Academic Medical Journal

IMPACT OF CEREBRAL PERFUSION STRATEGIES ON NEUROLOGICAL OUTCOMES IN AORTIC ARCH REPAIR USING THE FROZEN ELEPHANT TRUNK TECHNIQUE

Marjan Shokarovski — 2025-07-18

This study aimed to evaluate the impact of various cerebral perfusion strategies on neurological outcomes, comparing our results on trilateral antegrade cerebral perfusion (tACP) to reported rates from latest literature analysis on bilateral antegrade cerebral perfusion (bACP) and unilateral antegrade cerebral perfusion (uACP).

Methods: A retrospective analysis was performed on 15 patients who underwent surgical intervention at the University Clinic for Cardiac Surgery in Skopje between 2018 and 2023. All patients included had elective chronic aortic dissections. Preoperative evaluation encompassed a detailed medical history, physical examination, diagnostic imaging, and risk stratification using the EuroSCORE II model. Standardized surgical techniques, including trilateral cerebral perfusion, were employed intraoperatively. The primary endpoint was the incidence of major neurological complications, including stroke and SCI, while the secondary endpoint was all-cause mortality.

Results: Major neurological events, including stroke and transient ischemic attack (TIA), were observed in 6.7% of patients, with SCI occurring in a single case (6.7%). These rates are notably lower than previously reported figures of 5-15% for procedural strokes following complex aortic arch repairs employing uACP or bACP. All-cause mortality in our cohort was 20%, compared to the 31% reported in the literature for patients undergoing open aortic arch repair.

Conclusion: In patients undergoing total aortic arch repair with the FET technique, tACP appears to be a viable strategy for cerebral and spinal cord protection. The complication rates observed in our cohort are favorable and support further investigation with larger patient populations to validate these findings.

POLYMERASE CHAIN REACTION IN SERUM FOR DIAGNOSIS OF ASPERGILLOSIS

Gordana Mirchevska — 2025-07-18

Introduction: Aspergillosis is a major threat for immunocompromised and critically ill patients. Early diagnosis and initiation of appropriate antifungal therapy are essential for favorable clinical outcome.

Aim: The aim of this study was to evaluate the performance of a PCR assay in serum, compared to conventional method, for the diagnosis of aspergillosis.

Material and methods: Specimens 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, Faculty of Medicine, Skopje, with conventional and molecular methods, during a period of two years (2014-2016).

Results: Seventy-one isolates of Aspergillus were confirmed in BAL culture. Aspergillus was detected in 63.33% of patients with chronic aspergillosis, followed by 56.67% of cystic fibrosis patients, 51.43% of patients with primary immunodeficiency, and 43.33% of patients with prolonged stay in ICU. Sensitivity and specificity of BAL culture were: 64.29% and 100%, 59.09% and 100%, 54.55% and 12.5%, 100% and 54.17%, in the I, II, III and IV group, respectively. PCR performed in serum yielded the following results for sensitivity and specificity: 53.57% and 100% in group I, 36.36% and 100% in group II, 9.09% and 100% in group III, respectively. Serum PCR was not performed in the group with cystic fibrosis.

Conclusion: Our results indicate that PCR in serum could be a useful adjunct test for diagnosis of aspergillosis, along with results from conventional mycological method, so a timely antifungal treatment with a favorable clinical outcome, is achieved.

PRESENTATION OF VITAMIN D AND FOLATE SERUM LEVELS IN HISTOLOGICALLY VERIFIED CERVICAL INTRAEPITHELIAL LESIONS IN WOMEN

Ivana Nakov — 2025-07-18

Background Human papillomavirus is the most common sexually transmitted infection and main cause of cervical cancer. Cervical cancer is still one of the leading causes of death in women of reproductive age, so it is very important to prevent HPV infection and its persistence.

Objective Due to the increased interest in the role of nutrition in prevention of cervical cancer and the overall health burden of HPV infection, we have investigated the HPV status, BMI, smoking habits, and the levels of vitamin D and folate in women with histologically verified cervical intraepithelial lesions and in those with normal findings.

