Faculty of Medicine

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Visceral leishmaniasis as a leading cause of fever of unknown origin in immunocompetent adults: a prospective, observational, single-center study
(Pensoft Publishers, 2025-12-18)
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Shopova, Zhaklina
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Trajkova, Irena
To evaluate the presentation patterns of visceral leishmaniasis (VL) as a cause of fever of unknown origin (FUO) and compare them with other FUO etiologies. Materials and methods This prospective observational study was conducted at the Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of North Macedonia, from 2019 to 2025. We included ninety-four immunocompetent patients, aged 14 or over who met the FUO criteria by Durack and Street and had a definitive etiology subsequently established. Based on the final diagnosis, patients were categorized into those with VL and those with alternative FUO etiologies. Demographic, clinical, and laboratory data from standardized investigations were compared between the groups using appropriate statistical tests. Results Sixty-six percent of participants were male, and their median age was 49 years (IQR 36–65). Infectious diseases were responsible for 52.1% of all FUO cases, followed by noninfectious inflammatory disorders (20.2%), miscellaneous causes (17%), and malignancies (10.6%). VL was the leading single diagnosis, identified in 17% of the total cohort. Compared with non-VLFUO cases, VL patients more often presented with weight loss, diaphoresis, and splenomegaly (all <0.001), hepatomegaly ( =0.002), and higher febrile peaks (p=0.026). Hematologic abnormalities were more pronounced in VL, with lower hemoglobin, hematocrit, leukocyte, and platelet counts (all p≤0.006), as well as lower albumin (p=0.029) and higher globulin levels (p=0.001). Conclusion Visceral leishmaniasis can be an important yet underrecognized cause of FUO in endemic regions. Greater clinical awareness and early diagnostic testing are essential to prevent delays and inappropriate treatment.
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CONGENITAL DIAPHRAGMATIC HERNIA - DIAGNOSIS, TREATMENT AND FAMILY PLANNING
(Македонско лекарско друштво = Macedonian medical association, 2025-08)
Mirjana Kjaeva Pejkovska
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Introduction. Congenital diaphragmatic hernia is a rare structural and genetic disorder. Early diagnosis, proper treatment and expectance of the outcome in terms of future family planning are needed. Aim. To increase the awareness of early diagnosis and to present the current protocols for diagnosis, treatment and family planning if congenital diaphragmatic hernia occurs, particularly in early childhood. Methods. For the purpose of this retrospective study, 20 mothers who gave birth to children with congenital diaphragmatic hernia were enrolled. They had been given questionnaires regarding the timing of their fetus’s diagnosis, the treatment that followed, and the frequency of this condition in their family. Before the treatment, parents of the patients signed a consent form. Their data were collected and analyzed in the period of two years. Results. Early diagnosis can be life saving because the baby needs to be intubated as soon as the mother gives birth. Some mothers had to plan their deliveries ahead in institutions with highly developed intensive care, with Discussion. Early diagnosis is of crucial importance for timely preparation and treatment of both mothers and babies. ECMO treatment, to provide the best treatment protocol for better quality of life for both mother and child. In the literature the need for sterilized conditions during the treatment is described because of the possible complication such as sepsis caused by healthcare-associated infections. Conclusion. Congenital diaphragmatic hernia is a condition for which awareness must be raised for proper diagnosis, treatment and family planning.
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UTILIZATION OF CEPHALOMETRIC 2D AND 3D ANALYSIS DURING DIAGNOSIS, TREATMENT PLAN AND CASE MONITORING OF IMPACTED TEETHCASE REPORT D
(Macedonian Association of Anatomists and Morphologists, 2022-08-01)
Srbinoska, Daniela
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Trpeska, Vesna
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RTG projections are essential for diagnosis, treatment plan, follow-up and treatment outcomes. Three-dimensional (3D) cephalometry, which is done using a cone- beam computerized tomography (CBCT) examination, allows more detailed evaluation of the craniofacial hard and soft tissue structures than 2D radiograph. Using 3D analyses in diagnostic and treatment planning in orthodontics is more than necessary in cases with impacted teeth, cleft lip, and skeletal discrepancies requiring surgical interventions. CBCT has come into wider usage in other situations as root resorption, temporomandibular joint (TMJ) morphology and pathology, supernumerary teeth, alveolar boundary conditions and asymmetries; maxillary transverse dimensions and maxillary expansion; vertical malocclusion and obstructive sleep apnoea. The present descriptive study aimed to explore possible applications of 3D technologies during the diagnosis, treatment plan, case monitoring and result assessment in orthodontics including their advantages and disadvantages. Utilisation of 3D technique was more than necessary in diagnostic and treatment planning in this case because of presence of more than one impacted tooth. The fixed appliances, the surgical exposure, cortectomy and orthodontic traction were done. The tooth movement and positioning to the dental arch started six months ago. The impacted tooth is already seen and the treatment continues. The severity of this case is indication for utilization of control 2D and 3D radiographs in manner following the positioning of the central incisor on the appropriate place. 3D technique is less prone to error and can improve the clinicians’ workflow.
