Campylobacteriosis and other bacterial gastrointestinal diseases in Sofia, Bulgaria for the period 1987 – 2008

Campylobacter is the most commonly reported enteric bacterial pathogen in humans. We still do not have any systematic data concerning campylobacteriosis in Bulgaria. For that reason, we present data of the thermophilic Campylobacter jejuni and Campylobacter coli in the aetiology of diarrhoeal diseases in Sofia, for the period from 1987 to 2008. The study included patients from 0 to over 65 years-old. A total of 51,607 faecal specimens were screened for Campylobacter. C. jejuni and C. coli were detected in 3.58% (1,847) of the strains, with the highest percentage in 1988 (7.5%) and the lowest in 2006 (0.3%). Campylobacteriosis occurred most frequently in the wet months of March, April, May and June, with 105, 102, 124 and 141 cases, respectively, and was rare in January with 25 cases. The most affected groups were children between 0 and 4 years of age (52%) and between five and 14 years of age (30%). Campylobacter infection occurred in 22% of all bacterial gastrointestinal diseases in the city of Sofia during the study period. Salmonella was the most frequently identified pathogen with 32%, followed by Shigella (30%), Campylobacter (22%) and diarrhoeagenic Escherichia coli (16%). The study shows that Campylobacter plays an important role as a bacterial cause of enterocolitis in Sofia, Bulgaria.

Campylobacteriosis and other bacterial gastrointestinal diseases in Sofia, Bulgaria for the period 1987-2008

Campylobacter is the most commonly reported enteric bacterial pathogen in humans. We still do not have any systematic data concerning campylobacteriosis in Bulgaria. For that reason, we present data of the thermophilic Campylobacter jejuni and Campylobacter coli in the aetiology of diarrhoeal diseases in Sofia, for the period from 1987 to 2008. The study included patients from 0 to over 65 years-old. A total of 51,607 faecal specimens were screened for Campylobacter. C. jejuni and C. coli were detected in 3.58% (1,847) of the strains, with the highest percentage in 1988 (7.5%) and the lowest in 2006 (0.3%). Campylobacteriosis occurred most frequently in the wet months of March, April, May and June, with 105, 102, 124 and 141 cases, respectively, and was rare in January with 25 cases. The most affected groups were children between 0 and 4 years of age (52%) and between five and 14 years of age (30%). Campylobacter infection occurred in 22% of all bacterial gastrointestinal diseases in the city of Sofia during the study period. Salmonella was the most frequently identified pathogen with 32%, followed by Shigella (30%), Campylobacter (22%) and diarrhoeagenic Escherichia coli (16%). The study shows that Campylobacter plays an important role as a bacterial cause of enterocolitis in Sofia, Bulgaria.

Salmonellosis cases caused by a rare Salmonella Enteritidis PT6c associated with travel to Bulgaria, June-July 2008

In June 2008 an outbreak of gastroenteritis was registered in Sunny Beach resort situated on the Black Sea coast in Bulgaria, affecting 14 employees of a hotel, five of whom tested positive for Salmonella Enteritidis. During June-July 2008 four sporadic S. Enteritidis cases were also reported and two of them were foreign tourists. In the same period S. Enteritidis cases connected with travel to Bulgaria were reported to the European Centre for Disease Prevention and Control (ECDC) from Finland, United Kingdom, Sweden, Germany and Norway. We describe a study performed to find out relatedness between Bulgarian and Finnish S. Enteritidis isolates using phage typing (PT) and pulse-field gel electrophoresis (PFGE). Fifteen S. Enteritidis isolates from Bulgaria and 195 from Finland (including 28 from travellers to Bulgaria) were phage typed. Within Bulgarian isolates four different PTs were found and PT6c with eight strains was predominant. Nineteen out of 28 strains isolated from the Finns visiting Bulgaria belonged also to PT6c. PFGE typing (with one enzyme) of all S. Enteritidis PT6c strains (8 Bulgarian and 19 Finnish isolates) showed indistinguishable PFGE profile. The typing results thus demonstrated a link between Bulgarian and Finnish S. Enteritidis isolates. We conclude that S. Enteritidis PT6c was the cause of a salmonellosis outbreak in Sunny Beach and was exported to Finland, and likely to the United Kingdom, Norway, Sweden and Germany.

