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Volume 52, 2016


bullet 6'2016

Pancreatic exocrine insufficiency: general characteristic and therapy – Medical Review (Medicinski pregled), 52, 2016, № 6, 5-10.
M. Baymakova1, R. Andonova1, M. Pishmisheva2, N. Zaekov3, L. Pekova4, K. Plochev1

1Department of Infectious Diseases, Military Medical Academy – Sofia
2Department of Infectious Diseases, Hospital of Pazardzhik
3Department of Physiology and Biochemistry, National Sports Academy – Sofia
4Department of Infectious Diseases, University Hospital of Stara Zagora
Summary: Pancreatic exocrine insufficiency is an increasingly common medical problem which leading to active research and analysis. The purpose of this article is to present a brief analysis of pancreatic exocrine insufficiency. Topics as definition, pathogenesis, causes, diagnosis and therapy are described. Therapy with Creon is detailed presented. Increasing knowledge of the pancreatic exocrine insufficiency is beneficial for all physicians and their patients. Therefore, a similar review is timely and appropriate.
Key words: pancreatic exocrine insufficiency, Creon
Address for correspondence: Magdalena Baymakova, MD, PhD, Department of Infectious Diseases, Military Medical Academy, 3 Sv. Georgi Sofiyski Str., Bg – 1606 Sofia, e-mail: dr.baymakova@gmail.com



Next-generation sequencing: overview of the sequencing technology and application in tissue typing and molecular diagnostics of myeloid neoplasms – Medical Review (Medicinski pregled), 52, 2016, № 6, 11-16.
I. Pavlov, M. Ivanova

Department of Clinical Immunology with Stem Cell Bank, University Hospital “Aleksandrovska” - Sofia
Summary: Next-generation sequencing (NGS) technologies are superior to conventional sequencing methods in terms of sequencing capacity and sensitivity, the ability to multiplex samples, clonal sequencing of single molecules, cost benefits and others. These advantages as well as the possibility of developing new diagnostic approaches lead to the indispensable implementation ofNGS in clinical diagnostics. This review presents the methodology aspects, the advantages and disadvantages of the most widely used NGS platforms and a brief description of NGSapplications in tissue typing and molecular diagnostics of myeloid neoplasms.
Key words: next-generation sequencing, molecular diagnostics, tissue typing, myeloid neoplasms
Address for correspondence: Ivan Pavlov, Tel.: +359 887067676, e-mail: ivanypavlov@yahoo.com



The safety and efficacy of inhaled adrenaline in children with acute laryngotracheitis – Medical Review (Medicinski pregled), 52, 2016, № 6, 17-21.
M. Yankova, S. Mileva, I. Galeva
Pediatric Clinic, University Hospital “Aleksandrovska” – Sofia
The aim of this review is to present the results of studies on the efficacy of inhaled epinephrine in the treatment of children with acute laryngotracheitis (croup). The safety of application and effect of inhaled adrenaline on the general condition, clinical symptoms, heart rate and blood pressure are assessed. Fifteen studies on 623 patients aged 6 months to 6 years with acute laryngotracheitis are conducted. The efficacy of inhaled adrenaline 0.1% versus placebo (0.9% NaCl), racemic Epinephrine 2.25%, Budesonide and Dexamethasone is compared. There is a significant reduction in the severity of clinical symptoms and duration of hospitalization of children with croup treated with inhaled Epinephrine with no difference in the level of safety compared to the other groups. Conducted international clinical studies confirmed the effectiveness and clinical safety of inhaled adrenaline 0.1% in pediatric practice. Based on this evidence, we recommend the use of adrenaline 0.1% in children with moderate to severe croup.
Key words: inhalatory adrenalin, L-adrenalin, racemic adrenalin, acute laryngothacheitis, croup
Address for correspondence: Milena Yankova, MD, Clinic of Pediatrics, UMHAT „Alexandrovska”, 1 “Sv. G. Sofiyski” St., 1431, Sofia; tel.: +359 2 92 30 359, e-mail: milena_yankowa2001@yahoo.com



