Acta Medica Bulgarica

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GENETIC POLYMORPHISMS IN CYP2 GENE FAMILYIN BULGARIAN INDIVIDUALS AND THEIR CLINICALIMPLICATIONS
S. Yovinska, D. Bakalov, K. Mihova, K. Kamenarova, R. Kaneva, R. Nikolov, I. Dimova
Abstract. The cytochrome P450 superfamily consists of hemeproteins involved in the de-toxication of different xenobiotics, including drugs. The CYP2 gene family is responsible forthe metabolism of 80% of the drugs in clinical use. There are considerable interindividualand interethnic variabilities in the rate of drug metabolism as a result of genetic polymor-phisms. The goal of our study was to determine the frequency of 10 genetic polymorphismsin CYP2 family genes to give light on the pharmacogenetic defects of the main CYPs,involved in drug metabolism, in Bulgarian individuals. We detected high allele frequencyfor CYP2D6*10 (0.27), CYP2D6*4 (0.22), and CYP2B6*9 (0.24), followed by CYP2C19*2(0.14), CYP2C9*3 (0.11) and CYP2C9*2 (0.09). The genotype frequencies were also de-termined for all investigated variants. In total 47.2% of the analyzed individuals carriedCYP2D6 genetic polymorphisms – 5.6% carried a single variant and 41.6% were foundto have two or more such variants. Homozygotes for CYP2D6 variants were establishedamong 14% of Bulgarian individuals. Determination of the prevailing pharmacogeneticpolymorphisms of the CYPs, most responsible for drug metabolism, will lead to a lower riskof drug toxicity, increased drug efficacy, and drug dose optimization.
Key words: cytochrome P450, genetic polymorphisms, pharmacogenetics, drug safety

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PERMANENT PACEMAKER IMPLANTATION:EARLY POST-IMPLANTATION DATA
I. Yoncheva, D. Biserov, M. Negreva
31University Hospital – Burgas, Bulgaria2University Hospital “Virgin Mary” – Burgas, Bulgaria3University Hosptal “Sv. Marina” – Varna, BulgariaAbstract. Introduction: Data on the development of left ventricular dysfunction after perma-nent pacemaker implantation are available. Myocardial collagen deposition is a well-knownmechanism that occurs in left ventricular remodelling. This gave us reason to dynamicallymonitor the levels of the main molecules involved in collagen synthesis, PIPC (carboxy-terminal propeptide of type I procollagen) and PIIINP (amino-terminal propeptide of type IIIprocollagen). Materials and Methods: PIPC and PIIINP levels were studied using enzyme-linked immunoassays in plasma from 45 patients (25 men, 20 women, 72.1 ± 9 years) and46 controls (24 men, 22 women, 71.9 ± 8.7 years) without known cardiovascular diseases(except arterial hypertension, conduction disorder, indication for the procedure) at baseline(immediately before PPM implantation for patients), at 12 and 24 weeks.Results: There wasno difference in baseline levels of PICP and PIIINP between patients and controls (p > 0.05,Table abstract). At week 12, PICP levels increased significantly in patients compared to base-line in controls (p < 0.05, Table abstract). At week 24, values continued to increase and wereagain significantly higher than baseline in the controls (p < 0.001, Table abstract). At the 12-week follow-up visit, PIIINP values in patients were significantly higher than those at baselinein controls (p < 0.001, Table abstract). At week 24, the values of the patients were still higherthan those of the controls, but the di fference was not signi ficant (p > 0.05, Table abstract).Conclusion: This study showed early activation of collagen synthesis < 6 months after PPM(permanent pacemaker) implantation. Due to the selection of patients without concomitantcardiovascular pathology, we have reason to assume that it is a result of the procedure itselfand a serious prerequisite for increased collagen deposition in the myocardium.
Key words: PIPC, PIIINP, permanent pacemaker

