Search Results (68)

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives. Full article

The article is aimed at building on the existing studies devoted to the last stage of the assimilation policy directed at the Muslim population in Communist Bulgaria during the second half of the 1980s. The 40th anniversary of the forced change of the given Turkish–Arabic and Persian names of this population is an occasion to revisit this dark period of the recent past. This study focuses on the short- and long-term consequences of the political measures, which became known as the ‘Revival process’ (1984/1985–1989). For the first time, the author presents new written sources, including analytical and field reports commissioned by the Central Committee of the Bulgarian Communist Party and prepared by Bulgarian scholars during the second half of the 1980s, as well as later collected biographical data related to Muslims affected by the events, derived through an (auto)ethnographic method of research among Turks, Crimean Tatars and Muslim Roma. Full article

The white oil-bearing rose (R. alba L.) is the second of the industrially important rose species for Bulgarian rose cultivation and essential oil production. In recent years, the interest in white oil-bearing rose has increased, following the worldwide trend for searching for new aromatic alternatives. Therefore, the purpose of the current research is to evaluate the volatile compounds profile of fresh R. alba L. flowers using headspace solid-phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC/MS). More than 75 individual compounds were identified and quantified using HS-SPME-GC/MS. The study revealed that the aroma-bearing fraction of rose volatiles consists mainly of monoterpene alcohols; 2-phenylethanol was the most abundant component (8.4–33.9%), followed by geraniol (12.8–32.5%) and citronellol + nerol (17.7–26.5%). Linalool, α-pinene, β-myrcene, and rose oxides were also observed in low concentrations. The stearopten fraction in the HS phase was observed in low concentration, with main representatives nonadecane + nonadecene, heptadecane, heneicosane, and tricosane. The HS-GC profile of the R. alba fresh flowers shows distinct differences in relative abundance of the components between the two studied clones of the population, as well as between volatiles in petals and in the whole blossom. The absence of some undesirable components, such as allergenic and potentially carcinogenic methyl eugenol in fresh R. alba blossom, makes white oil-bearing rose a promising alternative to R. damascena in perfumery, natural cosmetics, and aromatherapy. Full article

Lung adenocarcinoma exhibits a heterogeneous molecular landscape shaped by key oncogenic drivers and tumor suppressor gene alterations. Mutation frequencies vary geographically, influenced by genetic ancestry and environmental factors. However, the molecular profile of lung adenocarcinoma in Bulgarian patients remains largely uncharacterized. We conducted a prospective study of 147 Bulgarian patients with metastatic lung adenocarcinoma, analyzing clinicopathologic features and somatic mutation frequencies using next-generation sequencing. Key mutations and their prevalence were assessed and compared with published data from other populations. The cohort included predominantly male patients (68.0%) with a median age of 67 years. TP53 mutations were most frequent (41.5%), followed by EGFR alterations (19.0%) and KRAS c.34G>T (p.Gly12Cys) (17.0%). Over half of the patients (51.0%) harbored two or more gene mutations. Mutation frequencies aligned closely with European cohorts, exhibiting a lower prevalence of EGFR mutations compared to East Asian populations. This study characterizes the molecular landscape of lung adenocarcinoma in Bulgaria, highlighting the predominance of TP53 and KRAS mutations. The findings emphasize the need for comprehensive molecular profiling to inform targeted therapies and support precision oncology approaches tailored to the Bulgarian population. Further research is needed to validate these results and improve clinical outcomes. Full article

