<abstract><title style='display:none'>Summary</title>According to the World Health Organization there are almost two billion people worldwide who consume alcohol on a regular basis. It’s a common abuse and almost 80 million are diagnozed with “alcohol abuse disorders” (WHO 2002, 2004). Excessive alcohol consumption is related to more than 60 different medical conditions, as suicide, homicide and different forms of accidents. Some conditions are acute, while other conditions such as liver cirrhosis, chronic pancreatitis, haemorrhagic stroke and various forms of cancer, are chronic consequences. Non-carious destructions of teeth like dental erosion are also associated with frequent alcohol consumption, because of precipitation of salivary proline-rich proteins caused by polyphenols present in most alcoholic drinks. The high concentration of organic and inorganic acids and the habit of keeping the alcoholic drink in the mouth can cause chronic inflammations of the soft tissues in the mouth and can increase the negative side effects from metals of crowns, bridges, orthodontic devises and various restorations. A literature review has been made due to the authors clinical observations and experiences.</abstract>

Conservative Dentistry, FDM, MU – Sofia, Faculty of Dental Medicine Medical University 1 Sv. G. Sofi yski St. BG – 1431 Sofia

Conservative Dentistry, FDM, MU – Sofia

Effect of Alcohol to Oral Health

<abstract><title style='display:none'>Abstract</title>The pulp hyperaemia is associated with increased blood flow in the pulp. Diagnosis of this condition is very important for the outcome of a dental treatment. There are new methods, which can detect the pulp blood flow. Such method, gaining increasing popularity nowadays, is pulse oximetry. In this study, intact teeth and teeth with diagnosis of hyperaemia pulpae are examined by pulse oximeter and electric pulp test. The results show that the threshold of irritation is decreased in teeth with hyperemia, and the saturation of the pulp is increased by 12.34% in frontal teeth and 7.27% in distal teeth. There is a statistically significant difference (p &lt; 0,05) in the values measured with pulse oximeter in the intact frontal and distal teeth and the teeth with hyperemia. Pulse oximetry can detect changes in pulp microcirculation in state of hyperemia. It is an extremely valuable method for early, objective diagnosis of pulp blood flow, as well as for its monitoring in dynamics.</abstract>

Pulse Oximetry and Electric Pulp Test in Intact Teeth and Teeth with Hyperaemia Pulpae

<abstract><title style='display:none'>Abstract</title>This study attempted to determine the level of psychological well-being among postgraduate students. The study also aimed to assess the relationship between psychological well-being and demographic factors, such as age and field of study. Psychological well-being questionnaires were administered to a sample of 192 Master of Education students. The findings demonstrated that Master of Education students possessed a slightly high level of psychological well-being. Differences were found in students’ psychological well-being across age groups, F (4, 167) = 3.178, p = 0.01, and field of study, F (8, 163) = 2.668, p = 0.01, respectively. According to the results, students in the age group of 41 years and above possessed the highest level of psychological well-being (M = 5, SD = 0.71).</abstract>

Psychological Well-being among Postgraduate Students

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Aims</title>
The aims of the present study are to investigate the relationship between the anthropometric indicators and peculiarities of the nutritional intake in people with overweight and obesity and the risk factors for the development of dental caries in adults.
</sec>
<sec>
<title style='display:none'>Materials and Methods</title>
The study involved 264 individuals aged between 18 and 60 years. The following risk factors for the development of dental caries were traced: diet (carbohydrate intake), oral hygiene habits and social status in overweight and obese people. The dental caries incidence was determined through the DMFT index, by assessing the total number of teeth which are decayed (D), missing (M) due to caries, or filled (treated, F).
</sec>
<sec>
<title style='display:none'>Results</title>
The age-related distribution was as follows: from 18 to 25 years – 14.4%; from 25 to 35 years – 16.7%; from 35 to 50 years – 42.4%; and over 50 years – 26.5%. The established average BMI was 25.60 ± 4.359, with the lowest and highest measured values – 18.5 and 37.55, respectively. The value of DMFT was 12.55 ± 5.545. A direct correlation between the elevated incidence of dental caries in patients with overweight and obesity was revealed. No significant relationship was found between the decreased nutritional intake of vitamin D and the incidence of dental caries in individuals with Class I and Class II obesity.
</sec>
<sec>
<title style='display:none'>Conclusion</title>
Dental caries and obesity have a similar etiology – improper dietary habits, excessive consumption of foods containing low molecular weight carbohydrates and carbonated beverages. The reported higher levels of dental caries in these groups could be explained by an improper diet and more frequent snacking.
</sec>
</abstract>

