The COVID-19 pandemic's impact on rheumatic disease patients' satisfaction with access to medical services.

The COVID-19 hurt various lifestyle aspects, especially the treatment and follow-up of patients with chronic diseases such as autoimmune inflammatory rheumatic diseases (RD). The new circumstances changed the frequency of medical examinations and the way patients with rheumatic diseases are followed up. The objective is to study the impact of COVID-19 on RD patients' satisfaction with access to medical services. A national multicenter observational cross-sectional anonymous online survey was conducted on patients with RD using a specially developed web-based platform and structured questionnaire https://rheumatologycovid19.bg/ . The study was carried out with the support of intra-university project №6/2022 MU-Plovdiv. 1288 patients participated, with an average age of 47.03 (SD ± 12.80 years), of whom 992 (81.6%) were women. The questionnaire contained 41 questions grouped into 5 panels. Descriptive statistics were used-mean, alternative analysis, logistic regression and Decision Tree using the CRT (classification and regression trees) method. The study found that RD patients' satisfaction with access to medical services was influenced by communication type and the frequency of visits to the rheumatologist, difficulties in prescribing and finding medicines and the presence of comorbidities. The likelihood of patients' satisfaction with their rheumatologist was 5.5 and 3 times higher for in-person and other means of communication, respectively, compared to those without any communication. The relative share of patients who communicated by phone was larger (59%) compared to pre-pandemic (41%), where direct contact with the physician prevailed (80%). The results of the study confirmed the need to optimize remote access to medical care for patients with RD during the pandemic.

The Serum ACE2, CTSL, AngII, and TNFα Levels after COVID-19 and mRNA Vaccines: The Molecular Basis.

BACKGROUND: The SARS-CoV-2 virus as well as the COVID-19 mRNA vaccines cause an increased production of proinflammatory cytokines. AIM: We investigated the relationship between ACE2, CTSL, AngII, TNFα and the serum levels of IL-6, IL-10, IL-33, IL-28A, CD40L, total IgM, IgG, IgA and absolute count of T- and B-lymphocytes in COVID-19 patients, vaccinees and healthy individuals. METHODS: We measured the serum levels ACE2, AngII, CTSL, TNFα and humoral biomarkers (CD40L, IL-28A, IL-10, IL-33) by the ELISA method. Immunophenotyping of lymphocyte subpopulations was performed by flow cytometry. Total serum immunoglobulins were analyzed by the turbidimetry method. RESULTS: The results established an increase in the total serum levels for ACE2, CTSL, AngII and TNFα by severely ill patients and vaccinated persons. The correlation analysis described a positive relationship between ACE2 and proinflammatory cytokines IL-33 (r = 0.539) and CD40L (r = 0.520), a positive relationship between AngII and CD40L (r = 0.504), as well as between AngII and IL-33 (r = 0.416), and a positive relationship between CTSL, total IgA (r = 0.437) and IL-28A (r = 0.592). Correlation analysis confirmed only two of the positive relationships between TNFα and IL-28A (r = 0.491) and CD40L (r = 0.458). CONCLUSIONS: In summary, the findings presented in this study unveil a complex web of interactions within the immune system in response to SARS-CoV-2 infection and vaccination.

The testicular form of angiotensin converting enzyme as a marker for human sperm quality assessment.

INTRODUCTION: Spermatozoa are rapidly changing cellular structures that are highly dependent on their interaction with the environment. These interactions cause fundamental changes in the spermatozoa's cells and membrane.

Localization and Distribution of Testicular Angiotensin I Converting Enzyme (ACE) in Neck and Mid-Piece of Spermatozoa from Infertile Men in Relation to Sperm Motility.

