Mucha, Argjent

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Mucha, Argjent

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Mucha, Argjent

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Trend of Kidney Replacement Therapy in North Macedonia from the Years 2015 Through 2020
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2024-11-01)
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Simjanovska, Simona
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Rushiti, Emine
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Cibrev, Dragan
Kidney replacement therapy (KRT) by dialysis or kidney transplantation represents the main treatment modalities for patients with kidney failure. Here we evaluate the trends in taking care of such patients in North Macedonia from 2015 through 2020.
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Дијабетично стапало- патогенеза и клиничка класификација
(SHMSHM / AAMD, 2012-06)
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RARE CASE OF OVARIAN STEROID CELL TUMOR NOT OTHERWISE SPECIFIED IN A POSTMENOPAUSAL WOMAN
(Macedonian Association of Anatomists, 2022-08-31)
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Plaseski, Toso
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Todorova, Biljana
Ovarian steroid cell tumors, not otherwise specified(NOS), are rare ovarian sex cord–stromal tumors with malignant potential.They represent less than 0.1% of all ovarian neoplasms.Little is known about this tumor, it is rare, and only a small number of case reports are available in the literature. This type of tumor can produce testosterone, leading to hyperandrogenism,virilizationand amenorrhea.Postmenopausal occurrences are rare.We present a 60-year-old woman with onset of virilization,worsening alopecia and excessive growth of hair onabdominal and genital parts of the body.She haselevated levelsof adrenal androgens.Radiologic studies were consistent with left sided ovarian changes. A diagnostic and therapeutic bilateral salpingo-oophorectomy confirmed steroid cell tumor NOS in bothovaries. Post-operatively, the patient had complete resolutionof her symptoms and normalization of testosterone levels.
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Once-weekly semaglutide use in glucagon-like peptide-1 receptor agonist naïve patients with type 2 diabetes in North Macedonia: Real-world data from the MIRAGE study
(Elsevier BV, 2023-11)
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Chekorova Mitreva, Biljana
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Aims The MIRAGE study aimed to evaluate the real-world use of once weekly (OW) subcutaneous semaglutide in glucagon-like peptide-1 receptor agonist naïve type 2 diabetes patients in routine clinical practice in North Macedonia. Methods MIRAGE was a multicentre, single-arm, retrospective and 30-weeks study, conducted in North Macedonia. Primary [change in glycated haemoglobin (HbA1c)] and secondary endpoints [change in body weight, fasting plasma glucose (FPG), lipid parameters, blood pressure, waist circumference, glycaemic and weight-loss target achievement] were evaluated between baseline and end of study (EOS). Results Baseline characteristics of 314 patients enrolled in the study were, mean age: 55.5 years, HbA1c: 9.0%, diabetes duration: 7.8 years, body weight: 105.2 kg and waist circumference: 114 cm. Patients at EOS experienced statistically significant estimated mean change in HbA1c: -2.2% points, body weight: -9.0 kg, and FPG: -4.1 mmol/L (all p<0.0001). At EOS, 62.1% patients achieved HbA1c <7%, and 79.3% had ≥1% HbA1c reduction. A weight reduction of ≥3% and ≥5% was noted in 88.3% and 73.3% patients, respectively. No new safety concern has emerged. Conclusions Findings from MIRAGE study demonstrated glycaemic and weight-loss benefits of semaglutide, with improvements in other cardiometabolic parameters. The study supports real-world OW subcutaneous semaglutide use in North Macedonia.
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THE ASSOCIATION OF HISTORY OF PREVIOUS SPONTANEOUS ABORTION OR STILLBIRTH WITH SUBSEQUENT RISK OF GESTATIONAL DIABETES MELLITUS
(Macedonian Association of Anatomists and Morphologists, 2024-12)
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Introduction: Gestational diabetes mellitus [GDM] is a disorder of glucose metabolism, with varying degrees of clinical severity, that first appears during pregnancy. The aim of this study is to examine the association of a history of previous spontaneous abortions and stillbirths with the occurrence of GDM in the current pregnancy. Material and methods: The study included all pregnant women who underwent an OGTT [Oral Glucose Tolerance Test] for the diagnosis of GDM, in the period of 3 years, in the laboratory of the University Clinic for Endocrinology, Diabetes and Metabolic Disorders – Skopje. Patients were divided into two groups: Study group [with a positive OGTT] and Control group [with negative OGTT]. Anamnestic and laboratory parameters were provided by medical documentation. Results: The analysis indicated that pregnant women with positive OGTT had a significantly higher number of previous miscarriages compared to pregnant women with a negative OGTT [Pearson Chi-square=8.6521, df=3, p=0.0343]. According to the analysis, pregnant women with a positive OGTT had significantly more stillbirths compared to pregnant women with a negative OGTT status [Pearson Chi-square=9.5779, df=2, p=0.0083]. Conclusion: History of previous miscarriages significantly increases the risk of gestational diabetes mellitus. A history of one miscarriage significantly increases the likelihood of gestational diabetes mellitus by 1.599 times. A history of two miscarriages significantly increases the likelihood of gestational diabetes mellitus by 2.339 times. Pregnant women with a positive history of one previous stillbirth are 4.365 times more likely to have a positive OGTT status compared to pregnant women who have not had any stillbirths.
