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

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UBLICATION 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

19/12/2024

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04/12/2024

High colchicine doses are really silver bullets against COVID-19
Vanyo Mitev

Keywords: COVID-19, colchicine, NLRP3 inflammasome, cytokine storm, colchicine toxicity

Abstract. The numerous attempts to prove a therapeutic effect of low-dose colchicine for the treatment of Coronavirus disease-2019 (COVID-19) have been discouraging. Increase of doses, however, leads to accumulation in leukocytes and inhibition of the cytokine storm thus preventing COVID-19 complications and hospitalizations. Hospital mortality drops up to 7 fold, while outpatients practically do not reach hospitalization.

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04/12/2024

Current development of virotherapy in breast cancer: a brief review
I. Sasmana, P. Putri, N. Dewi, I. Supadmanaba, D. Wihandani

Keywords: breast cancer, virotherapy, potential therapy, immunotherapy, viruses

Abstract. Breast cancer is the cancer with the greatest incidence in the world by 2020. This cancer has a high mortality rate, has the capability of metastasizing, and causes damage to important organs of the human body. Therefore, a lot of studies have been done to find the best therapy to overcome this problem. However, cancer has various special abilities that make it survive and continue to invade its host body, for example, the ability to evade its host immune system by several mechanisms. One of the potential cancer therapies is virotherapy. Virotherapy is a therapeutic method using viruses to destroy cancer cells. Several mechanisms can be provided by viruses, such as stimulating the host immune system and inducing apoptosis of cancer cells. Especially for breast cancer, there are 4 groups of viruses based on their genome that have oncolytic capability, such as the dsDNA, dsRNA, + ssRNA, and -ssRNA groups. Currently, there are several therapeutic virotherapy-based modalities for breast cancer that are in clinical trial phases. Each trial has shown positive
results in developing virotherapy for breast cancer.

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03/12/2024

Drug-induced liver toxicity
K. Stavrakeva, M. Popova, M. Esad, E. Apostolva, V. Kokova, M. Bacelova, A. Alakidi, A. Bivolarska

Keywords: drug-related disturbances, hepatotoxicity, mechanism, metabolism

Abstract. The liver performs many vital functions such as regulating homeostasis, bile production, storage of vitamins, and more. Another important function of the liver is to neutralize toxic substances entering the body. Substances entering the human body can be eliminated unchanged, retained unchanged, or undergo chemical transformation. Drugs are one of the most important and common causes of hepatotoxicity. It can manifest in various forms, ranging from elevated serum levels of transaminases to acute liver failure. The mechanisms of drug-induced liver damage may include the formation of a toxic metabolite (paracetamol), induction of oxidative stress, mitochondrial damage, suppression of key transcription factors and enzymes (methotrexate), suppression of beta-oxidation (valproate), impaired bile secretion and others. In some cases, hepatotoxicity is an idiosyncratic type and the exact mechanism of damage is unclear. Due to the importance of the problem, knowledge about the metabolism, potential adverse drug reactions, and the correct dosage regimen is essential.

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03/12/2024

Left amyand’s hernia in a 1-year-old male infant: report of a rare case in common presentation
E. Fikri, A. Alnaz

Keywords: amyand’s hernia, appendix, herniotomy, inguinal hernia

Abstract. Amyand’s hernia is a rare type of hernia with the appendix and cecum trapped in a hernial sac. A one-year-old male infant was referred with irreducible left inguinal hernia for about 1 week. No signs of intestinal obstruction were presented, and pain was tolerated. A herniotomy was performed on the patient. Intraoperatively, the appendix and cecum were found in the left hernial sac, which this rare presentation named left Amyand’s hernia. Cecum and appendix were considered normal. No perforation and significant inflammation were found; hence, no appendectomy was performed. Left Amyand’s hernia is a very rare case, mostly in pediatric surgery, in which the current decision of diagnosis-making can only be made intraoperatively.

