Medical University-Sofia Research Articles

Trends and motives in the post-graduate professional orientation of the young doctors of the 2023 class of Medical University-Sofia

The grown-up individual’s need for self-affirmation is a unified whole with his professional and labor activity and with the successful realization in it. For this reason, professional choice is a complex decision-making process, determined by social and personal factors, as it is dictated not only by the needs of society, but also by the interests, opportunities, needs and inclinations of the individual. In view of this, the present article will present and analyze data from an empirical study investigating the trends, motives and conditions in the professional orientation of young doctors of the 2023 Class of Medical university-Sofia.

Health literacy for the prevention of noncommunicable diseases–health sciences students’ perception

Abstract Background World Health Organization highlights the importance of health literacy development for noncommunicable diseases (NCDs) prevention and control. NCDs were recognized by the 2030 Agenda for Sustainable Development as a major challenge. The aim of our research is to explore health sciences students’ perception on the role of health literacy, digital health literacy and NCDs risk factors, related to their prevention. Methods A cross-sectional survey was conducted among 210 first year students from the Faculty of Medicine and the Medical College in Medical University-Sofia, Bulgaria. An anonymous questionnaire distributed among students and all respondents participated voluntarily. Data was collected during January 2023. A descriptive statistical method was used to analyze the data collected. Results Among respondents the majority 83,7% stated that promoting health literacy is an approach to promote the prevention of NCDs while 88,2% of them considered very important or important the role of digital health literacy among medical and non-medical professionals for NCDs prevention. Data collected show that a significant percentage (81,5%) among participants reported the necessity of interdisciplinary initiatives as an action to promote health literacy. In addition, more training on NCDs risk factors was pointed as essential by 82,0% of the students. Conclusions It appears very important for the future health professionals to develop health literacy on and be familiar with the risk factors associated with NCDs. That could lead them to gain confidence, and be more effective in health issues related decision making. Special attention should be given the digital tools and instruments, as they can significantly contribute for the health literacy improvement. An interdisciplinary approach can provide the environment to optimize access to health information, and support health and well-being of individuals and communities. Key messages • Both health professionals to build capacity on health literacy improvement, and the population to directly engage, need interdisciplinary actions, focused on NCDs control and prevention. • The successful digital transformation of health services, requires digital competencies and skills. They are the major components for digital health literacy, that supports health and wellbeing.

Medium-term results after partial (unicompartmental) knee arthroplasty with a mobile platform

Background: Early gonarthrosis is characterized by involvement of one compartment of the knee joint, most commonly the medial tibio-femoral joint (AMOA). Surgical treatment includes debridement, chondroplasty, corrective osteotomy, unicondylar knee arthroplasty (UKA), or total joint replacement (TKE). Materials and results: The aim of the study is a retrospective analysis of the clinical results after UKA from a cohort of patients operated at the Clinic of Orthopedics and Traumatology, University Hospital "Queen Joanna - ISUL", Medical University Sofia. Patients in the cohort reported a excellent functional outcome, with the exception of two of the participants in the study. Conclusion: UKA is a suitable surgical alternative for teams that have experience with the technique. Careful consideration of the preoperative parameters of patients, as well as creating acceptable and realistic expectations about the postoperative results are crucial for a positive end result.

THE ROLE OF BIOCHEMICAL BIOMARKERS FOR NEURONAL ACTIVITY AND CLINICAL NEUROPSYCHOLOGICAL TESTS IN PATIENTS WITH CAROTID STENTING

