Varna Medical University Press: Journals
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Does COVID-19 infection affect the effectiveness of hemodialysis?
Get PDFIntroduction: The COVID-19 pandemic has had a lasting impact on healthcare in many Western countries. It has been proven that the infection damages the vasculature of affected patients (both microvascular and macrovascular damage). In this study, we compared the effectiveness of the dialysis procedure by examining the parameters of the Urea Reduction Ratio (URR) and Kt/V in patients before and after infection with COVID-19.Materials and Methods: The study included 50 patients with end-stage renal disease undergoing chronic hemodialysis therapy who had also experienced COVID-19 infection. Among them, 29 were men and 21 were women, with an average age of 64 years. Of the 49 patients, 22 had an arteriovenous fistula, 24 had a permanent central venous catheter for hemodialysis, and 2 had a temporary central venous catheter. All patients were examined under the same conditions before and after COVID-19 infection (equal procedure duration, identical filters, and vascular access).Results: The values of the Urea Reduction Ratio (URR) and Kt/V were measured in patients before and after experiencing COVID-19 infection. The study did not find a significant difference in the effectiveness of hemodialysis before and after COVID-19 among the cohort of examined patients.Conclusion: Although macrovascular damage has been described in the literature in cases of COVID-19 infection, no significant difference in the quality of vascular access was observed in the studied population
Current aspects of neutrophil gelatinase-associated lipocalin (NGAL)
Get PDFNeutrophil gelatinase-associated lipocalin (NGAL) is a 25-kDa protein primarily secreted by immune cells such as neutrophils, macrophages, and dendritic cells, with its production stimulated in response to inflammation. NGAL concentrations can be measured in plasma, urine, and other body fluids. It is mainly recognized as a biomarker of acute kidney injury and is released following tubular injury as well as during renal regeneration. NGAL levels are also elevated in chronic kidney disease and dialysis patients and may serve as a predictor of renal function deterioration in those with renal failure. Additionally, NGAL plays a role in the diagnosis of liver diseases such as non-alcoholic fatty liver disease (NAFLD) and cardiovascular conditions. Elevated NGAL levels are also observed in obesity, diabetes, and metabolic complications, including insulin resistance. This review presents the current perspectives on NGAL and its role in kidney and liver diseases
The potential role of collagen biomaterials in periapical surgery—a review
Get PDFINTRODUCTION: Apical surgery is a method belonging to endodontic surgery, applicable in cases where conventional endodontic treatment or retreatment cannot lead to a healing process by itself. The primary objective is to create optimal conditions for the recovery of the periradicular tissue. The success of this procedure depends on various factors. Among them is the size of the bone defect. The formation of bone around the tooth root following apical surgery is crucial for its long-term prognosis. Tissue engineering has the potential to overcome the limitations of already existing bone regeneration methods through the application of scaffolding materials for the migration and attachment of cells with osteogenic potential. Natural polymers like collagen demonstrate significant suitability for these purposes. AIM: The aim of this study is to summarize the data in the literature regarding the application of collagen biomaterials in the field of bone regeneration. The healing processes after apical surgery were examined and the potential role of collagen materials in stimulating osteogenesis was also evaluated. MATERIALS AND METHODS: The present literature review is based on different researches in Google Scholar, PubMed, and Web of Science databases to obtain the needed information. The keywords used were: collagen-based materials, bone repair, apicoectomy, tissue engineering, and periapical surgery. All the articles that were researched were in English. RESULTS: There is evidence for the positive impact of collagen materials on bone regeneration processes. Applied alone or in combination with other materials, the porous structure of the collagen sponge has been proven to be a favorable environment for cell adhesion and proliferation. It possesses suitable structural characteristics to be used as a potential substrate to enhance bone regeneration. CONCLUSION: Despite collagen’s favorable biological characteristics, the question regarding its influence on the proliferation of connective tissue in complicated periapical lesions remains uncertain. Presently, there is a lack of data in the literature describing complete bone recovery in these defects achieved only by the application of collagen sponges. Further clinical studies are needed
A multidisciplinary approach for post-COVID-19 disease prevention of the staff of the Medical University of Varna
