Faculty of Medicine
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Item type:Publication, Prevalence of carotid artery disease in patients with metabolic syndrome(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2020)There is a growing body of scientific evidence on the impact of metabolic syndrome (MetS) on the progression of atherosclerosis, imposing the need for research of the association of MetS with carotid artery disease (CAD) as a significant risk factor for cerebrovascular insult (CVI) and transient ischemic attack (TIA). The aim of the study was to determine the prevalence of CAD as a risk factor for CVI and TIA in subjects with MetS. Material and methods: A cross-sectional study was performed including a total of 118 subjects, 65 men, 53 women, with MetS according to NCEP ATP III criteria that were analyzed clinically, biochemically and ultrasonographically in the City General Hospital „8th September“ - Skopje in the period from January 2017 to January 2018. Waist circumference, blood pressure, glycemia, triglycerides, and HDL cholesterol were determined according to standard routine protocols. The evaluation of the extracranial carotid trunk was done with a Color Doppler Duplex sonography with a linear probe of 7.5MHz. CAD assessment was performed using Ultrasound Consensus Criteria for Carotid Stenosis. An objective neurological assessment of the existence of CVI and TIA was performed by a standard protocol for neurological examination and brain CT results from medical history were reviewed. Results: The prevalence of CAD in this study was 77 subjects (65.25%), of which 35 subjects (29.66%) had symptomatic CAD, 17 subjects (48.57%) had CVI, 18 subjects (51.43%) had TIA. Regarding the degree of carotid artery stenosis (CAS) in the total number of subjects with MetS and CAD, no subjects with normal findings were registered, 16 subjects had stenosis <50% , 29 subjects had stenosis 50-69% , 23 subjects had stenosis 70-99% , while 9 subjects had occlusion. Conclusion: The results obtained in this study have shown that asymptomatic CAD is dominant in patients with MetS, which further imposed the need for timely extracranial ultrasonographic evaluation of the carotid trunk. This would achieve both effective prevention and adequate treatment of CVI and TIA, thereby reducing morbidity and mortality from cerebrovascular events which has a great health and socioeconomic significance. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, AORTIC DISSECTION: OFTEN NEGLECTED DIFFERENTIAL DIAGNOSIS IN EMERGENCY AMBULANCE SERVICES(MIT University Skopje, 2024-03); ; Abazi, AIntroduction: Aortic dissection is a rupture of the aortal medial layer produced by intramural hemorrhage that leads in a separation of the aortic wall layers, forming a false and true lumen with or without communication and is highly lethal. It causes a variety of symptoms, which can be discrete and subacute, or chronic, and is frequently misdiagnosed. Aim: This case report aims to present a case of a rare, subtle manifestation of transient ischemic attack caused by an aortic dissection. Case report: A 76-year-old man came to the Emergency Medical Service complaining of recent back and left shoulder pain accompanied by discomfort, as well as left-sided tingling of the face, arm, and leg, along with left hand weakness, that had occurred multiple times in the previous five days and lasted three to four minutes. On admission, he was clinically stable and had normal vital signs, without any neurological deficit. The ECG examination revealed RBBB without ST segment abnormalities. The anamnestic and hetero-anamnestic data were completely consistent with a cerebrovascular transient ischemic attack that occurred three days prior. After reevaluating the patient clinical status that was unchanged, he experienced temporary weakness, sweating, and dizziness revealed by shifting from supine to straight position, which was instantly relieved by kneeling down on the floor. The patient was immediately referred to secondary care. While a CT of the brain revealed normal findings, the CT angiography of the aorta showed an infrarenal aneurismatic dilatation with a 4cm wide flap indicative of impending aortal dissection. The patient was promptly referred to a tertiary care for further examination and medical care. Conclusion: Aortal dissection can easily go undetected in the Emergency Medical Services due to its pleomorphic clinical presentation, which oscillates between acute hemodynamic shocks to subtle, often undetectable symptomatology. Awareness of aortic dissection as differential diagnosis should be promptly lifted to a higher order thinking.