MEDIS – International Journal of Medical Sciences and Research
MEDIS – INTERNATIONAL JOURNAL OF MEDICAL SCIENCES AND RESEARCH Vol. 5. Issue 2 / 2026 Distinguished Teachers, Scientists, and Researchers in the field of Medicine We are pleased to inform you of that procedure for applying for your scientific and research papers in the field of Medicine, Medical Sciences, and Health, for the MEDIS IJ Vol. 5 Issue. 2. 2026, has started. The purpose of this publishing venture is to persevere the continuity and raise the quality of the work so far, in order for MEDIS IJ to be included in the SCOPUS or WOS list as soon as possible. From now on we offer a new opportunity to do so in MEDIS IJ, where papers will be published in English only. Important: One author can publish only 1 paper per issue The deadlines are as follows: - 27. 04. 2026 abstract submission deadline - 02. 05. 2026 till 12:00 AM full paper submission deadline More Info... Abstract template
ASSESMENT OF QUALITY OF LIFE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND DIABETIC POLYNEUROPATHY
Diabetes mellitus is a chronic disease that has a great effect on the quality of life of patients. It is one of the most progressively increasing chronic diseases of the 21st century. Modern medical practice defines the disease as an important risk factor for the development of severe debilitating complications, reduced quality of life. Predominant among the health-related complications reducing the quality of life is diabetic neuropathy. It is a serious and frequent complication of diabetes mellitus, with a chronic progressive course of development, which without adequate treatment can lead to potentially life-threatening complications, significant morbidity and increased mortality among people with diabetes. The aim of the present study was to assess satisfaction and health-related quality of life in individuals suffering from type 2 diabetes and a realized neurological complication. Researched and surveyed during the period November 2022 – April 2023, there are 20 patients, respectively 10 men and 10 women with type 2 diabetes mellitus and a diagnosed complication - diabetic neuropathy. With the help of a questionnaire consisting of 69 questions, divided into 3 groups of previously formulated questions, the patients were surveyed. Medical records were also used. Regarding general health, 80%(8) of men and 80%(8) of women rated it as good. 20%(2) of men and 20%(2) of women rated it as poor. 60% (6) of men and 20% (2) of women have no difficulty in daily walking of more than 1 mile (1.6 km) as a result of the disease and the complication. 40%(4) of women report very limited motor activity as a result of the polyneuropathy. 40%(4) of men and 40%(4) of women reported minor difficulties in motor activity. When asked if they had experienced pain in the last 4 weeks, 40%(4) of men answered that it was mild. 40% (4) of men and 100% (10) of women reported moderate pain, 20% (2) of men reported experiencing very severe pain in the past 4 weeks. Patients with DM and a realized neurological complication are not only physically sick, but also have a lower self-assessment of quality of life, compared to the healthy population. Diabetes has an effect on patients' quality of life. Pain, discomfort and impaired mobility are among the most common complaints that alter the quality of life.
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HIP DISORDERS AND IMPROVEMENT ON THE PATIENT LIFE OPPORTUNITIES BY THE HIP ENDOPROSTHESIS IMPLANTATION
The most common reason for the hip joint endoprosthesis implantation is advanced coxarthrosis of the hip, which can be primary, meaning that the cause of coxarthrosis is still unknown, and secondary, which occurs due to a detected disorder: insufficient development of the hip (dysplasia) or after joint trauma (hip fractures, dislocations). Osteoarthritis is the leading cause of physical disability in the elderly in developed countries, but it is also the fastest growing health and disability problem. Aim: To examine the possibilities of regular life activities in patients before and after the hip endoprosthesis surgery. Methods: the research was conducted with people who have hip disease, who are housed in the "Vaso Ćuković" Risan Special Hospital, who need hip endoprostheses. Results: Male patients answered that they feel healthy with a median of 20 (15-25) with a minimum of zero and a maximum of 100, while female respondents felt somewhat healthier 25 (20-30). After the surgery, male respondents answered that they felt healthy with a median of 90 (82.5-100), as did female respondents who felt healthier with mean of 90 (80-100). Male patients before hip surgery had a median health index of 0.35, or in the range -0.11 -0.48, female patients had the same median index value of 0.35, or range 0.07-0.48. Male patients after hip surgery had an median health index of 0.93, or in the range 0.88-1.00, female patients had the maximum index values of 1.0, or in the range 0.96-1.0. Conclusion; Implantation of a hip endoprosthesis provides greater opportunities for normal everyday activities.
Introduction:DAMAGE CONTROL - in orthopedic surgery and traumatology, it is indicated for fresh fractures, especially for trauma with open bone fractures. In all these fresh fractures, hemodynamic instability of the body occurs. In these cases, a minimally invasive procedure is recommended, which initially aims to temporarily stabilize the fractures and control bleeding Material and methods:In our work, we will present the official literature that deals with the issue of damage control in orthopedics. Discussion: One of the leading causes of death in people under 40 is polytrauma. Fractures of the diaphysis of the tibia, femur, and pelvis are the most common fractures that are stabilized using external fixation. Bilateral fractures of the femoral diaphysis are associated with a poor prognosis in terms of mortality and fat embolism syndrome.Hemodynamically stable patients should always undergo definitive fracture fixation. Any prolonged intervention in hemodynamically unstable patients worsens the favorable outcome. Then the immune response can be triggered and increased, which is identified with the clinical condition "Second trauma". Therefore, these patients should be immediately subjected to DAMAGE CONTROL with temporary stabilization and then delayed definitive fixation for a period of 5-10 days from damage control, i.e. in the second act. Orthopedic surgeons should be very careful and recognize the triangle of death - acidosis, hypothermia and coagulopathy, which are interconnected and eventually become irreversible and lead to death as the final outcome. Damage control surgery in orthopedics includes three stages: the first stage of treatment involves controlling bleeding, reducing contamination, and achieving temporary fracture fixation. The time in which all this is done should be as short as 1-2 hours. The second phase involves the stabilization of vital parameters in the ICU as well as the reanimation of the child with the prescription of the necessary therapy as well as blood replacement The aim: The aim of our work is to demonstrate the outcome and feasibility of damage control in orthopedic surgery for both adults and children with multiple limb injuries and polytraumatized patients Conclusion: Polytrauma is a condition of the body that requires immediate action and a special approach because the patient's life is at risk in a high percentage. The principles used to manage patients with multiple injuries including head, lower leg. Early fracture fixation led to earlier mobilization of patients and thus And reduced the percentage of complications, wound infections as well as reducing treatment costs. DAMAGE CONTROL is not only used in traumatized adult patients. It is also necessary to do it in children's patients.
