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Objectives: In the last few years an increasing frequency of diagnosed cases of HEV infections has been reported from various European countries. In recent years sporadic cases of HEV infections have emerged also in Bulgaria. METHOD‟s: In this retrospective study, 21 patients with acute viral hepatitis type E were included. To describe the clinical and demographic characteristic, we used information from cases recorded at the Clinic of Infectious Diseases, Military Medical Academy - Sofia, from January 2008 to December 2012. The diagnosis of HEV infection was confirmed by the finding of anti-HEV antibodies of class IgG and IgM (ELISA) in acute phase, and by disappearing of IgM anti-HEV in the convalescent period. Statistical analysis was performed using the chi-square test. RESULT‟s: Acute viral hepatitis E composes 5.8% of all acute viral hepatitis treated in Clinic of infectious diseases, MMA - Sofia. The mean age of the patients was 52.4 and 57.1% were males. The most frequent clinical signs were mild to moderate upper gastric symptoms (65%) and liver enlargement (91%). One of the patients was with coinfection HEV+HBV with signs of threatening acute hepatic failure. Another patient was a probable case of chronic HEV infection. The cholestasis enzymes (ALP and GGT) were elevated by most of the patients, but without clinical evidence of cholestasis. CONCLUSION‟S: Acute hepatitis E in Bulgaria emerges as an autochthonous infection with a low incidence rate. Most of the patients were with mild clinical form of acute viral hepatitis E. Patients with severe form have a history of chronic liver disease or co-infections. The question of probable chronic form of HEV infection was discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: In time of Global economic crisis it is necessary to estimate very precisely the cost for patient treatment so to avoid eventual losses for hospital. According to leading authors drug costs are evaluated between 10-40%. This imposes the necessity of using large range of economic and mathematical instruments for drugs cost control. OBJECTIVE: To assess the need of reducing drugs cost and on this base to propose computer model, adapted to HIS. MATERIAL AND METHODS: Data from Hospital Information System are used to calculate drugs expenditure in the most resource consuming unit in MMA - Anaesthesiology and Intensive Care Department for 5 year period. Statistic methods were used for extracting trends and evaluation. Questionnaire survey was conducted among 50 physicians in MMA, aimed to determine the main problems in drugs prescription. RESULTS: At the beginning of the studied period drugs cost was about 80% of the patient treatment and in the last year after introduced manager control it was reduced to 57%. Among the main reasons for high cost according to the survey are the lack of knowledge and ignorance of drugs prices by physicians. Using the capacity of HIS as an instrument for drugs cost control results in cost reducing up to 30%. CONCLUSIONS: Hospital Information System can play an important role in the reducing drugs costs, and it can help managers to control the process of prescription [ABSTRACT FROM AUTHOR]

INTRODUCTION: The frequency of skin and soft tissue infections (SSTIs) has increased over the last decade due to increased predispositions to those illnesses - diabetes, malignant diseases, obesity, varices, dermatomycosis, etc. MATERIALS and METHOD‟s: In this retrospective study we analyzed 368 military personnel with SSTIs, hospitalized in Clinic of infectious diseases of Military Medical Academy, Sofia for the period January 2006 - December 2012. The study population was grouped according to: gender, age, location of the exanthema, underlying comorbidities, immunodeficiency, risk factors, complications and recurrences. RESULT‟s and DISCUSSION: Of the 368 patients, 317 (86.1%) were male and 51 (13.9%) female, with mean age 32±6. The most common skin and soft tissue infections were erysipelas 198 (53.8%) followed by impetigo 82 (22.3%), cellulitis 44 (11.9%), post-operative wound infections 39 (10.6%) and necrotizing fasciitis 5 (1.4%). Most frequently was affected shank (63.3%), thigh (10.1%), face (10.6%), arm (8.5%), abdomen (4.8%) and chest (2.7%). Diagnosis was based on epidemiological, clinical, hystopatological and microbiological data. Among the isolates tested 185 (50.3%) were beta-hemolytic Streptococcus group A, followed by Staphylococcus aureus - 102 (27.7%); Streptococcus viridians 42 (11.4%); E. faecalis - 14 (3.9%); Haemophilus influenzae 11 (2.9%); P. vulgaris - 7 (1.9%); Ps. aeruginosa - 5 (1.4%) and B. cereus - 2 (0.5%). The approach of treatment has been guided by the microbiological type of SSTIs and the severity of clinical presentation. Given the increasing number of methicillinresistant Staphylococcus aureus, beta-lactam antibiotics are no longer reliable empiric therapy for SSTIs. As an alternative etiological therapy we used Vancomycin, Clindamycin, Rifampin, Meropenem, Linezolid, Daptomycin, Tigecyclime, Telavancin and Quinupristindalfopristin. Surgical treatment included incision, drainage and debridement applied in 24 (6.5%) patients. CONCLUSION‟s: The main problem was patients with SSTIs in age group 30-40, with obesity, metabolic disorders, heart diseases and frequent traumatism. There was statistically significant difference in clinical improvement between patients treated with beta-lactam antibiotics and those treated with Daptomycin, Tigecyclin and Telavancin. They can be alternative in parenteral treatment of patients with multiple predisposing SSTIs factors, complications, multiple recurrences and isolated Grampositive cocci. [ABSTRACT FROM AUTHOR]