rss_2.0Acta Medica Bulgarica FeedSciendo RSS Feed for Acta Medica Bulgarica Medica Bulgarica Feed Infection in Children and Young People in Bulgaria – A Prospective, Single-Center, Cohort Study<abstract> <title style='display:none'>Abstract</title> <p>Compared to other respiratory viruses, the proportion of hospitalizations due to SARS-CoV-2 among children is relatively low. While severe illness is not common among children and young individuals, a particular type of severe condition called multisystem inflammatory syndrome in children (MIS-C) has been reported. The aim of this prospective cohort study, which followed a group of individuals under the age of 19, was to examine the characteristics of patients who had contracted SARS-CoV-2, including their coexisting medical conditions, clinical symptoms, laboratory findings, and outcomes. The study also aimed to investigate the features of children who met the WHO case definition of MIS-C, as well as those who required intensive care. A total of 270 patients were included between March 2020 and December 2021. The eligible criteria were individuals between 0-18 with a confirmed SARS-CoV-2 infection at the Infectious Disease Hospital “Prof. Ivan Kirov” in Sofia, Bulgaria. Nearly 76% of the patients were ≤ 12 years old. In our study, at least one comorbidity was reported in 28.1% of the cases, with obesity being the most common one (8.9%). Less than 5% of children were transferred to an intensive care unit. We observed a statistically significant difference in the age groups, with children between 5 and 12 years old having a higher likelihood of requiring intensive care compared to other age groups. The median values of PaO<sub>2</sub> and SatO<sub>2</sub> were higher among patients admitted to the standard ward, while the values of granulocytes and C-reactive protein were higher among those transferred to the intensive care unit. Additionally, we identified 26 children who met the WHO case definition for MIS-C. Our study data supports the evidence of milder COVID-19 in children and young individuals as compared to adults. Older age groups were associated with higher incidence of both MIS-C and ICU admissions.</p> </abstract>ARTICLEtrue Hamartomas: Report of Two Rare Primary Cardiac Tumors (Rhabdomyoma and Hamartoma of Mature Cardiomyocytes) with Review of the Literature<abstract> <title style='display:none'>Abstract</title> <p>The most common primary cardiac tumors are myxomas, while cardiac hamartomas are rare. Cardiac hamartomas may constitute manifestation of a genetic disorder such as tuberous sclerosis, or could be diagnosed independently as a solitary lesion. We present two rare cases of primary cardiac tumors detected via diagnostic imaging and subsequent histopathology examination. The first described case is that of a male preterm foetus with multiple rhabdomyomas in the heart, discovered during foetal echocardiography. The finding was later confirmed by autopsy, which also revealed presence of cortical tubers with typical balloon cells constituting well known epileptogenic lesions in the foetal brain. The second case describes an even rarer benign cardiac lesion – a hamartoma of mature cardiomyocytes – which was discovered by chance in a 49-year old female patient during echocardiography. The performed CT scan revealed a 37 x 16 x 12 mm tumor in the right atrium obstructing the superior vena cava inlet. The malformation was surgically removed and examined histologically revealing disorganized hypertrophic mature cardiomyocytes, partly separated by fibrous strands and admixed with mature adipocytes. Differential diagnosis was performed to rule out other benign tumors with myocyte differentiation – cardiac rhabdomyoma, histiocytoid cardiomyopathy and adult cellular rhabdomyoma.</p> <sec><title style='display:none'>Conclusion</title> <p>The diagnosis of cardiac hamartomas was possible only after pathomorphological examination of material from the tumors. Reporting of rare neoplasms is crucial in order to determine their prevalence and to inform clinical practice.</p> </sec> </abstract>ARTICLEtrue of Insulin Resistance with Bone Mineral Density and Fracture Risk in Non-Diabetic Postmenopausal Women<abstract> <title style='display:none'>Abstract</title> <p>There is conflicting literature evidence regarding the independent effects of insulin resistance and concomitant hyperinsulinemia on bone mineral density. In addition, it is still under debate whether the net effect is favorable or unfavorable for the fracture risk. Therefore, we conducted a cross-sectional study.</p> <sec><title style='display:none'>Aim</title> <p>To assess the correlation between bone mineral density and fracture risk with insulin resistance and circulating insulin levels in non-diabetic postmenopausal women.