Terson's syndrome is commonly seen in patients with aneurysmal subarachnoid hemorrhage, leading to varying degrees of intraocular hemorrhage. Although in many cases the course of the disease is benign and may resolve without the need for surgical intervention, some patients may experience complications that necessitate surgery. Early confirmation of the diagnosis and appropriate intervention are crucial to avoiding complications and improving the quality of life.The gold standard for diagnosis is fundoscopy. However, since patients with subarachnoid hemorrhage are often in intensive care and require constant neurological monitoring, this method is not always feasible. The aim of this study is to present our experience in using ocular ultrasound and computed tomography as diagnostic methods for patients with Terson's syndrome. A retrospective study was conducted on the database for the period from May 2021 to December 2023, including all patients admitted to our clinic with a diagnosis of aneurysmal subarachnoid hemorrhage confirmed by computed tomography (CT), CT angiography, or digital subtraction angiography. We collected data on standard demographic characteristics of the patients, aneurysms, and clinical status. CT and ultrasound examinations of the visual apparatus were performed, and the results were compared with fundoscopy findings. Out of 171 patients examined during the study period, intraocular hemorrhage was detected in 16 (9.4{\%}) of them. The diagnosis was confirmed through ultrasound examination in all these cases. In contrast, changes were observed in 6 (37.5{\%}) out of these 16 patients, using computed tomography. Ocular ultrasound is an effective method for detecting intraocular hemorrhage in patients with Terson's syndrome, both as a primary diagnostic tool and for patients who are not suitable for other methods. Computed tomography should not be overlooked as a diagnostic method and understanding its limitations and appropriate timing for its application must be considered.
Introduction: Ischemic stroke (IS) is a leading cause of mortality and disability worldwide. Although the incidence of stroke has been decreasing in developed countries, there is evidence that the number of stroke cases among young and middle-aged populations is increasing. Inflammatory markers such as C-reactive protein (CRP) and leukocytes play a significant role in the pathophysiology of stroke and may serve as potential predictors of clinical outcomes. Objective: To evaluate the role of CRP and leukocytosis as predictors of mortality in young and middle-aged patients with acute ischemic stroke. Methods: This retrospective study includes 168 patients aged 18 to 59 years with acute IS, hospitalized at University Hospital "St. Marina", Varna, during the period 2017-2022. They were further divided into two groups: the target group, consisting of 67 patients who died during hospitalization, and the control group, comprising 101 patients who survived the acute phase. CRP and leukocyte levels were measured within 24 hours of hospitalization. Logistic regression was used to assess the association between these markers and mortality. Results: Mean levels of CRP and leukocytes were significantly higher in the target group compared to the control group (p<0.001). Logistic regression indicated that elevated CRP levels (coefficient 0.0241, p<0.001) and leukocyte counts (coefficient 0.1075, p=0.014) were significant predictors of mortality in ischemic stroke. The ROC analysis of the model based on these markers showed good prognostic ability (AUC=0.75). Conclusion: This study emphasizes the importance of CRP and leukocyte levels as easily accessible and reliable predictors of mortality in ischemic stroke among young and middle-aged patients.
Introduction: Spinal cord infarction is a rare, but severely disabling disease. It is characterized by sudden disruption of its circulation resulting in insufficient blood flow, respectively of oxygen and glucose to the spinal cord. Aortic dissection is one of the numerous etiological factors leading to spinal vascular damage. Clinical case: A 71-year-old female patient was urgently hospitalized because of a sudden onset of lower flaccid paraplegia. A a spinal stroke with hyperintense T2 signal of the myel & ocy;n was revealed by magnetic resonance imaging (MRI) from the Th9 level to the conus medullaris, mainly of the gray matter and anterior horns. A dissection of the ascending aorta Stanford Type A with wall d delamination to the Adamkiewitz artery and upper lumbar arteries originating from the false lumen was established by CT aortography. The patient underwent emergency cardiac surgery with a vascular prosthesis implanted. Discussion: Aortic dissection is a rare cause of spinal cord infarction but it should be considered in the differential diagnosis of patients with arterial hypertension, acute onset of debilitating neurological symptoms with paraparesis or paraplegia, accompanied or not by back pain. The gold standard for diagnosing a spinal cord infarction is MRI. Early diagnosis and timely treatment - conservative and/or surgical, are crucial in preventing life-threatening conditions and debilitating complications. Conclusion: Spinal cord infarction in aortic dissection though a rare condition should be included in the differential diagnosis of patients with sudden onset paraparesis/ paraplegia. A multidisciplinary approach is necessary to evaluate the most appropriate and timely therapeutic behavior in order to provide adequate diagnosis and therapy.
