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Reviews 2013

ARCHIVE

1/2013

ASTHMA AND PREGNANCY: DRUG THERAPY
L. Terziev
Sector of Clinical Immunology and Allergology, Medical University – Pleven

Summary: This review discusses the basic groups of drugs used in asthma treatment during pregnancy: inhaled and systemic corticosteroids, short- and long-acting beta-agonists, anti-inflammatory drugs, antihistamines, decongestants and others. Information about their effects on the fetus in pregnant women was presented. The categories of safety to which they belong and the daily doses of commonly used drugs were also shown.

Key words: asthma, pregnancy, corticosteroids, beta agonists, anti-inflammatory drugs, decongestants

SOME NEW TERMS AND DEFINITIONS IN THE EPIDEMIOLOGY OF INFECTIOUS DISEASES
V. Monev№, I. PopivanovІ, T. Petkovaі, N. BogdanovІ, Ts. TsvetanovІ, Ts. Doychinovaі, D. Shalamanovі and V. Doycheva4
№National Center of Infectious and Parasitic Diseases
ІMilitary Medical Academy  Sofia
іMedical University – Pleven
4Medical University  Sofia


Summary: The development and progress in epidemiological theory and practice establishes new terms and definitions. In addition, interactions of epidemiology with medico-biological, clinical and medico-social sciences, as well as with some non-medical sciences, also contribute to this trend. At the present stage, the impact of biological warfare (BW) and defense on civil population has increased. Therefore, related to BW terms and definitions deserve special attention. The paper examines the definitions of the following terms, categories and activities, introduced and approbated in modern epidemiology, and replaces or complements some commonly used terms in Bulgaria: infection control, pest control, insect control, rodent control, post-exposure prophylaxis, outbreak management, outbreak control, emerging diseases, travel medicine, biological warfare (weapon), BW agent, bioterrorism, BW defense, biodetection and identification.

Key words: term, definition, epidemiology, infectious diseases, biological warfare, biological defense

PHARMACOLOGICAL AND METABOLIC EFFECTS OF THYRONAMINES
D. Gavrailova
Faculty of Public Health, Medical University – Sofia

Summary: Thyronamines are biologically active metabolites of thyroid hormones that may play a role in the modulation of the effects of thyroid hormones or may function as endogenous regulators of other metabolic processes. It has been found that 3-iodothyronamine – (T1AM) and to a lesser extent non-iodothyronamine (T0AM) have influence on the cardiovascular and central nervous system, as well as on metabolism.

Key words: thyronamines, non-iodothyronamine (Т0АМ), 3-iodothyronamine (Т1АМ), synthesis, pharmacological effects, metabolic effects, G protein-coupled receptor (GPCR), dual-energy X-ray absorptiometry (DEXA)

LIVER HEMANGIOMAS PART II: TREATMENT ASPECTS
A. Taseva
Department of General and Liver-Pancreatic Surgery, UMHAT “Aleksandrovska”,
Medical University  – Sofia


Summary: Liver hemangiomas are the most common benign liver tumors, usually small in size and requiring no treatment. Management of patients with giant hemangiomas of the liver encounters persistent controversy. The hemangiomas complicated with consumative coagulopathy (Kasabach-Merritt syndrome) and those causing severe incapacitating symptoms, however, are generally considered as indicated for surgical resection or other type of treatment. In this review, we present various indications and methods of treatment of giant hepatic hemangiomas: transcatheter arterial embolization, ligation of liver vessels, sclerotherapy, surgical procedures – enucleation and various type of liver resections. The question of intraoperative vascular control was also discussed.

Key words: liver, hemangioma, treatment

BURNOUT SYNDROME – A HISTORICAL OVERVIEW, DEFINITION, NATURE, CONSEQUENCES
St. Harizanova and T. Tаrnovska
Department “Hygiene and Ecomedicine”, Faculty of Public Health, Medical University – Plovdiv

Summary: The aim of this literature review was to examine the main historical data, definitions, nature and known facts about the consequences of burnout syndrome. The literature data show that there is no unanimous agreement on burnout syndrome, both in definition and in terms of its characteristics. Further profound studies are needed over its manifestations in various professional fields.

