ARCHIVES OF THE BALKAN MEDICAL UNION

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Authors: Camelia C. DIACONU

Heart failure (HF) is a heterogeneous syndrome, with progressive evolution and negative impact on quality of life and mortality of patients. The incidence of HF in Europe and the United States of America varies between 1 to 9 cases per 1000 inhabitants, depending on the population studied and the diagnostic criteria used1. Currently, it is estimated that approximately 64.3 million people suffer from HF world-wide2. One of the most important therapeutic goals for patients with HF is represented by maintaining and improving the quality of life. Many patients value functional status and quality of life more than longevity. The most important predictors of the quality of life in HF are the presence of symptoms and their severity, functional status and depression3. Current guidelines recommend the combined use of medical and behavioural interventions to improve the functional status of these patients3.

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Authors: Nikoleta G. TABAKOVA

Introduction. Platelet-rich plasma (PRP) is a novel treatment of lichen sclerosus vulvae. Case presentation. We describe a case of lichen sclerosus vulvae in a 25-year-old woman treated with PRP. The diagnosis was confirmed by the histological examination. The patient’s symptoms were evaluated using Female Sexual Function Index (FSFI) questionnaire. PRP was prepared using Regen lab Cellular Matrix Kit and administered every two weeks, three times. The lesions disappeared at the visual examination. Conclusions. Our case confirms the effectiveness of PRP treatment for lichen sclerosus vulvae reported by other case reports. Nevertheless, future randomized controlled studies are needed to evaluate the safety of PRP treatment and to establish effective clinical protocols for its use in lichen sclerosus vulvae.

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Authors: Theodoros MICHAILIDIS, Aris LIAKOS, Nikolaos KAKALETSIS, Ioannis AVGERINOS, Stylianos MAMALIS, Sophia ASPRAGATHOU

Introduction. Multisystem inflammatory syndrome in adults (MIS-A) is a rare but potentially life-threatening sequel of SARS-CoV-2 infection, requiring early recognition and treatment. Nevertheless, it is often hard to distinguish MIS-A from other COVID-19-related hyperinflammatory complications. Case presentation. A 74-year-old male presented to the emergency department with persistent fever, diarrhea, altered consciousness, polymorphous rash with oral lesions and erythema of the palms and soles, with progressive exfoliation. The patient had been hospitalized for COVID-19 four weeks before and was suffering from chronic lymphocytic leukemia, diabetes and hypertension. During his recent hospital stay he received multiple courses of antibiotics and was discharged home with instructions to add sitagliptin and re-initiate therapy with ibrutinib. Upon re-admission, polymerase chain reaction test for SARS-CoV-2 was still positive and inflammatory markers were markedly elevated. Although MIS-A could not be excluded, a presumptive diagnosis of Stevens-Johnson Syndrome (SJS) was made, and the patient was treated empirically with intravenous immunoglobulin and high-dose methylprednisolone. SJS is usually considered an adverse drug reaction that affects the skin and mucous membranes. In this patient, MIS-A was also initially included in the differential diagnosis due to previous COVID-19, despite the patient’s advanced age and lack of cardiac involvement or conjunctivitis. The patient only partially fulfilled current diagnostic criteria for MIS-A. Conclusions. SJS results from a dysregulated immune response and can have a similar presentation to MIS-A. A better characterization of both conditions is required particularly in older adults with comorbidities, to facilitate timely diagnosis and management and to reduce mortality.

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Authors: Rosen B. TSOLOV

Introduction. Melanomas are the most aggressive skin carcinomas and a major cause of premature death from cancer. The risk factors for melanomas are UV rays, personal or family history of melanoma, large numbers of naevi, fair complexion, immunodeficiency, solar-damaged skin, etc. The scars from malignant melanoma on the face are serious challenge for the surgeons, so the successful plastic reconstruction of skin defects is very important for the normal life of the patient after surgery. Case presentation. A 82-year-old patient with a large malignant melanoma of the left cheek was admitted to the Clinic of Maxillo-facial Surgery, University Hospital „St. George”, Medical University of Plovdiv, Bulgaria, for treatment. The preoperative examination revealed the presence of a sloping heterogonic tumour, with axial dimensions of 55/28 mm, penetrating and engaging the dermis, subcutaneous tissue, levator oris and muscular orbicularis oris. Surgery was performed, under general anaesthesia. The tumour was removed, and the defect was repaired using several skin flaps, to use the adjacent tissues. The final outcome was favourable and the surgery was functionally successful. This case highlights the importance of an accurate diagnosis of malignant melanoma, that is essential for an adequate management and follow-up, considering its potentially aggressive behaviour.

