POS1009 COMPARING OF DISEASE ACTIVITY, FUNCTION AND QUALITY OF LIFE IN PATIENTS FROM THE CLINICAL AND IMAGING ARM OF NONRADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background

The concept of axial spondyloarthritis (axSpA) and non-radiographic axSpA (nr-axSpA), a subgroup of axSpA, has recently emerged. There are several studies proving the similar levels in disease activity and quality of life in patients with or without structural damage in spondyloarthritis.

Objectives

The aim of this study is to compare disease activity, functional status and quality of life in patients from the clinical and imaging arm of nonradiographic axial spondyloarthritis in Bulgaria.

Methods

A cross-sectional survey was conducted with rheumatologists and their consulting patients in Bulgaria from February 2012 through April 2019. Patients who had a rheumatologist confirmed diagnosis of nr-axSpA were eligible to participate. An information about patient demographics and symptoms duration were collected. Acute- phase reactants, patients’ reported data for disease activity (BASDAI), functional status (BASFI) and quality of life (ASQoL) were compared between the patients with or without MRI data for sacroiliitis. The level of significance was set to 0.05.

Results

A total of 98 patients from the imaging arm of nonradiographic arm and 62 patients from the clinical arm of nr-axSpA patients were included in this analysis. A higher proportion of patients from the imaging arm were male patients (51% vs 37%). The mean age was 33.8±7.71 in the imaging arm and 34.12±6.95 in the clinical arm (p>0.05), with mean symptoms duration in both groups- respectively 0.76±0.26 and 0.48±0.13 years (p>0.05). The mean value of C-reactive protein in the imaging arm was 14.81±28.59 and 7.05 ± 10.04, p=0.02 in both groups. The disease activity determined using patients reported data from BASDAI was 4.1±0.67 vs 4.01±0.78 (p>0.05) and using ASDAS-CRP 2.31±0.87 vs 2.05±0.52 (p>0.05) in the imaging and clinical arm. The evaluation of the function BASFI was 5.06±1.28vs 4.48±1.18, p>0.05 in both groups of patients with nr-ax SpA. The QoL, determined by ASQoL revealed non statistical significant values between the groups – 4.79±3.27 and 5.18±3.03, p>0.05.

Conclusion

Patients from the imaging and clinical arm of nr-axSpA share the same clinical features. The burden of the disease, as assessed by ASQoL measurement, is also similar in the investigated subgroups of Bulgarian nr-axSpA patients.

References

[1]Doward LC, Spoorenberg A, Cook SA et al. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 2003;62:20-26.

[2]Ivanova, M., Dimitrov, S., Hristova, S., Dimitrov, A., Kadinov, V. and Stoilov, R. 2018. COMPARATIVE CHARACTERISTICS OF PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS AND ANKYLOSING SPONDYLITIS. Rheumatology (Bulgaria). 26, 3 (Sep. 2018), 3-10.

Disclosure of Interests

None declared

AB1143 MUSCULOSKELETAL PAIN AS A PART OF THE RHEUMATIC SPECTRUM IN COVID-19

Background

Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) (1), our understanding of the underlying pathophysiology is constantly evolving in order to explain the wide range of heterogenic clinical manifestations (2). Nevertheless, limited data are available for the severity and multifactorial causality of musculoskeletal pain in COVID-19 patients (3).

Objectives

This study aimed to evaluate the prevalence and intensity of rheumatic pain symptoms – arthralgia and myalgia and their association with anxiety and depression in a cohort of COVID-19 patients, hospitalized at the COVID-19 rheumatology department of the University Hospital St. Marina, Varna, Bulgaria.

Methods

In the present single-center cohort study, а prospective analysis was performed among COVID-19 patients who were hospitalized from 1 Oct 2021 to 20 Jan 2022 and self-reported for new-onset of musculoskeletal pain. All 226 patients (age 26 - 91 years) were treated for moderate or severe SARS-CoV-2 infection confirmed by laboratory tests, including positive antigen test or polymerase chain reaction (PCR) test, and imaging modality. Detailed disease history and clinical examination were carried out by a fully certified rheumatologist. All patients who reported new-onset of musculoskeletal pain during the acute phase of the infection, participated on a voluntary basis in a questionnaire survey, by completed Zung self-rating anxiety scale (SAS), Zung self-rating depression scale (SDS) and visual analogue scale (VAS) for arthralgia and myalgia. The questionnaire form also elicited information on sociodemographic characteristics of the patients. In all patients, inflammation and thrombotic biomarkers were assessed. The level of significance was set to 0.05.

