News and Media

The results of a retrospective study published in the Journal of the American College of Cardiology show that the patients with critical limb ischemia who took statins had a significantly lower incidence of major adverse cardiac events (MACE) and amputations.

The register of patients with peripheral arterial disease (PAD) from 2006 to 2012 was analized and 380 cases were selected with at least one episode of critical limb ischemia confirmed by angiography with or without endovascular therapy. The average age in the study group was 69 years and the mean follow-up period – 409 days.

The patients were divided into two groups according to whether they are receiving (65%) or not (35%) statins prior to the episode of critical ischemia. The most commonly used statins in the study were simvastatin and atorvastatin.

In the group on statin the frequency of concomitant diseases (diabetes, hypertension, coronary heart disease, myocardial infarction, carotid stenosis, or stroke) was significantly higher.

Despite the higher comorbidity, after one year of follow up of patients receiving statin, the combined endpoint of myocardial infarction, stroke, and mortality was significantly lower (18%) compared with those who were not taking a statin (23%) before and after the incident of critical limb ischemia.

Interesting here is that the mortality is the main factor that determines the difference in frequency of MACE – 15% mortality in the presence and 21% in the absence of statin therapy

The combined risk of death or amputation of a limb is reduced by half when taking a statin.

The survey results support the recommendations in recent clinical guidelines that the administration of statins is indicated for all patients with PAD, even when the disease is in the final stage.

Despite all the strong evidence of the benefit of statins, only 65% ​​of patients in this retrospective study were taking statins. This indicates that the application of the guidelines for behavior in clinical practice has not yet reached the required level.

Tchaikapharma High Quality Medicines Inc. offers on the Bulgarian market the following statins:

Simvacor (Simvastatin) – CF 710 – 10 mg 

Simvacor (Simvastatin) – CF 711 – 20 mg

Simvacor (Simvastatin) – CF 712 – 40 mg

Atorva (Atorvastatin) – CF 996 – 10 mg 

Atorva (Atorvastatin) – CF 997 – 20 mg

Scientists from the Edinburgh University announced that they had found the mechanism that allows breast cancer to spread to the lungs, wrote The Guardian.

The team of scientists found that blocking it in mice with the disease reduced the number of secondary tumors in the lungs. The researchers hope that their achievement would lead to new therapies to stop the breast cancer development. The reason for the majority of deaths in this form of cancer is the penetration of malignant cells in other body parts, the lungs being the first organs affected.

The team from the Centre for Reproductive Health at the University has researched the role of an immune cell called a macrophage in relation to the spread of cancerous cells from the primary tumor. Previous studies have shown that cancer cells use macrophages to penetrate into the lungs. The new study found that macrophages communicate with the cancer cells through chemokine signaling molecules. When these signals in mice are blocked, the number of secondary tumors decreases by up to two thirds. Moreover, the suspension of the signal stopped the entry of malignant cells in the lungs through the bloodstream and prevented the already entrenched cells to form new tumors.
Cells in the human body use chemokines signals to communicate with each other, which gives hope that as a result of the discovery new treatments for other body parts can be created.

The party Patriotic Front (PF) would propose a change in the Hospitals Act with which to establish a Register of Medical Errors. This was announced by MP Dr. Sultanka Petrova. Building the system had been discussed for years, leading specialists and the Doctors’ Union had kept demanding that from time to time, but it hadn’t taken place up to that moment. The last to speak of this Register were the new leaders of the professional organization, according to whom this would be finalized in two years’ from that time.

“At the moment we have no idea who goes wrong and how, but when the Register starts running, it will become clear where the problems are rooted – to what extent they are due to the lack of motivation, specialization or professional exhaustion,” indicated Dr. Petrova. She added that the doctors at fault should be removed for a certain period from the system and continue their education. But the details of this process had to be put down in an Ordinance.

The Institution better known as the medical State Agency “National Security” announced: “The creation of the Register is established in the updated Health Strategy 2014 – 2020 as one of the priorities which the Executive Agency ‘Medical Audit’ should work on”. According to it, one first needs to start with a clarification of the terminology in this area – i.e. to adopt a clear and unambiguous concept of what a medical error is and its varieties. The Agency added that it was necessary to classify the errors, so they could be reported. Experts said that if there was a good organization and cooperation between doctors, nurses, patients and control officers for a year and a half or two, the Registers might start working. “And its purpose is to serve as information for all workers in the system. Moreover, the medical community has to regularly get acquainted with the analysis of the results from the Register, to draw the necessary conclusions and to prevent errors’ re-admission”, maintained “Medical Audit”. The public would also be informed.

