Faculty of Medicine

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Early Neonatal Morbidity Associated with Maternal Gestational Diabetes
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024-09)
Djordjevikj, Aleksandra
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Ivanov, Emilija
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Mehmedovikj, Nadica
Introduction: Any degree of glucose intolerance with onset in pregnancy is referred to as gestational diabetes mellitus (GDM). It is present in 10% of all pregnancies, it has an increasing tendency and represents a risk factor for the mother, pregnancy and fetus. The aim of the paper is to determine the mutuality of the most common disorders in newborns from mothers with GDM, compared to the control group of newborns, from pregnancies without gestational diabetes in our maternity hospital. Material and methods: Retrospective study, performed at the University Clinic for Gynecology and Obstetrics, in the period from 01.01. to 30.05.2024. The study included mothers with GDM, their newborns, as well as a control group of newborns and mothers without GDM. We evaluated maternal age, body weight, type of diabetes and comorbidities, maternal therapy, family history, way of delivery, Apgar scores, need for resuscitation, birth weight and maturity of the newborn, respiratory adaptation of the newborn, glycemia and needs for correction, hematocrit, Calcium, bilirubin, sucking reflex, jaundice. Results: The study included 60 parturients, 30 with GDM and 30 parturients without diabetes. In the group of mothers with GDM, the mean age was 33.6 (20%), they had a positive family history of diabetes and hypertension, 26 (87%) were obese, 12 (40%) had high blood pressure, 25 (83%) gave birth by caesarean section. 33% of their newborns were premature, 33% hypertrophic, 13% had hypoglycemia, 10% in need of oxygen support during the adaptation period, 7% with hypocalcemia, 27% with prolonged hyperbilirubinemia. A weaker sucking reflex and weaker muscle tone were noted in half of the newborns of mothers with GDM. Conclusion: With an increase in glucose intolerance and obesity in the young female population in the fertile period, GDM occurs as a frequent pathology after they become pregnant. Early screening in pregnancy plays a big role in reducing the consequences.
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Subdural hematoma with symptom of epileptic attacks after subarachnoidal anesthesia - a case report
(University of Nis, Faculty of Medicine, 2018)
Ivanov, Emilija
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Doneva, Ana
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Nojkov, Jordan
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The study describes a case of subdural hematoma developed after cesarean section in a 34- year-old patient with normal intra-operative course. During the first twelve hours after the operation, the patient had a headache considered as post-dural puncture headache (PDPH) and was treated in that direction. After the third operative day the headache was reduced, and on the fifth day the patient was discharged from the hospital in good condition. As soon as the patient was discharged, the headache appeared again with stronger and persisting intensity and at the end it was accom- panied by epileptic seizure. MR scan showed subdural hematoma in absorption. After conservative therapy, the condition was improved and the patient was without neurologic consequences. The differences between PDPH and other types of headache, as well as the potential etiopathogenesis of subdural hematoma in obstetric patient, are discussed in this study. We have come to the conclusion that after the long persisting headache, if we take into consideration this complication as a possibility, the early diagnosis and adequate treatment could lead to complete recovery.
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Промени во хемодинамските состојби кај родилките во општа и спинална анестезија во тек на царски рез
(SHMSHM - AAMD, 2016-06)
Ivanov, Emilija
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Ristevski, V
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Резиме: Бројот на царски резови е значително зголемен и затоа го испитуваме влијанието на видот на анестезијата врз хемодинамските параметри на родилките. Цел: Да се споредат ефектите на спиналната со општата анестезија преку хемодинамско следење на родилките и да се утврдат можните компликации. Материјал и методи: Испитани се 120 родилки кои се поделени во две групи.Група 1 се состоеше од 60 родилки во ОА. За премедикација: амп.метоклопрамид од 10mg. За вовед :пропофол (2,0-2,5 мг/кг/тт) .За олеснување на интубација сукцинил холин (1-1,5 мг/кг/тт ), или рокурониум бромид ( Есмерон) (0,4 - 0,6 мг/кг/тт).По екстракција на плодот, дававме анелгетик Фентанил ( 0,005 мг/кг/тт ) и деполаризантен релаксант. Односот на гасовите О2 и N2O беше 3:3 Л/мин.Група 2се состоеше од 60 родилки во СА. Лумбалната пункција беше изведувана помеѓу Л2 и Л3 или Л3 и Л4, со игла 26 или 27 G. Беше аплициран Бупивакаин 0.5% (2-3мл). Родилките беа хидриранисо 500-1000мл NaCl0.9% или Рингеров раствор. Беше следен волуменот на дадени раствори,вкупно и по видови од почетокот до крајот на интервенцијата. Кај двете групи беа следени: АП ,пулсот, бројот на респирации во минута и сатурацијата на периферната крв со кислород (SpO2). Резултати: Групата со СА покажа поголем пад на АП во однос на групата со ОА.Количината на ординирани раствори во групата со ОА изнесуваше 1000-1500 мл, додека во групатасо СА беше во распон од 2000-2500 мл. Немаше сигнификантни разлики во срцевата фрекфенција и бројот на респирации, како и во SpO2. Заклучок: Компарирано со општата анестезија, спиналната анестезија има приоритет.
