Faculty of Medicine

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Corrosive poisonings during the COVID-19 pandemic: trends and demographic shifts in the pre- and early vaccination periods (2020–2021)
(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2025-09-15)
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Bekjarovski, Niko
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Chibishev, Andon
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The COVID-19 pandemic significantly disrupted global healthcare and societal norms, leading to changes in poisoning patterns, particularly corrosive poisonings (CP). This study aimed to evaluate the impact of the pandemic on CP trends in North Macedonia by comparing observed data from 2020 and 2021 with predicted values (PV) based on a 10-year trend. Methods: A retrospective study was conducted using data from the Poisoning Registry at the PIC, University Clinic of Toxicology, Skopje. Patients with confirmed acute upper gastrointestinal corrosive injuries were included. Results: Between 2010 and 2021, 1,668 CP cases were recorded. While an overall downward trend was observed (y = -6.5x + 181.4, R² = 0.56), CP cases declined by 1.5% in 2020 and by 25.5% in 2021 compared to PV. Female cases decreased by 27.5% in 2021; male cases declined by 16.6% in 2020 and 32.4% in 2021. Adolescent CP increased by 12.8% in 2020 and 80.0% in 2021; cases in those over 75 years rose by 2.5% and 6.2%, respectively. The mean age of CP patients rose by 7.6% in 2020 and 11.0% in 2021. Suicidal poisonings increased by 9.9% in 2021. Disinfectant poisonings rose by 74.5% in 2020, while hydrochloric acid (+6.2%), detergents (+3.4%), and degreasers (+32.0%) increased in 2021. Case fatality ratios rose by 36.2% in 2020 and 44% in 2021. Conclusion: Although the overall number of cases declined, the increased severity, lethality, and demographic shifts—particularly among adolescents and the elderly—highlight the high-risk groups, mental health burden and toxicological risks associated with public health emergencies
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A Rare Case of Superior Ophthalmic Vein Thrombosis and Thrombocytopenia Following ChAdOx1 nCoV-19 Vaccine Against SARS-CoV-2
(PAGEPress®, 2021-06)
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Lazarevska, Menka
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Short‐ and long‐term outcome and predictors in an international cohort of patients with neuro‐COVID‐19
(Wiley, 2022-03-07)
Beghi, Ettore
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Helbok, Raimund
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Ozturk, Serefnur
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Karadas, Omer
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Lisnic, Vitalie
Background and purpose: Despite the increasing number of reports on the spectrum of neurological manifestations of COVID-19 (neuro-COVID), few studies have assessed short- and long-term outcome of the disease. Methods: This is a cohort study enrolling adult patients with neuro-COVID seen in neurological consultation. Data were collected prospectively or retrospectively in the European Academy of Neurology NEuro-covid ReGistrY ((ENERGY). The outcome at discharge was measured using the modified Rankin Scale and defined as 'stable/improved' if the modified Rankin Scale score was equal to or lower than the pre-morbid score, 'worse' if the score was higher than the pre-morbid score. Status at 6 months was also recorded. Demographic and clinical variables were assessed as predictors of outcome at discharge and 6 months. Results: From July 2020 to March 2021, 971 patients from 19 countries were included. 810 (83.4%) were hospitalized. 432 (53.3%) were discharged with worse functional status. Older age, stupor/coma, stroke and intensive care unit (ICU) admission were predictors of worse outcome at discharge. 132 (16.3%) died in hospital. Older age, cancer, cardiovascular complications, refractory shock, stupor/coma and ICU admission were associated with death. 262 were followed for 6 months. Acute stroke or ataxia, ICU admission and degree of functional impairment at discharge were predictors of worse outcome. 65/221 hospitalized patients (29.4%) and 10/32 non-hospitalized patients (24.4%) experienced persisting neurological symptoms/signs. 10/262 patients (3.8%) developed new neurological complaints during the 6 months of follow-up. Conclusions: Neuro-COVID is a severe disease associated with worse functional status at discharge, particularly in older subjects and those with comorbidities and acute complications of infection.
