Varna Medical University Press: Journals
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How to work safely with hazardous drugs
Full text linkIntroduction: Numerous published scientific articles in the 1970s and 1980s on the effects of cytotoxics on the personnel who work with them led to the introduction of the term “hazardous drug.” It was first used by ASHP (American Society of Health-System Pharmacists) in 1990. The term was revised by the US National Institute for Occupational Safety and Health (NIOSH) in 2004. It is used for drugs that are known or suspected to have adverse health effects as a result of employee exposure during work.Aim: Systematized presentation of the basic rules for safe handling of hazardous medicinal products, according to established American, European, and national standards.Materials and Methods: A documentary method was applied. The guidelines and recommendations of ASHP (American Society of Health-System Pharmacists), NIOSH (National Institute for Occupational Safety and Health), EU-OSHA (European Agency for Safety and Health at Work), and the Bulgarian legislation through the Health and Safety at Work Act and Ordinance No. 10 of 26.09.2003 on the protection of workers from risks associated with exposure to carcinogens, mutagens, or substances toxic to reproduction during work were studied and analyzed. The basic rules and good practices for safe work with hazardous medicinal products were derived.Results: There are established international standards for safe work with hazardous medicinal products, as well as regulatory documents of the European Union. Gradually, changes are being made to the Bulgarian legislation in this direction, and the foundations have been laid, but there are still many detailed guidelines and competent control measures that would guarantee the protection of employees who come into contact with mutagenic, carcinogenic, and reproductively damaging medicines.Conclusion: The presence of hazardous drugs in the workplace requires a series of measures on the part of employers, workers, and control authorities, to ensure safe working conditions. The creation of standard operating procedures in medical institutions, which cover all actions related to carcinogenic drugs—receipt, storage, protection, transport, preparation, administration, waste management—is part of the processes of prevention and protection of employees. However, even the best written procedures have no effect if they are not applied and followed
Medication-related osteonecrosis of the jaw—etiology, pathophysiology, clinical and radiological characteristics, and staging: A review
Full text linkIntroduction: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious condition, caused by several classes of pharmaceutical agents, the most common of which are antiresorptive and antiangiogenic drugs. It is characterized by exposed necrotic bone, most commonly associated with antiangiogenic or antiresorptive therapy, and without a history of radiation exposure to the head and neck.Aim: This review aims to compare, and summarize the current knowledge on the etiology, pathophysiology, clinical and radiological characteristics, and staging of MRONJ, to identify the research gaps in the scientific literature, and to give recommendations for further research.Materials and Methods: An advanced electronic search was performed in PubMed, Scopus, and Web of Science, using selected keywords. Results were extracted to an MS Excel spreadsheet and assessed for eligibility after duplicate removal. After analysis of the obtained data, 35 articles were included in this study.Results and Discussion: The most common medications that cause MRONJ are antiresorptive and antiangiogenic drugs. Other possible agents are immunomodulators, monoclonal antibodies, corticoids, cytostatic drugs, etc. Numerous hypotheses for the pathophysiology of MRONJ have been suggested, including bone remodeling inhibition, impaired angiogenesis, specific infections, etc. Further research is necessary to confirm the role of different drugs in the pathogenesis of MRONJ.Conclusion: Despite the strong association between MRONJ and antiresorptive and antiangiogenic drugs, the exact pathophysiology of the disease is not fully understood. Future studies should investigate their mechanisms of action and correlation to MRONJ. Understanding its etiopathogenesis is essential for all medical practitioners in order to reduce MRONJ incidence and avoid its misdiagnosis
Contemporary treatment in children with ventricular extrasystoles without underlying structural cardiac pathology
Full text linkIntroduction: Ventricular extrasystoles (VES) in childhood occur in both children with congenital heart malformations and those without structural heart pathology. In most cases, no treatment is necessary. In patients with a high frequency of VES and subjective complaints or the presence of an underlying cardiac indication, drug treatment should be initiated.Aim: The aim of this article is to summarize and evaluate therapeutic approaches in children with VES without underlying structural heart pathology by analyzing the available literature in PubMed, Google Scholar, Cochrane Library, Medscape.Results: Beta blockers are the first choice for the treatment of VES in children. In case of failure or contraindication to their use calcium antagonists are included. Antiarrhythmic drugs of class I or class III can also be used to treat more complex or resistant VES due to their proarrhythmic potential. If drug therapy fails, ablation of the focus is performed.Conclusion: Most patients do not require drug treatment. When initiating such treatment, an assessment of the VES, the patient's impact, and possible side effects should be made.
