Extrahepatic Portal Vein Thrombosis in Childhood: Risk Factors, Clinical Manifestations, and Management.

OBJECTIVE: Extrahepatic portal vein thrombosis (EHPVT) is a common cause of portal hypertension in children. The aim of the present study was to identify the clinical manifestations and the risk factors for development of EHPVT in pediatric patients. SUBJECTS AND METHODS: This was a single-center retrospective cohort study. A total of 12 children (6 boys and 6 girls) took part in the study. We noted the clinical presentations and the predisposing risk factors for development of EHPVT in all patients. In addition, as all of them had undergone an esophagogastroduodenoscopy for detection and grading of esophageal varices as part of the treatment algorithm, we analyzed the endoscopic findings and the therapeutic approach. RESULTS: The median age of subjects at diagnosis was 3.5 years (range: 1-17 years). The most frequent initial clinical manifestation was upper gastrointestinal bleeding (6 cases, 50.0%) followed by splenomegaly (3 cases, 25.0%). The most frequent systemic risk factor for EHPVT was presence of inherited prothrombotic disorder (10 cases, 83.3%), and the most common local risk factor for EHPVT was umbilical vein catheterization (5 cases, 41.7%). Esophageal varices were revealed in all the study participants, and in the most cases, they were grade ≥2. Propranolol was used as primary or secondary prophylaxis in 7 children (58.3%), and in 5 children (41.7%), a shunt was performed (Meso-Rex bypass in 3 children and splenorenal shunt in 2 children). CONCLUSION: Patients with known systemic or local risk factors for EHPVT are indicated for proactive ultrasound screening for early diagnosis and timely management.

Incentives Motivating Mentors and Criteria for Selecting Mentors in the Pre-Graduation Traineeship of Future Registered Nurses.

BACKGROUND: Modern education in the field of healthcare is faced with the challenge of coping with one of the most important tasks - to develop in students a set of competencies which serve as a sound basis for mastering a series of job-specific knowledge, skills and abilities, and which constitute a guarantee for coping successfully with all everyday tasks. The attention of the mentor is focused on finding the most reasonable solution to the various situations that the trainee may find him/herself in, and ensuring emotional comfort. AIM: To identify the grounds and criteria for selecting mentors for the pre-graduation traineeships of the future registered nurses. METHODS: To determine the opinion of the mentors, we surveyed 106 mentors in several university hospitals: 'St. Georgi' University Hospital - Plovdiv, MPHAT AD - Haskovo, 'Dr. At. Dafovski' University Hospital - Kardzhali, University Hospital - Stara Zagora. RESULTS: During the pre-graduation traineeship in a real-life environment, students have the opportunity to develop and consolidate a series of skills, competences and qualities which are an integral part of the modern image of the registered nurse. Logically, the mentor should be the leading factor in the pre-graduation traineeship, yet the tutor has organisational and control functions. CONCLUSION: Mentors are expected to ensure patient safety, as well to create suitable working conditions for students.

Vulvovaginal Candidiasis in Pregnant Women and its Importance for Candida Colonization of Newborns.

UNLABELLED: Vulvovaginal candidiasis is the second most common cause of vaginitis worldwide (after bacterial candidiasis). Maternal vulvovaginal candidiasis is a major risk factor for Candida colonization and infection of the infant where prognosis depends on different predisposing factors. The aim of this study was to determine the incidence and the etiological structure of vulvovaginal candidiasis in pregnant women and its impact on Candida colonization of newborns. MATERIALS AND METHODS: Samples of vaginal secretions from 80 healthy pregnant women who were clinically suspicious for Candida vaginitis were collected within 48 hours before delivery. Samples for probable Candida colonization from the oral mucosa and feces were collected from their newborns within 47-72 hours after birth. Samples were plated on Sabouraud agar, followed by species identification by API Candida yeast assay. RESULTS: Twenty-three (28.75 ± 5.06%) of the evaluated pregnant women were positive for Candida spp. Positive samples for Candida colonization were found in 18 (22.22 ± 4.62%) of the examined 81 newborns (one pair of twins) from mothers who were clinically suspicious for vaginal candidiasis. Isolates of the newborns were 100% identical to those of the mothers' vaginal secretion. Candida albicans was the predominant species identified in the pregnant women (91.67 ± 0.06%) and in the neonates (83.33±8.78%).