Aim: To investigate and compare the effects of tissue flossing with assisted stretching massage on the knee dysfunction. Materials and methods: Sixteen patients were studied, divided into two groups: Group A - control (n=8, men/women=5/3) with a mean age of 36 +/- 4.2 years and Group B - experimental (n=8, men/women=4/4) with a mean age of 38 +/- 3.8 years. All patients had impaired knee joint function with varying degrees of pain, limited range of motion and reduced muscle strength. The control group of patients was treated with the generally accepted effective stretching massage, and the experimental group - with the relatively new physiotherapeutic method of tissue flossing, applied to the entire lower limb, and not to one joint, as in previous studies. Before and after treatment, we measured the intensity of pain in the knee joint using a visual analog scale (VAS), the volume of motion (VOM) using knee goniometry, and muscle strength using dynamometry. Results: Both therapy modalities applied to the experimental and control groups showed positive impact on the patient's condition with slightly better results in the experimental group. A significantly better effect in patients treated with tissue flossing was found regarding pain intensity, knee flexion range of motion, and muscle strength. Conclusion: A positive effect on the impaired functionality of the knee joint was established after the application of both physiotherapeutic methods of tissue flossing and stretching massage. Tissue flossing therapy is more effective compared to stretching massage, it has a better effect on the intensity of pain, it increases and normalizes the volume of movement in the joint, increases muscle strength and control more significantly, which is why we recommend its use as a main or additional treatment modality.
The aim of this study was to evaluate the effect of dry needling (DNT) as an adjunctive therapy in reducing pain, improving function, and quality of life in patients with chronic lumbosacral pain. Material and methods: A total of 35 patients with chronic lumbosacral pain (LSP), radiating along the sciatic nerve, and with impaired sensorimotor function were studied, divided into two groups: Group K-control (n=15, 9 men and 6 women) and Group E-experimental (n=20, 11 men and 9 women). All patients were treated with classical therapeutic massage of the lumbosacral region and a complex of physical exercises, and those from Group E additionally by placing dry needles in the most painful muscle trigger points (TP) and along the sciatic nerve. To assess the effect of physiotherapy, all subjects were examined before and after treatment about: pain intensity on a visual analog scale (VAS), range of motion (ROM) by goniometry, and muscle strength in hip flexion and extension by dynamometry, and the overall subjective assessment by the Roland-Morris Disability Questionnaire (RMDQ). Results: All patients improved significantly but those from the experimental group more pronounced regarding: pain intensity by 1.12 points on the VAS; ROM in the hip joint goniometrically by 9.02 degrees in flexion and by 3.5 degrees in extension; and the overall subjective assessment of the therapeutic course by RMDQ; but not significantly for leg muscle strength in hip joint. Conclusion: Both therapeutic approaches reliably reduce pain and improve mobility in patients with chronic lumbosacral pain syndrome, but the additional application of DNT to classical therapeutic massage and physical exercises to increase leg muscle strength significantly enhances the effect of the standard intervention and reliably increases the therapeutic effect by significantly reducing pain symptoms, increasing mobility and functionality of the lower back and limb.
