Acta Medica Bulgarica

Acta Medica Bulgarica The Journal Acta Medica Bulgarica, published continuously since 1973, is the leading scientific journal of the Medical University – Sofia.

It is peer-reviewed and circulated entirely in English. AMB is available online as an open-access journal. AIM AND SCOPE
Journal subjects: Medicine, Basic Medical Science, Immunology, Clinical Medicine, other. Types of manuscripts accepted for publication: original research articles, scientific reviews and case reports in all areas of Medicine. Language: English
ISSN: 0324-1750
еISSN: 2719-5384

PUBLICATION TIMEFRAME AND ACCESS
This journal is published quarterly with 4 issues annually. It provides immediate open access to its content so as to make research freely available to the public in support of a greater global exchange of knowledge. Each issue is also available in print, and is distributed to libraries and medical organizations etc. If you'd like to receive a print or digital copy, please subscribe. REVIEW PROCESS
All manuscripts are subject to peer review and are expected to meet high academic standards. If approved by the editor, submissions will be considered by peer reviewers whose identities will remain anonymous to the authors (single blinded). The median peer review turnaround is 4-8 weeks. The time from acceptance to publication is from 4 weeks to 18 months. The current acceptance rate is approx. 40 %. About 10-20 % of articles are rejected upon submission and do not reach peer-review, due to lack of compliance with the Journal’s Author Guidelines or English language issues. An average of 20 articles are submitted each month, of which 70-80% are original research articles, and the remaining are case reports and review articles. ABSTRACTING AND INDEXING
AMB is covered by a range of indices, such as Scopus, CABI: Global Health Database, DOAJ, Embase, EBSCO, Elsevier - Reaxys, ExLibris, Google Scholar, etc. Scopus Cite Score 2022: 0.3
SJR 2022: 0.119
SNIP 2022: 0.028

Interested in submitting to this journal? Find out more >>> https://journals.mu-sofia.bg/index.php/amb/about/submissions

17/12/2025

Predictive power of biomarkers in preeclampsia in singleton pregnancies: a comprehensive review of current evidence and future directions

Z. Kirovakov, B. Stoilov, A. Anzaar

Keywords: preeclampsia, biomarkers, prediction, sFlt-1, PlGF, angiogenesis, pregnancy, maternal health, Fetal Medicine Foundation

Abstract. Preeclampsia is a significant cause of maternal and fetal morbidity and mortality worldwide, characterized by hypertension and proteinuria after 20 weeks of gestation. Early identification and management are critical to improving outcomes. Biomarkers have emerged as promising tools for predicting the onset and progression of preeclampsia, offering the potential for earlier intervention. This comprehensive review examines the current landscape of biomarkers in predicting preeclampsia, evaluating their predictive values, clinical applicability, and limitations, specifically in singleton pregnancies. Readers explore a range of biomarkers, including angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), which have shown high sensitivity and specificity in predicting preeclampsia. The roles of inflammatory markers, such as C-reactive protein (CRP) and cytokines, are also assessed for their predictive capabilities. In addition, the research discusses the emerging significance of metabolomic and proteomic profiles in enhancing predictive accuracy. Despite advancements, the clinical integration of these biomarkers is hindered by challenges such as variability in predictive performance across different populations and gestational stages. Moreover, the cost-effectiveness and accessibility of biomarker testing in routine prenatal care remain areas of concern. Future research should focus on validating biomarker panels in diverse populations and developing standardized guidelines for clinical implementation. In conclusion, while biomarkers hold substantial promise in the predictive landscape of preeclampsia, ongoing research is crucial to overcome existing barriers and translate these findings into improved clinical outcomes. This review aims to provide a comprehensive overview of the current evidence and future directions in the predictive use of biomarkers for preeclampsia.

