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Reviews 2014



L. Terziev and V. Tzvetkova-Vicheva
Sector “Clinical Immunology and Allergology”, Medical University – Pleven

Summary. The formation of isoprostanes and similarities and differences between them and prostaglandins are presented. Pulmonary diseases were identified, in which isoprostanes are definite, specific and non-invasive markers of oxidative stress. This identification is supported by results obtained in an experimental model of asthma. In addition, the effects of isoprostanes on various cell types in the lungs (smooth muscle, endothelial, inflammatory cells) were studied. These effects can worsen the clinical course of asthma, chronic obstructive pulmonary disease, pulmonary hypertension, acute lung injury, etc.

Key words: asthma, lung hypertension, acute lung injury, isoprostanes, chronic obstructive lung diseases
Address for correspondence: Lyudmil Terziev, MD, PhD, Sector "Clinical Immnunology and Alergology", Medical University, 1, Kliment Ohridski St., Bg ―5800 Pleven, e-mail: luterzi@mail.bg

M. Genova
Department of Clinical Laboratory and Clinical Immunology,
Central Clinical Laboratory, University Multiprofile Hospital for Active Treatment “Aleksandrovska”,
Medical University – Sofia

Summary. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during the current pregnancy. It appears to be a result of a wide spectrum of physiological and genetic dysfunctions, the synergistic action of some endogenous and exogenous factors. It identifies pregnant women with a high risk of perinatal mortality, prolonged overweight and impaired glucose tolerance after birth. Women with GDM have high risk for developing diabetes mellitus of type 2 (DMT2) outside pregnancy. There are several factors which can trigger GDM, but only some of them are well studied. Obesity, heredity and limited exercise activity are the main exogenous factors and abnormally high insulin resistance (IR) and changed b-cell function are the main endogenous factors which are key factors in the pathogenesis of DM T2. The pathogenetic mechanisms associated with impaired placental function, insulin resistance and b-cell dysfunction in pregnant women with GDM are not well studied. There are enough strong evidence for the crucial role of adipose tissue in the development of IR and DMT2. Expression and regulation of adipocytokine in tissues of pregnant women and their relationship with GDM do not fully understood. The importance of this medical problem in context of the increasing frequency of GDM, related consecutive complications for newborns and mothers and not sufficient investigation of this medical problem in the country, explains the interest in studying pathogenetic mechanisms and diagnostic opportunities for risk assessment and early diagnosis of the condition "gestational diabetes mellitus".

Key words: gestational diabetes mellitus, insulin resistance, insulin sensitivity, b-cell dysfunction
Address for correspondence: Mariana Genova, Department of Clinical laboratory and Clinical immunology, Central Clinical Laboratory, University Hospital “Aleksandrovska”, 1 Sv. G. Sofiiski, St., Bg – 1431 Sofia

V. Doycheva, Y. Mitova, S. Angelova and Ts. Mincheva
Department of Epidemiology, Medical University – Sofia

Summary. HIV infection is of major public-health importance in Europe. In 2011, 53 974 HIV diagnoses were reported by 50 of the 53 countries in the WHO European Region, of which 28 038 were reported by the countries in the European Union and European Economic Area (EU/EEA). The surveillance results suggest that HIV transmission continues in many countries, with an overall rate of 7.6 diagnoses per 100 000 population for the WHO European Region and 5.7 in the EU/EEA. The rates are highest in the East of the Region. The main transmission mode varies by geographical area, illustrating the wide diversity in the epidemiology of HIV in Europe; heterosexual transmission is the main mode of transmission in the entire WHO European Region but sexual transmission between men is the most common mode in the EU/EEA. The number of AIDS cases has continued to decline in many countries, although the number has increased in several countries in the East. The first cases of HIV were registered in Bulgaria in 1986. For the period 1986-2011 total number of registered HIV infected is 1461. The number of infected men is 795 (/morbidity 10.6 per 100 000), and women – 213 (morbidity 2.8 per 100 000).

Key words: HIV (Human Immunodeficiency Virus). AIDS, distribution, vulnerable groups, prevention and control

V. Doycheva and Y. Mitova
Department of Epidemiology, Medical University – Sofia

Summary. The origin of Smallpox as a natural disease is lost in prehistory. It is believed to have appeared around 10 000 BC, at the time of the first agricultural settlements in northeastern Africa. It seems plausible that it spread from there to India by means of ancient Egyptian merchants. The earliest evidence of skin lesions resemblied those of Smallpox is found on faces of mummies from the time of the 18-th and 20-th Egyptian Dynasties (1570-1085 BC). Smallpox was introduced to Europe sometimes between fifth and seventh centuries and was frequently epidemic during the Middle Ages. Turing point in the fight against this infection is the discovery of the English doctor Edward Jenner. In 1796 Jenner infects 8-year old boy with exudates from skin lesion at the hands of a milkmade in Gloucestershire (England). The procedure is effective because the boy develops a slight form of Smallpox and subsequently lasting immunity to the disease. The process of worldwide eradication of Smallpox was set in motion the World Health Assembly received a report in 1958 of the catastrophic consequences of Smallpox in 63 countries, mostly in Asia and Africa. In 1967, a global campaign began under the guardianship of the World Health Organization (WHO), which finally succeeded in eradicating Smallpox. On May 8, 1980 The World Health Assembly announced that the world was free of Smallpox and recommended that all countries cease vaccination.

