Biotechnology & Biotechnological Equipment, 2017
Variety of health technologies applied in medical and dental practice are associated with formati... more Variety of health technologies applied in medical and dental practice are associated with formation of fine water droplets/aerosols. This presents a potential risk of both the patients and the personnel acquiring Legionnaires' disease. The aim of this study was to assess the presence of Legionella antibodies in the personnel (medical and dental) and a control group. The serum antibody index (Ab index) to L. pneumophila Sg1-6 (IgG + IgM) was determined using enzyme-linked immunosorbent assay. L. pneumophila Sg 1-6 antibodies (Ab index > 5) were found in 27/66 (40.91%) of the personnel vs. 7/90 (7.78%) of the control subjects (x 2 = 24.55, p < 0.0001). There was no statistically significant difference in the seropositivity levels in the groups in terms of sex, concomitant chronic diseases, intake of medications affecting the immune response, smoking and history of pneumonia. Association was observed with the professional categories of the personnel (x 2 = 6.836, df = 2, p < 0.05): more than 50% of the physicians were seropositive for L. pneumophila. The logistic regression analysis proved the role of seropositivity associated factors such as age, use of protective equipment and workplace (building with proven presence of L. pneumophila in the water system). The seroprevalence rate of Legionella antibodies in the personnel can be associated with occupational risk exposure, especially in the absence of systematic and regular use of protective equipment during work and the lack of an established system for regular monitoring and preventive maintenance of the water systems in the healthcare facilities.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Introduction: In surgical procedures, tissue damage results in the release of a number of bioacti... more Introduction: In surgical procedures, tissue damage results in the release of a number of bioactive substances. Calcitonin gene-related peptide (CGRP) is a peptide released from sensory nerves, which determines its role in pain sensation. Its distribution in tissues determines its role as a primary afferent neurotransmitter. Aim: To determine the effect of CGRP on postoperative pain and reactive inflammatory process after surgical removal of impacted mandibular third molars, as well as the factors that have influence upon the perception of pain. Materials and methods: Forty patients with bilaterally impacted mandibular third molars were included in the study. Venous blood samples were collected before and 24 hours after the surgical procedure in order to test their serum levels of CGRP and procalcitonin. Two weeks later the procedure was repeated. The difficulty of the surgical procedure, its duration and complications were assessed in all patients. Results: The influence of some o...
In a context of recently decreasing childhood immunization coverage and low uptake of COVID-19 va... more In a context of recently decreasing childhood immunization coverage and low uptake of COVID-19 vaccines in Bulgaria, this study measures vaccine hesitancy among general practitioners (GPs) in the country, as they are central to forming patients&#39; attitudes. In 2022, a face-to-face survey was conducted through a simple random sample from an exhaustive national database of Bulgarian GPs. This study measured attitudes on vaccine importance, safety, and effectiveness, and attitudes toward the Bulgarian immunization schedule. Information was collected on demographic and GP practice characteristics and possible predictors of vaccine confidence in order to test for associations with attitudes toward immunization. GP attitudes toward vaccines and the immunization schedule in Bulgaria were generally positive. Among 358 respondents, 351 (98%,95%CI96-99%) strongly agreed/agreed that vaccines are important, 352 (98%,95%CI96-99%) that vaccines are effective, and 341 (95%,95%CI93-97%) that vaccines are safe. 347 respondents (97%,95%CI95-98%) affirmed that &quot;it&#39;s good that vaccines from the children&#39;s immunization schedule are mandatory&quot;, and 331 (92%,95%CI89-95%) agreed with the statement &quot;Bulgaria&#39;s childhood immunization has my approval&quot;. Trust in information from official institutions was among the strongest predictors of vaccine confidence. Respondents&#39; vaccine confidence levels are within the ranges reported by GPs in other European countries and above those reported within the general Bulgarian population. GPs&#39; vaccine confidence is highly associated with trust in official institutions. It is important to maintain trust in official institutions and to support GPs in communicating vaccine knowledge with patients so that vaccine hesitancy in the general population is countered.
Introduction: Varicella is an acute, highly contagious disease, characterised by generalised vesi... more Introduction: Varicella is an acute, highly contagious disease, characterised by generalised vesicular exanthema caused by the initial infection with varicella zoster virus (VZV) which usually affects children aged 2 to 8 years. Aim: To analyse the changes of varicella incidence in Bulgaria over the period of 1928–2019. Materials and methods: The time series analysis is based on the official data for varicella incidence (per 100,000) in Bulgaria for ninety-two years (1928–2019), obtained from three major sources. We utilized the method to construct a time series model of overall incidence (1928–2019) using time series modeller in SPSS v. 25. We followed all three steps of the standard ARIMA methodology to establish the model – identification, parameter estimation, and diagnostic checking. Results: Stochastic scalar time series modelling of the varicella incidence from 1928 to 2019 was performed. The stochastic ARIMA (0,1,1) was identified to be the most appropriate model. The decomp...
