Volume 8 (2015): Issue 1 (June 2015)

In Europe, as well as in Bulgaria, consumption of soft drinks and confectionery has increased during the last three decades and is partly responsible for the epidemic-like increase in obesity. These foods, originally sweetened by sucrose, are now sweetened by other caloric sweeteners such as fructose. In this study we investigated the effect of an eight-week intake of 20% fructose solution on body weight in rats. Two adult rat groups (aged 120±6 days) of Wistar line were studied: a Control group (C; n=10; 5 male and 5 female rats) received water and standard rodent chow, and a Fructose group (F; n=12; 6 male and 6 female rats) who received 20% fructose-in-drinking-water solution and regular rodent chow. All animals were weighed and measured (nose to anus length), and the Lee index (equivalent of BMI in rats) was calculated. Body fat was also analyzed. As indicators of increased caloric intake of the Fructose group we investigated glucose, triglycerides and cholesterol (total, HDL and LDL) in blood. In conclusion, consumption of fructose solution in rats resulted in increased body weight, length and measured body fat, increased blood glucose, total cholesterol and triglycerides in the Fructose group, as compared to the controls.

The aim of the study was to evaluate seizure liability in rats against the convulsant pentylenetetrazole (PTZ) during a 14-day treatment with retigabine (RTG). The seizure liability was also studied on the 1^st, 2^nd and 3^rd day after the abrupt determination of its administration. Male Wistar rats were divided in groups of 10 and treated orally for 14 days (1^st – 6^th group with distilled water, and 7^th – 12^th group with retigabine (RTG) at a dose of 60 mg/kg bw The tolerance to the anticonvulsant effect of RTG was studied using subcutaneous injection of PTZ (120 mg/kg bw) on the 1^th and 14^th day. To determine the possible neuronal hyperexcitability on the 1^st, 2^nd and 3^rd day after termination of drug administration, a lower dose of PTZ (65 mg/kg bw) was used. According to our results there was no change in the anticonvulsant activity of RTG during the whole period of treatment. The study on withdrawal syndrome showed slightly decrease of the effect on the first day after the last treatment, but with no significant difference to the controls. The anticonvulsant effect of RTG on the 2^nd and 3^rd day was close to that in the control group. Our results showed no development of tolerance on subchronic treatment with RTG. There was no significant change in the neuronal hyperexcitability on the 1^st, 2^nd and 3^rd day after the termination of treatment. Based on these results we can suggest that RTG has no potential to develop withdrawal syndrome.

The aim of this study was to examine force production during maximal isometric handgrip in unilateral (UL) and bilateral (BL) tasks in right- and left-handed subjects. Ten right-handed (RH) and 8 left-handed (LH) young men were studied. The subjects were instructed, after a command, to perform a shot-like handgrip, raising maximal force as fast as possible. Three series were performed as follows: 1) UL - right handgrip; 2) UL - left handgrip; 3) BL handgrip. We measured peak force, time to peak of force and rate of force. The BL/UL ratios for the right (R) and left (L) hand and L/R ratios for the UL and BL tasks were calculated. The L/R ratios for peak force and force rate in RH group ranged across all tasks and conditions from 0.71 to 0.75. They were significantly lower than 1 (p<0.01). These ratios did not differ significantly from 1 for LH subjects (0.98–1.02), indicating the handedness in RH group only. The BL/UL ratios for peak force were 0.89 and 0.89 in RH, suggesting symmetrical bilateral strength deficit. The magnitude of the bilateral deficit in LH group was larger for the dominant (L) hand compared to non dominant (R) hand – 0.93 and 0.97 (p<0.05) respectively, suggesting an asymmetry of bilateral deficit in LH. These ratios for time of force and rate of force indicated bilateral deficit (BD) in the dominant hand of RH group only.

The aim of the study is the translation, adaptation and validation of Side effects of antiepileptic drugs questionnaire in Bulgarian language (SIDAED-BG) in order to use it for objective monitoring of patients with epilepsy. One hundred and thirty one patients (mean age 40.13±13.37 years) took part in the investigation. The internal consistency and test-retest reliability were tested by Cronbach's α and ICC estimations. The convergent construct validity was evaluated by estimating the correlation of SIDAED-BG with the QOLIE-89 and the discriminant validity - by evaluation of the difference between SIDAED-BG scores and clinical parameters such as type of epilepsy using Kruskal-Wallis ANOVA. The Cronbach's α of the total scale was 0.93. The test-retest reliability was higher and determined the strong positive correlations between the first and second examination. The SIDAED-BG questionnaire showed good internal consistency (Cronbach's alpha ranged from 0.37 to 0.86) and the scores significantly correlated with other questionnaires such as QOLIE-89 and showed a good discriminative validity between groups with different levels of self-assessed adverse effects of antiepileptic drugs. The Bulgarian version of SIDAED is a reliable and valid tool in assessing the patient-reported adverse effects of antiepileptic drugs and their impact on the patient's outcome.