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Predictive Admission Risk Factors, Clinical Features and Kidney Outcomes in Covid-19 Hospitalised Patients with Acute Kidney Injury
(Macedonian Academy of Sciences and Arts/De Gruyter, 2023-12-01)
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Milenkova, Mimoza
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Vasileva, Adrijana Spasovska
Introduction: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients. Methods: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days. Results: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 - 0.958, p = 0.000; OR 0.987; 95%CI: 0.885-0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009). Conclusion: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself.
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A CASE OF COVID-19 PNEUMONIA IN HEMODIALYSIS PATIENT
(Macedonian Association of Anatomists and Morphologists, 2021)
Stojanoska, Tatjana
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Murtezai, Osman
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Taleska Matovska, Natasha
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Dimoska Chifligaroska, Elizabeta
SARS-CoV-2 (COVID-19) is an infectious disease caused by a novel corona virus that has spread rapidly, resulting in a worldwide pandemic. Even though end-stage renal disease (ESRD) patients are particularly susceptible to COVID-19 infection and can develop severe to critical clinical presentation, there are still limited studies and case reports about COVID-19 in ESRD patients.End-stage renal disease (ESRD) is a severe medical condition with a high prevalence of co-morbid conditions including diabetes, hypertension, and cardiovascular disease.We report case of a 72-years-old woman with ESRD on regular hemodialysis-outpatient, with history of diabetes mellitus type-2 and hypertension, which was positive to COVID-19 and developed pneumonia. She was one of our first registered cases of COVID-19 in our hospital and was successfully cured. Our patient reported symptoms typical of COVID-19, initially, (fever, sweating, weakness, stuffy nose, dry cough and shortness of breath, although she denied contact with infected individuals), but on the day of admission her clinical picture was atypical. She developed a severe clinical picture with the typical presentation of COVID-19 pneumonia on chest X-ray, but without leukopenia as a typical presentation of this disease in her laboratory findings. We describe the clinical presentation of this patient, the diagnostic process, the laboratory and imaging investigations, as well as the course and outcome of treatment.
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ARTERIAL THROMBOSIS IN A COVID-19 PATIENT
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2022)
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Shopova, Zhaklina
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Vidinic, Ivan
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Arterial thrombosis is one of the complications descry bed in severe COVID-19. Our presented case had throm bosis of abdominal aorta and left renal artery despite prophylactic treatment with low molecular heparin - enoxaparine. Thrombotic lesions were defined with CT angiography. Treatment consisted of therapeutic doses of low molecular heparin and Bergman solution. After 42 day of hospital treatment, the patient was dischar ged and vascular surgeon consultations were performed. By presenting this case, we want to draw attention to the need for early diagnosis of this complication and to highlight the need for treatment with therapeutic doses of low molecular heparin in patients with severe Covid pneumonia or oxygen dependent patients and in risk for thrombosis.
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CORTICOSTEROID RESPONSIVE COVID-19 ENCEPHALITIS - CASE REPORT
(SHMSHM - AAMD, 2024-12)
Atanasovski, Petar
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Zdravkov, Ilija
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Perovska, Marija
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The epidemiological burden of COVID-19 is a healthcare challenge reflected throughout the world. Different specialties are constantly confronted with unique cases that add to the array of Covid-19 symptoms. The neurological manifestations of SARS-CoV-2 infected patients are receiving increasing attention with the global spread of SARS-CoV-2. We present a novel case of SARS-CoV-2 associated acute encephalitis in a young adult without comorbidities and mild symptoms of infectious syndrome. The pathophysiological mechanism of acute encephalitis in COVID-19 is not well defined. There are two main hypotheses: a direct cytopathic effect of the infection of the brain tissue (the angiotensin-converting enzyme 2 receptors that the virus uses for attachment, margination, and internalization in the lung, are also expressed in the central nervous system; viral antigens were detected in CSF and brain samples), and an autoimmune/immunemediated cause (the general hyperinflammatory state releases cytokines and chemokines that impairs the bloodbrain barrier permeability and activate neuro-inflammatory cascades). In our case, the acute encephalitis induced by COVID-19 had a benign course, the patients improved quickly after IV steroids treatment and returned to their baseline state of health.
