Acta Medica Bulgarica

21/03/2026

📣 Предстоящи уебинари на Elsevier за България

Включете се серията от онлайн обучения, посветени на научните изследвания, публикационния процес и анализ на научни данни:

🔹Март 2026
📅 24 март | Navigating research landscapes with Scopus & ScienceDirect

📅 25 март | Literature search and review with Scopus & ScienceDirect – deep dive

📅 26 март | Selecting trustworthy journals: metrics, publishing models and ethics

🔹Април 2026
📅 31 март | SciVal for researchers – navigating trends and topics

📅 1 април | SciVal for research management

📅 2 април | Elsevier Open Office / Ask Me Anything / Практическа сесия за България

🎯 Уебинарите са подходящи за изследователи, преподаватели, докторанти, библиотекари и всички, които искат да подобрят уменията си за търсене, анализ и публикуване на научна информация.

Линковете за регистрация ще откриете тук 👉 https://view.highspot.com/viewer/d69ce5c53b613082ebb1c26ead6fb43e
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📣 Upcoming Elsevier Webinars for Bulgaria

We invite you to join a series of insightful online sessions focused on research discovery, publishing, and research analytics:

🔹 March 2026
📅 March 24 | Navigating research landscapes with Scopus & ScienceDirect

📅 March 25 | Literature search and review with Scopus & ScienceDirect – deep dive

📅 March 26 | Selecting trustworthy journals: metrics, publishing models and ethics

🔹 April 2026
📅 March 31 | SciVal for researchers – navigating trends and topics

📅 April 1 | SciVal for research management

📅 April 2 | Elsevier Open Office / Ask Me Anything / Practical session – Bulgaria

🎯 These webinars are suitable for researchers, faculty members, PhD students, librarians and anyone looking to improve their skills in searching, analyzing, and publishing scientific information.

Find the registration links here👉https://view.highspot.com/viewer/d69ce5c53b613082ebb1c26ead6fb43e

20/03/2026

Artificial intelligence in healthcare: advancing innovation and ethics to foster well‑being

B. Bayram, N. Leventi, A. Vodenicharova, A. Lamprianidou, M. Costantini

Keywords: artificial intelligence in healthcare, clinical decision-making, personalized medicine, ethical challenges, holistic well-being

Abstract. Artificial intelligence (AI) is reshaping healthcare by enhancing diagnostic precision, treatment personalization, and overall patient care. By leveraging technologies such as machine learning, deep learning, natural language processing, and computer vision, AI enables faster and more accurate decision-making, supports drug discovery and development, and facilitates remote patient monitoring. Beyond improving clinical outcomes, AI also contributes to holistic well-being by addressing physical, mental, social, occupational, and environmental health. Wearable AI devices promote proactive health management, virtual assistants improve mental health accessibility, and predictive analytics enable early intervention for disease prevention. However, the integration of AI in healthcare presents challenges, including data privacy concerns, algorithmic bias, and the need for transparency and trust. Ensuring the responsible and equitable deployment of AI requires robust ethical guidelines, interdisciplinary collaboration, and policies that safeguard patient rights while maximizing the technology’s benefits. By exploring both the transformative potential and inherent challenges of AI, this paper aims to highlight the critical role of AI in shaping the future of healthcare and human well-being.

The full article in the first comment 👇

20/03/2026

Cleft lip and/or palate: a comprehensive review and our treatment approach

К. Gigov, I. Ginev, M. Miteva

Keywords: congenital facial anomalies, surgical techniques, uranoplasty, surgical outcomes

Abstract. Cleft lip with or without cleft palate is the most common congenital malformation of the head and neck. Children with cleft anomalies may experience a multitude of physical and developmental challenges. Psychosocial and emotional concerns of the patients and their families can also occur. As such, comprehensive care for the patient with cleft lip and/or palate requires an interdisciplinary team. This article describes epidemiology, embryological developmental processes, known environmental and genetic risk factors, and their interaction, the assessment and current treatment recommendations for children born with cleft lip and/or cleft palate. We review the commonly used surgical techniques for repair, clinical outcomes and complications. Throughout the discussion, we share our experience and identify areas for future study with the focus on cleft palate management.

