The Academic Medical Journal is published by the Faculty of Medicine, University Ss. Cyril and Methodius in Skopje as a peer-reviewed, open-access, international journal, issued twice a year.
Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia
This work is licensed under CC BY 4.0
IN VITRO ACTIVITY OF CEFTAROLINE AGAINST GRAM-POSITIVE BACTERIA AND ENTEROBACTERALES WITH EMPHASIS ON MRSA: A SINGLE-CENTER STUDY
Introduction: Antimicrobial resistance (AMR) among Gram-positive pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA), remains a major clinical challenge. Ceftaroline fosamil is a fifth-generation cephalosporin with activity against resistant Gram-positive bacteria, including MRSA. Aim: To evaluate the in vitro activity of ceftaroline against Gram-positive bacteria and Enterobacterales isolated from clinical specimens. Material and methods: A two-phase study was conducted at the Institute of Microbiology and Parasitology, Faculty of Medicine in Skopje. The pilot study (July–August 2022) included 144 isolates, while the six-month study (January–June 2023) included 330 isolates from wound and lower respiratory tract specimens. Susceptibility testing was performed using the disk diffusion method according to EUCAST breakpoints. Results: All methicillin-susceptible Staphylococcus aureus (MSSA; n=133) and MRSA (n=76) isolates demonstrated 100% susceptibility to ceftaroline. Similar susceptibility was observed among coagulase-negative staphylococci and Streptococcus spp. (including S. pyogenes and S. pneumoniae). In contrast, all Enterococcus spp. isolates were resistant to ceftaroline. MRSA isolates were resistant to other tested cephalosporins. Among Enterobacterales, susceptibility varied. Escherichia coli isolates showed 86% susceptibility, while ESBL-producing strains were resistant. Klebsiella pneumoniae isolates demonstrated 60% susceptibility, with all ESBL-producing strains resistant. Susceptibility among Enterobacter spp. ranged from 46% to 63%, and among Proteus mirabilis from 65% to 75%. Conclusion: Ceftaroline demonstrated excellent in vitro activity against MRSA and MSSA, supporting its role as a potential therapeutic option for resistant Gram-positive infections. However, its activity against Enterobacterales is limited and variable, emphasizing the need for susceptibility-guided use.
Copyright (c) 2026 Ana Kaftandzieva https://creativecommons.org/licenses/by/4.0
CONGENITAL CYSTIC ADENOMATOID MALFORMATION OF THE LUNGS: A CASE REPORT
Congenital cystic adenomatoid malformations (CCAM) of the lung are a rare congenital disorder. The prevalence of this condition is 9 per 100,000 births, with a slight predominance in males. Most cases present clinically in the neonatal period, but may remain asymptomatic until adulthood. The etiology of CCAM is not fully understood. Fetal cystic changes of the lungs are detected prenatally by ultrasound, and postnatally, the definitive method is chest computed tomography (CT) or magnetic resonance imaging (MRI). Resection of CCAM is recommended due to the risk of malignancy. We present the case of a term-male hypotrophic newborn, in whom cystic changes of the right lung were detected prenatally. The chest X-ray and CT scan postnatally confirmed right-sided congenital adenomatoid cysts. At the age of 2 months, the infant underwent surgical resection of cystic changes, and CCAM type 1 was histologically proven.
Copyright (c) 2026 Sanja Ristovska, Snezana Jancevska, Lazo Jovceski https://creativecommons.org/licenses/by/4.0
EVALUATION OF BIOFILM PRODUCTION IN STAPHYLOCOCCUS AUREUS FROM CYSTIC FIBROSIS PATIENTS
Cystic fibrosis (CF) is a multisystemic, life-limiting autosomal recessive disease. It is characterized by impaired chloride transport, which results in mucus retention that predisposes patients to chronic respiratory infections. Among the most common pathogens isolated from CF patients is Staphylococcus aureus, which possesses the ability to form biofilms. This ability is a key factor contributing to antimicrobial resistance and persistence. This study aimed to evaluate biofilm production in 41 clinical isolates of S. aureus from CF patients and 11 non-CF controls, using the quantitative colorimetric microtiter plate assay. Results showed that 51% (21/41) of CF isolates were methicillin-sensitive S. aureus (MSSA), while 49% (20/41) were methicillin-resistant S. aureus (MRSA). Among non-CF isolates, 27.3% (3/11) were MRSA and 72.7% (8/11) were MSSA. Biofilm production was observed in 32% (13/41) of CF S. aureus isolates. Among these, 46% (6/13) were MSSA and 54% (7/13) were MRSA. The biofilm phenotypes of CF isolates were distributed as follows: 6.8% strong, 24.4% moderate, and 68.3% weak or non-producers. In non-CF isolates, 18.2% (2/11) were biofilm producers, with one strong and one moderate producer; the remaining 82% (9/11) were weak or non-producers. These findings highlight the clinical relevance of biofilm production in CF-associated S. aureus infections and underscore the need for tailored antimicrobial strategies.
