2026-03-12T20:03:34Z https://foliamedica.bg/oai.php

10.3897/folmed.61.e39425 2019-09-30 foliamedica

Therapeutic Approaches in Locked-in Syndrome Papadopoulou,Soultana Dionyssiotis,Yannis Krikonis,Konstantinos Lagopati,Nefeli Kamenov,Ivailo markoula,Sophia locked-in syndrome individualized treatment brain-computer interfaces (BCIs) rehabilitation communication improvement Folia Medica 61(3): 343-351 Locked-in syndrome (LIS) is a neuropsychological condition, in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. Diagnosis of LIS is difficult because of the similarities with other related syndromes, but it is of crucial importance to establish precise and early diagnosis in order to make the appropriate decisions according to the intervention and treatment planning. Access to a multidisciplinary, specialized team provides opportunity for continued improvement. Individualized treatment improves long-term management. Assistive technology and advanced communication aids may help people with disabilities to regain more independence and take part in everyday life. Technological achievements, such as brain-computer interfaces (BCIs) may potentially be of significant practical value to patients with LIS. Advancements in medical care, rehabilitation, and communication technology have focused on leading LIS patients to live meaningful lives in the society with the involvement of their families. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Invited Review text/html info:doi:10.3897/folmed.61.e39425 https://doi.org/10.3897/folmed.61.e39425 https://foliamedica.bg/article/39425/ https://foliamedica.bg/article/39425/download/pdf/ en

10.3897/folmed.61.e39120 2019-09-30 foliamedica

Epidemiology, Etiology and Prevention of Postpneumonectomy Pleural Empyema Petrov,Danail Subotic,Dragan Yankov,Georgi Valev,Dinko Mekov,Evgeni postpneumonectomy pleural empyema bronchopleural fistula epidemiology etiology prevention Folia Medica 61(3): 352-357 Background: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options developed over the last five decades it remains a major surgical challenge.Materials and methods: A literature search in MEDLINE database was carried out (accessed through PubMed), by using a combination of the following key-words and MeSH terms: pneumonectomy, postoperative, complications, broncho-pleural fistula, empyema, prevention. The following areas of intervention were identified: epidemiology, etiology, prevention.Results: Pleural empyema in a post-pneumonectomy cavity occurs in up to 16% of patients with a mortality of more than 10%. It is associated with broncho-pleural fistula in up to 80% of them, usually in the early postoperative months. Operative mortality could reach 50% in case of broncho-pleural fistula. Unfavourable prognostic factors are: benign disease, COPD, right-sided surgery, neoadjuvant and adjuvant therapy, time of chest tube removal, long bronchial stump and mechanical ventilation. Bronchial stump protection with vascularised flaps is of utmost importance in the prevention of complications.Conclusion: Postpneumonectomy pleural empyema is a common complication with high mortality. The existing evidence confirms the role of bronchopleural fistula prevention in the prevention of life-threatening complications. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39120 https://doi.org/10.3897/folmed.61.e39120 https://foliamedica.bg/article/39120/ https://foliamedica.bg/article/39120/download/pdf/ en

10.3897/folmed.61.e39160 2019-09-30 foliamedica

Epigenetic Targets for Therapeutic Approaches in COPD and Asthma. Nutrigenomics – Possible or Illusive Cherneva,Radostina Kostadinov,Dimitar epigenetic mechanisms epigenetic therapy nutri-genomics COPD asthma Folia Medica 61(3): 358-369 Oxidative stress generated by cigarette smoking, environmental pollution, or other noxious particles leads to epigenetic changes in the cells of the respiratory tract. They reflect cell adaptation in response to chronic exposure to external factors. Although there is no change in the genetic code, epigenetic changes may be heritable and translated from one generation to another, accumulating abnormalities and rendering cells into entirely different phenotype, causing disease. DNA methylation, post-translation histone modification, ubiquitination, sumoylation and miRNA transcriptional regulation are the major processes that are responsible for the epigenetic control of gene expression. All of them are reversible. They can be regulated by targeting specific enzymes/proteins involved in the process in order to mitigate inflammation. Chronic respiratory diseases have epigenetic signatures that affect gene expression in the lung. Targeting them provides the development of novel diagnostic and therapeutic approaches in respiratory medicine. Nutrigenomics reveals the beneficial effect of natural phytochemicals, affecting key steps in the signaling pathways of chronic respiratory diseases. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Invited Review text/html info:doi:10.3897/folmed.61.e39160 https://doi.org/10.3897/folmed.61.e39160 https://foliamedica.bg/article/39160/ https://foliamedica.bg/article/39160/download/pdf/ en

10.3897/folmed.61.e39409 2019-09-30 foliamedica

Risk Factors and Incidence of Poor Bowel Preparation in Elderly Patients: Prospective Study Doykov,Daniel Andonov,Vladimir Folia Medica 61(3): 370-376 This article has been withdrawn due to inaccuracy of the information provided. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39409 https://doi.org/10.3897/folmed.61.e39409 https://foliamedica.bg/article/39409/ https://foliamedica.bg/article/39409/download/pdf/ en

10.3897/folmed.61.e39418 2019-09-30 foliamedica

The Vertebral Artery Convergence to the Cervical Spine in Elders Alicioglu,Banu Gulekon,Nadir aging computed tomography angiography spine osteoarthritis vertebral artery Folia Medica 61(3): 377-383 Background: In the older population, tortuosity of the vertebral artery (VA), uncovertebral joint (UVJ) osteoarthritis, and abnormal vertebral alignment may alter the normal anatomy.Aim: We aimed to determine the anatomical variations and relationships between the cervical segment of the VA and the cervical spine with regard to ageing.Materials and methods: In this retrospective cross-sectional study, the computed tomography angiography scans of 110 subjects were reviewed. Any variations in the VA, UVJ degeneration were identified. The distance between the VA and uncinate process (UP) was measured electronically. The distance between the VA and UP were compared according to the age group (group A < 45, group B = 45-65, and group C > 65 years-old).Results: With regard to the transverse foramen, 7.2% of the cases had entering abnormalities of the VA, while in one case (0.83%), the right VA had an exiting abnormality (exiting from the C2 instead of the C1). UVJ degeneration was found to be significantly higher in the older age group (p < 0.05). Furthermore, at the C4-C7 levels, the distances between the VA and UP were significantly smaller in the older age group (p < 0.01).Conclusions: The VA-UP distance has been shown to decrease due to increasing UVJ osteoarthritis in the elderly. The convergence of the VA toward the spine occurs at the most mobile segment of the cervical spine, and this anatomical alteration may predispose temporary and/or permanent vertebral artery occlusion clinically, and be dangerous during cervical spine surgery. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39418 https://doi.org/10.3897/folmed.61.e39418 https://foliamedica.bg/article/39418/ https://foliamedica.bg/article/39418/download/pdf/ en

10.3897/folmed.61.e39344 2019-09-30 foliamedica

Impact of Orthopedic Surgery on Parents of Children Affected by Cerebral Palsy: a Preliminary Study in Greece tsibidakis,haridimos Tsibidakis,Haridimos Tsamparli,Anastasia kotzia,doxakotzia@gmail.com panou,Artemisia cerebral palsy parents Greece orthopedic surgery Folia Medica 61(3): 384-388 Background: Cerebral palsy (CP) is a serious disorder with an important impact not only on the affected person but also on parents and the entire family. CP children often undergo surgery with long stay hospitalization.Aim: The aim of the study was to highlight the impact of orthopedic surgery on parents of children affected by cerebral palsy in Greece.Materials and methods: The semi-structured interviews of 80 parents (40 fathers and 40 mothers) of nuclear and intact families were collected. All parents were of Greek nationality, belonged to the middle socio-economic class and had at least one child affected by CP candidate to orthopedic surgery.Results: The majority of parents’ perception was that CP is a condition requiring special education, need for specialized services and a medical problem that affects the entire family. Their expectations after orthopedic surgery were focused mainly on child’s healing and hope to have a “healthy” child, while expectations from future surgery were focused on improving child’s quality of life, movement and gait.Conclusions: Parents of CP children have different perceptions of the clinical condition and a variety of expectations about orthopedic surgery and its outcomes. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39344 https://doi.org/10.3897/folmed.61.e39344 https://foliamedica.bg/article/39344/ https://foliamedica.bg/article/39344/download/pdf/ en

10.3897/folmed.61.e39355 2019-09-30 foliamedica

What are the Risk Factors Responsible for the Delay in Diagnosis of Acute Appendicitis in Children? Eleven-year Research from a Single Institution Kambouri,Katerina Aggelidou,Maria Deftereos,Savvas Tsalikidis,Aggelos Vaos,George Pitiakoudis,Michail risk factors delay acute appendicitis diagnosis children Folia Medica 61(3): 389-396 Introduction: We conducted a retrospective analysis of 602 children operated on for acute appendicitis (AA) in our department between 1/2007 and 12/2017.Aim: The aim of this study was to identify factors that are related to a delay in diagnosing AA in children. Furthermore, we’d like to strengthen our previous preliminary results by a) adding gender as a new factor and b) studying a much larger population.Materials and methods: The time that elapsed from the onset of symptoms to the surgical intervention was associated with gender, age, obesity, use of antibiotics prior to diagnosis, and the initial examination by a paediatric surgeon or another physician. Univariate and multivariate logistic regression method (backward method) was applied.Results: The diagnosis of AA was delayed by at least 48 hours in 287 patients (group A, 47.7%) and was made within 48 hours in 315 patients (group B, 52.3%). In multivariate model we noticed that boys who were examined by a paediatric surgeon and didn’t take antibiotics had decreased odds of having length of diagnostic period >48 hours, girls who received antibiotics compared to girls who do not use antibiotics are almost 12 times more likely to have length of diagnostic period >48 hours, the very young age has а main effect оn the diagnostic delay and girls who have been examined by other physician compared to females who have been examined by paediatric surgeon have decreased odds of having length of diagnostic period >48 hours.Conclusions: Therefore, physicians examining children with abdominal pain must keep in mind the multiple causes of diagnostic delay that may exist alone or in combination, and which can lead to serious complications and lengthen the hospital stay. Performing repeated examinations and asking for advice from a specialist specifically for children who are a special category of patients, in areas where it is rather impossible to use imaging techniques, could be the key to correctly diagnosing and treating AA. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39355 https://doi.org/10.3897/folmed.61.e39355 https://foliamedica.bg/article/39355/ https://foliamedica.bg/article/39355/download/pdf/ en

10.3897/folmed.61.e39346 2019-09-30 foliamedica

Associations between Handgrip Strength and Vitamin 25(OH)D Levels in Geriatric Patients Kasapoğlu aksoy,Meliha Altan,Late aykurt karlıbel,ilknur vitamin D hand grip strength sarcopenia Folia Medica 61(3): 397-403 Introduction: Thirty percent of the muscle mass is lost between the third and eighth decades of life. Vitamin D may have different roles in different aspects of the muscle cell function.Aim: To assess the correlation between vitamin 25(OH)D levels, handgrip strength (HGS), and finger pinch strength (FPS) in elderly.Materials and methods: This was a clinical observational study. It included a total of 92 patients of 65 years and over with good general health status and 66 young healthy volunteers. They all underwent HGS and FPS measurements. Study groups were further stratified into those with a serum 25(OH)D levels higher than 30 ng/dl and those with lower than 30 ng/dl.Results: When geriatric patients were divided into two groups based on 25(OH)D levels, no statistically significant intergroup differences were found in FPS (p>0.05) while statistically significant differences were found in HGS (p<0.05). The analysis of the correlations between HGS and 25(OH)D concentrations revealed a positive, statistically significant correlation between these two parameters at r= 0.330 (p<0.05).Conclusions: This study demonstrated that serum vitamin 25(OH)D levels have an impact on HGS in both geriatric group and control group. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39346 https://doi.org/10.3897/folmed.61.e39346 https://foliamedica.bg/article/39346/ https://foliamedica.bg/article/39346/download/pdf/ en

10.3897/folmed.61.e39348 2019-09-30 foliamedica

Impact of a High-fat Diet on the Development of Chronic Inflammation in Heart of Wistar rats Dimitrov,Iliyan Kamenov,Vasil Boyadjiev,Nikolay Georgieva,Katerina Bivolarska,Anelia Draganova-Filipova,Milena Angelova,Penka Delchev,Slavi Daskalova,Elena Gerginska,Fanka Stankova,Teodora Gramatikov,Vilian high-fat diet low-grade inflammation CRP SAA IL-4 Folia Medica 61(3): 404-410 Introduction: Obesity is linked to the development of low-grade, chronic inflammation. Obesity-related inflammation appears to be a different type of inflammation, mainly due to excessive food intake and unusual homeostasis. It can be evaluated by measuring the concentration of pro- and anti-inflammatory marker molecules – C-reactive protein (CRP), serum amyloid-A (SAA) and interleukin-4.Aim: The aim of the present study is to evaluate the rate of the inflammatory process in heart, provoked by the consumption of a high-fat diet.Materials and methods: Sixty 8-week-old male Wistar rats were used in this experiment. The laboratory animals were fed orally with two different types of rodent food for 14 or 18 weeks – a high-fat diet (experimental groups) and standard rodent food (control groups). They all were kept under standard housing conditions. The levels of the pro- and anti-inflammatory markers in tissue homogenates from heart were analyzed using ELISA. Their expression in tissue samples was detected immunohistochemically by the biotin-streptavidin-peroxidase method. The total protein concentration was determined by the Lawry method.Results: CRP levels showed no significant differences when the control group was compared with the groups fed with a high-fat diet (p>0.05). The SAA levels detected were also insignificantly changed. Only the IL-4 tissue levels showed tendency to increase (p<0.05) in the high-fat diet group.Conclusions: Our experiment indicates that there is a specific reaction of the heart to a high-fat diet. It also refers to the existence of adaptive mechanisms allowing the heart to counteract the development of dietary induced inflammation. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39348 https://doi.org/10.3897/folmed.61.e39348 https://foliamedica.bg/article/39348/ https://foliamedica.bg/article/39348/download/pdf/ en

10.3897/folmed.61.e39394 2019-09-30 foliamedica

Changes in the Contractile Activity and Reactivity to 5-HT of Smooth Muscles of Rats Following Total Body Irradiation with Accelerated Electrons Anastasios Xenodochidis,Charilaos Ardasheva,Raina G. Popov,Veselin Prisadova,Natalia I. Turiyski,Valentin D. Kristev,Athanas Vlaikova,Mariya Grudeva,Zhanet Sopadjieva,Marieta accelerated electron beam gastric smooth muscles contractile activity 5-НТ Folia Medica 61(3): 411-418 Background: Besides its “classical” neurotransmitter function in the central and peripheral nervous systems, serotonin, or 5-hydroxytryptamine (5-HT) is also a local hormone in a number of tissues, including those of the GI tract. Radiation is known to be able to disrupt certain functions of the tract, modulated by 5-HT-signaling pathways, or the serotonin receptors themselves.Aim: The present investigation focused on clarifying the nature and extent of influence of an accelerated electron beam with energy of 9 MeV on the serotonergic mediation of healthy smooth muscle gastric tissue of rats following total body irradiation of the animals.Materials and methods: The study involved a control group and two experimental groups of animals exposed to 1 and 5 Gy, respectively, using Siemens Primus S/N 3561. Circular smooth muscle tissues were isolated from rats 1 hour and 18 hours after they were exposed to 1 and 5 Gy and also 5 days after irradiation from the rats that received a dose of 5 Gy in order to investigate the action of exogenous serotonin at increasing concentrations from 10-8 to 10-4 mol/l. The contractile reactivity of each group SM preparations was registered isometrically.Results: Electron beams with energy of 9 MeV did not damage the contractile apparatus of gastric SM of rats and had a stimulating effect on contractility resulting from rapidly developing processes (1 hour) or later occurring once (5 days).Conclusions: Difference was observed in the importance of the factors of received dose, lapse of time from irradiation to investigation of SM tissues, and exogenous 5-HT concentration for the changes in SM reactivity in serotonin-induced tonic and phasic responses. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39394 https://doi.org/10.3897/folmed.61.e39394 https://foliamedica.bg/article/39394/ https://foliamedica.bg/article/39394/download/pdf/ en

10.3897/folmed.61.e39343 2019-09-30 foliamedica

Serum Levels of Carbamylated LDL, Nitrotyrosine and Soluble Lectin-like Oxidized Low-density Lipoprotein Receptor-1 in Poorly Controlled Type 2 Diabetes Mellitus Stankova,Teodora Delcheva,Ginka Maneva,Ana Vladeva,Stefka carbamylated LDL sLOX-1 nitrotyrosine diabetes mellitus microalbuminuria Folia Medica 61(3): 419-425 Introduction: Carbamylated low-density lipoprotein (cLDL) has profound proatherogenic properties. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) has been identified as the primary cLDL receptor. The soluble form of LOX-1 (sLOX-1) and 3-nitrotyrosine (NT) have recently been suggested as biomarkers of vascular disease. Although type 2 diabetes mellitus (T2DM) is characterised by an increased atherosclerotic risk, the clinical data on cLDL, NT and sLOX-1 levels in T2DM are limited.Aim: To explore the possible role of cLDL, NT and sLOX-1 as potential biomarkers for disease progression and complications in poorly controlled T2DM patients with and without microalbuminuria.Materials and methods: The serum concentrations of cLDL, NT and sLOX-1 were measured by ELISA in a cross-sectional study of 60 T2DM patients and 35 nondiabetic controls.Results: Both the normoalbuminuric (n = 34) and the microalbuminuric (n = 26) patients had significantly higher serum levels of cLDL and NT than the healthy controls, but sLOX-1 was only elevated in the microalbuminuric subgroup (p < 0.05). Carbamylated LDL correlated positively with NT in the diabetic subjects (rs = 0.266, p = 0.04) while it correlated with urea only in the control group (rs = 0.475, p = 0.004). The serum concentration of sLOX-1 correlated significantly with fasting glucose (rs = 0.441, p < 0.001), HbA1c (rs = 0.328, p = 0.01) and microalbuminuria (rs = 0.272, p = 0.035) in the whole diabetic cohort.Conclusions: The present study highlights the potential of cLDL, NT and sLOX-1 as possible markers of diabetic complications. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39343 https://doi.org/10.3897/folmed.61.e39343 https://foliamedica.bg/article/39343/ https://foliamedica.bg/article/39343/download/pdf/ en

10.3897/folmed.61.e39208 2019-09-30 foliamedica

Taste Masking of Enalapril Maleate by the Precipitation Method Gvozdeva,Yana Pilicheva,Bisera Kokova,Vesela Apostolova,Elisaveta Kassarova,Margarita taste masking enalapril maleate precipitation method Folia Medica 61(3): 426-434 Background: Taste masking of bitter or unpleasant drugs is an important prerequisite to improve patient compliance, especially for children and elderly patients. We aimed at obtaining taste-masked microparticles intended for incorporation into orodispersible tablets (ODTs). We selected the precipitation method using enalapril maleate (ENA) as a model bitter-tasting drug and Eudragit EPO® as a pH sensitive polymer.Aim: The aim of this study was to obtain microparticles with enalapril maleate by the precipitation method in order to mask the bitter taste of the drug.Materials and methods: Nine models of enalapril maleate – Eudragit EPO® microparticles were prepared by the precipitation method at varied drug-polymer ratios. The models were characterized in terms of size, shape, production yield, drug content, encapsulation efficiency and moisture content. Fourier-transformed infrared spectroscopy, powder X-ray diffraction and differential scanning calorimetry were used to analyze possible interactions in the complex. In vitro drug release in simulated salivary fluid and in vivo taste evaluation in rats were realized to prove taste masking.Results: The particle size distribution varied from 266.9 µm to 410.9 µm. The shape of the resulting particles was irregular. The production yield varied from 23.6% to 78.2%. The drug content ranged between 2.3% to 4.8%, encapsulation efficiency increased from 1.6% to 9.0%. In vitro drug release data indicated significant taste masking.Conclusion: Some of the obtained microparticles by the precipitation method showed satisfactory taste masking efficiency, which proved the taste masking feasibility of this method. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39208 https://doi.org/10.3897/folmed.61.e39208 https://foliamedica.bg/article/39208/ https://foliamedica.bg/article/39208/download/pdf/ en

10.3897/folmed.61.e39351 2019-09-30 foliamedica

Laboratory investigation of Accuracy of Impression Materials for Border Molding Shopova,Dobromira Slavchev,Diyan border molding impression material complete dentures Folia Medica 61(3): 435-443 Introduction: Border molding of the edge of the individual impression tray is an important stage of prosthetic treatment of edentulous jaws, which often depends on the final result of the treatment. Classical thermoplastic impression materials for border molding have positive qualities that make them preferable by clinicians for their hardness, unlimited manipulation time and high impression sharpness. Modern silicone impression materials for border molding have long manipulating time and appropriate viscosity to allow dentists to perform functional tests.Aim: To determine the accuracy of different impression materials for border molding of individual impression trays.Materials and methods: Four impression materials for border molding were laboratory tested: Kerr impression compound green sticks and thermoplastic GC Iso functional sticks, additive type silicone Detaseal function and condensation type silicone sta-seal f. A modified individual impression tray designed by authors was used, allowing for laboratory load and stability. Ten impressions were taken and their formed edges were measured at 10 points three times - immediately after hardening/elasification, and 24 hours and 48 hours after hardening/elasification.Results: The results were analysed using ANOVA repetition analysis, where a statistically insignificant difference in the accuracy of three of the impression materials for border molding was established, except the C-type of silicone.Conclusions: Good manipulative qualities and measured accuracy in laboratory tests define these materials as very good for border molding procedures. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39351 https://doi.org/10.3897/folmed.61.e39351 https://foliamedica.bg/article/39351/ https://foliamedica.bg/article/39351/download/pdf/ en

