Tick-borne infections - challenges and problems – 40, 2004,
No 4, 5-12.
R. Komitova(1), E. Alexandrov(2) and I. Hristova(3)
(1)Clinic of Infectious, Parasitic
and Tropical Diseases, University hospital "Sv. I. Rilski” - Sofia
Referent Laboratory of Ricketsiosis, Military
Medical Academy - Sofia
(3)National Center of Contagious and Parasitic Diseases - Sofia
Summary: Tick-borne zoonoses as a
cause of human diseases have been known for many years but the major impact
on public health in Europe and in the USA was first recognized by identification of Borrelia
burgdorferi as the cause of Lyme
disease in early 1980s. Some of tick-transmitted diseases such as Mediterranean
spotted fever and human ehrlichiosis can be life-threatening but they are also eminently
treatable when recognized early. This article reviews the clinical and
epidemiological features of Mediterranean spotted fever and Lyme borreliosis, the prevailing
tick-borne diseases in Bulgaria, as well as Crimean-Congo hemorrhagic fever and ehrlichiosеs.
Current therapeutic and preventive strategy are
tick-borne zoonoses, Mediterranean spotted fever,
Crimean-Congo hemorrhagic fever, ehrlichiosеs,
Address for correspondence:
Radka Komitova, M. D., Clinic of Infectious, Parasitic and
Tropical Diseases, University Hospital "Sv. I. Rilski", 15 Acad. I.
Geshov Blvd., Bg - 1431 Sofia, e-mail: email@example.com
and cryoglobulinemic nephritis – 40, 2004, No
Clinic of Nephrology, University Hospital “Alexandrovskd”
Summary: Cryoglobulins are immunoglobulins
that precipitate at temperatures below 37 centigrade C and redissolve
when warmed. The presence in the serum of such immunoglobulins
is referred as cryoglobulinemia. This review
discusses the etiology, pathogenesis, clinical manifestations and treatment
of cryoglobulinemia and cryoglobulinemic
cryoglobulinemia, hepatitis C, hepatitis B,
Address for correspondence:
Milena Nikolova, M.
D., Clinic of Nephrology, University Hospital “Alexandrovska”,
1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, PB 45, tel. +359 2 92-30-299, e-mail:
Aspirin-induced asthma – 40, 2004, No 4, 18-22.
Clinic of Pediatric Pulmonology, University Hospital “Alexandrovska”
Summary: Aspirin-induced asthma (AIA) is a distinct clinical
syndrome affecting some asthmatic patients. In these patients, aspirin
may exacerbate asthma and prоvoke life-threatening reactions. Persistent rhinusinusitis
precedes development of nasal polyposis, aspirin
hypersensitivity and asthma. Although the name of the disease relates
to aspirin, it is well established that 93-100% of affected patients are cross sensitive to all
non-steroidal anti-inflammatory drugs (NSAIDs), that inhibit cyclo-oxygenase (COX) enzymes. Paracetamol
(acetaminophen) however, is seldom associated with cross sensitivity
in patients with AIA. Less than 2% of asthmatic patients are sensitive
to both aspirin and paracetamol and reactions
to paracetamol tend to be less severe. Patients
with AIA should avoid all products that contain aspirin or NSAIDs indefinitely; paracetamol
should be recommended, unless contraindicated.
Key words: aspirin, asthma,
paracetamol, nonsteroidal anti-inflammatory
Address for correspondence: Slavi Filtchev,
M. D., Chair of Pediatrics, University Hospital
“Alexandrovska”, Medical University, 1, Sv.
G. Sofiiski Str.,
Bg - 1431 Sofia, tel. +359 2 923-03-73; GSM 0887 3000 74
for the measurement of body composition – 40, 2004, No 4, 23-27.
Zh. Boneva(1), Vl. Christov(2), P. Popivanov(2), M. Boyanov(2) and N. Temelkova(2)
(1)Department of Endocrinology,
Medical Institute, Ministry of Internal Affairs - Sofia
of Endocrinology, University Hospital “Alexandrovska” - Sofia
Summary: The aim of this article is to compare the current methods for assessment of
body composition. Body composition measurements can be useful in laboratory
and epidemiological studies, as well as in clinical situations. Many diseases
and disorders are accompanied by changes or abnormalities in body composition
and the most common problem may be obesity. Body fat can be determined
in vivo in different ways, using rather accurate laboratory techniques
or using simple estimation techniques that can also be applied in clinical
conditions. The choice of particular technique should be based on a balance
of practical and financial considerations and the aim of the study.
