Faculty of Medicine

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Start date: 2020

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Now showing 1 - 10 of 2924
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    Primary dysmenorrhea in adolescents
    (Elsevier BV, 2026-06)
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    Stankovic, Zoran B.
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    PREGNANCY IN A PATIENT WITH A CONGENITAL UNICORN UTERUS AND CONIZATION DUE TO CERVICAL CANCER
    (University Ss. Cyril and Methodius in Skopje, 2024)
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    Bushinoska, Jasna
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    Ivanov, Jordancho
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    Rare case of super-response to Cardiac Resynchronization Therapy in Macedonian patient with Dilated Left Ventricular Non-Compaction Cardiomyopathy
    (Valley International, 2024-02-24)
    Shopov, Bozhin
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    Zafirovska, Planinka
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    Background: Left ventricular non-compaction (LVNC) is rare cardiomyopathy with increased and prominent endomyocardial trabeculations also known as spongy myocardium. It is often found in association with a dilated cardiomyopathy (DCM) and has high incidence of Heart failure (HF). Cardiac resynchronization therapy (CRT) is currently recommended by the available guidelines for selected patients with Heart failure with reduced ejection fraction (HFrEF). Aim: Our case report aims to highlight the therapeutic benefits and superresponse to CRT in a patient with Left ventricular non-compaction cardiomyopathy and HFrEF. Case report: 55-year-old Macedonian male patient with HFrEF, Left bundle branch block (LBBB) remained symptomatic (NYHA III) despite optimal medical treatment (OMT). Echocardiography and CMR findings were in addition to dilated and left ventricular non-compaction cardiomyopathy. Cardiac resynchronization therapy was indicated and 18 months after implantation of CRT-P device we have achieved complete and utter reversibility of systolic myocardial function (EF from 23% to 53%), left ventricular internal diameter was reduced from 90mm to 64mm, left ventricular end systolic volume (LVESV) was reduced from 319ml to 98ml and patient quality of life significantly improved. Conclusion: Cardiac resynchronization therapy is a safe and valuable method of treatment for patients with HFrEF due to dilated left ventricular non-compaction cardiomyopathy.
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    Microcatheter Crossing of Radial Artery Loops and Tortuosities: New Ideas in Reducing Trans Radial Approach Crossover
    (Scientific Foundation Spiroski (publications), 2021-12-29)
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    Spiroski, Igor M.
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    Jovkovski, Aleksandar
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    BACKGROUND: Transradial access is currently the default access site for percutaneous cardiovascular interventions. Radial artery (RA) anomalies present a significant challenge in radial access success. RA 360-degree loops are an uncommon, but quite challenging vascular anomaly even for the most experienced radial operators.CASE REPORT: We report on two cases of patients with complex RA loops referred for PCI through radial approach in a high-volume radial center. Pre-procedural RA angiography was performed in both cases identifying a 360-degree RA loop in the proximal part of the RA below the entrance into the brachial artery. In both cases, we present a novel “Microcatheter crossing” technique of the complex RA loop as a new strategy in overcoming even the most difficult radial adversary. After identifying the loop a hydrophilic wire 0.014 inch was used to cross the loop and extend it in the upper arm. Then a microcatheter ASAHI corsair (Asahi Intecc USA, Inc.) was advanced through the loop without difficulty. The microcatheter is advanced through the wire until middle of the upper arm. Hydrophilic wire is then exchanged with High Torque Iron man guide wire (Abbott Vascular). Again, the wire is advanced in the upper arm. Microcatheter is then removed and 5F catheter JR 4.0 or similar is advanced gently through the iron man wire with a clockwise rotation through the loop. Then, wire and catheter are pulled back to straighten the loop. The percutaneous angiography procedure was performed successfully in both cases.CONCLUSION: Both patients were discharged without registered bleeding complications from place of puncture. They both reported slight pain during the beginning of the procedure in the arm of puncture, but without additional problems after the procedure.
