Faculty of Medicine

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Miliary Pulmonary Metastases from Lung Adenocarcinoma: A Case Report
(SASPR Edu International Pvt. Ltd, 2026-08-05)
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Introduction: Miliary dissemination of adenocarcinoma is a rare, aggressive, and often terminal form of metastasis characterized by countless tiny (millimetric) nodules spreading throughout the lungs, mimicking miliary tuberculosis. It affects less than 5% of all lung adenocarcinomas. The aim of this study is to present a case of miliary disseminated adenocarcinoma originating from the lung with all diagnostic requirements. Materials and methods: A 57year old male patient with 80-pack year smoking status admitted for invasive diagnostics in our clinic between (22.10.2026-29.10.2026) due to x-ray showing miliary disseminated lung infiltrates and pleural effusion. Results: The light criteria of the pleural effusion showed exudate with high LDH values highly suspected of malignancy. Contrast enhanced CT was scheduled and it showed multiple miliary disseminated infiltrates, mediastinal and hilar lymphadenopathy. Liver and adrenal gland metastases were also noted. Bronchoscopy with TBB from the branch of the right upper lobe, together with TBNA from position 7 and 11R, both came positive for adenocarcinoma. Immunohistochemistry was positive in 50% of ROS1; TTF1; CK7; CEA; and negative on CK20; EGFR, ALK, PDL1 confirming primary adenocarcinoma of the lung. Additionally, the patient was presented on tumor bord for treatment options and staging being T4N3M1c2. Conclusion: Miliary disseminated adenocarcinoma is aggressive and usually diagnosed late. Immunohistochemistry can provide an exact origin of the malignant disease.
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CLINICAL RECOGNITION OF RETT SYNDROME
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2022)
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Lejla Muaremoska Kanzoska
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Learta Adili Ademi
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Helga Pavlovska
Rett syndrome is a rare genetic disorder that affects the development of brain, which results in severe mental and physical impairment. It is estimated that it affects one of 10,000 females born every year [1]. On rare occasions, it is also manifested in males. The most prominent symptoms are neurological, including epileptic attacks, motory deficits, neurogenic apnea and belated or absent speech. Rett syndrome includes periphery pathologies, such as osteopenia, scoliosis, gastrointestinal dysfunction and general growth deficit. It is characterised by normal early growth and development followed by tardiness, loss of voluntary movement of the hands, stereotypical movements of the hands, slow growth of the brain and head, walking problems, epileptic attacks and intellectual disabilities. The patient in the presented case report is a girl, aged 5 years, investigated due to developmental issues, with a mutation in the MECP2 gene that codes the methylCpG-binding protein 2 (MeCP2) suggesting Rett syndrome [1].
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Methods for tissue perfusion assessment after Dellon decompression of tarsal tunnels in diabetic neuropathy: key to effective management—a narrative review
(Wolters Kluwer Health, 2025-01-02)
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Tusheva, Sofija
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Background and Objective Diabetic neuropathy significantly elevates the risk of foot ulceration and lower-limb amputation, underscoring the need for precise assessment of tissue perfusion to optimize management. This narrative review explores the intricate relationship between sympathetic nerves and tissue perfusion in diabetic neuropathy, highlighting the important role of autonomic neuropathy in blood flow dynamics and subsequent compromises in tissue perfusion. The consequences extend to the development of diabetic peripheral neuropathy and related foot complications. By analyzing both non-invasive diagnostic methods and surgical interventions, such as tarsal tunnel decompression, the paper seeks to highlight their effectiveness in improving tissue perfusion, preventing ulcers, and reducing the risk of amputations in patients with diabetic peripheral neuropathy. Methods We reviewed current literature on both non-invasive diagnostic tools and surgical techniques for assessing and improving tissue perfusion in diabetic neuropathy. Methods discussed include transcutaneous oxygen pressure (TcPO2), Doppler ultrasound, Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI, and the SPY Laser Angiographic System. Key Content and Findings Emphasizing the critical importance of surgical interventions, such as tarsal tunnel decompression and neurolysis of the posterior tibial nerve, the article underscores their efficacy in enhancing tissue perfusion and preventing ulcers and amputations. Additionally, it addresses the significance of precise blood flow measurement and timely intervention in the management of diabetic neuropathy and foot ulcers. The non-invasive techniques for assessing tissue perfusion and blood flow in diabetic neuropathy such as TcPO2, Doppler ultrasound and Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI are explained. Also, this review introduces the SPY Laser Angiographic System, which employs near-infrared fluorescence imaging to assess blood flow and perfusion in tissues. This advanced tool generates real-time microvascular blood flow images and proves instrumental in diagnosing and monitoring diabetic foot ulcers. Conclusions In conclusion, surgical interventions, both vascular and peripheral nerve are pivotal for optimizing patient care. Early identification of foot ulcers and peripheral arterial disease is imperative, and an understanding of blood flow dynamics, combined with effective surgical techniques, constitutes key elements in managing diabetic neuropathy, healing and preventing ulcers, and limb salvage.
