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С тази рубрика улесняваме достъпа и насочваме вниманието към избрани статии, вече публикувани в наши издания. Подборът е читателски или редакционен, с основни критерии – значимостта на проблема и дефицитът на достъпна актуална литература по въпроса у нас. Publications from scientific medical periodicals, edited in Central Medical Library (CML)- MU Sofia

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A 20-year-old female patient with postburn lower extremities joint stiffness - case report - Медицински преглед, 44, 2008, № 4, c. 67-70.
(Централна медицинска библиотека, МУ София / Central Medical Library, MU Sofia, 2008-12) Murtezani, A.; Terziqi, H.; Dallku, I.; Krasniqi, V.; Rama, B.
This case study deals with implementation of physical exercise intended to achieve muscular strength modification, motor function- and psychological improvement. The goal of this case report presentation is to describe the results of an ambulatory rehabilitation program with components of musculoskeletal system exercise in children with severe burn injuries. The subject of our study is a female patient with severe burn injuries, dermatogenic stiffness, muscular hypotrophy and difficult walking with ambulation. Muscular strength and motor function improvements were observed. Patient started to walk without crutches. This research demonstrates the fact that regardless of how extensive the rehabilitation program is, the end results usually are good if physical therapy is integrated into the healing process. ***** Описва се случай с прилагане на програма с физически упражнения, насочени към изменение на мускулната сила и подобряване на двигателната функция и на психичното състояние. Целта на авторите е да представят резултатите от амбулаторна рехабилитационна програма с компоненти на упражнения за мускулно-скелетната система при деца с последствия от тежки изгаряния. Обект на проучването е момиче с тежки термични травми, кожни контрактури, мускулна хипотрофия и затруднено движение. Установява се подобрение на мускулната сила и на двигателните функции. Пациентката започва да ходи без патерици. Резултатите показват, че рехабилитационната програма е успешна, когато физикалната терапия е включена в оздравителния процес.
30 години епидемия HIV/СПИН – успехи на терапията и превенцията
(Централна медицинска библиотека, МУ София / Central Medical Library, MU − Sofia, 2011) Станоева/Stanoeva, К./К.; Аргирова/Argirova, Р./R.
От 1981 г. бе изминат дълъг и успешен път в борбата с HIV инфекцията: изолиране на причинителя, пълно разкриване на генетичния и антигенен състав на вируса, изясняване на естествения ход на инфекцията, откриване на няколко класа медикаменти и въвеждане на ефективна антиретровирусна терапия (АРТ), поставяне на научното начало за ерадикация на вируса и пълно излекуване на инфекцията. Въпреки това днес се отчита неуспешна първична и вторична профилактика, все още липсва ефективна ваксина срещу HIV, а СПИН продължава да бъде един от бичовете на африканския континент. Обезпокояващ е и фактът, че Източна Европа е регион с най-бърз темп на нарастване на новозаразените с HIV. Настоящата статия прави кратък преглед на успехите и постиженията в глобален мащаб на борбата с HIV/СПИН за 30 години, като отбелязва и новите надежди на науката в тази борба. .../... Since 1981 a long and successful way has been experienced in the fight against HIV-infection: isolation of the virus, detection of its genetic and antigenic structure, clarification of natural course of infection, discovery of several groups of antiretrovirals and introduction of highly effective antiretro-viral therapy (ART), starting of initiative for viral eradication “towards a HIV cure”. However, there are gaps in primary and secondary prevention, moreover, AIDS is still a burden for Africa. It is disturbing that Eastern Europe is considered a region with the highest incidence of HIV infections. This paper is briefing the success and achievements in the fight against HIV/AIDS, simultaneously marking the new hopes of science in this fight.
3D реконструкция на среден лицев етаж – представяне на клиничен случай
(Централна медицинска библиотека - МУ София / Central Medical Library - MU Sofia, 2013-11) Георгиев/Georgiev, К./K.; Борисов/, Р./R.; Величков/, Р./R.
