Faculty of Medicine

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Author: search.filters.author.Baloski, Marjan

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    Bleeding duodenal ulcer in a patient with Hemophilia A: A case report
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2024-12-31)
    Baloska, Ivana
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    Baloski, Marjan
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    <jats:p>Hemophilia A is a hereditary bleeding disorder characterized by excessive musculocutaneous hemorrhage due to a congenital deficiency of factor VIII. While upper gastrointestinal bleeding in patients with hemophilia A has been reported globally, specific literature on this topic remains scarce, emphasizing the need for further research. Case presentation: A 38-year-old male presented at the Univesrity Clinic of Gastroenterhogepatology, reporting a recent episode of black stool three days prior to admission. His digital rectal examination was unremarkable, and levels of blood urea and nitrogen (BUN) were within normal ranges. Apart from Helicobacter pylori infection, the patient lacked significant risk factors for duodenal ulcers. An esophagogastroduodenoscopy (EGD) revealed a duodenal ulcer (classified as Forest Ib), and endoscopic hemostasis was performed using 9ml adrenaline solution. Coagulation factor VIII was administered prior to the procedure. Following the EGD, the patient was treated according to the duodenal ulcer protocol and hospitalized at the University Clinic. Conclusion: Recognizing risk factors, such as Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs, is crucial in managing duodenal bleeding ulcers in patients with Hemophilia A. Screening for Helicobacter pylori infection can significantly reduce the risk of ulcer-related bleeding episodes and enhance overall patient health. Further research and the development of clinical strategies are essential to optimize the management of duodenal ulcers in this patient population.</jats:p>
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    Special Conditions in Venous Thrombembolism - Case Series
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2019-10-01)
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    Klincheva, Milka
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    Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable cause of in-hospital death, and one of the most prevalent vascular diseases. There is a lack of knowledge with regards to contemporary presentation, management, and outcomes of patients with VTE. Many clinically important subgroups (including the elderly, those with recent bleeding, renal insufficiency, disseminated malignancy or pregnant patients) have been under-represented in randomized clinical trials. We still need information from real life data (as example RIETE). The paper presents case series with VTE in special conditions, including cancer associated thrombosis, malignant homeopathies, as well in high risk population.
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    Special Conditions in Venous Thrombembolism – Case Series
    (Macedonian Academy of Sciences and Arts, 2019-10-01)
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    Klincheva, Milka
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    Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable cause of in-hospital death, and one of the most prevalent vascular diseases. There is a lack of knowledge with regards to contemporary presentation, management, and outcomes of patients with VTE. Many clinically important subgroups (including the elderly, those with recent bleeding, renal insufficiency, disseminated malignancy or pregnant patients) have been under-represented in randomized clinical trials. We still need information from real life data (as example RIETE). The paper presents case series with VTE in special conditions, including cancer associated thrombosis, malignant homeopathies, as well in high risk population.
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    Association of the apoe gene polymorphism with diabetic nephropathy
    (SHMSHM - AAMD, 2019-02)
    Hasan, Taner
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    Pakovski, Kiril
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    Josifovska, Slavica
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    Baloski, Marjan
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    Nedeska Minova, Natasha
    The protein isoformes that are products of the Apolipoprotein E (APOB) gene polymorphism have partially altered biological activity and that may lead to greater susceptibility of the patients to microvascular complications including Diabetic nephropathy (DN) in patients with the Type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the association between the allele Ԑ2, Ԑ3, and Ԑ4 of the APOE gene, as well as their combination, with the development of DN in patients with T2DM from the North Macedonia. The genotypic and allele frequency of the polymorphisms rs429358 and rs7412 in the APOE gene was determined in a group of patients with T2DM (with and without DN), and in the control group healthy subjects. The study is designed as a case-control genetic association study. The samples from 88 patients with T2DM were analyzed, including 57 patients with DN and 31 without DN and 26 healthy controls. The demographic, clinical and laboratory data were analyzed in addition to the genetic profiling of the patients. Genotyping of the APOE gene polymorphism resulted in determination of the patient’s genotype: Ԑ2/Ԑ2, Ԑ3/Ԑ3, Ԑ4/Ԑ4, Ԑ2/Ԑ3, Ԑ2/Ԑ4 or Ԑ3/Ԑ4, as well as of the alleles: Ԑ2, Ԑ3 or Ԑ4. The results revealed a statistically significant association of the genotype Ԑ2/Ԑ3 (p=0.016) and the allele Ԑ2 (p=0.020) with the occurrence of DN compared to the other genotypes and alleles. The presence of this genotype increases the chances of DN by 4,24 folds and the relative risk by 1,50 folds. In conclusion, the correlation of the APOE gene polymorphism and the development of the DN in patients with T2DM was confirmed indicating that there is a potential applicable value in the prognosis and treatment selection.
