Background and Objectives: Bulgaria had the highest mortality rate of COVID-19 in Europe and the second highest in the world based on statistical data. This study aimed to determine the mortality predictors in 306 adult patients with COVID-19 infection, treated at the COVID-19 Ward of St. George University Hospital in Plovdiv, Bulgaria in the period of August 2021–April 2022. Materials and Methods: All admitted and treated patients had a positive PCR test for SARS-CoV-2. They were assigned in three groups based on the severity rating scale published in NIH COVID-19 Treatment Guidelines by Stat Pearls Publishing, 2022. Demographic, clinical, and laboratory parameters and pre-existing comorbidities were investigated. Parametric and non-parametric methods were used for statistics. Logistic regression was applied for parameters significantly associated with mortality. Results: Data showed that demographic indicators were not significantly associated with poorer outcome. Among comorbidities, cardiovascular, chronic pulmonary and endocrine disorders were found to be related to poor survival rates (p = 0.003, p = 0.003 and p = 0.017 resp.) Clinical symptoms, such as sore throat, dry or productive cough and breathlessness, were determinants of poor outcome (p = 0.027, p = 0.029, p = 0.004 and p = 0.002 resp.). Laboratory parameters linked to mortality were elevated d-dimers (p = 0.015), ferritin (p = 0.009) and creatinine (p = 0.038). p02 < 50 and saturation < 90 also indicated a higher risk of death (p = 0.006 and p = 0021). Conclusions: Logistic regression showed that each stage of disease severity increased the risk of death 3.6 times, chronic pulmonary disorders increased it by 4.1, endocrine by 2.4 and dyspnea by 3.1 times.

Until now, the COVID-19 pandemic has resulted in at least 27 million cases and over 900,000 deaths worldwide. Bulgaria is one of the countries that is the most severely affected by the COVID-19 pandemic, and the mortality rate is among the highest registered in the world. The aim of this study is to investigate and analyze mortality rates due to the fact of COVID-19 in addition to the most common related underlying medical conditions in those hospitalized to outline the factors that have an impact on the mortality rate due to the fact of COVID-19. A descriptive cross-sectional research design with a retrospective analysis was used to collect data from a total of 128,269 hospitalized patients during the period from April 2020 to November 2021. During the study period, the number of hospital admissions due to the fact of COVID-19 was 5200. The patients’ mean age was 67.34 (SD ± 19.65), and 51.7% (2689) of the patients were men. Only 10% of out of a total of 5200 patients did not test positive for COVID-19 upon admission based on the antigen or PCR test. Out of all patients, 41.5% had no underlying medical conditions upon presentation, and the remaining 58.5% had diagnosed comorbidities, varying from one to five. One-third (1470) had a lethal outcome, and the remaining 71.7% recovered from the infection and were discharged from the hospital. Based on the analysis of our results, there is definite evidence that the CFR and susceptibility to symptomatic COVID-19 were higher in the elderly, men, and patients with more comorbidities, especially chronic cardiovascular, metabolic, and respiratory disorders, as well as in those admitted to hospital within 6 h after an emergency ward visit and who had a shorter mean hospital stay.

Introduction: Severe and critical forms of SARS-CoV-2 pneumonia are associated with high morbidity and mortality. Numerous research studies have been conducted around the world to investigate various variables (demographic, clinical, laboratory, etc.) in an attempt to understand the relationships between them and the course and outcome of patients with COVID-19 infection and pneumonia. Aim: To outline predictors of a severe or critical course and fatal outcome in patients with COVID-19–associated pneumonia. Materials and methods: The current study was conducted from August 2021 to April 2022 in the COVID-19 ward of the Clinics of Pulmonology and Phthisiology at St George University Hospital in Plovdiv. It included 146 patients with PCR-confirmed COVID-19 and with anamnestic, laboratory, and imaging evidence of pneumonia. The patients were divided into three groups based on the severity of infection: moderate, severe, and critical. Demographic, clinical, laboratory, and imaging studies were performed for all patients. The data was exported to IBM SPSS v. 23 statistical software and analyzed with descriptive statistics, parametric and non-parametric methods. The relationships between the above-mentioned indicators and the severe or critical course and fatal outcome of the COVID-19 infection were outlined. A regression model was applied if the tested variables had a statistically significant correlation with the lethal outcomes. Results: The age and sex of the patients appeared to be the most important demographic factors: the mean age of the patients who were discharged was 57 years, whereas the mean age of the deceased patients was 71 years. However, there was no statistically significant difference between the mortality rates of the age group under 65 and the age group over 65. Regarding sex, 30.8% of men and 25.5% of women had a fatal outcome, the difference failing to reach statistical significance (p=0.159). Among the clinical signs at admission, shortness of breath and mental status changes were related to a more severe course of the disease and increased mortality: statistically significant difference was found depending on the absence or presence of dyspnea (p=0.039). Of the patients without dyspnea, 90.9% were discharged, unlike 79.1% of the patients who had it, which makes a mortality rate of 29% for the latter group. There was also a statistically significant difference in the outcome depending on the presence of mental status changes – 45.5% of patients without mental status changes were discharged, whereas only 12% of those with mental status changes were discharged (p=0.011). Elevated D-dimers also seemed to affect the outcome – 82.2% of deceased patients had D-dimer levels of >0.5. In terms of illness severity, the disease had a moderate course in 46 (65.2%) patients without raised D-dimers, and a severe course in 75 (72.2%) patients who had elevated D-dimer levels, and a critical course in 22 (76%) patients. There was a statistically significant difference between the pO2 values and disease severity – the probability of a severe and critical course in those with pO2<60 mmHg was 77.2% (p=0.002). Presence of alveolar infiltrates seen in chest x-ray (CXR) or CT studies also led to a severe or critical course (p=0.000). The regression model showed that the three independent variables, shortness of breath, confusion at admission, and pO2 level <60, were found to be statistically significant based on the Wald criterion (p<0.000). Conclusions: The results of the study indicated that older age, shortness of breath, and altered mental state at admission are predictors of severe or critical course and lethal outcome in patients with COVID-19 pneumonia. Regarding the laboratory tests, the elevated D-dimers and pO2 levels <60 also indicate high risk and lethal outcomes.

