Original articles: Vol. 10, 2016


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Original articles

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Vol 10, 1/2016

Vol 10, 2/2016

Vol 10, 3/2016


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Protozoal intestinal flora in children with campylobacter-infection - Bulgarian medical journal (Български медицински журнал), 10, 2016, №3, 36-38.
V. Velev1, M. Pavlova2, S. Alexieva1, E. Dobreva2, А. Mangarov1 and T. Chervenyakova1

1Specialized Hospital for Active Treatment for Infections and Parasitic Disease “Prof. Iv. Kirov”, Medical University – Sofia
2Department of Microbiology, National Centre of Infectious and Parasitic Diseases – Sofia
Summary. Along with the commonly considered commensal Entamoeba coli, the most common disease-causing protozoa reported here are B. hominis and G. intestinalis. The Campylobacter infection is one of the most common bacterial intestinal infections globally. Objective. The objective of the study is to determine the frequency and characteristics of accompanying protozoal intestinal fl ora in children with Campylobacter infection. Materials and Methods. In the period January 2013 – February 2014, 105 children between 0 and 14 years old, with the acute diarrhea syndrome and at least two of the following symptoms: pathological impurities in stools, fever, abdominal pain, vomiting and/or a history of consumption of animal products, were examined in Hospital “Prof. Iv. Kirov”. All patients were examined by immunochromatographic assay (ICA) (CertestBiotec, Spain) for fecal Campylobacter antigen. Part of the positive samples were verified by culture through inoculation of feces on blood agar (BulBio-NCIPD Ltd) in membrane method to nitrocellulose membranes. All fecal samples were sown on dry food environments for Enterobacteriaceae (BulBio-NCIPD-Ltd) and EnteroPluri-Test (Liofi lchem). All samples were examined for intestinal parasites by a native method, and sedimentation methods. Results. From the studied 105 children 62 (59%) were male and 38 (41%) female. From the fecal samples 33 (31%) were positive with ICA for Campylobacter, and 12 of them (36%) were verifi ed also in culture. In parasitological studies of feces protozoa were found in 16 (15%) children − B. hominis − 2 (1.9%) children, G. duodenalis − 1 (0.9%) child, Ent. coli − 13 (12%) children. Of all patients with campylobacteriosis 10 (30%) had also accompanying protozoal invasion. In the control group consisting of 30 children with proven salmonellosis 3 (10%) patients had accompanying protozoa coinfection. Conclusion. Given the relatively severe course of campylobacteriosis, often with invasion in intestinal mucosa and dysbiosis, parasitological study of feces for protozoa and eventual inclusion of anti-protozoal agents in therapeutic plan of affected patients is recommendable.
Key words: protozoa, Campylobacter, diarrhea
Address for correspondence: V. Velev, MD, SHATIPD “Prof. Iv. Kirov”, Medical University, 17 Acad. Iv. Geshov Blvd., Bg 1606 Sofi a, e-mail: velev_md@abv.bg


Delta opioid receptors participate in the mechanisms of antinociception in diabetes: experimental studies - Bulgarian medical journal (Български медицински журнал), 10, 2016, №3, 39-42.
M. Varadinova, R. Metodieva and N. Boyadjieva

Department of Pharmacology and Toxicology, Medical Faculty, Medical University – Sofia
Summary. Current experimental data suggest that delta-opioid receptors play a role in the modifi cation of nociceptive mechanisms associated with polyneuropathy in diabetes. The results show that delta receptors take part in intracellular transduction cascades, and are related to disrupted reactivity to pain and hypersensitivity. The aim of the present research was to study the effects of delta-agonist and antagonist on the mechanisms of nociception of rats with experimental diabetes. Our results demonstrate increased pain sensitivity of rats with diabetes. The repeated treatment with DADLE increased the pain latency of the experimental rats in tail-fl ick test. Taken together, the data presented here and our previous results, which demonstrated decreased glucose levels of rats with streptozotocin-induced diabetes after treatment with opioid agonist, suggest a new direction of studying of pharmacological substances which may infl uence both carbohydrate metabolism and some complications of diabetes like polyneuropathy and the accompanying pain.
Key words: diabetes mellitus, delta-opioid receptors, pain
Address for correspondence: M. Varadinova, MD, Department of Pharmacology and Toxicology, Medical Faculty, Medical University, 2 Zdrave St., Bg – 1431 Sofia

