Original articles 2014



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

Summary. The infections of the external coverings (cover infections) are a group of infectious diseases, caused by pathogenic microorganisms which penetrate the human organism through the skin and the mucous membrane. In some of the infections of the external coverings, the source of the infection is human (anthroponoses), in others – wild and domestic animals (zoonoses) and in the third group of cases ― abiotic elements of the outer milieu (sapronoses). They are propagated sporadically. They are caused by bacteria and viruses. One can be infected in many different ways: through a direct contact with sick animals, by being bitten by sick animals (rabies), by dirty hands, in various injuries (wound infections) etc. The basic factors in spreading the infections of the external coverings can be various elements of the outer milieu. The dynamics and the basic indicators of the development of the epidemic process in certain infectious diseases having covering mechanism of propagation which have health and social importance, registered in Bulgaria have been explored in the course of the study.

Kеy words: anthrax, tetanus, rabies, epidemiological indicators, prevention and control, immunization
Address for correspondence: Dr. Tsvetanka Mincheva, Department of Epidemiology, Medical University,
1 Sv. G. Sofiyski, St., Bg ―1431, Sofia, tel. 00359 2 9523844, e-mail: tsvetanka.mincheva@gmail.com

N. Korsun1, A. Teodosieva1, М. Yordanova1, А. Kurchatova2 and М. Kozhucharova2
1National Reference Laboratory of Influenza and Acture Respiratory Disorders, Department of Virology,
2Department of Epidemiology and Surveillance of Contagious Diseases,
National Center of Contagious and Parasitic Diseases – Sofia

Summary. The aim of the study was to analyse the special features of influenza season 2012/2013 in Bulgaria and to determine the antigenic and genetic characteristics of circulating influenza viruses. During the period week 40/ 2012–week 21/2013, 1125 nasopharyngeal swabs from patients with influenza-like illness or acute respiratory diseases from different regions of the country were tested for influenza viruses. Detection and typing/subtyping of influenza viruses were carried out by the method Real Time RT-PCR with specific primers and probes. The cell cultures MDCK and MDCK-SIAT1were used for isolation of influenza viruses. Antigen characterization of isolates was performed by haemagglutination inhibition assay. A screening of 59 influenza A(H1N1)pdm09 viruses was carried out using Real Time RT-PCR discrimination assay for detection of the H275Y oseltamivir resistance point mutation. Of 1125 tested clinical specimens 329 (29) were influenza virus positive. Co-circulation of А(Н1N1)pdm09 (59/329, 18%), А(Н3N2) (21/329, 6%) and B (250/329, 76%) viruses was established with dominance of the B viruses during the most weeks of period. Antigenic analysis of A(H1N1)pdm09, А(H3N2) and В isolates showed similarity to the recent vaccine strains. It was not proven the mutation H275Y, causing resistance to oseltamivir among the pandemic viruses. Some epidemiological and clinical features of influenza epidemic in the last season are also presented. There were some features in biological properties, epidemiology and clinical activity of influenza viruses responsible for the recent influenza epidemic in Bulgaria that are important to form the seasonal influenza prevention and control policy.

Key words: influenza viruses, antigenic analysis
Address for correspondence: Prof. Neli Korsun, MD DSci, National Reference Laboratory of Influenza and Acture Respiratory Disorders, Department of Virology, National Center of Contagious and Parasitic Diseases, 44A General Stoletov Blvd., Bg ―1233 Sofia, tel. +359 2 931 81 32, e-mail: neli_korsun@abv.bg

A. Taseva, V. Tasev, P. Tokov and V. Dimitrova
Department of General and Liver–Pancreatic Surgery, University Hospital for Active Treatment
“Alexandrovska”, Medical University – Sofia

Summary. Surgical treatment of the liver hemangiomas is controversial. In some of the patients it is required due to relative or absolute indications. The aim of this publication is to present the single-center experience with enucleation as a method of treatment. During the period 1995–2013 in the Department of General and Liver-Pancreatic Surgery, University Hospital “Alexandrovska“ – Sofia, 101 patients with liver hemangiomas underwent surgery, with 124 surgical procedures. In 16 case enucleation was performed, and in another 19 – enucleoresection. One postoperative complication was observed in 1 patient. One patient required reoperation. No letal outcome of sutgical treatment was present. Assessing the risks and benefits of surgical treatment of hepatic hemangioma is particularly important from the point of view of the benign nature of the lesion. When there is indication, enucleation is the treatment of choice.