Copyright (c) 2026 Gordana Mirchevska, Nadica Krsteva, Sara Nedelkoska Kokaroska, Radomir Jovchevski, Elizabeta Janchevska, Aleksandra Kacarska, Valentina Cvejoska Cholakovska, Stojka Fushtikj Naceva, Vesna Kotevska https://creativecommons.org/licenses/by/4.0
A CASE REPORT OF PEDIATRIC HEREDITARY SPHEROCYTOSIS: MANAGEMENT OF HEMOLYTIC DISEASE AND CHOLELITHIASIS
Introduction: Hereditary spherocytosis (HS) is a congenital hemolytic anemia caused by defects in erythrocyte membrane proteins, most commonly inherited in an autosomal dominant pattern. Clinical severity ranges from mild hemolysis to severe anemia with complications such as splenomegaly and pigment gallstones. Case report: We report the case of a 10-year-old boy presenting with acute abdominal pain, jaundice, and dark urine. Physical examination revealed scleral icterus and splenomegaly. Laboratory investigations showed anemia (hemoglobin 7.9 g/dL), elevated mean corpuscular hemoglobin concentration (35.3 g/dL), reticulocytosis (9%), and indirect hyperbilirubinemia. Peripheral blood smear demonstrated numerous spherocytes. Abdominal ultrasonography confirmed splenomegaly and multiple gallstones. The patient had a history of recurrent hemolytic crises and a positive family history of HS. Based on clinical and laboratory findings, the diagnosis was established without further confirmatory testing. After appropriate vaccination, he underwent elective splenectomy with cholecystectomy. Postoperatively, clinical parameters improved significantly; however, moderate reactive thrombocytosis was observed. The patient remained asymptomatic during a 12-month follow-up period. Conclusion: This case highlights the classic presentation and effective management of hereditary spherocytosis in a pediatric patient. Splenectomy combined with cholecystectomy resulted in significant clinical improvement and prevention of further hemolytic episodes.
Copyright (c) 2026 Aleksandra Jovanovska, Bojan Teov, Valentina Cvejoska-Cholakovska, Sonja Bojadzieva, Svetlana Kocheva https://creativecommons.org/licenses/by/4.0
CHALLENGING POST-TRANSPLANT COURSE AND MULTIORGAN COMPLICATIONS IN FLT3-POSITIVE ACUTE MYELOID LEUKEMIA
Introduction: FLT3-mutated acute myeloid leukemia (AML) represents a biologically aggressive subtype associated with high relapse rates and poor overall survival. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the most effective curative therapy, yet it carries substantial risk of transplant-related morbidity and mortality. Case report: We report the case of a 42-year-old woman diagnosed with FLT3-ITD positive AML who underwent several chemotherapy regimens and achieved complete molecular remission prior to a matched unrelated donor allo-HSCT (9/10, MM in HLA-A). Following myeloablative conditioning (BuCy-ATG), engraftment occurred by day +19. The post-transplant course was complicated by cytomegalovirus (CMV) reactivation (day +28), acute graft-versus-host disease (aGvHD) with severe cutaneous and gastrointestinal involvement (day +31), and transplant-associated thrombotic microangiopathy (TA-TMA) accompanied by hemolysis, thrombocytopenia, and hyperbilirubinemia (day +40). Subsequent neurologic deterioration revealed posterior reversible encephalopathy syndrome (PRES) related to calcineurin-inhibitor toxicity. Despite combined therapy including corticosteroids, plasmapheresis, rituximab, and antiviral treatment, multiorgan dysfunction developed, culminating in fatal cardiorespiratory failure on day +99 post-transplant. Conclusions: This case underscores the extreme clinical complexity of post-transplant management in FLT3+ AML. The sequential onset of immune-mediated, endothelial, infectious, and neurologic complications highlights the necessity for vigilant monitoring, early diagnostic work-up, and coordinated multidisciplinary care. Proactive risk stratification and individualized prophylactic approaches remain essential to improve survival after allo-HSCT in high-risk AML.
Copyright (c) 2026 Tara Mojsovska, Nevenka Ridova, Olivera Gjeorgjieva Janev, Merve Purde, Martin Stojanoski, Lazar Chadievski, Zlate Stojanoski, Svetlana Krstevska Balkanov, Irina Panovska Stavridis, Marica Pavkovikj, Sonja Genadieva Stavrikj; Aleksandra Pivkova Veljanovska https://creativecommons.org/licenses/by/4.0
LEFT VENTRICULAR SYSTOLIC FUNCTION AFTER CORONARY ARTERY BYPASS GRAFTING: INSIGHTS FROM GLOBAL LONGITUDINAL STRAIN AND MYOCARDIAL WORK
Introduction. Patients with multivessel coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF) may have subclinical systolic dysfunction. Advanced echocardiographic parameters, including global longitudinal strain (GLS) and myocardial work (MW) indices, provide additional insights into myocardial performance and recovery after coronary artery bypass grafting (CABG). Aim. To assess changes in left ventricular systolic function using conventional echocardiography, GLS, and MW indices following CABG. Material and methods. This prospective study included 21 patients with multivessel CAD undergoing CABG. Echocardiography, including GLS, and MW indices (global work index [GWI], global constructive work [GCW], global wasted work [GWW], and global work efficiency [GWE]) was performed preoperatively and at 6-8 months postoperatively. Percentage changes and correlations were analyzed. Results. At baseline, patients demonstrated impaired GLS and abnormal MW parameters despite preserved LVEF, consistent with subclinical LV dysfunction. At follow-up, GLS showed a statistically significant but modest improvement (p=0.021), while LVEF showed a borderline increase (p=0.078). MW indices did not change significantly at the group level but demonstrated marked inter-individual variability. GLS increased by >5% in 42.9%, and >10% in 33.3% of patients, while LVEF increased by >5% in 52.4% of patients. Improvements in GWI, GCW, and GWE were observed in approximately half of the patients. Changes in MW indices correlated with improvements in both LVEF and GLS. Conclusion. In patients with preserved LVEF undergoing CABG, subclinical LV dysfunction is detectable using GLS and MW analysis. While structural remodeling and modest improvement in GLS were observed, MW indices showed heterogenous responses.