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D DIMERS - A POWERFUL TOOL IN THE DIAGNOSIS OF AORTIC DISSECTION
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
Jovanoski, Marko
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Nikolovski, Robert
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Petkovski, D.
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Introduction: Acute aortic syndrome is one of the most life threatening cardivascular conditions besides acute coronary syndrome and pulmonary embolism. Fifty percent of all the patients with aortic dissection do not survive for surgery or other therapeutic procedure to be performed and they experience a lethal end. D dimers although are a marker with a low specificity and sensitivity they can help us and guide us to make the right diagnosis. Aim: Using d dimers to raise the suspicion for acute aortic dissection and using the triple chest pain CT angiography protocol to confirm the right diagnosis. Case report: This series of case reports are about a few patients that presented in the emergency department with either a chest or back pain which was radiating to different body regions (including the lumbal region and the abdominal area). As these symptoms can sometime overlap and manifest as different acute cardiovascular syndromes, which can lead to increased morbidity and mortality, a CT angiography was performed after the regular noninvasive, low cost echocardiography was done to potentially find a possible diagnosis and show us the right diagnostic path. D dimers were also examined in all of the patients and increased level was found in all of the above mentioned. Aortic dissection (Stanford A or B ) was the final diagnosis in all of them, every single patient requiring a different therapeutic approach. Conclusion: D dimers in combination with a good clinical examination can be a perfect tool to raise the suspicion for acute aortic syndrome and after performing a triple chest pain protocol with CT angiography we can confirm and treat the diagnosis which requested a hospital admission.
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MISDIAGNOSIS OF CERVICOBRACHIAL SYNDROME WITH SUBOCCLUSION OF THE LEFT SUBCLAVIAN ARTERY
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
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Nikolovski, Robert
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Introduction: Cervical spondylosis (degenerative osteoarthritis) and subclavian occlusion, mostly caused by atherosclerosis, share similar symptoms. Both are diseases of the advanced age. Thus, there are similarities of overlapping or misdiagnosis of both diseases. The aim of this case report was to present diagnosis and treatment of subclavian subocclusion and possibility of misdiagnosis with cervicobrachial syndrome. Case report: We present the case of a 71-year-old woman with noncontrolled hypertension. For many years she complained of occasional pains and tingling in her neck, left shoulder, and hand, coolness in the fingers of the left hand, headache and occasionally dizziness. An x-ray finding of the cervical spine was in favor of spondyloarthrosis on the neck vertebrae, and after consulting an orthopedic specialist, she was diagnosed and treated as cervicobrachial syndrome for many years without success. Cardiology examination detected different high blood pressure readings in both arms and that induced us to perform a computerized angiography (CT). CT showed subocclusion on the left subclavian artery after which our patient underwent angiography and stent implantation. After the procedure, the blood pressure difference decreased and the symptoms disappeared. Conclusion: Due to similar symptoms, whenever cervicobrachial syndrome is diagnosed, the blood pressures in both arms should be measured. In case of their difference, subclavian stenosis should also be considered and appropriate investigations should be made, especially if the difference in pressures is high.
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Emphysematous Calculous Cholecystitis Diagnosed with Abdominal CT in a Diabetic Female Patient - Case Report
(Walter de Gruyter GmbH, 2023-12)
Misimi, Shqipe
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Aliu, Ilir
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Kanevce, Petar
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Emphysematous cholecystitis is reported to have a low incidence of less than 1% in all cases of acute cholecystitis and yet a high mortality rate of up to 15%. It is most commonly seen in male diabetic patients with advanced age. The diagnosis is established with the presence of gas in the gallbladder lumen and/or within its wall which can be seen on plain abdominal radiography, abdominal ultrasound, and abdominal computerized tomography. The clinical presentation refers to one of acute cholecystitis, but the treatment requires prompt cholecystectomy since the patient's condition can deteriorate due to the possibility of gallbladder perforation. We present a case of a 71-year-old female diabetic patient with calculous emphysematous cholecystitis treated with emergency open cholecystectomy.
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Hypertension in athletes
(MIT University, 2023-03)
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Furnadjiski, Atanas
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Mitevski, Goran
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Nikolovski, Robert
Hypertension is the most common cardiovascular disease in athletes. Prompt diagnosis and management is crucial for ensuring safe sport participation and prevention of long term complications in athletes. Many diagnostic tools are involved in the management algorithm of the hypertension starting from good anamnesis especially the family history, as well as other simple and sophisticated paramedical imaging techniques, as ECG, Echocardiography, 24 Hours ambulatory ECG monitoring, cardiac MRI and many others. Distinguishing an athlete heart from pathological heart muscle hypertrophy is the key step for the differential diagnosis. Conclusion: Proper pharmacological and non pharmacological measures will facilitate satisfying long term prognosis for the athletes.