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02/12/2024

A clinical case of a 10-month-old child with severe Covid 19 with diarrheal syndrome ended fatally
P. Parusheva, L. Pekova, S. Angelova

Keywords: COVID-19, infant, diarrhea, MIS-c

Abstract. At the beginning of the COVID-19 pandemic, it was assumed that children were at low risk of infection and that their infection was milder than adults. With an increase in the number of pediatric cases of SARS-CoV-2 infection associated with manifestations of hyperinflammation, the condition of multisystem inflammatory syndrome in children (MIS-C) was defined. We present a clinical case of a 10-month-old male child hospitalized in the Clinic of Infectious Diseases at University Hospital in Stara Zagora, Bulgaria, with a COVID-19. The patient had a number of co-morbidities, including protein-calorie malnutrition, chronic respiratory failure and bronchopulmonary dysplasia. During the hospital stay, he had an active diarrhea syndrome, with evidence of pneumonia and respiratory failure. In the clinical course, a progressive worsening of the condition with signs of multiple organ failure, increase in inflammatory markers and deterioration of coagulation indicators were observed. Placement in the ICU and the inclusion of artificial pulmonary ventilation were required, but after an 18-day hospital stay, the patient died. In conclusion, this was an acute case of COVID-19 in an infant that started with respiratory and gastrointestinal manifestations that progressed to MIS-C with multiple organ failure leading to death. We believe that the reason for this is the compromised immune status in connection with the highly damaged premorbid terrain and young age.

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02/12/2024

Advanced breast cancer: case reports and statistical analysis
S. Sopotenski, E. Aleksandrova, S. Petrov, I. Lytvynenko

Keywords: breast carcinoma, locally advanced breast cancer, metastatic carcinoma

Abstract. Breast cancer is a pathology associated with high morbidity and mortality among women of all nations worldwide. The low efficiency or total absence of national screening programs, the presence of comorbid mental illnesses or dementia, general lack of information and underestimation of the problem among patients are factors that often lead to late diagnosis of breast cancer and, as a result, to high mortality. The article presents 2 clinical cases of advanced breast cancer in women who underwent surgical treatment in our clinic, which demonstrate the necessity of emergency reconstruction of Bulgarian national screening program. A brief statistical analysis of morbidity, mortality and effectiveness of screening in different countries is conducted.

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29/11/2024

A rare case of a patient with a myocardial bridge in combination with bicuspid valve and subaortic stenosis.
Georgi Stoitsev

Keywords: myocardial bridge, bicuspid aortic valve, subvalvular aortic stenosis

Abstract. Combined congenital heart defects in adults are very rare, and knowledge of their diagnostic-therapeutic approach is of interest to specialists. Subaortic stenosis (SAS) is a heart disease of unclear etiology and variable clinical manifestation. In some cases, SAS is described in combination with a congenital bicuspid aortic valve, but a real rarity is the combination of the listed lesions with the non-obstructive coronary stenosis caused by a myocardial bridge. A middle-aged woman with chest pain and dyspnea during minimal physical exertion, that subsides after rest, was referred for surgery. Two-dimensional transthoracic echocardiography demonstrated a slightly left ventricular hypertrophy with preserved systolic function without anomalies of cardiac wall motion. A dynamic gradient is observed in the left ventricular outflow tract reaching up to 90mmHg. Bicuspid aortic valve is presented with high-grade regurgitation. The picture of myocardial ischemia is complemented by selective coronary angiography demonstrating a rarely presented myocardial bridge over the left anterior descending coronary artery. The diagnostic approach and surgical corrections performed are the subject of this report.