Methods 188 women were included in this prospective study and they were divided into 2 groups. The examined group included 107 women and a control group of 81 women.

Results Between the groups, a statistically significant difference was obtained in the levels of vitamin D and folate; however, for both micronutrients, the average value of the serum levels was lower in the studied group. Comparing the individual subgroups in the studied population, there are no significant differences, neither in the level of vitamin D nor in folate.

Conclusion According to the results obtained in our research, we can conclude that higher levels of vitamin D and folate are associated with a lower risk of cervical intraepithelial lesions. Patients with histopathologically verified intraepithelial lesions have significantly lower concentrations of vitamin D and folate.

EVALUATING CHRONIC RHINOSINUSITIS AS A COMORBID DRIVER IN COPD

Marjan Marolov — 2025-07-18

Introduction: Chronic rhinosinusitis (CRS) is increasingly recognized as a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD), particularly under the framework of the “united airways” model, which emphasizes shared inflammatory mechanisms across the upper and lower respiratory tract.

Aim: To evaluate inflammatory biomarker profiles among COPD patients with and without CRS, and to assess differences across distinct COPD phenotypes—non-exacerbators (NE), frequent exacerbators (E), and asthma-COPD overlap (ACO).

Material and methods: A cross-sectional study was conducted on 36 COPD patients at a university clinic in Skopje, including 21 with CRS and 15 patients without CRS. All participants underwent clinical phenotyping, nasal endoscopy, sinus CT, and serum biomarker analysis (IL-4, IL-5, IL-6, IL-8, CRP, leukocytes). Statistical comparisons were made using Mann–Whitney U and Kruskal–Wallis tests.

Results: CRS was predominantly found in patients with the ACO phenotype (71.4%, p = 0.0006). No statistically significant differences were observed in systemic biomarkers (IL‑4, IL‑5, IL‑6, IL‑8, CRP, leukocytes) between COPD patients with and without CRS. IL‑5 and IL‑6 were undetectable. Similarly, inflammatory profiles did not significantly differ among COPD phenotypes.

Conclusion: CRS appears disproportionately represented in the ACO phenotype, likely due to shared type‑2 inflammatory pathways. However, conventional systemic biomarkers lack the sensitivity to detect upper airway involvement or differentiate COPD phenotypes. These findings highlight the need for comprehensive airway assessment and more specific biomarkers in future studies to better understand the interplay between CRS and COPD.

CYTOKINE DYNAMICS AND LONG-TERM OUTCOMES IN GERIATRIC HIP FRACTURE PATIENTS

Marko Spasov — 2025-07-18

Introduction: Hip fractures in the elderly are associated with high morbidity, mortality, and reduced quality of life. This study investigated the role of systemic inflammation, measured through serum levels of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), in predicting outcomes following operatively treated hip fractures in patients over 65 years of age.

Materials and Methods: A prospective, nonrandomized study was conducted involving 40 patients with hip fractures classified as 31A or 31B (AO classification). Blood samples were collected at four time points: within 10 hours post-injury, 48–60 hours post-surgery, on the seventh postoperative day, and on the 30th postoperative day. Serum levels of CRP and TNF-α were measured using ELISA. Functional outcomes, including quality of life (SF-12), mobility, and pain, were assessed at 12 months post-injury.

Results: Elevated serum levels of CRP and TNF-α were significantly associated with reduced quality of life, mobility, and survival. Deceased patients exhibited significantly higher cytokine levels compared to survivors at all time points. Multivariate regression analysis identified CRP (p<0.0001) and TNF-α (p=0.017) as independent predictors of quality of life, while TNF-α was significantly associated with mobility (p=0.043).

Conclusion: CRP and TNF-α may serve as valuable biomarkers for identifying high-risk patients and guiding postoperative care. Monitoring inflammatory markers could improve outcomes in geriatric hip fracture patients by enabling targeted interventions and rehabilitation programs.

