Introduction: Sepsis is a significant cause of morbidity and mortality worldwide. Current clinical practice, however, lacks reliable diagnostic indicators for it and its prognosis. Aim: The present study aimed to investigate the efficacy of delta neutrophil index (DNI), which reflects the proportion of circulating immature granulocytes, in predicting infections and sepsis. Materials and methods: A prospective non-interventional single-center clinical follow-up study was performed in a Bulgarian ICU between January 1, 2017 and May 31, 2018. We analyzed adult patients: 45 patients met the sepsis criteria, as defined in SEPSIS-3, whereas 37 were infected patients fulfilling no criteria of sepsis. Logistic regression and Roc-curve analysis were used to evaluate the severity and prognostic value of DNI as a prediction marker in critically ill septic patients. Results: The results have shown that at DNI values of 1.4 there is 73% sensitivity and 87% specificity (AUC 0.764, 95% CI 0.650–0.878, p=0.0001) to assume the presence of sepsis. Additionally, DNI was significantly associated with the severity of the condition of patients, the organ dysfunction and the IL-8 marker. Conclusions: DNI may serve as a useful marker for early diagnosis of sepsis and could support decision making process regarding its treatment at an early stage of a disease development.

Introduction: Cardiac fibrosis is the hallmark of atrial remodeling in atrial fibrillation. Galectin-3 (Gal-3) is a biomarker of fibrosis. It is well studied in heart failure, but the data about its role in atrial fibrillation are sparse.Aim: The aim of the study was to evaluate the levels of Gal-3 in patients with atrial fibrillation after sinus rhythm restoration, to examine the association between this biomarker and other factors for developing atrial fibrillation and to assess its prognostic role.Materials and methods: We included 67 patients (35 male) at the mean age of 67.36±7.25 years, with Gal-3 test after sinus rhythm restoration, a subgroup of participants in placebo-controlled randomized clinical trial of treatment with spironolactone. They were followed up for atrial fibrillation recurrence and hospitalizations. The effect of demographic parameters and other factors on Gal-3 levels were evaluated before and one year after treatment.Results: Mean Gal-3 at baseline was 16.9±6.8 ng/ml. Higher levels of Gal-3 were associated with female gender (р=0.008), increasing age (р=0.005), renal dysfunction (p<0.0001) and gout (р=0.002). Higher thromboembolic risk as assessed by CHA2DS2-VASc score was significantly related to Gal-3. The levels of biomarker did not affect the number of atrial fibrillation recurrences (p=0.9) and hospitalizations. No correlation was found with treatment with spironolactone, antiarrhythmic and antihypertensive drugs.Conclusions: Higher Gal-3 in atrial fibrillation was associated with female sex, renal dysfunction, and history of gout. The levels of Gal-3 were not related to rhythm control. Treatment with spironolactone did not affect the biomarker of fibrosis Gal-3 in AF patients. Higher Gal-3 was related to high embolic risk.

Introduction: Procalcitonin (PCT) as a marker of inflammation has not been studied and analyzed in purulent inflammations of the head and neck of odontogenic origin, which is the aim of this original article. Materials and methods: This retrospective study includes 31 men with odontogenic abscesses of the head and neck with a mean age of 42 years. As a control group, 31 healthy men are used. In all of them, leukocytes (WBC), neutrophils (Neu), C-reactive protein (CRP), and procalcitonin (PCT) are tested. Results: The average values of the studied indicators in the patients are: CRP - 89.45±85.15 mg/l, WBC - 11.78±4.61x103/L, Neu - 8.79±4.58x103/L and PCT - 0.8±0.8 ng/ Jr. The average values of the same indicators in the control group are: CRP - 0.9±1.17 mg/l, WBC - 7.37±1.9x103/L, Neu - 4.13±1.43x103/L and PCT - 0.18±1.27 ng/ml. There is no positive correlation between PCT on the one hand and CRP, WBC and Neu on the other hand. Discussion: The mean values of CRP, WBC, Neu and PCT are higher in men with odontogenic abscesses compared to the healthy controls, and this is statistically significant. Although PCT does not correspond to WBC, Neu and CRP, it has a number of advantages over them - it increases its concentration only in infections of bacterial origin, it increases its levels earlier and reaches its highest concentration earlier, it has a longer half-life, and its level declines more rapidly after infections. Conclusions: All this suggests that PTC may soon become the most accurate marker in diagnosing, treating, and follow-up of patients with head and neck odontogenic abscesses.

