Faculty of Medicine

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COVID-19 IN CHILDREN WITH DOWN SYNDROME-CASE SERIES
(Macedonian Association of Anatomists and Morphologists, 2023-11-05)
Ivanovska, Julija
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Nestorov, Hristijan
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Popova, Gorica
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Chakalaroska, Irena
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Petlichkovska, Sandra
Down syndrome (DS) is the most common genetic disease and presents withcognitive impairment, cardiac and gastrointestinal abnormalities, increasedrisk of hematological malignancy and several autoimmune conditions in additionto other miscellaneous clinical conditionsThe aim is to show if the comorbidities that children with Down Sy have, were risk factors for more severe form of COVID-19.We present three cases of children with Down Sy and COVID-19, with different clinical features. All of them had good clinical outcome, only the firstchild had more severe form of Covid 19 with needfor oxygen support, longer hospitalization but with good clinical improvement and withdrawal of the X-ray changes. Children with Down Sy are always a high-risk group for more severeand prolonged course of disease, which are partiallyattributed to defects of the immune system.
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COMPLICATED TUBERCULOSIS IN A 13-YEAR-OLD CHILD WITH DOWN SYNDROME: A CASE REPORT
(Macedonian Association of Anatomists and Morphologists, 2023-11-05)
Nestorov, Hristijan
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Doksimovski, Filip
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Chakalaroska, Irena
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Ivanovska, Julija
Tuberculosis (TB) is the most common cause of infectious disease-related mortality worldwide. Most persons infected won’t develop active disease, but in certain instances such as extremes of age or defects in cell-mediated immune response, TB may develop. Down syndrome (DS) is the most common neurodevelopmental disorder of know genetic causeand described simply as arising from an extra copy of chromosome 21, presenting with characteristic features. Due to immune defects, DS suffer more frequently from respiratory tract infections than normal children.We present a case of a 13yearsold child with Down Syndrome who was diagnosed with lung tuberculosis, after a right sided lobectomy due to a lung abscess.The child was hospitalized, following a period of one and a half month with fever and vomiting that did not improve with therapy. Investigations were made, including CT scan on the lungs. Due to right sided empyema and abscess on the right upper lobe, right sided lobectomy was preformed. The postsurgical pathohistological findings were in addition to pulmonary tuberculosis. Four drug antituberculosis regimenwas started. The four-drugcourse was given for two months, and then a two-drugregime was continued. To this day the child is on the sixth month of the two-drugantituberculosis regime. CT scans, regular Chest X-rays and ultrasoundof the lungs were made, with gradual improvement.In Down syndrome patients who have a complicated pneumonia that doesn’t respond to standard treatment, a tuberculosis disease should be considered.
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TUBERCULOUS LYMPHADENITIS IN CHILDREN –14 YEARS OF EXPERIENCE
(Macedonian Association of Anatomists, 2023)
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Ivanovska, Julija
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Nestorov, Hristijan
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Popova, Gorica
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Petlichkovska, Sandra
Tuberculosis (TB)is a major public health problem worldwide. It is one of the main causes of infectious disease and mortality, especially in developing countries. Extra pulmonary tuberculosis accounts for 15-20 % of all types of tuberculosis. Lymph nodes are the second most common localization after pleural TB. In childhood, the most commonly envolved are the hilar lymph nodes. Material and methods: We analyzed the frequency of tuberculous lymphadenitis in children treated at the Institute for respiratory diseses in children-Kozle, in the last 14 years. From January 2006 to February 2020 , we’ve treated 397 children with TB. 55 of them (13,8%), were with tuberculous lymphadenitis. Female children were 34 (61%), the others were male.The most frequent was hilar lymphadenitis at 40 (72%), second localization were cervical lymph nodes in 10( 18%). There was 1 child with submandibular localization,1 supraclavicular, 2children with axillary lymphadenitis and one with mesenterial lymphadenitis. Most of the patients had contact with TB. The diagnosis was confirmed pathohistological in the patients with peripheral lymphadenitis. Tuberculosis treatment was started in all patients based on clinical criteria, exposure, positive TST, chest X-ray, or histological confirmation. All of the patients have finished the treatment successfully. Tuberculous lymphadenitis can be a diagnostic and therapeutic challenge in children. Early diagnosis and timely initiation of therapy lead to favorable therapeutic outcome and reduce complications.
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UNEXPECTED FOREIGN BODY AS A REASON OF LOBAR PNEUMONIA IN A 6,5 YEARS OLD BOY – CASE REPORT
(Macedonian Association of Anatomists, 2022)
Mitrovska Josifova, Veselinka
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Chakalaroska, Irena
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Spasova, Olga
We present a case of a foreign body as a reason for right lobar pneumonia in 6,5 years old boy. He was admitted in our hospital because of 6 day high fever (up to 40 Cͦ), malaise, cough, stomach ache. Clinically he had impaired breathing in the basis of the right lung, and laboratory findings were with elevated inflammatory markers. The radiogram of the chest showed round consolidation in the right low lung lobus. Microbiologicaly, we isolated Mycoplasma pneumonia (IgM) from pneumoslide, and also Staphylococcus aureus – MRSA from the sputum. Additional immunology tests like immunoelectrophoresis ( IgA, IgG, IgM) were done, all of them with results in normal ranges. After one week of therapy with parenteral rehydration, wide spectral antibiotics (according to antibiogram), inhalatory bronchodilatator and systemic corticosteroid, the child presented with scarce haemoptysis, with consecutive clear haemoptysis on the 10-th day. This set for bronchoscopy and Mx-test with PPD5, which was negative. Flexibile bronchoscopy was made at 11th day of the stay, with visualized foreign body- grass like structure in the openings of the arm of middle and lower right bronchus. We continued with rigid bronchoscopy, with successfully removed grass- Hordeum murinum. After the intervention we observed completely clinical recovery of the lung findings, as well as radiological improvement

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