Faculty of Medicine

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    Predictive Admission Risk Factors, Clinical Features and Kidney Outcomes in Covid-19 Hospitalised Patients with Acute Kidney Injury
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01)
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    Milenkova, Mimoza
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    Vasileva, Adrijana Spasovska
    Introduction: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients. Methods: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days. Results: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 – 0.958, p = 0.000; OR 0.987; 95%CI: 0.885–0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009). Conclusion: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself.
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    Evaluation of oxidative stress markers in hospitalized patients with moderate and severe COVID-19
    (Walter de Gruyter GmbH, 2021-11-20)
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    Background. Clinical evidence suggests increased oxidative stress in COVID-19 patients and this worsened redox status could potentially contribute to the progression of the disease. Objectives. To investigate the oxidative stress we have measured oxidative stress parameters, namely, PAT (total antioxidant power, iron reducing) and d-ROMs (plasma peroxides). Additionally we have investigated their correlation with the most frequently used clinical parameters CRP, LDH, and NLR in serum from moderate and severe COVID-19 patients hospitalized in a tertiary hospital. Methods. PAT and d-ROMs were determined by analytical photometric metric method in serum from 50 hospitalized patients. For each of them, two samples were collected and analyzed immediately after collection seven days apart. Results. All patients at admission had a much higher value for plasma peroxides and a significant correlation between oxidative stress parameters and CRP, LDH, and NLR. (p<0.05), except for OS index (OSI) vs CRP in the severe group. At discharge, plasma peroxides were reduced and OSI was improved in the moderate group. Conclusion. We consider that using OSI at the beginning of COVID-19 disease presents a valuable starting point for the general assessment of oxidative stress and hence enabling a better triage of the patients in terms of disease severity.
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    Hematological Findings and Alteration of Oxidative Stress Markers in Hospitalized Patients with SARS-COV-2
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2022-07-01)
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    Background/aim: Hematological parameters are the starting point in COVID-19 severity classification. The aim of this study was to analyze oxidative stress in hospitalized COVID-19 patients and to determine its association with D-dimer, neutrophil to lymphocyte ratio (NLR), and platelets to lymphocyte ratio (PLR) as markers for disease progression. Materials and methods: 52 patients with moderate and severe forms of COVID-19 were enrolled. A hematological and coagulation profile was performed for each patient. PAT (total antioxidant power, iron-reducing) and d-ROMs (plasma peroxides) were determined in serum at admission and 7 days after hospitalization. Results: The severe group presented parameters that indicated a poor prognosis. Patients that recovered had a significant reduction in d-ROM (t-test, p<0.01) and improvement in oxidative stress index (t-test, p<0.05). Patients that died had significantly decreased PAT (p<0.01) resulting in an increase in oxidative stress. Except for d-ROM vs PLR in both groups and d-ROM vs D-dimer in the severe group, a good correlation between oxidative stress parameters and D-dimer, PLR, and NLR was demonstrated (p<0.01). Conclusion: Our results show that oxidative stress markers can be used as a tool for disease progression in COVID-19. This analysis is easily accessible and affordable in addition to conventional hematological parameters performed for severity classification.
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    Effect of Supplemental Antioxidant-Based Therapy on the Oxidative Stress Level in COVID-19 Patients
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-03-01)
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    Background: COVID-19 is a disease in several stages starting with virus replication to dysregulation in immune system response, organ failure and recovery/death. Our aim was to determine the effect of Ganoderma lucidum, lycopene, sulforaphane, royal jelly and resveratrol extract on markers of oxidative stress, inflammation, routine laboratory analyses and duration of symptoms in COVID-19 patients. Methods: The oxidative stress parameters and interleukines 6 and 8 (IL-6, IL-8), tumor necrosis factor alpha (TNF-α) were determined in order to estimate the antioxidant and the anti-inflammatory effect of the product using a spectrophotometric and a magnetic bead-based multiplex assay in serum of 30 patients with mild form of COVID-19. Results: Statistically significant differences were obtained for all investigated parameters between the treated patients and the control group. Moreover, significant differences were observed for leukocytes, neutrophil to leukocyte ratio and iron. The average duration of the symptoms was 9.4±0.487 days versus 13.1±0.483 days in the treatment and the control group, respectively (p=0.0003). Conclusion: Our results demonstrated the promising effect of Ge132+NaturalTM on reducing the oxidative stress and the IL-6, IL-8 and TNF-α levels, and symptoms duration in COVID-19 patients. The evidence presented herein suggest that the combination of Ganoderma lucidum extract, lycopene, sulforaphane, royal jelly and resveratrol could be used as a potent an adjuvant therapy in diseases accompanied by increased oxidative stress and inflammation.
