Варненски медицински форум (Varna Medical Forum)

5-9

Authors: Veselina Mihaleva, Vanya Goranova, Meglena Angelova, Stoyan Pavlov, Tetsumori Yamashima, Anton Tonchev

Tissue and cellular mechanisms of damage and restoration аfter brain ischemia have fundamental as well as practical significance. The goal of the present study was to determine changes in cellular proliferation by bromodeoxyuridin (BrdU), indicator of DNA synthesis, in the cerebellum of newborn, one year old and adult Japanese monkeys (Macaca fuscata) after global brain ischemia. According to the age, BrdU paradigm (2 days х 250 mg/kg i.v. or 5 days х 100 mg/kg) and survival period after ischemia (4, 9 and 15 days correspondingly) the animals were distributed in several control and experimental groups. We applied immunohistochemical staining with peroxidase on frozen sections from cerebella of the monkeys examined to demonstrate the proliferative marker BrdU. Сomparison of thе аmount of BrdU+ cells in cerebellar cortex between non-ischemic control groups of different age showed a significant age dependent decline in the proliferative processes acheaving a relatively low supporting level. Comparison between groups of adult monkeys, subjected to ischemia with different duration, indicated that it is an important factor which induced cellular proliferation in the cerebellum but this effect declined with the time after ischemia. A forthcoming phenotyping of BrdU+ cells will differentiate between types of newborn cells and their relationship in the postischemic cerebellar cortex. The data acquired may expand and enlarge the understanding about restorative processes after ischemic injury to the cerebellum in the primates examined.

15-21

Authors: Radoslav Georgiev, Boyan Balev, Ara Kaprelyan, Marianna Novakova

Gliomas are the most common primary brain tumors with an annual incidence of 5-10 cases per 100,000 in Western populations. They are the leading cause of death among children and adults diagnosed with brain neoplasm. Gliomas are valued at the WHO classification by histopathological grades I to IV. Grades I and II are considered low-grade, while III, IV grades are high grade. Although they are histologically benign tumors most of II grade will transform into malignant grades III and IV in the range of 5-10 years of diagnosis. These grades are important because, they define therapeutic approach and prognosis in patients with gliomas. High grade gliomas were subjected to surgery and / or radiotherapy and / or chemotherapy, have a poor prognosis. Low-grade gliomas have sometimes conservative treatment. Conventional MR images provide important information on the presence of contrast enhancement, oedema, distant tumor foci, hemorrhage, necrosis, mass effect, etc., which are useful in the characterization of tumor aggressiveness and hence tumor grade. Modern techniques such as physiological techniques- MR diffusion and perfusion provide information about tumor physiology as microvascularity, angiogenesis, and cellularity, all of which are also important in determining the tumor grade. MR diffusion technique evaluates the structure of the tumor-cellularity, water content. MR perfusion technique is a marker for capillary density and neovascularisation.

29-32

Authors: Mariyana Mihajlova, Ilia Todorov, Vyara Locheva

The authors consider the place that traction therapy has in conservative treatment of disc disease, the main indications, principles of proper application and reasons for poor results. The proper and well-timed application of traction therapy is a reliable conservative treatment source that leads to fast regress of the illness and improves the quality of life of the patients.

36-40

Authors: Stefka Vulcheva-Kuzmanova, Valeriya Nikolova

On the Bulgarian market, the products containing omega-3 fatty acids (FA) are: one medicinal product (MP) and а a great number of food supplements (FS). The purpose of this study was to analyze the use of products containing omega-3 FA in Bulgaria for the period 2011-2013. The market research was done according to data from IMS Health. The results from the study showed that in the years 2011-2013 there was а slight increase in the sale of the MP containing omega-3 FA, both in number of packs sold and in terms of value accompanied by a slight increase in the average package price. As a whole, the sales of FS containing оmega-3 FA decreased in 2012-2013 compared to 2011 in number of packs sold, and in terms of value accompanied by a slight decrease in the average price per pack. In the study period, the market share of the FS was 500 times greater than that of the MP. The predominant share of FS could be explained by the greater variety and number of these products, as well as by the considerably lower cost of a FS pack compared to that of the MP.

