Plovdiv Medical University

INTRODUCTION:Atrial fibrillation (AF) is the most common arrhythmia in older people, with an increasing prevalence of various geriatric conditions, such as multimorbidity, and frailty. A contemporary integrated approach is effective in reducing the risk of clinical adverse events, particularly when streamlined through the application of the Atrial Fibrillation Better Care (ABC) pathway, as proven in 2 non-European trials. METHODS:The atrial fibrillation integrated approach in frail, multimorbid and polymedicated older people (AFFIRMO) trial, a European multicenter, open-label, cluster-randomized study, will examine whether a mobile-health integrated care approach based on the ABC pathway combined with a multidimensional Comprehensive Geriatric Assessment (CGA) can reduce the 12-month risk of unplanned all-cause hospitalizations in patients with AF ≥65 years with ≥1 concomitant chronic condition(s). RESULTS:The AFFIRMO trial enrolled 1,260 patients with AF (mean age 74 [SD 6] years; 44.4% female) across 6 European countries (Bulgaria, Denmark, Italy, Romania, Serbia, and Spain). At baseline, the median (IQR) CHA2DS2-VASc score was 4 (3-5), and the median (IQR) HAS-BLED score was 1 (1-2). Hypertension was reported in 992 (78.7%) patients, and diabetes mellitus in 369 (29.3%) patients. Among the enrolled patients, 507 (40.5%) were prefrail, and 171 (13.7%) were frail. Oral anticoagulants (OACs) were prescribed for 1,225 (97.2%) patients, with 1,149 (91.2%) patients receiving non-VKAs oral anticoagulants (NOACs). Follow-up is ongoing and planned to be completed in January 2026. CONCLUSIONS:The AFFIRMO trial will provide evidence on the efficacy of the ABC pathway in conjunction with the CGA approach in reducing the risk of unplanned all-cause hospitalizations and other clinical adverse events in older, multimorbid patients with AF. REGISTRATION:ClinicalTrials.gov identifier: NCT06775028.

Introduction and objective: This work integrates findings from functional connectivity and phenomenological psychopathology to answer the question: “Is there a relationship between disturbed implicit and explicit temporal experience and impaired interaction within the triple network in schizophrenia patients?”, proposing a hypothesis on schizophrenia in terms of a lack of synchrony disrupting the constitution of selfhood. Materials and methods: Five patients with schizophrenia (Positive and Negative Syndrome Scale, PANSS score ≥40) and five healthy controls were scanned (resting-state fMRI) during two trials, each lasting 6 minutes and 34 seconds. In the first trial, participants were asked to keep their eyes closed, and no stimulus was presented. In the second, a digital clock was displayed on the screen. Results: A two-sample t-test was applied to compare the two groups, revealing caudate and pallidum activity associated with explicit temporal experience (p < 0.01), confirmed by research on the basal ganglia and their involvement in governing the temporal structure for movement and cognition. The activity associated with implicit temporal experience showed no significant statistical differences (p < 0.05, p < 0.001). There was a loss of competition between the SAL/DMN and the CEN/Insula; instead, there was an all-time activation of the DMN and coactivation with the SAL (including the Insula), as reported in earlier research. Conclusions: The findings support grounding the notion of selfhood in temporal experience. The limitations and implications of the study are also considered.

Insulin resistance is a central mechanism underlying metabolic syndrome, type 2 diabetes mellitus, obesity, and related cardiometabolic disorders. This narrative review critically evaluates the current evidence regarding vitamin D, berberine, and chromium as complementary nutritional interventions for insulin resistance. A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for English-language publications published between 2010 and March 2026, with landmark earlier studies included where appropriate. Mechanistic, preclinical, observational, and clinical evidence was synthesized narratively. The reviewed supplements influence insulin resistance through distinct mechanisms involving insulin signaling, inflammation, oxidative stress, and glucose metabolism. However, clinical findings remain heterogeneous and appear to depend on baseline nutritional status, metabolic phenotype, supplement formulation, and study design. Current evidence supports their use only as adjuncts to lifestyle modification and evidence-based therapy in selected individuals with increased metabolic risk. Future well-designed randomized controlled trials are required to define their long-term efficacy, safety, and role in personalized metabolic management.

Over the last century, the nursing profession has undergone a dramatic development – from a volunteer, through a doctor's assistant, to a nurse with an independent role. Their participation in voluntary initiatives is essential for addressing challenges faced by many countries. The purpose of this study is to analyze the motivation and willingness of nursing students to participate in volunteer initiatives abroad. Material and methods: The study included 194 (96.5%) women and 7 (3.5%) men. The structural distribution of the 201 participants in the study from different Universities teaching "Nursing care". The results were processed with the statistical package SPSS. 21. A significant difference was considered p <0,05. Results: The students' responses regarding their willingness to participate in volunteer missions abroad are presented, grouped by university. The results show that students at a younger age make emotional decisions. This study emphasizes the importance of age and life circumstances in the formation of individual preferences and decisions related to volunteering. Conclusion: The results show that the main reason for participation in international missions is the humane nature of the profession, which testifies to the high level of professional ethics and humanitarian values built during their studies.

Aim: To evaluate the clinical effect of the probiotic BioGaia® ProDentis as an adjunctive therapy for the removal of black stains on tooth surfaces in children. Methods and materials: The study included sixty 5-12-year-old patients with extrinsic black stains, meeting equal inclusion and exclusion criteria. The Modified Lobene Index was used to evaluate the disturbance of black stain pigmentation. Patients were divided into two equal treatment groups. In the experimental group, black stains were removed through professional oral hygiene, followed by the prescription of the probiotic supplement BioGaia® ProDentis for a month, whereas in the control group, only professional oral hygiene was performed. Data processing and analysis were carried out using the statistical software IBM SPSS v 25 (SPSS Inc., IL, USA). An independent sample t-test was used to compare mean differences between two groups. Results: At the first visit, no significant difference in the distribution of black stain pigmentation was observed between the two groups (p >0.05). By the second visit, the experimental group showed a significant reduction of black stain pigmentation on vestibular and oral surfaces (p <0.001). By the third visit, these beneficial effects remained relatively stable (p <0.001). Conclusions: The adjunctive use of probiotic BioGaia® ProDentis leads to a progressive reduction of black tooth stains in pediatric patients, achieving statistical and clinical significance at the final assessment.