Introduction: A current non-pharmacological mean for attaining painless conservative treatment is... more Introduction: A current non-pharmacological mean for attaining painless conservative treatment is presented by laser analgesia (LA), considered as bio-photomodulation of pulp reactivity aiming reduction of nociceptive impulse formation. Currently no consensus is reached regarding a detailed protocol with laser parameter settings for pre-emptive LA. The purpose of this study is determining the efficacy of erbium-doped yttrium aluminium garnet (Er:YAG) laser in achieving pulpal analgesia and quantifying duration and extent of any effects assessed. Methods and analysis: The proposed study is a double-blind placebo-controlled randomized split-mouth clinical trial with 2-way repeated measures design. Eligible patients of age 10 to 12 years undergo 2 single-visit treatments, receiving LA or placebo analgesia (PA) prior to caries ablation, randomized via computer-generated, permuted-block sequence. Primary outcome measure is pain felt during treatment, reported by patient on visual-analogue scale. Secondary outcomes: changes in pulpal sensibility to electrical and cold-stimuli; patient experience during LA/PA; pain-related behavior according to Faces, Legs, Activity, Cry, Consolabilty (FLACC) scale; heart-rate dynamics. Data will be analyzed with intention-to-treat concept by Student t test for paired samples, P < .05. Pretest on 20 subjects resulted in n = 41 patients needing to be recruited.
Journal of IMAB - Annual Proceeding (Scientific Papers), 2019
Qualitative composition and content of phenolic compounds in the liquid extract obtained from plu... more Qualitative composition and content of phenolic compounds in the liquid extract obtained from plum fruits have been studied. Five phenolic substances were found, as gallic acid, three hydroxycinnamic acids and rutin. The dominant substance was neochlorogenic acid (2320±42 mg/kg). Phenolic substances were identified in the extract and their amount determined by HPLC. Diuretic activity as diurnal spontaneous diuresis and forced diuresis, hypouricosemic and the membrane-stabilizing effects of plum liquid extract and its influence on the rheological properties of blood were studied.
Background: Bisphosphonate-associated osteonecrosis of the jaws (BAONJ) is a complication of grea... more Background: Bisphosphonate-associated osteonecrosis of the jaws (BAONJ) is a complication of great medical importance. Some of the most discussed and controversial aspects are the risk factors, some of which are related to patients' smoking and alcohol consumption. The Aim: To study cancer patients with BAONJ and determine their participation in the mentioned above risky health-related habits. Material and methods: A prospective epidemiological study of 112 patients diagnosed with bisphosphonate-associated osteonecrosis of the jaw in 2016 and 2017 was conducted at the Clinic of Maxillofacial surgery of University hospital "St. George", Plovdiv, Bulgaria, based on anamnesis, clinical examination, and hospital documentation. SPSS Statistics v.24 was used for statistical analysis, at a significance level p<0.05. Results: Over 2/3 of the patients were smokers (40.18%) or ex-smokers (25.00%), which linked them with the risk factor of smoking. At the time of the study, pa...
Aim: To observe bacteremia following closed and open dental extraction. Material and methods: The... more Aim: To observe bacteremia following closed and open dental extraction. Material and methods: The study included two subject groups each comprising 29 participants. Group I patients received a single closed dental extraction, and group II patients – a single open extraction. Venous blood from the cubital vein of each patient was collected in three samples – preoperatively, 30 seconds after surgery, and 15 minutes after surgery. Anaerobic and aerobic hemocultures (Bact/ALERT, BioMerieux, Inc., Durhamn, N.C.) were used to study the bacteremia process. Results: Preoperatively, bacteremia was confirmed in 4 patients (6.9%) undergoing closed extraction and in 1 patient (1.7%) undergoing open extraction. Additionally, we found statistically significant relation between bacteremia and age (p=0.002). Thirty seconds after surgery bacteriemia was evident in 6 patients (10.3%) from group I and in 3 (5.2%) from group II. Fifteen minutes following surgery bacteremia was evident in 4 patients (6....
Introduction: One method to evaluate the clinical success of cemented restorations is measuring t... more Introduction: One method to evaluate the clinical success of cemented restorations is measuring the marginal adaptation. There is a correlation between the fitting of the restoration and problems caused by clinically undetectable passage of bacteria between the tooth structure and the veneer. Aim: To evaluate in comparison the marginal adaptation of veneers produced via CAD/CAM and press technique. Materials and methods: 32 extracted incisors are divided into two equal-number groups (n=16) according to the production technique – CAD/CAM zirconium veneers and press-ceramic veneers. Cut sections are examined under a SEM magnification. Marginal accuracy is measured as the distance between the finish line of the tooth and the margin of the veneer at eight fixed locations. Results: The mean values of marginal gap of group 1 are: external adaptation – 79.88±3.71 µm; internal adaptation – 79.14±15.70 µm; cervical adaptation – 82.39±28.55 µm; incisal adaptation – 86.85±21.72 µm. The mean va...
Introduction: The emergence of severe acute respiratory syndrome coronavirus disease (COVID19) i... more Introduction: The emergence of severe acute respiratory syndrome coronavirus disease (COVID19) in China at the end of 2019 caused a massive global outbreak that has become a major public health issue. Aim: Our aim was to investigate the diagnostic potential of chest CT in screening patients suspected of having COVID19 in highprevalence settings. Materials and methods: This is a reallife, prospective, observational study involving 260 patients. All patients received chest CT scan at the emergency department (ED) of Kaspela University Hospital, Plovdiv, Bulgaria and RTPCR testing for suspected COVID19 from March 27 to December 31, 2020. COVID19 likelihood was assessed by assigning each CT scan to a particular category of the COVID19 Reporting and Data System (CORADS). IBM SPSS v. 26 was used to process the data. Results: The maletofemale distribution ratio was 1.4:1 – 150 (57.7%) males vs. 110 (42.3%) females (p=0.014). The median age was 55 yrs (range 46–65 yrs). Discharge...