Salmonellosis cases caused by a rare Salmonella Enteritidis PT6c associated with travel to Bulgaria, June-July 2008

In June 2008 an outbreak of gastroenteritis was registered in Sunny Beach resort situated on the Black Sea coast in Bulgaria, affecting 14 employees of a hotel, five of whom tested positive for Salmonella Enteritidis. During June-July 2008 four sporadic S. Enteritidis cases were also reported and two of them were foreign tourists. In the same period S. Enteritidis cases connected with travel to Bulgaria were reported to the European Centre for Disease Prevention and Control (ECDC) from Finland, United Kingdom, Sweden, Germany and Norway. We describe a study performed to find out relatedness between Bulgarian and Finnish S. Enteritidis isolates using phage typing (PT) and pulse-field gel electrophoresis (PFGE). Fifteen S. Enteritidis isolates from Bulgaria and 195 from Finland (including 28 from travellers to Bulgaria) were phage typed. Within Bulgarian isolates four different PTs were found and PT6c with eight strains was predominant. Nineteen out of 28 strains isolated from the Finns visiting Bulgaria belonged also to PT6c. PFGE typing (with one enzyme) of all S. Enteritidis PT6c strains (8 Bulgarian and 19 Finnish isolates) showed indistinguishable PFGE profile. The typing results thus demonstrated a link between Bulgarian and Finnish S. Enteritidis isolates. We conclude that S. Enteritidis PT6c was the cause of salmonella outbreak in Sunny Beach and was exported to Finland, and likely to the United Kingdom, Norway, Sweden and Germany.

[Laparoscopic pelvic lymph node dissection-- method for prostate cancer staging]

INTRODUCTION

Laparoscopic pelvic lymph node dissection is recently widely used method for surgical staging for prostate cancer. The first case in urology has been reported in 1991 from Schuessler et al.

AIM

The aim of this study was to evaluate the surgical results from our first 20 cases of laparoscopic pelvic lymph node dissection. We analyze the operative time, blood loss, intraoperative et postoperative complications, number of lymph nodes, pain, hospital stay. To compare results of the first 10 and second 10 operations.

MATERIALS AND METHODS

Between April 2003 and December 2006 in our Clinic have been operated 20 patients with adenocarcinoma of prostate. Median age was 64.4 years. Median prostate specific antigen was 53.7 ng/ml. Clinical methods - digital rectal examination of prostate, transrectal ultrasound punction biopsy of prostate, level of hemoglobin in blood to evaluate the blood loss. Operative method - transperitoneal laparoscopic pelvic bilateral pelvic lymph node dissection.

RESULTS

Mean operative team for the first 10 cases was 178 minutes, and for the second 10 cases - 68.5 minutes. Hemotransfusion in first case only. No medication for pain in 6 cases, injectable medication in 7 cases and as tablet form in 3 patients. Median number of lymph nodes - 8 /0-15/. Median hospital stay 5,7 days/11-3/. No major complications, no conversion. One case of symptomatic lymphocele.

CONCLUSION

Laparoscopic pelvic lymph node dissection is a endoscopic method with short operative time, minimal blood loss, low level of pain, short hospital stay. The operative results are getting better after the first ten operations. This method is a useful for minimally invasive staging of prostate cancer.

Control by cytokinins of the cellular behavior in the plate meristem of zucchini cotyledons

The temporal and spatial effects of exogenous cytokinins on both cell expansion and division activity in the plate meristem of cultured zucchini cotyledons were studied. N6-benzylaminopurine (1-100 microM) and N-(2-chloro-4pyridyl)-N'-phenylurea (4PU-30) (0.1-100 microM) greatly stimulated the cell growth and division. They provoked multiple cell cycles, formation of larger clusters of daughter cells and an increase of the final number of cells. Both cytokinins led to earlier achievement of final cotyledon size and shortened the cell doubling time. By contrast to the purine cytokinin, phenylurea cytokinin 4PU-30 enlarged the cotyledon predominantly in length. Zeatin and kinetin were less effective, particularly in stimulating cell expansion. In low concentrations, all cytokinins were more effective in stimulating division activity rather than expansion. The cells in the cotyledon margins displayed a higher division activity, especially when treated with exogenous cytokinins. The final cotyledon and cluster areas were not of the strict proportional dependence upon the number of their cells. These results provide a novel example where stimulated cell division fails to evoke a respective increase in the final organ size.

