rss_2.0Journal of Biomedical and Clinical Research FeedSciendo RSS Feed for Journal of Biomedical and Clinical Research of Biomedical and Clinical Research 's Cover Rare Clinical Case of Lipoma in the Soft Tissues of the Sublingual Space: A Case Report<abstract> <title style='display:none'>Summary</title> <p>This report presents clinical case with a histopathologically established lipoma of the sublingual space. Lipomas are benign mesenchymal neoplasms produced by adipocytes. Our search in the literature demonstrated that the development of lipomas in the sublingual space is extremely rare. In the oral cavity, it is seen in less than 5% of patients. In this paper, we describe clinical features, imaging diagnostic and histopathological features. Lipomas are characterized by slow growth and could be asymptomic, therefore diagnosis could be delayed.</p> <p>This report describes and discusses the case of a 64 years-old-man with a formation, located below the left tongue, for a period of 4 years. The patient had repeatedly consulted with Ear-Nose-Throat (ENT) specialists and dentists who recommended surgical treatment. During the last month of the monitoring, the formation had grown significantly and the chewing and speech function had gradually worsened.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00Application of Enhanced Recovery after Surgery Protocols in Colorectal Cancer, Complicated by Malignant Bowel Obstruction: a Review of the Literature<abstract> <title style='display:none'>Summary</title> <p>Enhanced recovery after surgery (ERAS) protocols are standard in elective colorectal surgery. They lead to decreasing postoperative complications and shorten the hospital stay and the recovery period. Following these protocols is associated with better short-term results and better and disease-free survival in cases of respectable colorectal carcinomas. There is clear evidence of the beneficial effect of the protocols in reducing the rate of postoperative complications and shortening the hospital stay after elective colorectal surgery. There remains the question of whether these protocols are applicable effective in patients after emergency colorectal surgery. Over the last years, safe and effective ERAS protocols have been reported in patients with life-threatening conditions such as colorectal obstruction and intraabdominal infection.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00Granulocytic Expression of CD11b/CD18 and Thrombotic Risk in Patients with Myeloproliferative Neoplasms<abstract> <title style='display:none'>Summary</title> <p>Myeloproliferative neoplasms (MPN) are clonal hematological conditions characterized by excessive production of one or more cell lines in the bone marrow. The blood cells produced are often hyperactive in their functions, which could lead to complications in the disorder‘s clinical course. We aimed to define the role of granulocytic CD11b/CD18 expression for the thrombotic risk in MPN patients. We investigated 110 patients with a histologically confirmed diagnosis of a myeloproliferative disease and a control group of 46 healthy volunteers. In the patient group, we found an average expression 4.59 times higher than in the control group. The highest expression was found in a subgroup of patients with polycythemia vera – 71.55% of the patients’ neutrophils. In each subgroup with essential thrombocythemia, myelofibrosis, and chronic myeloid leukemia, the patients with a history of thrombotic complication had a higher expression than the patients without such complications.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00Growth Hormone Treatment: First Results of the Partnership Program for the Establishment of a Growth Center at the University Clinic of Pediatrics –Pleven<abstract> <title style='display:none'>Summary</title> <p>In March 2018, in the Clinic of Pediatrics of the University Hospital “G. Stranski ”- Pleven, we have created a Center for diagnosing and treating children with growth disorders, in active collaboration with an established expert center. During the study, 53 children with height &lt;-2 SDS were referred to the newly established Growth Center. The diagnoses of children receiving treatment with growth hormone (GH) were made in clinical settings based on the history, physical status, auxological assessment, imaging studies, basal and stimulated hormone tests, genetic tests. The children‘s mean age was 9.7 ± 4.5 years, with a significant gender difference (p&gt;0.05), living mainly in cities. For 18 months, we treated a total of 11 children (54.5% male) with an average age at the start of GH therapy of 8.1 ± 4.4 years and an average growth velocity of 10.3 ± 7.7 cm/year. Treatment with GH was introduced in Pleven after successfully establishing the Growth Center in the Clinic of Pediatrics. The first results showed a significant increase in the number of diagnosed and treated children whose follow-up we found an acceleration in growth and bone maturation, positive body composition changes, and lack of side effects from the treatment.