Medical University Plovdiv

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. 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). 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. 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. ClinicalTrials.gov identifier: NCT06775028.

This article describes the synthesis of a new Pd (II) complex by using 2,4-dithiouracil (2,4-DTu) as a starting reagent and its structure elucidation. The coordination compound was analyzed by several methods, including melting point determination, UV-Vis, 1H NMR-solution state, 1H- and 13C-NMR solid state, HSQC, 1H-1H COSY, ATR and Raman spectroscopy. The metal complex was formed by mixing aqueous solutions of metal salts with the ligand dissolved in DMSO and water, along with NaOH, in a metal-to-ligand-to-base ratio of 1:4:2. Furthermore, the compound's antimicrobial activity against Gram-positive and Gram-negative bacteria, as well as yeasts, was assessed. It should be noted that for the first time a biologically active mixed ligand complex of Pd (II) with 2,4-DTu and 2-Tu was obtained. The ligands 2,4-DTu and 2-thiouracil (2-Tu) are bidentately coordinated to Pd(II) through a deprotonated nitrogen atom and the adjacent heteroatom—sulfur or oxygen, respectively. Tentative structures of the Pd(II) complexes are proposed, in which DMSO-h₆ and H₂O may be located either in the inner or outer coordination sphere. The new Pd(II) complex exhibited a coordination number of 6 or 4, respectively. The newly formed coordination compound of the corresponding pyrimidine-based ligands, i.e. 2,4-dithiouracil and 2-thiouracil, with Pd (II) demonstrated the strongest activity against Staphylococcus aureus. It, also, showed a significant improvement in its antifungal activity in comparison with free ligand 2,4-dithiouracil.

In patients with decompensated liver cirrhosis, the presence of acute hemorrhage is a common clinical finding. The different types of bleeding that may be observed include variceal and non-variceal gastrointestinal bleeding and systemic bleeding due to abnormalities in overall coagulation status. This retrospective study included 438 patients with liver cirrhosis who were selected from the endoscopy records. Of all admitted patients, 323 had a variceal source of bleeding. The remaining 115 patients had non-variceal bleeding. The findings show that the most frequent etiology was variceal bleeding. Peptic ulcer (gastric and duodenal ulcer) was dominant (60%) in the etiology of non-variceal upper gastrointestinal bleeding. The significant rate of all acute GI hemorrhage in cirrhosis was variceal, but a considerable proportion had non-variceal causes. Our study showed that in about 26.3% of the cirrhotic patients with upper gastrointestinal hemorrhage, the bleeding occurred from non-variceal sources, of which the most frequent one was ulcer. These results show that therapy should be approached after clinical evaluation and upper gastrointestinal endoscopy.

Background/Objectives: This study evaluates the level of knowledge among dental students regarding infection prevention and control measures in dental practice. Methods: A total of 225 students from the Medical University of Plovdiv participated in an anonymous survey between November 2024 and March 2025. The survey assessed knowledge about epidemiological factors, disinfection protocols, and procedures for infection prevention and control. Results: The survey results revealed that while most students demonstrated a high level of knowledge of the importance of protective equipment and impression disinfection, a few students reported incorrect or inconsistent practices. Gender differences were observed in adherence to disinfection procedures. Conclusions: The findings highlight the need for enhanced training in infection control within dental curricula to ensure safe clinical practice and minimize cross-infection risks.

Background/Objectives: For successful wound management, dressings must be maintained in a moist environment to optimally enhance the microenvironment of the wound and efficiently deliver bioactive agents. Sodium humate has demonstrated potential wound-healing activity, although its topical delivery is still a challenge. This study aimed to develop and optimize polysaccharide-based dermal patches incorporating sodium-humate-loaded transferosomes and to assess their physicochemical and wound-healing properties. Methods: Transferosomes were obtained via thin-film hydration and prepared utilizing the Taguchi experimental design based on the impact of lipid content, lipid-to-surfactant ratio, and lipid-to-drug ratio on vesicle size, ζ-potential, and drug entrapment efficiency. The optimized transferosomes were loaded into alginate/HPMC composite dermal patches prepared through solvent evaporation. Results: The optimized transferosome formulation had an average size of 250.9 ± 2.3 nm, a ζ-potential of -3.57 ± 0.25, a high deformability of 93.01 ± 2.41%, and an effective drug-entrapment efficiency of 30.13 ± 1.04%. The use of transferosomes greatly affected patch thickness, moisture content, and surface morphology. A biphasic drug release profile of sodium humate was demonstrated via an in vitro release study, showing an initial burst followed by sustained drug release within 6 h. In vivo evaluation of transferosome-loaded patches showed that the formulations were able to effectively promote wound healing compared with the control. Conclusions: The developed transferosome-embedded alginate/HPMC dermal patches constitute a promising platform for the controlled topical administration of sodium humate and show promising enhancement of wound healing.

