Bajraktarova prosheva, Tatjana

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Bajraktarova prosheva, Tatjana

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Severe hyponatremia as presenting symptom of small cell lung carcinoma
(The Endocrine Society, 2023-01)
Stevchevska, Aleksandra
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Todorova, Biljana
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A 62-year-old female patient was admitted to ICU in our clinic with symptomatic severe hyponatremia with complaints of fatigue, vertigo, paresthesia of upper extremities and three episodes of loss of consciousness in the past month. She had been hospitalized two weeks before in neurology clinic because of the same symptoms. CT of the brain, EEG, ophthalmology examinations were negative. She did not complain of hemoptysis, cough, weight loss, fever, chest pain or dyspnea. Nephrologist was consulted and renal origin of the hyponatremia was excluded, before admission. Initial laboratory tests were glucose:5,47 umol/L,sodium:109 mEq/L,potassium;4.5 mEq/L,urea 3,9 umol/l;creatinine:52,7 mol/l,calcium:1,22umol/L,TSH 5;Cortisol 819nmol/L;ACTH:16,34 pg/ml. Her medical history included hypertension, primary hypothyroidism and history of smoking. Upon laboratory findings of low serum osmolality, high urine osmolality, high urine sodium levels and clinical euvolemia, and in the absence of renal, pituitary disfunction, adrenal insufficiency, inappropriate ADH syndrome was diagnosed and initially was treated with 3% NaCl. Since this treatment had no effect, it was started with fluid restriction, per os sodium intake was increased and therapy with loop diuretic was initiated, which resulted in correction of the hyponatremia. For the etiology consideration of inappropriate ADH syndrome CT of the thorax was performed, which revealed a neo infiltrative process with atelectasis in the poster basal segment of the left lobe. Histopathological sampling from the biopsy of the mass revealed small cell carcinoma of the lung. Metastasis were not detected. Since basal morning cortisol level was above upper range, with inappropriate measurements of ACTH constantly above 15 pg/ml, additional tests for ectopic Cushing syndrome were done. Overnight 1mg dexamethasone suppression test showed absent suppression of the morning cortisol values of 656nmol/L and ACTH of 22,14 pg/ml and absent circadian rhythm of cortisol secretion, with high measurements of midnight serum cortisol of 652 nmol/L. Diagnosis of ectopic Cushing syndrome and SIADH as part of paraneoplastic syndrome in small cell lung carcinoma was made. It is to be noted that patient had no significant symptoms or signs of hypercortisolemia.</jats:p> <jats:p>We report here a case of small cell carcinoma of the lung whose first presentation was with symptomatic hyponatremia as a result of inappropriate ADH syndrome. The most common neoplasms associated with hyponatremia are various forms of lung cancer. Because of the aggressive nature of the disease, the most common manifestation of small cell carcinoma of the lung is a metastatic one. Therefore, identifying the disease in earlier stages is very important. Unfortunately, these patients have low rates of survival and face a very poor prognosis even with treatment. The presence and early identification of paraneoplastic syndromes can be beneficial in this context.