Antiretroviral pre-exposure prophylaxis for prevention of HIV infection – Medical Review (Medicinski pregled), 52, 2016, № 6, 22-27.
R. Komitova.
Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University – Plovdiv
Summary: Despite two decades of highly active antiretroviral therapy HIV infection rates globally remain high (about 2 million new infections globally), even though HIV transmission is substantially attenuated when individuals use antiretroviral ART. Effective interventions to decrease HIV acquisition for individuals at greatest risk are needed. Antiretroviral pre-exposure prophylaxis (PrEP) is tailored for individuals who have a recurrent risk of being infected with HIV. Efficacy of PrEP was correlated with levels of adherence. It is well tolerated and the evolution of HIV resistance has been low. Compensatory increased sexual risk behavior was not observed. Studies have been under way to evaluate pericoital PrEP and assess other modes of PrEP such as vaginal ring, injectable medications and new topical formulations. PrEP is recently approved by the European Medicines Agency, although not yet reimbursed in most countries. No single intervention is likely to end the HIV epidemic and the PrEP scale-up is a global health imperative as a part of combined prevention efforts.
Key words: HIV prevention, pre-exposure prophylaxis, antiretrovirals
Address for correspondence: Assoc. Prof. Radka Komitova, M.D., Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University, 15A V. Aprilov Blvd, Bg  4000 Plovdiv, e-mail: radkakomitova@yahoo.com



Indices for measurement of disease activity and therapeutic response in psoriatic arthritis. Part I: peripheral arthritis, axial involvement, enthesitis, dactylitis, skin and nail involvement – Medical Review (Medicinski pregled), 52, 2016, № 6, 28-34.
A. Kopchev, S. Monov
Clinic of Rheumatology, Medical University – Sofia
Summary: Psoriatic arthritis, as a prototype member of the spondyloarthropathies, is associated with involvement of the musculoskeletal system, periarticular structures and other organs and systems. The current review shows the up-to-date methods for measuring the disease activity in the peripheral joints and axial skeleton, the skin and its structures and some extraarticular manifestations such as dactylitis and enthesisits. The indices for response to the therapy are also described.
Key words: psoriatic arthritis, enthesitis, dactylitis, systemic involvement, activity, therapeutic response, indices
Address for correspondence: A. Kopchev, Clinic of Rheumatology, Medical University, 13 Urvich St. 1612 Sofia



bullet 5'2016

Gastrointestinal diseases in HIV-infected patients – clinical manifestationsand diagnostic methods – Medical Review (Medicinski pregled), 52, 2016, № 5, 5-16.
N. Yancheva.
Summary: The gastrointestinal tract (GI) is a major site of disease during HIV infection. Almost half of HIV-infected patients present with gastrointestinal symptoms, such as anorexia, weight loss, dysphagia, odynophagia, abdominal pain, and diarrhea. The major diagnostic tests that are used for those patients are microbiological and parasitological analyses, endoscopic and histopathological evaluation. This review article summarizes the HIV-associated GI pathology with emphasis on clinical manifestations and major diagnostic tests.
Key words: HIV, gastrointestinal diseases, microbiological analysis, parasitological analysis, endoscopy, histopathological testing
Address for correspondence: Nina Yancheva, M. D., Department of Infectious Diseases, Parasitology and Tropical Diseases, Medical University, 17, Acad. Iv. Geshov Blvd., Bg – 1606 Sofia, е-mail: dr.yancheva@abv.bg



Vitamin D and autoimmune diseases – Medical Review (Medicinski pregled), 52, 2016, № 5, 17-22.
Mihaylov1,2, B. Pencheva1, D. Stoeva1
1Independent Medical Diagnostic Laboratory “Ramus” OOD
2Medical College “Y. Filaretova“, Medical University – Sofia
Summary: The role of Vitamin D for calcium homeostasis and differentiation of osteoclasts iswell studied. In recent years the scientific studies have focused on the importance ofVitamin D for a number of diseases, including autoimmune, such as type 1 diabetesmellitus, multiple sclerosis, systemic lupus erythematosus, etc. The importanceof Vitamin D receptors and Vitamin D binding proteins in the development ofautoimmunity has been examined. Vitamin D deficiency probably plays an importantrole in immune-mediated diseases. If vitamin D is the cause or consequence ofa particular autoimmune disease remains a controversial question. Thereforeadditional meta-analyzes and controlled studies are required.
Key words: calcidiol, calcitriol, vitamin D receptors, vitamin D binding protein, type 1 diabetesmellitus, multiple sclerosis, systemic lupus erythematosus

