Citation: Dzhambov AM, Tokmakova MP, Gatseva PD, Zdravkov NG, Gencheva DG, Ivanova NG, Karastanev KI, Vladeva SV, Donchev AT, Dermendzhiev SM. Community noise exposure and its eff ect on blood pressure and renal function in patients with hypertension and cardiovascular disease.Folia Medica 2017;59(3): 344-356. doi: 10.1515/folmed-2017-0045 Background: Road traffi c noise (RTN) is a risk factor for cardiovascular disease (CVD) and hypertension; however, few studies have looked into its association with blood pressure (BP) and renal function in patients with prior CVD. Aim: This study aimed to explore the eff ect of residential RTN exposure on BP and renal function in patients with CVD from Plovdiv Province. Materials and methods:We included 217 patients with ischemic heart disease and/or hypertension from three tertiary hospitals in the city of Plovdiv (March -May 2016). Patients' medical history, medical documentation, and medication regimen were reviewed, and blood pressure and anthropometric measurements were taken. Blood samples were analyzed for creatinine, total cholesterol, and blood glucose. Participants also fi lled a questionnaire. Glomerular fi ltration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. All participants were asked about their annoyance by diff erent noise sources at home, and those living in the city of Plovdiv (n = 132) were assigned noise map L den and L night exposure. The eff ects of noise exposure on systolic blood pressure (SBP), diastolic blood pressure (DBP), and estimated glomerular fi ltration rate (eGFR) were explored using mixed linear models. Results: Traffi c noise annoyance was associated with higher SBP in the total sample. The other noise indicators were associated with non-signifi cant elevation in SBP and reduction in eGFR. The eff ect of L den was more pronounced in patients with prior ischemic heart disease/stroke, diabetes, obesity, not taking Ca-channel blockers, and using solid fuel/gas at home. L night had stronger eff ect among those not taking statins, sleeping in a bedroom with noisy façade, having a living room with quiet façade, and spending more time at home. The increase in L den was associated with a signifi cant decrease in eGFR among men, patients with ischemic heart disease/stroke, and those exposed to lower air pollution. Regarding L night , there was signifi cant eff ect modifi cation by gender, diabetes, obesity, and time spent at home. In some subgroups, the eff ect of RTN was statistically signifi cant. Conclusions: Given that generic risk factors for poor progression of cardiovascular diseases cannot be controlled suffi ciently at individual level, environmental interventions to reduce residential noise exposure might result in some improvement in the management of blood pressure and kidney function in patients with CVD.
Obesity and poor glycemic control in patients with DM2 affect key immunological components of IgE-mediated allergic inflammation and possibly alter the immune response to allergens and antigens.
Background: Assessment and appraisal of new medical technologies require a balance between the interests of different stakeholders. Final decision should take into account the societal value of new therapies.Objective: This perspective paper discusses the socio-economic burden of disease as a specific reimbursement decision-making criterion and calls for the inclusion of it as a counterbalance to the cost-effectiveness and budget impact criteria.Results/Conclusions: Socio-economic burden is a decision-making criterion, accounting for diseases, for which the assessed medical technology is indicated. This indicator is usually researched through cost-of-illness studies that systematically quantify the socio-economic burden of diseases on the individual and on the society. This is a very important consideration as it illustrates direct budgetary consequences of diseases in the health system and indirect costs associated with patient or carer productivity losses. By measuring and comparing the socio-economic burden of different diseases to society, health authorities and payers could benefit in optimizing priority setting and resource allocation. New medical technologies, especially innovative therapies, present an excellent case study for the inclusion of socio-economic burden in reimbursement decision-making. Assessment and appraisal have been greatly concentrated so far on cost-effectiveness and budget impact, marginalizing all other considerations. In this context, data on disease burden and inclusion of explicit criterion of socio-economic burden in reimbursement decision-making may be highly beneficial. Realizing the magnitude of the lost socio-economic contribution resulting from diseases in question could be a reasonable way for policy makers to accept a higher valuation of innovative therapies.
Vulvovaginal candidiasis (VVC) is the most common vaginal infection. It is considered to be the reason for 15%-30% of all vulvovaginal symptoms. A diagnosis based only on clinical signs and/or on a syndrome-based approach, recommended by some authors and health institutions, is in many cases incorrect. There is no indisputable diagnostic method that guarantees high specificity, sensitivity and predictive value. There is no pathognomonic clinical feature of VVC. The aim of the present study was to assess the role of selected clinical and mycological indicators in the diagnosis of VVC using the standard complex scoring system. The research is retrospective and was conducted in several stages to give a more precise and detailed assessment of the examined clinical and microbiological indicators. Clinical, microbiological and statistical methods were used. The results showed the lowest level of compliance between clinical and laboratory diagnosis in VVC: 67.65%. We did not observe a statistically significant relation between the density of the vaginal smear, inflammation, odour test and VVC (p > 0.05). The results showed a moderate association between the positive yellow swab test and VVC (p < 0.05). A significant positive association was established between VVC and presence of microscopic signs of invasiveness (p < 0.001). The most common isolate was Candida albicans: 72.81% of all vaginal Candida isolates.
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