DOI: 10.3897/jbcr.e184319

Authors: Malik Yildiz, Boris Duhlenski

Abstract: Advanced rhinophyma is usually treated surgically to remove excess tissue and restore the normal shape of the nose. Several techniques, such as electrosurgery, laser resurfacing, coblation, and dermabrasion, may be used alone or in combination depending on disease severity and patient factors. We report the case of a 67-year-old male with type 2 diabetes mellitus and hypertension who presented with giant rhinophyma. Considering the patient’s comorbidities and the increased risk of postoperative complications, a surgical approach resulting in minimal intraoperative bleeding was considered essential. Although coblation alone is often effective for tissue reduction with limited bleeding, in this case, it was insufficient due to the excessive volume of hypertrophic tissue, so we combined electrosurgical and coblation approaches to remove tissue carefully, control bleeding, preserve nasal structure, and minimize scarring and delayed healing in a patient with poorly controlled diabetes.

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DOI: 10.3897/jbcr.e183988

Authors: Guilherme Linha Secco, Lucas Ribas Lachman, Leticia Alves de Oliveira, Maisa Baldinu Caramujo, Lunna Giovanna Gonçalves Campos, Alana Barroso de Carvalho, Giovanna Moreira Nascimento de Castro, Fábio Henrique Malinoski, Caroline de Oliveira Christoff, Mateus Cordeiro Merlim da Silva

Abstract: Background: Alzheimer’s disease (AD) is the leading cause of dementia worldwide, with prominent hippocampal and medial temporal lobe atrophy. Limbic-predominant (LP) AD has been proposed as a distinct subtype, but distinctions from typical AD remain unclear. This systematic review evaluates clinical, radiological, and immunohistological differences between LP and typical AD. Methods: Following PRISMA guidelines, PubMed, Embase, and Web of Science were searched. Data on baseline characteristics, clinical, radiological, and immunohistological features were extracted. Screening was performed with Rayyan.ai, and study quality was assessed using the Newcastle–Ottawa Scale. Results: From 211 articles, 21 studies were included, totaling 11,315 patients: 1,178 (15.7%) LP, 4,159 (36.7%) typical AD, and 5,378 (47.6%) other presentations. Weighted averages: education 24.31 years (LP) vs. 17.15 years (AD); age at onset 77.36 years (LP) vs. 72.33 years (AD); disease duration 8.43 years (LP) vs. 8.95 years (AD). Clinical presentations were similar, with cognitive impairment and memory deficits predominant. MRI and FDG-PET revealed lower hippocampal volume and higher metabolism in LP. Tau-PET showed lower R2 relaxation in parietal, cingulate, and cuneus regions and elevated hippocampal neurofibrillary tangles. Immunohistology revealed higher hippocampal tau burden and more TDP-43 inclusions in LP compared to typical AD. Conclusion: LP and typical AD exhibit notable radiological and immunohistological differences, though clinical presentations overlap. Current evidence cannot definitively classify LP as a distinct subtype or separate disease. Further studies are required to clarify these distinctions.

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DOI: 10.3897/jbcr.e184759

Authors: Yordanka Yamakova, Viktoria Ilieva

Abstract: Introduction: It is well known that sleep-related breathing disorders like obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) decrease quality of life and increase morbidity and mortality. OSA patients with good adherence to nighttime CPAP report improvement of their daily functioning, social interactions, emotional functioning, daytime sleepiness, and other symptoms. In OHS, both CPAP and non-invasive ventilation (NIV) show improvement in quality of life if prescribed accurately.Methods: We recruited 60 newly diagnosed obese patients with OSA and divided them into two groups: isolated – iOSA (n = 32) and OHS-OSA (n = 28). The health-related quality of life of all subjects was measured at baseline and after 3 months of treatment via the Interviewer Administered version of the EQ-5D-5L questionnaire.Results: The baseline EQ-5D value of the iOSA group (Median: 0.836; IQR: 0.113) was significantly higher than that of the OHS-OSA overlap syndrome (Median: 0.67; IQR: 0.209) (p < 0.001). Three months after treatment, both groups had increased their EQ-5D value significantly: The iOSA group from median: 0.836 with IQR: 0.113 to median:1 with IQR: 0 (p < 0.001), and the OHS-OSA group from median: 0.67 with IQR: 0,209 to median: 0.874 with IQR: 0.137 (p < 0.001) respectively. When we compared the EQ-5D values after treatment between the two groups, we observed the same statistically significant difference as before treatment (p < 0.001).Conclusion: NIV therapy makes a huge difference in the HRQoL of OHS-OSA patients, though it does not reach a subjective perception of full health like in subjects with iOSA.

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DOI: 10.3897/jbcr.e176808

Authors: Halil Islamoglu, Bilge Aslan, Ayça Dumanlı Özcan, Abdülkadir But

Abstract: Background: This randomized controlled trial investigated the effects of recruitment maneuvers on arterial oxygenation and lung compliance in patients undergoing robotic-assisted prostatectomy in the steep Trendelenburg position. Hemodynamic parameters were also monitored, with no significant differences observed among groups.Methods: Sixty patients were randomly assigned to three groups (n = 20 each).• Group 1 received 0 cm H2O positive end-expiratory pressure (PEEP),• Group 2 received 5 cm H2O PEEP,• Group 3 received 5 cm H2O PEEP combined with two recruitment maneuvers, applied 5 minutes after CO2 insufflation and 5 minutes after desufflation.Pneumoperitoneum was maintained at 12 mmHg. Anesthesia was maintained with sevoflurane and remifentanil infusion (FiO2 50%), titrated to maintain end-tidal CO2 (EtCO2) between 30–36 mmHg. Balanced crystalloid solutions were administered at 4–6 mL/kg/h, adjusted according to hemodynamic parameters. Hemodynamic variables, arterial blood gases, and respiratory mechanics were recorded at predefined intraoperative and postoperative time points.Results: Group 3 demonstrated significantly higher PaO2 and improved static and dynamic lung compliance compared to Group 1 (PaO2 at T3: 155.0 ± 51.3 mmHg vs. 121.2 ± 25.2 mmHg; p = 0.014). EtCO2 and peak heart rate (PHR) were significantly lower in Group 3 than in Group 1 (p = 0.018 and p = 0.007, respectively), though these findings were interpreted cautiously given potential vagal stimulation. Groups 2 and 3 both showed significantly better compliance and oxygenation than Group 1 (p < 0.001 and p = 0.006, respectively). No significant hemodynamic instability was observed.Conclusion: Recruitment maneuvers, when combined with moderate PEEP, may enhance intraoperative oxygenation and lung compliance during robotic prostatectomy without inducing significant hemodynamic compromise; however, the clinical relevance of these physiological improvements warrants further investigation in larger-scale studies.

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DOI: 10.3897/jbcr.e182990

Authors: Supriya Khade, Mohini Mahatme, Neha Meshram, Vikram Bobade

Abstract: Introduction: Artificial Intelligence (AI) has the potential to transform healthcare in various ways. It can turn large amounts of patient data into actionable information, improve public health surveillance, accelerate health responses & produce faster & more targeted research & development. In context of developing countries, the potential of AI in public health needs to be assessed. This study enables a comprehensive exploration of clinicians' views, aiming to identify actionable insights for addressing barriers to AI implementation in healthcare systems.Methodology: It is a cross-sectional study in which a pre-validated questionnaire developed. A purposive sample of 94 clinicians from various specialities taken in the study. Data is collected using a structured questionnaire designed after an extensive literature review & expert consultation. Data were analyzed using the appropriate statistical test.Results: The study identified key challenges hindering AI adoption in healthcare, based on responses from 94 clinicians. The primary barriers include insufficient infrastructure (68.5%), lack of AI-specific training (44.7%) & limited collaboration between healthcare sectors (63.8%). Clinicians' skepticism (58%) about AI’s decision-making accuracy and ethical concerns regarding patient data security (74.5%) were significant obstacles. Fragmented healthcare data systems (70%) further hindered the effective AI integration.Conclusion: While AI has substantial potential to enhance healthcare delivery, particularly in optimizing operations and personalizing treatment, addressing these challenges through comprehensive strategies involving ethical frameworks, robust data management & stakeholder engagement is crucial for successful implementation & acceptance of AI technologies in clinical practice.

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DOI: 10.3897/jbcr.e184929

Authors: Ahamed Akkeel Anzaar, Antonia Andreeva, Kamelia Dimitrova

Abstract: Objective: To summarize contemporary clinical algorithms for the management of high-risk pregnancy and to integrate international recommendations with regional clinical experience.Methods: Narrative review of international guidelines (ACOG, FIGO, NICE, WHO) and peer-reviewed literature, including data from Bulgarian obstetric practice.Results: Algorithm-based management improves early risk stratification, standardizes care, and supports individualized decision-making in hypertensive disorders, gestational diabetes, fetal growth abnormalities, and combined maternal–fetal risk.Conclusion: Clinical algorithms represent a cornerstone of modern high-risk pregnancy management. Integration of regional data enhances applicability without compromising international relevance.

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DOI: 10.3897/jbcr.e184757

Authors: Zornitsa Kamburova, Savelina Popovska, Chavdar Tsvetkov

Abstract: We report the case of a 52-year-old woman who presented with a large pelvic mass, which was surgically removed and diagnosed as a mucinous borderline ovarian tumour (MBT) of intestinal type. Comprehensive genomic testing revealed two significant alterations: a pathogenic germline WRN stop-gain variant (NM_000553.4:c.1105C>T, p.Arg369Ter; exon 9/35) and a somatic KRAS mutation (c.35G>T, p.Gly12Val). The coexistence of these findings suggests that inherited impairment of DNA repair mechanisms, which, together with acquired activation of the RAS pathway, may have cooperated in driving tumour formation. Functionally, loss of WRN activity could have promoted genomic instability, allowing the emergence of oncogenic KRAS activation as a secondary event. The patient underwent a total hysterectomy with bilateral adnexectomy. Histopathological examination confirmed an intestinal-type MBT without stromal invasion. This case illustrates how integrating germline and somatic analyses can uncover the molecular interplay between inherited predisposition and tumour evolution, offering valuable information for personalised risk assessment, family counselling, and long-term clinical surveillance.

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DOI: 10.3897/jbcr.e187203

Authors: Ivan Ivanov, Emilia Naseva, Angelika Velkova

Abstract: Abstract: Sleep is a key factor in human health. Lack of sleep is associated with many chronic diseases, including periodontal problems. Studies show that sleep disorders can worsen periodontal health and increase the risk of diseases such as gingivitis and periodontitis.The study aims to investigate the importance of sleep for periodontal health among patients aged 18 and older in the Republic of Bulgaria.Methods: In 2025, 504 patients were included in the current study. A detailed periodontal diagnosis and a survey with original questions and validated international instruments (Pittsburgh Sleep Quality Index) were performed.Results: The duration of sleep per day in the studied individuals varies substantially, from 3 to 12 hours. Most often, the night sleep lasted between 6 and 7 hours, in 59.4% of respondents. The examined women slept longer, about a quarter of an hour longer (p = 0.02).The study found approximately the same proportion of people without periodontitis (50.4%) and those with periodontitis at different clinical stages (49.6%). No significant differences were found in the average sleep duration in people without and those with periodontitis, as well as the time for falling asleep (p > 0.05). The entire score index for sleep quali­ty (PSQI) showed significantly lower values among patients with periodontitis (p = 0.049), indicating better sleep quality. Furthermore, patients with periodontitis were more prevalent in the group of PSQI < 5 (46.6% compared to 35.6% in the other group, p = 0.012).We further examined the differences in the questionnaire and found that patients with periodontitis had stayed awake less often. In addition, patients with periodontitis reported fewer sleep disturbance episodes.Conclusion: Periodontal diseases are common conditions and have socially significant potential due to the possibility of loss of dentition and changes in facial aesthetics. At the same time, there is a bidirectional relationship between sleep problems and the systemic response to untreated periodontal disease. Future studies are needed to establish the effect of insufficient sleep on the development and progression of periodontitis.

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DOI: 10.3897/jbcr.e179275

Authors: Maria Petkova, Eleonora Mineva-Dimitrova, Petya Dragomirova, Adelaida Ruseva, Nikolay Balgaranov

Abstract: Acute bronchiolitis is the most common lower respiratory tract disease in infancy and the leading cause of hospitalization in children under two years of age. Many authors emphasize the importance of viral agents for the clinical course of the disease. This study aimed to assess the clinical severity of acute bronchiolitis in hospitalized infants. We examined 49 hospitalized children between 1 month and 2 years with acute bronchiolitis. The study investigated viral aetiology and markers of inflammatory activity. Disease severity was assessed according to the ReSVinet scale. A viral agent was identified in 59.2% of cases, with RSV (respiratory syncytial virus) as the predominant aetiology in 32.7%, followed by rhinovirus in 14.0%, human metapneumovirus and Bocavirus in 4.1% each, and Adenovirus, Influenza type A, and Parainfluenza virus in 1 (2.0%) each. No causative agent was identified in 40.8% of cases. We observed a mild clinical course in 30.6%, mostly with combined viral infection; a moderate course in 61.2%, mainly with RSV aetiology; and a severe course in 8.2%, in which no predominant etiological factor was identified. Further investigations are needed to clarify the relationship between viral aetiology and disease severity.

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DOI: 10.3897/jbcr.e181833

Authors: Ragni Kumari

Abstract: Intraocular pressure (IOP) is a dynamic physiological parameter influenced by circadian rhythm, systemic health, corneal biomechanics, and hormonal status. In women of reproductive age, cyclical variations in estrogen and progesterone during the menstrual cycle may modulate aqueous humor dynamics. The available evidence, however, remains heterogeneous. This updated narrative review synthesizes human studies published between 2000 and 2024 that evaluate IOP across menstrual cycle phases and integrates contemporary endocrine – ocular literature. A structured search identified 214 records, of which 38 underwent full-text review, and 13 phase-specific human studies met eligibility criteria for core synthesis. Across studies, reported IOP changes were generally modest (1–3 mmHg) and frequently within the range of normal diurnal variation or tonometric measurement error. Some investigations report slightly lower IOPs around ovulation or in the mid-luteal phase, whereas others demonstrate no statistically significant phase-dependent differences. Methodological heterogeneity –particularly in menstrual phase verification, sample size, and tonometric technique – limits the strength of conclusions. Current evidence does not support routine clinical modification of IOP measurement timing based solely on menstrual phase. Greater methodological rigor, including biochemical phase confirmation and standardized ocular biometry, is required to determine whether hormonal fluctuations exert clinically meaningful effects on IOP.

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DOI: 10.3897/jbcr.e183593

Authors: Zlatko Kirovakov, Elitsa H. Gyokova, Nadezdha Hinkova, Nikolay Kostadinov, Antonia Andreeva

Abstract: The review critically synthesizes existing evidence on optimizing gestational diabetes mellitus (GDM) diagnostic procedures, focusing on best practices for early detection of at-risk mothers to address related obstetric complications. The review adopts the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature reviews and dissemination of study findings. The methodological framework follows three stages: planning, conducting the review, and reporting outcomes. The International Association of Diabetes and Pregnancy Study Group (IADPSG) screening criteria were more inclusive than those of other protocols, but no significant differences in maternal outcomes were reported between the protocols. One-step (75-g OGTT) performed relatively accurately compared with two-step screening (50-g GCT plus 75-g OGTT), even though no significant differences were reported, and the two-step screening was the more preferred diagnostic approach among participants. We found no statistically significant difference between early and routine Oral Glucose Tolerance Tests (OGTTs) in pregnancy outcomes. The review findings highlight the significant role of optimized diagnostic approaches in early detection of GDM to minimize the effects on pregnancy and related obstetric outcomes, as well as to reduce the incidence of diabetes mellitus later in life.