The aim of the investigation was to analyze the correlation between myocardial infarction and ischemic heart disease, on the one hand, and acute ischemic stroke (AIS), on the other hand. We studied 258 AIS patients (mean age 70.9±7.22 years, range 49-92 years) hospitalized in 2007-2013 in the First Clinic of Neurology, St. Marina University Hospital of Varna. The diagnosis of acute ischemic stroke was confirmed by Doppler sonography and computed tomography of the cerebral circulation. Data were statistically processed by variation and correlation analysis. Our results proved a relatively strong correlation between effort angina pectoris and ischemic heart disease (Pearson's coefficient: r=0.643) as well as a weak correlation between ischemic heart disease and myocardial infarction (Pearson's coefficient: r=0.243) among acute ischemic stroke patients. The well-known risk factors for these cardiovascular diseases such as obesity, tobacco smoking, low physical activity and alcohol abuse were common among the patients with acute ischemic stroke, too. In conclusion, both myocardial infarction and ischemic heart disease are strongly associated with the development of acute ischemic stroke. Such patients require strict and regular control by general practitioners. They should observe an appropriate diet and adhere to a healthy life-style.

The main objective of this analysis was to define the influence of multivessel disease involvement compared to single vessel disease on mortality rates in STEMI patients. The retrospective study included 549 patients, hospitalized with STEMI in St. Ekaterina University Hospital (age - 62.66±12.56; women - 31.3%) from 01.06.2008 to 30.06.2011. One-vessel disease was found in 232 patients (44%) as compared to two-vessel disease in 165 patients - 31% and multivessel disease in 130 patients - 25%. There was LM stenosis (>30) in 11 patients (2%); ostial lesion in 33 patients (6.3%); presence of Ca in 37 patients (7%). A stent was implanted in 484 patients (91.8%), and GP IIb/IIIa was used in 400 patients (75.9%). There was significant increase in mortality rates in patients with multivessel disease: 15.6% - 46 patients, compared to one-vessel disease - 6.5% (15 patients) (p<=0.01). Both early (30 days) and late mortality (one year) rates were higher in the multivessel group (6.8% vs. 2.6%, p<=0.05 and 10.2% vs. 3.9% (p<=0.0510), respectively. Multivessel disease is associated with higher mortality rates in STEMI patients, which may further alter clinical course and decision making.

The enzymatic method for the determination of serum creatinine is accepted as one of the most accurate methods in a clinical laboratory. This method was used on a biochemistry auto analyzer (Cobas Integra 400) to determine serum creatinine at the laboratory of University Hospital – Pleven. The characteristics and reliability of this enzymatic method for creatinine were compared with the Jaffe kinetic method. Effects of some interfering substances like bilirubin and glucose on the Jaffe kinetic method and the enzymatic method were compared. Glucose and bilirubin inhibit the reaction between creatinine and alkaline picrate. Glucose slowly reduces picric acid to picrate, while the bilirubin present in a sample is oxidized to biliverdin under alkaline conditions. This leads to a decrease in absorbance at 520 nm. We measured creatinine in serum samples with the enzymatic method and the Jaffe kinetic method in samples divided into four groups: group I –samples without bilirubin and glucose ; group II –samples with high level of glucose; group III - samples with high level of bilirubin, group IV – all samples. For Group I, the correlation coefficient obtained by comparing the enzymatic creatinine method and Jaffe's kinetic method was R = 0.983. There was a very good agreement between the two methods in terms of correlation coefficient even in the samples with high levels of glucose or bilirubin.

