Faculty of Medicine
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Item type:Publication, 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); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, KIDNEY FUNCTION DECLINE AND MORTALITY IN DONORS WITH EXPANDED CRITERIA - FIVE YEARS FOLLOW UP STUDY(Macedonian Association of Anatomists and Morphologists, 2024); ; ; ; Kidney donors are considered healthy, but with a need for continued medical follow up and encouragement for continued healthy lifestyle, especially when expanded criteria for donation are applied. This study aims to analyse the five years follow up of kidney donors after explanation, encountering risks of kidney function decline and donors’ mortality. In a retrospective study we evaluated a donor cohort with 5 years of follow up. Demographic characteristics as age, gender and the presence comorbidities as diabetes, hypertension, hyperlipidemia and Body Mass Index (BMI) >30kg/m2 were analyzed. Estimated glomerular filtration rate (eGFR) by CKD EPI formula was notified prior donation, and annually afterwards. Consultations with nephrologist or other specialists were notified. In a multivariate regression analysis, the reduction ratio (RR) of eGFR was explored as dependent variable. Cox regression analysis exploited mortality; Kaplan Meier survival curve was applied in respect of BMI. Seventy-five donors with average age above 55 years were predominantly women (69%), nearly every nineth patient had diabetes or obesity (9%). Proportion of donors referred to nephrologist at the 12 months, declined up to 58% at the fifth year, ignoring medical checks showed ascending trend to 16% at the end of second and third year and 12% at the end of observational period. The univariate regression analysis found diabetes, hyperlipidemia and hypertension, the presence of multiple comorbidities, gender and age as insignificant predictors of eGFR 12 months reduction ratio. The nephrologist referral showed borderline significance (β = - 0.103, p=0.076). Only BMI over 30kg/m2 worsened the kidney function (β = 0.600, p=0.001). Five years mortality rate was 6.7%. The diseased donors were significantly older, more frequently had diabetes and obesity also they had significantly lower eGFR pre-donation, at the end of the first year but also and more step decline of it after 12 months. In the multivariate analysis BMI>30kg/m2 emerged as most powerful predictor of mortality (HR 40.02; CI: [4.11-389), p=0.0001). Survival of obese patients was significantly shorter when compared with patients with lower body weight (43.28 ± 7.51 vs. 59.33±0.65, Log rank p=0.000), respectively. Our study demonstrates that the mortality and declination of renal function after donation are associated with nephrologist referral and other potentially modifiable factors, especially obesity. Improved protocols for pre-donation information, education and adequate after-donation follow up is mandatory to achieve better longevity and kidney function survival in these frail and precious individuals. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A novel id-iri score: development and internal validation of the multivariable community acquired sepsis clinical risk prediction model(Springer Science and Business Media LLC, 2020-04) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Predictors of active cancer thromboembolic outcomes. RIETE experience of the Khorana score in cancer-associated thrombosis.(Thieme, 2017) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Once versus twice daily enoxaparin for the initial treatment of acute venous thromboembolism(Thieme Medical Publishers, 2017) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Complications associated with acute pulmonary embolism – data from the registry of patients with venous thrombembolism(Македонско лекарско друштво = Macedonian Medical Association, 2022); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, INFLUENCE OF DAILY SODIUM INTAKE ON MORTALITY IN HD PATIENTS(Macedonian Association of Anatomists, 2022); ; ; The aim of our study was to assess the influence of daily sodium intake (DSI) on the cardiovascular mortality in dialysis patients (pts). In prospective, observational study, 156 pts on hemodialysis (HD) were followed for 36 months,until death or kidney transplantation. Cardiovascular (CV) mortality was defined as death resulting from coronary heart disease, sudden death, stroke or complicated peripheral vascular disease and was notified from the patients’ medical history at baseline. Estimated DSI, as a major predictor for CV mortality, was calculated using formula European Best Practice Guidelines (EBPG) on Nutrition. In respect of median DSI (11.7 ± 2.87 g/day) pts were stratified in two groups: Group 1 – pts with low DSI (<11.7 g/day) and Group 2 – patients with high DSI (> 11.7 g/day). The prevalence of CV comorbidities was not significantly different between two groups at baseline. At the end of the study, 41 pts (26.3%) died, among which 24 pts (60%) died from CV diseases. Kaplan-Mayer survival log rank test demonstrated that there was no difference in the cardiovascular survival between HD pts with high DSI and HD pts with low DSI(p>0.05).Serum levels of C-reactive protein (CRP) and mean age were significantly higher in pts diseased from CV disease compared to survived pts. Our results showed that HD pts may be particularly susceptible to non-osmotic sodium accumulation in skin and muscles. This study have shown that there was no significant influence of baseline DSI on the CV mortality of the pts included in the study. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Role of the radiological variables, clinical picture and values of C-reactive protein (CRP) and leukocytes in the brain edema development and eary intrahospital mortality in patients with hemorrhagic cerebrovascular insult(Macedonian Association of Physiologists and Antropologists, 2020); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Epidemiology of Community-Acquired Sepsis in Adult Patients: A Six Year Observational Study(Macedonian Academy of Sciences and Arts/Sciendo, 2018-07-01); ; ; ; Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection and it is a major cause of morbidity and mortality worldwide. The aim of this study is to describe epidemiology of community-acquired sepsis in the Intensive care unit (ICU) of the Macedonian tertiary care University Clinic for Infectious Diseases. A prospective observational study was conducted over a 6-year period from January, 2011 to December, 2016. All consecutive adults with community-acquired sepsis or septic shock were included in the study. Variables measured were incidence of sepsis, age, gender, comorbidities, season, source of infection, complications, interventions, severity indexes, length of stay, laboratory findings, blood cultures, 28-day and in hospital mortality. Of 1348 admissions, 277 (20.5%) had sepsis and septic shock. The most common chronic condition was heart failure (26.4%), and the most frequent site of infection was the respiratory tract (57.4%). Median Simplified Acute Physiology Score (SAPS II) was 50.0, and median Sequential Organ Failure Assessment (SOFA) score was 8.0. Blood cultures were positive in 22% of the cases. Gram-positive bacteria were isolated in 13% and Gram-negatives in 9.7% of patients with sepsis. The overall 28-day and in hospital mortality was 50.5% and 56.3% respectively. The presence of chronic heart failure, occurrence of ARDS, septic shock and the winter period may influence an unfavorable outcome. Mortality compared to previous years is unchanged but patients that we have been treating these last 6 years have had more severe illnesses. Better adherence to the Surviving Sepsis guidelines will reduce mortality in this group of severely ill patients. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MALNUTRITION-INFLAMMATION SCORE PREDICTS SURVIVAL IN HEMODIALYSIS PATIENTS(Macedonian Association of Anatomists, 2019); ; ; Canevska AleksandraThe 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.