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    Alergijska bronhopulmonalna aspergiloza (ABPA) bez istorije bronhijalne astme
    (Udruženje bronhologa Srbije, 2022-11)
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    Kochovska-Kamchevska, Nade
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    Baloski, Marjan
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    Bushev, Jane
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    Poposki, Bozidar
    Plućne bolesti povezane sa aspergilusom su spektar poremećaja kao što su aspergilom, invazivna aspergiloza i alergijska bronhopulmonalna aspergiloza (ABPA). ABPA je imunološka bronhopulmonalna inflamacija (reakcija preosetljivosti disajnih puteva) zbog imunološkog odgovora donjih respiratornih puteva protiv Aspergillus fumigatus. Glavni dijagnostički kriterijumi za ABPA su 1) bronhijalna astma, 2) plućna infiltracija, 3) eozinofilija periferne krvi, 4) pozitivan kožni test na Aspergillus fumigatus, 5) precipitin u serumu na Aspergillus semulino E fumigatus (E6) globulin E6) ), i 7) centralne bronhiektazije. Dijagnozu ABPA treba razmotriti kod astmatičara svih uzrasta. Evolucija bolesti obuhvata pet faza od akutnog do fibroznog stadijuma uključujući plućnu fibrozu i respiratornu insuficijenciju.
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    Hemoptiza kao prva klinička prezentacija metastatskog seminoma kod 24-godišnjeg pacijenta
    (Udruženje bronhologa Srbije, 2022-11)
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    Kochovska-Kamchevska, Nade
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    Baloski, Marjan
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    Bushev, Jane
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    Poposki, Bozhidar
    Rak testisa je najčešći malignitet kod muškaraca od 15 do 35 godina. On čini oko 1% svih karcinoma. Prevalencija raka testisa kod belaca je 4,5 puta veća kod crnaca. Seminomi su osetljiviji na terapiju zračenjem i lakše se leče od neseminoma. To je vrsta raka koja počinje u zametnim ćelijama kod muškaraca. Seminomi se najčešće javljaju u testisu, ali se mogu javiti iu drugim delovima tela, kao što su mozak, grudni koš ili stomak.
