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Vol. 48, 2012


bullet 4'2012

Ocular manifestations in tuberculosis 48, 2012, 4, 5-9.
Ts. Dimitrov(1), K. Andreev(1) and Zl. Yankova(2)

(1)Department of Ophthalmology, First Municipal Hospital -- Sofia, (2)Department of Internal Medicine, First Municipal Hospital -- Sofia
Summary: Tuberculosis is an infectious disease with a social impact, responsible for significant morbidity and mortality worldwide. The aim of this review was to describe the main clinical manifestations of ocular damages in tuberculosis. The diagnostic approach is summarized and the main ophthalmologic methods and laboratory tests are discussed.
Key words: ocular inflammation, chorioretinitis, tuberculosis
Address for correspondence: Krasimir Andreev, M.D., Ph. D., Department of Ophthalmology, First Municipal Hospital, 37, Patriarh Evtimiy Blvd., Bg -- 1000 Sofia, tel. +359 2 8059 366, e-mail: krassimir_andreev@yahoo.com


The hemostatic rebalance in patients with chronic liver disease - 48, 2012, 4, 9-13.
A. Ruseva(1) and А. Dimitrova(2)
(1)Clinical Laboratory, University Hospital -- Pleven, (2)Department of Physiology and Pathophysiology, Medical University -- Pleven
Summary: Disarrangement of hemostasis in patients with chronic liver disease (CLD) has been associated for a long time with bleeding events in these patients. Routine laboratory tests, such as determination of prothrombin time and platelet count, are frequently abnormal and point to a state which is hypocoagulable. However, the relatively poor correlation between bleeding and results from the laboratory tests, as well as the recent findings, that the thrombin generation and the platelet adhesion are normal in theses patients, support the concept that the patients with CLD possibly maintain their hemostatic balance via concomitant changes in both pro- and anticoagulation activities.
Кey words: hemostasis, rebalance, prothrombin time, chronic liver disease
Address for correspondence: Assoc. Prof. Adelaida L. Ruseva, M. D., Ph.D., Clinical Laboratory, University Hospital, 8a, G. Kochev Str., Bg -- 5800 Pleven, tel. +359 64 886 169, e-mail: adi-ruseva@dir.bg


Urinary tract infections in the elderly - 48, 2012, 4, 14-18.
Sv. Staykova
Clinic of Dialysis, Medical University -- Varna
Summary: With aging, urinary tract infections and asymptomatic bacteriuria become more frequent for both genders. The ascending path of infection predominates in the elderly patients. A very important factor is the decrease in their protective mechanisms, due to changes in the glomerules and tubular interstitial system of the kidney. The typical symptoms of upper urinary tract infection may not be presented.
Key words: urinary infections, microorganisms, kidney diseases, asymptomatic bacteriuria
Address for correspondence:
Svetla Staykova, M. D., Clinic of Dialysis, Medical University, 55, Marin Drinov Str., Bg -- 9002 Varna, tel. +359 885 841 663, e-mail: svetlastaykova@abv.bg


The role of superoxide dismutase isoforms in coronary artery disease and acute coronary syndromes - 48, 2012, 4, 19-26.
S. Denchev and N. Semerdzhieva
Clinic of Cardiology, University Hospital „Aleksandrovska”, Department of Internal Diseases, MU  Sofia
Summary: Coronary artery disease is one of the most common and important socially significant diseases which develops in the presence of oxidative stress. Oxidative stress induces modification of the low-density lipoproteins (LDL) within the vascular wall and is considered as the initial step, promoting the process of coronary arteriosclerosis. Oxidized LDL play an important role in the atherosclerotic plaque progression, too. Most of the studies give evidence that oxidized LDLs are independent predictors of coronary artery disease-related adverse events. The three isoforms of superoxide dismutase act as a primary defense mechanism against the acute and chronic oxidative stress. Higher superoxide dismutase levels tend also to be associated with the delayed onset of ischemic heart disease and further coronary events later in life. Superoxide dismutase isoforms determine the favorable myocardial remodeling after experienced myocardial infarction. Markedly higher overall superoxide dismutase activity and the gene expression, characteristic for the females, are associated with better outcomes with regard to ischemic heart disease and acute coronary syndrome in women.
Key words: oxidative stress, oxidized LDL, superoxide dismutase, ischemic heart disease, acute coronary syndromes, women
Address for correspondence: Nia Semerdzhieva M. D., Clinic of Cardiology, University Hospital „Aleksandrovska”, 1, Sv. G. Sofiyski Blvd., Bg -- 1431 Sofia, e-mail: niaemilova@yahoo.com


