Endoscopic Dacryocystorhinostomy – Our Experience

Objectives: The aim of this study is to present our experience with endoscopic management of chronic obstruction of the nasolacrimal duct.Matherials and methods: Retrospective analysis of the patients with chronic stenosis and obstruction of nasolacrimal product managed with endoscopic DCR. Patients’ demographics, management techniques, complications and outcomes, patient satisfaction are reported.Results: A total of 11 patients with stenosis or obstruction of the nasolacrimal duct were treated in our clinic. All patients were managed with endoscopic DCR. 8 of the patients were female and 3 – male. 9 of the patients had unilateral complaints and 2 – bilateral. The results showed patency of the operated nasolacrimal ducts in the absence of recurrence to date. There was one case of postoperative epistaxis. Other postoperative complications were not observed.Conclusions: Our experience shows that endoscopic management of chronic obstruction of the nasolacrimal duct is safe and effective, and this is in line with data reported by other authors

ESSENTIAL DRUGS AND THEIR ROLE IN THE HOSPITAL DRUG CONSUMPTION IN THE UNITED REGIONAL CLINICAL HOSPITAL-VARNA IN 1997

The consumption of the drugs included in the Model List of Essential Drugs (ED) of WHO was studied in the United Regional Clinical Hospital of Varna for the first time. The purpose of the study was to estimate the consumption of these drugs in the hospital as a whole as well as in every hospital division. The monthly variations of the consumption were analyzed according to the specific activity of these divisions. The mean ED consumption by the patients in all the divisions was calculated. Those of them with the highest frequency of ED usage recommended in the Model List were presented. Certain conclusions about the benefit of the introduction of this Model List of ED and its importance for some hospital pharmaco-economic factors were drawn

Baloon sinuplasty – first implementation in Bulgaria

Here we present the first two patients that were treated with baloon sinuplasty in Bulgaria. Review of the indications, benefits, risks, feasibility and efficacy of baloon sinuplasty. Chronic sinusitis – description and management alternatives.----------------------------------------В настоящото съобщение-обзор ние представяме първите двама пациенти, оперирани в България с използване на метода на балонната синупластика. Разгледани са индикациите, ползите, рисковете, приложимостта и ефикасността на този метод. Описание на заболяването хроничен синузит и алтернативите за лечение

Asessment of coronary arteries with ECG GATED 64-multidetector computed tomography (MDCT) in patients with suspected aortic dissection Stanford type A

The purpose of our study is to show the value of ECG gated 64-MDCT as an non - invasive and reliable method for simultaneous assessment of coronary arteries as part of the aortic root evaluation. Methods and Materials. From February 2009 until March 2010 we performed 46 ECG - gated, 64 MDCT examinations to confirm a diagnosis of suspected aorta ascendens dissection . A transthoracic (TTE) and/or transesophageal (TEE) echocardiography was initially performed in all patients ( mostly TEE) Patients (pts) with arrhythmia and non-stable haemodynamic conditions were excluded. All MDCT scans were performed with retrospectively ECG gated technique (0,625mm slice thickness). Premedicaton with i.v. betaBlocker (propranolol) was administrated in all with heart rate> 70 bpm

Surfactant-mediated and morphology-controlled nanostructured LiFePO4/carbon composite as a promising cathode material for Li-ion batteries

The synthesis of morphology-controlled carbon-coated nanostructured LiFePO4 (LFP/Carbon) cathode materials by surfactant-assisted hydrothermal method using block copolymers is reported. The resulting nanocrystalline high surface area materials were coated with carbon and designated as LFP/C123 and LFP/C311. All the materials were systematically characterized by various analytical, spectroscopic and imaging techniques. The reverse structure of the surfactant Pluronic® 31R1 (PPO-PEO-PPO) in comparison to Pluronic® P123 (PEO-PPO-PEO) played a vital role in controlling the particle size and morphology which in turn ameliorate the electrochemical performance in terms of reversible specific capacity (163 mAhg 1 and 140 mAhg 1 at 0.1 C for LFP/C311 and LFP/ C123, respectively). In addition, LFP/C311 demonstrated excellent electrochemical performance including lower charge transfer resistance (146.3 Ω) and excellent cycling stability (95% capacity retention at 1 C after 100 cycles) and high rate capability (163.2 mAhg 1 at 0.1 C; 147.1 mAhg 1 at 1 C). The better performance of the former is attributed to LFP nanoparticles (< 50 nm) with a specific spindle-shaped morphology. Further, we have also evaluated the electrode performance with the use of both PVDF and CMC binders employed for the electrode fabrication

Towards a better future for Canadians with bipolar disorder:principles and implementation of a community-based participatory research model