Objective: The application of carotid stenting is rising. We need biomarkers, which would guide us and help in the assessment of its effectiveness regarding brain blood flow and cognition. Potential candidate biomarkers are the markers for neuronal activity Brain Derived Neurotrophic Factor (BDNF) and Neural Growth Factor (NGF). Their serum concentration is correlated with brain hemodynamics and function. Design and method: We included 78 patients: 39 with hemodynamically significant carotid stenoses and 39 controls - without. All underwent ultrasound diagnostics and ELISA test of BDNF and NGF serum concentrations. The biomarkers for neural activity in patients with significant carotid stenoses, were tested at 3 phases: before (n34), 24 h. post (n22) and at least 1 month after stenting (n18). Cognitive functions were assessed with MMSE and MoCA. On their basis the patients were classified as having or not potential mild cognitive impairment (MCI) Statistical analysis was done with SPSS 19(IBM), p < 0.05, CI 95%. Results: There was a significant difference in the BDNF concentration before and after carotid stenting (p < 0.0001); in BDNF [p = 0.001, CI (-5.11- -1.44)] and NGF [p = 0.049, CI (0.64–347.75)] between patients with significant stenoses/stenting and controls. Periprocedural hypotension, stroke history and MCI did not influence biomarkers concentrations. Correlation analysis showed intermediate positive correlation between systolic, diastolic, pulse pressure and biomarkers at a certain time of sampling. This association was proven for the systolic blood pressure by the regression analysis too. The mean values of BDNF after stenting raised and for NGF lowered after carotid stenting. Conclusions: A larger sample is needed to prove further our results, namely: 1. Arterial blood pressure is an important factor for BDNF and NGF concentrations; 2. The correlation between these markers and interventional treatment may be not linear; 3. There are significant differences in the serum concentrations of biomarkers for neural activity between patients with and without significant carotid stenoses. Research Grant 2020 from Medical University Sofia, Bulgaria, contract 133/24.06.2020

CAN WE USE NEUROTROPHINS FOR CAROTID PLAQUE VULNERABILITY ASSESSMENT – IVUS VH CASE SERIES

Objective: Defining carotid atherosclerotic plaque vulnerability is problematic. The combination between imaging and biomarkers may be of practical significance for future assessment of extracranial stenoses. Brain derived neurotrophic factor (BDNF) and neuronal growth factor (NGF) are neurotrophins. There are some studies, which suggest association between endothelial dysfunction and circulating BDNF, impaired neurotrophins’ endothelial secretion in atherosclerosis and correlation between BDNF concentration and Agatson’s score, as well as coronary plaque vulnerability. Neurotrophins also play important role in cerebral functioning. Their role in carotid atherosclerosis is not known. Design and method: We share the results of 13 patients with angiographically significant carotid stenoses. The plaque morphology was assessed with IVUS VH and we evaluated their serum BDNF and NGF concertation. All the patients were without coronary artery disease or fully revascularized, as well as without significant or symptomatic peripheral artery disease. We had the results for BDNF and NGF from a reference group without any atherosclerotic disease. SPSS (IBM) was used for the statistical analysis, p < 0.05, CI 95%. Results: The patients with significant carotid stenoses had lower mean BDNF values than the reference group. There was correlation between luminal diameter and BDNF (p = 0.049; r = -0.605), total Ca2+ area (mm2) and BDNF (r = 0.681, p = 0.021), Proximal Ca2+area and BDNF (p = 0.007, r = 0.784), Necrotic core % in the proximal plaque area and NGF (r = 0.891, p = 0.001) Conclusions: BDNF concentration was negatively correlated with the maximal values for minimal luminal diameter and positively with total Ca2+ plaque area, t.i. with plaque stability. We found positive correlation with necrotic core % and NGF values. This case series is small, and a much larger sample is needed to define precisely any association. Nevertheless, this is a beginning of the study for the potential role of neurotrophins in carotid plaque morphology, either by their local endothelial secretion or by modification of their central secretion from the altered cerebral hemodynamics. They may be both markers and factors for carotid plaque vulnerability. The work was partially funded by a Research GRANT 2020 number 133 from Medical University Sofia, Bulgaria.

