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    Hydroxyurea Associated Cutaneous Lesions: A Case Report
    (Scientific Foundation SPIROSKI, 2018-08-20)
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    Hydroxyurea (HU) is an antimetabolite agent that interferes with the S-phase of cellular replication and inhibits DNA synthesis, with little or no effect on RNA or protein synthesis. It is used in the treatment of many myeloproliferative disorders (MD) and is particularly a first line treatment drug for intermediate to high-risk essential thrombocythemia. Although safe and very well tolerated by the patients suffering from MD, there have been numerous reports of a broad palette of cutaneous side effects associated with prolonged intake of the medication. These may include classical symptoms such as xerosis, diffuse hyperpigmentation, brown-nail discolouration, stomatitis and scaling of the face, hands, and feet or more serious side effects such as actinic keratosis lesions, leg ulcers and multiple skin carcinomas.
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    Comorbid Conditions in a Cohort of Inpatients with SARS-CoV-2 and their Association with In-Hospital Mortality During the Early Phases of the Pandemic
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01)
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    Cibrev, Dragan
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    Chamurovski, Nikola
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    Introduction: Studies determined that age and associated comorbidities are associated with worse outcomes for COVID-19 patients. The aim of the present study is to examine previous electronic health records of SARS-CoV-2 patients to identify which chronic conditions are associated with in-hospital mortality in a nationally representative sample. Materials and Methods: The actual study is a cross-sectional analysis of SARS-CoV-2 infected patients who were treated in repurposed hospitals. The study includes a cohort of patients treated from 06-11-2020 to 15-03-2021 for COVID-19 associated pneumonia. To examine the presence of comorbidities, electronic health records were examined and analyzed. Results: A total of 1486 in-patients were treated in the specified period, out of which 1237 met the criteria for case. The median age of the sample was 65 years. The overall in-hospital mortality in the sample was 25.5%, while the median length of stay was 11 days. From whole sample, 16.0% of the patients did not have established diagnoses in their electronic records, while the most prevalent coexisting condition was arterial hypertension (62.7%), followed by diabetes mellitus (27.3%). The factors of age, male gender, and the number of diagnoses showed a statistically significant increase in odds ratio (OR) for in-hospital mortality. The presence of chronic kidney injury was associated with the highest increase of OR (by 3.37) for in-hospital mortality in our sample. Conclusion: The study reaffirms the findings that age, male gender, and the presence of comorbidities are associated with in-hospital mortality in COVID-19 treated and unvaccinated patients. Our study suggests that chronic kidney injury showed strongest association with the outcome, when adjusted for age, gender, and coexisting comorbidities.
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    CHRONIC WOUNDS - MICROBIOLOGY AND BIOFILM FORMATION
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2024)
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    Ahtarova, Biljana
    Introduction: Chronic wounds are wounds that do not heal for more than 4 weeks. Among the most important causes of wound chronicity are wound infection, biofilm formation with microbial agents that are resistant to antimicrobial agents. Aim: To investigate microbial agents in chronic wounds, their potential to form biofilm. Material and methods: This was a prospective study involving 24 patients from the University Clinic for in Skopje. Microbiological swabs were taken from patients with chronic wounds on the lower extremities,and were analyzed at the Institute of Microbiology and Parasitology, Faculty of Medicine in Skopje. The biofilm formation potential in isolates was determined using the tissue culture plate (TCP) biofilm detection method. Results: In 17 patients, at least one microorganism was isolated from 23 wounds, a total of 36, and in 7 patients there was no positive isolate from 7 wounds. Eighteen wounds (60%) had an isolate with the potential to form a biofilm. The following microorganisms from the wound samples were recorded: 17 (47%) isolates of the genus Staphylococcus, 4 (11%) isolates each from the genera Proteusand Pseudomonas, 3 (8%) isolates each from Enterococcusand Escherichia, 2 (6%) isolates from Streptococcus, 1 (3%) each isolate from the genera Acinetobacter, Enterobacterand Candida albicans. Conclusion: In 60% of the isolates, a biofilm formation with different degrees was confirmed. A statistically significant association was found between the degree of wound healing and isolates with low potential for biofilm formation, as well as the type of isolate.
