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Introduction: Carotid stenting may produce significant bradycardia and/or hypotension. This may have negative short- and long-term effects for the elderly high-risk patients. Their cerebral hemodynamics is with exhausted adaptive capacity because of the multiple cardiovascular risk factors, advanced age, and significant stenosis., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Acute upper respiratory tract infections (AURTIs) are associated with a significant burden on society attributed to medical care and loss of productivity. Novel therapies that are able to shorten disease duration, while providing symptom relief and being well tolerated, are an unmet medical need., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cerebral developmental venous anomalies are asymptomatic benign cerebrovascular malformations that are commonly found accidentally on brain magnetic resonance imaging. It is not uncommon for cerebrospinal fluid flow to be obstructed at the level of the aqueduct of Sylvius, causing an obstructive non-communicating hydrocephalus. Most notable reasons for such an obstruction at that level are tumors, congenital etiology, or post-inflammatory gliotic atresia., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Bronchial asthma is a heterogeneous disease that includes various subtypes. They may share similar clinical characteristics, but probably have different pathological mechanisms., Aim: To identify phenotypes using cluster analysis in moderate to severe bronchial asthma and to compare differences in clinical, physiological, immunological and inflammatory data between the clusters., Patients and Methods: Forty adult patients with moderate to severe bronchial asthma out of exacerbation were included. All underwent clinical assessment, anthropometric measurements, skin prick testing, standard spirometry and measurement fraction of exhaled nitric oxide. Blood eosinophilic count, serum total IgE and periostin levels were determined. Two-step cluster approach, hierarchical clustering method and k-mean analysis were used for identification of the clusters., Results: We have identified four clusters. Cluster 1 (n=14) - late-onset, non-atopic asthma with impaired lung function, Cluster 2 (n=13) - late-onset, atopic asthma, Cluster 3 (n=6) - late-onset, aspirin sensitivity, eosinophilic asthma, and Cluster 4 (n=7) - early-onset, atopic asthma., Conclusions: Our study is the first in Bulgaria in which cluster analysis is applied to asthmatic patients. We identified four clusters. The variables with greatest force for differentiation in our study were: age of asthma onset, duration of diseases, atopy, smoking, blood eosinophils, nonsteroidal anti-inflammatory drugs hypersensitivity, baseline FEV1/FVC and symptoms severity. Our results support the concept of heterogeneity of bronchial asthma and demonstrate that cluster analysis can be an useful tool for phenotyping of disease and personalized approach to the treatment of patients.

Background: The patient's immune response is one of the major factors influencing HBV eradication or chronification, and it is thought to be responsible for the treatment success., Aim: Our study aimed to investigate whether cellular defense mechanisms are associated with the course of HBV infection (spontaneous recovery [SR] or chronification [CHB]) and with the therapeutic approach., Patients and Methods: A total of 139 patients (118 with CHB, 21 SR) and 29 healthy individuals (HI) were immunophenotyped by flowcytometry. Fifty-six patients were treatment-naïve, 20 were treated with interferons and 42 with nucleoside/ nucleotide analogues., Results: Deficiency of T lymphocytes, helper-inducer (CD3+CD4+), suppressorcytotoxic (CD8+CD3+) and cytotoxic (CD8+CD11b-, CD8+CD28+) subsets, activated T cells (CD3+HLA-DR+, CD8+CD38+) and increased CD57+CD8- cells, elevated percentages of B lymphocytes and NKT cells were observed in CHB patients compared with HI. In SR patients, elevated CD8+CD11b+, NKT and activated T cells were found in comparison with controls. The higher values of T cells and their subsets in SR patients than in CHB patients reflect a recovery of cellular immunity in resolved HBV infection individuals. In both groups of treated patients, reduced T lymphocytes, CD3+CD4+ and CD8+CD38+ subsets were found in comparison with HI. Higher proportions of cytotoxic subsets were observed in treated patients compared with treatment-naïve CHB patients, more pronounced in the group with interferon therapy., Conclusion: Our data demonstrate that cellular immune profiles may be of prognostic value in predicting the clinical course of HBV infection, and the determination of the therapeutic response.

In patients with cystic fibrosis (CF) lung damage secondary to chronic infection is the main cause of death. Treatment of lung disease to reduce the impact of infection, inflammation and subsequent lung injury is therefore of major importance. As Pseudomonas aeruginosa is the dominant pathogen in CF patients it has been the major target of all treatment strategies, possible antibiotic regimens and recommendations for years. More sophisticated antibiotic therapies introduced over the last decades have helped to improve the prognosis in cystic fibrosis, but then new multidrug-resistant pathogens emerged. We present a case of cystic fibrosis in a 16-year-old boy with pulmonary exacerbation due to colistin-resistant Stenotrophomonas maltophilia. This case raises some interesting questions regarding the antibiotic policy and treatment options in our country for patients with CF and multidrug-resistant strains. Colistin is used at present in Bulgaria as a strategic last option for the CF patients but with the advent of new more drug-resistant strains therapeutic approach should change - for instance, there should be restrictions imposed on the use of levofloxacin and trimethoprim/sulfamethoxazole which are regarded as "cheap and not so potent" antibiotics suitable for any infection and use them only in strict dependence on the respective culture results.

