Varna Medical University Press: Journals
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Progressive bilateral blepharoptosis accompanied by lateral shortening of the palpebral fissure
Get PDFIntroduction: The eyelids, along with their shape and position, play an important role not only in maintaining the optimal condition of the anterior ocular surface, aiding the normal function of the visual system, but also make up for our physical appearance and how we are perceived by othersAim: The aim of this article is to present three clinical cases of bilateral phimosis of the palpebral fissure, combined with ptosis of the upper eyelids.Materials and Methods: A retrospective analysis of the medical documentation of three women with progressive bilateral blepharoptosis, operated on and followed up at RESBIOMED and VISION eye care clinics for the period August 2020–July 2023.Results: The patients are women of ages 51, 61, and 78 years with complaints of bilateral ptosis of the upper eyelids, preceded by edema and shortening of the palpebral fissure. One of the patients was once operated during childhood and once again in 1997 following a relapse. The eyelids started to drop again in 2013, until in 2020, a week before being admitted for treatment, the ptosis was so severe, that the patient had to hold her eyelids open in order to see. The third patient underwent several blepharoplastic surgeries due to adhesions of the palpebral fissure. Objectively, all three patients had elongation of the lateral canthus up to 25 mm bilaterally, with referent range of 10–12 mm of length, with phimosis of the palpebral fissure up to 20 mm and MRD1 under 2 mm. All three patients underwent upper blepharoplastic surgery with shortening of the aponeurosis of the levator palpebrae superior and plastics of the lateral canthus, with subsequent full structural and functional recovery. Intraoperatively, wе discovered adhesions of the lateral canthus and infiltration of the levator palpebrae superior by an unknown substance. We obtained material for histology investigation, which did not show any deviations from the normal histological findings in patients with ptosis.Conclusion: All available documentation from early childhood was requested from all three patients in order to exclude a hereditary or congenital disease. In both literature and practice, such cases are extremely rare, as the combination of ptosis and horizontal shortening of the palpebral fissure are usually associated with a congenital syndrome. In a differential diagnostic aspect we also considered chronic orbital inflammation, which was excluded based on the histology result. The surgical treatment led to full recovery of the normal eyelid position, elongation of the palpebral fissure with good function of the visual system and recovery of the peripheral vision, and last but not least achieving good аesthetics. The etiology of this bilateral fibrosis of the lateral canthi remains a mystery, therefore all three patients are due to be followed up
Peripheral arterial disease. Integrated care—good practice from Europe
Get PDFPeripheral artery disease (PAD) is a disease of great importance to public health, affecting nearly 220 million people worldwide in 2021. It is the third most common clinical manifestation of atherosclerosis after coronary and cerebral localization. Its study and the determination of its public significance are still not sufficiently popular. The high rates of morbidity and mortality among patients with peripheral artery disease raise questions about the need to improve treatment strategies. There is still no established unified, clear, and effective model for assessing the prevalence of the disease in populations, the recommended pharmacotherapy, as well as the frequency and timing of meetings with vascular specialists
Mud therapy - а naturopathic approach to overall health and well-being
Get PDFMud therapy (peloidotherapy) dates back to antiquity, when various cultures recognised the healing potential of mud. Mud is a semi-colloidal substance that forms under the influence of various physical and chemical factors through geological and biological processes from a mixture of inorganic and organic substances and water. The chemical composition of mud is complex and rich in minerals such as magnesium, potassium, iron, phosphorus, zinc, calcium, and trace elements such as manganese, copper, selenium, iodine, etc. It also contains organic substances such as humic acid, fulvic acid, acetic acid, enzymes, hormones, and biologically active substances. The rich chemical composition of mud is essential for various functions of the human body and promotes optimal health and vitality. Healing mud has both specific and non-specific effects on the functions of the human body. Mud therapy, with its rich history and proven benefits, can be used for a variety of ailments. Its inclusion in modern wellness and spa practices allows for a holistic approach to treating a range of diseases
The central canal in adult primates as a proliferative niche
Get PDFThe formation of the functionally active neurons is known as neurogenesis. The presence of stem cells in the central nervous system (CNS) of adult mammals has been demonstrated, showcasing their ability to self-renew and subsequently differentiate into all major cell subtypes of nervous tissue A well-established proliferative niche is the subventricular zone of the telencephalon and the central canal of the spinal cord. In this study, conducted on mature Japanese monkeys, subjects were perfused with the thymidine analogue BrdU according to a pre-established protocol and euthanized at varying intervals after the last infusion. We observed a statistically significant increase in the density of newly formed cells only in the group with the shortest survival period (2 hours after BrdU) compared to those with longer survival periods (2, 5, 10 weeks). When examining the proliferative activity of progenitors at three anatomical levels, with focus on the region of the central canal, within each experimental group, we registered a statistically significant increase at the cervical segment level in the short-term experimental group compared to the thoracic and lumbar segments in the same animals
