National Heart Hospital

Viral infections, particularly those triggered by emerging pathogens like severe acute respiratory syndrome coronavirus 2, are increasingly recognized for their profound impact on the gut microbiota, causing dysbiosis, a condition characterized by an imbalance in microbial communities. Recent studies suggest that alterations in gut microbiota can influence disease progression, immune responses, and clinical outcomes. The bidirectional relationship between the gut microbiota and the host immune system is crucial in shaping responses to infection. Furthermore, dysbiosis has been linked to exacerbated inflammation, impaired mucosal barrier function, and altered drug metabolism, thereby complicating both disease pathogenesis and treatment efficacy. This review examines the interplay between viral infections and gut microbiota dysbiosis, with a focus on the underlying mechanisms and potential therapeutic strategies to modulate host immunity. We also evaluate the potential of microbiome-based interventions, such as probiotics, prebiotics, and fecal microbiota transplantation, as therapeutic strategies for restoring microbial balance and mitigating the severity of infections. The paper underscores the need for further research to optimize microbiota-targeted therapies and integrate them into clinical practice, offering a comprehensive approach to managing dysbiosis in viral infectious diseases.

Background/Objectives: Image-guided adaptive brachytherapy is a standard modality in the treatment of locally advanced cervical cancer. However, the availability of isotope-based brachytherapy is limited in countries with lower resources. The objective of this study is to report the first institutional dosimetric and clinical data on intracavitary electronic brachytherapy. Methods: A total of 25 patients with histologically proven cervical cancer stage IB-IVA were treated with concurrent chemoradiotherapy and electronic brachytherapy. The patients were followed up for a median of 12 months (range 6-24). Toxicity was evaluated by the radiation oncologist and gynecologist on each visit and scored by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results: All patients completed the treatment successfully with a median overall treatment time (OTT) of 52 days (range 39-89). The desired target coverage was achieved in all patients, and the dose limits for the organs at risk were achieved in 88% of the patients. No Grade 3 toxicities occurred. A total of 84% of the patients achieved local control in the cervix, and a complete response was noted in 72% of the patients. Conclusions: Electronic brachytherapy provides the option to deliver a high dose of radiation to the uterine cervix without leading to severe toxicity. Further improvements to the treatment protocol could provide better locoregional and systemic control of the disease. Studies with larger cohorts and longer follow-up are necessary.

This study presents data from the national electronic registry BG-EPHY on electrophysiologic (EP) studies and catheter ablations in 2024. Material and methods: Full one-year sample of the BG-EPHY registry was analysed retrospectively. Sex and age distribution of the patients, number of ablations, use of electroanatomic mapping (EAM), ablation energy source, distribution of different types of arrhythmias, acute procedural success, complications, recurrences and redo procedures are presented. Results: In 2024 ten EP centers performed 2624 ablations in 1714 men (65.3%) and 910 women, incl. 16 ablations in pediatric patients (0.61%). EAM was used in 1506 procedures (57.4%), irrigated-tip catheter – in 1535 (58.5%), cryocatheter – in 507 (19.3%), and intracardiac echocardiography – in 203 (7.7%). The most frequently performed primary ablation was pulmonary vein isolation (51.9%), followed by ablation for typical atrial flutter (15.1%) and AV nodal reentrant tachycardia (13.5%). The acute success was over 99%, while intraprocedural complications were less than 1.5%. Redo procedures for recurrence of the index arrhythmia were done in 190 patients (7.24%), with atrial fibrillation and atrial flutters accounting for the largest numbers (n = 147). Conclusion: The national registry of electrophysiology collects systematically and continuously data on all ablations of cardiac arrhythmias performed in the country. In 2024, the number of ablations increased compared to 2023, but at a slower pace. Distribution of EP procedure types was similar to previous years. Acute success was very high, while intraprocedural complications were rare.

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.