Background/Objectives: The forced oscillation technique (FOT) is a non-invasive, effort-independent method for assessing respiratory mechanics and is particularly suited for young children who cannot reliably perform spirometry. This study aimed to evaluate the main anthropometric determinants of respiratory impedance parameters—resistance (Rrs) and reactance (Xrs)—in healthy Bulgarian children aged 2 to 8 years. Methods: A total of 100 healthy children were evaluated using a commercially available device at oscillation frequencies of 5, 11, and 19 Hz. Anthropometric data were collected, and FOT measurements were conducted following ATS/ERS guidelines. Stepwise multiple linear regression was applied to identify predictors of Rrs and Xrs. Results: Height (mean height of the children: 113.89 ± 8.46 cm) emerged as the most significant determinant of both Rrs and Xrs across all frequencies with a moderate inverse correlation observed between Rrs at 5 Hz and height (r = −0.446; p < 0.001). Weight additionally influenced reactance at 5 Hz. The mean R5–19 was 0.55, but no significant associations with height or weight were found. Stepwise regression confirmed height as the sole consistent predictor, while sex and age had no significant effect. Conclusions: This study is the first to present the determinants of key FOT parameters in a population of Bulgarian children. Height was identified as the strongest predictor of respiratory impedance and should be prioritized in the development of reference values for children under 8 years old. These findings reinforce the clinical utility of FOT in early childhood. Full article

Background/Objectives: Cervical cancer remains a significant global health issue, with high incidence and mortality rates, particularly in Eastern Europe. Despite the availability of vaccines against human papillomavirus (HPV), regular screening remains crucial for prevention. Testing for HPV, alone or combined with cytology, has become an alternative to traditional methods. However, since many HPV infections are transient, additional tests are needed to identify high-risk cases. Methods: This study aims to generate detailed statistical data specific to the Bulgarian population, reinforcing the necessity of incorporating updated European methodologies and algorithms for the prophylaxis and prevention of cervical carcinoma. Results: By evaluating epidemiological trends, risk factors, and the effectiveness of current preventive measures, this research seeks to provide a strong foundation for enhancing cervical cancer screening and early detection programs. This method improves triage by identifying women who require further evaluation, ensuring timely referrals for colposcopy or biopsy. Conclusions: While liquid-based cytology (LBC) and HPV genotyping improve detection, the introduction of p16/Ki-67 dual staining has enhanced risk stratification, offering higher sensitivity and specificity for detecting high-grade lesions. These advancements are improving cervical cancer screening and patient outcomes. Full article

For the first time, the numerous scattered data on birds (wild and domestic) have been collected based on their medieval bone remains discovered on the modern territory of the Republic of Bulgaria. The collected information is about a total of 37 medieval settlements from the time of the First and Second Bulgarian Empires. Among the settlements studied are both the two medieval Bulgarian capitals (Pliska and Veliki Preslav), as well as other cities, smaller settlements, military fortresses, monasteries, and inhabited caves. The data refer to a total of 48 species of wild birds and 6 forms of domestic birds of 11 avian orders: Accipitriformes, Anseriformes, Ciconiiformes, Columbiformes, Falconiformes, Galliformes, Gruiformes, Otidiformes, Passeriformes, Pelecaniformes, and Strigiformes. The established composition of wild birds amounts to over one tenth (to 11.5%) of the modern avifauna in the country. Five of the established species (10.4%) have disappeared from the modern nesting avifauna of the country—the bearded vulture, the great bustard, the little bustard, the gray crane, and the saker falcon (the latter two species have reappeared as nesters in the past few years). First Bulgarian Empire (681–1018): Investigated settlements—22. Period covered—five centuries (7th to 11th c.). Found in total: at least 44 species/forms of birds, of which 39 species of wild birds and 5 forms of poultry. Second Bulgarian Empire (1185–1396): Investigated settlements—15. Period covered—3 centuries (12th to 14th c.). Found in total: at least 39 species/forms of birds, of which 33 species of wild birds and 6 forms of poultry. The groups of raptors, water, woodland, openland, synanthropic and domestic birds were analyzed separately. The conclusion was made that during the two periods of the Middle Ages, birds had an important role in the material and spiritual life of the population of the Bulgarian lands. Birds were mainly used for food (domestic birds), although some were objects of hunting. No traces of processing were found on the bones. Birds were subjects of works of applied and monumental art. Their images decorated jewelry, tableware, walls of buildings and other structures. Full article

