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    EFFECT OF SUPPLEMENTAL ANTIOXIDANT-BASED THERAPY ON THE OXIDATIVE STRESS LEVEL IN COVID-19 PATIENTS
    (Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences, 2023-03-15)
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    Background: COVID-19 is a disease in several stages starting with virus replication to dysregulation in immune system response, organ failure and recovery/death. Our aim was to determine the effect of Ganoderma lucidum, lycopene, sulforaphane, royal jelly and resveratrol extract on markers of oxidative stress, inflammation, routine laboratory analyses and duration of symptoms in COVID-19 patients. Methods: The oxidative stress parameters and interleukines 6 and 8 (IL-6, IL-8), tumor necrosis factor alpha (TNF-α) were determined in order to estimate the antioxidant and the anti-inflammatory effect of the product using a spectrophotometric and a magnetic bead-based multiplex assay in serum of 30 patients with mild form of COVID-19. Results: Statistically significant differences were obtained for all investigated parameters between the treated patients and the control group. Moreover, significant differences were observed for leukocytes, neutrophil to leukocyte ratio and iron. The average duration of the symptoms was 9.4±0.487 days versus 13.1±0.483 days in the treatment and the control group, respectively (p=0.0003). Conclusion: Our results demonstrated the promising effect of Ge132+NaturalTM on reducing the oxidative stress and the IL-6, IL-8 and TNF-α levels, and symptoms duration in COVID-19 patients. The evidence presented herein suggest that the combination of Ganoderma lucidum extract, lycopene, sulforaphane, royal jelly and resveratrol could be used as a potent an adjuvant therapy in diseases accompanied by increased oxidative stress and inflammation.
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    Organ dysfunctions, sources of infection and systemic inflammatory response syndrome as predictors for sepsis outcome
    (Macedonian Infectious Diseases Society, 2022-11-11)
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    Rangelov, Goran
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    Evaluation of severity scoring systems in patients with severe community acquired pneumonia
    ("N Gh Lupu" Foundation of Internal Medicine and Romanian Academy, 2021-12)
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    Background. The aim of this study was to evaluate the ability of severity scoring systems to predict 30-day mortality in patients with severe community-acquired pneumonia. Methods. The study included 98 patients aged ≥18 years with community acquired pneumonia hospitalized at the Intensive Care Unit of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia, during a 3-year period. We recorded demographic, clinical and common biochemical parameters. Five severity scores were calculated at admission: CURB 65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age ≥65 years), SCAP (Severe Community Acquired Pneumonia score), SAPS II (Simplified Acute Physiology Score), SOFA (Sequential Organ Failure Assessment Score) and MPM (Mortality Prediction Model). Primary outcome variable was 30-day in-hospital mortality. Results. The mean age of the patients was 59.08 ± 15.76 years, predominantly males (68%). The overall 30-day mortality was 52%. Charlson Comorbidity index was increased in non-survivors (3.72 ± 2.33) and was associated with the outcome. All severity indexes had higher values in patients who died, that showed statistical significance between the analysed groups. The areas under curve (AUC) values of the five scores for 30-day mortality were 0.670, 0.732, 0,726, 0.785 and 0.777, respectively. Conclusion. Widely used severity scores accurately detected patients with pneumonia that had increased risk for poor outcome, but none of them individually demonstrated any advantage over the others.
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    COMPARISON OF THREE SEVERITY SCORING MODELS FOR MORTALITY PREDICTION OF COMMUNITY-ACQUIRED PNEUMONIA
    (Peytchinski Publishing Ltd., Pleven, Bulgaria, 2024-10)
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    Rangelov, Goran
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    Cana, Fadil
    Introduction: Community-acquired pneumonia (CAP) is among the leading cause of morbidity and mortality worldwide. Several scoring models have been developed to accurately asses a disease severity and early to predict the outcome, however an optimal prognostic tool still is not clearly defined. The aim of this study was to compare three commonly used scores in patients with CAP, in order to determine the best tool that will early identify those with increased risk for mortality. Methods: The study included 129 patients aged ≥18 years with CAP hospitalized at the intensive care unit (ICU) at the University Clinic for Infectious Diseases in Skopje, during a 3-year period. Demographic, clinical and biochemical parameters were recorded and three scores were calculated at admission: SOFA (Sequential Organ Failure Assessment Score), SAPS II (Simplified Acute Physiology Score) and APACHE II (Acute Physiology and Chronic Health Evaluation II). Primary outcome was 30-day in-hospital mortality. Receiver Operating Curve (ROC) analysis was performed and areas under the curve (AUC) were compared to evaluate mortality prediction capacities of the scores. Results: The mean age of the patients was 61 year, predominantly were males (66,7%), most (79,1%) had co-morbid condition and Charlson Comorbidity index was significantly increased in non-survivors. An overall mortality was 43.4%. All severity scores had higher values in patients who died, that was statistically significant with the outcome. The AUC values of the scores were 0,749 for SOFA, 0.749 for SAPS II and 0.714 for APACHE II, showing similar prediction ability. Conclusion. Commonly used severity scoring models accurately identified patients with CAP that had an increased risk for poor outcome, but none of them showed to be superior over the others in ability to predict the mortality.
