Epidemiology of hip fractures in Bulgaria: development of a country-specific FRAX model.

A retrospective population-based survey was undertaken in a region of Bulgaria to determine the incidence of hip fracture. The estimated number of hip fractures nationwide for 2015 was 9322 and is predicted to increase to 11,398 in 2050. The hip fracture rates were used to create a FRAX model. OBJECTIVE: To describe the epidemiology of hip fractures in Bulgaria, which was then used to develop the country-specific fracture prediction FRAX® tool. METHODS: We carried out a retrospective population-based survey in Stara Zagora, Bulgaria, representing approximately 4.6% of the country's population. We identified hip fractures occurring in 2015, 2016 and 2017 from hospital registers and primary care sources held by the regional health insurance agency. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Bulgaria. Fracture probabilities were compared with those from neighbouring countries having FRAX models. RESULTS: The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 9322 and is predicted to increase to 11,398 in 2050. FRAX-based probabilities were higher in Bulgaria than those in Serbia or Romania, lower than those in Turkey and similar to those in Greece. CONCLUSION: The FRAX model should enhance accuracy of determining fracture probability among the Bulgarian population and help guide decisions about treatment.

[Results of the surgical treatment of thyrotoxicosis].

OBJECTIVE: The aim of this study was to evaluate the results of the surgical treatment of patients with thyrotoxicosis in three surgical clinics in Plovdiv. PATIENTS AND MEDHOTS: We studied 90 patients, who underwent surgical treatment for thyrotoxicosis between 2000-2004. Of those 19 men (21%) and 71 women (79%); men:women = 1:3.74; mean age 38 +/- 8.3 years. The nosological distribution was as follows: Graves' disease--72 subjects (80.00%), solitary toxic adenoma--4 subjects (4.40%), toxic nodular goiter--14 subjects (15.60%). 77 subtotal thyroidectomies (85%) and 9 total thyroidectomies were performed. Patients with solitary toxic adenoma underwent lobectomy. RESULTS: Massive bleeding witch required revision and haemostasis was encountered in 1 patient. Transient laryngeal nerve injury occurred in 3 patients (3.33%), and temporary hypoparathyroidism in 6 subjects (6.67%), necessitating calcium supplementation. One year postoperatively, 49.35% (n = 38) of the patients who have undergone subtotal thyroidectomy were euthyroid, 45.45% (n = 35) developed hypothyroidism, and 5.2% (n = 4) relapsed. DISCUSSION: Our results indicate that surgery is safe and effective for patients with thyrotoxicosis referred for radical treatment. Because of the high rate of postoperative thyroid disfunction, assessment of the non-operative factors, witch influence the functional results, is recommended.

Evaluation of health hazards in children from regions with nitrate pollution.

Nitrate pollution of drinking water can be potentially hazardous with health risks for considerable groups of people. Methemoglobin in blood and concentration of nitrates and nitrites in morning saliva, urine, and plasma as sensitive indicators of nitrate accumulation in the body were analysed in 12-14-year-old children living in villages with nitrate pollution of the drinking water. The children were distributed in two experimental groups of 18-21 children each. Nitrates and nitrites were analysed in biological fluids by a modified cadmium-reduction method. Nitrate accumulation in the body was significantly higher in the nitrate pollution exposed children than in the unexposed children which correlated with greater health hazards.

Comparative analysis of results from studies of goitre in children from Bulgarian villages with nitrate pollution of drinking water in 1995 and 1998.

The role of nitrates in goitre genesis has been discussed for a long time. In the present report a comparative analysis is made of results obtained in villages with nitrate pollution of the drinking water. In two pairs of villages children aged between 3 and 14 were included, whose thyroid status was investigated by a clinical examination. The study was carried out in 2 stages--in 1995 and 1998. In this period the goitre incidence was significantly reduced in both sexes. Both investigations showed a higher relative risk of goitre in children exposed to water pollution by nitrates. In the first, as well as in the second examination, goitre was diffuse. We concluded that nitrate pollution of drinking water undoubtedly participated in goitre genesis. We did not underestimate the strumigenic effect of nitrates in the diet as they were not the object of our investigation and which, according to WHO experts, have a less strumigenic effect. After the first investigation we recommended a higher antistrumin dose as prophylaxis. That is why we conclude that the considerable goitre reduction in the second investigation was the positive result of the doubled antistrumin prophylaxis during the period between the two investigations.

Possible mechanism of action of vanadium ions as an antidiabetic agent.

Vanadium compounds, at much higher concentrations than they are typically ingested, are being considered for use in the treatment of diabetes mellitus. They exert an insulin-mimetic effect in an insulin-receptor-independent manner. In our study we obtained new data about the vanadium insulin-receptor-independent mechanism of action on cell membranes. When rat stomach smooth muscle samples are treated with NH4VO3 (10(-7) divided by 10(-5) this action is possibly exhibited with increased influx of Ca2+ through VDCa2+C.

Incidence of goiter among children in a village with nitrate contamination of drinking water.

An epidemiological survey was conducted on the incidence of goiter among children in the 6-14 years age group, permanently living in a village with an increased content of nitrate pollutants in drinking water. Their incidence of goiter was compared to that in a control group of children. The study comprised a total of 359 children--181 from the experimental village and 178 from the control village. A high percentage (40.9%) of goiter is observed among the children in the village with nitrate contamination of drinking water. A statistically significant difference in goiter incidence in children between the experimental and control village is present.

[The role of nitrates in the genesis of goiter morbidity]. / Vurkhu roliata na nitratite v genezata na gushavostta.

Epidemiologic study was carried out concerning the level of goitrous morbidity in the growing up individuals aged from 3 to 14 years, permanently living in a settlement with increased nitrate content in the drinking water and natural Iodine deficiency. The data for the incidence of the goitrous morbidity were compared with those of a control group of children. The investigation included a total of 325 children. A high percentage of goitrous morbidity was recorded in the observed by us settlement with increased nitrate content in the drinking water, respectfully 35% versus 8.1% in the control settlement. Low degree of juvenile goiter predominated with slight prevalence of the female sex. A statistically reliable difference (p < 0.001) in the incidence of goitrous morbidity in the observed by us settlement and the control settlement.