Volume 11 (2018): Issue 1 (July 2018)

Over the last decade, there has been a steady trend in increasing the incidence of colorectal cancer on a global scale. The relative share of patients under the age of 40 increases with each year. There is also a tendency for the incidence to be almost the same in males and females. Despite the efforts of the National Cancer Institute (NCI) to establish and implement adequate screening for disease prevention, 45.8% of patients were diagnosed in the advanced (third and fourth) stages of the disease. In 44.7% of patients, it was in the first and second stages, and the stage was unspecified in the remainder [1].

The prognosis in patients with colorectal cancer has been significantly improved. Precise staging of the tumor, adequate interpretation of predictive and prognostic factors is essential in the choice of therapeutic behavior. On the other hand, an inappropriate therapy administered to a patient with a diagnosed cancer can lead to disease progression, metastasis, and death, which can be avoided by adequate, patient-specified treatment.

Fetuin-A is a secretory liver glycoprotein with multiple physiological functions such as regulation of insulin resistance, tissue calcification, bone metabolism, cellular proteolytic activity, and self-proliferative signaling.

Fetuin-A is a unique molecule which binds to the insulin receptor, modulating its sensitivity, and transducing “the physiological conditions” (serum levels of the metabolites like glucose, free fatty acids, inflammatory signals) from outside into inside the cells. Plasma fetuin-A levels correlate with reduced glucose tolerance and insulin resistance. Impaired insulin sensitivity leads to the development of metabolic syndrome, an increased risk for type 2 diabetes (T2DM), dyslipidaemias and cardiovascular diseases (CVDs). Furthermore, fetuin-A inversely correlates with inflammatory and activation biomarkers, e.g. in patients with T2DM. Thus, circulatory fetuin-A levels may have plausible predictive importance as a biomarker of risk of diabetes and negative acute phase protein. Dysregulated, it plays a crucial role in the pathogenesis of some metabolic disorders and clinical inflammatory conditions like metabolic syndrome, T2DM, CVDs, polycystic ovary syndrome (PCOS), etc.

Symptoms of fatigue and exhaustion are considered to be the most common complaints in patients with oncological diseases during and after treatment. The manifestations can be on a physical, cognitive and emotional level. At diagnosis, 40% of patients report fatigue, and this percentage increases to 90% during treatment. However, the exact determinants of fatigue are not yet known. This article is a literary review of the problem of cancer-related fatigue – mechanisms, risk factors, and the impact on the lives of those affected. Literary data on the role of subjective well-being in terms of fatigue and emotional responses of patients with oncological diseases are described. A number of contemporary studies of the combined effect of fatigue and pain on the functioning of oncology patients have been discussed. It is concluded that the symptoms of fatigue, exhaustion and pain are considered the most common complaints in patients with oncologic pathology during and after treatment, whose manifestations may be physical, cognitive and emotional. On the other hand, human health satisfaction is one of the most important predictors of life satisfaction, which contributes significantly to the overall well-being of the patients group discussed.

Many studies report benefits of planned home births by registered midwives. In the 21st century, there are still controversial views and vivid discussions. This publication presents results from a survey on the opinion of obstetricians and midwives about home birth. An individual self-administered questionnaire was distributed among 26 obstetricians and 60 midwives from 14 maternitycare units in Central Northern Bulgaria and 93 undergraduate students in their last year of midwifery education in 6 universities in Bulgaria. The study instruments were approved by the Institutional Review Board (IRB) at the Medical University – Pleven. Data analysis was performed with Microsoft Office Excel 2016 and SPSS v.21.0. Home births were supported by 26.9% of the obstetricians, 20.0% of the midwives and 66.8% of the students. According to 65.4% of the obstetricians, 23.3% of the midwives and 15.1% of the students, midwives are not qualified enough to provide homecare services at delivery. Only 11.6% midwives and 35.5% students were confident that midwives could give adequate home birth care. This lack of support for home births in all the study groups in our survey can be attributed to organizational factors within the health system, as well as to low self-confidence of midwives and mistrust on behalf of obstetricians.