Anesthetic considerations for microlaryngeal surgery

Introduction: Microlaryngeal surgery encompasses a wide range of laryngeal procedures. Patients presenting for microlaryngeal surgery frequently have a difficult airway. The chosen approach to this airway depends on the pathology and the patient’s symptoms. The Aim of the study is to determine the risk factors and anesthetic problems during microlaryngeal surgery. Materials and Methods: A prospective cohort study including 100 patients undergoing microlaryngeal surgery in the Department of Otorhinolaryngology at the University Hospital „Queen Giovanna“ – ISUL, Sofia, in the period 2020–2021; Medical University-Sofia. Preoperative examination of the larynx is performed in all patients by Storz 8402 ZX fiber optic laryngoscope with video capability. Results and discussion: In 69% of the patients the tumor mass causing obstruction is localized in the area of the larynx, and in 31% of them the tumor mass is localized in the area of the hypopharynx. From the patients with tumor mass causing laryngeal obstruction 42% are with 1st degree of obstruction, 29% are with 2nd degree, 27% are with 3rd degree and 2% are with respiratory failure at rest. Twenty six percent (26%) of the patients had pulse rate<45 beats per minute during putting on the tube of Kleinsasser. This is very dangerous reflex reaction of the heart, which we believe is caused by parasympathetic nervous system. The rate of difficult endotracheal intubation among patients presenting for microlaryngeal surgery is higher than among the general surgical patient population. Difficulties during endotracheal intubation in our study are due to higher percent of laryngeal obstruction and pharyngeal restriction because of the intraoral masses. Conclusion: Anesthesia for microlaryngeal surgery has always been demanding, as often pathology interferes with the anesthesiologist’s field of work.

STUDENTS’ VIEWS ON THE ROLE OF ETHICS EDUCATION FOR THEIR FUTURE MEDICAL PRACTICE

INTRODUCTION: Worldwide, in different ways, ethical dilemmas arise in medicine and life sciences. It is critical for medical professionals to respond with confidence when ethical challenges are addressed in their clinical practice. Medical ethics and bioethics education is recognized as an essential course of the medical curriculum. The course aims to provide students with knowledge and competencies on dealing with moral problems.
 OBJECTIVES: In this article, we aim to explore students’ views about the importance and role of medical ethics education for their future practice. Their suggestions on specific medical ethics and bioethics topics were also considered, as well as previous knowledge on ethics before they enrolled in university.
 METHODS: A paper questionnaire was developed and distributed among first-year foreign medical students from the Faculty of Medicine in the Medical University-Sofia in Bulgaria. All students participated in the study anonymously and voluntarily. The study was conducted during January and February 2020.
 RESULTS: Completed questionnaires were received from 366 medical students. Data collected demonstrates that only 19% of the students were taught ethics before enrolling in university and covered topics on philosophy and ethics, civil and human rights. The majority (92%) of the responders believe that the study of medical ethics and bioethics helps medical professionals to improve their skills in identifying ethical problems in their everyday practice. Interesting were the suggestions for topics in medical ethics and bioethics that needed further study during lectures and seminars and included principles of medical ethics and bioethics, ethical behavior in medicine and health care, ethical dimensions of new technologies in health care, ethical dimensions of clinical decisions and patients’ quality of life, ethics and health management.
 CONCLUSIONS: Medical ethics education is significant for future physicians, helping them to improve their skills in identifying ethical issues, and base their decisions on fundamental ethical principals in their everyday practice. Attention should be given to topics related to principles of medical ethics, models of patient-physician relationships, new technologies in health care, ethics and health policy.

DENTAL STUDENTS’ PERSPECTIVES ON THE IMPLEMENTATION AND EFFECTIVENESS OF ONLINE LEARNING DUE TO COVID-19 PANDEMIC: A DESCRIPTIVE CROSS-SECTIONAL STUDY IN BULGARIA

Purpose. As dental education was significantly influenced by the novel coronavirus pandemic, this study aims to investigate pre-clinical dental students’ perspectives on the implementation of remote education and school closure due to COVID-19 pandemic, self-reported effectiveness of on-line learning as well as their educational and personal experiences. Method. A self-administered questionnaire was posted online to a total of 258 out of 516 second and third-year preclinical dental students in Dec 2020/Jan 2021 at Faculty of Dental Medicine, Medical University-Sofia, Bulgaria. Survey items focused on 3 general domains: student attitude, assessment, and concerns regarding online learning; student current knowledge and perceptions of COVID-19 pandemic and student opinion of pandemic psychological impact on public health, personal experiences and intention for vaccination. Findings. One-hundred and sixty-nine students responded to the survey (response rate 65.5%). Most of them (70.4%) approved suspension of face-to-face classes due to the COVID-19 crisis. Eighty percent expressed dissatisfaction toward online teaching sessions and agreed that this will have negative effects on their education. Fifty-eight percent did not find remote education more stressful than in-person training. More concerns were expressed about financial issues than mental health problems. Intention for getting vaccinated was expressed by 53.3% and 40.8% thought that the vaccine would cause many side health effects. Implications for research and practice. Within the limitations of the study, identified gaps in online education could help increase effectiveness of learning environment and create opportunity to enhance education for the future. Dental student thoughts about COVID-19 vaccinations provide valuable information to administrators, public health professionals and policy makers to improve efforts towards preserving, protecting, and promoting public health.