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THE EFFECT OF METHYLPREDNISOLONE VERSUS DEXAMETHASONE IN INCREASING THE DIABETOGENIC EFFECT OF SARS-CoV-2 INFECTION AND THE DEVELOPMENT OF A NEW-ONSET DIABETES MELLITUS
(Macedonian Association of Anatomists, 2022)
Srbinoska Bogatinoska, Milena
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Milenkovski, Marijan
SARS-CoV-2 causes predominantly lung disease, but by way of binding to the angiotensinconverting enzyme 2 (ACE2) receptors, it can attack key metabolic organs and may lead to alterations of glucose metabolism. The aim of the study was to examine the effect of methylprednisolone compared with dexamethasone on the glycaemic control as well as the development of new-onset diabetes in patients who were hospitalized due toCOVID-19 pneumonia. We reviewed the records of 203 consecutive patients who were hospitalized with a clinical presentation of COVID-19 pneumonia in the modular hospital at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, from December 2020until May 2021. We identified 65 patients with diabetes (32,0%), 49 patients (75%) of whichwith pre-existing diabetes, and 16 (25%) with newly diagnosed diabetes. Impaired glycoregulation was recorded in 19,2% of patients, of whom 5,5% did not receive any corticosteroid-therapy, 22,4% were treated with methylprednisolone – pulse doses,and 21,4% were treated with dexamethasone. Patients with diabetes had a 1,9 times (CI 0,9-3,9) higher mortality rate than nondiabetic patients. We suggest that, if corticosteroid therapy is necessary during the treatment of COVID-19 pneumonia, it is safer to administer dexamethasone than methylprednisolone, especially in patients who have pre-existingdiabetes or are at risk ofdeveloping diabetes. Deterioration of glycoregulation and the need to replace oral antidiabetic therapy with insulin are common. New-onset diabetes often persists even after recovering from Covid-19
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Efficacy and Safety of Empagliflozine and Semaglutide (Once Weekly) in T2DM Patients in Shtip
(Walter de Gruyter GmbH, 2023-03-01)
Nakova, Valentina Velkoska
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Nakov, Zoran
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Dokuzova, Stojka
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Objective: The efficacy and safety of the following new treatment agents were analyzed: once weekly semaglutide (OWSem) and the empagliflozine (Empa). This was done with patients with type 2 diabetes mellitus (T2DM) at the Clinical Hospital in Shtip, R.N. Macedonia. Material and methods: One-hundred-twenty-one diabetic patients were treated for the first time with OWSema or Empa and were retrospectively analyzed. Glycemic control, serum creatinine, decrease in weight, co-morbidities, and hospitalization during treatment were recorded. Results: Among the 61 patients treated with OWSema and 60 patients treated with Empa, there were not any statistically significant differences in age, sex, BMI, duration of diabetes, and a number of patients treated with insulin. Both agents (OWSema and Empa) achieved statistically significant HbA1c reduction after 6, 12, and 18 months (9.2; vs. 7.6; 6.7; 6.6, and 9.3; vs. 7.5; 7.2, 7.5%, respectively) treatment. There were not any differences in the value of creatinine between the visits in both groups. During the period of 2 years, 3 patients (5%) from the Empa group died, all with multiple comorbidities. One patient from Empa group was hospitalized because of acute pulmonary edema and two from the OWSema group because of TIA and acute coronary syndrome. The median decrease in weight was more pronounced in the OWSema group (6.0 vs. 4.0kg). Five patients stopped the treatment with Empa because of a simple urinary infection, and one stopped the OWSema because of GIT intolerance. Eight patients did not tolerate the dose of 1mg, and they therefore continued with 0.5mg of OWSema. Conclusion: Once weekly treatment with semaglutide and empagliflozine achieves a great reduction in HbA1c, and as such are safe for treatment of T2DM.
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Case Report of Latent Autoimmune Diabetes in Adults - misdiagnosed as type 2 Diabetes Mellitus
(2022-12)
Todorova, Biljana
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Introduction: Latent Autoimmune Diabetes in Adults (LADA) is a form of autoimmune mediated diabetes in adults and a hybrid form of diabetes with features of both type 1 (T1DM) and type 2 diabetes (T2DM). The diagnosis of LADA according to Immunology of Diabetes Society is based on three features: age over 35, Presence at least one of four autoantibodies to pancreatic islet cell antigens and insulin independance at least 6 months after diagnosis. Unfortunately, patients with LADA are often misdiagnosed as having T2DM, shows a sustained poor glycemic control over time and significantly increased risk of microvascular complications. CASE REPORT: We present a fimale patient aged 52. She was diagnosed as T2DM when she was 36. Her past history includes: Rheumatoid Arthritis, family history-son and father diagnosed with type T1DM at the age of 26 and 33 years, respectively. She was treated with basal insulin therapy for seven years and due to poor glycaemic control the therapy was intensified. Several months before the admittance toour hospital she had have a history of frequent urination and hypoglicemic episodes followed by loss of consciousness. Laboratory revealed: HbA1c- 8.03% ; C- peptide 0,314ng/ml (0,53-2,9 ng/ml. The rest of the laboratory was normal. Ophthalmology exam stressed non-proliferative retinopathy. Immunologic analyses revealed positive Glutamic Acid Decarboxylase Autoantibodies (GADA) 65 and Insulin Autoantibodies (IAA). DISSCUSION: Our patient was diagnosed and treated as T2D for 15 years. The susspision for LADA was raised during her last exam. In our patient, there were two antibodies found out of four-GADA65 and IAA. She was already on insulin therapy and there was no need major change of the insulin therapy. CONCULION: Prevalence of LADA is increased in the patients with family history of T1DM. The early recognition of LADA is of utmost importance. Recognizing LADA at early stage will lead to early initiation of insulin, better glycemic control as well as the preservation of residual beta-cell function in adult-onset autoimmune diabetes.
