PAs in the Bulgarian healthcare system.

ABSTRACT: This article examines the importance of the physician associate/assistant (PA) profession in the healthcare system in Bulgaria. PAs in the country primarily work in emergency medicine and surgery, and are needed in other clinical settings, such as obstetrics and gynecology and psychiatric clinics, that are experiencing challenges because of physician shortages.

Dependence of Body Mass Index on Some Dietary Habits: An Application of Classification and Regression Tree.

Background: The purpose of this study was to determine the influence of some eating habits on body mass index (BMI) using a regression model created via the classification and regression tree method (CART). Methods: The study was conducted using a questionnaire specially developed for the study, evaluated for reliability and validity. In addition to demographics (age and sex), the questions concern the timing of the meals and the type of food consumed. The data contains records for 533 people (322 women and 211 men) aged 18 to 65 years. The survey was conducted in the period 2019-2021 in Stara Zagora, Bulgaria. Data were processed using descriptive statistics, and regression and classification data mining method CART. Results: A CART model with a dependent variable BMI and predictors Sex, Age, Breakfast type, Breakfast time, Lunchtime, Lunch type, Dinner time, Dinner type have been created. The obtained model is statistically significant at a significance level of P<0.0001 and a coefficient of determination R2 = 0.495. The normalized importance of the factors that affect the BMI is as follows: Sex (100%), Age (61.4%), Lunch type (26. 0%), Lunchtime (18.8%), Dinner time (13.9%), and Breakfast type (13.2%). Women have a lower BMI than men. BMI increases with age. Conclusion: The CART method allows to make a classification by the predictors used and gives opportunities for a more in-depth analysis of the reasons for the increase in BMI. The level of influence of diet and eating habits (type of food, time of consumption) on BMI was determined.

Effect of a Small Selective Inhibitor of C-Jun N-Terminal Kinase on the Inducible mRNA Expression of Interleukin-6 and Interleukin-18.

BACKGROUND: The expression of many inducible genes, involved in cell growth and differentiation as cytokine genes are regulated by receptor-activated intracellular signalling pathways, including the c-Jun N-terminal kinase (JNK) mitogen-activated protein kinase pathway. AIM: We examined the involvement of the JNK signalling pathway in the regulation of the inducible interleukin-6 (IL-6) and interleukin-18 (IL-18) gene expression at the transcriptional level. METHODS: Peripheral blood mononuclear cells (PBMC) from healthy donors were stimulated with lipopolysaccharide (LPS) and C3 binding glycoprotein (C3bgp) with or without SP600125 and cultured for 6 h. After mRNA isolation, a qRT-PCR was performed. RESULTS: Regarding IL-6 and IL-18 mRNA expression, donors were divided into two groups of high and low responders. SP600125 inhibited significantly IL-6 mRNA transcription in the high responder group and did not influence the transcription level in the low responder group. Concerning IL-18 mRNA, we detect the significant effect of SP600125 on the inducible mRNA in high responder group upon C3bgp stimulation. CONCLUSION: JNK transduction pathway is involved in the production of IL-6 mRNA, after LPS and C3bgp stimulation. We suggest that the inhibition of JNK may be beneficial only for higher responding patients during the treatment of inflammatory and autoimmune diseases.

Mathematical Model for Forecasting the Influence of Atmospheric Pollution on Population Morbidity in Stara Zagora Municipality (Bulgaria).

AIM: This paper aims to create a mathematical model for forecasting the morbidity of the population in the Republic of Bulgaria and the Stara Zagora Municipality in particular as a consequence of the atmospheric pollution. SUBJECTS AND METHODS: This model is based on a formula which determines the correlation between the average annual concentrations of atmospheric pollutants SO2, PM10, Pb aerosols, NO2 and H2S) and the morbidity of the population based on the number of people who visited their GPs in a relation with a chronic health problem or emergency condition and the number of hospitalisations in two age groups (newborn to 17 years olds and 18 and older) as well as for the entire population in the period 2009-2013, making it possible to predict morbidity levels. RESULTS: The expected morbidity level predictions based on the number of people who visited their GPs in Municipality are lower, while hospitalisation level predictions are higher. This model has been created and tested and is applicable in all residential areas. CONCLUSIONS: A new, very sensitive, mathematical model has been created and tested (average margin of error from 0.61% to 2.59%) and is applicable in all residential areas.