Laser therapy

Modern methods to treat of acne – low level laser therapy - Bulgarian medical journal (Български медицински журнал), 10, 2016, №3, 43-47.
K. Krahtova

MU – Varna
Summary. The laser therapy, which is based on the use of the Rikta – 02/1 (M1) device, is aimed to provide simultaneously multifactorial effects of pulsed infrared laser radiation, pulsed infrared broadband radiation, pulsating red light and a constant magnetic fi eld. The used exposure time and frequencies have remarkable medical effect. Laser therapy has characteristics and parameters that correspond to the electromagnetic processes occurring in the body at the cellular and intracellular levels. The impact of these factors on the human body leads to activation and mobilization of natural resources of the body. This device is widely used for prevention, treatment and rehabilitation of different disease units in the fi eld of dermatology and cosmetology. Laser therapy performed with the Rikta 02/1 device provides very good results. It turns out that the compromised cells respond better than the healthy cells so that short treatments with lowlight on damaged tissue may activate a complex chain of physiological reactions to promote enhancement of immunity, wound healing and tissue regeneration, reducing acute infl ammation, improvement of chronic pain and even to lead to a younger and more vital appearance of the skin.
Key words: skin, acne, contemporary therapy, laser therapy
Address for correspondence: Katrin Krahtova, Faculty of Medicine, MU, 55 Prof. Marin Drinov St., Bg – 9002 Varna, е-mail: dockrahtova@yahoo.com

Radiology and immunology

Assessment of indicators of humoral immunity, some non-specifi c factors of immunity and functional activity of lymphocytes in workers in NPP Kozloduy professional exposed with low doses of ionizing radiation - Bulgarian medical journal (Български медицински журнал), 10, 2016, №3, 48-67.
V. Rangelov, Pl. Petrunov, M. Hristozova, V. Vaseva and R. Popov

Military Medical Academy – Sofia

Summary. An important characteristic of the haemopoietic system is its particular sensitivity to the effects of various cytotoxic agents, including ionizing radiation, which may cause a non-specifi c response, manifesting itself as a change in the parameters of the peripheral blood. One of the most important properties of the body are its adaptive and protective abilities. The latter are determined by the full functioning of many organs and systems, among which the immune, nervous and endocrine systems have a leading importance. The state of immune system and its normal functioning have a direct connection with the health state of the body. Weakened immunity makes people susceptible to a number of infectious, autoimmune, and neoplastic diseases. The immune system refers to the most radiosensitive systems in the body. In the publication we present the results of the 15 tested indicators of the immune system – humoral immunity functional activity of lymphocytes, nonspecifi c factors of immunity and some specifi c proteins. Our research covers a part of the most radiation exposed contingent of NPP – nuclear power plant, who are professionally exposed to low doses of ionizing radiation working in the restricted area and subjected to regular dosimetric control. The obtained results showed that there were no signifi cant deviations from the norm of indicators of the respondents. The assessment of the immune system in studied personnel supports the concept of chronically stimulated immunity – humoral and cellular. It is possible the observed variations in some of the studied parameters refl ect a certain polarization to the humoral type immune response as a result of adaptation to chronic radiation impact. With higher doses, compensatory regulatory mechanisms that result in balancing the immune response are triggered. This confi rms the possibility of activation of compensatory biological mechanisms of the body and the immune system as a response to the subthreshold irritation of the low doses ionizing radiation.
Key words: low doses ionizing radiation, chronic occupational exposure, nuclear power plant (NPP), immune status, humoral immunity, health monitoring
Address for correspondence: V. Rangelov, MMA, 3 Sv. G. Sofi yski St., Bg - 1606 Sofia

