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    Vascular Lipoleiomyoma of the Uterus: an Unusual Case
    (2016-12)
    Chibisheva, Vesna
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    Trajanova, Milka
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    Uterine lipoleiomyomas are a rare type of uterine myomas, which have been seldom diagnosed and are less known and still unusual. Histologically they are composed of smooth muscle cells with multiple fat cells and fibrous tissue. Their pathogenesis is still a stigma and their preoperative diagnosis is still questionable. Case report history A 39-year old woman presented at the University clinic for obstetrics and gynecology with complaints of a mild low abdominal and pelvic pain, increased frequency of vaginal bleeding and abdominal distension. Ultrasound examination showed dislocated uterus by a large semisolid tumor, located between the uterus and the urinary bladder. This mass was not well defined and had great vascularity. Pelvic computerized tomography revealed a large heterogeneous tumor located behind the bladder, measuring 8.5x7.5cm in size, making compression on the other pelvic organs. Conclusion: We should pay more attention on the preoperative imaging studies, in order to select patients who require surgery and further treatment more appropriately.
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    ПЕРИУРЕТЕРАЛНА ЕНДОМЕТРИОЗА – ПРИКАЗ НА СЛУЧАЈ
    (SHMSHM - AAMD, 2022-09-01)
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    Целта на овој труд е да се прикаже редок случај на периуретерална ендометриоза кај возрасен пациент и да се нагласи важноста на сомнителната уринарна ендометриоза и важната улога на компјутер на мала карлица во поставувањето на точна дијагноза на оваа ретка болест. Презентираме редок случај на периуретерална ендометриоза со симптоми кои првенствено произлегуваат од ендометриоза на јајниците. Дијагнозата на периуретерална ендометриоза беше поставена врз основа на компјутеризирана томографија на малата карлица и абдоменот. Клучни зборови: ендометриоза, компјутер на мала карлица, периуретерална ендометриоза.
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    Comparison Between HPV DNA Testing and HPV E6/E7 MRNA Testing in Women with Squamous Cell Abnormalities of the Uterine Cervix
    (Walter de Gruyter GmbH / MANU, 2019-05-01)
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    Duvlis, Sotirija
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    The aim of the study was to compare the results of two human papillomavirus (HPV) diagnostic techniques: human papillomavirus deoxyribonucleic acid (HPV DNA) testing and human papillomavirus E6/E7 messenger ribonucleic acid (HPV E6/E7 mRNA) testing in women with squamous cell abnormalities of the uterine cervix.
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    HPV E6/E7mRNA association with interleukin 10 (rs1800872) polymorphism in a group of Macedonian women
    (Wiley, 2022-09)
    Duvlis, Sotirija
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    Osmani, Dugagjin
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    Interleukin 10 (IL-10) is an immunosuppressive cytokine and its genetic variants could have an indirect impact on viral biology and human papillomavirus (HPV) E6/E7 messenger RNA (mRNA) expression as well. This study evaluates the association between IL-10-592 C/A (rs1800872) single-nucleotide polymorphism and HPV E6/E7 mRNA expression in a group of women from the Republic of North Macedonia. Using a commercial test, 272 women's cervical samples were analyzed for HPV E6/E7 mRNA and HPV DNA presence. The cases were stratified into three groups: double-positive (n = 108, positive for both tests), negative (n = 51, negative for HPV E6/E7 mRNA and HPV DNA positive), and the control group (n = 113, negative for both tests). The IL-10-592 C/A polymorphism was analyzed using polymerase chain reaction-restriction fragment length polymorphism. The results showed the CC genotype and the C allele frequencies of IL-10-592C/A were significantly higher in double-positive (59.3% and 78.2%) compared to negative group (39.2% and 65.7%), (p = 0.018, confidence interval [CI] = 2.25; 1.14-4.45 and p = 0.016, CI = 1.88; 1.11-3.16, respectively). The CC genotype and C allele of rs1800872 polymorphism were shown to be associated with HPV E6/E7 mRNA but not with HPV DNA positivity, which implies a possible role of this polymorphism in the course of the infection only after HPV onset, and lack of association with the susceptibility to HPV.
