Varna Medical University Press: Journals
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Practical algorithms for the diagnosis of some salivary gland tumors
Get PDFSalivary glands represent one of the most complex organ localizations in terms of routine diagnostic practice in pathoanatomy. This is due to the fact that the tumors originating from them show enormous morphological diversity and a number of overlapping histological features. Despite the WHO's attempt to simplify the tumor classification in its latest edition, more than 30 types of neoplasias still require precise study for a successful diagnostic process.Determining the malignant potential of basaloid and biphasic tumors is sometimes a particularly complex task.It is important to know the basic cytoarchitectural features of each type of tumor, in particular whether the tumor shows double luminal-abluminal cell differentiation, so that the diagnosis can be made logically by analyzing the cellular components, cellular arrangement, and extracellular components. Therefore, when formulating a diagnosis, one should not rely on isolated fields of the tumor but take into account the overall characteristics, the most important of which are the tumor borders, the cellular composition and arrangement in the tumor tissue, the characteristics of individual cells, and the presence and characterization of myoepithelial stroma.In this review article, we discuss current recommendations and algorithms for distinguishing some salivary gland tumors that pose more frequent diagnostic problems
Relationship between stress levels and effectiveness of diet therapy in patients with irritable bowel syndrome
Get PDFIntroduction: Functional diseases of the gastrointestinal tract are a common diagnosis, with the most common manifestations being functional dyspepsia and irritable bowel syndrome (IBS). The pathophysiological mechanisms and etiology of this group of diseases are not fully understood, but stress is believed to play a key role.Aim: The aim of this study is to clarify the relationship between the severity of stress in patients with IBS and the effectiveness of diet therapy.Materials and Methods: Patients who meet the ROME IV criteria were included in the study. Questionnaires were used to assess stress levels (PSS-4), anxiety (GAD-7), severity of IBS (IBS Severity Score), and quality of life. The questionnaires were completed three times: at the beginning of the study, immediately after the end of the 4-week diet, and one month after the end of the diet therapy.Results: Stress levels showed no statistically significant effect on the effect of diet therapy on IBS improvement. Only anxiety (GAD7) showed a significant effect on the improvement of IBS with the introduction of a low-histamine diet.Conclusion: Patients diagnosed with IBS often have elevated levels of stress and anxiety. The treatment of these patients should be comprehensive. Further studies are needed to clarify the role of stress and anxiety in relation to the effectiveness of the applied dietary therapy
Surgical Methods for Minimizing the Incidence of Paracolostomy Hernias
Get PDFINTRODUCTION: Regardless of the advances in surgical techniques, parastomal hernia continues to be a frequent and serious complication after colostomy construction. The outcomes after surgical treatment are often not satisfactory, and the recurrence rate is high.AIM: The study aims to present modern surgical methods for the prevention of paracolostomy hernias.MATERIALS AND METHODS: The study included 77 patients with formed colostomies in the Clinic of Surgery of Alexandrovska University Hospital during the period from 2017 to 2022, analyzed with a follow-up period of at least six months. Group A includes 35 patients whose stoma was constructed by the extraperitoneal route. Group B consists of 42 patients with the traditional transperitoneal technique. In addition, 2 patients in whom synthetic mesh was used to treat and prevent paracolostomy hernia are reported.RESULTS: In group A only one patient was diagnosed with parastomal hernia, while in group B there were 9. The difference between the two groups was found to be statistically significant (p < 0.05). In the cases where a prophylactic synthetic mesh was utilized, no complications we observed.CONCLUSION: Improving surgical techniques for preventing paracolostomy hernias is crucial, as they represent an inevitable complication, in most cases, after colostomy formation. The results of the conducted study as well as the available literature data highlight the benefits of methods such as the extraperitoneal route for stoma construction and the prophylactic use of synthetic meshes
Trust in provider as a factor influencing health services utilization in Bulgaria
