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Ten Years of Parotid Gland Tumors: Regional Data from Bulgaria
No full textBackground: Demographic patterns of parotid gland tumors (PGTs) vary across regions and over time, which is important for clinical practice. We aimed to characterize the epidemiology of PGTs in seven regions from northeastern and north-central Bulgaria, focusing on patient demographics, laterality, benign–malignant distribution, histologic subtypes and temporal incidence.
Methods: A retrospective descriptive study was conducted at a single university maxillofacial surgery clinic in Bulgaria. Cases were reviewed over a 10-year period (1 January 2015–31 December 2024). Age, sex, histology, and benign/malignant status were recorded. Group differences were assessed with t-tests and χ² tests. Annual crude benign, malignant and total parotid tumor incidence rates of per 100,000 population were calculated (2015–2024).
Results: Benign tumors constituted 86.4% (312/361) and malignant 13.6% (49/361). Patients with benign tumors were significantly younger than those with malignancy (56.5 ± 14.2 vs 65.4 ± 14.3 years; t = −4.1; p < 0.001). The proportion of malignancy increased with age (χ² = 22.965; p < 0.001). Among benign neoplasms, Warthin’s tumor (WT) was most frequent (44.9%), followed by pleomorphic adenoma (PA) (34.3%); WT predominated in men and PA in women (p < 0.001). In children, PA was the only benign entity identified. Among malignancies, salivary duct carcinoma and adenoid cystic carcinoma were most common (18.4% each), with mucoepidermoid carcinoma close behind (16.3%); when pooled, malignant tumors showed no significant associations with sex or age.
Crude annual incidence rates for benign PGTs rose from 1.50 (2015) to 3.48 per 100 000 in 2023, (p=0.002). Malignant rates varied without a clear trend, (p=0.25) and total PGT incidence increased significantly from 1.79 (2015) to 3.80 per 100 000 in 2023, (p=0.001).
Conclusions: In this single-center study, most PGTs were benign (86.4%); benign cases presented younger, and the likelihood of malignancy increased with age. WT predominated, especially in men, whereas PA was more common in women and was the only diagnosed pediatric tumor; malignancies were mainly salivary duct carcinoma and adenoid cystic carcinoma (with mucoepidermoid carcinoma being also common) with no sex/age associations, and crude incidence rose over time for benign and total tumors but not for malignant entities
Etiology and Pathogenesis of Caries and Gingivitis in Young People. Prevention and Medicinal Treatment in the Complex Therapy of Caries and Gingivitis
Full text linkThe prevalence of periodontal diseases is extremely high, and in recent decades its significant increase in young people has been noted, and a more aggressive course of periodontal diseases has been identified. The development and progression of periodontal disease and caries in younger individuals exhibit distinctive peculiarities. Today, special attention is paid to the condition of microbiocenosis in the oral cavity, which can be both a consequence of various diseases and a contributing factor in the exacerbation and aggravation of dental diseases such as caries, gingivitis, periodontitis, stomatitis and others. The oral microflora is a highly sensitive indicator system that responds with qualitative and quantitative shifts to changes in the state of various organs and systems of the body, and requires further study. The control of dental plaque also serves to reduce gingivitis, which, in turn, helps to prevent the development of periodontitis in later life. Good oral hygiene, primarily through effective tooth brushing, reduces plaque and is crucial for the prevention of caries. Good oral hygiene habits, formed at an early age, thus help to lay the foundation for maintaining dental health. Oral hygiene with antimicrobial and remineralizing agents, in addition to the mechanical plaque removal, could be used to treat and prevent dental diseases.