Month: April 2025

Dr. Svetla Gecheva, leading clinical immunologist at Heart and Brain in Pleven and Burgas

• April 29 marks World Immunology Day, celebrating one of the most dynamically developing modern sciences. Immunology Day was first celebrated in Europe in 2005. Since 2007, this event has also been celebrated by the global immunology community.
• Immunologists around the world come together to present the achievements in clinical immunology to the public, its importance for the development of medicine and biology in the diagnosis and treatment of a number of diseases involving immune mechanisms – infections, immune deficiencies, tumors, autoimmune diseases, allergies, transplant and reproductive disorders.

– Dr. Gecheva, what is the motto of this year’s World Day and what messages does it convey?

– In 2025, World Immunology Day will be celebrated under the motto: “Brain and Immunity: Immunological Insights into Neurological Disorders.” The theme carries a very important message – we cannot view the brain and the immune system as completely separate worlds. Neuroimmunology studies this interaction in various aspects, for example, how infections, autoimmune diseases, and inflammatory processes can affect brain function and lead to symptoms such as fatigue, depression, or cognitive impairment. We are seeing how more and more neurological conditions—such as multiple sclerosis, autoimmune encephalitis, depression, and even autism—are beginning to be better understood through the lens of immunological mechanisms.

In recent years, the role of immunology in the diagnosis, prognosis, and treatment of socially significant diseases such as Alzheimer’s and other forms of dementia has grown significantly. New research shows that the immune system and inflammatory processes in the brain play a key role in the development and progression of these diseases. The role of microglia in neuroinflammation has been assessed and new biomarkers have been introduced. Specific anti-inflammatory therapies against microglial activity are being developed, as well as therapies with antibodies against beta-amyloid and tau proteins. Some of these have already been approved in the US (e.g., Lecanemab and Aducanumab).

– Why is immunology considered the most dynamic science in recent years?

– Immunology has established itself as one of the most dynamic medical sciences because it is fundamental to understanding and treating some of the major health challenges we face today. In my practice as a clinical immunologist at Heart and Brain, I see how advances in immunology are literally changing everyday medical practice. Discoveries about the role of the immune system are not limited to infections or autoimmune diseases—it is also proving to be key in oncology, neurology, metabolic diseases, and even psychiatry.

In recent years, we have witnessed real breakthroughs: the creation of innovative vaccines in record time, the development of immunotherapies that give cancer patients a new chance, new biomarkers for diagnosis, and personalized approaches to treatment. The immune system is no longer seen as just a “shield against infection,” but as a complex, intelligent network that participates in almost every physiological process. This dynamic is the result not only of scientific progress, but also of technological advances—modern bioinformatics, genomics, and proteomics allow us to peer into the depths of the immune response in ways that seemed unimaginable until recently. In this sense, I can categorically state that immunology is the driving force behind modern medicine. It is not just developing rapidly—it is advancing science and changing the lives of our patients in real time.

How does the multidisciplinary approach you apply in your work at Heart and Brain in Pleven and Burgas benefit patients?

The immunology laboratory works closely with almost all clinical medical specialties, providing timely and reliable immunological diagnosis, modern immunotherapeutic approaches, preventive care, and expert advice on immune-mediated disorders. The laboratory offers testing for a wide range of autoantibodies associated with rheumatological, gastroenterological, and hematological diseases, as well as conditions associated with an increased risk of thrombosis. In collaboration with other highly specialized diagnostic laboratories—genetic, clinical, and pathological—we ensure a high standard of diagnosis, supporting the modern and personalized treatment of our patients. In the spirit of the motto: “Brain and Immunity,” I will be more specific about research related to diseases of the nervous system. Immunological tests in cerebrospinal fluid (CSF) are extremely important in neurology, especially in the diagnosis of inflammatory, autoimmune, infectious, and oncological diseases of the central nervous system. We have recently added a new biomarker to the working algorithm for cerebrospinal fluid testing: free light chains κ and λ. Measuring their concentration provides valuable information about the presence of an inflammatory process in the nervous system, which, as we have said, is extremely important for a number of diseases. The data from this new biomarker is a valuable tool in the diagnosis and prognosis of multiple sclerosis, contributing to earlier detection and more precise management of the disease, which is essential for improving the quality of life of patients.

The laboratory also tests a panel of onco-neurological antibodies used primarily to diagnose paraneoplastic neurological syndromes. These are neurological conditions that arise as an immune response to a tumor, but this response mistakenly attacks the nervous system. In the presence of onconeural antibodies without an established tumor, the most common suspected conditions are: lung cancer, breast cancer, testicular or ovarian tumors, lymphomas, and others.

Another additional biomarker related to neurology is currently being introduced – neurofilaments. These are structural proteins of axons that are released into the interstitial space and then pass into the cerebrospinal fluid and blood when neurons are damaged. It has been found that levels of NfL (especially neurofilament light chain – NfL) are elevated in multiple sclerosis, neurodegenerative diseases, and acute neurological events.

The full news article can be found here.

Three young doctors from the cardiology clinic at ‘Heart and Brain’ actively participated and performed brilliantly in the 11th edition of the Sofia Echocardiography Days on 11 and 12 April.

