Varna Medical University Press: Journals
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Prevalence and Patterns of Malnutrition in Cerebral Palsy: A Comprehensive Narrative Review of Global Studies
Get PDFObjective: This narrative review aims to provide a comprehensive analysis of global studies on the prevalence and patterns of malnutrition in individuals with cerebral palsy (CP). By examining the available evidence, this review seeks to enhance our understanding of malnutrition in CP, identify research gaps, and propose directions for future research.Methods: A systematic search was conducted in PubMed, Scopus, Mendeley and Web of Science databases to identify relevant studies published between 2018 and February 2023. Studies reporting original observations in children and adolescents with CP, and measuring malnutrition through anthropometric measures, biochemical tests, or other nutritional factors, were included. The Systematic Review and Narrative Appraisal (SANRA) guidelines were followed during the review process.Results: A total of 28 studies met the inclusion criteria and were included in the review. The studies were conducted in more than 25 countries across all continents, providing a global perspective on malnutrition in CP. The prevalence of malnutrition varied across regions, with rates ranging from 15.4% to 92.6% for underweight, and 35% to 85.9% for stunting. Several factors, including motor impairment severity, feeding difficulties, and sociodemographic factors, were associated with malnutrition in CP. Micronutrient deficiencies, such as iron deficiency anemia, were also observed in some studies.Conclusion: This comprehensive narrative review highlights the significant prevalence of malnutrition in individuals with CP globally. The findings underscore the need for comprehensive nutritional assessments, tailored interventions, and close monitoring of nutritional status in clinical practice. By addressing malnutrition, healthcare professionals can improve the overall health, growth, and quality of life for individuals with CP. Further research is needed to explore the long-term trajectories of malnutrition in CP and to develop evidence-based interventions to mitigate its impact on this vulnerable population
Subependymal Gian Cell Astrocytoma in An Adult Without Tuberous Sclerosis Complex: A Neuropathologial Case Report of a Tumor Initially Misdiagnosed as Glioblastoma
Get PDFSubependymal giant cell astrocytomas (SEGA) are WHO CNS grade 1 tumors, predominantly diagnosed in the pediatric and young adult populations and almost always encountered in the context of the tuberous sclerosis complex (TSC). SEGAs develop from subependymal nodular (SEN), which are a component of TSC, while both have similar radiological and histological. Char-acteristically, SEN are small lesions that are growth stable and typically do not produce symptoms, while SEGAs are steadily growing lesions that produce compression-associated symptoms due to their periventricular location. Histologically, SEGAs present with pleomorphic, epitheloid-like, and giant multinucleated cells, with other glial phenotypes such as pyloid, histiocytic, and others also present. Tumors are sharply demarcated from the surrounding parenchyma and, other than the striking cellular appearance, may also show areas of palisading necrosis, making the histopathological diagnosis challenging. In cases of older patients or when a history of TSC is either not present or not known by the neuropathologist, the differential diagnosis can be quite challenging and includes a myriad of either lower-grade neuroglial tumors as well as high-grade astrocytic ones. Herein, we present a neuropathological case report of a 63-year-old female with no known TSC history and a CNS tumor with morpho-logical characteristics of SEGA
Customer experience aspects of Gen Z in tourism travels
Get PDFCustomer experience in tourism travels has become a vital element in the management approaches of private and public specialist organizations. In order to stay highly competitive on the marketplace, the contemporary tourism industry has to constantly find out ways to improve the quality of customer experience. A successful way in this direction is to obtain the most relevant knowledge about the customer and his / her experience characteristics. Therefore, the research goal of this study is to reveal the key customer attitudinal and perceptual experience characteristics of Generation Z while planning, consuming and post reflecting their tourist travels. The attitudinal features of cognitive, affective, and conative consumer behavior are researched in relation with the sensory aspects of the individual’s perceptions along with the standpoint of the company’s value proposition
Financial regulatory technologization in the context of Europe`s digital decade
Get PDFThe European Commission (EC) announced the Digital Decade as a vision for digital transformation of Europe by 2030 in four directions: skills, infrastructures, business, and government. Meanwhile, there is also an increasingly strong dependence of the financial sector on various technological innovations. Regulatory technologies in this regard play a key role in ensuring compliance with the ever-complex financial regulatory framework. The article analyzes the current state and prospects for the financial supervision system from the perspective of the European digital strategy. Emphasis is placed on the possibility of implementing smart technologies in the prevention of various financial violations and the formation of new levels of partnerships between financial institutions, regulators and RegTech firms as providers of regulatory expertise
Current threats and risks to health tourism in Bulgaria
