<abstract><title style='display:none'>Summary</title>Affective disorders, including depression, are of great social importance and lead to serious everyday life infringement and disability. Affective disorders are one of the main causes of suicide causes. Anxiety disorders represent a variety of psychic disorders that often lead to disability. Anxiety and depression syndromes together are often seen in patients. Vitamin B12 (cobalamin) is the only vitamin containing cobalt. Our aim was to investigate, evaluate and compare depression and increased anxiety and serum Vitamin B12 level in patients with depression, in patients with Vitamin B12 deficiency anemia and healthy controls. We investigated 74 subjects – 38 patients and 36 healthy controls. Serum Vitamin B12 level was measured in all participants. It is assumed that normal ranges of Vitamin B12 level vary. The most recently accepted ones are 200 to 900 pg/ml. In cases of levels below 200 pg/ml, a therapy with vitamin B12 should be applied. On the other hand, the level necessary for normal biochemical processes is higher – 250 pg/ml. In our study, serum Vitamin B12 level in more than 50% of patients with depression/anxiety was below 200 pg/ml, and in more than 60% of these patients it was below 250 pg/ml.</abstract>

Correlation between Depression and Anxiety and the Level of Vitamin B12 in Patients with Depression and Anxiety and Healthy Controls

<abstract><title style='display:none'>Summary</title>Nowadays, infertility is a problem that affects an increasing number of people. The causes of infertility in a couple may be due to a variety of factors – female, male or unexplained. One of the common problems associated with infertility in women is related to uterine cervical diseases. The cervix is an essential part of the sperm passage, so various disorders in the cervix structure and function may be the cause of infertility. The study aimed to identify the leading cervical causes of female infertility, methods of treatment and their success. The most common problems of cervical origin are cervical polyps and stenosis of the cervical canal. They are easily diagnosed with a routine gynaecological examination and ultrasound examination. Polyps are removed through polypectomy, and after that, a natural pregnancy can be achieved. In the case of stenosis of the cervical canal, there are two treatment options – dilation or intrauterine insemination (IUI). In younger patients and lack of male factor in the couple, dilation is performed. Dilation is mechanical with classic Hegar dilatiors or with synthetic hygroscopic dilatiors (Dilapan). If, in addition to the stenosis of the cervical canal in a woman, there is a male factor, treatment with IUI is preferred. Methods for cervical factor treatment vary in their success rate but are generally characterised by good results.</abstract>

Diagnostics and Treatment of Cervical Causes of Infertility

<abstract><title style='display:none'>Summary</title>Premature ejaculation (PE) is the most common sexual dysfunction in men, yet it is not well studied. Its frequency reaches 30% for men from 18 to 59 years of age in different countries. The aim of this article was to investigate the quality of sexual life in men with primary PE operated on with microsurgical penile denervation, using the Brief Male Sexual Functional Inventory (BMSFI). From September 2011 to March 2014, 22 patients were operated on with microsurgical penile denervation in the urology clinic of the University Hospital - Pleven and the Department of Urology at UMHAT Ruse AD. The mean result from the BMSFI in patients was 22 points preoperatively, indicating significant worsening of sexual function and quality of life in all five questionnaire domains. After surgery, the results increased to 28, 33 and 39 respectively, at 3, 6 and 12 months, respectively. Premature ejaculation not only leads to problems in controlling ejaculation but also worsens the overall sexual function and quality of life of patients.</abstract>

Quality of Sexual Life after Microsurgical Penile Denervation in Men with Primary Premature Ejaculation

