bluuebunny/crossref_metadata_2025 huggingface dataset:
STANDARDIZATION AS AN APPROACH TO IMPROVING THE QUALITY OF CLINICAL AND LABORATORY WORK
Authors: Trancheva Denitsa
Published: December 2021

Standardization is defined as an activity that regulates the general and repetitive application of a system of prescriptions on different (including specific) issues in order to achieve optimal order in certain circumstances. It involves the creation, dissemination and implementation of standards aimed at improving the common properties (quality, suitability, etc.) of products, processes and services. Standards are documents that contain rules, norms, and requirements for a product or service, in order to achieve better efficiency and meet the expectations of consumers and customers. Standards are means of information, serving to improve quality, to support the economic development and contributing to the benefit of the whole Society. The term ‘Standard’ is at the core of the standardization process. Applied to the health system, the standard is a regulatory document developed on the basis of different consensus and validated by a relevant body. This regulatory document establishes a set of rules and requirements concerning different types of medical activities and the results of their implementation. An important objective of each healthcare system is to provide the population with accessible, quality and safe medical care. The introduction of a system of standards in healthcare and in medicine, in particular, is a powerful tool for its achievement. This ensures high quality of the medical assistance offered, a rational use of financial, material and personnel resources as well as an optimization of the diagnostic and healing process. Standards set a minimum/optimal level of Quality Assurance through mandatory requirements that are the basis of State guarantees for affordable medical care, range and types of health services, lists of specific technologies with proven effectiveness, as well as guidelines to further improve the level of quality by formulating further scientifically substantiated recommendations. Standards allow for aggregation of information, which leads to optimization of solutions at all levels in the healthcare system. Standardization is one of the main means of achieving and maintaining the necessary level and one of the main tools in Quality Management. In laboratory medicine, standardization is an approach for the optimization of clinical and laboratory activities. The provision of high quality services is the responsibility of every professional working in the respective diagnostic structure. The quality and standardization in the Specialization of “Clinical Laboratory” are focused not only on the accuracy of laboratory results, but also they step on a broader basis, including each stage of the clinical and laboratory analysis, in order to make important medical decisions subject to patient care.
EXTRA RESOURCES POOL - A PREREQUISITE FOR HOSPITAL DISASTER RESILIENCE
Authors: Georgieva Mariya , Kostadinov Rostislav
Published: December 2021

Hospital resilience is function of an array of planning, organizational, physical and psychological features. They are related to the hospital staff readiness and preparedness, resources availability, type and stamina of the buildings and constructions, as well to the established communication and coordination within the region and country. When analyzing the disaster resilience, the main feature to be addressed is the disparity between required and available means and capabilities. The aim of this study is to analyze the hospital staff awareness regarding the need of focused resources planning for assuring the disaster hospital resilience. Material and methods: By the means of descriptive and comparative methods the records form diverse disaster medical support and hospitals involvement into the process are analyzed and the most frequent shortfalls regarding the resources exhaustion and its impact on hospital disaster resilience are presented. Dichotomous survey among 54 medical professionals was performed in order to discover their awareness regarding the existing into hospitals, they are working in, pools of resources dedicated for disaster medical support. Results and discussion: Great majority of the inquired hospital staff is demonstrating complete ignorance regarding the extra resources required in case of disastrous events. This could lead to improper use of the available resources when needed and to the poor disaster medical support results. Conclusion: Resources planning studies have to be more detailed during medical managers’ education.
STUDENT SATISFACTION BY QUALITY OF TRANING IN SUBJECT “HEALTHCARE MANAGEMENT”
Authors: Bogdanova Kamelia
Published: December 2021

The management of healthcare determines their quality and effectiveness. This depends on the training and professional skills of managers and nurses. The skills of managers in planning, organizing, targeting and controlling financial, human and material resources determine the healthcare quality and effectiveness, which is an important condition for the sustainable development of the healthcare establishments in terms of competition and market economy. This underlines the importance of training in educational establishments that create managers, health professionals and provide a basis for development and improvement of their qualification. The quality and effectiveness of education is connected to student satisfaction with the organization and quality of educational process, because this depends to a great extent on their motivation for participation, self-preparation and realization. All this is reflected in the modern educational system. The nurses are trained in universities by highly qualified teachers and have the opportunity to increase both their Bachelor's and Master's degrees, and also have opportunities for specialization in different fields. The aim of the study is to investigate student satisfaction by quality of training in subject "Healthcare Management". The study is based on the use of a direct individual survey and covers 200 students. The respondents are between 19 and 55 years old and most of them have professional experience to five years. The analysis of the data from the survey is aimed at the student satisfaction with the learning process and the possibilities for professional realization. A significant part of the students considers the theoretical and practical training as current and applicable for their realization in the healthcare system. This is a sign of the quality of work in the university and a prerequisite for creating managers with the necessary knowledge and skills to manage quality health care. Continuous increase in quality requirements for health services requires a continuous development of learning in conformity with European perceptions. Measures to improve the quality of training should be aimed at enhancing student satisfaction because this determines their motivation to participate in the training and realization in the healthcare system. The motivation of students in the learning process is largely related to their confidence in the applicability of the knowledge obtained after graduation. An important condition for the professional realization of the students is the working environment and the organization of the work in the healthcare establishments. The organization of work in hospitals should be based on the principle of continuing education and continuous training for effective use of human resources and development of professional skills acquired in university.
TRENDS IN THE USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES IN THE FIELD OF HEALTHCARE - A LITERARY REVIEW
Authors: Kilova Kristina , Milkov Denis , Kitova Tanya , Mateva Nonka
Published: December 2021