Address for correspondence: Blagovesta Pencheva, Independent Medical Diagnostic Laboratory “Ramus”OOD 2-4 „Аngista“ st., Bg  1527 Sofia, tel.: +359 2 943 1196, +359 2 943 1196,e-mail: blagovesta.pencheva@ramuslab.com



„Non-criteria” antiphospholipid antibodies and „non-criteria”clinical symptoms for the diagnosis of antiphospholipid syndrome – Medical Review (Medicinski pregled), 52, 2016, № 5, 23 – 28.
M. Nikolova-Vlahova1 and M. Baleva2
1Department of Nephrology, University Hospital “Alexandrovska”, Department of Internal Diseases,Medical University – Sofia
2Clinic of Clinical Immunology, University Hospital „Alexandrovska” – Sofia
Summary: In the last years the question about the so called “non-criteria” antiphospholipidantibodies (aPL) and “non-criteria” clinical symptoms of Antiphospholipid syndrome(APS) has been discussed. Many data show that aPL are a heterogeneous groupof antibodies, different from antibodies to cardiolipin (aCL), beta-2-glycoprotein I(aB2GPI) and lupus anticoagulant (LA). The diagnosis of “seronegative APS” (SNAPS)has been introduced. The arguments “for” and “against” this diagnosis havebeen discussed.
Key words: antiphospholipid syndrome, seronegative antiphospholipid syndrome
Address for correspondence: Milena Nikolova-Vlahova, Department of Nephrology, University Hospital“Aleksandrovska”, 1. Sv. G. Sofiyski st., Sofia 1431. e-mail: milena_i_dani@abv.bg



The role of probiotics in the therapy of bacterial vaginosis – Medical Review (Medicinski pregled), 52, 2016, № 5, 29-33.
V. Raykova1, D. Ovnarska2, R. Baykushev1
1Department of Medical Microbiology, Medical University – Sofia
2Student at Medical University of Sofia
Summary: The human microbiota is estimated to be 2.5-3.0 kg in human body. Bacterial colonization of the body (skin and mucosa) starts during embryonic development, then spreads during delivery, due to fetal contact with vaginal and intestinal maternal microorganisms, and continues to evolve during the whole life. The vagina is an important microenvironment colonized by different microorganisms that in healthy persons coexist in symbiosis. Violation of the fine balance of species inhabiting it causes dysbiosis. Vaginal dysbiosis may lead to bacterial vaginosis (BV) or vulvo-vaginal candidiasis (VVC), two very common conditions among women of reproductive age. Probiotics are a relatively new tool, used in the therapy of different dysbiotic conditions. More and more frequently they are used as monotherapy in the mild dysbiotic conditions. Additional studies over the microorganisms included in their composition, the route of administration – vaginal or oral, the doses and the dosing regimen are required to confirm their benefits or to clarify their role in the therapy of BV and VVC and their application in practice.
Key words: bacterial vaginosis, probiotics
Address for correspondence: Vessela Raykova, MD, Department of Medical Microbiology, Medical University, 2 Zdrave st., Bg 1431 Sofia; e-mail: pumpi@abv.bg





bullet 4'2016

Congenital coronary artery anomalies with origin  in the contralateral sinus of Valsalva -- when we should choose surgical treatment – Medical Review (Medicinski pregled), 52, 2016, № 4,  5-10.

Congenital coronary artery anomalies with origin in the contralateral sinus of Valsalva -- when we should choose surgical treatment
M. Popovska, P. Petrov and Ml. Grigorov
Clinik of Cardiology, Second MHAT – Sofia
Summary: Recent years have witnessed a change in the perception of congenital coronary artery anomalies. From being regarded as simple coronary angiographic observations of little clinical significance, they are being to be seen as potential causes of sudden death and myocardial ischemia. Diagnostic difficulties, their highly variable incidence and individual terapeutic management in each patiеnt have made congenital coronary artery anomalies of great interest to cardiologists. This article focuses on the group of coronary artery anomalies that is responsible for most clinical events: anomalies that have their origin in the contralateral sinus of Valsalva. Coronary artery anomalies are defined, their incidence is discussed, diagnostic criteria are given, and finally, a treatment algorithm based on current knowledge is proposed.
Key words: coronary artery, congenital anomaliеs, angina, risk stratification, surgical treatment
Address for correspondence: Monika Popovska, M.D., e-mail: monika_popovska@abv.bg



