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Vol. 45, 2009




Clinical manifestations, diagnosis, prevention and treatment of infections caused by human papillomaviruses - 45, 2009, No 4,  5-9.
Z. Kalvachev(1), V. Vladimirov(2), A. Gancheva(3), G. Mateev(4) and Y. Delchev(5)

(1)National Center of Infectious and Parasitic Diseases -- Sofia, (2)Clinic of Urology and Transplantation, Medical University -- Sofia, (3)Specialized Hospital for Active Treatment of Oncologic Diseases--Sofia, (4)Clinic of Dermatology and Venereology, Medical University -- Sofia, (5)Clinic of Gynecology, V MHAT--Sofia, Bulgaria
Summary: During the past 25 years, more than 100 genotypes of human papillomaviruses (HPV) have been identified. Most of them are found in benign proliferations, but others are discovered in malignant tumors: cervical or other anogenital cancers, as well as in some cancers of the skin, larynx, and the oral and nasal cavity. Here we review the classification, biology, pathology, diagnosis and therapy of HPV infections, altogether with some aspects of HPV prevention by new vaccines.
Key words: human papillomaviruses, oncoviruses
Address for correspondence: Prof. Zlatko Kalvatchev, M. D., DSci., Molecular Virology Laboratory, National Center of Infectious and Parasitic Diseases, 44-A, Stoletov Blvd., Bg -- 1233 Sofia, tel. +359 2 931-38-18, е-mail: kalvatchev@gmail.com


Antiviral effects of Interferon: 1. Induction, proteins and their receptors - 45, 2009, No 4, 10-18.
M. Vasilev and Zh. Vasileva

Internal Diseases Clinic, University Hospital „Lozenets” -- Sofia
Summary: Interferon (IFN) is a generic name used for designation of inducible and secreted proteins with antiviral effects. Their synthesis and secretion is initiated by molecular sensors which bind to viral nucleic acids and activate a cell signalling cascade which leads to the induction of IFN genes. The RNA helicases RIG-I and MDA 5, located in the cytoplasm of all nucleated cells and the TLR (Toll-like receptor), located in the endosomes of the sentinel phagocytic cells are the main sensors of foreign nucleic acids. The IFN secretion is context-dependend and leads to two main effects. The first, called antiviral state is due to the induction, through binding to the IFN receptor of the expression of over 300 ISG (ISG -- IFN stimulated genes). Here we review several of them (МхА, ISG 15, PKR and OAS-RNAase L), for which a direct antiviral effect was shown. The other group of effects, called immunomodulation, comprises the effects of IFN on the immunocompetent cells -- monocytes, dendritic cells (DC), NK, T and B lymphocytes. IFN induces maturation in monocyte and DC transforming them to professional antigen-presenting cells and NIPC (Natural IFN producing cells), which activate the adaptive immunity and secrete into the bloodstram large amounts of IFN. This IFN distributes into the body rendering the uninfected cells resitant to viral infection and provides restriction of viral spread until the appearance of effective antiviral adaptive immune response mediated by cytotoxic NK and T cells and antibody producing B cells. These features of IFN suggest that their appearance in the evolution is related to the integration of the innate and adaptive immune response against intracellular pathogens. In the first part, we review briefly the history of IFN discovery, the mechanisms of IFN induction and secretion, the known IFN molecules and their receptors; in the second part, we review the molecular biology of the known ISG’s with proven antiviral effects -- МхА protein, ISG 15, PKR and OAS-RNAase L.
Key words: interferon, interferon types, alpha, beta, gamma, omega, lambda, innate immu­nity, antiviral immunity, МхА protein, ISG 15, PKR, OAS-RNAase L
Address for correspondence: Milen Vasilev, M. D., Internal Diseases Clinic, University Hospital „Lozenets”, 1, Koziak Str., Bg 1407 -- Sofia; e-mail: milen_vassilev@hotmail.com