Genetic testing and insurance - 48, 2012, 4, 27-31.
B. Popov(1), S. Georgieva(2) and S. Lalchev(3)
(1)Department of Molecular Biology, Immunology and Medical Genetics, Trakia University -- Stara Zagora, (2)Department of Genetics, Animal Breeding and Reproduction, Trakia University -- Stara Zagora, (3)Department of Medical Genetics, Medical University -- Sofia
Summary: This review presents some aspects of genetic testing-associated problems and health insurance, as well as the complex questions resulting from this procedure, concerning the relationship between medical practitioners, patients and insurance companies. The issue of defining the terms genetic test, genetic diagnosis and genetic information is considered. Under discussion are the application and significance of genetic testing, when applying for different types of health insurance (e.g. insurance against sickness, "life" insurance, insurance against disability). The status of these issues is presented in an international aspect and in Bulgaria.
Key words: genetic testing, genetic test, genetic information, health insurance
Address for correspondence:
Borislav Popov, M. D., Department of Molecular Biology, Immunology and Medical Genetics, Faculty of Medicine, Trakia University, 11, Armeyska Str., Bg -- 6000 Stara Zagora, tel. +359 888 390 167, e-mail: dr_b_popov@abv.bg





bullet 3'2012

West Nile fever - 48, 2012, № 3, 5-17.
N. Kalvatchev(1), O. Mikov(2) and I. Christova(1)
(1)National Reference “Vector-borne Infections Laboratory”, National Centre of Infectious and Parasitic Diseases -- Sofia, (2)Laboratory of Experimental and Applied Parasitology, NCIPD – Sofia
Summary: West Nile virus was first isolated in Uganda during 1937. The virus that causes West Nile fever is responsible for thousands of cases of morbidity and mortality among birds, horses and humans. Through the history, epidemics have been described in Europe, Africa, the Middle East and a part of Asia. The virus mainly causes mild febrile illness in humans. However, in the end of the century, the virus became more virulent and expanded its geographic range all the way to North America. Clinical manifestations in humans range from asymptomatic (in approximately 80% of the infected) to encephalitis, paralysis and death (in less than 1% of the infected). There is currently no licensed vaccine, and only supportive treatment is recommended. Persons who survive infection often have a long-term recovery period. This article reviews the current literature on the molecular virology, epidemiology, clinical manifestations, pathogenesis, diagnosis, treatment, immunology and protective measures against the virus causing West Nile infection in humans.
Key words: West Nile virus, flavivirus, infection, pathogenesis, diagnosis
Address for correspondence: Nikolay Kalvatchev, M. D., Ph. D., National Reference Vector-borne Infections Laboratory, National Centre of Infectious and Parasitic Diseases, 44A, Stoletov Blvd., Bg -- 1233 Sofia, tel.: + 359 2 832 91 12, e-mail: nkalvat@yahoo.com



Unsuccessful maturation of human ovocytes: potential reason for unclear infertility - 48,  2012, № 3, 18-23.
G. Ingilizova(1)and I. Kostov(2)

