Volume 11 (2018): Issue 2 (December 2018)

Preterm birth (PTB) is a worldwide problem with great social significance because it is a leading cause of perinatal complications and perinatal mortality. PTB is responsible for more than a half of neonatal deaths. The rate of preterm delivery varies between 5-18% worldwide and has not decreased in recent years, regardless of the development of medical science. One of the leading causes for that is the failure to identify the high-risk group in prenatal care. PTB is a heterogeneous syndrome in which many different factors interfere at different levels of the pathogenesis of the initiation of delivery, finally resulting in delivery before 37 weeks of gestation (wg). The various specificities of risk factors and the unclear mechanism of initiation of labour make it difficult to elaborate standard, unified and effective screening to diagnose pregnant women at high-risk for PTB correctly. Furthermore, they make primary and secondary prophylaxis less effective and render diagnostic and therapeutic measures ineffective and inappropriate. Reliable and accessible screening methods are necessary for antenatal care, and risk factors for PTB should be studied and clarified in search of useful tools to solve issues of risk pregnancies to decrease PTB rates and associated complications.

Pure and nitrogen-doped titanium dioxide (N-doped TiO₂) photocatalysts were prepared by non-aqueous sol-gel method by means of the reaction between titanium (IV) chloride (TiCl₄) and C₆H₅CH₂ OH (benzyl alcohol), used as precursors and urea serving as a nitrogen source. The phase formation and short-range order of the resulting particles were characterized by X-ray powder diffraction (XRD) and infrared (IR) spectroscopy. The crystallite size of as-prepared composite powders was in the range 12-35 nm. The aim of this work was to investigate the efficiency of N-doped TiO₂ as a photocatalyst in degradation of model organic pollutants - dyes Reactive Black 5 (RB5) and Malachite Green (MG), under ultraviolet (UV) and visible (Vis) irradiation. 0ur results indicated that synthesized N-TiO₂ nanocomposites slightly improved the photocatalytic activity under UV irradiation, compared to the pure titanium dioxide (TiO₂), and had no effect under Vis light illumination.

The objective of this study was to investigate the attitudes and expectations of fourth-year student nurses regarding their professional fulfillment after completing basic education. A questionnaire survey was carried out in six higher educational institutions in the Republic of Bulgaria - Pleven, Sofia, Varna, Stara Zagora, Plovdiv, and Ruse. Almost half of the students involved (114, 49.10%), planned to apply for a master’s degree in management of health care, and 62 (26.70%) preferred fulfillment abroad. Concerning the place of work, 80 (34.50%) of the respondents wished to specialize in surgical care. Of this latter group, 108 (46.60%) expressed the opinion that they would obtain excellent training in surgical units, and 62 (26.70%) expected to like the specificity of work in such units. The most significant influence on professional orientation in the area of surgical care of the future nurses was that of the tutors from the clinical bases - 90 (38.80%).

Atrial fibrillation (AF) is the commonest type of arrhythmia seen in everyday clinical practice, which leads to a significant increase in both morbidity and mortality. Its incidence increases with age and tends to turn into an epidemic. The cause of AF in 10-20% of cases remains unknown. Several mutations and polymorphism that might be responsible for the development of AF have been found, including single nucleotide polymorphisms (SNPs) - rs2200733 and rs10033464 in the long arm of the fourth chromosome. These polymorphisms are selected o the basis of genome- wide association study in Iceland from 2007, the results from which were later confirmed in 4 other large populations. The rs2200733 is a common noncoding polymorphism, described in National Center for Biotechnology Information (NCBI) database dbSNP like NC_000004.12:g.110789013C>T, with a frequency of the less common allele between 0.1 and 0.24. In order to investigate the association between the rs2200733 polymorphism in chromosome 4q25 and the development of AF, we studied the frequency of this polymorphism in patients with heart diseases from the Pleven region, and thus evaluate the relationship between the individual genotype and the clinical condition of the patients. We carried out a case-control study on 80 patients: 40 with AF and 40 without AF- from the Pleven region. None of these had structural heart disease. The study was conducted between November 2015 and November 2017. With deoxyribonucleic acid (DNA) analysis, we determined rs2200733 polymorphism, using a TaqMan-based polymerase chain reaction (PCR). The Cochran-Armitage trend test, the Chi-Squared Pearson correlation, Fisher test we used confirmed the statistically significant association between the rs2200733 polymorphism in chromosome 4q25 and the development of AF. In the population examined, the genotypic frequencies were as follows: CC - 45 (56.2%), CT - 19 (23.8%), TT - 16 (20%), with value of Chi-Square (χ²) 24.496, df=2, p<0.001. Screening for SNPs could be a useful marker for the detection of patients predisposed to AF.