BACKGROUND: Angioedema (AE) is acute oedema of the skin and mucous surfaces, involving the respiratory and gastrointestinal tracts. AE could be a life-threatening medical condition. Regardless of its growing clinical importance, many aspects of its aetiology and pathogenesis remain poorly understood. Its incidence, demographic characteristics, diagnosis and therapy, need further investigation. AIM: This study reports our experience with angioedema concerning its social and demographic characteristics, aetiology, clinical features, diagnosis and treatment outcomes. Study design: Eighty-eight patients with AE were enrolled. The study is a retrospective analysis of patients treated in our Clinics. METHODS: All participants were asked on a voluntary basis to fill out a specially designed questionnaire on the day of their discharge. Other important data sources included: patients’ history and notes during the hospital stay, information from previous admissions, etc. Parametric and non-parametric statistical methods were used for data processing. Data analysis was performed using SPSS (SPSS Inc., IBM SPSS Statistica) version 20.0 RESULTS: Based on our results, AE affects more frequently patients over 50 years of age, regardless of their sex. Urban residents prevail, among them - more commonly working women. Non-steroidal anti-inflammatory drugs (NSAIDs), hormones and antibiotics were among the most common triggers – in 8%, 4.5% and 11.4% of the cases respectively. In 9.09% of the patients, food-induced AE was seen, the most common foods reported, were – nuts, eggs and egg products. The common sites of involvement were periorbital area and lips. In only 9.1% of the patients, oedema progressed to spread to the upper respiratory tract. Cardiac conditions were the most frequent underlying disorders – 33%, of the patients, auto-immune thyroiditis was the second most common-14.8%, followed by musculo- skeletal disorders (10.2%) and diabetes (4.5%) Family history of allergy was seen in 8.4% of the patients, the most frequent allergic disorder, reported, was asthma. In patients with HAE, family history was present in 2.9% of the patients. CONCLUSIONS: All patients received therapy with steroids and antihistamines, resulting in resolution of symptoms and no invasive procedures were necessary. Based on our results, the diagnosis of AE is often difficult and delayed and requires specialist evaluation. If recognised on time and adequately treated, the outcomes are favourable.

Patient safety culture is a key component of the organizational culture and a critical measure of the quality of healthcare. The aim of this study was to gain an insight into the problems concerning patient safety culture, based on the analysis of data, collected after interviewing healthcare specialists working in surgical and nonsurgical units in selected Bulgarian hospitals. This was a cross-sectional online study using a web-platform and the Bulgarian Version of Hospital Survey on Patient Safety Culture. It was conducted among healthcare workers (n = 620) in 2021. The B-HSOPSC incudes 42 scales grouped in 12 different domains. We compared the percentage of positive ratings and outcome dimensions between surgical and other hospital departments with the nonparametric Mann–Whitney U test, χ² tests, Fisher’s Exact Test, and OR. The results showed that there are no statistically significant differences between the ratings on Patient Safety Culture given by the surgical and the nonsurgical staff except for the dimension “Hospital management support for patient safety”. Results from the study highlighted that the most important aspect of hospital patient safety is the shortage of medical staff in both surgical and nonsurgical hospital units. Communication, work shift organization, handoffs and transitions between shifts and among different hospital units, as well as communication with line managers were rated as satisfactory in Bulgarian hospitals.

Background: The 2020 year was different. WHO announced a global pandemic and till now we have over 2 million fatality rate. The SARS CoV-2 virus causes acute respiratory viral infection and is associated with a wide range of complications. Aim: In this article we are representing six patients with deep venous and arterial thrombosis after Covid-19 and their treatment. Materials and Methods: The patients were treated successively by the Department of Vascular Surgery and the Department of Burns, Plastic, Reconstructive and Aesthetic Surgery of the "St. George" University Hospital, Medical University Plovdiv, Bulgaria. Results: Some of them were treated conservatively and others surgically. The localizations were upper and lower extremity and the hard palate. Amputation of the affected limb, soft tissue defects and conservative treatment was required. The arterial thrombosis were more than venous ones. All the patients were stable at discharge. Conclusion: After COVID-19 complications include Thrombotic events – Acute Limb Ischemia (ALI), Venous Thromboembolism (VTE), Pulmonary Embolism (PE), Disseminated Intravascular Coagulopathy (DIC) Syndrome. Thromboprophylaxis is very important. It dependent on the severity of the infection, the underlying causes and the course of treatment.