Kuzmanovski, Nikola
Preferred name
Kuzmanovski, Nikola
Official Name
Kuzmanovski, Nikola
Main Affiliation
12 results
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Item type:Publication, Rhabdomyolysis and Acute Kidney Injury in a Patient with Severe Form of Covid-19 Pneumonia- A Case Report(Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2020); ; ; Introduction. The ongoing pandemic with the novel Corona virus poses unprecented challenges for the me- dical professionals worldwide. Acute kidney injury is frequently seen in patients infected with corona virus and often associated with a poor patient outcome. Rhabdo- myolysis has been recognized as one of the possible contributing mechanisms. Case. A 68-year-old man was referred to the emergen- cy department complaining of a dry cough, myalgia, general weakness with devastated energy feeling, chest pain and difficulties in breathing, symptoms he expe- rienced in the past five days. He also noticed that his urine was dark and in reduced amount. Quick antigen test for SARS CoV2 was performed, and the patient found Covid-19 positive. He was admitted at the hos- pital ward in a covid-designated unit. Laboratory findings revealed elevation of the inflammatory markers and elec- trolyte disbalance. Metabolic degradation products were markedly increased, serum urea was 44mmol/L (RF=2.7- 7.8 mmol/L) and serum creatinine 689umol/L (RF=45- 109umol/L), when deterioration of the kidney function was diagnosed. Urgent intermittent hemodialysis treatment was initiated. Patient suffered from a severe form of covid-19 pneumonia and was continuously on high flow oxygen mask. Duration of the patient hospitalization was 30 days, and thereafter, he was transferred to the reha- bilitation center for 28 days. Complete restoration of the physical motion and activity was accomplished, oxygen support was no longer needed, since he main- tained blood oxygen saturation above 95%. Renal func- tion has also been recovered with degradation products maintained within normal ranges. Conclusion. Rhabdomyolysis in covid-19 patients should be always kept in mind. Sometimes it can be an initial clinical manifestation in covid-19 patients [15], but on the other hand it can be presented as a late complication sometimes caused by the therapy itself. Multidiscipli- nary and comprehensive approach in the diagnosis, treat- ment and follow up of the patients can only guarantee timely detection and wide range of therapeutical moda- lity, leading to a better prognosis and outcome. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, HAEMOPHILUS INFLUENZAE MENINGITIS IN A ADULT: A RARE ETIOLOGY OF MENINGITIS – CASE REPORT(Peytchinski Publishing Ltd., Pleven, Bulgaria, 2024-10); ; ; Rangelov, GoranHaemophilus influenzae is a gram-negative bacterium that commonly causes meningitis in children, rarely in adults, particularly in immunocompetent individuals. Most adult cases occur in those with predisposing conditions such as chronic diseases and immunosuppression. We describe a case of meningitis caused by Haemophilus influenzae in an immunocompetent 66- year-old male. The patient received treatment with ceftriaxone and he was discharged in good clinical condition, with no neurological deficits. Haemophilus influenzae meningitis in adults underscores the importance of considering this rare pathogen in the differential diagnosis of bacterial meningitis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Organ dysfunctions, sources of infection and systemic inflammatory response syndrome as predictors for sepsis outcome(Macedonian Infectious Diseases Society, 2022-11-11); ; ; ; Rangelov, Goran - Some of the metrics are blocked by yourconsent settings
Item type:Publication, METHICILLIN-SENSITIVE STAPHYLOCOCCUS AUREUS BACTEREMIA AND MENINGITIS ASSOCIATED WITH SPINAL AND PSOAS MUSCLE ABSCESS – CASE REPORT(Peytchinski Publishing Ltd., Pleven, Bulgaria, 2024-10); ; ; Rangelov, GoranMethicillin-sensitive Staphylococcus aureus (MSSA) can cause a range of severe infections, including bacteremia and meningitis. While MSSA-related bacteremia and meningitis are serious on their own, they can also be associated with complex complications such as intraspinal and psoas abscesses. We report a case of a 72-year-old male with symptoms including lower back pain, leg weakness, malaise, fever and headache. Initial laboratory results showed leucocythosis, hyponatriemia and elevated CRP, while cerebrospinal fluid analysis indicated significant pleocytosis and neutrophilia. After admission, three blood cultures were obtained, all of which isolated MSSA. During hospitalization, a CT scan of the thorax and MR of the spine were performed, revealing bilateral pleural effusion, L5-S1 intraspinal abscess, and an abscess in the ileopsoas muscle. After 6 weeks of antibiotic therapy, a follow-up MRI was performed, which showed regression of the abscesses. This case underscores the severe complications of Staphylococcus aureus infection, including meningitis, sepsis and abscesses. Effective management relies on prompt diagnosis, comprehensive evaluation, and targeted antibiotic therapy. The patient’s positive outcome highlights the importance of early recognition and tailored treatment in complex infections. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Evaluation of severity scoring systems in patients with severe community acquired pneumonia("N Gh Lupu" Foundation of Internal Medicine and Romanian Academy, 2021-12); ; ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, COMPARISON OF THREE SEVERITY SCORING MODELS FOR MORTALITY PREDICTION OF COMMUNITY-ACQUIRED PNEUMONIA(Peytchinski Publishing Ltd., Pleven, Bulgaria, 2024-10); ; ; Cana, FadilIntroduction: 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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); ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Assessment of Severity Scoring Indexes in mortality prediction of Severe Community Acquired Pneumonia(2022-11); ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SAFETY AND EFFECTIVENESS OF DIRECT-ACTING ANTIVIRALS IN PATIENTS WITH CHRONIC HEPATITIS C AND CHRONIC KIDNEY DISEASE(Macedonian Infectious Diseases Society, 2022-11); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, VARICELLA ZOSTER VIRUS AND MENINGITIS IN IMMUNOCOMPETENT PATIENT - CASE REPORT(Peytchinski Publishing Ltd., Pleven, Bulgaria, 2024-10); ; ; Varicella zoster virus reactivation, also known as herpes zoster is common in older adults and immunocompromised individuals and often causes a painful, vesicular rash limited to a dermatomal distribution. On occasion, it can lead to various neurological complications as well. Meningitis caused by varicella zoster virus infection is uncommon in immunocompetent patients. We report the case of a 49-year-old male patient that presented with a one-week history of persistent headache that did not resolve with analgesics. He was previously healthy and immunocompetent, with a history of chickenpox in childhood. The CSF PCR analysis revealed a VZV infection causing acute aseptic meningitis with no shingles rash eruption on physical examination. Intravenous treatment with Acyclovir was started and following a three-week treatment course, the patient was discharged in good general condition with normal CSF results.