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20/03/2026

Intraoperative gonioscopy – a necessity for minimally invasive glaucoma surgery

N. Velikova, B. Kutchoukov

Keywords: gonioscopy, minimally invasive glaucoma surgery, anterior chamber angle, intraoperative visualization, goniolens, trabecular meshwork

Abstract. Minimally invasive glaucoma surgery (MIGS) has transformed the surgical management of mild-to-moderate glaucoma by lowering intraocular pressure (IOP) with a favorable safety profile. Accurate intraoperative visualization of the anterior chamber angle (ACA) via gonioscopy is fundamental to the success of ab-interno angle procedures. This review synthesizes the optical principles underpinning gonioscopy, compares contemporary surgical lenses (direct, indirect, and upright designs), and outlines practical recommendations for intraoperative setup, patient selection, and troubleshooting. We highlight critical landmarks (e.g., scleral spur, trabecular meshwork pigmentation, Schlemm’s canal reflux) and discuss adjuvants, such as trypan blue for trabecular meshwork staining. By aligning lens selection with the intended procedure and optimizing the operative ergonomics, surgeons can enhance visualization, reduce complications, and improve outcomes.

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19/03/2026

📣Dear Authors, Reviewers and Readers,

Please be informed that, effective 1 April 2026, all journals of Medical University – Sofia will introduce Article Processing Charges (APCs) to support their transition to full Gold Open Access publishing 👉https://cml.mu-sofia.bg/en/article-processing-charges-apc

🗓️ For manuscripts submitted to Acta Medica Bulgarica on or after 1 April 2026, an APC of 300 Euro will be payable only after the manuscript has successfully completed peer review and has been formally accepted for publication.

Editorial decisions are made independently of payment and are based solely on the manuscript’s scientific merit and the outcome of the peer-review process.

Find out more on the journal’s submission platform 🖱️
https://journals.mu-sofia.bg/index.php/amb/about

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: EnglishISSN: 0324-1750еISSN: 2719-5384

19/03/2026

Drug-induced pruritus

G. Bocheva, J. C. Szepietowski, A. Reich

Keywords: itch, pruritus, medications, drugs, ADR

Abstract. Drug-induced pruritus is a common problem in daily medical practice. Many drugs can cause pruritus after systemic or topical administration, but often the exact mechanism underlying the pathogenesis of itching caused by drugs remains unclear. Therefore, the diagnosis and treatment of drug-induced pruritus are challenging. In the present review, the current knowledge of the most common medications inducing itch with or without skin rash and their underlying mechanisms is summarized. Opioids can cause pruritus, especially if they are administered intrathecally. Some antineoplastic agents can frequently cause intense pruritus due to immune-related cutaneous reactions (immune checkpoint inhibitors) or via triggering hypersensitivity reactions (taxanes) in cancer patients. Recently, it was found that MAS-related G protein-coupled receptor X2 (MRGPRX2), expressed on mast cells in humans, is responsible for drug-induced non-histaminergic pruritus and pseudoallergic reactions.

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19/03/2026

A case of atypical origin of superior laryngeal artery: anatomical and clinical relevance

S. Stanchev

Keywords: superior laryngeal artery, external carotid artery, variation, clinical significance

Abstract. The superior laryngeal artery (SLA) is considered a typical branch of the superior thyroid artery and serves as a primary source of blood supply of the larynx. The present case describes an atypical origin of the left SLA from the external carotid artery – a rarely observed anatomical variant. The review of literature reveals multiple documented variations in SLA origin with important clinical relevance for surgical procedures, such as thyroidectomy, laryngectomy, and targeted intra-arterial chemotherapy for laryngeal cancer. The detailed knowledge of SLA variations reduces the risk of surgical and postoperative complications in the neck region.