The aim of the study is to investigate the serum levels of adipokines-resistin and visfatin in patients with metabolic syndrome. A prospective study was performed, including 153 (103 female, 50 male) subjects with metabolic syndrome. Carbohydrate metabolism was estimated by oral glucose tolerance test with 75g of glucose. Of the subjects investigated, 40 were with normal glycaemic tolerance, 40 - with impaired fasting glycaemia, 28 - with impaired glucose tolerance and 45 - with newly diagnosed diabetes mellitus type 2. The results were compared to those in a control group of 20 subjects without findings indicating metabolic syndrome. The serum levels of resistin and visfatin were measured with an enzyme immunoassay method (ELISA, BioVendor Laboratory Medicine, Inc., Czech Republic). There were significant differences in body mass index, waist circumference, systolic blood pressure, plasma level of blood glucose and serum level of triglycerides between the examined subjects with metabolic syndrome, as compared with the control group. The amount of serum resistin in subjects with metabolic syndrome and newly diagnosed diabetes mellitus type 2 was significantly higher, as compared to the controls. Subjects with metabolic syndrome and pathological glucose tolerance-impaired fasting glycaemia, impaired glucose tolerance and newly diagnosed diabetes mellitus type 2 were found with a significantly higher serum level of visfatin, as compared to normal glucose tolerance and to the controls. Subjects with metabolic syndrome and pathological glucose tolerance-impaired fasting glucose, impaired glucose tolerance and newly diagnosed diabetes mellitus type 2 exhibited significantly changes in serum levels of adipokines-resistin and visfatin.

Cardiovascular diseases (CVD) of atherosclerotic origin and accompanying complications are a major cause of mortality in the world and Ukraine, in particular. Endothelial dysfunction is the key cause of atherosclerosis and atherothrombosis. One of the causes of endothelial dysfunction is hyperhomocysteinemia that may occur on the background of MTHFR (methylenetetrahydrofolate reductase) mutation.

Thus, the goal of the study was to investigate the interrelation between homocysteine (Hc) level and MTHFR polymorphism in patients with acute coronary syndrome (ACS).

161 patients with ischemic heart disease and ACS have been examined. The control group comprised 87 healthy individuals. Homocysteine level was the highest in the patients having ACS with ST-segment elevation and complicated course, and was 1.8 times higher than Hc level in the control group. The patients with the most severe ACS course comprised 27 % of homozygotes for the major allele C and 41 % of homozygotes for the minor allele T. Comparing the distribution of MTHFR gene C677T polymorphism in patients with ACS that were stratified by plasma Hc level, we observed a statistically significant association, P < 0.030 by chi-square test. We confirmed that these patients had a high T/T genotype frequency of MTHFR C677T polymorphism. The obtained data proved the association of T/T genotype of MTHFR C677T polymorphism with increased Hc level as well as ACS severity.

Selection of an appropriate surgical method for hysterectomy in an individual patient is currently an issue that remains open and debatable. This study aimed to analyze perioperative outcomes in gynecologic patients who underwent laparoscopic hysterectomy at a single institution during a 6-year period and to compare the data for simple hysterectomy patients treated with different surgical approaches. The study included a retrospective analysis of demographics, pre- and post-operative characteristics of 1,023 patients, operated on using four types of simple hysterectomy approaches: 635 laparoscopic hysterectomies (62.1%), 289 total abdominal hysterectomies (28.3%), 45 total vaginal hysterectomies (4.4%) and 54 robotic-assisted hysterectomies (5.3%). For the laparoscopic hysterectomy group, the mean operative time was shorter as compared to the abdominal and vaginal hysterectomy groups (p<0.05), as well as a significantly shorter hospital length-of-stay when compared to the abdominal, robotic or vaginal hysterectomy groups (p<0.05). Regression analysis revealed significant linear correlation between operative time and body-mass index of laparoscopic hysterectomy patients (R² =0.008; p=0.026). Complications emergence and hemotransfusion often prolonged the mean operative time significantly by 17.8 min (p=0.002) and 15.5 min, respectively (p<0.001). The rate of major complications was significantly higher in the laparoscopic vs. abdominal groups (p<0.05). Clinical outcomes in patients operated on with laparoscopic hysterectomy were better than in those operated with total abdominal and vaginal hysterectomy in terms of operative time and hospital length-of-stay. Prospective randomized multi-center studies would be desirable to further define the place of the modern minimally invasive hysterectomy approaches.

Biliopancreatic derivation with duodenal switch (BPDDS) as an operative technique in the management of morbid obesity was created as an alternative to BPD (Scopinaro's operation), because of BPD-DS's fewer malabsorption side effects, better restrictive effect to the stomach remnant, fewer peptic ulcers and dumping syndromes, as well as lower morbidity and mortality rate. Between January 2003 and June 2012 in the University Hospital Center of Albacete, 141 patients with morbid obesity underwent BPD-DS. The patients were divided in groups according to four criteria: length of the common channel, age, gender and initial Body Mass Index. On the 6^th postoperative year in our study the percent of excessive body weight loss was 67.6% and the percentage of excessive BMI loss was 73%. According to the evaluation announced by Hess D.S. & Hess D.W, our results could be assessed as successful after 6 months, good on the first year, excellent on the second, and good from 3^rd to 9^th postoperative years. Our results confirm the hypothesis that the biliopancreatic derivation with duodenal switch is a bariatric intervention, which leads to a significant weight loss, well preserved in time.

