Yozlem Kobakova

National Institute of Emergency Medicine "Pirogov"

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Co-Authors

Maria Moneva-Sakelarieva

National Institute of Emergency Medicine "Pirogov"

Stefka Ivanova

Medical University of Sofia

Petar Atanasov

National Institute of Emergency Medicine "Pirogov"

Spiro Konstantinov

Medical University of Sofia

Petar Atanasov

National Institute of Emergency Medicine "Pirogov"

Valentina Petkova

Medical University of Sofia

Georgi Momekov

Medical University of Sofia

Ventseslava Petrova Atanasova

Danka Obreshkova

National Institute of Emergency Medicine "Pirogov"

Maria Chaneva

National Institute of Emergency Medicine "Pirogov"

Cooperative Institutions

National Institute of Emergency Medicine "Pirogov"

Medical University of Sofia

National Medical and Surgical Center named after N.I. Pirogov

Medical University Plovdiv

Medical University Pleven

Sofia University "St. Kliment Ohridski"

National Specialized Hospital for Active Treatment of Hematologic Diseases

Chemotherapy Foundation

Institute of Pharmacology

Bandung Institute of Technology

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Tobacco smokers as target group for complicated coronavirus infection

Pharmacia (2022)

P.A. Atanasov Maria Moneva-Sakelarieva Yozlem Kobakova Danka Obreshkova Ivaylo Ivanov

The aim of current study was to determine, retrospectively, possible correlations between smoking and the incidence, course severity, intubation rate, and mortality (by gender and age) in patients treated for complicated coronavirus infection in the internal medicine clinic at UMHATEM ”N. I. Pirogov” Sofia for the period 01.03.2020–31.12.2020. In a prospective study, the recovery period and immunogenesis in smokers and non-smokers within a one-year period after hospital discharge was investigated. The applied methods were: 1) computed tomography and blood gas analysis 2) chemiluminescent immunoassay for the qualitative determination of total IgM, IgA and IgG anti-SARS-CoV2 AB. Results showed that the part of non-smokers with a positive PCR test is significantly higher compared to the group of former and current smokers. The data obtained from the study confirmed that Covid infection is much more severe among smokers and former smokers with a higher levels of inflammatory markers noticed among the smoking group.

Chemiluminescent immunoassay

2019-20 coronavirus outbreak

10.3897/pharmacia.69.e91095

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COVID-19 – the challenge to treat a disease and not a positive RT-PCR test

Pharmacia (2021)

Maria Moneva-Sakelarieva Yozlem Kobakova Petar Atanasov Данка Петрова Обрешкова Stefka Ivanova

The new pandemic disease COVID is quick spread worldwide.The primary method used for diagnosing of COVID-19 is detecting viral nucleic acids. The main problem with RT-PCR test is the false negative results. The negative RT-PCR does not exclude a SARS-CoV-2 infection and this method should not be used as the only diagnostic criteria. The RT-PCR result does not change the complex treatment of the disease. The aim of the current study is to compare the four groups clinical cases of the different parameters: RT-PCR test, rapid test, clinical picture, laboratory tests as hematology, inflammatory markers, coagulation status and chemistry and imaging examinations: Chest X-ray at and Chest CT scan. Complex therapeutic approach has been implemented: antibiotic, inflammatory, anticoagulants, oxygen therapy, hepatoprotectors, antimycotics, fibrinolytics, probiotics, essential oils, vitamins. During the follow-up period, a tendency for significant reduction and resorption of the pulmonary changes on the CT scans has been seen.

Hematology

Nucleic acid test

10.3897/pharmacia.68.e61906

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Common for COVID-19 cytokine storm in patients with SARS-CoV-2 infection and CLL (chronic lymphocytic leukemia)

Pharmacia (2024)

Yozlem Kobakova Maria Moneva-Sakelarieva Spiro Konstantinov Georgi Momekov Niya E Semerdzhieva

The cytokine storm has been identified as one of the leading causes of the severe course and, in some cases, the fatal outcome of COVID-19 infection. Other factors aggravating the course of the disease are accompanying disorders such as cardiovascular diseases, diabetes mellitus, diseases of the respiratory system, and oncological diseases. In this article, we present the course of the coronavirus infection in patients with an accompanying malignant disease, chronic lymphocytic leukemia (CLL), namely. The study included 8 patients with proven PCR-positive tests for SARS-CoV2 and confirmed chronic lymphocytic leukemia as a comorbidity. The course of the coronavirus infection in the CLL group was compared with that in the control group of 100 patients. In both groups, we compared subjective complaints such as tiredness, fatigue, and joint and muscle pain with objective criteria such as temperature, laboratory markers of inflammation, X-ray imaging, and frequency of necessary intubation. Despite the expected poor prognosis in patients with concomitant oncological disease, in the case of chronic lymphocytic leukemia, our results showed a quite different milder coronavirus infection course. Obviously, patients with CLL cannot develop a pronounced cytokine storm, most probably due to certain immunosuppression related to the pathogenesis and drug treatment options for the comorbidity of CLL.

