Faculty of Medicine

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Visceral Leishmaniasis in the Republic of North Macedonia: A Retrospective Cohort Study
(Galenos Yayinevi, 2025-11-11)
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Khezzani, Bachir
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Cana, Fadil
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Visceral leishmaniasis (VL) is a systemic protozoan vector-borne disease and represents the most severe clinical form of leishmaniasis, with fatal outcomes if left untreated. This study aimed to evaluate the key epidemiological, clinical, and laboratory findings, treatment options, and outcomes in patients with VL. Materials and Methods A retrospective analysis was conducted on the epidemiological and clinical characteristics of 84 patients diagnosed and treated for VL at the University Hospital for Infectious Diseases in Skopje, Republic of North Macedonia (RNM), between 2001 and 2023. Results The median age of patients was 47 years (range 1-74), with 77.4% being male. Contact with dogs was reported in 41.7% of cases. Seven percent of patients were immunosuppressed, and all were Human Immunodeficiency Virus-negative. The median time from symptom onset to diagnosis was 30 days (range 4-330 days). The predominant clinical manifestations were splenomegaly (97.6%), fever (96.4%), hepatomegaly (90.5%), and weight loss (54.8%). On admission, anemia, leukopenia, thrombocytopenia, and hypergammaglobulinemia were detected in 75%, 73.8%, 70.2%, and 63.1% of patients, respectively. A favorable outcome was achieved in 91.7% of cases; therapeutic failure occurred in 1.2%, and 7.1% of patients died. Conclusion VL should be considered a crucial differential diagnosis in patients from the RNM presenting with prolonged unexplained fever, splenomegaly, cytopenia, and hypergammaglobulinemia.
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SINUSITIS TREATMENT IN PREGNANCY- PERSONALISED AND INTEGRATED MEDICINE
(Македонско лекарско друштво = Macedonian medical association, 2024-12)
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Sofija Nikolovska
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Budima Pejkovska Shahpaska
Introduction. Sinusitis in pregnant patients is a disorder with incidence of around 3-4% worldwide, dependent from the impaired immune system. Long lasting symptoms are sometimes accompanied with nasal polyposis that is aggravated due to pregnancy hormones. The chronic condition has its relapses, with inflammatory or noninflamatory causes. Systematic analysis, diagnostic evaluations, treatment options must be personalized and dependent of the pregnancy trimester for a favorable pregnancy outcome with the help of integrated medicine. Methods. We present a pregnant patient in the second trimester of her third pregnancy. The symptoms that occurred in the 17.5 week of gestational age included headache, high body temperature, fatigue, muscle cramps, loss of appetite, nasal congestion and discharge. After clinical examinations of microbiological samples, nasal endoscopy, mechanical vacuum suction, chronic sinusitis aggravated by nasal polyposis with propagation from maxillary sinus was diagnosed. The treatment according to antibiogram and FDA approval for the trimester included local topic treatment with diluted cephalosporins, corticosteroids (fluticasone propionate),inhalations, antibiotics, probiotics and vitamins per os. Results and Discussion. Improvement of the subjective and objective symptomatology of the patient occurred after 5 weeks of treatment. Relapse occurred in the third trimester and two months postpartum. Immunopathohistologically, there is an antagonism of IgE, of interleukin IL-4, IL-5 and IL-13. The increase of IL-17 is proven for frequent exacerbations. Long lasting symptoms are sometimes accompanied with nasal polyposis that is aggravated due to pregnancy hormones. Conclusion. The immune system in pregnancy changes, with exaggerated inflammatory reaction inadequate to recover from sinusitis for a shorter period of time. Therefore, detailed examination and adequate therapy is obligatory as soon as the diagnosis is settled. All corticosteroids are not allowed in the second trimester due to proven unfavorable outcome for the fetus. Mechanical treatments and topic antibiotics were main therapeutic solution. Modern medicine aims to combine genetics and detection of the phenotype for chronic type of inflammation and the type of the immune response in order to stratify patients for appropriate treatment.