The placement of dental screw implants typically involves the use of rotary techniques and drills... more The placement of dental screw implants typically involves the use of rotary techniques and drills to create a bone bed. This study explores the potential benefits of combining this method with an Er:YAG laser. Split osteotomies were performed on 10 jaws of euthanized domestic pigs (Sus scrofa domestica), with 12 mandibular implant osteotomies in each jaw, divided into 4 groups. In order to make a comprehensive assessment of the effect of Er:YAG lasers, histomorphological techniques were used to measure the reduction in amorphous layer thickness after Er:YAG laser treatment, both with and without the placement of dental screw implants from different manufacturers. Following bone decalcification and staining, the thickness of the amorphous layer was measured in four groups: Group A—osteotomy performed without Er:YAG laser treatment—had amorphous layer thicknesses ranging from 21.813 to 222.13 µm; Group B—osteotomy performed with Er:YAG laser treatment—had amorphous layer thicknesses r...
Journal of IMAB - Annual Proceeding (Scientific Papers), 2021
Purpose: To study the body weight and height of adolescents and to compare them with gender and a... more Purpose: To study the body weight and height of adolescents and to compare them with gender and age standards. All the children are from the Plovdiv region. Material and methods: About 185 children from three different ethnic groups have been studied. It also hase been developed and used specifically for this purpose an author's questionnaire for students, which contains open, closed, and mixed questions. Have been used descriptive statistics for quantitative (mean ± SD) and qualitative (percentage ± SEp) variables, also T-test for proving statistically significant differences between two independent samples. A p-value < 0.05 had been considered statistically significant for all tests. For the statistical processing, we have used the data analysis software IBM SPSS Statistics v. 25. Results: The study was conducted in the Plovdiv district in the period of May 2019 - July 2019. The subject of the study has been 185 adolescents from different ethnic groups. The logical units of...
Expert review of pharmacoeconomics & outcomes research, 2017
А series of European Union (EU) political decisions have made rare diseases one of the cornerston... more А series of European Union (EU) political decisions have made rare diseases one of the cornerstones of the common European health policy. Adopted in 2009, Council Recommendation on an action in the field of rare diseases aimed to serve as a policy-making guideline. However, the implementation report, which followed it, neither performed detailed cross-country comparison, nor assessed the impact of the policies. Areas covered: A 10-indicator set was elaborated to structure the review and to describe rare disease activities in 14 Eastern European countries. Expert commentary: Taking into account all indicators, EU member states outperform candidate and potential candidate countries in terms of rare disease policy planning and implementation. Hungary is the top performer, followed by Bulgaria and Czech Republic. Non-EU countries form the bottom tier, with Serbia being the best ranked among them. While EU adhesion is a major facilitator for planning and adopting rare disease policies, l...
The aim of this study is to explore the pharmacists’ attitudes and patterns of economic behavior ... more The aim of this study is to explore the pharmacists’ attitudes and patterns of economic behavior during the sale of regulated antibiotics without a prescription. The sociological method of secret participant observation was used. The total number of the observations is 71 units. The results presented 52 (73.24%) of pharmacists surveyed as willing to perform a sale of regulated antibiotic agent, while 19 (26.76%) of them refused to provide the remedy without doctor’s prescription. The "patient-actor" role and the density of the population determine the pattern of economic behavior of the pharmacists.
International Journal of Technology Assessment in Health Care, 2017
INTRODUCTION:Health Technology Assessment (HTA) is applied to determine the value of innovative t... more INTRODUCTION:Health Technology Assessment (HTA) is applied to determine the value of innovative technologies. It usually relies on robust assessment of the clinical cost-effectiveness of the technology, while clinical and economic evidence required for this purpose are often not available for orphan drugs (OD) (1,2). The objective of the study is to undertake a systematic comparison between HTA agencies worldwide in order to identify similarities and differences in the methods and processes in HTA of OD.METHODS:A cross-sectional web-based survey was conducted between September 2013 and May 2015. The data were obtained from a semi-structured questionnaire. We received responces from 161 HTA organizations based in 39 countries.RESULTS:HTA of OD is performed by agencies in South America (38.5 percent), followed by agencies in Australia (37.5 percent) and Europe (36.1 percent). The agencies in high income countries produce more assessments of OD (36.8 percent), which in 31.2 percent the...