</p> </sec> <sec><title style='display:none'>Materials and methods</title> <p>The study analyzed 84 women. The mean age of the participants was 60.54 ± 7.07 years, and the mean postmenopausal period was 11.45 ± 6.62 years. A standard oral glucose tolerance test was performed with measurement of blood glucose and insulin levels at 0 and 120 min. Dual-energy X-ray absorptiometry was used to determine bone mineral density at lumbar spine and proximal femur. Fracture risk was calculated using the Fracture Risk Assessment Tool.</p> </sec> <sec><title style='display:none'>Results</title> <p>We found that in non-diabetic postmenopausal women lower basal insulin levels (fasting insulin) were associated with a higher 10-year risk of major osteoporotic fracture when insulin sensitivity was preserved (HOMA-IR index &lt; 2). Fasting insulin levels under 6.15 μIU/ml were considered high-risk regarding the fracture risk. On the other hand, higher stimulated insulin levels at 120 min (post-load insulin) were associated with a higher 10-year risk of major osteoporotic fracture at HOMA-IR index greater than 2. Stimulated insulin levels above 39.7 μIU/ml were considered high-risk regarding the fracture risk.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Our results revealed a negative relationship between stimulated insulin levels at HOMA-IR index above 2 and bone integrity in postmenopausal age. On the other hand, higher basal insulin levels at HOMA-IR index lower than 2 were associated with better parameters of postmenopausal bone health.</p> </sec> </abstract>ARTICLEtrue Better Approach of Assessing Lalerality by Using Combined Foot and Eye Dominance Scale in Mentally Healthy Subjects<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Objective</title> <p>To investigate the reliability (internal consistency) of a Combined Foot and Eye Dominance Scale in healthy subjects.</p> </sec> <sec><title style='display:none'>Materials and methods</title> <p>A total of 82 mentally healthy subjects were assessed with a Combined Foot and Eye Dominance Scale. The Foot Dominance Subscale included a modified Chapman &amp; Chapman Foot Dominance scale and a new Complex Tasks scale with four foot tests reflecting more complex tasks. The Eye Dominance Subscale included three eye tests. Scale reliability statistics (item-scale statistics, summary statistics for the items, Cronbach’s alpha), nonparametric Mann-Whitney test and Spearman’s rank correlation coefficient were used.</p> </sec> <sec><title style='display:none'>Results</title> <p>Considerable differences were found in the contribution of the single items to the Combined Scale. The means of some items were 37.83 times greater than those of other items (from 0.15 to 5.61), which suggested greater phenogenetic component and consequently greater contribution of these items to the total scale mean. The mean correlation between the items of the Combined Foot and Eye Dominance Scale was strongly positive (0.39), indicating good internal consistency of the scale.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Eye and foot dominance appear to be a much subtler indicator of altered hemispheric lateralization than hand dominance. The Combined Dominance Scale provides a more adequate tool for objective measuring of leftedness, as a way to assess laterality, since this scale is to a great degree unaffected by socio-cultural impact. The scale would provide comparability of leftedness as an indirect clue of abnormal lateralization in studies of mentally healthy subjects and subjects with neurodevelopmental disorders with presumed abnormal cerebral asymmetry across cultures.</p> </sec> </abstract>ARTICLEtrue Factors and Comorbidity in Patients with Bacterial Meningitis<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Bacterial meningitis is a severe disease with high mortality and frequent residual neurological sequelae. It is associated with multiple risk factors. The aim of the study was to establish the main risk factors associated with bacterial meningitis and to outline the incidence of chronic diseases in patients with bacterial meningitis and their relationship to the patients’ age and etiology of meningitis, if any.</p> <p><bold>Materials and methods.</bold> The study included 90 patients with bacterial meningitis admitted to the Clinic of Infectious Diseases, University Hospital “Sv. Georgi” – Plovdiv during the period January 1, 2016 – September 30, 2019. Epidemiological analyses, clinical examinations, laboratory and microbiological tests, and statistical methods were used.</p> <p><bold>Results.