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Volume 50, 2014



bullet 6'2014

Hepatitis E virus infection: underrated and unrecognized – Medical Review (Meditsinski pregled), 50, 2014, 6, 5-12.
M. Pishmisheva(1) and M. Baymakova(2)
(1)Department of Infectious Diseases, Hospital of Pazardjik, (2)Department of Infectious Diseases, Military Medical Academy -- Sofia
Summary: Hepatitis E virus, causing HEV infection, belongs to genus Hepevirus in the Hepeviridae family. The first HEV infection was described in the late 70's and early 80-ies of the XX-th century. In Bulgaria Teoharov et al. reported the first cases in 1995. At present there are four known genotypes (HEV1 and HEV2 are enterically transmitted and responsible for endemic cases, while HEV3 and HEV4, who are responsible for sporadic cases, are associated with consumption of raw or undercooked game meat or pork products). Typical for HEV infection is the severe course of illness in pregnant woman (mortality ranges from 39% to 73% in endemic areas). In recent years, the cases of chronic HEV infection have increased, most dramatically in the developed countries and in immunocompromised patients. The key to the prevention of the disease is the development of a vaccine (Chinese researchers work hard in this field; so far the project has reached final stage of investigation).
Key words: hepatitis E virus, pregnancy, chronic HEV infection
Address for correspondence: Magdalena Baymakova, MD, Department of Infectious Diseases, Military Medical Academy, 3 Georgi Sofiyski St., Bg -- 1606 Sofia, e-mail: dr.baymakova@gmail.com



Vascular dementia: ultrasound diagnostic tools – Medical Review (Meditsinski pregled), 50, 2014, № 6, 13-18.
D. Ovcharov, Yu. Petrova and L. Traykov
Department of Neurology, MU -- Sofia
Summary: In the modern world, many people begin to develop changes in cognitive and social abilities in all age periods. Subclinical atherosclerosis can be assessed by endothelial dysfunction, and measuring the ratio of the intima-media thickness (IMT). It has been shown that the increased IMT is associated with a reduced performance on the tests that evaluate attention and executive functions, in patients with cardiovascular diseases. It has been shown that a functional change in the arterial system can be associated with the development of dementia. The biomechanical parameters of the vessel wall can now be monitored by E-tracking. The relationship between stroke and cognitive impairment is of vital importance. One quarter of cognitive impaired patients had a stroke and more than 60% of patients with stroke have had a form of cognitive impairment. There is a correlation between the advanced carotid stenosis and low scores on neuropsychological tests, particularly those related to executive functions. It is important to emphasize that the processes leading to dementia itself are various and probably mechanisms of vascular diseases have an important role in the evolution of brain injury, which eventually leads to a decline in cognition and functional impairment.
Key words: vascular dementia, IMT, atherosclerosis, ultrasound, plaques
Address for correspondence: D. Ovcharov, M. D., Department of Neurology, MU, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia



Epigenetics of cancer and epigenetically targeted pharmacotherapy – Medical Review (Meditsinski pregled), 50, 2014, № 6, 19-22.
M. Varadinova, R. Metodieva and N. Boyadjieva
Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University -- Sofia
Summary: The term “epigenetics” refers to all heritable changes in gene expression that are not coded in the DNA sequence itself, which only alter phenotype without changing genotype. DNA methylation, RNA-associated silencing and histone modifications (methylation, acetylation, and phosphorylation) initiate and sustain epigenetic modulations. The epigenetic changes may result in heritable silencing of genes without changing their coding sequence. They may transfer dynamic environmental experiences on the “fixed” genome, resulting in stable alterations in phenotype and showing parent of origin effects. Epigenetic mechanism plays a role in development of cancer. The review summarizes the data from experimental and clinical studies about epigenetic of tumors. Both histone modifications and DNA methylation are involved in tumorogenesis. The role of enzymes in epigenetic mechanisms are illustrated. The elevation of DNA methyltransferases (DNMTs) was documented in breast cancer, colon cancer, etc. The inhibitors of enzymes were clinically approved by FDA for the treatment of cancers.
Key words: cancers, epigenetic changes, enzymes, drugs
Address for correspondence: Miroslava Varadinova, MD, Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University -- Sofia, 2, Zdrave Stл, Bg -- 1431 Sofia, tel. +359 2 9520539, e-mail: miria@abv.bg