Background/Objectives: Autism spectrum disorder (ASD) has a wide-ranging impact on individuals’ quality of life and development, and there is a critical need for greater awareness, early intervention, and comprehensive support strategies to effectively address the unique needs of those affected by ASD. Recent studies highlight the gut microbiome’s potential role in modulating ASD symptoms via the gut–brain axis, but specific microbial biomarkers remain unclear. This study aims to investigate differences in gut microbiota composition between ASD patients and neurotypical controls in a novel approach, specifically assessing ratios of Firmicutes/Bacteroidetes (F/B), Actinobacteria/Proteobacteria (A/P), and Prevotella/Bacteroides (P/B) as potential biomarkers. Methods: We analyzed gut microbiome samples from 302 Bulgarian children and adolescents diagnosed with ASD (aged 2–19 years). Microbial ratios (F/B, A/P, and P/B) were calculated and compared against previously reported reference meta-analytic means from European neurotypical populations. The statistical significance of deviations was assessed using parametric (t-tests), non-parametric (Wilcoxon signed-rank tests), and proportion-based (binomial tests) methods. Effect sizes were quantified using Cohen’s d. Significant differences between ASD cases and neurotypical reference values were observed across several age groups. Results: Notably, children with ASD demonstrated significantly lower F/B and A/P ratios, with the youngest cohort (0–4 years) exhibiting the greatest differences. Deviations in the P/B ratio varied across age groups, with a significant elevation in the oldest group (≥10 years). Collectively, ASD cases consistently exhibited microbiota profiles indicative of dysbiosis. Conclusions: Our findings support gut microbiome dysbiosis as a potential biomarker for ASD, highlighting significantly altered bacterial ratios compared to neurotypical controls. These microbiome shifts could reflect early-life disruptions influencing neurodevelopment. Future studies should adopt longitudinal and mechanistic approaches to elucidate causal relationships and evaluate therapeutic microbiome modulation strategies. Full article

Peaches (Prunus persica L. Batsch) and nectarines (Prunus persica L. Batsch var. nectarina [Ait.] Maxim) are economically important stone fruits consumed worldwide, both fresh and processed. Viruses and viroids significantly constrain the cultivation and productivity of peach orchards. Climate change may alter vector populations and lead to shifts in agricultural practices, influencing the spread of these viruses and viroids. Additionally, market globalization further intensifies the pressure on peach crops by facilitating the movement of pathogens, increasing the incidence of virus-induced diseases. In this study, we identified the viral and viroid communities in five peach cultivars from Bulgaria and assessed their impact on symptom development. RNA sequencing of symptomatic leaf samples revealed the presence of common peach viruses, such as plum pox virus and prunus necrotic ringspot virus. Notably, we identified peach latent mosaic viroid and cherry green ring mottle virus in Bulgarian peach orchards for the first time. Furthermore, bioassays of indicator plants, ELISA, and Sanger sequencing were performed for each peach tree to complement the RNA sequencing data. These findings provide valuable insights into the composition of viral and viroid pathogens affecting peaches in Bulgaria and will support the development of targeted strategies for monitoring and managing these pathogens, contributing to the sustainable production of peaches in the region. Full article

Respiratory syncytial virus (RSV) and rhinovirus (RV)—the two primary causative viruses of bronchiolitis in children—have been studied extensively in terms of their associations with disease severity and serious late disease outcomes. In this study, we explored the differences in the clinical values of IFN-γ and IL-10 serum levels in RSV and RV bronchiolitis in the Bulgarian childhood population. Eighty-eight children with acute bronchiolitis, aged two months to two years, who were admitted to the General Pediatrics Clinic of University Hospital “Prof. St. Kirkovich”, Stara Zagora, Bulgaria served as this study’s subjects. The degree of wheezing and respiratory failure were classified. Naso-pharyngeal swabs were collected from all participants, and molecular identification of viruses was performed using real-time PCR. Serum samples were used to determine IFN-γ and IL-10 quantities using ELISA kits, and data are presented as the median IQR (25–75%). The total serum IL-10 levels were significantly enhanced in RSV-infected children compared to those infected with RV (14.4 (12.2–24.0) vs. 8.9 (7.2–12.5); p < 0.001) and the other viral bronchiolitis groups (14.4 (12.2–24.0) vs. 6.65 (3.9–15.3); p = 0.003). The highest IL-10 levels (14.4 (12.8–27.9)) were found in RSV-positive patients with first-degree respiratory failure. Almost identical serum IFN-γ levels were determined for RSV- and RV-positive bronchiolitis patients (3.2 (1.6–6.8) and 2.8 (1.1–7.3); p = 0.781). Variance analysis of IL-10 serum levels revealed statistically significant differences among the patient groups depending on the type of viral infection, concerning respiratory failure (p = 0.005) and wheezing severity (p = 0.017). Our findings show that the IL-10 levels and the type of virus have a combined effect on disease severity. These data might contribute to patients’ personalized/individualized therapy and the prevention of recurrent wheezing later in life. Full article