The Supervisory Board of the National Health Insurance Fund is expecting from the BMA proposals for solving the problem of clinical pathways overspending. This became clear from the words of the member of the Supervisory Board Dr. Evgeni Tasovski. “We look at where the pain is, and this is the spot that is to be treated. And as good diagnosticians, we have let the BMA find the problem, so they should propose the solutions. The doctors themselves have to be analyzed, not the administrative structure, the problems have to be systematized and there has to be an indication what is to be done,” he said.

Dr. Tasovski said that the Medical Association had requested data on which were the most expensive pathways, how much were the overspent funds, and which hospitals had been overspending. He noted that at the meeting between the two parties a few days ago a decision had been reached by the experts of the professional organization and the NHIF to get together and discuss lighter measures than lowering the prices. The situation would be discussed again in two weeks from that time, said the supervisor.

When asked whether the NHIF had not come up with any suggestions to the BMA about which pathways could be transferred from hospital to outpatient services and if analysis had been made on what the savings would come up to, Dr. Tasovski said that no such proposals had been made. According to him, only the Manager of the Health Fund Dr. Glinka Komitov had presented ideas in this regard, but they had not yet been fully formed before the supervisor and the doctors. According to him, Dr. Komitov most likely would be ready the week after. Dr. Tasovski added that at that time there had been no talk about reducing the prices of pathways. “Supervision does not want to display force, but simply wants to show an understanding of the BMA,” he said.

Many people called their personal doctors to enroll for a checkup after the Health Minister Dr. Petar Moskov said that if routine preventive checkups were skipped, there should be a higher health insurance, announced the GPs.

Even now there is a fine of BGN 50 for skipping the annual checkup provided for in the Health Insurance Act. It has not come into practice as no health minister has so far developed a mechanism for its implementation.

“Increasing health contributions is a good step as a disciplinary measure, but all the details have to be taken into consideration,” said Assoc. Prof. Lyubomir Kirov, chairman of the National Association of General Practitioners. He added that everyone had to follow the rules, and the same way doctors were fined for violations, patients should be sanctioned as well. If the raise of health insurance contributions were paid by the insured, not the employer or the state, for example, there would be a real effect. Prof. Kirov explained that the state paid the contributions for pensioners, children, students, the unemployed and if the measures were automatically applied, the sanction would be distributed among all taxpayers.

Over 50% of Bulgarians over 18 do the mandatory annual preventive checkup at their GPs office, according to the Association. In the last Frame Contract the price for the check up had been increased to BGN 10, and the funds set aside for preventive examinations covered just over half of the insured. Separate are the tests that are not provided for independently, but have to be appointed within the common regulatory standard by the GP. If now 2 million people decide to do the examination, for example, this means at least BGN 40 million more, estimated the Association.

Some go on their own initiative, others – due to a particular health problem, and within the visit are done the preventive examinations as well. They include various activities and tests, depending on the age group.

There should be constant awareness campaigns in the media, because things just got forgotten, said Assoc. Prof. Kirov. Despite everything, however, we should not expect that the prophylactics at the GP office could cover the fully insured.

The expectation that preventive examinations could “detect” all diseases is not realistic as well. The point is to get the picture about the risk or the patients with the major diseases: hypertension, diabetes, certain cancers, obesity, etc. They affect more and more young people and it is important to detect them on time – thus preventing complications, improving the quality of life and lengthening the years of working efficiency.

Assoc. Prof. Kirov emphasized that a lot of patients still thought that the GP should look for them for the preventive check-up. This was a delusion left over from previous times. Patients’ health was their personal responsibility, so they had to be the active side. The GP was required only to declare at a noticeable place in his office what kind of preventive examinations and tests are to be done and with what frequency for the insured over the age of 18.

The GPs themselves have remarks on the amount and scope of the planned examinations and tests. Cholesterol and triglycerides tests, for example – a sign of cardiovascular disease and metabolic syndrome – are provided only for men over the age of 40, and then every five years.  Women do this test only after the age of 50 and also with a period 5 years in between.

Assoc. Prof. Kirov explained that this did not suffice and did not provide the sought preventive effect. At the initiative of the Association it was accepted in 2009 that all Bulgarians over the age of 18 should undergo such an examination, and a questionnaire for every patient had to be a filled out during the preventive checkups. Assoc. Prof. Kirov added that they had provided the software and that upon filling out the data from the checkup it immediately indicated the percent of patient risk for various diseases.

The goal was for 2-3 years to cover all and to present a complete picture of the health problems of the population, in order to provide the necessary prevention and therapies. This was done for only 1.5 years, and the opportunities for accurate statistics on people with hypertension, metabolic syndrome, diabetes and other socially significant diseases, were missed.