Dietary Intake of Vitamin D and Dental Caries Incidence in People with Overweight and Obesity

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Introduction</title>
Liver resection is widely accepted as a treatment option for primary liver cancer and metastases. The goal of surgery is to resect all tumours with negative histological margins while preserving sufficient functional hepatic parenchyma and reducing postoperative complications. The use of Indocyanine green (ICG) for liver function assessment and fluorescence image-guided surgery could be used to achieve that goal.
</sec>
<sec>
<title style='display:none'>Clinical Case Description</title>
We present the case of a 62-year-old female patient with diagnosed sigmoid colon cancer with four bilobar liver metastases who underwent a simultaneous sigmoid resection and ICG fluorescence image-guided liver resection 3 days after preoperative ICG liver function assessment. We decided to perform liver-sparing resection having in mind the liver metastases’ number, size and location and the slightly impaired liver function (ICG retention rate 15 – ICGR15 was 14,02%). All liver tumours were removed without complications, and the resected margins were all microscopically free of tumour tissue (R0 resection). The postoperative period was uneventful, without any signs of postoperative liver failure.
</sec>
<sec>
<title style='display:none'>Conclusions</title>
ICGR15 can be considered a safe and informative marker for liver function and indirectly for the degree of portal hypertension. ICG fluorescence provides an additional method to assist intra-operative tumour identification. The best timing of injection requires further study.
</sec>
</abstract>

Indocyanine Green Fluorescence for Liver Assessment and Imaging-Guided Resection of Colorectal Metastases: A Case Report

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Objective</title>
The aim of the present prospective clinical study was to highlight the importance of the proper application of the manual detorsion (MD) in cases of intravaginal testicular torsion. Major complications such as ischemia, reperfusion injury and testicular compartment syndrome could be avoided.
</sec>
<sec>
<title style='display:none'>Materials and Methods</title>
From January 2017 to February 2018, 26 boys aged between 8 and 16 years underwent surgical treatment for intravaginal testicular torsion (ITT) (14 left- and 12 right-sided). Diagnosis was made upon clinical criteria (both symptoms and signs); sudden onset of scrotal pain (n = 26, 100%), nausea and vomiting (n = 25, 96,15%), abdominal pain (n = 3, 11,53%), high testicular position (n = 21, 80,77%), absence of the cremasteric reflex (n = 26, 100%), harshness of the twisted testicle (TT) (n = 24, 87.5%), alteration on axis or orientation of the TT (n = 24, 94,31%), and pain during palpation (n = 26, 100%). Two cases presented with neglected scrotum leading to inability to evaluate the intrascrotal structures. Major ultrasonographic findings were the following: absence of perfusion, heterogeneity of the parenchyma and identification of the Whirlpool sign. Therefore, our study group consisted of 15 out of the 26 cases, in which the initial assessment at the Emergency Department occurred within the first 3-7 hours after the onset of ITT.
</sec>
<sec>
<title style='display:none'>Results</title>
Based on high clinical suspicion and ultrasonographic documentation of the ITT, MD was performed in all those cases. Pain alleviation followed immediately, while significant improvement of the clinical picture of the suffering scrotum was also observed. Successful detorsion was documented via ultrasonography. After completion of the preoperative assessment, bilateral orchidopexy was performed. All patients had an uneventful postoperative course and were discharged home on the second postoperative day.
</sec>
<sec>
<title style='display:none'>Conclusion</title>
In conclusion, we hereby document that MD is a safe, non-invasive method, easy to learn for every clinician. It can be applied immediately after the diagnosis of the ITT, converting a highly urgent surgery into an elective one. Of course, surgical exploration of intrascrotal structures constitutes a crucial final step.
</sec>
</abstract>

