Faculty of Medicine

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    MALNUTRITION-INFLAMMATION SCORE PREDICTS SURVIVAL IN HEMODIALYSIS PATIENTS
    (Macedonian Association of Anatomists, 2019)
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    Arsov, S
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    Canevska Aleksandra
    The short life span of dialysis patients is induced by traditional cardiovascular and non-traditional dialysis related factors such as inflammation, oxidative stress, protein energy malnutrition. Malnutrition-Inflammation Score (MIS) has been proposed as a new quantitative system for assessment of malnutrition and inflammation. In this study we sought to investigate the association of MIS and five-year-mortality in dialysis patients. In a prospective study were included 131 prevalent dialysis patients. Kalantar-Zadeh method (7) was used to calculate the malnutrition score. Patients were followed for five years. Kaplan-Meier survival and Cox-proportional mortality analysis were performed according to higher and lower malnutrition inflammation score, by cut-off value of 7. The mean age of study participants was 55.45 years and mean dialysis vintage was 111.04 months. After follow-up of 60 months 55 (42%) patients died from all-cause mortality and out of those 65% (36) were cardiovascular deaths. In comparative analysis among the survived and died patients, none of the inflammatory or nutritional variables such as CRP, albumin, creatinine, BMI or SGA significantly differed. There was a significantly longer survival among patients with lower MIS in respect of all-cause and cardiovascular mortality 49.28  1.88 vs. 39.29 3.53 months, p=0.011, 52.20  1.7 vs. 45.07  3.41, p=0.045, respectively. MIS emerged as a powerful predictor of all-cause and cardiovascular mortality through Cox regression analysis: HR 1.97 95%CI: (1.15 – 3.38), p=0.013; HR 1.063 95%CI-0.952-1.186, p=0.055), respectively. The malnutrition-inflammation score is a useful tool to predict outcomes. The key to improving survival and quality of life in dialysis patients could be gained by understanding of the malnutrition-inflammation complex syndrome and its interactions with cardiovascular disease and outcome.
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    Lifestyle risk factors and control of chronic non-communicable diseases
    (Institute of Public Health of Republic of Macedonia, 2018-06-15)
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    Chingoska, Daniela
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    Pecev, Petar
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    Non-communicable diseases, also known as modern-life diseases, are the leading cause of morbidity and mortality in the world and in the Republic of Macedonia. The complexity of their occurrence, often associated with multifactorial etiology and lifestyle risk factors, has a significant impact on preventive interventions, requiring broad intersectoral cooperation. The aim of the paper is to present thecurrent situation and burden of malignant neoplasms, cardiovascular diseases and diabetes in the Republic of Macedonia, associated with unhealthy lifestyle. Comparison between the mortality data for cardiovascular and malignant neoplasms and the prevalence of diabetes with data for Croatia, Slovenia and France was made. Data on morbidity and mortality for malignant neoplasms, cardiovascular diseases and diabetes was obtained from the reports on the health status of the population in the Republic of Macedonia, from the Register of chronic non-communicable diseases, as well as from the annual health reports for the population in R. Macedonia 2014 and 2015 and HFA database of the World Health Organization. The results are statistically analyzed, tabulated and graphically presented using an analytical-descriptive method. The data shows that in R. Macedonia the mortality rate from cardiovascular diseases is 545 per 100,000 inhabitants in 2014, and 180.4 per 100,000 inhabitants of malignant neoplasms. The prevalence of type 2 diabetes for 2013 expressed at the rate of 100.000 inhabitants is 2386.3. In R. Macedonia the data shows a continuous decline in hospital morbidity, both of cardiovascular diseases and malignant neoplasms, while ambulatory - polyclinic morbidity is on a steady increase. France shows the lowest rate of CVD mortality and malignant neoplasms. By analyzing the risk factors of chronic non-communicable diseases, we have noticed that a high percentage of the population in R. Macedonia has unhealthy lifestyle, especially the young population.
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    MOST COMMON FACTORS AFFECTING OCCURRENCE OF NEONATAL SEPSIS - CHALLENGE AND EXPERIENCE FOR TREATMENT AT NEONATAL INTENSIVE CARE UNIT
    (Macedonian association of anatomists and morphologists, 2018)
    Najdanovska-Aluloska Natasa
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    Angelkova N
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    Background: Neonatal sepsis remains a serious complication, especially among preterm infants. Neonatal sepsis is divided into early- and late-onset sepsis, based on timing of infection and presumed mode of transmission. Early - onset sepsis is defined by onset with in the first week of life, to infections occurring in the first 72 hours due to maternal intrapartum transmission of invasive organisms. Late - onset sepsis is defined as infection occurring after one week and is attributed to pathogens postnatally acquired. Materials and Methods: We have investigated neonatal sepsis in our NICU from 1 January till 31 December 2017, for one-year period, in order to determine mortality associated with sepsis and to identify the dependent predictors for morbidity and mortality. A total 216 infants were admitted in the NICU. Data were collected regarding the primary reason for NICU, maternal condition, gender, gestational age, length of NICU stay, duration of MV and non-invasive ventilation, using of umbilical catheter, and peripherally vein line. Results: Early - onset sepsis was detected in 15 neonates (12 %) within the first 72 hours. Late - onset sepsis was detected in 18 neonates (3,2 %) after 72 hours. Premature infants 23 (70 % range 26 - 37 gestational age) were more exposed to sepsis than term infants 10 (30 %; range 38-40 gestational age). 15 neonates (45,5%) were exposed to the early - onset sepsis, and 18 neonates (54,5%) were exposed to late-onset sepsis. The most frequent isolates were Staphylococcus aureus 7 ( 21,2 %), followed by Acinetobacter 6 (18,1 %), Meticillin- resistant Staphylococcus aureus 5 (72 % from total 7 Staphylococcus aureus) and Staphylococcus epidermidis 5 (15,1%), followed by Klebsiella pneumoniae 2 ( 6,06 % ), Serratia 2 (6,06 %) and Pseudomonas aureginosa 2 (6,06 %). Late - onset sepsis was significantly more common in premature infants. We confirmed that neonatal sepsis resulted with increase duration of NICU stay and duration of MV. Early diagnosis, followed by appropriate antibiotic treatment, short hospital stay and restricted use of invasive devices should be the aims to reduce the risk of late - onset sepsis during the stay in the NICU. Conclusion: Neonatal sepsis is a major cause of death in infants despite sophisticated neonatal intensive care. Early and adequate antibiotic therapy decreases the risk of morbidity of hospitalized patients.