Emilia Naseva
Medical University of Sofia, Faculty of Public Health, Department Member
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Assistant professor at the Medical University of Sofiaedit
(1) Background: Several recent studies on the clinical value of spirometry indexes demonstrated high sensitivity of FEF25-75 as a marker of bronchial obstruction in asthmatics with normal baseline spirometry. Our study aims to evaluate... more
(1) Background: Several recent studies on the clinical value of spirometry indexes demonstrated high sensitivity of FEF25-75 as a marker of bronchial obstruction in asthmatics with normal baseline spirometry. Our study aims to evaluate the clinical value of maximal mid-expiratory flow in children with asthma. (2) Methods: For two years, 257 children were included - 211 with asthma and 46 healthy controls. Pre- and post-bronchodilator spirometry, atopic status determination and asthma control assessment were performed. (3) Results: The small airway obstruction (SAO) group (FEV1≥80%, ММEF25/75<65%) demonstrated significantly lower values for FEV1, FEV1/FVC, PEFR, МMMF25/75 and a significant higher bronchodilator response (BDR, ΔFEV1% init. ≥12%) compared to normal baseline spirometry group (FEV1>80%, MMEF25/75≥65%) (Р<0.0001). In addition, we found a statistically significant difference in FEF25-75/FVC median between asthmatics and healthy controls (Р<0.0001) regardless of the FEV1 value. Children with SAO have a 2.338-fold higher risk of poor asthma outcome (OR 95% CI [1.077-5.294]) and a 6.171-fold (OR 95% CI [2.523-15.096]) greater probability of demonstrating positive BDR, compared to children with normal baseline spirometry. MMEF25/75 was found to be a good predictor for positive BDR with AUC 0.843 (CI 0.781-0.845) and a best cut-off value of 58.1% (77.8% sensitivity and 78.8% specificity). (4) Conclusion: Our results confirmed that a small but substantial group of asthmatic children with normal baseline FEV1 and low MMEF25-75 are at higher risk for poor asthma outcomes.
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Pharmacy, Medicine, Internal Medicine, Cholesterol, Measurement, and 3 morePharmacist, Heart, and Blood Lipids
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Aim: To identify the factors that influence physicians' under-reporting in Bulgaria and their attitude towards adverse event reporting system and to estimate the role of self-education by providing educational materials. Methods: A... more
Aim: To identify the factors that influence physicians' under-reporting in Bulgaria and their attitude towards adverse event reporting system and to estimate the role of self-education by providing educational materials. Methods: A randomized nested trial among physicians-general practitioners and specialists in Bulgaria was conducted by a validated questionnaire in order to evaluate their knowledge and attitude towards adverse event reporting system. One month after the intervention the participants were re-visited and were asked to answer the same questions again in order to estimate the change in their knowledge and attitude towards pharmacovigilance system and to obtain their evaluation for the materials provided. Results: The response rate was 91. Fifty seven (46.3%) physicians were not familiar with the pharmacovigilance system. The most common reason for non-reporting adverse drug reactions (ADRs) was uncertainty concerning the relationship between the suspected drug and ADRs, the ADRs were already known and the fact that the physician was not aware where they should report. Although 103 (83.7%) respondents in the entry survey and by 102 (82.9%) of those participating in the exit survey consider ADRs reporting as their obligation (p more than 0.05), only 50 (40.7%) and 31 (25.2%), respectively answered that they had ever reported ADRs; 109 (88.6%) of the surveyed physicians assessed the provided educational materials as useful for them. Conclusion: The physicians in Bulgaria have poor knowledge for the pharmacovigilance system; however self-education leads to a better knowledge and positive attitude towards ADRs reporting system. National drug regulatory authority should play a more active role in improving physicians' adherence to the ADRs reporting systems and the developed educational pack can be used in nationwide campaign.
