Volume 8 (2015): Issue 2 (December 2015)

The tubulin cytoskeleton is vital for maintenance and dynamics of eukaryotic cells and molecular defects in its components can lead to serious conditions. So far, mutations in genes for alpha-, beta- and gamma-tubulin, motor proteins of the kinesin and dynein family, microtubule-associated and centrosomal proteins have been found to cause disorders in humans. Most phenotypic effects are on the nervous system, leading to abnormal brain development (e.g. lissencephaly and microcephaly) or to neurodegeneration in later life (e.g. amyotrophic lateral sclerosis and frontotemporal dementia). Another group of disorders include the ciliopathies, caused by defects in the axoneme. They include primary ciliary dyskinesia (immotile cilia syndrome), which is characterized by chronic respiratory infections, male infertility and randomly established left-right asymmetry. In most cases, the underlying defects are in axonemal dynein. Mutations in genes for centrosomal components have been shown to cause cortical dysplasia and dwarfism by disrupting the mitotic spindle, and some cases of infertility with maturation arrest are likely to be caused by unidentified mutations damaging the meiotic spindle. In view of these diverse phenotypes, knowledge about mutations affecting tubulin cytoskeleton becomes increasingly useful for clinical practice.

Since 1994, alcohol septal ablation (ASA) has been used as a minimally invasive treatment of patients with hypertrophic obstructive cardiomyopathy, resistant to conservative medical therapy. This catheter-based intervention consists of injecting absolute alcohol in a septal perforator to induce infarction of the hypertrophied septum and thus diminish the left ventricle outflow tract obstruction. This reduction of the gradient is associated with reduction of symptoms and left ventricle remodeling. The procedure was improved after the introduction of myocardial contrast echocardiography for visualization of the area at risk of infarction and reduction of the alcohol amount. Major complications of ASA are rare but centers with experience have reported conduction disorders - about 10% of patients needed permanent pacing because of complete AV block. Large randomized prospective studies have not yet compared alcohol septal ablation to the gold standard for treatment of hypertrophic obstructive cardiomyopathy - surgical myomectomy.

The present study demonstrates the antihypertensive effect of magnesium sulfate (Cormagnesin^®) and its combination with Furosemide on conscious spontaneously hypertensive rats (SHR) after intravenous infusion. Experiments were carried out on six groups of conscious male SHR (n=6). Under short anesthesia the rats were chronically instrumented for intravenous (i.v.) drug administration. The arterial blood pressure (AP) was measured by indirect tale method. Cormagnesin^® was applied by i.v. infusion in doses of 5, 20 and 40 mg/kg; and furosemide (10 mg/kg) was applied intraperitoneally. Experimental results showed significant decrease of AP after i.v. infusion of 20 mg/kg Cormagnesin^® as well as after application of the Cormagnesin^® and furosemide combination. The hypotensive effects of 40 mg/kg Cormagnesin^® and of furosemide were not significant. There was no significant difference between the antihypertensive effects of Cormagnesin^® and its combination with furosemide but the combination showed much better hypotensive effect than Furosemide (p<0.05). Our study demonstrated the antihypertensive effect of magnesium sulfate on conscious SHR after i.v. application. Our results suggest that the antihypertensive effect of magnesium sulfate in the doses applied is not dose-dependent. Magnesium sulfate potentiates the antihypertensive effect of furosemide in SHR.

Aronia melanocarpa 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.

The incidence of deep venous thrombosis (DVT) depends on the specific genotype, inheritance of prothrombotic polymorphisms and the influence of environmental risk factors. Rs1799889(-) polymorphism in the promotor of PAI-1 gene has been described as a risk factor for hypercoagulable state. Objective: To evaluate the contribution of thrombophilic rs1799889 (-) in the promotor of PAI-1 gene on the incidence of DVT in women and men in groups below and above 45 years of age. Тhere was significantly higher rs1799889 (-) polymorphism carriage among female patients with DVT vs controls (Chi squared =5.506, OR=2.170, p=0.021) but not in male patients (Chi squared =0.090 OR=1.147, p=0.825). A significant contribution of rs1799889 (-) polymorphism to early onset of the disease was found in female patients aged 45+ and carriers of the polymorphism (Chi squared =7.476, p=0.006), but not in young women.

The aim of the retrospective study was to analyze results after penetrating keratoplasties in patients with bullous keratopathy. The study included 60 patients with bullous keratopathy who underwent penetrating keratoplasty for the period 1990-2011, at the Eye Clinic of Pleven University Hospital. The average age of patients was 67 years (range 29-84 years). Additional risk factors were registered in 22.67% of the patients. Early postoperative complications occurred in 56.79%. In the early postoperative period, 81.31% of the patients had clear graft and improvement of visual acuity was achieved in 83.77%. In the late postoperative period, the graft failed in 28.95% of the patients. These results suggest that bullous keratopathy is an important complication after cataract surgery, and improvement of vision is possible only with keratoplasty.

The aim of this study was to explore citizens' expectations about local health policies in order to create an adequate strategy. Local authorities in many countries place health in the core of their strategic planning aiming to create and improve a health-supporting social and physical environment, as they usually have primary responsibility for planning and/or delivering many of the services that are crucial to addressing the social determinants of health. Local health policies are created in consultation with local health services, NGOs and citizens. The survey was conducted among 400 citizens of Pleven Municipality. Of these, 335 (83.75%) responded to the invitation. Information on health problems and determinants of health was collected through a direct inquiry survey. The majority of citizens considered the impact of environmental, educational, cultural and economic factors as well as public security on their health. They expected that more purposeful efforts of the local authorities be directed for improving living conditions and inequalities in health. The citizens are willing to work together with municipalities to create health policies, which reduce negative factors and increase positive ones. They are aware that local policies and decisions have a very significant impact on the economic, social and environmental factors affecting health and well-being and therefore municipalities play a key role in improving and protecting the health of their citizens.

