Faculty of Medicine

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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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    A CASE OF COVID-19 PNEUMONIA IN HEMODIALYSIS PATIENT
    (Macedonian Association of Anatomists and Morphologists, 2021)
    Stojanoska, Tatjana
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    Murtezai, Osman
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    Taleska Matovska, Natasha
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    Dimoska Chifligaroska, Elizabeta
    SARS-CoV-2 (COVID-19) is an infectious disease caused by a novel corona virus that has spread rapidly, resulting in a worldwide pandemic. Even though end-stage renal disease (ESRD) patients are particularly susceptible to COVID-19 infection and can develop severe to critical clinical presentation, there are still limited studies and case reports about COVID-19 in ESRD patients.End-stage renal disease (ESRD) is a severe medical condition with a high prevalence of co-morbid conditions including diabetes, hypertension, and cardiovascular disease.We report case of a 72-years-old woman with ESRD on regular hemodialysis-outpatient, with history of diabetes mellitus type-2 and hypertension, which was positive to COVID-19 and developed pneumonia. She was one of our first registered cases of COVID-19 in our hospital and was successfully cured. Our patient reported symptoms typical of COVID-19, initially, (fever, sweating, weakness, stuffy nose, dry cough and shortness of breath, although she denied contact with infected individuals), but on the day of admission her clinical picture was atypical. She developed a severe clinical picture with the typical presentation of COVID-19 pneumonia on chest X-ray, but without leukopenia as a typical presentation of this disease in her laboratory findings. We describe the clinical presentation of this patient, the diagnostic process, the laboratory and imaging investigations, as well as the course and outcome of treatment.
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    Surgical complications in COVID-19 patients in the setting of moderate to severe disease
    (Baishideng Publishing Group Inc., 2021-08-27)
    Gulinac, Milena
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    Novakov, Ivan P
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    Velikova, Tsvetelina
    The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on the work of physicians and surgeons. The connection between the patient and the surgeon cannot be replaced by telemedicine. For example, the surgical staff faces more serious difficulties compared to non-surgical specialists during the COVID-19 pandemic. The primary concerns include the safest solutions for protecting healthcare staff and patients and the ability to provide adequate surgical care. Additionally, the adverse effects of any surgery delays and the financial consequences complicate the picture. Therefore, patients' admission during the COVID-19 pandemic should be taken into consideration, as well as preoperative measures. The COVID-19 situation brings particular risk to patients during surgery, where preoperative morbidity and mortality rise in either asymptomatic or symptomatic COVID-19 patients. This review discusses the recent factors associated with surgical complications, mortality rates, outcomes, and experience in COVID-19 surgical patients.
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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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    Unusual cause of death in a patient with Covid-19
    (Springer, 2021-09)
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    Dzengis, Jasar
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    Acute Pulmonary Thromboembolism – Use of Fibrinolysis to Treat a Hemodynamically Unstable Patient in the Era of the COVID-19 Pandemic: A Case Report
    (Medical Publishing, d.o.o., 2021-06)
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    Taravari, Hayber
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    Beqiri, Ardiana
    Pulmonary embolism (PE) is a common and potentially fatal condition. Despite advances in diagnostic procedures, late detection and non-detection of this condition is also not uncommon. In patients with PE, recurrent embolisms and death can be prevented with prompt diagnosis and adequate treatment. Due to presentation with a non-specific clinical picture and symptomatology, unfortunately almost one third of the patients remain undiagnosed and untreated. We know that there is a large difference in outcome between treated and untreated patients with PE (25-30% mortality in untreated and 2-8% in treated patients). We present a case of PE in the era of the COVID-19 pandemic in an adult patient with acute dyspnea, vomiting, presyncope, chest pain, and shock.
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    COVID-19 in the endoscopy unit: How likely is transmission of infection? Results from an international, multicenter study
    (Baishideng Publishing Group Inc., 2021-09)
    Papanikolaou, Ioannis S
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    Tziatzios, Georgios
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    Chatzidakis, Alexandros
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    Facciorusso, Antonio
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    Crinò, Stefano Francesco
    Coronavirus disease 2019 (COVID-19) significantly affected endoscopy practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU).
