rss_2.0Acta Medica Bulgarica FeedSciendo RSS Feed for Acta Medica Bulgarica Medica Bulgarica Feed of Psychosocial Distress in Nurses Working in Hemodialysis During Exposure to COVID-19 Pandemic in Bulgaria<abstract><title style='display:none'>Abstract</title> <p>A new type of virus, SARS-CoV-2, has spread globally throughout the world. The COVID-19 epidemic rapidly spread worldwide. The health care system, society and medical professionals have prepared to adapt, train and resist the increased psychosocial pressure. In this situation, the role and place of medical professionals has become noticeably more prominent, and the psychosocial stress of the work environment has increased its impact – progressing to high levels of harmful intensity towards the medical professionals. Focusing within the borders of Bulgaria, it can be argued that the initial two waves of high levels of COVID-19 prevalence were difficult and critical to overcome. The aim of our study is to investigate the impact of psychosocial stress on the functional status examined with the response of arterial blood pressure of nurses, practicing long-term care in hemodialysis clinics and centers during exposure to COVID-19 pandemic. A study was conducted on the subjective assessment of psychological and social risk factors, and arterial systolic and diastolic blood pressure in 2018-2019 (pre-COVID-19 period) and 2020 (COVID-19 period), respectively. The methods used were the NIOSH questionnaire – to assess psychosocial stress at work and to measure blood pressure with a sphygmomanometer. The results showed that the expansion of psychosocial risks from the work environment impacted on the functional status of nurses, with an increase in the level of social support and systolic blood pressure during the COVID-19 compared to the pre-COVID-19 period, and a decrease in the level of control when comparing the same periods. We will monitor and observe these effects with concern in order to respond in a timely manner with effective and practical strategies, policies and programs to counter and prevent psychosocial stress in the workplace. One of the outlined guiding goals and trends for this will be to both preserve and prolong the work life of nurses and to reposition them as a key and significant group for the healthcare system.</p> </abstract>ARTICLEtrue Basilaris Medianus as an Anatomical Variation in the Basilar Part of the Occipital Bone: A Descriptive Cone Beam Computed Tomographic Study<abstract><title style='display:none'>Abstract</title> <sec><title style='display:none'>Objectives: </title> <p>Canalis basilaris medianus (CBM) is a unique anatomical variation located in the basal occipital region of the skull, rarely encountered in head and neck radiographic imaging. The aim of the present study was to evaluate the prevalence and types of CBM using Cone Beam Computed Tomography (CBCT) scans.</p> </sec> <sec><title style='display:none'>Materials and Methods: </title> <p>CBCT (Full FOV) images of 200 patients aged between 10 to 70 years were selected for the current retrospective study following the inclusion and exclusion criteria. The image sections from the scan data were scrutinized for the presence of CBM, in addition to its classification based on the type of morphology. The presence and types of CBM were recorded based on the age and gender. The chi-square test was used to analyze the presence and types of CBM with regard to gender and age group.</p> </sec> <sec><title style='display:none'>Results: </title> <p>The overall prevalence of CBM was estimated as 9.5%. CBM was present in 13% of males and 3% of females (p = 0.021). Considering the types of CBM, the superior recess type was predominantly observed followed by the inferior recess, superior and inferior type. However, there was no significant gender-based differences noted among the types of CBM (p &gt; 0.05). Also, there was no statistically significant difference noted in the prevalence of CBM in different age groups (p &gt; 0.05).</p> </sec> <sec><title style='display:none'>Conclusion: </title> <p>It is necessary for maxillofacial radiologists to have a solid understanding of both normal and variant skull-base anatomy to facilitate recognition of variants such as CBM in order to recognize the associated anomalies. To our knowledge, this was the first study done which assesses the gender-based differences among the various types of CBM.