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Volume 49, 2013


bullet 4'2013

Novel structural biomarkers for assessment of renal function and early diagnosis of acute kidney injury - 49, 2013, № 4, 5-13.
Zh. Hristova and K. Tsachev

Department of Clinical Laboratory and Clinical Immunology, Faculty of Medicine, Medical University -- Sofia
Summary: Acute kidney injury (AKI) is a common serious condition afflicting extremely heterogeneous patient population. AKI diagnosis is usually based on the accumulation of end products of nitrogen metabolism, such as serum creatinine. Unfortunately, serum creatinine is an indicator, which is not reliable enough for early diagnosis of AKI for its concentrations are influenced by a variety of non-renal factors and clinically significant changes lag 1-3 days behind the initial structural damage. Considering the limitations of serum creatinine, the demand for improved biomarkers of AKI is of intense interest to modern medical science. The discovery, translation, and validation of neutrophil gelatinase-associated lipocalin (NGAL) give new opportunities in searching a new approach for assessment of renal function during AKI. NGAL appears an excellent independent biomarker in plasma and urine, providing both diagnostic and prognostic information. With determination of kidney injury molecule-1 (KIM-1) and interleukin-18 (IL-18) new assets for AKI estimation are disclosed.
Key words: acute kidney injury, early diagnosis, biomarkers, neutrophil gelatinase-asso­cia­ted lipocalin, kidney injury molecule-1, interleukin-18
Address for correspondence:
Zhulieta Hristova, M. D., Central Clinical Laboratory, Aleksandrovska University Hospital -- Sofia, 1431, 1 St. G. Sofiyski St., tel. +359 2 9230 918, e-mail: julieta_sd@yahoo.com



Bone proteins and soft tissue calcification in patients with chronic kidney disease - 49, 2013, № 4, 14-17.
D. Yonova(1), E. Vazelov(1), I. Popov (2), I. Trendafilov(1), V. Papazov(1), M. Georgiev(1), M. Lubih(1), I. Georgieva(1) and R. Boneva(3).
(1)Dialysis Center, Medical University -- Sofia, (2)First Internal Clinic, UMHAT -- Stara Zagora, (3)Nephrology and Dialysis Clinic, UMHAT “Dr. Georgi Stranski” -- Pleven
Summary: In the last decades a number of publications appeared about the mechanism of soft tissue calcification in patients with chronic kidney disease (CKD). They proved that one of the main factors for the rather higher total and cardiovascular morbidity and mortality in these patients are the disturbed mineral metabolism and the related to it pathological cardiovascular calcification. The traditional knowledge of the simple mechanical deposition of calcium in soft tissues was changed with the discovery of active mechanisms mediating calcification, which seem to play a crucial role in this pathology.
Key words: chronic kidney disease, cardiovascular calcification, disturbed mineral metabolism, bone proteins, bone morphogenetic protein-7, bone GLA-protein, fetuin-A
Address for correspondence: Assoc. Prof. D. Yonova, M. D., Dialysis Center, UMHAT “Aleksandrovska”, 1 “G. Sofiyski” St., Bg -- 1431 Sofia, tel. +359 2 9230889; +359 2 9230515; +359 2 9230463; e-mail: dr_ionova@email.com



Postoperative cognitive dysfunction: a problem with many open questions - 49, 2013, № 4,18-21.
M. P. Atanasova.
Clinic of Anesthesiology and Intensive Care, UMHAT “Aleksandrovska” -- Sofia
Summary: As the population of older patients that undergo surgery increases, postoperative cognitive dysfunction becomes a common problem with many unsolved questions. This is associated with increased postoperative morbidity, major demand for postoperative care and higher hospital costs. More knowledge is necessary for a better understanding of the epidemiology and pathophysiology and for determining the risk factors for postoperative cognitive dysfunction. Acquiring more information about the etiology and clinical features of this syndrome will help to prevent, avoid and treat it promptly. Future research is needed in order to improve our knowledge of the utility of different approaches in the prevention of postoperative cognitive dysfunction.
Key words: postoperative cognitive dysfunction, anesthesia, geriatrics, complications
Address for correspondence: M. P. Atanasova, M. D., Clinic of Anesthesiology and Intensive Care, UMHAT “Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia



