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Original papers

Vol. 44, 2008


bullet 4'2008

Acute hepatitides with other etiological agents with hepatotropic action
I. Dikov(1), G. Popov(1), V. Коvalyova(2), К. Plochev(1) and М. Мilkov(1)
(1)Clinic of Infectious, Parasitic and Tropical Diseases, MМА -- Sofia, (2)Center of Military Epidemiology and Hygiene
Summary: According to literature data, roughly 5 tо 10% оf acute infectious hepatitides are with etiology other than hepatitis viruses А, В, С, D and Е. Purpose of the investigation was to determine the frequency of these hepatitides in the Clinic of Infectious, Parasitic and Tropical Diseases (KIPTD), MМА, Sofia. All patients in the KIPTD for the period 01.01.2007 tо 30.09.2008 (21 months) with diagnosis acute viral hepatitis were virologically investigated for serological hepatitis markers, ЕВV, СМV, VZV, R. Burnetti, Mycoplasma pneumoniae, Chlamydia, Adenоvirus, Borrelia Burgdorferi. Of 146 hospitalized patients for the period, 37 (25%) were with other etiology of viral hepatitis as follows: acute hepatitis with ЕВV origin -- 20, СМV hepatitis -- 8, Herpes zoster hepatitis -- 2, mumps hepatitis -- 5, Rickettsia hepatitis -- 1 and Mycoplasma hepatitis -- 1. In nine patients (24%), there were mixed infections -- mostly СМV with other agents. In 26 patients, the liver lesion revealed anicteric form of hepatitis with mild clinical evolution. In the patients hospitalized with diagnosis acute viral hepatitis and negative serology for hepatitis markers А, В, С, D and Е, it is necessary to look for other etiology. This is important for diagnosis, therapy and prognosis of acute infectious hepatitis.
Кey words: acute hepatitis, infectious mononucleosis, ЕВV, СМV, VZV, Mycoplasma
Address for correspondence: Prof. Ivan Dikov, M. D., Clinic of Infectious, Parasitic and Tropical Diseases, MМА, 3, Sv. G. Sofiiski Str., Bg -- 1606 Sofia


Different BK viral activity in nephrolithiasis and chronic inflammatory renal diseases
Z. Kalvachev(1), S. Slavov(1), V. Vladimirov(2) and P. Simeonov(3)
(1)Laboratory of Molecular Virology, National Center of Infectious and Parasitic Diseases -- Sofia, (2)Clinic of Urology, Medical University -- Sofia, (3)Clinic of Nephrology, Medical University -- Sofia
Summary: Polyomavirus hominis 1, widely known as BK (BKV), persists in the urogenital tract cells without any characteristic symptoms. Having its appropriate conditions (immunologic disbalance), BKV enters into productive form of replication related to organ injury. This is mostly pronounced in renal-allograft patients or other severe renal disorders. We examined the activity of BKV infection among patients with lithiasis, different renal diseases and renal insufficiency. Our results show that while the lithiasis reveals little percentage of viral reactivation (6%), the inflammatory processes exhibit much higher values (26.7%). Most probably the chronic involvement of the kidney tissues offers the appropriate “area” for productive BKV infection, which worsens the main condition.
Key words: virus BK, BKV, reactivation, nephrolithiasis, pyelonephritis, glomerulonephritis
Address for correspondence: Assoc. Prof. Zl. Kalvatchev, M.D., Ph.D., Laboratory of Molecular Virology, National Center of Infectious and Parasitic Diseases, 44-A, Stoletov blvd., Bg -- 1233 Sofia, tel. +359 2 931-07-13, ext. 232, е-mail: kalvatchev@gmail.com


Influence of alcohol consumption on fat distribution and body composition
Zh. Boneva, M. Boyanov(2), P. Yovchevski(3), M. Petrova(4) and Ya. Asyov

(1)Department of Endocrinology, Medical Institute -- Ministry of Interior, (2)Clinic of Endocrinology – University Hospital “Alexandrovska”, (3)Department of Nephrology, Medical Institute -- Ministry of Interior, (4)Clinic of Gastroenetrology, Medical Institute -- Ministry of Interior -- Sofia
Summary: The aim of the present study was to evaluate the influence of alcohol consumption on body composition and fat distribution in individuals of Bulgarian population. One hundred overweight and first stage obese patients were enrolled in a cross-sectional study. The control group consisted of 30 healthy persons with normal weight. The mean age was 53 +/- 9.6 years (48-69). Body weight, body mass index (BMI) and body composition were analyzed by bioimpedance. Fat distribution was examined by means of anthropometry and ultrasound measurement of subcutaneous and visceral abdominal fat distance. Alcohol consumption was determined through questionnaire concerning frequency and quantity of weekly taken alcohol units. In overweight patients, those with alcohol consumption had significantly higher mean values of visceral fat distance, waist circumference and percent of adipose tissue and lower values of BMI (p < 0,001). In the normal weight group, there was a significant difference in waist circumference and visceral ultrasound distance between alcohol consuming persons and abstainers (p = 0,009). Our data suggest a significant association between alcohol consumption and higher accumulation of visceral adipose tissue in overweight individuals, as well as in normal weight ones.
Key words: alcohol consumption, metabolic risk, fat distribution
Address for correspondence: Zhivka Boneva, M. D., Department of Endocrinology, Medical Institute -- Ministry of Interior, 79, Skobelev Blvd., Bg -- 1606 Sofia


Analysis of activity of superoxide dismutase and catalase and plasma malondialdehyde concentration in patients with insulin-dependent diabetes mellitus, undergoing haemodialysis with polysulfone and cellulose diacetate membranes
P. Goycheva(1), A. Tolekova(2), B. Popov(3), S. Popova(3), V. Gadzheva(3), R. Koycheva(1) and D. Sapundzhiev(4)
(1)Department of Internal Medicine and Clinical Laboratory, (2)Department of Physiology, Pathophysiology and Pharmacology, (3)Department of Chemistry and Biochemistry, Medical Faculty, Thracian University -- Stara Zagora, (4)Department of Hemodialysis -- Stara Zagora
Summary: It has been established that the oxidative stress is involved in various pathological processes and diseases. Diabetes mellitus has recently been implicated as a causative factor for chronic oxidative damage. Due to hyperglycaemia, these complications have a higher incidence in patients receiving long-term haemodialysis. Increased concentration of urea promotes the development of ROS (Reactive Oxidative Species) further and leads to inefficiency of the antioxidant defence systems. The nature of the haemodialysis-procedure itself is a source of ROS on account of bio-incongruent dialysis-membranes. This study is designed to determine the activity of superoxide dismutase and catalase and the stage of lipid peroxidation in diabetic patients with diabetic nephropathy, undergoing haemodialysis -- before and after it. And also to evaluate the effects of two types of dialysis-membranes on the lipid peroxidation and some antioxidant enzymes. The studied parameters are evaluated in 10 diabetic patients undergoing haemodialysis and 17 healthy volunteers. We found enhanced oxidative stress in all patient groups due to an increase in lipid peroxidation and changed activities of antioxidant enzymes. In conclusion, it has been noticed that the oxidative stress persists in diabetes mellitus type I patients with chronic renal failure undergoing haemodialysis using both types of dialysis-membranes. In our study, the polysulfone membrane showed out some advantage.
Key words: diabetes mellitus, diabetic nephropathy, oxidative stress, malondialdehyde, antioxidant enzymes
Address for correspondence: Petya Goycheva, M. D., Section of Endocrinology, University Hospital, 11 Armeyska Str., Bg -- 6000 Stara Zagora, tel. +359 42 664 382, e-mail: petya_goicheva@yahoo.com


Chlamydia pneumoniae, acute phase proteins and immunoglobulins in patients with acute myocardial infarction
K. Ikonomova(1), M Shishenkov(2), P. Yordanova-Laleva(3) and M. Atanasova(1)

