Volume 14 (2021): Issue 1 (June 2021)

Nowadays, usage of sauces as part of a meal has seen a significant increase. In their diversity as raw materials and technology of production, sauces are a potential source of health problems. During their production, primary and secondary contamination with microorganisms and other physical or chemical contaminants is possible. Ineffective internal control is a prerequisite for the emergence of health problems among consumers. The subject of the study is а sauce manufacturer. An algorithm was designed to perform the audit and for the purposes of the. The prerequisite measures were placed in separate Good Hygiene Practices (GHP) and Good Manufacturing Practices (GMP) programs and in the technological documentation for all the sauces produced, with plans, procedures, orders, instructions, lists, registers and other documents, all closely related to the specifics of production. The technological documentation was found to be in agreement with the Food Safety Management System – the HACCP-plan. The technological documentation, which is part of the prerequisite measures, corresponded to its purpose and, with slight adjustments, is a good basis for the effective functioning of the Food Safety Management System. The conclusions contain specific recommendations for revision of the Internal Control System, including correction of elements of health and hygiene importance.

Enhanced recovery after surgery (ERAS) protocols are standard in elective colorectal surgery. They lead to decreasing postoperative complications and shorten the hospital stay and the recovery period. Following these protocols is associated with better short-term results and better and disease-free survival in cases of respectable colorectal carcinomas. There is clear evidence of the beneficial effect of the protocols in reducing the rate of postoperative complications and shortening the hospital stay after elective colorectal surgery. There remains the question of whether these protocols are applicable effective in patients after emergency colorectal surgery. Over the last years, safe and effective ERAS protocols have been reported in patients with life-threatening conditions such as colorectal obstruction and intraabdominal infection.

The human life span could be influenced by the combined effect of environment, lifestyle, and genetic factors. Twin and family studies suggest that our genes control up to 25% of the lifespan. The aging immune system undergoes age-associated changes at multiple levels, resulting in a gradual loss of its ability to protect the organism against infections, low vaccine responses, and an increased probability of developing autoimmune diseases and malignancies. The highly polymorphic HLA complex is one of the major gene candidates associated with aging due to its crucial role in developing adaptive immunity and protecting the organism. Most of the data available have so far demonstrated a positive association with healthy aging for HLA alleles/haplotypes as protective against malignancies, autoimmune diseases, and conferring better control and response to infections.

One of aging’s main manifestations is the chronic, low-grade inflammatory state observed in older people, caused by an imbalance between pro- and anti-inflammatory cytokines. In general, it is has been agreed that longevity is related to anti-inflammatory genotype profiles. With advanced age, changes also occur in the B cell repertoire, which significantly affects the humoral immunity and leads to inadequate responses to infections and vaccines in the elderly. New genetic biomarkers associated with aging are being explored and discovered, contributing to a better understanding of the molecular processes underlying the immune dysfunction related to aging and developing strategies for rejuvenating the immune system based on immune-risk phenotypes.

Cardiovascular diseases (CVD) are the leading cause of invalidity and death in developed countries. Among them, the main cause of death is coronary artery disease. In this retrospective study, 172 patients with acute coronary syndrome (STEMI, NSTEMI, UA) are included. They had been hospitalized on an emergency basis in the Cardiology Department, Invasive Sector of Prof. Dr. St. Kirkovich Hospital in Stara Zagora, and the Cardiology Hospital -Yambol between January 2009 and February 2010. We found a significant difference in the age at acute coronary syndrome (ACS) occurrence by sex: earlier manifestation was observed in men (p=0.018). The univariant regression analysis showed that elderly age (p=0.005, OR 1.024), glomerular filtration <90 ml/h (p=0.006, OR 0.964), GRACE-score > 140 pt (p<0.001, OR 1.045), HF (Killip class ≥ II) (p=0.002, OR 15.6) and EF<40% (p=0.003, OR 1) were factors for adverse prognosis in the first, fifth and ninth year. Only GRACE-score was an independent predictor of death obtained by multivariate regression analysis in the study (p=0.002, OR 1.052). The factors influencing long-term survival adversely after ACS are age, smoking, chronic kidney disease, previously experienced myocardial infarction, diabetes mellitus, three-vessel coronary disease, and decreased systolic function of the left ventricle, and GRACE > 140 p.

Myeloproliferative neoplasms (MPN) are clonal hematological conditions characterized by excessive production of one or more cell lines in the bone marrow. The blood cells produced are often hyperactive in their functions, which could lead to complications in the disorder‘s clinical course. We aimed to define the role of granulocytic CD11b/CD18 expression for the thrombotic risk in MPN patients. We investigated 110 patients with a histologically confirmed diagnosis of a myeloproliferative disease and a control group of 46 healthy volunteers. In the patient group, we found an average expression 4.59 times higher than in the control group. The highest expression was found in a subgroup of patients with polycythemia vera – 71.55% of the patients’ neutrophils. In each subgroup with essential thrombocythemia, myelofibrosis, and chronic myeloid leukemia, the patients with a history of thrombotic complication had a higher expression than the patients without such complications.