 Key words: hemangioma, liver, enucleation
Address for correspondence: D-r Anna Taseva, Department of General and Liver-Pancreatic surgery, UMHAT “Alexandrovska”, Medical University, 1 ”Sv. G.Sofiyski” St., Bg ―1431 Sofia, e-mail: annataseva85@gmail.com

L. Beshev1, V. Edreva2 and D. Nguen3
1Department of Surgery, Medical University – Pleven
2Department of Microbiology, Virology and Medical Genetics, Medical University – Pleven
3Clinical Microbiology Group, Medical University – Pleven

Summary. Bacterial colonization and subsequent development of infection is a common cause of problematic wound healing. The aim of this study wais to analyze the etiological structure of wound infections in patients with chronic arterial insufficiency, to track trends in resistance of the most frequently isolated pathogens, and to discuss the choices of antibiotics for prophylaxis and therapy. Analyses include 819 microbial strains isolated from 609 clinical specimens for a ten-year period. Gram-negative aerobic bacteria were predominant, followed by Gram-positive aerobic bacteria, anaerobes and fungi. 29.39% of the infections were polymicrobial. Analysis of antimicrobial resistance gives favor to cefuroxime as antibiotic for prophylaxis, and for empirical therapy – Ciprofloxacin or combinations of third generation cephalosporin and an aminoglycoside.

Key words: wound infections, vascular surgery, etiology
Address for correspondence: Lyubomir Beshev, MD, Vascular Surgery Ward, UMHAT “Georgi Stranski”, 8A Georgi Kochev,
Bg ―5800 Pleven, tel.: 00359 64/886359, e-mail: lyubomir_beshev@yahoo.com


Y. P. Yordanov
Unit of Plastic Surgery and Burns, Military Medical Academy – Sofia
Summary. Ablative and traumatic defects in the skull base region produce complex reconstructive problems with a high risk of significant postoperative morbidity and mortality. Over the past two decades, microvascular free tissue reconstruction following open conventional resections has been shown to improve outcomes and reduce complication rates when compared to the traditional use of pedicled flaps. The increasing use of free tissue transfer has been further strengthened by improved technical expertise and high flap success rates.This study was designed to demonstrate the free flap reconstruction of extensiveskull base defects, applying different microvascular flaps. All extensive anterior skull base penetrating tumor resections with microvascular reconstruction made in the plastic surgery unit of the General University hospital Gregorio Mrañón in Madrid (Spain) between September 2009 and December 2012 were reviewed. Seventeen patients with mean age 51.6 y were included in the study. Nineteen free microvascular flaps were used in total being the rectus abdominis flaps the most commonly used. However, four different types of flaps were applied. Two infectious complications were observed (11.7%), two cases of CSF leak (11.7%), one case of wound dehiscence (5.9%) and one case of partial distal necrosis of the flap (5.9%) were observed. Total flap necrosis was not registered in the study. Two latissimus dorsi donor site haematomas were observed (11.7%). Microvascular free tissue transfer is a safe and reliable method of anatomical reconstructing skull base defects while offering favorable cosmetic and functional results.
Key words: microsurgery, skull base reconstruction, free flaps, complications
Address for correspondence: Yordan P. Yordanov, MD, PhD, Unit of Plastic Surgery and Burns, Military Medical Academy, 3, Sv. G. Sofiyski St., Bg – 1606 Sofia, tel. +359 887 56 00 54, e-mail: yordanov_vma@abv.bg


