Volume 12 (2019): Issue 1 (July 2019)

This aim of this review was to examine the relationship between metabolic syndrome (MetS) and depression, which is complex and multifaceted with many inter-related factors includinggenetics, lifestylefactors, environmentalfactorsand other psychological factors at play. There is some evidence to suggest that depression may lead to the development of cardiovascular disease through its association with MetS. It has also been suggested that depressive symptoms may be a consequence rather than the cause of the MetS, as obesity and dyslipidemia have been shown as predictive of depressive symptoms. Thus, the relationship between MetS and depression seems to be a two-way street and bi-directional just as the two sides of the same coin.

In this experiment we studied the role of excitatory and inhibitory neurotransmissions in the ascending reflex pathways in isolated rat colon. Partitioned organ bath, electrical field stimulation (EFS), drugs and isolated preparations were used to evaluate motor activity of (LM) and circular muscles (CM). Ascending motor responses of LM and CM were frequency-dependent contraction, significantly more expressed in LM. Atropine (0.3 µM) decreased ascending contractions of LM. During atropine treatment spantide (0.1 µM) further suppressed ascending contractile motor responses. In the presence of atropine, L-NNA (0.5 mM) restored ascending contractions of LM, while contractions were strongly depressed after addition of L-arginine (0.5 mM). Ascending response in CM, caused by atropine, consisted of an initial relaxation followed by contraction. Spantide decreased the contraction. L-NNA reduced the relaxation and significantly restored the atropine-influenced contraction, while L-arginine induced a deep relaxation of CM. The presence of ChAT, SP-containing nerve cell bodies and fibers and NADPH-diaphorase-reactive cell bodies and processes in myenteric ganglia were detected. The results indicated that nitric oxide is an important modulator of ascending cholinergic and tachykininergic excitation in colonic region of the large intestine of rats.

Myeloproliferative neoplasms (MPN) are haematological diseases, characterized by clonal hematopoiesis. Hemostasis abnormalities are among the most critical and frequent complications, affecting the quality of life and a possible reason for death. Thrombotic complications are common and multifactorial. Our aim was to study some genetic thrombophilia factors – Factor V Leiden (FVL), G20210A mutation in prothrombin gene (PR G20210A) and PLA2 allele polymorphism of glycoprotein IIIa gene (GPIIIa gene), and their frequency and association with thrombotic risk in both Philadelphia-positive and Philadelphia-negative MPN – chronic myelogenous leukemia (CML), polycythemia vera (PV), essential thrombocythemia (ET), and primary and secondary myelofibrosis (MF). In our patient population, PLA2 allele polymorphism of GPIIIa gene proved to be the most common and significantly associated with thrombotic complications – 26.85% of our patients were carriers, and 24.14% of them reported thrombotic complications.

The aim of the study was to analyse the intraoperative parameters of hysteroscopic morcellation (HM) and conventional resectoscopy in the treatment of uterine polyps (UP). A total of 177 patients with ultrasound imaging of UP were included in a prospective study from February 2015 to February 2017. Out of them, 98 (55.4%) underwent HM and 79 (44.6%) had hysteroscopic resection (HR). We analyzed the following intraoperative parameters: total duration of the procedure, total operating time, time for dilation, actual operating time for HM/HR, the total amount of fluid distension media and fluid deficit. The mean operating time, measured as a total duration of the procedure, total operating time and actual operating time, was significantly shorter in the HM group, as compared to HR group, 8.27 and 19.48 minutes (min) – p<0.001, 6.15 and 16.33 min (p<0.001), 3.28 and 11.70 min (p<0.001), respectively. The total amount of fluid distension media was trustworthy lower in the HM group compared to HR, 446.02 ml and 2225.57 millilitres (ml) – p<0.001, respectively, as well as for the fluid deficit parameter – respectively 83.78 ml and 413.48 ml (p<0.001). This warrants the assumption that HM is an effective alternative to conventional resectoscopy for removal of UP with a favorable perioperative outcome.

Nowadays, infertility is a problem that affects an increasing number of people. The causes of infertility in a couple may be due to a variety of factors – female, male or unexplained. One of the common problems associated with infertility in women is related to uterine cervical diseases. The cervix is an essential part of the sperm passage, so various disorders in the cervix structure and function may be the cause of infertility. The study aimed to identify the leading cervical causes of female infertility, methods of treatment and their success. The most common problems of cervical origin are cervical polyps and stenosis of the cervical canal. They are easily diagnosed with a routine gynaecological examination and ultrasound examination. Polyps are removed through polypectomy, and after that, a natural pregnancy can be achieved. In the case of stenosis of the cervical canal, there are two treatment options – dilation or intrauterine insemination (IUI). In younger patients and lack of male factor in the couple, dilation is performed. Dilation is mechanical with classic Hegar dilatiors or with synthetic hygroscopic dilatiors (Dilapan). If, in addition to the stenosis of the cervical canal in a woman, there is a male factor, treatment with IUI is preferred. Methods for cervical factor treatment vary in their success rate but are generally characterised by good results.

Premenstrual syndrome (PMS) is often co-morbid with panic disorder (PD). Selective serotonin reuptake inhibitors (SSRis) are the first-line treatment for both PMS and PD when they manifest separately, but their co-occurrence often complicates the treatment. Our objectives were to evaluate the clinical picture of PMS, co-morbid with PD and the way it changes under 6-month SSRI treatment course. For that purpose, we conducted a longitudinal interventional study. We examined 30 women suffering from PMS and a current episode of PD, verified through premenstrual screening tool (PSST) and Mini International Neuropsychiatric Interview (M.I.N.I.6.0.), respectively. Before treatment initiation, irritability, mood lability, anxiety, breast tension and tenderness, changes in appetite, headaches, palpitations, and abdominal bloating were most common. The somatic symptoms were more than twice as common as the psychological. After 6 months of treatment, most of the symptoms mentioned above were still present but less severe. Forty per cent of the women recovered completely. It seems that in cases of comorbidity between PMS and PD, though somatic symptoms are more common, SSRIs are an effective option for managing both somatic and psychological symptoms.