</p> </sec> </abstract>ARTICLEtrue Pacemaker Implantation: Early Post-Implantation Data<abstract><title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction: </title> <p>Data on the development of left ventricular dysfunction after permanent pacemaker implantation are available. Myocardial collagen deposition is a well-known mechanism that occurs in left ventricular remodelling. This gave us reason to dynamically monitor the levels of the main molecules involved in collagen synthesis, PIPC (carboxy-terminal propeptide of type I procollagen) and PIIINP (amino-terminal propeptide of type III procollagen).</p> </sec> <sec><title style='display:none'>Materials and Methods: </title> <p>PIPC and PIIINP levels were studied using enzyme-linked immunoassays in plasma from 45 patients (25 men, 20 women, 72.1 ± 9 years) and 46 controls (24 men, 22 women, 71.9 ± 8.7 years) without known cardiovascular diseases (except arterial hypertension, conduction disorder, indication for the procedure) at baseline (immediately before PPM implantation for patients), at 12 and 24 weeks.</p> </sec> <sec><title style='display:none'>Results: </title> <p>There was no difference in baseline levels of PICP and PIIINP between patients and controls (p &gt; 0.05, Table abstract). At week 12, PICP levels increased significantly in patients compared to baseline in controls (p &lt; 0.05, Table abstract). At week 24, values continued to increase and were again significantly higher than baseline in the controls (p &lt; 0.001, Table abstract). At the 12-week follow-up visit, PIIINP values in patients were significantly higher than those at baseline in controls (p &lt; 0.001, Table abstract). At week 24, the values of the patients were still higher than those of the controls, but the difference was not significant (p &gt; 0.05, Table abstract).</p> </sec> <sec><title style='display:none'>Conclusion: </title> <p>This study showed early activation of collagen synthesis &lt; 6 months after PPM (permanent pacemaker) implantation. Due to the selection of patients without concomitant cardiovascular pathology, we have reason to assume that it is a result of the procedure itself and a serious prerequisite for increased collagen deposition in the myocardium.</p> </sec> </abstract>ARTICLEtrue of predefined bacterial species in the Vaginal Microbiota in SARS-COV-2-Positive Patients<abstract><title style='display:none'>Abstract</title> <p>Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be found in the vagina of infected women remains unclear; moreover, the impact of the virus on the normal vaginal microbiota is not known.</p> <sec><title style='display:none'>The aim </title> <p>of our study was to identify the vaginal presence of SARS-CoV-2 and detection of predefined bacterial species changes in the vaginal flora of women that tested positive for SARS-CoV-2 infection.</p> </sec> <sec><title style='display:none'>Materials and Methods. </title> <p>This prospective study included 40 women, aged 24-47 years, tested for SARS-CoV-2 via nasopharyngeal and vaginal culture (TaqPath ™COVID-19 CE-IVD RT-PCR), and vaginally tested for changes in the vaginal microbiota using the Femoflor® 16 REAL-TIME PCR Detection Kit.</p> </sec> <sec><title style='display:none'>Results. </title> <p>No one of women in this study was tested positive for vaginal presence of SARS-CoV-2. Three (7.5%) women with sexually transmitted disease were excluded. Irregularities were observed in the vaginal microbiota of 8 (21.6%) out of 37 patients included in the study: 3 (8.1%) from the SARS-CoV-2-positive group and 5 (13.5%) from the SARS-CoV-2-negative group. The remaining 29 (78.4%) women had normal vaginal flora; lactobacilli were found to be dominant. Although results revealed a difference in the vaginal microbiota between the two groups, the differences were not statistically significant (p ≥ 0.05).</p> </sec> <sec><title style='display:none'>Conclusions. </title> <p>Even though it remains unclear whether SARS-CoV-2 invades the vagina of infected women, there is no significant evidence to suggest that it causes a more frequent disturbance in the vaginal microbiota of infected women compared to that in healthy women.