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Volume 51, 2015



bullet 6'2015

Nosocomial fever of unknown origin origin - Medical Review (Meditsinski pregled), 51, 2015, 6, 5-8.
M. Baymakova

Department of Infectious Diseases, Military Medical Academy -- Sofia
Summary: Nosocomial (hospital-acquired) fever of unknown origin is differentiated from the basic concept for fever of unknown origin in a separated category. The factors leading to this differentiation are the increasing count of hospitalized patients and the differences of etiological groups of nosocomial fever of unknown origin compared with the classic prolonged febrile syndrome. In the category of hospital-acquired fever of unknown the diagnostic efforts are focused on the searching for two main groups of causes: the infectious and noninfectious conditions.
Key words: fever of unknown origin, hospitalized patients, infectious and noninfectious causes
Address for correspondence: Magdalena Baymakova, MD, Department of Infectious Diseases, Military Medical Academy, 3 Sv. G. Sofiyski St., Bg -- 1606 Sofia, e-mail: dr.baymakova@gmail.com




Esophageal adenocarcinoma - Medical Review (Meditsinski pregled), 51, 2015, № 6, 9-15.
A. Kotzev
Gastroenterology Unit, University Hospital „Aleksandrovska” -- Sofia
Summary: Esophageal adenocarcinoma (ЕАC) is a malignant disease with very low survival rates. The incidence of EAC is rising during the last decades and now EAC is the predominant type of esophageal cancer in Europe and North America. The main risk factors for the development of EAC are gastroesophageal reflux disease, Barrett’s esophagus and obesity. The treatment of EAC is still difficult and not sufficiently effective, because EAC is diagnosed at late stages and develops early metastases. Molecular changes in the carcinogenesis of EAC are studied intensively. The use of new diagnostic methods, wider use of endoscopic therapy and proper prophylaxis are promising tools for bigger success in the hard battle with EAC.
Key words: еsophageal adenocarcinoma, Barrett’s esophagus, risk and protective factors, carcinogenesis, diagnosis, therapy, prophylaxis
Address for correspondence: Andrey Kotzev, M. D., Gastroenterology Unit, University Hospital „Aleksandrovska”, 1, Sv. G. Sofiyski Blvd., Bg − 1431 Sofia, е-mail: dr_andrey_kotzev@abv.bg




Galantamine -- effective choice for symptomatic treatment of mild to moderate dementia of the Alzheimer's type type - Medical Review (Meditsinski pregled), 51, 2015, № 6, 16-22.
T. Handjieva-Darlenska(1), V. Belcheva(2) and E. Grigorov(3)
(1)Department of Pharmacology and toxicology, Medical Faculty, MU -- Sofia, (2)Department of Health economics, Faculty of Public Health, MU -- Sofia, (3)Department of Pharmaceutical Sciences and Pharmacy Management, Faculty of Pharmacy, MU -- Varna
Summary: Impairment of memory and other cognitive functions in mild cognitive im¬pair¬ment or dementia are a very actual issue. Dementia is one of the most common neurological conditions in the world. The purpose of thе article is to present an overview of the effectiveness of the use of medicinal products containing galantamine for therapy and symptomatic treatment of mild to moderate Alzheimer's type dementia. In this review we take into account the latest findings in the published scientific literature, expert and local specific data stipulated by the healthcare systems in Europe and Bulgaria.
Key words: galantamine, treatment, dementia of the Alzheimer's type
Address for correspondence: Assoc. prof. Evgeni Grigorov, PhD, e-mail: evgeni.grigorov@mu-varna.bg




Injury of the inferior alveolar nerve related to impacted and semi-impacted mandibular third molars surgery - Medical Review (Meditsinski pregled), 51, 2015, № 6, 23-26.
N. Pavlov
Oral surgeon, Private practice, Plovdiv
Summary: Seddon presented a morphophysiological triple classification of mechanical nerve injuries -- neuropraxia, axonotmesis, neurotmesis. Clinical symptoms are multiple and varying from paresthesia to complete numbness and/or pain. The author discussed etiological and risk factors for injury of the inferior alveolar nerve during third molar surgery.
Key words: inferior alveolar nerve, injury, etiology
Address for correspondence: Nikolay Pavlov, D.D., 15A, Lozarska St., Bg -- 4000 Plovdiv, tel. +359 888254906, e-mail: nikolai.v.pavlov@gmail.com




