The Progress in Bioprinting and Its Potential Impact on Health-Related Quality of Life.

The intensive development of technologies related to human health in recent years has caused a real revolution. The transition from conventional medicine to personalized medicine, largely driven by bioprinting, is expected to have a significant positive impact on a patient's quality of life. This article aims to conduct a systematic review of bioprinting's potential impact on health-related quality of life. A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, Google Scholar, and ScienceDirect databases between 2019 and 2023. We have identified some of the most significant potential benefits of bioprinting to improve the patient's quality of life: personalized part production; saving millions of lives; reducing rejection risks after transplantation; accelerating the process of skin tissue regeneration; homocellular tissue model generation; precise fabrication process with accurate specifications; and eliminating the need for organs donor, and thus reducing patient waiting time. In addition, these advances in bioprinting have the potential to greatly benefit cancer treatment and other research, offering medical solutions tailored to each individual patient that could increase the patient's chance of survival and significantly improve their overall well-being. Although some of these advancements are still in the research stage, the encouraging results from scientific studies suggest that they are on the verge of being integrated into personalized patient treatment. The progress in bioprinting has the power to revolutionize medicine and healthcare, promising to have a profound impact on improving the quality of life and potentially transforming the field of medicine and healthcare.

Compulsory vaccination against COVID-19 in the context of the principles of the convention on human rights and biomedicine.

INTRODUCTION: At this stage of the global health crisis caused by the SARS-CoV-2 coronavirus, an increasing number of countries are considering enacting legislation requiring compulsory vaccination or implementing a mechanism to ensure mass vaccination of the population. Such policy decisions raise a number of legal and deontological issues. AIM: The aim of the study was to analyze the legal and deontological issues related to the introduction of compulsory vaccination against COVID-19 in the context of the principles of the Convention on Human Rights and Biomedicine (Oviedo Convention). MATERIALS AND METHODS: The analysis looks at the international legal framework that governs the protection of human rights and freedoms, the principles and rules that apply to the achievements of biology and medicine, and, in particular, the Oviedo Convention. RESULTS: Vaccines against COVID-19 are a modern scientific success in biology and medicine, particularly those of the latest genera-tion of vaccines presented by the scientific community as a consequence of revolutionary mRNA technology. It is for this reason that the provisions of the Oviedo Convention should serve as guidelines for countries to follow in their fight against COVID-19 pandemic. CONCLUSIONS: Achieving mass vaccination of the population in accordance with the provisions of the Oviedo Convention and other rel-evant international standards for the protection of fundamental human rights, in conjunction with a large-scale information campaign, seems a sensible approach that would contribute to the rapid and peaceful resolution of the current global health crisis.

Communication Skills Teaching Methods in Dental Education - a Review.

Communication skills of dentists have been demonstrated to be part of the good dental practice. The aim we set ourselves in this study was to review the literature related to the methods of teaching communication skills at dental faculties, and develop a handout in the Bulgarian language about leading a successful conversation with a patient.According to some authors, the most important principles for effective communication training include the use of practical exercises, clinically relevant scenarios, students' self-assessment tools, videotapes, participation of patient actors, and training in small groups. Another communication training program is the so-called Miller pyramid. Using the method of objective structured clinical examina-tion (OSCE) can also be an effective way of teaching communication skills to dental students. The conclusion to be made is that communication skills should be taught across the entire dental curriculum as this leads to better understanding and sufficient outcome.

Early neurological and cognitive impairments in subclinical cerebrovascular disease.

