Medical University of Varna

Myasthenia gravis (MG) is a heterogeneous autoimmune neuromuscular disorder with distinct serological subtypes, including antibodies against acetylcholine receptors (AChRs), MuSK, and LRP4. Despite increasing recognition of these subtypes, clinical practice still lacks a standardized, subtype-specific approach to diagnosis, characterization, and management. Current treatment strategies are often applied uniformly, without fully accounting for differences in disease phenotype, prognosis, and therapeutic response among antibody-defined groups. This review provides a comprehensive overview of adult MG, focusing on the various autoantibody subtypes and their implications for pathogenesis, clinical features, diagnosis, and management. We highlight how combining serological findings with clinical subtyping can inform a more personalized approach to therapy and better align treatment decisions with disease biology. By emphasizing the clinical relevance of serological classification, this review aims to bridge the gap between immunopathological understanding and individualized patient care in MG.

Fenugreek (Trigonella foenum-graecum) has attracted growing interest as a complementary agent in the management of hepatocellular carcinoma (HCC), a leading cause of cancer-related mortality worldwide. Its rich botanical and phytochemical profile, including key bioactive compounds such as diosgenin, trigonelline, saponins, and flavonoids, underpins a spectrum of biological activities relevant to liver cancer therapy. This review critically examines the risks, benefits, and molecular targets of fenugreek administration in HCC, synthesising current evidence on extraction methods, standardisation, pharmacokinetics, and mechanisms of action. Preclinical studies highlight fenugreek's antitumor efficacy, mediated by apoptosis induction, cell cycle regulation, and modulation of oxidative stress and inflammatory pathways, while its hepatoprotective effects are supported by robust antioxidant and anti-inflammatory properties. However, the safety profile is nuanced, with potential risks including reproductive toxicity, rare hypersensitivity reactions, and herb-drug interactions, particularly in patients with compromised hepatic function or polypharmacy. The review identifies critical gaps in clinical evidence, especially regarding long-term safety and synergistic effects with conventional therapies and underscores the need for rigorous standardisation and patient monitoring. We describe the potential integration of fenugreek into multimodal HCC treatment strategies, if safety concerns are addressed. Future research should elucidate precise molecular targets, optimise formulations, and conduct well-controlled clinical trials to fully realise fenugreek's therapeutic potential in HCC management.

Background: The interplay between neuronutrition, physical activity, and mental health for enhancing brain resilience to stress and overall human health is widely recognized. The use of brain mapping via quantitative-EEG (qEEG) comparative analysis enables researchers to identify deviations or abnormalities and track the changes in neurological patterns when a targeted drug or specific nutrition is administered over time. High-functioning mild-to-borderline intellectual disorders (MBID) and autism spectrum disorder (ASD) constitute leading global public health challenges due to their high prevalence, chronicity, and profound cognitive and functional impact. Objective: The objectives of the present study were twofold: first, to characterize an extremely vulnerable group of children with functioning autism symptoms, disclosing their overall pattern of cognitive abilities and areas of difficulty, and second, to investigate the relevance of the effects of a mushroom (Hericium erinaceus) biomass dietary supplement on improvement on neurocognitive behavior. Methods: This study used qEEG to compare raw data with a normative database to track the changes in neurological brain patterns in 147 children with high-functioning autistic attributes when mushroom H. erinaceus biomass supplement was consumed over 6 and 12 months. Conclusions:H. erinaceus biomass in children with pervasive developmental disorders significantly improved the maturation of the CNS after 6 to 12 months of oral use, decreased the dominant slow-wave activity, and converted slow-wave activity to optimal beta1 frequency. Therefore, despite the lack of randomization, blinding, and risk of bias, due to a limited number of observations, it may be concluded that the H. erinaceus biomass may generate a complex effect on the deficits of the autism spectrum when applied to high-functioning MBID children, representing a safe and effective adjunctive strategy for supporting neurodevelopment in children.

This study introduces MedLex-25, a compact diagnostic instrument designed to quantify recognition–production asymmetries in medical English vocabulary. Second-year medical students at Medical University Varna, Bulgaria completed nine parallel test forms (50 targets per form; 225 unique lexical targets sampled from a coursebook corpus) under supervised conditions; usable data from 186 students were analysed, with a total of 9300 questions answered. Each form paired a four-option receptive item with a sentence-production task for the same targets; production responses were binary-scored (correct/incorrect) with tolerance for non-meaning-preventing surface errors. Results suggest a systematic recognition–production gap across five lexical categories (nouns, verbs, adjectives, adverbs, two-word multiword items): receptive accuracy consistently exceeded productive accuracy, and no item achieved perfect production. Counts of perfectly recognized items were: nouns 33/45, adjectives 27/45, verbs 23/45, adverbs 25/45, and multiword items 28/45. Verbs, adjectives and—most strikingly—adverbs exhibited the largest productive weaknesses (lowest production for erroneously = 0.071). Item-level diagnostics identify concrete teaching targets. The MedLex-25 test can guide focused instruction and recommend follow-up studies that expand item coverage, refine production scoring, and investigate etymology and cross-disciplinary exposure as mediating factors.

Alzheimer’s disease (AD) represents the most prevalent form of dementia, with acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitors constituting first-line symptomatic treatment. This study evaluates the inhibitory potential of ten naturally occurring flavonoids—apigenin, chrysin, fisetin, galangin, isorhamnetin, kaempferol, luteolin, myricetin, naringenin, and quercetin—against human AChE and BChE through molecular docking simulations. Results demonstrate that fisetin (FIS), luteolin (LUT), and apigenin (API) exhibit the highest affinity for AChE (lowest ΔG and Ki), consistent with their planarity and moderate polarity. For BChE, myricetin (MYR) forms the most stable complex, followed by FIS and LUT, as the wider and more polar active pocket favors highly hydroxylated flavonols. Isorhamnetin (IHN) shows the weakest affinity due to reduced donor–acceptor capacity from 3’-O-methylation. FIS and LUT emerge as dual-target candidates, whereas MYR demonstrates BChE selectivity. These findings identify promising natural scaffolds for developing safer cholinesterase inhibitors with potential therapeutic applications in neurodegenerative diseases, warranting further in vitro and in vivo validation.