Varna Medical University Press: Journals
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Modern Nurses and Their Place in Somnology Practice
Get PDFSleep medicine is defined as one of the new directions of medical science. It offers opportunities for medical specialists to grow and develop by mastering modern methods for diagnosing and treating breathing disorders during sleep. Somnological practice emphasizes the nurse's role as an active team participant, with autonomous functions and responsibilities. Global organizations addressing sleep issues emphasize that effective somnological care is the result of interdisciplinary collaboration. Nurses, as full members of the somnology team, have their duties and responsibilities in the effective management of Obstructive Sleep Apnea (OSA). Nurses can apply innovative approaches and care models to enhance the quality of life for individuals with OSA. Qualified and trained nurses provide competent and professional care, which in turn leads to higher patient satisfaction. Modern models of care indicate that patients increasingly want to be involved in managing their own health. They are no longer passive recipients of medical services, but active participants in the team.Delivering high-quality services is a key responsibility of medical teams across all healthcare systems. Implementing differentiated nursing care models and fostering autonomy in decision-making are strong predictors of improved quality of life for individuals with OSA. Patient education is a key aspect of modern nursing and focuses on health promotion, disease prevention, and treatment. Targeted training on sleep disorders throughout somnological practice is a proven, effective model for enhancing the efficiency and quality of care. Nurses' participation in training programs, combined with knowledge of telemedicine and eHealth approaches, constitutes a successful strategy for achieving effective OSA management
Patient selection for general anesthesia treatment in dental practice
Get PDFGeneral anesthesia treatment in dental practice is an indispensable part of modern dentistry. It is a specific procedure that includes strict working protocols and a trained team of different specialists. General anesthesia is a controlled loss of consciousness, which allows operative interventions to be carried out under optimal clinical conditions. Performing various dental procedures under general anesthesia carries risks, especially in patients with chronic diseases. Optimized patient care requires preselection, thorough health assessment, selection of appropriate anesthetic agents, use of appropriate modern equipment, and a highly qualified anesthesia team
Comparative analysis between RME and Alt-RAMEC protocols in the treatment of class III patients. A literature review
Get PDFThe development of skeletal class III is often due to an underdeveloped maxilla in which case early treatment requires transverse expansion and protrusion of the maxilla. Two main protocols applied to achieve this goal are: conventional RME (rapid maxillary expansion) and the Alt-RAMEC protocol introduced in 2005 by Eric Liou.The aim of this literature review is to compare the effectiveness of these two techniques and to determine when the use of the Alt-RAMEC/FM protocol is more effective compared to conventional RME/FM.For the purpose of this study, a literature review was performed using PubMed and Google Scholar. A keyword-based search yielded 247 articles. Among these, only ten articles presented a comparative analysis of RME/FM and Alt-RAMEC/FM therapies in class III patients.Compared with conventional RME, the Alt-RAMEC protocol achieves greater effect on the sutures of the nasomaxillary complex without excessive maxillary expansion. This is of great benefit, especially in prepubertal patients in whom suture ossification is at a more advanced level. In cases without transversal discrepancies, it is possible to control the degree of maxillary expansion. The application of Alt-RAMEC and facemask resulted in a greater skeletal effect in the protrusion of the nasomaxillary complex compared to the standard protoco
Laryngeal mask ventilation during myringotomy
Get PDFIntroduction: Children account for approximately one-third of all patients undergoing ear, nose, and throat (ENT) surgery. The most common surgical procedures on the ear are those performed to treat otitis media and its complications.The Aim of the study is to determine and characterize the specifics and complications of laryngeal mask airway (LMA) use during myringotomy.Materials and methods: A 1-year prospective cohort study of 20 patients who underwent myringotomy in the Department of ENT Surgery; University Hospital “Queen Giovanna”- ISUL; Medical University – Sofia.Results and discussion: Mean age of the patients included in the study is 4.25 years. A predominance of female sex is observed: women – 60%, men – 40%. Most patients have low preoperative ASA grades. None of the patients suffered desaturation during the operation. LMA displacement and need for repositioning by the anesthesiologist was observed in 20% of the patients. In all patients ETCO2 values are in the normal range. Fifteen percent (15%) of the patients experienced postoperative nausea and vomiting (PONV). In none of the cases we observed aspiration under the LMA and laryngospasm.Conclusion: The results from the study showed that LMA can be successfully and safely used in patients during myringotomy
