rss_2.0Journal of Biomedical and Clinical Research FeedSciendo RSS Feed for Journal of Biomedical and Clinical Research of Biomedical and Clinical Research Feed After Laparoscopic Sleeve Gastrectomy in a Series of 186 Patients<abstract> <title style='display:none'>Summary</title> <p>A retrospective study analyzed the complications in 186 patients who underwent laparoscopic sleeve gastrectomy (LSG). One hundred eighty-four patients were operated on at the University Hospital Centre of Albacete between May 2006 and September 2022. Two patients with early postoperative complications received surgical treatment in other centers. The overall postoperative complication rate (including GERD) was 13.9%. Ten patients (5.38%) had complications in the early postoperative period. In 4 cases (2.15%), there was stapler-line leakage. Abdominal bleeding associated with hemoperitoneum occurred in four patients (2.15%) immediately after the surgery due to bleeding from the suture line. In the long-term follow-up, two patients (1.08%) had gastric tube strictures requiring endoscopic pneumatic balloon dilation (EPBD). Fourteen patients (7.53%) presented with de novo Gastroesophageal Reflux, of whom 7 (3.76%) required revision surgery to Laparoscopic Rouxen-Y Gastric Bypass (LRYGB). Laparoscopic sleeve gastrectomy, in our experience, is a secure bariatric procedure with a low rate of morbidity and mortality, both post-surgical and long-term.</p> </abstract>ARTICLEtrue Case of Hepatosplenic γ/δ T-Cell Lymphoma Debuting With Massive Hemoptysis<abstract> <title style='display:none'>Summary</title> <p>Hepatosplenic γ/δ T-cell lymphoma (HSTL) is a very rare, aggressive extranodal lymphoma affecting mainly young adults. Clinically, presents with a symptomatic hepatosplenomegaly and systemic symptoms but without lymphadenopathy. The diagnosis is confirmed after careful evaluation of bone marrow and liver biopsies or, in some cases, after diagnostic splenectomy. Overall, survival is short regardless of chemotherapy regimens applied, including autologous stem cell transplantation. We present a case of γ/δ HSTL with massive pulmonary hemoptysis requiring bronchial artery embolization.</p> </abstract>ARTICLEtrue Hernia Repair: Tapp Versus Tep. A Single Centre Experience<abstract> <title style='display:none'>Summary</title> <p>Surgery for inguinal hernia is currently the most common surgical procedure worldwide, and every year over 20 million patients undergo open or laparoscopic hernia repair. Two generally accepted endoscopic approaches are transabdominal preperitoneal procedure (TAPP) and total extraperitoneal procedure (TEP). For nine years (2010 – 2018), 48 patients with inguinal hernia had laparoscopic hernia repair (TAPP or TEP) at Villarobledo General Hospital. Forty-three patients (89.6%)) were male, and five (10.4%) were female. Of these, ten had right inguinal hernia (RIH), 18 - left inguinal hernia (LIH), 12 - bilateral inguinal hernia (BIH), 6 had recurrent unilateral inguinal hernia (RUIH), and 2 had recurrent bilateral inguinal hernia (RBIH). In 33 patients (68.7%), transabdominal preperitoneal laparoscopic hernia repair (TAPP) was performed. Total extraperitoneal laparoscopic hernia repair (TEP) was performed on 15 patients (12%). In 8 patients (16.6%), simultaneous surgical procedures were performed: umbilical hernioplasty in 4 (8.3%) patients and laparoscopic cholecystectomy in 4 (8.3%) patients. There were no conversions in any of the surgical procedures. The average operative time was 77 minutes. Twenty-six patients underwent one-day surgery, 18 were in the hospital for one day, and four patients were discharged on the second postoperative day following surgery. In 7 patients (14%), recurrences occurred: in the first postoperative year - 1 patient; in the second year after surgery - 3 patients; in the third after surgery - 2 patients; and in the sixth year - 1 patient. The recurrence rate was 2 in 33 patients after TAPP (6%) versus 5 in 15 patients after TEP (33%), Chi-squared=5.91 (p=0.015). In one patient, perforation of the bladder occurred after TEP and was managed conservatively using a urethral catheter and preperitoneal drainage. TAPP and TEP had a considerable discrepancy in recurrence rates. Such discrepancy in recurrences is probably due to the higher complexity of the TEP technique and the required supervising of experienced surgeons during the learning curve.