Academic Medical Journal

LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (Lp‐PLA2) AS A PREDICTOR OF END-STAGE RENAL DISEASE IN PATIENTS WITH DIABETIC NEPHROPATHY

Irena Kostovska — 2024-12-11

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a specific biomarker for vascular inflammation. It is associated with microvascular complications such as diabetic nephropathy (DN) in patients with type 2 diabetes mellitus. To determine the predictive value of Lp-PLA2 concentration/activity for end-stage renal disease (ESRD) in patients with DN.

A total of 94 patients included in this cross-sectional study with DN were divided into four stages of chronic kidney disease (CKD) according to CKD-EPI: Stage II (n=20), Stage IIIa (n=29), Stage IIIb (n=38), and Stage IV (n=7). Forty-four healthy subjects were used as a control group. In addition to anamnestic data (age, gender, body weight, height, glycemic control), we measured the concentration of glucose, total cholesterol, triacylglycerols, blood urea, and creatinine in the blood serum using standard photometric methods. Lp-PLA2 concentration/activity was measured by chemiluminescence immunoassay-CLIA. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) serum creatinine was used to determine the GFR and CKD stages.

We found significant differences among subgroups of patients with DN divided according to CKD stage and healthy subjects regarding age, body mass index, duration of disease, blood glucose, glycated hemoglobin, total cholesterol, triacylglycerols, blood urea, serum creatinine, GFR, and Lp-PLA2. A significant negative correlation was found between Lp‐PLA2 and GFR. ROC analysis showed that Lp-PLA2 had a positive predictive value of 98.3% in patients with DN. Lp-PLA2 gradually increased in stages of DN.

Lp-PLA2 could be considered as a potential predictive biomarker for the progression of DN to ESRD.

EXTENDED SPECTRUM BETA-LACTAMASE (ESBL) PREVALENCE IN BACTERIA ISOLATED FROM URINE SAMPLES

Ivona Pecovska Gashevska — 2024-12-11

Urinary tract infections (UTI) due to E. coli are the most common infectious diseases. Extended spectrum beta-lactamases (ESBLs) are clinically important because they destroy cephalosporins - antibiotics which are used as first line agents in critically ill patients, including those with intra-abdominal infections, pneumonias and bacteremia. The aim of this study is to present the prevalence of ESBL E. coli/K. pneumoniae UTI through a retrospective review of medical records in the period from 2019 to 2023.

This was a retrospective study conducted at the Institute of Public Health (IPH) of the Republic of North Macedonia, in which the prevalence of ESBL E. coli/ K. pneumoniae UTI was elaborated covering the period from 2019 to 2023.

The analysis by year at the national level, presented in Table 1, shows that most of the reports were registered in 2019 - 134 or 32.1%, while the smallest number were reported in 2020 - 31 or 7.4%. The analysis of demographic data in terms of gender shows that a cumulatively higher number of reports at the national level was registered among women - 269 or 64.5%. If data from the IPH are analyzed according to this indicator, 46 women (82.1%) and 10 men (17.9%) were registered.

In conclusion, the current study indicated a significant rate of infection with ESBL-producing Gram-negative bacilli in patients with UTI.

OVERDIAGNOSIS OF ACUTE PULMONARY EMBOLISM DETECTED ON CTPA - A RETROSPECTIVE STUDY

Kristina Dimitrijevikj — 2024-12-11

Aim: To evaluate the prevalence of overdiagnosis of pulmonary embolism (PTE) by computed tomography pulmonary angiography (CTPA) and assess the clinical justification for CTPA use.

Methods: A retrospective study was conducted on 200 patients who presented with symptoms of PTE between 2023 and 2024. CTPA was performed, and results were analyzed to determine diagnostic yield and identify factors contributing to over diagnosis.

Results: Out of 200 patients, 22.5% were diagnosed with PTE, while 77.5% had negative results. Common symptoms included dyspnea (45%) and chest pain (42.5%). Elevated D-dimer levels were found in 92.5% of patients. For those with negative CTPA results, alternative diagnoses included pneumonia (29.03%) and pleural effusion (16.13%).