(1)National Transport Hospital ”Tzar Boris III” -- Sofia, (2)Fifth MHAT -- Sofia, (3)Medical University -- Pleven
Summary: The relation between Chlamydia pneumonie and myocardial infarction is established in seroepidemiological studies. High titers antichlamydial antibodies are detected also in patients with coronary and carotid stenosis and stroke. The aim of the study was to estimate the level of chlamydial infection and its relation to acute myocardial infarction. In parallel, the main elements of humoral immunity -- immunoglobulin classes IgG, IgA, IgM and acute phase protein CRP were measured. Forty two patients with acute myocardial infarction and 20 healthy controls were examined. High titers antichlamydial antibodies were measured in patients with acute myocardial infarction compared to the healthy controls (57% vs 37%). In the outbreak of myocardial infarction, the significant changes of immunoglobulins were not observed. CRP was elevated in 58% of the patients. The infectious pathogens can be treated successfully so they could be considered as reversible risk factors for myocardial infarction. The identification and modification of reversible risk factors is the best approach for primary and secondary myocardial infarction prophylaxis.
Key words: acute myocardial infarction, Chlamydia pneumoniae, acute phase proteins, immunoglobulins
Address for correspondence: K. Ikonomova, M. D., National Transport Hospital “Tzar Boris III”, 104 Maria Luiza Blvd, Bg -- 1233 Sofia


Vibrations in the working environment and risk of acute myocardial infarction
T. Dimitrova(1) and Е. Karaslavova(2)
(1)Department of Medico-Biological Sciences, Medical University -- Varna, (2) Department of Social Medicine and Public Health, Medical University -- Plovdiv
Summary: According to a number of authors, manufacturing vibrations appear to be a probable factor leading to changes in lipid and mineral metabolism of professional workers. Particular high frequency of dislipidemias is established in individuals with vibration disease in combination with arterial hypertonia. The work with hand vibrating machines is connected with a double risk of AMI without a specific dose-answer influence being established between them. The aim of this study is to explore the influence of vibration in the working environment on the AMI development. The relative share of people exposed to physical and chemical factors in the control group is statistically reliable higher than that among the cases. Considering the age, duration of the working day and working week, specialized work experience and the main conventional risk factors such as hypertonia, diabetes and enhanced values of serum cholesterol, the risk activity of the dust composition is established. The combined effect of vibrations and dust regarding the risk of AMI is higher than the isolated influence of dust on men in able-to-work age. Taken separately, neither local (shoulder-hand) nor general vibrations increase the risk of AMI. In males, dust and vibrations have unidirectional potentiating interaction for the risk of AMI.
Key words: acute myocardial infarction, vibrations, dislipidemia
Address for correspondence: Teodora Dimitrova, M. D., Department of Medico-Biological Sciences, Medical University, 55, Marin Drinov Str., Bg -- 9000 Varna, e-mail: tvd@mnet.bg



Holistic medicine and syncretic therapy -- alternatives of partialized diagnostics and one-sided therapy in Bulgarian health care system
A. Aleksiev

ХVІІ International Conference on HIV/AIDS
R. Argirova



Induction of pluripotent stem cells by genetic reprogramming of somatic cells
G. Milchev
IMB -- Bulgarian Academy of Sciences -- Sofia
Summary: Pluripotent cells arise from ex vivo cultures of early embryonic cells (morula, inner cell mass, epiblast, primordial germ cells). They are designated as ESC, EpiSC, EGC, respectively. Stringent criteria for pluripotent cells are: in vitro differentiation into cells that represent all three germ layers, active transcriptional regulatory network (Nanog, Okt4, Sox2, TCF3 and others), teratoma formation. Chimera formation with subsequent germ line transmission and tetraploid complementation assay are aplied for mouse cells only. Three distinct methods of experimentally induced pluripotency in somatic cells include: nuclear transfer, cell fusion, and direct reprogramming by ectopic expression of several transcription regulators. Induction of pluripotent cells from mouse fibroblasts and human dermal fibroblasts by ectopic expression of Oct4, Sox2, c-Myc, and Klf4 is described in details.
Key words: emlryonal stem cells, induced pluripotent stem cells, Okt4, Sox2, c-Myc, Klf4, Nanog, TCF3, Stat3
Address for correspondence: Georgi Milchev, M. D., 54 Skobelev Blvd., Bg -- 1606 Sofia, tel. +359 2 953-0983, e-mail: gmilchev@bio21.bas.bg



bullet 3'2008

Clinical and epidemiological profile of elderly patients with heart failure in Bulgaria -- analysis of the data derived from the Bulgarian patients randomized in the CORONA trial – 44, 2008, No 3, 24-28.
A. Goudev(1), E. Baldzhiev(2), St. Denchev(3), T. Donova(3), N. Gocheva(4), M. Grigorov(2), N. Zlatareva(1), D. Karastatev(5), D. Raev(6), V. Sirakova(5), At. Stoykov(3), S. Tisheva(7), Sv. Torbova(8), B. Chompalova(9), Y. Uzunangelov(7), V. Hergeldzhieva(10) and G. Georgiev(11)
(1)UMHAT “Tsaritsa Yoanna” -- Sofia, (2)II MHAT -- Sofia, (3)UMHAT “Alexandrovska” -- Sofia, (4)NCH -- Sofia, (5)UMHAT “Sv. Marina” -- Varna, (6)MI -- Ministry of Inferior, (7)UMHAT “G. Stranski” -- Pleven, (8)NMTH -- Sofia, (9)I MHAT -- Plovdiv, (10)MHAT -- Ruse, (11)Astra Zeneca
Summary:  Chronic heart failure is a leading cause оf morbidity and mortality in Bulgaria. Due to the lack of national register, data on clinical and epidemiological profile of these patients are missing. In this study, we present baseline data of Bulgarian patients randomized in CORONA trial. Data are compared with those from all patients randomized in CORONA, as well as with other trials and EuroHeart Survey on heart failure. Mean age of the patients randomized in Bulgaria was 69.5 years, almost 90% were in III NYHA class. Mean ejection faction was 34.6%. Hypertension disease in the medical history was reported by 87% and 58% had had a myocardial infarction. Approximately one third of the patents were in atrial fibrillation and had had diabetes mellitus. Clinical profile of Bulgarian patients in CORONA with heart failure is similar to that of the patients in other countries, but there are also some important differences.
Key words:  heart failure, functional class, ejection fraction, CORONA trial
Address for correspondence:  
Assoc. Prof. Assen Goudev, M. D., Department of Cardiology, University Hospital "Tsaritsa Yoanna", 8, Byalo more Str., Bg -- 1527 Sofia, e-mail: agoudev@abv.bg


Quality of in-patient medical care in Bulgaria. Opportunities for reducing cardiovascular mortality by establishing a national network of cardiac clinics with catheterization laboratories – 44, 2008, No 3, 29-31.
T. Vekov, S. Djambazov and M. Grigorov

UniCardio Clinic -- Pleven
Summary:  The underdeveloped network of hospitals equipped with catheterization laboratories and the low number of licensed interventional cardiologists lead to а high number of acute coronary syndrome (ACS) patients without reperfusion therapy. Therefore not only the mortality from ACS but also the cardiovascular mortality in Bulgaria are high and keep the negative trend. The development of a network of hospitals with catheterization laboratories will increase the percentage of patients treated with reperfusion, both in these hospitals and in the rest -- not equipped with cathlabs.
Key words:  acute coronary syndrome, acute myocardial infarction, reperfusion, cardiovascular mortality
Address for correspondence:
Toni Venkov, M. D., 1, G. M. Dimitrov Blvd., Bg -- 1172 Sofia, tel. +359 2 962 54 54, e-mail: t.vekov.hq@comleague.com