Key words: burnout syndrome, definition, etiology, symptoms

2/2013

STEM CELLS AND REGENERATIVE MEDICINE
E. Stoyanova1, M. Mourdjeva1 and S. Kyurkchiev2, 3
1Department of Molecular Immunology, Institute of Biology and Immunology of Reproduction,
Bulgarian Academy of Sciences – Sofia
2Institute of Reproductive Health
3Ob/Gen hospital ‘Dr Shterev’, TB Bulgen – Sofia


Summary: Regenerative medicine aims to generate conditions, in which damaged tissues and cells may be partially or fully restored. Extensive self-renewal and differentiation abilities of stem cells already found a place in medical practice. Great expectations for application of embryonic stem cells in medicine appear to be unrealistic due to some moral and ethical concerns. Recent data on construction of induced pluripotent stem cells, possessing the essential characteristics of embryonic stem cells, restore confidence that stem cells will find more and more wide applications in future. Increasing number of publications on stem cells and their involvement in the regenerative process of damaged cells or tissues is evidence that the use of these cells for treatment will radically change the existing medical practice.

Key words: stem cells, embryonic stem cells, induced pluripotent stem cells, mesenchymal stem cells, unipotent stem cells, regenerative medicine, clinical application

MODERN DNA MICROARRAY TECHNOLOGIES IN MEDICINE
S. P. Hadjidekova
Department of Medical Genetics, Medical Faculty, Medical University - Sofia

Summary: The DNA microarray platforms are a high-throughput technology applied in medicine and molecular biology. The new microarray methods allow simultaneous examination of thousand genes or comparison of the gene expression from two different tissue probes. With the progress in the development of new technologies several technical platforms at increasingly high resolution have been developed, giving the possibility to analyze changes in a single gene. The method consists in co-hybridization of alternative labeled with different fluorescent dyes test and control DNA to a selected set of pre-spotted genomic fragments (usually on glass slide). Depending on the purpose of the analysis the microarrays are divided in arrays for expression profiling, genotyping, methylation analysis, CNVs analysis and ChIP-on-chip microarrays. This technique is still in its infancy and promises to revolutionize the identification of genes involved in the development of various diseases.

Key words: microarray technology, genetic diagnosis

SIGNIFICANCE OF ANTIOXIDANTS GLUTATHIONE AND L-2-OXOTHIAZOLIDINE-4-CARBOXYLIC ACID IN ASTHMA
AND OTHER DISEASES RELATED WITH OXIDATIVE STRESS

L. Terziev and V. Tzvetkova
Sector of Clinical Immunology and Allergology, Medical University -Pleven

Summary: A characteristic of a non-enzymatic antioxidant glutathione was given. Depletion of glutathione in the body is associated with many diseases, neurodegenerative, pulmonary, viral infections, etc. The synthesis, distribution in the body and its functions related to the detoxification of xenobiotics, scavenging of free radicals and modulation of cellular processes were described. Some of the precursors of cysteine (the rate-limiting factor in glutathione synthesis) focused on L-2-oxothiazolidine-4-carboxylic acid (OTC) were presented. The results of the application in vitro and in vivo to restore depleted stocks of glutathione in some diseases such as ethanol intoxication, cisplatin-induced renal disorders and especially – bronchial asthma, were shown. The results obtained by the authors themselves on experimental murine asthma model are cited confirming the beneficial effects of OTC on some markers of inflammation, lipid peroxidation and antioxidant defense system in the lungs.

Key words: asthma, glutathione, L-2-oxothiazolidine-4-carboxylic acid

CHARACTERISTICS AND ROLE OF MANGANESE PORPHYRINS IN DISEASES, INDUCED BY OXIDATIVE STRESS
L. Terziev and V. Tzvetkova
Sector of Clinical Immunology and Allergology, Department of Clinical Laboratory,
Clinical Immunology and Allergology, Medical University – Pleven


Summary: Manganese mesoporphyrins, a group of antioxidants, are discussed in this overview. The characteristics of the most typical members of this group, such as MnTBAP, MnTE-2-PyP and MnTnHex-2-PyP, their distribution in the body, toxicity, half-life and properties are shown. Their beneficial effects in various disease induced by oxidative stress, including bronchial asthma, pulmonary fibrosis, neurodegenerative diseases, stroke, diabetes, cancer, status after radiotherapy, are reported. The beneficial effects of two manganese mesoporphyrins (MnTE-2-PyP and MnTnHex-2-PyP) on the markers of inflammation, lipid peroxidation, and antioxidant defense system in asthma mice model observed by the authors in their experiments are shown.