Autoimmune diseases, immunological tests and assisted reproductive technologies - 45, 2009, No 4,   19-22.
M. Panchovska-Mocheva(1) and F. Martinova(2)
(1)Clinic of Internal Diseases, MMA-- MHAT, MU -- Plovdiv, (2)Department of Transfusional Hematology and Immunology, MHAT “N. I. Pirogov”-- Sofia
Summary: This clinical review focuses on some aspects of autoimmunity and assisted reproductive technologies. Autoimmune diseases frequently affect women in reproductive age. Medical treatment of these diseases can lead to anovulatory cycles and infertility. In patients without autoimmune disease, but with clinically proven infertility, some immunological deviations -- positive tests for antinuclear, antiphospholipid and antithyroid antibodies, may be established. Antiphospholipid antibodies are found in women with habitual abortions. A possible correlation between autoimmunity, immunological aberrations and assisted reproductive technologies is still vaguely. There is a consensus about screening examinations in failed in vitro fertilization. Nevertheless, an unanimous concept concerning management in immunological deviations and assisted reproductive methods is missing.
Key words: autoimmune diseases, antibodies, assisted reproductive technologies
Address for correspondence: Assoc. Prof. Maria Panchovska-Mocheva, M. D., Clinic of Internal Diseases, Military Hospital, 81, Hr. Botev Blvd., Bg -- 4000 Plovdiv, e-mail: pancovska@abv.bg


Genetic polymorphisms of glutathione S-transferases in human population and association with multifactorial diseases. Part I - 45, 2009, No 4,   23-31.
I. Andonova(1, 2) and V. Ganev(3)

(1)Institute of Experimental Pathology and Parasitology, BAS -- Sofia, (2)Department of Medical Chemistry and Biochemistry, Medical University -- Sofia, (3)Sofia University „Sv. Kl. Ohridski”, Medical Faculty -- Sofia
Summary: Complex etiology of the multifactorial diseases supports the hypothesis that exposition to certain environmental factors causes disease in genetically susceptible individuals. Investigation of the genetic component of etiology is connected with studying the involvement of the xenobiotic enzymes such as glutathione S-transferases (GSTs), representing one of the major detoxification pathways. GSTs are phase II xenobiotic metabolizing enzymes involved in the detoxification processes of many toxic, mutagenic and carcinogenic compounds with endo- or exogenic origin. The variety of functions and isoforms involved at different stages of many metabolic processes, such as oxidative stress defense, metabolism of xenobiotics and estrogen metabolism, makes studying their role in the etiology of number of diseases and conditions of a certain interest. In human population, the frequencies of the common genetic polymorphic variants greatly vary according to the ethnics, race, inclusion criteria and size of the study.
Key words: genetic polymorphisms, glutathione S-transferases
Address for correspondence: Irena Andonova, Acad. G. Bonchev” Str., bl. 25, Bg -- 1111 Sofia, BAS -- IEPP, tel. +359 2 979 2360; +359 886 391 855, e-mail: irena.and@gmail.com


Еxtended-spectrum beta-lactamases in Pseudomonas aeruginosa - 45, 2009, No 4,   32-42.
E. Dobreva
National Reference Center for Nosocomial infections, NCIPD
-- Sofia
Summary: P. aeruginosa causes 10-15% of nosocomial infections in the world. They are difficult to treat, because of intrinsic and acquired antibiotic resistance. The intrinsic resistance to beta-lactams is result of decreased permeability of the outer membrane; constitutive expression of the efflux systems and synthesis of chromosomal AmpC cephalosporinase. The main mechanism of acquired resistance is the synthesis of beta-lactamases in the periplasmic space. Recently, the number and frequency of occurrence of these enzymes increase. Their studying with genetic and phenotypic methods is important for appropriate antibiotic therapy, and will limit the risk of spreading of nosocomial infections. Different kind of extended-spectrum-beta-lactamases (ESBL) proved in clinical isolates of P. aeruginosa in Bulgarian and foreign hospitals are presented and systematized in this review. These generalized data reveal variety in the kind of enzymes, concerning their hydrolysis activity, modifications in the protein structure and an established homogeneity. Molecular genetic methods for detection of the genes, coding beta-lactam resistance, as well as others for investigation of epidemiological distribution and clonality of significant clinical strains P. aeruginosa are presented also in this article.
Key words: Pseudomonas aeruginosa, expanded еxtended-spectrum beta-lactamases, metallo-beta-lactamases
Address for correspondence: Elina Dobreva, M. D., National Reference Center for Nosocomial Infections, NCIPD, 26, Yanko Sakazov Blvd., Bg -- 1504 Sofia, tel. +359 2 944-69-99, 208, e-mail: elina_g@abv.bg


