Introduction: Colorectal cancer (CC) is the third most common cause of cancer worldwide. Common symptoms of CC (change in bowel physiology, rectal bleeding, and weight loss) present late in the course of the disease and have low positive predictive value (3-4%). The most important prognostic factor is the stage of the disease at diagnosis; therefore, screening for CC is important for people ≥60 years of age. Objective: To determine the importance of faecal calprotectin (FCP) and M2-pyruvate kinase (M2-PK) values for the early diagnosis of CC with different localization. Material and Methods: A total of 90 participants were prospectively studied, divided into three groups as follows: 30 patients with colorectal carcinoma (target group), 30 patients with chronic organic disease of the gastrointestinal tract, and 30 patients with irritable bowel syndrome (control groups). All subjects were admitted or visited the University Hospital "Dr G. Stranski" – Pleven. The values of FCP and M2-PK were examined in all of them. Results: There is a significantly different degree of correlation between the values of FCP and M2-PK – in 85% of patients with colorectal carcinoma they are elevated, and in 50% of patients with irritable bowel syndrome, compared between the two groups and compared to participants in the control group. Conclusions: The present study shows that both faecal M2-PK and calprotectin levels can contribute to the early, noninvasive detection of colorectal cancer. These markers may serve as useful screening tools, especially in asymptomatic individuals, and help prioritize patients for further endoscopic investigation.
Purpose: The purpose of this review is to present various methods, technical considerations, and current indications of decompressive craniectomy (DC) in managing traumatic brain injury (TBI), summarizing key outcomes and potential complications. Methods: A comprehensive literature review was conducted, encompassing historical perspectives, contemporary surgical techniques, and recent randomized controlled trials (RCTs) evaluating the efficacy and safety of DC. Relevant databases, including PubMed, Crossref, and academic resources, were utilized to identify critical studies. Results: DC significantly reduces intracranial pressure (ICP), preventing secondary brain injury due to refractory intracranial hypertension. Various surgical techniques, including unilateral (hemicraniectomy), bilateral, hinge, osteoplastic craniotomy, and multi-dural stab methods have been developed, each with unique indications and limitations. Landmark trials such as DECRA, RESCUEicp, DESTINY, and STICH provide evidence on the timing, patient selection, and outcomes associated with DC. Early intervention generally correlates with improved survival, although functional outcomes vary considerably based on age, injury severity, and surgical timing. Complications such as infection, hemorrhage, and syndrome of the trephined remain significant concerns. Conclusion: DC is a life-saving procedure in severe TBI, effectively managing refractory intracranial hypertension. Its role, however, must be individualized, considering patient-specific factors and risks. Current evidence underscores the necessity of careful patient selection, timing, and appropriate surgical technique to maximize benefits and minimize complications. Further studies focusing on long-term outcomes and quality-of-life measures post-DC are required to refine guidelines and enhance patient care.
Purpose: To examine the reporting and influence of dataset quantity and quality in generative adversarial network (GAN)-based dental prosthetic generation and to summarize the evidence available through 16 July 2026. Material/Methods: A structured literature search was conducted in PubMed, Scopus, Web of Science, IEEE Xplore, SpringerLink, arXiv, and Google Scholar. Fifteen original GAN or explicitly adversarial studies of prosthetic generation or validation were included in the focused qualitative synthesis. Nine non-GAN generative or automated artificial-intelligence studies published in 2025-2026 were analyzed separately as contextual evidence. Results: Dataset definitions ranged from small three-dimensional collections to more than 1500 depth-map cases. ToothGAN used 814 natural-tooth and technician-designed cases and showed that the dataset composition affected anatomical features, groove depth, and occlusal contact characteristics. A 3D GAN implant-crown study demonstrated that overlap metrics should be interpreted together with clinically relevant emergence-profile parameters. Contextual transformer, point-cloud, diffusion, and commercial-system studies reported increasingly explicit data splits and clinical endpoints, although several proprietary systems did not disclose their training data. Conclusions: No universal minimum dataset size can be established. Dataset composition, anatomical diversity, ground-truth definition, resolution, augmentation, independent testing, and clinical validation are at least as important as sample count.