Testicular angiotensin converting enzyme (ACE) is known to play an essential role in the male reproduction and fertility. Data about tACE in cases of male infertility are quite scarce, and in this respect we aimed to study localization and distribution of tACE protein in the neck and mid-piece of spermatozoa from pathological samples in relation to sperm motility. The enzyme expression during capacitation and acrosome reaction was quantitatively assessed. In human ejaculated spermatozoa tACE is localized on sperm plasma membrane of the head, the neck and mid-piece of the tail. The immunoreactivity becomes stronger in capacitated spermatozoa followed by a decrease in acrosome reacted sperm. In different cases of semen pathology (oligozoospermia, asthenozoospermia and teratozoospermia) fluorescent signals in the neck and mid-piece are in punctate manner whereas in normozoospermia they were uniformly distributed. The expression area of tACE the neck and mid-piece was decreased in ejaculated and capacitated sperm from pathological semen samples compared to normospermia. Significant positive correlation was established between tACE area and progressive sperm motility, whereas with immotile sperm the correlation was negative. Our data suggest that proper distribution of tACE in the neck and mid-piece is required for normal sperm motility that could be used as a novel biomarker for male infertility.

Quality of Endodontic Treatment and Prevalence of Apical Radiolucencies in a Bulgarian Subpopulation: a CBCT Analysis.

INTRODUCTION: The advent of Cone Beam Computed Tomography (CBCT) in endodontics has enhanced the diagnosis of periapical radiolucencies and the assessment of endodontically treated teeth. AIM: The purpose of this study was to assess the prevalence of periapical radiolucencies in a Bulgarian subpopulation and the quality of previous endodontic treatment using CBCT scans. MATERIALS AND METHODS: This study included 2795 roots from 160 Large FOV CBCT which were evaluated by two independent examiners using two scoring systems: CBCT-PAI and PESS. RESULTS: The inter-examiner agreement spanned from strong to almost perfect (0.892 and 0.983). The prevalence of periapical lesions according to the two scoring systems was 23.1% and 12.9 %, respectively. The prevalence of endodontically treated teeth was high (34.1%). Sixty-five percent of them presented with signs of periapical radiolucencies, while only 1.4% of all non-treated roots had a periapical lesion. A significant association between periapical disease, poor quality of the root canal filling and inadequate coronal seal was found (p<0.001). CONCLUSIONS: The prevalence of periapical disease in endodontically-treated teeth in the Bulgarian subpopulation was high. Poor qual-ity of the root canal filling and inadequate coronal seal were assessed as prognostic determinants of treatment failure. CBCT techniques can augment conventional diagnostic techniques in the field of endodontics.

Psychometric properties of the Bulgarian version of Hospital Survey on Patient Safety Culture.

OBJECTIVE: To explore the psychometrics of the Bulgarian version of the Hospital Survey on Patient Safety Culture (B-HSOPSC) and its suitability for use in Bulgaria. DESIGN: A national web-based cross-sectional survey of the safety patient culture. SETTING: The hospitals' staffs from 28 administrative areas in the country. INTERVENTIONS: Web-based self-administered questionnaire. PARTICIPANTS: Physicians and non-physicians such as nurses, midwifes, etc., working at hospitals. MAIN OUTCOME MEASURES: Confirmatory factor analysis (CFA) was performed to assess the psychometric properties of the original US structure. Assessment of construct validity included convergent validity, discriminant validity, and nomological validity of constructs. RESULTS: A total of 525 valid cases were included in the analysis. The results of CFA revealed acceptable values for absolute indices and lower for the incremental index, comparative fit index. Due to the very low convergence validity, the dimension 'staffing' was removed from the model. Additionally, one item was removed from another dimension. The B-HSOPSC included 11 dimensions and 37 items. CONCLUSIONS: The B-HSOPSC had acceptable levels of global and local fits. Its safety culture dimensions were sufficiently distinguishable and correlated with outcome variables.

Health-related quality of life in end-stage renal disease patients, using the Missoula-Vitas quality of life index: a multicenter study.

