Faculty of Medicine

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A New Hope on the Horizon for Kidney and Cardiovascular Protection with SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Mineralocorticoid Receptor Antagonists in Type 2 Diabetic and Chronic Kidney Disease Patients
(Mary Ann Liebert Inc, 2024-04)
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Rroji, Merita
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Hristov, Goce
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Bushljetikj, Oliver
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Spahia, Nereida
Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD). In addition, the cardiovascular prevalence in diabetic patients is around 32.2%, with a two-fold increased mortality risk compared to those without diabetes. Recent investigations have shed light on the promising cardioprotective and nephroprotective benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) for individuals with T2D. The evidence robustly indicates that SGLT2i and GLP-1RA significantly reduce the risk of CKD and cardiovascular disease (CVD), all while effectively managing blood glucose levels. Furthermore, combining SGLT2i with nsMRAs amplifies the benefits, potentially offering a more profound reduction in cardiovascular and renal outcomes. The data analysis strongly supports the integration of these pharmacological agents in the management strategies for CKD and CVD prevention among T2D patients, highlighting the importance of awareness among nephrologists, especially in regions with limited healthcare resources.
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HEART BLOCK AS A COMPLICATION OF ACUTE MYOCARDIAL INFARCTION, CLINICAL ASSESSMENT AND APPROACH. A CASE REPORT
(Faculty of Medical Sciences, University of Tetova, 2023-09-24)
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Murtezani, Besir
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Zhaku, Vegim
Optimal treatment for acute ST-elevation myocardial infarction (STEMI) within 12 hours after symptom onset includes primary percutaneous coronary intervention (PCI) or thrombolytic therapy. For STEMI patients who present later than 12 hours, current guidelines do not recommend PCI except the presence of hemodynamic or electrical instability or continuing ischemic symptoms. Thus, our intention is to show that early reperfusion may also play a role in the early recovery of AV block that may occur as a complication of myocardial infarction (MI), more commonly inferior MI. Patient 49 years old patient (male) presented in our department with weakness, dizziness, short-term instability and nausea. The symptoms started one day before admission. The ECG on admission showed a total AV block with a heart rate approximately 33 b/min and ST segment elevation in the inferior leads. Laboratory tests were normal except for an extreme elevated high sensitive troponin. The echo showed normal finding with the exception of the slightly reduced kinetics of the apex, base and mid segment of the lower-posterior wall of the IVS. Coronary angiography was immediately performed, showing 100% stenosis of the rPDA. A stent is placed on the corresponding coronary artery. The total block was present all the time, and following the recommendations, a temporary pacemaker was placed in the patient due to hemodynamic instability and bradycardia. Despite reperfusion, the block persisted 7 days after the intervention, during which a permanent pacemaker was implanted and the patient was discharged for home treatment. This case highlights the importance and ways of early reperfusion to improve outcomes in patients with STEMI. Early reperfusion may also play a role in the early recovery of AV block that may occur as a complication of MI, more commonly inferior MI.
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SP136DEGREE OF CHRONIC KIDNEY DISEASE (CKD) IN TYPE 2 DIABETIC PATIENTS INCREASE THE PREVALENCE OF FOOT ULCERATION
(Oxford University Press (OUP), 2018-05-01)
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Busletikj Rambabova, Irena
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Anatomy and clinical significance of the posterior inferior cerebellar artery
(Macedonian Association of Anatomists and Morphologists, 2016)
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With the introduction of new techniques in diagnostic and interventional radiology and progress in micro neurosurgery, accurate knowledge of the brain blood vessels is essential in daily clinical work. The aim of this study was to describe the anatomical characteristics of the posterior inferior cerebellar arteries and to emphasize their clinical significance. In this study we examined radiographs of 103 patients who had CT angiography at the University Clinic for Radiology in Skopje, R. Macedonia. This study included 45 females and 58 males, age range from 25 to 82 years; mean age 58.4±13.2 years. The outer diameter of the posterior inferior cerebellar artery at its origin on the left side was in the range between 0.46 - 2.80 mm, mean 1.24 ± 0.42 mm. The outer diameter of the posterior inferior cerebellar artery on the right side was in the range between 0.54 - 2.50 mm, mean 1.18 ± 0.40 mm. Thorough knowledge of the anatomy and variations of the posterior inferior cerebellar artery is important for clinicians as well as for basic scientists who deal with problems related to intracranial vasculature on daily basis for safe performance of diagnostic and interventional procedures.