Purpose: To present a pediatric case of hand dermatitis associated with homemade slime exposure and to analyze the factors contributing to polysensitization in children. Material/Methods: A 6-year-old girl with a six-month history of recalcitrant hand dermatitis underwent clinical examination, detailed exposure history, and epicutaneous patch testing using the European baseline series. Patch test readings were performed on Day 2 and Day 4. Results: Dermatological examination revealed erythematous and scaly lesions on the dorsal and palmar surfaces of the hands. History revealed regular contact with homemade slime prepared using common household products. Patch testing was performed, and sensitization to seven allergens was confirmed: a mixture of parabens, lanolin alcohol, Peruvian balsam, a mixture of fragrances, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), methyldibrom glutaronitrile (MDBGN), and methylisothiazolinone (MI). In the treatment of the disease, the use of slime was strictly prohibited, and a short course of strong topical corticosteroids was used, which led to improvement. Conclusions: Irritant and allergic contact dermatitis in children is a serious disease, and recently it has often been associated with the use of homemade slime. Polysensitization may occur due to simultaneous exposure to multiple cosmetic and household products or cross-reactivity between isothiazolinone derivatives. Dermatologists should consider "mucous dermatitis" in cases of new-onset hand eczema in children, especially when lesions correlate with sites of exposure. Early recognition and avoidance can prevent chronic disease and long-term complications.
Purpose: This study aimed to perform a morphological analysis of the adhesive interface between three composite restorative systems and the dentin of primary teeth. Materials and Methods: The study included 30 extracted primary teeth, divided into three groups according to the restorative material used. The materials investigated were: the giomer Beautifil II with the adhesive system Clearfil SE Protect, the compomer Dyract with the adhesive system Evetric, the nanofilled composite Estelite Sigma Quick with the adhesive system Bond Force II. After dentin surface preparation and material application, the teeth were stored for 24 hours at 37°C, subjected to thermocycling, and prepared for morphological analysis. Results: All materials showed the presence of adhesive and hybrid layers with varying thickness and structure. The thickest adhesive layer was observed in the specimens restored with Beautifil II in combination with Clearfil SE Protect. The most pronounced hybrid layer was formed in the Dyract XP compomer combined with Evetric adhesive. A thin but continuous hybrid layer was found in Estelite Sigma Quick and Bond Force II.
Background: Acute pain is a universal feature of traumatic injury and one of the leading causes of distress among patients in the emergency department. Timely and effective analgesia not only relieves suffering but also improves physiological stability, facilitates diagnosis and treatment, and enhances patient satisfaction. Objective: This review summarizes contemporary strategies for pain management in trauma patients during the diagnostic process, explores their impact on patient satisfaction, and outlines best practices for anaesthesia and emergency teams. Methods: A narrative review of recent clinical trials, systematic reviews, and practice guidelines published between January 2020 and June 2026 was conducted through PubMed, MEDLINE, and Scopus databases. Conclusion: Multi-modal, patient-centred analgesia, including early assessment, pharmacologic and regional techniques combined with emphatetic communication, optimizes clinical outcome and patient experience. Patient satisfaction should be recognized as a vital quality indicator in trauma care.
Introduction: Nationally and internationally, various strategies are being sought and developed to improve the quality of life in patients with ischemic stroke who have reached different degrees of disability following an acute incident. Aim: The study aims to monitor improvements in the quality of life of patients who have experienced an ischemic stroke. Materials and Methods:One hundred patients aged 50–70 years were examined in the period 2008–2014 in the Neurology Department of a Multidisciplinary Hospital for Active Treatment in Blagoevgrad. The experimental group consisted of 10 patients who underwent intravenous thrombolysis. Control group 1 consisted of 45 patients, who did not receive thrombolysis and underwent the same kinesitherapeutic methodology applied to patients the EG. Control group 2 consisted of 45 patients, who received a standard kinesitherapeutic program. Results and Analysis: Our data regarding the recovery of motor function and quality of life in patients treated with intravenous thrombolysis within the first 3 hours of acute stroke onset are comparable with literature data. After the applied methodology and kinesitherapy, a large proportion of patients achieved functional independence, with relatively restored muscle strength and no tendency toward pathological muscle tone. Conclusion: Data analysis shows that a significant portion of patients in the experimental and control group 1 had a pronounced functional deficit upon hospitalization but could be rehabilitated through specialized exercises from our methodology by the time of discharge, whereas recovery in control group 2 was slower.