STUDY OF REVENUE CHANGE IN UNIVERSITY MULTIPROFILE HOSPITALS FOR ACTIVE TREATMENT IN BULGARIA
The success of a hospital medical care system needs to be measured by how efficiently and effectively it addresses the needs of the users of the services it provides. The difficulties caused by the spread of COVID-19 did not prevent the University Multiprofile Hospitals for Active Treatment from continuing to perform their public service functions - they took over the treatment of the most significant part of patients with SARS-CoV-2 infection, while at the same time continued to provide the necessary conditions for conducting practical medical education for future medical specialists. The aim of the study is to perform a comparative analysis of the change in revenue of the University Multiprofile Hospitals for Active Treatment for the period 2019 – 2021. Methodology: The following methods were used for processing and analyzing the received information: Documentary method - the source of the information is the annual reports of the medical facilities for hospital care, which are received and processed annually at the National Center for Public Health and Analyzes at the Ministry of Health; System analysis method; Comparative-analytical method; Economical analysis; Financial and accounting analysis; Statistical methods, including: analysis of the dynamics of phenomena and graphic analysis - to visualize the obtained results. Results: There is a trend of increasing the total revenues of UMHAT for the studied period by 32.6%. The first year since the onset of the COVID-19 pandemic (2020) has seen the strongest increase in revenue from the Ministry of Health, followed by revenue from donations. In 2021, the increase in revenues from voluntary health insurance companies was most pronounced, but there was a decrease in revenues from the Ministry of Health. Discussion: In the Report on the health of citizens of the Minister of Health, it is stated that the growth of costs in 2020 compared to those reported in 2019 in the system of the Ministry of Health by more than 58% is due to the complicated epidemic background, in connection with which the ministry initiated a number of activities to ensure the treatment of those affected and limit the spread of the infection. Conclusion: Based on the changes in the environment, as well as to the dynamically changing needs of hospital services, a more flexible adaptation to them is necessary for the modern university hospitals, in which teaching activities are carried out in addition to treatment. Recommendations: An essential condition for University Hospitals to ensure the quality that patients and future medical specialists are looking for is the attraction of additional financial resources, both to improve their material base and as a means of conducting a successful personnel policy.
University Multiprofile Hospitals for Active Treatment
ASSESSMENT OF PATIENT SATISFACTION WITH THE QUALITY OF DENTAL SERVICES PROVIDED BY STUDENTS OF DENTAL MEDICINE
In today's competitive world, the quality of dental services provided is extremely important. Dental service providers around the world consider patient satisfaction to be an important and fundamental factor in providing dental services. Patient satisfaction by the provided dental services is defined in the literature as the achieved match between the patient's expectations, his needs and the actual dental care provided to him/her. Understanding the importance of the concept dedicated to the quality of dental services and surveying the satisfaction of patients receiving these services is very important. Oral diseases are considered major health problems due to their high incidence and prevalence worldwide Aim:. The aim of the present study was to assess patient satisfaction by dental services provided by dental students. Materials and methods: Sociological survey has been carried out. For the respondents’ convenience participating in the research, the opportunity to choose between two options for filling out the survey card is provided: a paper survey card and Online questionnaire created in Google Forms. A survey was conducted on a voluntary basis in May-July 2023. The results of the survey are presented in table and graphic form, which are accompanied by analyzes and conclusions. For the purposes of the research, 358 patients treated by fourth, fifth- and sixth year students in the facility of the Faculty of Dental Medicine at the Medical University of Varna - were surveyed. Results: The results show a positive correlation between the quality of dental services provided by dental students and patient satisfaction. Conclusion: Measuring the quality of dental services has an important role in managing the dental care provided, diagnosing the problem and evaluating the effectiveness of the service. Patient satisfaction is one of the key indicators in the quality of services provided in the dental practice. The results of the conducted study dedicated to patient satisfaction with the provided dental services are an indicator for evaluating the quality of dental care provided by dental medicine students, based on a survey of patients' attitudes and opinions.
EFFECTIVE DOCTOR-PATIENT COMMUNICATION A KEY FACTOR FOR ASSESSING PATIENT SATISFACTION WITH DENTAL SERVICES PROVIDED
In recent years, great progress has been made in the communication between dental practitioners and their patients. In the 21 st century, communication has become an essential and necessary clinical skill for every dental professional. Communication skills are a skill that every medical professional must master in order to build the best possible relationships with patients. This includes the ability to form a certain idea about the patient's oral disease, altering the patient's mood (minimizing fear, anxiety, increasing confidence, hope for favorable treatment results), influencing the patient's lifestyle and behavior in order to carry out the recommendations given by the dental specialist treating him. They are described in the scientific literature the different models of the relationship between the doctor and the patient, as well as the research of authors regarding the importance of good communication about the patient's dental treatment procedure satisfaction. Aim: The present study aims to investigate the impact of efficient communication towards patient satisfaction with the quality of dental services provided. Sociological survey has been carried out. For the respondents’ convenience participating in the research, the opportunity to choose between two options for filling out the survey card is provided: a paper survey card and Online questionnaire created in Google Forms. A survey was conducted on a voluntary basis in May-July 2023. The results of the survey are presented in table and graphic form, which are accompanied by analyzes and conclusions. For the purposes of the research, 358 patients treated by fourth, fifth- and sixth year students in the facility of the Faculty of Dental Medicine at the Medical University of Varna - were surveyed. There is a positive correlation observed from the survey between effective doctor-patient communication and patient satisfaction with the quality of dental services provided. Good communication with the patient strengthens the trust in the dentist and helps the patient anxiety of the upcoming dental manipulations. Conclusion: Quality dental services are the basis for the success of the diagnostic - treatment process of any dental practice. Communication with the patient and his relatives is the duty of every dentist, which is of great importance for preserving the mental health of the patient. Great attention is paid to the development of communication skills by dental practitioners. According to a number of studies, effective communication with patients is at the heart of the success of any dental practice. Following some basic rules in communication is a key factor in a good relationship between the dentist and the patient.
THE NEED FOR ADDITIONAL TRAINING OF NURSES WORKING IN THE DIALISIS TREATMENT FIELD
According to the EU health strategy “Together for Health: A Strategic Approach for the EU”, health care specialists have a crucial role in maintaining the proper function of the entire health care system. Today, the education system gives health care specialists the opportunity to develop in different professional fields. Nursing care for patients undergoing renal replacement therapy is specific and requires that nurses have excellent theoretical knowledge and practical skills in the field of nephrology and the extra-renal blood purification methods, and be qualified to administer intensive and specialized procedures. The goal of this research is to study the necessity for nurses working in dialysis facilities attaining additional knowledge and skills on dialysis treatment in this specific field. Materials and methods: For the purposes of this research, 78 nurses working in dialysis facilities in Northwest Bulgaria participated in a survey, which was conducted by distributing a self-developed anonymous questionnaire in the 2020-2022 period. Results: The activity of the nurses caring for dialysis treatment patients is different from the activity in other health care facilities. Conclusion: Dialysis treatment requires that health care professionals have specific knowledge and skills. Currently, it is a fact that this discipline is not being taught in higher education institutions. The research detected a need for additional training in the renal replacement therapy field.