Поширеність захворювань пародонта є надзвичайно великою, а в останні десятиліття відзначено її значне зростання в осіб молодого віку, виявлено більш агресивний перебіг захворювань пародонта. Розвиток і перебіг захворювань пародонта та карієсу у молодому віці має свої особливості. Сьогодні особлива увага приділяється стану мікробіоценозу в ротовій порожнині, який в свою чергу може бути як наслідком різних захворювань, так і призводити до загострення та обтяження перебігу карієсу, гінгівіту, пародонтиту, стоматиту та інших стоматологічних захворювань. Мікрофлора ротової порожнини є високочутливою індикаторною системою, яка реагує якісними та кількісними зрушеннями на зміни в стані різних органів і систем організму, та потребує подальшого вивчення. Контроль зубного нальоту також зменшує гінгівіт, що, у свою чергу, допомагає запобігти розвитку пародонтиту в подальшому житті. Правильна гігієна ротової порожнини, насамперед шляхом ефективного чищення зубів, зменшує зубний наліт і має вирішальне значення для профілактики карієсу. Хороші звички до гігієни ротової порожнини, сформовані в ранньому віці, таким чином, допомагають створити основу для збереження стоматологічного здоров’я. Гігієна ротової порожнини за допомогою антимікробних та ремінералізуючих засобів, крім механічного видалення зубного нальоту, може бути використана для лікування та профілактики стоматологічних захворювань
ОБІЗНАНІСТЬ І ЗАСТОСУВАННЯ ПРОФІЛАКТИЧНИХ ТЕХНОЛОГІЙ РАННЬОГО ВИЯВЛЕННЯ ЗЛОЯКІСНИХ НОВОУТВОРЕНЬ ЩЕЛЕПНО-ЛИЦЕВОЇ ДІЛЯНКИ ЛІКАРЯМИ СТОМАТОЛОГАМИ ТА ЛІКАРЯМИ ПЕРВИННОЇ МЕДИЧНОЇ ДОПОМОГИ: Кафедра соціальної медицини та громадського здоров’я Івано-Франківський національний медичний університет, Івано-Франківськ, Україна
No full textThe aim. To assess the awareness and application of basic preventive technologies for head and neck cancer (HNC) early detection in the practice of dentists and primary care physicians (PCPs).
Materials and methods. There were interviewed 233 dentists and 66 primary care physicians.
Results. Only one in five PCPs (19.7% vs. 59.7% of dentists) conducts a full examination of the head and neck area for each patient visit. However, the technical quality of their examinations is characterized by greater oncological vigilance compared to dentists, who primary focus on the teeth condition (83.7% vs. 45.0% of PCPs) and much less often assess the oral mucosa (18.5% vs. 95.5%, respectively) or palpate the lymph nodes (6.9% vs. 83 .3%). The dentists are less aware of the benefits of screening for HNC (16.3% vs. 42.4% of PCPs) and the possibility of it being carried out by other doctors, in particular PCPs (14.2% vs. 72.7% of interviewed PCPs) or otorhinolaryngologists (25.3% vs. 50.0%). They overestimate the role of oncologists (45.9% vs. 16.7%), do not have sufficient knowledge about the risk factors of cancer, namely papillomavirus infection (30.0 % vs. 36.4%), alcohol abuse (62.2% vs. 36.4%), heredity (41.2% vs. 24.2%). However, they also acknowledge their own lack of awareness in the prevention of HNC (20.6% and 13.6%). It has been shown that identified informational and organizational deficiencies can lead to improper detection of oncological and precancerous diseases of head and neck area: 43.3% of dentists and 30.3% of PCPs not encounter such cases in their practice.
Conclusions. It is necessary to improve the organization of early detection of HNC, taking into account the established gaps in awareness and the deficiencies of the usage of preventive technologies in the activities of dentists and PCPs. Мета. Оцінити обізнаність та застосування основних технологій раннього виявлення злоякісних новоутворень (ЗН) щелепно-лицевої ділянки (ЩЛД) в практичній діяльності лікарів-стоматологів і лікарів первинної медичної допомоги (ПМД).
Матеріали та методи. Провели медико-соціологічне дослідження 233 лікарів-стоматологів та 66 лікарів первинної медичної допомоги.
Результати. Тільки кожен п’ятий лікар ПМД (19,7% у порівнянні із 59,7% лікарів-стоматологів) проводить повний огляд ЩЛД пацієнтів при кожному випадку звернення до нього, проте технічна якість їх проведення характеризується більшою онконастороженістю, ніж у лікарів-стоматологів, які головну увагу концентрують на стані зубів (83,7% проти 45,0% лікарів ПМД) і значно рідше оцінюють слизову оболонку порожнини рота (18,5% проти 95,5% відповідно) чи пальпують лімфовузли (6,9% проти 83,3%). Лікарі-стоматологи гірше обізнані щодо переваг скринінгу ЗН ЩЛД (16,3% проти 42,4% лікарів ПМД) та можливості його проведення іншими лікарями, зокрема ПМД (14,2% таких відповідей проти 72,7% опитаних лікарів ПМД) чи оториноларингологами (25,3% проти 50,0%), переоцінюють при цьому роль лікарів-онкологів (45,9% проти 16,7%), не володіють достатніми знаннями щодо чинників ризику ЗН ЩЛД, а саме: папіломавірусної інфекції (30,0% проти 36,4%), зловживання алкоголем (62,2% проти 36,4%), спадковості (41,2% проти 24,2%), але й усвідомлюють свою необізнаність з питань профілактики ЗН ЩЛД (20,6% та 13,6%). Показано, що встановлені інформаційні та організаційні недоліки можуть призводити до неналежного виявлення онкологічних і передракових захворювань ЩЛД: 43,3% лікарів-стоматологів та 30,3% лікарів ПМД не зустрічали у своїй практиці таких випадків.