Purpose: Preterm birth (PTB) is a major cause of neonatal morbidity and mortality worldwide. This study assessed the predictive value of combining sonographic parameters—cervical length (CL) and anterior utero-cervical angle—with biochemical biomarkers, foetal fibronectin (fFN) and phosphorylated IGFBP-1 (pIGFBP-1), in symptomatic pregnant women. Material and methods: In a prospective cohort of 48 singleton pregnancies (28–34 weeks' gestation) with threatened preterm labour, CL and anterior utero-cervical angle were measured by transvaginal ultrasound, and fFN and pIGFBP-1 were tested using qualitative immunoassays. LASSO regression identified key predictors, followed by logistic regression to assess diagnostic performance. Results: Ten participants (21%) delivered preterm. An anterior utero-cervical angle ≥124° achieved 80% sensitivity and 84% specificity (AUC: 0.892), outperforming CL alone (AUC: 0.829). fFN showed high accuracy (AUC: 0.824) and strong negative predictive value (92.3%). Combining sonographic and biochemical markers improved predictive performance (AUC: 0.95). Conclusions: The anterior utero-cervical angle is a promising sonographic marker for PTB risk. Integrating it with fFN and other established predictors enhances diagnostic accuracy and may optimize management, particularly in resource-limited settings. Further validation in larger cohorts is warranted.
Chronic kidney disease (CKD) affects over 10% of the global population, posing significant challenges due to its asymptomatic nature in early stages and progressive deterioration of renal function. The identification of reliable biomarkers for early diagnosis and monitoring of disease progression is crucial for improving prognosis and treatment. Neutrophil gelatinase-associated lipocalin (NGAL) is a promising candidate, already validated as a marker for acute kidney injury. Purpose: This study aimed to evaluate the potential of serum NGAL levels as a biomarker for diagnosis and monitoring the progression of CKD. Material/Methods: Seventy-one adult Caucasian patients at CKD stages G1–G4 according to the KDIGO criteria were divided into three groups: Group 1 (eGFR ≥90 mL/min/1.73m²), Group 2 (eGFR 45–89 mL/min/1.73m²), and Group 3 (eGFR 15–44 mL/min/1.73m²). Blood samples were collected and analyzed via standard biochemical and immunological techniques. Serum NGAL levels were measured using ELISA. Results: NGAL levels increased significantly with disease progression and strongly correlated with declining eGFR. Higher NGAL levels were linked to elevated serum creatinine and inflammatory markers, indicating progressive damage to the kidney tissue against the backdrop of persistent systemic inflammation. Conclusions: As a biomarker, NGAL has significant potential for identifying and monitoring kidney damage. Its application in clinical settings could complement and improve existing methods for diagnosing and observing CKD.