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29/11/2024

Antimicrobial susceptibility of fructophilic lactic acid bacteria on phzM gene of pseudomonas aeruginosa isolates from wounds infected
W. Anwer, M. E. Ahmed

Keywords: P. aeruginosa, phzM gene, bee gut, MDR

Abstract. Introduction: The study was to isolate and characterize fructophilic lactic acid bacteria (FLAB) species from the honey bee gut. Based on the results of this study, it was found that the FLAB species obtained from honey were gram-positive and catalase-negative, and this identification was confirmed through 16S rRNA gene sequencing. Materials and methods: The results indicated that yeast extract was the most effective nitrogen source, while glucose was the preferred carbon source for cell-free supernatant (CFS) production. The optimal pH for CFS production was found to be 5, and the incubation period of 72 hours was determined to be the most suitable for obtaining a high yield of CFS. Another aspect of the study aimed to identify multidrug-resistant P. aeruginosa isolates from burn wound infections. The isolates were identified using the VITEK 2 system, and the phzM gene was detected in all nine strains. Furthermore, the study evaluated the effect of the CFS of the selected strain (E5) on the expression of the phzM gene. Results: The study showed a significant down-regulation of phzM gene expression in multidrug-resistant P. aeruginosa isolates following exposure to the CFS, indicating the potential of E. faecium as an effective antimicrobial agent against P. aeruginosa infections that are resistant to multiple drugs. We performed a primary screening to evaluate the effect of the CFS obtained from E. faecium (E5), and it was observed that the CFS showed a high inhibition zone of 23 mm against multidrug-resistant P. aeruginosa, as determined by the agar well diffusion assay. The study also investigated further to determine the optimal conditions for producing CFS. Conclusion: Down-regulation and up-regulation in the expression of the genes following exposure to CFS indicate the potential of E. faecium as an effective antimicrobial agent against multi-drug resistant (MDR) P. aeruginosa infections.

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28/11/2024

Prostaglandin F2α disturbs oogenesis by causing meiotic spindle damage
Anton Kolarov

Keywords: prostaglandin F2 alpha, meiosis, oogenesis, oocytes, female infertility, meiotic spindle

Abstract. According to recent data, prostaglandin F2 alpha can have negative influence on meiosis during oogenesis. Previously, we have found that this prostaglandin may accelerate in a dosage-dependent way the postovulatory ageing in ovulated mature oocytes, compromising the integrity of their meiotic spindles. Aim. The study aimed to investigate the effects of prostaglandin F2α on the course and outcome of oocyte meiosis in a mouse model. Materials and Methods. Mouse oocytes were matured in vitro in the presence of prostaglandin F2α in a concentration of 100 ng/ml. Their meiotic stage, spindle morphology and chromosome arrangement were assessed by immunofluorescent labeling of tubulin and fluorescent staining of DNA. Results. We obtained higher percentage of immature oocytes in metaphase I after the treatment than in untreated control oocytes. In addition, there were specific morphological changes in the meiotic spindles of oocytes exposed to prostaglandin F2α associated with a reduced number of fibers. Conclusion. It is probable that prostaglandin F2α has an impact on the microtubule dynamics of the meiotic spindle that can prevent the transition of maturing oocytes to the second meiotic division, most likely by triggering the spindle assembly checkpoint.

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28/11/2024

Immunological profiles, oxidative stress biomarkersand plasma cholinesterase activities in patients with immune-mediated inflammatory diseasestreated in a clinic in Duhok, Iraq.ES IN DUHOK, IRAQ
Rabie G. Abdullah, Fouad Kasim Mohammad, Souzan H. Eassa

Keywords: chronic inflammatory diseases, ankylosing spondylitis, Behcet’s disease, inflammatory bowel diseases, psoriatic arthritis, systemic lupus erythematosus, psoriasis