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00A Study on Tumor-Infiltrating Lymphocytes in Different Subtypes of Breast Cancer<abstract> <title style='display:none'>Summary</title> <p>The study aimed to investigate immune cell infiltration in different subtypes of breast cancer (BC). Retrospectively were selected 100 patients with primary BC, grouped into four molecular surrogate subtypes (Luminal A and Luminal B-like, HER2-positive and triple-negative - TN), determined by immunohistochemistry (IHC). In each patient, a percentage of stromal tumor-infiltrating lymphocytes (TILs) was determined by hematoxylin-eosin staining. IHC was performed using primary antibodies CD3, CD4, CD8, CD20, and FOXP3. Immunophenotyped lymphocytes were counted (separately intratumoral and stromal) and semi-quantitatively graded. In the studied tumors, 10% were defined as lymphocyte-predominant BC. A high count of intratumoral and stromal TILs subsets was found mainly in TN and HER2-positive BC. The stroma is the preferred localization for immune cells in all four BC subtypes. CD3+ T predominates over CD20+ B lymphocytes, with CD8+ T cytotoxic and FoxP3+ T regulatory cells dominating T subtypes. HER2 and TN are more immunogenic than Luminal A and Luminal B – like subtypes of BC. The T-cells’ immune response was predominant in the studied cases of BC, with a predominance of CD8+ Tc and Foxp3+ Treg cells located mainly in the stroma.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00Health Assessment of Internal Hygiene Control in Sauce Production<abstract> <title style='display:none'>Summary</title> <p>Nowadays, usage of sauces as part of a meal has seen a significant increase. In their diversity as raw materials and technology of production, sauces are a potential source of health problems. During their production, primary and secondary contamination with microorganisms and other physical or chemical contaminants is possible. Ineffective internal control is a prerequisite for the emergence of health problems among consumers. The subject of the study is а sauce manufacturer. An algorithm was designed to perform the audit and for the purposes of the. The prerequisite measures were placed in separate Good Hygiene Practices (GHP) and Good Manufacturing Practices (GMP) programs and in the technological documentation for all the sauces produced, with plans, procedures, orders, instructions, lists, registers and other documents, all closely related to the specifics of production. The technological documentation was found to be in agreement with the Food Safety Management System – the HACCP-plan. The technological documentation, which is part of the prerequisite measures, corresponded to its purpose and, with slight adjustments, is a good basis for the effective functioning of the Food Safety Management System. The conclusions contain specific recommendations for revision of the Internal Control System, including correction of elements of health and hygiene importance.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00Predictors for Long-Term Prognosis after Acute Coronary Syndrome<abstract> <title style='display:none'>Summary</title> <p>Cardiovascular diseases (CVD) are the leading cause of invalidity and death in developed countries. Among them, the main cause of death is coronary artery disease. In this retrospective study, 172 patients with acute coronary syndrome (STEMI, NSTEMI, UA) are included. They had been hospitalized on an emergency basis in the Cardiology Department, Invasive Sector of Prof. Dr. St. Kirkovich Hospital in Stara Zagora, and the Cardiology Hospital -Yambol between January 2009 and February 2010. We found a significant difference in the age at acute coronary syndrome (ACS) occurrence by sex: earlier manifestation was observed in men (p=0.018). The univariant regression analysis showed that elderly age (p=0.005, OR 1.024), glomerular filtration &lt;90 ml/h (p=0.006, OR 0.964), GRACE-score &gt; 140 pt (p&lt;0.001, OR 1.045), HF (Killip class ≥ II) (p=0.002, OR 15.6) and EF&lt;40% (p=0.003, OR 1) were factors for adverse prognosis in the first, fifth and ninth year. Only GRACE-score was an independent predictor of death obtained by multivariate regression analysis in the study (p=0.002, OR 1.052). The factors influencing long-term survival adversely after ACS are age, smoking, chronic kidney disease, previously experienced myocardial infarction, diabetes mellitus, three-vessel coronary disease, and decreased systolic function of the left ventricle, and GRACE &gt; 140 p.