Based on the limited research focusing on the severity of cognitive deterioration in schizophrenia with preceding toxoplasmosis, we sampled 89 demographically matched paranoid schizophrenia patients (mean age 38.97 years) with (n = 42) and without (n = 47) seroprevalence of IgG type anti T. gondii antibodies as marker of past infection. They underwent examination of verbal memory (10 words Luria test), logical memory and visual memory (BVRT), processing speed (TMT-A/DSST) and executive functions (TMT-B/verbal fluency). We compared the results of both groups, taking into account the normative values for the Bulgarian population where available. We also compared the two groups in terms of clinical severity as evidenced by positive, negative and disorganization sub-scores of the PANSS. While both groups were expectedly under the population norms for verbal and logical memory, seropositive patients showed significantly bigger impairment in verbal memory (Luria Smax = 72.85 vs 78.51; p = 0.029), psychomotor speed (TMT-A 50.98 s vs 44.64 s; p = 0.017), semantic verbal fluency (27.12 vs 30.02; p = 0.011) and literal verbal fluency (17.17 vs 18.78; p = 0.014) compared to the seronegative ones. In addition to that, they gave less correct answers on the BVRT (2.98 vs 4.09; p = 0.006) while making markedly more errors (13.95 vs 10.21; p = 0.002). Despite not reaching statistical significance, past toxoplasmosis was associated with higher score on the PANSS disorganization sub-scale (16.50 points vs 14.72 points) and with lower educational attainment. Our results suggest a more profound neuropathological insult(s) resulting in greater cognitive impairment in schizophrenia cases that are exposed to T. gondii infection.

The study aimed to assess the impact of clinical symptoms and cognitive impairment on disability in patients with paranoid schizophrenia (PS). Methods: 108 patients with schizophrenia were included (66 male and 42 female). Their average age was 38.86 ± 10.02 years and the disease duration was 12.80 ± 8.20 years, with mean disease onset of 24 years. Clinical symptoms were assessed with the PANSS, and cognitive performance was measured using a seven-item neurocognitive battery. The disability level of the subjects was assessed using the World Health Organization—Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The relation between the variables studied was assessed using Spearman’s rank correlation coefficient (r_s) at a probability level of p < 0.05. Results: An increase in symptom severity resulted in worsening of the “participation in society” (r = 0.56, p < 0.01), “life activities—household” (r = 0.55, p < 0.01), and “getting along with people” (r = 0.59, p < 0.01) WHO-DAS 2.0 domains. Positive symptoms (13.89 ± 3.48) correlated strongly with “getting along with people” (r = 0.55, p < 0.01), “life activities—household” (r = 0.58, p < 0.01), and “participation in society” (r = 0.62, p < 0.01), and negative symptoms (14.25 ± 4.16) with “participation in society” (r = 0.53, p < 0.01) and “life activities—household” (r = 0.48, p < 0.01). Symptoms of disorganization (15.67 ± 4.16) had the highest impact on “life activities—household” (r = 0.81, p < 0.01), “getting along with people” (r = 0.56, p < 0.05), and “participation in society” (r = 0.65, p < 0.01). Episodic memory (r = −0.28, p < 0.01) was remotely related to comprehension and communication. The information processing speed (r_s = 0.38, p < 0.01), visual memory (r_s = −0.30, p < 0.01), and focused executive functions showed moderate correlations with all domains on the WHO-DAS 2.0 scale (r_s = 0.38, p < 0.01). Attention (r_s = −0.33, p < 0.01) was moderately related to community activities. Semantic (r_s = −0.29, p < 0.01) and literal (r_s = −0.27, p < 0.01) verbal fluency demonstrated weak correlations with “cognition—understanding”, “getting along with people”, and “participation in society”. Conclusion: Symptoms of disorganization and disturbed executive functions contribute most to disability in patients with schizophrenia through impairment of real-world functioning, especially in social interactions and communication. Severe clinical symptoms (negative and disorganization-related ones) as well as deficits in executive function, verbal memory, and verbal fluency cause the biggest problems in the functional domains of interaction with other people and participation in society.

The aim of our research was to evaluate and analyze serum 25(OH) vitamin D and parathyroid hormone (PTH) levels to investigate whether vitamin D deficiency serves as a risk factor for an increased incidence of acute respiratory infections (ARI) in children. Serum PTH levels were used as an indicator of vitamin D sufficiency, as normal PTH levels require an optimal concentration of 25(OH) vitamin D. The study included 129 children, divided into five subgroups: children with acute bronchopneumonia (n = 42), acute laryngotracheitis (n = 7), acute bronchiolitis (n = 32), acute bronchitis (n = 18), and a control group (n = 30). No statistically significant differences in 25(OH)D levels were observed between the overall population of children with ARI and the control group (p = 0.073). However, significant differences in 25(OH)D levels were identified between the control group and children with bronchopneumonia, acute bronchitis, and laryngotracheitis (p < 0.01, p < 0.05). Regarding PTH levels, statistical significance was found between the control group and the acute bronchiolitis group, due to the high percentage of children with hypervitaminosis in this subgroup. These results highlight the crucial role of vitamin D in the onset and progression of acute respiratory tract infections in children, emphasizing its impact on their overall respiratory health.

