Prevalence of antibodies against hepatitis C virus and hepatitis B coinfection in healthy population in Bulgaria. A seroepidemiological study.

AIM: Viral hepatitis C is often silent and is sometimes discovered only by routine serologic testing. We investigated healthy adults for seroprevalence of antibodies against hepatitis C virus (HCV), for markers of hepatitis B (HBV) coinfection and for risk factors of transmission blood borne viruses. METHODS: We performed a descriptive cross sectional study for the period 1999-2000. A caseload of 2,211 healthy randomly selected subjects (aged 10-69, both sexes) from a big Bulgarian city gave informed consent for participation and answered a standardized questionnaire. Serum samples were obtained and tested using ELISA method for anti-HCV antibodies, HBV markers (HBsAg, anti-HBc and anti-HBs antibodies), as well as for anti-HIV-1.2 antibodies. RESULTS: The overall anti-HCV seroprevalence was 1.08%, which coincides with the data submitted to WHO for the general Bulgarian population, as well as with the average data for Europe. Higher anti-HCV seroprevalence was ascertained with increasing age except in adolescents, in whom the anti-HCV positivity was high. A great part of the subjects with anti-HCV antibodies -- 62.5% had serological evidence for exposure to HBV. Anti-HCV carriage was in positive correlation with the summarized data for previous morbidity (surgery, blood transfusion and past liver disease), as well as with detecting markers for hepatitis B. In the studied caseload 0.68% had markers of double HCV and HBV infection. Nobody was found as seropositive for HIV-1.2. CONCLUSIONS: The results of our study suggest the need of more stringent measures for prevention and control of HCV infection, including screening focused on different groups of population, precise determination of risk factors for HCV transmission and offering of HBV vaccine to HCV positive individuals to reduce the high risk of double HCV and HBV infection.

Some characteristics of acute poisoning with psychoactive substances in the period of socioeconomic transition 1990-2000.

INTRODUCTION: Although scarce, the data about acute poisonings with psycho-active substances during the period of socioeconomic crisis in Bulgaria indicate the appearance and increase of the use of inhalants, prescribed and over-the-counter medications and the increase of acute poisoning rate with heroin. AIM: To ascertain some characteristics of acute poisonings with psycho-active substances in Plovdiv region from 01.01.1990 to 31.12.2000. MATERIAL AND METHODS: The whole caseload of 571 acute poisonings with psycho-active substances in Plovdiv region (8.8% of the population of the country) between 1990 and 2000, treated in the only Clinic of Toxicology in the region is studied retrospectively. The variables gender, age, type of psycho-active substance (DSM-IV criteria), grade of severity, duration of use, times of poisoning and some differences between alcohol and opioid poisonings are investigated. RESULTS: Acute poisoning with psycho-active substances are 5.43% of all intoxications. The moderate grade of severity (48.5%), alcohol (62.8%) and opioid (15.3%) intoxications, debut poisoning (86.8%) and poisonings occurring in the initial period of use predominate. An increase of acute poisonings with psycho-active substances in the last third of the studied period (1990-2000) is established--severe forms (2.59 times) and recidivistic intoxication (4 times). Alcohol and opioid poisonings predominate among severe intoxications. The hospital stay is relatively short--1.75 +/- 0.67 and hospital lethality is 1.6%. CONCLUSIONS: 1. The moderate grade of severity, alcohol and opioid intoxications (especially in the severe grade cases), occurrence in the initial period of use and relatively short hospital stay predominate in acute poisonings with psycho-active substances in the period of socioeconomic crisis. Hospital lethality (1.6%) is ascertained only in severe alcohol intoxication. 2. An increase of acute poisonings with psycho-active substances--severe forms, mild forms and recidivistic intoxications is established in the last third (1998-2000) of the studied period. The most expressed increase is ascertained in 2000. 3. Urgent complex measures are necessary to contain the spread of psycho-active substances and acute poisonings with them.

Acute poisoning mortality rate in Plovdiv Region, Bulgaria.

The severe recession in Bulgaria which followed the collapse of the totalitarian regime in 1989 had an unfavourable impact on the health status of the population. Systematic studies of acute poisoning mortality rate in the transitional period (1990-98) are scarce in the post-totalitarian Eastern European countries and are lacking in Bulgaria. This retrospective study analysed 1,150 deaths due to acute poisoning in Plovdiv Region for the period 1961-98. Acute poisoning mortality rate was moderately high in the period between 1990 and 1998 with respect to the average of 4.99 per 100,000 a year. It grew steadily during rapid socialist industrialization (1961-90) and showed a trend of slight decrease during transition (1991-1998). The decrease may largely be accounted for by the foundation of the regional toxicological centre and to a certain degree by a drop in industrial and agricultural production and exposure to hazards.

Characteristics of adult acute poisoning mortality in a large industrial-agrarian region of Bulgaria during socioeconomic transition and crisis (1990-1998).

