Rational probiotic use: specificity of application and approaches to optimize their effect through the prism of pharmaceutical care

Introduction: Probiotics are live microorganisms that, administered in adequate amounts, bring health benefits to the body. In practice, probiotics are indicated for various conditions, from mild diarrhea to conditions such as pseudomembranous colitis, irritable bowel syndrome, and an increase in the immune response. Their application becomes absolutely mandatory when it comes to antibiotic treatment, whose frequent adverse reaction is dysbiosis. As antibiotic use increases, so does the use of probiotics. The probiotics market was valued at USD 68.56 billion in 2022 and is expected to reach around USD 133.92 billion by 2030.Aim: The aim of the current study is to summarize the current information available regarding the appropriate probiotic strains for each condition, to note some of the risks of probiotic treatment, and to make recommendations for the implementation of adequate pharmaceutical care.Materials and Methods: A literature review was performed of available information in the World Gastroenterology Organization (WGO) guideline, Google Scholar, and PubMed, with statistics summarized by the World Health Organization, European Center for Disease Prevention and Control (ECDC).Results and Discussion: According to WGO recommendations, suitable strains in antibiotic-associated diarrhea are Lactobacillus acidophilus, L. casei (≥ 10e10 cfu, once daily), Lactobacillus rhamnosus (10e10 cfu, twice daily), Saccharomyces boulardii (250 mg, twice daily), and in C. difficile infection – Lactobacillus acidophilus, L. casei (≥ 10e10 cfu, once daily), Saccharomyces boulardii (250 mg, twice daily). An important aspect is that the antibiotic and probiotic should be taken separately, in order to avoid antagonizing the two products and the deterioration of antibiotic resistance. They should be taken 2 hours apart. It is advisable to continue using probiotics for at least 2-3 weeks after stopping the antibiotic. The side effects of probiotics are known in 4 main directions: systemic infections, metabolically harmful processes, excessive immune stimulation in susceptible individuals, and gene transfer. However, probiotic microorganisms are believed to be non-pathogenic, and the theoretical risk of infections is very low (mainly in immunocompromised patients). Studies on strain-specific properties, the study of pharmacokinetics, and studies looking for interactions between the strain and the host would prove useful for their more rational application according to scientific sources.Conclusion: Probiotics support the normal functioning of the gastrointestinal tract and prevent possible complications during antibiotic treatment. Each product contains one or more strains of bacteria, with different strains suitable for use in different conditions and antibiotic therapies. The regimen, dose, and duration of probiotic intake are determined by strain-specific properties. Pharmacists have a major role in the use of probiotics, based on patient opinion. Health professionals must obtain information about them from reliable sources and are required to warn patients about the peculiarities and risks of using probiotics

Segmentation and epicardial fat tissue measurements with 3D Slicer – accessible everyday solution in clinical practice and future AI involvement

Medical image segmentation is a process of analyzing and systematically partitioning digital data obtained through diagnostic imaging, aimed at extracting quantitative information about specific anatomical structures or pathological changes. This method is essential for the precise measurement of volumes, areas, and morphological characteristics, and finds broad application in clinical diagnostics, therapeutic planning, and scientific research. However, most established software solutions for medical segmentation are associated with high licensing costs, which limit their accessibility in academic and clinical settings with constrained budgets.In this context, 3D Slicer has emerged as a free, open-source platform offering a comprehensive set of tools for visualization, processing, and analysis of medical images. Its flexibility and modular architecture allow the integration of additional algorithms, including those based on artificial intelligence (AI), making it particularly suitable for innovative research applications.This article presents our experience with semi-automatic segmentation of epicardial adipose tissue (EAT), performed on computed tomography (CT) images using 3D Slicer. We discuss methodological aspects, challenges, and the potential for clinical translation, emphasizing the possibilities for automation through AI-based tools and their significance for the future development of personalized medicine

Where the Sea Heals: 120 Years of the First Children's Sea Sanatorium near Varna

In 2025, Bulgaria marks the 120th anniversary of the establishment of its first children's seaside sanatorium—a unique medical institution founded near Varna. This sanatorium marked the beginning of the organized fight against osteoarticular tuberculosis in children by utilizing natural healing factors such as sea climate, sun, air, and seawater baths. The article traces its history, founders, therapeutic approaches, and social significance, placing it in the context of European trends in thalassotherapy and social pediatrics

Evaluating the impact of specialized cardio-cycling exercises on the clinical status of chronic dialysis patients, objectified by examining laboratory indicators of mineral and bone disorders

