Acta Medica Bulgarica

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Acta Medica Bulgarica The Journal Acta Medica Bulgarica, published continuously since 1973, is the leading scientific journal of the Medical University – Sofia.

It is peer-reviewed and circulated entirely in English. AMB is available online as an open-access journal. AIM AND SCOPE
Journal subjects: Medicine, Basic Medical Science, Immunology, Clinical Medicine, other. Types of manuscripts accepted for publication: original research articles, scientific reviews and case reports in all areas of Medicine. Language: English
ISSN: 0324-1750
еISSN: 2719-5384

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UBLICATION TIMEFRAME AND ACCESS
This journal is published quarterly with 4 issues annually. It provides immediate open access to its content so as to make research freely available to the public in support of a greater global exchange of knowledge. Each issue is also available in print, and is distributed to libraries and medical organizations etc. If you'd like to receive a print or digital copy, please subscribe. REVIEW PROCESS
All manuscripts are subject to peer review and are expected to meet high academic standards. If approved by the editor, submissions will be considered by peer reviewers whose identities will remain anonymous to the authors (single blinded). The median peer review turnaround is 4-8 weeks. The time from acceptance to publication is from 4 weeks to 18 months. The current acceptance rate is approx. 40 %. About 10-20 % of articles are rejected upon submission and do not reach peer-review, due to lack of compliance with the Journal’s Author Guidelines or English language issues. An average of 20 articles are submitted each month, of which 70-80% are original research articles, and the remaining are case reports and review articles. ABSTRACTING AND INDEXING
AMB is covered by a range of indices, such as Scopus, CABI: Global Health Database, DOAJ, Embase, EBSCO, Elsevier - Reaxys, ExLibris, Google Scholar, etc. Scopus Cite Score 2022: 0.3
SJR 2022: 0.119
SNIP 2022: 0.028

Interested in submitting to this journal? Find out more >>> https://journals.mu-sofia.bg/index.php/amb/about/submissions

03/07/2025

The claustrum: barrier or portal?

F. Denaro, I. Sofowora, Y. Liadi, T. Solomon, P. D**e, J. Ladow, J. Wachira, L. R. Edelstein

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03/07/2025

The role of the vagus nerve in depressive disorders: a literature review and the potential of vagotomy to create a depression phenotype in rodents

F. Ataker, D. Pencheva, D. Bakalov

Keywords: vagotomy, depression, MDD, anxiety, rodents, VNS
Abstract. Major depressive disorder (MDD) affects 280 million people worldwide and is a major global health burden due to its link with su***de, physical comorbidities, and inadequate response to pharmacotherapy in many patients. The monoamine theory of depression has provided therapeutic targets, yet exploring additional mechanisms could enhance therapeutic outcomes and increase remission rates. This review examines the potential role of the vagus nerve in depression. Vagus Nerve Stimulation (VNS) has shown promising results in treating refractory depression and has been FDA-approved for MDD since 2005. Clinical and preclinical evidence suggests that vagotomy or vagus nerve ablation can both induce and alleviate depressive symptoms, depending on the context. Furthermore, we propose that structural and biochemical compromise of the vagus nerve may contribute to affective disorders, including depression, bipolar disorder, and anxiety phenotypes. To test this hypothesis, the intervention in question would involve performing vagotomy in rodents and the subsequent investigation for depression and anxiety phenotypes in the affected animals.

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02/07/2025

Personalized new (one step) surgery options for cutaneous melanoma patients: facts and controversies

G. Tchernev, S. Kordeva

Keywords: melanoma surgery, AJCC, ASCO, EJC, One step melanoma surgery, OSMS

Abstract. The differences in standardized and personalized surgical treatment of cutaneous melanomas lie in the number of surgical interventions performed, each of the mentioned methodologies relying on different basic criteria. The standard model of clinical management is always performed within two surgical sessions, whereas the personalized one-step approach creates the prerequisites for a more sparing single surgical manipulation, providing a number of advantages for patients. The choice of one approach over the other relies both on the patient’s characteristics and the professional view of the clinician, tailored largely to the patients’ wishes. Because guidelines are recommended but not mandatory, heterogeneous surgical approaches in practice are a good solution, an opportunity for optimization, and a hope for more optimal postoperative outcomes concerning overall survival and the development of recurrences. This article analyzes the positive aspects of personalized single-stage melanoma surgery, comparing it with standard recommendations for surgical treatment of melanomas according to AJCC/EJC and ASCO. Personalized single-stage melanoma surgery achieves the same endpoints as the AJCC/EJC and ASCO criteria for surgical treatment of cutaneous melanomas, but the latter is achievable within two surgical sessions.

