[A study on early-onset group "B" streptococcal neonatal infection].

The results achieved with 80% reduction in the incidence of early-onset neonatal group B streptococcal (GBS) sepsis following the implementation of the preliminary (1996, 2002) and subsequently the revised (2010) guidelines for intrapartum antibiotic prophylaxis imposed the discussion on a large scale of the updated:--algorithms for GBS screening (35-37 weeks of gestation) with the recommended dosage of penicillin-G for intrapartum antibiotic prophylaxis for women having normal labor and delivery;--algorithms for GBS screening and intrapartum antibiotic prophylaxis for women with preterm labor (PPROM) or premature rupture of membranes (PROM);--intrapartum antibiotic prophylaxis regimens for women with penicillin allergy;--algorithm for management of newborns with respect to risk of early-onset GBS disease. The present study is aimed at studying the distribution of the early-onset GBS disease in our country based on the data of leading obstetrics & gynecology clinics and wards. The aim is to diferrentiate clinically the cases and investigate the influence of the known risk factors on the part of the mother. A special accent is put over the microbiological diagnostics of cases in view of CDC expanded recommendations on the laboratory methods for identification of GBS. As a final conclusion the necessity for introduction of an official registration of the early- and late-onset GBS disease in the country is emphasized.

[A comparative study of the prognostic pH values of the fetus in utero, generated by the "quantitative cardiotocography" computer method, and the actual pH values measured immediately after delivery].

INTRODUCTION: The presented methodology for quantitative evaluation of the cardiotocographic (CTG) findings unconditionally provides essential opportunities for improving the diagnostic potential in modern obstetric practice. Current literature data concerning the clinical application of this method are scarce. Credible clinical trials are needed to determine what is the correlation between estimated and actual values of the studied variables. MATERIALS AND METHODS: A prospective study on 110 pregnant women was performed. All patients were monitored via indirect cardiotocography. The recordings were stored and analyzed by the computerized method for "quantitative cardiotocography". We compared the last prognostic fetal pH value, generated by the "quantitative cardiotocography" software during labor, with the actual pH measured from the umbilical artery (UA) of the newborn. RESULTS: For each of the stored CTG recordings we quantified the difference between the last forecast and the actual pH of the newborn. In 82% of these cases this difference was in range of -0081/+0074 from the projected results. However during the study we discovered that there is a significantly better correlation between the arithmetic average of the last 6 (six) predicted results and the actual pH of the newborn. In 85% of these cases the difference between forecast and actual pH values lies a in range of -0037/+0046. CONCLUSION: Using the arithmetic average of the last 6 (six) predicted results for pH leads to a significant increase in the clinical value of the "quantitative cardiotocography". More studied are needed if we are to find opportunities to further reduce the existing prediction variability.

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.

Comparative ultrastructural morphometrical studies in acute leukemia.

Four hundred paramyeloblasts (from meyloblastic, promyelocytic, monoblastic and lymphoblastic types), isolated from peripheral blood of untreated leukemia patients, were studied by planimetric ultrastructural morphometry. The data of 19 parameters for these four paramyeloblastic types were compared with statistical methods. More central "scattered" heterochromatin was found from this morphometric investigation, i.e. early prophases in the lymphoblastic type of acute leukemia (these cases are more sensitive to therapy). The absolute mean values of the areas of whole cells, areas of the nucleus and nucleolus, areas of the heterochromatin and other indices show that different cell clones will undergo leukaemic transformation.

Comparative ultrastructural morphometric studies of micromyeloblastoid and lymphoblastoid paramyeloblasts.

One hundred lymphoblastoid and one hundred micromyeloblastoid paramyeloblasts, isolated from peripheral blood of untreated leukaemia patients, were studied by electron microscopic morphometry. Considerable differences are to be found between the micromyeloblastoid and lymphoblastoid paramyeloblasts as regards the size of the nucleolar "apparatus", both in the absolute average values and in the index showing the ratio of the nucleolous of the remaining nuclear surface (4.76% for myeloblastoid and 9.96% for lymphoblastoid paramyeloblasts). The central heterochromatin (scattered), which is discussed to be essential for the detection of an early prophase, was found in 3% of the myeloblastoid cells and in 14% of lymphoblastoid ones. The effect of cytostatic therapy is discussed by taking these data into consideration.