Diagnosis of glucocorticoid-induced osteoporosis – Medical Review (Meditsinski pregled), 50, 2014, № 6, 23-28.
Tz. Petranova
Clinic of Rheumatology, University Hospital “Sv. Iv. Rilski”, Medical University -- Sofia
Summary: Chronic administration of glucocorticoids (GC) leads to disturbances in bone strength and the occurrence of secondary osteoporosis. Glucocorticoid-induced osteoporosis (GIO) differs from the postmenopausal osteoporosis (PMO) in a number of pathogenetic and histomorphological features, what is the reason for the delay in diagnosis. The discrepancy between the changes in the quantity and quality of bone considerably hampers the assessment of fracture risk. GIO must be suspected in all patients under chronic GC treatment. The examination includes a careful clinical evaluation of the patient, routine and specific laboratory tests, radiographs, as well as the assessment of bone density and microarchitecture.
Key words: diagnosis, glucocorticoid-induced osteoporosis, BMD, TBS
Address for correspondence: Tzvеtanka Petranova, M. D., Clinic of Rheumatology, Medical University, 13, Urvich St., Bg -- 1612 Sofia





bullet 5'2014

Cystic echinococcosis -- etiology, biology and epidemiology – Medical Review (Meditsinski pregled), 50, 2014, № 5, 5-12.
M. Muhtarov
Gastroenterology Ward, Multi-Profile Hospital for Active Treatment "Kardzhali" -- Kardzhali
Summary:  Cystic echinococcosis is a zoonotic disease caused by the small cestode Echinococcus granulosus. Adult forms of the tapeworm live in the intestines of carnivores subclinically. Dogs are particularly important for the zoonotic transmission due to their close relationship to humans and herbivores, which tend to be the intermediate hosts of the parasite. It has been observed that initially these intermediate hosts develop asymptomatic disease. The growth of the larvae, forming cysts in the vital organs (liver, lung, etc.) leads to developing the disease and often to death. The sharp increase in the incidence among the population of Bulgaria since 1992 to 8.47%ooo in 1996 and keeping it at high levels in the following years necessitated the conduction of the National Programme for Control of echinococcosis in humans and animals (2004-2008). After the implementation of the medical part of the program the incidence of echinococcosis was reduced to 3.75%ooo in 2010. However, Cystic echinococcosis (CE) continues to be a major medical and social problem for the public health in Bulgaria. The practice of slaughtering animals (sheep) at home without any veterinary control and feeding dogs with animal offal lead to maintaining the cycle of invasion -- dog -- sheep (human). In this review we have discussed some important aspects of the etiology, biology, life cycle, distribution and epidemiology of the E. granulosus.
Key words:  Cystic echinococcosis, Echinococcus granulosus
Address for correspondence: Marin Muhtarov, M. D., Gastroenterology Ward, Multi-Profile Hospital for Active Treatment "Kardzhali", 19, Trakia Blvd., Bg -- 6600 Kardzhali, tel. +359 361 66528, e-mail: mukhtarov@abv.bg



Common variable immunodeficiency: clinical and pathogenetic aspects – Medical Review (Meditsinski pregled), 50, 2014, № 5, 13-17.
N. Gesheva, S. Mihailova, S. Lesichkova, А. Mihaylova and E. Naumova
Clinic of Clinical Immunology, UMHAT “Aleksandrovska”, Medical University -- Sofia
Summary:  Common variable immunodeficiency (CVID) is a heterogeneous immuno­deficiency syndrome characterized by hypogammaglobulenimia, recurrent bacterial and less frequently viral infections as well as an increased susceptibility to develop autoimmune and malignant diseases. CVID is a part of group of rare diseases with estimated incidence in individuals from Europe around 1:30 000. Precise pathogenetic mechanisms leading to development of CVID have not yet been found. The supposed basic pathophysiologic process in CVID is a simple failure in the differentiation and function of B lymphocytes. The role of T cell subpopulations in the development of the disease is poorly understood. In recent years an answer has been searched whether defective antibody formation is a consequence of failure in both differentiation and function of B lymphocytes or there is a defect in T cell activation and regulation resulting in an ineffective interaction between T and B cells.
Key words:  Common variable immunodeficiency, B-lymphocytes, T-lymphocytes, hypogammaglobulenimia
Address for correspondence:  Nevena Gesheva, M. D., Clinic of Clinical Immunology, University Hospital Aleksandrovska, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, tel. +359 2 9230 450, e-mail: n_gesheva@hotmail.com
Acknowledgements:  This work was granted by Medical University Sofia, Grant#55/2013 project № 84



