Why, Mr Prime Minister, are you humiliating SANS and the prosecutor’s office and occupying them with tasks that are not theirs? This is how you discredit the state regulators, the Ministry of Health, the National Health Insurance Fund, the Ministry of Health and all the ministries, departments and agencies that have perfectly coordinated the regular Decision 318 of the Council of Ministers of 30 April. On top of that, you yourself have repeatedly admitted that it is legal, and now the SANS and the prosecutor’s office are looking for some crime in the regulators who have worked for 2 years to come to a reasoned proposal and the Council of Ministers to legally adopt the correct Decision 318.

For what reasons, Mr. Prime Minister, do you listen to various foundations and a public council to build a national children’s hospital by the state, which has built nothing, does not know how to build anything, and its “pundits” constantly refer to generally accepted “data and analysis” of a non-existent need for a new modern hospital in Sofia, which no one anywhere has acknowledged and accepted. Well, they are simply participating in the blockade of the right of choice of the metropolitans and the suppression of competition in quality that we, the law, Europe and the democratic world offer. At the same time, they are waiting for a funding bank to determine their bed requirements and paediatric care needs in the country – and the data is in the government statistics and information databases of the competent government bodies, regulators and legitimate professional organisations. All these pseudo-experts, without being physicians, pretend to be “experts”, pursue escapist and predatory interests and “sell” you shiny empty packages, while my colleague, Assoc. Prof. Svilen Todorov we treat and consult extremely severe cases and abnormalities – and that is why we are very indignant about this ongoing buffoonery!

You have not yet responded to the invitation to visit the state-of-the-art and newly-built ‘Mama and I’ maternal and child health clinic in Pleven, sent to you on May 4, 2024, and therefore we EXPECT you to receive us in the MC together with the Minister of Health and the Minister of Finance, as you receive the state paediatricians.

by Professor Yana Simova MD, Ph.D. – with over 500 publications in the world’s major scientific medical journals, Director of the Bulgarian Cardiac Institute

What “facts” […] “came out in the public”, Mr. Prime Minister, “that we had no way of knowing about and we immediately reacted to!”. How do these “facts” and “suspicions” of yours of May 6th threaten national security so much that you will activate the SANS and the prosecutor’s office?

In all my conscious life I have adored the medicine of evidence and justice, and the administration of justice by evidence. You single-handedly, without a gram of justification, tried to overturn on May 1st the decision No 318 of 30 April to authorise the new state-of-the-art multi-profile hospital “Mama and I” in Sofia, which you yourself acknowledged, repeatedly then and afterwards, to be perfectly lawful – by issuing the NULL AND VOID Decision No 319. No judgement or judgement by default was made on May 1, 2024 at 10:35 p.m.! This sets a unique and even shameful precedent in healthcare administration and government!

Instead of congratulating and even rewarding Dr. Kondeva, Dr. Penkov, Mrs. Dineva, Prof. Kolarov, Dr. Dobreva and all the qualified officials and medical specialists in the Ministry of Health who have worked on the file for two years, coordinated without objection by all departments, agencies and services in the executive branch, you now call SANS and the prosecutor’s office to investigate “suspicions” and “facts” known only to you. It would be better to spare the long and costly trials for the responsibility of the state in Sofia and abroad by simply acknowledging the NULL AND VOID Decision No 319 of 1 May this year.

When you accept the invitation of the experts of the first, in the last five decades, newly built clinic for maternal and children’s health “Mama and I” to visit us in Pleven, we will have the opportunity to discuss your “facts” and “suspicions” and even more important – we will draw the real ways to accelerate the development of Bulgarian healthcare. Well, we will also save the working time of the SANS agents who, like the majority of the Bulgarian people, fail to get their regular health check-ups.

by Dr. Velimir Simov, pediatrician, and all the doctors and medical specialists at the clinic for maternal and children’s health ‘Mama and I’ in Pleven

On May 1, President Rumen Radev launched a campaign against the decision of Council of Ministers No. 318 of April 30, which authorizes a new modern multi-profile hospital ‘Mama
and I’ in Sofia, and on May 6 he explained to all media „… there is room for private initiative in healthcare in Bulgaria, but especially children’s healthcare should be a national priority and here the state should stand its ground, and there is a delay of so many years in building a national children’s hospital…“.