BACKGROUND AND AIMS: Assessment of Health-related Quality of Life in chronic hemodialysis patients (CHD) is a predictive indicator of the outcome of the disease, including mortality and hospitalization. Regular surveys of the quality of life (QoL) in CHD patients have been conducted worldwide, using various, internationally validated and standardized tools, including the Missoula-VITAS Quality of Life Index scale (MVQOLI). The aim of this study was to examine the reliability and validity of the Bulgarian version of the Missoula-VITAS Quality of Life Index-15 (B-MVQOLI-15) and QoL in CHD patients using this instrument. METHODS: Our study was designed as multi-center cross-sectional. It incorporated 263 end-stage renal disease (ESRD) patients on CHD from across the country and applied the B-MVQOLI-15. Internal consistency and convergent validity of the index were assessed. Non-parametric methods were used to evaluate the impact of demographic factors on the different dimensions scores and on the total score. The relationship between the total QoL score, the total MVQOLI-15 score and dimensions scores were measured based on Spearman's rho Correlation Coefficient. RESULTS: The total MVQOLI-15 score in the study was 16.44, which is slightly above the middle of the index scale. The patients with higher education were less satisfied with the level of their symptom control compared to patients with lower education. However, high education patients seem to manage better with everyday life compared to those with low education. Men seem to feel more satisfied than women when fulfilling their daily activities (P=0.026). Retired patients and unemployed expressed more satisfaction, compared to the employed (P=0.021). Also, patients on dialysis for over 5 years had lower QoL scores (P=0.043). CONCLUSIONS: B-MVQOLI-15 is a reliable instrument to measure QoL in Bulgarian patients with CHD. The majority of CHD patients rate their QoL as "Fair". Four of all five dimensions positively affect the QoL of CHD patients. The most important dimensions positively affecting the QoL of CHD patients were: interpersonal relationships and transcendent factors. Future studies are necessary to assess the adequacy of the delivered dialysis, the level of medico-social care and the needs of ESRD patients treated with CHD in order to improve their QoL.

Academic Staff Satisfaction with their Work: A Cross-Sectional Study in a Medical University.

BACKGROUND: Employees' work satisfaction, combined with democratic management, are important predictors of future productivity in any organisation. AIM: The aim of this study is to investigate job satisfaction in academic staff as well as the associated working environment factors, using an original self-administered questionnaire. METHODS: A cross-sectional survey was conducted using an original standardised questionnaire. It involved 370 academic staff members at one of the five medical universities in Bulgaria. The questionnaire consists of 17 items (including occupational hazards, management style, conflict solving and demographic characteristics) rated on a 5-point Likert scale. RESULTS: The results revealed that the majority of academic staff (71.7%) works in a risky environment. Employees indicate that "mental strain", "work with chemical agents and dust" and "work with biological hazards" are the most common risk factors. Democratic leadership and cooperation are most commonly applied management styles. CONCLUSION: The instrument for the measurement of job satisfaction revealed high values of psychometric characteristics for reliability and validity. The study found a high level of satisfaction of academics with their working conditions. It is necessary to conduct similar studies periodically to detect more precisely the decrease in academic staff work satisfaction and take timely and adequate measures to improve it.

Burnout Syndrome in Physicians-Psychological Assessment and Biomarker Research.

Background and objectives: Burnout is a syndrome typically occurring in work environments with continuous and chronic stress. Physicians are at increased risk for burnout, as a result of 24-hour work, delayed work-life balance gratification, and the challenges associated with patient care. The aim of the present study was to evaluate the psychological parameters of burnout symptoms in relation to biomarkers of stress among physicians with different medical specialties. Materials and methods: A total of 303 physicians were contacted as potential participants. A comparison group of 111 individuals working outside medicine was used as a control to verify the results. The physicians were specialists in internal medicine, general surgery, pathology, and primary care. Serum cortisol, salivary cortisol, adrenocorticotropic hormone (ACTH), insulin (IRI), and prolactin levels were analyzed by chemiluminescence enzyme immunoassay (Access 2, Beckman Coulter). Fasting glucose in serum and glycated hemoglobin (HbA1C) in whole blood were measured using the automatic analyzer AU 480 Beckman Coulter system. Symptoms of burnout were measured with the Maslach Burnout Inventory (MBI). Results: The group with burnout presented significantly higher levels of serum and saliva cortisol, ACTH, prolactin, fasting glucose, and HbA1C compared with the control group. The correlation analysis between biomarkers showed a positive correlation with moderate strength between serum and saliva cortisol (r = 0.516, p = 0.01),as well as serum and saliva cortisol with ACTH (r = 0.418; r = 0.412, p = 0.01) and HbA1C (r = 0.382; r = 0.395, p = 0.01). A weak positive correlation was found between serum and saliva cortisol with prolactin (r = 0.236; r = 0.267, p < 0.01) and glucose (r = 0.271; r = 0.297, p < 0.01). In the multiple logistic regression model, saliva cortisol, HbA1C, and age were significantly associated with burnout (chi-square = 16.848, p < 0.032). Conclusion: Our findings demonstrated the interest of exploring biomarkers of stress related to burnout in health professionals.

