Historical Review And Analysis Of Contemporary Aspects In The Treatment Of Acute And Chronic Form Of Q-Fever

Световно разпространената зооноза Ку-треска се причинява от вътреклетъчния микроорганизъм Coxiella burnetii. Заболяването е ендемично за нашата страна и има две форми на протичане - остра и хронична. Поради неспецифичната симптоматика на Ку-треската поставянето на точна диагноза и правилно лечение са затруднени. В исторически план лечението на заболяването е претърпяло много промени, свързани с различни in vitro модели за проучване на чувствителността на Coxiella burnetii към антибиотични комбинации. За съвременното лечение на острата форма на Q-треската (Ку-треската) при възрастни се използва 100 mg доксициклин два пъти дневно за 14 дена, a при бременни се препоръчва ко-тримоксазол (триметоприм/сулфаметоксазол: 160 mg / 800 mg) два пъти дневно до последните шест седмици на бременността. Aктуалната терапия на хроничната форма на заболяването включва 100 mg доксициклин два пъти дневно, комбинирани с хидроксихлорохин три пъти дневно при 200 mg на доза в продължение на най-малко 18 месеца.Worldwide spread Q-fever zoonosis is caused by the intracellular microorganism Coxiella burnetii. The disease is endemic to our country and has both acute and chronic forms. Due to the non-specific symptoms of Q-fever, accurate diagnosis and proper treatment are difficult. Historically, the treatment of the disease has undergone many changes associated with various in vitro models for studying the sensitivity of Coxiella burnetii to antibiotic combinations. For acute treatment of the acute form of Q-fever in adults, 100 mg doxycycline is used twice daily for 14 days, and co-trimoxazole (trimethoprim/sulfamethoxazole: 160mg/800mg) twice daily during pregnancy is recommended up to the last six weeks of pregnancy. Current chronic disease therapy includes 100 mg doxycycline twice daily combined with hydroxychloroquine three times a day at 200 mg per dose for at least 18 months

Cystic Echinococcosis of the Breast - Diagnostic Dilemma or just a Rare Primary Localization

Introduction: Although the liver and lung are the most frequently affected organs in cystic echinococcosis, the cysts may develop in any viscera and tissues. Breast is a rare primary localization with few cases described in the literature. We present an updated and systematic review and discuss the possible mechanisms of spreading, diagnostic and treatment options.Materials and methods: We performed a literature search in PUBMED using the key words ‘hydatid disease’, ‘cystic echinococcosis’ and ‘breast echinococcosis’ without time limitation. Only studies reporting breast cystic echinococcosis were included.Results: Overall, 121 cases with cystic echinococcosis and 2 with alveolar echinococcosis were reported. A total of 52 cases were included in the analysis. The mean size of cysts was 5.5 cm (range 1.7-12). The most common clinical presentation was painless lump presented from 4 months to 19 years before the final diagnosis. Most cases had isolated breast CE, few cases had synchronous localizations – femoral, thigh and lung, and previous liver CE. Most were active CL and CE1-2 cysts (72%). Ultrasound was used in 83%, followed by mammography (35%). Fine needle aspiration was reported in 27 cases with positive finding in 59%.Conclusions: In cases with cystic breast lesions from endemic regions we recommend the US as a gold standard. CT and MRT are more accurate but expensive tools without the potential to change the surgical tactic. In contrast to the other localizations of CE, complete excision of the cysts is the best diagnostic and treatment approach

Temperament traits and personality disorders. Predictors for personality disorders

The objective of this study is related to the hypothetical assumption that there are biologically set predispositions as predictors of behavioural and personality disorders. The present work focused on identification of specific inherent predispositions as predictors of behavioural and personality deviations. The examined population of 901 subjects was provided with a battery of self-rating questionnaires: Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) for assessment and diagnosis of the temperament, Eysenck Personality Questionnaire (EPQ) for the assessment and diagnosis of relatively constant personality characteristics, International Personality Disorder Examination (IPDE-s) screening autoquestionnaire for the assessment and diagnosis of personality disorders and State Trait Anxiety Inventory – Form Y (STAI-Y) autoquestionnaire for the assessment and diagnosis of personality and situational anxiety. The results for the represented population showed statistically significant relationships, ranging from weak to strong positive correlation between the types of temperament in TEMPS-A and the personality disorders identified in screening IPDE, with the exception of the hyperthymic temperament scale in which very low non-significant negative relationships were observed. The analysis did not show significant correlations between personality disorders and the hyperthymic temperament type according to TEMPS-A. This temperament type showed weak statistically significant correlations with personality disorders from different clusters. Based on the high values of the linear correlation coefficients, some conclusions could be made on the causal correlation between the presence of a certain type of temperamental predispositions and the registered manifestations of possible personality disorders, namely, which personality disorder is most likely to occur in the prevalence of which temperament

Outcomes analysis of hospital management model in restricted budget conditions

Facing conditions of market economy and financial crisis, the head of any healthcare facility has to take adequate decisions about the cost-effective functioning of the hospital. Along with cost reduction, the main problem is how to maintain a high level of health services. The aim of our study was to analyse the quality of healthcare services after the implementation of control over expenses due to a reduction in the budgetary resources in Military Medical Academy (MMA, Sofia, Bulgaria). Data from the hospital information system and the Financial Department about the incomes and expenditures for patient treatment were used. We conducted a retrospective study on the main components of clinical indicators in 2013 to reveal the main problems in the hospital management. In 2014, control was imposed on the use of the most expensive medicines and consumables. Comparative analysis was made of the results of the medical services in MMA for 2013 and 2014. Our results showed that despite the limited budget in MMA over the last year, the policy of control over operational costs succeeded in maintaining the quality of healthcare services. While reducing the expenses for medicines, consumables and laboratory investigations by ∼26%, some quality criteria for healthcare services were observed to be improved by ∼9%. Financial crisis and budget reduction urge healthcare economists to create adequate economical instruments to assist the normal functioning of hospital facilities. Our analysis showed that when a right policy is chosen, better results may be achieved with fewer resources

Standardization and approbation of the Bulgarian version of the TEMPS-A for temperament evaluation. An example of “delinquent temperament” assessment

The aim of this study was to approbate the Bulgarian version of the international instrument for evaluation of temperamental traits, TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego –Autoquestionnaire), and to prove the need to include it in the instruments for research and diagnosis of personality. The study included 901 subjects, 540 of whom are healthy volunteers. One month after the initial test, 118 subjects from the control group were retested with a set of clinical tools to check the reliability of the instrument (temporal stability). The TEMPS-A scales showed high test–retest reliability and high internal consistency. The number of scales was verified and the construct validity of the Bulgarian version of TEMPS-A was confirmed. The results outline the limit for predictive scores on the axis normal–pathological values. The observed correlations did not prove a causal link between the measured variables but verified a statistically significant correlation between the TEMPS-A and Eysenck Personality Questionnaire results, which proved that the two instruments measure the same basic personality characteristics, namely the temperamental construct. The analysis verified the successful standardization and approbation of the Bulgarian version of TEMPS-A for Bulgaria. The comparative analysis of a group of 74 persons serving custodial sentence on the territory of Bulgaria and a control group (N = 74) showed statistically significant differences between the mean scores in the two groups on all TEMPS-A scales, except for hyperthymic temperament, suggesting that delinquent behaviour is connected with an individual's temperamental characteristics