Leriche syndrome treated by covered endovascular reconstruction of aortic bifurcation (CERAB)

Leriche syndrome, otherwise known as aortoiliac occlusive disease, is a result of atherosclerotic changes in the distal abdominal aorta, iliac arteries and/or common femoral arteries. Clinical manifestation includes a triad of symptoms: buttock claudication, impotence, and femoral pulselessness. Covered endovascular reconstruction of the aortic bifurcation (CERAB) is one of the new methods that can be used in the treatment of such lesions. Our aim is to present our clinical experience with this techniqu

Sierra Leone's Child Soldiers: War Exposures and Mental Health Problems by Gender

Purpose: To examine associations between war experiences, mental health, and gender in a sample of male and female Sierra Leonean former child soldiers. Methods: A total of 273 former child soldiers (29% females) were assessed for depression and anxiety by using the Hopkins Symptoms Checklist, and for hostility, confidence, and prosocial attitudes by using an instrument developed for use with Sierra Leonean child soldiers. Results: The former child soldiers had witnessed and perpetrated violence at largely comparable rates, although females experienced higher rates of rape (p.0001). More females scored within clinical ranges for depression (p .008) and anxiety (p.0001). In multiple regression analyses, female gender was a significant predictor of lower levels of confidence but not of mental health problems. Children who perpetrated injury or killing reported greater levels of depression (p.0001), anxiety (p.0001), and hostility (p.0001). Surviving rape was associated with increased anxiety (p.05) and hostility (p.05), in males. Surviving rape was also related to higher confidence levels (p.05) and prosocial attitudes (p.05). Male former child soldiers who lost caregivers were also more vulnerable to depression (p.05) and anxiety (p.05), strong and significant effects noted among male child soldiers. Conclusions: In our sample, female and male child soldiers experienced comparable levels of most war exposures. Female soldiers reported higher rates of rape and lower levels of adaptive outcomes. Toxic forms of violence (killing or injuring; rape) were associated with particularly poor outcomes. Although all boys and girls who experience rape and loss of caregivers are generally at risk for mental health problems, boys in our sample demonstrated increased vulnerability; these findings indicate a need for more inclusive mental health services

Photodynamic opening of the blood-brain barrier using different photosensitizers in mice

In a series of previous studies, we demonstrated that the photodynamic therapy (PDT), as a widely used tool for treatment of glioblastoma multiforme (GBM), also site-specifically opens the blood-brain barrier (BBB) in PDT-dose and age-related manner via reversible disorganization of the tight junction machinery. To develop the effective protocol of PDT-opening of the BBB, here we answer the question of what kind of photosensitizer (PS) is the most effective for the BBB opening. We studied the PDT-opening of the BBB in healthy mice using commercial photosensitizers (PSs) such as 5-aminolevulenic acid (5-ALA), aluminum phthalocyanine disulfonate (AlPcS), zinc phthalocyanine (ZnPc) and new synthetized PSs such as galactose functionalized ZnPc (GalZnPc). The spectrofluorimetric assay of Evans Blue albumin complex (EBAC) leakage and 3-D confocal imaging of FITC-dextran 70 kDa (FITCD) extravasation clearly shows a revisable and dose depended PDT-opening of the BBB toEBACand FITCD associated with a decrease in presence of tight junction (TJ) in the vascular endothelium. The PDT effects on the BBB permeability, TJ expression and the fluorescent signal from the brain tissues are more pronounced in PDT-GalZnPc vs. PDT-5-ALA/AlPcS/ZnPc. These pre-clinical data are the first important informative platform for an optimization of the PDT protocol in the light of new knowledge about PDT-opening of the BBB for drug brain delivery and for the therapy of brain diseases. © 2019 by the authors

Attitudes of Bulgarian students toward the introduction of health education as a new discipline in the high school curriculum

Introduction: Health Education as a school subject presents to high-school students knowledge about health and develops attitudes for responsible health behaviors. The school system is the second-best place, after the family, where children are be socialized and educated. Health promotion is an effective method to improve or change our health-related lifestyles. The aim of this study was to research the attitudes and opinions among school students in Bulgaria toward having Health Education as an additional subject in their school curriculum.Materials and Methods: Existing health education frameworks and programs for students were researched. Existing data on the state of children’s well-being and health attitudes among students in Bulgaria were studied using official policy and normative documents. New data were collected via a survey among school students in Bulgaria from diverse locales. In total, 720 students participated in the survey, aged 9 to 19, from the 5th to the 12th grades. The students were asked to fill in a questionnaire developed by the first author. The collected data were analyzed with statistical tools and conclusions were drawn based on the results.Results: Results from the survey show that a healthy lifestyle is quite popular among young people. Overall, they trust the information given by healthcare specialists and health institutions. Health issues are discussed formally in school several times during the school year. The students think that a new Health Education subject would be very useful and they would take part in the classes, especially if healthcare specialists present the subject. The study shows Health Education is most desired and needed by the students in the 7th grade (14 years of age).Conclusion: Existing studies show that health education in Bulgaria is still far away from what should be expected. Only the students from the largest cities are well-informed about health and healthy behaviors. Furthermore, Bulgarian youth consistently report poor health behaviors and low health status. On the other hand, in this study children underscored the importance of health education and reported high motivation to broaden their health-related knowledge

