Students' Opinion about Their Opportunity for Healthy Eating

Nutrition is a basic life process that plays a key role not only in the development, growth, and maintenance of the functions of any organism but also in the quality of life (2). The WHO is developing healthy eating projects for learners in order to develop healthy eating habits (3). With this study we examine the knowledge and behavior of students about their diet and the consequences that are currently observed on their health.The aim of the present study is to determine whether students have a healthy diet.The study included 78 students from the Shumen Affiliate of MU-Varna in April 2022. The methods used are documentary and statistical—the survey method and graphical analysis.Based on the analysis of the data obtained, it was found that 68% of the surveyed students are familiar with the term "healthy eating." A significant proportion of respondents indicated that they do not eat breakfast in the morning (32%). Almost half of the respondents (46%) consume fruit 3–4 times a week.The conclusions we drew from the analysis of the obtained data show that about 1/3 of the students consume fast food products daily. Not a small part (40%) of the surveyed students eat 1-2 times a day. Only 19% of the respondents confirmed that they read the labels of products before buying them and have the habit of choosing food in the store

eHealth and the need for education in biomedical and health informatics for the physicians in Bulgaria

Introduction. eHealth applications are numerous: electronic health records, evidence-based practice, delivering care from a distance, patient self-care, epidemiological research, healthcare management activities etc. However, the effective provision of healthcare as appropriate to the eHealth environment, needs not only suitable buildings and modern medical equipment, it needs adequately trained healthcare staff.The aim of this study is to assess the readiness and the willingness of the Bulgarian physicians to work in eHealth environment and to give reason for their still actual necessity of education in biomedical and health informatics.Material and methods. An enquiry was carried out in 2013 among the physicians in Bulgaria aiming at the assessment of their knowledge of using computers in their daily medical practice, their attitude to eHealth and their readiness to work in eHealth environment.Results. The results of the study showed the positive attitude of the Bulgarian physicians to information technologies (97%) and their recognized need of using computers in medicine (91.9%). Although 77.49% declared that they have the necessary skills and knowledge to use computers, the study proved that this is just a basic computer literacy (word-processing and Internet). About half of the respondents recognize the need of additional education: databases and medical information systems (37.64%), graphical software (40.59%), statistical software (47.98%), specialized medical software (48.34%). The majority of the participants (86%) wish to personally use computers in their daily medical practice, yet only 38.4% of them wish to enter patient data in a computer by themselves. In fact, only 17.7% are aware of the principles of eHealth.Conclusions. Тhe adequate education in biomedical and health informatics is one of the most important prerequisites for the successful implementation of eHealth in Bulgaria.Keywords: Biomedical and health Informatics, eHealth, computer literacy, IC

A BASIC PROGRAM FOR TEACHING MEDICAL INFORMATICS TO STUDENTS OF MEDICINE

A basic program for teaching medical informatics to students of medicine is presented. It comprises two main modules. The purpose of the first module, "introduction to informatics", is to give the students basic knowledge in the field of implementation and use of computers and computer systems (basic computer skills). The aim of the second module, "introduction to medical informatics", is to introduce to the students the basic principles and methodology of medical informatics as a discipline dealing with the application of data, information and knowledge in health care and medicine. The program complies with the European requirements in the field of education in information systems in medicine and health care and can be adapted for different levels and forms of education in medical informatics

