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Background: The patient’s immune response is one of the major factors influencing HBV eradication or chronification, and it is thought to be responsible for the treatment success.

Introduction. Hepatitis E is one of the leading clinical manifestations of acute viral hepatitis in developing countries. In industrialized countries, during the past several years, sporadic “autochthonous” cases of HEV infection have been increased. Objective. The aim of this study was to analyze the epidemiological, clinical and laboratory features of HEV infection among patients hospitalized at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria. Methods. A retrospective study of 806 cases of acute viral hepatitis was performed at the Department of Infectious Diseases in Military Medical Academy, Sofia, Bulgaria, between December 2004 and September 2012. The etiological diagnosis was established by ELISA. The statistical analysis was performed using Excel 2007 (Microsoft, Redmond, Washington, USA) and SPSS Statistics 19.0 (IBM Corp., Armonk, New York, USA). Results. Specific reaction to anti-HEV-IgM and anti-HEV-IgG antibodies were detected in 20 (2.48%) of 806 patients. The most observed clinical presentations were jaundice (85%), fatigue (85%), anorexia (65%), abdominal discomfort (55%) and fever (40%). The mean values of aspartate transaminase and alanine transaminase were 521 IU/l and 881 IU/l, respectively. The cholestasis was slight, marked with mean values of gamma-glutamyl transferase and alkaline phosphatase, respectively 418 IU/l and 486 IU/l. Conclusion. We report twenty autochthonous sporadic cases of acute infection with HEV. The zoonotic etiology of the virus as well as the foodborne transmission of the infection is discussed. We found that aging and pre-existing underlying diseases are risk factors for a severe course of the HEV infection.

Spending of financial resources in the public sector is a major challenge for any government. Mainly part of it is a healthcare expenditure. Health and education are the base of today's prosperity. The cost of healthcare is rising permanently since the middle 20th century. The question is whether this trend has been continued after the crisis of 2007-2008. We analyzed the cost of health services between the G-7 and several developing countries. The review showed that all countries increase their health care costs despite. Countries like USA, Canada and Japan have good results whereas Mexico, China and India are with the worst indicators. Despite the ambitions and claims for progress China and India remain poor and undeveloped, a fact supported by most significant indicator such as GDP per capita. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Hepatitis E is an infl ammatory liver disease caused by hepatitis E virus (HEV). It is one of the leading clinical manifestations of acute viral hepatitis in developing countries. In industrialized countries, during the past several years, sporadic “autochthonous” cases of HEV infection have been increased. METHODS: A retrospective study of 806 cases with acute viral hepatitis was done for the period from December 2004 to May 2012. The patients were hospitalized at the Department of Infectious Diseases in Military Medical Academy, Sofi a (Bulgaria). The full number of laboratory investigations was done. The etiological diagnosis was established by serological tests: enzyme-linked immunosorbent assay (ELISA). The statistical analysis was performed by Excel 2007 and SPSS Statistics 19.0. RESULTS: All patients are Bulgarian. The specifi c anti-HEV-IgM and anti-HEV-IgG were found in 20 (2,48%) patients. The leading clinical presentations were jaundice (17/20), fatigue (17/20), anorexia (13/20), abdominal discomfort (11/20) and fever (8/20). Mean value of Aspartate transaminase and Alanine transaminase are 521 IU/L and 881 IU/L, respectively. The cholestasis was slight with mean value of Gamma-glutamyl transferase and Alkaline phosphatase respectively 418 IU/L and 486 IU/L. CONCLUSION: The presented cases are autochthonous. It's discussed the zoonotic etiology of the virus, food-borne and water-borne transmission of the infection. The clinical and laboratory presentation is similar as the others acute viral hepatitis. The severe course is associated with elderly man and pre-existing underlying disease. [ABSTRACT FROM AUTHOR]

Introduction: SARS-CoV-2 infection is spreading around the world, including countries from Southeastern Europe. The purpose of the study was to present the clinical manifestations of COVID-19 patients admitted to the Military Medical Academy, Sofia, Bulgaria. Materials and Methods: A retrospective study was conducted for a period of 3 months from March 2020 to June 2020 on this infection in our hospital. All participants were laboratory confirmed cases of COVID-19. RT-PCR was performed for etiological diagnosis. The hospitalized patients were divided into two groups on admission, that is, nonsevere and severe. Results: One hundred thirty-eight COVID-19 patients were hospitalized and analyzed during the study period. The mean age was 52.9 years. Male was the dominant sex (sex ratio: male/female = 1/0.6). The leading clinical signs were fever, fatigue, cough, and headache. On comparative analysis of both groups (nonsevere and severe) was measured significant elevation of white blood cells (odds ratio [OR] = 1.238; p value = 0.006), C-reactive protein (OR = 1.021; p  < 0.001), creatinine (OR = 1.037; p  < 0.001), aspartate aminotransferase (OR = 1.014; p  = 0.040), lactate dehydrogenase (OR = 1.004; p  < 0.001), ferritin (OR = 1.002; p  < 0.001), fibrinogen (OR = 2.028; p  < 0.001), and d-dimer (OR = 2.162; p  = 0.002) in severe group than in nonsevere group. Interleukin 6 was tested in 17.4% of patients and high value was found-38.6 pg/mL (95% confidence interval: 16.5-60.7). Conclusion: The first Bulgarian retrospective study of COVID-19 hospitalized patients was presented. Older age, male sex, comorbidity, and signs of dyspnea and nausea were estimated as higher risk factors for severe form. Abnormality in inflammatory markers was associated with poor progression of the illness.