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Authors: Miglena TARNOVSKA, Rositsa DIMOVA, Gergana PETROVA

Introduction. The introduction of COVID-19 screening through rapid antigen tests has become a key mechanism to ensure the continuity of the learning process and safety of school environment during pandemic. The objective of the study was to investigate and analyse the attitudes and beliefs of students, teachers, and parents regarding the rapid antigen test as a method to limit COVID-19 spreading in school environment. Material and methods. An online anonymous survey was conducted among 228 participants, 11th and 12th grade high school students (n=114), teachers (n=44) and parents (n=70) in November 2021. Results. 43.9% of students and 52.9% of parents agree with rapid antigen testing for COVID-19, while over 63.3% of teachers disagree with it. Students (45.6%) and parents (48.6%) shared optimistic expectations that testing for COVID-19 would reduce the spread of the virus in schools, while 59.1% of the teachers surveyed remained sceptical about this prevention measure. The interruption of school classes does not find support among students and parents, as well as among members of the teaching staff. Conclusions. According to students and parents, rapid antigen testing for COVID-19 seems a more acceptable solution than closing school completely. Given the concern of teachers to conduct antigen tests in the school environment, it is necessary to adequately plan the participation of medical professionals in this process, instead of delegating these activities to teachers.

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Authors: Pavlo PETAKH, Vitaliia ISEVYCH, Vasilij GRIGA, Aleksandr KAMYSHNYI

Introduction. Leptospirosis is a re-emerging illness with a wide spectrum of clinical manifestations, from asymptomatic or moderate to severe and lethal results. Leptospirosis can be adequately treated if detected early; however, comparable clinical presentations with various other febrile illnesses or co-infections, as well as laboratory diagnosis problems can result in misdiagnosis, leading to severe illness. Identifying clinical predictors for the severe form of the disease is critical to reduce the disease complications and mortality. The objective of the study was to establish the risk factors for mortality in patients with leptospirosis. Materials and methods. A retrospective study of 102 medical records of patients diagnosed with leptospirosis in the period from 2009 to 2019 was conducted. Quantitative variables in the presence of normal distribution were compared using a paired Student’s t-test, and in the case of an abnormal distribution, the Mann–Whitney U test was used. The criterion χ2 was used for qualitative variables. A two-step cluster analysis was also performed. Results. The following factors associated with death from leptospirosis have been identified: oliguria (OR, 13.5; 95% confidence interval [CI], 2.56-71.12), serum creatinine and urea levels, direct and total bilirubin, platelets, and white blood cells count. Conclusions. These „red flag” laboratory and clinical characteristics will aid medical personnel in rapidly identifying a patient at risk of death, which is critical in determining the severity of the condition and the need for early intensive care and therapy adjustment.

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Authors: Olga PENINA

Introduction. Evidence on disparities of mortality by place of residence based on reliable data is needed for appropriate public health programmes aimed at reducing high mortality in Moldova. The objective of the study was to determine changes in mortality disparities for all causes and major groups of causes of death between rural and urban populations of the Republic of Moldova after independence. Material and methods. The data were analysed by sex and place of residence for all causes and seven main groups of causes of death for two periods: 1991-93 and 2017-19. Abridged life tables and standardised death rates with 95% confidence intervals were computed. Mortality inequities between rural and urban areas were analysed in absolute and relative terms. Results. Cardiovascular diseases and digestive system diseases in both sexes and external causes and respiratory system diseases among men accounted for the rural mortality disadvantage. Cancer mortality had a negative rural-urban gradient. During independence, the rural-urban gradient of all-cause mortality declined among women, but not among men. A more rapid reduction in mortality from circulatory system diseases and a more rapid growth of neoplasm mortality in rural areas than in urban areas narrowed the rural-urban disparities. For external causes and diseases of the respiratory system, inequalities in mortality between rural and urban areas increased over the study period. Conclusions. Public health programmes aimed at reducing elevated cardiovascular mortality in rural areas are a key strategy for addressing mortality disparities between rural and urban populations.

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Authors: Horatiu MOLDOVAN, Oana FRONEA, Claudia NICA, Mihai CACOVEANU, Cristian VOICA, Silvia PREDA, Marian BROASCA, Andra SIBISAN, Robert TIGANASU, Sabina SAFTA, Lucian CALMAC, Ondin ZAHARIA, Liliana MIREA, Camelia C. DIACONU, Horatiu SUCIU

Introduction. Heart failure (HF) is a clinical syndrome caused by structural and/or functional cardiac abnormalities, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. It is a progressive disease with a high risk of death in the first 6-12 months after the diagnosis of end stage HF. Cases presentation. We present the successful implantation of a left-ventricular assist device (LVAD) HEART MATE III in a 54-year-old male with ischemic cardiomyopathy and end stage HF, and a heart transplant in a 31-year-old male with non-ischemic dilated cardiomyopathy and end stage HF. Both procedures were guided by experienced surgeons and the overall management was according to the current standardised protocol. Conclusions. HF is one of the leading causes of death world-wide. The effort to stabilize and effectively treat patients with ventricular assist devices and/or orthotopic heart transplant is increasing. One of the few drawbacks is the complex Heart Team training, a difficult process that involves each member acquiring the necessary skills and knowledge. The end stage HF Team is composed of a large variety of members, such as cardiologists, cardiac surgeons, anaesthetists and intensive care doctors, interventional cardiology doctors, and nurses.