General practice health promotion activities for infants

Introduction: Health promotion and disease prevention are the key elements of modern Primary Health Care (PHC). The objective of this study is to estimate the time allocated for health promotion activities in GP daily routine.Methods: An anonimous servey was conducted among 526 GPs in 5 regions from the Eastern part of Bulgaria: Varna, Burgas, Shumen, Dobrich, Ruse (June-August 2009).Results: The time allocated for disease prevention and health promotion activities is mostly estimated as `average` (n=257; 48.9%). 47.6% (n=20) of the medical professionals who have obtained two specialties - GP and Paediatrics, as well as those with Paediatrics - 44.3% (n=58), allocate `much time` for health prevention activities (χ = 41.03; р=0.002; Spearman`s ρ= 0.13, p=0.009). The majority of GP (72.4%; n=380) consider the allocated time of 20.6 (5.9; 5÷40) minutes for children health check to be also adequate for disease prevention and health promotion activities. 336 (63.9%) of the GP would assign these activities to the nurse they work with, while contact with breastfeeding consultants would be advised by 78.6% (n=81) of the GP acquainted with the BC duties; and 65.2% (n=260) of the GP who do not know these. The respondents who assess the health promotion activities for infants as `unsatisfactory` are 54.9% (n=259) with the main reasons for this being: poor organization of the children PHC, parents` passivity and untrained GP neglecting health promotion.Conclusions: PHC has been still focusing mainly on disease and its treatment. The study identified a necessity for dispatching the health promotion activities for infants to professionals trained to these (healthcare nurses, breastfeeding and nutrition consultants, etc.)

Manual adjustment of brain extraction parameters in a volumetric study

INTRODUCTION: Brain volumetry is a contemporary method used in scientific and clinical research in neurodegenerative diseases. The process can be fully automated but it allows some parameters to be manually adjusted in order to minimize errors. The purpose of the present study is to analyze the use of additional settings in the process of extracting brain tissue from the skull in volumetric assessments performed using FSL-SIENAX, to point out the most frequently used ones, and to provide recommendations for their application.MATERIAL AND METHODS: 3DT1 MRI scans of 51 patients with multiple sclerosis were processed. After conversion from the native format, brain tissue was extracted using the BET procedure. Multiple experiments were done using different parameters followed by a visual assessment of the results. Optimal values were chosen for each case. Descriptive statistical analysis was performed.RESULTS: Manual corrections of the default settings of BET were made in all studied cases. The most frequently applied parameter (100% of cases) was `-f`, which adjusts the aggressiveness of the algorithm, followed by `-B` (51%), which reduces bias field and neck voxels, `-R` (31,4%), multiple iterations of the algorithm, `-g` (25,5%), correction of the vertical gradient, `-S` (2%), removal of wrongfully identified optic nerves and eyeballs.CONCLUSION: The fully automatic volumetric assessment of the brain performed by FSL-SIENAX accelerates the workflow, but may lead to imperfections in the results. Manual adjustment trials may begin with the "-f" parameter, followed by "-Ð’", "-R", "-g", and combinations between them

Characteristics of workers on specific job in pharmaceutical industry companies in Bulgaria

The pharmaceutical industry operates in a highly regulated environment, imposing many specific requirements. In the European Union (EU), the production of medicines for human use is governed by mandatory European rules and directives requiring compliance with the principles and guidelines of Good Manufacturing Practice (GMP). In order to be admitted and started to be offered on the pharmaceutical market, the medicinal products must meet the requirements for quality, efficacy and safety. Bulgaria. The article examines and analyzes the registered under Art. 148, item 2 / art. 161, para. 2, item 1 of LMPHM qualified persons and under Art. 149 of LMPHM – Production Manager (RP) and Quality Control Manager (RKK). The distribution by education and the interrelation between the working qualified persons by sex and region for planning in Bulgaria, as well as between the regions for planning or the so-called statistical areas (NUTS-2) and number of storage facilities

Dynamics of water separation in destruction of water-in-oil emulsions

The dynamics of drop formation and settling processes in breaking water-in-oil emulsions of the West Siberian oil fields was experimentally studied. The investigation results of drop formation in the water-in-oil emulsions were presented. The residual water content in oil was determined after the settling process at the varied initial water content, temperature, and hydrodynamic conditions of emulsion formation