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02/07/2025

Osteoma of the posterior wall of the sphenoid sinus in a 29-year-old woman – a case report

K. Bechev, Ts. Stoitsev, D. Markov, V. Aleksiev, S. Markov

Keywords: sphenoid sinus, osteomas of the sphenoid sinus, MRI examination of the skull base, CT of the paranasal sinuses and skull base, chordoma of the sphenoid sinus, transsphenoidal approaches to the skull base

Abstract. Skull base osteomas are rare tumors, typically asymptomatic and without specific clinical manifestations. These are slow-growing benign tumors that, in some cases, can reach signifi cant sizes and exert a mass eff ect on surrounding neural and vascular structures located at the skull base, leading to corresponding clinical symptoms. Tumors located on the posterior wall of the sphenoid sinus may appear on magnetic resonance imaging (MRI) and computed tomography (CT) as osteomas, polyps originating from the mucosa of the sphenoid sinus, chordomas, or chondrosarcomas. During the second and third decades of life, chordomas and osteomas are commonly encountered tumors. The two imaging modalities are interrelated and complementary since CT visualizes bony structures eff ectively, while MRI is superior for soft tissues and brain parenchyma. In the present case report, we describe a 29-year-old woman presenting with symptoms of numbness in the right limbs, dizziness, and nausea, without vomiting. She reported dropping objects with her right hand. An MRI of the brain was performed, revealing a lesion localized on the posterior wall of the sphenoid sinus, extending to the clivus and infiltrating the inferior surface of the sella turcica. The lesion showed increased signal intensity on T2-weighted sequences. Given the small size of the tumor and the absence of corresponding clinical manifestations, the lesion is subject to clinical monitoring. Surgical approaches for the removal of such tumors include the endoscopic transsphenoidal approach to the skull base or the sublabial transsphenoidal approach. Complications associated with these surgical interventions may involve dural laceration and subsequent cerebrospinal fluid leakage, as well as potential damage to critical vessels or nerves.

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01/07/2025

Use of minimal internal fixation in an open comminuted second to fifth metatarsal fracture by angle grinder: case report

G. P. Georgiev, S. Rangelov, L. Gaydarski, V. Stoyanov, B. Landzhov

Keywords: open metatarsal bone fractures, comminuted fractures, fracture fixation, injury, foot

Abstract. Open comminuted fractures of the metatarsal bones are surgical emergencies that pose a significant challenge for traumatologists. These injuries typically result from high-energy trauma, with common causes including machinery such as lawnmowers, motor saws, and angle grinders. Factors such as the extent of soft tissue damage, neurovascular injury, and fracture stability must be carefully evaluated before surgery. Herein, we present a rare case involving a 37-year-old male who sustained open comminuted fractures of the second to fifth metatarsal bones, along with injuries to the tendons of the long extensors of the toes, the muscle belly of the short extensor, and the dorsal nerves of the foot, following from a trauma with an angle grinder. At the six-month follow-up, the patient reported no complaints and had achieved full weight bearing with the injured foot. In summary, while metatarsal fractures are common in the emergency setting, open fractures of the central and fifth metatarsals are relatively rare. Optimal management requires thorough evaluation and strict adherence to the Gustilo-Anderson protocol, focusing on accurate injury assessment, infection prevention, soft tissue coverage, fracture stabilization, and effective rehabilitation.