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DOI: 10.3897/jbcr.e183844

Authors: Gizem Dogancali Yanchev, Petranka Chumpalova-Tumbeva, Ivanka Veleva, Kaloyan Stoichev, Snejena Murgova, Georgi Balchev, Emiliya Dimitrova-Ilieva, Aleksandar Todorov, Stanislav Kapinchev

Abstract: Eye movements represent an objective, quantitative indicator of the integrity of cognitive and perceptual processes. Since the beginning of the 20th century, research has shown that individuals with schizophrenia demonstrate characteristic deviations in smooth pursuit, -egulation, and visual exploration behaviour. These oculomotor alterations are linked to dysfunctions in attention, executive control, and perceptual organization, and have been discussed as potential biomarkers of impaired neural network regulation. More recent work further implicates disturbances in visual attention and integration, as well as reduced executive control over oculomotor activity, which may manifest in altered gaze behaviour.Building on this literature, the present study examined whether free-viewing eye-movement patterns capture markers of restricted exploration and altered scanpath organization under ecologically valid conditions. We recorded eye movements during passive viewing of landscape and abstract images in three groups: patients with schizophrenia (n = 30), healthy controls (n = 30), and close relatives (n = 21). Visual exploration was quantified using integrative indices of fixation number and duration (mean/median/total), scanpath length, coverage fraction, spatial dispersion (mean/median; dispersion_x and dispersion_y), center bias, fixations per second, gaze entropy (bits), and saccade metrics. Group and image type were tested in 2 × 2 mixed ANOVA models with FDR correction across metrics.In the patient-control analysis (N = 60), a significant main effect of group was observed across multiple exploration and oculomotor parameters after FDR correction (partial ηp² ≈ .12–.21; pFDR ≤ .032), with no main effect of image type and no group × image type interaction surviving correction, supporting a stimulus-nonspecific alteration of visual exploration in schizophrenia. In the relatives-controls analysis (N = 51), uncorrected trends suggested a more compact scan pattern (reduced dispersion and saccade amplitude). However, no effects remained significant after FDR correction. Overall, free-viewing eye-movement metrics showed medium-to-large, stimulus-nonspecific group differences in schizophrenia, consistent with a restricted and altered exploration mode, whereas potential vulnerability-related signals in first-degree relatives were weaker and did not survive correction, indicating the need for larger samples and/or targeted paradigms with predefined core metrics in familial-risk designs.

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DOI: 10.3897/jbcr.e182885

Authors: Kaloyan Tonev, Zhivko Dimitrov, Toni Stoyanov

Abstract: We present three cases of reconstruction of complex skin defects using pedicled flaps (gracilis, pectoralis major, and TRAM), all of which postoperatively exhibited venous congestion, characterized by cyanosis, edema, and dark bleeding on pinprick. While cumulative comorbidities increased the overall risk, potential mechanical causes included pedicle torsion or compression, hematoma, and skin–muscle island mismatch. Empirical treatment included therapeutic anticoagulation, decompression (partial suture removal and punctures), and operative revision when indicated. We compared these measures against existing literature. Because venous congestion led to partial flap loss in our series, we propose prevention and management strategies, including meticulous planning, gentle surgical technique, and early intervention, all of which are crucial for successful flap salvage.

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DOI: 10.3897/jbcr.e184307

Authors: Meri Shoshkova, Martin Karamanliev, Dobromir Dimitrov, Polina Marinova, Tsanko Yotsov

Abstract: Nutrition management in stage IV oncological patients is challenging. Finding a balance between ion, protein, carbohydrate, and lipid intake and output is often nearly impossible. A 36-year-old patient with terminal-stage ovarian cancer and bowel obstruction is presented. She was admitted to the surgery department with complaints of vomiting, abdominal pain, absence of flatulence, and defecation for the last two days. Laboratory findings showed anemia, low protein levels, low potassium, and elevated liver enzymes. Venous infusions were administered to restore nutritional values. Food and liquid intake were stopped. After 6 days of hospital stay, the patient underwent a surgical procedure - a high ileostomy, to restore stool passage. A serious complication occurred - nearly 1600 ml. of stool was excreted from the ileostomy every 24 hours. Combination of medications - loperamide hydrochloride (2 mg daily), continuous venous infusions with lipid and carb-rich solutions, and proper diet managed to decrease the stoma outtake to 600 ml per day. Placing a port-a-cath system provided the patient with an easily managed device, allowing her to continue parenteral nutrition at home and increasing the likelihood of discharge from the hospital.

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DOI: 10.3897/jbcr.e181346

Authors: Radka Nuneva-Doncheva, Irena Gencheva-Angelova

Abstract: Abstract: A high serum level of Lipoprotein(a) [Lp(a)] is inherited, but various chronic kidney diseases (CKD) can cause its secondary elevation because the kidney is involved in its catabolism. These two facts form the basis for the two theories of the causal relationship between high Lp(a) levels and CKD.Purpose: This review aimed to summarize the complex relationships between Lp(a) levels and renal function, focusing on the molecular and cellular mechanisms. Furthermore, it aimed to differentiate between primary (genetically determined) and secondary (non-genetic) elevations of Lp(a) in various forms of CKD.Materials and Methods: We conducted a comprehensive literature search across the following databases: PubMed, Science Direct, Google Scholar, and Wiley Online Library, covering the period from January 2010 to February 2025. The search strategy employed keywords such as “Lipoprotein(a)”, “chronic kidney disease”, “renal catabolism”, and “Lp(a) pathophysiology”. Inclusion criteria focused on peer-reviewed meta-analyses, cross-sectional studies with Mendelian randomization, and prospective clinical trials published in English. Studies with fewer than 50 participants or lacking clear markers of renal function were excluded. Data were synthesized through a thematic analysis of molecular mechanisms and a comparative review of clinical outcomes to ensure a robust overview of both genetic and secondary Lp(a) elevations. The research approach follows narrative literature review methodologies. The selection of studies focused on their relevance, the strength of their evidence, and temporal relevance.Results: There is a complex feedback loop between high primary Lp(a) levels, CKD, and the secondary increase in Lp (a). Renal health influences Lp(a) levels, which in turn can further damage the kidney.

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DOI: 10.3897/jbcr.e183126

Authors: Carla Navarro Moratalla, Antonio Melero Abellán, Toni Ivanov Stoyanov

Abstract: The role of Enterobius vermicularis in the pathogenesis of acute appendicitis remains controversial, as it may be associated with appendiceal colic in the absence of actual histological inflammation. A retrospective study was conducted in two hospitals in Spain between June 2016 and January 2021, including six patients with histologically confirmed E. vermicularis infection. 1 two males and four females with a median age of 20 years. All patients presented with right iliac fossa pain and underwent laparoscopic appendectomy. In all cases, the appendix appeared hyperemic without macroscopic signs of acute inflammation, and histological examination confirmed the absence of acute appendicitis. All patients received postoperative mebendazole. No postoperative complications occurred.Enterobius vermicularis may mimic acute appendicitis by causing appendiceal colic, but it is rarely associated with true inflammatory appendicitis. Appendectomy should therefore be performed with caution when the appendix appears non-inflamed, given the possibility of E. vermicularis infection and the associated risk of intra-abdominal contamination.

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DOI: 10.3897/jbcr.e177463

Authors: Martin Karamanliev, Meri Shoshkova, Stefka Petrova, Dobromir Dimitrov, Stoyan Vezenkov

Abstract: Virtual reality (VR) is increasingly adopted in surgical education as a safe and controlled environment for developing technical and non-technical skills. Parallel to this, physiological biofeedback has emerged as a promising method for assessing stress, workload, and cognitive performance during complex tasks. This review explores the current evidence on VR and biofeedback in surgical training, highlighting their synergistic potential. We discuss how VR simulations replicate operative scenarios with high fidelity and how biofeedback parameters such as heart rate variability and galvanic skin response can provide objective insights into surgeon performance and stress regulation. We then outline a pilot study design in which novice and experienced surgeons are placed in a VR operating room scenario, with biofeedback metrics recorded. We hypothesise that experienced surgeons will demonstrate more stable physiological responses and superior task performance, reflecting greater resilience and expertise. Such findings could inform adaptive, personalised training models that adjust difficulty levels or provide targeted feedback in real time. Integrating VR and biofeedback into surgical education has the potential to enhance skill acquisition, improve stress management, and bridge the gap between simulation and the operating room.

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DOI: 10.3897/jbcr.e172498

Authors: Viktoriya Varbanova, Margarita Alexandrova, Vanya Slavcheva, Svetla Blazheva

Abstract: Chronic lymphocytic leukaemia (CLL) is one of the most common leukaemias in adults. Although extensive data on its pathogenesis and progression have accumulated, the disease remains chronic and incurable. Marked heterogeneity at every stage of CLL development limits the usefulness of routinely applied risk-stratification criteria. Published research suggests that the course of the disease is associated with oxidative stress and an increased frequency of cytogenetic aberrations. However, current evidence is insufficient to establish a causal relationship between these two factors. CLL patients exhibit a distinct antioxidant profile and decreased intracellular reducing potential. Moreover, levels of both early and late oxidative damage products are higher than normal. Concentrations of malondialdehyde and 8-oxo-dG have been reported to correlate with specific FISH-detected chromosomal aberrations. Future studies are needed to determine the extent to which oxidative biomarkers can improve the diagnostic and prognostic performance of routinely used biochemical and cytogenetic indicators in patients with CLL.

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DOI: 10.3897/jbcr.e174917

Authors: Boyana Anatolieva, Ivan Ivanov, Dimitar Gospodinov

Abstract: Basal cell carcinoma is the most common malignant tumour in humans. In cases with indistinct morphology on H&E-stained slides, immunohistochemistry may help distinguish basal cell carcinoma from other similar-appearing lesions. Our study aimed to investigate the expression of a marker panel comprising EZH2, Bcl-2, and Ber-EP4 in morphologically diagnosed, CK20-verified cutaneous basal cell carcinomas.Materials and methods: A cross-sectional study of 50 histologically confirmed cases of basal cell carcinoma was conducted. Immunohistochemical staining was performed using the following markers: EZH2, Bcl-2, Ber-EP4, and CK20. Due to the lack of a standardised method for evaluating markers, we adopted and modified the staining index (SI), which semi-quantitatively combines staining intensity and the percentage of positive cells. The results were systematised and interpreted using IBM SPSS.Results: All 50 examined tumours tested negative for CK20 (100%), thereby excluding mimics. All 50 tumours stained positive for EZH2 and Bcl-2 (100%), and only one stained negative for Ber-EP4 (98% positive). We found no association between histological type and EZH2 (p = 0.376), Bcl-2 (p = 0.376), and Ber-EP4 (p = 0.318), respectively, or their co-expression (p = 0.258). High co-expression of two of the three markers was observed in 33 of the 50 examined cases (66%), and a low co-expression in 4 cases (8%).Conclusion: The marker panel demonstrates co-expression of the three markers in the context of negative CK20 in over 90% of the cases. In challenging cases, it is important to consider clinical, morphological, and immunohistochemical features together.

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DOI: 10.3897/jbcr.e177999

Authors: Kristina Yotova, Stanimira Elkina, Nikolay Balgaranov

Abstract: Iron deficiency (ID) remains the most prevalent nutritional deficiency worldwide and a major cause of morbidity in childhood. This review outlines the physiological basis, risk factors, consequences, and prevention strategies for ID and iron deficiency anemia (IDA) in infants, young children, and adolescents. Childhood includes two critical periods of heightened vulnerability—infancy/early childhood and adolescence—when rapid growth markedly increases iron requirements. Preterm birth, low birth weight, exclusive breastfeeding beyond 4–6 months without supplementation, early introduction of cow’s milk, poor dietary habits, menstrual blood loss in adolescent girls, and rapid pubertal growth in boys are identified as key contributors to negative iron balance. Beyond hematologic changes, ID can impair neurodevelopment, cognitive performance, immune function, and behavior, with some deficits persisting long-term even after treatment. Early recognition is essential, and serum ferritin combined with inflammatory markers (CRP) and transferrin saturation represent the most reliable diagnostic indicators. Preventive measures—including delayed cord clamping, timely introduction of iron-rich complementary foods, iron supplementation for at-risk groups, and limiting cow’s milk intake—are crucial to reducing the global burden of ID. Despite advances in understanding its physiology and management, iron deficiency in childhood remains a significant public health challenge requiring targeted screening and effective preventive strategies.

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DOI: 10.3897/jbcr.e173237

Authors: Victoria Tsvetkova, Malvina Todorova, Katya Todorova, Milena Atanasova, Irena Gencheva

Abstract: Background: It is now proven that insulin resistance occurring during SARS-CoV-2 infection is the major cause for the hyperglycemia observed, and it can even persist long after recovery. The precise mechanisms of insulin resistance, whether new-onset or pre-existing, remain largely a mystery. Chronic immune dysregulation, persistent subclinical inflammation, adipose tissue dysfunction and pro-inflammatory cytokines are thought to be of fundamental importance. The current study aims to investigate the role of SARS-CoV-2 infection and the related inflammation in the pathogenesis of insulin resistance in different types of newly emerging disorders of carbohydrate metabolism following infection.Methods and materials: The current study included 168 patients (59 males and 109 women; mean age 54.04 ± 8.08 years), divided into three groups: group 1 (patients with active COVID-19 infection; n = 100), group 2 (individuals with newly diagnosed carbohydrate disorders after proven COVID-19 or post-COVID group; n = 35) and group 3 (COVID-19 negative subjects with Metabolic Syndrome; n = 33). Standard biochemical and immunological parameters were measured, and atherogenic indices for IR (TyG index and TG/HDL-C ratio) were calculated using the corresponding formula.Results: Patients with active coronavirus infection demonstrated the highest levels of TyG index and TG/HDL-C ratio, which differed significantly from both the reference COVID-negative group and from the Post-COVID group (p < 0.05). Among the individuals in the post-COVID group, we found a positive correlation between TyG index and IL-10 (r = 0.481; p = 0.008), IL-17A (r = 0.384; p = 0.048) and HCF-D (r = 0.387; p = 0.038). In the same group, the TG/HDL-C ratio positively correlated with CD8 (r = 0.648; p < 0.001), TNF-α (r = 0.559; p < 0.001), IL-10 (r = 0.954; p < 0.001), 8-Epi-PGF2α (r = 0.451; p = 0.006) and HIF-1α (r = 0.863; p < 0.001).Conclusion: Immune dysregulation, along with oxidative stress and cellular hypoxia observed during and after infection, seems to be implicated in the genesis, maintenance and progression of the insulin resistance (IR). IR, as measured by widely used atherogenic indices, is present not only during the COVID-19 course but also in cases of newly emerging carbohydrate disorders following infection, including T2DM, prediabetes, and T1DM.

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DOI: 10.3897/jbcr.e169349

Authors: Kalina Razlozhka, Vasilen Gitsov, Tatyana Bodurska-Petkova, Nadya Stancheva, Konstantin Gospodinov, Georgi Dotsinski, Snezhanka Tisheva-Gospodinova

Abstract: We present a case of a 25-year-old primiparous woman with eclampsia imminens and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, requiring a cesarean section. Through efficient collaboration between obstetricians, neonatologists, cardiologists, resuscitators and neurologists, a successful therapeutic outcome was achieved for both the mother and the newborn.

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DOI: 10.3897/jbcr.e166617

Authors: Zlatko Kirovakov, Nadezdha Hinkova

Abstract: Objective: To perform a comprehensive and updated review of prevention and treatment of HPV infections during pregnancy, focus on existing research in Bulgaria and the United Kingdom, as well as any existing literature on the topic of research within the regional scope.Methodology: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature review. It adopted the methodological framework proposed by the Joanna Briggs Institute (2015) and by Arksey and O’Malley’s (2005) approach of summary and dissemination of research findings. The research methodology consisted of three primary steps: planning, conducting, and reporting the review findings.Findings: The prevalence of HPV infection is higher in pregnant women as compared to non-pregnant women, and increases with the progression of the pregnancy. HPV infection of the intrauterine environment translates to adverse pregnancy outcomes, including preterm birth, intrauterine growth restriction, preeclampsia, and preterm premature rupture of membranes. Behavioural and therapeutic programs, as well as vaccination efforts, enhance effective prevention and treatment measures for HPV.Conclusion: There is a direct correlation between HPV infection and adverse pregnancy outcomes. HPV vaccination is an effective prevention and treatment measure for adverse pregnancy outcomes. Surgical or laser excision or application of trichloroacetic acid treatments are effective treatment options.