Awake or asleep approach to difficult airway during microlaryngeal surgery

Introduction: Patients presenting for microlaryngeal surgery frequently have a difficult airway. The chosen approach to this airway depends on the pathology and the patient’s symptoms. The Aim of the study is to determine the safest anesthesiological approach to difficult airway during microlaryngeal surgery. Materials and Methods: A prospective cohort study including 200 patients undergoing microlaryngeal surgery in the Department of Otorhinolaryngology at the University Hospital “Queen Giovanna” - ISUL, Sofia, in the period 2014-2019; Medical University-Sofia. Preoperative examination of the larynx is performed in all patients by Storz 8402 ZX fiber optic laryngoscope with video capability. Results and discussion: In 76% of the patients the tumor mass causing obstruction is localized in the area of the larynx, and in 24% of them the tumor mass is localized in the area of the hypopharynx. In 20% of the patients with 3rd degree of laryngeal obstruction an awake tracheostomy is chosen as a primary approach because of impossible intubation. The same approach is chosen in all of the patients presenting with respiratory failure at rest. In 25% of the patients with tumor mass causing hypopharyngeal obstruction an awake tracheostomy is chosen as a primary approach because of impossible intubation. Conclusion The decision to proceed with an awake or asleep approach to an anticipated difficult airway depends on the degree of laryngeal or hypopharyngeal obstruction and the experience of the anesthesiologist.

Hemodynamic complications during microlaryngeal surgery

Introduction: Successful anesthetic management of microlaryngeal cases requires a high degree of cooperation with the surgeon, a reciprocal understanding of the potential problems, and adequate preparation on both sides to meet the anticipated challenges that may arise. The Aim of the study is to determine the hemodynamic complications during microlaryngeal surgery. Materials and Methods: A 5-year prospective cohort study of 200 patients who underwent microlaryngeal surgery in the Department of ENT Surgery; University Hospital “Queen Giovanna”- ISUL; Medical University-Sofia. All patients were monitored and recorded for: Systolic blood pressure (SBP), Diastolic blood pressure (DBP); heart rate (HR); continuous electrocardiography (ECG). The above parameters were recorded and analyzed at predetermined time intervals: 5-th minute before intubation, every 5 minutes after intubation and 5-th minute after extubation. Results and discussion: Mean systolic blood pressure of the patients during the operation is 147.33 mmHg, mean diastolic blood pressure is 93.5 mmHg and mean pulse rate is 57.64 beats per minute. 49% of the patients have arterial hypertension I grade during the operation, 28% of them are with isolated arterial hypertension and 23% are with normal blood pressure. 40% of the patients had pulse rate between 45-60 beats per minute during putting on the tube of Kleinsasser, 29% of them had pulse rate>60 beats per minute during putting on the tube of Kleinsasser and 31% had pulse rate<45 beats per minute during putting on the tube of Kleinsasser. Conclusion: Microlaryngeal surgery is specific kind of surgery which is characterized by hypertensive hemodynamic. There is a risk of severe bradycardia after putting on the tube of Kleinsasser which can cause hemodynamic instability and even cardiac arrest if not corrected immediately.