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Availability of technology for managing cancer patients in the Southeast European (SEE) region
(Elsevier BV, 2022-03)
Dosanjh, Manjit
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Georgieva, Petya
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Balin Kovacevic, Marijana
Background: The Southeast European (SEE) region of 10 countries and about 43 million people differs from Western Europe in that most SEE countries lack active cancer registries and have fewer diagnostic imaging devices and radiotherapy (RT) units. The main objective of this research is to initiate a common platform for gathering SEE regional cancer data from the ground up to help these countries develop common cancer management strategies. Methods: To obtain detailed on-the-ground information, we developed separate questionnaires for two SEE groups: a) ONCO - oncologists regarding cancer treatment modalities and the availability of diagnostic imaging and radiotherapy equipment; and b) REG - national radiation protection and safety regulatory bodies regarding diagnostic imaging and radiotherapy equipment in SEE facilities. Results: Based on responses from 13/17 ONCO participants (at least one from each country) and from 9/10 REG participants (all countries but Albania), cancer incidence rates are higher in those SEE countries that have greater access to diagnostic imaging equipment while cancer mortality-to-incidence (MIR) ratios are higher in countries that lack radiotherapy equipment. Conclusion: By combining unique SEE region information with data available from major global databases, we demonstrated that the availability of diagnostic imaging and radiotherapy equipment in the SEE countries is related to their economic development. While immediate diagnostic imaging and radiation therapy capacity building is necessary, it is also essential to develop both national and SEE-regional cancer registries in order to understand the heterogeneity of each country’s needs and to establish regional collaborative strategies for combating cancer.
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Leukotriene receptor antagonist (LTRA) added to regular preventive therapy: inhaled corticosteroids and longacting beta agonists (ICS/LABA) in patients with severe uncontrolled asthma
(Macedonian Pharmaceutical Association, 2020-10-29)
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Goseva, Zlatica
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Organization of intensive cardiac care units in Europe: Results of a multinational survey
(Oxford University Press (OUP), 2020-01-24)
Claeys, M J
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Roubille, F
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Casella, G
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Zukermann, R
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Nikolaou, N
Background: The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe. Methods: A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14). Results: A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries. Conclusion: More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on 'coronary microvascular dysfunction in cardiovascular disease'
(Oxford University Press (OUP), 2020-03-01)
Padro, Teresa
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Manfrini, Olivia
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Bugiardini, Raffaele
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Canty, John
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Cenko, Edina
Although myocardial ischaemia usually manifests as a consequence of atherosclerosis-dependent obstructive epicardial coronary artery disease, a significant percentage of patients suffer ischaemic events in the absence of epicardial coronary artery obstruction. Experimental and clinical evidence highlight the abnormalities of the coronary microcirculation as a main cause of myocardial ischaemia in patients with 'normal or near normal' coronary arteries on angiography. Coronary microvascular disturbances have been associated with early stages of atherosclerosis even prior to any angiographic evidence of epicardial coronary stenosis, as well as to other cardiac pathologies such as myocardial hypertrophy and heart failure. The main objectives of the manuscript are (i) to provide updated evidence in our current understanding of the pathophysiological consequences of microvascular dysfunction in the heart; (ii) to report on the current knowledge on the relevance of cardiovascular risk factors and comorbid conditions for microcirculatory dysfunction; and (iii) to evidence the relevance of the clinical consequences of microvascular dysfunction. Highlighting the clinical importance of coronary microvascular dysfunction will open the field for research and the development of novel strategies for intervention will encourage early detection of subclinical disease and will help in the stratification of cardiovascular risk in agreement with the new concept of precision medicine.
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International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19
(Elsevier BV, 2021-05-25)
Kite, Thomas A
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Ludman, Peter F
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Gale, Chris P
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Wu, Jianhua
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Caixeta, Adriano
Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear.
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Самоевалуација на здравјето кај лица со хемофилија како индикатор за квалитет на живот
(SHMSHM / AAMD, 2016)
Дејанова-Илијевска, В
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Исмаили, А

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