GJerakaroska radovikj, Marija

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GJerakaroska radovikj, Marija
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GJerakaroska radovikj, Marija

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    Predicting Post-operative Atrial Fibrillation in Cardiac Surgery – The Added Value of Echocardiography
    (Scientific Foundation Spiroski (publications), 2021-12-30)
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    INTRODUCTION: Post-operative atrial fibrillation (POAF) is a frequent rhythmic complication in cardiac surgery with the potential to cause sudden hemodynamic instability and catastrophic thromboembolic complications. Despite vast scientific research, it is still hard to predict and prevents its occurrence. AIM: The aim of this study was to determine whether selected pre-operative and intraoperative echocardiographic variables would be of added value in POAF prediction. МАTERIAL AND METHODS: This prospective observational follow-up study included 178 cardiac surgery patients undergoing coronary artery bypass graft intervention. Demographic as well as echocardiographic variables of interest were examined to detect significant independent predictors for POAF. RESULTS: POAF was detected in 90 (50.56%) patients versus 88 (49.44%) patients without POAF. Patients who developed POAF were significantly older and burdened with multiple comorbidities. In multiple regression analysis pre-operative echocardiographic variables-diastolic dysfunctions, enlarged left atrial (LA) volume indexed for body surface area, mitral annular calcification, and secondary mitral regurgitation were predictive of POAF. LA appendage flow velocity obtained by intraoperative transesophageal echocardiography was also a significant intraoperative predictor for POAF. CONCLUSION: The results of this study confirmed that two-dimensional echocardiography is a valuable diagnostic and prognostic tool in relation to POAF. The addition of the aforementioned echocardiographic independent predictors to traditional demographic variables could be a solid foundation of a new predictive model for POAF.
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    Management of Polyneuromyopathy in a Critically Ill Patient with a Left Ventricular Assist Device
    (Macedonian Academy of Sciences and Arts, 2022-12)
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    Gechevska, Daniela
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    Critical illness polyneuromyopathy after cardiac surgery is often unrecognized and is a rarely reported clinical condition. It is characterized by more proximal than distal symmetrical flaccid muscle weakness and difficulty in weaning from a respirator. When done in a timely manner, rehabilitation prevents early complications and reduces the length of hospitalization. Rehabilitation leads to better motor outcome, improves short-term and long-term functionality, and results in a better quality of life.
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    Predictors of atrial fibrillation following coronary artery bypass surgery
    (Scientific Foundation SPIROSKI, 2020-07-16)
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    <jats:p>Atrial fibrillation (AF) is the most common type of arrhythmia following open heart surgery and it contributes to prolonged hospital stay, increased prevalence of thromboembolic complications and overall increased postoperative morbidity and mortality. The aim of this prospective observational follow-up study was to determine the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass surgery, to identify predisposing  risk factors for its occurrence in the immediate preoperative period and to assess its effect on the postoperative outcome in patients at the University Clinic for Cardiac Surgery in Skopje, North Macedonia. Material and methods: The study included patients at the University Clinic for Cardiac Surgery in Skopje, North Macedonia undergoing coronary artery bypass surgery. The experimental group included patients developing POAF, whereas the control group those who did not develop the primary outcome. All patients were followed up for a period of 30 days postoperatively. Results: POAF was registered in 38% of the patient population and more frequently in the elderly. Patients developing POAF had significantly higher left atrial volume index, as well as higher CHADS2-VASC2, HATCH and Euroscore I values. Average time to POAF occurrence was 48-72 hours postoperatively. There were death outcomes, thromboembolic events, longer hospital stay, need for antiarrhythmic and oral anticoagulant therapy in the POAF group. Conclusion: POAF significantly increases postoperative morbidity and mortality in patients undergoing coronary artery bypass surgery. Age, higher CHADS2-VASC2, HATCH and Euroscore I values and left atrial volume were found to be significant predictors of POAF after coronary artery bypass surgery.</jats:p>
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    Dynamic Left Ventricular Outflow Tract Obstruction - when to Intervene?
    (International Medical Journal Corp., 2021)
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    Siljanovski, Nikola
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    Left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM), most commonly is provoked by the contact between the hypertrophied basal interventricular septum (IVS) and the systolic anterior motion (SAM) of the anterior leaflet of mitral valve, during systole, thus narrowing the left ventricular outflow tract (LVOT). Several theories have been proposed to explain the occurrence of SAM and LVOTO, the “drag effect” theory is widely accepted. Despite SAM, one of the others morphological features that can contribute to LVOTO is an insertion of an accessory muscle bundle extending from the apex to the basal anterior septum of free wall of the left ventricle. In this case report we present a case of 71-year-old man with dyspnea and syncope, exercise induced, as a result of severe dynamic LVOTO. The LVOTO was a result of HCM, mostly affecting the basal IVS, with concomitant insertion of an accessory muscle bundle at the basal segment of IVS, that was additionally thickening the IVS, and SAM of the anterior mitral lealflet (AML), that were narrowing the LVOT and causing high LVOT gradients (86,3 mm Hg) at rest. The patient was symptomatic, he had dyspnea and syncope, exercise induced. The patient underwent a septal myectomy and mitral valve repair, which successfully reduced the gradients and relieved the patient of the symptoms.
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    SGLT2 Inhibitor–Induced Euglycemic Diabetic кetoacidosis: A Case Report
    (University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Medical Faculty, University “Ss. Cyril and Methodius” - Skopje, 2022-10-13)
    Zhivkovikj, Marija
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    Mehmedovikj, Marija
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    Introduction: Euglycemic diabetic ketoacidosis (EuDKA) is a rare but serious complication of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We present a case of a 39 year old patient with EuDKA precipitated by empagliflozin therapy. Case report: Male patient with a history of type 2 diabetes for 7 years, on metformin, vildagliptin, gliclazide and multiple sclerosis for 2 years, on biological therapy, was treated with high doses of corticosteroids due to progression of neurological symptomatology. Because of poorly controlled diabetes with HbA1c of 12.1%, 10mg of empagliflozin was department with complaints of malaise, abdominal discomfort, loss of appetite and muscle cramps. Laboratory analysis showed glycaemia of 8,1 mmol/l, normal blood urea, creatinine, electrolytes and high levels of ketone in urine. Patient was treated with 0,9% solution of NaCl, 40mg of pantoprazole and discharged. Several hours later due to worsening of the condition patient was admitted to the intensive care unit. On admission glycaemia was 8,1 mmol/l, heart rate 130/min, arterial tension-127/66 mmHg, oxygen saturation 87%, arterial blood gases pH- 6.87, pO2- 177mmHg, pCO2- 7 mmol/l, bicarbonate-3,0 mmol/l, potassium-3,8 mmol/l, lactate-2,8 mmol/l. Therapy with intensive fluid replacement, intravenous insulin infusion, potassium chloride, bicarbonate and noradrenalin was instituted and mechanical ventilation was indicated. After patient condition gradually improved, transition to subcutaneous insulin therapy was made. Conclusion: Early identification of diabetic ketoacidosis despite euglycemia is essential for timely institution of treatment. Avoiding initiation of SGLT-2 inhibitors in volume-depleting illnesses, diminished oral intake, infection or other metabolic stressors reduces the risk for ЕuDKA .