Dr. Martina Samardzhieva, leading specialist and head of the department, was the speaker at the event with a presentation on “Imaging methods for mitral valve assessment”. In front of more than 500 participants, she presented the main imaging modalities for mitral valve assessment – transthoracic and transesophageal 2D and 3D echocardiography, computed tomography and cardiac magnetic resonance imaging for a more detailed assessment.

Again this year, a doctor from the ‘Heart and Brain’ clinic received a prestigious award. Dr. Teodora Stamenova, a specialist in the clinic, took second place for best clinical case at the Candle light session. “The case she presented is extremely innovative and is yet another proof of the success of the multidisciplinary team of specialists – cardiologists, cardiac surgeons and imaging specialists at our high-tech center of excellence”, informed Dr. Samardzhieva.

The topic was “Transcatheter closure of interatrial communication. Better late than never”. “A 46-year-old female patient presented to our clinic with frequent episodes of palpitations, flushing in front of the eyes, dizziness, nausea, feeling of head warming and tingling in the occiput. During hospitalization, the patient was found to have a persistent patent foramen ovale (PFO). It is the most common anatomical cause of interatrial septal defect, occurring in one quarter of the population. It is usually asymptomatic but can cause paradoxical embolism manifesting as stroke, transient ischemic attacks(TIA) or peripheral ischemia.

After performing multiple additional diagnostic tests such as transthoracic echocardiography with bubble test, transesophageal echocardiography with bubble test, transcranial Doppler sonography with bubble test, RoPE score system calculated, the association between the findings was established and the likelihood of PFO being an etiological factor for transient ischemic attacks was verified.

During cardiac surgery team decided to correct the defect by occluder closure, a device to close interatrial defects. Two days after closure of the defect, the patient was dehospitalized in good general condition,” informed Dr. Teodora Stamenova.

Dr. Vladimira Pavlova-Popova also presented a clinical case of a patient with a rare disease – amyloidosis, referred and diagnosed in the cardiology clinic.

Every year on 7 April we celebrate World Health Day. This year, the World Health Organization is focusing on the theme “Healthy Beginnings, Hopeful Futures”, with an emphasis on maternal and newborn care. On this occasion, we talk to Dr. Andrey Hristov – head of the neonatology department at the newest specialized hospital for maternal and child health in the country – ‘Mama and I‘.

Dr. Hristov is a long-standing national consultant in neonatology for Central Northern Bulgaria, intensive care therapist with extensive clinical experience in the resuscitation and treatment of newborns, including extremely premature babies. He is board certified in abdominal and transfontal ultrasonography and has introduced a number of innovative approaches to neonatology in our country. He has taught postgraduate and undergraduate students and today leads a team that works with a cause and a vision for the future. On World Health Day, we talk to the neonatologist:

What have you achieved in less than two years at , Mama and I’ Hospital?

Since the opening of the hospital on 1 June 2023, 477 babies have been born with us. We are glad that we are a preferred choice not only for the residents of Pleven region, but also for expectant mothers from neighboring and even more distant regions. Women today are looking for a modern, safe and human environment where they feel supported.

Our neonatology department concentrates high-risk pregnancies because of its high competence. With us, patients bring nothing from home – only faith and a smile. The rest is our care.

What is the most complicated case you remember?

Challenges are a daily occurrence in our specialty. Recently, we were faced with a proven incurable disease – yet we worked with faith and never allowed the thought that we would not succeed. Parents often say, “As long as it’s in your hands, then it’s going to be okay,” which speaks volumes about the trust we have established for parents of children.

The biggest challenge in your job?

Most recently, we had to treat a 650-gram newborn who was in critical condition and had an acute vascular complication – a thromboembolism of an artery in the arm. Specifically, an acute arterial occlusion of an upper extremity.

Such cases are extremely rare worldwide. We immediately organized a multidisciplinary team, including vascular surgeons and specialists from other clinics. Dr. Samardzhiev, head of the vascular surgery department, and specialists from other clinics responded at the minute, and we discussed therapy options.

We had to apply a modified therapeutic approach, without established algorithms, and we succeeded – we saved the child’s arm. For our team, this was a real test and an important success. The graduate students saw a condition that they will likely not see the end of their careers.

Is there any truth in the statement about the increase of children with congenital malformations in Pleven?

Absolutely not. Since the opening of ‘Mama and I‘, the most severe cases from all over Northern Bulgaria and sometimes from other parts of the country have been concentrated here. This is not a sign of a local problem, but rather evidence of confidence in our capacity.

Colleagues know that this is the hospital for Bulgaria’s seriously ill children. They receive precise diagnosis and treatment here. The incredible range of solutions we have enables us to make an etiological and often genetic diagnosis for patients.

Our hospital has an extremely precise genetic laboratory. Medical genetic counseling, cytogenetic analysis, and DNA analysis of thousands of rare diseases and monogenic ones are performed. This is what brings parents to us – the opportunity for clarity and treatment.

What would you wish your colleagues on the occasion of the World Health Day?

I wish all my colleagues the chance to work in hospitals like ‘Heart and Brain’ and ‘Mama and I’ – modern, well equipped, with great respect for the teams and a vision for the future. I believe that more and more Bulgarian cities deserve such hospitals.