Varna Medical University Press: Journals
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Nasal patency in opera singers – first examinations on the premises of Medical University – Varna
Get PDFBackground:Human voice is produced by air going through the vocal folds, causing them to vibrate. Human brain controls how they would fold and snap in order to produce the different sound waves. The Syndrome of Obstructive sleep apnea and snoring (SOSAS) is a widespread disease of significant social importance. Rhinomanometry can be used to assess nasal patency and monitor the effectiveness of CPAP therapy in severe forms of the syndrome by determining tissue resistance. The response of patients with milder forms of OSA treated with intraoral devices can be monitored with the help of rhinomanometry. The method is utilized in patients with allergic rhinitis, sinusitis of rhinogenic and other origins, and in patients with orthodontic deformities.The aim of the following article is to study the nasal resistance in opera singers and to continue the fruitful collaboration between the University medical and dental center, Medical University „Prof. Dr. Paraskev Stoyanov” – Varna and the Varna Opera theater.Methods:A total of 50 patients (27 males and 23 females) encompassing different voice types and ranges (soprano, tenor, baritone, bass, mezzo-soprano, alt), all from Varna Opera Theatre, have been recruited to the following study in the period November 2023-December 2024. The study was the first of its kind on the premises of Medical University – Varna. All of them were examined in the Sector „Audio-vestibular and Sleep medicine”, University medical and dental center, Medical University – Varna. All patients were examined by the same specialist in otorhinolaryngology. All participants, included in the study, underwent а full otorhinolaryngologic examination, including otoscopy, rhinoscopy and a hearing check-up – audiometry, tympanometry, OAE (all done with Interacoustics®, Dennmark devices) and rhinomanometry (Atmos® Rhino 31, Germany). The anterior measuring method is utilized when rhinomanometry examinations were executed. All examinees filled in written informed consent forms and questionnaires regarding their health status, general diseases, allergies present, surgical interventions done in the head and neck area. According to the specific clinical case, X-ray and CT-scans were done. Treatment and prophylactic measures have been prescribed. The study has received approval from Medical University – Varna’s Ethics commission (№ 131 / 11.05.2023).Results and discussion:Of the examined 50 participants, disorders have been diagnosed in 40 (80 %, 20 male and 20 female patients) of them. In 10 participants (7 male, 3 female) no ENT disorders have been diagnosed (control group). Chronic sinusitis, chronic pharyngitis, chronic laryngitis and allergic rhinitis were the most frequent diagnoses reached. Moderate symptoms of harshness and changed timbre and pitch were diagnosed. No cases of severe voice disorders caused by gastroesophageal reflux, vocal nodules, cancer of the larynx or neurological diseases were reported. No cases of hearing loss – either of conductive, sensorineural or mixed type were diagnosed. Rhinomanometry is a valuable and effective functional method for additional diagnostics and monitoring of patients with obstructive sleep apnea, allergic rhinitis (with and without nasal polyposis), sinusitis of rhinogenic and other origin, orthodontic deformities, monitoring of patients after COVID-19 infection and other diseases. Early detection of the changed upper airway resistance through rhinomanometry can slow and prevent the development of obstructive sleep apnea and snoring syndrome. It is important to emphasize the effects of allergic conditions on the nasal mucosa, as well as the prolonged use of nasal decongestants.Conclusions:Collaboration between different types of medical and dental specialists should be implemented nowadays in order to provide the right initial diagnostics, following treatment and care for patients. Prophylactic and preventive measures are to be executed on a daily basis to keep the health of the voice apparatus, including oncologic diseases
Prenatal and postnatal care among Roma mothers: ethnocultural factors and health challenges (Qualitative study)
Get PDFSummary: Background: Roma women in Bulgaria continue to face systemic barriers in accessing prenatal and postnatal care. Socio-economic difficulties, cultural specificities, and discriminatory attitudes in the healthcare system affect the quality of maternal and child health.Objective: To examine the cultural characteristics and challenges related to prenatal behavior and care for children aged 0 to 1 year among mothers of Roma origin.Method: Eleven in-depth interviews were conducted with Roma mothers from different locations (the town of Dulgopol and neighborhoods in Varna). The data were analyzed using thematic analysis.Results: Mothers demonstrate high motivation to care for their children, regularly attend antenatal and postnatal clinics, and evaluate some of the health services positively. However, the following were identified:limited postnatal support and lack of training in maternity wardsunsystematic home visits to newbornsinsufficient information about schools for parentssignificant influence of the family and kinship system — as a source of support, but also as a source of outdated and risky practices .discriminatory aspects of health carePositive changes are observed, such as later first births, a better attitude towards education for girls, and a more active role for fathers.Conclusion: Improving maternal and child health care in Roma communities requires a culturally sensitive and integrated approach that combines professional support, community work, father involvement, and increased health literacy
