[Features of red blood indexes in elderly patients with ischemic heart disease and pathology of heart valves before and after surgical correction].

Due to current options of cardiac surgery, operations on the heart of elderly patients have become routine in specialized cardiosurgical centers. The issue of pre- and postoperative anemia of different nature is essential in surgical correction of heart valves and coronary bypass. AIM: To study indexes of red blood in elderly patients with ischemic heart disease (IHD) and pathology of heart valves before and after surgical correction, including the relationship with position and type of the prosthesis. MATERIALS AND METHODS: 79 patients aged 61 [53;67] were evaluated. The patients had acquired heart valve disease of rheumatic origin, manifestations of heart connective провоtissue dysplasia, and IHD and were admitted to a cardiosurgical hospital. Blood tests were performed using a hematological analyzer, Cell-Dyn 3700 (USA), before the surgery and on days 5 and 10 following the surgical correction. Reticulocytes were counted using a unified manual method in a blood smear stained with brilliant cresyl blue and expressed per 1000 red cells. Reticulocyte indexes (corrected reticulocyte count, CRC, and reticulocyte production index, RPI) were computed. RESULTS: Elderly patients with a combination of acquired heart disease and mitral valve disease were characterized by preoperative morphological heterogenicity of red blood cells as evidenced by RDW. Postoperative anemia associated with significant decreases in mean hemoglobin concentration, red cell count, and hematocrit, and increased morphological heterogenicity of red cell pool were observed in patients with IHD and heart valve pathology on days 5 and 10 of the postoperative period. During the early postoperative period, more pronounced changes in red cell heterogenicity were observed in patients with implanted disk mechanical prosthesis, particularly in mitral position. In the early postoperative period following the surgical correction, elderly patients with IHD and valve disease were characterized with a low reticulocyte production index, which indicated reduced proliferative activity of bone marrow. The fastest stabilization of red blood indexes occurred in patients after coronary bypass.

[Neonatal bacteremia--frequency, spectrum of organisms and correlation between clinical symptoms and laboratory data for early onset sepsis].

UNLABELLED: Improved obstetrical management and evidence-based peripartum antimicrobial therapy in the last decades reduce the frequency of early-onset neonatal sepsis (EONS) and improve the outcome. The spectrum of the microrganisms is different according to regions, countries and periods of time. Appropriate diagnosis and treatment improve the outcome. However dissociation often occurs between clinical manifestation, laboratory and microbiological findings. AIMS: To determine the incidence of neonatal bacteremia in our hospital, to identify the spectrum of organisms from positive blood cultures (BC), to analyze the correlation between clinical manifestation of EOS and/or laboratory abnormalities. PATIENTS AND METHODS: This study was carried out at the University Hospital of Obstetrics and Gynecology "Maichin dom"- Sofia for 2012. From all 4081 inborn babies 848 were at risk for maternal-fetal infection. In the first two hours after birth they were screened for EONS using a panel of microbiological probes and laboratory blood tests, followed up the next days. According the guidelines of the Neonatology clinic a standard antibiotic therapy was started. 43 of the screened infants (1.05% of all inborn babies) had positive BC and were enrolled in this study. RESULTS: Sixteen from the 43 babies with positive BC were with birthweight > 2500g (0.48% from all 3316 life born term infants), 27--with birthweight < 2500g (3.5% from all 765 low birthweight babies), 24 were patients of the NICU (3.8% of all 635 babies admitted at the NICU for 2012). No one died. The following groups of organisms in BC were isolated: 24 BC with coagulase-negative Staphylococci, Methicilline sensitive (MSCoNS)--11 of them without any clinical symptoms and laboratory abnormalities were interpreted as result of contamination, 1 BC with Staphylococcus aureus MS (MSSA), 8 with alpha-Streptococci, 5 with Enterococcus faecalis (1 in combination with MSCoNS), 2 with GBS, 2 with Aerococcus urinae and 2 BC with Listeria monocytogenes. Gram-negative organisms were not found in BC after birth. 30 from the infants with positive BC didn't show any clinical symptom of EONS. 20 of them were without laboratory criteria for infection and were discharged after negative BC control. 10 newborns were with transient elevation of CRP but without clinical symptoms. 13 babies showed clinical symptoms of EOS, 3 of them had transient respiratory failure, but negative laboratory criteria. 10 babies met the clinical and laboratory criteria for EONS; in 8 of them the CRP was significantly elevated. Most critically ill were 3 ELBW and ELGA babies: 2 twins with Listeria and 1 baby with MSSA-EONS. CONCLUSIONS: In our study, CoNS were found to be the most common cause of EONS or bacteremia, low incidence of GBS sepsis was established. Almost the half of the babies with positive BC were asymptomatic and without laboratory data for infection. Elevation of the CRP-value was the most frequent laboratory abnormality in symptomatic infants.

