Faculty of Medicine

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    Acute severe poisoning with disinfectant in senior aged patient-case report and overview of literature considering age influence on treatment decision in alcohol-based intoxications
    (2021-09)
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    Afrodita Berat-Huseini
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    Kiril Naumoski
    We present our experiences in the first case of severe suicidal poisoning with 70% ethanol-disinfectant in North Macedonia, in an elderly patient with immunocompromising comorbidities. A 66-year-old unconscious woman was admitted at our clinic, with a history of seropositive rheumatoid arthritis treated with methotrexate. She was in a coma, without signs of serotonin syndrome, recurrent episodes of cardio-respiratory insufficiency under supportive treatment without invasive ventilation, metabolic acidosis, increased D-dimer 3254 ng/mL. The toxicology screening confirmed low benzodiazepines levels and alcoholaemia of 526 mg/dL (5.26 g/L), due to ingestion of 70% ethanol. Considering the decreased biotransformation in the elderly, immunocompromising comorbidities, reports of fatal outcome in poisoned elderly patients with disinfectants under standard fluids supportive protocol, haemodialysis was initiated, with registered associated hypercoagulability which resulted in complete stabilization after 48 h of admission. Treatment protocols of poisoning with ethanol-based disinfectant in the elderly should consider timely performing haemodialysis at lower alcoholaemia levels than recommended.
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    Pregnancy in End-stage Renal Disease Patients on Long-term Hemodialysis: Two Case Reports
    (Macedonian Society of Nephrology, Dialysis, Transplantation and Artifical Organs, Department of Nephrology, 2010)
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    Tozija, Liljana
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    Gelev, Saso
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    Adamova, Gordana
    Although still uncommon, pregnancy in haemodialysis (HD) patients does occur and frequency has been increased in the past 20 years. But unfortunately, the rates for premature delivery, neonatal death, maternal hypertension, and preeclampsia in the pregnant HD patient are much higher than in the general population. Infants are often born both prematurely and small for gestational age. We report here two cases of pregnancy in women on long-term HD, one successfully and the other unsuccessfully managed, despite the same treatment strategy. Case 1 was a 43-year-old female patient, 10th gravida, after six years of maintenance HD whose pregnancy was successfully managed up to the 33rd week of gestation with a delivery of a healthy boy weighing 2,100 g. Case 2 was a 32-year-old female patient, 2nd gravida, after five years of maintenance HD, whose pregnancy ended in spontaneous abortion with intrauterine death at week 19 of gestation. Maternal hypertension and anemia contributed partly to the unsuccessful outcome. A successful pregnancy in HD patients requires multidisciplinary management, but considering the previous nephrological/ prenatal/gynaecological/obstetric recommendations, many open questions remain when it comes to the best treatment and management of pregnancy in these women.