Search

BACKGROUND: Breast cancer (BC) represents the most common cancer in women worldwide and in Bulgaria. Its great medico-social importance determines the intensive complex research devoted to BC prevention, early diagnosis and management. AIM: The objective of the present investigation is to reveal some essential peculiarities of four main immunohistochemical markers used in the diagnosis of molecular subtypes of female BC. MATERIALS AND METHODS: During the period between December 1, 2017 and November 30, 2020, we examined a total of 128 randomly selected female BC patients operated on in Marko Markov Specialized Hospital for Active Treatment of Oncological Diseases of Varna, Bulgaria. We analyze BC molecular types and four immunohistochemical markers in BC patients. The expression of estrogen (ER) and progesterone (PR) receptors is assessed in mammary gland biopsies and surgical specimens by using the indirect immunoperoxidase method with EnVision™ FLEX MiniKit, that of HER2 with HercepTest™ and that of Ki-67 proliferation index with Leica Aperio Scan Scope AT2 device. The positivity and negativity of these receptors in single molecular subtypes is evaluated. RESULTS: The luminal B HER2-positive and the luminal B HER2-negative subtypes are most common - in 36.72% and 35.16% of the cases, respectively. TNBC subtype is established in 11.72%) the luminal A - in 8.59% and the non-luminal HER2-positive subtype - in 7.81% of the cases. The positive expression is statistically significantly more common in ER (t=8.972; p

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 Matteuccia struthiopteris, monocots Galanthus nivalis, Listera ovata, and Ophrys apifera, and dicots Astragalus dasyanthus and Paeonia officinalis subsp. banatica.

The current ethnobotanical study summarizes the use of medicinal plants by locals in the region of the Northern Black Sea Coast, Bulgaria. The survey was conducted in the period between 2014 and 2020. After prior informed consent, 709 local residents from 32 settlements were interviewed. The interviews with the local population were conducted using the “face to face” technique with the help of pre-prepared original questionnaires. The study presents quantitative ethnobotanical information on the use of medicinal plants in the study area. The results were analyzed using quantitative indices: Respondent Consensus Ratio (FIC), Loyalty Level Index (FL) and Significance Value Index (IVs). A total of 332 species of medicinal plants belonging to 250 genera of 90 families have been identified for the region of the Northern Black Sea Coast. The largest number of citations are registered for the use of medicinal plants for culinary purposes and for use in human medicine. The use of medicinal plants in other household applications has been studied.

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.

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.

Cyanoprokaryotes are distributed worldwide and they produce various bioactive compounds, including cyanotoxins. The major route of human exposure to cyanotoxins is the oral intake by using contaminated drinking water, by incidental intake of contaminated water during recreational and professional activities, and by consuming contaminated food or dietary supplements prepared from cyanobacteria. The prolonged chronic exposure to low concentrations of cyanotoxins provokes cell damage and may increase the risk for cancer development. Due to the variety of cyanotoxin chemical structures, different mechanisms of their toxic effects are known. At the same time, some of the natural compounds produced by cyanoprokaryotes have anticancer potential and are promising sources for the development of novel drugs. This chapter is dedicated to the target mechanisms behind the effects of the widely distributed cyanotoxins with an impact on human health, microcystins, nodularins, and cylindrospermopsin.

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. Prikazani su novi i značajni podaci sa područja JI Evrope i susednih regiona o parazitskoj gljivi Antherospora hortensis, saprofitskim gljivama Loweomyces fractipes i Pholiota henningsii, hari Chara canescens, mahovinama Grimmia caespiticia i Rhodobryum ontariense, paprati Woodsia alpina, monokotilama Aegilops triuncialis, Epipactis purpurata, Galanthus elwesii i Typha shuttleworthii i dikotili 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: 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.

There are single dermatoglyphic investigations devoted to hypothenar traits in twins In the present concise review some aspects of this specific research topic are described Attention is paid to the geographical distribution of qualitative palmar dermatoglyphic traits in several countries in Europe and Asia Hypothenar traits in monozygotic and dizygotic twins under normal conditions as well as in a variety of common diseases are described The importance of qualitative palmar dermatoglyphic investigations in patients with malignant diseases is outlined

The application of PRP products has gained vast popularity in a number of clinical fields of medicine—dermatology, orthopedics, sports traumatology, aesthetic and plastic reconstructive surgery, neurosurgery, maxillofacial surgery, cardiac surgery and others. As their use in practice increases, many existing techniques for preparation become obvious. A basic difference in the methods of extraction of autologous platelet concentrates is the use of standard laboratory centrifuges and consumables or the extraction through variety of commercial systems with specific kits. There are a lot of factors that affect the quality of PRP products—type of anticoagulant, number of centrifugations (spins), time of rotation and centrifugal force and the activator that is used. Differences in these factors lead to products with variations in platelet counts and the presence or absence of leukocytes. This in turn is essential for the levels of growth factors, which are a key element in the recovery process. The main growth factors released by platelet α-granules after activation are: platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), insulin-like growth factor (IGF), and epidermal growth factor (EGF). An important characteristic of PRP is that it represents an autologous product, which is prepared from the patient’s own blood. Therefore, the use of autologous PRP eliminates any concerns about the risk of cross-contamination, disease transmission or immune reactions. By using different methods, it is possible to get various PRP types in regard to the content of bioactive molecules. Beside platelets as a dominant PRP element, other bioactive factors may also be involved in the immune response modulation process.