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Rituximab in treatment of a patient with granulomatosis with polyangitis - a case report
(Македонско лекарско друштво = Macedonian medical association, 2023-01)
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Guchev, Filip
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Antova, Dubravka
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Karadzova Stojanovska, Anzhelika
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Vidinikj, Sonja
ANCA-associated vasculitis (AAV) is a necrotizing vasculitis with few or no immune deposits that can affect predominantly small vessels. It can affect vessels in every organ and tissue of the body; the clinical manifestations of the disease are extremely variable. B-cells are of major importance in the disease pathogenesis as precursors of ANCA-producing plasma cells and, possibly, also as antigen-presenting and cytokineproducing cells. Therefore, rituximab, a monoclonal antibody drug causing partial B-cell depletion, has emerged as a powerful option in the treatment of AAV such as granulomatosis with polyangiitis. We present the case of a 25-year-old female diagnosed with granulomatosis with polyangiitis and treated with rituximab and high-dose corticosteroids.
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CONGENITAL DIAPHRAGMATIC HERNIA - DIAGNOSIS, TREATMENT AND FAMILY PLANNING
(Македонско лекарско друштво = Macedonian medical association, 2025-08)
Mirjana Kjaeva Pejkovska
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Introduction. Congenital diaphragmatic hernia is a rare structural and genetic disorder. Early diagnosis, proper treatment and expectance of the outcome in terms of future family planning are needed. Aim. To increase the awareness of early diagnosis and to present the current protocols for diagnosis, treatment and family planning if congenital diaphragmatic hernia occurs, particularly in early childhood. Methods. For the purpose of this retrospective study, 20 mothers who gave birth to children with congenital diaphragmatic hernia were enrolled. They had been given questionnaires regarding the timing of their fetus’s diagnosis, the treatment that followed, and the frequency of this condition in their family. Before the treatment, parents of the patients signed a consent form. Their data were collected and analyzed in the period of two years. Results. Early diagnosis can be life saving because the baby needs to be intubated as soon as the mother gives birth. Some mothers had to plan their deliveries ahead in institutions with highly developed intensive care, with Discussion. Early diagnosis is of crucial importance for timely preparation and treatment of both mothers and babies. ECMO treatment, to provide the best treatment protocol for better quality of life for both mother and child. In the literature the need for sterilized conditions during the treatment is described because of the possible complication such as sepsis caused by healthcare-associated infections. Conclusion. Congenital diaphragmatic hernia is a condition for which awareness must be raised for proper diagnosis, treatment and family planning.
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Complications of Coronavirus Disease-19 in a Hospitalized Patient: A Case Report
(Scientific Foundation Spiroski (publications), 2020-12-25)
Meshkova, Iskra
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Simeonova, Magdalena
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Markovska, Zorica
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Markoska, Vesna
BACKGROUND: Coronavirus (CoV) disease (COVID)-19 infection is a major public health issue worldwide with no specific therapy or vaccine. CASE REPORT: COVID-19-positive patient was hospitalized due to a dry irritating cough that has persisted for 3 days. The polymerase chain reaction test to severe acute respiratory syndrome-CoV-2 was positive. Computed tomography (CT) scan of the lungs showed massive bilateral consolidation. The patient was set to oxygen support (6 L/min). Two hours after referring the patient’s condition worsened with shortness of breath, suffocation, wheezing, and decreased saturation (77%). The patient was given mechanical support with continuous positive airway pressure mask. Therapy included azithromycin 500 mg and ceftriaxone 2 g. On the 3rd day of hospitalization, there was a sharp deterioration of the condition and a decrease in saturation (40%). The patient was intubated and immediately placed on intermittent positive pressure ventilation. Azithromycin was now combined with meropenem 3 × 1 g. The next morning patient’s condition further worsened with decrease in saturation and heart rate. The resuscitation was unsuccessful. CONCLUSION: COVID-19 is primary a respiratory infection, but the virus also affects other organs with poor outcome.
