Background: Isolated adrenal gland metastases are not frequently finding. The aim of the present retrospective study was to estimate clinical and pathological parameters that could be used to predict survival after adrenalectomy.Material and methods: A total of 34 patients with adrenal gland masses suspected to be metastases was included in this study. The group of patients with isolated metastases was19 (56%) and a group of patients with adrenal adenomas -15 (44%).Results: The sample of patients consisted of 18 (53%) men and 16 (47%) women from 40 to 81 years old with a mean (±SD) age of 61.6±10.3 years, presented with adrenal mass suspected to be metastases. Nineteen (56%) of them had demonstrated metastases and 16 (84%) metachronous with median overall survival (OS) 54.6 (range 43-66) months. Median OS in the group with metastases was 22.6 months. Lung carcinoma was the most common primary tumour metastasizing in the adrenal gland -58% of all metastases with a disease-free interval (DFI) of 13 months. It was presented by shorter median survival than the rest primary tumour types (37.8 vs. 96.7months; logrank test, p=0.028). In the multivariate Cox's hazard analysis of the surgical technique was found to be an independent prognostic factor (p=0.047), together with lung carcinoma vs. renal cell carcinoma (p=0.045).Conclusion: Adrenalectomy due to isolated metastases in the adrenal glands showed the median overall survival of 22.6 months. Shorter survival periods were associated with lung carcinoma, DFI<12months, conversion to open surgery, synchronous metastases, but not with age, tumour size or resection status.

Introduction: Osteoarthritis (OA) is a widespread disease among adult population and is one of the major public health problems. OA is leading cause of disability the joints of lower limbs: knee and hip. As global life expectancy increases, it predicted that OA will be the leading cause of damage resulting in permanent disability. In cases of OA a reduction in cartilage tissue is observed, which is radiographically demonstrated by narrowing of the joint space and bone changes, osteophytes and subchondral bone sclerosis. However, a significant proportion of patients with radiological evidence of gonarthritis do not report joint pain. It is important to evaluate the changes occurring in the surrounding tissues. Muscle weakness of m. quadriceps femoris may occur before pain and impaired joint function. The development and application of new non-pharmacological methods in the rehabilitation of degenerative joint diseases is particularly important.Purpose: To establish the short-term therapeutic effects of treatment with Low-frequency and Low-intensive electrostatic field, applied through Deep Oscillation® method and complex of therapeutic exercises in rehabilitation of patients with osteoarthritis of the knee.Materials and methods: We conducted a one-year observational study involving 23 patients with clinical symptoms and radiologically proven II and III stage according Kellgren-Lawrence gonarthritis, aged between 42 and 78 years, were observed. 15 of them were women average age 61.73±12.9 years vs 8 - males average age 61.75±9.6 years (p=0.997). The duration of the current pain-episode was 1.7±0.7 months. The treatment was conducted in 10 sessions and included: Low-frequency and Low-intensity electrostatic field and complex therapeutic exercises.Results: The results were evaluated before and after completion of therapeutic course by assessing pain (VAS) at rest, when walking, climbing and descending on stairs, Manual Muscle Testing, Measurment of the knee joint circumference, Test Range of Motion and WOMAC Osteoarthritis Index, V.LK 3.1. were tracked. For processing statistical data SPSS v.13 was used. There was a statistically significant reduction of pain syndrome at rest (p<0.001), walking (p<0.001), descending stairs (p<0.001), climbing (p<0.001). Reduction of knee joint circumference (p<0.001). Increasing the range of flexion before Ме (Range) from 105º (90º-120º) versus 120º (100º-125º) after therapy. Reduced deficiency at an extension from 3.48 ± 4.38 before therapy to recovery of the extension. Improved total WOMAC Index (p<0.001), Stiffness (p<0.001) and Function (p<0.001).Conclusion: The short-term effects of the application of Low-frequency and Low-intensive electrostatic field in complex with therapeutic exercises show reduction of clinical symptoms and improvement of daily functional activity in patients with knee joint osteoarthritis. Reduction of pain of rest and physical activity (walking, descending and climbing stairs) is observed, oedema is reduced, joint range of motion increases, immediately after completion of the therapeutic course. Because of the small number of patients included in the study for better objectifying of the effects of the low-frequency and low-intensity electrostatic field, the studies should continue.