BENEFITS OF BALNEO AND MUD TREATMENT FOR LATE SEQUENCES OF COVID-19
Balneotherapy is one of the most used therapies, where natural factors are applied for treatment and prevention. It is used in various pathological conditions, with evidence of a good effect in rheumatic and neurological diseases, and in recent years also in patients recovering from COVID-19. The therapeutic factors that are used include: natural mineral or thermal waters, natural peloids (mud) and other environmental therapeutic factors. The pandemic of COVID-19 turned out to be a significant factor that led to changes in lifestyle and habits and, accordingly, the use of balneotherapy procedures for prevention and treatment. Balneotherapy (SPA-therapy) is recommended by the European SPA association after COVID-19, for better recovery of health and limitation of long-term symptoms in patients with post-COVID-19 syndrome (PCS). It is suggested that balneo-climate-treatment can improve lung function, increase the physical activity capacity and the performance of therapeutic exercises as well as the quality of life of patients in the recovery phase after COVID-19. The purpose of the present review is to investigate the benefits and effectiveness of both balneo and mud therapy in patients with long-term post-COVID-19 sequelae. Materials and methods: For the purpose of the present study, a review was made of the known scientific articles published in the world databases (Google Scholar, Pubmed, Science Direct Web of Science, Scopus, and literary sources in Cyrillic). The results were searched for the following keywords: post-COVID-19 condition, long-term effects of COVID-19, post-COVID-19 syndrome (PCS), rehabilitation, balneotherapy, SPA therapy, peloidotherapy, mud treatment, lye therapy, treatment with Rapa (highly concentrated solution of salts (most often NaCl)). Results: The review of the scientific literature published in specific medical journals found evidence for the therapeutic effectiveness and benefits of balneo and mud therapy in patients with long-term consequences of COVID-19. The described application methods are characterized by variety in the application methodology, both for external (baths, bathtubs, showers, therapeutic SPA applications) and for internal application (mainly through inhalations). On the other hand, different recommendations were found regarding the type and chemical characteristics of mineral (thermal) water and therapeutic mud that are preferred for therapy. Overwhelmingly, studies recommend combining balneo (SPA) and mud therapy with resort and climate treatment, moderate physical activity and a dietary regimen tailored to the individual characteristics of patients. Conclusion: Balneo (SPA) treatment, therapies with natural and preformed physical factors could have a preventive role, in order to improve the body's reactivity to the adverse factors of the external environment and pathogenic microorganisms and to increase insusceptibility to infectious diseases.
OCCUPATIONAL EXPOSURE TO NOISE DURING AIRPORT GROUND HANDLING - IMPACT AND RECOMMENDATIONS TO REDUCE THE OCCUPATIONAL RISK OF DAMAGE TO THE HEALTH OF WORKERS. CURRENT STATE OF LEGISLATION IN THE FIELD OF NOISE PREVENTION IN THE WORKPLACE IN BULGARIA
Those working in the ground handling of aircraft at the airport in the process of performing their activities are exposed to the impact of a complex of harmful and dangerous risk factors, including noise. Noise in the working environment above 85 dB(A) is one of the first unfavorable factors at the airport that affect the functional state of various organs and systems in the human body. Exposure to noise in the work environment at or above 85 dB(A) can cause a number of complaints related to the central and autonomic nervous systems, disorders in the vestibular and auditory apparatus up to permanent hearing loss, reduced work capacity, impaired concentration, fatigue, difficulty in verbal communication, the ability to hear warning signals, respond to environmental sounds, etc. All this affects the general safety and is a prerequisite for the occurrence of aviation accidents caused by the human factor. The purpose of the present study is to present the results of research conducted on noise at the airport itself and its impact on ground staff, by deriving good practices and examples, to make general conclusions and proposals with a practical orientation for the introduction of a standard for health monitoring and prevention of the risk of noise exposure among airport ground handling workers. The methods used are documentary, formal-logical with analysis of official documents, systematic review of articles and data in the surveyed area. The results of the survey show the lack of clear legal rules and standards in the Republic of Bulgaria regarding the health screening of hearing for those working in environments with excessive noise levels, including for ground handling operators at airports. Therefore, solutions to this problem must be implemented, in particular through the introduction of a standard and the introduction of clear criteria for health monitoring, engineering, ergonomic knowledge and preventive measures. Hearing prevention, early screening and health monitoring among workers at excessive levels of noise in the work environment should be a priority of every legislation, responsibility and obligation of every employer.
OCCLUSAL SPLINTS, RETAINERS AND THE RELATION BETWEEN THEM – A REVIEW ARTICLE
This article reviews different types of occlusal splints and retainers, and current trends of their creation by digital technologies. They were systematically searched by key words, single or combined. The key words were: bruxism, retainer, modification of occlusal splints, modification of retainers, 3D printing, CAD/CAM. It was used peer-reviewed articles published in Google scholar until July 2023. The articles were in English with available at least abstract with clear conclusion part. Paid for the reader articles are not included in the review. In this article are presented main and additional types of occlusal splints, different types of retainers and their modifications, the contact point between splints and retainers and their digital creation.
KEY FACTORS FOR SAFE AND RATIONAL SECURITY OF BLOOD AND BLOOD COMPONENTS
The use of human blood for therapeutic purposes requires the continuous construction of safety and quality systems, in order to minimize potential risks during the process of collection, processing, circulation and final use. Safety, security, rationality, and reliability are important prerequisites for the continuous provision of blood products, regardless of their purpose. Health institutions for blood and blood products should have an organized quality system that will be compatible with strategic goals, while at the same time emphasizing the self-sufficiency of a particular community. In this context, it is necessary to establish a stable and applicable mechanism for issuing permits and accreditation by certified institutions, from this field, which would ensure their operation in accordance with current regulations. Modern blood transfusion practice must provide guarantees to voluntary blood donors regarding the security and confidentiality of all data related to the health of each individual. The key factors, on which safe and rational provision of blood and blood products are based, are visible through continuous activities associated with the promotion of voluntary and unpaid blood donation, thus contributing, in a specific way, to raising and maintaining high standards. Medical and other personnel involved in the process of collection, examination, processing, storage and circulation of human blood and blood components should be qualified and should undergo continuous education. The future development of transfusiology will be based on teamwork and interdisciplinary cooperation, as well as continuous monitoring and application of regulations from this field. The implementation of the Type and Screen method, i.e., blood group typing and antibody screening, should become a standard in the rationalization of the need for blood, which ensures a greater number of available blood units, increases self-sufficiency and directly contributes to the preservation of the health of donors and recipients of blood and blood components.