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Obstetric anesthesia: present aspects
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2017-11)
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Ivanov, Emilija
The study reviews the well-established ways to apply labor analgesia which are practiced widely, with a simultaneous analytical overview of current and influential aspects in the field of obstetric anesthesia. In the introduction, attention is paid to the global morbidity and the morbid- ity trend in the field of obstetric anesthesia, which shows positive changes, primarily as a result of more frequent application of regional obstetric anesthesia in general. The current procedures and methods with their specifics have been analyzed, as well as up-to-date data regarding side effects, which have been duly addressed. Special emphasis on the respiratory depression risk caused by intrathecal opioid route is considered, whose usability is very common today. From that aspect, the study is conceived as an opportunity for better information and understanding of the current aspects of obstetric anesthesia, with the ultimate goal of improving the final outcome of the process of labor, thus implicating better well-being for both mother and newborn.
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EFFECT OF CYP2B6 POLYMORPHISM ON PROPOFOL IN PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2022-03)
Ivanov, Emilija
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Krstevska, Jasmina
Understanding why individuals respond differently to drug therapy is one of the most intriguing questions in modern medicine and pharmacology. The main premise is that individual differences in genetic variables in genes encoding metabolic enzymes, molecular transporters and propofol molecular binding sites are implicated in the sensitivity to the effects of propofol, a commonly used intravenous anesthetic. The goal of this research was to see how polymorphisms in the cytochrome P450 2B6 isozyme CYP2B6 gene impacted the propofol therapeutic outcomes in patients subjected to abdominal hysterectomy. This study included ninety patients ranging in age from 29 to 74 years old and from various ethnic backgrounds. TaqMan SNP genotyping analysis on Stratagene MxPro 3005P real-time polymerase chain reaction was used to determine the presence of polymorphisms (qPCR). The genetic variations were distributed inside the Hardy-Weinberg equilibrium. The allelic frequencies of polymorphic variations and genotype distributions across adult and elderly patients, as well as patients of different ethnicities, were not significantly different (p>0.05). According to our findings, the CYP2B6 gene variations did not cause any statistically significant effects on the analyzed clinical parameters i.e., doses for induction in anesthesia, additional doses, induction time and awakening time after anesthesia and adverse effects of propofol.
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SPINAL ANESTHESIA IN PARTURIENT WITH SEVERELY SCOLIOTIC SPINE
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2018-12)
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Ivanov, Emilija
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Veninov, Filip
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Spasovski, Sasho
The choice of anesthesia in parturients with severe scoliosis undergoing an elective cesarean section (C-section) is associated with potential risks for both mother and fetus and presents a challenge for the anesthesiologist when considering the type of anesthesia that should be used. Alterations in the maternal physiology and potential perioperative complications associated with this comorbidity can cause difficulties when both general and spinal anesthesia are used. After reviewing all risk factors associated with both types of anesthesia, we consider that a single shot spinal anesthesia can be a successful type of anesthesia in severely scoliotic individuals, especially in those with pulmonary compromise. Here we present a successful case of parturient undergoing а spinal anesthesia for C-section performed at the University Hospital for Genecology in Skopje.
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INFLUENCE OF POTENTIAL GENE POLYMORPHISMS ON PROPOFOL DOSAGE REGIMEN IN PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY
(Macedonian Academy of Sciences and Arts, 2021)
Ivanov, Emilija
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Budic, Ivana
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Nojkov, Jordan
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Propofol (2,6-diisopropylphenol) is the most common intravenous anesthetic used in modern medicine. It is postulated that individual differences in genetic factors [polymorphism of single nucleotide polymorphisms (SNPs)] in the genes encoding metabolic enzymes, molecular targets and molecular binding sites of propofol can be responsible for susceptibility to propofol effects. The aim of our study was to investigate the influence of the cytochrome P450 2B6 isozyme CYP2B6 (rs3745274), γ-aminobutyric acid type A (GABAA) receptor α1 subunit GABRA1 (rs2279020) and ATP-binding cassette subfamily B member 1 ABCB1 (rs1045642) gene polymorphisms on propofol therapeutic outcomes in the patients undergoing abdominal hysterectomy. Ninety patients aged 29-74 years, with different ethnicities were included in this study. The presence of polymorphisms was analyzed using TaqMan SNP genotype analysis on Stratagene MxPro 3005P real-time polymerase chain reaction (qPCR). The distribution of all three genetic variants was within the Hardy-Weinberg equilibrium. There was no significant difference (p >0.05) in the allelic frequencies of polymorphic variants and genotype distributions between adult and older patients and between patients of different ethnicities. Our study did not detect a statistically significant influence of the CYP2B6 (c.516G>A), GABRA1 (c.1059+15G>A) and ABCB1 (c.3435T>C) variants on the variability of clinical parameters (doses for induction in anesthesia, additional doses, induction time and wake time after anesthesia and side effects of propofol). However, the observed trend on the possible influence of the CYP2B6 (c.516G>A) and GABRA1 (c.1059+15G>A) variants warrant an extension of these studies on a larger number of patients.