(1)MHAT “Vita” -- Sofia, (2)Second SHATOG “Sheynovo” -- Sofia
Nowadays, sterility affects an increasing percent of reproductive-aged couples. With the development of assisted reproduction technologies during the last few years, pregnancy has become a reality for the majority of these patients. Following a standard in vitro fertilization (IVF) protocol, the patient is subjected to a controlled ovarian hyperstimulation (COH) with gonadotropins, in order the aspiration of a maximal number of fully mature oocytes at the metaphase ІІ (MII) stage of meiosis to be acieved. Only these oocytes can be successfully fertilized via IVF or intra-cytoplasmic sperm injection (ICSI). In vitro oocyte maturation (IVM) is a relatively new alternative of the conventional IVF methods. The method involves in vitro oocyte maturation from the stage of a germinal vesicle (GV) to the MII stage. The in vitro maturation is used mainly in women with polycystic ovary syndrome (PCOS) and women with regular menstrual cycles and normal ovaries, who have been treated with ICV or ICSI because of severe male-factor infertility. In some cases, however, due to unknown factors, immature or maturing oocytes are aspirated that are incapable of full in vitro maturation. The aim of the present review is to discuss some potential mechanisms, which might be responsible for this atypical blockage of the maturation process.
Key words: failed maturation, in vitro fertilization (IVF), intra-cytoplasmic sperm injection (ICSI), in vitro maturation (IVM)
Address for correspondence: G. Ingilizova, M. D., MHAT “Vita”, 9, Dragovitsa, Bg -- 1505 Sofia



Food allergy, breastfeeding and bronchial asthma - 48, 2012, № 3, 24-28.
B. Naydenova-Stoeva and Sl. Filchev

UMHAT “Sv. Anna” – Sofia
Summary: Food allergy is a common pediatric condition affecting 2-6% of children. Asthma is even more frequent and accounts for 5 to 8% of pediatric population. Over the past decades, both diseases have shown increasing incidences in children worldwide. Many studies have suggested that food allergen sensitization is a risk factor for the development of asthma, while other studies have found the association of food allergy and asthma to be independent of aeroallergen sensitization. Indeed, these diseases are frequently co-morbid and the relationship between them has been determined as an atopic march.
Key words: allergy, breastfeeding, childhood, asthma
Address for correspondence: Bozhana Naydenova-Stoeva, M. D., UMHAT “Sv. Anna”, 1, D. Mollov Str., Bg -- 1709 Sofia



Pharmacological treatment of vertigo - 48,  2012, № 3, 29-35.
G. Angov, Yu. Petrova, I. Petrova and M. Karadzhov

Clinic of Neurology, UMHAT “Alexandrovska” -- Sofia
Summary: This review discusses the pharmacological treatment of peripheral and central vestibular syndromes and oculomotor disorders, especially pathological nystagmus. The major neurotransmitters in the vestibular system and their mechanism of action are described. The main groups of drugs used to treat vestibular and oculomotor disorders include vestibular suppressants, anti­eme­tics, anticonvulsants, antidepressants, calcium channel blockers and other agents, such as betahistine and Ginkgo biloba extracts. The strategies for phar­ma­cotherapy of some most common vestibular disorders, such as  benign pa­ro­xys­mal positional vertigo, Meniere's disease, vestibular neuronitis, vertigo of cen­tral origin, psychogenic dizziness, are discussed. Pharmacological therapy of the most common types of pathological nystagmus and saccadic oscillations is described.
Key words: vertigo, pathologic nystagmus, saccadic oscillations, pharmacological treatment
Address for correspondence: Georgi Angov, M. D., Clinic of Neurology, UMHAT “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg -- 1431 Sofia, e-mail: g_angov@yahoo.com



Emdogain -- a panacea or a Trojan horse in the treatment of periodontal and mucosal lesions? A review on in vitro studies - 48, 2012, № 3, 36-39.
P. Pechalova
Maxillofacial Surgery Department, Faculty of Dental Medicine, Medical University – Plovdiv
Summary: The author have summarized the knowledge of Emdogain (EMD) effectiveness on normal and malignant tissues in the oral cavity, based on experimental in vitro studies that have not confirmed an EMD-induced increase of the production of carcinogenesis-related cytokines; however, the EMD has been found to stimulate other cellular functions and processes in malignant cells, and probably, to partially inhibit proliferation. These findings, as well as the limited studies of the EMD effects on malignant epithelial neoplasms and the unknown composition of the product are the reasons to suggest that the use of EMD is contraindicated in patients with oral carcinoma or mucosal dysplasia.
Key words: emdogain, dysplasia, carcinoma, oral cavity
Address for correspondence: Petia Pechalova, M. D., Maxillofacial Surgery Department, UMHAT „Sv. Georgi”, Medical University, 66, Peshtersko shose Str., Bg -- 4000 Plovdiv, GSM +359 898 468 498, e-mail: pechalova@abv.bg