10.3897/folmed.61.e39353 2019-09-30 foliamedica

Dental Fear of 6-12-year-old Children - Role of Parents, Gender and Age Shindova,Maria Belcheva-Krivorova,Ani Raycheva,Jeny dental fear parent gender age children Folia Medica 61(3): 444-450 Aim: To investigate the level of dental fear in middle childhood and the impact of various personal and social factors that contribute to developing dental fear.Materials and methods: The study included sixty-seven 6-12-year-old children and their parents, randomly selected while receiving their treatment at the Department of Pediatric Dentistry, Plovdiv. A modified version of Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS) was used to assess the dental fear of each patient. An interview was conducted with the parents to gather information about patient’s gender and age, parent’s dental anxiety (Corah’s dental anxiety scale-DAS) and pre-appointment preparation of children.Results: The results show that the mean of CFSS-DS for children is 30.28±1.17. Concerning the age and gender the comparison between groups of patients with different levels of dental fear demonstrate no significant difference (p>0.05). 60.6%±0.49 of parents prepare their children themselves for the future dental visit and 39.4%±0.49 rely on the dentists to do it. The analysis shows that parent’s dental anxiety and pre-appointment preparation are not associated with the level of dental fear of their children (p>0.05).Conclusions: In middle childhood the majority of children show no or low level of dental fear. The personal and social factors we studied are not determinant risk factors for 6-12-year-old children to develop dental fear. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39353 https://doi.org/10.3897/folmed.61.e39353 https://foliamedica.bg/article/39353/ https://foliamedica.bg/article/39353/download/pdf/ en

10.3897/folmed.61.e39410 2019-09-30 foliamedica

Ethical and Legal Aspects of Medical Screening for Early Diagnosis of Diseases. Prevention and Prophylaxis Ilieva,Antonia health healthcare medical screening health prevention Folia Medica 61(3): 451-457 Introduction: The main priorities of the implemented health policies in the Republic of Bulgaria are directly aimed at preserving and improving the health of the population, providing equal access of patients to modern and efficient healthcare, promptness and quality, in compliance with the normative requirements of the offered health service. In this sense, the focus of these health policies is to prioritize prevention and prophylaxis of early diagnosis of diseases. It is much more reasonable to prevent the disease or to manage it at an early stage than to slow down the treatment until the pathological processes develop into severe or irreversible complications.Aim: The aim of this systematic review is to investigate the effectiveness of existing legal acts governing the implementation of a common health policy in the field of health promotion and prevention. Another aim is to localize regulatory gaps and make relevant optimization suggestions.Materials and methods: The analysis of this systematic review is based on a thorough review of the existing regulatory framework (statutory and regulative legislation, case law, European practice) that concerns public health. Articles focused directly on the issues of medical screening and public health in a national and global perspective have been studied.Results: Two major legal acts, two regulations and strategies of the World Health Organization are considered. Suggestions for optimization of the control activity of the administrative bodies in the sector are presented.Conclusions: From the analysis done, proposals for optimization of the existing legal framework in the sector of health-care were made. The proposals were made based on the results of the analysis of w8orld trends regarding the methodology for state funding of medical screening for early diagnosis of diseases.The issue in question is up to date and raises issues related to legislative regulation, moral, ethical and deontological principles to which the medical profession adheres, as well as the health policy that is followed by the Ministry of Health in this aspect. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e39410 https://doi.org/10.3897/folmed.61.e39410 https://foliamedica.bg/article/39410/ https://foliamedica.bg/article/39410/download/pdf/ en

10.3897/folmed.61.e39349 2019-09-30 foliamedica

First Report of DHA-1 Producing Enterobacter cloacae Complex Isolate in Bulgaria Dimitrova,Dobromira Markovska,Rumyana Stoeva,Temenuga Stankova,Petya Boyanova,Lyudmila Mihova,Kalina Kaneva,Radka Mitov,Ivan Bulgaria AmpC DHA-1 Enterobacter cloacae complex Folia Medica 61(3): 458-461 The aim of the present study was to reveal the characteristics of an Enterobacter cloacae complex isolate producing DHA-1 AmpC enzyme recovered from a patient hospitalized in St Marina Hospital, Varna.Materials and methods: Susceptibility testing, conjugation experiments, isoelectric focusing, PCR and sequencing were carrying out.Results: Of 176 Enterobacter spp. isolates only one isolate was positive for blaDHA. The sequencing revealed the presence of blaDHA-1 and blaCTX-M-3. The antimicrobial susceptibility testing showed higher resistance rates to almost all beta-lactams (ceftazidime, cefotaxime, cefepime, amoxicillinclavulanic acid, piperacillin/tazobactam), tobramycin, gentamycin, trimethoprim/sulphomethoxazole and quinolones (ciprofloxacin and levofloxacin). The isolate was susceptible to imipenem, meropenem and amikacin. The isoelectric focusing showed a band at pI 5.4 without ceftazidime and cefotaxime activity; a band at pI 7.8 with cefoxitin activity and another - with pI 8.4 with cefotaxime activity. Conjugation experiments were successful only for blaCTX-M-3 carrying determinants. Conclusions: To the best of our knowledge this is the first report of DHA-1 producing isolate in Bulgaria. The emergence of DHA-1 producing E. cloacae complex demonstrates the possibility for further dissemination of the gene encoding this enzyme. Infectious control measures are needed for the prevention of this phenomenon. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Short Communication text/html info:doi:10.3897/folmed.61.e39349 https://doi.org/10.3897/folmed.61.e39349 https://foliamedica.bg/article/39349/ https://foliamedica.bg/article/39349/download/pdf/ en

10.3897/folmed.61.e39415 2019-09-30 foliamedica

Myelomeningocele with Associated Anomalies – Case Report and Literature Review Kitov,Borislav Kehayov,Ivo myelomeningocele Chiari malformation hydrocephalus neural tube defect CNS anomaly Folia Medica 61(3): 462-466 Myelomeningocele is a common defect of the development of the neural tube. It is a complex congenital malformation of the central nervous system (CNS) that can be associated with other concurrent anomalies. We report on a case of lumbar myelomeningocele with concomitant CNS malformations we followed up over a period of 15 years. A concise literature review has also been performed. The current report illustrates that the myelomeningocele is a complex anomaly that is commonly associated with a variety of other CNS malformations such as hydrocephalus and Chiari malformation. It may follow chronic progressive course with exacerbation of clinical symptoms in the long term. Patients that have undergone surgical correction of this spinal defect should be closely monitored over a long period of time because of the possibility of clinical deterioration of the concomitant anomalies such as hydrocephalus, Chiari malformation and siryngomyelia. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e39415 https://doi.org/10.3897/folmed.61.e39415 https://foliamedica.bg/article/39415/ https://foliamedica.bg/article/39415/download/pdf/ en

10.3897/folmed.61.e39414 2019-09-30 foliamedica

A Rare Case of Posterior Tibial Artery Hypoplasia and Fibular Artery Enlargement and their Impact on the Arterial Supply of Posterior Crural Region Piagkou,Maria Kapetanakis,Stylianos Tsakotos,George Samolis,Alexandros Anastasopoulos,Nikolaos Natsis,Konstantinos hypoplastic tibial artery enlarged fibular artery variation popliteal artery fibular graft Folia Medica 61(3): 467-471 Background: Detailed knowledge of the popliteal artery division and possible anatomical variants is of paramount importance for vascular surgery.Aim: The aim of the current study was to highlight a rare unilateral case of posterior tibial artery hypoplasia.Materials and methods: A dissection was performed at the posterior surface of the tibia in a 78-year-old Caucasian male cadaver of Greek origin.Results: The findings were consistent with unilateral posterior tibial artery hypoplasia and fibular artery enlargement. The variant fibular artery supplied the posterior surface of the distal leg and foot. Clinical implications of the fibular artery dominance are discussed.Conclusions: Rare anatomical variants of the tibial artery are of clinical significance to maximize safety and minimize intraoperative complications. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e39414 https://doi.org/10.3897/folmed.61.e39414 https://foliamedica.bg/article/39414/ https://foliamedica.bg/article/39414/download/pdf/ en

10.3897/folmed.61.e39419 2019-09-30 foliamedica

Spontaneous Pneumomediastinum – a Rare Asthma Complication Covantsev,Serghei Mazuruc,Natalia Uzdenov,Rasul Corlateanu,Alexandru spontaneous pneumomediastinum secondary pneumomediastinum asthma Folia Medica 61(3): 472-477 Asthma is the most common chronic respiratory disease worldwide and its prevalence is increasing. Acute asthma complications are often the reason for admission to emergency healthcare service. In our article we present a case of a rare asthma complication – spontaneous pneumomediastinum with a short review of its incidence, etiology, diagnosis and management. Spontaneus pneumothorax is important to differentiate with secondary pneumomediastinum as well as other conditions as cardiac diseases (acute coronary syndrome, pericarditis, cardiac tamponade, pneumopericardium), lung diseases (pneumothorax, pulmonary embolism, tracheobronchial tree rupture), musculoskeletal disorders, and diseases of the esophagus (rupture and perforation o the esophagus). A chest X-ray is often reliable for diagnosis of spontaneous pneumomediastinum and when inconclusive, can be followed by CT. The management is usually conservative with oxygen and analgesia. Surgery is required only in cases of tracheobronchial compression.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e39419 https://doi.org/10.3897/folmed.61.e39419 https://foliamedica.bg/article/39419/ https://foliamedica.bg/article/39419/download/pdf/ en

10.3897/folmed.61.e39163 2019-09-30 foliamedica

Learning from Mistakes – a Case of Pediatric Patient with Recurrent Whitlow Raykova,Vessela recurrent herpetic whitlow PCR Folia Medica 61(3): 478-480 Background: Herpetic whitlow is a herpes simplex virus infection of the fingers or thumb characterized by erythema accompanied by painful non-purulent vesicles. Aim: To draw attention to the typical appearance of herpetic whitlow and to distinguish it from bacterial infections and other skin diseases because of their different management.Materials and methods: The patient’s history, dermatological status, and scrapings from the vesicles were taken. The swabs were cultured for isolation of bacteria and fungi. DNA extraction and PCR were performed for detection of HSV. Results: Repeated identical infections of the finger were found in the patients’ history, commonly associated with respiratory infections. The cultured swabs for bacterial or fungal detection remained negative. The scraping from vesicle used for viral detection showed positive HSV result.Conclusion: It is important to distinguish herpetic whitlow from infectious and skin diseases and to learn from yet done mistakes - the patient was previously diagnosed with bacterial whitlow, contact dermatitis and dermatitis of unknown origin. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e39163 https://doi.org/10.3897/folmed.61.e39163 https://foliamedica.bg/article/39163/ https://foliamedica.bg/article/39163/download/pdf/ en

10.3897/folmed.61.e47958 2019-12-31 foliamedica

Can 3D Vision Improve Laparoscopic Performance in Box Simulation Training when Compared to Conventional 2D Vision? Osterberg,Johanna Sokratous,Arestis Georgiou,Konstantinos E. Enochsson,Lars basic surgical skills box training 3D vision 2D vision laparoscopy surgical simulation Folia Medica 61(4): 491-499 Introduction: Three-dimensional (3D) imaging systems have been introduced in laparoscopic surgery to facilitate binocular vision and dexterity to improve surgical performance and safety. Several studies have shown the benefits of 3D imaging in laparoscopy, but until now only a few studies have assessed the outcome by using objective variables. Box trainers are affordable alternatives to virtual laparoscopic surgical training, and the possibility of using real surgical instruments makes them more realistic to use. However, the data and feedback by a virtual simulator have not, until now, been able to assess. Simball Box®, equipped with G-coder sensors®, registers the instrument movements during training and gives the same feedback like a virtual simulator.Aim: The aim of this study was to objectively evaluate the laparoscopic performance in 3D compared to conventional 2D vision by using a box simulation trainer.Materials and methods: Thirty surgeons, residents and consultants, participated in the study. Eighteen had no, or minimal, laparoscopic experience (novices) whereas 12 were experts. They all performed three standard box training exercises (rope race, precision cutting, and basic suturing) in Simball Box. The participants were randomized and started with either 3D HD or traditional 2D HD cameras. The exercises were instructed and supervised. All instrument movements were registered. Variations in time, linear distance, average speed, and motion smoothness were analyzed.Results: The parameters time, distance, speed, and motion smoothness were significantly better when the 3D camera was used.Conclusion: All individuals of both subgroups achieved significantly higher speed and better motion smoothness when using 3D. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Invited Review text/html info:doi:10.3897/folmed.61.e47958 https://doi.org/10.3897/folmed.61.e47958 https://foliamedica.bg/article/47958/ https://foliamedica.bg/article/47958/download/pdf/ en

10.3897/folmed.61.e47943 2019-12-31 foliamedica

Treatment Optimization of Post-pneumonectomy Pleural Empyema Petrov,Danail Subotic,Dragan Yankov,Georgi Valev,Dinko Mekov,Evgeni complications post-pneumonectomy pleural empyema specific considerations treatment Folia Medica 61(4): 500-505 Introduction: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Despite various therapeutic options developed during the last five decades it remains a major surgical challenge. Results: There is no widely accepted treatment for post-pneumonectomy pleural empyema (PPE) and the management depends mostly on the presence or absence of broncho-pleural fistula (BPF) and the patient’s general condition. In the absence of BPF, the role of surgery is still not clear because of its high morbidity and impossibility to prevent recurrences. In the earlier period, the definitive treatment consisted of open window thoracostomy followed by obliteration of the pleural cavity with antibiotic solution at the time of chest wall closure. Subsequently, the proposed different methods and modifications improved the outcome. There is an association between hospital volume and operative mortality after the lung resection. Hospital volume and the surgeon’s specialty have more influence on the outcome than the individual surgeon’s volume.Conclusions: Treatment management of PPE should be individualized. Definitive treatment options comprise aggressive surgery that is not possible in quite a high proportion of impaired patients. Hospital volume, surgeon’s volume and surgeon’s specialty may influence the prognosis. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Invited Review text/html info:doi:10.3897/folmed.61.e47943 https://doi.org/10.3897/folmed.61.e47943 https://foliamedica.bg/article/47943/ https://foliamedica.bg/article/47943/download/pdf/ en

10.3897/folmed.61.e48259 2019-12-31 foliamedica

Late Choroidal Effusion after Phacoemulsification in Eyes with Previous Trabeculectomy Konareva-Kostianeva,Marieta Kostianeva,Snezhina Stoyanova,Nina S. choroidal effusion glaucoma phacoemulsification trabeculectomy Folia Medica 61(4): 506-511 Aim: To present 5 cases of late choroidal detachment occurring spontaneously in pseudophakic glaucomatous eyes with previous trabeculectomy before cataract surgery. We discuss the causes, risk factors, frequency, diagnostic methods, differential diagnosis, and treatment of this disease. Materials and methods: In the presented 5 cases the choroidal effusion is proved by ophthalmoscopy and echography. Late choroidal detachment occurs after phacoemulsification 6 months at the earliest and 9 years at the latest (mean period 2.5 years) in glaucomatous eyes with previous trabeculectomy. To prove choroidal detachment we accomplished routine ophthalmological examination including medical history, visual acuity, tonometry, examination of anterior segment (AS) and fundus. We have done B-scan echography using А/В Ocular Ultrasound Aviso Quantel Medical.Results: One of the patients had hemorrhagic detachment confirmed by B-scan echography, the other four patients had serous detachment. The examined patients had the glaucomatous disease for 10.4±6.11 years (mean±SD). Mean age at the time of choroidal effusion diagnosis was 76.8±7.6 years (68-87 years). The period between the trabeculectomy and the following phacoemulsification was 6±3.08 years (from 1 to 9 years). All patients received anti-glaucomatous topical therapy, including carbonic anhydrase inhibitors, before the occurrence of the effusion. In all cases conservative treatment with corticosteroids and cycloplegics was enough to overcome the detachment and restore visual acuity.Conclusion: Late choroidal effusion after phacoemulsification in eyes with previous trabeculectomy is associated with an application of unjustified powerful hypotensive topical medications after cataract surgery associated with an additional reduction of intraocular pressure in most cases. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e48259 https://doi.org/10.3897/folmed.61.e48259 https://foliamedica.bg/article/48259/ https://foliamedica.bg/article/48259/download/pdf/ en

10.3897/folmed.61.e47745 2019-12-31 foliamedica

Possible Role of Serum Leptin as Biomarker in COPD Zhelyazkova,Yanitsa Tacheva,Tanya Dimov,Dimo Vlaykova,Denitsa Bivolarska,Aneliya Vlaykova,Tatyana biomarker COPD ELISA leptin Folia Medica 61(4): 512-521 Leptin is one of the adipokines shown to exert a significant effect in respiratory diseases, including chronic obstructive pulmonary disease (COPD).The aim of the present study was to evaluate the possible role of serum leptin as biomarker in COPD.The serum leptin levels were assessed in 58 patents with stable COPD and 21 controls applying ELISA method.The leptin levels were higher, although not significantly, in COPD patients than in controls (221.52±24.28(SE) vs. 165.04±26.01 pg/ml, p=0.197). This tendency turned out significant when only females were compared (414.60±60.63 vs. 219.40±44.15 pg/ml, p=0.038). The levels of leptin were highly dependent on the BMI both in COPD patients (p<0.001) and in controls (p=0.024): they were the highest in obese individuals and decreased with reducing the BMI.In the COPD group, women had significantly higher leptin levels than men (p<0.0001) independent of the BMI. The non-smoking patients had significantly higher leptin levels than ex-smokers (p=0.007) and current smokers (p=0.007). In patients with BMI above 25, several associations were observed: patients with mild COPD had higher serum leptin level than those with severe or very severe COPD (p=0.038); the leptin levels correlated positively with FEV1% (r= 0.304, p=0.045) and FEV1/FVC ratio (I= 0.348, p=0.021), and tended to correlate negatively with ABCD GOLD groups (Rho=-0.300, p=0.043) and with the CAT points (Rho=-0.258, p=0.091); the leptin levels below 300 ng/ml determined 4.08-fold higher risk for more severe COPD.The results of our study confirm that the serum leptin levels depend significantly on the BMI and are interfered by gender and smoking habits. However, this adipokine cannot be used as a serum biomarker for distinguishing COPD patients, but its decrease might be associated with aggravation of the disease. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47745 https://doi.org/10.3897/folmed.61.e47745 https://foliamedica.bg/article/47745/ https://foliamedica.bg/article/47745/download/pdf/ en

10.3897/folmed.61.e47734 2019-12-31 foliamedica

Oral Microbial Flora in Bulgarian Adolescents with Moderate Plaque-induced Gingivitis Peycheva,Stela Apostolova,Elisaveta Peychev,Zhivko Gardjeva,Petya A Shishmanova-Doseva,Michaela Murdjeva,Mariana adolescents dental plaque microbiology plaque-induced gingivitis Folia Medica 61(4): 522-528 Introduction: In children and adolescents, the most common periodontal disease is the plaque-induced gingivitis.Aim: The aim of this study was to reveal the bacterial species associated with supragingival plaque of Bulgarian adolescents diagnosed with plaque-induced gingivitis.Materials and methods: Supragingival plaque samples from 70 healthy subjects with moderate plaque-induced gingivitis (37 females and 33 males), aged 12-18 years, were obtained and examined microbiologically.Results: A total of 224 microorganisms were isolated. Gram-negative bacteria were predominant compared to Gram-positive [132 (59%) vs. 92 (41%), p<0.001]. Aerobic microorganisms were detected more often than anaerobic (151; 67.5% vs. 73; 32.5%, p<0.001). The Streptococcus mutans group and Neisseria spp. were isolated from all adolescents. The frequency of isolation of C. albicans was relatively lower – 11 (15.7%). The anaerobes showed much greater microbial diversity (12 pathogen groups were isolated). Gram-negative rods were isolated from 57 of the adolescents (isolation frequency 81.4%). F. varium, P. melaninogenica, P. intermedia and P. assacharolyticus were detected respectively in 12 (16%), 9 (12%), 8 (11%) and 7 (10%) samples. The less frequently isolated anaerobes were Gram-positive cocci, Gram-negative cocci, Bacteroides uniformis and Bifidobacterium spp. together.Conclusion: The most frequently isolated microbiota in our study is part of the normal oral bacterial flora. The presence of anaerobes such as Prevotella, Fusobacterium, Bacteroides and Porphyromonas reflects the gradual change of the flora to more complex one. The results of quantitative and qualitative evaluation of the plaque of adolescents with moderate plaque-induced gingivitis may contribute to the selection of the prevention and treatment of this disease. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47734 https://doi.org/10.3897/folmed.61.e47734 https://foliamedica.bg/article/47734/ https://foliamedica.bg/article/47734/download/pdf/ en

10.3897/folmed.61.e47726 2019-12-31 foliamedica

Psychometric Properties and Contribution to Mental Health of the Bulgarian version of the 4-Factor Ruminative Thought Style Questionnaire Dzhambov,Angel Tilov,Boris Makakova,Desislava Dimitrova,Donka anxiety brooding depression repetitive thoughts resilience Folia Medica 61(4): 529-539 Background: The Ruminative Thought Style Questionnaire (RTSQ) is a multifaceted measure of general trait rumination. However, there is no instrument for measuring rumination in Bulgarian, which limits progress in the field.Aim: We aimed to validate the RTSQ in Bulgarian and examine its psychometric properties and contribution to several mental health outcomes.Materials and methods: We sampled 529 undergraduate students (18 – 35 years; 33.6% male; 80.9% Bulgarian) from the Medical University in Plovdiv, Bulgaria. They completed a questionnaire asking about rumination (RTSQ), mental health, and sociodemographic information. The RTSQ was first translated to Bulgarian. Its internal consistency was assessed with Cronbach’s alpha. Confirmatory factor analysis was performed on the 4-factor RTSQ, and multi-group CFA examined its measurement invariance. Structural equation modelling was used to test the relations between the RTSQ factors, depression, anxiety, and resilience to stress.Results: The RTSQ had acceptable internal consistency (α ≥ 0.8) and its 4-factor model had good fit to the data. In addition, its measurement invariance was supported across languages and cultures of administration. We observed differential associations with depression, anxiety, and resilience, with some of the RTSQ factors emerging as maladaptive (problem-focused thoughts and repetitive thoughts), while others as neutral (anticipatory thoughts) or potentially supportive of resilience (counterfactual thinking).Conclusion: The RTSQ was successfully validated in Bulgarian and represents a reliable measure of trait rumination. It could be useful in gaining further insight into strategies adopted by individuals to cope with stressors and could help develop interventions supporting healthy coping styles. These findings should be replicated in other non-clinical/clinical populations. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47726 https://doi.org/10.3897/folmed.61.e47726 https://foliamedica.bg/article/47726/ https://foliamedica.bg/article/47726/download/pdf/ en