</p> </abstract>ARTICLEtrue Dissection Type a in Combination with Acute Anterior Myocardial Infarction. Myocardial Protection<abstract> <title style='display:none'>Summary</title> <p>Acute aortic dissection is an extremely serious condition with a high mortality risk. Symptoms may mimic other emergencies such as myocardial ischemia, often leading to misdiagnosis. A combination between coronary hypoperfusion and aortic dissection is relatively rare, but when present it could be fatal. Early diagnosis and correct surgical approach are essential to success in those patients and the high mortality rate requires improvement of myocardial protection. Development of acute cardiac ischemia on top of mandatory global ischemia is a serious precondition for a severe postcardiotomy syndrome, and only excellent cardiac protection can lead to successful surgical intervention.</p> </abstract>ARTICLEtrue Rare Case of Vascular Malformation in the Orbit<abstract> <title style='display:none'>Summary</title> <p>We present the case of an 87-year-old female with a one-week history of redness, swelling, and pain in the left eye, accompanied by headache and neck pain. Computed tomography (CT) scan demonstrated extreme enlargement of the supraorbital artery, engaging the superior rectus muscle of the left eye. We could not find similar articles in well-recognized scientific networks. Conservative treatment was conducted, with no improvement. The patient refused surgery.</p> </abstract>ARTICLEtrue of the Measures Implemented in Bulgarian Legislation to Reduce the Content of Nitrates in Groundwater Used for Public Water Supply<abstract> <title style='display:none'>Summary</title> <p>The article analyzes the application of the current documents related to reducing nitrate pollution of groundwater bodies used for public water supply in the Pleven administrative region. The requirements of the European legislation are fully implemented in the Bulgarian legislation, but the legislative measures have not led to quick and permanent results, i.e., small drinking water sources contaminated with nitrates still exist. Special attention should be paid to the diffusive sources of pollution (mineral fertilization of soils) since they are of the most significant importance in groundwater contamination with nitrates. For settlements with permanently elevated nitrate content (over 50 mg/L), it is necessary to consider the application of an individual approach in dealing with this long-standing problem: changing the water source, mixing the water from two neighboring water sources or implementing specific purification methods (biological denitrification, ion exchange resins, etc.). We analyzed the data from the monitoring of drinking water carried out by the Regional Health Inspectorate – Pleven and found that in the Pleven region, there are 17 towns or villages (out of a total of 123) for which some of the listed measures should be foreseen. The district’s relative share of the exposed population is 3.2%, comparable to the country’s exposed population for 2004-2007.</p> </abstract>ARTICLEtrue Foot: Old Disease, New Challenges<abstract> <title style='display:none'>Summary</title> <p>Diabetes is a socially significant disease that brings a significant burden to healthcare systems worldwide. The vicious nature of the disease affects almost all of the systems and organs of the body. The foot is one of the most important and clinically significant areas where these complications are manifested. Diabetic foot gangrene is a leading cause of non-traumatic foot loss worldwide. Although the disease has been known for over a decade, understanding it has gone through highs and lows, leading to suboptimal results in many cases. In this review article, we focused on diabetic foot and the methods for evaluation and assessment of the condition to properly initiate adequate treatment.