Faculty of Medicine

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Maternal and perinatal outcomes in women with advanced maternal age affected by SARS-CoV-2 infection (Phase-2): The WAPM (World Association of Perinatal Medicine) Working Group on COVID-19
(Cetus Publishing, 2021-03-09)
D'Antonio, Francesco
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Şen, Cihat
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Di Mascio, Daniel
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Galindo, Alberto
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Villalain, Cecilia
Objective To elucidate the role of advanced maternal age (AMA) in determining the outcome of pregnancies complicated by SARS-CoV-2 infection. Methods Multinational cohort study included women with laboratory-confirmed SARS-CoV-2 infection from 76 centers in 27 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortality and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation (defined as intubation, need for continuous positive airway pressure, extra-corporeal membrane oxygenation), severe respiratory symptoms (including dyspnea and shortness of breath) or death. Results Eight hundred and eighty seven pregnant women were included in the study who were positive SARS-CoV-2 results by RT-PCR (reverse transcriptase-polymerase chain reaction) on their nasal and pharyngeal swab specimens (352 with and 652 with no AMA). The risk of composite adverse maternal outcome was higher in AMA group compared to that of under 35 years of age group, with an OR of 1.99 (95% CI 1.4–2.9; p=0.002). Likewise, women >35 years were also at higher risk of hospital admission (OR: 1.88, 95% CI 1.4–2.5; p<0.001), presence of severe respiratory symptoms (OR: 1.53, 95% CI 1.0–2.3; p=0.04) and/or admission to ICU (OR: 2.00, 95% CI 1.1–3.7; p=0.003); however, no difference was observed in terms of perinatal outcome risk. Conclusion Advanced maternal age is an independent risk factor for adverse maternal outcome in pregnancies complicated by SARS-CoV-2 infection. Accurate risk stratification of women presenting with suspected SARS-CoV-2 infection in pregnancy is warranted in order to identify a subset of women who may benefit from a personalized management, including elective hospitalization and/or prolonged surveillance in order to improve maternal outcome.
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Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection
(Wiley, 2021-02)
The WAPM (World Association of Perinatal Medicine) Working Group on COVID-19
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To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS-CoV-2 infection.
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The precision of CT in detecting atypical forms of active pulmonary tuberculosis
(European Society of Radiology, 2024-05)
The primary objective of this investigation is to underscore the intricate diagnostic capabilities inherent in Computed Tomography (CT) for discerning the nuanced presentations of active pulmonary tuberculosis (PTB). CT imaging stands out for its unparalleled precision in revealing subtle variations within PTB manifestations, often imperceptible through conventional radiography methods [1, 2]. This study emphasizes the paramount importance of comprehensive chest CT analysis in clinical practice. It aims to highlight the critical significance of identifiable diagnostic patterns and markers, advocating for their pivotal role as guiding indicators in the diagnostic process. The scientific underpinning of this approach stems from the collective observations in the field, underscoring the essentiality of leveraging discernible imaging features derived from CT scans for accurate and timely PTB diagnoses [3]. By delving into the nuanced insights gleaned from CT imaging, healthcare practitioners can better navigate the intricate challenges involved in the differential diagnosis of PTB. This research meticulously examines distinct CT imaging features, encompassing cavitation patterns, tree-in-bud opacities, and pleural involvement, with the goal of refining diagnostic precision and expanding the diagnostic toolkit available to clinicians. The comprehensive understanding and integration of these discernible CT imaging markers and patterns not only enhance diagnostic accuracy but also aid in monitoring treatment responses and identifying potential complications or disease relapses. This approach, founded on clinical observations and empirical evidence, empowers clinicians with a more nuanced, comprehensive, and evidence-based diagnostic approach essential for precise identification and effective management of PTB, thereby elevating standards of patient care.
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Necrotizing fasciitis after caesarean section - presentation of two cases
(Македонско лекарско друштво = Macedonian medical association, 2022)
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Trajkova, Andrijana
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Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019
(Elsevier BV, 2021-07)
D'Antonio, Francesco
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Sen, Cihat
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Mascio, Daniele Di
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Galindo, Alberto
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Villalain, Cecilia
It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03–2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07–2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41–3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42–4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19–5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15–2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02–1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90–5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
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Amnioplastic as a treatment of children’s combustions.
