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This paper presents new records and noteworthy data on the following taxa in SE Europe and adjacent regions: red algae Hildenbrandia rivularis, saprotrophic fungus Cryptomarasmius corbariensis, lichenised fungi Lecanora stenotropa, Micarea misella and Sticta sylvatica, liverworts Fossombronia caespitiformis and Peltolepis quadrata, mosses Dicranoweisia cirrata and Fissidens exilis, horsetail Equisetum × moorei, gymnosperm Juniperus virginiana, monocots Galanthus reginae-olgae subsp. vernalis and Spiranthes spiralis and dicots Linaria pelisseriana, Parthenocissus quinquefolia, Pilosella rhodopea and Taraxacum erythrospermum are given within SE Europe and adjacent regions.

Quadruple-negative breast cancer (QNBC) presents with negative expression of estrogen, progesterone, and androgen receptors and of human epidermal growth factor receptor 2. This BC subtype has the worst prognosis. In QNBC, there is a greater paucity of prognostic biomarkers than in androgen receptors-positive triple negative BC (TNBC). Absent androgen receptor expression confers a more aggressive QNBC course and correlates with the expression of cancer stem cell phenotype, COX-2, and basal markers such as CK5 and nestin. Basal-like phenotype is significantly associated with adverse prognostic markers including high KI-67, COX-2 expression, and cancer stem cell phenotype. Engrailed-1 expression is associated with unfavorable overall survival in QNBC patients. Non-coding ribonucleic acids play a significant role in BC tumourigenesis by virtue of their oncogenic and tumour-suppressive properties. The identification of QNBC-specific circulating microribonucleic acids may improve tumour detection and prognosis. There is an obvious necessity to intensify the problem-oriented interdisciplinary research on the hot topic of prognostic biomarkers of QNBC.

Recently, breast cancer (BC) continuously ranks first in the incidence rate of malignant neoplasms in womenworldwide. Quadruple negative BC (QNBC) is a recently identified subtype of triple negative BC (TNBC) presenting with negative androgen receptor expression. QNBC characterization and treatment is fraught with many challenges.There is cumulative evidence suggestingthat QNBC ishighly proliferative and immunogenic, rendering it anideal candidate for cytotoxic chemotherapy and immunotherapy. Several chemotherapeutic agents such as imatinib, cabozantinib, dasatinib, lucitanib,sunitinib, docetaxel, doxorubicin, and cyclophosphamidein QNBCpatients are highlighted. Some subtypes and related pathway proteins are preferentially expressed in QNBC and may act as effective therapeutic targets such as acyl-CoA synthetase4, S-phase kinase associated protein 2, immune checkpoint inhibitors, kinesin family member C1,and epidermal growth factor receptor. Several recent investigations comparing the therapeutic approach to QNBC and TNBC are briefly reviewed. Further more intensive and problem-oriented research in this topic of rising socio-medical importance is needed.

Treatment of implant related infections after surgicalor dentalproceduresare challengingcomplicationsandmay have devastating results for patients.The ability of microorganisms to adhere and form biofilm on implant surface is one of the main reasons for treatment failure in infections. When used in human body implants provide a suitable surfacefor cell attachment and bacterial colonization. One of the most common bacteriathat is isolated in hospital-acquired infections is Staphylococcus aureus, methicillin-resistant subtype. When a biofilm is formed, bacteria acquire an arsenal of properties that allow them to survive in an adverse environment, increasing their resistance to antimicrobial agents. Recently, as treatment modalities bioactive glass is used in the treatment of infections with multiresistant bacteria types. Its mechanism of action is to stimulate osteogenesis by releasing biologically active ions and at the same time it has antibacterial functionon a number of antibiotic-resistant bacteria due to increasementin osmotic pressure and environmental pH without affecting host tissues. These properties make bioactive glass extremelly suitablefor the treatment of infectionin boneswith destruction and bone loss. The aim of the present study is to review the outcomesreported in the literature on the antimicrobial effectiveness of bioactive glass S53P4 on Staphyloccocus aureus(MRSA).

This paper presents new records and noteworthy data on the following taxa in SE Europe and adjacent regions: red algae Lemanea rigida and Paralemanea torulosa, mycorrhizal fungi Amanita simulans and Terfezia pseudoleptoderma, parasitic fungus Microbotryum vinosum, saprotrophic fungus Sarcoscypha jurana, stonewort Chara tenuispina, mosses Brachytheciastrum collinum and Meesia longiseta, monocots Dactylorhiza romana and Neotinea maculata and dicots Adenophora liliifolia, Ambrosia artemisiifolia and Tanacetum corymbosum subsp. cinereum are given within SE Europe and adjacent regions.