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Редок случај на конгенитална адренална хиперплазија асоцирана со хиперкортизолемија
(2022)
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Marija Ilijovska
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Biljana Todorova
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Introduction: Congenital adrenal hyperplasia (CAH) describes a group of autosomal recessive disorders characterized by enzyme deficiency in the steroidogenic pathways most commonly due to 21 hydroxylase deficiency.CAH is generally associated with decreased or absent production of cortisol, increased ACTH secretion and excessive production of adrenal androgens and progesterone, including 17OH progesterone. We report a rare case of CAH associated with hypercortisolism. Case report:A 40 years old woman was referred to the Endocrinology unit for management of infertility presented with oligomenorrhea,acne and hirsutism. She had previously been labelled as a case of PCOSy and had been placed on various types of medications such as hormonal therapy and spironolactone.The first laboratory findings showed elevated levels of cortisol, adrenal androgens and testosterone. 17OH progesterone was also increased. After the diagnosis of CAH multiple laboratory tests were made and the plasma cortisol appeared to be repeatedly elevated. Dexamethasone test showed partial supression. 24hour urine cortisol test, abdominal CT and MRI of the pituitary glandwere also performedand showed no pathological findings. The diagnosis of CAH due to 21 hydroxylase deficiency was confirmed with genetic studies that showed mutation in CYP21A2(I172N). The genotype was homozygous. Conclusion:As the pathophysiology is basically a defect in the biosynthesis of cortisol, one may not consider CAH in patients with hypercortisolism. Althought this is an extremely rare case, more attention should be paid to this condition in hyperandrogenic womeneven if cortisol levels are elevаted. Key words: CAH, hyperandrogenism, PCOSy, hypercortisolemia
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CASE REPORT OF A WOMAN WITH LI FRAUMENI SYNDROME
(2022-10)
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Todorova, Biljana
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Pavlevska, Elena
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Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome associated with high risks for a diverse spectrum of childhood- and adult-onset malignancies. The lifetime risk of cancer in individuals with LFS is ≥70% for men and ≥90% for women. Five cancer types account for the majority of LFS tumors: adrenocortical carcinomas, breast cancer, central nervous system tumors, osteosarcomas, and soft-tissue sarcomas. We report a case of a 48-year-old lady reffered to endocrinology clinic as a routine part of preoperative endocri nology assessment due to tumorous formation seen on CT scan of the abdomen, located in the retroperitoneal, paraaortal and paravertebral part of the left hypochondrium (85x95x100 mm). She had her CT scan done due to numbness in the lower left part of her back, without any other health issues. She had normal gynecological his tory with no menstrual disturbances. The laboratory revealed Androstenedion> 10 ng/ml, DHEA-S 19,42 µmol/l, Total testosteron 6,08 nmol/l. The other hormonal analyses were normal, including 1 mg suppressive overnight dexamethasone test. Chromogranin A, VMA and methanephrine in 24 hr. A left adrenalectomy was done. The fi nal patohistology diagnosis was consistent with adrenocortical carcinoma - high grade. A month after the surgery, the breast cancer was discovered and radical left mastectomy was done. The genetic testing revealed Li Fraumeni Syndrome with c375G>TP53gen. And the patient is undergoing hemotherapy and radiotherapy. We conclude that whenever adrenocortical carcinoma, which is rear type of tumor, is established, it should be followed by genetic testing.