IntroductionA current non-pharmacological mean for attaining painless local anaesthesia (LA) is p... more IntroductionA current non-pharmacological mean for attaining painless local anaesthesia (LA) is presented by vibrotactile devices. Their concept is to reduce injection pain due to distraction by applying physical stimuli which interfere with pain signals. The aim of this study is to determine the efficacy of the DentalVibe (DV) device in reducing pain and anxiety associated with LA in paediatric patients.Methods and analysisThe proposed study is a randomised controlled clinical trial with split-mouth design. Included are positive patients aged 8–12 years, requiring buccal infiltration for extraction of two bilateral primary maxillary molars. After dental fear measurement, eligible patients undergo two single-visit treatments with DV device allocated to either first or second LA via computer-generated randomisation sequence. Outcome measures will be self-reported pain felt during LA on Visual Analogue Scale; self-reported anxiety on Facial Image Scale; pain-related behaviour accordin...
International Journal of Technology Assessment in Health Care, 2017
INTRODUCTION:In Bulgaria, the regulatory body sets for the first time legal requirements for Heal... more INTRODUCTION:In Bulgaria, the regulatory body sets for the first time legal requirements for Health Technology Assessment (HTA) in Law on Medicinal Products in Human Medicine (LMPHM) on 27 June 2015. The next essential step for HTA capacity building was the promulgation of Ordinance 9 / December 1, 2015 on the conditions and procedures for conducting health technology assessment by the Ministry of Health (1). In the beginning of 2016, the Main Price and Reimbursement Committee was set and launched a process for establishing the small working groups with the task of reviewing the first applicants reports of pharmaceuticals for inclusion in the Positive Drug List (PDL).METHODS:The objective of this study is to summarize the recommendations of the newly established HTA Committee in Bulgaria and to examine the characteristics of the technologies and the key considerations that led to those decisions. We systematically read all published by the Committee recommendations for 2016 and anal...
Introduction: Nosocomial infections (NI) are frequent complications in neonatal intensive care un... more Introduction: Nosocomial infections (NI) are frequent complications in neonatal intensive care units (NICU) which result in high morbidity and mortality. Aim: To determine and analyze the incidence, risk factors and etiologic agents of NI in newborns admitted in the NICU to help plan-ning future surveillance and prevention strategies. Materials and methods: A prospective cohort study was carried out at the NICU of St George University Hospital, Plovdiv, Bul-garia from January 1, 2017 to June 31, 2018. The number of neonates included in the study was 507. Descriptive statistics such as count, percent, mean and standard deviation was used. Chi-square test was performed to prove associations. Odds ratios, with 95% confidence intervals, were computed from the results of the binominal logistic regression analyses. Results: Of the 507 hospitalized newborns in NICU, 48 presented with 54 NI. The incidence and the density incidence rates were 9.5% and 7.67 per 1,000 patient-days, respective...
International Journal of Person Centered Medicine, Sep 11, 2012
ABSTRACT Background: The vulnerability to burn out is determined by the specific interaction of t... more ABSTRACT Background: The vulnerability to burn out is determined by the specific interaction of the two domains – personality disposition and complementary anomalies in the psychological climate of the work place. Our basic hypotheses include inferences in 3 different, but strongly associated dimensions: specific personality traits as measured by the Temperament and Character Inventory (TCI-R) will reveal profiles of vulnerability vs. resilience to burn out; dimensions of the psychological climate will elicit the relevant precipitating factors determining burn out and dimensions where significant relations between personality structure, psychological climate and burn out are anticipated. Aim: To design a complex person centered model (battery of assessment tools) for early detection of burn out in populations of healthcare employees at risk and to determine the profile of the individual vulnerability to burn out both in terms of personality and psychological climate. Methods: Based on a literature research, 5 healthcare personnel risk groups were identified as being highly affected by burn out syndrome: (i) general practitioners; (ii) palliative care physicians and nurses; (iii) psychiatrists; (iv) oncologists &amp; (v) emergency and intensive care personnel. The battery was tested on 73 randomly selected healthcare professionals from the above-mentioned groups. The following methods were employed in our cross-sectional study in order to construct the assessment battery: Personality Profile Inventory: TCI-R – 240 items; Inductive Measurement of Psychological Climate 40 items Psychological Climate Inventory (courtesy of Koys and DeCotiis); Measurements of burn out as control condition – 22 items Maslach Burn Out Inventory. Results: Temperamental traits (harm avoidance and persistence) and Character dimensions (selfdirectedness and cooperativeness) have been largely correlated with burn out performance, mostly represented by emotional exhaustion, depersonalization and reduced personal accomplishment and result from psychological climate impact, mediated by 8 basic criteria: independence, unity, confidence, pressure, support, recognition, honesty and innovation. Conclusion: We have identified so far two groups of vulnerability (proneness) and protective (resilience) factors in relevance with the emergence of burn out syndrome in healthcare personnel. The vulnerability is defined with the following constellations: (i) high levels of harm avoidance in combination with pressure leads to high emotional exhaustion; (ii) high persistence in combination with low autonomy leads to low personal accomplishment and high emotional exhaustion. The resilience is outlined with the following constellations: (i) high persistence with high autonomy determines high personal accomplishment and low emotional exhaustion; (ii) self-directedness is an independent indicator of resilience: (iii) high personal accomplishment and low emotional exhaustion (i.e. protects from burn out regardless of the psychological climate at workplace) &amp; (iv) cooperativeness in combination with high cohesion determines a low level of depersonalization. Also, cohesion and fairness from the Psychological Climate Inventory define resilience to burn out as independent indicators.