Research on effect of simvacor on flow-induced vasodilation in newly diagnosed severe hypercholesterolemia  – 44, 2008, No 3, – 44, 2008, No 3, 32-38.
L. Vladimirova-Kitova

Clinic of Cardiology, Medical University -- Plovdiv
Summary: Studies on statins influence on flow-induced vasodilation demonstrate controversial results. The aim of this study is to investigate the effect of simvacor on lipid biomarkers and flow-mediated vasodilation in patients with severe hypercholesterolemia (HH). The study included 120 patients with total cholesterol >= 7.5 mmol/l and age above 16 years. Biochemical parameters: glucosa, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol were examined with Konelab 60i, Thermo Electron Co, USA. Flow-mediated vasodilation (%FMD) was determined on base of guidelines of Celermajer (1992 and 2002). The diameter of brachial artery was determined with 7.5 MHz transduser of Hewlett Packard 2500 and automatic program MedicaSoft. IMT. lab. There was statistically significant decrease of total cholesterol, triglycerides, LDL cholesterol, Apo-B and Аpо-В/Апо-А1, and increase of HDL cholesterol and Apo-A1 after 1 month treatment with 40 mg simvacor (p < 0,0001). Absolute change of %FMD correlated statistically significant only with Apo-B. Index Аpо-В/Аpо-А1 is a better target for therapeutic monitoring of therapy with 40 mg simvacor for 1 month. Conclusion: Therapy with 40 mg Simvacor for 1 month is associated with reduced LDL cholesterol by 47.53% and Аpо-В by 48.79%, increased HDL cholesterol by 18.11% and Аpо-А1 by 26.67% as well as with 12.72% increase of %FMD.
Key words:  hypercholesterolemia, simvastatin, flow-mediated vasodilation, nitric oxide, endothel-dependent vasodilation
Address for correspondence:
Lyudmila Vladimirova-Kitova, M. D., Clinic of Cardiology, Medical University, 66 Peshtersko Shose Blvd., Bg -- 4000 Plovdiv, e-mail: kitov@vip.bg


Effect of two rosuvastatin regimens on C-reactive protein levels in patients with acute coronary syndrome – 44, 2008, No 3, 39-44.
A. Postadzhiyan(1), A. Tzontcheva(2), D. Hasarbasanov(1) and B. Finkov(1)

(1)Clinic of Cardiology, University Hospital „Sv. Anna” -- Sofia, (2)Chair of Clinical Laboratory and Clinical Immunology, Medical University -- Sofia
Summary:  The effectiveness of HMG-CoA reductase inhibitors in acute coronary syndrome, is ascribed not only to reduce cholesterol levels but also to stabilize the atherosclerotic plaque, to improve endothelial function and to depress the inflammatory process in the vessel wall. In this study, we assessed the effects of low and moderate dose rosuvastatin treatment on C-reactive protein concentrations in patients admitted for acute coronary syndrome without ST segment elevation. 30 patients were randomized into two groups, and received rosuvastatin 10 mg/day (n = 16) or rosuvastatin 20 mg/day (n = 14) for 12 weeks. Serum CRP levels decreased significantly in both treatment groups -- from 5.61 mg/l to 2.75 mg/l (p = 0.004) in patients receiving 10 mg rosuvastatin and from 5.5 mg/l to 1,18 mg/l (p = 0.003) in more aggressive treatment group. We demonstrate that an aggressive lipid-lowering regimen of rosuvastatin 20 mg daily is superior to a moderate regimen in terms of the proportion of individuals treated who ultimately will achieve LDL-C < 100 mg/dl and hsCRP < 3mg/l.
Key words:  atherosclerosis, inflammation, statins, acute coronary syndromes, C-reactive protein
Address for correspondence:
Arman Postadzhiyan, M. D., Clinic of Cardiology, University Hospital “Sv. Anna”, 1, D. Mollov Str., Bg -- 1784 Sofia, теl. +359 888 798 364, e-mail: armanp@abv.bg


Tularemia in Bulgaria, 2003-2004 – 44, 2008, No 3, 45-51.
R. Komitova(1, *), P. Petrov(1), T. Kantardzhiev(2), R. Nenova(2), B. Popov(2), I. Ivanov(2), L. Panchev(1), A. Nikolova(1), Ts. Georgieva(1), M. Rusinova(1), M. Borisova(3), E. Badalanova(1) and Pl. Padeshki(2)

(1)UMHAT “Sv. Anna” -- Sоfia, (2)NCIPD -- Sоfia, (3)RIPCPH -- Sоfia region, *present address -- UMHAT “D-r G. Stranski” -- Pleven
Summary: А second outbreak of tularemia in Bulgaria, about 40 years after the first one, occurred in 1997 in the adjacent Slivnitsa and Pernik regions of West Bulgaria, near the border with Serbia. In 2003, tularemia reemerged in the same focuses. A retrospective study of clinical, diagnostic and therapeutic findings in 26 patients from Slivnitsa region is presented. There was a predominance of oropharyngeal form of the disease (58%) and lymphadenopathy was the most common physical sign (100%). Diagnosis was confirmed by agglutination test in 24 patients. Cultivation of lymph node aspirates resulted in 3 Fr. tularensis isolates. Fr. tularensis was detected by PCR in 13 lymph node aspirates and in conjunctival nodule granuloma in 1 of 17 patients tested. Treatment failure was observed in 6 (23%) patients. Antibacterial therapy is with limited benefit if it is initiated in the late period of tularemia.
Key words:  Fr. tularensis, oropharyngeal tularemia, antimicrobial therapy
Address for correspondence:
Assoc. prof. R. Komitova, M. D., UMHAT “D-r G. Stranski”, 8А G. Kochev Str., Bg -- 5800 Pleven


Epidemiological features of leptospirosis in the region of Pleven – 44, 2008, No 3, 51-56.
G. Gancheva

Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Medical University -- Pleven
Summary: This retrospective study of 32 etiologically confirmed cases (by microagglutination test), treated in the Clinic of Infectious Diseases -- Pleven within thirty years (1978-2005), aimed to characterize epidemiological features of leptospirosis in the region of Pleven. Specific antibodies against thirteen serovars were obtained. A simultaneous presence of more than one serovar occurred in 53,12% of cases. The most spread causative serovar was L. copenhageni (34,38%) followed by L. pomona (31,25%). The incidence in the region was low (mean 0,43%ооо), but significantly variable during the years. The highest number of cases was registered during the summer (July, August, and June), and male infections prevailed (84,38%) (р < 0,001). Information on risk factors was available in 87,50% of the cases and the role of water as source of infection was significant (in 62,50% of the cases). Leptospirosis is underdiagnosed because of protean manifestations. Epidemiological knowledge about this reemergence disease could facilitate diagnosis. An active epidemiologic education of human population would be helpful to decrease the impact of the risk factors.
Key words:  leptospirosis, serovar, risk factors, incidence
Address for correspondence:
  Galya Gancheva, M. D., Clinic of Infectious Diseases, University Hospital, Bg -- 5800 Pleven, 8a, G. Кochev Str., Tel.: 064 886 339; fax 064 886 439; e-mail: galya_gancheva@abv.bg


The role of video-assisted thoracoscopy in diagnosis and treatment of malignant pleural effusions – 44, 2008, No 3, 57-61.
I. Novakov

