Jannis Papathanasiou

The Sellick Maneuver (SM) is used during Rapid Sequence Induction (RSI) to reduce the risk of regurgitation and Pulmonary Aspiration (PA); however, evidence regarding Bulgarian Healthcare Professionals’ (HPs) preparedness to perform the SM is limited. This multicenter cross-sectional study assessed knowledge, attitudes, and practices (KAP) regarding the SM and factors associated with Adequate Self-Reported Practical Application (ASRPA). A total of 135 HPs from six Bulgarian institutions completed a 31-item, psychometrically evaluated Bulgarian-language questionnaire comprising Knowledge (15 items; 0–15), Attitudes (8 items; 8–40), and Practices (8 items; 8–40) domains. Internal consistency was assessed using KR-20 and Cronbach’s α, factorability using the Kaiser–Meyer–Olkin (KMO) measure and Bartlett’s test, and associated factors using multivariable logistic regression. Overall preparedness was moderate in 45.2%, good in 39.3%, and low in 15.6% of participants; 51.1% demonstrated ASRPA. Mean scores were 9.6 ± 3.1 for Knowledge, 30.2 ± 5.4 for Attitudes, and 26.7 ± 6.2 for Practices. Reliability was good for Knowledge (KR-20 = 0.82) and acceptable for Attitudes (α = 0.76) and Practices (α = 0.71). Knowledge demonstrated adequate factorability (KMO = 0.76; Bartlett’s P < 0.001), with three factors explaining approximately 54% of variance. ASRPA was independently associated with non-Burgas institutional affiliation adjusted Odds Ratio (aOR), 1.76; 95% Confidence Interval (CI), 1.01–3.08), Previous SM Training (PSMT) (aOR, 1.94; 95% CI, 1.12–3.36), higher Knowledge scores (aOR, 1.15 per point; 95% CI, 1.05–1.27), and higher Attitudes scores (aOR, 1.11 per point; 95% CI, 1.02–1.21). Preparedness was predominantly moderate, supporting structured, simulation-enhanced, competency-based SM training. The Bulgarian KAP instrument showed promising preliminary psychometric properties but requires further independent validation.

Cricoid Pressure (CP) remains one of the most debated interventions during rapid sequence induction. Although traditionally used to reduce Pulmonary Aspiration (PA), its effectiveness remains uncertain because of conflicting clinical evidence and considerable variability in its application. This structured narrative review critically evaluates contemporary evidence regarding the anatomical rationale, clinical effectiveness, safety, guideline recommendations, performance errors, simulation-based training, and competency-based education for CP. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science through July 2026, including randomized controlled trials, systematic reviews, meta-analyses, anatomical studies, clinical guidelines, and educational research. Current evidence does not conclusively demonstrate that CP reduces pulmonary aspiration, while inappropriate anatomical localization, excessive or insufficient force, incorrect timing, and delayed release may adversely affect airway management. Contemporary guidelines increasingly recommend selective rather than routine use of CP and emphasize prompt release whenever ventilation or tracheal intubation is compromised. Educational evidence consistently demonstrates that simulation incorporating objective force-feedback improves immediate technical performance; however, evidence for long-term skill retention, clinical transfer, and patient-centered outcomes remains limited. A six-stage competency-based simulation training curriculum is proposed to standardize training, objective assessment, and periodic reassessment of CP performance. The review also discusses opportunities for implementing CPE within Bulgarian medical training.

Hip Tuberculosis (HTB) is a severe form of extrapulmonary Tuberculosis (TB) that can lead to progressive joint destruction, functional impairment, and reduced Quality Of Life (QoL). Optimal management requires timely Antitubercular Therapy (ATT), appropriate surgical intervention, and structured rehabilitation. This case report aims to present a 57-year-old Bulgarian female with advanced HTB, persisting chronic pain, severe functional limitation, and marked restriction in Range Of Motion (ROM) and Muscle Strength (MS). Baseline assessment revealed a Harris Hip Score (HHS) of 56 and pain intensity of 7/10 on the Visual Analogue Scale (VAS). Microbiological confirmation of Mycobacterium tuberculosis was obtained via bone biopsy. Following completion of ATT and normalization of inflammatory markers, the patient underwent Total Hip Arthroplasty (THA) using an anterolateral approach. An individualized Exercise-Based Postoperative Rehabilitation Program (EBRP) was implemented. At 6- Hip Flexion (HF) improved from 25° to 55°, while hip abduction increased from 15° to 40°. MS improved from 2/5 to 4+/5 in key muscle groups (MG). Functional performance improved significantly, with HHS increasing from 56 to 81 (+44.6%), and pain decreasing from 7/10 to 2/10 (−71.4%). No postoperative complications or infection recurrence were observed. This case highlights the importance of appropriate timing of THA after successful infection control with ATT, combined with a structured EBRP. A multidisciplinary approach is essential to optimize functional recovery and minimize complications in patients with HTB.