Distribution and structure of rheumatic diseases - 49, 2013, № 4,18-21.
N. Nikolov(1), M. Panchovska(2) and Zl. Kolarov(3).
(1)Rheumatic Unit, Medical University -- Pleven, (2)Department “Propedeutics of Internal Medicine”, Medical University -- Plovdiv, (3)Clinic of Rheumatology, Medical University -- Sofia
Summary: The structure of rheumatic diseases in primary care and in hospital practice gives important information about the incidence of various rheumatic diseases. This is important for better planning of resources -- personnel, facilities and finances, as well as adequate professional relationships in the interest of the patient. In Europe, the burden on the individual and the society related to the problems of rheumatic diseases is expected to increase dramatically. The prevalence of many of these diseases increases significantly with age. Many of them are related to lifestyle and factors such as obesity, smoking and physical inactivity. With the increasing number of elderly and the changes in lifestyle, it is expected that the economic burden on society in Europe will increase exponentially unless urgent measures are taken now. This finding was recognized by the United Nations and the WHO, who supported the global initiative The Bone and Joint Decade (2000-2010), meant to be the decade of rheumatic diseases.
Key words: rheumatic diseases, distribution, structure
Address for correspondence: Nikolay Nikolov, M. D., 37 "Han Krum" St., Bg -- 5500 Lovech, e-mail: dr.nicolov@ mail.bg



Еuropean policies for control of drugs expenditures - 49, 2013, № 4,26-30.
T. Vekov
Faculty of Public Health, Medical University -- Pleven
Summary: This paper focuses on European policies for rational use of medicines and for control of public expenditures. The work provides a brief review of the European Union countries’ drug policies: external and internal reference price formation; time-to-enter the market of certain products as a tool for control of public expenditures; procedures for price formation and reimbursement; drug policies that focus on regulating demand for and supply of medicinal products. The conclusion of the analysis is that pharmaceutical market is and should be strictly controlled and regulated.
Key words: drug policy, pharmaceutical market, European Union
Address for correspondence: Prof. Toni Vekov, Bulgarian Cardiac Institute, 1, G. M. Dimitrov St., Bg -- 1172 Sofia, tel. +359 2 962 54 54, e-mail: t.vekov.mu.pleven@abv.bg



Pricing and reimbursement of rare diseases and orphan drugs: a review of the literature ) - 49, 2013, № 4,31-38.
A. Zlatareva and G. Petrova.

Faculty of Pharmacy, Medical University -- Sofia
Summary: The goal of the current literature review was to highlight the most often used pricing and reimbursement approaches towards the rare diseases and orphan medicines. The literature review was performed in PubMed, Scopus and Google Scholar databases for publications on pricing and reimbursement of medicines for rare diseases and the most important articles were selected for this analysis. The analysis showed that the national strategies on pricing and reimbursement should be coordinated, fair, efficient and sustainable, equalizing all rare diseases, that sometimes might be difficult due to huge differences in epidemiology, patient population, and therapeutic approaches.
Key words: pricing, reimbursement, rare diseases, orphan medicines
Address for correspondence: Albena Zlatareva, Faculty of Pharmacy, 2, Dunav St., Bg -- 1000 Sofia



A literature review of the pharmacotherapy and cost of illness of psoriasis and psoriatic arthritis - 49, 2013, № 4,39-44.
L. Marinov, A. Savova, I. Nikolova and G. Petrova

Faculty of Pharmacy, Medical University -- Sofia
Summary: The goal of the current paper was to perform a literature review and summarize the articles for the contemporary pharmacotherapy and cost of illness of psoriasis and psoriatic arthritis. A systematic literature search was conducted using the PubMed database with key words psoriasis, psoriatic arthritis, cost of illness, pharmacotherapy. On total, 25 publications for psoriasis and 12 for psoriatic arthritis were systematized. Included studies show that with the increasing knowledge of the genetic and patogenetic mechanisms of both diseases, their therapy also improves. The therapy costs are high, with a predominance of direct medical costs, such as medication, health services, photo therapy etc.
Key words: psoriasis, psoriatric arthritis, pharmacotherapy, cost of illness
Address for correspondence: Irina Nikolova, Faculty of Pharmacy, 2, Dunav St., Bg -- 1000 Sofia, e-mail: nikolova60@gmail.com




bullet 3'2013

Vitamin D insufficiency and its repletion: a brief review - 49, 2013, № 3, 5-11.
M. Vankova(1) and M. Boyanov(2)