Stillbirth rate is an essential indicator of population health and is much more common than presumed. In 2014, it was 7.34‰ in Bulgaria. These trends are seen against the background of a continuous process of increasing proportion of births to unmarried women. This report aims to investigateand conduct a comparative analysis of indicators of stillbirth and extramarital births in Bulgaria for a 15-year period. The data was derived from the National Statistical Institute (NSI) and Eurostat and statistically processed with Statistical Package for Social Science version 24.0 (SPSS v.24.0). The correlation coefficient of Pearson was used to establish the relationship between stillbirth rates and extramarital births.

Despite the technological progress of contemporary medicine, the stillbirth rate in Bulgaria during the last 15 years remained almost the same – from 7.48‰ in 2000 to 7.34‰ in 2014. One of the factors that may increase the risk for stillbirth is the marital status of the mother. The proportion of extramarital stillbirths for the country was 74.70% of all stillbirths for 2014, but in several districts, this proportion was 100%. Extramarital births and stillbirth rate in Bulgaria seem to be related. There are persisting regional differences in Bulgaria. A potential explanation includes health inequalities and welfare differences.

Food allergy is an immunoglobulin E-meditated reaction, to which the organism’s immune system reacts to a food allergen, recognizing it as harmful. The study aimed to establish at what age cow’s milk protein allergy is manifested and determine the values of immunoglobulin E (IgE) and hemoglobin(Hb) in children with CMPA in Pleven region, Bulgaria. The study included 94 infants presenting with clinical manifestations of food allergy (age range 0 to 12 months) from Pleven and Pleven region, consulted in 2017 by a pediatrician at the University Hospital Consulting Center in Pleven. Venous blood was collected to determine the IgE and Hb values. Chronic iron-deficiency anemia could be the only clinical manifestation in children with CMPA. Out of all the children with CMPA, 17% had a pronounced anemic syndrome. The rest had normal Hb values. Anemic syndrome could have severe consequences for a growing child. Elevated IgE values were found in 73% of the children tested. CMPA is frequently seen in infants. Early diagnosis of clinical manifestations and diet could prevent severe complications of allergy such as chronic diarrhea, chronic urticaria, and asthma.

Chaenomeles maulei is the name of the cultivar of Chaenomeles japonica, which was introduced in Europe. The present study aimed to investigate the chemical composition and the antioxidant activity of Chaenomeles maulei fruit juice (CMFJ). The ingredients of the juice sample were measured by spectrophotometric, high-performance liquid chromatography (HPLC) and gravimetric methods. The antioxidant activity was measured by the oxygen radical absorbance capacity (ORAC) and hydroxyl radical averting capacity (HORAC) assays. The results showed that CMFJ was extremely rich in polyphenolic substances, amongst which the highest was the concentration of procyanidin oligomers, followed by phenolic acids (vanillic > caffeic > chlorogenic > neochlorogenic > p-coumaric > ellagic > ferulic > 4-dihydroxy-benzoic) and flavonoids (epicatechin > catechin > quercetin-3-β-glucoside > quercetin > rutin > naringin > kaempferol > myricetin). The sour taste of the juice and its low pH were due to the high content of organic acids (malic > quinic > citric > shikimic > ascorbic > oxalic). The carbohydrates were presented by glucose > fructose > galactose > xylose > rhamnose > arabinose. The antioxidant activity measured by ORAC and HORAC was very high. It could be attributed to the high content of polyphenolics in the juice.

The effect of aqueous matured stem extract of Opuntia dillenii on selected biochemical parameters in Male Wistar rats was explored. Standard analytical methods were applied. Forty Wistar rats (80-100g) were used in the animal studies, separated into four groups. The control group was solely administered normal feed and saline, group I was administered 100mgkg⁻¹ of the extract, group II received 300mgkg⁻¹ of the extract and group III received 500 mg/kg⁻¹ of the extract. A significant increase (p<0.05) in the activities of alanine aminotransferase (ALT) and alkaline phosphatase was observed in group II and III rats, as compared with the controls. A significant decrease in urea and creatinine concentrations was found only in group III rats against the controls. Also, a significant (p<0.05) decrease in triglyceride, total cholesterol, and low density lipoprotein (LDL)-cholesterol was seen in group II and group III rats when compared with the control. The hematological evaluation revealed a significant (p<0.05) decrease in red blood cell and hemoglobin levels in group III rats when compared with the control. The findings showed both beneficial and toxicological effects of the plant. Hence, for optimal therapeutic benefits, a further toxicological survey could still be carried out perhaps at higher doses.

