Lethality among Patients with HIV/AIDS Monitored in the Clinic of Infectious Diseases in St George University Hospital, Plovdiv, 2010-2014.

BACKGROUND: The introduction of complex antiretroviral therapy has resulted in signifi cant decrease in the mortality rate of HIV positive patients, but it still remains unacceptably high, especially in some groups of patients. AIM: To investigate the death rate in patients with HIV/AIDS, lethality and mortality in co-infection, and the most common causes and predictors of fatal outcome, focused on early diagnosis and appropriate therapy. MATERIALS AND METHODS: The study included 53 deceased patients with HIV/AIDS, monitored at the Clinic of Infectious Diseases in St George University Hospital, Plovdiv between 01.01.2010 and 31.12.2014. The methods of research included clinical analysis, laboratory tests, microbiological and serological tests (HCV, HBV, toxoplasmosis), ELISA, PCR. Statistical analysis was performed by descriptive statistics, the Student's t-test, the method of Van der Ward, and regression analysis (logistic regression). RESULTS: During the study period 316 patients with HIV/AIDS were monitored, 53 of them with lethal outcome. Lethality was 16.7% for the whole group; in intravenous drug users - 13.8%; in co-infected patients: HIV/M. tuberculosis - 46%, in HIV/HCV - 17.8%. Lethality and mortality in HIV(+) patients with co-infections in populations of diff erent age, gender, duration since starting сАRТ and degree of immunodefi ciency (according to CD4, VL) was compared with the lethality and mortality in patients with these conditions from the general population. CONCLUSIONS: Fatal outcome in patients with HIV/AIDS was most commonly associated with co-infections HIV/M. tuberculosis and HIV/HCV. Predictors of a fatal outcome are pulmonary tuberculosis, advanced immunodefi ciency with VL> 500 000 c/µL and CD4 <100/mm3, absence or non-systemic antiretroviral therapy.

Diagnostic Dilemmas in Hepatitis C Virus Infection for Hemodialysis Patients.

BACKGROUND: Hepatitis C virus (HCV) is a leading cause of chronic hepatitis in dialysis patients. The diagnosis of HCV infection in these patients is predominantly based on laboratory tests because of the specificity of the clinical course of the disease. AIM: The present prospective study aimed at determining very accurately the prevalence rate of HCV infection in patients on dialysis by simultaneously testing them for anti-HCV and for HCV RNA levels. MATERIALS AND METHODS: For the present cross-sectional longitudinal study we recruited and followed up 93 patients from St George University Hospital Hemodialysis Unit between July 2013 and December 2014. All patients were tested for anti-HCV and HCV RNA. The anti-HCV negative patients were tested for anti-HCV and HCV RNA at least twice at intervals of 6 months or more (up to 12 months). Anti-HCV antibodies were identified using a third generation ELISA assay. Commercial kits for real-time polymerase chain reaction (RT-PCR) were used to detect HCV RNA in the plasma and mononuclear cells. Aminotransferase and gammaglutamyl transpeptidase levels were studied to find if liver inflammation was present. RESULTS: The total seroprevalence in 68 patients was 20.6% (14). Of these, 10 patients were viremic (HCV RNA+/anti-HCV+), and 4 patients (5.9%) had discordant results (anti-HCV+/HCV RNA-). Acute hepatitis was detected in one patient. Duration of dialysis in HCV viremic patients was longer than that in aviremic patients (p=0.005). CONCLUSIONS: The present study suggests that HCV infection in dialysis patients can be diagnosed more accurately if these patients are tested using two diagnostic methods - a serological test and a biomolecular assay. Further studies with larger sample size may prove the feasibility of such approach for all dialysis patients in this country.

Evaluation of lymphocyte subpopulations in cord blood of Bulgarian newborns.

BACKGROUND: Umbilical cord blood (UCB) is a clinically useful source of hematopoietic stem and progenitor cells for treatment of a wide variety of malignant and non-malignant disorders. An important way to completing infor- mation on the quality and composition of units for transplantation is more extensive immunophenotyping of UCB. Moreover, phenotyping of lymphocyte subpopulations is essential for the diagnosis and follow-up of children with immunodeficiencies and other immune disorders and therefore, establishment of age-matched reference values of lymphocyte subsets is a necessity for each population. The aim of this study was to determine the normal range of T and B lymphocytes, and NK cells as well as the CD4 and CD8 subpopulations of T cells in cord blood collected from healthy term infants. METHODS: The relative and absolute number distributions (median, 5th and 95th percentile) of lymphocyte subsets in cord blood samples from 72 healthy newborns were examined by multi-colour flow cytometry with a view to obtaining reference values for Bulgarian neonates at birth. RESULTS: Mean percentages of lymphocyte subpopulations were: CD3 (62.27 ± 9.64), CD19 (17.47 ± 5.46), CD3- CD16/CD56+ (17.27 ± 8.4). Our results show the prevalence of helper-inducer CD3+CD4+ (44.88-8.21) compared to the suppressor-cytotoxic CD3+CD8+ (16.65 ± 4.54) T-cell subpopulation, which determines the positive CD4/CD8 ratio (2.86 ± 0.82; 1.4-4.8). Also, the absolute numbers of studied populations varied widely due to differences of the absolute number of lymphocytes in the samples. CONCLUSIONS: This study on distribution of lymphocyte subpopulations in UCB helps to enhance our knowledge about cell phenotypes in cord blood and improve characterization of products for cellular therapy, as well as contributes to the correct interpretation of laboratory results for infants with possible immune disorders. Our data can be used as normal intervals for lymphocyte subsets in Bulgarian neonates.