Slow Inhibition and Inhibitory Recruitment in the Hippocampal Dentate Gyrus

L’hippocampe joue un rôle central dans la navigation spatiale, la mémoire et l’organisation spatio-temporelle des souvenirs. Ces fonctions sont maintenues par la capacité du gyrus denté (GD) de séparation des patrons d'activité neuronales. Le GD est situé à l’entrée de la formation hippocampique où il reconnaît la présence de nouveaux motifs parmi la densité de signaux afférant arrivant par la voie entorhinale (voie perforante). Le codage parcimonieux est la marque distinctive du GD. Ce type de codage est le résultat de la faible excitabilité intrinsèque des cellules granulaires (CGs) en combinaison avec une inhibition locale prédominante. En particulier, l’inhibition de type « feedforward » ou circuit inhibiteur antérograde, est engagée par la voie perforante en même temps que les CGs. Ainsi les interneurones du circuit antérograde fournissent des signaux GABAergique aux CGs de manière presque simultanée qu’elles reçoivent les signaux glutamatergiques. Cette thèse est centrée sur l’étude des interactions entre ces signaux excitateurs de la voie entorhinale et les signaux inhibiteurs provenant des interneurones résidant dans le GD et ceci dans le contexte du codage parcimonieux et le patron de décharge en rafale caractéristique des cellules granulaires. Nous avons adressé les relations entre les projections entorhinales et le réseau inhibitoire antérograde du GD en faisant des enregistrements électrophysiologiques des CG pendant que la voie perforante est stimulée de manière électrique ou optogénétique. Nous avons découvert un nouvel mécanisme d’inhibition qui apparait à délais dans les CGs suite à une stimulation dans les fréquences gamma. Ce mécanisme induit une hyperpolarisation de longue durée (HLD) et d’une amplitude prononce. Cette longue hyperpolarisation est particulièrement prolongée et dépasse la durée d’autres types d’inhibition transitoire lente décrits chez les CGs. L’induction de HLD crée une fenêtre temporaire de faible excitabilité suite à laquelle le patron de décharge des CGs et l’intégration d’autres signaux excitateurs sont altérés de manière transitoire. Nous avons donc conclu que l’activité inhibitrice antérograde joue un rôle central dans les processus de codage dans le GD. Cependant, alors qu’il existe une multitude d’études décrivant les interneurones qui font partie de ce circuit inhibiteur, la question de comment ces cellules sont recrutées par la voie entorhinale reste quelque peu explorée. Pour apprendre plus à ce sujet, nous avons enregistré des interneurones résidant iii dans la couche moléculaire du GD tout en stimulant la voie perforante de manière optogénétique. Cette méthode de stimulation nous a permis d’induire la libération de glutamate endogène des terminales entorhinales et ainsi d’observer le recrutement purement synaptique d’interneurones. De manière surprenante, les résultats de cette expérience démontrent un faible taux d’activation des interneurones, accompagné d’un tout aussi faible nombre total de potentiels d’action émis en réponse à la stimulation même à haute fréquence. Ce constat semble contre-intuitif étant donné qu’en générale on assume qu’une forte activité inhibitrice est requise pour le maintien du codage parcimonieux. Tout de même, l’analyse des patrons de décharge des interneurones qui ont été activés a fait ressortir la prééminence de trois grands types: décharge précoce, retardée ou régulière par rapport le début des pulses lumineux. Les résultats obtenus durant cette thèse mettent la lumière sur l’important conséquences fonctionnelles des interactions synaptique et polysynaptique de nature transitoire dans les réseaux neuronaux. Nous aimerions aussi souligner l’effet prononcé de l’inhibition à court terme du type prolongée sur l’excitabilité des neurones et leurs capacités d’émettre des potentiels d’action. De plus que cet effet est encore plus prononcé dans le cas de HLD dont la durée dépasse souvent la seconde et altère l’intégration d’autres signaux arrivants simultanément. Donc on croit que les effets de HLD se traduisent au niveau du réseaux neuronal du GD comme une composante cruciale pour le codage parcimonieux. En