Faculty of Medicine

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Corrosive poisonings during the COVID-19 pandemic: trends and demographic shifts in the pre- and early vaccination periods (2020–2021)
(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2025-09-15)
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Bekjarovski, Niko
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Chibishev, Andon
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The COVID-19 pandemic significantly disrupted global healthcare and societal norms, leading to changes in poisoning patterns, particularly corrosive poisonings (CP). This study aimed to evaluate the impact of the pandemic on CP trends in North Macedonia by comparing observed data from 2020 and 2021 with predicted values (PV) based on a 10-year trend. Methods: A retrospective study was conducted using data from the Poisoning Registry at the PIC, University Clinic of Toxicology, Skopje. Patients with confirmed acute upper gastrointestinal corrosive injuries were included. Results: Between 2010 and 2021, 1,668 CP cases were recorded. While an overall downward trend was observed (y = -6.5x + 181.4, R² = 0.56), CP cases declined by 1.5% in 2020 and by 25.5% in 2021 compared to PV. Female cases decreased by 27.5% in 2021; male cases declined by 16.6% in 2020 and 32.4% in 2021. Adolescent CP increased by 12.8% in 2020 and 80.0% in 2021; cases in those over 75 years rose by 2.5% and 6.2%, respectively. The mean age of CP patients rose by 7.6% in 2020 and 11.0% in 2021. Suicidal poisonings increased by 9.9% in 2021. Disinfectant poisonings rose by 74.5% in 2020, while hydrochloric acid (+6.2%), detergents (+3.4%), and degreasers (+32.0%) increased in 2021. Case fatality ratios rose by 36.2% in 2020 and 44% in 2021. Conclusion: Although the overall number of cases declined, the increased severity, lethality, and demographic shifts—particularly among adolescents and the elderly—highlight the high-risk groups, mental health burden and toxicological risks associated with public health emergencies
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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/De Gruyter, 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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CORTICOSTEROID RESPONSIVE COVID-19 ENCEPHALITIS - CASE REPORT
(SHMSHM - AAMD, 2024-12)
Atanasovski, Petar
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Zdravkov, Ilija
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Perovska, Marija
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The epidemiological burden of COVID-19 is a healthcare challenge reflected throughout the world. Different specialties are constantly confronted with unique cases that add to the array of Covid-19 symptoms. The neurological manifestations of SARS-CoV-2 infected patients are receiving increasing attention with the global spread of SARS-CoV-2. We present a novel case of SARS-CoV-2 associated acute encephalitis in a young adult without comorbidities and mild symptoms of infectious syndrome. The pathophysiological mechanism of acute encephalitis in COVID-19 is not well defined. There are two main hypotheses: a direct cytopathic effect of the infection of the brain tissue (the angiotensin-converting enzyme 2 receptors that the virus uses for attachment, margination, and internalization in the lung, are also expressed in the central nervous system; viral antigens were detected in CSF and brain samples), and an autoimmune/immunemediated cause (the general hyperinflammatory state releases cytokines and chemokines that impairs the bloodbrain barrier permeability and activate neuro-inflammatory cascades). In our case, the acute encephalitis induced by COVID-19 had a benign course, the patients improved quickly after IV steroids treatment and returned to their baseline state of health.