Y. Mitova, V. Dojcheva and S. Angelova
Department “Epidemiology”, Medical University – Sofia
Summary. Despite the partial diagnostics and registry, nosocomial infections in Bulgaria are widespread and have a great significance on health, as well as social and economic impact. Statistical estimates of official data for the 2011-2013 period show that the frequency of registered nosocomial infections among hospitalized patients is under 1%. Within the clinical structure of nosocomial infections in Bulgaria during the discussed peroid leading part take pneumonia and other lower respiratory tract infections, with a 21,22% share. Their leading etiological agents in Bulgaria are Acinetobacter spp. and Pseudomonas spp. Infections of the urinary tract take 15,65% of the clinical structure of nosocomial infections. They are mostly caused by E. coli (29,68%). During the etiological decoding of the surgical site infection, the highest frequency of isolation is due to S. aurevs (20,67%) and E. coli (20,18%). As for the bloodstream infections the isolated agent in 29,55% of the cases is coagulase negative staphylococcus (primarily S. epidermidis).
Key words: nosocomial infections, distribution, clinical structure, etiological agents
Address for correspondence: Yordanka Mitova-Mineva, MD, PhD, Department of Epidemiology, Medical University, 2 Zdrave st., Bg – 1431, Sofia, e-mail:drmitova @mail.bg

M. Karcheva1, S. Mihaylova1,2, I. Makaveev3, A. Dimitrova3 and L. Mihaylova2
1Medical University – Pleven
2Pleven University Hospital
3Military Medical Academy – Hospital Facility for Active Treatment – Pleven

Summary. Aim: To study the competence of health care workers with respect to standard precautions for infection control. Material and methods: One hundred and thirty-one health care workers (nurses and midwives) aged from 24 to 60 years with work experience between 1 and 40 years were subject of investigation. A self-reported questionnaire was used. Data were processed by the program IBM SPSS Statistics 20.0. Results: The majority of health care workers indicated the aim of standard precautions (n = 93, 71.0%) and all possible cases in which they have to be applied (n = 109, 83.2%); identified the wrong answers connected with medical waste separation (n = 115, 87.8%) and personal protective equipment (n = 118, 90.1%); answered correctly the questions concerning mask usage (n = 109, 83.2%), working clothing (n = 112, 85.5%) and gloves (n = 113, 86.3%). A lower proportion of nurses and midwives recognized the necessary time for hand washing with soap and water (n = 47, 35.9%); knew permissible volume for filling containers with used needles and syringes (n = 67, 51.1%) and were informed that the front of protective glasses is considered contaminated (n = 89, 67.9%). Conclusion: Medical specialists demonstrate high levels of knowledge with respect to standard precautions. These results reflect the adaptation and introduction of internationally approved regulations and requirements in practice in Bulgarian hospitals. The gaps found could provide insight for choosing the topics for periodic instructions connected with infection control. In this way, a high quality of health care, safety, as well as protection of the rights of health care workers, patients and third parties will be provided.
Key words: competence, health care workers, standard precautions
Address for correspondence: Assoc. Prof. Milena Karcheva, MD, PhD, Section “Epidemiology, parasitology and tropical medicine”, Medical University, 1 Sv. Kliment Ohridski St., Bg – 5800 Pleven, e-mail: milena_karcheva@abv.bg

V. Velev1.2, N. Durvenyashka1,2, N. Naydenova1,2, V. Ilchova2, I. Tomova2, S. Aleksieva1,2 and M. Tiholova1,2
1Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical Universisty – Sofia
2SHATIPD “Prof. Iv. Kirov” – Sofia

Summary. The aim of the study was to investigate the differences in the clinical course of salmonellosis and campylobacteriosis in children. Diagnosed and treated were a total of 27 children, 15 with campylobacteriosis and 12 with salmonellosis – an average age of 3.9 years. The study included only children with culture proven cause for the period March 2012 – August 2013 from SHATIPD "Prof. Ivan Kirov". Used were clinical, epidemiological and lab methods of investigation. Salmonellosis occurred significantly more frequently with low-grade febrile values in comparison to Campylobacter disease (42% to 2.22%), but the difference in high febrile cases no longer exists (58% to 58.33%). In Campylobacter disease defecation varies between 3 and 5 times, at a 10 times over salmonellosis. In both diseases defecation occurs most frequently between 5 and 10 times (46% for Campylobacter to 50% of salmonellosis). In salmonellosis the impurity of mucus (67%) is frequent, while campylobacteriosis mucus and blood is frequent (73.33%). In salmonellosis vomiting ocurrsis frequenly more than 5 times (16.66% to 0%). Campylobacteriosis and salmonella as typical bacterial zoonoses have similar moments of course – diarrhea pathological impurities; upper dyspeptic syndrome and abdominal pain. Leading in campylobacteriosis is high febrile temperature in most cases, which is an expression of a more severe intoxication. In the majority of stool present both pathological impurity – mucus and blood. In salmonellosis are more pronounced incidence of upper and lower dyspeptic syndromes and impurities of mucus in the stools.
Key words: campylobacteriosis, salmonellosis, differential diagnosis
Address for correspondence: V. Velev, MD, Department of Infectious Diseases, Parasitology and Tropical Medicine, MU, 17 Akad. Ivan Geshov bvl., Bg – 1431 Sofia

