Varna Medical University Press: Journals
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Diabetes mellitus – a leading risk factor for the development and progression of chronic kidney disease
Full text linkChronic kidney disease (CKD) and diabetes mellitus (DM) are major noncommunicable diseases worldwide and represent interconnected and growing public health challenges. Diabetes is a leading risk factor for the development and progression of CKD, with up to 40% of patients with type 2 diabetes developing diabetic kidney disease. The increasing global burden of diabetes – including the increase observed following the COVID-19 pandemic – highlights the need for early prevention, screening, and integrated models of care. Epidemiological trends show a steady increase in the prevalence of CKD, with projections indicating that by 2040 CKD will be among the leading causes of mortality worldwide. Diabetic kidney disease develops through metabolic, vascular, and inflammatory mechanisms. Multiple modifiable and nonmodifiable risk factors accelerate kidney damage, highlighting the importance of early identification and prevention. Current therapeutic strategies focus on tight glycemic control, optimal blood pressure management, screening for albuminuria and eGFR, and the use of renoprotective medications such as ACE inhibitors/ARBs, SGLT2 inhibitors, and GLP-1 receptor agonists. Individualized dietary interventions and physical activity are essential components of comprehensive care. Pharmacists play a key role in therapeutic monitoring, medication optimization, patient education, and adherence support. In many countries, pharmacists are involved in the early detection of CKD through point-of-care testing (POCT) in pharmacies, facilitating early referral and intervention. This review highlights the importance of a multidisciplinary, proactive, and prevention-oriented approach aimed at slowing the progression of CKD and improving patient outcomes
Gender differences in color perception: genetic, physiological, and cognitive aspects
Full text linkColor vision is the result of complex biological, physiological, and cognitive processes in which gender differences play a significant role. Women demonstrate greater sensitivity to variations in hue, especially in the red–orange part of the spectrum, while men more often show an advantage in perceiving contrast and movement. Genetic mechanisms, including the localization of the genes for red and green pigments on the X chromosome, account for the higher incidence of congenital color blindness in men.This article aims to analyze gender differences in color perception through a systematic review of Bulgarian and international scientific publications (n = 15, last 10 years) and an educational survey involving 18 respondents (equal numbers of participants by gender). The survey contains questions aimed at self-assessment of color perception, difficulties in distinguishing nuances, and preferences for specific colors. The collected data are processed using descriptive statistical analysis and graphical representation, which allows for the identification of quantitative differences by gender.In the present study, 67% of women rated their color perception as “very good,” compared to 44% of men. These observations reflect trends in a small sample (n = 18) and correspond to the more widely described gender differences in color perception in the literature, where difficulties in distinguishing red–green hues are more common in men due to the higher frequency of red–green color defects.The results support the existence of distinct gender differences in color perception, shaped by genetic, physiological, and cognitive mechanisms, and highlight the potential significance of these differences for clinical practice, visual diagnostics, and health education
Contemporary approaches to iris color change: medical, risk, and ethical aspects
Full text linkIris color change is a topic that has become increasingly important in recent years, as it combines aesthetic desires, medical innovations, and significant ethical issues. The color of the iris is determined by the amount and distribution of melanin, and interest in its modification stems both from the desire for individual appearance and from the possibilities offered by modern ophthalmological technologies. Several basic approaches are described in the specialized literature: contact lenses, which provide the safest and most temporary change; laser depigmentation, which reduces the amount of melanin and makes the iris lighter; implantation of an artificial iris with a lasting effect; as well as experimental genetic methods, which are not yet regulated and are mainly developed under laboratory conditions.Analysis of the available data shows that these methods have both compelling advantages and significant disadvantages. On the positive side are the aesthetic and psychological benefits, the possibility of correction in cases of congenital anomalies or trauma, and the contribution to the development of new medical technologies. On the other hand, more invasive procedures carry risks such as infection, inflammation, increased intraocular pressure, and potential damage to vision. There are also insufficient long-term clinical studies to guarantee the safety of these interventions. Alongside the medical aspects, there are also important ethical questions related to the moral justification of changing innate human characteristics for purely aesthetic purposes, as well as social pressure to achieve certain standards of beauty.In summary, the topic of iris color change requires careful balancing between the human desire for self-expression and the need for medical safety and ethical responsibility. Stricter regulations, in-depth clinical research, and increased awareness are needed in order to support informed decisions about the future application of these techniques.