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PREVALENCE OF METABOLIC SYNDROME AND ITSCOMPONENTS IN PATIENTS WITH CONTROLLED GRAVES’DISEASE
M. Stoynova, L. Lilova, D. Petrova, I. Yankova, I. Dimitrova, A. Shinkov, R. Kovatcheva
Abstract. Aim: Our aim was to assess the prevalence of the metabolic syndrome (MetS)and its components in patients with controlled Graves’ disease (GD). Methods: This was across-sectional study involving 95 consecutive patients with GD referred to our tertiary careinpatient clinical center meeting the following inclusion criteria: controlled hyperthyroidism,treatment with antithyroid drugs, untreated Graves’ orbitopathy (GO), if present. Patients’ an-thropometric parameters were evaluated and laboratory tests were performed with measure-ment of fasting blood glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycer-ides, thyroid hormone and antibody levels. The presence of the MetS and its components asdefined by the International Diabetes Federation from 2009 were evaluated. Results: In ourpatient cohort 82.1% were females, 17.9% were males, mean age 50.2 ± 13 years, with me-dian duration of GD 16.5 months. The MetS was observed in 32.6% of our patients, obesity– in 34.7%, hyperglycemia in 38.9%, arterial hypertension – in 36.8%, low HDL-cholesterol –in 23.2% and hypertriglyceridemia – in 13.7%. There was not statistical difference neither be-tween the prevalence of the MetS, nor between the prevalence of its individual componentsin female and male GD patients. The MetS was significantly more frequent in older patients,as well as abdominal obesity, hyperglycemia and arterial hypertension. There was not statis-tical difference in the frequency of the MetS and its components between GD patients withand without GO, except for waist circumference, which was signi ficantly higher in patientswith GO. Conclusions: The presence of the MetS and its components among GD patientsare to great extent similar to those reported in the general population, which underlines theneed for their screening and proper treatment in this subpopulation.
Key words: Graves’ disease, metabolic syndrome, obesity, arterial hypertension, hyperglycemia,dyslipidemia

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DETECTION OF PREDEFINED BACTERIAL SPECIESIN THE VAGINAL MICROBIOTA IN SARS-COV-2-POSITIVEPATIENTS
M. Kovachev, M. Kunchev, S. Kovachev
Abstract. Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) canbe found in the va**na of infected women remains unclear; moreover, the impact of the vi-rus on the normal va**nal microbiota is not known.The aim of our study was to identify theva**nal presence of SARS-CoV-2 and detection of prede fined bacterial species changesin the va**nal flora of women that tested positive for SARS-CoV-2 infection. Materialsand Methods. This prospective study included 40 women, aged 24-47 years, tested forSARS-CoV-2 via nasopharyngeal and va**nal culture (TaqPath ™COVID-19 CE-IVD RT-PCR), and va**nally tested for changes in the va**nal microbiota using the Femo flor® 16REAL-TIME PCR Detection Kit. Results. No one of women in this study was tested posi-tive for va**nal presence of SARS-CoV-2. Three (7.5%) women with sexually transmitteddisease were excluded. Irregularities were observed in the va**nal microbiota of 8 (21.6%)out of 37 patients included in the study: 3 (8.1%) from the SARS-CoV-2-positive groupand 5 (13.5%) from the SARS-CoV-2-negative group. The remaining 29 (78.4%) womenhad normal va**nal flora; lactobacilli were found to be dominant. Although results revealeda di fference in the va**nal microbiota between the two groups, the di fferences were notstatistically significant (p ≥ 0.05). Conclusions. Even though it remains unclear whetherSARS-CoV-2 invades the va**na of infected women, there is no signi ficant evidence tosuggest that it causes a more frequent disturbance in the va**nal microbiota of infectedwomen compared to that in healthy women.
Key words: SARS-CoV-2, va**nal presence, va**nal flora, microbiota, microbial changes