</bold> A total of 76.8% of patients had concomitant conditions: cardiovascular diseases (38.9%), diabetes mellitus (16.7%), immunosuppression (16.7%), liver diseases (11.1%), pulmonary diseases (10%), neoplasms (7.8%), chronic kidney diseases (7.8%). The incidence of immunosuppression (p = 0.009), cardiovascular disease (p = 0.0001), and diabetes (p = 0.009) were significantly higher in adults compared to children. Risk factors were present in 37.8% of patients (44% in children and 35.4% in adults, p &gt; 0.05), especially in patients with pneumococcal meningitis (47.1%). The main risk factor was otitis or sinusitis in the last 3 months before meningitis (17.8%), followed by head trauma (6.7%), alcoholism (6.2%), recurrent episode of meningitis (4.4%), nasal leakage of cerebrospinal fluid (3.3%), general surgery (3.3%), and splenectomy (2.2%).</p> <p><bold>Conclusion.</bold> Elderly patients with meningitis had more frequent comorbidities than children, mostly cardiovascular diseases, diabetes, and immunosuppression. The highest incidence of chronic diseases was found in patients with listerial meningitis. Risk factors were found in both age groups.</p> </abstract>ARTICLEtrue Attitudes, Awareness and Fears Related to the Spread of COVID-19 in Bulgaria<abstract> <title style='display:none'>Abstract</title> <p>The pandemic caused by COVID-19 has led to radical lifestyle changes worldwide, particularly in the Republic of Bulgaria, and was a factor for global changes in economics, politics, healthcare and daily life.</p> <sec><title style='display:none'>Aim</title> <p>The aim of the study was to analyze the public attitudes, awareness and fears related to the COVID-19 disease in the Republic of Bulgaria.</p> </sec> <sec><title style='display:none'>Materials and Methods</title> <p>The survey was conducted between August 1st, 2022 and September 1st, 2022 via an anonymous questionnaire consisting of 24 closed questions. A total of 1861 people, aged 18-69 years and older, took part in the survey after being selected randomly. The data were statistically processed via MS Excel.</p> </sec> <sec><title style='display:none'>Results</title> <p>The main source of information to the respondents on issues related to COVID-19 was the Internet (29,8%), followed by TV (26%) and the specialized website (Single information portal) – 15,9%. More than one-third (35,1%) of the respondents was afraid of getting infected and an equal share of participants reported that they have been infected with COVID-19. More than half of the respondents (52,5%) adhered to all the provisions of the governmental bodies related to limiting the COVID-19 pandemic. The most frequent symptom of post- COVID-19 syndrome was being easily fatigued (26,7%), followed by shortness of breath (13,4%) and persistent cough (11,6%).</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>The survey could be useful in understanding what were the public attitudes, awareness and fears related to the COVID-19 disease in the Republic of Bulgaria during the pandemic.</p> </sec> </abstract>ARTICLEtrue Into Atopic Dermatitis – From Pathogenesis to Therapy<abstract> <title style='display:none'>Abstract</title> <p>Atopic dermatitis (AD), or eczema, is a common skin disease that is often associated with other atopic disorders, such as allergic rhinitis and asthma. The disease can develop both in infancy and adulthood, and characterizes with recurrent episodes impairing the quality of life. The review аnalyzes the genetical, immunological, and environmental factors in the pathogenesis of AD. The role of the skin barrier function is also considered in regard of the main hypotheses for AD development. Further elucidation of the mechanisms involved in the pathogenesis of AD could give interesting and useful clues for therapeutic protocols and prophylactic approaches.</p> </abstract>ARTICLEtrue of Hepatitis B in Random Bulgarian Blood Samples – A Single-Site Experience<abstract> <title style='display:none'>Abstract</title> <p>The worldwide distribution of the HBV infection has usually been estimated by the prevalence of hepatitis B surface antigen (HBsAg) among the general population. Total antibodies for hepatitis B core antigen (anti-HBc) are the most important diagnostic marker for proving prior exposure to HBV.</p> <sec><title style='display:none'>Aim</title> <p>The aim of this study was to determine the prevalence of Hepatitis B virus (HBV) infection among Bulgarian population. Reliable epidemiologic data is needed to estimate the prevalence of Hepatitis B in order to determine the actual burden of the infection and to plan prevention and control measures.</p> </sec> <sec><title style='display:none'>Materials and methods</title> <p>A total of 2140 serum samples were tested for major serological markers of HBV (HBsAg and anti-HBc) for a period of two years (2018-2019).</p> </sec> <sec><title style='display:none'>Results</title> <p>We established an intermediate prevalence of HBsAg (5.1%) and high prevalence of anti-HBc (27%) among HBsAg negative individuals.