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    Toxic Epidermal Necrolysis: Case Report and Review
    (Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia, 2024-03-12)
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    Stevens–Johnson syndrome and toxic epidermal necrolysis (TEN) are severe mucocutaneous adverse drug reactions primarily caused by drugs. Characterized by fever, prodromal symptoms, and extensive epidermal sloughing with mucous membrane involvement (>90%), they are collectively termed epidermal necrolysis and are considered a disease continuum.CASE PRESENTATION: A65-year-old man presented with widespread erythema and distinctive target-like lesions, accompanied by ruptured flaccid vesicles on the extremities. Following a 4-week carbamazepine treatment for a previous cerebrovascular insult, hematological analysis revealed abnormalities. Amultidisciplinary team, including a neurologist, endocrinologist, and ophthalmologist, prescribed a 3-day course of intravenous immunoglobulin at 0.5g/kg and an initial dose of 300mg prednisolone for 3days, supported by additional therapy. Discharged after 3weeks, the rash completely resolved within 2months. CONCLUSION: TEN, a severe mucocutaneous condition with a 30% mortality rate, often results from drug exposure. Swift identification of the causative drug is crucial for optimal outcomes. Treatment primarily includes discontinuing the offending drug and offering supportive care for mucocutaneous lesions. Amultidisciplinary approach is vital based on organ system involvement. The effectiveness of pharmacological treatments, such as intravenous immunoglobulin and corticosteroids, is continually under evaluation.
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    Lindsay's Nails and Terry's Nails in End Stage Renal Disease - Case Series
    (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2021-02)
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    Introduction. Nail changes occur as part of a single organ disease, multisystemic diseases or because of the intake of some medications. Chronic kidney disease (CKD) is associated with various nail abnormalities. Тo identify Lindsay’s nails and Terry’s nails in patients with end stage renal disease (ESRD) on maintenance he-modialysis (HD) and to determine the common anam-nestic, clinical and/or laboratory parameters that would help elucidate the etiopathogenesis of these nail pathology. Methods. Twenty patients with ESRD on hemodialysis were included into the study. Dermatological examina-tion took place during the dialysis session. Lindsay’s nails were identified when the distal part of the nail bed is red/rose-brown, clearly separated from the proxi-mal part of the nail bed, occupying 20-60% of the entire length of the nail bed. The proximal part of the nail bed is whitish, resembling grounded glass. When pressing the nail, the discoloration of the distal part of the nail bad does not fade completely. Terry’s nails were identified by a 0.5-3.0 mm wide distal band, pink-brown in color, with a proximal part of the nail bed that is white and occupies 80% of the entire nail bed. Data on demographic characteristics, history of the disease and the laboratory values were noted for each patient. Results. Out of 20 patients, all males, we diagnosed Half-and-Half nails, also called Lindsay’s nails, and Terry’s nails in 6(30%) patients [5 Half-and-Half nails (25%), and 1 with Terry’s nails (5%)]. All patients had sideropenic-free anemia, elevated urea and creatinine values and elevated parathyroid hormone (PTH) values (>190 pg/L, range 190.3-387.5 pg/L). Conclusion. After searching the relevant literature (MEDLINE, PubMed), we found this is the first study to link elevated PTH values and Half-and-Half nails (also called Lindsay’s nails), and Terry's nails in patients with ESRD on HD.
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    MICROBIOME AND MYCOBIOME IN CHRONIC WOUNDS
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
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    Skin as the biggest organ with protective function in the human body, makes an equilibrium between microbial communities and immune system. Skin microbiome is defined as the genome of microorganisms found on the skin with which microorganisms have a complex relationship. Microbiota of healthy skin consists of resident and transient microorganisms. Two most common factors for delayed healing process in chronic wounds are infection and biofilm formation. Thus, it is important to analyze microbiome and mycobiome of chronic wounds.