Chronic kidney disease leads to serious complications related to the disability of patients. This gives reason to discuss and work to improve their quality of life. In recent years, attention has been focused on physical activity and renal rehabilitation, in order to overcome movement disorders.In the Nephrology Clinic at St. Marina University Hospital, Varna, the influence of cardio-cycling exercises on the clinical status of hemodialysis (HD) patients was assessed, objectified by examining laboratory indicators, such as serum phosphorus, serum calcium, iPTH, and CRP.We studied a total of 69 patients-divided into two groups: control (n = 32) and experimental (n = 37), conducting cardio-cycling exercises. The values of serum phosphorus, calcium, and CRP were examined in both groups at the beginning, at the 3rd and at the 6th month, and the values of iPTH—at the beginning and at the 6th month.The analyzed data showed that in HD patients performing intradialytic exercises, bone mineral indices improve in terms of Ca and P, but not those for PTH. The highest correlation was found for serum Ca.In patients with CKD on HD treatment, in whom various techniques of renal rehabilitation were applied, good results were reported in the volume and cycling. The cooperation of patients is important. This requires convincing them of the positive effect of the test and its implementation in order to improve their tone and physical activity

Admission inflammation and coagulation biomarkers as early predictors of COVID-19-associated acute kidney injury

Introduction: Acute kidney injury (AKI) is a common and high-risk complication of COVID-19. Serum creatinine rises with delay, which limits early recognition of renal involvement (7,9). Inflammatory and coagulation biomarkers measured at hospital admission may provide an earlier indication of AKI (1,4,10–12).Materials and Methods: We analysed 436 hospitalisations with PCR-confirmed COVID-19 (01.2021–12.2022) at St. Marina University Hospital, Varna. AKI was defined according to KDIGO 2012 (by serum creatinine; the urine-output criterion was unavailable) (7). First-hour measurements included CRP, D-dimer, fibrinogen, ferritin, and LDH. ROC curves and Youden’s J were used to determine optimal cut-offs; an additional combined model was constructed from the three markers (CRP > 150 mg/L; D-dimer > 0.75 mg/L; fibrinogen > 6 g/L). Multivariable logistic regression was adjusted for age, sex, arterial hypertension, and diabetes (6,8,14).Results: 94/436 (21.6%) developed AKI. At admission, CRP, D-dimer, and fibrinogen were higher in patients who subsequently developed AKI; ferritin and LDH showed trends without independent predictive value. Individual AUCs: CRP 0.69, D-dimer 0.74, fibrinogen 0.62; the combined model achieved AUC 0.82. At the chosen threshold, sensitivity was 72% and specificity 76%. In the multivariable model, D-dimer > 0.75 mg/L (OR 2.3; 95% CI 1.4–3.8), CRP > 150 mg/L (OR 1.9; 95% CI 1.2–3.0), fibrinogen > 6 g/L (OR 1.6; 95% CI 1.1–2.6), and age > 70 years (OR 1.7; 95% CI 1.1–2.8) were independent predictors. A negative result on the combined assessment virtually rules out AKI (residual risk ≈ 9%), whereas a positive result indicates that nearly one in two patients will develop this complication (≈ 45%).Conclusion: A triad of CRP, D-dimer, and fibrinogen available within the first hour of admission provides early and inexpensive risk stratification for COVID-19-associated AKI, consistent with published evidence on the roles of inflammation and coagulopathy (1,4,10–13). Its implementation may support nephroprotective strategies and prioritisation for early consultation (9,10)

Animal models of skin wound healing – advantages and disadvantages

Skin wounds represent superficial or deep destructions of the skin, which occur as a result of various external influences or surgical interventions. Immediately after the injury, a series of pathophysiological processes begin, aimed at restoring tissue integrity. Wound healing is a process involving interconnected and overlapping stages of hemostasis, inflammation, proliferation, and tissue remodeling. Numerous cellular populations, the extracellular matrix, and soluble mediators are also involved. Abnormalities in the healing process can result from systemic diseases and may lead to serious complications for the individual. Despite medical advancements, wound healing remains a significant clinical challenge, necessitating proper and effective treatment. In addition to improving traditional wound care, it is essential to develop new therapeutic approaches. Experimental models are a very useful tool for studying various diseases. Over the past decades, different skin injury models have been developed, which increase our knowledge of tissue recovery processes and contribute to the development of new clinically relevant therapeutic strategies. This review summarizes the processes of skin wound healing and discusses the most commonly used animal models. Differences in the healing process and in the in vivo skin wound models are analyzed in detail

Medication-related osteonecrosis of the jaw—etiology, pathophysiology, clinical and radiological characteristics, and staging: A review