Copyright (c) 2026 Elena Grueva Nastevska, Vasil Papestiev, Marjan Shokarovski, Emine Rushiti, Ana Chelikikj, Ljubica Georgievska-Ismail https://creativecommons.org/licenses/by/4.0
TRANSVERSE SINUS THROMBOSIS PRESENTING WITH EARLY NEUROCOGNITIVE AND PSYCHIATRIC MANIFESTATIONS: A CASE REPORT
Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially life-threatening cerebrovascular disorder with a highly variable clinical presentation. Although headache is the most frequent presenting symptom, neurocognitive and psychiatric manifestations may occur and contribute to diagnostic delay. We report the case of a 59-year-old woman who presented with severe intermittent headache predominantly in the right occipital region, accompanied by nausea, photophobia, phonophobia gait slowing, and early cognitive disturbances. During hospitalization, intermittent episodes of confusion and visual hallucinations were observed in the absence of focal neurological deficits. Laboratory investigations revealed elevated D-dimer levels. Brain computed tomography demonstrated thrombosis of the right transverse sinus without evidence of parenchymal hemorrhage, mass effect, or midline shift. Electroencephalography and extracranial Doppler ultrasonography were unremarkable. Neuropsychological assessment revealed global cognitive impairment, predominantly affecting attention, memory, visuospatial abilities, and language functions. A short-lasting psychotic episode with preserved insight was confirmed by psychiatric evaluation. The patient was treated with anticoagulation and supportive therapy, resulting in gradual clinical improvement without the development of new neurological deficits. Follow-up imaging was planned to monitor recanalization. This case highlights that CVST may present with early neurocognitive and psychiatric symptoms even in the absence of focal neurological signs. Awareness of these atypical manifestations is essential to ensure timely diagnosis and appropriate management.
Copyright (c) 2026 Fatjona Kolari, Atifete Jakupi, Jovan Bozhinovski, Erjon Mahmudi, Shpresa Hasani, Anita Arsovska https://creativecommons.org/licenses/by/4.0
LEFT VENTRICULAR DYSFUNCTION IN HYPERTENSIVE PATIENTS WITH PRESERVED EJECTION FRACTION
Introduction: Arterial hypertension is a significant public health problem, and the single greatest risk factor for heart failure at a population level. Aim: The study goal was to evaluate the left ventricular dysfunction in patients with preserved EF and arterial hypertension with varying durations, in an attempt to detect latent impairment of LV systolic function. Material and methods: An analytical cross-sectional study was conducted at the Public Health Clinical Hospital Tetovo, Republic of North Macedonia in the period 2024/2025. A total of 92 patients over 18 years of age with a diagnosis of arterial hypertension and preserved EF above 50% were selected. Results: Out of 92 patients, 58 (63%) were males and 34 (37%) females. The average age was 56.34±8.36 years with a min/max of 40/68 years and 50% of patients aged ≤58 years, with no significant difference between the genders. Significantly worse values ​​were found for the echocardiographic parameters GLS (p=0.0003), RWT (p=0.00005), LVMI (p=0.00001), E/e’ratio (p=0.0015) and TEI index (p=0.0002) in patients from the group with atrial hypertension >5 years compared to those with hypertension duration ≤5 years. GLS significantly correlated with hypertension control, duration of hypertension and diabetes. No significant correlation was found between GLS and gender, age, and BMI. Conclusion: The implementation of larger cohort studies for evaluation of the left ventricular dysfunction in patients with preserved ejection fraction (≥50%) and arterial hypertension with different durations will support the detection of latent impairment of LV systolic function, will identify high-risk patients and will allow timely intervention.
Copyright (c) 2026 Anida Ferati Karemani, Elizabeta Srbinovska Kostovska, Ardian Ferati, Mentor Karemani, Nexhbedin Abazi https://creativecommons.org/licenses/by/4.0
SUSPECTED RHOMBENCEPHALITIS WITH VENTRICULITIS IN AN ELDERLY PATIENT WITH PREVIOUS MENINGITIS AND VENTRICULOPERITONEAL SHUNT: A CASE REPORT
Rhombencephalitis is a rare inflammatory disorder involving the brainstem and cerebellum, with a broad differential diagnosis that includes infectious, autoimmune, paraneoplastic, and post-infectious causes. Diagnostic evaluation may be particularly challenging in elderly patients with previous central nervous system pathology and cerebrospinal fluid diversion devices. We report the case of a 75-year-old man admitted with progressive neurological deterioration manifested by vertigo, gait instability, somnolence, confusion, and dysphagia. Brain magnetic resonance imaging revealed inflammatory changes involving the medulla oblongata and cerebellar peduncle, accompanied by ependymal and ventricular wall enhancement consistent with rhombencephalitis and ventriculitis. Cerebrospinal fluid analysis demonstrated elevated protein levels and blood–cerebrospinal fluid barrier dysfunction with minimal pleocytosis. Extensive microbiological, molecular, and immunological investigations, including polymerase chain reaction testing for neurotropic viruses and Mycobacterium tuberculosis, were negative. The patient had a history of meningitis six years earlier, complicated by hydrocephalus requiring ventriculoperitoneal shunt placement. The patient was treated with anti-edematous, empirical antimicrobial, and supportive therapy, resulting in partial clinical improvement. This case highlights the diagnostic complexity of rhombencephalitis in elderly patients with prior central nervous system disease and emphasizes the importance of a multidisciplinary approach and careful exclusion of infectious etiologies.