Get PDFIntroduction: The changes in the working conditions of higher education staff during the pandemic caused difficulties in organizing the study process, which impacted both their physical and mental health.Aim: The dual aim of this article was to apply a set of multidisciplinary interventions targeting disease prevention and evaluate the effectiveness of the multidisciplinary approach for post-COVID-19 disease prevention of the staff the Medical University of Varna (MU-Varna).Materials and Methods: The surveyed group included all members of staff of MU-Varna (approx. 1500 people). Personalized survey questionnaires and standardized questionnaires were used. The applied methods were: descriptive statistics, non-parametric hypothesis tests, correlation analysis, etc.Results: The majority of the surveyed subjects (63.9%) used a computer for more than six hours a day for five working days. Those who did sports twice or three times a week were 39.8%.Moderate to severe anxiety was registered in 12.1% of the participants. More than half of the staff demonstrated a high degree of emotional exhaustion according to the Maslach Burnout Inventory (MBI).A total of 40 employees received occlusal splints for treating their bruxism. They reported reduced episodes of affect, anxiety, and fatigue.During eye examinations, the predominant eye conditions were presbyopia (62%) and dry eye syndrome (74%).Cosmetic therapies causing controlled micro trauma on the skin had a faster and broader spectrum impact on the so-called mascne.Conclusion: The project activities proved the effectiveness of the multidisciplinary approach for disease prevention and better quality of life of MU-Varna employees
Professional Orientation of Students in the `Nursing` Specialty
Get PDFIntroductionThe profession of a nurse is dynamic, demands high responsibility, and provides opportunities for career realization in various fields of healthcare, corresponding to the needs of the population for health services. Students' professional choices are shaped during their studies.AimThe aim of this research is to study and analyze the factors determining the professional orientation of students majoring in Nursing.Materials and MethodsA study was conducted through an anonymous survey among Nursing students at the Sliven Affiliate of the Medical University of Varna.ResultsFor the majority of respondents (83.5%), Nursing was their first professional choice. Employment opportunities were the main motive in choosing a profession for 37.6% of respondents. Hospital care facilities were the preferred workplace for 54.1% of respondents, while the nature of the work was the leading factor in choosing a workplace for 55.6% of interviewees. Building on existing studies, further education towards a higher education qualification was a priority for 57.1% of the students surveyed.ConclusionMotivation for choosing a profession and professional orientation during the education of Nursing students is important both for the students themselves and for the healthcare system at large. Hospital care facilities are the most attractive for professional realization, with the nature of the work being the primary factor for professional orientation of future nurses. It is encouraging that a large number of students express a desire to continue their studies and pursue a higher educational degree after obtaining their Bachelor’s degree
Cytokeratin-18 as a noninvasive biomarker of inflammation in nonalcoholic fatty liver disease
Get PDFIntroduction: Nonalcoholic fatty liver disease (NAFLD) is a public health problem of global significance. It is defined as the presence of hepatic steatosis in more than 5% of hepatocytes, as determined by imaging or histological examination, in individuals consuming little or no alcohol, and in whom a secondary cause of steatosis has been excluded. Because of the proven association between NAFLD and metabolic syndrome (MetSyn), an international panel of experts has proposed to replace the term non-alcoholic fatty liver disease with the term metabolic-associated fatty liver disease (MAFLD). Nonalcoholic fatty liver disease is divided into two main groups: nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Multiple serum biomarkers have been investigated to predict the presence of NASH. Cytokeratin-18 (CK18) is the only validated biomarker. It is a marker of hepatocyte apoptosis and predicts presence of steatohepatitis.Aim: The aim of this article is to evaluate the application of CK18 as a diagnostic marker of inflammation in NAFLD and its relevance using anthropometric parameters, routine laboratory tests, ultrasonographically defined degree of steatosis, and stage of fibrosis calculated from non-invasive scores.Materials and Methods: The study included 61 persons with ultrasonographycally proven NAFLD (mean age 56.9 years). Data on anthropometry, clinical features, standard laboratory tests, ultrasound examination, and serum levels of total CK18, determined by the ELISA method, were collected. Using some laboratory parameters and clinical characteristics of the patients, scores for non-invasive assessment of fibrosis were calculated.Results: Normal CK18 levels were found in 55 patients (90.17%), and an increase in CK18 above 5 ng/mL, indicating the presence of steatohepatitis, was found in 6 patients (9.83%), of which 2 males and 4 females. In CK18 levels above 5 ng/mL (ULN), we accepted a diagnosis of steatohepatitis. We found moderately strong positive correlation between the level of triglycerides and CK18, indicating an increase in the levels of triglycerides in parallel with the CK18 levels. Such correlation was not found with the increase of body mass index (BMI) and waist circumference and the increase in CK18 levels. Significantly increased AST, ALT, and GGT levels were observed in the group of patients with CK18 above 5 ng/mL, compared to the patients in the group with normal CK18. In our study, the correlation analysis between the level of CK18 and the degree of steatosis and the stage of fibrosis did not find a statistically significant correlation.Conclusion: We assumed that the detection of elevated CK18 levels is a reliable method to prove inflammation in NAFLD