Objective: To develop written instructions for home kinesitherapy after spinal surgery due to low back pain and to evaluate the effect of patient education. Material and methods: The study included 80 patients operated on at the Neurosurgery Clinic of Sofiamed University Hospital-Sofia, divided into a control (CG, n=20) and experimental (EG n=60) group. On the day of discharge and 1 month later, they were tested using the Oswestry Disability Questionnaire for Low Back Pain (ODI) and the Health Self-Assessment Questionnaire (Health Survey-SF-36). The patients in the CG were given only verbal instructions, and those in the EG-written instructions on how to perform physical exercises and activities of daily living. Results: Significant improvement was found in the self-assesment of all the patients from both groups one month after spinal surgery and the implementation of motor exercises, but the outcomes were significantly better in EG patients: according to ODI data, the percentage of EG patients with a minimal degree of disability increased reliably at the expense of the percentages with moderate, severe and significant degrees of disability; from SF-36, the overall health score increased from 55 to 76 points, social and physical functions from 57 to 77, and limitations in performing tasks due to health problems from 34 to 51 points. Conclusion: Written instructions for home kinesitherapy and for performing basic daily activities of patients after spinal surgery due to low back pain led to a more pronounced improvement in their quality of life, related to physical and mental health and level of independence, and to a greater degree of disability reduction than the application of oral instructions alone.
Lateral femoral cutaneous nerve (LFCN) injury is one of the most common complications of total hip arthroplasty (THA) using the direct anterior approach (D & Acy;A), a widely used approach to the hip joint in the last decade due to faster patient recovery, less blood loss, and reduced pain. The disadvantages include the longer training period for the surgeon and the patient's position during surgery compared to other approaches. Aim: To study the frequency of iatrogenic perioperative lesion of the LFCN in THA by DAA performed by an operator with little experience, to analyze the dynamics of symptoms and to assess the recovery time after the surgical intervention. Materials and Methods: A retrospective, single-cohort observational study of 16 patients with LFCN injury in THA with DAA, performed by an orthopedist in the initial phase of training at the same center over a 4-year period, is presented. The LFCN lesion was confirmed by neurological examination. Pain intensity was also assessed. Patients were clinically followed up after 2 and 6 weeks, 6 months, 1 and 2 years after surgery. Results: Patients were examined on follow-up visits at 2 weeks, 6 weeks, 6 months, 1 and 2 years after surgery. In 8 patients damage to the LFCN was observed. Symptoms had different velocity from mild hypoesthesia to severe burning pain in the anterolateral thigh. All cases of clinically presenting LFCN injury clinically improved at the 1-year follow-up, with 5 patients fully recovered. 2 patients had still mild symptoms of nerve damage at the 1year follow up. By the 2-year follow up, all the symptoms resolved. The subjects studied had a mean age of 65.96 +/- 15.3 years. In 8 (50%) of them, damage to the LFCN was found with varying severity of symptoms-from mild numbness to severe burning pain in the anterolateral part of the thigh. During the 1-year follow-up, 6 patients with LFCN damage clinically improved, with 5 of them experiencing complete recovery, and in 1 patient mild symptoms of damage persisted. One of the patients was found to have a peripheral nerve complication with no effect from the therapy. In the 2nd year after THA all symptoms were completely restored. Conclusion: Damage to the LFCM is of significant importance in patients undergoing THAvia DAA. It does not affect the functional outcome of hip replacement surgery, but may lead to lower subjective patient satisfaction with the surgery, which can be avoided with adequate operator training.
Brain stroke is a socially significant disease that requires special attention to prevention and prophylaxis. The aim of this study was to investigate the awareness of the population about the risk factors for stroke, its early symptoms and their timely identification in order to undertak & iecy; the necessary actions and minimize morbidity and disability, depending on each individual. Materials and methods: A sociological method of a cluster sample survey was used through an anonymous questionnaire applied to 204 persons, conducted in September 2024. The survey included questions about the demographics of respondents, their knowledge of risk factors and early symptoms of cerebral stroke, information sources and the public awareness raising forms to be used. Results: Half of the respondents (50.8%) were not aware of the risk factors for & acy;& lcy; acute cerebrovascular accident. The rest of them most often identified as risk factors the arterial hypertension (92.6%), hypercholesterolemia (89.9%), previous stroke (87.8%), as well as alcohol abuse (82.7%), family history of stroke (71.1%) and smoking (68.1%). The sudden manifestations of: speech impairments (81.4%); facial asymmetry (79.8%); unilateral upper limb weakness (73.5%), motion and gait disturbances (66.5%), and dyscoordination (63.9%), were the most recognizable by the respondents. No more than two to three early symptoms of stroke were mainly recognized. Sources of information were predominantly neurologists and general practitioners. The preferred forms of raising awareness were the television broadcasts and social networks. Conclusion: A significant deficit in knowledge about stroke risk factors was identified. Raising awareness would contribute to their adequate preventive and therapeutic impact and dynamic follow-up, and combined with the timely recognition of symptoms, would increase the effectiveness of dealing with those socially significant acute cerebrovascular diseases.