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Background: Despite the long history of the BDR as a diagnostic tool there are still no commonly accepted rules for its performance and interpretation. There is no clear consensus about what affects the reversibility in children with... more
Background: Despite the long history of the BDR as a diagnostic tool there are still no commonly accepted rules for its performance and interpretation. There is no clear consensus about what affects the reversibility in children with bronchial obstruction. Aim: To define the clinical value of the BDR in asthmatic children and to validate different cut-offs and indices. Material and Methods: For a period of 2 years we evaluated medical history data of 211 children with asthma and 46 healthy children aged 5 to 17. For all children, we performed pre- and post-bronchodilator spirometry, specific IgE against aero- and food allergens and ACQ. Results: AUC for ΔFEV1% init. is 0.924 (95% CI 0,887-0,961) and the 6.15% threshold showed best sensitivity (82.8%) and specificity (100%). We analyzed alternative criteria for BDR compared to the classic one (∆FEV1%init.≥12%)- ∆MMEF25/75%init, ∆FVC%init. and ∆PEF%init. Best threshold for a positive BDR (ΔMMEF75/25% init.) is 29.9% with 84.1% sensitivity and 73.8% specificity. In children with asthma, independently from the initial FEV1 and the controller therapy, ∆FEV1%init.≥8% is associated with 2.369-fold (95% CI 1.077-5.213) higher risk for at least one hospitalization from the previous year and 2.871-fold (95% CI 1,239-6, 653) higher risk for school absence because of the asthma. Conclusion: BDR is widely used in confirming the diagnosis of asthma, but it can be a reliable method for monitoring the asthma control in children. Establishing a spirometry criteria adapted for children would improve substantially asthma control, therapeutic decisions making and identifying the risk of progressive loss of lung function.
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The significance of control increases with the push towards improving the overall effectiveness of the health insurance system. In order for public resources to be spent lawfully and effectively, there needs to be increased control not... more
The significance of control increases with the push towards improving the overall effectiveness of the health insurance system. In order for public resources to be spent lawfully and effectively, there needs to be increased control not only from the National Health Insurance Fund (NHIF), but citizen control also needs to be incorporated in the process. Materials and Methods The goal of this survey is to analyze the opportunities for implementing citizen control over the spending of public health funds and compare them to the real conditions as far as the outpatient medical care level. Legislation and news from NHIF’s webpage related to citizen control opportunities were studied. A direct, anonymous survey was carried out on the Google forms platform amongst Bulgarian citizens past the age of majority. Results The results of the questionnaire survey carried out between 24.06.2022 and 16.10.2022 among 1045 adults with compulsory health insurance from all over the country, showed that ...
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The widespread propagation of SARS-CoV-2 necessitated the development of vaccines, both for healthy individuals and for people with comorbidities. The aim of this article was to present data on the post-vaccination virus-neutralizing... more
The widespread propagation of SARS-CoV-2 necessitated the development of vaccines, both for healthy individuals and for people with comorbidities. The aim of this article was to present data on the post-vaccination virus-neutralizing response in people living with HIV (PLHIV) in Bulgaria, two months after the second dose of ChAdOx1 S vector vaccine. Totally 40 PLHIV had been vaccinated, 36/40 received a full vaccination course and finally, 32/40 participated in the study. The results were compared to 19 “healthy controls”, also with a completed vaccination protocol. All 32 patients were on antiretroviral therapy at the time of vaccination, most of them (27/32, 84%) had undetectable viral loads and the remaining 5/32 (15%) had a temporary spike up to 400 copies/ml. CD4+ T-lymphocytes counts in 31 of PLHIV group were >350 cells/mm3; one of them had 190 CD4+ T cells/mm3, but this did not affect the antibody response (93.29%). Sera of all participants were tested by blocking ELISA wi...
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Bulgaria is among the European Union (EU) countries with the highest burden of cervical cancers and life expectancy below the EU average. The majority of cervical cancer cases (more than 95%) are caused by the human papillomavirus (HPV).... more
Bulgaria is among the European Union (EU) countries with the highest burden of cervical cancers and life expectancy below the EU average. The majority of cervical cancer cases (more than 95%) are caused by the human papillomavirus (HPV). The aim of this retrospective, cost of illness study is to identify direct healthcare costs of cervical cancer in Bulgaria from the payer perspective and to calculate indirect costs and the associated years of life lost. Costs data were sourced from the National Health Insurance Fund from January 2018 to December 2020. Years of life lost were calculated based on the country and gender-specific life expectancy. Indirect costs due to productivity loss were calculated using the human capital approach. The total treatment costs for 3540 patients with cervical cancer are EUR 5,743,657 (2018), EUR 6,377,508 (2019), and EUR 6,751,182 (2020). The costs associated with drug acquisition and administration accounted for the majority (63%) of total healthcare c...
