Academic Medical Journal

RESOLUTION OF PEDIATRIC NOCTURNAL RESPIRATORY DISTRESS DUE TO UNDIAGNOSED ASTHMA: A CASE REPORT

2025-10-15T18:18:56+00:00

Introduction: Sleep disturbances in children may result from a range of medical or behavioral causes, with asthma often overlooked when symptoms are limited to nighttime. Asthma with atypical presentation, manifesting predominantly as nocturnal respiratory symptoms, is common but frequently misdiagnosed due to absence of daytime symptoms.

Case Report: A 10-year-old boy presented with a two-year history of nightly dry cough, dyspneic episodes, and distress. ENT evaluation revealed allergic rhinitis, and allergen testing confirmed sensitization to environmental allergens. Despite treatment with nasal corticosteroids and antihistamines, symptoms persisted. Overnight polygraphy showed significant nocturnal hypoxemia. Spirometry with bronchodilator testing confirmed reversible airway obstruction. Initiation of inhaled corticosteroid therapy led to complete and sustained resolution of symptoms.

Conclusions: This case illustrates how asthma with atypical presentation can mimic primary sleep disorders. Comprehensive respiratory evaluation, including spirometry, is essential for accurate diagnosis. Early initiation of inhaled therapy can result in rapid clinical improvement and reduce unnecessary investigations.

MECONIUM ILEUS AS INITIAL PRESENTATION OF CYSTIC FIBROSIS: A RETROSPECTIVE CASE SERIES FROM A MACEDONIAN PEDIATRIC CYSTIC FIBROSIS CENTER

2025-10-16T11:29:49+00:00

Introduction: Meconium ileus (MI) is often the earliest clinical sign of cystic fibrosis (CF), caused by intestinal obstruction due to thickened meconium from CFTR dysfunction. MI is commonly associated with severe CFTR mutations (classes I-III), which impair chloride and bicarbonate transport.

Case report: We report a retrospective case series of six neonates with MI, diagnosed with CF at Pediatric CF Center at University Children’s Clinic, Skopje, over the last eight years. During this period, newborn bloodspot screening (NBS) program for CF was conducted, based on two sequential measurements of immunoreactive trypsinogen (IRT) and IRT-IRT protocol. All infants presented with early intestinal obstruction requiring surgical intervention, including enterotomy and ileostomy. Postoperative care included pancreatic enzyme therapy and nutritional support. CF diagnosis was confirmed via sweat chloride testing and genetic analysis, which showed a predominant presence of the F508del mutation in homozygous or compound heterozygous forms. Despite timely surgical intervention, three infants experienced severe complications and early mortality. It is noteworthy that one of these cases had false-negative NBS result, highlighting limitations of the IRT-IRT protocol in MI cases. The remaining patients showed varied recovery and nutritional outcomes.

Conclusions: MI is a known cause of false-negative results in CF NBS, as IRT levels may be low in affected neonates. Therefore, any newborn presenting with MI should be presumed to have CF until proven otherwise. Confirmation requires sweat chloride testing and genetic analysis. These findings support the need for revised CF NBS protocols in all MI cases to ensure timely diagnosis and management.

ADULT PRESENTATION OF RIGHT-DOMINANT DOUBLE AORTIC ARCH WITH TRACHEOESOPHAGEAL COMPRESSION

2025-09-04T05:45:33+00:00

Introduction: Double aortic arch (DAA) is a rare congenital vascular ring anomaly resulting from the persistence of both fourth embryonic aortic arches, creating a complete encirclement of the trachea and esophagus. It is most frequently diagnosed in infancy when symptoms of airway or esophageal compression are pronounced. Adult presentation is uncommon and may manifest as progressive dysphagia or respiratory symptoms.

Case Presentation: We report the case of a 62-year-old male with a 3-month history of progressive dysphagia to solids. Initial esophagography demonstrated smooth, well-circumscribed indentation of the right lateral esophageal wall with leftward displacement, suggestive of a right aortic arch. Subsequent computed tomography angiography (CTA) revealed a double aortic arch with a dominant right arch and hypoplastic left arch, forming a complete vascular ring. There was significant anterolateral tracheal compression with leftward deviation and anterior displacement of the esophagus.

Conclusion: This case underscores that DAA, although typically diagnosed in childhood, can remain asymptomatic until late adulthood. CTA with three-dimensional reconstruction is the diagnostic modality of choice, providing essential anatomical detail for diagnosis and surgical planning in symptomatic adult patients.

“BREAKTHROUGH” ISCHEMIC STROKE ON NOAC THERAPY IN NEWLY DIAGNOSED NONVALVULAR ATRIAL FIBRILLATION: A CASE REPORT

2025-10-26T16:07:53+00:00

Introduction: Nonvalvular atrial fibrillation (NVAF) accounts for 20–30% of cardioembolic strokes. Despite the preference for nonvitamin K antagonist oral anticoagulants (NOACs) over vitamin K antagonists, ischemic stroke still occurs in 1–2% of patients. These “breakthrough strokes” are linked to high recurrence and mortality, and optimal secondary prevention remains unclear.

