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, 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, Opioid overdose or other somatic comorbidity - fatal case(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024-04); ; ; The aim of this case presentation is to emphasize the diagnostic challenges that the clinicians encounter when dealing with a comatose patient and the importance of keeping a broad differential diagnostic panel in mind. Case report: A 47-year-old female patient, was brought by ambulance to the University Clinic for Toxicology in Skopje. On admission, she was comatose (GCS=5), with miotic isochoric pupils, blood pressure was 90/60 mmHg, with oxygen saturation from 85 up to 92%. Тhe obtained data from family indicated that the patient was with opioid use disorder on methadone maintenance therapy. Recently, the patient has consumed large amounts of alcohol . Тhe family's suspicion was that perhaps the new condition was caused by excessive intake of alcohol or methadone or both. In the meantime, the result of alcoholemia showed 67.0 mg/dL (value <100mg/dLlow level) and the toxicological screening in urine sample for tetrahydrocannabinol, opiates, tramadol, amphetamine, 3,4-methylenedioxy-methamphetamine, cocaine, benzodiazepines, buprenorphine was negative with mildly elevated methadone values (the patient was on methadone substitute the last 7 years). Second day on physical examination a brisk response to deep tendon reflexes of the left side of the body with apparent right hemiplegia was noted. Computed tomography of the brain was performed immediately and showed an ischemic stroke with a compressive effect on the left lateral chamber. Although it was immediately started with an aggressive treatment, after 11 days the condition of the patient deteriorated and resulted in death. Conclusion: The notable opioid prevalence, mandates that physicians maintain a high index of suspicion when dealing with a comatose patient, especially if the patient has any known history of opioid abuse. Healthcare professionals should be aware that a comatose state in a patient could be caused by either non-toxicological trigger or by toxic causes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Chronic lithium toxicity(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024-04); ; ; Objective: Lithium toxicity can be acute or chronic and the effects may be disabling or life-threatening. We present a case with lithium toxicity due to chronic treatment. A 63-year-old man was brought to the University Clinic for Toxicology in Skopje with a 2-day history of confusion, slurred speech, nausea, vomiting, loss of appetite, and weakness. His medical history included bipolar disorder, which had been diagnosed 17 years previously, and since then he has been on lithium therapy 900mg orally daily. The patient had not had regular check-ups for several years. His oral intake was markedly reduced, for the last five days. On admission, he was severely dehydrated. Vital signs included a blood pressure of 110/50 mm Hg a pulse rate of 49 beats/min, and oxygen saturation of 97%. Investigations revealed serum lithium level 3.43 (normal 0.5–1.5 mmol/L) suggesting lithium toxicity, creatinine level 168 umol/L, urea 15 mmol/L alkaline phosphatase 182 U/L calcium 2.34 mmol/L. A 12-lead electrocardiogram showed normal sinus rhythm, precordial T-wave inversions, and a prolonged QTc interval of 533 ms. After one treatment of hemodialysis lasting two and half hours, his lithium level dropped to 2,04 mmol/L and creatinine to126 μmol/L. No intracranial abnormality was seen on a computed tomography scan of the head. Further investigation revealed parathyroid hormone 170 pg/ml, ionized calcium 1.43 mmol/L. Treatment management included volume replacement for dehydration. Abdominal computed tomography was with orderly finding. All investigations were at the normal therapeutic range before discharge and sent to the psychiatrist on the eleventh day. Conclusion: Patients on long-term lithium therapy with no regular check-ups are at high risk of developing toxicity. The toxicity was due to intravascular volume depletion, and impaired lithium excretion. The patients should be monitored frequently for all potential endocrine, renal, and neurological disorders. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparison of poisoning patterns during COVID-19 pandemic with the trend analysis-predicted models(2023-05); ; ; Berat Huseini, AfroditaObjective: The COVID-19 pandemic was associated with a reduced number of acute poisonings and changes in poisoning pattern in some countries. The aim of our study is to compare the profile of acute poisonings in 2020–2021 with the registered poisoning pattern in the previous 10-year period (2010–2019). Methods: Data from the Poisons Information Centre (PIC), University Clinic of Toxicology, Skopje, North Macedonia were analysed in a two-year retrospective study including data of 2212 acutely poisoned patients compared to the data from the trend analysis of registered poisonings in the past 10-year period (2010–2019). Results: During 2020 and 2021, a continuous decrease in poisonings was registered (23.6 and 25.7%, respectively), with a more significant decrease in females (30.5 and 26.8%, respectively) than in males (17.5 and 24.8%, respectively) compared to the predicted values. Beside the increased poisoning in males, there was no significant difference in gender distribution between the two observed years (v2¼2.304, df ¼1, p ¼ 0.129). There was significant partial association of females and recovery outcome in the last two years (v2¼ 5.743, df ¼1, p ¼ 0.017). The smallest decrease expressed in percentage change for 2020 and 2021 was registered for alcohol poisoning (17.8 and 15.7%, respectively), and psychoactive substance (PAS) use (22.4 and 23.3%) while the largest decrease was observed in drug poisoning (26.4 and 28.7%) followed by poisoning with chemicals (24.0 and 26.3%). During 2020, the biggest decrease compared to the predicted values was observed among adolescents (27.7%), then among the elderly (25.6%) and the smallest among adults (18.8%). In 2021, adolescents and the elderly had a smaller decrease compared to the predicted values (22.7 and 22.0%, respectively) and to the previous year. Conclusion: During the COVID-19 pandemic in 2020 and 2021, acute poisonings maintained a decreasing trend in comparison with predicated values according to the trend line statistic based on data from the previous 10 years. We registered a smaller decrease in the number of acute alcohol intoxications and use of PAS comparing to other types of poisoning, and an increase in poisonings in men. All of this indicates a changed intoxication pattern and an increased need to direct more medical attention to the treatment of PAS and alcohol abuse. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Severity and outcome in acutely intoxicated patients with elevated creatine kinase(2023-05); ; ; ; Bekjarovski, NikoObjective: Rhabdomyolysis is a clinical entity characterized by the release of intracellular enzymatic content from skeletal muscle into the bloodstream that leads to systemic complications. We determine the causes of mortality in patients with rhabdomyolysis following acute intoxication with psychotropic and chemical substances. Methods: This was a prospective clinical study, which included 140 patients with rhabdomyolysis divided into two groups depending on the substance taken, psychotropic or chemical intoxications. The severity of rhabdomyolysis was assessed according to the Poison Severity Score. Patients were divided into 3 groups a) mild rhabdomyolysis, CPK level from 250 to 1,500 U/L); b) moderate rhabdomyolysis CPK level from 1,500 to 10,000 U/L) and c) severe rhabdomyolysis CPK greater than 10,000 U/L. We included adult patients ages 18 and older with rhabdomyolysis in the study. They had been acutely intoxicated with either psychotropic or chemical substances within 48 hours prior to hospital admission. Results: In the group with psychotropic intoxications, the level of CPK on the first day in patients with a fatal outcome was significantly higher (p ¼ 0.0242) compared to survivors. In the chemical intoxication group, the patients with fatal outcomes compared to survivors had lower CPK levels on the first day, but this difference was not significant (p ¼ 0.2747 versus p ¼ 0.5779). Mortality was registered in a total of 9.3% (n ¼ 13) patients with rhabdomyolysis, of which 23.1% (n ¼ 3) had psychotropic intoxication and 76.9% (n ¼ 10) chemical intoxication. The analysis indicated a significantly lower mortality in psychotropic compared to chemical intoxications (p ¼ 0.0001). Mortality in the group of psychotropic intoxications, according to the etiological cause was highest with methadone at 13.3% (n ¼ 2), and neuroleptics at 8.3% (n ¼ 1). In the chemical intoxication group, the prevalence of mortality according to the etiological cause was highest in patients intoxicated with herbicides 50% (n ¼ 1), ethylene glycol 33.3% (n ¼ 1), corrosives 33.3% (n ¼ 4) and organophosphates 26.7% (n ¼ 4). Conclusion: Rhabdomyolysis had no significant effect on the fatal outcome in acutely intoxicated patients with psychotropic and chemical substances. Mortality was significantly lower in patients with rhabdomyolysis intoxicated with psychotropic drugs compared to chemical intoxications. In patients intoxicated with chemical substances, which were mild or moderate rhabdomyolysis, the causes of death were corrosive agents, ethylene glycol, herbicides, and organophosphates. The fatal outcome was due to the toxic effects of these agents and the severe disorders they cause. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Changes in the epidemiological profile of poisonings during COVID-19: differences between the first half of 2019 and 2020(2021-05-28); ; ; Naumoski, KirilObjective: The COVID-19 pandemic has changed the epidemio- logical profile of acute poisonings, due to social changes related to preventive measures for protection against SARS-CoV-2 [1]. The purpose of this analysis is to compare the changes in the epidemiological characteristics of acute poisonings between the first half of 2019 and 2020. Methods: A retrospective study analyzing the data from the Register for poisonings, of the Poison Information Center, University Clinic of Toxicology, Skopje, Macedonia. Results: During the first half of 2020, a total of 564 cases of acute poisoning were registered presenting a decrease of 23.7% compared to the same period in 2019. The monthly percentage distribution of patients in the first half of 2020 showed more patients in January and February, and a decrease in the remain- ing 4 months, which coincided with the onset of the COVID-19 pandemic. The lowest prevalence was registered in March and April with a percentage decrease (23.6% and 24.1%, respectively), when quarantine measures were introduced in Macedonia. Although there was no significant difference in out/inpatient treatment groups between 2019 and 2020 year (X2 ¼0.605, df ¼1, P ¼0.437), in April 2020, during quarantine, the percentage difference between inpatients and outpatients was the lowest (6%) of all months in 2019 and 2020. The distribution of poison- ings by motive (suicidal, abuse and accidental) did not differ sig- nificantly between the first half of the last 2 years (X2 ¼0.178, df ¼2, P ¼0.915). The percentage of ethanol abuse, medicines and mushroom poisoning cases was reduced in 2020 compared to 2019 by 2.2%, 7.4% and 79.3%, respectively. In contrast, psycho- active substance cases increased by 51.5% in the first half of 2020 compared to the first half of 2019. In the group of recre- ational drug abuse cases, the largest increase was observed in heroin (141.2%) and methadone (125.1%) overdose. For chemi- cals, there was a large increase in cases involving disinfectants (681.0%) in 2020. There was no change in the case fatality ratio of total (1.8%) and hospitalized patients (4.8%) between 2019 and 2020. Conclusion: The first half of 2020 compared to the same period in 2019 was characterized by an increase in poisonings with dis- infectants and psychoactive substances. he decrease in the total number of poisonings, with the largest decrease in the quaran- tine months, stress the need to examine family dynamics and communication as a social key to reducing the number of poisonings.