Varna Medical University Press: Journals
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Pharmacotherapy of non-small cell lung cancer with EGFR activating mutations using tyrosine kinase inhibitors: the role of hospital pharmacists in preventing drug-drug interactions in this class of medicines
Get PDFEuropean and American Cancer Society guidelines recommend targeted therapy as the standard treatment for advanced non-small cell lung cancer (NSCLC) stage IV with positive molecular test results (i.e., proven oncogenic drivers). In 2004, an EGFR mutation was identified in lung cancer, becoming the first target of genome-directed therapy. Two mutations, deletions in exon 19 and the single amino acid substitution L858R in exon 21, together account for approximately 85% of the observed EGFR mutations in NSCLC and confer sensitivity to EGFR tyrosine kinase inhibitors (TKIs). Currently, there are five EGFR TKIs from three generations approved and used in clinical practice: first-generation Erlotinib and Gefitinib; second-generation Afatinib and Dacomitinib; and third-generation Osimertinib. Afatinib is a P-gp and BCRP substrate, whereas the other EGFR TKIs undergo hepatic metabolism via cytochrome P450 (CYP) enzymes. Since the most frequently reported clinically relevant interactions are due to modulation of drug-metabolizing enzymes or transmembrane transporters, this presents a potential for drug-drug interactions of varying intensity that may influence the safety and/or therapeutic effect of the drugs. Hospital pharmacy professionals play a key role in the treatment of oncology patients receiving TKIs by detecting potential drug-drug interactions and adverse drug reactions early, as well as through patient education
Pharmacotherapy treatment options for advanced heart failure: a review
No full textHeart failure is one of the leading causes of adverse cardiac outcomes. Despite available disease-modifying therapies, about 10% of patients progress to advanced heart failure. The aim of this review is to summarize pharmacological treatment options for this phase. No large randomized trials have been conducted in patients with advanced heart failure. Most disease-modifying medications are beneficial and their use is recommended, although they are often difficult to tolerate. A personalized approach is needed
Electronic Learning Resources - A New Approach In Training
Get PDFINTRODUCTION: In recent years, a new learning environment has been created, and new technologies and processes have been implemented in the education system. In this way, the qualifications of teachers have increased. An international network was created for the exchange of good European practices. The purpose of this article is to study the classification of electronic learning resources and analyze the strengths and weaknesses of e-learning resources.MATERIALS AND METHODS: A documentary method was used, and reference was made to scientific publications from medical journals related to learning approaches through electronic learning resources.Results: A classification of electronic learning resources was made according to their characteristic features; a SWOT analysis of strengths and weaknesses, as well as threats and opportunities in training, is presented; practical applications of information resources are noted.CONCLUSION: Web-based learning is a set of technical tools that support learning, increase students’ knowledge and skills, and improve their applied skills. E-learning improves communication, models the learning process, and reduces the administrative burden on teachers. Modern computer technologies provide hardware and software products through which teachers can independently design the information, visual aids, tests, and graphic files necessary for training. To achieve a high level of teaching and learning with these tools, constant technical and informational training is necessary
Potential Barriers To The Implementation Of Physical Activity Recommendations In Patients With Type 1 Diabetes Mellitus
Get PDFIntroduction: Type 1 diabetes mellitus (type 1 DM) results from autoimmune destruction of insulin-producing beta cells in the pancreas in genetically predisposed individuals, leading to insulin deficiency and hyperglycemia. It usually manifests itself in childhood and adolescence, and its prevalence reaches epidemic proportions. It is a complex disease that affects not only the physical health of the individual, but also his social integration and quality of life. For their current treatment, patients with type 1 DM require exogenous insulin replacement therapy. Along with drug treatment, physical activity (PA) has a significant impact on the health status of those diagnosed with type 1 DM.PA, along with insulin treatment, is considered a tool of disease management and good control. The benefits of PA for people with type 1 DM can be seen as improving glycemic control, blood pressure, cardiac activity, lipid profile, weight reduction, physical and mental well-being, and delayed complications.Aim: The aim of the current review is placed on potential barriers to the implementation of physical activity recommendations in patients with type 1 DM.Materials and methods: A review and systematic search of databases of - Google Scholar, Pub Med, Medscape and Science Direct for the last 10 years has been made, with key words: diabetes type 