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%)

Acute intoxications with organophosphorus pesticides (OPs) are a challenge for the clinical toxicology, because they are common, severe and with high lethality. Most OPs are lipophilic. In recent years, intravenous lipid emulsion (ILE) has been successfully used to treat acute poisoning with lipophilic xenobiotics. A clinical case of a 64-year-old male hospitalized after oral intake of 50 ml of fenitrothion is reported. He had been hospitalized with tachypnea and depressed consciousness - 8 by Glasgow coma scale (GCS). Standardized for this type of intoxication treatment was initiated. On the 3rd hour treatment with Intralipid 20% was started, with a bolus dose of 1.5 ml/kg followed by infusion at a rate of 0.25 ml/kg/min to a total dose of 1000 ml. At the 16th hour consciousness was restored to GCS-15. In severe FTO intoxications ILE can be used as an additional method of controlling cardiotoxic and neurotoxic effects.

The use of intravenous lipid emulsions (ILEs) is a relatively new method of treatment in toxicology. Initially, it was applied to control the resistant to other therapeutic methods systemic toxicity of local anesthetics. In the last decade this therapeutic method has been approved and recommended. Thereafter, attempts have been made to clarify the effect of ILEs in cases of acute intoxications with lipophilic xenobiotics, other than the local anesthetics.

Fungal intoxications are important in the ethology of acute exogenous intoxications and A. phalloides mushrooms intoxications are the most important for clinical toxicology. Poisonings with A. phalloides mushrooms are infrequent, but they have high lethality due to their high toxicity. A retrospective analysis of poisonings with A. phalloides mushrooms in Varna region for a period of 25 years (1991-2015) was conducted and 147 patients have been registered. The frequency relative to all hospitalised patients with acute poisoning is 0.8%. Such intoxications are more common in males and the ratio of men to women is 1.62:1. The largest number of intoxications was registered in the age group of 45 to 60 years - 62 (42.2%). All intoxications occured following oral ingestion of A. phalloides mushrooms by mistake instead of edible mushrooms such as field mushroom - Agaricus campestris L. A lethal outcome was registered in 25 patients (17%). A. phalloides mushrooms account for 11.4% of the lethality in acute poisonings.

Food preparations containing substances with antioxidant activity have considerably aroused the interest of consumers, which has led to the marketing of a number of dietary supplements such as resveratrol, hesperidin or chlorogenic acid. On the other hand, natural antioxidants present in citrus fruit juices, together with dietary supplements, could contribute to an enhancement of their antioxidant properties and, in turn, alter their physiological impacts. The aim of the study was to evaluate the effect of supplementation of freshly squeezed citrus juices with resveratrol, hesperidin and chlorogenic acid on the in vitro antioxidant potential of the juices. The solutions of juices, selected polyphenols and the mixtures of solutions of juices and solution of polyphenols were analyzed to determine total polyphenol concentration using the Fast Blue method and total antioxidant potential by the ABTS method. As a result three different types of interactions were established: synergistic of chlorogenic acid which additionally increased the antioxidant potential by 35 - 38% over theoretical predictions, additive - after addition of resveratrol, and antagonistic - in the case of hesperidin. While the antioxidant potential was substantially higher in the mixture of mandarin juice with chlorogenic acid, the measured total polyphenol concentration decreased. Also a considerable decrease in the concentration of polyphenols was measured in the mixtures of mandarin and orange juices with resveratrol, all these possibly due to the sensitivity to other substances present in juices of the analytical method applied. A correlation between antioxidant potential of all examined solutions and total polyphenol concentration was found (r 2 = 0.8879).

The contribution of the conflict of 1999 to the environmental levels of uranium in the Balkan area was evaluated by means of lichens used as biomonitors. The average U concentration found in lichens in the present study was in line with the values reported for lichens from other countries and well below the levels found in lichens collected in areas with natural or anthropogenic sources of U. Measurement of isotopic ratios 235U/238U allowed to exclude the presence of depleted uranium. According to these results, we could not detect widespread environmental contamination by depleted uranium in the Balkan area.