<abstract>
<title style='display:none'>Summary</title>
The objective of this study was to determine the clinical picture of adult celiac disease in the population of eastern Algeria. We conducted a retrospective study on a sample of 156 patients in Internal Medicine service, Hepato-Gastroenterology Service, Endoscopy Service in the University Hospital BENBADIS - Constantine and the Military Regional University Hospital - Constantine. Our results have shown that, in this population, celiac disease can be manifested by a number of signs and related pathologies. A variety of digestive symptoms were reported, primarily chronic diarrhea (81.4%), abdominal pain (57.1%), anorexia (42.9%) and vomiting (48%). Extra-digestive symptoms manifested mainly as weight loss (90.4%), pallorous of skin and mucosa (84%), asthenia (60,3%), edema of the lower limbs (46.8%) and dehydration sings (37.8%). In addition, we noted biological disorders, the most common being hypocalcemia (77.4%) and hypoalbuminemia (57.7%), and a series associated pathologies namely: anemia (67.9%) and digestive diseases (38.46%). CD in adults in our population may express a variety of digestive and extra-digestive symptoms in addition to a number of associated pathologies.
</abstract>

Characteristics of Adult Celiac Disease in Eastern Algeria

<abstract><title style='display:none'>Summary</title>The aim of the study was to analyse the intraoperative parameters of hysteroscopic morcellation (HM) and conventional resectoscopy in the treatment of uterine polyps (UP). A total of 177 patients with ultrasound imaging of UP were included in a prospective study from February 2015 to February 2017. Out of them, 98 (55.4%) underwent HM and 79 (44.6%) had hysteroscopic resection (HR). We analyzed the following intraoperative parameters: total duration of the procedure, total operating time, time for dilation, actual operating time for HM/HR, the total amount of fluid distension media and fluid deficit. The mean operating time, measured as a total duration of the procedure, total operating time and actual operating time, was significantly shorter in the HM group, as compared to HR group, 8.27 and 19.48 minutes (min) – p&lt;0.001, 6.15 and 16.33 min (p&lt;0.001), 3.28 and 11.70 min (p&lt;0.001), respectively. The total amount of fluid distension media was trustworthy lower in the HM group compared to HR, 446.02 ml and 2225.57 millilitres (ml) – p&lt;0.001, respectively, as well as for the fluid deficit parameter – respectively 83.78 ml and 413.48 ml (p&lt;0.001). This warrants the assumption that HM is an effective alternative to conventional resectoscopy for removal of UP with a favorable perioperative outcome.</abstract>

A Comparative Study of Hysteroscopic Morcellation or Resection of Uterine Polyps

<abstract><title style='display:none'>Summary</title>Total mesorectal excision (TME) is a standard surgical procedure for rectal cancer. Robotic surgery has the potential to minimize the disadvantages of laparoscopic rectal resection. Circumferential margin and macroscopic quality assessment of the resected specimen are the major prognostic factors for local recurrence of the disease. The aim of this study was to research the macroscopic assessment of the quality of TME after robotic-assisted rectal resections for rectal cancer performed in a single center. Data was prospectively collected about macroscopic assessment of the quality of TME in thirteen patients after robotic-assisted rectal resections for rectal cancer between 09.04.2014 and 31.12.2016. After all robotic TMEs, a pathologist made macroscopic assessment of the completeness of the mesorectal excision. The quality of TME was complete in 12 cases and nearly complete in one case. The circumferential and distal resection margins were negative in all cases. The mean number of harvested lymph nodes was nine. This study indicated that using robotic surgery for rectal cancer does not lead to worsening the quality of TME. Further studies in this field are necessary.</abstract>

Macroscopic Assessment of Total Mesorectal Excision Quality after Robotic Assisted Rectal Resection for Rectal Cancer in Bulgaria: A Prospective Trial

<abstract>
<title style='display:none'>Summary</title>
Squamous cell carcinoma of the skin (SCCs) accounts for 20-30% of non-melanoma skin cancers, resulting in 1 million cases in the United States annually. The risk of developing SCCs increases annually, and this process will likely be continued because of the aging population. We investigated 355 patients with histopathologically confirmed SCCs. We rated the age- and sex-related incidence, risk factors, localisation, pathological features, staging systems and treatment, and the recurrence and mortality rates of the tumours. Staging and risk stratification for recurrence and metastases is significant. Most SCCs are successfully treated surgically, with a small subset of carcinomas leading to recurrence, metastasis, and death. Patients with advanced and metastatic disease are often inappropriate for surgical and radiation therapy. We present the first study on squamous cell carcinoma of the skin conducted for the population of the Pleven and Lovech regions of Bulgaria.
</abstract>