Key worlds: smallpox, eradication, vaccination, Edward Jenner
Address for correspondence: Assoc. Prof. Viktoriya Doycheva, PhD, Department of Epidemiology, Medical University – Sofia, SBALAG ” Maichin dom”, room 667, tel: 359 2 952 38 44, e-mail: v.doycheva@abv.bg

Ts. Velikova1, Z. Spassova2, Е. Ivanova-Todorova1, D. Kyurkchiev1 and I. Altankova3
1Medicо-Diagnostic Laboratory of Clinical Laboratory and Clinical Immunology,
University Multyprofile Hospital for Active Treatment "Sv. Ivan Rilski", Medical University – Sofia
2Clinic of Gastroenterology, University Multyprofile Hospital for Active Treatment "Sv. Ivan Rilski",
Medical University – Sofia
3University Hospital Lozenets, Sofia University

Summary. Gluten-sensitive enteropathy (GE) is a health problem with up to 1% frequency in population and with high risk of complication events in patients without therapy. A multidisciplinary approach is needed in management of this immune-mediated disease. GE is thought to be disease in childhood although many adults are diagnosed with GE nowadays. GE could pass subclinically for many years in elderly patients or could be presented with fatal complications at first time. Besides affirmed in clinical practice anti-gliadin antibodies (AGA), anti-reticulin antibodies, anti-endomisium antibodies (EMA), simultaneous investigation of antibodies against tissue transglutaminase (anti-tTG), anti-deamidated gliadin peptides antibodies (anti-DGP) and anti-actin antibodies could be useful in diagnostic process, management and follow-up of the disease.

Key words: gluten-sensitive enteropathy, anti-tTG, anti-DGP, AAA
Address for correspondence: Tsvetelina Velikova, MD, Medico-diagnostic laboratory of Clinical Laboratory and Clinical Immunology – UMHAT Sv. Ivan Rilski, 15 “Acad. Iv. Evst. Geshov” St., Bg ― 1431 Sofia, tel.: 00359 2 8527046, GSM: +359 883306049,
e-mail: cvetelina.mladenova@abv.bg



L. Beshev1, B. Tsankov2 and B. Ignatov2
1Vascular Surgery Ward, UMBAL – Pleven, Medical University – Pleven
2Vascular Surgery Cycle, Medical University – Pleven

Summary. The peripheral arterial disease (PAD) is a widespread and socially significant vascular disease. It‘s progressive development lead to critical limb ischemia(CLI), which in turn may lead to heavy and permanent disability of the patients. The unsatisfactory results in the treatment of patients in the advanced stage of the disease,underline the search and development of new methods and strategies of treatment. One such promising, easy to master, and safe method, which is already widely used in the developed western European countries and the USA is the auto transplantation of bone marrow derived stem cells. The therapy is performed using the patient‘s own biological material, which prevents any possible immunological conflicts, and takes about 20 minutes. The good results from clinical trials carried out in Germany, the Netherlands, USA and some Asian countries, provide a solid ground to promote this new and promising procedure.
Key words: critical limb ischaemia, stem cells, treatment
Address for correspondence: Lyubomir Beshev, MD, Vascular Surgery Ward, UMBAL “Georgi Stranski”, 8A Georgi Kochev Bvl., Bg – 5800 Pleven, tel.: 064/886359, e-mail: lyubomir_beshev@yahoo.com

I. Ivanova1, B. Atanasova2 and K. Tzachev2
1Department of clinical laboratory, University Hospital “St.Ivan Rislki”, Sofia
2Department of clinical laboratory and clinical immunology, University Hospital “Alexandrovska”,
Medical University – Sofia

Summary. Copper is an essential trace element for humans and animals. It plays crucial role as an integrative component of many copper metalloenzymes and participates in various physiological processes: pigmentation, erythropoesis, gene expression, oxidative stress, regulation of glucose balance. Clinical disorders of copper homeostasis are associated with deficiency or overload. Phenotypically these impairments have diverse expression. In recent medical practice the need for reliable laboratory markers that would allow effective evaluation of copper status in human body with high sensitivity to detect even small changes in body copper levels is boldly underlined. This review presents the main aspects in copper physiology, clinical disorders in copper metabolism and key laboratory biomarkers for assessment of copper status
Key words: copper metabolism, copper deficiency, copper overload, biomarkers of copper status, Menkes disease, Wilson’s disease, Alzhеimer’s disease
Address for correspondence: I. Ivanova, Department of clinical laboratory, University Hospital “Sv. Ivan Rislki”, 15 Akad. I. E. Geshov, bvl., Bg – 1431 Sofia, tel.: 02/8524883, +359 877721478, e-mail: irena.dimirtova@gmail.com