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00Glutathione Content and Glutathione Peroxidase Activity of Sperm in Males with Unexplained Infertility<abstract> <title style='display:none'>Summary</title> <p>The study aimed to investigate glutathione peroxidase (GPx) activity and glutathione (GSH) levels in the sperm of patients with unexplained infertility. The sperm samples were collected from subjects with normal semen parameters divided into fertile and infertile groups. Sperm analysis was performed according to the 2010 WHO criteria. Measurement of the GPx activity and GSH were performed by enzymatic assay kits. The higher enzymatic activity recorded in spermatozoa and seminal plasma in the infertile group was close to the significant one – p=0.054 for seminal plasma andp= 0.086 for the spermatozoa.GSH levels were higher in the fertile group in the seminal plasma (p=0.045). Defining the causes of unexplained infertility requires the addition of oxidative stress. In patients with unexplained infertility, the level of glutathione is reduced, and the activity of one of the significant enzyme antioxidants GPx is not changed significantly and even shows a tendency to rise.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00Some of the Immunogenetics Aspects of Aging<abstract> <title style='display:none'>Summary</title> <p>The human life span could be influenced by the combined effect of environment, lifestyle, and genetic factors. Twin and family studies suggest that our genes control up to 25% of the lifespan. The aging immune system undergoes age-associated changes at multiple levels, resulting in a gradual loss of its ability to protect the organism against infections, low vaccine responses, and an increased probability of developing autoimmune diseases and malignancies. The highly polymorphic HLA complex is one of the major gene candidates associated with aging due to its crucial role in developing adaptive immunity and protecting the organism. Most of the data available have so far demonstrated a positive association with healthy aging for HLA alleles/haplotypes as protective against malignancies, autoimmune diseases, and conferring better control and response to infections.</p> <p>One of aging’s main manifestations is the chronic, low-grade inflammatory state observed in older people, caused by an imbalance between pro- and anti-inflammatory cytokines. In general, it is has been agreed that longevity is related to anti-inflammatory genotype profiles. With advanced age, changes also occur in the B cell repertoire, which significantly affects the humoral immunity and leads to inadequate responses to infections and vaccines in the elderly. New genetic biomarkers associated with aging are being explored and discovered, contributing to a better understanding of the molecular processes underlying the immune dysfunction related to aging and developing strategies for rejuvenating the immune system based on immune-risk phenotypes.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00Vaginal Bacterial Profile in Pregnant Women<abstract> <title style='display:none'>Summary</title> <p>This study aimed to determine the bacterial profile of vaginal samples from pregnant women and the prevalence of identified microorganisms. Materials and methods: A prospective epidemiological study was conducted on 150 pregnant women admitted to the Clinic of Obstetrics and Gynecology at Dr. G. Stranski University Hospital in Pleven. Vaginal secretion samples were collected from all the 150 women. Direct microscopy of native smears prepared by the wet mount method to detect Trichomonas vaginalis and direct microscopy of Gram-stained smears was performed. Aerobic culture studies were conducted to identify pathogenic bacteria and Sabouraud glucose agar (SGA) to detect the presence of Candida spp. Samples were also collected from 107 of the women for PCR tests for mycoplasma detection. Results: The highest relative share in the study was women aged 21 to 35 years 104 (69.33%). Of all the hospitalized and examined pregnant women, 87 (57.99%) had medical problems