Benign mimikers of prostate cancer – Medical Review (Medicinski pregled), 52, 2016, № 4,  11-17.
Sv. Bachurska
Department of General and Clinical Pathology, Medical University – Plovdiv
Summary: Prostate cancer is the second most common neoplasm and ranked sixth as a cause of cancer mortality among the male population worldwide. With the introduction of a national screening program for prostate-specific antigen we could expect an increased level of morbidity due to the large number of men tested. These data demonstrate the importance of accurate histological diagnosis of this disease. Precision made in full interpretation of prostate biopsy and presumption is important for the subsequent therapeutic management of individual patients. Histological assessment of small area of the biopsy tissue is not always easy even for the experienced pathologists. The term "atypical small acinar proliferations" includes benign glandular lesions of the prostate which imitate prostate cancer. This diverse histologic group creates the greatest difficulty for interpretation of limit in size of the biopsy material.
Key words: prostate cancer, atypical small acinar proliferation, adenosis
Address for correspondence: Svitlana Bachurska, M. D., Department of General and Clinical Pathology, Medical University -- Plovdiv, e-mail: svitba@gmail.com



Molecular methods for the typing of enteropathogene bacteria – Medical Review (Medicinski pregled), 52, 2016, № 4,  18-23.
M. Pavlova
National Center of Infectious and Parasitic Diseases (NCIPD), Department of Microbiology – Sofia
Summary: The outbreaks of infectious diseases of which the most frequent human foodborne infections are а serious health problem in all countries. The rapidness ​​and high discriminative ability of the novel molecular methods of typing and characterization of the pathogenic isolates in the event of epidemic outbreaks, provide the opportunity for а rapid identification of the sources and the way of transmission of enteropathogens, as well as the exact distinction between related cases and sporadic infections. These advantages give the possibility for the implementation of timely and adequate measures to control the epidemic outbreak.
Key words: outbreaks, enteropathogens, typing, PFGE, MLVA, WGS
Address for correspondence: Maria Pavlova, National Center of Infectious and Parasitic Diseases (NCIPD), Department of Microbiology -- Sofia, е-mail: mimipavlova@mail.bg



Asymmetric dimethylarginine -- risk factor  and marker for atherosclerosis – Medical Review (Medicinski pregled), 52, 2016, № 4, 24-28.
Yu. Petrova (1), V. Manolov(2), G. Angov(1), I. Petrova(1), V. Vasilev(2) and K. Tzatchev(2 )
(1)Department of Neurology,
(2)Department of Clinical Laboratory and Clinical Immunology, Medical University -- Sofia
Summary: Atherosclerosis is one of the leading causes for mortality and for complications after cardio-vascular diseases (CVD) worldwide. Endothelial dysfunction preceded atherosclerosis manifestation. Nitrogen oxide (NO) from endothelium reacts as one of main vasodilatators. Low NO levels are connected to endothelial dysfunction. Asymmetric dimethyl arginine (ADMA) inhibits NO synthesis and thus may damage endothelial function and leads to atherosclerosis development. Elevated serum ADMA concentrations correlates to cardio-vascular factors such as hyper­cho­le­ste­rol­emia, arterial hypertension, diabetes mellitus, chronic heart failure, chronic kidney injury and smoking. ADMA is a predictor of carotid IMT progression. ADMA levels are powerful CVD predictors. Elevated ADMA is connected to increased stroke risk. ADMA concentrations are elevated in serum and SCF both, after acute stroke. Endothelial dysfunction predicts low performance in several cognitive domains. Some trials shows that a few number of medical suplies has conductive effect on CVD, lowering ADMA levels.
Key words: ADMA, oxidative stress, nitrous oxide, free radicals, L-arginine, LDL-cholesterol
Address for correspondence: Victor Manolov, MD, PhD, Department of Clinical Laboratory and Clinical Immunology, Medical University, 1, Sv. G. Sofiyski Blvd., Bg -- 1431 Sofia, tel. +359 2 9230928, e-mail: victhedoc2@yahoo.com



Metabolic acidosis in chronic kidney disease -- pathogenesis and consequences – Medical Review (Medicinski pregled), 52, 2016, № 4,  29-34.
D. Yonova and V. Papasov