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Редок случај на конгенитална адренална хиперплазија асоцирана со хиперкортизолемија
(2022)
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Marija Ilijovska
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Biljana Todorova
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Introduction: Congenital adrenal hyperplasia (CAH) describes a group of autosomal recessive disorders characterized by enzyme deficiency in the steroidogenic pathways most commonly due to 21 hydroxylase deficiency.CAH is generally associated with decreased or absent production of cortisol, increased ACTH secretion and excessive production of adrenal androgens and progesterone, including 17OH progesterone. We report a rare case of CAH associated with hypercortisolism. Case report:A 40 years old woman was referred to the Endocrinology unit for management of infertility presented with oligomenorrhea,acne and hirsutism. She had previously been labelled as a case of PCOSy and had been placed on various types of medications such as hormonal therapy and spironolactone.The first laboratory findings showed elevated levels of cortisol, adrenal androgens and testosterone. 17OH progesterone was also increased. After the diagnosis of CAH multiple laboratory tests were made and the plasma cortisol appeared to be repeatedly elevated. Dexamethasone test showed partial supression. 24hour urine cortisol test, abdominal CT and MRI of the pituitary glandwere also performedand showed no pathological findings. The diagnosis of CAH due to 21 hydroxylase deficiency was confirmed with genetic studies that showed mutation in CYP21A2(I172N). The genotype was homozygous. Conclusion:As the pathophysiology is basically a defect in the biosynthesis of cortisol, one may not consider CAH in patients with hypercortisolism. Althought this is an extremely rare case, more attention should be paid to this condition in hyperandrogenic womeneven if cortisol levels are elevаted. Key words: CAH, hyperandrogenism, PCOSy, hypercortisolemia
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Case report: therapeuthic approach in risperidone induced hyperprolactinemia
(University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Medical Faculty, University “Ss. Cyril and Methodius” - Skopje, 2022-10-13)
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Zhivkovich, Marija
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Jovanovska Todorova, Biljana
A 19-year-old female patient with disturbed menstrual cycles caused by chronic use of risperidone and worsening of her psychological state after the introduction of a dopamine agonist. The 17-year-old patient was diagnosed with dissociative conversion disorder. Therefore, she was placed on therapy with risperidone and lamotrigine. After the introduction of the antipsychotic therapy, the menstrual cycles became irregular. Hormonal studies confirmed high prolactin values of 2226 mIU/ml (40-530), and magnetic resonance (MR) confirmed a pituitary adenoma measuring 4 mm. Therefore, the gynecologist introduced therapy with the dopamine agonist cabergoline, 0.5 mg weekly dose. After a short period, the patient’s psychological state became destabilized, with an irritable, aggressive mood, which was followed by consultations with psychiatrists and frequent changes in antipsychotic therapy. After one year, the antipsychotic aripiprazole was introduced together with valproic acid and lorazepam. After two months, the patient noticed a significant improvement in behavior and mood. In the interim, the dose of cabergoline was reduced to 0.25 mg. The patient was referred to our clinic. Control prolactin values were low and cabergoline was discontinued. And the control MRI of the pituitary gland did not confirm the presence of a microadenoma. Discussion and conclusion: The clinical presentation of hyperprolactinemia affects the therapeutic strategy. Asymptomatic hyperpolactinemia should not be medically treated. In case of long-standing hyperprolactinemia, a pituitary adenoma may appear. Dopamine agonist treatment is risky because it may worsen the psychiatric condition as in our case. There are two strategic approaches in antipsychotic-induced hyperprolactinemia: therapy with combined oral contraceptives or treatment with aripiprazole, an antipsychotic that has a dual effect on D2 receptors (agonist/antagonist). Aripiprazole is an antipsychotic that does not cause hyperprolactinemia.
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Review of patients with diabetes in Macedonia