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DOI: 10.3897/jbcr.e166383

Authors: Zlatko Kirovakov, Elitsa Petkova

Abstract: Background: Vitamin D is essential for maternal health, fetal development, and pregnancy outcomes. Despite its importance, vitamin D deficiency is highly prevalent among pregnant women, increasing the risk of gestational diabetes mellitus (GDM), preeclampsia, preterm birth, and fetal growth restriction.Objective: This article explores the impact of maternal vitamin D deficiency on pregnancy outcomes and evaluates current strategies for its management and prevention, and supplementation.Methods: We onducted a comprehensive literature review of clinical trials, meta-analyses, and systematic reviews, focusing on the association between vitamin D levels and pregnancy complications and the effectiveness of supplementation and public health interventions.]Results: Studies suggest that vitamin D deficiency is linked to poor pregnancy outcomes, including hypertension, GDM, low birth weight, and neonatal health complications. Vitamin D supplementation (600–4,000 lU/day) has shown potential benefits in reducing these risks, but the optimal dosage and screening strategies remain debated. Food fortification and sunlight exposure may be complementary approaches to improve maternal vitamin D status.Conclusion: Managing vitamin D deficiency during pregnancy requires a multifaceted approach, including early screening, appropriate supplementation, dietary interventions, and public health policies. However, further large-scale clinical trials are needed to establish standardised guidelines for universal supplementation. Addressing vitamin D deficiency can significantly enhance maternal and neonatal health outcomes, making it a crucial public health priority.

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DOI: 10.3897/jbcr.e166507

Authors: Borislava Ivanova, Eleonora Mineva-Dimitrova, Mariela Kamburova

Abstract: Introduction: According to the current regulations of the Ministry of Health of the Republic of Bulgaria, the administration of the recommended vaccines is implemented at the request of the patient and for a fee. In this context, one of the key functions of the general practitioners (GPs) within the framework of outpatient primary care is to conduct health prevention, including the performance of immunizations. In 2024, the number of general practitioners in the Pleven district with a contract with the National Health Insurance Fund (NHIF) was 176.Objective: The objective of the study was to assess the influence of general practitioners’ personal experience and commitment on the implementation and promotion of recommended vaccinations.Materials and methods: In 2024, a comprehensive survey was carried out in the Pleven district covering 82 general practitioner selected at random from a total of 176 registered in the region. To analyse the correlation between the qualitative variables, a χ2 test was applied, with statistical conclusions drawn at a significance level of 0.05. Data collection was performed through semi-structured interview and processed by SPSS Statistics v.26.Results: Data analysis revealed high vaccination coverage among the respondents – 75 (91.5%), as well as significant activity in recommending the additional immunizations – 80 (97.6%). The personal experience with the recommended vaccines had an important impact on the professional behaviour of medical professionals (χ² = 21.964, df = 1, p < 0.001, Cramer’s V = 0.518).Conclusion: The present study outlined the significant influence of personal experience with the recommended immunizations on the professional behaviour of general practitioners. That highlighted the need to increase awareness and personal commitment to vaccination among healthcare professionals as a key factor in improving vaccination coverage of the population.

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DOI: 10.3897/jbcr.e168703

Authors: Mihail Georgiev, Kamelia Tsvetanova

Abstract: Genital carcinomas in women, such as endometrial and cervical carcinoma, remain one of the main reasons for death in women worldwide due to malignant tumours, and while the treatment options are relatively established today, the progression rate of the disease is still at high levels. Cytokines have been found to have a significant impact on the development and progression of these diseases, with pro-inflammatory factors such as interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) influencing the tumour’s growth, angiogenesis, and metastasis. The anaesthetics used during surgical treatment for these tumours have proven effects on the serum levels and local expression of cytokines in experimental settings. However, the results for propofol, which is the commonest choice for inducing anaesthesia, remain unclear in clinical settings, though the anti-cancer properties of propofol have been reported in specific carcinoma cell lines.

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DOI: 10.3897/jbcr.e156169

Authors: Marvellous Nonye Aniche, Zainab Abubakar Galadima, Josephine O. Abiri, Muhammed Garba, Esther Haruna Michael, Idoko Agumage, Abubakar Mustapha Danraka

Abstract: Background: Hypertension is a globally significant health burden, with a prevalence rate of nearly 49%. However, the clinical and economic burden is high and continues to increase. The NHIA, in partnership with HMOs in a bid to mitigate the financial burden on Nigerians, has in some way been beneficial. The delivery of universal health coverage through this integration involves a chain of processes, including acquiring a Pharmacy Authorization Code to obtain medications to improve the quality of life. However, with the implementation of a monthly authorization code process, the impact on the KAP of hypertensive outpatients (towards hypertension management) enrolled in the insurance scheme is limited. This study assessed the impact of the NHIA-HMO pharmacy authorization code (PAC) system on the KAP of hypertension in NHIA-enrolled outpatients within UATH. It also seeks to identify potential barriers within the coding system.Method: A cross-sectional study using a mixed-method approach was conducted with 345 hypertensive patients aged 18 years and above at UATH, Gwagwalada. A random sampling technique was used for the quantitative study, and data was collected through a validated, semi-structured questionnaire covering socio-demographics, KAP levels, and perceptions of the impact of the code system. The qualitative component utilized a pre-tested interview guide administered to purposively selected participants. Quantitative data was analyzed using SPSS (v27.02), while qualitative data underwent thematic analysis with visualization using ATLAS.TI (v25) and MS EXCEL (2019).Result: Correlation and regression analyses showed that the NHIA-HMO Code significantly influenced attitude and practice (r = 0.227, p < 0.001; r = 0.252, p < 0.001) but had no impact on knowledge (r = -0.023, p = 0.336). The regression model indicated that the code system predicts changes in attitude and practice but explains only 8.3% and 11.7% of their variance, suggesting other influencing factors. Emerging qualitative themes such as "difficulty obtaining the code," "long waiting hours," and "lack of HMO communication" highlight systemic challenges, whereas facilitators like "improved adherence, follow-up, and patient counseling" demonstrate its potential benefits.Conclusion: The NHIA-HMO code system does not enhance knowledge about hypertension but significantly influences attitude and practice, encouraging medication adherence. However, bureaucratic delays hinder its effectiveness. Additionally, long-term NHIS enrollment or HMO selection does not necessarily translate to improved KAP.

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DOI: 10.3897/jbcr.e154952

Authors: Kameliya Kostadinova, Krasen Venkov, Yonka Lazarova, Emilia Naseva, Ivan Tonev

Abstract: Introduction: Allogeneic hematopoietic stem cell transplantation (AlloHSCT) is a therapeutic method for the treatment of many malignant and non-malignant hematological diseases but is still associated with significant morbidity and mortality. Disease relapse recurrence and non-relapse mortality (NRM) remain the main causes of failure from AlloHSCT. The identification of the risk factors associated with this continue to be a subject of extensive scientific research.Aim: The aim of our study was to identify the prognostic significance of the early lymphocyte recovery (ELR), presented as absolute lymphocyte count (ALC) for the outcome of AlloHSCT.Materials and methods: 96 patients with diagnoses of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) and acute lymphoblastic leukemia(ALL) who underwent AlloSCT at the Hematopoietic Stem Cell Transplantation Unit of SHATHD between 2017 and 2021 were included in the study. Based on our previous study on the prognostic role of ELR such as absolute lymphocyte count (ALC) on the outcome of AlloSCT, in terms of overall survival (OS), patients were divided and evaluated into two groups.Results: At a median follow-up of 54.7 months , median OS, progression-free survival (PFS), cumulative incidence of relapse (CIR), and NRM for patients with ELR were not reached. Disease risk index (DRI), response to AlloSCT and choice of haploidentical donor were identified as significant risk factors for ELR. Analysing the data regarding the significance of ELR in post-transplant complications led to important conclusions regarding aGvHD, cGvHD and associated survival.Conclusion: ELR is an established, clinically significant prognostic factor for transplant outcome. Identification and modelling of risk factors and complications associated with ELR can significantly improve outcomes of AlloSCT.

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DOI: 10.3897/jbcr.e142717

Authors: Fagbohun Oyenike Bushirat, Hassan Abdusalam Adewuyi, Sakariyau Waheed Adio, Maryam Nana Musa, Timothy God-Giveth Olusegun, Ayomide Babatunde Ishola, Agumage Idoko, Adeola Victor Kolawole, Adesanmi Adefunmilayo Oluwatuyi, Sarah Ngozi Agwasim

Abstract: Adansonia digitata and Annona muricata are traditionally used medicinal plants with reported pharmacological properties. In this study, we aimed to elucidate the phytochemical composition, antioxidant activity, and antibacterial properties of partition fractions of Adansonia digitata and Annona muricata extracts obtained using chloroform, ethyl acetate, ethanol, and aqueous solvent systems. The plant extracts were successively partitioned using chloroform, ethyl acetate, ethanol, and aqueous solvent systems. Phytochemical analysis was performed using standard methods. Antioxidant activity was evaluated using FRAP and DPPH assays. Antibacterial activity was assessed using agar well diffusion and MIC determination. Phytochemical analysis revealed the presence of alkaloids (10.2-15.6%), flavonoids (8.5-12.1%), and phenolic acids (5.6-9.2%) in all fractions. The ethyl acetate fraction of Annona muricata exhibited the highest antioxidant activity (IC50 = 20.5 μg/mL) in the DPPH assay, while the chloroform fraction of Adansonia digitata showed significant antioxidant activity (IC50 = 35.2 μg/mL) in the FRAP assay. The antibacterial evaluation demonstrated that the chloroform fraction of Adansonia digitata exhibited broad-spectrum antibacterial activity (MIC = 0.5-1.5 mg/mL) against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, whereas the ethyl acetate fraction of Annona muricata showed potent antibacterial activity (MIC = 0.25-1.0 mg/mL) against Gram-negative bacteria. Additionally, the ethanol fraction of Adansonia digitata displayed moderate antibacterial activity (MIC = 1.0-2.5 mg/mL) against Gram-positive bacteria, and the aqueous fraction of Annona muricata exhibited weak antibacterial activity (MIC = 2.5-5.0 mg/mL) against all tested bacterial strains. Comparison of antioxidant and antibacterial activities among fractions revealed significant variations, indicating the importance of solvent selection in extracting bioactive compounds. The study validates the traditional use of Adansonia digitata and Annona muricata, highlighting their potential as natural antioxidants and antibacterial agents.

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DOI: 10.3897/jbcr.e145777

Authors: Sidi Mohammed Lahbib Seddiki, Mohammed Reda Mediouni, Wafa Benkhedda, Meghnia Hafdi

Abstract: The use of cell phones during medical care is a concern due to the transmission of pathogenic bacteria between medical staff and patients. This habit can lead to treatment errors, resulting in high mortality and additional therapeutic costs. The study aims to evaluate the infectious risk associated with using cell phones in the pediatric-neonatology department in Mecheria-Algeria, focusing on identifying bacteria that contaminate cell phone surfaces, the formation of biofilms and their resistance to antibiotics. The results showed that the microbial burden on cell phone surfaces ranged from 35±5 to 28×104±120 CFU/phone surface (CFU/PS). Gram-positive strains were predominant, including Staphylococcus xylosus and Bacillus sp. However, Gram-negative bacteria such as Aeromonas hydrophila, Micrococcus sp., Pseudomonas luteola and Sphingomonas paucimobilis were also isolated. The isolated bacteria showed complete resistance to Ceftazidime, while tetracycline and ciprofloxacin appeared effective against these isolates. The ability to form microbial biofilms was one of the characteristics observed in clinical isolates from the pediatric neonatology department, alongside isolates with hydrophobicity greater than 50%. However, most strains showed strong auto-aggregation at T = 0 min to T = 90 min, suggesting that initial incubation periods allowed for high auto-aggregation potential.

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DOI: 10.3897/jbcr.e144757

Authors: Vladimir M. Grigorov, Jan D. Esser, Mladen V. Grigorov, Valentina Y. Belcheva, Evgeni E. Grigorov, Maya P. Radeva-Ilieva

Abstract: This is a 200-patient retrospective single-centre study focused on evaluating the contribution of echocardiography (Echo) findings as an initial screening tool in selecting intensive care unit (ICU) patients with suspected pulmonary embolism (PE) for further diagnostic evaluation with ventilation/perfusion (V/Q) scintigraphy. These 200 patients with suspected PE were referred for a V/Q scan. Of them, 24 had Еcho findings of a dilated right ventricle (RV), and 8 of the 24 (33%) had a positive V/Q scan for PE. Seven of those 8 patients (88%) had large pulmonary emboli. Of the remaining 176 patients (without dilated RV), the V/Q scan was positive for pulmonary emboli in 39 cases (22%). If evaluating only the patients positive for pulmonary emboli on V/Q scan (47 patients), 8 of them (17%) had a dilated RV, and 39 (83%) did not have a dilated RV. Thus, we found that Еcho mainly contributed to identifying patients with life-threatening large pulmonary thrombo-embolic disease. In contrast to the above, echocardiography was non-contributory in the presence of small PE. This finding was in congruence with the existing literature.

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DOI: 10.3897/jbcr.e148797

Authors: Imrana Masood, Nosheen Neyazi, Shah Mohd Abbas Waseem, Hilal Hussain

Abstract: Abstract COPD and tuberculosis are on the rise in developing countries. There is evidence of post-tuberculosis lung function deterioration and the occurrence of obstructive airway diseases in such patient groups.Objectives: To study the burden and severity of obstructive airway disease in subjects with a history of pulmonary tuberculosis and find the demographic trends, features, and clinical presentations in tuberculosis-associated obstructive pulmonary disease (TOPD) and non-tubercular obstructive airway disease (non-tubercular OAD).Methodology: We investigated 125 patients divided into two groups, i.e., post-tubercular airway disease (n = 50) and airway disease due to other aetiology (n = 75). Age, gender, and BMI were analysed. Dyspnea grade was analysed using the Modified Medical Research Council (m MRC) scale. Spirometry was performed to find the pattern of airway disease in both groups. The severity of obstruction and lung functions were analysed using GOLD guidelines and spirometry.Results: The males accounted for 71.2%, and females –28.8% of the patients. There were more females in the tubercular airway disease group. The mean age of the tubercular group (46.94 ± 14.67) was significantly lower than that of the non-tubercular airway disease (58.47 ± 6.14). No significant difference was found for BMI. Obstructive airway disease was more common in both groups (46% and 49.30%, respectively), and the severity of obstruction was higher in the TOPD group. The severity of cough and dyspnea was higher in that group. FVC and FEV1 were significantly reduced in TOPD compared to non-tubercular obstructive airway disease (non-tubercular OAD). The mean latency of COPD symptoms after completion of ATT was found to be 5.38 ± 6.77 years.Conclusion: Post-tuberculosis subjects presented with lung function decline without confounding factors like smoking; thus, early screening of COPD is required once diagnosed; appropriate treatment should be initiated as early detection and treatment of these patients can help in better disease management and optimum treatment outcomes.

