Taleva, Biljana

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Taleva, Biljana

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Taleva, Biljana

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BARDET-BIEDL SYNDROME
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2025-03-01)
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Ljumani Bakiji, Lj
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Abstract Bardet-Biedl syndrome (BBS) is a genetic and multisystem disease that affects the genitourinary tract, locomotory system, causes eye anomalies, cognitive disorders and characteristic truncal obesity. It is caused by mutations in certain genes, namely: BBS1 to BBS21 gene. The approach to this disease is multidisciplinary. Material and Methods: We present a 3-years-old female child who was referred to the Clinic for Pediatric Surgery due to supernumerary toes on both feet. This is postaxial polydactyly. Intrauterine lobulated kidney structure was observed. The child had problems with her peers and avoids socializing with them. The following examinations were performed: cardiological, ophthalmological and genetic. Genetic examinations confirmed the BBS syndrome. Results: The patient was operated at the clinic for pediatric surgery, the operative and postoperative period were without complications. Conclusion: BBS is a rare autosomal disease that requires timely detection and appropriate multidisciplinary treatment. This allows complications to be reduced and the child to be included in everyday activities.
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Inflamed Mesenteric Pseudocyst Associated with Meckel’s Diverticulitis: Cause or Consequence
(Knowledge E DMCC, 2024-12-08)
Talev, Stefan
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Avramovska, Maja
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Avramovski, Petar
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Nikleski, Zorica
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Ivkovska, Tamara
Introduction: Mesenteric pseudocyst describes an abdominal mass that appears on small bowel mesentery or mesocolon, or at any part of the abdomen and retroperitoneum. This paper aims to emphasize the non-specific clinical appearance and highlight Meckel’s diverticulitis as a potential cause of the development of pseudocyst. Case Report: A 26-year-old male with a palpable mass in the right upper abdominal quadrant and an increased body temperature of 38.3∘C was admitted for further medical investigation. Computed tomography (CT) presented a cystic mass with a diameter of 5.5 cm, and emergency laparotomy was performed. Wedge resection of pathologic findings of small bowel, its mesenterium, and the cyst mass associated with nearby Meckel’s diverticulum was performed. Discussion: Meckel’s diverticulum can be considered as a risk for developing mesenteric pseudocyst, because of its frequent exacerbation of chronic inflammation. This report adds to the limited literature on the association between Meckel’s diverticulum and mesenteric pseudocysts, providing valuable insights that can guide future clinical evaluations and surgical interventions. Early and accurate diagnosis, aided by imaging techniques such as CT and magnetic resonance imaging (MRI), is essential for effective management. This case highlights the potential link between chronic inflammation in Meckel’s diverticulum and the formation of mesenteric pseudocysts. Conclusion: This case highlights the need to consider Meckel’s diverticulitis in patients with mesenteric pseudocysts, suggesting a possible pathophysiological link between them. Surgical resection is recommended for effective management.
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VERRUCOUS MALFORMATIONS AS A RARE CASE IN THE GROUP OF VASCULAR ANOMALIES WITH SLOW BLOOD FLOW IN CHILDREN
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04-04)
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Kamiloski, Marijan
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Lumani Bakiji, Njomza
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Racaj, Anila
Verrucous venous malformations belong to the group of vascular anomalies. The International Society for the Study of Vascular Anomalies (ISSVA) classifies these changes into two major groups: vascular tumors and vascular malformations. The vascular malformations group includes lymphatic malformations, venous malformations, and their combinations (malformations with slow blood flow), as well as arteriovenous malformations (malformations with fast blood flow). Verrucous venous malformations (VVM) are a rare congenital vascular anomaly first described by Helwig in 1967. They are characterized by varying degrees of hyperkeratosis of the skin and subcutaneous tissue. Clinically, they manifest as dark red solitary or multiple hyperkeratotic plaques, most commonly localized on the extremities. Treatment is combined and includes surgical intervention, electrocoagulation, laser therapy, topical agents, and systemic medications. Materials and Methods: Between 2019 and 2024, two children with suspected verrucous venous malformations were admitted to the Public Healthcare Institution – University Clinic for Pediatric Surgery. The lesions were unilaterally located on the lower extremities. The gender distribution was 1:1 (male to female), with an average age of 10 years. The changes had been present since birth. There was no positive family history in either patient. Clinically, one of the patients presented with inflammation of the lesion, accompanied by pain and serous secretion. Results: Following appropriate preoperative preparation, both patients underwent surgical excision and autologous skin transplantation. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis. After excision, electrocoagulation was applied to residual lesions. A reduction of approximately 90% in lesion size was recorded. Conclusion: Verrucous venous malformations are a rare type of malformation within the group of vascular anomalies, requiring a multidisciplinary treatment approach.
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Treatment of Pilomatrixoma in Pediatric Population - Our Experience
(Macedonian Association of Anatomists and Morphologists, 2021)
Sokolova Rozeta
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Lumani Bakili Njomza
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Pilomatrixoma is a type of benign tumor most commonly diagnosed in people under the age of twenty. It usually occurs at the passage of hairy parts of the body and is associated with hair follicles.It accounts for 1% of all benign tumors. The symptomatology varies according to the location of the tumor, however most are isolated and non-symptomatic. Rarely, pilomatrixoma can become malignant after the age of twenty. Tumor size over 10cm increases the possibility of malignant alteration. Complete surgical excision of the tumor is recommended.
