Glioblastoma multiforme (GBM) is known to be the most common malignant form of astroglial brain tumors. The etiology, cellular and molecular pathogenic mechanisms remain unclear to a great extent. Recent research indicates the role of the immune system in malignant glioma and especially in triggering the mechanisms of local resistance and systemic immune suppression. There is accumulating evidence that the concept of the CNS as an immune-privileged organ is no longer valid. Recent advances demonstrate that it is an immunologically active site, with complex immune responses mostly based on innate immune processes. Multifocal gliomas with varying histopathological appearance are extremely rare. We report the only case of GBM preceded by a gemistocytic astrocytoma with a very short survival time of just 3 months after the onset of complaints. Interestingly, a normal CD4/CD8 ratio but prominent change in the regulatory T cell lineage was recorded. The elevation of the suppressor CD8+CD11b+ cells and the reduction of cytotoxic CD8+CD11b- cells indicate the prevalence of a suppressor phenotype which provides an explanation for the occurrence of the second malignant tumor, the rapid tumor progression and fatal outcome.

Background and purposes: Anomic aphasia is common in patients with left hemispheric strokes. The purpose of this study was to explore the verbal production of ischemic stroke patients with anomic aphasia. Contingent and methods: Fifty ischemic stroke patients admitted to the Neurology Clinic of University Hospital Pleven were studied by neuropsychological battery and CT scan of the brain. Verbal productivity changes found were analyzed in relation to the speech recovery education. Results: All the patients showed lower scores at all nominative and reproductive speech subtests. Discussion: Among the ischemic stroke patients with mild anomic aphasia comparatively great was the percentage of low frequency word actualization and verbal fluency impairment. The usage of nominatives in speech expression of ischemic stroke patients is less as compared with that one of predicatives. Actualization of particles, unions, prepositions and interjections was comparatively high thus compensating the difficulty in choice of a definite lexical number. Conclusion: Future studies on testing of verbal choice in ischemic stroke patients should confirm its practical significance for the assessment of speech disorders concerning a special speech- recovery education.

Objective: To define the prognostic value of clinical and neuroimaging parameters on the 30-th day mortality and clinical outcome after spontaneous intracerebral hemorrhage (sICH). Materials and methods: we examined 88 patients with sICH admitted to Neurology Clinic, UMHAT Pleven within 48 hours after clinical symptoms onset. Glasgow Coma Scale (GCS) score was used to assess the primary stroke severity; neurological deficit on admission was assessed by National Institute of Health Stroke Scale (NIHSS); clinical outcome at discharge was evaluated by modified Rankin Scale (mRS) and by Glasgow Outcome Scale (GOS) on the 30-th day after sICH onset. Hematoma volume was measured by the formula of Kothari: AxBxC/2 in ml. The statistical analysis was performed by SPSS 19.0 and Statgraphics plus 4.1 for Windows. Results: Initial assessment of primary stroke severity and neurological deficit by GCS и NIHSS, hematoma localization and volume were found strongly correlated with the clinical outcome on the 30-th day after the sICH onset. Age and vascular risk factors did not correlate with the clinical outcome. Male patients had better survival on the 30-th day compared with the female ones. Discussion: Neurological deficit on admission, hematoma localization and volume were found reliable predictors of the 30-th day clinical outcome that could serve for early stratification of patients and optimal choice of therapeutic approach.

Aim: To establish the degree of patient satisfaction as factors of quality diagnostic laboratory activity. Materials and methods: Patients` satisfaction with laboratory service was studied by means of an anonymous inquiry of 150 patients from Varna during the February - April 2013. Results and Discussion: The maximum patient satisfaction of laboratory studies indicates a high level of the diagnostic laboratories. The quality of the medical service and professionalism of the staff is the main reason for the patients' preferences. These estimates have an increasing importance for the future of diagnostic laboratories in a developing market of an economy and health system based on the patient choice. Conclusion: Quality of the medical service and professionalism of the staff is the main motive for the preferences of patients, followed by good attitude and personal attention. The overall degree of patients’ satisfaction with the laboratory services was high.

Aim: To assess the gender differences among suspected pulmonary tuberculosis patients undergoing diagnostic sputum smear microscopy. Materials and methods: The study covered the patients with TBC diagnosed and treated in the region of Varna during 2012. Data have been gathered by the Laboratory of Microbiology at the Specialized Hospital of Pneumologic and Phthisiatric Diseases of Varna Ltd. Results: Gender and age are both traditionally known variables in terms of incidence and prevalence of pulmonary tuberculosis. The patients were classified into various groups according to gender and age. In 2012 the number of the men suffering from tuberculosis is repeatedly greater than those concerning the women (42 men to 29 women from 2012). This is probably due to the numerous risk factors among men, but biological mechanisms may actually account for a significant part of this difference between male and female susceptibility to TB.

Inflammatory processes are involved in the pathogenesis and development of chronic heart disease. The promising novel inflammatory biomarker YKL-40 is related to the degree of inflammation and pathological tissue remodeling. The aim of this study was to determine serum YKL-40 levels in patients with chronic heart failure and to evaluate the potential relationship with ultrasonography findings. Forty-three individuals were enrolled in the study – 24 patients (10 females and 14 males) with chronic heart failure, aged 70±11 (mean ± standard deviation) and 16 healthy people as age-matched controls (above 50 years). The serum YKL-40 levels were assessed by ELISA. Sonographic measurements such as two-dimensional, Power wave, Continuous Wave, Colour mode and M-Mode were performed using a diagnostic ultrasound system (PHILIPS Ultrasound, Washington, US) with a L11-3 probe of 3-11 MHz. The six minute walk test was used to assess functional capability of patients. Our study revealed significantly higher serum YKL-40 levels in patients compared to the control group (P=0.010). No relation was found between the glycoprotein and the results from the ultrasonographic and functional examination. We suppose that increased serum YKL-40 levels in patients with chronic heart failure might reflect the inflammatory route in the development of the disease.