A study on early-onset neonatal group B streptococcal infection, Bulgaria, 2007-2011.

This study examines neonatal group B streptococcal (GBS) colonization and its relation to early-onset GBS disease (EOGBSD), based upon the experience of leading obstetrics and gynecology centers in Bulgaria. The objectives of the study were to update neonatal colonization rates and to assess relationships between clinically differentiated cases (culture-proven GBS newborns) and risk factors inherent to the infant and mother, using a computerized file. The neonatal GBS colonization rate ranged from 5.48 to 12.19 per 1000 live births. Maternal-fetal infection (MFI, a provisional clinical diagnosis in culture-proven colonized infants with initial signs of infection that is usually overcome with antibiotic treatment) and/or intrapartum asphyxia (IA) have been demonstrated as the most frequent clinical manifestations, with significant correlations for the primary diagnosis, but not affirmative for the final diagnosis at discharge, resulting from adequate treatment of neonates. MFI and IA were significantly related to prematurity, and reciprocally, prematurity was associated with the risk of MFI, indirectly suggesting that preterm birth or PPROM (preterm premature rupture of membranes, an obstetric indication associated with early labor and delivery, one of the major causes of preterm birth) is a substantial risk factor for EOGBSD. The regression analysis indicated that in the case of a newborn with MFI, a birth weight 593.58 g lower than the birth weight of an infant without this diagnosis might be expected. Testing the inverse relationship, i.e., the way birth weight influences a certain diagnosis (logistic regression) established the presence of a relationship between birth weight categories (degree of prematurity) and the diagnosis of MFI. The proportions and odds ratios, converted into probabilities that a baby would develop MFI, indicate the particularly high risk for newborns with extremely low and very low birth weight: extremely low birth weight (≤1000 g), the probability of developing a MFI is 66%; very low birth weight (1001-1500 g), 81%; low birth weight (the birth weight category including premature and small for gestational age term infants: 1501-2500 g), 40%; normal birth weight (term infants) (>2500 g), 32%. In conclusion, the need to introduce separate categories for early- and late-onset GBS disease in the registration nomenclature of neonatal infectious diseases is highlighted by these results. Drawing up intrapartum antibiotic prophylaxis (IAP) guidelines is also strongly recommended.

[Screning study on pregnant women and neonatal infection with streptococcus agalactiae (group B streptococci)].

We report the results of a screening study on pregnant women and early onset neonatal group B streptococcal infections in Sofia, Bulgaria, July 2009-July 2010. Women were studied for risk factors at delivery, intrapartum antibiotic prophylaxis (lAP) and outcome for the newborns. All GBS positive women who had risk factors at delivery gave birth to newborns with neonatal infection despite the IAP given in 50% of the cases. The majority of the GBS positive women who had no risk factors at delivery gave birth to healthy newborns although only 32% of them received IAP However 11% of the GBS positive women without risk factors delivered children with neonatal infection. We consider that IAP should be given to all GBS positive women to prevent from neonatal infection. The dominant GBS serotypes were ll, 11 and la. The isolates were 100% susceptible to penicillin, cefazolin, cefotaxime, vancomycin and 91.66% susceptible to erythromycin and clindamycin, the resistant strains being from the MLSB phenotype.

[Multipurpose treatment of vaginal infections].

Untreated bacterial vaginosis is related with many complications for non-pregnant women in reproductive age, most common from them are vaginal discharge and postoperative infections. The aim of our investigation was to compare the effectiveness of two therapeutic regimes which consist in Macmiror/Macmiror Complex alone and in combination with Feminella Vagi C for treatment of bacterial vaginosis (BV) and/or mycotic infection. 117 non-pregnant women with symptoms of vaginal infection were prospectively enrolled into two groups according their treatment. First group consist 66 women treated with Macmiror tablets and vaginal capsules followed with local application of Feminella Vagi C, the second group consist 54 women treated with Macmiror tablets and vaginal capsules only. The impact of treatment on clinical symptoms was observed at the end of medication and 20 days after it. Microbiological testing was repeated 20 days after treatment. Over than 80% (78.6 divided by 86.7%) of the cases with vaginal infection (BV and mycotic one) were successfully treated with Macmiror/Macmiror Complex. Supplement treatment with Feminella Vagi C lead to higher percentage of clinically recovery (86.7% vs 84.6%), better microbiological cleaning (86.7% vs 82.1%) and longer effect of treatment. Used medication showed higher efficacy against BV than to fungal infection. According obtained results we may conclude that bacterial vaginosis was better treated with multipurpose treatment (Nifuratel, Nistatin and vit. C) than with Macmiror alone.