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19/03/2026

Persistent median artery as a cause of carpal tunnel syndrome? A case report highlighting the indispensable role of ultrasonography in diagnosis

A. Al-Sadek, L. Gaydarski, G. Varbanov, B. Antonov, G. P. Georgiev

Keywords: persistent median artery, carpal tunnel syndrome, structural cause, undiagnosed risk, artery preservation, medical ultrasound

Abstract. Carpal tunnel syndrome (CTS) stands as the most common entrapment neuropathy. The PMA, a transient embryonic vessel, is found in approximately 3-7% of the population, yet it is extremely rare to present as a possible symptomatic space-occupying lesion or a source of pulsatile compression within the carpal tunnel. Herein, we report a case of a 66-year-old female with CTS together with large PMA, surgically treated by simple open carpal tunnel release. Following meticulous surgical decompression and preservation of the artery in situ, the patient achieved complete symptomatic relief. Post-operative high-resolution sonography was utilized to confirm the vascular anomaly and document the successful decompression. This case underscores a critical diagnostic dilemma in orthopedic surgery: performing a blind carpal tunnel release in the elderly without prior imaging carries an inherent danger, as failure to detect such a variant preoperatively risks iatrogenic vascular injury.

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18/03/2026

Surgical management of Chiari malformation type I in the pediatric patients with syringomyelia and related to Klippel‑Feil syndrome: a case series and literature review

D. A. Encarnación-Santos, G. Chmutin, I. B. Anvardzhonovich, E. Chmutin, B. Arstanbekov, Sh. Kurbonov, S. Bodanova, B. Chaurasia

Keywords: Chiari malformation type 1, posterior fossa decompression, foramen magnum, Klippel Feil syndrome, syringomegaly

Abstract. Background: Chiari type I malformation (CM-1) is a birth defect where the back part of the skull does not develop properly, leading to the formation of a small and shallow space at the back of the head. The aim of this case series is to determine the causes and pathologies associated with Chiari type 1 malformation and the possible management and treatment, as well as the best outcomes that aid in the postoperative evolution of CM-1 decompression. Case Presentation: A 13-year-old patient presented to the emergency department with severe, frequent, and daily headaches of five years’ duration. An 8-year-old girl presented to our clinic with severe headaches of one year’s duration. A 9-year-old boy presented to the clinic with weeks of severe headaches and numbness in the fingers of his right hand. MRI was performed, which diagnosed Arnold-Chiari syndrome type 1, fusion of the C1-C2 vertebrae, and triphalangeal fingers of the hand, which are associated with the Klippel-Feil syndrome (KFS). Conclusion: CM-1 is associated with syringomyelia, which is more prominent in Case 2, whereas Case 3 is associated with Klippel–Feil syndrome; therefore, karyotyping and Sanger sequencing of the GDF6 gene were recommended.

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18/03/2026

Fetal growth restriction and placental markers: а retrospective study of first-trimester predictors

Z. Kirovakov, A. Dushepeev

Keywords: fetal growth restriction, PAPP-A, uterine artery Doppler, first-trimester screening, β-hCG, placental function

Abstract. Background: Prenatal care must prioritise the early detection of Fetal growth restriction (FGR), as it is a major contributing cause of postnatal problems and deaths. Early detection of risk in pregnancies for FGR plays an essential role in optimizing prenatal care and improving outcomes. Maternal serum biomarkers and uterine artery Doppler measurements during the initial trimester have been proposed as potential predictors. Aim: The purpose of this research was to find the connection between uterine artery Doppler indices and maternal blood markers from the first trimester and the emergence of FGR later on. Materials and methods: This retrospective study of 642 singleton pregnancies monitored at a specialized fetal medicine unit between January, 2023 and December, 2024. All women underwent first-trimester examination between 11+0 and 13+6 weeks of pregnancy, which involved evaluating PAPP-A, or pregnancy-associated plasma protein A, free beta-human chorionic gonadotrophin (β-hCG), and the pulsatility index (PI) of the uterine artery via Doppler ultrasound. A birth weight below the third percentile was referred to as FGR. Results: Fetal growth restriction (FGR) was diagnosed in 65 patients (10.1%). A higher mean uterine artery pulsatility index (PI) (1.93 ± 0.68) and lower maternal serum pregnancy-associated plasma protein A (PAPP-A) levels (0.56 ± 0.26 MoM) were significantly more common in affected pregnancies compared with unaffected pregnancies (PAPP-A: 1.18 ± 0.56 MoM; PI: 1.57 ± 0.45; p = 0.001 and p = 0.014, respectively). There was no statistically significant difference in β-hCG levels between the two groups. Multivariate logistic regression analysis confirmed elevated uterine artery PI and low PAPP-A levels as independent predictors of FGR risk. Conclusion: High uterine artery PI and decreased PAPP-A levels in the mother’s blood during the first trimester are both linked to a higher risk of fetal growth limitation. Although their predictive capacity is limited, these markers may aid in early risk stratification when used in conjunction with other clinical assessments.