10.3897/folmed.61.e47957 2019-12-31 foliamedica

Subchronic Central Administration of Cannabinoid Ligands Modulates Nociception in Bulbectomized Rats Tashev,Roman Stavreva,Galya Tz. Velikova,Margarita CB1 cannabinoid receptors depression nociception olfactory bulbectomy rat Folia Medica 61(4): 540-544 Introduction: Endocannabinoid system is involved in neuropsychiatric disorders such as major depression. The bilaterally olfactory bulbectomized rat is widely used as an animal model of depression. The removal of the olfactory bulbs produces behavioural, physiological, and neurochemical alterations resembling clinical depression. There is increasing evidence that highlights the important role of cannabinoid signalling in depression and nociception.Aim: To investigate the effect of CB1 receptor agonist HU 210 and CB1 receptor antagonist SR 141716A administered icv subchronically (for 7 days) on nociception of rats with model of depression - bilateral olfactory bulbectomy (OBX).Material and methods: Experimental model of depression - bilateral olfactory bulbectomy (OBX). Bilaterally olfactory bulbectomized rats were used as an experimental model of depression. HU 210 (5 µg) or SR 141716A (3 µg) were infused icv for 7 consecutive days, starting 15 days after the olfactory bulbectomy. Nociception was examined by applying paw pressure test (analgesy-meter) evaluating the rat pain threshold. On day 7, five minutes after the last microinjection, the rats were tested in an analgesy-meter and their mechanically evoked pain responses were measured in arbitrary units (AU).Results: Microinjections of HU 210 (5 µg) significantly decreased the pain threshold in olfactory bulbectomized rats, while SR 141716A (3 µg) exerted antinociceptive effect by increasing the pain threshold.Conclusions: Data point to an involvement of CB1 receptors in depression-like behaviour and nociception in olfactory bulbectomized rats and support the data for the association between depressive disorder and pain pathways. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47957 https://doi.org/10.3897/folmed.61.e47957 https://foliamedica.bg/article/47957/ https://foliamedica.bg/article/47957/download/pdf/ en

10.3897/folmed.61.e47954 2019-12-31 foliamedica

Endothelin-1 Level in Patients with Simple Renal Cyst Çalışkan,,Selahattin Sungur,Mustafa Eser,Barış Kanbay,Mustafa Kocan,Huseyin Topaktas,Ramazan Bosniak decortication endothelin-1 simple renal cyst laparoscopy Folia Medica 61(4): 545-550 Introduction: Endothelin-1 (ET-1) is potent vasoconstrictive peptide and elevated ET-1 levels are associated with hypertension, endothelial dysfunction and atherosclerosis. Research on (ET-1) has demonstrated that elevated ET-1 levels in autosomal dominant polycystic kidney disease leads to systemic hypertension. The prevalence of simple renal cysts increases with age and the association with simple renal cyst and hypertension is not clear. The aim of this study was to investigate the ET-1 levels in patients with simple renal cyst and compare them with those in healthy adults.Materials and methods: The study included patients that underwent laparoscopic renal cyst decortication in the Department of Urology and healthy controls. Serum and urinary ET-1 levels were measured before surgery and one month after it in the patients with simple renal cyst. Serum ET-1 levels were measured in healthy adult patients. Ambulatory blood pressure was measured in all patients. Glomerular filtration rate was measured according to the chronic kidney disease epidemiology collaboration formula.Results: Thirty-two patients were included in the present study. Of these, 16 patients with simple renal cyst were allocated into group 1 and 16 healthy patients - in group 2. There was no significant difference between systolic and diastolic blood pressure between the groups (p=0.820 and p=0.618, respectively). Serum EL-1 levels were significantly lower in group 1 than those in group 2 (p=0.036). Interestingly, serum EL-1 levels were increased after laparoscopic cyst decortication and there was no significant difference with healthy patients (p=0.429).Conclusions: The present study demonstrated that serum EL-1 level in patients with simple renal cyst was lower than that in healthy people. Further studies are needed to investigate the EL-1 levels in simple renal cyst patients. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47954 https://doi.org/10.3897/folmed.61.e47954 https://foliamedica.bg/article/47954/ https://foliamedica.bg/article/47954/download/pdf/ en

10.3897/folmed.61.e47955 2019-12-31 foliamedica

Synthesis of Azide Functionalized Tetrahydrobenzofurans and their Antineoplastic Study Pandit,Chintan Kapadiya,Khushal antineoplastic activity azide phenacylbromides NCI-60 cell-lines tetrahydrobenzofuran Folia Medica 61(4): 551-558 Background: In chemistry, the derivatives of benzofuran which are substituted on five-membered ring constitute one of the salient moieties in medicinal field and a survey of literature revealed that a good number of reports have shown that tetrahydrobenzofuran derivatives are of valuable biological activities.Aim: On the basis of previous survey, we aimed to generate a series of 2-(4-azidobenzoyl)-3-substitutedaryl-6,6-dimethyl-2,3,6,7-tetrahydrobenzofuran-4(5H)-one bearing azide group which were identified by anti-cancer screening against sixteen cell-lines of NCI (National Cancer Institute) using nine different cancer cell panels.Materials and methods: The tetrahydrobenzofuran derivatives were synthesized by multi-component reactions. It was achieved by coupling of dimedone (3.57 mmole), 4-azido phenacyl bromide (3.92 mmole) and various aromatic aldehydes (3.57 mmole) using two different bases i.e. pyridine and N,N- diethylethanamine under reflux condition. Anti-cancer activity was carried out by NCI-60 cell-lines using standard protocol by National Institute of Health.Results: The results from anti-cancer study shows that the compound 4a exhibited diverse cytotoxic activity against renal cancer panel (UO-31) with significant selectivity and had inhibitory effect on the generation of UO-31 (growth percent= 69.36%) and the compound 4e showed comparable activity in the same cell-line (UO-31: growth percent= 80.86%).Conclusions: In summary, a series of azide group containing tetrahydrobenzofuran derivatives have been synthesized and were evaluated for their anticancer activity. It was concluded that the derivatives 4a and 4e exhibited promising anticancer activity. Nature of substituent on phenyl ring seems to be the crucial factor affecting the activity in both the compounds. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47955 https://doi.org/10.3897/folmed.61.e47955 https://foliamedica.bg/article/47955/ https://foliamedica.bg/article/47955/download/pdf/ en

10.3897/folmed.61.e47941 2019-12-31 foliamedica

Molecular-genetic Method for Fast Direct Detection of Staphylococcus Aureus and Methicillin Resistance in Blood Cultures and Punctures Gergova,Raina Tsitou,Virna-Maria Mitov,Ivan blood cultures methicillin resistance punctures PCR Staphylococcus aureus Folia Medica 61(4): 559-565 Background: Invasive infections caused by methicillin resistant Staphylococcus aureus and coagulase-negative staphylococci (MRSA/MRSCoN) require fast, adequate treatment. The aim of this study was to develop a faster protocol for direct detection of MRSA/MRSCoN in blood cultures and in abscess punctures based on mecA and species specific identification of S. aureus by polymerase-chain reaction (PCR).Materials and methods: We examined 77 growth-positive BACTEC blood cultures and 50 abscess punctures by routine microbiological assay and simultaneous PCR detection of MRSA/MRSCoN. The specificity of the PCR was evaluated by using DNA from another 15 microbial species for negative controls. We determined the minimum inhibitory concentration (MIC) of oxacillin, vancomycin, tigecycline, linezolid, levofloxacin, clindamycin, and erythromycin against the S. aureus isolates using the E-test. Results: In the blood cultures, the two methods detected 39.3% of MRSA, and 93.9% of MRCoNS. In the punctures, the PCR assay identified 20.9% of MRSA and 79.2% of MSSA. In the puncture cases, there were three PCR MRSA positive and culture negative samples. Screening for susceptibility to 14 antimicrobial agents demonstrated significantly higher (p<0.05) methicillin resistance in blood culture isolates than in the puncture ones (39.3% and 20.0%, respectively). Conclusion: The new PCR protocol was very fast and specific. It was more sensitive in detecting MRSA from abscess punctures than the routine microbiological techniques. This protocol will speed up the right choice of empirical therapy, which is extremely important for saving patients’ lives. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47941 https://doi.org/10.3897/folmed.61.e47941 https://foliamedica.bg/article/47941/ https://foliamedica.bg/article/47941/download/pdf/ en

10.3897/folmed.61.e47858 2019-12-31 foliamedica

Socio-demographic Factors Affecting Initiation and Duration of Breastfeeding in a Culturally Diverse Area of North Eastern Greece Tsanidou,Eirini Gougoula,Vasiliki Tselebonis,Athanasios Kontogiorgis,Christos Constantinidis,Theodoros Nena,Evangelia breastfeeding initiation breastfeeding duration Greece socio-demographic factors Folia Medica 61(4): 566-571 Background: Breastfeeding is not only important for the bond between the mother and the child but is also associated with many health benefits. Socio-demographic factors have been found to be important for the initiation and longer duration of breastfeeding. Aim: To record the breastfeeding characteristics and to explore possible associations with socio-cultural and demographic factors in a culturally diverse area in Greece.Materials and methods: A questionnaire including information about breastfeeding characteristics, medical history and demographics was completed by parents of children in the primary schools of the area.Results: The study included 700 school-age children (352 boys), mean age 9.4±1.9 years. Breastfeeding was reported in 54.9% of them, with median (IQR) duration of 120 (range 60-360) days. Prevalence of breastfeeding was slightly higher in semi-urban areas, versus rural or urban settlements, but the duration there was significantly lower (p<0.001). Better educated mothers tended to initiate or sustain breastfeeding for a longer period; however, this difference was not statistically significant. Children of the native Muslim minority had been breastfed for a longer time (median duration 360 vs. 120 days, p<0.001), however, no difference was noted in prevalence.Conclusion: Prevalence of breastfeeding in Greece is approximately 55%, similar to previous reports and along with duration is determined by certain socio-cultural factors. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47858 https://doi.org/10.3897/folmed.61.e47858 https://foliamedica.bg/article/47858/ https://foliamedica.bg/article/47858/download/pdf/ en

10.3897/folmed.61.e47760 2019-12-31 foliamedica

Evaluation of Anti-HBs Antibody Immune Response against Hepatitis B virus in Vaccinated People in а North-eastern Bulgaria Region Tsaneva-Damyanova,Denitsa Ivanova,Liliya Pavlova,Silviya Todorova,Svetlana Popova,Tsvetelina anti-HBs Ab HBV HBV vaccination Folia Medica 61(4): 572-578 Introduction: Hepatitis B virus (HBV) is one of the most significant human pathogens responsible for a huge number of acute and chronic liver infectious diseases worldwide.Aim: To find the duration of post-vaccination immune response in individuals allocated to five age groups from 6 months to 20 years.Materials and methods: All tested subjects were born between 1999 and 2018 and therefore covered by the compulsory vaccination program against hepatitis B. For the serological marker anti-HBs Ab we investigated 449 serum samples taken from ambulatory people and patients of St Marina University Hospital in Varna.Results: A positive antibody response (anti-HBs Ab > 10 mIU/ml) was reported in 79.7% (n = 51) of the group of subjects up to one year old, in 70.0% (n = 196) of the subjects in the age range 1 year/1 month to 15 years, and in 39.3% (n = 33) of the subjects 15 years/1 month to 20 years old. Female sex had a better post-vaccination response than male sex with statistically significant relationship between sex and anti-HBs Ab titer (χ2 = 24.76, p <0.01).Conclusions: Regardless of the mass immunization against HBV in Bulgaria, the relative share of chronic HBV infections does not show a downward trend. Therefore, it is very important to study the duration of the post-vaccination immune response by demonstrating the anti-HBs antibodies and to apply a booster dose from the vaccine if needed. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47760 https://doi.org/10.3897/folmed.61.e47760 https://foliamedica.bg/article/47760/ https://foliamedica.bg/article/47760/download/pdf/ en

10.3897/folmed.61.e47810 2019-12-31 foliamedica

Effects of Chaenomeles maulei Fruit Juice on Reserpine-induced Behavioral Changes in Rats Borisova,Vesela Eftimov,Miroslav Valcheva-Kuzmanova,Stefka Chaenomeles maulei fruit juice locomotor activity polyphenols reserpine rats Folia Medica 61(4): 579-583 Background: The fruit juice from Chaenomeles japonica var. maulei (Mast.) Lavall,e is very rich in polyphenolic compounds.Aim: The aim of the current study was to investigate the effects of Chaenomeles maulei fruit juice (CMFJ) on reserpine-induced beha-vioral changes in rats.Materials and methods: The experimental design included a total of 50 animals, divided in the following groups: control, R, R+CMFJ2.5, R+CMFJ5, and R+CMFJ10. All groups except the control received a single intraperitoneal injection of reserpine while the Control group was injected with the vehicle. CMFJ was applied through an orogastric cannula at 0, 19, and 23 hours after reserpine injection at doses of 2.5 ml/kg, 5 ml/kg, and 10 ml/kg to groups R+CMFJ2.5, R+CMFJ5, and R+CMFJ10, respectively. The groups control and R received distilled water (10 ml/kg) at the same time points. The open field test (OFT) and the forced swim test (FST) were carried out. In the OFT, crossings and rearings were recorded as a measure of locomotor activity. In the FST, the immobility time served as a measure of depressive-like behavior.Results: In the OFT, the number of crossings of rats were significantly reduced (p<0.05) by reserpine. CMFJ antagonized the effects of reserpine on rat locomotor activity. In the FST, reserpine caused an insignificant reduction of the immobility time while CMFJ reversed this effect probably by increasing the locomotor activity.Conclusion: CMFJ reversed reserpine-induced hypokinesia in rats. This effect of CMFJ might be attributed to the polyphenols found in very high concentrations in the juice. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47810 https://doi.org/10.3897/folmed.61.e47810 https://foliamedica.bg/article/47810/ https://foliamedica.bg/article/47810/download/pdf/ en

10.3897/folmed.61.e47965 2019-12-31 foliamedica

Antimalarial Phytochemicals Identification from Euphorbia Hirta against Plasmepsin Protease: an In Silico Approach Shah,Ashish Parmar,Ghanshyam Sailor,Girish Kumar Seth,Avinash ADMET docking Euphorbia hirta malaria plasmepsin Folia Medica 61(4): 584-593 Background: Aspartic protease found in plasmodium parasites such as plasmepsin I, II and IV plays an important role in the degradation of hemoglobin. The studies have shown that effective drug must be able to inhibit more than one type of plasmepsin to avoid further growth of parasites and to prevent resistance of drug. Therefore, plasmepsins are believed to be excellent drug target for malarial disease. Extract of the plant Euphorbia hirta has been proved to exert antimalarial activity. However, molecular mechanism of this activity was not described.Aim: The aim of present investigation is to identify antimalarial phytochemicals of Euphorbia hirta as plasmepsin protease inhibitors using an in silico approach.Materials and methods: Docking studies were performed on three different protein targets plasmepsin I, II, and IV using iGEMDOCK. ADME and bioactivity predictions were done using molinspiration online tool. Toxicity studies were performed using ProTox-II online tool.Results: In the docking studies seven compounds showed significant inhibitory activity with low docking score as compared to standard drug artemisinin. Six compounds showed no violations as per Lipinski rule. Bioactivity prediction states that all the compounds may act through enzyme inhibition. The results of in silico studies suggest that out of the eleven selected phytochemicals isorhamnetin and pinocembrin have more drug likeliness properties and lesser in silico toxicity with more binding affinity than artemisinin on all receptors. Conclusion: These findings indicate that isorhamnetin and pinocembrin have promising potential for development of antimalarial drug as plasmepsin inhibitors. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47965 https://doi.org/10.3897/folmed.61.e47965 https://foliamedica.bg/article/47965/ https://foliamedica.bg/article/47965/download/pdf/ en

10.3897/folmed.61.e47893 2019-12-31 foliamedica

Oral Hygiene Status and Gingivitis in Overweight and Obese Children Sapunarova,Plamena Nihtyanova,Tanya Petrova,Svetla Kukleva,Maria body mass index gingivitis obesity oral hygiene Folia Medica 61(4): 594-599 Introduction: Obesity poses a significant health risk to our society with prevalence that has dramatically increased in children. Obesity and periodontal diseases share many common risk factors.Aim: To study the oral hygiene status and prevalence of gingivitis in children with increased body mass index. Materials and methods: A cross-sectional study was performed in Plovdiv, October-December 2017 and January-March 2018 among 1826 school children aged 6-11. The oral hygiene status was determined using Silness-Loe plaque index and Green-Vermillion calculus index assessed on vestibular surfaces of first maxillary permanent molars and one maxillary and one mandibular central permanent incisor, and lingual surfaces of mandibular first permanent molars. The condition of the gingiva was determined as presence or absence of gingivitis.Results: The study included 1826 children (953 boys and 921 girls). With regard to BMI, the distribution should be 5% underweight, 66.5% normal weight, 17.7% overweight, and 10.8% obese, as in the text below. There was no significant correlation between age and BMI. No significant correlation was found between BMI and gingivitis (p>0.05). Quality of oral hygiene was significantly associated only with gender: χ2(2)=18.847, p<0.001; χ2(1) =7.582, p<0.05 as the group of boys presented with greater accumulation of dental plaque and calculus.Conclusion: Increased BMI is not an independent predictor of gingivitis. Poor oral hygiene is strongly associated only with gender info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47893 https://doi.org/10.3897/folmed.61.e47893 https://foliamedica.bg/article/47893/ https://foliamedica.bg/article/47893/download/pdf/ en

10.3897/folmed.61.e47949 2019-12-31 foliamedica

Bacteremia Following Closed and Open Dental Extraction Gavazova,Galina Hristozova,Eli Kisselov,Stanimir Raycheva,Ralitsa Pechalova,Petia bacteremia closed extraction coagulase negative Staphylococcus hemocultures open extraction Folia Medica 61(4): 600-604 Aim: To observe bacteremia following closed and open dental extraction.Material and methods: The study included two subject groups each comprising 29 participants. Group I patients received a single closed dental extraction, and group II patients – a single open extraction. Venous blood from the cubital vein of each patient was collected in three samples – preoperatively, 30 seconds after surgery, and 15 minutes after surgery. Anaerobic and aerobic hemocultures (Bact/ALERT, BioMerieux, Inc., Durhamn, N.C.) were used to study the bacteremia process.Results: Preoperatively, bacteremia was confirmed in 4 patients (6.9%) undergoing closed extraction and in 1 patient (1.7%) undergoing open extraction. Additionally, we found statistically significant relation between bacteremia and age (p=0.002). Thirty seconds after surgery bacteriemia was evident in 6 patients (10.3%) from group I and in 3 (5.2%) from group II. Fifteen minutes following surgery bacteremia was evident in 4 patients (6.9%) undergoing typical extraction and in one patient (1.7%) undergoing surgical extraction. No statistically significant relation between type of extraction and presence of bacteria in the bloodstream at 30 seconds (p=0.285) and at 15 minutes (p=0.166) was found. Coagulase-negative Staphylococcus was the most frequently found microorganism (22.2% of aerobic and 11.1% of anaerobic hemocultures). The results show greater significance of bacteremia at 30 seconds, compared to preoperative samples for both subject groups (p=0.03).Conclusions: Bacteremia following dental extraction is unaffected by duration of intervention, type of extraction and gender. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47949 https://doi.org/10.3897/folmed.61.e47949 https://foliamedica.bg/article/47949/ https://foliamedica.bg/article/47949/download/pdf/ en

10.3897/folmed.61.e47961 2019-12-31 foliamedica

Evaluating the Effectiveness of Simulation Training in Obstetrics and Gynecology, Pediatrics and Emergency Medicine Sandeva,Milena Tufkova,Stoilka Ketev,Kostadin Paskaleva,Diana debriefing efficiency medical education self-assessment simulation training Folia Medica 61(4): 605-611 Simulation training in medicine is a powerful tool for acquiring knowledge and practical skills in an environment close to the real world. Decreasing training opportunities directly on the patient tend to introduce simulations close to the real hospital environment without compromising the patient’s safety. The aim of the study was to evaluate the effectiveness of simulation training in the Medical Simulation Training Center (MSTC) at the Medical University of Plovdiv.A prospective observational descriptive study was performed at the MSTC at Plovdiv Medical University between September 2017 and March 2019. The study included 245 respondents who participated in one or more practical simulation trainings and were surveyed.The results of the study suggest that the knowledge, skills and attitudes of the trainees improve after training sessions. By increasing the number of visits, the self-esteem and confidence in performing the manipulation also increases, knowledge and technical performance significantly improve and mistakes are reduced. A statistically significant relationship has been demonstrated between the sequence of visits and acquired competencies (p=0.0001). There are no performance mistakes in those attending three or more times, but 16.2% of them still experience uncertainty while performing. Here, however, 83.8% performed the manipulation automatically and without mistakes. Simulation training in medicine is effective and useful. It has its place in the curriculum for students and is a good tool for acquiring knowledge, skills and techniques in postgraduate education. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47961 https://doi.org/10.3897/folmed.61.e47961 https://foliamedica.bg/article/47961/ https://foliamedica.bg/article/47961/download/pdf/ en

10.3897/folmed.61.e47916 2019-12-31 foliamedica

Comparison of Radial Extracorporeal Shockwave Therapy versus Ultrasound Therapy in the Treatment of Rotator Cuff Tendinopathy Dedes,Vasileios Tzirogiannis,Konstantinos Polikandrioti,Maria Dede,Ariadni Maria Nikolaidis,Christos Athanasios,Mitseas PANOUTSOPOULOS,GEORGIOS musculoskeletal injuries shockwave therapy tendinopathy rehabilitation ultrasound therapy Folia Medica 61(4): 612-619 Introduction: People suffering from rotator cuff tendinopathy exhibit reduced mobility due to pain. The pain and the limited functionality affect negatively the overall quality of life.Aim: The present study aimed to investigate the intensity of pain, the functionality of the upper limbs and the quality of life of patients with rotator cuff tendinopathy by using two different therapeutic modalities, shockwave and ultrasound, whose outcomes were assessed pre-treatment and post-treatment as well as after a 4-week follow-up.Materials and methods: Out of the total sample of 115 patients with rotator cuff tendinopathy, 56 patients constituted the shockwave intervention group, 47 patients constituted the therapeutic ultrasound group and 12 patients made up the control group. The self-administered questionnaire “The University of Peloponnese Pain, Functionality and Quality of Life Questionnaire, UoP – PFQ” was used where the intensity of pain, functionality and quality of life of the upper limbs were evaluated on a five-point Likert scale, pre-treatment, post-treatment and at a 4-week follow-up.Results: The pain intensity was reduced and both the functionality and quality of life were improved after shockwave therapy post-treatment (p<0.001) and at a 4-week follow-up (p<0.001) compared with those found after the treatment. Similar improvements in all three parameters were also observed after ultrasound treatment but the outcomes were not as pronounced as in the shockwave group. Conclusion: Both radial shockwave and ultrasound therapies were found to be effective in the treatment of rotator cuff tendinopathy, the statistical analysis showing that radial shockwave therapy was superior to the ultrasound therapy post-treatment and at the 4-week follow-up. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Research Article text/html info:doi:10.3897/folmed.61.e47916 https://doi.org/10.3897/folmed.61.e47916 https://foliamedica.bg/article/47916/ https://foliamedica.bg/article/47916/download/pdf/ en