Trabecular Bone Score (TBS) -- new opportunity for effective clinical evaluation of fracture risk – Medical Review (Meditsinski pregled), 50, 2014, № 5, 18-21.
Tzv. Petranova
Clinic of Rheumatology, Medical University -- Sofia
Summary:  Osteoporosis is a major health problem of modern society as a result of the severe physical and mental consequences associated with its complications -- osteoporotic fractures. Important for early diagnosis is the adequate and timely eva­luation of fracture risk. Measurement of bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) is the gold standard for the diagnosis of osteoporosis. However, many accidental fractures occur in women who do not have osteoporosis. The reason for this is the presence of other factors that determine bone strength -- microarchitecture of trabecular bone, macro-geometry of cortical bone, bone mineralisation and turnover, which are difficult to define in routine clinical practice. In recent years, a new methodology for effective, non-invasive clinical evaluation of bone microarchitecture -- TBS has been introduced to practice, which in addition to BMD, improves the possibilities for assessing bone strength and fracture risk, and could be used in the monitoring of the therapeutic effect of antiosteoporotic drugs in routine clinical practice.
Key words:  osteoporosis, bone mineral density, Trabecular Bone Score
Address for correspondence: Tzvеtanka Petranova, M. D., Clinic of Rheumatology, Medical University, 13, Urvich St., Bg -- 1612 Sofia



Modern trends in the management of acute postoperative pain – Medical Review (Meditsinski pregled), 50, 2014, № 5, 22-29.
D. Tonev(1) and I. Gruev(2)
(1)Department of Anesthesiology and Intensive Care, National Transport Hospital “Tsar Boris III” -- Sofia, (2)Clinic of Cardiology, National Transport Hospital “Tsar Boris III” -- Sofia
Summary: The management of the postoperative pain is still a challenge, despite of the big progress of modern surgery, anesthesiology and pharmacology. The aim of the current review is to show the modern trends and future perspectives for overcoming of this significant medical problem.
Key words:  postoperative pain, management, multimodal analgesia
Address for correspondence:  Assoc. Prof. Dimitar Tonev, M.D., Ph.D., Department of Anesthesiology and Intensive Care, National Transport Hospital “Tsar Boris III”, 108, Maria-Luisa Blvd., Bg -- 1233 Sofia, tel. +359 2 932 36 86, e-mail: dgtsofia@abv.bg





bullet 4'2014

Sarcoidosis and the kidney  – Medical Review (Meditsinski pregled), 50, 2014, № 4, 5-9.
M. Nikolova and A. Iliev
Clinic of Nephrology, University Hospital Aleksandrovska -- Sofia
Sarcoidosis is a systemic autoimmune inflammatory disease of unknown etiology. The disease is characterized by the development of typical noncaseating epithelioid granulomas in different organs. Sarcoidosis can affect all tissues and organs in the human body. The authors discuss the different types of renal involvement in sarcoidosis.
Key words: sarcoidosis, renal involvement, glomerulonephritis, tubulointerstitial nephritis, renal failure
Address for correspondence: Milena Nikolova, M. D., Clinic of Nephrology, University Hospital Aleksandrovska, 1 G. Sofiyski St., Bg -- 1431 Sofia, e-mail: milena_i_dani@abv.bg



Globulomaxillary cysts  – Medical Review (Meditsinski pregled), 50, 2014, 4, 10-13.
Ts. Tsvetanov
Department of Oral Surgery, Faculty of Dental Medicine, Medical University -- Plovdiv
From a historical perspective the first description of the globulomaxillary cysts has been ascribed to Thoma (1937). The globulomaxillary cysts is a cyst which is situated between the maxillary lateral incisor and the adjacent canine. It exhibits as an "inverted pear-shaped radiolucency". The purpose of this review is to look at existing discussions in the literature about terminology, frequency, cases of development around non-vital teeth, difference in origin, clinical, radiological symptoms and treatment methods.
Key words: globulomaxillary cysts, aetiology, treatment, symptoms
Address for correspondence: Tsvetan Tsvetanov, Ph.D, Asst. Prof., Department of Oral Surgery, Faculty of Dental Medicine, Medical University, 3, Hristo Botev Blvd., Bg - 4000 Plovdiv, tel. +359 898-32-53-32.