(1)Department of Endocrinology, MHAT “Tokuda Hospital Sofia”, (2)Clinic of Endocrinology, UMHAT “Aleksandrovska” -- Sofia
Summary: Over the last decade, vitamin D has gained a lot of interest. Dependent on the definition of vitamin D sufficiency, serum 25(OH)D level either 50 or 75 nmol/L, some degree of hypovitaminosis D is found in every studied region of the world and Bulgaria is no exception to the rule. This paper briefly reviews the most important facts about vitamin D, such as its effects on bone health, and outlines the determinants, which may influence its level in the body. Different supplementation and treatment dosing regimens most commonly used in practice are also discussed. Population screening for vitamin D deficiency has not been recommended, yet. However, individuals who are at increased risk for vitamin D deficiency should be examined, treated and followed-up.
Key words: vitamin D deficiency, supplementation, treatment, dosage
Address for correspondence: Mira Vankova, M. D., MHAT “Tokuda Hospital Sofia”, 51B, N. Vaptsarov Blvd., Bg -- 1407 Sofia, e-mail: miravankova@abv.bg



Specificity of urinary tract infections in kidney transplant recipients - 49, 2013, № 3, 12-18.
B. Zlatkov(1), Zh. Filipov(1), E. Paskalev(1), B. Markova(2), Yu. Marteva-Proevska(2) and A. Kolevski(2)

(1)Clinic of Nephrology and Transplantation, (2)Central Microbiology Laboratory, UMHAT “Aleksandrovska” -- Sofia
Summary: Kidney transplantation (KT) is the best treatment option for patients with chronic kidney disease. Urinary tract infections (UTIs) are one of the most prevalent complications of KT. Bacterial UTIs are one of the most common infections in kidney transplant recipients (KTRs), which determines their great importance. The risk factors for UTI after KT are female gender, advanced age, immunosuppressive regimen, mode of KTR follow-up, urologic treatment, etc. UTIs can cause deterioration of the graft function, may progress to acute pyelonephritis (APN), which is one of the leading causes for graft loss. APN may progress to bacteriaemia and sepsis. Often UTIs can be asymptomatic due to the immunosuppressive treatment. The methods for treatment and prophylaxis of UTIs after KT are still a topic of discussion.
Key words: urinary tract infections, immunosuppression, kidney transplantation, asymptomatic bacteriuria
Address for correspondence: B. Zlatkov, M. D., Clinic of Nephrology and Transplantation, UMHAT “Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia



Treatment approaches for FIGO stage IB cervical cancer аccording to ESGO guidelines - 49, 2013, № 3, 19-23.
E. Ismail, Ya. Kornovski and St. Slavchev

Departmеnt of Obstetrics and Gynecology, Medical University -- Varna
Summary: Cervical cancer is the most common cancer in women in the developing countries. The treatment options are definitive concurrent chemoradiation therapy or radical surgery with or without neoadjuvant or adjuvant therapy. The treatment decision should be based on the patient’s status and preferences, tumor characteristics, and the experience of the clinician. This article will review and compare the treatment modalities and rationales of combined treatment approaches, including surgery, radiation, and chemotherapy for FIGO stage IB cervical cancer.
Key words: cervical cancer, stage IB, treatment, radical hysterectomy, neoadjuvant chemo­therapy, concurrent chemoradiation therapy
Address for correspondence: E. Ismail, M. D., Gynecology Clinic, MHAT “Sv. Anna”, 100, Tsar Osvoboditel St., Bg -- 9000 Varna



