-Background & Purpose: Hyperhomocysteinaemia has been postulated to participate in pathogenesis of ischaemic stroke (IS). However, especially in young adults, there is possibility of significantly increased IS risk due to increased 'normal' homocysteinaemia, i.e., 'hidden' ('pathologically dormant') prevalence within a healthy, normally-defined range. We performed a post-hoc modelling investigation on plasma total homocysteinaemia (THCY) in gender-and age-matched young patients in the acute IS phase. We evaluated relationships between THCY and prevalence of other potential risk factors in 41 patients vs. 41 healthy controls. Method: We used clinical methods, instrumental and neuroimmaging procedures, risk factors examination, total plasma homocysteine measurements and other laboratory and statistical modelling techniques. Results: IS patients and healthy controls were similar not only for matching variables, but also for smoking, main vitamin status, serum creatinine and lipid profile. Patients with IS, however, had lower vitamin B6 levels and higher THCY, fibrinogen and triglycerides (TGL). At multivariate stepwise logistic regression only increased THCY and TGL were significantly and independently associated with the risk for stroke (72% model accuracy, p model =0.001). An increase of THCY with 1.0 µmol/L was associated with 22% higher risk of ischaemic stroke [adjusted OR=1.22 (95%CI 1.03÷1.44)]. In this way, novel lower cut-off value for HCY of 11.58 µmol/L in younger patients has been revealed (ROC AUC = 0.67, 95CI% 0.55-0.78, p=0.009). Conclusion: The new THCY cut-off clearly discriminated between absence and presence of IS (sensitivity>63%, specificity>68%) irrespectively of age and gender and may be applied to better evaluate and more precisely define, as earlier as possible, the young patients at increased IS risk.KEY WORDS: homocysteine, epidemiology, ischaemic stroke, young patient.Aumento de homocisteína em acidente vascular cerebral isquêmico: análise post-hoc com casos controles em pacientes jovens RESUMO -Objetivo: Hiperhomocisteinemia tem sido postulada como um dos fatores de risco na patogê-nese do acidente vascular cerebral isquêmico (AVCI). Todavia, em adultos jovens existe a possibilidade de aumento significativo de risco de AVCI devido a aumento "normal" da homocisteinemia, "oculta" (patologicamente adormecida) dentro de uma variação definida como normal. Neste trabalho foi investigado um modelo post-hoc de dosagem de homocisteina no plasma (HC) em pacientes jovens com AVCI agudo pareados por gênero e idade. Foi avaliado também relações entre HC e prevalência de outros fatores de risco para AVCI em 41 pacientes e 41 controles normais. Método: Foi utilizado exame clínico, procedimentos instrumentais e de neuroimagem, exame de fatores de risco, dosagem da homocisteína no plasma, outros exames laboratoriais e análise estatística. Resultados: Não foram encontradas diferenças quanto a presença de fumantes, dosagem de vitaminas, creatinina sérica e perfil lipídico entre os pacientes com A...
The objective of the present study was to analyze the clinical pattern of contemporary Mediterranean spotted fever in children and to compare it with the clinical pattern in adults. The research involved 257 children. The more common symptoms in children were severe onset, fever, rash, "tache noire," swelling of lymph nodes and enlarged liver or spleen.
Communication skills of dentists have been demonstrated to be part of the good dental practice. The aim we set ourselves in this study was to review the literature related to the methods of teaching communication skills at dental faculties, and develop a handout in the Bulgarian language about leading a successful conversation with a patient. According to some authors, the most important principles for effective communication training include the use of practical exercises, clinically relevant scenarios, students’ self-assessment tools, videotapes, participation of patient actors, and training in small groups. Another communication training program is the so-called Miller pyramid. Using the method of objective structured clinical examina-tion (OSCE) can also be an effective way of teaching communication skills to dental students. The conclusion to be made is that communication skills should be taught across the entire dental curriculum as this leads to better understanding and sufficient outcome.
BACKGROUND: Self-medication with antibiotics is a major concern worldwide because of the high risks of antimicrobial resistance which may result in complicated courses of treatment, increased risk of death and excess costs to the healthcare systems.AIM: The aim was to study the attitudes and self-medication patterns as related to the use of antibiotics among the general Bulgarian population and their determinants.MATERIALS AND METHODS: A questionnaire-based survey was performed among the patients in two randomly selected municipalities. The questionnaire was mailed to 50 randomly selected adult patients by each of the 33 responding GPs thus addressing a total of 1650 participants.RESULTS: A total of 1050 patients completed and returned the questionnaire. The observed self-medication rate was 43%. The women and the younger employees and students tended to have a higher self-medication rate. Fever (22%), sore throat and cough (12.7%) and discomfort when urinating (8.2%) were the most frequent patterns related to the practice of self-medication.CONCLUSION: This analysis reported an extensive use of self-medication with antibiotics in the study population before the changes in the Bulgarian legislation. Younger age and social status (students, employed) were the most important socio-demographic patterns that had probably led towards self-medication with antibiotics.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.