bullet 5'2015

KIR genes, HLA ligands and viral infections - Medical Review (Meditsinski pregled), 51, 2015, № 5, 5-9.
А. Georgieva, А. Мihaylova and Е. Naumova
Department of Clinical Immunology and Stem Cell Bank, University Hospital “Alexandrovska”, Medical University -- Sofia
Summary: The participation of NK cells in the antivirus protection is undoubted. NK-cell functional activity is determined by the polymorphic KIR genes and HLA class I ligands. Polymorphisms of KIR and HLA class I ligands can favor the escape of virus infected cells from immune surveillance and may directly participate in the pathogenesis of viral infections. Clinically significant KIR phenotypes and receptor ligand interactions leading to recovering from infection or infection chronicity have been identified in several genetic researches. KIRs and their cognate HLA ligands have been determined to be important for the clinical outcome of viral infections. In this review we summarize and discuss the data from studies on the role of KIR genes and their HLA class I ligands in the HBV, HCV, HIV, HCMV, HSV and Influenza infections.
Кey words: NK cells, KIR, HLA ligands, viral infections
Address for correspondence: Atanaska Georgieva, Department of Clinical Immunology, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski St, Bg -- 1431 Sofia, e-mail: neiseria@abv.bg



Role of hepcidin in the development of anemia in multiple myeloma - Medical Review (Meditsinski pregled), 51, 2015, № 5, 10-14.
M. Velizarova(1), V. Manolov(1), E. Hadzhiev(2), K. Tzatchev(3), J. Hristova-Dimitrova(1), B. Atanasova(3) and G. Tcvetkova(2)
(1)Department of Medical Genetics, Medical University -- Sofia, (2)Clinic of Hematology, Department of Internal Diseases, University Hospital Alexandrovska -- Sofia, (3)Department of Clinical Laboratory and Clinical Immunology, Medical University -- Sofia
Summary: Multiple myeloma (MM) is a still incurable malignant plasma cell dyscrasia. MM presents with monoclonal proliferation of plasma cells in the bone marrow, overproduction of circulating monoclonal immunoglobulin, bone lesions, hypocalcaemia, renal failure and anemia. Anemia is one of the prominent features of MM and affects approximately 73% of patients at diagnosis. Several causes have been implicated, but anemia of chronic disease related to the inflammatory cytokines, appears to be one of the main reasons. IL-6, produced in bone marrow microenvironment, modulates the transcription of several liver-specific acute phase protein genes, including C-reactive protein and hepcidin. Hepcidin, by binding to its cellular receptor, ferroportin, causes anemia by blocking iron export from enterocytes and macrophages. As a result, iron depletion on the site of active erythropoiesis and progressive anemia is shown. Baseline serum hepcidin levels correlates significantly with the severity of MM-associated anemia and may serve as a predictor for therapeutic response in myeloma treatment.
Key words: multiple myeloma, anemia, hepcidin
Address for correspondence: Assoc. prof. Milena Velizarova, M.D., Department of Medical Genetics, Medical University, 2 Zdrave St., Bg -- 1431 Sofia, tel.: +359 2 9230 926, e-mail: mvelizarova@abv.bg



Apicoectomy - Medical Review (Meditsinski pregled), 51, 2015, № 5, 15-19.
Ts. Tsvetanov
Department of Oral Surgery, Faculty of Dental Medicine, Medical University -- Plovdiv
Summary: Historically, this method is developed by C. Partsch in 1897. According to him, the removal of the affected apex and surrounding changed tissues is required to remove inflammatory process in the periapical area. The main goal of apical surgery is to prevent bacterial leakage from the root-canal system into the periradicular tissues by placing a tight root-end filling and following root-end resection. The aim of this review is to show the discussions in literature about terminology of the method, its application in different dental groups, the administration of orthograde and retrograde filling materials before and during the surgical intervention, surgical treatment methods, and the filling materials for postoperative bone defect obturation.
Key words: apicoectomy, treatment, filling materials, terminology
Address for correspondence: Tsvetan Tsvetanov, Ph.D, D.D.S., 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



Vitamin D: metabolism and biological effects - Medical Review (Meditsinski pregled), 51, 2015, № 5, 20-26. R. Mihaylov, D. Stoeva and B. Pencheva
Clinical Laboratory, University Hospital “Tzaritza Joanna -- ISUL” -- Sofia