10.3897/folmed.61.e47811 2019-12-31 foliamedica

Fatal Chemotherapy-induced Combined Infection in a Hodgkin’s Disease Patient: a Case Report Kalchev,Yordan Lengerova,Gergana Asif,Uswah Burnusuzov,Hasan Murdjeva,Mariana febrile neutropenia Hodgkin’s disease influenza А virus Listeria monocytogenes multiplex PCR Folia Medica 61(4): 620-623 Multimodal therapy, used for the treatment of patients with Hodgkin’s disease (HD), makes them prone to life-threatening infections, attributed mainly to febrile neutropenia. Herein, we present a case report of fatal combined bacterial and viral infection in a 49-year-old female patient, subject to polychemotherapy for HD. Rapid microbiological diagnosis performed by multiplex polymerase chain reaction elucidated the causes of the infection within hours. Listeria monocytogenes was detected in both the cerebrospinal fluid and blood samples. Nasopharyngeal swabs returned positive for two swine-derived strains of influenza A virus. We aimed to emphasize the importance of these pathogens and draw attention to their association in the aetiology of infections among patients receiving chemotherapy. In conclusion, better surveillance is needed to improve the early diagnosis of infectious complications in these patients. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e47811 https://doi.org/10.3897/folmed.61.e47811 https://foliamedica.bg/article/47811/ https://foliamedica.bg/article/47811/download/pdf/ en

10.3897/folmed.61.e47948 2019-12-31 foliamedica

Intradural Extramedullary Metastasis of the Upper Thoracic Spine – Case Report and Literature Review Kehayov,Ivo Genova,Sylvia Gicheva,maria Nuri,Bahar Kitov,Borislav intradural extramedullary metastasis pulmonary adenocarcinoma surgery Folia Medica 61(4): 624-629 We report a case of 46-year-old male operated on for moderately differentiated lung adenocarcinoma. Postoperatively, he underwent six courses of chemotherapy and radiotherapy. He developed progressive severe inferior paraparesis accompanied by excruciating pain between the shoulders two years later. Magnetic resonance imaging revealed metastases in the bodies of T2 and T3 vertebrae with adjacent intradural extramedullary lesion compressing the spinal cord. The patient underwent surgical decompression and vertebral body cement augmentation that lead to pain relief and partial neurological recovery. The histological examination was consistent with metastases from low differentiated pulmonary adenocarcinoma. Surgical resection of intradural extramedullary metastasis improves patient quality of life by reducing pain intensity and neurological deficit. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e47948 https://doi.org/10.3897/folmed.61.e47948 https://foliamedica.bg/article/47948/ https://foliamedica.bg/article/47948/download/pdf/ en

10.3897/folmed.61.e47829 2019-12-31 foliamedica

Postoperative Cerebellar Mutism Syndrome in an Adult Patient Shamov,Todor Tivcheva,Ioanna Eftimov,Tihomir adult patients hyperthermia medulloblastoma postoperative cerebellar mutism risk factors Folia Medica 61(4): 630-633 Postoperative cerebellar mutism syndrome is a common complication occurring after surgical treatment of medulloblastoma in children. The clinical course of this syndrome is characterized by delayed onset after the surgical intervention, loss of speech, emotional lability, hypotonia, and oropharyngeal dysfunction. This syndrome is rarely seen in adults. We report here a case of postoperative cerebellar mutism in a 25-year-old female patient, who underwent a surgical intervention due to medulloblastoma of the forth ventricle. There are very few reported cases in literature of this syndrome. In the discussion we discuss the likely reasons for the syndrome to develop in adult patients. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e47829 https://doi.org/10.3897/folmed.61.e47829 https://foliamedica.bg/article/47829/ https://foliamedica.bg/article/47829/download/pdf/ en

10.3897/folmed.61.e47956 2019-12-31 foliamedica

A Collision between Fibroma and Serous Ovarian Cystadenoma Mimicking Carcinoma Shopov,Spasimir collision tumor fibroma ovarian tumor serous cystadenoma Folia Medica 61(4): 634-638 Collision tumors represent a coexistence of two adjacent but histologically distinct tumors without histologic admixture in an organ.Ovarian fibroma is the most common benign stromal tumor. Serous tumors of the ovary are the most common of epithelial tumors. However, a collision between them is a rare pathology mimicking a malignant tumor. We report a 63-year-old woman with sparse postmenopausal bleeding. Ultrasound examination of organs in a small pelvis rounded right ovary formation with hypo and hyperdense sections. Paraclinical: CA125 slightly increased. Histological: collision between two benign ovarian tumors imitating carcinoma. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e47956 https://doi.org/10.3897/folmed.61.e47956 https://foliamedica.bg/article/47956/ https://foliamedica.bg/article/47956/download/pdf/ en

10.3897/folmed.61.e47947 2019-12-31 foliamedica

Neuromyelitis Optica and Systemic Lupus Erythematosus Association – the Chicken or the Egg Dilemma: a Case Report Chaneva,Orlina Viteva,Ekaterina Trenova,Anastasiya Slavov,Georgi Shukerski,Krasimir Manova,Maria Zahariev,Zahari I. aquaporin IgG opticomyelitis of Devic optic neuritis systemic lupus erythematosus transverse myelitis Folia Medica 61(4): 639-642 We present a case report of a 32-year-old woman diagnosed with opticomyelitis of Devic (OMD) and systemic lupus erythematosus (SLE). The onset of neurological symptoms was with optic neuritis. Five months later the neurological deficit progressed within a few days to lower paraplegia and upper paraparesis, retention of urine and faeces, impaired somatic and deep sensation below the level of Th1 dermatome. The results from laboratory investigations confirmed anaemic syndrome, increased urea and creatinine, hypoproteinemia and severe proteinuria. The results from CSF investigations demonstrated hyperproteinorachia with extremely high Ig fractions. Serum and CSF oligoclonal bands and positive serum Aquaporin IgG 32 times higher than the upper referent limit were found. The association with SLE was confirmed by the increased levels of total ANA and anti-ds-DNA ANA. MRT visualized the spinal cord as non-homogenously hypointense on T1 and extremely hyperintense on FLAIR sequences through its whole length up to the bulbar-pontine region. The MRT findings and the serum Aquaporin IgG confirmed the diagnosis OMD. The patient was treated with intravenous immunomodulating agents. We consider the presented case of special interest because of the comorbidity of an aggressive autoimmune systemic and an organ-specific disease of the central nervous system.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e47947 https://doi.org/10.3897/folmed.61.e47947 https://foliamedica.bg/article/47947/ https://foliamedica.bg/article/47947/download/pdf/ en

10.3897/folmed.61.e47945 2019-12-31 foliamedica

Pulmonary Kaposi's Sarcoma - Initial Presentation of HIV Infection  Komitova,Radka T. Chudomirova,Krasimira Abadjieva,Tsvetana acquired immunodeficiency syndrome bronchoscopy combination antiretroviral therapy Kaposi’s sarcoma Folia Medica 61(4): 643-649 Kaposi’s sarcoma is the most common malignancy associated with human immunodeficiency virus. It commonly affects the skin but can present with visceral involvement, including the lungs. A 23-year-old homosexual male presented with fever, intractable cough and dyspnea. On examination, multiple skin lesions were revealed. Chest computed tomography visualized multiple nodules, bronchoscopy showed endobronchial lesions. Histopathological study of the skin lesions showed Kaposi’s sarcoma and the endobronchial biopsy – a proliferative inflammatory process. Diagnosis of Kaposi’s sarcoma was made based on clinical, laboratory, computed tomography and bronchoscopy data as well as on the regression of pulmonary nodules by the combination antiretroviral therapy. The diagnosis of pulmonary Kaposi’s sarcoma is still a challenge due to concomitant occurrence of opportunistic infections. This case emphasizes the need to strongly consider pulmonary KS as a possible cause for respiratory illness in any HIV-positive patient with cutaneous Kaposi’s sarcoma.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e47945 https://doi.org/10.3897/folmed.61.e47945 https://foliamedica.bg/article/47945/ https://foliamedica.bg/article/47945/download/pdf/ en

10.3897/folmed.61.e47962 2019-12-31 foliamedica

Therapy with L-thyroxine and Omnadren after Cardiac Surgery. A Case Report Stoitsev,Georgi Gavrilov,Veselin Manchev,Georgi Markov,Boyan Goranovska,Valya Tsankov,Boris Gegouskov,Vassil anabolic metabolism cardiac surgery L-thyroxine nutrition testosterone Folia Medica 61(4): 650-654 Background: Cardiopulmonary bypass in cardiac surgery produces systemic inflammatory response and catabolic state. Severe stress frequently causes abnormalities in thyroid hormones in the absence of primary thyroid disease, defined as sick euthyroid syndrome (SES).Materials and methods: Supplementation therapy with thyroid and anabolic hormones in combination with an adequate nutritional support has been used to improve outcome in critically ill patient after cardiac surgery.Results: Administration of thyroid and anabolic hormones significantly improved patient’s condition.Conclusions: Supplementation therapy with thyroid and anabolic hormones in combination with an adequate nutritional support could be used to improve hemodynamics, achieve transition to anabolic metabolism and enhance recovery, which could eventually help for a reduction in post-operative morbidity and mortality. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2019 Case Report text/html info:doi:10.3897/folmed.61.e47962 https://doi.org/10.3897/folmed.61.e47962 https://foliamedica.bg/article/47962/ https://foliamedica.bg/article/47962/download/pdf/ en

10.3897/folmed.62.e49802 2020-03-31 foliamedica

Good Manufacturing Practice for Medicinal Products in Bulgaria: an Analysis of Regulatory Inspection Findings H. Stoimenova,Assena Kirilov,Bogdan Gueorguiev,Stanislav Petkova-Gueorguieva,Elina S. Ognianov,Sava medicinal products human medicine Good Manufacturing Practice compliance deficiencies Folia Medica 62(1): 165-171 Background: The manufacture of medicinal products for human use in the European Economic Area is governed by European Directives and Regulations stipulating the relevant principles and guidelines of Good Manufacturing Practice, describing the minimum standard to be fulfilled in the production processes. Aim: To present analysis of the deficiencies reported following Good Manufacturing Practice inspections in Bulgaria in two consecutive years (2016, 2017) and to compare them with results from similar inspections reported by other EU member states. Materials and methods: A retrospective study was carried out by reviewing the complete Good Manufacturing Practice inspection reports of all manufacturers conducted by the Bulgarian Drug Agency in 2016 and 2017, according to relevant requirements and applicable local legislation. The items reviewed were scope of inspection, type of companies, classification of deficiencies – ‘critical’, ‘major’ and ‘other significant deficiencies’, their nature and reference to EU Good Manufacturing Practice. Results: The analyzed data included 55 inspections, revealing 460 various deficiencies, of which 2 were critical and 102 – major. Twenty inspections were performed in 2016 vs. 35 inspections in 2017.The pattern of deficiencies was similar to the findings of other EU regulatory agencies, showing that equivalent requirements were applied. Our analysis showed that Bulgarian Drug Agency inspectors rarely raised deficiencies related to Computer Systems, Qualification/Validation, Personnel and Qualification of Suppliers unlike other EU regulators agents. Conclusions: Our analysis of Good Manufacturing Practice inspection findings in 2016 and 2017 showed that the Bulgarian Drug Agency demonstrated its ability to detect non-compliances and take necessary regulatory actions. Quality related issues constitute the main reasons for non-compliances with the requirements.Publishing the results from the inspections performed by the national competent authorities enhances the regulatory transparency that can be useful for industry to improve its Good Manufacturing Practice compliance. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e49802 https://doi.org/10.3897/folmed.62.e49802 https://foliamedica.bg/article/49802/ https://foliamedica.bg/article/49802/download/pdf/ en

10.3897/folmed.62.e49370 2020-03-31 foliamedica

Antiviral, Cytotoxic and Antioxidant Effects of Tanacetum Vulgare L. Crude Extract In Vitro Vilhelmova,Neli Simeonova,Lora Nikolova,Nadya Pavlova,Elitsa Gospodinova,Zlatina Antov,Georgi Galabov,Angel Nikolova,Ivanka antioxidant activity CVB1 H3N2 HSV-1 Tanacetum vulgare L. Folia Medica 62(1): 172-179 Introduction: Due to the high prevalence of viral infections having no specific treatment and the constant emergence of resistant viral strains, searching for effective antiviral compounds is crucial. The present study explores in vitro the antiviral activity of ethanolic extract from aerial parts of Tanacetum vulgare L. against viral strains of three taxonomic groups, including agents that cause socially significant diseases in humans for which antiviral chemotherapy is indicated, namely coxsackievirus B1 (family Picornaviridae), herpes simplex virus type 1 (family Herpesviridae) and influenza A virus (family Orthomyxoviridae). Aim: The aim of the current study was to evaluate antiviral activity of ethanolic extract from herbaceous plant Tanacetum vulgare L. against some important human viruses for which antiviral chemotherapy is needed and to characterize extract for its antioxidant activity in vitro. Materials and methods: The crude aqueous ethanolic extract from aerial parts of Tanacetum vulgare L. contained flavonoids determined as apigenin, coumarins determined as aesculin, tannic compounds determined as tannin, and others. Antiviral activity of ethanolic extract from herbaceous plant Tanacetum vulgare L. against coxsackievirus B1, influenza A and herpes simplex virus type 1 was evaluated by viral yield reduction technique. The total antioxidant activity was determined by measuring the capacity of the sample to inhibit the generation of thiobarbituric acid reactive substances (TBARS). Results: The results show that the extract has the lowest toxicity on the MDBK cell line and similar cytotoxicity in Hep-2, whereas in the MDCK cells it has more than twice the highest toxicity. Testing the antiviral activity of Tanacetum vulgare L. extract revealed a slight inhibition of replication of HSV-1 with a selective index of 7.07 and IAV/H3N2 (SI = 3.69) but no specific antiviral effect against CVB1 replication was found. The evaluation of the antioxidant activity showed great antioxidant activity of the ethanolic extract from T. vulgare – 26 mmol/l for the applied 20 mg/ml extract. Conclusion: The crude extract from aerial parts of the medicinal plant Tanacetum vulgare L. demonstrated low cytotoxicity in Hep-2, MDBK and moderate cytotoxic effects in MDCK cells. It exerted significant antiviral activity against HSV-1 as determined by the recorded inhibition of viral replication, the blockage of virus entry - absorption stage and direct virucidal effects on extracellular virions. The observed effect when testing Tanacetum’s extract on influenza A H3N2 virus infection in vitro was milder, which probably resulted from the interference with the cellular pathways involved in the replication cycle. The presence of virucidal and adsorption-suppressing activity but the absence of viral replication inhibitory effects against CBV-1 suggests a possible interaction of the extract’s components with viral capsid proteins or related cell receptors. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e49370 https://doi.org/10.3897/folmed.62.e49370 https://foliamedica.bg/article/49370/ https://foliamedica.bg/article/49370/download/pdf/ en

10.3897/folmed.62.e48018 2020-03-31 foliamedica

Comparative Study of Occlusal Contact Marking Indicators Bozhkova,Tanya articulating foil articulating paper occlusal contacts Folia Medica 62(1): 180-184 Background: A variety of indicators to register occlusal contacts are used in the daily dental practice. One of the most frequently used qualitative occlusal indicators is the articulating paper. Its reliability is often disputed because this indicator could produce false positive results or fail to register any occlusal contacts. Aim: To compare the number and size of the recorded contacts on a tooth surface obtained with articulating paper and foil. Materials and methods: Typodonts of upper and lower jaw with intact dental arches Frasaco A-3Z were fixed in a Girbach arcon articulator. Articulating contacts were marked with 12-micron Bausch articulating foil and 200-micron Bausch articulating paper under the same load. For each study a new sheet of the occlusal indicators was used, and 10 repetitions were made for each one. After every marking, the lower jaw was dismounted from the articulator and the distribution of the markings was videographed using a camera. The number of occlusal contacts was entered in a table. We analysed the markings on the first maxillary and first mandibular molars. Results: We found that fewer and bigger contacts were recorded using the 200-micron articulating paper in comparison with the contacts obtained using the foil.Statistical analysis showed that there is significant difference in the number of the occlusal contacts registered with articulating paper, since p < 0.05. Conclusions: The type of occlusal contact indicator has an effect on the number and the size of the occlusal contact markings info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Case Report text/html info:doi:10.3897/folmed.62.e48018 https://doi.org/10.3897/folmed.62.e48018 https://foliamedica.bg/article/48018/ https://foliamedica.bg/article/48018/download/pdf/ en

10.3897/folmed.62.e47749 2020-03-31 foliamedica

Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating from the Para-Hisian area - QRS Morphology Change and Late Effect of the Ablation: Case Series Dzhinsov,Krasimir Stoyanov,Milko Shalganov,Tchavdar catheter ablation bundle of His para-Hisian premature ventricular contractions Folia Medica 62(1): 185-189 Introduction: Radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating in the para-Hisian region could be challenging because of a potential risk of iatrogenic atrioventricular block. Uncommonly, shift of the exit site during the ablation can be observed. Consequently, different approaches of radiofrequency catheter ablation of para-Hisian ventricular foci can be needed. Case series presentation: Three patients (2 males) underwent electroanatomical mapping and catheter ablation for idiopathic premature ventricular contractions originating near the His bundle. Patients underwent 24-h ECG Holter monitoring during follow-up. All patients had premature ventricular contractions with left bundle branch block morphology and inferior or horizontal axis. However, change of QRS morphology during ablation was observed, due to a change in the exit site. In two patients there was reduction of the arrhythmia burden after initially unsuccessful procedure. Mapping and ablation in the aortic root were needed in one patient. There were no complications. Discussion: Radiofrequency catheter ablation of para-Hisian ventricular arrhythmias is feasible and safe when performed cautiously. A change in the premature ventricular contractions’ morphology and exit site during ablation may ensue; therefore, extensive mapping on both sides of the interventricular septum as well as in the aortic root may be warranted. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Case Report text/html info:doi:10.3897/folmed.62.e47749 https://doi.org/10.3897/folmed.62.e47749 https://foliamedica.bg/article/47749/ https://foliamedica.bg/article/47749/download/pdf/ en

10.3897/folmed.62.e49813 2020-03-31 foliamedica

Papillary Endometrioid Carcinoma of Intermediate Grade with Infiltration in a Leiomyoma Shopov,Spasimir carcinoma immunohistochemical leiomyoma uterus Folia Medica 62(1): 190-194 In endometrioid cancer cases, the depth of myometrial invasion, the lymphovascular space invasion (LVSI) and the microcystic, elongated, and fragmented (MELF) glands type of invasion are predictors for a metastasis. Although the intermediate grade papillary endometrioid adenocarcinoma of the endometrium is currently not included in the latest classification of the tumors in the female reproductive system, its existence provokes an interest due to the necessity to perform differential diagnosis against other endometrioid tumors. Hereby presented is a case of papillary endometrioid carcinoma of intermediate grade with invasion in leiomyoma, expressed via LVSI and MELF syndrome with intact myometrium. Morphological and immunohistochemical algorithms have been performed. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2020 Case Report text/html info:doi:10.3897/folmed.62.e49813 https://doi.org/10.3897/folmed.62.e49813 https://foliamedica.bg/article/49813/ https://foliamedica.bg/article/49813/download/pdf/ en

10.3897/folmed.62.e47875 2020-03-31 foliamedica

Primary Peritoneal Serous Carcinoma Detected by Abnormal Cervical Smear: a Case Report Blontzos,Nikolaos Iavazzo,Christos Giovannopoulou,Eirini Galanopoulos,George Psomiadou,Victoria Vorgias,George cervical smear extrauterine malignancies glandular atypia primary peritoneal serous carcinoma Folia Medica 62(1): 195-199 Primary peritoneal serous carcinoma (PPSC) is a rare malignancy, the clinical characteristics of which resemble ovarian serous carcinoma. We present a rare case of PPSC detected by an abnormal cervical smear, the first one with an absence of ovarian tissue at the time of the initial diagnosis.A 59-year-old asymptomatic woman presented with glandular atypia on routine Papanicolaou smear. Endocervical and endometrial curettage showed an adenocarcinoma with focal squamous differentiation and uncertain further classification. The patient had a past surgical history of bilateral salpingoophorectomy due to endometriosis. Abdominal MRI depicted omental multinodularity, great amount of ascites and possible endometrial tumor. The patient underwent total hysterectomy, omentectomy and biopsies of implants on Douglass pouch.  Surgical and histological findings were consistent with primary peritoneal serous carcinoma. Abnormal pap smear could rarely be suggestive of extrauterine malignancies, such as peritoneal cancer. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Case Report text/html info:doi:10.3897/folmed.62.e47875 https://doi.org/10.3897/folmed.62.e47875 https://foliamedica.bg/article/47875/ https://foliamedica.bg/article/47875/download/pdf/ en

