Faculty of Medicine

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    Association Between the Polymorphism of Angiotensin-Converting Enzyme Gene and Interleukin-1 Beta Gene and the Response to Erythropoietin Therapy in Dialysis Patients with Anemia
    (Walter de Gruyter GmbH, 2023-12)
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    Eftimovska-Otovikj, Natasha
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    The polymorphism of the angiotensin-converting enzyme (ACE) gene and interleukin-1 beta (IL-1b) gene could be associated with resistance in the treatment of anemia in dialysis patients with recombinant human erythropoietin (rHuEPO). The aim of the study was to evaluate the association between the polymorphism of the ACE and IL-1b genes and the response to rHuEPO therapy in dialysis patients with anemia.
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    Attrition in Everyday Dental Clinical Practice
    (Macedonian Academy of Sciences and Arts/De Gruyter, 2024-12)
    Mladenovska Spasic, Emica
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    Pejkovska Shahpaska, Budima
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    Introduction Attrition, its prevention and therapy is a complex problem, with a multifactorial etiology. The aim of this paper is to examine the treatment of attrition in everyday dental clinical practice with the help of soft inserts. Material and method In this study, 30 patients were included, divided into two groups of 15 patients, the study and the control group. The examined patients had first degree of attrition diagnosed according to the Bardsley index, after which the condition was noted in four intervals: the initial situation, after 2, 4 and 6 months from the first visit. The research data were processed in Statistica for Windows 7.0 and SPSS version 20, and the same were presented graphically. Results In the study group with I degree of attrition, for p>0.05, no statistically significant difference was determined in the range of the Bardsley index between the four measurement times (Friedman Test: N=15; Chi-Square=7,200; df =3; p=0.0658). In the control group, for p<0.05, a significant difference was determined in the range of the Bardsley index between the four measured times (Friedman Test: N=15; Chi-Square=15.180; df=3; p=0.0017) with a significantly high value after 6 months. Discussion From the results obtained when comparing the study group in patients with I degree of attrition and the control group, a negative change from the parafunction bruxism was observed in 20% of the test group and 47% of the control group. The results of our research indicated that in patients with the first degree of attrition from the study group, soft dental inserts give significantly better results than untreated patients in the control group. This correlates with the research of Khayat N. et al. Conclusions From the results of the subjects in the group with I degree of attrition, we can conclude that the soft inserts has great efficiency as a means of management of this parafunction and therefore its application in daily therapy is recommended.
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    Small and large cell neuroendocrine carcinomas of the uterine cervix. A report of 10 cases.
    (Springer, 2005-08)
    Kubelka-Sabit, Katerina
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    Plaseska-Karanfilska, Dijana
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    Prodanova, Irina
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    Yashar, Genghis
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    Hadzi-Nicheva, Biljana
    BACKGROUND: Small (SCC) and large cell (LCC) neuroendocrine carcinomas of the uterine cervix are rare and highly aggressive neoplasms. Their association with the integration of human papilloma virus (HPV) DNA of the types 16 or 18 has been documented in many studies. AIMS: The purpose of this study is to present the clinical, histopathological, immunohistochemical characteristics and the presence of HPV DNA in ten cases of SCCs and LCCs of the uterine cervix. METHODS: Seven patients with primary SCCs and three patients with LCCs of the uterine cervix were diagnosed at our department between 1989 and 2004. Clinical data were retrieved from the patients’ files and included age, recurrence and survival. Routinely processed operative and/or biopsy specimens were used for immunohistochemical stains and hybridization procedures. Primary antibodies against several epithelial, neuroendocrine, mesenchimal and proliferative markers were included. The presence of HPV DNA was assessed by conventional in situ hybridization (ISH) using probes for HPV 16/18 and 31/33/51 and polymerase chain reaction (PCR), using three primers (MY09/11, GP5+/GP6+, E6). Six of the patients were surgically treated. Postoperatively, four received chemo and/or radiotherapy, two rejected further treatment and one patient was lost to follow-up. The other four patients underwent conservative treatment due to advanced disease. RESULTS: The patients’ age ranged from 25 to 71 years. Histologically, the tumors showed trabecular, nesting or a sheet-like pattern, with areas of necrosis and frequent mitoses. Their neuroendocrine nature was confirmed by diffuse positive immunostaining for neuron-specific enolase and low-molecular weight cytokeratins. Focal positivity for chromogranin, synaptophysin and S100, together with pancytokeratin and EMA, was evident in the majority of the tumors. Their aggressive potential was confirmed by high Ki-67 proliferative index (50-90%). HPV types 16/18 were found in 4 tumors using ISH, and HPV 16 in additional 3, using PCR (type 16). 3 of the patients developed distant metastases and died 7-48 months after receiving partial or full treatment, while 6 are alive and without evidence of disease after 4-38 months. CONCLUSIONS: SCCs and LCCs are highly aggressive neoplasms. However, early diagnosis and combined therapy may improve survival in some patients. Although mainly a morphologic diagnosis, immunohistochemistry may help in the diagnosis of SCC and LCC.