Global technological developments are gradually entering spheres, concerning human health. Today, users have the opportunity to use information and communication technologies (ICTs) to access health information, communicate with healthcare establishments and receive remote consultation and treatment.
The opportunities provided by information and communication technologies in the healthcare sector are steadily increasing. With ICT, health promotion activities, whose mission is to promote health as a core value, can be improved. They affect the prophylaxis, treatment and rehabilitation of a number of diseases. ICT in healthcare is an opportunity to raise the health culture of the population, which will improve the functioning of the healthcare system as a whole. People who are well informed about health as a whole could better follow the recommendations for disease prevention, know when to seek medical attention, and have better compliance with a prescribed treatment. Higher public health culture and disease awareness will make it easier for doctors and other health care professionals in medical centers. All this would gradually lead to the development of a society with lower morbidity and disease, better treatment outcomes, lower healthcare costs.
CHARACTERISTICS OF THE HEALTH CARE SYSTEM
Authors: Świeboda Wioletta
Published: December 2021

The purpose of this paper is to present the main data about the health care sector depends on how it is financed and thus the choice of an appropriate model healthcare system. The article shows a comparative analysis of health care systems in European countries of the OECD. Based on the literature, the general characteristics of Beveridge and Bismarck systems are presented. The evolution of the health care system in the world arises from a different history, conditions for economic development, diversity, under State policy, geographical location and cultural. Every country in the world takes part in the financing of health care, which is 20-80% of the expenditure on health. According to t. Szumlicza you must distinguish between concepts: "model" and "standard". The "formula" is understood in the context of the broader concept of "model of the health system". As the author of finding "patterns express different real concept of health policy while the term" pattern "prejudge the specific choice of health policy, which is a reference to the health care system".
The World Health Organisation defines the term "health system" as a system covering all organizations, investment and institutions whose concept is to create actions on improved health. According to the Organization's objectives is the basis for the operation of the system of health protection, which targets focus on: constant improving population health, meeting the demand needs of health services, where the recipient is you as a consumer. On the other hand, the term "health care" defined by the WHO as a program of benefits in accordance with medical knowledge necessary to promote and maintain health by sharing individuals and entire populations. C. Wlodarczyk stresses that for the proper definition of the concept of health system you must extract the three spheres of the impact of health policy: health, administrative institutions and finance health and traditional public health activities. Many definitions that appear in the literature points to the narrower scope of the definition of the concept of "health care system" than those WHO suggested.. Author B. McPake and colleagues present the thesis that the health system consists of payers, healthcare providers and regulatory bodies together with relationships that occur between them. These relationships are presented for four health system functions: regulatory, financial, allocation of resources and the provision of services. C. Bailey and S. Poździoch describe that the health system is a whole, consisting of a variety of elements, the associated affinity, between which there are relationships. S. Poździoch is used for the definition of the system: "organized and coordinated team actions, whose aim is the realization of benefits and services and awareness campaign-therapeutic and rehabilitation aimed at protection and improvement of the health status of the individual and the collective ". The fact is the large role played by the State in the health system.
ETYOLOGY OF CIRCULAR CARIES
Authors: Kokoceva-Ivanovskа Olga , Zabokova-Bilbilovska Efka , Mijoska Aneta
Published: December 2021

In everyday dental practice, because of the incorrect diet and the absence of oral hygiene in the earliest childhood age, we increasingly face the problem of diagnosing circular cavities in the advanced developmental phase. The aim of the research was to show whether the diseases and complications which occur during the pregnancy period of the mother, and the child’s health condition immediately after the birth, affect the appearance and predisposition of the circular caries. Our examines were children 2-3 years old, where during the standard check-ups we diagnosed starting phases of circular caries-initial lesion (white spot) and superficial form. A questionnaire prepared in advance was given to the mothers of the children diagnosed with circular caries, where we inserted the data for the period of pregnancy (pathologic pregnancy, premature birth with complications and normal pregnancy without any complications) as well as the diseases of the children during the first year of their life (bronchitis, pneumonias, infective diseases). After elaborating the data from the questionnaire, we got the number of 28.21% mothers who had pathological pregnancy and 18.80% had premature birth accompanied with complications. In the first year of the age 35.38% of the children had bronchitis, pneumonias and very often 10% infective diseases. The analysis of the results showed that the circular caries so called early childhood caries is present more often at children whose mothers had pathological pregnancy, premature born children and children who were often ill during the first year of age. These results prove that the fact that problematic pregnancy and the child’s state of health immediately after the birth are factors of predisposition to the appearance of the early childhood caries.
STUDY OF THE SIZE OF THE ANGLE OF THE MANDIBLE
Authors: Jovevska Svetlana , Petrovski Mihajlo
Published: December 2021