Prevalence of depression among three cohorts of medical students

Abstract Background Medical education is often related to serious distress for students, that affects negatively their mental well-being. Depression, poor academic performance, increased alcohol consumption, suicidal thoughts, are some of the detrimental effects of diminished mental health. Studies on depression in medical students reveal a higher prevalence (1.4-73.5%) than in the general population. This study aimed to assess and compare depression prevalence and severity in three cohorts of medical students in Bulgaria and Turkey. Methods We conducted a cross-sectional online survey with 257 Bulgarian and 288 foreign medical students from Medical University-Sofia, Bulgaria, and with 270 Turkish medical students from Ankara in the winter semester of 2019-2020 academic year. We used the Beck depression inventory (BDI) as valid and reliable instrument to assess depression. The students were categorised according to BDI scores in three groups: with mild depression (10- 18 points); moderate depression (19-29); severe depression (30- 63). Data were analysed with program product Python 3 (v3.6.9) with Pandas v0.25.3 and Scipy v1.4.1. Results Depressive symptoms reported 71.5% of Turkish students, 47.1% of Bulgarian and 48.7% of foreign medical students. The depression frequency among Turkish and Bulgarian medical students was significantly different (chi2 = 35.31; p = 0,001). Mean BDI scores were similar for Bulgarian medical students (11.0) and foreign medical students, studying in Bulgaria (11.6). Turkish medical students scored highest on BDI (15.3). Severe depression was detected in 5.6% of foreign, 4.3% of Bulgarian and 6.3% of Turkish students. Conclusions Depression prevalence was high in all studied medical students cohorts, with Turkish cohort affected most, probably because of cultural and curriculum differences. Key messages Support of student’s mental health should be an integral part of the educational policies of all Medical Universities worldwide. Depression among medical students has to be prevented by comprehensive approach.

Pioneers in Dermatology and Venereology: An interview with Prof. Nikolay Tsankov.

Pioneers in Dermatology and Venereology: An interview with Prof. Nikolay Tsankov.

"Allergic or pseudo-allergic reaction to latex during prick-testing"

Summary: A lot of latex products are used every day in medical and dental practice, as well as in households. This could lead to the development of sensibilisation amongst work-related groups of people, as well as in patients. Reactions that could be seen are not only affecting the skin, presented mainly like allergic contact dermatitis, but might be also severe life-threatening ones. The aim is to present a case of allergic reaction tolatex during regular skin prick testing. Clinical case: We present a clinical case of 47-year-old woman who has been forwarded to the Department of “Imaging and Oral Diagnostics”, Faculty of dental medicine, Medical University-Sofia, for testing the sensitization to latex products because of history for burning sensation, throbbing and itching in the area of the hard palate, lips and the pick of the tongue after regular dental clinical examination with latex gloves. Results: Three different types of testing were conducted for proving a latex allergy- serological examination: ImmunoCAP Phadia, prick-test and epicutaneous test. Additional testings were performed for clarifying the general allergic status of the patient. Conclusion: The diagnosing of sensitization to latex proteins seems to be easily doable but in fact it turns out to be challenging in clinical settings. Despite the performed three diagnostic tests (which are with different results), of great importance turns out to be the prick-testing and the initial clinical symptoms of allergic reaction which is manifested with feeling for edema and itching in the oral cavity. The administration of adrenaline, corticosteroids and antihistamines, included in the protocol for management of emergency situations in this specific case prevented the development of more severe condition.

Copy number variations in critical cell-signalling genes with potential targeted therapeutic application

Abstract Background Brain tumours are among “hard-to treat” world malignancy with the median survival time of 15 months for the most aggressive form - Glioblastoma multiforme (GBM). It is extremely complex and heterogeneous brain cancer, characterized by rapid progression, infiltration and therapeutic resistance. Currently, many trials for target therapy are focused on understanding the molecular heterogeneity of GBM and designing molecules that inhibit most common genetic alterations. Methods In the present study, somatic copy number variations (CNVs) in critical signalling genes suitable for future target therapy are examined among Bulgarian patients. Fresh brain biopsies were collected from patients with primary and secondary GBM. Genomic DNA was isolated and CNVs were analysed by Multiplex ligation – dependent probe amplification (MLPA). Results CDKN2A deletion is the most frequent genetic alteration (78%) among Bulgarian patients with GBM. The loss of this gene is a progression-associated genetic marker. Nearly 60% of GBM patients showed EGFR amplification. It is a prognostic and predictive marker and some patients with this aberration are suggested to respond better to EGFR inhibitors in combination therapy. PTEN deletion is another common event with the incidence rate of 33% and its loss corelates with the choice of mTOR and MEK inhibitors, as well as, the resistance to some EGFR inhibitors. TP53 deletion was found in only 11% of the analysed patients which is a positive marker and the presence of wild-type TP53 is targeted by a MDM2 inhibitors. In addition, MDM2 amplification was observed in one patient and this event also serve as a potential target by MDM2 inhibitors.Amplification in PDGFRA is observed in one patient. Depending on the status of other receptor tyrosine kinases, it could be targeted by PDGFR inhibitor and is also suggested to be a poor prognostic marker. Conclusions Personalized treatment, customized for an individual patient genetics, has the potential to improve the therapy response. CNVs data could be useful for designing more effective personalized therapy. This is a small study on CNVs with potentially targeted therapeutic application in GBM for Bulgaria and recruitment of more patients is in progress. Legal entity responsible for the study The authors. Funding Medical University Sofia, Grant number D-127/2019. Disclosure All authors have declared no conflicts of interest.

