Faculty of Medicine

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SQUAMOUS CELL CARCINOMA ARISING IN A KELOID SCAR: A CASE REPORT AND LITERATURE REVIEW
(Macedonian Association of Pathology and North Macedonia Division of IAP, 2025)
Boshkova E
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Angelovska T
Introduction: Keloids are characterized by abnormal fibroblast proliferation and excessive collagen deposition. While typically benign, they have been recognized as potential predisposing factors for cutaneous neoplasia. Case Presentation: We present a rare case of squamous cell carcinoma (SCC) arising within a keloid scar in a 38-year-old female with a history of exuberant keloid formation on the feet. Histopathological examination of the excised lesion revealed moderately differentiated SCC developing within keloid tissue, marked by invasive nests of atypical squamous cells and keratin pearl formation embedded in dense keloidal stroma. Conclusion: Although exceedingly rare, malignant transformation of keloid scars into SCC can occur, particularly in lesions exposed to chronic irritation, inflammation, ulceration, repeated trauma, or ultraviolet radiation. Clinicians should maintain a high index of suspicion when evaluating morphological changes in long-standing keloids. Early biopsy of suspicious lesions is crucial for timely diagnosis and appropriate management.
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ASSOCIATION BETWEEN LOW BIRTH WEIGHT AND MODE OF DELIVERY IN TERM PREGNANCY
(Association of Albanian Medical Doctors in Macedonia, 2025-10)
Arta Islami Zulfiu
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Nurdzan Asani Ajeti
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Besa Islami Pocesta
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Introduction: Low birth weight (LBW), defined as a birth weight of less than 2500 grams, regardless of gestational age. Globally, it is estimated that 15-20 % of all births, or 20 million newborns annually, are low birth weight infants. It remains a significant public health concern due to its association with increased neonatal morbidity and mortality. The mode of delivery is frequently influenced by fetal condition, maternal health, and the availability of institutional resources. Understanding the relationship between LBW and delivery method is essential because such cases are common, and decision making must balance clinical urgency with resource availability. 57 XXX Takim profesional mjekësor Aim: The aim of the study was to find out the association between low birth weight and mode of delivery in a term pregnancy. Material and methods: This was a cross-sectional study conducted at the Special Hospital for Obstetrics and Gynaecology “Mother Teresa”, Cair, Skopje, North Macedonia, from January 2024 to September 2024. Data were collected from the hospital register of pregnant women in our population who delivered full-term infants ( 37 0/7 - 41 0/7 weeks of gestation) with a birth weight of less than 2500 grams. The newborns were weighed immediately after birth. Results: During the study period from January 2024 to September 2024 total number of birth was 2677. 102 ( 3.8 %) newborns weighed less than 2500 g. Parity was less than two in 73 %. 50 % were primigravida. In 67% maternal age was from 18 to 24 years old. The majority (87%) of the mothers didn't have any comorbidity, 13% suffered from comorbidity. 61 babies were born by cesarean section (CS), and 41 were delivered by normal vaginal delivery. Of the total number of cesarean sections, 42 were primary cesarian section, 15 were with repeat cesarean section and 4 were with third cesarian section. Conclusion: Caesarean section should not be routinely recommended solely based on low birth weight. Delivery mode decisions must be individualized and guided by obstetric indications such as fetal distress, abnormal presentation, or maternal complications. This approach minimizes unnecessary surgical risks while ensuring optimal maternal and neonatal outcomes. Careful clinical assessment and resource considerations are essential in managing pregnancies complicated by low birth weight unless there are other obstetric indications.