EFFECTIVENESS OF PHYSIOTHERAPY FOR MUSCO-SKELETAL DISORDERS AND THE ROLE OF REMOTE PHYSIOTHERAPEUTIC INTERVENTIONS
For patients with musculoskeletal diseases, physiotherapy is a safe and efficient treatment option that can help them manage their symptoms and enhance their health. In primary care, physiotherapists aid in the diagnosis, cure, and manage of a broad spectrum of acute and chronic disorders, as well as promote physical exercise, mobility, and function. Physiotherapists in basic medical teams maximize patients' mobility in accordance with their lifelong needs. This brief study emphasizes the significance of musculoskeletal disorders treatable with physiotherapy. Physiotherapy interventions, when delivered remotely through e-Health platforms, have gained prominence as accessible and effective tools for managing musculoskeletal conditions. These interventions provide patients with valuable resources for self-management, while greatly used to improve everyones quality of life. At the same time, helping to moderate the challenges that this load can create on healthcare systems. The use of telehealth in physiotherapy offers opportunities for personalized care, continuous monitoring, and the implementation of evidence-based interventions. The relevancy of this approach is mainly noticed when put in the context of the COVID-19 pandemic, where the need for remote healthcare delivery has become paramount. Telehealth allows patients to receive timely care and support while adhering to social distancing guidelines. The concept of adherence to eHealth technology in physiotherapy is crucial for ensuring the success of remote interventions. Understanding when and how patients engage with eHealth platforms can guide the development of more effective interventions. It is essential to explore factors that influence patient adherence to technology-driven physiotherapy interventions to optimize their benefits. As healthcare systems worldwide face increasing demands, the implementation of remote physiotherapeutic e-Health interventions can help alleviate the burden by offering scalable and cost-effective solutions. These interventions have the potential to reach a broader patient population and improve access to care for individuals with musculoskeletal disorders. The evaluation of the effectiveness of these remote interventions is essential to provide evidence-based guidance for their integration into clinical practice. By conducting systematic reviews and meta-analyses, researchers can contribute valuable insights into the outcomes and impact of telehealth-based physiotherapy on pain management and overall patient well-being.
INSURANCE WITH SPECIALIST DOCTORS AND HEALTH CARE SPECIALISTS IN REGIONAL CITIES WITH MEDICAL UNIVERSITIES IN BULGARIA
People are the most important resource for any organization, including healthcare. The analysis of the geographical distribution of human resources in the "Healthcare" sector in the Republic of Bulgaria shows that there are certain disproportions. The lack or insufficiency of specialists can lead to a deficit in the diagnostic-treatment-rehabilitation activity in certain medical specialties, or to non-use of certain available medical equipment. The purpose of the present study is to examine the number and relative share of doctors with a specialty and health care specialists, where they are most numerous - in the cities where there are medical universities in Bulgaria and their adjacent areas for 2021. Material and methods: The following methods were used to carry out the research: documentary method - based on official data from the National Statistical Institute, comparative analysis, economic analysis, mathematical-statistical method, tabular analysis. Based on the obtained results, it is clear that in Bulgaria the number of general practitioners is the highest - 3,945, and the number of "Infectious Diseases" specialists is the lowest. Per 10,000 people of the population, the highest share of doctors and medical specialists in health care is in Pleven district, 67.3 and 95.0, respectively, and the lowest in Varna district, respectively – 50.7 and 63.8. Discussion: The number of doctors in Bulgaria is above the average for the European Union, but despite this there is a serious shortage of doctors in certain specialties, which had its impact on the treatment of patients during the COVID-19 pandemic. Our country is one of the countries in the EU with the lowest provision of nurses. Their shortage is due to several factors, among them the emigration of trained nurses, the aging of the workforce - with the average age of this type of specialist being over 50, dissatisfaction with wages and working conditions. Conclusion: The human factor is a significant element in any healthcare organization at all levels. The provision and use of other types of resources depends on human resources. A higher supply of doctors implies a stronger health sector, and a higher supply of health care professionals, and above all nurses, is a guarantee of more economical and better health care.
CONNECTION BETWEEN THROMBOCYTES VALUES AND ELEVATED D-DIMER AND LDH LEVELS IN PATIENTS WITH Sars-Cov-2
СОVID-19 is an infеction caused by the new cоrоnavirus Sаrs-Cov-2. For thе specific treatment of patients, it is impоrtant to detеrmine thе sеverity of the disease with thе help of biomarkers when they are hospitalized. Many of them rеveal a range of chаnges in patients with COVID-19. Among the mоst commonly оbserved changes are decreased thrombocytes count, increased D-dimer and LDН values. The aim of the present study is to present the changes in Thrombocytes (Thr), Lactatedehydrogenase (LDH) and D-Dimer values in hospitalized patients with Sars-Cov-2 and the relationship between them. For our research, we took the values from the clinical laboratory results of 106 hospitalized patients for the treatment of Covid-19 in the "St. Ivan Rilski" town of Zagora. Patients were divided into two subgroups depending on the period of their hospitalization. In both groups, the laboratory values of LDH, Thre, D-Dimer on the first day of admission to the hospital are presented. Results: In the two groups of patients studied by us, we found a positive correlation between thrombocytes values ​​​​and LDH values ​​​​at admission: r=0.234, p<0.05. A greater number of patients developed thrombocytopenia during hospitalization in Group II 26.53% (n=13). A number of authors have reported that in COVID-19, LDH correlates with disease severity and can be considered a major predictor of lung injury in these patients. Elevation of LDH was observed in over 96% of patients in both groups. Conclusion: Thrombocyte count monitoring during hospitalization is important in the prognosis of patients with coronavirus disease. Thrombocytopenia, elevation of D-dimer, and the following cоmplications in pаtients with COVID-19 аrе among the most common laboratory findings requiring hospitalization.
THE UTILITY OF HEALTHCARE SYSTEM BEFORE AND DURING THE COVID-19 PANDEMIC
According to the European Charter of Patients' Rights, every person has the right to access health services in accordance with their health needs. The aim of this study is to analyze the utility of the healthcare service before and during the COVID-19 pandemic. Material and methods: An anonymous survey was conducted through a questionnaire in Google Forms among individuals over 20 years old (n=645), who were divided into several groups. Documentary, sociological and statistical methods were applied. Results: 58.4% of respondents reported that they maintained their GP visits during the COVID-19 pandemic. 43.3% of them had no obstacles to contact him/her by phone and 45.7% had no obstacles to visit him/her in person. Conclusion: The spread of the SARS-CoV-2 virus has presented the health system with many challenges, one of which is the burden on all its levels. However, between patient and doctor there is an established relationship, adequate communication and mutual trust.
THE RELATIONSHIP BETWEEN CHRONIC VENOUS DISEASE AND THE APPEARANCE OF SUPERFICIAL THOMBOPHLEBITIS
The most common complications of chronic venous disease are venous ulcers and superficial thrombophlebitis. The current study aimed to determine the incidence of superficial thrombophlebitis in patients with chronic venous disease and to follow frequency and cause of disease recurrence. In a nine years period, 495 patients were treated for superficial thrombophlebitis in the clinic of Vascular Surgery of Military Medical Academy and in the diagnostic-consultative office of vascular surgery. Of them 108 (22%) patients, were admitted for surgery. The goals of therapy for STP are to prevent the clot progressing into the deep venous system and to hasten the resolution of the inflammatory and thrombotic processes in areas already affected. The first option of treatment consists of perscription of nonsteroid anti-inflammatory drugs, venotonics and low molecular weight heparin. Only in cases when the thromboplebitis of the great or small saphenous vein cames closer the SFJ or SPJ, the surgery is necessary. The surgical techniques that are usually applied are crossectomy of the GSV, or SSV and less often thrombectomy of the EIV, phlebotomy, phlebocutaneoectomy. The other 387(78%) patients underwent conservative therapy with AINS, antiagregant or anticoagulant therapy. Patients with chronical venous insufficiency and varicose veins are more at risk for superficial thrombophlebitis appearance.
