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    Cardiovascular toxicity in acute tricyclic antidepressant (Amitriptyline) overdose
    (Elsevier BV, 2006-09)
    Pavlovski, Branimir
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    Becarovski, Niko
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    Melovska, Letka
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    Popovski, Nestor
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    Diagnostic Potential of Calprotectin for Spontaneous Bacterial Peritonitis in Patients Withliver Cirrhosis and Ascites
    (Walter de Gruyter GmbH / Macedonian Academy of Sciences and Arts, 2021-12-30)
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    The development of spontaneous bacterial peritonitis (SBP) is a serious and life-threatening condition in patients with cirrhosis and ascites. The aim of this study was to determine the diagnostic potential of calprotectin in ascites, for SBP in patients with liver cirrhosis and ascites before and after antibiotic treatment and to compare the mean values of calprotectin in ascites in patients with and without SBP. This prospective-observational study was comprised of 70 patients with cirrhosis and ascites, divided into two groups, the SBP and the non-SBP group. Quantitative measurements of calprotectin in ascites was completed with the Quantum Blue Calprotectin Ascites test (LF-ASC25), using the Quantum Blue Reader. The average value of calprotectin in the SBP group was 1.5 ± 0.40 μg / mL, and in the non-SBP group it was lower (0.4 ± 0.30). The difference between the mean values was statistically significant with p <0.05. The mean value of calprotectin in ascites before therapy among the SBP group was 1.5 ± 0.4, and after antibiotic therapy, the value decreased significantly to 1.0 ± 0.6; the difference between the mean values was statistically significant with p <0.05. ROC analysis indicated that calprotectin contributed to the diagnosis of SBP with a 94.3% sensitivity rating (to correctly identify positives), and the specificity was 62.5%, which corresponded to the value of 0.275. Our research confirmed that ascitic calprotectin was a good predictor, and is significantly associated with the occurrence of SBP in patients with liver cirrhosis. By monitoring the value of calprotectin in ascites on the 7th day of antibiotic treatment, the effectiveness of antibiotic treatment in patients with SBP can be determined.
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    254 Late complicationes of caustic injuries
    (Elsevier BV, 2003-09)
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    Bozinovska, C.
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    Naumovski, J.
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    Pavlovski, B.
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    Biologic Therapy in Inflammatory Bowel Disease - Results from a Single Tertiary Care Center in North Macedonia
    (Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences/Walter de Gruyter GmbH, 2023-07-01)
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    Medical therapies used for Inflammatory Bowel Disease (IBD) include conventional (e.g. 5-aminosalicylates, steroids, immunomodulators) and biologic (e.g. inhibitors of tumor necrosis factor - alpha, integrin inhibitors, interleukin inhibitors) medications. Biologics, due to their high cost, were unfortunately not covered by the public health insurance system in North Macedonia until 2019 and, therefore, not widely utilized for our IBD patients. In 2019, the University Clinic of Gastroenterology and Hepatology in Skopje developed a biologic therapy supply, provided by the National Health Insurance Fund, making this therapy available for a larger number of patients. This report presents the initial results of our prospective, single tertiary-care center study on the effects of biologic therapy in patients with IBD in North Macedonia. The study is focused on the evaluation of clinical outcomes after anti-tumor necrosis factor alpha (anti TNF-alpha) therapy in IBD patients with prior inadequate response to conventional medications.
