Faculty of Medicine
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Item type:Publication, Miliary Pulmonary Metastases from Lung Adenocarcinoma: A Case Report(SASPR Edu International Pvt. Ltd, 2026-08-05); ; ; Introduction: Miliary dissemination of adenocarcinoma is a rare, aggressive, and often terminal form of metastasis characterized by countless tiny (millimetric) nodules spreading throughout the lungs, mimicking miliary tuberculosis. It affects less than 5% of all lung adenocarcinomas. The aim of this study is to present a case of miliary disseminated adenocarcinoma originating from the lung with all diagnostic requirements. Materials and methods: A 57year old male patient with 80-pack year smoking status admitted for invasive diagnostics in our clinic between (22.10.2026-29.10.2026) due to x-ray showing miliary disseminated lung infiltrates and pleural effusion. Results: The light criteria of the pleural effusion showed exudate with high LDH values highly suspected of malignancy. Contrast enhanced CT was scheduled and it showed multiple miliary disseminated infiltrates, mediastinal and hilar lymphadenopathy. Liver and adrenal gland metastases were also noted. Bronchoscopy with TBB from the branch of the right upper lobe, together with TBNA from position 7 and 11R, both came positive for adenocarcinoma. Immunohistochemistry was positive in 50% of ROS1; TTF1; CK7; CEA; and negative on CK20; EGFR, ALK, PDL1 confirming primary adenocarcinoma of the lung. Additionally, the patient was presented on tumor bord for treatment options and staging being T4N3M1c2. Conclusion: Miliary disseminated adenocarcinoma is aggressive and usually diagnosed late. Immunohistochemistry can provide an exact origin of the malignant disease. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, GNB1-related neurodevelopmental disorder due to a pathogenic exon 6 variant NM_002074.5:c239T>A (p.Ile80Asn) inherited from an asymptomatic father with mosaicism(BMJ, 2026-05); Ademi, BlerimGNB1-related neurodevelopmental disorder is a rare developmental encephalopathy caused by pathogenic variants in GNB1 The disorder presents with early-onset developmental delay, hypotonia, movement disorders, seizures and/or epilepsy and varied electroencephalographic (EEG) findings, which may occur even in the absence of seizures.We report a male toddler with early-onset global developmental delay, hypotonia, dysmorphic features, bilateral sensorineural hearing loss, nystagmus, transient neonatal focal seizures and emerging EEG findings. Genetic testing identified a pathogenic GNB1 missense variant NM_002074.5:c239T>A (p.Ile80Asn) inherited from an asymptomatic father with mosaicism.This case illustrates the clinical variability of GNB1 encephalopathy, expands the spectrum of reported inheritance patterns and highlights the importance of early genetic testing of infants with developmental delay and pathological EEG patterns. Recognition of the electroclinical patterns is essential for early diagnosis, genetic counselling and multidisciplinary management. The future expansion of longitudinal clinical and EEG data will be essential for prognosis and possible future therapeutic approaches. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Neurodevelopmental disorder associated with NARS1 gene mutation in a child with cerebral palsy(Medip Academy, 2024-04-30); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CLINICAL RECOGNITION OF RETT SYNDROME(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2022); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Xenobiotics Induced Liver Toxicity(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2026-06-01); ; ; ; Technological advancement and industrialization have significantly increased human exposure to xenobiotics, a diverse group of foreign chemical substances with potential toxic effects. Xenobiotics include pharmaceuticals, pesticides, personal care products, industrial chemicals, and environmental pollutants. The liver, as the primary organ responsible for biotransformation, plays a central role in the detoxification and activation of these compounds. However, metabolic processes may generate reactive intermediates that contribute to hepatocellular injury. This review provides a comprehensive overview of xenobiotic classification, mechanisms of hepatic biotransformation, and the molecular pathways underlying xenobiotic-induced hepatotoxicity. Special emphasis is placed on oxidative stress, reactive metabolite formation, and immune-mediated mechanisms. Clinical manifestations, diagnostic approaches, and current management strategies are also discussed. Understanding these processes is essential for early detection, prevention, and improved therapeutic outcomes in patients with xenobiotic-induced liver injury. