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Reviews 2009

ARCHIVE

1/2009
CROHN’S DISEASE – HISTORICAL REVUE OF CLASSIFICATIONS

P. Penchev

Clinic of Gastroenterology, University Hospital "Tsaritsa Yoanna" – Sofia

Summary: Crohn’s disease is a heterogeneous, chronic, granulomatous inflammation, localized in the gastrointestinal tract, predominantly in the terminal ileum and the proximal part of the colon. The variety of phenotype characteristics of the disease causes extreme difficulties in setting up standardized criteria for finding correlation between possible etiologic factors (genetic and environmental), for assessment of the disease evolution and evaluation of the effect of the treatment. For this purpose, consistently defined criteria have been developed, which are basic principles in the Vienna classification accepted in 1998 and the Montreal classification in 2004.

Key words: Crohn’s disease, Vienna classification, Montreal classification

Address for correspondence:
P. Penchev, MD, Clinic of Gastroenterology, University Hospital “Tsaritsa Yoanna”,
8 Bialo more str., Bg-1527 Sofia, tel. (02)9432519, e-mail: penchev.dr@gmail.com
SOME CONTEMPORARY ASPECTS OF APPLICATION OF GAMMA RAYS STERILIZATION IN MEDICINE

I. Jelev1, D. Obreshkova2, E. Petkova3, L. Peikova2, R. Semova4 and S. Papanov1

Department of Pharmacognosy and phitochemistry, Pharmaceutical Faculty Medical University – Plovdiv
Department of Pharmaceutical chemistry, Pharmaceutical Faculty, Medical University – Sofia
Medical college, Medical University – Plovdiv
Medical University – Plovdiv

Summary: Gamma rays are a form of electromagnetic radiation, produced in result of radioactive transformation. They have the highest frequency and the shortest wavelength in the electromagnetic spectrum. The effect of γ-rays on microorganisms is used for sterilization in medicine, pharmacy and cosmetic industry. This process does not change the chemical structure of pharmaceutical agents.