Oesophageal and Gastric Varices – Pathogenesis, Screening and Primary Prophylaxis
Full text linkOesophageal and gastric varices represent one of the most serious complications of portal hypertension in patients with liver cirrhosis. They reflect advanced liver damage and are a leading cause of significant morbidity and mortality associated with acute variceal bleeding. Understanding the pathogenesis—encompassing elevated portal pressure, haemodynamic alterations and structural adaptations in the portosystemic circulation—is essential for optimal clinical management.In recent years, substantial progress has been made in strategies for the early identification of patients at high risk of a first bleeding episode. Endoscopic screening remains the gold standard, but non-invasive methods such as transient elastography and serum-based indices have been introduced and validated, allowing postponement or avoidance of invasive procedures in selected patients. Primary prophylaxis is a cornerstone of contemporary cirrhosis management and includes pharmacological therapy with non-selective beta-blockers or endoscopic variceal ligation, with the choice depending on the individual risk profile and endoscopic findings.This review presents current concepts in the pathogenesis, diagnostic approach and primary prophylaxis of oesophageal and gastric varices, with emphasis on personalised risk assessment and the integration of modern non-invasive methods into clinical practice
Mobile Apps and Challenges for Type 1 Diabetes Control in Children
Full text linkIntroduction: Mobile applications are increasingly being utilized in the management of type 1 diabetes (T1D) in children, providing tools to enhance glycemic control, self-management, and adherence to treatment protocols. However, their impact on clinical and behavioral outcomes remains understudied.Aim: This study aimed to evaluate the differences in glycemic control, hypoglycemia frequency, and related management behaviors between children who use mobile apps for carbohydrate counting and those who do not.Methods: A cross-sectional study was conducted among 76 children with T1D, divided into app users (n = 16) and non-users (n = 60). Data on demographic characteristics, glycemic control metrics, hypoglycemia frequency, blood glucose monitoring methods, and challenges in carbohydrate counting were collected. Statistical analysis included chi-square tests for categorical variables and independent t-tests for continuous variables.Results: App users had a significantly lower prevalence of abnormal glycated hemoglobin (HbA1c) levels compared to non-users (37.5% vs. 75.0%; p = 0.005) and reported no challenges in carbohydrate counting (0% vs. 26.7%; p = 0.043). Hypoglycemia frequency differed significantly between groups (p = 0.027), with daily hypoglycemia being more common among app users (37.5% vs. 10.2%), while non-users experienced more weekly or less-than-weekly hypoglycemia. Time spent outside the glycemic range was not significantly different between groups. Anthropometric and demographic characteristics, including age, BMI, height, weight, and parental education, were comparable between groups.Conclusion: Mobile apps for carbohydrate counting are associated with improved glycemic control and fewer challenges in diabetes management. However, the higher frequency of hypoglycemia among app users highlights the need for app optimization to balance glycemic control while preventing hypoglycemia. These findings underscore the importance of integrating digital tools into pediatric diabetes care and refining their functionalities to maximize their clinical benefits
Non-Pharmacological Approaches For Optimizing Glycemic Control In Patients With Diabetes Mellitus
Full text linkThe incidence of diabetes mellitus increases with age, mainly due to impaired insulin secretion and insulin sensitivity. There is a linear relationship between weight gain and the risk of developing diabetes, with obesity being a significant risk factor. All patients with diabetes mellitus should be informed of the need to change their lifestyle as soon as they are diagnosed. The aim of this study is to evaluate the role of non-pharmacological interventions for optimizing glycemic control in patients with diabetes mellitus. We conducted a documentary and content analysis of the guidelines issued by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD) and scientific publications, included in the Medline database. Diabetes self-management education and support, medical nutrition therapy (MNT), routine physical activity and psychosocial care are essential for improving glycemic control in patients with diabetes mellitus. MNT is associated with a reduction in glycated hemoglobin (HbA1c) level of 1.0–1.9% in patients with type 1 diabetes and 0.3–2.0% in patients with type 2 diabetes. Regular physical activity (≥150 min/week) leads to an average reduction in HbA1c of 0.66%. The prevalence of diabetic distress ranges between 18-45%. The administration of psychosocial care in patients with diabetes leads to a reduction in HbA1c level by an average of 0.19%
