Medical University of Varna

About: Medical University of Varna is a education organization based out in Varna, Varna, Bulgaria. It is known for research contribution in the topics: Population & Medicine. The organization has 1199 authors who have published 1273 publications receiving 32940 citations. The organization is also known as: MU-Varna & Higher Medical Institute of Varna.

Streptococcus Agalactiae Meningitis Presented with Cerebral Infarction in Adult Patient – Clinical Case and Review

Abstract: Background: Bacterial meningitis (BM) is an inflammation of the meninges, associated with the invasion of bacteria. The etiologic agents vary by age group. BM because of Group B streptococcus (GBS) is common for the neonatal period but considered as rare in adult patients. Acute BM can have various presentations and adverse effects, such as ischemic stroke in 10% to 29% of the cases.Objective: This study aimed to present a rare case of GBS meningitis presented with cerebral infarction (CI) in an adult patient and to make a brief review of the etiology and incidence of GBS infections in adults.Case Report: We present a case of a 62-year-old female who presented with acute onset of central lesion of the right facial nerve, mild hemiparesis on the right, and partial sensorimotor aphasia. There were no signs of meningoradicular irritation. The pupils were equal, with slow reaction to light, and unaffected eye movements. There was a central lesion of the right facial nerve and mild hemiparesis on the right. Tendon reflexes were unremarkable and Babinski's sign was negative bilaterally.Discussion: This review shows an increasing incidence of cases in elderly patients. A higher risk of GBS is found in adults with more medical comorbidities. CI, as a rare adverse effect in BM, is both a sign for severity and a predictor of a poor clinical outcome with a high lethal rate. GBS infections are a growing problem in older adults and those with chronic medical conditions. The involvement of the central nervous system as meningitis is a less common manifestation with a high lethal rate.Conclusions: CI is a rare adverse effect of neuro infections leading to an even worse clinical outcome. Early recognition of the infection and appropriate antimicrobial therapy are the crucial moments of successful management of GBS disease.

The Diagnostic Dilemma of Epithelial Marker Expression in Glioblastoma.

Abstract: To the Editor, Glioblastoma Multiforme (GBM) is a hot topic for research as the intimacies of this type of malignancy seem to be a long way from being truly understood. Diagnostically however, despite decades of research and many attempts at standardizing the histopathological diagnostic process, GBM remains an entry to be diagnosed by experienced neuropathologists. A key point in the pathological diagnostic process is the immunohistochemical (IHC) phenotypisation of tumor samples. While some glial specific IHC markers such as glial fibrillary acidic protein (GFAP) give a constant positive reaction, and are used as a diagnostic medium in GBM, there is a wide panel of IHC markers that give positive IHC reactions with GBM tissue samples. Some of these such as Vimentin are very unspecific and are mainly used as a positive control for IHC reactions, but can also be used in some instances to distinguish between epithelial and non-epithelial tumors. Some IHC markers, such as cytokeratin (CK) AE1/AE3 and epithelial membrane antigen (EMA) are highly specific to epithelial cells, but can very often give positive IHC reaction with GBM tumor tissue, producing a diagnostic dilemma (Figs. 1 and 2) [1–5]. Terada (2015) reported positive IHC expression of several types of keratin antibodies, especially for the CKAE1/AE3 antibody, confirming the findings reported by other similar studies [1–3]. Terada also stated that this positivity is due to the production of keratin proteins from GBM cells, but this statement is not supported by anything more than IHC investigations [1]. However, IHC is not the most specific immunology based test and a phenotypically positive tissue sample on IHC may not truly express the antigens tested due to conformational mimicry between the antibody and a similar epitope in another antigen. Such is the case with keratins and perhaps also with other epithelial markers, such as EMA, in GBM [2–5]. Whilst many authors and practicing pathologists believe that IHC is a full proof testing method and that a high number of GBM cases express some type of keratin molecules, especially the epitheloid and giant-cell GBM subtypes. This is not entirely true, as demonstrated by Kriho et al. in 1997 in a comparative study of keratin expression in GBM [2]. She concluded that the AE3 fraction of the CKAE1/AE3 antibody cocktail is the one that reacts with an antigen in GBM cells, however in immunoblot and electrophoresis test a protein with the characteristics of keratin filaments was not detected [2]. Therefore, Kriho suggested that these IHC false positive results are caused by a three-dimensional conformational mimicry with another intermediate cytoskeletal protein such as the dysmorphic GFAP produced by the neoplastic astrocytes [2]. Although the result of Kriho et al. have not been recreated since, the specifics of a Western immunoblot test highly outweigh those of IHC and are used in explaining the GBM-CK AE1/AE3 phenomena by a number of authors [2–4]. Some * George Stoyanov georgi.geesh@gmail.com