[Group B streptococcus (GBS) infection in newborns in university hospital "Maichin Dom" EAD Sofia for the period 2008-2010].

For the period 2008-2010 in the University Hospital "Maichin Dom" EAD were born 10 774 babies. The newborns in the intensive care clinic (according to Apgar 1-5 min, the severity of RDS, the birth weight, gestational age, C-reactive protein and the values of blood tests) were screened for mother-fetal infections immediately after birth. The tests performed were blood culture, stomach aspirate, ear, anal and nose secretion, throat and tracheal aspiration (if intubation was performed). In case of meningitis liquor was tested. Standard therapy included Ampicillin/Sulbactam. The healthy, eutrophic children were also screened for bacterial mother-fetal infections--routinely ear and stomach aspiration. The babies, without clinical and paraclinical symptoms, but positive for GBS colonization, were also treated with Ampicilin. As a result from the screening and therapy no cases with meningitis were detected, as well as late neonatal sepsis caused by GBS.

[Susceptibility to antibiotics of microorganisms related with recurrent bacterial vaginosis].

There are presented data of sensitivity to a range of antibiotics of the main microorganisms related with the problem "recurrent bacterial vaginosis". G. vaginalis are sensitive in 34% to metronidazole, and 82% to clindamycin. Atopobium spp. and HP/+/Lactobacillus spp. are resistant to metronidazole and sensitive to clindamycin.

[Application of sumamed in treatment of bacterial vaginal infections during pregnancy].

OBJECTIVE: To study the efficacy of Sumamed in cases of endogenous bacterial vaginal infections during third trimester of pregnancy. MATERIALS AND METHODS: 34 women in last trimester of pregnancy with Streptococcus group B, Streptococcus group A, alpha hemolytic Streptococci, S. aureus infections and intermediate state of vaginal ecosystem (Nugent score 4-6) were treated with Sumamed (Azithromycin, 500 mg. p.o. for 3 days). Patients were separated in two groups. First group included 19 women with symptomatic and microbiologically proven recurrent vaginal infection during last 6 months. Second group included 15 symptom free pregnant women, in whom, pathogenic bacteria were found on vaginal swab and culture. RESULTS AND DISCUSSION: Culture revealed 2 cases of Streptococcus group A infection in the second study group. Streptococcus group B was isolated in 19 patients--11 group 1 and 8--group 2. S. aureus was found in 6 patients from group 1 and 3 patients from group 2. Alpha hemolytic streptococci were cultured in 4 cases--2 from group 1 and 2 from group 2. Isolated microorganisms showed in vitro sensibility toward Sumamed. After treatment completion, control swab and culture was performed in 26 cases (14 group 1 and 12 group 2 patients). In group 1 in 12 (85,7%) patients no pathological microorganisms were cultured, Nugent scores were between 0-3 and no subjective symptoms were reported. 2 (14,3%) patients had Candida infection. In the second group 10 patients (83,5%) had normal vaginal microbiology, 2(16,5%) remained with intermediate vaginal microflora state. No newborn infections and cases of endometritis were found in both study groups. Sumamed is an efficacious treatment in cases of streptococcal and staphylococcal vaginal infections during pregnancy. Application of Sumamed results in alleviation of clinical symptoms and in sanitation of birth canal.

[Gynalgin--one more opportunity in the treatment of bacterial vaginosis].

The data of 30 nonpregnant women in reproductive age BV treated with Gynalgin were presented. On clinical and microbiological indicator Gynalgin showed a good effect on BV-associated microorganisms (80%). Only one of the cases of BV was not affected (4%). With nixed infection of BV and Candida we established clinical improvement and recovery of Lactobacillus spp. In 66.6%, but in all cases on Candida is not effect. We consider that Gynalgin is still one more easily applicable and clinically effective opportunity for treatment of BV.

[Treatment in cases of recurrent vaginal candida infection during pregnancy].