Get PDFOver the last decade, modern society and various economic actors have faced risky instabilities, trials and challenges due to increasing globalization and the emergence of various global crises. Considering the last five years to date, management in the tourism sector is by no means immune from the unexpected threats, economic and health crises that continue to negatively impact all processes and future business development prospects. The need for the emergence of a new economic concept of risk and its management has been identified as urgent. The rapid development of tourism in the country and the absence of an adequate risk management strategy lead to the emergence of a number of undesirable consequences, aggravation of existing problems and generation of numerous adverse trends in the tourism and hotel industry in the country.The object of the study is health tourism in the hospitality industry in Bulgaria. The hotel product is complex, designed to satisfy the needs of guests. Composed of different elements, this paper focuses and analyses the complementary product, which with its service complements and enriches the final needs and satisfaction of the customer. Medical Spa Centres, as the subject of the study, are an example of a pulling force in the choice of a destination in health tourism. They improve economic growth, industry competitiveness and stimulate tourism consumption. The processes in the Medical Spa Centers are strongly influenced by the surrounding external and internal environment, working together under the wing of the hotel complex. Respectively, they increase the valuation of the economic entity, contribute to higher financial performance and at the same time satisfy various human needs of a health and wellness nature. The role and importance of Medical Spas has been proven in the development of the hotel product, therefore the need to implement strategic management approaches to address risk and unexpected threats should be analyzed.The methodology is based on a systematic approach and on different research methods, including: theory, publications, analysis and systematization. The empirical research was conducted through in-depth interview with managers of hotel complexes with Medical Spa centers to identify threats and risks typical for health tourism, and ways to overcome them in their organization with actual management measures. The last part of this paper analyzes the application of a model risk management system for a hotel tourism enterprise and the need to implement such a standard in our country
Public support for market risk management in Bulgarian agricultural holdings
Get PDFThe growing uncertainty of the external environment presents economic organizations in agriculture with new challenges for building sustainability. The purpose of this paper is to examine the potential of the public toolkit in Bulgaria to stimulate and demotivate market risk management in agricultural holdings. A set of indicators was synthesized to assess the potential of publicly funded instruments to impact farming strategies. Based on secondary data analysis, it is concluded that market risk management support is entirely designed to address the consequences of risk events and has a high potential to constrain producers' risk prevention and mitigation initiatives
Implementation of integrated software for management and optimization of warehouse operations in port terminals
Get PDFPort warehouses are an important operational element of supply chains. In most cases they are built in intermodal terminals, play important role in transport chains and significantly affect the service levels and the costs of the supply chain network. The functions of warehouses at port terminal are connected with reducing the downtime and time for load, discharge or transfer of cargoes to other means of transport, storage of various cargo for short and long period of time and dispatching them for further carriage by sea or inland.Automated warehouse operations eliminates the risk of errors during performing of manual operations, enables real- time process tracking and improves customer service. Information systems accomplish control, coordination and management of all warehouse activities. The paper analyze implementation of integrated software for warehouse management system in port terminals
Communication and information system support for the navy aspects
Get PDFNowadays improving the information environment is of growing importance not only for the Navy. It is well known that Communication and Information System is a crucial factor in effective command and control. That is why the progress in military communications is so important. In this article some current aspects of Bulgarian Naval Communication and Information System are overviewed
Determination of skeletal age by the Baccetti method in children aged 7–17 years
Get PDFIntroduction For the purposes of orthodontic treatment planning, skeletal age is determined on lateral teleradiography (TRG) by the morphological characteristics of the second, third, and fourth cervical vertebrae and is a valuable diagnostic tool for determining the beginning of orthodontic treatment.АimThe aim of the present study was to determine the skeletal age of children in different age groups of 7 to 17 years by the degree of maturity of the cervical spine.Materials and Methods On 320 digital TRGs, the skeletal age of children of 7–17 years was determined. They were divided into 11 age groups by the method of Baccetti et al.Results In boys, cervical maturity stages (CMS) I and II were observed in the majority of children up to 12 years of age. Cervical maturity stages III and IV that coincide with the peak of puberty were between the ages 13 and 14. In the group of 15-year-old CMS V dominated. Among 17-year-old boys, none had reached CMS VI. In girls, CMS I and II were observed in the majority of children up to 10 years of age and CMS III and IV—between the ages of 10 and 12. In the group of 13-year-olds CMS V dominated. Among 17-year-old girls, all examined had reached CMS VI.Conclusion In case the clinician does not have TRG, chronological age could be used to define the stage of growth and development. For Bulgarian children, the optimal age for orthopedic correction of the upper jaw is up to 11 years for girls and 13 years for boys, or CMS I–CMS II). The peak of mandibular growth, CMS III–CMS IV) is between 10 and 12 years for girls and 13 and 14 years. for boys
Change-supporting organizational structures: challenges and limitations
Get PDFIn the dynamic modern world, organizations are faced with the challenge of increasingly frequently undergoing changes as a response to the changed environment they operate in. The effectiveness of the undertaken changes, the time their implementation requires, and how easily they occur are strongly determined by organization design and, in particular, by organizational structure. Based on a review of findings by a number of researchers, consultants and practitioners, this paper outlines the dimensions of structuring which would enable organizations to incorporate change in their daily routine, to include it in their organizational mindset, and, in this way, to become continuously changing organizations instead of such that are required to undergo radical changes. The advantages and limitations of those structures that are considered to be change-supporting, are discussed. The conclusions can be of use to managers in revising the existing structures in their organizations and in choosing such ones which would facilitate the implementation of whatever changes are necessary and whenever they are necessary