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>In conclusion, the prevalence of Hepatitis B is much higher among those born before the introduction of universal hepatitis B vaccination in Bulgaria (1992).</p> </sec> </abstract>ARTICLEtrue Control in Primary Outpatient Care – Opportunities and Realities in Bulgaria<abstract> <title style='display:none'>Abstract</title> <p>The significance of control increases with the push towards improving the overall effectiveness of the health insurance system. In order for public resources to be spent lawfully and effectively, there needs to be increased control not only from the National Health Insurance Fund (NHIF), but citizen control also needs to be incorporated in the process.</p> <sec><title style='display:none'>Materials and Methods</title> <p>The goal of this survey is to analyze the opportunities for implementing citizen control over the spending of public health funds and compare them to the real conditions as far as the outpatient medical care level. Legislation and news from NHIF’s webpage related to citizen control opportunities were studied. A direct, anonymous survey was carried out on the Google forms platform amongst Bulgarian citizens past the age of majority.</p> </sec> <sec><title style='display:none'>Results</title> <p>The results of the questionnaire survey carried out between 24.06.2022 and 16.10.2022 among 1045 adults with compulsory health insurance from all over the country, showed that they were poorly informed on the opportunities for citizen control which have been regulated and created in practice and don’t take advantage of them. Only 45,6% of the participants were aware of the digital services “Record review for health-insured persons”, which is found on NHIF’s webpage, and less than half of them (42,8%) used this service. The NHIF’s mobile application for feedback was used by as little as 11,8% of the respondents, and only seven patients have used it to share an opinion, while nine have used it to get notifications for data changes in their patient record. The portion of participants who have taken part in NHIF inquiries was also very small – 2,5%. Merely 2,8% have posted a complaint to the NHIF after being denied medical services.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>All of this makes it evident that a change is necessary in order for citizen control to be strengthened as a mechanism. This will lead to the correction of proven deviations in reported medical activities and will make it easier to get the patients’ opinions on the medical care they have been provided with.</p> </sec> </abstract>ARTICLEtrue of Depression Among Employees in the Public Administration, Private and Industrial Sectors<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Symptoms of depressive disorder have been found to be particularly common among employees in the private administration, public, and industrial sectors.</p> </sec> <sec><title style='display:none'>Aims</title> <p>This study aimed to assess the prevalence of depression among the specified groups of workers and to identify the main stressors that lead to symptoms of this condition.</p> </sec> <sec><title style='display:none'>Materials and methods</title> <p>A self-administrated questionnaire was completed by respondents comprised of three groups of workers in the Republic of North Macedonia – Skopje. The survey assessed the sociodemographic characteristics and mental health (Patient Health Questonnaire-9). Logistic regression models were used to estimate associations between depressive symptoms and demographics, working environment and lifestyle parameters.</p> </sec> <sec><title style='display:none'>Results</title> <p>The analysis of the total PHQ-9 score divided into two groups (≤ 10 and ≥ 10) indicated that 89% of the respondents had minimal/mild depression and 11% had moderate/severe depression. We have found a significant association between the group to which the respondent belongs and the degree of depression. Severe depression was significantly associated with work in public institutions.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Screening for depression among workers is necessary because of its high prevalence and high rates of underdiagnosis in the workplace. Early diagnosis and appropriate interventions are recommended, including actions focused on the risk factors for depression at the workplace.</p> </sec> </abstract>ARTICLEtrue Activity of Natural Flavonoid Fustin Isolated from the Heartwood of Scop. Against Breast and Colon Cancer Cell Lines<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Background and objective</title> <p>Cotinus coggygria Scop. is a valuable medicinal plant species with pronounced pharmacological potential due to its numerous biological activities. The herb is characterized by a high content of polyphenols among which is fustin. The anticancer activities of fustin, however, are extremely weakly studied. The aim of the present study was to investigate the in vitro antiproliferative potential of fustin isolated from the heartwood of C. coggygria against cell lines originating from two of the most common cancer types – breast (MDA-MB-231 and MCF7), and colon cancer (Colon 26).