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    COVID-19 from a Perspective of Neuromuscular Diseases: Meeting the Challenges
    (Scientific foundation Spiroski, 2020)
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    Kalcev, Goce
    Abstract Dear Editor, The new SARS-CoV-2 epidemic is imposing immense strain on the health systems in several countries. The growth of the epidemic has led the WHO to declare the 2019-nCoV disease as a global pandemic (1). COVID-19 pandemic has the potential to affect patients with neuromuscular diseases. The evaluation of the overall risk of COVID-19 in patients with neuromuscular diseases depends on several factors: the specificity of the neuromuscular disease, the general condition, the presence of other comorbidities, age, and the type of immunosuppressive treatment they receive. It is important to emphasize the fact that most patients with neuromuscular disease are not expected to suffer from severe complications due to coronavirus infection. Corona infections can affect certain myopathies. In a recent study published in China, related to COVID-19 is shown that hospitalized patients experienced fatigue and myalgia (44-70%), and increased creatine kinase (33%) in the serum (2). Apart from this, a third of hospitalized patients infected with the coronavirus had rhabdomyolysis (3). All of this points to the fact that coronavirus infection may be responsible for viral myositis. In addition, is the finding that some of the critical cases have developed polyneuropathy or myopathy (4). On the other hand, it is well known that infection is a trigger for exacerbation of certain neuromuscular diseases. There is no data that measured the risk of exacerbation as a result of coronaviruses infection for neuromuscular disorders. However, in one retrospective study, COVID-19 infection was a leading reason for the exacerbation of myasthenia gravis (5). As a result of this, an increased incidence of exacerbations of certain neuromuscular diseases should be expected, as well as the appearance of new clinical presentations during this pandemic. It is important to note that there are still no neuromuscular diseases-specific recommendations for patients who are infected with the coronavirus. Observation is recommended in patients at high and medium risk, especially in those patients where there is a possibility of a decrease in respiratory function. Last but not least, we would like to emphasize the need for reorganization of clinical care for these patients (6). The goal is to reduce exposure of patients to areas where the coronavirus could be found. Moreover, non-urgent or outpatient care is remarkably reduced. In conclusion, we must learn to apply our clinical practices in order to reduce the complications that may occur in patients with neuromuscular disease due to COVID-19. The primary goal is to develop evidence-based medical practices in order to reduce morbidity and mortality. Collaboration among institutions worldwide will be able to give us the data needed for planning management for neuromuscular disorders with COVID-19 and maintain clinical research against strong challenges.
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    Cases of Guillain-Barre Sundrome associated with COVID-19
    (SHMSHM / AAMD, 2022)
    Dalipi, Teuta
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    Stojkovska, Frosina
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    Mitrevska Velkov, Jasmina
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    Babunovska, Marija
    A novel member of human RNA coronavirus, which is an enveloped betacoronavirus, has been termed severe acute respiratory syndrome coronavirus-2 (SARS COV-2). The illness caused by SARS COV-2 is referred to as the coronavirus disease 2019 (COVID-19). It is a highly contagious disease that has resulted in a global pandemic. The clinical spectrum of COVID-19 ranges from asymptomatic illness to acute respiratory distress syndrome, septic shock, multi-organ dysfunction, and death. The most common symptoms include fever, fatigue, dry cough, dyspnea, and diarrhea. Neurological manifestations have also been reported. However, the data on the association of Guillain-Barré syndrome (GBS) with COVID-19 are scarce. We report two case of a COVID-19-positive patients who presents clinical features of GBS. In both cases clinical examination showed generalized weakness mostly in lower extremitis and hyporeflexia. The cerebrospinal fluid (CSF) analysis showed albuminocytological dissociation. The neurological condition was different in both patients they both recived kortikosteroids in first case it has good results but in second cases Intravenous immunoglobulin (IVIG) was administered. A thoracolumbar spine magnetic resonance imaging was obtained to rule out other causes, which was normal. COVID-19 is believed to cause a dysregulated immune system, which likely plays an important role in the neuropathogenesis of GBS.