MEDIS – International Journal of Medical Sciences and Research
MEDIS – INTERNATIONAL JOURNAL OF MEDICAL SCIENCES AND RESEARCH Vol. 5. Issue 2 / 2026 Distinguished Teachers, Scientists, and Researchers in the field of Medicine We are pleased to inform you of that procedure for applying for your scientific and research papers in the field of Medicine, Medical Sciences, and Health, for the MEDIS IJ Vol. 5 Issue. 2. 2026, has started. The purpose of this publishing venture is to persevere the continuity and raise the quality of the work so far, in order for MEDIS IJ to be included in the SCOPUS or WOS list as soon as possible. From now on we offer a new opportunity to do so in MEDIS IJ, where papers will be published in English only. Important: One author can publish only 1 paper per issue The deadlines are as follows: - 27. 04. 2026 abstract submission deadline - 02. 05. 2026 till 12:00 AM full paper submission deadline More Info... Abstract template
ASSESSMENT OF SENSORY PROCESSING IN CHILDREN WITH AUTISM SPECTRUM DISORDER USING THE SHORT SENSORY PROFILE: A STUDY OF 60 PARTICIPANTS
Alterations in sensory processing are widely recognized as a fundamental characteristic of Autism Spectrum Disorder and play a critical role in shaping everyday functioning, behavioral responses, and participation in daily activities. The precise evaluation of these sensory characteristics is crucial for designing effective intervention strategies, particularly when applying integrated rehabilitation models. The present study was designed to investigate patterns of sensory processing in children diagnosed with ASD through the use of the Short Sensory Profile, with emphasis on its role in informing a combined physiotherapy and occupational therapy framework. The sample consisted of 60 children within the age range of 4 to 7 years. Sensory processing characteristics were measured using the Short Sensory Profile, a standardized caregiver-based assessment tool that examines multiple domains, including tactile responsiveness, movement-related sensitivity, and low energy/weakness. Data were collected as part of an initial comprehensive assessment within an integrated therapeutic framework combining physiotherapy and occupational therapy interventions. Descriptive and inferential statistical analyses were conducted to examine the distribution and severity of sensory processing differences. The results indicated that the majority of participants exhibited definite differences across multiple sensory domains. Specifically, approximately 69% of the children demonstrated definite differences in at least two sensory domains. The most pronounced impairments were identified in tactile sensitivity, movement sensitivity, and the low energy/weakness subscale. Children within this profile demonstrated reduced muscle strength, poor postural control, and limited endurance. They fatigued easily, particularly during activities requiring sustained posture or physical effort, exhibited weak grip strength, experienced difficulty lifting age-appropriate objects, and frequently required external support even during routine tasks. These findings highlight the strong relationship between sensory processing difficulties and motor function in children with ASD. The identified patterns emphasize the importance of integrating sensory-based approaches with targeted motor and functional training. The Short Sensory Profile proved to be a valuable tool for guiding individualized intervention planning within a comprehensive therapeutic model. In conclusion, this study provides evidence that specific sensory processing deficits—particularly in tactile, movement, and low energy domains—should be central considerations in intervention design. The integration of sensory-based strategies within combined physiotherapy and occupational therapy programs may improve functional outcomes and enhance participation in daily activities for children with ASD. Future research should explore the long-term effects of such integrated interventions on sensory and motor development.
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc/4.0
THE IMPACT OF ULTRA-PROCESSED FOODS ON THE GLOBAL OBESITY EPIDEMIC
Obesity has become one of the most urgent health concerns worldwide, shaped by a complicated mix of biological, lifestyle, and environmental influences. Among these, the fast rise in intake of ultra-processed foods (UPFs) has attracted increasing scientific scrutiny. UPFs, defined within the NOVA classification system as industrial formulations composed of refined ingredients and additives, are marked by substantial caloric concentration, excessive sugar, salt, and unhealthy fats, and low nutritional quality. This narrative review synthesizes current epidemiological evidence linking UPF consumption with obesity-related outcomes, including increased body mass index, abdominal adiposity, and metabolic dysfunction. Proposed mechanisms include impaired satiety signaling, alterations in gut microbiota, activation of neurobiological reward pathways, and promotion of chronic low-grade inflammation. While observational studies consistently demonstrate positive associations, methodological challenges and controversies—such as confounding lifestyle factors and limitations in dietary assessment—remain unresolved. Nevertheless, the convergence of biological plausibility and epidemiological findings underscores the immediate need for comprehensive public health strategies aimed at reducing UPF intake. Policy interventions including taxation, labeling, marketing restrictions, and product reformulation may represent critical tools in mitigating the global obesity epidemic.
A CASE REPORT OF GAS GANGRENE CAUSED BY RARE TYPE OF CLOSTRIDIUM – CLOSTRIDIUM LIMOSUM
Introduction: Gas gangrene (GG) is a necrotizing soft tissue infection with extremely poor outcome. It is caused predominantly by Clostridium perfringens and is related with compromised immunity. Case report: We present a clinical case of 38 years old male with metastatic oesophageal cancer who developed gas gangrene as a site infection in the area of port-a-cath used for chemotherapy. Unfortunately, the patient died sooner after the admission and the performed surgery. Bacterial wound culture revealed Clostridium limosum – unusual type of Clostridium bacteria as a cause of the infection. Conclusion: Gas gangrene could be caused by different types of Clostridium Species. It has very high mortality rate even with timely treatment.
BONE AND SOFT TISSUE MORPHOLOGICAL MARKERS IN MOUTH-BREATHING CHILDREN USED BY ORTHODONTISTS AND OTOLARYNGOLOGISTS
Several morphological markers are observed in children with nasal breathing disorders. They are often diagnosed during orthodontic analysis in relation to concomitant orthodontic deformities. Mouth breathing leads to muscle activity changes affecting the oral functions - mastication, swallowing and phonation. The muscles involved in the mouth breathing contract at the same time as the muscles in involved in the other oral functions and affect each other. Aim of the research was to describe a method for simultaneously identifying bone and soft tissue changes in the orofacial region. In orthodontics, a large field of view (FOV) CBCT covering the entire skull, is obtained. A 3D imaging software is used to evaluate the changes in the bones, the soft tissues and the upper airways. A single CBCT scan can establish the three-dimensional development of the maxilla and mandible, the level of bone insufficiency, TMJ disorders (TMDs), facial asymmetries, assess bone maturation and determine bone age. It gives the ability to objectively measure airway volume, identify areas of upper airway obstruction, superimpose images of anatomic structures and to track soft tissue changes. It is used in the planning of orthognathic reconstructions and in the digital designing of surgery guides or orthodontic appliances. Evaluation of Consecutive CBCTs (before and after treatment with maxillary expander) of patients with upper airway obstructions, can be done by both an orthodontist and an otorhinolaryngologist. They can establish the changes in the widths of the bony palate, the maxilla and the interzygomatic space. Additionally, the increase in volume of the nasal, nasopharyngeal and pharyngeal airways can be measured and the areas of obstruction can be identified.