Тhe mandible is a paired bone that develops within the mandibular arch, embedding teeth and forming anarticulation of the jaw with the cranium. Morphological changes are brought about by aging. The gonial angle, orthe angle of mandible, is formed by the line tangent to thelower border of the mandible and the line tangent to the distal border of the ascending ramus and condyle ie the lower jaw angle is formed by the ramus line (RL) and the mandibular line (ML), where RL is the tangent to the posterior border of the mandible and ML is the lower border of the mandible through the gnathion (gn) Withage the masticatory muscles change in function and structure with decreased contractile activity and lower muscle density. The gonial angle can be used as a tool inforensic odontology, but has received less attention. The aim of this study was to evaluate the angle of mandible comparing mandibular bones and OPGs. The study further intends to evaluate the variation in age using the gonialangle as a parameter. A total of 50 mandibles and 50 OPGs were included in the study. The study materials were obtained from theDepartment of Anatomy and the Department of Radiology of Simple methodology was employed for obtaining data. The gonial angle in mandibular bones was measured as the angle formed by the base of the mandible and the posterior border of the ramus by the scale of protractor, which isplaced over the angle of mandible in such a way that the base of the protractor coincides with the base of the mandible. The angle was recorded in degrees.The gonial angle in OPG was measured by a line drawn tangential to the lower border of the mandible and the linedrawn tangential to the posterior border of the ramus and the condyle. The intersection of these two lines formed the gonial angle which was measured using a protractor in the same way. The angle was recorded in degrees.All the readings were recorded and the mean value was calculated.The present study shows various values of gonial angle inOPG and mandibular bones. No significant difference was observed between these two. On comparison of gonial angle the mandibular bone showed slightly greater value than OPG
The mean value of the gonial angles were found to beslightly more in mandibular bones and were lesser in OPG.There seems to be differencein the gonial angle with different age groups but not significant. Both mandibular bones and OPGs showed almost similar readings. Thusgonial angle serves as an adjuvant and additional forensic parameter which guides for age group assessment, subjectto odontological status.
DIFFERENCE IN CRANIOFACIAL CHARACTERISTICS IN ATTRACTIVE MALE AND FEMALE FACES
Authors: Carceva Shalja Sofija , Atanasova Sandra , Petrovski Mihajlo
Published: December 2021

Beauty, or more precisely, the art that is hidden in the creation of human face has always attracted great interest and has been a research point in many areas. Contemporary orthodontic is science which is trying to stady human face throught mesurable and objective parameters. Since ancient cultures and societies, huge attention has been focused on facial aesthetics and phisical atractivness. Today, phisical atractivness in both male and female continues to be much more highlited and the interest for facial aesthetics is growing.The aim of this study is to determine the influence of the gender on skeleton-facial characteristics(Sagittal jaw relationship, vertical jaw relationship and profile convexity) between attractive male and female faces. The study was performed on 54 attractive individuals (18 males and 36 females) ranging in age between 14-25 years. Facial attractiveness was assessed by using an-face photographs examined by a panel of 50 students. For ranking facial attractiveness VAS-Visual Analog Scale was used. Craniofacial morphology was determined by using lateral head film. Cephalometric analyses included measuring of sagittal jaw relationship, vertical jaw relationship and profile convexity. The data obtained from cephalometric analyses were compared between the two groups. Results in this study reveals that when comparing attractive males with attractive females, the attractive Macedonian males had larger SNB angle(p<0.001) and SNPg (p<0.05), or more precisely anterior positioned mandible with prominence of the chin. There was statistically significant difference for the angle ANB(P<0.001) i Wits(p<0.01) confirming the presence of biger profile convexity (NSPg p<0.001 i NsSnPgs p<0.001) in attractive female individuals that shows the existance of the sex dimorphism. Based on our findings we can concluded that more flat profiles are preferred today, actually perception of an ideal male profile in modern times is flat profile with smaller dominance of the nose and more convex profiles in attractive female faces
INTRODUCTION TO ORTHODONTIC EDUCATION IN BULGARIA OF DIGITAL TECHNOLOGIES AND 3D ARCHIVING
Authors: Atanasova Sandra , Carceva Salja Sofija , Prosheva Ljubica
Published: December 2021