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    НОКТИТЕ НА LINDSAY И НОКТИТЕ НА TERRY КАЈ ПАЦИЕНТИ СО ХРОНИЧНА БУБРЕЖНА БОЛЕСТ СТАДИУМ 5 НА ХЕМОДИЈАЛИЗА – СЕРИЈА НА СЛУЧАИ
    (2022)
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    Митрова Телента, Јулија
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    Филиповиќ, Дејан
    Цел: Да се идентификуваат половина-и-половина но- ктите или уште наречени ноктите на Lindsay и ноктите на Terry кај пациентите со хронична бубрежна болест (ХББ) на хемодијализа (ХД) и да се утврдат заедничките анам- нестички, клинички и/или лабораториски параметри кои би помогнале во расветлување на етиопатогенезата на оваа ноктена патологија. Материјали и методи: 20 пациенти со ХББ стадиум 5 на хроничен хемодијализен програм беа вклучени во студијата. Дерматолошкиот преглед се одвиваше за време на дијализната сесија. Критериуми за дијагноза на поло- вина-и-половина нокти беа присуство на јасна граница помеѓу проксималниот и дисталниот дел од ноктеното лежиште, дисколорација на дисталниот дел со црвено/ розеникавo-кафеава пребоеност со афекција на 20-60% од целата должина на ноктеното лежиште и проксимален дел со белузлава пребоеност, налик на заматено стакло. При притисок на ноктот, дисколорацијата на дисталниот дел од ноктеното лежиште не бледее во целост. Ноктите на Terry се идентификуваа со наод на 0.5-3.0 мм широка дистална трака/лента, розево-кафеавкасто пребоена, со проксимален дел на ноктеното лежиште кој е белузлав и зафаќа 80% од целото ноктено лежиште. За секој пациент се нотираа податоците за демографските карактеристики (возраст и пол), за историјата на болеста (дијагноза на бубрежното заболување, стандардната терапија, време- траење на ХД) и за лабораториските вредности од меди- цинските истории [хемоглобин, феритин, калциум, фос- фор, албумини, креатинин, уреа и паратхормонот (PTH)]. Резултати: Кај 6/20 пациенти (30%), сите од машки пол, се дијагностицираа промени на ноктите од типот половина-и-половина нокти и ноктите на Terry. Кај 5 па- циенти се дијагностицираа половина-и-половина нокти (25%), а само кај 1 пациент се дијагностицираа ноктитена Terry (5%). Сите пациенти имаа анемија без сидеропе- нија, покачени вредности на уреа и креатинин и покачени вредности на паратхормонот (PHT) ( >190 pg/L, ранг 190.3 pg/L -387.5 pg/L). Заклучок: По пребарување на релевантната литера- тура (MEDLINE, PubMed), утврдивме дека ова е прва сту- дија во која се доведуваат во врска покачените вредности на РТН и промени на ноктите од типот половина-и-по- ловина нокти и нокти на Terry кај пациентите со ХББ на ХД. Секундарниот хиперпаратироидизам е основа да се постави хипотезата дека РТН со своето вазорелаксирачко и вазодилататорно дејство е одговорен за присуство на дилатиран венски плексус во ноктеното лежиште и црве- но-кафеавото пребојување на дисталниот дел од ноктот, додека белата боја на проксималниот дел од ноктите се должи на анемијата и депозитите на калциум во зидот на крвните садови.
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    Контактен дерматит на рацете кај здравствените работници во Македонија во тек на ковид-19 пандемијата
    (Лекарска комора на Република Северна Македонија, 2020-10)
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    Neloska, Lenche
    Пандемијата со ковид-19 резултираше со потребата и препораките зазасилена хигиена и носење на заштитни ракавици. Тоа резултира со зачестена појава на контактен дерматит (КД)на рацете кај здравствените работници (ЗР), особено кај ониекои се директно вклучени во грижата за пациенти заболени со корона вирусот. Цел Да се истражи појавата на контактен дерматит нарацете кај здравствените работници кои не се директно вклучени во лекувањето на пациенти со ковид-19. Метод Беше спроведена интернет анкета кај 272 здравствени работницикои не се директно вклучени во грижата за пациенти со ковид-19, на територијата на цела Македонија. Анкетата содржеше прашања за појава на промени на кожата на рацете и фактори кои влијаат на тоа. Резултати Во тек на епидемијата соковид-19, контактен дерматит на рацете забележале 132 (49%) од испитаниците, од нив 110 (53.9%) се лекари. Оваа појава е почеста кај здравствените работницивработени во секундарназдравствена заштита (56 или 47%) и нехируршките гранки (92 или 52.5%). Заклучок Зголемената хигиена на рацете, употребата на алкохолни дезинфициенси, како и ретката примена на емолиенти, се поврзани со појава наконтактен дерматиткај здравствените работници.