ESH and SCORE strategies. J Hypertens. 2007;25(4):757-62. 4. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281-357. 5. Stoianov M. [Assessment of cardiovascular risk by SCORE]. Science Cardiology. 2010;3:142-7. Bulgarian. 6. Erhardt L, Moller R, Puig JG. Comprehensive
Joana I. Simeonova, Snejanka T. Tisheva-Gospodinova, Yoana M. Todorova, Petkana A. Hristova, Asia N. Yanakieva and Martin I. Hristov
Desislava D. Drenska and Dimitar B. Maslarov
References 1. Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol . 2007;6(12):1063-72. 2. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. The ABCD, California, and unified ABCD2 risk scores predicted stroke within 2, 7, and 90 days after TIA. Lancet. 2007;369:283-92. 3. Josephson SA, Sidney S, Pham TN, Bernstein AL, Johnston SC
Rumyana N. Kuzmanova, Irina Z. Stefanova, Irena V. Velcheva and Katerina I. Stambolieva
The aim of the study is the translation, adaptation and validation of Side effects of antiepileptic drugs questionnaire in Bulgarian language (SIDAED-BG) in order to use it for objective monitoring of patients with epilepsy. One hundred and thirty one patients (mean age 40.13±13.37 years) took part in the investigation. The internal consistency and test-retest reliability were tested by Cronbach's α and ICC estimations. The convergent construct validity was evaluated by estimating the correlation of SIDAED-BG with the QOLIE-89 and the discriminant validity - by evaluation of the difference between SIDAED-BG scores and clinical parameters such as type of epilepsy using Kruskal-Wallis ANOVA. The Cronbach's α of the total scale was 0.93. The test-retest reliability was higher and determined the strong positive correlations between the first and second examination. The SIDAED-BG questionnaire showed good internal consistency (Cronbach's alpha ranged from 0.37 to 0.86) and the scores significantly correlated with other questionnaires such as QOLIE-89 and showed a good discriminative validity between groups with different levels of self-assessed adverse effects of antiepileptic drugs. The Bulgarian version of SIDAED is a reliable and valid tool in assessing the patient-reported adverse effects of antiepileptic drugs and their impact on the patient's outcome.
Savelina L. Popovska, Ivan N. Ivanov and Dorian Y. Dikov
Neoadjuvant chemotherapy is the standard of care for patients with locally advanced breast cancer (LABS). The aim of this study was to determine the effects of neoadjuvant chemotherapy on metastatic and nonmetastatic breast cancer axillary lymph nodes (ALNs). Seventy-seven patients with LABS and cytologically documented ALN metastases were treated in two prospective trials. Patients had breast surgery with level I and level II axillary dissection followed by additional chemotherapy or radiation treatment. Clinical nodal status was determined by physical examination and compared with histological and immunohistochemical findings. The regressive changes in primary tumor and ALNs were achieved using scoring systems. Objective clinical response in primary tumor was seen in 48.05% of patients. Histologic evidence of regression was noted in 46 cases (59.75%), with complete histologic regression achieved in 5 cases (6.49%). The number of cases according to the ALNs regression scoring system was as follows: 0 grade - viable metastases without effect - 21 patients (30%); 1 grade - cytotoxic effect in metastases - 20 patients (28.58%), 2 grade - micrometastasis - only3 patients (4.28%); 3 grade - no residual metastatic disease - 1 patient (1.43%); 4 grade - negative ALNs before and after treatment - 25 patients (35.71%). Nodular fibrotic area and iron-loaded macrophages suggested previous presence of tumor metastasis. There was significant relationship between histologic regression in the primary tumor and the presence of effect of cytotoxic agents on ALNs metastases (r=0.9123; p<0.00001). As chemotherapy is widely used in the treatment of breast carcinoma, pathologists should be aware of chemotherapy-induced changes in metastatic and in nonmetastatic ALNs.
Violeta S. Rilcheva, Nina P. Ayvazova, Lyubomira O. Ilieva, Svetlana P. Ivanova and Emiliana I. Konova
The objective of the study was to investigate the influence of sperm DNA fragmentation index (DFI) by DNA integrity test on pregnancy outcome and pregnancy loss after assisted reproductive technology (ART) procedure: autologous intracytoplasmic sperm injection (ICSI), donation eggs ICSI, and intrauterine insemination (IUI). We investigated men from 531 couples undergoing autologous ICSI procedure (n=416), from couples undergoing donation eggs procedure (n=39) and IUI (n=76). We performed the following interventions: semen analysis, DNA integrity test, embryo scoring by Gardner and Schoolcraft grading system (1999). The study showed no statistically significant differences between the group regarding pregnancy rate (χ2=0.55; p>0.05; OR=1.25, 95% Cl 1.23-1.46; p>0.05). However, with increased levels of DFI, the number of pregnancy losses became higher (including biochemical pregnancies and spontaneous abortions) at OR=5.65 (95% Cl 4.32-7.11; p=0.05). We examined the percentage of grade I blastocysts (by Gardner and Schoolcraft, 1999) before donation eggs embryo transfer and found a statistically significant correlation with both the DFI (χ2=7.80; p<0.05) and sperm morphology (χ2=6.14; p<0.05). Analysis of the relationship between DFI and IUI output (clinical pregnancy, miscarriage) revealed significant correlations in both directions: between DFI and pregnancy rate after IUI (χ2=6.29; p<0.05) and between the DFI and pregnancy development after IUI (χ2=6.87; p<0.05). The three group categories (autologous, heterologous ICSI procedures and IUI) studied showed that sperm samples with DFI>27% were associated with increased riskofearlypregnancyloss. Men with infertility should undergo DNA fragmentation assay in addition to the standard semen analysis. When DFI exceeds 27%, ICSI should be a method of choice, even in cases where the conventional parameters of semen analysis tests are normal.