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17/12/2025

Endometriosis in adolescents

D. Hristova, I. Ibryam, S. Hitrova-Nikolova, R. Tocev, I. Kostov

Keywords: endometriosis, adolescents, therapeutic management

Abstract. Endometriosis is an estrogen-dependent chronic inflammatory disease characterized by the proliferation of endometrial glandular tissue and stroma outside the uterine cavity. It is estimated that 4 to 17% of adolescent girls have the same form of endometriosis, and it is particularly common among those with dysmenorrhea who respond poorly to analgesics or estroprogestins. For those suffering from recurrent and chronic pelvic pain, the percentage rises to 25-38%. Possible explanations for the pathogenesis of endometriosis are: coelomic metaplasia, embryonic Müllerian rests, iatrogenic implantation, vascular and lymphatic metastasis, the genetic theory, and endometrial stem/progenitor cells that represent different hypotheses besides Sampson’s theory, the classic retrograde menstruation, which is the most widely accepted theory to explain the ectopic implantation of endometrium. According to the ESHRE guidelines, suggestive manifestations for endometriosis include early menarche, severe dysmenorrhea, dyspareunia, abnormal uterine bleeding, midcycle or acyclic pain, resistance to empiric medical treatment, and gastrointestinal and genitourinary symptoms. Known risk factors for developing endometriosis include: Genetic predisposition; Epigenetic variables – prematurity, bottle feeding, exposure to some pollutants with estrogenic activity; Dysregulation of the immune and inflammatory response, as well as obstructive anomalies of the reproductive tract. Diagnosis is made by accurate anamnesis – personal and family history, gynecological examination and Ultrasonographic evaluation (transabdominal and transvaginal ultrasound). Magnetic resonance can be useful to detect obstructive reproductive tract anomalies and to identify and characterize endometriotic lesions that are difficult to locate by ultrasound. A multidisciplinary diagnostic approach should be considered for a complete evaluation of these patients. Laparoscopic evidence serves as the gold standard for verifying peritoneal endometriosis and determining its stage, spread, and severity. A differential diagnosis of gastrointestinal pathologies, Müllerian anomalies, recurrent infections, and adenomyosis must be made. The treatment of this disease includes medical and surgical interventions, and a combination of both. ESRHE guidelines advise clinicians treating women with endometriosis to prescribe hormonal contraceptives or progestins to reduce endometriosis-associated pain. The use of gonadotropin hormone-releasing hormone agonists is acceptable in adolescents only if the patient with known endometriosis is refractory to other medical therapies or surgical treatments. The goals of medical therapy in the adolescent patient include symptomatic relief, suppression of disease progression, and protection of future fertility.

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17/12/2025

Melanoma in situ and phototoxic drug reaction appearing simultaneously after antihypertensives intake: photo nitroso carcinogenicity of drugs as possible risk factor for the development and progression of cutaneous melanoma

G. Tchernev, S. Kordeva

Keywords: nitrosamines, drug related photoxicity, photocarcinogenicity, melanoma, telmisartan, hydrochlorothiazide, lisnopril, amlodipine, clinical case report

Abstract. Drug-mediated nitrosogenesis or oncopharmacogenesis of skin cancer in general and melanoma skin cancer development in particular could be pathogenetically determined/ explained by the presence of photocarcinogens in drugs. These photocarcinogens are also known as nitrosamines. A number of studies in the scientific literature have linked the intake of antihypertensive drugs from heterogeneous groups to the generation of phototoxicity and the subsequent development of cutaneous melanomas. However, these particular groups of antihypertensive drugs belong at the same time to those declared by regulatory authorities worldwide (FDA/EMA) as affected by contamination with photocarcinogens. According to the most recent literature, 1) the number of potentially nitrosamine-contaminated antihypertensive drugs taken and 2) exposure to ultraviolet radiation could correspond to the severity of the clinical picture. We report a patient who developed a phototoxic reaction and melanoma in situ in the context of a relatively short-term use of the four types of antihypertensive drugs: lisinopril/ amlodipine, followed by valsartan/ hydrochlorothiazide. An analysis of the possible
pathogenetic association is made, discussing recent literature concepts such as: drug-induced photo nitrosogenesis / carcinogenesis of cutaneous melanoma.

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16/12/2025

A case study of a child with Down syndrome: a dilemma for the accompanying pulmonary impairment

I. Chakarov

Keywords: immunoglobulins, mycosis, pneumonia, itraconazole, trisomy 21

Abstract. This is a 12-year-old boy with proven trisomy 21 (Down syndrome). During the last calendar year, a series of severe inflammatory manifestations of the lower respiratory tract began. Before the fi rst hospitalization, he was in a serious general condition, with a pronounced biological syndrome of inflammation (CRP – 197 mg/L), but without leukocytosis. Oxygen saturation was 60%. The performed chest radiograph showed left-sided lung destruction and a multifocal inflammatory-infiltrative process in the right lung. In the following months, an active exacerbation of the manifestations of respiratory failure and radiographic progression of pulmonary changes followed. A new chest CT scan was performed – with data on consolidation of the parenchyma in both lobes of the left lung to the extent of atelectasis. In the right lung – middle and lower lobes, extensive ground glass areas, emphysema in the right apical and dislocation of the mediastinum. The subsequent chest X-ray showed no changes compared to the previous one, except for marking the interlobe on the right. After consultation with a thoracic surgeon, a left-sided pulmonectomy was proposed. In the mycograms performed at the same time, a result was obtained proving the presence of Paecilomyces spp. Due to the negative result for Aspergillus, the treatment started with Voriconazole was changed to Itraconazole according to the obtained result. At present, the patient is at the end of the first month of his treatment cycle with itraconazole, and a new imaging study is to be conducted to assess the effect of the treatment.

