Faculty of Medicine
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Item type:Publication, THE TREND OF RENAL REPLACEMENT THERAPY IN N. MACEDONIA FROM 2015 TO 2020: DATA FROM THE ERA-EDTA ANNUAL REGISTRY(Oxford University Press (OUP), 2023-06); ; ; ;Cibrev, DraganBackground and Aims Kidney Failure (KF) is treated with three modalities of renal replacement therapy (RRT): kidney transplantation (Tx), hemodialysis (HD), and peritoneal dialysis (PD). Our study aimed to present the trend of RRT in N. Macedonia from 2015 to 2020. Method The epidemiological retrospective study analyzed the patients with kidney failure by gender, age, etiology of kidney disease, and modality of RRT. The data were processed from the annual reports of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). The study patients were divided into group 1 (prevalent) with patients on the RRT at the current year, group 2 (incidence at Day 1) with patients on the RRT with a duration of at least 1 day, and group 3 (incidence at Day 91) with patients on the RRT with a duration beyond 91 days. Results A total of 10395 patients were analyzed with a mean age of 59.2 ± 9.5 years (median 60.4 years), of which 60.2% were male. From 2015 to 2019, there was an increasing trend in all groups, and most patients were reported in 2019. In group 1, 1598 patients were registered in 2015, and 1762 patients were registered in 2020, which is an increasing trend of 10.3%. The number of patients in group 2 was increasing every following year, with the highest growth in 2019 up to 12.1%, compared to 2018. The number of patients in group 3 also showed significant growth from 253 patients in 2015 to 324 patients in 2019, but there was a decrease of 16.4% in 2020 (271 patients). Deviations are observed in 2020, with a decrease in the number of patients in group 1 and group 3, as well as a slowdown in the growth dynamics of patients in group 2, which might be associated with the start of the SARS-CoV-2 pandemic. According to the modality, most of the patients (84.7%) were on HD in 2015 and 85.9% in 2020. The most frequent age group of patients was from 45 to 64 years, from 36.3% to 49.4%. There was an increasing trend of patients from older age groups (over 64 years) and male patients. The increasing number of patients from the age group 75+ years was also noted in all groups. Etiology of kidney disease: hypertension (25.8%) and diabetes mellitus (17.4%) were the leading causes of KF in patients requiring RRT. Conclusion The study showed a constantly increasing trend of patients with KF requiring RRT. The largest number of patients were men, aged from 45 to 64 years. Hypertension and diabetes mellitus were the leading causes of KF, and most of the patients were treated with HD. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Trend of Kidney Replacement Therapy in North Macedonia from the Years 2015 Through 2020(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2024-11-01); ; ;Simjanovska, Simona ;Rushiti, EmineCibrev, DraganKidney replacement therapy (KRT) by dialysis or kidney transplantation represents the main treatment modalities for patients with kidney failure. Here we evaluate the trends in taking care of such patients in North Macedonia from 2015 through 2020. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comorbid Conditions in a Cohort of Inpatients with SARS-CoV-2 and their Association with In-Hospital Mortality During the Early Phases of the Pandemic(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01); ;Cibrev, Dragan; ;Chamurovski, NikolaIntroduction: Studies determined that age and associated comorbidities are associated with worse outcomes for COVID-19 patients. The aim of the present study is to examine previous electronic health records of SARS-CoV-2 patients to identify which chronic conditions are associated with in-hospital mortality in a nationally representative sample. Materials and Methods: The actual study is a cross-sectional analysis of SARS-CoV-2 infected patients who were treated in repurposed hospitals. The study includes a cohort of patients treated from 06-11-2020 to 15-03-2021 for COVID-19 associated pneumonia. To examine the presence of comorbidities, electronic health records were examined and analyzed. Results: A total of 1486 in-patients were treated in the specified period, out of which 1237 met the criteria for case. The median age of the sample was 65 years. The overall in-hospital mortality in the sample was 25.5%, while the median length of stay was 11 days. From whole sample, 16.0% of the patients did not have established diagnoses in their electronic records, while the most prevalent coexisting condition was arterial hypertension (62.7%), followed by diabetes mellitus (27.3%). The factors of age, male gender, and the number of diagnoses showed a statistically significant increase in odds ratio (OR) for in-hospital mortality. The presence of chronic kidney injury was associated with the highest increase of OR (by 3.37) for in-hospital mortality in our sample. Conclusion: The study reaffirms the findings that age, male gender, and the presence of comorbidities are associated with in-hospital mortality in COVID-19 treated and unvaccinated patients. Our study suggests that chronic kidney injury showed strongest association with the outcome, when adjusted for age, gender, and coexisting comorbidities. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, BRIEF REVIEW OF THE THROMBOTIC CEREBROVASCULAR COMPLICATIONS ASSOCIATED WITH NONSTEROID ANTI-INFLAMMATORY DRUGS IN PATIENTS WITH CEREBROVASCULAR DISEASES(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2023) ;Kerala, Coskun; ; ; Introduction. The use of the commonly used non-steroid anti-inflammatory medications can lead to specific complications in patients with cerebrovascular conditions. Their safety profile can be associated with both hemorrhagic and thrombotic complications, which can exert untoward influence in these patients. The aim of the present text is to 1) meaningfully recapture the main literature findings on the thrombotic complications due to use of NSAIDs in these patients and to 2) provide aid for physicians that encounter such decisions. Inhibition of the cyclo-oxygenase as main effect. The use of these medications rely on a common mechanism that inhibits a specific set of enzymes called cyclooxygenase inhibitors. Here, we revisit the specific cascade that enables their effect and the important interplay that may occur in patients with cerebrovascular diseases, including medications that exert unspecific vs targeted inhibition of those specific enzymes. Conclusion. The use of particular NSAIDs have been evaluated in patients with cerebrovascular diseases, and their specific risk for thrombotic complications in these patients have been examined in wide collection of patients. So far, these evaluations emphasize the association between the duration of use and type of selectivity of a particular NSAID and its risk for further thrombotic complications. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Effectiveness after immunization with BNT162b2 and Gam-COVID-Vac for SARS-CoV-2 and neutralizing antibody titers in health care workers(Walter de Gruyter GmbH, 2024-05-24); ;Cibrev, Dragan ;Kerala, Coskun; Ajeti, ValdrinaObjectives The aim of this study was to describe the effectiveness of the vaccines (Tozinameran and Sputnik V), administered on a convenience sample of healthcare workers, and also to describe the relationship between the levels of neutralizing antibodies (NAbs) and the type of vaccine used, as well as their association with incident cases during follow-up. Methods The study included 262 participants, who underwent vaccination during the period from September 2021 until August 2022. For determining the levels of NAbs we used the CLIA based method, and all the samples were processed with the SNIBE Maglumi 800 analyzer. The patients were observed for one year for occurrence of incident infection. Results The participants with prior SARS-CoV-2 positivity showed substantially higher titer of NAbs (8.86 vs. 0.94, p<0.001). The participants in the Gam-COVID-Vac group had median levels of NAbs of 1.57 (IQR 0.42–5.73), while they in the Tozinameran group showed substantially higher levels of 2.37 (IQR 0.9–6.27). The incident cases after immunization had substantially lower median values of NAbs when compared to the rest (0.48 vs. 3.97, p<0.001), and the interval between the second dose and the serological measurements were similar. Conclusions The current study showed that the tested vaccines demonstrated vaccine effectiveness of over 50 % during the first year after the vaccination in a sample of health care workers. Although health care workers remain separate population group, when compared to the rest, the results could be extrapolated to populations with similar age and immune experience. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Diabetes and arterial stiffness, our experiences(Македонско лекарско друштво = Macedonian medical association, 2021); ;Cibrev, Dragan ;Angelovska, Makedonka; Introduction. The incidence and prevalence of diabetes mellitus (DM) has increased worldwide but also in the Republic of Macedonia, Diabetes is a high-ranking a cause of death, primarily as a cause of cardiovascular death. In the United States, 42% of diabetic patients have diabetic nephropathy, with a 20-fold increased risk of cardiovascular mortality. Arterial rigidity is another independent risk factor for CV death, which is a degenerative process of remodeling the large arteries wall. There is increased arterial rigidity in both: diabetic patients and in patients with arterial hypertension, but studies that address these issues do not have consistency in the results, which was our motive for this study. Methods. This was a cross-sectional study that comprised 62 patients with diabetes mellitus type 2, aged over 38 years, followed at the University Clinic for Nephrology for diagnosis of, or already diagnosed hypertension. The control group consisted of 22 healthy subjects who had not been diagnosed with either DM type 2 or arterial hypertension. We examined pulse wave velocity, and analyzed hypertension with data obtained from 24-hour ambulatory blood pressure monitoring. The obtained data were statistically processed. Results. The results were displayed in tables. Conclusion. Arterial stiffness (measured by PWV) was higher in patients with DM compared to the control group of healthy subjects. In our study HgA1c had impact on PWV which can serve as a tool for assessing CV risk and arterial rigidity. Keywords: diabetes mellitus, arterial hypertension, arterial rigidity, pulse wave velocity - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries(Elsevier BV, 2022-03) ;Munir, Kerim ;Oner, Ozgur ;Kerala, Coskun ;Rustamov, IkramBoztas, HamitThe study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The blood flow rate on the first day after arteriovenous fistula creation is a predictor of successful fistula maturation(Wiley, 2022-12-02); ; ;Cibrev, Dragan; The determination of blood flow rate (BFR) is a useful tool for assessing the function of arteriovenous fistula (AVF).