Purpose: To analyze epidemiological and clinical data of individuals tested for pertussis within the framework of routine disease surveillance Material and Methods: We conducted a retrospective analysis of epidemiological and clinical characteristics in 109 patients tested for pertussis from five regions in Central and Northeastern Bulgaria. Nasopharyngeal samples were collected from all subjects. Bacterial DNA was extracted using the SaMag Bacterial DNA Extraction Kit (SM006, Sacace Biotechnologies, Italy) according to the manufacturer’s instructions. DNA amplification was performed using the Bordetella multiplex Real-TM PCR kit (Bordetella pertussis/B. parapertussis/B. bronchiseptica Real-TM, B84-100FRT, Sacace Biotechnologies, Italy), targeting the conserved region of the ptxA gene and species-specific genomic regions of Bordetella pertussis. Amplification and analysis were performed using the CFX96 qPCR system (Biorad, USA). All positive samples demonstrated amplification of the ptxA gene and specific genomic regions of B. pertussis. Results: Between May and December 2024, a total of 109 nasopharyngeal samples from patients with suspected pertussis were tested at the Virology Laboratory of the Medical University – Pleven. PCR analysis confirmed pertussis infection in 25 cases (22.94%). The highest proportion of positive cases was observed among children aged <1 year (n = 12) and those aged 5–9 years (n = 4). Unimmunized individuals accounted for 12 (48%) of all laboratory-confirmed cases. According to epidemiological classification criteria, 16 cases (14.68%) were categorized as possible, 4 (3.67%) as probable, and 18 (16.51%) as confirmed. Conclusion: Strengthening laboratory diagnostics, optimizing vaccination strategies, and conducting comprehensive epidemiological investigations are essential to enhance pertussis surveillance and control efforts.
Introduction: The size and shape of the external nose have been the subject of numerous studies. The objective data provided by these studies is essential for the successful performance of various surgical and aesthetic procedures, as well as for the assessment of genetic syndromes and malformations. The aim of the present study was to provide information about the type of nose in young Bulgarians, males and females. Material/Methods: The three-dimensional coordinates of several soft-tissue landmarks on the face were obtained using a hand-held laser scanner in 85 healthy individuals (41 males and 44 females) of Bulgarian origin aged 21-30 years. Using these three-dimensional landmarks, the following linear distances were measured (mm): nasal height (n-sn), nasal width (alr-all). Based on the nasal width and nasal height, a nasal index was calculated (nasal width /nasal height x100). Results: The results of the study indicate that the highest percentage of the studied males and females possessed high and narrow noses, lepthorrhine, 77.8% and 51.4%, respectively. The proportion of females exhibiting a very high and narrow nose hyperleptorrhine was found to exceed that observed in males, with percentages of 48.7% and 22.2%, respectively. Statistically significant gender differences in percentage distribution were found in both categories (p<0.05). Conclusion: Data obtained from nasal measurements in healthy individuals from different populations will provide objective norms and criteria in planning and reporting treatment outcomes in different areas of medical practice.
Radiculomegaly is a rare dental anomaly characterized by abnormally elongated tooth roots, most commonly associated with syndromic conditions such as oculofaciocardiodental (OFCD) syndrome. Generalized radiculomegaly in the absence of systemic findings is exceptionally rare, particularly in male patients. I report the case of a 62-year-old Bulgarian male who presented with dental hypersensitivity and localized pain in the left mandibular region. Clinical examination revealed multiple missing teeth, generalized tooth wear, and retained permanent teeth with elongated crowns. Panoramic radiography and cone beam computed tomography (CBCT) revealed generalized root elongation involving multiple teeth in both arches. The maxillary canines showed the most pronounced elongation, with roots measuring up to 35.62 mm. No clinical signs of syndromic conditions such as OFCD were present, and the patient's medical and family history were unremarkable. The purpose of this article is to present a case of a non-syndromic Bulgarian male patient diagnosed with an occurrence of Radiculomegaly (Root Gigantism) affecting the permanent dentition, especially the maxillary canine. Conclusion: Dentists need to be informed of the clinical and radiographic features of different dental anomalies, especially radiculomegaly. The challenges faced dentist include repairing the root canals, extracting and/or moving the teeth orthodontically.