Acetaminophen (APAP) overdose can induce potentially fatal nephrotoxicity. Micromeria frivaldszkyana (M. frivaldszkyana), an endemic plant to Bulgaria, has demonstrated significant antioxidant activity. This study represents the first evaluation of the nephroprotective effects of a methanolic extract of M. frivaldszkyana in an APAP-induced rat model of kidney injury. The aim of the study was to investigate the protective potential of orally administered M. frivaldszkyana methanolic extract against APAP-induced nephrotoxicity. Male Wistar rats received a one-week treatment with saline, M. frivaldszkyana extract (250, 400, or 500 mg/kg), rosmarinic acid (100 mg/kg), or silymarin (125 mg/kg). On day 7, renal injury was induced by oral administration of APAP (2000 mg/kg). Forty-eight hours later, blood and kidney samples were collected for biochemical and histological analyses. The extract at 500 mg/kg significantly reduced the elevated levels of serum urea (1.83 ± 0.24 vs. 3.49 ± 0.75, p < 0.05), creatinine (59.51 ± 2.30 vs. 72.27 ± 3.92, p < 0.05), and uric acid (477.55 ± 52.48 vs. 898.33 ± 65.30, p < 0.001), while restoring renal glutathione (GSH) levels (4.43 ± 0.19 vs. 2.64 ± 0.10, p < 0.001) and catalase activity (3802.78 ± 142.05 vs. 2485.03 ± 143.23, p < 0.01), compared with APAP-treated rats. Malondialdehyde levels were significantly reduced by the extract (25.19 ± 0.95 vs. 69.66 ± 4.11, p < 0.001), with similar effects observed across all tested doses. In conclusion, M. frivaldszkyana methanolic extract confers significant protection against APAP-induced nephrotoxicity, likely through antioxidant-mediated mechanisms, enhanced GSH restoration, and attenuation of lipid peroxidation, highlighting its potential as a nephroprotective agent.

Background: Differentiating atypical endometrial hyperplasia, also known as endometrial intraepithelial neoplasia (EAH/EIN) from endometrial hyperplasia without atypia is crucial due to the higher risk of progression to endometrioid adenocarcinoma, associated with atypical lesions. Immunohistochemical markers such as PAX2 and PTEN have emerged as potential adjuncts to improve diagnostic accuracy in morphologically challenging cases. Objective: To evaluate the diagnostic value of PAX2 and PTEN expression in distinguishing atypical from endometrial hyperplasia without atypia in the Bulgarian population. Materials and Methods: A total of 96 endometrial hyperplasia cases (48 typical, 48 atypical) were included. Histopathological evaluation was performed on hematoxylin and eosin–stained sections, with two experienced pathologists confirming diagnoses according to the WHO criteria. Immunohistochemical analysis of PTEN and PAX2 was conducted on formalin-fixed, paraffin-embedded tissue sections. Results: PTEN expression loss was observed in 6% (3/48) of hyperplasia without atypia cases, compared with 81.3% (38/48) of EAH/EIN cases. For PAX2, strong nuclear staining was retained in 60% (29/48) of endometrial hyperplasia without atypia cases, with no complete loss of expression. In contrast, 64.6% (31/48) of EAH/EIN cases showed complete loss of PAX2 expression, while only 35.4% (17/48) preserved nuclear immunoreactivity. Together, these results highlight clear and consistent differences in PTEN and PAX2 expression between hyperplasia without atypia and EAH/EIN and may aid pathologists in distinguishing these two entities in routine diagnostic practice. Conclusions: Expression loss of PAX2 and PTEN is significantly associated with EAH/EIN. Immunohistochemical evaluation of these markers provides valuable adjunctive information for the diagnosis of morphologically ambiguous cases and may enhance diagnostic reproducibility and accuracy. Incorporating PAX2 and PTEN into routine assessment may guide appropriate clinical management and risk stratification of patients with endometrial hyperplasia.

Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques-both invasive and non-invasive-have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain. We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman-Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I2 statistic and Cochrane's Q test. Twelve RCTs involving 413 patients (mean age 53years; 55% female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD-0.82; 95% CI [-1.13, -0.50]; p<0.00001; I2=53%) and analgesic consumption (SMD-0.91; 95% CI [-1.63, -0.20]; p=0.01; I2=81%) compared to sham. No significant difference was found in functional disability (SMD-0.31; 95% CI [-0.85, 0.24]; p=0.28; I2=44%). The pooled female proportion was 55% (95% CI [42.99, 66.95]; I2=73%), and the prevalence of adverse effects was 12.48% (95% CI [6.13, 20.39]; I2=0%). This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.