Get PDFIntroduction: Trust in the physician affects many important aspects of health behaviors and attitudes, including patients' willingness to seek care, undergo treatment, and adhere to prescribed therapy.Objective: To investigate and analyze the impact of trust in health service providers on the utilization of outpatient and inpatient medical care in the country.Material and methods: An online survey was conducted concerning the use of health services (primary, specialist, and hospital) and the degree of trust of respondents in health service providers. Differences in utilization were proven according to the degree of trust in the provider, using a χ2-test of independence. Binary logistic regression was applied to investigate the influence of trust on the use of health services.Results and discussion: There were 1292 respondents who completed the survey in its entirety. The vast majority of them (82.3%) trust specialist doctors, followed by 74.9% who trust general practitioners and 50.7% who trust hospitals. The share of service users is highest in the categories having a very high level of trust, or rather, trust in the provider. Higher levels of trust have been associated to higher odds of seeing a general practitioner (OR = 1.83; p < 0.001) and higher chances of being hospitalized (OR = 1.31; p < 0.001). Under- or overutilization of health services can result from a lack of trust in the providers.Conclusion: Trust in providers affects healthcare utilization, and increasing trust can improve efficiency in the sector
Clinical Application Of Endoanal And Endorectal Ultrasound For Benign And Malignant Conditions Of The Anus, Perianal Space, And Rectum
Get PDFINTRODUCTION: Benign and malignant conditions of the anus, perianal space, and rectum encompass various disorders: perianal abscesses and fistulas, anal fissures, hemorrhoids, incontinence, defecation disorder, rectovaginal and rectovesical fistulas, rectal prolapse, neoplasms of the anal canal and rectum. Very often patients have more than one condition. The high prevalence of benign anal disorders makes them socially significant. In the last two decades, a lot of new diagnostic methods were introduced. This has improved the understanding of the pathogenesis of these conditions. Endoanal and endorectal endoscopic ultrasound has become an important part of the evaluation of anal and rectal disease. This method is widely preferred because of its low price, accessibility, lack of complications, and good tolerance to the examination without sedation.MATERIALS AND METHODS: Thirty patients have undergone endorectal ultrasound (ERUS) examination, from April 2023 to June 2023. All ERUS examinations were performed using 3D 20R3 and 3D X14L4 endorectal transducers connected to BK 3000 Ultrasound System (BK Medical Aps, Denmark).RESULTS: The mean age was 48.4. Eighteen patients were male (60%). The main clinical indication was an evaluation of perianal abscesses and fistulas or neoplasms. Nine of the examinations, or 30%, were performed for anal and rectal tumors. Perianal abscesses were identified in 7 cases (23%); 5 patients had anal fissures; 4 had perianal fistulas (13%); 1 had a rectovaginal fistula. The rest of the patients had hemorrhoidal disease.CONCLUSION: Endorectal and endoanal ultrasound is a sensitive and reliable method for the assessment of the anatomical structures and diagnosis of benign and malignant diseases of the anus, perianal space, and rectum
Sleeve gastrectomy and active intestinal bypass in patients with severe obesity
Get PDFINTRODUCTION: Bariatric surgery is the most effective treatment modality for severe obesity in adults and children. Numerous recent investigations by foreign authors have convincingly proven the successful and safe implementation of a variety of bariatric and metabolic surgical methods for definite and stable weight reduction.AIM: The aim of the present article is to concisely review the most recent publications in the field of bariatric surgery in patients with morbid obesity and to share our initial experience by three case reports.MATERIALS AND METHODS: We briefly report three patients with severe obesity, two women and one man, who were operated on by sleeve gastrectomy and active intestinal bypass in the Clinic of Surgery at the Naval Hospital in Varna, part of the Military Medical Academy, in the 2020–2022 period. They were followed up until 2024.RESULTS: This surgical intervention resulted in a remarkable weight loss and a body mass index reduction. The male patient’s weight decreased from 220 kg down to 82 kg. The female patients’ weight reduction was from 198 kg down to 83 kg and from 127 kg down to 76 kg, respectively.CONCLUSION: There is accumulated evidence on the sufficient safety and significant effectiveness of the bariatric surgery in selected patients with severe obesity. A broader implementation of this modern method in the clinical practice in Bulgaria should be recommended
Ergonomic workplace evaluation among office IT workers in Varna, Bulgaria