Case report: A 65-year-old male with NVAF on rivaroxaban presented with left hemiparesis and central facial palsy. One month prior, he experienced transient perceptual disturbance and expressive aphasia. Workup revealed paroxysmal atrial fibrillation, mild carotid atheromatosis, and normal echocardiography. Brain CT showed leukoaraiosis and cortical atrophy; MRI demonstrated a subacute ischemic lesion in the right periventricular region. NOAC adherence and dosing were appropriate. Persistent neurological deficits and mild cognitive impairment (MoCA: 22) were noted. Management included low molecular weight heparin prophylaxis, dual antiplatelet therapy, high-dose statin, antihypertensives, and supportive measures.

Discussion: Stroke, despite anticoagulation, may result from suboptimal dosing, alternative etiologies such as small vessel disease, or non-AF-related embolism. Data from a large Hong Kong cohort study suggest that continuing the same NOAC is associated with better outcomes, while switching to another NOAC or to warfarin increases recurrence risk. Conversely, some studies report benefit from switching in select cases, highlighting the need for individualized strategies.

Conclusion: Breakthrough ischemic stroke in NVAF patients on NOAC therapy is multifactorial and carries a poor prognosis. Continuation of the same NOAC may be favorable when alternative mechanisms are excluded, but randomized trials are required to guide optimal secondary prevention.

FROM DIAGNOSIS TO LIFE-SAVING INTERVENTION - PNEUMOTHORAX DETECTION USING FAST IN A RESOURCE-LIMITED EMERGENCY UNIT: A CASE REPORT

2025-11-19T09:06:03+00:00

Introduction: Tension pneumothorax is a life-threatening pediatric emergency that requires rapid recognition and intervention. In resource-limited environments, bedside extended Focused Assessment with Sonography for Trauma (eFAST) can provide a rapid and reliable diagnosis when advanced imaging is unavailable.

Case report: We report the case of a 13-year-old boy who developed acute respiratory distress after a fall form height. Bedside eFAST revealed absence of lung sliding and a barcode sign on M-mode, consistent with pneumothorax. Immediate needle decompression was followed by tube thoracostomy, with computed tomography confirming a right-sided pneumothorax and hemothorax. The patient recovered fully and was discharged after two weeks.

Conclusion: This case underscores the value of eFAST as a rapid, accurate, and life-saving diagnostic tool in resource-limited emergency settings, where timely bedside imaging can guide intervention before advanced imaging is available.

TRUE AXILLARY ARTERY ANEURYSM DUE TO REPETETIVE BLUNT FORCE TRAUMA

2025-12-04T06:47:03+00:00

The incidence of vascular pathology due to repetitive blunt force trauma of the axillary pit by using axillary crutches has been described in the medical literature. We report a case of axillary artery aneurysm with brachial, radial and ulnar artery embolization in a 53-year-old man with a severe case of spastic quadriparesis subsequent to childhood poliomyelitis. The patient presented with aggravating pain in the past 2 weeks, due to subacute right arm ischemia. We performed bypass grafting from the axillary to brachial artery with exclusion of the aneurysm followed by distal thrombectomy. An axillary artery aneurysm is rare, but potentially lethal for the upper extremity; therefore, surgical treatment must be performed prior to the development of permanent sequalae.

DIAGNOSTIC EVALUATION AND SURGICAL TREATMENT OF EXOTROPIA IN A PATIENT WITH STRAATSMA SYNDROME - CASE REPORT

2025-10-27T06:53:31+00:00

Straatsma syndrome is a rare ophthalmic condition characterized by the triad of myelinated retinal nerve fibers, high myopia, and amblyopia. It is often associated with strabismus, nystagmus, heterochromia of the iris, and optic nerve hypoplasia.

We present a case of a 22-year-old patient with this syndrome, who presented with high unilateral myopia, amblyopia, and myelinated retinal nerve fibers along the inferior temporal arcade of the affected eye. In addition, the patient had a hypoplastic optic nerve and a large-angle exotropia, which required surgical correction for cosmetic reasons. Due to untreated amblyopia in childhood, the patient had very poor visual function in the affected eye.

This case highlights the importance of early recognition and diagnosis of Straatsma syndrome, as delayed diagnosis may prevent effective treatment of amblyopia.

FEVER OF UNKNOWN ORIGIN: DIAGNOSTIC CHALLENGES FROM INFECTIOUS DISEASES PERSPECTIVE

2025-11-06T19:38:29+00:00

Aim: To evaluate the diagnostic value of potentially diagnostic clues in distinguishing infectious from non-infectious causes of fever of unknown origin (FUO).

Material and methods: We conducted a retrospective–prospective, single-center study involving patients older than 14 years who met the criteria for classical FUO. Medical history, physical examination findings, and a standardized laboratory panel were collected for all participants. After the final diagnosis, patients were divided into infectious and non-infectious groups. Demographic characteristics, clinical features, and laboratory results were compared between groups.