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16/12/2025

Surgical approach to peri-implantitis: case series of regenerative treatment protocol

E. Deliverska, B. Yordanov, G. Hadjiev, Z. Pashova-Tasseva

Keywords: bone regeneration, peri-implantitis, surgical treatment

Abstract. The implementation of dental implants has revolutionized the treatment of the partially and completely edentulous patients, offering significant benefits in restoring oral function and esthetics. However, routine dental implant placement is often associated with complications such as peri-mucositis and peri-implantitis, which can compromise the long-term success of the implant. One of the primary challenges in managing peri-implant diseases is the absence of acute symptoms, often leading to delayed detection and diagnosis by the patient. As peri-implant diseases progress, patients may seek dental care due to the exacerbation of symptoms, prompting the dentist to consider surgical intervention. Surgical therapy offers a critical opportunity to restore compromised implants and peri-implant tissues, potentially improving implant survival rates. The surgical management of peri-implantitis, which involves debridement, decontamination, and regenerative procedures, provides an effective alternative for addressing the infected peri-implant tissues and can contribute to long-term implant stability and function.

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16/12/2025

Mandibular fractures associated with third molar odontectomy

P. Petrov, A. Zheleva, I. Radev, I. Doykova, D. Shopova, A. Georgiev, S. Harizanova, M. Dimova-Gabrovska

Keywords: mandibular fracture, odontectomy, third molar

Abstract. Background: Intraoperative and postoperative fractures of the mandibular angle are among the most common complications associated with surgical interventions in this region. These fractures may occur intraoperatively or postoperatively, leading to significant patient discomfort and prolonged treatment duration. The aim of this study is to present several cases of intraoperative and postoperative fractures occurring in the mandibular angles after third molar extractions. Results: We report three cases of patients who sustained postoperative mandibular angle fractures following the odontectomy of lower third molars. Factors contributing to this complication were analyzed, along with the treatment methods employed. Intraoperative and postoperative fractures are relatively rare complications. While some fractures occur during surgery, others may develop spontaneously at a later stage due to the weakened structural integrity of the mandible. Certain preventive approaches, such as prophylactic immobilization, have demonstrated positive outcomes; however, they may also increase patient discomfort. Conclusion: Each surgical case should be assessed individually. In cases of significantly elevated fracture risk, prophylactic immobilization may be a reasonable preventive measure.

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15/12/2025

Distal radius resection and replacement with fibular graft in bone tumors: report of three cases with long-term follow-up and critical analysis of complications

G. P. Georgiev, S. Slavchev

Keywords: distal radius, bone tumors, fibular graft, complications

Abstract. The distal radius is a rare location for primary or metastatic bone tumors. Reconstruction of this bone after en bloc resection is a daunting challenge. Herein, we present three cases of distal radius resection due to bone tumors, with replacement of the resected bone using a fibular graft, and long-term follow-up. Moreover, we made a critical analysis of the reported complications after treatment. We hope this article and our comments will be helpful to surgeons who work in this area.

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15/12/2025

Kochia scoparia seed infusion ameliorates behavioral impairment in rats subjected to calorie-dense diet

M. Reyzov, S. Gancheva, M. Eftimov, M. Todorova, S. Valcheva-Kuzmanova, M. Zhelyazkova-Savova

Keywords: Kochia scoparia, cognitive impairment, anxiety, depression, calorie-dense diet, rats