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    EFFECT OF ADIPOSITY AND FAT DISTRIBUTION ON ENDOMETRIAL CANCER RISK IN POSTMENOPAUSAL PATIENTS
    (University Ss. Cyril and Methodius in Skopje, 2023)
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    Evaluation of HOMA IR in perimenopause patients with abnormal uterine bleeding
    (MSD Publications India Pvt Ltd., 2024-02-25)
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    <jats:p>Introduction: Perimenopause as a clinical entity is characterized by a series of symptoms that occur due to estrogen deficiency in multiple organs and systems. Obesity is a risk factor that favors all these changes, especially hyperplasia. Glucose homeostasis is often impaired in these patients, insulin levels are increased, and HOMA IR is increased. Goals: to detect hyperplasia in obese perimenopausal patients with abnormal uterine bleeding to determine insulin levels, HOMA IR, to determine the association between hyperplasia and HOMA IR. Material and Methods: This was a prospective cohort study, performed at the OB/GYN Clinic, over 1 year. 100 patients with abnormal uterine bleeding during the perimenopause were involved, aged 45–50, divided into two groups based on BMI. 1-patients with a BMI above 30, 2-patients with a BMI under 30, and the control group consisted of 40 asymptomatic patients. Results: The average value of glycemia in the first group was higher and was 5.7 mmol/l, the cut-off value was 5,5. The average value of the HOMA-IR insulin resistance index in the first group was highest - 2.8 (the cut-off value was 1.8). Endometrial hyperplasia was registered in the first group at 40.9%. Discussion: The first group registered a significant association between HOMA IR and hyperplasia, the risk of endometrial hyperplasia occurring was eight times higher. The first group registered a significant association between glycemia and endometrial hyperplasia. High levels of glycemia increase the risk of endometrial hyperplasia occurring three times. Conclusion: In menopausal transition patients with abnormal uterine bleeding there is an increased incidence of endometrial hyperplasia, hyperglycemia, and increased HOMA IR. There is a strong association between these changes and the risk of cardiovascular disease increases. Menopause is a period in a woman’s life that requires a multidisciplinary approach to diagnostics and treatment. Keywords: HOMA IR, perimenopause, abnormal bleeding, hyperplasia.</jats:p>
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    PREGNANCY WITH POLYCYTHEMIA VERA - AN OBSTETRIC CHALLENGE
    (DEPARTMENT OF ANAESTHESIA AND REANIMATION, FACULTY OF MEDICINE, “SS. CYRIL AND METHODIUS” UNIVERSITY, SKOPJE, MACEDONIA, 2022)
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    Polycythemia vera (PV) is a rare chronic myeloproliferative disorder of the haematopoietic stem cell type characterized by increased erythrocyte production. The disease is associated to a high risk of clinical complications - arterial and venous thrombosis, especially in pregnancy, bleeding, possible evolution to myelofibrosis and acute myeloid leukemia. We present the case of a 28-years-old patient, whose diagnosis was made 2 years before pregnancy (positive for mutation JAK2 V617F, bcr-abl negative, MPL, CALR negative). She was regularly monitored at the Hematology Clinic, had therapeutic venipunctures performed and anticoagulant therapy was prescribed. Pregnancy was regularly followed, with proper fetal growth and development, regular screening for fetal abnormalities, under anticoagulant therapy and under the supervision of a hematologist. At 34 weeks gestation, due to bleeding and pain, she was hospitalized in the Peripartal Intensive Care Department suspected of placental abruption. A caesarean section was performed immediately, a premature fetus was delivered in relatively good condition, and during the operation abruption of 1/3 of the placenta was found. The operative and postoperative periods were stable, the patient received replacement therapy and was discharged from the hospital on the 5th postoperative day in good general condition. The newborn was stabilized and discharged in good general condition after 3 weeks of stay at the Neonatal Intensive Care Department. Conclusion: Pregnancy in patients with this disease carries serious risks to the life and health of both mother and fetus, which requires special attention during pregnancy in order to reduce antenatal and postnatal morbidity.
