Faculty of Medicine

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    Efficacy and Safety of COVID-19 Convalescent Plasma in Hospitalized Patients-An Open-Label Phase II Clinical Trial
    (MDPI (Multidisciplinary Digital Publishing Institute), 2022-10-09)
    Grubovic Rastvorceva Rada
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    Sedula Useini
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    Background: COVID-19 convalescent plasma (CCP) is an important antiviral option for selected patients with COVID-19. Materials and Methods: In this open-label, phase 2, clinical trial conducted from 30 April 2020 till 10 May 2021 in the Republic of North Macedonia, we evaluated the efficacy and safety of CCP in hospitalized patients. Treatment was with a single unit of CCP having an anti-RBD IgG concentration higher than 5 AU/mL. Results: There were 189 patients that completed the study, of which 65 (34.4%) had WHO 8-point clinical progression scale score of 3 (requiring hospital care but not oxygen support), 65 (34.4%) had a score of 4 (hospitalized and requiring supplemental oxygen by mask or nasal prongs), and 59 (31.2%) had a score of 5 (hospitalized and requiring supplemental oxygen by non-invasive ventilation or high-flow oxygen). Mean age was 57 years (range 22−94), 78.5% were males, 80.4% had elevated body mass index, and 70.9% had comorbidity. Following CCP transfusion, we observed clinical improvement with increase rates in oxygenation-free days of 32.3% and 58.5% at 24 h and seven days after CCP transfusion, a decline in WHO scores, and reduced progression to severe disease (only one patient was admitted to ICU after CCP transfusion). Mortality in the entire cohort was 11.6% (22/189). We recorded 0% mortality in WHO score 3 (0/65) and in patients that received CCP transfusion in the first seven days of disease, 4.6% mortality in WHO score 4 (3/65), and 30.5% mortality in WHO score 5 (18/59). Mortality correlated with WHO score (Chi-square 19.3, p < 0.001) and with stay in the ICU (Chi-square 55.526, p ≤ 0.001). No severe adverse events were reported. Conclusions: This study showed that early administration of CCP to patients with moderate disease was a safe and potentially effective treatment for hospitalized COVID-19 patients. The trial was registered at clinicaltrials.gov (NCT04397523).
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    Relationship Between Azithromycin and Cardiovascular Outcomes in Unvaccinated Patients With COVID-19 and Preexisting Cardiovascular Disease
    (Lippincott Williams & Wilkins / Wolters Kluwer, 2023-07-14)
    Bergami, Maria
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    Manfrini, Olivia
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    Nava, Stefano
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    Caramori, Gaetano
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    Yoon, Jinsung
    Background Empiric antimicrobial therapy with azithromycin is highly used in patients admitted to the hospital with COVID‐19, despite prior research suggesting that azithromycin may be associated with increased risk of cardiovascular events. Methods and Results This study was conducted using data from the ISACS‐COVID‐19 (International Survey of Acute Coronavirus Syndromes‐COVID‐19) registry. Patients with a confirmed diagnosis of SARS‐CoV‐2 infection were eligible for inclusion. The study included 793 patients exposed to azithromycin within 24 hours from hospital admission and 2141 patients who received only standard care. The primary exposure was cardiovascular disease (CVD). Main outcome measures were 30‐day mortality and acute heart failure (AHF). Among 2934 patients, 1066 (36.4%) had preexisting CVD. A total of 617 (21.0%) died, and 253 (8.6%) had AHF. Azithromycin therapy was consistently associated with an increased risk of AHF in patients with preexisting CVD (risk ratio [RR], 1.48 [95% CI, 1.06–2.06]). Receiving azithromycin versus standard care was not significantly associated with death (RR, 0.94 [95% CI, 0.69–1.28]). By contrast, we found significantly reduced odds of death (RR, 0.57 [95% CI, 0.42–0.79]) and no significant increase in AHF (RR, 1.23 [95% CI, 0.75–2.04]) in patients without prior CVD. The relative risks of death from the 2 subgroups were significantly different from each other ( P interaction=0.01). Statistically significant association was observed between AHF and death (odds ratio, 2.28 [95% CI, 1.34–3.90]). Conclusions These findings suggest that azithromycin use in patients with COVID‐19 and prior history of CVD is significantly associated with an increased risk of AHF and all‐cause 30‐day mortality.