Резюме. Реконструкцията на орбитата в случай на травматични краниофациални дефекти в средната част на лицето често изисква индивидуални хирургични техники. За постигането на най-удовлетворителни резултати във функционално и естетическо отношение е необходимо възстановяването на различни анатомични структури, участващи в изграждането на средния лицев етаж. Специфичната форма на орбитата и назоорбитоетмоидалният комплекс са предизвикателство при реконструктивните операции. Представеният случай разкрива възможностите на съвременните 3D технологии за възстановяването с алопластичен материал на орбитата за постигане на най-добри и предсказуеми анатомични и функционални резултати. ***** Summary. Orbital reconstruction in case of traumatic craniofacial defects of midface often requires individual surgical approach. Most satisfying results (both functional and aesthetic) can be reached with the recovery of different anatomic structures of midface. Specific shape of orbit itself and naso-orbito-ethmoidal complex is a great challenge for reconstructive surgery. Presented case reveals opportunities of 3D technologies in orbit recovery by using alloplastic grafts for the purpose of best prognosis and results  functional and aesthetic.
A-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.
Acute 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.
Alcohol 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.
Anaplasma phagocytophilum при български пациенти – клинични случаи
(Централна медицинска библиотека, МУ - София / Central Medical Library, MU - Sofia, 2017-06) Пишмишева/Pishmisheva, М./M.; Баймакова/Baymakova, М./M.; Цачев/Tsachev, И./I.; Христова/Христова, И./I.
Резюме: Анаплазмозите са заболявания сред животните и хората. Протичат с ток- сико-инфекциозни прояви и промени в кръвните показатели. Причиняват се от микроорганизми, които избирателно атакуват гранулоцити. Целта на настоящата статия е да се представи клиничната характеристика на трима пациенти с човешка гранулоцитна анаплазмоза, лекувани в Инфекциозно отделение на МБАЛ – Пазарджик. ***** Abstract: Anaplasmosis are diseases among animals and humans. These illnesses are presented with acute febrile syndrome, intoxication, and alteration in blood parameters. The pathological agents are microorganisms that infect granulocytes. The aim of this study is to present the clinical characteristics of three clinical cases of human granulocytic anaplasmosis. The patients are treated at the Department of Infectious Diseases, Hospital of Pazardzhik, Bulgaria.
Angiokeratoma 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.
Angioneurotic 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.
Anterograde 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.
Arterial 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.
Arthrogryposis 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.
Arthroscopic 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.
Association 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
Association 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.
Asymmetric dimethylarginine – рисков фактор и маркер за атеросклероза
(Централна медицинска библиотека, МУ София / Central Medical Library, MU Sofia, 2016-07) Петрова/Petrova, Ю./Yu; Манолов/Manolov, В./V.; Ангов/Angov, Г./G.; Петрова/Petrova, И./I.; Василев/Vasilev, В./V.; Цачев/Tzatchev, К./K.
Резюме: Атеросклерозата е една от водещите причини за смъртност в света и услож- нения след прекарани сърдечно-съдови иннциденти. Ендотелната дисфунк- ция предхожда изявата на атеросклероза. Азотен оксид, получен от ендотели- ума, е мощен ендогенен вазодилататор. Ниските нива на NO са свързани с нарушена ендотелна функция. Асиметричният диметиларгинин (АДМА) е ес- тествен продукт на обмяната на веществата в кръвната плазма и урина. По- вишени нива на AДMA инхибират NO синтез и следователно могат дa увредят ендотелната функция и по този начин се насърчава атеросклерозата. Пови- шените плазмени нива на АДМА корелират с кардиоваскуларни фактори като хиперхолестеролемия, артериална хипертония, захарен диабет, хронична сърдечна недостатъчност, диабет, хронична бъбречна недостатъчност и тю- тюнопушене. AДMA е предиктор на каротидната прогресия на IMT. Нивaта на AДMA са едни от най-силните предиктори за стабилна и нестабилна ангина. Значително повишено ниво на AДMA прогнозно се свързва с повишен риск от инсулт. Концентрацията на AДMA се увеличава след остър инсулт както в плазмата, така и в ликвора. Ендотелната дисфункция прогнозира ниско из- пълнение в няколко когнитивните домейни. Някои медикаменти имат благоприятен ефект върху сърдечно-съдовите заболявания чрез частично намаляване на нивата на ADMA, но засега няма убедителни данни. ***** Atherosclerosis is one of the leading causes for mortality and for complications after cardio-vascular diseases (CVD) worldwide. Endothelial dysfunction preceded atherosclerosis manifestation. Nitrogen oxide (NO) from endothelium reacts as one of main vasodilatators. Low NO levels are connected to endothelial dysfunction. Asymmetric dimethyl arginine (ADMA) inhibits NO synthesis and thus may damage endothelial function and leads to atherosclerosis development. Elevated serum ADMA concentrations correlates to cardio-vascular factors such as hypercholesterolemia, arterial hypertension, diabetes mellitus, chronic heart failure, chronic kidney injury and smoking. ADMA is a predictor of carotid IMT progression. ADMA levels are powerful CVD predictors. Elevated ADMA is connected to increased stroke risk. ADMA concentrations are elevated in serum and SCF both, after acute stroke. Endothelial dysfunction predicts low performance in several cognitive domains. Some trials shows that a few number of medical suplies has conductive effect on CVD, lowering ADMA levels.