45-51

Authors: Maya Doychinova

Objective: The objective of the survey is to evaluate the level of awareness, clinical use and interest to antibacterial photodynamic therapy (APDT) among dentists practicing in Varna. Materials and Methods: The analysis is performed based on the opinions of 120 dentistsq surveyed by direct individual questionnaire, on personal contact basis, for a period of 120 days. Statistical analysis is perfomed with SPSS. Results: The share of dental practitioners aware about APDT is below 50% and the share of the ones using it into their dental practice varies from 8% to 2% , depending on clinical entity. More than half of the interviewed (63%) declare interest in implementing a method for caries prevention based on APDT. Conclusion: The level of awareness concerning APDT is low, the application in dental clinical practice represents an exception rather than routine. There is interest in including the method as part of the protocol for the prevention of caries in adults. Focused efforts should be done in order to promote the use of APDT in daily dental practices, such as lectures, workshops, informational materials and brochures.

59-63

Authors: Desislava Ruseva, Diana Radkova

The article targets at giving a proof for the necessity of redundant psychological assistance after announcement of death and its effectiveness in coping with grief. 170 cases of relatives of deceased people were studied separated into two groups: Group A (relatives of people who died after prolonged illness) and Group B (relatives of people who died after an accident). Their reactions and emotions were registered at the beginning and the end of a session with a therapist. The results show necessity for psychological therapy in both groups, especially for the people in Group B.

73-77

Authors: Galina Petrova, Todorka Kostadinova

The following article aims to reveal some advantages, disadvantages and opportunities for development of SPA and wellness centers in Varna. The main factors for the growth of SPA and wellness services in the city are presented. Classification of the types of centers is made on the basis of the main therapeutic, recreational and beauty methods applied in the SPA centers. Semi-structured interviews among eleven SPA center managers in Varna are made and the results from them reveal that the main consumers of the above mentioned types of services are in the age group 40-65 and are mainly women. The wide range of therapeutic and recreational methods in SPA centers in Varna as well as the combination of mineral water and pleasant climate conditions allows the city to become a good SPA, wellness and recreational tourism.

84-87

Authors: Antoaneta Tsvetkova

The principles set by WHO for financing health care stipulate free access to health services regardless of any economic barriers such as low socioeconomic status. Nevertheless, various studies evidence the existence of such a relation as a result of the deteriorated socioeconomic environment in the country. Bulgaria in one of the countries within the EU with the lowest level of preventive health care. Bulgarian patients are not actively seeking preventive health care services and products because of financial constraints, bureaucracy and poor informational environment.

93-97

Authors: Svetlana Popova, Albena Kerekovska

The article reflects the results of a study of the employment impact on the subjective well-being amongst the yout. With a questionnaire designed for this purpose а psychometric study is conducted in a sample of 250 people (average age 22,81±3,43 g), divided into three groups - students, workers and students who work and study. The comparative analysis of self-assessment of subjective well-being as employment showed that the happiest workers are young people, followed by students. Young people who study and work at the same time have the lowest self-assessments of happiness. It was established, that the locus of control has significant impact on the level of happiness amongst the participants – according to the study, this personal construct reflects on the level of personal aspirations and contributes for the statistically significant differences in the subjective well-being. The influence of the employment 0,14 % on the level of life satisfaction 0,25 % on the self-assessment for happiness, unlike the influence of locus of control - 6,30 % on the satisfaction and 10,05 % on the level of happiness.

5-9

Authors: Meglena Angelova, Vanya Goranova, Dessislava Marinova, Stoyan Pavlov, Vesselina Mihaleva, Tetsumori Yamashima, Anton Tonchev

Cerebral cortex оf mammals is mainly generated during the embryonic period by stem cells and their derivative progenitors in the palium of the developing telencephalon. Various genes in complex interactions are involved in the processes of differentiation of the cerebral neurons. Transcriotional factor Sox2 plays a key role for self renewing and sustaining multipotency of embryonic neural stem/progenitor cells. Data about the expression and function of Sox2 in human fetal brain are insufficient and controversial. In the present sudy tissue samples of spontaneously aborted human fetuses aged between 12th to 28th gestational weeks (g. w.) were examined by a standard histological and immunohistochemical technique for paraffin sections. Sox2 expression was followed in the zones of cellular proliferation and migration in the occipital lobe of human fetal telencephalon mainly during 17th g. w. Within ventricular and outer subventricular zones we detected similar amount approximately 45% Sox2+ cells, whereas in the intermediate zone, cortical plate and marginal zone expression of Sox2 was not found. The data obtained on the location and expression dynamics of Sox2 contribute to a more complete understanding of neural stem/progenitor cell biology during embryonic neurogenesis in the human cerebral cortex.

