Chronic Treatment with Opiate Agonists in Bulgaria - Assessing the Quality of Life Using SF 36 v. 2.

INTRODUCTION: Drug addictions to psychoactive substances are disorders with a complex bio-psycho-social genesis, which are characterized with chronic relapses. Substance addiction causes multifactorial damage to the normal functioning of individuals and requires a multicenter approach for the treatment process. AIM: The aim of the study was to assess the quality of life of patients undergoing chronic treatment with the opiate agonist methadone using a standardized questionnaire method in Bulgarian. MATERIAL AND METHODS: The study included patients aged 18 to 40 years undergoing chronic treatment with methadone for at least six months. The study included 100 subjects. Seventy-six patients were from 5 clinical programs in Bulgaria; twenty- four clinically healthy age-matched subjects with no history of drug abuse, psychiatric and somatic diseases were the control group. RESULTS: We found significant differences between patients and controls in all components of the survey (P<0.05). The patients had lower scores than the control group in the SF-36 in terms of all eight components and both the physical and mental component summaries of the SF-36-survey. Patients compared between the groups by dose, duration of treatment with methadone and period of heroin abuse before initiating treatment did not show significant differences. There were no significant differences between patients with and without hepatitis C virus. CONCLUSIONS: Opiate addiction is a state associated with poor quality of life. The duration of treatment, the methadone dose, period of heroin abuse before initiating treatment and illness of hepatitis C virus does not correlate with lower results.

Acute Poisoning with Dapsone and Olanzapine: Severe Methemoglobinemia and Coma with a Favourable Outcome.

Dapsone is a drug commonly used in the treatment of leprosy. In Europe it is rarely prescribed, mostly for the treatment of skin diseases such as dermatitis herpetiformis. Poisoning with dapsone is rare and reports of such cases are of interest for toxicological practice. We describe the only acute dapsone poisoning in a caseload series of 21,000 intoxications treated in the Clinical Toxicology Clinic at St George University Hospital in Plovdiv, Bulgaria between 1999 and 2013. We report on a 36-year-old woman who attempted deliberate self-poisoning with an ingestion of approximately 4.5 g of dapsone and 0.3 g of olanzapine. On admission, the patient was in a state of severe intoxication and comatose. On admission to hospital 9 hours after the ingestion, the methemoglobin level was 51.7%. The patient recovered 8 days later. She received complex treatment including intubation, ventilation, repeated gastric lavage, hemodialysis, blood exchange transfusion and antidote treatment with methylene blue. She was discharged in good clinical condition with minimal organ damage such as mild toxic hepatitis.

Sexual Fears and Avoidant Sexual Behavior in Medical Students.

UNLABELLED: Sexual fears, sometimes in the form of phobias, lead to aversive or sexually avoidant behavior blocking sexual closeness and resulting in deep personal and interpersonal distress. OBJECTIVE: To determine the types of sexual fears and aversive behavior in young people of reproductive age (students) and their degree of markedness as to encourage a further implementation of prevention programs and interventions. MATERIALS AND METHODS: The study included 116 fifth-year medical students in Plovdiv Medical University. Of these, 55 men and 61 women were assessed with the Sexual Aversion Scale, a 30-item self-rating questionnaire. The Diagnostic and Statistical Manual of Mental Disorders criteria of sexual aversion were used. The statistical analyses used were descriptive statistics and independent samples t-test. RESULTS: Sexual fears and aversive or blocking behavior are mild to moderate, mean score of 1.54 ± 0.04, without statistically significant gender differences. Both sexes have established fear-related sexual aversive motives of sexual behavior related to the risk of unwanted pregnancy and HIV infection. Women have significantly higher average scores for the following statements: fear of sexual intercourse (1.61 vs 1.25), avoidance of situations in which they may be involved sexually (1.95 vs 1.51), avoidance of genital sexual contact (1.44 vs 1.16), fear of catching a sexually transmitted disease (2.46 vs 2.09 ), fear of pregnancy (2.61 vs 2.15) and concerns what other people think of them (2.34 vs 1.93 ). CONCLUSIONS: Sexual fears and aversive or blocking behavior were mild to moderate. In both sexes similar fears--aversive or blocking patterns of sexual behavior were found, mainly associated with the fear of unwanted pregnancy and the risk of HIV infection, more expressed in women.

Snake venom poisoning in the Plovdiv region from 2004 to 2012.