Results

Among all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n = 121), were men. Mean age was 65.6 years. We found a significant correlation of depression and anxiety scales scores with pain intensity (both arthralgia and myalgia), all < 0.001. A multiple regression analysis found that SDS and SAS accounted for significant variance in the prediction of muscle pain (β = 0.441, p < 0.001; β = 0.293, p = 0.003, respectively) while SDS significantly predicted joint pain (β = 0.341, p = 0.043). On the other hand, musculoskeletal pain does not correlate with any of inflammation and thrombotic biomarkers assessed in SARS-CoV-2 patients (p > 0.05).

Conclusion

Rheumatic pain manifestations are part of the heterogeneous spectrum of COVID-19 disease. The pain intensity is significantly associated with anxiety and depression symptoms and does not correlate with inflammation and thrombotic biomarkers.

References

[1]Meng Lv et al. Coronavirus disease (COVID-19): a scoping review. Euro Surveill. 2020;25:2000125

[2]Kutsuna S. Clinical Manifestations of Coronavirus Disease 2019. JMA J. 2021;4:76-80

[3]Ahmed S et al. COVID-19 and the clinical course of rheumatic manifestations. Clin Rheumatol. 2021;40:2611–2619

Disclosure of Interests

None declared

AB1163 ATTITUDES AND HESITANCY IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES TOWARDS SARS-CoV-2 VACCINATION: A SINGLE-CENTER STUDY FROM BULGARIA

Background

Bulgaria is among the countries with the lowest vaccination rate of adult population in Europe. The presence of autoimmune rheumatic disease could further contribute to vaccine hesitancy and skepticism and influence patients’ attitudes towards vaccination [1, 2]. However, little is still known about the willingness and particular causes of hesitancy in patients with inflammatory joint diseases in the skeptical part of adult population across Europe.

Objectives

Our goal was to assess the rate of SARS-CoV-2 vaccination among patients with immune-mediated rheumatic joint diseases receiving biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) and to determine the modifiable predictors of vaccination hesitancy.

Methods

Patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis undergoing biological or targeted synthetic DMARDs therapy were consecutively selected and included in this single-center cross-sectional study. Excluding criteria in patients were psychiatric or neurological disease preventing understanding or responding to the questions, being illiterate, or not willing to participate in the study. Various demographic, anthropometric, and clinical data were collected. Disease activity was determined using DAS28-CRP for rheumatoid arthritis and peripheral psoriatic arthritis and ASDAS for ankylosing spondylitis and psoriatic spondylitis. All patients were given a questionnaire assessing their vaccination status, hesitancy, and attitude towards vaccination. Binary logistic regression analysis was used to analyze the relationship between self-reported modifiable parameters and vaccination status for SARS-CoV-2.

Results

Two hundred and one participants were eligible for participating in the study with mean age and BMI of 54.6 years and 28.2, respectively. Of these, 40.3% were women; 30.3% had rheumatoid arthritis, 17.9% - psoriatic arthritis, and 51.7% - ankylosing spondylitis. 29.4 % of all participants had already survived a COVID-19 infection with a mean time of 8.4 months since the COVID-19 onset. Only slightly above 1/3 (35.8%) of the study group was fully vaccinated and the majority of them were vaccinated with BNT162b2 (68.1%). Among the modifiable factors, we identified preceding discussion with a rheumatologist, hesitancy due to autoimmune disease presence and (un)awareness of vaccine safety and efficacy as significant predictors of vaccination status

Conclusion

Our data suggest that there are still possibilities to influence rheumatic patients on their decision to vaccinate against SARS-CoV-2 in Bulgaria. Raising the awareness of the safety and efficacy of the SARS-CoV-2 vaccines and spending more time on the education of patients with rheumatic diseases may positively affect their attitude towards vaccination.

