ABSTRACT
Background: The relative association between cardiovascular disease (CVD) and mortality in COVID-19 remains unclear. Aim(s): to evaluate the relationship of CVD with in-hospital death among hospitalized patients with Covid-19. Material(s) and Method(s): retrospective cohort study included hospitalized patients aged >= 18 years with confirmed COVID-19 between October and December 2021 in Single COVID -19 department of UMHAT "Alexandrovska". Demographic, clinical and outcome (in-hospital mortality) data were obtained from medical records. All CVD comorbidites were recorded. Multivariate logistic regression models were fitted to quantify the risk and predictors of in-hospital mortality from COVID-19 in patients with these comorbidities. Result(s): 165 patients with a mean age of 64.6+/-15 of whom 44.8% were men were included. In-hospital mortality was 20%. The presence of CVD was associated with increased in-hospital mortality. Mortality risk was higher in patients having hypertension (28.7% vs. 8.7%, p<0.05), coronary artery disease (27.0% vs. 6.5%, p<0.001), previous ischemic stroke (8.1% vs. 1.6%, p< 0.05), valvular heart diasease (16.2% vs. 4.1%), chronic heart failure (29.7% vs. 4.0%, p<0.001). Significant predictors of mortality from COVID-19 in patients with CVD were three vessel disease (HR: 2.04;95% CI 1.42-9.82, p<0.05), previous percutaneous coronary intervention (HR: 5.0;95% CI 2.05-8.56, p<0.05), systolic dysfunction (HR: 5.4;95% CI 1.85-15.76, p<0.05) and advanced heart failure NYHA III-IV (HR: 2.62;95% CI 1.55-4.78, p<0.001). Conclusion(s): COVID-19 patients with CVD comorbidites have a higher risk of in-hospital death. Optimal care and good control of CVD are essential in this patient group.
ABSTRACT
Antimicrobial resistance occurs naturally but is enhanced by human activities related to the use of antibiotics (for example, excessive use and misuse of antimicrobial agents). Our study aimed to gain insight into the knowledge, attitudes and practice of the use of antibiotics among the general Bulgarian population. A cross-sectional survey was conducted during a 4-week period in April-May 2022. Our sample included 516 participants of whom 398 (77.1%) were females, mainly Bulgarians by ethnic group, with a university degree (master degree 58.9%;bachelor degree 17.2%) and living in big regional cities (91.5%). The main health reasons that respondents from all age groups share for taking antibiotics in the last year were bronchitis, sore throat, infections, including urinary tract infections, and pneumonia. Interestingly, about 14% of the respondents have treated the SARS-2-coronavirus infection with antibiotics. Our results highlighted existing attitudes toward antibiotic use in the surveyed sample. Overall, respondents from all age groups showed similarities in their attitudes toward treatment with antibiotics. People's behavior and actions toward antibiotics play an important role in the spread of antimicrobial resistance. Our study provided some important insights concerning the knowledge and practices related to antibiotic use and antimicrobial resistance in the Bulgarian population. In general, good knowledge of antibiotic use and antimicrobial resistance was evident among the surveyed sample.