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SEROPREVALENCE OF IGG ANTIBODIES AGAINSTSARS-COV-2 N PROTEIN AMONG VACCINATEDAND UNVACCINATED SUBJECTS IN LAHORE, PAKISTAN
A. Donia, M. Nawaz, M. F. Shahid, R. Shahid, A. Javed, T. Yaqub, H. Bokhari
Abstract. The spread of SARS-CoV-2 represented a global health crisis. On May 5, 2023,the chief of the World Health Organization (WHO) officially announced the end of COVID-19as a global health emergency. Serological assays can identify previously infected SARS-CoV-2 individuals, even if they did not go for testing while acutely ill. The current studysought to detect antibodies directed against the nucleocapsid of SARS-CoV-2 (IgG againstthe SARS-CoV-2 N protein) in both vaccinated and unvaccinated COVID-19 individuals. Ofthe 100 participants, 53 and 47 were vaccinated and unvaccinated, respectively. The vac-cination status of the cohort based on gender data indicates that 41 (41%) of all participantswere vaccinated males, whereas 12 (12%) were vaccinated females. We found that 42 (42%)were unvaccinated males and 5 (5%) were unvaccinated females. Of 53 vaccinated subjects,42 and 11 participants were positive and negative for IgG against the SARS-CoV-2 N pro-tein, respectively. Of 47 unvaccinated participants, 28 and 19 were positive and negative forIgG against the SARS-CoV-2 N protein, respectively. The average of S/P “Sample/Positivecontrol” percentages, which correlate to levels of IgG against SARS-CoV-2 N protein, weresignificantly higher among the vaccinated patients (73.8%) as compared to non-vaccinatedpatients (57.1%), with p = 0.02. There was a downward trend in levels of IgG against theSARS-CoV-2 N protein with increasing age, except for the 60–69 age group.
Key words: SARS-CoV-2 N protein, COVID-19, SARS-CoV-2

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CANALIS BASILARIS MEDIANUS AS AN ANATOMICALVARIATION IN THE BASILAR PART OF THE OCCIPITALBONE: A DESCRIPTIVE CONE BEAM COMPUTEDTOMOGRAPHIC STUDY
D. Darwin, G. Babu, V. Ajila, S. Hegde, M. Asan
Abstract. Objectives: Canalis basilaris medianus (CBM) is a unique anatomical varia-tion located in the basal occipital region of the skull, rarely encountered in head and neckradiographic imaging. The aim of the present study was to evaluate the prevalence andtypes of CBM using Cone Beam Computed Tomography (CBCT) scans. Materials andMethods: CBCT (Full FOV) images of 200 patients aged between 10 to 70 years wereselected for the current retrospective study following the inclusion and exclusion criteria.The image sections from the scan data were scrutinized for the presence of CBM, in addi-tion to its classification based on the type of morphology. The presence and types of CBMwere recorded based on the age and gender. The chi-square test was used to analyze thepresence and types of CBM with regard to gender and age group. Results: The overallprevalence of CBM was estimated as 9.5%. CBM was present in 13% of males and 3%of females (p = 0.021). Considering the types of CBM, the superior recess type was pre-dominantly observed followed by the inferior recess, superior and inferior type. However,there was no signi ficant gender-based di fferences noted among the types of CBM (p >0.05). Also, there was no statistically significant difference noted in the prevalence of CBMin different age groups (p > 0.05). Conclusion: It is necessary for maxillofacial radiologiststo have a solid understanding of both normal and variant skull-base anatomy to facilitaterecognition of variants such as CBM in order to recognize the associated anomalies. Toour knowledge, this was the first study done which assesses the gender-based differencesamong the various types of CBM.
Key words: Canalis basilaris medianus, Skull base, Anatomic variation, Cone Beam Computed Tomography

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EXPANSION OF PSYCHOSOCIAL DISTRESS IN NURSESWORKING IN HEMODIALYSIS DURING EXPOSURETO COVID-19 PANDEMIC IN BULGARIA
N. Madjarov, R. Nikolova, T. Kundurzhiev, L. Hristova, K. Lyubomirova, I. Tonev
Abstract. A new type of virus, SARS-CoV-2, has spread globally throughout the world.The COVID-19 epidemic rapidly spread worldwide. The health care system, society andmedical professionals have prepared to adapt, train and resist the increased psychosocialpressure. In this situation, the role and place of medical professionals has become notice-ably more prominent, and the psychosocial stress of the work environment has increasedits impact – progressing to high levels of harmful intensity towards the medical profession-als. Focusing within the borders of Bulgaria, it can be argued that the initial two waves ofhigh levels of COVID-19 prevalence were difficult and critical to overcome. The aim of ourstudy is to investigate the impact of psychosocial stress on the functional status examinedwith the response of arterial blood pressure of nurses, practicing long-term care in hemodi-alysis clinics and centers during exposure to COVID-19 pandemic. A study was conductedon the subjective assessment of psychological and social risk factors, and arterial systolicand diastolic blood pressure in 2018-2019 (pre-COVID-19 period) and 2020 (COVID-19period), respectively. The methods used were the NIOSH questionnaire – to assess psy-chosocial stress at work and to measure blood pressure with a sphygmomanometer. Theresults showed that the expansion of psychosocial risks from the work environment im-pacted on the functional status of nurses, with an increase in the level of social support andsystolic blood pressure during the COVID-19 compared to the pre-COVID-19 period, anda decrease in the level of control when comparing the same periods. We will monitor andobserve these effects with concern in order to respond in a timely manner with effective andpractical strategies, policies and programs to counter and prevent psychosocial stress inthe workplace. One of the outlined guiding goals and trends for this will be to both preserveand prolong the work life of nurses and to reposition them as a key and signi ficant groupfor the healthcare system.
Key words: COVID-19 pandemic, psychosocial stress, nurses, hemodialysis, arterial blood pressure