Висновки. Необхідно удосконалити організацію раннього виявлення ЗН ЩЛД з врахуванням встановлених прогалин обізнаності та недоліків застосування профілактичних технологій в діяльності лікарів-стоматологів і лікарів ПМД.
Ключові слова. Злоякісні новоутворення щелепно-лицевої ділянки; організація раннього виявлення; профілактична обізнаність; лікарі-стоматологи; лікарі ПМД
Preoperatively Confirmed Idiopathic Myointimal Hyperplasia of the Mesenteric Veins: A Case Report
Full text linkIdiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare cause of colonic ischemia. First documented in the literature in 1991, this condition has remained exceedingly rare, with only a limited number of case reports since its initial mention. It involves proliferation of intimal smooth muscle within the mesenteric veins, resulting in colonic ischemia due to venous constriction and non-thrombotic occlusion. Patients experience a prolonged clinical course and adverse outcomes due to its rarity and nonspecific symptoms. The definitive diagnosis is typically confirmed after surgical resection of the affected colon, as initial biopsies are not deep enough to confirm the diagnosis. Histological examination of these biopsies reveals arteriolization of capillaries, subendothelial hyaline deposits, and fibrin thrombi. We present a case of a patient with a one-year history of diarrhea and abdominal pain. Biopsy samples obtained during colonoscopy showed colitis and proliferation of muscularized capillaries, consistent with IMHMV, prior to colon resection. The patient ultimately underwent laparoscopic total abdominal colectomy to the distal one-third of the rectum with end ileostomy. IMHMV is commonly treated surgically and mismanagement of this condition involving corticosteroids and immunomodulatory agents may result in unfavorable outcomes. This case report is one of the few cases of IMHMV diagnosed preoperatively within existing literature, which highlights a rare etiology of nonspecific colitis, emphasizing the critical divergence in its management approach
Attitudes of Gynecologists on Oral Health Care During the Pregnancy in the Republic of North Macedonia
No full textObjective: The aim of the study was to determine the attitudes and the knowledge of gynecologists in the Republic of North Macedonia on oral health care during the pregnancy.
Materials and methods: The specialists and residents of obstetrics and gynecology in Republic of North Macedonia were involved in this cross-sectional study. The survey was conducted by a questionnaire which consisted the questions on general demographic data and issues related to the attitudes of gynecologists to oral health care of pregnant women. The data were collected from January to May 2022 using Google Form, a link to which questionnaire was send via available social media platforms.
Results: Out of the total number of 120 respondents, 86 (71.64%) were specialists and 34(28.33%) residents of obstetrics and gynecology. As many as 116 (96.67%) gynecologists answered that they advise their patients to visit the dentist for an examination. However, of these 116 gynecologists, 16 (13.33%) responded by advising their patients to postpone a visit to the dentist until the end of the pregnancy. 79 (65.83%) gynecologists answered that their patients complained of gingival bleeding during pregnancy. 48 (40.33%) gynecologists answered that their patients complained about tooth mobility during pregnancy. When respondents were asked where they get information about the connection between oral health and pregnancy, only 27 respondents answered correctly that they receive information from all the above sources. Only 7 (5.83%) respondents, 5 specialists and 2 residents of obstetrics and gynecology know that breastfeeding a child can cause dental caries.