15-20

Authors: Kader Dervisheva, Stefka Valcheva-Kuzmanova

On the Bulgarian market, the products containing Ginkgo biloba extract are three categories – medicinal products (MP) and food supplements (FS), which are mono-products and combined products. The purpose of this study was to analyze the use of products containing Ginkgo biloba extract in Bulgaria for the period 2011-2013 and by a questionnaire method to study the practice of doctors to prescribe such products. The market research is done according to data from IMS Health and by interviews with doctors from the regions of Varna and Dobrich. The results from the study showed that in the years 2011-2013 there was an increase in the sale of products containing Ginkgo biloba extract, both in number of packs sold and in terms of value at a relatively unchanging average package price. In the study period, the greatest was the increase in the use of MP. The greatest was the market share of the combined FS. The predominant share of combined FS cuold be explained by the greater variety and number of these products. The four products with the greatest market share were combined FS. The survey showed that almost all physicians prescribe products containing Ginkgo biloba extract. The most prescribed and recommended are the combined FS. Most often Ginkgo biloba containing products are prescribed for disturbances in blood flow and memory in patients above the age of 60. Decisive in the choice of a product is the combination of efficacy, quality and price.

25-28

Authors: Anna Todorova, Antoaneta Tsvetkova, Ana-Maria Velcheva, Maia Radeva, Kristina Decheva, Teodora Georgieva, Nadia Agova

In recent decades, both worldwide and in our country, there is a noticeable increase in allergic diseases, including those of respiratory system – bronchial asthma and allergic rhinitis. Epidemiological studies show that these conditions often coexist in the same patient. Allergen – specific sensitization is one of the major risk factors for the development of asthma in children. Allergic rhinitis usually precedes asthma. The premise “one respiratory system, one disease” marks a change in diagnostics and therapeutic treatment of respiratory allergies. Currently allergen-specific immunotherapy, administered in the early stage of the disease, is the only treatment that could have disease-modifying effect. The aim of this study is to analyze what proportion of children with asthma suffer from allergic rhinitis and what are the most common therapeutic schemes and practices used in the prophylaxis and treatment of the condition. For this purpose we conducted a survey among parents of children suffering from bronchial asthma on the territory of the city of Varna. Data were processes statistically based on respondent’s answers and were presented graphically. Results confirm that allergic rhinitis is a widespread disease among children with asthma and that is often neglected and not diagnosed and managed in time. Early diagnostics and adequate control of allergic rhinitis is crucial to stop the disease progression to asthma.

33-35

Authors: Ilia Todorov, Mariana Mihaylova, Todor Todorov

Introduction: The authors reveal the opportunities for a diagnosis and treatment with the methods of manual medicine of a muscle very often responsible for the cases of muscle dysbalance in the thoracolumbar passage, lumbar region and the lower extremities. In addition, the anatomic position and function of the muscle very often lead to the association of the clinical symptoms with other deceases. Objectives and tasks: Accomplishment of an effective treatment algorithm for dealing with the problem. Materials and methods: We have executed on a group of patients the most common techniques of manual diagnostics and have discovered the chain links between the observed pathology and other regions of the vertebral column – the thoracolumbar and lumbosacral passages. We also have shown the results of the manual therapy techniques applied – postisometric relaxation (PIR) as well as manual manipulation for the chain-linked blockages. The authors reveal the possible combinations of manual medicine and physical factors. Results: Of the 44 patients included in the study by 37 (84,09%) a pathology of the iliopsoas muscle has been found. By 36 of the mentioned 37 patients a complete relief of the pain symptoms has been achieved and by all of the patients with a change of the posture normalization occurred. Conclusion: The final results of the investigation prove the effectiveness of the exercised clinical approach in dealing with the pathology of m.iliopsoas. The manual diagnostics has proven itself as a leading method of tracking of the somatic dysfunction of a muscle, the effects of the applied PIR techniques decisively excelling the medication with non-steroid drugs.

