Barbov, Ivan

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Barbov, Ivan
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Barbov, Ivan
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    Biological Rhythms in People from North Macedonia with Bipolar Disorder: Application of the Macedonian Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN)
    (Bentham Science Publishers Ltd., 2022-11-10)
    Kalcev, Goce
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    Kotevska, Pavlina Ilieska
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    Preti, Antonio
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    Carta, Mauro G.
    <jats:sec> <jats:title>Objective:</jats:title> <jats:p>The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) is a tool aimed at clinically evaluating disturbances in biological rhythm. In this study, we examined the reliability and validity of the Macedonian version of the BRIAN.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A total of 100 participants, including 50 subjects with bipolar disorder (BD) and 50 control healthy subjects, were recruited. Construct validity was tested by comparing the mean BRIAN scores of the BD patients and control subjects.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>No difference by gender or age was noticed, but patients differed from controls in education and occupation. Reliability, as measured with Cronbach’s alpha, was good in BD individuals, except for the Rhythms subscale. Reliability in controls was less good, especially for the Sleep and Rhythms subscales. The tool was able to discriminate patients with controls, with large differences on all subscales. However, since the reliability was suboptimal for some of these subscales, these differences cannot be entirely trusted.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>The study suggests that the Macedonian version of this instrument has good psychometric characteristics and also encourages the chance of developing mixed screening tools by incorporating elements of biological rhythm dysregulation into the routine evaluation of mood.</jats:p> </jats:sec>
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    Case report of a patient with Morbus Hirayama - presentation, diagnosis and differential diagnostic aspects
    (Bugarian Society of Neurology, 2021)
    Teodor Angelov
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    Teodora Chamova
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    Dora Zlatareva
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    Nevena Fileva
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    Hirayama disease, also known as monomelic amyotrophy, is a rare disease characterized by slowly progressive muscle weakness and atrophy in one upper limb, most commonly in the muscles groups of the forearm and wrist. In addition to taking a detailed neurological status, electromyography (EMG) and magnetic resonance imaging (MRI) of the cervical region, native and after contrast enhancement of the image, in a neutral position and flexion, play a key role in the diagnosis process. In terms of differential diagnostic, more common disorders such as amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA) and advanced carpal tunnel syndrome should be considered. We report „Hirayama disease” in a 16-year-old female who presented with gradual right upper limb weakness and wasting in the distal muscles, that was confirmed by electrophysiological and neuroimaging studies.
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    Overview of the Current Situation and Challenges about Neuromyelitis Optica Spectrum Disorders in the Republic of Macedonia
    (Scientific foundation SPIROSKI, 2020-02-05)
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    Boshkova-Petkovska, Tatjana
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    Smokovski, Aleksandar
    Abstract BACKGROUND: Neuromyelitis optica spectrum disorders (NMOSD) are rare, progressive inflammatory disorders of the central nervous system characterized by severe, immune-mediated demyelination targeting optic nerves and spinal cord. Prior establishment of diagnostic criteria, patients were often misdiagnosed which led to delayed/inappropriate treatment and disability. Current practice involving immunotherapies is insufficient. Recent data are encouraging since the novel treatments allow effective prevention. AIM: The primary objective was to evaluate the current situation to identify challenges and develop intervention that might improve the current state as secondary objectives. METHODS: Standard questionnaire containing 22 questions was developed. Collected data were analyzed and descriptive report was created. RESULTS: Current estimated prevalence is approximately 20 NMOSD patients; trend is unknown due unavailability of patient registry. Six neurologists from one health-care institution are responsible for the whole management. Despite physician’s insufficient experience, ~80% of them are willing to switch patients into innovative treatments once available. Aquaporin-4-IgG testing is not routinely available resulting in ~30% testing rate. Approximately 80–90% of patients are on maintenance treatment with immunosuppressant, corticosteroids are used for acute relapse. Lack of novel innovative medications is evident. CONCLUSION: Current NMOSD management is challenging with significant unmet needs. Highest priorities that might provide improvement are: APQ4-IgG testing availability, establishment of patient registry, and availability of novel treatments.