Key words: obesity, body composition, body fat, fat-free mass
Address for correspondence:
Zhivka Boneva, M.
D., Department of Endocrinology, Medical Institute, Ministry of Internal
Affairs, 79, Skobelev Blvd., Bg
- 1606 Sofia,
tel. +359 2 51-57-351
in the treatment of atopic dermatitis – 40, 2004, No 4, 28-32.
Clinic of Dermatology and Venereology, Higher Medical
Institute - Pleven
Summary: Atopic dermatitis (AD) is
a chronically-relapsing disease with increasing prevalence and serious
impact on the quality of life of the patients and their families. The
most common methods for treatment of AD include antihistamines, topical
or systemic corticosteroids, emollients and physiotherapy. The introduction
of the local immunosuppressors (tacrolimus,
pimecrolimus) marks the beginning of a new era
in the therapy of the disease in children and adults. Their main advantage
compared with the topical corticosteroids is the lack of serious side
effects. The initial investigations over the role of some saprophytic
microorganisms (L. rhamnosus, M. vaccae) in the treatment
and prevention of AD also give encouraging results. The most recalcitrant
forms of the disease often require the use of systemic immunosuppressors (mycophenolate
mophetil). A new approach in the treatment of AD is the application
of antileukotriens and some of the methods of
the Chinese medicine.
atopic dermatitis, treatment
Address for correspondence:
Sonia Valkova, M. D., Clinic of Dermatology
and Venereology, Higher Medical Institute, 130, Doiran Str., Bg - 5800
Pleven, e-mail: firstname.lastname@example.org
Hormone replacement therapy for cardiovascular disease prevention - a
myth or reality?
Part II: Evidence from clinical trials – 40, 2004, No 4, 33-42.
Department of Internal Medicine, Medical University – Varna
The importance of the cardio-vascular diseases (CVD) in the modern developed society proves the interest in the peculiarities
in their development in the female gender and the possibilities for their
prevention. The hormone replacement therapy (HRT) is a good candidate
for the well-known beneficial effects of estrogens on the atherosclerosis process, on the lipid and carbohydrate metabolism, and the vascular dilation.
These protective on the cardio-vascular system biological effects of the
estrogens are confirmed in numerous observational epidemiologic studies
and meta-anаlyses which show on the average 25-30% lower risk from
CVD in women taking HRT. The large randomized, placebo-controlled trials
have to confirm whether these benefits from the HRT in the
prevention of CVD would be proven
in the clinical practice. Unfortunately, all available trials failed to
find a significant difference between the HRT and the placebo groups,
have shown a higher risk especially during the first months or year of
treatment. All studies proved higher incidence of deep venous and pulmonary
thromboembolic events, of breast cancer, and of genital bleeding, the
last being the most important reason for withdrawal from participation.
The lack of any evident benefit from HRT in decreasing CVD and the presence
of increased additional risk of other diseases do not give reason nowadays to propose HRT for the primary and
secondary prevention of the CVD.
cardiovascular diseases, hormone replacement therapy, clinical trials
Address for correspondence:
Yoto Yotov, M. D.,
First Cardiology Clinic, University Hospital “Sv.
Marina”, Medical University, 1, Hristo Smirnenski Blvd., Bg - 9010 Varna, tel.
+ 359 52-30-28-51/286, fax + 359 52-30-29-33, е-mail:
Substitution of cyclosporine microemulsion
(Neoral) by new generic formulations in renal
– 40, 2004, No
E. Paskalev and P. Simeonov
Clinic of Nephrology and Transplantation, University Hospital "Alexandrovska”
Summary: Neoral microemulsion formulation is a main immunosuppressant in organ
transplantation nowadays. It is a critical-dose drug because a small change
in its dose or concentration results in a clinically significant change
in efficacy or toxicity. Generic formulations of cyclosporine A (CyA) are becoming more widely available, but standard criteria
for bioequivalence in healthy volunteers demonstrate that mean pharmacokinetic
parameters fall within 80-125% of the mean values for Neoral. The limited available clinical evidence has shown
that stable renal transplant patients receiving Neoral
have a significant reduction in mean CyA level
after conversion to the Cicloral formulation.