Cord blood units -- reliable cellular therapy product - 49, 2013, № 3, 24-29.
V. Atanasova, A. Mihaylova and E. Naumova
Department of Clinical Immunology, University Hospital “Aleksandrovska” -- Sofia
Summary: Cord blood is a valuable source of haematopoietic stem and progenitor cells applicable for the treatment of a wide variety of malignant and non-malignant diseases. Umbilical cord blood units intended for an unrelated allogeneic trans­plan­tation are stored in public banks, whose number is constantly growing due to the rapid development in both clinical and technological, as well as in organizational aspects. Obtaining of ready to use high-quality units is related directly to the high efficiency of all stages of cord blood banking: collection, processing, testing, storage, selection and releasing for transplantation. Furthermore, the use of cord blood stem and progenitor cells beyond the hae­ma­topoietic reconstitution is an objective of active research, especially in the field of regenerative medicine.
Key words: cord blood units, cord blood banking, allogeneic cord blood transplantation, cellular therapy
Address for correspondence: Valentina Atanasova, M. D., Department of Clinical Immunology, University Hospital “Aleksandrovska”, 1, Sv. G. Sofiyski St., 1431 Sofia, tel. +359 2 9230 690, e-mail: v_atanasova2008@abv.bg



Clinical pharmacy -- essence, progress and challenges in practice - 49, 2013, № 3, 30-36.
I. Getov(1), , E. Kostov(2), Hr. Lebanova(1) and E. Grigorov(1)
(1)Department “Organization and Economics of Pharmacy”, Faculty of Pharmacy, Medical University -- Sofia, (2)Medical College, Medical University -- Pleven
Summary: Clinical pharmacy is a concept for dividing the activities performed by pharmacists in hospitals into two groups. The first group includes the traditional functions of procurement, storage and dispensing of medicines for the needs of bedridden patients, and the second large group are the activities associated with consulting and expertise in the wards in relation to drug therapy for each individual patient. Specially trained pharmacists are carrying out activities aimed at optimizing drug therapy and promoting a healthy lifestyle, wellbeing and disease prevention. The practice of clinical pharmacists includes philosophy of care, combined with a specific orientation towards the patients to ensure optimal results from the ongoing pharmacotherapy. As a scientific discipline, clinical pharmacy contributes to the achieving of new knowledge, leading to a higher quality of life and lower costs for effective treatment.
Key words: clinical pharmacy, drug therapy, pharmacists, hospital pharmacy
Address for correspondence: I. Getov, Department “Organization and Economics of Pharmacy”, Faculty of Pharmacy, Medical University, 2, Dunav St., Bg -- 1000 Sofia, tel. +359 2 9236 587, e-mail: ilko.getov@gmail.com



The path that a patient with a rheumatic disease walks - 49, 2013, № 3, 37-40.
N. Nikolov(1), M. Panchovska(2) and Zl. Kolarov(3)
(1)Rheumatic Unit, Medical University -- Pleven, (2)Department “Propedeutics of Internal Medicine”, Medical University -- Plovdiv, (3)Clinic of Rheumatology, Medical University -- Sofia
Summary: From the manifestation of the first symptoms of rheumatic diseases, first registered by the GP, and the referral to a specialist in rheumatology, a different period of time passes, sometimes long and difficult enough. An analysis of the path that patients with rheumatoid arthritis have to follow in primary care, gives us information why a delay in the correct diagnosis and the initiation of adequate treatment often occurs. The ability of GPs to respond to the needs of patients with inflammatory joint diseases and, in particular, their readiness to diagnose and treat rheumatoid arthritis, is essential for the successful management of this disease.
Key words: path, patient, rheumatoid arthritis, delayed diagnosis, rheumatic diseases
Address for correspondence: Nikolay Nikolov, M. D., 37 "Han Krum" St., Bg -- 5500 Lovech, e-mail: dr.nicolov@ mail.bg