This paper presents new records and noteworthy data on the following taxa in SE Europe and adjacent regions: stonewort Chara intermedia, liverworts Fossombronia wondraczekii and Pseudomoerckia blyttii, mosses Hamatocaulis vernicosus and Hookeria lucens, monocots Gladiolus palustris, Neotinea tridentata, and Orchis militaris and dicots Cardamine serbica, Cardamine waldsteinii, Hieracium kotschyanum and Pilosella petraea are given within SE Europe and adjacent regions.

Coronavirus disease 2019 represents a serious challenge for modern society worldwide because of the considerable and unfavourable consequences of the pandemic in terms of human health, economics and social life. In the present concise survey, some essential peculiarities of ozone as disinfecting and therapeutic means under the conditions of COVID-19 pandemic as reflected in the recent literature are described. Particularttention is paid to modern hospital disinfection means and methods. Ozone exerts antiviral activity through the inhibition of viral replication and direct inactivation of viruses by interfering with the virus replication phase and attacking capsid proteins. Ozone therapy is very inexpensive and may safely exploit the critical vulnerability in COVID-19.

Purpose: The objective of the present study is to analyze scientometrically some essential patterns of the dynamic science institutionalization on breast cancer immunohistochemistry and to outline the most significant scientists, journals, scientific institutions conference proceedings in this interdisciplinary field. Material/Methods: In December 2019, a retrospective problem-oriented, title-word based search was performed in Web of Science Core Collection (WoS), MEDLINE and BIOSIS Citation Index (BIOSIS) of Web of Knowledge as well as in Scopus for 2003-2018. The following parameters were comparatively assessed: annual dynamics of publications, author’s names, journal titles, scientific institutions, and scientific forums. Results: There were 1187 publications abstracted in WoS, 776 publications abstracted in BIOSIS, 711 publications abstracted in Scopus, and 616 publications abstracted in MEDLINE. There were journal articles in 288 journals abstracted in WoS, in 234 journals abstracted in MEDLINE, in 156 journals abstracted in Scopus, and in 140 journals abstracted in BIOSIS. The most productive authors were David G. Hicks, Rohit Bhargava and Ian O. Ellis. The ‘core’ journals were Modern Pathology, Laboratory Investigation and Cancer Research. The most influential scientific institutions were the University of Texas System (USA) and the University of Texas MD Anderson Cancer Center (USA). The annual meetings of the US and Canadian Academy of Pathology and the Annual San Antonio Breast Cancer symposia were most attractive to the investigators worldwide. Conclusion:Our comprehensive results could be of interest to breast cancer researchers and clinicians from smaller countries, institutional science managers, and journal editors.

Purpose: Wild edible mushrooms are collected and consumed for centuries worldwide and in Bulgaria as well. This questionnaire investigation aimed at assessing some common mushroom usage practices in a random sample from the population in Varna region, Bulgaria. Material/Methods: We performed a study of 200 adult individuals, 100 males and 100 females, from Varna region using anonymous questionnaire with 12 basic items about wild edible mushroom usage. Statistical data processing was performed using descriptive methods and correlation analysis. Results: There was a prevalence of male and female individuals with secondary and higher education. Most respondents preferred wild edible mushroom gathering in contrast to purchasing. The positive attitude towards wild edible mushroom usage as food is more common in males than in females. Most respondents consumed wild edible mushroom several times during any year. There were statistically significant correlations between urban main residence, on one hand, and wild edible mushroom non-nutritional usage, cooking, drying, preservation and freezing, on the other hand; between secondary educational level, on one hand, and positive attitude towards nutritional usage of wild edible mushrooms, wild edible mushroom cooking, preservation, freezing and drying and applications as therapeutic means; as well as between individual female sex belonging and wild edible mushroom applications as therapeutic means, on the other hand. Conclusion: This questionnaire investigation revealed several interesting peculiarities of the attitudes towards wild edible mushrooms among the population of Varna region and the extent of usage of common mushrooms depending on sex, educational level and main residence of respondents.