Squamous Cell Carcinoma of the Skin: Epidemiology, Diagnosis, Management, Recurrence and Mortality Rates for the Bulgarian Population

<abstract>
<title style='display:none'>Summary</title>
Depression and anxiety are the most common nonmotor symptoms in Parkinson‘s disease-NMSPD in the department of the neuropsychiatric disorders. Depression is present in all stages of PD - early and advanced even in premorbid stage of PD. The incidence of depression in PD varies in large limits according of used methods and criterions. Some somatic symptoms are part of the depression syndrome. At the presence no consensus exists about the etiology of depression in PD. The concomitant occurrence of depression and PD and the overlapping symptomatology of PD and depression usually lead to the terminological discussion and discrepancy. To explain the high prevalence of depression in PD some hypotheses have been proposed. Many scales were used for assessment of depression in PD. The properties and critique of nine scales was discussed.
</abstract>

Depression in Parkinson’s Disease – Profile and Assessment

<abstract>
<title style='display:none'>Summary</title>
The purpose of оur research was to evaluate the effect of remote education on ocular health among medical students during the current COVID-19 pandemic. The students included in the study were 219 in total, all from Medical Universities in Bulgaria. They were asked about their eye health and comfort during the distance-learning semester. They were interviewed anonymously, with an online questionnaire, between April 1-30, 2021. The findings of the study highlighted that digital learning increases screen time, at potentially dangerous for eye health levels. The most common presenting complaints were eye fatigue (83.1%), tearing (epiphora) (58.9%), dry eyes (58.4%), blurred vision (40.2%), photophobia (37.4%), itchiness (34.7%) etc. Regarding the longest uninterrupted time spent working on a computer, 32% of the students reported 1-2 hours without a break, 57.1% - more than 2 hours, and only 3.7% spent less than 20 min before taking a break. As the conclusion of this study, it was observed that distance learning during the pandemic and social isolation adversely affected eye health and eye fatigue among medical students. Increased screen time during online semester causes digital eye strain, which interferes with the quality of life and is an emerging public health issue.
</abstract>

Ocular and Visual Discomfort Epidemic Amid COVID-19 Pandemic: A Sample of Medical Students in Bulgaria

<abstract>
<title style='display:none'>Summary</title>
Breast cancer is the most common cancer in women worldwide. The gold standard for biopsy is core needle biopsy. However, in certain cases, core needle biopsy cannot be applied, and the method of choice is vacuum-assisted biopsy. It is a minimally traumatic and precise method for diagnosing microcalcifications and small breast lesions. We aimed to present the initial experience with stereotactic vacuum-assisted biopsy in breast diseases at the Department of Surgical Oncology. We show indications and contraindications for this kind of biopsy and present our initial experience. From February 2020 to December 2022, 29 stereotactic vacuum-assisted biopsies were performed. Benign histology was found in 9 cases, malignant – in 15, and 5 cases were precancerous. Therefore, being an innovative, minimally invasive, and highly accurate method for diagnosing breast lesions with a good cosmetic effect, it allows early diagnosis of breast cancer, and, last but not least, the procedure can be curative for benign lesions.
</abstract>

