Faculty of Medicine

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Author: search.filters.author.Nancheva, Andrea

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    MINIMALLY INVASIVE APPROACH IN PATIENT WITH EXTRAFORAMINAL DISC HERNIATION
    (Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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    Kostova, Masha
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    Jovanoska, Ivona
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    Nancheva, Andrea
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    Dungevski, Gjorgi
    Objective: The aim of our study was to evaluate the history, treatment and clinical outcome of a patient with low back pain and radiculopathy caused by extraforaminar disck herniation, after a minimally invasive procedure (PRT) periradicular therapy and physical therapy in order for educational purposes. Clinical features: A 48-year-old patient without comorbidities was presented with 3-week history of lumbar pain with irradiation to the left lower extremity. The patient had difficulty sitting and standing with antalgic movement without being able to assume an upright position.. The pain was intensified by lateral movements dominant left and positioning backwards with propagation to the left side and hip. Dominant symptom was radicular pain with paresis and hypesthesia of the affected dermatoma of lower limb. The diagnosis was confirmed by magnetic resonance imaging with showed exoforaminar disc herniation on the level L4-L5. Intervention and outcome: Advantages of PRT are: minimal invasive procedure, CT guided intervention for exact and precise delivery of the medications, low risk in damage of important local anatomical structures, short recovery time, easy approach and low cost for patient and for the medical institution, respectively. In our study, CT Siemens 16 slice was used for the intervention. The patient was treated with lumbar epidural corticosteroid application and physical therapy. Physical therapy included self-traction and strengthening exercises. Functional status was measured using a Modified Oswestry Questionnaire and numerical pain assessment scale VAS scale. Initially, before intervention, functional status was assessed at 68%, with pain 8/10. After treatment, functional status was 4% and pain was assessed as 1/10. Conclusion: Multidisciplinary approach is needed in patients with extraforaminal disc herniation for better results. In our case study, PRT demonstrated a significant role in treating our patient. As a result of the treatment significant reduction of pain and improvement of functional status was observed. The patient returned to normal life habits and activities in a very short time, which was primary goal.
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    General anesthesia: Is it safe for newborns, infants and young children?
    (Association of medical doctors "Sanamed" Novi Pazar, 2016)
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    Nancheva, Andrea
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    The exposure of neonates, infants and small children to general anesthesia is becoming a common occurrence. Accumulating preclinical data indicate that exposure to commonly used general anesthetic agents during key periods of brain development in this population(between late gestation and 3 to 4 years of age,) can lead to apoptotic neurodegeneration, synapse loss, and cognitive and neurobehavioral deficits that persist as the organism matures. New work suggests that infants and small children undergoing some types of surgery could have better recovery if they receive regional anesthesia rather than general anesthesia. In response to this concerns, the Food and drug administration (FDA) and the International Research Society in anesthesia (IARS) started an initiative called Smart Tots (Strategies for Mitigating Anesthesia- related neuro Toxicity in Tots) which examine the effects of anesthesia on brain development. Also another two major prospective studies are ongoing in children : PANDA (Pediatric Anesthesia Neurodevelopment assessment Study )project is a large, multi-center study based at the Morgan Stanley Childrens Hospital of New York at Columbia University, and another one is GAS study which is a multisite randomized controlled trial comparing neurodevelopment outcomes in infant receiving general anesthesia compared to spinal and other regional anesthetics to the stress response to surgery. The findings from these studies will help researches to design the safest anesthetic regimens and to develop the new and safer anesthetic drugs for use in pediatric medicine.