Department of Thoraco-Abdominal Surgery, Medical University -- Plovdiv
Summary: Malignant pleural effusions (MPE) are sign for spreading and inoperability of neoplastic diseases. The aim of this study was to demonstrate the role of video-assisted thoracoscopic surgery (VATS) in diagnosis and treatment of MPE. 142 patients with MPE were included in this retrospective study. VATS as a diagnostic procedure was used for pleural biopsy and evaluating the lung expansion. Intermittent pleural drainage and talc pleurodesis by VATS-control were used for the treatment of MPE. Lung cancer caused MPE in 79 patients (55, 62%). Breast cancer was the second cause for MPE. VATS determined trapped lung in 29 patients with MPE (20, 5%). Intermittent pleural drainage was our therapeutic option in cases of trapped lung. Talc-pleurodesis was used for the treatment of the rest of the patients. 71 (62,8%) of patients with talc-pleurodesis were followed-up. Only 8 of them failed the procedure. VATS is an effective procedure in diagnosis as well as treatment of MPE -- it achieves both goals in one step.
Key words:  malignant pleural effusion, video-assisted thoracoscopic surgery, pleural drainage, pleurodesis
Address for correspondence:
  Ivan Novakov, M. D., Department of Thoracoabdominal Surgery, Medical University, 54, Petrova niva Str., Bg -- 4004 Plovdiv, e-mail: inovakov2003@yahoo.com


Speech disorders in children with spastic cerebral palsy – 44, 2008, No 3, 62-65.
I. Boshnjaku-Dallku, H. Hundozi-Hysenaj, Q. Hysenaj, A. Mustafa, A. Murtezani and N. Baftiu

University Clinical Centre of Kosovo -- Prishtina
Summary: Speech disorders are common in children with cerebral palsy (CP). Speech  disorders occur more often in CP accompanied by mental retardation and hearing disorders. Speech impairments include articulation, fluency, and intelligibility as well as respiration, phonation, and resonance disorders. We sought to determine the relationship between CP and speech disorders according to gender, etiology, topographical, and pathophysiological forms of CP with and without mental retardation. This study involved 154 children with cerebral palsy, aged 7-15 years, who were treated at the University Clinical Centre of Kosova in Prishtina, during the 5-year period of 2000-2005. We compiled a questionnaire seeking relevant information and used epidemiological methodologies for analysis. Speech disorders were noted in 63 (40.9%) of the 154 children with CP. Quadriparetic children were more frequently affected (43 or 68.3%). Among the 63 children, 44 (70%) had speech disorders, associated with mental retardation, and hearing impairment, while  19 (30%) of them had no mental retardation or hearing disorders. The severity of the speech disorders in CP children was closely related to the severity of the neurological impairment. Children with spastic CP had more frequent speech impairments because of neuromotor disorders in controlling the structures responsible for speech.
Key words:  cerebral palsy, speech disorders
Address for correspondence:
Iliriana Boshnjaku-Dallku, M. D., Klinika e Fiziatrise, Qendra Klinike Universitare e Kosoves, Rr. "Bulevardi Deshmoret e Kombit", Prishtina, Kosova, е-mail: iliriabd@yahoo.com


Flow cytometric measurement of sperm DNA fragmentation in normospermic infertile men – 44, 2008, No 3, 66-72.
Ts. Lukanov(1, 2), D. Lichev(1, 2), E. Konova(1, 2), A. Emin(1, 2), N. Ayvazova(1), R. Kotsev(1, 4), G. Veleva(2), A. Velkova(3) and R. Rusev(1, 5)

(1)Medical Center “Clinical Institute for Reproductive Medicine” --  Pleven, (2)Center for Reproductive Medicine, Medical University -- Pleven, (3)Department of Social Medicine, Medical University -- Pleven, (4) Sector of Urology, Department of Surgical Diseases, Medical University -- Pleven, (5)”Millenova” Immunology Laboratory -- Chicago
Summary: The objective of this study was to evaluate the levels of sperm DNA fragmentation, respectively a sperm nuclear DNA integrity, in spermatozoa of fertile donors and of normospermic infertile men, by sperm DNA integrity assay (SDIа). Semen samples were obtained from forty-eight normospermic infertile men and 30 fertile donors. Flow cytometry has been extensively used to study sperm DNA damage by SDIа and the results were expressed as % DNA fragmentation index (DFI). Increased levels of DFI were observed in 19 of 48 (39,58%) normospermic infertile men. The % DFI in normospermic infertile men was significantly higher than in fertile donors (P = 0.03). There were statistically significant negative correlations between the percentage of spermatozoa with DNA fragmentation (% DFI) and sperm motility (r = -0.48, P < 0.0001) and normal morphology (r = -0.37, P = 0.022) in normospermic infertile men, but not in fertile donors. In conclusion, this study indicates that the levels of sperm DNA fragmentation in normospermic infertile men were significantly higher compared with the levels in the fertile group. This finding suggests that SDIа has an important diagnostic and prognostic value in the evaluation of male infertility, particularly in relation to assisted reproductive technologies.
Key words:  sperm DNA damage, flow cytometry, male infertility, sperm
Address for correspondence:
Tsvetan Lukanov, M. D., MС “Clinical Institute for Reproductive Medicine”,  20, “Skobelev” Str., Bg -- 5800 Pleven, tel. +359 64 886778 , е-mail: lukanovtz@abv.bg


Inflammatory diseases in maxillo-facial region in patients with diabetes mellitus:  II. Surgical treatment – 44, 2008, No 3, 73-77.
P. Sapundzhiev

Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, MU, Specialized University Hospital for Active Treatment in Maxillofacial Surgery -- Sofia
Summary: The aim of this study was to define the treatment scheme carried out by dental physicians, oral and maxillofacial surgeons in respect of surgical treatment -- incision and teeth extraction in inflammatory diseases in maxillofacial region in patients with diabetes mellitus. Investigations were made on 92 patients -- 46 diabetic patients with inflammatory diseases in maxillofacial region, and 46 non-diabetics with similar diseases, divided according to sex, age, type and duration of diabetes and applied treatment -- incision, teeth extraction and antibiotic treatment. The patients with inflammatory diseases in maxillofacial region were divided into two groups. In the first group, there were registered patients with suppurative focus. In the second group, there were included patients without pus formation and patients with no certain data for involvement of adjacent regions. In cases of inflammatory diseases in maxillo-facial region with diabetes mellitus, an emergency incision and extraction of the tooth as a causative agent should be performed, and the patient should must be hospitalized regardless of the type and compensation of diabetes and the severity of the inflammatory process. The antibiotic treatment starts with broad spectrum antibiotics or potentiating combination of antibiotics. After obtaining the microbiologic results, the treatment should be corrected according to the antibiogram.
Key words:  antibiotic treatment, diabetes mellitus, incision, surgical treatment, tooth extraction
Address for correspondence:
Peter Sapundzhiev, M. D., Ph. D., Department Oral and Maxillofacial Surgery, Faculty of Dental Medicine, MU, Specialized University Hospital for Active Treatment In Maxillofacial Surgery, 1, ”Sv. G. Sofiyski” Blvd, Bg -- 1431 Sofia, GSM +359 886 629 425, e-mail: psapundjiev@abv.bg


Discordance between clinical and postmortem diagnosis: an alternative outlook on the problem – 44, 2008, No 3, 78-81.
V. Dokov(1) and Vil. Dokov(2)

(1)Department of Medicobiological Sciences, (2)Department of Forensic Medicine, Medical University -- Varna
Summary: Over a 13-year period (1993-2005), the medical records of 2311 autopsies were studied and processed using an alternative analysis with a maximum error of representativeness with guaranteed probability Р (t) = 0.95, Student t test with a guaranteed probability 0.99. Using the method of the smallest squares, a linear trend was built. Values of Р < 0.05 were assumed to be statistically reliable. The relative share of DPD (Discordance with Primary Disease) was within the range of 11.76% and 33.33%. The highest relative share of DPD (53.55%) was observed in the period of 15-27 days, whereas in the first 24 hours, it was 14.8%, with a statistically reliable difference. The linear trend of the DPD cases showed a tendency to increase with prolonged hospitalization. When observing the linear trend of the number of autopsies, there was a clearly visible downward tendency, whereas the DPD linear trend revealed an upward tendency.
Key words:  postmortem diagnosis, discordance with primary disease, tendencies
Address for correspondence:
V. Dokov, Department of Forensic Medicine, Medical University, 55 Marin Drinov Str., Bg -- 9002 Varna, е-mail: Dokov@seznam.cz