Aктуални проучвания в ход по отношение на рака на маточната шийка (РМШ)
(Централна медицинска библиотека, МУ София / Central Medical Library, MU − Sofia, 2012-08) Корновски/Kornovski, Я./Y.; Исмаил/Ismail, Е./E.
Резюме. Направен е обзор на литературата по отношение на актуалното състояние на нау- ката при лечение на рака на маточната шийка (РМШ). Разгледани са проучвания в ход на EORTC (European Organisation for Research and Treatment of Cancer), както и други проучвания на GOG (Gynecology Oncology Group) при хирургичното и нехирургичното лечение на пациенти с РМШ. Маркирани са и съвременните насоки и тенденции в лечението на авансирал и рецидивиращ РМШ. ***** Summary. A review of the literature with regard to current knowledge in the management of cervical cancer patients has been made. Ongoing studies of the EORTC (The European Organisation for Research and Treatment of Cancer) and other studies of the GOG (Gynecology Oncology Group) in surgical and non-surgical management of cervical cancer patients have been described. The current trends and tendencies in the treatment of patients with advanced or relapsed cervical cancer have been traced.
Aктуални тенденции в коморбидния профил на алкохолно зависими пациенти
(Централна медицинска библиотека, МУ София / Central Medical Library, MU Sofia, 2016-10) Нейкова-Василева/Neykova-Vasileva, Л./L.
Резюме. Алкохолната зависимост е хронично-рецидивиращо заболяване, изискващо лечение. Алкохолът е причина за над 60 вида болести и травми – т.нар. коморбидност. Те могат да се появят по едно и също време или последователно. Цел на материала е да се актуализират типът и честотата на коморбидните заболявания при пациентите с алко- холна зависимост с оглед оптимизиране на детоксичното лечение. Тера- певтичният детоксикационен подход е съобразен не само с физиологич- ните промени, свързани с алкохолната злоупотреба, но и със съпътстващата коморбидност, което води до оскъпяване на лечението и до по-висок среден болничен престой. ***** Summary. Alcohol dependence is a chronic relapsing disease that requires treatment. Alcoholism causes over 60 types of diseases and injuries – the so-called comorbidity. They may occur at the same time or sequentially. The purpose of the article is to update the type and the frequency of the comorbid diseases in patients with alcohol addiction in order to optimize the detoxficating treatment. Detoxification therapeutic approach is consistent with the physiological changes associated with alcohol abuse, but also with the accompanying comorbidities, leading to much more expensive treatment and a higher average hospital stay.
Aнализ на разходите по диагнози, заплащани от НЗОК за амбулаторна терапия – част ІІ
(Централна медицинска библиотека - МУ София / Central Medical Library - MU Sofia, 2014-11) Златарева/Zlatareva, А./A.; Сопотенски/Sopotenski, С./S.; Грозданова/Grozdanova, М./M.; Петрова/Petrova, Г./G.
