Faculty of Medicine
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Item type:Publication, From unknown poisoning to carbamazepine poisoning(2023-06); ; Biljana IvanovaIn the 2020 annual report of the American Association of Poison Control Centers, 2562 toxic exposures to carbamazepine have been reported, 908 resulted in hospitalization, and among these about 5-6% were life-threatening or resulted in significant disability. A 15-year-old female patient was brought under suspicion of alcohol poisoning. The result of alcoholemia was 11.0 mg/dL and the toxicological screening for THC, opiates, methadone, tramadol, amphetamine, MDMA, cocaine, benzodiazepines, buprenorphine was negative. At admission she was comatose (GCS=6), with metabolic acidosis, hypotension, rare short-term partial seizures, isochoric and later dilated pupils, body temperature was 36.4°C, with oxygen saturation from 89 up to 93%. Toxicological analysis were immediately extended. After three hours of admission, a result was obtained where the plasma concentration for carbamazepine was 167mmol/L. The patient was quickly prepared for hemodialysis which was performed for four hours. After 8 hours of admission the patient woke up with stable vital parameters. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, FATAL ACUTE SELF-POISONING WITH ONE PHOSTOXIN TABLET – A CASE REPORT(2023-05); ; Aluminum phosphide (AlP) is well known as an effective pesticide for grain preservation, but also as a suicidal agent due to its high human toxicity. Phosphine gas (PH3), which is released in contact with stomach acid, is responsible for systemic toxicity and high mortality. We report the first case of severe intentional AlP poisoning treated in our clinic with a fatal outcome and review the therapeutic modalities. A 35-year-old woman with a history of epilepsy was admitted to the University Clinic for Toxicology two hours after the intentional ingestion of a phostoxin (AlP) tablet. She presented with vomiting, abdominal pain, leukocytosis, ECG changes (prolonged PT interval, inverted T waves in D3, AVF, and left precordial leads), hypotension (80/40 mmHg, heart rate 120/min) and respiratory failure, after which she was transferred to the ICU. Signs of hepatic lesion, rhabdomyolysis, renal failure and metabolic acidosis (pO2 9.6 kPa, pCO2 4.14 kPa, pH 7.15, bicarbonate 11 mmol/L, BE -15) were noted. Despite the application of mechanical ventilation, fluid supplementation and inotropic support, hemodynamic instability worsened. Cardiopulmonary resuscitation was performed three times, but unfortunately the patient had a fatal outcome on the fourth day of hospitalization. Freshly opened phostoxin tablets (3 g) are very toxic, and the dose of AlP they contain is sufficient to cause progressive life-threatening symptoms and a fatal outcome. In the absence of antidote, consensus on treatment and elucidated mechanisms of toxicity, the key to treatment is rapid decontamination and initiation of resuscitation measures. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, TROPONIN I VISOKE OSETLJIVOSTI I DUŽINA BORAVKA U BOLNICI KOD AKUTNO OTROVANIH PACIJENATA SA RABDOMIOLIZOM(2023-05); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CANNABIS AND AMPHETAMINE USE IN PATIENTS ON BUPRENORPHINE MAINTENANCE TREATMENT(2023-05); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Role of Urgent Esophagogastroduodenoscopy in Prognosis of Acute Caustic Poisonings(Academy of Medical Sciences of Bosnia and Herzegovina, 2011); ; ; Vesna ChibishevaIntroduction: Ingestion of corrosive substances causes severe lesions to the upper gastrointestinal tract. The aim of this paper was to present our clinical experience with the 4-grade endoscopic classification of post-corrosive injuries in prognosis of the outcome in acute caustic poisonings. Material and methods: This was a retrospective study comprising 33 patients with grade II B and III injury hospitalized at the University Clinic for Toxicology in Skopje, Republic of Macedonia in the period 2008-2009. The grade of injury was determined with urgent esophagogastroduodenoscopy performed in the first 12-24 hours. After treatment the patients were followed for a minimum of six months. Results: A total of 33 patients were analyzed. At the time of hospital admission post-corrosive injuries of grade III predominated (n=22, 66.67%) and post-corrosive injuries of grade II B (n=11, 33.33%). The most common late postcorrosive complications of the esophagus was stenosis esophagei (n=19, 57.58%). The most common post-corrosive damages of the stomach were: stenosis antropylori (n=10, 30.30%), stenosis pylori (n=6, 18.18%) and stenosis antri (n= 3, 9.09%). Conclusion: Urgent esophagogastroduodenoscopy has to be done in all acute caustic poisonings in the first 12-24 hours and they are to be classified according to