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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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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