Mean pharmacokinetic values have been reported as equivalent following
conversion to Gengraf in one study, but mean
CyA level fell and mean serum creatinine
rose significantly. The only clinical outcome data available are from
retrospective study of de novo renal transplant patients, which reported
a significantly higher incidence of biopsy proven acute rejection in patients
receiving Gengraf versus Neoral (39% versus
25%, p < 0.05). Bioequivalence does not equal clinical equivalence
and clinical equivalency requires extensive comparative testing in clinical
practice. It is well known that CyA pharmacokinetics
affects clinical outcome and formulation choice is a key factor affecting
clinical outcome. In conclusion, the use of CyA generic formulations affects survival of renal graft -
a main characteristic of good clinical practice.
transplantation, cyclosporine A, cyclosporine A generic formulation, clinical outcome
Address for correspondence:
Ass. Prof. Emil Paskalev, M. D., Clinic of Nephrology
and Transplantation, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, tel.
+359 2 923-02-40, e-mail: email@example.com
Regarding medical information given
to parents and patients
– 40, 2004, No
Medical University - Plovdiv
Summary: The parents, the
patients and particularly the children have the right to be informed and
to receive clear, comprehensive and unambiguous answer of their questions
correspondingly to the limits of current medical knowledge and practice.
Achieving full-bodied and free of conflicts contacts between the parents/patients/children
and medical staff depends on proper targeted education of the teams. They
need good knowledge and skills to deal with parents, patients, relatives
and non-medical members of the team, properly convey the good and the
bad news, to facilitate obtaining informed consent, to give additional
information and/or to suggest suitable information sources. The physicians
in our country still do not have enough experience and skills in this
field. They rely on personal quality and experience. The aims of this
study are presented as followеs.
To define, describe and characterize
the main groups of individuals, searching for medical and related information;
to evaluate the main information sources used by parents, patients and
relatives; to study the uses and abuses of information excess. Following
problems are discussed: 1) Different medical and related information sources
for parents and patients; 2) Assessment of the information gained from
different sources; 3) The impact of the information; 4) Problems related
to lack of information; 5) Problems related to information
excess. Searching for information, the parents and the patients may become
victims of persons or criminal groups, their private information might
be misused etc. Both the lack and the excess of information may be complicated
by misunderstanding, misuse or incorrect comments, making the dialog between
parents/patients and physicians substantially difficult. These problems
are not well known and developed in our country,
the physicians are not properly trained to solve them. Large multicenter
studies in accordance to medical low and ethics are lying ahead.
medical information, information sources, misinformation, parents/children/physician
Address for correspondence:
M. D., International Collaboration, Medical University, 15-a Vasil Aprilov
Str., Bg - 4002 Plovdiv, е-mail:
Properties of Coumarins - Review. 40, 2004, Suppl. 1, pp. 1-26.
I. Kostova (1), I. Manolov
(2) and P. Atanasov (3)
(1) Department of Chemistry, Faculty of Pharmacy,
Medical University - Sofia
(2) Department of Organic Chemistry, Faculty of
Pharmacy, Medical University - Sofia
(3) Section Of Emergency Internal Diseases and Cardiology,
Institute of Emergency Medicine "N. I. Pirogov"
The review contains data on the most pronounced biological activities
of coumarins, including anticoagulant, antimicrobial, spasmolitic, antineoplastic,
antioxidant ones etc. The most active compounds of this class and their
mechanism of action are shown. The pharmacological and biochemical effects,
as well as the therapeutic application of the compounds depend on the
substituents in the coumarin structure. Researches of the structure-activity
relationship are shown in order to determine the most important groups
Address for correspondence: Irena Kostova, Department of Chemistry,
Faculty of Pharmacy, Medical University, 2, Dunav Str., Bulgaria, 1000
Sofia, tel +359 2 923 65 69.
Low back pain
- 40, 2004, No 3, 5-9.
and Y. Sheitanov(2)
of Rheumatology, Medical University - Plovdiv
of Rheumatology, Medical University - Sofia
Summary: Low back pain (lumbalgia) is often registered by general practitioners and
other specialists - rheumatologists, neurologists,
orthopedists, neurosurgeons. Up to 80% of the
adults report of lumbalgia in different periods
of their life. The article presents the causes of low back pain, the differential
diagnostic approach and the algorithm of conduct in acute and chronic
pain. The possibilities of various imaging methods are analysed. Directions
for conservative and surgical treatment according to the etiology of the syndrome are presented.
