Renal colic - one of the urgent conditions in pediatrics

Бъбречната колика е остро състояние, причинено от конкремент в уретера, предизвикващ нарушение в уринния оток с последващо повишено налягане в кухинната система на бъбрек. Клиничната картина при деца се отличава от тази при възрастни. Водещ симптом е коремната болка, съчетана с хематурия. Диагнозата е комплекс от анамнестични данни, клинични, лабораторни и образни изследвания. Важно е изключването на „остър хирургичен корем”. Лечението изисква адекватна хидратация, нестероидни противовъзпалителни средства, спазмолитици, антиеметици, при необходимост – антибактериални средства. Целта е овладяване на болковия синдром, предпазване от усложнения и профилактика на рецидивите.Renal colic is an acute condition, caused by a ureteral stone that disturbs urine flow and increases the pressure in the kidneys. Clinical symptoms in children are much different from adults. The main complaint is an abdominal pain, combined with haematuria. The diagnosis is a complex of patient‘s medical history, clinical, laboratory and imaging tests. The most important issue is to exclude an acute surgical disease that needs an urgent operation. Medical treatment requires adequate hydration, nonsteroid anti-inflammatory drugs, spasmolytics, and if necessary – antibi-otics. The most important aim is to overcome the pain, to prevent complications and relapses of kidney stone disease

The challenge - pediatric pulmonology emergencies

Заболяванията на дихателната система в детска възраст се нареждат на първо място по честота в детската патология. Коректно снетата анамнеза, познаването на симптомите, адекватната и бърза реакция от страна на специалистите определя изхода на заболяването и неговите усложнения. Спешните състояния в детската пулмология са чести и представляват сериозно предизвикателство за общопрактикуващи лекари, педиатри, пулмолози, специалисти по здравни грижи. Познаването на причините за дихателна недостатъчност в детска възраст дава възможност за насоченото им търсене и своевременна бърза преценка и подход. Като най-чести спешни състояния на дихателната система, свързани с проявите на дихателна недостатъчност в детска възраст, са: аспирация, чуждо тяло, епиглотит, ларингит, пневмония, бронхиална астма. Преценката, бързината в амбулаторни и болнични условия при дете със спешно състояние на дихателната система е изключително важен момент, определящ изхода на заболяването.Respiratory diseases in children are the leader in frequency in pediatric pathology. A properly examined medical history, knowledge of the symptoms, an adequate and prompt reaction by the specialists determine the outcome of the disease and any following complications. Emergency conditions in pediatric pulmonology are frequent and they present a serious challenge for general practitioners, pediatricians, pulmonologists, healthcare professionals. Knowing the causes for respiratory insufficiency in children allows for their accurate identification and a rapid evaluation and adequate approach. The most frequent emergency conditions, associated with the occurrence of respiratory insufficiency in children are: aspiration, foreign body, epiglottitis, laryngitis, pneumonia, bronchial asthma. The judgment, the swiftness in ambulatory and hospital conditions in regards to a child with an emergency condition of the respiratory system are of utmost importance, determining the outcome of the disease