PHYSICAL THERAPY AND NEUROREHABILITATION OF PATIENTS WITH CEREBROVASCULAR STROKE
Cerebral stroke represents an acute disturbance of circulation in the brain, which occurs with local and general brain symptoms. Main etiological factors are: arteriosclerosis, increased blood pressure, arterial hypotension, heart diseases, malformations of brain blood vessels, etc. Stroke is the most common neurological disease and the leading cause of mortality in the world, right after cardiovascular and malignant diseases. Cerebrovascular stroke is a focal neurological deficit caused by intracerebral hemorrhage. It is a condition that occurs due to a change in blood circulation in the brain and a very low supply of oxygen and nutrients to parts of the brain, which results in their damage and disruption of the functions that depend on them. There are two types of cerebrovascular stroke: ischemic - thrombosis and thromboembolism (85%) and hemorrhagic – intracerebral and subarachnoid bleeding (15%). The clinical picture can develop gradually or, the patient can suddenly fall into a coma. Absence of movements of the affected limbs predominates, always opposite to the side of the impact with an outburst of the facial nerve of the central type. Hemiplegia is a loss of the voluntary movements of one half of the body, caused by damage to the opposite brain hemisphere. The musculature is atonic, tendon reflexes are reduced or lost The aim of the research is to determine the effectiveness of physical therapy and neurorehabilitation in patients with cerebrovascular brain stroke. Treatment of stroke: In the acute stage, physical therapy is aimed at preventing complications of the loco-motor apparatus (contractures, muscle and tendon retraction, heterotropic ossifications), the respiratory system (hypostatic pneumonia) and the skin (decubitus). This is achieved through treatment with position (frequent change of the position of the body in bed), passive exercises performed according to strictly defined rules, breathing exercises, exercises for healthy limbs and great care of the skin. The trophic changes of the skin are treated with ultraviolet radiation in suberythemic doses or with D'Arsonval currents. Methods of research: The research was conducted at the University of Southeast Europe - (Stul University) at the Faculty of Health Sciences in the Department of Physical Therapy and Rehabilitation, over a period of 6 months, from the beginning of From the beginning of May - to the end of October 2023. The research included 27 stroke patients, of which 11 patients had a left-sided stroke, and the remaining 14 patients had a right-sided stroke. According to the gender structure, 12 patients are male and the remaining 15 patients are female. Results: After completing the six-month treatment with physical therapy, kinesitherapy and the methods of Vojta and Carl and Bertha Bobat, the results show great progress in almost all parameters. A decrease in tonic primitive reflexes, neck and labyrinthine tonic reflexes, reduction of extensor hypertonia, improvement of motor-reflex activity, proprioceptive afference, coordination, reduction of neck tone, foot reflex, stimulation of the grip reflex and improvement of the position of the neck, limbs and body. The presented results shows significant improvement in both groups of participants Conclusions: Physical therapy and rehabilitation combined with kinesitherapy have an exceptional positive effect in: prevention of pathological primitive reflexes;creation and automation of normal active movements;saving irregular positions of the limbs and the whole body;establishment of balance and correct pattern of movement; fight against spasticity, secondary contractures and deformities; improvement of coordination and awareness of the body in relation to the environment;
EFFECTIVENESS OF PHYSICAL THERAPY AND REHABILITATION IN IMPROVING MOTOR SKILLS AND MENTAL FUNCTION IN CHILDREN WITH CEREBRAL PALSY
Cerebral palsy was first described by William John Little in 1846. There are many definitions of cerebral palsy that vary from author to author. However, we can say that cerebral palsy (CP) is a chronic non-progressive brain damage, postural and body motility disorder. Apart from sensorimotor abnormalities, some cases are accompanied by mental disorders as well as disorders of cognitive functions. It can occur during pregnancy, at birth or during the postnatal period, ie. prenatal, perinatal and postnatal - equally in both sexes. There are different classifications of cerebral palsy: according to changes in muscle tone, according to topographic features and according to the severity of the clinical picture.According to changes in muscle tone, they are divided into: Spastic form, Athetoid form, Ataxic form, Hypotonic form and Mixed form. According to the topography they are classified as: Diplegia, Quadriplegia, Hemiplegia, Triplegia and Monoplegia Physical therapy program is determined based on the clinical form of the disease When determining a rehabilitation program, the principle of an individual approach is followed. Rehabilitation includes: physical medicine, kinesitherapy, reflex exercises according to Vojta, manual massage, thermotherapy, education of parents for rehabilitation at home; orthopedic aids; special education techniques. The aim of this study is to determine the role and impact of Physical Medicine and Rehabilitation in the treatment of children with Cerebral Palsy in early childhood Methods of research: The research was conducted at the University of Southeast Europe - (Stul University) at the Faculty of Health Sciences in the Department of Physical Therapy and Rehabilitation, over a period of 6 months, from the beginning of April to the end of September 2023. 61 patients with cerebral palsy are included in the research, of which 28 are male, and the remaining 33 patients are female. The patients included in the research are classified into groups according to: gender, age and clinical form of cerebral palsy. Methods of treating cerebral palsy: The treatment of Cerebral Palsy (CP) has a complex character and includes medical, pedagogical and social rehabilitation. The individual tasks of the rehabilitation are determined after a functional examination of the motor abilities, where the main role is played by muscle tone, normal and pathological reflex motor activity, in the period up to 1 year of age. The goal of treatment with Physical Therapy and Rehabilitation is to achieve correct and timely development of movements and correction of pathological movement stereotypes (models), which occurred as a result of brain tissue damage. Results: As for the motor deficit, kinesitherapy plays a major role. Established modern methods for kinesitherapy are the specialized methods for neuromuscular re-education of Vojta and Bobath. The Rood and Rabat methods werw also be used to facilitate the required movements and train coordination. Discusion: Physical therapy and rehabilitation combined with kinesitherapy have an exceptional positive effect in: prevention of pathological primitive reflexes;creation and automation of normal active movements;saving irregular positions of the limbs and the whole body;establishment of balance and correct pattern of movement; fight against spasticity, secondary contractures and deformities; improvement of coordination and awareness of the body in relation to the environment;
DEVELOPING STEPS TO IMPROVE ADHERENCE IN HEALTHCARE PROFESSIONALS DAILY PRACTICE