During last ten years, we have developed a digital library with educational materials in Physical medicine and rehabilitation. The objective of current article is the preparation of an electronic library with educational materials in the area of physical medicine, physical therapy and rehabilitation, and the comparative evaluation of the impact of this repository on the quality of education of students and trainees in the field. The electronic library includes e-books on different topics, elements of the specialty "Physical and rehabilitation medicine (PRM)" or Physiatry - with theoretical data, practical issues and case reports with videos of real patients. From the field of basic physiatry we included: books on kinesiological and pathokinesiological analysis, functional evaluation; physiotherapy (active exercises, soft-tissue techniques), ergotherapy (activities), balneotherapy (mineral baths and peloids, underwater gymnastics), manual therapy (tractions, mobilizations, manipulations), preformed physical factors (electric currents, magnetic field, ultrasound, light, laser, etc). In special physiatry we prepared manuals on: neurological and neurosurgical rehabilitation, orthopedic and traumatologic rehabilitation, rheumatologic rehabilitation, cardiac and cardiosurgical rehabilitation, etc. The digital library has been applied to educate 1,186 learners (graduate and post-graduate studies): students in Bachelor's degree (Physiotherapy, Nursing, Midwifery, Medical assistants) and in Master's degree (Physiotherapy, Medical rehabilitation and balneology), medical doctors-residents in Physical and Rehabilitation medicine (PRM), participants in long-life learning courses (physiatrists, physiotherapists and nurses). At the end of every educational course, we collected data from the practical and theoretical exams (investigation period-from April 2020 to October 2024). Additionally, we evaluated learners' opinion using anonymous questionnaires on the usefulness of the electronic library. Comparative analysis of the results revealed significant improvement in theoretical knowledge and practical skills of students and trainees, as evidenced by online assessments, and face-to-face theoretical and practical exams. The majority of learners consider the electronic repository useful. The authors consider this electronic library (with books, manuals, video-presentations and case studies) a valuable resource in both graduate and post-graduate education within the rehabilitation field. We recommend the application of electronic repositories in the process of education of the students and trainees.

<p><strong><span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 宋体; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-ansi-language: EN-GB; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;">Background and Aim: </span></strong><span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 宋体; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-ansi-language: EN-GB; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;">Ivabradine is indicated in chronic heart failure (HF) and reduced ejection fraction (EF) of < 35% and resting heart rate (HR) of > 70 bpm. However, role of Ivabradine in acute decompensated chronic HF (ADCHF) is not well known. The aim of this study was to evaluate one-year outcomes of ADCHF patients discharged with and without Ivabradine. <strong>Materials and Methods: </strong>This is a prospective observational cohort study of ADCHF patients from January 2016 to January 2018. Main exclusion criteria was new onset de-novo acute HF, those with EF > 50% and atrial fibrillation. Data were analysed from 130 patients who were discharged with (62 patients) or without Ivabradine (68 patients). The primary end points were one-year re-hospitalization and cardiovascular mortality between two groups. <strong>Results:</strong> The mean age of patients were 56 ± 15 years and 61 ± 17 years between Ivabradine and Non-ivabradine groups. EF upon discharge was 37.48% ± 5.34% vs 40.01% ± 8. 12%, with <em>p</em>-value of 0.036. At discharge, higher HR was noted in patients with Ivabradine 84 ± 13 bpm compared to 77.84 ± 12. 13 bpm in patients without Ivabradine (<em>p</em>-value = 0.006). After a year, HR in Ivabradine group was low compared to non-Ivabradine group, but was not statistically significant, 66.15 ± 8 vs. 69.29 ± 11.3 bpm, respectively. In the Ivabradine group 27.4% of patients visited emergency room (ER) more than once compared to 60.2 % without Ivabradine (<em>p</em>-value = 0.0001). 9.7% of patients in Ivabradine group required one readmission compared to 55.9% without Ivabradine (<em>p</em>-value = 0.0001). <strong>Conclusions: </strong>In ADCHF patients there was significant reduction in ER room visit and re-admission rate in patients discharged with Ivabradine. Hence Ivabradine therapy may be considered in patients with ADCHF with EF < 50% and HR > 70 bpm to prevent re-hospitalization and save hospitalization costs.</span><span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-IN; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;"> </span></p>

Background: Recurrent pericarditis is the most problematic complication following acute pericarditis and occurs in 20–50% patients of all age groups. Clinical manifestations vary and range from asymptomatic to life-threatening. Despite normally good prognoses, it ensues a negative impact on patients. Cardiac rehabilitation (CR) has demonstrated a cardinal role in management of patients who undergo pericardiectomy, yet no specific rehabilitation protocols are available for reference. Case Presentation: A 27-year-old man presented with pericardial effusion and cardiac tamponade in recurrent pericarditis. His prior admission history included chest pains for 3 months. He was diagnosed with tuberculous pericarditis and commenced on ATT. Patient complained of worsening difficulties in breathing, orthopnoea, cough, chest pains and had a significant history of exposure to PTB during childhood, but was HIV negative. His physical examination revealed tenderness on the left chest and muscle weakness in left arm. His baseline spirometry and 6MWT scores were 68% and 250 meters. Patient had right lower lobe atelectasis associated with reduced air entry. He received a pre-operative regimen of chest-physiotherapy and resistance exercises and radical pericardiectomy was performed three weeks later. Post-operative physiotherapy continued in ICU within 24 hours. He was transferred to the ward and discharged on day 8 with a prescribed physiotherapy home program. On follow-up, the patient made incredible progress on the three reviews at 2 weeks, 3 months and 1 year. Conclusion: Our case demonstrates a cardinal role of exercise-based CR in patients undergoing pericardiectomy hence the need to establish a standardized exercise protocol and identify means to transform post-hospital care for people with heart disease.