Copyright (c) 2026 Atifete Jakupi, Fatjona Kolari, Jovan Bozhinovski, Aleksandra Angelova, Anita Arsovska https://creativecommons.org/licenses/by/4.0
PIVKA-II – AN INDEPENDENT INDICATOR OF ACUTE AND ACUTE-ON-CHRONIC LIVER FAILURE
Introduction: PIVKA-II is an abnormal coagulation factor induced by vitamin K absence or use of vitamin K antagonists, and is useful in the diagnosis of hepatocellular carcinoma (HCC). PIVKA-II may also correlate with liver failure, with one study demonstrating an association with hepatitis E infection. Materials and methods: A total of 406 subjects with chronic viral hepatitis, steatofibrosis, cirrhosis and hepatocellular carcinoma were evaluated for PIVKA-II, AFP, BCLC (only HCC patients), Child-Pugh-Tourcotte score, and MELD-Na score. Results: A statistically significant positive correlation was found between PIVKA-II and MELD-Na and CPT scores. Conclusion: PIVKA-II may be an independent indicator of acute and acute-on-chronic liver failure.
Copyright (c) 2026 Beti Todorovska, Gregor Krstevski, Fana Josifovikj Lichoska, Elena Ristovska Curakova, Emilija Trpchevska Nikolovska, Dzem Adem, Kalina Stardelova Grivcheva, Nenad Joksimovic, Mitko Miloshevski, Vladimir Andreevski, Magdalena Dimitrova Genadieva, Filip Nikolov, Stefan Pejkovski, Dafina Nikolova, Ance Volkanovska, Gjorgji Deriban, Arzana Jusufi Hasani, Dijana Rafajlovska Bibovska, Ilina Todorovska, Vesna Stefanovska Velikj, Meri Trajkovska https://creativecommons.org/licenses/by/4.0
ADOLESCENT NASAL DEFORMITY FROM NEONATAL IATROGENIC TRAUMA: SURGICAL RESTORATION VIA FAT AND CARTILAGE GRAFTING: A CASE REPORT
Defects of the nasal complex can cause significant functional and psychosocial impairment whether acquired or congenitally inherited. Iatrogenic nasal deformities are uncommon complication of supportive care in neonates. Poor placement, insufficient immobilization of the cannula or prolongated nasopharyngeal intubation can result in injury to the nasal lining and can lead to aplasia of the nasal cartilage. We present the case of a 17‑year‑old female who developed an iatrogenic nasal deformity following prolonged nasotracheal intubation as a premature neonate at seven months gestation, necessitating a three‑month NICU stay. On examination, right nostril asymmetry and breathing difficulties were noted. During open rhinoplasty, agenesis of the medial and lateral crura of the right lower lateral cartilage was discovered - an anatomical deficiency creating a significant reconstructive challenge. Our surgical approach employed two stages: first, fat grafting to restore soft tissue volume and contour; second, autologous cartilage grafting from the septum (with options including conchal cartilage or dorsal hump cartilage) to reconstruct the undeveloped lower lateral cartilages. This method successfully restored nasal symmetry and improved airway function. The case underscores the importance of recognizing iatrogenic cartilage damage in patients with neonatal airway interventions and illustrates effective staged reconstructive strategies for such rare but impactful deformities.
Copyright (c) 2026 Igor Peev, Renata Kocoska, Elizabeta Mirchevska Zjogovska https://creativecommons.org/licenses/by/4.0
ANTIBODY SCREENING IN BLOOD DONORS CONTRIBUTES TO BLOOD SAFETY
Screening for irregular red blood cell (RBC) antibodies is a mandatory test for every blood donation in accordance with national blood testing strategy. The aim of this study was to determine the prevalence, specificity and frequency of irregular RBC antibodies detected using column agglutination technology (CAT) based on indirect antiglobulin test (IAT). A total of 252,641 blood donations collected between 2020 and 2024 were screened using pooled screening cells on immune-hematological analyzer (IH 500/1000). Antibody specificity was determined by using commercially available 11-cell identification panel. Donations were obtained from 205,532 male (81%), 47,109 female (19%), and 47,919 first-time donors (17%). Irregular RBC antibodies were confirmed in 119 donations corresponding to an overall prevalence of 0.05%. The most frequently detected antibody was anti-M (33%), followed by antibodies of the Rh system (22%) and anti-K (15%) antibodies. Antibodies of the Rh system were anti-D (8%), anti-C (2%), anti-E (9%) and anti-c (3%). Female donors showed a significantly higher prevalence of irregular RBC antibodies (0.11%) than male donors (0.03%). The most frequent anti-M antibody had similar representation in both genders, 0.015% in male and 0.016% in female donors, as a result of the rejuvenation of our donor pool. Also, in female donors more frequent antibodies were anti-K (0.03%), anti-D (0.02%) and anti-E (0.01%). Positive direct antiglobulin test (DAT) were more frequent among female donors (0.02%). The low prevalence reflects effective donor selection and sensitive screening methods. Identification of clinically significant antibodies remains essential for ensuring transfusion safety and preventing hemolytic transfusion reactions.