Guest autors

Clinical laboratory

Changes of red blood cells membranes phospholipids fatty acids composition among the patients with ischemic heart desease during atrial fi brillation paroxysm - Bulgarian medical journal (Български медицински журнал), 10, 2016, №3, 68-72.
I. O. Merkulova

Internal medicine department № 4 (Chief of the Department – prof. Lizogub, V.G.) NMU named by O. O. Bogomolets, Kiev, Ukraine
Summary. Atrial fi brillation (AF) is the most common chronic arrhythmia. Coronary heart disease (CHD) is the cause of AF in more than 20% of incidence. However, pathogenic mechanisms of AF development still are not understood among CHD patients. Recently, role of the FA in the AF pathogenesis has been actively studied. During the work 40 CHD patients with paroxysmal and persistent AF clinical forms were examined by gas-liquid chromatography before and after paroxysm. 10 healthy people were also investigated, and they made up the control group. The study objects were erythrocytes membranes phospholipids. FA composition of erythrocytes membranes phospholipids characterized by appearance of myristic and pentadekanic acids in the group of CHD patients with AF. A signifi cant decrease in relative content of arachidonic acid and increase of palmitic acid was detected among CHD patients during AF paroxysm. Correlation analysis detected associations between AF paroxysms duration among patients with CHD and relative content of palmitic acid, stearic acid, saturated FA, unsaturated FA and polyunsaturated FA in erythrocytes membranes phospholipids. Correlation associations between the relative content of palmitic acid, saturated and unsaturated fatty acids with AF paroxysms duration remained the save after rate normalization.
Key words: fatty acids, atrial fi brillation, ischemic heart disease
Address for correspondence: Merkulova Iryna Olegovna, Ukraine, Kiev, 01011, 8 P. Myrnogo St., apartment 9, tel. +380502893355, e-mail: ira_merkulova@mail.ru

Hallux valgus minimally invasive surgery: radiologic evaluation of our experience - Bulgarian medical journal (Български медицински журнал), 10, 2016, №3, 73.
T. A. Al-Sadek1, N. I. Dimitrov2, D. Niklev3 and A. Al-Sadek4

1Department of Orthopaedics and Traumatology, Belhoul European Hospital – UAE, Dubai
2Department of Special Surgery, Thoracic Surgery, Vascular Surgery, Pediatric Surgery and Orthopedics and Traumatology,University Hospital “Prof. Dr. St. Kirkovich” – Stara Zagora, Bulgaria
3Orthoapedic and Trauma Clinic, University Multiprofi le Hospital for Active Treatment and Emergency
Medicine „N. Pirogov“
4Medical University – Sofia, Bulgaria
Summary. The condition known as hallux valgus is a foot deformity involving the fi rst ray, and is characterized by the lateral displacement of the great toe. Objective. To assess the effectiveness of minimally invasive surgery to treat hallux valgus.
Key words: Hallux Valgus, Minimally Invasive Surgery, Forefoot
Address for correspondence: e-mail: drthabet@abv.bg

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Surgical treatment of scoliosis in children with neurofi bromatosis - Bulgarian medical journal (Български медицински журнал), 10, 2016, №2, 52-56.
V. Yablanski1, A. Ivanov1, E. Vlaev1, V. Stefanov2, B. Kamenova2 and G. Simeonov2

