Acta Medica Bulgarica
Постоянни адреси на тази колекция
Многопрофилно списание, излизащо само на английски език от 1973 г. и до момента. Съдържа авторски статии от водещи български медицински специалисти, отразяващи върховите постижения на българската медицина наука и практика. Публикуват се материали, отразяващи резултати от експериментални проучвания, клиника и казуистика. ***** Излиза 2 пъти годишно. ***** ISSN:0324-1750 ***** Уебсайт: http://www.medun.acad.bg/cmb_htm/AMB/index.html
***** About 30 years ago - in 1973, on the initiative of the Publishing House „Medicine and Physical Culture", namely its former director Mr. Traian Ivanov, the Ministry of Health set up and accepted to subsidize a new medical magazine that was to be published only in the English language and had to reflect the status and the achievements of the Bulgarian medical science.
Thus the language barrier was overcome and stable relations were established with the international medical society, large libraries, and university centers. The famous internationally known scientist professor Assen A. Hadjiolov was elected edition-in-chief by the first editorial staff and the magazine was named Acta Medica Bulgarica. For over 20 years, the staff of „Medicine and Physical Culture" did all the work related to the publishing of AMB regardless of the fact that the magazine kept on its appearance as organ of the Medical Academy, respectively of the Sofia Medical University. Editors-in-chief throughout the years were prof. Atanas Maleev, prof. Nikolay Belovezhdov, prof. Dimitar Djerov and prof. Vladimir Ovcharov. Gradually a greater number of scientists from all over the world as well as universities and scientific institutes demonstrated stronger interest in publishing their papers in AMB. The magazine is in demand by over 300 world medical libraries working on the exchange principle. For the last couple of years, AMB has been organ of the Sofia Medical University has been published by the Central Medical University Library - department of Medical Information. More than 30 years prof. Wenzeslav Bossnev has been responsible for the scientific edition of the magazine, while prof. Stoian Danev was later committed to the English version. The editorial staff respectfully marks out the joint efforts of all the colleagues that have of to the publishing of the magazine during the years of complex changes in social life and wishes the next generation of scientists to further develop and improve its scientific level and consolidate its position among international medical literature. ***** ISSN:0324-1750 ***** Website: http://www.medun.acad.bg/cmb_htm/AMB/index.html
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- ДокументA-waves in patients with Bell’s palsy(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Alexandrov, A.; Muradyan, N.; Christova, L.; Kosarov, D.; Daskalov, M.; Ishpekova, B.The aim of this study is recording and investigation of multiple A-waves from frontalis and orbicularis oris muscles in patients with Bell’s palsy. Twenty-one males and 34 females with Bell’s palsy participated in electrophysiological studies. The control group consisted of 28 subjects (16 women and 12 men). A-waves were obtained during conventional F-wave investigation with 16 supramaximal stimuli with a frequency below 1Hz. Electrical stimulation with square wave pulses 0.2 ms in duration was applied via a bipolar surface electrode fixed over the nerve just below the ear and anterior to the mastoid process. The evoked compound muscle action potential (CMAPs) of frontalis and orbicularis oris muscles was recorded with concentric needle electrode (diameter of 0.45 mm) at an amplification of 200 V/div. On the basis of the electromyographic manifestations (parameters of recorded CMAP of m. orbicularis oris and m. frontalis and conduction time (CT) of n. facialis), the patients were separated in three groups – with mild, moderate and severe facial paresis. A-waves were observed between CMAP and F-wave. They were with lower amplitude, approximately constant shape and latency. In 2 patients, A-waves were not found in both investigated muscles. Single A–wave recorded from frontalis muscle were observed in 8 (14.5%), multiple A-waves – in 35 (63.6%), and in 12 (21.8%) of patients, A-waves were not found. Multiple and single A-waves were observed in orbicularis muscle in 33 (60%) and 8 (14.5%) of patients respectively and in 14 (25.5%) of them, A-waves were not recorded. The multiple A-waves are common signs in the early stage of Bell’s palsy in cases of mild and moderate degree of paresis.
