Simulation training in medicine is a powerful tool for acquiring knowledge and practical skills in an environment close to the real world. Decreasing training opportunities directly on the patient tend to introduce simulations close to the real hospital environment without compromising the patient’s safety. The aim of the study was to evaluate the effectiveness of simulation training in the Medical Simulation Training Center (MSTC) at the Medical University of Plovdiv. A prospective observational descriptive study was performed at the MSTC at Plovdiv Medical University between September 2017 and March 2019. The study included 245 respondents who participated in one or more practical simulation trainings and were surveyed. The results of the study suggest that the knowledge, skills and attitudes of the trainees improve after training sessions. By increasing the number of visits, the self-esteem and confidence in performing the manipulation also increases, knowledge and technical performance significantly improve and mistakes are reduced. A statistically significant relationship has been demonstrated between the sequence of visits and acquired competencies (p=0.0001). There are no performance mistakes in those attending three or more times, but 16.2% of them still experience uncertainty while performing. Here, however, 83.8% performed the manipulation automatically and without mistakes. Simulation training in medicine is effective and useful. It has its place in the curriculum for students and is a good tool for acquiring knowledge, skills and techniques in postgraduate education.

Introduction: Asthma is a chronic respiratory disease affecting approximately 5 million children in the US, but little is known about whether asthma alters children’s attention and memory functions. Most studies on this topic focus on psychiatric and QoL outcomes rather than cognitive functions, leaving a gap in the literature. We aimed to conduct a systematic review and meta-analysis to evaluate the attention deficit and memory function outcomes in children with bronchial asthma. Methods: A systematic search was conducted in PubMed, Web of Science, and Cochrane Library from inception to 28 February 2025 for studies evaluating attention deficit and memory function in children with bronchial asthma. Outcomes of interest included attention deficit and memory function. Statistical analysis was performed with R 4.3.1. Heterogeneity was accessed using the I² statistics and Cochrane Q test. The standardized mean difference (SMD) with restricted maximum-likelihood estimator random-effects method was computed for all outcomes. Results: A total of seven studies were included in the final meta-analysis, comprising 104,975 patients, of whom 10,200 (9.7%) had bronchial asthma (mean age ± 8.98 years, mean 45% females). In the pooled analysis, children with asthma had a worsened attention deficit compared to the healthy group (SMD 0.29; 95% CI [0.07; 0.51]; p = 0.01; I² = 92%). However, no statistically significant difference was found in memory function between groups (SMD −0.24; 95% CI [−1.81; 1.33]; p = 0.77; I² = 96%). Conclusions: Children with asthma showed significantly higher attention deficit scores compared to healthy children. No statistically significant differences were observed in memory function between the groups. These findings may have implications for early cognitive screening in pediatric asthma management.

The C-terminal binding protein 1 (CTBP1) is a transcriptional corepressor with a major role in nervous system growth and development. There are only 20 published cases with CTBP1 mutations, displaying a phenotype of Hypotonia, Ataxia, Developmental Delay and Tooth enamel defect Syndrome (HADDTS). Histochemical evidence of decreased mitochondrial respiratory chain activity has been previously reported, but comprehensive data on the metabolic phenotype assessed by various cellular respiration parameters are still missing. We present a 10-year-old female with typical HADDTS features, harboring the most reported de novo heterozygous CTBP1 mutation c.991C>T. To elucidate her metabolic phenotype, we quantified mitochondrial respiration in peripheral blood mononuclear cells (PBMCs) utilizing an analyzer for assessing mitochondrial function (Seahorse XFp). Real-time metabolic assays revealed profound mitochondrial dysfunction with significantly attenuated maximal respiration and spare respiratory capacity compared to neurotypical controls. Following mitochondria-targeted nutritional support for one-year measurable bioenergetic improvements and reduced number of respiratory infections were registered. However, neurological recovery and new skill acquisition were not observed. We present a novel case of CTBP1-related neurodevelopmental disorder and demonstrate, for the first time, the application of non-invasive, real-time mitochondrial functional assessment in this setting, providing additional evidence for mitochondrial dysfunction in HADDTS.

We report the case of a boy diagnosed at age 9 with a large aortopulmonary septal defect and Eisenmenger syndrome, highlighting the challenges of late diagnosis and management of fixed pulmonary hypertension. Over the course of six years (2018–2024), the patient underwent several follow-ups, including invasive hemodynamic assessments and echocardiography, revealing progressive pulmonary vascular disease. Despite the administration of medical therapy with sildenafil, bosentan, and antiplatelets, the patient’s condition remained unfavorable due to fixed pulmonary vascular obstructive disease. This case underscores the importance of early diagnosis and the complexities of managing advanced pulmonary hypertension in congenital heart defects.

Background: Hepatitis A virus (HAV) infection is a common cause of acute viral hepatitis in children. Severe complications are rare but may occur, particularly in older children or in the presence of concomitant conditions. Case Presentation: We report the case of an 11-year-old girl with acute hepatitis A with severe hepatic derangements who developed life-threatening upper gastrointestinal bleeding due to a previously undiagnosed duodenal ulcer. Emergency endoscopy confirmed active bleeding from a duodenal ulcer, and the patient survived the complications with treatment with a proton pump inhibitor and hemostatic management with blood products. Conclusions: Although hepatitis A is generally benign in children, this case highlights the potential for severe and life-threatening complications.