Risks to the fetus born in breech delivery - 45, 2009, No 4,  43-47.
P. Petrov
MHAT „Sv. Mina” -- Plovdiv
Summary: Breech delivery increases significantly the risk for the fetus. Among the most common risks are fetal anomalies, increased incidence of prolapse of the umbilical cord, delivery traumas, intrapartal asphyxia, locking head and injuries of the spine. Good knowledge of possible complications and risks and proper assessment of the benefit-risk ratio are essential for the successful outcome.
Key words: breech delivery, risk, trauma, injury, fracture, asphyxia
Address for correspondence: Petar Petrov, M. D., MHAT “Sv. Mina”, 5, Vesela Str., Bg-- 4000 Plovdiv, GSM +359 898809490; +359 878580908


Clinical application of lasers in ophthalmology - 45, 2009, No 4,   48-54.
H. Blagoeva(1, 2), D. Petrov(2) and R. Hristova(1)
(1)University Hospital ”Tsaritsa Yoanna” -- Sofia, (2)Hospital ”Sv. Sofia” -- Sofia
Summary: The abbreviation LASER means Light Amplified Simulated Emission of Radiations. As the laser technologies progress, the usage of lasers gets on in diagnostic and treatment of eye diseases as these of ocular adnexa (tumors of eyelids, trichiasis, opening or obturation of lacrimal puncta), diseases of anterior eye segment (pterigium, ametropia, primary glaucoma, secondary glaucoma, after cataract extraction), diseases of posterior eye segment (retinal degenerations, retinal ruptures, diabetic retinopathy, tumors, treatment of exudative macular degeneration, chorioretinitis). The excellent effect of lasers makes them useful in everyday clinical practice.
Key words: lasers, ophthalmology, treatment
Address for correspondence: Hristina Blagoeva, M. D., Ph. D., Department of Ophthalmology, Hospital “Sv. Sofia”, 104, Bilgaria Blvd., Bg -- 1680 Sofia, tel. +359 2 818 46 23, e-mail: ch_blagoeva@abv.bg


Contemporary approaches to complex pulmonary rehabilitation - 45, 2009, No 4,   55-60.
S. Kemerov
Department of Physical Medicine and Rehabilitation, University Hospital “Lozenets” -- Sofia
Summаry: Pulmonary rehabilitation is a multidisciplinary integrated discipline that aims at improving physical and social status of patients with chronic pulmonary diseases. Rehabilitation programs in use consist of exercise training, education about disease and psychosocial components oriented towards reduction of dyspnea, increase of physical capacity and improvement of quality of life of these patients. Because of some unclear moments in mechanism of action and dosage of applied factors, there is a lack of unanimous view on an optimal rehabilitation program, and some new approaches for better effectiveness are discussed.
Key words: chronic pulmonary diseases, chronic obstructive lung disase, pulmonary rehabilitation
Address for correspondence: Stoyan Kemerov, M. D., Department of Physical Medicine and Rehabilitation, University Hospital “Lozenets”, 1 Kozyak Str., Bg -- 1407 Sofia


