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Хроничната обструктивна белодробна болест е причина за заболяемост и смъртност в световен мащаб. Наличието на възпалителни маркери в циркулацията, храчките и бронхоалвеоларната течност предполага, че системното възпаление е един от потенциалните механизми, отговорни както за обструктивната белодробна болест, така и за метаболитния синдром. Циркулиращите маркери на възпалението, от друга страна, са тези, за които е установено, че могат да предскажат и бъдещи сърдечно-съдовите събития. Една от основните причини за повишения кардиоваскуларен риск при пациенти с хронична обструктивна белодробна болест и метаболитен синдром е хипергликемията. Тя индуцира оксидативен стрес и впоследствие микро- и макроваскуларни усложнения. Настоящият обзор има за цел да проследи механизмите, чрез които метаболитният синдром оказва влияние върху дългосрочните резултати при пациенти с хронична обструктивна белодробна болест и сърдечно-съдова патология. Chronic obstructive pulmonary disease is a cause of morbidity and mortality worldwide. The presence of infl ammatory markers in circulation, sputum, and broncho-alveolar fl uid suggest systemic infl ammation is one of the potential mechanisms responsible for both chronic obstructive pulmonary disease and metabolic syndrome. Circulating markers of infl ammation, on the other hand, are those that have been found to predict future cardiovascular events as well. One of the main causes of increased cardiovascular risk in patients with chronic obstructive pulmonary disease and metabolic syndrome is hyperglycemia. It induces oxidative stress and subsequently micro- and macrovascular complications. This review describes in details the various components of metabolic syndrome and its impact on long outcomes in chronic obstructive pulmonary disease and cardiovascular pathology.

В нашата институция постъпи пациент с диагноза сърдечен тумор, най-вероятно миксом, в дясното предсърдие, открит при ехокардиография. Направи се изследване с кардиомагнитен резонанс, което показва хомогенно мастно съдържание, мастна пролиферация и хипертрофия по стената на дясното предсърдие и междупредсърдната преграда, без обхващане на овалната ямка и имитираща тумор с дефект в изпълването и с лека компресия на долната и горната празна вена. С помощта на техниките на двойна и тройна инверсия, магнитно-резонансната томография може да даде тъканно специфична диагноза, в случая мастно еквивалентна лезия по типа на липом или липоматозна хипертрофия, и по този начин да спести допълнителни изследвания и да предопредели терапевтичния подход. A patient was admitted to our institution with a diagnosis of a cardiac tumor, most likely myxoma, in the right atrium, detected at echocardiography. The cardio-magnetic resonance examination was performed and depicts a homogeneous fatty content, fatty proliferation and hypertrophy along the wall of the right atrium and the interatrial septum, sparing the oval fossa and mimicking a tumor with a filling defect and with slight compression of the inferior and superior vena cava. With the help of double and triple inversion techniques, magnetic resonance imaging can give a tissue-specific diagnosis, in this case a fat-equivalent lesion of the type of lipoma or lipomatous hypertrophy, and thus save additional studies and predetermine the therapeutic approach.

Представяме случай на 75-годишен мъж с проведена първична перкутанна коронарна интервенция в хода на остър миокарден инфаркт със ST-елевация, който 12 дни по-късно е хоспитализиран с COVID-19 пневмония. По-късно пациентът реализира повторен остър коронарен синдром със ST-елевация в същата зона в резултат на инстент тромбоза. Регистрирани са преходни атриовентрикуларни проводни нарушения преди и след провеждането на коронарната ангиография. Обсъждат се възможните причинно-следствени връзки между COVID-19 инфекцията и настъпилата инстент тромбоза, както и подлежащите патофизиологични механизми. We present a case of a 75-year-old male who underwent percutaneous coronary intervention in the setting of acute myocardial infarction with ST-segment elevation and who was hospitalized 12 days afterwards with COVID-19 pneumonia. Later the patient presented himself again with acute coronary syndrome with ST-segment elevation in the same region due to in-stent thrombosis. Transient atrioventricular conduction disorders were registered before and after the percutaneous coronary intervention. Possible pathophysiological mechanisms of the in-stent thrombosis following COVID-19 infection are discussed.

Introduction: Familial hypercholesterolemia (FH) is an established risk factor for the development of atherosclerotic cardiovascular diseases (CVD), which determines early morbidity and mortality. Intensive reduction of the high levels of low-density lipoprotein cholesterol (LDL-c) reduces the incidence of CVD.Aim: The aim of this article is to analyze changes in lipid levels after intensification of the treatment of patients with familial hypercholesterolemia.Participants and Methods: Lipid levels of 59 patients with familial hypercholestrolemia from Eastern Bulgaria were studied with the aim of optimizing the management at an FH treatment center at St. Marina University Hospital, Varna. The period covered was from October 2017 to July 2020. The diagnosis of FH was determined as probable or certain according to the Dutch Lipid Clinics Network (DLCN) with a score of ≥ 6 points. After evaluation of the inclusion criteria for initiating treatment with evolocumab, all patients were monitored every 6 months for their lipid status. Baseline demographic characteristics and changes in the levels of laboratory tests for total cholesterol, LDL-c, and HDL cholesterol (HDL-c) were analyzed. A t-test for grouped pairs was used to estimate the difference from the baseline.Results: Of all 59 who passed through the center, the majority were men (58%). The mean age was 57.66 ± 9.57 years, from 37 to 76 years. A total of 54% had ischemic heart disease, 30.5% had survived a myocardial infarction, and 12% had a previous stroke. The mean baseline of total cholesterol was 8.23 ± 3.65 mmol/L, that of LDL cholesterol was 5.31 ± 1.95 mmol/L, and that of HDL-c was 1.25 ± 0.4 mmol/L. After 6 months, LDL-c levels dropped down to an average of 2.46 ± 1.59 mmol/L (p

84 p., Durante las últimas décadas, las nuevas tecnologías han irrumpido prácticamente en todos los sectores de la actividad económica y uno de los más favorecidos ha sido el sector financiero. La innovación es constante y la transformación en este sector no ha hecho más que comenzar. Sin duda, estos cambios presentarán muchos beneficios, pero, a la vez, muchos retos. El objetivo de este trabajo será analizarlos y crear una imagen global del sistema que está por venir. Para ello, nos centramos en analizar cómo están afrontando las entidades clásicas el cambio. Además, investigamos sobre el origen y la posición de los nuevos agentes del sector. Finalmente damos paso a explicar los beneficios y retos de las nuevas tecnologías. Con todo ello, extraemos las principales conclusiones del análisis y tratamos de proporcionar un concepto holístico de todos los cambios., During the last few decades, new technologies have broken into almost all sectors of economic activity and one of the most benefited has been the financial sector. The innovation is constant and the transformation of the industry has only just begun. Undoubtedly, these changes will have many benefits, but, at the same time, will bring on many challenges. The purpose of this document will be to analyze these benefits and challenges and create a global image of the system that is to come. For this matter, we focus on analyzing how the classic organizations are facing the change. In addition, we investigate the origin and competitive position of new agents in the sector. Finally we give way to explain the benefits and challenges of new technologies. After the whole analysis, we extract the main conclusions of the investigation and try to provide a holistic concept the new digital financial system.