Cost-Effectiveness Evaluation Of The Use Of Malaria Chemoprophylaxis
Get PDFThe aim of the article is to evaluate the cost-effectiveness of malaria chemoprophylaxis in adult individuals using a cost-effectiveness economic analysis and applying the payer's perspective in Bulgaria (NHIF). The methodology includes documentary and comparative analysis of official recommendations and guidelines, as well as national legislation on chemoprophylaxis. Two economic models were used to assess the cost-effectiveness of chemoprophylaxis: the decision tree and the Markov model, created using the specialized modeling software TreeAge Pro 64-bit.A cost-effectiveness analysis was conducted to assess the cost-effectiveness of malaria chemoprophylaxis, using incremental values for costs and health benefits in the form of additional life years (LY). Based on these values, the incremental cost-effectiveness ratio (ICER=BGN/LY) was calculated. The analysis was performed at a cost-effectiveness threshold of BGN 86,215/LY (three times the GDP per capita for 2023 in Bulgaria, according to NSI data). The regimen chosen for modeling was Malarone (INN: atovaquone + proguanil hydrochloride).The decision tree traces the pathway of a patient exposed to malaria risk, with the final outcomes generated based on the probability of the modeled events occurring. The model assumes a 1-year duration, using annual probabilities of event occurrence, as well as annual values for health benefits and costs. The probability of mortality was calculated based on malaria mortality data in Bulgaria for the period 2011–2020 (2.70%), while the probability of recurrence was based on expert opinion (25%). The analysis shows that the "with prophylaxis" strategy is economically advantageous and effective. It results in an average cost of BGN 940.14 per patient, which is BGN 400.56 less compared to the "without prophylaxis" strategy. In addition to financial benefits, "with prophylaxis" provides an additional 1.08 years of life. According to the Markov model, the "with prophylaxis" strategy dominates by offering lower costs and higher health benefits
Implantation of a pacemaker in a patient with stenotic reimplanted tricuspid valve prosthesis
Get PDFA 67-year-old woman was admitted to a Cardiology Department with clinical signs of decompensated heart failure on the background of atrial fibrillation with absolute arrhythmia and a history of syncope. The patient had a history of two tricuspid valve replacements. Transthoracic echocardiography revealed significant tricuspid stenosis of a biological Ionescu–Shiley valve prosthesis.During hospitalization, episodes of bradycardia and prolonged pauses were recorded, necessitating implantation of a permanent pacemaker. Due to limited anatomical options, a PM-mode-CRT-P system was implanted with a single electrode.Subsequent follow-up demonstrated satisfactory overall condition, without exacerbation of heart failure, and with effective ventricular pacing.This case highlights the challenges in managing patients with biological tricuspid valve prostheses, in whom degenerative restenosis is a common late complication requiring an individualized approach when selecting the optimal pacing strategy
Acute sialoadenitis of the submandibular salivary glands and acute inflammation of the submandibular lymph nodes. A review article
Get PDFINTRODUCTION: Acute inflammation of the submandibular salivary glands and submandibular lymph nodes in humans are common diseases. Their clinical manifestation largely overlaps, but there are also a number of significant differences between them.MATERIALS AND METHODS: This is a review article whose aim is to provide clear and understandable information on the diagnosis, treatment and prognosis of acute inflammation of the submandibular salivary glands and submandibular lymph nodes in humans. It was written after analyzing information on the topic from 57 full-text articles from peer-reviewed medical journals.RESULTS AND DISCUSSION: The causes of sialoadenitis of the submandibular glands are mainly the anatomical features of the submandibular duct, the high viscosity of the saliva produced by them, and previous sialolithiasis of the duct or of the parenchyma of the gland. In children, acute lymphadenitis of the submandibular lymph nodes is most often due to infections of the upper respiratory tract, and in adults it has an odontogenic origin. The treatment of both diseases includes the mandatory intake of antibacterial drugs, and in the presence of purulent exudate, surgical treatment is carried out in the form of incision, lavage and drainage.CONCLUSION: With early diagnosis and treatment, the prognosis of these diseases is good, but with high virulence of the bacterial causative agents and/or congenital and acquired diseases of the patient’s immune system, the treatment may be prolonged