Impact of the COVID-19 pandemic on antibiotic use in Bulgaria
Get PDFIntroduction: The COVID-19 pandemic has increased the risk of antibiotic resistance around the world.Aim: The study’s goal is to investigate the impact of the COVID-19 epidemic on antibiotic use in Bulgaria.Materials and Methods: A comparative study from reports of the European Centre for Disease Prevention and Control (ECDC) of the nation's antibiotic use and level of antibiotic resistance for the years 2018–2022. An online survey was conducted in September 2022 among citizens who had been diagnosed with COVID-19 through social media using Google Forms. A total number of 213 respondents participated in the survey.Results: During the pandemic, antibiotics were used more frequently in hospital and outpatient settings compared to previous years. The greatest increase was observed in outpatient settings according to ECDC data. Almost half of the respondents (49.8%) were prescribed an antibiotic as a treatment for COVID-19 based on the attending physician’s judgment. A total of 60.4% of the patients were recommended antibiotic treatment without a preliminary laboratory test. Almost all patients (94.4%) who were prescribed an antibiotic purchased it. For 43.6% of them, therapy was prescribed over the phone. Antibiotic therapy was mostly recommended by general practitioners (80.4%).Conclusion: The COVID-19 pandemic has increased the use of antibiotics in Bulgaria
Patients With Heart Failure And The Nursing Care
Get PDFThe purpose of the study is to monitor the condition of patients with heart failure and identify opportunities to improve their well-being through the application of ambulatory nursing care.Material and methods: А рrospective study was conducted. The individual empirical information was collected in the period 2020-2022. The patient’s examination followed a standard protocol: observation, physical examination, assessment of the psychological state and the quality of life, biochemical analysis, ECG, echocardiogram, 6-minute walking test. Statistical analysis included: analysis of variance, correlation, t-test, Chi-square test, logistic regression analysis.Results: The data from the study showed a constant body weight in the first two visits B-0 and B-1 and a significant decrease in the subsequent three, with an average reduction in body weight of 2 (two) kilograms at the end of the follow-up (6 months), which indicates a lack of significant heart failure decompensation and the positive effect of follow-up. The values of systolic arterial pressure remained stable during the study period, independent of gender and other factors monitored in the patients. In the group of patients monitored in the program, the heart rate remained stable throughout the observation period.Conclusion: The results of the clinical trial showed an improved condition and an improved quality of life among patients with heart failure. The role of the nurse is aimed at providing coordinated care, covering both health and educational aspects. Comprehensive cardiac care is provided in partnership with medical specialists, which indicates the need for implementing a Nursing Care Model for patients with heart failure
Myocardial infarction with non-obstructive coronary arteries (MINOCA)—a case report
Get PDFMyocardial infarction in the absence of obstructive coronary artery disease is found in up to 6% of patients with acute coronary syndrome who are referred for coronary angiography. The incidence of myocardial infarction with non-obstructive coronary arteries (MINOCA) is higher in women and leads to increased mortality and nonfatal myocardial infarction. The possible mechanisms of MINOCA are atherosclerotic plaque disruption, spontaneous coronary artery dissection, coronary spasm, embolism, and microvascular dysfunction. We present a case report of a young female patient with ST-elevation MINOCA
A rare clinical case of a patient with malignant Langerhans cell histiocytosis and recurrent bilateral pneumothoraces and pleural effusions. The role of VATS in diagnosis and treatment
Get PDFIntroduction: Histiocytoses represent a heterogeneous group of diseases characterized by abnormal proliferation of histiocytes. This rare condition primarily affects young smokers, most commonly in the age range of 20 to 40 years, and may present as either a localized or multiorgan form.Aim: The aim of this article is to present a rare clinical case of a patient with Langerhans cell histiocytosis, predominantly involving the lungs and skin.Materials and Methods: An 18-year-old patient presented with a clinical picture of progressing dyspnea lasting two weeks, bilateral chest pain, subcutaneous emphysema in the chest and right arm, and imaging findings of bilateral spontaneous pneumothoraces, necessitating emergency pleural drainage. The patient denied excessive tobacco smoking, environmental exposures, and accompanying illnesses. Computed tomography of the chest revealed extensive disseminated involvement of the lung parenchyma.Results: The patient was sequentially drained on the left and right sides using Bülau drains. Due to persistent air leak and the inability of the lung to fully expand, active aspiration and the use of the Heimlich valve were implemented in outpatient settings. Video-assisted thoracoscopic surgery (VATS) on the right confirmed the diagnosis of Langerhans cell histiocytosis, and pleurodesis was performed through parietal pleural scarification.Conclusion: Our experience with this rare condition demonstrates the challenges in managing recurrent spontaneous pneumothoraces and prolonged air leaks in Langerhans cell histiocytosis with significant bilateral lung involvement