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DOI: 10.3897/jbcr.e147733

Authors: Galya Gancheva, Milena Karcheva, Ivaylo Pakov, Kalina Terzieva

Abstract: Introduction: The incidence of infectious diseases directly reflects the realities in all spheres of public life. Objective: to describe and analyse the dynamics of infectious morbidity in the country and the Pleven region against the background of fundamental changes in the general socio-economic plan and specific changes in the health sector over 20 years (2004–2023). Material and methods: A retrospective study on the incidence of infectious diseases in Bulgaria and the Pleven region for a 20-year period (2004–2023) was conducted. We used the following sources of information: official population statistics from the National Statistical Institute; official statistics from the National Center for Public Health and Analysis (NCPHA); analysis of the incidence of infectious diseases in the National Center for Infectious and Parasitic Diseases (NCCPD), annual reports of Regional Health Inspectorate – Pleven. Results: Significant changes were found in the incidence of specific infectious diseases related to changes in the immunisation strategy, the entry into force of the health reform at the beginning of the 21st century, and the admission of Bulgaria to the European Union. The impact of the COVID-19 pandemic on the actual reporting of infectious (and not only) morbidity is also evident. Conclusion: There is a permanent trend of decrease in the incidence of infectious diseases in the country and the Pleven region, most pronounced in diseases with mass vaccine prophylaxis. Follow-up in the dynamics of infectious diseases is a sensitive indicator of public health at the national and regional levels.

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DOI: 10.3897/jbcr.e144003

Authors: Valya Goranovska, Vassil Gegouskov, Georgi Manchev

Abstract: Central venous dialysis catheters are the first line of choice to start on hemodialysis. They could be a bridge to establish another dialysis access. Dialysis catheters are essential of two types: temporary (non-tunnelled) and permanent (tunnelled). Insertion of a dialysis catheter is a ubiquitous procedure in renal medicine. One of the rare but serious complications is vascular erosion. We report on a case of a 68-year-old female patient with acute kidney injury who needed emergency hemodialysis. A permanent dialysis catheter was inserted into her right subclavian vein. There was not good flow in the dialysis catheter’s afferent and efferent lumens. The nephrologist performed a contrast chest roentgenoscopy, which showed that the dialysis catheter followed an abnormal course by passing into the ascending aorta. Emergency surgical extraction of the dialysis catheter was initiated using median sternotomy and supraclavicular incision to identify the entry point of the catheter into the subclavian artery. Due to the dissection of the subclavian artery, we performed an extra-anatomic aorto-subclavian bypass with a saphenous vein graft. The dialysis catheter was inserted through open access into the right subclavian vein.

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DOI: 10.3897/jbcr.e143051

Authors: Evgeniya Byrzashka, Boyan Mednikarov, Mariya Peneva, Teodora Valova, Georgi Alexandrov, Rositsa Nedeva

Abstract: The maritime profession is an extreme test of the crew’s mental health. Psychobiotics are live bacteria that improve the gut microbiome and benefit the host’s mental health. The study aims to establish the effect of a probiotic containing Lactobacillus bulgaricus DWT1 on the mental resilience of the crew of the St. St. Cyril and Methodius research ship during the First Bulgarian Military Antarctic Expedition during the 127-day journey to Antarctica. The crew was divided into two groups: the first took the probiotic, and the second did not. Zung questionnaires were used to test anxiety and depression levels in everyone before departure and after return. We used the Wilcoxon test to analyze data from sleep quality assessments. The individuals taking the probiotic showed no statistically significant differences in anxiety and depression levels before and after the journey and maintained sleep quality under the expedition’s extreme conditions. The ones not taking the probiotic had a significant increase in anxiety and depression levels, which correlatively worsened physiological sleep. The journey of the military ship crew to Antarctica is a model for studying the effects of probiotics containing Lactobacillus bulgaricus DWT1 on the mental health of people subjected to extreme stress. The probiotic’s formula is psychobiotic, maintains the gut-brain axis, protects against depression and anxiety and improves physiological sleep under stress.

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DOI: 10.3897/jbcr.e134034

Authors: Polya Gergova, Stela Georgieva, Eleonora Mineva-Dimitrova

Abstract: Despite the advances in diagnostic technologies, oncology diseases in Bulgaria are detected at advanced stages. Nurses play a key role in planning, coordinating and delivering complex care. This review aimed to evaluate the role of nurses in the transition care for oncology patients and give recommendations for its updates according to the existing transition care models. In five oncology departments, we studied 67 patients and 49 nurses using a direct individual self-administered questionnaire. Data was processed with Microsoft Office Excel 2019 и SPSS v.26. A significant number of nurses affirmed providing information to the patients within their competence (77.6%), but only orally in two-thirds of cases (65.3%). Moreover, in most cases, it happens on discharge when the patient is agitated and cannot remember all the recommendations. After discharge, the patients would seek advice from an oncologist (76.1%), with only one would ask a nurse. Patients rely on the help of their families (64.2%) to cope with the disease. Nurses should play a crucial role in improving the quality and safety of care. Intervention programs for the prevention of oncology diseases should be prepared.

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DOI: 10.3897/jbcr.e144426

Authors: Elitsa H. Gyokova, Ahamed Akkeel Anzaar

Abstract: Introduction: Abortion is the termination of pregnancy, whether spontaneous or intentional. Attitude regarding abortion varies widely according to culture or religion and even political siding. Restricted access to abortion leaves women in need vulnerable to seeking unsafe termination methods. Objectives: To gauge medical students‘ attitude regarding abortion and their willingness to carry out terminations as qualified doctors, and to establish factors that impacted their attitude towards it. A secondary aim was to assess students‘ knowledge of Bulgarian abortion laws. Methods: A cross-sectional study was conducted in the form of a self-administered questionnaire, which was then distributed and collected online. It consisted of five distinct sections: (A) sociodemographic data; (B) personal experience of abortion; (C) attitude; (D) knowledge of Bulgarian laws regarding abortion; and (E) willingness to perform abortions as qualified doctors. Results: Being Christian or Agnostic/Atheist, being in clinical years, and believing that life begins at birth showed a higher positive attitude toward abortion. On the converse, being in preclinical years, being religious, and believing that life begins at the time of conception lends itself to having a poorer attitude towards abortion. Individuals with negative attitudes denied performing abortions if the need arose during their professional careers. Conclusion: By appreciating the differences and understanding the relationships with attitudes towards abortion, we can create strategies to minimize the stigmatization of women and reduce the harm they may encounter with unsafe abortions.

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DOI: 10.3897/jbcr.e145118

Authors: Nadezhda Hinkova, Kamelia Tsvetanova, Tihomir Totev, Margarita Nikolova, Teodora Semova, Dimitar Dimitrov, Elitsa Petkova

Abstract: Endometrial carcinoma remains one of the leading places in terms of frequency among oncogynecological diseases, both in countries with developed primary and secondary prevention and in countries with poorly functioning prevention. The implementation of screening programs would lead to the detection of oncological diseases in outpatient settings at an early stage, which would lead to positive socio-economical effects for society. This study aims to determine the test’s validity through the following criteria: sensitivity, specificity, and negative and positive predictive value of endometrial cytology compared with the histological result of examined tissue samples. We studied 300 women with abnormal uterine bleeding examined at the Clinic of Obstetrics and Gynecology at Saint Marina University Hospital– Pleven. Specimens for endometrial cytology were taken from all patients before invasive intervention. We compared the cytological results to evaluate the test validity, including sensitivity, specificity, and negative and positive predictive value in the cases with endometrial carcinoma. Statistical data processing was performed using the software programs MS Office Excel 2019 and IBM SPSS Statistics 28.0. The significance of results, findings and conclusions was determined at p < 0.05. A comparative analysis was performed on the cytological and histological results we obtained before and after the invasive manipulation. The study found statistical significance between the Pipelle biopsy results and cytological results (χ2 = 50.05, df = 24, p = 0.01, Cramer’s v = 0.439). Data analysis showed that endometrial cytology had a high specificity in proving endometrial carcinoma and a low positive predictive value (Se = 80%; Sp = 98%; PV = 66.7%; NV = 96.9%). Endometrial cytology could be an effective diagnostic method and can be applied to diagnose endometrial pathology. The combination of the two methods - cytological examination and transvaginal ultrasound would undoubtedly improve the detection rate of endometrial carcinoma. Additionally, cytology is an appropriate outpatient procedure that can be recommended for endometrial screening, especially in patients at high risk of developing endometrial cancer.

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DOI: 10.3897/jbcr.e143448

Authors: Georgi J. Stoitsev, Vassil Gegouskov

Abstract: Background. Cardiac surgeons increasingly favour the adoption of minimally invasive techniques for patients with aortic disease. Methods. We retrospectively analyzed the clinical data of 41 patients who underwent the Bentall procedure performed by the same surgical team between January 2014 and February 2024. We compared 10 patients who received the minimally invasive Bentall procedure to 31 patients who underwent a conventional median sternotomy. Results. Our operative times are consistent with those documented in the literature: the cardiopulmonary bypass (CPB) duration averaged 170.9 ± 31.62 minutes, and aortic cross-clamping time was 114.8 ± 19.34 minutes for patients with minimally invasive access, compared to 172.36 ± 79.98 and 104.14 ± 31.62 minutes respectively for the patients with standard approach (p = 0.503 and p = 0.194). Mortality in patients with minimal surgical access was one patient or 10%, and with total median sternotomy, it was three or 9.7%, with almost identical results p = 0.976. There was never a re-sternotomy due to bleeding or other reasons, nor a conversion to total sternotomy due to a complication related to the surgical intervention. Conclusion. This report highlights that the increasing demand and preference for more minimally invasive techniques in cardiac surgery can be met by careful patient selection in experienced centres without reducing safety or surgical efficacy, even in more complex cardiovascular pathologies.

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DOI: 10.3897/jbcr.e138925

Authors: Borislav Ignatov, Tatyana Simeonova, Tsvetelina Eftimova, Anelia Dimitrova, Krasimir Kostov

Abstract: Introduction: Chronic kidney disease (CKD) patients are at high risk for cardiovascular disease, largely due to the presence of vascular calcification and its associated complications. Undercarboxylated matrix Gla protein (ucMGP), which inhibits vascular calcification, plays a crucial role in preventing this condition.Aim: Our study aimed to compare ucMGP levels in CKD patients with preserved and reduced renal function and to evaluate its role as a biomarker for cardiovascular risk.Materials and methods: We studied 84 patients with predialysis CKD. They were divided into two groups according to the kidney function: Group I – patients with preserved renal function (GFR ≥ 90 ml/min) and Group II – patients with mild to severely decreased renal function (GFR between 15 and 89 ml/min). Blood samples were analyzed using the Cobas E 311 automated analyzer and the ucMGP levels were measured using an ELISA kit from Abbexa, UK.Results: In Group I, CVD patients had significantly higher inorganic phosphates, blood urea nitrogen and serum creatinine. In Group II, CVD patients had significantly higher ucMGP concentrations. UcMGP levels were associated with age and CVD in Group II and highly correlated with inorganic phosphate and serum creatinine levels in Group I.Conclusions: UcMGP levels show a significant increase in CKD patients with CVD and are strongly connected to various renal function indices, indicating its potential as a biomarker for cardiovascular risk assessment.

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DOI: 10.3897/jbcr.e139746

Authors: Venka Tsankova, Galya Stavreva, Milena Atanassova

Abstract: GR 159897 is a potent, selective NK2 receptor antagonist with anxiolytic properties that inhibits the contraction of experimental animals’ tracheal and intestinal smooth muscle. This study evaluated its effects on stress hormones and cytokines in rats under repeated stress.Methods: Wistar rats underwent water avoidance stress (WAS) and heterotypic stress (HS). Measurements included fecal pellet output, colorectal transit, and plasma levels of CTRH, ACTH, corticosterone (CORT), and cytokines.Results: Control rats gained weight, while WAS rats lost weight. Stressed rats treated with GR 159897, increased weight significantly. In HS, there was no significant change in the body weight (BW), and the administration of GR 159897 resulted in a noticeable increase in BW. WAS and HS caused an increase in fecal pellet excretion output in animals, and GR159897 significantly reduced the average number of pellets in WAS animals. CRH levels were significantly different in WAS and HS groups compared to controls. GR 159897 reduced CRH in WAS rats. ACTH levels increased in stress-subjected groups, significantly in HS rats, but GR 159897 decreased its concentration in both stress groups. CORT levels indicated significant differences among the control, WAS, and HS groups. GR 159897 reduced CORT levels in WAS+GR group, but not statistically significant to WAS group. GR 159897 significantly reduced elevated IL-6 levels in stressed rats.Conclusion: The ability of GR 159897 to reduce colorectal contractions, fecal pellet output, stress hormone levels, and proinflammatory cytokines leads us to conclude that NK2 receptor antagonists could help treat conditions like IBS or inflammatory bowel disease.

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DOI: 10.3897/jbcr.e144785

Authors: Natmir Mena

Abstract: Colonic diverticulosis is a common condition and the most frequent occasional finding during fibrocolonoscopy in asymptomatic patients in Western countries. The incidence rate of diverticulitis is relatively high. The descending and sigmoid colon are the predominant locations of the disease. The study aimed to analyze the diagnosis and treatment outcomes of a single institution series of 104 consecutive patients with colonic diverticulitis treated at the Clinic of Visceral Surgery, Hospital of Wallis, Switzerland, between January 1, 2023, and December 31, 2023. The mean age of patients was 63.37 years (±14.79). The diagnosis was based on clinical symptoms, leukocytosis, elevated CRP levels, diagnostic imaging (abdominal ultrasound, computed tomography) and fibrocolonoscopy. Treatment schemes included analgesics and antibiotics in all the cases and elective or emergency surgery – in 32 cases. The study demonstrated that an individualized treatment approach based on accurate laboratory and imaging diagnostics was both safe and effective.

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DOI: 10.3897/jbcr.e144006

Authors: Georgi Danielov Prandzhev, Grigor Angelov Gortchev, Dobromir Dimitrov Dimitrov, Radoslav Iliev Miltchev, Dimitar Rangelov, Slavcho Tomov Tomov

Abstract: Cervical cancer remains a leading cause of morbidity and mortality among women worldwide, particularly in regions with limited access to advanced medical care. Accurate and timely diagnosis of precancerous changes in the cervix is critical for effective prevention and treatment. This study introduces a deep learning algorithm for colposcopic analysis of the transformation zone of the uterine cervix. Intel & MobileODT Cervical Cancer Screening competition provided a comprehensive dataset designed to advance the application of artificial intelligence (AI) in classifying transformation zones (TZ) of the cervix, a key site where precancerous changes develop due to Human Papillomavirus (HPV) infection. This study highlights the significance of TZ classification for targeted biopsy during colposcopy, a gold-standard diagnostic method. However, challenges such as clinician’s subjectivity and interobserver variability, false negatives and positives interpretations limited accessibility, and resource intensity have spurred the integration of AI into colposcopic evaluations. The dataset comprises diverse cervical images, categorized into three types of TZs, enabling the development of AI models to distinguish between these categories. By leveraging deep learning algorithms, AI has demonstrated potential in enhancing the sensitivity and specificity of colposcopic findings while mitigating subjectivity and observer dependency. This abstract outlines the anatomical basis of cervical pathology, the critical role of colposcopy in diagnosing transformation zone abnormalities, and the transformative potential of AI in improving cervical cancer screening processes. The integration of AI-assisted tools could significantly improve diagnostic accuracy, reduce invasive procedures, and enhance access to cervical cancer prevention measures, particularly in underserved regions.

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DOI: 10.3897/jbcr.e139155

Authors: Atanas Drumev, Danelina Vacheva

Abstract: The ability of living organisms to navigate their environment is essential for survival. In scientific literature, this ability is known as locomotion, with walking being the primary mode of human movement. Our focus on the potential for independent movement within the environment arises from the high incidence of lower limb injuries and the significant number of patients requiring assistive devices to improve their walking ability, which is why we are conducting this review. The gait cycle begins with the stance phase, marked by heel contact, and consists of five subphases: initial contact, loading response, mid-stance, terminal stance, and pre-swing. The subsequent swing phase includes three subphases: initial, mid, and terminal swing. Key characteristics for assessing gait parameters are categorised into spatial and temporal indicators. Spatial indicators include stride length, step length, stride width, and foot angle, while temporal indicators encompass stance and swing phases, cadence, stride and step time, single and double support time, and speed. Human gait analysis has been done using numerous research methods, with traditional approaches being semi-subjective. Recent technological advancements have led to devices for objective evaluation, classified into non-wearable and wearable sensors. Our research focused on gait parameters to monitor recovery in patients with lower limb injuries and evaluated the G-WALK model, a wearable inertial sensor device which effectively registers spatial and temporal gait parameters.Numerous unanswered questions about gait recovery after lower extremity trauma motivated this review.

