Varna Medical University Press: Journals
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One Health – the global framework addressing regional healthcare challenges
Get PDFIntroduction: The concept of One Health (OH) emphasizes the interconnectedness of human, animal, and environmental health. Despite its global importance, OH remains unknown and understudied in the academic settings, therefore, misunderstood and underutilized in public healthcare in Bulgaria.Aim: This article aims to introduce the OH ideas and to focus the regional academic attention towards the OH potential to manage pressing public healthcare challenges at a regional level.Materials and Methods: Purposeful content analysis is applied to global and regional policy documents, and articles with keywords in PubMed for the last ten years, to the present 2023.Public Healthcare Challenges in Bulgaria and OH Solutions: Bulgaria’s healthcare system faces significant challenges. Rising healthcare costs, driven by increasing expenditures on treatments, hospitalizations, and pharmaceuticals, strain the system. Implementing OH approaches, targeting prevention and early intervention, particularly for zoonotic disease outbreaks and antimicrobial resistance (AMR), could reduce costs. Bulgaria has one of Europe’s highest AMR rates, exacerbated by inappropriate antibiotic use and the absence of an OH Action Plan or intersectoral mechanism. Limited OH education in universities further hinders interdisciplinary solutions. Strengthened surveillance and intersectoral collaboration are crucial for addressing emerging zoonotic diseases and the regional environmental hazards.Conclusion: One Health is the collaborative framework that can unite academic and field health workers in Bulgaria. By integrating OH into the national policy and university curricula, Bulgaria could enhance its healthcare resilience and promote sustainable health outcomes
Laryngeal mask ventilation during tympanoplasty and mastoidectomy
Get PDFIntroduction: Although otologic surgery encompasses a wide range of procedures from simple myringotomy with tube placement to radical mastoid tumor resections, many of the surgical and anesthetic considerations for these procedures are universal throughout the spectrum of disease prevalence and severity.The Aim of the study is to determine and characterize the specifics and complications of laryngeal mask airway (LMA) use during tympanoplasty and mastoidectomy.Materials and methods: A 2-year prospective cohort study of 30 patients who underwent tympanoplasty and mastoidectomy in the Department of ENT Surgery; University Hospital "Queen Giovanna" – ISUL; Medical University-Sofia.Results and discussion: Mean age of the patients included in the study is 29.27 years. A predominance of male sex is observed: men – 60%, women – 40%. Most patients have low preoperative ASA grades. None of the patients suffered desaturation during the operation. LMA displacement and need for repositioning by the anesthesiologist was observed in 13.33% of the patients. In all patients ETCO2 values are in the normal range. Sore throat was recorded in 20% of patients. Forty percent (40%) of the patients experienced postoperative nausea and vomiting (PONV). The incidence of hoarseness among patients was 3.33%. In none of the cases we observed aspiration under the LMA and laryngospasm.Conclusion: The results from the study showed that LMA can be successfully and safely used in patients during tympanoplasty and mastoidectomy
Providing care to maintain the health status of populations' vulnerable groups
Get PDFThe need to care for both sick and healthy individuals in a vulnerable situation exists permanently. All the following: newborns, children, elderly people, people after being discharged from hospital, people with disabilities, people with reduced capacity living alone, etc., who need someone to take care of them are in a vulnerable situation. Care can be provided by relatives of those in need and by medical and nonmedical personnel in specialized institutions or at home.Aim: The aim of the article is to present the main types of health supportive care and their providers for individuals in a vulnerable situation.Material and methods: A literature review was conducted on the types of care for people and providers for healthy and sick individuals and patients with terminal illnesses.Results: Supportive care is intended to help individuals who, for various reasons, are in a vulnerable situation and cannot perform daily activities independently. The main supportive care providers are caregivers and health assistants. Caregivers are informal (unpaid) and formal (employed, paid). Palliative and hospice care are aimed at individuals who are not expected to receive radical treatment and aim to alleviate the suffering of patients and support them to live a dignified life. They can be provided in a home environment and in specialized institutions with the participation of multidisciplinary teams
Manifestations and significance of Hodgkin lymphoma in maxillofacial surgery—a review article