Boyan A. Stoykov, Nikolay H. Kolev, Rumen P.Kotsev, Fahd Al-Shargabi, Pencho P. Genov, Aleksandar Vanov, Jitian A. Atanasov, Manish Sachdeva, Pencho T. Tonchev and Maria I. Koleva
The experience accumulated with low-intensity extracorporeal shock wave therapy (LI-ESWT) from international clinical trials has demonstrated its safety, efficacy and good tolerance in treatment of erectile dysfunction (ED). The aim of this retrospective study was to investigate the effect of LI-ESWT in patients with ED after bilateral nerve sparing radical surgery for prostate cancer. Twenty-seven patients underwent bilateral nerve sparing radical retropubic prostatectomy (BNSRRP) at the clinic of urology of the university hospital in Pleven between January 2016 and December 2016. Twenty-one of these patients had pre-operative preserved erectile function (EF), as reported according to the International Index of Erectile Function (IIEF-5). Postoperatively, these 21 patients experienced a mild (18-21 points) impairment of EF. In 10 patients (group 1), LI-ESWT was performed. The procedure was performed once a week for 6 weeks with a LI-ESWT (BTL 6000 SWT Topline) instrument. The reading was obtained with IIEF-5 on the third and sixth month after the end of therapy. The other 11 patients (group 2) were used as a control group and did not receive treatment. In 5 patients in group 1, a recovery of EF (> 21 points) as per IIEF-5 was recorded at the third month after treatment. In two patients, the same score was recorded at the sixth month. No improvement was seen in three men in group 1. In the controls (group 2), a spontaneous EF improvement in four patients at sixth month was registered. Despite the small number of patients and their short-term follow-up, our initial results indicate that LI-ESWT is effective, safe and well-tolerated. It could be an alternative for early penis rehabilitation in patients who have undergone BNSRRP.
Ivelina A. Yordanova, Desislava D. Tsvetanova, Diana D. Strateva, Pavlina D. Yordanova-Laleva and Dimitar K. Gospodinov
years of age.Actas Dermosifiliogr. 2009;100:33-7. 13. Adityan B, Kumari R, Thappa DM. Scoring systems in acne vulgaris. Indian J Dermatol Venereol Leprol. 2009;75:323-6. 14. Hacivelioglu S, Gungor AN, Gencer M. Acne severity and the Global Acne Grading System in polycystic ovary syndrome. Int J Gynaecol Obstet. 2013;123(1):33-6. 15. Lehmann PM. Rosacea - epidemiology, pathogenesis, clinical presentation, and treatment. Dtsch Arztebl. 2007;104:1741-6. 16. Ljubojević S1, Lipozencić J, Turcić P. Perioral
Daniela Y. Arabadzhieva, Zhaneta T. Georgieva, Ara G. Kaprelyan and Zdravko D. Slavov
, Ohno M, et al. Prevalence of subclinical coronary artery disease in ischemic stroke patients. J Cardiol. 2015;65(1):71-5. 12. Wu DF, Yin RX, Cao XL, Chen WX. Association between single nucleotide polymorphism rs1044925 and the risk of coronary artery disease and ischemic stroke. Int J Mol Sci. 2014;15(3):3546-59. 13. Hoshino T, Ishizuka K, Shimizu S, Uchiyama S. CHADS2, CHA2DS2-VASc, and R2CHADS2 scores are associated with 3-month functional outcome of stroke in patients with prior coronary artery disease. Circ J. 2014;78(6):1481-5. 14. González
Kameliya T. Tsvetanova, Dobromir D. Dimitrov, Hyuliya E. Feradova, Vasil Nanev, Tsvetomir M. Ivanov and Todor Iv. Dimitrov
-POSSUM scoring for mortality risk assessment after surgery for colorectal cancer. Colorectal Dis. 2002;4(3): 197-200. 13. Ascanelli S, Navarra G, Tonini G, Feo C, Zerbinati A, Pozza E, Carcoforo P. Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery. Tumori. 2003;89(1): 36-41. 14. Damhuis RA, Wereldsma JC, Wiggers T. The influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer. Int J Colorectal Dis. 1996;11(1):45-8. 15. Agarwal N, Leighton L, Mandile MA, Cayten CG
Daniela Y. Arabadzhieva, Ara G. Kaprelyan, Zdravko D. Slavov, Zhaneta T. Georgieva and Aleksandra Zh. Tsukeva
, Longstreth WT Jr, Nazarian S, et al. P-wave morphology and the risk of incident ischemic stroke in the multi-ethnic study of atherosclerosis. Stroke. 2014;45(9):2786-8. 12. Siu CW, Lip GY, Lam KF, Tse HF. Risk of stroke and intracranial hemorrhage in 9727 Chinese with atrial fibrillation in Hong Kong. Heart Rhythm. 2014;11(8):1401-8. 13. Fava C, Sjögren M, Olsson S, Lövkvist H, Jood K, Engström G, et al. A genetic risk score for hypertension associates with the risk of ischemic stroke in a Swedish case-control study. Eur J Hum Genet. 2014 Oct 8. doi: 10