- ДокументAcute exogenic intoxications and level of the antioxidant selenium(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Tufkova, S.; Karaslavova, E.The human organism possesses a well built antioxidant defence system having as a purpose neutralizing the free radical processes. The antioxidant defence of the human organism can be divided in to three functional levels. Great importance is given to the second level represented by enzyme and non-enzyme components which defuse the already formed free radicals. Here a main representative is the microelement selenium. Aim of the study was tracing the level of selenium – a main element of the secondary antioxidant defence system of the human body in acute exogenic intoxications with cerebrotoxic medicaments, alcohol and heroin. The study is prospective and longitudinal comprising 118 patients with average and heavy degree of acute poisoning with cerebrotoxic medicaments (n=45), alcohol (n=40), heroin (n=33) and control (n=35). The clinical laboratory tests are made under definite standards of the clinical laboratory. Following statistical analyses are used: variational analysis/u-criterion for normal distribution, t-test of Student, dispersive analysis under the method of ANOVA test and non-parametric analysis. Our results show a statistically significant decrease of serum concentration of selenium in acute exogenic intoxications with cerebrotoxic medicaments, alcohol heroin – Р<0,001, without it correlating with the weight of the acute intoxication – Р>0,05. As a reliable marker for a complex estimate of the antioxidant system of humans is the tracing the serum level of selenium and its careful interpretation.
- ДокументAlcohol and children(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Loukova, A.One of the major challenges faced by states and communities is the prevention of underage alcohol access. Underage drinking is widespread and, to a large extent, tolerated by society. It is also implicated in a range of health and social problems that are both tragic and costly. There are good reasons for a high level of concern about underage drinking: alcohol is the drug most commonly used by youth-more than tobacco and far more than marijuana or any other illicit drug; alcohol is one of the most common contributors to injury, death, and criminal behavior among young people; in addition to the immediate and potentially tragic consequences of underage drinking, early onset of alcohol use increases the risk for chronic alcohol addiction. The bad news is clear and all too visible. Underage alcohol use is a serious problem. But fortunately there is good news as well: a variety of effective strategies have been developed to reduce underage drinking. These strategies can be applied in all sectors of the nation, state, and community – in all areas of the systems that produce, distribute, promote, and consume alcohol. Preventing underage drinking saves lives and saves futures.
- ДокументAngiokeratoma circumscriptum – successful treatment with a new technology(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2012-06) Kamoona, B.; Kazandjieva, J.; Nikolova, A.; Bardarov, E.; Marina, S.The term angiokeratoma means hyperkeratotic, dark-red to purple papules, with dimensions of 1-10 mm in diameter. Histopathologically they are seen as vascular ectasias in the upper dermis surmounted by hyperkeratosis of the epidermis. Several clinical variants of angiokeratomas exist. Some variants are localized on the genitals (Fordyce’s angiokeratoma), on the fi ngers and toes (Mibelli’s angiokeratoma) or form confl uent plaques (Angiokeratoma circumscriptum). We present a 15-year old female patient with Angiokeratoma circumscriptum of one year duration, which expands in size with time. Interestingly, angiokeratoma circumscriptum appeared on the place of an operational scar. Laser treatment is one of the effective options for removal of localized angiokeratoma. The spectrum of treatment options includes ablative lasers, argon laser and IPL. In our case we achieved an excellent and rapid therapeutic result using a laser apparatus with elōs technology.
- ДокументAngioneurotic edema caused by dental materials: a case report(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2011-04) Dermendjiev, S.; Stoyneva, Zl.The synthetic polymers are high-weight molecular organic substances which are formed from one compound (monomer) or by several compounds through chemical processes of polymerisation or polycondensation. Acrylamide, for example, is used in dentistry to harden compositions with high adhesion. Methyl methacrylate (MMK) is the main monomer in obtaining acrylic. It is widely used in households and in different industries – production of organic glasses, lacquers, resins, displays. MMK is often used as a substance in the preparation of various composites, used in dentistry, dental fi llings, etc. MMK can be a health risk factor, both in terms of acute, often occupational exposure and prolonged effects on the human body. While acute exposure to high concentrations MMK produces clinical manifestations of intoxication, which clinical picture and course are well known, the adverse health effects arising from prolonged contact with this substance are very diverse, involve different organs and systems, and some are still poorly studied. It is known for example that MMK, like other polymeric substances and plastics exhibits sensitizing effect in contact with skin and mucous membranes. After exposure to methyl methacrylate, cases of contact dermatitis are described. Is it possible, however, MMK, and substances in which it participates, to create another type of allergic reactions? Responses to this question can provide the case we present.