Introduction of Stereotactic Vacuum-Assisted Breast Biopsy in Bulgaria

<abstract>
<title style='display:none'>Summary</title>
The current study aimed to evaluate the influence of Japanese quince (Chaenomeles japonica) fruit juice (JQFJ) on the myocardium and on the coronary arteries of rats with diet-induced metabolic syndrome (MS). Male Wistar rats (n=50) were divided into 5 groups: Control, MS, MS+JQFJ2.5, MS+JQFJ5 and MS+JQFJ10. MS was induced with a high-fat high-fructose diet for 10 weeks. During that period, all animals were daily orally treated with distilled water (Control and MS groups) or with JQFJ at doses of 2.5 ml/kg, 5 ml/kg and 10 ml/kg (the other three groups, respectively). At the end of the experiment, the myocardium and coronary arteries were examined histopathologically. In group MS, necrotic endothelial cells and exposed basal membrane were observed. JQFJ at 2.5 ml/kg reduced the impairment but activated endothelial cells were still found. JQFJ at 5 ml/kg and 10 ml/kg prevented coronary artery endothelium damage, preserving the normal morphology. The myocardium in MS group presented with cardiomyocyte degeneration and increased distance between the cells. In group MS+JQFJ2.5, the degeneration was decreased. In groups MS+JQFJ5 and MS+JQFJ10, the histology of the myocardium resembled that of the control group. In the current histopathological evaluation, JQFJ prevented the MS-induced impairment of myocardium and coronary arteries.
</abstract>

Japanese Quince Fruit Juice Exerts a Cardioprotective Effect in a Model of Diet-Induced Metabolic Syndrome in Rats

<abstract>
<title style='display:none'>Summary</title>
Hepatobiliary sepsis and biliary septic shock are defined as a group of purulent-inflammatory diseases of the biliary tract which, in their progression, lead to sepsis in case of delayed diagnosis and treatment. The study aimed to analyse all the cases of hepatobiliary sepsis treated at the Clinic of Surgery, Dr G. Stranski University Hospital – Pleven, from 2016 to 2020 and create a reliable prognostic score for surveillance for patients with hepatobiliary sepsis. Retrospectively, we analysed the records of 697 patients (81%) with a hepatobiliary tract infection, including 79 (11.3%) diagnosed with hepatobiliary sepsis and six fatal cases (1.3%). We evaluated all statistically significant factors that affected mortality: immune deficiency comorbidity (р&lt;0.005), pathogenesis-related to trauma and ascending biliary tract infection (p&lt;0.005), positive hemoculture (p&lt;0.001), length of hospital stay, the need of treatment in intensive care unit and all septic complications. We designed four different prognostic indices based on calculated individual SOFA scores and factors that significantly affected mortality in the high SOFA score patients: immune deficiency, pathogenesis-related risks of sepsis or positive blood culture. The newly designed indices for the outcome are original and have 80% sensitivity and 87% specificity, compared with a simple SOFA score.
</abstract>

Surgical Sepsis of Hepatobiliary Origin: Cоmplications and Prognosis

<abstract><title style='display:none'>Summary</title> The objective of the study was to investigate the influence of sperm DNA fragmentation index (DFI) by DNA integrity test on pregnancy outcome and pregnancy loss after assisted reproductive technology (ART) procedure: autologous intracytoplasmic sperm injection (ICSI), donation eggs ICSI, and intrauterine insemination (IUI). We investigated men from 531 couples undergoing autologous ICSI procedure (n=416), from couples undergoing donation eggs procedure (n=39) and IUI (n=76). We performed the following interventions: semen analysis, DNA integrity test, embryo scoring by Gardner and Schoolcraft grading system (1999). The study showed no statistically significant differences between the group regarding pregnancy rate (χ2=0.55; p&gt;0.05; OR=1.25, 95% Cl 1.23-1.46; p&gt;0.05). However, with increased levels of DFI, the number of pregnancy losses became higher (including biochemical pregnancies and spontaneous abortions) at OR=5.65 (95% Cl 4.32-7.11; p=0.05). We examined the percentage of grade I blastocysts (by Gardner and Schoolcraft, 1999) before donation eggs embryo transfer and found a statistically significant correlation with both the DFI (χ2=7.80; p&lt;0.05) and sperm morphology (χ2=6.14; p&lt;0.05). Analysis of the relationship between DFI and IUI output (clinical pregnancy, miscarriage) revealed significant correlations in both directions: between DFI and pregnancy rate after IUI (χ2=6.29; p&lt;0.05) and between the DFI and pregnancy development after IUI (χ2=6.87; p&lt;0.05). The three group categories (autologous, heterologous ICSI procedures and IUI) studied showed that sperm samples with DFI&gt;27% were associated with increased riskofearlypregnancyloss. Men with infertility should undergo DNA fragmentation assay in addition to the standard semen analysis. When DFI exceeds 27%, ICSI should be a method of choice, even in cases where the conventional parameters of semen analysis tests are normal. </abstract>

