Samardjiski, Igor

Preferred name

Samardjiski, Igor

Official Name

Samardjiski, Igor

Translated Name

Samardziski, Igor

Alternative Name

Samardziski, Igor

Самарџиски, Игор

Igor Samardjiski

Main Affiliation

Now showing 1 - 10 of 35

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SUCCESSFULLY DELAYED DELIVERY OF SECOND TWIN AFTER EARLY SECOND TRIMESTER RUPTURE OF MEMBRANES OF THE FIRST TWIN: A CASE REPORT
(Институт за јавно здравје на Р Северна Македонија = Institute of Public Health of R North Macedonia, 2020-07)
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Twin pregnancies are high-risk pregnancies accompanied with multiple complications, such as: spontaneous abortion, preterm rupture of the membranes, preterm delivery, intrauterine death of one or both twins etc. There is no consensus about the management of twin pregnancies complicated with preterm rupture of the membranes of one twin and risk of preterm delivery. These cases are rarely found in the literature. We present a case of a 35 years old patient, hospitalized in a tertiary level institution, because of a diamniotic dichorionic twin pregnancy complicated with preterm rupture of the membranes of the first twin at 19 weeks of gestation. She had one delivery with Caesarean section 16 years ago. In consultation with the patient induction of labor was done with delivery of the first twin, a death male fetus. After that, antibiotics and tocolytic therapy were administrated and the patient remained in the hospital about one week. The patient was discharged at home with regular control of her condition and condition of the fetus. The patient was again hospitalized at 33 weeks of gestation with uterine contractions on cardiotocography. After administration of corticosteroid therapy for fetal lung maturation she delivered spontaneously the second twin in a good condition and she was discharged from hospital after 16 days. In twin pregnancies clinicians must think about delayed interval delivery of the second twin, after delivery of the first twin, with an aim to increase chances for survival, especially for pregnancies less than 30 weeks of gestation.
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Postpartum decline in sflt-1/plgf ratio confirms placental source of angiogenic imbalance and endothelial dysfunction in preeclampsia
(Elsevier BV, 2024-02)
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Todorovska, Irena
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Paneva, I.
Preeclampsia (PE) is a multisystem disorder in pregnancy with a specific collection of signs and symptoms as a result of serious dysfunction of multiple organs. Abnormal placentation in the first trimester, most likely triggers the disbalance of the placental anti-angiogenic factor soluble fms-like tyrosine kinase-1(sFlt-1) and pro-angiogenic placental growth factor (PlGF), which result in systemic endothelial dysfunction (injury) to progressive end-organ damage. According the PROGNOSIS study, the cut-off value of the sFlt-1/PlGF ratio over 85 confirms the suspected PE and proved to be useful in preeclampsia diagnosis. A severely elevated sFlt-1/PlGF ratio is associated closely with the need to deliver within 48hours.
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The outcome of Pregnancy with Fetal Primitive Neuroectodermal Tumor
(ID Design 2012/DOOEL Skopje, 2018-08-20)
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Stefanija, Adela
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Josheva, Jasminka
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Fetal intracranial tumours are very rare. The overall incidence is 0.34 per one thousand live birth newborns. According to the new classification of central nervous system tumour (2016), a primitive neuroectodermal tumour of (PNETs) is an embryonal tumour group; these are tumours with high malignancy and belong to group IV (WHO). In our case, we will present a case of PNETs in 28 gestation week old fetus, diagnosed antenatally and confirmed postnatally.
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Rare concomitant myxoid and cystic degeneration of uterine leiomyoma: Case report
(Centre for Evaluation in Education and Science (CEON/CEES), 2021)
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Paneva, Iva
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The uterine leiomyomas are monoclonal tumours of myometrial smooth muscle cells that are oestrogen dependent. A 43-year-old patient was referred by her gynaecologist under a suspected diagnosis of ovarian tumour. She complained of prolonged and profuse, regular menstrual bleeding that leaded to anaemia. The ultrasound examination showed a complex tumour mass with dimensions 68 x 85 mm, with several cystic formations fulfilled with clear fluid, which protrudes from the posterior wall of the uterus. Therefore, the diagnosis of leiomyoma with a cystic degeneration was considered preoperatively. In the case of cystic degeneration of the myoma, the ultrasound shows a combination of cystic and solid components with irregular shape and variable echogenicity. The ovarian malignancy should be ruled out in the presence of a large cystic mass with irregular septa and solid nodular parts filling the small pelvis. Ultrasound characteristics of degenerative myomas should always be considered, so as not to replace it with an ovarian mass, especially if it is subserosal and on the loop.
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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.
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Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019
(Elsevier BV, 2021-07)
D'Antonio, Francesco
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Sen, Cihat
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Mascio, Daniele Di
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Galindo, Alberto
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Villalain, Cecilia
It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03–2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07–2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41–3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42–4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19–5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15–2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02–1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90–5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
