Faculty of Medicine
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Item type:Publication, 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); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Poisonings with Endemic Plants in Macedonia(Macedonian Association of Internal Medicine, 2022-05); ; ; Jurukov, Irena - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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); ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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); ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparison of HOMA-IR, Tg/Glucose Index and Tg/HDL-C ratio for predicating Metabolic Sy in HCV seronegative heroin dependents(2024-10-23); ; ; - Some of the metrics are blocked by yourconsent settings
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, Frequency of cannabis and amphetamine use past month in patients on opioid maintenance treatment with buprenorphine(2024-10-23); ; ; Background Maintenance treatment for opioid use disorder, either with methadone or buprenorphine-based medications, improves retention in the treatment and reduces abuse of illicit opioids. We aimed to examine the cannabis and amphetamine use before and while the treatment with buprenorphine, as well as the correlation of this findings with the demographic characteristics and duration of opioid use disorder. Methods This analytical cross-sectional study was implemented at the Skopje University Clinic for Toxicology. Participants diagnosed with opioid use disorder receiving pharmacological treatment buprenorphine, were asked to self-report the past month cannabis and amphetamine use. Specially for this study designed questionnaire adapted to the “treatment demand indicator” was used to collect the data. Results Тotal of 112 participants (88.39% male and 11.61% female) were enrolled. Before the buprenorphine treatment, cannabis use was permanent in 60 (53.57%), and periodic or not used in 52 (46.43%) participants, and amphetamine use was permanent in 40 (35.71%), and periodic or not used in 72 (64.29%) participants. After the buprenorphine treatment cannabis was not used or used occasionally by 71 (63.39%) of the participants, ones per week or less was used by 14 (12.50%), 2-6 days per week was used by 9 (8.04%), daily used by 6 (5.36%) and unknown by 12 (10.71%) participants, with not significant association with the gender (p=0.732). negative not significant correlation with the age (R=-0.011; p=0.951) and positive not significant correlation with the duration of opioid dependence (R=0.032; p=0.733). Amphetamine after the buprenorphine treatment was not used or used occasionally by 103 (91.96%) participants, used ones per week or less by 6 (5.36%) and 2-6 days per week by 3 (2.68%) participants with significant association of male gender with no use (p=0.009), negative not significant correlation with the age (R=-0.073; p=0.445) and positive not significant correlation with the duration of opioid dependence (R=0.027; p=0.774). Conclusions Before starting treatment of opioid use disorder with buprenorphine, more than half of the patients had a permanent use of cannabis, while more than a third use amphetamines. After initiation of buprenorphine treatment, although some of the patients occasionally use cannabis and amphetamines, the permanent use of these psychoactive substances is reduced. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute kidney injury and necessity of renal replacement therapy in acutely intoxicated patients with rhabdomyolysis(Serbian Medical Society, 2024-03); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, FATAL INTOXICATION AFTER DELIBERATE INGESTION OF 2-METHYL-4- CHLOROPHENOXYACETIC ACID (MCPA)(Macedonian Association of Anatomists and Morphologists, 2024); ; ; ; Although intentional poisonings with 2-Methyl-4-chlorophenoxyacetic acid (MCPA) are relatively rare and in most cases cause moderate toxicity, deaths have been described, mainly due to cardiorespiratory arrest. Treatment is generally supportive, with opposing effects from the application of urinary alkalization and other methods for secondary elimination of the poison. Case report. Herein we report a case of an adult female who was admitted to theUniversity Clinic for Toxicology several hours after a suicidal ingestion of an unknown toxic agent that resulted in vomiting and loss of consciousness. After MCPA ingestion was confirmed, she received supportive care, urinary alkalinization, and hemodialysis. Despite this, the patient was hypotensive, after which signs of acute kidney injury, rhabdomyolysis, hyperamylasemia, hepatic lesion, electrolyte abnormalities, metabolic acidosis, disseminated intravascular coagulation, and respiratory failure developed. Despite applied mechanical ventilation and inotropic support, the patient died several days later. Conclusion: MCPA is a poisonous herbicide that can cause severe forms of poisoning and fatal outcome especially after large intentional ingestions. The availability of rapid qualitative toxicological confirmation of the xenobiotic can contribute to early etiological diagnosis and initiation of appropriate therapeutic measures that would improve survival even in more severe forms. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Delayed treatment of severe hepatitis in unrecognized phalloides syndrome(European Association of Poisons Centres and Clinical Toxicologists (EAPCCT), 2024-05); ; Objective: Delayed or insufficient antidote treatment of patients with mushroom poisoning is a challenge for every toxicologist[1]. We present a case of delayed recognition of severe phalloides syndrome treated with an additional acetylcysteine dose to the standard protocol with favorable outcome. Case report: A middle-aged man was admitted to the Clinic on the 4th day after ingestion of mushrooms he had picked and eaten under the assumption that they were parasol mushrooms (Macrolepiota procera). He had a medical history of diabetes mellitus type 2, coronary artery bypass graft x3 (only aspirin) and hypertension. Profuse gastroenterocollitis developed 16 h after ingestion (over a weekend) and for the first 2 days he was treated at a local medical center for infectious enterocolitis as an outpatient. Laboratory analyzes on the third day showed an increased transaminase activity with a progressive increase the next day, after which he was brought to the clinic. He was alert, blood pressure 100/60 mmHg, an electrocardiogram (ECG) showed sinus rhythm, heart rate 100/min, pain under the ribs in the right upper quadrant, with yellow discoloration of the sclera. Laboratory analysis revealed platelets 129 10i/L, gamma-glutamyl transferase (GGT) 199 U/L (later 608 U/L), alanine aminotransferase (ALT) 8389 U/L, aspartate aminotransferase (AST) 13804 U/l, lactate dehydrogenase (LDH) 7961 U/L, direct bilirubin 104 mmol/L, blood urea nitrogen (BUN) 17.1 mmol/L, creatinine 133.8 mmol/L, prothrombin time (PT) 29.3 s (11–14 s), and D-dimer 8183 ng/mL. Hepatitis viral marker negative. The patient was intensively rehydrated, treated with IV acetylcysteine (200 mg/kg over 4 h, followed by 100 mg/kg over 16 h, with additional 100 mg/kg dose), oral silymarin (100 mg 3 2) and supportive treatment. Abdominal ultrasound presented enlarged liver (not congested) with intensive steatosis. Progressive thrombocytopenia from day 2 of hospitalization was noted with a nadir of 58 10i/L (150–450 10i/L) on the 9th day of poisoning. He received dexamethasone and low molecular weight heparin (LMWH) and PT normalized on the 8th day of poisoning (14.2 s). The patient recovered after 10 days of treatment, with normalized transaminases after 3 months. The mushroom ingested was assumed to be Amanita phalloides, based on the clinical features, laboratory findings and recognition of the ingested mushroom with a look-alike poisonous mushroom from a mushroom atlas by the patient. Conclusion: Data about the consumption of picked mushrooms should be seriously considered when determining the etiology of severe acute gastroenterocollitis. Delayed treatment of phalloides syndrome may worsen the clinical course and increase the potential risk of lethal outcome.