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DOI: 10.3897/jbcr.e136313

Authors: Joana Simeonova, Angelika Velkova, Lidia Georgieva, Peshka Pesheva, Kristina Popova, Nikolai Hristov, Elia Georgieva, Maria Pravchanska

Abstract: Despite the various theoretical frameworks of acculturation, the mechanisms by which acculturation affects health and well-being remain unclear. This cross-sectional study explores the role of acculturation in self-rated health (SRH) among international medical students. The study was conducted in 2024 at the Medical University – Sofia and included 326 participants. The Stephenson Multigroup Acculturation Scale (SMAS) was employed to assess cultural influences from both the host and home countries, focusing on two dimensions: Ethnic Society Immersion (ESI) and Dominant Society Immersion (DSI). SRH was measured using a five-category Likert scale. Covariates included perceived stress, social support, and health behaviour factors. Logistic binary regression was applied for analysis. The findings revealed that most international medical students rated their health as good (56.4%). Poor health was significantly associated (p < 0.05) with lower ESI (Mdn = 3.4), higher stress levels (Mdn = 22), and a lack (31.9%) or insufficiency (54.2%) of physical activity (PA). ESI emerged as a significant predictor of good health (Exp(B) = 0.403; p = 0.004). The impact of DSI on poor SRH was mediated by PA (Exp(B) = 4.629 and Exp(B) = 2.699, p < 0.05 for both risk groups). The results of this study can be useful in planning health and social services for international students, considering their specific needs.

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DOI: 10.3897/jbcr.e135548

Authors: Malvina Todorova, Katya Todorova

Abstract: With the outbreak of the COVID-19 pandemic, the scientific community has directed its attention towards studying the impact of the causative agent, SARS-CoV-2, on the endocrine system. It has been proven that the virus exhibits organotropism towards the cortex of the adrenal glands, causing tissue damage and hormonal dysfunction. The aim of this exposition is to address the question of whether SARS-CoV-2 causes disruptions in the hormonal regulation of glucocorticoid hormones. Based on a thorough review of the current literature, it is suggested that the virus could potentially directly damage the hypothalamus, leading to a disruption in the regulation of the hypothalamic-pituitary-adrenal axis. The decrease in cortisol secretion is a secondary effect. As a result, there is a loss of stress-induced cortisol elevation due to the inflammatory process and an increased risk of adrenal crisis. On the other hand, inflammatory cytokines synthesized during the inflammatory process could stimulate cortisol secretion through an ACTH-independent mechanism. The magnitude of the biological response is influenced by the newly emerged resistance of cortisol receptors, disturbances in intracellular cortisol signaling, and dysregulation between ACTH and cortisol secretion. The detailed study of functional changes in cortisol secretion in response to SARS-CoV-2-associated inflammation provides a new horizon for scientific research following recovery from COVID-19.

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DOI: 10.3897/jbcr.e125766

Authors: Zlatko Kirovakov, Elitsa H. Gyokova, Nadezhda H. Hinkova, Emiliana I. Konova

Abstract: The current article aims to provide an analytical review of the aetiology, pathophysiology, diagnosis, and treatment of recurrent pregnancy loss (RPL) with a focus on Bulgaria. RPL has become an important reproductive health issue worldwide and affects 2%–3% of reproductive-aged women. The findings showed that the etiological factors can be biological, hereditary or environmental, and in approximately 50% of RPL cases, these factors remain unknown. In relation to pathophysiological processes associated with the condition, the findings showed that different etiological factors affect different gestational processes, such as alteration of the structural and nanomechanical abnormalities of the platelets and disruption of the ANXA5 protective shield that prevents adverse pregnancy outcomes. Also, acquired uterine structural defects such as submucosal uterine leiomyomas, endometrial synechiae, and polyps disrupt the implantation and embryonic development processes, which can result in recurrent miscarriages. A common factor for diagnostic approaches to recurrent pregnancy loss is the examination of historical medical records of patients who have experienced the condition and the identification of possible etiological and risk factors. The management and treatment of recurrent pregnancy loss are often based on the results of the diagnostic tests used to determine the underlying etiological factors associated with the condition.

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DOI: 10.3897/jbcr.e125467

Authors: Miroslava Mihaylova-Strashilova, Pencho Tonchev Tonchev

Abstract: Aim: The aim of this study was to determine the incidence of thrombocytopenia in cases with liver cirrhosis and its relationship with the severity of the disease. A retrospective study of cases with liver cirrhosis was conducted out from 2017 to 2021. The information was collected from the patient’s hospital records at their first admission. The study group included 361 individuals over the age of 18 - 258 (71%) men and 103 (29%) women. A platelet count below 150 G/L was considered an indicator of thrombocytopenia. Results were analized using IBM SPSS 26 and Eхcеl statistics. Results: Thrombocytopenia was found in 171 (47.4%) subjects. In 45 (26%) cases, accounting for 12.46% of the studied population with cirrhosis, thrombocytopenia was not accompanied by hematological abnormalities. There was no statistical relationship between the Child-Pough stage and the presence of thrombocytopenia (p = .400) and no statistically significant differences in platelet counts among the three Child-Pough stages (p = .205). The thrombocytopenia cases had a higher MELD Na than those without, with a statistically significant difference between the two groups (p = .002). Of the thrombocytopenia cases, 73.7% had oesophageal varices (p = 0.000). A cut-off value of 181G/L with 73% sensitivity and 54.5% specificity for predicting the occurrence of varices was established. There was no statistical association between thrombocytopenia and portosystemic encephalopathy (PSE); (p = .591). Thrombocytopenia is an important laboratory finding in the progression of portal hypertension in liver cirrhosis. An isolated finding also requires ruling out chronic liver disease and endoscopic examination to exclude oesophageal varices.

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DOI: 10.3897/jbcr.e138140

Authors: Dimitar Dimitrov, Nadezhda Hinkova, Teodora Semova, Zornitsa Gorcheva, Mirela Vasileva, Elitsa Petkova

Abstract: The main methods of histological diagnosis of endometrial carcinoma are dilatation and curettage, fractional curettage, and diagnostic hysteroscopy with endometrial biopsy. This retrospective study aims to compare the preoperative histological results obtained by different diagnostic methods with the postoperative ones in patients with endometrial carcinoma and determine the most accurate and safest method for diagnosing the disease. From 06.2020 to 09.2023, a retrospective study was conducted on 80 patients with histologically proven carcinoma of the endometrium, treated at University Hospital Saint Marina-Pleven. The mean age of the patients was 58.04 ± 10.46, ranging from 28 to 78. The comparative analysis of the discrepancies of the histological verification methods in the evaluation of the preoperative and postoperative histological result showed that a statistically significantly higher percentage of discrepancies (19.5%) had the dilatation and curettage compared to the zero discrepancy of the hysteroscopy (0.0%). The relative proportion of discrepancies of the fractional curettage is 14.3%. The cytological result was negative for tumor cells in 97.5% and positive in 2.5%. In all patients with a positive cytological result for tumor cells, the method of histological verification was dilatation and curettage. Performing diagnostic hysteroscopy and observing safety principles such as creating low intrauterine pressure and short operative time is a safe and reliable method for diagnosing endometrial carcinoma.

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DOI: 10.3897/jbcr.e138141

Authors: Teodora Semova, Slavcho Tomov, Tihomir Totev, Dimitar Dimitrov, Zornitsa Gorcheva, Valeria Racheva

Abstract: Standard treatment for ovarian cancer includes optimal cytoreduction, followed by chemotherapy in most cases. This study aimed to evaluate the role of minimally invasive approaches in diagnosing and treating ovarian carcinoma. We conducted a retrospective analysis of patients diagnosed with ovarian carcinoma who underwent surgery at the Department of Obstetrics and Gynecology at St. Marina University Hospital–Pleven from January 2020 to April 2023. The study included 213 patients; the average age was 58.90 years. Out of all patients in the study, 64 initially received only diagnostic intervention. Of these patients, 53 (24.9%) underwent minimally invasive diagnostic intervention, while 11 (5.2%) had diagnostic intervention through conventional laparotomy. Among the patients who had surgery, the most common procedure (53.1%) was total abdominal hysterectomy with bilateral salpingo-oophorectomy, followed by diagnostic laparoscopy with subsequent laparotomy (14.6%). Thirty-one (14.6%) of the patients had interval surgery. Twenty-seven (87.1%) patients underwent minimally invasive diagnostic intervention. Moreover, 21 (67.7%) patients who had interval surgery also underwent surgery using a minimally invasive approach. The obtained results show that minimally invasive approaches are widely used in the diagnosis and treatment of ovarian carcinoma. The increasing adoption of interval surgery will expand another application of minimally invasive surgery - robot-assisted interval surgery after neoadjuvant chemotherapy.

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DOI: 10.3897/jbcr.e121855

Authors: Miroslava Mihailova-Strashilova, Pencho Tonchev

Abstract: This study aimed to determine the frequency of available complications in patients with liver cirrhosis and any dependence according to the Child-Pough score. A retrospective study of cases with newly diagnosed liver cirrhosis was conducted in the Gastroenterology Clinic of UMBAL Pleven from 2017 to 2021. Of them, 258 (71.5%) were men and 103 (28.5%) were women. The mean age of the studied population was 57.8 years ± 11.4 years. The leading aetiology was alcohol in 244 (67.6%) of them. All cases were classified according to Child-Pough score system into three groups: Child A 98(27%), Child B 141(39%), and Child C 122(34%). Ours findings show that the occurrence of ascites is most common in the studied population at 232 (64.5%). Esophageal varices were found in 164 (62.4%) patients out of 264 who underwent upper gastrointestinal endoscopy. Portal encephalopathy was found in 170 (47.09%), with a predominance of the minimal in 116 (68.23%) of them. Jaundice was found in 124 (34.34%), and more of them were in Child C. In 65 (18%), renal dysfunction was found, such as acute renal dysfunction in 12.4%. In conclusion, the high frequency of available complications is closely related to late diagnosis.

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DOI: 10.3897/jbcr.e128440

Authors: Zhivko Yovchev, Konstantin Gospodinov, Yoana Todorova, Snezhanka Tisheva-Gospodinova

Abstract: The paper highlights the correlation between COVID-19 and the heightened susceptibility to arrhythmia - a cardiac rhythm disturbance, in hospitalised individuals. The data indicates a significant positive link between the quantity of COVID-19 instances and the number of patients with rhythm pathology. The COVID-19 infection is linked to an increased risk of arrhythmia. The precise ways in which COVID-19 harms the heart tissue and leads to rhythm and conduction disturbances are not completely known and necessitate additional investigation. Moreover, research indicates that a previous SARS-CoV-2 infection may increase the likelihood of rhythm complications.

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DOI: 10.3897/jbcr.e125424

Authors: Teodora M. Velkovska, Adelaida L. Ruseva

Abstract: This review aims to briefly describe and summarize data from various studies on the role and the link between serum Total Antioxidant Status (TAS) levels in patients with BPH and PC, as well as other more widely available endogenous antioxidants, the levels of markers of inflammation (CRP, Leuc.), as well as the link between the values of endogenous antioxidants and various harmful factors. Their levels and adequate assessment could help in the proper management of patients with BPH and PC, as well as in reducing morbidity.

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DOI: 10.3897/jbcr.e132202

Authors: Georgi Dimitrov, Maya Danovska, Eleonora Mineva-Dimitrova

Abstract: The objective of our study was to compare the age-related differences in the prevalence of modifiable risk factors (RF), stroke subtype and functional outcome at hospital discharge in young and middle-aged patients with first-ever ischemic stroke (IS). The study included 120 patients with acute first-ever IS, aged 18–59 years, admitted to the Neurology Clinic of Dr. Georgi Stranski University Hospital, Pleven. Of these, 41 (34.2%) were in the young-age group and 79 (65.8%) were middle-aged. The middle-aged patients had higher rates of arterial hypertension (81.0%), diabetes mellitus (45.6%), dyslipidemia (83.5%), low levels of HDL cholesterol (68.4%), high levels of LDL cholesterol (72.2%) and arterial fibrillation (7.6%). The most common subtype of IS in middle-aged patients was large artery atherosclerosis (40.5%), small vessel occlusion (29.1%) and cardioembolism (6.3%). In comparison, we found a higher incidence of IS in the young patients with other determined (34.1%) and undetermined aetiology (34.1%). Our data on functional outcomes at hospital discharge confirm age-related differences in the prevalence of modifiable RFs and stroke subtype in young and middle-aged patients with first-ever IS. These findings highlight the need to develop specific therapeutic approaches for early identification and effective control of health- and lifestyle-related RFs to reduce the incidence of the most common subtypes of IS.

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DOI: 10.3897/jbcr.e124109

Authors: Mirela Vasileva, Zornitsa Gorcheva

Abstract: Endometrial cancer is one of the most common gynecological malignancies, especially in high-income regions of the world, and its incidence rates have continued to increase over the past decade. Its staging is surgical, with treatment planning based on the FIGO stage and histological subtype and grade. Imaging is obligatory in the diagnostic work-up process in order to allow more tailored treatment. Magnetic resonance tomography is the preferred imaging modality that may be used to aid in the preoperative risk stratification, surgical planning and individualized therapy.

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DOI: 10.3897/jbcr.e122925

Authors: Milen Hristov, Pavlina Andreeva-Gateva

Abstract: Various studies have emphasized the intricate relationship between hydrogen sulfide (H2S) and nitric oxide (NO) in regulating diverse physiological processes. In this investigation, we aimed to elucidate the effects of simultaneous inhibition of the H2S-producing enzyme cystathionine γ-lyase and the NO-producing enzyme nitric oxide synthase on food and water intake, body mass gain and body temperature in rats. Specifically, we explored the combined impact of dl-propargylglycine, an irreversible inhibitor of cystathionine γ-lyase, and Nω-Nitro-L-arginine methyl ester (l-NAME), a non-selective inhibitor of nitric oxide synthase, on these physiological parameters. Co-administration of dl-propargylglycine (50 mg/kg, i.p.) and l-NAME (50 mg/kg, i.p.) effectively suppressed food intake and body mass gain in fasted rats at 24 hours post-injection, accompanied by a notable decrease in water intake. Furthermore, this combined treatment induced a significant decline in body temperature at 90, 120, and 150 minutes post-injection compared to the control group, shedding light on the complex role of H2S and NO systems in modulating body temperature regulation. These findings enhance our understanding of the potential physiological implications of targeting the cystathionine γ-lyase/H2S and nitric oxide synthase/NO pathways.

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DOI: 10.3897/jbcr.e119983

Authors: Meri Shoshkova, Martin Karamanliev

Abstract: Rectal stump leak following Hartmann’s procedure resulting in an abscess formation is quite a rare complication. The size of the cavity, the healing process, neoadjuvant radiotherapy, and the patient’s overall condition may play a huge role in the stoma reversal rates, functional outcomes, and the patient’s quality of life. Moreover, it can lead to septic complications if not treated properly. We present a case of a 75-year-old male patient who underwent Hartmann’s procedure due to low rectal carcinoma. He presented one month after the procedure in our office with a fever and anal secretion. He was treated with three different types of antibiotics, drainage of the abscess cavity, and dressing twice a day of the wound with a povidone-iodine solution without success. Amputation of the rectal stump, debridement of the necrotic tissue, and VAC therapy resolved the symptoms and closed the perineal defect. VAC therapy may be used successfully for chronic pelvic inflammatory complications after Hartmann’s procedure.

