Faculty of Medicine
Permanent URI for this communityhttps://repository.ukim.mk/handle/20.500.12188/14
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Item type:Publication, The Paradox of SMURF-less Outcomes and its Implication for Diabetes(Oxford University Press (OUP), 2026-01-28) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, KIDNEY FUNCTION DECLINE AND MORTALITY IN DONORS WITH EXPANDED CRITERIA - FIVE YEARS FOLLOW UP STUDY(Macedonian Association of Anatomists and Morphologists, 2024); ; ; ; Kidney donors are considered healthy, but with a need for continued medical follow up and encouragement for continued healthy lifestyle, especially when expanded criteria for donation are applied. This study aims to analyse the five years follow up of kidney donors after explanation, encountering risks of kidney function decline and donors’ mortality. In a retrospective study we evaluated a donor cohort with 5 years of follow up. Demographic characteristics as age, gender and the presence comorbidities as diabetes, hypertension, hyperlipidemia and Body Mass Index (BMI) >30kg/m2 were analyzed. Estimated glomerular filtration rate (eGFR) by CKD EPI formula was notified prior donation, and annually afterwards. Consultations with nephrologist or other specialists were notified. In a multivariate regression analysis, the reduction ratio (RR) of eGFR was explored as dependent variable. Cox regression analysis exploited mortality; Kaplan Meier survival curve was applied in respect of BMI. Seventy-five donors with average age above 55 years were predominantly women (69%), nearly every nineth patient had diabetes or obesity (9%). Proportion of donors referred to nephrologist at the 12 months, declined up to 58% at the fifth year, ignoring medical checks showed ascending trend to 16% at the end of second and third year and 12% at the end of observational period. The univariate regression analysis found diabetes, hyperlipidemia and hypertension, the presence of multiple comorbidities, gender and age as insignificant predictors of eGFR 12 months reduction ratio. The nephrologist referral showed borderline significance (β = - 0.103, p=0.076). Only BMI over 30kg/m2 worsened the kidney function (β = 0.600, p=0.001). Five years mortality rate was 6.7%. The diseased donors were significantly older, more frequently had diabetes and obesity also they had significantly lower eGFR pre-donation, at the end of the first year but also and more step decline of it after 12 months. In the multivariate analysis BMI>30kg/m2 emerged as most powerful predictor of mortality (HR 40.02; CI: [4.11-389), p=0.0001). Survival of obese patients was significantly shorter when compared with patients with lower body weight (43.28 ± 7.51 vs. 59.33±0.65, Log rank p=0.000), respectively. Our study demonstrates that the mortality and declination of renal function after donation are associated with nephrologist referral and other potentially modifiable factors, especially obesity. Improved protocols for pre-donation information, education and adequate after-donation follow up is mandatory to achieve better longevity and kidney function survival in these frail and precious individuals. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, COMPARISON OF THREE SEVERITY SCORING MODELS FOR MORTALITY PREDICTION OF COMMUNITY-ACQUIRED PNEUMONIA(Peytchinski Publishing Ltd., Pleven, Bulgaria, 2024-10); ; ; Cana, FadilIntroduction: Community-acquired pneumonia (CAP) is among the leading cause of morbidity and mortality worldwide. Several scoring models have been developed to accurately asses a disease severity and early to predict the outcome, however an optimal prognostic tool still is not clearly defined. The aim of this study was to compare three commonly used scores in patients with CAP, in order to determine the best tool that will early identify those with increased risk for mortality. Methods: The study included 129 patients aged ≥18 years with CAP hospitalized at the intensive care unit (ICU) at the University Clinic for Infectious Diseases in Skopje, during a 3-year period. Demographic, clinical and biochemical parameters were recorded and three scores were calculated at admission: SOFA (Sequential Organ Failure Assessment Score), SAPS II (Simplified Acute Physiology Score) and APACHE II (Acute Physiology and Chronic Health Evaluation II). Primary outcome was 30-day in-hospital mortality. Receiver Operating Curve (ROC) analysis was performed and areas under the curve (AUC) were compared to evaluate mortality prediction capacities of the scores. Results: The mean age of the patients was 61 year, predominantly were males (66,7%), most (79,1%) had co-morbid condition and Charlson Comorbidity index was significantly increased in non-survivors. An overall mortality was 43.4%. All severity scores had higher values in patients who died, that was statistically significant with the outcome. The AUC values of the scores were 0,749 for SOFA, 0.749 for SAPS II and 0.714 for APACHE II, showing similar prediction ability. Conclusion. Commonly used severity scoring models accurately identified patients with CAP that had an increased risk for poor outcome, but none of them showed to be superior over the others in ability to predict the mortality. