Faculty of Medicine

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    CELLULAR AND HUMORAL IMMUNITY IN PATIENTS WITH COVID-19 CORRELATED WITH SEVERITY OF CLINICAL PRESENTATION AND SARS COV-2 VACCINATION STATUS
    (Македонско лекарско друштво = Macedonian medical association, 2024)
    Aleksandra Tatabitovska
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    Dejan Todevski
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    Introduction. The COVID-19 pandemic has changed life across the planet, claiming approximately 7 mi- llion lives and more than 776 million cases reported globally, leaving many people with lasting sequelae. Of particular importance is understanding the immune system's defense responses against SARS-CoV-2 infection, with an emphasis on T-lymphocyte cells that modulate both cellular and humoral part. Aims. To determine epidemiological and clinical featu- res, especially comorbidities in patients who have had severe and mild COVID-19, to determine differences in cellular and humoral immune response and to co- rrelate with vaccination status for SARS CoV-2. Methods. A 6-month-prospective cohort study was conducted at the University Clinic for Pulmonology and Allergology and the Institute of Immunobiology and Human Genetics at the Faculty of Medicine - Skopje. The study included 88 patients with pre-exis- ting COVID-19 divided into two groups: patients with mild clinical manifestations and patients with severe clinical manifestations requiring hospitalization. The parameters of patients' medical history, number and type of comorbidities, parameters of cellular and hu- moral immune response, data on vaccination against SARS-CoV-2 were analyzed. Conclusion. The severity of the clinical presentation correlated directly with the number of comorbidities, and inversely with the vaccination status. Comorbidi- ties were present in 87.7% of patients with a severe clinical course. No correlation was found with the smoking status. The study showed that 97.72% of all patients had positive neutralizing antibodies for SARS- CoV-2. Positive cellular immunity had 54.55% of pa- tients, significantly higher in the group with severe COVID-19 and vaccinated patients. There was a posi- tive correlation between cellular and humoral immu- nity, but in 2 cases (4.16%) where the humoral respon- se was absent, a positive cellular response was verified.
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    UNUSUAL PRESENTATION OF THROMBOEMBOLIC DISEASE IN A HOSPITALIZED PATIENT WITH A COVID-19 INFECTION: A CASE REPORT
    (Macedonian Association of Anatomists and Morphologists, 2021-12)
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    Nedeska Minova, Natasha
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    Terzievska, Keti
    With no ideal specific therapy confirmed by the science community, and many low income countries barely being able to obtain a sufficient number of vaccines, as well as the long-term mental health impact, the COVID-19 infection makes for a worldwide health and global problem. A COVID-19 positive patient was admitted due to poor condition, malaise and bilateral interstitial pneumonia with borderline oxygen saturation of 94%, hypoxemia with pO2 of 64mmHg, and elevated C reactive protein (CRP) of 70. The patient was put on oxygen support of 3l/min, and started parenteral antibiotic and LMWH in prophylactic doses - a combination that primarily improved the patient’s condition. Three days after hospitalization marked shortness of breath with a drop in oxygen saturation of 62% referred. With further increasing of the oxygen flow, and a transfer to ICU, gas pressures showed significant worsening and the patient was put on mechanical support with a CPAP mask. Despite adding pulsed doses of potent corticosteroid, rapid acting insulin for blood glucose control, and administerring convalescent plasma and parenteral nutrition, the CRP levels were increasing and oxygen was decreasing. Hypotensive, tachycardic and with reduced urine output, the patient was intubated and set up on IPPV mechanical support. Vasopressor stimulation didn’t improve the diuresis and elevation of degradation products followed, as well as elevation of the troponin and cardiospecific enzymes - non of which was caused by sepsis. Eight days after admission, the left arm presented as pale, cool and cyanotic. Fully deteriorated laboratory findings of multiple organ system failures (MOFS) were undoubtable; with the oxygen levels incompatible of life, and a CT scan with ARDS presentation, a continuous heparin infusion was the only solution. At the beginning, nothing indicated the deleterious outcome; however, with a highly unusual presentation of arterial thrombosis, the upper limb gangrene became too much and the patient died. COVID-19 is primary a respiratory infection, but the virus can affect other organs and systems, with some very rare presentations and deleterious outcomes.