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DOI: 10.3897/jbcr.e123690

Authors: Zlatko Kirovakov, Elitsa Gyokova, Nadezdha Hinkova, Emiliana Konova

Abstract: Compared with non-pregnant women, pregnancy alone carries a three- to fivefold higher risk of venous thromboembolism (VTE). Despite the increasing use of low-molecular-weight heparin in identified high-risk patients, pulmonary embolism is still the leading cause of maternal mortality. However, evidence for optimal use of thromboprophylaxis is scarce. Thrombophilia (hereditary or acquired) is thought to predispose to both VTE and is also associated with complications of pregnancy, such as recurrent miscarriages and preeclampsia. This review discusses the current evidence for optimal thromboprophylaxis during pregnancy by focusing primarily on VTE prevention strategies, the potential to prevent recurrent complications during pregnancy with low molecular weight heparin (LMWH), aspirin, and Nattokinase in pregnant women with congenital thrombophilia.

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DOI: 10.3897/jbcr.e122210

Authors: Тoni Ivanov Stoyanov

Abstract: Hiatal hernia (HH) is often seen in surgery practice. The main feature of HH is the migration of abdominal viscera in the mediastinum via the esophageal hiatus. We performed - on 53 patients from November 2009 to June 2018 in the Department of General and Digestive Surgery of General Hospital of Villarobledo. Forty-one patients were diagnosed with hiatal hernia, 9 - with gastroesophageal reflux disease (GERD), and 3 - with Barrett’s esophagus. The average operative time was 89 ± 33 minutes, and the average follow-up was four years. The following complications were recorded: perforation of the distal esophagus in 1 patient (1.9%), postoperative spleen hemorrhage requiring emergency laparotomy in 1 patient (1.9%), dysphagia in 6 patients (11.3%) in the early postoperative period (treated conservatively), one patient had small bowel obstruction in the fourth postoperative year, three patients (5.6%) had radiological signs of HH recurrence and GERD despite the fundoplication. One patient (1.9%) was reoperated for stenosis of the distal esophagus and recurrent paraesophageal hiatal hernia one year after the first intervention. Postoperative ventral hernia (POVH) was seen in 2 patients (3.8%). All recurrence rate was 7.5%, recorded in 4 patients.

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DOI: 10.3897/jbcr.e121803

Authors: Desislava Marinova, Stefan Trifonov

Abstract: Acetylcholine plays an important role as a neurotransmitter in the central and peripheral nervous systems. Its biosynthesis is catalyzed by choline acetyltransferase (ChAT). In mice, the ChAT gene has three 5′-noncoding (R, N, and M) and 14 coding exons, from which seven mRNA isoforms (M, N1, N2, R1, R2, R3, and R4) are transcribed. They differ in the 5′-noncoding ends and encode the same protein (common ChAT). An additional isoform that lacks coding exons from 5 to 8 encodes a smaller protein (peripheral ChAT). This research aimed to design and check the specificity of primers targeting R3, N1, N2, M, peripheral ChAT, and common ChAT isoforms. The optimal PCR conditions and specificity of the primers were tested in a series of PCR reactions. Specially designed DNA fragments or plasmids containing isoform-specific nucleotide sequences were used as templates. The appropriate annealing temperature, which yields sufficient specificity for each tested primer pair, was as follows: R3 – 60 °C; N1 – 63 °C; N2 – 65 °C; M – 65 °C; peripheral ChAT – 65 °C and common ChAT – 63 °C.

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DOI: 10.3897/jbcr.e127525

Authors: Anabela Glavanova, Branimir Raduilov, Tsvetelina Miteva, Mariela Kamburova, Ivan Polyakov, Evgeni Mekov

Abstract: Thyroid diseases are common and, in most cases, can be safely and effectively detected and treated in primary medical care. This article aimed to analyze and evaluate the rate of thyroid ultrasonographic abnormalities in a primary medical care practice in Bulgaria. The research was conducted from 2016 to 2021. A random cohort of patients undergone annual preventive screening was included. Demographic information (age and sex) was collected. The descriptions of the ultrasonographic findings were standardized based on the following parameters: deviations in shape, size, position of the thyroid gland, deviations from normal parenchymal echogenicity (hyper-, hypo-, and heteroechogenic parenchyma), presence and size of detectable formations, and presence of calcifications. The total number of participants in this study was 3 178. Of these, 60% (1 907/3 178) were women and 40% (1 271/3 178) were men. The average age of participants was 40.1 ± 11.3 years, and there was no significant difference between the males and females. Deviations from normal ultrasonographic findings were observed in 36.2% (1 151/3 178), with a frequency increasing with age. Detectable formations were seen in 19.7% (625/3 178) of the patients, and those larger than 1 cm accounted for 4.4% (139/3 178) of all cases and 22.2% of all formations (139/625). Calcifications were found in 0.5% (15/3 163). Over 1/3 of the performed thyroid ultrasounds revealed abnormalities. Thyroid ultrasonographic abnormalities were significantly more common in women compared to men, and their frequency increased with age.

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DOI: 10.3897/jbcr.e125939

Authors: Miroslava T. Hristova, Tsvetelina V. Miteva

Abstract: The importance of an emergency medical care system for ensuring affordable and quality healthcare in any country is indisputable. Studying and analyzing existing problems in organizing this system is the first step to solving them. The present study aimed to investigate and outline the possible scope of the problems of emergency medical care, their recurrence, and similarity in 17 European countries. Content analysis of documents was used. The most characteristic organizational problems in providing emergency medical care for each of the countries are identified and grouped into five categories: Direct patient access to hospital emergency departments; Overloading of emergency departments by non-urgent, self-referral patients; Telephone triage by dispatchers - nurses or assistants; Existing and/or impending shortage of doctors in Emergency Medical Services (EMS); Regional and social inequalities in access to emergency medical care. A quantitative measurement of the categories and their relative weight were reported. Based on the analysis, the conclusions of the study were drawn. The identified problems, grouped into categories of weaknesses of the existing emergency medical care organization in European countries, may serve as a basis for undertaking health care reforms.

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DOI: 10.3897/jbcr.e126573

Authors: Stanimir Stanimirov, Petar Vatov

Abstract: Nephrolithiasis is a disease that occurs with the formation of stones in the urinary tract. The occurrence of such stones depends on geographical, climatic, ethnic, dietary, and genetic factors. Most often, they are seen in countries with warm and dry climates. The Balkans are an endemic area, and 2% of the population is estimated to have the condition annually. The frequency is the same in both sexes. It is relatively rarer in childhood. This study aimed to show the modern possibilities for surgical treatment of kidney stone disease and combinations of different surgical approaches to achieve mini-invasiveness, short-term hospital stay, and reduction of postoperative complications. We present a clinical case of a patient with kidney stone disease with multiple lithiasis with multiple localization found in the left kidney. A combined (hybrid) operative approach was used – combining the laparoscopic technique and flexible renoscopy. We combined the possibilities of the two operative procedures and achieved a one-act cure for the patient. The method was minimally invasive. The hospital stay was shorter, and no postoperative complications occurred.

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DOI: 10.3897/jbcr.e126717

Authors: Elka Tumbeva, Tsvetelina Valentinova

Abstract: The study aimed to evaluate and analyze the impact of the COVID-19 pandemic on the emotional state of patients in General Medical Practice in Bulgaria. In July-December 2022, a survey was organized among 306 GPs working in primary health care (PHC) in Bulgaria. They represent about 8% of the country’s general practitioners and work in eight regions. An individual self-completion questionnaire was offered. After obtaining permission from the Ethics Committee, respondents were randomly selected. The data was processed with a specialized statistical software package, SPSS 22. The COVID-19 pandemic has increased the number of patients with anxiety and depressive symptoms in the period 2020–2022, according to 95.3% (286) of the GPs surveyed. According to the GPs, the reasons for this were social isolation – 79.4%, negative information from the media – 73.1%, uncertainty – 65%, financial worries – 51.7%, uncertainty about the future – 38.8%, and other – 2.1%. The population of Bulgaria has been greatly affected by the COVID-19 pandemic. The pandemic has increased the number of patients with anxiety and depression in the General Medical Practice for the period 2020–2022. Bulgarians often resort to self-medication despite the easy access to general practitioners and the possibility of consultation with a psychiatrist.

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DOI: 10.3897/jbcr.e126709

Authors: Hristo S. Milev, Vasil Nanev, Desislava Dimitrova, Strahil Strashilov, Angel Yordanov, Miroslava Mihailova-Strashilova, Silvia Naneva, Simoneta Ivanova, Milena Karcheva, Ivan Ivanov

Abstract: There are no specific recommendations for evaluating the Ki-67 index in heterogeneous breast carcinomas. This study aimed to evaluate the applicability of currently accepted recommendations for Ki-67 evaluation in breast cancer in the context of intratumor heterogeneity. Twelve cases of heterogeneous breast carcinomas obtained from 110 patients were retrospectively studied. Ki-67 staining was performed according to protocols provided by the reagent manufacturer. Results for Ki-67 of the separate components in each tumor were obtained, described, and analyzed statistically using a paired t-test. Values of p < 0.05 were considered as statistically significant. SPSS software was used for statistical analysis. Results from the comparison of the Ki-67 index evaluation in each heterogeneous component of the studied tumors demonstrated no statistically significant difference of mean values t = 0.4802, p = 0.6405. The anticipation of an average Ki-67 score in the evaluated cases would have changed the molecular subtype from Luminal B to Luminal A (due to the Ki-67 index below 14%) in two of the cases. Heterogeneous tumors had a different Ki-67 index in their separate components. Our observations suggest that Ki-67 in heterogeneous breast carcinoma is evaluated and reported separately for the distinguishable tumor components.

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DOI: 10.3897/jbcr.e126698

Authors: Elitsa Y. Stoyanova, Mariela Kamburova

Abstract: The main risk factors for Human papillomavirus (HPV) infection, and the development of associated diseases are related to sexual behavior and health literacy of the population. The study aimed to investigate the impact of risk and protective factors for HPV infection and the development of associated diseases in adult women. A case-control study was conducted from January 2020 to May 2022A. Respondents had sought outpatient and/or inpatient obstetric-gynecological care in the city of Pleven. The significance of results, findings, and conclusions was determined at p

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DOI: 10.3897/jbcr.e126686

Authors: Elena Borisova, Snejanka Ivankovska, Plamen Pavlov, Asparuh Nikolov, Pavlina Glogovska

Abstract: At the end of 2019, several cases of pneumonia provoked by an unknown causative agent were identified in China. In March 2020, the World Health Organization announced a pandemic of a new strain of Coronavirus - SARS-CoV-2. The neutrophil/lymphocyte ratio (NLR) is a biomarker that has recently become an important diagnostic and prognostic indicator in many diseases. The study‘s objective was to look for a relationship between NLR and the outcome of Covid-19 infection. Retrospectively, we studied 288 patients (mean age 69.1 ± 12.5) treated in an intensive pulmonology unit over ten months since 01.08.2021. All patients had severe pneumonia caused by SARS-CoV-2 infection, proven by a polymerase chain reaction (PCR) test. Leukocytes, lymphocytes, neutrophils, and NLR were traced. Hundred and seventy-four (60.4%) of the patients died, and the rest were discharged with improvement. Concerning NLR, we found values of 9.52 in the group of the deceased and 7.87 in those discharged, respectively, at the beginning. In the end, this indicator increased in the group of deceased to 15.04, while we found a drop to 7.3 in those discharged. A statistically significant difference was found regarding the outcome of the disease and the change in the NLR values in dynamics (p = 0.005). NLR is a cheap and reliable biomarker that can predict the outcome of Covid-19 infection.

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DOI: 10.3897/jbcr.e126655

Authors: Krasimir T. Petrov, Ivan Ivanov, Tatyana Betova, Reni Tsvetkova, Radoslav Trifonov, Savelina Popovska

Abstract: In this paper we summarize the results of a retrospective investigation of tumor budding in endoscopic preoperative biopsies in patients with colorectal adenocarcinoma (CRC). The aim of this study was to assess the peritumoral budding evaluation interpretability, based on endoscopic colorectal biopsies in left and right sided colorectal carcinoma and some of the factors that influence it. A group of 100 patients, with preoperative endoscopic biopsies was selected and the tumor buds were counted on H&E stained slides, according to contemporary clinical recommendations. In the studied patient group, budding was identified in a total of 13 patients (13% of the studied cases). The primary localization of the tumor in the left or right colon was not associated with the reporting of budding in endoscopic biopsies of colorectal carcinoma. No budding was observed in highly differentiated tumors, and the presence of budding was reported less frequently in poorly differentiated tumors compared to moderately differentiated ones. Budding was accessible for evaluation in nearly 1/10 of the small biopsies from CRC. Artifacts from the sample management as well as factors related to the tumor characteristics predetermined the possibility for evaluation of tumor budding on small biopsies.

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DOI: 10.3897/jbcr.e126649

Authors: Ivelina J. Pitakova, Todor Kozhuharov, Dimana Mitsova

Abstract: Vision is a complex act that allows the visual analyzer to perceive and analyse objects in the environment. The teams of two eye clinics conducted a “good vision-good driver” awareness campaign in combination with a survey. In most countries in the world, drivers over the age of 65 are required to renew their licences every 2 or 3 years. The European Commission wants car drivers over 70 to prove their ability every 5 years. The aim was to analyze the relationship between patients’ visual performance concerning their self-reported driving and their subjective general health. The survey was conducted through a direct survey at St. Nikolay Chudotvorets Eye Clinic Eye Clinics from 1.06.2021 to 31.06.2022. For the period, 103 patients were surveyed, 84 male and 19 – female. The group of 50–70-year-olds was the most numerous. Uncorrected vision equal to or less than 0.3 was present in 45.6% of all 206 eyes. Almost all respondents drove a car, only 3 were not drivers, and most (50.9%) had no difficulty driving. More than 42% of the respondents found driving difficult only at night, and 6.8% had difficulty always. There is an overlap in the results of the questions of whether the patient had had a traffic accident – positive in 13.7% and whether they had ever had a stroke. The ability to drive is a multifactorial process in which vision plays an undeniable role. Visual acuity reflects the need for correction in the driving licence. The present research proves the need because it shows patients with poor vision driving and not at a young age who overestimate their general and visual objective condition.

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DOI: 10.3897/jbcr.e126554

Authors: Radina Kirkova, Snezhana V. Murgova, Vidin Kirkov, Tzvetomir Dimitrov, Georgi Balchev, Ivan Tanev

Abstract: Age-related macular degeneration (AMD) is a degenerative, progressive disease, which destroys the central retina. AMD has two main forms - „dry“ and „wet“ (exudative). In order to make the diagnosis of AMD with CNV, apart from ophthalmoscopy, specialized tests are needed - fluorescein angiography (FA), indocyanine angiography, OCT, OCT-angiography (OCT-A). OCTA is a new and non-invasive technology. Compared to the old, well-known techniques for retinal evaluation, it is very precious because of its high resolution and detailed images – which allow early diagnosis and objective monitoring of the lesions in the future. The aim of this review is to describe the principles of function, features of the device and its application in everyday clinical practice in diagnosing patients with macular pathology. A systematic search of the literature, published in the past decade was identified from PubMed and Ovid databases with reference to the Preferred Reporting items for Systematic Review. AMD is a disease that is increasingly socially important because of the aging population in developed countries. The increasing use of OCT-A nowadays suggests new classification systems. The non-invasiveness, the short examination time and the high informativeness that OCT-A brings in relation to AMD requires a deeper study of the methodology and the development of new classifications to facilitate clinical practice.