10.3897/folmed.62.e47874 2020-03-31 foliamedica

Diffuse Large B-cell Lymphoma of Testis: a Case Report and Current Literature Review Güler,Yavuz Ucpinar,Burak Erbin,Akif diffuse large B-cell lymphoma testis Folia Medica 62(1): 200-203 Introduction: Testicular cancers detected in older males are mostly testicular lymphomas. Primary testicular lymphoma (PTL) is a rare, clinically aggressive form of extranodal lymphoma. In population-based studies, the  incidence of PTL is 0.09-0.26/100.000. The vast majority of PTL are diffuse large B-cell lymphoma (DLBCL). Case presentation: We present a case of PTL diagnosed in a 68-year-old male patient and also, we discuss the incidence, clinical presentation, prognostic factors and management of this rare pathology in the light of current literature. Histopathological and immunohistochemical exams of the patient confirmed the diagnosis of DLBCL after radical orchiectomy. According to the internal prognostic index (IPI), patients’ IPI score was evaluated as 5 and according to Ann Arbor staging, patients’ stage was interpreted as grade 3E. Cyclophosphamide, vincristine, etoposide, and prednisolone chemotherapy was planned for the patient and until now, the patient received his first chemotherapy regimen. Discussion: Primary testicular lymphoma should be kept in mind for every patient who admits with a testicular mass, especially in advanced age.  Misinterpreatation of the clinical findings can delay the definitive diagnosis. Primary testicular lymphoma should be managed with a multi-disciplinary team including urologists, medical and radiation oncologists.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Case Report text/html info:doi:10.3897/folmed.62.e47874 https://doi.org/10.3897/folmed.62.e47874 https://foliamedica.bg/article/47874/ https://foliamedica.bg/article/47874/download/pdf/ en

10.3897/folmed.62.e47723 2020-03-31 foliamedica

Takotsubo Cardiomyopathy after Elective Aortic and Mitral Valve Replacement Vazhev,Zaprin Stoev,Hristo aortic valve replacement mitral valve replacement postoperative acute myocardial infarction Takotsubo cardiomyopathy Folia Medica 62(1): 204-207 Takotsubo cardiomyopathy is a syndrome characterized by transient acute left ventricular dysfunction, electrocardiographic changes that can mimic acute myocardial infarction and minimal release of myocardial enzymes in the absence of obstructive coronary artery disease (CAD). Reports of Takotsubo syndrome after cardiac surgery are exceptional. We describe a case of Takotsubo cardiomyopathy in a 57-year-old man after elective aortic and mitral valve replacement following recent convalescence from infective endocarditis. Takotsubo syndrome should be considered in the differential diagnosis of patients presenting acute myocardial infarction, cardiogenic shock or any low cardiac output syndrome after cardiac surgery. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Case Report text/html info:doi:10.3897/folmed.62.e47723 https://doi.org/10.3897/folmed.62.e47723 https://foliamedica.bg/article/47723/ https://foliamedica.bg/article/47723/download/pdf/ en

10.3897/folmed.62.e47731 2020-03-31 foliamedica

Aesthetic Improvement of White Spot Fluorosis Lesions with Resin Infiltration Todorova,Veselina Filipov,Ivan Khaliq,Abdul Verma,Pankaj white fluorosis lesions resin infiltrant Folia Medica 62(1): 208-213 Dental fluorosis changes the colour and/or structure of enamel, leading to an unaesthetic appearance. One of the main goals in the treatment is aesthetic improvement of the affected teeth. Two clinical cases of patients with white spot fluorosis lesions on frontal teeth are presented. All treated teeth are infiltrated with low-viscous light-curing resin (ICON, DMG). A significant improvement in the aesthetic appearance of all the treated tooth surfaces is visible immediately after resin infiltration, and in most of the teeth - a complete disappearance of the white spots. Resin infiltration is an alternative micro-invasive approach for treatment of white spot lesions of different origin. It allows a quick and natural recovery of the affected teeth. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Case Report text/html info:doi:10.3897/folmed.62.e47731 https://doi.org/10.3897/folmed.62.e47731 https://foliamedica.bg/article/47731/ https://foliamedica.bg/article/47731/download/pdf/ en

10.3897/folmed.62.e47772 2020-03-31 foliamedica

Musculoskeletal Ultrasound in Rheumatology - New Horizons Sapundzhieva,Tanya Karalilova,Rositsa Batalov,Anastas enthesitis musculoskeletal ultrasound rheumatology synovitis Folia Medica 62(1): 7-16 Musculoskeletal ultrasound is a non-ionizing, cheap, reproducible, reliable imaging method, well accepted by the patients, that plays an important role in daily rheumatology practice. It can be used to assess joint and periarticular involvement, including tendon, bursae, enthesis, skin thickness, nails, lung and large vessels. Musculoskeletal ultrasound is more sensitive than physical examination, improves the diagnostic process, monitoring of treatment response, the accuracy of joint and soft tissue injections. It has proved its role as an important imaging modality in a number of rheumatic diseases – inflammatory joint diseases, systemic connective tissue diseases, large-vessel vasculitides, and degenerative and metabolic bone diseases. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e47772 https://doi.org/10.3897/folmed.62.e47772 https://foliamedica.bg/article/47772/ https://foliamedica.bg/article/47772/download/pdf/ en

10.3897/folmed.62.e48003 2020-03-31 foliamedica

Review of Potential Significance of Mutations of ADAMTS20, NF1 and PKHD1 Detected Using Next Generation Sequencing (NGS) in Dermal Fibrosarcoma Arising in Dermatofibrosarcoma Protuberans Kowalik,Artur Wincewicz,Andrzej Zięba,Sebastian Kopczynski,Janusz Koda,Mariusz Sulkowski,Stanisław Kańczuga-Koda,Luiza Góźdź,Stanisław ADAMTS20 dermatofibrosarcoma protuberans fibrosarcoma NF1 and PKHD1 Folia Medica 62(1): 17-22 We examined a status of fibrosarcoma arising in dermatofibrosarcoma protuberans of 64-year-old male patient. A dermal, solid, grayish-yellow, desmin-negative trichrome-bluish tumor measured 1.5 cm in diameter pT1a (edition 8 pTNM). It was composed of spindle cells. It was consistent with dermatofibrosarcoma protuberans (ICD-O3: 8832/3) in areas of low mitotic activity, low atypia and sustained CD34 positivity. CD34-negative texture with high mitotic index and atypia was consistent with the high grade sarcoma apparently of fibrous origin, given category of poorly differentiated fibrosarcoma. The high grade component was graded (G3) and scored according to French Federation of Cancer Centers Sarcoma Group (FNCLCC): total score of 6 points: tumor differentiation: 3 points + Mitotic count: 3 points (up to 26 mitoses/ 10HPF in high-grade fields), + no necrosis: 0 points. In low grade sarcomatous component ADAMTS20 (NM_025003: c.1661C>T, p.P554L) NF1 (NM_001042492: c. 2173G>T, p.E725X) and PKHD1 (NM_138694: c. 11074C>T, p.R3692X) were revealed with following allelic frequencies: 25%, 27% and 17%. In high grade component allelic frequencies of the same mentioned mutations were 30%, 30% and 14% respectively. In the light of our findings, none of detected mutations can be regarded as a mutation that would definitely induce phenotype of high malignancy, because ADAMTS20, NF1 and PKHD1 mutations were detected both in high grade sarcoma and in low grade areas of dermatofibrosarcoma protuberans. It also points that these mutations appeared on early stages of tumor development. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e48003 https://doi.org/10.3897/folmed.62.e48003 https://foliamedica.bg/article/48003/ https://foliamedica.bg/article/48003/download/pdf/ en

10.3897/folmed.62.e47740 2020-03-31 foliamedica

Cystic Echinococcosis of the Breast - Diagnostic Dilemma or just a Rare Primary Localization Mutafchiyski,Ventsislav Popivanov,Georgi Tabakov,Mihail Vasilev,Vladimir Kjossev,Kirien Cirocchi,Roberto Philipov,Anthony Vaseva,Virsavia Baitchev,Georgi Ribarov,Racho Konaktchieva,Marina breast cystic echinococcosis hydatid disease Folia Medica 62(1): 23-30 Introduction: Although the liver and lung are the most frequently affected organs in cystic echinococcosis, the cysts may develop in any viscera and tissues. Breast is a rare primary localization with few cases described in the literature. We present an updated and systematic review and discuss the possible mechanisms of spreading, diagnostic and treatment options. Materials and methods: We performed a literature search in PUBMED using the key words ‘hydatid disease’, ‘cystic echinococcosis’ and ‘breast echinococcosis’ without time limitation. Only studies reporting breast cystic echinococcosis were included. Results: Overall, 121 cases with cystic echinococcosis and 2 with alveolar echinococcosis were reported. A total of 52 cases were included in the analysis. The mean size of cysts was 5.5 cm (range 1.7-12). The most common clinical presentation was painless lump presented from 4 months to 19 years before the final diagnosis. Most cases had isolated breast CE, few cases had synchronous localizations – femoral, thigh and lung, and previous liver CE. Most were active CL and CE1-2 cysts (72%). Ultrasound was used in 83%, followed by mammography (35%). Fine needle aspiration was reported in 27 cases with positive finding in 59%. Conclusions: In cases with cystic breast lesions from endemic regions we recommend the US as a gold standard. CT and MRT are more accurate but expensive tools without the potential to change the surgical tactic. In contrast to the other localizations of CE, complete excision of the cysts is the best diagnostic and treatment approach. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e47740 https://doi.org/10.3897/folmed.62.e47740 https://foliamedica.bg/article/47740/ https://foliamedica.bg/article/47740/download/pdf/ en

10.3897/folmed.62.e47737 2020-03-31 foliamedica

Anti-tumoral Effect of a Cell Penetrating and Interfering Peptide Targeting PP2A/SET Interaction Andrini,Laura Marin,Gustavo Inda,Ana Maria Bruzzoni-Giovanelli,Heriberto Garcia,Marcela Errecalde,Jorge Rebollo,Angelita apoptosis cancer drug research peptide Folia Medica 62(1): 31-36 Objective: To test cell penetrating and interfering peptide Mut3DPT-PP2A/SET in interaction between serine threonine phosphatase PP2A and its physiological inhibitor, the oncoprotein SET. Materials and methods: Adult male C3H/S-strain mice, 60 days old, were given a graft of breast adenocarcinoma cells (TN60) into subcutaneous tissue. Mut3DPT-PP2A/SET peptide was used to block PP2A and SET oncoprotein interaction. The graft-bearing animals were divided into a control group (injected with saline buffer), and an intervention group injected intraperitoneally with Mut3DPT-PP2A/SET peptide (5 mg/kg) every day from day 5 to day 37. The variables we used to compare the outcome in both groups were tumor size in mm (length×width) and histological changes. In the statistical analysis we used ANOVA and Student-Keuls multiple comparisons test and Tuckey for the post-test analysis. Results: 48 mice were grafted at day 0 with breast UNLP-C3H/S tumor cells, and after randomization, they were assigned to one of the two study groups. At day 5 all mice were injected either with placebo or with the peptide. The treated group showed significant tumor reduction (p<0.07). Histological changes showed presence of apoptosis and necrosis of tumor in treated group. Conclusion: The peptide Mut3DPT-PP2A/SET has demonstrated anti-tumor activity by reduction in vivo of tumor growth becoming a promising future in anticancer therapy.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47737 https://doi.org/10.3897/folmed.62.e47737 https://foliamedica.bg/article/47737/ https://foliamedica.bg/article/47737/download/pdf/ en

10.3897/folmed.62.e47932 2020-03-31 foliamedica

Evaluation of the Immune Response Against Helicobacter pylori in Infused BALB/c Mice by pcDNA3.1(+)-ureA  Nasr-Esfahani,Maryam Doosti,Abbas Sharifzadeh,Ali cytokine genes Helicobacter pylori pcDNA3.1(+)-ureA recombinant vector Folia Medica 62(1): 37-45 Background: The purpose of the present study was to produce a pcDNA3.1(+)-ureA recombinant vector and evaluate the capacity of this vector to stimulate the immune response against H. pylori infection in infused BALB/c mice.  Materials and methods: The pcDNA3.1(+)-ureA construct was prepared and transformed into E. coli, successfully. The animals we used in the study were allotted into three groups for infusion of 1) recombinant plasmid, 2) pcDNA3.1(+)-ureA + nanoparticles, and 3) pcDNA3.1(+). Blood and tissue specimens from each group of mice were collected at days 15, 30, and 45 after the last infusion and the expression levels of cytokines such as TGF-β1, IL-4, and IFNγ genes comparing to GAPDH as well as the expression of ureA in the mice’s thigh muscle were evaluated.  Results: The genes expression analysis showed that the IL4 expression significantly decreased (p<0.001) but IFNγ and TGF-β1 expression increased in the blood of infused mice (p<0.001). Also, the urea expression level in pcDNA3.1(+)-urea and pcDNA3.1(+)-ureA+ nanoparticle 15, 30, and 45 days after the last infusion was significantly different (p<0.001) and its expressions at days 15 and 30 were significantly different (p<0.001), but 45 days after the last infusion it was not significantly different (p>0.05).  Conclusion: The pcDNA3.1(+)-ureA recombinant vector with or without chitosan nanoparticles can stimulate the immune response in animal models against H. pylori infection. Also, after combining the recombinant vector with nanoparticles we observed a better immune response was observed. In future studies this recombinant construct can be used as a biomarker and therapeutic approaches in eukaryotic systems. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47932 https://doi.org/10.3897/folmed.62.e47932 https://foliamedica.bg/article/47932/ https://foliamedica.bg/article/47932/download/pdf/ en

10.3897/folmed.62.e47714 2020-03-31 foliamedica

DAS28-ESR and DAS28-CRP - are they Interchangeable in Measuring the Activity of Rheumatoid Arthritis in Response to Treatment with Biological Agents? Shivacheva,Tanya DAS28-ESR DAS28-CRP rheumatoid arthritis Folia Medica 62(1): 46-51 Introduction: The European League Against Rheumatism updates the recommendations for managing rheumatoid arthritis. Again, it is not specified which DAS28 is there in view (with erythrocyte sedimentation rate or C-reactive protein). Aim: The aim of the study is to check whether Disease Activity Score-28 (erythrocyte sedimentation rate) and Disease Activity Score-28 (C-reactive protein) represent equally the activity of rheumatoid arthritis in the course of treatment with biological agents. Materials and methods: In a retrospective study we analyzed the database of real clinical practice over a 12-month period of biological treatment of rheumatoid arthritis. Disease Activity Score-28 (erythrocyte sedimentation rate) and (C-reactive protein) are compared at the start and at the end of the study. Results: The mean difference between the two variants of disease activity scores at baseline and at the end of the study is significant (p < 0.001). The Disease Activity Score-28 (erythrocyte sedimentation rate) represents a remarkably small proportion of patients with remission and low activity (<3.2) at baseline (18.46%) and at the end of the study (40.51%). Disease Activity Score-28 (C-reactive protein) represents a significantly high proportion of patients in remission and low activity (<3.2) at the end of the study (69.74%). Estimates of activity according to the two variants show significant discrepancy between each other and low level of agreement (kappa = 0.235-0.464). Discrepancies are not related to the type of biological drug (anti-TNF or not). Conclusion: The two DAS28 variants are not interchangeable with the same threshold for low activity in measuring the response to biological therapy. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47714 https://doi.org/10.3897/folmed.62.e47714 https://foliamedica.bg/article/47714/ https://foliamedica.bg/article/47714/download/pdf/ en

10.3897/folmed.62.e47712 2020-03-31 foliamedica

Intravenous Administration is the Best Route of Mesenchymal Stem Cells Migration in Improving Liver Function Enzyme of Acute Liver Failure Putra,Agung Rosdiana,Ika Darlan,Dewi Masyithah Alif,Iffan Hayuningtyas,Fitri Wijaya,Indriani Aryanti,Rita Makarim,Fadhli Rizal Antari,Arini Dewi acute liver failure intravenous intraperitoneal mesenchymal stem cells vascular endothelial growth factor Folia Medica 62(1): 52-58 Background: Mesenchymal stem cells (MSCs) migrate and transmigrate to acute liver failure (ALF) area due to vascular endothelial growth factor (VEGF) stimulation as an attractant molecule then actively giving the paracrine signaling and or differentiating into primary hepatocytes, however the best route of MSCs transplanted to liver injury area remains unclear. Aim: In this study we compare intravenous (IV) and intraperitoneal (IP) route of MSCs administration by analyzing serum glutamic pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT) and bilirubin level as improvement markers of liver function and VEGF as attractant-proliferation molecule on days 2 and 5. Materials and methods: Eighteen male Sprague-Dawley rats weighting 200 g were used in this study. They were divided in three study groups: vehicle control, IP and IV groups. The IV group was treated by MSCs at dose 1×106 by lateral tail vein injection and IP group received 1×106 MSCs via IP injection. The level of SGPT, SGOT and bilirubin were measured by an automatic analyzer, the VEGF level using enzyme-linked immunosorbent assay (ELISA), while the CD73 expression was evaluated using immunohistochemistry. Results: This study showed that IV injection of MSCs was more efficient for increasing liver function than IP treatment group that confirmed by the observed significant decrease in SGPT, SGOT and bilirubin level on days 2 and 5 (p<0.001). This effect was most likely mediated by the significant increase of VEGF level (p<0.05) on days 2 and 5. Conclusion: Our result conclude that an IV administration of MSCs was more efficacious than the IP administration for liver injury  regeneration.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47712 https://doi.org/10.3897/folmed.62.e47712 https://foliamedica.bg/article/47712/ https://foliamedica.bg/article/47712/download/pdf/ en

10.3897/folmed.62.e47762 2020-03-31 foliamedica

Various Aspects of Tiagabine Effectiveness as Add-on Therapy in Patients with Refractory Epilepsy Viteva,Ekaterina Zahariev,Zahari I. tiagabine epilepsy efficacy tolerability adverse events Folia Medica 62(1): 59-64 The aim of the present study was to investigate various aspects of tiagabine (TGB) effectiveness in Bulgarian patients with drug-resistant epilepsy. This open, prospective study recruited the patients with epilepsy attending the Clinic of Neurology at the University Hospital of Plovdiv, Bulgaria. The patients completed diaries about the seizure frequency, severity, and adverse events. There were regular documented visits at 3 or 6 months during the first year of treatment with TGB and at 6 months or 1 year afterwards, with dynamic assessment of seizure frequency, severity, adverse events, and EEG recordings. TGB was applied as an add-on treatment in 43 patients (24 males, mean age 39 years). There was relatively mild and transient dynamic improvement of seizure severity, satisfactory seizure frequency reduction in 32.6% of participants, stable mean seizure frequency reduction (40-50%) from month 6 to month 24 and a stable response rate (52.3-50%) during the same period. New seizure types (myoclonic, myoclonic-atonic) occurred in 2 patients. The final clinical efficacy was higher in patients with initial monotherapy. There were adverse events (dizziness/vertigo, sedation, memory impairment, loss of appetite and weight, confusion, psychosis, insomnia, transient diplopia, lymphadenomegaly, rash, nausea, depression, anxiety, tremor of hands, unstable gait, legs edema, thrombocytopenia, cervical muscles tightening) in 26.19% of patients. In conclusion, TGB treatment is associated with low and transient improvement of seizure severity, good and stable improvement of seizure frequency, possible worsening of seizure control, possible appearance of new seizure types, and acceptable safety and tolerability. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47762 https://doi.org/10.3897/folmed.62.e47762 https://foliamedica.bg/article/47762/ https://foliamedica.bg/article/47762/download/pdf/ en

10.3897/folmed.62.e47768 2020-03-31 foliamedica

A New Method of Eliciting Pyramidal Tract Impairment in Adults Osuagwu,Ferdnand Bradley,Ronald Pasupuleti,Usha Pasupuleti,Devakinanda Babinski extensor plantar response pyramidal sign Pasupuleti sign Folia Medica 62(1): 65-69 Background: To suggest a new way of eliciting pyramidal tract dysfunction in adults since the most widely utilized plantar reflex, which is the Babinski reflex, has limitations with different reliability and consistency among different examiners.  Materials and methods: 168 adult subjects were examined for the new sign in addition. It consists of just an observation of the patient’s feet and toes in a conscious patient looking for the extension of the great toe along with fanning, spreading and plantar flexion of the small toes either at rest or when patient elevates one leg up at a time. Results: We were able to observe the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients with impairment of pyramidal tract. The specificity was 94% while the sensitivity was 96%. Conclusion: Pyramidal tract lesion in adults can be elicited by this new test that observes the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients. We suggest this sign as a complement to established signs like Babinski reflex. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47768 https://doi.org/10.3897/folmed.62.e47768 https://foliamedica.bg/article/47768/ https://foliamedica.bg/article/47768/download/pdf/ en

10.3897/folmed.62.e47735 2020-03-31 foliamedica

Investigation of the Effects of Octreotide Agent on Oxidative Stress, 8-Hydroxy Deoxyguanosine in Experimental Hepatic Carcinogenesis Rat Model Unsal,Velid Belge Kurutas,Ergul 2-AAF DEN Hsp70 octreotide oxidative stress Folia Medica 62(1): 70-75 Introduction: 2-AAF and DEN are well-known liver toxicants commonly used to stimulate tumors in laboratory animals.  Aim: The aim of this study was to investigate the effect of octreotide on DEN-induced and 2-AAF-supplemented hepatocarcinogenesis in Wistar albino rats. Materials and methods: In this study, 64 Wistar albino rats were divided into 8 groups. DEN (175 mg/kg) initiated and 2-AAF (20 mg/kg) promoted liver carcinogenesis in rats. The tumor growth inhibitor octreotide (300 μg/kg) was used. Rats were sacrificed at the end of experiment and their liver tissues were taken for the study. SOD, GSH-Px, CAT activities, NO and MDA levels were measured spectrophotometrically. Also, Hsp70 and 8-OHdG was measured by the ELISA method.  Results: In group 7, MDA, 8-OHdG, and Hsp70 levels were significantly increased. In addition, SOD, GSH-Px activity was significantly reduced in this group. MDA, 8-OHdG and Hsp70 levels were significantly reduced in Group 8, which received octreotide for treatment.  Conclusion: DEN and 2-AAF cause very serious liver damage. Octreotide protects the liver from carcinogenesis, increases the activity of cellular antioxidant enzymes and helps reduce DNA damage. Therefore, octreotide may be an inhibitor in tumor cells and may reduce oxidative stress. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47735 https://doi.org/10.3897/folmed.62.e47735 https://foliamedica.bg/article/47735/ https://foliamedica.bg/article/47735/download/pdf/ en

