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Vol. 54, 2018

 

4'/2018

C O N T E N T S 

bullet REVIEWS

K. Kostov, Y. Vanev, O. Cholakov and A. Dimova. Specific approaches in the treatment of traumatic colon injuries – Medical Review (Medicinski pregled), 54, 2018, № 4, 5-8.  
T. Strateva. Virulence factors in the pathogenesis of infections caused by Acinetobacter baumannii– Medical Review (Medicinski pregled), 54, 2018, № 4, 9-21.
A. Gotseva and N. Yancheva-Petrova. Lymphonodular syndrome in infectious diseases – Medical Review (Medicinski pregled), 54, 2018, № 4, 22-28.

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ORIGINAL ARTICLES

M. Baleva and Kr. Nikolov. Antiphospholipid antibodies and VDRL test – Medical Review (Medicinski pregled), 54, 2018, № 4, 29-33.
R. Gergova, A. Muhtarova, R. Markovska, K. Mihova, R. Kaneva and I. Mitov. Molecular-genetic analysis of rarer causative agents of bacterial tonsillopharyngitis -- the group C and G streptococci similar to the group A (Streptococcus pyogens)– Medical Review (Medicinski pregled), 54, 2018, № 4, 34-38.
D. Ovcharov, J. Petrova and L. Traykov. Homocysteine as a risk factor for atherosclerosis and cognitive decline in adults – Medical Review (Medicinski pregled), 54, 2018, № 4, 39-42.
R. Nikolov and G. Bogdanov. Effect of risperidone on hyperthermia in experimental serotonin syndrome in rats – Medical Review (Medicinski pregled), 54, 2018, № 4, 43-46.
T. Vekov, Zh. Kolev and S. Tzankov. A cost-effectiveness analysis of therapeutic approaches in squamous cell carcinoma of head and neck after failed platinum containing therapy – Medical Review (Medicinski pregled), 54, 2018, № 4, 47-51.

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CASE REPORTS

A. Pavlova and A. Simeonova. Perfusion scintigraphy among diagnostic methods for pulmonary thromboembolism: a case report – Medical Review (Medicinski pregled), 54, 2018, № 4, 52-54.

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LETTERS TO THE EDITOR

G. Tchernev and I. Temelkova. Squamous cell skin cancer -- fast dermatosurgical decisions under ambulatory conditions – Medical Review (Medicinski pregled), 54, 2018, № 4, 55-57.
I. Temelkova, T. Lotti and G. Tchernev. Giant congenital melanocytic nevus of the head: Problematic issues in clinical management – Medical Review (Medicinski pregled), 54, 2018, № 4, 58-60.

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CONSENSUS

Methodological guidelines for diagnostics monitoring and treatment of Gaucher disease – Medical Review (Medicinski pregled), 54, 2018, № 4, 61-72.

 

razdelitel

 

bullet REVIEWS

Specific approaches in the treatment of traumatic colon injuries – Medical Review (Medicinski pregled), 54, 2018, № 4, 5-8.
K. Kostov, Y. Vanev, O. Cholakov and A. Dimova
3rd Surgical Clinic, UMHATEM “N. I. Pirogov” -- Sofia
Abstract: By using the algorithm of damage control techniques (DCT or DCP) definitive reconstruction in unstable patients with hypothermia and coagulopathy is post­po­ned, and it is mainly used for stopping hemorrhage and intestinal contamination. An adv­antage of the DCT is the prevention or treatment of the lethal triad of hy­po­thermia, coagulopathy and acidosis. In this regard there are analyzed publications from research collectives of the last 35 years until today in order to optimize the therapeutic algorithm in traumatic colon injuries. Data were collected from patients groups for preoperative and therapeutic approach. Analysis of discussion and approaches in the treatment of the colon injuries were summarized.
Key words: trauma, colon injury, specific approach
Address for correspondence: Konstantin Kostov, MD, PhD, 3rd Surgical Clinic, UMHATEM “N. I. Pirogov”, 21, Totleben Blvd., Bg -- 1606 Sofia, e-mail: dr.k.kostov@gmail.com

 