We performed a retrospective evaluation of the criteria for suspected pulmonary embolism (PE) and requests for computed tomography angiography (CTA) by the emergency room (ER) teams. Simultaneously, we tried to find irregularities in their work. Then we designed new behavioral protocols, and yearly we evaluated the effect on the workload of the computed tomography (CT) unit of the Roentgenology and Radiology at the University Hospital – Pleven and the total impact on the behavior of the teams in cases of suspected for PE. The data from before and after the intervention was evaluated. After the implementation of the protocols, matching the criteria of PE rule-out criteria (PERC), the number of D-dimer testing, echocardiography, and computed tomography pulmonary angiographies (CTPA) was significantly higher. We found that the number of patients urgently transported for primary thrombectomy had increased, and the reduction of PE mortality in the Emergency Unit proves the safety of our intervention. Overall, the intervention in the attitude of the ER teams has a significant positive effect on the management of patients with suspected PE.

This paper aims to demonstrate that improving automated systems used to spread regulated information has a positive social effect. The provision of capability to replace manual insertion, and particularly direct import of data in XML-format into the systems of information agencies will save time (“economization of time”) spent for spreading financial statements by 90%. The saved working time can be utilized to fulfill other office tasks within current employees’ obligations, carrying out office assignments not listed as present obligations. Employees could improve their qualification through familiarization with novelties in normative bases or with good practices of other companies, substitute colleagues absent from work (leave or sick leave), and analyze work environment and suggest improvements.

Our purpose was to present a technique of pneumodissection applied with total mesorectal excision that ensured effective pelvic nerve preservation. Its detailed description emphasized the role of the proper definition of optimal dissection plane around the rectal cancer, the so-called ‘holy plane’ for total mesorectal excision. The study covered 28 rectal cancer patients at a mean age of 58±7.6 years (range 53 to 69 years). Rectal cancers were of TNM stages I-III and differentiation grades of G1-G3. Total mesorectal excision with pneumodissection between 2011 and 2016 was performed. Inflation of the pararectal space with CO₂ improved visualization of the operative field between visceral and parietal fascia thus preserving plexus (pl.) vesicalis, pl. deferentialis, pl. prostaticus and pl. cavernosus penis. A fast and clean mesorectum mobilization was made without any damage to the visceral fascia, and total mesorectal excision was performed in the embryonal plane. Pl. hypogastricus superior in the region of the aortic bifurcation nervi (nn.) hypogastrici dextri et sinistri laterally to the rectum and pl. hypogastricus inferior were preserved, too. Encouraging postoperative results included pelvic nerve preservation and absence of complications. A broader application of the safe method of pneumodissection in open and laparoscopic rectal cancer surgery should be recommended.

Aronia melanocarpa fruit juice (AMFJ) has been intensively studied for effects on the central nervous system. The study aimed to investigate AMFJ for possible sedative-hypnotic effects in rats after acute and subchronic administration. Male Wistar rats were treated orally with three doses of AMFJ (2.5, 5.0 and 10.0 ml/kg) either once (acute treatment) or in 30 days (subchronic treatment). Control rats were similarly treated with distilled water. The tests were performed 1 hour after the last AMFJ administration. The possible sedative-hypnotic effects of the juice were investigated in the open field test (OFT) and thiopental-induced sleeping time test. Substances with sedative-hypnotic effects decrease locomotor activity in the OFT and prolong the time of thiopental-induced sleep. The results from the OFT showed that neither the acute, nor the subchronic treatment of rats with all AMFJ doses affected the horizontal and vertical locomotor activity significantly. The two patterns of administration of AMFJ (acute and subchronic) had no significant effect on the duration of thiopental-induced sleep. The lack of effect of AMFJ on locomotor activity and the lack of prolongation of thiopental-induced sleep showed that AMFJ did not display sedative-hypnotic effects in rats.