University Clinical Dialysis Center, Medical University – Sofia
Summary: Acid-base balance is maintained by natural elimination of carbon dioxide by the lungs (which affects the partial pressure of carbon dioxide) and normal excretion of nonvolatile acid by the kidneys (which affects the plasma bicarbonate concentration). The hydrogen ion concentration of the blood is determined by the ratio of the PCO2 and plasma bicarbonate concentration. Most individuals produce approximately 15000 mmol of carbon dioxide and 50 to 100 mEq of nonvolatile acid each day. This review concerns the problems of acidosis in chronic kidney disease.
Key words: acid-base balance, carbon dioxide, plasma bicarbonate concentration, chronic kidney disease, hemodialysis
Address for correspondence: Prof. Diana Yonova, M. D., University Clinical Dialysis Center, Medical University, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, e-mail: yonovad@abv.bg





bullet 3'2016

Hereditary gastric cancer – Medical Review (Medicinski pregled), 52, 2016, № 3, 5-10.
M. Mirchev(1), A. Kotzev(2) and I. Kotzev(1)
(1)Clinic of Gastroenterology, UMHAT “Sv. Marina” -- Varna, (2)Clinic of Propedeutics of Internal Medicine, UMHAT Aleksandrovska -- Sofia
Summary: Hereditary diffuse gastric cancer (HDGC) is diagnosed in up to 3% of patients with gastric cancer. CDH1 is the responsible gene that codes Е-cadherin, a key factor responsible for the adherent junctions between epithelial cells. Formation of multiple loci with “signet cell” carcinoma under macroscopically intact mucosa represents the main characteristics of the syndrome; hence early endoscopic diagnosis remains so far a challenge. International Gastric Cancer Linkage Consortium (IGCLC) criteria are applied for accurate diagnosis of HDGC. The latter is associated with lobular carcinoma of the mammary glands in female patients. The approach to CDH1 gene mutation carriers is prophylactic gastrectomy for reduction of cancer risk. In the presence of cancer the next step is tumor staging. Prognosis in early stage is very good, but malabsorption, dumping syndrome, deficiency of vitamins and micronutrients, strictures, etc. are common postoperative complications which require appropriate treatment.
Key words: hereditary gastric cancer, diffuse gastric cancer, CDH1, IGCLC criteria, endoscopic screening
Address for correspondence: Milko Mirchev, M.D., Clinic of Gastroenterology, UMHAT “Sv. Marina”, 1, Hristo Smirnenski Blvd., Bg -- 9010 Varna, tel. +359 889350224, e-mail: mbmirchev@yahoo.com



Traumatic esophageal injury – Medical Review (Medicinski pregled), 52, 2016, № 3, 11-16.
A. Kotzev(1) and M. Mirchev(2)
(1)Gastroenterology Unit, University Hospital „Aleksandrovska”, Medical University -- Sofia, (2)Clinic of Gastroenterology, University Hospital „Sv. Marina”, Medical University -- Varna
Summary: Traumatic esophageal injury is a rare, but potentially life-threatening condition. Iatrogenic traumatic injuries are caused mainly by endoscopic procedures, placement of nasogastric and other tubes, whereas noniatrogenic traumatic injuries include penetration or, less commonly, blunt injuries. Mallory-Weiss syndrome is characterized by gastrointestinal bleeding secondary to the longitudinal nontransmural esophageal tear, whereas Boerhaave syndrome is a transmural perforation of the esophagus. Main symptom of the rare spontaneous esophageal hematoma is the chest pain and therefore a wrong diagnosis is possible. Traumatic esophageal injuries require fast diagnosis and conservative, endoscopic or surgical therapy.
Key words: esophagus, trauma, perforation, bleeding, Х-ray examination, endoscopy, surgery, therapy
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