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Epidural Anesthesia for Caesarean Section and Occurrence of Horner’s Syndrome
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2017-06-01)
Spasovski, Sasho
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Recently, specifically in the last decade, at the University Clinic of Gynecology and Obstetrics, the number of patients treated with epidural analgesia for painless childbirth, which in some percentage ends in Caesarian section (35%), has increased. The increased use of the epidural anesthesia and analgesia is due to the fact that it is one of the most popular ways of childbirth today. This situation is a result of the benefits that epidural anesthesia has for the patient, which consist of allowing the pregnant woman to be conscious during childbirth and to feel and see her child coming into the world, accompanied with smaller intensity of intraoperative and postoperative pain. However, the results or the effects in practice have shown that in certain insignificant percentage patients can have negative consequences from the received analgesia (anesthesia) such as: headache, cases of durra puncture, epidural abscess or hematoma, neurological outbursts etc. But, the subject of this analysis or the aim of this study is the appearance of Horner’s syndrome, as one of the negative effects of the epidural anesthesia, which even though rarely (only in 1% of the cases) can appear as a result of the epidural anesthesia. In the case study using the historic, comparative and empirical method we will try through a specific case to determine the causes for the occurrence of the Horner’s syndrome, how it should be treated and what are the consequences for the patient.
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Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19
(Walter de Gruyter GmbH, 2020-11-26)
Di Mascio, Daniele
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Sen, Cihat
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Saccone, Gabriele
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Galindo, Alberto
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Grünebaum, Amos
Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
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2022-RA-766-ESGO Cutaneous vulvar metastasis after combined treatment of cervical cancer-case report
(BMJ Publishing Group Ltd, 2022-10)
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Stojchevski, Sasho
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Introduction/Background Invasive adenosquamous carcinoma of the cervix has an incidence of only 4% of all epithelial cervical tumors. Additionally to the local invasion, this type of cancer is characterized by the appearance of distant metastases in the lungs, bones and liver, while cutaneous metastases are extremely rare. Methodology We present a rare case of cutaneous vulvar metastasis originating from adenosquamous cervical cancer after combined treatment. Nine months after the operation, due to observed vulvar lesions, a clinical examination and imaging diagnostic procedures were performed. After the removal of the vulvar lesions, a histopathology report describes them as poorly differentiated adenosquamous carcinoma with identical morphological characteristics as the primary neoplasm of the cervix. Results Cutaneous metastasis from carcinoma of the uterine cervix is very rare. The incidence of cutaneous metastases in treated cervical cancers is 0.8%, with a rare occurrence of cutaneous vulvar metastases, usually 3.5 to 6 years after surgical treatment. Therefore, this is a rare case of secondary metastatic deposit that occurs at an unusual localization for a relatively short period of time. Conclusion Vulvar lesions in patients with previously diagnosed and treated cervical cancer need to be histologically verified in order to confirm or exclude a possible metastatic process from the primary cervical neoplasm.
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VITAMIN D AND BODY MASS INDEX IN GESTATIONAL DIABETES MELLITUS
(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University in Skopje, R.N.Macedonia, 2021)
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Todorovska, Irena
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ABSTRACT Gestational diabetes mellitus (GDM) is a glucose intolerance established for the first time in pregnancy. Vitamin D deficiency is common in pregnant women. Deficiency is connected with risk for preeclampsia, GDM and macrosomia. Aim Aim of the study was to evaluate vitamin D status in GDM pregnancies and normoglycemic women and to establish whether body mass index in normoglycemic and GDM pregnant women has impact on vitamin D deficiency. Material and Methods Prospective study was conducted at the University Clinic for Gynecology and Obstetrics, Skopje in a period of one year. One hundred pregnant women in the second trimester were evaluated: 50 women with GDM and a control group of 50 women with negative OGTT with BMI more or less than 25. Vitamin D levels (Advia Centaur) were performed from periphery blood specimens from the pregnant women. Results Significantly lower values of vitamin D were found in GDM women vs control group (16.91 ± 6.2 nmol/l vs 24.54 ± 11.7 nmol/l). Vitamin D deficiency was found in 82.5% of the women with GDM and 54.76% of the women with negative OGTT. Vitamin-mineral supplementation received 82% of the normoglycemic pregnant women and 66% of the pregnant women with GDM, p=0.036. In pregnant glucose tolerant women vitamin D was significantly lower in overweight vs normal weight women. Women with GDM and normal weight had significantly lower vitamin D levels vs normoglycemic women with normal weight. Conclusion We can conclude that gestational diabetes mellitus in our study is associated to lower values of vitamin D. Pregnant women with GDM less often received vitamin supplementation. Lower vitamin D levels were found in normoglycemic overweight women. In GDM women body mass index didn’t have impact on vitamin D deficiency – normal weight GDM women had significantly lower vitamin D levels than normoglycemic women with normal weight. However, vitamin D supplementation is essential for overweight pregnant women in order to possibly achieve better perinatal outcome.

Samardjiski, Igor

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