Hemodynamic Complications During Laser Surgery of the Larynx

Introduction: Laser surgery of the larynx offers several advantages over conventional surgical methods, including a bloodless operative field and microscopic precision. However, the anesthetist faces special issues in the management of these patients. The Aim of the study is to determine the hemodynamic complications during laser surgery of the larynx. Materials and Methods: A 2-year prospective cohort study of 50 patients who underwent laser microsurgery of the larynx in the Department of ENT Surgery; University Hospital „Queen Giovanna”- ISUL; Medical University-Sofia. We used total IV anesthesia. All patients were monitored and recorded for: Peripheral Capillary Oxygen Saturation (SpO2); Systolic blood pressure (SBP), Diastolic blood pressure (DBP); heart rate (HR); continuous electrocardiography (ECG). Results and discussion: The mean age of the patients is 61.04 years. 8% of them are females and 92% are males. According to anesthesia risk assessment 4% of the patients are with ASA 1 class, 30% of them are with ASA 2 class, 64% are with ASA 3 class and 2% are with ASA 4 class. The mean duration of operation is 57.06 minutes. Mean systolic blood pressure of the patients is 141.22 mmHg, mean diastolic blood pressure is 86.2 mmHg and mean pulse rate is 60.94 beats per minute. 44% of the patients have arterial hypertension I grade, 24% of them are with isolated arterial hypertension and 32% are with normal blood pressure. 44% of the patients had pulse rate between 45-60 beats per minute during putting on the tube of Kleinsasser, 32% of them had pulse rate&gt;60 beats per minute during putting on the tube of Kleinsasser and 28% had pulse rate&lt;45 beats per minute during putting on the tube of Kleinsasser. Conclusion: Laser surgery of the larynx is specific kind of surgery which is characterized by hypertensive hemodynamic. There is a risk of severe bradycardia after putting on the tube of Kleinsasser which can cause hemodynamic instability and even cardiac arrest if not corrected immediately.

THE ROLE OF CERTAIN POLYMORPHIC VARIANTS IN GENES, ASSOCIATED WITH ARTERIAL HYPERTENSION WITH DEVELOPMENT OF CORONARY HEART DISEASE

Objective: To analyze the effect of polymorphic variants associated with the blood pressure values in previous studies in/next to genes and locuses CYP7A1 and PLEKHA7 for the development of ischemic coronary heart disease in Bulgarian patients (Caucasian). Design and method: 100 consecutive patients with angiographically proven coronary heart disease were included. The genotyping was with 7900 HT Fast Real-Time PCR with TaqMan® method. The control group consisted of healthy controls from the database of the Molecular Medicine Center, Sofia BG. SPSS and PRINK were used for the statistical analysis with level of significance <0.05 and confidence interval 95%. Results: The mean age was 63.71 ± 9.35 years; 35 (35%) females. Previous myocardial infarction 38(38%); one-vessel – 39(39%); two-vessel - 28(28%); three-vessel disease - 34(34%); 43(43%) with diabetes mellitus; 92(92%) with arterial hypertension; 77(77%) with dyslipidemia; 42(42%) smokers; 25(25%) smokers. The analysis of the genotype and allele frequencies of the studies polymorphisms rs11191548 next to CYP17A1 gene and rs381815 in PLEKH7 gene did not show any significant difference between patients with coronary heart disease and the healthy controls (p > 0.05). In the dominant model of rs381815 in PLEKH7 (CC against CT/TT) there was a tendency for coronary heart disease in comparison to healthy controls (p = 0.061, CI 0.98–2.52). Conclusions: We studied the link between genes associated with arterial hypertension and multiple metabolic pathways of the steroids and particularly sex hormones (CYP17A1); calcium membrane exchange and intercellular junctions (PLEKHA7). We did not find any significant association between polymorphisms rs11191548 CYP17A1 and rs381815 PLEKHA7 and angiographically proven coronary heart disease in patients with family history and/or early manifestation. In dominant model there was a tendency for association of rs381815 in PLEKH7 and coronary heart disease. This is the first notion of such correlation and it should be tested in a larger cohort. The study was conducted with a Grant from Medical University Sofia, BG.