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    Cases of Guillain-Barre Sundrome associated with COVID-19
    (SHMSHM / AAMD, 2022)
    Dalipi, Teuta
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    Stojkovska, Frosina
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    Mitrevska Velkov, Jasmina
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    Babunovska, Marija
    A novel member of human RNA coronavirus, which is an enveloped betacoronavirus, has been termed severe acute respiratory syndrome coronavirus-2 (SARS COV-2). The illness caused by SARS COV-2 is referred to as the coronavirus disease 2019 (COVID-19). It is a highly contagious disease that has resulted in a global pandemic. The clinical spectrum of COVID-19 ranges from asymptomatic illness to acute respiratory distress syndrome, septic shock, multi-organ dysfunction, and death. The most common symptoms include fever, fatigue, dry cough, dyspnea, and diarrhea. Neurological manifestations have also been reported. However, the data on the association of Guillain-Barré syndrome (GBS) with COVID-19 are scarce. We report two case of a COVID-19-positive patients who presents clinical features of GBS. In both cases clinical examination showed generalized weakness mostly in lower extremitis and hyporeflexia. The cerebrospinal fluid (CSF) analysis showed albuminocytological dissociation. The neurological condition was different in both patients they both recived kortikosteroids in first case it has good results but in second cases Intravenous immunoglobulin (IVIG) was administered. A thoracolumbar spine magnetic resonance imaging was obtained to rule out other causes, which was normal. COVID-19 is believed to cause a dysregulated immune system, which likely plays an important role in the neuropathogenesis of GBS.
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    Genetic and clinical aspects of the transthyretin familial amyloid polyneuropathy: Report of a family
    (2019)
    Kalcev, Goce
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    Abstract Introduction: Genetic testing in addition to clinical features marks this rare disease. Proving a mutation in the TTR gene is the most important tool in establishing a diagnosis. Materials and Methods: We report a Macedonian family from v. Bansko, Strumica (three brothers) Republic of North Macedonia, affected by transthyretin familial amyloid polyneuropathy. Results: Three brothers with TTR-FAP from North Macedonia were hospitalized at the Clinic of Neurology in Skopje. In addition, there was a positive finding from the genetic analysis. It showed present pathogen mutation in the TTP gene, Glu109Gln. The method used in this genetic testing consists of DNA Extraction with Phenol Chloroform, PCR Amplification of exon 3 of TTR gene, Direct DNA Sequencing with BigDye Terminator Sequencing Kit of exons of TTR gene by the method of Sanger and Analysis of ABI PRISM 3500 automatic genetic analyzer. The family gave information that there were deceased members of the same disease in the family. Congo red staining of samples from subcutaneous fat tissue aspiration biopsy was positive which is in favor of amyloid deposits Also, echocardiography registered left ventricular hypertrophy and dilatation at the same time. Electromyography with the neurography provided data for a generalized, symmetrical, chronic, partial sensor-motor neurogenic lesion with features predominantly of axonal neuropathy with signs of segmental demyelination. Conclusion: The clinical and genetic features of patients with TTR gene mutations are related to each other. Proving a mutation in the TTR gene clarifies the diagnostic puzzle and gives us the opportunity to begin therapy as soon as possible.
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    COVID-19 from a Perspective of Neuromuscular Diseases: Meeting the Challenges
    (Scientific foundation Spiroski, 2020)
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    Kalcev, Goce
    Abstract Dear Editor, The new SARS-CoV-2 epidemic is imposing immense strain on the health systems in several countries. The growth of the epidemic has led the WHO to declare the 2019-nCoV disease as a global pandemic (1). COVID-19 pandemic has the potential to affect patients with neuromuscular diseases. The evaluation of the overall risk of COVID-19 in patients with neuromuscular diseases depends on several factors: the specificity of the neuromuscular disease, the general condition, the presence of other comorbidities, age, and the type of immunosuppressive treatment they receive. It is important to emphasize the fact that most patients with neuromuscular disease are not expected to suffer from severe complications due to coronavirus infection. Corona infections can affect certain myopathies. In a recent study published in China, related to COVID-19 is shown that hospitalized patients experienced fatigue and myalgia (44-70%), and increased creatine kinase (33%) in the serum (2). Apart from this, a third of hospitalized patients infected with the coronavirus had rhabdomyolysis (3). All of this points to the fact that coronavirus infection may be responsible for viral myositis. In addition, is the finding that some of the critical cases have developed polyneuropathy or myopathy (4). On the other hand, it is well known that infection is a trigger for exacerbation of certain neuromuscular diseases. There is no data that measured the risk of exacerbation as a result of coronaviruses infection for neuromuscular disorders. However, in one retrospective study, COVID-19 infection was a leading reason for the exacerbation of myasthenia gravis (5). As a result of this, an increased incidence of exacerbations of certain neuromuscular diseases should be expected, as well as the appearance of new clinical presentations during this pandemic. It is important to note that there are still no neuromuscular diseases-specific recommendations for patients who are infected with the coronavirus. Observation is recommended in patients at high and medium risk, especially in those patients where there is a possibility of a decrease in respiratory function. Last but not least, we would like to emphasize the need for reorganization of clinical care for these patients (6). The goal is to reduce exposure of patients to areas where the coronavirus could be found. Moreover, non-urgent or outpatient care is remarkably reduced. In conclusion, we must learn to apply our clinical practices in order to reduce the complications that may occur in patients with neuromuscular disease due to COVID-19. The primary goal is to develop evidence-based medical practices in order to reduce morbidity and mortality. Collaboration among institutions worldwide will be able to give us the data needed for planning management for neuromuscular disorders with COVID-19 and maintain clinical research against strong challenges.