during the current pregnancy and postpartum complications, and 63 women (42%) gave birth without accompanying complications. In 86 (57.32%) of the women, bacteria were detected by direct microscopy of Gram-stained smears. Of these, 24 (16%) had gram-negative rods, 28 (18.66%) had gram-positive cocci. In 34 (22.66%), we found gram-negative and gram-variable pleomorphic bacteria. The aerobic culture study revealed microbiological growth in 44 (29.33%) of the women investigated. Conclusions: Studies on the profile of the vaginal microbiota in pregnant women and the spread of pathogenic microorganisms are essential for make prognoses for pregnancy outcome, evaluating the risk of developing a maternal-fetal infection, and discussing options for timely treatment.</p> </abstract>ARTICLE2021-07-12T00:00:00.000+00:00An Angiosarcoma in the Right Atrium: A Case Report<abstract><title style='display:none'>Summary</title><p> Angiosarcoma is a rare malignant tumor of vascular endothelial cell origin, accounting for 1-2 % of all sarcomas. We present a 24-year-old female patient, initially diagnosed and treated for tuberculous pleurisy for one month. Then transthoracic echocardiography (TTE) revealed a rare cause for the pleural and pericardial effusion - a tumoral mass apparently arising from the right atrium and extending into the upper vena cava. The patient presented with worsening dyspnea, stabbing pain in the right hemithorax and persistent, irritating cough, a recent history of haemoptysis, bilateral pleurisy and hemorrhagic pericardial effusion. The ECG showed sinus rhythm with negative T-waves in leads DI, Dll, aVL, V3 to V6. The TTE showed an irregularly shaped right atrial tumoral mass, not resembling a thrombus, which extended to the upper vena cava. The transesophageal echocardiography showed an invasion of the serous (parietal and visceral) pericardium and a dilated right atrium almost completely occupied by the tumoral mass. The CT scan revealed invasion of the upper vena cava ostium and anterior mediastinum with pretracheal adenopathies, and hemorrhagic pleural and pericardial effusion suggestive of a sarcoma. The histological examination and immunohistochemistry confirmed the diagnosis of angiosarcoma. Although a rare form of malignant tumor that affects the head, neck, breast, bone, liver, spleen and heart, angiosarcoma must be considered as a possible cause of pleural and pericardial effusion, especially in previously healthy young patients. </p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00Late Prosthetic Vascular Graft Infections after Reconstructions on Aortoiliac Segment: An Eleven Years Experience<abstract><title style='display:none'>Summary</title><p> The purpose of the study was to evaluate the frequency and etiology of late prosthetic vascular graft infections after reconstructions on aortoiliac segment. From 2001 to 2011,545 primary reconstructions were performed on 545 consecutive patients. We had 18 cases of late intracavitary graft infections in 14 of them. A total of 58 clinical specimens collected from patients before, during and after reoperation were analyzed. Pathogens were isolated using conventional methods for aerobic and anaerobic bacteria. The isolates were identified down to species level by conventional biochemical methods, VITEK 2 and mini API Systems (bioMereux, France). During an 11-year period after prosthetic grafting of the abdominal aorta and aortoiliac segment the incidence of late (more than 4 months after implantation) infection was 3.11%. The mean interval between the initial operation and development of infection was 39.2 months (range 4 to 84). Positive microbial cultures were found in 46 clinical specimens. A total of 66 microbial isolates were cultured, comprising 27 clinical strains. Gram-positive bacteria were predominant - 15 (55.55%) strains, followed by Gram-negative bacteria - 9 (3 3.33%), Candida albicans - 2 (7.4%) and Bacteroides fragilis - 1 (3.7%). In 7 cases, the infection was monobacterial, caused predominantly by Staphylococcus species. In the rest of the cases, the infections were polymicrobial, caused by association between two microbial species. Mortality rate was 35.71% (5 cases) - in 4 of them the infection was caused by association between two species of Gram-negative bacteria or between Gram-negative bacteria and Candida albicans. The incidence of late intracavitary vascular graft infection was low. The average period for development of this complication was about 3 years after reconstruction. Among the causative agents, Gram-positive