Gigovska, Irena

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Gigovska, Irena

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Gigovska, Irena

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Ново дијагостицирана атријална фибрилација кај пациентка со активен карцином на дојка: тераписки предизвик - приказ на случај
(2023-10)
Breast cancer is the most common malignant disease in females. The specific cancer treatment protocol involves drugs with known cardiovascular toxicity. Patients with significant risk of cancer therapy-related cardiovascular toxicity (CRT-CVT) should be reported for cardiology referral. CASE REPORT: Seventy-year-old, obese patient with a previous history of hypertension and low normal left ventricular ejection fraction (LVEF) was diagnosed with breast cancer and scheduled for baseline assessment before initiating cardiotoxic cancer treatment protocol. Regular monitoring for an already high-risk patient for CRT-CVT was not enough for developing of first diagnosed, paroxysmal, asymptomatic atrial fibrilation after completing the 4 th cycle of anthracyclines and total cumulative dose of 208.3mg/m2. Transthoracic echocardiography did not reveal significant changes in LVEF and global longitudinal strain, so cancer therapy-related cardiac dysfunction was not the related diagnosis. Laboratory measurements of cardiac biomarkers did not confirm subclinical cardiac injury. Besides ACEinhibitors already prescribed for hypertension, drugs for rate control and anticoagulation therapy with both low-molecular-weight heparin and NOAC was the preferred therapeutic decision for successful completion of the oncological treatment. After a week, the electrocardiogram showed sinus rhythm. The patient also completed left-sided radiotherapy with total tumor dose of 41,25Gy, and six months after has stabile cardiac performances and normal sinus rhythm. CONCLUSION: CRT-CVT is the second leading cause of death in breast cancer patients. Management of the adverse effects is challenging and complex due to the imperative of completing the cancer therapy and frequent drug-drug interactions. Early detection, multidisciplinary approach and close monitoring are the cornerstone for overall good outcome in these patients.
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POST-PNEUMONECTOMY SYNDROME IN ADULT PRESENTING WITH RECURRENT SYNCOPE
(Macedonian Association of Anatomists and Morphologists, 2022-12)
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Ristovski, Vladimir
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Eftimovska-Otovic, Natasha
Post-pneumonectomy syndrome is a rare, late complication of pneumonectomy, caused by a mediastinal shift, rotation and deviation of the remaining lung into the contralateral hemithorax, most commonly resulting in symptomatic central airway compression. Case report: Recurrent syncope following a left pneumonectomy was described in a 63 year-old man, forty years after the initial treatment. Four years physician visit including the family doctor, a neurologist, neurosurgeon, physiatrist, radiologist, psychiatrist and finally a cardiologist made the diagnosis hard to establish and the treatment delayed. The post-pneumonectomy syndrome is a complex constellation of symptoms, following previous lung pneumonectomy, with various presentations mimicking different pathologies. Its diagnosis is often misleading, making the treatment and prognosis hard to predict.
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UNUSUAL PRESENTATION OF THROMBOEMBOLIC DISEASE IN A HOSPITALIZED PATIENT WITH A COVID-19 INFECTION: A CASE REPORT
(Macedonian Association of Anatomists and Morphologists, 2021-12)
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Nedeska Minova, Natasha
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Terzievska, Keti
With no ideal specific therapy confirmed by the science community, and many low income countries barely being able to obtain a sufficient number of vaccines, as well as the long-term mental health impact, the COVID-19 infection makes for a worldwide health and global problem. A COVID-19 positive patient was admitted due to poor condition, malaise and bilateral interstitial pneumonia with borderline oxygen saturation of 94%, hypoxemia with pO2 of 64mmHg, and elevated C reactive protein (CRP) of 70. The patient was put on oxygen support of 3l/min, and started parenteral antibiotic and LMWH in prophylactic doses - a combination that primarily improved the patient’s condition. Three days after hospitalization marked shortness of breath with a drop in oxygen saturation of 62% referred. With further increasing of the oxygen flow, and a transfer to ICU, gas pressures showed significant worsening and the patient was put on mechanical support with a CPAP mask. Despite adding pulsed doses of potent corticosteroid, rapid acting insulin