Abstract. Aim: The current study aimed to assess the effects of aqueous Kochia scoparia seeds infusions (KSSIs) on the behavioral indices of anxiety, depression, and spatial memory impairment in rats receiving a calorie-dense diet (CDD). Materials and Methods: Five groups (n = 10 each) of male Wistar rats were used. For ten weeks, the control group received a standard laboratory diet, and the other groups – CDD. KSSIs were prepared at increasing strengths by soaking 1.5, 3.0 and 6.0 g Kochia scoparia seeds in 100 ml of boiling water and were given orally ad libitum to groups named CDD+1.5KSSI, CDD+3KSSI and CDD+6KSSI, respectively. The anxiety-like behavior was assessed by the open field test (OFT) and the social interaction test (SIT), the depression-like state – by the forced swim test (FST), and the spatial memory – by the object location test (OLT). Results: KSSI-treated animals spent more time in the central zone in the OFT and demonstrated lower immobility time in the FST compared to the CDD group. As revealed by the OLT, CDD induced the impairment of the spatial memory of the rats and the highest strength of KSSI prevented the changes. Conclusion: Our results suggest that KSSI might exert anxiolytic-like, antidepressant-like and memory-enhancing effects in rats receiving a calorie-dense diet.

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15/12/2025

Infrared thermography reveals alterations in surface body temperature in streptozotocin-induced diabetic mice

M. Hristov, P. Andreeva-Gateva

Keywords: infrared thermography, diabetes, streptozotocin, body temperature, thermoregulation, mice

Abstract. Diabetes mellitus is associated with impaired thermoregulation, yet the extent of these alterations remains insufficiently understood. This study aims to evaluate changes in surface body temperature in streptozotocin-induced diabetic mice using infrared thermography, a non-invasive technique for assessing body temperature regulation. Experimental studies were conducted on male BALB/c mice. Type 1 diabetes was induced with a single intraperitoneal injection of streptozotocin (150 mg/kg). Infrared imaging was performed 20 days after streptozotocin injection at 11:00 AM (light phase) and 7:00 PM (transition to the dark phase). The analysis focused on key body regions, including the head, interscapular area, and tail base. The results revealed a significant reduction in surface body temperature in diabetic mice compared to controls at both time points, with a more pronounced decrease observed in the evening. The interscapular region exhibited lower surface temperatures in diabetic mice, suggesting impaired thermogenesis in brown adipose tissue. Additionally, reduced tail base temperature indicated increased vasoconstriction, further supporting the hypothesis of compromised thermoregulation. These findings highlight the impact of diabetes on body temperature regulation and suggest a potential circadian component to these alterations. The study underscores the utility of infrared thermography as a valuable method for assessing thermoregulatory dysfunction in metabolic disorders. Future research should explore the progression of these temperature changes over time and their response to different environmental conditions and pharmacological interventions.

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12/12/2025

Minimally invasive regenerative treatment of vertical bone defects: a clinical trial

K. Kotsilkov, V. Dosseva-Panova, Z. Pashova-Tasseva, H. Maynalovska

Keywords: vertical bone defects, periodontal regeneration, minimally invasive surgical treatment, enamel matrix derivatives
Abstract
The aim of the current study was to analyze and evaluate the outcomes of regenerative therapy using a bone graft and enamel matrix proteins, applied through a minimally invasive surgical approach for the treatment of vertical bone defects. Materials and methods: Ten systemically healthy patients with a total of 30 vertical bone defects were treated using a minimally invasive surgical approach combining enamel matrix derivative (Emdogain) with a bone graft. Probing pocket depth (PPD), clinical attachment level (CAL), and radiographic defect depth were analyzed before and at the 6-month postoperative follow-up. Statistical analysis was performed using descriptive statistics and the paired Student’s t-test (p < 0.05). Results: At the 6-month follow-up, a statistically significant reduction in probing pocket depth (mean reduction: 4.00 ± 1.44 mm; p < 0.0001) and a significant gain in clinical attachment level (mean gain: 4.62 ± 2.13 mm; p < 0.0001) were recorded. Radiographic evaluation also revealed a statistically significant reduction in bone defect depth (mean change: 2.95 ± 1.34 mm; p = 0.0027), with a residual mean depth of 0.57 ± 0.73 mm. Conclusion: The minimally invasive approach using enamel matrix derivatives (EMD) in combination with bone grafting proved effective in the treatment of vertical bone defects. The favorable clinical and radiographic outcomes suggest periodontal stability and support the long-term preservation of the treated teeth.