Purpose: The interest in evaluation of real knowledge of wild edible mushrooms at individual and population level increases mainly in developing countries. The purpose of our inquiry study was to assess the level of knowledge and awareness of the wild mushrooms in a random sample from the population of Varna region in Bulgaria. Material/Methods: We performed an anonymous questionnaire investigation of 200 adult individuals, 100 males and 100 females, from Varna region, including 17 potential opinions from their personal knowledge of wild edible mushroom usage. Statistical data processing was performed using descriptive methods, variation and correlation analyses. Results: Most respondents acquired their knowledge of wild edible mushrooms from their relatives. From all 200 persons investigated 78 respondents were not capable of recognizing at least one wild edible mushroom at all. More respondents trusted other people, who have very good experience with preparation of wild mushrooms, thus relying on differentiation of a mushroom poison. Their awareness was associated with their capacity to properly recognize wild mushrooms as well as their long-term practice to recognize toxic mushrooms. Just a minority of respondents shared that wild mushrooms in their vicinity could be a problem and had a slight idea of mycotherapy. Only two females had heard about training for wild mushroom recognition. There were statistically significant correlation dependences between respondent’s awareness of wild edible mushrooms, on one hand, and individual sex status, educational level and main residence, on the other hand. Conclusion: Our study identified two most recognized wild edible mushroom species in Varna region, edible boletus (Boletus edulis Bull) and parasol mushroom (Macrolepiota procera S. F. Gray). Most respondents acquired their knowledge of wild edible mushrooms from relatives. A problem-oriented training of the population on this topic should be performed to improve awareness of common mushroom features and avoid mushroom poisoning.

This paper presents new records and noteworthy data on the following taxa in SE Europe and adjacent regions: cyanobacteria Anagnostidinema amphibium, mycorrhizal fungus Tricholoma frondosae, stonewort Chara connivens, mosses Dicranum polysetum and Ulota intermedia, and dicots Eclipta prostrata, Paeonia daurica subsp. daurica, Ruta graveolens and Sorbus bosniaca.

This paper presents new records and noteworthy data on the following taxa in SE Europe and adjacent regions: saprotrophic fungi Psathyrella typhae, Stropharia halophila, mosses Bryum klingraeffii and Buxbaumia viridis, liverwort Scapania gymnostomophila, fern Matteucia struthiopteris, monocots Galanthus nivalis, Listera ovata, and Ophrys apifera, and dicots Astragalus dasyanthus and Paeonia officinalis subsp. banatica.

Coronavirus disease 2019 represents a serious challenge for modern society worldwide because of the considerable and unfavourable consequences of the pandemic in terms of human health, economics and social life. In the present survey, some essential peculiarities of ozone as an air pollutant and powerful oxidant under the conditions of the COVID-19 pandemic as reflected in the recent literature are described. The understanding of ozone chemistry during COVID-19 lockdown can improve ozone parameterization in models of chemical transport. Ozone peroxides such as ozonides, aldehydes, hydrogen peroxides, and organic peroxide serve as messengers to modulate the human immune system and improve blood rheology.

This paper presents new records and noteworthy data on the following taxa in SE Europe and adjacent regions: parasitic fungus Antherospora hortensis, saprotrophic fungi Loweomyces fractipes and Pholiota henningsii, stonewort Chara canescens, mosses Grimmia caespiticia and Rhodobryum ontariense, fern Woodsia alpina, monocots Aegilops triuncialis, Epipactis purpurata, Galanthus elwesii and Typha shuttleworthii and dicot Umbilicus luteus.

This paper presents new records and noteworthy data on the following taxa in SE Europe and adjacent regions: diatom alga Stauroneis neofossilis, parasitic fungus Anthracoidea arenariae, horsetail Equisetum hyemale, liverwort Harpanthus flotovianus, mosses Fissidens exilis and Rhizomnium punctatum, monocots Epipactis helleborine subsp. orbicularis, Himantoglossum calcaratum subsp. rumelicum and Schoenus nigricans and dicots Calluna vulgaris, Mahonia aquifolium and Willemetia stipitata subsp. albanica

Purpose: To perform a retrospective analysis of mushroom poisonings in Varna region for 25 years (1991-2015). Mushroom poisonings account for 10.7% of hospitalizations associated with acute exogenous intoxication. Poisoning with Amanita phalloides, Amanita pantherina, Amanita muscaria and various fungi that cause only gastrointestinal symptoms are of greatest importance for the clinical toxicology in the Republic of Bulgaria. Material/Methods: Objects of the study were 1872 patients who received treatment at the Clinic for Intensive Treatment of Acute Intoxications and Toxicoallergies, Naval Hospital – Varna, Military Medical Academy, Bulgaria after eating mushrooms. Results: Patients with irritative gastroenteritis – 1703 (91%) were with the highest frequency, followed by those with Amanita phalloides intoxication - 147 (7.8%). Amanita phalloides poisonings are not common and have a low relative share to all mushroom intoxications, but they are characterized by severe course and high lethality. Poisonings with Amanita pantherina and Amanita muscaria are even less common – 22 (1.2%). Patients accepted for treatment were both male (50.5%) and female (49.5%). Patients in age between 25 and 60 years were prevalent – 1171 (62.6%). A fatal outcome was registered in only 25 patients with Amanita phalloides intoxications, which represents 17% of all patients with Amanita phalloides poisoning and 1.3% of all patients with mushroom intoxications. Conclusion: Mushroom poisonings causing irritant gastroenterocolitis and those with Amanita pantherina and Amanita muscaria have a good prognosis. Amanita phalloides intoxications are characterized by the development of life-threatening organ damages and high lethality.