Leptin and GABA -- thermoregulatory interactions – Medical Review (Meditsinski pregled), 50, 2014, 4, 14-17.
K. Yakimova, R. Nikolov, I. Todorov and M. Hristov
Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University -- Sofia
Leptin is a 167-aminoacid polypeptide hormone which is produced by adipocytes. In the brain, leptin, by binding to tyrosine-kinase associated receptors, inhibits expression of neuropeptide Y and agouti-related peptide. Leptin inhibits feeding, reduces body weight and increases thermogenesis. Experimental data suggest involvement of GABAergic mechanisms in the regulation of feeding behavior and energy balance. The present review discusses various interactions between leptin and γ-aminobutyric acid (GABA) on the level of thermoregulation.
Key words: leptin, GABA, interactions, thermoregulation
Address for correspondence: Prof. Krassimira Yakimova, MD, PhD, Dsci, Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University, 2 „Zdrave“ St., Bg -- 1431 Sofia, tel.: +359 2 951 56 52, e-mail: kyakimova@yahoo.com; kyakim@medfac.acad.bg



bullet 3'2014

Non-small cell lung cancers: frequency of EGFR/KRAS mutations, racial differences and classification approaches – Medical Review (Meditsinski pregled), 50, 2014, № 3, 5-13. 
S. Genova(1), St. Bichev(2) and V. Belovezhdov(1)
Pediatric Clinic, UMHAT “Aleksandrovska” -- Sofia
(1)Department of General and Clinical Pathology and Forensic Medicine, MU -- Plovdiv, (2)National Genetic Laboratory, SHATAG “Maichin dom” -- Sofia
Summary: Non-small cell lung cancers (NSCLC) constitute approximately 80% of all morphological types of lung cancers. The histological subtype appears to be a major determinant of survival and subsequent therapy. The receptor for epidermal growth factor (EGFR) is expressed in normal human cells to a much lower level, while metaplastic bronchial epithelial and human tumors often express high levels of epidermal growth factor and his receptors. The overexpression of EGFR has been observed in 40-80% of NSCLC and has been associated with tumor aggression, high proliferative activity and a poor prognosis. Mutations in the tyrosine kinase domain coding range from 9.4% to 40% in different populations and races. The article covers the epidemiology, mutations in NSCLC, analysis of gene family and their frequency in different races and regions. Advances in the target therapy with tyrosine kinase inhibitors require accurate histologic subtyping, immunohistochemistry and genetic analysis. We also reviewed the new diagnostic algorithms for lung cancer, which comply with the revised pathological classification and multidisciplinary classification of adenocarcinomas.
Key words: NSCLC, EGFR/KRAS mutations, TKI, classification
Address for correspondence: Silvia Genova, M. D., Department of General and Clinical Pathology and Forensic Medicine, 15А, V. Aprilov Blvd., Bg -- 4002 Plovdiv, tel. +359 887 198 557, +359 32 602 444, e-mail: sylvia_genova@abv.bg



Risk factors for colorectal carcinoma – Medical Review (Meditsinski pregled), 50, 2014, № 3, 14-18.
A. Ruseva and D. Nikolovska
Clinic of Gastroenterology, Medical Institute -- Ministry of Interior -- Sofia
Summary: Colorectal cancer is a significant social and health problem, because of its high frequency. The official statistics in Bulgaria shows that colorectal cancer is the most frequent malignant disease of the gastrointestinal tract. Adenocarcinoma is the most common histological type. There is a trend towards an increase of proximal localizations and decrease of rectal localizations of tumors, although the majority of colorectal cancers are still seen in the distal part of the bowel. About 10% of all colorectal cancers are hereditary, and the rest 90% develop without genetic predisposition, and are what’s called sporadic.
Key words: colorectal cancer, risk factors, dietary pattern, physical activity, environment factors
Address for correspondence: Adriana Ruseva, M. D., Clinic of Gastroenterology, Medical Institute -- Ministry of Interior, 79, Gen. Skobelev Blvd., Bg -- Sofia, tel. +359 2 98 21 356, e-mail: dr_aruseva@abv.bg