Orthodontic treatment, especially during the period of active growth, can significantly affect the development of the jaws and teeth. Treatment with extraction of molars is more complicated because the space that needs to be closed is larger than the premolar spaces and the time of treatment will be longer. However, in cases where we have a lack of space, teeth protrusion or dental asymmetry, and the extraction of permanent teeth is indicated, the damaged molars should be the first option for extraction when premolars are in better condition. The third molars in different ways are affected by orthodontic therapy. One of them is orthodontic treatment by applying the extraction of the third molars, this situation being widely explored. Extraction of third molar for orthodontic reasons is justified when it prevents the eruption of the second molar or otherwise affects the other teeth. The indications of extraction and selection of teeth to be removed depend on the specific aspects of malocclusion. Premolars are teeth that are usually extracted from orthodontic reasons, but this is not the rule and depends on individual treatment needs. The decision to correct the malocclusion with teeth extraction should be based on the ratio of the size of the dental arch with the size of the teeth, facial appearance and other factors arising from the diagnosis itself. Indications for extraction of the third molars during orthodontic treatment are: mandibular incisor crowding, if they in some way constitute a obstruction of orthodontic treatment as well as preparation for orthognathic surgery. The success of an orthodontic treatment involving the extraction of molars is directly related to the patient complaints and psychological profile, the absence of diseases and skeletal discrepancies, the professional experience as well as the fact whether the patient underwent previous orthodontic treatment with extraction. Patients with partially or completely non-erupted teeth are significantly more likely to have certain consequences: before, during or after the orthodontic treatment. Therefore, orthodontists need to raise patient awareness of these consequences in the context of orthodontic treatment.
INFLUENCE OF GROWTH IN TREATED CLASS III GROWING PATIENTS WITH FACE MASK THERAPY AND UNTREATED PATIENTS
Authors: Carceva Shalja Sofija , Atanasova Sandra
Published: December 2021

Developing Class III Malocclusion in most of the cases affects dentofacial appearance. The goal of this study is to investigate the changes in the facial appearances in treated patients withFace mask orthopedic treatment and untreated Class III patients. The sample consisted 49 patients (boys and girls),with average age of 9 years, who had a Class III Malocclusion with an anterior crossbite and a component of maxillary deficiency. 28 of them were treated with protraction Face mask- Delair mask (petit tipe), and the other 21 were presenting the control group consisted of untreated Class III Patients.In treated group pretreatment and posttreatment cephalometric radiographs from 28 patients(15 males and 13 females) were analyzed and compared with the results of cephalometric analyzes in untreated group(observation period of 1 year). Results from these study showed forward displacement of maxilla(SNA p<0.05),increasing of maxillary length(Co-A p<0.05)correction of maxillary-mandibular relationship(ANB p<0.05) in treated group while in untreated groupvalues for the parameters in the upper jaw and inter jaw relationship before and after the observation period of 1 yearshowed no statistically significant changes pointing to the negative impact of incorrect skeletal terms in Class III growing patients.Based on our findings we can concluded that in Class III patients there is a big motivation for orthodontic treatment because their dentofacial appearance deviates from sociocultural norms.Therefore, an important objective of accepting maxillary protraction treatment in Class III malocclusion is providing nonsurgical alternative in the treatment and improving the physico-social wellbeing and appearance of the patients, especially during their teenage years.
ACREDITED MOLECULAR METHODS FOR DETECTION OF INFECTIONS CAUSED BY HIV, HEPATITIS B VIRUS AND HEPATITIS C VIRUS
Authors: Gelmanovska Belinda , Taleski Vaso
Published: December 2021

Hepatitis B and C, as well as HIV infections are common pathology in present time. According current assessments 350 million are carriers of Hepatitis B virus, 170 million of Hepatitis C virus and over 60 million infected by HIV. Timely detection and prompt diagnosis of these viral infections are of great importance.
According assessments, in our country about 1 of 50 persons are infected by Hepatitis B or Hepatitis C. From the beginning of the epidemic in 1987, until 2016 total number of registered of HIV/AIDS is 311 (179 with AIDS and 131 HIV positive).
In JZU - University Clinic for Infectious Diseases and Febrile Conditions Skopje, diagnosis of these viral infections are made by accredited molecular diagnostics methods, PCR, at Department for molecular diagnostics using HCV-RNA, HBV-DNA and HIV-RNA. Aims of accreditation of particular procedures in laboratories is protection and advancing of human health, and preventing of spreading of viral infections.
With great success, Department for molecular diagnostics as part of the University Clinic For Infectious Diseases and Febrile Conditions Skopje use the System for quality management according standard MKS EN ISO 15189:2013 for medical laboratories. Accredited molecular methods in use for detection of Hepatitis C virus, Hepatitis B virus and HIV are Polymerase Chain Reaction (PCR) and Genotypisation of HCV with method of Reverse hybridization.
FLUORESCENT IN SITU HYBRIDIZATION AND IMMUNOHISTOCHEMISTRY FOR SUBTYPING “NON-CLASSIFIABLE” RENAL CELL CARCINOMAS
Authors: Ivanov Atanas , Stoyanova Vili
Published: December 2021

