Month: January 2025

Malina Vitkova is a senior midwife at the maternity ward of ‘Mama and I’. She has been a senior nurse at the maternity ward for 26 years. For her, every new birth is a blessing, every baby’s first cry is a satisfaction and the tears in the mother’s eyes are a reward. Today – 21 January – Midwifery Day we talk to her about her choice and dedication to the profession – midwife.

– When and why did you choose to be a midwife?

– From a very young age I always wanted to study medicine. The decision to dedicate myself to midwifery came spontaneously after the birth of my first daughter. At the most important and difficult time for me, I saw in my midwife support, protection and peace of mind. She was my inspiration and I realized that this was my calling.

– How does it feel to be part of the birth of a new life every day?

– Being a part of the birth of a new life is a privilege for me and the feeling is unique. Every baby born in my arms is a blessing. The moment I hear the cry of a new life, the exhaustion and stress disappear. I forget about problems, difficulties, worries. And the tears of joy in the mother’s eyes are the greatest reward. Each birth is different in its own way, so the work of the midwife is not patterned. It takes knowledge, skill, patience and love, every time! A midwife’s job is not just about giving birth. Caring for the mother is also very important, both during and after pregnancy. Today, pregnant and birthing women use many more and different sources of information than women did decades ago. They ask a lot of questions and expect us to have the right answers. Today the midwife must be a psychologist and a friend as well as a professional. She does not have “office hours”. She has to be constantly by the woman’s side, to gain her trust and respond to her needs. Also the routine of the profession must not dominate the purely human warmth and respect, for the people who have chosen our hospital for this so important and expected event.

– How do the teams at ‘Mama and I’ deal with the challenges and needs of today’s expectant parents?

– Expectant parents choose the maternity ward of ‘Mama and I’ with great expectations and hope. They are enchanted by the excellent facilities, the dedicated team of doctors and midwives and the opportunities we provide for young families – for example, both parents being together with their newborn from day one. Expectant mothers spend the hours leading up to meeting their newborn in a comfortable environment, as close to home as possible, with the support of their relative and discreet supervision from the team.

The maternity sector has rooms for natural or operative birth. There is also a choice of a private delivery room for normal birth, where the presence of an attendant during labour is also permitted.

In the postpartum sector of ‘Mama and I’ the stay after birth is organized – everything necessary for the mother and the newborn is provided. The teams of doctors and midwives work as one, the knowledge and skills provide security and adequate response, and can sometimes be life-saving.

To meet the needs of pregnant women, we have also formed a school for expectant parents, which is gaining in popularity. In it, we discuss with expectant parents various topics related to childbirth and child rearing in a relaxed and friendly environment. Along with the school, we also hold individual meetings with them on a daily basis so that they are relaxed and as prepared as possible in caring for their child after discharge from the ward. And we are with them at discharge – all babies leave here with a gift – an album capturing their first moments – first photo, first foot and hand print, first impressions.

– You have been elected by the Board of the Alliance of Bulgarian Obstetricians as the President of the structure in Pleven region. The city will host the Academy of Midwives in the autumn of 2025. What goals have you set yourself?

– What we have to develop in midwifery care is the so-called “home patronage” – the care of the mother and child in a home setting. This is a difficult time for the woman, when she feels confused and insecure and needs our care and advice.

– What is 21 January for you and what is your wish for the holiday?

– For me, and for all my colleagues, it is a very special day and I feel extremely proud. The midwifery profession is a destiny and a calling! I wish all my colleagues good health! May they work with love, heart and soul!

The German professor has patented his own method of hip arthroplasty

The first of its kind academy of orthopaedics is being established in the high-tech hospitals ‘Heart and Brain‘ in Pleven and Burgas – this was announced a few days ago by prof. In the last few days the head of the clinic of orthopaedics, Prof. Asparuh Asparuhov, was announced. The initiative is the result of the excellent cooperation of the specialists from ‘Heart and Brain‘ with world-renowned experts in the field of orthopaedic surgery such as prof. Heinz Röttinger , a pioneer in the field of minimally invasive hip and knee arthroplasty, and Dr. Steffen Haug, an international consultant in minimally invasive spinal surgery and degenerative spine pathology. They are joined by Prof. Dr. Nick Spindler from Germany, a leading specialist in plastic surgery for severe trauma cases, and Prof. Prof. Oliver Marin-Peña from Spain, Vice President of the European Hip Society.

The first major scientific forum organised by the academy will be in April on the topic of “Knee joint navigation prosthesis”. The event will bring together orthopaedists from all over the country in Pleven, with scientific sessions and surgeries broadcast in real time. By the end of the year, two more symposia are planned, related to revision of complications after hip prosthesis and shoulder prosthesis with the so-called Reverse Prosthesis.

“Our main goal is to train young doctors, not only from our hospitals but from all over the country. We start with minimally invasive surgery, arthroplasty and endoscopic surgery to get to revision arthroplasty with complications after infections,” said Prof. Asparuhov. “We have achieved a lot – we have built an outstanding team of professionals, we have high-tech equipment and we apply the most advanced world standards in the field of endoprosthetics and revision orthopaedic practice. It’s time to build on this – to implement more new world techniques,” adds Dr. Yordan Valeshkov.