39-40

Authors: Evgenia Vladeva

The article reveals the physicochemical characteristics of the sea lye, lixivium and particularly sea lixivium “Longoza”, the main healing agents during it’s usage and the indications for the treatment of different diseases.

5-9

Authors: Dessislava Marinova, Vesselina Mihaleva, Meglena Angelova, Stoyan Pavlov, Tetsumori Yamashima, Vanya Goranova, Anton Tonchev

Ìultipotent progenitors exist in the adult mam- malian central nervous system, capable of producing both neurons and glia. Their proliferation in the spi- nal cord is limited. Generation of putative stem/pro- genitor cells has been reported in intact and injured spinal cord of rodents and in a limited number in monkeys with a spinal injury, but not in intact spi- nal cord in vivo. We recently reported de novo gener- ated cells in the intact spinal cord of macaque mon- keys. Here we extend these findings by showing data of intact juvenile and neonatal monkey spinal cord. We used bromodeoxyuridine (BrdU) to label the de novo generated cells in the experimental animals and stud- ied their quantity and distribution at different time- points after the BrdU infusion. As expected, we found a significant elevation of the BrdU-labeled cells at neo- natal stage. However, there was no difference between juvenile and adult stages. These results suggest that the survival of newly born cells in the intact primate spinal cord does not change after juvenile stage and this could be used to further study repair mechanisms in adult primate spinal cord.

15-20

Authors: Stefka Valcheva-Kuzmanova, Petko Denev, Maria Krachanova, Adriana Surleva, Anna Belcheva

Aronia melanocarpa is a woody shrub of the Rosaceae family. Its fruits are used for consumption either fresh, or as juice, jam and wine. The aim of the present study was to measure the concentration of some biologically active substances and the antioxidant activity of two samples of Aronia melanocarpa fruit juice (AMFJ). The juice was prepared from fresh fruits. One of the samples was produced using a juice centrifuge and was preserved with potassium sorbate (1.0 g/l). The other sample was produced by crushing and squeezing of fruits after which the juice was filtered and sterilized at 100 °C for 10 min. The contents of biologically active substances in the juice samples were measured by spectrophotometric and high-performance liquid chromatography methods. The antioxidant activity of the two juice samples was measured by the ORAC (oxygen radical absorbance capacity) and HORAC (hydroxyl radical аverting capacity) methods. The results showed that both samples were extremely rich in polyphenolic substances, amongst which the highest was the concentration of procyanidins followed by phenolic acids (chlorogenic and neochlorogenic) and anthocyanins. Sample 1 had higher concentration of total phenolics and contained higher quantities of most polyphenolic substances with the exception of anthocyanins. It also contained micro-quantities of cyanogens. The variations in the composition of the two samples could be attributed to the different methods of juice production and conservation. Both juice samples showed very high ORAC and HORAC values which were higher for sample 1 (the sample with the higher concentration of polyphenolic substances). The high antioxidant activity of the two AMFJ samples could be attributed to their polyphenolic ingredients.

29-35

Authors: Vasil Bozhkov, Plamen Chernopolsky, Rosen Madjov

As a renal replacement therapy, peritoneal dialy- sis has been applied in the clinic since the 1970s. Com- pared with hemodialysis, it has a unique superior- ity since it requires only simple equipment and sur- gery and it is more effective at protecting residual re- nal function. In recent years, with significant improve- ment of the peritoneal dialysis connecting system and peritoneal dialysis solution biocompatibility, as well as increasing standartization of patients’ training has be- come the best method of early renal replacement ther- apy for patients with end-stage renal disease. We present you a review of different techniques, the cost effectiveness and comparison of the most frequent complications and we share our ten years’ experience in peritoneal catheter placement in our clinic.

