Faculty of Medicine
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Item type:Publication, BLEEDING RECTAL VARICES IN A PATIENT WITH ETHYLIC LIVER CIRRHOSIS - A CASE REPORT(SHMSHM - AAMD, 2022); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Diet-Related Improvement Of Non-Alcoholic Steatohepatitis(2020); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Diagnostic and predictive potential of the c-reactive protein in serum and ascites for spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites.(Macedonian Association of Anatomists and Morphologists, 2021); ; ; ; Spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis is a spontaneous bacterial infection of sterile ascites fluid in the absence of intra-abdominal sources of infection or malignancy. The purpose of the study is to determine the diagnostic and predictive potential of CRP in serum and ascites, as an inflammatory indicator of SBP in patients with liver cirrhosis and ascites and to compare the mean values of CRP in serum and ascites in patients with and without SBP. In this prospective-observational study were included 70 patients with cirrhosis and ascites, divided into two groups, SBP and non-SBP group. Quantitative measurement of CRP in serum and ascites was determined by immunoturbidimetric method using latex particles. The average value of CRP in serum in SBP group was 35.4 ± 29.51 mg / L, and in control non-SBP group it was lower (18.6 ± 18.71 mg/L), and this difference was statistically significant for p = 0.006132. The average value of CRP in ascites in SBP group was 7.3 ± 7.2, and in non-SBP group it was lower (2.9 ± 3.1l), with statistically significant difference of p = 0.001604. ROC analysis indicates that CRP contributes to the diagnosis of SBP with 71.0% (p = 0.003) (good predictor). Univariate analysis showed that serum CRP> 6 mg / L and CRP in ascites> 6 mg / L significantly increased the chance of SBP by seven times ((Exp (B) = 7,319) and three times ((Exp (B) = 3,059), respectively. Our research confirmed that serum CRP is a good predictor, significantly associated with the occurrence of SBP in patients with liver cirrhosis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Correlation of plasma d-dimers with stages of liver cirrhosis and its complications.(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2023); ; ; To investigate plasma D-dimer levels in correlation with Child-Pugh-Turcotte (CTP) and Model for End-Stage Liver Disease (MELD) scores in patients with liver cirrhosis (LC) of different severity, as well as the correlation with LC-associated clinical, biochemical parameters and complications. Material and methods: Fifty patients with LC were divided in three groups according to LC severity using the CTP Score (CTP-A, CTP-B, CTP-C). The levels of D-dimer were measured in sodium-citrate plasma on Siemens, BCS XP Blood Coagulometer. Kruskal-Wallis test was used to compare D-dimer levels between the groups. Mann-Whitney U test was used to evaluate the difference of D-dimer levels in groups with different MELD score, and to evaluate the difference in D-dimer levels in patients with presence or absence of ascites and the difference of D-dimer levels in patients with or without spontaneous bacterial peritonitis (SBP). Pearson’s coefficient of correlation was used to evaluate the correlation between D-dimer levels with MELD score and the correlation between D-dimer levels and the concentration of LC-associated biochemical, clinical parameters and complications. Results: D-dimer levels increased with severity of the disease as assessed with CTP and MELD scores, with a statistically significant difference between the groups (p=.0000 and p=.0001, respectively). Group CTP-C demonstrated the highest D-dimer levels, followed by groups B and A. Patients with SBP had significantly higher levels of D-dimers than patients without SBP (p=.0006). A significant positive correlation between D-dimers and CTP and MELD score was detected (r= 0.74 and r=0.44, respectively; p<.001). A correlation between D-dimer levels and several biochemical parameters characterizing progressive liver dysfunction was observed. From all investigated biochemical parameters, the highest significant correlation was detected between D-dimer levels and the concentration of serum albumin (r= -0.65, p<.001). Conclusions: Plasma D-dimer levels are tightly correlated with the degree of liver dysfunction and LC-associated complications. Therefore, D-dimer levels could be utilized as a prognostic stratification marker and adjunctive diagnostic marker in LC-associated complications. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Survival in Patients with Liver Cirrhosis: A Prospective Study(Walter de Gruyter GmbH, 2023-12); ; The differences in the survival time of cirrhotic patients reported by different studies are probably caused by the influence of many contributing factors. The aim of the study was to evaluate the survival over a one-year period, to register the occurrence of acute decompensation (AD) and to determine the most frequent causes of death. Material and methods: Out of 71 patients enrolled in the study, 63 completed the prospective one-year follow-up. During the follow-up, we evaluated the occurrence of AD, the causes of death, and we registered three-month, six-month and one-year survival regarding the AD status at presentation. Results: Of the 63 patients, 24 (38.09%) died before the end of the study (14 patients before the end of three months, 6 before the end of six months and 4 patients before the end of one year). The overall survival was 38.09% and the mean survival time was 108 ± 98.53 days. The most prevalent cause of death was bleeding from esophageal varices (5 patients, 20.83%). AD patients had a significantly shorter survival than patients without AD (97±90.54 vs. 229±138.59) and 78.57% of them died during the follow-up. The estimated six-month and one-year median survival time were 272.8 [95% CI (238.4-307.2)] and 267.1 [95% CI (232.9-301.2)] days, respectively. The six-month and one-year survival were significantly shorter in AD patients (p<0.0001). Conclusion: The etiology, stage of liver disease and the presence of AD are important factors that influence on the survival in cirrhotic patients. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, IMPAIRED BALANCE OF CLOTTING FACTORS IN LIVER CIRRHOSIS(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023); ; ; Liver cirrhosis (LC) has been accepted as prototype of a disease with acquired prohemorrhagic diathesis. However, as the synthesis of all coagulant factors is affected, a rebalanced but fragile hemostasis is maintained. With increasing disease severity, a disproportion between levels of certain coagulants occurs that can lead to prothrombotic tendency. We aimed to evaluate the levels of factor VIII (FVIII), protein C (PC) and their ratio (FVIII/PC) as the main determinants of thrombin generation in patients with LC at different stages of disease. Fifty patients with LC were divided in three groups according to LC severity using the Child-Turcotte-Pugh Score (CTP-A, CTP-B, CTP-C). The levels of FVIII and protein C were measured in sodium citrate plasma on Siemens, BCS XP Blood Coagulometer. The levels of FVIII, PC and FVIII/PC were compared between the groups and a correlation of their values to MELD score was performed. Plasma levels of FVIII increased with severity of the disease, with concurrent statistically significant decrease of plasma PC levels (p=0.0008). This was accompanied with statistically significant increase of the FVIII/PC ratio (p=0.0004) indicating hypercoagulable state in advanced stage of the disease. A significant correlation to MELD score was identified for PC in group CTP-B and CTP-C and for FVIII/PC ratio in group CTP-C. As liver cirrhosis severity increases, a disproportion in plasma levels of the most powerful determinants of thrombin generation occurs. This could be the explanation for the observed increased risk of venous thromboembolism in patients with liver cirrhosis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PARACENTESIS-INDUCED ABDOMINAL WALL HEMATOMA: CASE REPORT AND REVIEW OF LITERATURE(Македонско лекарско друштво = Macedonian medical association, 2019); ; ; ; Despite the well-known coagulopathy-associated compli-cations, paracentesis is considered a relatively safe procedure when performed inpatients with liver cirrho-sis. We present a case of a large abdominal wall hema-toma after paracentesisin a 72-years-old male with de-compensated cirrhosis, portal hypertension, refractory ascites and moderately prolonged prothrombin time. Several hours after therapeutic paracentesis wasperfor-med at the usual point, in the left lower abdominal quad-rant, the patient was admitted with severe abdominal pain, circulatory instability and significant blood loss. Ultrasound of the abdominal wall revealed a 10 cm intra-mural hematoma at the puncture site.In addition to the usual resuscitative measures, the patient required fresh frozen plasma and five units of cryoprecipitate for defi-nitive stabilization. Paracentesis-associated abdominal wall hematoma is a potentially serious, life-threatening complication requiring invasive therapeutic interven-tion in most cases. In some caseshowever the conser-vative treatment with cryoprecipitate and fresh frozen plasma can also be quite effective. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, THE SIRS SCORE RELEVANCE FOR ASSESSMENT OF SYSTEMIC INFLAMMATION COMPARED TO C-REACTIVE PROTEIN IN PATIENTS WITH LIVER CIRRHOSIS(Македонско лекарско друштво = Macedonian Medical Association, 2019); ; ;