bullet 2'2013

Fractures of the talus: complications and prognosis - 49, 2013, № 2, 5-12.
S. Asyov, V. Tzanov, K. Tzonkov, L. Zahariev, H. Sto
ychev, D. Pachev and M. Iliev
Second Clinic of Orthopedic Traumatology, Multiprofile Hospital for Active Treatment and Emergency Medicine "N. I. Pirogov" -- Sofia
Summary: Regardless of the advances in surgical techniques, complications of talus fractures remain very common. They depend, to a very high extent, on the severity of the initial injury (i.e. the type of fracture), but also on the choice of treatment and its prompt initiation. The early complications are usually related with soft tissue damage and include infections, skin necroses, and wound dehiscence. The late complications, such as osteonecrosis, post-traumatic arthritis, osteomyelitis, malunion and nonunion, are common and may lead to worsening of prognosis and functional limitations. The aim of the current review is to focus on the most common complications following talus fractures, causes for their occurrence, prognosis and preventive options, and treatment.
Key words: talus fractures, complications, avascular necrosis, osteoarthritis, prognosis
Address for correspondence: Sasho Asyov, M. D., Second Clinic of Orthopaedic Traumatology, Emergency Institute „N. I. Pirogov”, 21, Totleben Blvd., Bg -- 1606 Sofia, tel. +359 2 9154 256, e-mail: assiovmd@abv.bg



Risk factors for osteoporosis - 49, 2013, № 2, 13-19.
S. Monov (1), R. Rashkov(1), R. Shumnalieva(1) and D. Monova(2)
(1)Clinic of Rheumatology, Medical University -- Sofia, (2)Medical Institute -- Ministry of Interior -- Sofia
Summary: According to one of the contemporary definitions for osteoporosis, the latter is present when measurement of bone mineral density (BMD) shows a score below -2.5 standard deviations. Risk factors which influence the main characteristics of bone turnover, such as peak bone mass and bone loss, are very diverse. Some of them could be modified, others not. For the development of complications of osteoporosis, such as bone fractures, are important not only those risk factors, which influence BMD, but also some other factors such as overloading of the skeleton and falls, a history of previous low-trauma fracture, chronological age, a family history of osteoporosis and others. For assessing the risk of osteoporosis one can use the one-minute test and FRAX-index.
Key words: osteoporosis, risk factors, fractures, FRAX-index
Address for correspondence: Simeon Monov, M. D., Clinic of Rheumatology, UMHAT “Sv. Iv. Rilski”, 13, Urvitch St., Bg -- 1612 Sofia



Virulence factors and bacteriocins among clinically important bacteria belonging to the genus Enterococcus - 49, 2013, № 2, 20-30.
D. Atanasova, T. Strateva and I. Mitov

Department of Medical Microbiology, Medical Faculty, Medical University -- Sofia
Summary: Enterococci are widespread bacteria in humans, animals, food products and the environment. Considered to be harmless in the past, nowadays they are one of the leading causative agents associated with a wide range of infections, some of which with high mortality rates. The most common targets of infection are the urinary tract, cardiovascular system, abdomen, biliary tract, burn wounds, etc. This review describes the various virulence factors of Enterococcus spp. and the way they contribute to the pathogenesis of infectious diseases -- by increased adherence, colonization and invasion of the tissues; by modulation of the immune response and extracellular production of enzymes and toxins. The most frequently produced bacteriocins, their effect on closely related bacterial species and their impact on the pathogenic potential of Enterococci are also presented.
Key words: genus Enterococcus, infections, virulence factors, bacteriocins
Address for correspondence: Daniela Atanasova, M. D., Department of Medical Microbiology, Medical University of Sofia, 2, Zdrave St., Bg -- 1431 Sofia, tel. +359 2 9172740, е-mail: dany.atanasova@abv.bg



Development of the spiral ganglion cells - 49, 2013, № 2, 31-40.
E. Ivanov and Sv. Pencheva