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Bilayer Technique for Alveolar Ridge Augmentation in Pre-Prosthetic Implant Surgery: Indications and Problems
Deliverska B. Yordanov, J. Kirilova
Abstract. Background: Prosthetic rehabilitation of missing teeth with dental implant-supported restorations has recently become a predictable treatment option in contem-porary dentistry with a highly successful rate. Due to di fferent factors, vertical andhorizontal bone loss could present, and the available alveolar bone may not be suf-ficient for optimum implant position. Ridge augmentation procedures could be appliedto increase the volume of the deficient sites for accurate prosthetic implant placement,which assures functional and esthetic stability of tissues around the implants, essentialfor long-term success. Our study aims to evaluate the e fficiency of the bilayer tech-nique of guided bone regeneration for alveolar ridge augmentation procedure in casesof bone de ficiency for optimum implant placement and long-term success. Materialsand methods: We present several cases of alveolar bone de ficiency treated with thebilayer technique – the combination of allo- and xenograft, covered by collagen mem-brane, with long-term follow-up. The defects were filled with allograft, and a layer ofxenograft and barrier membrane was placed above it. This technique combines thebenefits of all xenografts and barrier membranes. Results: The bilayer technique withallo- and xenograft and collagen membranes is predictable, with a high success rateand lower morbidity. We have a 100% survival rate of the implants placed in a graftedarea with long-term follow-up with excellent aesthetic and functional results. Conclu-sions: The bilayer technique uses the benefits of two bone graft materials, is associat-ed with less morbidity for the patients, and has excellent long-term results if performedaccurately according to indications and technique.
Key words: guided bone regeneration, bone substitute materials, dental implants, bilayer technique

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OPERATIVE TREATMENT OF IDIOPATHIC ISOLATEDCLITOROMEGALY – A CLINICAL CASES.
Stoyanov, K. Ivanova, I. Koleva
Abstract. Idiopathic clitoromegaly is a relatively rare disease. A case of isolated idiopath-ic clitoromegaly is presented. It concerns a 31-year-old woman, in whom the cl****is hasshowed a tendency for progressive enlargement in the last 3-4 years. The patient had nogynecological and systemic diseases and disorders. Karyotype and hormone levels werenormal. No cystic changes in the ovaries and other changes in the abdominal organs weredetected during ultrasound. Computerized axial tomographic (CAT) scan of the adrenalglands was performed and showed normal appearance. Method of selection in such casesis operative treatment – clitoroplasty with storage of neurovascular bundle of the cl****is.
Key words: clitoromegaly, clitoroplasty

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EPIDEMIOLOGICAL SURVEILLANCE OF ACUTE FLACCIDPARALYSIS FOR ERADICATION OF POLIOMYELITIS(A BRIEF REVIEW)
I. Simeonova, I. Mladenova, A. Patel
Abstract. In May 1988 the World Health Assembly set to World Health Organization(WHO) the goal to achieve a global eradication of poliomyelitis by the year 2000. Surveil-lance of the acute flaccid paralysis (AFP) remains the ‘gold standard’ for the detection ofpolio. The criterion of sensitivity of the surveillance system is the incidence from non-poliorelated AFP, in children under 15 years of age. The aim is to detect more than 1 case ofAFP, per 100,000 children. In 2019, WHO announced the eradication of wild poliovirus 3,and poliovirus 2 was eradicated in 2015. Wild poliovirus 1 continues to circulate. The maingoals of the WHO Polio Eradication Strategy for the period 2022-2026 are: permanentlyinterrupt all poliovirus transmission in endemic countries (Afghanistan and Pakistan), stopcVDPV (circulating vaccine-derived poliovirus) transmission and prevent outbreaks in non-endemic countries.
Key words: poliomyelitis, polio eradication, acute flaccid paralysis (AFP), inactivated polio vaccine(IPV), oral polio vaccine (OPV), circulating vaccine-derived poliovirus (cVDPV)