Adherence is a a term that has been prominently used and emphasized recently, representing the connection between a patient and their treatment. Medical adherence has its hierarchical structure, with roots primarily stemming from legislative bodies to the healthcare system, institutions and ultimately healthcare professionals (doctors, nurses, technicians). However, medical adherence faces a significant obstacle in achieving therapy goals and improving treatment outcomes among many patients, especially those with chronic conditions. Social and sociental conditions, as well as the state organization in Bosnia and Herzegovina (BiH), greatly influence the healthcare system and the purchasing power of healthcare service users. Due to significant barriers and challenges regarding adherence, efforts are being made to maintain a system that supports increasing patient adherence levels. Within this research paper, three questionable theses are presented: internal and external education, improvement of the healthcare system and the implementation of systematic data collection on patient adherence. All three questionable thesis recived positive feedback from respondents (200 participants). From the first thesis, 154 respondents voted in favor, for the second thesis, 142 respondents and for the third thesis, 134 respondents agreed with the proposed suggestions. Unfortunately, in BiH insufficinet attention is given to patient adherence and there is no unified strategy to increase adherence levels. Internal and external education would be essential as healthcare workers are not adequately trained, nor are conditions created for its implementation. Increasing the level of adherence can greatly benefit healthcare workers in their daily practice if they have adequate conditions in place. Unfortunately, a significant number of healthcare employees lack the knowledge, experience and a clearly defined strategy on how to increase patient adherence. The complexity of measuring adherence only adds to the intricacy of an already complex problem and the inefficiency and sluggishness of the healthcare system hinder the creation of appropriate activities that should result in increased patient adherence. The patient's adhrence is influenced by numerous factors for which there is no unique solution or overcoming suggestions. Also, problems in the process of identifying and measuring adherence further complicate the already complex matter and the process of increasing user adherence. Creating a strategy to improve adhrence at the state level in Bosnia and Herzegovina is almost impossible; therefore, the increase in adhrence can only be achived at the level of the patient, healthcare personnel and ideally, at the level of healthcare institutions. Unfortunately, in most cases, conditions and workload do not allow healthcare workers to spend enough time with patients, establish adequate communication and demonstrate that the patient is genuinely important to them. Providing not only the necessary care but also essential information about the illness and treatment can directly impact the level of patient adhrence. The healthcare system in developed countries, although technologically possible, lacks and adequate mechanism for collecting, processing and analyzing data related to the adherence level of patients with a specific condition or in a particular geographic region. Data is often collected based on indirect methods that do not provide accurate and precise information, posing a significant challenge in proving the role and importance of medical adhrence in the healthcare system and treatment outcomes. Considering that the adhrence level ranges from 43% to 78%, which is too high for certain treatment regimens, legislative reforms are needed. In addition to the law and its govering body, it is necssary to ensure all essential materials, from medications to specific medical supplies are provided to all healthcare institutions, hospitals and healthcare centres. Both internal and external education are crucial for patient treatment and therefore it sholud be implemented and carried out on a monthly basis. In addition to healthcare professionals, the education of patients with medical conditions is essential, considering they can be divided into those who are not familiar with using modern technologies to educate themselves and understand the role and significance of medical adherence. Moreover, there are patients who are adept at using modern tchnology to research their condition and treatment options, but they lack sufficinet knowledge and information to assess the accuracy of the available data.
OPPORTUNITIES FOR TREATMENT WITH A TEMPORARY OBTURATOR MADE OF THERMOPLASTIC FOIL
Prosthetic treatment with a temporary obturator is an intermediate stage in the overall prosthetic rehabilitation of patients with maxillary resection. According to prevailing opinions, treatment with a temporary obturator should start around 2 weeks to 2-3 months after resection and to continue until the final completion of the healing processes in the defect. Due to the dynamic changes in the defect, this treatment stage is associated with many difficulties, requiring frequent correction of the obturator and up to 12-14 clinical visits on average. The aim of the research is to track the opportunity for fabrication of a temporary obturator of thermoplastic foil with vacuum forming apparatus and its efficiency for restoring speech and fluid intake in patients with maxillary resection. Materials and methods: For the aim of the study we conducted a treatment of a 45-year-old patient operated a week ago for maxillary carcinoma. As a result, the left alveolar bone and a part of the hard palate with a diameter of 10 mm were resected, with teeth 13 to 23, 16 and 17 preserved. The defect was padded with gauze and an impression with an irreversible hydrocolloid impression material was taken. In the laboratory a grade 4 plaster working model was cast on which the borders of the palatal plate were outlined. For the frontal teeth, these were the cervical areas of the teeth, and for the distal - their equators. In the area of the defect and the missing teeth the border reached the transitional fold, and distally - the soft palate. The plate was made from foil of 1 mm diameter which was drawn onto the model with a vacuum forming apparatus and was cut along the indicated borders. Results: The palatal plate - obturator successfully closed the comunication to the nasal cavity and restored the opportunity for fluid intake, which was the main problem for the patient. The use of a foil with a thickness of 1 mm provided stability and resistance of the construction. As a result of this, the necessary hermetic seal of the defect was achieved and the speech of the patient was normalised. Conclusions: The described treatment methodology with a temporary obturator allows the successful restoration of speech and fluid intake during the healing processes in the defect. The main advantages of the method are the fast and easy fabrication, the opportunity for multiple corrections and the short period of adaptation.
PROSTHETIC TREATMENT OF A PATIENT WITH RESECTION OF THE HARD PALATE WITH AN OBTURATOR WITH A SILICONE BASE
Introduction: The most commonly used treatment method for maxillary resection patients is with an obturator, closing the communication between the oral and nasal cavity. Prosthetic methods and means with different types of materials are used for its fabrication. The purpose of the described clinical case is to track the opportunity for treatment of a patient with resection of the hard palate, with an obturator with a silicon base. Materials and methods: The clinical case tracks the treatment of a patient with maxillary carcinoma. Preliminary alginate impressions were taken from the jaws. A custom tray with which a functional impression with a silicone material was taken, was fabricated for the mandible. The height and the central position of the mandible were determined with record bases with wax rims. The dentures were finished with heat cured resin. The upper denture was used as a custom tray for taking a functional impression of the prosthetic field with silicone cream material. After packing in the laboratory, the impression material was replaced with permanent soft relining material Molloplast B (Detax). The finished dentures were adjusted and articulated until bilaterally balanced occlusion was achieved. Results: Treatment results showed good retention and stability of the prosthetic construction. Functional impression shaping and subsequent replacing with silicon material ensured a good and tight hermetic seal in the area of the defect. The use of permanent soft relining material allowed a trauma-free transmission of masticatory pressure and a stable connection with the plastic base of the obturator. The patient's eating and speech as well as the fluid intake were successfully restored. The achieved results improved the quality of life of the patient and his self-esteem. Conclusions: Prosthetic treatment with an obturator with a silicon base provides good retention and stability of the prosthetic construction which allows successful restoration of the patient`s eating and speech.