1, barriers, physical activity, recommendations, from which an overview of recommended physical activity in type 1 DM and difficulties in its implementation is written. From 493 overview articles which were reviewed, 68 met the criteria for full-text inclusion. From these, only overview articles on the subject have been analysed and included. Inclusion criteria included patients diagnosed with type 1 DM for more than 1 year; on insulin therapy with pump therapy and multiple daily applications of fast-acting and long-acting insulin; aged ≥ 18 years. Exclusion criteria included pregnant or patients with severe diabetic complications, with chronic conditions unable to move (eg, severe peripheral or autonomic neuropathy), patients over 65 years of age in whom (IPAQ) was invalidated.Results: The analysis of the data shows that the patients included in the study with an average age of 40 years and a diagnosis of type 1 DM with a long duration of insulin treatment. To evaluate interventions, an international physical activity questionnaire (IPAQ), an axelometer, and continuous blood glucose (CGM) monitoring systems are often used. Overweight and obesity were found in a large part of the patients. PA recommendations are implemented by only a third of patients enrolled in the studies.Conclusion: PA improves physical fitness and strength, reduces cardiovascular risk factors, and improves well-being in type 1 DM. It also significantly reduces insulin requirements and has been shown to improve glycemic control as measured by HbA1c
The effect of TAP block in postoperative opiate consumption in inferior median laparotomy
Get PDFIntroduction: With the increasing number and complexity of surgical interventions, anesthesiologists are faced with the need to control and even prevent perioperative pain. Opioids are the mainstay of treatment for intra- and postoperative pain. Although they are very effective analgesics, side effects may limit their use. For this reason, new strategies to reduce opioids are being developed. Multimodal anesthesia and analgesia is the basis for intra- and postoperative pain management. The use of regional anesthetic techniques, such as transversus abdominis plane (TAP) block, allows the decrease of opiate consumption.Aim: The main aim of our study is to compare postoperative opiate consumption in patients undergoing inferior median laparotomy, with and without TAP block, during the first 24 hours.Material and methods: A total of 171 patients were included in our combined retrospective and prospective study. They were divided into two groups: group I with TAP block (N = 82) and group II without TAP block (N = 89). All research methods were used to evaluate the perioperative results in the studied groups; statistical analysis methods included in IBM SPSS.Results: The mean amount of pethidine used postoperatively in the experimental group was 45.43 mg (SD ± 22.6), whereas in the control group it was 84.8 mg (SD ± 19.4). This difference is with high statistical significance (U = 6613, p < 0.001). The reduction in postoperative opioid dose was 46% in the TAP-block group.Conclusion: The administration of a TAP block leads to reduction in postoperative opiate consumption and achieving opioid-free and opioid-sparing analgesia in the early postoperative period
Occupational Stressors in the Educational Process among Medical Students
Get PDFVarious studies reveal increasing levels of stress in modern society, highlighting that individuals in education and healthcare face the greatest occupational stress. Long-term exposure to stress is commonly identified as a risk factor for heart disease, malignancy, lung disease, and suicide. Alarmingly high levels of stress are reported among health practitioners and medical students, adversely affecting their physical and mental health due to the highly stressful environment in colleges and universities. The global shortage of healthcare personnel and high dropout rates among interns necessitate measures to identify stressors and develop stress management programs for healthcare professionals and students.The purpose of this study is to identify occupational stressors among medical students during their academic training. The presented data examine potential factors provoking stress among future health professionals in both academic and clinical settings. Identifying these stressors highlights critical areas in education that require increased attention and creates a basis for reducing elevated stress levels among students pursuing careers in healthcare. The study reveals that daily activities during clinical practice, such as performing medical procedures and integrating into a functioning hospital environment, are among the primary stress factors for students. These findings highlight the need for more detailed research into the specific causes of stress in the learning process and the development of effective stress management strategies
The Public Health Challenge “Antimicrobial Resistance” through the Behavioral Lenses