(Scientific association of endocrinologist and diabetologist of Macedonia, 2014)
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I. Ahmeti
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NGAL and Cystatin C: Two possible early markers of diabetic nephropathy in patients with type 2 diabetes mellitus
(Македонско лекарско друштво = Macedonian Medical Association, 2020-12)
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Introduction. Diabetic nephropathy (DN) is a progressive renal impairment characterized by impaired renal architecture and function and is one of the leading causes of permanent renal impairment. Patients with DN have a high mortality rate, which is primarily due to cardiovascular complications. In everyday practice in the Republic of North Macedonia, serum creatinine, microalbuminuria and glomerular filtration rate are used to detect DN. However, these standard tests do not always allow for detection of initial DN damage. Aim. The aim of this study was to investigate the role of NGAL (in urine) and Cystatin C (in serum) values as adjunctive testing of existing markers (microalbuminuria and creatinine) in unmasking early structural and functional renal impairment in asymptomatic patients with type 2 diabetes mellitus (DM type 2). Methods. This was a prospective, observational (6-month follow-up) study, involving 60 patients aged 35-70 years. The first two groups were patients with diagnosed DM type 2 for a minimum of 5 years, 15 patients diagnosed with DM type 2 with diabetic nephropathy and 15 patients without diabetic nephropathy. The third group consisted of healthy respondents (30). In addition to standard biochemical analyses, the three groups were also examined for body fluid concentrations of NGAL (architect urine NGAL) and Cystatin C (nephelometry), as well as standard biomarkers for renal nephropathy (serum creatinine and microalbumin). Results. The respondents from the three analyzed groups did not differ significantly in terms of gender structure (p=0.71) and age (p=0.068). The study found that (the core values) baseline creatinine, microalbuminuria, NGAL and Cystatin C serum levels were higher in patients diagnosed with DM type 2 and diabetic nephropathy (DN) compared to those with diabetes and without diabetic nephropathy in healthy trials. Also, after 6 months of follow-up, it was proven that in patients diagnosed with DM type 2 and DN all four parameters were higher with confirmed significance unlike the group of patients with DM type 2 without DN. In the group with diabetes and diabetic nephropathy, during the re-evaluation after 6 months of monitoring we registered a non-significant increase in the biomarker NGAL p=0.16), and a significant increase in the biomarker Cystatin C (p=0.016). There was a statistically significant correlation between baseline creatinine values and baseline control values of Cystatin C (p<0.0001), creatinine and NGAL values after a 6-month re-evaluation (p=0.014), all of which were positive. The correlation between the two biomarkers NGAL and Cystatin C were statistically insignificant in the first measurements (p=0.160), and were significant and direct positive on the second measurements, after 6 months (r=0.536, p=0.039). The two markers changed in direct proportion to the serum, with the increasing of one marker in the serum. Also, the other biomarker increased, and vice versa. Conclusion. NGAL and Cystatin C, biomarkers of renal impairment, are correlated with decreased renal function in patients with DM type 2, suggesting that NGAL and Cystatin C may be used as adjunctive tests to existing ones (creatinine and microalbuminuria) to unmask early renal dysfunction.
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A RARE CASE OF A PATIENT WITH HYPERTHYROIDISM AFTER HYPOTHYROIDISM
(Georgian Business Press LLC, 2023-08)
Biljana Jovanoska Todorova
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Georgieva Janev, O.
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Primary hypothyroidism caused by an underlying autoimmune thyroiditis disease is very common in clinical practice, while one of the most commonly seen types of hyperthyroidism states is Graves’ disease. In hypothyroidism, patients are thought to be lifelong treated with substitution therapy with the lacking levothyroxine hormone. Usually due to the started autoimmune process that progressively destroys the thyroid tissue, the doses of levothyroxine increase in a different period of time during the follow ups. Rarely, the doses need to be tapered down, and that is the exact moment when the physician should be suspicious of a possible conversion from a hypothyroid state to a hyperthyroid one. We describe a case of a woman who was diagnosed with hypothyroidism and treated with suitable doses of levothyroxine, and then gradually the levothyroxine doses were tapered and eventually discontinued because of the clinical and laboratory confirmed state of hyperthyroidism- requiring a treatment with thiamazole. To our knowledge, this case is one of rarest worldwide so far published cases that illustrate the shortest time interval between the diagnosis of hypothyroidism and its switch to a hyperthyroid state.

Mucha, Argjent

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