</p> </abstract>ARTICLEtrue Reconstitution in Late-Presenting HIV-Positive a Case with Idiopathic Liver Cirrhosis and Ischemic Brain Stroke<abstract> <title style='display:none'>Summary</title> <p>A patient diagnosed with late-presenting HIV infection [CD4 count 86 cells/mm<sup>3</sup>, viral load (VL) 95 000 copies RNA/mL], treated with DRV/c 800/150 mg (Rezolsta®) and TDF/FTC 200/245 mg, was hospitalized with ischemic brain stroke, confirmed by CT scan and MRI. Motor functions quickly recovered, but nausea, abdominal heaviness, ascites, and hepatosplenomegaly appeared. Laboratory investigations revealed anaemia, thrombocytopenia, normal transaminases, increased GGT and negative serological tests for HBV and HCV and she was diagnosed with Gastroenterologists diagnosed liver cirrhosis. After 20 days of hospital treatment, the patient recovered from the stroke and ascites but with persisting anaemia and thrombocytopenia. Liver cirrhosis had been confirmed, and relevant treatment had been administered. Six months later, an MRI of the brain revealed an improved image. Follow-up showed stabilized somatic and neurologic status, improved laboratory parameters, stable T-helper count and undetectable viral load (VL). ART regimen continued with Raltegravir 400 mg (Isentress®) 2×1 tablet/24 h, TDF/FTC 200/245 mg 1 tablet/24 h. Three months later, the patient continued her treatment continued abroad. The increased access to precise diagnosis and treatment with improved adherence has transformed the HIV-infection into a manageable chronic health condition, even in complicated cases.</p> </abstract>ARTICLEtrue of Adult Celiac Disease in Eastern Algeria<abstract> <title style='display:none'>Summary</title> <p>The objective of this study was to determine the clinical picture of adult celiac disease in the population of eastern Algeria. We conducted a retrospective study on a sample of 156 patients in Internal Medicine service, Hepato-Gastroenterology Service, Endoscopy Service in the University Hospital BENBADIS - Constantine and the Military Regional University Hospital - Constantine. Our results have shown that, in this population, celiac disease can be manifested by a number of signs and related pathologies. A variety of digestive symptoms were reported, primarily chronic diarrhea (81.4%), abdominal pain (57.1%), anorexia (42.9%) and vomiting (48%). Extra-digestive symptoms manifested mainly as weight loss (90.4%), pallorous of skin and mucosa (84%), asthenia (60,3%), edema of the lower limbs (46.8%) and dehydration sings (37.8%). In addition, we noted biological disorders, the most common being hypocalcemia (77.4%) and hypoalbuminemia (57.7%), and a series associated pathologies namely: anemia (67.9%) and digestive diseases (38.46%). CD in adults in our population may express a variety of digestive and extra-digestive symptoms in addition to a number of associated pathologies.</p> </abstract>ARTICLEtrue Case of a Patient with Extranodal Diffuse Large B-Cell Lymphoma and Surgical Complications<abstract> <title style='display:none'>Summary</title> <p>Diffuse large B-cell lymphoma (DLBCL) is one of the most common types of non-Hodgkin lymphoma in adults. In most of the cases a complete remission is possible to obtain by applying conventional immunochemotherapy (rituximab in combination with cyclophosphamide, doxorubicin, vincristine, methylprednisolone or R-CHOP). Its effect depends on some risk factors, cellular origin of the lymphoma and to some extend – the localization when extranodal involvement is confirmed.</p> <p>We present the case of a patient with DLBCL of small intestine and non-specific clinical manifestation. Following treatment with standard therapy R-CHOP patient fail to achieve disease response and gastrointestinal track (GIT) complications were registered.</p> </abstract>ARTICLEtrue of Self-Medication with Antibiotics in Europe: A Scoping Review<abstract> <title style='display:none'>Summary</title> <p>The most common cause of antibiotic resistance is the irrational use of antibiotics. Most of the irrational use of antibiotics is related to use in the community and the prevalence of self-medication in different populations. This review aimed to explore the prevalence of self-medication with antibiotics in European countries and the main sources of antibiotics. An online search of Pubmed and Scopus was conducted to identify relevant studies. A two-phase mapping approach was used. All steps in this scoping review were carried out using the Covidence® software. A total of 22 studies were included. The prevalence of self-medication with antibiotics is greater in Southern European countries than in Northern and Western European countries. The main sources of over-the-counter antibiotics are community pharmacies and leftovers from previous courses. Targeted communication strategies and interventions are needed to reduce the overuse of antibiotics and to slow down the spread of antibiotic resistance until new classes of effective antibiotics are developed.