Get PDFIntroduction: The first data that became known with the description of Hodgkin's disease date back to 1832, when the eminent British pathologist Thomas Hodgkin described a series of autopsy cases of patients with lymphadenopathy and splenomegaly. Only in the late 1990s, the understanding of its essence as a malignant disease originating from germinal center B cells led to its current name Hodgkin lymphoma.Materials and Methods: This article is based on a comprehensive review of 32 modern full-text articles in English, summarizing the results of studies conducted over the past few decades. The information from them, after detailed examination, was analyzed and systematized in order to obtain a complete full-text publication on the features of Hodgkin lymphoma.Results and discussion: Hodgkin lymphoma is one of the most common lymphomas in the Western world, affecting 3 per 100,000 people annually, with a male:female ratio of 2:1, and most commonly occurring between the ages of 20 and 34. This malignancy affects the peripheral lymph nodes and can involve organs such as the liver, lungs, and bone marrow. Based on the different histological findings and tumor cell phenotype, Hodgkin lymphoma is classified as: nodular sclerosis, mixed cell composition, lymphocyte-rich, lymphocytic depletion, and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). A common presentation is painless lymphadenopathy that develops over months. Enlargement of the cervical lymph nodes is among the most common locations.Conclusion: Hodgkin lymphoma is a type of cancer that affects the lymphatic system and its most common clinical manifestation is peripheral lymphadenopathy. The first symptoms frequently include enlarged cervical lymph nodes, which creates a difficulty in the differential diagnostic plan. The maxillofacial surgeon may be among the first specialists to diagnose the disease, which requires its comprehensive knowledge
Application of autogenous platelet-rich plasma in periodontology
Get PDFINTRODUCTION:Autogenous platelet-rich plasma (PRP) is a platelet-rich substance obtained after specific processing of peripheral blood.AIM:The purpose of the present study is to describe and examine the autogenous platelet-rich plasma and its application in periodontology.DISCUSSION:In the last decade, PRP has gained wide popularity and is used in a variety of fields of medicine. The implementation of PRP is basically a regenerative procedure using an autogenous graft. Therefore, it is believed that there is no danger of genetic interference, sensitization, or any kind of disease transmission. Platelet-rich plasma therapy is a safe and effective option with no known risks or side effects. In the last decade or two, the amount of published studies focused on the joined use of barrier membranes and bone repair materials with PRP has increased. One of the main benefits of using PRP to administer damaged tissues is that it activates and releases growth factors, which can enhance collagen and elastin formation by fibroblasts, boost blood supply and metabolism in the affected area, as well as help promote angiogenesis (the formation of new blood vessels). In this way, PRP therapy can effectively restore lost tissue.CONCLUSION:The presented study shows that the implementation of autogenous PRP is an innovative method for periodontal regenerative therapy based on the fact that regenerative therapy methods show different success rates and different long-term results, depending on the materials that are used
Prognostic and predictive factors in urothelial carcinomas: tumor parenchyma part 2
Get PDFMalignant tumors are diseases that, with their characteristics and biological behavior, including an unfavorable outcome of the disease, represent a serious social, economic, and psychological problem for a significant part of the population in the world. The fatal outcome is most often associated with recurrence or tumor metastases. With a diagnostic purpose and based on the defined mandatory morphological prognostic and predictive parameters, attention is increasingly focused on the search for new markers involved in the processes of angiogenesis, cell proliferation, and differentiation, which could help unravel tumor biology. These markers are of interest in different types of carcinomas, including urothelial cancer, which, although favorable in the early stages of its development, carries a high risk of recurrence and progression. Markers can originate either from the tumor parenchyma or from the tumor stroma. The identification and practical use of more precise immunohistochemical markers originating from the tumor parenchyma in urothelial cancer, in combination with the morphological characteristics of the tumor and the differentiation and staging of the tumor process, makes it possible to refine the diagnosis and, if possible, to determine the prognosis of the patients. CK20 has been widely discussed in the literature, yet there are conflicting data on CK20 expression in relation to differentiation, staging, and recurrence in urothelial neoplasms. Further studies are needed to determine CK20 as a predictive and prognostic marker in urothelial neoplasms. A review of the literature shows differences in studies on CD10 in terms of differentiation, stage, and prognosis. The relation of CD10 expression to the development of tumor recurrence has not been described in medical literature. In 2007, GATA3 was proposed to be a novel marker of urothelial differentiation, which helps to distinguish metastatic lesions. A reliable marker discussed in the literature is gp130, which may appear as a reliable predictive and prognostic marker in urothelial carcinoma