Department of Anatomy, Histology, Cytology and Biology, MU -- Pleven
Summary: The spiral ganglion cells provide the afferent innervation of the hair cells of the organ of Corti. SGCs fall into two categories, having different morphology, synaptic connections and functions. 95% of these cells (termed as type 1 spiral ganglion neurones) are in synaptic contact with the inner hair cells, whereas about 5% of them are type 2 cells, which are responsible for the sensory innervation of the outer hair cells. The Rosenthal’s canal does not only accommodate the SGCs, but it also contains nerve fibres originating from the superior olivary nucleus, forming the crossed and uncrossed olivocochlear bundles, and providing the efferent innervation of the organ of Corti. The postnatal development of the spiral ganglion cells in the rat was studied from birth until the adult stage. At birth, a single population of ganglion cells is present, some of them surrounded by one or two layers of satellite cell processes. With maturation, the satellite cell processes increase in number around the cell body and its processes. At the end of the first postnatal week, two important events occur. The first is the appearance of myelin lamellae in both ganglion cell processes, and the cell body, and the second event is the appearance of a new type of cell (the type 2 spiral ganglion cell). At this stage, the type 2 cell is mainly characterized by densely packed neurofilamentous structures in the cytoplasm. Later, the kinetics of myelination decrease in the processes, and increase in the cell body. At all stages including the adult one, the fibers have a myelin sheath composed of more lamellae than the cell body. A light microscopic and transmission electron microscopic study of the spiral ganglion was done during postnatal period of the white rats, followed by morphometric evaluations of the cell and nuclear area.
Key words: spiral ganglion, development, innervation, type 1, type 2 neurons, ultrasructure, morphometric analysis
Address for correspondence: Assoc. Prof. E. Ivanov, Department of Anatomy, Histology, Cytology and Biology, Medical University, 1, “Sv. Kl. Ohridsky” St., Bg -- 5800 Pleven



Hepcidin measurement in biological fluids - 49, 2013, № 2, 41-46.
V. Manolov, B. Atanasova, M. Velizarova and K. Tzatchev

Department of Clinical Laboratory and Clinical Immunology, MF, MU -- Sofia, Central Clinical Laboratory, University Hospital “Aleksandrovska” -- Sofia
Summary: The peptide hormone hepcidin plays a central role in the regulation of iron metabolism. It is predominantly synthesized in the hepatocytes, where its expression is regulated by the body iron status, erythropoetic activity, oxygen tension and inflammatory cytokines. Hepcidin lowers serum iron concentration by counteracting the function of the cell exporter ferroportin, presented mainly in the membrane of macrophages, hepatocytes and duodenal enterocytes. There is a need of implementing available and reliable quantitative methods in the clinical-laboratory practice for measuring hepcidin in the blood and urine. Prior to the use of hepcidin as a new marker for iron disorders in the routine clinical practice, efforts are required to harmonize the various assays, to provide high result comparability between the different laboratories and to define the general lines of medical decision making.
Key words: iron metabolism, regulation of iron homeostasis, clinical iron disorders, hepcidin, quantitative measurements of hepcidin, harmonization of analytical methods
Address for correspondence: Victor Manolov, M. D., Central Clinical Laboratory, University Hospital “Aleкsandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, tel. + 359 2 9230 928, e-mail: victhedoc2@yahoo.com





bullet 1'2013

New surgical approaches in the management of cervical cancer
Ya. Kornovski and Е. Ismail
Clinic of Gynecology, MHAT “Sv. Anna” -- Varna
In the present review, recent literature data are presented in terms of new surgical techniques and approaches, which take place in the surgical ma­na­gement of cervical cancer. These approaches lead to better quality of life of the operated patients (nerve-sparing radical hysterectomy); more accurate staging (laparoscopic extraperitoneal paraaortic lymph node dissection); faster recovery after ultraradical surgery (laparoscopic exenterations); more radical operations and a lower risk of relapses (total mesometrial resection -- TMMR); more radical surgery without adjuvant radiotherapy and a lower risk of complications (laterally extended parametrectomy (LEP); give opportunities for patients with local relapses, such as salvage therapy (laterally extended endopelvic resection).
Key words: cervical cancer, surgical approaches
Address for correspondence:Assoc. Prof. Yavor Kornovski, M. D., Clinic of Gynecology, MHAT “Sv. Anna”, 150, Tsar Osvoboditel Str., Bg -- 9000 Varna