ANATOMICAL AND MORPHOLOGICAL VARIATIONS OF THE BASILAR ARTERY ASSOCIATED WITH CEREBRAL CIRCULATION CHANGES
The basilar artery (BA) is one of the main vessels that supplies oxygen rich blood to the brain and it plays a very important role in cerebral circulation. It is formed by the union of the left and right vertebral arteries at the junction between the medulla oblongata and the pons, near the abducens nerve (CN VI) The vertebrobasilar system is a major blood supply route to the posterior part of the brain, and variations in the basilar artery (BA) may affect blood flow and contribute to neurological symptoms or ischemic events. Aim: This study aimed to assess how often anatomical variations of the BA occur according to sex and age, to measure BA diameter, and to evaluate theiir possible clinical relevance in patients with different neurological and traumatic conditions. Materials and Methods: A retrospective study was conducted on 60 patients (25 women, 41.67% and 35 men, 58.33%) with a mean age of 45.0 ± 12.0 years. Patients were examined at the Clinical Hospital Tetovo over a one-year period. CT, MRA, and Doppler ultrasound were used to evaluate the basilar artery. Measurements were taken and classified as normal, hypoplasia (<2 mm), or dolichoectasia (>4 mm). Data were analyzed using SPSS v26. Results: Normal BA morphology was the most common finding in both sexes, especially in males (74.3%) compared to females (64%). Hypoplasia was more frequent in females (32%) than males (17.1%), while dolichoectasia was slightly more common in males (8.6%) than females (4%). In hypoplastic arteries, diameters ranged from 1.80 to 1.95 mm, while in dolichoectasia they exceeded 4.0 mm. Overall, the findings showed noticeable sex-related differences and were in line with previous studies. Conclusion: Anatomical variations of the basilar artery are relatively common and may influence blood flow in the posterior circulation. Recognizing these changes early through modern imaging techniques is important for better diagnosis, risk evaluation, and clinical decision-making
IMPACT OF INOSITOL SUPPLEMENTATION ON ENDOCRINE FUNCTION, MENTAL HEALTH AND CARDIOVASCULAR RISK FACTORS: A CLINICAL STUDY
This study investigates the effects of 30 mg inositol supplementation on endocrine, mental health, and cardiovascular parameters in 20 participants. Pre- and post-treatment measurements were taken to evaluate changes in insulin, androgen levels, glucose, blood pressure, lipid profiles (LDL, HDL, total cholesterol, triglycerides), depression, anxiety, general mental clarity, energy, and fatigue. Results showed significant improvements in endocrine and cardiovascular parameters, including a reduction in insulin levels (from 15 µU/mL to 11 µU/mL, p=0.05), androgen levels (from 50 ng/dL to 45 ng/dL, p=0.04), and blood pressure (from 140/100 mmHg to 115/75 mmHg, p=0.05). Lipid profiles also improved, with LDL decreasing from 135 mg/dL to 120 mg/dL (p=0.02), HDL increasing from 45 mg/dL to 55 mg/dL (p=0.03), and triglycerides decreasing from 150 mg/dL to 130 mg/dL (p=0.04). Mental health assessments revealed significant reductions in depression (PHQ-9 score from 10 to 5, p=0.02) and anxiety (GAD-7 score from 8 to 4, p=0.01), along with an improvement in general mental clarity (from 60 to 75, p=0.04). Energy levels showed a significant increase (from 60 to 75, p=0.05), while fatigue was slightly reduced, but not significantly (from 70 to 60, p=0.07). These findings suggest that inositol supplementation may offer substantial benefits in improving metabolic, cardiovascular, and mental health outcomes. Further studies with larger sample sizes and longer durations are needed to confirm these results and explore the underlying mechanisms of action.
HYPERCOAGULABILITY AND THROMBOTIC RISK IN BETA-THALASSEMIA: CLINICAL AND LABORATORY INSIGHTS
Beta-thalassemia is increasingly recognized as a multisystem disorder associated with a chronic hypercoagulable state and an elevated risk of thrombotic complications. Beyond ineffective erythropoiesis, chronic anemia, and transfusion-related iron overload, abnormalities in coagulation and vascular function play an important role in long-term morbidity. Accumulating evidence indicates that patients with beta-thalassemia exhibit persistent activation of cellular and plasma components of hemostasis, even in the absence of overt clinical thrombosis. Hypercoagulability in beta-thalassemia is multifactorial, arising from altered red blood cell membrane architecture with phosphatidylserine externalization, chronic platelet activation, endothelial dysfunction driven by hemolysis and nitric oxide depletion, increased circulating procoagulant microparticles and extracellular vesicles, and imbalances in natural anticoagulant pathways. Iron-related oxidative stress and inflammation further amplify vascular activation and thrombin generation. The magnitude and clinical expression of these abnormalities differ substantially across disease phenotypes. Beta-thalassemia trait is generally not associated with clinically significant thrombosis, whereas non-transfusion-dependent thalassemia (NTDT) carries a particularly high thrombotic burden, especially in splenectomized patients. In transfusion-dependent thalassemia (TDT), regular transfusion modifies erythroid-driven procoagulant mechanisms but introduces additional risk modifiers, including iron overload and catheter-related thrombosis. This review summarizes current knowledge on coagulation disturbances and thrombotic complications in beta-thalassemia, integrating pathophysiological mechanisms with clinically relevant laboratory markers. Particular emphasis is placed on global coagulation assays, cellular biomarkers, and phenotype-specific clinical-laboratory patterns, as well as on contemporary monitoring strategies in TDT. A better understanding of these mechanisms is essential for individualized risk stratification and optimization of thrombosis prevention in patients with beta-thalassemia.