</p> </sec> </abstract>ARTICLEtrue Treatment of Idiopathic Isolated Clitoromegaly – A Clinical Case<abstract><title style='display:none'>Abstract</title> <p>Idiopathic clitoromegaly is a relatively rare disease. A case of isolated idiopathic clitoromegaly is presented. It concerns a 31-year-old woman, in whom the clitoris has showed a tendency for progressive enlargement in the last 3-4 years. The patient had no gynecological and systemic diseases and disorders. Karyotype and hormone levels were normal. No cystic changes in the ovaries and other changes in the abdominal organs were detected during ultrasound. Computerized axial tomographic (CAT) scan of the adrenal glands was performed and showed normal appearance. Method of selection in such cases is operative treatment – clitoroplasty with storage of neurovascular bundle of the clitoris.</p> </abstract>ARTICLEtrue of IgG Antibodies Against SARS-CoV-2 N Protein Among Vaccinated and Unvaccinated Subjects in Lahore, Pakistan<abstract><title style='display:none'>Abstract</title> <p>The spread of SARS-CoV-2 represented a global health crisis. On May 5, 2023, the chief of the World Health Organization (WHO) officially announced the end of COVID-19 as a global health emergency. Serological assays can identify previously infected SARS-CoV-2 individuals, even if they did not go for testing while acutely ill. The current study sought to detect antibodies directed against the nucleocapsid of SARS-CoV-2 (IgG against the SARS-CoV-2 N protein) in both vaccinated and unvaccinated COVID-19 individuals. Of the 100 participants, 53 and 47 were vaccinated and unvaccinated, respectively. The vaccination status of the cohort based on gender data indicates that 41 (41%) of all participants were vaccinated males, whereas 12 (12%) were vaccinated females. We found that 42 (42%) were unvaccinated males and 5 (5%) were unvaccinated females. Of 53 vaccinated subjects, 42 and 11 participants were positive and negative for IgG against the SARS-CoV-2 N protein, respectively. Of 47 unvaccinated participants, 28 and 19 were positive and negative for IgG against the SARS-CoV-2 N protein, respectively. The average of S/P “Sample/Positive control” percentages, which correlate to levels of IgG against SARS-CoV-2 N protein, were significantly higher among the vaccinated patients (73.8%) as compared to non-vaccinated patients (57.1%), with p = 0.02. There was a downward trend in levels of IgG against the SARS-CoV-2 N protein with increasing age, except for the 60–69 age group.</p> </abstract>ARTICLEtrue of Metabolic Syndrome and its Components in Patients with Controlled Graves’ Disease<abstract><title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim: </title> <p>Our aim was to assess the prevalence of the metabolic syndrome (MetS) and its components in patients with controlled Graves’ disease (GD).</p> </sec> <sec><title style='display:none'>Methods: </title> <p>This was a cross-sectional study involving 95 consecutive patients with GD referred to our tertiary care inpatient clinical center meeting the following inclusion criteria: controlled hyperthyroidism, treatment with antithyroid drugs, untreated Graves’ orbitopathy (GO), if present. Patients’ anthropometric parameters were evaluated and laboratory tests were performed with measurement of fasting blood glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, thyroid hormone and antibody levels. The presence of the MetS and its components as defined by the International Diabetes Federation from 2009 were evaluated.</p> </sec> <sec><title style='display:none'>Results: </title> <p>In our patient cohort 82.1% were females, 17.9% were males, mean age 50.2 ± 13 years, with median duration of GD 16.5 months. The MetS was observed in 32.6% of our patients, obesity – in 34.7%, hyperglycemia in 38.9%, arterial hypertension – in 36.8%, low HDL-cholesterol – in 23.2% and hypertriglyceridemia – in 13.7%. There was not statistical difference neither between the prevalence of the MetS, nor between the prevalence of its individual components in female and male GD patients. The MetS was significantly more frequent in older patients, as well as abdominal obesity, hyperglycemia and arterial hypertension. There was not statistical difference in the frequency of the MetS and its components between GD patients with and without GO, except for waist circumference, which was significantly higher in patients with GO.</p> </sec> <sec><title style='display:none'>Conclusions: </title> <p>The presence of the MetS and its components among GD patients are to great extent similar to those reported in the general population, which underlines the need for their screening and proper treatment in this subpopulation.