Summary Cutaneous demodicosis (CD) is a pilosebaceous unit disease, overlapping clinically with other facial dermatoses, mainly rosacea, and acne. It is usually improved by acaricidal monotherapy. This study investigates the association of CD with metabolic disturbances. It was conducted with 141 patients with primary and secondary CD. The study investigated the correlation between CD and dyslipidemia based on disturbances in total cholesterol (TC) and Low-Density Lipoproteins (LDL) and between CD and impaired glucose tolerance, diagnosed with elevated fasting blood sugar levels, 120 minutes blood sugar levels in oral glucose tolerance test (OGTT) and the mathematically calculated Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index. The study results were verified with control groups. It was established that patients with CD do not show statistically significant deviations in serum lipoproteins compared with the control group. However, the patients with CD tended to have impaired glucose tolerance, demonstrated with elevated fasting glucose levels and elevated HOMA-IR, compared to the control group. Interestingly enough, the tendency towards prediabetes and diabetes was not confirmed by the 120 minutes blood glucose levels of the OGTT. The presented data confirm the need for testing impaired glucose tolerance in every patient with cutaneous demodicosis. Based on the presented evidence, it is recommended to perform the screening by evaluating fasting glucose levels and fasting insulin levels, followed by calculating the HOMA-IR index.

PURPOSE: The aims of this Erasmus+ are to establish an academic partnership, to exchange practice in teaching and research. In September 2016 was signed an inter-institutional agreement for staff mobility for teaching between the University of Southampton, UK and Trakia University, Bulgaria for the period 2016-2021. Assoc. Prof. Dr Borislav Dimitrov, a former colleague from Stara Zagora working at the University of Southampton and Assoc. Prof. Katya Peeva from the Medical faculty were the contact persons for this contract. RESULTS: Until the year 2020 in the program have participated six professors from the University of Southampton, who delivered lectures and courses to teaching staff at Trakia University “Introduction into Biostatistics with R” and “Medical Statistics using SPSS”. From the Medical Faculty the participants were four professors with lectures, seminars, posters and taking part as a teaching assistant in a statistical course at the University of Southampton. CONCLUSIONS: Assoc. Prof. Dr Borislav Dimitrov created a fantastic opportunity. The plus in Erasmus+ signifies learning as more than just an academic exercise. I'm sure that Borislav would have hoped we learn that academic endeavour and partnership could be an area able to rise above the differences between individual countries.

Introduction: Children born prematurely are at higher risk of mortality, morbidity, and impaired motor and cognitive development in childhood than prematurely born babies. Aim: To establish the relationship between the corresponding levels of pregnancy-related plasma protein-A (PAPP-A) and the frequency of premature birth. Materials and methods: The study is prospective. The data was collected through monitoring patients through a questionnaire and sonographic examination at 11-13 gestational weeks. The study excluded all known risk factors for preterm birth, such as previous preterm births, pregnant women with gestational diabetes, preeclampsia, hypertension, placenta previa, hydramnion, multiple pregnancies, smoking, structural and chromosomal abnormalities of the fetus and planned preterm birth. The data from the measured values of PAPP-A and the frequency of premature birth in 636 pregnant women were analyzed. Conclusions: PAPP-A levels are a statistically significant factor for preterm birth. It is expected with a 95% probability in the population with PAPP-A values below 0,515 that the cases with premature birth will be from 7 to 14 times more. Pregnant women with PAPP-A level less than 10th per cent are significantly associated with an increased risk of preterm birth.

