[A case of acute purulent otitis media complicated by atypical mastoiditis on the background of an unverified HIV infection]. / Sluchai ostrogo gnoinogo srednego otita, oslozhnennogo atipichnym mastoiditom, na fone neverifitsirovannoi VICh-infektsii.

According to the literature, acute otitis media is complicated by mastoiditis in 0.15-1% of cases. In turn, mastoiditis can be complicated by meningitis, encephalitis, abscess of temporal lobe of brain and cerebellum, epidural and subdural abscesses, facial nerve paresis, labyrinthitis, phlegmon of soft tissues of neck, as well as subperiosteal abscess, which makes 7% in the structure of mastoiditis complications. Nowadays, when doctors have a wide range of antibacterial preparations at their disposal, a complicated course of acute otitis media and further mastoiditis is caused both by an aggressive atypical infectious agent and immunocompromised status of a patient. The article deals with a clinical case of a prolonged course of acute otitis media complicated by mastoiditis and subperiosteal abscess against the background of outpatient courses of antibacterial therapy. The examination revealed an atypical pathogen of otitis media Pseudomonas aeruginosa and HIV-positive status of the patient, previously unknown. Timely surgical intervention and the right combination of antibacterial drugs, meropenem and ciprofloxacin, prevented the development of intracranial and septic complications, despite the presence of multiple foci of bone destruction of the mastoid process and temporal bone pyramid, bordering the middle fossa and sigmoid sinus, according to multispiral head computed tomography. As a part of additional examination in the Center for AIDS and Infectious Diseases Prevention and Control, the patient was diagnosed with HIV infection, clinical stage 4C, progressing phase on the background of absence of antiretroviral therapy, and the necessary amount of treatment was prescribed.

[Low Apgar score in term newborn infants and delivery pattern].

OBJECTIVE: Examine the influence of delivery pattern over neonatal condition in the first minutes of life. MATERIALS AND METHODS: We have studied 3624 term newborns of single pregnancies for period of 2 years in the city of Pleven. The patients were divided in 4 groups by the delivery pattern: vaginal delivery with head presentation (2497 infants), vaginal delivery with instrumental assist (45 infants), per vias naturales in breech presentation (44 infants), delivery via Caesarean section (1038 infants). RESULTS: According to our results the Apgar score differs itself from the pathology of a given newborn. Neonatal deaths are significantly higher in the newborns with low Apgar score than deaths in the general population. From all cases of low Apgar score without other clinical problems the highest is the percentage in the infants delivered via Caesarean section. CONCLUSIONS: The goal of the Apgar score is to focus attention on the infant's condition in the first few minutes of its life and the need of resuscitation. Low Apgar score is an important predictor of the newborn morbidity and death rate. The Apgar score alone is not a proof for intrapartal asphyxia and is not associated with long-term neurological damage.

[Neonatal complications of children born after in vitro fertilization].

The purpose of this report is to compare the neonatal indices and the frequency of neonatal pathology in children, born after in vitro fertilization with those after natural conception. The study, which is a retrospective one, comprises all newborns from the three maternity hospitals of Pleven (University hospital, Saint Marina Obstetrical clinic, Avis-Medica Hospital) for the last 2 years. The comparative indices of the babies in the two groups are: birth weight and gestation age at birth, morbidity by separate nosological units: asphyxia, intraamniotic infection, intrauterine growth retardation, neonatal respiratory distress syndrome, congenital anomalies etc.), multiple births. The maternity age, delivery pattern, mean hospital stay and mortality are discussed too. The results are compared with other international data.

[Diagnosis and prevention of neural tube defects--where are we? (Data based on the registry of congenital anomalies in the Pleven region)].

AIMS: to present some clinical and epidemiological data, concerning diagnosis and prevention of neural tube defects (NTDs), based on the registry of congenital anomalies (CAs) in the Pleven region; to analyse our data comparing with the data of other registries in Europe. MATERIALS AND METHODS: The source of the data was the regional population-based registry of Cas (in live births, stillbirths and terminations of pregnancy following prenatal diagnosis) using criteria according to EUROCAT recommendations. During the study period 1988-2006, 47 622 births were surveyed in the University hospital, City of Pleven. RESULTS: A total of 107 cases of NTDs were ascertained. About 20% of the cases with isolated NTDs were in terminations of pregnancy following prenatal diagnosis, in 80% of the case the diagnosis was ascertained in liveborn and stillborn fetus. The isolated NTDs were among the most common CAs, with a proportion of 8% of all registered cases and a prevalence of 2 per 1000 births. The genetic counseling revealed familial data (other affected child/pregnancy) in 7% of families with NTDs. Prenatal diagnosis was provided to the subsequent risk pregnancies in the affected families and NTDs were detected in 7% of the pregnancies. CONCLUSION: Neural tube defects are a common type of congenital defects that demonstrated a relatively high prevalence in the Pleven region. The data of the study indicates that there is a need to develop an official government policy regarding prevention of NTDs (pericoceptional folic acid supplementation and antenatal screening of CAs).

Increased virulence of Marek's disease virus type 1 vaccine strain CV1988 after adaptation to qt35 cells.

CVI988/Rispens strain of Marek's disease virus type I (MDV-1) is widely used as efficient vaccine to control Marek's disease (MD) in chicken flocks. Similarly to other live MD vaccine viruses it is propagated in freshly prepared chicken embryo fibroblasts (CEF). In this study, MDV-1 CVI988/Rispens strain was adapted to QT35 cells. The adapted virus, designated QT-CVI, exhibited similar cytopathic effect (CPE) in vitro to that of parental virus propagated in CEE In contrast, QT-CVI induced MD symptoms typical for mild MDV-1 strains after injection to birds. For identification of differentially expressed transcripts that might be involved in increased virulence of QT-CVI, we performed subtractive suppression hybridization (SSH). Subtracted PCR products mapped within MDV-1 BamHI-A and -H fragments and differential gene expression was also confirmed by Northern blot analysis with probes derived from these regions. To examine possible divergence at the virus genome level, PCR analysis was carried out. The BamHI-H fragment- specific 132 bp repeats were present at variable copy number, ranging from 2 to more than 30 copies in both CVI988/ Rispens and QT-CVI DNAs. PCR assays with primers mapping at the US/lRS junction identified CVI988/ Rispens-specific insertion of 116 bp in the region upstream of the ICP4 open reading frame (ORF). PCR analysis was positive also for DNA from non-infected QT35 cells and was consistent with the observation of Yamaguchi et al. (J Virol. 74, 10176-10186, 2000) who have found that QT35 cells carry a latent MDV-1 genome. It is likely, that adaptation of CVI988/Rispens to QT35 cells resulted in reactivation of an endogenous MDV-1 or at least in induction of expression of virulence-related transcripts that have consequently led to QT-CVI pathogenicity for chickens.