Observable Effects of Atmospheric Pollution on Outpatient and Inpatient Morbidity in Bulgaria.

BACKGROUND: One of Europe's most well-developed industrial regions is found in the Republic of Bulgaria. The industrialization of the region has a big impact on air pollution. Thermal power plant "Maritza East" (the largest of its kind in southeastern Europe), the army training range, machine manufacturers, household heating and high volume of automobile traffic are all major sources of pollution in the region. METHODS: A five year study (2009-2013) followed yearly concentrations of principal atmospheric pollutants such as sulfur dioxide, dust, nitrogen dioxide, lead aerosols and hydrogen sulfide, and the way in which those levels had an effect on morbidity (outpatient and inpatient medical care) in the area. Statistical processing of data has been completed to represent and analyze the collected data in nonparametric and alternative format. RESULTS: Atmospheric pollution affects human health directly through pathological changes in the human organism. The registered outpatient care provided for the period 2009-2013 is highest for diseases of the cardiovascular system (11.85%), the respiratory system (17.34%) and the genitourinary system (9.76%). The registered rate of hospitalization for the same period is for diseases of the digestive system (11.90%), the cardiovascular system (11.85%), respiratory system (10.86%) and the genitourinary system (8.88%). CONCLUSION: The observed period shows a decrease in average yearly concentrations of the principal atmospheric pollutants in the industrial region (Bulgaria) and reflects a decrease in morbidity based on outpatient care and an increase in morbidity by inpatient care (hospitalization). Our findings should be corroborated in future longitudinal studies.

Free radical reactions might contribute to severe alpha amanitin hepatotoxicity--a hypothesis.

Alpha amanitin is a powerful natural hepatotoxin that belongs to the amatoxins isolated from deadly poisonous Amanita phalloides mushroom. The basic molecular mechanism of their toxicity was attributed to inhibition of RNA polymerase II of the eukaryotic cells. At present, the most effective clinical antidote to acute Amanita phalloides mushroom poisoning is silybin, an antioxidant possessing free radical scavenger activity and inhibiting lipid peroxidation, stabilizing membrane structure and protecting enzymes under conditions of oxidative stress. Bearing in mind the biological mechanism of silybin action and the fact that for different amatoxins (alpha, beta, and est. amanitins) does not established straight correlation between their in vivo LD50 and inhibitory constants (Ki) toward RNA polymerase III in vitro determined we supposed some additional toxic effects of these toxins might contribute to their severe hepatotoxicity. Our formerly in vitro experiments demonstrated that alpha amanitin could act either as an antioxidant or as a prooxidant depending on the treatment conditions and toxin concentration. By UV-visible spectroscopy we also shown that alpha amanitin was sensitive to oxidation by a system of lactoperoxidase/H(2)O(2) and assumed formation of free radical toxin intermediates. Having in mind some exogenic compounds including natural toxins can induce increased production of reactive oxygen species (ROS) we suggested similar generation of ROS provoked by alpha amanitin. Our recently in vitro studies have demonstrated that the alpha amanitin could increase superoxide dismutase (SOD) activity and inhibit catalase (CAT) activity to a considerable degree after together incubation of the toxin with any of enzymes. We have also shown that in vitro increased SOD activity was due to superoxide anion radical scavenging activity (SSA) of the toxin. This therefore informed the decision to study the in vivo effect of alpha amanitin on SOD and CAT activity and the level of lipid peroxidation (LPO) products in liver homogenates isolated from mice treated with the toxin. Statistical significant increased level of LPO products was found at the 6th day comparing to the 20th hour after mice treatment with a subletal dose of the toxin. Based on our previous in vitro and present in vivo studies we have made a hypothesize that in vivo during liver accumulation of the toxin it might be transformed to free radical intermediates causing increase in ROS levels. As a result a peroxidative process in hepatocytes might contribute to the severe alpha amanitin hepatotoxicity.