Local and systematic changes in rats, treated with cigarette smoke – 44, 2008, No 3, 82-87.
R. Ivancheva(1), F. Shterev(1), I. Damyanov(2), D. Popov(2), S. Genova(3), N. Boyadzhiev(2) and Zl. Yankova(1)

(1)Clinic of Pulmonology, MU -- Plovdiv, (2)Department of Physiology, MU -- Plovdiv, (3)Department of Pathoanatomy, MU -- Plovdiv
Summary: COPD (Chronic obstructive pulmonary disease) is a systematic disease. The induction of limited air stream (associated with an abnormal inflammatory response) and lung emphysema are not the only changes, related with the effect of tobacco smoke. Cigarette smoking is the most important risk factor for the development of COPD and systemic comorbidities. By subchronic treating there are achieved different degrees of local changes --  lung emphysema, bronchial epithel methaplasia and complex inflammation. There exist a systematic effect in the bone marrow -- clastogenicity. Treated rats exhibited > doubled level of chromosomal damages -- micronucleated polychromatic erythrocytes (PCE) in the bone marrow were 4.35 ± 50, compared with the control group -- 1,58 +/- 0,33. No toxicity was observed in these rats as inferred from PCE/NCE ratio. This experiment is a base of future studies of COPD like as а systematic disease.
Key words:  tobacco smoke, COPD, emphysema, polychromatic erythrocytes clastogenicity
Address for correspondence:
Rositsa Ivancheva, M. D., Clinic of Pulmonology, UMHAT “Sv. Georgi”, 15A, Vasil Aprilov Blvd., Bg -- 4000 Plovdiv, tel. +359 32 60-27-97


Problems of blood alcohol and other psychoactive compound investigation in forensic expertise in Bulgaria. Chemical investigation of blood alcohol – 44, 2008, No 3, 91-96.
V. Atanasov(1, 2), B. Mechkarska(3), Y. Sabeva(4), K. Kanev(5) and A. Hubenova(6)
(1)Laboratory of Analytical Toxicology, Clinic of Emergency Toxicology and Allergology, Military Medical Academy -- Sofia, (2)Laboratory of Bioinorganic and Bioanalytical Chemistry, Department of Analytical Chemistry, Faculty of Chemistry, Sofia University, (3)Sector for Toxico-chemical Analysis and Control, Emergency Medicine Institute "Pirogov" -- Sofia, (4)Laboratory of Toxicology, Department of Anaesthesiology, Maritime and Intensive Medicine,  Military Medical Academy -- Naval Hospital -- Varna, (5)Clinic of Emergency Toxicology and Allergology, Military Medical Academy -- Sofia, (6)Clinic of Toxicology, Emergency Hospital “N. I. Pirogov” -- Sofia
Summary: This work is a critical view of the present Regulation No 30 of 27 June 2001 concerning the procedure for blood alcohol and psychoactive compound investigation of motor drivers. The basic moments, which are essential for the reliability of the results from blood alcohol analyses, are discussed. An elaborate comment on crucial details is made. The necessity of interlaboratory proficiency testing and uniformity of the analytical methods is discussed in order to ensure analytically correct and comparable results. Concrete proposals for actualization and modernization of the investigation of blood alcohol are suggested.
Key words:  Regulation No 30/27 June 2001, blood ethanol investigation, gas-chro­ma­to­graphy, vacutainers
Address for correspondence: Vasil Atanasov, M. D., Laboratory of Bioinorganic and Bioanalytical Chemistry, Department of Analytical Chemistry, Faculty of Chemistry, Sofia University,  1 J. Bаucher Blvd., Bg -- 1164 Sofia, tel. +359 2 8161 609, e-mail: vatanasov@chem.uni-sofia.bg




bullet 2'2008

Drug treatment for elderly patients with systolic dysfunction in Bulgaria--analysis of the data derived from the Bulgarian patients randomized in the CORONA trial – 44, 2008, No 2, 36-40.
A. Goudev(1), E. Baldzhiev(2), St. Denchev(3), T. Donova(3), N. Gocheva(4), M. Grigorov(2),N. Zlatareva(1), D. Karastatev(5), D. Raev(6), V. Sirakova(5), At. Stoykov(3), S. Tisheva(7), Sv. Torbova(8), B. Chompalova(9), Y. Uzunangelov(7), V. Hergeldzhieva(10) and G. Georgiev(11)

(1)UMHAT “Tsaritsa Yoanna” -- Sofia, (2)II MHAT -- Sofia, (3)UMHAT “Alexandrovska” -- Sofia, (4)NCH -- Sofia, (5)UMHAT “Sv. Marina” -- Varna, (6)MI -- Ministry of Inferior, (7)UMHAT “G. Stranski” -- Pleven, (8)NMTH -- Sofia, (9)I MHAT -- Plovdiv, (10)MHAT -- Ruse, (11)Astra Zeneca
Summary: The treatment of the chronic congestive heart failure requires a combination of drugs in optimal doses. CORONA is the first randomized trial which evaluates the role of the statins in the treatment of the chronic heart failure. 391 patients with mean age of 69,5 years were randomized in Bulgaria. Based on the baseline data during randomization of the patients, we analyzed heart falure drug treatment. Treatment with ACE-inhibitors received 82% of patients, while 74% received treatment with beta-blokers. The most commonly used ACE-inhibitor was enalapril with an average dose of 16,7 mg, and the most frequently used beta-bloker was carvedilol in an average dose of 11 mg. Approximately half of the patients received treatment with spironolacton and one third -- with digitalis. The treatment of the Bulgarian patients randomized in the CORONA trial is corresponding to the modern standards in the matter of distribution of types of drugs, while some of the drugs were used in suboptimal doses.
Key words: heart failure, ACE inhibitors, beta blockers, diuretics
Address for correspondence:
Assoc. Prof. Asen Goudev, M. D., Department of Cardiology, University Hospital "Tsaritsa Yoanna", 8, Byalo more Str., Bg--1527 Sofia, e-mail: agoudev@abv.bg


The role of some clinical lab tests in acute exogenic intoxications – 44, 2008, No 2, 41-47.
St. Tufkova(1), E. Karaslavova(2) and M. Ivanova(3)

(1)Toxicological Clinic, Multiprofile Hospital for Active Treatment -- University Hospital ”Sv. Georgy”, (2)Section Medicine in Disastrous Situations, Department of Social Medicine and Healthcare Management, (3)Department of Management of Healthcare and General Medicine, Medical University – Plovdiv
Summary: Acute intoxications represent a topical diagnostic-curative problem in contemporary medicine, and as urgent life-threatening conditions they require fast application of curative schemes, based on the accurate judgment on the heaviness and the type of intoxication. The adequate therapy can be realized on the basis of an extensive clinical examination, expressed symptomatics, toxico-chemical analysis and the clinical lab tests. The precise and express lab information considerably helps in achieving of the main aims of the emergency medicine: fast and precise diagnosis, accelerated medical aid and intensive treatment, decreased death rate and shortened stay in the reanimation wards etc. These aims are also of great importance for the clinical toxicology, especially in cases with severe and not clear acute exogenic intoxications, considering also the more aggresive character of the acute intoxications in the last decades.
Key words: acute intoxication, clinical lab tests
Аddress for correspondence:
Stoilka Tufkova, Clinic of Toxicology, MHAT “Sv. Georgy”, 15A, V. Aprilov blvd., Bg -- 4000 Plovdiv, tel. +359 32 602-406, GSM: +359 889/302-953, e-mail: tuffi_med@yahoo.com


