Arterial hypertension and diabetes mellitus

The pathogenesis of arterial hypertension in patients with diabetes is a complicated process and involves a complex of biological and ecological factors, as well as genetic predisposition; as a result, the elevated blood pressure (BP) in patients with diabetes mellitus (DM) creates a higher risk of adverse events. Morbidity and mortality increase in diabetic patients who do not effectively control their BP to the targeted values of less than 140/90 (130/80) mm Hg. Large randomized trials and meta-analyses of large randomized controlled studies showed that the pharmacological reduction of BP is the most effective single way for reduction of mortality and of target organs damage in patients with DM, especially the related cardiovascular risk. Frequently, a combination of two or more medications (diuretics, angiotensin converting enzyme inhibitors, β-blockers, calcium channel blockers, angiotensin receptor blockers, spironolactone, etc.) is needed for effective pharmacotherapy, mostly in patients with difficult BP control. However, the costs of the health care to intensively lower BP are significantly lower than the expenditures to treat the hypertension complications, and the latter may be even prevented with BP reduction

Dyslipidemias - modern understanding and management

Сърдечно-съдовите заболявания (ССЗ) са основна причина за смърт и инвалидност у нас и по света. За развитието им основно значение има нарушението в липидния метаболизъм, което води до атеросклероза на съдовете. Дислипидемиите представляват всяко нарушение в нивата и/или функцията на плазмените липопротеини. Те са семейство нарушения в липопротеиновия метаболизъм и са различни по вид и причина. Честотата им е висока в общата популация и сред пациентите със ССЗ. Разгледани са съвремнните разбирания за развитието на дислипидемиите, които отчитат не само нивата на липопротените, но и техния брой, форма, големина, както и други показатели на липидния метаболизъм. Посочени са съвременните препоръки за поведение при дислипидемия. Те включват комплексни мерки за промяна в начина на живот и храненето, както и приложението на различни лекарствени средства. Посочени са основните цели за лечение. В медикаментозното лечение се отбелязва водещата роля на статините за снижение на плазмените липиди. Посочени са и други класове медикаменти, както и съвременни експериментални начини за повлияване на дислипидемиите.Cardiovascular diseases (CVDs) are the major cause of mortality and disability in Bulgaria and worldwide. Lipid metabolism disorders have a major impact on their development and this leads to vascular atherosclerosis. Dyslipidemias are any disorder in the levels and/or the function of plasma lipoproteins. These represent a family of disturbances in the lipoprotein metabolism and are different in form and etiology. Their rate of occurrence is high in the general population and in patients with CVDs. The modern understanding of the development of dyslipidemias is overviewed. It takes into account not only the levels of the lipoproteins but also their number, form, size, as well as other indices of the lipid metabolism. The current guidelines on dyslipidemia management are discussed. They include complex measures for lifestyle and diet changes, as well as application of different classes of medications. The major targets for treatment are pointed out. The pivotal role of statins in plasma lipid reduction is stressed on. Other classes of medications are also mentioned, as well as up-to-date experimental methods for affecting dyslipidemias

Galectin-3: multiple clinical applications

Galectin-3 is a β-galactoside binding lectin, containing carbohydrate-recognition domain, which interacts with a number of ligands. It is found in many tissues and is distributed intra– and extracellularly. The localization of the biomarker determines its function. Galectin-3 is involved in variety of biological processes sush as inflammation, fibrosis, immunological response and neoplastic growth. It may be used as a diagnostic or prognostic biomarker especially in cancer and cardiovascular diseases. The present review summarizes some of the properties of this biomarker

Specialisation : pro and anti-globalizing 1990-2002

Specialization alters the incidence of trade costs to buyers and sellers, with pro-and anti-globalizing effects on 76 countries from 1990-2002. The structural gravity model yields measures of Constructed Home Bias and the Total Factor Productivity effect of changing incidence. A bit more than half the world's countries experience declining constructed home bias and rising real output while the remainder of countries experi- ence rising home bias and falling real output. The effects are big for the outliers. A novel test of the structural gravity model restrictions shows it comes very close in an economic sense

Gold Standard Gravity

This paper provides striking confirmation of the restrictions of the structural gravity model of trade. Structural forces predicted by theory explain 95% of the variation of the fixed effects used to control for them in the recent gravity literature, fixed effects that in principle could reflect other forces. This validation opens avenues to inferring unobserved sectoral activity and multilateral resistance variables by equating fixed effects with structural gravity counterparts. Our findings also provide important validation of a host of general equilibrium comparative static exercises based on the structural gravity model.

Aspects of personal data protection in handling cardiac data

Сърдечната недостатъчност като крайна фаза на всички сърдечни заболявания е проблем, за решаването на който е необходимо лекарят да притежава голям обем информация, свързана със състоянието на пациентите. Процесите на консултации, диагностика и лечение са свързани с обработка на специални категории лични данни, която трябва да бъде приведена в съответствие с общия регламент относно защитата на данните на физическите лица, приет на 4 май 2016г и влизащ в сила от 25 Май 2018г. В доклада се изясняват задължителните изисквания, които е необходимо да бъдат изпълнени, и се дават препоръки за приложимите ор-ганизационни и технически мерки за постигане на съответствие с регламента.Heart failure as an end stage of all heart cardiovascular diseases is a problem for which a physician needs to have a large amount of information related to the condition of patients. Consultation, diagnosis and treatment processes are related to the processing of special categories of personal data, which must be brought into line with the General Data Protection Regulation of Natural Persons adopted on May 4, 2016 and in force since May 25, 2018. The report clarifies the mandatory requirements that need to be met and provides recommendations on the applicable organizational and technical measures to comply with the Regulation