1Department of Orthopaedy and Traumatology, Tokuda Hospital – Sofia
2Department of Anesthesiology and Reanimation, Tokuda Hospital – Sofia
Summary. The spine deformities occur in patients with neurofi bromatosis type 1, and are considered the most common skeletal manifestation with an incidence ranging up to 60% within this group. The surgical treatment is a very diffi cult and challenging task, with high rate of complications compared to the other forms of scoliosis. Despite of the high level of risk, the surgical treatment of scoliosis in children with neurofi bromatosis is an option with main purpose to prevent damages of other organs and systems and to improve the prognosis connected to the quality and longevity of life of these patients. Objective: To present our experience with the surgical treatment of scoliosis in children with neurofi bromatosis. Material and methods: For fi ve years period we did surgery in eight patients with scoliosis and neurofi bromatosis diagnosed based on clinical and other signs of the disease. We present retrospective evaluation of the achieved results and observed complications. Results: In our group of patients, average 12 levels were included into the fused segment; as a result, 64% in frontal and 54% in sagittal plane correction were achieved. Conclusion: Our results are comparable to the reported in the literature. Complication within this group of patient could be expected at any time of the treatment.
Key words: scoliosis, neurofi bromatosis, spine, surgical treatment
Address for correspondence: Vasil Yablanski, MD, PhD, Department of Orthopaedy and Traumatology, Tokuda Hospital, 51B “Nikola Vaptsarov” Blv., 1307 Sofi a, Tel.: +359884933300, e-mail: vyablanski@yahoo.com

Laboratory studies of the oral vaccination of foxes against rabies in Bulgaria in 2015 - Bulgarian medical journal (Български медицински журнал), 10, 2016, №2, 57-62.
D. Ilieva and M. Staleva

National Reference Laboratory “Rabies and Monitoring of Effectiveness of Vaccination”,
National Diagnostic Research Veterinary Medical Institute “Prof. Dr G. Pavlov” – Sofia
Summary. In the course of 2015 in Bulgaria an intensive monitoring of rabies was carried out. From the vaccination areas and the areas not covered by oral vaccination a total of 2497 brain samples from wild and domestic animals were tested via Fluorescent antibody test (FAT). From the areas with oral vaccination 894 blood samples from foxes were serologically tested. A seroconversion ranged to 42.7% and the presence of biomarker tetracycline in fox teeth ranged to 64.7%. During 2015 there were no incidents of rabies in animals and humans detected in Bulgaria. Analysis of the epidemiological situation in neighboring countries Romania and Turkey in the same period of the time shows a drastic reduction of the rabies cases. In Serbia several cases of rabies in wild animals were reported, and in Macedonia and Greece there was lack of the positive cases.
Key words: rabies, monitoring, oral vaccination
Address for correspondence: Assoc. Prof. Dr. Darinka Ilieva, PhD, Head of NRL ”Rabies and Monitoring the effectiveness of the vaccination”, National Diagnostic Research Veterinary Medical Institute, 15А “P. Slaveykov” Blvd., 1606 Sofi a, e-mail: emd@mail.orbitel.bg


A study on gait in patients with certain endocrine diseases - Bulgarian medical journal (Български медицински журнал), 10, 2016, №2, 63-67.
B. B. Mihov1 and O. Kolev1,2

1Hospital of Neurology and Psychiatry “Sv. Naum”, Medical University – Sofia
2Institute of Neurobiology, Bulgarian Academy of Sciences – Sofia
Summary. Endocrine system infl uences functions of many organs and systems. Certain endocrine disorders impair nervous system and the sensory systems. The aim of this study is to establish changes in locomotorics in some of the common endocrine diseases: prolactinoma, acromegalia, hypothyroidism and hyperthyroidism. Locomotorics was evaluated in 4 groups of patient and was compared to the group of healthy controls. Testing for assessment of gait included a locomotor reproduction of the visually memorized route to a defi ned target, localized on 8 meters away from the tested subject and situated in four positions to the tested subject: forwardly, backwardly, leftside and right-side. Statistically signifi cant variations were found in the patients with acromegalia and prolactinoma. The other two groups, the patients with hyperthyroidism and hypothyroidism, also showed milder pathological deviations, which, however, did not reach statistical signifi cance. In conclusion, the present study demonstrated that evaluation of locomotorics can contribute at a different degree to the objectifi cation of the nervous and vestibular systems in this group of endocrine diseases.
Key words: endocrine diseases, locomotorics was
Address for correspondence: B. B. Mihov, MD, Hospital of Neurology and Psychiatry “Sv. Naum”, Medical University, 1 Lyuben Rusev Str., Bg – 1113 Sofi a