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    Patients with Schizophrenia and Self-Care
    (Scientific Foundation SPIROSKI, 2014-06-15)
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    Hadzihamza, Kadri
    <jats:p>INTRODUCTION: Patients with schizophrenia have severe problems with self-care which affects their quality of life.OBJECTIVE: The aim of the paper was to monitor self-care in patients with schizophrenia and to find out the differences regarding socio-demographic characteristics and ambulatory and day hospital treatment.METHOD: The investigation included 120 subjects each with diagnosis F20 according to ICD 10 criteria; divided in two groups of 60 patients regarding their actual treatment (the first group received ambulatory care whereas those from the second group had a day hospital treatment). Patients were of different age and gender, receiving regular antipsychotic therapy. They were included in individual and group psychosocial therapeutic procedures during the day hospital treatment. The investigation utilized the following diagnostic instruments: standardized clinical interview and Personal and social performance scale (PSP scale), non-standardized questionnaire of socio-demographic data, family support and existence of mental disorder in other family members.RESULTS: The results have shown better personal and social functioning in patients who had family support, in those who are employed, in those with no mental disorder in other family members and in patients on day hospital treatment against patients receiving ambulatory care.CONCLUSION: Day hospital treatment, family support and social support improve self-care of patients with schizophrenia.</jats:p>
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    Recommendations for the diagnosis and management of transthyretin amyloidosis with gastrointestinal manifestations
    (2021-05-01)
    Nakov, Radislav
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    Suhr, Ole B
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    Ianiro, Gianluca
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    Kupcinskas, Juozas
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    Segal, Jonathon P
    Transthyretin amyloid (ATTR) amyloidosis is an adult-onset, rare systemic disorder characterized by the accumulation of misfolded fibrils in the body, including the peripheral nerves, the heart and the gastrointestinal tract. Gastrointestinal manifestations are common in hereditary (ATTRv) amyloidosis and are present even before the onset of the polyneuropathy in some cases. Delays in diagnosis of ATTRv amyloidosis with gastrointestinal manifestations commonly occur because of fragmented knowledge among gastroenterologists and general practitioners, as well as a shortage of centers of excellence and specialists dedicated to disease management. Although the disease is becoming well-recognized in the societies of Neurology and Cardiology, it is still unknown for most gastroenterologists. This review presents the recommendations for ATTRv amyloidosis with gastrointestinal manifestations elaborated by a working group of European gastroenterologists and neurologists, and aims to provide digestive health specialists with an overview of crucial aspects of ATTRv amyloidosis diagnosis to help facilitate rapid and accurate identification of the disease by focusing on disease presentation, misdiagnosis and management of gastrointestinal symptoms.
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    Treatment with Cladribine Tablets Beyond Year 4: A Position Statement by Southeast European Multiple Sclerosis Centers
    (Springer Science and Business Media LLC, 2023-02)
    Habek, Mario
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    Drulovic, Jelena
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    Brecl Jakob, Gregor
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    Radulovic, Ljiljana
    Based on the results of the pivotal CLARITY study, cladribine tablets were approved for use in the European Union in 2017 as a high-efficacy therapy for highly active relapsing-remitting multiple sclerosis (MS). Cladribine tablets are used as an induction therapy: half of the total dose is given in year 1 and the other half in year 2. In the CLARITY Extension trials, repeating the dose routinely in years 3 and 4, was not associated with significantly improved disease control. However, there is very limited evidence on how to manage people with MS (pwMS) beyond year 4, which is increasingly important because more and more patients are now ≥ 4 years after cladribine treatment. Overall, postapproval data show that treatment with two cladribine cycles effectively controls disease activity in the long term. However, there is general agreement that some pwMS with suboptimal response could benefit from retreatment. This study reviews the practical aspects of using cladribine tablets, summarizes the evidence from clinical trials and real-world studies on the safety and efficacy of cladribine, and proposes a treatment algorithm developed by expert consensus for pwMS previously treated with cladribine. In brief, we propose that additional courses of cladribine tablets should be considered in patients with minimal (no relapses, 1-2 new lesions) or moderate (1 relapse, 3-4 new lesions) disease activity, while significant disease activity (> 1 relapse, > 3 new lesions) or progression should warrant a switch to another high-efficacy treatment (HET). More evidence is needed to improve the treatment guidelines for pwMS who previously received cladribine.