Gadolinium-Containing Contrast Agents - not as Safe as We Thought

Introduction: Gadolinium-based contrast agents (GBCA) are extensively used as magnetic resonance imaging (MRI) contrast agents owing to their outstanding signal enhancement, low immunogenicity, and easiness of chemical modification. GBCA are most commonly used for enhancement of vessels in MR angiography or for brain tumor enhancement associated with the degradation of the blood-brain barrier. In 2006, however, a negative association between the use of GBCA and the development of nephrogenic systemic fibrosis (NSF) has been reported for the first time in patients with acute and chronic renal failure. An isolated case of gadolinium-induced NSF has also been registered in Bulgaria in November 2009. Nephrogenic systemic fibrosis (NSF) is a rare and serious syndrome, which was recognized in 1997. It consists of fibrosis of skin, joints, eyes, and internal organs. The mechanism of NSF is not fully understood despite extensive research. The most common symptoms include bone/joint pain and head/neck symptoms including headache, vision change, and hearing change manifested within 2 to 8 weeks after the patients had been exposed.Materials and Methods: We have used public internet databases - PubMed, SCOPUS, MEDLINE, and EMBASE.Results: Collected data from different sources shows that GBCA can be extremely toxic to patients with impaired kidney functions, in patients around the time of liver transplantation, in newborn babies less than four weeks of age, etc.Conclusions: In order to preserve the patients` health, physicians should be more aware of GBCA`s side effects and the patient`s history before every MRI, to restrict the dose to the minimum recommended and all patients should be screened for kidney problems before injection with these types of agents

International Development and Early Learning Assessment Technical Working Paper

Early Childhood Care and Development (ECCD) programs help ensure that young children fulfill their right to healthy development and education, and ultimately assist them in reaching their full potential. There is mounting evidence from around the world demonstrating that the first years of life are critical in the development of children as they shape cognitive, social and language skills, as well as lifelong approaches to learning. The review concluded that despite the existence of ECCD tools in the global space, none of the instruments available at the time offered a balance between 1) international applicability, especially within low and middle income country contexts, 2) feasibility and ease of administration and adaptation and 3) psychometric rigor. With these criteria in mind, and lessons learned from years of early childhood programming, Save the Children began the process of developing and validating the International Development and Early Learning Assessment (IDELA). The goal for IDELA was to develop a holistic, rigorous, open source instrument that is feasible and easily adapted to different national and cultural contexts. IDELA was developed with an aim to support continuous program improvement across Save the Children’s and partners’ numerous country sites, to increase accountability among ECCD initiatives globally, and to offer cohesive and ongoing data and evidence about children’s learning and development across countries that can help governments and global actors to bring successful ECCD programs to scale

Human resources in health care - state and trends

Introduction: Human resources are a very important factor for the development of health care. Labour in health care is carried out by people with different occupations and qualifications who perform medical and non-medical activities. However, the imbalance between different types of specialists and their territorial distribution creates a number of difficulties. The aim of the study is to analyse the latest health workforce trends in Bulgaria in a comparative perspective.Materials and methods: The study is based on official reports, analyses, and statistical data by the WHO, European observatory, Organization of Economic Cooperation and Development (OECD), the European Union and Bulgarian sources.Results: The results show the increase in availability of physicians and dentists in Bulgaria between 2000 and 2015. In 2014, the number of physicians and dentists were much higher than the average for the EU 13 and the Region. Although the proportion of physicians is high, only 16.6% of all physicians are general practitioners in 2015, which is much lower than the EU average of 30%. Additionally, in 2015, Bulgaria is one of two countries (together with Cyprus) with the highest densities of practising dentists in the EU. The number of nurses per 1000 population (4.9) is considerably lower than the EU13 average (6.1), EU15 average (9.4) and EU27 average (8.7). Despite a decrease in the number of midwives in the country, their availability is still greater than the average for both the Region and the EU 13.Conclusion: Despite the good availability of doctors in general, the tendency is the reduction in the number of doctors in some specialties. The low availability of health professionals and the unfavourable proportion of nurses and doctors will create even more serious difficulties in providing the necessary health care to the population in the future