Key words: antioxidants, manganese mesoporphyrins, MnTE-2-PyP, MnTnHex-2-PyP

PLACE OF SELENIUM IN THE TREATMENT OF THYROID DISEASES
D. Gavrailova
Faculty of Public Health, Medical University – Sofia

Summary: The essential trace mineral, selenium (Se), is of fundamental importance to human health. Many of its physiologic roles may be ascribable to its presence within selenoproteins, known for their antioxidant properties. Several studies have investigated the potential positive effects of Se supplementation in thyroid diseases, characterized by increased levels of hydrogen peroxide and free radicals (autoimmune chronic thyroiditis, Graves‘ disease). These studies have supplied evidences indicating that Se supplementation, maximizing the antioxidant enzymes activity, may reduce the thyroid inflammatory status. Then, it may be assumed that Se could have therapeutic role in autoimmune thyroid disease.

Key words: selenium, selenoenzymes, thyroid, autoimmunе thyroid diseases

PREGNANCY ASSOCIATED THROMBOTIC THROMBOCYTOPENIC PURPURA AND ACUTE KIDNEY INJURY
M. Lubomirova
Clinic of Nephrology, University Hospital ”Aleksandrovska” – Sofia

Summary: Acute kidney injury (AKI) is a rare but serious complication of pregnancy. Renal insufficiency can complicate several other pregnancy-specific conditions. In particular, severe preeclampsia/HELLP syndrome, acute fatty liver of pregnancy (AFLP) and thrombotic thrombocytopenic purpura (TTP) are all frequently complicated by AKI, and share several clinical features which pose diagnostic challenges to the clinician. In this article, we discuss the clinical and laboratory features, pathophysiology and treatment of these 3 conditions, with particular attention to renal manifestations. It is imperative to distinguish these conditions to make appropriate therapeutic decisions which can be lifesaving for the mother and fetus. Typically AFLP and HELLP improve after delivery of the fetus, whereas plasma exchange is the first-line treatment for TTP.

Key words: pregnancy, acute kidney injury, thrombotic thrombocytopenic purpura

SUMMARY OF SURGICAL OPERATIONS WHEN COLECTOMY AND PROCTOCOLECTOMY
E. Zhivkov, P. Tokov, R. Todorov, V. Popov, L. Simonova and V. Solunkin
Clinic of General, Hepato-Biliary and Panсreatic Surgery, University Hospital „Alexandrovska“ - Sofia

Summary: From many years, the surgeons try to resolve the problem of intestinal continuity during operations with resection of major part of colon or total colectomy with amputation of rectum included. The necessity of parameters of resection is one side of the problem and the quality of life of patients suffered such operation is the other side. In this article, we try to make a review of operative techniques, their evolution, advantages and limitations. We also performed an analysis of the complications.

Key words: proctocolectomy, ileoanal anastomosis, reservoir stoma

3/2013

PATHOGENETIC FACTORS OF EOSINOPHILIC INFLAMMATORY PROCESS IN BRONCHIAL ASTHMA
А. Spasova
Specialized Hospital for Active Treatment of Pulmonary Diseases "Sv. Sofia"

Summary: The concept of bronchial asthma as a chronic inflammatory disease has led to the development of methods of monitoring the underlying inflammatory process. Eosinophil is one of the main protagonists in this process, and the control of the proteins that are released by eosinophil, when it is activated, could provide valuable information for this purpose. The ECP has been used in the diagnosis of asthma, in the prognosis of wheezing infants, as a marker for the exposure to the allergen, to evaluate the results of provocation tests, and asthma severity, to control the effect of different anti-inflammatory treatments as well as to monitor the performance of these treatments. However, the great complexity of asthmatic inflammation obliges us to take into account a series of considerations, limiting our expectations for ECP.

Key words: bronchial asthma, eosinophilic celll, eosinophil cation protein
Address for correspondence: A. Spasova, SHATPD Sveta Sofia, 17 Acad. Iv. Geshov, Bg ― 1431 Sofia

HISTOPATHOLOGICAL TYPE AND LYMPHOVASCULAR SPACE INVOLVEMENT
AS PROGNOSTIC FACTORS FOR SURVIVAL IN CERVICAL CANCER

E. Ismail, Y. Kornovski and St. Slavchev
Gynecology Clinic, Multiprofile Hospital for Active Treamtnet "Sv. Anna" – Varna
Department of Obstetrics and Gynaecology, Medical University – Varna


Summary: Histological type, parametrial involvement and lymphovascular space involvement (LVSI) are among the prognostic factors for survival in cervical cancer. In recent years the incidence of adenocarcinomas has increased. The increase of adenocarcinoma incidence in 13 European countries is reported. These tumours usually arise in endocervical canal and the diagnosis is often delayed. Prognostic importance of adenocarcinoma as a histological type is very controversial. LVSI is a prognostic factor influencing overall and disease-free survival. LVSI presents the occurrence of tumour cells in the blood and lymph vessels. A study of patients with early cervical cancer received radical hysterectomy shows that lymphovascular space involvement is an important prognostic factor for metastatic lymph nodes and recurrence.