When two viruses collide: coronavirus disease after hepatitis B virus reactivation.

The COVID-19 pandemic has exploded since the first cases were reported in Wuhan in December 2019, engulfing the globe. Many infected individuals are asymptomatic or have a mild or moderate disease. A subset of people with advanced age, the immunocompromised and those with chronic diseases, are prone to serious-to-critical illness. We report a fatal case of metastatic colorectal cancer survivor who developed COVID-19 after clinically reactivated hepatitis B virus (HBV) due to chemotherapy. The patient's COVID-19 illness was supposed to be related to her recent medical evaluation. Although being diagnosed with chronic HBV infection for decades, she was not treated with nucleotide analogue and the possibility to preclude HBV reactivation was missed. Moreover, infectious control practices must be draconian in order to save such a fragile population from infections.

Cholestatic syndrome in viral hepatitis A.

AIM: To study the cholestatic forms of viral hepatitis A that are described as unusual and very rare, but that are of great significance because of their severe course and high morbidity rate. MATERIAL AND METHODS: We describe herein 17 cases of hepatitis A virus (HAV) infection with pronounced cholestasis treated in the Clinic of Infectious Diseases at St. George University Hospital between 2002 and 2006. They are taken from a contingent of 820 patients we studied in the course of the research: of these 400 were cases of sporadic disease and 420 patients were involved in an epidemic outbreak of the disease. All got this diagnosis based on an anti-HAV/IgM test. Eight parameters were analyzed: age, max TBil, max ALT, ALP, GGT, no urobilinogen in urine, ultrasound monitoring of hepatomegaly, and hospital stay. RESULTS: The 17 patients we discuss here are 2.07% of the total 820 patients with viral hepatitis A (VHA). In 14 the disease had a cholestatic component; 3 cases were a cholestatic form of the disease. The mean hospital stay was 49.1 +/- 11.5 days, the longest--75 days. The hyperbilirubinemia had high levels at the disease climax - the mean concentration was 356.6 microkmol/l, and remained greater than 150 microkmol/l for more than a month. In 10 patients (58.2%) transaminase activity was over 1400 U/l, (mean 2011 U/l). CONCLUSION: Viral hepatitis A ran with cholestatic syndrome in 2.07%; 23.5% of these cases were classified as severe forms of the disease and 76.5%--as moderate. This is evinced by the enhanced transaminase activity, the elevated TBil, pronounced intoxication, the adynamia, vomiting, headache, the vertigo, all of these items in the objective severity score system we used.

Prevalence of cytomegalovirus infection in hospitalized infants.

UNLABELLED: Data on cytomegalovirus infection (CMV) prevalence and course in hospitalized infants are rather scarce, obsolete and considerably inconsistent. AIM: to determine the prevalence, rate of clinical manifestations, risk factors and predictive capacity of clinical manifestations of CMV infection in hospitalized infants during their first year of life. PATIENTS AND METHODS: All 163 infants hospitalized in the Pediatric Ward for Nonrespiratory Pathology in a tertiary hospital were serologically screened for cytomegalovirus infection for 10 months. In infants up to 6 months old that were CMV IgG (+) and CMV IgM (-) we followed up the CMV IgG concentration or compared it with that of their mothers. RESULTS: The CMV prevalence for the entire study sample was 33.1 +/- 3.7% (54 seropositive out of 163 examined infants); in newborns it was 19.4 +/- 6.7% (7 of 36), in infants aged 1-3 months--23.8 +/- 5.4% (15 of 63), in 4-6-month olds--28.1 +/- 8.1% (9 of 32), and in 7-12-month old--71.9 +/- 8.1% (23 of 32). The rates of clinically apparent infections in the respective groups was 33.3 +/- 6.5%, 57.01 +/- 20.2%, 53.3 +/- 13.3%, 33.3 +/- 16.6%, and 13.0 +/- 7.17%. The overall rate of clinically apparent CMV infection in all 163 children was between 11.0 +/- 2.5% and 17.2 +/- 2.9%. The probability of CMV infection increased with age and duration of breastfeeding. Hepatitis, cerebral vasculopathy and pneumonia (alone or combined) turned out to be predictors of CMV infection, but none of these symptoms had a frequency greater than 22%. CONCLUSIONS: We found a high rate of cytomegalovirus infections in hospitalized infants less than one year of age. This infection is the reason why at least 10% of the newborns and 12% of the children aged 1 to 3 months were hospitalised. The course was clinically apparent in over half of the infected children of up to 3 months of age.