A Model for Enhancing the Verbal Communication Skills for Physician-Patient Communication of Medical Students at the Medical University-Sofia Based on a Needs Analysis

Enhancing future physicians’ communication skills represents a central problem of medical education. Communication experts have reached consensus on the stages of medical communication, on a key set of communication skills, and helped decisions on the communication curricula of medical schools. Adequate language techniques for physician-patient communication are proposed by the Clear writing and plain language campaign. However, a needs analysis is obligatory in planning and designing communication training for the concrete students. The present study is conducted with the medical students at the Medical University-Sofia, Bulgaria. The comparative analysis of the survey results of undergraduate and graduate respondents reveals students’ growing understanding of the factors, problems and importance of physician-patient communication, increasing willingness and readiness to enhance verbal communication skills as well as a preference for the teaching methods of role play in a realistic context. To meet the medical students’ needs, a Model for enhancing the verbal communication skills of future physicians has been proposed, based on the stages of medical communication and language techniques for the communication between medical professionals and patients. The Model is assessed by experts as an adequate tool to improve future physicians’ communication skills and to help increase the quality of patient health care and patient satisfaction. The researchers recommend that the Model to enhance medical students’ verbal communication skills should be included in the communication training curriculum of the Medical University-Sofia.

Protocol for clinical articulation of complete dentures in maximum intercuspation

The aim of the study was to evaluate the application of clinical protocol for articulation of complete dentures (CDs) in maximum intercuspation (MIP) under the control of T-Scan 8 system and articulation paper. The study involved 32 edentulous patients, aged from to years (mean age 71±9.28 years), who had been treated with complete dentures in the Faculty of Dental Medicine, Medical University-Sofia. Two sets of Superacryl Plus plastic CDs with Flat Ac Acrylic resin teeth were made for each patient according to the classic methodology. The first set of CDs (group 1) was articulated in the MIP under the control of articulation paper only, while the second set of CDs (group 2) was articulated according to a clinical protocol, in which a digital T-Scan 8 analysis and an articulation paper registration were combined. In group 1, occlusion time (OT) higher than normal (56.2%); force outliers (81.25%); and reduced vertical dimension of occlusion (43.8%) were found, resulting in total occlusal force of 100% in the MIP in only 15.67% of the cases. In group 2, OT higher than normal was found in only one set of CDs (3.12%) and force outliers in four sets of CDs (12.5%). The strongest contacts were 2.03±1.57 per denture and most distally situated, and the total force in the MIP averaged 99.39±0.66%. Thus clinical protocol for articulation of CDs under digital control in combination with articulation paper allows the proper selection of contacts in articulation of dentures in the MIP by overcoming the subjective factor.

What are the biggest challenges international medical graduates face when starting work in the NHS?

Dear Sophia, what are the biggest challenges that international medical graduates face when starting work in the NHS? Marcus Dawson, sixth year medical student, Medical University Sofia, Bulgaria International medical graduates (IMGs) make a substantial contribution to healthcare in the United Kingdom. As of July 2017, over one third (37%) of doctors on the General Medical Council list of registered medical practitioners had gained their primary medical qualification outside the UK.1 Taking your first step on the career ladder in the UK is daunting for all medical graduates, and those who …

Vitamin D Pleiotropy after Renal Transplantation

Experimental Techniques in Urology & Nephrology Vitamin D Pleiotropy after Renal Transplantation Jean J Filipov* Department of Nephrology and Transplantation, University Hospital “Alexandrovska", Bulgaria *Corresponding author: Jean J Filipov, Department of Nephrology and Transplantation, University Hospital 'Alexandrovska”, Sofia, Bulgaria Clinical Center of Nephrology, Medical University-Sofia, Bulgaria Submission: January 22, 2018;Published: January 31, 2018 DOI: 10.31031/ETUN.2018.01.000516 ISSN: 2578-0395 Volume1 Issue4