Financial analysis of university hospitals in Bulgaria
Get PDFImproving the financial condition of university hospitals is a high priority for their owners and stakeholders. One of the most common problems for state-owned hospitals in Bulgaria is their financial instability. The stable financial state of these hospitals is imperative for their increasing development and ensures the success of their socially required functions.The study aims to analyse the financial health of university hospitals in Bulgaria and draw conclusions regarding the hospitals' long-term solvency and level of financial stability.The study covers a period of five years, from 2017 to 2021. Key financial indicators are observed to assess the financial state of the predominantly government-owned university hospitals. The primary information source for this study is the annual financial statements published in the Commercial Register.Results indicate a contrast in the values of financial indicators between hospitals in good and improving financial states and those in deep financial distress. In the latter, there is a high level of dependence on creditors and financial support by the owner. There is a clear correlation between low liquidity and profitability ratios and changes in capital structure, leading to increased indebtedness and deepening processes of reducing owner's equity.The results of the financial analyses are crucial to the hospital management boards. They provide detailed information on the current financial health and have high predictive value. Every responsible health manager should be familiar with the indicators for assessing the financial status of the structure they manage and take measures when alarming trends are present. The financial analysis should be used as a basis for better-informed management decisions
Incretin-mimetic drugs—nature, benefits, and risks
Get PDFIncretins are gut-derived hormones that are secreted within minutes of a meal to regulate insulin secretion from the pancreas. Currently, the two best-studied incretins are glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Incretin-mimetic drugs are the GLP1-receptor agonists and the dual agonist of GIP and GLP-1 receptors. They represent the most modern and effective therapy for patients with type 2 diabetes mellitus. Their application is associated with an improvement in glycemic control, as well as many additional benefits for patients treated with them.The aim of this review is to analyze the available data on the benefits and risks of incretin mimetics.Among these benefits are a loss of body mass, a favorable influence on the lipid profile, a reduction in blood pressure, and beneficial effects on atherosclerotic cardiovascular disease, confirmed in a number of clinical studies.However, the use of this relatively new class of drugs may be associated with certain side effects. The most common are gastrointestinal symptoms, injection site reactions, headache, and nasopharyngitis, but these effects usually do not lead to discontinuation of therapy. Studies suggest an increased risk of pancreatitis and thyroid cancer in patients treated with these medications, but several meta-analyses have failed to confirm the relationship between their use and the development of these adverse effects. Ongoing and future studies should evaluate and further elucidate the cardiovascular and overall safety profile of GLP-1 receptor agonists and the dual agonist of GIP and GLP-1 receptors
Risk factors, prevention, and treatment of the medication-related osteonecrosis of the jaw: A review
Get PDFMedication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with the administration of antiresorptive and antiangiogenic drugs. It can affect both jaws, but the lower one is more frequently involved. Its clinical features include bone exposure and necrosis in patients who have undergone antiangiogenic or antiresorptive therapy and without a history of radiation in the maxillofacial area.This review aims to summarize and analyze the current knowledge on the risk factors, prevention, and treatment of MRONJ, to identify the research gaps, and to give recommendations for future research.An electronic search in PubMed, Scopus, and Web of Science was conducted in August 2024. After analysis of the obtained data, 23 articles were included in this study.Risk factors for developing MRONJ include the type of medication, treatment duration, dosage, and route of administration, poor oral hygiene, local infection and inflammation, smoking, corticosteroid therapy, and comorbidity. Triggering factors are invasive dental procedures, dentoalveolar surgery, and other traumatic agents, such as dentures that do not fit well.Prevention strategies include full dental consultation, radiological evaluation, treatment, and professional oral hygiene before initiating antiresorptive or antiangiogenic therapy, perioperative antimicrobial prophylaxis, and primary wound closure. One of the most common prevention methods in case of dental problems requiring invasive treatment has been the so-called drug holiday, which is a pause from drug administration before bone surgery.The treatment of MRONJ depends on its stage, severity, and individual characteristics. It includes conservative therapy, surgical interventions, adjuvant therapy, and a combination of them