OBJECTIVE: To study the therapeutic application of Gynazol in cases of recurrent vaginal Candida infections during the last trimester of pregnancy. MATERIALS AND METHODS: 28 pregnant women in third trimester with recurrent vaginal Candida infection were included in the study. All cases were treated with a single vaginal application of Gynazol (butoconazole nitrate 2%). Follow up of reported subjective complaints and control vaginal swab and culture 10-14 days after treatment was performed. RESULTS AND DISCUSSION: In 24 (85.72%) cases of recurrent vaginal Candida infection, Candida albicans was isolated. C. tropicalis and C. parapsilosis were found in 3 (10.71%) and 1 (3.57%) cases respectively. Single vaginal application of Gynazol led to alleviation of subjective symptoms 24-48 hours after initiation of treatment. Control vaginal swab and culture were performed in 24 patients. Negative cultures were found in 21 cases (87.5%) and single Candida colonies were isolated in 3 (12.5%) patients. According to our results, application of Gynazol is recommended in cases of recurrent vaginal Candida infection during third trimester of pregnancy.

[Cervicovaginal infections during pregnancy as a risk factor for preterm delivery].

OBJECTIVE: To establish the incidence of cervicovaginal infections in patients with preterm and term deliveries. MATERIALS AND METHODS: 88 pregnancies with no previous detectable risk factors have been included in a retrospective study. 48 patients delivered at term and 40 had delivery between 24 and 37 weeks of gestation. A vaginal swab for bacterial infections and a cervical swab for detection of Chlamydia trachomatis infection, using PCR, have been performed in each case. The vaginal ecosystem has been appreciated according Nungent criteria. RESULTS AND CONCLUSIONS: C. trachomatis has been detected in 5% (2/40) of preterm deliveries and in 2.08% (1/48) of term deliveries. In preterm delivery group bacterial vaginosis has been isolated in 15% (6/40), Enterococcus spp. in12.5% (5/40) and Group B Streptococcus in 12.5% (5/40) of cases. In patients, delivered at term, bacterial vaginosis has been proved in 6.25% (3/48), Enterococcus spp in 8.33% (4/48), Group B Streptococcus in 4.17% (2/48) patients. Significant differences between both groups have been found in GBS and BV (p < 0.05). Although the difference C. trachomatis infection is not significantly higher in preterm delivery group, testing for C. tracomatis, using highly specific methods, along with vaginal swab are recommended as routine tests in pregnancy.

[Listeria monocytogenes infection during pregnancy--modern aspects].

During a ten years period (1997-2006) at the delivery ward of Maychin dom university hospital were admitted 31,430 parturients. Among all of them we indentified and evaluated only 4 pregnant patients with Listeria monocytogenes infection. During the first 8 years of the investigated period there was no even single case of the infection, whilst during the last 2 years the frequency of the Listeria infection among all birth deliveries was 0,068%. All of our four cases were admitted with clinical symptoms of preterm birth and had premature labor. One of the four examined births underwent urgent Caesarean Section because of intrapartal fetal distress, which makes 25% of the operative birth deliveries. All the maternity patients are diagnosed during the postpartum period whilst searching for the microbial reason of the severe infection of the newborns. All of the four newborns experience infection complications. Septic condition of one of the neonates was not possible to be overcome and was followed by an exitus. The observed neonatal mortality among the group is 25%.

[Impact of infection with Listeria monocytogenes on the pregnancy].

During a ten years period (06.1998a.-06.2007) at the delivery ward of Maychin dom university hospital were admitted 31 627 parturients. Among all of them we indentified and evaluated only 6 pregnant patients with Listeria monocytogenes infection. During the first 8 years of the investigated period there was no even single case of the infection, whilst during the last 2 years the frequency of the Listeria infection among all birth deliveries was 0.10%. The first five of our cases were admitted with clinical symptoms of therapeutically uninfluenced preterm birth and had premature labor. One of the five examined births underwent urgent Caesarean Section because of intrapartial fetal distress, which makes 20% of the operative birth deliveries. All five maternity patients are diagnosed during the postpartum period whilst searching for the microbial reason of the severe infection of the newborns. All of the five newborns experience infection complications. Septic condition of two of the neonates was not possible to be overcome and was followed by an exitus. The observed neonatal mortality among the group is 33.3%. The last observed case of infection was diagnosed by detecting the level of antibodies against Listeria monocytogenes in 11th week of gestation. The enhanced antibodies level was accompany by clinical symptoms. Patient was treated with Penicillin 4 x 2.0 g i.v. for fourteen days Repeated serological results was normal. The pregnancy was followed up till the term.

[Participation of the genital mycoplasmas: Ureaplasma urealyticum and Mycoplasma hominis in the processes of preterm birth].

