[Features of methodology for the formation of standard operational procedure in the practice of bureau of forensic medical expertise]. / Osobennosti metodologii formirovaniya standartnykh operatsionnykh protsedur v prakticheskoi deyatel'nosti byuro sudebno-meditsinskoi ekspertizy.

OBJECTIVE: To analyze and summarize data on formation and implementation in practice of standard operational procedures for developing algorithm to improve the quality management system of bureau of forensic medical expertise. MATERIAL AND METHODS: Normative legal documents regulating principles of standardization in healthcare were studied. Literature was analyzed in PubMed, Google Scholar, eLIBRARY search engines in English and Russian languages on the issues of development and implementation of standard operational procedures in practice. RESULTS: Data on using standard operational procedures as a standardization element in medical practice have been analyzed and generalized. Specific proposals for developing system of standard operational procedures, based on general principles for the creation of such documents, in forensic medical expert institutions have been proposed. CONCLUSION: Suggested recommendations can be used in practice to develop new common standard operational procedures.

Efficacy of an aerosol-resistant pepsin powder used in artificial digestion for the detection of Trichinella larvae in meat.

Trichinellosis is an important worldwide foodborne zoonosis. The gold standard test to detect Trichinella spp. larvae in muscle samples of animals intended for human consumption is the artificial digestion method. Handling and dispensing of conventional pepsin powder present significant safety risks for analysts. The use of pepsin powder that is resistant to aerosolization should alleviate these safety concerns. The aim of this study was to compare the efficacy of an aerosol-resistant pepsin powder to conventional pepsin powder in the artificial digestion method. Proficiency samples of pork diaphragm containing specific numbers of viable Trichinella spiralis larvae were tested in two laboratories. The results revealed that aerosol-resistant pepsin was simple, effective and convenient to use, and showed good solubility and larval recovery that met the requirements of the European Union regulation EU 2015/1375. Overall, the efficacy of the aerosol-resistant pepsin was comparable to the conventional pepsin and safer for analysts.

[Assessment of nutritive status and its correction in oncological patients after operations in the hepatopancreatoduodenal zone].

Surgical interventions in the hepatopancreatoduodenal zone in cancer patients are associated with high risk of nutritional deficiency in the postoperative period. This feature is due to both the volume of the operation itself (pancreatoduodenectomy), and the predominance of catabolic processes in the early postoperative period. In this regard, the monitoring of the main indicators of carbohydrate, protein and fat metabolism in the early postoperative period becomes fundamental for choosing the correct tactics of nutritional support for this patients. Aim. Improvement of the nutritional status of cancer patients after operations carried out in the hepatopancreatoduodenal zone in connection with malignant neoplasms by means of a comprehensive comparative analysis of the effectiveness of isolated enteral, isolated parenteral and mixed types of nutritional support in the early postoperative period. Material and methods. The examination included 40 patients with an average age of 44.5±6.8 years (15 men, 25 women). All patients for analysis were divided into two groups: the first, the main - patients receiving strictly enteral and/or probe nutrition (n=21), the second, control - isolated parenteral nutrition (n=19). The dynamic of the main predictors of nutritional status in the early postoperative period was assessed: the level of total blood protein, including albumin, lymphocyte count, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, their ratio - the de Ritis coefficient (as indirect criterion of cytolytic syndrome), total bilirubin. The analysis included the time interval of the enteral and parenteral nutrition in the early postoperative period, together with the number of bed-days required to correct the nutritional status in these patients in an intensive care unit. To objectify and clarify the dynamics of the nutritional status of patients in the pre- and postoperative period, we used the generally accepted scales for assessing nutritional status - Subjective Global Assessment (SGA) Nutritional Risk Index (NRI). Results. According to the SGA and NRI rating scales, the overwhelming majority of patients in the main and control groups (85.7% and 94.7%, respectively) had a normal nutritional status before the operation. In the postoperative period, 4 (21%) patients in the control group showed signs of moderate malnutrition by day 12, which regressed after the enteral nutritional support was connected. There were no statistically significant changes in nutritional status in patients of the main group. The basal metabolic rate in patients of both groups had no statistical differences before surgery (2296±279 kcal/day). On the 15th day of the postoperative period, its increase by 394 kcal/day was recorded in the main group, in the control group an increase in the basal metabolic rate was observed only with the addition of the enteral component of nutritional support, on average, by 321 kcal/day. There was no statistically significant decrease in the level of blood lymphocytes in patients of the main group (p=0.289) in comparison with the traced tendency to lymphopenia (p=0.019) in patients of the control group. The patients of the main group showed a slower regression of the ALT activity, and, accordingly, less increase in the de Ritis coefficient. Conclusion. In patients operated in the hepatopancreatoduodenal zone due to malignant neoplasms, in the early postoperative period, the enteral administration of nutritional mixtures may be preferable, both as an isolated method of nutritional support and as a supplement to parenteral nutrition, given its positive effect on the gastrointestinal tract passage, the level of basal metabolism, the state of the protein-synthetic function of the liver and, indirectly, the degree of cytolytic syndrome.

