INSUFFICIENCY OF LEVOTHYROXINE THERAPY IN AUTOIMMUNE HYPOTHYROIDISM: EFFECT OF GLUCOCORTICOID ADMINISTRATION.

OBJECTIVE: The non-effectiveness of levothyroxine administration in hypothyroidism depends on many factors and mechanisms influencing its absorption in small intestins or bounding of circulating hormone with different active molecules. METHODS: Thyroid hormones, TSH, rT3, TGl, TPO-Ab, TG-Ab, were measured using commercially available assays. For anti-T4ab, radioiodine-labeled T4 was added to the patient's serum and the IgG fraction subsequently precipitated by addition of 15% polyethylene glycol. Background was determined by testing 100 control sera from individuals without autoimmune thyroid disease. RESULTS: A 42-year old woman (71.5 kg) with Hashimoto thyroiditis receiving levothyroxine (L-T4) 150 µg and liothyronine (L-T3) 37.5 µg was admitted to the hospital with clinical data of hypothyroidism, TSH-23.8 mU/L, FT4-6.18 pmol/L (n.range 9-19 pmol/L), TPO-Ab 696 IU/mL, TG-Ab 818 IU/mL, circulating T4- antibodies positive. She has a good adherence to medication, malabsorption or administration of other drugs were excluded. L-T4 absorption test revealed 44% increase of serum FT4 at 120 min after ingestion of 150 mcg L-T4 (2.1 mcg/kg). Methylprednisolone pulses of 500 mg i.v. administered in three consecutive days at equal doses of L-T4/L-T3 resulted in a rapid increase of FT4 to 14.5 pmol/L, fall of TSH to 0.18 mU/L and decrease of anti-T4 antibodies to referent range; TPO-Ab and TG-Ab also decreased significantly. Monotherapy by 150 mcg L-T4 was continued in the next three months. A recurrence of hypothyroidism with increase of circulating T4-Ab was observed 100 days later. New administrations of methylprednisolone two pulses of 500 mg revealed a similar normalization of thyroid hormones and anti-T4 antibodies. CONCLUSION: The data showed that T4-antibodies might be a cause of insufficient effects of levothyroxine therapy in autoimmune hypothyroidism. This could be overcome by glucocorticoid administration probably resulting in FT4 release from circulating immune complexes.

[Hygiene research in solving the health aspects of urban development]. / Khigiennite prouchvaniia v reshavaneto na zdravnite aspekti na urbanistichnoto razvitie.

The urban development and the problems it raises at present, are in direct relation with the conditions, which affect considerably the health of the population. The territorial and settlement system, the urban planning on ecological basis, the new methods of building in applying polymeric materials, the conditions of the environment in health establishments, the regulations of the physical factors, noise and electromagnetic energy are subject to the hygienic studies, in which the Institute of Hygiene and Occupational Health is engaged. The connective unit in the variety of the mentioned fields of investigation is the health of the inhabitants and finding the right way in its protection and keeping. The attitudes of prophylaxis, the creation and establishing of urban environment, corresponding to the conflict-free existence and potentiation of the health development of the inhabitants, are clarified, as they are related to the basic trends of the world Health Organization, whose targets are "Health for All by the year 2000".

[Changes in the chemical properties of environmental air in contact with polymeric construction materials used in modern buildings]. / Vurkhu niakoi promeni na khimichnite kachestva na vuzdushnata sreda, kontaktirashta s polimerni stroitelni materiali (PSM), izpolzuvani v suvremenite sgradi.

Sanitary and chemical studies of 15 types of polymeric building materials, used in the construction of modern establishments as floor coverings, lining and roofing materials, isolating materials and pastes. Elimination of chemical substances of the polymeric building materials is established. In the first days after their production or use the concentrations of the eliminated substances are considerably above the MAC--with some of the tens and hundreds times above the hygienic norm. MAC of the eliminated polymeric building materials is reached for different periods of time, as the latter define also the quarantine dates for permitting the usage of the materials. For materials which point out to considerable deviations of the norms on the first days after production or use a new instruction for technical safety is required. The diffused floor coverings on epoxide basis, paste "Pirolik" and some types of ligneous surfaces on the basis of carbamide-formaldehyde pitch, received unfavourable hygienic assessment. They show elimination of chemical substances considerably above MAC, even after more than 9 months of their production.

[Pathomorphology and histokinesis of the changes due to Eimeria in turkey poults experimentally infected with Eimeria adenoeides]. / Patomorfologiia i khistokinez na eimerioznite izmeneniia pri puicheta, eksperimentalno invazirani s Eimeria adenoeides.