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PREVALENCE OF INCIDENTAL FINDINGS IN ORALAND MAXILLOFACIAL CONE-BEAM COMPUTEDTOMOGRAPHY: A SYSTEMATIC REVIEW AND META-ANALYSIS
F.Abesi, M. Amouzadeh Omran, M. Zamani
Abstract. Background: As the use of cone-beam computed tomography (CBCT) is in-creasing and the quality of images is enhanced, the likelihood of incidental findings detec-tion in CBCT radiographs is raised. Variable frequency of incidental findings on oral andmaxillofacial CBCT scans has been reported. Aims: To perform a systematic review andmeta-analysis to resolve the con flicting results about the overall prevalence of incidentalfindings in oral and maxillofacial CBCT scans. Methods: We searched the literature inPubMed, Embase, and Scopus databases from inception to 31 October 2022 to identifystudies that reported the frequency of incidental findings in the subjects undergoing CBCTimaging. We pooled the extracted data and reported the estimates as a percent with a 95%confidence interval (CI). Results: A total of 21 eligible studies were included, comprising9,788 patients (54.2% women) and 10,625 CBCT scans. Analysis showed that the inci-dental findings were present in 69.1% (95% CI: 55.6-80.0) of the CBCT scans. There were1.48 incidental findings per CBCT scan. Pooled prevalence of incidental findings in menwas 50.2% (95% CI: 23.1-77.3), which was higher than in women (41.8% [95% CI: 16.5-72.2]). Conclusion: A considerable prevalence of incidental findings was observed in oraland maxillofacial CBCT scans.
Key words: incidental findings, oral and maxillofacial radiology, cone-beam computed tomography,systematic review

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Changes in the Cytokine Profile in Patients During COVID-19 Infection
N. Ivanov, S. Mihailova, R. Bilyukov, C. Popov, T. Kundurzhiev and E. Naumova
Abstract: COVID-19 has proven to be a disease that affects not only the respiratory tract but also leads to a state of generalized systemic hyperinflammation and overall immune dysregulation. An important role in its pathogenesis is the disturbance of many cytokines – a condition which, in its most pronounced form, is also called a „cytokine storm“.
Objective
To evaluate the serum cytokine levels during COVID-19 infection as potential biomarkers for the severity and course of infection.
Materials and methods
By design, the study is a retrospective cross-sectional, in which the serum concentrations of 10 pro- and anti-inflammatory cytokines (IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF-α, and GM-CSF) were investigated in 36 individuals (divided into 3 groups by severity – with a mild form of the infection/presymptomatic, moderately severe and severe/critical) within two periods – before and after the second week from the onset of symptoms of the disease.
Results
In the period up to the 2nd week, the serum concentrations of IFN-γ (p = 0.029), IL-1β (p = 0.017), and IL-5 (p = 0.014) showed a statistically significant correlation with the disease severity, however in the later stage of the disease the cytokine levels did not show any clinical value.
Conclusion
Cytokine testing could be used to predict the severity of COVID-19 infection which could support individual therapeutic decisions. Analysis of a larger group of patients is needed to unfold the full potential of such testing.
Keywords: COVID-19, cytokines, hyperinflammation, dysregulation, biomarkers, severity

Changes in the Cytokine Profile in Patients During COVID-19 Infection COVID-19 has proven to be a disease that affects not only the respiratory tract but also leads to a state of generalized systemic hyperinflammation and overall immune dysregulation. An important role in its pathogenesis is the disturbance of many cytokines – a condition which, in its most pronounc...