Copyright (c) 2026 Elena Ristovska, Tatjana Makarovska Bojadjieva, Emilija Velkova, Elena Petkovikj, Violeta Dejanova Ilievska, Bojan Todorovski, Elena Stojkovska, Marija Tashkovska https://creativecommons.org/licenses/by/4.0
FOOD ALLERGEN SENSITIZATION AND IGE PROFILES IN CHILDREN WITH ATOPIC DERMATITIS: A CROSS-SECTIONAL STUDY
Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease frequently associated with allergic sensitization and elevated immunoglobulin E (IgE) levels. Food allergen sensitization is common in children with AD, but its relationship with disease severity and clinical relevance remains uncertain. Objective: To evaluate patterns of food allergen sensitization in children with AD and their association with total IgE levels, disease severity, and polysensitization. Material and methods: This cross-sectional study included 54 pediatric patients (≤18 years) with AD evaluated at the University Clinic of Dermatology. Disease severity was assessed using the SCORing AD (SCORAD) index. Allergy testing included skin prick testing (SPT) and in vitro specific IgE assays for common food allergens. Total serum IgE levels were measured in all participants. Polysensitization was defined as sensitization 3≤ allergens. Results: Food allergen sensitization was detected in 35.2% of patients by SPT and in 37.0% by in vitro IgE testing. Polysensitization occurred in 14.8% and 18.5% of patients, respectively. Egg allergens were the most frequently detected sensitizers. Total IgE levels showed a moderate positive correlation with SCORAD severity (Spearman ρ = 0.396, p = 0.003). Polysensitization patterns involving egg allergens were strongly associated with markedly elevated IgE levels (>1000 kU/L), with the egg white–egg yolk combination showing the strongest association (OR 31.5, p=0.000196). Conclusion: Food allergen sensitization is common in pediatric AD, with egg allergens representing the dominant sensitization pattern. However, sensitization does not necessarily indicate clinically relevant food allergy, and allergy testing should guide targeted management while avoiding unnecessary restrictive diets.
Copyright (c) 2026 Anita Najdova, Katerina Damevska https://creativecommons.org/licenses/by/4.0
CONSERVATIVE TREATMENT OF A CHRONIC WOUND WITH HYDROFIBER DRESSINGS: A CASE REPORT
Chronic postoperative wounds represent a serious challenge, both for the medical personnel treating the wound and for the patient. Their size, anatomical localization, and the presence of infection further complicate the healing process. In this case report, we present a 52-year-old patient, without diabetes or vascular diseases, who was operated on due to the presence of an extrasphincteric fistula and a system of perianal fistulas. Due to the presence of the fistulous system, a fistulectomy was performed, along with skin incisions in the gluteal and inguinal regions, as well as the perineum. Postoperatively, an extensive wound (15 × 15 cm) was obtained. In the postoperative period, infection with Enterococcus spp. was noted. Treatment included antibiotic therapy, repeated sharp debridement, mechanical debridement, wound irrigation, and the application of hydrofiber dressings with silver ions (Aquacel® Ag). Six months after the surgical procedure, complete wound resolution and coverage with granulation tissue were achieved, without the need for reoperation. This case report confirms the possibility of treating extensive wounds in a conservative manner, without additional surgical interventions and hospitalization. It also underscores the role of modern hydrofiber dressings in the treatment of chronic postoperative wounds.
Copyright (c) 2026 Vladimir Mihajloski, Ognen Kostovski, Gjorgji Trajkovski, Goce Volchevski, Ljubomir Ognjenovic, Radomir Gelevski, Vanja Trajkovska, Irena Kostovska, Elvira Mekikj, Dijana Grupche https://creativecommons.org/licenses/by/4.0
A NEWBORN WITH DOUBLE ATRESIA: ESOPHAGEAL WITH DISTAL TRACHEOESOPHAGEAL FISTULA FOLLOWED BY CONCOMITANT ANAL ATRESIA: A CASE REPORT
Esophageal atresia (EA) represents the most frequent congenital anomaly of the upper gastrointestinal tract in newborns with estimated incidence of one in 2500-4500 newborns worldwide. We present a rare case report of a newborn with double atresia, esophageal with distal fistula followed by anal atresia. A one-day-old male newborn was admitted to the Department of Pediatric Surgery at the Clinical Hospital Acibadem Sistina, Skopje, with the chief medical complaints of difficulty breastfeeding, vomiting and respiratory distress. After the initial clinical examination, and based on the medical history and physical findings, RTG revealed esophageal atresia with a distal fistula, followed by the identification of anal atresia. An urgent indication for surgical treatment was established, and a three-stage surgical plan was devised. In the first stage, the fistula was resected, followed by T-T esophageal anastomosis and sigmoidostomy. In the second stage, a laparoscopic pull-through Soave procedure was performed. The third and final surgical intervention was closure of the sigmoidostomy. On the seventh postoperative day (the primary procedure), an esophagogram showed adequate passage of contrast agent into the distal portion of the esophagus and stomach, with no fistulas. Neurological check-up showed normal EMG conducting of the anal sphincter. Esophageal atresia represents a surgical pathology with an overall survival rate of 85%–95%. The prognosis is corresponding to the presence of associated malformation. It is essential to emphasize that a thorough understanding of the anatomy of congenital malformations is indispensable to accomplish a successful repair and favorable outcomes in newborns.