Objective: To compare the effects of two nutritional supplementation strategies Amendcor® (Creatine, D-ribose, coenzyme Q10, and vitamin E) vs. Ubiquinol+D-ribose, combined with a 12-wk group-based high-intensity aerobic interval training (GB-HIAIT) on functional exercise capacity (FEC), health-related quality of life (HRQoL), left ventricular ejection fraction (LVEF), and perceived exertion (PE), in patients with heart failure with reduced ejection fraction (HFrEF). Design: 68 patients with HFrEF were randomly assigned to a Creatine + D-ribose + CoQ10 + Vit. E) ( n = 35) or a Ubiquinol + D-ribose group ( n = 33) and performed GB-HIAIT. The primary outcome was FEC, assessed via the 6-minute walk test (6MWT), peak VO₂, and peak respiratory exchange ratio (RER). Secondary outcomes included HRQoL, LVEF, and PE. Results: Study participants supplemented with Creatine + D-ribose + CoQ10 + Vit. E demonstrated significantly greater improvements in FEC (6MWT: +19.88%, VO₂ peak: +25.46%, PE: -38.53%), HRQoL: -25.64%, LVEF: +40.94%, compared with subjects supplemented with Ubiquinol + D-ribose (P < 0.05). Conclusions: Patients with HFrEF who received multi-ingredient supplementation combined with GB-HIAIT demonstrated superior improvements in FEC, HRQoL, LVEF, and PE, compared with those supplemented with Ubiquinol + D-ribose.

This study investigated whether functional characteristics and barriers to cardiac rehabilitation (CR), assessed through the Cardiac Rehabilitation Barriers Scale (CRBS), predict 30-day hospital readmission following discharge for acute coronary syndrome (ACS). Single-center, observational longitudinal study conducted at a cardiology hospital.At hospital discharge, participants underwent assessments of respiratory muscle strength (maximum inspiratory [MIP] and expiratory pressures [MEP]), handgrip strength (HGS-D), and functional capacity (6-minute walk distance [6MWD]). At 30 days post-discharge, patients completed the CRBS, encompassing four domains (perceived needs/healthcare factors, logistical factors, work/time conflicts, and comorbidities/functional status) and were evaluated for hospital readmission. A total of 320 patients (63.8% men, mean age 63.5 ± 11.3 years, median GRACE score 109 [range 63-173]) were included. After adjustment for confounders (age, sex, BMI, GRACE score, length of stay, and time since discharge), shorter 6MWD (OR = 0.981, 95%CI 0.968-0.994, p = 0.005), lower MEP (OR = 0.891, 95%CI 0.841-0.945, p < 0.001), and higher CRBS comorbidities/functional status scores (OR = 1.429, 95%CI 1.241-1.645, p < 0.001) were associated with increased odds of hospital readmission. Additionally, 6MWD was inversely associated with the CRBS sum score (β = -0.020, 95%CI -0.034 to -0.006, p = 0.005). Functional impairments and perceived barriers to cardiac rehabilitation are significant predictors of 30-day hospital readmission in ACS patients. Early identification of at-risk individuals may enhance post-discharge care strategies and reduce readmission rates.

Health-related quality of life (HRQoL) is a critical outcome measure in oncology research and clinical care. This study aimed to translate, culturally adapt, and psychometrically validate the Bulgarian versions of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy–General (FACT-G), focusing on Internal Consistency (IC), Test–Retest Reliability (TRR), and Construct Validity (CV) in Cancer Survivors (CS) diagnosed with breast, lung, or colorectal cancer. A total of 235 Bulgarian CS (mean age 62.3 ± 11.2 years; 118 males, 117 females) were recruited from five tertiary care hospitals in a cross-sectional study design. The EORTC QLQ-C30 and FACT-G were translated and culturally adapted according to the official EORTC and FACIT guidelines. Psychometric evaluation included data quality (floor and ceiling effects, missing responses), IC, TRR, and CV assessed via convergent and Discriminant Validity (DV). A subsample of 78 study participants (33.2%) completed both questionnaires twice over a 14-day interval for TRR assessment. CV was supported by strong item-scale and cross-instrument correlations (r = 0.62–0.81). IC was excellent across all domains (Cronbach’s α = 0.88–0.95), and TRR demonstrated high stability (ICC = 0.75–0.89). Bland–Altman analysis showed acceptable agreement, with a mean difference of 23.20 (95% CI: 21.87–24.53) and limits of agreement ranging from +3.77 to +42.63. Minimal Floor Effects (FE) were observed, while Ceiling Effects (CE) were noted in specific domains (e.g., Social Functioning (SF) and Global Health (GH) in the EORTC QLQ-C30; Social Well-Being (SWB) and Emotional Well-Being (EWB) in the FACT-G). The findings support that the Bulgarian versions of the EORTC QLQ-C30 and FACT-G are valid, reliable, and culturally appropriate instruments for evaluating HRQoL in Bulgarian CS. Their use is recommended in both clinical practice and research contexts.