</p> </sec> </abstract>ARTICLEtrue Polymorphisms in CYP2 Gene Family in Bulgarian Individuals and their Clinical Implications<abstract><title style='display:none'>Abstract</title> <p>The cytochrome P450 superfamily consists of hemeproteins involved in the detoxication of different xenobiotics, including drugs. The CYP2 gene family is responsible for the metabolism of 80% of the drugs in clinical use. There are considerable interindividual and interethnic variabilities in the rate of drug metabolism as a result of genetic polymorphisms. The goal of our study was to determine the frequency of 10 genetic polymorphisms in CYP2 family genes to give light on the pharmacogenetic defects of the main CYPs, involved in drug metabolism, in Bulgarian individuals. We detected high allele frequency for CYP2D6*10 (0.27), CYP2D6*4 (0.22), and CYP2B6*9 (0.24), followed by CYP2C19*2 (0.14), CYP2C9*3 (0.11) and CYP2C9*2 (0.09). The genotype frequencies were also determined for all investigated variants. In total 47.2% of the analyzed individuals carried CYP2D6 genetic polymorphisms – 5.6% carried a single variant and 41.6% were found to have two or more such variants. Homozygotes for CYP2D6 variants were established among 14% of Bulgarian individuals. Determination of the prevailing pharmacogenetic polymorphisms of the CYPs, most responsible for drug metabolism, will lead to a lower risk of drug toxicity, increased drug efficacy, and drug dose optimization.</p> </abstract>ARTICLEtrue Technique for Alveolar Ridge Augmentation in Pre-Prosthetic Implant Surgery: Indications and Problems<abstract><title style='display:none'>Abstract</title> <sec><title style='display:none'>Background: </title> <p>Prosthetic rehabilitation of missing teeth with dental implant-supported restorations has recently become a predictable treatment option in contemporary dentistry with a highly successful rate. Due to different factors, vertical and horizontal bone loss could present, and the available alveolar bone may not be sufficient for optimum implant position. Ridge augmentation procedures could be applied to increase the volume of the deficient sites for accurate prosthetic implant placement, which assures functional and esthetic stability of tissues around the implants, essential for long-term success.</p> </sec> <sec><title style='display:none'>Our </title> <p>study aims to evaluate the efficiency of the bilayer technique of guided bone regeneration for alveolar ridge augmentation procedure in cases of bone deficiency for optimum implant placement and long-term success.</p> </sec> <sec><title style='display:none'>Materials and methods: </title> <p>We present several cases of alveolar bone deficiency treated with the bilayer technique – the combination of allo- and xenograft, covered by collagen membrane, with long-term follow-up. The defects were filled with allograft, and a layer of xenograft and barrier membrane was placed above it. This technique combines the benefits of all xenografts and barrier membranes.</p> </sec> <sec><title style='display:none'>Results: </title> <p>The bilayer technique with allo- and xenograft and collagen membranes is predictable, with a high success rate and lower morbidity. We have a 100% survival rate of the implants placed in a grafted area with long-term follow-up with excellent aesthetic and functional results.</p> </sec> <sec><title style='display:none'>Conclusions: </title> <p>The bilayer technique uses the benefits of two bone graft materials, is associated with less morbidity for the patients, and has excellent long-term results if performed accurately according to indications and technique.</p> </sec> </abstract>ARTICLEtrue Surveillance of Acute Flaccid Paralysis for Eradication of Poliomyelitis (A Brief Review)<abstract><title style='display:none'>Abstract</title> <p>In May 1988 the World Health Assembly set to World Health Organization (WHO) the goal to achieve a global eradication of poliomyelitis by the year 2000. Surveillance of the acute flaccid paralysis (AFP) remains the ‘gold standard’ for the detection of polio. The criterion of sensitivity of the surveillance system is the incidence from non-polio related AFP, in children under 15 years of age. The aim is to detect more than 1 case of AFP, per 100,000 children. In 2019, WHO announced the eradication of wild poliovirus 3, and poliovirus 2 was eradicated in 2015. Wild poliovirus 1 continues to circulate. The main goals of the WHO Polio Eradication Strategy for the period 2022-2026 are: permanently interrupt all poliovirus transmission in endemic countries (Afghanistan and Pakistan), stop cVDPV (circulating vaccine-derived poliovirus) transmission and prevent outbreaks in non-endemic countries.