low back pain, etiology, diagnosis, treatment
Address for correspondence:
Ass. Prof. Maria Pantchovska, M. D., P. B. 136, Bg - 4023 Plovdiv,
tel. 0888-60-23-81,e-mail: firstname.lastname@example.org
virus and its role in child pathology. Diagnosis and prophylaxis – 40,
2004, No 3, 10-14.
and S. Filtchev(2)
of Influenza and Acute Respiratory Diseases, Department of Virology, National
Center of Infectious and Parasitic Diseases - Sofia
of Pediatric Pulmonology, UMHAT “Alexandrovska” - Sofia
Summary: Respiratory syncytial virus (RSV) is one of the most common
pathogens of the lower respiratory tract in infants and young children
and about 40% of the infected patients develop bronchiolitis or pneumonia.
The current report summarizes the role of RSV in some groups at high risk
(prematurely born infants, infants with bronchopulmonary dysplasia, congenital
heart diseases and immunodeficient patients). Subjects regarding the symptoms
and complications, contemporary diagnosis, treatment and possible immunoprophylaxis
of infections etiologically connected with RSV are discussed. The purpose
of this review is to present recent data with regard to this agent and
respiratory syncytial virus, high risk groups, diagnosis, prophylaxis
Address for correspondence: Slava Pavlova, M. D., Department of
Virology, National Center of Infectious and Parasitic Diseases, 44A, Stoletov
Blvd., Bg - 1233 Sofia, tel. + 359 2 931-07-13/207
Monkeypox: an emerging zoonosis – 40, 2004, No 3, 15-19.
Clinic of Infectious, Parasitic and Tropical Diseases, University Hospital
“Sv. Iv. Rilski” - Sofiа
Summary: Human monkeypox is a rare viral zoonosis endemic to Central
and Western Africa that has recently emerged in the USA.
Laboratory diagnosis is important because the virus can cause disease
that is clinically indistinguishable from other pox-like illnesses, particularly
smallpox and chickenpox. Although the natural animal reservoir of the
monkeypox is unknown, rodents are the probable sourse of its introduction
into the USA. A clear understanding
of the virulence and transmissibility of human monkeypox has been limited
by inconsistencies in epidemiological investigations. Monkeypox is the
most important orthopoxvirus infection in human beings since the eradication
of smallpox in the 1970s. There is currently no proven treatment for human
monkeypox and questions about its potential as an agent of bioterrorism
Key words: monkeypox, smallpox vaccination,
Address for correspondence: Radka Komitova, M. D., Clinic of Infectious,
Parasitic and Tropical Diseases, University Hospital, “Sv. Iv. Rilski”,
15 Acad. Iv. Geshov Blvd., Bg - 1431 Sofia
Reactive oxygen species, endogenic antioxidants and acute
gastric injury – 40, 2004, No 3, 20-26.
D. Paskalev(2), H. Divanyan(3)
and T. Yankova(1)
(1)Department of Preclinical,
Clinical Pharmacology and Biochemistry, Medical University – Varna
(2)Clinic of Nephrology and
Dialysis, University Hospital “Sv. Marina” – Varna
(3)Department of Medical Physics,
Chemistry and Biology, Medical University – Varna
Summary: Recent evidences indicated that oxidative stress plays
a significant role in the pathogenesis of acute gastric mucosal injury.
Reactive oxygen species (ROS) are implicated in the mucosal damage induced
by ischemia-reperfusion, Helicobacter pylori infection, stress, ethanol
and non-steroidal anti-inflammatory drugs. Recent studies on experimental
models and clinical trials demonstrated that ROS are involved in the impairment
of the protective mechanisms of the mucosa and the mucosal damage. The
main cellular sources of ROS production in mucosal injury are xanthine
oxidase, activated in local ischemia-reperfusion, lipid peroxidation,
activated phagocytic cells etc. Oxidative stress can become an injuring
factor due to decreased cellular antioxidant defence systems (reduced
glutathione and glutathione-related enzymes, superoxide dismutase, catalase
etc.), thus contributing to mucosal damage. Therefore, antioxidants combined
with the conventional therapy may be a more successful approach in the
treatment of acute mucosal injury.
