Faculty of Medicine

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Non-ampullary mucinous adenocarcinoma of the small intestine unmasked by persistent anemia: A Case Report
(Liga-Inform, Ltd., 2026-02-23)
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Jankoski D
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Kutanoski D
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Kostovska, Irena
Non-ampullary mucinous adenocarcinoma of the small intestine unmasked by persistent anemia: A Case Report
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Perforated solitary mid-rectal diverticulum diagnosed with colonoscopy: a case report and literature review
(Oxford University Press (OUP), 2025-12-24)
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Avramoski, Vladimir
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Gjinoska, Klaudia
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Kostovska, Irena
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Stoicovski, Emil
Rectal diverticulum is an exceedingly rare clinical entity, typically occurring as a solitary lesion or, less frequently, as up to three diverticula. Its development is often associated with underlying conditions such as obstructive defecation syndrome, rectal malignancy, pelvic floor weakness, chronic rectal impaction, obesity, or infection-related muscular atrophy. Although uncommon, rectal diverticulitis represents a surgical emergency requiring timely recognition and management. In this case, a female patient presented with rectal bleeding and secondary anemia. During the clinical course, the patient developed pelvic sepsis secondary to rectal diverticulitis. Appropriate surgical intervention, combined with antimicrobial therapy and supportive management, led to a favorable outcome. Rectal diverticulitis is a rare but potentially life-threatening condition. Awareness of this entity and early diagnosis are essential to prevent severe complications such as perforation and pelvic sepsis. This case highlights the importance of considering rectal diverticulum in the differential diagnosis of lower gastrointestinal bleeding and pelvic infections.
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Linking inflammation and cardiovascular disease: the emerging role of lipoprotein-associated phosphoplipase A2
(Ltd Chetverta Кhvylia, 2025-12)
Kostovska, Irena
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Over the past decades, inflammation has been recognized as a key contributor to the development of atherosclerosis, prompting extensive research. Numerous inflammatory markers have demonstrated predictive value for both initial and recurrent coronary events in individuals with or without established coronary vascular disease (CVD). Among these, lipo protein associated phospholipase A2 (Lp PLA2) has garnered significant attention. Lp PLA2 may be involved in the athero sclerotic process and contribute to plaque destabilization through its inflammatory activity within atherosclerotic lesions. Lipoprotein associated phospholipase A2 (Lp PLA2), a recently identified cardiovascular specific inflammatory mediator, is closely associated with the onset and progression of cardiovascular events. This review explores the potential of Lp PLA2 as both a risk marker and a therapeutic target in CVD. Elevated levels of Lp PLA2 mass and activity have been linked to an increased risk of CVD in both the general population and patients with pre existing disease. However, it remains uncer tain whether incorporating Lp PLA2 measurements into risk prediction models significantly enhances risk stratification beyond traditional cardiovascular risk factors. Additionally, the failure of darapladib, a potent and selective Lp PLA2 inhibitor, to reduce CVD events in major randomized, placebo controlled trials suggests the importance of ongoing research to fully understand its functions and develop effective strategies for CVD prevention and treatment.
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Laparoscopic revision of open appendectomy complicated by high-output colo-cutaneousfistula:acasereport
(Oxford University Press and JSCR Publishing Ltd., 2025-12)
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Jankoski, Daniel
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Kostovska, Irena
Colo-cutaneous fistulae are rare complications following appendectomy, especially when high-output, and can cause significant morbidity. We report a 66-year-old male who presented nine days post-open appendectomy with fecal discharge from the incision. Imaging showed cecal adherence to the anterior abdominal wall, consistent with a colo-cutaneous fistula. Conservative management failed, with persistent high-output drainage of 600–1000 mL/day. The patient underwent laparoscopic revision, including adhesiolysis, mobilization of the terminal ileum and ascending colon, and resection with extracorporeal ileocolic anastomosis. Postoperative wound healing was managed with secondary intention and negative pressure therapy. The patient recovered well and was discharged in stable condition. This case demonstrates the effectiveness of laparoscopic intervention in high-output colo-cutaneous fistulae and highlights the need for timely surgical management when conservative measures fail.
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DIAGNOSTIC VALUE OF FINE-NEEDLE ASPIRATION BIOPSY IN PATIENTS WITH THYROID CANCER AND HASHIMOTO THYROIDITIS
(Department of Anaesthesia and Reanimation Faculty of Medicine, “Ss. Cyril and Methodius” University, Skopje, R.N.Macedonia, 2025-12)
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Kostovska, Irena
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Introduction: Thyroid nodules are a common finding in clinical practice, with prevalence ranging from 2-6% on physical examination, 19–35% on ultrasound, and 8–65% in autopsy studies. Their incidence increases with age and is more frequent in women, individuals with iodine deficiency, and those previously exposed to ionizing radiation. Hashimoto’s thyroiditis may alter cytological interpretation and affect diagnostic accuracy.