Regulation of Neprilysin Activity and Cognitive Functions in Rats After Prenatal Hypoxia.

The amyloid-degrading enzyme neprilysin (NEP) is one of the therapeutic targets in prevention and treatment of Alzheimer's disease (AD). As we have shown previously NEP expression in rat parietal cortex (Cx) and hippocampus (Hip) decreases with age and is also significantly reduced after prenatal hypoxia. Following the paradigms for enhancement of NEP expression and activity developed in cell culture, we analysed the efficacy of various compounds able to upregulate NEP using our model of prenatal hypoxia in rats. In addition to the previous data demonstrating that valproic acid can upregulate NEP expression both in neuroblastoma cells and in rat Cx and Hip we have further confirmed that caspase inhibitors can also restore NEP expression in rat Cx reduced after prenatal hypoxia. Here we also report that administration of a green tea catechin epigallocatechin-3-gallate (EGCG) to adult rats subjected to prenatal hypoxia increased NEP activity in blood plasma, Cx and Hip as well as improved memory performance in the 8-arm maze and novel object recognition tests. Moreover, EGCG administration led to an increased number of dendritic spines in the hippocampal CA1 area which correlated with memory enhancement. The data obtained allowed us to conclude that the decrease in the activity of the amyloid-degrading enzyme NEP, as well as a reduction in the number of labile interneuronal contacts in the hippocampus, contribute to early cognitive deficits caused by prenatal hypoxia and that there are therapeutic avenues to restore these deficits via NEP activation which could also be used for designing preventive strategies in AD.

Aliphatic-aromatic stacking interactions in cyclohexane-benzene are stronger than aromatic-aromatic interaction in the benzene dimer.

Stacking interactions between cyclohexane and benzene were studied in crystal structures from the Cambridge Structural Database and by ab initio calculations. Calculated at the very accurate CCSD(T)/CBS level of theory, the cyclohexane-benzene interaction energy is -3.27 kcal mol-1, which is significantly stronger than the interaction in the benzene dimer (-2.84 kcal mol-1) indicating the importance of aliphatic-aromatic interactions.

Prenatal Hypoxia Impairs Olfactory Function in Postnatal Ontogeny in Rats.

Analysis of the age-related dynamics of olfactory behavior in the odor preference and food search testsshowed that all male Wistar rats, regardless of age, preferred valerian essential oil, whose components have the properties of pheromones in rodents, when given a selection of eight essential oils; young rats displayed better food-seeking results than adult and old animals. Acute prenatal hypoxia (PH) on E14 (7% O2 for 3 h) led to impairment of the valerian odor preference at all ages studied and to decreased productivity of food searches. Neurodegenerative processes were seen in the piriform cortex after PH, with reductions in the number of neurons and increases in glial elements. We have previously observed these changes in the entorhinal cortex and hippocampus, but not in the olfactory bulbs. This suggests that PH-induced decreases in olfactory function in rats may result from impairments to the formation of the central elements of the analyzer during the first months of postnatal ontogeny.

Maternal Hyperhomocysteinemia Induces Neuroinflammation and Neuronal Death in the Rat Offspring Cortex.

Maternal hyperhomocysteinemia is one of the common complications of pregnancy that causes offspring cognitive deficits during postnatal development. In the present work, we evaluated the effect of prenatal hyperhomocysteinemia on structural and ultrastructural organization, neuronal and glial cell number, apoptosis (caspase-3 content and activity), inflammatory markers (tumor necrosis factor-α, interleukin-6, and interleukin-1ß), and p38 mitogen-activated protein kinase (p38 MAPK) phosphorylation in the offspring brain cortex in early ontogenesis. Wistar female rats received methionine (0.6 g/kg body weight) by oral administration during pregnancy. Histological and biochemical analyses of 5- and 20-day-old pups' cortical tissue were performed. Lysosome accumulation and other neurodegenerative changes in neurons of animals with impaired embryonic development were investigated by electron microscopy. Neuronal staining (anti-NeuN) revealed a reduction in neuronal number, accompanied by increasing of caspase-3 active form protein level and activity. Maternal hyperhomocysteinemia also elevated the number of astroglial and microglial cells and increased expression of interleukin-1ß and p38 MAPK phosphorylation, which indicates the development of neuroinflammatory processes.

