Faculty of Medicine

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    Wernicke’s Encephalopathy from Hyperemesis Gravidarum. A Case Report
    (Albanian Society for Trauma and Emergency Surgery, 2024-07-20)
    Dalipi, Teuta
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    Mehmeti, Gazmend
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    Dalipi, Rezeart
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    EMERGING BIOMARKERS AT THE CROSSROADS OF CARDIAC, RENAL, AND HEPATIC DYSFUNCTION: A NEW ERA IN MULTIORGAN RISK STRATIFICATION
    (Faculty of Medicine, Ss Cyril and Methodius University in Skopje, 2026-03-24)
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    Petkovski, Dusan
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    Vranjko, Elif
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    Dobjani, Amela
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    DERMATOGLYPHIC PATTERNS AMONG STUDENTS IN NORTH MACEDONIA
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2026-03-24)
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    Introduction: Dermatoglyphics is a scientific discipline that studies the epidermal ridge patterns present on the palmar surfaces of the hands, the toes and the plantar surfaces of the feet. Aim. An analysis of individual dermatoglyphic characteristics in healthy medical students of Macedonian and Albanian ethnicity was conducted. Material and methods: The study included 234 healthy students; palm prints were obtained and dermatoglyphic parameters were read, classified and compared with data reported in the dermatoglyphic literature. Imprinting was done by the Cummins and Midlo ink method. The reading and classification of dermatoglyphic patterns were performed according to Henry's system. Results: Ulnar loops were the most prevalent patterns, followed by circular, arcuate and complex patterns, which were present in a small percentage in both genders; radial loop was present only on the second finger in both genders. There were differences on the right hand for the second, fourth and fifth finger, and on the left hand for the third, fourth and fifth finger between males and females. Also, significant differences were found in the third and fourth interdigital spaces and hypothenar area. The triradii distribution formula in females was: a > b > d > c > t; whereas in males it was: a > t > b > c = d. Additional triradii were rare in both genders. The atd angle was within the range of 32ᵒ -55ᵒ in females and 33ᵒ -50ᵒ in males, most often 40ᵒ in both groups. Conclusion: This population-based study have shown similarities and differences in the prevalence of some dermatoglyphic features in males and females among healthy students.
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    MINIMALLY INVASIVE GLAUCOME SURGERY, TECHNIQUES AND PROCEDURES
    (Journal of Morphological Sciences, 2024-12-23)
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    Pandilov, Stefan
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    Muhamedin Rushiti
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    Pathohistomorphometric and Immuno-Histologic Changes in Early Arteriovenous Fistula Failure in Patients with Chronic Kidney Disease
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2024-07-15)
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    Popov, Zivko
    Background Hemodialysis is a prevalent treatment for the end-stage chronic kidney disease (CKD) worldwide. The primary arteriovenous fistula (AVF), widely considered the optimal hemodialysis access method, fails to mature in up to two-thirds of the cases. The etiology of the early AVF failure, defined as thrombosis or inability to use within three months post-creation remains less understood, and is influenced by various factors including patient demographics, surgical techniques, and genetic predispositions. Neointimal hyperplasia is a primary histological finding in stenotic lesions leading to the AVF failure. However, there are insufficient data on the cellular phenotypes and the impact of the preexisting CKD-related factors. This study aims to investigate the histological, morphometric, and immunohistochemical alterations in the fistula vein, pre-, peri-, and post-early failure. Materials and Methods Eighty-nine stage 4-5 CKD patients underwent standard preoperative assessment, including the Doppler ultrasound, before a typical radio-cephalic AVF creation. Post-failure, a new AVF was created proximally. The vein specimens were collected during the surgery, processed, and analyzed for morphometric analyses and various cellular markers, including Vimentin, TGF, and Ki 67. Results The study enrolled 89 CKD patients, analyzing various aspects of their condition and AVF failures. The histomorphometric analysis revealed substantial venous luminal stenosis and varied endothelial changes. The immunohistologic analysis showed differential marker expressions pre- and post-AVF creation. Conclusion This study highlights the complexity of the early AVF failures in CKD patients. The medial hypertrophy emerged as a significant preexisting lesion, while the postoperative analyses indicated a shift towards neointimal hyperplasia. The research underscores the nuanced interplay of vascular remodeling, endothelial damage, and cellular proliferation in the AVF outcomes.
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    The azygos vein as an alternative route for haemodialysis catheterisation
    (SMC Media, 2025-05-20)
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    Janushevski, Filip
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    Introduction: Central venous catheterisation (CVC) is essential for haemodialysis in end-stage kidney disease, but superior vena cava (SVC) stenosis or occlusion often complicates long-term access. The azygos vein, a collateral drainage pathway, has been rarely used intentionally for catheterisation. Case description: We report on a 68-year-old male on haemodialysis with SVC perforation and stenosis due to prolonged catheter use. After a failed guidewire-assisted exchange, a non-tunnelled CVC was successfully placed in the enlarged azygos vein under fluoroscopy. The patient continued haemodialysis without complications, and the two-month follow-up confirmed catheter patency. Conclusion: This case demonstrates the azygos vein as a viable alternative for haemodialysis access in SVC stenosis.