Summary: Vitamin D was discovered in 1782 but was isolated in 1920. The human body provides this vitamin in two ways: a) endogenously -- via synthesis in the skin by ultraviolet B rays (UVB) and b) exogenously -- through animal and plant food. From the intestines through the chylomicrons and from the skin the fat-soluble vitamin D enters the lymph and then the venous circulation. Here it binds to proteins: 85-90% with vitamin D binding proteins (DBP), 10-15% with albumin and only less than 1% is in a free form. Coming from the circulation Vitamin D is hydroxylated to 25-hydroxyvitamin D (25-OH-D or calcidiol). This is the major circulating metabolite of vitamin D. Some of the circulating calcidiol is hydroxylated in the proximal tubules of the kidney to 1,25-hydroxy vitamin D (1,25-OH-2D3 or 1,25 (OH)2D) known as calcitriol, hormonally active metabolite of vitamin D. Local synthesis of calcitriol is also found in many cells and tissues. For its intracellular action vitamin D uses nuclear receptors (VDR) found in 1988. Now it is known that vitamin D is not only "bone vitamin", but it is involved in the regulation of cell proliferation and differentiation, inflammation, immune system and endocrine system, including RAS, insulin resistance and lipid metabolism.
Key words: vitamin D, calcidiol, calcitriol, vitamin D receptor, vitamin D binding protein
Address for correspondence: Rossen Mihaylov, M.D., Clinical Laboratory, University Hospital “Tzaritza Joanna -- ISUL”, 8, Byalo more St., Bg -- 1527 Sofia






bullet 4'2015

Nosocomial infections caused by Stenotrophomonas maltophilia   - Medical Review (Medicinski pregled), 51, 2015, 4, 5-11.
М. Bozhkova, T. Stoeva, K. Bozhkova
Department of Microbiology and Virology, Medical University -- Varna
Summary: Stenotrophomonas maltophilia is increasingly recognized as one of the most important and problematic multidrug resistant nosocomial pathogens. It is the third most commonly isolated aerobic Gram negative bacterium from clinical specimens after Pseudomonas aeruginosa and Acinetobacter baumannii. Debilitated and immunocompromised individuals and cystic fibrosis patients are at risk for development of S. maltophilia infections. As an opportunistic pathogen, this bacterial species is a causative agent of infections with different localization and level of severity. Respiratory tract infections (ventilator associated pneumonia) and bacteriemia are most common. Endocarditis, skin and soft tissue infections, urinary tract infections, meningitis, intraabdominal and ocular infections, septic arthritis, although rare, are also associated with this bacterial species. In this review, the natural habitat of S. maltophilia and its distribution in the hospital environment, as well as the spectrum and the clinical manifestations of the nosocomial infections associated with this species are presented. The specific risk factors for acquisition of S. maltophilia are also discussed.
Key words: Stenotrophomonas maltophilia, nosocomial infections
Address for correspondence: Milena Bozhkova, M. D., Department of Microbiology and Virology, Medical University, 55, Marin Drinov St., Bg 9001 -- Varna, tel. +359 52 978566; +359 887997762, e-mail: drbojkovam@abv.bg