Key words: reactive oxygen species, antioxidants,
Address for correspondence: Bistra Galunska, M. D., Department
of Preclinical, Clinical Pharmacology and Biochemistry, Medical University,
55, Marin Drinov Blvd., Bg - 9002 Varna, tel. + 359 052/60-67-86/251,
Hormone replacement therapy for cardiovascular disease prevention
– a myth or reality? Part I: Biological plausibility and epidemiologic
evidence – 40, 2004, No 3, 27-35.
Department of Internal Medicine, Medical University – Varna
Summary: Cardio-vascular diseases (CVD) in women are a substantial
scientific, medical, and social problem because of their importance and
because of the biological and clinical differences in the course of the
diseases in the female gender. CVD are the major cause of death in females,
and acount for two thirds of the fatal cases in Bulgaria.
The incidence of CVD increases after menopause, which implies that hormone
replacement therapy (HRT) as a substitution of the natural hormone activity
could have a beneficial effect on the morbidity and mortality from CVD.
The biological effects of the estrogens on the cardio-vascular system
are presented in the first part of the proposed reviews as well as the
results from animal experiments, studies on the potential risk factors
of atherosclerosis and from the large descriptive epidemiological studies.
All of them show an extensive cardiovascular protective effect of the
estrogens, which results in decrease of LDL-cholesterol and increase of
HDL-cholesterol, beneficial effect on the vascular reactivity, inflammation
processes and coagulation, as well as antioxidant effects. All large observational
studies and meta-analyses of the results describe a significant risk reduction
of CVD between 16% and 50%, especially in the high-risk groups. But in
the era of the evidence-based medicine, large clinical trials are needed
to prove in practice these potential benefits of HRT for the CVD protection
Key words: cardiovascular diseases, hormone replacement
Address for correspondence: Yoto Yotov, M. D., First Cardiology
Clinic, University Hospital “Sv. Marina”, Medical University, 1, Hristo
Smirnenski Blvd., Bg - 9010 Varna, tel. + 359 052-30-28-51/286, fax +
359 052-30-29-33, е-mail: email@example.com
Rare diseases as a clinical and public health problem - 40, 2004, № 2, 5-8.
R. Stefanov (1, 2) and E. Daina (2)
Social Medicine and Health Management, Medical University - Plovdiv, Bulgaria
Centre for Rare Diseases "Aldo e Cele Dacco"
Mario Negri Institute for Pharmacological Research,
Summary: Generally, rare diseases could
be defined as pathological conditions with low prevalence and incidence.
Each disease affects comparatively small part of
the population, but summed as a total, because of the huge number of nosological
units, rare diseases emerge as a serious public health problem for the
health systems worldwide. The aim of the article
is to introduce to the Bulgarian scientific and medical community the
most important contemporary problems of patients with rare diseases and
their doctors. The necessity of establishment of a national policy in
Bulgaria towards the rare diseases is discussed.
Key words: rare diseases, orphan
drugs, public health
Address for correspondence: Rumen Stefanov, M. D., Department
of Social Medicine and Health Management, Medical University, 15а, Vasil Aprilov Blvd., Bg
- 4000 Plovdiv, e-mail: firstname.lastname@example.org; email@example.com
severe acute respiratory syndrome (SARS) outbreak - one year later- 40, 2004, № 2, 9-17.
Clinic of Pediatric Pulmonology, UMHAT “Alexanrovska”
Summary: Severe Acute Respiratory Syndrome (SARS) is an acute respiratory
illness caused by infection with the SARS Co-V virus. Fever followed by
a rapidly progressive respiratory compromise is the key complex of signs
and symptoms, which also include chills, muscular aches, head-ache and
loss of appetite. The mortality of SARS ranges from 0% to 50% depending
on the age group affected: less than 1% in persons aged 24 years or younger
and greater than 50% in persons aged 65 years and older. The etiologic
agent of SARS, a specific coronavirus, is predominantly spread by droplets
or by direct and indirect contact. Shedding in feces and urine also occurs.
Medical personnel, physicians, nurses, and hospital workers are among
those commonly infected. Control of this disease relies on the rapid identification
of cases and their appropriate management, including the isolation of
suspect and probable cases and the management of their close contacts.
At present, the most efficacious treatment regimen for SARS is still subject
to debate. For patients with progressive deterioration, intensive and
supportive care is of primary importance. Immunomodulation by steroid
treatment may be important. The signs and symptoms of SARS are nonspecific,
and there is no early diagnostic test, no specific treatment, and no vaccine.