[Functional criteria for differentiating blast cells in acute leukemia]. / Funktsionalni kriterii za diferentsiatsiiata na blastnite kletki pri ostra levkoza.

Eighty nine patients were examined that had various clinical-morphological forms of acute leukosis, the phagocytic activity of leukosis cells being determined and the synthesis and secretion of lysozyme by them followed up, reflected in its serum level. Leukosis cells of monoblast type were established to have the ability to ingest staphylococci, candida and particles of latex, as well as to synthesize lysozyme, confirmed by the highly elevated enzyme quantity in the sera of the patients. Those functional manifestations are proposed to be used as additional criteria in the determination of cellular type of leukosis proliferation.

[Ultrastructural studies of the plasma cells in multiple myeloma]. / Ultrastrukturni prouchvaniia na plazmatichnite kletki pri multiplen mielom.

Electron microscopic investigations of 38 patients with multiple plasmocytoma were carried out, the patients being divided into three groups according to the type of monoclonic immunoglobin in serum or urine. Light to moderate cellular-cytoplasmatic asynchronism was found as well as hypertrophic nucleoli and versatile changes in cytoplasmatic organelles of the poliferous plasmocytes. Cellular-cytoplasmatic asynchronism is discussed as a characteristic sign of neoplastic plasmatic cells. No correlation was found between the morphological changes in the nuclei and cytoplasma and the immunoglobin class, secreted from the cells.

[Clinical and laboratory aspects of multiple plasmacytoma]. / Vurkhu niakoi kliniko-laboratorni aspekti na multipleniia plazmotsitom.

Clinical-laboratory observations were carried out on 40 patients with multiple plasmocytoma. Morbidity maximum was established to be during the fifth and sixth decade of life and that males are more frequently affected and bone manifestations are dominating initial symptoms. The anemic syndrome, the renal syndrome, erythrocyte sedimentation reaction and the data of the differential leukocyte count are discussed in details. Special attention is paid to the pathognomonic examinations in making the diagnosis: myelogram, electrophoresis and immunoelectrophoresis and bone roentgenography. The absence of changes in one of those examinations is concluded not to exclude the diagnosis multiple plasmocytoma as it is found in 10--20 per cent of the cases.

[Examination of platelet aggregation and ultrastructure in patients with non-Hodgkin's lymphoma]. / Untersuchungen der Thrombozytenaggregation und Ultrastruktur bei Patienten mit NHL.

Aggregation and secretion reaction of thrombocytes were studied in 54 patients suffering from Non-Hodgkin's++Lymphoma. Results were compared with electron-microscopic findings on thrombocytes of the same patients. Slight changes were found in stage II. In stage IV distinct therapy-resistant changes were noted in combination with storage pool disease syndrome which is to be considered as a consequence of impaired generation of thrombocytes in bone marrow.

[Thrombocyte functions in malignant blood diseases]. / Prouchvane na trombotsitnite funktsii pri niakoi zlokachestveni kruvni zaboliavaniia.

Platelet aggregation with various inductors and platelet secretion were studied in chronic lymphoid leukemia, myeloma, chronic myeloid leukemia and acute leukemia. It was established that disturbed aggregation with adrenaline and disturbed secretion are found more often in these malignant blood diseases. An interesting fact is that there is no correlation between the disturbed platelet functions in vitro and the clinical manifestations of disturbed hemostasis (hemorrhages or thrombosis).

[Pathologic neutrophilia in acute leukemia]. / Patologichna neutrofiliia pri ostrite levkozi

The morphological hemogram peculiarities are described in 10 patients with acute leukosis (nine with myeloblastoid variance and one with monocytoid variance of acute leukosis). Leukemic hiatus is not to be found in all the patients and besides paramyeloblasts--granular "filamented neutrophils" are present in the peripheral blood in considerable absolute values. Cytomorphologic, cytochemical and electron microscopic investigations were carried out on those "paraneutophils". Complex data for pathological leukosis characteristics of those cells were established that differed them from the normal cells. In five of the patients--definite data for acute leukosis were obtained with the histomorphological investigation of the blood tissue, in that way excluding primary myeloblast phase of myeloleukosis. Conclusions were drawn that those cells ("paraneutrophils") have the same prognostic value in peripheral blood as paramyeloblasts and are not affected by polychemical therapy. This was stressed to be a more particular variance of acute leukosis.