Regional differences in diabetic patients' pharmacotherapy in Bulgaria.

BACKGROUND: The regional analyses play an important role in understanding a state of diabetes mellitus management and to support informed policy options. They need to be explored in more details in order to ensure an equal patients' access to health care services of the same value and quality. AIM: The aim of this study is to analyze regional differences in a cost of diabetes therapy for insulin users in Bulgaria. MATERIALS AND METHODS: It is a combined prospective and retrospective observational study with duration of 6 months. Diabetic patients on insulin therapy were recruited by 35 endocrinologists. Information about the health care resources used was collected within 3-prospective and 3 retrospective months in 2010 and 2011. The regional cost of illness analysis was performed by calculating the average cost attributable to each individual patient despite the fact that some might not use a particular health care resource. Subgroup analysis was performed for hospitalized patients. RESULTS: A detailed analysis revealed cost differences in the regions, especially with more vulnerable population like Burgas and Pleven regions. Another reason for the cost differences is the type of insulin or type of therapy. Our study confirms the fact that the hospitalizations are the major cost driver. Rising diabetes prevalence and associated costs, including hospitalizations and management of diabetes complications, are a growing concern. The last possible reason for regional differences is the patients' characteristics and therapy differences. We add evidence demonstrating that the patients on insulin and OAD consume more resources including hospitalizations and suffer from more complications of diabetes. CONCLUSIONS: Reasons for regional differences might have different origin as there are various population characteristics, type of therapy, socio economic status and others.

[Cyproterone acetate improves beta-cell function in postmenopausal women with diabetes mellitus type 2]. / Cyproterone acetate podobriava beta-kletuchnata funktsiia pri postmenopauzalni zheni sus zakharen diabet tip 2

Menopause is associated with two main risk factors for the development of type 2 diabetes mellitus--impaired beta-cell insulin secretion and insulin resistance. Physiologically estrogens improve carbohydrate metabolism, but this is not the case with different progestogens. The aim of the present study was to evaluate the effect of Cyproterone acetate (a progestogen with antiandrogenic activity) on insulin secretion, peripheral insulin sensitivity, lipid parameters and parameters of oxidative stress. Seven type 2 diabetic females, of mean age 55.4 +/- 4.7 years and mean BMI 30.8 +/- 9.39 kg/m2, in menopause for average 5 years, in good borderline glycaemic control (mean HbAic 7.8%), with dyslipidaemia, normal parameters of calcium and phosphate metabolism and with osteopenia (T-score < 88%) were enrolled in the study. They were treated with Estradiol valerate + Cyproterone acetate (Climen, Schering) for three months. Phases of insulin secretion--first phase (FPIS), second phase (SPIS) and AUC for FPIS and SPIS were assessed during IVGTT. Insulin sensitivity was determined with the manual method of euglycaemic hyperinsulinaemic clamp technique. The postmenopausal diabetic women in the present study were with overweight and obesity; they did not increase their body weight during HRT and even decreased it by mean 0.7%. Insulin secretion improved after Climen--FPIS increased by 16% and SPIS by 44%. Insulin sensitivity increased by 15%; triglycerides decreased by 16% and HDL-cholesterol increased by 27%. Total antioxidant capacity of the serum (TAOK) increased by 7%. The favourable effect on the pathophysiological mechanisms improved metabolic control--HbAic was reduced by mean 3% after 3 months. In conclusion, our results suggest that HRT with the progestogen Cyproterone acetate (Climen) should be preferred in postmenopausal type 2 diabetic females with predominant beta-cell insulin secretion defect.

[Clinical trial of domestic drug polyoxidonium in secondary immunodeficiency]. / Klinincheskoe primenenie otechestvennogo preparata polioksidoniia pri vtorichnykh immunodefitsitakh vzroslykh.

AIM: To test clinical efficiency and immunocorrectives characteristics of polyoxidonium in patients with chronic bronchitis (CB) and chronic recurrent furunculosis. MATERIALS AND METHODS: 56 patients entered the trial; 13 with CB in remission, 22 with CB in exacerbation and 21 with chronic recurrent furunculosis. Clinical examinations and tests were made before polyoxidonium therapy and 2-3 days after it. Immunological tests consisted of determination of sub-population composition of peripheral blood lymphocytes, serum immunoglobulins and phagocytic activity of neutrophils. RESULTS: Polyoxidonium is an effective and safe immunocorrector. It has a strong influence on functional activity of blood phagocytic cells. CONCLUSION: Polyoxidonium treatment of CB and chronic recurrent furunculosis results in positive shifts in hematological and immunological indices. This allows to recommend it for treatment of acute and chronic infections.

