Seroepidemiological and microbiological study of brucellosis in Kuwait.

OBJECTIVE: The primary objective of the study was to determine the prevalence of brucellosis and the antimicrobial susceptibility pattern of local Brucellae isolates in the Infectious Diseases Hospital, Kuwait. SUBJECTS AND METHODS: A single serum sample was collected from each of 1,836 patients of different nationalities from January 2000 to December 2001. Any patient with a provisional diagnosis of fever or brucellosis had a standard tube agglutination (STA) test for the quantitation of Brucella antibodies. Blood cultures were done in 166 of 455 patients with significant STA titers, using the Bactec system. Antimicrobial susceptibility testing of 123 isolates of Brucella spp. was done against 8 antimicrobial agents. RESULTS: A total of 455 serum samples (24.8%) having an STA titer of > or =1:160 were presumptively diagnosed as cases of brucellosis. The peak isolation was in April and May. Brucella spp. were isolated from 123 blood cultures (74.1%). The blood culture isolation rate was significantly higher in patients with an STA titer of >/=1:1,280 than in those with an STA titer of

[Problems in the diagnosis and treatment of solitary and multiple kidney cysts]. / Problemi pri diagnostiraneto i lechenieto na solitarnite i mnozhestvenite bubrechni kisti.

Over the period 1989-1994, thirty-three patients presenting solitary cysts, and 19--polycystosis undergo clinical study. A variety of examination and differential diagnostic methods are used, namely: echography, venous urography, gamma chamber scintigraphy, CAT and biochemical analysis of the cystic fluid. The listed methods contribute greatly to make exact diagnosis and undertake adequate treatment of the patients.

[The assessment of arsenic exposure in copper smelting]. / Otsenka na ekspozitsiiata na arsen v medodobivnoto proizvodstvo.

The arsenic exposure in the main departments and occupational groups of the copper smelter in Pirdop has been estimated in the present study. The contents of arsenic is measured in the air and in biological samples--urine and nails. At most of the workplaces the time-weighted average (TWA) concentrations do not exceed the threshold limit value (0.05 mg/m3). The maximum TWA level is about three times higher. The intake of arsenic is significantly increased in almost all observed occupational groups. However, the excretion of only 8% of the workers is higher than the maximum background level (100 micrograms/l). The estimated degree of exposure corresponds to a low health risk. Some of the most heavily exposed occupational groups may be expected to reach higher levels of intake and health risk.

[Clinico-therapeutic and microbiological research on the preparation Monaspor in patients with active pyelonephritis]. / Kliniko-terapevtichni i mikrobiologichni prouchvaniia na preparata monaspor pri bolni s aktiven pielonefrit.

The urinary antiseptic efficacy of cefsulodin (Monaspor--Ciba) was studied in 22 patients with active pyelonephritis. The results were considered very good in 81.8% of the patients with urologic infections caused by P. aeruginosa, P. mirabilis and E. Coli. The drug was well tolerated. The microbiological studies in vitro of the urinary antiseptic efficacy of Monaspor on 575 bacterial strains isolated from patients with active pyelonephritis showed that the antibiotic was most active against Pseudomonas sp., beta-streptococcus, Staph. aureus, P. mirabilis.

[Chromosome markers in Balkan endemic nephropathy]. / Khromosomnyi marker pri balkanskoi éndemicheskoi nefropatii.

Balkan endemic nephropathy (BEN) is wide-spread in definite districts of Bulgaria, Yugoslavia and Romania. A specific chromosome marker in BEN was established. The marker is characterized by a band asymmetry in chromosome pairs #3, due to a shortening of the 3q25 band and faster fusion of sub-bands 3q26. 1 and 3q26.3.

[Chromosome marker in Balkan endemic nephropathy. I]. / Khromozomen marker pri balkanskata endemichna nefropatiia (I suobshtenie).

Marker third choromosome was established in 15 patients with Balkan entemic nephropathy (BEN) by high resolutive analysis, the chromosome characterized by altered rate of band differentiation in the distal half of the long arm--shortening of the band 3q25 and faster fusion of the subbands 3q26.1 and 3q26.3, not corresponding to the stage of chromosomal contraction. The reason for the asynchronization in the band characteristic observed is admitted to be the microstructural chromosomal reconstruction--del 3q24.2.

[Familial cytogenetic studies in Balkan endemic nephropathy. II]. / Familni tsitogenetichni prouchvaniia pri balkanskata endemichna nefropatiia (II suobshtenie).

Twenty clinically healthy relatives were studied of patients with Balkan endemic nephropathy via high resolutive chromosome analysis. Dynamic deviations in G-band structure of third chromosome was established in 10 of the subjects studied, namely--shortening of the band 3q25 and a faster fusion of subbands 3q26.1 and 3q26.3, not corresponding to the stage of chromosomal contraction. A complete coincidence was obtained between the carriership if marker chromosome A3 and the data from the biopsy studies, revealing initial morphological changes in the kidney, characteristic for Balkan endemic nephropathy.

[Familial nature of Balkan endemic nephropathy]. / Familnost pri balkanskata endemichna nefropatiia.

Quite contradictory data are found in literature as regards the family character of Balkan endemic nephropathy (BEN). Various authors report various incidence, ranging from 30 to 100%. During the period 1961-1980, a total of 2252 patients with BEN were followed up. With the processing of their family-grams, the greater part of the patients showed a familial grouping. Two or a greater number of affected by BEN were found in the family-grams of 1982 of the patients, i.e. the family character was established in 88%. In many families, followed-up for years as free of BEN, single cases of the disease appeared. In spite of that fact, the family character of BEN is characteristic for the disease and deserves a particular attention in the elucidation of etiology and pathogenesis of BEN.