Arming in the global economy: The importance of trade with enemies and friends

We analyze how trade openness matters for interstate conflict over productive resources. Our analysis features a terms-of-trade channel that makes security policies trade-regime dependent. Specifically, trade between two adversaries reduces each one's incentive to arm given the opponent's arming. If these countries have a sufficiently similar mix of initial resource endowments, greater trade openness brings with it a reduction in resources diverted to conflict and thus wasted, as well as the familiar gains from trade. Although a move to trade can otherwise induce greater arming by one country and thus need not be welfare improving for both, aggregate arming falls. By contrast, when the two adversaries do not trade with each other but instead trade with a third (friendly) country, a move from autarky to trade intensifies conflict between the two adversaries, inducing greater arming. With data from the years surrounding the end of the Cold War, we exploit the contrasting implications of trade costs between enemies versus trade costs between friends to provide some suggestive evidence in support of the theory

Dark costs, missing data: shedding some light on services trade

A structural gravity model is used to estimate barriers to services trade across many sectors, countries and time. Since the disaggregated output data needed to flexibly infer border barriers are often missing for services, we derive a novel methodology for projecting output data. The empirical implementation sheds light on the role of institutions, geography, size and digital infrastructure as determinants of border barriers. We find that border barriers have generally fallen over time but there are differences across sectors and countries. Notably, border effects for the smallest economies have remained stable, giving rise to a divergent pattern across countries

Estimating the effects of non-discriminatory trade policies within structural gravity models

Abstract only in English and FrenchWe propose a simple method to identify the effects of unilateral and non‐discriminatory trade policies on bilateral trade within a theoretically consistent empirical gravity model. Specifically, we argue that structural gravity estimations should be performed with data that include not only international trade flows but also intra‐national trade flows. The use of intra‐national sales allows identification of the effects of non‐discriminatory trade policies such as most favoured nation tariffs, even in the presence of exporter and importer fixed effects. A byproduct of our approach is that it can be used to recover estimates of the trade elasticity, a key parameter for quantitative trade models. We demonstrate the effectiveness of our techniques in the case of most favoured nation tariffs and “time to export” as representative non‐discriminatory determinants of trade on the importer and on the exporter side, respectively. Our methods can be extended to quantify the impact on trade of any country‐specific characteristics as well as any non‐trade policies. = Évaluation de l’incidence des politiques commerciales non discriminatoires au sein de modèles de gravité structurels. Dans un modèle de gravité empirique théoriquement cohérent, nous proposons une méthode simple pour identifier les effets des politiques commerciales unilatérales et non discriminatoires sur le commerce bilatéral. Plus précisément, nous affirmons que les estimations basées sur des modèles de gravité structurels doivent être réalisées en tenant compte non seulement des données relatives aux flux commerciaux internationaux, mais aussi nationaux. L’utilisation de données relatives aux ventes domestiques permet d’identifier les effets des politiques commerciales non discriminatoires, par exemple les tarifs douaniers de la nation la plus favorisée (NPF), même en présence d’effets fixes importateur et exportateur. Notre approche peut être utilisée pour redresser les estimations relatives à l’élasticité des échanges, un paramètre clé des modèles commerciaux quantitatifs. Nous démontrons l’efficacité de nos techniques dans le cadre des tarifs douaniers NPF et des délais d’exportation, facteurs déterminants, représentatifs et non discriminatoires sur le commerce, à la fois pour l’importateur et l’exportateur. Il possible d’étendre nos méthodes pour quantifier les effets de n’importe quelle caractéristique spécifique à un pays sur le commerce, ainsi que de n’importe quelle politique non commerciale.Benedikt Heid, Mario Larch, Yoto V. Yoto

Depression in patients with heart failure

Introduction: Heart failure (HF) is a chronic progressive syndrome, which is a result of preceding heart diseases and manifests with serious symptoms. Depression and anxiety are frequent comorbidities in chronic HF, which deteriorate the general status of the patients and are related to unfavorable health results—increased number of hospitalizations, deteriorated quality of life, and elevated mortality.Aim: The aim of this article is to assess the tendency to fall into depression of patients with HF in NYHA class III-IV, hospitalized in the non-invasive cardiology clinic of St. Marina University Hospital, Varna and the link to socioeconomic factors—social isolation, family status, educational level, region of residence and so on.Materials and Methods: Overall, 39 patients with HF (17 women and 22 men) were investigated. They were in III-IV NYHA functional class during hospitalization. After preliminarily informed consent, they were asked to fill out a validated screening questionnaire for depression in adults—the 15-item Geriatric Depression Scale (GDS). The link to the patients’ socioeconomic, demographic, biological, and clinical characteristics was sought with the help of a multi-factor linear and logistic regression analysis.Results: The results for the level of depression among HF patients were related to socioeconomic factors—region of residence, level of education, social isolation as well as to other variables—gender, age, and systolic left ventricular function assessed through the ejection fraction (EF). Higher levels of depression were observed in patients who resided in larger populated areas, with higher level of education and patients living alone. As far as gender was concerned, females were more susceptible to depressive episodes than males. At an average EF of 49.54 ±15.29%, the decreased left ventricular systolic function was also a factor of the degree of development of anxiety and depression. In a multi-factor analysis, however, only living alone was related to enhanced depressive attitude.Conclusion: Depression/anxiety in HF patients requires increased need of health care, shows poor health results, has high costs for treatment related to the serious symptoms, disability and high mortality. Regardless of that, no programs for timely detection, diagnosis, and treatment have been developed yet