Eight years of quality control in Bulgaria: impact on mammography practice.

The requirements for quality control (QC) in diagnostic radiology were introduced in Bulgarian legislation in 2005. Hospital medical physicists and several private medical physics groups provide QC services to radiology departments. The aim of this study was to analyse data from QC tests in mammography and to investigate the impact of QC introduction on mammography practice in the country. The study was coordinated by the National Centre of Radiobiology and Radiation Protection. All medical physics services were requested to fill in standardised forms with information about most important parameters routinely measured during QC. All QC service providers responded. Results demonstrated significant improvement of practice since the introduction of QC, with reduction of established deviations from 65 % during the first year to 7 % in the last year. The systems that do not meet the acceptability criteria were suspended from use. Performance of automatic exposure control and digital detectors are not regularly tested because of the absence of requirements in the legislation. The need of updated guidance and training of medical physicists to reflect the change in technology was demonstrated.

[Contraception via a vaginal hormonal ring]. / Kontratseptsiia posredstvom vlagalishten khormonalen prusten.

PIP: Research on the hormonal vaginal ring began in the US in 1973. Its prototype with a diameter of 55 mm releasing in even doses small amounts of hormone was introduced 17 years later. Its high effectiveness with a failure rate of 3-4 pregnancies/100 woman use years is similar to that of most IUDs. The first type contains a combination of estrogen-gestagen consisting of levonorgestrel and 17-beat-estradiol as in oral preparations. It has to be used from the beginning of the menstrual cycle for 3 weeks and removed for 1 week. The second one, devised by a special program of WHO, contains gestagen only in the form of levonorgestrel (LNG) releasing 20-25 mcg of LNG daily. The third type contains progesterone only which is suitable for use by lactating women, as the progesterone eventually absorbed in the maternal system does not pose any risk to the nursing child. At present its effectiveness is being tested, and then its practical application will be examined. The introduction of the prototype was delayed by 2 years when initial investigations showed that the substance used for polymerization of the plastic used for the vaginal ring was carcinogenic, however, this was refuted in subsequent investigations. The vaginal ring is already sold regularly in Great Britain and in some western European countries. This new method allows doctors to provide an alternative contraceptive in addition to the existing ones.^ieng

[Obstetrical and gynecologic prophylaxis of medical demographic risks in family development]. / Akushero-ginekologichna profilaktika na mediko-demografskite riskove vuv formiraneto na semeistvoto.

PIP: The formation of the family represents a complex dynamic process and frequently, there are obstacles which interfere with personal design. Only 7.3% of the husbands in this study found that their original plans for family formation continued as planned. One risk to which the Bulgarian family has been exposed to was contraceptive failure prior to marriage for between 7.3-24%. Additionally, families have experienced infertility in between 6.6-8.8%, delayed desired pregnancy, miscarriage, stillbirth, delivery of children with birth defects in 2%, undesired sex ratio in children born, risk of divorce, premature death, as well as unwanted or unplanned pregnancy. It is suggested that couples take advantage of the available services in the area of health care, especially in the field of obstetrics and gynecology, to assist them. (author's modified)^ieng

[The experience of European countries in stimulating fertility through economic means]. / Otnosno opita na evropeiskite strani za stimulirane na plodovitostta posredstvom ikonomicheski merki.

PIP: Demographic trends in various European countries during the end of 19th and 20th century are reviewed with special emphasis on the historic changes in population dynamics. Transition from high birth rate and high mortality rate to low birth rate and low mortality rate led to a zero growth and even to a negative population growth. The decrease in birth rate is associated with the changes in the need to have children and with changes in the attitude of parents. The measures to stimulate birth rate are based on the assumption that parents want to have children but are prevented by socioeconomic factors. Birth rate can be stimulated by direct subsidies (1-time cash payments after the birth of a child, maternity leave, monthly bonus payments) or by indirect subsidies (loans for housing, medical care, education). 1-time cash payments vary from country to country and can amount to an average monthly salary. In the USSR, the amount of payment depends upon the income of the parents. All European countries provide for maternal leave (12-16 weeks). Monthly bonus payments for a 2nd child range from 1%-21% of an average monthly salary; the lowest payments are given in Greece and Spain and the highest--in Hungary. Countries with relatively low birth rate (Austria, Belgium, Luxembourg, West Germany, France, Holland) are characterized by the highest child payments, while counties with relatively high birth rate (Greece, Ireland, Spain, Italy, Poland, Portugal) have the lowest child payments.^ieng

[The provision of specialized medical personnel in the obstetrical-gynecological network in the People's Republic of Bulgaria]. / Otnosno obezpechenostta sus spetsializirani lekarski kadri na akushero-ginekologichnata mrezha v NR Bulgariia.