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    Association Between the Polymorphism of Angiotensin-Converting Enzyme Gene and Interleukin-1 Beta Gene and the Response to Erythropoietin Therapy in Dialysis Patients with Anemia
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01)
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    Eftimovska-Otovikj, N
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    Introduction The polymorphism of the angiotensin-converting enzyme (ACE) gene and interleukin-1 beta (IL-1b) gene could be associated with resistance in the treatment of anemia in dialysis patients with recombinant human erythropoietin (rHuEPO). The aim of the study was to evaluate the association between the polymorphism of the ACE and IL-1b genes and the response to rHuEPO therapy in dialysis patients with anemia. Material and methods The study investigated 69 patients on dialysis with anemia treated with recombinant human erythropoietin for 12 months. Genotyping of ACE and IL-1b polymorphism was done in all study patients at the initiation of the study. The patient’s demographic characteristics, dialysis vintage, and laboratory parameters were also evaluated as factors associated with rHuEPO resistance. The erythropoietin resistance index (ERI) was calculated as the weekly rHuEPO dose per kg of body weight, divided by the hemoglobin (Hb) concentration in g/dl. Results The Hb ≥ 110 g/l was registered in 37 (53.6%) patients. Patients with Hb ≥ 110 g/l were characterized by significantly higher serum levels of albumin, cholesterol, and iron than those with Hb < 110 g/l. The serum level of the CRP, the weekly dose of rHuEPO, and ERI were significantly higher in patients with Hb < 110 g/l compared to patients with Hb ≥ 110 g/l. The ERI value of ≥ 10 IUkg/weekly/g/dl was present in 27 (39.1%) patients. The serum levels of ferritin and CRP, and weekly dose of rHuEPO were significantly higher in patients with ERI value ≥ 10 IU kg/weekly/g/dl compared with the patients with ERI value < 10 IUkg/weekly/g/dl. There was no significant association between the ERI and polymorphism of the ACE and IL-1b genes in study patients. Conclusion The polymorphism of the ACE and IL-1b genes was not significantly associated with the response to erythropoietin therapy in dialysis patients with anemia. Iron deficiency, malnutrition, and inflammation were factors associated with anemia and resistance to erythropoietin therapy in dialysis patients.
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    Predictive Admission Risk Factors, Clinical Features and Kidney Outcomes in Covid-19 Hospitalised Patients with Acute Kidney Injury
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01)
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    Milenkova, Mimoza
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    Vasileva, Adrijana Spasovska
    Introduction: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients. Methods: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days. Results: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 – 0.958, p = 0.000; OR 0.987; 95%CI: 0.885–0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009). Conclusion: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself.
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    Comparison between different methods in evaluating haemodialysis adequacy
    (Oxford University Press (OUP), 2025-10)
    Usprcov, Julijana
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    Kabova, Angela
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    Milenkova, Mimoza
    Background and Aims An increasing number of patients with chronic kidney disease (CKD) increased the need for hemodialysis. Inadequate hemodialysis affects morbidity and mortality of hemodialysis patients. KDOQI guidelines recommend that Kt/V should be kept above 1.2 or URR 65% for thrice weekly routine hemodialysis. The aim of this study was to compare the urea reduction ratio (URR), Kt/V estimation by Daugirdas formula with the results measured by an Online Clearance Monitor (OCM). Method Cross-sectional study was conducted on 15 patients on hemodiafiltration (HDF) with age 36–79 years, 4-hour hemodiafiltration sessions three times a week and hemodialysis experience ≥ 6 months, using highflux dialyzers. For every patient blood flow rate was ≥ 350 ml/min and dialysis flow rate was 500 ml/min. According to vascular access all had AVF. Kt/V was calculated by the OCM of the Nipro Surdial X machine (the hemodialysis machine automatically calculate the measured sodium ion clearance based on the plasma conductivity). Results A total of 80 sessions were assessed with a predominance of males 51% (8). The mean of URR was 78.4 ± 10. Mean Kt/V values obtained with the Daugirdas formula was 1.9 ± 0.19. Mean Kt/V delivered by machine (OCM) was 1.87 ± 0.2. There was no significant difference between age, sex, comorbidities with adequacy of hemodialysis. The study show that there was no significant difference between the URR and Kt/V calculated with the Daugirdas formula and the OCM in the evaluation adequacy of hemodialysis. Conclusion Online Clearance Monitor (OCM) can be used as noninvasive guide to the real-time adjustment of the dialysis dose.