References

[1]Gaur P, Agrawat H, Shukla A. COVID-19 vaccine hesitancy in patients with systemic autoimmune rheumatic disease: an interview-based survey. Rheumatol Int. 2021;41(9):1601-1605

[2]Georgiev T, Angelov AK. Complexities of diagnosis and management of COVID-19 in autoimmune diseases: Potential benefits and detriments of immunosuppression. World J Clin Cases. 2020 Sep 6;8(17):3669-3678

Disclosure of Interests

None declared

AB0224 SUSTAINABLE LOW DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: REAL-WORLD EXPERIENCE WITH TOCILIZUMAB

Background:

Sustainability, the ability of drugs to maintain remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA), plays a crucial role for the prevention of structural damage to joints and thus, preserving patients’ functional capacity, health-related quality of life and general sense of well-being. Therefore, studying the sustainable effectiveness of tocilizumab (TCZ) as a monotherapy or combined with methotrexate (MTX) is important (1).

Objectives:

We aimed to examine to what extend TCZ, alone or combined with MTX, could achieve and further sustain LDA in patients with long-standing RA in the light of current, strictly index-based definitions of LDA and to compare the two versions of DAS28 in patients in real clinical practice

Methods:

85 RA patients treated with TCZ for at least eighteen months were consecutively enrolled in the present single-center, retrospective cohort study. All participants met the 1987 ACR classification criteria and attended the rheumatology department of University Hospital “St. Marina” Varna in an outpatient setting. Patients receiving pre-filled syringe contained 162 mg TCZ once weekly subcutaneously. Real-world data were extracted and analyzed from patient’s full medical file. For each visit, disease activity score 28 with ESR and CRP (DAS28-ESR and DAS28-CRP) and simple disease activity index (SDAI) were calculated simultaneously according to generally adopted formulas. A twelve-month result was determined for sustained LDA at each of the patient’s three visits (at 6-month intervals), according to DAS28 and SDAI. Descriptive statistics, Chi square test, Cochran´s Q test, kappa statistic were used, a binary logistics model was compiled to study the impact. Significance level of p <0.05.

Results:

Two hundred fifty-five patient visits were analyzed. The mean durations of RA and treatment with TCZ were 12.6 (±9.6) years and 3.64 (±1.8) years, respectively. The mean age of patients was 60.3 years (37-87 years), 80% were women, 24.7% were obese, 65.9% have concomitant hypertension. 61.2% of patients are treated with combination therapy TCZ with MTX.

Of all patients, these with a sustained 12-month LDA were 41.2%, 28.2% or 23.5% depending on the studied index (DAS28-CRP, SDAI, or DAS28-ESR, respectively).

A 12-month SDAI LDA was found in a significantly small proportion of patients (28.2%, p = 0.001). The DAS28 ESR determined a proportion similar to SDAI (23.5%, p> 0.05), while according to the DAS28 CRP, patients with a sustained 12-month LDA were significantly more (41.2% p = 0.005). A moderate level of agreement was found between the assessments of SDAI and the two variants of DAC28 when determining 12-month results of Tocilizumab treatment (DAS28-ESR k = 0.511, p <0.001 and DAC28-CRP k = 0.618, p <0.001). No relationship was found between the combination of TCZ with MTX and the patients’ chance of a sustained 12-month LDA, regardless of which index the result was measured.

Patients with hypertension were significantly less likely to have sustained 12-month LDA according to SDAI and DAS 28 ESR (OR 0.135, 95% CI 0.048-0.386; OR 0.313, 95% CI 0.111-0.882, respectively), but not according to DAS28 CRP.

Conclusion:

Sustained 12- month LDA with TCZ in patients with long-term RA remains uncommon in daily clinical practice. Co-administration of MTX is not associated with an increased likelihood of achieving a sustained LDA in the analysis of long-term responses. Patients with concomitant hypertension are less likely to be in a sustained 12-month LDA, according to SDAI and DAS28-ESR. The results according to DAS28 ESR, but not according to DAS28CRP are comparable to those of SDAI when measuring long-term results of treatment with TCZ.

References:

[1]Hamann PDH, Pauling JD, McHugh N, Shaddick G, Hyrich K; BSRBR-RA Contributors Group. Predictors, demographics and frequency of sustained remission and low disease activity in anti-tumour necrosis factor-treated rheumatoid arthritis patients. Rheumatology (Oxford). 2019 Dec 1;58(12):2162-2169.

Disclosure of Interests:

None declared

POS1224 RHEUMATIC MANIFESTATIONS IN COVID-19 PATIENTS - SINGLE-CENTER EXPERIENCE AMIDST THE PANDEMIC

Background:

Recently evolved from a monochromic flu-like disease to a polysyndromic “spectrum of disease”, our understanding of coronavirus disease 2019 (COVID-19) is still far from being complete [1]. Hyperinflammation involving not only the lungs but also the musculoskeletal system, skin, cardiovascular, genitourinary systems is immune-mediated resembling the flares of a full-blown rheumatic disease [2,3].