</p> </abstract>ARTICLEtrue of Incidental Findings in Oral and Maxillofacial Cone-Beam Computed Tomography: A Systematic Review and Meta-Analysis<abstract><title style='display:none'>Abstract</title> <sec><title style='display:none'>Background: </title> <p>As the use of cone-beam computed tomography (CBCT) is increasing and the quality of images is enhanced, the likelihood of incidental findings detection in CBCT radiographs is raised. Variable frequency of incidental findings on oral and maxillofacial CBCT scans has been reported.</p> </sec> <sec><title style='display:none'>Aims: </title> <p>To perform a systematic review and meta-analysis to resolve the conflicting results about the overall prevalence of incidental findings in oral and maxillofacial CBCT scans.</p> </sec> <sec><title style='display:none'>Methods: </title> <p>We searched the literature in PubMed, Embase, and Scopus databases from inception to 31 October 2022 to identify studies that reported the frequency of incidental findings in the subjects undergoing CBCT imaging. We pooled the extracted data and reported the estimates as a percent with a 95% confidence interval (CI).</p> </sec> <sec><title style='display:none'>Results: </title> <p>A total of 21 eligible studies were included, comprising 9,788 patients (54.2% women) and 10,625 CBCT scans. Analysis showed that the incidental findings were present in 69.1% (95% CI: 55.6-80.0) of the CBCT scans. There were 1.48 incidental findings per CBCT scan. Pooled prevalence of incidental findings in men was 50.2% (95% CI: 23.1-77.3), which was higher than in women (41.8% [95% CI: 16.5-72.2]).</p> </sec> <sec><title style='display:none'>Conclusion: </title> <p>A considerable prevalence of incidental findings was observed in oral and maxillofacial CBCT scans.</p> </sec> </abstract>ARTICLEtrue Death of Sperm Cells<abstract> <title style='display:none'>Abstract</title> <p>A major factor affecting male fertility is excessive death of germ cells, both immature germ cells and mature spermatozoa. It can be due to various factors causing testicular and/or post-testicular damage, such as infections, obstructive conditions, toxins, oxidative stress, hormonal imbalance, hyperthermia, and anti-sperm antibodies. Massive death of spermatozoa leads to a high proportion of dead sperm cells in the ejaculate (necrozoospermia or necrospermia) while death of immature germ cells can lead to low sperm count (oligozoospermia or oligospermia). Cell death can occur both by necrosis and by apoptosis; in recent decades, it has been found that apoptosis of mature spermatozoa is not only possible but quite common, and can contribute to infertility. Treatment approaches are primarily directed to the underlying condition, i.e. removing the cause(s) of sperm cell death whenever possible, but include also attempts to bypass the cell death event by intracytoplasmic sperm injection with testicular spermatozoa.</p> </abstract>ARTICLEtrue in the Cytokine Profile in Patients During COVID-19 Infection<abstract> <title style='display:none'>Abstract</title> <p>COVID-19 has proven to be a disease that affects not only the respiratory tract but also leads to a state of generalized systemic hyperinflammation and overall immune dysregulation. An important role in its pathogenesis is the disturbance of many cytokines – a condition which, in its most pronounced form, is also called a „cytokine storm“.</p> <sec> <title style='display:none'>Objective</title> <p>To evaluate the serum cytokine levels during COVID-19 infection as potential biomarkers for the severity and course of infection.</p> </sec> <sec> <title style='display:none'>Materials and methods</title> <p>By design, the study is a retrospective cross-sectional, in which the serum concentrations of 10 pro- and anti-inflammatory cytokines (IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF-α, and GM-CSF) were investigated in 36 individuals (divided into 3 groups by severity – with a mild form of the infection/presymptomatic, moderately severe and severe/critical) within two periods – before and after the second week from the onset of symptoms of the disease.