Algorithm of behavior in children with acute kidney failure

Острата бъбречна недостатъчност (остра бъбречна увреда - ОБУ) е клинико-лабораторен синдром, настъпващ с остро отпадане на основните бъбречни функции: хомеостазна, екскреторна, регулаторна. Честотата на ОБУ в детска възраст варира от 20 случая на година на 100 000 популация при новородени до 2 случая на година на 100 000 при юноши и е едно от най-драматичните състояния в детската нефрология. ОБУ протича с олигурия, хиперкалиемия,отоци, тахикардия, високи стойности на артериално налягане. Различава се преренална, ренална и постренална ОБУ, в зависимост от причините, които я предизвикват. Алгоритъмът на поведение включва: анамнестични данни за гадене, повръщане, диариен и болков синдром, оперативна интервенция, екзогенни въздействия, вродени аномалии, рецидивиращи инфекции на пикочните пътища, нефролитиаза, общо състояние (степен на дехидратация, бледост на кожа и видими лигавици), лабораторна оценка (CRP, урея, креатинин, пикочна киселина, общ белтък, йонограма, коагулационен статус, уринен анализ) и лечение в интензивно отделение. Здравните грижи включват: следене на температура, диуреза (постоянен катетър). Основните жизнени показатели - дишане, сърдечна дейност, се мониторират. Изработването на добра терапевтична стратегия е част от мениджмънта на това сериозно бъбречно състояние.Acute kidney failure (AKF, also called acute kidney injury - AKI) is a clinical laboratory syndrome occurring with acute failure of basic kidney functions: homeostasis, excretion, regulation. The frequency of AKF in childhood ranges from 20 cases per year per 100,000 population in neonates to 2 cases per year per 100 000 in adolescents. AKF is one of the most dramatic conditions in pediatric nephrology. AKF proceeds with oliguria, hyperkalemia, oedema, tachycardia, arterial hypertension. The causes of AKF are commonly categorized into prerenal, intrinsic, and postrenal.The algorithm of behavior includes: a history of nausea, vomiting, diarrhea and pain syndrome, surgery, exogenous effects, congenital disorders, recurrent urinary tract infections, nephrolithiasis, status (degree of dehydration, pallor of the skin and visible mucous membranes), laboratory evaluation (CRP, urea, creatinine, uric acid, total protein, detailed ionogram, coagulation status, urine analysis) and intensive care treatment. Healthcare includes: monitoring of temperature, diuresis (indwelling catheter). Basic vital signs - body temperature, blood pressure, heart rate and respiratory rate also must be monitored.Development of good therapeutic strategy is part of the management of this serious kidney condition

Evaluation of the tourist functions of protected areas: A case study of Shumen Plateau Nature Park

Protected territories have great potential for nature-based forms of tourism. These specific forms of tourism have also been considered as a tool for developing sustainable forms of tourism. Therefore, they have been a subject of scientific research in recent years. The purpose of this study is to evaluate the tourist functions of the Shumen Plateau Nature Park in North-East Bulgaria. It is among the small natural parks in terms of area, but it is a valuable natural site among the vast, highly anthropogenically modified territory of the eastern part of the Danube plain. By using the survey method, the study determines the overall recognition of the area and analyzes the visitor‘s opinions regarding the tourist use of the park territory. According to the results of this study the Shumen Plateau Nature Park has potential for protection and management of natural processes and, in parallel, an opportunity for the development of sustainable tourism and the implementation of ecological-educational and tourist programs. Visitors are well aware of the possibilities for tourism and sports, while they do not take advantage of all possibilities, but only the ones that are a priority for them. 100% of respondents answer positively when asked “Would you visit the Shumen Plateau again?”. Further research could combine more innovative and mixed methodologies to broaden the research interest

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Изследване на ресурснија потенцијал на туристичките реони во Бугарија

Целта на проекта е чрез изследване на ресурсния потенциал на туристическите райони на България да се създадат предпоставки за развитие на устойчив туризъм; формиране на нови туристически дестинации и нови туристически продукти; засилване на туристическата конкуренция; промотиране на културното, историческото и природното наследство и съвременните достижения. Туризъм, туристически ресурси, ресурсен потенциал, устойчив туризъм, туристически район

Novel heavy metal resistance gene clusters are present in the genome of Cupriavidus neocaledonicus STM 6070, a new species of Mimosa pudica microsymbiont isolated from heavy-metal-rich mining site soil.

