Compulsory vaccination against COVID-19 in the context of the principles of the convention on human rights and biomedicine.

INTRODUCTION: At this stage of the global health crisis caused by the SARS-CoV-2 coronavirus, an increasing number of countries are considering enacting legislation requiring compulsory vaccination or implementing a mechanism to ensure mass vaccination of the population. Such policy decisions raise a number of legal and deontological issues. AIM: The aim of the study was to analyze the legal and deontological issues related to the introduction of compulsory vaccination against COVID-19 in the context of the principles of the Convention on Human Rights and Biomedicine (Oviedo Convention). MATERIALS AND METHODS: The analysis looks at the international legal framework that governs the protection of human rights and freedoms, the principles and rules that apply to the achievements of biology and medicine, and, in particular, the Oviedo Convention. RESULTS: Vaccines against COVID-19 are a modern scientific success in biology and medicine, particularly those of the latest genera-tion of vaccines presented by the scientific community as a consequence of revolutionary mRNA technology. It is for this reason that the provisions of the Oviedo Convention should serve as guidelines for countries to follow in their fight against COVID-19 pandemic. CONCLUSIONS: Achieving mass vaccination of the population in accordance with the provisions of the Oviedo Convention and other rel-evant international standards for the protection of fundamental human rights, in conjunction with a large-scale information campaign, seems a sensible approach that would contribute to the rapid and peaceful resolution of the current global health crisis.

Early neurological and cognitive impairments in subclinical cerebrovascular disease.

BACKGROUND: The subclinical cerebrovascular disease (SCVD) is an important public health problem with demonstrated prognostic significance for stroke, future cognitive decline, and progression to dementia. The earliest possible detection of the silent presence of SCVD in adults at age at risk with normal functioning is very important for both clinical doctors and scientists. MATERIALS AND METHODS: Seventy-seven adult volunteers, recruited during the years 2005-2007, with mean age 58.7 (standard deviation 5.9) years, were assessed by four subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB)-Eclipse cognitive assessment system. We used a questionnaire survey for the presence of cerebrovascular risk factors (CVRFs) such as arterial hypertension, smoking and dyslipidemia, among others, as well as instrumental (Doppler examination) and neurological magnetic resonance imaging (MRI) procedures. Descriptive statistics, comparison (t-test, Chi-square) and univariate methods were used as followed by multifactor logistic regression and receiver operating characteristics analyses. RESULTS: The risk factor questionnaire revealed nonspecific symptoms in 44 (67.7%) of the subjects. In 42 (64.6%) of all 65 subjects, we found at least one of the conventional CVRFs. Abnormal findings from the extra- and trans-cranial Doppler examination were established in 38 (58.5%) of all studied volunteers. Thirty-four subjects had brain MRI (52.3%), and abnormal findings were found in 12 (35.3%) of them. Two of the four subtests of CANTAB tool appeared to be potentially promising predictors of the outcome, as found at the univariate analysis (spatial working memory 1 [SWM1] total errors; intra-extra dimensional set 1 [IED1] total errors [adjusted]; IED2 total trials [adjusted]). We established that the best accuracy of 82.5% was achieved by a multifactor interaction logistic regression model, with the role CVRF and combined CANTAB predictor "IED total ratio (errors/trials) × SWM1 total errors" (P = 0.006). CONCLUSIONS: Our results have contributed to the hypothesis that it is possible to identify, by noninvasive methods, subjects at age at risk who have mild degree of cognitive impairment and to establish the significant relationship of this impairment with existing CVRFs, nonspecific symptoms and subclinical abnormal brain Doppler/MRI findings. We created a combined neuropsychological predictor that was able to clearly distinguish between the presence and absence of abnormal Doppler/MRI findings. This pilot prognostic model showed a relatively high accuracy of >80%; therefore, the predictors may serve as biomarkers for SCVD in subjects at age at risk (51-65 years).

Transient ischaemic attacks and minor strokes (analyses and clinically significant comparisons).

UNLABELLED: The transient ischaemic attacks (TIA) and minor strokes are independent predictors of disabling strokes with a high medical and social value. PURPOSE: Analysis and comparison of the data from the clinical monitoring of TIA and minor stroke patients in correlation with the different duration of the transient neurological deficit. PATIENTS AND METHODS: 234 patients were monitored clinically in the Clinic of Cerebrovascular Diseases, University Hospital "St. George"-Plovdiv between 2002 and 2004. Clinical data were collected for 79 patients who met the clinical criteria for TIA and 155 patients who met the clinical criteria for minor stroke. Our protocol included medical history, cardiac and neurological examinations, assessment of cerebrovascular risk factors and laboratory tests. The instrumental assessment included CT scan, MRI and Doppler examination. The data were processed using descriptive statistics, non-parametric methods and charts. RESULTS: The comparative analysis between the TIA and minor stroke patients shows a significant difference only in the number of registered conductive disturbances, which are more frequent in the TIA patients. In the TIA group the significantly more frequent features are acute onset of the neurological deficit, significantly more frequent normal CT scan images or lacunar infarctions findings. In the minor stroke group the significantly more frequent features are the subacute onset, more frequent CT findings of vascular encephalopathy or CT scans revealing one large ischaemic zone. CONCLUSIONS: The differences may be explained with the dominant pathogenetic mechanisms in each of the conditions: microembolisation of extracranial vascular origin in TIA and local thrombosis or cardioembolisation in minor stroke. Previous vascular damage in minor stroke patients is more evident.