10.3897/folmed.62.e49809 2020-03-31 foliamedica

Peak Responses during Exercise Treadmill Testing using Individualized Ramp Protocol and Modified Bruce Protocol in Elderly Patients Kozlov,Sergey Caprnda,Martin Chernova,Olga matveeva,Marina Alekseeva,Irina Gazdikova,Katarina Gaspar,Ludovit Kruzliak,Peter Filipova,Slavomira Gabbasov,Zufar elderly adults exercise treadmill testing exercise capacity individualized ramp protocol modified Bruce protocol Folia Medica 62(1): 76-81 Background: Exercise capacity is well known to be an important prognostic factor in patients with cardiovascular disease and among healthy persons. Aim: To determine if there are any differences between the peak exercise response during exercise treadmill testing with the individualized ramp protocol and the modified Bruce protocol in elderly patients. Materials and methods: The study included 40 patients (both male and female), aged 70 years and older, who had not had a baseline history of the confirmed coronary artery disease or heart failure diagnoses. All patients underwent exercise treadmill testing using modified Bruce protocol and individualized ramp protocol for 2 consecutive days. Peak heart rate, peak systolic and diastolic blood pressure, peak pressure-rate double product, exercise duration, and peak metabolic equivalents were recorded in both tests. Perceived level of exertion was evaluated using the Borg 10-point scale. Results: The average duration of exercise was longer for the ramp protocol than for the modified Bruce protocol. When the modified Bruce protocol was used, patients achieved a lower workload than they did in using the ramp protocol. The rating of perceived exertion using the revised Borg scale (0 to 10) was 5.6±1.4 for the ramp protocol and 8.7±1.4 for the modified Bruce protocol, which indicates that the patients found the ramp protocol easier. Conclusion: In elderly patients the individualized ramp treadmill protocol allows to achieve the optimal test duration with higher degrees of workload and greater patient comfort during the test more often than does the modified Bruce protocol. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e49809 https://doi.org/10.3897/folmed.62.e49809 https://foliamedica.bg/article/49809/ https://foliamedica.bg/article/49809/download/pdf/ en

10.3897/folmed.62.e47913 2020-03-31 foliamedica

Investigation of Kisspeptin Role in Experimental Kidney Ischemia/Reperfusion Injury Kudaibergenova,Assel Aydogdu,Nurettin Kandemir,Nihayet Aydin,Muhammed Ali acute kidney ınjury ischemia/reperfusion kisspeptin peptide Folia Medica 62(1): 82-88 Introduction: Kisspeptin is biologically active peptide encoded by the KISS1 gene that is structurally found in the kidney tubule, collecting duct and vein smooth muscle cells.  Aim: We aimed to investigate the role of kisspeptin in kidney function and renal pathophysiology in experimental kidney ischemia/reperfusion (I/R) injury.  Materials and methods: Male Spraque-Dawley rats were divided into control and I/R groups (n=8). Both kidney vessels of I/R group rats were clamped and subjected to ischemia for 60 minutes and reperfusion for 48 hours. After the reperfusion period blood samples and kidney tissue were collected under anesthesia.  Results: Levels of urea, creatinine (p<0.01) in serum, Kim-1 in urine (p<0.05) were increased, creatinine clearance, aldosterone and ANG II levels in serum were decreased in the I/R group compared with the Control group (p<0.05). Kidney kisspeptin levels decreased and urine kisspeptin levels increased (p<0.05).  Conclusions: The present study has shown that the levels of kisspeptin change in kidney damage and thus the kisspeptin may play a role in the regulation of renal function and in the pathophysiology of acute kidney injury. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47913 https://doi.org/10.3897/folmed.62.e47913 https://foliamedica.bg/article/47913/ https://foliamedica.bg/article/47913/download/pdf/ en

10.3897/folmed.62.e47797 2020-03-31 foliamedica

Correlation of Disease Activity and Quality of Life of Patients with Psoriasis after Narrow-band Ultraviolet B Therapy Dourmishev,Lyubomir Lyubomirova,Karolina DLQI NB UVB therapy PASI psoriasis quality of life Folia Medica 62(1): 89-93 Introduction: Treatment with ultraviolet light is a well-established and effective treatment option for mild to moderate psoriasis. The aims of the study were to measure the psoriasis area and severity index (PASI) reduction after narrow-band ultraviolet B (NB UVB) therapy, to evaluate the quality of life before and after treatment using the dermatology life quality index (DLQI), and to compare the clinical effectiveness with quality of life improvement. Material and methods: Twenty two patients (13 male and 9 female patients), aged between 21 to 70 years (mean age 40±14.65 years) were enrolled in the study. NB UVB treatment was performed with 10 to 25 (mean 18.5; SD 3.39) procedures with cumulative doses of 5 to 19.4 J/cm2. The baseline median PASI score was 20.027 which decreased after therapy to 11.11. More than PASI 50% reduction was achieved in 40.91% of the patients after at least 6 weeks of treatment and the results are highly statistically significant. Quality of life (QoL) assessed using DLQI was found moderately affected by disease pretreatment. NB UVB therapy significantly increased DLQI score in spectrum of ‘symptoms and feelings’ and ‘treatment’. Discussion: The PASI score reduction that we observed after NB-UVB therapy is consistent with the results reported by other authors. Baseline DLQI scores were indicative of moderate QoL impairments associated with disease. At the same time, the reduction of the DLQI index corresponding to improved QoL correlated with the objective clinical symptom assessment.  Conclusion: Our data suggest that DLQI and PASI indexes are important complementary methods for comprehensive health assessment of patients with psoriasis.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47797 https://doi.org/10.3897/folmed.62.e47797 https://foliamedica.bg/article/47797/ https://foliamedica.bg/article/47797/download/pdf/ en

10.3897/folmed.62.e47743 2020-03-31 foliamedica

Initial Factors Affecting 6-month Outcome of Patients Undergoing Surgery for Acute Post-traumatic Subdural and Epidural Hematoma Kulesza,Bartłomiej Litak,Jakub Mazurek,Marek Nogalski,Adam traumatic brain injury epidural hematoma subdural hematoma factors outcome Folia Medica 62(1): 94-104 Introduction: The most frequent consequences of a traumatic brain injury are acute subdural (SDH) and epidural hematoma (EDH), which usually require a surgical treatment. Most of the factors affecting the prognosis have been analyzed on a wide group of traumatic brain injuries. Nonetheless, there are few studies analyzing factors influencing the prognosis regarding patients with EDH and SDH. The aim of the study is to identify factors which have prognostic value in relation to 6-month outcome of patients undergoing surgery for acute hematoma. Patients and methods: The study included a group of 128 patients with isolated craniocerebral injuries. The patients were divided into two groups, namely a group of 28 patients operated on due to epidural hematoma and a group of 100 patients operated on due to acute subdural hematoma. All patients were operated and treated in the Department of Neurosurgery at the Medical University in Lublin from 1.10.2014 to 31.08.2017. The following factors from the groups were analyzed: demographic data, physiological factors, laboratory factors, computed tomography scan characteristics, and time between the trauma and the surgery. All the factors were correlated with six-month outcome in Glasgow outcome scale. Results: The univariate analysis has confirmed the influence of many factors affecting the outcomes. Conclusion: It is interesting that the factors such as GSC score, saturation, respiratory rate, and systolic blood pressure were associated with outcome with highly statistically significant differences in both group. These are factors that, with an appropriate treatment, could be normalized at the place of the accident. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47743 https://doi.org/10.3897/folmed.62.e47743 https://foliamedica.bg/article/47743/ https://foliamedica.bg/article/47743/download/pdf/ en

10.3897/folmed.62.e47765 2020-03-31 foliamedica

Traumatic Brain Injury and the Importance of Neurosurgical Care: 10-year Retrospective Study on Cadavers Nikova,Alexandrina Dimitrov,Ivaylo Birbilis,Theodossios Zaharieva,Lora cadavers healthcare neurosurgery trauma traumatic brain injury Folia Medica 62(1): 105-111 Objective: Traumatic brain injury (TBI) due to transport accidents is a serious cause of death and disability. In every case, however, quick response and a proper health care are required. Materials and methods: We collected 10-year data retrospectively from the laboratory of forensic science and toxicology in Montana, Bulgaria with the intention to show the importance of neurosurgical care in the traumatology and its connection to mortality rate. Results: 124 cadavers were included with significant male predominance. The data analysis shows that the mortality rate at the hospitals without neurosurgical facilities and the mortality at the scene of the accident is the same for traffic brain injuries. Furthermore, we found that the age has no correlation with the mortality rate. Conclusion: Road injuries are the most common type of brain injury. We believe that the outcome of these TBIs depends on the availability of a neurosurgical unit. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47765 https://doi.org/10.3897/folmed.62.e47765 https://foliamedica.bg/article/47765/ https://foliamedica.bg/article/47765/download/pdf/ en

10.3897/folmed.62.e48001 2020-03-31 foliamedica

Changes in the Level of DNA Fragmentation in Sperm Cells detected by Acridine Orange Test in Men with Sub/infertility Treated with Nutritional Supplement PAPA Томов,Стоил Stoyanova,Radoslava Atanasova,Pepa Dechev,Ivan DNA fragmentation nutritional supplement Acridine Orange PAPA human sperm Folia Medica 62(1): 112-116 Background: When diagnosing and treating male infertility it is important to determine whether there are defects in the maturation process of sperm nuclei. Using nutritional supplements can improve the morphological and physiological condition of the spermatozoa. In recent years there has been an increase in the usage of supplements with different compositions which strives to determine the best combination and avoid side effects. Aim: To study the effect of PAPA nutritional supplement on the levels of DNA fragmentation of sperm cells tested with acridine orange test (single stranded DNA against double stranded DNA) in men with sub/infertility. Materials and methods: 48 men with confirmed sub/infertility underwent treatment for three months with nutritional supplement PAPA containing 9 micronutrients. The differences in levels of DNA fragmentation were determined with acridine orange test, which was conducted before and after the treatment. Results: The results were statistically significant (p<0.001) showing an increase in the number of green spermatozoa (normal DNA), and a decrease of damaged ones (orange and red). After treatment the level of sperm DNA fragmentation decreased by 10.2%. Conclusion: Men with confirmed sub/infertility that took nutritional supplement PAPA for three moths showed a decrease in DNA fragmentation levels of 10.2% determined by AO test which implies an improvement of male fertility levels. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e48001 https://doi.org/10.3897/folmed.62.e48001 https://foliamedica.bg/article/48001/ https://foliamedica.bg/article/48001/download/pdf/ en

10.3897/folmed.62.e47789 2020-03-31 foliamedica

Non-Opioid Substances Acute Poisonings with Suicidal Intent in Patients with Opioid Use Disorder Natasha,Natasha Velikj Stefanovska,Vesna Babulovska,Aleksandra acute poisoning opioid use disorder suicide attempt Folia Medica 62(1): 117-123 Introduction: Several epidemiological studies have evaluated the role of illicit drug use in suicide behaviour. Aim: To assess patients with opioid use disorder and suicidal intent related to behavior, severity of acute poisoning and the most commonly used non-opioid substances. Materials and methods: This cross sectional study included 67 patients diagnosed with opioid use disorder. The study was conducted at the University Clinic of Toxicology in Skopje over a 5-year period (2013-2017). The following variables were examined: gender, age, duration and route of opioid administration, duration of hospitalization, and types of substances used in acute poisoning. Assessment of patients’ behavior and severity of poisoning was made by using the Suicide Behaviours Questionnaire-Revised and the Poison severity score. Results: The majority of patients were male (88.1%). The mean age of patients was 30±6.1 years. The average duration of opioid use disorder was 8.5±3.9. A single poisoning was found in 62.7%, double poisoning in 25.4%, and triple poisoning in 11.9% of participants. Benzodiazepines were most commonly used by the patients (55.2%). The largest number of patients (32.8%) had minor Poison severity score (PSS), and only 17.9% had severe PSS. None of the patients had a fatal suicide attempt. 86.6% of patients had a score of ≥7 indicating a high risk of repeat suicide attempts. Conclusion: Benzodiazepines were most commonly used as a single or combined substance in patients with opioid use disorder. PSS indicated that most of the participants were with minor PSS and with high risk of a repeat suicide attempt. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47789 https://doi.org/10.3897/folmed.62.e47789 https://foliamedica.bg/article/47789/ https://foliamedica.bg/article/47789/download/pdf/ en

10.3897/folmed.62.e49805 2020-03-31 foliamedica

Clinical Comparison of Adding Sulfate Magnesium and Dexmedetomidine in Axillary Plexus Block for Prolonging the Duration of Sensory and Motor Block: Study Protocol for a Double-blind Randomized Clinical Trial Shahtaheri,Yousef Tavakoli rad,Mohammad Yazdi,Bijan Azami,Mehran Kamali,Alireza axillary block dexmedetomidine magnesium sulfate motor block sensory block Folia Medica 62(1): 124-132 Background: The purpose of this study was to compare the effect of magnesium sulfate adjunct to dexmedetomidine on increasing the duration of sensory and motor block in axillary block. Materials and methods: This study is a double-blind clinical trial. Ninety-nine patients were included in the study. They were undergoing forearm and hand surgery and were referred to Vali-e-Asr Hospital in Arak. The patients were divided into three groups. The first group received lidocaine (1.5%) and dexmedetomidine (0.5 μg/kg). The second group patients were given lidocaine (1.5%) plus magnesium. In the control group, lidocaine  (1.5%) was adjusted to 35 cc with normal saline. The final volume was 35 cc in the three groups. Sensory and motor block and pain were measured and data were analyzed using SPSS v. 20. The final volume was 35 cc in the three groups. Results: The sensory and motor block onset time and the stabilization time of the sensory and motor block in the magnesium sulfate group were lower (p<0/001). Pain in recovery, 2, 4, 6, 12, and 24 hours after surgery was lower in the magnesium sulfate group when compared with the dexmedetomidine group (p<0.001). The lowest dose of opioid was used in the dexmedetomidine group 24 hours after surgery (p<0.001). Conclusion: The results showed that dexmedetomidine decreases pain. Magnesium sulfate increased the sensory and motor block onset time, and the sensory and motor block stabilization time, but dexmedetomidine increases the motor block duration. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e49805 https://doi.org/10.3897/folmed.62.e49805 https://foliamedica.bg/article/49805/ https://foliamedica.bg/article/49805/download/pdf/ en

10.3897/folmed.62.e47804 2020-03-31 foliamedica

Evaluation of the Possible Risk Factors on Bronchial Closure Techniques for Bronchopleural Fistula after Lung Resection Yanık,Fazlı Karamustafaoğlu,Yekta Altemur Yoruk,Yener bronchus fistula thorax surgery Folia Medica 62(1): 133-140 Background: Broncho-pleural fistula (BPF) can occur after pulmonary resections as a complication with high morbidity and mortality rates.  Aim: In the present study, we analyzed the relation between the possible risk factors and the two major bronchial closure techniques for BPF after lung resections, and the management methods of BPF.  Materials and methods: A total of 26 cases detected and managed with BPF diagnosis in our clinic between September 2005 and September 2017 were evaluated retrospectively. The cases were divided into two groups: Group 1 (n=14); bronchial closure performed manually and Group 2 (n=12) bronchial closure with stapler. We analyzed cases for age, gender, body mass index, pulmonary function tests, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, presence of bronchial stump coverage, and the mean survivals. Results: Twenty-three of the cases were males (88.5%) with a mean age of 60.03±8.7 years (range 38-73). While BPF was detected in twenty-three (88.5%) of the cases after pneumonectomy, three (11.5%) of them were after lobectomy. There was no statistically significant correlation between the two groups in gender, age, BMI, preoperative FEV1, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, and presence of bronchial stump coverage (chi-square test, p>0.05). As a result of the applied Kaplan-Meier analysis, we found no statistically significant difference in the mean survival rates between the two groups (p>0.05). Conclusions: Broncho-pleural fistulas still remains a major challenge. Although there is no statistical relationship between bronchial closure techniques and possible risk factors in our study, patients should be assessed in terms of possible risk factors. The management strategy for BPF varies according to individual patients’ clinical condition, the size of the fistula, and development time. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47804 https://doi.org/10.3897/folmed.62.e47804 https://foliamedica.bg/article/47804/ https://foliamedica.bg/article/47804/download/pdf/ en

10.3897/folmed.62.e48268 2020-03-31 foliamedica

Respiratory Symptoms of Exposure to Substances in the Workplace among Bulgarian Dental Students: a Self-report Questionnaire Survey Stoeva,Iliyana Dencheva,Maria Mircheva,Kristina Chonin,Atanas respiratory symptoms dental students dental materials latex gloves Folia Medica 62(1): 141-146 Background: Dental students are at high risk of developing adverse respiratory reactions as a result of their practical work during their dentistry degree program when they come into contact with multiple airborne irritants and allergens.  Aim: To estimate the prevalence of respiratory symptoms of exposure to substances in the workplace and associated risk factors in Bulgarian dental students. Materials and methods: A cross-sectional study of dental students at the Plovdiv Medical University and Sofia Medical University was performed by using a self-report questionnaire. A total of 467 dental students completed the questionnaire (response rate 51.8%). Results: The prevalence of self-reported respiratory symptoms related to the pre-clinical and clinical training courses of the dentistry program was 12.4%. According to logistic regression analysis, the most important risk factors for work-related respiratory symptoms were a personal history of allergic rhinoconjunctivitis (odds ratio (OR) 6.34, 95% confidence interval (CI): 3.14-12.78), atopic dermatitis (OR 2.81, 95%CI: 1.26-6.26), and exposure to chemicals from dental environment for more than 6 hours a day (OR 3.60, 95%CI: 1.21-10.70). Conclusion: The results of this study suggest that work-related respiratory symptoms are frequent among dental students and indicate the need for efforts to establish effective primary preventive programs for occupational respiratory disorders at national level. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e48268 https://doi.org/10.3897/folmed.62.e48268 https://foliamedica.bg/article/48268/ https://foliamedica.bg/article/48268/download/pdf/ en

10.3897/folmed.62.e49799 2020-03-31 foliamedica

Application of Soft Relining Materials in Dental Medicine - Clinical Results Hristov,Ilian Kalachev,Yavor Grozev,Lyubomir soft relining materials questionnaire stability Folia Medica 62(1): 147-158 Aim: The objective of this study was to carry out an in vivo investigation of patients wearing dentures relined with soft materials, assuming their positive and negative alterations in time. Materials and methods: A direct survey method was used to gather data from 23 patients included in this study (11 male and 12 female patients). Twenty-seven dentures were made (12 partial and 15 total dentures) 9 of which in chairside procedures, 11 - in a laboratory, and 7 were made using the direct-indirect method. Patients were included in regular follow-ups at one month and six months, and at one, two, and three years after dentures delivery. The study started in 2014 and continued till 2017. The materials we used in the study were quite appropriate to this type of investigation, following the proper clinical and laboratory protocols. The two most commonly used groups of relining materials on the dental market nowadays were tested. Results and discussion: All participants completed questionnaires which included questions related to changes in retention and stability of the relined dentures, changes in color and softness, in bond strength, and inflammation. The majority of patients were satisfied with the new dentures, but they also reported some problems concerning the staining and hardness of some of the investigated materials. Conclusion: There were no significant differences in the behavior of the different groups of materials at six months. After six months we observed decline in the bond strength of the vinyl-polysiloxane (VPS) materials, as well as increased staining and hardness in the poly-methyl-methacrylate (PMMA). info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e49799 https://doi.org/10.3897/folmed.62.e49799 https://foliamedica.bg/article/49799/ https://foliamedica.bg/article/49799/download/pdf/ en

10.3897/folmed.62.e47894 2020-03-31 foliamedica

Caries Prevalence in 12-year-old Children from Plovdiv - a Multifactorial Regression Analysis Onov,Michael Beltcheva,Ani caries prevalence children etiological factors Folia Medica 62(1): 159-164 Introduction: Dental caries is among the most important social diseases. The changes in caries prevalence occurring in different regions provide important information about the influence of etiological factors – primary and secondary, and about understanding the connections between the factors themselves. Aim: The aim of this study was to investigate the prevalence of dental caries in 12-year-old children from Plovdiv, Bulgaria and the effect of etiological factors – single-factor and multifactorial influence. Materials and methods: The study included 228 children divided into 2 groups: group 1 - children living in the city of Plovdiv, city proper (125 children), and group 2 - children living in the surrounding villages (103 children). A questionnaire with an attached written consent form for clinical examination was completed by the parents of each child with results recorded in the WHO Oral Health Assessment Form for Children. Statistical analysis of the recorded data was used to determine DMFT index for the two groups, percentage of caries-free children and the influence of etiological factors through regression analysis. Results: Statistical analysis showed the DMFT scores as follows - 1.568 for city proper, 2.917 for surrounding villages. The caries-free children were 38.4% and 17.5% for group 1 and group 2, respectively. OHI is the highest predicting factor in a multifactorial regression analysis with over 19% predictive function. Conclusion: There was statistically significant difference in caries prevalence and percentage of caries-free children between the city proper and the surrounding villages. Etiological factors have specific influence in the investigated age group. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47894 https://doi.org/10.3897/folmed.62.e47894 https://foliamedica.bg/article/47894/ https://foliamedica.bg/article/47894/download/pdf/ en

10.3897/folmed.62.e47794 2020-06-30 foliamedica

Vitamin D and Autoimmune Thyroid Diseases - a Review Miteva,Mariya Nonchev,Boyan I. Orbetzova,Maria M. Stoencheva,Snejana thyroid autoimmunity vitamin D vitamin D supplementation Folia Medica 62(2): 223-229 The essential biological action of vitamin D is regulation of calcium and phosphorus metabolism and preserving bone health. In recent years there have been reports about the extraskeletal actions of vitamin D and its role in the regulation of immune system. Vitamin D supplementation appears to reduce the incidence of cardiovascular diseases, cancer, and infections and be able to reduce all-cause mortality. Deficiency of vitamin D has been found to correlate with the increased incidence of autoimmune diseases, including type 1 diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis. Autoimmune thyroid diseases (AITD), including Graves’ disease, Hashimoto’s thyroiditis are relatively common autoimmune disorders affecting more than 5% of general population. It has been shown that vitamin D receptors (VDR) and 1-alpha hydroxylase are expressed in papillary thyroid cancer and normal thyroid tissue, suggesting local synthesis of 1,25(OH)2D in the thyroid. While VDR gene polymorphism has been found in much research to be associated with AITDs, very few studies have examined the impact of vitamin D deficiency on the incidence of AITDs in humans with conflicting results. This review focuses on the association between vitamin D and autoimmune thyroid diseases and summarizes the results of vitamin D supplementation studies in patients with AITD. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e47794 https://doi.org/10.3897/folmed.62.e47794 https://foliamedica.bg/article/47794/ https://foliamedica.bg/article/47794/download/pdf/ en