ABSTRACT
Background Bulgaria faced significant COVID-19 morbidity and mortality rates, but many people underestimated the risk of transmission and severity of infection. Rising vaccine-related fear and misinformation exacerbated existing hesitancy and mass vaccination remained a challenge. This study aims to investigate the factors influencing COVID-19 vaccination uptake in Bulgaria. Methods A cross-sectional study was conducted in April 2022 in a sample of 1,200 respondents. Data were collected via an online self-administered questionnaire, measuring perceived risk of COVID-19, vaccine attitudes, trust in health system, and sociodemographics. Results were analyzed using bivariate and multivariate statistical methods. Results Bivariate analyses showed that the majority of vaccinated respondents (81.9%) expressed concern about infection, compared to 47.1% of non-vaccinated. Significant differences were related to perceived risk of COVID-19 vaccine: 61.0% of vaccinated assessed risk as small versus 7.4% of refusers. Non-vaccinated participants demonstrated distrust in vaccine benefits and lack of trust in health system, science and pharmaceutical companies. The multivariable regression revealed associations between age, income, vaccine perception, and vaccination uptake. The 45-54 and 55-64 age groups were less likely to refuse vaccination compared to the youngest age group (OR = 0.34, p = 0.009 and OR = 0.38, p = 0.036). Odds of refusing the COVID-19 vaccine decreased as income increased (OR = 0.33, p = 0.036). A high perceived risk of adverse effects increased the odds of vaccine refusal by 7.02 (p<.001). Conclusions The lack of confidence in the vaccine safety and effectiveness, coupled with an underestimation of the coronavirus disease, formed a critical barrier to the vaccine uptake. The misinformation fueled vaccination fear. Public health campaigns should address vaccine-related concerns and promote vaccination adherence in more consistent manner targeting also the spread of fake news. Key messages The lack of confidence became a crucial barrier for vaccination coverage in Bulgaria. Understanding driving factors for vaccine uptake is of utmost importance to design effective vaccination programs.
ABSTRACT
Background Vaccinations are an essential public health strategy to control preventable diseases. A much-discussed approach to increase coverage is mandatory vaccination;however, its legitimacy and effectiveness were put to question during the COVID-19 pandemic. As of March 1,2022, Bulgaria had one of Europe's lowest immunization coverage rates against COVID-19. Only 29.3% of Bulgarians had completed COVID-19 vaccination, compared to 71% in the EU and EEA, and the country ranked last in number of booster doses (9.9% vs 51.4 %). This study aims to investigate the public's attitudes toward proposed mandatory COVID-19 vaccination and toward the long-standing mandatory child immunization schedule in the context of the COVID-19 pandemic. Methods An online cross-sectional survey was conducted in April 2022 using a self-administered anonymous questionnaire to collect information on sociodemographic characteristics, vaccination status and attitudes toward mandatory vaccination to COVID-19 and the mandatory childhood immunization schedule. Results Out of 1433 reached respondents, 1200(84%) completed the survey. The largest relative share of respondents is between 35-44y-33.3%;72.7% were women;mainly highly educated (50.8%), and vaccinated participants (59.3%). There is a significant and large difference between vaccinated and unvaccinated regarding the full support of mandatory COVID vaccinations (46.1% vs 1.8%), and regarding mandatory child vaccinations (77.9% vs 50.4%). Mandatory childhood vaccination schedules are supported by 88.7% of those in favor of obligatory COVID-19 vaccinations and 56% of those who oppose them (p < 0.001). Significance is preserved after adjustment for vaccination status. Conclusions Public health authorities need to develop well-organized vaccination campaigns in which accurate evidence-based information is adequately disseminated with respect to individuals’ autonomy. More research on the determinants of vaccination attitudes in Bulgaria is necessary. Key messages Mandatory vaccination programs should be proceeded by investigation of the social readiness for acceptance. Exploration of cultural specificities to influence vaccination decision is needed.
ABSTRACT
Spontaneous pneumomediastinum is a condition, in which the presence of free air in the mediastinum is established, without previous trauma, surgery or other medical procedure. Due to its relative rarity and difficulty in establishing clinical manifestations, its diagnosis can easily be missed. Pneumomediastinum is rare in viral infections, with only single cases of patients with COVID-19 and pneumomediastinum reported in the literature. The clinical case presented by us is of a 58-year-old man with bilateral inflammatory lung changes associated with COVID-19 infection and development of spontaneous pneumomediastinum. The complication was controlled against the background of oxygen therapy, without the need for intubation and mechanical ventilation. Although pneumomediastinum is a rare complication in patients with COVID-19, there is evidence that its occurrence is a factor associated with disease exacerbation as well as an increased risk of death. Early diagnosis of pneumomediastinum enables better management of the acute respiratory failure with conservative approach, which improves the prognosis in these patients. © 2021, Central Medical Library Medical University – Sofia. All rights reserved.