Abstract. Aim: The purpose of the present study was to measure levels of selected plasma biochemical variables among cases of immune-mediated inflammatory diseases (IMIDs) other than rheumatoid arthritis in the city of Duhok, Iraq, since such information is scarce in the region. Methods: This was a case-control study on IMIDs patients in Duhok, Iraq from February 2022 to June 2023. A total of 29 patients of both genders with IMIDs and 61 healthy controls were recruited at the Duhok Center for Rheumatic Diseases and Medical Rehabilitation, Duhok, Iraq. The laboratory tests conducted on plasma samples from IMIDs patients and healthy controls included measurements of interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha, malondialdehyde (MDA), total antioxidant status (TAS) and cholinesterase (ChE) activity. Results: No significant differences were found in gender distribution, age, and body mass index between the IMIDs patients and healthy controls. Most of the patients (69%) received conventional therapy combined with biologic agents, whereas the remaining (31%) received conventional medications only. The IMIDs identified among the 29 patients were Behcet’s disease (27.6%), ankylosing spondylitis (24.1%), inflammatory bowel diseases (24.1%), psoriatic arthritis (10.3%), systemic lupus erythematosus (6.9%) and psoriasis (6.9%). Conventional therapy used was mostly azathioprine (44.8%) and methotrexate (17.2%), whereas biological therapy included mostly etanercept (27.6%) and adalimumab (24.1%). Values of CRP, IL-6 and TNF-α among the IMIDs patients were not significantly different from those of the controls. The oxidative stress biomarker MDA was elevated in IMID patients (2.93 ± 1.106 µmol/L vs. 2.52 ± 0.478) at a p value of 0.064 (though not significant). The TAS level (1.21 ± 0.422 mmol Trolox Equiv./L vs. 1.00 ± 0.338, p= 0.022) and plasma ChE activity (1.18 ± 0.50 ∆ pH/20 min vs. 0.83 ± 0.30, p= 0.001) were significantly higher in IMIDs patients compared to controls. Conclusions: The data suggest that oxidative stress and changes in plasma ChE activity might be part of the pathophysiological alterations among IMIDs patients. Therapeutic drug monitoring and its clinical outcome as well as response of IMIDs patients to anti-ChE agents are worth of further in depth exploration and pursuing. These are essential for better diagnosis, treatment, and management of IMIDs.

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27/11/2024

Antibiotic prescribing practices to children among in- and outpatient physicians in Bulgaria
K. Zaykova, S. P. Nikolova, R. Pancheva, A. Serbezova

Keywords: antibiotic prescribing practices, antimicrobial resistance, pediatricians, inpatient and out-patient settings, general practitioners

Abstract. Assessing the particular trends and factors influencing antibiotic prescription practices for pediatric patients by inpatient and outpatient physicians in Bulgaria is essential for pinpointing areas needing improvement and devising strategies to encourage judicious use of antibiotics. The aim of this study is to offer practical insights for both hospital and outpatient care. By recognizing and comprehending the specific details of antibiotic usage in pediatric healthcare, this study seeks to facilitate the creation of tailored stew ardship strategies to address the growing challenge of antimicrobial resistance. A crosssectional, multicenter survey was conducted between September and November 2022, involving specialists from various medical fields. The study used a 4-point Likert scale to evaluate the most prevalent clinical scenarios in which antibiotics were prescribed. A total of 222 physicians participated in the survey, with 108 respondents chosen for analysis. Their primary patient population consisted of at least 25% children. The study’s results highlight notable variations in antibiotic prescription patterns between general practitioners and outpatient physicians in Bulgaria. Specifically, general practitioners were found to have a higher tendency to prescribe antibiotics before holidays or weekends compared to outpatient physicians. Moreover, GPs in Bulgaria displayed an increased likelihood of prescribing antibiotics when they had personal familiarity with the patient and did not consider further tests necessary. They also exhibited lower rates of prescribing antibiotics based on antibiogram and blood test results compared to outpatient physicians. Healthcare providers play a crucial role in addressing antimicrobial resistance, highlighting the necessity of their proactive participation in combating this global health concern. Despite being aware of the issue, there is need for additional education and interventions to enhance appropriate prescribing practices. The authors underline the significance of adopting a well-balanced approach to antibiotic prescription, taking into account both individual patient requirements зand potential public health implications associated with antibiotic misuse.