It is known that increased morbidity with temporary incapacity for work (MTIW) is related to stress level and psychosocial factors at work. Practices for stress management, conflict avoidance and optimization of working conditions are known to reduce MTIW level. The aim of the present study was to analyze MTIW and propose measures to optimize and reduce strain at work. The study covered MTIW in labour inspectors, a total of 334 people, men and women aged from 24 to 69. The evaluation was based on 11 of the generally accepted indices. MTIW structure was analyzed. MTIW was rated as high according to case frequency and as very high according to day frequency. The average duration of a TI case was 12.63, and the relative share of people who were frequently taken ill for a long period was 12.81. In the ITI structure, diseases of the respiratory system (42.0%) ranked first, followed by diseases of the nervous system (18.8%), the digestive system (9.9%), CVS (8.3%) and MSS (7.2%). These 5 groups of diseases covered 86.2% of all diagnoses. The remaining 7 groups of diseases covered less than 14% of the diagnoses. The group of people most frequently taken ill for long periods included 28 inspectors who had used 42.5% of the total number of days. Two inspectors with 140 days of absence from work were cases of TI resulting from severe stress and adaptation disorder. Measures were proposed regarding the reduction of strain at work and the risk of stress.

Psychosocial factors (PSF) are leading among the new risks and modern challenges in providing safe and healthy conditions at work. Due to the high mental strain, inspectors are at highest risk for stress at work. The aim of the present study was to make a comparative analysis of PSFs in control activities, rate them and investigate subjective perception of stress at work. Two exhaustive cross-sectional studies were conducted consecutively, involving 338 and 355 inspectors, respectively, working at two organizations with control activities. The inspectors were men and women aged from 24 to 70. The statistical processing of data utilized the SPSS software version 17, at a significance level of p<0.05. A number of common characteristics were found in the activities, the composition and structure of different groups of government staff: the number of women was greater (58% и 62.6%), with people over 40 years of age prevailing (67.3% и 70.9%), and the group with specialized work experience of 6 to 10 years comprised the greatest number of people. We found reliable differences in the answers concerning task requirements and activity organization. Rating PSF, one of the groups of inspectors placed “insufficient time to perform the check-up” in the first place, whereas the other one reported “conflicts while performing the check-up”. PSFs exert an influence on the cognitive functions of inspectors, change their behaviour and emotional reactions and result in more frequent complaints of health deterioration. We found difference in the subjective stress perception depending on gender, age and duration of work experience as an inspector.

Parental alcohol drinking is associated with an increased risk of alcohol consumption in adolescents and social drinking is often the first step to regular alcohol consumption. The purpose of the study was to investigate the association between social drinking in adolescence and parental alcohol consumption. We conducted a survey, using a self-completed questionnaire about alcohol drinking habits. Of 903 students (aged 15-19), 279 (30.9%) were found to be abstainers (NDA) and 455 (50.39%) were social drinkers (SDA). These two groups were statistically compared for drinking patterns of their parents. It was found that SDA are fourfold less likely than NDA to have two alcohol abstaining parents (OR=0.26, 95%CI =0.19-0.37) and fourfold more likely to have two alcohol drinking parents (OR=3.89, 95%CI =2.77-5.45). There were no significant differences between SDA and NDA regarding probability to have one abstaining and one socially drinking parent, and SDA were less likely to have one abstaining and one regularly drinking parent (OR=0.54, 0.37-0.8). The social learning theory explains well adolescent drinking patterns when there is no contradiction in parental modeling. It seems, however, that the presence of contradicting patterns of parental alcohol drinking needs another explanation. Since contradicting parental modeling prevents adolescents from social drinking, it could be considered in health prevention intervention.

Colon cancer is one of the most common malignant diseases with high grade of malignancy and mortality at high rate. Approximately one million people are diagnosed with colorectal cancer each year. Metastases affect mostly the liver, followed by the lungs. Here is a rare case of a patient with rectal cancer without disease progression or recurrence who underwent surgery due to a trans-stomal hernia, combined with high transstomal fistula of the ileum. Acute respiratory failure developed in the postoperative period and led to fatal deterioration as a result of enlarged metastatic mediastinal lymph nodes, which was very difficult to diagnose.