PRONATED AND FLAT FEET: DISTINCT ENTITIES OR OVERLAPPING CONDITIONS
The terms pronated foot and flat foot are often used interchangeably in clinical practice, despite representing distinct biomechanical and morphological conditions. In many respects, the two conditions present with analogous clinical manifestations and may elicit similar symptomatology; however, their underlying genesis differs. Accurate differentiation between these conditions requires not only advanced expertise in biomechanics and the anatomy of the ankle–foot complex, but also comprehensive knowledge of the distinct stages of foot development from a podiatric perspective. Misinterpretation of these entities may lead to inappropriate therapeutic strategies and suboptimal clinical outcomes, particularly in pediatric and physically active populations. The purpose of this article is to clarify the differences between pronated foot posture and flat foot deformity, with emphasis on structural characteristics, functional behavior, and clinical relevance. The paper reviews current concepts of foot biomechanics and presents commonly used plantographic assessment methods, including Clarke’s angle and footprint-based indices, to illustrate diagnostic distinctions. Special attention is given to the clinical applicability and limitations of these assessment tools in routine physiotherapy practice. Understanding the difference between dynamic pronation and structural flattening of the medial longitudinal arch is essential for accurate diagnosis, appropriate treatment planning, and prevention of misclassification. Clear differentiation between these conditions may improve clinical decision-making in physiotherapy and related disciplines.
INFLAMMATION-LINKED PSA VARIABILITY IN BPH PATIENTS TREATED WITH ANTIBIOTICS: A LONGITUDINAL STUDY WITH HISTOPATHOLOGIC CORRELATION
Benign prostatic hyperplasia (BPH) frequently coexists with prostatic inflammation, which may elevate prostate-specific antigen (PSA) and complicate differentiation from prostate cancer. To evaluate longitudinal changes in C-reactive protein (CRP) and PSA parameters following culture-guided antibiotic therapy in men with BPH, and to assess associations with prostate biopsy outcomes. A longitudinal retrospective observational study included 24 men with BPH followed from January to December 2025. CRP, total PSA (tPSA), and free PSA (fPSA) were measured at baseline without antibiotics (January) and at three subsequent timepoints (May, September, December) after antibiotic therapy guided by urine culture and antibiogram. Antibiotic regimens included levofloxacin 500 mg once daily for 28 days, nitrofurantoin 100 mg three times daily for 10 days, and cefixime 400 mg once daily for 10 days. Prostate biopsy was recommended to all patients; those declining biopsy were retained as a descriptive subgroup. Statistical analysis: Continuous variables were summarized as median and interquartile range. Repeated-measures comparisons across four timepoints were performed using the Friedman test. Between-group comparisons were performed using the Mann–Whitney U test. A two-sided p value < 0.05 was considered statistically significant. Results: CRP and PSA parameters demonstrated longitudinal variation over the four timepoints. PSA kinetics differed according to histopathologic findings among biopsied patients. Conclusion: Serial CRP and PSA assessment under culture-guided antibiotic therapy may support risk stratification and biopsy decision-making in BPH patients with suspected inflammation.
ANTI-AGING ESTHETIC TREATMENTS: PSYCHOLOGICAL EFFECTS, EXPECTATIONS, AND CLINICAL OUTCOMES
Anti-aging esthetic dermatology has become an increasingly important area of contemporary medical practice, primarily due to advances in minimally invasive procedures, improved technologies, and growing social interest in maintaining a youthful appearance. In addition to medical and technological progress, psychological and social factors play an increasingly important role in the decision-making process of patients seeking esthetic treatments. Expectations regarding improved self-confidence, social acceptance, and overall quality of life frequently influence the motivation to undergo anti-aging procedures. The aim of this paper is to analyze psychological factors influencing patients’ decisions to undergo anti-aging esthetic treatments and to examine the relationship between patient expectations, perceived outcomes, and overall satisfaction. The study is based on a narrative review of relevant scientific literature in the fields of dermatology, psychology, and medical aesthetics, with particular attention to recent studies addressing patient-reported outcomes, psychosocial determinants of treatment satisfaction, and quality-of-life indicators. Available evidence indicates that patient satisfaction depends not only on objective clinical results but also on the alignment between expectations and achieved outcomes. Unrealistic expectations, inadequate communication, and insufficient understanding of treatment limitations may lead to dissatisfaction even when clinical results are technically successful. Conversely, effective physician–patient communication, clear explanation of treatment goals, and individualized therapeutic approaches significantly improve both subjective satisfaction and long-term treatment adherence. Psychological determinants such as body image perception, self-esteem, aging anxiety, and social influence are consistently identified as important predictors of treatment demand and satisfaction. Ethical considerations and professional responsibility are also increasingly emphasized in contemporary esthetic dermatology, particularly in the context of managing patient expectations and ensuring realistic treatment planning. In conclusion, understanding the psychological background of patients seeking anti-aging esthetic treatments is essential for achieving optimal clinical outcomes and maintaining high levels of patient satisfaction. A multidisciplinary approach that integrates dermatological expertise with psychological awareness represents a key component of safe, effective, and patient-centered anti-aging practice.
ADDRESSING THE ESCALATING HIV EPIDEMIC IN ALBANIA: POLICY EFFICACY, IMPLEMENTATION CHALLENGES, AND STRATEGIC PATHWAYS FOR IMPROVEMENT
Albania, despite its historically low HIV prevalence, is experiencing a concerning and continuous rise in new infections, with reported cases doubling over the past decade. This trend necessitates a critical examination of the nation's public health response to HIV/AIDS within its unique socio-cultural and economic context. This section outlines the methodological approach for reviewing grey literature. Due to its complexity and limited indexing, a structured search plan based on a systematic review protocol was developed, using four strategies: grey literature databases, customized Google searches, targeted websites, and expert consultation. Grey literature, including government, NGO, and institutional reports, which were assessed. This study conducted a qualitative policy analysis using national reports, global agency data (e.g., UNAIDS, WHO), and academic literature It critically examined the implementation and impact of Albania’s core legal frameworks: the “Prevention and Control of HIV/AIDS Law” (2008) and the “National Action Plan 2020–2025.” Results indicate that 60–72% of new HIV cases are diagnosed at late stages, exposing serious gaps in early detection and access to testing. Key populations, such as men who have sex with men, people who inject drugs, and sex workers, remain underserved due to stigma, and traditional cultural values. Additionally, the withdrawal of major international donors, including the Global Fund, has led to critical shortages in testing supplies and awareness campaigns. While ART is available, it remains centralized in Tirana, limiting rural access. Albania's progress in controlling its HIV epidemic is substantially impeded by deeply entrenched social stigma, systemic under-reporting, and an unsustainable reliance on external funding. To meet SDG Target 3.3 by 2030, Albania must decentralize HIV services, establish sustainable national funding mechanisms, and prioritize anti-stigma strategies through multi-sectoral collaboration. Addressing these multifaceted challenges is paramount for improving public health outcomes and ensuring equitable HIV prevention and care in Albania.
