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We conducted a Pubmed/Medline database survey of ethical decision-making models in medical practice and health care.

Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia, which is caused by impaired insulin secretion, insulin action, or both. Four complications of DM have been identified – diabetes microangiopathy including nephropathy, retinopathy and polyneuropathy and diabetes macroangiopathy. DM is diagnosed on the basis of one of the following criteria: 1. Presence of typical symptoms – polyuria, polyphagia, polydipsia, weight loss and accidental plasma glucose value ≥ 11.1 mmol/l. 2. Fasting plasma glucose level ≥ 7.0 mmol/l. 3. Oral Glucose Tolerance Test (OGTT) – 2-hour blood glucose level ⩾ 11.1 mmol/l. 4. Test for glycated hemoglobin HbA1c⩾6.5%. Regular monitoring of blood glucose is crucial for good control of diabetes. Two are the most commonly available methods for glycemic monitoring – 1) home self-assessment; 2) HbA1c test. In this paper we discuss the diagnostic and prognostic value of HbA1c in comorbid patients with DM and diseases, where there are deviations in hemoglobin and erythrocyte values. In the scientific literature, single reports are available that give scarce guidance on how to manage these patients. It is mentioned that anemia should be treated individually, however no data could be found on what should be the standard behavior in such patients. According to the American Diabetes Association, only the blood glucose should be used when the relationship between HbA1c and glycemia is altered. Because of the diverse gene pool of the US population, different variants of hemoglobin may interfere with HbA1c measurements, although tests in the USA are standardized. Discrepancies between HbA1c and plasma glucose should suggest that testing for HbA1c may not be reliable for a particular patient. We present a clinical case of a comorbid patient with DM and thalassemia minor, whose glycemic control with glycated hemoglobin HbA1c is unreliable.

Background. In an attempt to stop the distribution of falsified medicinal products, the EU has adopted Directive 2011/62/EU. Since 9th February 2019, each package of medicinal product must be given a unique number in combination with a mandatory indicator of integrity. The Directive requires the creation of a system of serialization and verification of the medicinal products.

Background. International guidelines for Chronic Obstructive Pulmonary Disease (COPD) propose the most cost-effective management of the disease. However, the management of COPD differs between countries and between clinics within the same country. The aim of the study is to examine prescription trends for COPD by pulmonologists from different regions in Bulgaria and to study prescription adherence to international guidelines in order to identify the reasons for potential deviations. Methods. A combined methodology is applied including documentary analysis for reviewing the normative basis for COPD treatment, sociological and mathematic-statistic methods Results. The results suggest that compliance to international COPD management-guidelines do not showed a tendency to guideline adherence. Main omission in the treatment patterns is the group of long acting bronchodilatators /LAAC and LABA/, which are the most important for the successful management of COPD Conclusions.. For the studied period the price of the therapy with LABA is very expensive and unaffordable for the COPD patients, because of their low incomes and the existing reimbursement restrictions In this case the pulmonologists prefer to prescribe LABA/ICS, even for the mild, moderate and severe COPD with no evidence repeating of exacerbations, because of their affordable price, although ICS are not recommended by the GOLD guidelines for these cases and often worse the symptoms. The xantines are recommended widely for all stages of COPD, because of their low price although they are not recommended because of their adverse drug reactions. This is a reason for the inadequate control of the disease in Bulgaria. [ABSTRACT FROM AUTHOR]