The purpose of the study is to investigate the influence of therapeutic exercises on orthostatic dysautoregulation after supratentorial unilateral ischemic stroke (SUIS). Material and methods: A study was conducted on 67 patients with supratentorial unilateral ischemic stroke in a chronic period (SUISChP). The experimental group (EG) included 56 patients (32 men and 24 women), with duration of the disease of 7.8 +/- 2.0 months, in which the specialized kinesitherapy program was applied (SKT) for 10 days under control, and then continued to be performed at home as an adapted exercise program for a period of 3 weeks. The control group (CG) consisted of 11 patients (9 men and 2 women) with duration of the disease of 7.3 +/- 1.5 months, treated in a routine way, using an usual 10-day kinesitherapy program. They only had control follow-ups without performing a kinesitherapy program after the 10-day treatment. To determine the type of orthostatic reactivity, the classification of O. Thulesius (1976) is used, which is based on the change in heart rate (HR) and systolic arterial pressure (SBP) when changing the initial position from lying down to standing. Results: The study shows that after the applied specialized kinesitherapy, which was later continued as a program of exercises at home, patients with SUISChP and pathological orthostatic autoregulation normalized their orthostatic reactivity, which was most pronounced at the 1st month after the start of treatment (p<0.001). In patients from the control group, who did not perform long-term SKTP, a return to the initial state was established at the end of the monitored period. Conclusion: Specialized and routine kinesitherapies had a significant positive effect on orthostatic autoregulation on the 10th day, which was more pronounced in EG. At the end of the 1st month, the effect accumulates in the EG and is exhausted in the control patients.
Introduction: There has been an increase in the incidence of spinal epidural abscesses in the recent years. Most published series do not distinguish abscesses secondary to spondylodiscitis from non -associated with spondylodiscitis that originate directly in the epidural space. Materials and Methods: During the period from March 2014 to March 2022, 4 patients (two females and two males) aged from 48 to 70 years with spinal epidural abscesses without presence of spondylodiscitis, were treated at our institution. The history, clinical presentation, paraclinical and imaging data, the type of treatment and outcome were analyzed. Results: All patients had vertebralgia, and in three of the cases it was accompanied by pronounced motor and sensory deficits. Abscesses were located in the cervicothoracic region in two patients, in the thoracic region in one, and in the thoracolumbar region in one, involving segments 5, 7, 4, and 11, respectively. In all patients, a posterior operative access was used - laminectomy, through which decompression of the nerve structures and evacuation of the epidural abscess was achieved. Staphylococcus aureus was isolated from the abscess in three cases. Postoperatively, the neurologic deficits improved in all patients except for one, who developed uncontrollable sepsis and multiple organ failure and died 48 hours after surgery. The last patient was diagnosed with COVID-19 during the second week, and the patient died on day 35. Conclusion: In pure spinal epidural abscesses not associated with spondylodiscitis, there is no involvement of the vertebral bodies by the infection, which significantly reduces the risk of subsequent development of instability, and spinal fusion is required only in isolated cases.