Biotechnology & Biotechnological Equipment, 2017
Variety of health technologies applied in medical and dental practice are associated with formati... more Variety of health technologies applied in medical and dental practice are associated with formation of fine water droplets/aerosols. This presents a potential risk of both the patients and the personnel acquiring Legionnaires' disease. The aim of this study was to assess the presence of Legionella antibodies in the personnel (medical and dental) and a control group. The serum antibody index (Ab index) to L. pneumophila Sg1-6 (IgG + IgM) was determined using enzyme-linked immunosorbent assay. L. pneumophila Sg 1-6 antibodies (Ab index > 5) were found in 27/66 (40.91%) of the personnel vs. 7/90 (7.78%) of the control subjects (x 2 = 24.55, p < 0.0001). There was no statistically significant difference in the seropositivity levels in the groups in terms of sex, concomitant chronic diseases, intake of medications affecting the immune response, smoking and history of pneumonia. Association was observed with the professional categories of the personnel (x 2 = 6.836, df = 2, p < 0.05): more than 50% of the physicians were seropositive for L. pneumophila. The logistic regression analysis proved the role of seropositivity associated factors such as age, use of protective equipment and workplace (building with proven presence of L. pneumophila in the water system). The seroprevalence rate of Legionella antibodies in the personnel can be associated with occupational risk exposure, especially in the absence of systematic and regular use of protective equipment during work and the lack of an established system for regular monitoring and preventive maintenance of the water systems in the healthcare facilities.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Introduction: In surgical procedures, tissue damage results in the release of a number of bioacti... more Introduction: In surgical procedures, tissue damage results in the release of a number of bioactive substances. Calcitonin gene-related peptide (CGRP) is a peptide released from sensory nerves, which determines its role in pain sensation. Its distribution in tissues determines its role as a primary afferent neurotransmitter. Aim: To determine the effect of CGRP on postoperative pain and reactive inflammatory process after surgical removal of impacted mandibular third molars, as well as the factors that have influence upon the perception of pain. Materials and methods: Forty patients with bilaterally impacted mandibular third molars were included in the study. Venous blood samples were collected before and 24 hours after the surgical procedure in order to test their serum levels of CGRP and procalcitonin. Two weeks later the procedure was repeated. The difficulty of the surgical procedure, its duration and complications were assessed in all patients. Results: The influence of some o...
In a context of recently decreasing childhood immunization coverage and low uptake of COVID-19 va... more In a context of recently decreasing childhood immunization coverage and low uptake of COVID-19 vaccines in Bulgaria, this study measures vaccine hesitancy among general practitioners (GPs) in the country, as they are central to forming patients&#39; attitudes. In 2022, a face-to-face survey was conducted through a simple random sample from an exhaustive national database of Bulgarian GPs. This study measured attitudes on vaccine importance, safety, and effectiveness, and attitudes toward the Bulgarian immunization schedule. Information was collected on demographic and GP practice characteristics and possible predictors of vaccine confidence in order to test for associations with attitudes toward immunization. GP attitudes toward vaccines and the immunization schedule in Bulgaria were generally positive. Among 358 respondents, 351 (98%,95%CI96-99%) strongly agreed/agreed that vaccines are important, 352 (98%,95%CI96-99%) that vaccines are effective, and 341 (95%,95%CI93-97%) that vaccines are safe. 347 respondents (97%,95%CI95-98%) affirmed that &quot;it&#39;s good that vaccines from the children&#39;s immunization schedule are mandatory&quot;, and 331 (92%,95%CI89-95%) agreed with the statement &quot;Bulgaria&#39;s childhood immunization has my approval&quot;. Trust in information from official institutions was among the strongest predictors of vaccine confidence. Respondents&#39; vaccine confidence levels are within the ranges reported by GPs in other European countries and above those reported within the general Bulgarian population. GPs&#39; vaccine confidence is highly associated with trust in official institutions. It is important to maintain trust in official institutions and to support GPs in communicating vaccine knowledge with patients so that vaccine hesitancy in the general population is countered.
Introduction: Varicella is an acute, highly contagious disease, characterised by generalised vesi... more Introduction: Varicella is an acute, highly contagious disease, characterised by generalised vesicular exanthema caused by the initial infection with varicella zoster virus (VZV) which usually affects children aged 2 to 8 years. Aim: To analyse the changes of varicella incidence in Bulgaria over the period of 1928–2019. Materials and methods: The time series analysis is based on the official data for varicella incidence (per 100,000) in Bulgaria for ninety-two years (1928–2019), obtained from three major sources. We utilized the method to construct a time series model of overall incidence (1928–2019) using time series modeller in SPSS v. 25. We followed all three steps of the standard ARIMA methodology to establish the model – identification, parameter estimation, and diagnostic checking. Results: Stochastic scalar time series modelling of the varicella incidence from 1928 to 2019 was performed. The stochastic ARIMA (0,1,1) was identified to be the most appropriate model. The decomp...