- ДокументAnterograde facial-submental artery island fl ap for palate repair after carcinoma ablation – a case report(Централна медицинска библиотека - МУ София / Central Medical Library - MU Sofia, 2013-09) Yordanov, Y.; Shef, A.; Lasso, J. M.Summary. The submental island fl ap is a reliable alternative in the armamentarium of the plastic surgery for reconstruction of various head and neck defects including those affecting the oral mucosa and the palate. Since it was fi rst described, it has been affirmed as a safe, rapid and easy reconstruction method with minimal to missing donor site morbidity.We present a clinical case of complete reconstruction of soft palate using an anterograde pattern submental fl ap. We believe this flap to be safer than the reverse-fl ow one that has been typically used for defects located in this region. The surgical technique is described.
- ДокументArterial thrombosis in utero causing arm gangrene in the infant of a diabetic mother(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Zhekova, N.; Todorova, K.; Guenova, M.; Tsachev, K.Gangrene of a limb presenting at birth is rare and has heterogenous etiology. Approximately 25% of the cases have been reported to occur in infants of diabetic mothers (IDMs). We report a newborn IDM with brachial artery thrombosis in utero and neonatal gangrene which necessitated a below elbow amputation at 5th day of life. The diagnosis of external left brachial artery thrombosis was made by Doppler sonography flow studies and was confirmed at autopsy. Despite the use of anticoagulants, the gangrene advanced and amputation of the necrotic forearm was performed. The postoperative period was complicated by mesenteric artery thrombosis with subsequent necrotizing enterocolitis, convulsions, septicemia and death. The reason for the increased tendency to develop thrombi in IDMs has not been elucidated. Changes in coagulation factors have been reported in newborn IDMs with poor control of maternal diabetes. Increased clotting and decreased fibrinolysis found in diabetics may lead to arterial thrombosis in IDMs in utero and postnatally. Use of anticoagulants in at-risk infants should be considered early to prevent further thrombosis and ischemic complications postnatally.
- ДокументArthrogryposis multiplex congenita, epileptic seizures and cortical dysplasia: a case report(Централна медицинска библиотека - МУ София / Central Medical Library - MU Sofia, 2013-09) Viteva, E.Summary. We have presented a case of a 22-year-old patient having a rare variety of arthrogryposis multiplex congenita - arthrogryposis with epileptic seizures and defect in neural migration. We have described the patient’s disease history, the clinical, and laboratory data by giving prominence to the lack of mental retardation and the late onset of the generalized tonic-clonic seizures, despite the present cortical dysplasia. We have also discussed cases reported by other investigators. We consider that our case report is a contribution to the knowledge about the clinical manifestations, the possible results from neuroimaging and electrophysiological methods, and the progression of arthrogryposis multiplex congenita.
- ДокументArthroscopic surgery in cases with an aging locked posterior dislocation of the shoulder(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2012-04) Dimitrov, N.; Tsekov, P.; Matev, B.The shoulder joint is most vulnerable to dislocation. Anterior dislocation is common, while the posterior one is very rare – about 4% of all dislocations of the shoulder. Because of this, the diagnosis is frequently missed at the initial examination – McLaughlin called the situation a “diagnostic trap”. The surgical treatment of posterior dislocations initially aimed at reduction of the joint. However, this is not suffi cient for aging dislocations. Stability is to be provided. In recent years, the promotion of arthroscopic treatment is becoming increasingly important, especially given for its indisputable advantages. In the Department of Surgery of the Upper Limb in the University Specialized Hospital for Active Treatment in Orthopedics USHATO – “Prof. B. Boychev” for the period 2005-2011, were operated 12 patients (8 men and 4 women – a total of 12 shoulders). All had persistent posterior dislocation of the shoulder as a result of injury, after a lapse of between 3 and 8 months – an average of 4.5 months. In all cases an osteohondral defect from 25 to 45% (average 30%) located on the front surface of the head of the humerus was set. Surgery: Seven patients were fi rst operated through arthroscopic reduction and then stability was restored by transposition of m.subscapularis in the osteohondral defect. Five patients were operated without prior arthroscopic reduction – only through open surgery. Follow-up period was from 6 months to 6 years (3 years averagely). The reported results indicate that abduction, fl exion and internal rotation increased much more rapidly and to a larger volume in patients in which fi rst arthroscopic reduction was made, compared with those where it was held via conventional surgery, due to its larger volume and greater operational trauma. These results were also confi rmed using two post-operative function of the shoulder joint scoring systems: Murley Constant Score and UCLA.