</p> </sec> <sec> <title style='display:none'>Results</title> <p>In the period up to the 2nd week, the serum concentrations of IFN-γ (p = 0.029), IL-1β (p = 0.017), and IL-5 (p = 0.014) showed a statistically significant correlation with the disease severity, however in the later stage of the disease the cytokine levels did not show any clinical value.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Cytokine testing could be used to predict the severity of COVID-19 infection which could support individual therapeutic decisions. Analysis of a larger group of patients is needed to unfold the full potential of such testing.</p> </sec> </abstract>ARTICLEtrue Therapeutic Options in Active Moderate-to-Severe Thyroid-Associated Ophthalmopathy<abstract> <title style='display:none'>Abstract</title> <p>Active moderate-to-severe TAO is a disease, the treatment of which requires a multidisciplinary team, an individualized approach and strict follow-up, yet it is often suboptimal. Recent knowledge about the pathogenesis of the disease and the randomized controlled trials conducted in recent years made it possible to use new therapeutic combinations and biological agents. The currently recommended first-line therapy for active moderate-to-severe TAO is the combination of intravenous glucocorticoids (GCs) in moderate doses and mycophenolate or, in more severe cases, a high-dose GC treatment alone. There are several options for second-choice therapy, if needed: a new course with GCs, combination of orbital radiotherapy and GCs (preferably intravenous), cyclosporine and oral GCs, azathioprine and oral GCs, rituximab, tocilizumab or teprotumumab. The clinical manifestations of TAO should also be considered when choosing second-line treatment. Thus, for example, teprotumumab best affects diplopia, orbital radiotherapy – visual disturbances and diplopia, while intravenous GCs, mycophenolate, cyclosporine, rituximab and tocilizumab – the inflammatory manifestations of TAO. However, the question of the availability of the new drugs in routine clinical practice remains unsolved.</p> </abstract>ARTICLEtrue of Athletes Towards Dietary Supplements<abstract> <title style='display:none'>Abstract</title> <p>At the beginning of 2023 we carried out a survey among active athletes asking about their attitude towards dietary supplements.</p> <sec> <title style='display:none'>Aim</title> <p>The aim of the study was to evaluate the attitude of athletes towards dietary supplements using a survey method. The objective of the study was to determine whether active athletes use dietary supplements.</p> </sec> <sec> <title style='display:none'>Materials and methods</title> <p>The participants in the study were asked to anonymously complete a survey consisting of 16 questions. In January 2023, we surveyed 50 active athletes from the „Vasil Levski” National Sports Academy (35 men and 15 women). Forty-six of the participants were between 18 and 22 years old and 4 were between 23 and 27 years old.</p> </sec> <sec> <title style='display:none'>Results</title> <p>The majority (94%) of the surveyed athletes trusted the advertisement of a particular dietary supplement. Ninety per cent had complete trust in the pharmacists’ advice. Pharmacists played a significant role in the choice of dietary supplements. A high percentage (60%) of the respondents who used dietary supplements had not sought medical advice prior to their use. Ninety per cent of the respondents used dietary supplements for weight loss in order to fit in a particular category; 78% indicated that they used dietary supplements for improvement of their sports achievements; 72% used supplements to increase their stamina and 46% – to shorten their time for recovery. A campaign should be initiated to encourage the use of dietary supplements only when they are prescribed by physicians.</p> </sec> </abstract>ARTICLEtrue Vitro Evaluation of Corn Silk Extract as a Potential Alternative Therapy for Vulvovaginal Candidiasis<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Aim</title> <p>To determine the effectivity of corn silk extract in inhibiting the growth of C. albicans.