Purpose: The wide-spread use of organophosphorus pesticides (OPP) and their substantial toxicity determine the high frequency of poisoning with them. Despite the modern treatment methods, the acute exogenous intoxications (AEI) continue to exhibit high lethality and are the source of one of the most serious problems in the clinical toxicology. A number of not commonly accepted criteria have been suggested to estimate the gravity of the organophosphorous intoxication. Until now no system of clinical criteria exists that would forecast the outcome of this type of acute poisoning. The aim of this study is to develop an outcome forecast of AEI with OPP with the help of basic clinical criteria. Materials/Methods: The subjects of the study are 160 patients. We explore the significance of five of the most typical clinical indicators of the acute poisoning with OPP for the outcome of the intoxication and the need of artificial pulmonary ventilation, with the aid of discriminatory statistical analysis. The selected indicators form a discriminatory model with automatically built discrimination function. Results: The obtained classification coefficients allow us to construct a forecast matrix containing score estimates designed for practical applications.

Purpose: Several criteria have been suggested to estimate the intoxication severity, yet so far no system of clinical criteria has been developed to determine the duration of hospitalisation. The forecast is linked to the influence of the extended corrected QT interval and GCS (Glasgow Coma Scale) on the frequency of the developing acute pulmonary insufficiency and lethality. The average duration of hospital treatment is also crucial. First of all, it is determined by the intoxication severity and lasts from 3 to 26 days. The aim of this study is to develop an individual forecast about the duration of hospitalisation for patients suffering from acute exogenous intoxication with organophosphorus pesticides (OPP). Materials/Methods: The subjects are 160 patients. We use statistical regression analysis to study the significance of 5 of the most typical clinical indicators of organophosphorus intoxication on the duration of hospitalisation: type of conscience, presence of spasms, pulmonary oedema, shock and multi-organ insufficiency syndrome (MOIS). To forecast the treatment length, we obtain simplified mathematical expressions in the form of score estimates. Results: The significance of the clinical indicators “MOIS”, “conscience” and “spasm” has been confirmed. A forecast matrix that gives the opportunity to forecast the personal duration of hospital treatment for each patient has been built.

Purpose: The review is provoked because of lack of awareness of the medical practitioners in Bulgaria concerning of the ethnology, pathogenesis, clinical symptoms and treatment of the ciguatera fish poisoning (CFP). This can be a source of prolonged diagnostic delays, as some cases reporting in another country in Europe, for example Germany, Spain and UK. Varna is the sea town with many sailor crews returning from tropical and subtropical regions, or CFP can affect people who travel to the Pacific and Caribbean or ate exotic fish from supermarket. The information of this fish food-borne poisoning is part of student’s education in discipline “Marine medicine” in Medical University, Varna. Materials and methods: To present better information from different authors and last scientific data, we made review of published materials of 58 issues to construct definition, history, etiology, pathogenesis (toxins and mechanisms of action), clinical symptoms, treatment and prevention of the Ciguatera or ichtyosarcotoxicosis, a wide spread food-born poisoning. Results: Ciguatera poisoning is ichtyosarcotoxicosis, a wide-spread foodborne poisoning in people after consumption of flesh of different kinds of fishes in which toxins produced by poisonous microorganisms (Dinoflagellates) have accumulated. The poisoning develops by accumulating toxins higher up the food chain starting with toxin producing dinoflagellates (species: Gambierdiscus toxicus, Prorocentrum concavum, Pr. lima, Ostreoposis lenticularis, Ostr. Siamensis and others), continuing with the poisoned algae (species: Portieria, Halymenia, Turbinaria, Sargassum), and after that involving small crustacea and small fishes to greater fishes (vector fishes, genus Herbivores and Carnivores), in which the toxins have been stored in amount, great enough to cause foodborne poisoning in humans. This poisoning is widespread in tropical and subtropical regions, but because of its delayed toxic effects, lasting for months and years, there is a possibility that every medic can encounter its unusual symptoms, requiring specific treatment. The following toxins cause the poisoning: ciguatoxin, meitotoxin, ostreotoxin, domoic acid and some other unspecified toxins. They are lipid soluble, thermo stable and cannot be decomposed by culinary processing. These toxins have neurotoxic, cardiotoxic, hemolytic properties and cause diarrheic syndrome. Clinical presentation is characterized by average latent period of 12 hours after the consummation, vomiting and diarrhea next 24 hours and neurological symptoms that appear at the beginning of the poisoning with paresthesias along the body, changing feeling of hot and cold, strong myalgia. Disturbances in cardiac rhythm and conduction, strong dehydration or shock are possible in severe cases. Light cases pass over in several days, but, more often the poisoning has a chronic course – from 3-4 months to 1 year, with prevalence of neurologic symptoms: myalgia, paresthesias, skin itching with scratches, depression. The management is not specific and includes stomach lavage with activated charcoal, fluids replacement during the first 24 hours, corticosteroids, antiallergics, high doses of vitamins from group B (Vit. B1, Vit. B6, Vit. B12), mannitol IV, nootropic medicaments, antidepressants and other symptomatic medicaments. The prophylaxis is done by examining every fish with specific test for detecting ciguateratoxin.

