Faculty of Medicine
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Item type:Publication, Rhabdomyolysis in patients following opioid overdose(2024-10-23); ; ; Rhabdomyolysis is a clinical entity characterized by the destruction of skeletal muscle with the resultant release of intracellular enzymatic content into the bloodstream, leading to systemic complications. This study aimed to determine the clinical and some of the biochemical findings in patients with rhabdomyolysis following opioid overdose. Methods: This study randomly recruited 140 patients suffering from rhabdomyolysis due to acute intoxication and was implemented for one year at the University Clinic for Toxicology. Rhabdomyolysis was defined as a creatine phosphokinase (CK) >250 U/L according to poisoning severity score (PSS). We included adult patients ≥ 18 years of age. We excluded patients with myocardial infarction, renal impairment, acute and chronic hepatitis B and C, and other hepatic impairments, based on the medical history. Results: Out of a total of 140 patients with rhabdomyolysis due to acute intoxication, 14.2 % (n=20) were opioid overdose (male n=19; female n=1). The average age of methadone patients was 36.7±6.6 and in heroin patients 33.6±9.3. On the first, third, and fifth days, serum creatine kinase (CK) values in heroin patients were 8925 vs. 6404.5 vs. 996 U/L, and for methadone overdose 5548.3 vs. 10300 vs. 2114 U/L. Severe rhabdomyolysis according to the PSS score occurs in methadone overdose 46.67% (n=7), and in heroin overdose 40% (n=2). Moderate rhabdomyolysis was observed in heroin overdose 40% (n=2) and in methadone overdose 40% (n=6). For mild rhabdomyolysis, we determined a heroin overdose of 20% (n=1) and a methadone overdose of 13.33% (n=2). Determined values of hs-cTnI in methadone overdose were (n=5) 279.7±190.7 µg/L, and in heroin overdose were (n=4) 78.48±28.88 µg/L. On the first, third, and fifth day, AST values in heroin overdose were 823 vs. 415 vs. 93.5 U/L, and for methadone 242 vs. 420 vs. 285 U/L. In the three measurement times, the highest values of urea in heroin patients were 10.1 vs. 27.2 vs. 20.2 mmol/L, and methadone 6.3 vs. 23 vs. 11.3 mmol/L, the highest values for creatine were in heroin 228 vs. 405.5 vs. 302.5 µmol/L and methadone overdose 108 vs. 199.8 vs. 483.5 µmol/L. Acute kidney injury (AKI) occurred in 21 patients of which heroin was 14.2% (n=3) and 28.5% (n=6) methadone. Renal replacement therapy was applied in 13 patients of which 15.3% (n=2) in heroin and 30.7% (n=4) in methadone overdose. Conclusion: Physicians should be aware that severe and moderate rhabdomyolysis occurs more often in patients with methadone and heroin overdose. Increased levels of CK, high-sensitivity troponin I, AST, urea, and, creatine were associated with opioid overdose and should be identified to initiate appropriate treatment. Acute kidney injury is a common complication in heroin and methadone overdose patients and often there is a need for renal replacement therapy. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Management of acute renal failure(epartment of Anesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2020)In multiple clinical settings, Acute Kidney Injury (AKI) is a frequent condition. AKI increases the short and long-term mortality rate. Although the condition has become more widely recognized, yet there is still lack of definitions and increased number of studies has appeared examining AKI across many different clinical settings. Detailed medical history and physical examination are the key in determining the etiology of AKI and timeline of the progress. The fundamental principles in management of AKI are to treat the underlying cause, optimizing fluid balance and hemodynamics, correct electrolytes and eliminate or adjust the dose of nephrotoxic drugs. Therefore, optimizing hemodynamics and correction of volume depletion will minimize continuation of kidney injury and will improve recovery, preventing any chronic impairment of the kidney. However, there are no guidelines for improving hemodynamics and optimizing volume status for kidney protection. International guidelines for management of sepsis and septic shock recommend a goal-directed therapy (GDT). Acute Dialysis Quality Initiative has proposed a new fluid resuscitation strategy consisting of four phases: rescue, optimization, stabilization and de-escalation phases. Liberal fluid administration is allowed in the rescue phase; in the optimization phase, where the patient is hemodynamically stable, percutaneous fluid management is required with the aim to maintain hemodynamic stability; in the stabilization phase, when the patient is stable, equal or negative fluid balance is preferred; and in last de-escalation phase, all excessive fluid should be removed. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Sex differences and disparities in cardiovascular outcomes of COVID-19(Oxford University Press (OUP), 2023-01-18) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, DIURESIS AND HEMODIALYSIS AS RISK FACTORS ON SHORT-TERM OUTCOME IN ELDERLY PATIENTS WITH ACUTE KIDNEY INJURY(Balkan Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2022-11); ; ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Rhabdomyolysis and Acute Kidney Injury in a Patient with Severe Form of Covid-19 Pneumonia- A Case Report(Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2020); ; ; Introduction. The ongoing pandemic with the novel Corona virus poses unprecented challenges for the me- dical professionals worldwide. Acute kidney injury is frequently seen in patients infected with corona virus and often associated with a poor patient outcome. Rhabdo- myolysis has been recognized as one of the possible contributing mechanisms. Case. A 68-year-old man was referred to the emergen- cy department complaining of a dry cough, myalgia, general weakness with devastated energy feeling, chest pain and difficulties in breathing, symptoms he expe- rienced in the past five days. He also noticed that his urine was dark and in reduced amount. Quick antigen test for SARS CoV2 was