Fever of unknown origin: fi rst retrospective study of Bulgaria - Bulgarian medical journal (Български медицински журнал), 10, 2016, №2, 68-78.
M. Baymakova1, I. Dikov1, K. Plochev1, T. Kundurdjiev2, G. Popov1, R. Mihaylova-Garnizova1 and V. Kovaleva3

1Department of Infectious Diseases, Military Medical Academy – Sofia
2Department of Occupational Health, Faculty of Public Health, Medical University – Sofia
3Center of Military Epidemiology and Hygiene, Military Medical Academy – Sofia
Summary. The aim of this study was to describe the etiological distribution, clinical and laboratory characteristics of patients with Fever of unknown origin (FUO), admitted to one Bulgarian hospital. A retrospective study was done for a period of four years. The modifi ed criteria of Petersdorf and Beeson were applied. Complete history, physical examination and basic laboratory investigations were done. According to the potentially diagnostic clues, specifi c tests, immunological and imaging methods were performed. The invasive procedures were the last step. Fifty-four patients met the inclusion criteria. The estimated causes were: infection 59.3%, neoplasm 3.7%, non-infectious infl ammatory disease 14.8%, miscellaneous 5.5% and undiagnosed cases 16.7%, respectively. The mean age was 44.3 years. The leading clinical features were fever, chills, sweats and fatigue. The association of clinical signs, physical exam and laboratory results were discussed. The infectious diseases were the leading cause of FUO. The etiological distribution of causes was near to results reported from South-East Europe. Some geographic, climatic, zoonotic and social factors infl uenced the results.
Key words: fever of unknown origin, infection, diagnostics, retrospective study
Address for correspondence: Magdalena Baymakova, MD, PhD, Department of Infectious Diseases, Military Medical Academy, 3 Sv. Georgi Sofi yski St., Bg – 1606 Sofi a, e-mail: dr.baymakova@gmail.com


Breast cancer in Bulgaria – a growing concern? - Bulgarian medical journal (Български медицински журнал), 10, 2016, №2, 79. (Part of the publication)
V. Modesto dos Santos.
Breast cancer represents a social and economic burden in lower-middle-income economies. The mortality rate of the commonest (26.4%) cancer in women has been unchanged, but the annual incidence of this malignancy has increased both in Bulgaria (1.8%) and in Brazil [1- 3]. This malignancy is uncommon before the age of 40 in these countries [1,2]. .....


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Oral surgery

Flamexin® (Piroxicam Β-cyclodextrin) – analgesic and anti-infl ammatory action to lower third molars removal requiring osteotomy - Bulgarian medical journal (Български медицински журнал), 10, 2016, №1, 42-46.
Ts. Tsvetanov and А. Bakardjiev.

Department of Oral Surgery, Faculty of Dental Medicine, Medical University – Plovdiv
Summary. After removal of retained and semiretained lower third molars the postoperative pain and facial swelling are very common conditions. The main purpose of the surgeon is to stop the pain and the postoperative infl ammation. Most frequently used drugs in contemporary medicine are non steroidal antiinfl ammatory drugs, and one of them is Flamexin® from oxicam’s group. The aim of this work is to study analgesic and anti-infl ammatory action on the patients of Flamexin® after lower third molars removal requiring osteotomy. Materials and methods: Retained and semiretained lower third molars were to be extracted on the 30 patients. To study population comprised 11 males and 19 females. Flamexin® is reception in doses of 20 mg/daily for 5 days and the fi rst reception is after the transition effect on the anaesthesia. The analgesic effect was recorded subjectively by means of Visual Analogue Scale (VAS). To study antiinfl ammatory effect, as a measure was taken the ratio on limited mouth opening distance, in mm, between the mesial-incisal corners and postoperative oedema. The facial swelling was determinated with a linear method before the surgery, 24 hour after intervention and in the
7th postoperative day. This method takes into account the sum of the following measures: distance between angle of the mandible and lateral corner of the eye, and distance between outer corner of the mouth and tragus. The appearance of adverse reactions render an account by means of description. This study was done by permission of the Scientifi cal Commission of Ethics. Results and discussion: The received results in connection with the pain have show different levels of pain. Postoperative oedema and trismus usually decrease on the
3th and 7th day after intervention. Conclusion: The patients’ postoperative pain, trismus and facial swelling in the lower third molars can be successfully controled by Flamexin®.
Key words: lower third molars, nonsteroidal anti-infl ammatory drugs, postoperative pain, Flamexin®
Address for correspondence: Tsvetan Tsvetanov, Ph.D, D.D.S., Chief Assistant, Department of Oral Surgery, Faculty of Dental Medicine, Medical University, 3 Hristo Botev Bvld., Bg – 4000 Plovdiv, tel.: 00359 898-32-53-32