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27/11/2024

Myopia – risk factors, prevalence in Bulgarian schools, and prevention
Ch. Vidinova, A. Koeva

Keywords: myopia, progression, prophylaxis

Abstract. Myopia is a type of clinical refraction, a form of spherical refractive anomaly in which the eye has a relatively stronger refractive power for the corresponding length of the anteroposterior axis. The focus of this optical system is far in front of the retina. Myopia can be congenital or manifest later, most often at school age. It can be stationary or progressive. Progresive myopia is sight-threatening. The article discusses results from a screening program for myopia progression in Bulgarian schools between 2018-2023. The risk factors for myopia development have been outlined, and the ways of prophylaxis have been pointed out.

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27/11/2024

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26/11/2024

The impact of inherited thrombophilia on first trimester combined aneuploidy screening parameters
Z. Kirovakov, N. Hinkova, E. Konova

Keywords: pregnancy-associated plasma protein A (PAPP-A), human chorionic gonadotropin (HCG), nuchal translucency (NT), trisomy

Abstract. Objective. To investigate the impact of thrombophilia on pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotropin (hCG) and the nuchal translucency (NT) during the first trimester of the pregnancy. Material and Methods. A case-control research study was conducted at a prenatal outpatient unit of a tertiary referral hospital in Burgas, Bulgaria, between January 1st, 2021 and March 31st, 2023. A total of 309 pregnant women patients with congenital thrombophilia took part in the experimental research of the study, while 150 healthy pregnant women patients without evidence of thrombophilia were the control sample. Results. A statistically significant difference in the pregnancy-associated plasma protein A (PAPP-A), t(369) = 1.028, p < 0.05 between the two groups, with the experimental group reporting lower multiples of median (MoM) values as compared to the control group. The results showed statistically significant differences in the median values of PAPP-A and NT between the different types of inherited thrombophilia but no statistically significant difference in the median values of HCG. The results showed no statistically significant difference in age, gravidity, or parity between the experimental and control groups. Conclusion. The first trimester combined aneuploidy screening parameters are important in prenatal detection of the pregnancy status for identification of any variations in terms of chromosomal and fetal structural anomalies. Inherited thrombophilia adversely impacts the aneuploidy screening parameters during the first trimester of pregnancy.

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26/11/2024

Aspects on social egg freezing – current state in Bulgaria
D. Dyulgerova–Nikolova, I. Antonova, L. Valkova, T. Timeva, M. Yunakova, T. Milachich

Keywords: social freezing, oocyte cryopreservation, postpone reproduction, assisted reproduction

Abstract. Problem statement: Oocyte cryopreservation for non-medical reasons has been widely promoted among young women who tend to delay their reproduction. As the methodology has proved its safety and efficiency in the field of assisted reproduction technology and the embryo laboratory, the interest in oocyte cryopreservation has increased highly. However, do social freezers ever come back and use these oocytes, or they keep them as a safety boat with no real near-future plans for reproduction? Methods: The following study has been performed as a retrospective analysis of 296 women who had oocyte freezing procedure for non-medical (social) reasons, medical conditions (oncological treatment) and oocyte donation from January 2013 to June 2023 at Medical Complex Ob/ Gyn “Dr Shterev” – Sofia, Bulgaria. Results: Throughout the observed period, 190 women with 221 procedures vitrified their oocytes for future use. Only 9.47% of them had medical conditions and 7.36% were hindered to use their reproductive gametes at the day of the oocyte retrieval (absence of spermatozoa, sickness). The average age of the women in this group was 35.59 ± 1.5 years and the mean number of cryopreserved oocytes was 5.63 ± 1.4 per women. Compared to social cryopreserves, and bound to the Bulgarian legislation, the 106 women who donated their oocytes were younger (28.86 ± 1.5 years (p < 0.05)) with 7.34 ± 1.7 (p < 0.05) cryopreserved oocytes per donor. As the clinic has well represented program for oocyte donation 82.1% of the donors were used. In result, there were 37 clinical pregnancies with 47 children born. In the same period, only 46 (24.2%) women who stored their own gametes in our cryobank came back and claimed them for assisted reproduction. Nine clinical pregnancies had been registered and 10 children were born. An intriguing fact we can point from the medical history of the clear social freezers (SF) is the record of previous procedure(s) for abortion on demand. It was reported for 12% of the women in this group. Conclusion: According to the results we observed as evident that patients need more clarity towards the procedures for oocyte cryopreservation and consequent fertility treatment. We should rise more awareness to the most preferable age for cryopreservation and number of oocytes to be stored.