Assessment of the effect of palliative radiotherapy for cancer patients with intracranial metastases using EORTC-QOL-C30 questionnaire.

UNLABELLED: Assessment of quality of life (QOL) is of crucial importance when assigning palliative radiotherapy of brain metastases in cancer patients. AIM: To investigate the influence of whole brain radiotherapy on brain symptoms in patients with cerebral metastases; to evaluate their quality of life before and after radiation therapy using the EORTC-QOL-C30 questionnaire, as well as its influence on patients' survival. PATIENTS AND METHODS: Sixty-five patients with various locations of the primary tumor and brain metastases were included in this study. All of them underwent radiotherapy with cobalt unit. The realized dose of the whole brain was above 30 Gy: 10 x 3 Gy or 15 x 2 Gy. The patients filled in the EORTC-QOL-C30 questionnaire before radiation, at the end of the radiotherapeutic course and a month after it. Clinical characteristics of patients before and after radiotherapy were compared and assessed. All patients were treated with radiotherapy and concurrent corticosteroid treatment. RESULTS: The mean age of the patients was 53 +/- 7.8 years and the median survival was 6.6 months for lung cancer patients and 9.8 months for breast cancer patients. Each EORTC-QOL-C30 questionnaire assessed the patients in three main aspects: functional aspects, general symptoms and global health. Improvement was reported (p < 0.001) for functional indicators and health related quality of life (HRQOL). Several symptoms did not change significantly--financial difficulties, dyspnea and diarrhea. CONCLUSIONS: Whole brain radiation of cancer patients with cerebral metastases is very well tolerated. Side effects are frequently met and can be compensated by applying steroids. The assessment of quality of life gives information on patients' improvement which is more substantial in functioning, symptoms and global health. This study is a precondition for future investigations of the effect of whole brain radiation on cancer patients' quality of life.

A study of plasma total homocysteine levels in healthy people.

UNLABELLED: Elevated plasma levels of homocysteine have been identified as an independent risk factor for atherosclerosis. AIM: The aim of this study was to determine the reference limits of plasma total homocysteine for Bulgarian population. MATERIALS AND METHODS: We investigated 153 healthy individuals without vitamin deficiency aged from 18 to 65 years. The reference group consisted of 74 males and 79 females with mean age respectively 37.80 +/- 1.36 and 39.32 +/- 1.33 years. Plasma total homocysteine was determined by high performance liquid-chromatography (HPLC) modified and validated in our laboratory. RESULTS: The reference intervals were 7.4-18.5 micromol/l for males and 5.5-14.5 micromol/ 1 for females. The mean levels of plasma homocysteine were significantly higher in males in comparison with females (11.86 +/- 0.33 micromol/l vs. 9.88 +/- 0.27 micromol/l; P < 0.001), without considerable correlation with age. Comparing the values of total homocysteine between the two groups of age - < or = 49 and > or = 50 years showed that the investigated individuals > or = 50 years had higher plasma concentration, and the difference was significant only for the group of females. Hyperhomocysteinemia according to ECAP cut-off value (> 12.1 micromol/l) was registered in 30.7% of healthy volunteers. CONCLUSIONS: The results of our study demonstrated that homocysteine levels depend on sex and, to a lesser degree, on age. We have determined plasma total homocysteine reference intervals for the Bulgarian population. This will help the interpretation of the results and contribute to adequate and efficient prevention of blood vessel diseases.

Specific peculiarities in the family model of the Turkish minority in Bulgaria.

INTRODUCTION: There is a significant decrease in the average number of children in Bulgarian families during the 80s and 90s. This phenomenon is noticed even in some regions with usually higher natality, like Kurdjali, Pazardjik, Blagoevgrad, etc. AIM: The aim of this study was to characterize the reproductive behaviour of Turkish minority in Bulgaria. METHODS: 260 women in reproductive age with Turkish ethnical origin from the town of Kurdjali (Bulgaria) were approached by a direct individual inquiry. Data were analysed by descriptive statistics and non-parametric tests. RESULTS AND DISCUSSION: The average number of children in the Turkish families in Bulgaria is 1.69 +/- 0.04 and in 78.2% of cases, the pregnancy has been wanted and approved by both spouses. This fact determines the reproduction of this ethnos to be a realized necessity. The comparison of indices, characterizing the reproductive behaviour of Turkish and Bulgarian population shows a statistically significant difference between the real and desired number of children in the family (P < 0.001). However, the analysis failed to find a statistically significant difference in the opinion of both compared groups about the ideal number of children in the family (P > 0.05). CONCLUSIONS: There are no changes in the traditional conceptions of Turkish people about the family and role of women. We observe significant differences in the reproductive plan and behaviour between the Bulgarian and Turkish population.