Platelet Distribution Width and Increased D-Dimer at Admission Predicts Subsequent Development of ARDS in COVID-19 Patients.

In the current pandemic of coronavirus disease (COVID-19), the identification of the patients admitted with severe infection-who are disposed to a high risk of acute respiratory distress syndrome (ARDS) development, is of a major significance for the determination of the appropriate therapeutic strategy. Laboratory records in admission were retrospectively reviewed from 493 cases of severe COVID-19 divided into two groups: Group 1 with ARDS and Group 2 without ARDS. The platelet distribution width (PDW) difference between Group 1 and Group 2 is significant-15.10 ± 2.08 fl for those who developed ARDS versus 12.94 ± 2.12 fl for those without ARDS. The sensitivity and the specificity of this parameter is lower than that of D-dimer. After grouping of the PDW values into intervals and combining them with the rate of increase in D-dimer (D-PDWf index) to form a forecasting index, a significant increase in the specificity and sensitivity of the two parameters is identified-area under the ROC curve (AUC) is 0.874 for D-PDWf index, with respective AUC for PDW 0.768 and AUC for D-dimer 0.777. Conclusion: PDW is a significant predictive parameter at admission for subsequent development of ARDS in patients, with increased significance in combination with the degree of increase in D-dimer.

Relative share of asymptomatic forms of hepatitis a in Plovdiv region, Bulgaria.

OBJECTIVE: To study the relative share of asymptomatic forms of Hepatitis A in family reservoirs of infection with different hygienic conditions. MATERIALS AND METHODS: Asymptomatic forms were identified by detecting anti-HAV IgM using ELISA. Two types of households: with poor hygiene and with good hygiene, were studied. The study was designed as case-control. A group of Hepatitis A contact children attending day nurseries and kindergartens was also included in the study. RESULTS: The relative share of asymptomatic forms of HAV infection in poor hygiene households was 58.62%, while in those with good hygiene it was 41.57%. The comparison using Fisher's exact test yielded OR = 1.99 and 95% CI (P < 0.05). Asymptomatic forms were found in 7.75% of the investigated contacts among children attending day nurseries and kindergartens. CONCLUSION: Asymptomatic forms of hepatitis A are very common which makes them epidemiologically quite significant as many of the cases remain unrecognized and later become focal points of new cases of the disease. Poor hygiene conditions are likely to cause more asymptomatic forms. The high relative share of asymptomatic forms found in the households supports the need for immunoprophylaxis of the contacts.

Dextrin Nanocomposites as Matrices for Solid Dosage Forms.

Safe application of water-insoluble acaricides requires fast release from solid dosage systems into aquatic environments. Dextrin is a water-soluble form of partially hydrolyzed starch, which may be used as matrix material for these systems if retrogradation can be inhibited by the inclusion of nanofillers. Several glycerol-plasticized thermoplastic dextrin-based nanocomposites were prepared with a twin-screw extrusion-compounding process. The nanofillers included a layered double hydroxide (LDH), cellulose nanofibers (CNF), and stearic acid. The time-dependent retrogradation of the compounds was monitored by X-ray diffraction (XRD) and dynamic mechanical thermal analysis (DMA). XRD showed that composite samples that included stearic acid in the formulation led to the formation of an amylose-lipid complex and a stable crystallinity during aging. The most promising nanocomposite included both stearic acid and CNF. It was selected as the carrier material for the water-insoluble acaricide Amitraz. Fast release rates were observed for composites containing 5, 10, and 20% (w/w) of the pesticide. A significant reduction in the particle size of the released Amitraz powder was observed, which is ascribed to the high-temperature compounding procedure.

Seroprevalence of hepatitis A viral infection in Plovdiv, Bulgaria.