Background/Objectives: Iron plays an important role in cognitive, behavioral, and motor development. This study aims to assess the iron nutritional status of Bulgarian children with cerebral palsy (CP) and autism spectrum disorder (ASD), focusing on iron deficiency (ID) and its impact on children’s development. We hypothesized that children with CP and ASD suffer from iron deficiency. Methods: The cross-sectional study includes 95 children from northeastern Bulgaria. Data were collected in two periods (2017–2018 and 2023–2024). Demographic questionnaires, food frequency questionnaires, and laboratory tests for hemoglobin, serum iron, serum ferritin, serum albumin, and CRP were conducted. Anthropometric measurements were evaluated. The Gross Motor Function Classification System scale was used to assess motor function in children with CP. Statistical analysis was performed using Jamovi software, ver. 2.6.44, with a significance level of p < 0.05. Results: Of the 95 children, 62.1% had CP and 37.9% had ASD. Most children had normal hemoglobin and serum iron levels, but 62.7% of those with CP and 36.8% of those with ASD had low serum ferritin levels, indicating latent ID. A higher proportion of children with CP than those with ASD consumed meat daily, while fish was more commonly consumed by children with ASD. Anthropometric data showed delayed growth and lower height-for-age scores in children with CP. Conclusions: The study identifies latent ID in children with CP and ASD. An evaluation of dietary habits highlights the need for interventions to improve nutritional status and development. The observed deficiencies emphasize the need for regular monitoring and targeted dietary programs for children in these groups.

Introduction. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is a marker of endothelial dysfunction and has been linked to vascular injury. Its clinical relevance for cardiovascular risk (CVR) assessment in adults with long-standing type 1 diabetes mellitus (T1DM) remains unclear. The objective of this study was to examine whether serum ADMA levels relate to established CVR stratification models and to explore their associations with key clinical variables relevant to vascular risk (albuminuria (AlbU), glycated hemoglobin (HbA1c), diabetes duration, and sex). Methods. This cross-sectional study included 124 adults with long-standing T1DM and 59 age- and sex-matched non-diabetic controls. Serum ADMA was measured by ELISA; C-reactive protein (CRP), HbA1c, and AlbU were quantified using standardized clinical laboratory methods. CVR was assessed using the Steno Type 1 Risk Engine (ST1RE), the 2019 European Society of Cardiology Guidelines on Diabetes, Pre-Diabetes and Cardiovascular Diseases (ESC 2019), and a composite RiskFactor3 model integrating CRP, HbA1c, and AlbU categories. Non-parametric methods were applied due to non-normal distributions. Results. ADMA levels did not differ significantly between the T1DM and control group (0.49 [0.32–0.68] vs. 0.56 [0.43–0.69] μmol/L, p = 0.092). Within the T1DM cohort, ADMA correlated positively with AlbU (p = 0.004) but showed no meaningful associations with age, diabetes duration, HbA1c, or CRP. A multivariable regression, including AlbU and HbA1c, explained 15% of ADMA variability (p < 0.001). ADMA values overlapped extensively across the ST1RE, ESC 2019, and RiskFactor3 categories. Receiver operating characteristic analyses demonstrated limited overall discriminatory capacity (AUC ≈ 0.5). In females, a trend toward moderate discrimination was observed for identifying ≥ 2 RiskFactor3 components (AUC = 0.653, 95% CI (0.565–0.881), p = 0.067). Conclusions. Serum ADMA is not a universal marker of global CVR in adults with long-standing T1DM. Its strongest clinical association was with AlbU, consistent with renal-endothelial stress rather than overall CVR burden as defined by multivariable risk equations. The observed sex-specific signal in females warrants further investigation. Larger prospective studies are needed to determine whether ADMA may have targeted value in phenotype-specific or sex-specific CVR assessment strategies.

Despite the visible progress in reducing morbidity and mortality from intestinal infections and acute diarrhea associated with them, especially in childhood, the problem of their diagnosis and treatment remains relevant. The article discusses the structure, function and application of lipocalin-2 in infectious diseases as a non-invasive biomarker of bacterial inflammation in the intestine.