The development of the medical obstetric-gynecological staff in the People's Republic of Bulgaria is characterized by a high rate of quantitative growth. Conversely worsening of the index of the relative part of obstetricians-gynecologists with acquired specialty is present; this index is reduced by almost 10% for the whole country during the recent two decades. Regional differences are established as the regions, located in the western part of the country, lag behind in training staff. An attempt is made to determine the factors, which cause the existing regional differences. Adequate measures are proposed to improve postgraduate qualification of medical staff for obstetric-gynecological services in the country during next years.

[Early artificial termination of pregnancy by Karman's method]. / Rannoto izkustveno prekusvane na bremennostta po Karman.

PIP: After a brief survey of the expected advantages of the early interruption of pregnancy by the Karman method, the author describes his own observations on immediate and early complications in 850 cases. In the course of intervention, 7.45% of the patients reacted with a vegetative manifestation of cervical shock--pallor, nausea, vomiting, colic-like pain in the lower part of the abdomen (mainly in nullipara). The aspirated amount of material did not surpass 50 ml in women with amenorrhea of 40-45 days duration. The mean duration of the aspiration was 1 minute, 57 seconds. There was menstruation-like bleeding from day 3 to days 10-12 in 86.3% of the women with interruption of pregnancy. Its occurrence in 2.49% of the patients was preceded by colic-like pain and shortlived elevation of axillary temperature up to 38oC. Inflammatory complications were registered up to the 2nd month in 2.49% of the 79.3% followed. The aspiration system with the hand vacuum extractor (Malstrom type) was used successfully for creating negative pressure and thus the special syringe (Karman type) was replaced.^ieng

[Hormonal contraception using the oral depot preparation, Deposiston]. / Khormonalna kontratseptsiia s pomoshtta na oralen depo-preparat Deposiston.

PIP: The efficacy of a new contraceptive delayed-action preparation, Deposiston is reviewed. Deposiston is the estrogen-progestin preparation with predominant estrogen activity. The estrogen and progestin eomponents of the preparation are ehtinyl estradiol and norethindrone acetate, respectively. Contraceptive effect is associated with gonadotropic stimulation by estrogen component, while progestin component provides the thermogenic effect. Mutagenicity, carcinogenicity, and toxicity tests show safety of Deposiston. Clinical trials of Deposiston in 815 women over the period of 16,207 cycles (18.1 cycles/woman) confirm contraceptive efficacy of the preparation: pregnancy occurred in only 12 women. Side effects of Deposiston include nausea (16.06%), vomiting (3.7%), headache (5.08%), and vaginal discharge (11.86%). Each Deposiston package contains 3 white estrogen tablets and 2 red progestin tablets. A woman starts to take Deposiston on day 4 of the cycle: white tablets are taken on days 4, 11, and 18 and 2 red tablets are taken on day 25. On day 2-7 after the red progestin tablets, the woman experiences hemorrhage. Average duration of and the amount of blood loss during the hemorrhage do not differ from those during the normal menstruation. Deposiston is indicated for women with recurrent uterine hemorrhages, gastrointestinal disorders, and decreased libido. The preparation is contraindicated for adolescents younger than 16 years of age, for women with hormonal active tumors, thromboembolism, chronic liver diseases, and idiopathic jaundice.^ieng

[New more-effective model of intrauterine contraceptive loop covered with copper wire--TC 200]. / Nov po-efektiven model intrauterinen kontratseptiven pesar, pokrit s medna nishka--TS 200

PIP: Despite great achievements in intrauterine contraception, it is still not widely used even in countries where it is relatively popular. This is due largely to the various side effects and to its inefficiency. In the process of searching for new more convenient contraceptives, there are very interesting data on the possible mechanisms of the intrauterine loop in both women and animals. The fact that after the addition of zinc or copper the efficiency of the loops is increased is a new step in their perfection. The combination of the T-like form and a copper wire combines the advantages of chemically-active metal with the favorable form of the loop. Also described are the peculiarities of the loop TC200 and its allocation. (Author's modified)^ieng

[Extraction of pieces of an intrauterine contraceptive device]. / Ekstrakhirane na skusan na chasti vutrematochen kontratseptiven pesar.