This retrospective study was conducted to follow out acute intoxications with methanol in Varna region (Bulgaria) for a 25-year period (1991-2015). At that time, 98 patients with methanol poisoning were regis- tered in the Clinic of Toxicology of Military Medical Academy in Varna, Bulgaria. The average age of the patients was 44.5 years. The diagnosis was made based on symptoms and was confirmed by gas chromato- graphic analysis of methanol concentration. The majority of poisonings were accidental - 88.9 %, and only a small part was with suicidal intentions (9.2%). Lethal outcome was registered in 38 patients. Eight of the survived patients (13.3%) were with residual visual impairment and six of them had permanent neurologi- cal complications.

Ethylene glycol (EG) is a bivalent alcohol. It is composed of many commercial and industrial products such as anti-freeze, coolants, deicing fluids, brake solutions, detergents and lacquers and is used as an organic solvent of many substances. Accidental and intentional poisonings with EG are rare, but potentially lethal and are a challenge to the clinical toxicology. Retrospectively, we followed the acute intoxications with EG for a 25-year period (1991-2015) in the Varna region, Republic of Bulgaria. The subject of the study were 95 patients with acute EG poisoning, at an average age of 46.8 years (21-77), who had received treatment at the Clinic of Toxicology and the diagnosis was confirmed by gas chromatographic method. EG intoxications are specific to the male gender, at male:female ratio of 6.9:1. All poisonings resulted from oral intake, mainly of anti-freeze, 92.6% of them being accidental and only 7.4% - deliberate. A lethal outcome was registered in 8 (8.4%) patients. Extreme renal insufficiency occurred in 9 (10.3%) of the surviving patients.

The interest in phytotherapy in Bulgaria has a longstanding tradition. This ethnobotanical study aims to investigate the attitude of the local population of the North Black Sea coast area towards the use of plant-based products compared to conventional medications and to report the impact of various demographic indicators on it. The survey was conducted in the period April - June 2015 in various urban and rural areas, using face-to-face interviews technique with random demographic selection of respondents, men and women of different social status and age. The Pearson correlation coefficient (r) was used for assessment of the impact of demo­graphics on respondents` answers. Maximum positive attitude has been declared by the highest percentage of respondents - 33.51 percent. Neg­ative responses score a minimum of 0.54 percent. Demographics analysis presents moderate impact of age only. The percentage of respondents with a score of 10 is significantly higher for those aged over 41, com­pared to the ones under the age of 40. Results vary in terms of ‘0` evaluation. Highest values were observed in the age groups of 41-50 and over 70. The majority of interviewees - 75.68 percent, prefer combination therapy; 29.19 percent rely only on herbal remedies, and 12.97% indicate both answers. The population of the North Black Sea coast area demonstrates a positive attitude towards the use of medic­inal plants and herbal remedy treatment. A clear case position has been defined: 100 percent use of medici­nal plants for prophylactic purposes, treatment - use of herbal remedies in combination with medications.

Настоящето изследване е част от по-широко етноботанично проучване проведено в района на Северното Черноморие през периода април - юни 2015 година, чрез техниката интервю лице в лице. Анкетирани бяха 185 души избрани на случаен принцип. Целта на настоящото проучване бе да разберем кои билки са най-популярните и да съберем данни за местните имена, използваема част и етноботанична употреба, като определим кои са „Билките на Баба` - най-популярните билки, за които информацията се предава основно словесно. От споменатите в анкетата 103 растителни вида принадлежащи към 54 семейства, 83 вида са български и 20 вида са чужди растения, като за 79 вида български растения са попълнени данните посочени в анкетата. На база посочените данни е установено наличие на стабилно познание за билките и тяхната етноботанична употреба сред местното население на Северното Черноморие. Най-популярни се оказаха 26 български растения и те съответно бяха определени като „Билките на Баба`.

Резюме Настоящото проучване представя резултатите от ретроспективно и проспективно проследяване на морфологичните особености на яйцеклетките в зависимост от възрастта и хормоналния статус при пациентки с намален яйчников резерв. Материали и методи: Изследването включва 3038 яйцеклетки, произхождащи от 419 пациентки, участвали в програма за лечение на безплодието чрез оплождане ин витро от м. февруари, 2011г. до м. февруари, 2014г., 72 от които с намален овариален резерв и 347 – с нормален. Резултати: Пациентките с намален и нормален овариален резерв показаха статистически значима разлика по отношение на морфологията на яйцеклетките. При пациентките с незадоволителен овариален отговор се наблюдава умерена статистически значима отрицателна линейна зависимост между възрастта и морфологията на яйцеклетките. Резултатите ни показват тенденция към намаляване на процента яйцеклетки с нормална морфология и увеличаване на процентите яйцеклетки с дефекти с понижаване на стойностите на антимюлеровия хормон (АМН) и повишаване на базалните стойности на фоликулостимулиращия хормон (FSH). Заключение: Морфологичните характеристики на яйцеклетките при пациентките с намален яйчников резерв се влошават видимо при възраст над 35 години и стойности на AMH £ 0,2 ng/ml и FSH > 15 mIU/ml.