Kjaev, Ivo

Preferred name

Kjaev, Ivo

Official Name

Kjaev, Ivo

Translated Name

Ќаев Иво

Alternative Name

Kaev.I

Ivo Kjaev

Caev.I

Ќаев Иво

Kjaev.I

Main Affiliation

ivokjaev@gmail.com

ivo.kaev@medf.ukim.edu.mk

Now showing 1 - 10 of 38

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Impact of epysiotomy on anal continence in women after vaginal delivery
(Macedonian Association of Anatomists and Morphologists, 2019)
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Lazarova-Stojovska, Aleksandra
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Aim: The purpose of this study to determine the impact of episiotomy use in women after vaginal delivery on the female anal continence Methods: The study was designed as a cross-sectional. It was performed at the University Clinic of Obstetrics and Gynecology, University of "Ss. Cyril and Methodius" in Skopje, Macedonia during a period of one year. The study included 470 women of reproductive age with at least 1 previous vaginal delivery. The following variables were analyzed with regard to their influence on anal continence: use of episiotomy, type of episiotomy, perineal injury and degree of perineal injury. Data was acquired using a questionnaire specially designed for this study. The severity of anal incontinence quantified using St. Mark's Anal Incontinence Score. Results: Both the use of episiotomy and the severity of perineal trauma exerted a significant effect on anal continence. The use of episiotomy has been associated with lower St. Mark’s scores, while higher degrees of perineal trauma, were proven to significantly increase the value of the St. Mark’s score Conclusion: Anal incontinence is an unsettling condition affecting women that is inextricably linked to vaginal delivery. Further studies are needed to prove the benefit of episiotomy, which is traditionally regarded as a protective procedure and a method for prevention of pelvic floor disorders.
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Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia
(Македонско лекарско друштво / Walter de Gruyter GmbH, 2017-06-01)
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Ivanov, Emilija
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Introduction.Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO<jats:sub>2</jats:sub>), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO<jats:sub>2</jats:sub> was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO<jats:sub>2</jats:sub> and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.
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Left ventricular function in patients with advanced stages of chronic obstructive pulmonary disease in correlation with GOLD classification system
(2024)
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Background: Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disease, with irreversible airflow obstruction, disease with high morbidity and early mortality rate. COPD is not just a disorder limited to the lungs. As the disease progresses, extra pulmonary co morbidities occur, where cardiovascular diseases are the most common. They mostly affect the right side of the heart, but sometimes changes also occur on the left side of the heart, as a result of long-term strain from the right ventricle (RV) and pulmonary hypertension which follows COPD. Material and methods: The design of our study was prospective-clinical cross-sectional study with 2 years follow up. In the study were included 94 patients with previously confirmed chronic obstructive pulmonary disease with spirometry and classified by Tiffeneau index in four gold classes. We have analyzed the values of some echocardiographic parameters that were selected as indicators of left heart function, and also we have analyzed them in relation to the progression of COPD from milder to more severe Golden classes, such as: left ventricular diastolic dimension (LvdD - mm), left ventricular ejection fraction (EF %), myocardial performance index (MPI) of the left ventricle, global longitudinal strain (Gl strain - %) of LV, diastolic function (E/e'). Echo analysis was done by Vivid 7 echo machine with a special feature to left heart chamber characteristics and function. Results: All echocardiographic parameters analyzed in our study, underline their significance in disease progression in patients with COPD and increasing Gold classes. A varies of statistical methods and parameters were used to evaluate: left ventricular diastolic dimension(mm), Ejection fraction of left ventricle (%), MPI of the left ventricle obtain by Tissue Doppler, GL strain of left ventricle (%) and E/e' in correlation of disease progression and GOLD class. Echo-parameters MPI of the left ventricle and Global longitudinal strain LV (%), progressively grow with the rise of the gold class (form I to IV). On the contrary the values of the parameters LvdD and EF% gradually decrease with the progression of the disease and gold class. Echocardiographic parameter GL strain LV % has the highest value and statistically by decreasing the