INTRODUCTION: Hepatitis A occurs throughout the world, albeit with different endemicity. The level of endemicity is determined for each country from the annual incidence rate and from the age-specific seroprevalence of anti-HAVt. AIM: To assess the anti-HAVt seroprevalence in 180 people with no hepatitis A history. The study also aimed at determining the susceptibility of the separate individuals to the disease. PATIENTS AND METHODS: Two groups of people with no history of hepatitis A were studied; the study subjects were randomly selected from two quarters of Plovdiv--one with poor hygienic and sanitary conditions and the other with normal ones. The study was performed using Dia Sorin kits and equipment. RESULTS: Ninety-three subjects were included in Group I; 84 (90.23%) of these were anti-HAVt positive. Group II included 87 subjects of which 39 (44.83%) tested positive. The mean anti-HAVt seroprevalence for the whole sample (n=180) was 68.33%. CONCLUSIONS: The established mean seroprevalence of anti-HAVt is typical for countries with intermediate level of hepatitis A endemicity. The epidemiology of the disease, however, is completely different for each one of the groups. This finding makes it necessary that different preventive approach be used for each one of these groups, specifically related to the individual susceptibility to the disease--something that is not done in everyday practice.

Booster immunity - diagnosis of chronic hepatitis B viral infection.

INTRODUCTION: Diagnosis of chronic hepatitis B virus (HBV) infection particularly its occult form requires monitoring and repeat serological and molecular studies. The aim of the study was to investigate the possible relation between the case of a family outbreak of hepatitis A and the finding that a member of this family was diagnosed with chronic hepatitis B. METHODOLOGY: A mother and her two sons, one previously diagnosed with chronic HBV infection, were hospitalized due to suspected acute hepatitis. Serological markers for hepatitis A, hepatitis B and hepatitis C were assessed. Additionally, HBV DNA was tested with a sensitive PCR. Hepatitis B vaccine was administered to the mother to differentiate resolved from occult HBV infection. RESULTS: A family outbreak of hepatitis A was confirmed, alongside a focus of chronic HBV infection. The serological profile for two brothers was HBsAg(+), anti-HBcIgM(-), anti-HBc(+), HBcAg(-)/anti-HBe(+). The mother was negative for all HBV markers except anti-HBc. HBV DNA was detected at a level of 461 IU/mL in the elder brother, 3647 IU/mL in the younger brother and was negative in the mother on two occasions. Her anti-HBc alone, having two sons with chronic HBV infection, and her lack of antibody response to hepatitis B vaccine despite being negative for HBV DNA, led to the diagnosis of probable occult HBV infection. CONCLUSION: Our results confirmed that a vaccination approach could facilitate diagnosis of chronic HBV infection in the presence of isolated anti-HBc. If it were not for a family outbreak of hepatitis A, this unexpected family HBV focus would not have been revealed.

Advantages of bariatric medicine for individualized prevention and treatments: multidisciplinary approach in body culture and prevention of obesity and diabetes.

Bariatric surgery is a component of the multimodal treatment of obesity, which consists of multidisciplinary evaluation and diagnosis, conservative and surgical treatments, and lifelong follow-up care. The current guideline extends the BMI-based spectrum of indications that was previously proposed (BMI greater than 40 kg/m(2), or greater than 35 kg/m(2) with secondary diseases) by eliminating age limits, as well as most of the contraindications. A prerequisite for surgery is that a structured, conservative weight-loss program has failed or is considered to be futile. Type 2 diabetes is now considered an independent indication under clinical study conditions for patients whose BMI is less than 35 kg/m(2) (metabolic surgery). The standard laparoscopic techniques are gastric banding, gastric bypass, sleeve gastrectomy, and biliopancreatic diversion. The choice of procedures is based on knowledge of the results, long-term effects, complications, and individual circumstances. Structured lifelong follow-up should be provided and should, in particular, prevent metabolic deficiencies.

Catalogue of the ants (Hymenoptera, Formicidae) of Bulgaria.

The present catalogue of the ants (Hymenoptera, Formicidae) of Bulgaria is made on a base of critical reconsideration of literature (covering the period from 1892 till 2009 and part of 2010) as well as on examination of the authors' and several museum's collections. A lot of data were omitted in the previous Bulgarian monograph on ants, lots of new data were recently added and many important additions and alterations were made due to taxonomic revisions of Eurasian Formicidae during the last three decades. Two new species are reported for the country [Temnothorax graecus (Forel, 1911) and Temnothorax cf. korbi (Emery, 1924)].This catalogue contains a list of 163 ant species belonging to 40 genera of 6 subfamilies now known from Bulgaria. Synonyms and information on the previously reported names in relevant publications are given. Known localities of the species are grouped by geographic regions. Maps with concrete localities or regions for each species were prepared. The conservation status of 13 ant species is given as they are included in IUCN Red List of Threatened Species and Bulgarian Biodiversity Act. In comparison with adjacent Balkan regions the ant fauna of Bulgaria is quite rich and its core is composed of South European elements.