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Cognitive Function Assessment Using the Stroop Test: Exploring the Broader Therapeutic Potential of L-Ornithine L-Aspartate (LOLA, Hepa-Merz), a Hepatic Encephalopathy Medication
(ECRONICON open acesss, 2025-04-11)
Petar Avramovski
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Emilija Parisko
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Maja Avramovska
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Pece Stefanovski
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Zorica Nikleski
Background: L-Ornithine L-Aspartate (LOLA), known commercially as Hepa-Merz, is widely used in the treatment of hepatic encephalopathy (HE) due to its ability to facilitate ammonia clearance via both urea and glutamine pathways. In addition to its established role in HE, emerging evidence suggests LOLA may aid liver regeneration, support mitochondrial function, and reduce oxidative stress. This study investigates LOLA's potential impact on cognitive performance in individuals with minimal hepatic encephalopathy (MHE), utilizing the Stroop Test as a neuropsychological evaluation tool and correlating findings with serum ammonia concentrations. Methods: Sixty-five patients diagnosed with MHE underwent cognitive evaluation before and after administration of LOLA. Ammonia levels were quantified both pre- and post-intervention. The Stroop Test, including Stroop Word (SW), Stroop Color (SC), Stroop Color-Word (SCW), and the Total Stroop Test (TST), was used to assess changes in cognitive speed and accuracy. Data were analyzed using unpaired t-tests to evaluate the significance of observed changes. Results: Post-treatment results showed a significant decrease in blood ammonia levels (from 123.2 ± 27.1 µmol/L to 112.7 ± 24.1 µmol/L, p < 0.05). All Stroop Test components demonstrated marked improvement, with faster TST indicating better cognitive processing. Moreover, patients with initially elevated ammonia levels tended to perform worse on cognitive testing, reinforcing the link between hyperammonemia and cognitive dysfunction. Conclusion: Hepa-Merz demonstrates efficacy in reducing systemic ammonia and enhancing cognitive function in MHE patients. The Stroop Test proves to be a sensitive and practical measure for detecting neurocognitive changes and treatment effects. These findings support further exploration of LOLA’s (Hepa-Merz) benefits beyond traditional HE management, particularly in preserving or improving brain function.
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Correction of Congenital Ear Deformities - Our Experience
(2018-10)
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Jovceski, Lazo
Congenital ear deformities cover a wide range of defects concerning the outer ear. Prominent ear, lop ear and microtia are most frequently encountered congenital ear problems in pediatric plastic surgery. The aim of this study is to present our experience in the correction of congenital ear deformities, with a special emphasis on the correction of prominent ears.
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ASPARTATE AMINOTRANSFERASE AND GAMMA GLUTAMYL TRANSFERASE: INTRIGUING CLINICAL BIOMARKERS IN DISCRIMINATION OF HEPATIC LESION BETWEEN HEPATITIS C INFECTED PATIENTS AND HEALTHY CONTROLS
(Sestre Milosrdnice University Hospital, Institute of Clinical Medical Research, 2023-12-31)
Biljana Ilkovska
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Bisera Kotevska Trifunova
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Maja Avramovska
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Stefan Talev
SUMMARY – Over 1.5 million new cases of chronic hepatitis C virus (HCV) infection occur each year, infecting an estimated 58 million people worldwide. We aimed to find differences in peripheral blood count, liver enzymes and degradation products between HCV infected and healthy controls, and their impact on detection of the disease and discrimination of the diseased from non-diseased subjects. We performed laboratory testing for peripheral blood count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (γ-GT) and biliru bin in 40 HCV patients and 40 healthy controls. There were statistically significant differences in leuko cytes (p=0.001), ALT (p<0.0001), AST (p<0.0001), ALP (p<0.0001), γ-GT (p<0.0001), total bilirubin (p<0.018) and indirect bilirubin (p<0.030) between the HCV infected and control groups. On multiple regression, the independent variables of HCV titer (p=0.5091), granulocytes (p=0.7061) and total biliru bin (p=0.2022) showed no impact on liver lesion estimated by a dependent variable of γ-GT. On logistic regression, only AST [p=0.0112, odds ratio (OR)1.2161, area under the curve (AUC) 0.887] and γ-GT (p=0.0283, OR 1.1041, AUC 0.815) showed a statistically significantly positive predicting value when discriminating healthy subjects and diseased patients. In conclusion, HCV titer, granulocytes and total bilirubin did not show a statistically significant impact on hepatic lesion expressed by γ-GT, whereas only AST and γ-GT showed a statistically significant positive predicting value to discriminate infected patients from healthy controls. Each unit increase in AST and γ-GT resulted in 21.6% and 10.4% higher possibility for possible HCV infection, respectively.
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Pitfalls, Myths, and Errors in Pulse Oximetry: Understanding False Readings in Severe Hypoxemia
(ECRONICON open acesss, 2025-03-13)
Avramovska, Maja
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Nikleski, Zorica
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Siklovska, Vesna
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Todorovska, Liljana
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Pulse oximetry is a widely used, non-invasive method for monitoring oxygen saturation (SpO2) in clinical and specialized settings, including maritime and high-altitude medicine. However, several pitfalls and misconceptions can lead to false readings, particularly in cases of severe hypoxemia. This mini-review explores the limitations of pulse oximetry, the role of perfusion index (PI) in assessing peripheral circulation, and common sources of measurement errors, such as low perfusion states, motion artifacts, and skin pigmentation. The clinical interpretation of SpO2 levels is discussed, emphasizing the need for caution when readings fall below 65%, where peripheral cyanosis is evident, rendering further saturation assessment redundant. Additionally, a nomogram illustrating the relationship between SpO2, partial pressure of oxygen (PaO2), pH, and PaCO2 is presented, aiding in the understanding of respiratory acidosis and alkalosis. The review also highlights the importance of SpO2 monitoring in critical conditions, including cytokine storm syndromes, and discusses the integration of Bluetooth-enabled pulse oximeters for real-time data transmission. Understanding the limitations and proper interpretation of SpO2 readings is crucial for avoiding misdiagnosis and ensuring accurate clinical decision-making.

Taleva, Biljana

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