Introduction: The University Hospital for Active Treatment and Emergency Medicine (UHATEM) “N. I. Pirogov” LTD is a pivotal institution in Bulgaria’s emergency medical services (EMS). However, funding challenges adversely affect its operational efficiency and quality of care. Aim: This study aims to identify the primary perceived advantages of UHATEM “N. I. Pirogov” LTD compared to other medical facilities, assess differences in perceptions between patients and staff, and evaluate the impact of funding limitations on hospital operations. Materials and methods: A cross-sectional study was conducted between January and July 2023 using a self-administered online questionnaire with 16 questions across four domains. A total of 1,041 participants were surveyed. Data analysis included descriptive statistics, chi-square tests, Cramér’s V, and one-way ANOVA to identify significant differences in perceptions and mean scores across age groups. Results: “Fast and fail-safe 24-hour access” was the most valued advantage among both patients and staff. The staff highlighted the hospital’s “multidisciplinary profile and teams” and “unique and unparalleled clinics and structures” as significant strengths. Chi-square analysis confirmed significant associations between perceived advantages and respondent type. Funding-related challenges, such as limited financial resources and high operational costs, were identified as critical issues. Conclusions: To improve EMS quality and sustainability at UHATEM “N. I. Pirogov” LTD, consistent state funding, public-private partnerships, and operational efficiencies are needed. Addressing these challenges is essential for maintaining high-quality care and operational stability.

Reconstruction of the Anterior Cruciate Ligament (ACL) in Skeletally Immature Patients (SIP) poses challenges due to anatomical and developmental factors. This randomized controlled trial evaluated the Functional Recovery (FR) of pediatric patients undergoing ACL Reconstruction (ACLR), comparing Transphyseal Reconstruction (TPR) and physeal-sparing reconstruction (PSR). Forty-three young athletes (mean age 14.1 ± 2.3 years), including 29 boys and 14 girls, were randomized to TPR (n=23) or PSR (n=20). FR was assessed by using the Pediatric International Knee Documentation Committee (Pedi-IKDC) questionnaire at baseline, 8 months, and 12 months post-surgery. At the 12-month follow-up, the TPR group demonstrated a significantly greater improvement in Pedi-IKDC scores, with a 66.95% increase compared to 56.73% in the PSR group, reflecting notable differences in knee function between the groups at both 8 and 12 months (p < 0.001). Additionally, 80% of participants in the TPR group returned to sports, with 56% resuming limited activities, while the PSR group exhibited a slower recovery trajectory. These preliminary findings indicate that TPR provides superior FR and a faster return to sports compared to PSR, underscoring the importance of tailored rehabilitation protocols and long-term follow-up to optimize outcomes in SIP.

In the last year, Chat Generative Pre-Trained Transformer (ChatGPT), a web software based on artificial intelligence has been showing high potential in every field of knowledge. In the medical area, its possible application is an object of many studies with promising results. We performed the current study to investigate the possible usefulness of ChatGPT in assessing low back pain. We asked ChatGPT to generate a questionnaire about this clinical condition and we compared the obtained questions and results with the ones obtained by other validated questionnaires: Oswestry Disability Index, Quebec Back Pain Disability Scale, Roland-Morris Disability Questionnaire, and Numeric Rating Scale for pain. We enrolled 20 subjects with low back pain and we found important consistencies among the validated questionnaires. The ChatGPT questionnaire showed an acceptable significant correlation only with Oswestry Disability Index and Quebec Back Pain Disability Scale. ChatGPT showed some peculiarities, especially in the assessment of quality of life and medical consultation and treatments. Our study shows that ChatGPT can help evaluate patients, including multilevel perspectives. However, its power is limited, and further research and validation are required.

The study aimed to evaluate the effectiveness of radial extracorporeal shock wave therapy (rESWT) and conventional physical therapy (CPT) protocol on the gait pattern in stroke survivors through a new gait analysis technology. Fifteen (n=15) stroke survivors took part in this prospective, observational study and were assessed clinically and through an instrumented treadmill before and after rESWT and CPT. Spasticity grade 95% CI 0.93 (0.79 +/- 1.08), pain intensity 95% CI 1.60 (1.19 +/- 2.01), and clonus score decreased significantly 95% CI 1.13 (0.72 +/- 1.54). The sensorimotor function 95% CI -2.53 (-3.42 +/- 1.65), balance 95% CI -5.67 (-6.64 +/- - 4.69), and gait parameters were enhanced at the end of the program. Step length 95% CI -3.47 (-6.48 +/- 0.46) and step cycle were improved 95% CI -0.09 (-0.17 +/- -0.01), and hip 95% CI -3.90 (-6.92 +/- -0.88), knee 95% CI -2.08 (-3.84 +/- -0.32) and ankle flexion-extension 95% CI -2.08 (-6.64 +/- -4.69) were augmented. Adding the quantitative analysis to the clinical assessment, we gained easy access to track progress and obtained an individualized therapeutic approach for stroke survivors.