Background and objectives: Burnout is a syndrome typically occurring in work environments with continuous and chronic stress. Physicians are at increased risk for burnout, as a result of 24-h work, delayed work–life balance gratification, and the challenges associated with patient care. The aim of the present study was to evaluate the psychological parameters of burnout symptoms in relation to biomarkers of stress among physicians with different medical specialties. Materials and methods: A total of 303 physicians were contacted as potential participants. A comparison group of 111 individuals working outside medicine was used as a control to verify the results. The physicians were specialists in internal medicine, general surgery, pathology, and primary care. Serum cortisol, salivary cortisol, adrenocorticotropic hormone (ACTH), insulin (IRI), and prolactin levels were analyzed by chemiluminescence enzyme immunoassay (Access 2, Beckman Coulter). Fasting glucose in serum and glycated hemoglobin (HbA1C) in whole blood were measured using the automatic analyzer AU 480 Beckman Coulter system. Symptoms of burnout were measured with the Maslach Burnout Inventory (MBI). Results: The group with burnout presented significantly higher levels of serum and saliva cortisol, ACTH, prolactin, fasting glucose, and HbA1C compared with the control group. The correlation analysis between biomarkers showed a positive correlation with moderate strength between serum and saliva cortisol (r = 0.516, p = 0.01),as well as serum and saliva cortisol with ACTH (r = 0.418; r = 0.412, p = 0.01) and HbA1C (r = 0.382; r = 0.395, p = 0.01). A weak positive correlation was found between serum and saliva cortisol with prolactin (r = 0.236; r = 0.267, p < 0.01) and glucose (r = 0.271; r = 0.297, p < 0.01). In the multiple logistic regression model, saliva cortisol, HbA1C, and age were significantly associated with burnout (chi-square = 16.848, p < 0.032). Conclusion: Our findings demonstrated the interest of exploring biomarkers of stress related to burnout in health professionals.

To validate the Bulgarian EUROPEP-questionnaire and its implementation to measure patient evaluation of general practice care in Bulgarian population.A multicenter cross-sectional study was conducted at twenty five primary care practices from South-Central ...

Testicular angiotensin converting enzyme (ACE) is known to play an essential role in the male reproduction and fertility. Data about tACE in cases of male infertility are quite scarce, and in this respect we aimed to study localization and distribution of tACE protein in the neck and mid-piece of spermatozoa from pathological samples in relation to sperm motility. The enzyme expression during capacitation and acrosome reaction was quantitatively assessed. In human ejaculated spermatozoa tACE is localized on sperm plasma membrane of the head, the neck and mid-piece of the tail. The immunoreactivity becomes stronger in capacitated spermatozoa followed by a decrease in acrosome reacted sperm. In different cases of semen pathology (oligozoospermia, asthenozoospermia and teratozoospermia) fluorescent signals in the neck and mid-piece are in punctate manner whereas in normozoospermia they were uniformly distributed. The expression area of tACE the neck and mid-piece was decreased in ejaculated and capacitated sperm from pathological semen samples compared to normospermia. Significant positive correlation was established between tACE area and progressive sperm motility, whereas with immotile sperm the correlation was negative. Our data suggest that proper distribution of tACE in the neck and mid-piece is required for normal sperm motility that could be used as a novel biomarker for male infertility.

Background: The reduced fracture resistance in endodontically treated teeth requires the use of radicular posts, with their advantages and disadvantages. Aim: To evaluate the clinical performance of teeth restored with or without radicular posts at 6 and 12 months. Materials and methods: The study included 22 patients who received endodontic therapy on premolars with a loss of one or two proximal walls. The premolars were divided into groups according to the restoration method: metal post group (MP), fiber post group (FP), and no post group (NP). For the NP group, a dentinal core of fiber-reinforced composite was used. The McNemar test, marginal homogeneity test and Kruskal-Wallis test were used in the statistical analysis. At the 6 and 12 month recall, both the direct composite restorations and the integrity of the post systems were assessed. Results: At 6-month recall assessment, there was no statistically significant difference in the categories of ‘appropriate colour’, ‘secondary caries’ and ‘obturation integrity’. That was not the case with ‘marginal discoloration’, ‘marginal adaptation’, ‘proximal contact’ and ‘surface smoothness’. The recall at 12 months showed a continuation of this tendency, with significant decrease in the category of ‘adequate colour’. Assessment of post longevity at the two recalls did not show any significant changes. The teeth restored without a post showed survival rates comparable to that of teeth restored with a post for the 12-month period of observation. Conclusions: There were no failures of the different posts used. The observed changes were attributed to the progressive deterioration of the composite restorations.

Background: The SARS-CoV-2 virus as well as the COVID-19 mRNA vaccines cause an increased production of proinflammatory cytokines. Aim: We investigated the relationship between ACE2, CTSL, AngII, TNFα and the serum levels of IL-6, IL-10, IL-33, IL-28A, CD40L, total IgM, IgG, IgA and absolute count of T- and B-lymphocytes in COVID-19 patients, vaccinees and healthy individuals. Methods: We measured the serum levels ACE2, AngII, CTSL, TNFα and humoral biomarkers (CD40L, IL-28A, IL-10, IL-33) by the ELISA method. Immunophenotyping of lymphocyte subpopulations was performed by flow cytometry. Total serum immunoglobulins were analyzed by the turbidimetry method. Results: The results established an increase in the total serum levels for ACE2, CTSL, AngII and TNFα by severely ill patients and vaccinated persons. The correlation analysis described a positive relationship between ACE2 and proinflammatory cytokines IL-33 (r = 0.539) and CD40L (r = 0.520), a positive relationship between AngII and CD40L (r = 0.504), as well as between AngII and IL-33 (r = 0.416), and a positive relationship between CTSL, total IgA (r = 0.437) and IL-28A (r = 0.592). Correlation analysis confirmed only two of the positive relationships between TNFα and IL-28A (r = 0.491) and CD40L (r = 0.458). Conclusions: In summary, the findings presented in this study unveil a complex web of interactions within the immune system in response to SARS-CoV-2 infection and vaccination.

Introduction: The advent of Cone Beam Computed Tomography (CBCT) in endodontics has enhanced the diagnosis of periapical radiolucencies and the assessment of endodontically treated teeth. Aim: The purpose of this study was to assess the prevalence of periapical radiolucencies in a Bulgarian subpopulation and the quality of previous endodontic treatment using CBCT scans. Materials and methods: This study included 2795 roots from 160 Large FOV CBCT which were evaluated by two independent examiners using two scoring systems: CBCT-PAI and PESS. Results: The inter-examiner agreement spanned from strong to almost perfect (0.892 and 0.983). The prevalence of periapical lesions according to the two scoring systems was 23.1% and 12.9 %, respectively. The prevalence of endodontically treated teeth was high (34.1%). Sixty-five percent of them presented with signs of periapical radiolucencies, while only 1.4% of all non-treated roots had a periapical lesion. A significant association between periapical disease, poor quality of the root canal filling and inadequate coronal seal was found (p<0.001). Conclusions: The prevalence of periapical disease in endodontically-treated teeth in the Bulgarian subpopulation was high. Poor qual-ity of the root canal filling and inadequate coronal seal were assessed as prognostic determinants of treatment failure. CBCT techniques can augment conventional diagnostic techniques in the field of endodontics.