Faculty of Medicine

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    Complications of Coronavirus Disease-19 in a Hospitalized Patient: A Case Report
    (Scientific Foundation Spiroski (publications), 2020-12-25)
    Meshkova, Iskra
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    Simeonova, Magdalena
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    Markovska, Zorica
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    Markoska, Vesna
    BACKGROUND: Coronavirus (CoV) disease (COVID)-19 infection is a major public health issue worldwide with no specific therapy or vaccine. CASE REPORT: COVID-19-positive patient was hospitalized due to a dry irritating cough that has persisted for 3 days. The polymerase chain reaction test to severe acute respiratory syndrome-CoV-2 was positive. Computed tomography (CT) scan of the lungs showed massive bilateral consolidation. The patient was set to oxygen support (6 L/min). Two hours after referring the patient’s condition worsened with shortness of breath, suffocation, wheezing, and decreased saturation (77%). The patient was given mechanical support with continuous positive airway pressure mask. Therapy included azithromycin 500 mg and ceftriaxone 2 g. On the 3rd day of hospitalization, there was a sharp deterioration of the condition and a decrease in saturation (40%). The patient was intubated and immediately placed on intermittent positive pressure ventilation. Azithromycin was now combined with meropenem 3 × 1 g. The next morning patient’s condition further worsened with decrease in saturation and heart rate. The resuscitation was unsuccessful. CONCLUSION: COVID-19 is primary a respiratory infection, but the virus also affects other organs with poor outcome.
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    Drug Interactions
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024)
    Drug interactions can be described as the pharmacological influence of one drug on another drug, when administered in combination. Drug interaction can cause an increased or decreased effect of the drug, but it can also lead to a toxic effect. In daily practice in operating rooms and intensive care units, anesthesiologists routinely combine drugs. Interactions are usually divided according to the mechanism of occurrence and the most frequent are pharmacokinetic and pharmacodynamic. In pharmacokinetic interactions, the interactions are at the level of absorption, distribution, metabolism, or elimination processes. Such interactions are predictable, but their extent cannot be predicted. Pharmacodynamic interactions refer to antagonistic or synergistic action between drugs. It remains a challenge to teach clinicians how to combine these drugs in order to achieve and maintain optimal anesthetic and vital conditions, while minimizing side effects. A good understanding and knowledge of drug interactions can improve the ability to titrate multiple drugs more effectively.
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    Evaluation of severity scoring systems in patients with severe community acquired pneumonia
    ("N Gh Lupu" Foundation of Internal Medicine and Romanian Academy, 2021-12)
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    Background. The aim of this study was to evaluate the ability of severity scoring systems to predict 30-day mortality in patients with severe community-acquired pneumonia. Methods. The study included 98 patients aged ≥18 years with community acquired pneumonia hospitalized at the Intensive Care Unit of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia, during a 3-year period. We recorded demographic, clinical and common biochemical parameters. Five severity scores were calculated at admission: CURB 65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age ≥65 years), SCAP (Severe Community Acquired Pneumonia score), SAPS II (Simplified Acute Physiology Score), SOFA (Sequential Organ Failure Assessment Score) and MPM (Mortality Prediction Model). Primary outcome variable was 30-day in-hospital mortality. Results. The mean age of the patients was 59.08 ± 15.76 years, predominantly males (68%). The overall 30-day mortality was 52%. Charlson Comorbidity index was increased in non-survivors (3.72 ± 2.33) and was associated with the outcome. All severity indexes had higher values in patients who died, that showed statistical significance between the analysed groups. The areas under curve (AUC) values of the five scores for 30-day mortality were 0.670, 0.732, 0,726, 0.785 and 0.777, respectively. Conclusion. Widely used severity scores accurately detected patients with pneumonia that had increased risk for poor outcome, but none of them individually demonstrated any advantage over the others.
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    Seasonality of Pseudomonas spp. In Surgical intensive Unit
    (DEPARTMENT OF ANAESTHESIA AND REANIMATION, FACULTY OF MEDICINE, “SS. CYRIL AND METHODIUS” UNIVERSITY, SKOPJE, MACEDONIA, 2021)
    Petrovska Basovska Branka
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    Toleska Marija
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    Pseudomonas strains are frequent microorganisms associated to healthcare-acquired infections. Pseudomonas aeruginosa is one of the leading intra-hospital pathogens in the intensive care units. Pseudomonas infections usually present wide antimicrobial resistance in treatment and they are important public health problem. Medical devices are the most often responsible for nosocomial infections in the intensive care centers. Pseudomonas colonization and its ability to form biofilm on medical devices highlights this organism as emergent pathogen at the Clinic for Anesthesiology, Resuscitation and Intensive Care in Skopje. Multidrug-resistant Pseudomonas aeruginosa is an endemic problem in the intensive care units. Also, Pseudomonas spp. strains demonstrate seasonality. This research will investigate its existence on respiratory medical devices (endotracheal tubes and nasal cannulas). The study will determine its seasonal variation and it will indicate preventive medical measures in critical seasons.
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    EPIDEMIOLOGY, TREATMENT, AND COMPLICATIONS OF CROUP SYNDROME IN CHILDREN
    (Macedonian Association of Anatomists and Morphologists, 2020)
    Gjinovska Tasevska, Elena
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    Doksimovski, Filip
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    Tasevska Rajkovikj, Аna
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    Petlichkovska, Sandra
    Introduction: Croup syndrome is an urgent pediatric condition. It is characterized by the abrupt onset, most commonly at night, of a barking cough, that is usually accompanied by inspiratory stridor, hoarseness and respiratory distress resulting from upper-airway obstruction. This is the most common reason why parents are upset and immediately seek medical help. Objective: This study aimed to evaluate the frequency, treatment, and possible complications of croup syndrome in children hospitalized at our institute. Materials and methods: In our retrospective study we examined 56 pediatric cases with croup syndrome that were hospitalized in our Institute and we analyzed gender and age, the season in which we had the most frequent hospitalizations of children with croup syndrome, as well as treatment and possible complications after completion of croup symptoms. Period of examination was one year. Results: Mean age at diagnosis of children with croup was 26,5 ±2.6 months (range from 45 days to 8 years). As well the world statistics we got a larger number of hospitalized boys with croup syndrome, rather than girls (ratio 2,3:1). Regarding the period of the year, the autumn period was dominant. As far as the treatment, we noticed significant number of children with moderate to severe croup syndrome that required in-patient care. All of them received nebulized adrenalin as well as parenteral corticosteroid. The average duration of the hospitalizations that occurred in our unit for close monitoring and semi-intensive care was 5 days (1-14d). Antibiotics were used in 71% (n=40). Most common comorbidity was pneumonia and bronchopneumonia (14,2%, n=8). None of the children was of need of intubation and referral to intensive care unit. Conclusion: Our one-year research has documented considerable number of children with the necessary hospitalization, as many as 10% of hospitalized children in our Institute were due to moderate to severe croup syndrome. The sex, the age of the children as well as the season are most often in line with world statistics. We are noticing high percent of hospitalized patients with moderate croup. There is evident discrepancy between the use of antibiotics and its duration in our practice in comparison with other reports. These observations lead to reassessment of the hospitalization criteria as well as more rational use of antibiotics.