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THE IMPACT OF INFLUENZA A ON BLOOD DONATION
(Macedonian Association of Anatomists and Morphologists, 2026-05-22)
Kiril Lazov
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Numerous elements affect the body's and the provided components' safety. The primary factor that guarantees safe transfusion is the management of a steady stream of voluntary, frequent, unpaid, and willing contributions. Through quantitative analysis of the total number of blood donors, voluntary blood donors, multiple blood donors, age structure, social structure, and unresolved blood donors, this paper aims to present the impact of influenza A on blood donation and the issuance of units in clinical service during the period from 2024 to 2025. By enabling the safe and efficient conveyance of the necessary components, transport medicine plays a crucial role in contemporary healthcare. Healthcare workers can use blood transfusions to save lives, restore life-support capacity, and assist the life support system. Blood transfusions are a medical procedure that can save lives. Optimal transfusion therapy necessitates knowledge of components and natural cross-matching, blood sources and donor selection, blood collection and delivery techniques, component therapy, transfusion responses, and red cell replacements.
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Dosimetric comparison of organs at risk in ultra-hypofractionated versus hypofractionated postoperative radiotherapy for early breast cancer: single center clinical study
(Walter de Gruyter GmbH, 2026-02-06)
Petkovska, Gordana
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Ratosa, Ivica
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Bojovska Trajanovska Valentina
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Creslovnik, Albina Pupakovski
Background Growing evidence of safety and feasibility has prompted a shift toward ultra-hypofractionated (UHF) schedules in postoperative radiotherapy in early breast cancer. Patients and methods Eighty patients over 50 years of age with early breast cancer (T1-2 and N0-1) who underwent postoperative, 3D conformal, free-breathing whole breast radiotherapy were included. The prospective arm consisted of 40 patients treated with UHF (26 Gy/5 fractions/one week) from 2023-2024, whereas the control arm was retrospective and represented by data from 40 patients treated with hypofractionated radiotherapy (HF) (40.5–42.2Gy/15–16 fractions/3 weeks) between 2015 and 2020. Dosimetric parameters for organs at risk (OARs) (heart and ipsilateral lung) were derived from the dose-volume histograms. Statistical evaluation was done with paired sample t-test and Mann-Whitney U test. Results Dosimetric analysis revealed that patients treated with UHF schedule received significantly lower equivalent doses in 2 Gy fractions (EQD 2 Gy) to OARs compared with those treated with the HF schedule. The mean ipsilateral lung EQD 2 Gy dose was significantly lower in the UHF group (3.94 ± 2.1 Gy) than in the HF group (6.24 ± 2.4 Gy; p < 0.01). Among patients with left-sided breast cancer, the mean heart EQD 2 Gy dose was also significantly reduced in the UHF group (1.34 ± 0.5 Gy) compared with the HF group (3.02 ± 1.4 Gy; p < 0.01). Conclusions These findings indicate a consistent dosimetric advantage of the UHF schedule, particularly in reducing radiation exposure to the heart and ipsilateral lung. These results support the dosimetric safety and feasibility of UHF schedules in early breast cancer treatment.
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Conformity Index and Homogeneity Index of the Postoperative Whole Breast Radiotherapy
(Scientific Foundation Spiroski (publications), 2017-09-13)
Petrova, Deva
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BACKGROUND: The treatment of breast cancer involves a multidisciplinary approach in which radiotherapy plays a key role. AIM: The conformity index and the homogeneity index are two analysis tools of a treatment plan using conformal radiotherapy. The purpose of this article is an analysis of these two parameters in the assessment of the treatment plans in 58 patients undergoing postoperative radiotherapy of the whole breast. MATERIALS AND METHODS: All 58 patients participating in the study had a conservatively treated early-stage breast cancer. The treatment was performed using a standard regimen of fractionation in 25 fractions up to a total dose of 50Gy. Dose-volume histograms were generated for both plans with and without segmental fields. RESULTS: Pair samples t-test was used. The technique with segmental fields allowed us more homogeneity distribution when compared to standard two tangential field techniques. The HI values were 1.08 Â± 0.01 and 1.09 Â± 0.01 for segment and technique with two tangential fields (p < 0.001). The DHI values were 0.92 Â± 0.02 and 0.901 Â± 0.01 for segment and technique with two tangential fields (p < 0.001). The CI values were 1.38 Â± 0.02 and 1.43 Â± 0.3 for segment and technique with two tangential fields (p = 0.0018). CONCLUSION: The results showed that the conformity and the homogeneity index are important tools in the analysis of the treatment plans during radiation therapy in patients with early-stage breast cancer. Adding segment fields in the administration of radiotherapy in patients with conservatively treated breast cancer can lead to improved dosage homogeneity and conformity.