This research-based article examines the challenges that social workers are facing in the context of intense reforms and transformations in a period of transition from centralised and institutionalised system of social care towards a decentralised and deinstitutionalised one. Key issues for social workers are determined through an exhaustive empirical study, assessing the degree of subjective attractiveness of the professional activity of social workers in the Protected housing service in Bulgaria. The study aims to give insights on what components of working conditions need to be improved to provide adequate support to social workers, enabling them to offer quality service to users. The study further analyses how workers prioritise these components, how the desired state differs from their current work situation and how work attractiveness relates to socio-demographic characteristics. The results show a low degree of work attractiveness and discrepancies on factors across the board between what social workers' rate as significant for work to be attractive and their actual work situation. When considering the findings within the wider European context, the authors suggest the Bulgarian experience is of significance for other societies going through fast and fundamental transformations.

ABSTRACT Objectives: The aim of this research is by using sociological methods of scientific research for tracking the pain and satisfaction indicators to prove that decreasing the number of ports in the VATS (Video-assisted thoracic surgery) for Malignant Pleural Effusion reduces postoperative pain and improves patient’s satisfaction. Methods: Our study included 117 VATS procedures performed in the period from 01 January 2013 to 31 September 2016. The sociological method used to measure the pain indicator was an interview. The severity of postoperative pain was determined and reported according to a ten-point pain visual analogue scale (VAS). The degree of satisfaction was determined and reported according to a six-point and ten-point grading systems on the basis of a research interview procedure. Results: In the single-port method, the verbal pain scale for all the days covered by the research study statistically showed significantly lower values (P ˂ 0.0001) in comparison with the conventional method (P ˂ 0.0001). With regard to the patient’s satisfaction, determined on the basis of the six-point system, the results were as follows: conventional VATS approach – average 3.1 with a standard deviation of 1.1 and ranging from 0 to 5; single-port VATS approach – average 4.3 with a standard deviation of 1.0 and within the range from 0 to 6. Conventional VATS approach – 6.8 – neutral. Single-port VATS approach – 8.1 – prevailing satisfaction. Conclusions: Based on our study and the studies of other authors, it can be concluded that postoperative pain and satisfaction after VATS in patients with MPE (Malignant pleural effusion) are influenced by the number of ports and the one-port technique shows better results than the conventional three-port method. The research study was registered and approved by the Clinical Research and Ethics Committee at the ‘Prof. Dr. Stoyan Kirkovich’ AD University Multi-Profile Hospital for Active Treatment Hospital, Stara Zagora. According to Protocol No. 11, Ref. No. 12471/30.10.2015 approved are the methods used by the sociological research study which uses predefined indicators to track patients who have undergone conventional VATS and single-port VATS. Indicators: postoperative pain and satisfaction.

BACKGROUND: The present study aims at determining whether there is a statistically significant difference in postoperative survival time after VATS talc pleurodesis for palliative treatment of MPEs with VATS surgical methods -conventional and single-port, as well as revealing whether the histological variation of the primary tumor is a determining factor for postoperative survival time. METHODS: Total 147 patients with MPEs were treated at the Clinic of Thoracic Surgery. Of all 147 patients 117 underwent VATS talc pleurodesis. Survival analysis was performed by the Kaplan-Meier method. The test for comparing the equality of the survival distributions between the study groups was done by use of the Mantel-Cox Log Rank. RESULTS: For conventional VATS talc pleurodesis the Mean Survival Time was estimated at 8.170 months with SEM 1.305. Median Survival Time was estimated at 4.133 months with standard error of Mean (SEM) of 0.731. For single-port VATS talc pleurodesis Mean Survival Time was estimated at 14.849 months with SEM of 4.965. Median Survival Time was estimated at 2.900 months with standard error of 0.907. CONCLUSIONS: Histologically different variants of primary tumor after VATS talc pleurodesis cannot be interpreted as a statistically significant factor for survival (P>0.05). Histologically different types of the pulmonary carcinoma can be interpreted as a statistically significant factor for survival after VATS talc pleurodesis for treating MPE (P<0.05).