Copyright (c) 2026 Risto Simeonov, Zlatko Aleksovski, Martin Angjelov, Lazo Jovcheski, Kamelija Simeonova, Natali Jordanovska, Sandra Petkovska https://creativecommons.org/licenses/by/4.0
RELATIONSHIP BETWEEN GRAF ANGLES AND FEMORAL HEAD COVERAGE IN HIP ULTRASOUND SCREENING FOR DEVELOPMENTAL HIP DYSPLASIA
Introduction: Ultrasound examination is a widely accepted method for developmental hip dysplasia screening, diagnosis and treatment monitoring. The Graf technique, routinely used in the Republic of North Macedonia is reliable and reproducible when performed in a precise and standardized manner, but it can be challenging when used by inexperienced ultrasonographers. We analyzed the relationship between findings of ultrasound scans obtained by the Graf method and femoral head coverage (FHC), in order to examine its usefulness in infant hip screening. Material and methods: Hip sonograms of 105 infants aged 0 to 6 months were examined. Measurements of alpha and beta angles according to Graf were performed and FHC was calculated as d*/D ratio. Multiple regression analysis was performed to examine the relationship between FHC, alpha and beta angles and infant age. Results: Two hips in a single patient were abnormal (grade 2c and D) according to Graf technique, with incidence of 0.95%. Seven hips (3.3%) had FHC below 50%, including the 2c and D hips and five hips with Ib grade according to Graf. FHC increased for 0.71% for each degree increase of alpha angle and decreased for 0.68% for each degree increase of beta angle. Infant age did not influence FHC. Conclusion: There was a positive correlation between alpha angle and FHC and negative correlation between beta angle and FHC. FHC above 50% is strongly indicative of normal hip morphology. FHC can be used in addition to the Graf method for assessment of infant hips.
Copyright (c) 2026 Danica Popovska, Magdalena Manasieva, Roza Djoleva - Tolevska, Nenad Atanasov, Aleksandar Saveski, Milena Bogojevska Doksevska, Daniela Georgieva https://creativecommons.org/licenses/by/4.0
SUBCUTANEOUS ENDOSCOPICALLY- ASSISTED LIGATION AS A SURGICAL CHOICE FOR RIGHT-SIDED INGUINAL HERNIA IN A 2.5-YEAR-OLD FEMALE CHILD: A CASE REPORT
Inguinal hernia is among the most common pediatric surgical conditions, with a higher incidence in males; however, it carries significant morbidity when present in females due to the risk of ovarian involvement. Traditional open herniotomy has long been the golden standard for surgical treatment; however, minimally invasive approaches such as subcutaneous endoscopically- assisted ligation (SEAL) have gained attention for their esthetic advantages, reduced postoperative pain, and comparable recurrence rates. This case report focuses on a 2.5-year-old female child with a right-sided inguinal hernia treated successfully with SEAL. This case report highlights the diagnostic process, surgical technique, postoperative course, and discusses the advantages and limitations of SEAL compared to the conventional methods. It underscores the feasibility and safety of SEAL in young female patients and contributes to the growing body of evidence supporting minimally invasive pediatric hernia repair.
Copyright (c) 2026 Zlatko Aleksovski, Martin Angjelov, Risto Simeonov, Lazo Jovcheski, Kamelija Simeonova, Natali Jordanovska, Sandra Petkovska https://creativecommons.org/licenses/by/4.0
PROGNOSTIC VALUE OF POST-REDUCTION COMPUTED TOMOGRAPHY AFTER CLOSED REDUCTION FOR DEVELOPMENTAL DYSPLASIA OF THE HIP
Introduction: Assessment of hip position after closed reduction for developmental dysplasia of the hip (DDH) is challenging using plain radiography because of cartilaginous anatomy and cast-related artifacts. Post-reduction computed tomography (CT) performed in a narrow window may improve detection of inadequate reduction and guide early management. Aim: To evaluate the prognostic and decision-making value of post-reduction narrow window CT compared to plain radiography after closed reduction for DDH. Material and methods: A prospective clinical study included 50 children treated with closed reduction for DDH. Twenty-five patients underwent native radiography and post-reduction CT in a narrow window protocol. CT parameters assessing quality of reduction were analyzed and compared to early need for re-intervention, persistent dysplasia and radiographic outcome at follow-up. Results: CT identified persistent or inadequate reduction in 5 of 39 dislocated hips (12.8%), all of which required immediate change in treatment. In the native radiographs, persistent dislocation was reliably identified in only one case (2 hips), while three cases were initially missed because of poor visualization. None of the CT-derived parameters demonstrated a statistically significant correlation with later residual dysplasia defined by the center–edge angle. However, with another design of the study and a bigger sample, some parameters might show a statistically significant correlation. Conclusion: Post-reduction narrow window CT provides superior detection of inadequate reduction compared to plain radiography and directly influences early clinical decision-making. However, CT parameters at the moment showed no certain prognostic value for predicting residual acetabular dysplasia.