performed, and the patient found Covid-19 positive. He was admitted at the hos- pital ward in a covid-designated unit. Laboratory findings revealed elevation of the inflammatory markers and elec- trolyte disbalance. Metabolic degradation products were markedly increased, serum urea was 44mmol/L (RF=2.7- 7.8 mmol/L) and serum creatinine 689umol/L (RF=45- 109umol/L), when deterioration of the kidney function was diagnosed. Urgent intermittent hemodialysis treatment was initiated. Patient suffered from a severe form of covid-19 pneumonia and was continuously on high flow oxygen mask. Duration of the patient hospitalization was 30 days, and thereafter, he was transferred to the reha- bilitation center for 28 days. Complete restoration of the physical motion and activity was accomplished, oxygen support was no longer needed, since he main- tained blood oxygen saturation above 95%. Renal func- tion has also been recovered with degradation products maintained within normal ranges. Conclusion. Rhabdomyolysis in covid-19 patients should be always kept in mind. Sometimes it can be an initial clinical manifestation in covid-19 patients [15], but on the other hand it can be presented as a late complication sometimes caused by the therapy itself. Multidiscipli- nary and comprehensive approach in the diagnosis, treat- ment and follow up of the patients can only guarantee timely detection and wide range of therapeutical moda- lity, leading to a better prognosis and outcome. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, INCIDENCE, RISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY IN PRETERM NEWBORNS(Macedonian Association of Anatomists, 2021); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, NEONATAL ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT(2017); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, NEONATAL ACUTE KIDNEY INJURY ASSOCIATED WITH COMORBID CONDITIONS(Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2015)Acute kidney injury (AKI) is a common clinical problem in neonatal intensive care units. Predisposing factors are perinatal asphyxia, prematurity, sepsis, and congestive heart failure. The aim of this study was to determine the contributung conditions associated with neonatal acute kidney injury.Materials and methods. In a clinical prospective sudy we evaluated neonates with acute kidney injury who had been hospitalized in the NICU at University Childrens Hospitals in Skopje, Republic of Macedonia. We studied medical records of neonates with a diagnosis of acute kidney injury in the period 2013-2014. Results. Out of 450 hospitalized neonates, 29(6.4%) with a documented acute kudney injury were analyzed in the study. The male to female ratio was 2.6:1. Most of the neonates involved in the study were term neonates (66%). Prerenal AKI was evaluated in 80% of cases. Perinatal asphyxia was the most common predisposing factor for kidney injury in our study and was evaluated in 56% cases with predomination of term infants and male. Sepsis was present in 44% of cases, prematurity in 34%, and congenital malformations in 27% of cases. Mortality rate was 26% and it was significantly higher in patients with assisted ventilation and sepsis (p<0.05). Conslusion. Early recognition of risk factors and rapid effective tratment of contributing conditions will reduce acute kudney injury in neonatal period. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SCORE FOR NEONATAL ACUTE PHYSIOLOGY PERINATAL EXTENSION II (SNAPPE II) IN NEONATES WITH ACUTE KIDNEY INJURY(Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2019); ; Timovski VObjective: Acute kidney injury is a serious clinical problem in neonatal intensive care unit. It is defined as a sudden decrease in kidney function resulting in derangements in fluid balance, electrolytes, and waste products. SNAPPE 2 score is a useful tool for assessing the severity of the disease that correlates with neonatal mortality. The aim of the study was to determine the incidence of AKI and the role of SNPPE 2 score in predicting mortality and morbidity in AKI in neonates. Materials and Methods. The study was designed as a prospective, clinical, epidemiological investigation conducted in the period of three years, which included 100 newborn infants (50 with AKI and 50 without AKI) hospitalized in NICU of University Children’s Hospital. The severity of the illness of hospitalized newborn infants was estimated with SNAPPE 2 score realized in the first 12 hours of admission in NICU. Medical data records of admitted neonates with AKI were analyzed. The material was statistically processed using methods of descriptive statistics. Results. During the study period 770 newborns were hospitalized in NICU due to various pathological conditions and 50 newborns have been selected with AKI. As the control group, 50 newborns were taken with comparable associated pathological conditions, but without kidney injury. The calculated prevalence of AKI in neonates was 6.4%. Most of involved neonates in the study in both groups (AKI and non AKI) were born at term (64% and 54%) with predominance of male (68% and 60%). The mortality rate was higher in newborns with AKI than control group (36% vs 24%). In half of newborn infants with AKI predominate severe score level, while in control group predominate median score level (42%). There is a significant difference between the mean score value in neonates with AKI and lethal outcome compared to neonates with AKI without lethal outcome (70.73 ± 18.6 vs. 40.2 ± 16.6). Conclusion: Acute kidney injury is a life threatening condition with still high mortality rate. The severity of the illness of hospitalized newborn infants in NICU is estimated by SNAPPE 2 score. The high score level is associated with the severity of the disease and higher mortality. Appropriate treatment of newborns with severe kidney injury improves the outcome and reduces the mortality of the disease. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ACUTE KIDNEY INJURY IN NEONATES AND NEUTOPHILIC GELATINOUS ASSOCIATED LIPOCALIN AS EARLY BIOMARKER(Macedonian Association of Anatomists, 2019); ;