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(1) Background: We aimed to analyze currently available studies with intraoperative radiotherapy (IORT) as a choice of treatment where the Xoft Axxent ® electronic brachytherapy (eBx) system was used as a single-dose irradiation and an exclusive radiotherapy approach at the time of surgery in patients with early breast cancer (EBC). We also compared the results of the systematic review to the Bulgarian experience. (2) Methods and Materials: We performed a systematic review of the studies published before February 2021, which investigate the application of a single-fraction 20 Gy radiation treatment, delivered at the time of lumpectomy in EBC patients with the Xoft Axxent ® eBx System. A systematic search in PubMed, Scopus, and ScienceDirect was performed. The results are reported following the PRISMA guidelines. The criteria on patients' selection for IORT (the additional need for EBRT), cosmetic outcomes, and recurrence rate from the eligible studies are compared to the treatment results in Bulgarian patients. (3) Results: We searched through 1032 results to find 17 eligible studies. There are no published outcomes from randomized trials. When reported, the cosmetic outcomes in most of the studies are defined as excellent. The observed recurrence rate is low (1-5.8%). Still, the number of patients additionally referred to postoperative external breast radiotherapy (EBRT) is up to 31%. Amongst the 20 patients treated in Bulgaria, the cosmetic outcomes are also evaluated as excellent, five of which (25%) are referred for EBRT. Within median follow-up of 39 months, there was one local and one distal recurrence. (4) Conclusions: Current evidence demonstrates the Xoft Axxent ® eBx system as a safe and feasible technique for IORT delivery in EBC patients. There are no randomized controlled trials conducted at this time point to prove its long-term effectiveness. Better patient selection and a reimbursement strategy have to be proposed to extend the application of this technique in Bulgaria.

Background: Familial hypercholesterolemia (FH) is a genetic disorder characterized by a high level of low-density lipoprotein cholesterol (LDL-C) and is an important cause for premature cardiovascular disease. Because of underdiagnoses, an acute event is often the first clinical manifestation of FH. There are limited data on the prevalence and treatment of FH among adults admitted for treatment of acute cardiovascular events in Bulgaria. Our objective was to assess the proportion and management of FH patients from those admitted to hospital for treatment of acute symptomatic acute atherosclerotic cardiovascular events (ASCVD), the achievement of LDL-C targets of European Society of Cardiology/European Atherosclerosis Society guidelines and related public healthcare resources., Objective: Digitalized healthcare records for patients admitted for treatment of symptomatic ASCVD acute events between August 2018 and August 2019 were used for the analysis. Five cardiology hospitals provided data for hospitalizations, laboratory tests, and ambulatory follow-ups up to February 2020. Patients' hospital and ambulatory records were linked, and medical histories were extracted via a specifically developed algorithm, and analyzed. Outcomes included the proportion of patients classified as FH as defined by the Dutch Lipid Network Criteria (DLNC), use of lipid-lowering therapy, LDL-C achieved by 1, 3, 6, and 12 months post-index event, and public resources spent on hospital and ambulatory treatment., Results: We reviewed 11,090 hospital records of patients admitted for treatment of acute events in the period August 2018-August 2019 with ICD codes for ASCVD (Supplementary Table S3). FH was identified in 731 (6.6%) patients, with DLNC score ≥ 3, (682 with coronary artery disease, 32 with cerebrovascular disease, and 17 with peripheral artery disease). We did not find the criteria for FH in 5797 patients. The remaining 4562 records were inconclusive due to lack of data in the hospital dossier. Less than half of FH patients (274/731, 37%) were discharged on high-intensity statin therapy prescribed (34/731, 5%) with combination therapy. The vast majority (96.2% with LDL-C ≥ 1.8 mmol/l) had poorly controlled LDL-C during the first year after discharge. Patients with a probable/definite DLNC score ≥ 6 points and those with recurrent events contributed to the higher cost paid both by the healthcare system and the patients themselves., Conclusion: These findings reinforce the need for more aggressive lipid-lowering therapy, and underline the efficiency of using an electronic medical records search tool to support physicians in improving early FH diagnosis, aiming to minimize residual and future ASCVD events among FH patients and their family members. Supplementary file1 (MP4 21838 KB).