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Comparative features and outcomes of major neurological complications of COVID-19
(Wiley-Blackwell, 2022-10)
Beghi E
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Moro E
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Davidescu EI
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Popescu BO
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Grosu O
Background and purpose: The aim of this study was to assess the neurological complications of SARS- CoV- 2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations. Methods: The data source was a registry established by the European Academy of Neurology during the first wave of the COVID- 19 pandemic. Neurologists collected data on patients with COVID- 19 seen as in- and outpatients and in emergency rooms in 23 European and seven non- European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID- 19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/ subacute selected neurological manifestations in patients with COVID- 19 were analysed, comparing individuals with and without each condition for several risk factors. Results: By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16– 101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep– wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non- neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome. Conclusions: Patients with COVID- 19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.
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CLINICAL SYMPTOMATOLOGY OF COVID-19 PATIENT AFTER AN ABORTION
(Bulgarian Association of Young Surgeons (ScopeMed), 2021)
Pejkovska, Mirjana
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Shahpaska Pejkovska, Budima
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Introduction: WHO declared the outbreak a Public Health Emergency of International Concern in January 2020 and a pandemic in March 2020. Since then, it was realized that the virus that caused the outbreak for COVID-19, is knownassevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case Report: The purpose of this research is to discover the association between obstetrical condition and symptomatology of COVID-19 and to present the treatment of a patient in self-isolation after the abortion. A patient who has had an abortion, after that was diagnosed with COVID-19. Blood analyses were performed after her abortion and during and after her contagion with the virus. Analyses of d-dimmers were monitored continuously. Every symptom was carefully observed, using clinical, paraclinical, digital methods and pulls oximeter. The patient was prescribed vitamins, supplements antibiotics and immunomodulators. Patients with previous comorbidities, loss of blood, abortions, have weakened immune system. That is why they are more susceptible to infections. One of them is the coronavirus or SARS-CoV-2. Some aspects of the virus remain a mystery for medical experts. It takes a multidisciplinary approach and everyday treatment so that the patient can have elimination of the symptoms before the vaccine can be applied worldwide. Conclusion: Women who have abortions, give stillbirth sometimes can experience difficulties regarding their immune system. It is systemically and psychologically a hard moment for them an entire family. Thus the more they are prone to become specifically ill they need more time to recover.
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Avascular Necrosis of the Hip Joint and Femoral Head Related with Long COVID-19 or Post-COVID-19: Case Report Study
(Scientific Foundation SPIROSKI, 2024-02-25)
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Jovanovski, Mario
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Savin, Tanja
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Novachkova-Siljanovska, Bojana
<jats:p>BACKGROUND: Post-COVID conditions can include a wide range of ongoing health problems. As a consequence of long COVID-19 or post-COVID-19 an increase in osteonecrosis has been detected in different series of patients. CASE PRESENTATION: We present two patients diagnosed with COVID-19 and pneumonia, one with moderate and the other with severe clinical picture. They were treated with corticosteroid equivalent to prednisolone 993.5 mg (400–1587 mg) which correlates with steroid dose documented in the literature as causative for avascular necrosis (ANV) in patients with COVID-19. After the mean time of 65 days, due to pain in the groin and difficulty in movement, magnetic resonance imaging (MRI) was performed in both patients and AVN was diagnosed. Compared to our results, the literature records a longer time required for the development of AVN in patients without COVID-19, which is 6–36 months. This indicates the potency of the virus itself to cause disturbances in the microcirculation, and thus the development of AVN. The bone damage correlates with the degree of inflammation and the severity of the clinical picture. CONCLUSION: After a course of COVID-19 as part of a long COVID-19, ANV should be considered a possible complication, especially in patients who have clinical manifestations. Early detection of AVN and diagnosis using MRI on clinical suspicion would help early intervention with bisphosphonate therapy in patients with osteonecrosis of the hip. If the disease is detected in the more advanced stage, it is necessary to perform a surgical intervention and even a possible hip replacement.</jats:p>

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