Gastric MALT lymphoma: a modern outlook   - Medical Review (Medicinski pregled), 51, 2015, 4, 12-18.
M. Stamboliyska and K. Ivanov
Clinic of Gastroenterology and Hepatology, University Hospital ''Sv. Marina'' -- Varna
Summary: Mucosa-associated lymphoid tissue (MALT) lymphoma is defined as an extranodal B-cell neoplasia. Gastrointestinal tract is the most common location of extranodal lymphoma, with the stomach being the most commonly affected organ -- in almost 85% of cases. Gastric MALT lymphoma is a rare disease and represents from 2 to 8% of all tumors of the stomach. Gastric lymphoma originating from MALT is typically a low-grade B-cell neoplasia, strongly associated with Helicobacter pylori (НР) infection. Pathogenetic relation between gastric MALT lymphoma and Helicobacter pylori infection is well-proven. Infection with HP is considered a causal factor and is strongly associated with the great majority of cases. It was found that lymphatic follicles are lacking in normal gastric mucosa; they may develop following inflammatory process, forming the so-called MALT. It has been demonstrated that HР-related gastritis is the main cause of the MALT onset on gastric mucosa. Indeed, development of MALT in gastric mucosa may be considered a pathognomonic sign of H. pylori infection. Only certain HР strains in some genetically predisposed patients determine lymphoma development in the stomach. Gastric MALT lymphoma in most cases behaves as an indolent disease. The clinical presentation of gastric lymphoma is poorly specific, with the symptoms ranging from vague dyspepsia, including epigastric pain or discomfort centered in the upper abdomen and less frequently -- alarm symptoms such as gastrointestinal bleeding or persistent vomiting are present. Gastric MALT lymphoma is diagnosed by fibrogastroscopy performed due to dyspeptic symptoms and confirmed by the histomorphological and immunohistochemical studies. Endoscopic biopsy is the gold standard in the diagnosis of gastric MALT lymphoma. Endoscopic ultrasonography plays also an important role in the diagnosis and staging of gastric MALT lymphoma. Diagnosis is “per exclusionem”. The discovery of the etiologic role of H. pylori infection in gastric lymphoma has radically changed the therapeutic approach for such neoplasia. The new guidelines recommend eradication therapy in all low-grade MALT lymphoma patients, irrespective of HР status, before resorting to the aggressive, costly and potentially more toxic oncologic therapies.
Key words: Helicobacter pylori, MALT lymphoma, gastric lymphoma, eradication therapy, anti-tumor therapy
Address for correspondence: Miglena Stamboliyska, M.D., Clinic of Gastroenterology and Hepatology, University Hospital ''Sv. Marina'' -- Varna, tel. +359 52 978 231, e-mail: m.stamboliyska@abv.bg





bullet 3'2015

Prediabetes and prediabetic neuropathy -- etiology and pathogenetic mechanisms - Medical Review (Medicinski pregled), 51, 2015, № 3, 5-11.
S. Nacheva(1), Yu. Petrova(1) and Z. Kamenov(2)
(1)Neurology Clinic, University Multiprofile Hospital for Active Treatment “Alexandrovska” -- Sofia, (2)Endocrynology Clinic, University Multiprofile Hospital for Active Treatment “Alexandrovska” -- Sofia
Summary: Diabetic neuropathy remains a serious problem in a large part of the Bulgarian population, despite the fact that there is logical pathogenetic solution in choosing a medication. Although in many cases the first symptoms of polyneuropathy occur on early stage in glycemic dysregulation, the condition is diagnosed at the overly advanced stage of impairment, when even the most aggressive treatment strategy can hardly bring any improvement. The logical solution is to focus our attention on the early stages of glycemic impairment -- impaired glucose tolerance and impaired fasting glucose, early pathogenetic mechanisms of the reversible damage of the peripheral nerves and determination of components of the peripheral nervous system, which suffer first. This gives a hope for possible successful treatment of prediabetic neuropathy and prevention of its severe disabling complications.
Key words: prediabetic neuropathy, impaired glucose tolerance, impaired fasting glucose, pathogenesis, diagnostic criteria, oxidative stress, hyperglycemia, diabetes type 2
Address for correspondence: S. Nacheva, M.D., Neurology Clinic, University Multiprofile Hospital for Active Treatment “Alexandrovska”, 1, Sv. G. Sofiyski Str., Bg -- 1431 Sofia



Immune-deficient fever of unknown origin - Medical Review (Medicinski pregled), 51, 2015, № 3, 12-21.
M. Baymakova
Department of Infectious Diseases, Military Medical Academy -- Sofia
Summary: Due to the growing count of the people with immune deficiency, it is obligatory to define fever of unknown origin (FUO) among this population. This category is separated in an independent group since 1991 by Durack and Street. But at recent years the scientific interest is rising and more studies and reviews are published. Immune-deficient FUO is a subtype of FUO, encompasses neutropenic FUO and patients after solid organ transplantation. Infections are the leading and main reason of fever among these persons (87%). The diagnostic and therapeutic protocols are distinguished from that applied to classic FUO. Laboratory investigations are extended and guided to identify the etiological agents. The initiating of an empirical therapy is indispensable and life-saving.
Key words: fever, immune deficiency, neutropenia, solid organ transplantation
Address for correspondence: Magdalena Baymakova, M.D., Department of Infectious Diseases, Military Medical Academy, 3, Sv. G. Sofiyski Str., Bg -- 1606 Sofia, e-mail: dr.baymakova@gmail.com