Renal tumors account for about 3% of the malignancies in adults. Clear cell subtype renal cell carcinoma (RCC) and papillary RCC are the most common renal tubular epithelial carcinomas and their differentiation is important because they have a different prognosis and are associated with different treatment protocols. In most cases, histological features allow accurate diagnosis of renal cell carcinomas. There are also overlapping morphological findings between certain kidney neoplasms that make their subtyping extremely difficult. Some of them display papillary architecture but also have a clear cell component and it is not clear whether they should be classified as clear cell RCC or papillary RCC.
In our study we performed an immunohistochemical and genetic analysis of 24 cases of RCC classified as non-classifiable with mixed papillary and clear cell components treated at Clinic of Urology in University Hospital "St. George "-Plovdiv. The mean age of patients was 54.5 years, and gender distribution: 60% male and 40% female.
Based on the results of immunohistochemistry and fluorescence in situ hybridization (FISH), patients were stratified in 2 groups. The first group included 16 of the cases where strong immunoreactivity was found for alfa-methyl coenzyme A racemase (AMACR), with cytokeratin 7 (CK7) being present in 15 of these. In all cases in this group, FISH proved trisomy 7 and 17, in 4-9p deletion, and in 2- 3p deletion. The remaining 8 cases were stratified in the second group - all negative for CK7 and only one positive for AMACR. Genetic analysis showed a lack of trisomy 7 and 17 in all cases, as well as a deletion of 3p and 9p in 7 of them.
The combination of immunohistochemical and genetic analyzes allows with a high accuracy to differentiate cases of papillary RCC from those with clear cell RCC.
JEJUNAL ADENOCARCINOMA: A CASE REPORT
Authors: Bozhinovska Beaka Gordana , Prgova Veljanovska Biljana , Zdravkovska Milka , Eftimovska Rogac Irena , Bozhinovska Nadica
Published: December 2021

Tumors of the small intestine are extremely rare, and clinical signs and symptoms are nonspecific, resulting in prolongation of the diagnosis process and subsequently worsening the outcome of the treatment. In addition to non-specific symptomatology, additional difficulty in diagnosing is the very inaccessibility of the jejunum through endoscopic techniques. The following is a review of the case of a female patient with jejunum carcinoma. CASE REPORT. A 64-year-old patient with nonspecific symptoms of fatigue, weight loss and sore pain in the stomach initially hospitalized due to anemic syndrome. An endoscopic evaluation was performed, and the fining was chronic gastritis. The patient was prescribed with iron supplementation therapy and was sent home. Within a month, the fore mentioned symptoms started to intensify, and the patient was hospitalized at the General Hospital in Skopje, where extensive investigations were conducted. Upper digestive endoscopy was made, and the finding again only showed chronic gastritis. Due to lack of findings, the doctors performed abdominal ultrasonography that indicated only a bolded intestinal segment with a thick wall of 9mm in the projection of the left flexure to the descending colon. The need for additional investigations grew and computed tomography with contrast of the abdomen and small pelvis was performed. The finding of the computed tomography was in favor of an irregular intestinal segment in the projections of the jejunal convolutions, with a thickened heterogenic wall and pathological post-contrast coloring. Due to the need for correlation with other trials, MRI was performed, and its finding was highly suspected of a tumor change in the jejunum, but an inflammatory disease was not excluded. Because of this finding, the patient was sent to the Department of Digestive Surgery at the same facility. From a surgical point of view, the patient was treated with an upper medial laparotomy, which made it possible for the tumor to be released from its surroundings. The surgery and after surgery course and the patient’s condition were all as expected. The patient was in a stable general condition after the surgery, and she was sent home. The pathophysiological finding resulted in jejunal adenocarcinoma (Latin adenocarcinoma intestinijejuni). After the pathophysiological finding was obtained, the patient was referred to an oncologist for eventual adjuvant therapy. DISCUSSION. Small intestine carcinoma is a specific clinical and surgical entity, which is often diagnosed in an already overdue phase. This is due in part to the non-cohesive symptomatology, but largely due to the still insufficiently sophisticated detection methods. Because of this enigmatic nature of these carcinomas, it may be necessary to think of a special team in the digestive surgery departments, which would solely work on this pathology, in order to speed up diagnosis and improve the outcome of the treatment for the patient.
SPLENIC ABSCESS IN PATIENT WITH CHRONIC PANCREATITIS: A CASE REPORT
Authors: Bozhinovska Beaka Gordana , Noveska-Petrovska Biljana , Prgova Veljanovska Biljana , Bozhinovska Nadica
Published: December 2021