Cytokine Storm

2019-20 coronavirus outbreak

10.3897/pharmacia.71.e135468

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Lymphoma with skin localization and COVID 19 – a clinical case and review of literature

Pharmacia (2024)

Maria Moneva-Sakelarieva Yozlem Kobakova Spiro Konstantinov Georgi Momekov Niya E Semerdzhieva

In this article, we present a clinical case of a 63-year-old patient who was treated in the COVID unit of the Clinic for Internal Diseases of UMBALSM (University General Hospital for Active Care and Emergency Medicine) “N. I. Pirogov” on the occasion of a proven coronavirus infection with a PCR positive test for SARS-CoV2-virus, clinical symptoms of severe coronavirus pneumonia, and with accompanying disease - lymphoma with skin localization, condition after lower right lobectomy, chemotherapy and checkpoint therapy for squamous cell carcinoma of the lung. We also examined the role of the transcription factor NF-kB in the course of the coronavirus infection in a patient with the indicated lymphoproliferative disease and a history of active smoking. We tried to clarify questions such as “Do severe forms of coronavirus infection and the relatively rare disease lymphoma with cutaneous localization have a common pathogenesis?” Is it possible to effectively pharmacotherapeutically influence two, at first glance, so heterogeneous diseases?’’ The conclusions drawn can help us to specify certain nosological units as “more vulnerable” to severe forms of COVID19 infection.

2019-20 coronavirus outbreak

10.3897/pharmacia.71.e135467

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Immunogenesis in patients with medium and severe coronavirus infection – dynamics in different age groups

Pharmacia (2022)

Petar Atanasov Stefka Ivanova Yozlem Kobakova Maria Moneva-Sakelarieva Danka Obreshkova

The results of a one-year prospective study, during which the process of immunogenesis in patients over 18 years of age with moderate and severe coronavirus infection was monitored and analyzed in clinical and paraclinical (clinical laboratory) aspects, are summarized and presented. The study included 2683 patients, all treated in the Clinic of Internal Diseases at the University Multiprofile Hospital for Active Treatment and Emergency Medicine “N. I. Pirogov” EAD, Sofia for the period from April 2020 to December 2020. Patients were followed for one year after recovering from moderate to severe coronavirus infection. Patients are grouped into four age categories as follows: 18–45 years; 46–65 years; 66–80 years and over 80 years. The results of our study show that during the study period in 97% of patients the level of anti-SARS-CoV2, rose and in the remaining three percent it was flat or followed by subsequent waning (in less than 1% of patients), but does not reach critically low levels (i. e. below the positivity conditional threshold). The level of IgG reached a peak and then waned, but on the other hand, as mentioned above, the amount of Ig-Total tested shows a significant increase. This trend is observed in all age groups, with a difference in the level of IgG and Ig-Total depending on age. The results of the additional screening in the target period in terms of virulence and virus segregation, categorically rule out the suspicion of the presence of “silent spreader”. During the follow-up period, no patients were re-hospitalized due to recurrence of Coronavirus infection (re-infection and illness).

Age groups

Coronavirus

10.3897/pharmacia.69.e81063

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The role of immunostimulants in the complex therapy of Covid 19 – a clinical case

Pharmacia (2020)

Yozlem Kobakova Maria Moneva-Sakelarieva Petar Atanasov Stefka Ivanova Danka Obreshkova

The aim of current study was the investigation of complex treatment including nutritional supplement with recognized antioxidant and immunomodulatory properties (malic, glycyrrhizic, ascorbic and folic acids, glucosamine, arginine, glycine, calcium pantothenate, cyanocobalamine, zinc sulfate, pyridoxal) and purely plant systemic protease supplement (Serrapeptase, Bromelaim, Boswellia, Uncaria tomentosa, Quercetin) as a strategy against Covid 19. A clinical case of a 33-year-old patient treated in Internal Clinic Diseases ”Pirogov” against atypical bilaterally viral pneumonia with RT-PCR proven coronavirus have been presented. A complex treatment strategy was applied: Doxycycline, Amikacin sulfate, food additive containing malic and glycyrhizic acids, aminoacids, B-vitamins, antioxidants, proteolytic agent, Methylprednisolone, anticoagulant: Nadroparin calcium, hepatoprotector: Ademethionine. After 16 days hospitalization and two negative RT-PCR tests the patient was discharged in improved condition and home treatment with Levofloxacin hemihydrate, vitamins, probiotics, immunomodulatory and proteolytic products for one month was recommended. Immunostimulating, proteolytic and other products have an important role in complex treatment.