The Importance of Manual Detorsion in Intravaginal Testicular Torsion

<abstract>
<title style='display:none'>Abstract</title>
Keratoplasty is one of the most common tissue transplants. However, its application in children remains a high-risk procedure. The child eyeball is smaller, the cornea and sclera are more elastic, a higher pressure on the vitreous body and often other malformations of the anterior eye segment are present, all of which makes it a significantly more difficult intervention than that in adults. The aim of the report is to present a case of keratoplasty in a child with corneal perforation due to trauma. A 7-year-old child, who fell off a bicycle 4 days ago and hit their eye area, was admitted to the eye diseases clinic. In the clinic, an examination was performed under general anesthesia; a foreign body was removed from the left eye and a perforation of the cornea was established. A penetrating keratoplasty was performed. Two months after the surgery, loosening of the sutures began, and scarring and their gradual removal became necessary. 18 months after the operation, the eye is completely calm and the transplant is transparent. Penetrating keratoplasty in children remains a major challenge for most surgeons. A good collaboration with the parents is necessary to preserve the transparency of the transplant and improve visual acuity.
</abstract>

Penetrating Keratoplasty in Children

<abstract>
<title style='display:none'>Abstract</title>
Primary defects in two or more ectodermally-derived tissues during embryonic development characterize ectodermal dysplasia, a vast, varied group of inherited illnesses. Skin, hair, nails, eccrine glands, and teeth are the primary tissues affected. Most cases of ectodermal dysplasia are caused by the X-linked recessive form of the disease (also known as Christ–Siemens–Touraine syndrome), which is passed down from female carriers to their male offspring. It is characterized by an absence of sweat glands (hypohidrosis or anhidrosis), malformed teeth (anodontia or hypodontia), and scant hair (atrichosis or hypotrichosis). Lack of teeth and unusual look were cited as major causes for alarm. The usual manifestations of hypohidrotic hereditary ectodermal dysplasia have been described in two case reports. Two identical siblings with possible typically X-linked recessive hypohidrotic ectodermal dysplasia are described here. Despite the lack of a cure, patients can benefit from a multidisciplinary approach to treatment planning and an expedient diagnosis.
</abstract>

Hereditary Ectodermal Dysplasia in Two Identical Siblings

<abstract>
<title style='display:none'>Abstract</title>
Sporadic Creutzfeldt–Jakob disease is a rare and fatal human prion disease characterized by a rapidly progressive dementia, myoclonus, cerebellar, pyramidal, extrapyramidal, visual, and psychiatric symptoms. These findings are all non-specific and making diagnosis is often difficult at the symptoms onset, especially in case of atypical clinical and radiological presentation. This case report describes a woman in her 60s, who presented with rapid cognitive decline, confusion, ataxia and electroencephalographic changes compatible with nonconvulsive status epilepticus. Her symptoms progressively worsened and she died 8 weeks after the onset. The two cerebrospinal fluid analyses were normal and no 14-3-3 protein was detected. The brain MRls revealed areas of cortical restricted diffusion involving the right frontal and parietal lobe. The electroencephalographic findings of continuous periodic generalized bi-triphasic complexes, typical for sporadic Creutzfeldt–Jakob disease, were detected 1 month after the onset. Sporadic Creutzfeldt–Jakob disease was neuropathologically confirmed. Although sporadic Creutzfeldt–Jakob disease is a rare neurodegenerative disease, it should be considered in the differential diagnosis of all cases with unexplained and rapid cognitive decline and confusion, along with ataxia, pyramidal/ extrapyramidal signs, myoclonus and dysphagia.
</abstract>