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    Presentation of cytokine profile in relation to oxidative stress parameters in patients with severe COVID-19: a case-control pilot study
    (F1000 Research Ltd, 2021-10-14)
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    COVID-19 can be worsened by hyper-production of cytokines accompanied by increased level of oxidative stress. The aim of this study was to investigate the correlation between a set of cytokines and the markers of the oxidative stress. The levels of cytokines IL-2, IL-4, IL-6, IL8, IL-10, VEGF, IFN-γ, TNF-α, IL-1α, MCP-1 and EGF were determined by using High Sensitivity Evidence Investigator™ Biochip Array technology. The oxidative stress parameters (d-ROM, PAT, OS index) were measured in serum on FRAS5 analytical photometric system. Results: IL-6, IL-8, IL-10, VEGF, MCP-1 and EGF were significantly higher (p&lt;0.05) in the patients with severe COVID-19 with increased levels of IL-2, IFN-y, TNF-α and IL-1α. The d-ROM, OS index, and PAT were significantly higher (p&lt;0.05) in severe COVID-19 patients. IL-6 demonstrated the strongest correlation with all of the markers of the oxidative stress, d-ROM (r=0.9725, p=0.0001), PAT (r=0.5000, p=0.0001) and OS index (r=0.9593, p=0.012). Similar behavior was evidenced between IFN-y and d-ROM (r=0.4006, p=0.0001), PAT (r=0.6030, p=0.0001) and OS index (r=0.4298, p=0.012). Conclusion:The oxidative stress markers show good correlation with the tested cytokines which can be measured at the beginning of the disease in a primary care setting to predict the course of COVID-19.
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    Corrosive poisonings during the COVID-19 pandemic: trends and demographic shifts in the pre- and early vaccination periods (2020–2021)
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2025-09-15)
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    Bekjarovski, Niko
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    Chibishev, Andon
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    The COVID-19 pandemic significantly disrupted global healthcare and societal norms, leading to changes in poisoning patterns, particularly corrosive poisonings (CP). This study aimed to evaluate the impact of the pandemic on CP trends in North Macedonia by comparing observed data from 2020 and 2021 with predicted values (PV) based on a 10-year trend. Methods: A retrospective study was conducted using data from the Poisoning Registry at the PIC, University Clinic of Toxicology, Skopje. Patients with confirmed acute upper gastrointestinal corrosive injuries were included. Results: Between 2010 and 2021, 1,668 CP cases were recorded. While an overall downward trend was observed (y = -6.5x + 181.4, R² = 0.56), CP cases declined by 1.5% in 2020 and by 25.5% in 2021 compared to PV. Female cases decreased by 27.5% in 2021; male cases declined by 16.6% in 2020 and 32.4% in 2021. Adolescent CP increased by 12.8% in 2020 and 80.0% in 2021; cases in those over 75 years rose by 2.5% and 6.2%, respectively. The mean age of CP patients rose by 7.6% in 2020 and 11.0% in 2021. Suicidal poisonings increased by 9.9% in 2021. Disinfectant poisonings rose by 74.5% in 2020, while hydrochloric acid (+6.2%), detergents (+3.4%), and degreasers (+32.0%) increased in 2021. Case fatality ratios rose by 36.2% in 2020 and 44% in 2021. Conclusion: Although the overall number of cases declined, the increased severity, lethality, and demographic shifts—particularly among adolescents and the elderly—highlight the high-risk groups, mental health burden and toxicological risks associated with public health emergencies
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    Short‐ and long‐term outcome and predictors in an international cohort of patients with neuro‐COVID‐19
    (Wiley, 2022-03-07)
    Beghi, Ettore
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    Helbok, Raimund
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    Ozturk, Serefnur
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    Karadas, Omer
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    Lisnic, Vitalie