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01/07/2025

Laser-assisted surgery in the treatment of chronic periodontitis

P. Petrov, D. Shopova, I. Aleksiev, G. Petrov, M. Dimova-Gabrovska

Keywords: periodontitis, laser, endodontic treatment

Abstract. Background: Laser-assisted treatment of pathological processes in the hard and soft periodontal tissues is an innovative approach that offers several advantages compared to traditional methods. Root resorption is a pathological process, in which the degradation of the dental structure is observed, often as a result of trauma, infection, or orthodontic treatment. Our aim is to present a case of total periodontitis, with indications for extraction of the causative tooth, treated with a combined endodontic approach and laser-assisted periapical surgery. Case presentation: A 60-year-old female patient, with total periodontitis of tooth 11, sought help for esthetic correction 5 years ago. During the examination, the following were found: discolored upper right central incisor with a fistula, extensive carious defect involving the cervical tissues, marginal recession, root perforation, and a periapical lesion. Conclusion: Laser-assisted surgery, in combination with precisely executed endodontic treatment, increases the success rate in similar clinical cases and can be considered an appropriate treatment option for clinicians.

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30/06/2025

Systemic nitric oxide synthase inhibition suppresses apelin-induced rise in body temperature in rats

M. Hristov, P. Andreeva-Gateva

Keywords: apelin, aminoguanidine, L-NAME, metabolism, nitric oxide synthase, thermoregulation

Abstract. Apelin is a peptide involved in the regulation of various physiological processes, including thermoregulation, metabolism, and energy balance. This study investigates the role of nitric oxide (NO) in mediating apelin’s eff ects on body temperature, food intake, and body mass gain in rats. Using the non-selective nitric oxide synthase (NOS) inhibitor LNAME and the selective inducible NOS inhibitor aminoguanidine (AG), we assessed how systemic inhibition of NO synthesis modulates apelin-induced responses. Male Wistar rats were administered intraperitoneal injections of [Pyr1]apelin-13 following pre-treatment with L-NAME or AG. Our results show that both L-NAME and AG suppressed the apelin-induced rise in body temperature, with L-NAME having a more pronounced effect. Additionally, LNAME significantly reduced apelin-induced food intake and body mass gain, while AG had a lesser impact. These findings suggest that NO plays a key role in mediating the apelin’s thermoregulatory and metabolic eff ects. The differential outcomes between L-NAME and AG highlight the potential involvement of multiple NOS isoforms in these processes. Further investigation into the distinct roles of NOS isoforms may provide deeper insights into NO-apelin interactions and their relevance to metabolic regulation, offering potential therapeutic targets for metabolic disorders.

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30/06/2025

Attitudes of active athletes towards alcohol

I. Miteva, V. Valtchev, M. Yancheva-Stoycheva

Keywords: alcohol, sports, athletes, survey

Abstract. Purpose: The purpose of this study is to assess the attitudes of active athletes towards alcohol, using a survey method. The task of this survey is to find out whether active athletes consume alcohol and whether they know how alcohol affects their bodies. Materials and Methods: We surveyed 50 active male athletes who had been training for more than 10 years. They completed an anonymous paper survey containing 14 closed questions. The survey was conducted in January 2024. Results: 80% of respondents do not know whether systematic alcohol consumption leads to the medical condition known as alcohol use disorder. Only 4% of respondents admit that their germ cells can be damaged when drinking alcohol. All male respondents drink alcohol regularly, and only 4% of them do this occasionally. 80% of respondents drink beer and distilled alcohols; 12% prefer distilled alcohol, and 8% drink only beer. Conclusions: The survey shows that all respondents regularly drink alcohol, and only 4% of them do this occasionally. In Bulgaria, a campaign to clarify the harms caused by alcohol to active athletes should be proposed.

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27/06/2025

Sleep bruxism in school-aged children – are tooth wear and orthodontic anomalies common risk factors?