Sporadic Creutzfeldt–Jakob Disease

<abstract>
<title style='display:none'>Abstract</title>
Nuclear protein in testis carcinoma is a very rare but extremely aggressive highgrade carcinoma characterized by the presence of a fusion NUT gene – an oncogene. It is also called midline carcinoma because it mainly affects structures along the midline – head, neck, and lungs. We report a case of a woman with lung nuclear protein in testis carcinoma, diagnosed by bronchoscopic fibro-punch biopsy. The histological examination showed massive infiltration of bronchial wall of predominantly spindle-shaped neoplastic cells with unclear cytoplasmic borders. In some areas groups of rounded cells with clearly visible nucleoli and high mitotic rate were present. Foci with necrosis were also found. Immuno-histochemistry showed positive expression of cytokeratin, p63, CD56 and nuclear protein in testis antibodies and negative reaction for TTF1 and chromogranin A in neoplastic cells. The proliferative activity of tumor cells was very high (&gt; 70%). Immunohistochemical study of the nuclear protein in testis expression is mandatory in cases with poorly differentiated lung tumors, with predominantly midline mass.
</abstract>

A Rare Case of Lung Nuclear Protein in Testis Carcinoma

<abstract>
<title style='display:none'>Abstract</title>
Aggressive angiomyxoma (AAM) is a rare and benign mesenchymal tumor that localizes predominantly in the female pelvis. Its invasive growth and local recurrence are challenging for professionals. Histologically, AAM is a tumor with a myxoid stroma that is highly vascular and hypocellular. The diagnosis is made relatively late due to nonspecific symptoms. Treatment of AAM is extensive local surgical excision with intact resection lines. Gonadotropin-releasing hormone agonists are added postoperatively. The prognosis is good and metastasis is rare. We present a case of an aggressive angiomyxoma located in the left greater labial area in a 50-year-old woman. After discussion and informed consent signed by the patient, on 27.01.2023 at the University Hospital “St. Marina” Pleven, the patient was admitted to the hospital. The tumor was extirpated under epidural anaesthesia on the date of the patient&amp;#39;s informed consent. The patient was prescribed postoperative therapy with Zoladex 3,6 mg implant according to the schedule.The patient was subjected to monthly gynecological check-ups for one year after the surgical intervention. To date, no recurrence of the underlying disease has been detected. Long-term results show a good trend. In conclusion, we can say that the optimal treatment of AAM is wide local excision. It is not recommended to aim for radicality because of the risk of postoperative complications. Postoperative administration of GnRH-a is advisable to avoid recurrences. All patients undergo regular follow-up examinations for long-term follow-up.
</abstract>

Aggressive Angiomyxoma of the Female External Genitalia

<abstract>
<title style='display:none'>Abstract</title>
Ventriculoperitoneal shunt malfunction is frequently observed, with the ventriculoperitoneal shunt fracture being a prevalent etiology. The occurrence of ventriculoperitoneal shunt malfunction is approximately 40% in the first year after implantation and increases to 50% in the second year. Ventriculoperitoneal shunt fracture accounts for 15% of total ventriculoperitoneal shunt malfunction incidents. Ventriculoperitoneal shunt fractures commonly occur due to calcification, immune reactions, and abrasions. The report describes a 5-year-old child who exhibited ventriculoperitoneal shunt malfunction based on clinical examination and CT scan findings. The patient presented with fever and pain in the postoperative wound located posteriorly to the left ear. Radiographic imaging of the cranium and thoracoabdominal region revealed the presence of a ventriculoperitoneal shunt fracture and a C5 spinal disconnection. Additionally, it was demonstrated that the distal catheter had relocated to the abdominal cavity. The laboratory examination and cerebrospinal fluid analysis yielded normal results. The fractured ventriculoperitoneal shunt was subsequently removed and replaced with a new one. It is important to thoroughly investigate and comprehend ventriculoperitoneal shunt malfunctions, even during routine follow-ups.
</abstract>