Get PDFINTRODUCTION:The frequency of office-based work has increased significantly in the last decades. Employees are exposed to multiple occupational hazards, some of which are related to the static pressure on the muscles of the back, neck, and shoulders due to improper posture, irregularities in the office furniture, and improper breaks during the shift. The ocular complaints of office workers are also common and can be related to non-ergonomically designed work furniture and insufficient, irregular breaks during the shift.AIM:The aim of this article is to create and apply an instrument for ergonomic assessment of office facilities. In addition, it includes evaluation of the ergonomic factors in the office environment during the work shift and prescribe preventive measures.MATERIALS AND METHODS:For the needs of ergonomic evaluation of the working environment in the IT industry, an assessment instrument was developed.RESULTS:Office IT workers (173) received ergonomic evaluation of their workplace in the period October–December 2021. The mean age of the employees was 32.49 +/- 0.59 (21 to 54 years). Gender distribution of the workers was with dominance of the men—117 individuals, or 67.6% of all participants. The assessment of the office furniture showed: 85 (49.1%) of the cases had ergonomic irregularities regarding the chair, 51 (29.5%) had irregularities of the desk. Correction of the work posture was recommended to 113 (65.3%) workers.CONCLUSION:Further studies are needed in Bulgarian companies to assess the proportion of employees affected by ergonomic occupational hazards and their impact
Using art and digital techniques in educating people with intellectual disabilities about relationships, emotional life and sexuality
Get PDFIntroduction: All people, whether they have a disability or not, need age-appropriate sex education to develop positive attitudes towards their sexuality and avoid negative consequences. The aim of this training initiative is to develop a methodology for organizing and conducting sexuality education for young people with intellectual disabilities, which takes into account the specifics arising from the type of disability and their age needs. A comparative analysis of the policies on health and sexuality education of young people with intellectual disabilities in Belgium and Bulgaria is made. Material and methods: A training program on relationships, emotional life and sexuality for young people with intellectual disabilities has been developed, offered by specialists who work with people with intellectual disabilities in the social services provided by the Association for Support of People with Mental Disabilities, Varna, Bulgaria, and Les Jardins du 8ème jour, Brussels, Belgium. For a year, 4 groups of participants – in Bulgaria and Belgium – worked on the various topics included in this comprehensive training on relationships and sexuality. The methods of non-formal education were used, as well as specific art techniques. The results show that, like their peers in the general population, young people with intellectual disabilities respond to different topics related to relationships and sexuality, according to their upbringing and values, as well as the degree of reference to their personal experience. The main conclusion of the pilot implementation of this program is that the training should be comprehensive, adequate, accessible and timely, to form the necessary social and communication skills, to assist young people with intellectual disabilities to build their understanding of personal boundaries that they know and can respect
ХИБРИДНИ КЛИНИЧНИ ТЕРМИНИ В АНГЛИЙСКАТА МЕДИЦИНСКА ТЕРМИНОЛОГИЯ
No full textThe development of medicine, new methods of investigation and treatment lead to a continuous enrichment of the clinical terminology system and explain the impossibility of its international standardization. This study presents word-formation patterns of Greek-Latin terms excerpted from Stedman's Medical Dictionary, 1995. It traces the manifestations of lexical cross-linguistic synonymy of root-suffix clinical terms as a result of the capacity of combining forms to create multiple configurations. The reason for the integration of Latin anatomical terminology is its borrowing into English anatomical terminology mediated by French. Greek suffixes and suffixoids, because of their persistent meaning, come in combination with different root terminological elements: Greek (in traditional clinical terms), Latin or English (in hybrid clinical terms). In this dynamic process, replacing the Greek element with its Latin equivalent often results in a change of the object in the terminological designation. There are trends in the emergence of new clinical terms that make more extensive use of Latin combining forms and also allow the use of English non-terminological language register as a root term element in medical terms. The study elucidates problems in teaching Latin in the English language to undergraduate medical students