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PRIMARY SINONASAL MENINGIOMA MIMICKING BENIGN NASAL LESIONS - A CASE REPORT AND LITERATURE REVIEW
(Macedonian Association of Pathology and North Macedonia Division of IAP, 2025)
H. Sulejmani
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Jovcheva, A
Introduction: Primary extracranial meningiomas are rare neoplasms, accounting for less than 2% of all meningiomas. The sinonasal tract represents an uncommon site of origin and frequently presents diagnostic challenges due to nonspecific clinical and radiological features. Case Presentation: A 79-year-old male presented with a unilateral nasal cavity mass. Computed tomography revealed diffuse polypoid mucosal thickening with near-complete opacification of paranasal sinuses and obliteration of aeration. Histopathology showed a circumscribed neoplastic proliferation arranged in lobular and whorled patterns beneath intact respiratory epithelium. Tumor cells displayed uniform morphology with oval nuclei, eosinophilic cytoplasm, and inconspicuous nucleoli. Psammoma bodies and delicate vascular channels were present. Necrosis, nuclear atypia, and mitotic activity were absent. Immunohistochemistry showed strong positivity for epithelial membrane antigen (EMA), vimentin, p63, and progesterone receptor, while cytokeratin AE1/AE3, CD34, smooth muscle actin (SMA), S100, SOX10, desmin, and synaptophysin were negative. The proliferative index (Ki-67) was <5%. Discussion: Extracranial meningiomas are rare neoplasms with poorly understood histogenesis, presumably arising from displaced meningothelial cells during embryonic development. Sinonasal meningiomas may mimic other nasal masses including nasal polyps, inverted papilloma, olfactory neuroblastoma, or carcinoma. In this case, the morphological features combined with the supportive immunohistochemical profile confirmed the diagnosis of WHO Grade I meningothelial meningioma with angiomatous features. Conclusion: Primary sinonasal meningioma should be included in the differential diagnosis of sinonasal masses. Accurate recognition through comprehensive histopathological and immunohistochemical analysis is essential for proper diagnosis and management.
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LAPAROSCOPIC VERSUS OPEN KASAI PORTOENTEROSTOMY FOR BILIARY ATRESIA: A SYSTEMATIC REVIEW AND META-ANALYSIS BY THE PEDIATRIC SURGERY META-ANALYSIS STUDY GROUP (PESMA)
(European Society of Paediatric Endoscopic Surgeons, 2025-10)
Duygu Gurel
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Mustafa Azizoglu
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Carlos Delgado Miguel
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Federica Pederiva
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Mehmet Hanifi Okur
Introduction: Biliary atresia (BA) is a rare but life-threatening neonatal liver disease requiring timely surgical intervention. The Kasai portoenterostomy (KPE) is the standard treatment, traditionally performed via laparotomy. Recently, laparoscopic approach has been introduced, but its efficacy remains debated. This systematic review and meta-analysis compared laparoscopic and open KPE in patients with BA. Methods: A comprehensive literature search of PubMed, Scopus, EMBASE, and Web of Science was conducted through April 2025. Primary outcomes were jaundice clearance, cholangitis, overall complications, 2-year native liver survival rate, and postoperative intestinal obstruction. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using Mantel–Haenszel methods under fixed- or random-effects models, based on heterogeneity (I²). We used RevMan 5.4 software meta-analysis statistic program. Results: A total of 26 studies were included. Jaundice clearance (17 studies; OR=1.10; 95%CI: 0.76–1.59; p=0.61; I²=42%) and cholangitis (15 studies; OR=1.17; 95%CI: 0.87– 1.59; p=0.30; I²=0%) rates showed no significant differences between laparoscopic and open groups. No significant differences were observed in overall complication rates (8 studies; OR=0.71; 95%CI: 0.24–2.09; p=0.54; I²=57%). Postoperative intestinal obstruction (7 studies) and 2-year native liver survival (8 studies) also showed comparable outcomes (OR=0.91; 95% CI: 0.36–2.27; p=0.83; I²=0% and OR=0.74; 95% CI: 0.49–1.10; p=0.13; I²=30% respectively). Conclusion: Laparoscopic KPE appears to be a safe and feasible alternative to the open approach, with comparable outcomes across major clinical parameters. While current evidence supports its feasibility, further high-quality prospective studies are needed to validate these findings and inform surgical practice.
