Faculty of Medicine

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    False positive drug test in patient with acute poisoning
    (Македонско лекарско друштво = Macedonian Medical Association, 2025-04-07)
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    Plasmapheresis in managing copper sulphate poisoning
    (Informa UK Limited, 2025-05-27)
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    Chibishev, Andon
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    Bekjarovski, Niko
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    D-dimer as a prognostic biomarker of the outcome in acute corrosive poisoning
    (2025-05-27)
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    Bekjarovski, Niko
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    Chibishev, Andon
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    Fatal Case of Opioid Overdose with Somatic Comorbidity: A Case Report and Review
    (Türkiye Klinikleri, 2025-03-21)
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    Kiril NAUMOVSKI
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    Kristin KOSTADINOVSKI
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    Corrosive poisonings during the COVID-19 pandemic: trends and demographic shifts in the pre- and early vaccination periods (2020–2021)
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2025-09-15)
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    Bekjarovski, Niko
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    Chibishev, Andon
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    The COVID-19 pandemic significantly disrupted global healthcare and societal norms, leading to changes in poisoning patterns, particularly corrosive poisonings (CP). This study aimed to evaluate the impact of the pandemic on CP trends in North Macedonia by comparing observed data from 2020 and 2021 with predicted values (PV) based on a 10-year trend. Methods: A retrospective study was conducted using data from the Poisoning Registry at the PIC, University Clinic of Toxicology, Skopje. Patients with confirmed acute upper gastrointestinal corrosive injuries were included. Results: Between 2010 and 2021, 1,668 CP cases were recorded. While an overall downward trend was observed (y = -6.5x + 181.4, R² = 0.56), CP cases declined by 1.5% in 2020 and by 25.5% in 2021 compared to PV. Female cases decreased by 27.5% in 2021; male cases declined by 16.6% in 2020 and 32.4% in 2021. Adolescent CP increased by 12.8% in 2020 and 80.0% in 2021; cases in those over 75 years rose by 2.5% and 6.2%, respectively. The mean age of CP patients rose by 7.6% in 2020 and 11.0% in 2021. Suicidal poisonings increased by 9.9% in 2021. Disinfectant poisonings rose by 74.5% in 2020, while hydrochloric acid (+6.2%), detergents (+3.4%), and degreasers (+32.0%) increased in 2021. Case fatality ratios rose by 36.2% in 2020 and 44% in 2021. Conclusion: Although the overall number of cases declined, the increased severity, lethality, and demographic shifts—particularly among adolescents and the elderly—highlight the high-risk groups, mental health burden and toxicological risks associated with public health emergencies
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    Poisonings with Endemic Plants in Macedonia
    (Macedonian Association of Internal Medicine, 2022-05)
    Bekjarovski, Niko
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    Jurukov, Irena
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    Insulin resistance and metabolic syndrome in hepatitis C virus seronegative heroin dependents
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2023-12)
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    Janicevic Ivanovska, Danijela
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    Initial studies on impaired glucose-insulin homeostasis in heroin dependents have not defined the impact of concomitant hepatitis C infection (HCV), which has been strongly associated with the development of insulin resistanceand metabolic syndrome (MS). The aim of our study was to evaluate the association of heroin dependence with glucose-insulin homeostasis and MS in heroin dependents with HCV seronegativity. Materials and methods: The study was prospective and cross-sectional, including 160 heroin dependents compared to a control group of 60 participants.MS was diagnosed using International Diabetes Federation criteria. The homeostatic model assessment for insulin resistance (HOMA-IR) and pancreatic β-cell function (HOMA-%B) were used for assessing insulin resistance and β-cell function of pancreas. Results: MS was detected in 9.32% of heroin addicts. Heroin dependents with MS compared to dependents without MS were older, had higher BMI, waist circumference and significantly higher systolic and diastolic blood pressure, increased triglycerides (F=8.233, df=2, p<0.001), apoB (F=8.154, df=2, p=0.001), and reduced HDL-C (F=25.926, df=2, p<0.001) and apoA-I (F=16.406, df=2, p<0.001), significantly increased inuslinemia (F=4.928, df=2, p<0.05), insulin resistance-HOMA-IR (F=4,928, df=2, p<0,05) and insignificantly increased pancreatic β-cell function (194.66 ±224.05) (F=2.461, df=2, p>0.05). Conclusions: Insulin resistance and МS, independent of HCV, was also registered in heroin dependence. Timely recognition will enable more successful treatment of comorbidities and illicit drug dependence.
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    Drug-induced vasculitis with multi-organ injury in a splenectomised patient and mycophenolate mofetil therapy – a case report
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2025-02)
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    Bekjarovski, Niko
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    We present a case with p-ANCA positive general vasculitis and severe multi-organ injury in a splenectomised patient, which developed during ceftriaxone and metamizole administration for treatment of upper respiratory infection. Case report: A middle-aged woman with 400C fever and sore throat got a treatment with IV metamizole and ceftriaxone in a local hospital. She had a post- traumatic splenectomy 5 years ago. After metamizole, during ceftriaxone administration she felt burning in her face, developing red rush which spread over the face and darkened, later extended to her palms and feet. After visiting several clinics, she was referred finally to the University Clinic for Toxicology in Skopje. On admission, she had hypotension, hypoxemia, livid oro-pharynx, necrotic vasculitis with predominant facial distribution and unpalpable purpura on the extremities. The examinations revealed high levels of inflammatory biomarkers, anaemia, polyserositis, acute pancreatitis, hepatomegaly, acute kidney injury, disseminated intravascular coagulation, right eye vitreous haemorrhage and rhabdomyolysis. Microbiological investigations were negative. Immuno-serology showed positive p-ANCA. The acute renal failure and polyserositis resolved under methylprednisolone, meropenem, furosemide, low molecular weight heparin, fresh frozen plasma, and other symptomatic therapy, which decreased the inflammatory biomarkers, but DIC with thrombocytopenia persisted. A skin biopsy finding was inconclusive. After 25 days, the rheumatologist recommended mycophenolate mofetil with prednisolone peroral therapy during two years that resulted in stabilizing the vasculitis. The patient maintained stable after therapy discontinuation. Conclusions: Drug-induced vasculitis has the potential to induce a severe multi-organ injury with life-threatening complications. Mycophenolate mofetil procured a safe and successful treatment of drug-induced vasculitis. Splenectomy may be a potential risk factor for immunomodulated response to drugs and drugs interactions, especially during infections.
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    Comparison of HOMA-IR, Tg/Glucose Index and Tg/HDL-C ratio for predicating Metabolic Sy in HCV seronegative heroin dependents
    (2024-10-23)
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    Bekjarovski, Niko
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    Metabolic syndrome (MetSy) with insulin resistance was represented, although in lesser extend, in heroin dependents as well as in general population1. Recent studies showed that patients on methadone substitution had a worse metabolic profile compared to buprenorphine2. The quick and easy detection of MetS in heroin addicts is important not only as a metabolic and cardiovascular risk factor, but also as an indicator for recommending a substitution program. The study aims to compare the predictive power of surrogate markers such as Triglyceride-Glucose (TgG) index, HOMA-IR and Triglyceride/HDL-C ratio (Tg/HDL-C) for easier detecting MetSy in heroin dependents.