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Guidance in the application of quality management in the field of chromatography in routine medical laboratories – EFLM Committee: Accreditation and ISO/CEN Standards point of view
(Walter de Gruyter GmbH, 2026-06-22)
Milinković, Neda
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Çubukçu, Hikmet Can
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Kanellopoulos, Panagiotis
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Sciacovelli, Laura
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Linko, Solveig
Background Chromatographic separation has become a critical analytical technique in routine laboratory medicine. Although several documents address standardisation in chromatography, they largely focus on industrial and pharmaceutical applications. Routine medical laboratories remain underserved, creating a need for guidance tailored to their specific context. This paper aims to provide technical guidance on applying ISO 15189:2022 requirements to chromatographic methods, ensuring quality and risk management across all laboratory phases. Content Building on previous work of the European Federation of Laboratory Medicine Committee on Accreditation and ISO/CEN Standards, we reviewed ISO 15189:2022 requirements and interpreted them in relation to chromatographic procedures. Key vulnerabilities inherent to chromatography – such as sample preparation variability, column performance drift, and detector calibration – were identified and mapped to relevant quality and competence clauses. Summary and Outlook The guidance highlights chromatography-specific risks and proposes structured verification, documentation, and risk management strategies. It addresses pre-analytical, analytical, and post-analytical phases, emphasizing traceability, method verification, and result of release. Special consideration is given to laboratory-developed tests using chromatographic techniques, aligning them with European in vitro diagnostic regulation. By contextualising ISO 15189:2022 within the technical realities of chromatography, this paper provides laboratories and auditors with practical tools to safeguard quality, reduce uncertainty, and ensure reliable patient results. The proposed framework advances regulatory harmonisation and supports the routine implementation of chromatography in medical laboratories.
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Non-ampullary mucinous adenocarcinoma of the small intestine unmasked by persistent anemia: A Case Report
(Liga-Inform, Ltd., 2026-02-23)
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Jankoski, D.
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Kutanoski, D.
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Kostovska Irena
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Perforatedsolitarymid-rectaldiverticulumdiagnosedwith colonoscopy:acasereportandliterature review
(Oxford University Press (OUP), 2026-01-27)
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Avramoski, Vladimir
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Gjinoska, Klaudia
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Kostovska, Irena
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Stoicovski, Emil
Rectal diverticulum is an exceedingly rare clinical entity, typically occurring as a solitary lesion or, less frequently, as up to three diverticula. Its development is often associated with underlying conditions such as obstructive defecation syndrome, rectal malignancy, pelvic floor weakness, chronic rectal impaction, obesity, or infection-related muscular atrophy. Although uncommon, rectal diverticulitis represents a surgical emergency requiring timely recognition and management. In this case, a female patient presented with rectal bleeding and secondary anemia. During the clinical course, the patient developed pelvic sepsis secondary to rectal diverticulitis. Appropriate surgical intervention, combined with antimicrobial therapy and supportive management, led to a favorable outcome. Rectal diverticulitis is a rare but potentially life-threatening condition. Awareness of this entity and early diagnosis are essential to prevent severe complications such as perforation and pelvic sepsis. This case highlights the importance of considering rectal diverticulum in the differential diagnosis of lower gastrointestinal bleeding and pelvic infections.
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Antihypertensive Medication Use and Biochemical Outcomes in Primary Care Patients: A Multicenter Study in Kosovo
(Oriental Scientific Publishing Company, 2026-03-20)
Alidema, Fitim
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Kostovska, Irena
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Alidema, Arieta Hasani
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Mustafa, Lirim
Arterial hypertension remains a major public health challenge that requires longterm pharmacological management; however, antihypertensive therapy may also be associated with metabolic and biochemical alterations. This multicenter retrospective study evaluated the association between antihypertensive drug use and biochemical parameters among primary care patients in Kosovo and compared outcomes across three healthcare centers (Prishtina, Ferizaj, and Gjilan). A total of 900 patients with essential hypertension receiving continuous treatment for at least 12 months were included. Data were extracted from medical records and laboratory registers between January 2024 and January 2025 and comprised demographic variables, treatment regimens (monotherapy or combination therapy), and biochemical parameters, including lipid profile, fasting glucose, renal markers, and electrolytes. Statistical analyses included ANOVA or Kruskal–Wallis tests, chi-square tests, correlation analysis, and multivariate logistic regression. Combination therapy was associated with significantly higher levels of LDL cholesterol, triglycerides, and creatinine compared to monotherapy (p < 0.05), while lipid alterations were more prominent among patients treated with beta-blockers and diuretics (p < 0.01). The use of two or more antihypertensive drug classes independently predicted an increased risk of dyslipidemia (OR 1.8, 95% CI: 1.2–2.5; p = 0.004). No significant differences were observed in glucose levels between the study centers (p = 0.21). Long-term antihypertensive therapy, particularly polytherapy, is associated with clinically relevant biochemical changes affecting lipid metabolism and renal function, highlighting the necessity for routine laboratory monitoring and individualized treatment optimization in primary care practice.

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