Introduction: A current non-pharmacological mean for attaining painless conservative treatment is... more Introduction: A current non-pharmacological mean for attaining painless conservative treatment is presented by laser analgesia (LA), considered as bio-photomodulation of pulp reactivity aiming reduction of nociceptive impulse formation. Currently no consensus is reached regarding a detailed protocol with laser parameter settings for pre-emptive LA. The purpose of this study is determining the efficacy of erbium-doped yttrium aluminium garnet (Er:YAG) laser in achieving pulpal analgesia and quantifying duration and extent of any effects assessed. Methods and analysis: The proposed study is a double-blind placebo-controlled randomized split-mouth clinical trial with 2-way repeated measures design. Eligible patients of age 10 to 12 years undergo 2 single-visit treatments, receiving LA or placebo analgesia (PA) prior to caries ablation, randomized via computer-generated, permuted-block sequence. Primary outcome measure is pain felt during treatment, reported by patient on visual-analogue scale. Secondary outcomes: changes in pulpal sensibility to electrical and cold-stimuli; patient experience during LA/PA; pain-related behavior according to Faces, Legs, Activity, Cry, Consolabilty (FLACC) scale; heart-rate dynamics. Data will be analyzed with intention-to-treat concept by Student t test for paired samples, P < .05. Pretest on 20 subjects resulted in n = 41 patients needing to be recruited.
Journal of IMAB - Annual Proceeding (Scientific Papers), 2019
Qualitative composition and content of phenolic compounds in the liquid extract obtained from plu... more Qualitative composition and content of phenolic compounds in the liquid extract obtained from plum fruits have been studied. Five phenolic substances were found, as gallic acid, three hydroxycinnamic acids and rutin. The dominant substance was neochlorogenic acid (2320±42 mg/kg). Phenolic substances were identified in the extract and their amount determined by HPLC. Diuretic activity as diurnal spontaneous diuresis and forced diuresis, hypouricosemic and the membrane-stabilizing effects of plum liquid extract and its influence on the rheological properties of blood were studied.
Background: Bisphosphonate-associated osteonecrosis of the jaws (BAONJ) is a complication of grea... more Background: Bisphosphonate-associated osteonecrosis of the jaws (BAONJ) is a complication of great medical importance. Some of the most discussed and controversial aspects are the risk factors, some of which are related to patients' smoking and alcohol consumption. The Aim: To study cancer patients with BAONJ and determine their participation in the mentioned above risky health-related habits. Material and methods: A prospective epidemiological study of 112 patients diagnosed with bisphosphonate-associated osteonecrosis of the jaw in 2016 and 2017 was conducted at the Clinic of Maxillofacial surgery of University hospital "St. George", Plovdiv, Bulgaria, based on anamnesis, clinical examination, and hospital documentation. SPSS Statistics v.24 was used for statistical analysis, at a significance level p<0.05. Results: Over 2/3 of the patients were smokers (40.18%) or ex-smokers (25.00%), which linked them with the risk factor of smoking. At the time of the study, pa...
Aim: To observe bacteremia following closed and open dental extraction. Material and methods: The... more Aim: To observe bacteremia following closed and open dental extraction. Material and methods: The study included two subject groups each comprising 29 participants. Group I patients received a single closed dental extraction, and group II patients – a single open extraction. Venous blood from the cubital vein of each patient was collected in three samples – preoperatively, 30 seconds after surgery, and 15 minutes after surgery. Anaerobic and aerobic hemocultures (Bact/ALERT, BioMerieux, Inc., Durhamn, N.C.) were used to study the bacteremia process. Results: Preoperatively, bacteremia was confirmed in 4 patients (6.9%) undergoing closed extraction and in 1 patient (1.7%) undergoing open extraction. Additionally, we found statistically significant relation between bacteremia and age (p=0.002). Thirty seconds after surgery bacteriemia was evident in 6 patients (10.3%) from group I and in 3 (5.2%) from group II. Fifteen minutes following surgery bacteremia was evident in 4 patients (6....
Introduction: One method to evaluate the clinical success of cemented restorations is measuring t... more Introduction: One method to evaluate the clinical success of cemented restorations is measuring the marginal adaptation. There is a correlation between the fitting of the restoration and problems caused by clinically undetectable passage of bacteria between the tooth structure and the veneer. Aim: To evaluate in comparison the marginal adaptation of veneers produced via CAD/CAM and press technique. Materials and methods: 32 extracted incisors are divided into two equal-number groups (n=16) according to the production technique – CAD/CAM zirconium veneers and press-ceramic veneers. Cut sections are examined under a SEM magnification. Marginal accuracy is measured as the distance between the finish line of the tooth and the margin of the veneer at eight fixed locations. Results: The mean values of marginal gap of group 1 are: external adaptation – 79.88±3.71 µm; internal adaptation – 79.14±15.70 µm; cervical adaptation – 82.39±28.55 µm; incisal adaptation – 86.85±21.72 µm. The mean va...
Introduction: The emergence of severe acute respiratory syndrome coronavirus disease (COVID19) i... more Introduction: The emergence of severe acute respiratory syndrome coronavirus disease (COVID19) in China at the end of 2019 caused a massive global outbreak that has become a major public health issue. Aim: Our aim was to investigate the diagnostic potential of chest CT in screening patients suspected of having COVID19 in highprevalence settings. Materials and methods: This is a reallife, prospective, observational study involving 260 patients. All patients received chest CT scan at the emergency department (ED) of Kaspela University Hospital, Plovdiv, Bulgaria and RTPCR testing for suspected COVID19 from March 27 to December 31, 2020. COVID19 likelihood was assessed by assigning each CT scan to a particular category of the COVID19 Reporting and Data System (CORADS). IBM SPSS v. 26 was used to process the data. Results: The maletofemale distribution ratio was 1.4:1 – 150 (57.7%) males vs. 110 (42.3%) females (p=0.014). The median age was 55 yrs (range 46–65 yrs). Discharge...