- ДокументAssociation between biochemical markers of bone turnover and markers in the estrogen receptor (ER) gene(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2010-10) Ivanova, Zh.; Toshev, А.; Tsachev, K.Bone metabolism is characterized by two opposite activities: the formation of new bone by osteoblasts and the degradation of old bone by the osteoclasts. Osteoporosis is a disease in which subtle modifi cations of bone remodeling can result in a substantial loss of bone over a prolonged period of time. The needs for non-invasive techniques that can be applied more widely and repeated several times in a single patient explain the development of markers of bone turnover that are measured in blood and urine. The prognostic value of parameters as risk indexes for osteoporosis is not enough. This makes it possible to use genetic markers, which together with already existing risk indexes will improve the identifi cation of individuals with higher osteoporosis risk. The future development of genetic studies in osteoporosis will proceed in two major directions: identifi cation of further candidate genes, their interaction with each other and their application to defi ned diseases of bone metabolism. Abbreviations: (BMD) bone mineral density; (ER) estrogen receptor; (Pyr) pyridinoline; D-Pyr) deoxypyridinoline; (Cr) creatinine
- ДокументAssociation of 13q14 deletion with clinico-laboratory parameters in B-cell chronic lymphocytic leukemia (B-CLL)(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2012-06) Hadzhiev, E.; Alexandrova, K.; Velizarova, M.; Dimova, I.; Toncheva, D.A deletion of chromosome band 13q14 (13q-) detected by fl uorescence in situ hybridization (FISH) analysis is the single most common cytogenetic abnormality in patients with chronic lymphocytic leukemia (CLL). In our study we disccused the incidence of molecular-cytogenetic deletion of 13q14 marker in BCLL in order to determine the association of this aberration with clinical manifestation, laboratory parameters and poor disease prognosis. Patients with 13q14 aberrations were significantly older. They had ZAP (+) status, rapid disease progression and therapy dependency. A determination of 13q14 genetic abnormality should, therefore, be included in the investigations of the prognostic factors of B-cell chronic lymphocytic leukemia.
- ДокументBCR/ABL molecular testing by fl uorescence in situ hybridization in untreated adult acute leukemia(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2012-06) Velizarova, M.; Dimova, I.; Hadzhiev, E.; Tsatchev, K.The BCR/ABL detection infl uences diagnosis, prognosis and treatment decisions in patients with chronic myeloid leukemia (CML) and acute lymphoblastic leukemia (ALL). We studied the feasibility and the sensitivity of LSI BCR/ABL dual-colour, dual-fusion probe as a usual assay for detection BCR-ABL gene fusion in acute leukemia. A total of 3229 successfully hybridized interphase nuclei from 34 newly diagnosed patients with acute leukemias (12 AML and 22 ALL cases) were analyzed. We used interphase fl uorescence in situ hybridization (FISH) method and LSI BCR/ABL dual-colour, dual-fusion probe (Vysis) for detection of BCR-ABL gene that span the common breakpoints of t(9;22)(q34;q11.2) and that detect double BCR-ABL fusion in bone marrow cells with this translocation, one on the abnormal chromosome 9 and one on the Philadelphia chromosome (Ph chromosome). Fusion BCR-ABL gene was observed in 9 (28.13%) of the cases with successful hybridization and in 6 (18.75%) of them the results had clinical reliability. The aberrant cell lines were of different sizes − 53%-96% of cells were positive for BCR-ABL gene. Fusion signals for BCR-ABL were reported in 2 (16.67%) of AML and in 4 (18.18%) of ALL cases. In conclusion, we proved that LSI BCR-ABL dual-colour, dual-fusion probe (Visys) is characterized with high specifi city and sensibility.
- ДокументBiologically active composition and health impact of Allium cepa(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2011-04) Tsanova-Savova, S.The aim of this study is to present contemporary information for the biologically active compounds in Allium cepa and correspondingly their health benefits, as well as to present analytical HPLC results for the content of the main antioxidants in Allium cepa – the fl avonols quercetin and kaempferol, in different types of Bulgarian onion, and to submit data about onion consumption on national and international level. The potent antioxidant activity of the biologically active compounds in onion is an important factor for the prevention against different degenerative diseases like cardiovascular disease, cancer, diabetes. Results for content of the flavonols quercetin and kaempferol in different types of Bulgarian onions are presented. The red onion contains highest amount of quercetin – average value 452.5 mg/kg and a maximum value found – 832.2 mg/kg. It was determined that the green part of spring onion contains relatively equal values of quercetin (30.2 – 61.1 mg/kg) and kaempferol (27.4 – 52.3 mg/kg). This results characterize spring onion as very important dietary source of kaempferol in Bulgarian healthy diet emphasizing their role in development of different preventive diets.