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18/03/2026

Synthesis and in vitro evaluation of neurotoxicity and MAOA/B inhibitory effects of new pyrrolyl-based furan, substituted furan and indole azomethine derivates

M. Sharkov, M. Georgieva, M. Kondeva-Burdina

Keywords: pyrrole hydrazones, neurotoxicity, MAOA/B inhibition

Abstract. In this study the synthesis of three new N-pyrrolyl azomethine derivatives comprising furan, substituted furan and indole residues is presented. A classical Paal-Knorr cyclization was used for synthesis of the initial N-pyrrolyl hydrazine and the final azomethines were obtained in a micro synthesis scale, assuring about 69–76% yields, low harmful emissions and reagent economy. The compounds were elucidated by IR, 1H NMR and 13C NMR spectral analyses and the obtained results were consistent with the assigned structures. The purity of the substances was proven by TLC characteristics and corresponding melting points. In addition, the neurotoxicity and possible MAO-A and MAO-B inhibitory effects were elucidated in vitro. The obtained results indicated that the target molecules are with low neurotoxicity and no MAOA/B enzyme inhibiting effects.

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17/03/2026

Comorbidities and pregnancy complications as determinants of COVID‑19 severity in pregnant women: a retrospective study at a National Maternal Referral Center

R. Bur, D. Danukusumo, M. A. R. Putra, S. R. Talib, S. Pramuktini, N. Safanta, M. Gebrina, F. E. S. Dewi, A. B. Dharmala, D. Megawulandari

Keywords: comorbidity, COVID‑19, disease severity, pregnancy

Abstract. Background: Pregnant women are considered people at risk in the context of COVID-19 due to physiological changes in immunity, cardiopulmonary function, and metabolic status. These changes may increase susceptibility to infection and lead to progression to severe diseases. In particular, maternal comorbidities and pregnancy-related complications have been identified as potential risk factors for worsened clinical outcomes. However, data from low- and middle-income countries remain scarce, limiting the generalizability of global evidence to these findings. Indonesia, one of the most populous countries in Asia, had high maternal morbidity during the pandemic, yet few studies have focused on determinants of COVID-19 severity among pregnant women. Objective: This study aimed to assess the association between maternal comorbidities, pregnancy-related complications, and the severity of COVID-19 in a national maternal referral hospital. Materials and methods: A retrospective observational study was conducted, involving 252 pregnant women with confirmed COVID-19 admitted to Harapan Kita Women and Children Hospital, Jakarta, between 2020 and 2022. COVID-19 severity was categorized as moderate or severe based on the World Health Organization (WHO) classification. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for associations between clinical variables and disease severity. Results: Maternal comorbidities were significantly associated with severe COVID-19 (OR 3.2; 95% CI 1.08-9.26). Diabetes mellitus (DM) was the strongest independent predictor of severe disease (OR 5.0; 95% CI 1.28-19.88). Hypertension (OR 2.8; 95% CI 0.59-13.60) and preeclampsia (OR 1.2; 95% CI 0.40-3.75) were not statistically significant. These findings align with global reports that metabolic dysfunction exacerbates inflammation and immune dysregulation. Conclusions: Comorbidities, particularly diabetes mellitus, significantly increase the risk of severe COVID-19 in pregnancy. Targeted screening and early intervention are essential, especially in resource-limited countries, in order to improve maternal outcomes.

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