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Reviews 2011

ARCHIVE

1/2011

NOSOCOMIAL INFECTIONS CAUSED BY АCINETOBACTER BAUMANNII
T. Stoeva
Department of Microbiology and Virology
Medical University – Varna


Summary: Аcinetobacter baumannii is оne of the most important and problematic nosocomial pathogens. Multidrug resistance (MDR) and the ability to cause longlasting and difficult to control nosocomial outbreaks are its typical features. In this review, the spectrum and the epidemiological aspects of nosocomial infections, caused by A. baumannii, as well as the therapeutic options for MDR A. baumannii infections are presented.
Key words: Acinetobacter baumannii, nosocomial infections, multidrug resistance
Address for correspondence: Temenuga Stoeva, MD, Department of Microbiology and Virology, Medical University,
55 Marin Drinov str., Bg-9001 Varna, tel.: 052/978566; 0887 614 008, e-mail: temenuga.stoeva@abv.bg

BIOLOGICAL ASPECTS OF THE INFECTIOUS DISEASE
W. Monev


Summary: The interrelations between macro- and microorganisms are established historically, in the course of the time. They are result of evolution taking millions of years of contact between them. In a normal microorganism, there exist and reproduce a huge quan­tity of diverse kinds of microorganisms, although the great parts of humans and animals do not suffer any harms. Infec­tious disease arises only as exception, and evidences the ability of macroorganism to react speci­fically and to adapt itself. Infectious disease is not a struggle for vic­tory (recovery) or defeat (death). It is a peciliar process of accommodation to coexistence, ending most often with a new form of symbiosis between macro- and microorganism – immunity.
Key words: infectious disease, endogenous and exogenous forms, interrelation of macro- and microorganisms
Address for correspondence: Prof. W. Monev, 19 Yuriy Venelin str., Bg-1141, Sofia, tel.: +359 2 989-83-98

GENETIC POLYMORPHISMS OF DRUG TARGETS AND DISEASE-MODIFYING GENETIC POLYMORPHISMS
S. Valcheva-Kuzmanova
Department of Preclinical and Clinical Pharmacology and Toxicology,
Medical University – Varna


Summary: Pharmacogenetics is the study of the genetic basis for variation in drug response. Genetic polymorphisms can result in variability in drugs pharmacokinetics and pharmacodynamics and can underlie the drug-induced manifestation of a disease. In this review, there are considered some of the genetic polymorphisms of drug targets (enzymes and receptors) that determine variability in drug action and, respectively, variability in drug effects (therapeutic and adverse effects). Discussed are also some disease-modifying genetic polymorphisms determining drug-induced clinical manifestation of an illness.
Key words: pharmacogenetics, pharmacogenomics, genetic polymorphisms, drug targets, disease-modifying polymorphisms
Address for correspondence: Assoc. Рrof. Stefka Valcheva-Kuzmanova, MD, PhD,
Department of Preclinical and Clinical Pharmacology and Toxicology, Medical University,
55 Marin Drinov str., 9002 Varna, tel.: 052/ 677 078, e-mail: stefkavk@yahoo.com

COUGH – A FREQUENT SYMPTOM IN CHILDHOOD. PECULIARITIES, APPROACHES AND NECESSARY RESEARCHES
G. Foreva, R. Asenova and L. Despotova-Toleva
Daptment of Health Management, Health Economics and General Practice, Public Health Faculty,
Medical University – Plovdiv


Summary: Cough is one of the most frequent symptoms making the patients seek consultation. Cough is a powerful physiological mechanism of cleansing the respiratory tract from excessive secretion. It is a reflex response to irritation of endings of nervus vagus and nervus glossopharyngeus, both located in the respiratory tract mucosa. The pleurae are also a significant receptor area. Cough reflex does not originate in the alveoli. Specific irritants are: aspirated foreign bodies; inhaled dust particles or chemical substances, edema, hypersecretion, inflammatory reaction resulting from an infectious or allergic process.
Key words: cough, children, general practice
Address for correspondence: Gergana Foreva, MD, Department of Health Management, Health Economics and General Practice, Public Health Faculty, Medical University, 15a Vasil Aprilov blvd., Bg-4002 Plovdiv,  tel.: 032 602500, e-mail: gforeva@dir.bg

2/2011

BRAIN ASYMMETRY AND CONTROL OF PHYSIOLOGICAL FUNCTIONS: NORM AND CLINICAL IMPLICATIONS
Zl. Stoyanov, P. Nikolova, I. Pashalieva and L. Decheva
Department of Physiology and Pathophysiology,
Medical University – Varnа