effet, ce type de codage semble être la marque distinctive de cette région étant donné que nous avons aussi observé un faible niveau d’activation chez les interneurones. Cependant, le manque d’activité accrue du réseau inhibiteur antérograde peut être compensé par le maintien d’un gradient GABAergique constant à travers le GD via l’alternance des trois modes de décharges des interneurones. En conclusion, il semble que le codage parcimonieux dans le GD peut être préservé même en absence d’activité soutenue du réseau inhibiteur antérograde et ceci grâce à des mécanismes alternatives d’inhibition prolongée à court terme.The hippocampus is implicated in spatial navigation, the generation and recall of memories, as well as their spatio-temporal organization. These functions are supported by the processes of pattern separation that occurs in the dentate gyrus (DG). Situated at the entry of the hippocampal formation, the DG is well placed to detect and sort novelty patterns amongst the high-density excitatory signals that arrive via the entorhinal cortex (EC). A hallmark of the DG is sparse encoding that is enabled by a combination of low intrinsic excitability of the principal cells and local inhibition. Feedforward inhibition (FFI) is recruited directly by the EC and simultaneously with the granule cells (GCs). Therefore, FFI provides fast GABA release and shapes input integration at the millisecond time scale. This thesis aimed to investigate the interplay of entorhinal excitatory signals with GCs and interneurons, from the FFI in the DG, in the framework of sparse encoding and GC’s characteristic burst firing. We addressed the long-range excitation – local inhibitory network interactions using electrophysiological recordings of GCs – while applying an electrical or optogenetic stimulation of the perforant path (PP) in the DG. We discovered and described a novel delayed-onset inhibitory post synaptic potential (IPSP) in GCs, following PP stimulation in the gamma frequency range. Most importantly, the IPSP was characterized by a large amplitude and prolonged decay, outlasting previously described slow inhibitory events in GCs. The long-lasting hyperpolarization (LLH) caused by the slow IPSPs generates a low excitability time window, alters the GCs firing pattern, and interferes with other stimuli that arrive simultaneously. FFI is therefore a key player in the computational processes that occurs in the DG. However, while many studies have been dedicated to the description of the various types of the interneurons from the FFI, the question of how these cells are synaptically recruited by the EC remains not entirely elucidated. We tackled this problem by recording from interneurons in the DG molecular layer during PP-specific optogenetic stimulation. Light-driven activation of the EC terminals enabled a purely synaptic recruitment of interneurons via endogenous glutamate release. We found that this method of stimulation recruits only a subset of interneurons. In addition, the total number of action potentials (AP) was surprisingly low even at high frequency stimulation. This result is counterintuitive, as strong and persistent inhibitory signals are assumed to restrict GC v activation and maintain sparseness. However, amongst the early firing interneurons, late and regular spiking patterns were clearly distinguishable. Interestingly, some interneurons expressed LLH similar to the GCs, arguing that it could be a commonly used mechanism for regulation of excitability across the hippocampal network. In summary, we show that slow inhibition can result in a prolonged hyperpolarization that significantly alters concurrent input’s integration. We believe that these interactions contribute to important computational processes such as sparse encoding. Interestingly, sparseness seems to be the hallmark of the DG, as we observed a rather low activation of the interneuron network as well. However, the alternating firing of ML-INs could compensate the lack of persistent activity by the continuous GABA release across the DG. Taken together these results offer an insight into a mechanism of feedforward inhibition serving as a sparse neural code generator in the DG