Purpose: The main purpose of the study was to assess the levels of perceived stress among university teachers and to investigate whether a statistically significant relationship exists between perceived stress scores and age, sex, marital status, workload, financial status, years of teaching and physical activity of university teachers.Method: The research was carried out at Trakia University, Stara Zagora, Bulgaria. The sample was comprised of 86 university teachers. For statistical processing of the data were used descriptive analysis, Student's T-test and ANOVA with Dunnett's Post Hoc Tests for comparing the means. The IBM Statistical Package for Social Science (SPSS) 25th Version software was used to analyse the data.Results: There were no significant differences in the level of stress when the respondents were grouped as to age, sex, marital status and workload while a significant difference was found between perceived stress score and financial status, years of teaching, and physical activity. Conclusion: Stress among university teachers is a serious problem that requires additional research with a larger sample. University teachers should adopt positive coping strategies, such as regular rest and physical activity. Specific recommendations for coping with stress are suggested.

The high incidence of disturbed posture among preschool children is not only a public concern but also a public health problem for wider preventive measures to improve the motor activity of children. It is necessary to draw up large-scale national programs for early diagnosis and prevention of vertebral distortions at pre-school and school age. The purpose of the present study is to analyze the results of a research of the physical development study in pre-school children aged 5-6 to prevent vertebral distortions and overweight in kindergartens on the territory of the town of Stara Zagora and to prepare a rehabilitation program for prevention of vertebral distortions. The children in 25 kindergartens in Stara Zagora were studied for the period October - December 2017. Out of all 2,029 children, 1483 (73.1%) were examined, of whom 970 children (65.41%) have a disorder, 181 (12.2%) are overweight, the other 333 children (22.39%) have no problems. The largest share of the studied children (75-80%) is in six kindergartens (№7, №25, №3, №23, №10, №8) and the lowest is less than 50% in SG №11. This is proof of the good scale of the study. Physical development study was performed with a specially designed Early Diagram Attachment Card, adapted to the age of the children, corresponding to their physical development, with the tests of OTT and Schober being modified for 5-6 years old children compared to the height. Overweight children were also surveyed by innovative methodology, compliant with the physical development and compared with the height and weight, individual peculiarities and eating habits. In the study of physical development, the total percentage of children with impaired standing was 65.41% with 95% CI (62.91%, 67.83%), confidence interval. Kindergartens with numbers 6, 24, 29 and 34 have statistically significantly higher values of the percentage of children with disordered posture compared to the total for all kindergartens (P <0.05).The high incidence of disturbed posture among preschool children is not only a public concern but also a public health problem for wider preventive measures to improve the motor activity of children. It is necessary to draw up large-scale national programs for early diagnosis and prevention of vertebral distortions at pre-school and school age. The purpose of the present study is to analyze the results of a research of the physical development study in pre-school children aged 5-6 to prevent vertebral distortions and overweight in kindergartens on the territory of the town of Stara Zagora and to prepare a rehabilitation program for prevention of vertebral distortions. The children in 25 kindergartens in Stara Zagora were studied for the period October - December 2017. Out of all 2,029 children, 1483 (73.1%) were examined, of whom 970 children (65.41%) have a disorder, 181 (12.2%) are overweight, the other 333 children (22.39%) have no problems. The largest share of the studied children (75-80%) is in six ...

The specialty "Medical Rehabilitation and Ergotherapy" is relatively new and not yet well known in our country, but it is one of the fastest growing professions in Europe and the world. Clinical practice is a basic element of the practical training of the students for acquiring Bachelor's degree and professional qualification "Medical rehabilitator-ergotherapist", it is held during the seven semesters, the summer practice after the fourth and the sixth semester and the pre-graduate practice in the final eighth semester of the training . Incorporating innovations into clinical practice facilitates the acquisition of knowledge, skills and competences, and also provides more comprehensive professional training for students. The aim of the present study is to improve the general and specific professional competencies of the students by introducing innovative methods in the clinical practice training. The study included 57 students in the specialty "Medical rehabilitation and ergotherapy" for the period 2017-2018. The statistical analysis was carried out with SPSS version 25. After the conducted study, 75.4% of the three studied courses are satisfied with the innovative methods of clinical practice training, 72% have perfected the specific professional competencies and 82.5% have indicated a very good and good evaluation regarding the implementation of the diagnosing children from kindergartens and acquiring professional skills.