Clinical laboratory

Analytical performance and clinical application of the VIDAS Gal-3 method for analysis of galectin 3 - Bulgarian medical journal (Български медицински журнал), 10, 2016, №1, 47-49.
M. Boncheva(1) and G. Nikolov(2)

(1)Department of General Medicine and Clinical Laboratory, Medical University – Varna, Bulgaria
(2)University Clinic of Clinical Biochemistry, Skopje, Macedonia
Summary. In the last years the circulating level of galectin-3 (Gal-3), is a marker of cardiac fi brosis and remodeling, contribute to the risk stratifi cation of patients with heart failure (HF). The aim of our study was to determine the analytical validity and clinical application of a novel automated Gal-3 assay and the determination of values in the blood in healthy people of Bulgarian population. Materials and methods. We analyzed Gal-3 with automated immunofl uorescence method by VIDAS® system (Vidas Gal-3 bioMérieux). We analyze samples from healthy people (40 people) to determine the upper limit of the serum concentration of Gal-3. Four-fold dilution of the control serum and then conducted analyzes confi rmed the lower limit of detection of the method. Results. We found the within run imprecision CV% between 3,7% and 4,7%. Accuracy determinate with control material of the kit (bioMerieux) was d% -2,5%. The lower limit of detection of the method is confi rmed – 3 ng/ mL. In healthy group were established values of 4,6 ng/mL to 18,2 ng/mL. The method for analyse blood levels of D-3 with VIDAS Gal-3 has a highly analytical reliability of results and easy implementation in the laboratory practice. Investigation of Gal-3 in patients in the early stages of HF makes this biomarker that identifi es those who are at high risk of progression to symptomatic HF.
Key words: galectin-3, method VIDAS Gal-3, analytical performance
Address for correspondence: Assoc. Prof. Margaritka Boncheva, MD, PhD, Department of General Medicine and Clinical Laboratory, Medical University, Bg – 9002 Varna, tel. 00359 888 680551, e-mail: mbon@mail.bg


The infection – an another view - Bulgarian medical journal (Български медицински журнал), 10, 2016, №1, 54-55.
W. Monev.

Expert Council of Surveillance and Control of Infectious Diseases and Immunoprophylaxis,
Ministry of Health – Sofia
Summary. With the advance of molecular biology and genetics, discovery of antibiotics and enlargement of possibilities of vaccinations, the confi dence about the ability of mankind to grapples with infections, received a hypertrophy. The optimism cracks after the discovery of AIDS. Considered are the contemporary directions in understanding the interrelations between pathogenic microbes and man. The evolution of microbes adapted them faster and much more successful at co-existence. with a mankind that sharked off from delusions of domination of Homo sapiens. It is necessary new strategies to control pathogenic agents. The optimistic hypothesis on parasitism consider that for the microbe it is better to cause a disease terminating without the dead of its host, and the microbe leaving the macroorganism before building of immunity. The man and the microbe should be considered as a „superorganism“. The pessimistic hypothesis indicates that the „strategy“ of pathogenic microbe is based on the control of the genes of the host. The virus is integrated into gene of the host, but the immune system of the man do not perceive it as an alien. Conclusion is that it is impossible to create a vaccine against the disease (exx. AIDS). The society of men and the populations of microbes always will be in competition and man always must be careful to observe the environment, and to try to control this environment.
Key words: parasitism, infectious diseases, hypothesis

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