The study aimed to investigate glutathione peroxidase (GPx) activity and glutathione (GSH) levels in the sperm of patients with unexplained infertility. The sperm samples were collected from subjects with normal semen parameters divided into fertile and infertile groups. Sperm analysis was performed according to the 2010 WHO criteria. Measurement of the GPx activity and GSH were performed by enzymatic assay kits. The higher enzymatic activity recorded in spermatozoa and seminal plasma in the infertile group was close to the significant one – p=0.054 for seminal plasma andp= 0.086 for the spermatozoa.GSH levels were higher in the fertile group in the seminal plasma (p=0.045). Defining the causes of unexplained infertility requires the addition of oxidative stress. In patients with unexplained infertility, the level of glutathione is reduced, and the activity of one of the significant enzyme antioxidants GPx is not changed significantly and even shows a tendency to rise.

In March 2018, in the Clinic of Pediatrics of the University Hospital “G. Stranski ”- Pleven, we have created a Center for diagnosing and treating children with growth disorders, in active collaboration with an established expert center. During the study, 53 children with height <-2 SDS were referred to the newly established Growth Center. The diagnoses of children receiving treatment with growth hormone (GH) were made in clinical settings based on the history, physical status, auxological assessment, imaging studies, basal and stimulated hormone tests, genetic tests. The children‘s mean age was 9.7 ± 4.5 years, with a significant gender difference (p>0.05), living mainly in cities. For 18 months, we treated a total of 11 children (54.5% male) with an average age at the start of GH therapy of 8.1 ± 4.4 years and an average growth velocity of 10.3 ± 7.7 cm/year. Treatment with GH was introduced in Pleven after successfully establishing the Growth Center in the Clinic of Pediatrics. The first results showed a significant increase in the number of diagnosed and treated children whose follow-up we found an acceleration in growth and bone maturation, positive body composition changes, and lack of side effects from the treatment.

The study aimed to investigate immune cell infiltration in different subtypes of breast cancer (BC). Retrospectively were selected 100 patients with primary BC, grouped into four molecular surrogate subtypes (Luminal A and Luminal B-like, HER2-positive and triple-negative - TN), determined by immunohistochemistry (IHC). In each patient, a percentage of stromal tumor-infiltrating lymphocytes (TILs) was determined by hematoxylin-eosin staining. IHC was performed using primary antibodies CD3, CD4, CD8, CD20, and FOXP3. Immunophenotyped lymphocytes were counted (separately intratumoral and stromal) and semi-quantitatively graded. In the studied tumors, 10% were defined as lymphocyte-predominant BC. A high count of intratumoral and stromal TILs subsets was found mainly in TN and HER2-positive BC. The stroma is the preferred localization for immune cells in all four BC subtypes. CD3+ T predominates over CD20+ B lymphocytes, with CD8+ T cytotoxic and FoxP3+ T regulatory cells dominating T subtypes. HER2 and TN are more immunogenic than Luminal A and Luminal B – like subtypes of BC. The T-cells’ immune response was predominant in the studied cases of BC, with a predominance of CD8+ Tc and Foxp3+ Treg cells located mainly in the stroma.

This study aimed to determine the bacterial profile of vaginal samples from pregnant women and the prevalence of identified microorganisms. Materials and methods: A prospective epidemiological study was conducted on 150 pregnant women admitted to the Clinic of Obstetrics and Gynecology at Dr. G. Stranski University Hospital in Pleven. Vaginal secretion samples were collected from all the 150 women. Direct microscopy of native smears prepared by the wet mount method to detect Trichomonas vaginalis and direct microscopy of Gram-stained smears was performed. Aerobic culture studies were conducted to identify pathogenic bacteria and Sabouraud glucose agar (SGA) to detect the presence of Candida spp. Samples were also collected from 107 of the women for PCR tests for mycoplasma detection. Results: The highest relative share in the study was women aged 21 to 35 years 104 (69.33%). Of all the hospitalized and examined pregnant women, 87 (57.99%) had medical problems during the current pregnancy and postpartum complications, and 63 women (42%) gave birth without accompanying complications. In 86 (57.32%) of the women, bacteria were detected by direct microscopy of Gram-stained smears. Of these, 24 (16%) had gram-negative rods, 28 (18.66%) had gram-positive cocci. In 34 (22.66%), we found gram-negative and gram-variable pleomorphic bacteria. The aerobic culture study revealed microbiological growth in 44 (29.33%) of the women investigated. Conclusions: Studies on the profile of the vaginal microbiota in pregnant women and the spread of pathogenic microorganisms are essential for make prognoses for pregnancy outcome, evaluating the risk of developing a maternal-fetal infection, and discussing options for timely treatment.

This report presents clinical case with a histopathologically established lipoma of the sublingual space. Lipomas are benign mesenchymal neoplasms produced by adipocytes. Our search in the literature demonstrated that the development of lipomas in the sublingual space is extremely rare. In the oral cavity, it is seen in less than 5% of patients. In this paper, we describe clinical features, imaging diagnostic and histopathological features. Lipomas are characterized by slow growth and could be asymptomic, therefore diagnosis could be delayed.

This report describes and discusses the case of a 64 years-old-man with a formation, located below the left tongue, for a period of 4 years. The patient had repeatedly consulted with Ear-Nose-Throat (ENT) specialists and dentists who recommended surgical treatment. During the last month of the monitoring, the formation had grown significantly and the chewing and speech function had gradually worsened.