M.Dimitrova, N. Mitova

Keywords: sleep bruxism, tooth wear, orthodontic anomalies, attrition

Abstract. Sleep bruxism is a parafunction characterized by squeezing and/or grinding of the teeth. It occurs in both adults and children, and is associated with a wide variety of risk factors like harmful habits, tooth wear, orthodontic anomalies, psychological issues, etc. Aim: The aim of the present study is to investigate the prevalence and clinical characteristics of sleep bruxism in school-age children and its relationship with tooth wear and orthodontic anomalies. Materials and Methods: The object of the study are 262 children in 2 age groups: elementary scholars (aged 7-10) and middle scholars (aged 11-14). They underwent clinical examinations, which included registration of dental status, type, degree and prevalence of tooth wear and orthodontic malocclusions. Afterwards, the parents completed a questionnaire about the child’s general health, bruxism, harmful habits, etc. The results were statistically processed with SPSS-19. Results: Sleep bruxism was found in 22.1% of the examined children without predominance in any gender, but a slightly higher prevalence in the elementary school group. Tooth wear was registered in 70.6% of the examined patients. The registered orthodontic anomalies had almost the same frequency – 66.4%. None of the examined risk factors presented a significant relation with sleep bruxism. Conclusions: Sleep bruxism occurs in 1/5 of the examined children, but cannot be definitely related to tooth wear or orthodontic anomalies.

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27/06/2025

Comprehensive clinico-demographic analysis of malignant pleural effusions in the bulgarian population: insights from an observational case-control study

V. Aleksiev, B. Yavorov, D. Markov

Keywords: pleural carcinomatosis, hydrothorax, demographic, clinical manifestation, malignant pleural effusion
Abstract
Malignant pleural eff usions represent a signifi cant problem both from a clinical perspective and from a socioeconomic standpoint. They constitute a substantial burden on the healthcare system. Affecting approximately 1 million people each year, malignant pleural effusions are a leading cause of debilitating dyspnea and decreased quality of life for many patients. Distant metastasis to the pleural layers is one of the most common complications in many malignancies, with approximately 20% of cancer patients experiencing pleural eff usions during treatment. The average survival after diagnosis varies between 4 and 9 months, depending on the type and stage of neoplasm. This underscores the necessity for proper understanding of this pathology and the development of an appropriate diagnostic and therapeutic algorithm to address its consequences. To clarify the clinicodemographic aspects of malignant pleural eff usions, we carried out a one-year case-control observational study, which included patients of varying ages, clinical manifestations and primary etiologies. A total of 151 patients were included in the analysis. The control group consisted of 72 patients, all of whom were diagnosed with benign disease, confirmed by subsequent biopsy. Of these, 38 cases were confi rmed as infl ammatory, and 34 were verifi ed as pleural eff usions of non-infl ammatory origin. Malignant pleural involvement was confirmed in 79 patients. These two groups are representative of the main types of pleural pathology. We aimed to define the main characteristics of pleural malignancies and correctly recognize patients at risk.

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26/06/2025

Complications after percutaneous biliary drainage placement: a personal experience and a literature review

Y. Asenov

Keywords: percutaneous transhepatic biliary drainage, PTBD, biliary obstruction, biliary complications, biliary drainage management

Abstract. Background: Percutaneous transhepatic biliary drainage (PTBD) is an essential procedure for managing biliary obstructions, particularly in cases where endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or contraindicated. While PTBD is effective, it is associated with a range of complications, necessitating continuous evaluation of its safety and efficacy. Objective: This study aims to provide a comprehensive analysis of the complications and outcomes associated with PTBD during a single specialist’s learning curve. Additionally, a thorough review of the literature on PTBD complications will be conducted, and best practices for preventing and managing complications will be explored, focusing on improving clinical outcomes. Materials and methods: A retrospective analysis of 45 patients who underwent PTBD between 2022 and 2024 was conducted. All procedures were performed under combined ultrasound and fluoroscopy guidance. Data on procedural success, complications, and in-hospital mortality were collected. Complications were classified as minor or major based on clinical significance. The analysis focused on the types of early complications and mortality occurring during the patient’s hospital stay directly related to the procedure. Results: Technical success was achieved in 43 patients (95.5%). Complications were observed in 18 patients (41.9%), with 8 cases (18.6%) classified as major. The most common complication was hemobilia (30.2%), followed by cholangitis, which occurred in 5 patients (11.6%) during their hospital stay. Minor complications were managed conservatively, while major complications required invasive interventions such as embolization for severe hemobilia and percutaneous drainage for abscesses and bilomas. Two patients (4.6%) died during hospitalization due to underlying conditions unrelated to the procedure. Discussion: The findings align with existing literature, emphasizing PTBD’s effectiveness despite a high overall complication rate. Preventive strategies, including adequate pre-procedural preparation and precise catheter placement, are crucial for minimizing risks. This study underscores the importance of early recognition and prompt management of complications, particularly cholangitis and bleeding. Conclusion: PTBD is a safe and effective intervention for biliary obstructions when performed with meticulous technique and appropriate patient selection. Despite its inherent risks, most complications can be effectively managed, reinforcing PTBD’s role in complex biliary cases. Further studies are needed to optimize strategies for reducing complications and improving clinical outcomes.