Interdependence between the quantity of malondialdehyde, changes in the activity of superoxide dismutase and catalase and the development of microvascular complications in type 2 diabetes  – 44, 2008, No 2, 48-52.
P. Goycheva(1), B. Popov(2), V. Gadzheva(2) and S. Popova(2)
(1)Department of Internal Medicine and Clinical Laboratory, (2)Department of Chemistry and Biochemistry, Medical Faculty, Thracian University--Stara Zagora
Summary: Oxidative stress is increased in diabetes mellitus and may play an important role in the pathogenesis of the typical long-term complications of human diabetes, like microangiopathy. Protein glycation and glucose autooxidation induced by hyperglycemia can generate free radicals that can catalyze lipid peroxidation. Other potential mechanisms of oxidative stress include the reduction of antioxidant defense. The direct effect and the interaction of diabetic angiopathy and metabolic control on free radical and antioxidant activity indices were investigated in our study. Serum levels of lipid peroxides and erythrocyte antioxidant enzyme activities were measured in 64 type 2 diabetic patients among whom 48 had microvascular complications. All the diabetic patients had higher concentration of glycated hemoglobin (HbA1C = 10.95 +/- 2.45%) compared to 74 healthy controls. Significantly increased levels of malondialdehyde were observed in diabetic patients compared to controls (MDA: 2.5060 +/- 0.0858 µmol/l vs. 1.8240 +/- 0.0569, p < 0.05). Erythrocyte catalase activity was increased in diabetic patients compared to controls too (CAT: 26.423 +/- 1.666 KUnits/g Hb vs. 18.299 +/- 1.074, p < 0.05), but no significant change in superoxide dismutase activity was observed in diabetic patients at all (SOD: 3.2007 +/- 0.221 KUnits/g Hb vs. 2.9033 +/- 0.191, p = 0.42). In addition, only the diabetic group with microvascular complications had increased SOD activity compared with the controls (SOD: 3.5898 +/- 0.296 KUnits/g Hb vs. 2.9033 +/- 0.191, p < 0.05). The increase in MDA level, SOD and CAT activities in diabetics with microvascular complications in this study indicates that these factors may contribute to the occurrence of microvascular complications in type 2 diabetic patients.
Key words: diabetes mellitus, superoxide dismutаse, catalase, oxidative stress, malondi­al­de­hyde, microvascular complications
Address for correspondence:
Petya Goycheva, M. D., Section of Endocrinology, University Hospital, 11 Armeiska Str., Bg6000 Stara Zagora, tel. +359 42 664 382, e-mail: Petya_goicheva@yahoo.com


Lipid peroxidation and activity of superoxide dismutase and catalase in astrocytomas – 44, 2008, No 2, 53-57.
B. Popov(1), V. Gadzheva(1), P. Valkanov(2), A. Tolekova(3) and S. Popova(1)

(1)Department of Chemistry and Biochemistry, (2)Clinic of Neurosurgery, University Hospital, (3)Department of Physiology, Medical Faculty, Thracian University -- Stara Zagora
Summary: This study was aimed at determining the lipid peroxidation and activity of total superoxide dismutase and catalase in astrocytoma tissues in respect to non-neoplastic postmortem human brain tissue. Samples of tumor tissue were obtained from 14 astrocytoma patients undergoing surgery in Neurosurgery Clinic of Thracian University, Stara Zagora. Eightеen normal brain tissues, obtained from Pathology Department of Multiprofile Hospital for Active Treatment, Stara Zagora, were used as control. Lipid peroxidation product as malonil dialdehyde was determined by thiobarbituric acid method and calculated in mcmol/g pr. Catalase activity was determined at 240 nm by measuring the rate of hydrogen peroxide utilization as described by Beers et al. Superoxide dismutase activity was measured at 560 nm by the rate of suppression of reduction of nitroblue tetrazolium when superoxide anion radical was generated during oxidation of hypoxanthine by xanthine oxidase. Levels of antioxidant enzyme activities were calculated in U/mg pr. Concentration of MDA in astrocytomas1.83 +/- 0.33 was insignificantly lower (p > 0.05) in comparison with that in controls (2.10 +/- 0.128). SOD activity was found significantly lower (p = 0.001) in the cancer group3.03 +/- 0.56 U/mg Pr in comparison to the control one -- 4.99 +/- 0.26 U/mg pr. CAT activity was lower in the patients--13.7 +/- 1.99 U/mg protein with respect to the controls -- 16.89 +/- 1.18 U/mg pr, but the difference was not statistically significant (p > 0.05). According to these results, there are differences in the antioxidation status of astrocytoma and normal brain tissue.
Key words: lipid peroxidation, superoxide dismutase, catalase, astrocytoma
Address for correspondence:
Boris Popov, Department of Chemistry and Biochemistry, Medical Faculty, 11, Armeiska str., Bg 6003 -- Stara Zagora, tel. +359 42/664 326, e-mail: bpopov@mf.uni-sz.bg


Inflammatory diseases in the maxillofacial region in the patients with diabetes mellitus: I. Clinical features –– 44, 2008, No 2, 58-62.
P. Sapundzhiev

Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, MU, Specialized University Hospital for Active Treatment in Maxillofacial Surgery--Sofia
Summary: The aim of this study was to define the initial local clinical manifestations, subjective complaints and functional disorders; general status -- lassitude, temperature increase, fever, headache, the tooth as a causative agent, attendant diseases; to follow up clinical recovery with determining the time for cessation of suppuration and dynamics in blood sugar changes in development of acute purulent infection in diabetic patients. Investigations were made on 92 subjects -- 46 diabetic patients with inflammatory diseases in the maxillofacial region and 46 non-diabetics with similar diseases, divided according sex, age, type and duration of diabetes and the above described indices. There were registered to a various degree pain, swelling, reddeness, temperature increase and functional disturbance in both groups, but only swelling was found in 100% of the diabetic patients -- P < 0,05, while other parameters did not show statistically significant value -- P > 0,05. Changes in blood sugar levels showed, that added inflammatory process had a negative influence on carbohydrate metabolism, decompensating it. It is concluded that inflammatory diseases in maxillofacial region in diabetic patients develop more quickly, they are associated with more acute pain sensation, fast tissue infiltration with solid consistency, unclear borders and with a different expressed fluctuation, temperature increase up to fever and worsening of the general condition. Local functional disturbances are also present -- facial assymetry, disturbances in speech, nutrition, gulp, gesture, limitation in mouth opening. It is necessary to control carbohydrate and other kind of metabolism, to treat attendant diseases of cardiovascular and other systems under leadership of endocrinologist and other clinical experts.
Key words: inflammation diseases, clinical features, diabetes mellitus, maxillofacial region
Address for correspondence:
Peter Sapundzhiev, M. D., Ph. D., Department Oral and Maxillofacial Surgery, Faculty of Dental Medicine, MU, Specialized University Hospital for Active Treatment In Maxillofacial Surgery, 1, ”Sv. G. Sofiyski” Blvd, Bg -- 1431 Sofia, GSM +359 886 629 425, e-mail: psapundjiev@abv.bg

Consensus for diagnosis and treatment of early localized Lyme borreliosis – 44, 2008, No 2, 81-95.