Studied were the morphologic changes in an experimental Eimeria adenoeides infection in turkey-poults. The birds were killed daily from the 1st to the 10th day of infection, keeping records of the gross lesions and the microscopic changes in the internal organs. It was found that Eimeria adenoeides performs two cycles of shisogony in the caeca. Most severe were the changes on the 4th and 5th day of infection, which corresponded to the second shisogony and the gametogonia. At the same time there were in the liver, kidneys, and heart granular protein dystrophy which was believed to be a second one, being the result or resorption of toxic cell detritus products in the intestines.

[Changes in the physical environmental factors in modern buildings related to the use of polymeric construction materials]. / Vurkhu niakoi promeni na fizicheskite parametri na sredata v suvremennite sgradi, svurzani s izpolzuvaneto na polimerni stroitelni materiali.

The polymeric materials are used on a large scale in building and furnishing of modern edifices. However, in spite of the doubtless positive effect there are a number of important hygienic problems, related to the ability of these new materials, at unregulated and not controlled usage, to cause unfavourable changes in the parameters of the environment and through them to affect the health and spirits of the inhabitants. The basic hygienic problems in the application of polymeric building materials /PBM/ are derived from the elimination of harmful chemical substances from the latter. Besides of great importance are the changes in the physical parameters of the environment in the premises of the edifices, arising from the accumulation of static electricity on the surface of the PBM, the aggravated thermal technical characteristics of some materials, etc. The results of the hygiene investigations for thermal protective properties of different types of PBM, used as floor covering and their effect on the thermal metabolic processes and colds of the inhabitants are pointed out. The biological effect of static electricity and the dependence of the electrification of the materials on the composition and the physico-chemical nature of the materials and some microclimatic parameters and other exploitation conditions are clarified. Recommendations are given for the preliminary hygienic control of these materials, in order to avoid the aggravation of the parameters of the environment in the modern buildings.

[Histokinesis in experimental ovine cysticercosis]. / Vurkhu khistokinezata pri eksperimentalna ovisna tsistitserkoza.

The dynamic of the morphologic changes taking place in the viscera of lambs was followed up in lambs with an experimental Cysticercus ovis infection. The tests were carried out with 6 two-month-old lambs infected with 30,000 ova of Taenia ovis each. The animals were killed on the 2nd, 4th, 12th, 54th, and 70th day of infection, taking notes on the gross and microscopic changes in the internal organs. It was found that in the predilection sites of localization the migrating oncospheres were transformed into cysticerci around which specific granuloma were formed from the center to the periphery, consisting of eosinophile leukocytes, epitheloid and gigantic cells, lymphocytes, lymphoid cells, and outermost--a connective tissue capsule. As the result of the abundant leukocyte infiltration the cysticerci quickly perished and a suppurant was formed instead that later on was replaced by connective tissue.

[Inhibitory effect of oil emulsions on the oocyst infectiveness of Eimeria tenella]. / Potiskashto vliianie na niakoi masleni emulsii na invazionnostta na ootsisti na Eimeria tenella.

Comparative studies were carried out on the inhibitory effect of some oleoemulsions on the acute course of an experimental coccidial infection caused by Eimeria tenella. Such effect was demonstrated with the oral application of sporulated oocysts both with the complete and incomplete Freund's adjuvant and with oleum ricini and oleum helianthi in combination. The results of histopathologic investigations showed that the two types of Freund's adjuvant inhibited the rapid and joint excysting of a large number of oocysts. Inhibited was the invasion of sporozoits in the epithelial cells of the mucous membrane and thus the acute course of the coccidial infection caused by Eimeria tenella.

[Several current hygienic problems in residential and recreational environments--results of studies during the 7th five-year-plan]. / Niakoi aktualni khigienni problemi na sredata za obitavane i otdikh - rezultati ot prouchvaniia prez sedmata petiletka.

Dwelling and rest - two of the basic elements of life activity, draw now-a-days the attention of state, political, economic and scientific bodies and organizations in our country. The care of man in our society is expressed in such a formation and protection of the environment that could guarantee adequate conditions for dwelling and rest at present and in the future. The hygienic problems, associated with that type activity, include planning and construction of new settlement systems studies on the deleterious and favourable physical factors (noise, vibration, electromagnetic fields, natural solar radiation), mode of construction, equipment and exploitation of residential and administrative buildings. They are the object of the present paper, which presents, in a summarized way, the experience of the research work at the laboratory "Physical factors of the environment, planning and construction in settlements", at the RIHOD, carried out during the seventh 5-year period. Some results are presented that have an essential share in the new approach to the hygienic standardization and regulation of the qualities of the environment for dwelling and rest.

