Faculty of Medicine
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Item type:Publication, The Impact of Pneumonia on the Course and Outcome in Patients with Seasonal Influzenza(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2020-09-01); ; ; ; Introduction: Seasonal influenza, although often presented as a mild, self-limiting disease, is frequently accompanied by complications that lead to the development of a severe clinical presentation and a fatal outcome. The most common are respiratory complications, with secondary bacterial pneumonia being the leading cause. Aim: The aim of this study is to determine the impact of pneumonia on the severity of the clinical presentation and outcome in patients with seasonal influenza. Materials and Methods: This research is comparatively group-based and has been conducted at the University Clinic for Infectious Diseases and Febrile Conditions during a three-year period. The analysis consists of 122 adult patients with clinically and laboratory-confirmed influenza. Based on the severity of the clinical picture, the patients are divided into two groups, severe (n=87) and mild (n=35) forms of the disease. The study included demographic, general data, clinical symptoms, and signs as well as complications. Results: Of 122 patients with seasonal influenza, complications were registered among 108(88.52%), with a significantly more frequent emergence among the group with severe influenza 93.1% vs 77.14% (p=0.012). Pneumonia was the most common 98(80.33%) and had a significant effect on disease severity (p=0.002). Complications from the types of ABI 8(6.56%), ARDS 7(5.74%), sepsis 5(4.1%), DIC 4 (3.28%) and otitis 2(1.64%) were reported only in the group with severe influenza. Acute meningoencephalitis was registered among 5(4.1%), gastroenterocolitis among 3(2.46%), and hepatic damage among 14(11.47%) of patients. Conclusion: Pneumonia as the most common complication among patients with seasonal influenza significantly impacts the clinical course and outcome of the illness. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Pneumonia as a primary manifestation of infective endocarditis - Case report(Macedonian Association of Anatomists and Morphologists, 2024-10); ; Kartalova Janeku, MarijaThis case report discusses the clinical presentation, diagnostic challenges, and clinical implications of a patient initially hospitalized for pneumonia, later diagnosed with infective endocarditis with negative blood cultures. A 72-year-old female presented with a 3-day history of general infection symptoms and a chest X-ray indicative of right-sided pneumonia. The patient did not respond adequately to standard antimicrobial therapy, prompting further diagnostic investigation. A computed tomography scan of the chest revealed a suspected thrombus in the left atrium. Echocardiography confirmed vegetation on the posterior mitral leaflet. Blood cultures and serological tests were negative. Follow-up echocardiography showed progression of the vegetation with compromised mitral valve function, necessitating surgical intervention, and the patient was transferred to the Cardiac Surgery Clinic. The case emphasizes the importance of timely recognition of infective endocarditis, even when patients initially present with respiratory symptoms. The diagnostic protocol includes echocardiographic methods for detecting valve vegetations. Negative blood cultures do not rule out endocarditis. Rapid diagnosis is crucial, as surgical intervention is often indicated, and failure to diagnose can have fatal consequences. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Consequences of COVID 19 in Patients with Laryngeal Cancer(SHMSHM - AAMD, 2024-05-10); ; ; Background: The global pandemic, triage and telemedicine have contributed to late diagnosis of patients with advanced carcinoma of the larynx. Warming and humidification of air in this type of patient are completely cut off and lost, which devotes to the occurrence of chronic lung disease. Aim: Representing patients with laryngeal carcinoma who became infected with Covid 19, recognizing the severity of Covid 19 manifestation and its outcome. Material and methods: University ENT Clinic in Skopje was Covid Center for treatment and care of patients with Covid 19. A total of 405 patients with moderate and severe clinical picture were hospitalized in the period from 2019 to 2021. There were 8 patients with laryngeal cancer. Results: In all 8 patients auscultatory, oxygen saturation, CT scan presents massive interstitial pneumonia, typical of Covid 19. Four patients who survived had high oxygen saturation, low CRP and laryngectomy performed more than 10 years ago. The other four patient who failed the disease had low saturation, high CRP, and total laryngectomy which was performed not more than 4 years ago. Conclusion: According to our experience, the reasons for the presented number of lethal outcome cannot be fully determined that is in line of the professional literature, which was confirmed in this case. It is estimated that a lack of tracheostomal warmers and humidifiers leads to increased mortality in cancer patients, especially in Covid 19 pandemic. Application of protection and rehabilitation protocols in these patients is necessary to improve the quality of life and reducing the risk factor for Covid disease 19. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ANALYSIS OF THE OCCURRENCE OF POSTOPERATIVE PULMONARY COMPLICATIONS AFTER LUNG SURGERY(MIT University Skopje, 2023); - 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Challenging Case of Multisystem Inflammatory Syndrome in a 19- Year Old Female: A Case Report(Macedonian Society of Nephrology, Dialysis, Transplantation and Artifical Organs, Department of Nephrology, 2022); ; Introduction. In comparison to older adults, SARSCoV-2, leads to a mild illness in children and young adults typically manifested with fever, cough and gastrointestinal symptoms. However, the multisystem inflammatory syndrome in children and young adults (MISC) emerged during the coronavirus disease in 2019 pandemic. Case report. We report a challenging case of a 19- year old female patient with signs and symptoms of multisystem inflammatory syndrome and SARS-CoV2 infection, most probably as a post infectious disease with onset between 2 to 4 weeks after the infection. Its clinical symptoms may have overlaped with classical Kawasaki disease (systemic vasculitis) or Kawasakilike syndrome (atypical) with fever, gastrointestinal symptoms, rash, conjunctival injection, hypotension, sore throat, mucosal changes with a relative lack of severe respiratory disease, myocarditis, hypoalbuminemia and elevated inflammatory markers. And indeed, the clinical presentation of COVID-19 in young adults resembles Kawasaki disease with gastrointestinal manifestations to severe inflammation with myocarditis. Conclusion. Timely diagnosis and proper treatment of the multisystem inflammatory syndrome and SARSCoV-2 infection are real challenge requiring multidisciplinary approach and tertiary resources. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, THE EFFECT OF METHYLPREDNISOLONE VERSUS DEXAMETHASONE IN INCREASING THE DIABETOGENIC EFFECT OF SARS-CoV-2 INFECTION AND THE DEVELOPMENT OF A NEW-ONSET DIABETES MELLITUS(Macedonian Association of Anatomists, 2022); ; ; Milenkovski, MarijanSARS-CoV-2 causes predominantly lung disease, but by way of binding to the angiotensinconverting enzyme 2 (ACE2) receptors, it can attack key metabolic organs and may lead to alterations of glucose metabolism. The aim of the study was to examine the effect of methylprednisolone compared with dexamethasone on the glycaemic control as well as the development of new-onset diabetes in patients who were hospitalized due toCOVID-19 pneumonia. We reviewed the records of 203 consecutive patients who were hospitalized with a clinical presentation of COVID-19 pneumonia in the modular hospital at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, from December 2020until May 2021. We identified 65 patients with diabetes (32,0%), 49 patients (75%) of whichwith pre-existing diabetes, and 16 (25%) with newly diagnosed diabetes. Impaired glycoregulation was recorded in 19,2% of patients, of whom 5,5% did not receive any corticosteroid-therapy, 22,4% were treated with methylprednisolone – pulse doses,and 21,4% were treated with dexamethasone. Patients with diabetes had a 1,9 times (CI 0,9-3,9) higher mortality rate than nondiabetic patients. We suggest that, if corticosteroid therapy is necessary during the treatment of COVID-19 pneumonia, it is safer to administer dexamethasone than methylprednisolone, especially in patients who have pre-existingdiabetes or are at risk ofdeveloping diabetes. Deterioration of glycoregulation and the need to replace oral antidiabetic therapy with insulin are common. New-onset diabetes often persists even after recovering from Covid-19 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Impact of Pneumonia on the Course and Outcome in Patients with Seasonal Influzenza(Macedonian Academy of Sciences and Arts/Sciendo, 2020-09-01); ; ; ; Introduction: Seasonal influenza, although often presented as a mild, self-limiting disease, is frequently accompanied by complications that lead to the development of a severe clinical presentation and a fatal outcome. The most common are respiratory complications, with secondary bacterial pneumonia being the leading cause. Aim: The aim of this study is to determine the impact of pneumonia on the severity of the clinical presentation and outcome in patients with seasonal influenza. Materials and methods: This research is comparatively group-based and has been conducted at the University Clinic for Infectious Diseases and Febrile Conditions during a three-year period. The analysis consists of 122 adult patients with clinically and laboratory-confirmed influenza. Based on the severity of the clinical picture, the patients are divided into two groups, severe (n=87) and mild (n=35) forms of the disease. The study included demographic, general data, clinical symptoms, and signs as well as complications. Results: Of 122 patients with seasonal influenza, complications were registered among 108(88.52%), with a significantly more frequent emergence among the group with severe influenza 93.1% vs 77.14% (p=0.012). Pneumonia was the most common 98(80.33%) and had a significant effect on disease severity (p=0.002). Complications from the types of ABI 8(6.56%), ARDS 7(5.74%), sepsis 5(4.1%), DIC 4 (3.28%) and otitis 2(1.64%) were reported only in the group with severe influenza. Acute meningoencephalitis was registered among 5(4.1%), gastroenterocolitis among 3(2.46%), and hepatic damage among 14(11.47%) of patients. Conclusion: Pneumonia as the most common complication among patients with seasonal influenza significantly impacts the clinical course and outcome of the illness.