Varna Medical University Press: Journals
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Metabolic-associated fatty liver disease and its relationship with the chronic kidney disease
Full text linkIn recent years, the terminology related to non-alcoholic fatty liver disease (NAFLD) has undergone significant revision to more accurately reflect its pathophysiological association with metabolic dysfunction. In 2023, the term metabolic dysfunction-associated steatotic liver disease (MASLD) was officially introduced, replacing NAFLD. The updated diagnostic criteria now require the presence of at least one cardiometabolic risk factor. This change not only enhances the clinical definition of the disease but also shifts attention toward its systemic complications.Growing evidence highlights a significant association between MASLD and chronic kidney disease (CKD). Mechanistically, this relationship is driven by shared pathogenic pathways, including insulin resistance, chronic low-grade inflammation, endothelial dysfunction, and activation of the renin–angiotensin–aldosterone system. Individuals with MASLD are at an increased risk of developing CKD compared to those without metabolically associated hepatic steatosis, even when traditional risk factors are accounted for
The port innovation office as a key driver In the transition to smart ports
No full textThe increasing volume of international trade, digital transformation, and growing sustainability requirements are placing ports under significant pressure to adopt innovative managerial and technological solutions. This paper aims to substantiate the need to establish and ensure the effective operation of an innovation office within the port ecosystem as a key enabler of the transition toward smart, sustainable, and competitive logistics hubs. The study examines the role, functions, and organizational models of innovation offices, as well as their contribution to the implementation of innovative technologies and management practices in ports. To achieve this objective, a combination of theoretical and empirical research methods is employed, including analysis and synthesis, induction and deduction, comparative analysis, the examination of best practices, and expert assessment. The findings indicate that the innovation office functions as an integrating and catalyzing element within the port ecosystem, fostering an innovation-oriented culture and enhancing coordination among stakeholders. In conclusion, the institutionalization of innovation processes through a dedicated organizational structure is identified as an essential prerequisite for the sustainable development and long-term competitiveness of modern ports
Surgical treatment and pathohistological characteristics of cavernous sinus meningioma
Full text linkIntroductionMeningiomas are among the most common primary brain tumors, generally following a benign course, and account for about 40% of central nervous system tumors. These tumors can develop in various locations, depending on the origin of the altered meningothelial cells within the arachnoid layers. For this reason, there are numerous classification systems for meningiomas, with the most significant factors being tumor location and histological type. Cavernous sinus meningiomas are quite rare, occurring at a rate of approximately 2 cases per 100,000 people annually. The majority of tumors in the cavernous sinus are of meningeal origin.Treatment options include microsurgical resection, with the goal of maximal tumor extirpation, although the delicate area of the cavernous sinus rarely allows for radical surgery. Other literature suggests that stereotactic radiosurgery (SRS) is an alternative method of treatment. This type of treatment is overtreated in processes with small tumor volume, which is not applicable in the presented clinical case due to the larger tumor volume.Case PresentationWe present the case of a 49-year-old woman with a clinical presentation of double vision, difficulty focusing on objects, and mild ptosis of the left eyelid. Magnetic resonance imaging revealed a lesion in the left cavernous sinus, consistent with a cavernous sinus meningioma. The chosen treatment was microneurosurgical resection via a left pterygoid approach, combined with superior lateral orbitotomy and anterior clinoidectomy. Extradural access to the cavernous sinus allowed for a subtotal resection of the tumor.Results: Postoperatively, the neurologic status worsened on the part of the oculomotor nerves, and the patient was discharged from the neurosurgery department with evidence of complete ophthalmoplegia.Conclusion: The aim of this case report is to present the features of microsurgical access to the cavernous sinus, to compare the surgical treatment with radiosurgery, and the possibilities of postoperative complications
Excisional hip arthroplasty (case reports)
Full text linkIntroduction: Excisional hip arthroplasty, or femoral head ostectomy, was first described by the English orthopedist Gathorne Girdlestone in 1928 and bears his name. The procedure involves removing the head and neck of the femur. Nowadays, a rather extended variant is usually performed, since, in addition to the classical removal of the head and neck, resection, fenestration, sequestrectomy in the proximal part of the femur is often required. In such cases, it is more correct to speak of a suspended hip joint. Surgery is used as a last resort and often a life-saving procedure in cases of severe, including periprosthetic, infections in the hip joint area.Aim: An attempt is made to answer the question: Does Girdlestone surgery (suspended hip joint) have a place in the modern treatment of severe infections, including periprosthetic ones in the area of the hip joint?Patients and Methods: Four patients are presented—3 women and 1 man, aged 45 to 74 years.Result: A meticulously performed debridement, including excision of the contaminated soft tissues and bony areas, with a removal of the existing endoprosthesis, combined with a closed permanent irrigation system, proved to be the only effective and life-saving procedure for the presented patients.Conclusion: Despite the listed disadvantages, the Girdlestone operation (suspended hip joint), in which the contaminated tissues and all foreign bodies are removed, often combined with a closed permanent irrigation system, has not lost its relevance, since in most cases it leads to complete sanitation of infection, is often a life-saving procedure or an important stage for subsequent repeat endoprosthetics