През 2016 година междуинституционално споразумение за мобилност на служители за преподаване бе подписано между Southampton Statistical Sciences Research Institute при Университета в Саутхемптън, Великобритания и Тракийски университет, България, за периода 2016-2021. Доц. Борислав Димитров, бивш колега от Стара Загора, работещ в университета в Саутхемптън и доц. Катя Пеева от катедра Социална медицина и здравен мениджмънт при Факултета по медицина към Тракийски университета бяха лицата за контакт. Целите на нашия Еразъм+ договор са да се създаде академично партньорство в областта на медицинската статистика, общественото здраве и епидемиологията, да се наблюдават и обменят практики в преподаването и научните изследвания в тази област.

The increasing incidence of overweight and obese pre-school children is a serious medical and social problem for almost all countries [10]. There is also a need for starting prevention from the earliest possible age. The aim of this study is to examine the effect of infant weight on the static-strength stability of the abdominal, trunk, and gluteal muscles in normal and overweight children. Study cohort:104 children at 5 to 6 years of age for the period 2017-2018 at the territory of the Stara Zagora municipality. A modified Kraus-Weber test according to V. Zhelev, L. Venova was applied to determine the static-strength stability of the trunk, abdominal and gluteal muscles. The study found an increase in the strength of the abdominal, trunk and gluteal muscles with age in the study group. Girls exhibited better static strength of abdominal flexors, gluteal muscles and trunk extensors than boys. The presence of an indirect, weak statistical relationship between the infant's weight and the strength of the flexors of the abdomen and hip joint, the trunk extensors and the lower limb extensors is demonstrated.

Introduction: Scientific studies and their publication have always been messengers for future advances in medicine, as the primary tool for technological and scholarly advances in the field. They are an integral part of the professional life of specialists working in a university. Creating your own scientific publication of any kind is often an undervalued activity whose procedural stages and significance remain insufficiently known. The path to the final publication can be a monotonous and extensive process. While the road to a final draft could be tortuous and monotonous, the pace and mood of walking it are heavily determined by the researcher’s motivation. Postgraduate scientific work in academia is an area less preferred to a clinical career, and not favorite for medical graduation students. The main goal of higher education is to prepare students for work, so the introduction to scientific thinking is an important factor for better results in the professional field. During their studies, students must learn how to properly work with scientific literature and create their own scientific work. Training students in the principles of creation and assessment of academic projects is an important factor for better science. Our aim is to explore the preparedness of medical students for scientific work. We can use this information to identifying strategies for the promotion of research skills among them. Materials and Methods: We gathered the opinions of 278 Bulgarian and English medical students in the second and fourth year of study, using a multiple-choice questionnaire, specifically designed and approbated to correspond to our research mission. Data was processed with the predictive analytics software IBM SPSS Statistics, v. 25. Results: Almost all students have had a certain level of previous experience with scientific work. They have mostly done presentations and essays; 94% of them have used scientific literature. The students generally exhibit consciousness of its importance and follow the requirement to properly cite used sources. The year of education is a factor in predicting a student‘s assessment of the level of importance. Even though 90% admit that it is important to learn how to create scientific work, only 76% are of the opinion that their own knowledge is lacking, and thus would potentially opt for a module on scientific writing. Discussion: Students' experience factored by their year of medical education and completed degree of previous studies is a factor that changes their opinions towards a greater understanding of the meaning of scientific work and the need for further training. Students agree that they need further training in research methodology to be able to develop valid and efficient skills to undertake scientific work.