Hospital information systems -- a necessity for an effective management of clinics -- 45, 2009, No 4, 61-64.
I. Kostov
II SOGHAT “Sheynovo” -- Sofia
Summary: The review considers the essence of a hospital information system (HIS) and its main administration and finance part, medical part, scientific research part, reporting part and additional components. Common standards and technologies for establishment of HIS and expected results after successful implementation of the system are presented.
Key words: hospital management, information systems
Address for correspondence: Ivan Kostov, M.D., I SOGHAT “Sheynovo”, 19, Sheynovo Str., Bg -- 1504 Sofia






Indications and timing of surgery in native valve infective endocarditis  – 45, 2009, No 3, 5-8.
D. Nikolov(1), E. Kinova(2) and A. Goudev(2)
(1)Cardiac Surgery Department, Tokuda Hospital -- Sofia, (2)Department of Cardiology, University Hospital “Tsaritsa Yoanna” -- Sofia
Summary: During the last three decades, valve replacement and even valve reconstruction, have become common used methods in the management of certain complications of infective endocarditis (IE). The reduction in mortality is achieved as a result of combination of antibiotic therapy and timely cardiac surgery. The direct usefulness of surgical intervention has not and can not be evaluated in randomized controlled trials because of high mortality in some patients without surgery. The aim of this review is to summarize and analyze the published data until now, regarding principal indications for cardiac surgery in native valve endocarditis. Complex assessment of hemodynamic status, infectious etiology, infected valves, clinical manifestations and imaging modalities findings allow individual approach to management in any particular case. The most common indications for surgery, irrespective of duration of antibiotic therapy, are worsening of heart failure due to valve regurgitations, persistent infection, large vegetations with obstruction and/or embolization, and perivalvular extention of IE.
Key words: infective endocarditis, cardiac surgery, heart failure
Address for correspondence: Dimitar Nikolov, M. D., Cardiac Surgery Department, Tokuda Hospital, 51B N. Vaptsarov Blvd., Bg -- 1407 Sofia, tel. +359 2 4034912, fax +359 2 4034010, e-mail: dpnikolov_dr1@yahoo.com


Most common complications in breech delivery – 45, 2009, No 3, 9-16.
P. Petrov
MHAT „Sv. Mina” -- Plovdiv
Summary: Some four decades ago, breech delivery was considered physiological, but today it is clearly determined as a pathologic presentation. The most serious problems that justify this definition are: nuchal arms, “splinted” legs, prolapse and compression of the umbilical cord, “hanging” of the head on the symphisis, head entrapment by the cervix, intrapartal asphyxia, deflexion and hyperextension of the head etc. Timely recognized complications and adequate approach can significantly reduce negative consequences.
Key words: breech delivery, complications, approach, nuchal arms, “splinting” legs, prolapse, compression, entrapment, deflexion, diagnosis
Address for correspondence: Petar Petrov, M. D., MHAT “Sv. Mina”, 5, Vesela Str., Bg -- 4000 Plovdiv, GSM +359 898809490; +359 878580908



Chondroprotectors and lubricants in osteoarthritis – 45, 2009, No 3, 17-25.
R. Rashkov and Zl. Kolarov
Clinic of Rheumatology, Medical University – Sofia
Summary: Discussed are the main groups of structure-modifying drugs in osteoarthritis with effect upon the articular cartilage: glucosamine hydrochloride, chondroitin sulfate, avocado/soybean unsaponifiables and hyaluronic acid products. Described is the essence of viscosupplementation which includes recovery and improvement of the rheologic properties of articular fluid and pharmacologic effect on articular structures by modification of hialuronic acid qualities through use of lubricants. The main differences between the particular hyaluronans are pointed out.
Key words: chondroprotectors, lubricants, side effects, osteoarthritis
Аddress for correspondence: Prof. Rasho Rashkov, M. D., Clinic of Rheumatology, Medical University, 13, Urvitch Str., Bg -- 1612 Sofia, tel. +359 2 958-29-27