Patient transfer from hemodialysis to peritoneal dialysis: a single center experience
INTRODUCTION Peritoneal dialysis and hemodialysis are complementary ways of treating end-stage renal failure. Changing the dialysis modality from hemodialysis to peritoneal dialysis is a rare and poorly studied phenomenon. MATERIALS AND METHODS Retrospective cohort study conducted on the population of adult patients with end-stage chronic renal failure who were treated at the Nephrology Clinic of the Clinical Center of the University of Sarajevo in the period from 2006 to 2023. A total of 109 adult patients, whose medical documentation was complete and who were in the peritoneal dialysis program at the Nephrology Clinic of the Clinical Center of the University of Sarajevo during the observed period, were included in this study. One group started the treatment with peritoneal dialysis, and the other with hemodialysis. Demographic data were collected for each patient: age, gender, underlying kidney disease, comorbidities (heart disease and diabetes), duration of treatment modality, data on modality change, complications and treatment outcomes. Data from physical and electronic patient histories were used. RESULTS Total of 109 adult patients were included in this study. They are divided into two groups. Group 1 (n=99) in which peritoneal dialysis was the first treatment modality and Group 2 (n=10) in which haemodialysis was the first treatment modality, but in which patients, after a certain time, were transferred to peritoneal dialysis. The median age of patients in Group 1 was 60 (-/-14.07) years and 54 (-/+12.23) years for Group 2. Within Group 1 the most common cause of terminal renal failure was diabetic nephropathy (n=40, 40.4%) and nephroangiosclerosis (n=24, 24.24%). The mean age of onset of peritoneal dialysis was 60 (-/-14.07) years, while the mean age of cessation of peritoneal dialysis was 63 (±13.69) years. The average duration of peritoneal dialysis treatment was 38.36(±34.14) months. During the stay at peritoneal dialysis, death was recorded in 63 patients (62.38%). The number of patients who replaced peritoneal dialysis treatment with hemodialysis was 26. The most common reason for switching to haemodialysis was insufficiency of peritoneal dialysis (n=13, 14%). After switching to haemodialysis, the average length of staying on it was 10.22 months. The reason for discontinuation of haemodialysis was death (n=17, ) or transplantation (n=1, 3.7%). Kaplan-Meier test shown worse outcome in patients with haemodialyis first than peritoneal dialysis first. CONCLUSION Changing the dialysis modality carries with it a high risk of mortality, especially in the first month. Changing the way of active treatment with dialysis speaks in favor of severe comorbidities.
ON THE POSSIBILITIES AND STRATEGIES FOR INCORPORATION ANTIMICROBIAL AGENTS INTO RESIN COMPOSITE DENTAL MATERIALS – A NARRATIVE REVIEW
Because of the high frequency of recurrent caries following composite resin restorative treatment, as well as the large number of cariogenic microorganisms present in the oral cavity, which represent a potential risk factor for the development of new carious lesions, the antimicrobial effects of composite resins are receiving increasing attention. Recently, attempts have been made to include specific antimicrobial compounds in restorative materials, mainly GJCs and composites, in addition to fluorides. Conventional composites' lack of antibacterial qualities implies a lack of an inhibitory impact against plaque accumulation on their surface, allowing bacteria such as mutans streptococci to grow freely. As a result, the antibacterial properties of dental resin composites are crucial to their therapeutic applications. The present study demonstrates the methods and possibilities for incorporating antimicrobial chemicals, both leachable and non-leachable, into the resin matrix or filler of composite resins.
NEW CONCEPT OF FRONTAL TEETH RESTAURATION FOR EXCELLENT FUNCTION AND AESTHETIC
This clinical case report aimed to investigate impact of a novel inner ferrule (IF) preparation around root canal on the subsequent esthetic restoration. Material and Methods: This clinical research involved a case report featuring endodontically treated teeth (ETT) restored using a newly developed ceramic post. Special drills (Edenta AG GmbH, Switzerland) were utilized for root canal preparation, involving horizontal preparation around the cervical portion of the root canals and post spaces. Experimental samples (ETT) were prepared with and without a 2mm IF preparation. The newly designed zirconia ceramic posts (TZ-3Y-SBE, Tosoh, Japan) were cemented with Multilink Automix (Ivoclar), upgraded with MultiCore (Ivoclar), and crowned with an all-ceramic zirconia crown (Zirkonzahn, Italy). Results: Our clinical case provided insights into a new type of all-ceramic aesthetic restoration of prepared teeth (ETT) with a new IF preparation design and a new zirconia post-core design. Conclusion: The novel horizontal IF preparation around the root canal was developed to accommodate the initial retentive coronal ring of the newly designed zirconia posts. The incorporation of IF preparation and coronal retentive rings within the zirconia post structure effectively enhances the fracture resistance of ETT. This new modern aesthetic rehabilitation in all restored teeth significantly reduces the severity of root fractures for excellent function and aesthetic restoration of ETT.
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FORCED OSCILLATION TECHNIQUE (FOT) – A NOVEL METHOD FOR THE DETECTION OF EARLY AIRWAY CHANGES
According to the World Health Organization in 2019 chronic obstructive pulmonary disease (COPD) was the third leading cause of death worldwide, causing more than 3 million deaths whereas bronchial asthma affected more than 250 million people and caused 455 000 deaths. Both diseases are chronic obstructive conditions which need to be diagnosed early in order to prevent or slow down the complications. Consequently the world requires new effortless methods for diagnosis of airway obstructions, especially for small children and people who cannot perform the spirometry maneuver. The purpose of this report is to describe the objectives of the forced oscillation technique (FOT) and to establish its applications in the clinical practice. Studies and clinical cases regarding pulmonary function testing are summarized and analyzed. They are found in the following databases - PubMed, Google Scholar and Science Direct. Spirometry is the ‘gold standard’ for the diagnosis of airflow obstruction but it requires effort and can be difficult for patients to perform. Forced oscillation technique (FOT) on the other hand is a relatively new method that may hold the key to identifying smoking-related respiratory early alterations and childhood asthma. FOT requires tidal breathing while applying external, small amplitude oscillations in order to determine the response of the respiratory system. Therefore, it is easy for pre-school children to perform. The benefit of FOT should be taken into account for patients who cannot perform spirometry or other pulmonary function ttests. The minimal cooperation of the patient and the easy tidal breathing maneuvers make this method a great option for every pulmonologist. Compared to spirometry this technique may be more sensitive in the detection of disturbances of the peripheral airways and may be effective for the control of therapy at a long term. The Forced oscillation technique has been successfully applied in many pediatric respiratory disorders, such as asthma, cystic fibrosis, and chronic lung disease. Considering these qualities FOT may be used as an alternative of spirometry in heterogenous ventilatory disturbances of the small airways.