Questions:
How exactly is the ‘Mama and I’ project in Sofia preventing the state from standing its ground?

Obviously not with the envisaged 40 pediatric beds, which the investor was ready to give up; is there something else?

Is there state protectionism in Sofia healthcare and a blockade of patient access to quality competition; where does the VP’s husband work and what is his salary?

Do you believe that we physicians, and pediatricians in particular, are serfs and can be feudalized into someone else’s public or private healthcare estate?

Notwithstanding the fact that you, Mr. President, have issued the decree appointing Prime Minister Glavchev and his government, should you not strictly observe the fundamental
constitutional principle of separation of powers and not interfere in the work of the executive branch with instructional calls to overrule lawful and correct decisions?

Do you think that by blocking Sofia patients and preventing the entry of competition on European and American quality of practiced medicine, the 50 percent empty and
unattractive beds in the capital will be filled, or the severe deficit of pediatricians and nurses will be overcome?

Do you believe that PM Glavchev can legally overrule a legitimate decision of the Council of Ministers because of “doubts” and unsettled “facts”?

Why have you never taken it upon yourself to block many hundreds of new hospital beds and activities in Sofia licensed by your caretaker and regular governments until now?

Can a blockade of quality competition address the demographic crisis or stop patients and families continuing to pour their last savings into private hospitals abroad?

We have already invited Prime Minister Glavchev, and today, most cordially, kindly and openly, on the Day of Bravery and the Great Bulgarian Army, we invite you to visit us in
Pleven where we treat the most severe cases of sick children from all over Bulgaria – to see that the European level of healthcare is possible in the Motherland – because children are
the most precious thing!

“We dared to imagine, we did it ourselves and we found a brighter future for our children”, … “We are the first newly built clinic for maternal and children’s health in Bulgaria in the
last 50 years, which opened its doors on June 1, 2023 and achieves high results”.

By Prof. Dr. Yana Simova, Ph. 
Director of the Bulgarian Cardiology Institute,
with over 400 scientific publications in the world’s leading journals

“My main professional and research passion is advanced medicine and leading-edge medical science. The management of a large research organization and the multifaceted methodical leadership of the newest and most modern hospitals inevitably led me to conceptual analyses in health care policy in our country, Europe and developed democratic countries.

Why have all those in the MoH and National Assembly who are against the licensing of ‘Heart and Brain’ Sofia failed and will fail in their political careers?

Because they cannot answer the question of how this new hospital, which practices medicine and research at the European and American level, will infringe on the right of choice guaranteed in the law and on the interests of the people of Sofia, who have one of the lowest levels of satisfaction with medical care in the country and in the European Union. The primitive populism that has been exercised over the last four years, in all its forms, including through parliamentary scrutiny, has a serious conflict with itself. Populism does not have the dignity to acknowledge the simple truth that the private initiative is competent, takes on the worst pathology in hospitals outside Sofia, operates state-of-the-art 24 hours a day and 7 days a week, and has remarkably good social outcomes for all – from low in-hospital mortality and high industrial productivity to record GDP and unprecedented tax collection. […]

People from home and abroad now choose to be treated here, says the manager of the high-tech ‘Heart and Brain’ clinic

Two positive news on the eve of the professional holiday of doctors April 7, told Darik Dr. Lidiya Stefanova, manager of the hospital ‘Heart and Brain’ Burgas and chairman of the Health Committee in the local parliament.

For the first time we are witnessing a reverse migration – not outside, but to Burgas. Patients choose to be treated here, coming from different regions of the country, and also Bulgarians living abroad. Most often they are from Romania, Turkey, Great Britain.

“These are people who have researched very well where they can get quality treatment without it costing them a huge amount,” says the cardiologist. On the other hand, more and more doctors are heading to Southeast Bulgaria’s largest city for professional development, training and permanent settlement.

She says the city’s greatest achievements can be noted in healthcare because of the quality of hospital care. “With the investments attracted in this area, projects are being implemented that have put Burgas on the health map of Bulgaria. There is a new trend – the so-called medical tourism, which until recently took Bulgarians to Turkey, but now is in the direction of Burgas and Pleven”.

The head of the region’s high-tech hospital believes that the doctor-patient relationship has been restored, and that it is closely linked to the attitude of specialists towards those they treat.