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Liver Echinococcosis - A Single-Center Retrospective Study
(GALENOS PUBLISHING HOUSE, 2025-12)
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Kostovska, Irena
Liver echinococcosis, endemic to Mediterranean and livestock-farming regions, is characterized by hydatid cyst formation, primarily affecting the liver. Surgical management remains the primary treatment for large or complex cysts. The study aimed to evaluate surgical outcomes, complications, and recurrence rates associated with the Papadimitriou procedure, hepatic resections, and splenectomy in patients with liver echinococcosis at a single center.
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Contrasting molecular pathways in colorectal carcinogenesis: insights from the Cancer Stem Cell paradigm
(Liga-Inform Ltd, 2025-12)
Kostovska, Irena
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Contrasting molecular pathways in colorectal carcinogenesis: insights from the cancer stem cell paradigm.
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Serum amyloid A as a biomarker: diagnostic relevance and clinical association with acute ischemic stroke
(MEDICAL FACULTY - SKOPJE, 2025-10-16)
Ivanovska, Slavjana
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Kerala, Coskun
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Kostovska, Irena
Serum amyloid A (SAA) is an acute-phase protein that circulates at low levels bound to high-density lipoproteins (HDL). During inflammation, its concentration rises sharply, altering HDL composition, lipid transport, and cholesterol metabolism. These changes contribute to vascular pathology, particularly atherosclerosis. Owing to its multifunctional role, SAA has gained attention as a potential biomarker in cardiovascular and cerebrovascular diseases, although its role in acute ischemic stroke (AIS) remains insufficiently clarified.
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Association of FGF23 with markers of macrovascular complications, lipid profile, and inflammation in patients with type 2 diabetes mellitus and early-stage chronic kidney disease
(Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2025-12)
Minova Nedeska, Natasha
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Kostovska, Irena
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Baloski M
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Ilievska CV
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COMPARATIVE ACCURACY OF LDL-CHOLESTEROL ESTIMATION: OMPARATIVE ACCURACY OF LDL-CHOLESTEROL ESTIMATION: A META-ANALYSIS OF THE FRIEDEWALD AND MARTIN-HOPKINS EQUATION META-ANALYSIS OF THE FRIEDEWALD AND MARTIN-HOPKINS EQUATION
(Bulgarian Society of Cardiology and Pensoft Publishers, 2025-12-04)
Kostovska, Irena
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Introduction: Low-density lipoprotein cholesterol (LDL-C) is a cornerstone biomarker for cardiovascular risk. The Friedewald formula has long been the standard for estimating LDL-C, however, it has limitations, particularly in patients with hypertriglyceridemia or low LDL-C levels. Several alternative equations, including the Martin–Hopkins (M/H) and Sampson formulas, have been developed to improve accuracy. Among them, M/H has gained recognition for its performance in specific populations, but it represents only one of several refined methods used across professional communities. This study aimed to perform a meta-analysis comparing the accuracy and precision of the Friedewald and M/H formulas in diverse populations, acknowledging that other approaches also exist. Methods: A systematic review of articles published between 2018 and 2024 was conducted using PubMed, Embase, Scopus (Elsevier), and Web of Science-eligible studies directly compared both formulas against direct LDL-C measurement in adult populations. A random-effects model was used to pool mean absolute errors (MAEs), root mean square errors (RMSEs), correlation coefficients, and p-values. Heterogeneity was assessed using the I² statistic. Results: Eight novel studies, involving a total of 192,094 participants, were included. The M/H formula showed significantly lower MAE (3.6 mg/dL vs. 8.4 mg/dL, p < 0.001), lower RMSE (5.1 mg/ dL vs. 9.8 mg/dL, p < 0.001), and a stronger correlation with direct LDL-C (r = 0.92 vs. r = 0.84) compared to the Friedewald formula. The superiority of the M/H formula was especially evident in patients with triglycerides >200 mg/dL or LDL-C <70 mg/dL. Conclusion: The M/H formula provides more accurate and precise LDL-C estimation than Friedewald, particularly in clinically vulnerable groups. However, it should be considered one of several improved approaches, alongside other equations such as Sampson, which may perform better in certain populations. M/H can be recommended as a strong option, but is not the sole alternative for routine lipid profiling.

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