Andreevski, Vladimir
Preferred name
Andreevski, Vladimir
Official Name
Andreevski, Vladimir
Alternative Name
Vladimir Andreevski,
V Andreevski,
Andreevski V,
Владимир Андреевски,
В Андреевски,
Андреевски В,
Д-р Владимир Андреевски,
Main Affiliation
Email
vladimir.andreevski@medf.ukim.edu.mk
banebumbar_med@hotmail.com
41 results
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Item type:Publication, 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); ; ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Onset and Prognosis of Hepatorenal Syndrome - Three Year Single Center Experience(BANTAO Association, 2010-12); ; Introduction: The hepatorenal syndrome (HRS) refers to the development of acute renal failure in the setting of advanced liver disease. It can occur in a substantial proportion of patients with fulminate hepatic failure from any cause. The aim of our study was to investigate the onset, outcome and prognosis of patients with hepatorenal syndrome hospitalized at our unit. Methods: This is a cross-sectional retrospective study in a cohort of 543 cirrhotic patients, during a period of 3 years (January, 2008 - December, 2010). Hepatorenal syndrome was detected in 20 (3.7%) patients and in all of them a few variables such as: age, gender, history of cirrhosis or other liver disease, etiology of cirrhosis, Child-Pugh classification, other complications of the cirrhosis except for HRS, treatment and survival were analyzed. Results: The average preceding time up to the occurrence of HRS was around 3 years (36.8±47.8 months), although there were 4 patients who developed HRS only a month after the onset of cirrhotic symptoms. A group of seven patients with HRS diagnosed during the first year of the onset of symptoms. The mean age of patients was 55.5±13.3 years. There was a significant difference in the gender distribution, three quarters of patients being males. With regard to the etiology, 12 patients had alcoholic abuse, and a half of them (50%) were with mixed etiology (Hepatitis B plus alcohol abuse). Two patients had a pure chronic hepatitis B virus (HBV) infection as a cause of cirrhosis. Four were with chronic liver disease of unknown etiology (2 of them with confirmed histology of chronic hepatitis). All of the cirrhotic patients were scored as grade C according to the Child – Pugh classification. Hepatic encephalopathy was the most predominant concomitant complication present in 17 (85%) patients with HRS. Only 2 showed signs of malignancy with suspected hepatocellular carcinoma (HCC). The estimated average hospital stay was 6.15 days, ranging from 1-14 days. The applied treatment was generally unsuccessful. Majority of cases (14) were supported with albumin and fresh frozen plasma transfusion and haemodialysis was performed in 4 patients. The mortality rate was high, reaching 80% (16 patients) with an average time of death at 6.8±4.4 days after the hospital admission. Although the evaluation period was short, there is a clear raising trend in number of detected patients with HRS at our Clinical Center. Conclusion: Compared to other reports, our single centre experience shows lower occurrence rate. Despite the use of available conservative medical treatment, there was no recovery of the hepatic failure in any of HRS patients. The absence of liver transplantation or TIPS in our country is the second contributing factor related to the high mortality rate in our cohort. Finally, gastroenterohepatologists should be aware and try to prevent iatrogenic precipitants of HRS as an aggressive diuretic treatment or removal of large volumes of ascitic fluid by paracentesis without compensating for fluid depletion by intravenous replacement could additionally impair the renal failure. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Pancreas and duodenum herniation in a giant inguinal hernia sac in a patient with severe scoliosis: a rare case report(Oxford University Press (OUP), 2025-07); ; ; Giant inguinal hernias (GIHs) are rare clinical entities, typically containing omentum or small bowel. Involvement of retroperitoneal organs, such as the pancreas and duodenum, is exceedingly uncommon due to their fixed anatomical positions. We report a unique case of a 52-year-old male with a longstanding right GIH and severe scoliosis, in whom preoperative imaging and surgical exploration revealed herniation of the pancreatic head and duodenum into the hernia sac. Contributing factors included altered retroperitoneal geometry from spinal curvature, reduced abdominal wall tone, and congenital right hip displacement with associated functional limitation. Incidental findings of multiple left hepatic duct calculi raised concerns for biliary stasis due to chronic duodenal displacement. This case highlights the importance of considering atypical hernia content in patients with longstanding hernias and complex musculoskeletal deformities, and underscores the role of comprehensive imaging and multidisciplinary assessment in surgical planning. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Evaluation of the Effects of Gastro Protect as an Alternative Medicine on Gastritis and Other Gastrointestinal Symptoms(Macedonian Academy of Sciences and Arts, 2024-03-01); ; ; ; Introduction: The use of herbal medicine as a part of the Complementary and Alternative Medicine is increasing worldwide. Herbal remedies are used to better different conditions including gastritis. Material and Methods: We conducted a prospective randomized control clinical trial on a total sample of 72 patients with gastritis in order to examine the effects of the commercial herbal product Gastro Protect. After 6 weeks of conventional therapy the patients were divided into two groups with 36 patients each. As a continuation of the treatment, Group 1 received conventional therapy + Gastro Protect and Group 2 received conventional therapy + Placebo. We analyzed 14 selected gastrointestinal symptoms, five related to digestive problems, and nine related to stool and bowel problems. For assessing the selected symptoms we used seven point gastrointestinal symptom rating scale (GSRS). Results: The Gastro Protect group had a significantly lower GSRS score (better condition) compared to the Placebo group related to all five selected symptoms of digestive problems as: abdominal pain (p=0.0250), hunger pain (p=0.0276), nausea (p=0.0019), heartburn (p=0.00001), and acid reflux (p=0.0017). The Gastro Protect group, also had a significantly lower GSRS score (better condition) compared to the Placebo group related to three out of nine selected bowel symptoms: rumbling (p=0.0022), abdominal distension (p=0.0029), and gas or flatus (p=0.0039). Conclusion: Gastro protect was effective in treating gastritis and other gastrointestinal symptoms. It was safe for usage and showed almost no side effects. In our study, Gastro Protect reduced the examined gastric symptoms and related examined intestinal symptoms. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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); ; ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, FOUR YEAR RESULTS OF CONSERVATIVE TREATMENT OF BENIGN STRICTURES OF THE ESOPHAGUS WITH SVARY GILLIARD TECHNIQUE OF BOUGIENAGE: CROSS-SECTIONAL STUDY REPRESENTING FIRST EXPERIENCES IN REPUBLIC OF MACEDONIA(Macedonian Academy of Sciences and Arts, 2018-01); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Efficacy and tolerability of hyaluronic acid, tea tree oil and methyl-sulfonyl-methane in a new gel medical device for treatment of haemorrhoids in a double-blind, placebo-controlled clinical trial(Springer Science and Business Media LLC, 2012-09); ; ; Zuccari, CTopical formulations are widely used in anti-haemorrhoidal treatment, but often lacking controlled clinical trials. Here, we report the results from a controlled clinical trial performed with a new gel medical device (Proctoial) containing hyaluronic acid with tea tree oil and methyl-sulfonyl-methane as major components. The total number of 36 haemorrhoidal patients (grade 1-3) was enrolled in a double-blind, placebo-controlled clinical trial and divided into 2 equal parallel groups. The anal pain, pain during defecation, visible bleeding, pruritus and irritation/inflammation were recorded before and after 14-day treatment using a visual analogue scale both by the investigators and by the patients. Safety and tolerability of the treatments were also recorded. The new gel medical device statistically significantly reduced all the symptoms after the treatment compared to placebo. The results indicated also a very good tolerability and safety of the treatments. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Short and Medium-Term Therapeutic Effects of Pneumatic Dilation for Achalasia: a 15-year Tertiary Centre Experience(Macedonian Academy of Sciences and Arts, 2013); ; Nenad JokismovikPneumatic dilatation (PD) is commonly used endoscopic technique to weaken the lower esophageal sphincter in patients with achalasia. It is considered as the most effective non-surgical therapeutic option for achalasia, but further data on the overall effectiveness and rate of complications is needed. Aims: Determine the short and medium-term therapeutic effectiveness of PD for achalasia and estimate the cumulative probability of remaining in remission over one year after a single treatment. Study also aimed to identify clinical predictors of therapeutic outcome achieved by PD and assess for PD-related complications. Methods: A total of 26 patients with achalasia who were treated with PD between 1997 and 2011 at a tertiary care center were followed for up to 1 year. Data related to demographics, clinical symptoms and PD-related complications was collected. Short (1 and 3 months) and medium (1 year) term therapeutic effectiveness of PD was assessed with the use of Eckhart scoring system for evaluation of clinical symptoms. Probability of staying in remission one year after a single PD was determined by using Kaplan-Meier estimator. In order to prevent major complications limited maximal pressure of no more than 11 PSI was used during PD. Results: Twenty six patients with symptomatic achalasia (mean age 47.1 ± 18.5 years, 82% males) underwent 44 PD procedures (mean 1.7/patient). Thirteen patients (50%) had a single PD, 10 patients (38%) had two dilatations, and 3 patients (12%) had three or more dilatations over one year. Nineteen out of the 26 patients (73%) were in remission, at one and three months each, following