The abscess of the spleen is a rare condition with diverse аetiologies and highly polymorphic clinical expression. It is more common in male than female patient, with a wide age range. Regarding varied and often unspecific symptomatology it poses a great problem for diagnostic and overall treatment with a very high mortality rate in untreated patients. Recent diagnosis and treatment are based on modern imaging techniques that enable precise and rapid diagnostics. The following is a presentation of a case that refers to a young male patient with splenic abscess.
CASE REPORT. A 37-year-old patient with a history of hypertensive crisis and multiple previous admittances to the emergency room regarding acute attacks of pancreatitis and persistent reduction in body weight was admitted to the emergency room with nonspecific symptoms of abdominal pain, more prominent in the upper left quadrant. Laboratory findings revealed leukocytosis and elevated levels of CRP. Infective panel for hepatitis and HIV was negative. Additional ultrasound investigations were made which revealed hypoechogenic lesion in the spleen, clearly demarcated from the neighboring parenchyma and partially encapsulated, with near proximity to the tail of the pancreas. Hospitalization with additional MRI and surgical treatment was advised, but the patient refused and contrary to the advice of the doctor decided to leave the hospital. After 10 days he was again admitted to the emergency room with persistent leukocytosis and elevated CRP. Because of the worsening condition, he accepted the previously proposed treatment and was hospitalized. The conducted MRI investigation revealed three cystic lesions with dense content in the spleen, measuring from 5x3sm to 2sm in diameter with propagation towards the tail of the pancreas. Surgical splenectomy with partial pancreatectomy was performed, and the surgical specimen was forwarded for histopathological examination. The microscopic examination on the selected specimens revealed severe stasis in the splenic parenchyma with subcapsular abscess formation, and also confirmed the chronic pancreatitis condition. The postoperative course went well without any complications, as well as on the following regular checkups.
DISCUSSION. Splenic abscess is very uncommon entity associated with versatile etiologies which covers primary immunocompromised patients, trauma or patients with infective endocarditis. As a potentially life-threatening condition it is essential to emphasize the need for fast detection and splenectomy as a choice of treatment. But also it is very important as a potential aetiology to have in mind other chronic conditions like pancreatitis, especially in young male patients, given that management of the underlying disease is of great importance.
ROLE OF GOUT IN ATRIAL FIBRILLATION
Authors: Kisheva Antoniya
Published: December 2021

Atrial fibrillation (AF) is the most prevalent arrhythmia in clinical practice. Atrial fibrillation (AF) is the most prevalent arrhythmia in clinical practice. There is increasing evidence for the role of inflammation in the development and maintenance of AF and gout is associated with inflammation and oxidative stress. In the last years several studies were published to assess the role of gout as a risk factor for occurrence of atrial fibrillation (AF). There are not enough data on the importance of gout in patients, who already have AF. The aim of the study is to assess the impact of gout on the clinical course of AF. Overall 101 patients – 51 females and 50 males at mean age 68,02 ± 7,001, with AF after sinus rhythm restoration were included in a clinical trial of one-year placebo-controlled treatment with spironolactone. Gout was reported in 6,8% of them. They were analyzed for AF recurrence, hospitalization for AF, all-cause admissions, composite endpoint (recurrence episodes of AF, all-cause hospitalization and death) and value of biomarker Galectin-3 (Gal-3). Results: Patients with gout had double risk of recurrence of AF, even though not significant, HR=1.97, 95%CI=0,78-4.98, p=0,15. In our study presence of gout was significant predictor for hospitalization for AF in unifactor analysis (HR 4,46, 95% CI=1.51 – 13.19, p=0,007) and the only significant in multifactor analysis – model, including gender, age categories, hypertension, diabetes and use of spironolactone (HR=4,23, 95%CI=1,28–14,1, p=0,018). Gout influenced significant also the all-cause hospitalizations, HR =3.17, 95%CI 1.10-9.14, p=0.033. There was a significant difference between the value of Gal-3 in patients with gout as opposed to patients without (28,52±15 vs 16,02±5,49, р=0,002). Conclusion: We found that gout significantly influences the course of AF. Presence of gout in patients with atrial fibrillation is a risk factor for recurrence and hospitalization – cause-specific for AF and all-cause. The value of Gal-3 as a marker of fibrosis and inflammation is higher in patients with AF and gout.
DYABETTE CONTROL PROGRAM AND PREVENTION OF THEIR CONDITIONS - PROPOSALS AND GUIDELINES
Authors: Pancheva Varvara , Vassilev Valentin
Published: December 2021