Conclusion: The study highlights a significant issue of overdiagnosis due to excessive reliance on CTPA. The low positive yield suggests overuse of this imaging modality, potentially driven by inadequate application of clinical decision rules and the D-dimer test. Recommendations include improving adherence to clinical guidelines and optimizing the use of diagnostic tools to reduce unnecessary imaging and radiation exposure.

ASSOCIATION OF HLA-B AND HLA-DRB1 LOCI AND INFLAMMATORY CYTOKINES WITH THE CLINICAL PRESENTATION OF PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Marija Neskovska Sumenkovska — 2024-12-11

Juvenile idiopathic arthritis (JIA) is the most common rheumatic chronic disease in childhood presented with various clinical symptoms of arthritis in children younger than 16 years.The aim of this study was to evaluate the correlation between HLA-B, HLA-DRB1 and inflammatory cytokines with the clinical presentation of juvenile idiopathic arthritis.

In this study, we analyzed 35 patients with juvenile idiopathic arthritis diagnosed at the University Clinic for Pediatric Diseases in Skopje, North Macedonia in the period from 2018 - 2024. All patients fulfilled the inclusion criteria for entering the study, that is, the ILAR reevaluated criteria from 2001 for diagnosis of juvenile idiopathic arthritis. Patients were genotyped for HLA-B and HLA-DRB1 loci. Concentrations of IL-1, IL-6 and TNF-alpha were determined in patients’ serum at two time points, before starting the treatment and 6 months after therapy. These analyses were performed at the Institute of Immunobiology and Human Genetics, Faculty of Medicine in Skopje, North Macedonia.

The most frequent HLA-B allelic groups in our patients were HLA-B*27, B*35 and B*18, whilst in HLA-DRB1 locus the most frequent were DRB1*11, *01, *04 and *16. Increased risk for development of JIA was detected for HLA-B27 (p=0.001959, OR=3.39), B*15 (p=0.000058, OR=7.29) and DRB1*08 (p=0.02758, OR=4.54). Cytokine levels in patients decreased after therapy.

Conclusion: HLA typing is important in JIA patients for detection of different subtypes and detection of the concentration of proinflammatory cytokines helps in the therapy management of these patients.

CLINICAL PATTERN IN PFO-ASSOCIATED STROKE

Sanja Djambazovska Zikova — 2024-12-11

Patent foramen ovale (PFO) has been documented as a cause of stroke in young patients. The aim is to determine the prevalence, clinical pattern and trigger factors in young patients with PFO-associated stroke.

We prospectively examined the prevalence of PFO–associated stroke in 95 consecutive patients, aged ≤57 years with stroke/TIA, its clinical and imaging characteristics, and relationship with physical activity - induced Valsalva trigger factors.

PFO was detected in 56.6% of patients with cryptogenic stroke (CS)/TIA and in 18.18% of patients with stroke/TIA with a known cause, and CS/TIAs with PFO were significantly more often localized in the vertebrobasilar circulation compared to strokes/TIA without a PFO (60% vs 30.43%; p=0.03). Exposure to physical activity as a trigger factor was significantly associated with the presence of PFO compared to patients without PFO (37% vs 8.33%, p=0.023). RoPe score ≥7 was obtained in 73.33% of patients with CS/TIA. In 96.67% of patients with right to left shunt detected on Bubble-cTCD with CS/TIA, a PFO was confirmed by TEE and percutaneous PFO closure was performed in 73.33% of patients.

Our results suggest that there is a large proportion of patients with PFO and CS/TIA, with the likelihood that PFO in their case is etiologically related to stroke. We showed that physical activity - induced Valsalva could provoke an asymptomatic PFO to become pathological, causing PFO-associated stroke in young adults, more likely in the vertebrobasilar circulation.