</p> </sec> <sec> <title style='display:none'>Materials and methods</title> <p>Cell growth inhibitory properties of fustin were examined by MTT assay. Subsequently, phase-contrast and fluorescence microscopy analysis as well as colonyforming assay were carried out on the most sensitive to the cytostatic action of the fustin cell line.</p> </sec> <sec> <title style='display:none'>Results</title> <p>The obtained results showed that fustin reduced the proliferation of all studied cell lines. The highest cytostatic effect was registered towards breast cancer MDA-MB-231 cells with a half maximal inhibitory concentration (IC<sub>50</sub>) value of 56.02 μg/ml followed by colon cancer cells with an IC<sub>50</sub> of 78.07 μg/ml. MCF7 cell proliferation was least affected with a calculated IC<sub>50</sub> of 187.8 μg/ml. Further investigations on breast cancer MDA-MB-231 cells indicated decreased density of cell monolayer and some morphological alterations, significant attenuation in the number of viable cells, and diminished clonogenic ability of cells after fustin exposure.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>It could be concluded that fustin isolated from the heartwood of medicinal plant C. coggygria possesses marked antiproliferative properties against breast cancer cell line MDA-MB-231 which will be a subject of our more detailed future investigations.</p> </sec> </abstract>ARTICLEtrue Clinical Case of Tonsillar Lymphangiomatous Polyp<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Introduction</title> <p>Tonsil lymphangiomas are extremely rare benign tonsil tumors. They could be asymptomatic, especially when they are small, and in these cases, they are most often found by chance on physical examination.</p> </sec> <sec> <title style='display:none'>Clinical case</title> <p>The authors present a 67-year-old man with complaints of discomfort, a sore throat, and an unspecific formation on his right tonsil. Upon microscopic examination, we found a polypoid mass covered by squamous epithelium with a stroma composed of lymphoid tissue.</p> </sec> <sec> <title style='display:none'>Discussion</title> <p>Benign tonsillar tumors are significantly more common than malignant ones. Lymphangiomatous polyps located in the tonsillar region, on the other hand, have been described as very rare, and their etiology and pathogenesis remain unclear. They tend to occur in areas where lymph vessels are abundant, with more than 90% of all lymphangiomas occurring in the head and neck region.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Lymphangiomatous polyps should be considered in the differential diagnosis of all benign tumors, and it is extremely important to differentiate them from malignant tonsil lesions.</p> </sec> </abstract>ARTICLEtrue Variant rs11206510 in PCSK9 and Risk of Coronary Artery Disease in Bulgarians<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Objective</title> <p>The aim of this study was to investigate the potential association of rs11206510 in PCSK9 gene with coronary artery disease (CAD) and myocardial infarction (MI) in Bulgarians.</p> </sec> <sec> <title style='display:none'>Materials and Methods</title> <p>The current analysis included 261 patients with angiographically documented CAD (153 with MI and 108 without MI) and 496 population – based controls. Genomic DNA was extracted from venous blood samples. The selected polymorphism was genotyped by TaqMan SNP Genotyping Assay. The genotype and allele frequencies were compared between cases and controls using χ<sup>2</sup> test.</p> </sec> <sec> <title style='display:none'>Results</title> <p>In this study, the presence of the T allele of rs11206510 in the PCSK9 gene was found to be associated with elevated risk for MI in patients with already existing myocardial ischemia (allele T, OR1.78,CI95:1.16-2.73, p = 0.007). The result was enhanced in the male subgroup (allele T, OR1.74, CI95:1.02-2.96, p = 0.038). Also, we found reduced risk of CAD (without MI) for T allele (OR0.70, CI95:0.49-0.99, p = 0.04). This trend was stronger in the male subgroup (OR0.56, CI95:0.35-0.90, p = 0.02). There was not any relationship of the studied genetic variant with the levels of total cholesterol, triglycerides, low density lipoproteins and high-density lipoproteins, or with systolic and diastolic blood pressure values.