Faculty of Medicine

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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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Assessment of the Motivation for Smoking Cessation among the Citizens of the Republic of North Macedonia
(Galore Knowledge Publication Pvt. Ltd., 2022-04-19)
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Prosheva, Sanja
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Marya Hubbard
Introduction: North Macedonia is among the top rated countries with high smoking prevalence with high rate of adult smoking 48.4%, and nearly 81.4% of the smokers started smoking before being 25 years of age. This paper will highlight the prevalence and public’s motivation on smoking cessation, broken down into age groups throughout the entire country of North Macedonia. Materials and Methods: The method is an analytical-descriptive method with cross sectional study, as a result to a quantitative-qualitative survey conducted among the population in 2021 with the collaboration of the Virginia Tech University and the NGO Link Across. Data from the Qualtrics housed surveys and the completed paper surveys were entered into an Excel DB. Descriptive statistics were generated for all questions. Bivariate data were analyzed using r. Results and Discussion: Smoking is widely spread among all age groups, but with a trend to decrease in numbers as the age is of a higher number - 32.2% belongs to the 18 to 24 year old group. Distribution by gender -57.8% female, 40.4% male. Younger age groups have the highest relative frequencies about the intention to quit smoking within one month. Approximately 16% of participants who were smokers and attempted to quit, were smoke free and successful in cessation. Majority of survey participants who attempted to quit were not successful and resumed smoking within 6 months. This is strong justification of smokers who attempt to quit needing a program that would guide them and maintain the attempts for cessation. Conclusions: New state programs for smoking cessation should be offered as soon as possible. Also regarding the changes in smoking protection laws, they should be analyzed; some of the changes need to be reverted regarding the law legislation of the new modern ways of tobacco use, which are on the rise all over the world.
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Health promotion challenges and opportunities in the Western Balkans: a review of contemporary policies and actions
(Frontiers Media SA, 2026-01-27)
Gabrani, Jonila
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Rommel, Alexander
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Anton, Aline
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Cilović-Lagarija, Šeila
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Grujić-Vujmilović, Dragana
Background Countries in the Western Balkans (WBCs) fall behind the European Union in implementing effective health promotion. This study explores the key components of national health promotion policies and action plans in Albania, Federation of BiH, and the Republic of Srpska, Montenegro, North Macedonia, and Serbia, with the aim of describing key action trends, gaps, and challenges, and recommendations for health promotion implementation improvement. Methods Within the framework of the “Western Balkan Strategic Partnership for Health Protection” (WASP) project, implemented in five WBCs on behalf of the Global Health Protection Programme (GHPP), 2023–2025, and using the” Ottawa Charter for Health Promotion” a descriptive observational study was employed, combining data and information provided from the desk review of national legal frameworks, country-specific reports and consultative meetings to describe health promotion policies and action plans implementation in the period from 2010 to 2022. Results WBCs highlight diverse national priorities, such as promoting education and healthy lifestyles (e.g., Albania, Serbia, Federation of BiH, and the Republic of Srpska), addressing health inequalities (e.g., Federation of BiH, and the Republic of Srpska, Serbia), and digital health systems. The strategies and action plans of WBCs have common health promotion goals, and challenges. Community engagement and enforcement of public health policies are insufficient. Preventive care services are notably underdeveloped in rural areas with inadequate healthcare infrastructure. Although legal frameworks show that there is commitment to health promotion, putting action plans into practice is still a challenge, especially when it comes to involving communities and focusing on prevention. Budget transparency and working together across the region could also be improved to better tackle health inequalities and build stronger health systems. Conclusion While WBCs demonstrate growing political commitment to health promotion, substantial gaps remain in translating strategies into sustainable action. Strengthening intersectoral collaboration, improving monitoring systems, securing stable financing, and expanding community participation are crucial for advancing equitable, prevention-oriented health systems across the region.
