Faculty of Medicine
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Item type:Publication, Case report: First diagnosis of Fabry disease in North Macedonia in a patient presenting with kidney failure on hemodialysis(Frontiers Media SA, 2024); ; ; Fabry disease is a rare X-linked lysosomal storage disorder caused by α-galactosidase A (α-Gal A) deficiency. Reduced or absent enzyme activity causes progressive lysosomal accumulation of globotriaosylceramide (Lyso-Gb3) in various cells throughout the body to trigger inflammation and fibrosis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Oral Health Status in Diabetic and Non-Diabetic Patients on Maintenance Hemodialysis Treatment(Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2022); Introduction. Uremic toxins and inflammation influence the oral health in patients on maintenance hemodialysis treatment. The presence of diabetes additionally aggravates the oral status. The aim of the study was to compare the oral health status in diabetic and non-diabetic patients on chronic hemodialysis program. Methods. Observational, cross-section, monocentric study was conducted in 72 hemodialysis (HD) patients divided into two groups regarding the presence of Diabetes mellitus (DM). Demographic characteristics as patients age, dialysis vintage, laboratory inflammatory markers as C-reactive protein (CRP), albumin and Interleukin 6 (IL-6) were measured at the start of the study. Also, uremic small and middle molecules as blood urea nitrogen (BUN), creatinine, β2-microglobilin (β2M), myoglobin, albumin, free light chains kappa (FLC-k), and free light chains lambda (FLC-λ) were analyzed. Patients were examined by a dentist specialist scoring the oral hygiene index (OHI) by Greene Vermillion as good, fair and poor. Presence of hyperkeratosis, periodontal disease, erosions, ulceration, erythema, pigmentations, tongue coating and uremic fetor were notified. Gingival hyperplasia (GH) was scored (1-3) with 3 for the worst score. Data was presented as mean and standard deviation for continuous and percentages for nominal values. X squared Fisher exact and Mann Whitney test were used for statistical analysis. P<0.05 was considered as significant. Results. The patients from group 1-with DM (N=26) didn’t differ from the non-diabetic group (N=46) in respect of gender, age but had significantly shorter dialysis vintage (48.68±37.45 vs. 88.13±63.29, p=0.02, respectively). From the inflammatory markers only Il6 was significantly higher in DM patients (p=0.03). All the analyzed uremic toxins-small and middle molecules also didn’t differ between the two groups. Diabetic patients were at 3 fold risk for manifestation of fissure, 4 fold risk for pigmentations and 7 fold risk for erythema (OR 3.58; CI:1.017-12.380, p= 0.003; OR 4.12; CI:0.684-22.870; p=0.02, OR 4.84; CI:1.343-17.498, p=0.000), (OR 7.25; CI:1.123-46.880, p=0.000), respectively. GH was more likely to be present in diabetic patients (35%, 54%, 11% vs 83%, 15, 0%, p=0.000, respectively). The presence of hyperkeratosis, periodontal disease, erosions, didn’t differ between the groups. Patients with DM were found with higher percentage of bad oral hygiene index (38% vs 20%), but the overall comparison of OHI showed no significant difference. Conclusion. Oral health is significantly deteriorated in dialysis patients, especially in those with inflammation. Diabetic patients are at higher risk of developing changes in the oral health status. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Lindsay's Nails and Terry's Nails in End Stage Renal Disease - Case Series(Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2021-02); ; ; ; Introduction. Nail changes occur as part of a single organ disease, multisystemic diseases or because of the intake of some medications. Chronic kidney disease (CKD) is associated with various nail abnormalities. Тo identify Lindsay’s nails and Terry’s nails in patients with end stage renal disease (ESRD) on maintenance he-modialysis (HD) and to determine the common anam-nestic, clinical and/or laboratory parameters that would help elucidate the etiopathogenesis of these nail pathology. Methods. Twenty patients with ESRD on hemodialysis were included into the study. Dermatological examina-tion took place during the dialysis session. Lindsay’s nails were identified when the distal part of the nail bed is red/rose-brown, clearly separated from the proxi-mal part of the nail bed, occupying 20-60% of the entire length of the nail bed. The proximal part of the nail bed is whitish, resembling grounded glass. When pressing the nail, the discoloration of the distal part of the nail bad does not fade completely. Terry’s nails were identified by a 0.5-3.0 mm wide distal band, pink-brown in color, with a proximal part of the nail bed that is white and occupies 80% of the entire nail bed. Data on demographic characteristics, history of the disease and the laboratory values were noted for each patient. Results. Out of 20 patients, all males, we diagnosed Half-and-Half nails, also called Lindsay’s nails, and Terry’s nails in 6(30%) patients [5 Half-and-Half nails (25%), and 1 with Terry’s nails (5%)]. All patients had sideropenic-free anemia, elevated urea and creatinine values and elevated parathyroid hormone (PTH) values (>190 pg/L, range 190.3-387.5 pg/L). Conclusion. After searching the relevant literature (MEDLINE, PubMed), we found this is the first study to link elevated PTH values and Half-and-Half nails (also called Lindsay’s nails), and Terry's nails in patients with ESRD on HD. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, DIURESIS AND HEMODIALYSIS AS RISK FACTORS ON SHORT-TERM OUTCOME IN ELDERLY PATIENTS WITH ACUTE KIDNEY INJURY(Balkan Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2022-11); ; ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, USE OF ULTRASONOGRAPHY FOR CONFORMATION OF CENTRAL VENOUS CATHETER PLACEMENT FOR HEMODIALYSIS - SINGLE CENTER EXPERIENCE(Faculty of Medicine, Ss Cyril and Methodius University in Skopje, 2022); ; Conformation for safe placement of central venous catheter for hemodialysis and exclusion of pneumothorax is done with chest x ray. However, this procedure is time consuming, so in order to shorten this time several attempts have been tried to use bedside ultrasound. To use bedside ultrasonography to confirm tip location of central venous catheter and rule out pneumothorax. The second aim was to compare these results with plain chest x ray. In 50 patients on hemodialysis central venous catheter were inserted in internal jugular vein or subclavian vein under ultrasound guidance. After insertion, a subxiphoid 4 chamber view was obtained looking to detect turbulence or microbubbles shortly after 10ml saline flush through catheter. Then, ultrasound of the patient's chest was performed to exclude pneumothorax. After the exam, a plain chest x raywas performed for the conformation of the findings. From 50 placed hemodialysis catheters, 47 were adequately placed. All catheters were identified with the use of ultrasound. The tip of the 3 misplaced catheters could not be detected with the use of ultrasound. No pneumothorax was observed. The average time for detection of correct catheter placement was much faster with the use of ultrasound compared with chest x ray (11,5min and 80 min, accordingly). The use of bedside ultrasound for conformation of central venous catheter placement and excluding pneumothorax is as accurate as with chest radiography, but it is can be done much faster. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Hypomagnesemia and cause-specific mortality in hemodialysis patients: 5-year follow-up analysis(SAGE Publications, 2017-10-13); ; ; The aim of this prospective study was to evaluate the association between serum magnesium (Mg) and mortality, in particular the cause-specific mortality of Mg and other risk factors in hemodialysis (HD) patients.