WHEN THICKNESS MATTERS: THE IMPORTACE OF ENDOMETRIAL THICKNESS MEASUREMENT IN PATIENTS WITH INTRAUTERINE FLUID COLLECTION

Kristina Skeparovska — 2024-12-11

Numerous patients are referred by their gynecologists for a histological evaluation due to an ultrasound finding of “mucometra” (intrauterine fluid collection) without endometrial thickness being measured and reported. It seems that for a large number of doctors, intrauterine fluid collection by itself rather than the thickness of the endometrium is of significance when suspecting a possible pathology of the uterus.

The aim of this study was to assess the histological significance of intrauterine fluid collection as such versus intrauterine fluid collection accompanied by endometrial thickness.

The study was retrospective. It included 98 postmenopausal patients with sonographically confirmed mucometra that underwent dilatation and curettage. Subjects were divided in 3 groups: patients with mucometra; patients with mucometra and endometrial thickness >10 mm and patients with mucometra and endometrial thickness ≤10 mm. Data regarding histological findings were obtained from medical history.

Behind TVS finding of “mucometra” regardless of endometrial thickness presence, histopathology analysis revealed 84.6% atrophic endometrium, 12.8% benign, and 2.6% premalignant or malignant lesion.

Among patients with endometrial thickness up to 10 mm, atrophic endometrium was found in 80%, and 20% of patients had benign findings. Patients with endometrial thickness above 10 mm had premalignant or malignant lesion in 11%, benign lesion in 21%, and the remaining 68% had atrophic endometrium.

Endometrial thickness rather than intrauterine fluid accumulation itself is crucial in making the decision for further histological evaluation.

LEVELS OF C-REACTIVE PROTEIN IN PREDICTION OF PREECLAMPSIA

Irena Todorovska — 2024-12-11

Preeclampsia is the cause of significant maternal and fetal morbidity and mortality. C-reactive protein is considered a sensitive inflammatory marker and its values increase in response to inflammation that occurs during tissue injury. The level of C-reactive protein increases, correlating with the severity of the clinical picture of preeclampsia.

To determine the level of C-reactive protein in patients with preeclampsia and the correlation of the value with the severity of the clinical picture of preeclampsia.

This study included 25 patients with a moderate form of preeclampsia, 25 patients with severe preeclampsia and 30 patients without symptoms, with normal pregnancy. All women were in the third trimester of pregnancy, hospitalized at the University Clinic for Gynecology and Obstetrics, Skopje, in the Department of preeclampsia, intrauterine growth retardation and premature births. Patients were examined in the period from 01.10.2022 to 10.04.2023. The severity of preeclampsia was determined by blood pressure, 24-hour proteinuria, and laboratory tests characteristic of preeclampsia.

The results obtained showed that increased CRP levels were statistically significant (p<0.001) in the serum of patients with moderately severe form of preeclampsia (group A) (mean value 8.4 mg/L; 6.1-11.3 mg/L) and severe preeclampsia (group B) (mean value 30.2 mg/L; 13-54 mg/L) in correlation with the control group (group C) (mean value 2.5 mg/L; 0.2-4.5 mg/L). There was a significant correlation between serum CRP levels and systolic blood pressure (p<0.001) and proteinuria (p<0.001).

High levels of serum CRP correlate with the severity of the clinical picture of preeclampsia.