Резюме: Цел на проучването е да се извърши сравнителен анализ на разходите за терапия на заболяванията като диагнози в извънболничната помощ, зап- латени от НЗОК за 2012 и 2013 г. Събрани са официални публикувани данни за периода 2012-2013 г. и са анализирани разходите по анатомо- терапевтични групи. При направения анализ за периода януари-декември 2013 г. се наблюдава процес на нарастване на сумата, заплатена от НЗОК, като тази тенденция продължава до края на 2013 г. Причина за това е включването на нови лекарствени продукти, както и увеличението на броя болни с една или повече ресурсоемки диагнози, за чието лечение НЗОК заплаща. С най-голям дял е E11 Неинсулинозависим захарен диабет – 15%, на второ място като дял на изразходваните средства са хипертониите – 11%, третото място заема J44 Хронична обструктивна белодробна бо- лест – 9%, заболяването Артрити е на четвърто място по относителен дял на разхода със 7%, а на петоJ45 Астма с 6%. Динамиката в разходите за лечението им се определя от два основни фактора – включване на нови INN в лечението и промени в референтната реимбурсна стойност. ***** Summary: The purpose of this study is to perform a comparative analysis of the cost of pharmacotherapy paid by the National Health Insurance Fund (NHIF) for ambulatory care visits of patients with chronic conditions in 2012 and 2013. Official data were collected through the NHIF databases that were systematized and analyzed by INN, ICD code and therapeutic groups. For the analyzed period from January 2013 to December 2013, a process of increasing the amount, paid by the NHIF, was observed and this trend was noted until the end of 2013. The reason for this is the inclusion of new medicines and the increase in the number of patients with one or more resource consuming diagnoses for which treatment NHIF pays. With the largest share arel CD codes E11, ”Non-insulin-dependent diabetes mellitus”15%, followed by ”Hypertension” codes11%, third place is occupied by J44 “Chronic obstructive pulmonary disease”9%, the disease “Arthritis” is the fourth highest share of expenditure with 7% and the fifth one is J45 „Asthma” by 6%. The dynamics in the expenditures is a results of the influence of two main forces, which are the inclusion of new INN in the therapy and changes in the reference reimbursement value.
Aсоциирана с бременността тромботична микроангиопатия и остра бъбречна увреда
(Централна медицинска библиотека, МУ София / Central Medical Library, MU − Sofia, 2013-09) Любомирова/Lubomirova, М./M.
Резюме: Острата бъбречна увреда (ОБУ) е рядко, но сериозно усложнение по време на бременността. Бъбречната недостатъчност може да усложни няколко други специфични за бременността състояния – тежката прееклампсия/HELLP синдром, острата чернодробна стеатоза на бременността (AFLP) и тромботичната тромбоцитопенична пурпура (TTP) най-често се усложняват с ОБУ. Тези заболявания са диагностични предизвикателства пред клинициста. В статията се обсъждат клиничните и лабораторните характеристики, патофизиологията и лечението на тези три условия, с особено внимание към бъбречните прояви. Наложително е заболяванията да се разграничат, за да се предприемат съответните терапевтични решения, които могат да бъдат животоспасяващи за майката и плода. Обикновено AFLP и HELLP се подобряват след родоразрешението, а за ТТП плазмафереза е първа линия на лечение, като бъбречното възстановяване е проблемно и майчината смъртност остава все още висока. ***** Summary: Acute kidney injury (AKI) is a rare but serious complication of pregnancy. Renal insuffi ciency can complicate several other pregnancy-specifi c conditions. In particular, severe preeclampsia/HELLP syndrome, acute fatty liver of pregnancy (AFLP) and thrombotic thrombocytopenic purpura (TTP) are all frequently complicated by AKI, and share several clinical features which pose diagnostic challenges to the clinician. In this article, we discuss the clinical and laboratory features, pathophysiology and treatment of these 3 conditions, with particular attention to renal manifestations. It is imperative to distinguish these conditions to make appropriate therapeutic decisions which can be lifesaving for the mother and fetus. Typically AFLP and HELLP improve after delivery of the fetus, whereas plasma exchange is the first-line treatment for TTP.

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