FOREIGN BODY INGESTION IN CHILDREN - AN EMERGENCY CONDITION REQUIRING IMMEDIATE EVALUATION
Accidental foreign body ingestion is common in pediatric practice. Young children, especially those under five years, tend to put different kinds of small objects from their environment into their mouths. Sometimes due to the still immature reflexes, they are unintentionally swallowed. Most often these are coins, followed by magnets, button batteries, toys or jewelry, but also many others. Luckily, in most cases, these foreign bodies pass through the gastrointestinal tract without causing any symptoms or injuries. Some of them don’t even get noticed or registered. However, it is estimated that in 10 to 20 percent of the cases there is a need for medical intervention. A critical condition is lodgment in the esophagus because it requires extraction as soon as possible. Most often it occurs in its upper third. At this location the object is able to cause serious clinical discomfort, requiring rapid approach. Even dyspnea by compressing the trachea is possible. Injuries of the tissues, particularly after delayed diagnosis and treatment, might be a further dangerous consequence. Especially lodged button batteries cause critical damage of the esophageal wall in a very short time due to an electrolysis reaction on the site of the negative pole. This generates an alkali burn that might lead to life-threatening complications as perforation, fistulas to the trachea or to major blood vessels. Lethal outcomes are reported. Studies have demonstrated the development of significant injuries even only two hours of impaction. This emphasizes the importance of initiation of the extraction immediately. Thus, in spite of the overall good prognosis clinicians have to be extremely alert when confronted with a child after foreign body ingestion. Immediate and profoundly evaluation is necessary in order to detect or exclude lodgment in esophagus- a condition requiring quick intervention. Especially when button batteries are involved time is crucial in order to prevent devastating complications.
THE EVOLUTION OF GOOD CLINICAL PRACTICE: A COMPARATIVE REVIEW OF ICH GCP E6 (R2) AND E6 (R3)
Good Clinical Practice (GCP) provides the ethical and scientific foundation for conducting clinical trials and safeguarding participant welfare. The transition from ICH GCP E6 (R2) to E6 (R3) represents a significant evolution in response to increasingly complex study designs, digital technologies, and decentralized trial models. These developments require regulatory guidance that remains robust while allowing sufficient flexibility to support innovation. In addition, the globalization of clinical research and the growing involvement of multiple stakeholders have further emphasized the need for harmonized yet adaptable regulatory standards. The aim of this review is to compare ICH GCP E6 (R2) and E6 (R3) and evaluate the practical impact of the updated framework on investigators, sponsors, and other research stakeholders. Specific attention was given to how the revised guidance supports operational efficiency without compromising ethical safeguards or scientific validity. A structured qualitative analysis of both versions was conducted. Key aspects examined included trial design, quality management, data governance, investigator and sponsor responsibilities, monitoring strategies, and participant protection. The review focused on identifying major conceptual shifts and evaluating their significance for contemporary clinical research practice. The analysis demonstrates that ICH GCP E6 (R3) adopts a principle-based, risk-proportionate approach, moving beyond the more prescriptive structure of R2. It prioritizes the identification and management of factors critical to participant safety and data integrity, encouraging sponsors and investigators to tailor processes according to study-specific risks. This approach supports innovative methodologies, including decentralized and hybrid trials, facilitates the integration of digital health technologies, and promotes proactive quality management systems embedded throughout the trial lifecycle rather than relying primarily on retrospective corrective actions. For example, in multicenter oncology trials, monitoring activities may focus on critical safety endpoints and high-risk procedures rather than exhaustive source data verification. Such targeted oversight reduces administrative burden while maintaining scientific rigor and regulatory compliance. Furthermore, R3 provides clearer expectations regarding the validation and oversight of digital systems, the management of diverse data sources, and the maintenance of continuous ethical oversight throughout the trial lifecycle. Overall, ICH GCP E6 (R3) aligns regulatory standards with contemporary clinical research realities, enhancing efficiency, flexibility, and sustained participant protection while advancing innovation in global clinical development.
ASSOCIATION OF SCREEN TIME WITH BMI AND ACADEMIC PERFORMANCE AMONG CHILDREN AGED 6-17 YEARS IN TIRANA
Excessive engagement with screen-based devices has emerged as a significant behavioral risk factor in childhood, contributing to sedentary lifestyles and increasing rates of overweight and obesity. Although extensive international research has documented these associations, evidence from Balkan countries remains limited, particularly regarding the combined relationship between screen exposure, body mass index (BMI), and academic performance. The aim of this study was to assess the relationship of daily screen time with BMI status, and academic achievement in schoolchildren aged 6 to 17 years in Tirana, Albania. The research was a descriptive analytical, cross-sectional and observational study conducted in 2025, with 600 pupils selected through a multi-stage probabilistic sampling procedure from public schools. The data collection instrument was a structured questionnaire, designed based on international literature. Variables included socio-demographic characteristics, sleep duration, physical activity, BMI, academic performance, and screen exposure. Screen time was categorized as ≤2 hours/day and >2 hours per day, while BMI was determined in three categories: underweight, healthy weight, and overweight / obese. Nonparametric tests such as Chi-Square, Mann Whintey U and binary logistic regression were used in the analysis. The level of statistical significance was set at 0.05. Overall, 26.3% of participants reported more than two hours of daily screen exposure. Schoolchildren who spent more than 2 hours/ day on screens were significantly more likely to belong to higher BMI categories. Chi-square analysis demonstrated a significant relationship between daily digital use and BMI categories (χ² = 23.743, df = 2, p = 0.000). Watching TV during a meal was significantly related to higher BMI. (χ²=8.500; p=0.014). Pupils with normal BMI achieved significantly better academic results than their overweight/obese peers (p<0.001). Furthermore, prolonged screen time was independently associated with poorer academic outcomes (χ² = 35.033, df = 2, p<0.01). Binary logistic regression indicated that age (OR=1.323; 95%CI: 1.232-1.422; p=0.000) and male gender (OR=2.098; 95%CI: 1.377-3.196; p= 0.000) were associated with higher odds of excessive time spent using a device such as a computer, television, or iPad (>2 hours per day). An increased BMI was a risk factor (OR=1.059; 95%CI: 0.999-1.123; p=0.054). Longer sleep duration (≥9 hours/night) was a protective factor (OR=0.547; 95%CI: 0.352-0.848; p=0.007), and regular physical activity reduced the odds of excessive screen time (OR=1.681 for non-active participants; 95%CI: 1.002-2.818; p=0.049). These results emphasize interrelationship between sedentary behavior, weight status, sleep patterns, and educational attainment. Comprehensive public health strategies aimed at moderating screen exposure and promoting healthier daily routines are warranted to improve both physical health and academic performance among schoolchildren.