Therapeutic riding in child with Williams syndrome
Full text linkIntroduction: Williams syndrome (Williams–Beuren) is a rare disorder with a genetic basis, caused by a microdeletion on the long arm of chromosome 7. The condition is characterized by a specific facial dysmorphism, cardiac issues – most commonly supravalvular aortic stenosis – early childhood hypercalcaemia, hypotonia, delayed motor development, and a cognitive profile characterized by relatively strong verbal abilities but significantly impaired visuospatial reasoning.Aim: To propose a therapeutic approach for a child with Williams syndrome.Materials and Methods:Material: This report presents a clinical case of a 7-year-old child diagnosed with Williams syndrome. The patient’s clinical profile is characterized by cardiovascular system abnormalities, uncoordinated motor movements, distinctive mimic synkineses, pronounced hyperreactivity to various auditory stimuli, speech impairments, muscle hypotonia, and hypermobility of the joints and ligamentous structures. A kinesitherapeutic plan was developed, incorporating therapeutic horseback riding, with a frequency of two sessions per week.Methods: A documentary content analysis was conducted, involving a review and synthesis of scientific publications on the topic. The search was performed through academic databases using key terms such as “Williams syndrome,” “kinesitherapy,” and “therapeutic horseback riding.” Results: Hippotherapy represents one of the effective kinesitherapeutic approaches for individuals with Williams syndrome, exerting a primary influence on the musculoskeletal system and the body’s reactive capabilities. Therapeutic horseback riding is a specialized intervention method targeting physical, intellectual, emotional, and sensory impairments. It complements the comprehensive kinesitherapeutic approach applied in children with Williams syndrome. Conclusion: Therapeutic horseback riding, as a specialized form of kinesitherapeutic treatment, has a proven positive effect on the motor and cognitive functions of children with Williams syndrome. The movements of the horse activate the body in ways analogous to human gait, which stimulates postural muscle control, movement coordination, and sensorimotor integration. Additionally, the emotional and social connection with the animal helps develop self-confidence, reduce anxiety, and improve communication skills. Therapeutic horseback riding serves as a valuable complementary method to traditional kinesitherapy, enriching the overall support options for children with Williams syndrome.
Epidemiology and risk factors for non-variceal upper gastrointestinal bleeding: a review article
Full text linkAcute gastrointestinal bleeding is a potentially life-threatening emergency in medical practice and remains a frequent cause of hospital admission. The social significance of this problem stems from the fact that, despite advances in therapeutic endoscopic modalities and the widespread use of acid-suppressing medications, the in-hospital mortality rate has remained relatively stable—ranging from 2% to 10%. Upper gastrointestinal bleeding is defined as bleeding originating proximally to the ligament of Treitz, namely from the oesophagus, stomach, or duodenum. The most common causes include peptic ulcer disease of the stomach and duodenum, oesophageal or gastric varices, erosions of the upper gastrointestinal tract, gastroesophageal reflux disease, Mallory–Weiss syndrome, vascular malformations, and neoplasms. Although the aetiology often remains uncertain until oesophagogastroduodenoscopy is performed, in clinical practice upper gastrointestinal bleeding is classified as variceal or non-variceal. Risk factors for non-variceal upper gastrointestinal bleeding include Helicobacter pylori infection, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, other antiplatelet agents, anticoagulants, and others. Proper risk factor assessment, accurate triage of patients with bleeding, early resuscitation, and precise endoscopic diagnosis are the key determinants of prognosis and patient outcome
Application of manual lymphatic drainage in children
Full text linkLymphedema is a clinical complication characterized by the excessive accumulation of lymphatic fluid, leading to swelling, most commonly localized in the limbs. In pediatric patients, lymphedema occurs less frequently than in adults and may occur as a result of congenital malformations or acquired damage to lymphatic vessels and nodes. Manual lymphatic drainage (MLD) is one of the main and gentle methods for managing lymphatic stasis and plays a central role in the complex approach to restoring normal lymphatic function in pediatric patients. The careful and precisely dosed execution of this specialized technique has been shown to effectively support both the prevention and treatment of lymphedema in children with cardiovascular, urinary, and endocrine disorders, following surgical interventions, and in cases of post-traumatic complications. This therapeutic approach significantly contributes to improving their overall quality of life. The purpose of this article is to examine the impact of manual lymphatic drainage application in children