The potential of homeopathy for treating allergic rhinitis
Get PDFAllergic rhinitis is not only a medical but also a social problem. The impairment of quality of life from rhinitis is comparable to that of moderately severe bronchial asthma. In search of a safe, but also effective, alternative to the established therapy for the long-term effects of allergic rhinitis, more and more patients are directed to a consultation with a homeopathic doctor. The present study aimed to investigate homeopathy's effectiveness in treating allergic rhinitis. More than 20 literature sources have been studied, presenting successful therapy for patients with allergic rhinitis and other diseases with homeopathy. Databases such as Scopus, Web of Science, PubMed, and Google Scholar were used, as well as the medical documentation of a patient with seasonal allergic rhinitis, treated with homeopathy, treated with homeopathy at the "Dr. Kehayovi Health Center" in the city of Varna. The literature review results and the clinical case showed that homeopathy is an effective and completely safe alternative to conventional medicine, providing the patient with disease control and reduced exacerbations
Contemporary imaging diagnosis and operative treatment of carotid artery atherosclerosis
Get PDFIn this review, novelties in the field of imaging diagnosis and surgical treatment of patients with atherosclerotic stenosis of the carotid arteries are presented. Ultrasonography, computed tomography, computed tomographic angiography, magnetic resonance imaging, and magnetic resonance angiography are the main modern diagnostic methods. These methods are applied either alone or in combination to patients with asymptomatic and symptomatic carotid stenosis. Recently published results from the application of carotid artery stenting, carotid endarterectomy, and transcarotid artery revascularization are also discussed
Cerebral vasospasm in subarachnoid hemorrhage: Fisher scale classification, treatment challenges, and prognosis
Get PDFCerebral vasospasm is one of the most serious complications after subarachnoid hemorrhage (SAH), leading to significant morbidity and mortality. Vasospasm is characterized by prolonged and unpredictable narrowing of blood vessels in the brain, which can lead to ischemia and secondary stroke. Understanding the pathophysiological mechanisms and developing effective diagnostic and therapeutic strategies is critical to improving clinical outcomes in patients with SAH(1).Subarachnoid hemorrhage usually occurs as a result of aneurysm rupture or trauma, leading to hemorrhage into the subarachnoid space. The blood in this space causes an inflammatory reaction, which is a major factor in the subsequent vasospasm(2).The pathophysiology of vasospasm is multifactorial and complex. The main mechanisms include:1. Inflammatory reactions: Blood in the subarachnoid space triggers the release of inflammatory mediators such as cytokines and free radicals, which can cause direct vasoconstriction and endothelial cell damage.2. Mechanical factors: The presence of blood and products of its degradation (for example, hemoglobin) can lead to mechanical irritation and narrowing of the vessels.3. Endothelial dysfunction: Endothelial cell damage reduces the production of vasodilator agents such as nitric oxide, thereby predominating the vasoconstrictor effects.4. Neurogenic mechanisms: Activation of the sympathetic nervous system may contribute to vasoconstriction by releasing catecholamines.Vasospasm usually occurs between the 3rd and 14th day after the onset of SAH. Clinical symptoms include:• Headache• Changes in consciousness• Neurological deficits such as hemiparesis or aphasia• New ischemic strokesDiagnosisInstrumental methods1. Transcranial Doppler sonography (TCD): TCD is a non-invasive method for monitoring blood flow in the basal arteries of the brain. An increase in blood flow rate may indicate vasospasm.2. Cerebral angiography: The gold standard for the diagnosis of vasospasm, allowing visualization of vessel narrowing.3. CT angiography: A non-invasive method that can provide additional information about the vascular status of patients.TreatmentPrevention and early treatment1. Hemodynamic management: Maintenance of adequate blood flow through hypervolemia and hypertension (triple H therapy) is a standard approach to the prevention and treatment of vasospasm.2. Pharmacological therapy:• Nimodipine: A calcium antagonist that reduces the risk of ischemic complications through vasodilation.• Vasodilators: Intra-arterial administration of papaverine or nicardipine can be used for severe vasospasm.3. Endovascular interventions: Balloon angioplasty or intra-arterial infusion of vasodilators can be used in patients with resistant vasospasm
