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, Insulin resistance and metabolic syndrome in hepatitis C virus seronegative heroin dependents(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2023-12); ; ; Initial studies on impaired glucose-insulin homeostasis in heroin dependents have not defined the impact of concomitant hepatitis C infection (HCV), which has been strongly associated with the development of insulin resistanceand metabolic syndrome (MS). The aim of our study was to evaluate the association of heroin dependence with glucose-insulin homeostasis and MS in heroin dependents with HCV seronegativity. Materials and methods: The study was prospective and cross-sectional, including 160 heroin dependents compared to a control group of 60 participants.MS was diagnosed using International Diabetes Federation criteria. The homeostatic model assessment for insulin resistance (HOMA-IR) and pancreatic β-cell function (HOMA-%B) were used for assessing insulin resistance and β-cell function of pancreas. Results: MS was detected in 9.32% of heroin addicts. Heroin dependents with MS compared to dependents without MS were older, had higher BMI, waist circumference and significantly higher systolic and diastolic blood pressure, increased triglycerides (F=8.233, df=2, p<0.001), apoB (F=8.154, df=2, p=0.001), and reduced HDL-C (F=25.926, df=2, p<0.001) and apoA-I (F=16.406, df=2, p<0.001), significantly increased inuslinemia (F=4.928, df=2, p<0.05), insulin resistance-HOMA-IR (F=4,928, df=2, p<0,05) and insignificantly increased pancreatic β-cell function (194.66 ±224.05) (F=2.461, df=2, p>0.05). Conclusions: Insulin resistance and МS, independent of HCV, was also registered in heroin dependence. Timely recognition will enable more successful treatment of comorbidities and illicit drug dependence. - 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, 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, Severe systemic toxicity after intravenous administration of metamizole and ceftriaxone in a splenectomised patient-case report(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024-04); ; ; Drug-induced toxicity can have a mild to severe clinical presentation as a life-threatening condition. We presented a case with a general vasculitis and severe multi-organ failure in a splenectomised middle-aged woman, which developed after ceftriaxone and metamizole parenteral administration. A middle-aged woman was treated with IV metamizole and ceftriaxone for a fever and soar throat in a local hospital. She had a post traumatic splenectomy 5 years ago. After metamizole, during ceftriaxone administration she felt burning in her face with maculo-papulose rash which started to conflate, spread to whole body and intensively darkened. She was transferred to the University Toxicology Clinic with а hypotension, hypoxemia, generalized necrotic vasculitis with predominant facial distribution. There was increased values for CRP (250 mg/l), WBC (27x10^9/l) and LDH (1867 U/l) during hospitalisation. She also presented anaemia (Er 2.6x10^12/l, Hgb 88 g/l, Hct 0.24), polyserositis-ascites, pleural effusion and mild pericarditis (high sensitive troponin 107 ng/l), acute pancreatitis (amylase 1048 U/l, lipase 881 U/l), hepatomegaly, acute kidney injury (BUN 36.5 mmol/l, creatinine 528 μmol/l, oliguria), disseminated intravascular coagulation (Plt 23x10^9/l, DD 7658ng/ml, PT 56 sec, aPTT 120 sec), vitreous haemorrhage of the right eye and rhabdomyolysis, CPK 428U/l. Microbiological findings were negative. Immunoserology showed positive p-ANCA. The acute renal failure, ascites and pleural effusions resolved under methylprednisolone, meropenem, LMWH, haemodialysis and symptomatic therapy, with normalization of laboratory parameters. A skin biopsy finding was inconclusive. After 25 days, rheumatologist recommended mycophenolate mofetil PO. She was asymptomatic with prednisolone and mycophenolate mofetil therapy during following two years and maintained stable after their discontinuation. Drug-induced toxicity have potential to induce a severe multiorgan failure with life-threatening complications. Splenectomy may be studied as a potentially 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 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, Rhabdomyolysis and Aminotransferase Activity Due to Acute Intoxication With Psychotropic and Chemical Substances(Arak University of Medical Sciences, 2023-01); ; ; ; Background: Rhabdomyolysis is caused by the release of enzymes from skeletal muscles into the blood, which leads to systemic complications with diverse etiologies. This study evaluated the serum aminotransferases in patients with rhabdomyolysis following acute intoxication with either psychotropic drugs or other chemical agents. Methods: This study randomly recruited 140 patients suffering from rhabdomyolysis. They were divided into two groups affected by either psychotropic drugs or chemical agents. Rhabdomyolysis was defined as having serum creatine kinase (CK) levels greater than 250 U/L, based on the poisoning severity score. Results: On day 1, the CK/AST correlation was significantly stronger in the psychotropic than the chemical group (P=0.0009). On day 5, patients in the psychotropic group had significantly higher AST (P=0.0138) and ALT (P=0.0129) than those poisoned with other chemicals. The difference in the strength of the CK/ALT correlation between the two groups was insignificant. Between the two groups, the differences between the CK levels and the following serum parameters were insignificant: Alkaline phosphatase; gamma-glutamyl transferase; prothrombin time; total bilirubin; and albumin. Conclusion: The elevated aminotransferases in patients with rhabdomyolysis due to acute psychotropic toxicity might have resulted from the skeletal muscle injury rather than hepatotoxicity. In rhabdomyolysis patients poisoned with other chemicals, the elevated serum aminotransferases are likely due to liver toxicity arising from the consumed substances. These patients are likely to manifest clinically severe long-term multi-organ failure. Intoxications with typical agents, such as herbicides, petroleum distillates, and corrosives were responsible for the rhabdomyolysis in the second group - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SEVERE DELIBERATE METFORMIN POISONING-CASE REPORT AND LITERATURE REVIEW WITH REFERENCE TO CURRENT TREATMENT MODALITIES AND OUTCOME(Macedonian Association of Internal Medicine, 2022-05); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MYOGLOBIN IN ACUTELY INTOXICATED PATIENTS WITH RHABDOMYOLYSIS(Macedonian Association of Internal Medicine, 2022-05); ; ; ; Bekjarovski Niko - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute poisonings in geriatric population in a one year period(Taylor & Francis, 2022-05-25); ; ;