Objective To explore the knowledge, perceptions of and attitudes to digital health of Bulgarian hospital professionals in the first study of digital health in this professional group. Methods A paper-based questionnaire was administered to doctors, trainee doctors, nurses, midwives, and laboratory assistants working in multiprofile or specialized hospitals. Topics included the following: state, objectives, benefits, and future of digital health; data storage, access, security, and sharing; main software used; patient-held Personal Information System (PIS); and telemedicine. A total of 1187 participants from 14 hospitals completed the survey in two phases: September 2013–April 2014 and May 2015–April 2017. Data were analyzed through descriptive statistics and multilevel logistic regression. Results Three-quarters of participants evaluated the state of development of digital health in Bulgaria as subpar (36.0% negative; 38.9% passable; 24.5% positive). 27.2% (323) endorsed patients having unconditional access to their data. In contrast, 89.5% (1062) of participants considered it appropriate to have full access to patient data recorded by colleagues. Doctors were more likely to endorse patients having access to their data than healthcare specialists (OR = 1.79 at facility, OR = 1.77 at location). Conclusion The largely negative or lukewarm attitudes toward the state of development of digital health in Bulgaria are likely to result from the high number of failed projects, unmet expectations, misunderstood benefits, and unforeseen challenges. This study provides a much-needed stimulus and baseline for researching the ways in which the digital health landscape in Bulgaria has matured—or not.

Summary Cardiovascular diseases (CVD) are the leading cause of invalidity and death in developed countries. Among them, the main cause of death is coronary artery disease. In this retrospective study, 172 patients with acute coronary syndrome (STEMI, NSTEMI, UA) are included. They had been hospitalized on an emergency basis in the Cardiology Department, Invasive Sector of Prof. Dr. St. Kirkovich Hospital in Stara Zagora, and the Cardiology Hospital -Yambol between January 2009 and February 2010. We found a significant difference in the age at acute coronary syndrome (ACS) occurrence by sex: earlier manifestation was observed in men (p=0.018). The univariant regression analysis showed that elderly age (p=0.005, OR 1.024), glomerular filtration <90 ml/h (p=0.006, OR 0.964), GRACE-score > 140 pt (p<0.001, OR 1.045), HF (Killip class ≥ II) (p=0.002, OR 15.6) and EF<40% (p=0.003, OR 1) were factors for adverse prognosis in the first, fifth and ninth year. Only GRACE-score was an independent predictor of death obtained by multivariate regression analysis in the study (p=0.002, OR 1.052). The factors influencing long-term survival adversely after ACS are age, smoking, chronic kidney disease, previously experienced myocardial infarction, diabetes mellitus, three-vessel coronary disease, and decreased systolic function of the left ventricle, and GRACE > 140 p.

Background: To identify the prevalence of H. pylori in patients with gastric carcinoma and their first-degree relatives, the possible risks of acquisition of infection and developing of gastric cancer. Methods: We investigated 31 families (total 75 human volunteers) with a family member, diagnosed as a gastric carcinoma patient and their first-degree relatives. Patients were tested forH. pylori stool antigen by "DIAQUICK" H. pylori Stool Cassette-a rapid test for the qualitative detection of H. pylori antigen. A questionnaire for sociodemographic and lifestyle possible risk factors for acquisition of infection and for developing of gastric cancer was completed by 75 people. The statistical analysis was performed using Fisher's test and ANOVA. Results: Fisher's Test shows that smoking (χ 2 = 4.172; р = 0.386), animals at home (χ2 = 0.376; p = 0.871), and diet (χ 2 = 2.166; р = 0.725) are not significantly associated; however, the family history of gastric cancer (χ 2 = 56.886; р = 0.001), level of education of patients (χ 2 = 17.374; р = 0.004) and sex (χ 2 = 6.669; р = 0.039) are significantly associated with the acquisition of infection and the developing of gastric cancer in patients and their first-degree relatives. Conclusion: Concern authorities should develop and implement strategies to improve educational status, basic sanitary facilities, and socioeconomic status to minimize H. pylori infection.