Virulence factors in the pathogenesis of infections caused by Acinetobacter baumannii – Medical Review (Medicinski pregled), 54, 2018, № 4, 9-21.
T. Strateva
Department of Medical Microbiology, Faculty of Medicine, Medical University -- Sofia
Abstract: Acinetobacter baumannii is undoubtedly one of the most widespread pathogens responsible for nosocomial infections in the modern healthcare system. The increasing prevalence of infections and outbreaks caused by multidrug-resistant (MDR) strains significantly reduces the number of effective antibiotics to combat A. baumannii. Overcoming this therapeutic problem requires knowledge of pathogenesis and antimicrobial resistance mechanisms. This review article presents the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides (LPS), phospholipases, outer membrane vesicles, metal acquisition, protein secretion systems, biofilm formation, and others. In the future, some of them (such as LPS) are expected to be the cornerstone for synthesis of new antibiotics. Other virulence factors, such as OmpA porin, outer membrane vesicles, capsular polysaccharides, and type V secretion system Ata, have shown the potential of vaccine candidates or specific sera to play an important role as alternatives to the control of infections caused by MDR strains. At present, the toxicity and pathogenicity of A. baumannii remain incompletely clarified and outline a direction of intensive future research by the world scientific community.
Key words: Acinetobacter baumannii, infections, pathogenesis, virulence factors
Address for correspondence: Assoc. Prof. Tanya Strateva, MD, PhD, Department of Medical Microbiology, Faculty of Medicine, Medical University, 2 Zdrave St., Bg -- 1431 Sofia, tel. +359 2 9172750; e-mail: dr.strateva@abv.bg

 

Lymphonodular syndrome in infectious diseases – Medical Review (Medicinski pregled), 54, 2018, № 4, 22-28.
A. Gotseva(1) and N. Yancheva-Petrova(2)
(1)Military Medical Academy -- Sofia, (2)SHATIPD "Prof. Ivan Kirov" -- Sofia
Abstract: Infectious diseases are characterized by a variety of clinical symptoms, as a result of the body's infected functional and structural changes of an inflammatory, toxic and allergic nature. Essential for the early diagnosis is knowledge of the symptoms specific for an infectious disease, which in turn determines the timely and correct therapeutic behavior. One of the syndromes common in infectious diseases is lymphonodular syndrome. The presence of reticuloendothelial cells in the lymph nodes determines their involvement in pathogenetic mechanisms in many infections. Lymph nodes are among the first defense mechanisms along the path of the infectious agents intrusion into the body and are actively involved in the infectious process.
Key words: lymph nodular syndrome, infectious diseases
Address for correspondence: Aneliya Gotseva, MD, e-mail: anelialg@abv.bg


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ORIGINAL ARTICLES


Antiphospholipid antibodies and VDRL test – Medical Review (Medicinski pregled), 54, 2018, № 4, 29-33.
M. Baleva and Kr. Nikolov
Department of Clinical Immunology and Stem Cell Bank, University Hospital „Aleksandrovska” -- Sofia
Abstract: Antiphospholipid antibodies to cardiolipin (aCL), beta-2-glycoprotein I (aB2GPI), phosphatidylserin (aPS) and prothrombin (aPT) have been studied in 24 patients with positive VDRL test (14 with Lues, 2 pregnant women, 1 -- with SLE, 2 -- with psoriasis vulgaris, 1 blood donor and 4 -- investigated before marriage). All of them, except for the patients with Lues, had a negative confirmatory test for syphilis. Only 3/14 (21%) of patients with Lues had no aPL. More frequent in these patients were positive aCL и aPS, followed by аРТ и aB2GPI, and 3 patients had positive tests for more than one antibody. Nobody had symptoms for Antiphospholipid syndrome (APS). A female patient with SLE had positive aCL and recurrent abortions. Two pregnant women had positive aCL, but both of them had successful delivery. Patients with psoriasis had positive aCL and aPS, without symptoms for APS. The blood donor and one healthy woman had high values of aCL. One of the healthy female subjects had positive aPS; two subjects (a man and a woman) were positive for aCL, aPS and aB2GPI. The need for a long time observation of patients with high aPL values without APS symptoms is discussed.
Key words: antiphospholipid antibodies, VDRL test, antiphospholipid syndrome
Address for correspondence: Prof. Marta Baleva, PhD, DSc, Department of Clinical Immunology and Stem Cell Bank, University Hospital „Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia, e-mail: marta.baleva@gmail.com

 