T. Vrabcheva, J. Tishkova, T. Barakova and V. Christova-Bagdassarian
Food Contact Materials Department, National Center of Public Health and Analyses – Sofia
Summary. Food contact materials are used along the whole chain of food supply, processing, storage and consumption. These materials are insufficiently studied source of exposure. In this connection, surveys for overall migration from commercially available food contact plastics were conducted for the first time in Bulgaria. For this purpose, standard European methods were verified. The test conditions of the items are selected according to the relevant guidelines of the European Reference Laboratory for food contact materials. The results obtained for 68% of samples were below the limit of detection of the method. For 9.8% of the samples noncompliance with the regulations was found. The results obtained were stratified according to type of the polymer and intended use. The item’s groups, indicating a risk to human health have been established. Attention was focuses to the materials and articles showing the results significantly above the limit on overall migration (color masterbatch and polyamide articles).
Key words: food contact materials, plastics, overall migration
Address for correspondence: Chief Assistant Eng. Valentina Christova-Bagdassarian, PhD, Food Contact Materials Department, National Center of Public Health and Analyses, 15, Akad. Iv. Ev. Geshov Blvd., Bg – 1431 Sofia, Phone number: +359 2 80 56 375, е-mail: v.hristova@ncpha.government.bg


V. Stefanova1, S. Tzanova2, M. Manolova1 and D. Dimitrova2
1Department of Operative Dentistry and Endodontics, Faculty of Dental Medicine
2Department of Health Management, Economics of Health Care and General medicine,
Faculty of Public Health, Medical University – Plovdiv

Summary: Aim: This study aims to investigate the information and attitude of dental medicine practitioners towards the new materials and technologies in biological treatment of the pulp. Methods: An inquiry sociological study addressed to the dental medical practitioners, members of the Regional Body of the Bulgarian Dental Association in Plovdiv was made. The respondents filled an original anonymous inquiry paper. The analyses of data and graphical visualization of results were performed by statistical software SPSS 13.0. Results: The mean age of the respondents is 43.8 years. Men are 32.2%, women – 83.7%. The average length of working is 19.0 years. 31.2% are specialists in General Dental Medicine, 55.4% are without specialty. 83.7% of the respondents have a contract with the National Health Insurance Fund. In this investigation women with a longer working length prevail (p < 0.05, х2 = 10.269). With statistical significance it was proved (p < 0.01; х2 = 18.332) that dental medical practitioners at the age under 40 and those over 51 apply biological treatment to people not older than 35 years and those who apply the method only to patients under the age of 18 are in the age group 41-50. With the increase of age of the practitioners the usage of local anesthesia during this method is decreasing (p < 0.05; х2 = 8.354). In between groups connections investigation proved (p < 0.01; х2 = 24.948) that dental medicine practitioners who choose tricalcium silicate cement as their favorite pulp capping material consider the dental laser the most atraumatic in caries lesion excavation in biological treatment of the pulp. Conclusion: Dental medicine practitioners know the new pulp capping materials for biological treatment of the pulp but a small part use them in their everyday practice. Although practitioners are familiar with the advantages of dental laser in dental caries excavation their application is limited. The common level of knowledge of the method of biological treatment of the pulp in the studied contingent may be considered high.
Key wоrds: biological treatment of the pulp, vital pulp therapy, pulp capping materials, dental lasers
Address for correspondence: Vesela Stefanova, Chief Assistant Professor, Department of Operative Dentistry and Endodontics, Faculty of Dental Medicine, Medical University, 3 Hristo Botev blvd., Bg – 4000 Plovdiv, tel.: +359 888656232, vesela_st@yahoo.com