10.3897/folmed.62.e47831 2020-06-30 foliamedica

Genetic Polymorphisms Implicated in Major Pregnancy Complications: a Review DRYLLIS,GEORGIOS Liakou,Panagiota Politou,Marianna genetic polymorphisms gestational diabetes intrauterine growth retardation obstetric complications placental abruption preeclampsia premature labor Folia Medica 62(2): 230-237 Pregnancy short- or long-term complications may involve the mother’s health, the fetus’s health, or both. A systematic literature review was performed, including studies up to October 2018 from Medline (PubMed), Science Direct, Web of Science and Google Scholar. The following inclusion criteria were applied: studies published until 2018 concerning the genetic background of pregnancy complications such as high blood pressure, gestational diabetes, preeclampsia, pregnancy loss, endometrial death, placental abruption, premature labor, and intrauterine growth retardation which may render pregnancy a high risk condition.We identified 164 articles that met the inclusion criteria and reviewed and analyzed them. The results so far are contradictory and the pathogenicity of these pregnancy complications remains unclear. For most of the polymorphisms studied so far, data refer to small studies size but research is on-going.The identification of genetic polymorphisms with strong correlations with certain pregnancy complications could provide us with useful tools which could be incorporated in diagnostic algorithms that could facilitate early detection and treatment of major pregnancy complications. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e47831 https://doi.org/10.3897/folmed.62.e47831 https://foliamedica.bg/article/47831/ https://foliamedica.bg/article/47831/download/pdf/ en

10.3897/folmed.62.e39599 2020-06-30 foliamedica

The Role of the Immune Response in Chronic Marginal and Apical Periodontitis Karteva,Teodora Manchorova-Veleva,Neshka asymptomatic apical periodontitis chronic marginal periodontitis pathogenesis host susceptibility Folia Medica 62(2): 238-243 The immune response is a complex, dynamic and strongly individual biologic network that plays an essential role in the pathogenesis of chronic apical and marginal periodontitis. Recent research in the field of periodontology has indicated that the major determinant of susceptibility to disease is the nature of the immunoinflammatory response as marginal periodontal tissue damage is thought to be primarily mediated by the host reaction. Whether the same rules apply for the development of apical periodontitis, however, remains largely unexplored. This review aims to draw parallels between the pathogenesis of chronic periodontitis of endodontic and marginal origin, outline the evidence for the destructive role of immune response in chronic marginal periodontitis and raise questions about its role in chronic apical periodontitis. It would be worthy to further explore the impact of the immune system on the characteristics and progress of these diseases and transfer some of the scientific models from the field of periodontology to the field of endodontics. Research in this area could lead to a more comprehensive understanding of the dynamics of apical and marginal periodontitis and lay the foundation of new personalized treatment strategies.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e39599 https://doi.org/10.3897/folmed.62.e39599 https://foliamedica.bg/article/39599/ https://foliamedica.bg/article/39599/download/pdf/ en

10.3897/folmed.62.e49842 2020-06-30 foliamedica

The Role of miRNAs and lncRNAs in Laryngeal Squamous Cell Carcinoma - a Mini-Review Kyurkchiyan,Silva Popov,Todor Mitev,Vanyo Kaneva,Radka biomarkers lncRNAs laryngeal cancer LSCC miRNAs Folia Medica 62(2): 244-252 Laryngeal squamous cell carcinoma is a common malignancy in men. Bulgaria is one of the countries in Europe with the highest incidence and mortality rates of the aggressive, severe disease of laryngeal cancer. Proven etiological factors are the abuse of tobacco and alcohol beverages. Despite the progress of technologies of multimodal medical treatment, survival rates have not reached satisfactory levels. Over the last few decades, scientific and clinical research data have led to a growing interest in exploring potential biomarkers. In the last years, non-coding RNAs have become promising biomarkers. They are important key regulators in both normal and tumour specific biological processes as well as in the response to environmental factors and treatment, including chemo- and radiotherapy. Studies have shown ectopic expression of a number of ncRNAs in laryngeal cancer. Published data provide evidence of the lncRNAs and miRNAs that could help us better understand complex carcinogenesis in laryngeal cancer and would provide reliable diagnostic, prognostic and predictive biomarkers. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e49842 https://doi.org/10.3897/folmed.62.e49842 https://foliamedica.bg/article/49842/ https://foliamedica.bg/article/49842/download/pdf/ en

10.3897/folmed.62.e47722 2020-06-30 foliamedica

Presence of IL-8 Gene Polymorphism and IL-8 Serum Levels in Patients with Chronic Periodontitis - Literature Review Mlachkova,Antoaneta Popova,Hristina Doseva,Velichka chronic periodontitis cytokines interleukin-8 gene polymorphism Folia Medica 62(2): 253-257 Multifactorial nature of chronic periodontitis is well known. The data indicate that the bacteria of subgingival biofilm (with their presence at high levels, too), as well as the immune response of the organism, genetic components and environmental factors play a significant role in the development of periodontal destructive disease. On the one hand the strong relationship between microorganisms from the “red complex” has been proved. On the other hand the initiation and progression of chronic periodontitis has been verified, as well. The presence of bacterial metabolic products and other substances (lipopolysaccharides, enzymes and toxins) results in increased expression of proinflammatory cytokines and release of active agents leading to the development of a local tissue lesion. Thus, the negative (destructive) side of the immune response is expressed and associated with the immunopathological nature of periodontitis. Literary data testify the importance of interleukin-8 (IL-8) in regulating the inflammatory response to bacterial infection and suggest its association with susceptibility to periodontitis. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e47722 https://doi.org/10.3897/folmed.62.e47722 https://foliamedica.bg/article/47722/ https://foliamedica.bg/article/47722/download/pdf/ en

10.3897/folmed.62.e47690 2020-06-30 foliamedica

Retreatability of Bioceramic Endodontic Sealers: a Review Zhekov,Kostadin Stefanova,Vesela bioceramics retreatment review Folia Medica 62(2): 258-264 In 2009 a new type of endodontic sealers was introduced to the market. The so called “bioceramic” sealers are a promising alternative to the present golden standard of root canal fillings. Now a decade later, still very little is known about the ability to remove these sealers in cases of non-surgical endodontic retreatment (NSER). There are only a limited number of articles that provide such information. The commonly used hand files are not efficient in removing thoroughly the sealer from the main canal walls. Machine driven files are much easier and faster alternative to the hand ones, but are still not able to ensure complete removal. Although ultrasonics can be applied only in the straight portion of the main canal, they raise the efficacy of sealer removal. Photon-initiated photoacoustic streaming (PIPS) is another way to enhance the removal of bioceramics. Solvents like chloroform and orange oil are effective in softening gutta-percha, but not the bioceramics. This article reviews the available scientific data concerning removal of bioceramic materials in the context of a NSER.  info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Invited Review text/html info:doi:10.3897/folmed.62.e47690 https://doi.org/10.3897/folmed.62.e47690 https://foliamedica.bg/article/47690/ https://foliamedica.bg/article/47690/download/pdf/ en

10.3897/folmed.62.e39518 2020-06-30 foliamedica

Reduction of Liver Iron Load in Adult Patients with β-Thalassemia Major Treated with Modern Chelation Modalities Georgiev,Pencho Sapunarova,Katya Goranova-Marinova,Veselina Goranov,Stefan beta-thalassemia major hepatic iron overload ferritin MRI T2* Folia Medica 62(2): 265-270 Background: Management of beta-thalassemia major (TM) requires life-long hemotransfusions leading to iron overload. Iron elimination is enhanced by the use of modern chelators. Aim: To assess the effect of modern chelation therapy by dynamics of serum ferritin concentration and liver MRI T2*.Patients and methods: Forty-six patients with TM (male to female ratio =1:1, mean age 33.2±10.9 years) were prospectively studied between 2011 and 2014. Twenty-one patients (45.7%) were treated with deferasirox, 17 (37%) – with deferiprone, and 8 (17.3%) – with deferiprone in combination with deferoxamine. Ferritin was measured by ELISA. MRI T2* was assessed by Siemens Magnetom Avanto 1.5T. The patients were allocated into 3 groups based on their initial ferritin level and liver MRI T2*. Statistical analysis was performed using SPSS v. 18 for Windows. Data were analysed by descriptive analysis, analysis of variance and correlative analysis, means were compared using t-test and one-way ANOVA.Results: In 2011, 9 (19.5%) patients had normal liver MRI T2*; in 2014 they were 17 (37%). The patients with mild grade liver siderosis were 12 (26%) in 2011, and in 2014 they were 14 (30.4%). In 2011, the patients with moderate liver siderosis were 14 (30.4%), and in 2014 – 12 (26.0%). Eleven patients (23.9%) had severe liver siderosis in 2011 and only two patients (4.0%) were diagnosed with the condition in 2014.Conclusion: A reduction of iron overload was found in all studied groups. This positive effect is attributed to the use of modern chelators and the ease of access to accurate monitoring. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e39518 https://doi.org/10.3897/folmed.62.e39518 https://foliamedica.bg/article/39518/ https://foliamedica.bg/article/39518/download/pdf/ en

10.3897/folmed.62.e47830 2020-06-30 foliamedica

Surrogate Markers of Intestinal Inflammation in Paediatric Patients with Inflammatory Bowel Disease Shentova,Rayna Baycheva,Mila Kofinova,Denitza Hadjiiski,Petio Yaneva,Penka faecal calprotectin surrogate markers paediatric inflammatory bowel disease Folia Medica 62(2): 271-275 Background: Endoscopic evaluation is the gold standard for monitoring the disease activity in inflammatory bowel disease (IBD) but the procedure is invasive and not appropriate for frequent use, especially in the paediatric population. The aim of the present study was to assess the correlation between the levels of several inflammatory biomarkers and the degree of intestinal inflammation in paediatric patients with IBD.Materials and methods: A single center study including 31 children with ulcerative colitis (UC) and 22 children with Crohn’s disease (CD) with different disease duration and activity. All participants provided blood samples to measure the levels of white blood cell count, platelets, C-reactive protein, erythrocyte sedimentation rate, albumin and fibrinogen, and faecal samples for measurement of faecal calprotectin and faecal alpha-1 antitrypsin. All participants underwent endoscopic evaluation. Endoscopic disease activity was assessed according to the Mayo Endoscopic Subscore and Simple Endoscopic Score for Crohn‘s Disease in UC and CD patients, respectively.Results: 135 visits were included: 73 for UC patients and 62 for CD patients. In UC patients the strongest correlation was between the Mayo Endoscopic Subscore and the faecal calprotectin (r=0.867, p<0.001) followed by the albumin (r=0.523, p<0.001) and the C-reactive protein (r=0.487, p<0.001). In CD the strongest correlation was between the Simple Endoscopic Score for Crohn’s disease and the faecal calprotectin (r=0.872, p<0.001) followed by the C-reactive protein (0.708, p<0.001) and the erythrocyte sedimentation rate (0.605, p<0.001).Conclusions: The faecal calprotectin is a valuable surrogate marker of intestinal inflammation that is useful for monitoring of a disease activity in paediatric patients with IBD. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47830 https://doi.org/10.3897/folmed.62.e47830 https://foliamedica.bg/article/47830/ https://foliamedica.bg/article/47830/download/pdf/ en

10.3897/folmed.62.e48212 2020-06-30 foliamedica

Closed Reduction in Developmental Dysplasia of the Hip in Patients Older than One Year Bozinovski,Zoran Bogojevska Doksevska,Milena Tokmakova,Keti closed reduction developmental dysplasia of the hip walking age Folia Medica 62(2): 276-281 Introduction: Besides an effective screening method for developmental dysplasia of the hip, there is certain number of children in whom the condition has been overseen or they have never been screened and the parents have noticed the odd walking pattern in their toddler. Treatment of such patients is controversial. One of the recommended treatment methods because of the short-term hospitalization, but often considered unsuccessful is closed reduction of the hip followed by cast immobilization.Hypothesis: Closed hip reduction in late diagnosed developmental dysplasia of the hip gives good results. Aim: Our aim in this retrospective study was evaluation of the success of the treatment with closed reduction of hip dislocation in children older than 12 months. Patients and methods: In the study, we included 20 patients treated at our clinic from June 2004 to May 2017. Of these 20 patients, 8 had bilateral involvement, 12 had unilateral, in a total of 28 hips. In all patients we noted preoperatively the range of movement, the presence of limp, any limb inequality, and hip pain. We used clinical and radiological parameters for evaluation. Clinically, we examined the range of movement, limb inequality as well as limb function and we classified it according to the modified McKay’s criteria. Same examinations were done at 1, 3, and 5 years after closed reduction.Results: At the last follow-up examination, using McKey’s criteria for clinical evaluation we rated the hips in two patients (7%) as grade III, i.e. fair grade, 10 hips (36%) were grade II – rated good, and 16 hips (57%) were evaluated as grade I. In four hips, there were signs of avascular necrosis of the hip, while in one patient the avascular necrosis developed after the closed reduction. Radiographic assessment (Figs 3, 4) using Severin’s scoring system showed no hips with types V and VI, type IV was observed in 7%, type III in 21%, type II in 29%, while most of the hips (12, 43%) were type I.Conclusion: We concluded that the procedure was justified. An advantage of this method is that it is inexpensive; it entails no direct operative changes of the bone structures and gives good results. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e48212 https://doi.org/10.3897/folmed.62.e48212 https://foliamedica.bg/article/48212/ https://foliamedica.bg/article/48212/download/pdf/ en

10.3897/folmed.62.e39402 2020-06-30 foliamedica

Drug-neutralizing Antibodies against TNF-α blockers as Biomarkers of Therapy Effect Evaluation Kraev,Krasimir Geneva-Popova,Mariela Popova,Velichka Popova,Stanislava Maneva,Ana Batalov,Anastas Stankova,Teodora Delcheva,Ginka Stefanova,Katya biomarkers inflammatory joint disease TNF-α blockers Folia Medica 62(2): 282-289 Introduction: TNF-α blocker therapy is part of the treatment with biologics used in the management of inflammatory joint diseases. In recent years, drug-induced neutralizing antibodies have been shown to have a negative effect on the course of the disease process.Aim: To investigate drug-induced neutralizing antibodies against TNF-α blocking drugs used in patients with inflammatory joint diseases and their effect on the clinical course of the disease.Materials and methods: The study included 121 (56.8%) patients with rheumatoid arthritis, 50 (23.5%) patients with ankylosing spondylitis, 42 (19.7%) patients with psoriatic arthritis, and 31 sex and age-matched healthy controls. The patients were monitored at 0, 6, 12, and 24 months after initiation of TNF-α blocker treatment. The demographic data, vital signs and the parameters of inflammatory activity (C-reactive protein, erythrocyte sedimentation rate, and disease activity indices) were analyzed in all patients. Drug-induced anti-TNF-α blockers antibodies (adalimumab and etanercept) were analyzed using ELISA. Statistical analysis was performed with SPSS v. 24.Results: Drug-induced neutralizing antibodies against adalimumab were obtained in 11.57% of patients at 6 month, in 17.64% at 12 month, and in 24.8% at 24 month. Drug-induced neutralizing antibodies to etanercept were not demonstrated in patients followed up at 6 months, at 7.77% at 12 months, and at 9.63% at 24 months. Between the presence of neutralizing antibodies to blockers of TNF-α and indices available for disease activity, there is a strong positive correlation and Pearson Correlation = 0.701, p=0.001. Patients with poor clinical response and available antibodies against adalimumab at 12 months were 82.36% and patients treated with etanercept 71.42%. The difference between the two groups was non-significant (U = 0.527, p> 0.05). Patients with poor clinical response and available anti-adalimumab antibodies at 24 month were 75%, and in patients treated with etanercept – 87.50%, the difference between the two groups not being able to reach significance (U = 0.623, p> 0.05). Conclusion: Drug-induced neutralizing antibodies against TNF-α blockers (adalimumab and etanercept) have a negative effect on the course of inflammatory joint disease and can be used as reliable biomarker to assess the effect of the treatment with these drugs. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e39402 https://doi.org/10.3897/folmed.62.e39402 https://foliamedica.bg/article/39402/ https://foliamedica.bg/article/39402/download/pdf/ en

10.3897/folmed.62.e47727 2020-06-30 foliamedica

Risk Factors for Anastomotic Leakage after Low Anterior Resection Kostov,Gancho Dimov,Rossen D Almeida,Daniela anastomotic leakage low anterior resection total mesorectal excision Folia Medica 62(2): 290-294 Introduction: Low anterior resection (LAR) is a standard surgical procedure for distal rectal carcinoma that allows creation of a colorectal anastomosis, with anal sphincter preservation and permanent colostomy avoidance. Anastomotic leakage (AL) is a potential complication of LAR present in 3% to 20% of cases leading to a significant increase in postoperative morbidity. AL represents a communication between the intra luminal and extra luminal compartments caused by a violation of the integrity of the intestinal wall. The risk factors of this procedure have been discussed and still remain a controversial issue. Prevention is the best management. Patients with predisposing factors should be paid special attention.Aim: Our objective was to identify and analyze the risk factors of anastomotic leakage after low anterior resection of rectal carcinoma.Patients and methods: This study included all patients who underwent low anterior resection for rectal cancer at the Department of Surgery of University Hospital Kaspela between 2011 and 2016.Results: Low anterior resections were performed in 141 patients during the study period. Due to a positive air leak test on 16 patients, a protective ileostomy was created and these patients were eliminated from the study. The sex distribution of the remaining 125 patients was 69 men (55.2%) and 56 women (44.8%). The height of the anastomosis from the dentate line was 3.0 cm on an average (range 2.5 to 4 cm).Conclusion: Anastomotic leakage remains the most feared and serious complication after low anterior resection surgery. The evidence suggests that the main risk factors for anastomotic leakage at low anterior resection are the height of the anastomosis and the high ASA score. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47727 https://doi.org/10.3897/folmed.62.e47727 https://foliamedica.bg/article/47727/ https://foliamedica.bg/article/47727/download/pdf/ en

10.3897/folmed.62.e47788 2020-06-30 foliamedica

Serum Levels of Antibodies to Advanced Glycation End Products in Patients with Type 2 Diabetes Mellitus and Hypertension Nikolov,Asparuh Blazhev,Alexander Tzekova,Maria Kostov,Konstantin Popovski,Nikola anti-advanced glycation end products antibodies arterial hypertension diabetic microvascular complications Folia Medica 62(2): 295-301 Background and Aims: Proteins containing advanced glycation end products are highly immunogenic and anti-advanced glycation end products antibodies (anti-AGEs antibodies) are found in the sera of diabetics.Materials and methods: Enzyme-linked immunosorbent assay (ELISA) was used for measuring levels of anti-advanced glycation end products antibodies in sera of 93 patients with type 2 diabetes mellitus and arterial hypertension (mean age 61.4±11.3 years, diabetes duration 9.88±3.12 years; hypertension duration 9.28±4.98). These values were compared to serum anti-AGEs antibodies in 42 age and sex matched controls. Diabetics were divided in two groups according to presence or absence of microangiopathy, group 1 (n=67) and group 2 (n=26), respectively.Results: Serum levels of anti-AGEs antibodies in patients with type 2 diabetes mellitus and arterial hypertension were statistically significantly higher than those in the control group (1.39±0.39 vs. 1.05±0.32), (p<0.05). Group 1 showed significantly higher levels of anti-AGEs antibodies than those of healthy controls (1.53±0.14 vs. 1.05±0.32), (p<0.01). Anti-AGEs antibodies levels were higher in patients with microvascular complications than these in patients without complications. Anti-AGEs antibodies correlate with diastolic blood pressure (r=0.26, p=0.05) and body mass index (r=0.37, p=0.03). We found significantly higher percentage of positive patients for anti-AGEs antibodies (mean+2SD) in group 1 than in group 2.Conclusion: Determining the levels of serum anti-AGEs antibodies can help physicians make early diagnosis and prognosis of the severity of late diabetic complications in hypertensive patients. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47788 https://doi.org/10.3897/folmed.62.e47788 https://foliamedica.bg/article/47788/ https://foliamedica.bg/article/47788/download/pdf/ en

10.3897/folmed.62.e47567 2020-06-30 foliamedica

Depth of Gingival Sulcus in Healthy Children with Erupting Permanent Teeth Mitova,Nadezhda Rashkova,Maya eruption gingival sulcus probing Folia Medica 62(2): 302-307 Introduction: Measuring the gingival sulcus depth in children while their permanent teeth erupt is rather difficult especially if using reference norms for adults for a base.Aim: Assessment of the depth of the gingival sulcus during the period of tooth eruption in healthy children.Materials and methods: Thirty children were included in the study (age range 6 – 14 yrs). The children had good oral hygiene and no history of systemic disease. They were clinically examined – their dental statuses were taken, stages of permanent teeth eruption (up to 1/3 of the clinical crown, between 1/3 and 2/3, over 2/3, in occlusion contact), and their gingival sulcus depth was measured at 6 distovestibular, vestibular, mesiovestibular, mesiolingual, lingual, and distolingual sites using an electronic probe Parometer (Orange). It was concluded that the one with the highest value would be considered the maximum depth of the sulcus.Results: The gingival sulcus depth in fully erupted teeth is very similar to that in healthy adults (2.20 – 0.49 mm). The change of sulcus depth in incisors and canines has a variation of 1.5 mm, which at the end of eruption is close to those in adults. Maximum sulcus depth for molars, premolars and incisors was measured distovestibularly, and for canines – mesiovestibularly.Conclusion: At the various stages of eruption, the depth of the gingival sulcus plausibly decreases in all tooth types, and by the end of eruption it reaches a depth similar to that of the adult standard. Most indicative in regard to depth are the vestibular probing point. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47567 https://doi.org/10.3897/folmed.62.e47567 https://foliamedica.bg/article/47567/ https://foliamedica.bg/article/47567/download/pdf/ en