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12/12/2025

Effectiveness of company websites and pages in retaining patients of dental clinics

D. Shtereva-Tzouni, V. Mitreva, Emilia Naseva

Keywords: dentists, effectiveness, dental digital marketing, website, page
Abstract
Introduction and aim: Even though a dental practice is based on the clinical activity, it requires the application of smart marketing strategies and a strong online presence, which is well-positioned in the marketplace. The aim of the study is to analyse the opinions of dentists regarding the effectiveness of promoting their dental practices through a website and a company page, and the positive implications of this for the prosperity of their practices, especially in times of financial crisis. Materials and Methods: A cross-sectional study was conducted between 23 February and 23 May 2023 via an online anonymous survey among 528 dentists who work in Bulgaria. Results: Over a third (39.2%) of dentists have a website and almost half (46.5%) have a company page, with this being more common in the capital as well as in group practices and medical/medical-dental centres. Doctors who devote resources to advertising their dental clinics are significantly more likely to have both a website and a company page. Having a company page helped to maintain and increase patient count through the inflationary year 2022, since 55.4% of participants experienced an increase in the patient count having such a page, as well as 65% maintained the patient count as a result of proactive actions on their parts (p=0.001). Conclusions: Dental clinic websites and company pages are a significant marketing tool and help maintain and increase patient count even in difficult economic times. Dentists practicing in smaller towns, as well as smaller dental clinics and individual dental care practices, will benefit most from the creation of company websites and pages.

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12/12/2025

Endoscopic endonasal resection of advanced stage T3/T4 sinonasal malignancies involving the skull base: monocentric single-surgeon study (2020-2024)

T. Popov, S. Dimitrov, V. Dobriyanova, S. Valcheva, L. Dimitrov, V. Marinov, Tz. Marinov, A. Schreiber, S. Skelina

Keywords: skull base endoscopic surgery, squamous cell carcinoma, internal carotid artery, dura mater, recurrence-free survival

Abstract. Objective: This study aims to evaluate the outcomes of endoscopic endonasal resection in patients with advanced-stage T3/T4 sinonasal malignancies involving the skull base, analyzing surgical efficacy, challenges, and implications for future clinical practice. Materials and Methods: A retrospective analysis was conducted on a monocentric single-surgeon cohort of 16 patients (mean age 60.7 ± 10.5 years) diagnosed with T3/T4 sinonasal malignancies affecting subsites of the skull-base region between 2020 and 2024. All the patients underwent primary radical endoscopic endonasal resection at the Department of ENT, Head & Neck Surgery, University Hospital “Tsaritsa Ioanna – ISUL”, Medical University – Sofia, followed by adjuvant radiotherapy. Results: The cohort consisted of predominantly male patients (56.25%), with squamous cell carcinoma being the most common histological type (81.25%). Outcomes indicated a recurrence-free survival rate of 81.3% at a median follow-up of 30 months. Intraoperative findings revealed complexities in distinguishable tumor invasion, especially concerning critical anatomical structures, necessitating meticulous surgical techniques. Conclusions: Endoscopic endonasal resection demonstrates potential efficacy in managing advanced sinonasal malignancies, with a favorable recurrence-free survival rate underscoring its role as a viable surgical option. The study emphasizes the importance of individualized treatment strategies and the need for multidisciplinary collaboration to optimize patient care in this challenging clinical scenario.

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https://journals.mu-sofia.bg/index.php/amb

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About us

In 1973, on the initiative of “Medicine and Physical Culture" Publishing House, more precisely the then manager Mr. Trayan Ivanov, the Ministry of Health set up and approved to subsidize a new medical journal, published only in the English, which to reflect the status and achievements of Bulgarian medical science. Thus the language barrier was overcome and stable relations were established with the international medical societies, large libraries and university centres.

The internationally known scientist Prof. Assen A. Hadjiolov was elected Editor-in-chief by the first editorial board and the journal was named Acta Medica Bulgarica. For more than 20 years, the “Medicine and Physical Culture" personnel did all the work related to the publishing of Acta Medica Bulgarica, regardless of the fact that the magazine kept on its appearance as an organ of the Medical Academy, respectively of the Sofia Medical University.

Through the years, following the tradition of electing the Rector of Sofia Medical University to lead the publishing of the journal, Editors-in-chief were Prof. Atanas Maleev, Prof. Nikolay Belovezhdov, Prof. Dimiter Djerov, Prof. Vladimir Ovcharov, and Prof. Vanyo Mitev. Presently, Prof. V. Zlatkov,, the Rector of Sofia Medical University, is the Editor-in-chief of Acta Medica Bulgarica.

Gradually, a greater number of scientists from all over the world, as well as universities and scientific institutes, demonstrated a stronger interest in publishing their papers in AMB. The journal is on demand by over 300 world medical libraries working on principles of medical information exchange.