Т. Vekov1 and Zh. Kolev2
1Public Health Faculty, Medical University – Pleven
2Pharmaceutical Faculty, Medical University – Varna

Summary. The focus of our study is about the comparative analysis of the normative requirements for marketing, promotion and advertising of the drugs in European Union. The aim is to evaluate the regulatory normative mechanisms in Bulgaria. Having in mind the increase of the expenditures for medicines and the chronic deficit of public financial resources for reimbursement it is necessary the good European practices to be implemented. Thus the modulation of the prescription model will be possible.
Кey words: drugs, marketing, promotion, commercials, normative requirements, Еuropean Union
Address for correspondence: Prof. T. Vekov, DSci, Faculty of Public Health, Medical University, 1, Sv. Kliment Ohridski, st., Bg ― 5800 Pleven


V. Dontchev1, Е. Hayvazov2, S. Vasev2, S. Konstantinov3, G. Momekov3, J. Ilieva3, E. Stefanova1
and B. Landzhov1

1Department of Anatomy and Histology, Faculty of Medicine, Medical University – Sofia
2Department of Orthopaedics and Traumatology, Hospital „Doverie“ – Sofia
3Department of Pharmacology, Pharmacotherapy, Toxicology, Faculty of Pharmacy, Medical University – Sofia

Summary. Chondrocytes are highly differentiated cells. They are surrounded by themselves produced extracellular matrix  which secretes collagen type 2 and some proteoglycans (mainly aggrecan). They provide specific properties of cartilage. Removed from their environment and cultured in vitro, cells reducing their differentiation, change the secretion of collagen type to another, approaching phenotype to cells resembling fibroblasts. Aim of the study was to cultivate cells with characteristics of chondrocytes, which in a subsequent stage can be incorporated in the three-dimensional structure which can be developed to become the basis of implant for restoration of damaged articular cartilage. For this purpose, we are cultivating and using two biological models, namely: 1) culturing of autologous primary chondrocytes and 2) culturing chondrosarcoma cells of a cell line SW 1353. Basic idea was to compare the parameters of both cell models. Their secretion, in particular collagen type 2 and proteoglycans, was verified and established. Both types of cells have the potential for formation of cartilage tissue. They synthesize collagen type 2, but the secretion of chondrosarcoma cells is relatively constant over time, whereas in primary chondrocytes, it reduces significantly in result of cell passage and age of the cultures. In cultures of chondrosarcoma cells prove more proteoglycans. Ultimately, in order to assess which of the two models is promising, experiments are needed to generate three-dimensional structure of chondrocytes and its implantation.
Key words: chondrocytes, cell cultures, collagen type 1, collagen type 2, aggrecan

Address for correspondence: Assoc. Prof. Vasil Dontchev, Department of Histology, Faculty of Medicine, Medical University,
2 Zdrave st., Bg – 1431 Sofia, e-mail: dvd03@mail.bg


T. Petkova and Tz. Doichinova
Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine,
Medical University – Pleven

Summary. For the purpose of the study was performed retrospective epidemiological and clinical laboratory analysis of data from the hospital records of 12 patients diagnosed with herpes zoster, treated at the Clinic of Infectious Diseases, University Hospital „Dr. G. Stranski„ – Pleven, in the period 2010-2014. During the study period predominate among hospitalized women (75%). The age of infected ranged from 17 to 78 years (= 59.08; sd = 18.66). The study on the seasonality of herpes zoster showed the highest proportion of sufferers in the spring. 83.33% of cases are primary forms. Topographical distribution of the infection showed mainly involvement area of ​​a dermatome according to the course of thoracic nerves (33.33%) or the upper branch of n. trigeminus (zoster ophthalmicus – 25%). Clinical forms are defined as moderate and severe at 33.33% and 66.67% of the patients respectively. 75% of patients are established comorbidities – diabetes, chronic cardiovascular and renal diseases, arthrosis, neoplasms. A major risk factor is increasing age (66.67%). Early treatment with the antiviral drugs reduces the likelihood of developing postherpetic neuralgia as late complication.
Key words: herpes zoster, herpes zoster ophthalmicus
Address for correspondence: Chief Assist. Prof. Tdnya Petkova, MD, Department of Infections  Diseases, Epidemiology, Parasitology and Tropical Medicine, Medcial University, 1 Sv. Kliment Ohidski St., Bg – 5800, Pleven, email: tanja_1973@abv.bg, GSM: 0885 33 87 74