BACKGROUND: The subclinical cerebrovascular disease (SCVD) is an important public health problem with demonstrated prognostic significance for stroke, future cognitive decline, and progression to dementia. The earliest possible detection of the silent presence of SCVD in adults at age at risk with normal functioning is very important for both clinical doctors and scientists. MATERIALS AND METHODS: Seventy-seven adult volunteers, recruited during the years 2005-2007, with mean age 58.7 (standard deviation 5.9) years, were assessed by four subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB)-Eclipse cognitive assessment system. We used a questionnaire survey for the presence of cerebrovascular risk factors (CVRFs) such as arterial hypertension, smoking and dyslipidemia, among others, as well as instrumental (Doppler examination) and neurological magnetic resonance imaging (MRI) procedures. Descriptive statistics, comparison (t-test, Chi-square) and univariate methods were used as followed by multifactor logistic regression and receiver operating characteristics analyses. RESULTS: The risk factor questionnaire revealed nonspecific symptoms in 44 (67.7%) of the subjects. In 42 (64.6%) of all 65 subjects, we found at least one of the conventional CVRFs. Abnormal findings from the extra- and trans-cranial Doppler examination were established in 38 (58.5%) of all studied volunteers. Thirty-four subjects had brain MRI (52.3%), and abnormal findings were found in 12 (35.3%) of them. Two of the four subtests of CANTAB tool appeared to be potentially promising predictors of the outcome, as found at the univariate analysis (spatial working memory 1 [SWM1] total errors; intra-extra dimensional set 1 [IED1] total errors [adjusted]; IED2 total trials [adjusted]). We established that the best accuracy of 82.5% was achieved by a multifactor interaction logistic regression model, with the role CVRF and combined CANTAB predictor "IED total ratio (errors/trials) × SWM1 total errors" (P = 0.006). CONCLUSIONS: Our results have contributed to the hypothesis that it is possible to identify, by noninvasive methods, subjects at age at risk who have mild degree of cognitive impairment and to establish the significant relationship of this impairment with existing CVRFs, nonspecific symptoms and subclinical abnormal brain Doppler/MRI findings. We created a combined neuropsychological predictor that was able to clearly distinguish between the presence and absence of abnormal Doppler/MRI findings. This pilot prognostic model showed a relatively high accuracy of >80%; therefore, the predictors may serve as biomarkers for SCVD in subjects at age at risk (51-65 years).

Feasibility of immunochemical faecal occult blood testing for colorectal cancer screening in Bulgaria.

PURPOSE: Colorectal carcinoma (CRC) is the second most common cancer in Europe. Screening guidelines recommend a range of screening options that include faecal occult blood tests (FOBTs). The efficacy of FOBT-based CRC screening is dependent on the participation rate, thus emphasizing the importance of the latter. This study aimed at analysing the feasibility of CRC screening with immunochemical FOBT (iFOBT). METHODS: A cross-sectional study of 600 asymptomatic persons at average risk, aged ≥45years from urban and rural municipalities was performed. An educational brochure, iFOBT kit with translated colored leaflet, informed consent form and questionnaire were administered to participants by 30 general practitioners. Faecal samples were analysed for occult blood using point-of-care rapid iFOBT (cut off 10 ng(GPs)Hb/ml) by the patients themselves at home. The questionnaire aimed to establish if they encountered difficulties in self-testing and self-analysing. Direct and indirect measures of test feasibility were used difficulties for reported study participation rate. RESULTS: The participation rate was 78.8% (473 participants). Patients < 65 years (x² =70.8, Р<0.001), those with lower education level (x² =82.1, p<0.001), and patients living in villages (x² =4.3, p<0.05) reported difficulties more frequently and they needed help for self-testing by iFOBT. Positive test was found in 8.5% of all participants. Of them 19 persons (48.7%) had haemorrhoids, 8 (20.0%) benign neoplasms, and 3 (7.5%) had CRC. CONCLUSIONS: CRC screening study by means of iFOBT as a point-of-care test proved to be feasible, since a high participation rate was obtained.

Mediterranean spotted fever in children in the Pazardjik region, South Bulgaria.

The objective of the present study was to analyze the clinical pattern of contemporary Mediterranean spotted fever in children and to compare it with the clinical pattern in adults. The research involved 257 children. The more common symptoms in children were severe onset, fever, rash, "tache noire," swelling of lymph nodes and enlarged liver or spleen.

