Acute Management of Deep Periorbital Burns: A 10-Year Review of Experience.

Deep periorbital burns are an important issue mainly due to the presence of the eyes in the region, and the crucial importance of preservation of vision. There is no consensus regarding their treatment. A retrospective analysis of the treatment and outcome of 446 patients with deep burns of the periorbital region admitted to the Department of Burns and Plastic Surgery of St George's University Hospital in Plovdiv, Bulgaria over 10 years was conducted. The study covers 446 patients, 162 female (36.5%) and 284 male (63.5%) aged from 5 months to 92 years. Deep periorbital burns accounted for 74.8% of hospitalized deep facial burns. Most frequent burn agents were hot liquids and flames. The mean total body surface area affected was 19.6% (min 0.5%, max 80.0%). Concomitant ocular pathology was diagnosed in 14% (n=63) of the patients. An early, staged and precise surgical approach was preferred, aimed at fast wound closure without sacrificing survived tissues. Follow up time ranged from 3 months to 5 years, median 37 months. Late ocular sequelae occurred in 7.4% (n=33) of the patients. There was no incidence of secondary corneal perforation or definitive loss of vision. Timely and adequate treatment during the acute period can minimize initial damage and late sequelae. Favor is given to the early, balanced surgical approach aimed at rapid wound closure between day 2 and 10 post burn. Preservation of vision is a determining factor for the significance of trauma and the effectiveness of treatment.

La gravité des brûlures péri- orbitaires profondes tient à la nécessité de préserver la vision. Il n'existe pas de consensus quant à leur prise en charge. Nous avons revu les dossiers de 446 patients victimes de brûlure péri- orbitaire profonde traités dans le CTB du CHU St Georges de Plovdiv (Bulgarie) sur une période de 10 ans. On comptait 284 hommes (63,5%) et 162 femmes (36,5%) âgés de 5 mois à 92 ans. Un atteinte péri- orbitaire était présente dans 74,8% des brûlures faciales profondes dans le cadre d'une brûlure touchant en moyenne 19,6% SCT (0,5 à 80%), dues dans la plupart des cas à une flamme ou à un ébouillantement. Une atteinte oculaire était objectivée dans 14% des cas (63 patients). Une excision précoce et soigneuse, visant à recouvrir les lésions tout en préservant le maximum de tissu était la stratégie habituelle. La durée de suivi médiane était de 37 mois (3 mois à 5 ans). Trente- trois patients (7,4%) ont souffert de séquelles oculaires, sans toutefois de perforation cornéenne ni perte de vision. Un traitement adapté techniquement et temporellement permet de limiter les dégâts initiaux et la survenue de séquelles. Nous préconisons une première intervention chirurgicale entre J2 et J10, la préservation de la fonction visuelle étant le marqueur d'une prise en charge adaptée.

Combined testing of cerebrospinal fluid IL-12 (p40) and serum C-reactive protein as a possible discriminator of acute bacterial neuroinfections.

INTRODUCTION: Central nervous system infections (CNS) are life-threatening diseases, with meningitis being the most common. Viral infections are usually self-limiting diseases but bacterial pathogens are associated with higher mortality rates and persistent neurological sequelae. We aimed to study the role of IL-6, IL-8, IL-10, IL-12(p40), TNF-α cytokines, classical cerebrospinal fluid (CSF) parameters, and serum C-reactive protein levels (CRP) for discriminating bacterial from viral central nervous system infections. MATERIAL AND METHODS: This prospective study included 80 patients with clinical signs and abnormal cerebrospinal fluid laboratory findings typical for neuroinfection admitted to St. George University Hospital-Plovdiv. Routine methods such as direct microscopy, culturing and identification were used for microbiological analysis as well as latex-agglutination test and multiplex PCR. Cytokines' concentrations were measured by ELISA. CRP and CSF parameters were collected from the patients' medical records. RESULTS: We observed the highest discriminatory power among cytokines for cerebrospinal IL-12(p40) (AUC = 0.925; p = 0.000). CSF protein levels were the best predictor for bacterial neuroinfection (AUC = 0.973; p = 0.000). The AUC for the serum CRP as a stand-alone biomarker was estimated to be 0.943. The discriminatory power can be increased up to 0.995 (p = 0.000) when combining cerebrospinal fluid IL-12(p40) and serum CRP, with an optimal cut-off value of 144 (Sensitivity 100%; Specificity 90.9%). CONCLUSION: The combined testing of CSF IL-12(p40) and serum CRP is associated with the highest diagnostic accuracy.

Difficulties in achieving and maintaining the goal of measles elimination in Bulgaria.

Measles is a disease with almost a hundred year history of existing registration in Bulgaria and has been subject to mass immunization since 1969. In 2017, after a three-year period with a low number of measles cases registered, an epidemic upsurge has been recorded affecting 3 of the total 28 regions in the country. The purpose of this study was to analyze the changes of measles morbidity in Bulgaria over the period of 1921-2017 and focus on the epidemiological characteristics of the last outbreak in the region of Plovdiv in 2017. For the whole period (1921-2017) the average measles morbidity amounts to 157.69%ооо, decreasing from 525.02%ооо in 1921 to 2.32%ооо in 2017, with 99.5% rate of reduction. In the period prior to vaccination the average morbidity was 247.14%ооо while in the vaccination period it was 70.08%ооо. The ARIMA model could be used as a short-term forecast to predict the morbidity rate. Against the background of the downward tendency in morbidity this study reports a small measles outbreak in Plovdiv, involving 141 cases, after three years of no local virus transmission in the country. An unvaccinated child who returned from abroad probably imported the disease. The measles cases were mainly Roma children and a large number of them were infants. The low intensity and prolong course of the outbreak was indicative of relatively high vaccination coverage of the population. To achieve measles elimination goals, efforts must be made to strengthen surveillance and increase the vaccination coverage, targeting children and especially Roma children.