</p> </sec> <sec> <title style='display:none'>Materials and Methods</title> <p>Corn silk used in this study was Zea mays L. var. indurata and was collected from Desa Suka Makmur, Deli Serdang, Sumatera Utara Province, Indonesia. Tested C. albicans is C. albicans from VVC patients, obtained from the Microbiology Laboratory of Faculty of Medicine, Universitas Sumatera Utara. Preparation of this study included corn silk extraction by maceration method with 96% ethanol, followed by dilution with 10% DMSO (Dimethyl Sulfoxide) into concentrations of 75%, 50%, 25%, and 12.5%. Well diffusion method was used to detect growth inhibition of C. albicans and agar dilution was used to determine MIC (Minimum Inhibitory Concentration) and MFC (Minimum Fungicidal Concentration) of corn silk extract. Data were statistically analyzed with Kruskal-Wallis analysis.</p> </sec> <sec> <title style='display:none'>Results</title> <p>From this study, corn silk extract of all concentrations showed an inhibitory effect against C. albicans. The mean diameter of inhibition zones for each concentration respectively from highest to lowest concentration were 27.4875 ± 0.3838 mm, 26.7250 ± 0.2533 mm, 25.7250 ± 0.2598 mm, and 24.9375 ± 0.2462 mm. Kruskal-Wallis analysis showed significant results (p-value 0.001). MIC and MFC were 1.5625% and 6.25%, respectively.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>Corn silk extract of concentrations 75%, 50%, 25%, and 12,5% have antifungal activity against C. albicans. The higher the concentration of corn silk extract, the higher the efficacy in inhibiting the growth of C. albicans.</p> </sec> </abstract>ARTICLEtrue Clinical Trials – Current Environment, Potential Barriers and Facilitators for Implementation and Risk Mitigation: A Review of the Literature<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Introduction</title> <p>Decentralized clinical trials are a new approach in health technology research and development that take advantage of innovative digital technologies in data collection for clinical trial purposes. Decentralized clinical trials achieve shorter participant recruitment periods, better adherence to assigned therapy, lower drop-out rates and shorter trial duration overall. Participants reported greater convenience compared to traditional clinical trials due to the studies being conducted at home and the removal of transport and time barriers.</p> </sec> <sec> <title style='display:none'>Materials and methods</title> <p>A literature review was conducted using the Scoping Review methodology defined by Arskey and O’Malley in 2005 and further updated in 2010 and 2014. PubMed, Scopus, and Google Scholar scientific databases were searched using predefined inclusion and exclusion criteria and keywords: virtual clinical trials, and/or decentralized clinical trials and barriers and challenges.</p> </sec> <sec> <title style='display:none'>Results</title> <p>The literature review found 40 articles that met the specified inclusion and exclusion criteria. The results of the different studies in this area show that decentralized clinical trials achieve shorter recruitment periods, better adherence to assigned therapy, lower dropout rates from trials, and shorter trial duration overall. Participants reported greater convenience compared to traditional clinical trials due to the studies being conducted at home and the removal of transport and time barriers. Major challenges with this type of trial is the difficulty in conducting physical examinations, invasive therapies by the investigators, and privacy protection.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>The adoption of a regulatory framework for digital healthcare, education of medical professionals and patients about innovative technologies are necessary, especially in countries from Central and Eastern Europe.</p> </sec> </abstract>ARTICLEtrue of Bacterial and Viral Infections and Co-Infections in Miscarriages<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Aim</title> <p>To investigate the potential role of the following bacterial/viral panel (Chlamydia trachomatis, Ureaplasma urealyticum/parvum, Mycomplasma hominis/genitalium, Gardnerella vaginalis, HSV1/2, EBV, CMV, VZV, HHV6, HHV7, HHV8) as causative factors for miscarriages in women by testing endometrial biopsies. Anaerobic and aerobic microorganisms causing dysbiosis and endometrial bacterial colonization by unbalanced growth were additionally tested.</p> </sec> <sec> <title style='display:none'>Materials and methods</title> <p>In total, 65 patients with a history of early and late miscarriages were analyzed. DNA extractions, real-time qPCR, agarose gel-electrophoresis were applied. Comparative analysis of the current with previously obtained data on the described panel in menstrual tissue samples was performed.