Surveillance of human salmonellosis in Bulgaria, 1999-2004: trends, shifts and resistance to antimicrobial agents

This article analyses the distribution of resistant salmonella and resistance mechanisms among the most frequently encountered serotypes in Bulgaria. Culture, biochemical tests and serotyping were used for identification. Screening for resistance to 14 antimicrobial agents with the standard Bauer-Kirbi disk-diffusion method. The double disk synergy method was used to determine production of extended-spectrum â-lactamases (ESBL). Transfer of genes coding for ESBLs with experimental conjugation. Specific primers were used for PCR detection of bla-CTX-M, bla-SHV and bla-TEM. 245 resistant salmonella strains were determined in our study; the majority originated from sporadic cases of human illness or asymptomatic infection and the remaining 23 were isolated from outbreaks. 79 producers of ESBL were detected: 5 S. Enteritidis, 1 S. Typhimurium, 9 S. Isangi and 62 S. Corvallis with types of enzymes: CTX-M3, TEM and SHV. Gene coding for extended-spectrum â- lactamases were successfully transferred into a recipient Escherichia coli C1A strain simultaneously with genes coding for resistance to aminoglycosides and sulphonamides (for bla-CTX-M3) and gene coding for resistance to aminoglycosides and chloramphenicol (for bla-SHVand bla-TEM). PCR amplification revealed bla-CTX-M3 genes in S. Enteritidis, and bla-SHV and bla-TEM in S. Corvallis. Salmonellae have revealed increasing resistance to all clinically important groups of antimicrobial agents. Bulgaria is the first country in the world where ESBL in serotype Corvallis has been reported. A wide diversity of resistance genes is found among the leading serotypes of salmonella causing human disease in Bulgaria.

Surveillance of human salmonellosis in Bulgaria, 1999-2004: trends, shifts and resistance to antimicrobial agents

This article analyses the distribution of resistant salmonella and resistance mechanisms among the most frequently encountered serotypes in Bulgaria. Culture, biochemical tests and serotyping were used for identification. Screening for resistance to 14 antimicrobial agents with the standard Bauer-Kirbi disk-diffusion method. The double disk synergy method was used to determine production of extended-spectrum a-lactamases (ESBL). Transfer of genes coding for ESBLs with experimental conjugation. Specific primers were used for PCR detection of bla-CTX-M, bla-SHV and bla-TEM. 245 resistant salmonella strains were determined in our study; the majority originated from sporadic cases of human illness or asymptomatic infection and the remaining 23 were isolated from outbreaks. 79 producers of ESBL were detected: 5 S. Enteritidis, 1 S. Typhimurium, 9 S. Isangi and 62 S. Corvallis with types of enzymes: CTX-M3, TEM and SHV. Gene coding for extended-spectrum a- lactamases were successfully transferred into a recipient Escherichia coli C1A strain simultaneously with genes coding for resistance to aminoglycosides and sulphonamides (for bla-CTX-M3) and gene coding for resistance to aminoglycosides and chloramphenicol (for bla-SHVand bla-TEM). PCR amplification revealed bla-CTX-M3 genes in S. Enteritidis, and bla-SHV and bla-TEM in S. Corvallis. Salmonellae have revealed increasing resistance to all clinically important groups of antimicrobial agents. Bulgaria is the first country in the world where ESBL in serotype Corvallis has been reported. A wide diversity of resistance genes is found among the leading serotypes of salmonella causing human disease in Bulgaria.

[One-stage operation for multi-organ echinococcosis (bilateral pulmonary, hepatic and splenic) by sterno-laparotomy]

Between 1990 and 2001 in Thoracic Surgery Department at SHATPD "Saint Sophia"--Sofia a total of 821 patients with pulmonary hydatidosis were operated on. In 5 (0.6%) of them the cysts were situated in the both lungs, lever and spleen. For the first time in the surgical practice a sterno-laparotomy were carried out for one-stage cysts' removal in this multi-organ localization. The stages of this approach as well as the indications and contraindications for its applications are described in detail.