V. Manolov1, B. Bogov2, D. Yonova3, E. Vazelov3, M. Velizarova1, V. Vasilev1 and K. Tzatchev1
1Department of Clinical Laboratory and Clinical Immunology, Medical University – Sofia, Bulgaria
2Department of Clinical Nephrology, Medical University – Sofia, Bulgaria
3Dialysis Center, University Hospital “Aleksandroska”, Medical University – Sofia, Bulgaria

Summary. Aim: Hepcidin-25 is an iron regulating peptide, secreted in liver. Its serum quantification provides new topics for the pathogenesis of iron metabolism and its treatment. Data: We use an ELISA method to quantificate serum hepcidin levels. Groups included: healthy control group (CG, n = 50) and patients with chronic kidney disease (CKD including dialysis, n = 50). Including criteria for CG was no evidence of iron metabolism disorders, evaluated by clinical parameters for iron status. RESULTS: We found that serum hepcidin levels differs significantly between two groups: 15.1 ± 8.7 µg/L (for CG) to 90.7 ± 51.1 µg/L (for CKD without dialysis) and 201.1 ± 81.1 µg/L (for CKD on dialysis). A significant correlation between MCV, TIBC and hepcidin in dialysis patients was found (0.3 < r < 0.5, p < 0.05). We found no correlation between hepcidin and other iron metabolism parameters (-0.297 < r  < 0.156, p < 0.05). Conclusions: Quantification of serum hepcidin provide a new efforts for therapy management of iron deficiency in CKD.
Key words: hepcidin, iron deficiency anemia, chronic kidney disease, dialysis
Address for correspondence: Victor Manolov, MD, Department of Clinical Laboratoy and Clinical Immunology, Medical University,
1 Sv. Georgi Sofiyski st., Bg – 1431 Sofia, tel.: +359 2 9230 928, GSM: +359 887 222 069, e-mail: victhedoc2@yahoo.com

M. Valcheva, V. Doycheva and Y. Mitova-Mineva
Department of Epidemiology, Medical University – Sofia
Summаry. Rabies is an acute infectious disease of the central nervous system with Rabies virus as an agent. Predators, domestic animals and some species of bats are the source and main reservoir of the infection. Rabies virus is usually present in the saliva of the sick animal and it provokes infection by a bite, a scratch or drivel on broken skin or mucosa membranes, i.e. through a coating mechanism of transmission. Two basic forms of rabies spread can be distinguished – wild (woodland) rabies – a form which affects wild animals and street (city) rabies. Rabies virus is widespread all over the world with few exceptions. It circulates in North and South America, Africa, Asia and some parts of Europe. Few countries (mainly islands) due to their geographical position and strict compliance with the legislative measures manage to stay free of rabies: Australia, New Zealand, Japan and parts of Europe. Rabies control in nature is achieved by oral EAST vaccination of wild predatory animals. This method was developed 36 years ago and the first attempt of oral vaccination against rabies (ORV) in foxes was successfully carried out in Switzerland in 1978.
Key words: rabies, oral vaccination, rabies, prevention and control
Addres for correspondence: Dr. Milena Valcheva, Department of Epidemiology, Medical University, SBALAT "Maychin dom", room 670, 2 Zdrave st., Bg – 1431 Sofia, tel.: 02 952 38 44, e-mail: miraelena@abv.bg

D. Ilieva
National Reference Laboratory of Rabies and monitoring the effectiveness of the vaccination,
National Diagnostic Research Institute of Veterinary Medicine – Sofia

