Faculty of Medicine

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Пулмонален синдром при инфекција со Ханта вирус
(Residents' Doctor Association RDA, 2023-11)
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Suzana Arbutina
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Aleksandra Georgieva
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Ile Kuzmanoski
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STUDIJA PRESEKA – KVALITET ZIVOTA PACIJENATA SA HOBP-OM: UPOTREBA SGRQ I HADS
(2024-01-06)
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Suzana Arbutina
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Aleksandra Stefanovska
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Verce Jovanovska
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Valentina Smileska
Hronična opstruktivna bolest pluća (HOBP) je dugotrajna, progresivna bolest pluća koja ometa normalan protok vazduha u plućima.Ova bolest obuhvata dva glavna stanja:hronični bronhitis i emfizem.Glavni uzroci HOBP-a su pušenje, dugotrajna izloženost drugim iritansima pluća, zagađenja vazduha ili hemikalija na radnom mestu. Simptomi HOBP-a uključuju kašalj, prisusvo sputuma, dispneju i umor. Lečenje HOBP-a obično uključuje promene u načinu života, kao što su prestanak pušenja, redovno vežbanje i ishrana, kao i lekove za olakšavanje simptoma i sprečavanje komplikacija. Teže slučajeve HOBP-a može zahtevati dodatne terapije poput kiseonika ili pulmološke rehabilitacije. Rano prepoznavanje i upravljanje HOBP-om ključni su za kontrolu simptoma i očuvanje kvaliteta života.Ova presečna studija imala je cilj da proceni kvalitet života pacijenata sa HOBP-om koji koristi respiratorni upitnik Svetog Đorđa (SGRQ) i bolničku skalu anksioznosti i depresije (HADS). Studija je obuhvatila 62 pacijenta koji su popunjavali upitnike na početku hospitalizacije i ponovo nakon otpuštanja iz bolnice. Rezultati studije su pokazali da je značajan deo pacijenata sa HOBP imao simptome anksioznosti i depresije. Utvrđeno je da su ovi simptomi mentalnog zdravlja snažno povezani sa negativnim ishodima kvaliteta života pacijenata. Studija je takođe otkrila da je anksioznost više zastupljena među pacijentima sa anksioznošću i depresijom u anamnezi, kao i među ženskom populacijom. Pored toga, utvrđeno je da komorbiditeti u HOBP-u doprinose nižem kvalitetu života u smislu simptoma mentalnog zdravlja. Korelacionom analizom otkrivena je jaka povezanost između SGRQ rezultata i prisustvo simptoma anksioznosti i depresije, naglašavajući međusobnu povezanost prirode fizičkog i mentalnog zdravlja kod pacijenata sa HOBP. Zaključak ovih nalaza naglašavaju važnost bavljenja i respiratornim i psihološkim aspektima HOBP u strategijama nege i lečenja pacijenata. Prepoznajući vezu između respiratornih simptoma i psihičkog stresa, zdravstveni radnici mogu da sprovedu ciljane intervencije za poboljšanje kvaliteta života pacijenata sa HOBP. Ova studija preseka pruža uvid u odnosu između respiratornih simptoma i psihološkog blagostanja kod ovih. Nalazi naglašavaju potrebu za integrisanim pristupom koja se bavi fizičkim i psihološkim aspektima HOBP
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Pulmonary fibrosis - symptoms, causes and treatment
(Македонско здружение за алергологија и клиничка имунологија - МЗАКИ, 2023-09)
Suzana Arbutina
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Hipoventilacioni sindrom gojaznih (HSG) -Simptomi,dijagnoza i ljecenje
(2024-06-06)
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Suzana Arbutina
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Lence Zdraveska
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Eleonora Milosheska
Uvod. Hipoventilacioni sindrom gojaznih (HSG) predstavlja kombinaciju gojaznosti (BMI> 30), poremećaja disanja tokom spavanja i povišenih vrednosti parcijalnog pritiska ugljen dioksida (PCO2) u arterijskoj krvi tokom dana. Poznat je i pod nazivom Pikvikov sindrom (Sy Pickwick). HSG predstavlja kombinacija faktora: gojaznost, hipoventilacija, naruseno spavanje, apneja u toku spavanja, opstruktivna sleep apnea (OSA). Postoji globalna epidemija hipoventilacionog sindroma gojaznih koja obuhvata sve uzraste, uključujući decu, adolescente i odrasle; stoga se rasprostranjenost takođe povećava u ovim starosnim grupama. Trenutno 35 % stanovništva Sjedinjenih Ametickih Država pati od morbidne gojaznosti (BMI> 40 kg/m2). HSG je zastupljen sa oko 0.4% u opštoj populaciji i ukoliko se ne leči, udružen je sa visokim mortalitetom. Simptomi sindroma hipoventilacije se obično javljaju zbog hipoksemija. Ovi simptomi mogu da uključuju: nedostatak daha (dispeju), umor, nedostatak energije, dnevnu tromost, glavobolje, vrtoglavica, depresije. Tokom spavanja kod pacijenta se primecuje glasno hrkanje, gušenje ili dahtanje, pauze u disanju. Dijagnostika podrazumeva, pored anamneze i fizikalnog pregleda, određivanje BMI, merenje obima vrata. Potrebno je napraviti EKG, labaratorijske analize, pulsnu oksimetriju, spirometrijsko ispitivanje plućne funkcije, radiografiju grudnog koša, merenje gasnih analiza arterijske krvi i polisomnografsko ispitivanje. Spirometrijski nalaz može biti uredan ili se može naći restriktivan poremećaj. Ključnu ulogu u lečenju ima promena navika u ishrani, higieno-dijetetski rezim, povecana fizicka aktivnost, redukcija telesne i prekid pušenja. Primena neinvazivne CPAP-a ili BiPaP-a, mogla bi da bude od pomoci kod ovih pacijenata. Kod određenih pacijenata koji ispunjavaju kriterijume može se uraditi barijatrijska operacija. Paralelno sa primenom NIV-a potrebno je lečiti komorbiditete kao što su HTA, hiperlipidemija, dijabetes, hipofunkcija štitne žlezde, drugih endokrinioloskih i metabolnih poremecaja. Komplikacije bolesti su mogobrojne a u prvom redu podrazumevaju pojave DM2, HTA, srčane slabosti, hronično plućno srce, hronična respiratorna insuficijencija, sekundarna eritrocitoza i plućne tromboembolijske bolesti. Zaključak. Hipoventilacioni sindrom gojaznih je udružen sa visokim mortalitetom I prisustvom komorbiditeta kao HTA, DM2,srcane slabosti, hroničnog plućnog srca i hronične respiratorne insuficijencije. Vazna je dijagnostikovati bolest i leciti je na vreme. Pacijente kod koji postoji sumnja na HSG potreban je multidisciplinarni pristup. Ključne reči: Hipoventilacioni sindrom gojaznih, opstruktivna, sleep apnea, NIV, CPAP
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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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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
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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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