FREQUENCY OF SURGICAL SITE INFECTIONS FOLLOWING SURGICAL TREATMENT OF ISOLATED FRACTURES: A RETROSPECTIVE STUDY

Valentin Vejseli — 2024-12-11

Surgical site infections (SSIs) are a frequent and serious complication that occur after surgical treatment of isolated fractures, leading to increased morbidity, mortality, prolonged hospital stays, and higher healthcare costs. This study aimed to identify the frequency and risk factors associated with SSIs. Methods: This retrospective observational study included 51 patients who underwent open reduction and internal fixation (ORIF) surgery for isolated fractures and later developed bacterial infections. We analyzed factors such as the presence of comorbidity, patient age, gender, body region affected, and duration of the operation. We used multinomial logistic regression and chi-square tests as statistical analyses to examine the relationships between these factors and the types of pathogens as a cause of bacterial infection, classified as Gram-positive bacteria only, Gram-negative bacteria only, or both. Results: Our study found that in 18%, 56% and 26% of patients the cause of infection was Gram-positive, Gram-negative and both groups of bacteria, respectively. The factors that did not significantly predict the type of bacterial infection were: comorbidity presence, although the observed trends suggested further investigation was needed; duration of operation; and patient age. Gender analysis concluded a marginally significant association, with males less likely to have infections caused by Gram-positive bacteria. Additionally, the body region affected showed a marginally significant correlation with infection type, with the thigh region being more sensitive to infections caused by Gram-negatives.

Our study highlights trends and marginal associations in SSIs post-ORIF surgery, suggesting the need of personalized infection control strategies.

EPIDEMIOLOGICAL PATTERNS AND CLASSIFICATION OF ANKLE FRACTURES: A RETROSPECTIVE STUDY

Marko Spasov — 2024-12-11

Ankle fractures are among the most common types of fractures, with a rising global incidence, particularly in the elderly population. Despite this, comprehensive epidemiological data on all forms of ankle fractures remain limited. This study aimed to provide a detailed epidemiological analysis of ankle fractures classified by the AO/OTA system within a cohort from a trauma center in Skopje over a seven-year period.

This observational study analyzed data from 559 patients with ankle fractures treated at the University Clinic for Traumatology in Skopje between 2017 and 2024. Fractures were classified using the AO/OTA system, and data on patient demographics, injury mechanisms, and seasonal variations were collected. Descriptive statistics were employed to analyze the distribution of fractures.

The study found that AO/OTA type B fractures were the most common, accounting for 62.9% of cases, predominantly affecting elderly women. Men under 45 years had a higher incidence of ankle fractures, often associated with high-energy trauma. The mean age of patients was 52 years, with women showing a higher mean age (62 years) than men (53 years). Seasonal variation was evident, with a peak in fractures during the winter months.

This study highlights the prevalence of ankle fractures among elderly women and the impact of high-energy trauma in younger males. The findings underscore the importance of targeted prevention strategies, particularly in high-risk populations, and call for further research through multicenter studies to validate and extend these insights.

ASSESSMENT OF PRE- AND POST-OPERATIVE VALUES OF ERYTHROCYTES, HEMOGLOBIN, HEMATOCRIT AND DRAINAGE VOLUME AFTER ADMINISTRATION OF TRANEXAMIC ACID IN TOTAL HIP ARTHROPLASTY

Dejan Damjanovikj — 2024-12-11

Total hip arthroplasty is a well-established and effective treatment for hip osteoarthritis. However, it is commonly associated with significant blood loss and an increased need for blood transfusions. Tranexamic acid, an antifibrinolytic agent, prevents the degradation of fibrin and preserves the integrity of the fibrin matrix. This study aimed to assess the pre- and postoperative levels of erythrocytes, hemoglobin, hematocrit, and drainage volume following intravenous administration of tranexamic acid during total hip arthroplasty.

A total of 40 patients participated in the study, divided into two groups: an experimental group receiving intravenous tranexamic acid and a control group not receiving the drug.

On the second postoperative day, the experimental group showed a smaller decrease in erythrocytes (0.2935 x 10¹²/L), hemoglobin (11.093 g/L), and hematocrit (0.032) compared to the control group. Furthermore, the total drainage volume from the day of surgery and the first postoperative day was reduced by 137.65 ml in the experimental group.

Overall, the use of tranexamic acid proved to be a safe and effective strategy for minimizing postoperative declines in erythrocyte, hemoglobin, and hematocrit levels, while also reducing postoperative drainage volume. This ultimately leads to decreased blood loss and a lower requirement for blood transfusions.