(2004-11)
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Evgenija Lazarova
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Biljana Mitevska
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Vesna Tanovska
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Early wound infections following removal of positioning screw from the distal tibio-fibular syndesmosis
(Македонско лекарско друштво = Macedonian Medical Association, 2018)
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Arsovski, Oliver
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Nikolov, Ljupco
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Merdzanoski, Igor
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Antifungal susceptibility profile of Aspergillus species from patients with increased risk for aspergillosis
(Macedonian Pharmaceutical Association, 2022-02-25)
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Marija Stojanova
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Aspergillosis is the most common fungal infection caused by molds, especially in highrisk patients. The treatment of these diseases is based on the use of polyene and azole antifungal drugs. Resistance rates of Aspergillus species to antifungal drugs vary widely across medical centers around the world. Antifungal susceptibility testing of Aspergillus species to antifungal agents could provide useful information for clinicians to make decision regarding the patient therapy. The aim of the study was to evaluate the antifungal susceptibility profile of Aspergillus species towards amphotericin B, itraconazole, voriconazole and caspofungin, isolated from patients with increased risk for aspergillosis. During a 2-year period, clinical specimens from 125 patients divided into 4 groups according to clinical diagnosis and EORTC/MSG criteria, were analysed at the Institute of Microbiology and parasitology, Faculty of Medicine, Skopje, Republic of North Macedonia. These groups included patients with primary immune deficiency, critically ill patients treated in intensive care units, patients with chronic aspergillosis and cystic
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FUNGI IN SKIN AND SOFT TISSUE INFECTIONS - A THREE-YEAR STUDY
(Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R Macedonia, 2021-12)
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Mehmeti, Blerta
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Stojanova, Marija
Introduction: Exposure of subcutaneous tissue following a loss of skin integrity provides a suitable environment for microbial colonization and proliferation, which contributes to delayed healing and infection of the wound. The aim of this study was to retrospectively investigate the spectrum of fungi responsible for skin and soft tissue infections over a 3-year period, and to compare the results with those from other parts of the world. Material and methods: The study was performed during a 3-year period (2017-2019) and included analysis of 11 863 wound samples, which were obtained from patients hospitalized at the University Clinics of the “Mother Theresa” campus, City hospital ”8th September” and University Clinic for Surgical Diseases “St. Naum Ohridski” in Skopje. All specimens were analyzed by standard mycological methods at the Institute of Microbiology and Parasitology. Results: Growth of fungi was confirmed in 5.5%, 5% and 6.2% of the positive specimens, during a 3-year period, respectively. C.albicans was the predominant yeast (67.6%, 63%, 63.2% in 2017, 2018 and 2019, respectively). Molds were represented by Aspergillus confirmed in 3, 4 and 5 specimens, and Fusarium was confirmed in 2, 3 and 3 specimens during the 3-year period respectively. Mucor was detected in 3 patients, in 2019 only. Conclusion: Species identification of fungal microbes in wound specimens revealed that Candida species was the most predominant species, followed by Aspergillus and non-Aspergillus molds. It is crucial for every institution that treats patients with wounds to be aware of fungi as possible etiological agents of wound infections.
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Cardiovascular disease and COVID-19: a consensus paper from the ESC Working Group on Coronary Pathophysiology & Microcirculation, ESC Working Group on Thrombosis and the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Heart Rhythm Association (EHRA)
(Oxford University Press (OUP), 2021-09-16)
Cenko, Edina
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Badimon, Lina
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Bugiardini, Raffaele
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Claeys, Marc J
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De Luca, Giuseppe
The cardiovascular system is significantly affected in coronavirus disease-19 (COVID-19). Microvascular injury, endothelial dysfunction and thrombosis resulting from viral infection or indirectly related to the intense systemic inflammatory and immune responses are characteristic features of severe COVID-19. Pre-existing cardiovascular disease and viral load are linked to myocardial injury and worse outcomes. The vascular response to cytokine production and the interaction between SARS-CoV-2 and ACE2 receptor may lead to a significant reduction in cardiac contractility and subsequent myocardial dysfunction. In addition, a considerable proportion of patients who have been infected with SARS-CoV-2 do not fully recover and continue to experience a large number of symptoms and post-acute complications in the absence of a detectable viral infection. This conditions often referred to as "post-acute COVID-19" may have multiple causes. Viral reservoirs or lingering fragments of viral RNA or proteins contribute to the condition. Systemic inflammatory response to COVID-19 has the potential to increase myocardial fibrosis which in turn may impair cardiac remodelling. Here we summarize the current knowledge of cardiovascular injury and post-acute sequelae of COVID-19. As the pandemic continues and new variants emerge, we can advance our knowledge of the underlying mechanisms only by integrating our understanding of the pathophysiology with the corresponding clinical findings. Identification of new biomarkers of cardiovascular complications, and development of effective treatments for COVID-19 infection are of crucial importance.

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