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Our study found a difference in the frequencies of rs11206510 genotypes and alleles in the PCSK9 gene between cases and controls, and the relationship of the investigated polymorphism to the risk of cardiac injury in the Bulgarian population was demonstrated. Further investigations with a larger number of cases and controls will be needed in order to evaluate a possible association between this variant and CAD/MI in Bulgarians.</p> </sec> </abstract>ARTICLEtrue Incision: An Alternative Technique for the Management of Inguinoscrotal Pathologies, Experience from 76 Cases<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Introduction</title> <p>The aim of this clinical study was to present our experience gained by using the intrascrotal incision through the mid raphe for the management of a variety of inguinoscrotal pathologies.</p> </sec> <sec> <title style='display:none'>Materials and Methods</title> <p>A total of 76 male patients, between 2 and 16 years, underwent surgical treatment through a mid raphe intrascrotal incision, for a wide range of inguinoscrotal diseases, including torsion of the spermatic cord, torsion of the testicular appendages, non-communicating hydrocele, communicating hydrocele, ectopic testis, retractile testicles, palpable undescended testis, testicular trauma and testicular prosthesis placement.</p> </sec> <sec> <title style='display:none'>Results</title> <p>All the patients had an uneventful postoperative recovery, with none mentioned complication, and none of them required convention to the traditional inguinal method. The follow-up examination ranged from 6 months to 3 years, with no surgical complication highlighted.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>We recommend that the intrascrotal incision through the mid raphe may be considered as an alternative technique to inguinoscrotal pathologies, instead of other approaches. The ability to treat a variety of pathologies regarding both two hemi-scrotums and the inguinal region at the same time, the provision of adequate surgical site, while succeeding much less dissection and disruption of tissue, the excellent cosmetic result, the greater comfort for the ‘day-case’ child, the ability to use the scrotal septum in order to fix the testis in the scrotum and the avoidance of an extra incision are the main advantages of the intrascrotal incision.</p> </sec> </abstract>ARTICLEtrue in Ophthalmology: Lessons from the COVID-19 Era and Beyond<abstract> <title style='display:none'>Abstract</title> <p>The progress of information and communication technologies in the era of COVID-19 created an unprecedented opportunity for medicine to adapt to new models of care. Telemedicine and telehealth have enabled medical care at a distance in various fields, including ophthalmology. <bold>The aim</bold> of this article is to review the current state and the opportunities for telemedicine in ophthalmology.</p> <sec> <title style='display:none'>Materials and methods</title> <p>PubMed, ScienceDirect Database, Google Scholar databases, as well as official sites of various governmental and non-governmental institutions were explored. The search was conducted between May 1, 2022 and July 31, 2022 using as key words “teleophthalmology”; “telemedicine/telehealth and ophthalmology”; “ophthalmology and COVID-19”.</p> </sec> <sec> <title style='display:none'>Results</title> <p>87 primary sources were reviewed. An exploratory analysis of the current state and application of telemedicine in ophthalmology was made.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>A great number of innovations have created an environment allowing for teleophthalmology to flourish, whereas the COVID-19 epidemic has accelerated the development and adoption of these digital technologies. Telemedicine has become an extremely valuable tool during a pandemic, and even if it would never fully replace in the person-to-person patient visits, it certainly has an important role in our dynamic and high-tech world.</p> </sec> </abstract>ARTICLEtrue Intake of Vitamin D and Dental Caries Incidence in People with Overweight and Obesity<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Aims</title> <p>The aims of the present study are to investigate the relationship between the anthropometric indicators and peculiarities of the nutritional intake in people with overweight and obesity and the risk factors for the development of dental caries in adults.</p> </sec> <sec> <title style='display:none'>Materials and Methods</title> <p>The study involved 264 individuals aged between 18 and 60 years. The following risk factors for the development of dental caries were traced: diet (carbohydrate intake), oral hygiene habits and social status in overweight and obese people. The dental caries incidence was determined through the DMFT index, by assessing the total number of teeth which are decayed (D), missing (M) due to caries, or filled (treated, F).