Key words: cervical cancer, prognostic factors, cervical adenocarcinoma, lymphovascular space involvement
Address for correspondence: Elis Ismail, MD, Gynecology Clinic, MHAT "Sv. Anna", 100A, Tsar Osvoboditel blvd., Bg ― 9000 Varna, tel.: +359 52/ 821 255, e-mail: elibet@abv.bg

SENTINEL LYMPH NODES BIOPSY AS A SURGICAL PROCEDURE FOR DETECTION OF METASTATIC LYMPH NODES
E. Ismail and Y. Kornovski
Gynecology Clinic, Multiprofile Hospital for Active Treatment "Sv. Anna" – Varna
Department of Obstetrics and Gynecology, Medical University – Varna


Summary: Biopsy of the sentinel lymph nodes is a method, by which, using specific marking, the lymph nodes that are first in the way of lymph drainage and metastasis can be detected and examined. In some cases they give us information for the metastatic status of the whole lymph region. They are defined as sentinel (warning). Sentinel lymph node biopsy in cervical cancer is used to reduce the morbidity of full lymph node dissection.

Key words: sentinel lymph node, cervical cancer, lymphatic mapping
Address for correspondence: E. Ismail, MD, Gynecology Clinic, MHAT "Sv. Anna", 100A, Tsar Osvoboditel blvd., Varna, tel.: 052/ 821 255, e-mail: elibet@abv.bg

CURRENT TRENDS IN ENDOSCOPIC TREATMENT OF COLORECTAL AND NEUROENDOCRINE TUMOURS
E. Tosheva, A. Yonkov, D. Bulanov, S. Bonev, V. Stoyanov, N. Kandilarov, P. Tokov and V. Dimitrova
Clinic of General and Hepatic-Pancreatic Surgery,
University Multiprofile Hospital for Active Treatment "Alexandrovska", Medical University – Sofia


Summary: Neuroendocrine tumours (NET) are heterogeneous groups of tumours, which are found in different localizations and have the common ability to produce vasoactive peptides and hormones. They develop from the cells of the diffuse neuroendocrine system (DNES) and can be localized anywhere in the body, but are mainly focused in the respiratory and the gastrointestinal systems. Previously the guidelines of the European Neuroendocrine Tumour Society (ENETS) were that all NETs should be treated by segmental colectomy and regional lymphadenectomy, similarly to the colorectal adenocarcinomas. The 2012 ENETS guidelines suggest endoscopic treatment in the form of polypectomy or endoscopic mucosal resection as a therapeutic option for lesions < 2 cm. In the recent years with the introduction in everyday clinical practice of more sophisticated endoscopic methods as endoscopic submucosal dissection (ESD) and transanal endoscopic micro-surgery, more and more authors share the opinion that endoscopic treatment should be contemplated in all lesions < 1 cm, as well as lesions between one and 2 cm, when no adverse prognostic factors for metastasis are present.

Key words: neuroendocrine tumours, endoscopic mucosal resection, endoscopic submucosal dissection
Address for correspondence:  E. Tosheva, Clinic of General and Hepatic-Pancreatic Surgery,  UMHAT Alexandrovska, 52 "Pencho Slaveykov" St., 1431 Sofia

A BRIEF HISTORY OF ORIGIN AND RESEARCH OF OCCUPATIONAL MORBIDITY 
A. Vatkova 
Department of Neurology, Psychiatry, Physiotherapy and Rehabilitation, Preventive Medicine and Public Health, Medical Faculty, Sv. Kliment Ohridski Sofia University

Summary: In this article we do a short historical review of occupational morbidity, giving us an idea of the way, in which the essence of human work changed during the different stages of human development simultaneously with the work conditions. In parallel to that, the human awareness about health hazards relating to human work was developing. Such international organizations as ILO (International Labor Organization) and ICOH (International Commission of Occupational Health) were founded. Efforts are exercised in improvement of work conditions and in right education of workers for keeping rules of work safety. This on one hand results in strengthening and protecting human health and on the other hand increases the work productivity.

Key words: historical review, occupational morbidity, occupational health, preventive measures, acceptable risk
Address for correspondence: Albena Vatkova, Department of Neurology, Psychiatry, Physiotherapy and Rehabilitation, Preventive Medicine and Public Health, Medical Faculty, Sv. Kliment Ohridski Sofia University, 1 Kozyak St., Bg ― 1407 Sofia


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