Summary: The effects of brain asymmetry on the control of autonomic physiologic functions are reviewed. The differentiated roles of right and left hemisphere in cardiac control, neuroendocrine control and neuroimmunomodulation are outlined. Attention is paid on handedness-related peculiarities, because the fact that left-handers show some specificity in the pattern of brain asymmetry.
Key  words: brain asymmetry, hemispheric control, cardiovascular functions, neuroendocrine functions, immunity, handedness
Address for correspondence: Irina Pashalieva, MD, Department of Physiology and Pathophysiology, Medical University, 55 M. Drinov Str., Bg – 9002 Varna, tel.: +359 52 67 70 50, 26 30, e-mail: ipashalieva@abv.bg

APPLICATION OF MULTIFOCAL ELECTRORETINOGRAM IN DISEASES AFFECTING THE RETINA
K. Koev and R. Georgiev
Clinical Centre of Emergency Medicine, MU – Sofia,
Clinical of Ophthalmology, UMHAT „Alexandrovska”

Summary: The multifocal electroretinogram (ERG) incorporates state-of-the-art stimulus and recording technology with powerful analysis algorithms. At the simplest level, the multifocal ERG provides an objective equivalent to the visual field by simultaneously assessing approxi­mately 100 retinal locations. The ultimate power of the procedure, however, lies in the fact that the local responses contain components from all levels of the retina. The evolving capability of the analysis routines to separate photoreceptor from ganglion cell components is leading to an increasingly sensitive diagnostic test and a potentially powerful tool for evaluating treatment efficacy.
Key words: multifocal electroretinogram, retinal localization, treatment
Address for correspondence: Assoc. Prof. Krasimir Koev, MD, Clinical Centre for Emergency Medicine, UMHAT “Tsaritsa Yoanna”, 8 Byalo more str., Bg – 1527 Sofia, e-mail: k0007@abv.bg

THRACIAN SURGICAL INSTRUMENTS DATING FROM THE 1-ST CENTURY, MONG WHICH THOSE FOR OCULAR SURGERY RESEMBLE THE CONTEMPORARY ONES
К. Кoev
Clinical Centre for Emergency Medicine, MU – Sofia


Summary: It is followed the develpment of surgery and of ocular surgery in ancient times. There are presented 18 surgical instruments, among which those for ocular surgery of the Thracians, dating from 1-st sentury in an ancient necropolis in Karanovo. Some of them resemble the contemporary ones, which shows the high level of development of Thracian surgery. The presence of this set of medical instruments, belonging to a buried physician in one of the Thracian mounds in Karanovo shows not only his high social status, but also the fact that this social status was equal to the one of the tracian rulers.
Key words: surgical instruments, Thracians, history medicine, treatment of the eyes diseases
Address for correspondence: Assoc. Prof. Krasimir Koev, MD, Clinical Centre for Emergency Medicine, MHAT “Tsaritsa Joanna”, 8 Byalo more str., Bg – 1527 Sofia, e-mail: k0007@abv.bg

3/2011

ADVANTAGES OF 8-ISOPROSTANE AS A BIOMARKER OF OXIDATIVE STRESS
L. Terziev
Section of Clinical Immunology and Allergology, MU – Pleven

Summary: Markers of lipid peroxidation, used in practice, such as malondialdehyde, volatile alkanes (ethane and pentane), and especially 8-isoprostane, are discussed. Emphasis is placed on a number of advantages of 8-isoprostane as a stable, suitable, non-invasive biomarker for assessing lipid peroxidation in various diseases, associated with oxidative stress.

Key words: lipid peroxidation, malondialdehyde, oxidative stress, 8-isoprostane

Address for correspondence: L. Terziev, MD, Ph D., Section of Clinical Immunology and Alleregology, Medical University, 1 Kliment Ohridski Str. Bg – 5800 Pleven, e-mail: luterzi@mail.bg

NEW CLINICALLY SIGNIFICANT MARKERS FOR IMMUNOMEDIATED GASTROINTESTINAL DISEASES
Ts. Mladenova1, D. Kyurkchiev1, Z. Spasova2 and I. Altankova1
1Laboratory of Clinical Immunology, “Sv. Ivan Rilski”, Medical University – Sofia
2Clinic of Gastroenterology, “Sv. Ivan Rilski”, Medical University – Sofia

Summary: Immune-mediated intestinal diseases such as celiac disease, Crohn`s disease and ulcerative colitis have unknown etiology and are difficult to diagnose and treat. Studying the actual aspects of their pathogenesis will assist in developing new markers for diagnosis and treatment, follow up therapy and will decrease the need for invasive procedures. Some potential new high informative markers are discussed: antibodies against deamidated gliadin peptide (anti-DGP), antibodies against Saccharomyces cerevisiae (ASCA), fecal calprotectin and lactoferrin.

Key words: celiac disease, Crohn`s disease, ulcerative colitis, anti-DGP, ASCA, calprotectin, lactoferrin

Address for correspondence: Tsvetelina Mladenova, MD, Laboratory of Clinical Immunology, UMHAT “Sv. Ivan Rilski”, 15 “Acad. I. Ev. Geshov” bul., Bg – 1431 Sofia, tel.: +359 2 8527046, GSM: +359883306049, е-mail: cvety.mladenova@gmail.