BACKGROUND:Cupriavidus strain STM 6070 was isolated from nickel-rich soil collected near Koniambo massif, New Caledonia, using the invasive legume trap host Mimosa pudica. STM 6070 is a heavy metal-tolerant strain that is highly effective at fixing nitrogen with M. pudica. Here we have provided an updated taxonomy for STM 6070 and described salient features of the annotated genome, focusing on heavy metal resistance (HMR) loci and heavy metal efflux (HME) systems. RESULTS:The 6,771,773 bp high-quality-draft genome consists of 107 scaffolds containing 6118 protein-coding genes. ANI values show that STM 6070 is a new species of Cupriavidus. The STM 6070 symbiotic region was syntenic with that of the M. pudica-nodulating Cupriavidus taiwanensis LMG 19424T. In contrast to the nickel and zinc sensitivity of C. taiwanensis strains, STM 6070 grew at high Ni2+ and Zn2+ concentrations. The STM 6070 genome contains 55 genes, located in 12 clusters, that encode HMR structural proteins belonging to the RND, MFS, CHR, ARC3, CDF and P-ATPase protein superfamilies. These HMR molecular determinants are putatively involved in arsenic (ars), chromium (chr), cobalt-zinc-cadmium (czc), copper (cop, cup), nickel (nie and nre), and silver and/or copper (sil) resistance. Seven of these HMR clusters were common to symbiotic and non-symbiotic Cupriavidus species, while four clusters were specific to STM 6070, with three of these being associated with insertion sequences. Within the specific STM 6070 HMR clusters, three novel HME-RND systems (nieIC cep nieBA, czcC2B2A2, and hmxB zneAC zneR hmxS) were identified, which constitute new candidate genes for nickel and zinc resistance. CONCLUSIONS:STM 6070 belongs to a new Cupriavidus species, for which we have proposed the name Cupriavidus neocaledonicus sp. nov.. STM6070 harbours a pSym with a high degree of gene conservation to the pSyms of M. pudica-nodulating C. taiwanensis strains, probably as a result of recent horizontal transfer. The presence of specific HMR clusters, associated with transposase genes, suggests that the selection pressure of the New Caledonian ultramafic soils has driven the specific adaptation of STM 6070 to heavy-metal-rich soils via horizontal gene transfer

Novel heavy metal resistance gene clusters are present in the genome of Cupriavidus neocaledonicus STM 6070, a new species of Mimosa pudica microsymbiont isolated from heavy-metal-rich mining site soil

International audienceBackground: Cupriavidus strain STM 6070 was isolated from nickel-rich soil collected near Koniambo massif, New Caledonia, using the invasive legume trap host Mimosa pudica. STM 6070 is a heavy metal-tolerant strain that is highly effective at fixing nitrogen with M. pudica . Here we have provided an updated taxonomy for STM 6070 and described salient features of the annotated genome, focusing on heavy metal resistance (HMR) loci and heavy metal efflux (HME) systems.Results: The 6,771,773 bp high-quality-draft genome consists of 107 scaffolds containing 6118 protein-coding genes. ANI values show that STM 6070 is a new species of Cupriavidus . The STM 6070 symbiotic region was syntenic with that of the M. pudica-nodulating Cupriavidus taiwanensis LMG 19424 T. In contrast to the nickel and zinc sensitivity of C. taiwanensis strains, STM 6070 grew at high Ni 2+ and Zn 2+ concentrations. The STM 6070 genome contains 55 genes, located in 12 clusters, that encode HMR structural proteins belonging to the RND, MFS, CHR, ARC3, CDF and P-ATPase protein superfamilies. These HMR molecular determinants are putatively involved in arsenic ( ars ), chromium (chr), cobalt-zinc-cadmium (czc), copper (cop, cup), nickel (nie and nre), and silver and/or copper (sil) resistance. Seven of these HMR clusters were common to symbiotic and non-symbiotic Cupriavidus species, while four clusters were specific to STM 6070, with three of these being associated with insertion sequences. Within the specific STM 6070 HMR clusters, three novel HME-RND systems (nieIC cep nieBA, czcC2B2A2, and hmxB zneAC zneR hmxS) were identified, which constitute new candidate genes for nickel and zinc resistance. Conclusions: STM 6070 belongs to a new Cupriavidus species, for which we have proposed the name Cupriavidus neocaledonicus sp. nov.. STM6070 harbours a pSym with a high degree of gene conservation to the pSyms of M. pudica-nodulating C. taiwanensis strains, probably as a result of recent horizontal transfer. The presence of specific HMR clusters, associated with transposase genes, suggests that the selection pressure of the New Caledonian ultramafic soils has driven the specific adaptation of STM 6070 to heavy-metal-rich soils via horizontal gene transfer