Results: A total of 79 patients were included, with a mean age of 50.6±17.1 years (range 15–77). Males represented 61.1% of cases and were more common in the infectious FUO group (p=0.016), with this group showing higher febrile peak (p<0.001). Infectious diseases accounted for 51.9% of cases. In this group, notable clinical findings included fatigue (sensitivity 63.4%), fever (sensitivity 75.6%), heart murmur (positive likelihood ratio [+LR] 4.8), and splenomegaly (+LR 2.23). Key features of the non-infectious group were arthralgia (+LR 3.96), neck pain (+LR 3.49), joint swelling (+LR 6.44), and rash (+LR 3.49). Elevated procalcitonin (p=0.006), ALT (p=0.04), AST (p=0.02), and globulin levels (p=0.016) was noted in infectious FUO, while ferritin (p=0.047) and LDH (p=0.03) were higher in the non-infectious group.

Conclusions: The identified differences in diagnostic variables between infectious and noninfectious causes of classical FUO may assist initial etiologic differentiation and improve utilization of the diagnostic process.

EVALUATION OF (1,3)-B-D-GLUCAN ASSAY IN RESPIRATORY SAMPLES FOR DIAGNOSIS OF ASPERGILLOSIS

2025-10-26T16:03:23+00:00

Introduction: Aspergillosis is significant problem in immunocompromised and critically ill patients. Early diagnosis is still challenging, and therefore there is a need for rapid and more sensitive diagnostic methods.

Aim: the aim was to evaluate the performance, sensitivity and specificity of the panfungal (1,3)-b-D-glucan marker in respiratory samples, compared to conventional method, for early diagnosis of aspergillosis.

Material and methods: Samples of 125 patients divided into 4 groups, classified according to clinical diagnosis and EORTC/MSG criteria, were analysed at the Institute of Microbiology and Parasitology, with conventional methods and (1,3)-b-D-glucan marker in respiratory samples, during a period of two years.

Results: A total of 71 isolates of Aspergillus were confirmed in this study. Four isolates originated from bloodcultures. Culture of respiratory samples revealed Aspergillus in the group of chronic aspergillosis (63.33%), followed by groups of cystic fibrosis (56.67%), primary immune deficiency (51.43%), and the group with prolonged ICU stay (43.33%). Sensitivity and specificity of respiratory samples’ culture were: 64.29% and 100%, 59.09% and 100%, 54.55% and 12.5%, 100% and 54.17%, in all four groups, respectively. Sensitivity and specificity of panfungal (1,3)-b-D-glucan marker in respiratory samples, were: 71.43% and 85.71%, 72.73% and 62.5%, 68.18% and 0%, 50% and 50%, in all 4 groups, respectively.

Conclusion: Results of this study demonstrate that a positive (1,3)-b-D-glucan marker in respiratory samples highlights the value of this test as a diagnostic adjunct in diagnosis of aspergillosis, along with results from conventional mycological analyses, so timely antifungal treatment with a favorable clinical outcome, is achieved.

RED BLOOD CELL DISTRIBUTION WIDTH IN THE ASSESSMENT OF EARLY MORTALITY RISK IN PATIENTS WITH ACUTE PULMONARY EMBOLISM

2025-08-14T08:45:39+00:00

Introduction: Pulmonary embolism (PE) is a life-threatening condition with variable clinical presentation and prognosis. Early identification of patients at increased risk of mortality remains a challenge, especially in intermediate-risk categories. Red blood cell distribution width (RDW), a routinely measured hematologic parameter, has emerged as a potential prognostic marker in various cardiovascular conditions.

Aim: To evaluate the predictive value of RDW for early (30-day) mortality in patients with acute PE.

Material and methods: This retrospective study included 58 consecutive patients with CTPA-confirmed acute PE treated at a tertiary cardiac center between 2023 and 2024. Patients were stratified into early mortality risk groups according to the 2019 ESC guidelines. RDW and other hematologic and biochemical parameters were recorded on admission. Correlation, logistic regression, and receiver operating characteristic (ROC) analyses were used to assess associations with 30-day mortality.

Results: Seven patients (12.1%) died within 30 days. RDW values were significantly higher among non-survivors with a moderate positive correlation with mortality (r=0.363, p=0,005). ROC analysis revealed an AUC of 0.771 for RDW in predicting early mortality, with an optimal cut-off of ≥14.05% (sensitivity 83.3%, specificity 59.6%). In logistic regression, RDW was an independent predictor of 30-day mortality (OR 1.637, 95% CI: 1.058-2.535; p= 0.027). Traditional clinical scores such as PESI and sPESI were not significantly associated with mortality.

Conclusion: RDW is an independent, easily obtainable predictor of early mortality in acute PE and may enhance risk stratification, particularly in intermediate-risk patients. Its integration into clinical assessment could improve early decision-making and patient management.