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IMPACT OF TIME-TO-TREATMENT AND THROMBECTOMY TECHNIQUE ON OUTCOMESINACUTEISCHEMICSTROKE:ASINGLE-CENTERCOHORTANALYSIS
(Macedonian Association of Anatomists and Morphologists, 2025-06)
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Introduction:Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). Time-to-reperfusion is the most critical determinant of patient outcome. This study aimed to conduct a comprehensive analysis of key time metrics and the efficacy of MT at our institution, evaluating their impact on both angiographic and clinical results to identify areas for process optimization.Methods:We conducted a retrospective analysis of a cohort of 17 consecutive patients treated with MT for LVO stroke. We analyzed demographics, baseline clinical status (mRS), occlusion location, detailed time-to-treatment intervals, procedural techniques, and outcomes. The primary angiographic endpoint was successful reperfusion, defined as an extended Thrombolysis in Cerebral Infarction (eTICI) score of ≥2b. Clinical endpoints included functional outcome at 3 months, measured by the mRS, and the rate of symptomatic intracranial hemorrhage (sICH).Results:The mean patient age was 60.9 years, with a significant male predominance (70.6%). All patients presented with severe stroke (initial mRS 4-5), indicating a high-acuity cohort. The mean time from symptom onset to final reperfusion was prolonged at 505 minutes (8 hours 25 minutes). Despite this, a high rate of successful reperfusion (eTICI ≥2b) was achieved in 85.7% of patients, with complete reperfusion (eTICI ≥2c/3) in 57.1%. However, this technical success did not fully translate to clinical recovery, as a good functional outcome (mRS 0-2) at 3 months was achieved in only 30.8% of patients. The rate of sICH was 15.4%.Conclusion:Our center achieves high rates of technical success in reperfusion (85.7% eTICI ≥2b), comparable to international benchmarks. However, prolonged treatment delays are significantly attenuating clinical outcomes, with only 30.8% of patients achieving functional independence. This analysis underscores that procedural excellence alone is insufficient; optimizing system-wide time-to-treatment protocols isthe critical next step to improve patient recovery.
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‘What’ and ‘How’ to Measure in Allergy and Clinical Immunology: A Systematic Review of Core Outcome Sets and Outcome Harmonisation Processes
(Wiley, 2026-04-13)
Demidova, Anastasia
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Kiknavelidze, Nata
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Purtskhvanidze, Kristine
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Alieva, Elvina
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Ebrahimnejad, Mehrshad
Background Heterogeneity in outcome reporting and inconsistent use of outcome measurement instruments in allergy and clinical immunology research affects the comparability, synthesis, and clinical applicability of study findings. Harmonisation efforts, particularly Core Outcome Set (COS) development, aim to address these challenges by establishing standardised, evidence‐based and consensus‐driven outcome recommendations. This systematic review aims to map available COS and other harmonisation processes (HP) in allergy and clinical immunology, evaluate their methodological approaches, and assess their alignment with established development standards. Methods We systematically searched MEDLINE, EMBASE, and the COMET Initiative database until June 7, 2024 to identify COS and HP. We included studies if they provided recommendations on ‘core’ outcomes and/or outcome measurement instruments. Data extraction included disease focus, methodological approach, stakeholder involvement, and adherence to the Core Outcome Set‐STAndards for Development criteria. We synthesised the data at the initiative (process) level rather than the publication level because harmonisation initiatives are frequently iterative and reported across multiple papers (e.g., protocol, Delphi rounds, consensus statement, and subsequent instrument‐selection outputs). Results A total of 15,612 records were identified, with 44 studies (representing 22 initiatives both finished and in development) meeting inclusion criteria. The majority of initiatives focused on asthma ( n = 9), followed by eczema (atopic dermatitis n= 2; hand eczema = 1; eczema = 1), urticaria ( n= 2), allergic rhinitis ( n= 2), chronic rhinosinusitis ( n = 1), celiac disease ( n = 1), Immunoglobulin E (IgE)—mediated food allergy ( n = 1), eosinophilic esophagitis ( n = 1), and hereditary angioedema ( n= 1). No COS or HP addressed drug allergy, anaphylaxis, or other immune‐mediated allergic conditions. ‘Quality of life’ was consistently included in all COS with ‘signs and symptoms’, ‘exacerbations’ and ‘disease control’ frequently selected as well. Methodological approaches to COS development varied widely, with most employing Delphi surveys, consensus meetings, and stakeholder involvement, though levels of engagement differed. COS developers inconsistently adhered to Core Outcome Set‐STAndards for Development criteria, with some initiatives demonstrating rigorous methodology while others lacked transparency in key developmental steps. Conclusion This review highlights growing efforts to harmonise outcome assessment in allergy and clinical immunology. Major gaps remain in coverage and methodological rigour. Quality of life and patient‐reported symptoms are frequently recommended outcomes, yet definitions and measurement tools are inconsistent. Strengthening methodological consistency and expanding COS development to neglected areas are critical next steps to improve outcome reliability and comparability in the field.