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    METABOLIC SYNDROME (METS) AS ONE OF THE MAJOR COMORBIDITIES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
    (Association of pulmologists from Republika Srpska, 2023-05)
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    Baloski, Marjan
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    Bushev, Jane
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    Mickovski, Ivana
    Aim: We aimed to investigate the association between COPD and MetS, the relation to the severity of airflow limitation. Methods: This is a cross-sectional study including 220 patients with initially diagnosed COPD (IG), aged 40 to 75 years and 58 non-COPD subjects matched by age, smoking status, body mass index, as controls (CG). All study participants underwent anthropometric measurements, fasting blood sugar (FBS), lipid profile, pulmonary evaluation (dyspnea severity assessment, baseline and postbronchodilator spirometry, gas analyses, chest X-ray). Results: Results presented statistically significant difference in presence of MetS in COPD patients compared to controls (32.27% vs 10.34%; P=0.0009). According to the GOLD classification, the frequencies of MetS in COPD patients were categorized in stages I, II, III, IV (17.54%, 37.10%, 34.62%, 40.82%, respectively). The proportion of patients with increased glycemic values was: a) GOLD1 - 18 (31.58%); b) GOLD 2 - 32 (51.61%); c) GOLD3 - 29 (55.77%); and d) GOLD4 - 31 (63.27%). There was no significant difference between IG and CG patients regarding HDL level. According to arterial hypertension the highest proportion was observed in GOLD3 - 22 (42.31%) followed by GOLD4 - 20 (40.82%), and GOLD3 - 22 (35.48 %), smallest in GOLD1 - 17 (29.82%). Conclusion: We found higher prevalence of MetS in patients with COPD even in early COPD stages compared to non-COPD. Our findings suggest an urgent need to develop comprehensive strategies for prevention, screening and start of treatment in early stage.
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    COPD as a risk factor for carotid artery disease (CAD) and low-extremity artery disease (LEAD)
    (European Respiratory Society, 2020-09-07)
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    Kochovska Kamchevska, Nade
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    Baloski, Marjan
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    Poposki, Bozidar
    We aimed to investigate the association between COPD and peripheral artery disease (PAD), the relation to the severity of airflow limitation and the level of serum C-reactive protein (CRP). Cross-sectional study including 120 patients with initially diagnosed COPD, aged 40 to 75 years and 60 non-COPD subjects matched by age, smoking status, body mass index, as controls. All study participants underwent pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, chest X-ray), Doppler ultrasonography and measurement of serum CRP. Results presented statistically significant difference in presence of LEAD in COPD patients compared to controls (78.3% vs 38.3%; P<0.001). According to the Fontaine classification, COPD patients with LEAD were categorized in stages I, IIA and IIB (60%, 30% and 15%, respectively), whereas all controls with LEAD were in the Fontaine stage I. COPD patients with LEAD presented significant association between disease severity and clinical manifestations due to the vascular changes (P=0.001) and CRP (P<0.05). Comparison between presence of CAD in COPD and controls showed statistical significance (70% vs 36%; P < 0.0001). The mean value of intima-media thickness (IMT) in COPD patients with CAD was significantly higher than its mean value in controls (0.8 ± 0.2 vs. 0.6 ± 0.1; P=0.0043). IMT value in COPD patients with CAD was significantly related to FEV1 decline (P=0.000) and CRP (P=0.001). We found higher prevalence and severity of PAD in COPD patients compared to non-COPD and significant relation to FEV1 decline and serum CRP. Our findings suggest a need for early screening for PAD in COPD and an integrated-care approach.
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    Carotid Artery Disease and Lower Extremities Artery Disease in Patients with Chronic Obstructive Pulmonary Disease
    (Scientific Foundation SPIROSKI, 2019-07-15)
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    Kochovska-Kamchevska, Nade
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    Doneva, Ana
    To assess the frequency of carotid artery disease (CAD) and lower extremities artery disease (LEAD) in patients with chronic obstructive pulmonary disease (COPD) and their relation to the severity of airflow limitation and the level of C-reactive protein (CRP).
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    Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: echocardiography changes and their relation to the level of airflow limitation
    (Scientific Foundation SPIROSKI, 2019-10-14)
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    Kochovska Kamchevska, Nade
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    Petkovikj, Natasha
    <jats:p>Objective. To compare frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. Methods. Study population included 120 subjects divided in two groups. Group 1 included 60 patients with COPD (52 male and 8 female, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire , pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. Results. We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000) showing linear relationship with severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs. 64.8 ± 2.7; P = 0.0000) with no correlation with severity of airflow limitation.       Conclusion. Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention. Key words: airflow limitation, chronic obstructive pulmonary disease, Doppler echocardiography, pulmonary hypertension, ventricular dysfunction.  </jats:p>