Nonka G. Mateva

Relationship of asymmetric dimethylarginine with flow-mediated dilatation in subjects with newly detected severe hypercholesterolemia

Background:  Little is know about the relationship between asymmetric dimethylarginine (ADMA) and percent flow‐mediated dilatation (%FMD) in subjects with severe hypercholesterolemia (HH).

Incidence of Parkinson’s Disease in Bulgaria

The incidence of Parkinson’s disease (PD) was studied over a 3-year period (2002–2004) in the district of Plovdiv, Bulgaria with a mean population of 713,090. Of 663 possible cases, 244 patients diagnosed with PD were included in the study. The diagnosis PD was based on UK PD Society Brain Bank Criteria. The average crude incidence rate of PD was 11.44/ 100,000 person-years. After age adjustment to the general Bulgarian population, incidence was 11.65/100,000: 17.46 for men; 7.24 for women; 12.97 for the urban group and 9.55 for the rural group. Age-specific incidence was 0.67/100,000 in the age range 40–44, reached a maximum of 112.73/100,000 for males and 52.58/100,000 for females in the age range 75–79 years and declined in the elderly. The present study estimates the incidence of PD in Bulgaria, which is similar to that in other European countries. The incidence rate in the Bulgarian population is twofold higher in men compared to women and slightly higher in the urban population compared with the rural population.

Serum Melatonin in Women with Polycystic Ovary Syndrome

ABSTRACT There has been a surge of interest in recent years in studying the changes of serum melatonin concentrations in disorders that are associated with insulin resistance such as diabetes mellitus type 2 and polycystic ovary syndrome (PCOS). AIM: The present study was designed to investigate the day-time and night-time levels of serum melatonin and the cortisol rhythm in women with PCOS and compare them with those of healthy women. PATIENTS AND METHODS: This is a case-control study which included 30 women with PCOS and 25 healthy women. All hormonal measurements in both the study group and controls were carried out between days 3 and 5 counted from the beginning of the last regular menstrual cycle; they included serum levels of melatonin and cortisol at 03:00 a.m and 08:00 a.m, total testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), luteinizing hormone (LH), follicle stimulating hormone (FSH), and immunoreactive insulin at 08:00 a.m. RESULTS: Women with PCOS were found to have a significantly higher melatonin level at 08:00 a.m. and smaller mean night-day difference in the concentrations of melatonin in comparison with those of healthy women (natural log (Ln) night-day difference 0.60 ± 0.10 pg/ml versus 1.15 ± 0.14, p < 0.002). Melatonin to cortisol ratios at 03:00 a.m. and 08:00 a.m. showed no statistically significant differences between the two groups (Ln melatonin/ cortisol 03:00 a.m., 1.01 ± 0.06 versus 1.05 ± 0.05; Ln melatonin/cortisol at 08:00 a.m., 0.62 ± 0.01 versus 0.56 ± 0.03, p > 0.05). CONCLUSION: The results we obtained about the changes of melatonin in women with PCOS could help in elucidating the complex pathophysiological pattern of this disease. РЕЗЮМЕ ВВЕДЕНИЕ: В последние годы увеличился интерес к изучению изменений сывороточного мелатонина при заболеваниях, прототекающих с инсулиновой резистентностью как сахарный диабет типа 2 и синдром поликистозных яичников (PCOS). ЦЕЛЬ: Настоящее исследование ставит себе целью изучить дневные и ночные уровни сывороточ- ного мелатонина и кортизоловый ритм у женщин с PCOS и сравнить их с этими у здоровых женщин. МАТЕРИАЛ И МЕТОДЫ: Обследовано 30 женщин с PCOS и 25 здоровых женщин. Гормональные ис- следования и патологической, и контрольной групп женщин проведены в рамках 3-его - 5-ого дня от начала последнего регулярного менструального ци- кла и включают измерения сывороточных уровней мелатонина и кортизола в 3:00 и в 8:00 ч., общего тестостерона (T), DHEA-S, LH, FSH и иммуноре- активного инсулина в 8:00 ч. РЕЗУЛЬТАТЫ: Установлено, что женщины с PCOS имеют сигнификантно более высокий мелатонин в 8:00 ч. и соответственно меньшую ночно-дневную разницу мелатонина по сравнению со здоровыми женщинами (Ln ночно-дневная разница 0.60 ± 0.10 pg/ml по отношению к 1.15 ± 0.14 pg/ml, Р < 0.002). Отношение мелатонин/кортизол в 3:00 и в 8:00 ч. не различается статистически значимо между обеими группами (Ln мелатонин/кортизол в 3:00 ч. 1.01 ± 0.06 по отношению к 1.05 ± 0.05; Ln мелатонин/кортизол в 8:00 ч. 0.62 ± 0.01 по отношению к 0.56 ± 0.03, P > 0.05). ЗАКЛЮЧЕНИЕ: Полученные авторами данные об изменениях мелатонина у женщин с PCOS могли бы способствовать выяснению сложной патофи- зиологии этого заболевания.