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ЕФИКАСНОСТ И БЕЗБЕДНОСТ НА ЕМПАГЛИФЛОЗИН И ЕДНАШ НЕДЕЛЕН СУБКУТАН СЕМАГЛУТИД КАЈ ПАЦИЕНТИ СО ДИЈАБЕТЕС ТИП 2 ВО ШТИП
(2022-10)
Велкоска Накова, Валентина
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Докузова, Стојка
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Цел: Ефикасноста и безбедноста на новите лекови (еднаш неделен субкутан семаглутид (OWSem) и емпаглифлозин (Empa)) беа анализирани кај пациенти со дијабетес тип 2 (T2DM) во Клиничката болница во Штип, Р.С. Македонија. Материјал и методи: Сто дваесет и еден пациент лекувани за прв пат со OWSema или Empa беа ретроспективно анализирани. Се следеше гликемиската контрола, серумскиот креатинин, намалувањето во телесната тежина, присутните коморбидитети и евентуална хоспитализација за време на третманот. Резултати: Помеѓу 61 пациент третиран со OWSema и 60 пациенти третирани со Empa, немаше статистички значајни разлики во возраста, полот, индексот на телесна маса, времетраењето на дијабетот и бројот на пациенти третирани со инсулин. Двата лека (OWSema и Empa) постигнаа статистички значајно намалување на HbA1c по 6, 12 и 18 месеци (9,2; наспроти 7,6; 6,7; 6,6 и 9,3; наспроти 7,5; 7,2, 7,5%, соодветно) третман. Немаше разлики во вредноста на серумскиот креатинин помеѓу посетите во двете групи. Во периодот од 2 години починале 3ца пациенти (5%) со повеќе коморбидитети од групата Empa. Еден пациент од групата Empa беше хоспитализиран поради акутен пулмонален едем и двајца од групата OWSema поради TIA и акутен коронарен синдром. Просечното намалување на тежината беше поизразено во групата OWSema (6,0 наспроти 4,0 kg). Пет пациенти го прекинаа третманот со Empa на почетокот поради некомплицирана уринарна инфекција, а еден го прекина OWSema поради гастроинтестинална нетолеранција. Осум пациенти не ја толерираа дозата од 1 mg и продолжија со 0,5 mg OWSema. Заклучок. Субкутаниот семаглутид и емпаглифлозин се ефикасни и безбедни за третман на Т2ДМ.
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RESULTS FROM POST - MARKETING OBSERVATIONAL STUDY FOR THE ASSESSMENT OF SAFETY OF INTRAVENOUS IBANDRONIC ACID IN POSTMENOPAUSAL WOMEN
(SHMSHM - AAMD, 2020-12-23)
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Stefanovska, Dushica
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Our study was non interventional, observational, open, uncontrolled and prospective- retrospective study, multicentre and one branch - during 2009-2011 at secondary and tertiary medical level. 5 medical centres and two clinics from N. Macedonia were included. The study entered 611 pts, but finished 153 pts. 146 were bisphosphonate naive, 7 had previous received peroral bisphosphonate therapy. In our group of patients 36 side effects were registered in 31 patients. 35/36 appeared during first 7 days of application,15/36 did not appeared after first application, 28/36 were with mild intensity and 5 were with moderate intensity and 2 were SAERS. We analyzed review database (2009 to 2011), from the perspective of recent studies. And to point out, that DXA results, together with CMAJ guidelines and FRAX questionnaire, were not changed during last 10 years. Both of them (CMAJ and FRAX), together or without DXA, are solid foundation to begin antiresorbtive bisphosphonate therapy. DXA finding of osteoporosis, sex, and presence of one major or two minor risk factors was the basis of initiating the therapy. All of our patients were female. With the major risk factors 2,1 present in 129 (84%) from 153 patients. In 123 (80,09%) we have registered more than 1 minor risk factors (1,7). Intravenous bisphosphonate therapy, is still most useful steadily in the last decade. It is due to the simple dosing regimens, the adherence, excellent compliance and persistence accurate for certain group of patients. This therapy have few adverse effects.