The objective of our study was to compare the age-related differences in the prevalence of modifiable risk factors (RF), stroke subtype and functional outcome at hospital discharge in young and middle-aged patients with first-ever ischemic stroke (IS). The study included 120 patients with acute first-ever IS, aged 18–59 years, admitted to the Neurology Clinic of Dr. Georgi Stranski University Hospital, Pleven. Of these, 41 (34.2%) were in the young-age group and 79 (65.8%) were middle-aged. The middle-aged patients had higher rates of arterial hypertension (81.0%), diabetes mellitus (45.6%), dyslipidemia (83.5%), low levels of HDL cholesterol (68.4%), high levels of LDL cholesterol (72.2%) and arterial fibrillation (7.6%). The most common subtype of IS in middle-aged patients was large artery atherosclerosis (40.5%), small vessel occlusion (29.1%) and cardioembolism (6.3%). In comparison, we found a higher incidence of IS in the young patients with other determined (34.1%) and undetermined aetiology (34.1%). Our data on functional outcomes at hospital discharge confirm age-related differences in the prevalence of modifiable RFs and stroke subtype in young and middle-aged patients with first-ever IS. These findings highlight the need to develop specific therapeutic approaches for early identification and effective control of health- and lifestyle-related RFs to reduce the incidence of the most common subtypes of IS.

Introduction: Care for patients with oncology diseases is a specific area of competence in nursing. The nurse, as part of an interdisciplinary team, has an essential role in organizing, planning, implementing and evaluating the results of patient clinical care. The study aimed to investigate patients' and nurses' opinions on the role of the nurse-patient relationship in improving the quality of care. Material and methods: Data were collected by direct individual self-administered questionnaire among 49 nurses and a "face to face" semi-structured interviewwith 67 patients in five departments. Data were processed with the statistical program Microsoft Office Excel 2015 и SPSS v.21. Results: The idea of the therapeutic relationship "nurse-patient" was examined from the view point of both patients and nurses. More than half of the patients (53,7%) arrange as particularly important nurse skills to relieve physical pain, followed by 40,3% to inspire confidence and hope and 35,8% - the ability to listen and give advice. One in 10 patients expects to be included as a decision-making partner in planning care; every fifth patient expects information from the nurse according to her competence. Professional ethics and the relationship "nurse-patient" was evaluated by 55,2% of patients as excellent. All nurses (100%) underlie the principles of the therapeutic relationship, regardless of the length of the contact are respect, genuineness, empathy, active listening, trust, and confidentiality. Conclusion: The nurse-patient relationship is a common responsibility of both: nurses and patients. Both groups evaluated the importance of its components for mutual satisfaction in such communication.

Background: The administrative division of Bulgaria divides it into 28 regions, which differ significantly in terms of both socioeconomic development and a number of demographic indicators. The death rate is an indicator according to which our country has been at the top of the world rankings for several years. Cardiovascular diseases stand out among the leading causes of death and they are one of the most important problems facing our society and health system. The study aims to analyse the relationship between the death rate due to CVD in different regions in Bulgaria with the average annual salary of employed persons as an indicator for the socioeconomic development of the regions. Methods: The regional differences in the death rate due to CVD and the average annual salary of employed persons were analysed based on the National Statistical Institute data. Analysis and calculations were performed by MS Excel 2019. Results: The death rate due to CVD in Bulgaria varies widely - from 1739.7 per 100000 in region Vidin, 1685,2 in region Montana to 878.0 in the city of Sofia, with a national average of 1163.2 /2021/. At the same time, Vidin and Montana regions are also among the regions with a very low average annual salary of employed persons - respectively 12 855 and 13 983 BGN, which is much lower than the average for the country - 21 128 and than the capital Sofia - 25 724 BGN /2021/. Conclusions: The regional health inequalities in Bulgaria are very important in order to control and decrease the level of mortality in the country, especially the death rate due to CVD. Bulgaria is among the counties that have the most serious challenges related to high cardiovascular deaths and should be among the priorities of public policy. The profound regional differences that were found impose permanent monitoring and directing the regional social and public health policies to avoid their unfavourable effects. Society should be making major and cost-effective efforts to reduce mortality. Key messages: • The elimination of regional inequalities in the country is one of the possible ways to deal with the difficult demographic situation which occurred in the years after the democratic changes. • Regional health inequalities create the need for a long-term health policy that will improve the population's health status and the effective functioning of the healthcare system in our country.