Role of Bacterial and Viral Infections and Co-Infections in Miscarriages
K. Mesechkova, A. Kavrakova, E. Todorova, B. Georgieva, I. Sigridov,
V. Mitev and A. Todorova
Abstract. Aim
To investigate the potential role of the following bacterial/viral panel (Chlamydia trachomatis, Ureaplasma urealyticum/parvum, Mycomplasma hominis/ge***alium, Gardnerella va**nalis, HSV1/2, EBV, CMV, VZV, HHV6, HHV7, HHV8) as causative factors for miscarriages in women by testing endometrial biopsies. Anaerobic and aerobic microorganisms causing dysbiosis and endometrial bacterial colonization by unbalanced growth were additionally tested.
Materials and methods
In total, 65 patients with a history of early and late miscarriages were analyzed. DNA extractions, real-time qPCR, agarose gel-electrophoresis were applied. Comparative analysis of the current with previously obtained data on the described panel in menstrual tissue samples was performed.
Results
In 64,6% of all tested endometrial biopsies bacterial and/or viral pathogens were detected. In 49,23% of all tested samples we found bacterial, while in 15,3% – viral pathogens. These results are similar to our previous data on menstrual tissue samples of infertile women – 61,1% infected, as 48,8% had bacterial and 22,2% had viral pathogens. Gardnerella va**nalis and Ureaplasma parvum were detected in 31,25% and 3,12% of all bacterial infected endometrial biopsies, significantly lower in comparison to the estimated rate of 69,31% and 61,36% on menstrual tissue. Anaerobic and aerobic dysbiosis were detected in 53,33% and 27% of the bacterial infected endometrial samples. In 13,33% a dysbiosis with a mixed etiology was found, while in 7% a dysbiotic condition with a totally absent findings of targeted bacteria and Lactobacillus was observed. EBV, CMV, HHV6 and HHV7 were detected in 30%, 30%, 20% and 20% of the positive for viral factors endometrial biopsies and in 40%, 7,5%, 10% and 42,5% in menstrual tissue samples. In the current study 62,5% bacterial co-infection and 12,5% bacterial/viral co-infection variants were found. Infections with the rest of the target pathogens were not detected in the endometrial biopsies. In contrast to the endometrial biopsy results, Mycomplasma hominis, Ureaplasma urealyticum and HSV2 were detected in our previous research on menstrual tissue samples.
Conclusions
Our research suggests a possible dysbiosis as a consequence of bacterial/viral endometrial colonization, associated with miscarriages. We prove that menstrual tissue, containing parts of the functional endometrial layer, is a reliable and accurate noninvasive sample for infectious screening of the upper ge***al tract.
Keywords: endometrium, inflammation, HHVs, infertility, menstrual tissue

Role of Bacterial and Viral Infections and Co-Infections in Miscarriages Aim To investigate the potential role of the following bacterial/viral panel (Chlamydia trachomatis, Ureaplasma urealyticum/parvum, Mycomplasma hominis/ge***alium, Gardnerella va**nalis, HSV1/2, EBV, CMV, VZV, HHV6, HHV7, HHV8) as causative factors for miscarriages in women by testing endometrial bi...

Changes of Serum Angiotensin Peptides, Pro-Endothelin-1 Levels in Women One Year After Preeclampsia and their Association with Cardiovascular Risk Factors
N. Popovski, A. Nikolov, Ts. Lukanov, S. Blazheva and T. Totev
Abstract. Introduction
Women who suffered preeclampsia (PE) have two to four times higher risk for development of cardiovascular disease (CVD) compared with women with a history of normotensive pregnancy. Microvascular and endothelial dysfunction, mediated by different vasoactive factors have been suggested as attainable pathophysiological pathways. The study aimed to: (1) determine changes in circulating levels of key vasoactive peptides in sera of women with history of PE and in women who had a normal pregnancy 1 year after delivery and (2) investigate whether an association exists between these molecules and cardiovascular risk factors.
Materials and methods
The current research examined 32 women one year after preeclampsia (mean age 25.3 ± 6.3 years) and control group of 20 women one year after normal pregnancy (mean age 25.6 ± 5.6 years). The enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of angiotensin II (AngII), angiotensin-(1-7) [Ang-(1-7)] and pro-endothelin-1 (Pro-ET-1).
Results
We found that at 1 year after delivery 38.46% of women who suffered PE have developed hypertension and 5.77% have developed diabetes mellitus. Women who had normal pregnancy developed neither hypertension, nor diabetes mellitus 1 year after delivery. Serum AngII levels in women one year after PE were statistically significantly lower than in women one year after normotensive pregnancy 0.9 (0.55÷1.7) vs. 2.3 pg/ml (2.0 ÷ 2.9) (KW = 20.849; p = 0.0001). Ang-(1-7) concentrations in women one year after PE were lower than in women one year after normal pregnancy, but not significantly 1.7 (0.3÷4.5) vs. 3.2 ng/ml (0.2÷8.0) (p>0.05). Levels of serum Pro-ET-1 in women one year after PE were statistically significantly higher than in women one year after normal pregnancy 322.65 (261.75÷391.85) vs. 248.7 pmol/L (231.05÷282.15) (KW = 6.639; p = 0.009). AngII showed correlation with AH grade (r = -0.33; 0.02), Ang-(1-7) (r = 0.27; 0.05), DBP (r = -0.28; p = 0.04), mean arterial pressure (r = -0.43; p = 0.002), pulse pressure (r = -0.28; p = 0.04), BMI (r = -0.30; p = 0.03), TC (r = -0.31; p = 0.03) and LDL (r = -0.30; p = 0.03). Pro-ET-1 correlated with age (r = 0.30; p = 0.03), mean arterial pressure (r = -0.25; p = 0.05) and pulse pressure (r = 0.41; p = 0.003).
Conclusion
Our data showed an association between key vasoactive peptides and major CVD risk factors in women one year after PE. We suggest that imbalance between AngII, Ang-(1-7) and Pro-ET-1 could have a potential imply on the vascular wall after PE, reflecting persistent microvascular and endothelial injury/dysfunction postpartum. Further studies are warranted to clarify these vasoactive peptides’ role in the ongoing vascular endothelial function after delivery and the pathogenic mechanisms determining development of CVD in previously PE women.
Keywords: angiotensin-II, angiotensin-(1-7), pro-endothelin-1, history of preeclampsia, cardiovascular risk factors

