Varna Medical University Press: Journals
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Impact of essential oils on the characteristics of white brined cheese during production and storage: Advances in dairy science
Full text linkThe shift in consumer dietary habits has increased the demand for foods free of artificial preservatives, necessitating the exploration of various herbal extracts with antimicrobial activity and their application in the production and storage of brined cheeses. Essential oils (EOs), natural plant-derived compounds, are widely used in medicine, flavoring, and food preservation due to their proven antioxidant, antibacterial, and antifungal properties. This review investigates the role of EOs in the technological process and microbiological control during white brined cheese production, as well as their impact on cheese characteristics and starter cultures
Pharmacotherapy in patients with acute and exacerbated chronic pyelonephritis
Full text linkUrinary tract infections are one of the most common nosocomial infections. The most common cause of urinary tract infections worldwide is Escherichia coli – a Gram (-) bacterium that normally inhabits the human gastrointestinal tract. When the bacterium enters other organs and cavities, it can cause inflammation. Possible clinical cases of infection with E. coli range from asymptomatic bacteriuria, which does not always require special treatment, to acute pyelonephritis or exacerbated chronic pyelonephritis. Treatment is complex, with the choice of antibiotic playing a major role. The aim of the article is to show the positive effect of antibiotic treatment, mainly fluoroquinolones, in patients with urinary tract infections and clinical cases related to the diagnosis of pyelonephritis, treated at the Clinic of Internal Medicine in the Military Medical Academy in Sofia
A review of the reported pharmacokinetic interactions of sildenafil with natural products
Full text linkINTRODUCTION: Sildenafil belongs to the class of drugs called phosphodiesterase 5 inhibitors. It is used in the treatment of erectile dysfunction and pulmonary arterial hypertension. Sildenafil is metabolized predominantly by CYP3A4 and, to a lesser extent, by CYP2C9. Thus, it may be involved in pharmacokinetic interactions when co-administered with other substrates of these enzymes.AIM: The current study aimed to review the reported herb-drug interactions between sildenafil and concomitantly used herbs, foods, and beverages.MATERIALS AND METHODS: A thorough review of scientific databases such as Web of Science, Scopus, PubMed, and ResearchGate was conducted.RESULTS AND DISCUSSION: Overall, relatively few studies are found on potential interactions between sildenafil and natural products. Some authors reported pharmacokinetic interactions in vivo when sildenafil is taken simultaneously with herbal extracts, foods, and beverages. As a result, either an increase or a decrease in oral bioavailability of sildenafil was observed.CONCLUSION: Although sildenafil is relatively safe when taken under medical prescription, its administration may be potentially dangerous when used concomitantly with other drugs or nutritional supplements, as well as with some foods and beverages, especially without medical advice. The occurrence of interactions may lead to adverse drug reactions or therapy failure. Therefore, simultaneous intake of sildenafil with herbal extracts as well as certain foods is not recommended until more data about its safety is available
A mandibular supernumerary supplemental incisor: A literature review
Full text linkIntroduction: Hyperdontia refers to the presence of an excessive number of teeth beyond the normal count for a given dentition, whether temporary or permanent. These supernumerary teeth may be located in both the anterior and distal regions of the alveolar ridge in the maxilla and the mandible. Supernumerary maxillary incisors are particularly rare, predominantly occurring in the permanent dentition, with an incidence rate ranging from 0.01% to 1% of all permanent supernumerary teeth.Aim: The purpose of this publication is to present the incidence and presumed etiological factors associated with the rare occurrence of supernumerary mandibular incisors. Additionally, it reviews the diagnostic and therapeutic methods documented in the literature concerning such clinical cases. This study also details a rare clinical case involving an additional mandibular central incisor. The review of dental literature focuses on outlining key diagnostic and treatment guidelines developed in recent decades.Materials and Methods: For the purposes of this research, literature sources published in English over the past 30 years were analyzed, drawing from PubMed and Google Scholar databases.Results: Based on the data reviewed, it can be concluded that non-syndromic supernumerary mandibular incisors are exceedingly rare. When present, they may erupt with either normal morphology and size or in a rudimentary form.Conclusion: The identification of supernumerary teeth, particularly those of rare occurrence, is essential for selecting the most appropriate treatment approach and for preventing potential complications associated with these anomalies
Admission inflammation and coagulation biomarkers as early predictors of COVID-19-associated acute kidney injury
Full text linkIntroduction: Acute kidney injury (AKI) is a common and high-risk complication of COVID-19. Serum creatinine rises with delay, which limits early recognition of renal involvement (7,9). Inflammatory and coagulation biomarkers measured at hospital admission may provide an earlier indication of AKI (1,4,10–12).Materials and Methods: We analysed 436 hospitalisations with PCR-confirmed COVID-19 (01.2021–12.2022) at St. Marina University Hospital, Varna. AKI was defined according to KDIGO 2012 (by serum creatinine; the urine-output criterion was unavailable) (7). First-hour measurements included CRP, D-dimer, fibrinogen, ferritin, and LDH. ROC curves and Youden’s J were used to determine optimal cut-offs; an additional combined model was constructed from the three markers (CRP > 150 mg/L; D-dimer > 0.75 mg/L; fibrinogen > 6 g/L). Multivariable logistic regression was adjusted for age, sex, arterial hypertension, and diabetes (6,8,14).Results: 94/436 (21.6%) developed AKI. At admission, CRP, D-dimer, and fibrinogen were higher in patients who subsequently developed AKI; ferritin and LDH showed trends without independent predictive value. Individual AUCs: CRP 0.69, D-dimer 0.74, fibrinogen 0.62; the combined model achieved AUC 0.82. At the chosen threshold, sensitivity was 72% and specificity 76%. In the multivariable model, D-dimer > 0.75 mg/L (OR 2.3; 95% CI 1.4–3.8), CRP > 150 mg/L (OR 1.9; 95% CI 1.2–3.0), fibrinogen > 6 g/L (OR 1.6; 95% CI 1.1–2.6), and age > 70 years (OR 1.7; 95% CI 1.1–2.8) were independent predictors. A negative result on the combined assessment virtually rules out AKI (residual risk ≈ 9%), whereas a positive result indicates that nearly one in two patients will develop this complication (≈ 45%).Conclusion: A triad of CRP, D-dimer, and fibrinogen available within the first hour of admission provides early and inexpensive risk stratification for COVID-19-associated AKI, consistent with published evidence on the roles of inflammation and coagulopathy (1,4,10–13). Its implementation may support nephroprotective strategies and prioritisation for early consultation (9,10)
