Primary immunodeficiency screening in an infant with cytomegalovirus disease reveals HIV infection.

Cytomegalovirus is widely spread worldwide, and it is not uncommon for it to complicate the congenital human immunodeficiency virus (HIV) disease as an acquired or congenital coinfection. However, the association of the two infections is not common amongst infants with primary immune deficiencies.We describe a case of a 6-month-old infant with acquired cytomegalovirus and HIV infections, diagnosed in the course of the patient's clinical and laboratory workup for a presumed primary immunodeficiency. To date, this is the first reported case of such a combination in a child from Bulgaria.

Severe SARS-CoV-2 and respiratory syncytial virus co-infection in two children.

The Coronavirus Disease 2019 (COVID-19) caused by a novel coronavirus (SARS-CoV-2) affects mainly older adults. Those with comorbidities are at a higher risk of severe disease and even death. The symptomatic infection rate of children is lower, manifestations are milder, and severe forms are scarce. We present here two children with severe COVID-19 and a respiratory syncytial virus, with the goal of emphasizing the possibility of coinfection with a severe course and a different result. The microbiological diagnosis was made using multiplex PCR. This assay not only provided an early and accurate diagnosis but also aided in the implementation of contact precautions. Further research should be done to determine the influence of coinfection on the clinical course and outcome of pediatric patients.

Evaluating the Effectiveness of Simulation Training in Obstetrics and Gynecology, Pediatrics and Emergency Medicine.

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.