PREREQUISITES FOR EFFECTIVE COMMUNICATION IN SEASONAL INFLUENZA VACCINATION- A STUDY OF GENERAL PRACTITIONERS IN BULGARIA
This study investigates the prerequisites and barriers to effective communication regarding seasonal influenza vaccination by examining the perspectives of general practitioners (GPs) in Bulgaria. GPs play a crucial role in providing primary healthcare services, including health information, promotion of health, disease prevention, and vaccination programs. However, they face significant challenges related to patient trust in social media and internet sources, patients' tendency to neglect their health, and administrative burdens that can hinder their ability to engage in preventive measures. The survey involved 368 GPs who completed an anonymous questionnaire assessing various aspects of their work and relationships with patients. Results indicate that most GPs believe patients heavily rely on potentially misleading information from social media, which complicates efforts to promote vaccinations. Additionally, many patients tend to neglect their health, making them less receptive to health promotion campaigns. Furthermore, GPs often feel overwhelmed by administrative tasks, limiting their capacity to participate in additional preventive programs. Despite these challenges, GPs recognize the importance of communication skills, with 94% considering them as vital as diagnostic and treatment skills. This highlights the need for ongoing training and development of communication skills to improve interactions with patients and enhance the effectiveness of vaccination programs. In conclusion, addressing misinformation, promoting patient responsibility, and reducing administrative burdens are essential steps towards improving communication and increasing vaccination rates among the Bulgarian population.
LEVELS OF GENE EXPRESSION FOR LAD1 AND EGFR IN PATIENTS WITH LARYNGEAL CANCER
Laryngeal cancer is a multiheterogenic disease. Numerous genetic mechanisms are known to be involved in oncogenesis, disease progression, and patient survival prognosis. Some authors speculate that there is a genetic difference between the primary site and the secondary metastasis. We analyzed the known mutations associated with squamous cell cancers. We decided to evaluate gene expression levels of LAD1 and EGFR at three sites: the primary laryngeal site, the tumor periphery, and the lymph node suspected of metastatic spread. In this current study, we present patients operated on for advanced-stage laryngeal cancer. In every patient, a bilateral neck dissection has been performed as well as a total laryngectomy. The cohort consists of 20 patients. The tissues were fresh-frozen in liquid nitrogen, transported to the Genetics Department at Medical University Sofia, and evaluated by real-time PCR. Every tissue sample was pathologically evaluated. In the evaluated tissue samples, we identified gene expression differences between LAD1 and EGFR, even within samples from the same patient. 100 % of the patients are heavy smokers. 100% of the patients are male. We established a notable difference in EGFR and LAD1 gene expression. In some cases, even in different sites of the same patient. There may be prognostic value in LAD1 expression levels and in tumour progression and metastasis. Further studies are needed to establish and validate LAD1 as a predictive marker.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc/4.0
REHABILITATION STRATEGIES FOR MEDIAL TIBIAL STRESS SYNDROME: A PHYSIOTHERAPY PERSPECTIVE
Chronic overuse is a social problem that affects not only athletes but also the general population. It can lead to a variety of injuries, including microtears, stress fractures, tendinitis, and articular cartilage damage. Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent overuse injury among athletes and physically active individuals. It is often ignored or mismanaged, which results in complications, reduced physical activity, and impaired quality of life. MTSS is characterized by pain along the medial border of the tibia induced by physical activity, often associated with repetitive loading, biomechanical dysfunctions, and training errors. Pain typically worsens with activity and subsides with rest. Risk factors include gender, navicular bone drop, elevated body mass index, high-intensity activities, and increased external hip rotation range in males. Patients often report bilateral pain in the distal leg, particularly on the anterior and medial aspects. The medial tibial border—most commonly in the distal third—is a frequent pain site, though shin splints can affect the entire length of the tibia.
SPEECH AND ORTHODONTIC ANALYSIS IN CHILDREN WITH SYMPTOMS OF OBSTRUCTIVE SLEEP APNEA - PILOT STUDY
The topic of children's sleep health and the consequences that arise from its disorders is becoming an increasingly relevant and discussed topic. The interdisciplinary team is united around the idea that the manifestation of symptoms of obstructive sleep apnea is also associated with manifestations of orthodontic deformities, as well as communication disorders. The purpose of this study is to investigate the relationship between obstructive sleep apnea, speech disorders, and orthodontic deformities. Methodology: For this study, nine children were examined, their histories were taken, and diagnoses were provided by an ENT specialist, an orthodontist, and a speech-language therapist. Each parent completed the sleep questionnaire after an otorhinolaryngological examination. For the study of language and speech, the "Methodology for assessing the educational needs of children and students" was applied, as well as the Diagnosis and prevention of language 3–4. Orthodontic diagnostics was performed through a primary examination by an orthodontist. The patients were given a photo protocol with extra- and intraoral photographs; digital impressions were taken; X-ray examinations were prescribed (orthopantomography and teleradiography); and they underwent a detailed orthodontic analysis. Results: The PSQ results divided the children into a clinical group (five) and a borderline group (four). The ENT diagnosed adenoid vegetation in all children, grades III-IV, and four with hearing loss after audiometry and tympanometry. In three children from the clinical sample, disorders of receptive language were observed, and in one, an expressive language disorder was also present. Among the children with a borderline value according to the PSQ, one child with an expressive form of language disorder stood out. All children were diagnosed with an articulation disorder of the polymorphic type. The orthodontic examination in the clinical group identified two children with an Angle Class II occlusion, accompanied by a deep bite and cross-bite in the posterior segment, due to compression of the upper jaw, a direct consequence of mouth breathing. In the borderline group, two children are with Angel class II sagittal occlusion, with an open bite in the frontal segment and cross bite in the posterior segment. One of the children has an Angel class I and an open bite in the frontal segment. Conclusion: The study's data reveal connections between obstructive sleep apnea symptoms, speech and language disorders, and orthodontic changes. As a consequence of prolonged sleep disturbance caused by adenoid vegetation, which led to irregular breathing and tongue position at rest, occlusal irregularities in the three planes—sagittal, vertical, and transverse —and, last but not least, speech and language disorders.