Kikendall’s four-grade classification. The classification in four grades of post-corrosive injuries to the upper gastrointestinal tract might help in therapeutic approach and prognosis of the outcome - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Corrosive poisonings in adults(ScopeMed Publishing, 2012); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Program of the University Clinic of Toxicology, Skopje, Republic of Macedonia in treatment of drug addiction (buprenorfin treatment protocol)(ScopeMed Publishing, 2011); ; ; Irena JurukovThe program of our Clinic includes, not only treatment of acute intoxication with opioids and other drugs, but also comprehends clinical investigations and treatment of the somatic complications of this population. For the first time in our country our Clinic offers to this population the alternative way of treatment with Buprenorfin. The Clinic started with this protocol on August 1, 2009. During a period of two years, the treatment with Buprenorfine has been initiated in 353 patients, of which 211 regularly attend the medical check ups. This model is used according to the national clinical guidelines and procedures for the use of buprenorfine in the treatment of opioid dependence The dose of this medicament depends on the evolution of the withdrawal symptoms. We have used the objective and subjective opioid withdrawal scale for the observation of these symptoms (OOWS ; SOWS - Handelsman et al 1987). This protocol starts with a complete clinical investigations, (i.e. where all patients undergo the inclusion and exclusion criteria with a written consent). Afterwards, the patients are hospitalized and start with a Buprenorfin teratment. After period of 7-10 days hospitalization they come to our Clinic, like outpatients for a regular controls. We have precise evidence for every patient who comes for control (e.g. medical record with all biochemical and toxicological screenings). All patients are recommended a tight cooperation with psychiatrists who are specialized to treat the problematic drug addictions. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Heroin dependence duration influences the metabolic parameters: mechanisms and consequences of impaired insulin sensitivity in hepatitis C virus seronegative heroin dependents(Hagerstown, MD : Lippincott Williams & Wilkins, 2012-12); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Presence of Some Humoral Immunologic Indicators and Clinical Manifestations in Cryoglobulin Positive Heroin Addicts without Evidence of Hepatitis Virus Infection(2015-05); ; SUMMARY Introduction Cryoglobulins are single or mixed immunoglobulins that are subject to reversible precipitation at low temperatures. Objective The aims of this paper were: 1. Comparison of cryoglobulin positive (CP), cryoglobulin negative (CN) heroin addicts and the control group (CG) in terms of serum immunoglobulins IgG, IgA and IgM and complement components C3 and C4; 2. Comparison of CP and CN heroin addicts in terms of rheumatoid factor (RF) and circulating immune complexes (CIC); 3. Assessment of clinical manifestations in CP heroin addicts. Methods This is a comparative study of cases (outpatients) treated at the University Clinic of Toxicology in Skopje over 3.5 years, from January 2009 to June 2012. In this study 140 heroin addicts without HbsAg were examined, seronegative for HCV and HIV infections. They were divided into 2 groups: 70 CP and 70 CN heroin addicts. A previously designed self-administered questionnaire was used as a data source on participants. All heroin addicts underwent the following analyses: urea and creatinine in serum; creatinine in urine; proteinuria; 24-hour proteinuria; IgM, IgG, IgA, C3, C4 ; RF; CIC; creatinine clearance; ECG; toxicological analyses for opioids in a urine sample; cryoglobulins. In addition to these 2 groups, IgG, IgA, IgM, C3 and C4 were also examined in 70 healthy subjects (CG). Results The study showed that there was no statistically significant difference between CP, CN heroin addicts and CG regarding the concentration of IgA, IgG, IgM, C3 and C4, and between CP and CN regarding the concentration of CIC. There was significant difference between CP and CN regarding the concentration of RF. The following conditions were significantly more frequently manifested in CP than in CN heroin addicts: arthralgia, Raynaud’s phenomenon, respiratory difficulties, neurological disorders, manifested skin changes, hematuria, 24-hour proteinuria levels, and decreased renal clearance. Conclusion There were no differences in concentrations of IgG, IgA, IgM, C3, C4 and CIC, while there was a difference in concentration of RF between CP and CN heroin addicts. Clinical manifestations (arthralgias, Raynaud’s phenomenon, respiratory, neurologic, renal disorders and skin changes) were more common in CP heroin addicts.