44-47

Authors: Tosho Ganev, Lidiya Petkova, Tony Statelov, Nikolay Evtimov

Serum PSA gives information about the future increase of prostate volume, deterioration of symptoms and patient’s anxiety, sexual dysfunction, deterioration of urinary flow and risk of urinary retention and prostate surgery. Higher PSA strongly indicates higher risk of future BPH progression. Strong correlation is proven between prostate volume ,,age and PSA-data are from study including 4627 patients with BPH(Roehrborn et al.1999). The results of the studies show that with the increase of PSA-value, increases its sensitivity and specifity. The Curve of PSA for detecting prostate cancer is higher in men receiving dutasteride compared with placebo-group. After 6-months of treatment with 5-alpha reductase inhibitors the value of serum PSA decreases with about 50%.

52-56

Authors: Anna Todorova, Antoaneta Tsvetkova, Ana-Maria Velcheva, Maia Radeva, Kristina Decheva, Teodora Georgieva, Nadia Agova

Bronchial asthma is a major cause of morbidity in children in developed countries. In recent years, a large number of epidemiological studies have found an in- creased incidence of childhood asthma which makes this respiratory disorder the most frequent chronic dis- ease in childhood. Many factors are responsible for the huge incidence of asthma: triggering factors from the external environment, the use of inappropriate an- ti-inflammatory medication, lack of assistance with regard to therapeutic regimen, inadequate training of patient (family). The quality of life adolescents suffer- ing of bronchial asthma and their families often is ex- tremely deteriorated. Asthma may limit the ability of children to play, learn and sleep, to lead normal active life. Achieving disease control is the main goal of the treatment conducted. The Global initiative for asthma (GINA) defines control on asthma as minimal chron- ic symptoms, no emergency medical visits, no need of saving medication, normal daily activity, social adap- tation and school attendance. The aim of this study is to analyze the quality of life of children with asthma based on the achieved disease control. To achieve this goal a survey was conducted among parents and children of various ages in the city of Varna. Data from the surveys were processed using mathematical and statistical methods, and the results are presented by graphic images. Results show that in early childhood, when the treatment is performed under the supervision of par- ents, a well-controlled treatment is achieved compared to teenage years. Bronchial asthma is a chronic disease that is best affected in “therapeutic cooperation” between clini- cians, patients and their families. Implementation of training programs for children and parents will im- prove their compliance and execution of their indi- vidual treatment plan, and hence disease control and quality of life of patients.

62-65

Authors: Todor Todorov, Ilia Todorov, Mariana Mihajlova, Evgenia Vladeva

The article reveals modern aspects of physical threatment of low back pain – electro- and light ther- apy, thermotherapy, passive kinesitherapy – massage, manual therapy, tractions, exercises, lasertherapy, acupuncture.

69-74

Authors: Paraskeva Mancheva

The realization of the rights of disabled people in Bulgaria is directly related to the activity of Medical Committee. The Expert decision published by Medical Committee is a necessary requirement for the usage of these rights. The insufficiency of a current informa- tion from available source slows down the process of social integration. Also these legal assumptions, which underline these rights are changing dynamically too. The general practice is the point of beginning, from which the procedure for certification starts. This is the place where disabled people come back and look for the answers of their questions, which are created from the Expert decision. The continuing education of general practitioners is an opportunity for improving their competence in this area.

82-86

Authors: Ivan Kostov, Ivan of Lazarov

Electronic Health Portal is a web-based platform that collects and distributes health information between individuals, medical professionals, pharmacies and others. The portal is a unique elec- tronic solution that unites participants in the health sector through the network and thus enables to effec- tively exchange information in real time. Thus may be used various options to facilitate the citizens, doctors and businesses. A flow of increasing the number of us- ers, using this type of electronic platforms for differ- ent purposes is being watched. The main among them are: e-shopping, online consultations, public access of information about different types of medicines, choice in real time of an adequate specialist, etc. The elec- tronic health portal has as a main purpose to make the health services better and it is a complementary di- vision to the traditional forms of interaction between doctors and patients.

