Faculty of Medicine

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Barriers and factors that facilitate the use of long-term oxygen therapy at home and the quality of life of patients with COPD
(Association of Traditional Chinese Medicine and Acupuncture Tong Da Tang TCM, Skopje R.N. Macedonia, 2024)
Suzana Arbutina
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Aleksandra Stefanovska
Background: Long-Term Oxygen Therapy (LTOT) is a critical intervention for managing chronic obstructive pulmonary disease (COPD) in patients with severe hypoxemia. Despite its clinical benefits, the effective use of LTOT at home faces numerous barriers and facilitating factors that significantly influence the quality of life (QoL) of COPD patients. Objective: This study aims to explore the barriers and factors that influence the use of LTOT at home, as well as its impact on the quality of life of COPD patients Methods: Through a comprehensive review of the literature, we identify the challenges and facilitators associated with LTOT use, along with the factors that contribute to the quality of life of patients. A mixed-methods approach was utilized in this study, involving qualitative data from semi-structured interviews with patients, caregivers, and healthcare providers. The study included a cohort of COPD patients on LTOT, assessing their experiences and QoL over a specified period. Results: Key barriers to effective LTOT use at home included physical limitations, social stigma, equipment management issues, and insufficient patient education. Facilitating factors identified were robust social support, comprehensive education programs, and regular follow-up with healthcare providers. Conclusion: Understanding the barriers and facilitating factors in the use of LTOT at home is essential for enhancing adherence and improving the QoL of COPD patients. Tailored interventions that address these barriers and leverage facilitating factors can lead to more effective LTOT use and better patient outcomes. This study highlights the importance of a holistic approach in managing COPD, incorporating both medical treatment and supportive measures to optimize patient well-being. The findings provide valuable insights into enhancing the effectiveness of LTOT at home and improving the overall well-being of individuals living with COPD.
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Pulmonary embolism - Pulmonary thromboembolism in patient with rectal adenocarcinoma
(Association of Traditional Chinese Medicine and Acupuncture Tong Da Tang TCM, Skopje R.N. Macedonia, 2024)
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Suzana Arbutina
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Gabrijela Dimoska
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Aleksandra Stefanovska
Pulmonary thromboembolism (PTE) is potentially life-threatening disorder. The pathogenesis of pulmonary thromboembolism isn’t fully understood, but it is believed to involve imbalance between pro-coagulants and anticoagulants, as well as endothelial dysfunction and acute or chronic inflammation. Pulmonary embolism (PE) occurs when there is a disruption to the blood flow in the pulmonary artery or pulmonary branches by a thrombus that originated somewhere else. Risk factors for PE are deficiency of protein S,protein C deficiency, anti-thrombin III deficiency, LA-lupus anticoagulant, factor V Leiden deficiency, antiphospholipid syndrome (APLS), previous surgical treatment, chemotherapy, immunosuppressive drugs, immobility, overweight ,oral contraceptives, pregnancy ,history of vein thrombosis ,thrombophlebitis , varicose veins. There is a relationship between higher body mass index (BMI) and VTE, and patients with severe obesity (BMI ≥ 35) have higher risk of pulmonary thromboembolism compared with those of normal BMI. Patients with pulmonary thromboembolism may present with a spectrum of symptoms, including chest pain, shortness of breath, tachycardia, hemoptysis, asymmetric pitting edema on legs, prominent superficial collateral vessels, tenderness and pain to palpation of the leg, red or purple color, warmth on the affected leg. The diagnostic work-up of suspected pulmonary embolism includes D-dimer testing, ECG, ultrasonography of heart and CT angiography. Direct oral anticoagulants are first-line treatment options for venous thromboembolism because they are associated with a lower risk of bleeding disorders than vitamin K antagonists. Use of thrombolysis should be limited to pulmonary embolism associated with haemodynamic instability. Anticoagulants should be continued for at least 3 to 6 months to prevent early recurrences and relaps of PE. Haematological malignancies, lymphoma, lung cancers and colorectal cancers are the most common cause of PE
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Complications associated with acute pulmonary embolism – data from the registry of patients with venous thrombembolism
(Македонско лекарско друштво = Macedonian Medical Association, 2022)
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Dejan Todevski
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Suzana Arbutina
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Correct estimation of the severity, mortality, and complication risk are crucial for effective treatment of pulmonary embolism (PE). A total of 162 patients hospitalized with acute PE, treated either with standard treatment with heparin and vitamin K antagonists (VKA) or heparins, followed by direct oral anticoagulants (DOAC) were followed for a 90-days period. Demography, clinical and radiologic presentation, smoking status and concomitant comorbidities were analyzed. The mortality risk was estimated by calculating PESI and sPESI score. The results showed uneven utilization of both treatment modalities (93.8% treated with VKA versus 6.17% with DOAC). Smoking as an independent factor was detected in 55.56% of patients, and is greater than the overall smoking prevalence in Macedonia. Central propagation of PE was found in 57.79% of cases and together with the presence of pleural effusion was associated with a greater risk for complications. Estimation of 30-day mortality risk with PESI and sPESI showed their high predictive value, with an advantage of sPESI, in terms of better accuracy and simplicity of performance. Correct estimation of risk for complications and mortality is important for improving the overall safety of patients with PE and has a positive „cost-benefit“ effect for organization of the treatment.
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Evaluation of IL-8 and MEF25-75 in patients with severe COPD who were treated with combined therapy of ICSs / LABAs plus tiotropium bromide
(Europian Respiratory Society, 2013)
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Zlatica Gosheva
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Angelko Gjorchev
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Suzana Arbutina
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The aim of this study was to determine the effect of combined therapy of ICSs/LABAs plus tiotropiumbromide in patients with COPD, by analyzing of IL-8 and MEF25-75 at the beginning and after 6 months oftherapy. The study included 33 patients with severe COPD. In each of them were measured serum IL-8levels by the ELISA method and MEF25-75 which are indicated the small airways obstruction. They weretreated with combined therapy of ICSs/LABAs (500mcg) plus Tiotropium Bromide (18mcg) daily in durationof 6 months. The results were statistically elaborated according to the T-test for Dependent Samples. Theobtained results of IL-8 showed that the level of IL-8 before the start of therapy were much higher and thattreatment significantly reduces their value (t=3.13, p=0.003, p<0.05). The results of MEF 25-75 at the startof therapy were lower and after 6 months of treatment showed a slight improvement of lung function butstatistically insignificant (t= -0.83, p=0.41,p<0.05). The concentration of IL-8 is closely related with airwayobstruction in patients with COPD and may serve as a marker for evaluating the severity of airwayinflammation. ICSs/LABAs and tiotropium bromide have inhibitory effect on neutrophilic inflammationthrough the suppression of IL-8 production from epithelial cells and thus may contribute to lower cellularinflammation in COPD. Because it is a progressive disease and airflow limitation is not fully reversible, wecannot expect spectacular results like we show with the value of MEF25-75, but should strive to preventprogression and reduce airway remodeling with education, pharmacologic and non pharmacologic treatment

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