The most effective way to control diabetes and its complications is to prevent, within the framework of programs for common coordinated approaches and actions to reduce the level of risk factors, early diagnosis, treatment and rehabilitation of the patients and to ensure a healthy living environmen. Recommendations to Bulgaria for comprehensive healthcare reform in terms of quality of care for diabetes mellitus and improvement of prevention, as well as the lack of long-term state policy, are the reason to make some suggestions and guidelines and make a modest contribution to the development of a combat program with diabetes and its complications, without claiming an exhaustive presentation of the problem under consideration. The experience of the leading countries shows that where there is a policy aimed at preventing the disease and its complications, significant results have been achieved.
ALGORITHM OF COMPLEX PROGRAM FOR TREATMENT AND REHABILITATION IN DEGENERATIVE DISEASES OF THE VERTEBRAL COLUMN IN THE CERVICAL AREA. PREVENTION OF CERVICAL ARTHROPATHY
Authors: Kasnakova Petya
Published: December 2021

Degenerative changes of the spine are a common disease and represent a serious medical-social problem, requiring a complex program for treatment, rehabilitation and prevention. Nowadays life and immobilization create favorable prerequisites for the spreading of disease. The cervical region of the spine is subjected to significant dynamic and static loads, which often leads to pain and limited mobility. Improper posture, continuous static tension, muscular hypertonia and functional blockages in the cervical region provoke psychosommatic discomfort, stiffness, headaches and reduced capacity to work. An essential place in the treatment of osteoarthrosis occupy physical and rehabilitative means. Very good results are obtained from the recreated physical methods, kinesitherapy, extension, manual therapy, massage and natural factors combined with training of the patient. The purpose of this publication is to present an algorithm of a complex program for physical treatment and rehabilitation of cervicoarthrosis, as well as preventive measures and ergonomic control in a sitting working posture. Improving and maintaining the functional state of patients with spondyloarthroasis is essential for their quality of life.
THE DIAGNOSIS OF DAUCUS CAROTA AS ALERGOGEN ON THE IMMUNE SYSTEM IN WHITE LABORATORY RAT
Authors: Spasov Mire , Gjorgoski Icko
Published: December 2021

The allergic reaction or type I hypersensitivity is a hypersensitive disorder to the immune system, which occurs by ingress of non-pathogenic agents from the external environment in the body. Antigens, in this case allergens, are substances from the environment that are harmless to most people. In allergies there is an inherent tendency to inherit the genes that make these people susceptible to allergies. Rapid sensitization may occur as a local reaction, which is just unpleasant (seasonal rhinitis or hay fever), severe exhaustion (asthma), or culminating in a fatal systemic disorder (anaphylaxis). Allergens in the body are inserted by inhalation, ingestion or injection, and move to mucous membranes, where they are accepted by T-lymphocytes. TN2 lymphocytes produce IL-4, which stimulate B-lymphocytes to differentiate into plasma cells. These cells excrete IgE, which recognize allergens. Excreted IgE antibodies sensitize mast cells that originate from the bone marrow. When sensitized individuals again expose themselves to an allergen from the external environment, they bind to specific IgE-antibodies to the mast cells (memory cells), whereby various mediators are excreted, causing inflammatory response, mucus secretion, vasoconstriction of blood vessels, and spasm of the airways.
The aim of the study was to investigate the allergenic effect of Daucus carotte on the change in the number of leukocytes, lymphocytes, monocytes, granulocytes, basophils, and immunoglobulins as important components of the immune system. From the pollen of this plant, recombinant allergen is extracted, in the form of injections with a volume of 150μI. In the experiments, as experimental models were used Wistar white rats at the age of 6 to 9 weeks. We injected the allergen into the first, second, third and fourth week in a group of 6 rats in an amount of 5 μl and a second group of 6 rats in an amount of 2.5 μl allergen absorbed in 100 μl AI (OH) 3 (Serva, Heidelburg, Germany, 2 μg / mI) in a total volume of 150μI sterile PbS. The third group of 6 rats was a control group. The results showed that the Dacus carota causes an allergic reaction in Wistar white rats and its intensity depends directly on the volume of the allergen and the individuals that come into contact with it. Once we compared the values of blood parameters, leukocytes, lymphocytes, monocytes, granulocytes, and basophils, as well as the IgG, IgG1, IgG2a, and IgE IgG, IgG1, IgG2a, and IgE concentrations, we concluded that the higher concentration of Daucus carota causes a higher elevation in blood parameters and concentrations of immunoglobulins, compared to the smaller concentration of the same allergen.
From the studies conducted over a period of one month, it was found that Dacus carota causes an allergic reaction, which is classified in Type I hypersensitivity in white laboratory rats of the Wistar strain.
THE DIAGNOSIS OF PHLEUM PRATENSE AS ALERGOGEN ON THE IMMUNE SYSTEM IN WHITE LABORATORY RAT
Authors: Spasov Hristijan , Spasov Mire , Gjorgoski Icko , Ademi Majlinda
Published: December 2021