Molecular-genetic analysis of rarer causative agents of bacterial tonsillopharyngitis -- the group C and G streptococci similar to the group A (Streptococcus pyogens) – Medical Review (Medicinski pregled), 54, 2018, № 4, 34-38.
R. Gergova(1), A. Muhtarova(1), R. Markovska(1), K. Mihova(2), R. Kaneva(2) and I. Mitov(1)
(1)Department of Medical Microbiology, Faculty of Medicine, Medical University -- Sofia, (2)Department of Medical Chemistry and Biochemistry, Center for Molecular Medicine, Medical University -- Sofia
Abstract: In the recent years, isolation of beta-hemolytic streptococci from the groups C and G (GCS/GGS) from infections, which are typical for the group A streptococcus (GAS), is increased. The aim of our study is to identify the genes encoding virulence factors in Bulgarian GCS/GGS isolates similar to those in GAS, and to perform genotyping as emm genes encoding the M protein are detected. Using PCR, 15 strains of GCS (n = 7) and GGS (n = 8) isolated from patients with tonsillopharyngitis were studied for the presence of 16 genes encoding virulence factors, and emm genes were sequenced. Molecular-genetic analysis of GCS/GGS isolated in over 10% of patients with bacterial tonsillopharyngitis was performed for the first time. Over 86% of these isolates have been shown to have at least one gene encoding GAS virulence factors. The most commonly found gene is slo -- in 90% of GGS, respectively, 40% of GCS. The presence of speA, speC, speF, speG, speH, speM, ssa, speM, smeZ in the GCS/GGS genome was demonstrated, with the speFand speHgenesbeing reported for the first time in the literature. Most genes are less frequent for GCS/GGS, but some of them such as speM, speC and speH are found more often in these groups than in GAS. The speA, speB, speI, speJ, speK, speL, spyCep, sdaB were not foundin GCS/GGS. In the half of the GGS representatives were confirmed and sequenced emmgenes, and for the first time 3 circulating in Bulgaria serotypes of GGS (stG10.0, stG480.0 and stG6792.0) were identified with genotyping. These data draw the attention to the increase of virulence in these groups, which is seen also in other microbial species in the last years, and requires a more thorough monitoring and study of their etiological role.
Key words: beta-hemolytic streptococci, virulence factors, emm genotyping
Address for correspondence: Assoc. Prof. R. Gergova, MD, Department of Medical Microbiology, Faculty of Medicine, Medical University, 2, Zdrave St., Bg -- 1431 Sofia, е-mail: rtgergova@gmail.com

 

Homocysteine as a risk factor for atherosclerosis and cognitive decline in adults – Medical Review (Medicinski pregled), 54, 2018, № 4, 39-42.
D. Ovcharov, J. Petrova and L. Traykov
Department of Neurology, Medical University -- Sofia
Abstract: Carotid atherosclerosis is a risk factor for cerebrovascular disease in adults. One of the risk factors for atherosclerosis is the elevated level of homocysteine in the blood. It leads to the vascular wall damage and subsequent cerebrovascular disease with clinical neurological symptoms. The elevated blood homocysteine level leads to increased synthesis of metalloproteinases (MMPs) in the mitochondrial matrix. This process, along with oxidative stress, leads to degradation of the extracellular matrix and damage to the blood-brain barrier. 35 patients aged 43 to 83 years who have a subjective and objective memory deficit are examined. The correlation between hyperhomocysteinemia and cognitive decline is clearly evident in the studied patients. A battery of neuropsychological tests, as well as sonographic examination of carotid arteries, was performed. It was found that the elevated IMT index, decreased vascular elasticity, and reduced neuropsychological test scores correlate with elevated plasma homocysteine levels.
Key words: homocysteine, atherosclerosis, cerebrovascular disease, IMT, cognitive impairment
Address for correspondence: Assoc. Prof. J. Petrova, MD, e-mail: jcat@abv.bg

 