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    Bleeding duodenal ulcer in a patient with Hemophilia A: A case report
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2024-12-31)
    Baloska, Ivana
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    Baloski, Marjan
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    <jats:p>Hemophilia A is a hereditary bleeding disorder characterized by excessive musculocutaneous hemorrhage due to a congenital deficiency of factor VIII. While upper gastrointestinal bleeding in patients with hemophilia A has been reported globally, specific literature on this topic remains scarce, emphasizing the need for further research. Case presentation: A 38-year-old male presented at the Univesrity Clinic of Gastroenterhogepatology, reporting a recent episode of black stool three days prior to admission. His digital rectal examination was unremarkable, and levels of blood urea and nitrogen (BUN) were within normal ranges. Apart from Helicobacter pylori infection, the patient lacked significant risk factors for duodenal ulcers. An esophagogastroduodenoscopy (EGD) revealed a duodenal ulcer (classified as Forest Ib), and endoscopic hemostasis was performed using 9ml adrenaline solution. Coagulation factor VIII was administered prior to the procedure. Following the EGD, the patient was treated according to the duodenal ulcer protocol and hospitalized at the University Clinic. Conclusion: Recognizing risk factors, such as Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs, is crucial in managing duodenal bleeding ulcers in patients with Hemophilia A. Screening for Helicobacter pylori infection can significantly reduce the risk of ulcer-related bleeding episodes and enhance overall patient health. Further research and the development of clinical strategies are essential to optimize the management of duodenal ulcers in this patient population.</jats:p>
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    ACUTE PANCREATITIS AS ADVERSE REACTION ТО PERINDOPRIL THERAPY
    (2019)
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    Many drugs and drug classes have been reported to be associated with acute pancreatitis. Angiotensin-converting enzyme inhibitors are one of the most commonly prescribed classes of medications, as they are used in hypertension, heart failure and proteinuria. Although well tolerated, acute pancreatitis has been reported in a few subjects treated with drugs from this group. We present a rare case of pancreatitis occurring as an adverse reaction to therapeutic doses of perindopril with good outcome. Case report: We report а case of a 63 year-old-woman presented with clinical signs of acute pancreatitis, 2 months after administration of perindopril 4 mg once daily for treatment of hypertension and reduction of proteinuria. The patient has had a 3-year-history of diabetes treated with metformin 2 x 850 mg daily, which is also classified as a possible drug that causes pancreatitis. Other causes of the disease were ruled out. After cessation of perindopril her clinical status improved and pancreatic enzymes level decreased. Conclusion: Because perindopril has a widespread clinical use, we wish to alert clinicians and urge close monitoring for pancreatitis as well as other adverse effects. Discontinuation of the drug leads to an improvement in the clinical condition.
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    252 Prothrombine time-usefull prognostic marker in amanita phalloides poisoning
    (Elsevier BV, 2003-09)
    Petkovska, L.
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    Naumovski, Dz.
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    Bozinovska, C.
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    Petrovski, D.
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    PREDICTIVE POTENTIAL OF BLOOD AND ASCITIC FLUID LABORATORY PARAMETERS FOR SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH CIRRHOSIS
    (Georgian Association of Business Press, 2021-12)
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    Patients with spontaneous bacterial peritonitis (SBP) usually have serious complications associated with deteriorating synthetic and excretory function of the liver cells, and require hospitalization and regular monitoring of biochemical parameters in blood and ascites.Aims - to determine the average values of laboratory parameters in blood and ascites in patients with SBP, to determine whether there is a difference in the average values between patients with SBP and non-SBP as well as their predictive power for the diagnosis of SBP.The study was designed as a prospective-analytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje for a period of one year. The study population included hospitalized patients with established liver cirrhosis, regardless of etiology; 70 patients, divided into two groups, 35 patients with SBP and 35 non-SBP. The selection of patients who were included in the study was conducted according to pre-determined inclusion and exclusion criteria. All diagnostic test specimens were immediately referred to the Central Clinical Laboratory. Five ml of a total of 10 ml of ascites were used for automatic counting of PMNC, and 5 ml for biochemical analysis of ascites (total sweat-WP). At the same time, for the needs of biochemical blood tests, a venipuncture of 10 ml of blood was performed.The univariate analysis showed that INR, albumin/s, creatinine/s, TP/ascites (p=0.039, p=0.035, p=0.013, p=0.000, p=0.030) were independent risk factors for the development of SBP. INR>1.2 significantly increased the chance of SBP by three times (Exp (B) = 3.222 (CI (1.063-9.768)). Serum albumin<35 g/L significantly increased the chance of SBP by five and a half times (Exp (B) = 5.712 (CI (1.135-28.748). Creatinine/s>115 µmol/L significantly increased the chance of SBP by four times (Exp (B) = 4.070 (CI (1.352-12.255)).TP in ascites ≤10 significantly increased the chance of SBP by five times (Exp (B) = 5.337 (CI (6.243-416.469). The multivariate logistic analysis confirmed that INR>1.2 and creatinine>115 µmol/L were statistical risk factors (predictors) that increased the chance of SBP.Low serum albumin values are independent risk factors for predicting SBP and significantly increase the risk of developing SBP by five and a half times. Patients with SBP have lower mean TP values in ascites than non-SBP. Low TP values in ascites<11g/L are independent risk factors for the development of SBP and significantly increase the risk of SBP by five times. Of course, additional and larger studies are necessary in order to confirm our conclusion in the future.
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