Faculty of Medicine

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    Item type:Publication,
    Covid infection as devastating post-transplant complication
    (Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs, 2020)
    Dohchev, Sasho
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    Trifunovski, Aleksandar
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    Trajkovski, Dimitar
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    Janchulev, Josif
    In march 2020 Covid 19 was declared as a pandemic by World Health Organisation. The marked risk group were older patients and patients with comorbidity such as hypertension, DM, obstructive pulmonary disease and chronic kidney disease. Patients on dialysis and kidney transplant recipients are among highest risk groups to be infected with Corona virus. Since the very beginning, Corona virus pandemic have great impact on the transplant program worldwide. There are recommendations for kidney transplant profe- ssionals that suggest the prioritization of patients for kidney transplantation. We present an expanded criteria donor, and recipient with multiple vascular access problems as an indication for kidney transplantation. In the early posttransplant period vascular problems with implication on the graft function were diagnosed and surgically treated, and cholecystecto- my was performed due to an uncalculous cholecystitis. Unexpected Corona virus infection early post transplan- tation occurred as a devastating complication for our kidney transplant recipient.
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    Factors Associated with Lethal Outcome in Patients with Severe Form of Influenza
    (Macedonian Academy of Sciences and Arts/Sciendo, 2016-11-01)
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    Kirova Uroshevik, Valerija
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    Cvetanovski, Vlatko
    Introduction: Clinical manifestations of influenza range from relatively mild and self-limiting respiratory infections to severe clinical manifestations with significant morbidity and mortality. The awareness of predictive indicators for the lethal outcome of influenza is of particular significance in making timely and exact decision for adequate treatment. The aim of this study was to identify the factors in patients with a severe form of influenza, resulting in lethal outcome. Materials and methods: The investigation was a prospective group comparison conducted at the University Clinic for Infectious Diseases in Skopje, R. Macedonia in the period from January 01, 2012 to January 01, 2015. The study included adult patients with a severe form of influenza who were further categorized into a group of either survived patients or a group of deceased patients. Demographic, clinical and biochemical data were noted in all patients included in the study on admission. The variables of the univariate analysis that showed a significant difference in terms of the outcome were used for creating multivariate logistic and regression analysis of the outcome as dependent factors. The independent predictors for lethal outcome in severe cases of influenza were identified by using logistic regression. Results: The study included 87 patients with a severe form of clinical and laboratory confirmed influenza. The patients were divided in two groups: survived (n = 75) and deceased (n = 75). The overall mortality was 13.79%. Multivariate analysis conducted on admission to hospital identified cardiovascular comorbid diseases (p = 0.014), urea values higher than 8.3 U/L (p = 0.045) and SAPS score (p = 0.048) as independent predictors of the outcome in patients with severe form of influenza. Influenza patients with cardiovascular diseases had 2.024 times greater risk of death from influenza in comparison to the patients having influenza without history of such a disease (OR = 2.024 95% CI 1.842-17.337). Patients with serum urea values higher than 8.3 U/L had 1.89 times higher chance of death compared to patients with normal values (OR = 1.89 95% CI 1.091-11.432). The increase of the SAPS score in one point increased the chance of death in patients with influenza by 1.2% (OR = 1.12 95% CI 1.01-2.976). The ROC analysis indicated that cardiovascular diseases, increased urea values and SAPS score in combination act as a good prognostic model for the fatal outcome. The global authenticity of this predictive model to foresee lethal outcome amounts to 80%, sensitivity being 82%, and specificity 70%. Conclusion: Cardiovascular diseases, increased values of urea over 8.3 mmol/l and SAPS score are independent predictive indicators for lethal outcome in severe influenza. Early identification of the outcome predictors in patients with severe influenza will allow implementation of adequate medical treatment and will contribute to decreasing of mortality in patients with severe form of influenza.