Scientific reviews: Vol. 11, 2017


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Vol 11, 1/2017

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Comparative values of T-spot in peripheral blood and bronchoalveolar lavage in children with various forms of tuberculosis - Bulgarian medical journal (Български медицински журнал), 11, 2017, № 3,  7-13.
N. Gabrovska

Department of Pediatric Lung Diseases, Clinical Center for Lung Diseases,
University Hospital “Sv. Sofia”, Medical University Sofi a – Sofia
Abstract. Tuberculosis is one of the leading causes of illness and death in the world. Despite constant improvement in diagnosis, its rapid establishment remains a challenge in signifi cant number of cases. Culture identification of M. tuberculosis remains the gold diagnostic standard. That, however, takes more than two weeks and its diagnostic sensitivity does not exceed 80%. In childhood rapid diagnosis and prompt initiation of specifi c treatment are essential. According to the literature, a very small part of children (8-15%), suffering from tuberculosis, are spreading the infection, meaning that in the children population is diffi cult to fully count on cultural results. Fast diagnosis of tuberculous infection is also diffi cult when tuberculous bacteria cannot be detected in sputum or gastric lavage smears with direct microscopy. For more than ten years now imununological test – IGRA (IFN-gamma Release Assays) tests – QuantiFERON, TSPOT. TB are successfully used in clinical practice for diagnosting of the infectious of the macroorganism with M. tuberculosis. Their main advantage is high specifi city (97.1% [95% CI: 86.8-99.9% for T-SPOT.TB) and sensitivity (95.6%) in patients with active tuberculosis. They are usually performed using venous blood from the patient. Other body fl uid specimens like bronchoalveolar lavage, pleural effusions and cerebrospinal fl uid are successfully used for immunological studied as well. Although not routine in clinical practice T-SPOT.TB offers fast local identifi cation of tuberculous infection and disease. Irrespective of the invasive nature of the method, local immunodiagnosis (using BAL) is a promising and fast method for diagnosis of tuberculous disease in suspected children otherwise negative on sputum and gastric lavage material smears.
Key words: tuberculosis in children, immunological diagnosis, T-SPOT.TB in blood, T-SPOT.TB in bronchoalveolar lavage
Address for correspondence: Nataliya Gabrovska MD, Department of Pediatric Lung Diseases, University Hospital “Sv. Sofi a”, 17, Acad. Iv. Geshov blvd., Bg – 1431 Sofi a, e-mail:

Epidemiology and infectology

Molecular epidemiology of hepatitis C - Bulgarian medical journal (Български медицински журнал), 11, 2017, № 3, 14-19.
K. Terzieva1, D. Shalamanov1, M. Kunchev2, V. Doycheva3, C. Doychinova1, K. Mecushinov2

1Department „Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine“,
Medical University – Pleven
2Department of Military Epidemiology and Hygiene, Military Medical Academy – Sofia
3Department of Epidemiology, Medical University – Sofia
Abstract. The review summarizes current accumulated data from molecular genetic studies of hepatitis virus C. The results are interpreted from the perspective of infectious epidemiology. The biological characteristics and specifi cally the genetic variants of the virus are examined according to epidemiological criteria. The historical aspects of the transfer of this bio-pathogen in the different geographic regions have been traced. The contemporary global distribution of the major genetic types, subtypes and quasi-species is shown. On this basis, the endemicity of the viral hepatitis C disease is rationalized in its current stage of development. The perspectives for optimization of the epidemiological theory and prevention of HCV through the use of molecular genetic methods have been discussed. The validation and widespread application of such diagnostic approach will lead to utmost tangibility of the epidemiological research with scientifi c or practical focus.
Key words: hepatitis C virus, molecular epidemiology, evolution, distribution
Address for correspondence: Assist. prof. K. Terzieva, MD, Department of „Infection diseases,epidemiology, parasitology and tropical medicine“, Medical University, 1, Sv. Kliment Ohridski Str., 5800 Pleven, tel. 00359 64 884 225, e-mail:


Epidemiology of HIV infection and AIDS in Europe and Bulgaria 2016 - Bulgarian medical journal (Български медицински журнал), 11, 2017, № 3, 20-24.
V. Doycheva, Y. Mitova, Ts. Mincheva and J. Donkov