MC Clinical Institute for Reproductive Medicine - Pleven 20, Skobelevblvd. Pleven 5800,

Institute of Biology and Immunology of Reproduction, Sofia,

Institute of Biology and Immunology of Reproduction, Sofia

Center for Reproductive Health, Medical University - Pleven,

Sperm DNA Integrity Test and Assisted Reproductive Technology (Art) Outcome

<abstract><title style='display:none'>Summary</title>Osteoporosis is a systemic skeletal disease characterized by decreased bone mass, destruction of the microarchitectonics of bone structure and a high risk for fracture. One of the criteria for altered bone homeostasis includes the changes in serum levels of alkaline phosphatase (ALP) and the activity of matrix metalloproteinases (MMPs). The purpose of this study was to determine the serum concentrations of calcium (Ca2+), phosphorus (P), magnesium (Mg2+), alkaline phosphatase (ALP) and MMP-9 in ovariectomized rats. We used 35 female Wistar rats at reproductive age (2 months) divided into 2 groups: a control group (G1-SHAM) – 20 animals subjected to “false” ovariectomy and placebo-operation, and an ovariectomized group (G2-OVX) – 15 animals subjected to bilateral ovariectomy. Blood was collected from the abdominal aorta for testing levels of Ca2 +, P, Mg2+, ALP and MMP-9. No statistically significant differences in serum concentrations of Ca2+, P and Mg2+ were found between G2 and G1 (p&gt;0.05). The values of ALP and MMP-9 in rats of G2 were statistically significantly increased, as compared to G1 (p&lt;0.05). The serum activity of ALP, which is a marker for bone formation, was increased in OVX-induced osteoporosis. Elevated serum MMP-9 levels in G2 confirmed the hypothesis that it is a marker for osteoclast activity.</abstract>

Changes of Serum Concentrations of Alkaline Phosphatase and Metalloproteinase-9 in an Ovariectomized Wistar Rat Model of Osteoporosis

<abstract><title style='display:none'>Summary</title><italic>Aronia melanocarpa</italic> fruit juice (AMFJ) is very rich in polyphenolic compounds. Quercetin is a naturally occurring flavonoid, one of AMFJ polyphenols. The aim of the present study was to investigate the effect of AMFJ in comparison with quercetin in a model of paracetamol-induced hepatotoxicity in rats. AMFJ at doses of 2.5 and 5.0 ml/kg and quercetin at doses of 50 and 100 mg/kg were administered daily orally from day 1 to day 7 to different animal groups. Paracetamol was applied intraperitoneally (1.0 g/kg) on day 5. Blood and liver ware taken for biochemical investigations on day 7. Liver toxicity was estimated by the serum activities of the enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Oxidative stress was estimated by the levels of thiobarbituric acid reactive substances (TBARS) in liver homogenate and serum. Paracetamol caused a significant elevation of serum AST and ALT, and induced lipid peroxidation as measured by the significant increase of TBARS in serum and liver. In animals pretreated either with AMFJ or quercetin, liver enzyme activities did not differ significantly from the control levels. Both AMFJ and quercetin prevented the elevation of TBARS in the liver at the two applied doses and in the serum only at the higher of the tested doses. In the present model of paracetamol-induced hepatotoxicity, the protective effect of AMFJ was comparable to that of quercetin.</abstract>

Comparative Study Of The Protective Effect Of <italic>Aronia Melanocarpa</italic> Fruit Juice And Quercetin In A Model Of Paracetamol-Induced Hepatotoxicity In Rats