Effect of risperidone on hyperthermia in experimental serotonin syndrome in rats – Medical Review (Medicinski pregled), 54, 2018, № 4, 43-46.
R. Nikolov and G. Bogdanov
Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University -- Sofia
Abstract: Serotonin syndrome is a life-threatening adverse drug reaction associated with in­creased serotonin concentration in the central and peripheral nervous sys­tems. It is observed in the single or combined administrations of serotonergic drugs. The aim of the present study was to investigate the effects of risperidone (1 mg and 2.5 mg, i.p.) on hyperthermic response in an experimental model of serotonin syndrome induced by the combined administration of fluoxetine and tranylcypromine. The body temperature of the animals was measured using thermistor probes (TX-8) inserted rectally, and monitored on multichannel recorder (Iso-Thermex 16). Pre-administration of risperidone reduced or inhibited the hyperthermic response in a serotonin syndrome model in rats.
Key words: hyperthermia, risperidone, serotonin syndrome, serotonergic drugs, rats
Address for correspondence: Rumen Nikolov, M.D., Ph.D., Department of Pharmacology and Toxicology, Faculty of Medicine, Medical University, 2 Zdrave St., Bg -- 1431 Sofia, tel. + 359 2 91 72 501, e-mail: ru_nikolov@abv.bg

 

A cost-effectiveness analysis of therapeutic approaches in squamous cell carcinoma of head and neck after failed platinum containing therapy – Medical Review (Medicinski pregled), 54, 2018, № 4, 47-51.
T. Vekov(1), Zh. Kolev(2) and S. Tzankov(1)
(1)Faculty of Pharmacy, Medical University -- Pleven,(2)Faculty of Pharmacy, Medical University -- Varna
Abstract: The aim of the study is to model local data for costs and health benefits in patients with metastatic squamous cell carcinoma (r/mSCCHN), whose disease progresses after platinum containing therapy. Direct com­parison of data for therapeutic efficacy and safety of nivolumab (NIV), docetaxel (DOC), methotrexate (MTX) and cetuximab (CET) (the CheckMate 141 clinical trial) was made. Modeling of data for future health benefits and costs is made through the Markov's model with three health states; time horizon is lifelong, costs and benefits are discounted by 5% per year; the selected perspective is the point of view of a third party payer. The results show that NIV is not a cost-effective technology for treatment of r/mSCCHN in comparison with therapeutic alternatives СЕТ, DOC, MTX due to excessive high cost for a relatively modest added health benefit. There is not a possibility that NIV in comparison with the alternatives will approximate the commonly accepted threshold for cost effectiveness of three times gross domestic product per capita in Bulgaria. The results of the present analysis of cost-effec­ti­ve­ness are supported by the assessments of similar health technologies in the target group of patients, which are performed in USA and Canada.
Key words: carcinoma of head and neck, nivolumab, docetaxel, methotrexate, cetuximab, cost-effectiveness analysis, network metaanalysis, Markov's model
Address for correspondence: Prof. Tony Vekov, e-mail: t.vekov.mu.pleven@abv.bg


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CASE REPORTS

Perfusion scintigraphy among diagnostic methods for pulmonary thromboembolism: a case report – Medical Review (Medicinski pregled), 54, 2018, № 4, 52-54.
A. Pavlova and A. Simeonova
Department “Nuclear Medicine”, Medical Institute of Ministry of Interior -- Sofia
Abstract: The clinical case demonstrates the place and significance of the nuclear-medical examination in the diagnostic algorithm for pulmonary thromboembolism and its role in the follow-up of patients suffering from it.
Key words: pulmonary thromboembolism, diagnosis, perfusion scintigraphy
Address for correspondence: Adelina Pavlova, MD, PhD, e-mail: a_pavlova@abv.bg

 

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LETTERS TO THE EDITOR

Squamous cell skin cancer -- fast dermatosurgical decisions under ambulatory conditions – Medical Review (Medicinski pregled), 54, 2018, № 4, 55-57.
G. Tchernev and I. Temelkova

Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior -- Sofia, Onkoderma -- Clinic for Dermatology, Venereology and Dermatologic Surgery -- Sofia
Key words: skin cancer, squamous cell carcinoma, surgery, undermining plastic approach, survival benefit

 

Giant congenital melanocytic nevus of the head: Problematic issues in clinical management – Medical Review (Medicinski pregled), 54, 2018, № 4, 58-60.
I. Temelkova(1), T. Lotti(2) and G. Tchernev(1)
(1)Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior -- Sofia, Onkoderma -- Clinic for Dermatology, Venereology and Dermatologic Surgery -- Sofia, (2)Department of Dermatology, University of Rome “G. Marconi”, Department of Biotechnology, Delft University of Technology -- Rome, Italy
Key words: giant congenital melanocytic nevus, head, newborn, option to treat

 

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CONSENSUS

Methodological guidelines for diagnostics monitoring and treatment of Gaucher disease

 

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