Key words: gamma rays, ionizing effect, sterilization, microbial purity

Address for correspondence:
Iliya Zh. Slavov, Pharmaceutical Faculty, Medical University, 120 Bratiya Buckstone, Bg-4004 Plovdiv, e-mail: ijelev80@abv.bg
2/2009
CONTEMPORARY CONCEPTS ON TREATMENT OF RHEUMATOID ARTHRITIS WITH DISEASE-MODIFYING DRUGS
Zl. Kolarov
Rheumatology Clinic, Medical University – Sofia
Summary. Viewed are the contemporary concepts on the aim of rheumatoid arthritis treatment, benefits and disadvantages of the use of disease-modifying agents (Aurum salts, salazopyrin, methotrexat, antimalarics, D-penicillamine, leflunomide), possibilities for their combined use as well as for combination with biological agents. Presented are modern indices and scales for assessment of disease activity, clinical remission onset and radiographic disease progression. There are shown results and conclusions of clinical studies on the opportunity for cessation of the treatment with disease-modifying drugs.
Key  words: disease-modifying agents, rheumatoid arthritis
Address for correspondence: Prof. Zlatimir Kolarov, MD, Clinic of Rheumatology, Medical University,
13, Urvich Str., Bg – 1612 Sofia, tel. +359 2 958-29-27
VIEW OF CONFLICTS AND OPPORTUNITIES FOR COMMUNICATION IN MEDICAL PRACTICE
A. Lukova
Психиатричен сектор, МБАЛСМ „Пирогов”
Summary: Globalization issues in contemporary society call for a search of values, virtues and principles, facilitating the establishment of ethical behavior and elationships between people. Model of human relations in medical practice is based on the idea of humanity and the personal motivation of workers to participate in solving the tasks of the organization. Conflicts are considered an organic part of people's lives. They are accompanying organizational life and every human activity. Each individual has his knowingly mades a strategy of behavior in conflict situations whereas opportunities for communication will depend on the individual psychological characteristics and life skills.
Key words: communication, conflict, skills
Adress for correspondence: Dr. Anelia Loukova, Toxicology Clinic – Psychiatry Sector, MATHEM Pirogov, 21 Totleben Blvd., Bg  1606 Sofia, tel.+359 2 9154409, е-mail: aloukova@yahoo.com
CARDIOMYOPATHIES IN CHILDREN
HYPERTROPHIC CARDIOMYOPATHY
L. Marinov
Second Pediatric Clinic, UMHAT „Sveta Marina“ – Varna
Summary: Hypertrophic cardiomyopathy continues to be an object of high interest by many investigators. The definition and classification of the disease underweut different changes in the last few years, due to consideration that the phenotype expression of the left ventricular hypertrophy could be a consequence of other diseases, especially in children. A marked family inheritance is established – autosomal dominant with incomplete penetration. Receut results from genetic trials, the main hemodynamic and clinical findings of the disease and the contemporary diagnostic and therapeutic approaches are summarized.
Key words: hypertrophic cardiomyopathy, hereditity, left ventricular hypertrophy, genetic defects, arrhythmia
Address for correspondence: Lachezar Marinov, MD, Second Clinic of Pediatrics, UMHAT „Sveta Marina“, 1 Hristo Smirnenski Str., Bg  9010 Varna, GSM: +359 899 67 05 25, e-mail: marrinovs@abv.bg
ADULT RESPIRATORY DISTRESS SYNDROME – CURRENT TREATMENT TENDENCIES
R. Anastasova1, V. Zachariev2 and V. Naydenov3
1Department of Propedeutisc of Internal Diseases, Medical University – Sofia
2Depatment of Social Medicine and Health Management, Medical Univerisity – Sofia
3Medical Institute – Ministry of Interior – Sofia
Summary: The article presents main tendencies in the treatment of the acute respiratory distress syndrome (ARDS). The new treatment methods are discussed with an emphasis on the necessity of a more active and elaborate research on ARDS pathogenesis, immunological and pathophysiological changes in order to introduce new approaches to the therapy. The etiology, pathophysiological and pathoanatomical changes are also viewed as well as the diagnostic criteria and ARDS frequency in terms of the clinical risk.
Key words: ARDS, diagnostic criteria, clinical risk, treatment
Address for correspondence: Ralitsa Anastasova, MD, Department of Propedeutics of Internal Diseases, Clinic of Pulmology,
UMHAT “Aleksandrovska”, 1 Sv. G. Sofiyski Str., Bg -1431 Sofia, tel. +359 2 92 30 470; +359 2 92 30 604, e-mail: ralitza1@yahoo.com
OXIDATIVE STRESS AND ASTHMA – TREATMENT WITH ANTIOXIDANTS
L. Terziev and V. Tsvetkova
Sectoion “Clinical Immunology and Allergology”, MU – Pleven
Summary: Purpose of the current review is to summarize recent evidence demonstrating the important role of oxidative stress in asthma pathogenesis. Natural enzymatic and non-enzymatic antioxidants and their localization are examined. The available oxidants and antioxidants in bronchial asthma are described. All therapeutic possibilities and extending potentialities in last years are followed up including different classes antioxidants and their positive effect on symptoms and morphology of the disease. Mechanisms of lipid peroxidation suppression in patients with asthma by use of antioxidants are considered.
Key words: lungs, asthma, cytokines, antioxidants
Address for correspondence: Lyudmil Terziev, MD, PhD, Clinic of allergology, Medical University, 1 Kliment Ohridski Str.,
Bg  5800 Pleven, е-mail: luterzi@mail.bg
3/2009

DILATED CARDIOMYOPATHY IN CHILDREN
L. Marinov
Second Pediatric Clinic, UMHAT “Sveta Marina“ – Varna
Summary: Cardiomyopathies in children are the main reason for death from cardiovascular diseases. Dilated cardiomyopathies are the biggest group of diseases of the cardiac muscle, part of which exhibit familial inheritance. According to the last revision, as cardiomyopathies are defined all the diseases of myocard muscle accompanied by cardiac dysfunction. The term dysfunction defines the mechanical and electrical disorders. Cardiomyopathies are divided into two main groups: with structural and without structural disorders. In the last few years, the data concerning the etiology and the genetic defects are summarized. An attempt was made to summarize the main pathogenetic and hemodynamic changes in the ventricular cardiac muscle, clinical findings of the disease, the main diagnostic methods, treatment and evolution of the disease. The cardiomyopathies are the main reason for heart transplantation in children.
Key words: dilated cardiomyopathy, myocard dysfunction, genetic defects, heart failure
Address for correspondence: Lachezar Marinov, MD, Second Clinic of Pediatrics, UMHAT “Sveta Marina“,
1 Hristo Smirnenski Str., Bg-9010 Varna, GSM: ++359 899 67 05 25, e-mail: marrinovs@abv.bg