Conclusion: Additional collaboration between gynecologists and doctors of dental medicine is essential in order for every pregnant woman to receive a satisfactory level of dental care and proper education on the preservation of oral health
Features of the Dermatoglyphic Foot Pattern in Suicider Males
No full textSince suicide is one of the most common types of violent death among people of working age (including military personnel) and children, it is necessary to conduct in-depth studies of the structure of skin patterns in a group of people with completed suicide in order to develop methods of active suicide prevention. In order to determine the propensity to commit suicide, the dermatoglyphs of the distal phalanges and metacarpal pads of the toes of 138 male subjects aged 18 to 59 years who committed suicide and 100 control subjects aged 18 to 59 years were studied. The type of pattern (arc, tibial or fibular loop, curl, complex pattern), delta and comb counts were determined. It was found that the suicide group differs from the control group mainly in a higher number of interruptions (ending X) of the main plantar lines A, B and C; an increase in the frequency of arc patterns on most toes of both feet with a degree of reliability; a decrease in the frequency of curls on the third toe of the left foot to 44.5±11.2 (p<0.001) and an increase in the frequency of this pattern on the second toes of both feet; an increase in the value of the comb count in the area of the tibial edge of the foot, with a decrease in the values near the fibular edge of the foot.Оскільки суїцид є одним з найпоширеніших родів насильницької смерті серед осіб працездатного віку (зокрема, військовослужбовців) та дітей, вбачається за необхідне проведення поглиблених досліджень будови шкірних візерунків у групі осіб із завершеним суїцидом з метою розробки методів активної профілактики самогубств. З метою визначення схильності до самогубств були вивчені дерматогліфи дистальних фаланг та підпальцевих подушечок пальців ніг 138 осіб чоловічої статі, віком від 18 до 59 років, що вчинили суїцид, та 100 осіб контрольної групи віком 18 - 59 років. Визначали тип візерунку (дуга, петля тібіальна чи фібулярна, завиток, складний візерунок), дельтовий та гребінцевий рахунки. Встановлено, що група суїцидентів відрізняється від контрольної головні вищою кількістю переривань (закінчення X) головних підошвових лінії А, В та С; збільшенням частот дугових візерунків на більшості пальців обох стоп зі ступенем достовірності; зниженням частоти завитків на третьому пальці лівої стопи до 44,5±11,2 (p<0,001) і збільшення частот цього візерунка на других пальцях обох стоп; збільшенням значення гребінцевого рахунку у ділянці тибіального краю стопи за умови зниження величин біля фібулярного краю стопи
Tuberous Sclerosis: A Case of Delayed Retrospective Diagnosis
Full text linkTuberous sclerosis is a rare genetic disorder, often diagnosed based on clinical manifestations. We report a case of a 39-year-old woman retrospectively diagnosed with tuberous sclerosis after giving birth to a child with cardiac rhabdomyomas. This case highlights the awareness of clinical manifestations of orphan diseases among physicians and the need for a broader approach to managing patients, extending beyond the limited perspective of medical professionals specializing in a particular area of health and facilitated through multidisciplinary consultations, highlighting the significance of educational initiatives among specialists and the general population for early detection and implementation of corrective measures in rare genetic disorders
Results of Primary Arteriovenous Fistulas Formation with Different Types of Anastomoses in the Early Postoperative Period in Patients on Programmed Hemodialysis
Full text linkThe study includes the analysis of the results of using the different types of arteriovenous anastomoses in the formation of arteriovenous fistulas and their impact on fistula maturation in the early postoperative period. One of the main aspects of the work is to determine the optimal type of anastomosis to ensure the proper functioning of arteriovenous fistula that is an important element of vascular access in patients on renal replacement therapy. It is important to consider such factors as the diameter of formed arteriovenous fistula, the blood flow velocity through it, the incidence of complications and the duration of its functioning. The study also takes into account the impact of patients’ characteristics, such as age, condition of arteries and veins, as well as general health indicators on the results of surgery. Taking these factors into account allows to identify the groups of patients who can benefit most from a particular type of anastomosis.
During the sample period, 384 patients with terminal stage of renal failure aged 20 to 84 years undergoing programmed hemodialysis, the native arteriovenous fistula was formed. It was found that 94.01 % of arteriovenous fistulas were successful in the early postoperative period. The average age of these patients was 44.2 years, while unsuccessful cases developed in people with an average age of 66.8 years. It was also found that within an hour after surgery for the formation of an arteriovenous fistula with the type end-to-side anastomosis, its diameter increases from 2.08±0.42 mm to 2.96±1.68 mm, and the blood flow velocity increases from 21.4±7.6 ml/min to 212.4±74.6 ml/min. The risk factor for effective fistula formation, in addition to age, is the diameter of vessels, anatomical features of the venous system, the presence of concomitant pathology (primarily diabetes mellitus).