The placement of dental screw implants typically involves the use of rotary techniques and drills... more The placement of dental screw implants typically involves the use of rotary techniques and drills to create a bone bed. This study explores the potential benefits of combining this method with an Er:YAG laser. Split osteotomies were performed on 10 jaws of euthanized domestic pigs (Sus scrofa domestica), with 12 mandibular implant osteotomies in each jaw, divided into 4 groups. In order to make a comprehensive assessment of the effect of Er:YAG lasers, histomorphological techniques were used to measure the reduction in amorphous layer thickness after Er:YAG laser treatment, both with and without the placement of dental screw implants from different manufacturers. Following bone decalcification and staining, the thickness of the amorphous layer was measured in four groups: Group A—osteotomy performed without Er:YAG laser treatment—had amorphous layer thicknesses ranging from 21.813 to 222.13 µm; Group B—osteotomy performed with Er:YAG laser treatment—had amorphous layer thicknesses r...
Journal of IMAB - Annual Proceeding (Scientific Papers), 2021
Purpose: To study the body weight and height of adolescents and to compare them with gender and a... more Purpose: To study the body weight and height of adolescents and to compare them with gender and age standards. All the children are from the Plovdiv region. Material and methods: About 185 children from three different ethnic groups have been studied. It also hase been developed and used specifically for this purpose an author's questionnaire for students, which contains open, closed, and mixed questions. Have been used descriptive statistics for quantitative (mean ± SD) and qualitative (percentage ± SEp) variables, also T-test for proving statistically significant differences between two independent samples. A p-value < 0.05 had been considered statistically significant for all tests. For the statistical processing, we have used the data analysis software IBM SPSS Statistics v. 25. Results: The study was conducted in the Plovdiv district in the period of May 2019 - July 2019. The subject of the study has been 185 adolescents from different ethnic groups. The logical units of...
Expert review of pharmacoeconomics & outcomes research, 2017
А series of European Union (EU) political decisions have made rare diseases one of the cornerston... more А series of European Union (EU) political decisions have made rare diseases one of the cornerstones of the common European health policy. Adopted in 2009, Council Recommendation on an action in the field of rare diseases aimed to serve as a policy-making guideline. However, the implementation report, which followed it, neither performed detailed cross-country comparison, nor assessed the impact of the policies. Areas covered: A 10-indicator set was elaborated to structure the review and to describe rare disease activities in 14 Eastern European countries. Expert commentary: Taking into account all indicators, EU member states outperform candidate and potential candidate countries in terms of rare disease policy planning and implementation. Hungary is the top performer, followed by Bulgaria and Czech Republic. Non-EU countries form the bottom tier, with Serbia being the best ranked among them. While EU adhesion is a major facilitator for planning and adopting rare disease policies, l...
The aim of this study is to explore the pharmacists’ attitudes and patterns of economic behavior ... more The aim of this study is to explore the pharmacists’ attitudes and patterns of economic behavior during the sale of regulated antibiotics without a prescription. The sociological method of secret participant observation was used. The total number of the observations is 71 units. The results presented 52 (73.24%) of pharmacists surveyed as willing to perform a sale of regulated antibiotic agent, while 19 (26.76%) of them refused to provide the remedy without doctor’s prescription. The "patient-actor" role and the density of the population determine the pattern of economic behavior of the pharmacists.
International Journal of Technology Assessment in Health Care, 2017
INTRODUCTION:Health Technology Assessment (HTA) is applied to determine the value of innovative t... more INTRODUCTION:Health Technology Assessment (HTA) is applied to determine the value of innovative technologies. It usually relies on robust assessment of the clinical cost-effectiveness of the technology, while clinical and economic evidence required for this purpose are often not available for orphan drugs (OD) (1,2). The objective of the study is to undertake a systematic comparison between HTA agencies worldwide in order to identify similarities and differences in the methods and processes in HTA of OD.METHODS:A cross-sectional web-based survey was conducted between September 2013 and May 2015. The data were obtained from a semi-structured questionnaire. We received responces from 161 HTA organizations based in 39 countries.RESULTS:HTA of OD is performed by agencies in South America (38.5 percent), followed by agencies in Australia (37.5 percent) and Europe (36.1 percent). The agencies in high income countries produce more assessments of OD (36.8 percent), which in 31.2 percent the...