ON THE CONTEMPORARY VIEW OF STREPTOCOCCAL INFECTIONS AND RHEUMATIC FEVER
T. Petkova1 and V. Doycheva2
1Department of Epidemiology, Parasitology and Tropical Medicine,  Medical University – Pleven
2Department of Epidemiology, Medical University – Sofia
Summary: Since with second half of XX century, WHO successfully coordinateds the struggle against severe streptococcal diseases and rheumatic fever. Developed countries have achieved remarkable results for a short period of time. Some authors assume that penicillin can eliminate rheumatic fever as an illness. However, in the discussion, considerable number of ill people and high mortality in the developing countries are not taken into consideration. Moreover, even in the countries with morbidity under the possible biological minimum of 4%ooo, the rheumatic fever elimination needs permanent penicillin prophylaxis because of the high risk of morbidity increase. The great number of serological M type of group A streptococci and the lack of specific immunoprophylaxis confirm the significance of the problem. This discussion is important for Bulgarian rheumatology and epidemiology in order to keep the achieved elimination and restriction of the problem rheumatic fever.
Key words: acute rheumatic fever, group A streptococci, post-streptococcal sequelae
Address for correspondence: Tanya Pterova, MD, Sectrion “Epidemiology, Parasitology and Tropical Medicine”, Medical University,
1 “Sv. Kliment Ohridski” str., Bg-5800 Pleven, tel. 064/ 884 269, GSM 0885 33 87 74, e-mail: tanja_1973@abv.bg

CONGENITAL DISORDER OF GLYCOSYLATION TYPE IA
M. Stancheva
Pediatric Clinic, University Hospital ”Alexandrovska” – Sofia
Summary: Congenital disorders (CDG) of glycosylation are genetic defects in the synthesis or the attachment of the glycan moiety of glucoconjugates, particularly glycoproteins and glycolipids. They are mostly severe and with few exceptions multisystem diseases. The nervous system is mostly involved. CDG show a large and steadily growing number of clinical presentations. The present review aims to inform the Bulgarian medical specialists about the most common type of the disorders of glycosylation – CDG Ia type, in the context of the possibility to detect the disease in Bulgaria with the newly introduced screening method – Isoelectrofocusing of serum transferrin.
Key  words: glycosylation, genetic defects, central nervous system, screening method
Address for correspondence: Malina Stancheva, MD, Pediatric clinic, University Hospital “Alexandrovska”,
1, Sv. G. Sofiiski, str., Bg-1431, Sofia, Bulgaria, tel. 0359 2 9230 640
4/2009

ESCULIN – SYNTHESIS AND BIOLOGICAL EFFECTS
I. Pencheva1, D. Obreshkova1, I. Zhelev2, E. Petkova3, V. Hadjidekova4 and S. Pupanov2
1Department of Pharmaceutical chemistry, Pharmaceutical Faculty, Medical University – Sofia
2Pharmaceutical Faculty, Medical University – Plovdiv
3Medical College, Medical University – Plovdiv
4NCRRZ – Sofia

Summary: Esculin is a biologically active substance, similar to the vitamin P, with a broad application in medicine both as pure substance or as a component of 3 Bulgarian and more than 40 European drugs. Therefore, we summarize the esculin synthesis, its biological activity, the products containing eskulin and also methods for esculin analysis.
Key words: esculin, biological effects, analysis methods
Address for correspondence: Iliya Zhelev Slavov, Pharmaceutical Faculty, Medical University – Plovdiv, 15 Vasil Aprilov str., Bg  4000 Plovdiv, e-mail: ijelev80@abv.bg

CONTEMPORARY DIAGNOSTICS OF TUBERCULOSIS IN CHILDREN: T SPOT TB – ANOTHER ALTERNATIVE
S. Velizarova
University Pediatric Clinic of Lung Diseases,
SBALBB “Sveta Sofia”

Summary: Diagnosis of TB in children is very difficult. The percentage of smear positive children in Bulgaria is low, due to BCG vaccination. After detection of tuberculosis bacterial genome, only 7-8 highly specific for tuberculosis bacterium proteins were found. This led to the establishment in 2000-2005 of IGRA (Interferon Gamma Release Assays) – T SPOT, QFT tests. In University Clinic of Lung Diseases in Children for the period 09.2007-09.2008, there were studied 54 children with T SPOT TB: 34 children were with different forms of tuberculosis, 11 – with LTBI and 9 were control group. Our opinion is that the new diagnostic test T SPOT TB has its place in etiological diagnosis of tuberculosis, especially in children at an early age. The diagnostic value is higher at 4-7 years of age. Tuberculin skin test and T SPOT TB shоw similar results in children with primary tuberculosis. Future studies with both IGRA (T SPOT TB, QFT) tests will enable to define the relationships in the diagnosis of tuberculosis in children.
Key words:
Address for correspondence: Svetlana Velizarova, MD, University Pediatric Clinic of Lung Diseases, SBALBB “Sveta Sofia”, 17 Acad. Iv. Evst. Geshov str., Bg  1431 Sofia, tel. +359 2 80-54-299

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