for blood glucose control, and administerring convalescent plasma and parenteral nutrition, the CRP levels were increasing and oxygen was decreasing. Hypotensive, tachycardic and with reduced urine output, the patient was intubated and set up on IPPV mechanical support. Vasopressor stimulation didn’t improve the diuresis and elevation of degradation products followed, as well as elevation of the troponin and cardiospecific enzymes - non of which was caused by sepsis. Eight days after admission, the left arm presented as pale, cool and cyanotic. Fully deteriorated laboratory findings of multiple organ system failures (MOFS) were undoubtable; with the oxygen levels incompatible of life, and a CT scan with ARDS presentation, a continuous heparin infusion was the only solution. At the beginning, nothing indicated the deleterious outcome; however, with a highly unusual presentation of arterial thrombosis, the upper limb gangrene became too much and the patient died. COVID-19 is primary a respiratory infection, but the virus can affect other organs and systems, with some very rare presentations and deleterious outcomes.
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UNUSUAL PRESENTATION OF THROMBOEMBOLIC DISEASE IN A HOSPITALIZED PATIENT WITH COVID-19 INFECTION: A CASE REPORT
(Macedonian Association of Anatomists, 2021-12)
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Nedeska Minova, Natasha
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Terzievska, Keti
With no ideal specific therapy confirmed by the science community, and many low income countries barely being able to obtain a sufficient number of vaccines, as well as the long-term mental health impact, theCOVID-19 infection makes for a worldwide health and global problem. Case report A COVID-19 positive patient was admitted due to poor condition, malaise and bilateral interstitial pneumonia with borderline oxygen saturation of 94%, hypoxemia with pO2 of 64mmHg, and elevated C reactive protein (CRP) of 70. The patient was put on oxygen support of 3l/min, and started parenteral antibiotic and LMWH in prophylactic doses-a combination that primarily improved the patient’s condition. Three days after hospitalization marked shortness of breath with a drop in oxygen saturation of 62% referred. With further increasing of the oxygen flow, and a transfer to ICU, gas pressures showed significant worsening and the patient was put on mechanical support with a CPAP mask. Despite adding pulsed doses of potent corticosteroid, rapid acting insulin for blood glucose control, and administering convalescent plasma and parenteral nutrition, the CRP levels were increasing and oxygen was decreasing. Hypotensive, tachycardia and with reduced urine output, the patient was intubated and set upon IPPV mechanical support. Vasopressor stimulation didn’t improve the diuresis and elevation of degradation products followed, as well as elevation of the troponin and cardio specific enzymes -non of which was caused by sepsis. Eight days after admission, the left arm presented as pale, cool and cyanotic. Fully deteriorated laboratory findings of multiple organ system failures (MOFS) were undoubtable; with the oxygen levels incompatible of life, and a CT scan with ARDS presentation, a continuous heparin infusion was the only solution. At the beginning, nothing indicated the deleterious outcome; however, with a highly unusual presentation of arterial thrombosis, the upper limb gangrene became too much and the patient died. COVID-19 is primary a respiratory infection, but the virus can affect other organs and systems, with some very rare presentations and deleterious outcomes.
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Hemoptiza kao prva klinička prezentacija metastatskog seminoma kod 24-godišnjeg pacijenta
(Udruženje bronhologa Srbije, 2022-11)
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Kochovska-Kamchevska, Nade
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Baloski, Marjan
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Bushev, Jane
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Poposki, Bozhidar
Rak testisa je najčešći malignitet kod muškaraca od 15 do 35 godina. On čini oko 1% svih karcinoma. Prevalencija raka testisa kod belaca je 4,5 puta veća kod crnaca. Seminomi su osetljiviji na terapiju zračenjem i lakše se leče od neseminoma. To je vrsta raka koja počinje u zametnim ćelijama kod muškaraca. Seminomi se najčešće javljaju u testisu, ali se mogu javiti iu drugim delovima tela, kao što su mozak, grudni koš ili stomak.
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POST-PNEUMONECTOMY SYNDROME IN ADULT PRESENTING WITH RECURRENT SYNCOPE: A CASE REPORT
(Macedonian Association of Anatomists, 2022-12-29)
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Ristovski, Vladimir
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;