Hematuria from an orthotopic neobladder
Full text linkIntroduction: Bladder cancer is one of the most common urological malignancies, with painless macroscopic hematuria being the primary symptom leading to diagnosis. For muscle-invasive urothelial carcinoma, the standard treatment includes radical cystectomy with subsequent urinary diversion. The orthotopic neobladder is one of the possible continent reconstructive options. Urethral recurrence is a rare but possible complication.Case presentation: We present the case of a 43-year-old male with a history of radical cystoprostatectomy and orthotopic neobladder reconstruction (2012), hospitalized with macroscopic hematuria and lower abdominal pain. CT scan and cystoscopy revealed a lesion suspicious for recurrence at the anastomosis between the urethra and the neobladder. Histology confirmed a poorly differentiated papillary urothelial carcinoma. Four months later, the patient underwent neocystectomy and urethral resection with the creation of an incontinent ureterocutaneostomy.Conclusion: The presence of macroscopic hematuria in patients with a history of urothelial carcinoma and continent urinary diversion requires thorough evaluation. Although rare, local recurrence after radical cystectomy with neobladder reconstruction must be considered and diagnosed early
Specifics of pharmaceutical care for children
Full text linkProviding pharmaceutical care for children can be challenging, especially when selecting an appropriate medicinal product, determining the correct dosage, and choosing the proper route of administration. Pharmacists share responsibility for the treatment outcome together with other healthcare professionals and patients. The role of the pharmacist is particularly important in the use of medicines in pediatrics, especially regarding the provision of information and proper counseling of parents. Practice shows that parents often turn to pharmacists for advice on prevention or at the early stages of their children's illnesses. Pharmacists must exercise particular caution when treating children, as they represent a more vulnerable group of patients. One of the pharmacist’s most important tasks is to build trust with the parent of the sick child and to emphasize the importance of strictly adhering to the prescribed therapy. The responsible behavior of parents, combined with the pharmacist’s professional competence, is essential to ensure the safe and effective use of medicines in children. Pharmaceutical care in pediatric drug therapy requires consideration of a number of specific factors, such as effective communication with parents, accurate and precise dosing of medicinal products, the selection of an appropriate dosage form, and other relevant aspects. All these aspects highlight the importance of the pharmacist’s active involvement in pediatric drug therapy as a key factor for achieving optimal therapeutic outcomes. Pharmaceutical care for children requires in-depth knowledge, a high level of responsibility, and an individualized approach to each young patient to ensure safety, effectiveness, and high-quality care.
Most commonly used medications for the treatment of BPH: A cross-sectional study
Full text linkIn this study, w Most commonly used medications for the treatment of BPH – cross-sectional study e present which medications are prescribed for the treatment of the symptoms caused by benign prostatic hyperplasia. A single-center study was conducted. The study subjects were 396 patients, examined at St. Anna Hospital in Varna from April 2022 to April 2025. The results show that alpha-blockers are most often prescribed in the form of a monotherapy. Combination therapies (alpha-blocker + dutasteride and alpha-blocker + solifenacin) are a modern tool, which, however, is not yet widely used
Development and neurophysiological effects of medical dry needling as a treatment modality
Full text linkIntroduction: Dry needling emerges as a treatment modality based on traditional Chinese acupuncture, in which specific tender points referred to as “ashi” points are punctured. These points are commonly known as myofascial trigger points. A great number of neurophysiological changes in the musculoskeletal system occur following direct puncturing of the myofascial trigger points.Aim: To trace the historical development of the dry needling method and to investigate the mechanisms of neurophysiological impact on the musculoskeletal system.Materials and Methods: A search was conducted in MEDLINE (PubMed), the Cochrane Library, and Scopus for English-language articles on the application of dry needling in physiotherapy practice, published in the last 10 years up to April 2025. The following key search phrases were combined to identify potentially relevant articles: (“dry needling” OR “needling” OR “trigger point”) AND (“therapy”) AND (“evolution” OR “development” OR “history”) AND (“physical therapy”) AND (“neurophysiology”). A total of 9,646 results were identified. After reading the titles and abstracts and assessing their eligibility based on the full texts of the articles, 29 articles remained and were included in this review.Results: Among the 29 selected studies, 10 tracked the historical development and progress of the method as a therapeutic modality, while another 10 studies showed the influence of the method on the musculoskeletal system from a neurophysiological perspective. The remaining 9 studies tracked the therapeutic effects of dry needling.Conclusion: The studied method is successfully included in the treatment programs of a number of musculoskeletal conditions and has gained particular popularity over the last 20 years. The use of this therapeutic modality in modern physiotherapy practice allows for acceleration of the healing process in a number of musculoskeletal conditions
Unilateral fusion of mandibular central and lateral incisors. A clinical case of a child treated under general anesthesia
Full text linkINTRODUCTION: Tooth fusion is a dental anomaly that occurs when two adjacent tooth buds merge, forming a larger tooth structure. The fusion can be categorized as complete or incomplete, depending on the development stage at which the tooth buds unite. The fusion can occur either before the calcification phase or during a later stage known as morphodifferentiation. The fused teeth may share a common pulp chamber and root canal, or possess separate ones.AIM: This article aims to present a clinical case of a fused central and lateral incisor, featuring a common pulp chamber and root canal. This condition was discovered incidentally during dental treatment under general anesthesia.MATERIALS AND METHODS: The child's level of cooperation was highly negative. To ensure accurate diagnostics, a detailed clinical examination, and segmented bitewing radiographs were used during the treatment of the child under general anesthesia.RESULT: A 4-year-old child with early childhood caries (ECC) was treated under general anesthesia. During the treatment, a dental anomaly was established in the incisal region of the right mandible. The child had fewer teeth than expected. A segmental radiograph was taken to evaluate the situation. Fusion between 81 and 82 exhibited a common pulp chamber and root canal, indicating that the anomaly occurred during the early stages of development, before the mineralization of both tooth germs.CONCLUSION: Pediatric dentists have a crucial role in the early diagnosis of fused teeth in childhood, potential complications, long-term treatment, prevention, regular follow-up, and prognosis
The role оf thalassotherapy in the preparation of women undergoing in vitro fertilization
Full text linkIntroduction: Female infertility represents an increasing medical and social challenge, affecting a significant proportion of couples of reproductive age. Despite advancements in assisted reproductive technologies, the success rate remains limited, particularly in the presence of inflammatory and hormonal disorders. Thalassotherapy, which involves the use of seawater, marine climate, and products such as algae and peloids, when applied as an adjunctive therapeutic approach, may enhance uterine perfusion in women with implantation failures and increase the chances of achieving pregnancy.Aim: The objective of the present study is to evaluate the effects of integrating marine therapeutic procedures into the preparation of patients undergoing in vitro fertilization (IVF).Materials and Methods: A literature review was conducted using sources from the European Journal of Obstetrics and Gynecology (EJOG) database and other specialised medical literature.Results and Discussion: A thorough evaluation of the scientific literature indicates that thalassotherapy exerts vasodilatory and anti-inflammatory effects, improves microcirculation, and regulates estrogen and progesterone secretion. It is effective as secondary prevention in pelvic inflammatory diseases, with potential to reduce the risk of adhesions and intrauterine synechiae. Therapeutic agents derived from the Black Sea, Dead Sea, Baikal peat, sulphide, radon, and other mineral waters were used. In a prospective study involving 80 women preparing for IVF due to tubal insufficiency and peritoneal factor, half received intravaginal applications of Dead Sea peloid, while the others underwent phonophoresis and ultrasound therapy. Peloid therapy led to a reduction in chronic endometritis (from 51.7% to 20%) and luteal phase deficiency (from 48.3% to 15%). Additionally, three spontaneous pregnancies were observed, along with a higher pregnancy rate following IVF (40% vs. 15%).Conclusion: Thalassotherapy shows excellent outcomes as part of preconception care in infertile women, improving IVF success rates and offering the potential for spontaneous conception