Lymph nodes of the head and neck: in normal and pathological conditions
Get PDFBackgroundThere are about 800 lymph nodes in the body of a healthy adult human being. Three hundred of them are in the head and neck area. The presence or absence of metastatic cancer in the head and neck lymph nodes is essential for the survival of patients. Materials and methodsThis article is an overview and is based on a thorough review of 25 other scientific works (24 foreign and 1 in Bulgarian)—articles, monographs, textbooks, anatomical and patho-anatomical atlases, and websites. DiscussionLymph nodes are a major part of the lymphatic system. They are small cluster formations located in strategic places in groups that play a key role in the lymphatic drainage of regional anatomical structures. The location of the lymph nodes in the head and neck region is associated with the different topographic anatomical lodges. There are different ways to group them.Topographically and anatomically, the groups of lymph nodes in the head are divided into superficial and deep. There are five types of superficial lymph nodes: facial, occipital, retroauricular, preauricular, and superficial parotid. The facial groups on their part are divided into suborbital or upper, buccal or middle, and supramandibular. Deep lymph nodes of the head include the repharyngeal and deep parotid lymph nodes.The neck lymph nodes can either be deep or superficial. Superficial lymph nodes include the submental, submandibular, and superficial lymph nodes located in front of and above the sternocleidomastoid muscle. The deep lymph nodes of the neck are classified into three groups based on their location: the upper, the middle (also called subdigastric lymph nodes), and the lower cervical third.For malignant processes in the head and neck area, nearby dissemination in the regional lymph basin (sentinel lymph nodes) is more characteristic. Depending on the initial diagnosis, the distant metastatic disease most commonly affects the lung, bones, and brain.ConclusionKnowledge of the structure, function, exact location, and lymphatic drainage of the lymph nodes of the head and neck, as well as the areas of lymphatic drainage in the same parts of the human body, is essential for making the correct diagnosis and determining the treatment plan for patients with lymphadenomegaly
Intranasal Splints as an Alternative to Intranasal Packing Following Septoplasty: A Literature Review
Get PDFIn the postoperative period following septoplasty, various types of tamponades and nasal splints are used. They play an important role in surgical outcomes. The use of intranasal packing and splints still remains controversial in the medical literature. Since the beginning of the 21st century, the method of transmucoseptal sutures following septoplasty has been utilized as a reliable alternative to intranasal packing. Recent studies recommend the use of intranasal splints instead of tamponades, reporting a positive impact on postoperative bleeding, patients’ comfort, the prevention of erosions and trauma to the nasal mucosa, and the development of synechiae
Obstructive sleep apnea through the viewpoint of the patientEA THROUGH THE VIEWPOINT OF PATIENT
No full textIntroduction: Obstructive sleep apnea (OSA) is a chronic disease that requires long-term, multidisciplinary treatment. Persistence and adherence to prescribed OSA therapy is a proven practice for successful disease control. Monitoring the effect of treatment is a key component in the “continuum of care” that aims to improve symptoms, reduce the risk of motor vehicle crashes, and prevent the severe complications of untreated sleep apnea.Objective: to study and present the problems of patients with OSA related to control and follow-up /adherence to the prescribed PAP therapy and treatment results/, through their experience, experiences, and feelings.Material and methods: A qualitative method was applied – in-depth interviews with patients. Inclusion criteria: diagnosed with obstructive sleep apnea syndrome OSA and undergoing continuous positive airway pressure (CPAP) therapy for over 1 year. Ten patients participated in the study. The average duration of one interview was from 50 to 65 minutes.Results: The implementation of PAP therapy leads to rapidly occurring positive changes in the health status of all interviewees. Serious problems are identified in the stage of monitoring and control of the disease - lack of information about the place and method of conducting regular monitoring of their condition, lack of connection with the health system, which causes anxiety and uncertainty in patients.Discussion In our country, there is no established algorithm for the control and monitoring of people with obstructive sleep apnea (OSA). The difference between the experience of a Bulgarian patient treated in Spain and one treated in Bulgaria is drastic.Conclusion: Increasing public awareness of the disease, creating a registry of patients with OSA, and establishing an algorithm for the health system's behavior from diagnosis to control and follow-up are essential steps to reduce the lasting consequences of lack of or ineffective treatment of Obstructive Sleep Apnea