Background: Intracranial lipomas are rare congenital abnormalities. The prevalent subtype among them is the interhemispheric lipoma, often linked to anomalies in the callosal region, such as hypogenesis or complete agenesis of corpus callosum. Aim: To present a case study of a patient diagnosed with interhemispheric osteolipoma, complete agenesis of corpus callosum and a developmental venous anomaly (DVA) as an additional finding. Patient and Methods: We present a case of a 39 -year -old man with chronic headache. Brain computed tomography (CT) followed by contrast -enhanced magnetic resonance imaging (MRI) were performed. Results: Brain computed tomography showed a extra -axial low -density lesion with peripheral calcifications. For further better characterization, contrast -enhanced magnetic resonance imaging (MRI) was performed. The mass formation demonstrated high signal intensity on both T1- and T2 -weighted images, and low signal intensity on fat -saturated sequences. An abnormal venous structure draining into the superior sagittal sinus was observed - a finding consistent with a deep venous angioma. Both lateral ventricles had a parallel configuration, which together with colpocephaly and the absence of a corpus callosum confirmed its agenesis. Conclusion: Imaging recognition of the presented extra -axial lesions is crucial for an accurate diagnosis and appropriate treatment. Usually, intraosseous lipomas are treated conservatively unless they affect bone stability. Neurosurgical treatment combined with bone grafting is rarely necessary only in symptomatic cases with imminent fractures. Knowledge of accompanying anomalies of the central nervous system is crucial for specifying the diagnostic strategies, therapy and patient follow-up.
Purpose: To investigate the influence of therapeutic exercises on functional recovery after supratentorial unilateral ischemic stroke (SUIS). Contingent and methods: The study was conducted in 78 patients with supratentorial unilateral stroke in the chronic period (SUISChP) - (67 patients in the experimental group (EG) - 36 males and 31 women with a pathology duration of 6.9 +/- 3.0 months and 11 patients in the control group (CG) - 9 men and 2 women with pathology duration 7.3 +/- 1.5 months). Patients from the EG were treated with a specialized 10-day kinesitherapy (KT), which was later performed as an adapted home exercise program for a period of 1 month. A modified Chedoke-McMaster scale was used to determine the gravity of the phase that the 4th and 5th stage patients had a moderate degree of involvement, and the 6th and 7th stages had a slight degree of involvement. On this basis, the patients were divided into two subgroups (moderate and mild). Results: Compared to baseline data in the experimental group, there was a significant improvement in upper and lower extremity abilities as shown by the Chedoke-McMaster test. The results of monitoring the muscle tone of upper and lower limbs, according to the Ashworth scale before and after kinesitherapy in EG, are similar. An improvement between mild and absent spasticity was noted, and the results are maximal at 1 month of treatment (p<0.001). Conclusion: The lasting positive effect in EG may be related to different mechanisms in which the applied goal-directed movements affect the functional capabilities of patients with SUISChP.
Aim: The aim of this study is to examine and compare the effects of tissue flossing compared to massage and stretching on the lower extremity function condition - range of motion ROM of the, and muscle strength and pain perception in the knee. Materials and methods: This study involved 16 patients that were divided in two groups, Group A - controlled (n=8) (male=5, female=3) mean age 36 +/- 4.2 years and Group B - experimental (n=8), (male=4, female=4) mean age 38 +/- 3,8 years. All patients were with impaired knee function, involving to a different degree: pain, limited range of motion and decreased muscle strength. The controlled group received a treatment of massage and stretching and the experimental group a tissue flossing therapy. Before and after the treatment we measured the levels of pain, ROM and muscle strength. Results: the therapy modalities for both groups showed positive impact on the patient's condition with slightly better results in the experimental group. Statistical significance was marked in the measurement of VAS, ROM flexion and dynamometry testing. Conclusion: Tissue flossing has a positive influence on decreasing of pain and normalization of range of motion and enhancing muscle strength and control, we recommend its use as a main or additional treatment modality.
Introduction: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic condition, which is diagnosed based on strict criteria. The main symptoms include recurrent epistaxis episodes, multiple mucocutaneus telangiectasia, the presence of organ arteriovenous malformations (AVMs) and a family history of the disease. Up to 98% of patients present with epistaxis episodes, some of which could potentially be life threatening. Different approaches have been used in historical perspective to gain control over the site of bleeding, with hemodynamically unstable patients requiring urgent medical supportive care. Endovascular therapy is a still relatively unexplored treatment option for such cases. Purpose: To establish the safety and efficacy of endovascular embolization as a treatment option of malignant refractory epistaxis in patients with HHT. Materials and methods: We present a case series of endovascular embolizations of the maxillary artery and/or its branches, supplying bleeding lesions in patients, refractory to other conventional means of treatment. Between the period of February 2022 and March 2024, nine patients with HHT underwent such an endovascular procedure. Results: Satisfactory results were achieved in all cases, with no added neurological complications being observed. Only one of the patients had a recurrence of the condition and required an additional embolization procedure. Conclusion: Endovascular embolization of the maxillary artery and its branches for malignant recurrent epistaxis in patients with HHT is a safe and effective way to control the site of bleeding.