GLYCEMIC CONTROL AND LEFT ATRIAL FUNCTION ASSESSED BY STRAIN-BASED ECHOCARDIOGRAPHY

2025-08-29T08:39:31+00:00

Introduction: Diabetes mellitus (DM) and prediabetes are associated with adverse cardiac remodeling. Left atrial (LA) strain, assessed by speckle-tracking echocardiography, can detect subtle LA dysfunction before structural changes occur.

Aim: To evaluate the relationship between glycemic control and LA strain in patients with type 2 DM and prediabetes.

Methods: We studied 155 consecutive patients with DM or prediabetes who underwent standard 2D echocardiography and LA strain analysis. Glycemic control was assessed by HbA1c and categorized as good or poor. LA reservoir (PALS) and contractile (PACS) strain were compared between groups. Correlation and multivariate regression analysis were performed to assess association between HbA1c and LA strain.

Results: Patients with poor glycemic control (n = 33) had significantly lower PALS (p=0.012) and higher prevalence of PALS values above the lowest normal (p=0.006) compared to those with good control. HbA1c was positively correlated with the presence of PALS and PACS above the lowest normal value. However, in multivariate regression, poor glycemic control did not retain independent predictive value for impaired LA strain after adjusting for age, BMI, LA volume, and/or LV global longitudinal strain (GLS%) in the whole cohort and in the prediabetic subgroup.

Conclusion: In patients with type 2 diabetes and prediabetes, poor glycemic control is associated with early LA dysfunction, as detected by strain analysis, even in the absence of LA enlargement or overt LV systolic impairment. LA strain may serve as an early marker of subclinical atrial remodeling in dysglycemia.

IMPACT OF INSULIN SENSITIZERS ON ANTI-MÜLLERIAN HORMONE IN POLYCYSTIC OVARY SYNDROME

2025-09-26T10:14:28+00:00

Introduction: Elevated AMH level is considered an indicator of anovulation in PCOS. It is postulated that the use of insulin sensitizers will lead to a reduction in insulin resistance, hyperandrogenism and consequently AMH levels, as a result of ovulation induction in these patients.

Aims: The study aimed to determine the impact of therapy with the insulin sensitizers, Metformin and Myoinositol, on Anti-Mullerian hormone and to determine its association with insulin resistance in women with polycystic ovary syndrome.

Material and methods: A prospective, randomized, clinical study was conducted at the University Clinic for Endocrinology, Diabetes and Metabolic Diseases in Skopje, in the period 2022/2023. The study included 64 women, aged 18 to 40 years, diagnosed with polycystic ovarian syndrome, according to the 2003 Rotterdam criteria. Patients were divided into two groups: group A received Metformin 1500 mg XR, and group B was on Myoinositol 2 gr TID, during 6 months. The parameters BMI, AMH, HOMA-IR (homeostasis model assessment index) and FAI (free androgen index) were monitored.

Results: After completion of treatment, a significant decrease in AMH levels was observed in both groups - group A (p=0.0012) and group B (p=0.0014). This was accompanied with decline in HOMA IR and FAI values after the end of treatment in both groups.

Conclusion: In line with the results obtained, AMH could be considered a marker of the efficacy of treatment with insulin sensitizers in PCOS.

SOCIOECONOMIC AND ENVIRONMENTAL DETERMINANTS IN OVERWEIGHT CHILDREN WITH ASTHMA

2025-08-29T08:33:17+00:00

Childhood asthma and overweight are prevalent chronic conditions that often co-occur, particularly among children exposed to socioeconomic disadvantage. While each condition has been studied independently, their intersection especially in relation to environmental and household factors remains underexplored. A prospective cross-sectional study was conducted to examine the influence of socioeconomic and environmental determinants on asthma in overweight children, and to identify patterns of comorbidity across distinct population groups. A total of 112 children, aged 7-17 years, were divided into three groups: overweight (N=41), asthma with normal BMI (N=38), and overweight with asthma (N=33). Data were collected through parental interviews and clinical examinations. Socioeconomic and environmental variables including maternal education, household heating method, presence of mold/dampness, family size, number of rooms, and household smoking were analyzed using SPSS 22.0, with significance set at p<0.05. Family size was significantly larger in the asthma group (mean 5.4 ± 1.7; p=0.0433), suggesting a potential link between household density and respiratory health. Mold/dampness was most prevalent in the asthma group (42.1%), though not statistically significant (p=0.0841). No significant associations were found for heating method, maternal education, number of rooms, or household smoking.

Conclusion: Тhe association between larger family size and increased household mold presence in children with asthma highlights the potential impact of household density and indoor environmental conditions on pediatric respiratory health. Although other socioeconomic and environmental determinants were not statistically significant, their distribution patterns suggest that cumulative socioeconomic disadvantage may contribute to both asthma and overweight risk.

SCREENING FOR HEPATITIS E VIRUS IN BLOOD DONORS IN NORTH MACEDONIA

2025-10-01T07:44:53+00:00

Introduction: Hepatitis E virus (HEV) is an emerging transfusion-transmissible pathogen and a growing concern for blood safety. Since 2023, all blood donations in North Macedonia have been screened for HEV RNA, providing the first national prevalence data.