KNEE OSTEOARTHRITIS TREATED WITH MESENCHYMAL STEM CELLS ARTHROSCOPY AND PHYSIOTHERAPY: EVALUATION WITH WHOQOL

Fitim Badalli — 2025-07-18

Introduction: Osteoarthritis (OA), a degenerative joint disease, affects the quality of life (QoL). Although there are various therapy options, no existing therapy fully restores cartilage tissue. Mesenchymal stem cells (MSC) arthroscopy has emerged as a promising treatment. Impact of MSC arthroscopy with physiotherapy on patients' QoL requires further study.

Aim: This study examined the effects of MSC arthroscopy, combined with an eight-week standard physiotherapy regimen, on QoL in knee OA patients, with a focus on gender- and age-related differences.

Material and methods: This mono-centric clinical study involved 35 knee OA patients (aged 45-65, both genders) treated with MSC arthroscopy and physiotherapy. QoL was assessed pre- and post-treatment using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), focusing on physical health, psychological health, social health and environmental health domains. Additionally, the influence of age and gender on treatment efficacy was analyzed to understand demographic impacts on therapeutic response.

Results: The average WHOQOL-BREF score after the treatment in male patients presented better condition compared to the female in individual domains and for WHOQOL-BREF total. The physical health domain showed the greatest improvement followed by the psychological health domain. Younger age was associated with better outcomes in QoL.

Conclusion: The results of the study show MSC arthroscopy therapy in combination with physiotherapy for managing knee OA a promising treatment approach showing significant improvement in QoL. However, further research is needed to understand long-term effects and optimize the treatment of patients with diverse demographic backgrounds.

COMPARATIVE EVALUATION OF VIDEO LARYNGOSCOPY AND CONVENTIONAL LARYNGOSCOPY DURING TRACHEAL INTUBATION

Elena Tashkovska — 2025-07-18

Introduction: Video laryngoscopy (VL) is relatively new technique, and has become a pivotal advancement in tracheal intubation, offering enhanced visualization of vocal cords and improving success rates.

Aim of the study: This study aimed to compare the efficacy of video laryngoscopy versus conventional laryngoscopy in adult patients requiring tracheal intubation for elective ENT surgeries.

Material and methods: This study involved 300 adult patients classified as ASA 1 and 2, aged 18 to 70, scheduled for elective ENT surgeries at a University Clinic in Skopje. Patients were divided into two groups: one underwent intubation using conventional Macintosh laryngoscopy, while the other utilized video laryngoscopy. Key parameters measured included intubation time, glottic visualization using the Cormack-Lehane score, number of intubation attempts, and instances of glottic trauma.

Results: The mean intubation time was significantly shorter in the VL group (26.09 seconds) compared to the ML group (34.01 seconds) (P < 0.001). The VL group exhibited superior glottic visualization, with 105 patients achieving Cormack-Lehane Score I versus 45 in the ML group (P = 0.001). Complications were notably lower in the VL group; only 3 instances of blood on the laryngoscope were reported compared to 10 in the ML group (P < 0.017).

Conclusion: Video laryngoscopy significantly enhances tracheal intubation success rates, reduces intubation time, and minimizes the risk of complications compared to conventional laryngoscopy, establishing it as a preferred technique in managing difficult airways.

CT PULMONARY ANGIOGRAPHY IN ACUTE PULMONARY EMBOLISM: THE IMPACT OF CONCOMITANT DEEP VEIN THROMBOSIS ON THE IMAGING BIOMARKERS OF RIGHT HEART STRAIN

Sonja Nikolova — 2025-07-18

Objective: To assess the influence of concomitant deep vein thrombosis (DVT) on CT pulmonary angiography (CTPA) markers of right heart strain (RHS) in patients with acute pulmonary embolism (APE).