Changes of Serum Angiotensin Peptides, Pro-Endothelin-1 Levels in Women One Year After Preeclampsia and their Association with Cardiovascular Risk Factors Introduction Women who suffered preeclampsia (PE) have two to four times higher risk for development of cardiovascular disease (CVD) compared with women with a history of normotensive pregnancy. Microvascular and endothelial dysfunction, mediated by different vasoactive factors have been suggested a...

In Vitro Evaluation of Corn Silk Extract as a Potential Alternative Therapy for Vulvova**nal Candidiasis
P. Liberty, I. B. Putra, N. K. Jusuf and M. I. Sari
Abstract. Aim
To determine the effectivity of corn silk extract in inhibiting the growth of C. albicans.
Materials and Methods
Corn silk used in this study was Zea mays L. var. indurata and was collected from Desa S**a Makmur, Deli Serdang, Sumatera Utara Province, Indonesia. Tested C. albicans is C. albicans from VVC patients, obtained from the Microbiology Laboratory of Faculty of Medicine, Universitas Sumatera Utara. Preparation of this study included corn silk extraction by maceration method with 96% ethanol, followed by dilution with 10% DMSO (Dimethyl Sulfoxide) into concentrations of 75%, 50%, 25%, and 12.5%. Well diffusion method was used to detect growth inhibition of C. albicans and agar dilution was used to determine MIC (Minimum Inhibitory Concentration) and MFC (Minimum Fungicidal Concentration) of corn silk extract. Data were statistically analyzed with Kruskal-Wallis analysis.
Results
From this study, corn silk extract of all concentrations showed an inhibitory effect against C. albicans. The mean diameter of inhibition zones for each concentration respectively from highest to lowest concentration were 27.4875 ± 0.3838 mm, 26.7250 ± 0.2533 mm, 25.7250 ± 0.2598 mm, and 24.9375 ± 0.2462 mm. Kruskal-Wallis analysis showed significant results (p-value 0.001). MIC and MFC were 1.5625% and 6.25%, respectively.
Conclusions
Corn silk extract of concentrations 75%, 50%, 25%, and 12,5% have antifungal activity against C. albicans. The higher the concentration of corn silk extract, the higher the efficacy in inhibiting the growth of C. albicans.
Keywords: Candida albicans, corn silk extract, vulvova**nal candidiasis

In Vitro Evaluation of Corn Silk Extract as a Potential Alternative Therapy for Vulvova**nal Candidiasis Aim To determine the effectivity of corn silk extract in inhibiting the growth of C. albicans. Materials and Methods Corn silk used in this study was Zea mays L. var. indurata and was collected from Desa S**a Makmur, Deli Serdang, Sumatera Utara Province, Indonesia. Tested C. albicans is C. albicans...