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PHARMACODYNAMICS OF PROPOFOL INFLUENCE OF GABRE AND ABCB1 GENES
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024-05)
Ivanov, Emilija
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Pop-Stefanija Corbeva, Vesna
We live in a world where the pharmaceutical industry is experiencing its rise and attention, and every day we face different reactions, different response to different drugs in different people. On the other hand, we are witnessing a wave of encouraging new drugs, especially in the field of oncology, which are based on the concept of individualized therapy. The aim of our study was to investigate the influence of the cytochrome, γ -aminobutyric acid type A (GABAA) receptor γ1 subunit GABRA1 (rs2279020) and ATP-binding cassette sub-family B member 1 ABCB1 (rs1045642) gene polymorphisms on propofol therapeutic outcomes in the patients undergoing abdominal hysterectomy. Ninety patients aged 29-74 years, with different ethnicities were included in this study. The presence of polymorphisms was analyzed using TaqMan SNP genotype analysis on Stratagene MxPro 3005P real-time polymerase chain reaction (qPCR). Our study did not detect a statistically significant influence of the GABRA1 (c.1059+15G>A) and ABCB1 (c.3435T>C) variants on the variability of clinical parameters (doses for induction in anesthesia, additional doses, induction time and wake time after anesthesia and side effects of propofol). The observed trend on the possible influence of the GABRA1 (c.1059+15G>A) and ABCB1 (c.3435T>C) variants warrant an extension of these studies in a larger number of patients.
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ANESTHETIC MANAGEMENT FOR PATIENT WITH TRACHER COLLINS SYNDROME SCHEDULED FOR ELECTIVE CESAREAN DELIVERY
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2018-12)
Zlatkova, Milica
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Ivanov, Emilija
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Popovska, Rusanka
Tracher Collins Syndrome is an autosomal dominant genetic disorder, as a result from mutation in TCOF1 gene. Other names for Treacher Collins Syndrome include Franceschetti- Zwalen-Klein syndrome, mandibulofacial dysostosis (MFD), zygo-auro-mandibular dysplasia and Treacher Collins Franceschetti syndrome. These changes cause deformities of the facial bones and occurrence at antimongoloid slant of the eyes, micrognathia and deformity of the ears. Complications may include breathing problems, seeing problems, cleft palate and hearing lost. Diagnosis of TCS is made through clinical evaluation, radiographic examination and molecular genetic analysis. Treatment is tailored to the specific needs of each individual by a multidisci- plinary craniofacial management team. We report a case of TCS with second twin pregnancy achieved with IVF. The first pregnancy ended with c-section (and death of the newborn after 23 days of delivery due to dysmorphia – TCS on the fetus). The patient was hospitalized at our clinic for evaluation and ending of pregnancy with elective section cesarean. The patient was managed successfully under regional anesthesia which is generally preferred technique to general anesthesia, in order to avoid potential complications associated to difficult airway management. The patient was left home on the fifth postoperative day with her two healthy children.
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Intravenous Remifentanil for Labor Analgesia - A Review
(Medical Faculty Ss. Cyril and Methodius University in Skopje, 2016)
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Ivanov, Emilija
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In modern obstetrics there has been a need for safe, efficient, and easy-to-use systemic analgesia with a rapid and short onset, and without an effect on either mother or fetus. Although epidural analgesia remains the gold standard for labor analgesia, opioids applied intravenously can be very useful in cases when epidural analgesia is contraindicated, refused by the patient, or in the absence of skilled anesthesiologist. Closest to the ideal for systemic analgesia is remifentanil, a potent, ultra short-acting μ-1 agonist, which is rapidly metabolized in both mother and fetus. This article, through a literature review, will present the efficacy of remifentanil, its pharmacokinetics, the most effective dose, the safety for both mother and fetus and satisfaction for the mother. The results available show that remifentanil can be quite a satisfactory alternative to neuroaxial analgesia, hence taking its deserved place in modern obstetrics. A low number of reported side effects from mother and child are enough to open a field for future research.

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