Detection of mutations in breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene is an effective method of early diagnosis and prevention of breast cancer (BC). The mutational spectrum of both genes in Bulgarian population has not been studied in depth. The aim of this study was to investigate the prevalence of five deleterious BRCA1/2 point mutations in high-risk BC women, selected according to the National Comprehensive Cancer Network (NCCN) Guidelines including early age of onset, triple-negative BC and family history of breast or ovarian cancer. The prevalence of two BRCA1 mutations (C61G and 5382insC) and three BRCA2 mutations (6079del4, 9326insA and 9908delA) was evaluated in 80 females with BC, obtained from the Cancer Registry of University Hospital - Pleven. Genetic testing was performed by direct DNA sequencing. One deleterious mutation (5382insC in exon20 in BRCA1) was been found in two patients (2.5%). Both women were diagnosed with BC before age 45. The prevalence of BRCA mutations established in our study was lower than the one found in another preliminary study on Bulgarian population. We concluded that this discrepancy was due to the genetic heterogeneity of the population and the specific mutational spectrum of the BC patients from the Pleven region.

The rising incidence of bronchial asthma and obesity in children raises the question of whether there is a link between them. Chronic low-grade systemic inflammation could be one of the linking mechanisms. We aimed to determine the serum concentrations of high-sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6) and tumour necrosis factor a (TNF-a) in children with asthma and obesity and to seek a relationship between these inflammatory markers and asthma control. We investigated 88 children aged 6 to 17 years - 25 asthmatic obese children (AsOb), 25 asthmatic non-obese children (AsNOb), 19 obese non-asthmatic children (ObNAs), and 19 non-obese non-asthmatic children as controls. Serum levels of IL-6 and hs-CRP were significantly increased in asthmatic obese and ObNAs compared to AsNOb and the control group. Serum TNF-a concentration was similar in the four studied groups. There were no statistically significant differences in serum levels of these inflammatory markers between controlled and partially controlled/uncontrolled asthmatics (obese and non-obese). Knowing the possible mechanisms of interaction between bronchial asthma and obesity would contribute to a more effective therapeutic approach in these patients.

The Ca²⁺/calmodulin dependent kinase II (CaMKII) represents a family of serine/threonine kinases with diverse functions, implicated in various signalling pathways in the cell, especially in those controlling cellular proliferation and cellular death. The human epidermoid carcinoma cell line A431 is an established model for the study of the cell cycle and cancer-associated signalling, in which the role of CaMKII is not so well elucidated. Therefore, the present study aimed to investigate the role of CaMKII in the induction of apoptosis in the cell line A431 following ultraviolet (UV) irradiation and to determine the downstream events with a focus on the caspase cascade. For the latter purpose, we employed a method initially developed for the simultaneous determination of the activity of 10 different caspase enzymes. Following exposure to UV light, we observed activation of the activator caspase-8 followed by activation of the effector caspase-3, triggering apoptosis in the epidermoid carcinoma cell line A431. The results supported a pivotal role of caspases and demonstrated that a protein kinase cascade involving caspases-8 and -3 is the main pathway driven in UV-induced apoptosis in the human carcinoma cell line A431, and apoptotic stimuli triggering this pathway passed through activation of the kinase CaMKII.

Craniometric points are essential for orienting neurosurgeons in their practice. Understanding the correlations of these points help to manage any pathological lesion located on the cortical surface and subcortically. The brain sulci and gyri should be identified before craniotomy. It is difficult to identify these anatomical structures intraoperatively (after craniotomy) with precision. The main purpose of this study was to collect as much information as possible from the literature and our clinical practice in order to facilitate the placement of craniotomies without using modern neuronavigation systems. Operative reports from the last five years on cranial operations for cortical and subcortical lesions were reviewed. All the craniotomies had been planned, using four methods: detection of craniometric points, computed tomography (CT) scans/topograms, magnetic resonance imaging (MRI) scans/topograms, and intraoperative real-time ultrasonography (USG). Retrospectively, we analyzed 295 cranial operations. Our analysis showed that operating on for cortical lesions, we had frequently used the first and the second method mentioned above (118 patients), while in cases of subcortical lesions, we had used craniometric points, MRI scans/topograms and intraoperative real-time USG as methods of neuronavigation (177 patients). These results show that craniometric points are essential in both neurosurgical procedures.

Deciding on a treatment approach for early stage lung cancer (0-1) is sometimes difficult because of uncertainties regarding the depth of tumour invasion and its margins. Even with advanced technology, such as endobronchial ultrasound and autofluorescence bronchoscopy, it is often difficult to be precise. In this currently discussed case, treatment of a 61-year-old female patient with early stage IA lung cancer could not proceed for such reasons. Fortunately, timely surgical intervention allowed preservation of lung function and the patient is now under close surveillance.

Colorectal cancer in pregnant women is rare and represents a diagnostic and therapeutic challenge for clinicians. We present a case of a 38-year-old pregnant woman, diagnosed with colorectal cancer and liver metastases during the 29th week of gestation. After clinical evaluation and making the diagnosis, the patient underwent an emergency cesarean section (C-section) and bypass anastomosis between the transverse colon and sigmoid colon. The babies were born healthy without any complications. After recovery, the mother started treatment with chemotherapy, but two months later she died due to the spread of the disease. Cancer during pregnancy is always a challenge for diagnosis and treatment.