Although the recent outbreak of SARS appears to have waned, most experts
believe SARS is here to stay. This will be true especially if there is
an animal reservoir that cannot be eradicated.
severe acute respiratory syndrome (SARS), SARS coronavirus, epidemic,
Address for correspondence: Slavi Filtchev, M. D., Chair of Pediatrics,
University Hospital “Alexandrovska”, Medical University, 1,
Sv. G. Sofiiski Str., Bg - 1431 Sofia, tel. +359 923-03-73;
schizophrenia spectrum: schizotaxia and prodromes - 40, 2004, № 2, 18-23.
Department of Psychiatry, Medical University
Summary: Apart from the syndromal schizophrenia spectrum, attenuated
cognitive and behavioral disturbances in individuals without manifest
psychopathology are encountered. There is undoubtful evidence, especially
from neurogenetics, functional morphometrics and neuro-psychological research,
demonstrating links between these disturbances and arrest in the maturation
process of the CNS. These disturbances are conceptualized in the framework
of a broader endophenotype with underlying schizotaxia. A detailed review
of its phenomenology demonstrates huge variety and relatively low specificity.
Core features of the subsyndromal spectrum are discrete changes in self-experience,
e.g. in bodily self-perception, authorship of inner experience, and intuitive
attunement to common sense aspects of reality. Epistemology of such subjective
phenomena is a challenge to general psychopathology that is still – despite
Jaspers’ legacy – more oriented to recognition of observed and clearly
verbalized signs and symptoms. Not unexpectedly, the contemporary diagnostic
criteria of schizophrenia are twisted towards positive psychotic symptoms
at the expense of features like autism and formal thought disorder. Subsyndromal
phenomena may persist over the life cycle as “formes frustes” of schizophrenia,
or may escalate to psychosis. Their role as prodromes, in the latter case,
still being assessed mainly in a retrospective way, is at the background
of one of the most promising developments in psychiatry aiming at early
recognition and interventions in the pre-psychotic stage. Some of the
perspectives and ethical problems ahead of this new development are presented.
Key words: schizophrenia spectrum, schizotypy,
schizotaxia, endophenotype, prodromes, early diagnosis, early interventions
Address for correspondence: Georgi Onchev, Department
of Psychiatry, Medical University, 1, Sv. G. Sofiiski Str., Bg
- 1431 Sofia
factors for development of vascular calcifications in hemodialysis patients
- 40, 2004, № 2, 24-27.
Dialysis Clinic, University Hospital “Alexandrovska” - Sofia
Summary: Patients with advanced renal failure on conservative or dialysis
treatment are in a status of disturbed mineral, protein, lipid and other
kinds metabolism, that predispose development of several types of soft
tissue calcifications, between them especially significant cardiovascular
calcifications. The mechanisms of appearance and enlargement of these
calcifications is not clearly defined up to now, but a multi-factor genesis
was recently proved and a key role was designated to hyperphosphatemia,
high calcium body burden and lower levels of some protective proteins.
A strict control of the above mentioned factors would reduce the risk
of cardiovascular calcifications and would decrease cardiovascular morbidity
and mortality in uremic patients on conservative or dialysis treatment.
Key words: chronic renal failure, dialysis, mineral
metabolism, hyperphosphatemia, vascular calcifications
Address for correspondence: Diana
Ionova, M. D., Clinic of Dialysis, University
Hospital “Alexandrovska”, 1, Sv.
G. Sofiiski Str., Bg - 1431 Sofia,
tel. + 359 923-04-63, 923-05-15,
intima-media thickness assessment - a possiblity
for early diagnosis of atherosclerosis - 40, 2004, № 2, 28-33.
J. J. Petrova (1), A. Marintchev (2) and I. Staikov (3)
(1)Clinic of Neurology, University Hospital "Alexandrovska" - Sofia
I. Pentchev” - Sofia
(3)Clinic of Neurology,
University Hospital “Tzaritza Ioanna” - Sofia
Summary: The atherogenic risk can be evaluated by non
invasive methods by measuring the intima-media
thickness of the blood vessel wall. The intima-media
thickness is considered to be an early marker of atherosclerosis. Its
measuring by ultrasound is possible due to the different histological
characteristics of the tissues of the blood vessel wall. One of the recent
methods in use is the measuring of the a. carotis
interna at a distance of 1-2 cm from the bifurcation.
