Incidence, Risk Factors and Outcome of Bloodstream Infections in Patients After Hematopoietic Stem-Cell Transplantation: A Single Center Study.

The bloodstream infections (BSIs) are among the most common infectious complications after hematopoietic stem-cell transplantation (HSCT), often associated with high mortality rates. The aim of this study was to evaluate the incidence, risk factors and outcome of BSIs in HSCT recipients from the Transplantation Center of the University Hospital in Varna, Bulgaria during the period January 2019-December 2021. The role of patient- and transplantation-related variables was studied as potential risk factors for BSIs and survival after HSCT. Seventy-four patients were included in the study. The cumulative incidence of BSIs was 35%. The mean period of BSI onset after HSCT was 8 days. The Gram-positive bacteria were more commonly isolated as causative agents (52.3%). The mortality rate 30 days after the diagnosis of BSI was 23%. Fecal colonization with multidrug-resistant (MDR) bacteria (p = 0.005) and pre-transplant BSI (p = 0.05) were associated with significantly increased risk for post-HSCT BSIs. The overall 4-month survival was 86.5%. A statistical significance was found between the type of the underlying disease (acute leukemia and lymphoma, p = 0.043), previous HSCT (p = 0.001) and 4-month survival. This study confirms that the fecal colonization with MDR bacteria before transplantation and pre-transplant BSIs are independent risk factors for the occurrence of BSI in the early period after HSCT. Pre- and posttransplant monitoring of the patient fecal colonization status with MDR organisms, could contribute considerably to the prevention and successful management of the infectious complications in patients after HSCT.

Incidence of Non-melanoma Eyelid Malignancies in Bulgaria (2000-2015).

PURPOSE: Malignant eyelid tumours are the most common malignancies in ophthalmic practice. We report here the incidence of non-melanoma eyelid malignancies in Bulgaria, for the period 2000-2015. METHODS: All cases coded with the International Classification of Diseases (ICD) code C 44.1, received from the Bulgarian National Cancer Registry, were used for estimating crude incidence rates by age and sex. In addition, directly age standardized incidence rates for non-melanoma eyelid malignancies are presented based on the European Standard population (year 2013) for Bulgaria and the region of Varna. RESULTS: Over the 16-year period there were 3,046 cases in total, of which 1,457 (47.8%) were among men. The age standardized rate (ASR) of non-melanoma eyelid malignancies in men was 2.9 per 100,000 (95% CI 2.79-3.11), in women it was 2.4 per 100,000 (95% CI 2.30-2.54), and the mean ASR was 2.6 per 100,000 (95% CI 2.53-2.73) for both sexes during the period. The ASR increased for women and for both sexes combined.The risk of eyelid malignancies was higher for men than for women with RR of 1.21 (95% CI 1.08-1.41) during the whole period. The risk was higher in women up to the age of 55 and over 55 years it was higher in men. CONCLUSION: We report results for the incidence of eyelid non-melanoma malignancies in a south-eastern European country, Bulgaria. They are comparable with earlier reports from other European countries.

Perceived challenges to public health in Central and Eastern Europe: a qualitative analysis.

BACKGROUND: There is a major gradient in burden of disease between Central and Eastern Europe compared to Western Europe. Many of the underlying causes and risk factors are amenable to public health interventions. The purpose of the study was to explore perceptions of public health experts from Central and Eastern European countries on public health challenges in their countries. METHODS: We invited 179 public health experts from Central and Eastern European countries to a 2-day workshop in Berlin, Germany. A total of 25 public health experts from 14 countries participated in May 2008. The workshop was structured into 8 sessions of 1.5 hours each, with the topic areas covering coronary heart disease, stroke, prevention, obesity, alcohol, tobacco, tuberculosis, and HIV/AIDS. The workshop was recorded and the proceedings transcribed verbatim. The transcripts were entered into atlas.ti for content analysis and coded according to the session headings. After analysis of the content of each session discussion, a re-coding of the discussions took place based on the themes that emerged from the analysis. RESULTS: Themes discussed recurred across disease entities and sessions. Major themes were the relationship between clinical medicine and public health, the need for public health funding, and the problems of proving the effectiveness of disease prevention. Areas for action identified included the need to engage with the public, to create a better scientific basis for public health interventions, to identify "best practices" of disease prevention, and to implement registries/surveillance instruments. The need for improved data collection was seen throughout all areas discussed, as was the need to harmonize data across countries. CONCLUSIONS: To reduce the burden of disease across Europe, closer collaboration of countries across Europe seems important in order to learn from each other. A more credible scientific basis for effective public health interventions is urgently needed. The monitoring of health trends is crucial to evaluate the impact of public health programmes.

Expression of matrix metalloproteinase-1, -9, -13, and tissue inhibitor of metalloproteinases-1 in basal cell carcinomas of the eyelid.

BACKGROUND: Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) function in the remodelling of the extracellular matrix in morphogenesis, angiogenesis, tissue repair, and tumor invasion. Elevated levels of distinct MMPs in tumor tissue are related to worse prognosis. However, no overall consistent pattern of expression in human cancer has been identified. The aim of the present study was to evaluate the expression of MMP-1, -9, -13 and TIMP-1 in tumor epithelial cells and surrounding connective tissue in primary basal cell carcinomas (BCC) of the eyelid, and to assess their role as prognostic markers for tumor recurrence. METHODS: Surgical specimens of 49 histologically proven primary BBCs of the eyelid of different histological subtypes were included. Immunohistological studies were performed using antibodies against MMP-1, MMP-9, MMP-13 and TIMP-1, and staining intensity was analyzed semi-quantitatively. RESULTS: MMP-1, -9, -13, and TIMP-1 were expressed at various intensities in epithelial tumor cells and surrounding stromal cells including fibroblasts, inflammatory cells, and vascular endothelial cells in all tumor subtypes. Staining was especially prominent at the invading edge of the BCC. A statistically significant correlation was seen between increased TIMP-1 expression in tumor and/or stromal cells with the presence of MMP-13 (p = 0.007 and p < 0.0001 respectively). Moreover, TIMP-1 expression in tumor and/or stroma was significantly associated with relapse (p = 0.012 and p = 0.042 respectively). CONCLUSION: MMP-9, MMP-13 and TIMP-1 expression may serve as a prognostic marker for early tumor invasiveness. Moreover, up-regulation of TIMP-1 in tumor and/or surrounding stromal cells may indicate an increased risk for BCC recurrence.

Public understanding of the causes of high stroke risk in northeast Bulgaria.

BACKGROUND: Knowledge of stroke risk factors is undocumented in Bulgaria. METHODS: 188 subjects in 2000 and 447 in 2003 were asked: 'Why do you think stroke is so common in this region?' RESULTS: Stress and poverty accounted for 69% of the first mentions in 2000 and 59% in 2003. There were no mentions of high blood pressure and no first mentions of smoking in 2000. High blood pressure appears only 10 times and smoking 12 times among 745 answers in 2003. CONCLUSION: Health education on the established causes of stroke is an urgent priority in Bulgaria.