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Factors that have impact on natural population change in Republic of North Macedonia(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2023-12); ; The planning of public health programmes is directly related with the demographic characteristics and the population change has long term impact on the health, health care and community interventions. The objective of this paper is to analyze the factors influencing the trend of population change in the Republic of North Macedonia. Material and methods: Data from the National Statistical Office and World Health Organization have been used. Literature review was conducted applying public health approach and descriptive method. Results: The natural population change in North Macedonia has negative trend in the last 10 years, the birth rate has declined, while the mortality is increasing. The biological factors and fertility rate have significantly influenced the birth rate, while the burden of chronic noncommunicable diseases, road injures, violence and COVID-19 are lead causes of mortality. Numerous factors indirectly affect the negative trend of population change such as the high rate of unemployment, poverty, socioeconomic and political context, migration and availability and quality of health care. Conclusion: А detailed analysis of the factors affecting the natural population change and an appropriate national response with the aim of reducing the negative trends is needed. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A novel id-iri score: development and internal validation of the multivariable community acquired sepsis clinical risk prediction model(Springer Science and Business Media LLC, 2020-04) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Predictors of active cancer thromboembolic outcomes. RIETE experience of the Khorana score in cancer-associated thrombosis.(Thieme, 2017) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism.(2017) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Once versus twice daily enoxaparin for the initial treatment of acute venous thromboembolism(Thieme Medical Publishers, 2017) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Evaluation of severity scoring models in mortality prediction of severe community acquired pneumonia.(2023-09); ; Rangelov GoranBackground: community-acquired pneumonia (CAP) is one of the most common infection worldwide and major cause of death particularly in elderly and patients with comorbidities. Severe CAP (sCAP) refers to acute lung infection that require intensive care treatment due to disease severity. Recently, two major criteria are widely accepted to define sCAP: need of mechanical ventilation or need of vasopressors for shock. Several prediction models are designed for assessment of disease severity and for early prediction of pneumonia outcome. Aim of this study was to evaluate the mortality prediction capacities of the most commonly used severity scoring models in patients with sCAP. Material and methods: the study included 129 adult patients with sCAP hospitalized at ICU within Clinic for Infectious Diseases in Skopje during a 3-year period. Primary outcome was 30-day in-hospital mortality. Demographic, clinical and biochemical parameters were recorded and seven severity scores were calculated: Charlson comorbidity Index, CURB 65, SCAP at admission, SAPS II and APACHE II after 24 hours, MPM and SOFA during the first 48 hours. Receiver Operating Curve (ROC) analysis was performed and areas under the curve (AUC) were calculated to evaluate the prediction capacities of analysed scores. Results: the mean age of studied patients was 61 year and 66,7% were males. An overall mortality was 43.4%. Charlson Comorbidity Index has higher value in non-survivors and it was associated with poor outcome. All scores showed significantly increased values among non-survivors, except CURB-65 that had similar results in both groups, and no significance with the outcome. AUC for all scores had close values, ranging from 0.714 for APACHE II to 0.755 for SCAP. The highest AUC showed MPM and SOFA when calculated at 48 hour upon admission, with values of 0.800 and 0.839 respectively. Conclusion: the results of our study showed that the most commonly used severity scoring models had great ability to identify the patients with pneumonia that had increased risk for poor outcome, however, none of them presented stronger capacity over the others to predict the disease mortality.
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