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DOI: 10.2478/jbcr-2023-0026

Authors: Alexander Popov, Klimentina Gospodinova, Veronika Gincheva, Daniela Grozeva, Dimitar Gospodinov

Abstract: Atopic dermatitis (AD) is a chronic inflammatory disease based on genetic and immune alterations and is part of the atopic symptom complex, including allergic rhinitis, allergic conjunctivitis, and bronchial asthma. A disturbed barrier function facilitates antigen penetration through the skin, with the subsequent development of allergic contact dermatitis (ACD). The gold standard for diagnosing ACD is epicutaneous (patch) testing, also applied to objectify contact sensitization in AD. This study aimed to determine the frequency of contact allergy (CA) among individuals with atopic history and the allergens that caused ACD in those cases. We studied 453 individuals tested in the period 2009-2022. Of these, a subpopulation of 189 individuals with atopic diathesis was identified. A retrospective analysis was used. Using clinical and allergological methods, we divided the tested patients according to sex, age, professional occupation, and areas of the body affected by dermatitis and identified the most common contact allergens that cause positive reactions and ACD. In conclusion, our results highlight the possibility of developing ACD in people with atopic diathesis. As far as we know, our study is the first one in Bulgaria to examine the frequency of contact sensitization in AD patients.

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DOI: 10.2478/jbcr-2023-0025

Authors: Klimentina Gospodinova, Adriana Angelova, Malena Gergovska, Daniela Grozeva

Abstract: The study aimеd to investigate the association between the professional environment and hypersensitivity reactions to various contact allergens, features of the clinical course, and types of allergic contact dermatitis (ACD) in 34 manicurists and ten service users. The analysis was based on the data on length of professional experience, localisation of rashes, clinical diagnoses and allergens, and the cause of positive reactions in epicutaneous testing. Pathological skin changes most often affected the upper limbs (hands, palms, fingers). As a diagnosis, the frequency of ACD was the highest – 79.4%, followed by that of dyshidrotic eczema (DE) – 17.6%, which also determines the highest percentage of dermatitis on the upper limbs (97%). Of the patients, 47.1% had a history of the disease for up to one year. For manicurists, the results of patch tests with the specialised MH-1000 series showed the highest frequency of positive reactions to 2-Hydroxyethyl methacrylate (2-HEMA) and 2-Hydroxypropyl methacrylate (2-HPMA) – 88.88% each, Ethylene glycol dimethacrylate (EGDMA) – 83.33% and 2-Hydroxyethyl acrylate (2-HEA) – 61.11%. After combining data for manicurists and clients, correlation analysis found a significant effect on the development of ACD to 2-HPMA (p=0.003) and EGDMA (p=0.005), as well as for hand dermatitis to 2-HEMA (p=0.05) and 2-HEA (p=0.044).

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DOI: 10.2478/jbcr-2023-0024

Authors: Preslav Vasilev, Milen Karaivanov, Martin Karamanliev, Dobromir Dimitrov, Petranka Troyanova, Ivelina Yordanova

Abstract: Squamous cell carcinoma of the skin (SCCs) accounts for 20-30% of non-melanoma skin cancers, resulting in 1 million cases in the United States annually. The risk of developing SCCs increases annually, and this process will likely be continued because of the aging population. We investigated 355 patients with histopathologically confirmed SCCs. We rated the age- and sex-related incidence, risk factors, localisation, pathological features, staging systems and treatment, and the recurrence and mortality rates of the tumours. Staging and risk stratification for recurrence and metastases is significant. Most SCCs are successfully treated surgically, with a small subset of carcinomas leading to recurrence, metastasis, and death. Patients with advanced and metastatic disease are often inappropriate for surgical and radiation therapy. We present the first study on squamous cell carcinoma of the skin conducted for the population of the Pleven and Lovech regions of Bulgaria.

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DOI: 10.2478/jbcr-2023-0023

Authors: Georgi Manchev, Valya Goranovska, Georgi Stoitsev, Boyan Markov, Vassil Gegouskov

Abstract: The choice between mechanical and bioprosthetic aortic valve implants is affected by relatively clear criteria. However, the choice between porcine or pericardial valve is more complex regarding bioprosthetic devices. We aimed to elucidate any hemodynamic and clinical difference between two widely used bioprosthetic valves: the Sorin Mitroflow bovine pericardial valve and the St. Jude Medical Epic Supra porcine valve. We retrospectively studied 71 consecutive patients separated into two groups based on the valve they received. Clinical outcomes included patient survival and hemodynamic performance of the implanted prostheses. Patients were assessed at one and five years postoperatively. Mean transprosthetic pressure gradients were used as a marker of hemodynamic performance. The Mitroflow valve exhibited lesser mean transvalvular gradients than the Epic valve for all labelled sizes at one and five years postoperatively. The 5-year survival was equal between groups. Both prostheses demonstrated a small but significant increase in mean pressure gradients in the fifth year. Most patients enjoyed significant clinical improvement as assessed by NYHA functional class. Both bioprostheses performed very well with excellent hemodynamic parameters. The pericardial valves are a safe and appropriate choice for surgical bioprosthetic aortic valve replacement.

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DOI: 10.2478/jbcr-2023-0022

Authors: Ivelina Petrova-Burdzheva, Martin Karamanliev, Daniela Simova, Dobromir Dimitrov

Abstract: Breast cancer is the most common cancer in women worldwide. The gold standard for biopsy is core needle biopsy. However, in certain cases, core needle biopsy cannot be applied, and the method of choice is vacuum-assisted biopsy. It is a minimally traumatic and precise method for diagnosing microcalcifications and small breast lesions. We aimed to present the initial experience with stereotactic vacuum-assisted biopsy in breast diseases at the Department of Surgical Oncology. We show indications and contraindications for this kind of biopsy and present our initial experience. From February 2020 to December 2022, 29 stereotactic vacuum-assisted biopsies were performed. Benign histology was found in 9 cases, malignant – in 15, and 5 cases were precancerous. Therefore, being an innovative, minimally invasive, and highly accurate method for diagnosing breast lesions with a good cosmetic effect, it allows early diagnosis of breast cancer, and, last but not least, the procedure can be curative for benign lesions.

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DOI: 10.2478/jbcr-2023-0021

Authors: Polina Marinova

Abstract: Hepatobiliary sepsis and biliary septic shock are defined as a group of purulent-inflammatory diseases of the biliary tract which, in their progression, lead to sepsis in case of delayed diagnosis and treatment. The study aimed to analyse all the cases of hepatobiliary sepsis treated at the Clinic of Surgery, Dr G. Stranski University Hospital – Pleven, from 2016 to 2020 and create a reliable prognostic score for surveillance for patients with hepatobiliary sepsis. Retrospectively, we analysed the records of 697 patients (81%) with a hepatobiliary tract infection, including 79 (11.3%) diagnosed with hepatobiliary sepsis and six fatal cases (1.3%). We evaluated all statistically significant factors that affected mortality: immune deficiency comorbidity (р

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DOI: 10.2478/jbcr-2023-0020

Authors: Polina Marinova

Abstract: Perforation of the gallbladder wall leads to a local perivesical abscess or progression to biliary peritonitis. The study aimed to analyse clinical, laboratory, and imaging indicators that have the strongest relationship with the presence of gangrenous cholecystitis and perforation of the wall and to design a predictive scoring system that highlights the risk of developing gangrenous cholecystitis with perforation. We performed a retrospective analysis of a total of 331 patients operated for five years (2016-2020) at the Department of Surgical Diseases” of Medical University - Pleven, with histologically verified chronic cholecystitis (120 patients; 36.4%), acute cholecystitis (100 patients; 30.1%), and destructive cholecystitis (111 patients; 33.5%). The statistical analysis identified nine main factors with the most substantial statistical significance in patients with gangrene and perforation of the gallbladder wall: age >65, male gender, diabetes mellitus, cardiovascular pathology, tachycardia>90 bpm, WBC>14.109, the thickness of gallbladder wall > 4 mm with pericholecystic fluid, ASAT and ALAT > 40 UI, CRP>150 ng/l. The total possible score was 11 points. The positive predictive value of the scale was 96% and identified the cases with micro-perforation and perivesical abbesses among the group with the highest total score.

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DOI: 10.2478/jbcr-2023-0019

Authors: Vesela Lubenova, Zehra Gay, Snezhana Murgova

Abstract: The purpose of оur research was to evaluate the effect of remote education on ocular health among medical students during the current COVID-19 pandemic. The students included in the study were 219 in total, all from Medical Universities in Bulgaria. They were asked about their eye health and comfort during the distance-learning semester. They were interviewed anonymously, with an online questionnaire, between April 1-30, 2021. The findings of the study highlighted that digital learning increases screen time, at potentially dangerous for eye health levels. The most common presenting complaints were eye fatigue (83.1%), tearing (epiphora) (58.9%), dry eyes (58.4%), blurred vision (40.2%), photophobia (37.4%), itchiness (34.7%) etc. Regarding the longest uninterrupted time spent working on a computer, 32% of the students reported 1-2 hours without a break, 57.1% - more than 2 hours, and only 3.7% spent less than 20 min before taking a break. As the conclusion of this study, it was observed that distance learning during the pandemic and social isolation adversely affected eye health and eye fatigue among medical students. Increased screen time during online semester causes digital eye strain, which interferes with the quality of life and is an emerging public health issue.

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DOI: 10.2478/jbcr-2023-0018

Authors: Adelaida Ruseva, Gergana Todorova, Aygulya Akisheva, Diana Pendicheva-Duhlenska, Vasil Todorov, Milena Stoimenova

Abstract: A prospective study was carried out of serum erythropoietin levels in patients with chronic renal failure/chronic kidney disease in the predialysis period. The study is part of scientific project № 2/2022, financed by Medical University-Pleven. Fifty patients were tested – 22 males and 28 females (average age 63.7±13.0), with average serum creatinine 253±127 mcmol/l and average glomerular filtration rate of 22.6±11.8 ml/min/1,72 m2. The results showed that the serum erythropoietin level varied from 1.86 to 48.50 U/l and was below the borderline in only three patients. There were no significant differences between serum erythropoietin and haemoglobin values in both genders. No differences were found between the average haemoglobin values of patients with different values of serum erythropoietin. Non-significant differences were found in the values of serum erythropoietin in patients with different haemoglobin values. A statistically significant difference between the average value of serum erythropoietin was seen in the group of patients who were not undergoing treatment for anaemia with recombinant erythropoietin (8.5±5.9 U/l) and the groups treated with a dose above 3000 UI/weakly (from 18.6±11.3 to 19.7±8.8 U/l).

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DOI: 10.2478/jbcr-2023-0017

Authors: Gena Petkova, Boiko Shentov

Abstract: Our study aimed to determine and analyze the serum levels of 25 (OH) vitamin D and parathyroid hormone (PTH) to assess vitamin D deficiency as a risk factor for increased morbidity of acute respiratory infections (ARI) in childhood. The changes in the serum parathormone level were used as a criterion for vitamin D sufficiency since an optimal level of 25 (OH) vitamin D is required for normal PTH values. The study included 87 children divided into four subgroups, respectively – children with acute bronchopneumonia (n=49), children with acute laryngotracheitis (n=11), children with acute bronchiolitis (n=16), and a control group (n=11). Subnormal Vit. D levels were found in the individual groups: in the bronchopneumonia group, 18 children showed evidence of insufficiency; in the group of children with laryngotracheitis, five children showed insufficiency, and one child had Vit.D deficiency; children with acute bronchiolitis showed abnormalities in vit. D levels: seven children with insufficiency and two children - with deficiency. The preliminary results showed that Vit. D status deviations are more common in children with acute respiratory infections than in healthy children.

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DOI: 10.2478/jbcr-2023-0016

Authors: Preslava Gatseva, Alexander Blazhev, Zarko Yordanov, Victoria Atanasova

Abstract: The aim of this study was to determine the potential of early inflammatory markers to diagnose late-onset neonatal sepsis – interleukin 6 (IL-6), interleukin 8 (IL-8) and endocan (ESM-1), and to compare them with routinely used markers like C-reactive protein (CRP) and procalcitonin (PCT). A prospective (January, 2022 – January, 2023) clinical-epidemiological study was conducted in a third level NICU in Pleven, Bulgaria. Patients with suspected nosocomial infection and healthy controls were tested. A sandwich ELISA method was used to measure the serum concentrations. Sixty newborns with an average gestational age of 29.75±3.61 gestational weeks were included, of which 35% were symptomatic and infected, 33.3% were symptomatic but uninfected, and 31.7% were asymptomatic controls. The mean values of PCT and IL-6 differ significantly in the three groups. For ESM-1, IL-8 and CRP, the difference was statistically insignificant. The best sensitivity (78%) and negative predictive value (84%) was found for IL-6. The introduction into routine practice of indicators such as PCT and IL-6 may provide an opportunity to promptly optimize the diagnostic and therapeutic approach to LOS.

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DOI: 10.2478/jbcr-2023-0015

Authors: Miroslav Eftimov, Klementina Moneva-Marinova, Maria Tzaneva, Elis Gasanzadeeva, Mehmed Abtulov, Milena Salbashqn

Abstract: The current study aimed to evaluate the influence of Japanese quince (Chaenomeles japonica) fruit juice (JQFJ) on the myocardium and on the coronary arteries of rats with diet-induced metabolic syndrome (MS). Male Wistar rats (n=50) were divided into 5 groups: Control, MS, MS+JQFJ2.5, MS+JQFJ5 and MS+JQFJ10. MS was induced with a high-fat high-fructose diet for 10 weeks. During that period, all animals were daily orally treated with distilled water (Control and MS groups) or with JQFJ at doses of 2.5 ml/kg, 5 ml/kg and 10 ml/kg (the other three groups, respectively). At the end of the experiment, the myocardium and coronary arteries were examined histopathologically. In group MS, necrotic endothelial cells and exposed basal membrane were observed. JQFJ at 2.5 ml/kg reduced the impairment but activated endothelial cells were still found. JQFJ at 5 ml/kg and 10 ml/kg prevented coronary artery endothelium damage, preserving the normal morphology. The myocardium in MS group presented with cardiomyocyte degeneration and increased distance between the cells. In group MS+JQFJ2.5, the degeneration was decreased. In groups MS+JQFJ5 and MS+JQFJ10, the histology of the myocardium resembled that of the control group. In the current histopathological evaluation, JQFJ prevented the MS-induced impairment of myocardium and coronary arteries.

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DOI: 10.2478/jbcr-2023-0014

Authors: Krasimira Ashikova, Stela Linkova

Abstract: Two periods adjacent to starting dialysis are called “chronic kidney disease - peridialysis.” The predialysis period is of varying duration, while the dialysis period lasts up to 3 months after the first dialysis session. During the peridialysis period of chronic kidney disease, complications, mortality, and treatment costs increase significantly. The rate of glomerular filtration rapidly decreases, which requires intensive treatment. Management of the peridialysis period is a challenging clinical problem. This review aims to acquaint all working with patients with chronic kidney disease with the novelties published in the medical literature in recent years about the principle of work in patients with glomerular filtration below 15 ml/min per 1.73 m².

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DOI: 10.2478/jbcr-2023-0013

Authors: Elitsa Gyokova

Abstract: The administration of antenatal corticosteroids (ACS) to accelerate fetal lung maturation is considered one of the most valuable antenatal therapies in preterm labour. Although early indications that administering antenatal corticosteroids has a positive impact on fetal lung maturation and despite the widespread recommendations to use this treatment in women at risk of preterm birth, there is still some uncertainty regarding its effectiveness, particularly in lower-resource settings and in high-risk groups such as women with hypertension or multiple pregnancies. The optimal timing of administration has not improved in over 50 years. This assessment aimed to evaluate the effects of administering a course of corticosteroids to women before anticipated preterm birth (before 37 weeks of pregnancy) on fetal and neonatal morbidity and mortality, maternal mortality and morbidity, and the child’s health later in life. It is advised that clinicians only administer a single course of ACS in high-risk cases of preterm birth likely to occur within the next seven days, and the gestational age is between 22+0 and 33+6 weeks. The diagnosis of preterm labour should be made based on available resources and expertise and supported by comprehensive protocols in the relevant setting.