Summary. In the article contemporary data for rabies cases in humans in the world and in Bulgaria are presented retrospectively. The sources of infection in humans are mostly infected animals. Control measures and the implementation of programs for the eradication of rabies in wildlife in Europe, in particular in Bulgaria limited the prevalence of the disease and transmission of this dangerous zoonosis to humans. The use of modern means of immunoprophylaxis of rabies in infected humans avoids the fatal exit of the disease
Key words: rabies, epidemiology, prevention, post-exposure prophylaxis of humans
Address for correspondence: Assoc. Prof. Darinka Ilieva, Head of NRL of rabies and monitoring the effectiveness of the vaccination, National Diagnostic & Research Veterinary Medical Institute, 15 A P. Slaveykov Blvd., Bg – 1606 Sofia, GSM: +359 877 399 322,
e-mail: emd@mail.orbitel.bg

B. Mihov
Candidate of Neurology, Medical University – Sofia
Summary. The aim of the study was to assess a potential correlation between the concentration of prolactin and vestibular irritation. The method used was investigation of the concentration of prolactin in the blood serum of the patients prior to and immediately after dosage spinning vestibular stimulation. Two groups were tested: 20 patients as controls and 20 diabetic patients. Results: The serum prolactin increases after irritation of vestibular system with average 1.3% in the healthy patients and 2.5% in patients with diabetes. Conclusion: The research has shown that in patients with diabetes the prolactin concentration increase is higher than the baseline compared with the concentrations in the control individuals after dosage spinning vestibular stimulation.
Key words: prolactin, vestibular system, diabetes
Address for correspondence: B. Mihov, Neurology Clinic, Medical University, 1 Sv. G. Sofiiski St., Bg – 1431 Sofia

M. Kamusheva, G. Petrova and Sv. Georgieva
Faculty of Pharmacy, Medical University – Sofia
Summary. With the development of new technology and scientific approaches, coming of the era of personalized medicine is unavoidable. Due to the rare diseases’ characteristics and the lack of adequate therapy, the new therapeutic approaches are going to be discovered. The goal of this study is to follow the main characteristics and opportunities of implementation of personalized medicine into the area of rare diseases. A systematic review of the published scientific literature in the databases of Google Scholar, PubMed, Scopus, Science Direct was performed using key words – rare diseases (RD), orphan drugs, personalized medicine (PM) as well as published Bulgarian books, studies and experts’ opinions in the area. The selected studies include information about the approaches and the nature of PM, definitions, classification and problems in the therapy of RD as well as examples about the implementation of PM in RD. The number of reviewed studies for RD was 34, for PM – 37, for the implementation of PM in RD – 5 and 13 for specific RD, which are object of PM. 4 of the studies, which are focused on implementation of PM in RD are rather overview and give information about the complex nature of RD, the unknown pathologic mechanisms, the limited number of patients, the lack of therapy or very expensive ones. The implementation of the approaches of PM – integral diagnostic approaches, molecular diagnostic, monitoring, pharmacogenomics, pharmacogenetics, pharmacoproteomics – and connected therapies – cell, gene, target by nanoparticles and liposomes – support development and implementation of the personalized approach in some RD – chronic myeloid leukemia (the patients’ number in Bulgaria is 328), cystic fibrosis (the patients in Bulgaria are approximately 200), alpha 1 antitrypsin deficiency, dermatofibrosarcoma protuberans, lymphangioleiomyomatosis, Erdheim-Chester disease, large granular lymphocyte leukemia, rare neuromuscular and neurodegenerative diseases, rare skin disorders. The application of target therapy is also helpful for treatment of rare oncological diseases. The implementation of PM’s approaches in RDs is a challenge in front of every healthcare system but gives enough opportunities for personal approach and for improving of the condition and quality of life of patients, as well as saving costs for non-responsible therapeutic regimen, complications and adverse drug reactions.
Key words: personalized medicine, rare diseases, pharmacogenomics, pharmacogenetics, pharmacoproteomics, target therapy
Address for correspondence: M. Kamusheva, Faculty of Pharmacy, Medical University, 2 Dunav St. Bg – 1000 Sofia

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