Copyright (c) 2026 Milena Bogojevska Doksevska, Zoran Bozinovski, Daniela Georgieva, Vilijam Velkovski, Danica Popovska, Marina Komnenovik, Teodora Todorova, Teodora Bozinovska, Milan Samardziski https://creativecommons.org/licenses/by/4.0
SONOGRAPHIC EVALUATION OF THE MECHANISM OF LABOR-OUR PRELIMINARY EXPERIENCE
Introduction: Intrapartum ultrasound evaluation is a contemporary diagnostic tool that provides insight into the process of normal labor and assists in its monitoring. Standardized mathematical parameters are used to assess the relationship between defined landmarks on the fetal head and structures of the soft and bony tissues of the birth canal. Aim: This study was designed to show that intrapartum sonographic parameters, primarily the angle of progression and the distance between the fetal head and maternal perineum, are equally effective in the management of labor progress, as vaginal digital examinations. Material and methods: A prospective cohort study was conducted involving 50 laboring women who were admitted at the delivery department of the University Clinic for Obstetrics and Gynecology in Skopje. They were all in the active stage of labor and were evaluated with intrapartum ultrasound, both transabdominal and transperineal, during the first, second and third hours after admission. Results: An increase in the angle of progression and a decrease in the distance between the fetal head and the maternal perineum can help in predicting the mode of delivery and the time interval to delivery. Conclusion: Introducing intrapartum ultrasound as a complementary tool to the digital vaginal examinations, offers new perspectives in the perinatology, with a unique opportunity for modification and modernization of the traditional protocols for management of labor and delivery, still used across the modern countries worldwide.
Copyright (c) 2026 Vesna Chibisheva, Vesna Antovska, Goran Kochoski, Maja Pejkovska-Ilieva, Gabriela Bushinovska, Ivana Kijajova https://creativecommons.org/licenses/by/4.0
TREATMENT OF VENTRAL HERNIA WITH COMPOSITE MESH: A CASE REPORT
After each abdominal surgical intervention, there is a risk of developing a hernia in the anterior abdominal wall. Тhis type of hernia are also known as incisional hernia. Such hernias can happen regardless of the type of abdominal incision, but they are more common with midline and transverse incisions. The use of synthetic mesh has become a common practice nowadays as it has lower risks of complications during surgery and lower rates of hernia recurrence compared to non-mesh repairs. In this case, a 31-year-old female patient with a large ventral hernia was scheduled for planned surgical intervention with the placement of a composite mesh for correction of the defect. The use of the composite mesh proved to be an excellent surgical solution for hernia correction in this particular case.
Copyright (c) 2026 Vladimir Joksimovic, Ljubomir Ognenovic, Gjorgji Trajkovski, Marija Joksimovic https://creativecommons.org/licenses/by/4.0
EPITHELIAL HEPATOBLASTOMA IN A MALE INFANT WITH BECKWITH-WIEDEMANN SYNDROME: A CHALLENGING CASE REPORT
Hepatoblastoma (HB) is among the most common pediatric primary liver tumor and constitutes almost 90% of tumors in children, aged 5 years, or younger. Hepatoblastomas are classified based on histological subtypes, which describe the types of cells and tissues present in the tumor. The primary classification divides them into epithelial and mixed epithelial and mesenchymal types. A two-month-old male infant was admitted at the Department of Pediatric Surgery-Clinical Hospital Acibadem Sistina, via referral from a pediatrician, with chief medical complaints of macroglossia, left-sided longitudinal hemi-hypertrophy and facial dysmorphic stigmatic features, for further clinical evaluation. After the initial physical examination, clinical investigations were obtained by protocol. Laboratory results showed elevated levels of lymphocytes, thrombocytes, RDW-SV, and hyperglycemia as well. The levels of alpha-fetoprotein (AFP) were >1000.0 (0-28 kiU/L). Imaging CT scan showed two tumefactions located between the 5th and 6/7th liver segments, clearly demarcated with dimensions of 57 mm (larger lesion) and 33 mm (smaller lesion), while the other intra-abdominal organs appeared normal. An urgent indication for surgical treatment was established, and a right-sided laparotomy was made. Intraoperative findings were two large liver masses located in the right lobe. Cholecystectomy and right partial hepatectomy were performed. Histopathological analysis revealed epithelial hepatoblastoma, embryonal subtype. Histopathology was performed using the PRETEXT (Pretreatment Extent) staging system developed by the International Society of Pediatric Oncology (SIOPEL). After the procedure, chemotherapy was initiated according to the standard protocol.
