Faculty of Medicine

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    Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
    (Wiley, 2024-08)
    Amil-Dias, Jorge
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    Oliva, Salvatore
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    Papadopoulou, Alexandra
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    Thomson, Mike
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    Gutiérrez-Junquera, Carolina
    Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and histologically by predominantly eosinophilic infiltration of the squamous epithelium. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published a guideline in 2014; however, the rapid evolution of knowledge about pathophysiology, diagnostic criteria, and therapeutic options have made an update necessary.
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    Early resuscitation - what is changed in the treatment of Traumatic Brain Injury (TBI)
    (MedCrave Group Kft., 2020-03-09)
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    Demjanski, Vasko
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    Kishman, Aleksandar
    Background: The classical therapeutic approaches to thetraumatic brain injury (TBI) are based on astandardized care and prevention of secondary brain injuries and insults.Brain is the most sensitive tissue to hypoxemia what consequently burdens maintenance of adequate circulation. The development of hypoxia hypoxemia during traumatic brain injury (TBI) with severe shock and anaemia is the main cause for the development of secondary brain injury, which is responsible for the high fatality of the TBI. Objectives and method: The aim of this review is to discuss the available literature and guidelines for this field and to find out the possible benefits of early resuscitation. Results: Initial resuscitation starts with infusions of isotonic crystalloid solutions (e.g. sodium chloride). The main goal of the treatment is to achieve normal blood pressure and adequate oxygen supply to the tissue. Aggressive resuscitation with excessive fluid load in TBI patients may aggravate the brain oedema. The data, about early use of blood and its products in TBI patients with severe haemorrhage are poor with controversial opinions. Conclusion: The resent published guidelines do not support any specific fluid or specific transfusion practices in this setting.
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    Nutritional Therapy in the Intensive Care Unit
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2020-10)
    Meeting appropriate nutritional demands is a fundamental aspect of optimal patients’ care. Optimizing nutrition delivery and preventing malnutrition can have a significant positive effect on clinical outcomes and costs of the care. Providing nutrition in critically ill patients has long been challenging issue, due to the difficulties in determining the nutrition requirements of the patients with heterogeneous characteristics, and selecting the timing and the route of administration. Different guidelines have been created by the experts in order to help clinicians to choose the appropriate nutritional therapy. Unfortunately these guidelines and recommendations sometimes are changed over the time according to the knowledge from the latest studies. This review aims to provide a comprehensive synthesis and interpretation of the so far known literature for nutritional therapy in ICU in order to assist clinicians in making practical decisions regarding nutrition management during the different stages of critical illness. As a conclusion from the literature, indirect calorimetry is the preferred method for assessing resting energy expenditure and the appropriate caloric and protein intake to counter energy and muscle loss. Enteral nutrition (EN) is recommended as a preferred route for early nutrition therapy in critically ill patients over parenteral nutrition (PN). Both European and American guidelines recommend hypocaloric nutrition in the first 48 hours, at 70 – 80% of calculated caloric needs in order to avoid overnutrition. From day three, the European guidelines recommend a more aggressive approach in which nutritional support can be increased to as much as 100% of the patient’s requirements and supplemental parenteral nutrition can be provided if necessary.
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    Consensus statement: RECOMMENDATIONS FOR THE DIAGNOSTIC ALGORITHM IN LUNG CANCER CONSENSUS STATEMENT OF THE MACEDONIAN RESPIRATORY SOCIETY AND THE MACEDONIAN ASSOCIATION OF PATHOLOGY
    (Македонско лекарско друштво = Macedonian Medical Association, 2019)
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    Dejan Todevski
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    Arben Rexhepi
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    Aleksandra Tatabitovska
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    Lung cancer is the “number one cancer killer” in the world. Its prevalence is associated with smoking as the primary cause, although air pollution in general and genetic factors are also important. The mortality especially from advanced stage lung cancer is still high, although there has been a significant improvement in the past 10 years, mostly due to the introduction of novel compounds such as targeted and immunological treatment. The advances in the treatment of NSCLC have imposed updating of the guidelines for the diagnostic procedure and screening of LC, for the indications for molecular testing as well as for targeted selection of patients who shall benefit the most from the novel treatment modalities. These recommendations shall fulfil their purpose only if implemented in the educational curriculum and if incorporated in the healthcare system strategies.