Segmentation and epicardial fat tissue measurements with 3D Slicer – accessible everyday solution in clinical practice and future AI involvement
Full text linkMedical image segmentation is a process of analyzing and systematically partitioning digital data obtained through diagnostic imaging, aimed at extracting quantitative information about specific anatomical structures or pathological changes. This method is essential for the precise measurement of volumes, areas, and morphological characteristics, and finds broad application in clinical diagnostics, therapeutic planning, and scientific research. However, most established software solutions for medical segmentation are associated with high licensing costs, which limit their accessibility in academic and clinical settings with constrained budgets.In this context, 3D Slicer has emerged as a free, open-source platform offering a comprehensive set of tools for visualization, processing, and analysis of medical images. Its flexibility and modular architecture allow the integration of additional algorithms, including those based on artificial intelligence (AI), making it particularly suitable for innovative research applications.This article presents our experience with semi-automatic segmentation of epicardial adipose tissue (EAT), performed on computed tomography (CT) images using 3D Slicer. We discuss methodological aspects, challenges, and the potential for clinical translation, emphasizing the possibilities for automation through AI-based tools and their significance for the future development of personalized medicine
Screening program for early detection of breast cancer in Bulgaria
Full text linkBreast cancer is a significant public health issue, characterized by high incidence and mortality rates. The primary goal of screening programs is the early detection of the disease to improve treatment effectiveness and reduce mortality. Motivation for participation is influenced by multiple factors, including socio-economic conditions, health literacy, and social norms.The development of a breast cancer screening program in Bulgaria followed several steps: conducting a literature review to define the program structure and identify the most effective screening methods; analyzing local epidemiological data and identifying high-risk groups; designing the patient pathway from invitation to receipt of results; examining motivational factors for participation; and conducting cost-effectiveness and budget impact analyses.This study aims to develop a population-based organized screening program for clinical breast cancer in the Bulgarian population, including an assessment of the target population and an analysis of the expected outcomes in terms of cost-effectiveness and budget impact. A systematic literature review was conducted, along with analysis of local epidemiological data and calculations of cost-effectiveness and budget impact for two scenarios: one based on the National Cancer Control Plan and one based on the actual age-specific population. Data from the National Statistical Institute, the National Cancer Registry, and expert opinions were used. Economic and budget impact models were developed in MS Excel.The analysis is presented in two scenarios. The first reflects the perspective of Bulgaria’s National Cancer Control Plan until 2030, using the target population defined in the plan. The second scenario incorporates real-world practice, based on local data on breast cancer risk among women aged 40 to 69. The present analysis also includes age groups beyond the strictly recommended range by ECIBC, in order to assess the impact of an expanded coverage and the associated costs.The economic evaluation shows that early diagnosis is more cost-effective than late diagnosis—BGN 309.33 per QALY versus BGN 903.08 per QALY.Implementation costs for the screening program range from BGN 3.86 million in the first year to BGN 15.44 million in the fifth year under the National Plan, and from BGN 48.78 million to BGN 64.94 million in the alternative scenario. Breast cancer mortality is expected to decrease by 25–30%. The estimated indirect contribution to GDP due to improved survival is BGN 379,370.31
Analysis and impact of stress and social support in patients with CKD at pre-dialysis and dialysis stages
Full text linkChronic kidney disease (CKD) represents one of the major public health issues worldwide (1). The need to adhere to specific restrictions regarding the hygiene-dietary regimen and outpatient monitoring of nitrogenous waste levels in the predialysis stage aims to slow the progression of kidney disease. At the same time, patients undergoing chronic hemodialysis (CHD) are prone to disturbances in their psycho-emotional state, manifested by stress, anxiety, and tension. Psychological stress is defined as a negative emotional response resulting from chronic illness and hinders effective coping with it (2,3). Social support depends on the patient's perception of being part of a network of relationships and is considered a key factor in the adaptation of patients with ESRD to HD therapy (7,11).Using questionnaires, interviews, and document analysis, a study was conducted on 90 patients aged between 28 and 82 years at the Clinic of Nephrology at St. Marina University Hospital in Varna. The patients were divided into two groups – those in the predialysis and dialysis stages of CKD. The analysis showed that a higher level of social support is associated with more effective disease management and better coping with psychological stress. This support can be provided by family, friends, colleagues, and a multidisciplinary team in the dialysis center