PIP: With the increasing usage of IUDs, the number of cases in which the gynecologist has extracted them from the uterine cavity has increased. In rare cases, this cannot be done. The author reviews such cases of induction difficulty. When the extraction of the loop from the uterine cavity is accomplished, then the thread or part of the loop can be cut off and the loop is disconnected within the cavity and the thread is found. The author reviews the ways in which the loop is localized and extracted. He proposes his own model for a hook prepared with steel wire; the technique of extraction is also described, as well as its advantages in comparison with other practiced methods. He stresses that the loop should be searched for more frequently on the anterior wall of the uterus. The patient should not be pregnant at the moment of extraction since this could induce abortion. The author infers that the most important elements are that the physician should have instruments and prepare a technique for easy and quick extraction of this type of foreign body. (author's modified)^ieng

[Changes in the legislation regulating the legal status of artificial abortion in the world in the past 10 years]. / Izmenenie na zakonodatelstvoto, koeto regulira pravniia rezhim na izkustveniia abort v sveta prez poslednite 10 godini.

PIP: Current status of abortion legislation in different countries is reviewed. During the period from 1967-1977, a total of 43 countries introduced certain changes in their legislation. Of these 43 countries, 40 liberalized abortion procedures and 3 countries limited the rights of abortion seekers. Liberalization of abortion legislation in France and Italy was associated with women's rights movement and adoption of Human Rights Declaration. Austria, France, East Germany, West Germany, Italy, Sweden, Norway, and Denmark have the most liberal abortion policy, while Rumania, Hungary, Czechoslovakia, and Bulgaria have the most restricted legislation. Liberalization of abortion does not necessarily mean availability on demand. High cost in private clinics and hospitals prevents many women from seeking a legal abortion. In Asia, Singapore, China, and India permit abortions, while in the Philippines, Indonesia, and Burma abortions are banned. In Northern and Latin America, abortions are legalized in the US and Cuba; liberalization of abortion legislation is recorded in Guatemala, El Salvador, Uruguay, Chile, and Colombia. In spite of a general liberalization of legislation, abortion policies are still affected by religious and political groups. Ban on legal abortion increases the frequency of criminal abortion, which in turn leads to increase in maternal mortality.^ieng

[Sexual violence as a sociomedical problem]. / Seksualnoto nasilie kato mediko-sotsialen problem.

A review is made on data, described in the literature, in respect to frequency and significance of sexual abuse. In spite of the scarcity of data and discretion, with which the problem is surrounded, it could be determined that in some countries around 10 to 25% of women at mature age run a risk of sexual abuse. The forms are described, in which this violation of sexual freedom of the personality are manifested: abuse, combined abuse and "passive" form of sexual abuse (s refusal of sexual contact in family partners). Data are given on the characteristic of the abuser and his victims. Sexual abuse is connected with individual constitutional factors: character, biorhythms of sexual needs, physiological states leading to frigidity or impotence as well as socially determined factors: education, usage of alcohol, crimogenic environment, ect. In the end a review is made on the measures, which are taken in various countries in the struggle with sexual abuse: legal protection, institutions for recovery of victims of abuse, "hot telephone lines" social measures, etc.

[Triphasic hormonal contraceptives]. / Trifazni khormonalni kontratseptivi.

PIP: History of development, composition, effectiveness, and side effects of first and second generation steroid contraceptive agents are briefly reviewed with special emphasis on advantages of third generation contraceptives, including triphasic hormonal contraceptives. Mechanism of action of triphasic contraceptives is based on the physiological biorhythm in the formation, secretion and blood levels of estrogens and gestagens during the menstrual cycle. The first phase (5 to 7 tablets) is characterized by high levels of estrogens and relatively low levels of gestagens. The second phase (5 to 10 tablets) is characterized by relatively high levels of estrogens and gestagens. And the third phase (7 to 10 tablets) is characterized by decreased levels of estrogens and significantly increased levels of gestagens. The most commonly used gestagens are levonorgestrel, norethindrone, and norethisterone. Ethinyl estradiol is the most commonly used estrogen. During various phases of the cycle the dosage of gestagens ranges from 0.03 to 1.00 mg and dosage of estrogen ranges from 0.3 to 0.4 mg. A single package of triphasic contraceptives contains 21 tablets. Duration of a cycle is 23-25 days with 7-day interval between the cycles. Hemorrhage during the first half of the cycle can be successfully treated with additional estrogens, while hemorrhage during the second half can be treated with gestagens. Side-effects of triphasic contraceptives include headache, dizziness, and irregular menstrual cycle. Triphasic contraceptives are specifically indicated to women older than 35 years of age, to smoking women, and to women with changes in lipid metabolism.^ieng