Introduction: Diabetes mellitus (DM) is estimated to affect 2-37% of COPD patients, results varying widely between studies. DM may also correlate with quality of life and lung function., Aim: To examine correlations between DM and quality of life and lung function in COPD patients admitted to hospital with exacerbation of COPD., Patients and Methods: A hundred and fifty-two patients were included in the study. They were all examined for diabetes mellitus. All patients completed CAT and mMRC questionnaires and underwent spirometry., Results: 13.2% (20/152) of patients received medications for DM. 21.7% (33/152) had newly diagnosed DM and 30.9% (47/152) had prediabetes. DM is not associated with reduced quality of life and worse pulmonary function. However, untreated DM is associated with both reduced quality of life and worse pulmonary function. HbA1c is negatively correlated with FVC and positively correlated with CAT score., Conclusions: COPD patients hospitalized for exacerbation are at high risk for impaired glucose metabolism. Untreated DM is associated with worse lung function and lower quality of life, which stresses the importance of screening for the disease. The patients may benefit from optimizing blood glucose level.

Aim: Evaluation of the effect of a novel physical therapy method--post-isometric relaxation taping (PIR-taping)--compared with the effect of a conventional postisometric relaxation (PIR) in the treatment of outpatients with myofascial pain as a result of muscle spasm and shortening of static muscles, resulting in muscle imbalance., Patients and Methods: The study recruited 320 outpatients with myofascial pain due to muscle spasm and shortening, resulting in muscle imbalance in one of 8 kinetic segments. We treated randomly 8 groups of 20 patients by PIR and 8 matched groups by PIR-taping. The treatment consisted of one procedure daily (PIR or PIR-taping) with duration of 10 minutes for 10 working days. The pain was assessed by a visual analogue scale before and after each procedure., Results: The pain decreased significantly after the treatment course in each group (p < 0.05), but no difference was found between any pair of groups (p > 0.05). The pain before the next PIR procedure tended to increase in comparison with the pain after a previous one, unlike the pain in PIR-taping treatment which tended to decrease. Pain intensity after PIR procedure decreased significantly compared with the pain after a previous one (p < 0.05), while in PIR-taping--after two previous procedures (p < 0.05). Treatment with PIR increased pain significantly during the weekends (p < 0.05), while in treatment with PIR-taping the pain decreased insignificantly during the weekends (p > 0.05). The pain reduced significantly after PIR procedure (p < 0.05), as well as after PIR-taping procedure (p < 0.05). The pain after PIR procedure was significantly lower than that after PIR-taping procedure (p < 0.05), although the pain before PIR procedure was statistically equal with the one before PIR-taping procedure (p > 0.05)., Conclusion: Despite the better short-term effect of PIR versus PIR-taping, there was no difference between the final results of both methods, due to the continuous (24-hour) effect of PIR-taping.

Aim: To study differences and prognostic effect of some factors on brain (B-type) natriuretic peptide (BNP) levels at discharge of patients with chronic heart failure (CHF) treated in accord with current treatment guidelines., Patients and Methods: Eighty-five consecutive patients hospitalized for CHF were recruited into the study. A standardized study protocol was used for them including collection of blood samples for measurement of electrolytes, creatinine at baseline and BNP at discharge. High BNP levels were determined at values above the threshold value for the highest BNP quartile (> or = 463 pg/ml). Linear regression analyses were performed using the SPSS 16.0., Results: High BNP levels at discharge were measured in 21 (24.7%) of the patients. Patients with persisting high BNP levels, despite the administered correct therapy, had significantly more frequently worse clinical and instrumental characteristics: pulmonary congestion (76.2% vs. 40.6%), IV NYHA functional class (23.8% vs. 4.7%), atrial fibrillation (AF) (71.4% vs. 35.9%) and ischemic etiology of HF (47.6% vs. 15.6%). Multivariate linear regression analysis (F = 7.1, p < 0.001) identified systolic blood pressure (SBP), AF and instrumental data for pulmonary congestion as significant and independent predictors of high BNP at discharge., Conclusions: There were statistically significant differences in the distribution and prognostic effect of the studied factors across the BNP levels. CHF patients with hypotension, AF and instrumental evidence for pulmonary congestion at admission are at higher risk of high BNP levels at discharge and require special care and clinical approach.

Objective: The objective of this study was to assess the implication of copy number changes of epidermal growth factor receptor (EGFR) in lung cancer pathogenesis., Materials and Methods: We used the highly reliable method of FISH, applied on tissue microarray (TMA), containing 306 lung tumors of different histological types, grades and tumor stage, in order to analyze the correlations between gene copy number changes and tumor phenotype., Results: The frequency of EGFR copy number changes was 22.2%-2.8% amplifications and 19.4% gains. EGFR gains occurred more commonly in the squamous cell cancers (23.5%) than in adenocarcinomas (11.8%). Amplifications of EGFR were found only in the squamous cell cancers. Regarding cancer phenotype, there was a statistically significant correlation between EGFR copy number changes and histological grade (p = 0.001). No statistically significant relation could be observed with the metastatic spread of the tumors (lymphogenic and haematogenic) (p = 0.082 and p = 0.1, respectively). In our study EGFR could not be determined as a prognostic factor of survival (p = 0.6115)., Conclusion: EGFR copy number changes could supplement the clinical significance of EGFR as a marker related to its pathogenesis and targeted therapy.