EFFECTIVENESS OF LACTOBACILLUS JENSENII IN TREATING VAGINAL AND UROGENITAL INFECTIONS: AGE-RELATED DIFFERENCES IN RESPONSE AND IMMUNE FUNCTION
This study aimed to evaluate the effects of Lactobacillus jensenii on vaginal and urogenital infections in women aged 20 to 45. A total of 30 participants were included, with those aged 20–35 showing the most significant improvement, as no pathogens or infections were detected post-treatment. However, women older than 40 experienced persistent infections, such as bacterial vaginosis, vaginal candidiasis, and urinary tract infections, despite the probiotic treatment. These results indicate that older women may have reduced immune function and hormonal changes that hinder the effectiveness of probiotics.The findings suggest that L. jensenii can effectively reduce pathogen presence and infections in younger women, likely due to their stronger immune response and hormonal balance. However, in older women, the decreased immune function and altered hormonal levels, such as during postmenopause, might prevent complete resolution of infections. This age-related immune sensitivity, combined with shifts in vaginal microbiota, may necessitate more personalized and multifaceted therapeutic approaches for older populations.Moreover, while probiotics like L. jensenii show promise in restoring microbial balance and preventing infections, the persistence of infections in older women implies that additional therapies may be needed to support the immune system and optimize microbial management. Further research is needed to explore combined probiotic therapies or integrative approaches to improve long-term outcomes for women in this age group. Additionally, attention should be given to factors like comorbidities and previous infections, which could contribute to the higher frequency of infections in older women.This study underlines the potential of Lactobacillus jensenii as a therapeutic agent for vaginal and urogenital health, but also emphasizes the need for age-specific treatment strategies that account for immunological and hormonal changes in postmenopausal women.
SILENT INTRUDERS: HOW STREPTOCOCCUS AGALACTIAE AFFECTED THE PREGNANCY OF PRETERM BIRTHS
Cervico-vaginal infection with Streptococus agalactiae is a known risk factor for premature rupture of amniotic membranes and preterm birth, significantly increasing the incidence of neonatal complication such as sepsis, pneumonia, neonatal meningitis etc. This study analyzes the impact of cervico-vaginal infection with Streptococcus agalactiae on preterm birth using clinically collected data from our patients.This prospective, analytical study included 819 women with preterm delivery in the period between January 1, 2023, and December 31, 2023, at the University Hospital and Clinical Service of Kosovo, Clinic of Gynecology and Obstetrics in Prishtina, Kosovo. Cervico-vaginal samples were collected and analyzed for Streptococcus agalactiae using standard microbiological and PCR methods. Preterm birth was defined according to WHO guidelines (birth before the 37th week of gestation). Data were analyzed using SPSS v.26 with the Chi-square (χ²) test, t-test, and Mann-Whitney U test. As statistically significant was used p <0.0001. The prevalence of cervico-vaginal infection with Streptococcus agalactiae was 11.44% (74 cases). Infection was associated with significantly increased leukocytes and CRP in mothers and newborns, lower birth weight, lower Apgar scores, and a higher probability of cesarean section. A statistically significant association was found between infection and preterm birth (p<0.0001). Cervico-vaginal infection with Streptococcus agalactiae significantly contributes to preterm birth. Early screening and treatment of this infection is essential for preventing preterm birth.
PERFORMANCE PROFILLING AND DATA ANALYTICS IN ELITE SHORT TRACK SPEED SKATING: A CASE STUDY OF THE HUNGARIAN OLYMPIC TEAM
This study explores the composition and performance of the Hungarian Olympic short track speed skating team, with a focus on data-driven analysis to assess trends, strategies, and athlete development. Hungary has emerged as a competitive force in short track speed skating, notably securing its first Winter Olympic gold medal in 2018. By compiling biographical and performance data of team members across multiple Olympic cycles, the analysis identifies key factors contributing to success, including age, experience, specialization (e.g., 500m vs. 1500m), and team dynamics in relay events. Advanced performance metrics such as lap times, split consistency, and overtaking patterns are examined using statistical and machine learning techniques to uncover predictive indicators of medal contention. The research also highlights the importance of strategic decision-making, pacing, and positioning, especially in relay events where Hungary has consistently excelled. This study provides insights into how data analysis can be used to enhance training, selection, and race strategies, offering a model for other national teams seeking to improve performance through evidence-based approaches.
RADIOLOGICAL FEATURES OF LUNG CANCER SUBTYPES: A STUDY OF CT PATTERNS AND PATHOLOGICAL CORRELATES
Primary lung cancer encompasses heterogeneous histopathological subtypes with distinct clinical and radiological features. Accurate correlation of CT patterns with histology can improve diagnostic assessment and contribute to earlier recognition of aggressive tumor behavior. A retrospective study was conducted on 33 patients (25 males, 8 females; mean age 67.3 years) with histologically confirmed primary lung cancer. Demographic factors, smoking history, histological subtype, and CT characteristics—including lesion size, lobar and segmental distribution, necrosis, and metastatic spread—were analyzed. Radiological staging was performed according to the TNM system, and findings were correlated with histopathology. Results: Histology: Adenocarcinoma was the most frequent subtype (51.5%), followed by squamous cell carcinoma (27.3%), with fewer cases of large cell, small cell, mixed, and plano-cellular carcinomas. Adenocarcinoma predominated in both smokers and non-smokers, whereas squamous carcinoma was more frequent among smokers. Tumor size and location: Mean lesion diameter was 5.9 cm (range: 1.5–13 cm). The most common sites were the right lower lobe (33.3%) and right upper lobe (30.3%), particularly in posterior basal and posterior segments. Necrosis: Present in 54.5% of tumors, necrosis was more frequent in squamous carcinomas (44.4%) compared with adenocarcinomas (33.3%), while adenocarcinomas were more often necrosis-free (75%). Metastases: Distant spread occurred in 27.3% of patients, predominantly to adrenal glands (44.4%) and brain (22.2%), with additional involvement of liver (11.1%) and lymph nodes/contralateral lung (55.6%). Adenocarcinoma accounted for two-thirds of metastatic cases. Staging: Advanced disease predominated, with stage IIIB (27.3%) and stage IVA (18.2%) most frequent. Only 24.2% of patients were diagnosed at early operable stages (IA–IIB). CT–pathology correlation demonstrated that adenocarcinoma is the predominant subtype across smoking categories, whereas squamous carcinoma more frequently exhibited necrosis. Most patients presented with large tumors and advanced disease, with metastases reflecting typical spread patterns. These findings underscore the diagnostic value of CT in characterizing histological subtypes, staging, and guiding clinical management, while reinforcing the need for earlier detection and screening strategies.