bullet 2'2012

Postpartum thyroiditis - 48, 2012, 2, 5-9.
D. Gavrailova

Faculty of Public Health, Medical University -- Sofia
Summary: Postpartum thyroiditis is a potentially destructive lymphocytic thyroiditis occurring in about 8% of pregnant women, making it one of the most common endocrine disorders associated with pregnancy. It occurs within up to 12 months post parturition and is characterized by development of postpartum thyroid dysfunction. It is usually presented by transient hyperthyroidism with subsequent transient hypothyroidism. The phenomenon is due to changes in the immune system, as immunological abnormalities are observed before the start of thyroid dysfunction. Among methods for detecting sub-clinical thyroid autoimmunity, the most useful marker is the measurement of thyroid microsomal antibodies (MCAb) or anti-thyroid peroxidase (TPO) antibodies, which can serve to predict the occurrence of postpartum thyroid dysfunction. According to some studies, hypothyroidism and the presence of anti-thyroid antibodies (anti-thyroid peroxidase and/or anti-thyreoglobulin) have their impact on development of postpartum depression.
Key words: pregnancy, рostpartum thyroiditis, risk factors, postpartum depression
Address for correspondence: Daniela Gavrailova, M. D., Faculty of Public Health, Medical University, 8, Byalo more Str., Bg -- 1527 Sofia, tel. +359 2 9432-219



Lymph node status and primary tumor size as prognostic factors in cervical cancer - 48, 2012, №2, 10-13.
E. Ismail and Y. Kornovski

Clinic of Gynecology, MHAT “Sv. Anna” -- Varna
Summary: Tumor size and FIGO stage are major prognostic factors in cervical cancer. Tumor diameter is the only prognostic factor that can be determined preoperatively by bimanual examination. An incontestable prognostic factor is the status of lymph nodes. There are many studies of the impact of metastatic lymph nodes on survival of patients with cervical cancer. The number, level (pelvic, para-aortic) and detectable characteristics (microscopic or macroscopic) of metastatic lymph nodes are of prognostic significance.
Key words: cervical cancer, prognostic factors, primary tumor size, metastatic lymph nodes, DNA ploidy
Address for correspondence: Е. Ismail, M. D., Clinic of Gynecology, MHAT “Sv. Anna” -- Varna, e-mail: elibet@abv.bg



Genital papilloma virus -- infections in men: risk, treatment and prophylaxis - 48, 2012, 2, 14-16.
Z. Kalvachev(1) and V. Vladimirov(2)

(1)Laboratory in Molecular Virology, Military Medical Academy -- Sofia, (2)Clinic of Urology, UMHAT “Alexandrovska”, MU -- Sofia
Summary: In the recent years, most of the studies of human papilloma viruses (HPVs) have been focused on women because the persistent viral infection is associated with a serious risk for developing a cervical cancer. It should not be underestimated, however, that HPV-infection may also pose serious health problems to men. The article discusses questions concerning the risk, consequences and treatment of HPV-infection, as well as the role of vaccine prophylaxis, this time, however, focused on men.
Key words: Human papilloma virus, men, risk, treatment, prophylaxis
Address for correspondence: Valentin Vladimirov, M. D., Clinic of Urology, UMHAT Alexandrovska, 1, Sv. G. Sofiiski Str., Bg -- 1431 Sofia, e-mail: vladimirovv@abv.bg