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    PUNCTURE INJURY IN THORACOLUMBAR REGION
    (Faculty of Medicine, Ss Cyril and Methodius University in Skopje, 2022)
    Volcevski, Goce
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    Mihajloski, Vladimir
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    BOUVERT'S SYNDROME: A CASE REPORT
    (University Ss. Cyril and Methodius in Skopje, 2024)
    Hadzi Manchev, Dragan
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    Osmani, Bujar
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    Gjoshev, Stojan
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    Divestment–Adventitia Resection in Order to Decrease Morbidity and Mortality and Improve R0/R1 Ratio in Curative Pancreatoduodenectomy for Advanced Pancreatic Head Carcinoma
    (Scientific Foundation Spiroski (publications), 2026-06-14)
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    Kolari, Arbijon
    Abstract BACKGROUND: Pancreatic head carcinoma (PHC) is a highly aggressive malignancy associated with substantial morbidity, mortality, and poor long-term survival. Achieving an R0 resection margin during pancreatoduodenectomy (PD) is crucial for improving oncological outcomes. However, in borderline resectable (BRPHC) and locally advanced pancreatic head carcinoma (LAPHC), arterial involvement often necessitates complex arterial resections associated with high perioperative risks. Periarterial sub-adventitial divestment has emerged as a potential alternative to arterial resection, aiming to improve radicality while reducing complications. AIM: To evaluate whether sub-adventitial arterial divestment during curative pancreatoduodenectomy decreases perioperative morbidity and mortality and improves the R0/R1 resection ratio in patients with BRPHC and LAPHC. METHODS: A retrospective study was conducted on 50 consecutive patients with BRPHC or LAPHC treated between 2009 and 2017 following neoadjuvant therapy when indicated. All patients underwent extensive pancreatoduodenectomy with triangle operation, extended lymphadenectomy, and periarterial sub-adventitial divestment of the superior mesenteric, common hepatic, and/or celiac arteries. Clinicopathological data, perioperative morbidity, mortality, length of hospital stay, and R0/R1 resection status were analyzed. RESULTS: Among the 50 patients, 27 (54%) were male and 23 (46%) were female, with a mean age of 63.1 ± 8.97 years. Overall mortality was 8% (4/50). Major complications included postoperative pancreatic fistula (24%), postoperative biliary fistula (2%), postpancreatectomy hemorrhage (4%), reoperation (6%), necrotizing pancreatitis (4%), thromboembolism (4%), cardiac failure (2%), and pulmonary complications (8%). Venous resection was required in 12% of patients. Postoperative pain relief was achieved in 92% of cases. Mean hospital stay was 10.56 ± 6.09 days. Histopathological examination demonstrated R0 resection in 28 patients (56%) and R1 resection in 22 patients (44%). Morbidity and mortality rates were comparable to standard PD and appeared lower than those reported for PD combined with arterial resection. CONCLUSION: Sub-adventitial arterial divestment during pancreatoduodenectomy is a feasible and safe technique for selected patients with borderline resectable and locally advanced pancreatic head carcinoma. The procedure provides acceptable morbidity and mortality rates while achieving favorable R0 resection outcomes, representing a promising alternative to arterial resection in specialized high-volume centers. Keywords Pancreatic head carcinoma Pancreatoduodenectomy Arterial divestment Borderline resectable pancreatic cancer R0 resection
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    The role of rapid chromatographic immunoassay tests in acute poisoning: two case reports and literature overview
    (Edizioni Minerva Medica, 2026-03-22)
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    This report through the presentation of two case studies highlights the common problem with false-positive urine drug screen faced by many physicians to the emergency and toxicology departments. Case 1: a 29-year-old male patient was admitted after acute poisoning with analgesics/antipyretics (Caffetin Cold, Caffetin); diazepam; amlopin. Case 2: a 56-year-old female patient was admitted with impaired consciousness. According to the data obtained from the patient’s family they suspected that she took the following drugs: Zanfexa, Zalasta and Diazepam. A rapid chromatographic immunoassay urine test was performed in both patients for the following substances: opiates, amphetamines, metamphetamine, MDMA (3,4-methylenedioxymethamphetamine), oxycodone, phencyclidine, cocaine, methadone, barbiturates, cannabinoids, benzodiazepines, tricyclic antidepressants, and tramadol. Case 1 was positive for opiates, benzodiazepines and amphetamines. Gas chromatography mass spectrometry and high-performance liquid chromatography were used and confirmed the presence of caffeine, codeine, paracetamol, propyphenazone, pseudoephedrine, dextromethorphan, nordazepam, ramipril and amlodipine in urine sample. Case 2 was positive for tramadol and benzodiazepines. Gas chromatography mass spectrometry was used and confirmed the presence of venlafaxine, its metabolites and nordazepam in serum and urine samples. If a false-positive urine screen result is suspected, nonimmunologic techniques, such as gas chromatography/mass spectrometry or high-performance liquid chromatography, are necessary for confirmation.
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    Late emergence of myasthenia gravis complicating envenoming by Vipera ammodytes
    (Elsevier BV, 2026-10-01)
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    Kostadinovski, Kristin
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    PREMATURE BIRTH AS A RESULT OF CONGENITAL ANOMALY IN A UNICORN UTERUS
    (Walter de Gruyter GmbH, 2025-05-16)
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    Jordancho Ivanov
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    Bushinoska Jasna