microorganisms had a predominant role but infections caused by Gram-negative bacteria, especially when they were in association, had a worse outcome. </p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00The Place of Penetrating Keratoplasty in Corneal Diseases<abstract><title style='display:none'>Summary</title><p> The aim of the study was to analyze the results from penetrating keratoplasties (PK) in patients with different comeal diseases. The retrospective study included 124 patients (130 eyes) who underwent penetrating keratoplasty at the Eye Clinic, Pleven, between 1990 and 2011. The patients were divided into four groups, according to the main indication for keratoplasty: 1 - bullous keratopathy - pseudophakic and aphakic bullous keratopathy (PBK and ABK); 2 - degeneration and dystrophy (including keratoconus); 3 - keratitis, scar, trauma; 4 - repeat keratoplasty. The main indications for penetrating keratoplasty included regraft - 27%, PBK - 22.62%, ABK - 11.9% and keratoconus - 10.71%, though the leading cause had been different at different periods of time. By the time of suture removal (8-9 months on the average) in the group of patients with bullous keratopathy, the percentages of clear grafts were as follows: 55.88% in the group of patients with bullous keratopathy, 97.44% in the group with comeal degeneration and dystrophies, and 60% in the group with keratitis, corneal scar and trauma. In patients with regrafts, For the whole period of the study, grafts failed in 61.54% of patients with one regraft, and in 50% of the cases with second and third regrafts. Penetrating keratoplasty proved a valuable method of treatment for a number of comeal diseases. The prognosis and outcome, however, depended on the pathology responsible for comeal blindness.</p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00Effects of Long-Term Treatment with Atorvastatin and Rosuaastatin on Active Avoidance Test in Intact Rats<abstract><title style='display:none'>Summary</title><p> Statins are widely used for treatment of hyperlipidemia. They have been shown to possess pleiotropic effects apart from their lipid-lowering activity - anti-inflammatory, immunomodulatory, and neuroprotective. Most studies suggest that statins can protect the brain against damage but it is not clear whether they improve cognitive function in patients without neuropathy. The aim of the present study was to investigate the effect of 3-month treatment with atorvastatin and rosuvastatin on learning and memory processes in rats without brain damage. Wistar rats were treated orally for 90 days with atorvastatin and rosuvastatin at a dose of 10 mg/kg b. w. in parallel with the vehicle-treated group. After that period, learning ability and memory retention was evaluated using an active avoidance test - automatic reflex conditioner (shuttle box). The learning session was carried out on 5 consecutive days. Memory retention test was performed on day 12. The following behavioral reactions were investigated: conditioned responses (avoidance), unconditioned responses (escapes), and intertrial crossings. We found increased number of conditioned responses in groups, treated with atorvastatin 10 mg/kg b.w., and with rosuvastatin 10 mg/kg b.w. during the learning session and on the memory retention test, as compared to the same-day control group. The atorvastatin-treated group showed an increased number of unconditioned responses on days 1 and 2, as compared to the control group. In the group treated with Rosuvastatin there was an increased number of escapes on days 1,2 and 4, as compared to the vehicle-treated group. Atorvastatin and rosuvastatin at a dose of 10 mg/kg b.w. improved processes of learning and memory retention after the 3-month treatment. </p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00Etiology of Diabetic Foot Infection in Patients with Poorly Controlled Diabetes<abstract><title style='display:none'>Summary</title><p> The aim of the study was to define the spectrum and susceptibility of microorganisms, isolated from diabetic foot ulcers in patients with poorly controlled diabetes, treated at the clinic of surgery, and compare microbial findings of specimens collected superficially and from deep tissues. The study included 19 patients with type 1 and 2 diabetes with clinical signs of infection. All patients were with poorly controlled diabetes and staged from 3rd to 5th grade according to the Wagner diabetic foot scale. Swab samples from non-debrided wounds and biopsy samples from deep tissues were collected from each patient. Specimens