ARTIFICIAL INTELLIGENCE IN DRUG DEVELOPMENT: CURRENT APPLICATIONS, CHALLENGES AND FUTURE PERSPECTIVES
Drug development is a complex, time-consuming, and costly process, with average timelines exceeding a decade and success rates remaining low. Artificial intelligence (AI) has emerged as a transformative tool with the potential to accelerate and optimize every stage of the drug development pipeline. By leveraging vast biomedical datasets, advanced algorithms, and computational power, AI can support target identification, predict molecular properties, design novel compounds, and optimize clinical trial processes. Recent advances in machine learning, deep learning, and natural language processing have demonstrated the ability to uncover patterns and relationships beyond the reach of conventional approaches. AI-driven platforms have already contributed to the discovery of promising therapeutic candidates and facilitated more efficient decision-making. Despite significant progress, challenges remain in data quality, model interpretability, regulatory acceptance, and ethical considerations. This review provides a comprehensive overview of AI methodologies applied to drug discovery and development, highlights notable case studies from academia and industry, and critically examines both the opportunities and limitations of these technologies. We also explore future directions, including integration with complementary technologies, collaborative data sharing models, and evolving regulatory frameworks. By evaluating the current state and potential of AI in pharmaceutical research, this article aims to provide scientists, clinicians, and policymakers with a clear understanding of how AI can be harnessed to transform the drug development landscape.
ANTI-XA ACTIVITY IN CHILDREN ON TREATMENT AND PROPHYLAXIS WITH LOW MOLECULAR WEIGHT HEPARIN
In recent years, the use of low molecular weight heparins (LMWHs) for the prevention and treatment of thrombosis in children has increased. This is due to the increased percentage of critically ill children and the rate of thrombotic events. The efficacy and dose-dependent laboratory and clinical response data to achieve target levels in treatment and prophylaxis with LMWH have not yet been clarified. According to recommendations from leading experts in the field, monitoring of anti-Xa activity is mandatory in children receiving LMWH. However, there are still many questions about the most appropriate dose and time to achieve target anti-Xa levels. Objective: To investigate and monitor anti-Xa activity in pediatric patients of different age groups undergoing prophylaxis or treatment with LMWH. Material and Methods: We studied 22 children (mean age of 11.77±1.6 years) with malignant diseases, ischemic stroke, cerebral venous sinus thrombosis, deep vein thrombosis (DVT) and multisystem inflammatory syndrome. 41% (n=9) of the children were on treatment with LMWH and 59% (n=13) on prophylaxis, with the dose adjusted for age and weight. Plasma levels of anti-Xa activity were determined by chromogenic anti-Xa assay on a Sysmex CS 2500 coagulation system, using LMWH-specific calibrators and controls. Screening coagulation tests were also performed. Results: In 30.7% (n=4) of the children on prophylaxis, plasma levels of anti-Xa activity were lower than the recommended prophylactic range and in 55.5% (n=5) of the children on treatment, anti-Xa levels were below the therapeutic range. Conclusion: Our findings support current clinical recommendations that emphasize personalized dose adjustment guided by serial anti-Xa measurements. Active and dynamic monitoring of plasma levels of anti-Xa activity in pediatric patients on treatment and prophylaxis with LMWH is essential for optimizing the efficacy of anticoagulant therapy while minimizing its adverse effects.
COMPARISON OF THE EFFECTS OF TWO PHYSIOTHERAPY APPROACHES IN THE TREATMENT OF CERVICO-THORACIC SYNDROME
Cervico-thoracic syndrome is extremely common in modern life, which motivated us to investigate it - specifically in the cervico-thoracic region. This condition is characterized by impaired posture, often resulting in pain, which is the most frequent complaint among affected individuals. Objective: The aim of this study was to examine and compare the effects of selected physiotherapeutic interventions in the treatment of cervico-thoracic syndrome. Materials and Methods: The study included 24 patients experiencing cervical pain accompanied by motor deficits and postural disturbances. Participants were divided into two groups: Group A (control) and Group B (experimental). Both groups underwent a physiotherapy program consisting of 10 sessions over 15 days. Group A (Control): Ultrasound therapy applied to the cervico-thoracic junction, medical massage of the cervico-thoracic region, post-isometric relaxation, and kinesitherapy. Group B (Experimental): Techniques for soft tissue mobilization in the form of manipulative massage, positional release techniques, and kinesitherapy. To assess treatment effectiveness, measurements were taken before and after therapy, including subjective pain assessment (VAS), Cervical mobility palpatory evaluation of muscle tone. Results: Both therapeutic approaches demonstrated positive effects on patients’ conditions, with slightly better outcomes observed in the experimental group. Differences were noted across all measured parameters. Conclusion: The application of soft tissue manipulation techniques combined with kinesitherapy has a beneficial effect on pain reduction, correction of muscle imbalance, and improvement of movement range and control. Restoration of normal function begins with pain control, which enables better and more accurate proprioception. These findings are consistent with previous research.
INFLUENCE OF NUTRITIONAL FACTORS ON LIPID PROFILE AND LEVELS OF MAGNESIUM, COPPER, ZINC, SELENIUM AND RUBIDIUM
Background: Nutrition has been shown to significantly influence the biomarkers of both the multielement status and the lipid profile. However, there are some specific local environmental and genetic factors, that define the substantial variability of their levels in different populations. Several large studies in the last decade report that Bulgaria is among the first countries in the European Union in terms of premature death from cardiovascular diseases under the age of 65. This emphasizes the importance of the recommended annual screening of the lipid profile by adults. The essential role of the elements copper (Cu), zinc (Zn), selenium (Se), rubidium (Rb) and magnesium (Mg) for the antioxidant and immune defense of the body has been a subject of scientific interest in the last thirty years. However, there is scarce data on the influence of nutrition habits of Bulgarians on the serum levels of Mg, Cu, Zn, Se, and Rb. Aim: To determine the serum levels of Mg, Cu, Zn, Se, Rb, total cholesterol, LDL-, HDL-cholesterol, and triglycerides, and evaluate their relationship with nutrition. Methodology: A group of 107 directly selected healthy volunteers of Bulgarian nationality (50 males and 57 females, aged 18 to 65 years) were included in the study. Exclusion criteria were acute or chronic diseases, and intake of dietary supplements containing Se, Zn, Cu, Rb and Mg in the last 6 months. Venous blood serum levels of Cu, Zn, Se, Rb, and Mg were determined via collision cell inductively coupled plasma mass spectrometry (ICP-MS). Enzymatic methods were used to measure total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides. Results: In participants consuming fish less than once a week, we measured significantly lower Se levels (р < 0.0001) and lower LDL-cholesterol (p = 0.038). Significantly higher total cholesterol levels were found in the group consuming meat less than twice a week (p = 0.038). We observed suboptimal Se levels (less than 80 μg/L) in 42% of the participants. Dyslipidemia was found in more than 50% of the total group: total cholesterol > 5.2 mmol/L, 50.5%; LDL-cholesterol > 2.6 mmol/L, 74.8%; HDL-cholesterol < 1.68 mmol/L for women, and < 1.45 mmol/L for men, 49.5%. Conclusion: The established suboptimal serum levels of Se and lipid profile parameters in healthy individuals from the Bulgarian population emphasizes the importance of targeted monitoring of these laboratory indicators in patient groups at increased risk of cardiovascular and autoimmune diseases. Moreover, the influence of nutrition habits on multielement and lipid profile must be considered in assessing the need for lifestyle corrections, micro- and macronutrient supplementation in these pathological conditions.
nutrition, minerals; trace elements, lipid profile, atherosclerotic risk.