Postoperative chemo-radiotherapy with temodal in patients with glioblastoma multiforme--survival rates and prognostic factors.

UNLABELLED: Glioblastoma multiforme (GM) is the most malignant histological type of brain tumors. It affects the active age and independent of the applied general therapeutic methods in oncology the problem with the short survival of the patients still remains. In the recent years simultaneous application of Temodal and radiation therapy was introduced in medical practice. AIM OF THE PRESENT STUDY: To compare the survival rate of a group of patients subjected to radiation therapy only to the survival rate of a group subjected to simultaneous treatment with Temodal and radiation therapy (RT). MATERIALS AND METHODS: 179 patients with GM were divided into 2 groups and subjected to radiation therapy with realized total dose of 60 Gy fractionated into 5 x 2 Gy weekly. 44 of the patients underwent chemo-radiotherapy with Temodal dosed 75 mg/m2, and the rest 135 ones received RT alone. All patients received corticosteroid treatment. The Karnofski status (KPS) of the group with Temodal treatment was 90-100%. Survival rates were assessed using the Kaplan-Mayer method and side effects for-the group with simultaneous chemo-radiotherapy. RESULTS: Chemo-radiation therapy was well tolerated by all patients. Median survival time was 14.83 months for the group with Temodal and 14.67 months for the other group. The progression-free time was 8.5 months. Vomiting was observed in 11.4% of the patients and was corrected with antiemetics. No side hematological deviations were developed as well as pneumonias. CONCLUSION: Temozolomide in combination with chemotherapy is a gold standard for GM patients and it shows a tendency of increased survival. The clinical tolerance is good and no marked side reactions are observed

Modelling of increased homocysteine in ischaemic stroke: post-hoc cross-sectional matched case-control analysis in young patients.

BACKGROUND & PURPOSE: Hyperhomocysteinaemia has been postulated to participate in pathogenesis of ischaemic stroke (IS). However, especially in young adults, there is possibility of significantly increased IS risk due to increased normal homocysteinaemia, i.e., hidden (pathologically dormant) prevalence within a healthy, normally-defined range. We performed a post-hoc modelling investigation on plasma total homocysteinaemia (THCY) in gender- and age-matched young patients in the acute IS phase. We evaluated relationships between THCY and prevalence of other potential risk factors in 41 patients vs. 41 healthy controls. METHOD: We used clinical methods, instrumental and neuroimmaging procedures, risk factors examination, total plasma homocysteine measurements and other laboratory and statistical modelling techniques. RESULTS: IS patients and healthy controls were similar not only for matching variables, but also for smoking, main vitamin status, serum creatinine and lipid profile. Patients with IS, however, had lower vitamin B6 levels and higher THCY, fibrinogen and triglycerides (TGL). At multivariate stepwise logistic regression only increased THCY and TGL were significantly and independently associated with the risk for stroke (72% model accuracy, p model=0.001). An increase of THCY with 1.0 micromol/L was associated with 22% higher risk of ischaemic stroke [adjusted OR=1.22 (95%CI 1.03?1.44)]. In this way, novel lower cut-off value for HCY of 11.58 micromol/L in younger patients has been revealed (ROC AUC= 0.67, 95CI% 0.55-0.78, p=0.009). CONCLUSION: The new THCY cut-off clearly discriminated between absence and presence of IS (sensitivity>63%, specificity>68%) irrespectively of age and gender and may be applied to better evaluate and more precisely define, as earlier as possible, the young patients at increased IS risk.