Pulmonary Embolism. Predisposing Factors and Management

Pulmonary thromboembolism (PTE) is serious and sometimes life-threatening condition which may happen in any medical specialty. It is difficult to diagnose and easily can be missed which may lead to fatal outcome. In this review, the main diagnostic methods to detect PTE are considered, with a stress on early screening and diagnosis of the suspected patients. The principal therapeutic algorithms for management of confirmed PTE are revealed depending on the form and severity of the clinical presentation. The basic preventive measures are pointed out to avert this serious disease

PROGNOSTIC FACTORS IN PATIENTS WITH LUNG CANCER

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Atrial Fibrillation in Cancer Patients

Сърдечните аритмии са чест проблем при пациентите с карцином, могат да повлияят качеството на живот и да усложнят лечението на неопластичното заболяване. Скорошни проучвания показват, че новопоявилото се предсърдно мъждене (ПМ) е значим рисков фактор за последваща диагноза на карцином. ПМ се среща по- често при пациенти с малигнени заболявания, особе- но при тези, които са подложени на операция. Нашите данни показват, че 6% от пациентите, хоспитализирани по повод пристъпно или персистиращо ПМ, са с карци- ном. ПМ при пациентите с неопластични заболявания може да бъде придружаващо заболяване, последица от основното заболяване или усложнение на терапията. Карциномът е протромботично състояние, не е вклю- чен в скалите за оценка на риска и някои от химиотера- певтиците действат протромботично. В същото време някои от малигнените заболявания са свързани с пови- шен риск от хеморагия. Няма специфични препоръки за лечение на ПМ при карциномно болни. Спазват се някои от общите препоръки, заложени в настоящите ръководства, като се имат предвид и наличните данни при карциномно болни, но е необходим индивидуали- зиран подход от мултидисциплинарен екип.Cardiac arrhythmias are a common problem facing cancer patients and, when present, can affect quality of life and complicate the treatment of their malignancies. Recent study shows that new-onset atrial fibrillation (AF) is a sig- nificant risk factor for the subsequent diagnosis of incident cancer. AF has been found to occur with an increased fre- quency in patients with malignancies, particularly in those undergoing cancer surgery. Our data shows that 6 % of tne patients, hospitalized for paroxysmal or persistent AF are with cancer. AF in a cancer patient may be a comorbid- ity, may be a consequence of the cancer or a complication of cancer therapy. Cancer is a prothrombotic state, it is not incorporated in the risk prediction scores and some antican- cer agents act prothrombotic. At the same time some malig- nancies are associated with increased risk of hemorrhagia. There are no specific guidelines for AF management in can- cer patients. Treatment is based on general recommenda- tions from current guidelines in noncancer patients and the existing evidence in cancer patients, but there is a need of an individualized approach from a multidisciplinary team

Depression in patients with heart failure

Introduction: Heart failure (HF) is a chronic progressive syndrome, which is a result of preceding heart diseases and manifests with serious symptoms. Depression and anxiety are frequent comorbidities in chronic HF, which deteriorate the general status of the patients and are related to unfavorable health results—increased number of hospitalizations, deteriorated quality of life, and elevated mortality.Aim: The aim of this article is to assess the tendency to fall into depression of patients with HF in NYHA class III-IV, hospitalized in the non-invasive cardiology clinic of St. Marina University Hospital, Varna and the link to socioeconomic factors—social isolation, family status, educational level, region of residence and so on.Materials and Methods: Overall, 39 patients with HF (17 women and 22 men) were investigated. They were in III-IV NYHA functional class during hospitalization. After preliminarily informed consent, they were asked to fill out a validated screening questionnaire for depression in adults—the 15-item Geriatric Depression Scale (GDS). The link to the patients’ socioeconomic, demographic, biological, and clinical characteristics was sought with the help of a multi-factor linear and logistic regression analysis.Results: The results for the level of depression among HF patients were related to socioeconomic factors—region of residence, level of education, social isolation as well as to other variables—gender, age, and systolic left ventricular function assessed through the ejection fraction (EF). Higher levels of depression were observed in patients who resided in larger populated areas, with higher level of education and patients living alone. As far as gender was concerned, females were more susceptible to depressive episodes than males. At an average EF of 49.54 ±15.29%, the decreased left ventricular systolic function was also a factor of the degree of development of anxiety and depression. In a multi-factor analysis, however, only living alone was related to enhanced depressive attitude.Conclusion: Depression/anxiety in HF patients requires increased need of health care, shows poor health results, has high costs for treatment related to the serious symptoms, disability and high mortality. Regardless of that, no programs for timely detection, diagnosis, and treatment have been developed yet

Regional disparities in all-cause mortality in Bulgaria for the period 2000 - 2012

Health inequalities are an exclusive focus of scientific research in all European countries. Subnational studies have the potential to detect regional variations, to evaluate health problems, and to plan policies for reducing them.This study presents regional all-cause mortality disparities in Bulgaria with crude and standardized rates for a period of 13 years, from 2000 to 2012