METABOLIC SYNDROME IN A SAMPLE OF WORKING POPULATION

Dragana Bislimovska — 2024-12-11

Metabolic syndrome (MetS) is a cluster of risk factors, including central obesity, hypertension, hyperglycemia, hypertriglyceridemia, and reduced HDL cholesterol, -that increase the risk of type 2 diabetes and cardiovascular diseases. Its prevalence is growing globally, and the association with occupational factors is increasingly recognized.

To determine the frequency and characteristics of MetS and its components among the working population in North Macedonia, related to gender, age, and occupation.

A cross-sectional study was conducted among 537 workers aged 20-67 years during their regular preventive medical check-ups. Participants were divided into four occupational groups based on the International Labor Organization classification. The presence of MetS was determined according to the NCEP ATP-III criteria when at least three of five factors were present.

MetS was detected in 31.5% of participants. The frequency was significantly higher in males (42%) than in females (20.3%), and higher in participants older than 45 years (45.8% vs. 17.6%). MetS frequency varied by occupation, being higher among workers with manual jobs (Groups 1 and 2) compared to those with sedentary jobs (Groups 3 and 4) (39.9% vs. 25.9%, p = 0.0064).

MetS is prevalent among the working population, particularly in males, older workers, and those engaged in manual labor. These findings highlight the need of targeted health promotion programs and preventive interventions to reduce cardiometabolic risk factors among workers.

EXPLOITING EMG SIGNALS FOR THE RECOGNITION OF FINGER FLEXIONS USING WAVELET TRANSFORM AND MACHINE LEARNING

Klimentina Paunkoska — 2024-12-11

Electromyography (EMG) is a technique that measures and records electrical activity in response to a nerve’s stimulation of the muscle. EMG signals are biomedical signals that represent electrical currents generated in muscles during their contraction. EMG signals acquired from muscles require advanced methods for detection, decomposition, processing and classification. Various mathematical techniques have received extensive attention and one of the most popular is Wavelet transform. Wavelet transform is a mathematical tool for analyzing data where the signal values vary at different scales, such as in EMG signals, so it is widely used in EMG signal processing systems. This study explored the potential of applying wavelet transform to EMG signals, which were collected using two sensors placed on the forearms of eight subjects performing individual finger flexions. We experimented with various mother wavelets and decomposition levels to determine the most effective combination. After evaluating the results obtained from training models, we selected the Daubechies wavelet (db1) with a second level of decomposition as the optimal solution. To generate meaningful features from the wavelet coefficients, we extracted time-frequency domain features, which were then used as inputs for training and testing machine learning models. We employed five classification algorithms: K-nearest neighbors, Support Vector Machine, Decision Tree, Random Forest, and Extreme Gradient Boosting (XGBoost). By evaluating and comparing the performance of these algorithms, we demonstrated enhanced accuracy and robustness achieved by the combination of wavelet transform and feature extraction in EMG signal analysis.

A UNIQUE DISTAL NERVE TRANSFER FOR RECONSTRUCTION AND FUNCTIONAL RESTORATION OF THE THENAR BRANCH IN A HIGH MEDIAN NERVE LESION

Sofija Pejkova — 2024-12-11

This article illustrates reinnervation of thenar muscles following high median nerve injury using fascicles from the deep branch of the ulnar nerve. We present a 30-year-old male with a history of open humeral fracture, soft tissue defect and total division of the median nerve. Six months after bone and soft tissue reconstruction, the median nerve was reconstructed at midarm level with sural nerve cable grafts. Immediate restoration of FPL and index finger FDP function was achieved using brachioradialis tendon transfer and side-to-side tenorrhaphy to the ring finger FDP. The thenar branch of the median nerve was reconstructed with 2.5 cm nerve graft using fascicle group from abductor digiti minimi. Pre- and postoperative nerve function was evaluated electroneurographically, with quantitative sensory-motor testing, photo- and video-documentation. Modified Bishop Rating Scale was used for endpoint analysis 18 months postoperatively. Early electroneurographic evaluations revealed clear evidence of innervation of thenar muscle targets by ulnar nerve axons. The abductor digiti minimi showed signs of chronic denervation. At 18-months, two-point discrimination was 4 mm for the little finger and 8 mm for the index and thumb, the middle finger not regaining this capacity. Pinch- and power grip strength reached mean values of 64% and 38%, respectively, compared to the unaffected hand. The presented data validates that fascicles from the deep branch of the ulnar nerve provide sufficient axonal power for challenging median nerve targets at early post-reconstruction, offering valuable window of opportunity in high or late median nerve reconstruction.