LOW-INTENSITY SHOCKWAVE TREATMENT FOR NEUROGENIC BLADDER WITH CHRONIC URINE RETENTION - CASE REPORT
We present a case of neurogenic bladder accompanied by chronic urine retention in a patient diagnosed with multiple sclerosis (MS). This condition was effectively managed by low-intensity shockwave therapy (Li-ESWT). Low-intensity focused shockwave therapy (Li-ESWT) is becoming increasingly important in the treatment of urological problems. This case study investigates the feasibility and efficacy of using Li-ESWT to reduce post-void residual volume in persons with neurogenic bladder, representing the first examination of its sort. Bladder dysfunction (BD) frequently occurs in patients who have been diagnosed with multiple sclerosis (MS). Bladder dysfunction (BD) can occur due to the impairment of nerve impulses in the central nervous system regions involved for regulating bladder function and managing the contractions of the urinary sphincters, which is caused by the lesions associated with multiple sclerosis (MS). Urinary retention can cause various symptoms, including insufficient bladder emptying, urinary incontinence, frequent urinary tract infections, urosepsis resulting in the development of kidney abscesses due to localised kidney infection, and reduced kidney function. Optimal bladder function is essential for individuals with MS, as it plays a critical role in preserving kidney health, preventing urinary tract infections and incontinence, reducing the frequency of MS episodes, and improving their overall well-being. A 31-year-old woman was referred to our urology office with a chronic urinary tract infection caused by a neurogenic bladder with a significant volume of residual urine. A kidney abscess formation was identified as a complication. Li-ESWT, which stands for low-intensity extracorporeal shockwave therapy, was used as a part of a multimodal strategy to treat the urinary bladder. This treatment was delivered off-label. The therapy was given on a weekly basis for a period of 6 weeks. The procedure included administering 2500 shocks at a rate of four pulses per second, with an energy flux density (EFD) of 0.25 millijoules per square millimetre. The EFD (Energy Flux Density) used in our study exceeded 0.32 mJmm2,4, the fR (frequency rate) was set at 8 Hz (pulses per second), the treatment sessions consisted of 12 cycles of Li-ESWT (Low-Intensity Extracorporeal Shockwave Therapy), and a total of 3000 shocks were administered. At the intervals of one week, three months, six months, nine months, and twelve months following the administration of Li-ESWT and tadalafil 2.5 mg, the post-void residual (PVR) volume was consistently below 50 ml. The Li-ESWT treatment effectively reduced the post-void residual urine volume. Low-intensity extracorporeal shockwave therapy (Li-ESWT) can safely and efficiently decrease the amount of urine left in the bladder after voiding in individuals with neurogenic bladder caused by multiple sclerosis (MS). We have effectively demonstrated that Li-ESWT is a feasible and safe treatment for chronic urine retention, resulting in a decrease of post-void residual (PVR) volume from 200 ml to 50 ml. In the future, Li-ESWT has the potential to be advanced as a more efficacious alternative therapy for individuals experiencing chronic urinary retention. Further investigation is necessary to confirm the effectiveness of ESWT in addressing the neurogenic bladder.
PERSONALIZED MEDICINE AS TREND IN PHARMACEUTICAL INDUSTRY
Personalized medicine is indeed a significant trend in the pharmaceutical industry, revolutionizing the way treatments are developed and administered. It is an innovative perspective that ultimately magnifies the quality of healthcare and creates multiple opportunities in transforming the prospects of medicine development, clinical trials, and patient care. Genomics and data analytics are essential in advancing personalized medicine. The challenges in implementing personalized medicine are numerous, yet the opportunities to remodel healthcare are immense. The perspectives of personalized medicine in the pharmaceutical industry are encouraging, with great potential to inspire innovation and establish transformation od drug development.
CHARACTERISTICS OF TONSILLITIS PATIENTS IN CHILDREN AT UNIVESITAS KRISTEN INDONESIA HOSPITAL, 2010-2017
Tonsillitis is a common disease in Ear Nose Throat (ENT) clinic, especially in the age of children and adolescents. Tonsillitis is inflammation of the palatine tonsils caused by bacteria, viruses or other immunological factors. The research is to find the characteristic of patients tonsillitis at Christian University of Indonesia Hospital. Method: This research uses descriptive method with retrospective approach done at Christian University of Indonesia General Hosipital with sample number of 40 patient. Statistical data checks using SPSS version 25. Result: Based on the medical record data obtained patients tonsillitis in children most often in the age group 0-6 62.5%, male gender 55%, have good nutrition status 57.5%, the main complaints of sorethroat 60%, size of T2-T2 tonsils 40%, medical diagnosis is acute tonsilitis 75%, medical treatment 77.5%. Conclusion: The profile of patients with tonsillitis in children was predominantly in the age group 0-6 years, male gender with good nutritional status had major complaints was swallowing pain, tonsils size T2-T2 and diagnosed acute tonsillitis. Medicamentous administration was an option in the treatment of tonsillitis.
NON-COMMUNICABLE DISEASES IN REPUBLIC OF SERBIA: CAUSES AND CONSEQUENCES
The growing trend of chronic non-communicable diseases, which affects both developed and developing countries, is linked to changes in diet and lifestyle. Despite numerous epidemiological pieces of evidence and recognized risk factors for the development of chronic non-communicable diseases, there are still worrying indicators of morbidity and premature mortality as a consequence of non-communicable chronic diseases. The goal of the work is to point out the urgent need to create effective and sustainable health policies that would provide answers to growing public health challenges. Additionally, the authors emphasize in the paper the key risk factors and the necessity of transforming patterns of inadequate behavior in order to mitigate, and in the future, to stop the unfavorable trend of newly diagnosed cardiovascular diseases, stroke, diabetes, and cancer, as the leading causes of disability and premature death, as well as to reduce the burden on health funds.
DYNAMICS OF MORTALITY FROM DISEASES OF THE CIRCULATORY ORGANS IN BULGARIA, SOUTH CENTRAL REGION AND PLOVDIV PROVINCE
In the European Union, Bulgaria ranks first in terms of mortality and last in terms of life expectancy. According to Eurostat data for 2018 in Bulgaria, from 2011 until this moment, the coefficients of both preventable mortality with good prevention and mortality preventable with good treatment are higher than the corresponding values for the EU as a whole. There are no prospects for their improvement. The rate of preventable mortality with good prophylaxis reached 226 per 100,000 population, which is significantly higher than the value of the rate in the whole EU (160 per 100,000). On the one hand, weak primary prevention and health promotion, and on the other hand, the need to improve protocols for diagnosis and treatment of the leading causes of death can be pointed out as reasons. The aim of the present study is to perform a comparative analysis of the dynamics of mortality from diseases of the circulatory organs for Bulgaria, its South Central Region and the Plovdiv province as part of this region. Materials and methods: documentary analysis - based on data from the National Statistical Institute; inductive and deductive methods; comparative analysis; structural analysis; economical analysis; statistical methods - analysis of the dynamics of phenomena, tabular and graphic analyzes - to visualize the obtained results. Results: Both for Bulgaria as a whole, as well as for its South Central region and the Plovdiv province, there is a trend of increasing mortality (per 100,000 people of the population) from diseases of the circulatory organs. Conclusion: From the data of our study, it is clear that, in general, for the observed 10-year period, and more specifically for the last of the years under consideration - 2022, for the entire country, the highest relative share in mortality (per 100,000 population) is occupied by other diseases of the heart. For the South Central region, the mortality rate from ischemic heart disease is the highest. The situation is similar for the Plovdiv province, as part of this region, where the relative share is also the highest - a noticeable 44.0% of the mortality from IHD. Recommendations: A comprehensive approach and addressing health inequities in all areas aimed at reducing the burden of cardiovascular disease as part of non-communicable chronic diseases is imperative. Of primary importance is the fact that health promotion and disease prevention can lead to a significant reduction in this burden.