Material and Methods: A retrospective analysis was conducted on 119 patients diagnosed with APE using CTPA. Key imaging parameters evaluated included the pulmonary artery obstruction index (PAOI), diameters of the right and left atria and ventricles, pulmonary artery (PA) and aorta (Ao), the RV/LV and RA/LA diameter ratios, interventricular septal (IVS) deviation, and inferior vena cava (IVC) contrast reflux. Patients were stratified based on the presence of DVT confirmed by clinical symptoms or ultrasound.

Results: DVT was identified in 49 of 119 patients (41.2%). Compared to those without DVT, this group demonstrated significantly elevated PAOI values (61.5 ± 29.2 vs. 49.3 ± 26.3; p = 0.023), larger RA/LA diameter ratios (1.44 ± 0.44 vs. 1.25 ± 0.42; p = 0.016), and higher RV/LV ratios (1.49 ± 0.53 vs. 1.24 ± 0.46; p = 0.017). While PA/Ao ratios and IVC diameters were numerically greater in the DVT group, differences were not statistically significant. IVS shift and IVC contrast reflux were more frequently observed in the DVT subgroup (53.1% and 69.4%, respectively), although without statistical significance (p > 0.5).

Conclusions: The presence of DVT in patients with acute PE is associated with more pronounced CTPA markers of right heart strain, particularly elevated PAOI and increased ventricular and atrial diameter ratios. These findings suggest a greater hemodynamic burden in PE patients with concomitant DVT.

ALAMA COVID-19 MEDICAL RISK ASSESSMENT TOOL - KOSOVO DEMOGRAPHIC EXPERIENCE

Aferdita Kurti Meta — 2025-07-18

Introduction: The coronavirus disease 2019 (COVID-19) is an infectious disease caused by the newly discovered Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

Aim: In our study, we aimed to present the Kosovo’s COVID-19 pandemic experience using the ALAMA COVID-19 Medical Risk Assessment tool to evaluate overall vulnerability as а part of the health assessment of fitness for work related to gender and age groups.

Material and methods: This analytical cross-sectional study was conducted during a period of two years (2020-2021) on a national sample of 200 patients with COVID-19 treated at the Clinical Center in Prishtina, Republic of Kosovo. All patients had a confirmed COVID-19 positive status by RC-PCR test.

Results: The average vulnerability of ALAMA COVID-19 Medical Risk Assessment score in the study group of patients was 46.42±19.92, with min/max of 20/85, and 50% of the patients had an ALAMA COVID-19 score of ≤43 (low vulnerability), with a median IQR = 43 (28-65). The average ALAMA COVID-19 score was higher in males compared to females: 50.21±20.09 vs. 42.74±19.14, respectively. Approximately 25% of males had an ALAMA COVID-19 score >70 (high vulnerability) compared to 25% of females with a score > 57 (moderate vulnerability). The ALAMA COVID-19 Medical Risk Assessment tool showed significantly higher vulnerability in male compared to female patients (p=0.0065).

Discussion: The ALAMA COVID-19 Medical Risk Assessment tool showed significantly higher vulnerability in male compared to female patients.

QANTITATIVE ANALYSIS OF THE EFFICACY OF TREATMENT WITH NEUROFEEDBACK METHOD IN PATIENTS WITH AFFECTIVE DISORDERS

Aleksandar Risteski — 2025-07-18

Introduction: Depression affects approximately 300 million people globally, with about 5% of adults experiencing an episode each year, making it a major public health concern.

The main goal of this study was to measure the effectiveness of the combined treatment of the neurofeedback method and antidepressants in the treatment of patients diagnosed with affective disorder.