Tinea capitis -- the current trends of the well-known disease - Medical Review (Medicinski pregled), 51, 2015, № 3, 22-30.
A. Chokoeva and L. Zisova
Department of Dermatology and Venereology, Medical University -- Plovdiv
Summary: Tinea capitis is the most common fungal infection in childhood, which is significantly less often seen in adults. It is caused by dermatophytes, as the etiological structure shows some variations in different latitudes, which is connected on one hand with various environmental factors and the differences in the socio-economic status in other. While in urban areas of Europe, the dominant etiological agents are the anthropophilic dermatophytes, in rural areas, among the isolated causative agents of tinea of the scalp prevail the zoophilic dermatophytes -- whose carriers are some agricultural animals and rodents. Tine caused by Microsporum spp. showed no significant differences in the epidemiological structure in different areas, remaining relatively equal frequency of occurrence over the years, seasons and regions of the world. Microsporum canis remains the most common causative agent of Tinea capitis in Europe, as a significant increase in the incidence of infection as well as a significant resistance to certain zoophilic dermatophyte species to current antifungal therapy, including M. canis, have been established lately. A significantly increase of the incidence of infection in adult patients, is observed-from 1 to 11% in different regions, as the clinical picture in these cases is atypical. Asymptomatic carriers of infection are found in a large number of contact individuals, which requires a conduction of mycological examination of all members of the families of these patients. Except immunodeficiency, Hepatitis C virus infection is established to be the most common co-morbidity in elderly patients with Tinea capitis.
Key words: tinea capitis, children, elderly, epidemiology
Address for correspondence: Anastasia Chokoeva, M.D., Department of Dermatology and Venereology, Medical University, 15A, Vasil Aprilov Blvd., Bg -- 4000 Plovdiv, e-mail: assia_chokoeva@abv.bg



Laboratory diagnostics of non-alcoholic fatty liver disease - Medical Review (Medicinski pregled), 51, 2015, № 3, 31-34.
A. Ruseva
Clinical Laboratory, University Hospital “Dr. G. Stranski” -- Pleven
Summary: Moderate increases in serum transaminases are the most common and usually the only laboratory finding in patients with NAFLD. Because of the limitations in routine non-invasive tests, new biomarkers are searched based on current knowledge of the pathophysiological mechanisms involved in the development of NAFLD. In order to facilitate non-invasive assessment of the presence of NAFLD and differentiate the different stages of the disease diagnostic panels and scoring systems have been developed. It has been found that they are more informative to the detection of more advanced fibrosis than in the intermediate and early stages of fibrosis, when there is an expectation of better response to therapeutic interventions.
Key words: laboratory diagnostics, nonalcoholic fatty liver disease, scoring systems
Address for correspondence: Adelaida Ruseva, Clinical Laboratory, University Hospital “Dr. G. Stranski”, 8a G. Kochev St., Bg -- 5800 Pleven, tel. +359 888 309 371, e-mail: adi-ruseva@dir.bg



Prenatal and preimplantational genetic diagnosis in oncology - Medical Review (Medicinski pregled), 51, 2015, № 3, 35-38.
R. Krastev(1) and V. Mitev(2)
(1)Medical College, Medical University -- Sofia, (2)Medical Faculty, Medical University -- Sofia
Summary: The usage of prenatal diagnosis and preimplantational genetic diagnosis for the discovery of genes predisposing towards diseases in childhood and in teenage years is embraced in Europe for 15 years. Investigations of embryos for diseases with late onset and especially for breast and ovary cancer (BRCA1 and BRCA2 genes) are also accomplished in some European countries in the last years. Is it ethically justified to interrupt pregnancy or to select embryos for diseases which eventually could develop after 50-60 years of age? Which one of the two diagnostic tests should be preferred in case of familial burden of the couple? The unregulated application of preimplantational genetic diagnosis in the private reproductive centers in Bulgaria is also discussed.
Key words: reproduction, ethics, prenatal diagnosis, preimplantational genetic diagnosis, cancer diseases
Address for correspondence: R. Krustev, Medical College, Medical University -- Sofia




bullet 2'2015

Fever of unknown origin - Medical Review (Medicinski pregled), 51, 2015, № 2, 5-15.
M. Baymakova

