Faculty of Medicine

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CELLULAR AND HUMORAL IMMUNITY IN PATIENTS WITH COVID-19 CORRELATED WITH SEVERITY OF CLINICAL PRESENTATION AND SARS COV-2 VACCINATION STATUS
(Македонско лекарско друштво = Macedonian medical association, 2024)
Aleksandra Tatabitovska
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Dejan Todevski
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Introduction. The COVID-19 pandemic has changed life across the planet, claiming approximately 7 mi- llion lives and more than 776 million cases reported globally, leaving many people with lasting sequelae. Of particular importance is understanding the immune system's defense responses against SARS-CoV-2 infection, with an emphasis on T-lymphocyte cells that modulate both cellular and humoral part. Aims. To determine epidemiological and clinical featu- res, especially comorbidities in patients who have had severe and mild COVID-19, to determine differences in cellular and humoral immune response and to co- rrelate with vaccination status for SARS CoV-2. Methods. A 6-month-prospective cohort study was conducted at the University Clinic for Pulmonology and Allergology and the Institute of Immunobiology and Human Genetics at the Faculty of Medicine - Skopje. The study included 88 patients with pre-exis- ting COVID-19 divided into two groups: patients with mild clinical manifestations and patients with severe clinical manifestations requiring hospitalization. The parameters of patients' medical history, number and type of comorbidities, parameters of cellular and hu- moral immune response, data on vaccination against SARS-CoV-2 were analyzed. Conclusion. The severity of the clinical presentation correlated directly with the number of comorbidities, and inversely with the vaccination status. Comorbidi- ties were present in 87.7% of patients with a severe clinical course. No correlation was found with the smoking status. The study showed that 97.72% of all patients had positive neutralizing antibodies for SARS- CoV-2. Positive cellular immunity had 54.55% of pa- tients, significantly higher in the group with severe COVID-19 and vaccinated patients. There was a posi- tive correlation between cellular and humoral immu- nity, but in 2 cases (4.16%) where the humoral respon- se was absent, a positive cellular response was verified.
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CLINICAL PATHOLOGICAL CHARACTERISTICS AND FREQUENCY OF ALK MUTATIONS IN NON-SMALL CELL LUNG CANCER (NSCLC)
(Македонско лекарско друштво = Macedonian medical association, 2021)
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Dejan Todevski
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Aleksandra Tatabitovska
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Abstract Introduction. Lung cancer is a malignant tumor origi-nating from the respiratory epithelium of the lungs: the alveolar epithelium and the epithelium of the tracheo-bronchial stem. It is the most common cause of death associated with malignant diseases in the world. The incidence of lung cancer varies depending on gender and race. It is twice as high in men, although in recent years there has been a significant decline in the inci-dence in men, while the rate in women has risen in the last decade. About 80-85% of all lung cancers are of the non-small cell lung cancer (NSCLC) type, while about 15% are small cell lung cancers. Smoking is the most common risk factor. In 5% of patients with NSCLC, an inversion of chromosome 2 consisting of a juxtaposition of the 5' end echinoderm microtubule asso-ciated with protein 4 (EML4) gene with a 3' end of ana-plastic lymph node with oncogene EML4-ALK is de-tected. Screening for this fusion gene in NSCLC is par-ticularly important because "ALK-positive" tumors are highly sensitive to targeted therapy with ALK inhibitors. Objectives. 1. To determine the distribution of non-small cell lung cancer (NSCLC) by gender and age, smoking status, histological subtype; 2. To determine the stage of the disease determined by radiological TNM classifica-tion; 3. To determine the frequency of ALK mutations in patients with NSCLC. Methods. This is a prospective study conducted at the PHI University Clinic for Pulmonology and Allergology and the Institute of Pathology, Faculty of Medicine - Skopje over a period of 1 year. In all patients included in the study, tissue samples obtained from lung biopsy (bronchobiopsy or transthoracic biopsy) were analyzed. The microscopic description included histological type ________________________ definition of the tumor and the degree of histological differentiation. The study also processed clinical pa-tient data and disease stage with radiological TNM cla-ssification (determined by contrast CT of the chest and mediastinum). To determine the mutation of the ALK gene, tissue samples were processed with FISH using an identical DNA probe. Conclusion. ALK mutations were noted in 3 of a total of 52 patients, or 5.77%, which was very close to the global trend of mutations of about 5%. Given the small sample of participants, it is possible that the general population of patients with NSCLC follows exactly the world trend. According to the available studies, screening with low-dose computed tomography of the lungs is recommended for all current heavy smokers or individuals who have smoked 15 or more years, aged 55 to 80 years. All this coincides with our research, in which most of the patients diagnosed with NSCLC were smokers and over 50 years of age. Keywords: NSCLC, ALK, TNM, EML4, histopathology
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ADENOID CYSTİC CARCINOMA TREATED WITH ELECTROCAUTERY– 5-YEAR SURVIVAL
(Македонско лекарско друштво = Macedonian Medical Association, 2020)
Arben Rexhepi
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Dejan Todevski
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Aleksandra Tatabitovska
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Adenoid cystic carcinoma (ACC) is an uncommon neoplasm which arises from the major and minor salivary glands of the head and neck. Rarely, it can develop from secretory glands originating in the trachea, breast, lacrimal glands or other exocrine glands. We present a case of a fifty-years-old female patient with a polypoid adenoid ACC, growing from the middle of the left main bronchus causing obstruction of the bronchial lumen. Complete resection of the polypoid mass was accomplished using an electrocautery snare through the flexible bronchoscope, cauterizing the stalk in one attempt. The tumor was extracted in the manner of foreign body extraction, attaining complete recanalization and providing patency of the visible bronchial tree with no immediate or late complications. The followup bronchoscopy after 6 months found no signs of persistent or recurrent disease. The patient was followed at 6 and 12 months and every year for 5 years and no signs for local recidive or metastasis was found. We recommend considering endoscopic electrocautery for selected endobronchial or endotracheal cases of ACC, where surgical or oncologic treatment is not possible, in curative or palliative purposes.
