Bisphosphonate-associated Osteonecrosis of the Jaws: a Survey of the Level of Knowledge of Dentists about the Risks of Bisphosphonate Therapy.

INTRODUCTION: Bisphosphonate-associated osteonecrosis of the jaws (BAONJ) is a side effect of treatment with bisphosphonate (BP). Reports of this complication have increased recently. AIM: To evaluate the level of knowledge of dentists from Plovdiv, Bulgaria, about possible complications of bisphosphonate therapy of patients in dental practice. MATERIALS AND METHODS: Three hundred and twenty-three dental practitioners from Plovdiv, Bulgaria, took part in an anonymous survey containing 25 questions, designed to evaluate the knowledge of dentists about the complications of BP therapy. RESULTS: Oral and maxillofacial surgeons have the best knowledge about the indications and side effects of BP therapy, while dentists with a specialty in Pediatric Dentistry and General Dentistry have insufficient knowledge. Of the respondents, 17.03% are absolutely uninformed about BP and their side effects, and 1/2 declare that they have never had a patient with complications from BP therapy in their practice, probably due to a lack of awareness of the problem. Approximately half of the dentists we surveyed agree to carry out prophylactic examinations of patients receiving BP and know what the prophylactic examination includes. Only 15.48% of the respondents have correctly responded that in order to be treated as clinically healthy, patients should have stopped taking BP for more than 10 years. CONCLUSION: With the exception of specialists in Oral and Maxillofacial Surgery, dental practitioners in Plovdiv and the region are poorly informed about the complications associated with BP therapy. Therefore, efforts must be made to make these dentists better informed about BAONJ, especially about the methods and means of preventing this condition.

Immune response and immunologic memory in medical personnel vaccinated with hepatitis B vaccine.

UNLABELLED: The occupation-related nature of Hepatitis B viral infection in medical personnel has been well documented in a lot of studies. The only reliable way of prevention of this infection is immunisation with hepatitis B vaccine. AIM: To follow-up the primary immune response after immunisation with recombinant vaccine and its duration in adult immunocompetent subjects. MATERIALS AND METHODS: One hundred sixty-five health-care workers working at St. George University Hospital, Plovdiv in 2009/2010 were included in the study and allocated to two groups. Group 1 (N1 = 70) was followed up for the primary immune response after immunization; group 2 (N2 = 95) was with documented immunization in 1998/1999 (n = 81) and in 1994/1995 (n = 14). Tests based on ELISA for quantitative determination of anti-HBs in mIU/ml were used. The measurement were performed at the National Reference Laboratory of Viral Hepatitis at the NCIPD, Sofia. Descriptive statistics, non-parametric and parametric tests, qualitative correlation were used to analyse data. RESULTS: Group 1 mean age was 40.3 +/- 2.6 years; anti-HBs concentration of > or = 10 mIU/ ml was found in 92.8%. No association between the immune response and the commonly involved factors such as gender, age, overweight, smoking, etc., was found. In group 2, anti-HBs concentration of > or = 10 mIU/ml was found in 77.9%: it was in 75.3% in those immunized 10 years before, and in 92.9% in those immunized 15 years before (t = 0.24, p > 0.05). A booster dose of the vaccine was received by 15/21 subjects from group 2 (those immunized 10 years before that) with anti-HBs < 10 mIU/ml. After the booster, 9/15 produced anti-HBs in protective concentrations (anamnestic immune response). The actual level of seroprotection among the immunized more than 10 years ago was 92%. CONCLUSION: This study and the documentation of the primary postvaccinal immunity in high-risk medical personnel will help specify if additional hepatitis B vaccine shots are needed.

Epidemiological, immunological and clinical characteristics of acute hepatitis C.

UNLABELLED: The aim of the study was to make a clinical and epidemiological and immunological characteristic of patients with acute hepatitis C infection (AHC). PATIENTS AND METHODS: The study included 178 patients with AHC; they were studied in terms of clinical course, biochemical constellations, T and B lymphocyte subpopulations, level of TNF-alpha in the blood serum, presence of autoantibodies, and the outcome of the disease in a five-year follow-up period. METHODS: anti-HCV (EIA), HCV-RNA (PCR), HCV genotyping; ALT, AST, AP, gamma-GT; ultrasonography and liver biopsy. RESULTS: AHC incidence increased six-fold between 2000 and 2006. The prevalence of the disease among intravenous drug-users (IDUs) was 46.07%. Young people (31.71 +/- 1.21) and males (67.98%) were prevalent. The genotype HCV-1 was prevalent. AHC ran with icterus in 70.22% of all cases, while it was anicteric in 29.78%; ALT-activity was high--it was mean 1007.94 +/- 59.87 U/l; intrahepatic cholestasis was found in 38.80%. A light form of the disease was found in 43.26%, mild--in 50.56%, and severe--in 6.18%, without reaching acute liver failure. In the acute stage of the disease, an increase of helper/inducer CD3+CD4+ (p = 0.001), memory T helper CD4+CD29+ (p < 0.0001), activated CD3+HLA-DR+ (p <0.0001), mature CD3+ T cells (p < 0.05), naive CD2+T (p < 0.01), and B-lymphocytes CD19+ (p < 0.001) was found, together with a non-significant increase of the suppressor/cytotoxic CD3+CD8+ T lymphocytes in comparison with the controls. The total killer CD56+ were reduced, as well as the MHC restricted killer cells CD8+CD56+. TNF-alpha was elevated in the serum in the light and mild forms (p < 0.0001). The participation of non-organ-specified antibodies (NOSAs) was minimal. Anti-MLA titer was 1/80 in two patients. Five years after the outset of AHC, a spontaneous viral clearance was established in 36.67% and chronic hepatitis in 63.33%. CONCLUSION: Despite the initially activated immune cellular response strongly correlating with a well expressed cytolytic syndrome around 2/3 of the AHC patients develop a chronic form of the disease.

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.

Immunological and microbiological investigations of patients with burn injuries.

UNLABELLED: Susceptibility of patients with burn injuries to infections is associated with disturbances of the humoral and cell-mediated immunity. The aim of the present study was to investigate the dynamics of phagocytic indices and serum immunoglobulin levels in patients with burn injuries as there is a high risk of colonization and infection of the burn wound. PATIENTS AND METHODS: Between December 2004 and April 2005, we studied the dynamics of the following indices of the phagocytic system and humoral immunity of 30 burned patients: phagocytic index, phagocytic number, nitro blue tetrazolium chloride test, leukocyte number in the peripheral blood, the percentage of the neutrophilic leukocytes from the differential blood count, serum levels of immunoglobulins A, G and M and the percentage of lymphocytes. In addition, microbiological tests of the wound secretions were performed using conventional microbiological methods. RESULTS: The changes in the phagocytic indices suggested that it is the decreased phagocytic index and number that are important for the evaluation of wound infection risks. The increased total number of leukocytes and elevation of the neutrophil levels usually observed in burned patients indicate the presence of bacterial infection and the prompt involvement of the phagocytic mechanisms. The lower percentage of lymphocyte in comparison with the healthy controls was indicative also of a possible involvement of the cell-mediated immune response. The characteristic humoral mechanisms of the immune response (serum immunoglobulins) in patients with thermal injuries altered only slightly. CONCLUSIONS: The analyzed data may be of help in evaluating the risk of colonization and infection of the burn wound in patients with burn injuries. We would like to recommend a compulsory battery of microbiological tests and several immunological investigations phagocytic index, phagocytic number, leukocyte number, differential blood test and serum immunoglobulins with a view to applying an adequate antimicrobial and immune modulating treatment.