- ДокументClinical assessment and molecular genetics of an autosomal dominant retinitis pigmentosa in a bulgarian roma family(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2011-10) Koev, K.; Cherninkova, S.; Chakarova, Ch.; Georgiev, R.; Dimitrova, S.; Kaneva, R.; Bhatacharya, S.Summary. Purpose was to make a clinical assessment and molecular genetic analysis in patients with autosomal dominant form of retinitis pigmentosa (adRP) in a Bulgarian Roma family. Clinical assessment and genealogical analysis in a Bulgarian Roma family suggested the presence of RP with autosomal dominant inheritance with at least 12 affected in 4 generations. Clinical results showed best corrected visual acuity. Performed were kinetic Goldmann perimetry; direct and indirect ophthalmoscopy; ERG; fl uorescein angiography. The molecular genetic analysis involved screening of 15 known adRP genes using microarray panel of Asper Biotech in the index patient. T in exon 4 of the RP1 gene, leading to an amino acid substitution T373I was found in heterozygous condition. Conclusion shourd adRP is a severe and genetically heterogeneous retinal degeneration. We present a Bulgarian Roma family with typical clinical symptoms of RP and heterozygous change in the RP1 gene, which has previously been described as a possible disease causing mutation in a Pakistani family with adRP and in homozygous condition leading to a severe arRP in 2 consanguineous families of Pakistani origin. The clinical and genetic analysis of additional affected and unaffected family members is ongoing. This will allow better genotype-phenotype correlations to be made.
- ДокументA clinical case with PMM2-CDG and Dandy-Walker malformation(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2010-10) Stancheva, M.; Kremenski, I.; Apostolova, M.; Jaeken, J.; van Schaftingen, E.; Matthijs, G.; Ivanova, N.; Bojinova, V.; Radeva, B.; Perenovska, P.; Vladimirova, K.; Vajarova, R.; Todorova, D.The authors report a 6-year-old boy with PMM2-CDG who presented with mild mental retardation, microcephaly, facial dysmorphysm, concomitant convergent strabismus, pseudobulbar, cerebellar and epileptic syndrome, inverted nipples, inguinal hernia, cryptorchidism, pectus carinatum. The MRI in the early childhood period showed Dandy-Walker malformation. The diagnosis was revealed with IEF of serum transferrin and confi rmed with capillary zone electrophoresis. In cultured skin fi broblasts, the patient exhibited deficient phosphomannomutase (0.9 mU/mg protein). The sequence analysis showed compound heterozygosity for the common R141H/V231M mutations.
- ДокументComparative determination of glycated hemoglobin with direct photometric immunoassay and affi nity chromatography(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2012-06) Vucheva, E.; Genova, М.; Niagolov, Y.; Doncheva, N.; Peichinova, G.; Tsatchev, K.Glycated hemoglobin (HbA1c) is the gold standard in long-term assessment of glycaemic control in patients with diabetes mellitus (DM). Liquid Chromatography-Isotope Dilution-Mass Spectrometry is a reference method for HbA1c, but other methods used in practice need standardization and comparison. This study was aimed to perform a comparative evaluation of the results from HbA1c determination by direct immuno-photometric method (A) and affi nity chromatography method (B). The study included 50 samples with values from all clinically measurable areas. HbA1c in whole blood was studied using Olympus AU 400 analyzer and NycoCard READER II by, applying method A and method B, respectiovely. The results are compared using the program Method Validator, as for the reference method the chromatographic method was accepted. The imprecision in series for method A has been traced in 10 parallel samples from two patients in border and abnormal area of values. The inaccuracy was evaluated in normal and pathological human control material for 25 consecutive days. The results from correlation and regression analysis show linear regression coeffi cient r = 0.949, slope = 0.919 and intercept = 0.59. Assessment of imprecision for method A shows CV values of 1.21% and 1.91% for both cases, respectively. Accuracy monitoring of method A with control materials shows d% 4.979 in the normal area, and 5.033 in the pathological area. The results show high positive correlation and comparability between the two methods. Direct immuno-photometric method has good accuracy and precision and is applicable for analyzer Olympus AU 400.