[Clinical aspects, pathomorphology and histokinetics in experimental Eimeria acervulina infection in chickens]. / Vurkhu klinikata, patomorfologiiata i khistokinezata pri pileta, eksperimentalno zarazeni s Eimeria acervulina.

Experiments were carried out with birds experimentally infected with Eimeria acervulina. It was found that this causative agent was responsible for catarrhal to hemorrhagic enteritis, however, the feces did not contain blood despite their becoming watery. In the duodenum it was shown to accomplish schizogony three times: the first schizogony took place up to the 72nd hour, the second one--up to the 120th hour, and the third one--up to the 168 th hour. On the other hand, gametogony started at the 168 th hr. Most severe lesions in the mucosa were found on the 7th-8th day following infection. They coincided in time with the third generation of schizonts and the gametogony. The alteration processes in the mucous membrane affected the villi to a larger extent than the propria mucosae. Villi regeneration proceeded from the 9 th to the 12 th day. The prepatent period lasted 144 hours. Macrophages were not found to carry the sporozoites to the glands. Dystrophic and necrobiotic changes in the viscera predominated over the proliferation processes, and this made it reasonable to believe that the basic moment in the pathogenesis of the disease was the mechanical destruction of the epithelial cells of the villi as well as the adsorption of toxic products from the decomposition of the necrotic cell mass in the intestinal lumen. Eimeria acervulina was said to produce pathogenic, but not lethal effects.

[Action of sodium sulfachlorpyrazine (ESB3) on the endogenous development of Eimeria tenella in the experimental infestation of chickens]. / Prouchvane deistvieto na sulfakhlorpirazin-natriia (ESB3) vurkhu endogennoto razvitie na Eimeria tenella pri eksperimentalna invaziia na pileta.

Studies were carried out on the action of sulfachlorpyrisine-Na (ESB3) on the endogenic development of Eimeria tenella in the case of experimental infection in birds. Most sensitive to the preparation were the endogenic forms between the 48 h and the 72 nd following the act of infection. Given to birds on the day of infection and 24 hours later it produced no harmful effect on the further endogenic development of E. tenella. When the preparation was applied at the 72 nd hour it led to the degeneration of most of the II generation schizonts and inhibited their further development. As a result no oocysts were found in the feces of birds up to the 10 th-11 th day after infection. When applied at the 92 nd and the 120 th hour sulfachlorpyrisine-Na interfered with the development of the already finite forms of gametogony without concurrent degenerative effects.

[Hygienic evaluation of the effectiveness of short-term suburban recreation from the viewpoint of natural climatic and demographic factors]. / Khigienna otsenka na efektivnostta na kratkovremenniia kraigradski otdikh s ogled na prirodoklimatichnite i demografskite faktori.

The importance of recreation grew considerably with the increase of leisure time and cultural level of the workers. In our country, on the other hand, there are no complete hygienic studies on the problems of organization and necessary equipment for recreation. In that connection, hygienic-urbanization, hygienic-sociological, microclimatic and physiological studies, as well as investigations on ultraviolet radiation, level of noise and extent of air pollution in some typical recreation places (Sofia and Varna) were carried out. Better conditions were established in nature - town ourskirts environment (as regard ultraviolet radiation, noise level, degree of air pollution, temperature-humidity and radiation microclimate) and their favourable effect on the physiological functions of organism (particularly as regards thermoregulation and cardiovascular system). A dependence was also established between the population recreation needs and social-demographic and nature - climatic factors. Tangible recommendations for the improvement of the state of short-term town outskirts recreation in Sofia and Varna are proposed on the base of the results.

[Hygienic evaluation of the planning and construction of housing complexes]. / Khigiena otsenka na planiraneto i stroitelstvoto na zhilishtni kompleksi.

Three blocks of flats were the subject of this study. They have been projected and built at different periods and the study covers the following principal aspects: sanitary urbanization analysis, assay of some of the basic environmental physical factors and physiologic reactions of the human organism and atmosphere contamination. These blocks of flats are still unable to provide wholy adequate sanitary conditions, in conformity with the urbanization setup, edifice situating, planning and organization of public services on the territory and anthropogenic factors. For an optimal environment one should take into consideration all sanitary requirements early in the process of projecting blocks of flats.