the initial PD. Seventeen out of the 26 patients (65%) remained in remission after one year. A total of 5 patients (19%) were referred for surgery over 1 year due to lack of success of endoscopic treatment. The mean Eckhart symptom scores, at 1 month (3.2 ± 1.2), 3 months (3.5±1.3) and 1 year (1.8 ± 0.6) after the initial PD, were significantly lower when compared to the mean initial Eckhart symptom score (9.7 ± 4.4 ,P<0.05). Using a symptom score above 3 as a cutoff value for treatment failure, the probability of remaining in remission (relapse-free) after a single dilatation was 35% at one year. Patient gender appeared as important treatment outcome predictor. Namely, 4 out of the 5 patients (80%) with PD treatment failure were males. There were no major complications from the 44 PDs. One patient (3.8%) developed significant heartburn. Majority of PDs (33/44, 75%) were followed with minor, subclinical esophageal mucosal bleeding from the dilation site as seen on post-dilation esophagoscopy. Conclusion: Pneumatic dilatation is effective short and medium term treatment option for majority of patients with achalasia without significant related complications. Further studies are warranted to assess the possible role of limited maximal pressure use of no more than 11 PSI during PD in preventing esophageal perforations. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Polymorphism IL 28B and response to therapy in chronic hepatitis C(2016); ; ; ; INTRODUCTION: Chronic hepatitis C is still a majgor cause for developing cirrhosis and hepatocellular carcinoma which often results in liver failure and thus in liver transplantation. According to the World Health Organisation 180 million people are infected worldwide and 3-4 million new infections per year were estimated (1). The current standard of care (SOC) for chronic HCV infection is a combination of pegylated interferon (PegINF -2a or PegINF -2b) plus body-weighted ribavirin (RBV) for the duration of 24 weeks or 48 weeks depending on the HCV viral genotypes (2). The primary goal of the treatment is HCV eradication, which is actally sustained viral response (SVR). The SVR is defined as undetectable HCV RNA in serum, 24 weeks after the completion of the antiviral treatment (3). However, only about 40-50% genotype 1 or 4 patients treated and 80% genotype 2 or 3 patients treated could respond completely and achive sustained virological response (4,5). Moreover, side effects from the therapy such as influenza-like symptoms, psychiatric symptoms and hematological abnormalities, could result in the dose reduction or even the premature discontinuation of the treatment (6). To avoid these potential adverse events in patients who do not benefit from the treatment and to reduce the cost of therapy, it is necessary to predict an individual’s response before at the early stage of the treatment. Virus-specific characteristic (viral load, genotype, viral variants as mutations of interferon sensitivity determining region- ISDR) may be responsible for virologic response but also clinical parametars (age, gender, BMI, fibrosis stage, liver enzymes) (7,8). Investigations on genetic determinants of chronic hepatis C established that a single nucleotide polymorphism (SNP) in the interleukin (IL)-28B gene promoter region affected the spontaneous and induced clearance of hepatitis C virus (9). Among 500 000 genetic variants which were analyzed genome-wide, a few associated with virologic response were identified, and showed variable frequency and importance across human ethnic groups (10). The mechanism by which SNPs influence the outcome of HCV infection and its treatment is not clear. It is suggested that regulation of the promoter region of IL28B in antiviral activity may also affect two other genes belonging to interferon (INF)- family encoded in this region (10, 11). INF- possess antiviral activities agains hepatitis C virus (12). The genome-wide associated studies (GWAS) showed that SNPs near IL28B gene (CC for rs12979860, TT for rs8099917 and AA for rs12980275) were associated significantly with treatment outcome in patient with chronic hepatitis C. However, about 50% of patients with a sustained virological response do not carry favorable IL28B alleles (13). The factors which increase the chance of a therapeutic response in these patient are not yet known. A detailed analysis if the course of therapy of chronic hepatitis C with pegylated INF and ribavirin in the presence of a hazardous IL28B allele might better delineate the clinical characteristics of the difficult-to-treat group of patients. The aim of the study was to evaluate the effects of IL28B polymorphism on response to treatment with peginterferon and ribavirin in patients with chronic hepatitis C. MATERIAL AND METHODS: Twenty-five adult Caucasians previous assessed with chronic hepatitis C due to HCV genotupe 1 and 3 were included in the study. The study protocol was approved by the institutional ethics committee and written informed consent was obtained from each study participant. Patients were treated with standard antiviral therapy with pegylated INF alfa and ribavirin. Pegylated interferon alfa 2a 180 μg was administered subcutaneously once a week. Body-weighted ribavirin was administered