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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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    THE PRINCIPLES OF ANISOMETROPIC AMBLYOPIA TREATMENT
    (Medical faculty, Ss Cyril and Methodius University in Skopje, 2017)
    Aim: Postoperative examination of the methods of treatment of anisometropic amblyopia without strabismus. Material and method:52 patients (from 6-11 years old) with anisometropic amblyopia without strabismus were included in this study .After the prescription of spectacles on the second visit, if there was no improvement of the visual acuity of the amblyopic eye and if there was no improvement of the visual acuity of the amblyopic eye and if there is still difference of two or more lines on the vision chart between the eyes, occlusion was prescribed for at least 6 hours a day of the sound eye. Resultats:28 patients from all 52,(53%) wee female and 24 patients (47%) were male. The age of the patients was average 9,2 years. Average visual acuity on the amblyopic eye at baseline was approximately 0,33 with correction before the patching treatment. There were 7 patients (13,7%) which resolved the amblyopia only with spectacles without patching. Average time for resolution of amblyopia was 8,2 months (range 3 to 16 months)The visual acuity of 20/20 achieved 43% patients with hypermetropy anisometropic amblyopic eye and 3,8% patients with astigmatic anisometropic amblyopia. Conclusion: Early screening of preschool children for detection of anisometropic and other types of amblyopia is important for the on time treatment of the amblyopic eye.
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    CLINICAL MANIFESTATION AND PROGRESSIVE SENSORINEURAL HEARING LOSS IN THE PATIENTS WITH RETINITIS PIGMENTOSA
    (University Ss. Cyril and Methodius, Medical Faculty in Skopje, 2018)
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    Jakimovska Ditka
    Retinitis pigmentosa (RP) is an inherited retinal disorder characterized by progressive loss of photoreceptors and retinal pigment epithelium. RP is characterized by impaired night vision, slowly progressive peripheral to central visual field loss, and often a decline in visual acuity. Aim: Clinical examination of patients with retinitis pigmentosa. Material and method: From January 2006 to December 2017, 24 patients with retinitis pigmentosa (RP) were examined. The visual acuity, slip lamp and fundus examination, visual field, red cam investigation, FFA and OCT of the posterior segment were done. In the patients, the hearing condition was examined with vestibular testing. Most of the cases are still followed in the University Eye Clinic in Skopje. Results: Clinical symptoms, FFA angiograms, OCT slides and visual fields results are discussed. All 24 patients showed either arteriolar attenuation, retinal bone-spicule pigmentation and/or waxy disc pallor, which result in progressive vision loss. 18 patients showed familiar characteristic presentation of the disease and 6 patients showed sporadic cases. Myopia was found in 62,5% (15 patients) and keratoconus in 25% (6 patients). On the posterior segment, fundus, drusen of the PNO in 20,8% (5 patients) and macular abnormalities (macular edema, macular atrophy, cellophane maculopathy) in 16,7% (4 patients) was observed. Vitreous opacification 66,7% (16 patients) and cataract 62,5% (15 patients) were present and lead to additional deterioration of vision acuity. The open-angle glaucoma was found in 12,5% (3 patients). The results of the sensorineural hearing tests suggest that most of the patients with RP have difficulty communicating and socially inadequate hearing. Sensorineural hearing loss was observed in 62,5% (15 patients). In these 15 patients with hearing loss, alteration of vestibular function of peripheral type was found in 80% (12 patients) and of mixed type in 20% (3 patients). Conclusion: Treating the retinitis pigmentosa visual and hearing manifestations, as well as continuous following of the RP-affected patients is vital for preserving the vision acuity, auditory acuity and quality of life. Patients with neurosensory hearing loss of unknown genesis should necessarily undergo a preliminary eye examination to confirm or exclude the RP diagnosis.
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    MOOREN’S ULCER –A CASE REPORT
    (University Ss. Cyril and Methodius, Medical Faculty in Skopje, 2020)
    Introduction: Mooren’ s ulcer is a painful, relentless, chronic ulcerative keratitis that starts peripherally and progresses circumferentially and centrally. Mooren’s ulcer is a rare corneal ulcer and it is important to be recognized early and treated properly. The different clinical symptoms and local sings and presentation (unilateral or bilateral) of corneal Mooren’s ulcer, separate this entity in two groups, benign-limited form and aggressive or progressive form with severe symptoms and morbidity, high tendency for recurrence and increased risk of unsuccessful treatment. Case presentation: A case of Mooren’s ulcer in a female patient 65-year-old is present. She was treated at the University Clinic for eye disease in Skopje after one month of leech extraction of her left eye. The patient came at the Clinic as urgent case with melting syndrome of the peripheral left cornea. Slit lamp examination of the anterior segment confirm the Mooren’s ulcer clinical characteristic such as crescent-shaped, peripheral half-circumferential corneal ulcer which start from the limbus with gray infiltrated margin. The sclera around was not involved. The patient complained of pain in her eye and blurred vision. Red eye, foreign body sensation and epiphora were present also. Corneal and conjunctival culture was taken. The lacrimal canal was examined with the straight lacrimal cannula on a 3 ml saline –filled syringe inserted into the lower canaliculus. There was no obstruction in the upper or lower or the common canaliculus. The lacrimal canaliculus was without secretion. Conclusion: A proper, rigorous and early treatment of the Mooren’s ulcer is important for improvement of the local status of this peripherally circumferential melting syndrome. The leech extraction from the patient left eye, a month before, maybe is one of the key factors in the pathogenesis of Mooren’s ulcer.