were inoculated on media for isolation of aerobic and anaerobic bacteria. Identification and susceptibility testing of the isolated oiganisms were performed by conventional methods, and VITEK 2 and mini API Systems (bioMerieux, France). A total of 88 bacterial isolates were cultured, comprising 56 clinical strains. Gram positive bacteria were the most common isolated organisms (53.57%), followed by Gram negative bacteria (26.78%) and anaerobic bacteria (19.64%). Staphylococcus aureus was the most common organism detected (10 strains), followed by Enterococcus spp. (7 strains), Escherichia coli (7 strains), Bacteroides spp. (6 strains) and various other organisms of low incidence. Polymicrobial infection was detected in 17 (89.47%) of the patients. In most of the cases infections were caused by 3 bacterial species. Mixed aerobic/anaerobic infections were detected in 9 (47.3%) patients. In 15 (78.94%) patients, there was a coincidence of bacterial findings from superficial and deep tissue samples. The strains isolated were susceptible to commonly used antimicrobials for treatment of diabetic foot infection. The predominant part of the diabetic foot infections were polymicrobial, caused by association between two or three microbial species. In half of the cases the infection was mixed. There was a good correlation between microbial findings from superficial swabs and deep tissue specimens when they were delivered to the microbiology laboratory immediately after collection.</p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00Ultrastructural Study of the Synaptic Glomeruli in the Rat’s Cochlear Nucleus<abstract><title style='display:none'>Summary</title><p> The granule cell domain of the cochlear nuclear complex contains interneurons, which are the targets for nonprimary auditory inputs from the superior olivary complex, inferior colliculus, auditory cortex, cuneate and trigeminal nuclei of the somatosensory system. The cellular targets of the non-primary projections are unknown due to a lack of information regarding postsynaptic profiles in the granule cell areas. In the present paper, we examined the synaptic relationships between a heterogeneous class of large synaptic terminals, called mossy fibers and their targets within subdivisions of the granule cell domain. During the late stage of postnatal development, we observed heterogenous groups of complex synaptic glomeruli. Using electron microscopy, we provide evidence for ultrastructural features of dendrites that receive input from the mossy fibers. The distinct synaptic relations between mossy fibers and dendrites of microneurons further imply fundamentally separate roles in processing of acoustic signals.</p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00Effect of Aronia Melanocarpa Fruit Juice on Fearning and Memory in the Two-Way Active Avoidance Task in Rats<abstract><title style='display:none'>Summary</title><p> Amnia melanocarpa fruits are one of the richest natural sources of phenolic substances, among them flavonoids, mainly from the subclass of anthocyanins. Flavonoids, which are constituents of Amnia melanocarpa fruit juice, have been found to localize in various brain regions that are important for memory. The aim of the present study was to investigate the learning and memory effects of Amnia melanocarpa fruit juice (AMFJ) in young/healthy male Wistarrats. AMFJ was applied orally for 21 and 30 days at a dose of 10 ml/kg b.w., and comparisons were made with saline-treated (10 ml/kg b.w.) controls. Learning and memory functions were evaluated, using the two-way active avoidance task (shuttle box). Administered for the two treatment periods, the juice significantly increased the number of avoidances on training days 1 and 2, as well as at the retention test (24 h after the 2<sup>nd</sup> training session). These effects were more pronounced in rats treated with AMFJ for 30 days. The learning and memory effects of AMFJ are probably due to its polyphenolic constituents. The findings from the present study suggest that AMFJ applied subchronically improved learning and memory in young/healthy rats. </p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00Three-Dimensional Reconstruction of Arterial-Lymphatic Vascular Complex (Vessel Within the Vessel) in Breast Tissue<abstract><title style='display:none'>Summary</title><p> The phenomenon “vessels within vessels” was initially described by Merchant S et al. as arteries found free-floating inside the lumen of veins. We have described another version of the “vessels within