Summary The study is a statistical analysis of the dynamics and structure of forensic autopsies performed on dead bodies and body remains at University Hospital “Dr. Georgi Stranski” in Pleven. The study was based on forensic autopsy records database and forensic autopsy reports for the period 2009-2013. A total of 976 cases, including forensic autopsies, exhumations, examination of bone remains and inspection of dead bodies at the site of death (without following forensic autopsy), were analyzed. The studied data was coded and processed with Microsoft Excel software. A detailed data analysis of the number of autopsies, frequency of death by cause, distribution of death by gender, age, residence, place of death and its forensic category is presented. According to our results, the deaths due to diseases comprised 35% of all forensic autopsies. The most common cause of violent death was damage by mechanical factors (53%), followed by asphyxia (24.7%). The most common mechanical factor was vehicle crash trauma, followed by falling (22.5%). Accidents were the most common cause of death 62%, followed by suicides (31 %) and homicides 7%. Fifty-nine percent of the suicides were by hanging. The preliminary analyses of the studied data lead to several conclusions. The number of forensic autopsies was found to be progressively decreasing, but the road traffic death rate remained unchanged. Most of the forensic autopsies were performed in July. The highest death rates by age was observed in the age group between 51 and 60 years, with predominance of males over females (3.3 males: 1 females).

Introduction Cervical cancer ranks as the fourth leading cause of female cancer in Bulgaria. The objective of the study was to describe the current burden of cervical cancer in Bulgaria for a one-year period and prevention options. Methods In this retrospective epidemiological study, online database from National Statistical Institute-Sofia, National Center of Public Health and Analyses-Sofia, National Center of Infectious and Parasitic Diseases-Sofia for one year were analyzed. Annual data were presented in numbers and per 100 000 of population. Results A total of 15,759 women in Bulgaria were diagnosed with cervical cancer in 2018. Morbidity is 23.5 of 100 000 population. Mortality of malignancy of the cervix in 2018 per 100 000 populations was 8.4 among women. Differences of mortality have been recorded as per statistical regions. A low immunization range has been recorded of vaccine against human papilloma virus (HPV) -7.2% (girls 13 years of age) and 12.8% (girls 12 years of age) for first dose and 11.9% (girls 12 year of age) for second dose in 2019.Conclusions High morbidity and mortality from cervical cancer were registered in Bulgaria. The immunization coverage was low. The strategy for disease prevention through mandatory screening and mandatory immunizations needs to be rethought. Keywords Incidence, mortality, HPV, vaccine coverage. Introduction1According to the World Health Organization (WHO), cervical cancer is the fourth most frequent cancer in women with an estimated total 570 000 new cases in 2018 representing 6.6% of all female cancers. Approximately 90% of deaths from cervical cancer occurred in lowand middle-income countries.

Background The incidence and mortality rate of cervical cancer in Bulgaria are higher than in most European Union countries, with an upward trend in the last three decades. Bulgaria is one of the 98 countries that, since 2012, has implemented a nationally funded national program for the primary prevention of cervical cancer. The purpose of this study is to investigate how this program is implemented in Bulgaria and why it is ineffective in our country. Methods A documentary study and a direct individual survey were conducted among 161 GPs from the Pleven region. The questions concern the attitudes of GPs to carry out immunoprophylaxis and the causes of low coverage. Results The immunization coverage with a complete scheme of three intakes in 2013 was 23.83% and in 2014 - 19.6%. In 2015, it switched to a two-dose regimen and its scope dropped sharply below 10% in this and subsequent years. The survey found that 17% of GPs felt that vaccination was unnecessary. 26% have not immunized any of their patients and 32% have covered less than 10%. Only 22% of GPs report that they are actively seeking out patients. The main reasons for the low coverage that respondents include are: rejection by parents (74%) due to fear of complications (41%), do not believe in the benefit of the vaccine (19%), and consider the vaccines to be harmful (10%); poor awareness (43%); negative information on the Internet and media (38%). Conclusions It is too early to take into account the effect of Cervical Cancer Immunoprophylaxis, conducted in Bulgaria, but the low coverage of those subject is alarming. It is necessary to undertake active health education activities among the population and additional training of GPs. Key messages Bulgaria has introduced a national program for primary prevention of cervical cancer, funded by the country. There is a very low coverage of subordinates due to insufficient awareness of the population, negative attitudes and insufficient commitment of GPs to implement the program.

Background Metabolic syndrome (MetS), a risk factor for many vascular conditions, may be a prodromal manifestation of vascular cognitive impairment. Diagnosing early stages of cerebrovascular pathology can lead to prevention and delay of the progression of pathological conditions such as vascular cognitive impairment. Methods The objective of the study was to investigate new biomarkers for early diagnosis of MetS and cognitive decline as a follow-up. A cardiological, neuropsychological and neurological study was conducted among 75 Bulgarian participants. Beta amyloid in the blood, procalcitonin (PCT), NT-proBNP as predictors of cognitive impairment in patients with metabolic syndrome were identified. Clinical, anthropometric, biochemical, neuropsychological, cognitive and statistical data processing. Plasma amyloid beta (Aβ) levels, procalcitonin, NT-proBNP in MetS were investigated in participants with MetS and in group of healthy people. Results In the present study, plasma levels of Aβ42 and Aβ40 were found to be reduced in MetS participants. Procalcitonin concentration was significantly higher in males than in females. NT-proBNP was significantly higher in females than in males (p < 0.001). Regression analysis showed a positive relationship between NT-proBNP and systolic blood pressure (p < 0.001) and fasting blood glucose (p < 0.05). An inverse relation between NT-proBNP and diastolic blood pressure, waist circumference, triglycerides, HDL- and LDL cholesterol was found. Conclusions There was a positive association between PCT levels, decreased levels of Aβ42 and Aβ40, as well as elevated NT-proBNP and cognitive impairment in people with MetC. A concentration of NT-proBNP of 60 pg / ml or greater could be an indicator of metabolic abnormalities and early cognitive decline. Key messages Metabolic syndrome may be a prodromal manifestation of vascular cognitive impairment. The use of new biomarkers for diagnosis can lead to preventing and slowing the progression of complications associated with MetS.