“Our desire is to pass on our experience and knowledge to motivated young orthopedists in Pleven and Burgas. It is a pleasure for me to consult them during the surgeries and I am proud to be able to train the new Bulgarian medical generation”, says Prof. Roettinger and gives Dr. Georgi Dimitrov a friendly hug.

“Every month I am in Pleven to train young doctors specifically in the diagnosis and treatment of the degenerative spine and I meet with exceptional interest. This attitude inspires me. We are preparing a course for Bulgarian specialists in minimally invasive and plastic hand surgery at our clinic in Germany,” said Dr Haug.

The majority of men are ashamed to go to the examination

Prof. Anakievski is the head of the urology clinic at the high-tech hospital complexes Heart and Brain. He graduated from the Medical University – Varna in 2004. In the same year he started specialization in surgery and in 2013 he acquired a second specialty in urology. She defended her dissertation for the degree of Doctor of Medicine in 2015 on the topic “Evaluation and validation of some preoperative and postoperative prognostic models in prostate cancer”. In 2021, he defended the academic position of Professor of Urology. He is the main author and co-author of more than 200 scientific papers.

Is there a prevention of prostate cancer and what should young men do in an attempt to avoid the disease? From what age onwards and at what intervals should they see a urologist, and is there any prevention?

– Prostate cancer is the second most commonly diagnosed cancer in men, with an estimated 1.4 million diagnoses and 375,000 deaths worldwide in 2020. In Europe, it is the most commonly diagnosed cancer in men and the third most common cancer-related cause of death in men. It is a major health concern, particularly in developed countries, due to the higher proportion of older men in the general population and the potential risk of overtreatment after early diagnosis. Unfortunately, there is no prevention for RP. There is screening, which is still used in this country to detect new cases, but it is not sufficient on its own to diagnose prostate cancer, so it is not used in most countries around the world. There are three well-established risk factors for prostate cancer: increasing age, ethnicity and genetic predisposition.

There are a wide variety of exogenous factors (environmental factors) that we associate with the risk of developing prostate cancer or identify as etiologically important in the progression from latent (dormant) to clinical prostate cancer.

However, there are currently no known effective preventive dietary or pharmacological agents. However, it is important to mention a few risk factors for prostate cancer development that should be given special attention, which are: metabolic syndrome, obesity, smoking, excessive alcohol use, and intake of hormonal drugs. Family history (burden) and ethnicity are associated with an increased incidence of prostate cancer, suggesting a genetic predisposition. Generally, both the European and American Urological Associations have proposed recommendations for individualised early detection through early PSA (prostate-specific antigen) testing in men at increased risk of RP:

– Men over 50 years;
– men over 45 with a family history of RP;
– men of African descent over 45 years of age;
– men carrying breast cancer gene 2 (BRCA2) mutations after age 40 years.

A risk-adapted strategy (based on initial PSA level) has also been devised in recent years, with 2-year follow-up intervals for those initially at risk. These are men with a PSA level >1ng/ml at age 40 and men with a PSA level >2ng/ml at age 60.

What are the symptoms of prostate changes? How are they diagnosed? At what age do they most commonly occur?

– Localised prostate cancer is usually asymptomatic. Local progression can cause symptoms such as more frequent urination, night-time getting up, erectile dysfunction (ED), urinary retention (retention), pain on urination, blood in the urine (haematuria) or in the semen.

Prostate cancer is usually suspected based on high PSA levels and/or a positive rectal exam, and if there is a family history of a deceased with prostate cancer. The diagnosis of prostate cancer is most often based on a positive MRI, which is currently the standard and is analyzed as the initial test along with a positive rectal exam and high PSA levels. In addition to suggesting the presence of prostate cancer, imaging also allows for targeted biopsy (Fusion) of the prostate and provides information for staging the patient. As previously mentioned, age ranges from 45 to 70 years and depends on whether anyone in your family has a burden of prostate cancer.

How would you motivate men to see a doctor, what are your patients afraid of? At what stage of the disease do they come to you?

– We have noticed for years that the majority of patients are ashamed to visit a urologist – a sort of Bulgarian phenomenon. The other part are afraid of finding a malignant process, which would disturb their quality of life. I always tell men that it is better to detect a growth in time to treat it properly than to wait and live in ignorance. With the advancement of technology in medicine today, in most of the cases, we are able to cure the patient even though it is a malignancy. Unfortunately, about 30-40% of prostate cancer patients come in at an advanced stage and yet that does not mean they cannot be treated. Prostate cancer is a disease that allows for multimodal treatment, namely surgery, radiation and hormone therapy.

What is the treatment for prostate cancer detected at different stages?

– The gold standard treatment for localized prostate cancer is radical removal of the prostate, regardless of the method used – open, laparoscopic or robot-assisted surgery. The best functional results (preservation of continence and erectile function) are achieved with robot-assisted surgery. For advanced RP and local lymph node metastases without bone involvement, depending on the patient’s age and general status, robotic-assisted surgical treatment combined with subsequent radiotherapy and hormone therapy may be considered. Of course, there are other treatments for prostate cancer, such as radiotherapy with its variations.

What are the innovative and bloodless treatment methods for prostate cancer? What methods do you and your team use?

– At Heart and Brain hospitals in Pleven and Burgas we perform robot-assisted surgery for prostate cancer – we apply the most advanced approach, with the best results for the patient and minimal recovery time. I will not hide that we are currently a leading centre for robotic-assisted surgery for various urological diseases, including prostate cancer.