</p> </sec> <sec> <title style='display:none'>Results</title> <p>In 64,6% of all tested endometrial biopsies bacterial and/or viral pathogens were detected. In 49,23% of all tested samples we found bacterial, while in 15,3% – viral pathogens. These results are similar to our previous data on menstrual tissue samples of infertile women – 61,1% infected, as 48,8% had bacterial and 22,2% had viral pathogens. Gardnerella vaginalis and Ureaplasma parvum were detected in 31,25% and 3,12% of all bacterial infected endometrial biopsies, significantly lower in comparison to the estimated rate of 69,31% and 61,36% on menstrual tissue. Anaerobic and aerobic dysbiosis were detected in 53,33% and 27% of the bacterial infected endometrial samples. In 13,33% a dysbiosis with a mixed etiology was found, while in 7% a dysbiotic condition with a totally absent findings of targeted bacteria and Lactobacillus was observed. EBV, CMV, HHV6 and HHV7 were detected in 30%, 30%, 20% and 20% of the positive for viral factors endometrial biopsies and in 40%, 7,5%, 10% and 42,5% in menstrual tissue samples. In the current study 62,5% bacterial co-infection and 12,5% bacterial/viral co-infection variants were found. Infections with the rest of the target pathogens were not detected in the endometrial biopsies. In contrast to the endometrial biopsy results, Mycomplasma hominis, Ureaplasma urealyticum and HSV2 were detected in our previous research on menstrual tissue samples.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>Our research suggests a possible dysbiosis as a consequence of bacterial/viral endometrial colonization, associated with miscarriages. We prove that menstrual tissue, containing parts of the functional endometrial layer, is a reliable and accurate noninvasive sample for infectious screening of the upper genital tract.</p> </sec> </abstract>ARTICLEtrue Rare Case of Adult Precursor B-Cell Lymphoblastic Lymphoma/Leukemia Presenting with Multiple Osteolytic Bone Lesions as Sole Manifestation<abstract> <title style='display:none'>Abstract</title> <p>Primary precursor B-lymphoblastic lymphoma/leukemia (B-LBLL) of bone is uncommon neoplasm that accounts for less than 1% of primary bone tumors. It has been commonly reported in pediatric population but is rare in adults. We present a case of a 20-year-old man with multiple osteolytic lesions as sole presentation of acute lymphoblastic leukemia, whose diagnosis was established by bone biopsy. A peripheral blood smear and the bone marrow aspirate showed no blast cells. The patient received treatment according to BFM 99 protocol and achieved complete response confirmed by F-FDG-PET/CT.</p> </abstract>ARTICLEtrue of Electrophysiologal Studies for Detection of Simulation and Aggravation in Ophthalmology<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Objective</title> <p>To present the importance of the electrophysiological studies for detection of malingering and aggravation in ophthalmology.</p> </sec> <sec> <title style='display:none'>Materials and methods</title> <p>Six eyes of three patients underwent a complete clinical examination, fundus-autofluorescence (FAF), fluorescein angiography (FA), optical coherence tomography (OCT), visual field testing, electrophysiological (EF) studies – full-field, multifocal and pattern electroretinography (ffERG, mfERG and PERG) and visual evoked potentials (VEPs), for detection of simulation or aggravation.</p> </sec> <sec> <title style='display:none'>Results</title> <p>After the electrophysiological studies’ results, which are objective and non-manipulable, we purposefully reviewed and repeated some of the tests already done, which allowed a comprehensive interpretation of the results. It turned out that discrete changes in targeted search can be detected in several of the studies performed, which greatly facilitates the correct diagnosis.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>EF studies are objective methods for studying the visual analyzer’s function, that can not be manipulated, which makes them indispensable for detecting simulation and aggravation in ophthalmology. A detailed extensive study of the degree of simulation and aggravation among the ophthalmological patients is needed, which will enrich our knowledge and make us more precise in our expertise.</p> </sec> </abstract>ARTICLEtrue