A correlation between the intima-media thickness and the development of atherosclerotic
plaque has been found. The evaluation of the intima-media
thickness can be usefull in early diagnosis
and prophylaxis of patients with brain circulatory disease.
words: intima-media thickness, atherosclerosis, risk factors, ultrasound
Address for correspondence: J. J. Petrova, M. D., Clinic of Neurology, University Hospital “Alexandrovska”,
Medical University - Sofia, 1,
Sv. G. Sofiiski Str., Bg - 1431 Sofia
role of Notch receptors in the intercellular signaling in different biological
events - 40, 2004, № 2, 34-42.
R. Trifonova and M. Stamenova
Department of Immunochemistry,
Institute of Biology and Immunology of Reproduction, Bulgarian Academy
of Sciences - Sofia
Summary: Notch are
evolutionarily conserved cell surface receptors that initiate signaling
events between neighbouring cells in multicellular
organisms. Notch signaling plays a crucial role in cell fate determination
through the regulation of cell proliferation, differentiation and apoptosis.
The review presents the molecular mechanisms of the Notch signaling events,
mediated by the interaction between Notch receptors and their putative
ligands. The role of Notch during the embryogenesis and postembryonic
development is discussed. This review presents also data about the association
of aberrant Notch signaling with different pathological conditions in
Key words: Notch receptors, Delta ligand, Jagged ligand
Address for correspondence: Ass. Prof. M. Stamenova, Department of
Molecular Immunology, Institute of Biology and Immunology of Reproduction,
Bulgarian Academy of Sciences, 73, Tzarigradsko
schosse Blvd., Bg
- 1113 Sofia, tel. +359 2 870-72-85, e-mail: firstname.lastname@example.org
is the news in the pathophysiology of acne? - 40, 2004, № 1, 5-9.
Department of Dermatology, Higher Medical Institute – Pleven
Summary: Acne is a common inflammatory skin disease affecting the
pilo-sebaceous unit. The four basic pathophysiologic
mechanisms of the disease are: hyperandrogenemia,
hyperseborrhoea, infundibular hyperkeratosis
and inflammation. Latest scientific investigations establish that hyperseborrhoea
develops due to an increased expression of androgen receptors, hyperactivity
of the enzyme 5*-reductase and the secretion of an insulin-like growth factor.
Different cytokines which potentiate inflammation
and infundibular hyperkeratinization
are also of significant importance. One of the main inflammatory factors
in acne is Propionibacterium acnes. It produces
a number of chemotactic factors, enzymes and
proinflammatory molecules. Genetic predisposition and stress
are also considered to play an important role in the development of the
disease. Despite the latest scientific achievements, in the pathophysiology
of acne still exist a lot of questions. Their
solution in future would greatly facilitate the introduction of new, causative
methods for treatment of the disease.
Key words: acne, pathophysiology
Address for correspondence: Sonia Valkova,
M. D., Department of Dermatology, Higher Medical Institute, 130, Doiran
- 5800 Pleven, e-mail: email@example.com
transplantation and cardiovascular diseases - 40, 2004, № 1, 10-14.
Clinic of Nephrology and Transplantation, University Hospital "Alexandrovska"
Summary: It is now well established that patients with chronic
renal failure are at increased risk of cardiovascular disease. Many studies
suggest that this problem is attenuated, but is not corrected by successful
renal transplantation. Cardiovascular disease has now emerged along with
infection as the leading cause of mortality in renal transplant recipients,
particularly after the first year. Since many of these patients die with
functioning graft, these deaths represent an increasingly important cause
of graft loss. More grafts were lost by patients mortality than rejection during the 2-5 year post-transplant
period (49% vs 41%). Ischaemic heart disease and other vascular events collectively
accounted for 63% of these deaths. Improvement of cardiovascular status
in renal transplant patients is of significant importance in attaining
better results for survival of graft, rather than further advances in
immunosuppressive or antimicrobial therapy. The goal of the survey is
to summarize real clinical possibilities for assessment of the risk of
ischaemic heart disease and its minimizing in renal transplant
Key words: kidney transplantation, risk factors,
ischaemic heart disease
Address for correspondence: Emil Paskalev,
M. D., Clinic of Nephrology and Transplantation, University Hospital "Alexandrovska", 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia,tel. +359 2 923-02-40, e-mail: firstname.lastname@example.org
and treatment of nasal polyps - 40, 2004, № 1, 15-17.