Modelling of increased homocysteine in ischaemic stroke: post-hoc cross-sectional matched case-control analysis in young patients

BACKGROUND & PURPOSE: Hyperhomocysteinaemia has been postulated to participate in pathogenesis of ischaemic stroke (IS). However, especially in young adults, there is possibility of significantly increased IS risk due to increased ænormalÆ homocysteinaemia, i.e., æhiddenÆ (æpathologically dormantÆ) prevalence within a healthy, normally-defined range. We performed a post-hoc modelling investigation on plasma total homocysteinaemia (THCY) in gender- and age-matched young patients in the acute IS phase. We evaluated relationships between THCY and prevalence of other potential risk factors in 41 patients vs. 41 healthy controls. METHOD: We used clinical methods, instrumental and neuroimmaging procedures, risk factors examination, total plasma homocysteine measurements and other laboratory and statistical modelling techniques. RESULTS: IS patients and healthy controls were similar not only for matching variables, but also for smoking, main vitamin status, serum creatinine and lipid profile. Patients with IS, however, had lower vitamin B6 levels and higher THCY, fibrinogen and triglycerides (TGL). At multivariate stepwise logistic regression only increased THCY and TGL were significantly and independently associated with the risk for stroke (72 percent model accuracy, p model=0.001). An increase of THCY with 1.0 æmol/L was associated with 22 percent higher risk of ischaemic stroke [adjusted OR=1.22 (95 percentCI 1.03?1.44)]. In this way, novel lower cut-off value for HCY of 11.58 æmol/L in younger patients has been revealed (ROC AUC= 0.67, 95CI percent 0.55-0.78, p=0.009). CONCLUSION: The new THCY cut-off clearly discriminated between absence and presence of IS (sensitivity>63 percent, specificity>68 percent) irrespectively of age and gender and may be applied to better evaluate and more precisely define, as earlier as possible, the young patients at increased IS risk.

OBJETIVO: Hiperhomocisteinemia tem sido postulada como um dos fatores de risco na patogênese do acidente vascular cerebral isquêmico (AVCI). Todavia, em adultos jovens existe a possibilidade de aumento significativo de risco de AVCI devido a aumento "normal" da homocisteinemia, "oculta" (patologicamente adormecida) dentro de uma variação definida como normal. Neste trabalho foi investigado um modelo post-hoc de dosagem de homocisteina no plasma (HC) em pacientes jovens com AVCI agudo pareados por gênero e idade. Foi avaliado também relações entre HC e prevalência de outros fatores de risco para AVCI em 41 pacientes e 41 controles normais. MÉTODO: Foi utilizado exame clínico, procedimentos instrumentais e de neuroimagem, exame de fatores de risco, dosagem da homocisteína no plasma, outros exames laboratoriais e análise estatística. RESULTADOS: Não foram encontradas diferenças quanto a presença de fumantes, dosagem de vitaminas, creatinina sérica e perfil lipídico entre os pacientes com AVCI e os controles normais. Todavia os pacientes com AVCI apresentaram diminuição de níveis de vitamina B6 e aumento de homocisteína, fibrinogênio e trigliceridios. A análise multivariada de regressão logística mostrou diferenças significativas apenas para HC e trigliceridios independentemente associadas para fatores de risco para AVCI (72 por cento acuracia, p= 0,001). Um aumento de homocisteína de 1,0 æmol/L estava associado com aumento de 22 por cento de risco de AVCI [OR=1,22 (95 por centoIC 1,03-1,44)]. Foi evidenciado portanto um novo valor de cut-off para HC de 11,58 æmol/L em pacientes jovens com AVCI (ROC auc=0,67, 95 por cento IC 0,55-0,78, p= 0,009). CONCLUSÃO: Este novo valor de cut-offpara a homocisteína discrimina claramente a ausência ou presença de AVCI (sensibilidade >63 por cento, especificidade >68 por cento) independente do gênero ou idade e deve ser aplicado para uma melhor avaliação precoce de pacientes jovens com risco de AVCI.

Transient ischaemic attacks and minor strokes (analyses and clinically significant comparisons).