According to contemporary data Ureaplasma urealiticum and Mycoplasma hominis are considered to be the most frequently isolated causative microorganisms from the amniotic cavity. They cause intrauterine infection on preterm birth. The genital mycoplasma are detected in vaginal smears more than 25% of healthy pregnant women and the reason for their invasion towards the uterine cavity in some cases are still unknown. The aim of this study is to investigate the relation between vaginal mycoplasmal contamination and preterm birth. The observed cases are distributed into 2 groups:--patients with preterm birth--35 pregnant women,--term birth--31 pregnant women. The vaginal secretion was tested with a standard microbiological methods and with specific test mycoplasma detection and quantitative assessment. In the first group in five patients (14.3%) Ur. urealiticum was detected in association with other vaginal pathogens (bacterial vaginosis and GBS). In the term birth group 2 patients were mycoplasma positive (6.5%) and associated Enterococcus and Lactobacillus was found in them. All neonates of the mycoplasma positive mothers had sings of infection and underwent antimicrobial therapy course. The results did not demonstrate statistically significant difference in the incidence of vaginal mycoplasmal presence in preterm and term delivery but shows possible relationship between preterm birth caused by ascending mycoplasmal infection which is in association with other vaginal pathogens.

[Vaginal candida infection in the third trimester of pregnancy].

The aim of this study is the determination of the frequency of vaginal Candida colonization in pregnant women in the third trimester, the status of the vaginal ecosystem, the grade and the subspecies of the candidal colonization, clinical manifestations and the therapeutic effect of the local antimycotic treatment. In this study it has been followed 172 pregnant women with a normal pregnancy at the end of the third trimester. It has been estimated that about 28.4% of all women get a vaginal yeast colonization - Candida spp. In 89.7% (44 women) of the cases, the colonization was caused by an overgrowth of the yeast Candida albicans. The remaining cases are caused by other subspecies of Candida - 5 cases (10.3%) - C. tropicalis /2/, C. parapsilosis /2/, C. glabrata/1/. The women in the first group were with symptoms of active candidosis (25.6%) and 88.3% of the cases were confirmed by microscopy, and 90.6% after a bacterial growth in a culture. In 7.7% of the cases was specified a mild to moderate colonization without a clinical signs of infection (II group). The local treatment with antimycotic vaginal globules and crème for 5 to 7 days alleviates the clinical symptoms. It was not observed a case of maternal - fetal transmission of this infection not a clinical manifestation in the early postpartal period.

[Cytolytic vaginosis--clinical and microbiological study].

47 women at reproductive age were diagnosed with cytolytic vaginosis according to their clinical and microbiological findings, including abundant lactobacilli/score 0 by Nugent/, free nuclei due to cytolysis, paucity of leucocytes, over 200 colony of HP/+/Lactobacillus spp., but no fungal growth. Heavy growth of HP/+/Lactobacillus spp. creates conditions under which the intensified cytolysis, displayed as abundant fluor, is likely to be due not only to the increased quantity of lactic acid but as well as to hyper production of hydrogen peroxide. 32 patients report improvement of their condition after at an average of 2 cycles of vaginal douches with sodium bicarbonate.

[Prophylaxis of neonatal sepsis caused by group B streptococci--fast method of positivity detection and its clinical use].

UNLABELLED: Asymtomatic infection with group B streptococci in pregnant women, the screening methods concerning colonized patients and the therapeutic approach towards then are still under discussion. PURPOSE: To determine the effectiveness and clinical use of the selective media Granada in the diagnosis of beta-haemolytic contamination in pregnant women. MATERIALS AND METHODS: The study is prospective and it comprises one year period. The patients included are pregnant women in the second half of the pregnancy, with or without sings of preterm delivery. Vaginal smear was collected by both standard microbiological technique and selective media Granada. Sensitivity, time of first positive results and the practical use of both methods were compared. The effect of intrapartal prophylaxis with Cefazolin 3 x 2.0 g i.v. was taken into consideration. RESULTS AND DISCUSSION: The obtained results demonstrate that for the period of investigation the incidence of asymptomatic contamination with GBS in patients admitted to "Maichin Dom" Hospital is 6.2% for all pregnant women and 16% for the selected study group. The application of both microbiological methods demonstrated similar sensitivity. For the selective media the time needed for diagnose the presence of beta-haemolytic agent was significantly shorter (approximately 16 h). This results defines the media Granada as appropriate for clinical screening and selective prophylaxis of neonatal streptococcal infection.