[Clinical and morphologic stages in Balkan endemic nephropathy]. / Klinichni i morfologichni stadii pri balkanskata endemichna nefropatiia.

The first clinical classification of Balkan endemic nephropathy was elaborated by A. Puhlev et al in 1960, according to which two stages could be established in the course of the disease-compensated and decompensated. Gradually, many new data accumulated as regards the various aspects of the disease, that cannot be put into the frames of the first clinical classification. On the base of the author's own long-term complex clinical-laboratory, functional, instrumental and nephrobiopsic studies, he admits the existence of four stahes in the clinical and morphological course of the Balkan endemic nephropathy. 1. Initial stage, reflecting the onset of the morbid process. The disease, at that stage, could be diagnosed via some provoking methods or renal biopsy. Morphologically, light alterations in some glomerules were established as well as more severe ones in the cells of the proximal tubules. 2. Subclinical stage - decreet and inconstant manifestations of the disease were established with completely preserved renal function. The size of the kidneys is slightly reduced - bilaterally. The morphological alterations are localized in the glomerules, proximal tubules, small vessels and interstitium. 3. Compensated stage - with manifested renal symptomatics and considerable morphological alterations in renal parenchyma, but still preserved excretory function. 4. Decompensated stage - where the known four stages of the chronic renal insufficiency are included. The classification proposed reflects the dynamics of the advancement of the morbid process. In this way, the most adequate treatment is enabled as well as the prophylaxis and assessment of working capacity and disability of the patients with Balkan endemic nephropathy.

[Rescreening study of the population of the endemic village Gorno Peshtene, Vrachansk]. / Reskriningovo izsledvane na naselenieto ot endemichnoto selo Gorno Peshtene, Vrachansko.

The number of the recorded patients with Balkan endemic nephropathy gradually decreased during the period after 1970. The author explains that by the interrupted prophylactic examinations and screenings of the population from the endemic villages during that period. The results obtained with the repeated screening, after 16 years, of the population of one hyperendemic village in Vratza district support that view point. New 74 patients with Balkan endemic nephropathy were found, 8 of them with uroepithelial tumours of the upper urinary pathways. Together with the 45 patients known so far, their total number amounts to 119, suggesting that 13,7 per cent of the population from that village has been affected by the disease. Those data convincingly suggest that the morbidity rate from Balkan endemic nephropathy in our country has not decreased - only its recording has been neglected, due to the interruption of the active search of those patients via screening of the population from the endemic settlements. That emphasizes the great importance of those investigation methods in the establishment of the real Balkan endemic nephropathy morbidity.

[Longitudinal observation of patients with subclinical stages of Balkan endemic nephropathy]. / Longitudinalno nabliudenie na bolni v subklinichen stadii na balkanskata endemichna nefropatiia.

One hundred patients with Balkan endemic nephropathy, subclinical stage were complexly examined under clinical conditions, and later, in the course of 20 years they were subjects of followup care. The indices followed up revealed how slowly and gradually the characteristic clinical and laboratory signs of the disease were manifested. The duration of the disease was established to be far longer than that known so far (7-8 years), determined by anamnestic data of the patients about the disease onset, which usually coincided with some of the stages of the chronic renal insufficiency. Furthermore, by a long-term observation of the patients in the subclinical stage, it was established that the preazotemic stage of the disease was much longer than the azotemic. That fact is of great significance for the non-specific prophylaxis of the disease with a view to a further prolongation of its azotemic-free stage.

[Clinical and ultrastructural studies of the kidneys of children in families with endemic nephropathy]. / Klinichni i ultrastrukturni prouchvaniia na bubretsite pri detsa ot familii s endemichna nefropatiia.

Examinations of clinically healthy children, coming from families with endemic nephropathy (EN) were carried out with a view to establishing initial manifestations of endemic nephropathy. No clinico-laboratory and functional disorders were found. Pathological type erythrocyturia was provoked by prednisolon test, supplying grounds to admit the presence of latently developing renal disease. Renal biopsy was taken for disease confirmation. One-type pathological changes with manifested focal character were found in all children examined through the electron microscopic investigation of renal tissue. The capillary loops of glomeruli are segmentally injured. Tubular changes are mainly found in the proximal canaliculi curves. Cellular cytoplasma reveals the picture of vacuolar dystrophia. Changes in mitochondria were also found and most frequently osmiophilic formations with dimensions 0.1 to 0.5 mu were observed. Basal membrane of the tubules injured is unevenly thickened, often stratified. The ultrastructural kidney disorders of the children examined are identical, in character and localization, to those in case of clinically manifested forms of EN. According to degree and spread, they are not sufficiently manifested, to conditioned the clinical-laboratory and functional signs of the disease. The data found reveal that EN develops at a rather early age than thought so far and progresses latently in its initial stage.

[Onset of the disease process in endemic nephropathy]. / Nachaloto na bolestniia protses pri bolnite ot endemichna nefropatiia

Patients with endemic nephropathy family aggravation are described, that had left-their native endemic villages at the age of 6 months to 6 years and had lived in non-endemic settlements and in spite of that suffered and died of endemic nephropathy. The diagnosis, of all of themt is pathologoanatomically and histomorphologically confirmed. It is concluded that a long time sojourn in the endemic region is not necessary for those born there with endemic nephropathy family aggravation, in order to suffer of the same disease even in the new residence. The author admits, based on those data, that the beginning of the pathological process of endemic nephropathy is during the first infant years, so that the children of sick patients would be the best objects for investigation of the endemic nephropathy initial stage.