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Abnormal ECG patterns during the acute phase of subarachnoid hemorrhage in patients without previous heart disease

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Atanassova P., Tokmakova M., Djurkova A., Naydenov V., Chalakova N., Dimitrov B.
Open Medicine
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2006
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vol. 1
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issue 2
148-157
EN
Subarachnoid hemorrhage (SAH) occurs primarily during early to mid-adulthood; approximately 30% of individuals with SAH die within 2 weeks, and mortality is 30% to 45%. SAH happens suddenly, without patients being aware of previous heart abnormalities. Here, we performed a pilot single cohort (historical) study to examine the hypothesis that early abnormal electrocardiographic (ECG) changes may reveal unknown but “silent” heart pathologies in SAH patients without previous heart disease (PHD). Data were collected retrospectively on 56 consecutive patients during the acute phase of SAH (29 men, 27 women; mean age 49.0 ± 6.2 years) with different degrees of neurologic deficit (Hunt-Hess scale assessment) in a 2-year period single-cohort study. Repolarization abnormalities were most frequent (p<0.05) and were independent of a history of PHD, although it corresponded to a higher risk for such abnormalities (odds ratio OR=3.21; CI95%=1.01–10.22). ECG changes in patients without PHD were similar to those in PHD patients, confirming the hypothesis that SAH is associated with previously “silent” heart pathology. The increased frequency of ECG changes in PHD patients and their high incidence in no-PHD patients suggested a neurogenic form of myocardial dysfunction following SAH. Notably, repolarization changes were more frequent in patients with less severe deficit (p<0.05), whereas rhythm and conductive abnormalities were more frequent in patients with more severe neurologic deficit.
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ACNE IN BULGARIA AND GREECE: COMPARISON STUDY OF PATIENT ADHERENCE

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Petkova V., Hussain S., Filinada D., Karamisheva V.
Acta Poloniae Pharmaceutica - Drug Research
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2019
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vol. 76
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issue 5
913-916
EN
Background: Acne vulgaris is a chronic inflammatory disorder of the skin. Low level of adherence of acne patients to treatment can lead to poor clinical efficacy, increased healthcare costs, and unnecessary treatments that can lead to adverse drug reactions. Objective: The aim of this study is to compare the level of adherence of acne patients between Greece and Bulgaria. Methods: A multicenter observational study utilized self-completed questionnaires to assess medication adherence among patients visiting 45 pharmacies throughout Bulgaria and Greece between May and December 2018. A total of 225 patients were included in the study. Subjects included acne patients undergoing treatment who had a medical consultation prior to the study. All patients had acne therapy prescriptions. The likelihood of adherence was assessed using the Elaboration d'un outil d'evaluation de l'observance (ECOB) Adherence Questionnaire. Adherence Questionnaire. The ECOB scale was translated into Bulgarian and standardized by forward translation, backward translation, and a pretest. The data collected were proceeded through SPSS ver. 22.0. Results: According to the ECOB scores, good adherence to treatment was documented in 42.0 % of the Bulgarian patients on topical treatment and 39 on oral medication. For the Greek patients good adherence to topical medication was judged to be good for 53% and for 40% on oral treatment. Conclusion. Greek and Bulgarian patients show similar level - of high rate of non-adherence to acne treatment. Perhaps patients could be monitored about their adherence and this can be performed in the dermatology clinic or in the pharmacy.
3
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Diastolic blood pressure cut-off predicts major cerebrovascular events after minor ischaemic stroke: a post-hoc modelling study

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Atanassova P., Chalakova N., Dimitrov B.
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EN
Only few follow-up studies have studied in detail the role of most important risk factors, but no reports were found on critical values (cut-offs) for such factors in prospectively predicting cerebrovascular events (CVE) in patients with minor ischaemic stroke (MIS). Estimates of predictive importance of such cut-offs may better inform and contribute to optimize treatment. This was a post-hoc modelling study with unique data from Bulgaria on 54 consecutive patients with MIS, aged ł 40, followed for 12 months for nonfatal or fatal CV events. A set of routine clinical demographic and known risk factors (SBP, DBP, HDL cholesterol, etc.) were explored using univariate statistics and multivariate regression models to identify the most important independent predictors of secondary CVE. An artificial neural network (ANN) model, irrespective of usual statistical constraints, also confirmed the specific role and importance of identified predictors. A receiver operating characteristics (ROC) curve and stratified survival analyses were used to define the best cut-off of most important predictors and validate the final model. During follow-up period of 11.1±2.4 months, 8 secondary CV events (14.8%) were observed only in males with MIS at the 5.8±2.7 months mark. No difference in age of patients with CV event (61.1±12.6 years) vs. those without (62.1±9.6 years) was found (p>0.05). The one-year risk for CVE was.15% (95%CI 7.1, 27.7%). The two most important risk factors in patients with versus without CV events were acute MIS onset (62.5 vs. 13.0%) and mean DBP at day 30 post-MIS (101.3±9.9 vs. 92.3±10.8 mmHg), with a relative importance by ANN of 20.92 versus 15.9 points, respectively. At multivariate logistic analysis only MIS onset and DBP were independently associated with the risk for secondary CVE (79.6% model accuracy, p model=0.0015). An increase of DBP with 1 mmHg was associated with 8% higher risk of CVE [adjusted OR=1.08 (95%Cl 1.004, 1.158)]. With this method, a novel cut-off predictive DBP value of 95 mmHg (ROCAUC=0.79, 95%Cl 0.60, 0.99, p=0.009) for CV events in patients with MIS has been found. In conclusions the new DBP cut-off (sensitivity >87%, specificity >69%) clearly discriminated between absence and presence of secondary CVE as also confirmed by stratified survival analysis (7 vs. 1 events, plog-rank =0.0103). This cut-off may be applied to better precisely evaluate and define, as earlier as possible, MIS patients at increased risk of secondary CV events.
4
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Assessment of lipid-lowering treatment in Bulgaria - The CEPHEUS study

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Gotcheva N., Raev D., Trendafilova E., Postadzhiyan A., Runev N., Vandenhoven G., Temmerman A.-M., Staneva M.
Open Medicine
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2013
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vol. 8
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issue 5
627-637
EN
This is a multicenter cross-sectional survey of 2,500 Bulgarian adult patients taking lipid-lowering drugs (LLDs) for at least 3 months with no dose change for a minimum of 6 weeks. The primary objective was to establish the proportion of patients who are on LDL-C target, according to the Fourth Joint European Task Force (FJETF) guidelines. The secondary objectives were to define the proportion of patients at target: according to the 2001 National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III and the 2004 NCEP ATP III guidelines. The patients’ demographics, current LLD treatment, cardiovascular medical history were recorded. Next the lipid profile, glucose level and HbA1c were obtained from these patients. The investigators and patients completed questionnaires related to the LLD therapy. Gender, BMI, history of CHD, therapy compliance, risk category, lack of patient’s awareness of LDL-C targets were all studied as determinants of the undertreatment. Despite the satisfactory awareness of guidelines for management of hypercholesterolaemia, their implementation in clinical practice is still poor. Only 43.10% of patients reached the FJETF-recommended LDL-C goal, 45.24% achieved the 2001 NCEP ATP III recommended LDL-C goal, and only 21.51% - reached the 2004 NCEP ATP III recommended target. Males, CHD patients and those who were aware of LDL-C targets had more chance of reaching their desired LDL-C target.
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