Faculty of Medicine

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    A comparing the treatment of pain with continuous epidural analgesia versus systemic analgesia in patients with hip fracture
    (SHMSHM - AAMD, 2015)
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    Introduction: The systemic postoperative analgesia is unefficient in most of the patients with hip fracture, which is the reason for pain, especially during leg movement. Continuous epidural analgesia is efficient option for pre and post operative pain relief. The aim of this study was to compare the effect of continuous epidural analgesia versus sistemic analgesia, as a pre- and post operative analgesia in patients with hip fracture. Methods: Sixty patients with hip fracture were included and were randomly assigned to two groups of 30 patients: SA group –patients with sistemic analgesia; and EDC group - patients with a continuous epidural analgesia. In all patients pain intensity was measured at rest and passive hip flexion by using VDS (0 – 4) in several intervals: 1 and 12h before surgery, after analgesic treatment and 24 and 48 hours after intervention. The motor blockade was measured at the same times only in patients from EDC group, along with the side effects in both groups. Results: The values of VDS were significantly lower in patients from EDC group versus patients from SA group in rest and movement in all time intervals for p<0.05. Motor block was 0 in all patients from EDC group according to modified Bromage score. Registered side effects were sedation, dizziness itching and urine incontinence. Conclusion: Pain relief in pre- and post operative period has been superior in EDC group versus SA group at rest and movement in patients with hip fracture.
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    A comparison of continuous femoral nerve block versus continuous epidural analgesia for analgesia in elderly patients with hip fractures
    (World Academy of Science, Engineering and Technology, 2020)
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    Popovska, Snezhana
    Uncontrolled acute pain and stress of surgery in elderly patients may cause increased cardiac morbidity and mortality. Early administration of central or peripheral block reduces the incidence of myocardial ischemia and dysrhythmias and the response to stress. The aim of this study was to compare the effect of continuous central and peripheral blocks on the incidence of cardiac complications and their analgesic effect in patients with high cardiac risk with hip fracture.
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    DIURESIS AND HEMODIALYSIS AS RISK FACTORS ON SHORT-TERM OUTCOME IN ELDERLY PATIENTS WITH ACUTE KIDNEY INJURY
    (Balkan Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2022-11)
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    INFLUENCE OF CARDIAC RISK PREDICTORS ON SURGERY OUTCOME IN ELDERLY WITH HIP FRACTURE
    ("Ss Cyril and Methodius"University, Faculty of Medicine, Skopje, R. N. Macedonia, Department of Anesthesia and Reanimation, 2017)
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    Mojsova Mijovska, Maja
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    ABSTRACT Introduction: Patients with hip fracture are usually older and stress of trauma and surgery may increase cardiac morbidity and mortality. The aim of this study was to compare the influence of cardiac risk factors on surgical outcome in elderly patients with hip fracture. Methods: 120 patients with hip fracture older than 70 years with previously defined high or low per operative cardiac risk according to ACC/AHA guidelines were included and were assigned to two groups of 60 patients: Risk group –patients with high cardiac risk; and NR (non risk) group without or with low cardiac risk. Recipients from the both groups were pain relief with intravenous analgesia: Niflam 2 x 100 mg/iv and Tramadol 50 mg/iv every 8 hours; As an end point of the study were registered the incidence of cardiac events in both groups: cardiac death, myocardial infarction, congestive heart failure, unstable angina and new-onset atrial fibrillation. In all patients was determined pain intensity by using Verbal Descriptive Scale as well as the side effects. Results: Recipients with high cardiac risk has higher incidence of postoperative cardiac events versus patients with low cardiac risk (Risk group 46.6% vs. 15% in NR group) and the same result is with mortality rate (10% in Risk group vs. 0% in NR group). The values of VDS were equal in recipients from both groups. Conclusion: Patients with hip fracture are classified as a high risk patients according the presents of high risk cardiac predictors, and have significantly higher incidence of postoperative cardiac morbidity and mortality.
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    Acute severe poisoning with disinfectant in senior aged patient-case report and overview of literature considering age influence on treatment decision in alcohol-based intoxications
    (2021-09)
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    Afrodita Berat-Huseini
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    Kiril Naumoski
    We present our experiences in the first case of severe suicidal poisoning with 70% ethanol-disinfectant in North Macedonia, in an elderly patient with immunocompromising comorbidities. A 66-year-old unconscious woman was admitted at our clinic, with a history of seropositive rheumatoid arthritis treated with methotrexate. She was in a coma, without signs of serotonin syndrome, recurrent episodes of cardio-respiratory insufficiency under supportive treatment without invasive ventilation, metabolic acidosis, increased D-dimer 3254 ng/mL. The toxicology screening confirmed low benzodiazepines levels and alcoholaemia of 526 mg/dL (5.26 g/L), due to ingestion of 70% ethanol. Considering the decreased biotransformation in the elderly, immunocompromising comorbidities, reports of fatal outcome in poisoned elderly patients with disinfectants under standard fluids supportive protocol, haemodialysis was initiated, with registered associated hypercoagulability which resulted in complete stabilization after 48 h of admission. Treatment protocols of poisoning with ethanol-based disinfectant in the elderly should consider timely performing haemodialysis at lower alcoholaemia levels than recommended.
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    CIRS-G score as a rapid way to determine the overall multimorbidity burden and to select optimal and individualized therapy in newly diagnosed eldery CLL patients
    (Македонско лекарско друштво = Macedonian Medical Association, 2020)
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    Slobodanka Trpkovska Terzieva
    Introduction. Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the elderly population. Many of these patients have multiple comorbidities, which might influence the choice of an adequate upfront chemoimmunotherapy option. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score seems to be a reliable tool for assessment of the burden of comorbidity in elderly cancer patients. Objectives. The primary objective of our study was to assess the distribution of CIRS score status in CLL patients in real clinical practice. The secondary objective was to analyze which treatment option was used, and the effects it produced in each patients’ group, classified according to the CIRS score. Methods. In our prospective, single-center study, we focused on CLL patients that were referred to the University Clinic for Hematology in Skopje between 2017 and 2019. Comorbidity was assessed by the CIRS-G score in all patients included in our study (n=56) prior to the process of deciding on the most adequate treatment option. Results. The median age was 69 (±9.4) years. Comorbidities were identified in 80.4% of the study population, with an average CIRS score of 3.9. The three most common comorbidities were related to involvement of the vascular system (41.1%), endocrine-metabolic disorders (32.1%), and respiratory system disorders (17.9%). Only 16.1% of the patients had only 1 affected organ or system, other than hematological issues, while 64% of the patients had ≥2 affected systems. In 33.9% of the study patient cohort, the watch and wait initial approach was the standard of care. We considered 66.1% of patients to be requiring treatment, as follows: chemotherapy (chlorambucil, fludarabine+cyclophosphamide, bendamustine) only (30.4%), rituximab-based therapy (33.9%), and 1.8% of patients, due to the high comorbidity burden, were eligible only for supportive care. There was a stable trend of correlation between the CIRS score assessment and the treatment option prescribed (rs=0.7188, p<0.000001). Conclusions. The comorbidity status is a major consideration when treating elderly patients with CLL. Our study shows that comorbidity is quite a common feature in CLL patients and that it is increasing with age. CIRS is helpful in identifying the best treatment combination for the patients, that will enhance achieving long-term control of CLL, maintaining an optimal quality of life level.