Material and methods: All blood donations collected in 2023 and 2024 were screened for HEV RNA using the Procleix UltrioPlex E nucleic acid test (NAT) on the Panther platform. Initially reactive (IR) samples were retested in duplicate, and repeatedly reactive (RR) samples underwent serological testing for anti-HEV IgM and IgG. Blood units were discarded upon the first positive NAT result. RR donors were recalled for follow-up testing after 4–6 months to assess viral clearance.

Results: A total of 107,950 donations from 71,306 donors were screened over two years. HEV RNA was initially detected in 130 samples (0.12%), with 75 confirmed as RR, yielding an overall prevalence of 0.069%. Prevalence was higher in 2024, reflecting a 64% increase. Follow-up showed viral clearance in 91.9% within 4–6 months, with all donors RNA-negative by the third follow-up. HEV positivity was not significantly associated with age or gender, though men had higher prevalence in 2023 (p = 0.031). Repeat donors in 2024 were more often positive than first-time donors (p = 0.042). Geographic clustering occurred in Skopje and Kavadarci, with seasonal peaks in March.

Conclusion: The detection of HEV among blood donors in North Macedonia highlights its relevance as a transfusion-transmissible infection and underscores the need for sustained surveillance and consideration of screening strategies.

DOSIMETRIC EVALUATION OF SURFACE-GUIDED DEEP-INSPIRATION VERSUS FREE-BREATHING POSTOPERATIVE RADIOTHERAPY IN PATIENTS WITH LEFT-SIDED EARLY BREAST CANCER: EUROPEAN SCHOOL OF ONCOLOGY (ESO) CLINICAL TRAINING CENTER BREAST CANCER FELLOWSHIP EXPERIENCE

2025-10-31T10:25:05+00:00

Introduction: Late toxicities related to radiotherapy in early breast cancer, especially cardiac toxicities are those that bring concerns in long-life survivors.

Material and methods: Patients who underwent breast-only postoperative irradiation utilizing the deep inspiration breath hold (DIBH) technique with the Optical Surface Monitoring System (OSMS) during the years 2024-2025 were randomly selected. All patients had two simulation CTs (free-breathing, FB, and DIBH). Three-dimensional radiotherapy treatment plans were created for both (FB and DIBH) CT scans. Dosimetric evaluations were made from the dose-volume histograms (DVH). Statistical evaluation was done with paired sample t-test (two-tailed) and statistical significance was determined at p<0.05.

Results: Eleven patients were included in the study. Target coverage (PTV95%) wasn’t statistically significant between groups. The mean heart dose decreased significantly in DIBH plans by 57%, median difference 1.44 Gy. Heart D16Gy (%) and Heart D16Gy (cm3) were reduced by 91.5% and 89.1% in DIBH plans, respectively (p values 0.005 and 0.022). In comparison to FB plans, DIBH plans resulted in reductions of 87.7% in left anterior descending artery (LAD) Dmean and 68.2% in LAD Dmax (p < 0.001). The left ventricle Dmean and Dmax showed reduced values with DIBH plans by 68.2% and 68.9% (p=0.003 and <0.001), respectively. The ipsilateral lung volume was considerably greater in DIBH plans (p < 0.005), with a median difference of 1133 cm³.

Conclusion: Our study has demonstrated a significant reduction in radiation doses delivered to the heart and its substructures in DIBH plans compared to FB plans, consistent with prior studies.

DIFFERENCE IN LIFE SATISFACTION AND HOPELESSNESS BETWEEN CISGENDER AND TRANSGENDER INDIVIDUALS

2025-11-21T08:57:00+00:00

Life satisfaction and hopelessness in cisgender and transgender individuals is a critical area of research in understanding the mental health disparities between these groups. Cisgender individuals, whose gender identity matches their sex assigned at birth, generally report higher levels of life satisfaction compared to transgender individuals. Transgender individuals often face significant challenges that negatively impact their life satisfaction, including discrimination, social rejection, and barriers to accessing gender-affirming healthcare.

The aim of the study was to determine the difference in life satisfaction and hopelessness between cisgender and transgender individuals.

The study included 99 participants from RN Macedonia. Life satisfaction was assessed with the Life Satisfaction Scale (SWLS), designed to measure global cognitive judgments of one's life satisfaction using a seven-point Likert scale. Hopelessness is conceptualized as negative beliefs and expectations about the future. Hopelessness consists of two basic elements: (1) negative expectations about outcomes, and (2) expectations of helplessness in changing such outcomes, measured by the Beck Hopelessness Scale (BIH).

INFLUENCE OF CYP2D6 POLYMORPHISMS ON CLINICAL OUTCOMES AND QUALITY OF LIFE IN RISPERIDONE-TREATED PATIENTS WITH SCHIZOPHRENIA

2025-11-06T07:11:57+00:00

Introduction: Schizophrenia is a chronic mental disorder that significantly affects patients’ quality of life (QoL), despite antipsychotic treatment. Variability in therapeutic response and frequent adverse effects pose major challenges, making QoL a crucial treatment outcome.