Efficient and fair allocation of donated blood depends on multiple factors, like medical urgency, donor/recipient compatibility, blood availability, geographic location, limited shelf life, etc. Due to the limited supply of blood and its critical role in healthcare, fair distribution protocols are essential. This study builds upon previous authors’ research that proposed a general mathematical model for fair blood allocation, taking as inputs the universal blood compatibility chart and the assumption of allocating equal shares of the donated blood from each blood type to recipients with respectively compatible blood types. The sum normalization technique was performed (twice, first per recipients and then per donors) for the purpose of balancing between donation needs and options. The result was an indicative blood allocation reference framework in support of the decision making in transfusion haematology. In the present paper, we tailor that general model by introducing as model variables the actual blood group frequencies of a given population. Additional customization is proposed by adding weight coefficients to the values along the framework’s main diagonal that represent ABO-identical transfusions, preferred to non-identical transfusions for minimizing the risks of hemolytic reactions. The model is further elaborated via intervalization of the estimations in the resultant blood allocation framework, thus making the model more flexible and usable. While demonstrated with Bulgarian blood group distributions from 2023, the model can be adapted to other populations and contexts. Full article

Objectives: The aim of this study was to establish the etiology of uveitis and to examine its relationship with anatomical localization, age, and gender. Methods: A prospective study on patients with uveitis was conducted over a 13-year period at the Department of Ophthalmology, University Hospital “St. George”, Plovdiv, Bulgaria. Each case was diagnosed based on a comprehensive eye examination, a review of the systems, and additional laboratory and specialized examination methods. Patients were categorized into four groups based on the location of inflammation: anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis. Results: A total of 606 patients with uveitis were included in the study. The mean age of the study group was 46.5 ± 18.6 years. There was no statistically significant difference in gender distribution (p = 0.329). Anterior uveitis was the most dominant anatomical localization (p < 0.001). Cases with clarified etiology were significantly prevalent (p < 0.001). The most frequently identified etiology was HLA B27-associated uveitis (32.5%), followed by viral uveitis (16.8%). A significant correlation between etiology and anatomical localization was found (p < 0.001). The highest proportion (93%) of cases with clarified etiology was associated with posterior uveitis, while the lowest (39.7%) was linked to intermediate uveitis. Conclusions: We found that anterior uveitis was the most common anatomical localization, followed by intermediate uveitis. The disease is rare in childhood, while in elderly patients, there is an increase in idiopathic and viral uveitis cases. Our results provide valuable information about the most common etiologies of uveitis among the Bulgarian population. Full article