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DOI: 10.2478/jbcr-2023-0012

Authors: Desislava Marinova, Maya Danovska, Yoanna Todorova, Trayana Obreshkova

Abstract: Depression and anxiety are the most common nonmotor symptoms in Parkinson‘s disease-NMSPD in the department of the neuropsychiatric disorders. Depression is present in all stages of PD - early and advanced even in premorbid stage of PD. The incidence of depression in PD varies in large limits according of used methods and criterions. Some somatic symptoms are part of the depression syndrome. At the presence no consensus exists about the etiology of depression in PD. The concomitant occurrence of depression and PD and the overlapping symptomatology of PD and depression usually lead to the terminological discussion and discrepancy. To explain the high prevalence of depression in PD some hypotheses have been proposed. Many scales were used for assessment of depression in PD. The properties and critique of nine scales was discussed.

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DOI: 10.2478/jbcr-2023-0011

Authors: Georgi Stoitsev, Veselin Gavrilov, Vassil Gegouskov

Abstract: Acute aortic dissection is an extremely serious condition with a high mortality risk. Symptoms may mimic other emergencies such as myocardial ischemia, often leading to misdiagnosis. A combination between coronary hypoperfusion and aortic dissection is relatively rare, but when present it could be fatal. Early diagnosis and correct surgical approach are essential to success in those patients and the high mortality rate requires improvement of myocardial protection. Development of acute cardiac ischemia on top of mandatory global ischemia is a serious precondition for a severe postcardiotomy syndrome, and only excellent cardiac protection can lead to successful surgical intervention.

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DOI: 10.2478/jbcr-2023-0010

Authors: Ivaylo Pakov

Abstract: A patient diagnosed with late-presenting HIV infection [CD4 count 86 cells/mm3, viral load (VL) 95 000 copies RNA/mL], treated with DRV/c 800/150 mg (Rezolsta®) and TDF/FTC 200/245 mg, was hospitalized with ischemic brain stroke, confirmed by CT scan and MRI. Motor functions quickly recovered, but nausea, abdominal heaviness, ascites, and hepatosplenomegaly appeared. Laboratory investigations revealed anaemia, thrombocytopenia, normal transaminases, increased GGT and negative serological tests for HBV and HCV and she was diagnosed with Gastroenterologists diagnosed liver cirrhosis. After 20 days of hospital treatment, the patient recovered from the stroke and ascites but with persisting anaemia and thrombocytopenia. Liver cirrhosis had been confirmed, and relevant treatment had been administered. Six months later, an MRI of the brain revealed an improved image. Follow-up showed stabilized somatic and neurologic status, improved laboratory parameters, stable T-helper count and undetectable viral load (VL). ART regimen continued with Raltegravir 400 mg (Isentress®) 2×1 tablet/24 h, TDF/FTC 200/245 mg 1 tablet/24 h. Three months later, the patient continued her treatment continued abroad. The increased access to precise diagnosis and treatment with improved adherence has transformed the HIV-infection into a manageable chronic health condition, even in complicated cases.

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DOI: 10.2478/jbcr-2023-0009

Authors: Ralitsa Ilieva, Doroteya Todorieva-Todorova, Ivaylo Hristov, Vasilena Tsintsarska

Abstract: Diffuse large B-cell lymphoma (DLBCL) is one of the most common types of non-Hodgkin lymphoma in adults. In most of the cases a complete remission is possible to obtain by applying conventional immunochemotherapy (rituximab in combination with cyclophosphamide, doxorubicin, vincristine, methylprednisolone or R-CHOP). Its effect depends on some risk factors, cellular origin of the lymphoma and to some extend – the localization when extranodal involvement is confirmed. We present the case of a patient with DLBCL of small intestine and non-specific clinical manifestation. Following treatment with standard therapy R-CHOP patient fail to achieve disease response and gastrointestinal track (GIT) complications were registered.

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DOI: 10.2478/jbcr-2023-0008

Authors: Antonio Antonov

Abstract: Hepatosplenic γ/δ T-cell lymphoma (HSTL) is a very rare, aggressive extranodal lymphoma affecting mainly young adults. Clinically, presents with a symptomatic hepatosplenomegaly and systemic symptoms but without lymphadenopathy. The diagnosis is confirmed after careful evaluation of bone marrow and liver biopsies or, in some cases, after diagnostic splenectomy. Overall, survival is short regardless of chemotherapy regimens applied, including autologous stem cell transplantation. We present a case of γ/δ HSTL with massive pulmonary hemoptysis requiring bronchial artery embolization.

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DOI: 10.2478/jbcr-2023-0007

Authors: Georgi Balchev, Zehra Gey, Boris Duhlenski, Tsvetomir Stoyanov, Snezhana Murgova

Abstract: We present the case of an 87-year-old female with a one-week history of redness, swelling, and pain in the left eye, accompanied by headache and neck pain. Computed tomography (CT) scan demonstrated extreme enlargement of the supraorbital artery, engaging the superior rectus muscle of the left eye. We could not find similar articles in well-recognized scientific networks. Conservative treatment was conducted, with no improvement. The patient refused surgery.

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DOI: 10.2478/jbcr-2023-0006

Authors: Emilia Bankova

Abstract: The article analyzes the application of the current documents related to reducing nitrate pollution of groundwater bodies used for public water supply in the Pleven administrative region. The requirements of the European legislation are fully implemented in the Bulgarian legislation, but the legislative measures have not led to quick and permanent results, i.e., small drinking water sources contaminated with nitrates still exist. Special attention should be paid to the diffusive sources of pollution (mineral fertilization of soils) since they are of the most significant importance in groundwater contamination with nitrates. For settlements with permanently elevated nitrate content (over 50 mg/L), it is necessary to consider the application of an individual approach in dealing with this long-standing problem: changing the water source, mixing the water from two neighboring water sources or implementing specific purification methods (biological denitrification, ion exchange resins, etc.). We analyzed the data from the monitoring of drinking water carried out by the Regional Health Inspectorate – Pleven and found that in the Pleven region, there are 17 towns or villages (out of a total of 123) for which some of the listed measures should be foreseen. The district’s relative share of the exposed population is 3.2%, comparable to the country’s exposed population for 2004-2007.

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DOI: 10.2478/jbcr-2023-0005

Authors: Toni Stoyanov

Abstract: Surgery for inguinal hernia is currently the most common surgical procedure worldwide, and every year over 20 million patients undergo open or laparoscopic hernia repair. Two generally accepted endoscopic approaches are transabdominal preperitoneal procedure (TAPP) and total extraperitoneal procedure (TEP). For nine years (2010 – 2018), 48 patients with inguinal hernia had laparoscopic hernia repair (TAPP or TEP) at Villarobledo General Hospital. Forty-three patients (89.6%)) were male, and five (10.4%) were female. Of these, ten had right inguinal hernia (RIH), 18 - left inguinal hernia (LIH), 12 - bilateral inguinal hernia (BIH), 6 had recurrent unilateral inguinal hernia (RUIH), and 2 had recurrent bilateral inguinal hernia (RBIH). In 33 patients (68.7%), transabdominal preperitoneal laparoscopic hernia repair (TAPP) was performed. Total extraperitoneal laparoscopic hernia repair (TEP) was performed on 15 patients (12%). In 8 patients (16.6%), simultaneous surgical procedures were performed: umbilical hernioplasty in 4 (8.3%) patients and laparoscopic cholecystectomy in 4 (8.3%) patients. There were no conversions in any of the surgical procedures. The average operative time was 77 minutes. Twenty-six patients underwent one-day surgery, 18 were in the hospital for one day, and four patients were discharged on the second postoperative day following surgery. In 7 patients (14%), recurrences occurred: in the first postoperative year - 1 patient; in the second year after surgery - 3 patients; in the third after surgery - 2 patients; and in the sixth year - 1 patient. The recurrence rate was 2 in 33 patients after TAPP (6%) versus 5 in 15 patients after TEP (33%), Chi-squared=5.91 (p=0.015). In one patient, perforation of the bladder occurred after TEP and was managed conservatively using a urethral catheter and preperitoneal drainage. TAPP and TEP had a considerable discrepancy in recurrence rates. Such discrepancy in recurrences is probably due to the higher complexity of the TEP technique and the required supervising of experienced surgeons during the learning curve.

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DOI: 10.2478/jbcr-2023-0004

Authors: Toni Stoyanov, Pedro Cascales-Sánchez, Agustina Moreno

Abstract: A retrospective study analyzed the complications in 186 patients who underwent laparoscopic sleeve gastrectomy (LSG). One hundred eighty-four patients were operated on at the University Hospital Centre of Albacete between May 2006 and September 2022. Two patients with early postoperative complications received surgical treatment in other centers. The overall postoperative complication rate (including GERD) was 13.9%. Ten patients (5.38%) had complications in the early postoperative period. In 4 cases (2.15%), there was stapler-line leakage. Abdominal bleeding associated with hemoperitoneum occurred in four patients (2.15%) immediately after the surgery due to bleeding from the suture line. In the long-term follow-up, two patients (1.08%) had gastric tube strictures requiring endoscopic pneumatic balloon dilation (EPBD). Fourteen patients (7.53%) presented with de novo Gastroesophageal Reflux, of whom 7 (3.76%) required revision surgery to Laparoscopic Rouxen-Y Gastric Bypass (LRYGB). Laparoscopic sleeve gastrectomy, in our experience, is a secure bariatric procedure with a low rate of morbidity and mortality, both post-surgical and long-term.

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DOI: 10.2478/jbcr-2023-0003

Authors: Nousseiba Abed, Imen Bouzaroura, Amel Guergour

Abstract: The objective of this study was to determine the clinical picture of adult celiac disease in the population of eastern Algeria. We conducted a retrospective study on a sample of 156 patients in Internal Medicine service, Hepato-Gastroenterology Service, Endoscopy Service in the University Hospital BENBADIS - Constantine and the Military Regional University Hospital - Constantine. Our results have shown that, in this population, celiac disease can be manifested by a number of signs and related pathologies. A variety of digestive symptoms were reported, primarily chronic diarrhea (81.4%), abdominal pain (57.1%), anorexia (42.9%) and vomiting (48%). Extra-digestive symptoms manifested mainly as weight loss (90.4%), pallorous of skin and mucosa (84%), asthenia (60,3%), edema of the lower limbs (46.8%) and dehydration sings (37.8%). In addition, we noted biological disorders, the most common being hypocalcemia (77.4%) and hypoalbuminemia (57.7%), and a series associated pathologies namely: anemia (67.9%) and digestive diseases (38.46%). CD in adults in our population may express a variety of digestive and extra-digestive symptoms in addition to a number of associated pathologies.

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DOI: 10.2478/jbcr-2023-0002

Authors: Dobromir Nguen, Vasil Dimitrov

Abstract: Diabetes is a socially significant disease that brings a significant burden to healthcare systems worldwide. The vicious nature of the disease affects almost all of the systems and organs of the body. The foot is one of the most important and clinically significant areas where these complications are manifested. Diabetic foot gangrene is a leading cause of non-traumatic foot loss worldwide. Although the disease has been known for over a decade, understanding it has gone through highs and lows, leading to suboptimal results in many cases. In this review article, we focused on diabetic foot and the methods for evaluation and assessment of the condition to properly initiate adequate treatment.

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DOI: 10.2478/jbcr-2023-0001

Authors: Stanislav Gueorguiev, Hristina Lebanova, Svetoslav Stoev, Nadia Veleva, Simona Belcheva, Vasil Madzharov

Abstract: The most common cause of antibiotic resistance is the irrational use of antibiotics. Most of the irrational use of antibiotics is related to use in the community and the prevalence of self-medication in different populations. This review aimed to explore the prevalence of self-medication with antibiotics in European countries and the main sources of antibiotics. An online search of Pubmed and Scopus was conducted to identify relevant studies. A two-phase mapping approach was used. All steps in this scoping review were carried out using the Covidence® software. A total of 22 studies were included. The prevalence of self-medication with antibiotics is greater in Southern European countries than in Northern and Western European countries. The main sources of over-the-counter antibiotics are community pharmacies and leftovers from previous courses. Targeted communication strategies and interventions are needed to reduce the overuse of antibiotics and to slow down the spread of antibiotic resistance until new classes of effective antibiotics are developed.

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DOI: 10.2478/jbcr-2022-0026

Authors: Zornitsa Gorcheva, Mirela Vasileva

Abstract: With over one million newly diagnosed cases in 2018, gastric cancer remains the fifth most common malignancy worldwide. Early detection of the disease is challenging as most patients are asymptomatic. The lack of screening programs leads to detection at an advanced stage and worsens the prognosis. Using biomarkers or endoscopic methods for early diagnosis would reduce the mortality from gastric cancer. We present a case of total extended (TEG) in advanced gastric cancer and a literature review of indications and complications of this treatment.

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DOI: 10.2478/jbcr-2022-0025

Authors: Yoana Ivanova-Yoncheva, Muhammad Gohar, Elitsa Gyokova, Angel Yordanov, Dobromir Dimitrov

Abstract: Uterine fibroids are the most common benign uterine tumours in women of reproductive age. They can present with different symptoms, including menorrhagia, cramping lower abdominal pain, bloating, urinary/bowel symptoms, spotting, and infertility. Management could be medical and surgical. Other options include uterine artery embolization and non-invasive treatment with high-intensity focused ultrasound (HIFU). We present a case of a 32-year-old woman with menorrhagia and severe pelvic pain. Ultrasound examination revealed an intramural myoma measuring 93x98x87 mm. The patient signed informed consent for HIFU ablation of the fibroid. Three months after the procedure, an MRI scan showed the fibroid had shrunk to 75% of its original size with dimensions 32x35x29. After six months, she became pregnant and gave birth to a healthy infant at 38-weeks gestation with caesarean section, at which point the fibroid measured 2 cm. HIFU is an alternative to surgical therapies and is highly beneficial in women wishing for future pregnancies. Preserving the option for future pregnancies in patients with uterine fibroids is only one of its benefits and might be the key solution for these women. HIFU treatment of uterine fibroids is an innovative approach. It should be encouraged: it is widely adopted in similar cases where it has positively impacted the treatment of uterine fibroids.

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DOI: 10.2478/jbcr-2022-0024

Authors: Klimentina Gospodinova, Adriana Angelova

Abstract: The study aimed to investigate the relationship between the professional environment and hypersensitivity reactions to various contact allergens, the features of the clinical course, and the type of allergic contact dermatitis (ACD) in 35 hairdressers. The analysis was based on data on length of professional experience, localization of rashes, clinical diagnosis and allergens, and the cause of positive reactions in patch testing. Skin changes most often affect the hands, palms, face, and neck. The frequency of ACD diagnosed was 46%, followed by dyshidrotic eczema (DE) - 34%. The highest percentage of contact dermatitis (68%) was seen in the upper extremities, followed by dermatitis of the face and hands (26%). Of the patients investigated, 34% had a history of illness up to 3 years. A negative correlation was found between professional experience and “hand eczema” (p=0.005). Patch tests showed that the most frequent positive reactions were to Nickel (II) sulfate hexahydrate (Nickel, 15 times) and p-Phenylenediamine (PPD, 14 times). These contact allergens are directly correlated with hand eczema. We compared the results with those published in the literature.

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DOI: 10.2478/jbcr-2022-0023

Authors: Milena Yankova, Gergana Todorova, Vasil Todorov

Abstract: Abnormalities in mineral and bone metabolism are a risk factor for increased cardiovascular and all-cause mortality and bone fractures in patients with chronic kidney disease stage 5D (CKD 5D). This single-center study aimed to investigate the age-related features of mineral and bone disorders in patients with CKD 5D on haemodialysis treatment and analyse the therapy provided. The biochemical parameters of mineral and bone metabolism and the ongoing therapy were studied in 90 patients undergoing hemodialysis treatment, of whom 44 (48.9%) were aged

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