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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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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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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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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FATAL INTOXICATION AFTER DELIBERATE INGESTION OF 2-METHYL-4- CHLOROPHENOXYACETIC ACID (MCPA)
(Macedonian Association of Anatomists and Morphologists, 2024)
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Although intentional poisonings with 2-Methyl-4-chlorophenoxyacetic acid (MCPA) are relatively rare and in most cases cause moderate toxicity, deaths have been described, mainly due to cardiorespiratory arrest. Treatment is generally supportive, with opposing effects from the application of urinary alkalization and other methods for secondary elimination of the poison. Case report. Herein we report a case of an adult female who was admitted to theUniversity Clinic for Toxicology several hours after a suicidal ingestion of an unknown toxic agent that resulted in vomiting and loss of consciousness. After MCPA ingestion was confirmed, she received supportive care, urinary alkalinization, and hemodialysis. Despite this, the patient was hypotensive, after which signs of acute kidney injury, rhabdomyolysis, hyperamylasemia, hepatic lesion, electrolyte abnormalities, metabolic acidosis, disseminated intravascular coagulation, and respiratory failure developed. Despite applied mechanical ventilation and inotropic support, the patient died several days later. Conclusion: MCPA is a poisonous herbicide that can cause severe forms of poisoning and fatal outcome especially after large intentional ingestions. The availability of rapid qualitative toxicological confirmation of the xenobiotic can contribute to early etiological diagnosis and initiation of appropriate therapeutic measures that would improve survival even in more severe forms.
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Spontaneous omental infarction in an obese young female patient treated with laparoscopy: a case report
(Oxford University Press (OUP), 2024-06)
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Mojsilovic, Dino
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Argirov, Ivan
Partial infarction of the great omentum is a rare cause of abdominal pain and may present as a surgical emergency. Omental infarction might occur due to its torsion, but cases without obvious cause are reported. Risk factors related to this condition are overweight, obesity, abdominal trauma, recent abdominal surgery, hypercoagulability, postprandial vascular congestion and an increase in intra-abdominal pressure. Because of the condition's rarity, most patients are treated with surgery and the diagnosis is established intraoperatively. Preoperative diagnosis allows successful conservative treatment with analgesics and anti-inflammatory drugs. This case reports a young female patient with class III obesity presented with spontaneous partial infarction of the great omentum treated with laparoscopy.

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