Aim: To assess the impact of CYP2D6 genetic polymorphisms, psychopathology, and adverse drug reactions on subjective QoL in patients with schizophrenia treated with risperidone.

Material and methods: A prospective observational study was conducted at the University Clinic for Psychiatry, Ss. Cyril and Methodius University in Skopje. Ninety-one adult patients (20–63 years; 42 males, 49 females) with ICD-10 F20–F29 psychotic disorders treated with risperidone (1–6 mg/day) were evaluated on admission and discharge using SQLS, PANSS, and BPRS scales. Patients were classified by CYP2D6 metabolic phenotype. Data were analyzed using SPSS v23.0; p < 0.05 was considered significant.

Results: CYP2D6 phenotype significantly influenced QoL, with poor metabolizers showing lower scores than moderate and extensive metabolizers (p=0.00003). Psychopathology severity strongly correlated with reduced QoL on discharge. Specific adverse effects, including anxiety (p=0.026), dizziness (p=0.00007), vertigo (p=0.004), suboptimal effect (p=0.00003), and rigor (p = 0.022), were associated with QoL impairment.

Conclusion: CYP2D6 pharmacogenomic profiling can guide personalized risperidone therapy, reducing adverse effects and improving QoL. Optimal control of psychopathology and proactive management of side effects are essential for enhancing patient outcomes.

MQUALITY OF ACUTE STROKE CARE AT THE DEPARTMENT OF URGENT NEUROLOGY / UNIVERSITY CLINIC FOR NEUROLOGY: ANALYSIS OF PROCESS METRICS AND OUTCOMES DURING THE FIRST HALF OF 2025

2025-10-26T16:08:54+00:00

Introduction: Rapid reperfusion improves acute stroke outcomes. Guidelines recommend intravenous thrombolysis (IVT) within 60 min in ≥ 75% of eligible patients and 45 min in ≥ 50%. Endovascular therapy (EVT) should start within 90 min, with brain imaging completed in ≤ 25 min and interpreted in ≤ 45 min. This study assessed local compliance during early 2025.

Aim: To compare acute stroke process metrics, treatment rates, and outcomes between Q1 and Q2 2025 at the Department of Urgent Neurology, University Clinic for Neurology in Skopje, and benchmark against standards.

Material and methods: We retrospectively analyzed hospital and RES-Q registry data for all acute stroke admissions from January–June 2025. Variables included demographics, stroke type, time metrics, reperfusion rates, post-acute care indicators, and discharge outcomes.

Results: Q1: 79 patients (88.6% ischemic), median NIHSS 14, onset-to-door 180 min, door-to-imaging 26 min (48% ≤25 min). IVT in 29% (DTN 53 min: 57% ≤60 min, 43% ≤45 min); EVT 1% (door-to-groin 194 min). Q2: 28 patients (78.6% ischemic), NIHSS 13, onset-to-door 105 min, imaging 20 min. IVT rose to 35%, EVT to 15%, combined IVT+EVT 5%, recanalization 55%. DTN worsened to 87 min; door-to-groin improved to 93 min (meeting target). Carotid imaging rose from 65% to 83%.

Conclusion: In early 2025, imaging compliance and EVT use improved, with faster onset-to-door and door-to-groin times. However, DTN performance declined in Q2, and pre-hospital notification was lacking. Focused workflow optimization and EMS engagement are needed to achieve IVT benchmarks.

QUALITY OF RECOVERY AFTER TOTAL ABDOMINAL HYSTERECTOMY

2025-10-09T20:30:13+00:00

Introduction: Open gynecological surgery results in a large wound and severe postoperative pain, and adequate postoperative analgesia is necessary. This observational case review aimed to assess the quality of postoperative recovery in women undergoing open abdominal hysterectomy under general anesthesia.

Aim: This study aimed to evaluate the quality of recovery and analgesia performed under general anesthesia in total abdominal hysterectomy (TAH).

Patients and Methods: This retrospective observational case review was conducted in 26 females, ASA I or II, who presented for elective TAH under standard general anesthesia (GA). The primary outcome was the postoperative pain and analgesia assessed by using the Quality of Recovery Scale (QoR-40) and Visual Analog Scale (VAS scale). Secondary outcomes included the intraoperative opioid consumption, time to first flatus, and time to first discharge from bed, postoperative nausea and vomiting, and patient satisfaction.

Conclusion: The observational case review presented through open hysterectomy conducted under general endotracheal anesthesia showed postoperative global QoR-40 scores ranging between 218.24 and 282.02 (198-245). Furthermore, intraoperatively opioid consumption was high, and postoperatively, the time to first flatus, time to first discharge from bed, and post-anesthesia care unit discharge time were prolonged. Patient satisfaction was average.

