MEDICO-LABORATORY SERVICES IN OUTPATIENT CARE IN NORTHEASTERN BULGARIA – STATE AND PROSPECTS

Aim: The aim of this article is to study the satisfaction of patients with laboratory services in outpatient care in Northeastern Bulgaria regarding access and quality of service. Study design: Prospective cohort study Material and methods: The survey was carried out on the territory of Northeastern Bulgaria and covered the districts of Varna, Dobrich and Shumen and thirty municipalities. The following methods were applied in the study: sociological method by applied direct anonymous questionnaire, documentary method and statistical methods for analysis and interpretation of the data in order to reveal the nature of the observed phenomena and their interrelations. Results: The research data show that 24,4% of the respondents live at a distance of more than ten kilometres from the nearest medico-diagnostic laboratory. The larger share of these patients are residents of small settlements in Northeastern Bulgaria. More than half (55%) of the respondents are not satisfied with their provision of laboratory services, but the majority of patients claim that the location of the selected laboratory is accessible (69,4%) and the quality of the laboratory service is high (83,7%). Conclusion: The main problems in outpatient care are related to the poor provision of medico-laboratory services and specialized outpatient care in the smaller settlements in Northeastern Bulgaria

KETOGENIC DIET – FROM THE IMPLEMENTATION IN CLINICAL PRACTICE TO NOWADAYS

Introduction: The ketogenic diet (KGD) is a high-fat, adequate-protein, low-carbohydrate diet. In 1920`s the diet was developed to treat difficult-to-control epilepsy in children. Nowadays its efficacy has been proven in many other diseases, such as metabolic disorders, brain tumours, autism, Rett syndrome, and in other areas, it has been actively studied. Aim: The aim of this article is to represent the historical review of the therapeutic implication of KGD, as well as to reveal the contemporary clinical trends in which it is being used. Material and Methods: A literature review of 96 scientific reports in English has been made. Results and Discussion: The KGD was developed in the early 1920s. In the period 1970-1990, the therapeutic use of the diet was discontinued, due to the breakthrough of the new anticonvulsants for epilepsy. The interest in KGD was recovered after a meeting of the “American Epilepsy Society” in 1996. The diet demonstrates anticonvulsant efficacy in epilepsy therapy. According to a survey in 2013, the incidence of seizures among half of the number of children was reduced by at least a half, and 15% of them were completely discontinued. The diet is also used in the treatment of metabolic diseases, such as GLUT 1-deficiency syndrome, reducing the incidence of seizures, improving muscle coordination and concentration. It is also effective in pyruvate dehydrogenase deficiency syndrome by replacing the major energy source - glucose with ketones. Along with these, it is also used in patients with autism (in approximately 60% of patients it improves learning ability and social skills), Rett syndrome, Alzheimer's disease, Parkinson's disease, and others. Its mechanism of action is not fully clarified, as well as its degree of effectiveness in some areas. Conclusion: The ketogenic diet is widely implemented worldwide. It comprises a tremendous therapeutic potential that has been growing considerably during the past decades

Abstracts Of The Proceedings And The Posters From The Third Scientific Session Of The Medical College Of Varna

October 2-3, 201