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Objective To compare and assess the efficacy of two vitamin D delivery systems (oil-based and microencapsulated) on 25-hydroxy-vitamin D (25(OH)D) levels, body mass index (BMI) and insulin resistance (IR) in women with established... more
Objective To compare and assess the efficacy of two vitamin D delivery systems (oil-based and microencapsulated) on 25-hydroxy-vitamin D (25(OH)D) levels, body mass index (BMI) and insulin resistance (IR) in women with established polycystic ovary syndrome (PCOS) and vitamin D deficiency. Materials and methods A monocentric, retrospective study was conducted, using the data of 70 female patients, who visited the endocrinology department of the “Dr. Shterev” Hospital, Sofia, Bulgaria between May 2020 and September 2020. The patients were divided into two groups according to the type of vitamin D3 supplementation: either a microencapsulated liposomal form (n=35), or a conventional oil-based form (n=35). The following clinical measures were analysed and compared: BMI, serum levels of 25(OH)D, fasting plasma glucose levels, fasting immunoreactive insulin (IRI), homeostatic model assessment (HOMA) index, levels of antimullerian hormone (AMH) II generation, and testosterone. In all selected patients, these measurements were performed at baseline and 3 months after initiation of vitamin D supplementation. Results Significantly increased serum levels of 25(OH)D were observed in patients supplemented with the microencapsulated form of vitamin D3 in the third month from the beginning of therapy, compared with the control group (p=0.003). In the microencapsulated vitamin D group, there was a decrease in IRI serum levels (p=0.023), HOMA-IR (p=0.021), serum AMH (p=0.010) and testosterone levels (p=0.006). The fasting plasma glucose levels did not change significantly. Conclusion The results of our study show that the patients supplemented with a microencapsulated form of vitamin D3 achieved faster compensation of 25(OH)D levels, which in turn, under equal conditions, led to significant improvement in the metabolic profile, in particular insulin sensitivity.
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Objective: To analyze therapy of glaucoma among the elderly population, 65 years old and above, in Sofia city, the capital of Bulgaria. Methods: Two prophylactic ophthalmic campaigns were realized in the summer of 2016 and 2017, in Sofia... more
Objective: To analyze therapy of glaucoma among the elderly population, 65 years old and above, in Sofia city, the capital of Bulgaria. Methods: Two prophylactic ophthalmic campaigns were realized in the summer of 2016 and 2017, in Sofia city. All patients passed thorough ophthalmic examinations and filled pen-and-paper questionnaires. The results and files were collected and statistically analyzed to estimate current antiglaucoma therapy among the elderly citizens of Sofia city. Results: The predominant number of persons who were diagnosed with glaucoma, was treated with conservative monotherapy. Prostaglandin analogues have been prescribed to more than half of the patients in both studies. Fixed combinations have been used in 86% of the cases who needed combined therapy with two substances and in 100% of those with three medications. Conclusions: The therapeutic scheme used for treating glaucoma among elderly citizens of Sofia city is similar and corresponding to practice worldwid...
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Objective: The purpose of our research is to emphasize the role of underestimated predisposing conditions for microbial keratitis in contact lens users, to draw attention to the complications of wearing contact lenses without ophthalmic... more
Objective: The purpose of our research is to emphasize the role of underestimated predisposing conditions for microbial keratitis in contact lens users, to draw attention to the complications of wearing contact lenses without ophthalmic examination, and to offer a short questionnaire for fast and easy estimation of the risk factors for bacterial keratitis. Methods: A series of 23 cases of healthy young individuals, treated for bacterial keratitis, provoked а research on the predisposing factors for its development. Results: 55% of the patients had started to wear contact lenses without specific examination. 75% had made mistakes in the hygiene and storage of the lenses. We identified risk factors for development of bacterial keratitis in all cases. Conclusions: A thorough anamnesis and ophthalmic examination are crucial in decision making about contact lens wearing because they could reveal some of the predisposing conditions for the occurrence of ocular complications. The usage of ...