Alterations in serum levels of IL-17 in contrast to TNF-alpha correspond to disease-modifying treatment in relapsing-remitting multiple sclerosis

Abstract Cytokines of different types play an important role in multiple sclerosis (MS) pathogenesis as mediators and regulators of the immune processes in the central nervous system. The aim of the study was to determine the effect of interferon-beta and glatiramer acetate on serum concentrations of TNF-alpha and IL-17 A and their correlation with the degree of disability in clinically stable patients with relapsing-remitting MS. A cross-sectional, case-control study of 220 patients (68 treatment naïve; 152 treated with interferon-beta or glatiramer acetate) and 99 clinically healthy age-gender-body mass index-matched subjects were performed. Serum cytokine concentrations were measured during remission of the disease by means of ELISA. Treatment naïve patients showed significantly higher levels of IL-17 A than the treated individuals (p = .000109) and controls (p = .000044). Within the treated group, only patients with interferon-beta had significantly higher serum IL-17 than the controls (p = .023). TNF-alpha concentrations were significantly higher in the treated patients compared to the healthy controls (p = .000013), regardless of the type of the therapy. Treatment naïve individuals did not differ from the controls according to their serum TNF-alpha (p = .922). No correlation was found between the serum cytokine concentrations and Expanded Disability Status Scale (EDSS) score (p > .05). Serum concentrations of these cytokines could not be regarded as reliable predictors for the severity of the residual neurological deficit during disease-modifying treatment. Our data suggest that suppression of IL-17 A production as one of the mechanisms underlying the beneficial effect of first-line disease-modifying treatments is stronger in glatiramer acetate than in interferon-beta.

Repeat transrectal prostate biopsies in diagnosing prostate cancer.

ABSTRACT Patients with negative prostate biopsy and persistent suspicion of prostate cancer (PCa) can pose a serious diagnostic problem. The AIM of our study was to determine the frequency of PCa found on repeat prostate biopsy and the factors leading to higher possibility of cancer positive histological result. PATIENTS AND METHODS: We studied retrospectively 113 patients (82 from University Clinic, Jena, Germany and 31 from Department of Urology, Plovdiv, Bulgaria) with initial negative biopsy for cancer who underwent repeat biopsies. The patients were examined between January 1999 and May 2010. The target group included patients with Prostate Specific Antigen (PSA) level lower than 12.5 ng/ml and without suspicious finding on digital rectal examination (DRE). Different biopsy schemes were used in the initial and the following biopsies, depending on patient age and total prostate volume. RESULTS: Overall PCa detection rate was 22.1% (25 of 113). The repeat biopsy found PCa in 15.9% (18 of 113). In patients with 3 biopsies the PCa detection rate was considerably lower - only 8.6% (3 of 35). PCa was found in only 1 patient of 18 (5.5%) who underwent four or more biopsies. Transurethral resection of the prostate (TURP) was performed in 15 patients with at least two previously negative biopsies. The pathohistological examination of the resected tissue showed PCa in 3 of the patients (20%). CONCLUSION: The interval between biopsies is not a significant predictive factor for positive prostate biopsy. The chance for detecting PCa after the second negative transrectal biopsy procedure is low. Therefore, TURP can be used as an alternative procedure to harvest adequate tissue material for pathologic examination, especially in patients with obstructive voiding symptoms.

