Premature birth is a serious medical, social and economic problem. Its consequences are multiple health complications leading to high neonatal mortality worldwide. Respiratory insufficiency and surfactant deficiency significantly increase the risk of developing Hyaline Membrane Disease (HMD) and other forms of Respiratory Distress (RDS). These are the most common causes of death in premature babies. In prenatal and neonatal medicine, new and adaptive prophylaxis is being implemented to reduce the risk of death of premature babies and reduce the development of health complications. The goal of effective corticosteroid prophylaxis is to reduce mortality, reduce complications in prenatal new-borns, and shorten their stay in neonatal and intensive units respectively. A retrospective study of 167 preterm infants was conducted, of which 89 (53.3%) had prophylaxis with dexamethasone. In 25 (15%) of preterm infants, there was a Hyaline Membrane Disease (HMD) and 101 (60.5%) developed other forms of Respiratory Distress Syndrome (RDS). The results obtained show that the incidence of HMD in preterm infants is mediated by the early gestational age and advanced age of the mother, and decreased by corticosteroid therapy.

Introduction: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate. Aim: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome. Materials and methods: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021. Results: Seventeen of the patients were men and nine – women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77±12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice. Conclusions: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients.

Introduction: Premature birth is now one of the most profound prenatal problems worldwide because of the high morbidity and mor-tality it is associated with at the beginning of life. Advances in prenatal medicine over the past decades have led to a significant improve-ment of neonatal survival in risk groups of newborns. Infants of gestational age of 22-25 weeks represent the greatest medical, social, and ethical dilemma in neonatology. Most of these newborns need intensive care to survive, and most infants born between 28 and 32 weeks of gestation require special care. Those born 34 to 36 weeks’ gestation also have higher rates of short-term morbid premature birth-related conditions such as respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH) than their peers born at term. Aim: To carry out an analysis of morbidity during the neonatal period in premature babies. Materials and methods: A retrospective triennial study was conducted on 598 premature newborns. Results: The results of the study show that morbidity rate in premature born infants is high. The most frequent reasons for admission to the neonatal intensive care unit are the other forms of respiratory distress syndrome (45%). Respiratory distress syndrome (RDS) was observed in 23.41% of the prematurity, 10.7% of them were suspected of having other pathology, and 20.9% of premature neonates  manifested no complications in the neonatal period. There was a significant difference in the diagnosis of newborns after birth (p=0.0001, r=0.58), with the newborns with RDS demonstrating the most complications in the neonatal period. Conclusions: The conclusions to be drawn from the analysis of the data are as follows: there is wide comorbidity in the prematurity of RDS. Lower gestational age strongly correlates with the development of RDS. If no corticosteroid therapy is administered the risk of developing hyaline membrane disease increases. There is extremely high probability of neonatal mortality in children with hyaline membrane disease. There is significant difference between the primary diagnosis and the condition of the child at discharge from the medical establishment. Adequate and specialized prenatal care is essential when trying to reduce the incidence of preterm birth.

Simulation training in medicine is a powerful tool for acquiring knowledge and practical skills in an environment close to the real world. Decreasing training opportunities directly on the patient tend to introduce simulations close to the real hospital environment without compromising the patient’s safety.  The aim of the study was to evaluate the effectiveness of simulation training in the Medical Simulation Training Center (MSTC) at the Medical University of Plovdiv. A prospective observational descriptive study was performed at the MSTC at Plovdiv Medical University between September 2017 and March 2019. The study included 245 respondents who participated in one or more practical simulation trainings and were surveyed. The results of the study suggest that the knowledge, skills and attitudes of the trainees improve after training sessions. By increasing the number of visits, the self-esteem and confidence in performing the manipulation also increases, knowledge and technical performance significantly improve and mistakes are reduced. A statistically significant relationship has been demonstrated between the sequence of visits and acquired competencies (p=0.0001). There are no performance mistakes in those attending three or more times, but 16.2% of them still experience uncertainty while performing. Here, however, 83.8% performed the manipulation automatically and without mistakes.  Simulation training in medicine is effective and useful. It has its place in the curriculum for students and is a good tool for acquiring knowledge, skills and techniques in postgraduate education.

Abstract Background: Lung cancer is the leading cause of death in men and women worldwide. The average five-year survival rate for patients with lung cancer is 22% and is significantly lower than the survival rate for other cancers. Aim: The aim of the study was to determine the five-year survival rate in women after surgery for non-small cell lung cancer. Methods: A prospective cohort study was performed on 59 operated women with primary lung cancer for the period 2011-2020 in the "Second Surgical Clinic" - University Hospital "St. George" and in the Department of "Special Surgery" - Medical University, Plovdiv. Five-year survival rate was calculated using the Kaplan-Meier method and the Life-tables method. Results: The mean age of the study group was 58.51 ± 10.84. Out of 59 operated patients, 39 (66.1%) survived and 20 (33.9%) survived the follow-up period. The group with the highest survival rate was in the IA stage - 53.14 months (4.42 years). This group has also the lowest mortality rate. The five-year survival at this stage was 71.4%. In stage IV, 57.1% of the patients survived a 60-month period, and in stage IIA and IIB, 42.9% and 33.3%, respectively. In stage IIIA is the largest number of operated patients. The five-year survival rate in this group was 25%. In stage IV, a five-year survival rate of 12.5% ​​was reported. Conclusions: The five-year survival of women operated on for lung cancer depends on the stage at which the disease is diagnosed and the extent of surgery.