Results: The study revealed a significant reduction in depressive symptoms in the SG compared to the CG. At baseline, both groups had similar BDI scores (18.88±5.8 in SG vs. 21.0±8.7 in CG; p=0.15). However, by the second follow-up, the SG exhibited a statistically significant improvement (BDI: 16.80±5.7 vs. 20.56±8.8; p=0.013), pointing towards a 11.02% score reduction in the SG compared to a 2.09% in the CG. This trend continued throughout the study, with the final assessment showing a mean BDI score of 13.14±5.9 in the SG versus 19.58±8.2 in the CG (p=0.00002). As for the CGI scale, a greater reduction in the total CGI scale score was recorded at the second assessment in the SG (12.15%), compared to the CG (2.46%), confirming the faster treatment response with the combined treatment approach. The CGI scores indicated greater clinical improvement in the SG, with a mean CGI score of 7.34±2.4 compared to 9.54±2.5 in the CG (p=0.000016) at the final assessment.

Conclusion: The combined treatment encompassing neurofeedback training and antidepressant therapy demonstrated superior efficacy in reducing depressive symptoms compared to antidepressant monotherapy.

GIANT CONDYLOMA ACUMINATUM OF BUSCHKE-LOWENSTEIN: A CASE REPORT

Irena Shuplinovska — 2025-07-18

Buschke-Löwenstein tumor is a rare, slow-growing tumor that may arise from a pre-existing condylomatous lesion and has exophytic, cauliflower-like, or papillomatous growth pattern.

These tumors are associated with low-risk human papillomavirus infection, most commonly types 6 or 11. They predominantly occur in men in the anogenital region, and are associated with immunodeficiency. The treatment is controversial, but the greatest success has been observed with “cold knife” surgical resection with clear margins.

We present the case of a 42-year-old woman with a tumor in the anogenital region that grew progressively over the course of 6 months. The giant condyloma acuminatum covered most of the labia majora of the vulva in a continuous pattern. Multifocal condylomas were observed both at the vaginal introitus and at the lateral aspect of the primary tumor.

The patient was tested and had no other sexually transmitted infections. After adequate preoperative preparation, a wide partial vulvectomy was performed. The postoperative course was uneventful.

Adequately planned surgery remains a treatment of choice for patients with giant condylomas.

PARTIAL AVULSION OF THE OPTIC NERVE HEAD: A CASE REPORT

Suzana Klenkoski — 2025-07-18

Avulsion of the optic nerve is a rare but quite serious injury characterized by severe and permanent visual impairment. It is mainly encountered in the working-age population, with a male predominance.

In this paper, we describe the case of a 15-year-old patient who presented for an ophthalmological examination due to pain and sudden loss of vision in the left eye after an injury caused by a wooden object. Clinical and imaging examinations revealed a tissue defect at the level of the optic disc with surrounding intraretinal and preretinal hemorrhages and partial hemophthalmus in the central parts of the vitreous. A diagnosis of partial avulsion of the optic nerve papilla was made. The patient was evaluated over six months, during which there was a gradual resolution of the hemorrhages and a modest improvement in visual acuity.

This case indicates the seriousness of the problem and the need for appropriate prevention as the most effective strategy in its management.

LUPUS PANNICULITIS - A CASE REPORT WITH LONG-TERM FOLLOW-UP

Ema Stoicovska — 2025-07-18

Lupus erythematosus panniculitis (LEP), also known as lupus erythematosus profundus, is a rare subtype of chronic cutaneous lupus erythematosus (CCLE), characterized by inflammation of the subcutaneous adipose tissue. It is estimated to affect 1-3% of patients diagnosed with cutaneous lupus. It can present as a distinct clinical entity or in association with discoid lupus erythematosus (DLE) or systemic lupus erythematosus (SLE).

We report a case of lupus panniculitis with long-term follow-up in a 54-year-old woman, initially presenting with unilateral periorbital erythema and edema. The patient’s medical history revealed intermittent episodes of unilateral periorbital edema on the affected side over the previous three years along with the development of an erythematous, indurated lesion on the right cheek, which resolved with an atrophic, depressed plaque. During this period, the patient had been treated with oral antibiotics, corticosteroids, and antiviral therapy due to suspected clinical diagnoses of contact dermatitis, recurrent herpes simplex, and periorbital cellulitis. Considering the patient’s history, clinical presentation, histological evidence of lymphocytic lobular panniculitis, and immunological findings, a diagnosis of lupus panniculitis was established.