Aim. The objective of this study is to present a rare clinical case of herpes zoster–associated neuropathy of the hard palate, resulting from involvement of the right greater palatine nerve (n. palatinus major dextra) of the maxillary nerve (n. maxillaris) following herpes zoster virus (HZV) infection. In addition, the report aims to review the frequency, clinical characteristics, diagnostic approaches, and therapeutic strategies for both systemic and oral manifestations of this condition. Materials and Methods. We describe the case of a female patient presenting with a unilateral, intensely painful vesicular eruption on the right side of the hard palate, accompanied by malaise, fatigue, and pain affecting the right half of the face, but without extraoral clinical signs. Results. A review of the relevant literature indicates that herpes zoster involving the maxillary nerve—and specifically limited to the greater palatine nerve—is relatively uncommon and often presents with non-specific features. Such manifestations may also occur in isolation, without concurrent involvement of other anatomical regions. Conclusion. Recognition of this rare clinical presentation of herpes zoster affecting the oral cavity, and particularly the hard palate, is essential for accurate diagnosis and timely referral. Early detection enables the prompt initiation of antiviral therapy, which can reduce viral replication and dissemination, mitigate sensory nerve damage and pain, and prevent complications associated with herpes zoster infection.
The Covid-19 pandemic passed several years ago, but a significant proportion of people still suffer its consequences. Physicians face the difficult task of managing these consequences, monitoring their patients over time, and the need to apply an individual-specific approach. In this article, the main risk factor and mechanisms for developing post-COVID fibrosis are discussed. The available therapeutic options for preventing and treating of that type of fibrosis are summarized. The need for follow-up of these patients is emphasized. Basic guidelines and optimal time intervals for their follow-up are presented.
Polymyositis is an idiopathic inflammatory myopathy classified under a heterogeneous group of autoimmune diseases predominantly presenting with symmetrical proximal muscle weakness, weakness of neck muscles with the manifestation of a "dropped head" symptom, dysphagia, dysphonia; elevated serum levels of creatine kinase (CK), sometimes in conjunction with elevated liver enzymes; characteristic EMG findings and muscle biopsy. The presence of myositis-specific antibodies in more than half of the patients facilitates the definition of distinct clinical subtypes and aids in accurate diagnosis, with an associated higher risk of involvement of other organs and systems such as the lungs, heart, liver, etc., most commonly presenting as interstitial pulmonary fibrosis, cardiomyopathy, and significantly less frequently primary biliary cirrhosis. A twofold increase in malignancies has been established compared to the general population, or the manifestation of myositis can be presented as a paraneoplastic syndrome. The first-line treatment method is the administration of intravenous corticosteroids in moderate or high doses combined with cytostatic therapy, with rare necessity for intravenous immunoglobulin administration, while plasmapheresis is considered an inapplicable method. We report a case of polymyositis with characteristic clinical and serological findings, with severe respiratory failure, developing twice in the absence of interstitial pulmonary fibrosis, primarily secondary myocardial damage during disease activity, and the presence of asymptomatic ovarian cancer and primary biliary cirrhosis discovered during the course of the disease, demonstrating the best therapeutic effectiveness from plasmapheresis. Accurate diagnosis relies on clinical, electrophysiological, and immunological findings, posing diagnostic challenges and questions that require the collaborative efforts of a multidisciplinary team.
Purpose. To evaluate children's behaviour using the Frankl scale during the treatment of dentin carious lesions (code 05 according to ICDAS II) on primary molars, using chemo-mechanical excavation with Brix 3000. Material. The study included 57 children aged 4 to 6 years, divided into two groups: Group 1 - 33 children aged 4-5 years; Group 2 - 24 children aged 5-6 years. Methods. The treatment protocol consisted of four main steps: carious lesion exposure, selective removal of infected dentin from the EDJ and cavity walls, and excavation of the cavity floor to affected dentin. In both groups, carious dentin was removed using Brix 3000 (half a grain of rice in amount, 2 minutes of application), followed by placement of a liner and restoration with compomer. Children's behaviour was assessed using the Frankl scale before and after treatment. To influence behaviour, the "Tell-Show-Do" technique was applied. Results. After the completion of treatment with Brix 3000, no children in either group exhibited definitely negative behaviour. The number of children with negative behaviour also decreased. There was an increase in the proportion of children showing positive and definitely positive behaviour following chemo-mechanical excavation with Brix 3000. Conclusion. Chemo-mechanical excavation with Brix 3000 positively influences children's behaviour during treatment. Combined with the "Tell-Show-Do" technique, it helps build trust and a positive attitude — crucial for successful paediatric dental care.