Department of Infectious Diseases, Military Medical Academy --  Sofia
Summary: Puzzling prolonged febrile conditions, called fever of unknown origin (FUO), have been excited mental and intellectual activities of the physician from ancient times to our days. The definition of the condition is written since 1961 based on the report of Petersdorf and Beeson. Infections and non-infectious inflammatory diseases are the leading causes of FUO, followed by groups of neoplasms and miscellaneous disorders. Although active diagnostic events, undiagnosed cases are not a small percentage of all. For accuracy, efficiency and achieving success in the searching of the reason of FUO, the diagnostic algorithm is structured. The therapeutic approaches have been minimized in order to avoid camouflage of the condition, which will delay the process of diagnosis. The application of an etiological therapy is justified in cases of established, proved cause.
Key words: prolonged fever, causes, diagnostic algorithm
Address for correspondence: Magdalena Baymakova, MD, Department of Infectious Diseases, Military Medical Academy, 3 Sv. Georgi Sofiyski Str., Bg --  1606 Sofia, e-mail: dr.baymakova@gmail.com



HIV-associated sarcoma Kaposi - Medical Review (Medicinski pregled), 51, 2015, № 2, 16-21.
E. Trayanova(1), K. Chudomirova(1) and R. Komitova(2)
(1)Department of Dermatology, University Hospital “Sv. Georgi” --  Plovdiv, (2)Department of Infectious Diseases, University Hospital “Sv. Georgi” --  Plovdiv
Summary: Кaposi sarcoma (KS) is a multicentric angioproliferative cancer of endothelial origin typically occurring in the setting of immunodeficiency, i.e. coinfection with human immunodeficiency virus (HIV) or transplantation. The incidence of KS has dramatically decreased in both US and Europe in active antiretroviral therapy (ART) era. Nevertheless, it remains one of the most common AIDS-defining malignancies. HIV associated KS has a variable clinical course ranging from very indolent form to a rapidly progressive disease. ART presents the first treatment step for slowly progressive disease. Chemotherapy plus ART is indicated for visceral and/or rapidly progressive disease. Novel target therapy, based on anti-angiogenic agents has been in final stages of clinical trials. These drugs may represent effective strategy for patients with advanced HIV associated KS (AIDS-KS), which may progress despite chemotherapy and/or ART. In this review we focus on clinical presentation and current therapeutic options of AIDS-KS.
Key words: АIDS associated Кaposi sarcoma, active antiretroviral therapy, liposomal anthracyclines
Address for correspondence: Assoc. Prof. Radka Komitova, M.D., Department of Infectious Diseases, University Hospital “Sv. Georgi”, 66, Peshtersko shoes St., Bg --  4000 Plovdiv, tel. +359 882 495 800



Psychiatric comorbidity in somatic disorders -- hidden morbidity and its health economic consequences - Medical Review (Medicinski pregled), 51, 2015, № 2, 22-25.
I. Natsov
Government Psychiatric Hospital --  Karlukovo, Psychiatrist --  Cherven Briag
Summary: The incidence of mental disorders in the general hospital wards is higher than in the general population. However, a considerable part of them remains unrecognizable from hospital doctors. There is a significant correlation between mental comorbidity, prolonged hospital stay and rehospitalizations one year after discharge. Other consequences of the inability to work with the psychosomatic comorbidity are: unnecessary and often expensive laboratory tests; alternating hospitalizations; drug addiction; disturbed doctor–patient relationship; secondary impact on family and social functioning; loss of funds; dependence on the health system in an effort to obtain social support. Psychiatric comorbidity is associated with a 45-75% increase in the price of the service of chronic physical diseases. Psychological-psychiatric interventions in patients with physical illnesses treated in a general hospital can reduce the price to 20%.
Key words: psychiatric comorbidity, somatic diseases, health economics
Address for correspondence: Ivo Natsov, M. D., Psychiatrist, 61, Yane Sandanski Str., Bg --  5980 Cherven Briag, e-mail: ivo_nacov@abv.bg




