Faculty of Medicine
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Item type:Publication, Pattern of benzodiazepine use among death cases in Republic of North Macedonia(Macedonian Pharmaceutical Association, 2021); ; ; The aim of this study was to determine the pattern of benzodiazepine related deaths in Republic of North Macedonia. Retrospective survey of post-mortem toxicology data from eight-year period, obtained from Laboratory of Forensic Toxicology was performed, including cases with known gender, age, cause and manner of death and complete toxicology report. Post-mortem toxicology analyses were conducted with Fluorescence Polarization/Enzymatic Immunoassay and Biochip Array Technology method for screening of urine and blood respectively, and confirmation by GC-MS after solid phase extraction. Total of 1169 cases were investigated. Benzodiazepines were detected in 30.05% of the cases, with statistically significant difference between cases of natural and of violent cause of death, as well as between genders, but without statistically significant difference due to the age between both genders. Study revealed women were more likely to use benzodiazepines with the median age to be 52.88 and 49.87 for males and females, respectively. According to post-mortem toxicology data benzodiazepines are the most used drugs in our country. Of them, diazepam was found to be the most often used one. Data analyses have shown that benzodiazepines were often combined with alcohol, psychoactive medicines and drugs of abuse. In 46.6% of all cases with positive findings for benzodiazepines, use of drugs of abuse was detected, mostly heroine and methadone. Important note should be given to the simultaneous use of benzodiazepines with heroine and methadone, which have resulted in increased number of fatal intoxications. Further studies are needed to determine the reason for popular use of benzodiazepines among drug addicts. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparison of Rhabdomyolysis in Acutely Intoxicated Patients with Psychotropic and Chemical Substances(2023-06); ; ; ; Introduction: Rhabdomyolysis is characterized by a muscle injury that leads to the release of intracellular muscle contents/constituents into the systemic circulation. Aim: We examined the association between the severity of the clinical presentation and creatinine phosphokinase values in patients with rhabdomyolysis acutely intoxicated with psychotropic and chemical substances. Materials and methods: This clinically controlled prospective study included 140 patients with rhabdomyolysis hospitalized at the University Clinic of Toxicology in 2019. They were divided into two groups by the substance used for intoxication (psychotropic or chemical). Results: On the third day of hospitalization, we found a significant association between the type of intoxication and the degree of rhabdomyolysis according to the poisoning severity score (p=0.0256). The significance was due to intoxications with neuroleptics – 50% (n=6), anticonvulsants – 20% (n=1), antidepressants – 16.67% (n=2), heroin – 25% (n=1), and methadone – 54% (n=6). According to the poisoning severity score, the majority of intoxicated patients with chemical substances – other gases 100% (n=1), and those intoxicated with psychotropic substances – methadone 46.67% (n=7), neuroleptics 42.67% (n=5), heroin 40% (n=2), antidepressants 8.33% (n=1), had severe rhabdomyolysis. In psychotropic intoxications, creatine kinase had a significant linear positive weak correlation with mortality (p=0.0234). Conclusions: Rhabdomyolysis and its clinical symptoms and signs were significantly more common in patients intoxicated with psychotropic substances compared to chemical intoxications. Intoxicated patients with psychotropic substances had more severe rhabdomyolysis on the third day of hospitalization. In psychotropic intoxication, with increasing creatine kinase level on the first day there was a significant increase in mortality. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MYOGLOBIN IN ACUTELY INTOXICATED PATIENTS WITH RHABDOMYOLYSIS(Macedonian Association of Internal Medicine, 2022-05); ; ; ; Bekjarovski Niko - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CLINICAL AND BIOCHEMICAL FINDINGS OF RHABDOMYOLYSIS IN ACUTE INTOXICATIONS WITH PSYCHOACTIVE AND CHEMICAL SUBSTANCES(2020); ; ; ; The aim of the study is to identify possible differences in demographic, laboratory and clinical characteristics between patients with rhabdomyolysis due to intoxication with psychoactive and chemical substances. The study is a cross-sectional study conducted between 1 January and 30 June 2019. All the patients included during this period were treated due to intoxication (outpatient or hospitalized) at the University Clinic of Toxicology in Skopje. The patients with rhabdomyolysis were divided in two groups according to the nature of the substance used for intoxication: a) psychoactive substances and b) a chemical substance. Rhabdomyolysis was determined with a value of CPK (creatinine phosphate kinase) >250 U/L. Patients with rhabdomyolysis due to intoxication with chemical substances were significantly older than patients with rhabdomyolysis due to intoxication with psychoactive substances. There is a significant difference between the two groups of patients with rhabdomyolysis in terms of CPK, urea, hemoglobin values during the first day with regards to significantly higher values in the group where intoxication occurred with psychoactive substances. Five patients with rhabdomyolysis due to intoxication with psychoactive substances experienced muscle pain (10.9%), and one patient (3.8%) of those with rhabdomyolysis due to intoxication with chemicals, without any significant association between muscle pain and type of intoxication (Fisher exact test: p=0.3003). Muscle weakness and pigmented urine were identified consequently in six patients (13.0%) vs. five (10.9%) of patients with psychoactive intoxication and none with chemical. Rhabdomyolysis caused by psychoactive and chemical substances is associated with clinical manifestations and biochemical abnormalities. The values of CPK, myoglobin, AST, ALT, LDH, urea and creatinine were higher in favor of the group of intoxicated patients with rhabdomyolysis with psychoactive substances. The clinical symptoms of rhabdomyolysis are not present in all intoxicated patients, but are more present in the group intoxicated with psychoactive substances. Biochemical findings are crucial in establishing the diagnosis of rhabdomyolysis. Abnormalities of biochemical findings need to be identified in order to initiate appropriate treatment immediately to prevent mortality and morbidity.