Development and establishment of the clinical role of the hospital pharmacist in multidisciplinary teams at the European level
Full text linkIntroduction: The dynamic development of the pharmaceutical profession, alongside prevailing trends in European healthcare, positions the clinical practice of pharmacists at the core of integrated care. In this context, the role of master’s-level pharmacists employed in healthcare institutions is expanding significantly, with their expertise becoming central to the provision of high-quality patient treatment. Contemporary concepts of effective healthcare management designate the pharmacist as a key member of multidisciplinary teams (MDTs), actively engaged in delivering integrated care and clinical pharmacy services. There is a clear trend toward increasing the integration of pharmacists as active participants in the therapeutic process across numerous European countries.Aim: This article aims to analyze the extent to which the hospital pharmacist, as part of a multidisciplinary team, is engaged in providing clinical pharmaceutical services at the European level and to assess the challenges of their establishment at the hospital level.Materials and Methods: A documentary method was applied, involving a systematic review and comparative analysis of the scientific literature using the Web of Science, Scopus, Google Scholar, and ResearchGate databases. Published informational materials from the official websites of the European Association of Hospital Pharmacists (EAHP) and the European Society of Clinical Pharmacy (ESCP) were also consulted. The analysis of the scientific literature covers the period from 2010 to 2023.Results: Within the European Union, there is strategic support for the integration of pharmacists into multidisciplinary teams (MDTs), facilitated by new regulatory initiatives and pharmaceutical policies aimed at improving access, innovation, and the sustainability of medication therapy. Annual analyses conducted by the EAHP (2016–2023) indicate a clear integration of pharmacists into multidisciplinary teams in several countries, including England, France, Germany, and Italy. The data analysis also highlights challenges to integration, such as poorly defined responsibilities, workforce shortages, and the need for additional qualifications or specialized education.Conclusion: The inclusion of hospital pharmacists in multidisciplinary teams is increasingly prevalent and is considered a desirable practice in healthcare institutions, with the primary aim of enhancing the quality of care and services provided. Challenges such as workforce shortages, regulatory constraints, and the need for additional specialized training remain obstacles to the full participation of pharmacists
The future of renal health: Biotechnological innovations and sustainable solutions
Full text linkEnd-stage chronic kidney disease affects millions of patients worldwide and places a significant burden on both healthcare systems and the environment. Traditional hemodialysis is associated with high consumption of water, energy, and the generation of waste. In contrast, modern biotechnological solutions—including portable and implantable bioartificial kidneys as well as 3D bioprinting of renal tissues—offer a novel approach for renal replacement therapy. These technologies have the potential to significantly improve patients’ quality of life while reducing the environmental impact of treatment. This systematic review analyzes data from clinical trials and experimental models, evaluating the functionality, resource efficiency, and ecological benefits of the biomaterials used. The findings indicate that portable systems provide stable filtration with minimal resource expenditure, implantable devices demonstrate sustained renal function without frequent interventions, and 3D bioprinting facilitates the creation of microarchitectural tissues with optimal cellular integration. Collectively, these innovations may transform nephrological practice by delivering more effective treatment with a lower environmental footprint
Influence of arterial hypertension and diabetes mellitus on the risk of acute kidney injury and mortality in COVID-19 patients
Full text linkCOVID-19 can cause various complications, among which acute kidney injury (AKI) holds a significant place. Arterial hypertension (AH) and diabetes mellitus (DM) are identified as major risk factors for severe disease progression. The study aims to evaluate the impact of AH and DM on AKI development and mortality in hospitalized COVID-19 patients. Data from 436 patients were analyzed. Results show an increased risk of AKI and mortality associated with AH and DM. The data emphasize the need for intensive monitoring and preventive measures in these patients
Animal models of skin wound healing – advantages and disadvantages
Full text linkSkin wounds represent superficial or deep destructions of the skin, which occur as a result of various external influences or surgical interventions. Immediately after the injury, a series of pathophysiological processes begin, aimed at restoring tissue integrity. Wound healing is a process involving interconnected and overlapping stages of hemostasis, inflammation, proliferation, and tissue remodeling. Numerous cellular populations, the extracellular matrix, and soluble mediators are also involved. Abnormalities in the healing process can result from systemic diseases and may lead to serious complications for the individual. Despite medical advancements, wound healing remains a significant clinical challenge, necessitating proper and effective treatment. In addition to improving traditional wound care, it is essential to develop new therapeutic approaches. Experimental models are a very useful tool for studying various diseases. Over the past decades, different skin injury models have been developed, which increase our knowledge of tissue recovery processes and contribute to the development of new clinically relevant therapeutic strategies. This review summarizes the processes of skin wound healing and discusses the most commonly used animal models. Differences in the healing process and in the in vivo skin wound models are analyzed in detail