The Collaborative RESearch Team to study psychosocial factors in bipolar disorder (CREST.BD) is a multidisciplinary network dedicated to advancing science and practice around psychosocial issues associated with bipolar disorder (BD), improving the care and wellness of people living with bipolar disorder, and strengthening services and supports for these individuals. CREST.BD specializes in community-based participatory research, in which research is conducted as a partnership between researchers and community members. This article describes the evolution of the CREST.BD network and CREST.BD’s commitment to community-based participatory research in bipolar disorder research. Examples of CREST.BD projects using community-based participatory research to study stigma, quality of life, psychosocial interventions, and creativity in bipolar disorder are highlighted, and opportunities and challenges of engaging in community-based participatory research in bipolar disorder specifically and the mental health field more broadly are discussed. This article demonstrates how CBPR can be used to enhance the relevance of research practices and products through community engagement, and how community-based participatory research can enrich knowledge exchange and mobilization

Optimal duration of risperidone or olanzapine adjunctive therapy to mood stabilizer following remission of a manic episode: A CANMAT randomized double-blind trial

Atypical antipsychotic adjunctive therapy to lithium or valproate is effective in treating acute mania. Although continuation of atypical antipsychotic adjunctive therapy after mania remission reduces relapse of mood episodes, the optimal duration is unknown. As many atypical antipsychotics cause weight gain and metabolic syndrome, they should not be continued unless the benefits outweigh the risks. This 52-week double-blind placebo-controlled trial recruited patients with bipolar I disorder (n=159) who recently remitted from a manic episode during treatment with risperidone or olanzapine adjunctive therapy to lithium or valproate. Patients were randomized to one of three conditions: discontinuation of risperidone or olanzapine and substitution with placebo at (i) entry (\u270-weeks\u27 group) or (ii) at 24 weeks after entry (\u2724-weeks\u27 group) or (iii) continuation of risperidone or olanzapine for the full duration of the study (\u2752-weeks\u27 group). The primary outcome measure was time to relapse of any mood episode. Compared with the 0-weeks group, the time to any mood episode was significantly longer in the 24-weeks group (hazard ratio (HR) 0.53; 95% confidence interval (CI): 0.33, 0.86) and nearly so in the 52-weeks group (HR: 0.63; 95% CI: 0.39, 1.02). The relapse rate was similar in the 52-weeks group compared with the 24-weeks group (HR: 1.18; 95% CI: 0.71, 1.99); however, sub-group analysis showed discordant results between the two antipsychotics (HR: 0.48, 95% CI: 0.17; 1.32 olanzapine patients; HR: 1.85, 95% CI: 1.00, 3.41 risperidone patients). Average weight gain was 3.2 kg in the 52-weeks group compared with a weight loss of 0.2 kg in the 0-weeks and 0.1 kg in the 24-weeks groups. These findings suggest that risperidone or olanzapine adjunctive therapy for 24 weeks is beneficial but continuation of risperidone beyond this period does not reduce the risk of relapse. Whether continuation of olanzapine beyond this period reduces relapse risk remains unclear but the potential benefit needs to be weighed against an increased risk of weight gain

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe

Hematopoietic IKBKE limits the chronicity of inflammasome priming and metaflammation

Obesity increases the risk of developing life-threatening metabolic diseases including cardiovascular disease, fatty liver disease, diabetes, and cancer. Efforts to curb the global obesity epidemic and its impact have proven unsuccessful in part by a limited understanding of these chronic progressive diseases. It is clear that low-grade chronic inflammation, or metaflammation, underlies the pathogenesis of obesity-associated type 2 diabetes and atherosclerosis. However, the mechanisms that maintain chronicity and prevent inflammatory resolution are poorly understood. Here, we show that inhibitor of κB kinase epsilon (IKBKE) is a novel regulator that limits chronic inflammation during metabolic disease and atherosclerosis. The pathogenic relevance of IKBKE was indicated by the colocalization with macrophages in human and murine tissues and in atherosclerotic plaques. Genetic ablation of IKBKE resulted in enhanced and prolonged priming of the NLRP3 inflammasome in cultured macrophages, in hypertrophic adipose tissue, and in livers of hypercholesterolemic mice. This altered profile associated with enhanced acute phase response, deregulated cholesterol metabolism, and steatoheptatitis. Restoring IKBKE only in hematopoietic cells was sufficient to reverse elevated inflammasome priming and these metabolic features. In advanced atherosclerotic plaques, loss of IKBKE and hematopoietic cell restoration altered plaque composition. These studies reveal a new role for hematopoietic IKBKE: to limit inflammasome priming and metaflammation