<abstract><title style='display:none'>Summary</title>Fetuin-A is a major plasma glycoprotein released mainly by the liver. Its functions include inhibition of the activity of insulin receptor, regulation of response to inflammation, inhibition of calcified matrix metabolism and ectopic mineralization, etc. Three major functional domains of fetuin-A have been identified: one similar to the Ca-binding domains, one inhibiting cysteine protease, and a domain with high affinity to insulin receptor. The fetuin-A molecule may be considered as a highly pleomorphic protein with an important impact in a variety of clinically expressed metabolic and pathological processes. It could be used as a marker in clinical practice in the future.</abstract>

Fetuin-A – Alpha2-Heremans-Schmid Glycoprotein: From Structure to a Novel Marker of Chronic Diseases Part 1. Fetuin-A as a Calcium Chaperone and Inflammatory Marker

<abstract><title style='display:none'>Summary</title>Anemia is an important public health problem worldwide. Although iron (Fe) deficiency is considered the main factor in the pathogenesis of anemia, only 40-60% of anemia cases are responsive to Fe supplementation. Considerable data exist that other micronutrient deficiencies, such as selenium (Se), could be possible causes of anemia. The issue of Se deficiency as a risk factor for the development of anemia is of particular interest to our country since the Balkan region is known by a low Se content of soils. The aim of the study was to examine the contemporary conception of the influence of Se deficiency on the development of anemia by a review of the scientific literature. Most animal studies have shown a significant relation between Se deficiency and anemia, but one study indicates that there is no impact of Se deficiency on the hematological parameters. Associations of low serum Se with anemia have been found in a number of human studies including subjects of various age groups and pathological conditions. Three possible biological mechanisms have been suggested for the involvement of Se deficiency in the development of anemia: increased oxidative stress, modulation of inflammation through induction of interleukin-6, and increased expression of heme oxygenase-1. A more categorical clarification of the relationships between Se deficiency and development of anemia is needed with respect to appropriate trace element supplementation in cases of anemia with insufficient or absent therapeutic response to Fe treatment.</abstract>

Selenium Deficiency as a Risk Factor for Development of Anemia

<abstract><title style='display:none'>Summary</title>In Europe, as well as in Bulgaria, consumption of soft drinks and confectionery has increased during the last three decades and is partly responsible for the epidemic-like increase in obesity. These foods, originally sweetened by sucrose, are now sweetened by other caloric sweeteners such as fructose. In this study we investigated the effect of an eight-week intake of 20% fructose solution on body weight in rats. Two adult rat groups (aged 120±6 days) of Wistar line were studied: a Control group (C; n=10; 5 male and 5 female rats) received water and standard rodent chow, and a Fructose group (F; n=12; 6 male and 6 female rats) who received 20% fructose-in-drinking-water solution and regular rodent chow. All animals were weighed and measured (nose to anus length), and the Lee index (equivalent of BMI in rats) was calculated. Body fat was also analyzed. As indicators of increased caloric intake of the Fructose group we investigated glucose, triglycerides and cholesterol (total, HDL and LDL) in blood. In conclusion, consumption of fructose solution in rats resulted in increased body weight, length and measured body fat, increased blood glucose, total cholesterol and triglycerides in the Fructose group, as compared to the controls.</abstract>

Department of Physiology, Pathophysiology and Pharmacology, Medical Faculty, Trakia University

Department of Hygiene, Infectious Diseases, and Epidemiology, Medical Faculty, Trakia University

Clinical Laboratory, First Internal Clinic, Medical Faculty, Trakia University, Stara Zagora

Effect Of High-Fructose Solution On Body Weight, Body Fat, Blood Glucose And Triglyceride Levels In Rats

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Journal of Biomedical and Clinical Research

 Journal of Biomedical and Clinical Research (JBCR) is a peer reviewed, multidisciplinary scientific journal of Medical University - Pleven, open to...

 Journal of Biomedical and Clinical Research (JBCR) is a peer reviewed, multidisciplinary scientific journal of...

Journal of Biomedical and Clinical Research

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