MUCOLYTICS
N. Danchev and I. Nikolovа
Department of Pharmacology, Pharmacotherapy and Toxicology,
Faculty of Pharmacy, MU – Sofia

Summary: Mucolytics are a diverse pharmacotherapeutic group of drugs that reduce the viscosity of bronchial secretion and facilitate its elimination from the respiratory tract. Diseases that are associated with overproduction of mucus (main constituent of bronchial secretions) and violation of its clearance are: chronic bronchitis, asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis or mucoviscidosis. In modern pharmacological classification, mucolytics are divided into four main groups: thiol derivatives, benzylamines, piperazines and proteins. Acetylcysteine ​​is used for chronic bronchitis and other diseases associated with overproduction of mucus. Other representatives of the thiol derivatives are carbocisteine, erdosteine and MESNA. Benzylamines include bromhexine and its active metabolite ambroxol. A piperazine mucolytic is eprazinone. Peptide derivatives include dornase alpha, which is used to treat mucoviscidosis. Effective mucolytic therapy reduces exacerbations of COPD; reduces the need for antibiotics; improves cough, dyspnea and mucus expectoration.

Key words: mucolytics, mucus, COPD, cystic fibrosis, thiol derivatives, benzylamines, piperazines, proteins

Address for correspondence: Prof. N. Danchev, Department of Pharmacology, Pharmacotherapy and Toxicology, Faculty of Pharmacy, 2 Dunav str., Bg – 1000 Sofia, tel.: +259 2 89-76-40, e-mail: ndanchev@pharmfac.acad.bg

KERATOCONUS
B. Kyuchukov and L. Dimanova
Clinic of Ophtalmology, UMHAT “Alexandrovska” – Sofia

Summary: Keratoconus is the most common primary corneal ectasia. Most often it develops during the second decade and has neither sexual nor racial predisposition. Its prevalence amongst general population is about 54 per 100 000. Clinical symptoms vary depending on disease severity. Early and mild forms may remain unrevealed unless corneal topography is performed. Keratoconus progression reduces best corrected visual acuity, makes the central cornea thinner and steepens the keratometry readings. In moderate and advanced cases a hemosiderin arc around the cone base is formed (Fleischer’s ring). Vertical lines of Descemet membrane (Vogt striae), V-shaped deformation of the lower eyelid when the gaze is in downward position (Munson sign), a focused light reflection at the nasal limbus when light is directed from temporal direction (Rizzuti’s sign), sudden stromal oedema due to breaks in the Descemet membrane (acute hydrops) with consequent development of corneal opacities are also typical for advanced keratoconus. There are various classifications based on morphology, evolution, clinical symptoms and corneal topography. The treatment of keratoconus depends on the disease severity. Formes frustes require glasses, moderate cases are managed with contact lenses and crosslinking to stop the progression of the disease, while in advanced stages lamellar or penetrating keratoplasty is performed.

Key words: keratoconus, crosslinking, keratoplasty

Address for correspondence: Borislav Kyuchukov, MD, Clinic of Ophtalmology, UMHAT “Alexandrovska”, 1 “Sv. G. Sofiysky” blvd. Bg – 1431, GSM: +359888556724, e-mail: kutchoukov@abv.bg

THE PLACE OF GENE THERAPY IN THE CONTEMPORARY TREATMENT OF PROSTATE CANCER
P. Gateva1, N. Boyadzhieva1 and M. Nikolovski2
1Pharmacology Department, Medical University – Sofia
2Urology Department, Medical University – Sofia

Summary: The incidence of prostate cancer tends to increase worldwide, including in Bulgaria. The development of this type of cancer is markedly influenced by hereditary factors. The role of epigenetics is also increasingly elucidating as well as the influence of environmental factors on genes, including those involved in prostate cancerogenesis. Proliferative inflammatory atrophy seems to be one of the important mechanisms of the interference of environmental factors on genetic predisposition. In our days the treatment of prostate cancer depends on the stage of the disease. With the identification of gene aberrations specific for prostate cancer arose the possibility for the development of substances targeting genetic and biochemical causes of malignant transformation. Genetic immunotherapy gives the opportunity to overcome the conventional immunotherapy resistance of cancerous cells. The oncolytic vector gene therapy is another contemporary branch in the treatment of prostate cancer. The paper is focused on recent evaluations of the opportunities given by gene therapy and immunotherapy in prostate cancer, transfer of genes, the p53-based therapy, and gene therapy targeting regulation of the ceramide expression in prostate and marks the place of those therapeutic approaches.

Key words: prostate cancer, gene therapy, genetic immunotherapy

Address for correspondence: P. Gateva, MD, Pharmacology Department, MU, 2 “Zdrave” str., Bg – 1431 Sofia, e-mail: pandreeva_gateva@yahoo.com

 

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