CONCOMITANT IPSILATERAL ACHILLES TENDON RUPTURE AND MEDIAL MALLEOLUS FRACTURE

Nenad Bogdanovski — 2024-12-11

Concomitant ipsilateral ankle fracture with Achilles tendon (AT) rupture is a rare injury pattern with no consensus on optimum management. The present report discusses this rare combination. A 34-year-old man twisted his ankle with foot fixated on the ground following an unexpected sliding 100 m down while he was hiking and sustained a closed fracture of the medial malleolus, with an ipsilateral complete Achilles tendon (TA) rupture. Fortunately, both lesions were diagnosed from the start although such combination of injuries is commonly delayed or misdiagnosed.

PENETRATING ORBITAL TRAUMA – CASE REPORT

Stefan Pandilov — 2024-12-11

Penetrating orbital trauma (POT) includes injuries that affect the structures in the orbit caused by the penetration of an object at a certain speed. Due to the close communication of the orbit with the surrounding cranial structures, a multidisciplinary approach is necessary in the evaluation of these patients.

We present a case of a 42-year-old patient with a penetrating injury in the right orbit caused by a plastic foreign body that occurred during a traffic accident. After evaluation of vital parameters and imaging studies at the Emergency Surgical Center, an ophthalmological examination was performed. Pupil reaction to light was preserved, bulbus, extraocular muscles and optic nerve were intact, without penetration of the object into other cranial compartments. A surgical intervention was performed - extraction of the foreign body, achieved surrounding hemostasis and treatment of the entrance wound. Postoperatively, the patient was treated with local and systemic antibiotic and corticosteroid therapy as well as pain relief therapy. The best-corrected visual acuity of the follow-up ophthalmological examination was 6/6, with preserved bulbar motility, no eyelid ptosis and normal fundoscopic findings.

BILATERAL UVEAL COLOBOMA IN COMBINATION WITH A SYSTEMIC SYNDROME – A CASE REPORT

Bekim Tateshi — 2024-12-11

Coloboma of the uvea is a relatively rare ophthalmic entity, which occurs as a result of a disturbance in the process of closing the embryonic optic fissure. It can be hereditary, sporadic or part of systemic syndromes. Each of the structures of the uveal tract, alone or together, unilaterally or bilaterally, can have the presence of a coloboma. In this paper, we describe the case of a 9-year-old girl with bilateral coloboma and accompanying ectrodactyly of the lower limbs, probably as part of a syndrome - Ectrodactyly-ectodermal dysplasia-cleft syndrome. The patient is regularly monitored with biomicroscopic and funduscopic examination supplemented with posterior optical coherence tomography and perimetry, with the aim of timely recognition of possible ophthalmic complications.

MUTATION OF ABCA4 GENE AS A CAUSE OF AUTOSOMAL RECESSIVE FORM OF STARGARDT DISEASE - CASE REPORT

Angelka Spirkoska Mageroska — 2024-12-11

Stargardt disease is the most common type of juvenile macular dystrophy. It is inherited autosomal recessively, although autosomal dominant forms have also been described. It affects both sexes equally, without racial predisposition. Patients experience a progressive deterioration of the macular region and loss of central vision, leading to legal blindness in the majority of affected individuals.

In this paper, we describe the case of an 11-year-old boy who presented for an ophthalmological evaluation due to a progressive decrease in visual acuity. The fundoscopic examination supplemented with imaging ophthalmological methods were sufficient to establish a working diagnosis of Stargardt disease. The diagnosis was confirmed by genetic testing, a mutation of the ABCA4 gene, which is associated with this dystrophy. The importance of this case report is that it is one of the first documented cases of Stargardt disease with ABCA4 mutation in Macedonia.