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    Sex differences in transradial access failure in ST segment elevation myocardial infarction
    (Wiley, 2024-09-30)
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    Jovkovski, Aleksandar
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    Taravari, Hajber
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    Kitanoski, Darko
    Background Transradial access (TRA) is now the default access site for PPCI, but technically is a more challenging approach mostly due to anatomic challenges connected to the RA. Aims To assess the differences according to sex in radial artery (RA) access site characteristics during primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI). Material and Methods All 5092 consecutive STEMI patients from our center in the period from March 2011 until December 2017 were examined. The right proximal radial was the “intention‐to‐treat” access in all patients. Preprocedural RA angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, need to use another arterial access sites (the primary endpoint for this study), and procedure time were analyzed by sex. Using logistic regression, we selected predictors of radial crossover. Access site bleeding complications and vascular complications were also recorded. Results The STEMI population in this period included 1326 females and 3766 male patients. Females were older (65 ± 11 years) than males (59 ± 11 years, p < 0.0001). Among standard risk factors, hypertension and diabetes mellitus were more common in women and smoking less common. RA anomalies were more frequent in the females (8.8% vs. 6.5%, p < 0.0001), with complex RA loop and tortuous RA twice as frequent in women. Failure of TRA access as the initially chosen site occurred in 4.6% (61) of females versus 2.5% (97) of male STEMI patients (p = 0.0003). The most common subsequent access site was right ulnar access in both groups (57 and 61% respectively). Access site bleeding complications were more common in women 4.4% versus 3.2%, mirrored in hematomas with EASY score III to V. Clinical RA spasm (RAS) was significantly more frequent in females (5.7% vs. 2.2%, p < 0.0001). Multiple regression analysis identified 5 independent predictors for TRA access crossover: previous TRA, anomalous RA, RAS, along with female sex and diabetes. Conclusion Female sex is a significant predictor of more complex TRA in STEMI. Understanding sex differences and predictors for TRA crossover will strengthen the use of different procedural modalities that can help in preserving a successful wrist access in female STEMI patients.
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    Diabetic Kidney Disease Position Paper of the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO), Macedonian Society of Cardiology (MSC), and Scientific Association of Endocrinologists and Diabetologists of Macedonia (SAEDM)
    (Walter de Gruyter GmbH, 2024-11-01)
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    Diabetic kidney disease (DKD) is a significant and growing global health concern, affecting a substantial proportion of individuals with diabetes mellitus. This position paper of Scientific societies of endocrinologists, nephrologists and cardiologists has been consensually brought at a couple of mutual meetings, aiming to synthesize current knowledge on screening, diagnosis and staging of DKD, emphasizing the need for an early detection and intervention in order to prevent progression to end-stage renal disease (ESRD). The role of glycemic control, blood pressure management, lipid management and the use of reno and cardioprotective agents, including angiotensin-converting enzyme inhibitors, sodium-glucose co-transporter 2 inhibitors and non-steroidal mineralocorticisteroid receptor antagonist has been entirely considered. Furthermore, we highlight the importance of a multidisciplinary approach in the care of patients with DKD, integrating lifestyle modifications and patient education into the clinical practice. This paper advocates for the implementation of standardized screening protocols and the development of personalized treatment strategies to optimize patient outcomes. By addressing the complexities of DKD, we aim to provide a comprehensive framework for healthcare professionals to enhance the quality of care for individuals at risk of or living with this condition.
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    Ipsilateral transulnar artery approach catheterizations after failure of the radial approach—Are two sheaths in the same arm safe?
    (Wiley, 2021-05-28)
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    Jovkovski, Aleksandar
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    Taravari, Hajber
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    Kitanoski, Darko
    Aims To assess the safety and feasibility of ipsilateral transulnar access (TUA) after failure of radial access (TRA), with two sheaths placed in the radial and ulnar arteries (RA and UA) in the same arm. Materials and Methods All consecutive patients with TUA due to inability to cross from ipsilateral TRA in the period from March 2011 until September 2020 were included in the study. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TRA. Patients were assessed by duplex ultrasound post‐procedure (at an average of 56 ± 31 months) and followed clinically (functional and pain assessment). Results In this period, out of 51,866 patients 112 (0.2%) had a transulnar artery approach due to inability to cross from ipsilateral radial approach. Mean age of patients was 65 ± 11 years with 44% females. Cause for crossover to ipsilateral TUA was inability to cross a RA anomaly in 107 (95%) patients, mostly due to the presence of a “360°” RA loop in 88 patients. Type 3 and 4 EASY Score hematoma was present in 3 patients (2.6%). Six (5.3%) of the patients had new ipsilateral radial artery occlusion noted on duplex on follow up. There were no ulnar artery occlusions detected. There were no clinical or ischemic hand complications seen during a median 4.3 years of follow up. Conclusion Ipsilateral transulnar artery access following failed radial artery access crossing is safe and successful for coronary angiography and intervention with low rates of complications.
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    Abstract 18529: Early Coronary Revascularization Among "Stable" Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: The Role of Diabetes and Age
    (Ovid Technologies (Wolters Kluwer Health), 2023-11-07)
    Fabin, Natalia
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    Cenko, Edina
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    Vadalà, Giuseppe
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    Mendieta Badimon, Guiomar
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