R. Komitova, I. Hristova and K. Plochev.





European survey on coercion in psychiatry: epidemiological data and general sample in Bulgaria – 44, 2008, No 1, 43-51.
G. Onchev(1), I. Gerdzhikov(2), Ts. Ivanova(2), Yu. Pulchev(2), R. Trendafilova(1), S. Aleksiev(1), M. Vukov(3) and
K. Ganev(4)
(1)Department of Psychiatry, Medical University -- Sofia
(2)State Psychiatric Hospital “Sv. Ivan Rilsky”  --  Novi Iskar
(3)National Centre for Health Information  --  Sofia
(4)Dinamika Centre  --  Sofia
Summary: The aim of the study was to present epidemiological data and description of the general sample from the Bulgarian center in the European study on coercion in psychiatry (EUNOMIA). Two groups of patients consecutively admitted during 2 years in the acute wards attached to a defined geographical region were assessed: legally involuntarily admitted and legally voluntarily admitted but feeling coerced at screening. The assessment was done with standardized instruments in 3 time points, parallel to recording of individual coercive measures on current basis during the hospitalization and standardized assessment of the region and the participating wards. The legally involuntary patients are younger and more frequently males and schizophrenic, as compared to the legally voluntarily admitted. One quarter of all hospitalizations are involuntary, and yet one quarter of all voluntaries are with perceived coercion when admitted. The indicators for average number of beds per room and those concerning staff density in the wards tend towards the poorest pole across the European centers. The differences between the general sample and the sample included in the main survey are described. For the first time in this country, realistic epidemiological data concerning coercion for psychiatric hospitalization are found, providing merits for accepting the existence of covert coercion, in a context of care with unfavorable characteristics. Perceived coercion in voluntary patients is more frequent in males, and does not have evident connection to age or diagnosis.
Key words:  coercion in psychiatry, epidemiology, perceived coercion, care context
Address for correspondence:  Georgi Onchev, MD, Department of Psychiatry, Medical University Sofia, 1 Sv.  G..Sofiysky str., Bg  --  1431 Sofia, tel.  +35929230520, e- mail: georgeonchev&hotmail.com


Influence of vitamin D receptor polymorphism (Fok І) on developing of secondary hyperparathyroidism in patients with predialysis chronic renal failure – 44, 2008, No 1,  52-56.
E. Kumchev, E. Dimitrakova, Zh. Ivanova, P. Pavlov
and D. Dimitrakov
Medical University -- Plovdiv, Medical University  --  Sofia
Summary: 1,25/OH/2D3 is the main factor in controlling PTH synthesis, parathyroid cell proliferation and development of secondary hyperparathyroidism in patients with chronic renal failure. There were some investigations about the effect of VDR polymorphism Bsm I and Apa I on parathyroid response in predialysis patients, but up to now there were only two publications about influence of Fok I VDR polymorphism. The aim of this study was to established the allele distributions of VDR Fok I polymorphism and its influence on development of secondary hyperparathyroidism in predialysis stage. Forty patients -- 22 men and 18 women in predialysis stage were investigated. VDR polymorphism was detected by polymerase chain reaction. Fok I restrictase was used for chain cleavage. The allele distribution of Fok I polymorphism in patients showed: Ff -- 67.5%, FF -- 27.5% and ff -- 5.0%. The intact parathormone was increased significantly in patients with FF alleles -- 204.7 +/- 60.9 pg/ml, compared to these with Ff alleles -- 89.4 +/- 19.6 (p < 0.05). Serum creatinine, calcium, phosphorus and duration of cronic renal failure in the groups were similar. The results suggest that VDR Fok I polymorphism can predetermine parathyroid response and progress of secondary hyperparathyroidism in predialysis patients with chronic renal failure.
Key words:  chronic renal failure, intact parathyroid hormone, Vitamin D receptor Fok I polymorphism
Address for correspondence: Emil Kumchev, M. D., Cinic of Nephrology and Haemodyalysis, UMHAT “Sv. Georgi”, 15A, V. Aprilov Blvd., Bg  --  4000 Plovdiv


Anemia and tumor necrosis factor in the prognostic evaluation of patients with heart failure  – 44, 2008, No 1,  57-62.
A. Goudev(1), N. Stancheva(2), S. Tisheva(2) and S. Kyurkchiev(3)
(1)Clinic of Cardiology with Intensive Care Unit, UMHAT “Tsaritsa Yoanna” -- Sofia
(2)Clinic of Cardiology and Rheumatology, UMHAT “G. Stranski” -- Pleven
(3)Section of Molecular Immunology, Bulgarian Academy of Sciences
Summary: Anemia is often recognized as a problem in chronic heart failure (HF) patients probably with strong impact on prognosis. The relationship of tumor necrosis factor-alpha (TNF-alpha) with the progression of HF has already been established but its role in predicting the outcome in chronic HF is still contradictive. The aim of this study was to evaluate the role of anemia and plasma concentration of TNF-alpha as predictors of outcome in hospitalized HF patients. One hundred and twenty-seven patients with symptomatic HF ranging from II to IV NYHA functional class were included, 69 males (57.0%) with mean age 61.9 +/- 8.4 years. The patients were consecutively hospitalized due to aggravated HF. On the day of discharge, standard laboratory samples were obtained, echocar­diography was performed and venous plasma for TNF-alpha was collected. The primary endpoint was defined as rehospitalization for aggravated HF within 6 months after discharge, more than 2 hospitalizations in 1 year or cardiac death. One hundred and twenty-one (95.3%) patients were followed for mean of 387 +/- 117 days. Fifty-four (44.6%) of them reached at least one of the endpoints. At univariate and multivariate analysis, neither TNF-alpha (chi-square = 1.17, р = 0.76) nor anemia (chi-square = 6.72, p = 0.15) proved to be significant predictors of outcome. The correlation between hemoglobin concentration and TNF-alpha showed no statistical significance. In hospitalized patients with HF, anemia and plasma concentration of TNF-alpha at discharge are not predictive of outcome in HF. More detailed studies are needed to establish the role of anemia and TNF-alpha for the prognostic evaluation of HF.
Key words:  anemia, tumor necrosis factor, heart failure, prognosis
Address for correspondence: Assoc. Prof. Asen Goudev, Department of Cardiology, University Hospital "Tsaritsa Yoanna", 8, Byalo more Str., Bg  --  1527 Sofia, e-mail: agoudev@abv.bg


Ultrasound examination of the parathyroid glands in patients with secondary hyperparathyroidism   – 44, 2008, No 1,  62-67.
M. Lubomirova(1), A. Tzontcheva(2), B. Bogov(1), R. Djerassi(1) and B. Kiperova(1)
(1)Clinic of Nephrology, University Hospital “Alexandrovska”  --  Sofia
(2)Sector Hormones, Department of Clinical Laboratory, University Hospital “Alexandrovska”  --  Sofia
Summary: Secondary hyperparathyroidism (SHPT) in patients with chronic renal failure (CRF) is characterized by high secretion of parathyroid hormone (PTH) and hyperplasia of parathyroid glands. 94 pts were examined, average age 56,65 +/- 13,5 with CRF, mean creatinine clearance was 38,59 +/- 15,11 ml/min. The chronic kidney disease duration was 8,86 +/- 8,9 years and of CRF  --  3,1 +/- 1,6 years. 8 pts. with proven primary hyperparathyroidism (PHPT) with creatinine clearance > 90 ml/min were used as control group for ultrasound examination of the glands. In all pts., calcium, phosphate, alkaline phosphatase (AF) and CaX P products were examined. PTH levels were tested using chemiluminescence assay. Conventional and Doppler ultrasound (US) of parathyroid glands were done. Patients with CRF had hypocalcemia, slightly elevated phosphate levels and normal Ca x P products and AP. In all pts with CRF, iPTH levels were three times higher (26,68 +/- 25,5), but iPTH levels in 8 pts with PHPT were 68 +/- 12,5 pmol/l, which was significantly higher than the levels in the SHPT group, p < 0,001. A statistically significant correlation between iPTH and renal function and CRF duration was found. In 42% of pts with SHPT and CRF, the parathyroid glands were not visible when US examination was done, and in 56% their enlargement was proved. Patients with PHPT had mean diameter of the gland 55,8 mm +/- 8, which was significantly higher than the mean value of the parameter in pts. with SHPT and CRF (20,8 mm +/- 8, p < 0,001). Positive correlation between iPTH levels and gland’s diameter in CRF pts with SHPT was proved ( r = 0,532, p < 0,001). Blood supply in the enlarged parathyroid glands (n = 54) assessed by Doppler US didn’t correlate with the gland size in pts. with CRF and SHPT. Such correlation was found in pts with PHPT and normal renal function. Conventional and Doppler US of parathyroid glands in parallel with laboratory tests gives reliable information about pathological changes in parathyroid glands in patients with CRF and SHPT.
Key words:  chronic renal failure, secondary hyperparathyroidism, parathyroid hormone, ultrasound examination of parathyroid glands
Address for correspondence: Mila Lubomirova, M. D. Clinic of Nephrology, University Hospital “Alexandrovska”,  1, Sv. G. Sofijski Str., Bg  --  1431 Sofia, tel. 9230229, e-mail: Mljubomirova@yahoo.com