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Avascular Necrosis of the Hip Joint and Femoral Head Related with Long COVID-19 or Post-COVID-19: Case Report Study
(Scientific Foundation SPIROSKI, 2024-02-25)
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Jovanovski, Mario
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Savin, Tanja
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Novachkova-Siljanovska, Bojana
<jats:p>BACKGROUND: Post-COVID conditions can include a wide range of ongoing health problems. As a consequence of long COVID-19 or post-COVID-19 an increase in osteonecrosis has been detected in different series of patients. CASE PRESENTATION: We present two patients diagnosed with COVID-19 and pneumonia, one with moderate and the other with severe clinical picture. They were treated with corticosteroid equivalent to prednisolone 993.5 mg (400–1587 mg) which correlates with steroid dose documented in the literature as causative for avascular necrosis (ANV) in patients with COVID-19. After the mean time of 65 days, due to pain in the groin and difficulty in movement, magnetic resonance imaging (MRI) was performed in both patients and AVN was diagnosed. Compared to our results, the literature records a longer time required for the development of AVN in patients without COVID-19, which is 6–36 months. This indicates the potency of the virus itself to cause disturbances in the microcirculation, and thus the development of AVN. The bone damage correlates with the degree of inflammation and the severity of the clinical picture. CONCLUSION: After a course of COVID-19 as part of a long COVID-19, ANV should be considered a possible complication, especially in patients who have clinical manifestations. Early detection of AVN and diagnosis using MRI on clinical suspicion would help early intervention with bisphosphonate therapy in patients with osteonecrosis of the hip. If the disease is detected in the more advanced stage, it is necessary to perform a surgical intervention and even a possible hip replacement.</jats:p>
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Coping styles and mental health in healthcare workers during the COVID-19 pandemic
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
Kunovski, Ivo
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Introduction: There is limited research on the factors influencing mental health of healthcare workers during the COVID-19 pandemic. Studies show that coping styles variably influence the severity of mental health symptoms. However, no data is available on the effects of coping styles on mental health of healthcare workers in North Macedonia and the wider region of Southeast Europe. Materials and methods: A cross-sectional web-based study was conducted with 342 participants during the early period of the COVID-19 pandemic. Participants provided sociodemographic data and were assessed in regard to coping styles, and symptoms of depression, anxiety and stress. Associations between the variables were examined using nonparametric tests, and their additive effects were tested using generalized linear models. Results: Identifying as a woman, single, and of younger age was associated with higher levels of mental health symptoms. The coping styles that contributed to poor mental health outcomes included the use of active coping, instrumental support, substance use, venting, behavioral disengagement, self-blame, and the low use of emotional support and humor. Conclusion: The findings help identify vulnerable populations, and add to the growing research on gender differences in the impact of COVID-19 on healthcare workers. The study may help in the development of mental health prevention programs for populations at risk during health crises.
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Association of Inflammatory Markers with Disease Severity and Outcome in Covid-19 Patients
(Macedonian Academy of Sciences and Arts, 2023-03-01)
Gjuzelova Aleksoska, Aleksandra
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Nakova Velkoska, Valentina
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Metodieva, Marija
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Stojkoska Jorganovic, Aleksandra
Objectives: The coronavirus pandemic was associated with a high mortality rate in the Republic of North Macedonia. Finding early markers of the disease's severity may predict outcomes and guide the treatment of the disease. The aim of our study was to evaluate the role of inflammatory markers in predicting the outcome of COVID-19 in hospitalized patients. Methods: The study included 104 PCR-confirmed COVID-19 patients who underwent hospital treatment at the Institute of Lung Diseases and Tuberculosis in Skopje, North Macedonia, between November 2020 and May 2021. Inflammatory markers were assessed in all patients and correlated with the disease severity and outcome in terms of survival or death. Results: IL-6 and LDH at admission were significantly elevated in patients with a severe or critical form of the disease and among non-survivors. In addition, IL-6 showed 87.9% of sensitivity and 61.8% of specificity for distinguishing non-survivors from survivors with a cut-off value of 21.7 pg/ml in the receiver operator curve (ROC). Procalcitonin was significantly increased in non-survivors. Parallel to the increase of disease severity, the values of CRP and LDH increased significantly during hospitalization. Conclusion: The results of the study indicate that a significant association exists between the highly increased levels of CRP, LDH, IL-6 and procalcitonin and the severity of the disease and mortality in COVID-19 patients. Their measurements and follow-up during the course of the disease could be used as predictors for prognosis and outcome but also as a subject for targeted therapy.