</p> </sec> <sec> <title style='display:none'>Results</title> <p>The age-related distribution was as follows: from 18 to 25 years – 14.4%; from 25 to 35 years – 16.7%; from 35 to 50 years – 42.4%; and over 50 years – 26.5%. The established average BMI was 25.60 ± 4.359, with the lowest and highest measured values – 18.5 and 37.55, respectively. The value of DMFT was 12.55 ± 5.545. A direct correlation between the elevated incidence of dental caries in patients with overweight and obesity was revealed. No significant relationship was found between the decreased nutritional intake of vitamin D and the incidence of dental caries in individuals with Class I and Class II obesity.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Dental caries and obesity have a similar etiology – improper dietary habits, excessive consumption of foods containing low molecular weight carbohydrates and carbonated beverages. The reported higher levels of dental caries in these groups could be explained by an improper diet and more frequent snacking.</p> </sec> </abstract>ARTICLEtrue New Case of Childhood Acute Lymphoblastic B-Cell Leukemia from Pristina<abstract> <title style='display:none'>Abstract</title> <p>Acute lymphoblastic leukemia (ALL) is a malignant disease caused by mutations in B- or T-cell precursors of bone marrow cells. Childhood acute lymphoblastic leukemia (ALL) is a subtype of pediatric cancer with a 1 in 2000 incidence. Here we present a new childhood ALL in a 3-year-old girl. As CD45/19, CD10/19, CD3, CD8, CD10, and CD19 were positive in immunohistochemically analyses of blast cells, a B-ALL was diagnosed with a causative ETV6-RUNX1 gene fusion. The patient was treated based on standard protocols BMF-ALL 2009. Interestingly, an aunt and a grandfather of the patient had experienced malignancies as well, which may be carefully interpreted as a hint on a familial cancer syndrome.</p> </abstract>ARTICLEtrue Importance of Manual Detorsion in Intravaginal Testicular Torsion<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Objective</title> <p>The aim of the present prospective clinical study was to highlight the importance of the proper application of the manual detorsion (MD) in cases of intravaginal testicular torsion. Major complications such as ischemia, reperfusion injury and testicular compartment syndrome could be avoided.</p> </sec> <sec> <title style='display:none'>Materials and Methods</title> <p>From January 2017 to February 2018, 26 boys aged between 8 and 16 years underwent surgical treatment for intravaginal testicular torsion (ITT) (14 left- and 12 right-sided). Diagnosis was made upon clinical criteria (both symptoms and signs); sudden onset of scrotal pain (n = 26, 100%), nausea and vomiting (n = 25, 96,15%), abdominal pain (n = 3, 11,53%), high testicular position (n = 21, 80,77%), absence of the cremasteric reflex (n = 26, 100%), harshness of the twisted testicle (TT) (n = 24, 87.5%), alteration on axis or orientation of the TT (n = 24, 94,31%), and pain during palpation (n = 26, 100%). Two cases presented with neglected scrotum leading to inability to evaluate the intrascrotal structures. Major ultrasonographic findings were the following: absence of perfusion, heterogeneity of the parenchyma and identification of the Whirlpool sign. Therefore, our study group consisted of 15 out of the 26 cases, in which the initial assessment at the Emergency Department occurred within the first 3-7 hours after the onset of ITT.</p> </sec> <sec> <title style='display:none'>Results</title> <p>Based on high clinical suspicion and ultrasonographic documentation of the ITT, MD was performed in all those cases. Pain alleviation followed immediately, while significant improvement of the clinical picture of the suffering scrotum was also observed. Successful detorsion was documented via ultrasonography. After completion of the preoperative assessment, bilateral orchidopexy was performed. All patients had an uneventful postoperative course and were discharged home on the second postoperative day.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>In conclusion, we hereby document that MD is a safe, non-invasive method, easy to learn for every clinician. It can be applied immediately after the diagnosis of the ITT, converting a highly urgent surgery into an elective one. Of course, surgical exploration of intrascrotal structures constitutes a crucial final step.</p> </sec> </abstract>ARTICLEtrue Effect of Smoking and Opioid Consumption on the Severity of the Disease and Duration of Hospitalization in COVID-19 Patients<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Objective</title> <p>In the Coronavirus 2019 (COVID-19) global pandemic, various studies on the target communities of this virus were widely started and rapidly progressed. Smokers and opioid consumers are one of the virus targets since they have a vulnerable respiratory system. Due to the contradictory results in previous studies and the lack of similar investigations in this area, we aimed to perform this study to investigate the effect of smoking and opioid consumption on the consequences of the COVID-19 disease.