I. Bogoeva
Bulgarian Food Safety Agency, Risk Assessment Centre
Summary. Improper use of plant protection products in modern agriculture is a major source of environmental pollution and food commodities with pesticide residues. This is a major factor in damaging the ecosystems and their inhabitants and also – the human health as an integral part of the nature. Pathways of these substances in the body are through direct contact or through contaminated food uptake. The presence of a number of pesticides in the human body can cause irreversible consequences and violations in its functioning, and at higher doses can lead to a lethal effect. The most vulnerable groups are people, working in the production of pesticides, their users and also – children. There is a harmonized European legislation to establish maximum levels for pesticide residues in food of plant and animal origin to all Member States. The aim of this study is to draw attention to the irreversible harmful effects on the environment and human health, which pesticides could cause, and to call for reasonable use.
Key words: persticides, injurious human health
Address for correspondence: I. Bogoeva, Bulgarian Food Safety Agency, Risk Assessment Centre, 136 Tzar Boris III bvl., Bg – 1618 Sofia, tel.: 359 882 469 414, e-mail: iren.bog@abv.bg; irena.bogoeva@nvms.government.bg

A. Vatkova
Department of Nevrology, Phsihyatry, Physioterapy and Rehabilitation, Preventive Medicine and Public Health, Medical faculty, Sofia University "Sv. Kliment Ohridsky"
Summary. The development of the human society has been always connected to the development of the technology and science up to the modern high technologies. The revolution in science and technology marks a new stage in the development of human society – this of the industrial society. Today, we say we are living in a post industrial society, where new technologies are developing at lightning speed. This is inextricably bound up with the working process and different factors determining it. Parallel to this process, the human awareness evolved in connection to relation between work process, work conditions and human health. Nowadays, on the background of the running globalization, the concentration of the workforce in megapolicies, computerization, migration and hyper information are fact. In this article, on the base of number of scientific researches, we talk about health determinants of the occupational diseases in their dynamics, reflecting the level of the science and technology development and the social and cultural challenges.
Key words: health determinants, modern society, globalization, occupational diseases, occupational health, social factors, level of education, work burden
Address for correspondence: Albena Vatkova, Medical faculty, SU "Sv. Kliment Ohridsky", 1 Kozyak str., Bg – 1407 Sofia, e-mail: hariomabby@abv.bg


N. Boyadzhieva, M. Varadinova and R. Metodieva
Department of Pharmacology and Toxicology, Medical Faculty,
Medical University – Sofia

Summary. Stem cells are undifferentiated cells. They are 2 groups: embryonic and adult stem cells. They have the following characteristics: a) the capacity to proliferate (self-renewal); b) the capacity to differentiate in various mature cells; c) agglutination. They express antigens (markers). During development of embryo, basic blastula forms the colony of stem cells and the colony forms 3 important groups of stem cells: endoderm, mesoderm and ectoderm. Each of them can differentiate in different mature cells as followings: endoderm (lung cells, pancreatic cells and thyroid gland cells), mesoderm (muscle cells, cardiomyocytes, erythrocytes, kidney cells, etc.) and ectoderm (skin cells, neuronal cells, glia, etc.). The application of stem cells in medicine is to treat various diseases as the followings: neurological, cancers, haemopoetic, cardiovascular, autoimmune, endocrine, reproductive, skin diseases, etc. In addition, the in vitro and in vivo studies on stem cells plays a role in future progress for cell transplantation (cell-based therapy). 
Key words: stem cells, cell-based therapy, cell transplantation, phenotype cell differentiation
Address for correspondence: Miroslava Georgieva Varadinova, MD, PhD, Department of Pharmacology and Toxicology, Мedical University, 2 Zdrave st., Bg – 1431 Sofia, tel.: 00359 2/952 05 39, e-mail: miria@abv.bg

V. Doycheva and Y. Mitova-Mineva
Department of Epidemiology, Medical University – Sofia
Summary. Arboviruses (arthropod-borne viruses) are the large group viruses, transmitted by arthropods, causing hemorrhagic fevers and encephalitis. These viruses are interesting because they have large genetic plasticity and complex cycle of transmission. They are influenced by ecological changes, observed in the last decades. Thus arboviral infections placed in the group of ‘emerging infections’. In this article the main ecological features of arboviruses and their vectors and reservoirs, and epidemiological features of arboviral infections are discussed.
Kеy words: arboviruses, arboviral infections, vectors, natural foci, epidemiology, ecology
Address for correspondence: Assoc. Prof. Viktoriya Doycheva, PhD, Department of Epidemiology, Medical University, SBALAG ” Maychin dom”, room 667, 2 Zdrave st., Bg – 1431 Sofia, tel: 359 2 952 38 44, e-mail: v.doycheva@abv.bg

N. Pavlov
Private practice of oral surgery – Plovdiv
Summary. TThird molar impaction is a disease of a modern civilization. There are different theories that try to explain etiology of impaction. Many classifications were suggested. Surgical removal of impacted third molars causes some complications. It is important to specify indications for mandibular third molar removal.
Key words: impaction, different theories, mandibular third mola
Address for correspondence: Nikolay Pavlov, MD, private practice – Oral surgery, 15A Lozarska st., Bg – 4000 Plovdiv,
tel.: 0888254906, e-mail: nikolai.v.pavlov@gmail.com

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