YKL-40 and cytokines - a New Diagnostic Constellation in Rheumatoid Arthritis?

Abstract Background: Rheumatoid arthritis (RA) causes chronic inflammation and alteration of articular tissue and joints. The pathogenesis of the disease remains unclear although it is known that proinflammatory cytokines play a major role in its induction. YKL-40 is a chitinase-like glycoprotein produced by activated macrophages, neutrophils, arthritic chondrocytes and cancer cells. It has been shown that YKL-40 is implicated in tissue remodeling, angiogenesis and inflammation. Aim: to investigate serum and synovial YKL-40 levels in relation to IL-1β, TNF-α, and IL-6 in RA patients. Materials and methods: Serum and synovial concentrations of YKL-40, TNF-α, IL- 6, and IL-1β were determined by ELISA in 39 patients (mean age 53.18 ± 16.54 yrs) with active RA. Results: Serum YKL-40 levels were increased in all patients. The highest levels were found in synovial fluid (P<0.01). Our study showed a strong association between serum and synovial levels of YKL-40 and serum TNF-α and IL-1 β (P<0.05). Conclusion: This is the first study finding a significant correlation between serum TNF-α and IL-1β and YKL-40 in active RA. We suggest that these molecules together might play a dominant role in the pathogenesis and disease activity and could possibly serve as a new diagnostic constellation in rheumatoid arthritis.

Reliability and cross-cultural validity of the Bulgarian version of IRES-3

Abstract Introduction: The IRES -3 questionnaire (Indicators of rehabilitation status, version 3) was developed to evaluate the rehabilitation effect in patients with psychosomatic, cardiac, orthopedic, oncologic, neurologic, gastroenterological and other disorders. Aim: The aim of the present study was to validate the Bulgarian version of IRES-3 and assess its reliability and internal consistency. Materials and methods: Validation of the IRES-3 questionnaire was carried out at the Specialized Rehabilitation Hospital, the National Complex PLtd, the Hisar branch. The study included 46 patients: 14 males (30.43%) and 32 females (69.57%). Patients’ age ranged between 43 and 75 years (mean age 63.52 ± 1.27). All participants got preliminary instructions and after that, within a period of one week, they completed the questionnaire two times. To evaluate IRES-3 reliability we used the split-half-reliability model and calculated the Spearman-Brown coefficients (rsb) for each of the scales. Internal consistency was estimated using Cronbach’s alpha coefficient. We used the mean value of the inter-item correlation coefficients as well. Results: The high values of rsb and Cronbach’s coefficient alpha as well as the low values of the inter-item correlation coefficient which were obtained in our study demonstrate that the questionnaire under investigation is of high reliability and internal consistency. Our results are very similar to the results of the original German questionnaire which have been reported in literature. Conclusion: The Bulgarian version of the IRES-3 questionnaire shows high reliability and cross-cultural validity and can be applied widely for evaluation of the effect of rehabilitation. Резюме Введение: Вопросник IRES-3 предназначен для оцен- ки эффекта реабилитации пациентов с психосома- тическими, кардиологическими, ортопедическими, онкологическими, неврологическими, гастроэнтеро- логическими и другими заболеваниями. Цель: Обосновать болгарский вариант IRES-3, оценивая его надежность и внутреннюю согласо- ванность. Материал и методы: Обосновывание вопросника проведено в Специализированной больнице реабили- тации (Национальный комплекс, г. Хисар). В исследо- вание авторы включили 46 пациентов: 14 (30.43%) мужчин и 32 (69.57%) женщин в возрасте от 43 до 75 лет (средний возраст - 63.52 ± 1.27). После проведенной инструкции все участники пополнили данный вопросник двукратно в течение недели. При оценке надежности (reliability) авторы ис- пользовали split-half-reliability model и определили Spearman-Brown coefficient (rsb) для каждой шка- ле. Внутреннюю согласованность оценили с помо- щью коэффициента Кронбаха-альфа (Cronbach’s Alpha). Использовали также и средную стоимость корреляционных коэффициентов - inter-item correlation coefficient. Результаты: Полученные высокие стоимости rsb и Cronbach’s Alpha и низкие inter-item correlation coefficient показывают, что вопросник обла- дает очень хорошей надежностью и внутренней согласованностью. Полученные авторами результаты близки к опубликованным результатам оригинального немецкого вопросника. Заключение: Болгарская версия вопросника IRES-3 показывает хорошую надежность и кросс- культуральную обоснованность, и его можно ши- роко применять в целях оценки эффекта реабили

Do Personality Characteristics Constitute the Profile of Burnout-Prone Correctional Officers?