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CORRELATION OF SCORING SYSTEMS WITH HISTOPATHOLOGICAL FINDINGS AND THEIR IMPORTANCE IN REDUCING THE PERCENTAGE OF UNNECESSARY APPENDECTOMIES
(Македонско лекарско друштво = Macedonian medical association, 2019)
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Markov, Petar
Introduction. Acute appendicitis (AA) is one of the most common emergency surgical conditions, where emergency laparotomy is necessary. However, perforation rates and negative laparotomies during this procedure have not been reduced. The purpose of this paper was to evaluate the importance of the scoring systems in the differenttial diagnosis for setting an indication for appendectomy. Method. Prospective comparisons of the values of 4 scoring systems were performed among 60 patients: Alvarado, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis. Values for the scores were determined in all patients treated with lower right quadrant (LRQ) abdominal pain, under a differential diagnosis of AA. After the appendectomy (open surgery or laparoscopic), a correlation was obtained between the histopathologic findings (HP) and the corresponding latent values. Results. In the study 63.33% of the patients were male. Distribution of patients according to the values of the three different systems (Alvarado, RIPASA and Tzanakis) showed that the largest number of patients had values higher than 8 and AIR values of 7- 8. In the study, 95% of the operated patients were positive for appendicitis compared to the histopathological finding. 80% of the surgeries included on-time appendectomy, 15% delayed diagnosis, and 5% were found to be with an unnecessary appendectomy. According to the HP findings of those with positive findings, 77.2% of the cases had appropriate preoperative ultrasonographic (US) diagnosis. A statistically significant association of the scores with HP findings (promptly phlegmonous, promptly gangrenous, late perforated and unnecessary) was found only for the Alvarado, AIR, Tzanakis, and no statistically significant association was found for the RIPASA score. Conclusion. Scoring systems are useful diagnostic tools for appendectomy indication. Using one or a combination of two or more scoring systems reduces the percentage of unnecessary appendectomies.
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Примарен малигнен меланом на грлото на матката - приказ на случај
(Македонско лекарско друштво = Macedonian medical association, 2001)
Veljanoska, Slavica
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Arsovski, Oliver
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Tolevska, Cveta
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Примарниот малигнен меланом на грлото на матката е ретко заболување. Клиничката слика е мошне неспецифична и не се разликува од онаа на вообичаените симптоми на порциото. Се манифестира со контактни, а подоцна во текот на болеста и спонтани вагинални крварења, односно во напреднатите стадиуми и со симптоми од дисеминација на процесот. Самото дијагностицирање на овој ентитет бара огромно внимание, особено во разграничувањето на ПММГМ од метастаза на меланом на грлото на матката. Недвосмислен доказ за постоење на ПММГМ е неговата хистопатолошка верификација во преодниот епител. Кај ПММГМ се јавува и проблем при одредување на стадиумот на болеста, но сепак повеќето автори го користат FIGO системот наспроти критериумите за одредување на стадиумите кај кутаниот малигнен меланом според Clark и Breslow. Радикалната хистеректомија според Wertheim Meigs и адјувантната хемиотерапија се методи на избор во третманот на ПММГМ. Примарниот меланом на вратот на матката кој се дијагностицира во напреднат стадиум на болеста (иноперабилен) покажува резистенција на било каков вид на конзервативна терапија, со тенденција за брза локална и системска прогресија на болеста, што резултира со исклучително лоша прогноза. Primary malignant melanoma of the uterine cervix (PMMUC) is an extremely rare disease. Clinical presentation of PMMUC is not specific and not different from the common cervical malignancies. It presentс with postcoital spotting, spontaneous vaginal bleeding, even with the signs of dissemination in the advanced stages of the disease. The diagnosis is difficult, because it is essential to differentiate PMMUC from secondary malignant melanoma, by the presence of melanocytes in the epithelium and verification of junctional activities. There is a consensus about staging procedure using FIGO criteria, rather than that of Clark and Breslow (TNM clasification, UICC). Radical hysterectomy is accepted as the most important initial approach, while the role of pelvic lymphadenectomy remains unclear. We present a case of PMMUC in advanced, inoperable stage of the disease, treated in our institution by radiotherapy and chemotherapy. There was no response to any available conservative treatment.
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Our experiences with Virtual CT pneumocystography and the detection of bladder cancer.
(2014-03)
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Nikolov, Kiril
Our goal was to evaluate the prospect of future use, sensitivity and specificity of CT volume- rendering techniques in the evaluation of bladder wall changes, without the need of conventional endoscopic procedures which is limited by its invasiveness and the difficulty to explore the bladder in full potential. This study investigates the sensitivity range of virtual CT and 3D reconstruction techniques in assessing lesions of the bladder wall to compare it with that of conventional endoscopy, and outlines the indications, advantages and disadvantages of virtual CT-pneumocystography.

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