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Health, besides being a value, is a prerequisite for economic prosperity of the society. This is one of the reasons which determine the importance of the indicators of public health measuring. The purpose of this article is to study,... more
Health, besides being a value, is a prerequisite for economic prosperity of the society. This is one of the reasons which determine the importance of the indicators of public health measuring. The purpose of this article is to study, analyze and present specific health and social characteristics of different groups of patients in Yambol region. During the summer of 2012, 647 patients were interviewed by using a questionnaire for self-assessment of their health (EuroQol 5-D), as well as their socio-economic status. The results show that the population health differs between the subregions.
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This paper presents a comprehensive analysis of the mechanisms, major issues and trends in the hospital financing approaches during the recent decade. It is well known that the hospitals are the most expensive component of healthcare... more
This paper presents a comprehensive analysis of the mechanisms, major issues and trends in the hospital financing approaches during the recent decade. It is well known that the hospitals are the most expensive component of healthcare costs as their maintenance and functioning exhaust the greatest part of healthcare resources of each country. While the hospitals consume a significant share of the healthcare resources, the healthcare managers search for novel payment strategies guaranteeing the efficient provision of healthcare. The most important instrument for hospital management and modeling of hospital performance is the financing mechanism. Thus, the appropriate, rational choice of financing model in the hospital sector has a strategic effect on the overall national healthcare system.
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Готовността за епидемия и пандемия и прилагането на ответни мерки зависят в голяма степен от общественото възприятие за риск, добрата комуникация и доверието към здравните власти. Проведена е Гражданска консултация с цел да се проучи... more
Готовността за епидемия и пандемия и прилагането на ответни мерки зависят в голяма степен от общественото възприятие за риск, добрата комуникация и доверието към здравните власти. Проведена е Гражданска консултация с цел да се проучи мнението на гражданите по четири теми, свързани с готовността и мерките за отговор при епидемии и пандемии. Резултатите показват, че гражданите имат необходимост от повече здравна информация, дават приоритет на сигурността за здравето пред личната свобода и подкрепят задължителните мерки при епидемии. С най-голямо доверие се приема информацията от личния лекар и компетентните европейски и национални здравни органи, a предпочитаните канали за получаването ѝ са телевизията и държавните медии.
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Background and objectives: To assess whether placental growth factor (PlGF) levels may have a predictive value for the onset of gestational diabetes mellitus (GDM) and thyroid dysfunction during pregnancy. Materials and Methods: This... more
Background and objectives: To assess whether placental growth factor (PlGF) levels may have a predictive value for the onset of gestational diabetes mellitus (GDM) and thyroid dysfunction during pregnancy. Materials and Methods: This single-center retrospective analysis was conducted at the Specialized Hospital for Active Treatment in Obstetrics and Gynecology “Dr. Shterev”, Sofia, Bulgaria, from December 2017 to December 2019. Using pregnant women’s electronic records, we analyzed and compared the data of 412 women diagnosed with GDM and 250 women without evidence for carbohydrate disorders. Thyroid function was tested in all patients at the time of performing GDM screening. The following measurements were compared and assessed: body mass index (BMI), fasting blood glucose levels, thyroid-stimulating hormone levels (TSH), free thyroxine, and triiodothyronine (FT4 and FT3) levels, and serum placental growth factor (PlGF). The sensitivity and specificity of PlGF as a predictive marke...
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Background and objectives: To assess whether placental growth factor (PlGF) levels may have a predictive value for the onset of gestational diabetes mellitus (GDM) and thyroid dysfunction during pregnancy. Materials and Methods: This... more
Background and objectives: To assess whether placental growth factor (PlGF) levels may have a predictive value for the onset of gestational diabetes mellitus (GDM) and thyroid dysfunction during pregnancy. Materials and Methods: This single-center retrospective analysis was conducted at the Specialized Hospital for Active Treatment in Obstetrics and Gynecology “Dr. Shterev”, Sofia, Bulgaria, from December 2017 to December 2019. Using pregnant women’s electronic records, we analyzed and compared the data of 412 women diagnosed with GDM and 250 women without evidence for carbohydrate disorders. Thyroid function was tested in all patients at the time of performing GDM screening. The following measurements were compared and assessed: body mass index (BMI), fasting blood glucose levels, thyroid-stimulating hormone levels (TSH), free thyroxine, and triiodothyronine (FT4 and FT3) levels, and serum placental growth factor (PlGF). The sensitivity and specificity of PlGF as a predictive marke...