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COVID-19 IN CHILDREN WITH DOWN SYNDROME-CASE SERIES
(Macedonian Association of Anatomists and Morphologists, 2023-11-05)
Ivanovska, Julija
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Nestorov, Hristijan
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Popova, Gorica
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Chakalaroska, Irena
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Petlichkovska, Sandra
Down syndrome (DS) is the most common genetic disease and presents withcognitive impairment, cardiac and gastrointestinal abnormalities, increasedrisk of hematological malignancy and several autoimmune conditions in additionto other miscellaneous clinical conditionsThe aim is to show if the comorbidities that children with Down Sy have, were risk factors for more severe form of COVID-19.We present three cases of children with Down Sy and COVID-19, with different clinical features. All of them had good clinical outcome, only the firstchild had more severe form of Covid 19 with needfor oxygen support, longer hospitalization but with good clinical improvement and withdrawal of the X-ray changes. Children with Down Sy are always a high-risk group for more severeand prolonged course of disease, which are partiallyattributed to defects of the immune system.
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Menstrual Cycle Disorders after Covid-19 Vaccination
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2023)
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Popovska, Verica
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Iliev, Darko
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Introduction. COVID-19 vaccines were developed one year after the official first case of COVID-19 in China was reported by the WHO. More than 3 billion doses have been administered so far. Menstrual disturbances have also been reported, primarily by women, and confirmed in scientific research. Aim. To evaluate menstrual cycle irregularities after COVID-19 vaccination among females in North Macedonia. Methods. A cross-sectional study was conducted that used a questionnaire to collect data in the period 03.2022-03.2023, including women aged 18-45 and residents of the Republic of North Macedonia. Women who were referred for an examination at the University Clinic for Gynecology and Obstetrics in the capitol of the country, were invited to participate in the survey. The questionnaire was distributed electronically. Results. A total of 191 women participated in this study, with a mean age of 34.318.05 years, 163 (85.3%) have been vaccinated, and 28 (14.7%) not vaccinated. Changes in menstrual cycle after COVID19 vaccination were found in 89 (46.6%), predominantly after their second dose. The most frequent menstrual cycle changes were: heavy periods/ bleeding (menorrhagia), infrequent/irregular periods (oligomenorrhea) and painful menstruation (dysmenorrhea). Disorders were noticed right after vaccination (at the first menstrual cycle) in 30(15.7%) women, and in 35(18.3%) the menstrual cycle normalized, while in 63(33.0%) the changes still lasted. Conclusion. In this study, an association of menstrual cycle changes and COVID-19 vaccination was found. More studies are needed and further follow-up in women with reported menstrual cycle changes.
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Assosiation of COVID-19 Infection and Acute Mesenteric Ischemia
(The First Faculty of Medicine of Charles University - Karolinum press, 2023-12)
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Lazarova, Irena
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Popchanovski, Bojan
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Kostovska, Irena
COVID-19 is an infectious disease that is considered to be a thrombo-inflammatory disorder. The study was aimed to determine the prevalence of COVID-19 in patients with acute mesenteric ischemia (AMI) and the outcomes of surgical treatment in relation to COVID-19. A total of 140 patients were included in this multicentric study divided into two groups: the test group (n=65) consisted of cases of AMI detected during the COVID-19 pandemic and the control group (n=65) consisted of cases of AMI detected before the pandemic. Test group patients were classified as COVID-positive (COVID+), or COVID-negative (COVID–) if they tested positive, respectively negative test for COVID-19 on admission. Primary outcomes were: prevalence of COVID-19 infection among test group patients, association between COVID-19 infection and inoperability, and between COVID-19 and treatment outcome. Secondary outcomes were association between each blood parameter and inoperability and treatment outcome. There were no statistically significant differences between inoperability and COVID-19 positivity on admission, overall mortality between the control group and the test group and overall mortality between COVID+ and COVID– patients, as well as among those patients that have been surgically treated (p>0.05). There were statistically significant differences between serum amylase levels (p=0.034), and serum LDH levels (p=0.0382) and inoperability, between serum LDH levels and postoperative mortality (p=0.0151), and overall mortality (p=0.00163). High level of LDH and serum pancreatic amylase are associated with a higher rate of inoperability and a higher postoperative and overall mortality rate. COVID-19 does not seem to independently influence the treatment outcome of AMI.
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Pandemic-induced stress escalation among women in North Macedonia
(Journal of Morphological science, 2023-11)
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Darko Iliev
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