AIM: This study examined the relationship between personality characteristics and burnout syndrome among Bulgarian correctional officers. METHODS: The cross-sectional study took place through individual, voluntary and anonymous interviewing of 307 employees from three district prisons. Maslach burnout inventory, Eysenck personality questionnaire and demographic characteristics were administered. RESULTS: The personality predictors of emotional exhaustion were low emotional stability and low level of dimension extraversion. The predictors of depersonalization were high levels of neuroticism and psychoticism and low level of extraversion. CONCLUSION: This research helps to identify employees who are at risk for developing burnout as a result of their personalities. In Bulgaria, there is still no official information about studies in this area.

Circulating levels of interleukin-17A, tumor necrosis factor-alpha, interleukin-18, interleukin-10, and cognitive performance of patients with relapsing-remitting multiple sclerosis

Abstract Multiple sclerosis (MS) is associated with cytokine imbalance and high rate (40–70%) of cognitive impairment. The objective of this study is to investigate the relationship between serum concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-17A, IL-18, IL-10, and cognitive performance in patients with relapsing-remitting MS (RRMS). Methods The study comprised 159 patients with RRMS (mean age 40.08 ± 8.48 years) in remission phase and 86 age-, gender-, and education-matched healthy controls. Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities test (SDMT), and Isaacs test were used for assessment of working memory, attention, visuo-perceptual abilities, information processing speed, and executive functions. Serum cytokine concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results Patients had significantly increased serum concentrations of TNF-alpha and IL-17A and decreased levels of IL-10 compared to the controls (p < 0.05). Negative correlation was found between serum TNF-alpha and SDMT score in patients with disease evolution longer than 10 years (rxy = −0.258 p = 0.033); PASAT and SDMT scores were in negative correlation with concentration of IL-17A (rxy = −0.229 p = 0.004; rxy = −0.166 p = 0.041). Cognitive impairment was established in 46.5% (n = 74) of the patients. Cognitively impaired patients had significantly higher serum IL-17A than cognitively preserved individuals (p = 0.007). Multiple linear regression analysis revealed IL-17A as a significant predictor of cognitive performance in RRMS patients. Conclusion The results from this study suggest that pro-inflammatory cytokines IL-17A and TNF-alpha simultaneously with decreased IL-10 are involved in cognitive deterioration in RRMS.

Clinical Evaluation of CAD/CAM Indirect Zirconia Restorations of Severely Destroyed Vital Teeth in the Posterior Area – Early Clinical Results

Abstract Background: Dental applications of CAD/CAM concept have been available for almost 30 years. They have allowed dentists to work with novel materials with better properties. One of these materials is zirconia ceramic. Aim: To evaluate prospectively the longevity of CAD/CAM indirect zirconia restorations of severely destroyed vital molars and to study the risk factors associated with restoration failures. Materials and methods: Thirty-two indirect zirconia restorations were made in 19 patients. The treated teeth were extremely destroyed vital molars. Thermal and electrical tests for pulp vitality were performed for all teeth. Radiographs were made pre-operatively, post-operatively, and at the 6-month recall. Cvar and Ryge criteria were used for direct clinical evaluation of each restoration at the 6-month recall. Results: All 32 zirconia restorations were evaluated at 6 months. As per Cvar and Ryge criteria, discrepancies were found in two of the cases: postoperative sensitivity in only one of the teeth immediately after cementing the restoration; a partial fracture of one of the restorations after six months. Good marginal and gingival adaptation of the indirect restorations, good periodontal condition and no peri-apical lesions were observed clinically and radiographically. The thermal and electrical pulp tests were within the normal range for vital posterior teeth. Conclusions: The present study suggests that the new restorative zirconia materials are promising clinical alternative. They can give the clinicians a broader scope of opportunities in the treatment of their patients, aiming at more sustained and improved results.