Department of Epidemiology, Medical University – Sofia
Abstract. HIV infection continue to be serious problem for Europe, particularly in the Eastern part of the European Region. In 2016, more than 160,000 people were diagnosed with HIV infection – once again the highest annual number for the Region. The vast majority of the new cases – 80% were diagnosed in the East and 18% in EU/EEA. The data presented in this review show worrying signs to increase over the past 10 years the number of new diagnosed cases with HIV infection in the part of East and Central Europe and the trend of stabilization and decreasing morbidity through recent years in some Eastern European countries and countries of EU/EEA. In Bulgaria in 2016 are registered 202 cases of HIV infection, with which the total number of HIV carriers it is offi cial 2505.
Key words: HIV infection, AIDS, epidemiological characteristics, WHO European Region
Address for correspondence:
Prof. Viktoriya Doycheva, MD, PhD, Department of Epidemiology, Medical University – Sofi a, SBALAG “Majchindom”, fl oor 6, room 667, e-mail:


Rare disease

The Juberg-Marsidi syndrome - Bulgarian medical journal (Български медицински журнал), 11, 2017, № 3, 25-28.
Kr. Koev

Department of Emergency Medicine, Medical University – Sofia
Abstract. The review article presents the rare genetic disease Juberg-Marsidi syndrome. It affects males. The disease is established at birth or during early childhood. The review presents the physical abnormalities and disturbances observed, based on which, through their in-depth clinical evaluation, this rare syndrome can be detected. Treatment requires coordinated efforts from a multidisciplinary team and manages the specifi c symptoms that are visible in any individual affected by the disease.
Key words: Juberg Marsidi-syndrome, craniofacial abnormalities, ocular anomalies, strabismus, telecanthus, epicanthus, deafness
Address for correspondence: Assoc. Prof. Krasimir Koev, MD, PhD, Department of Emergency Medicine, Medical University – Sofia, telephone: 00359 896291020, e-mail:


The Niemann-Pick disease - Bulgarian medical journal (Български медицински журнал), 11, 2017, № 3, 29-32.

Kr. Koev
Department of Emergency Medicine, Medical University – Sofia
Abstract. The review describes the rare genetic disease of progressive nature  Niemann-Pick disease (NPC). Typical of this disease is the lack of the enzyme named acid sphingomyelinase (ASM), which degrades sphingomyelin, and because of that the lipids are accumulated abnormally in the cells of different body tissues. The individuals with NPCs have mutations in one of the two genes – NPC1 or NPC2. Type A of the disease is severe and with poor prognosis and high lethality. An ocular anomaly called a cherry-red spot occurs in peoples affected by the type A of Niemann-Pick disease. Typically, lung infections and thrombocytopenia are observed in patients with the type B of NPC, and about 1/3 – ocular anomalies (cherry-red spots) or neurological lesions. Treatment is targeted at specifi c symptoms in each individual. Swallowing diffi culties should be regularly monitored and the risk of aspiration should be assessed.
Key words: hepato-/splenomegaly, vertical supranuclear gaze palsy, cherry-red spot, acidic sphingomyelinase, deafness
Address for correspondence:
Assoc. Prof. Krasimir Koev, MD, PhD, Department of Emergency Medicine, Medical University – Sofia, tel.: 00359 896291020, e-mail:



Omalizumab in severe allergic asthma - Bulgarian medical journal (Български медицински журнал), 11, 2017, № 3, 33-41.
L. Terziev1 and V. Tsvetkova-Vicheva2
1Department of Clinical Laboratory, Clinical Immunology, and Allergology,
2Department of Dermatology, Venerology and Allergology, Medical University – Pleven
Abstract. The review presents the mechanism of action of omalizumab (recombinant humanized monoclonal antibody) in allergic bronchial asthma. The metabolism and pharmacokinetics of the drug, its dosage and preparation are discussed. The effect of omalizumab on severe bronchial asthma respiratory diseases such as allergic rhinitis and nasal polyposis, allergic bronchopulmonary aspergillosis, skin diseases (chronic urticaria), and food-related anaphylaxis have been studied. The safety and tolerance of the drug are discussed, focusing on anaphylaxis, arterial thrombosis, malignant neoplasms and intestinal infections. Issues related to the length of treatment and its cost, are presented. Conclusion: Recently omalizumab is one of the most benefi cial drugs that bind circulating IgE antibodies not only in severe asthma-resistant treatment but also in other IgE-mediated diseases.
Key words: omalizumab, bronchial asthma, bronchopulmonary aspergillosis, nasal polyposis, allergic rhinitis
Address for correspondence: e-mail:




arrow Vol. 11, 2/2017



Sacred plants and mushrooms with psychoactive properties and their use throughout the centuries - Bulgarian medical journal (Български медицински журнал), 11, 2017, №2, 7-14.
J. Radenkova-Saeva