Clinical Assessment of Endodontically Treated Teeth, Restored with or without Radicular Posts.

BACKGROUND: The reduced fracture resistance in endodontically treated teeth requires the use of radicular posts, with their advantages and disadvantages. AIM: To evaluate the clinical performance of teeth restored with or without radicular posts at 6 and 12 months. MATERIALS AND METHODS: The study included 22 patients who received endodontic therapy on premolars with a loss of one or two proximal walls. The premolars were divided into groups according to the restoration method: metal post group (MP), fiber post group (FP), and no post group (NP). For the NP group, a dentinal core of fiber-reinforced composite was used. The McNemar test, marginal homogeneity test and Kruskal-Wallis test were used in the statistical analysis. At the 6 and 12 month recall, both the direct composite restorations and the integrity of the post systems were assessed. RESULTS: At 6-month recall assessment, there was no statistically significant difference in the categories of 'appropriate colour', 'secondary caries' and 'obturation integrity'. That was not the case with 'marginal discoloration', 'marginal adaptation', 'proximal contact' and 'surface smoothness'. The recall at 12 months showed a continuation of this tendency, with significant decrease in the category of 'adequate colour'. Assessment of post longevity at the two recalls did not show any significant changes. The teeth restored without a post showed survival rates comparable to that of teeth restored with a post for the 12-month period of observation. CONCLUSIONS: There were no failures of the different posts used. The observed changes were attributed to the progressive deterioration of the composite restorations.

The EUROPEP questionnaire for patient's evaluation of general practice care: Bulgarian experience.

AIM: To validate the Bulgarian EUROPEP-questionnaire and its implementation to measure patient evaluation of general practice care in Bulgarian population. METHODS: A multicenter cross-sectional study was conducted at twenty five primary care practices from South-Central Region of Bulgaria. A total of 1000 adult patients aged over 18 years and visiting the practice for more than a year were approached consecutively to take part in the study. The internal consistency and test-retest reliability of the EUROPEP questionnaire were evaluated. To confirm the construct validity of the questionniare, еxplanatory factor analysis was performed. RESULTS: Cronbach'alpha for "clinical behaviour" is 0.95 and for "organisation of care" 0.81. Factor analysis identifed two factors, which accounted for 77.0% of the total variation in these items. On average, 58.7% of respondents rated the level of care received as excellent. The waiting time in the waiting room was the item most poorly rated (33.8%). The item "keeping patients' records and data confidential" was the most highly rated (88.8%). Patients were less satisfied with "providing quick services for urgent health problems" (78.5% excellent or good) and "getting an appropriate for them appointment" (76.2% excellent or good). CONCLUSION: Two scales with satisfactory psychometric properties were established in the Bulgarian version of the EUROPEP-questionnaire. The study identified areas requiring improvement in general practice, such as reduction in waiting times and obtaining patient's convenience appointment.

Clinical Impact of Dental Adhesives on Postoperative Sensitivity in Class I and Class II Resin-Composite Restorations.