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    SUCCESSFULLY COMPLETED PREGNANCY IN A PATIENT WITH KLIPPEL FEIL SYNDROME (KFS) - CASE REPORT
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024-09-15)
    Todorovska, Irena
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    Klippel-Feil syndrome is a congenital anomaly characterized by fusion of two or more cerebral vertebrae. The three main manifestations are a low hairline, a short neck and limited neck movement. This syndrome can cause chronic headaches and neck and back pain. Klippel-Feil syndrome is diagnosed by clinical evaluation, identification of characteristic physical findings and specialized tests. Diagnosis begins with X-rays or other advanced imaging techniques, such as Magnetic Resonance, which shows the fusion of the cervical vertebrae and the open spaces (interspaces) between the vertebrae. Treatment: Therapy is symptomatic and supportive. Careful evaluation, continuous follow-up, and coordination of multiple specialists are required to improve the outcome. The patient is thirty years old, with a fixed diagnosis of Klippel-Feil syndrome, thoracis scoliosis, pre-existential hypertension, deafness. During the examination, it was established that it is a eutrophic fetus, without major anomalies, orderly fetoplacental flow, orderly fetal movements. A recommendation was given to do control examinations at the Clinic for Pulmonology, Orthopedics, Cardiology and Nephrology. The next two controls were on a weekly basis until the 27th gestational week, when, due to malignant hypertension, admission was done to PHI GAK. During hospitalization, high values of the angiogenic factors sFLT/PLGF up to 793.05, proteinuria 0.79g/L and malignant hypertension regulated by double antihypertensive therapy were determined. NST was reactive. The ultrasound finding was normal, the fetus had a normal fetoplacental flow. After detailed anesthetic preparation, the patient was delivered by elective caesarean section at 28.5 weeks of gestation and a live female fetus was obtained with RTM=920g/35cm and AS=6/7/7. The intervention went smoothly
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    High-risk HPV E6/E7 messenger RNA testing versus HPV DNA testing in women with squamous cell abnormalities of the uterine cervix
    (BMJ Publishing Group Ltd, International Gynecologic Cancer Society & European Society of Gynaecological Oncology, 2017-11)
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    Duvlis, Sotirija
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    Micevska, Megi
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    Dabeski, Ana
    Aims The study is performed in order to compare the results of two HPV screening methods: High-risk HPV E6/E7 mRNA and HPV DNA. Method Comparative prospective study, conducted in the period for April 2016 to March 2017 at the University Clinics for Gynecology and Obstetrics and Radiotherapy and Oncology in Skopje and Institute of Public Health of Republic of Macedonia of 98 sexually active women, age groups of 20 to 60 years, with squamous cell abnormalities on the cervical cytology. In all 98 women were done: HPV DNA testing, High-risk HPV E6/E7 mRNA testing and colposcopy and directed biopsy with endocervical curettage for histopathological analysis. Results Histopathologically, there were: 36.7% non-neoplastic lesions, 20.4% LGSIL cases, 29.6% HGSIL cases and 13.3% invasive squamous cell carcinomas. HPV DNA was found 78.6% of the cases; E6 and E7 transcripts were found in 58.2%. The rates of detection of HPV DNA and E6 and E7 transcripts were 83.3% and 22.2% for cases with non-neoplastic finding; 65.0% and 45.0% for cases with LGSIL; 75.9% and 93.1% for cases with HGSIL and 92.3% and 100% for cases with invasive squamous cell carcinoma. High-risk HPV E6/E7 mRNA testing showed a higher sensitivity than the HPV DNA testing (79.0% and 75.8%), higher specificity (77.8% and 16.7%) and a higher positive predictive value for HGSIL ( 93.1% and 75.9%) and invasive squamous cell carcinoma (100% and 92.3%). Conclusion High-risk HPV E6/E7 mRNA testing could be more powerful than HPV DNA testing for screening and investigation of HGSIL and invasive squamous cell carcinoma.
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    Cystis paratubaris mesonephricus lateris sinistri; their incidence, diagnostic challenge and treatment
    (SHMSHM - AAMD, 2020-04)
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    Zlateska, Sofija
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    Broad ligament cystadenofibroma and paraovarian mesonephric cysts and other paraovarian masses are part of the adnexal pathology found in all age groups of females from fetuses to adult women, more commonly from 3rd to 5th decade. They all contain 10-20% of all adnexal masses. Paratubal cysts, including Hydatid cysts of Morgagni, are of paramesonephric origin, while paraovarian ones originate from Wolffian ducts. Borderline or malignant tumours occur in 2-3% of cases. Broad ligament cystadenofibroma is a rare entity with only few articles published, and scarce data concerning their incidence. Paratubal mesonephric cyst is more common than broad ligament cystadenofibroma but there is also no data on their incidence. This article presents a case of concomitant presence of paraovarian cyst and Broad ligament cystadenofibroma in a 19-year-old patient, with no history of pregnancies. The patient sought medical attention due to abdominal pain. Laboratory tests showed a reduction of haemoglobin and hematocrit values, tumour markers Ca 125 and CEA were within normal limits, bHCG was negative. Transvaginal ultrasound and color Doppler revealed cystic adnexal mass on the left side measuring 43 mm of dimension, and a small amount of fluid in Douglas pouch (Figure 1). Due to abdominal pain and reduction of haemoglobin values, laparotomy was indicated and extirpation in toto of the tumor was performed. The histopathology confirmed the benign nature i.e. paraovarian cyst and Broad ligament cystadenofibroma. The case is presented regarding to extremely rarity of Broad ligament cystadenofibroma, possible urgent conditions of paratubal mesonephric cyst, way of treatment and their diagnostic challenge.