5-8

Authors: Svetlana Popova

The meaning of life and the pursuit of development excite every healthy person. In antiquity, Aristotle states that the ultimate goal of human development is to achieve eudaimonia (happiness). One of the aspects of eudaimonia is health and storing it for a long time has been associated with the theory of homeostasis. Researchers in the new time challenge the idea of homeostasis with another theory, i.e. of noodynamics. The aim of this study is to explore at theoretical and empirical level the importance of the meaning of life and the pursuit of self-actualization in the context of a healthy personality. We studied classical and modern scientific theories of healthy personality. Respondents were 100 people in Varna region in the stage of youth. Alternative, graphic and comparative analyses were accomplished. Our study shows that the availability of purpose that gives meaning and direction in life is extremely important for 80% of the participants. Some 60% believe that they are aware of their personal and professional development over the next 5 years. Some 80% do not accept their life-style and strongly desire certain change. Between 24% and 80% of the participants experienced emptiness in their life as a manifestation of an existential vacuum. For a healthy personality it is not so important to maintain homeostasis, as much as noodynamics related to the realization of personal purposes and goals. The existential vacuum is the result of frustrated development needs and a negative health indicator.

15-22

Authors: Lyudmila Angelova

Genetic factors for development of insulin-dependent diabetes mellitus (IDDM), non-insulin dependent diabetes mellitus (NIDDM) and maturity onset diabetes of the young (MODY) according to the classification of hyperglycemia in children and adolescents are reviewed. Original studies showing an association between HLA from MHC with IDDM have revealed protective and susceptibility alleles in HLADQB1 locus. About 20 genes other than class II MHC loci can also predispose to the development of the disease. Genome-wide screen and data analyses have shown that an allele for a transcription factor TCF7L2 is significantly associated with NIDDM. Another predisposition variant, i. e. a mutation in PPARG that is a member of the nuclear hormone receptor family, plays an important role in the regulation of adipocyte function and differentiation. Antigens involved in β-cell autoimmune reaction, genetic risks for occurrence (recurrence) of affected family members, gestational diabetes mellitus and protection approach towards congenital anomalies among mothers with diabetes mellitus are considered.

27-30

Authors: Gergana Ingilizova, Ivan Kostov, Ivan Lazarov, Daniela Velkova

The first baby conceived and born as a result of intracytoplasmic sperm injection (ICSI) was reported by Palermo et al. in 1992 in Belgium (12). Since then onwards, ICSI has become a popular fertilization technique proved to be a very efficient way in treating the male infertility. As a result of this procedure, many healthy children with normal physical and mental development have been born worldwide. However, because of the complexity of the technology and the poor characteristics of the spermatozoa used, concerns about the safety of ICSI still exist. According to some researchers, congenital malformations in infants born after ICSI occur more often than in naturally conceived children or even in conventional in vitro fertilization (IVF) conceived children. However, the literature reviewing the subject is far more contradictory and medical opinions differ significantly amongst the medical research centers. A conclusive report from the Practice Committee of the American Society of Reproductive Medicine states that ICSI is an effective and safe procedure for treatment of male infertility; however, it increases the risk of transmitting certain DNA mutations to the offspring. The reason is not only due to the procedure itself but also to the likelihood of carrying such gene mutations in parents. The aim of the present survey is to review and discuss the advantages and disadvantages of such a procedure and to focus clinicians’ attention on refining its application in order to minimize possible complications during and after pregnancy.

35-39

Authors: Silviya Filkova, Vanya Todorova, Violeta Kovacheva

Physical activity (PA) is one of the basic factors for primary health prevention. It counteracts hypodynamia that is a risk factor for the occurrence of numerous socially significant diseases. According to 2010 Eurobarometer data, 82% of the population in Bulgaria does not go for sports or does it one time per month as this relative share is the highest one in the European Union. The objective of this survey is to enhance the awareness about the influence on the human organism of PA, its benefits for health and its dosage in the single age groups of healthy individuals. Modern literature sources were analysed. As a result from systematic physical loadings some positive structural and functional changes in the organism can be achieved. The risks of many non-infectious diseases are reduced. This is of benefit for the society as social interaction and involvement enhances. PA is a main means for improvement of the physical and psychic health of people. It is not only an issue of public health but also it stimulates well-being of people and environmental protection. PA is an investment in the health of future generations and that is why it should turn into a model of health behaviour.