Allergic reactions in the body are initiated by non-pathogenic allergens that cause hypersensitivity to the immune system of the type I hypersensitivity group, characterized by excessive activation of the cells of the white blood cell, mast cells and basophils by IgE, resulting in an inflammatory response. The particles of the allergen in the body mainly penetrate the mucous membranes of the body openings causing a series of reactions by activating T cells and B cells. The main symptoms of allergic reactions are secretion from the mucous membrane, irritation, swelling with itching and redness.
The aim of the research came from the assume that in the white laboratory rat, when treated with an allergen isolated from the pollen of the Phleum pratense plant, there may be an allergic reaction, and hence a change in some parameters of the immune system.As a result of these assumptions the following specific goals were set. To determine the change in the concentration of immunoglobulins in serum from the blood taken from the rats every week for a month, to determine the variation in the total number of leukocytes, determine the number of basophils that compared to the reference value will indicate whether there are certain changes. The basophils were the target of the study because it is known that their number is the same with the number of mast cells that also increase during the allergic reaction. Our goal was also to determine the changes in the above parameters in relation to the different concentration of the allergen.As an experimental model we used white laboratory rats from the Wistar kind.All of them were female at the age of 6 to 9 weeks. The chosen age is due to their genetic predisposition to develop Th2-type cells that are involved in the immune response to the model of the allergy that has been studied. The rats were divided into three groups of six animals, the first group of rats being treated with an allergen in a quantity of 5 μL, adsorbed in 100 μl Al (OH) 3 (Serva, Heidelburg, Germany, 2 mg / mL) in a total volume of 150 μl sterile PbS., treated with a recombinant allergen from Phleum pratense at room temperature, a second group treated with an allergen in an amount of 2.5 μl, and a third group of control rats that are not treated and serve to compare the results. Our studies have shown that in the treatment with an allergen isolated from the pollen of the plant Phleum pratense at concentrations of 5 μl and 2.5 μl,the white laboratory rat develops an allergic reaction with a change in the concentration of immunoglobulins, changes in the total number of leucocytes, the percentage of lymphocytes , monocytes and basophils. The results obtained by the ELISA test of the two volumes show that the concentrations of immunoglobulins during the experimental period of day by day, are continuously increasing, and are proportional to the volume of the allergen.
PERSPECTIVES IN HEALTH CARE FOR CHILDREN WITH SPECIAL NEEDS IN CHILDREN'S AND SCHOOL HEALTH
Authors: Obreykova Monika , Terzieva Galina
Published: December 2021

The nursing profession in child and school health care faces a number of health, political and economic challenges. The process of integrating children with special educational needs (SEN) into the education system started after 2002, when legislative acts, which regulating then ecessary basic prerequisites for the implementation of this process, were accepted. Integrated education for children with SEN is an education where the child, regardless of the type of disability, is included in the general educational environment. This is accomplished by building and operating a supportive environment that includes appropriate architectural and socio-living conditions, individual educational programs and prepared medical professionals. The aim of the survey is to research the nurses' opinion about factors affecting their work with children with SEN. The subject of the survey is the process of forming professional competencies for nurses and their position to improve the care of children with disabilities. The object of the survey are the views, attitudes and evaluation of the nurses to improve the communicative skills between them and the children in preschools and schools.The scope of the survey are 100 respondents: nurses from "Children and School Health" in city of Burgas. Approaches and methods to study the problem: a theoretical analysis of the problem in the literature; documentary research; Anonymous survey. The results of the study outline difficulties in the communication of nurses with children with disabilities - 64%. 78% of respondents stated that they would participate intraining that would lead to effective performance of their professional activities.
VISUAL SCREENING OF SCHOOL CHILDREN IN THE MUNICIPALITY OF SAPAREVA BANYA IN SOUTHWESTERN BULGARIA
Authors: Stoykova Slavena , Petrova Ekaterina
Published: December 2021

Within 3-days-program almost 200 children and 50 adults had their vision checked by an international qualified team of eye specialists in the local school in Sapareva Banya. Visual acuity, objective and subjective refraction, color perception, binocular vision, cover test, pupillary reaction and other tests were performed. Apart from the ophthalmic examination, all the patients’ parents also filled in questionnaire regarding visual strain regimen, previous eye doctor visits and other details. The aim was to promote visual health, establish and possibly treat refractive errors and amblyopia, to facilitate access to specialized medical care, optical and optometrist’s service for children’s population of remote municipalities with population under 10 000 people. The visual screening of Sapareva Banya school children was of great value because only 38% of children had been examined before. There were no major deviations, severe anisometropia and ametropia values or very low visual acuity patients not wearing optical correction. A surprisingly high incidence of color vision deficiency was found 9, 2% males and 4, 3 % females.