Objectives:

To describe the prevalence and type of rheumatic manifestations in a cohort of COVID-19 patients hospitalized in the COVID-19 rheumatology department in University Hospital St. Marina, Varna, Bulgaria.

Methods:

In the present single-center cohort study, а retrospective database analysis was performed among all COVID-19 patients hospitalized from 1 Dec 2020 to 22 Jan 2021. All 243 patients (age 19 - 93 years) were treated for moderate or severe SARS-CoV-2 infection confirmed by laboratory tests, including positive polymerase chain reaction (PCR) test, and imaging modality. Inpatient treatment included antibiotics, dexamethasone, anticoagulants, and antiviral drug remdesevir (optional). Detailed disease history and clinical examination were carried out by a fully certified rheumatologist and/or specialist in internal medicine.

Results:

Among all 243 COVID-19 patients, those with prominent self-reported myalgia and arthralgia were 26% (n = 63) and 21.3 (n = 52), respectively. We had 4 (1.6%) cases of newly developed cutaneous vasculitis and 2 (0.8%) cases of severe Raynaud’s phenomenon after SARS-CoV-2 infection onset. Two patients experienced severe muscle weakness, had elevated creatine phosphokinase, and were diagnosed with inflammatory myopathy secondary to COVID-19. Lupus-like syndrome was observed in 2 (0.8%) patients.

Conclusion:

Rheumatic manifestations are part of the heterogeneous spectrum of COVID-19 disease. Amidst the COVID-19 crisis, each newly onset rheumatic manifestation warrants exclusion of SARS-CoV-2 infection. Therefore, a rheumatologist should be a part of a multidisciplinary approach towards the COVID-19 treatment.

References:

[1]Misra DP, Agarwal V, Gasparyan AY, Zimba O. Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets. Clin Rheumatol. 2020;39(7):2055-2062

[2]Georgiev T, Angelov AK. Complexities of diagnosis and management of COVID-19 in autoimmune diseases: Potential benefits and detriments of immunosuppression. World J Clin Cases. 2020;8(17):3669-3678

[3]Ciaffi J, Meliconi R, Ruscitti P, Berardicurti O, Giacomelli R, Ursini F. Rheumatic manifestations of COVID-19: a systematic review and meta-analysis. BMC rheumatology. 2020 Dec;4(1):1-5.

Disclosure of Interests:

None declared

AB0368 TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITH BELIMUMAB – PROSPECTIVE OBSERVATION OVER 2 YEARS

Background:

Systemic lupus erythematosus (SLE) is autoimmune connective tissue disorder of unclear etiology. It is characterized by autoantibody production and a variety of clinical manifestations. The introduction of biological treatment over the past few years provided an opportunity for a disease control.

Objectives:

The aim was to assess the effectiveness and safety profile of Belimumab in the treatment programs of SLE patients during a 2 year period.

Methods:

We initiated a prospective observational study of SLE patients in the Rheumatology Department in University Hospital St Marina – Bulgaria. The study comprises data from 26 patients at baseline before Belimumab treatment initiation and data after 6, 12, 18 and 24 months of treatment. All patients were with moderate disease activity according to SELENA – SLEDAI index and were on treatment with immunosuppressive drug (azathioprine) and glucocorticoids (GCs). We observed the change in the dosage of glucocorticoids over the observed period, the number of flares of SLE, as well the SELENA – SLEDAI index change. Safety profile of Belimumab was also registered.

Results:

We included 26 patients with SLE over a period of 4 years – between 2015 and 2019. The mean age was 45.8 + 11.4 years and 94% were Caucasian females. All patients were on a stable dosage of GCs at least 3 months before the first infusion of Belimumab and azathioprine 100 mg daily. Ninety percent of patients were diagnosed with SLE for more than 6 years according to ACR – SLE criteria. All of SLE patients were with moderate disease activity. Main reasons for biological treatment decision were persistent mucocutaneous manifestations (20%), polyarthritis (15%), haematological disturbances (35%) and persistent immunological markers (30%). One patient was excluded from the study due to infusion- related flush and severe hypotension reaction while the rest 25 completed the observation. We investigated and analyzed haematological results, ANA, anti – ds DNA, anti – Sm autoantibodies and complement fractions at baseline as well on the 12th and 24th month of treatment. The mean SELENA – SLEDAI index changed from 8.9 to 4.5 after 12 months of treatment and remained unchanged until the end of the study. We observed a mean reduction of GCs daily dosage from 12 mg to 6 mg after 18 months.