The association between adolescent drinking and drinking of significant others is well known but underlying mechanisms are still not well understood. The purpose of the study was to investigate the association between social drinking in adolescents and drinking patterns of their significant others. We conducted a survey using a self-completed questionnaire on alcohol drinking habits. Of 903 students (aged 15-19), 279 (30.9%) were found to be abstainers (NDA) and 455 (50.39%) – social drinkers (SDA). These two groups were compared statistically about drinking patterns of their significant others. It was found that SDA were more likely to have fathers (OR=0.26; 95%CI=0.19-0.37), mothers (OR=0.26; 95%CI=0.19-0.37), friends (OR=0.26; 95%CI=0.19-0.37) and lovers (OR=0.26; 95%CI=0.19-0.37) that drank socially than NDA, but there were no significant differences in regular drinking of their fathers, friends and lovers. Only SDA mothers were more likely to drink regularly (OR=0.26; 95%CI=0.19-0.37). SDA were also more likely to receive alcohol offers from all their significant others, except from lovers. Social drinking in adolescence seems to be strongly socially motivated by drinking modeling and social pressure. The SDA mothers’ regular drinking is hard to explain in terms of social learning and social control theory and needs an alternative explanation.

This study aimed to investigate the opinion of students of medicine, nursing and midwifery on their training in communication skills as an optional course. The participants included in the study were 126 students altogether. Information was gathered using a self-administered questionnaire. The results showed the level of motivation to participate in the training process, the results desired and achieved by the students and their evaluation of the quality of the training. The respondents were convinced that such training would be an asset for their future work as medical professionals and they were satisfied with the quality of training.

Jacob Moreno defined sociometry as “the inquiry into the evolution and organization of groups and the position of individuals within them”. Every person composes their own group of significant others and the social relations in this dominated by the person group of the most important people in their life is called sociometric profile. The sociometric profile provides an opportunity to reveal social bonds, dependences and influences that impact one's behavior. The aim of the study was to describe the sociometric profile of regularly drinking adolescents as a result from comparison with the sociometric profile of non-drinking adolescents. We conducted a survey among 903 students (aged 15-19), by means of a self-administered questionnaire about relations with father, mother, friends and lovers. Of these, 169 identified themselves as regular drinkers (RDAs) and 279 ‒ as abstainers (NDAs). We compared these groups to reveal the comparative sociometric profile of drinking adolescents. It was found that RDAs were significantly more likely to be: 1) highly dependent on their lovers (OR=1.6); 2) detached from their mothers (OR=4.55); 3) in ambivalent relations with their friends; 4) without significant differences in relations with their fathers. It seems that the Stars of RDAs are their lovers, the Isolates are their mothers and friends are their ambivalent Mutual Choice. This comparative sociogram suggests that lovers are likely to be the most influencing person among RDAs' significant others and intimate relations might be the main target in alcohol prevention programs.

Congenital cystic adenomatoid malformation (CCAM) is a rare abnormality of lung development. It was classified into 5 types by Stocker in 2002 and is also known under the name of congenital pulmonary airway malformation (CPAM). Cases are typically identified prenatally by routine ultrasonography screening. CCAM may present in the older child and adult as an incidental finding. The case presented is of a 21-year-old male patient who suffered from pulmonary infections with a recurrent productive cough 3-4 times the last 4 years. CT scanning of the thorax showed multiple cystic lesions in the right middle and lower lobes. The areas with the lesions were resected. The macroscopic and histological findings were typical for congenital cystic adenomatoid malformation type 2, which was the final diagnosis. Clinical presentations and prognosis depend on the type of lesion and its sequelae. The diagnosis is confirmed histologically.

A case of an unusual variation of the blood supply of an upper limb is presented. During a routine anatomical dissection, it was found that the posterior circumflex humeral artery had an unusual course and branching. It arose as a branch of the brachial artery, not the axillary one, and it did not accompany the axillary nerve. It ran under the lower border of the teres major muscle instead of passing through the lateral axillary foramen, then followed its usual course around the surgical neck of the humerus, supplying the deltoid muscle. It was also found that instead of arising from the brachial artery, the deep brachial artery arose from the posterior circumflex humeral artery. Variations are reported and their clinical relevance is discussed.

Epidermoid cysts are benign lesions composed of ectodermal structures. They account for less than 2% of primary intracerebral tumors. They can be present at birth (congenital cysts), or can be acquired cysts (after surgery or trauma). Some cysts are asymptomatic but depending on their location, they may cause symptoms such as headache, vertigo, seizures, focal deficits, increased intracranial pressure. The major differential diagnosis of epidermoid cysts are dermoid cyst, any cystic neoplasm, craniopharyngioma, arachnoid cyst. A 39-year-old female patient with complaints of headache, vertigo, nausea and vomiting was admitted to the hospital. Radiological data suggested intracranial tumor in fossa posterior. Craniotomy was performed and the biopsy specimen demonstrated the mass lesion to be an epidermoid cyst of the intracranial dermal sinus tract. Intracranial cystic-appearing masses can be problematic for both radiologists and physicians. Important characteristics demonstrated by computed tomography scans and classical magnetic resonance imaging sequences are significant for the accurate diagnosis, but the imaging appearances of intracranial cystic lesions are sometimes nonspecific, and the diagnosis is usually established by histological examination.