of Russia until 2030

Fever of unknown origin and Q-fever: a case series in a Bulgarian hospital

Background: Fever of unknown origin (FUO) is a perplexing medical problem. The causes for FUO are more than 200 diseases. The aim of the study was to present human clinical cases of Coxiella burnetii infection debuting as FUO. Methods: The following methods were conducted in the study: literature search, laboratory, imaging, and statistical methods. Criteria of Durack and Street were applied for FUO definition. For the etiological diagnosis indirect immunoenzyme assay (ELISA) for antibodies detection against Coxiella burnetii was used (cut-off = 0.481–0.519). Results: From 2008 until 2015, nine patients with FUO caused by C. burnetii were hospitalized at the Military Medical Academy of Sofia. Male gender was predominant (male/female – 77.8 /22.2), mean age was 48.78±14.52 years (range: 26–67), hospital stay was 9.78±2.95 days (range: 5–15), fever duration was 54.33±56.23 days (range: 21–180). Laboratory investigations estimated the elevation of erythrocyte sedimentation rate 49.11±31.74mm/h (95CI = 13.09–111.31), C-reactive protein 37.68±37.62mg/L (95 CI = 36.07–111.42) and fibrinogen 5.69±1.59g/L (95 CI=2.57–8.81). The mean values of liver enzymes were in reference range. Among imaging tests, abdominal ultrasound and X-ray demonstrated 33.3 contribution to the final diagnosis. Transthoracic echocardiography found 22.2 contribution. Serological methods presented 100 contribution. Conclusion: C. burnetii infection was accepted as a final diagnosis among 9 patients with FUO based on the integrated information from the applied methods. Active search and establishment of this pathogen among FUO should lead to avoiding potential complications and consequences in case of untreated patients infected with C. burnetii

Cultural and Historical Aspects in Developing the System of Accounting

The article considers historical stages in the development of accounting as a part of the world culture. The specific features of each stage of evolution are represented and the main aspects of accounting information system as a source of relevant data are identified. The effectiveness of the controlling toolkit to improve the system of accounting is substantiated, the main provisions of the controlling conception are singled out and generalised; the scientific schools and their differences are identified. The analysis of various definitions revealing the content of the notion "culture" based on the condition and achievements of society as a collective of individuals who are in turn characterised by the unity of social, economic and cultural life is carried out. The essence of the notion "culture" and its versatility are determined; the actions of individuals responsible for the evolution of the economic life of society as a reaction to the obtained information are substantiated. The necessity to reflect the main provisions of accounting from the standpoint of their influence on economic decision-making, individuals’ consciousness, distribution of resources, trajectory of economic development and the well-being of economic entity is investigated. The necessity to represent accounting as a subsystem of culture is substantiated. The main definitions of the notion "culture" which are most appropriate for characterising the subject matter of accounting are studied. The key aspects of describing the system of accounting as a culture component are identified

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

The development of export oriented agriculture: methods of region export potential assessment

The study uses a systematic approach to ensure the complexity and focus of scientific recommendations, analytical, abstract-logical, calculating-constructive, economic-statistical, economic-mathematical, monographic methods of research. The methodical approach to justifying the placement of organic agricultural products and food production, localizing it using method of mapping. The Based on the acceptance of mapping with allocation locally segments based on certain criteria or features based on the points-rating system. This allows us to distinguish local segments of industry production and organic farming using signs of geographical and behavioral segmentation. At the same time, the criterion of segmentation by geographical basis may be the natural and economic zoning of the area in question; the criterion of segmentation by behavioral basis may be the degree of need of the residents of the area for a particular product. In the end, the allocation of segments is reduced to ranking local zones of production and processing of organic agricultural products and markets, forming in the