47-50

Authors: Rositsa Stancheva, Boryana Kavaldzhieva, Staniela Porozhanova, Ruzha Pancheva

Honey bees produce unique products that provide health and promote human longevity. Honey is the best known and most widely consumed substance produced by bees. The purpose of this study is to assess the role of bee honey for the nutrition of Varna citizens and the level of their awareness about the benefits of honey and bee products. A total of 438 individuals from the town of Varna at an average age of 42,90±10,90 years (range, 27 to 83 years) were recruited. They filled-in a questionnaire about their nutritive habits in regard to honey. Respondents were divided into two age groups - aged up to 40 and above 40 years old. The study shows that people aged over 40 years consume more often honey every day compared to those aged up to 40 years (p<0,05). Besides 20,55% of all the respondents consume honey every day, 13,47 % do only in winter and 14,84% - only when they are ill. Only 5,94% of the respondents do not consume honey at all. Over half of the respondents (60,50%) share that they would consume honey more often. In 46,35% of the respondents honey has been used as a sweetener. A total of 32,65% respondents replace sugar with honey always when possible, 50,68% of them do it occasionally only, and 15,30% never do it. People under the age of 40 years hardly replace sugar with honey when possible. Only 33,79% of the respondents consume honey as food. This is more common among subjects aged up to 40 years (p<0,05). In 24,20% of the cases honey is a means for treatment of diseases. The majority of respondents (92,69%) believe that bee products are useful because they are natural, contain essential ingredients for the human body and strengthen the immune system.

55-59

Authors: Mihaela Varneva, Petya Yakimova, Daniel Kostadinov

Mentoring in the education of the students in the speciality of dental technician at the Medical College of Varna manifests itself as a voluntary partnership between the student and the mentor taking place in an independent medico-technical laboratory for dentistry certiWed to be a basis for student’s education. Yis method of education can be assessed through gathering the information about the manner of performance and proposals for its optimization. Ye result can be used as a mean of assessing the quality of the education. It is recommended that such an assessment should periodically be done. Ye purpose of the present study is to Wnd out by using feedback from the mentors their opinion about the quality and usefulness of mentoring. An inquiry examination was used. Subjects of the examination were the workers in 13 out of 31 dental laboratories used (41,93%). While processing these data it was established that all the respondents gave a very positive evaluation of the mentoring as a method of education and of the quality of their work with the students (100%). Yis shows that mentoring is an extraordinarily accessible and e^ective method for delivering work experience, knowledge and professionalism during the practical training and probation prior to graduation.

65-73

Authors: Elena Tubinis, Ilko Bakardzhiev, Margarita Stancheva, Desislava Gesheva

Dry skin (хerosis cutis) is a common problem a`ecting people art di`erent age and of di`erent skin types. he reasons for dry skin can be natural (physiological), pathological, or related to the inquence of unfavourable environmental factors. he purpose of the paper is to elaborate an algorithm for diagnosis and management of patients with dry skin of various etiology. A retrospective search in the following data-bases was carried out: MEDLINE (PubMed) of the National Library of Medicine (USA), Consilium-Medicum (Russia) and Russkij meditsinskij zhurnal (Russia). When the diagnosis of dry skin is made, usually, one takes into consideration the disturbance of the hydratation of the corneal layer (10%) only. his parameter can be considered as a screening tool only and should not be the only criterion for choice of therapy. he pathophysiological changes are assocaited with disturbace of the epidermal barrier, incerase of the transepidermal water loss and pH alterations of stratum corneum. he basic diagnostic criteria are the following: transepidermal water loss and fatty secretion level (i.e., normal, low or high). hese parameters should be born in mind in the selection of treatment and can be assessed through the application of rapid real-time invivo methods such as TEWL-metry and sebumetry. he recent research achievements demonstrate that natural moisturizing factor, ceramides and aquaporins are the key factors for skin hydratation. he chouice of therapy in patienst with dry skin is a great challenge. It is strictly individualized. Treatment errors could lead to patient’s status worsening.