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    CASE REPORT: REACTIVATION OF CONGENITAL OCULAR TOXOPLASMOSIS IN AN IMMUNOCOMPETENT PATIENT AFTER RECEIVING MEASLES
    (Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, 2022-08-31)
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    Pandilov, Stefan
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    Jovanov, Zoran
    case of recurrent ocular toxoplasmosis, presented through diagnostic imaging techniques and laboratory tests. To show the course and development of the clinical picture of ocular toxoplasmosis in a 19-year-old girl with good visual acuity in both eyes, which was accidentally detected during a routine ophthalmological examination for a driver's license. At the University Clinic for Eye Diseases in Skopje, several imaging diagnostic methods have been performed, such as: fundus photography, aurofluorescence, optical coherence tomography (OCT) and fundus fluorescence angiography (FFA). Imaging techniques, along with laboratory tests for specific anti-toxoplasmosis IgG and IgM antibodies, have helped to diagnose this not-so-common entity-ocular toxoplasmosis. The development of the disease was followed by a clinical picture, certain diagnostic methods in a period of seven years. Three recurrences of the parasitosis occurred during that period. The third attack of toxoplasmosis was associated with the occurrence of measles in an otherwise healthy young woman, a possible trigger for reactivation of the disease. Regular laboratory tests of anti-toxoplasma IgG and IgM antibody titers were performed with the help of ELISA at PHI UC for infectious diseases and febrile conditions in Skopje, during the entire process of monitoring. The lesion described by the diagnostic modalities corresponded to the data obtained from the literature and together with the elevated values ​​of anti-toxoplasma IgG and IgM antibodies confirmed the diagnosis of congenital ocular toxoplasmosis.
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    Anxiety in acute myocardial infarction survivors
    (SHMSHM / AAMD, 2020)
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    Sevime Sallahi Pasholli
    Introduction :Data obtained in some studies indicate that somatic disorders, in a certain percentage, are associated with a mental health problems, whether in a form of two co-existent diseases, whether psychological problems are only associated symptoms and/or response to somatic disease. Anxiety is psychological symptoms frequently encountered in patients suffering from acute myocardial infarct (AMI). The AIM of our study was to determine the percentage of anxiety in two investigated groups of patients with myocardial infarction and to determinate the correlation between socio-demographic characteristic and level of anxiety in survivors of AMI. Material and methods: The study was designed as observation cross-section including 80 patients treated at the university Clinic of Cardiology Skopje , observed as 2 groups : group 1 was presented with patients during hospitalization for AMI, and 2 group were patients survivors after 6 months of the acute coronary event. Anxiety status was assessed using HAMA scale. Results : The two groups of patients did not show significant difference according distribution of gender , smoking , physical activity, stress , age, mean HAMA , BMI , age of education and marital status . In the first group 21 (51,2%) of patients have anxiety symptoms while in second group 25 (64,1%). In our study acute MI was more prevalent in a men but women had a higher risk of anxiety disorders 27,3% v.s (22,7%). In examination groups the anxiety (HAMA score) was positive correlate with socio-demographic and clinical parameters where only we got negative correlate between anxiety with marital status and BMI in the first group and negative correlation with married status, smoking status, physical activity, stress and BMI in the second group . .Conclusion: The results in our study showed indicative representation of anxiety in patients survivors of AMI. So screening for anxiety in all AMI patients is also important because this patients should be treated differently than those who are not anxiety.
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    ACE/ARB INHIBITORS, COVID-19 AND FALSE NEWS
    (MIT University, Skopje, 2020-10)
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    Светската човечка цивилизација се наоѓа пред здравствен и социо-економски амбис предизвикан од Ковид-19 вирусната глобална пандемија. Исправени сме пред најголем цивилизациски предизвик со кој се соочува човештвото од времето после втората светска војна. Како и при секоја криза и во овој случај постојат бројни лажни вести кои го дезинформираат населението. Во тој контекст постои дилема за користењето на лековите од групите на ангиотензин конвертирачкиот ензим инхибиторите (АКЕ) и ангиотензин рецептор блокаторите (АРБ) во редовната терапија на пациентите со Ковид-19. Постојат лажни информации за влијанието на оваа група на лекови кои преку инхибиција на АКЕ-2 рецепторот наводно го олеснуваат влезот на Ковид-19 вирусот во организмот. Овие лажни вести може да доведат и до смртен исход кај овие пациенти. Со овој труд се врши анализа на досегашните медицински студии и истражувања за влијанието на АКЕ/АРБ лековите кај пациентите со Ковид-19. Заклучок: Медицинските анализи покажаа дека нема негативно влијание на АКЕ/АРБ инхибиторите врз пациентите со Ковид-19. Пациентите треба да продолжат со најредовна употреба на АКЕ/АРБ лековите во својата терапија.