IntroductionA current non-pharmacological mean for attaining painless local anaesthesia (LA) is p... more IntroductionA current non-pharmacological mean for attaining painless local anaesthesia (LA) is presented by vibrotactile devices. Their concept is to reduce injection pain due to distraction by applying physical stimuli which interfere with pain signals. The aim of this study is to determine the efficacy of the DentalVibe (DV) device in reducing pain and anxiety associated with LA in paediatric patients.Methods and analysisThe proposed study is a randomised controlled clinical trial with split-mouth design. Included are positive patients aged 8–12 years, requiring buccal infiltration for extraction of two bilateral primary maxillary molars. After dental fear measurement, eligible patients undergo two single-visit treatments with DV device allocated to either first or second LA via computer-generated randomisation sequence. Outcome measures will be self-reported pain felt during LA on Visual Analogue Scale; self-reported anxiety on Facial Image Scale; pain-related behaviour accordin...
International Journal of Technology Assessment in Health Care, 2017
INTRODUCTION:In Bulgaria, the regulatory body sets for the first time legal requirements for Heal... more INTRODUCTION:In Bulgaria, the regulatory body sets for the first time legal requirements for Health Technology Assessment (HTA) in Law on Medicinal Products in Human Medicine (LMPHM) on 27 June 2015. The next essential step for HTA capacity building was the promulgation of Ordinance 9 / December 1, 2015 on the conditions and procedures for conducting health technology assessment by the Ministry of Health (1). In the beginning of 2016, the Main Price and Reimbursement Committee was set and launched a process for establishing the small working groups with the task of reviewing the first applicants reports of pharmaceuticals for inclusion in the Positive Drug List (PDL).METHODS:The objective of this study is to summarize the recommendations of the newly established HTA Committee in Bulgaria and to examine the characteristics of the technologies and the key considerations that led to those decisions. We systematically read all published by the Committee recommendations for 2016 and anal...
Introduction: Nosocomial infections (NI) are frequent complications in neonatal intensive care un... more Introduction: Nosocomial infections (NI) are frequent complications in neonatal intensive care units (NICU) which result in high morbidity and mortality. Aim: To determine and analyze the incidence, risk factors and etiologic agents of NI in newborns admitted in the NICU to help plan-ning future surveillance and prevention strategies. Materials and methods: A prospective cohort study was carried out at the NICU of St George University Hospital, Plovdiv, Bul-garia from January 1, 2017 to June 31, 2018. The number of neonates included in the study was 507. Descriptive statistics such as count, percent, mean and standard deviation was used. Chi-square test was performed to prove associations. Odds ratios, with 95% confidence intervals, were computed from the results of the binominal logistic regression analyses. Results: Of the 507 hospitalized newborns in NICU, 48 presented with 54 NI. The incidence and the density incidence rates were 9.5% and 7.67 per 1,000 patient-days, respective...
International Journal of Person Centered Medicine, Sep 11, 2012
ABSTRACT Background: The vulnerability to burn out is determined by the specific interaction of t... more ABSTRACT Background: The vulnerability to burn out is determined by the specific interaction of the two domains – personality disposition and complementary anomalies in the psychological climate of the work place. Our basic hypotheses include inferences in 3 different, but strongly associated dimensions: specific personality traits as measured by the Temperament and Character Inventory (TCI-R) will reveal profiles of vulnerability vs. resilience to burn out; dimensions of the psychological climate will elicit the relevant precipitating factors determining burn out and dimensions where significant relations between personality structure, psychological climate and burn out are anticipated. Aim: To design a complex person centered model (battery of assessment tools) for early detection of burn out in populations of healthcare employees at risk and to determine the profile of the individual vulnerability to burn out both in terms of personality and psychological climate. Methods: Based on a literature research, 5 healthcare personnel risk groups were identified as being highly affected by burn out syndrome: (i) general practitioners; (ii) palliative care physicians and nurses; (iii) psychiatrists; (iv) oncologists &amp; (v) emergency and intensive care personnel. The battery was tested on 73 randomly selected healthcare professionals from the above-mentioned groups. The following methods were employed in our cross-sectional study in order to construct the assessment battery: Personality Profile Inventory: TCI-R – 240 items; Inductive Measurement of Psychological Climate 40 items Psychological Climate Inventory (courtesy of Koys and DeCotiis); Measurements of burn out as control condition – 22 items Maslach Burn Out Inventory. Results: Temperamental traits (harm avoidance and persistence) and Character dimensions (selfdirectedness and cooperativeness) have been largely correlated with burn out performance, mostly represented by emotional exhaustion, depersonalization and reduced personal accomplishment and result from psychological climate impact, mediated by 8 basic criteria: independence, unity, confidence, pressure, support, recognition, honesty and innovation. Conclusion: We have identified so far two groups of vulnerability (proneness) and protective (resilience) factors in relevance with the emergence of burn out syndrome in healthcare personnel. The vulnerability is defined with the following constellations: (i) high levels of harm avoidance in combination with pressure leads to high emotional exhaustion; (ii) high persistence in combination with low autonomy leads to low personal accomplishment and high emotional exhaustion. The resilience is outlined with the following constellations: (i) high persistence with high autonomy determines high personal accomplishment and low emotional exhaustion; (ii) self-directedness is an independent indicator of resilience: (iii) high personal accomplishment and low emotional exhaustion (i.e. protects from burn out regardless of the psychological climate at workplace) &amp; (iv) cooperativeness in combination with high cohesion determines a low level of depersonalization. Also, cohesion and fairness from the Psychological Climate Inventory define resilience to burn out as independent indicators.
Uploads
Papers by RAy Ral