You can find the full interview here in Bulgarian.

Why did a national specialist choose to apply electrophysiology and cardiac pacing in Burgas?

On the eve of the professional holiday of doctors – April 7, here is what the leading specialist told Darik:

Dr. Protich, what are the new methods to protect the heart from developing heart failure?

Apart from drug therapy /with a group of glyphlosins/, which in the last ten years have started to gain more and more popularity and become part of our recommendations in the treatment of diseases such as hypertension, heart failure and diabetes, in my specialty this is done by implanting special pacemakers that aim to improve the pumping function of the heart, thus fighting the manifestations of heart failure and significantly improving the quality of life of our patients. Of course, this treatment is not applicable to all patients. And our goal is to select those of them we can help. We should not fool people into thinking that this is the only way to treat and it is not a stand-alone treatment, but is also associated with medical treatment.

The full article is available here in Bulgarian.

Interview with prof. Ivan Dimitrov – Head of the Clinic for Nervous Diseases at ‘Heart and Brain’ Burgas on the occasion of World Parkinson’s Day

Every year on 11 April we celebrate World Parkinson’s Day. What is this disease?

Parkinson’s disease is a progressive degenerative disease of the nervous system that is most commonly diagnosed in patients between 55-60 years of age. Both sexes are affected, with a slight male predominance. It is estimated that there are about 12 000 patients in Bulgaria. Although at first sight such a number of patients does not seem too large, the disease cannot actually be described as rare. The celebration of the World Day is a good occasion to give publicity to the possibilities of diagnosis and treatment of the disease.

What are the manifestations of the disease and the complaints that point to this diagnosis?

Unfortunately, at the beginning the disease develops asymptomatically. There is a period with non-specific complaints when it is difficult to make the diagnosis. Among the typical symptoms that appear later are slow movements, stiffness of the body and limbs and trembling (tremor). It is the tremor that most often impresses the patient and his relatives. It is important to stress, however, that not every tremor is a manifestation of Parkinson’s disease. For example, essential tremor disease is much more common.

 Are specialist tests needed to make the diagnosis?

A neurological examination is particularly important. A medication test is also done. Of course, the diagnostic process also includes some apparatus tests – a tremorogram, brain imaging. In any case, the diagnosis should be made by a specialist neurologist.

 And what is the treatment, can the development of the disease be stopped?

There are different types of treatment depending on the stage of the disease. In the early stages, after the diagnosis is made, treatment with medication is initiated, the appropriate ones being selected according to the specific clinical case. Some of these have neuroprotective effects and are thought to be able to slow the progression of the disease. In late Parkinson’s disease, when various complications occur, other therapeutic methods are also applied. These are the introduction of special medications via portable pumps or deep brain stimulation.

What options for diagnosis and treatment of Parkinson’s disease does the Heart and Brain Hospital in Burgas provide?

The Clinic of Nervous Diseases at ‘Heart and Brain’ Burgas works actively with patients with Parkinson’s disease, as well as with those in whom the diagnosis has not been made and should be confirmed. The hospital has a contract with the National Health Insurance Fund to work on clinical pathways covering Parkinson’s disease, essential tremor and other diseases associated with similar symptomatology. We have equipment for neurophysiological and imaging diagnostics, as well as a transcranial magnetic stimulator, treatments with which can relieve some of the patients’ symptoms.

In the past year 2023, 1494 hip and knee alloplasties were performed in the high-tech hospital complexes ‘Heart and Brain’ in Pleven and Burgas. This puts them in first place in endoprosthetics. The NHIF data show an overall increase in orthopaedic surgeries in the country, with the number approaching pre-pandemic levels.

The orthopaedics and traumatology teams at ‘Heart and Brain’ work to the most advanced global standards in the field of major joint arthroplasty (hip, knee, shoulder), applying the methods of minimally invasive primary and revision arthroplasty. It is thanks to their high level of expertise that they have traditionally collaborated with leading European specialists in the field and have received high praise from the thousands of patients who have undergone them. “Our designation as the main centre for revision arthroplasty in the country is a high recognition,” says the head of the clinic in Pleven, prof. Asparuh Asparuhov. “The constant upgrading of the knowledge and skills of our doctors, the respect for each patient and the good cooperation with the rehabilitation teams create all the prerequisites for long-term preservation of our position as one of the leading orthopaedic centres in the country.”