Conclusion:

Biological treatment with Belimumab added to the standard treatment with GCs and AZA in patients with non-lupus nephritis SLE patients adds additional benefits. Our results show that there is a reduction in SLEDAI index as well as reduction in daily GCs intake. Safety profile is not different from the one reported previously.

Disclosure of Interests:

None declared

Dynamics of excited state proton transfer in nitro substituted 10-hydroxybenzo[h]quinolines

The ground state tautomerism and excited state intramolecular proton transfer (ESIPT) of 10-hydroxybenzo[h]quinoline (HBQ) and its nitro derivatives, 7-nitrobenzo[h]quinolin-10-ol (2) and 7,9-dinitrobenzo[h]quinolin-10-ol (3), have been studied in acetonitrile using steady state as well as time dependent spectroscopy and quantum-chemical calculations. In addition to the enol form absorbance in the range 360-390 nm, the absorption spectra of 2 and 3 exhibit a red shifted band at ∼450 nm. Chemometric data processing, based on individual band decomposition, allowed us to estimate the position of the ground state enol-keto tautomeric equilibrium (ΔG values of 1.03 and 0.62 kcal mol^-1 respectively for 2 and 3). The fluorescence stems from the keto form even if the enol form is optically excited as proven by the shape of the excitation spectra indicating that ESIPT takes place. The Stokes shift of the substituted compounds is substantially lower compared to HBQ, which follows from the fact that the substitution occurs in the formal cyclohexa-2,4-dienone moiety and leads to a decrease of the HOMO level of the keto tautomer. The pump-probe experiments show that in the nitro substituted HBQs 2 and 3 ESIPT occurs with a time constant of 0.89 ps and 0.68 ps, respectively. In both cases a mixture of the enol and proton transfer forms is optically excited. The enol form exhibits then the ESIPT and subsequently both fractions take the same relaxation path. We propose that in 2 and 3 the ESIPT path exhibits a potential energy barrier resulting in an incoherent rate governed process while in HBQ the ESIPT proceeds as a ballistic wavepacket motion along a path without significant barriers. The theoretical calculations (M06-2X/TZVP) confirm the existence of a barrier in the ground and excited states as result of the substitution.

10-Hydroxybenzo[h]quinoline: switching between single- and double-well proton transfer through structural modifications

Proton transfer in HBQ and modified compounds was investigated experimentally (steady state absorption and emission spectroscopy, NMR and chemometrics) and theoretically (DFT and TD-DFT M06-2X/TZVP calculations) in ground and excited singlet state.

EPIDEMIOLOGICAL REGISTRY OF NEUROENDOCRINE TUMORS IN BULGARIA--A PILOT SURVEY

The National registry of patients with neuroendocrine tumors (NET) in Bulgaria was established in 2013 as a joint initiative of the Bulgarian Surgical Society and the Institute for Rare Diseases. The register aims to explore the epidemiology of NET in Bulgaria, as well as the different diagnostic and treatment approaches for the disease throughout the country. This the first of its kind retrospective study of NET in the country is covering the period January 2012 - January 2013. A total of 127 patients with NET were identified. At the time of the survey the average age of patients with NET was 58.61 ± 15.59 years. The data show almost equal distribution between the genders with a slight predominance of women. The largest relative part of NET is those of NET located in the gastrointestinal tract (54.10 ± 4.51%), followed by those located in the pancreas (12.30 ± 2.97%) and in the lungs (10.66 ± 2.79%). In 72.44 ± 3.96% of the patients a immunohistochemical diagnosis was performed. The study confirmed the leading role of the surgery method of the NET management. In 65.83 ± 4.33% of the patients a radical removal of the tumor was conducted, while the relative part of the undertaken partial resection was 7.50 ± 2.40%. A statistically significant association between the type of surgical treatment and during the follow-up of patients was found. An update of the information in the register will allow a more precise determining of the distribution and management of NET in Bulgaria.