Fracture into the Abdominal Cavity and the Presence of A Retroauricular Pseudocyst Are Diagnostic of A Partial Ventriculoperitoneal Shunt Dysfunction

<abstract><title style='display:none'>Summary</title>Biological rhythm of sleeping is a natural disparity in an organism corresponding to and in reply to cyclic environmental changes, such as daylight hours and hours of darkness or elevated and low down flow. There is some evidence, based upon epidemiological studies as well as studies upon smaller groups of subjects, that individuals who work during the night and sleep during the daytime show cognitive impairment at work, have poorer and fragmented daytime sleep, and have increased risks of developing a wide range of social, psychological, physiological and medical impairments and disorders. Circadian rhythms are one of the most important effective factors on the physiological and physical performances of humans and disturbing this normal rhythm leads to different groups of diseases. The majority of investigations in biological rhythm demeanor vary noticeably in regards to the exact type of disease, population and protocols of sampling over the other outcomes or issues. We conducted a systematic review of [Science Direct, Pubmed, Scopus] to identify influence of different kinds of diseases among shift workers in response to abnormal rhythm of sleeping. The results of this review indicate that abnormal patterns of sleeping can lead to immunological issues, hypertension, metabolic syndrome, insomnia, cardiovascular disease, obesity and depression. It is vital for subsequent investigations to find a way to reduce negative effects (such as decreased amount of works’ time and altered diet) without side effects to help them.</abstract>

Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia

Faculty of Physical Education and Sport Science, Shahid Bahonar University of Kerman, Kerman, Iran

Faculty of Educational Studies, Department of Sport Sciences, University Putra Malaysia, Malaysia

The Adverse Health Effects of Shift Work in Relation to Risk of Illness/Disease: A Review

<abstract><title style='display:none'>Summary</title>There are a variety of body aches that fall under the umbrella term of Musculoskeletal Discomforts (MSDs). These can be distinguished based on the level of pain suffered by the patient, ranging from mild and sporadic to serious, constant and fatal. It has been suggested that a link exists between MSDs and risk factors involving one’s occupational conditions and physicality. Examining the prevalence rate of musculoskeletal discomforts based on the severity among office workers was the main objective of this study. In order to achieve this objective, we had, in February 2015, selected from a population of 20 000 Malaysian office workers, 753 subjects within the age range of 20-50 years who have had a minimum of a year’s working experience. For this study, a form of structured questionnaire, known as the Cornell questionnaire, has been evaluated and put to use. Under the watch of the researchers, the subjects were instructed to complete the questionnaire in the morning before they begin their respective jobs. Based on their responses, the Cornell questionnaire has revealed that at least one case of severe pain in the neck, shoulder or lower back, respectively, is suffered by 69.7% of the subjects. In the case of neck-related aches, 15% low pain, whereas 51% involved mild pain and 33.9% were cases of severe pain. That being said, 19.3% low pain in the lower back, while 50.7% suffered from mild pain and 30% had severe pain in the same region. Percentages of 34.9% for high severity, 45.4% for mild severity and 19.7% for low severity were simultaneously reported in the shoulder section. In a nutshell, the study has revealed that, in comparison with body aches in the arms, knees, upper back, forearms, wrists, hands, hips and thighs, the subjects are more vulnerable to body aches in the neck, shoulders and lower back. </abstract>

Department of Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia

Department of Orthopedics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia

University for the Enhancement of Academic Performance, University of Malaya, Malaysia

Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia

Prevalence Rate of Musculoskeletal Discomforts Based on Severity Level Among Office Workers