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INCIDENTAL HEMATOPERITONEUM IN LAPAROSCOPIC APPENDECTOMY IN PREGNANT PATIENT
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
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Shurlani, Arben
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Ismaili, Bashkim
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Acute appendicitis is the most common non obstetric emergency in pregnant women and often associated with a late diagnosis and complications such as perforation and fetal loss. We present a case of a 25-year-old primigravida, with epigastric pain radiating to the lower right quadrant that appeared 12 hours before admission, nausea, vomiting, white tongue and foetor ex ore. The laboratory values: WBC 18.000, RBC 4.12, HCT 36.2, CRP 22. Ultrasound examination: fetal biometry corresponded to 7 gestational weeks, positive cardiac activity, a small amount of peritoneal fluid was present in the right paracolic, ileocecal region and in Douglas's space, thickening of the wall of appendix vermiformis, surrounding inflammation of fatty tissue. The patient was observed in the next 6 hours, pain persisted in the lower right quadrant with propagation to the left quadrant. An indication for laparoscopic intervention for acute appendicitis has been made. The patient was placed in the supine position with the first camera and extraction port supraumbilically (10 mm) and the second port (5 mm) suprapubically. On laparoscopic exploration, 200 ml of bloody content was found in the pelvis and the vermiform appendix with reactive changes in the middle part towards the apex. An infundibular paraovarian cyst with a diameter of 20 mm was present on the right fallopian tube. The right ovary was ruptured with bleeding on one side. A third port (5 mm) was placed left pararectally. Aspirated pelvic blood was sent in the laboratory for beta HCG determination and partial resection of the right ovary and appendectomy were performed. After lavage, a Redon drain was placed in the pelvis through the suprapubic port. Postoperative course was normal and the drain was removed on the second postoperative day. Gynecological ultrasound was performed on the third postoperative day, the findings were normal and patient was discharged home.
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Percutaneous Nephrostomy in the Treatment of Hydronephrosis in Renal Transplant Patients - Case Report
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2022-11-01)
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Percutaneous nephrostomy is a first-line minimal invasive treatment option for ureteral obstruction following kidney transplantation, with high effectiveness and a low complication rate. Percutaneous nephrostomy might be used as a temporary salvage therapy, providing acute decompression of the kidney collecting system and preventing graft loss. It can also function as a permanent and sometimes only possible option in transplant patients with frequent recurrences of ureteral stenosis who either fail an open surgical reconstruction or who are not good candidates for these procedures. We present two patients with acute decline in urine output after renal transplantation with radiologically verified hydroureteronephrosis of the transplanted kidney (graft) caused by stenosis of distal ureter. In both cases, nephrostomy was placed within 48 hours as a temporary salvage treatment that ameliorates renal function and prevents graft loss. The permanent nephrostomy was the only possible solution for the preservation of the graft's function in the first case because of the recurrences of ureteral stenosis after several percutaneous interventions and open-surgery ureteral reconstruction. A few episodes of nephrostomy tube-related infections were resolved with antibiotics in the first case. The second case was treated with open ureteroneocystostomy with resection of stenotic segment and reinsertion of the ureter into the bladder (ureterocystoneostomy) because of the length of the involved ureteral segment. Both patients had stable graft function in the follow-up period.
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Pediatric Echinococcosis: diagnosis, urgent surgical intervention, and treatment – case report
(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2024-11)
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Sulejmani, Haris
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Racaj, Anila
Echinococcus tapeworms cause human echinococcosis, which causes hydatid cysts, most commonly in the liver and lungs but also in other organs. Delays in symptom onset can lead to diagnostic issues, especially in children. Pediatric cases are rare and often lead to unintentional diagnoses. Living in a rural area increases risk. Imaging and serological testing are essential for diagnosis. This case is rare since it involves pediatric echinococcosis. Children rarely get echinococcosis, and symptoms are often vague; thus, diagnosis is mainly by accident. Case report: A 10-year-old female child developed symptoms and signs such as tachycardia, fever, and facial urticaria. On the first clinical examination, classic signs of an acute abdomen were present, indicating a possible abdominal emergency. Laboratory results showed significantly high levels of inflammatory markers, including CRP and WBC, indicating an active inflammatory process, most likely caused by infection or tissue injury. Imaging examinations, particularly a contrast CT scan of the abdomen, revealed two burst liver cysts in the peritoneal cavity, confirming the diagnosis of echinococcal cysts in the liver. We undertook an urgent surgical intervention to address the burst cysts and avert potential complications like peritonitis or sepsis. Post-operative treatment included constant monitoring of the patient's condition, antibiotic and antihelminthic medication to control infection, pain management, and supportive measures to help with recovery. Echinococcosis in children manifests as nonspecific symptoms, which often leads to a rare suspicion and coincidental diagnosis. Echinococcosis is often considered a possible cause of stomach discomfort. The standard treatment for echinococcosis usually involves a combination of antiparasitic medication and surgical removal of the cyst.