[Common variable immunodeficiency in adults and problems of its immunotherapy]. / Obshchaia variabel'naia immunnaia nedostatochnost' u vzroslykh i problemy ee immunoterapii.

AIM: Clinicoimmunological study of adult patients with prevailing defect of humoral immunity, development of diagnostic criteria and treatment of this disease. MATERIALS AND METHODS: Clinical, immunological and microbiological examinations were made in 68 patients with defects of antibody formation. RESULTS: Total variable immunodeficiency (TVID), selective deficiency of IgA, congenital agammaglobulinemia, hyper-IgM-syndrome were detected in 74, 13, 10 and 3% of patients, respectively. TVID was frequently associated with respiratory, chronic ENT and gastrointestinal diseases, low CD4+ and high CD8+ levels. The response was achieved with combined therapy: antibacterial treatment + immunocorrection + differentiated replacement with plasma or immunoglobulins. CONCLUSION: In choice of immunotherapy of TVID patients it is necessary to consider parameters of immunogram. Intravenous administration of immunoglobulin preparations provided the highest effect in good safety.

[The clinico-immunological efficacy of the likopid treatment of chronic bronchitis patients]. / Kliniko-immunologicheskaia éffektivnost' lecheniia likopidom bol'nykh khronicheskim bronkhitom.

AIM: Elucidation of likopid effect on clinical and immunological pictures in patients with chronic bronchitis (CB). MATERIALS AND METHODS: A trial of 52 CB patients in remission and exacerbation. 2 schemes of likopid treatment were used: 1 mg/day for 10 days (a course dose 10 mg); 10 mg/day for 6 days (a course dose 60 mg). Clinical and laboratory parameters, systemic immunity (measurement of lymphocyte subpopulations, levels of serum IgA, IgM and IgG, functional activity of peripheral blood phagocytes). RESULTS: The 10 mg and 60 mg courses of likopid produced prolongation of remission to 5-6 months in 66% of CB patients in exacerbation and in 80% of patients in remission, respectively. 10 mg of likopid in exacerbation and 60 mg in remission promoted normalization of functional activity of blood phagocytes. CONCLUSION: Likopid administration for CB in a 10 mg course dose in exacerbation and 60 mg course in remission prolongs CB remission to 5-6 months and promoted normalization of phagocytic functional activity.

[A trial of the use of the new Russian preparation oxymetacil in patients with chronic nonspecific lung diseases]. / Opyt primeneniia novogo otechestvennogo preparata oksimetatsila u bol'nykh khronicheskimi nespetsificheskimi zabolevaniiami legkikh.

The trial of oxymethacyl was conducted in 20 CNSPD patients. Clinicoimmunological examinations provided evidence on the drug effectiveness as it stimulated cell immunity, phagocytosis, was well tolerated, caused no side effects. The highest response was achieved in combination of oxymethacyl with antibacterial therapy. Normalization of clinical and immunological indices in CNPD patients suggests immunocorrective effect of oxymethacyl.

[The clinico-immunological evaluation of the ribomunyl treatment of chronic bronchitis patients]. / Kliniko-immunologicheskaia otsenka lecheniia ribomunilom bol'nykh khronicheskim bronkhitom.

The paper reports the results of ribomunil trial in chronic bronchitis (CB) patients who suffered from frequent exacerbations. The drug was found to act primarily on a phagocytic component of the immunity and local immunity of the respiratory mucosa. Because of its vaccine-like effect, ribomunil administration is most beneficial in CB remission. Ribomunil treatment results in reduction of the number and duration of CB exacerbations, of the scope of antibacterial therapy.

[The immune status in different clinical forms of insulin-dependent diabetes mellitus]. / Immunnyi status pri razlichnykh klinicheskikh formakh insulinzavisimogo sakharnogo diabeta.