Get PDFIntroduction: Antimicrobial resistance (AMR) is identified as a serious public health threat. Consumers play a leading role in the increase of AMR through self-medication and the irrational use of antibiotics (ABs) in outpatient settings. Health promotion applies classical theoretical models, such as the Health Belief Model (HBM), to identify factors influencing individual behavioral change towards responsible AB use to control AMR.The aim of this study is to identify and analyze the factors that promote and hinder the prudent use of antibiotics among the Bulgarian population through the behavioral lenses of the HBM.Materials and Methods: A review of the scientific literature in PubMed and Google Scholar was conducted for articles published between 2000 and 2023. Original scientific studies assessing AB use in the Bulgarian population were searched using specific keywords. The results reported in the articles were used as the material basis, and the HBM was applied as a methodological framework for the analysis. Additionally, articles in the international literature relevant to the problem of AMR were reviewed.Results and Discussion: The analysis included three original scientific studies. The results were interpreted and analyzed through the individual elements of the HBM. The behavioral factors contributing to the responsible or irrational use of ABs in Bulgaria are comparable to those found in international studies.Conclusions: Changing personal behavior towards responsible AB use to control AMR is a multi-faceted process, influenced by many complex encouraging and hindering behavioral factors. Effective public health interventions to control the public health challenge of AMR must take into account all these factors influencing people when making decisions related to their health. Only then will these interventions lead to healthy behavioral change
Functional and anatomical results after 25G pars plana vitrectomy for rhegmatogenous retinal detachment
Get PDFIntroduction Retinal detachment is an ophthalmic emergency. It occurs between the retinal pigment epithelium and the remaining 9 layers of the retina (neuroepithelium). If left untreated, permanent vision loss can occur. The frequency of rhegmatogenous detachment is the greatest, in which there is a retinal tear.АimThe aim of this article is to conduct a follow-up of the functional and anatomical outcome in patients who underwent pars plana vitrectomy for rhegmatogenous retinal detachment.Materials and Methods The operative approach consists in performing a 25G pars plana vitrectomy, replacing the vitreous body with a long-acting gas—octafluoropropane (C3F8), and conduct a treatment with an endolaser. The visual acuity of the patients was examined at 1st, 3rd, and 6th months. The optical coherence tomography (OCT) method was used to monitor the postoperative anatomical outcome at the structural level.Results The obtained and analyzed postoperative results show anatomical recovery and an increase in visual acuity.Discussion The data from the conducted study confirm the achievement of a good and long-lasting postoperative result in 25G pars plana vitrectomy and replacement of the vitreous body with C3F8 gas in patients with rhegmatogenous retinal detachment.Conclusion Timely recognition of symptoms, early diagnosis of rhegmatogenous retinal detachment, and surgical treatment increase the chances of repositioning the retina and restoring functional vision, which is a key factor for the patients’ quality of life
Influence of implant scanbody material on the accuracy of digital impressions: A literature review
Get PDFIntroduction: In recent years, the use of intraoral scanners in the fabrication of fixed implant-supported restorations has become widespread in modern dental implantology. To register the position and angulation of implants in the oral cavity using an intraoral scanner, implant scan bodies (ISBs), are utilized.The aim is to evaluate the influence of ISB material on the accuracy of the digital impression.Materials and Methods: Articles related to the topic were searched in databases such as Google Scholar, PubMed, Scopus, and ScienceDirect, using various keyword combinations. Only full-text articles in English, published between 2019 and 2024, were included.Results: The articles included in this study are clinical and experimental research as well as several literature reviews. The studies examine the impact of different materials—titanium (Ti), polyetheretherketone (PEEK), PEEK-Ti—used to manufacture ISBs.Conclusion: The material from which ISBs are made plays a crucial role in scan accuracy. Differences in materials, such as titanium (Ti) versus polyetheretherketone (PEEK), have been identified as influencing factors. The findings show that the lowest deviations in the accuracy of the digital impression of the implant prosthetic area are achieved by using ISBs made of PEEK, followed by Ti ISBs, with the greatest deviation observed in ISBs made from PEEK-Ti
Social epidemiology of childhood obstructive sleep apnea
Get PDFObstructive sleep apnea is a severe and sometimes life-threatening disorder in childhood and adulthood. During the last decades, its incidence and prevalence rates gradually increase worldwide. The undoubted medico-social significance of the pediatric obstructive sleep apnea stimulates the investigations of this hot topic by scientists from all over the world.The purpose of this concise review is to outline the most recent achievements in some social epidemiological aspects of the disease. In addition, it deals with the etiopathogenetic role of a series of common accompanying diseases as well as of the numerous risk factors deserving a special attention by the medical community and broad public