values of this parameter the risk of disease progression from gold stage I/II to Gold stage III/IV is 1.570 times higher, with high statistical significance(p<0,01). The calculated value of the parameter EF% is lower than 0,75, which indicates that the model of prediction is not the best one but it's acceptable. Conclusion: COPD is a progressive disease that affects the dimensions of the right and left heart chambers, as well as the function of both chambers and the development of pulmonary hypertension. Monitoring echocardiographic parameters intended for assessment cardiac dimension and function can help tо predict disease progression for timely inclusion of specific therapeutic strategies. We suggest screening of all COPD patients for cardiac assessment using echocardiography as a non-invasive and repeatable method for their follow-up.
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Influence of obstetrically-associated risk factors in assessing anal incontinence in patients post vaginal delivery
(Macedonian Association of Anatomists and Morphologists, 2018)
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Stojoska Lazarova, Aleksandra
Introduction: Anal incontinence (AI) is an inconvenient and limiting medical condition that can cause social and hygienic problems, isolation, low self-esteem and low quality of life. The etiology is multifactorial. Women are eight times more affected than men and the reason is considered to be childbirth. In order to prevent this social, physical and psychological problem, it is necessary to define the risk factors leading to development of such symptoms in female patients after undergoing vaginal delivery. Factors that influence occurrence of anal incontinence in patients after vaginal delivery, have been categorized into obstetric, maternal and fetal factors. Objective: The purpose of this study is to determine the impact of individual obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery, and express it as anal score value. Materials and methods: We designed the study cross-sectional, and developed the research it at the University Clinic of Obstetrics and Gynecology, "Ss. Cyril and Methodius" University in Skopje, Macedonia, in a 3-month period, from August to November 2017. In this study, we engaged patients in their reproductive age, who had undergone at least one vaginal delivery. The degree of incontinence was determined using St. Mark's Anal Incontinence Score (SMIS). Results: In the examined segments, multi-parity (at least 2 vaginal births) increased by OR = 4.69 (95% CI 2.04-10.82) the patient's risk of having St. Mark’s score of ≥8 and this is statistically significant difference. Induced labor also reduced the likelihood of OR = 0.39 (95% CI 0.15-1.04) for St. Mark’s score of ≥8, but the difference was not a statistically significant one. Use of mediolateral episiotomy had protective significance against the risk of St. Mark score of ≥8. Conclusion: Results of this study show consistency with data published so far on the influence of obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery. Changes in anal incontinence are expressed in increased St. Mark’s score. Our study showed that the following factors had statistically significant impact on the score value: multi-parity, fetal macrosomia and perineal injury (grades 3 and 4).
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Echocardiographic Heart Changes in Pregnancies Complicated with Gestation Hypertension and Preeclampsia
(International Scientific Invention Journals, 2019-02-13)
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Milkovski, Daniel
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Introduction: Echocardiography as an imaging method is increasingly being used in obstetrics in the management of hemodynamic changes which occur in normal but also in pregnancies with gestational hypertension/preeclampsia. Aim: The aim of the study is to show that some of the heart changes in pregnancies complicated with gestational hypertension and preeclampsia are abnormal and further follow up of these patients is needed. Methods: A total of 81 patients were enrolled in the study. The patients were further divided in two groups. Pregnant women with gestational hypertension or preeclampsia (51) and a control group of normotensive pregnancies (30). A total of 3 echocardiograph exam were made, the first upon entry in the study (28 -34 g.w), the second 2 weeks after delivery and the last 6 months after delivery. Results and discussion: We found several statistically significant results that involve the IVS, PWLV, LKM, left chamber hypertrophy and diastolic function. Diastolic dysfunction usually shows up before systolic dysfunction in the evolution of ischemic/hypertensive cardiovascular disease and is of prognostic value in predicting long term cardiovascular morbidity. The changes seen 6 months after delivery on our last control mean that those changes are permanent and need further prevention strategies. Conclusion: From the noninvasive methods echocardiography is the most favorable method in identifying structural changes and functional changes in pregnancies with hypertension. Echocardiography allows fast, reproducible information and is both safe for mother and fetus.