Immune mechanisms in bronchial asthma - 49, 2013, № 1, 9-12.
Tz. Markova(1), B. Aleksieva(2), I. Sainova(2), K. Simeonova(1) and E. Nikolova(2)
(1)Department of Pharmacology and Toxicology, Medical University -- Sofia, (2)Institute of Experimental Morphology and Anthropology with Museum, Bulgarian Academy of Sciences -- Sofia
This review focuses on some immune mechanisms, leading to inflammatory reactions in bronchial asthma. Asthma is characterised with chronic inflammation of the respiratory tract, in which many inflammatory cells are involved. Th2-lymphocytes and secreted interleukins play a central role in the processes of allergic inflammation. B-lymphocytes also play an important role in allergy diseases, including bronchial asthma, through the release of allergen-specific IgE. Mast cells play a key role in allergic inflammation through the release of histamine, leukotrienes (LTC4, LTD4, LTE4) and prostaglandin D2 (PGD2). The number of macrophages, as well as the secretion of chemotactic factors, stimulating the migration of eosinophils (CC-chemokines), has been shown to be increased in the lungs of patients with asthma. The functional role of eosinophils in asthma is not clear yet.
Key words: bronchial asthma, immunology, T-lymphocytes, B-lymphocytes, mast cells, macrophages, eosinophils
Address for correspondence: Tzvetanka Markova, M. D., Department of Pharmacology and Toxicology, Medical University, 2, Zdrave Str., Bg -- 1431 Sofia, e-mail: tzvetamarkova@yahoo.com



Antibodies to cyclic citrullinated peptides - 49, 2013, № 1, 13-15.
M. Baleva, S. Lesichkova and Kr. Nikolov
Department of Clinical Immunology, University Hospital “Aleksandrovska” -- Sofia
Summary: The determination of antibodies to CCP is an usefull test for an early diagnosis and prognosis of patients with RA. The evaluation of meta-analysis of 50 reports on CCP, determined with first and second generation methods and 37 reports on RF shows a high diagnostic accuracy of these two parameters in RA. The last consensus of ARA/EULAR in 2010 recommends the investigation of CCP antibodies as a diagnostic marker of RA.
Key words: rheumatoid arthritis, rheumatoid factor, CCP antibodies
Address for correspondence:Prof. Marta Baleva, M. D., University Hospital “Aleksandrovska”, 1, Sv. G. Sofiyski Str., Bg -- 1431 Sofia, e-mail: marta_baleva@yahoo.com



Vitamin D status in patients with kidney transplantation - 49, 2013, № 1, 16-19.
Zh. Filipov(1), B. Zlatkov(1), E. Paskalev(1), D. Svinarov(2) and V. Vladimirov(3)

(1)Clinic of Nephrology and Transplantation, UMHAT “Aleksandrovska” -- Sofia, (2)Clinical Laboratory of Medicinal and Therapeutic Monitoring, UMHAT “Aleksandrovska” -- Sofia, (3)Clinic of Urology, UMHAT “Aleksandrovska” -- Sofia
Vitamin D is a widely recognized factor in mineral and bone metabolism. Recently a larger number of publications deal with the pleiotropic effects of vitamin D -- renoprotection, modulating immune response, etc. The serum levels of the two metabolites of vitamin D -- 25-OH vit. D and 1, 25-OH vit. D are reduced in patients with advanced CKD, which is the cornerstone for secondary hyperparathyroidism. After kidney transplantation vitamin D insufficiency is highly prevalent due to several factors -- reduced sun exposure, immunosuppressive agents, reduced kidney function, etc. The aim of our review is to collect the current data concerning vitamin D and kidney transplantation and to give further recommendations about therapeutic strategy. Low serum level of vitamin D is a highly prevalent problem in kidney transplant recipients, having complex importance and etiology, without fully clarified treatment plan.
Key words: vitamin D, kidney transplantation, chronic kidney disease, pleiotropic effects
Address for correspondence:Zh. Filipov, M. D., Clinic of Nephrology and Transplantation, UMHAT “Aleksandrovska”, 1, Sv. G. Sofiyski Str., Bg -- 1431 Sofia



The role of uncoupling proteins in thermoregulation, oxidative stress, obesity and diabetes - 49, 2013, № 1, 20-24.
K. Ikonomova