Bromfenac 0.09% ophthalmic solution for postoperative pain and ocular discomfort after cataract surgery with phacoemulsification

Abstract: Цел Да се изследват ефектите на бромфенак 0.09% (Bromfenac 0.09%) за очно приложение при лечение на болка и други очни симптоми след операция на катаракта. Материали и методи Проследени са 51 пациенти (61 очи), планирани за операция за отстраняване на катаракта чрез факоемулсификация. Те са случайно разпределени в две групи: в едната получават стандартната постоперативна локална терапия, a в другата е добавен бромфенак 0,09%. Всички пациенти попълват въпросници, касаещи локална болезненост и други очни симптоми, предоперативно и при три следоперативни визити. Резултатите са обработени чрез SPSS (v22.0) и поради липсата на нормално разпределение, данните са анализирани чрез методите на непараметричен анализ. Променливите са представени с техните медианни стойности, a нулевата хипотеза е тествана при доверителен интервал от 95% (CI=95%). Резултати В деня след операцията 80.8% от тестовата група дават оценка за зрението си „много добро` и „отлично`, докато 68.6 % от контролната са маркирали „добро` или по-висока. След седмица средната субективна оценка за качеството на зрението е значимо по-висока за тестовата група в сравнение с контролната. Тази тенденция се запазва в края на месеца, но разликата не е статистически значима. В деня след операцията 92.3% от тестовата група и 88.6% от контролната смятат зрението си за стабилно през повечето или през цялото време (p=0.05). Заключение Bromfenac 0.09% очни капки, в допълнение към стандартното постоперативно лечение, показва добра ефективност не само по отношение облекчаване на постоперативния очен дискомфорт след неусложнена факоемулсификация, но и за по-бързото постигане на стабилна рефракция и зрителна функция след операция на катаракта. Успешният резултат не се ограничава само до добре извършена, неусложнена процедура за отстраняване на помътнената леща, водеща до оптимален рефрактивен и зрителен резултат, но е от особена важност да се осигури на пациентите безболезнен, спокоен и удовлетворяващ възстановителен период. В името на това е добре да се възползваме от всяка терапевтична възможност, която може да допринесе за постигането на тази цел, освен ако не носи допълнителен риск.

Endovascular treatment for acute ischemic stroke - current recommendations of the European Stroke Organization

Abstract: Acute stroke is an emergency medical condition due to acute brain circulation disorder that can lead to death or severe disability. In the acute stage of ischemic stroke, differentiated treatment with intravenous thrombolysis is recommended within 4.5 hours of symptom onset, and mechanical thrombectomy - up to 6 hours from symptom onset. A combination of both treatment methods can be considered in certain cases. The assessment of treatment with mechanical thrombectomy is taken by a multidisciplinary team according to the relevant criteria set out in the national consensus for treatment of acute ischemic stroke. The latest international consensus on mechanical thrombectomy, adopted by the European Stroke Organization (ESO) in 2019, introduces additional recommendations for the use of mechanical thrombectomy. The recommended larger therapeutic window for mechanical thrombectomy, up to the 24th hour of onset of symptoms, allows a greater number of patients to benefit from differentiated methods for treating ischemic stroke. It aims to reduce mortality and disability in patients suffering from the acute stage of stroke. The existence of numerous studies related to endovascular treatment in patients with acute ischemic stroke and the availability of additional recommendations for differentiated treatment necessitate the update of the current consensus in Bulgaria.

Cryoablation for simultaneous surgical treatment of atrial fibrillation and valvular or ischemic heart diseases - our early experience in Varna

Abstract: Atrial fibrillation (AF) is a problem with rising frequency and importance in developed countries. The consequences of that condition are a significant medical, social and economic problems: high risk of development of heart failure, ischemic stroke, decreased quality of life and lowered life expectancy. With the development of theoretical knowledge and technical means in medicine, new surgical methods have been established and validated for the treatment of AF, among them is cryoablation. We present our early experience with the concomitant treatment of AF with cryoablation for patients undergoing surgical treatment of coronary artery disease (CAD), mitral and aortic valvular pathology. The system used for cryoalbation uses nitrous oxide (N2O). The results from patient follow-up show high effectiveness of the procedure even in the initial phase of mastering the skill.