Background and Objectives: Hypertension is found as the leading cardiovascular disease in Bulgaria and the most frequent lifelong condition with a high risk of non-adherence. The aim of this study is to assess the hypertension patients’ adherence to medication therapy in Bulgaria by using the self-efficacy for appropriate medication use scale (SEAMS). Materials and Methods: A cross-sectional study was conducted in the major cardiology settings in the capital Sofia and in Burgas, the fourth largest city in Bulgaria. Data were collected from January 2024 to July 2024. The SEAMS was validated in Bulgarian in a sample of patients with hypertension that made it extremely suitable for our study. We applied 19 questions. Additionally, we used Cronbach’s α, ANOVA analysis, Pearson correlation, and covariance tests for statistical significance. Results: A total of 232 patients completed the study. Both genders are almost equally distributed (49.6% male and 50.4% female). The results reveal that the increase in the number of diseases and prescribed medicinal products leads to a worsening adherence level. Advancing age negatively affects the adherence scores. The study showed that in half of the age groups studied (patients’ age: 40–49, 60–69, and 70–79), adherence in patients treated with FDCs was better or almost the same (patients’ age: 50–59) as those treated with several mono-products. Conclusions: Measuring adherence with SEAMS in the hypertensive Bulgarian population in two regions reveals a good level of adherence. Factors negatively affecting adherence were older age, polypharmacy, co-morbidity, and therapy with monoproducts. Full article

Background: Type 2 diabetes is a chronic disease with high global prevalence and significant social and economic burden. The pandemic affected patients’ diagnostics and medicines dispensing. Diabetes was among the most-affected conditions during lockdown due to the limited resources and unaffordable medicines. The impact of the pandemic on utilisation and cost has not been thoroughly studied, which inspired us to conduct the current study. Objectives: The study explored cost dynamics, changes in antidiabetic medicines utilisation, and public expenditure of pharmacotherapy in three periods: pre-pandemic (2018–2019), during the pandemic (2020–2021), and post-pandemic (2022–2023). Methods: It is a retrospective, observational, macroeconomic analysis. Reimbursed cost and utilisation were analysed as a crude sum and as indexes of the average value. Results: The result shows that five new INNs have been included in the Positive Medicines List (PML), two of these being fixed dose combinations (FDCs). During the pandemic, a slow tendency of increase of the crude sum of public expenditure was observed, followed by a sharp increase in the post-pandemic period. The public spending increased more than twice, and we found a 30,018,982 Euro growth. The highest public spending is found for dapagliflozine in post-pandemic vs. pandemic period (index = 1.67), as well as empagliflozin/metformin and dapagliflozine in pandemic vs. pre-pandemic period (index = 0.21). Total utilisation increases from 58.16 to 71.78 DDD/1000 inh/day during 2018–2023. The most significant rise of utilisation is found for canagliflozin (index = 0.68) pandemic vs. pre-pandemic and dapagliflozin (index = 3.66) post-pandemic vs. pandemic. Conclusions: Analysis of the antidiabetic medicines market reveals the rising of reimbursed cost and utilisation in pre-, post-, and during the pandemic. In conclusion, organisation of the supply and financing of antidiabetic medicines was not affected during the pandemic. Full article

Long-term data on the phytoplankton of the Bulgarian Black Sea (BBS) coast describe three states for the ecosystem: a “pristine” reference phase (1954–1970 years); an intensive anthropogenic eutrophication (1970–1992 years) phase; and a post-eutrophication phase after the early 1990s of the 20th century. The eutrophication period is characterised by ecosystem degradation and intense phytoplankton blooms, some of which were formed by the potentially toxic species Lingulodinium polyedra. This warm-water species is a red tide former that is associated with fish and shellfish mortality events. In the 1980s, L. polyedra reached the highest biomass of 84.4 g·m⁻³ in Varna Bay, BBS. The aim of this study (1992–2022) was to provide an overview of the development of L. polyedra in the phytoplankton biocenosis in the Bulgarian part of the Black Sea, taking into account the influence of anthropogenic stress and the climatic variables NAO and SST on the development of the species population. An analysis of the distribution of the dinoflagellate L. polyedra is based on a total of 5126 phytoplankton samples collected during the period between 1992 and 2022 under projects led by the Institute of Fish Resources, Varna. The samples were analyzed using standard methods validated for the Black Sea, and phytoplankton abundance and biomass were determined. The species are most abundant in summer in the coastal marine areas exposed to anthropogenic influence. During the analyzed period, a decrease in the abundance and biomass of L. polyedra in Bulgarian Black Sea waters were observed. It was found that the influence of climatic factors such as NAO and SST on the species population is from weak to moderate, and the correlation with NAO cycles is better expressed. Full article