National Transport Hospital “Tsar Boris III” -- Sofia
Uncoupling proteins (UCPs) are members of the family of mitochondrial transporter proteins. They are situated on the inner mitochondrial membrane and contribute to the proton re-uptake in the respiratory chain. The UCPs are capable of uncoupling oxygen consumption from oxidative phosphorylation, thus directing the produced energy not to the ATP synthesis, but to its release as heat. The UCPs play a major role in thermoregulation, heat generation and maintenance of the basal metabolic rate. In mammals, 5 uncoupling proteins are identified, from UCP-1 to UCP-5. The UCP-1 plays a major role in respiratory chain uncoupling. It is expressed in the brown adipose tissue and is of essential importance for the thermogenesis in hibernated animals and newborns. In adults, the UCP-1 plays an important role in body weight regulation and energy expenditure. The UCP-2 is highly expressed in many tissues of the adult animals and humans. After lipid consumption, the UCP-2 expression is increased in the white adipose tissue. In relation to this, the UCP-2 is considered to be a regulator in the energy balance, body weight and thermoregulation. The UCP-3 is expressed mainly in skeletal muscles, which are the source of 40% of total body thermogenesis. The UCP-3 plays a main role in the regulation of energy expenditure. The UCP-4 and UCP-5 are expressed mainly in brain and neurons. They participate in multiple processes associated with neurotransmission and thermogenesis. Besides thermogenesis and energy expenditure, the UCPs participate in the antioxidant protection of the body and the development of type 2 diabetes mellitus. Their antioxidant activity is related a decrease in the mitochondrial membrane potential. Thus, the generation of free oxygen radicals falls below the critical level. In patients with type 2 diabetes, the UCP-2 and UCP-3 are associated with the reduction of insulin secretion and the induction of oxidative stress. Upon activation of UCP-2 in beta cells of the pancreas, the glucose-stimulated insulin secretion decreases. In diabetes, UCP-3 reduction in skeletal muscle occurs, which results in glucose-induced oxidative stress. Uncoupling proteins are a promising target in the medicinal management of obesity and related diseases.
Key words: uncoupling proteins, thermoregulation, antioxidant protection, obesity, type 2 diabetes mellitus
Address for correspondence:K. Ikonomova, M. D., National Transport Hospital “Tsar Boris III”, 108, Knya­ginya Maria-Luiza Blvd., Bg -- 1233 Sofia



Plant extracts as genotoxic agents - 49, 2013, № 1, 25-28.
B. Popov
Department "Molecular Biology, Immunology and Medical Genetics", Medical Faculty, Trakia University -- Stara Zagora
This review presents some aspects of the problems associated with plant extracts as genotoxic agents. The causes and factors that affect genotoxic potentials of total extracts and their various fractions are identified. Also, mutagenic, clastogenic and promutagenic effects of plant extracts and their options for synergistic and antagonistic interactions with proven anti-mutagens, xenobiotics and their metabolites are considered.
Key words: genotoxicity, mutagenicity, clastogenicity, plant extract
Address for correspondence:B. Popov, Faculty of Medicine, Department of Molecular Biology, Immunology and Medical Genetics, Trakia University, 11, Armeiska Str., Bg -- 6000 Stara Zagora, tel. +359 888 390 167, e-mail: dr_b_popov@abv.bg



Antecedences of burnout syndrome among the employees in a penitentiary - 49, 2013, № 1, 29-36.
St. Harizanova
Department of Hygiene and Ecomedicine, FPH, Medical University -- Plovdiv
Summary: Burnout syndrome has been studied in many countries around the globe. The purpose of the current review is to focus on the antecedences of burnout syndrome among the employees in prisons. Because of the constant increase of the frequency of burnout syndrome and the lack of effective treatment, it is extremely important to know the preconditions for its occurrence and development, in order to implement effective prevention. In this review, 105 literary sources have been used to analyze the problem. A serious deficiency of literature data, characterizing the causes of the burnout syndrome among the employees in a penitentiary setting, has been found.
Key words: burnout syndrome, polic, penitentiary
Address for correspondence:Stanislava Harizanova, M. D., Department of Hygiene and Ecomedicine, FPH, Medical University, 15А, Vasil Aprilov Str., Bg -- 4002 Plovdiv, tel. +359 32 602 543, +359 887 915119; e-mail: dr.harizanovi@abv.bg



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