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Methods for tissue perfusion assessment after Dellon decompression of tarsal tunnels in diabetic neuropathy: key to effective management—a narrative review(Wolters Kluwer Health, 2025-01-02); ; ; Background and Objective Diabetic neuropathy significantly elevates the risk of foot ulceration and lower-limb amputation, underscoring the need for precise assessment of tissue perfusion to optimize management. This narrative review explores the intricate relationship between sympathetic nerves and tissue perfusion in diabetic neuropathy, highlighting the important role of autonomic neuropathy in blood flow dynamics and subsequent compromises in tissue perfusion. The consequences extend to the development of diabetic peripheral neuropathy and related foot complications. By analyzing both non-invasive diagnostic methods and surgical interventions, such as tarsal tunnel decompression, the paper seeks to highlight their effectiveness in improving tissue perfusion, preventing ulcers, and reducing the risk of amputations in patients with diabetic peripheral neuropathy. Methods We reviewed current literature on both non-invasive diagnostic tools and surgical techniques for assessing and improving tissue perfusion in diabetic neuropathy. Methods discussed include transcutaneous oxygen pressure (TcPO2), Doppler ultrasound, Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI, and the SPY Laser Angiographic System. Key Content and Findings Emphasizing the critical importance of surgical interventions, such as tarsal tunnel decompression and neurolysis of the posterior tibial nerve, the article underscores their efficacy in enhancing tissue perfusion and preventing ulcers and amputations. Additionally, it addresses the significance of precise blood flow measurement and timely intervention in the management of diabetic neuropathy and foot ulcers. The non-invasive techniques for assessing tissue perfusion and blood flow in diabetic neuropathy such as TcPO2, Doppler ultrasound and Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI are explained. Also, this review introduces the SPY Laser Angiographic System, which employs near-infrared fluorescence imaging to assess blood flow and perfusion in tissues. This advanced tool generates real-time microvascular blood flow images and proves instrumental in diagnosing and monitoring diabetic foot ulcers. Conclusions In conclusion, surgical interventions, both vascular and peripheral nerve are pivotal for optimizing patient care. Early identification of foot ulcers and peripheral arterial disease is imperative, and an understanding of blood flow dynamics, combined with effective surgical techniques, constitutes key elements in managing diabetic neuropathy, healing and preventing ulcers, and limb salvage. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease(Multidisciplinary Digital Publishing Institute (Switzerland), 2025-02-12); ; ; Jovanovska, KaterinaBackground: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is revolutionizing surgery by providing a bloodless field without tourniquet use, reducing risks, costs, and enhancing patient comfort. While extensively used in hand surgery, its application in foot and ankle procedures, particularly for high-risk patients with diabetic neuropathy and peripheral artery disease (PAD), remains underexplored. This study evaluates the safety, efficacy, and outcomes of WALANT for tarsal tunnel decompression in such patients. Methods: Between March 2022 and April 2024, 32 patients with diabetic neuropathy and PAD underwent Dellon decompression of the tarsal tunnel. Five received spinal anesthesia with a tourniquet, while 27 underwent WALANT. Outcomes assessed included operative time, Visual Analogue Scale (VAS) pain scores, posterior tibial artery blood flow (via Doppler ultrasonography), and complications. Data were collected preoperatively, immediately postoperatively, and at six and nine months. Results: WALANT reduced operative time (40 ± 8 min vs. 65 ± 10 min) and required fewer personnel (four vs. six). VAS scores improved significantly in the WALANT group (from 8.65 ± 0.84 preoperatively to 1.21 ± 0.24 at nine months). Posterior tibial artery blood flow also showed superior improvements with WALANT (5.30 ± 0.65 cm3/s vs. 2.50 ± 0.45 cm3/s). Minor wound healing delays were noted in two WALANT cases; no major complications occurred. Conclusion: WALANT offers a safe, efficient alternative to spinal anesthesia for tarsal tunnel decompression in high-risk patients, minimizing ischemic risks, enhancing vascular outcomes, and reducing postoperative pain. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, THE IMPACT OF INFLUENZA A ON BLOOD DONATION(Macedonian Association of Anatomists and Morphologists, 2026-05-22) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dosimetric comparison of organs at risk in ultra-hypofractionated versus hypofractionated postoperative radiotherapy for early breast cancer: single center clinical study(Walter de Gruyter GmbH, 2026-02-06); Creslovnik, Albina PupakovskiBackground Growing evidence of safety and feasibility has prompted a shift toward ultra-hypofractionated (UHF) schedules in postoperative radiotherapy in early breast cancer. Patients and methods Eighty patients over 50 years of age with early breast cancer (T1-2 and N0-1) who underwent postoperative, 3D conformal, free-breathing whole breast radiotherapy were included. The prospective arm consisted of 40 patients treated with UHF (26 Gy/5 fractions/one week) from 2023-2024, whereas the control arm was retrospective and represented by data from 40 patients treated with hypofractionated radiotherapy (HF) (40.5–42.2Gy/15–16 fractions/3 weeks) between 2015 and 2020. Dosimetric parameters for organs at risk (OARs) (heart and ipsilateral lung) were derived from the dose-volume histograms. Statistical evaluation was done with paired sample t-test and Mann-Whitney U test. Results Dosimetric analysis revealed that patients treated with UHF schedule received significantly lower equivalent doses in 2 Gy fractions (EQD 2 Gy) to OARs compared with those treated with the HF schedule. The mean ipsilateral lung EQD 2 Gy dose was significantly lower in the UHF group (3.94 ± 2.1 Gy) than in the HF group (6.24 ± 2.4 Gy; p < 0.01). Among patients with left-sided breast cancer, the mean heart EQD 2 Gy dose was also significantly reduced in the UHF group (1.34 ± 0.5 Gy) compared with the HF group (3.02 ± 1.4 Gy; p < 0.01). Conclusions These findings indicate a consistent dosimetric advantage of the UHF schedule, particularly in reducing radiation exposure to the heart and ipsilateral lung. These results support the dosimetric safety and feasibility of UHF schedules in early breast cancer treatment. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Conformity Index and Homogeneity Index of the Postoperative Whole Breast Radiotherapy(Scientific Foundation Spiroski (publications), 2017-09-13); BACKGROUND: The treatment of breast cancer involves a multidisciplinary approach in which radiotherapy plays a key role. AIM: The conformity index and the homogeneity index are two analysis tools of a treatment plan using conformal radiotherapy. The purpose of this article is an analysis of these two parameters in the assessment of the treatment plans in 58 patients undergoing postoperative radiotherapy of the whole breast. MATERIALS AND METHODS: All 58 patients participating in the study had a conservatively treated early-stage breast cancer. The treatment was performed using a standard regimen of fractionation in 25 fractions up to a total dose of 50Gy. Dose-volume histograms were generated for both plans with and without segmental fields. RESULTS: Pair samples t-test was used. The technique with segmental fields allowed us more homogeneity distribution when compared to standard two tangential field techniques. The HI values were 1.08 ± 0.01 and 1.09 ± 0.01 for segment and technique with two tangential fields (p < 0.001). The DHI values were 0.92 ± 0.02 and 0.901 ± 0.01 for segment and technique with two tangential fields (p < 0.001). The CI values were 1.38 ± 0.02 and 1.43 ± 0.3 for segment and technique with two tangential fields (p = 0.0018). CONCLUSION: The results showed that the conformity and the homogeneity index are important tools in the analysis of the treatment plans during radiation therapy in patients with early-stage breast cancer. Adding segment fields in the administration of radiotherapy in patients with conservatively treated breast cancer can lead to improved dosage homogeneity and conformity.