Occupational occupies an important place in the practical training of students in Medical rehabilitation and occupational therapy in the Faculty of Medicine and is an important factor for the formation of professional skills and competencies. Is performed training - practical bases defined curriculum. The aim of the present study is to study students' satisfaction with participation in practical training and to determine the factors influencing the formation of professional skills in occupational therapy. The object of the study were 77 students of specialty Medical rehabilitation and occupational therapy during 2016-2018g. The statistical analysis was performed using the SPSS version16.0 (SPSS Inc., Chicago, IL). Was performed analysis of the results, 80,5% of students are well motivated and actively participate in practical training, 75 percent are satisfied with the choice of specialty and 68% are satisfied with training in occupational and its application in practical bases. Expanded the possibilities for practical work in occupational in clinical practice. It was drawn up new rules for practical training and summer internship.

PURPOSE: Skull morphometrics is very important in archaeology and forensic sciences for sex identification, especially when only limited osteometric data are available. The foramen magnum (FM) and occipital condyles, appears to be the most permanently preserved region of the human skeleton. The FM length (FML) is the most frequently measured, and often, the single available parameter of the FM in dry skulls. METHODS: FM data for 2524 skulls were taken from the Howells craniometric dataset (HCD). The validation cohort consisted of data for 177 Greek adult non-pathological intact dried skulls (GRD) as provided by the Aristotle University and National and Kapodistrian University (Athens). Descriptive statistics, parametric and non-parametric tests were used. Logistic regression modelling with the derivation of predicted probabilities and receiver operating characteristic ROC curve analyses with 95% CI were applied. Two-tailed P<0.05 was considered significant. RESULTS: The results indicate that the mean of the HCD FML in male was 35.78mm while FML mean in GRD was 35.337mm. The original regression model had predicted correctly 65% of skulls. CONCLUSIONS: There was no significant difference between the predicted and observed values for sex in the Greek skulls validation set. FML, alone, can predict sex (male) with accuracy limit of 71%.

Illness perception manages illness behavior. Emotional illness perception refers to psychological distress of patients. 237 patients with rheumatic arthritis, ankylosing spondylitis, hypertension and diabetes mellitus type 2 have been studied. PURPOSE: The purpose of the study is to evaluate the influence of optimism, negative expectations, health locus of control and chronic disease self-efficacy on emotional illness perception. METHODS: Optimism and Negative expectancies Inventory, Multidimensional Health Locus of Control Scales, Brief Illness perception Questionnaire, Chronic Disease Self-efficacy Scales; Statistical methods: Kolmogorov-Smirnov test, Linear regression, ANOVA, Student's t-test, P value of less than 0.05 was regarded as significant. RESULTS: According to the data of the study, negative expectations and self-efficacy to manage symptoms and depression are significant predictors of distress. The negative expectations increase distress during an illness, whereas the self-efficacy reduces distress. Health locus of control and optimism are not significant factors of emotional distress level. High chronic disease self-efficacy is significantly associated with less distress. CONCLUSIONS: Perceived competence to manage physical symptoms and coping with psychological distress are equally important for adaptation to the disease. Negative expectations predict distress in chronic disease, optimism does not.

The aim of this prospective study is to examine the frequency and the severity of intra-abdominal hypertension in a mixed ICU of the University hospital.Methods: A closed system for intravesical intermittent measurement of IAP was constructed.Results: The frequency and the severity of IAH were examined in the period from June 2009 to December 2012 in 240 ICU patients divided into 3 groups (patients submitted to elective surgery, emergency surgery, and medical patients) in the University Hospital. In the elective surgery group there was 12.5% IAH, while in the emergency group IAH was 43.75%, and in the medical patients it was 42.5%. There was no statistical significant difference in the frequency of IAH among the mixed population of patients we examined and those studied by other authors with the same type of population.Conclusions. The standardized measurement of intra-abdominal pressure is fundamental for defining intra-abdominal hypertension and abdominal compartment syndrome. The measurement of intra-abdominal pressure should be a part of the basic monitoring of patients at risk of intra-abdominal hypertension. Our point of view is that before there are indications for a surgical decompression, less invasive treatment options should be optimized.