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P-21 Maturity onset diabetes of the young 7: Case report
(The Endocrine Society, 2024-01)
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Todorova, Biljana
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Stevchevska, Aleksandra
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Maturity Onset Diabetes of the Young (MODY) is a rare form of diabetes which is different from both type 1 and type 2 diabetes, and runs strongly in families. MODY is autosomal dominant inherited type of diabetes, caused by a mutation (or change) in a single gene. If a parent has this gene mutation, any child they have, has a 50% chance of inheriting it from them. Recently, 14 gene mutations have been found to be associated with MODY. The Krüppel-like factor 11 (KLF11) gene mutation is the pathogenic gene of MODY7.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Case</jats:title> <jats:p>A 17-year-old female patient with a previous history of obesity was admitted at outpatient office for regular control of weight and body mass index (BMI). Two years ago the patient was diagnosed with obesity, hyperinsulinemia and insulin resistance, with body weight (BW) 90 kg, body height (BH) 167 cm and BMI 32,3. The patient is on therapy with Metformin 2×500 mg. Results of the moment of examination: BW 100 kg, BH 168 cm, BMI 35,4; HbA1c 5,96%; Fasting plasma glucose (FPG) 6.8 mmol/l; Insulinemia 13,17; C-peptide 1,00; oral glucose tolerant test (OGTT): 0’ 6,5 mmol/l 120’ 11,0 mmol/l; insulinemia during OGTT (μU/mL): 0’ 14,05; 120’ 98,75; C-peptide during OGTT (ng/mL): 0’ 1,00; 120’ 6.95; Fundus examination and Doppler ultrasonography of both lower limbs showed no abnormalities. Family history was positive for Diabetes mellitus type 2 (mother, grandmother). The Immunological tests for Diabetes mellitus type 1 were negative for antibodies: GAD65, IAA, ICA and IA-2; Because there was doubt for MODY, genetic tests were performed with targeted resequencing of 4800 clinically relevant genes. The presence in the KLF11 gene associated with MODY7 was determined, c.911>G, p.(Lys304Arg). Тhe change is found in heterozygous form and is inherited from the mother. The patient continued treatment with metformin and lifestyle changes and this resulted in weight loss and good glycoregulation. Control one year later showed weight loss and good glycoregulation, FPG 5.1 mmol/l; HbA1c 5.5%; BW 89 kg, BH 168 cm, BMI 31.5; The level of blood glucose was controlled and stable. The patient's mother and grandmother were also treated with metformin.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Young patients with signs of DM2 should be tested for genetic types of diabetes. The number of patients with MODY is small, especially regarding MODY7, which rarely occurs. MODY is the most common type of monogenic β-cell function defect. It accounts for 2% to 15% of young diabetic patients. Studies have found that oral hypoglycemic drugs and dietary interventions are beneficial for MODY7 patients, and the control of the intake of staple food carbohydrates helps to control blood glucose which was also shown in our patient (1).</jats:p> <jats:p>1. Chen L, Hou X. Clinical and Functional Characteristics of a Novel KLF11 Cys354Phe Variant Involved in Maturity-Onset Diabetes of the Young. J Diabetes Res. 2021;2021:7136869</jats:p> </jats:sec>
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Incidence of acromegaly in the Republic of North Macedonia for the period from 2015 to 2020,according to data derived from the national ehealth system
(2022-10)
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Mihajlovska Dzuliana
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Bajraktarova prosheva, Tatjana

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