bullet 2'2014


Bone alterations in cystic fibrosis fibrosis   – Medical Review (Meditsinski Pregled), 50, 2014, No 2, 5-10.
B. Naydenova-Stoeva
Pediatric Clinic, UMHAT “Aleksandrovska” -- Sofia
Summary: Cystic fibrosis (CF) is the most common genetic disease with the highest incidence among the Caucasian population. The more aggressive pathogenetic treatment of these patients can improve the quality and quantity of their life. On the other hand, the clinical symptoms become enriched with new events, among which are those related with the skeletal system. They are determined by a lot of factors. All of these factors lead to a delay in growth and weight gain, delayed pubertal development, and decreased quality and quantity of the bone mineral, resulting in osteopenia and osteoporosis. Therefore, pathologic fractures and kyphosis may occur earlier than expected. These complications worsen the patients overall health, quality of life and further disable them. Prevention, early recognition and treatment are the most effective strategies for sustaining bone health to help maintain quality of life in patients with CF.
Key words: cystic fibrosis, bone mineral density, bone markers
Address for correspondence: B. Naydenova-Stoeva, M. D., Pediatric Clinic, UMHAT “Alek­sandrovska”,
1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, e-mail: jani_2005@mail.bg



Alpha-1-antitrypsin deficiency in type 2 diabetes mellitus - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 11-16.
R. Mekova(1), M. Boyanov(1) and E. Mekov(2)
(1)Clinic of Endocrinology and Metabolic Disorders, Department Internal Diseases, UMHAT “Aleksandrovska” -- Sofia, (2)Clinical Center of Pulmonary Diseases, SHATPD “Sv. Sofia”, Medical University -- Sofia
Summary: Alpha-1-antitrypsin (AAT) is a major protective protein in the circulation. The main function of AAT is inactivation of neutrophil elastase and other proteases, thereby maintaining the balance between proteases and antiproteases. Alpha-1-antitrypsin deficiency (AATD) is a common and often undiagnosed genetic disorder that affects between 1:600 ​​and 1:5000 children and predisposes to liver disease and emphysema in early age. AATD is a risk factor for development of diabetes mellitus (DM) type 2. Although no difference was found in the average level of AAT between patients with and without type 2 diabetes, the number of patients with AAT < 1 g/l was 50% higher in the diabetic group, and the frequency of the genotypes AATD is higher in diabetic patients when compared to controls. In patients with type 2 DM, women have higher concentration of AAT than men. The mechanism of action of AAT in type 2 DM is largely unclear, but it is known that AAT protects pancreatic beta-cells from apoptosis by inhibiting caspase-3. According to present concepts pathogenesis of DM type 2 is associated with beta-cell damage. Administration of AAT in patients with DM type 2 can reduce the severity of the disease, but research in this area is insufficient.
Key words: diabetes mellitus, alpha1-antitrypsin, deficiency
Address for correspondence: R. Mekova, M. D., Clinic of Endocrinology and Metabolic Disorders, UMHAT “Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia



Contemporary methods for diagnostics of Clostridium difficile infections infections - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 17-24.
E. Dobreva
Department of Мicrobiology, National Centre of Infectious and Parasitic Diseases -- Sofia
Summary: Clostridium difficile is an anaerobic, Gram-positive, toxin-producing and spore-forming bacterium. The spectrum of C. difficile infections (CDI) varies from mild diarrhea to life- threatening colitis, pseudomembranous colitis, toxic megacolon, sepsis and death. The enteropathogen is predominantly associated with healthcare-associated infections and rarely with infections acquired in the community. Culture-based microbiological diagnosis is relatively difficult, because of the specific physiological requirements of C. difficile. Detection of cytotoxin B in tissue cell culture, currently considered the “gold standard”, has shown adequate sensitivity and specificity, but is expensive and depends on maintenance of cell lines. Direct immunoassays for detection of toxins in clinical specimens are becoming popular due to their rapidness, and although specific, they lack adequate sensitivity and frequently produce false-negative results. Overall, the shortcomings of the conventional diagnostic methods require the implementation of integrated approach for the definitive CDI diagnosis. During the last decade, there have been developed various molecular methods for identification and detection of C. difficile in clinical specimens. Modern molecular typing methods are applied for characterization and investigation of highly virulent strains (ribotype 027) and hospital outbreaks. The rapid and accurate laboratory diagnosis is critical to reduce C. difficile infections and for the prevention and control of healthcare-associated infections.
Key words: Clostridium difficile, C. difficile infections, toxins, diagnostics
Address for correspondence: Elina Dobreva, PhD, Department of Microbiology, NRL “Control
and Monitoring of Antibiotic Resistance”, NCIPD, 26, Yanko Sakazov, Blvd.,
Bg -- 1504 Sofia, tel. + 359 2 944 69 99, ex. 208, е-mail: elina_g@abv.bg