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RITUXIMAB IN TREATMENT OF A PATIENT WITH GRANULOMATOSIS WITH POLYANGIITIS – A CASE REPORT
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024-12-15)
Bojadzioska, Maja
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Guchev, Filip
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Antova, Dubravka
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Karadzova-Stojanoska, Anzhelika
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Vidinikj, Sonja
ANCA-associated vasculitis (AAV) is a necrotizing vasculitis with few or no immune deposits that can affect predominantly small vessels. It can affect ve-ssels in every organ and tissue of the body; the clinical manifestations of the disease are extremely variable. B-cells are of major importance in the disease patho¬ge¬nesis as precursors of ANCA-producing plasma cells and, possibly, also as antigen-presenting and cytokine-producing cells. Therefore, rituximab, a monoclonal anti¬body drug causing partial B-cell depletion, has emerged as a powerful option in the treatment of AAV such as granulomatosis with polyangiitis. We present the case of a 25-year-old female diagnosed with granu-lomatosis with polyangiitis and treated with rituximab and high-dose corticosteroids.
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Laryngotracheal Stenosis: A Retrospective Analysis of Their Aetiology, Diagnose and Treatment
(Scientific Foundation SPIROSKI, 2019-05-26)
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BACKGROUND: Laryngotracheal stenosis created as a result of a long-term consequence of prolonged endotracheal intubation is a state of narrowing of the airway, which, depending on the degree of narrowing, can be from an asymptomatic to a potentially life-threatening condition. AIM: To understand the severity of postintubation laryngeal stenoses, their diagnosis, endoscopic evaluation, endoscopic and surgical treatment and their success in a multi-year period realised in the University Clinic for Ear, Nose and Throat in Skopje, Macedonia. MATERIAL AND METHODS: Through a proper history, physical examination, endoscopic and imaging evaluation of the ear, nose and throat in the Clinic, in the period of 8 years, that is, from 2010 to 2017, laryngotracheal stenosis was diagnosed in a total of 36 patients. During this period, 24 male or 66.7% were diagnosed, as were 12 female subjects or 33.3% of diagnosed patients. Of the analysed total of 36 patients, by Mayers cotton classification, 14 or 38% are patients with grade 1 stenosis, 5 or 13% are grade 2, and 10 or 27% are grade 3, while 7 or 19% are grade 4 stenosis RESULTS: It is essential for all laryngotracheal stenoses to exist or to provide a breathing path that depends on the degree of stenosis. Further course of treatment also depends on the characteristics of the stenotic zone that is visualised endoscopically. At the Clinic for ear nose and throat in Skopje, endoscopic treatment was performed through a series of dilatations within 21 patients, or 58 % of the examinee, as well as the administration of mitomycin and corticoderates in 21 patients or 52% of the examinee. The applied actions and procedures had shown 100% outcome on stenoses not longer than 2 cm, who have a fibro-inflammatory scar and by Myer cotton classification 1 and second stadium. Patients that have failed endoscopic treatment, surgical treatment are a method of choice. Surgical treatments have been performed in 4 patients with realised end of the anastomosis, and 3 crycotracheal reconstructions, which is decannulated. After an extensive follow-up of these patients, depending on their condition, multiple endoscopic evaluations have been decannulated to 21 patients or 58%, and after a series of multiple unsuccessful endoscopic treatments, a condition with tracheal stoma occurs in 8 patients or 22% of the examinee. CONCLUSION: The observations indicate that the methods used, which are explained previously, have good effects in terms of the achieved outcomes. Due to limited resources, it is necessary to improve new methods and approaches in the treatment of stenoses, depending on their type and severity, thereby improving patient outcomes. Also, to reduce laryngotracheal stenoses, appropriate tubes and low pressure of the caffeine in the endotracheal tubules should be used.

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