Objectives: An exploratory investigation is reported into the role of spirituality and religious practice in protecting against depression among older people living in rural villages in Bulgaria and Romania, two neighbouring countries with similar cultural, political and religious histories, but with differing levels of current religiosity., Methods: In both countries, interviews were conducted with samples of 160 persons of 60 years and over in villages of similar socio-economic status. The Hospital Anxiety and Depression-D scale and the Royal Free Interview for Religious and Spiritual Beliefs were used to assess depression and spiritual belief and practice respectively. In addition social support, physical functioning and the presence of chronic diseases were assessed. One year later, follow-up interviews were conducted with 58 of the original sample in Bulgaria, in which additional measures of depression and of spiritual belief and practice were also included., Results: The study demonstrates, as expected, significantly lower levels of spiritual belief in the Bulgarian sample (Bulgarian mean 29.7 (SD = 19.1), Romanian mean 47.6 (SD = 11.2), t = 10.2, p < 0.001), as well as significantly higher levels of depression (Bulgarian mean 12.0 (SD = 4.9), Romanian mean 7.3 (SD = 4.1), t = 9.3, p < 0.001), the latter attributable in large part to higher morbidity and disability rates, but less evidently to differences in strength of belief. However, analyses from both the cross-sectional study and the one-year follow-up of the Bulgarian sample do suggest that spiritual belief and practice may both influence and reflect physical and mental illness., Conclusions: Much of Eastern Europe displays high rates of depression among its older population and provides opportunities for investigation of the role of religious belief and practice in preventing and coping with depression. Further research is encouraged in populations of diverse religiosity.

The arsenic exposure in the main departments and occupational groups of the copper smelter in Pirdop has been estimated in the present study. The contents of arsenic is measured in the air and in biological samples--urine and nails. At most of the workplaces the time-weighted average (TWA) concentrations do not exceed the threshold limit value (0.05 mg/m3). The maximum TWA level is about three times higher. The intake of arsenic is significantly increased in almost all observed occupational groups. However, the excretion of only 8% of the workers is higher than the maximum background level (100 micrograms/l). The estimated degree of exposure corresponds to a low health risk. Some of the most heavily exposed occupational groups may be expected to reach higher levels of intake and health risk.

Lipid peroxides, glutathione, and metals (lead, cadmium, and arsenic) were measured in pregnant women residing in the vicinity of a copper smelter. A diagnosis of pregnancy complications experienced by each woman was made on the basis of interview and clinical record. Patients were assigned to groups of normal or pathologic pregnancies (threatened spontaneous abortion, toxemia, and anemia) according to this diagnosis. Biochemical changes suggestive of increased lipid peroxidation and decreased antioxidant protection (involving the reduced: oxidized glutathione balance) were found in the diagnostic groups of pregnancy complications. These changes were independent of measured maternal variables. Maternal exposure to metals (as indicated by blood lead and cadmium) was associated with a decrease in reduced glutathione in blood. Since increased lipid peroxidation has been implicated in other studies as a pathogenetic factor for maternal toxemia, it is suggested that exposure to metals during gestation could enhance the development of pregnancy complications by increasing lipid peroxidation via depletion of reduced glutathione reserves.

Examination is performed on 87 miners from mine for copper production subject to intensive local vibrations with average rate of increase (K) of the norms for the individual octave frequencies 2.4 times for 3 h exposure of the working shift, as well as to intensive noise--113-115 dB/A equivalent level, general dust--23 mg/m3, fine dust--3.5 mg/m3 and fine quartz--0.43 mg/m3. There are data for vibration effect--changes in the cold test, vibration sensoriness, ultra sound sonometry, in all miners. In a significant part of them are established dyslipoproteinemia--increase of triglycerides, total and LDL cholesterol, values beyond reference (mainly above the norm) of 10 electrolytes and microelements in blood serum (blood). An extremely high prevalence of the cases and the days of total morbidity with temporary disability (respectively 189.7 and 2935 per 100), with predominance in its structure of diseases of the central and peripheral nervous systems, hypertension disease, etc. The importance of vibrations for disorder in the metabolic processes in the organism and development of temporary diseases are underlined.

An economic evaluation is made on temporary disability because of disease of trauma, for a three-year period in one shop of technological plant for nonferrous metallurgy. The established, by means of economics-mathematical method, not produced production sums up to approximately 18 million leva.