UNLABELLED: The transient ischaemic attacks (TIA) and minor strokes are independent predictors of disabling strokes with a high medical and social value. PURPOSE: Analysis and comparison of the data from the clinical monitoring of TIA and minor stroke patients in correlation with the different duration of the transient neurological deficit. PATIENTS AND METHODS: 234 patients were monitored clinically in the Clinic of Cerebrovascular Diseases, University Hospital "St. George"-Plovdiv between 2002 and 2004. Clinical data were collected for 79 patients who met the clinical criteria for TIA and 155 patients who met the clinical criteria for minor stroke. Our protocol included medical history, cardiac and neurological examinations, assessment of cerebrovascular risk factors and laboratory tests. The instrumental assessment included CT scan, MRI and Doppler examination. The data were processed using descriptive statistics, non-parametric methods and charts. RESULTS: The comparative analysis between the TIA and minor stroke patients shows a significant difference only in the number of registered conductive disturbances, which are more frequent in the TIA patients. In the TIA group the significantly more frequent features are acute onset of the neurological deficit, significantly more frequent normal CT scan images or lacunar infarctions findings. In the minor stroke group the significantly more frequent features are the subacute onset, more frequent CT findings of vascular encephalopathy or CT scans revealing one large ischaemic zone. CONCLUSIONS: The differences may be explained with the dominant pathogenetic mechanisms in each of the conditions: microembolisation of extracranial vascular origin in TIA and local thrombosis or cardioembolisation in minor stroke. Previous vascular damage in minor stroke patients is more evident.

Assessment of the effect of palliative radiotherapy for cancer patients with intracranial metastases using EORTC-QOL-C30 questionnaire.

UNLABELLED: Assessment of quality of life (QOL) is of crucial importance when assigning palliative radiotherapy of brain metastases in cancer patients. AIM: To investigate the influence of whole brain radiotherapy on brain symptoms in patients with cerebral metastases; to evaluate their quality of life before and after radiation therapy using the EORTC-QOL-C30 questionnaire, as well as its influence on patients' survival. PATIENTS AND METHODS: Sixty-five patients with various locations of the primary tumor and brain metastases were included in this study. All of them underwent radiotherapy with cobalt unit. The realized dose of the whole brain was above 30 Gy: 10 x 3 Gy or 15 x 2 Gy. The patients filled in the EORTC-QOL-C30 questionnaire before radiation, at the end of the radiotherapeutic course and a month after it. Clinical characteristics of patients before and after radiotherapy were compared and assessed. All patients were treated with radiotherapy and concurrent corticosteroid treatment. RESULTS: The mean age of the patients was 53 +/- 7.8 years and the median survival was 6.6 months for lung cancer patients and 9.8 months for breast cancer patients. Each EORTC-QOL-C30 questionnaire assessed the patients in three main aspects: functional aspects, general symptoms and global health. Improvement was reported (p < 0.001) for functional indicators and health related quality of life (HRQOL). Several symptoms did not change significantly--financial difficulties, dyspnea and diarrhea. CONCLUSIONS: Whole brain radiation of cancer patients with cerebral metastases is very well tolerated. Side effects are frequently met and can be compensated by applying steroids. The assessment of quality of life gives information on patients' improvement which is more substantial in functioning, symptoms and global health. This study is a precondition for future investigations of the effect of whole brain radiation on cancer patients' quality of life.

A study of plasma total homocysteine levels in healthy people.

UNLABELLED: Elevated plasma levels of homocysteine have been identified as an independent risk factor for atherosclerosis. AIM: The aim of this study was to determine the reference limits of plasma total homocysteine for Bulgarian population. MATERIALS AND METHODS: We investigated 153 healthy individuals without vitamin deficiency aged from 18 to 65 years. The reference group consisted of 74 males and 79 females with mean age respectively 37.80 +/- 1.36 and 39.32 +/- 1.33 years. Plasma total homocysteine was determined by high performance liquid-chromatography (HPLC) modified and validated in our laboratory. RESULTS: The reference intervals were 7.4-18.5 micromol/l for males and 5.5-14.5 micromol/ 1 for females. The mean levels of plasma homocysteine were significantly higher in males in comparison with females (11.86 +/- 0.33 micromol/l vs. 9.88 +/- 0.27 micromol/l; P < 0.001), without considerable correlation with age. Comparing the values of total homocysteine between the two groups of age - < or = 49 and > or = 50 years showed that the investigated individuals > or = 50 years had higher plasma concentration, and the difference was significant only for the group of females. Hyperhomocysteinemia according to ECAP cut-off value (> 12.1 micromol/l) was registered in 30.7% of healthy volunteers. CONCLUSIONS: The results of our study demonstrated that homocysteine levels depend on sex and, to a lesser degree, on age. We have determined plasma total homocysteine reference intervals for the Bulgarian population. This will help the interpretation of the results and contribute to adequate and efficient prevention of blood vessel diseases.