Immune status with reference to the disease duration and genetic factors (HLA-typing) was studied in various clinical variants of insulin-dependent diabetes mellitus. The disease duration appeared the key factor in development of immune deficiency in insulin-dependent diabetes mellitus. Critical immunological values were established (CD5+ cells--1200 in 1 microliter, CD4+ cells--35%, expression of CD5 and antigens HLA class II--110 and 75%, respectively) for septic complications which are highly probable in lower indices. Females with diffuse thyroid enlargement, subclinical hypothyroidism, wide spectrum of antibodies to DNA, antigenic determinants of thyroid gland, hypophysis were found to be a group associated with HLA--DR3 carriage.

[The possibilities of using immunological indices as criteria for determining the stage of HIV infection and the disease prognosis]. / Vozmozhnosti ispol'zovaniia immunologicheskikh pokazatelei v kachestve kriteriev opredeleniia stadii VICh-infektsii i prognoza zabolevaniia.

The authors studied the immune status of 14 HIV-infected patients, 6 of whom had lymphadenopathy, 4 were diagnosed as having AIDS-related complex and 4, a full-blown AIDS. Analysis of laboratory findings showed that of predictive value are serum levels of immunoglobulin B, a CD4 cell count less than 200, reduced populations of CD20 and CD16 lymphocytes, and a depressed response to pokeweed mitogen. Based on the clinical manifestations and laboratory results, three stages characterizing the immune system in HIV infection have been identified.

[The immunomodulating action of extracorporeal treatment methods and the late effect from their use in patients with rheumatoid arthritis]. / Immunomoduliruiushchee deistvie ékstrakorporal'nykh metodov lecheniia i otdalennyi éffekt ikh primeneniia u bol'nykh revmatoidnym artritom.

Unlike hemocarboperfusion (HCP), plasmapheresis (PA) produces a long-term effect in the treatment of serious cases of rheumatoid arthritis. This explains why the rebound syndrome occurs in PA two times less frequently. The analysis of the immunomodifying action of both the treatments and comparison of their efficacy suggest the conclusion that long-term and complete remissions are associated with the immunosuppressive effects, while the development of exacerbations accompanies the immunomodifying effect. HCP stimulates the immune system, while PA can induce both stimulation and suppression. Therefore, HCP can be used as an adjuvant treatment of highly active rheumatoid arthritis before the basic therapy. In PA immunosuppressive effect, it may be used as an original treatment method.

[Cellular immunity function in HIV-1-infected persons]. / Izuchenie sostoianiia kletochnogo immuniteta u HIV-1 infitsirovannykh lits.

The data on the state of cell-mediated immunity in patients with AIDS-related complex are presented. The synthetic peptide of membrane protein gp120 of HIV-1 was shown to inhibit leukocyte adhesion in persons under examination, as well as to have the tendency towards inhibiting the chemotaxis of migratory cells. The maximum effect was achieved at a peptide concentration of 10(-6) M. The data obtained in this investigation suggest the presence of specific cell-mediated sensitization to the fragment of protein gp120, detected by the adhesion inhibition test with the use of spectrophotometric techniques and the capillary evaluation of the chemotaxis of migrating cells, in patients with AIDS-related complex.

[Inhibitor factors in the serum of patients with the AIDS-related complex]. / Ingibitornye faktory v syvorotke bol'nykh so SPID-assotsiirovannym kompleksom.

The data on the presence of factors blocking the reaction of E-rosette formation and leukocyte chemotaxis in the blood sera of patients with AIDS-related complex (ARC) and HIV-positive donors are presented. Most frequently the blocking of E-rosette formation coincided with the presence of a inhibiting effect on the migration capacity of leukocytes. This blocking activity was not linked with the presence of C-reactive protein in the circulation stream. The treatment of ARC patients with plasmapheresis and/or travolol was accompanied either by the disappearance of blocking activity or by the appearance of activity stimulating E-rosette formation.

[Tobacco smoking and beta-cell secretion]. / Tiutiunopushene i beta-kletuchna sekretsiia.

The beta-cell secretion was studied in 7 healthy volunteers (women) by a venous glucagon (1 mg) test. First the test was carried out without smoking and then repeated one week later on the background of continuous smoking (4 cigarettes at intervals of 15 min). The C-peptide was examined at the 0, 10, and 60, min. The mean age of the volunteers was 44.5 +/- 5.1 years and the mean body mass index was 24.22 +/- 1.9 kg/m2. The area of the stimulated insulin secretion under the C-peptide curve in the test on the background of smoking was significantly smaller than in the test without smoking (F = 5.09, p less than 0.05). The conclusion is that smoking exerts an unfavourable influence on the beta-cell secretion.