ALTERATIONS OF MACULAR RETINAL MICROCIRCULATION EXAMINED WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AFTER SWITCHING FROM ORAL HYPOGLYCEMICS TO INSULIN THERAPY IN PATIENTS WITH TYPE 2 DIABETES

2025-09-20T16:43:33+00:00

Aim: To assess the impact of insulin therapy in the initial period on blood vessels density in the area of the macula lutea, evaluated with optical coherence angiography (OCTA) in patients with type 2 diabetes.

Materials and methods: A prospective observational study including 21 patients with type 2 diabetes was conducted. In 4 examined eyes, a nonproliferative diabetic retinopathy form of diabetic retinopathy was present without diabetic macular edema, while the remaining examined eyes were without the presence of DR/DME. Patients had been treated only with oral hypoglycemic drugs before inclusion in the study, and all of them were prescribed insulin therapy at the time of enrollment in the study. The main investigated parameters were changes in the density of blood vessels in the superficial vascular plexus and deep vascular plexus (DVP) in the macular area measured by optical coherence angiography.

Results: Тhe density of blood vessels in the first month of starting insulin treatment showed a significant decrease, especially in the deep vascular plexus. Three months after the start of insulin therapy, a decrease in the blood vessels density in the superficial vascular plexus was noticed. All parameters showed a return to normal values after the sixth month. The average HBA1 levels showed better results after insulin therapy.

Conclusion: This study suggests that in the initial phase of insulin therapy compared to oral antidiabetic agents, changes in the density of the blood vascular network in the macular region were observed with no corresponding change in the visual acuity.

ORGAN DONATION AND TRANSPLANTATION IN NORTH MACEDONIA

2025-12-03T08:15:50+00:00

Introduction: In the era of transplantation development, the number of available organ donors is still insufficient. Several factors, including public education regarding organ donation, contribute to this shortage.

The aim of our study was to assess public opinion and level of information regarding transplantation and organ donation among citizens of the RNM and to assess the development of transplantation from a deceased donor in recent years.

Material and methods: The study was conducted using a questionnaire and by reviewing official data on transplantations performed in the Republic of North Macedonia. The study included 90 randomly selected respondents (29 men and 61 women) with different level of education and ethnicity, and was realized in the period from January to February 2024.

Results: Most respondents (87.7%) responded that they were familiar with organ donation and transplantation and were informed about the development of transplantation in our country. From them, 74.4% fully supported organ transplantation and 70% supported cadaveric transplantation - mostly because of the desire to give life. Insufficient information about the entire transplantation process was the most common reason why families do not agree to donate organs. Cadaveric transplantation in our country has been increasing, with a peak in 2021/2022 (3.89 donations per million population), and it includes transplantations of kidney, heart, bone, ligament tissues, and liver.

Conclusion: Our study has shown that there is sufficient information and a positive attitude toward organ transplantation and organ donation in our country, as well as significant progress in transplantation from a deceased donor.

CLINICAL OUTCOMES FROM COVID-19 INFECTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: 5 YEARS LATER

2025-09-30T06:32:00+00:00

Introduction: Evidence of impact of COVID-19 infection on course of chronic obstructive pulmonary disease (COPD) is still limited.

Aim: To assess clinical outcomes of moderate COVID-19 infection in patients with moderate COPD by comparison of disease control, i.e., the frequency and severity of symptoms, level of health status impairment, values of spirometrc parameters and exacerbation risk, registered at two points in time: 2020 and 2025.

Material and methods: We performed a cross-sectional study including 74 patients with moderate COPD divided in two groups. The first group (COVID-19 group) included 37 COPD patients who had COVID-19 infection of moderate severity in 2020. The second group (non-COVID-19 group) included patients with COPD who did not have coronavirus disease in the period 2020-2025. The frequency and severity of symptoms and level of health impairment were assessed by COPD Assessment Test (CAT): lung function was assessed by spirometric measurements, and exacerbation risk was predicted by exacerbation rate registered in the previous year.

Conclusion: Our findings indicated significant impact of the COVID-19 infection on symptoms, patient’s health and daily life, as well as on the lung function and exacerbation risk emphasizing a need of careful monitoring of these patients upon recovery from COVID-19 infection in order to minimize the impact of infection on COPD progression.

PREVALENCE AND CHARACTERISTICS OF CHRONIC RESPIRATORY SYMPTOMS AND LUNG FUNCTION AMONG VINEYARD WORKERS

2025-10-16T12:14:47+00:00

Aim: To determine the frequency of chronic respiratory symptoms and ventilatory function in a group of vineyard workers.