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Eftimovska Otovikj, Natasa
Post-pneumonectomy syndrome is a rare, late complication of pneumonectomy, caused by a mediastinal shift, rotation and deviation of the remaining lung into the contralateral hemithorax, most commonly resulting in symptomatic central airway compression. Case report Recurrent syncope following a left pneumonectomy was described in a 63 year-old man, forty years after the initial treatment. Four years physician visit including the family doctor, a neurologist, neurosurgeon, physiatrist, radiologist, psychiatrist and finally a cardiologist made the diagnosis hard to establish and the treatment delayed. The post-pneumonectomy syndrome is a complex constellation of symptoms, following previous lung pneumonectomy, with various presentations mimicking different pathologies. Its diagnosis is often misleading, making the treatment and prognosis hard to predict.
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Alergijska bronhopulmonalna aspergiloza (ABPA) bez istorije bronhijalne astme
(Udruženje bronhologa Srbije, 2022-11)
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Kochovska-Kamchevska, Nade
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Baloski, Marjan
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Bushev, Jane
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Poposki, Bozidar
Plućne bolesti povezane sa aspergilusom su spektar poremećaja kao što su aspergilom, invazivna aspergiloza i alergijska bronhopulmonalna aspergiloza (ABPA). ABPA je imunološka bronhopulmonalna inflamacija (reakcija preosetljivosti disajnih puteva) zbog imunološkog odgovora donjih respiratornih puteva protiv Aspergillus fumigatus. Glavni dijagnostički kriterijumi za ABPA su 1) bronhijalna astma, 2) plućna infiltracija, 3) eozinofilija periferne krvi, 4) pozitivan kožni test na Aspergillus fumigatus, 5) precipitin u serumu na Aspergillus semulino E fumigatus (E6) globulin E6) ), i 7) centralne bronhiektazije. Dijagnozu ABPA treba razmotriti kod astmatičara svih uzrasta. Evolucija bolesti obuhvata pet faza od akutnog do fibroznog stadijuma uključujući plućnu fibrozu i respiratornu insuficijenciju.
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Carotid Artery Disease and Lower Extremities Artery Disease in Patients with Chronic Obstructive Pulmonary Disease
(Scientific Foundation SPIROSKI, 2019-07-15)
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Kochovska-Kamchevska, Nade
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Doneva, Ana
To assess the frequency of carotid artery disease (CAD) and lower extremities artery disease (LEAD) in patients with chronic obstructive pulmonary disease (COPD) and their relation to the severity of airflow limitation and the level of C-reactive protein (CRP).
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METABOLIC SYNDROME (METS) AS ONE OF THE MAJOR COMORBIDITIES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
(Association of pulmologists from Republika Srpska, 2023-05)
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Baloski, Marjan
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Bushev, Jane
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Mickovski, Ivana
Aim: We aimed to investigate the association between COPD and MetS, the relation to the severity of airflow limitation. Methods: This is a cross-sectional study including 220 patients with initially diagnosed COPD (IG), aged 40 to 75 years and 58 non-COPD subjects matched by age, smoking status, body mass index, as controls (CG). All study participants underwent anthropometric measurements, fasting blood sugar (FBS), lipid profile, pulmonary evaluation (dyspnea severity assessment, baseline and postbronchodilator spirometry, gas analyses, chest X-ray). Results: Results presented statistically significant difference in presence of MetS in COPD patients compared to controls (32.27% vs 10.34%; P=0.0009). According to the GOLD classification, the frequencies of MetS in COPD patients were categorized in stages I, II, III, IV (17.54%, 37.10%, 34.62%, 40.82%, respectively). The proportion of patients with increased glycemic values was: a) GOLD1 - 18 (31.58%); b) GOLD 2 - 32 (51.61%); c) GOLD3 - 29 (55.77%); and d) GOLD4 - 31 (63.27%). There was no significant difference between IG and CG patients regarding HDL level. According to arterial hypertension the highest proportion was observed in GOLD3 - 22 (42.31%) followed by GOLD4 - 20 (40.82%), and GOLD3 - 22 (35.48 %), smallest in GOLD1 - 17 (29.82%). Conclusion: We found higher prevalence of MetS in patients with COPD even in early COPD stages compared to non-COPD. Our findings suggest an urgent need to develop comprehensive strategies for prevention, screening and start of treatment in early stage.

Gigovska, Irena

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