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Nutrition, Supplements and their Interaction with Drugs in Diets for the Prevention and Treatment of Diseases
(SASPR Edu International Pvt. Ltd, 2026-01-17)
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Ramova, Elizabeta Popova
The promotion of healthy eating and physical activity is part of the prevention and treatment of diseases in modern medicine. The aim of our research was to study the clinical principles in compiling a diet for patients who are already on drug therapy for a diagnosed disease, guided by the principle of healthy eating. Material and method: we conducted a study motivated by personal experiences on the interaction of drugs and nutrients in diets prescribed for healthy eating in certain diseases, with a special aspect of anticoagulant therapy. The basic principle of the protocol should include the underlying disease, medications for the same, past diseases with a deficit of certain organs in function and an assessment of the existing diet and supplements to prevent drug interactions. Results: More than 30% of people take supplements on their own. Knowledge of the interaction of drugs with supplements and nutrients with medications is of crucial importance for preventing the consequences of their synergistic or antagonistic interaction, of which bleeding is the key and most dangerous. Discussion: Modern management of patients in the perioperative period is crucial to avoid bleeding or thrombosis. The medical team takes into account all possible risks, based on the clinical examination, blood laboratory and possible drug interactions, but there is not always available data on the patients' supplementary therapy, which may be a risk. Conclusion: When recommending the consumption of supplements and diet for a given disease, the possible interaction of the drug and the condition of the organs that may be damaged should be taken into account. Keywords: Diet, Supplements, Medications, Interaction.
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PON1 (Paraoxonase 1) Q192R Gene Polymorphism in North Macedonian Population with Confirmed Coronary Artery Disease
(Walter de Gruyter GmbH, 2025-12-01)
Krsteva Jakimovska, K
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Aim This study aims to examine the association between the prevalence of Q192R polymorphism of PON1 gene and the occurrence of atherosclerosis and coronary artery disease in patients in Republic of North Macedonia. Method This cross-sectional study includes subjects undergoing percutaneous coronary angiography with or without stenting due to monitoring of stable angina or induced ischemia, divided into two groups. Q192R polymorphism and its genotypic variants were analysed. The Polymerase Chain Reaction technique was used as a method for determining the single nucleotide polymorphism. Results A total of 165 subjects (106 belonging to the coronary artery disease (CAD) group and 59 to non-CAD group were evaluated in terms of their biochemical parameters and genetic variants. Results of the PON1 SNP Q192R groups (QQ, QR and RR) association related to CAD and non-CAD groups, resulted in a non-significant association (p=0.0632, OR=0.511, CI: 0.25–0.595, χ 2=3.4508, df=1). In further analyses, to obtain a more precise association, we analysed the association between SNP Q192R groups and stenting patients (control vs. stenting group). Further analysis confirmed the association of QQ vs. QR and control vs. stenting (p=0.0418, OR=0.461, CI: 0.216–0.589, χ2=4.1432, df=1). Conclusion Results support the concept that genetic variants may contribute to an increased risk of CAD, emphasizing the importance of combined biochemical and genetic testing for better stratification of cardiovascular risk and early confirmation of the predisposition to develop serious cardiovascular disease. Further studies with a larger sample size are needed before Q192R gene polymorphism can be considered as a genetic risk factor for CAD.
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CHOLANGIOCARCINOMA: CLINICAL AND LABORATORY TECHNIQUES WITH SPECIAL EMPHASIS ON IMAGING TECHNOLOGIES
(Macedonian Association of Anatomists and Morphologists, 2026-02-23)
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Bozhinovska, Biljana
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Kostova, Masha
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Bozhinovska Beaka, Gordana
Cholangiocarcinoma is a rare and highly aggressive malignancy of the biliary epithelium, marked by considerable anatomical heterogeneity and a largely nonspecific clinical presentation, factors that frequently contribute to delayed diagnosis. The purpose of this study was to examine the demographic, clinical, laboratoryand imaging characteristics of patients with cholangiocarcinoma and to assess their relationship with imaging-based anatomical tumor classification.This retrospective study included 40 adult patients with histopathologically confirmed cholangiocarcinoma diagnosed in General Hospital “8th September” in Skopje, Republic of North Macedo-nia, between January 2022 and December 2025. Clinical presentation, hepatobiliary laboratory parameters, and imaging findings obtained using contrast-enhanced computed tomography, and most often magnetic res-onance imaging with magnetic resonance cholangiopancreatography were reviewed. Based on imaging find-ings, tumors were classified as intrahepatic, perihilar, or distal cholangiocarcinoma. The study population demonstrated a male predominance (62.5%), with a mean age at diagnosis of approximately 68 years. Perihilar cholangiocarcinoma was the most commonly identified type (55%), followed by distal (27.5%) and intrahepatic tumors (17.5%). Jaundice and pruritus occurred exclusively in patientswith extrahepatic disease, whereas all asymptomatic patients had intrahepatic tumors. Laboratory analysis revealed a marked cholestatic pattern in perihilar and distal cholangiocarcinoma, with substantially higher bilirubin, alkaline phosphatase, and gamma-glutamyl transferase levels compared with intrahepatic disease. Overall, these findings highlight the importance of anatomical tumor classification and support the integrated use of imaging(MR and MRCP), clinical assessment, and laboratory data in the diagnostic evalua-tion ofcholangiocarcinoma.

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