Toxicology Clinic, UMHATEM “N. I. Pirogov” – Sofia
Abstract. Some psychoactive substances have been used in religious ceremonies, shamanic and spiritual rituals since prehistoric times. There is archaeological evidence for the use of psychoactive substances, dating back at least 10,000 years. Most often these are herbs, plants and fungi, which are representatives of hallucinogenic and other substances with psychoactive properties. The author presents some of the traditional „sacred plants“ and active substances with psychoactive properties: cannabis, coca, kykeon, iboga, soma, peyote, ayahuasca, еrginе, “the magical” psilocybe mushrooms, opium and their use throughout the centuries. Although some psychoactive substances are taboo, and most of them are banned in the Christian and Islamic societies, their presence and significance in terms of the spiritual traditions of different cultures is undisputed.
Key words: psychoactive substances, sacred plants, mushrooms, hallucinogens
Address for correspondence: Assoc. Prof. J. Radenkova-Saeva, MD, Toxicology Clinic, UMHATEM “N. I. Pirogov”, 21, Totleben Blvd., Bg – 1606 Sofi a, e-mail:


Social burden of COPD – literature review - Bulgarian medical journal (Български медицински журнал), 11, 2017, №2, 15-21.
K. Tachkov, K. Mitov and A. Savova

Faculty of Pharmacy, Medical University – Sofia

Abstract. The current literature review is following the available scientifi c articles for the social burden of COPD, as the second leading chronic diagnosis in Europe. A systematic literature review on the international scientifi c literature was performed with key words COPD, epidemiology, and social burden. Total of 63 articles of the leading international organizations and scientifi c teams were selected and analyzed in the work. Results show that COPD is a widespread disease, with high prevalence worldwide. The social burden leads to loses of healthy life and inability to work, affecting negatively the quality of life of the patients.
Key words: COPD, epidemiology, social burden
Address for correspondence: K. Tachkov, Faculty fo Pharmacy, Medical University, 2 Dunav St., Bg  1000 Sofia, e-mail:




arrow Vol. 11, 1/2017

Clinical laboratory and clinical immunology

Clinical signifi cance of serum hepcidin concentrations in infl ammatory and tumor bowel diseases - Bulgarian medical journal (Български медицински журнал), 11, 2017, №1, 7-10.
V. Manolov1, O. Georgiev2, D. Stefanova-Petrova3, V. Vasilev1, R. Tsrancheva3, K. Tzatchev1 and V. Mitev4

1Department of Clinical Laboratory and Clinical Immunology, МU – Sofia
2Department of Propaedeutics of Internal Diseases, МU – Sofia
3Clinic of Internal Medicine and Gastroenterology, UH „Aleksandrovska” – Sofia
4Department of Medical Chemistry and Biochemistry, МU – Sofia
Abstract. Infl ammatory bowel disease (IBD) includes various intestinal pathologies, the most common of which are ulcerative colitis (UC) and Crohn’s disease (CD). Both, UC and CD, are manifested clinically with similar symptoms which may include diarrhea, rectal bleeding, abdominal pain and weight loss. Anemia is one of the most common symptoms of infl ammatory bowel disease. The pathophysiology of anemia in IBD is complex and may be associated with infl ammation, intestinal bleeding or impaired iron absorption. Other less frequent causes are vitamin B12/folate defi ciency or drug-induced anemia. Recent data suggests that hepcidin is a major mediator of anemia and plays a major role in the homeostasis of the iron metabolism. It regulates iron absorption and its release from the cells by blocking the action of ferroportin, which is the iron intracellular exporter from macrophages, hepatocytes and duodenal enterocytes. Evaluation of serum hepcidin in IBD patients may become a key element in the diagnosis and treatment of anemia in the near future. The quantifi cation of hepcidin has potential usefulness in diagnostic algorithms for differentiating between iron defi ciency anemia (IDA) and anemia in chronic diseases (ACD) and the combination IDA/ACD.
Key words: anemia, hepcidin, infl ammatory bowel diseases, tumor bowel diseases, ulcerative colitis, Crohn’s disease
Address for correspondence: V. Manolov, MD PhD, Department of Clinical Laboratory and Clinical Immunology, MU, 1 Sv. G. Sofyiski St., Bg-1431 Sofia, tel. +359 2 9230 928, e-mail:

Molecular medicine

Small ribonucleic acids as potential biomarkers in laryngeal cancer - Bulgarian medical journal (Български медицински журнал), 11, 2017, №1, 11-19.
S. Giragosyan, Iv. Popov, G. Stancheva, V. Mitev and R. Kaneva

Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical Faculty,
Medical University – Sofia
Abstract. Laryngeal squamous cell carcinoma (LSCC) is one of the most common cancers of the head and neck. LSCC is characterized by a high frequency in Bulgaria and Europe, 8.9/100 000 и 3.2/100 000, respectively. No change was observed in the survival, despite the introduction of modern approaches in treatment. It is therefore necessary to establish biomarkers that can be successfully applied in clinical and medical-biological practice for the diagnosis and therapy of patients with LSCC. Micro RNAs are small non-coding sequences that are actively involved in the regulation of cellular processes. Altered expression levels are commonly seen in cancers of the head and neck, including the LSCC, in both tissue samples and in samples of plasma, serum and saliva. It was found that micro RNAs may have oncogenic or tumor suppressor functions in the carcinogenesis of LSCC, which makes them attractive as molecular biomarkers. In this review we summarize current knowledge of the altered expression levels of micro RNAs in patients with LSCC and in malignant cell lines, and their potential as noninvasive biomarkers in clinical practice and their role in the processes of resistance to treatment.
Key words: laryngeal cancer, micro RNA, expression, noninvasive markers, resistance
Address for correspondence: S. Giragosyan,


Infectology and immunology

Infectology and immunology: diagnostic challenges - Bulgarian medical journal (Български медицински журнал), 11, 2017, №1, 20-26.
K. Plochev, M. Baymakova, G. Popov and R. Mihaylova-Garnizova

Department of Infectious Diseases, Military Medical Academy – Sofia
Abstract. The literature review has an aim to summarize the knowledge, and therefore the requirement for introduction into clinical practice of modern immunological methods. Those should help to detect alterations in the macro-organism of patients suffering from circulating in our geographic region contagious infectious diseases. It is necessary to emphasize that the purpose is not to apply etiological methods. The second aim of our article is to apply in clinical practice innovative, reproducible and contemporary immunological laboratory tests using the mechanisms of health insurance. Those new methods should improve not only the diagnosis but also the appropriate administration of immunotherapeutic agents in the course of treatment. In the material are described, based on literature data, which investigations as a part of protocol (algorithm) could be useful for evaluation of alterations in the immune homeostasis of macro-organism in the course of the acute phase of the illness. In the discussion section, the authors discuss the optimal amount of immunoassays, which would satisfy the balance of benefi t and cost.
Key words: infectious diseases, immunology, diagnosis
Address for correspondence: Magdalena Baymakova, MD, PhD, Department of Infectious Diseases, Military Medical Academy, 3 St. Georgi Sofi yski St., Bg  1606 Sofi a, e-mail:

Laser therapy

Low intensity laser light in the treatment of rosacea and acne (Literature review) - Bulgarian medical journal (Български медицински журнал), 11, 2017, №1, 27-31
K. Krahtova1, K. Nastev2 and A. Zlatareva3

1Department of Infectious Diseases, Parasitology and Dermatovenereology, Faculty of Medicine, Medical
University – Varna; 2Multiprofi le Hospital for Active Treatment „Skin systems”; 3Department of Economics and Health Care Management, Faculty of Public Health, Medical University – Varna
Abstract. The purpose of this article is to analyze the advantages and effects of low-intensity laser radiation in the treatment of rosacea and acne. Was conducted literature search in the databases PubMed, Scopus, Google Scholar for publications in the fi eld of low intensity laser radiationas application in dermatology (rosacea, and acne). More important publications are discussed in this review. The analysis of the literature suggests that as a stand alone method or in combination with other,low intensity laser radiationstimulates the healing process in the body and contributes to the infl uencing of such disease.
Key words: low intensity laser radiation, laser therapy, laser beams, rosacea, acne
Address for correspondence: Katrin Krahtova, FM, MU – Varna, e-mail:


Nuclear medicine

Specific pathology that can be diagnosed with nuclear medicine - Bulgarian medical journal (Български медицински журнал), 11, 2017, №1, 32-35.
A. Pavlova1 and S. Dineva2

1Department of Nuclear medicine, 2Department of Radiology, Medical Institute of Ministry of Interior – Sofia
Abstract. The inflammation is specifi c pathologythat can be affect the wholebody – gastrointestinal, respiratory, endocrine, bone, urinary tract, cardiovascular, central nervous systems and other. Various methods are used for diagnose, but in case of negative results specifi c nuclear methods,which are highly sensitive, specifi c and accurate, are. Nuclear medicine offers ideal techniques for visualizing infl ammatory processes using noninvasive methods of whole-body scanning, enabling the determination of both the localization and the number of infl ammatory foci.
Key words: infl ammation, nuclear medicine
Address for correspondence: S. Dineva, MD, Department of Radiology, Medical Institute of Ministry of Interior, 79 Skobelev Blvd., Bg – 1606 Sofi a, e-mail:


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