Rehabilitation is a necessary continuation of comprehensive treatment, given the increasing survival rates and advances in medical technology care. Improving the quality of life of cancer patients was put at the center of discussions only in the second half of the 20th century, and only complete decongestant therapy was accepted as the "gold standard". Purpose: To study and research the evolutionary development of oncological rehabilitation Material and Methods: Material: The study covers full-text scientific publications for the period 1985-2025 by keywords rehabilitation in malignant diseases, lymphatic drainage, complex decongestive therapy, oncorehabilitation from the scientific databases Google Scholar, PubMed, Web of Science and Scopus published in English. Methods: Documentary content analysis of relevant scientific publications. Results: 35 full-text articles for the research period, of which 20 (about 57%) focus on complex decongestive therapy. Most often, complex decongestive therapy is applied in the rehabilitation plan of patients with oncological diseases. The researchers build on the classic method of manual lymphatic drainage, the creator of which is Emil Vodder. In Bulgaria, rehabilitation services are increasingly offered to patients with oncological diseases, with a gradual increase in practical and scientific interest in the last two decades. Conclusion: The modern view of oncorehabilitation is associated with the holistic nature of human health, which requires efforts to be directed towards the treatment of oncological diseases and the prevention of complications that arise during the course of the disease. Despite the studies in this area, larger-scale studies involving a longer period of time are needed in the future in order to monitor the sustainability of the results.
The skin is the largest anatomical organ in the human body and performs many physiological functions. Protection of the body from harmful environmental influences is among the main functions of the skin. Skin wounds initiate a protective programme to restore tissue integrity and maintain the homeostasis of the body. This process occurs in four consecutive phases: haemostasis, inflammation, proliferation, and tissue remodelling. Different types of cells participate, among which immune cells play a key role. The complex interactions between these cells and the extracellular matrix ensure the physiological course of tissue healing. The purpose of this review is to present the skin as a protective organ and to describe the involvement of immune cells, specifically granulocytes and mononuclear cells, in the distinct stages of wound healing.
Purpose: The aim of this literature review is to investigate and summarize the main factors that influence the outcome and lead to success after performing an orthograde root canal treatment, such as the initial situation and different treatment-related factors. Materials and Methods: Related articles, publications and case reports, published from 2002 until 2025 were investigated in order to summarize the main factors influencing the outcome of the endodontic treatment. Results: Many factors are considered to influence the long-term prognosis of endodontically treated teeth, such as preoperative condition of the periradicular tissues, chemo-mechanical preparation of the root canal system, the length and density of the root canal obturation, the coronal seal, the occurrence of iatrogenic mishaps in clinical cases with more complex root canal system anatomy. Conclusion: The main factors that influence the longevity of root canal treated teeth are the preoperative condition of the periapical tissues and the possibility of achieving a proper apical and coronal seal.
Purpose: Posterior Reversible Encephalopathy Syndrome (PRES) is a neurotoxic condition characterized by reversible subcortical white matter and cortical edema, commonly affecting the parieto-occipital regions. Pregnancy, particularly in the context of preeclampsia or eclampsia, represents a significant risk factor for PRES. Material/methods: We report a case of a 26-year-old woman with monochorionic diamniotic twins who developed PRES in the immediate postoperative period following elective cesarean section at 36 weeks of gestation. Despite initial normal blood pressure and laboratory findings, she experienced sudden bilateral vision loss accompanied by confusion. Results: MRI revealed symmetrical occipital cortical hyperintensities consistent with PRES. Intensive management, including antihypertensive therapy and close monitoring, led to full recovery of vision and normalization of MRI findings within one month. Conclusion: This case underscores the importance of prompt recognition and early intervention in PRES, even in normotensive postpartum patients. Awareness of PRES in the context of pregnancy is critical, as timely diagnosis and management significantly improve clinical outcomes and reduce the risk of long-term neurological sequelae.