Lipid, hemostatic andinflammatory markers of atherothrombotic risk – 45, 2009, No 2, 5-16.
N. Doncheva(1) and Y. Nyagolov2
(1)Department of Clinical Lipidology,Medical Institute -- Ministry of Interior
2Department of Physiology, Medical University -- Sofia
Summary: Dyslipidemias are most frequent metabolic disorders of contemporary man that are involved in pathogenesis of atherosclerosis. Cellular and humoral components of multifactor atherothrombotic process create inflammatory and prothrombotic state. People in this country who have suffered myocardial infarction and stroke are approximately 1 350 000 and prognosis is disturbing. This requires knowledge of risk factors of early and progressing atherosclerosis, their interrelationships, immediate laboratory diagnostics and adequate prophylaxis. The roles of vascular endothelium, platelets and clotting factors are reviewed. Literature facts and own data about classical and new biomarkers of lipid metabolism, blood clotting and inflammation are presented (LDL-C, sdLDL, oxLDL, Lp (a), apo B, apo A I, apo A-V, Lp-PLA2; platelets, tissue factor, fibrinogen, clotting factors II, VII, VIII, IX, X, XI, V Leiden, CD 40 ligand, coagulation inhibitors, hsCRP, serum amyloid A, P-selectin, TNF-alpha, asymmetric dimethylarginine, myeloperoxidase, cellular and vascular adhesion molecules, cytokines, homocysteine and gamma-glutamyl transferase). Their independent and synergistic involvement in the development and complications of atherosclerosis is discussed. Dyslipidemias without clinical expression of CAD are associated with an elevated procoagulation potential, while manifested atherosclerosis is accompanied by a prothrombotic condition. Gene polymorphism of factors of lipid metabolism, hemostasis and inflammation may be essential for thrombotic complications of atherosclerosis.
Key words: atherosclerosis, dyslipidemia, coagulation, inflammation
Address for correspondence: Assoc. Prof. N. Doncheva, M. D., PhD, Department of Clinical Lipidology, Medical Institute, Ministry of Interior, 79 A, Skobelev Blvd., Bg -- 1606 Sofia, tel.+3592 9821 416, e-mail: ndon4eva@abv.bg



Cognitive impairment in schizophrenia – 45, 2009, No 2, 17-22.
E. Bozhkova
Psychiatric Clinic, University Hospital Alexandrovska -- Sofia
Summary: This review includes the main notions and results about cognitive impairment in schizophrenia from the creation of the concept of this illness till now. The neuropsychological deficits, most likely generalized, are a core feature of the schizophrenic disorder, they are present at its onset, influence the social functioning of the individual and predict the outcome. The cognitive assessment may be of great value in developing realistic expectations about patient’s functioning and creating adequate treatment programs.
Key words: schizophrenia, neuropsychological assessment, memory, executive functioning, generalized cognitive deficit
Address for correspondence: Elka Bozhkova, Psychiatric Clinic, University Hospital Alexandrovska, 1, Sv. G. Sofiiski Str., Bg -- 1431 Sofia, tel. +359 888 580030, e-mail: mail@bozhkova.info; www.bozhkova.info



Maintenance treatment of affective disorders with lithium. Clinical effectiveness  – 45, 2009, No 2, 23-33.
V. Stoyanova
Psychiatric Clinic, University Hospital “Alexandrovska” -- Sofia
Summary: Affective (mood) disorders are widely spread, often recurrent illnesses with serious consequences for personal and social life. The medical model of diagnosis and management is an important part of overcoming the stigma of mental illness and the acceptance of mentally ill as equal in rights with somatic ill patients. Achievement and retaining the state of full remission is of great importance for prognosis and outcome of these disorders. In this review, different phases of affective disorders with unipolar and bipolar course, and the role of lithium in maintenance treatment and recurrence prophylaxis are discussed. In spite of introduction of new mood stabilizers like anticonvulsants and atypical antipsychotics in the last 10 years, lithium is still comparable with them regarding its effectiveness. Advantages of lithium over new agents are associated with its independent antisuicidal activity, the long-standing experience in regard to safety and tolerability and thoroughly investigated and controlled side effects in long-term treatment.
Key words: affective disorders, treatment, prophylaxis, lithium
Address for correspondence: V. Stoyanova, M. D., Psychiatric Clinic, University Hospital “Alexandrovska” -- Sofia, 1, Sv. G. Sofiiski Str., Bg -- 1431 Sofia, е-mail: vestoyan@yahoo.com