Molecular methods for the identification of enteropathogene bacteria – Medical Review (Medicinski pregled), 52, 2016, № 3, 17-23.
M. Pavlova
Department of Microbiology, National Center of Infectious and Parasitic Diseases -- Sofia
Summary: The last decade was revolutionary in the development and application of molecular methods in the diagnosis and control of communicable diseases. With the increasing wealth of data about the genomes of different organisms, techniques for the analysis of DNA by polymerase chain reaction (PCR), plasmid profile, restriction analysis, DNA sequencing, etc., are increasingly entering in clinical laboratories. They allow rapid identification of microorganisms, which had previously been difficult to define with conventional microbiological methods. In addition, PCR methods are extremely useful for the detection of pathogens in the beginning of the disease, which is a condition for successful prevention and control of any contagious outbreak.
Key words: enteropathogens, PCR, identification, diarrhea, microarray
Address for correspondence: е-mail: mimipavlova@mail.bg



The role of E-cadherin as an element of epithelial-mesenchymal transition in ovarian carcinoma – Medical Review (Medicinski pregled), 52, 2016, № 3, 24-28. D. Bozhkova(1, 2) and E. Poriazova(1)
(1)Department of General and Clinical Pathology and Forensic Medicine, Medical University -- Plovdiv, (2)Department of Clinical Pathology, University Hospital “Sv. Georgi” -- Plovdiv
Summary: Ovarian carcinoma is one of the most common and lethal malignant diseases of the female reproductive system. Epithelial-mesenchymal transition is a fun­da­men­tal process in morphogenesis and tumorigenesis. Data show that this process participates in the tumor invasion and metastasis of ovarian cancer. De­creased E-cadherin expression refers to loss of cell adhesion as an element of epithelial-mesenchymal transition. The function of E-cadherin in ovarian cancer cells remains controversial. New studies are required to establish the correlation with traditional clinicopathological factors in ovarian carcinoma. The aim of this re­view article is to investigate the role of E-cadherin in the progression of ova­rian carcinoma immunohistochemically and in connection with the epithelial-me­sen­chymal transition.
Key words: ovarian carcinoma, epithelial-mesenchymal transition, E-cadherin, immuno­his­to­che­mistry
Address for correspondence: Desislava Bozhkova, М. D., Department of General and Clinical Pathology and Forensic Medicine, Medical University, 15A Vasil Aprilov St., Bg -- 4000 Plovdiv, tel. +359 32 602047, e-mail: desislava_lapteva@abv.bg



Viral hemorrhagic fever Ebola -- part II – Medical Review (Medicinski pregled), 52, 2016, № 3, 29-35.
N. Kalvatchev
Department of Medical Microbiology, Faculty of Medicine, Medical University -- Sofia
Summary: The epidemic of Ebola Virus Disease (EVD) in West Africa surprised the biggest experts in infectious diseases and public health field. The outbreak during 2013-2015 left over 26,000 ill patients and more than 11,000 dead cases. It is considered that this situation is more due to social factors than viral biological characteristics. At this point, little is known about the exact mechanism of transmission of this infection, mainly because of the small number of studied clinical cases described before 2013. This article provides a summary of diverse information accumulated during last events, discusses ways of transmission of EVD between humans and/or animals, and gives evidence about the clinical features of this viral hemorrhagic fever.
Key words: viral hemorrhagic fever ebola, Ebola virus, transmission
Address for correspondence: Nikolay Kalvatchev, MD, PhD, Department of Medical Microbiology, Faculty of Medicine, Medical University -- Sofia, 1, Sv. G. Sofiyski Blvd., Bg -- 1431 Sofia, tel. +359 2 91 72-779/577, e-mail: nkalvat@yahoo.com




bullet 2'2016

Phenotypic and genetic characteristics of antibiotic resistance to carbapenems in Acinetobacter baumannii and Pseudomonas aeruginosa – Medical Review (Medicinski pregled), 52, 2016, № 2, 5-14.
A. Petrova(1, 2) and M. Murdzheva(1, 2)

(1)Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University -- Plovdiv, (2)Laboratory of Microbiology, University Hospital “Sv. Georgi” -- Plovdiv
Summary: The last years of our contemporaneity are stamped by the increasing problem concerning resistance to antimicrobial drugs especially those with broad spectrum of activity as carbapenems. This is of a direct concern of Gram-negative non-fermenters facing Acinetobacter baumannii and Pseudomonas aeruginosa. The mechanisms of resistance are of great variety and often combined. The production of carbapenem-hydrolyzing enzymes class oxacillinases is considered the main factor of carbapenem resistance in Acinetobacter whereas in Pseudomonas the loss of transmembrane OprD protein together with the hyperexpression of some major efflux pumps are assumed to lead to this type of resistance. The production of metaloenzymes in the latter is considered to play a secondary role. The epidemiological situation in our country resembles the pattern of worldwide tendency.
Key words: antibiotic resistance, Gram-negative non-fermenters, carbapenems
Address for correspondence: Atanaska Petrova, Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University -- Plovdiv, е-mail: atanasia_petroff@abv.bg