Tissue microarray -- a bridge between science and diagnostics diagnostics - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 25-28.
D. Tashkova(1), S. Bachurska(1), D. Staykov(1), C. Mihalkova(1), P. Rashev(2) and V. Belovezhdov(1)
(1)Department of General and Clinical Pathology, Medical University -- Plovdiv, (2)Section “Immunobiology of Reproduction”, Institution of Biology and Immunology of Reproduction, BAS -- Sofia
Summary: Tissue microarray (TMA) is the new, high-throughput technology widely used as a tool for quality control of diagnostic immunohistochemistry, in oncology, molecular pathology and screening of diseases. This method combines tens to hundreds of specimens of different tissues onto a single slide for investigation at the same time, at the same conditions, using the standard protocols for all the different analysis. The aim of this review was to describe the construction and the optimal design of TMA, as well as to show the main advantages and disadvantages of this method.
Key words: tissue microarray, TMA, construction, design
Address for correspondence: Desislava Tashkova, M. D., Department of General and Clinical Pathology, Medical University, 15A Vasil Aprilov Blvd., Bg -- 4000 Plovdiv, tel. +359 886 613211, +359 32 602 387, e-mail: desi.tashkova@abv.bg





bullet 1'2014

New effects of some old uremic toxins  - 50, 2014, № 1,5-7.
D. Yonova (1), E. Vazelov(1), I. Popov(2), I. Trendafilov(1), V. Papazov(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: The uremic symptoms appear in patients with advanced chronic renal failure by retention of substances that in healthy subjects are secreted by the kidneys into the urine. These compounds are toxic and disturb many physiologic functions. However, many of the retained compounds remain unknown, as well as many of the effects of the known uremic toxins. Extra-renal methods of clearing are more effective for removing low molecular weight than high molecular weight uremic toxins or toxic protein-bound substances. The improvement of these methods and the implementation of new strategies give hope for a better standard of life and life prolongation of the uremic patients.
Key words: chronic renal failure, uremic toxins, guanidine compounds, advanced glycation end products, protein-bound uremic solutes
Address for correspondence: Assoc. Prof. D. Yonova, M. D., Dialysis Center, UMHAT “Aleksandrovska”, 1 “Sv. G. Sofiyski” St., Bg -- 1431 Sofia, tel. +359 2 9230889; +359 2 9230515; +359 2 9230463; e-mail: dr_ionova@email.com



Clinical application and prognostic value
of cardiac troponins in patients with chronic kidney disease  - 50, 2014, № 1,8-13.
R. Koycheva (1), E. Paskalev(2), M. Penev(3) and V. Tsoneva(4).
(1)Department of Nephrology , University Hospital "Prof. Dr. Stoyan Kirkovich" -- Stara Zagora, (2)Clinic of Nephrology and Transplantation, University Hospital " Aleksandrovska" -- Sofia, (3)Clinic of Cardiology , University Hospital "Prof. Dr. Stoyan Kirkovich" -- Stara Zagora, (4)Clinical Laboratory, University Hospital "Prof. Dr. Stoyan Kirkovich" -- Stara Zagora
Summary: Cardiovascular diseases (CVD) are the most common cause of morbidity and mortality in patients with chronic kidney disease (CKD). Although the exact pathophysiological mechanisms are not fully understood, it can be said that there is a considerable overlap between CVD and CKD, as they are mutually conditioned, progressively aggravating each other. Cardiovascular risk stratification may allow early identification of patients at high risk, optimize treatment plans and improve patient prognosis. Cardiac troponins are a highly sensitive and specific marker of myocardial injury, and this test is the "gold" standard for non-invasive diagnosis of acute myocardial infarction in the general population. This overview provides a review of the diagnostic possibilities, clinical application and prognostic role of cardiac troponins in patients with CKD.
Key words: chronic kidney disease, cardiovascular risk, cardiac troponins
Address for correspondence: R. Koycheva, M. D., Department of Nephrology , University Hospital "Prof. Dr. Stoyan Kirkovich", 2, Gen. Stoletov St., Bg -- 6000 Stara Zagora, е-mail: koychevar@abv.bg