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The suprising stories of the acute abdomen:Tosion of the appendix vermiformis
(2025-04)
Srbakovska, Bisera
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Ognenoska, Biljana
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Acute appendicitis is the most common cause of acute abdominal pain needing surgical treatment. However, it can be clinically and radiologically mimicked by other conditions, some of them with an extremely rare occurrence. A two year old boy presented to our hospital with a history of abdominal pain and vomiting in the last 48 hours. On physical examination, the patient was found to be dehydrated, with a dry mouth and a white-coated tongue. Tenderness was noted throughout the entire abdomen, with rigidity and guarding, especially in the right lower quadrant. Laboratory results showed an elevated Creactive protein level of 50.2 mg/L and a white blood cell count of 25,800/μL. Under the suspicion of acute complicated appendicitis, emergency McBurney laparotomy was performed. Operative findings revealed an enlarged, dark purple, congested appendix, twisted 720° around its base at the cecum in the anticlockwise direction. There was no evidence of perforation. A typical appendectomy was performed. The postoperative course was uneventful and the patient was discharged home on the fourth post-operative day. Microscopic examination confirmed the hemorrhagic infarction and ischemic necrosis of the appendix, followed by an inflammatory reaction caused by the torsion. To our knowledge only 22 cases of torsion of the vermiform appendix in children have been reported in literature, with our case being the 23rd. Though extremely rare, it should be considered as a potential diagnosis in patients presenting with right lower abdominal pain. Histopathology is crucial in differentiating primary from secondary causes of appendicular torsion.
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The role of the clinical pharmacy specialist in monitoring adherence to inhaled therapies in patients with cystic fibrosis in the Republic of North Macedonia
(Elsevier BV, 2021)
Atanasova Nadzinska, M
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A major problem in the treatment of cystic fibrosis is nonadherence to inhaled therapies, which can influence lung function and health outcomes in patients with cystic fibrosis (CF). Our aim is to determine the adherence to inhaled therapy after providing medications closer to home and the active role of the pharmacist in the process and education of patients.
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P112 Sleep disorders and exercise capacity in adult patients with cystic fibrosis in the Republic of North Macedonia
(Elsevier BV, 2021)
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Vidoevska, A
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Nocturnal hypoxemia and sleep disturbances in patients with cystic fibrosis (CF) are problems that affect their daytime life. Overnight polysomnography (PSG) may help identify respiratory deterioration.
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P158 Fungal airway colonisation in cystic fibrosis patients in the Institute for Respiratory Diseases in Children - Skopje, Republic of North Macedonia
(Elsevier BV, 2021)
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Vidoevska, A.
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Popova, Gorica
Respiratory tract of cystic fibrosis (CF) patients has polymicrobial colonisation. Clinical impact of the fungal colonisation in CF patients is still much less understood. Here, we provide epidemiological data of fungal airway colonisation in CF patients in CF department in the Institute for Respiratory Diseases in Children in Skopje, Republic of North Macedonia.
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P167 Prevalence of liver disease in cystic fibrosis patients in the Institute for Respiratory Diseases in Children - Skopje, Republic of North Macedonia
(Elsevier BV, 2021)
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Vidoevska, A
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Gjinovska Tasevska, Elena
Our aim is to provide epidemiological data of liver disease in cystic fibrosis (CF) patients in the CF Department in the Institute for Respiratory Diseases in Children in Skopje, Republic of North Macedonia.
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P168 Use of faecal elastase in patients with cystic fibrosis and mutation analysis in the Republic of North Macedonia
(Elsevier BV, 2021)
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Mirchevska, V
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In the Republic of North Macedonia, patients with cystic fibrosis (CF) use pancreatic enzymes and its use is based on clinical criteria and through indirect methods of measuring pancreatic insufficiency.

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