</p> </sec> <sec> <title style='display:none'>Materials and Methods</title> <p>In this retrospective study, the required information was collected and analyzed from the archives of Razi Hospital, Rasht, Iran. Study variables included age, sex, the need for intubation, hospital length of stay, history of current smoking or opioid consumption, and intensive care unit (ICU) admission, ICU length of stay, admission oxygen saturation, disease severity, and the outcome of death or recovery. Data were collected and divided into the case (including current cigarette smokers, opioid consumers, and cigarette-opioid consumers) and control (non-smokers and non-opioid-consumers) groups. Out of 986 patients, 489 patients met the criteria for inclusion and subsequent analysis. The average age was 69.79 ± 16.06, and 294 (60.1%) patients were male. The median age of the case group (65.15 ± 42.41) was older than the control group (57.45 ± 15.71, P = 0.001). The case group consisted of more male patients than the control group (P = 0.001).</p> </sec> <sec> <title style='display:none'>Results</title> <p>The adjusted regression models demonstrated that current cigarette smoking, opioid, and cigarette-opioid consumption did not significantly predict hospital and ICU length of stay, ICU admission, disease severity, and mortality outcomes (P &gt; 0.05). Current cigarette smoking and opioid consumption could not be an independent predictor for the consequences of ICU admission, hospital and ICU length of stay, the need for intubation, disease severity, and mortality in COVID-19 patients.</p> </sec> </abstract>ARTICLEtrue Control of 78 Patients with Chronic Hypoparathyroidism Referred between 2006 and 2020 – Where do We Actually Stand?<abstract> <title style='display:none'>Abstract</title> <p>Hypoparathyroidism (hypoPT) is a relatively rare endocrine disease, mainly due to thyroid surgery. The classical supplementation with calcium and active vitamin D may represent a challenge to the clinician.</p> <sec> <title style='display:none'>Objective</title> <p>To describe the level of biochemical control in patients with chronic hypoPT and to look for differences between postsurgical and non-surgical cases referred between 2006 and 2020.</p> </sec> <sec> <title style='display:none'>Materials and Methods</title> <p>This was a retrospective cross-sectional study with data review from the database of a tertiary endocrine clinic from the last 15 years. Cases with hypocalcemia not related to PTH were excluded. The patients’ medical history was reviewed as well as concomitant diseases and medications. Serum calcium (total, albumin-corrected and ionized; sCa, corrCa, iCa<sup>+</sup>) and phosphates (P), magnesium, creatinine, alkaline phosphatase together with 24hr urinary calcium and phosphate were measured. The intact parathyroid hormone (iPTH) was determined by electro-hemi-luminescence (Elecsys, Roche Diagnostics). Thyroid and abdominal ultrasound (US) were both performed.</p> </sec> <sec> <title style='display:none'>Results</title> <p>Seventy-eight patients met the study criteria – 69 were females. Most of them were between 30 and 60 years (mean age 50.6 ± 14.5 years). Albumin-corrected calcium was in target in 20.5% of the patients, ionized calcium – in 36.5%, serum phosphate – in 46.3%, serum magnesium – in 87.9%. When all four parameters were taken together, less than 20% were in target. Hypercalciuria was registered in 11.8%, while 57.1% of the patients had nephrolithiasis and 27.3% had CKD grade 3-4. Thus, a high proportion of patients with kidney involvement was identified. Calcium carbonate and calcitriol were the preferred replacement choices. Comparing patients with post-surgical and non-surgical hypoPT significant differences were found only for age, total serum calcium, serum magnesium and TSH.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Our study is the first of its kind in our country during the last two decades describing the contemporary clinical and biochemical picture of chronic hypoPT in patients referred for specialized care. Low supplementation doses leading to hypocalcemia and hyperphosphatemia were a common finding. Low patient’s adherence may be just one possible explanation. Non-surgical cases tend to have even lower calcium and magnesium levels. The patients, their families and treating physicians should be better informed about up-to-date management of chronic hypoPT and the possible impact of suboptimal treatment on morbidity and mortality of the affected subjects.</p> </sec> </abstract>ARTICLEtrue