Radionuclide therapy of cancer patients with bone metastases.

OBJECTIVES: We report our experience in the use of radionuclides in the treatment of bone metastases in patients with various primary cancers: breast cancer, prostate cancer, lung cancer, etc. MATERIAL AND METHODS: Eighty-seven patients (53 women, 34 men) with bone metastases were treated for pain relief with either 32-P (71 patients) or 89-Sr (16 patients). Fifty-three of the patients had breast cancer, 27--rostate cancer, 6--lung cancer and 1--kidney cancer. The patients were examined for side effects when 32-P was administered perorally and 89-Sr injected intravenously. We also studied the changes in the levels of hemoglobin, white blood cells (WBCs) count and platelets count. RESULTS: We found a significant decrease in the WBC and platelet count in the patients treated with 32-P (U = 2.20, P < 0.05 and U = 4.57, P < 0.001) one month after the therapy. These parameters showed no significant decrease in the group treated with 89-Sr. The pain, which was the rationale to use the radioactive isotopes, was relieved and the patients restored their previous mobility. DISCUSSION: The fact that 32-P alleviated the grave symptom of pain at the relatively weak radiation dose used (2 mCi) is a strong indication that this radiopharmaceutical can be used successfully for such a purpose, although some authors argue against its use in view of the myelosuppresion it causes. This myelosuppression, however, is mild and transient even without treatment and patients could benefit from this adjuvant treatment to manage the pain syndrome. 89-Sr administered intravenously in a dose of 4mCi also relieves pain efficiently but its use is limited by the cost of the quantity needed for 1 patient and for a single dose. The National Health Insurance Fund currently reimburses for a very limited quantity of this substance which makes the cost of the procedure 15 times as expensive as that using radioactive phosphorus. CONCLUSIONS: Using the radiopharmaceuticals 32-P and 89-Sr provides an additional, easy and efficacious means for palliation of cancer patients with bone metastases, especially those who are refractory to percutaneous irradiation.

Specific peculiarities in the family model of the Turkish minority in Bulgaria.

INTRODUCTION: There is a significant decrease in the average number of children in Bulgarian families during the 80s and 90s. This phenomenon is noticed even in some regions with usually higher natality, like Kurdjali, Pazardjik, Blagoevgrad, etc. AIM: The aim of this study was to characterize the reproductive behaviour of Turkish minority in Bulgaria. METHODS: 260 women in reproductive age with Turkish ethnical origin from the town of Kurdjali (Bulgaria) were approached by a direct individual inquiry. Data were analysed by descriptive statistics and non-parametric tests. RESULTS AND DISCUSSION: The average number of children in the Turkish families in Bulgaria is 1.69 +/- 0.04 and in 78.2% of cases, the pregnancy has been wanted and approved by both spouses. This fact determines the reproduction of this ethnos to be a realized necessity. The comparison of indices, characterizing the reproductive behaviour of Turkish and Bulgarian population shows a statistically significant difference between the real and desired number of children in the family (P < 0.001). However, the analysis failed to find a statistically significant difference in the opinion of both compared groups about the ideal number of children in the family (P > 0.05). CONCLUSIONS: There are no changes in the traditional conceptions of Turkish people about the family and role of women. We observe significant differences in the reproductive plan and behaviour between the Bulgarian and Turkish population.