Faculty of Medicine

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    The Consequences of COVID 19 in Patients with Laryngeal Cancer
    (SHMSHM - AAMD, 2024-05-10)
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    Kamshikoski, Igor
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    Background: The global pandemic, triage and telemedicine have contributed to late diagnosis of patients with advanced carcinoma of the larynx. Warming and humidification of air in this type of patient are completely cut off and lost, which devotes to the occurrence of chronic lung disease. Aim: Representing patients with laryngeal carcinoma who became infected with Covid 19, recognizing the severity of Covid 19 manifestation and its outcome. Material and methods: University ENT Clinic in Skopje was Covid Center for treatment and care of patients with Covid 19. A total of 405 patients with moderate and severe clinical picture were hospitalized in the period from 2019 to 2021. There were 8 patients with laryngeal cancer. Results: In all 8 patients auscultatory, oxygen saturation, CT scan presents massive interstitial pneumonia, typical of Covid 19. Four patients who survived had high oxygen saturation, low CRP and laryngectomy performed more than 10 years ago. The other four patient who failed the disease had low saturation, high CRP, and total laryngectomy which was performed not more than 4 years ago. Conclusion: According to our experience, the reasons for the presented number of lethal outcome cannot be fully determined that is in line of the professional literature, which was confirmed in this case. It is estimated that a lack of tracheostomal warmers and humidifiers leads to increased mortality in cancer patients, especially in Covid 19 pandemic. Application of protection and rehabilitation protocols in these patients is necessary to improve the quality of life and reducing the risk factor for Covid disease 19.
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    ANALYSIS OF THE OCCURRENCE OF POSTOPERATIVE PULMONARY COMPLICATIONS AFTER LUNG SURGERY
    (MIT University Skopje, 2023)
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    Cholancevski, Risto
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    Andov, Mishel
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    Gacovski, Aleksandar
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    Nedxati, J
    Introduction: Postoperative Pulmonary Complications (PPCs) reported after lung surgeries are correlated with increased morbidity and mortality. Literature does not emphasize factors that lead to PPCs. Aim of this study was to evaluate clinical data in patients who developed PPCs after lung surgery. Material and method: This study included data analyses from patients with malignancy aged <79, ASA I-III scheduled for lung surgery was during 3-year period. Obtained patient data was divided in two groups, Group PPCs (n=30)- patient with PPC and control group (n=30) that included patients without PPC. Demographic, clinical preoperative and preoperative data was analyzed, compared between both groups. Results: Patients in Group PPC were significantly older than the control group. Patients in the analyzed group had more comorbidities, lower levels of FEV1%, FVC% even though not statistically significant. The time of one lung ventilation was 132+ 54.3 vs 109.9+42 in respect to the groups and was statistically significantly different between the groups. The most common PPCs found was pneumonia. Conclusion: According to our study patients who are at risk to develop PPCs are patients who are older and who had longer time of one lung ventilation during surgery The most common PPC after lung surgery is pneumonia.
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    Evaluation of severity scoring models in mortality prediction of severe community acquired pneumonia.
    (2023-09)
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    Rangelov Goran
    Background: community-acquired pneumonia (CAP) is one of the most common infection worldwide and major cause of death particularly in elderly and patients with comorbidities. Severe CAP (sCAP) refers to acute lung infection that require intensive care treatment due to disease severity. Recently, two major criteria are widely accepted to define sCAP: need of mechanical ventilation or need of vasopressors for shock. Several prediction models are designed for assessment of disease severity and for early prediction of pneumonia outcome. Aim of this study was to evaluate the mortality prediction capacities of the most commonly used severity scoring models in patients with sCAP. Material and methods: the study included 129 adult patients with sCAP hospitalized at ICU within Clinic for Infectious Diseases in Skopje during a 3-year period. Primary outcome was 30-day in-hospital mortality. Demographic, clinical and biochemical parameters were recorded and seven severity scores were calculated: Charlson comorbidity Index, CURB 65, SCAP at admission, SAPS II and APACHE II after 24 hours, MPM and SOFA during the first 48 hours. Receiver Operating Curve (ROC) analysis was performed and areas under the curve (AUC) were calculated to evaluate the prediction capacities of analysed scores. Results: the mean age of studied patients was 61 year and 66,7% were males. An overall mortality was 43.4%. Charlson Comorbidity Index has higher value in non-survivors and it was associated with poor outcome. All scores showed significantly increased values among non-survivors, except CURB-65 that had similar results in both groups, and no significance with the outcome. AUC for all scores had close values, ranging from 0.714 for APACHE II to 0.755 for SCAP. The highest AUC showed MPM and SOFA when calculated at 48 hour upon admission, with values of 0.800 and 0.839 respectively. Conclusion: the results of our study showed that the most commonly used severity scoring models had great ability to identify the patients with pneumonia that had increased risk for poor outcome, however, none of them presented stronger capacity over the others to predict the disease mortality.