    Background and purpose: Despite the increasing number of reports on the spectrum of neurological manifestations of COVID-19 (neuro-COVID), few studies have assessed short- and long-term outcome of the disease. Methods: This is a cohort study enrolling adult patients with neuro-COVID seen in neurological consultation. Data were collected prospectively or retrospectively in the European Academy of Neurology NEuro-covid ReGistrY ((ENERGY). The outcome at discharge was measured using the modified Rankin Scale and defined as 'stable/improved' if the modified Rankin Scale score was equal to or lower than the pre-morbid score, 'worse' if the score was higher than the pre-morbid score. Status at 6 months was also recorded. Demographic and clinical variables were assessed as predictors of outcome at discharge and 6 months. Results: From July 2020 to March 2021, 971 patients from 19 countries were included. 810 (83.4%) were hospitalized. 432 (53.3%) were discharged with worse functional status. Older age, stupor/coma, stroke and intensive care unit (ICU) admission were predictors of worse outcome at discharge. 132 (16.3%) died in hospital. Older age, cancer, cardiovascular complications, refractory shock, stupor/coma and ICU admission were associated with death. 262 were followed for 6 months. Acute stroke or ataxia, ICU admission and degree of functional impairment at discharge were predictors of worse outcome. 65/221 hospitalized patients (29.4%) and 10/32 non-hospitalized patients (24.4%) experienced persisting neurological symptoms/signs. 10/262 patients (3.8%) developed new neurological complaints during the 6 months of follow-up. Conclusions: Neuro-COVID is a severe disease associated with worse functional status at discharge, particularly in older subjects and those with comorbidities and acute complications of infection.
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    Predictive Admission Risk Factors, Clinical Features and Kidney Outcomes in Covid-19 Hospitalised Patients with Acute Kidney Injury
    (Macedonian Academy of Sciences and Arts/De Gruyter, 2023-12-01)
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    Milenkova, Mimoza
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    Vasileva, Adrijana Spasovska
    Introduction: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients. Methods: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days. Results: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 - 0.958, p = 0.000; OR 0.987; 95%CI: 0.885-0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009). Conclusion: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself.
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    A CASE OF COVID-19 PNEUMONIA IN HEMODIALYSIS PATIENT
    (Macedonian Association of Anatomists and Morphologists, 2021)
    Stojanoska, Tatjana
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    Murtezai, Osman
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    Taleska Matovska, Natasha
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    Dimoska Chifligaroska, Elizabeta
    SARS-CoV-2 (COVID-19) is an infectious disease caused by a novel corona virus that has spread rapidly, resulting in a worldwide pandemic. Even though end-stage renal disease (ESRD) patients are particularly susceptible to COVID-19 infection and can develop severe to critical clinical presentation, there are still limited studies and case reports about COVID-19 in ESRD patients.End-stage renal disease (ESRD) is a severe medical condition with a high prevalence of co-morbid conditions including diabetes, hypertension, and cardiovascular disease.We report case of a 72-years-old woman with ESRD on regular hemodialysis-outpatient, with history of diabetes mellitus type-2 and hypertension, which was positive to COVID-19 and developed pneumonia. She was one of our first registered cases of COVID-19 in our hospital and was successfully cured. Our patient reported symptoms typical of COVID-19, initially, (fever, sweating, weakness, stuffy nose, dry cough and shortness of breath, although she denied contact with infected individuals), but on the day of admission her clinical picture was atypical. She developed a severe clinical picture with the typical presentation of COVID-19 pneumonia on chest X-ray, but without leukopenia as a typical presentation of this disease in her laboratory findings. We describe the clinical presentation of this patient, the diagnostic process, the laboratory and imaging investigations, as well as the course and outcome of treatment.