Computer vision syndrome in the nurse`s daily activities

Новите технологии наложиха ежедневна работа с компютър във всички сфери на производството, услугите и образованието. Компютърният зрителен синдром (КЗС) представлява комплекс от негативни усещания и включва намаляване на броя на премигванията и понижена слъзна секреция.Компютърната грамотност е част от квалификационната характеристика на медицинската сестра, a работата пред монитор е ежедневие в сестринската практика. Това довежда до често срещани оплаквания: сълзене на очите, парене, усещане за „пясък в очите`, зрителна умора, главоболие. За появата на тези симптоми в голяма степен допринасят и постоянното префокусиране на погледа от клавиатурата върху екрана или печатни документи.Целта на настоящото проучване е да се установи степента на информираност относно очното здраве и профилактичната дейност на медицинските сестри, свързани с КЗС.Материали и методи: В периода 13-20.06.2016 г. е проучено мнението на 40 студенти първокурсници от специалности „Медицинска сестра` и „Акушерка`, обучаващи се в МУ-Варна, Филиал Велико Търново, и 30 медицински сестри от МОБАЛ „Д-р Стефан Черкезов` АД, гр. Велико Търново.Проведена бе анкета с 15 въпроса, от които 14 затворени и 1 отворен. Проучването бе анонимно.Резултатите сочат, че работата с компютър е съществена част от ежедневието на анкетираните. Разнообразните субективни симптоми, които се установиха, са резултат от неспазването на нормите за хигиена при работа с компютър. 49% от анкетираните не са информирани за нормите на хигиена, 39% ги познават и едва 20% - отчасти.Изводи: Необходимо е медицинските сестри да са запознати с „компютърния зрителен синдром`, за да могат да извършват ефективни дейности по превенция и профилактика на очните заболявания и обучение на пациенти в тази насока.New technologies have imposed the use of computers in all spheres of production, services and education on a daily basis. Computer vision syndrome is a complex of negative sensations and includes decreased blinking rate and tear production.Computer literacy is a necessary qualification in the nurse profession and the work before a computer screen is an everyday activity. It results in frequent complaints, such as watery eyes, burning eyes, sandy feeling in the eye, eye fatigue and headaches. A constant gaze shift from the keyboard to the screen or any printed material aggravates such symptoms. The purpose of the current survey is to evaluate the level of information about eye health and prophylactic activities of nurses related to CVS.Materials and Methods: The opinions of 40 firstyear students from the Nurse and Midwife programs of the Medical University of Varna at its Veliko Tarnovo Affiliate, and 30 nurses from the Regional Hospital Dr Stefan Cherkezov (MOBAL), Veliko Tarnovo, were surveyed in the period 13-20 June, 2016. They were asked 15 questions, 14 of which were closed-ended questions and one was open-ended. The survey was anonymous.The results show that the work done on a computer is an essential part of the surveyed people`s everyday routine. The different personal symptoms that were identified are the result of breaking the norms of hygiene in working on a computer. Of the surveyed, 49% are clueless about the hygienic norms; 39% are familiar with them and only 20% of the people are partially familiar.Conclusions: It is necessary for nurses to know about the computer vision syndrome so that they can work effectively towards prevention and prophylaxis of eye diseases and training patients in this direction

Natural preservatives vs. artificial preservatives

Aim: To increase the awareness towards the health risks of the usage of artificial preservatives and to inform about the advantages of natural preservatives.Materials and methods: Systematic approach of the available scientific literature on the problem.Results: Preservatives prolong the shelf-life of food, cosmetics and pharmaceuticals by preventing their spoilage caused by microbial growth and unwanted chemical reactions. Nowadays the artificial preservatives - nitrites, nitrates and benzoats (parabens) that possess antimicrobial activity, are widely used. They destroy or inhibit the growth of bacteria, molds and yeasts in the products. Some of them are toxic; some even have life-threatening effects. The recent investigations show that big part of the artificial preservatives such as nitrates, benzoates, sulphates,p arabens etc. can cause serious health hazards - from headaches and diarrhea to hypersensitivity reactions, asthma attacks, neurological disorders and cancer. Therefore people are looking towards the nature in search of natural preservatives.Conclusions: The recent investigations recommend the use of natural preservatives as safer to human health