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Consensus statement: RECOMMENDATIONS FOR THE DIAGNOSTIC ALGORITHM IN LUNG CANCER CONSENSUS STATEMENT OF THE MACEDONIAN RESPIRATORY SOCIETY AND THE MACEDONIAN ASSOCIATION OF PATHOLOGY
(Македонско лекарско друштво = Macedonian Medical Association, 2019)
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Dejan Todevski
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Arben Rexhepi
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Aleksandra Tatabitovska
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Lung cancer is the “number one cancer killer” in the world. Its prevalence is associated with smoking as the primary cause, although air pollution in general and genetic factors are also important. The mortality especially from advanced stage lung cancer is still high, although there has been a significant improvement in the past 10 years, mostly due to the introduction of novel compounds such as targeted and immunological treatment. The advances in the treatment of NSCLC have imposed updating of the guidelines for the diagnostic procedure and screening of LC, for the indications for molecular testing as well as for targeted selection of patients who shall benefit the most from the novel treatment modalities. These recommendations shall fulfil their purpose only if implemented in the educational curriculum and if incorporated in the healthcare system strategies.
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Inflammatory markers in peripheral blood in patients with asthma
(2020-12)
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Dejan Todevski
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Monika Tushevska Mitkovska
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Nikola Chamurovski
Asthma is one of the most common chronic diseases all over the world, resulting from a state of persistent sub-acute inflammation of the airways. The main attribute of asthma is inflammation, which leads to airway remodeling, bronchial hyper-reactivity and reversible or partly reversible airway obstruction. Asthma is a chronic inflammatory disorder of the airways in which many cells and inflammatory mediators play a role. (GINA). Many cells and mediators take part in creating the asthmatic inflammatory reaction, but eosinophils play a central role. All of the inflammatory cells and mediators can be detected in the airflow tissue. Some of them can be detected in the asthmatics peripheral blood too. This study includes 30 patients of the Pulmology and Allergy Clinic, Skopje, with confirmed bronchial asthma, treated with ICS. In all of the patients we followed Eo count, ECP and IL-5 in peripheral blood at the beginning of the study, after 2 and 6 months treatment. Following the parameters during treatment with ICS we registered changes in all of the tested parameters. Our conclusion is that the ICS objectively suppress the inflammatory reaction in asthma and the biologic markers (IL-5, Eo and ECP), which we have followed, can measure the accomplished effect. They could be used in every day practice, not only as diagnostic parameters but also as valid therapeutic guides in the treatment of asthma
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Management of tobacco dependence
(2018-10-27)
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Dejan Todevski
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Suzana Arbutina
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Monika Tushevska Mitkovska
Tobacco is the leading cause of premature death and disability in Europe. Each year, more than 700,000 Europeans die from tobacco-related illness. In Macedonia, 46.6% of the male and 26.8% of the female population are active smokers. These numbers acertain Macedonia to the high place in Europe by smoking rates. There is nothing more important we can do for patients who smoke than help them stop! Doctors and health professionals must take into account that tobacco dependence is a medical condition and not a habit, vice, pleasure, or life-style choice and it must be diagnosed and treated in the same way as other chronic diseases. Most smokers are not able to stop on their own (without help). Nicotine dependence is a chronic relapsing condition and has two components: physical dependence and psychological dependence. The tenacity of nicotine addiction means that many smokers who attempt to quit will relapse. Relapse is most common within the first few weeks of quitting. The ENSP Tobacco Treatment Guidelines recommend five strategies for addressing tobacco use in clinical settings. Known as the “5As” these strategies are: Ask all patients about smoking status and document in medical record; Advise patients who smoke to quit; Assess readiness to quit; Assist with making a quit attempt, including providing behavioral counselling and prescribing first-line smoking cessation medications; and Arrange follow-up. Behavioral support (Motivational interviewing) is the keystone of tobacco dependence treatment. It is generally matched to the patient’s motivation to quit smoking also known as the patients “stage of change”. There are five stages of change. Pre-contemplation, Contemplation. Preparation, Action and Maintenance. Tobacco dependence may need persistent and repeated therapeutic interventions, as well as long- term follow-up until it is cured. In order to give our contribution to the reduction of tobacco consumption in Macedonia, we are implementing a program for education of doctors and health workers for smoking cessation. The project represents partnership between the Medical faculty in Skopje and the Henry Ford Health System from Detroit, Michigan, USA.
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Maintenance of therapeutic effect of oral anticoagulants (Acetocoumarol) in long-term treatment of patients with pulmonary embolism - reality or vision
(Македонско лекарско друштво = Macedonian Medical Association, 2017)
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Dejan Todevski
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Elena Janeva

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