Purpose: The best treatment for lung cancer is a surgical resection. Patients in advanced stage are subject to chemotherapy and/or radiotherapy. Our aim is to evaluate whether the survival is related to perfusion index, stage and presence of radio and/or chemotherapy. Materials And Methods: We analyzed the follow-up of 125 patients (118 men and 7 women, 30-76 years of age) with lung perfusion scintigraphy made between years 1989 and 1998 until 2013. Fortythree patients have been treated by radio-chemotherapy and 82 by chemotherapy. Patients have been staged by TNM classification from II to IV clinical stage. Survival was calculated by the KaplanMeier method, and groups were compared by the Mantel-Cox Log Rank test. Results: Perfusion changes varied from impaired in different extent perfusion to lack of perfusion in one of the lungs. The Median survival of radio-chemotherapy treated patients with perfusion index of affected lung less than 49% was 10,5 months and with perfusion index greater than 49% was 18,4 months. The overall Median survival of radio-chemotherapy treated patients was 11,2 months. The median survival of chemotherapy treated patients with perfusion index of affected lung less than 49% was 7,9 months and with perfusion index greater than 49% was 4,4 months. The overall Median survival for chemotherapy treated patients was 6,9 months. Conclusion: Perfusion index and stage were not statistically significant factors for the survival of patients with radio-chemotherapy and chemotherapy. Overall radio-chemotherapy treated patients have better median survival than the median survival by stage

PURPOSE : The surgical treatment is the most successful treatment of non-small cell lung cancer (NSCLC) in oncology practice. Lung perfusion scintigraphy as a non-invasive method for evaluation of the perfusion defect related to tumor localization in lung cancer patients is considered the differentiating line of pulmonary tests to predict post-operative lung function. MATERIALS AND METHODS : We analyzed retrospectively the value of lung perfusion scintigraphy in 10 cases with primary lung carcinoma who had a pulmonectomy (9 left and 1 right pulmonectomy). RESULTS : Changes in affected lung perfusion varied from impaired in different rate to perfusion defect in at least 3 lung segments (presented in 3 of the patients), 4 lung segments (present in 2 of the patients), or parts of segments, or defect affecting whole lobe. Impaired perfusion in a zone with polycyclic outlines in homolateral hilum was present in 7 of the patients. Perfusion indices at localization in the left lung (8 of the patients) were mean = 36,79%, SD=19,35%, SE=6,8%. CONCLUSION : Lung perfusion scintigraphy is a valuable method in the complex of pre-operative examinations to define the extent of the impairments in pulmonary perfusion and predicting the post-operative pulmonary function when pulmonectomy is about to be elaborated. The rate of perfusion changes and the percentage of involvement of the affected lung in the common pulmonary function correlate with survival. The low perfusion in the affected lung is not necessarily a contraindication for operative treatment.

Introduction: Diabetes affects about 8,3% of elderly population on the planet. Its complications affect all organs and systems as there is a heavy effect on vision. Diabetic retinopathy is one of the leading causes of blindness. Timely screening and treatment can prevent it and slow the worsening of vision. Aims and tasks: Assessing the implementing of new screening technique in hospital settings. Methods and materials: Pictures were taken of the fundi of 29 patients in the Clinic of Endocrinology in Medical University-Plovdiv. Afterwards anonymous questionnaires were handed and filled by each patient. Results and discussion: Visual opacities in the cornea did not allow us to take pictures of two of the ocular fundi. The methods shows high sensitivity and specificity (over 80%). All questionnaires were returned fit for analysis. The patients demonstrated high level of knowledge of their disease and admit to be very satisfied with the methodology. Conclusion: The presented methodology shows great promise for implementation not only in general practice settings, but also in hospital settings.