INTRODUCTION: Envenomation by poisons of biological origin is very common globally in the tropical and subtropical areas mainly, where the biological diversity of the species clearly leads to evolution of highly toxic species. The weather warming trend in Bulgaria, whether cyclic or permanent, allows for a change in the biological response of reptiles and insects inhabiting the temperate zone by a possible migration of biological species from the subtropical zone towards the temperate zone because of the new environmental conditions. There are very few studies on snake bite envenoming in Bulgaria. The AIM of the study was to find the incidence of the acute accidental intoxication (AAI) caused by snake venom in adult individuals in a large region of Bulgaria between 2004 and 2012 and characterises it by number, type, main clinical features, course and socio-demographic parameters of the victims so that preventive measures can be taken, wherever necessary. MATERIALS AND METHODS: We studied retrospectively all 68 cases of AAI caused by snake venom in adult individuals (> 18 years old) hospitalized in the Clinic of Toxicology in St. George University Hospital, Plovdiv over the period from 2004 to 2012 by 23 quantitative and qualitative parameters. RESULTS: We found that the average annual incidence of snake venom AAI in adult population in the region of Plovdiv was relatively low for the specified period (9.5 per 100000 residents); the snake venom AAI increases or decreases every other year, with no clearly delineated trend for now. The prevalence of envenomation by poisons of biological origin increased from 2.3% in 1990-1998 to 9.5-10.33% between 2007 and 2012. The main sociodemographic characteristics of snake bite victims are similar to those in other Balkan and Central European countries. The clinical response to poisons of biological origin is generally identical with the response to the viper (Vipera ammodytes)--mild to medium intensity with predominantly local toxic syndrome. CONCLUSIONS: The algorithm of Clinical Pathway 293 (CP) is effective and conducive to the reduction of duration of the morbid condition. There are, however, still aspects of it that can be optimised.

A rare case of multiple rattlesnake bites.

The rattlesnake (Crotalus adamanteus) is a venomous viper inhabiting the southeastern parts of the United States. It is not found in the Balkans and Europe habitats. Subjects of the species are grown and seen in museums, exhibitions and terrariums, and sometimes in private collections. This may generate potentially toxic exposures to the venom in accidental contact. Acute poisoning with rattlesnake poison in Bulgaria is exotic, rare and even casuistic. The venom of the rattlesnake exhibits neuropathic, proteolytic and hemolytic activities. Antivenom is not currently easily available in Bulgaria--it is not usually stored in hospitals because it is very rarely used and therefore rather expensive. We present a case of multiple envenomation (two different occasions) of one and the same person who kept rattlesnakes in a private terrarium. Local toxic syndrome was observed with burning and stinging pain at bite site combined with limited hemorrhage and necrosis. The hemolytic reaction and the local toxic results were successfully managed without resorting to any specific antidotal therapy.

Severe hypotension and ischemic stroke after disulfiram-ethanol reaction.

Disulfiram (tetraethylthiuram disulfide) has been used for almost 60 years in the treatment of alcohol addiction. It causes aversive behavior due to disulfiram-ethanol reaction (DER). The classical DER includes flush, sweating, tremor, nausea, vomiting, tachycardia, moderate decrease in blood pressure and restlessness. Complete recovery is the usual outcome in clinical settings. Life-threatening reactions are rare but sometimes occur. We present a case of a 53-year-old man developing severe hypotension and ischemic stroke as a result of disulfiram treatment and ethanol intake. Use of adrenalin as a drug of choice in this critical condition, together with other therapeutic approaches led to stabilization of hemodynamics and reversal of neurological symptoms. Our case had a favorable outcome, but it should be remembered that patients unable to comply to the strong restrictions in treatment for alcohol rejection are not eligible for this therapeutic modality used in the management of alcohol dependency.

A rare case of severe intoxication from multiple bee stings with a favorable outcome.

A 73-year old female of no allergic diathesis was attacked by bees and stung all over her body accidentally sustaining more than 518 stings for a very short time. Severe acute poisoning developed from the bee venom, manifested by coma, rhabdomyolysis, toxic hepatitis, acute renal failure, gastric hemorrhage and anemia. Following an active treatment the patient recovered. Literature search shows this to be a rare case of survival after multiple bee stings.

Surgical treatment of necrotizing pancreatitis and complicated forms of cholecystopancreatitis.

The authors present a retrospective clinical analysis of 25 operated patients with necrotizing pancreatitis and severe cholecystopancreatitis. The severity of the disease was evaluated by the Ranson scale. Diagnosis was made using all available contemporary diagnostic methods. Eleven of the patients were operated in the first 2-5 days after admission because of severe form of acute pancreatitis resisting medical therapy (Ranson > 3) and 8 patients with infected necrotizing pancreatitis underwent surgery within 2-3 weeks after the disease onset. Five of the patients died (26.32%). Only one patient died (16.66%) out of the patients of the second group including patients with acute complicated cholecystopancreatitis (n = 6). The authors think that treatment of acute pancreatitis at its onset should be mainly conservative. Laparotomy should be resorted to only in cases of uncertain diagnosis. Surgery or percutaneous drainage should be used in infected necrotizing pancreatitis and the most favorable term of operation is 2-3 weeks after the disease onset. Severe pancreatitis associated with gallstone disease and its complications require emergency surgery.