Epidemiological, pathogenetic, clinical and financial aspects of rheumatoid arthritis: Current data – 45, 2009, No 2,  34-38.
Zl. Kolarov
Rheumatology Clinic, Medical University -- Sofia
Summary: Viewed are different aspects of rheumatoid arthritis -- epidemiological, pathogenetic, clinical and financial in the light of clinical research performed in the past decade. Outlined is the pathogenetic role of B-lymphocytes in the formation of rheumatoid inflammatory reaction -- antigen presentation, T-cell regulation, cytokine –and autoantibody synthesis etc. Presented is the price difference between the classical disease activity modifying agents and the newly introduced biological preparations. It is stressed that contemporary treatment requires a strict observation of cost-effectiveness balance of the respective therapeutic agents.
Key words: rheumatoid arthritis, pathogenesis, immunity, clinical manifestation, treatment
Address for correspondence: Prof. Zlatimir Kolarov, M. D., Clinic of Rheumatology, Medical University, 13, Urvitch Str., Bg -- 1612 Sofia, tel. +359 2 958-29-27



Molecular and clinical pharmacology of GABAA-ergic receptors – 45, 2009, No 2, 39-44.
R. Nikolov
Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University -- Sofia
Summary: GABAA-receptors mediate fast inhibitory synaptic neurotransmission. The GABAA-ergic receptor is a heterooligomeric glycoprotein consisting of five membrane-spanning subunits from several polypeptide classes. Combination of three major subunits -- alpha, beta, and gama, is necessary for physiological and pharmacological functions. Benzodiazepines, barbiturates, etifoxine, hypnotic Z-drugs, inhaled anaesthetics, etomidate and propofol facilitate GABA-mediated inhibition at different GABAA-receptor sites.
Key words: GABAA-receptor, barbiturates, benzodiazepines, ethanol, neurostheroids, etifoxine, general anaesthetics, hypnotic Z-drugs, flumazenil
Address for correspondence:
Rumen Nikolov, M.D., Ph.D., Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University, 2, Zdrave Str., Bg -- 1431 Sofia, tel. + 359 2 91 72 621, e-mail: ru_nikolov@abv.bg






Tularemia – 45, 2009, No 1, 5-13.
K. Marinov
Microbiological Research Laboratory, Military Medical Academy – Sofia
Summary: Tularemia is a zoonotic infection, caused by the bacterium Francisella tularensis. In humans, tularemia is manifested by different clinical forms, in dependence on the infection route. More than 300 cases were diagnosed in Bulgaria in the last 10 years. The aim of this review is to describe in brief the different aspects of tularemia. Ulceroglandular and glandular tularemia are the most common forms of the infection and are usually a consequence of a tick bite or handling of contaminated materials. The pulmonary and typhoid forms of the disease occur rarely. They are severe and occasionally fatal. The diagnosis of tularemia is not straightforward. F. tularensis is difficult to culture, and the handling of this bacterium poses a significant risk of infection. Serological assays are used to detect specific antibody response. PCR and immune fluorescence microscopy are used to detect bacteria in clinical samples. Aminoglycosides and fluoroquinolones are drugs of choice in the treatment of tularemia. Some data from studies on tularemia in Bulgaria are presented.
Key words: tularemia, F. tularensis, dissemination, forms, diagnosis, treatment, biological weapon
Address for correspondence: Krustyu Marinov, M. D., Microbiological Research Laboratory, Military Medical Academy, 3, Sv. G. Sofiiski Blvd., Bg -- 1606 Sofia, tel. +359 2 922 64 25, GSM +359 887 30 90 52, e-mail: krustju_marinov@yahoo.com