Department of Otorhinolaryngology, Medical University
Summary: Nasal polyps are а common disorder and a significant
burden on society. Individuals with associated sinusitis have a significantly
impaired quality of life. Many cells of the immune system and their mediators
have a crucial role in the pathogenesis of nasal polyps. There are different
methods for treatment.
nasal polyps, diagnosis, treatment
Address for correspondence:
D. Vicheva, M. D., Department of Otorhinolaryngology,
Medical University, 81A, Il. Makariopolski Str.,
Bg - 4000, Plovdiv; e-mail: email@example.com
and classification of eye injuries -
40, 2004, № 1, 18-21.
Clinic of Ophthalmology, University Hospital "Tzaritza
Summary: Ocular traumatism has always been and unfortunately still
is a main problem in ophthalmology. There are many classifications of
eye injuries, according to different criteria. According to the mechanism
and the conditions of occurance, they are divided
into domestic, professional, transport, sport, criminal and military trauma.
Another classification of ocular trauma is according to the type of the
eye trauma. The distribution of ocular trauma according to sex, age and
socioeconomical status is an important characteristic
in the study of traumatism. The purpose of this review is to pay attention
to this very important problem in ophthalmology and its wide distribution
eye injury, epidemiology, classification
Address for correspondence: Irina Kuneva, M. D., Clinic of Ophthalmology,
University Hospital "Tzaritza Ioanna", 8, Bialo more Str., Bg - 1527 Sofia, tel. + 359
in the hepatitis B virus genome and their significance - 40, 2004, № 1, 22-32.
A. Sakarev and P. Teocharov
National Center of Infectious and Parasitic Diseases - Sofia
Summary: Hepatitis B virus infection
remains a major public health problem worldwide with more than 300 million
chronic carriers. Under the influence of different factors, changes can
occur in genome of the hepatitis B virus and mutated variants of the virus
with changed characteristics appear. There are different factors that
may lead to such changes. From viral side, the unusual way of replication
with reverse transcriptase involved in it is the main reason for such
"mistakes". Other important reasons are the contact of the virus
with the host immune system, ongoing treatment with different medicines
and a large immunization programs carried out worldwide. Recent evidence
suggests a possible association of some hepatitis B virus mutants with
the development of severe liver diseases, including hepatocellular
carcinoma and could lead to unreliable diagnostics procedure. They also
lead to drug resistance. The main problem is the appearance of "escape"
mutants which are undetectable for the immunity after vaccination. So
far such mutants are rare but they should be monitored very closely because
of the possibility of domination over the wild type hepatitis B virus
population. The problems caused by the changes in the viral genome apply
for the development of new diagnostic methods, new drugs and even modification
of the existing vaccines.
Key words: hepatitis, hepatitis B virus, mutation,
Address for correspondence: A. Sakarev, M. D., National Center of Infectious and Parasitic
Diseases, 44A, Stoletov Blvd., Bg
- 1233 Sofia, tel. +359 2 931-07-13
Erythropoietin and erythropoietin therapy.
Part II. Erythropoietin in surgical patients.
Erythropoietin treatment of anemia in congestive heart failure, HIV-infection,
anemia of prematurity and other states of hypoxia- 40, 2004, № 1, 33-37.
Clinic of Nephrology, University Hospital Alexandrovska
Summary: After the introduction of recombinant human erythropoietin
(rhEPO) in the clinical practice for the treatment
of anemia in chronic renal disease and malignancy, a wide range of new
clinical indications for the use of rhEPO has
been published in the medical literature. Among these new indications
are: erythropoietin treatment before major elective surgery (for autologous
transfusion of red blood cells); when the patient is reluctant or contraindicated
to receive blood transfusions; anemia in HIV-infection; cardio- and neuroprotection;
in critically-ill patients; blood-doping etc. This review focuses on these
new indications for EPO treatment.
erythropoietin, anemia in chronic congestive heart failure, anemia in
HIV-infection, anemia of prematurity, neuroprotection, treatment
Address for correspondence: Milena Nikolova, M. D., Clinic of
Nephrology, University Hospital Alexandrovska,
PB 45, 1431 Sofia, e-mail: firstname.lastname@example.org
Central Medical Library
1, Sv. G. Sofijski Str., Bg- Sofia 1431
phone 952-05-09, fax 952-23-93
Executive secretary, Manuscript Editor and Proofreader I. Miteva, Terminology
controlB. Stantcheva, M.D., Web-site support - Dr. Zh. Surcheva
- Sofia, Central
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