The study aimed to identify the type of refraction in children with unilateral and bilateral congenital nasolacrimal duct obstruction (CNLDO) who underwent nasolacrimal duct probing. One hundred and twelve children aged 1.8 to 13 years, diagnosed with CNLDO, were included in a retrospective study. All the patients had their visual acuity examined, and their refractive status was evaluated. The refractive errors of both eyes were noted, followed by an appropriate management plan. Of the 112 children, 79 (70.5%) had a unilateral obstruction, and 33 (29.5%) had bilateral obstruction. Nine children (11.4%) in the former group and six children (18.2%) in the latter group were with visual acuity <0.8. The most frequent refractive error among the studied children was hyperopia. No statistically significant difference (p>0.05) between refraction of the two eyes in the evaluated children were found. Amblyopia risk factors were identified in 9 of the patients (8.0%). CNLDO did not adversely affect the refractive status. However, amblyogenic risk factors were found more often in our patients, as compared to general populations. Therefore, a detailed evaluation should be performed to find out these risk factors.

Early diagnosis of congenital hearing impairment is of great importance to later development and social life of the affected newborns. Otoacoustic emission screening test (OAEs) is a useful tool for early evaluation of hearing in neonates and infants. Some specific risk factors (RFs) associated with prenatal, birth and early postnatal periods may influence the first screening results and further diagnostic findings. Results from OAEs in newborns in University Hospital in Pleven between 2013-2015 years are analyzed. In low birth weight children (under 2500 grams or g), and those born before the 36^th gestation week (GW), we found deviations in the OAEs. A negative test result proved higher in newborns subjected to oxygen therapy during the first hours after birth (15.5%), as well as in newborns with higher leucocytes count (11.0%) or higher serum bilirubin value immediately after birth. The average birth weight of the newborns was lower in the cases with negative test results (2848.7±506.5 g) and unilateral negative test results (2823.3±535.2 g), as compared with the group with positive test results (3191.9±387.9 g). Elevated bilirubin levels were more frequently established and can be expected with higher probability in low birth weight children. They shall be subject to a follow-up in time, and newborns with initial negative test result shall undergo a second test 2 months after birth. Long term monitoring is recommended for newborns with these risk factors.

Nursing degree courses in Bulgaria provide a wide range of career opportunities to graduates. These opportunities, however, do not solve the current problems of the healthcare system. This communication presents the results of a survey conducted among graduate students majoring in the nursing specialty at the Medical University in Pleven. The survey aimed to acquire information on the graduates’ willingness to practice in nurseries. A questionnaire containing 26 questions specially designed for the study was used. The data were processed with statistical software packages Statgraphics; SPSS v. 19 and Excel for Windows. Despite the sound theoretical and practical course of training, 13 (21.67%) of the students were embarrassed, and 13 said they had been cautious when they first entered a crèches during their training. Almost half of the respondents – 29 (48.33%) reported that they might work in a crèches only if it is necessary, and 16 (26.66%) – never. Only 9 (15.00%) declared they would be committed to caring for children aged one to three years. At the end of their training, student nurses did not feel sufficiently prepared for the psychological and pedagogical challenges to practice their profession in such child day care centers. The respondents had no clear idea of the role of the nurse in a crèches. Very few of the student nurses reported a willingness to work in a crèches.

The case presented is that of a young man with atypical pathogenesis of myocardial infarction with ST-elevation (STEMI) after physical stress. It was provoked by partial thrombosis of the distal segment of the left main coronary artery (LM) at the bifurcation of the left anterior descending artery. After the emergency treatment, the disease process underwent reverse development without any consequences for left ventricular kinetics.

The variations of the cystic duct are so common that only 30% of all humans present the classical anatomical arrangement between the common bile duct (CBD), the cystic duct, and adjacent arteries. Thus, it could be considered that anomalies of the biliary tree are a rule rather than an exception. Duplication of the cystic duct, however, is a very uncommon anatomical finding. In the Department of General and Digestive Surgery of the University Hospital Complex Albacete, a 73-year-old patient was admitted with symptoms of cholangitis. He underwent emergency surgery that found exacerbated chronic cholecystitis and dilation of the CBD. Cholecystectomy was performed with identification of a double cystic duct that drained separately in the CBD and exploration of the last revealed cholangitis without choledocholithiasis. The postoperative period progressed favourably, proceeding to discharge from the hospital with Kehr drainage closed. In conclusion, we consider that the routine use of intraoperative cholangiography when there is suspicion of anatomical variations of the biliary tree is mandatory to rule out lesions or alterations thereof.

Gangliocytic paraganglioma (GP) is an uncommon finding in the periampullary region of the duodenum. In the Department of General and Digestive Surgery of the Albacete University Hospital Complex, a 45-years-old patient was diagnosed with a 17x13mm hypervascular nodular lesion in the descending part of the duodenum during an examination for hepatic hemangiomas. Ampullectomy was performed, followed by a favourable postoperative period. Histological analysis proved GP. There were no involvement of lymph nodes and a malignancy potential, so the clinical and radiological follow-up opted. In conclusion, because such tumours have unpredictable behavior, we recommend local resection of the tumour, except in cases in which local or ganglionic progression is suspected or confirmed, and thus cephalic pancreaticoduodenectomy (CPD) and lymphadenectomy are suggested.