The severe socioeconomic crisis in Bulgaria, accompanying the transition after the collapse of the totalitarian regime affected unfavorably the health status of the population, increasing the incidence of socially important diseases by making poverty, unemployment, emigration, alcoholism and drug addiction widespread. Systematic studies of acute poisoning suicide and poisoning mortality still lack. To analyze acute poisoning (AP) characteristics during this period in a large industrial-agricultural region of Bulgaria, we retrospectively examined 327 adult AP deaths in Plovdiv region 1990-1998. Males (73.1%) prevail in all age categories. As a caseload men predominate in "working age" categories, women in "pre/retirement age". Mortality rates tended to increase with age, more marked in men. The main cause of death from AP was alcohol intoxication in men (30.1%) and drugs in women (33.7%). Suicides prevailed over accidents (54.1% vs. 45.9%). Accidents were significantly higher in men, suicides in women; 57.5% received no medical aid for more men than women (61.9% vs. 45.5%). Untapped resource for decreasing AP mortality rates are patients who do not receive medical aid and die at home, although that is difficult to correct in a period of crisis.

Psychopathology and psychosocial causes in adult deliberate self-poisoning in Plovdiv region, Bulgaria.

INTRODUCTION: The percentage of deliberate self-poisoning among acute intoxications continues to be high in the medical practice worldwide; in Plovdiv region it reaches 64% of all acute poisoning cases. MATERIAL AND METHODS: A representative retrospective study of 311 acute deliberate self-poisoning cases over 14 years of age, treated in the Regional toxicological center of Plovdiv region between 01.01.1990 and 31.12.1998 was carried out. The following factors were studied: gender, age, type of poisoning, psychiatric diagnosis and psychosocial stressors. The classification criteria of Diagnostic and Statistical Manual--4th edition (DSM-IV) of the American Psychiatric Association were applied. RESULTS: We identified a first attempt of deliberate self-poisoning in 237 patients (71.6%) and a second consecutive attempt in 62 patients (18.7%). Thirty two (9.7%) of the attempts were committed in a state of alcohol intoxication. The percentage of women was statistically significantly higher. The age group of 14-19 years represented the highest percentage (27%). In 168 patients (50.8%) a psychiatric disorder was diagnosed. Adjustment disorder (53.57%) and depressive and schizophrenic disorders (26.79%) were the leading diagnoses among adults committing deliberate self-poisoning. The problems with primary support group (in 61.8% as a single stressor and in 13.71% in combination with other stressors) were the most common psychosocial factors for deliberate self-poisoning. CONCLUSIONS: To reduce the number of adult deliberate self-poisonings, measures including harmonization of the relationships in the primary support group and active treatment of patients with depressive and schizophrenic disorders are needed.

Our experience in the treatment of acute Amanita phalloides poisoning.

INTRODUCTION: The present study aimed at investigating phalloid mushroom poisoning and the toxicological aid services in Plovdiv region as this pathology shows in this country high mortality rate (40-100%) and increasing incidence; it is difficult to diagnose and is far from featuring adequately in the literature in our country. MATERIAL AND METHODS: A caseload of 270 patients with mushroom poisoning from Plovdiv region, Bulgaria, admitted for treatment to the Clinic of Toxicology, Higher Medical Institute, Plovdiv, for the period 1991-1998 was studied. Of these 270 patients 25 (9.26%) had an acute phalloid poisoning. The following indicators were registered: gender, age, reported type of consumed mushrooms, time of appearance of the first complaints after the mushroom consumption, time of medical aid, disease outcome. The diagnosis and the applied treatment was based on our own diagnostic-therapeutic protocol for phalloid intoxication. RESULTS: All phalloid poisoning cases were accidental by character. The most frequently reported type of ingested mushroom was unidentified wild edible mushrooms. Of all the patients males were 56%, females--44% with mean age of 47.71 years (SD = 17.53). From 25 phalloid poisoning cases 15 survived (60%), 10 died (40%). The summer-fall seasonal pattern of phalloid poisoning occurrence was apparent. The mean duration of the latency period was 12 hours (SD--6.66). In 4 (16%) patients the disease exhibited an unusually early onset--up to 2 hours after the mushroom ingestion. The mean time period from the mushroom ingestion to the presentation in a medical institution for first medical aid was 32 hours (SD--21.69), for men--27.59 hours, for women--43.75 hours. Almost one third (32%) of the diseased presented for medical help more than 36 hours after the poisoning. CONCLUSIONS: The acute mushroom poisoning cases in adults comprise 7.01% of the total acute poisoning caseload. The phalloid poisoning accounts for 9.26% of the total number of patients with mushroom poisoning admitted for treatment. The application of contemporary diagnostic-therapeutic protocol lowers the hospital lethality rate from phalloid poisoning to 40%. There were no statistically significant differences in the compared parameters between the subgroups of patients with favorable and lethal outcome and between the subgroups of men and women--most probably due to the small sample. In order to lower the incidence and mortality rate from phalloid mushroom poisoning the authors recommend preventive health education on the problem, targeting the population at risk and the introduction of contemporary diagnostic and treatment methods--determining the amatoxins, intravenous application of Silibinin and liver transplantation.