PROVING THROMBOPHILIA IN SYMPTOMS OF HYPERSPLENISM
Our interest in proving thrombophilia in symptoms of hypersplenism was sparked by a common and, at first glance, innocent clinical symptom - heaviness or pain in the left lower abdomen, in patients with anemia caused by iron deficiency or vitamin deficiency B12. We aimed to investigate some aspects of hypersplenism. Our task was to pay attention to how some, insignificant at first glance, clinical symptoms could hide the pathogenesis of tomophilias. For the realization of this task, we examined 130 patients, using their subjective complaints, supplemented them with abdominal ultrasound and laboratory blood analysis (PCK - WBC count; Er; Thr (thrombopenia; erythropenia; leukopenia;-pancytopenia), morphology of erythrocytes, morphology of platelets. Biochemistry - bilirubin - total and direct, iron, VLDL, VLDL, ferritin, vitаmin B12, etc. Coagulation - bleeding time). In the course of the study, we found that more than two-thirds of the patients with the diagnosed disease (97 people) complained of this type of heaviness or pain, which appeared very often after physical, and in some cases even after nervous- mental strain. Often, precisely these symptoms are the reason, if the patient comes to a competent doctor, to do the right tests, to make the correct diagnosis and to start adequate treatment. In the specific setting, we found that with adequate application of the substitution therapy and reaching the laboratory parameters characterizing the recovery, the pain and severity subside. Such symptoms, however, should always provoke the difficult and often very unpleasant diagnosis of thrombophilias in terms of differential diagnosis.
thrombophilia; hypersplenism; iron; ferritin; vit. B12.
QUALITY IN TERMS OF DENTAL HEALTH SERVICES
Providing quality medical and dental services has become a major task and priority of every health system. Dental medicine, as an integral part of primary and specialized medical care, in order to function properly requires clear and reliable indicators for assessing the dental care, which ensure that the dental services provided are timely, safe, effective and focused on the specific needs of the patient. In recent decades, there has been a significant increase in interest in measuring and assessing the quality of dental services and various research approaches have been used for this purpose. The most widely used quality assessment model is Donabedian’s invented in 1988, which categorizes the assessment indicators into three main groups: structure, process and outcome. Aim: The present study aims to present a systematic review of dental service quality indicators and to assess their applicability in clinical practice. Materials and methods: A systematic review of the scientific literature on the topic published in the period from 1980 to 2025 was conducted, including articles from the databases PubMed, Web of Science (WoS), Scopus, Wiley. Keywords which were used for the purposes of scientific research are: “oral health care quality”, “quality of dental services”, “dental quality indicators”, “Donabedian´s model”. Only publications with validated indicators for assessing the quality of dental services were included in the scientific study. Results: The results of the scientific study show that the most frequently used indicators are from the process group, which reflects the desire for traceability and control over daily clinical dental activity. Outcome indicators, such as the indicator of patient satisfaction with the provided dental care and Oral Health- related Quality of Life (OHRQoL), are described in the scientific literature as being more difficult to measure. Digitalization in dentistry creates the need to create new indicators, such as Dental Data Synthetic Index (DDSI), which assesses the level of digital awareness and maturity of a dental practice, in the context of providing quality dental care. Conclusion: In the sense of global efforts to improve patients’ dental health and optimize resources, the definition and implementation of standardized indicators for the quality of dental services is key to evaluating and improving dental practice.
oral health care quality, quality of dental services, dental quality indicators
PULMONARY REHABILITATION IN THE ELDERLY PATIENT
Ageing is a physiological process in which body deterioration is observed, which is associated with a variety of pathologies in different organs and systems, most often of the cardiovascular, respiratory and nervous systems. Degenerative joint diseases also become more frequent in elderly and old people. The chronic respiratory diseases are common in the elderly patient, and therefore the application of pulmonary rehabilitation is of utmost importance. It includes special breathing exercises and techniques that improve the function of the respiratory system, the general body condition and the quality of life of the elderly patient. The aim of the present review was to analyse the literature sources associated with the application and effects from pulmonary rehabilitation in elderly patients with chronic respiratory illnesses and following COVID-19. The research methodology includes a literature overview of scientific publications in the following databases: Research Gate, PubMed, Google Scholar. According to the reviewed scientific sources, the application of breathing exercises has a beneficial effect on respiratory function and the quality of life in elderly patients. The pulmonary rehabilitation is used in chronic diseases of the respiratory system and in patients recovering from COVID. It is applied in clinical, outpatient and sanatorium settings. The respiratory rehabilitation improves the lung vital capacity, respiratory volume and psycho-emotional tone of elderly patients.
chronic respiratory illnesses, pulmonary rehabilitation, elderly people, quality of life.
BOTTLED OR TAP WATER – THE CONSUMER’S CHOICE?
This study investigates consumer preferences between bottled and tap water, emphasizing health concerns, environmental awareness, and sociodemographic influences. An anonymous survey was conducted among 79 students and workers at the Medical University of Plovdiv, Bulgaria, between April and May 2025. The questionnaire included 40 questions regarding water consumption habits, health perceptions, environmental attitudes, and demographic data. Findings show that 55.7% of respondents consume bottled water daily, while 46.8% consume tap water. The preference for consuming mostly bottled water or the choice of tap water is related to the situation in which consumers find themselves. Although many prefer bottled water due to taste and safety concerns, 88.6% would drink tap water if properly filtered, and 77.2% would pay more for improved tap water quality. According to 74.7%, long-term consumption of water stored in plastic bottles poses serious health risks, and 82.3% would not reuse plastic water packaging. A large proportion (78.5%) support banning single-use plastic bottles, and 94.9% favor alternative packaging. Over 74% believe bottled water poses long-term health risks. Despite recognizing health and environmental risks, bottled water consumption remains high. Public education, programе development, improved infrastructure, and promotion of safe, filtered tap water are essential to shift consumer behavior toward sustainable choices.
bottled water, tap water, consumer behavior, environmental awareness, health risks.