Faculty of Medicine

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    Persistent foramen ovale as a cause of cerebral strokes in young individuals - case reports
    (MIT University Skopje, 2025-03)
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    Nikolovski, Robert
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    Zhaku, Vegim
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    Foramen ovale is a small congenital defect in the level of the interatrial septum of the heart that occurs as a result of the failure of fusion between the septum primum and septum secundum during embryogenesis. It is present in about 25% of the population and is usually clinically insignificant. However, in some cases, it can lead to paradoxical embolism, which may result in an ischemic stroke. Objective: To investigate the association between patients with persistent foramen ovale (PFO) and the occurrence of strokes in young individuals, with a case report. Case Report: A 27-year-old patient presented for a check-up with a history of multiple episodes, especially in the morning, of weakness in the left limbs, particularly the left arm, accompanied by dizziness. These symptoms spontaneously improved, but in the last episode, the symptoms lasted up to 5 hours from the onset. The patient lives in a small area at a higher altitude. The patient was referred for a neurological examination. The neurological examination was unremarkable at the time of the visit, but due to the recurring symptoms, the patient was referred for a magnetic resonance imaging (MRI) scan of the brain, where punctiform hyperintense lesions were detected. The patient was then referred to a cardiologist, where a transthoracic echocardiogram (TTE) revealed a thin septum, leading to a recommendation for transesophageal echocardiography (TEE). TEE showed the presence of a 2mm PFO, after which the decision was made to close it using an Amplatzer PFO Occluder – 25mm in size. Conclusion: Although rare, a transient ischemic attack (TIA) in younger individuals should prompt consideration of the potential existence of PFO. Timely diagnosis and treatment of PFO are crucial for the lives of these patients.
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    D DIMERS - A POWERFUL TOOL IN THE DIAGNOSIS OF AORTIC DISSECTION
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
    Jovanoski, Marko
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    Nikolovski, Robert
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    Petkovski, D.
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    Introduction: Acute aortic syndrome is one of the most life threatening cardivascular conditions besides acute coronary syndrome and pulmonary embolism. Fifty percent of all the patients with aortic dissection do not survive for surgery or other therapeutic procedure to be performed and they experience a lethal end. D dimers although are a marker with a low specificity and sensitivity they can help us and guide us to make the right diagnosis. Aim: Using d dimers to raise the suspicion for acute aortic dissection and using the triple chest pain CT angiography protocol to confirm the right diagnosis. Case report: This series of case reports are about a few patients that presented in the emergency department with either a chest or back pain which was radiating to different body regions (including the lumbal region and the abdominal area). As these symptoms can sometime overlap and manifest as different acute cardiovascular syndromes, which can lead to increased morbidity and mortality, a CT angiography was performed after the regular noninvasive, low cost echocardiography was done to potentially find a possible diagnosis and show us the right diagnostic path. D dimers were also examined in all of the patients and increased level was found in all of the above mentioned. Aortic dissection (Stanford A or B ) was the final diagnosis in all of them, every single patient requiring a different therapeutic approach. Conclusion: D dimers in combination with a good clinical examination can be a perfect tool to raise the suspicion for acute aortic syndrome and after performing a triple chest pain protocol with CT angiography we can confirm and treat the diagnosis which requested a hospital admission.
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    SARS-COV-2 INFECTION: CARDIAL AND MULTI-ORGAN INVOLVEMENT
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2022-12)
    Furnadziski, Aleksandar
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    Mitevski, Goran
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    Nikolovski, Robert
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    SARS-COV-2 is a single-strain RNA virus that attacks primarily the respiratory system. The second most commonly affected system is the cardiovascular. Often it attacks multiple organ systems causing multi-organ failure. Atrial fibrillation (AF) is the most common sustained supraventricular arrhythmia in acute settings of COVID-19 infection and is associated to more complications and mortality rates. The presence of AF in patients with COVID-19 pneumonia should be managed with increased attention to prevent adverse outcomes. COVID-19 may be a cause of multiple organ damage in some infected patients.
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    LEFT MAIN CORONARY ARTRY STENTING IN PATIENTS WITH CHRONIC KIDNEY DISEASE - A LIFESAVING PROCEDURE
    (MIT University Skopje, 2022-10)
    Mitevski, Goran
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    Taravari, Hajber
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    Background: Chronic kidney disease (CKD) is one of the most important factors for adverse outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention. These patients have poorer outcomes in comparison with patients without CKD. The strategy for the best revascularization technic in patients with CKD and coronary artery disease is still unknown because these patients are usually excluded from most clinical trials, especially in patients with moderate or severe CKD. Aim: This case report aims to show that percutaneous coronary intervention is a necessary and life-saving procedure in a critically ill patient with CKD despite the risk of complications and worsening renal function. Case Report: We present a 76 years patient with a medical history of CKD stage 4, Diabetes Mellitus type 2 on insulin therapy, and hypertension, one year ago she got a drug-eluted stent on the left anterior descendent (LAD) coronary artery, after which she has developed contrast-induced nephropathy and she underwent on hemodialysis after which kidney function stabilized. She was diagnosed with heart failure with reduced EF (23%). This patient came to the emergency department with pulmonary edema and subacute myocardial infarction. She was medically stabilized and underwent delayed percutaneous coronary intervention (PCI) with stenting to LM/pLAD after which deterioration of kidney function was observed (Creatinin456.8..498..701umol/L, Urea 22.6..23.4..27mmol/L). She underwent hemodialysis after which previously kidney function was obtained and she was dismissed in good health. Conclusion: PCI and Left main stenting is a lifesaving procedure in patients with CKD. A multidisciplinary approach and an experienced invasive cardiologist are of crucial importance for a good outcome in these patients.
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    Hypertension in athletes
    (MIT University, 2023-03)
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    Furnadjiski, Atanas
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    Mitevski, Goran
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    Nikolovski, Robert
    Hypertension is the most common cardiovascular disease in athletes. Prompt diagnosis and management is crucial for ensuring safe sport participation and prevention of long term complications in athletes. Many diagnostic tools are involved in the management algorithm of the hypertension starting from good anamnesis especially the family history, as well as other simple and sophisticated paramedical imaging techniques, as ECG, Echocardiography, 24 Hours ambulatory ECG monitoring, cardiac MRI and many others. Distinguishing an athlete heart from pathological heart muscle hypertrophy is the key step for the differential diagnosis. Conclusion: Proper pharmacological and non pharmacological measures will facilitate satisfying long term prognosis for the athletes.