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Појава на срцево оштетување кај трудници со гестациска хипертензија/прееклампсија
(2018-05-31)
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Side Effects of Intravenous Patient-Controlled Analgesia with Remifentanil Compared with Intermittent Epidural Bolus for Labour Analgesia - A Randomized Controlled Trial
(Walter de Gruyter GmbH, 2019-12-01)
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Ivanov, Еmilija
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Epidural analgesia is considered a gold standard in obstetric anaesthesia and analgesia. However, in situation when it is contraindicated, unwanted by the patient or simply unavailable, remifentanil can be an excellent alternative. The goal of our study is to analyse the side effects of intravenous patient-controlled analgesia (IV PCA) with remifentanil compared with epidural analgesia during delivery.
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COMBINED SPINAL-EPIDURAL ANESTHESIA FOR ABDOMINAL HYSTERECTOMY IN PATIENTS WITH COPD
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, 2017-04)
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Ivanov E
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Introduction: All patients with chronic obstructive pulmonary disease (COPD) are with increased risk for intra and postoperative complications during abdominal surgery. In our study we present another approach in anesthetic management in these highly risk patients. Methods: We analyzed 20 patients, ASA III, scheduled for elective abdominal hysterectomy. After appropriate preoperative preparation in every patient epidural catheter was placed on Th12 - L1 or L1-L2 level, while spinal punction with standard spinal anesthesia was performed on lower levels. We evaluate basic hemodynamic parameters, patients’ satisfaction and postoperative pulmonary complications.Results: All hemodynamic parameters showed decrease in the first 30 minutes and then constant flow until the end of surgery. 4 patients developed postoperative pulmonary infection, and ended well. All patients were very satisfied with anesthesia procedure.Conclusion: Combined spinal-epidural anesthesia provides good hemodynamic stability, large patients’ satisfaction with fewer postoperative pulmonary complications in patients with COPD. Encouraging this anesthesia technique might increase the safety margin of surgery in patients with severe pulmonary diseases.
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A rare case of pleomorphic dermal sarcoma presented during pregnancy, a case report
(John Wiley & Sons, Inc., 2024)
Milkovski, Daniel
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Gjirevski, Vlatko
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Kijajova, Ivana
Soft tissue sarcomas are rare tumors arising in mesenchymal tissues and can occur almost anywhere in the body. They are rarely diagnosed during pregnancy. Pleomorphic dermal sarcoma (PDS) are dermal-based malignant tumors that usually present on sun-exposed sites of elderly patients and are morphologically similar to atypical fibroxanthoma (AFX). PDS is considered an aggressive cancer and likely to metastasize and reappear. Early detection and aggressive treatment improve outcomes.
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Acute appendicitis in the third trimester of a pregnancy finished with spontaneous vaginal delivery
(Asclepius, 2018)
Milkovski, Daniel
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Acute appendicitis is the most common surgical problem occurring during pregnancy. Its incidence is more common in the second trimester and is confirmed in 1/1000 pregnancies. Clinical manifestations of acute appendicitis in pregnant patients are generally very similar to non- pregnant patients. We present, here, the case of a 29-year-old pregnant patient at 35+4 weeks of gestation with the signs of acute appendicitis. The patient underwent a successful open appendectomy of her perforated appendix, without performing a cesarean section (CS) at the same time. 5 weeks postoperatively, at term, labor was induced with vaginal prostaglandins and the patient delivered a healthy female baby without any complications. Immediate diagnosis of acute appendicitis during pregnancy is recommended and management with the suitable surgical intervention should not be delayed for >24 h as it increases the risk of perforation with its subsequent critical complications. The treatment of acute appendicitis is always surgical, with an appendectomy and perioperative broad-spectrum antibiotics. Except in cases of high maternal and fetal mortality, a CS should not be done simultaneously with the appendectomy in cases of a perforated appendix with diffuse peritonitis, due to the very high risk of dehiscence of the uterus.

Kjaev, Ivo

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