</p> </abstract>ARTICLEtrue Article. Matrix Metalloproteinase Mmp-2 and Mmp-9 Activities in Seminal Plasma<abstract><title style='display:none'>Summary</title><p> Matrix metalloproteinases (MMPs) areagroup of proteases containing Zn ions asacofactor, which are involved in degrading ofalarge number of extracellular matrix proteins, and bioactive molecules. They also playamajor role in processes such as cell proliferation, cell migration, differentiation and apoptosis. Very little is known about the expression and function of MMPs in the male reproductive tract. Occurrence of MMP-2 and MMP-9 activity in human seminal plasma has been previously reported but their origin and function are still not fully understood. The aim of this study was to examine the presence of MMP-2 and MMP-9 in normal and abnormal human sperm samples and find if any correlation existed between the levels of expression of MMPs and fertilization potential of the spermatozoa. Human spermsamples were examined for the presence of MMP-2 and MMP-9 by gel zymography and western blot analysis. A DNAfragmentation test was performed. The samples were divided into two groups - samples with normozoospermia and teratozoospermia. The gelatin zymography showed gelatinolytic bands with molecular weight 64 and 72 k Da corresponding to active and inactive form of MMP-2. MMP-9 was not detected. The MMP-2 enzymatic activity appeared to be much higher in samples with compromised sperm morphology as compared to the normozoospermic samples. The mean DNAfragmentation index (DFI) of the group with teratozoospermia was relatively higher (22.16%) and over the upper reference limits, compared to the normozoospermic group, in which it was within the normal range (17.26%).</p></abstract>ARTICLEtrue Article. Diagnostic Value of Tru-Cut Biopsy in Diagnosing Breast Lesions<abstract><title style='display:none'>Summary</title><p> Breast cancer is the most common cancer in women worldwide. The standard for detecting it includes clinical exam, mammography and fine-needle aspiration cytology. Our aim was to establish the role of the tru-cut biopsy in the diagnosis of malignant breast lesions. We provideatwo-year retrospective clinical study defining 98.67%sensitivity, 100%specificity, 100%positive predictive value, 80%negative predictive value and an overall diagnostic accuracy of 98.73%. In 89.1%of the malignant lesions, the sample was adequate to define the receptor status. Therefore, tru-cut biopsy is an easy, cheap, safe and accurate alternative to fine-needle aspiration cytology in the diagnosis of breast lesions.</p></abstract>ARTICLEtrue Article. Open Retropubic and Robot-Assisted Radical Prostatectomy in Prostate Carcinoma: Advantages of Methods<abstract><title style='display:none'>Summary</title><p> Prostate cancer (PC) is the most common type of cancer in men inanumber of countries. The choice of surgical technique for radical prostatectomy (RP) concerns both patients and urologists. The choice is not easy to make, since data is still limited due to the lack of large multicentric randomized research trials. For three years (2011-2014), 244 patients with limited prostate cancer were operated in the Urology Clinic of the University Hospital in Pleven. Robot-assisted radical prostatectomy (RARP) was performed on 35 patients (14%), open retropubic radical prostatectomy (ORP) - on 199 patients (81%), and laparoscopic RP - on 12 patients (5%). The preoperative and post-op results from the first two groups were compared. For the follow-up period of 12 months, functional results in 82 patients of the ORPgroup were compared to the results in the 35 patients of the RARPgroup. The operative time was significantly longer in the RARPgroup, and blood loss was lower. The catheter stay was shorter in patients with RARP. The percentage of significant postoperative complications was 0%in the patients with RARPand 3%in the patients with an ORP. RARPpatients demonstrated better continence: 91%vs. 87%and erectile function46%vs.40%at 12 months.