Brucellosis -- a worldwide but unpopular zoonosis in Bulgaria – 45, 2009, No 1, 14-21.
R. Komitova
Clinic of Infectious Diseases, University Hospital – Pleven
Summary: Although brucellosis was discovered over 100 years ago, the disease remains a world-wide problem, especially in developing countries. It still presents clinicians with several challenges such as the understanding of pathogenesis of Brucella spp., the lack of marker for disease severity and treatment response and available vaccine. Brucellosis remains a diagnostic puzzle due to non-specific manifestations. The history of travel to endemic countries along with exposure to animals and exotic foods are critical for the clinical diagnosis. A high index of suspicion and close collaboration between clinician and microbiologist are essential to correctly diagnose and treat the infection. Recently the Ioannina Recommendations statement on the current optimal treatment options of human disease was set. This review summarizes current knowledge of clinical manifestation, diagnostic and treatment options and outlines the situation in Bulgaria.
Key words: brucellosis, standard agglutination test, doxycycline
Address for correspondence: Assoc. Prof. Radka Komitova, M. D., Ph. D., Infectious Diseases Clinic, University Hospital, 8a, G. Kochev Str., Bg -- 5800 Pleven



Heparin-induced thrombocytopenia and cardiac surgery -- a dangerous myth or unknown truth – 45, 2009, No 1, 22-28.
A. Neykova(1, 2), B. Tzvetkov(2), M. Kirsch(2) and S. Tisheva(1)
(1)Cardiology Department, Medical University -- Pleven, (2)Cardiovascular Surgery, University Hospital Henri Mondor -- Paris
Summary: The unfractioned heparin used during cardiopulmonary bypass is well known about his immunogenicity. Well known is the severe iatrogenic complication of the heparin treatment -- the heparin-induced thrombocytopenia -- HIT. This immune mediated disease is presented by thrombocytopenia or drop of platelets count by more than 50 percent from the baseline number, and a prothrombotic state with severe prognosis. HIT occurs between 4 and 10 days after the initiation of the unfractioned heparin therapy and a few days later in a case of low molecular weight heparin therapy. The patients after cardiac surgery and cardiopulmonary bypass are at risk for HIT compared with a non-surgical ward patients. Heparin-induced thrombocytopenia and thrombosis are associated with significant morbidity and mortality. Diagnosis of HIT in the postoperative setting of cardiac surgery remains particularly difficult because these patients usually present multiple other causes for thrombocytopenia. A diagnosis of HIT requires to stop the treatment with heparin and to start an alternative anticoagulant therapy.
Key words: heparin-induced thrombocytopenia, heparin, cardiac surgery
Address for correspondence: A. Neykova, M. D., Cardiology Department, Medical University, 1, Sv. Kl. Ohridski Str., Bg -- 5800 Pleven



Use of biologic agents in rheumatoid arthritis: General considerations – 45, 2009, No 1, 29-32.
Zl. Kolarov
Clinic of Rheumatology, Medical University  -- Sofia
Summary: Viewed are the mechanism of action, basic characteristics, resemblances and differences between various biologic agents, their therapeutic efficacy and the most common adverse drug reactions. Presented are contraindications, kinds of resistance and reasons for lack of therapeutic response in the treatment of patients with rheumatoid arthritis. Discussed are the necessity of their combining with disease activity modifying agents as well as the long-term results concerning the disease activity and the slow-down of roentgen progression of early and long-lasting rheumatoid arthritis.
Key words: rheumatoid arthritis, biologic agents
Address for correspondence: Prof. Zlatimir Kolarov, M. D., Clinic of Rheumatology, Medical University, 13, Urvitch Str., Bg -- 1612 Sofiа, tel. +359 2 958-29-27


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About the Journal Current Issue Archive Review Articles Original Papers Case Reports Requirements to the Authors Editorial Board Contacts CML Home