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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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Management of tobacco dependence
(2018-10-27)
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Dejan Todevski
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Suzana Arbutina
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Monika Tushevska Mitkovska
Tobacco is the leading cause of premature death and disability in Europe. Each year, more than 700,000 Europeans die from tobacco-related illness. In Macedonia, 46.6% of the male and 26.8% of the female population are active smokers. These numbers acertain Macedonia to the high place in Europe by smoking rates. There is nothing more important we can do for patients who smoke than help them stop! Doctors and health professionals must take into account that tobacco dependence is a medical condition and not a habit, vice, pleasure, or life-style choice and it must be diagnosed and treated in the same way as other chronic diseases. Most smokers are not able to stop on their own (without help). Nicotine dependence is a chronic relapsing condition and has two components: physical dependence and psychological dependence. The tenacity of nicotine addiction means that many smokers who attempt to quit will relapse. Relapse is most common within the first few weeks of quitting. The ENSP Tobacco Treatment Guidelines recommend five strategies for addressing tobacco use in clinical settings. Known as the “5As” these strategies are: Ask all patients about smoking status and document in medical record; Advise patients who smoke to quit; Assess readiness to quit; Assist with making a quit attempt, including providing behavioral counselling and prescribing first-line smoking cessation medications; and Arrange follow-up. Behavioral support (Motivational interviewing) is the keystone of tobacco dependence treatment. It is generally matched to the patient’s motivation to quit smoking also known as the patients “stage of change”. There are five stages of change. Pre-contemplation, Contemplation. Preparation, Action and Maintenance. Tobacco dependence may need persistent and repeated therapeutic interventions, as well as long- term follow-up until it is cured. In order to give our contribution to the reduction of tobacco consumption in Macedonia, we are implementing a program for education of doctors and health workers for smoking cessation. The project represents partnership between the Medical faculty in Skopje and the Henry Ford Health System from Detroit, Michigan, USA.
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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
;
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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