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    ПРИКАЗ НА СЛУЧАЈ: ТРЕТМАН СО ЕМБОЛИЗАЦИЈА НА ХЕМАТОМ ВО ПРАВИОТ СТОМАЧЕН МУСКУЛ КАЈ ПАЦИЕНТ СО КОВИД-19 A CASE REPORT: EMBOLIZATION TREATMENT OF RECTUS SHEATH HEMATOMA IN A COVID-19 PATIENT
    (Македонско лекарско друштво = Macedonian Medical Association, 2022-10)
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    Sopova, Zaklina
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    Osmani L., Arlinda
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    Introduction. In this case report we present a patient with COVID-19 pneumonia and rectus sheath hematoma (RSH) treated with embolization. Methods. A 63-year-old man positive for SARS-CoV- 2 presented with cough, fever and dyspnea to our Clinic. The patient was admitted and treated with oxygen, antibiotics, corticosteroid, anticoagulant and oral antiplatelet therapy. Thirteen days after admission the patient had severe abdominal pain, the CT scan confirmed left rectus sheath hematoma and he underwent a CT angiography with embolization of the left inferior epigastric artery. Ten days after embolization the patient recovered completely and was discharged. Result. SARS-CoV-2 infection is associated with coagulopathy, hence the anticoagulant therapy. The main side effect of anticoagulant therapy is an increased risk of bleeding. A rare complication of anticoagulant therapy is rectus sheath hematoma. The treatment is usually conservative with intravenous fluids, pain medication, discontinuation of anticoagulant therapy, and blood transfusion in cases of severe anemia. The computed tomography is the most common method to establish or confirm the diagnosis. Еmbolization of bleeding vessels can be performed in large RSH with hemodynamic instability and/or with evidence of active bleeding. Conclusion. Inpatient treatment of COVID-19 pneumonia includes anticoagulant agents, but clinicians must carefully monitor their possible side effects and suspect a rectus sheath hematoma in patients with abdominal pain and palpable mass. Those with clinically relevant rectus sheath hematoma that do not respond to supportive care can be successfully treated using embolization, thus avoiding invasive surgical approach.
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    Акутна миелоидна леукемија и КОВИД-19: приказ на случај
    (Macedonian Infectious Diseases Society, 2022-11-11)
    Stamenkovska, Angela
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    Hasipi, Mesut
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    Janeku Kartalova, Marija
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    Veleska, Meri
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    Bogoeva Tasevska, Sunchica
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    Assessment of Severity Scoring Indexes in mortality prediction of Severe Community Acquired Pneumonia
    (2022-11)
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    Rangelov Goran
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    Introduction: community acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Approximately 8-36% require treatment in the intensive care unit (ICU) due to disease severity. Aim of the study: to asses the capacity of severity scoring indexes to predict the mortality of severe CAP. Methods: the study included 129 adult patients with CAP hospitalized at ICU of the University Clinic for Infectious Diseases in Skopje during a 3-year period. Primary outcome variable was 30-day in-hospital mortality. Demographic, clinical and biochemical parameters were recorded and seven severity scores were calculated: Charlson comorbidity Index, CURB 65, SCAP at admission, SAPS II and APACHE II after 24 hours, MPM and SOFA score during the first 48 hours. Receiver Operating Curve (ROC) analysis was performed and areas under the curve (AUC) were calculated for all analyzed severity indexes to evaluate their capacities to predict the mortality. Results: the mean age of studied patients was 61 year and 66,7% were males. An overall mortality was 43.4%. Charlson Comorbidity Index has higher value in non-survivors and it was associated with a poor outcome. All scores had significantly increased values among non-survivors, except CURB-65 that had similar results in both groups, with no statistical significance with the outcome. AUC for all scores had close values, ranging from 0.714 for APACHE II to 0.755 for SCAP. The highest AUC showed MPM and SOFA score when calculated at 48 hour after the admission, with values of 0.800 and 0.839 respectively. Conclusion: according to the results of our study, the most commonly used severity scoring indexes had strong ability to detect patients with pneumonia that had increased risk for poor outcome, but none of them showed to be superior over the others in pneumonia mortality prediction.
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    SAFETY AND EFFECTIVENESS OF DIRECT-ACTING ANTIVIRALS IN PATIENTS WITH CHRONIC HEPATITIS C AND CHRONIC KIDNEY DISEASE
    (Macedonian Infectious Diseases Society, 2022-11)
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    Gasheva, Magdalena
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