bullet 1'2015


Rickettsial diseases in the globalizing world. I. Tick-born rickettsiae and rickettsial diseases in Europe and Africa - Medical Review (Meditsinski pregled), 51, 2015, №1, 5-14.
I. Baltadzhiev(1) and A. Kevorkyan(2)
(1)Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical Faculty, Medical University -- Sofia, (2)Department of Epidemiology and Disaster Events Medicine, Faculty of Public Health, Medical University -- Plovdiv
Summary: Rickettsiae are widespread but unevenly distributed across the world. Serious and sometimes debilitating rickettsial diseases account for a significant, but commonly undetected part of the acute febrile illnesses. The available, effective treatment contributes to disease attenuation and reduces mortality however this requires adequate knowledge of the clinical features and reliable diagnostic methods. The aim of the authors was to present a literature review of the current state of the group of tick-born spotted fevers (SFG) rickettsiae and rickettsial infections in the globalizing world. This information is needed for wide tourism developments with easy access to the most remote areas of the earth. A review of the available literature over the last 10-15 years was performed, focused on: newly discovered rickettsiae and emerging rickettsial diseases, as well as on re-emerging known, but long-term absent rickettsial infections in individual countries and regions. Previously unidentified imported rickettsial diseases in non-endemic areas were also included in the survey. The spread of rickettsiae and rickettsial infections in today's globalizing world and especially in Europe, North Africa and Sub-Saharan Africa was presented. Attention was paid on the re-emergence of Mediterranean spotted fever (MSF) in Bulgaria in the past 20 years, based on the authors’ own experience.
Key words: Rickettsiae, SFG-rickettsial diseases, globalizing world, surveillance, control
Address for correspondence: Ivan Baltadzhiev, M.D., Department of Infectious Diseases, Medical University, 15A Vasil Aprilov Blvd., Bg -- 4002 Plovdiv, tel. +359 32 602 851, e-mail: ivan_balt@yahoo.com



The role of chimerism analysis in hematopoietic stem cell transplantation - Medical Review (Meditsinski pregled), 51, 2015, №1, 15-19.
Ts. Lukanov and E. Naumova
Department of Clinical Immunology, University Hospital „Aleksandrovska” -- Sofia
Summary: One of the most important events in the post-hematopoietic stem cell trans­plan­ta­tion (HSCT) is the immune system restoration -- a process characterized by a con­siderable dynamics. During this period patients are exposed to different life-threatening complications. In this review article we consider chimerism levels in relation to the conditioning regimens and disease type. Furthermore the predictive role of chimerism analysis as an important method in monitoring the early diagnosis of GVHD, MRD, graft failure or rejection, and disease relapse has been discussed.
Key words: chimerism, allogeneic hematopoietic stem cell transplantation, GVHD, relapse
Address for correspondence: Tsvetelin Lukanov, M.D., Clinic of Clinical Immunology, University Hospital “Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, tel. +359 2 9230-690, GSM: +359 886-86-96-20



Is low-energy laser therapy effective in the treatment of wounds? - Medical Review (Meditsinski pregled), 51, 2015, №1, 20-24.
G. Georgiev(1)
and K. Kazalakova(2)
(1)Department of Physiotherapy, Military Medical Academy -- Sofia, (2)Department of Physiotherapy, Emergency Hospital „Pirogov” -- Sofia
Summary: The extensive experimental studies of the wounds treatment using LELT have started in the 1960’s. Most of the articles dedicated to this treatment method do not specify the exact procedure and dosage used, which is an obstacle to the reproducibility of treatment. So far there is a lack of data concerning the effect of the dose in clinical cases. The unsatisfactory results in some of the studies are probably due to the use of ineffective wave length or radiance exposition. For the treatment of wounds a radial exposition of 0.5-36 J/cm2 is used. This interval is too variable for the concrete patient, the pathology treated and the duration of the treatment. Based on our experience we believe that the development of the LELT would strongly improve the effectiveness of wound treatment.
Key words: wounds, LELT, LLLT
Address for correspondence: G. Georgiev, M.D., Department of Physiotherapy, Military Medical Academy, 3, Sv. G. Sofiyski St., Bg -- 1606 Sofia



Teeth retention - Medical Review (Meditsinski pregled), 51, 2015, №1, 25-30.
Ts. Tsvetanov
Department of Oral Surgery, Faculty of Dental Medicine, Medical University -- Plovdiv
Summary: The aim of this review is to present some aspects of the issues concerning teeth retention. The incidence, clinical symptoms and choice of treatment method are discussed. The author provides an overview of the literature that covers other authors’ experience on postoperative complications.
Key words: postoperative complications, retention
Address for correspondence: Tsvetan Tsvetanov, Ph.D, Asst. Prof., Department of Oral Surgery, Faculty of Dental Medicine, Medical University, 3, Hristo Botev Blvd, 4000 Plovdiv, tel. +359 898-32-53-32


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