The patient demonstrated an excellent response to treatment with hydroxychloroquine and prednisolone, achieving complete resolution of her dermatological symptoms. However, after a three-year period without medical supervision and discontinuation of therapy, she presented with new lesions on the facial region, including one on the nose suspected to be DLE and multiple atrophic, depressed plaques on the upper arms.

HYPERPARATHYROIDISM DUE TO INTRATHYROIDAL PARATHYROID ADENOMA

Tanja Makazlieva — 2025-07-18

Introduction: The intrathyroidal parathyroid adenoma (IPA) represents a rare anatomical variant where parathyroid tissue is located within the thyroid gland instead of its usual extrathyroidal position. This condition arises due to aberrant embryologic migration of the parathyroid glands and is identified in approximately 1.3% to 6.7% of all parathyroid lesions.

Case report: We present the case of a 56-year-old female diagnosed with a thyroid nodule, incidentally found on neck ultrasound. Fine-needle aspiration biopsy reported only microfollicular and macrofollicular arrangement of benign thyrocytes and lymphocytes. Due to continuous fatigue, loss of appetite, pain in bones, osteoporotic changes and constipation, hyperparathyroidism was suspected and laboratory revealed hyperparathyroidism with increased parathormone (1587 pg/mL), ionized calcium (2.25 mmol/L) and low phosphates.99mTc-MIBI scintigraphy revealed a focal accumulation in the lower quadrant of the right thyroid lobe, indicative of intrathyroidal parathyroid adenoma, which was confirmed by histopathology report. After surgery, continuous decrease in PTH levels were reported, and after 7 months PTH levels were 66.73 pg/mL, ionized calcium 1.12 mmol/L and inorganic phosphate 1.15 (0.8-1.4 mmol/L). Follow-up of the patient revealed variations in the PTH levels, above the upper reference limit, along with hypoechogenic nodule in the posterior parts of the contralateral thyroid lobe. Further close follow-up is recommended due to the possibility of recurrence.

ARTHROSCOPIC REMOVAL OF A LOOSE BODY FOLLOWING RADIAL HEAD FRACTURE

Krsto Nikolikj — 2025-07-18

Radial head fractures are common elbow injuries that may be associated with intra-articular loose bodies. Fractures of the radial head constitute approximately 3% of all fractures and 33% of elbow fractures ^{[1, 2]}. We present a case of a 40-year-old female patient who complained of persistent pain and mechanical locking symptoms following conservative treatment of a radial head fracture. A computed tomography (CT) scan revealed an intra-articular loose body in the anterior compartment of the elbow, which was successfully removed arthroscopically. This case highlights the efficacy of elbow arthroscopy in addressing intra-articular pathology and restoring function in patients with mechanical symptoms.

UNVEILING UNFORESEEN COMPLICATIONS: A NEONATAL CASE REPORT ON CORD CLAMPING AND ACUTE INTESTINAL OBSTRUCTION

Zlatko Aleksovski — 2025-07-18

This neonatal case report presents an unexpected and rare complication associated with cord clamping during the immediate postnatal period. The report focuses on a newborn who developed acute intestinal obstruction shortly after birth. The neonate's clinical course was examined, detailing the sequence of events from cord clamping to the emergence of gastrointestinal complications. Despite the routine nature of cord clamping and its perceived safety, this case highlights the need for heightened awareness of potential complications that can arise in the delicate transition from intrauterine to extrauterine life. Timely recognition of abdominal distension, impaired feeding, and other clinical signs prompted surgical intervention, leading to the diagnosis of intestinal obstruction. The management and subsequent outcomes of this case underscore the significance of careful monitoring and prompt intervention in neonatal care. This case report serves as a reminder that while cord clamping is a routine procedure, healthcare providers should remain vigilant to unforeseen complications that may demand immediate attention in the early moments of neonatal life.