</p></abstract>ARTICLEtrue Report. A Case Report of Adult Acne<abstract><title style='display:none'>Summary</title><p> Acne vulgaris is among the commonest inflammatory skin diseases affecting pilosebaceous units. It occurs mainly in puberty and affects adolescents at the age of 14-19 years both females and males, in relation to sebum production of hair follicles under the action of sex hormones. Clinically the disease is presented with comedones, papules, pustules, nodules and scars in some cases. Seborrheic areas face, chest and back are affected. Recent epidemiologic studies have shown significant number of female patients aged over 25 years with acne and the term Adult onset acne (AOA)was established.The latter is manifested clinically in the lower third of the face. Primary etiological cause of AOAisahormonal imbalance, mainly hyperandrogenemia. Acase ofa25-year-old woman with adult acne and elevated levels of testosterone and prolactine is presented in this paper.</p></abstract>ARTICLEtrue Approaches for Health Technology Assessment in Europe: Situational Analysis<abstract><title style='display:none'>Summary</title><p> Health technology assessment (HTA) isaprocess, which should answer the question“Isagiven health technology/medication worth its price for the value it provides?” In the spirit of the amendments to the Bulgarian Health Insurance Act and institutionalization of HTA, our team prepared this situational evaluation aiming to throw light on the practices and approaches to HTAin European countries. As awhole,we can identify two types of agencies that perform it: those servicing the population of an entire nation oraregion, and those working at the level of hospitals oranetwork of hospitals. All the agencies studied have two common characteristics. First, they were created withanon-profit purpose and second, all of them are financed by public funds inavariety of ways. It also becomes clear from the comparative analysis performed that the ways HTAis conducted in Europe differ from country to country. Irrespective of the variations, the common aspiration is that the value forapatient, to which the approved health technologies contribute, should be greater than the price to be paid for them. Bulgaria is may be the last EUstate to implement HTAin its domestic legislation and this also gives the advantage of having and using the experience of the other countries. Establishing an independent structure, which is appointed to prepare local health technologies assessment would result in transparent decision-making, participation of all concerned parties and optimization of the budget for medicines regarding the effectiveness/benefit ratio, as well as expenses.</p></abstract>ARTICLEtrue Article. Urinary Tract Desobstruction in Patients with Malignant Neoplasms of the Uterine Cervix<abstract><title style='display:none'>Summary</title><p> Cancer of the cervix causes internal, external compression or both of the upper urinary tract in 50-60%of patients in advanced stages. Retrograde stenting is the most widely used technique for desobstruction of the upper urinary tract in urology practice. Diversion of urine flow is an alternative, achieved by nephrostomy of one or both kidneys.We studied retrospectively 33 women with upper urinary tract obstruction caused by carcinoma of the uterine cervix operated on between March 2014 and March 2015 in the urology clinic at the University Hospital in Pleven, Bulgaria. Apercutaneous nephrostomy (PNS) was placed in 17 patients, and 11 patients hadaretrograde catheterization with ureteral stent type JJ. Five patients were treated with both methods. Placement ofa JJstent was the first choice procedure for all patients since it providesabetter quality of life. PNSimproves renal function faster than retrograde JJstenting. Therefore, the first method of choice for patients with an untreated primary cervical, uterine cancer is the placement of PNS. Retrograde JJstenting is the method of choice in patients who undergo surgery and radiation therapy withoutarelapse of the disease.