vessels”complex, composed of arteries found inside the lumen of lymphatic vessels. The purpose of the present study was to describe the structure of the lympho-arterial vascular complex in a breast tissue specimen from a male subject using three- dimensional tissue reconstruction. A histological specimen from a 64 year-old male subject diagnosed with gynecomastia was used. The tissue sample was sectioned in a multi-step manner. An overall of approximately 150pm thick tissue material was sampled. Immunostaining with anti-CD34 antibody and anti-podoplanin antibody was performed. Three-dimensional reconstruction of the vessel within the vessel structure was performed with “Reconstruct” software When the reconstruction of the breast parenchyma was revealed as a 3D image, it became apparent that the arterial vessel was situated inside the lymphatic vessel and could be followed along the entire length of the vascular segment studied. We have proved that these vascular complexes are not artificial phenomenon and do exist. The function of the vascular complexes is still uncertain, and is probably related to lymph propulsions in the initial collector vessels. </p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00Comparison of Four Methods for Corneal Thickness Measurement<abstract><title style='display:none'>Summary</title><p> The aim of the study was to evaluate the thickness of the normal cornea in order to establish correlation between four methods of measuring including: ultrasound pachymetry (USP), anterior segment optical coherence tomography (ASOCT), non-contact tono/pachymetry (TONOPACHY) and laser-scanning confocal microscopy (LSCM). The study was based on evaluating repeatability and comparability of four different methods formeasuring the corneal thickness. Non contact specular microscopy was first performed on all 27 patients (aged between 20 and 24 years) to evaluate corneal characteristics and confirm the absence of pathological changes. Each participant was examined by USP, ASOCT and TONOPACHY, and 13 eyes of 10 persons were also examined by LSCM. The values of average central corneal thickness measured by USP, ASOCT, TONOPACHY and LSCM were 532.20±4.5 pm, 553.33±12.1 pm, were 548.20±5.62 pm and 573.33±7.22 pm, respectively. There was a high correlation between the instruments. The mean differences for central corneal thickness measurements were 41.43±1.67 pm between USP and LSCM, 20.43±2.4 pm between USP and ASOCT, and 22.1 ±3.88 pm between USB and TONOPACHY. Anterior segment optical coherence tomography overestimated corneal thickness as compared with that measured by USP, which is believed to be a gold standard. Anterior segment optical coherence tomography had better agreement with USP, as compared with LSCM. However, the results of measured cornea thickness by TONOPACHY were very close to cornea thickness measured by ASOCT.</p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00Multidrug Resistance Among Enterococci at a Tertiary Care Hospital in Northern Bulgaria<abstract><title style='display:none'>Summary</title><p> Multidrug-resistant (MDR) enterococci are a growing threat. The aim of this study was to determine the species distribution and prevalence of multidrug resistance among 100 enterococcal strains, isolated from patients treated in the University Hospital in Pleven, Bulgaria. Susceptibility to 11 antimicrobial agents was determined, using the disc diffusion method according to the performance standards of Clinical Laboratory Standards Institute (CLS1), 2012. All isolates were screened for high-level aminoglycoside resistance and resistance to vancomycin according to the recommendations of CLS1, 2012. For strains with reduced susceptibility to vancomycin, minimal inhibitory concentrations (MIC) of glycopeptides were determined by Etest (Liofilchem, Italy) and by Vitek 2 automated system. Our results demonstrated decreased susceptibility of enterococci to almost all intensively used anti-enterococcal drugs. Resistance to both penicillins (ampicillin and penicillin) among E.faecium strains was significantly higher (83-87%) than among E.faecalis isolates (4-27%). HLGR was detected in 70% of E.faecium and 38% of E.faecalis isolates. All HLGR strains were foundtobemultiple-drug resistant. Of particular note was the emergence of concomitant resistance to 6 antimicrobials in almost 50% of E.faecium isolates. Despite the wide dissemination of MDR E.faecium strains penicillins in our hospital, acquired resistance to vancomycin was not found.</p></abstract>ARTICLE2016-11-30T00:00:00.000+00:00en-us-1