The effect of leptin on thermoregulation in various homeostatic states states – Medical Review (Medicinski pregled), 52, 2016, № 2, 15-21.
M. Hristov
Department of Pharmacology and Toxicology, Medical Faculty, Medical University -- Sofia
Summary: Leptin, a hormone secreted by the cells of the adipose tissue, acts in the central nervous system by regulating body weight, food intake and energy expenditure. Its effect on thermoregulation is well documented but as yet not fully known by what mechanism of action carries them out. However, in recent years, our knowledge of neuronal thermoregulatory circuits grew strongly and opened up areas of the target of leptin action (groups of neurons expressing the long form of the leptin receptor -- LepRb), through which it regulates the thermogenesis in the brown adipose tissue. In this review there are presented data for modulating activity of leptin on thermoregulation in various homeostatic states.
Key words: leptin, thermoregulatory circuits, thermogenesis, brown adipose tissue, homeostatic states
Address for correspondence: Milen Hristov, M. D., Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University, 2, Zdrave St., Bg -- 1431 Sofia, tel. +359 2 9 172 631, e-mail: milen_hristov@abv.bg



Pathogenesis of inflammatory bowel disease disease – Medical Review (Medicinski pregled), 52, 2016, № 2, 22-28.
R. Nakov(1) and Tsv. Velikova(2)
(1)Clinic of Gastroenterology, „Tsaritsa Yoanna -- ISUL” University Hospital -- Sofia, (2)Laboratory of Clinical Immunology, “Sv. Ivan Rilski” University Hospital -- Sofia
Summary: Recent advances of medicine have provided substantial insight into the pathogenesis of Inflammatory Bowel Disease (IBD). From immunological point of view, the main issue in this direction is dysregulation of the mucous immune system and inappropriate immune response to the composition of the normal intestinal flora, food antigens and other exogenous factors. The cells responsible for intestinal homeostasis use diverse intracellular and intercellular networks to promote immune tolerance, inflammation or epithelial restitution. Current aspect in the pathogenesis of IBD are the defects in mucous barriers and antimicrobial peptides associated with increased intestinal permeability. Furthermore, genomic studies identified predisposing to IBD loci of genes. This review aims to present better understanding of the up-to-date multicomponent pathogenesis of IBD, which is the basis for the search for better diagnostic and therapeutic approaches to these diseases.
Key words: Inflammatory Bowel Disease, pathogenesis, mucous immune system, Тh17, IL-17, Tregs
Address for correspondence: Radislav Nakov, M. D., Clinic of Gastroenterology, „Tsaritsa Yoanna -- ISUL” University Hospital, 8, Byalo more St., Bg -- 1527 Sofia, e-mail: radislav.nakov@medicalnews.bg




bullet 1'2016

Cognitive dysfunction in multiple sclerosis and its connection to some biological markers - Medical Review (Medicinski pregled), 52, 2016, № 1, 5-9.
T. Kunchev, M. Raycheva, M. Petrova and L. Traykov
Department of Neurology, University Hospital “Aleksandrovska” -- Sofia
Summary: Multiple sclerosis is a progressive demyelinating and degenerative disease characterised by the presence of inflammatory plaques in the brain and spinal cord. The diffuse formation of these plaques in the central nervous system is the reason for the various symptoms of the disease -- dysfunction of motor, bladder and bowel functions, loss of superficial and deep sensation, visual problems and difficulties with coordination. Cognitive and behavioural dysfunction is observed to varying degrees in patients with multiple sclerosis (30-70%), often early in the course of the disease. They seriously affect social activities, work efficiency, quality of life and often are the cause for employment loss. These disturbances can be detected with the help of competently selected tests and scales, for which not enough convincing data is present. It is assumed that these disturbances are linked to early changes in some biological markers for multiple sclerosis.
Key words: multiple sclerosis, cognition, biomarkers
Address for correspondence: Todor Kunchev, M. D., Department of Neurology, University Hospital „Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, e-mail: drtodorkunchev@yahoo.co.uk