[Corection of pectus excavatum with total sternal turnover]

A case of 23-year-old man with Pectus Excavatum (grade II) is reported on. The functional cardiorespiratory impairment was a leading symptom. The technique of sternal turnover with preservation of a vascular supply based on the internal mammary pedicle is introduced for the first time in Bulgaria. All procedure steps are described. Nine months after the operation cosmetic and functional results are considered excellent.

The status of antimicrobial resistance of Helicobacter pylori in eastern Europe

OBJECTIVE

To evaluate the primary, secondary and combined resistance to five antimicrobial agents of 2340 Helicobacter pylori isolates from 19 centers in 10 countries in eastern Europe.

METHODS

Data were available for centers in Bulgaria, Croatia, the Czech Republic, Estonia, Greece, Lithuania, Poland, Russia, Slovenia and Turkey. Susceptibility was tested by agar dilution (seven countries), E test (five countries) and disk diffusion (three countries) methods. Resistance breakpoints (mg/L) were: metronidazole 8, clarithromycin 1, amoxicillin 0.5, tetracycline 4, and ciprofloxacin 1 or 4 in most centers. Primary and post-treatment resistance was assessed in 2003 and 337 isolates respectively. Results for 282 children and 201 adults were compared.

RESULTS

Primary resistance rates since 1998 were: metronidazole 37.9%, clarithromycin 9.5%, amoxicillin 0.9%, tetracycline 1.9%, ciprofloxacin 3.9%, and both metronidazole and clarithromycin 6.1%. Isolates from centers in Slovenia and Lithuania exhibited low resistance rates. Since 1998, amoxicillin resistance has been detected in the southeastern region. From 1996, metronidazole resistance increased significantly from 30.5% to 36.4%, while clarithromycin resistance increased slightly from 8.9% to 10.6%. In centers in Greece, Poland, and Bulgaria, the mean metronidazole resistance was slightly higher in adults than in children (39% versus 31.2%, P > 0.05); this trend was not found for clarithromycin or amoxicillin (P > 0.20). Post-treatment resistance rates exhibited wide variations.

CONCLUSIONS

In eastern Europe, primary H. pylori resistance to metronidazole is considerable, and that to clarithromycin is similar to or slightly higher than that in western Europe. Resistance to amoxicillin, ciprofloxacin and tetracycline was detected in several centers. Primary and post-treatment resistance rates vary greatly between centers.

[Post-cystectomy derivations - a rule or control of technical skills?]

Limitations in gaining better understanding of bladder tumor responsiveness do exist, and accordingly the therapeutic interventions undertaken in diverse forms of the disease are conspicuous for discrepancies (M. J. Droller, 1990). E. Bricker in 1950 is the first to practically implement ileal conduit for urine derivation, and thus initiates the new and newest continent derivations. Over the period 1992-1998, in the Chair of Urology are performed 76 cystectomies with different urine derivations, using seven methods for the purpose: [table: see text] Also discussed are the conditions a derivation should mandatorily meet. Emphasis is laid on the fact that the choice of derivation is still largely dependent on the skill and experience of urologists.

Molecular analysis of a new cytoplasmic male sterile genotype in sunflower

Mitochondrial DNA from 1 fertile and 6 cytoplasmic male sterile (CMS) sunflower genotypes was studied. The CMS genotypes had been obtained either by specific crosses between different Helianthus species or by mutagenesis. CMS-associated restriction fragment length polymorphisms (RFLPs) were found in the vicinity of the atpA locus, generated by various restriction enzymes. The organization of the mitochondrial genes 26S rRNA, 18S + 5S rRNA and coxII was investigated by Southern blot analysis. These genes have similar structures in fertile and all studied sterile sources. Using the atpA probe, 5 from the 6 investigated CMS genotypes showed identical hybridization patterns to the Petiolaris CMS line, which is used in all commercial sunflower hybrids. Only 1 cytoplasm derived from an open pollination of Helianthus annuus ssp. texanus, known as ANT1, contained a unique mitochondrial DNA fragment, which is distinguishable from the fertile and sterile Petiolaris genotypes and from all investigated CMS genotypes. Male fertility restoration and male sterility maintenance of the ANT1 line are different from the Petiolaris CMS system, which is a confirmation that a novel CMS genotype in sunflower has been identified.