The obtained results can serve as a basis for the developing of recommendations for the optimal choice of anastomosis type for certain categories of patients who will undergo renal replacement therapy. The study is aimed at improving the results of surgical treatment and increasing the quality of life of patients with chronic renal failure
Thiol-Disulfide Balance in Fibromyalgia: A Case-Control Study
Full text linkAim. We aimed to examine the thiol-disulfide (SS) balance, a recognized marker of oxidative stress, in fibromyalgia syndrome (FMS).
Methods. The study comprised 98 female participants (61 newly diagnosed patients and 37 patients under treatment) with FMS, along with 82 apparently healthy female volunteers. In both groups, assessments were conducted using the Fibromyalgia Impact Questionnaire (FIQ), Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Short Form-36 (SF-36), Tender Point Count, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Native thiol (NT) and total thiol (TT) levels were measured, SS levels and SS/NT ratio were calculated.
Results. FMS patients demonstrated significantly lower NT levels, higher SS levels, and an elevated SS/NT ratio compared to the control group (p< 0.05 for all groups). In FMS patients, a statistically significant correlation was found between SS level and the SS/NT ratio, as well as the number of tender points (r=-0.24, p=0.02; r=-0.21, p=0.04), SF-36 pain subscales (r=0.22, p=0.032; r=0.21, p=0.04), and BAI scores (r=-0.22, p=0.01; r=-0.23 p=0.03). In the subgroup analysis, all health assessment scales were observed to exhibit statistically significant differences between the under-treatment group and newly-diagnosed group when compared to the control group (p< 0.05 for all groups). The FIQ, VAS, FSS, and BAI scores were found to be significantly lower in the under-treatment group as compared to the newly-diagnosed group (p< 0.05 for all groups). In the newly-diagnosed group, NT was significantly lower and the SS/NT ratio was significantly higher than those in the control group (p< 0.05). In the under-treatment group, SS levels and SS/NT ratio were significantly higher as compared to the control group (p< 0.05). In the multivariate regression analysis, which incorporated age, health assessment scales, patient subgroups, tender points, and duration of symptoms to predict the SS/NT ratio, variabes such as being in the under-treatment group, tender points, and BAI score were identified as significant predictors (p< 0.05).
Conclusions. The thiol-SS balance was observed to shift in the oxidative direction, and oxidative stress was higher in the FMS group. The absence of a significant difference between the under-treatment group and the newly-diagnosed group in terms of thiol-SS balance parameters suggests a shift to oxidative stress in patients, independent of the treatment status
Relationship Between Malnutrition Risk, Activities of Daily Living, and Adaptation to Chronic Diseases in Older People with Chest Diseases
Full text linkIntroduction. The increased risk of malnutrition in older people may have significant impacts on chronic disease management and quality of life.
This study aimed to investigate the relationship between chronic diseases, activities of daily living (ADLs), and malnutrition risk.
Methods. This cross-sectional, correlational study was conducted on 352 patients over 65 years old, who had a chronic disease for at least one year and were admitted to Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey. The data were collected using the Descriptive Information Form, Adaptation to Chronic Illness Scale (ACIS), Nutrition Risk Screening-2002 (NRS-2002), and Katz Activities of Daily Living (Katz ADL) scale.
Results. The mean age of the participants was 70.65±4.18 years. All participants were at risk of malnutrition according to the NRS-2002 assessment, 29% were independent, and 35.8% were partially dependent based on the Katz ADL scale assessment. The ACIS score was 82.83±13.88. Multivariate linear regression analysis revealed that age, disease duration, perceived disease knowledge, and interference from the disease with planned activities were significant positive predictors of ACIS, while hospitalization in the last 6 months, the number of meals per day, difficulty in meeting personal care needs, and NRS-2002 were significant negative predictors of ACIS (p<0.05).
Conclusions. Despite the unexpected homogeneity in malnutrition risk, the NRS-2002 score emerged as a negative predictor of chronic disease adaptation. Furthermore, recent hospital admissions, daily meal consumption, and impairment in self-care were also found to have a negative influence, while age, disease duration (in years), appropriate disease knowledge, and the absence of interference from the disease with planned activities demonstrated a positive impact on chronic disease adaptation