daily. The treatment duration was 48 weeks for patients with HCV genotype 1 and 24 weeks for patients infected with HCV genotype 3. SVR was used for the assessment of the antiviral treatment effectiveness. SVR is defined by undetectable viral RNA 24 weeks after the end of treatment. Finaly eighteen patients were analysed, because two premature discontinuated the treatment and for five there are no available data for SVR. Sample od peripheral blood were collected from each patient enrolled in the study for HCV quatntification and IL28B polymorphism genotyping. Reverse transcriptase-polymerase chain reaction assay for HCV quantification was done with One-tube real time PCR HCV amplification with lower detection limit 70 IU/ml. Polymorphisms rs12979860 (C>T) and rs8099917 (T>G) in gene IL28B were genotyed by PCR. Each polymorphism assay contained one pair of primers and one pair of probes, and each allele of the polymorphisms was labeled. For statistical analysis mean and standard deviation were used for parametric variables. Considering the small sample difference test (percentage of structure) was used to determinate the genetic predictors of the SVR. A p<0.05 was consideded statistically significant. RESULTS: The study population included 9 genotype 1 and 9 genotype 3 HCV infected patients. Their median age was 31.4±4.4 years and 88.88% were males. SVR were achived in 83.3% patients. The distribution of the frequencies od rs12979860 genotypes in the analyzed sample was: 10 (55.55%) patients with CC genotype and 8 (44.44%) patients with CT genotype. The distribution of the frequencies od rs8099917 genotypes was: 15 (83.33%) patients with TT genotype and 3 (16.66%) patients with TG genotype. The difference test showed that difference in persentage which is registered between SVR in CC and CT is not statistically significant (p=0,6714). There is no association in achievement SVR in CC and non-CC genotypes of rs12979860. There also no significance in achieving SVR in patients with TT genotype of rs8099917 and in patients with TG genotypes (p=0.3961). Futhermore there was no association with the achivment od SVR as compared with genotype (p=0.0579). DISCUSION: In this study, no significant difference was found in the response to treatment and allele proportions of SNPs rs12979860 and rs8099917 possibly due to the small size of the sample. The study of Silva Conde et al. confirmed similar effect of IL28B polymorphism on SVR in infected HCV patients (14). In another study from Norway and Denmark involving genotype 3 HCV-infected patients, RVR was achived by a significantly greater number of patients who had CC and TT genotypes at rs 12979860 and rs8099917, respectively, but these genotypes showed no association with SVR (15). Consistent to our findings were results of the study of Sarrazin et al.which present no significant association of SNPa rs8099917 with virologic treatment response (16). Investigation of a comparable number of genotype 2/3 infected patients in study by Rauch et al. also showed no correlation between the rs8099917 genotype and virologic response to pegylated interferon/ribavirin combination therapy (17). In contrast, the GWAS identified that homozygosis for C allele of rs12979860 and homozygosis for the T allele of rs8099917 were favorable genotypes of the IL28B gene polymorphisms which predicted the SVR in patients with chronic hepatitis C treated with peginterferon and ribavirin (18,19). The distribution of frequencies of rs12979860 genotypes in our study group was : CC 55.55% and CT in 44.44% . The distribution of frequencies of rs8099917 genotypes in our study sample was TT 83.33% and TG 16.66%. Sticchi et al. reported distribution of rs8099917 genotypes TT in 55%, TG in 40% and GG in 5% of the study participants (20). Results of other studies reported bigger percentage of CT than CC for distribution of the frequencies of rs12979860 (21.22). However, about 50% of patients with a sustained virological response do not carry favorable IL28B alleles (13). The factors which increase the chance of a therapeutic response in these patient are not yet known. Other factors, such as HCV genotype, viral-load, ethnicity should be used together with IL28B genotype as predictors of response on antiviral therapy. CONCLUSION: We did not find a significant association of SNPs rs12979860 and rs8099917 with SVR thus disagreeing with studies that found an association between genotype CC (rs12979860) and SVR in individuals with genotype 1, 2 and 3 as well as between genotype TT (rs 8099917) and SVR in individuals with genotype 3. Our study is limited by its sample size. And possibly results due to this fact. Nevertheless genotyping of this polymorphism on a large HCV population will aid clinical decision making for both current standard care and potentially for the integration of other agents in future, providing an opportunity for clinicians to individualize treatment regimens for hepatitis C patients. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Non-occlusive mesenteric ischemia (NOMI) in a 36-year old patient, indicating proctocolectomy with ileal J pouch anal anastomosis - a case report(МАКЕДОНСКОТО ЛЕКАРСКО ДРУШТВО = MACEDONIAN MEDICAL ASSOCIATION, 2012); ; Radomir Gelevski