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26/06/2025

HPV-associated diseases and their cytodiagnosis

N. Hinkova, T. Semova, D. Dimitrov, M. Vasileva, V. Racheva, Z. Gorcheva

Keywords: screening, HPV, `PAP

Abstract. Introduction: Conventional cytodiagnosis (PAP) has been used since the 1950s as a method for cervical cancer (CRC) prevention. Through the PAP smear test, the presence of persistent HPV infection could be proven, which cytopathologists described as the presence of koilocyte changes, a consequence of the nuclear membrane destruction. The objective of the present study has been to present the relevance of the conventional PAP smear as a method for the diagnosis of HPV-associated precancerous and cancerous diseases of the cervix. Materials and Methods: During the period 2019-2021, a retrospective study was carried out covering 128 female patients from Hinkomed MC LTD and Sv. Marina University Multi-Profi le Hospital for Active Treatment (UMPHAT) LTD, Pleven. The obtained data were processed with MS Office Excel 2019 software. Results: The covered group of patients was divided into two, according to the obtained results from the PAP smear test. The first group consisted of 74 patients (57.8%) with PAP I-II results (not signaled – cytologically). HPV-associated disease was diagnosed in 74.5% (38 patients) of them, and cervical inflammation in 13 (25.5%). The second group included 54 female (42.2%) with a PAP IIIa result and a higher group, called cytologically signaled. The study proved that 2 of the cases (3.7%) were false positive, 21 of the cases were true negative. There were 46 true positive cases and 39 false negative cases. Conclusion: The PAP smear test has been insufficient for the diagnosis of HPV-associated precancerous and/or cancerous diseases of the cervix. As an independent diagnostic method, it has been used only for HPV infection detection.

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About us

In 1973, on the initiative of “Medicine and Physical Culture" Publishing House, more precisely the then manager Mr. Trayan Ivanov, the Ministry of Health set up and approved to subsidize a new medical journal, published only in the English, which to reflect the status and achievements of Bulgarian medical science. Thus the language barrier was overcome and stable relations were established with the international medical societies, large libraries and university centres.

The internationally known scientist Prof. Assen A. Hadjiolov was elected Editor-in-chief by the first editorial board and the journal was named Acta Medica Bulgarica. For more than 20 years, the “Medicine and Physical Culture" personnel did all the work related to the publishing of Acta Medica Bulgarica, regardless of the fact that the magazine kept on its appearance as an organ of the Medical Academy, respectively of the Sofia Medical University.

Through the years, following the tradition of electing the Rector of Sofia Medical University to lead the publishing of the journal, Editors-in-chief were Prof. Atanas Maleev, Prof. Nikolay Belovezhdov, Prof. Dimiter Djerov, Prof. Vladimir Ovcharov, and Prof. Vanyo Mitev. Presently, Prof. V. Zlatkov,, the Rector of Sofia Medical University, is the Editor-in-chief of Acta Medica Bulgarica.

Gradually, a greater number of scientists from all over the world, as well as universities and scientific institutes, demonstrated a stronger interest in publishing their papers in AMB. The journal is on demand by over 300 world medical libraries working on principles of medical information exchange.