Faculty of Medicine

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    Item type:Publication,
    RELATIONSHIP BETWEEN THE MEATABOLIC SYNDROME AND THE INDIVIDUAL METABOLIC RISCK FACTORS AND SYMPTOMATIC AND ASYMPTOMATIC CAROTID ARTERY DISEASE: IS THE WHOLE LARGER THAN ITS PARTS
    (Macedonian Association of Anatomists and Morphologists, 2021)
    Deleva Stoshevska, Tatjana
    ;
    Nikoloska, Sofija
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    Stoshevski, Bojan
    ;
    Nikoloski, Marko
    ;
    Metabolic syndrome (MetS) is a group of at least three of the following metabolic risk factors : central obesity, elevated glycaemia, high serum triglycerides, low serum high-density lipoprotein (HDL), and high blood pressure. Atherosclerosis is the most common cause of extracranial CAD. It may be asymptomatic and symptomatic with clinical presentation of cerebrovascular insult (CVI) and transient ischemic attack (TIA). Aim: to determine the relationship between MetS as a whole compared to individual metabolic risk factors and CAD. This analytical unicentric cross-sectional study included 160 subjects divided into two groups: 80 subjects with MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria in the examined group (EG) and 80 subjects who have 1 or 2 individual metabolic risk factors and do not meet the diagnostic criteria for MetS in the control group (CG). CAD was diagnosed with the Esaote My Lab70 HVG device, with a linear probe (7.5 MHz), according to the Ultrasound consensus criteria for CAD of the Association of Radiologists (2002, San Francisco). CAD was significantly more frequently diagnosed in 77 (96.25%) EG subjects, compared to 34 (42.5%) CG subjects (p <0.0001). In EG symptomatic CAD had 52 subjects (67.5%) compared to only 2 (5.9%) subjects in CG. With asymptomatic CAD were 25 (32.47%) EG and 32 (94.12%) CG subjects, which was statistically confirmed as significant (p <0.0001). MetS is significantly associated with CAD, which is of cardinal importance for primary and secondary prevention of CVI and TIA.
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    AORTIC DISSECTION: OFTEN NEGLECTED DIFFERENTIAL DIAGNOSIS IN EMERGENCY AMBULANCE SERVICES
    (MIT University Skopje, 2024-03)
    Furnadjiski, Atanas
    ;
    Antova, I
    ;
    ;
    ;
    Abazi, A
    Introduction: Aortic dissection is a rupture of the aortal medial layer produced by intramural hemorrhage that leads in a separation of the aortic wall layers, forming a false and true lumen with or without communication and is highly lethal. It causes a variety of symptoms, which can be discrete and subacute, or chronic, and is frequently misdiagnosed. Aim: This case report aims to present a case of a rare, subtle manifestation of transient ischemic attack caused by an aortic dissection. Case report: A 76-year-old man came to the Emergency Medical Service complaining of recent back and left shoulder pain accompanied by discomfort, as well as left-sided tingling of the face, arm, and leg, along with left hand weakness, that had occurred multiple times in the previous five days and lasted three to four minutes. On admission, he was clinically stable and had normal vital signs, without any neurological deficit. The ECG examination revealed RBBB without ST segment abnormalities. The anamnestic and hetero-anamnestic data were completely consistent with a cerebrovascular transient ischemic attack that occurred three days prior. After reevaluating the patient clinical status that was unchanged, he experienced temporary weakness, sweating, and dizziness revealed by shifting from supine to straight position, which was instantly relieved by kneeling down on the floor. The patient was immediately referred to secondary care. While a CT of the brain revealed normal findings, the CT angiography of the aorta showed an infrarenal aneurismatic dilatation with a 4cm wide flap indicative of impending aortal dissection. The patient was promptly referred to a tertiary care for further examination and medical care. Conclusion: Aortal dissection can easily go undetected in the Emergency Medical Services due to its pleomorphic clinical presentation, which oscillates between acute hemodynamic shocks to subtle, often undetectable symptomatology. Awareness of aortic dissection as differential diagnosis should be promptly lifted to a higher order thinking.