A case of a 69-year-old man with a prosthetic aortic valve after DeBakey type II aortic dissection who developed endocarditis caused by Enterococcus faecalis is presented. What makes this case unique is the combination and complex interactions of rare clinical manifestations in the course of the disease. The patient's condition was complicated by the development of a subacute stroke and the discovery of colon adenocarcinoma. The complex relationship between enterococcal endocarditis and colonic malignancies has been explored. This case highlights the importance of the diagnostics in considering rare clinical convergences in complex patients with multiple comorbidities, highlighting the need for multidisciplinary collaboration and a comprehensive diagnostic approach.
Cardiovascular diseases are a leading cause of morbidity and mortality worldwide. In Bulgaria, there is no study of the risk factors, the clinical picture, the accompanying diseases and the outcome of the disease in patients with peripheral arterial disease depending on gender. The aim of the study is to evaluate risk factors, clinical characteristics and comorbidity of patients with peripheral arterial disease of the extremities depending on gender, with an emphasis on concomitant carotid pathology and experienced cerebrovascular events. Material and methodology: The study included 200 patients - 100 women and men each with diagnosed peripheral arterial disease (PAD). For each patient, the PAD stage according to Fontaine's clinical classification was determined, anamnestic data on past and accompanying diseases and risk factors for atherosclerosis with an emphasis on cerebrovascular disease (CVD) were recorded: experienced ischemic stroke (IS), transient ischemic attack (TIA) ), vascular interventions, and degree of carotid involvement, which was assessed by color-coded duplex sonography. Results: No statistical difference was found in the frequency of the registered risk factors by gender, with the exception of the smoking factor, where a significant preponderance was found among men compared to women (66% and 33%, p=0.001). No statistically significant differences were found regarding the presence of IS, previous IS or TIA (p=0.237). The frequency of carotid artery involvement in female patients is higher - 63%, compared to male patients - 40% (p=0.001). The relative share of women with atherosclerotic plaques up to 2 mm is also higher - 41% compared to that of men - 17% and carotid artery stenosis below 70% (21% women compared to 14% men, p=0.001). In men, the relative share of patients with chronic thrombosis of the carotid artery is higher - 9% versus 0%. A significantly greater risk of CVD was found in women with dyslipidemia and PAD compared to women with PAD without dyslipidemia, OR=4.5 (p=0.006). No dependence of the carotid intervention carried out in the past on gender was found. Conclusion: In patients with PAD, no gender-dependent differences were observed regarding experienced cerebrovascular accidents, previous carotid intervention, as well as the type of intervention. The frequency of involvement of the carotid artery in the female gender is greater, with the exception of chronic thrombosis, which prevails among the male gender.
There is certain discordance between the functional (hemodynamic) and imaging methods for assessing the characteristics of the atherosclerotic plaques. It would be of practical value to find if there was a correlation between neurotrophins - brainderived growth factor (BDNF), neuronal growth factor (NGF) and carotid plaque morphology. Aim: To make a first attempt to combine biochemical and morphological markers to better assess the risk of carotid plaques. Material and Methods: Thirteen consecutive patients (Eastern European - Caucasian race, 9 males and 4 females; mean age 73.08 +/- 7.65 years) with angiographically proven significant carotid atherosclerotic stenoses, referred for carotid stenting were evaluated. Plaque morphology was evaluated with intravascular ultrasound (IVUS) and virtual histology (VH). Serum concentrations of BDNF and NGF were tested and their results compared with a control group of 17 individuals without documented clinically significant atherosclerotic disease, carotid pathology, or cardiovascular risk factors. Results: The patients with significant carotid stenoses had lower mean BDNF values than the reference group (Eastern European, Caucasian race). There was a negative correlation between luminal diameter and BDNF (p=0.049; r=-0.605), and positive correlation between: total Ca2+ area (mm2) and BDNF (r=0.681, p=0.021), proximal Ca2+area and BDNF (p=0.007, r=0.784), fibro-fatty area and total calcium area and NGF (p=0.001). The results of carotid IVUS and VH measurements and serum BDNF and NGF concentrations in patients with carotid stenoses compared to patients without carotid artery disease are discussed. Both groups were free of acute vascular incident in other vascular territories. Conclusion: Preliminary results from a small case series study with intravascular ultrasound and serum levels of BDNF and NGF established a potentially meaningful clinical association between carotid atherosclerosis and neurotrophins, necessitating future expansion of the studies.