Intrahepatic cholestasis – clinical spectrum and therapeutic approach - Medical Review (Medicinski pregled), 52, 2016, № 1, 10-23.
D. Gancheva
Clinic of Gastroenterology, Hepatology and Nutrition, University Hospital “Sv. Marina”, Medical University -- Varna
Summary: The review discusses a significant problem in the gastroenterological clinical practice -- cholestatic syndrome. Cholestasis is defined as an impaired bile syn-thesis and secretion with a decreased bile flow into the duodenum. The morpho-logical, functional and etiological classifications are presented, as well as the current concepts of pathogenesis and pathophysiological mechanisms of this pathology. The rare inherited forms of cholestasis are considered along with to-tal parenteral nutrition-associated cholestasis, drug-induced and sepsis-related cholestatic injury. The mechanisms of intrahepatic cholestasis of pregnancy, heart-induced liver dysfunction, and jaundice following surgery and liver trans-plantation are interpreted, too. Particular attention is paid to granulomatous and infiltrative liver disorders with cholestasis. Alcoholic and non-alcoholic fatty liver disease presenting with cholestasis as well as acute and chronic viral hepatitis are also described. The present review illustrates the classical and contempo-rary therapeutic methods for cholestasis management. Ursodeoxycholic acid and ademetionine are validated therapeutic options, whereas obeticholic acid is a novel and promising opportunity for improvement of the biochemical and morphological cholestatic parameters among selected patient groups.
Key words: cholestasis, intrahepatic cholestasis of pregnancy, neonatal cholestasis, sepsis-induced cholestasis, drug-induced cholestasis, treatment
Address for correspondence: Diana Gancheva, M.D., Clinic of Gastroenterology, Hepatology and Nutrition, University Hospital “Sv. Marina”, Medical University, 1, Hristo Smirnenski St., Bg -- 9010 Varna, е-mail: gancheva_vn@abv.bg


Differential diagnosis -- Crohn's disease and tuberculosis of the gastrointestinal tract - Medical Review (Medicinski pregled), 52, 2016, № 1, 24-30.
M. Bazitov
Department of Gastroenterology, First MHAT -- Sofia
Summary: Crohn's disease is a chronic social disease which affects mostly young people, but also occurs in older age. Tuberculosis is an infectious socially significant disease that affects people of all ages, very common in countries with high incidence and prevalence of tuberculosis. Crohn's disease and tuberculosis of the gastrointestinal tract are diseases that share common clinical, para-clinical, endoscopic, histological and imaging features that hinder diagnosis. Therapeutic approach between them is totally opposite because of different diagnostic algorithms based on multiple studies. The differential diagnosis between the two diseases is difficult. Diagnosis should be based on history, clinical monitoring, laboratory tests, endoscopic findings and pathomorphological study. Imaging diagnostic, bacteriological testing and data on current or past pulmonary TB in support of clinical practice. The wide differential diagnosis allows for an accurate diagnosis and to take proper treatment and an important part of medical-diagnostic process.
Key words: Crohn's disease, tuberculosis of gastrointestinal tract, differential diagnosis, clinical monitoring, laboratory testing, endoscopic findings, histological features, pathomorphological study
Address for correspondence: Minko Bazitov, M. D., Department of Gastroenterology, First MHAT, 37 Patriarh Evtimiy Blvd., Bg -- 1000 Sofia


Medication-related osteonecrosis of the jaws - Medical Review (Medicinski pregled), 52, 2016, № 1, 31-34.
P. Pechalova
Department of Oral Surgery, Faculty of Dental Medicine, Medical University -- Plovdiv
Summary: This paper summarizes recent data about medication-related osteonecrosis of the jaws. It describes types of drugs, the possible pathophysiological mechanisms and discusses paraclinical tests and recommended therapeutic approach for medication-related osteonecrosis of the jaws.
Key words: jaws, osteonecrosis, bisphosphonates, antiresorptive and antiangiogenic medications
Address for correspondence: Assoc. Prof. Petya Pechalova, Ph. D., Faculty of Dental Medicine, Medical University, 3 Hristo Botev Blvd., Bg -- 4000 Plovdiv, e-mail: pechalova@abv.bg


Last update: 15.03.2017



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