Faculty of Medicine

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    Item type:Publication,
    Cognitive impairment in CKD patients: a guidance document by the CONNECT network
    (Oxford University Press (OUP), 2024-09)
    Bolignano, Davide
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    Simeoni, Mariadelina
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    Hafez, Gaye
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    Pepin, Marion
    ;
    Gallo, Antonio
    Cognitive impairment is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). This position paper, developed by the Cognitive Decline in Nephro-Neurology: European Cooperative Target network, provides guidance on the epidemiology, risk factors, pathophysiology, diagnosis and clinical management of CKD-related cognitive impairment. Cognitive impairment is significantly more common in CKD patients compared with the general population, particularly those undergoing haemodialysis. The development of cognitive impairment is influenced by a complex interplay of factors, including uraemic neurotoxins, electrolytes and acid-base disorders, anaemia, vascular damage, metabolic disturbances and comorbidities like diabetes and hypertension. Effective screening and diagnostic strategies are essential for early identification of cognitive impairment utilizing cognitive assessment tools, neuroimaging and circulating biomarkers. The impact of various drug classes, including antiplatelet therapy, oral anticoagulants, lipid-lowering treatments and antihypertensive drugs, on cognitive function is evaluated. Management strategies encompass pharmacological and non-pharmacological interventions, with recommendations for optimizing cognitive function while managing CKD-related complications. This guidance highlights the importance of addressing cognitive impairment in CKD patients through early detection, careful medication management and tailored therapeutic strategies to improve patient outcomes.
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    FACTORS INFLUENCING THE EARLY POSTOPERATIVE QUALITY OF LIFE IN PATIENTS TREATED SURGICALLY FOR GYNECOLOGICAL MALIGNANCIES
    (Macedonian association of anatomists and morphologists, 2019)
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    Jovanovska V
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    Tanturovski D
    ;
    Stojchevski S
    ABSTRACT Aim: To evaluate the influence of inherent patient characteristics on early postoperative QoL in patients treated surgically for gynecological malignancies Materials and methods: The study was designed as a prospective cohort study. Patients scheduled for surgical treatment of a gynecological malignancy at the Department of gynecological oncology at the University Clinic of Gynecology and Obstetrics in Skopje, in the period January – December 2018. Quality of life was quantified using a standardized and validated questionnaire (FACT-G) preoperatively and 1 month after surgical treatment. We explored the effect of the following variables: age, BMI, nationality, education, marital status, place of residence, employment, primary location of the neoplasm, disease stage, extent of surgical resection, comorbidities and smoking. Results: Data from 123 patients were included in the final analysis. The average age of patients at the time of recruitment was 58±10 years (range 23-79 years). Eighty-four patients (68.29%) had endometrial cancer, 22 (17.89%) patients had cervical cancer, while 17 (13.82%) patients had ovarian cancer. Postoperative FACT-G scores were significantly lower (p=0.015). A clinically relevant postoperative decrease in quality of life was identified in 51 patients (41.5%). Independent predictors of deteriorated postoperative QoL in this study were: advanced disease stage, extensive surgical resection, comorbidities and higher education. Conclusion: The results illustrate the physical, psychological, and social effects of the surgical treatment on the early postoperative QoL, thereby emphasizing the need for a comprehensive, multidisciplinary approach to the pre and postoperative care of these patients.