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious condition, caused by several classes of pharmaceutical agents, the most common of which are antiresorptive and antiangiogenic drugs. It is characterized by exposed necrotic bone, most commonly associated with antiangiogenic or antiresorptive therapy, and without a history of radiation exposure to the head and neck.Aim: This review aims to compare, and summarize the current knowledge on the etiology, pathophysiology, clinical and radiological characteristics, and staging of MRONJ, to identify the research gaps in the scientific literature, and to give recommendations for further research.Materials and Methods: An advanced electronic search was performed in PubMed, Scopus, and Web of Science, using selected keywords. Results were extracted to an MS Excel spreadsheet and assessed for eligibility after duplicate removal. After analysis of the obtained data, 35 articles were included in this study.Results and Discussion: The most common medications that cause MRONJ are antiresorptive and antiangiogenic drugs. Other possible agents are immunomodulators, monoclonal antibodies, corticoids, cytostatic drugs, etc. Numerous hypotheses for the pathophysiology of MRONJ have been suggested, including bone remodeling inhibition, impaired angiogenesis, specific infections, etc. Further research is necessary to confirm the role of different drugs in the pathogenesis of MRONJ.Conclusion: Despite the strong association between MRONJ and antiresorptive and antiangiogenic drugs, the exact pathophysiology of the disease is not fully understood. Future studies should investigate their mechanisms of action and correlation to MRONJ. Understanding its etiopathogenesis is essential for all medical practitioners in order to reduce MRONJ incidence and avoid its misdiagnosis

Overview of the quality aspects and regulatory frame of the non-interventional studies

Unmet medical needs require the development of new medicines and health technologies. Non-interventional studies (NIS) are one of the most effective ways to obtain real-world additional information regarding drug efficacy, effectiveness, and safety. These studies are conducted with approved medicines and within the scope of their standard use, aiming at collecting additional drug safety information from patients and healthcare professionals. A good understanding of NIS requires a clear distinction between them and clinical trials. European regulatory documents in the field of clinical trials are not applicable to non-interventional studies due to the lower risk of their conduct, but country-specific regulation is used instead. The national legal framework governing public relations related to clinical trials and non-interventional studies is diverse and includes a large number of regulations, which is a prerequisite for inconsistency in its applicatio

Unilateral fusion of mandibular central and lateral incisors. A clinical case of a child treated under general anesthesia

INTRODUCTION: Tooth fusion is a dental anomaly that occurs when two adjacent tooth buds merge, forming a larger tooth structure. The fusion can be categorized as complete or incomplete, depending on the development stage at which the tooth buds unite. The fusion can occur either before the calcification phase or during a later stage known as morphodifferentiation. The fused teeth may share a common pulp chamber and root canal, or possess separate ones.AIM: This article aims to present a clinical case of a fused central and lateral incisor, featuring a common pulp chamber and root canal. This condition was discovered incidentally during dental treatment under general anesthesia.MATERIALS AND METHODS: The child's level of cooperation was highly negative. To ensure accurate diagnostics, a detailed clinical examination, and segmented bitewing radiographs were used during the treatment of the child under general anesthesia.RESULT: A 4-year-old child with early childhood caries (ECC) was treated under general anesthesia. During the treatment, a dental anomaly was established in the incisal region of the right mandible. The child had fewer teeth than expected. A segmental radiograph was taken to evaluate the situation. Fusion between 81 and 82 exhibited a common pulp chamber and root canal, indicating that the anomaly occurred during the early stages of development, before the mineralization of both tooth germs.CONCLUSION: Pediatric dentists have a crucial role in the early diagnosis of fused teeth in childhood, potential complications, long-term treatment, prevention, regular follow-up, and prognosis

Application of manual lymphatic drainage in children

Lymphedema is a clinical complication characterized by the excessive accumulation of lymphatic fluid, leading to swelling, most commonly localized in the limbs. In pediatric patients, lymphedema occurs less frequently than in adults and may occur as a result of congenital malformations or acquired damage to lymphatic vessels and nodes. Manual lymphatic drainage (MLD) is one of the main and gentle methods for managing lymphatic stasis and plays a central role in the complex approach to restoring normal lymphatic function in pediatric patients. The careful and precisely dosed execution of this specialized technique has been shown to effectively support both the prevention and treatment of lymphedema in children with cardiovascular, urinary, and endocrine disorders, following surgical interventions, and in cases of post-traumatic complications. This therapeutic approach significantly contributes to improving their overall quality of life. The purpose of this article is to examine the impact of manual lymphatic drainage application in children