10.3897/folmed.62.e47647 2020-06-30 foliamedica

Evaluation of Non-polar Composition in Plumbago Zeylanica Leaves by Gas Chromatography and Mass Spectrometry Dhalani,Jayesh Dubal,Gaurang Rathod,Chirag Nariya,Pankajkumar fatty acid GC-MS plumbaginaceae plumbagin sterol Folia Medica 62(2): 308-313 Background: Plumbago zeylanica plant belongs to Plumbaginaceae. The plant is reported for many pharmacological activities.Aim: The objective of the study was to identify fatty acids and non-polar chemical compounds in Plumbago zeylanica leaves. Materials and methods: Petroleum ether extract was prepared using soxhlet apparatus. Saponifiable and unsaponifiable matter was separated with saponification process. To identify fatty acids in saponifiable matter further esterification was performed. Gas chromatography and mass spectrometry analysis was performed of both saponifiable and unsaponifiable fractions. All the fatty acid methyl esters and non-polar chemical compounds were identified using NIST library data.Results: A total of 14 compounds were identified with comparison of NIST data. From that, 8 fatty acid methyl esters and 6 non-polar chemical compounds were identified. Here we have analyzed fatty acids and non-polar chemical compounds by the same GC-MS method.Conclusions: The present analysis showed that Plumbago Zeylanica leaves contain 8 fatty acids and 6 non-polar chemical compounds. Principal determination of the research was development of efficient method to identify non-polar compound from plant by single injection using chromatographic technique. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47647 https://doi.org/10.3897/folmed.62.e47647 https://foliamedica.bg/article/47647/ https://foliamedica.bg/article/47647/download/pdf/ en

10.3897/folmed.62.e48038 2020-06-30 foliamedica

The Effect of Indocyanine Green Antimicrobial Photothermal/Photodynamic Therapy on the Expression of BCL-2 and BAX Messenger RNA Levels in Human Gingival Fibroblast Cells Pourhajibagher,Maryam Gharesi,Samira Chiniforush,Nasim Bahador,Abbas antimicrobial photothermal/photodynamic therapy apoptosis human gingival fibroblast cells gene expression indocyanine green periodontitis qRT-PCR Folia Medica 62(2): 314-323 Background: Antimicrobial photothermal/photodynamic therapy (PTT/PDT) with indocyanine green (ICG) is an adjuvant therapeutic approach in the treatment of periodontitis. To explore whether PTT/PDT with ICG causes cell death by apoptosis in human gingival fibroblast (HGF) cells, BAX and BCL-2 genes expression as key events for apoptosis were evaluated in this study.Materials and methods: HGF cells were treated with: 1) different concentrations (500–2000 µg/mL) of ICG alone, 2) Diode laser irradiation alone with a fluency of 39.06 J/cm2; 3) PTT/PDT combined different concentrations (500–2000 µg/mL) of ICG with an 808 nm diode laser with a fluency of 39.06 J/cm2, and 4) controls (untreated cells). After that, BAX and BCL-2 messenger RNA levels were evaluated by real-time quantitative reverse transcription PCR.Results: PTT/PDT with 500 µg/mL of ICG caused significant increases in the expression of the BAX gene, with an 8.5-fold increase, which was approximately 7- and 8.5-fold higher than PTT/PDT with ICG for 1500 and 2000 µg/mL of ICG, respectively, indicating induction of apoptosis in HGF cells. ICG (in different test concentrations), diode laser, and PTT/PDT with ICG (1500 and 2000 µg/mL of ICG) treatment displayed insignificant increases in expression levels of BAX (all p>0.05). Our experiments showed an insignificant increase (1.1–1.6-fold) in the expression of BCL-2 after ICG, diode laser, and PTT/PDT with ICG treatment (all p>0.05).Conclusions: This study suggests that various concentration of ICG can be the diverse expression of BAX responses to PTT/PDT on HGF cells. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e48038 https://doi.org/10.3897/folmed.62.e48038 https://foliamedica.bg/article/48038/ https://foliamedica.bg/article/48038/download/pdf/ en

10.3897/folmed.62.e39371 2020-06-30 foliamedica

Pilot Study of Pharmacists’ Attitudes towards and Expectations for Remuneration of Valueadded Pharmacy Services (VAPS) in Bulgaria Balkanski,Stefan Simeonova,Joana Gueorguiev,Stanislav R. Petkova-Gueorguieva,Elina S. Gitev,Ivan Getov,Ilko value-added pharmacy services remuneration pharmacists community pharmacy patient benefits Folia Medica 62(2): 324-330 Introduction: Value-added pharmacy services (VAPS) are additional services to the traditional pharmacy activities, which do not in­clude dispensing of medicinal products and professional consultation. These services have cost reduction effect on the healthcare system and add value to the work of the pharmacist as a healthcare professional.Aim: To assess the pharmacists’ attitudes and expectations towards the remuneration of value-added pharmacy services (VAPS) in Bulgaria.Materials and methods: A cross-sectional study including pharmacists working in community pharmacies was carried out between August 2018 and October 2018. A web-based 15-item questionnaire was developed. The questionnaire was distributed to all members of the Bulgarian Pharmaceutical Union (n=5165). Two hundred thirty-three questionnaires were filled in and returned (response rate of 4.5%). Data were processed by SPSS v. 24.0.Results: Over 51% of the community pharmacies in Bulgaria offer VAPS, mainly measuring blood pressure (67.4%) and blood glucose (12.9%). Over two-thirds of the pharmacists considered charging a remuneration fee for blood pressure measurement irrelevant. About 30.5% of those who held the opposite opinion proposed that the fee charged should not be higher than EUR 2.56. Over 44% of the re­spondents proposed that the fee for blood glucose measurement should not be higher than the same amount. Most pharmacists (98.3%) supported the idea of charging a remuneration fee for injections and influenza vaccination in a pharmacy.Conclusion: The study shows that pharmacists in Bulgaria are ready to offer VAPS, but additional remuneration for the services should be provided. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e39371 https://doi.org/10.3897/folmed.62.e39371 https://foliamedica.bg/article/39371/ https://foliamedica.bg/article/39371/download/pdf/ en

10.3897/folmed.62.e39507 2020-06-30 foliamedica

Higher Order Aberrations (HOA) Changes after Femto-LASIK in Topography and Wavefrontguided Treatments Taskov,Georgi Taskov,Todor astigmatism femto-LASIK higher order aberrations myopia topography wavefront Folia Medica 62(2): 331-337 Background: Publications have focused on comparing the effect of various methods of refractive surgery or ablation profiles on higher order aberrations (HOA), yet the effect of WG compared to TG ablation in femtosecond laser-assisted in-situ keratomileusis femto-LASIK on HOAs has not been studied adequately.Materials and methods: We reviewed the changes of HOAs before and after femto-LASIK for simple myopia or compound myopic astigmatism after topography-guided (TG) and wavefront-guided (WG) ablation profiles. In this retrospective study, 42 eyes underwent TG and 31 WG femto-LASIK.Results: The total HOAs increased from 0.41±0.16 μm pre-operatively to 0.66±0.30 μm post-operatively in the TG group and from 0.42±0.13 μm pre-operatively to 0.59±0.27 μm post-operatively in the WG group without statistically significant difference between the two groups. However, the postoperative change of secondary astigmatism showed a statistically significant difference between the two groups [0.20 (0.0-0.53) vs. 0.0 (0.0-0.20) for TG and WG groups, respectively; p=0.009].Conclusions: The total HOAs increased compared to pre-operative data, in both the TG and WG ablation profile groups. The extent of increase of secondary astigmatism was significantly lower in the WG group, which might favour the postoperative quality of vision. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e39507 https://doi.org/10.3897/folmed.62.e39507 https://foliamedica.bg/article/39507/ https://foliamedica.bg/article/39507/download/pdf/ en

10.3897/folmed.62.e46678 2020-06-30 foliamedica

Normal Reference Ranges of Optical Coherence Tomography Parameters in Children Krumova,Silviya Sivkova,Nelly Marinov,Vassil Koleva-Georgieva,Desislava Voynikova,Desislava anterior chamber depth axial length children macular thickness peripapillary retinal nerve fiber layer spherical equivalent Folia Medica 62(2): 338-344 Aim: To measure the macular thickness, macular volume and peripapillary retinal nerve fiber layer (RNFL) in healthy Caucasian chil­dren using spectral domain optical coherence tomography (SDOCT) and analyze the correlation of these values with age, refraction, and biometric measurements.Materials and methods: In this cross-sectional study, we recruited 270 healthy children (150 female and 120 male) aged 6 to 17 years with no ocular abnormalities. All children underwent a detailed eye examination. The measurements were obtained using a SDOCT device (SOCT Copernicus REVO). Main outcome measures were macular thickness, macular volume and RNFL thickness. Their correlations with age, refractive error, anterior chamber depth (ACD) and axial length (AL) was analyzed. Right eyes of all subjects were selected for analysis.Results: In this study group (mean age 10.70±2.82 years), the average peripapillary RNFL thickness was 117.11±9.15 μm, the central macular thickness was 232.10±15.81 μm, the average macular thickness was 286.70±9.82 μm, and the average macular volume was 8.01±0.28 mm³. The average values for the biometric data were: axial length – 23.16±0.94 mm, anterior chamber depth – 3.64±0.26 mm, the spherical equivalent (SE) value – +0.81±0.58 diopter. Central macular thickness, inner macular thickness (superior, inferior, nasal, temporal quadrants) values, total macular thickness and macular volume were significantly higher in males than in females. We found a positive correlation between central macular thickness, inner nasal macular thickness, outer inferior macular thickness values, and age. Also, we found a significant correlation between the average macular thickness values and the average macular volume values (p<0.0001). RNFL measurements did not correlate with age (p=0.199). Almost all macular parameters were consistently positively cor­related with SE. A significant correlation was also found between the central macular thickness, inner inferior macular thickness, inner nasal macular thickness and the ACD. We found a significant correlation between the average macular thickness, macular volume, inner superior macular thickness, outer macular thickness (superior, inferior, nasal, temporal quadrants) values and the AL.Conclusion: This study found normal reference ranges for RNFL and macular parameters measured by SOCT Copernicus REVO in healthy Caucasian children aged 6-17 years. This normative values could be very useful in early diagnosing and monitoring of optic neuropathy, glaucoma and macular diseases in childhood. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e46678 https://doi.org/10.3897/folmed.62.e46678 https://foliamedica.bg/article/46678/ https://foliamedica.bg/article/46678/download/pdf/ en

10.3897/folmed.62.e47463 2020-06-30 foliamedica

Refraction in Preschool Children in Kazanlak, Bulgaria Slaveykov,Kiril Trifonova,Kalina refraction children plus-Optix screening Folia Medica 62(2): 345-351 Introduction: The refractive state of the eye changes as the eye’s axial length increases and the cornea and lens flatten. In general, eyes are hyperopic at birth, become slightly more hyperopic until the age of 7, which at this point we see a myopic shift toward plano until the eyes reach their adult dimensions, usually by about the age 16.Aim: To determine the prevalence of refractive error in preschool children aged 3 - 6 in the city of Kazanlak, Bulgaria.Materials and methods: A cross-sectional study was conducted in a kindergarten based school within the city of Kazanlak, Bul­garia. Out of 15 kindergarten schools, 10 chose to participate in the study. The children underwent non-mydriatic refraction screening using a Plus-Optix S12с mobile camera. Myopia, hyperopia and astigmatism were defined as being a spherical equivalent (SE) ≤ −0.50 D, SE ≥ +2.00 D and cylindrical diopters ≤ −1.00 D.Results: A total of 596 children were screened. Out of these 596 children; 526 were with ametropia (470 hypermetropia, 46 myopia) and 50 had astigmatism. Strabismus was found in 12 children, with a further 8 children suffering from amblyopia and finally 8 children were also found to be diagnosed with anisometropia. In 8 cases there were no results due to opacities or due to the small size of the pupil.Conclusion: The prevalence of refractive error in preschool children is similar to that found in other research in the field. While most cases fall into the category of emmetropia or mild hypermetropia, most of the children had never been to an ophthalmologist. A manda­tory checkup should be issued for all children below the age of seven. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47463 https://doi.org/10.3897/folmed.62.e47463 https://foliamedica.bg/article/47463/ https://foliamedica.bg/article/47463/download/pdf/ en

10.3897/folmed.62.e39515 2020-06-30 foliamedica

Comparative Analysis of Root Dentin Loss when Using Modern Mechanical Cleaning Instruments in Immature Permanent Teeth Hristov,Krasimir Gateva,Natalia Stanimirov,Pavel Ishkitiev,Nikolay Doitchinova,Liliya immature permanent teeth Gentlefile Brush XP-endo finisher regenerative endodontics Folia Medica 62(2): 352-357 Introduction: The full decontamination and disinfection of the root canal system is essential for the success of regenerative endodontic procedures. The current literature does not have information regarding mechanical cleaning of immature teeth with contemporary endodontic instuments.Aim: To compare the thickness and volume of the dentin removed from the roots of immature teeth after endodontic preparation using XP-endo Finisher, GentleFile Brush and a standard H-file scraping technique through micro-computed tomography.Methods: The study included 51 immature permanent molars. Endodontic access was prepared and without performing preliminary extirpation of the pulp, the teeth were divided into three groups. The first group of teeth were instrumented for two minutes with XP-endo Finisher, the second - two minutes with Gentlefile Brush, in the third group the root canals walls were scraped with a No. 40 H-file. The thickness and the volume of the removed dentin was assessed using micro-CT imaging before and after the use of the instruments.Results: There is no statistically significant difference in the mean values of thickness of dentin removed between the teeth, prepared with XP-endo finisher and Gentlefile Brush. When comparing the mean values of volume of dentin removed between the separate groups, a statistically significant difference was discovered for every compared pair with the highest volume of removed dentin in the group prepared with a hand instrument.Conclusion: The endodontic systems tested when used in immature permanent teeth remove significantly less quantity of hard dental structures compared to a hand file for scraping the root canal. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e39515 https://doi.org/10.3897/folmed.62.e39515 https://foliamedica.bg/article/39515/ https://foliamedica.bg/article/39515/download/pdf/ en

10.3897/folmed.62.e47534 2020-06-30 foliamedica

In Vitro Comparison of Several Methods for Initial Proximal Caries Detection Todorova,Veselina Filipov,Ivan Petrova,Reneta detection initial proximal caries lesion Folia Medica 62(2): 358-364 Introduction: Initial proximal caries is both diagnostic and therapeutic challenge. The disadvantages of the conventional methods for caries detection and the development of technologies led to the creation of contemporary optical devices for early caries detection.Aim: In vitro comparison of the diagnostic accuracy of several methods for early proximal caries detection – visual-tactile, bitewing radiography and laser fluorescence device (DIAGNOdent pen).Materials and methods: Fifty-eight proximal surfaces of extracted human permanent premolars and molars were examined by two examiners using visual inspection, bitewing radiography, DIAGNOdent with proximal contact, and DIAGNOdent directly in the lesion. Results were compared with the histological gold standard. Statistical analysis with ROC curve, sensitivity, specificity and diagnostic accuracy of each detection method was performed. Analysis was conducted in 3 diagnostic thresholds – initial, developed and advanced demineralization.Results: Sensitivity of visual inspection was 16%–33%, specificity 93.3%–100%, sensitivity of bitewing radiography 54%–67%, speci­ficity 93%–94%, sensitivity of DIAGNOdent with proximal surfaces in contact 88%–91%, specificity 79%–89%, sensitivity of DIAG­NOdent directly 89%–92.5%, specificity 81.29%–93%. The highest diagnostic accuracy, increasing with the rise of the level of demin­eralization, was shown by DIAGNOdent directly, followed by DIAGNOdent with proximal contact, bitewing radiography, and visual inspection with the lowest accuracy.Conclusion: The use of contemporary diagnostic devices significantly increases the possibility for early detection of proximal lesions. DIAGNOdent can be used as an adjunct to and increasing the diagnostic accuracy of the conventional caries detection methods. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47534 https://doi.org/10.3897/folmed.62.e47534 https://foliamedica.bg/article/47534/ https://foliamedica.bg/article/47534/download/pdf/ en

10.3897/folmed.62.e46533 2020-06-30 foliamedica

Correlation between CGRP Levels and the Neuropathic and Inflammatory Component of Postoperative Pain Neychev,Deyan Sbirkova,Tanya Ivanovska,Mariya Raycheva,Ralitsa Murdjeva,Mariana Atanasov,Dimitar calcitonin gene-related peptide inflammatory pain neuropathic pain neuropeptide pain Folia Medica 62(2): 365-371 Introduction: In surgical procedures, tissue damage results in the release of a number of bioactive substances. Calcitonin gene-related peptide (CGRP) is a peptide released from sensory nerves, which determines its role in pain sensation. Its distribution in tissues deter­mines its role as a primary afferent neurotransmitter.Aim: To determine the effect of CGRP on postoperative pain and reactive inflammatory process after surgical removal of impacted mandibular third molars, as well as the factors that have influence upon the perception of pain.Materials and methods: Forty patients with bilaterally impacted mandibular third molars were included in the study. Venous blood samples were collected before and 24 hours after the surgical procedure in order to test their serum levels of CGRP and procalcitonin. Two weeks later the procedure was repeated. The difficulty of the surgical procedure, its duration and complications were assessed in all patients.Results: The influence of some of the studied factors upon postoperative pain was established. Differences in the sensation of pain between the two sexes were found when comparing pain intensity reported by the patients. Significant difference between pain inten­sity after the 1st and 2nd surgical procedures (6 hours) was found in females (Z=2.63, p=0.009;), whereas in males the difference was observed at 24 hours (Z=1.99; p=0.047).Regarding the existence of sex-related association, а significant, strong positive correlation between CGRP levels after the 1st and 2nd surgical procedures (24 hours) was found in males (rxy=0.78; p=0.004), whereas in females this correlation was also significant, although moderately significant (rxy=0.44; p=0.020). CGRP levels at the first and second extractions were generally similar in males, and not as much in females. We proved significantly moderate positive association between CGRP and pulse levels measured before the second surgery (rxy=0.37, p=0.021).Conclusion: The results of our study suggest a significant role of CGRP in reactive (neurogenic) inflammation. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e46533 https://doi.org/10.3897/folmed.62.e46533 https://foliamedica.bg/article/46533/ https://foliamedica.bg/article/46533/download/pdf/ en

10.3897/folmed.62.e46759 2020-06-30 foliamedica

Protective Effect of Flax Seed on Brain Teratogenicity Induced by Lamotrigine in Rat Fetuses kamali,mahsa Johari,Habibolah Kamali,Mahsa lamotrigine teratogenesis flax seed Folia Medica 62(2): 372-377 The objective of this study was to assess the effects of the hydroalcoholic extract of flax seed on the teratogenic activity of lamotrigine in the brain of fetuses of rats who had received the drug. In this experimental study, 40 female rats were assigned randomly into four groups and after mating and confirming the vaginal plug, the control animals (group 1) were kept with no intervention, and the other three experimental groups were intraperitoneally injected with respective lamotrigine (75 mg/kg), and 100 and 200 mg/kg of flax seed hydroalcoholic extract. The drug was administered during the organogenesis period. Rats were sacrificed at the 20th day of gestation (one day before term) and fetuses were macroscopically examined, weighed and crown-rump length measured. Fetal brain specimens were processed for H&E and for histological study, using the ImageJ software. Results showed that fetuses of the experimental groups that received lamotrigine had reduced body weight, prefrontal cortical and hippocampal thickness, and pyramidal neurons in the hip­pocampus; Nevertheless, these factors were improved by high-dose administration of flax seed in the experimental group 3 and 4. Our research concludes that lamotrigine negatively influences the development of brain in rats and flax seed has a protective impact on these complications. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e46759 https://doi.org/10.3897/folmed.62.e46759 https://foliamedica.bg/article/46759/ https://foliamedica.bg/article/46759/download/pdf/ en

10.3897/folmed.62.e47510 2020-06-30 foliamedica

Experimental Model of Subclinical Vitamin K Deficiency Gancheva,Silvia Kitanova,Martina Ghenev,Peter Zhelyazkova-Savova,Maria osteocalcin rats vascular calcification warfarin Folia Medica 62(2): 378-384 Introduction: Vitamin K (VK) is a co-factor in the post-translational gamma glutamic carboxylation of Gla-proteins. VK-dependent coagulation factors are carboxylated in the liver by VK1. Osteocalcin and Matrix-Gla protein (MGP) are carboxylated in extrahepatic tissues by VK2. A model of VK deficiency would be suitable for studying extrahepatic Gla-proteins provided that severe bleeding is prevented.Aim: The aim of this work was to adapt an established protocol of vascular calcification by warfarin-induced inactivation of MGP as a calcification inhibitor, in an attempt to create a broader state of subclinical VK deficiency and to verify its safety.Materials and methods: Two consecutive experiments, each lasting 4 weeks, were required to modify the dosing schedule of warfa­rin and VK1 and to adapt it to the Wistar rats used. The original high doses of warfarin used initially had to be halved and the protective dose of VK1 to be doubled, in order to avoid treatment-induced hemorrhagic deaths. The second experiment aimed to confirm the efficacy and safety of the modified doses.To verify the VK deficiency, blood vessels were examined histologically for calcium deposits and serum osteocalcin levels were mea­sured.Results: The original dosing schedule induced VK deficiency, manifested by arterial calcifications and dramatic changes in carboxyl­ated and uncarboxylated osteocalcin. The modified dosing regimen caused similar vascular calcification and no bleeding.Conclusion: The modified protocol of carefully balanced warfarin and VK1 doses is an effective and safe way to induce subclinical VK deficiency that can be implemented to investigate VK-dependent proteins like osteocalcin. info:eu-repo/semantics/altIdentifier/eissn/1314-2143 info:eu-repo/semantics/altIdentifier/pissn/0204-8043 info:eu-repo/semantics/openAccess CC BY 4.0 Plovdiv Medical University 2020 Research Article text/html info:doi:10.3897/folmed.62.e47510 https://doi.org/10.3897/folmed.62.e47510 https://foliamedica.bg/article/47510/ https://foliamedica.bg/article/47510/download/pdf/ en cGFnZT0xJnNldD1mb2xpYW1lZGljYSZmcm9tPSZ1bnRpbD0mbWV0YWRhdGFfcHJlZml4PW9haV9kYw==