<abstract><title style='display:none'>Summary</title>Wound reparative process after surgery, burns, injuries, and inflammatory processes results in a spectrum of scar formation ranging from nearly scarless healing to excessive fibrosis or atrophy. Scarring is considered a major medical problem that leads to aesthetic and functional sequelae. Scar tissue is clinically distinguished from normal skin by an aberrant color, rough surface texture, increased thickness (hypertrophy), occurrence of contraction, and firmness. In the last decade, the concept of wound healing kinetics has been developed to describe the delicate balance of cell activity involved in scar formation and remodeling. Hypertrophic scars and keloids are formed as a result of the process of abnormal wound healing. Despite all that has been written on improving the appearance of these types of scars, there are no definitive management protocols. The aim of the present article is to make a brief review of the basic wound healing, while focusing on medicine’s latest understanding of the development and treatment of keloids and hypertrophic scars.</abstract>

Unit of Plastic Surgery and Burns, Military Medical Academy, Sofia

Department of Dermatovenereology and Allergology, Military Medical Academy, Sofia

Hypertrophic Scars and Keloids – Contemporary Concepts and Treatment Options

<abstract><title style='display:none'>Abstract</title>Cotinus coggygria Scop. leaf aqueous ethanolic extract was examined for its in vitro antiproliferative and antioxidant activity. Antiproliferative effect was assessed on four human gynecological cancer cell lines: breast (MCF7, T47D), cervical (HeLa) and ovarian (A2780) and compared to the cell growth inhibitory effect on non-cancerous breast epithelial cell line MCF10A using MTT cell proliferation assay. Radical scavenging assay with DPPH was applied to evaluate antioxidant potential of the extract. The obtained results showed that the herb inhibited cell growth of all of the tested cancer cell lines and the highest was the cytostatic effect on A2780 cells with a half maximal inhibitory concentration (IC50) value of 30.8 μg/ml. For the other cell lines the IC50 values were in the range of 55-122.7 μg/ml. Additionally, the extract exerted considerably weaker reduction in cell proliferation of the non-cancerous cell line MCF10A compared to cancer cells, which indicates for antiproliferative selectivity. C. coggygria extract showed high free radical scavenging activity with an IC50 value of 11.2 μg/ml. The obtained data provide evidence for pharmacological potential of the tested extract and future more detailed studies concerning the molecular mechanisms of the anticancer effect of the herb are needed.</abstract>

Antiproliferative Properties Against Human Breast, Cervical and Ovarian Cancer Cell Lines, and Antioxidant Capacity of Leaf Aqueous Ethanolic Extract from <italic>Cotinus coggygria</italic> Scop.

<abstract><title style='display:none'>Abstract</title>Available antiepileptic drugs interact with a variety of different molecular targets. The mechanism of action of most anticonvulsants is most often complex with a number of affected regions. The combination of mechanisms of action of drugs in particular proportions can possibly determine the showcase of its antiepileptic activity. The common factor between the different supposed mechanisms for a number of drugs includes the possibility for modulating the excitatory and inhibitory neurotransmission through effects upon the voltage-gated ion channels, synaptic plasticity, heterogeneous receptors, and metabolism of neurotransmitters. There are controversial data on the extent to which a specific action can be the reason for the wholesome anticonvulsive characteristics of various medications, as well as the relation with the presence of undesired drug effects. The complexity of the action of some antiepileptic drugs creates conditions for optimal choice during therapy. In many cases, the insufficient familiarity with individual genetic differences and the disease related receptor damages can hinder defining a particular drug action. Characterizing the mechanisms of action of the present antiepileptic medications would increase the understanding for the pathophysiological mechanisms of epileptic seizures, as well as the development of new therapeutic strategies. The development of novel antiepileptic drugs and the ongoing research regarding the mechanism of action of established antiepileptic drugs, are continuously increasing the level of complexity in the spectrum of molecular targets relevant for epilepsy therapy. The current state of knowledge as well as the limitations in our understanding should guide future research aiming for a more detailed elucidation of the impact of genetics and pathophysiological mechanisms on interindividual differences in expression and function of antiepileptic drug targets.</abstract>

Basic Mechanisms of Action of the Antiepileptic Drugs

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pISSN: 0324-1750, eISSN: 2719-5384  Aim &amp; Scope  The Journal Acta Medica Bulgarica (AMB), published continuously since 1973, is...

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