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Background and objectives: To assess whether placental growth factor (PlGF) levels may have a predictive value for the onset of gestational diabetes mellitus (GDM) and thyroid dysfunction during pregnancy. Materials and Methods: This... more
Background and objectives: To assess whether placental growth factor (PlGF) levels may have a predictive value for the onset of gestational diabetes mellitus (GDM) and thyroid dysfunction during pregnancy. Materials and Methods: This single-center retrospective analysis was conducted at the Specialized Hospital for Active Treatment in Obstetrics and Gynecology “Dr. Shterev”, Sofia, Bulgaria, from December 2017 to December 2019. Using pregnant women’s electronic records, we analyzed and compared the data of 412 women diagnosed with GDM and 250 women without evidence for carbohydrate disorders. Thyroid function was tested in all patients at the time of performing GDM screening. The following measurements were compared and assessed: body mass index (BMI), fasting blood glucose levels, thyroid-stimulating hormone levels (TSH), free thyroxine, and triiodothyronine (FT4 and FT3) levels, and serum placental growth factor (PlGF). The sensitivity and specificity of PlGF as a predictive marke...
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The treatment of patients with isolated adrenal metastases remains controversial. Metastases from NSCLC suggest that these patients could have improved survival. The role of N2 status as independent predictor of poor survival is still... more
The treatment of patients with isolated adrenal metastases remains controversial. Metastases from NSCLC suggest that these patients could have improved survival. The role of N2 status as independent predictor of poor survival is still unclear and under discussion. The aim of this study was to evaluate the role of mediastinal nodal status in patients with isolated adrenal metastases form Non Small Cell Lung Cancer (NSCLC) treated with surgery. A total of eight patients with NSCLC and isolated adrenal lesions were operated on for a period of ten years. They were divided into two groups depending on the morphology of the adrenal lesion. Group I includes 4 patients with adrenal metastases which underwent lobectomy and Retroperitoneal Endoscopic Adrenalectomy (REA). The loco regional stage was pI in 3 patients and pIIA in one. The mean size of the metastases was 24.5 mm, without capsular invasion and all of them were metachronous. The other four patients were proven to be with adenomas o...
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The reporting rate of adverse drug reactions by pharmacists in Bulgaria is low. This is partly due to the shared responsibility for patients’ health between physicians and pharmacists, and the unconscious role of the pharmacists in the... more
The reporting rate of adverse drug reactions by pharmacists in Bulgaria is low. This is partly due to the shared responsibility for patients’ health between physicians and pharmacists, and the unconscious role of the pharmacists in the process. The aim of the study is to test the modified “mystery consumer” approach to assess the knowledge and skills in the field of pharmacovigilance and risk communication of a representative sample of community pharmacists in Sofia and conducting a social study for the purposes of post-marketing drug monitoring. Object of the study were 60 community pharmacies in the city of Sofia. They were visited by a pre-trained "mystery consumers" in order to assess the level of knowledge and skills of the pharmacists in the field of pharmacovigilance. The "mystery shopper" is a reliable method for assessing the knowledge of pharmacists and conducting an observational study.
Introduction: An atopic status assessment (skin prick test or specific immunoglobulin (sIgE)) in asthmatic children is considered a milestone in identifying potential risk factors and triggers provoking loss of asthma control and asthma... more
Introduction: An atopic status assessment (skin prick test or specific immunoglobulin (sIgE)) in asthmatic children is considered a milestone in identifying potential risk factors and triggers provoking loss of asthma control and asthma exacerbation. Objective: The study aims to perform a comparative analysis of different laboratory methods for a serological assessment of an atopic status in asthma and respiratory allergies in children. Material and methods: A total of 86 children were included, all of whom were diagnosed with bronchial asthma, aged from 5 to 17 years and screened for total IgE level using enzyme-linked immunosorbent assay (ELISA). In 48 randomly selected children, we performed a semi-quantitative serological in vitro assessment of the specific IgE antibodies against food and aeroallergen, using two different laboratory methods—Euroimmun Immunoblot and ImmunoCAP (Phadiatop/fx5). Results: In 70% of the children with a history of allergies, and 65.3% without clinicall...