BACKGROUND: Self-etch adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations. STUDY OBJECTIVE: A hypothesis that a one-step self-etch adhesive (1-SEA) would result in less postoperative sensitivity than a three-step etch-and-rinse adhesive (3-E&RA) was tested. PATIENTS AND METHODS: One hundred restorations were placed with a 1-SEA and 100 restorations with a 3-E&RA. Teeth were restored with Filtek Supreme nanofilled resin-composite and were evaluated for sensitivity to cold and masticatory forces at baseline, 7 days, 14 days, 30 days, and 6 months postoperatively. Vitality test scores of the teeth were recorded at the same periods. RESULTS: The evaluation of cold sensitivity intensity (VAS score) for all observation periods in both restoration groups did not reveal any statistical significance. The differences in the response time to cold stimulation (0 - 15 sec) for the restorations made with a 1-SEA and those made with a separate etch step are statistically insignificant. There are no significant differences in the vitality of the restored teeth at intra- or inter-group comparison. The statistical analysis revealed significant differences in postoperative sensitivity to masticatory forces at postoperative day 14 and day 30 in the 3-E&RA group. CONCLUSIONS: Postoperative sensitivity depends on the type of dentin adhesive used. More intensive complaints of postoperative sensitivity were recorded under masticatory forces at postoperative day 14 and day 30 in 3-E&RA in comparison with 1-SEA.

Clinical Effect of Dental Adhesive on Marginal Integrity in Class I And Class II Resin-Composite Restorations.

BACKGROUND: Dental adhesives are believed to influence marginal adaptation and marginal discoloration when used under posterior resin-based composite restorations. Studies on the latest adhesive systems reveal that the group of the three-step etch-and-rinse adhesive (3-E&RA) and the one-step self-etch adhesive (1-SEA) have entirely different bonding mechanisms, as well as different bond strength and resistance to chemical, thermal and mechanical factors. STUDY OBJECTIVES: A hypothesis that a 1-SEA would result in greater enamel marginal discoloration and poorer marginal adaptation than a 3-E&RA was tested. MATERIAL AND METHODS: One hundred restorations were placed with a 1-SEA and 100 restorations with a 3-E&RA. Teeth were restored with Filtek Supreme nanofilled resin-composite and were evaluated for marginal adaptation and marginal discoloration at baseline, and 6 months, 12 months, and 36 months postoperatively. RESULTS: The statistical analysis revealed significant differences in marginal integrity between test groups. The 1-SEA resulted in greater enamel marginal discoloration and poorer marginal adaptation than the 3-E&RA at any recall time. CONCLUSIONS: Marginal adaptation and marginal discoloration depend on the type of dentin adhesive used. The restorations with Filtek Supreme and Scotchbond MP are better than the restorations with Adper Prompt L-Pop with regard to the marginal adaptation and marginal discoloration at 6-, 12- and 36-month evaluations.

Factors for post-operative sensitivity in dental caries treatment according to practicing dentists--application of network analysis.

INTRODUCTION: The postoperative tooth sensitivity is a dental caries post-treatment complication of unknown origin. The variety of clinical symptoms of this condition, the contributing factors and their interactions may be presented by means of network analysis. AIM: The aim of the present study was to apply network analysis to present the relationships between factors contributing to post-operative sensitivity according to practicing dentists. PATIENTS AND METHODS: We carried out an anonymous questionnaire survey of 213 dentists to assess their experience with diagnosed post-operative sensitivity. The duration and kind of the condition was studied to find its correlation with the type of restorative material, the location of carious defect, and the depth of carious defect. The respondents gave their opinions about the probable causes of post-operative sensitivity. Multiple answers to one question were allowed. Data was processed with the help of SPSS and UciNet. RESULTS: 806 ties between factors for post-operative sensitivity were investigated. Their absolute size (C) ranged from -16 to +175. The most significant relationships, defined at C > or = 0.3, comprised 20% of all ties. CONCLUSIONS: The following relationships between factors associated with post-operative sensitivity were found: cold-induced pain of up to 1 week duration after treatment of caries profunda acuta and placement of an amalgam restoration; pressure-induced pain of up to 3 weeks duration after treatment of caries profunda chronica, class II cavities and placement of a composite resin restoration. The visualized structures of interrelated factors represented only the clinical experience of the questioned dentists. Their confirmation in clinical practice is a matter of future investigations.