The fascinating world of lichens draws the attention of the researchers because of the numerous properties of lichens used traditionally and, in modern times, as a raw material for medicines and in the perfumery industry, for food and spices, for fodder, as dyes, and for other various purposes all over the world. However, lichens being widespread symbiotic entities between fungi and photosynthetic partners may acquire toxic features due to either the fungi, algae, or cyano-procaryotes producing toxins. By this way, several common lichens acquire toxic features. In this survey, recent data about the ecology, phytogenetics, and biology of some lichens with respect to the associated toxin-producing cyanoprokaryotes in different habitats around the world are discussed. Special attention is paid to the common toxins, called microcystin and nodularin, produced mainly by the Nostoc species. The effective application of a series of modern research methods to approach the issue of lichen toxicity as contributed by the cyanophotobiont partner is emphasized.

Purpose: Poisoning with drugs occupies a leading position among the causes of acute intoxications. Etiological distribution of medicated poisoning in different countries, even if they are adjacent, is different. In the most studies it was reported that the highest incidence of poisoning is with benzodiazepines or other psychoactive drugs. A retrospective analysis of acute poisoning with benzodiazepines and other hypnotic drugs in the Varna region for 25 years period – from 1991 to 2015 was carried out. Material and Methods: The number of patients who received hospital treatment after poisoning with benzodiazepines is 1741, and those with other hypnotics is 293, representing respectively 26.37% and 4.44% of all drug intoxications. Results: The share of poisoning with benzodiazepines and hypnotics compared to all acute intoxications is 11.66%. They are more common in women – 1566 (77%). Men are 468 (23%), the ratio of men to women was 3.34:1. The largest number of intoxications is in the age group up to 24 years - 1123 (55.2%), and only 4.1% of patients over 60 years. Intentional suicide attempts are 1896 (93.2%). Death is registered in 8 (0.4%) patients.

Purpose: Poisoning with drugs is a serious medical and social problem worldwide. Retrospective analysis of acute poisoning with narcotic drugs had been performed in Varna region for 25 years (1991-2015). Material and Methods: The number of patients received hospital treatment after poisonings with narcotic substances was 677, which represented 3.9% of all acute exogenous intoxications. Results: Narcotic poisonings were more common in men – 546 (80.6%), than in women – 131 (19.4 %). The ratio male/ female was 4.17:1. The largest number of intoxications were in the age group up to 24 years – 1123 (66%), and only 2.65% of patients were over 45 years. Death was registered in 6 (0.9%) patients.

Purpose: Methanol (CH3OH) is a monohydric alcohol, vastly used both in housekeeping and industry. Although the acute methanol intoxications are rare, they may include life-threatening symptoms, substantial lethality and negative consequences such as neurological disorders and vision damage. Aim of the work is to conduct a retrospective study on the acute methanol intoxications within Varna region for a 10-year period (2006-2015). Material/Methods: This study covers 39 patients of the Clinic for Intensive Treatment of Acute Intoxications and Toxicoallergies at Naval Hospital – Varna, all of which had their diagnosis confirmed, including gas chromatography methods. Results: Methanol intoxication prevalence showed male/female ratio close to 2.9:1. The major part of the cases concerned economically active population, the age group of 25-60 being the most affected. In all instances an oral methanol intake has been involved. Death occurred in 14 cases (35.9%)