Proteolytic enzymes

10.3897/pharmacia.67.e58024

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Immune response – genesis, duration, and strength in patients with moderate and severe coronavirus infection of different age groups

Zenodo (CERN European Organization for Nuclear Research) (2023)

Petar Atanasov Maria Moneva-Sakelarieva Yozlem Kobakova Maria Chaneva Ivaylo Ivanov

Coronavirus

2019-20 coronavirus outbreak

10.3897/pharmacia.70.e111767

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Natural products as part of triple negative breast cancer

Pharmacia (2025)

Yozlem Kobakova Maria Moneva-Sakelarieva Spiro Konstantinov Georgi Momekov Stefka Ivanova

Triple negative breast cancer (TNBC) continues to be the breast cancer subtype with the highest recurrence and mortality rates. Treatment of TNBC can be challenging because the disease has different molecular subtypes. Various treatment options are available, such as chemotherapy, immunotherapy, radiation therapy, and surgery. Chemotherapy is the most common of these options. The serious side effects of chemotherapy significantly limit its use. Long-term toxicity can affect the majority of breast cancer survivors, significantly reducing their quality of life. Immunotherapy causes a wide variety of toxic effects called immune-related adverse events (IRAEs). This necessitates the search for alternative methods of treatment for triple negative breast cancer. More and more research in this field is focused on single or combination therapy based on compounds obtained from natural sources. Natural products such as curcumin, resveratrol, and epigallocatechin-3-gallate, with their mechanisms of action and antineoplastic properties, are the subject of numerous studies.

Triple-negative breast cancer

10.3897/pharmacia.72.e143465

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The role of the transcription factor NF-kB in the pathogenesis of inflammation and carcinogenesis. Modulation capabilities

Pharmacia (2025)

Maria Moneva-Sakelarieva Yozlem Kobakova Spiro Konstantinov Georgi Momekov Stefka Ivanova

The nuclear factor kappa B (NF-kB) signaling module is a complex and highly interconnected molecular network with important functions in all nucleated cells. Most chronic diseases caused by lifestyle factors appear to be related to inflammation. The NF-kB plays a major role in the pathogenesis of the inflammation and its intimate molecular mechanism. This transcription factor participates in the evolution of diabetes and its complications. In T1D (Type 1 Diabetes), proinflammatory cytokines such as interleukin-1β (IL-1β), tumor necrosis factor (TNF), and CD40L secreted by immune cells in islets induce the activation of NF-kB in β-cells through both canonical and noncanonical roads. NF-kB activation increases the expression of genes, including TNF-α, IL-1β, IL-6, MCP-1, and ICAM-1, that initiate and promote atherosclerosis. In particular, the severity and lethality of acute lung injury or acute respiratory distress syndrome (ALI/ARDS) caused by pneumonia or sepsis is primarily associated with an NF-kB-mediated “cytokine storm,” in which massive polymorphonuclear (PMN) extravasation and the subsequent release of cytokines cause rapid deterioration due to widespread inflammation and coagulation. Nuclear translocation of NF-kB p65 can induce the transcription of several genes involved in the induction of EMT (epithelial-to-mesenchymal transition). This has been confirmed in various types of cancer, including brain, breast, lung, and gastric cancer. Cutaneous T-cell lymphoma (CTCL) encompasses a group of lymphoproliferative disorders characterized by invasive neoplastic T cells in the skin and various clinical prognoses. In the early stages of CTCL, NF-kB activation and cell proliferation are stimulated by the autocrine production of TNFα, leading to increased NF-kB activation and resistance to apoptosis. Bladder cancer is the second most common genitourinary cancer and is often recurrent and/or chemoresistant after tumor resection. NF-kB is a transcription factor that plays a critical role in normal physiology and bladder cancer. Bladder cancer patients have pathologically active NF-kB induced by proinflammatory cytokines, chemokines, and hypoxia, enhancing carcinogenesis and progression of the disease.

Pathogenesis

Transcription

10.3897/pharmacia.72.e146759

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COVID-19 as a concomitant diagnosis and the emergencies behind COVID-19 mask – a real challenge that requires a multidisciplinary view of the patient

Pharmacia (2021)

Petar Atanasov Maria Moneva-Sakelarieva Yozlem Kobakova Stefka Ivanova Данка Петрова Обрешкова

The etiological cause of Coronavirus infection, which has captured the attention of almost the whole world at the moment, is SARS-CoV2. The clinical picture of coronavirus infection varies from asymptomatic to severe respiratory infection with manifestations of respiratory failure, the development of respiratory distress syndrome and even death. Already in the first months of the coronavirus pandemic in the United States there was a serious decline in the number of patients seeking medical care in the Emergency Department (49.3%) compared to 2019. There is evidence of increased mortality during the pandemic, which causality cannot be directly or associated with coronavirus infection. Even in the context of a global pandemic, we must not forget all other diagnoses and conditions that exist as comorbidity, and emergency care must be provided without delay and delay.

Pandemic

Coronavirus

Concomitant

10.3897/pharmacia.68.e71287

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