Eye movement examination
 - 50, 2014, № 1,14-17.
R. Ikonomov.
Department of Neurology, MHAT “Sofiamed” -- Sofia
Summary: Eye movement examination is an important diagnostic method not only in the routine neurological practice, but in the field of the complicated scientific research as well. It comprises a large spectrum of techniques and tests, ranging from direct monitoring of the eyeballs to the usage of expensive specialized technical equipment. In this review we are trying to present the most important methods for eye movement analysis -- direct monitoring, usage of high-diopter glasses and the widely used oculographic techniques -- electro- and video oculography and Magnetic field scleral search coil technique. We have identified the major advantages and disadvantages of each method and the field of their implementation. We have given recommendations with regard to the usage of the methods in the different stages of the diagnostic process.
Key words: eye movements, oculographic techniques, electrooculography, videooculography
Address for correspondence: Rosen Ikonomov, M. D., Department of Neurology, MHAT ” Sofiamed”, 16, G. M. Dimitrov Blvd., Bg -- 1797 Sofia



Hepcidin -- diagnostic opportunity in anemia in chronic kidney diseases  - 50, 2014, № 1,18-24.
V. Manolov(1), B. Atanasova(1), V. Vasilev(1), D. Yonova(2), E. Vazelov(2), B. Bogov(3) and K. Tzatchev
(1)Department of Clinical Laboratory and Clinical Immunology, Central Clinical Laboratory, University Hospital “Aleksandrovska”, Medical University -- Sofia, (2)Clinical Center of Dialysis, University Hospital “Aleksandrovska”, Medical University -- Sofia, (3)Department of Internal Diseases, Clinic of Nephrology, University Hospital “Aleksandrovska”, Medical University -- Sofia
Summary: Anemia of chronic disease (ACD), also known as anemia of inflammation, is the most common type of anemia in hospitalized patients worldwide. It has been observed in patients with acute or chronic inflammatory diseases, including infection, cancer, rheumatoid arthritis and chronic kidney disease. It is now clear that inflammatory cytokines are released during acute infection or chronic illness; they may modify the system of iron metabolism by stimulating the synthesis of hepcidin, iron regulatory hormone. Hepcidin blocks the export of iron from the cells as broken cell iron exporter -- ferroportrin; also, the main reason for iron lack and restricted erythropoesis in ACD is caused by increased levels of hepcidin. In recent years, the scientific interest has been focused on the application of new therapeutic agents, who act on the axis hepcidin-ferroportrin: they could inhibit the pathways of hepcidin synthesis or stimulate exports through ferroportrin. Similar therapeutic strategies would lead to better management of breaches in the distribution of iron and subsequently developing anemia of chronic disease.
Key words: iron, iron homeostasis, hepcidin, ferroportrin, anemia in chronic diseases, chro­nic kidney diseases, dialysis
Address for correspondence: Victor Manolov, M. D., Department of Clinical Laboratory and Clinical Immunolo­gy, Medical University, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, tel. +359 2 9230 928, e-mail: victhedoc2@yahoo.com



 Challenges in the investigation of occupational morbidity  - 50, 2014, № 1,25-32.
A. Vatkova.
Medical Faculty, Sofia University
Summary: The investigation of occupational diseases is connected with the arising of unceasing and different challenges in the context of dynamics and trends in occupational morbidity. As it is known, by definition, the occupational disease is an illness, which appears exclusively under the effects of work environment and work process on the body. Factors, determining the hazards of work environment are various and dynamic, depending on the change in technologies, industries, social and economical trends in society. This determines the interdisciplinary character of the science occupational medicine, which deals with the study of work-related diseases and accidents. In this review, we try to synthesize some of the challenges, standing before the scientific society, which deals with occupational morbidity.
Key words: occupational morbidity, challenges and trends, border sciences, health and safety at work, risk assessment
Address for correspondence: Albena Vatkova, Medical Faculty, Sofia University “Sv. Kliment Ohridski”- Sofia, 1 Koziak St., Bg -- 1407 Sofia


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