A study was carried out on soils for heavy metals content in the region of one of the largest scale enterprises in the country - Copper Extraction Plant "G. Damjanov", Srednogorie town. A sensitive method was used with atom absorption spectrophotometer Perkin Elmer, Model 272, for the determination of the heavy metals investigated: manganese, nickel, zinc, copper, lead and cadmium. The authors investigated soil samples from two horizones: from 0.30 and from 30-60, comparing the results obtained with those in control "pure" soils and with the existing maximum allowable concentration (MAC). Elevation of the quantity of heavy metals in the soils was established, being best manifested with copper and lead, 90% of the samples containing copper over MAC, and with lead-over 33%.

The study of morbidity rate with temporary disability according to subjects, based on the Soviet experience has an approximately thirty year history in our country. Even though, numerous scientific, methodical and organizational problems with a view to the application of the method-according-to-subjects are still unsolved. The object of our study is a plant of the Union of the Blind in Bulgaria, producing cork stoppers, electrical materials and haircloth. The information derived from the patients' chart by an individual index-card, allowed a more detailed and more comprehensive analysis of the indices of the morbidity rate with temporary disability according to subjects, cases and the days lost because of temporary disability, depending on age-sex structure, occupational group, workshop, length of service and place of residence. The results obtained were compared with those supplied by the official statistics of the TIITs-Gabrovo. The groups of often and continuous sick subjects (6.96%) and (8.56%) have been established for 1983, covering about 40% of the cases with temporary disability and over 60% from the labour losses for that year. Well grounded hygienic and medical-prophylactic measures are recommended on the base of the conclusions drawn.

Extremely important for the character of the health status of the medical staff of the Bulgarian Medical Academy is tracing the level and dynamics of their morbidity (general, expressed by means of integral parameters of morbidity with temporary incapacity for work and of the professional, including the industrial traumatism). On the basis of a two-year study performed at the Medical Academy, with the assistance of the confidential medical staff was gathered the necessary information for the extent and noslogical structure of the morbidity with temporary work incapacity and the number and nosology of the professional diseases, poisonings and occupational accidents. By making use of the basic statistical analyses, the prepared information served to establish the status of morbidity (low for the cases and high for work loss), in order to arrange the Institutes and Departments according to the incidence of temporary work incapacity for work (in days), and give recommendations for undertakings directed on the one side to more profound study of the morbidity and on the other to its practical decrease.

The authors examined whether the groups of aged people who, following the public invitation of the gerontological institutes in the capitals of two countries, i. e. in Budapest and in Sofia requested health examination respectively preventive care, are in conformity regarding their organic and mental health state, their personality characteristics and the self-evaluation of their own situation. We found that the same invitation was accepted in Sofia by a group whose organic and mental health state was objectively worse than of the group in Budapest. The deviations of the typical complaints and the correlations of the self-evaluations both point to the fact that the various sociocultural units and traditions modify the notion which people formed of the health care and of the possibilities which might be expected from it. The international experiences in care and in the organization have to be flexibly adapted when they are used.

The economic aspects of morbidity with temporary incapacity for work are in close connection with the setbacks of the industrial unit, as a result of illness of their workers. On the basis of data taken from the Planning and Economic Department of the Success Plant and using the corresponding method for defining the waste of production, connected with temporary incapacity for work because of illness, which comes up to more than 2 million leva and at the same time payed compensations for 73,000 leva. This allows to establish the true balance between the expenditures of the plant for preventive measures, directed towards a decrease of the setback because of temporary invalidity and take decisions on behalf of the managers of the plant.

A survey is carried out among the population of a district with nonferrous metallurgy in view of studying the mutual relation between the exposure to heavy metals and some basic risk factors for the development of ischemic disease of the heart. The study pertains to the content of lead, cadmium, copper and zinc in blood and its relation to the serum lipids, glutathione in blood, arterial pressure and age. A higher level of triglycerides and free butyric acids were established in the serum with absence of clinical manifestations as a result of exposure to heavy metals. A significant correlation of cadmium, copper and zinc with serum lipids was found. On the basis of regressive analysis equations for the changes in the biochemical indices are derived under the effect of exposure to heavy metals, as well as for the connection of the arterial pressure with age and serum cholesterol. It is reckon that in clinical healthy young people under the effect of nonoccupational exposure to heavy metals a prerequisite is created for development of atherosclerotic diseases in mature and advanced age. It is recommended that the environmental pollution by nonferrous metallurgy to be accepted as risk factor for development of ischemic disease of the heart and to be taken under consideration in the complex preventive measure for this disease.