Methods for obtaining synthetic carbonate apatite for bone regeneration: A review
Full text linkThis review examines the most common methods for the preparation of synthetic carbonate apatite for bone repair in the last ten years. The article is organized into two sections. First, the methods for obtaining powdered carbonate apatite with nanosized particles by wet chemical precipitation reactions are presented, considering the starting reagents and the conditions of the chemical reactions. The second section presents the preparation of carbonate apatite blocks and/or granules by dissolution-precipitation reactions. The transformations occurring in these interactions are systematized according to the type of precursor, soaking solution, and reaction conditions
Сборник с резюмета. I научна конференция с межд. участие "Здравните грижи – принос за качеството на живот"
No full textMaxillary sinus—structure, function, and inflammatory diseases. A review article
Full text linkINTRODUCTION: Diseases of the maxillary sinuses are diverse and are the subject of different medical specialties. We divide them mainly into those of odontogenic origin, which require maxillofacial surgery, and those of rhinogenic etiology, which are the subject of otolaryngology specialists.MATERIALS AND METHODS: The present review article was written after analyzing information from 31 full-text articles published in prestigious medical journals.RESULTS AND DISCUSSION: The maxillary sinuses are paired intraosseous spaces located within the maxillary bone. They have six walls, are innervated by the trigeminal nerve, and their blood circulation is carried out by three different arterial sources. They communicate with the nasal cavity through an opening that communicates with the middle nasal passage. Their inflammations, called sinusitis, according to their course, are divided into acute and chronic and are treated both conservatively and surgically. The most common surgical intervention in the treatment of odontogenic maxillary sinusitis is radical maxillary antrotomy. Predisposed to the occurrence of odontogenic infection are sinuses with less bone in their floor, in which the tooth apices are located higher and are closer to the sinus cavity. The most common tooth causing an odontogenic sinus infection is the upper first molar. Their diagnosis includes imaging studies (usually computed tomography or nuclear magnetic resonance), general laboratory tests, microbiological, virological, and pathological analysis.CONCLUSION: Of primary importance for inflammatory diseases of the maxillary sinuses are their early diagnosis, their timely treatment and the individual approach to each patient, which is based on an important and not always easy collaboration between different medical specialists
Overview of the quality aspects and regulatory frame of the non-interventional studies
Full text linkUnmet medical needs require the development of new medicines and health technologies. Non-interventional studies (NIS) are one of the most effective ways to obtain real-world additional information regarding drug efficacy, effectiveness, and safety. These studies are conducted with approved medicines and within the scope of their standard use, aiming at collecting additional drug safety information from patients and healthcare professionals. A good understanding of NIS requires a clear distinction between them and clinical trials. European regulatory documents in the field of clinical trials are not applicable to non-interventional studies due to the lower risk of their conduct, but country-specific regulation is used instead. The national legal framework governing public relations related to clinical trials and non-interventional studies is diverse and includes a large number of regulations, which is a prerequisite for inconsistency in its applicatio