- ДокументDetection of dental hypoplasia – ability of fluorescence methods(Централна медицинска библиотека - МУ София / Central medical Library - MU Sofia, 2013-06) Boteva, E.; Peycheva, K.Third molars are a challenge because of the large varieties of crowns and roots, difficulties in the access, differences in the level of mineralization and root development. The aim of this study was to test the ability of quantitative laser fluorescence (QLF) method and light-induced fluorescence (LIF) method to detect dental hypoplasia of third molars. Forty-nine third molars from the same geographical and practice area were diagnosed for fissure caries: clinically – by ICDAS II, and paraclinically – by QLF method, using as a tool DIAGNOdent Classic and LIF method – applied with SoproLife diagnostic lamp. Eleven third molars with non-completed root development were separated in a group and examined using the same methods. Four of them with almost the same development of the roots were examined by X-ray. Different clinical manifestations of hypoplasia were observed. The diagnosed defects were: enamel hypoplasia, idiopathic white spots, hypomineralization of enamel – “etched enamel”. For dental hypoplasia the LIF method served as an intraoral camera with magnification – x 30 – x 100 times. DIAGNOdent incorrectly measured mineral loss as a carious lesion with different depth. In conclusion, only best clinical knowledge and experience can diagnose properly hypoplastic teeth. Magnification of intraoral cameras like SoproLife can facilitate clinical decision making.
- ДокументDirect electrothermal atomic-spectrophotometric method for determination of tin in human plasma(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Vassilev, V.; Tsachev, K.; Atanassova, B.Tin is spread all over the world. Many studies have been related to the toxicity of the element and its compounds. In the last few decades, the essential character of tin has been established. The aim of the present study is to develop a direct method for tin analyses in human plasma using graphite furnace with Zeeman correction and matrix modification. The optimized furnace conditions and evaluation of the analytical reliability indicate that the atomic absorption assay is suitable for the purposes of toxicological analyses.
- ДокументDisloyal competition among Bulgarian general practitioners.(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Ivanova, M.; Tufkova, S.With market economy established in primary health care, new ethical problems arise. The increasing competition for a greater market share of patients among general practitioners poses a danger of its mutation into various non-correct forms. This study is aimed at establishing the presence of disloyal competition among general practitioners (GPs) regarding patients registration with GP practices. The need for new ethical and legal regulations in this sphere is obvious. 221 general medicine practices in several municipalities of Bulgaria were included in this study. The method of the direct individual questionnaire was employed. There is data regarding the illegal enlistment of patients with GP practices through patients’ personal data misuse. Professional relations among physicians lack the corresponding level of trust. The Ethical Code of Bulgarian Physicians requires adoption of new principles for loyal competition as well as rules for good medical practice in the condi-tions of the health care market.
- ДокументEconomic analysis of the cost savings after implementation of antibiotic policy in hospital(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2011-10) Manova, M.; Savova, A.; Stoimenova, A.; Angelovska, B.; Petrova, G.The antibiotic policy is an essential part of the hospital pharmacy activities. It leads to decrease in the microbial resistance, optimisation of the medicine utilisation, and cost savings. The goal of the study is to analyse the results of implementation of antibiotic policy on the medicine utilization and related cost savings in a city hospital in Sofi a. The study is a comparative retrospective and prospective analysis of the antibiotic prescribing and cost of therapy, before and after the introduction of the antibiotic policy. There were gathered and systematized 2582 prescriptions for hospitalized patients in 3 hospital departments (surgical, urology, and internal wards). For the evaluation of the most often prescribed combination, the sample was made for 30 patients from each unit. The selection of patients was made at random for the most common diagnoses in the studied wards. The antibiotic utilization was also measured in monetary terms and cost savings were calculated for the period after the antibiotic policy introduction. The comparison of the cost of antibiotic therapy in urology, surgical and internal wards for 2004 and 2005, after the introduction of AB policy showed that in all three studied wards signifi cant savings were realized. Reduction of costs in 2005 compared to 2004 was in total 26 832 BGN (28.48%). Total expenditures on medicines in the studied hospital were 447 810 BGN for 2004 and 396 659 BGN for 2005. Savings of 51 151 BGN were realized, which is a signifi cant value and a signifi cant proportion of the total costs (28.48%). Analysis of the results of the implementation of antibiotic drug policy confi rmed that the optimization of drug administration leads to positive economic results. It also confi rms the usefulness of measurement of utilization and cost saving, especially in hospital wards with high cost services. The antibiotic policy should be an obligatory part of drug policy in the hospitals with scarce resources. Measuring the impact of antibiotic policy implementation is a useful tool for optimization of the general hospital medicines policy and realization of cost savings. It gives possibility for practical solutions on medicines utilization optimization. Introduction of antibiotic policy in hospitals leads to the reduction of their usage, saves money and improves therapeutic options.