</p></abstract>ARTICLEtrue Article. Diagnostic and Prognostic Potential of Oxidative Stress Markers in Adults with Immune Thrombocytopenia<abstract><title style='display:none'>Summary</title><p> Immune thrombocytopenia (ІTP) is one of the most common causes of clinically overt hemorrhage. Despite the progress made in recent years in clarifying the pathogenesis of the disease, the exact unlockmechanisms still remain unclear. The aim of the study was to correlate the oxidative stress markers and the severity of immune thrombocytopenia in adults and to investigate their predictive value of transforming the acute formof ITPinto chronicІTP.We studiedatotal of 58 subjects (14 patients with newly diagnosedІTP, 13 patients with chronic form ofІTR, and 31 controls). The plasma levels of human pantetheinase ( vanin-1) and lipid hydroperoxides were measured using commercial assay kits.We found that the form of the disease was not significantly related to the plasma vanin-1 levels (p=0.120). Asignificant difference in the vanin-1concentrations was observed between newly diagnosed IPTand the controls (p=0.046). Further studies with larger and more homogenous groups of patients and including more indicators of oxidative stress are needed to be able to draw statistically valid conclusions about the role of oxidative biomarkers in diagnosing and treatment ofІTP.</p></abstract>ARTICLEtrue Arterial and Venous Thrombotic Events in a Patient with Psoriasis. Impact of PAI-1 Polymorphism: A Case Report<abstract><title style='display:none'>Summary</title><p> Psoriasis isachronic autoimmune multisystem disease, mainly affecting the skin and joints. Its origin is related to both environmental and genetic factors. The condition affects 1-3%of the population worldwide. Psoriasis is also associated with cardiovascular risk factors, atherothrombotic events, and markers of hypercoagulation (platelet activation and hyperhomocysteinemia). Venous thromboembolism (VTE) isawidespread severe disease. Both VTEand psoriasis are connected with risk factors for cardiovascular disorders (obesity and hypertension). The incidence of VTEevents in patients with psoriasis is higher. Patients with psoriasis should be checked for risk factors (metabolic disorders and cardiovascular diseases).We reportacase of a 53-year old man, diagnosed with plaque psoriasis 20 years ago, andafive year history of hypertension. In 2006, he hadastroke, and in 2011 ‒aheart attack. In 2013 he was diagnosed with thrombophlebitis. The patient was recently diagnosed with Type IIdiabetes, dyslipidemia and metabolic syndrome. The DNAanalysis revealed that the patient wasahomozygous carrier of 4G/4G (rs1799889) polymorphism in plasminogen activator inhibitor 1 (PAI-1) -a risk factor for thrombophilia. This case is important because of the major comorbidities, more particularly thrombotic events in combination withaprothrombotic mutation.</p></abstract>ARTICLEtrue Article. Sensitization to Aeroallergens in Pediatric Patients with Allergic Rhinitis and Asthma<abstract><title style='display:none'>Summary</title><p> Asthma and allergic rhinitis are common in childhood. Establishing sensitization to aeroallergens is crucial to effectively prevent exacerbation of these respiratory allergic diseases. The study aimed to evaluate sensitization to the most common aeroallergens in children with asthma and allergic rhinitis.We establishedacorrelation between patients sensitized to indoor, outdoor and simultaneously to both allergens. The study population consisted of 276 patients (168 boys and 108 girls) ages 4 to 16 years with asthma (A) and allergic rhinitis (AR). Skin prick tests were performed with 21 commercial allergen extracts: pollens, mites, epithelia and insects, and molds. We found that 217 patients were sensitized to at least one aeroallergen: 117 patients hadapositive result to mites, 92 to pollens, 72 to epithelia and insects, and 63 - to mold allergens. Dermatophagoides pteronyssinus was the most prevalent aeroallergen. Sensitized only to indoor allergens were 104 patients, 60 - only to outdoor allergens, and 53 were sensitized to both. Mites were the most frequent aeroallergens in children with Aand AR. Lately there has been foundasignificant increase in rates of sensitization to mold allergens, especially to Alternaria alternata. Our study has confirmed the dominant role of indoor allergens in children with respiratory allergic diseases.</p></abstract>ARTICLEtrue