A conversation with Dr. Valentin Krastev about this urgent and life-threatening condition

Dr Krastev, what is pulmonary thromboembolism and why is it so important?
– In fact, pulmonary thromboembolism and deep vein thrombosis alone or together represent the third most common cardiovascular disease after ischemic heart disease and stroke. The two, united in venous thromboembolism, are often a transition from thrombosis/thrombophlebitis/ of the peripheral veins, most commonly of the legs, in which clots break off from the veins and go to the pulmonary artery. The significance is justified by the fact that it is common, rarely diagnosed and mortality in severe forms is as high as 50%. In survival, an accurate diagnosis is made in only 7% of cases.

Who are the most vulnerable groups to this disease?
– First of all, we should mention that in almost all cases the thrombus comes into the lungs from somewhere. Therefore, all conditions that imply immobility or increased clotting favour the formation of thrombi in the pelvic veins or veins of the lower limbs, and these are immobility, operations, recent hospital stay, pregnancy, malignancy, prolonged travel and genetically determined changes in clotting factors. It is also more commonly seen in women, and the likelihood increases manifold with age.

What are the most common symptoms?
– The severity of symptoms is determined by the size of the thrombus and the condition of the heart and lungs before the embolism occurs. In the most severe, there may be loss of consciousness, a drop in blood pressure or sudden severe shortness of breath. In the milder forms unexplained onset of easy fatigue, breathlessness on ordinary exertion, quickening of the pulse, etc.

How is the treatment you apply different from the standard one?
– For low-risk pulmonary embolisms, treatment is with anticoagulants and there is nothing new to offer at this stage. For high and moderate risk emboli, where the signs of heart burden are also present, we have 2 approaches. In the first, we have recently deployed equipment equipped with a system to suction the thrombi out of the pulmonary arteries via a special catheter connected to a negative pressure line. This makes it possible to remove a large part of the thrombus that is in the pulmonary artery and thus improve the patient’s chances of successfully getting through the critical condition. The second approach is by inserting catheters with side holes through the thrombi and incorporating a medication that melts them called a thrombolytic. This lasts for 24 hours and allows for a much better outcome at a much lower dose of thrombolytic – hence a much lower risk of complications as opposed to the widely used and unscientific method of a single injection of this medication into the pulmonary artery.

Have you already had positive results from the application of this clot suction system?
– In just one week we used it in two patients despite the fact that the cost is very high and not covered by the Health Insurance Fund. One case was particularly interesting as it was a very young man with a pulmonary embolism and a vein thrombus on one leg and with a blockage in the abdomen where the veins from both legs join. We treated the pulmonary embolism with a catheter and a thrombolytic, and unblocked the blocked vein with the new suction and stent system, which allows a full recovery for a man with the very important profession of being an aviator. In addition, I should note that we treat pulmonary embolism as a level of urgency as acute myocardial infarction, i.e. we are on call 24/7.

A high-tech pacemaker has been implanted in a 95-year-old woman who was admitted to the Cardiology Clinic of Heart and Brain Center of Clinical Excellence on an emergency basis with a very slow heart rhythm. The official records show that this is the oldest patient in Bulgaria to have such a device implanted.

On admission to the clinic, the patient was taken over by Dr Nikolay Petrov. After investigations, he and his colleagues found that the woman was suffering from heart failure and had severely reduced heart pump function. Despite her advanced age and high-risk profile for complications, the team did not hesitate and made the decision to place a complex resynchronizing pacemaker.

“There was the option of implanting a standard pacemaker, but due to the risk of worsening heart failure in the future, my colleagues and I undertook the more technically complex procedure. The high-tech pacemaker not only stabilizes the heart rhythm but also treats heart failure. It is one of the few devices that reduces symptoms and prolongs the life of heart failure patients,” said Dr Petrov.

The entire procedure took 90 minutes and went without complications. The very next day, the 95-year-old patient left the clinic in good health. At the first follow-up examination, she said she felt an extraordinary improvement in her general condition.

“Age is no vice, but a privilege and regardless of the age of the patients, they should receive the best and most modern medical care”, the specialists from ‘Heart and Brain’ Pleven are adamant.