Divergent impact of factor V Leiden on development of early and late fetal loss – 44, 2008, No 1,   68-72.
P. Ivanov(1), R. Komsa-Penkova(1), K. Kovacheva(2), E. Konova(3), I. Ivanov(1), K. Todorova(5), M. Simeonova(2), Sv. Gecheva(3), Sv. Stoykov(4), Y. Popov(4) and St. Tanchev(4)
(1)Department of Biochemistry, Medical University -- Pleven
(2)Department of Medical Genetics, Medical University -- Pleven
(3)Center of Clinical Immunology, University Hospital -- Pleven
(4)Department of Obstetrics and Gynecology, Medical University -- Pleven
(5)Department of Obstetrics and Gynecology, Medical University -- Sofia
Summary:  The aim of this study was to evaluate the impact of inherited thrombophilic mutation Factor V Leiden (FVL) on development of early and late fetal loss (recurrent spontaneous abortions and stillbirths) depending on growing stage of placenta. We investigated 71 women with very early pregnancy loss before 10th week of gestation (w.g.), 50 women with spontaneous abortion from 10th to 14th w.g., 39 women with spontaneous abortion and stillbirth after 14th w.g., and 80 healthy women with at least one uncomplicated full-term pregnancy. There was not significant occurrence of FVL in women with very early pregnancy loss before 10th w.g. (8.4% and 6.3% respectively for patients and controls, OR: 1.385; 95% CI: 0.353-5.539). Women with spontaneous abortion from 10th to 14th w.g. and spontaneous abortion and stillbirth after 14th w.g. had significant occurrence of FVL compared to controls. In particular, the prevalence of the mutation was higher in the group of women with reproductive failure after 14th w.g. (respectively 20%, OR: 3.750; 95% CI: 1.078-13.671, p = 0.035, и 25.6%, OR: 5.172; 95% CI: 1.455-19.276, p = 0.007). Pregnancy-induced reductions in protein S activity enhanced FVL prothrombotic effects: as gestation progresse, there was also a significant fall in the protein S activity. Thus may be explained high risk of late fetal loss in FVL carriers. High prevalence of FVL in women with late fetal loss encouraged routine testing of patients with such pathology and consideration of possible prophylactic anticoagulant therapy in further pregnancy.
Key words:  recurrent spontaneous abortions, stillbirths, factor V Leiden, risk
Address for correspondence: Petar Ivanov M.D., Department of Biochemistry, Medical University, 1, St. Kliment Ohridski Str., Bg  --  5800 Pleven, e-mail: mdivanov@gmail.com


Clinical features, laboratory parameters and treatment in etiologically confirmed gastrointestinal infections – 44, 2008, No 1,  73-77.
P. Ilieva, P. Tsvetkova, G. Gancheva, Y. Obretenova and H. Hristov
Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine
Medical University -- Pleven
Summary: This retrospective study of 119 etiologically confirmed cases treated in the Clinic of Infectious Diseases -- Pleven during five years (2002-2006) aimed at characterizing clinical and laboratory features and treatment of gastrointestinal infections. Results showed the following etiological structure -- salmonellosis in 53% and shigellosis in 47%. The most prevalent serotype of Salmonella was S. enteritidis (52%); in shigellosis -- S. sonnei (27%) and S. flexneri (20%). Salmonellosis had a severe course in 33%; the complications were not rare. In shigellosis caused by S. flexneri, severe forms were prevalent (in 42%). Leucocytosis with neutrophilia was observed in 48% of cases with shigellosis; increased serum creatinine levels were found more often in salmonellosis (16%). In conclusion: Nelidix, Ciprofloxacin and Ceftriaxon are most effective for treatment of gastrointestinal infections.
Key words:  salmonellosis, shigellosis, S. enteritidis, S. Sonnei, S. Flexneri
Address for correspondence:  Pavlina Tsvetkova, M. D., Pleven 5800, Clinic of Infectious Diseases, University Hospital, 8a, Georgy Cochev Str., tel. +359 64/ 886301, e-mail: pdc_pleven@abv.bg


Comparative investigation of parotitis epidemica in randomly chosen districts in North Bulgaria – 44, 2008, No 1,  78-80.
M. Karcheva(1), T. Velislavova(2) and K. Alexieva(3)
(1)Sector of Epidemiology, Parasitology and Tropical Medicine, MU  --  Pleven
(2)Department of Antiepidemic Control Regional Inspectorate of Public Health Protection  --  Gabrovo
(3)Department of Antiepidemic Control Regional Inspectorate of Public Health Protection  --  Vidin
Summary:  Parotitis epidemica is a vaccine preventable disease. This is of interest because outbreaks were reported in some regions in Bulgaria. The aim of this review is analysis and comparison of morbidity and epidemiological characteristics of parotitis epidemica in different districts of North Bulgaria from 2000 to 2005. The used information comes from epidemiological investigation documents in that period from the regions of Pleven, Vidin and Gabrovo. We have found changeable epidemiological characteristics -- the morbidity in the different regions is of varying intensity depending on peoples’ susceptibility, morbidity is higher in summer and in men. All ages are affected, but the incidence is higher above the age of 15.
Key words:  parotitis epidemica, morbidity, prophylaxis, epidemic process
Address for correspondence: Milena Karcheva, M. D., Sector of Epidemiology, Parasitology and Tropical Medicine, MU, 1, Sv. Kliment Ohridski Str., Bg -- 5800 Pleven, tel. +359 64/ 884-269, e-mail: milena_karcheva@abv.bg


Physical medicine in treatment of urinary incontinence in men – 44, 2008, No 1, 81-83.
K. Kazalakova
Sector of Physiotherapy and Rehabilitation, Urological Clinic, MHATEM “N. I. Pirogov”
Summary:  In this work, the author studies a problem of the present day of patients with urinary incontinence. 82 men were treated for this disorder, and it is searched for the successful application of methods for strengthening of the pelviс floor muscles.
Key words:  urinary incontinence, physical therapy, exercise, electrical stimulation
Address for correspondence: K. Kazalakova, M.D., Sector of Physiotherapy and Rehabilitation, Urological Clinic, MHATEM “Pirogov”, № 21 “Totleben” blvd., Bg  --  1606 Sofia, tel. +359 2 9154-502




Are “clinical pathways” in Bulgaria clinical pathways? Analysis of their characteristics, implementation and use in 2001-2008  – 44, 2008, No 1,  89-94.
G. Christoff
Clinic of Allergology, UMHAT “Alexandrovska”  --  Sofia
Summary:  Clinical pathways are the keystone in the relations between NHIF and hospitals. However, they are predominantly considered as a tool for reimbursement of hospital expenses, especially since 2005. Clinical pathways being constantly in the centre of public attention cause rising dissatisfaction. Our opinion is that the reason for that fact is to be found in the answer to the question: Are “clinical pathways” in Bulgaria really  clinical pathways?
Key words:  clinical pathways, quality of health care, statistical and economic indices, hospital expenses
Address for correspondence: Georgi Christoff, M. D., Clinic of Alergology, UMHAT “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg -- 1431 Sofia


New classes of antiretroviral preparations and their mechanism of action. Fourth conference on pathogenesis, treatment and prevention of HIV/AIDS, Sydney, Australia, July 22-25, 2007 – 44, 2008, No 1,  95-100.
R. Argirova




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