7-12

Authors: Mario Milkov, Plamen Nedev, Tsvetan Tonchev, Hristina Madzhova

Burning mouth syndrome is characterized by a bilateral burning sensation in the oral mucosa and perioral areas, taste disorders, oral dryness and absent objective findings. It is difficult to diagnose and manage as well. Three main therapeutic approaches are nowadays used: behavioural interventions, topical medications and systemic medications. The first one includes cognitive behavioural therapy, group psychotherapy and electroconvulsive therapy. Topical drugs belong to several groups such as benzodiazepines, anesthetics, atypical analgesics, tricyclic antidepressants, nonsteroidal anti-inflammatory drugs, antimicrobials and mucosal protectors. System drugs additionally include anticonvulsants, selective inhibitors the reuptake of serotonin and norepinepherine, antioxidants, dopamine agonists, histamine-2 receptor antagonists, herbal medicines and salivary stimulants as well. Lowenergy laser therapy can be successfully applied, too.

19-23

Authors: Daniela Arabadzhieva

In the present paper, the results from the clinical analysis of the patients with ischemic stroke and diagnosed risk diseases were analysed. During the period from 2007 to 2012, a total of 960 patients who had survived ischemic stroke, 456 males (47,50%) and 504 females (52,50%), aged between 32 and 94 years and hospitalized in the First Clinic of Neurology, St. Marina University Hospital of Varna, were examined. Some cerebrovascular, cardiovascular and metabolic diseases belonged to the most common pathology related with enhanced risk for ischemic stroke. The patients within the age groups between 40 and 59 years represented a considerable part among this contingent. There were statistically significant differences between males and females concerning the incidence rate of heart rhythm disturbances (p<0,001). A further more detailed analysis of the mutual relationships between ischemic stroke and the diseases related with higher risk for it will be carried out.

31-34

Authors: Georgi Kobakov,Kiril Kirov, Daniel Yankov,Daniel Kostov

The objective of the present study is to elaborate a prognostic index for qualitative assessment of the operative risk in the surgical treatment of colorectal cancer (CRC). The documentation of 150 CRC patients, 91 males and 59 females, operated on in the Clinic of Surgery, Marko A. Markov Specialized Hospital of Oncological Diseases of Varna during the period from June 2008 till April 2009 was analyzed. Mean patients’ age was 64,2 years (range, 34-84 years). Seventy patients presented with colon cancer, 76 - with rectum cancer while 4 patients presented with multiple tumour localizations. The risk factors included the following: patient’s age and gender; ASA stage; CRC localization according to ICD of WHO; surgical procedure according to OPCS4 system; emergency; CRC stage according to TNM classification; resection type, and hematocrit level. There were 55 patients with TNM stage I, 80 patients with TNM stages II-III, and 15 patients with TNM stage IV. The most common interventions were anterior resection (in 48 patients), right hemicolectomy (in 41 patients), and sigmoidectomy (in 23 patients). Thirty-day operative lethality rate was zero. The created data-base can successfully be used for the purposes of CRC prognostication with the patients forwarded to operative treatment.

41-45

Authors: Svetlana Georgieva,Gergana Angelova-Popova,Radoslava Dimitrova

Autism and autistic disorders are a heterogeneous group of disorders of the neuropsychological development which are of complex genetic etiology. They are characterized to a different extent by difficulties in social interaction, verbal and non-verbal communication and behaviour problems. Recently, the incidence of autism as well as the interest in it increases and the establishment of more centres to work with these children testifies to that. An inquiry investigation among the relatives and parents of children with autistic disorders concerning their awareness about autism status, opportunities to meet the specific needs of their children and support of their development and social interaction as well as concerning the effectiveness of the applied treatments, programs, and interventions in ‘Faith, Hope and Love’ Daily Care Centre of Bourgas for working with the children with autism was carried out.

53-57

Authors: Dimitar Stavrev, Georgi Marinov

Periodic medical press in Bulgaria dates back to 80s of the XIX century, when the first scientific medical journals have been published. A sample of publications devoted to a specific medical problem, i. e. of the rare variations of the female reproductive system was studied by means of a detailed analysis of the literature from this period. In this paper the articles concerning the description of variations, journals containing them and their authors along with a short biographic data were presented. The results showed a high professionalism and desire for research of these authors.