Application of the Rey-Osterrieth complex figure test for assessment of cognitive impairment in multiple sclerosis

INTRODUCTION: Cognitive impairment is frequent in multiple sclerosis and predominantly affects visuospatial abilities, memory, attention, and executive functions. Because of the specific cognitive profile, different from that in Alzheimer's disease and other frequent disorders presenting with dementia, specific neuropsychological instruments need to be used in multiple sclerosis. The aim of the present study is to assess the applicability of the Rey-Osterrieth complex figure test (ROCFT) for assessing cognitive impairment in patients with multiple sclerosis in comparison with a control group.MATERIAL AND METHODS: One hundred and two persons, 70 patients with MS and 32 healthy control subjects were assessed using ROCFT. A standardized system for assessment by points and percentiles was used. The results of both groups were compared statistically using independent samples t-test.RESULTS: On the copying task, the differences between patients and controls reached statistical significance, p<0.05 for the raw score, and p<0.001 after results were grouped by percentiles. On the drawing by memory task the differences between the two groups also showed statistical significance, p<0.01.CONCLUSION: ROCFT shows statistically significant differences between patients with multiple sclerosis and healthy subjects. Highest levels of significance were observed for copying, scored by percentiles, and for drawing by memory. The application of ROCFT can provide valuable information about cognitive dysfunction in multiple sclerosis

Mortality in childhood-onset type 1 diabetes

It is well-recognized that diabetes-related complications are the leading cause of the still increased morbidity and mortality from diabetes and exert a heavy economic burden on society. The discovery of insulin led to a dramatic change in life expectancy of patients with type 1 diabetes (T1D). Furthermore, it caused a major shift in the distribution of causes of death - from diabetic coma in the pre-insulin era, to long-term complications being the predominant causes of death nowadays. The aim of the present review is to assess the trends in the absolute and the relative mortality rates as well as the leading causes of death among patients with childhood-onset (< 18 years) T1D in populations from different latitudes. It is also observed how disease duration, age at diagnosis, and year of diagnosis affect these mortality trends. Eight population-based studies published in English in the last 14 years, as well as another one, published in 2001, with different duration of follow-up, are included in the review. However, it is hard to compare different populations due to the dissimilarities in the study methods and the characteristics of the examined cohorts

Epicardial fat as an imaging biomarker in the assessment of cardiometabolic risk in patients with type 1 diabetes with a duration of over 15 years

Diabetes mellitus is one of the most frequent metabolic diseases and is characterized by increased coronary risk. Data from epicardial fat quantification in long-term type 1 diabetes patients with poor control and healthy volunteers, performed with computed tomography and magnetic resonance tomography, is analyzed in relation to biochemical and anthropometric indicators. Statistically significant correlations are established between epicardial fat volume and body mass index in diabetic men, as well as between epicardial fat volume and dyslipidemic markers

Editorial

The article „Correlation Between Diabetic Retinopathy and Glycemic Variability, Assessed with Continuous Glucose Monitoring in Patients with Type 2 Diabetes Mellitus—a Review“ by Velina Kerekovska, Mila Boyadzhieva, Zornitsa Zlatarova, and Kiril Hristozov represents a comprehensive review of the correlation between diabetic retinopathy and glycemic variability assessed with continuous glucose monitoring in patients with type 2 diabetes mellitus. The review summarizes the current scientific knowledge on the topic, identifies the gaps, and raises issues for future research. It is focused on a topical and socially significant health problem and the innovative methods for its timely diagnosis and prevention. Diabetic retinopathy is a serious microvascular complication of diabetes mellitus that has a considerable impact on the patient and on society. It is a leading cause of preventable blindness among the working age population worldwide. In recent decades there have been a number of studies on the negative role of glycemic variability on the development and progression of microvascular complications of diabetes, including diabetic retinopathy. However, the acquired information remains insufficient and controversial, especially regarding type 2 diabetes mellitus. Therefore, there is a growing interest in clarifying the association between diabetic retinopathy and glycemic variability assessed with continuous glucose monitoring in patients with type 2 diabetes mellitus that brings additional value to the present review. The current article reviews the use of continuous glucose monitoring as an emerging tool for the management of type 2 diabetes mellitus and diabetic retinopathy, as this method presents detailed data on the glycemic control. This review provides valuable information on the correlation between glycemic variability and diabetic retinopathy, and could contribute to forming new strategies for handling this socially significant problem. Results from a great number of studies are presented and summarized in this review. The literature reference list contains sources of predominantly recent (last 5 years) research.The article is presented in a very good scientific style and illustrates a deep knowledge of the subject matter