Secure and responsible training: the key role of cybersecurity in simulation-based medical education. Implementing a Zero Trust Architecture
Get PDFThis article examines the challenges and solutions related to enhancing cybersecurity in the use of medical simulators for training healthcare professionals. The focus is on the necessity of implementing modern security architectures, particularly Zero Trust Architecture (ZTA). The aim of this study is to develop a methodological protocol for applying ZTA in organizations that provide simulation-based healthcare training, in order to improve cybersecurity, resilience, system availability, and the protection of data processed during the educational process.Methodology: An interdisciplinary approach is adopted, integrating tools and principles from the fields of information security, IT system architectural design, medical education and bioethics, and cyber risk management. The proposed protocol draws on decades of practical experience in IT system architecture and public health expertise.Results: A five-phase Zero Trust protocol is encompassing: (1) asset and network architecture assessment; (2) definition of trust zones and access policies; (3) selection and implementation of appropriate technologies; (4) monitoring strategies and incident response planning; and (5) a deployment methodology focused on continuous improvement. A conceptual architectural model is also presented via a UML diagram, detailing key layers and interactions. The proposed protocol has been validated through theoretical methods, including expert evaluation, in-depth analysis of hypothetical scenarios (threat modeling), and the application of evaluation criteria such as resilience, controllability, and compliance with regulations (e.g., GDPR, HIPAA, NIS2). Additionally, a comparative analysis was conducted against leading industry standards (NIST Cybersecurity Framework, ISO/IEC 27001, CIS Controls), along with an impact assessment of security measures on the operational efficiency of the training process. The validation results confirm that the Zero Trust approach significantly enhances cybersecurity, providing more resilient and adaptive protection while minimizing negative impacts on performance and user experience.Conclusion: This study addresses a critical gap in the academic literature by offering a structured and applicable methodological framework for protecting critical educational infrastructures in the healthcare sector
The mystery of the missing space on the second basement level in the house of D. Kenkov in Varna: Facts and assumtions
Get PDFThis publication raises a yet unanswered question that emerged during the work of architects N. Stamatova and M. Hlebarova on the restoration of the most richly ornamented facade in the city of Varna. The house of the entrepreneur Dimitar Kenkov was built according to a project from 1912 by the great Bulgarian architect Nikola Lazarov. In parallel with the restoration of the facade, the design team conducted research on the interior spaces of the building, needed for the technical passport of the building. The 3D model of the building revealed unusual (hidden or illogical) spaces, as well as the absence of expected ones. The research poses a question related to the lack of such a space, expected according to Nikola Lazarov's original project, but not implemented in place or subsequently walled up. It is unclear whether the reasons were difficulties in carrying out excavation work related to archaeology near the antique fortification wall of Odessos (5th–6th century) or if it is associated with the change in the socioeconomic reality in Bulgaria after 1944. Further on-site research would be required to discuss this matter in depth. Upon completion of the restoration work on the facade, access to the interior spaces of the building was restricted for specialists
Rhinomanometry as an additional diagnostic method in cases of the Obstructive sleep apnea and snoring syndrome
Get PDFBackground:In recent decades, diagnostic methods in otorhinolaryngology and sleep medicine have been developing and improving at an extremely rapid pace. On a global scale, the problem of timely and correct diagnosis of the Syndrome of Obstructive Sleep Apnea and Snoring Syndrome (SOSAS) is relevant, since SOSAS affects the quality of life of patients. Nowadays, the most widely used method for diagnosing OSA is polysomnography. For even more precise diagnosis and timely correct treatment in patients with nasal obstruction and SOSAS, it is recommended to apply the methods of rhinomanometry.The aim of the following article is to research the role of rhinomanometry as an additional diagnostic method in cases of the Obstructive sleep apnea and snoring syndrome.Methods:In the period November 2023 – March 2025, a scientific study was conducted in the facility of the Medical University – Varna, in the Sector „Audiovestibular Medicine and Sleep Medicine”. The scientific study was approved by the Ethics Committee of the Medical University – Varna (No. 131 / 11.05.2023). A total of 70 participants took part in the scientific study, of which 50 were male and 20 were female, examined by the same ENT-specialist. All patients studied gave their voluntary written