Introduction: Measuring an individual's cognitive load and psycho-emotional state in real time while performing various activities still poses a challenge for researchers today. Tracking the individuals' workload, emotional status and stress levels is especially important in the field of aviation, where pilot's error can cause a serious accident with possible catastrophic consequences. Aim: To evaluate the cognitive and emotional state of operators during a flight with an unmanned aerial vehicle (UAV), by objective automatic measurement of eye parameters and the distribution of visual attention by Eye tracking technology combined with EEG recording. Material and methods: The study was conducted in the "Laboratory for training of UAV operators", located in the Space Research and Technologies Institute at the Bulgarian Academy of Sciences - Sofia (SRTI - BAS), in collaboration with aviation medicine experts from the Military Medical Academy - Sofia. The study included 9 participants - an instructor, 2 experienced and 6 inexperienced UAV operators, at an average age of 38 years. There was a total of 90 simulation flights during which data were recorded by an Eye tracking method (registration of eye movements of the operators via a stationary oculograph Gazepoint GP3 HD, with the automatic recording of visual fixations and pupil diameter size), and a parallel EEG recording by means of an innovative EMOTIV wireless EEG system and software processing to calculate the so-called "Performance Metrics". Results: The results show a trend for higher pupil diameter values during the execution of turns, an expression of increased cognitive load for beginning operators, and lowest values during cruise due to a decline in mental effort. The inexperienced operator demonstrated very high levels of engagement and cognitive load throughout the flight, especially during the turns, which reflected significant mental effort. One of the experienced operators had higher stress values even than the inexperienced operator, assuming that effectiveness in critical situations depends not only on knowledge and experience, but also on temperament and innate personality characteristics. Conclusion: Innovative infrared oculographic technology combined with modern EEG methods and software data processing algorithms are a non-invasive, affordable and effective way to successfully study and comprehensively assess the workload and stress levels of the human factor during flight without risk to the flight process.
Aim: To evaluate the hemodynamic changes associated with orthostatic body positions and the application of 3D camera video games for rehabilitation in autonomous elderly and older adults. Materials and methods: 50 generally healthy elderly and older people were studied (24 women were included in the experimental group, mean age 76.75 +/- 6.89 years, and 26 women in the control group, mean age 73.69 +/- 6.89 years). Orthostatic autoregulation was assessed by orthostatic test. Blood pressure and heart rate were determined at the 1(st), 5(th) and 10(th) minute from the supine, standing and again supine positions. The effect of the application of video games for rehabilitation was evaluated in comparison with the control group, which was on conventional group physiotherapy. In both groups, the exercise program was conducted 3 times weekly, with a duration of 4 weeks. Orthostatic autoregulation was assessed twice, before and after the treatment at week 4. Results: Depending on the orthostatic reactivity, the subjects from both groups were divided into 3 subgroups according to the Thulesius classification. Before application of the video games in the experimental group, normotonic orthostatic reactivity (NOR) was observed in 8 women, a sympathetic orthostatic reactivity (SOR) in 5 and asympathetic orthostatic reactivity (AOR) in 11 people. At the 4th week, a significant improvement in orthostatic autoregulation was found as NOR was observed in 19 subjects (80.3%). No significant changes were found in the followed-up subjects from the control group, after the application of routine physiotherapy without video games. Conclusion: The applied 3D camera video games for rehabilitation significantly improved orthostatic reactivity in generally healthy older people with orthostatic dysautoregulation.