Copyright (c) 2026 Lazo Jovcheski, Risto Simeonov, Zlatko Aleksovski, Martin Angjelov, Kamelija Simeonova, Natali Jordanovska, Sandra Petkovska https://creativecommons.org/licenses/by/4.0
CHRONIC RESPIRATORY SYMPTOMS AND SPIROMETRIC PARAMETERS AMONG PROFESSIONAL DRIVERS - THE IMPACT OF OCCUPATIONAL EXPOSURE AND WORK TENURE
Aim. To assess the prevalence of chronic respiratory symptoms, spirometric parameters and the effects of occupational exposure among professional drivers. Material and methods. A cross-sectional epidemiological study was conducted including 70 male professional drivers and 70 administrative staff matched by age, work tenure, occupational exposure and smoking status. Data on respiratory symptoms, smoking status, occupational exposure to harmful agents and work tenure were collected using a standardized questionnaire. Spirometry was performed to assess lung function. Results. Professional drivers had a significantly higher prevalence of respiratory symptoms compared to controls, including any respiratory symptom (81.4% vs. 58.6%, p=0.003), nasal symptoms (35.7% vs. 8.6%, p<0.001), cough (61.4% vs 34.3%, p=0.002), cough with phlegm (37.1% vs. 20.0%, p=0.040), dyspnea (31.4% vs. 17.1%, p=0.049) and wheezing (25.7% vs. 7.1%, p=0.006). All spirometric parameters were significantly lower in drivers, indicating involvement of both large and small airways (p<0.05). Drivers with ≥ 20 years of work tenure exhibited a significantly higher prevalence of symptoms and lower spirometric values. Multivariable logistic regression identified exposure to gases as the strongest independent predictor of respiratory symptoms (adjusted OR up to 12.4, p<0.01), followed by exposure to smoke (adjusted OR up to 6.31, p<0.05). Dust exposure showed a non-significant trend, while vapors were not associated with respiratory symptoms. Conclusion. Professional drivers are at increased risk of developing respiratory symptoms and lung function impairment compared to the control group. Occupational exposure to gases and smoke represents the main independent risk factor, while longer work tenure suggests a cumulative adverse effect.
Copyright (c) 2026 Goran Andonov, Sasho Stoleski https://creativecommons.org/licenses/by/4.0
BEHAVIORS, ATTITUDES, MOTIVATION AND REASON FOR CYCLING IN SKOPJE, NORTH MACEDONIA
Introduction: Cycling is an effective way to incorporate physical activity into daily life. Despite its potential to promote health and well-being, cycling in the Republic of North Macedonia, particularly in Skopje, remains insufficiently supported. The aim of this study was to investigate cycling behaviors, motivations, barriers, and route preferences among residents of Skopje, and to identify factors influencing cycling frequency and route choice. Materials and methods: An online survey involving 1,169 participants who regularly cycled for different purposes was conducted using a 35-item Google Forms questionnaire. Data were analyzed using SPSS 16.0, and associations between nominal variables were evaluated using Chi-square tests (p < 0.05). Results: Most participants (77.1%) cycled 4–7 times per week, primarily between 7:00 AM and 6:00 PM, with peak activity during May and June. The mean cycling distance per trip was 8.9 km, while the mean commuting distance was 5.6 km. Recreation (76.1%) and commuting to work (70%) were the most common cycling purposes. Speed (79.3%) and perceived health benefits (78.9%) were the leading motivations, whereas adverse weather conditions (79.4%), insufficient cycling infrastructure (42.7%), and air pollution (36.3%) were the main barriers. Availability of dedicated bike lanes strongly influenced route choice (54%). Conclusion: Cycling in Skopje is currently sustained primarily by an active and motivated subgroup of cyclists. Improving cycling infrastructure, environmental conditions, and institutional support may contribute to broader participation and support cycling as a more sustainable mode of urban transport.
Copyright (c) 2026 Jansun Bukovetz, Kristina Shuntova, Aneta Kostova, Danica Stevkovska, Mihail Kochubovski, Igor Spiroski https://creativecommons.org/licenses/by/4.0
EVALUATION OF SPEECH COMPREHENSION USING A TEST OF SIMPLE QUESTION UNDERSTANDING IN COCHLEAR IMPLANT RECIPIENTS
Objectives: The objective of this study was to evaluate speech performance in individuals of different ages with prelingual hearing impairment who use a cochlear implant and to assess the influence of age on the communicative benefit derived from cochlear implantation (CI). Materials and methods: A retrospective-prospective study was conducted including 31 individuals with prelingual hearing impairment who underwent CI. The age of participants ranged from 6 to 29 years, with a mean age of 13±6.2 years. Individuals were divided into three age groups and were followed for at least 6, 12 and 24 months. The Glendonald Auditory Screening Procedure (GASP), which assesses the ability to understand simple questions, was used. Results: The performance on the simple question comprehension test was monitored at follow-up intervals of 6, 12 and 24 months. The most favorable outcomes were observed 24 months after cochlear implantation (CI). At 6 months after the intervention, 50% of participants in the youngest age group were unable to comprehend the meaning of any of the simple questions. After 24 months of intervention, CI users were able to understand up to 8 of the 10 administered questions; this maximum performance was attained by 25% of participants in the youngest age group, and by none of the participants in the oldest age group. Conclusions: The potential for the development of verbal communication skills and speech comprehension is substantially greater when CI is performed at a younger age.
Copyright (c) 2026 Vesna Lazarovska https://creativecommons.org/licenses/by/4.0