Results: Most of the vineyard workers believe that they are sufficiently informed about the health risks related to their work activities and the necessary measures needed for health protection. Also, most of them use the mandatory personal protective equipment, while almost all workers during their work, to a greater or lesser extent, were exposed to occupational respiratory hazards: dust, smoke, fumes, gases and pesticides. About 45% of subjects had one or more respiratory symptoms, and the most common symptoms were cough (40%), cough with phlegm (31.1%), as well as dyspnea and wheezing (22.2%). The frequency of chronic respiratory symptoms was higher in workers with more than 15 years of exposure, with a statistically significant difference in frequency of cough, cough with phlegm, and dyspnea. The risk of respiratory symptoms was about 3 times higher in active smokers and about 2 times higher in vineyard workers with exposure duration longer than 15 years. The mean values of all spirometric parameters were within the reference values, while lung function impairment of obstructive, restrictive and combined pattern was registered in about 20% of them. The mean values of spirometric parameters in vineyard workers with exposure duration longer than 15 years were lower than those with less than 15 years of experience, with a significant difference for small airways flow indices.

Conclusion: The obtained results indicate the need to improve preventive measures.

EFFECTS OF CUMULATIVE EXPOSURE TO SILICA DUST ON VENTILATORY FUNCTION IN UNDERGROUND MINERS

2025-10-06T09:27:20+00:00

Introduction: Occupational exposure to crystalline silica is encountered in more workplaces due to its widespread application in multiple industries.

Aim: To assess the impact of estimated cumulative exposure to silica dust on ventilatory function in underground miners.

Methods: А cross-sectional study included 320 underground miners divided in two groups by duration of their work experience (≤ 15 and >>15 years). The study protocol included completion of a questionnaire on demographic and other characteristics, measurements of respirable dust and crystalline silica at the worksite and spirometric measurements.

Results: The mean values of forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) in underground miners with work tenure ≤ 15 years was significantly higher compared to the mean value in underground miners with longer work tenure (103.35 ± 9.01 vs. 97.97 ± 9.94, p=0.00001; and 97.06 ± 11.32 vs. 90.84±14.15, p=0.00003; respectively). With increase of work tenure, the values of spirometric parameters significantly decreased, i.e. a significant linear negative correlation between cumulative exposure to silica dust and FVC, FEV1 and FEV1/FVC ratio values was registered (p=0.00003; p=0.00001 and p=0.0104, respectively).

Conclusion: We found a significant impact of cumulative exposure to silica dust on ventilatory function in underground miners. Our findings indicated a need of implementation of more stringent occupational health standards in order to protect respiratory health of exposed workers.

mHEALTH APPLICATION AS A TOOL TO ASSIST FAMILY DOCTORS IN THE MANAGEMENT OF HYPERTENSION

2025-09-04T06:53:44+00:00

Аim: The aim of this study was to determine the impact of using a mHealth application in work organizing of primary care clinics in managing patients with newly diagnosed hypertension in RN Macedonia.

Material and methods: A prospective randomized controlled multicenter study with 12-month follow-up of newly diagnosed patients with hypertension was performed. The intervention group received standard care + mHealth application, while the control group received only standard care. The mHealth application enabled transmission of measured blood pressure values in real time and two-way doctor-patient communication via SMS messages. The study monitored the number, reasons and justification of additional visits in the primary care clinic.

Results: From 192 participants included, 75(39.06%) had an additional visit - 23(24.21%) in the intervention and 52(53.61%) in the control group (p=0.0001). In terms of the number of additional visits per patient, only 1 in the intervention versus 17 in the control group had 3 emergency examinations (p=0.004). The most common reason for examination was blood pressure measurement in 15(7.81%) patients. No adverse events were recorded in either group.

Conclusion: The mHealth application with two-way patient-doctor communication represents an additional intervention to standard care that can reduce the need for “face-to-face"visits with a family doctor and provides an opportunity for better organization of work in family doctor outpatient clinics.

MEDICAL SPECIALISTS’ KNOWLEDGE AND PERCEPTIONS OF BIOLOGICS AND BIOSIMILARS: A LITERATURE REVIEW

2025-09-04T08:18:29+00:00

Introduction: Newly developed biological medicines offer essential treatment for many acute and chronic conditions. In addition, the increasing availability of biosimilar drugs improve access to vital biologic treatments. Medical specialists prescribe biological medicines, thus the adoption of these products in the market heavily relies on their readiness to prescribe, and integrate them into clinical practice, which depends on their knowledge, perspectives, and beliefs.

Aim: To review the scientific literature regarding knowledge and perceptions related to the use of originator biologics and biosimilars, along with the need for additional education on this topic.

Material and methods: A literature search was conducted using journal databases, such as PubMed, Cochrane Library, and Scopus, with carefully selected search terms, and applying the inclusion criteria that match the aim of the study.

Results: The majority of studies meeting the specified criteria were carried out in Europe and the USA, primarily in the form of brief surveys. Studies show that most of the medical specialists are familiar with the biologic medicines, however their measured knowledge was less extensive than their self-assessed knowledge. In general, a larger percentage of those who were surveyed expressed the need for additional education.

Conclusions: Medical specialists’ knowledge and opinions towards biologics in general are highly variable, with a general observation that there is a need of increasing the knowledge in the field. Therefore, education is a key prerequisite for better understanding the differences among originator biologics and biosimilars, which will support their inclusion into treatment plans.