informed consent to participate in the scientific study. All participants included in the study underwent a complete otorhinolaryngological examination with devices (Interacoustics®, Dennmark), Home sleep apnea test (HSAT) (Weinmann® Somnocheck micro cardio) and rhinomanometry (Atmos® Rhino 31, Germany). For the purposes of the study, the anterior measurement methods were used when performing rhinomanometric examinations.Results and discussion:When conducting the rhinomanometric examination in all patients, the anterior measurement method was used. After relaxing for at least 20 minutes, in one nostril at a time, all patients were examined using the active anterior rhinometry method in a sitting position. After a complete otorhinolaryngological examination, only 20% of the participants (14 participants) were not diagnosed with any ENT-disease. Among the remaining, allergic rhinitis, chronic rhinogenic and odontogenic sinusitis, chronic pharyngitis were observed, and patients with more than one of the indicated diseases combined were described. The most frequently placed diagnosis was the chronic allergic rhinitis (more than 40% of the cases), often combined with nasal polyposis. SOSAS cases were diagnosed in 50 out of the 56 patients with an ENT-disorder. All patients with a SOSAS case were diagnosed with a nasal obstruction of a different degree. Authors re-tested the sleep quality and quantity of all SOSAS patients, after treating the nasal obstruction condition and found out that AHI tends to reduce. Symptoms of OSA were alleviated.Conclusions:It can be concluded that early detection of altered pressure, volumetric airflow and nasal resistance using rhinomanometry can prevent or delay the development of the syndrome of obstructive sleep apnea and snoring. The results of the scientific study show that rhinomanometry is an effective clinical diagnostic method for measuring, assessing and diagnosing nasal breathing. Timely diagnosis of SOSAS is the key to successful and correct treatment of patients and improving their quality of life. Treating the nasal obstruction alleviates the symptoms of OSA
A study of sleep patterns among nursing students
Get PDFSleep is a vital biological process essential for sustaining daily activities, significantly influencing health, productivity, and overall well-being.Aim: This study aims to examine the sleep patterns of nursing students.Materials and Methods: An anonymous electronic survey was conducted in April 2024 among 86 first-, second-, and third-year nursing students at MU-Varna.Results: Sleep is known to restore energy and influence brain function, which affects students’ engagement in the educational process and their performance during exam periods. About two-thirds of the participants reported sleeping between 5 and 7 hours per night, with consistent bedtimes and wake times. However, slightly more than a quarter of the students experience daily sleepiness. Good sleep was reported to positively affect their productivity, and nearly half of the respondents indicated that they sleep more on weekends. Approximately three-quarters of the students noted significant changes in their sleep patterns during exam periods. All respondents believed that their sleep quality would improve with a better sleep schedule and reduced stress levels.Conclusion: Sleep occupies one-third of the day, allowing the body to recover from accumulated stress. A lack of sleep adversely affects attention and decision-making, which are critical skills in the daily routines of nursing students
Prehospital management of cardiac arrest due to drowning
Get PDFIntroduction: Drowning represents respiratory impairment due to submersion or immersion in liquid, with hypoxemia due to fluid aspiration being the primary mechanism by which victims deteriorate into cardiac arrest. It is the third leading cause of unintentional injury death worldwide.Aim: This article aims to review recent evidence and provide practical guidance for lay rescuers, trained first aiders, and emergency medical personnel in managing cardiac arrest due to drowning in the prehospital setting.Materials and methods: A comprehensive literature review was conducted by analysing scientific research from evidence-based sources such as guidelines from the European Resuscitation Council, American Heart Association, Wilderness Medicine Society, point-of-care medical resource software UpToDate as well as journal articles and textbooks.Results: Based on the conducted literature review we suggest that to improve survival, drowning victims should be extricated from water within ten minutes. Once the victim is out of the water, all rescuers should assess the need for cardiopulmonary resuscitation and start it as soon as possible. In-water resuscitation should only be performed by highly trained rescuers. Automatic external defibrillators are safe and should be used in cardiac arrest due to drowning. Rescuers should initiate basic manoeuvres to limit heat loss and commence rewarming alongside cardiopulmonary resuscitation, especially in hypothermic casualties.Conclusion: Timely rescue and effective resuscitation by lay people and emergency medical personnel can significantly enhance the prognosis of drowning victims. The traditional Airway-Breathing-Circulation model of resuscitation should be employed when managing cardiac arrest due to drowning.