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25/11/2024

Fasting GLP-1 levels in women with PCOS and CAH
R. Robeva, G. Kirilov, A. Elenkova, S. Zacharieva

Keywords: CAH, PCOS, GLP-1, hyperandrogenism, incretin

Abstract. Background: Polycystic ovarian syndrome (PCOS) is the most prevalent condition associated with increased androgens, but some rare diseases, e.g., congenital adrenal hyperplasia (CAH), should also be considered in the differential diagnosis of hyperandrogenemia. The potential role of incretin hormones has been thoroughly studied in different metabolic conditions, but data about women with PCOS and CAH are insufficient. Aims: Therefore, the present study aims to investigate the fasting GLP-1 levels in women with PCOS and CAH compared to healthy women and to establish the possible associations with the ovarian and adrenal androgens, obesity, and hyperinsulinemia in these conditions. Methods: Fasting GLP-1 levels were measured in 47 women with PCOS, 11 CAH patients, and 26 healthy volunteers. The associations between the GLP-1, metabolic, and hormonal characteristics in the investigated groups have been studied. Results: GLP-1 levels did not differ between healthy women and patients with PCOS but were significantly higher in CAH patients (p = 0.025). CAH patients were similarly obese as PCOS women, but they showed increased testosterone (p = 0.009), 11-ketotestosterone (p = 0.046), 17-OH-progesterone (p < 0.001), and insulin levels (p = 0.043), and lower luteinizing hormone (p = 0.002) and dehydroepiandrosterone-sulfate levels (p = 0.004). In the PCOS group, the fasting GLP-1 levels were positively related to BMI (r = +0.327; p = 0.024) but not to other hormonal or metabolic indices. Conclusions: Our results show increased fasting GLP-1 and insulin levels in CAH individuals compared with PCOS patients but similar fasting GLP-1 levels in PCOS and healthy women. Further studies are necessary to clarify the incretin effects and the role of incretin-based therapy in women with different hyperandrogenic states and increased metabolic risk.

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25/11/2024

Serum levels of semaphorin 4C in breast cancer – assessment of prognostic value and potential for monitoring surgical treatment response
Ts. Popov, S. Maslyankov, A. Arabadzhiev, M. Sokolov, S. Kandilarova

Keywords: breast cancer, serum biomarker, semaphorin 4c, surgical treatment, monitoring

Abstract. Introduction. The global burden of breast cancer (BC) has encouraged cease less research in exploring novel biomarkers, aiming to optimize BC management and prognosis. Objective. To explore the prognostic value of serum SEMA4C and investigate its potential for monitoring the response to surgical treatment in patients with BC. Materials and methods. Seventy-five (75) pre-treatment patients from the Clinic of Surgery with invasive BC without any initial treatment prior to blood sample collection were included in the study. The enzyme-linked immunosorbent assay (ELISA) method was used to measure serum levels of SEMA4C in human serum. Participants were divided based on pathological stage, nodal involvement and histological grade. Follow-up blood samples of 35 patients who underwent surgery were collected to investigate if SEMA4C could measure the response to surgical treatment. Results. Postoperative serum levels of SEMA4C were significantly lower than preoperative levels (p p < 0.001). Regarding prognostic value, no statistically significant difference was observed in terms of the pathological stage (p = 0.181), lymph node (LN) status (p = 0.752), and histological grade (p = 0.412). Conclusion. According to our study, serum SEMA4C levels did not differ significantly in terms of pathological stage, LN status and histological grade. Notably, postoperative serum levels of SEMA4C were significantly decreased after surgical treatment compared to preoperative values, which underscores the potential of SEMA4C as a putative candidate biomarker for monitoring response to therapy in patients with BC. However, additional research is mandatory to validate the role of SEMA4C in BC.

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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.