Evaluation of the clinical value of the newly identified urine biomarker HIST1H4K for diagnosis and prognosis of prostate cancer in Bulgarian patients

PURPOSE

Searching for diagnostic and prognostic biomarkers for prostate cancer (PC) is main public health priority. DNA methylation in body fluids is a stable, easily detectable and promising PC biomarker. The major advantages of urine-based assays are their noninvasive nature and the ability to monitor PC with heterogeneous foci. The aim of this study was to determine the diagnostic value of the recently identified candidate PC biomarker HIST1H4K.

METHODS

We investigated DNA methylation of HIST1H4K in urine samples from 57 PC patients, 29 controls with benign prostatic hyperplasia (BPH) and 50 young asymptomatic men (YAM) by MethyLight real-time PCR.

RESULTS

The frequency of HIST1H4K promoter hypermethylation significantly discriminated PC patients from YAM (AUC =0.763; 95% CI 0.672-0.839; p<0.0001), but did not show any statistical difference between PC patients and BPH controls (AUC=0.513, 95% CI 0.402-0.622; p=0.8255). HIST1H4K could not outperform the prostatic specific antigen (PSA) in our sample (AUC=0.785; 95% CI 0.679-0.870; p<0.0001). Methylation of HIST1H4K showed significant correlation with aging (r=0.5418; p<0.0001), but with no other clinicopathological characteristics.

CONCLUSION

The results suggest that the promoter hypermethylation of HIST1H4K is rather due to aging than related to prostate carcinogenesis. To elucidate this observation analysis of larger samples is needed.

[Orbital lymphoma]

INTRODUCTION

Orbital lymphomas are neoplasms with increasing incidence in recent years in immunocompromised, as well as immunocompetent patients, which defines their social importance.

AIM

To describe and analyze the experience of the University hospital "'Sv. Ivan Rilski" with the treatment of this pathology for the period 1997-2008.

MATERIAL AND METHODS

Fourteen patients (8 females, 6 males - 13 primary orbital lymphomas, 1 systemic lymphoma). Mean age at diagnosis was 65.6 years (from 50 to 80 years). In 2/3 of the patients the lesion was localized in left eye, without a case with bilateral orbital involvement. Seven cases the diagnosis was made 6 months from the onset of symptoms, 5 cases - 1 year and 2 cases - more than one year. The most common clinical symptoms were exophthalmus (12 case), tumor or bulging mass of the eyelid - 8, diplopy - 6, decreased visual acuity - 5. Intraconal localization of the tumor was in 6 cases, extraconal - 2. intra-extraconal - 6. The diagnosis was made by neuro-ophthalmologist and precised with the aid of CT and MRI. All the patients were operated on with the following approaches - fronto-orbital - 9 cases, lateral - 3, anterior orbitotomy (without bone resection) - 2 cases. In six cases "'gross total" resection was achieved, in the rest of the cases the resection was partial. On histological examination, a high grade lymphoma was established in 2 cases with primary orbital lymphoma and one case with systemic lymphoma. All other cases were diagnosed as low-grade B-call small lymphocytic non-Hodgkin's lymphoma. Long-term survival (over 5 years) was observed in 4 cases with primary lymphoma, whereas the patient with systemic form of the disease died 10 months after the operation.

Clinical study of the effect of the preparation DEODAN on leukopenia, induced by cytostatics

The aim of the study is to establish the effect of the preparation DEODAN on leukopenia induced by chemotherapeutics in oncological patients. DEODAN is an oral preparation, obtained from lyzozyme lysates of Lactobacillus bulgaricus strain "I. Bogdanov patent strain tumoronecroticance B-51" ATCC 21815, called shortly LB51. In the study there are included two groups of patients--from National Oncological Centre, Sofia, the other from Clinic of Medicine, Bertha Academic Hospital, Clinics of Duisburg, Duisburg. All the patients, (78) have undergone combined chemotherapy. In all patients, leukopenia has been established in moderate and medium levels. The scheme of the application of DEODAN has been 3 g, three times a day before meals, from the first day of establishing the disturbances of the haemopoesis. The treatment lasted until the restoration of the haematological values. Only DEODAN was applied. The results obtained show that the recovery of the WBC count (values above 3000) took place in all of the patients between days 3 and 5. None of the patients displayed any infectious or febrile complications, as a result of the applied chemotherapy and the treatment with the preparation. DEODAN also improves the general condition of the patients.