USE OF THE PROBIOTIC Lactobacillus reuteri DSM 17938 IN THE PREVENTION OF ANTIBIOTIC-ASSOCIATED INFECTIONS IN HOSPITALIZED BULGARIAN CHILDREN: A RANDOMIZED, CONTROLLED TRIAL

Objective: To evaluate the effectiveness of Lactobacillus reuteri DSM 17938 for the prevention of antibiotic-associated diarrhoea and Clostridium difficile-related infections in hospitalized children in a Bulgarian hospital. Study design: Children (n=100, aged 3 to 12 years) admitted to the hospital for acute infections were enrolled in a randomized, double- blind, placebo-controlled trial. They were assigned to receive either a probiotic supplement containing 1 x 108 CFU Lactobacillus reuteri DSM 17938 in the form of one chewable tablet once per day (n=49) (BioGaia AB, Stockholm, Sweden) or placebo (n=48). The probiotic or placebo was taken 2 hours after lunch each day, during the entire period of antibiotic treatment at the hospital and for additional 7 days. Results: Data from 97 children were included in the final analysis. The incidence of diarrhoea (defined as at least 3 loose or watery stools per day in a 48-hour period that occurred during or up to 21 days after cessation of antibiotic treatment) was unexpectedly low in both groups - L. reuteri (n=1) versus placebo (n=1): 2,04 vs. 2,1 per 100 (p>0,05, risk ratio 1,02, 95% CI 0,7-1,4). L reuteri DSM 17938 did not significantly affect the incidence or severity of AAD diarrhoea and Clostridium difficile infection. We found unusually high colonisation rate of non-symptomatic C. difficile measured by toxin-specific ELISA. There was no difference between the probiotic and placebo groups for any of the other secondary outcomes (i.e., incidence of mild diarrhoea, frequency of stool samples positive for C. difficile toxin A and B at the beginning and at the end of study period, frequencies of other gastrointestinal symptoms in the same study period) (p<0,05). No adverse events were reported. Conclusion: Due to the low incidence of antibiotic-associated diarrhoea in both groups, no conclusion can be made on the efficacy of L. reuteri DSM 17938 on AAD in hospitalized Bulgarian children. The probiotic did not affect the non-symptomatic high rate of C. difficile colonisation (33.3% in the placebo and 38.8% in the L. reuteri group at baseline) in this population. There was also no difference between groups regarding different gastrointestinal side effects

BRAIN AND LESION VOLUMES CORRELATE WITH EDSS IN RELAPSING-REMITTING MULTIPLE SCLEROSIS.

Background: Demyelination and neurodegeneration are hallmarks of multiple sclerosis (MS). Axonal damage is considered to be the leading factor for persisting disability in the course of the disease. In different studies, expanded disability status scale (EDSS) scores have been found to correlate with brain atrophy, lesion load, or both. Objective: To assess the possible correlations between EDSS scores and volumes of brain, grey and white matter, and subcortical structures in patients with relapsing-remitting multiple sclerosis. Subjects and Methods: 46 patients with RRMS were included in the study. Total brain volume, grey and white matter volumes were calculated using SIENAX, and subcortical structure volumes were obtained using FIRST, parts of FSL. EDSS was scored by a qualified rater. Statistical analysis was performed. Results: Moderate negative correlation of EDSS was demonstrated with total brain volume, grey and white matter volume, volumes of left and right pallidum, putamen, caudate nucleus, n. accumbens (p<0.01), and with the volumes of left and right thalamus (p<0.05). Moderate positive correlation was found between EDSS and T2 lesion volume (p<0.01). Correlation between EDSS and hippocampal volumes was weak. Conclusions: Our results demonstrate that in patients with relapsing-remitting multiple sclerosis, higher disability correlates with lower volumes of brain, grey and white matter, and some subcortical structures, but also with higher T2 lesion load. We support the hypothesis about a possible causal relationship between white matter damage and brain atrophy, as well as the role of both demyelination and neurodegeneration for disability in MS