bullet 1'2012

Preoperative evaluation and management of patientswith pulmonary diseases - 48, 2012, 1, 5-11.
Y. Yamakova and R. Petkov
Hospital of Pulmonary Diseases „Sv. Sofia” -- Sofia
Summary: Despite advances in anesthesia practice and surgical care, perioperative pulmonary complications remain a significant cause of morbidity, mortality, and prolonged hospital stay. Patients with pre-existing pulmonary pathology are at increased risk. It is thus important to identify these patients preoperatively and implement appropriate measures to optimize their pulmonary function, with the aim of preventing or reducing perioperative morbidity.
Key words: pulmonary diseases, anesthesia, surgery, complications
Address for correspondence: Yordanka Yamakova, M. D., Ph. D., Clinic of Anesthesiology and Intensive Care, Hospital of Pulmonary Diseases „Sv. Sofia”, 19, Akad. Iv. Geshov Blvd., Bg -- 1431 Sofia, e-mail: y_yamakova@hotmail.com



Vaccine against HIV: the challenge of the 21st century  - 48, 2012, 1, 12-19.
R. Argirova

National Center of Infectious and Parasitic Diseases
Summary: Despite the enormous successes of antiretroviral therapy (HAART) and prophylaxis against HIV-infection (medicinal discontinuation of the mother-to-child transmission of the virus; pre-exposure prophylaxis with antiretroviral drugs), the HIV/AIDS pandemic is still lacking control. It can be only achieved if effective combination of preventive strategies is introduced, including prophylactic HIV-vaccine similar to other viral infection-vaccines. This review has examined some of the most modern approaches for developing prophylactic HIV-vaccine and their post-implementation results that were reported until the end of 2011.
Key words: HIV/AIDS, prophylactic HIV-vaccine
Address for correspondence: Prof. Radka Argirova, M. D., National Center of Infectious and Parasitic Diseases, 44А, Stoletov. Blvd., Bg -- 1233 Sofia, e-mail: radkaargirova@abv.bg



Local bone marrow renin-angiotensin system -- a participant in the pathogenesis of atherosclerosis - 48, 2012, №1, 20-25.
G. Krasteva (1) and E. Lakova(2).
(1)Division of Experimental and Clinical Pharmacology, (2)Division of Pathophysiology, Medical University -- Pleven
Summary: Atherosclerosis is an inflammatory chronic disease that leads to the accumulation of mononuclear cells and lipoproteins and the formation of atherosclerotic lesions in the vessel wall. Renin-angiotensin system plays a critical role in the initiation and progression of atherosclerosis. Recent evidences suggest that activated local bone marrow renin-angiotensin system (RAS) participates in the pathogenesis of atherosclerosis by generation of atherogenic monocytic phenotype and by accelerating inflammatory cell infiltration in the vessel wall. Therefore, blockade of the RAS not only in vascular cells but also in the bone marrow could be an important therapeutic approach to prevent atherosclerosis.
Key words: atherosclerosis, renin-angiotensin system, bone marrow, inflammation
Address for correspondence: Genka Krasteva, M.D., Division of Experimental and Clinical Pharmacology, Medical University, 1, Kl. Ohridski Str., Bg -- 5800 Pleven, tel. + 359 64 884 282, e-mail: krusteva_med@abv.bg



Application of outsourcing-approachin hospital services -- benefits and risks - 48, 2012, №1, 26-31.
R. Dimova (1) and R.
(1)Department of Healthcare Management, Health Economics and Primary Care, Medical University -- Plovdiv, (2)IІІ Surgery Clinic, Department of General Surgery, Medical University -- Plovdiv
Summary: Outsourcing, or the so-called use of external resources, is a trend that has considerably invaded almost all fields of economics in the last few decades. Health care is no exception to the rule, although in that field the steps are on a smaller scale. There areinsufficient official published data on the factors that influence decision making and the degree of satisfaction with the implementation of outsourcing in hospitals or health organizations. That is why а panel of authors made a review and an analysis of literature with regard to the advantages and risks of this management method when applied in the health care.
Key words: outsourcing, cost-effectiveness, hospital, health management
Address for correspondence: Rositsa Dimova, M. D., Department of Healthcare Management, Health Economic and Primary Care, Medical University, Bg -- 4000 Plovdiv, tel. +35932 60 2039, +359 887363033



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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