Faculty of Medicine

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    Failure rate of the pulmonary embolism rule-out criteria rule for adults 35 years or younger: Findings from the RIETE Registry
    (Wiley (United States), 2025)
    Jossein T,
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    Mazzolai L,
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    Lorenzo Hernández A,
    ;
    ;
    Rivas Guerrero A,
    Background The use of a computed tomography pulmonary angiogram to diagnose pulmonary embolism (PE) has increased, leading not only to higher PE diagnoses but also to overdiagnosis and unnecessary radiation exposure, even in young patients despite a lower PE incidence. The aim of this study was to assess the failure rate of the pulmonary embolism rule-out criteria 35 (PERC-35) rule developed to reduce unnecessary testing in individuals aged ≤35 years among patients included in the Registro Informatizado de la Enfermedad TromboEmbolica Venosa (RIETE) Registry. Methods This retrospective cohort study used data from the RIETE Registry, an ongoing, international prospective registry of patients with objectively confirmed venous thromboembolism. The primary outcome was the missed PE rate using PERC-35 criteria. Secondary outcomes included the comparison of demographic and clinical characteristics, PE localization, treatment strategies, and outcomes between PERC-negative (PERC-35N) versus PERC-positive (PERC-35P) patients. Results Of 58,918 adult patients with acute PE, the PERC-35 rule demonstrated a low missed PE rate of 0.35% (n = 204), with an upper 95% confidence interval [CI] of 0.40%. The missed rate was 7.0% (95% CI 6.0%–7.9%) in the 18- to 35-year subgroup. Compared to PERC-35P patients, PERC-35N patients were younger (mean age 28.4 years), with a lower body mass index, and included a higher proportion of pregnant/postpartum women. PERC-35N patients had a significantly lower rate of chronic diseases and presented less frequently with dyspnea or syncope but more often with chest pain. They showed lower rates of positive D-dimer and troponin levels. PERC-35N patients experienced fewer major bleeding episodes, similar recurrence rates of PE/deep vein thrombosis, and no deaths during anticoagulation. Conclusions The PERC-35 rule demonstrated a low failure rate to exclude PE in patients aged 18–35 years and could reduce imaging and radiation exposure in young patients with a low PE pretest probability if confirmed prospectively.
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    Minimal screening analysis based algorithm for diagnosis and clinical stratification of patients with acute myeloid leukaemia (AML): single centre experience
    (Macedonian Academy of Sciences and Arts, 2012-07)
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    Ivanovski, Martin
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    Hadzi-Pecova, Liljana
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    Dukovski, Dushko
    A b s t r a c t: In this paper we present our results from a study designed in order to establish and standardize a diagnostic algorithm for acute myeloid leukaemia (AML) in the Republic of Macedonia. A total of 146 consecutive adult patients (> 15 years) were enrolled in the study. First, we determined the correct lineage assignment of the blast cells and evaluated the incidence of the favourable PML/RARα, AML1/ETO, CBFβ/MYH11 genetic markers among the AML cases. Additionally, the obtained results were correlated with patients’ age, comorbidities, and performance status, and each single AML patient was stratified to effective treatment strategy. Our results showed that morphology and cytochemistry established a lineage in 132 (89.1%) of the patients, but not in 16 cases that presented as acute leukaemia, of which 7 were assigned as myeloid, and in two a non-haematopoietic malignancy was indicated with immunophenotyping. Mulitparameter flow cytometry immunophenotyping also changed the assigned lineage based on morphology and cytochemistry in 5 (3.3%) of the patients from lymphoid to myeloid and improved diagnosis in 21 (14.1%) cases. By using a reverse transcriptase-polymerase chain reaction (RT-PCR) essay 28 (23.1%) patients were classified in the prognostically favourable AML genetic group; 8 patients expressed the fusion transcript PML/RARα, 5 AML1/ETO and 15 CBFβ/MYH11. Moreover, analyses of the age, performance status and comorbidities further stratified an additional 12.5% of the patients to a different risk-adapted therapy. The applied minimal screening-analysis-based diagnostic algorithm enabled improved and more precise diagnosis and clinical stratification in 37.2 % of AML patients from our study group.
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    Consensus statement: RECOMMENDATIONS FOR THE DIAGNOSTIC ALGORITHM IN LUNG CANCER CONSENSUS STATEMENT OF THE MACEDONIAN RESPIRATORY SOCIETY AND THE MACEDONIAN ASSOCIATION OF PATHOLOGY
    (Македонско лекарско друштво = Macedonian Medical Association, 2019)
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    Dejan Todevski
    ;
    Arben Rexhepi
    ;
    Aleksandra Tatabitovska
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    Lung cancer is the “number one cancer killer” in the world. Its prevalence is associated with smoking as the primary cause, although air pollution in general and genetic factors are also important. The mortality especially from advanced stage lung cancer is still high, although there has been a significant improvement in the past 10 years, mostly due to the introduction of novel compounds such as targeted and immunological treatment. The advances in the treatment of NSCLC have imposed updating of the guidelines for the diagnostic procedure and screening of LC, for the indications for molecular testing as well as for targeted selection of patients who shall benefit the most from the novel treatment modalities. These recommendations shall fulfil their purpose only if implemented in the educational curriculum and if incorporated in the healthcare system strategies.