HERPES ZOSTER IN 5-YEAR-OLD GIRL WITH NO PREVIOUS HISTORY OF CHICKENPOX: CASE REPORT

Mesut Hasipi — 2024-12-11

This case report describes a herpes zoster infection in an immunocompetent 5-yearold girl, whose hetero-anamnesis from the parents provides information that the girl has not had chickenpox, and that she was not vaccinated against chickenpox, the mother denies that she had chickenpox as a child, and during pregnancy.

Case report: A 5-year-old girl with the appearance of a macule, papule, vesicular rash in the area of the chest and back, in the area of the 4th, 5th, and 6th dermatome, in the form of clusters. Before the appearance of a rash accompanied by burning pain. Serological analyses in addition to Herpes Zoster infection with elevated values of ELISA VZV IgM positive + 2.8, ELFA VZV IgG-+1.38 positive.

This case of a 5-year-old girl with herpes zoster, without previous evidence of varicella infection or immunodeficiency, presents a unique and interesting clinical scenario. It highlights the complexity of VZV infections and the need for comprehensive clinical and immunological evaluations in pediatric patients with herpes zoster. Future research in the mechanisms of viral latency and reactivation in such atypical cases will be critical to enhance our knowledge and management of VZV infections in children.

YOLK SAC TUMOR OF THE OVARY WITH SYNCHRONOUS IPSILATERAL AND CONTRALATERAL BENIGN CYSTIC TERATOMA

Katerina Kubelka Sabit — 2024-12-11

Yolk sac tumor and teratoma are germ cell tumors, the former showing preferential differentiation toward yolk sac structures, while teratoma consists of tissues that originate from at least two embryonic germinal layers. The yolk sac tumor is characterized by significantly elevated serum alpha fetoprotein level.

The aim of this study was to present a rare case of yolk sac tumor of the ovary in a young female with synchronous ipsilateral and contralateral mature cystic teratoma.

A Caucasian 19-year-old female presented with severe abdominal pain and abdominal swelling. Ultrasound examination revealed a large, 15 cm in diameter tumor of the right ovary with suspicion for adnexal torquation and tumor rupture. Immediate surgery was performed and right uterine adnexa was removed. The pathologic examination showed predominantly solid ovarian tumor. A few centimeters in diameter cysts were also evident, filled with sebum, keratin debris and hair. Microscopic examination revealed tumor composed of meshwork of anastomosing spaces and cysts lined by a single layer of tumor cells. Schiller–Duval bodies were also present. Postoperative ultrasound follow-up one week after the initial surgery confirmed the intraoperative suspicion of ovarian tumor in the contralateral ovary. The left ovarian tumor was resected and histopathology revealed a mature cystic teratoma measuring 5 centimeters in maximal diameter.

Benign teratoma can appear synchronously or metachronously with yolk sac tumors in the ipsilateral or contralateral ovary. Recognition of the benign nature of the teratomatous component is important to avoid misinterpretation of mixed germ cell tumor and possible overtreatment of these patients.

INOTUZUMAB OZOGAMICIN FOR RELAPSED/REFRACTORY ACUTE LYMPHOBLASTIC LEUKEMIA – A BRIDGE TO HAPLOIDENTICAL STEM CELL TRANSPLANTATION

Aleksandra Pivkova Veljanovska — 2024-12-11

Introduction: At present, allogeneic hematopoietic stem cell transplantation (allo-HCT) is considered the only curative option for patients with R/R B-ALL with best outcomes achieved after effective salvage re-induction therapy and transplantation in complete remission (CR) without measurable residual disease (MRD). Inotuzumab ozogamicin (INO) is a CD22-directed humanized monoclonal antibody conjugated to the potent cytotoxin, calicheamicin, via an acid labile linker, which was developed as a targeted therapy for B-cell malignancies. In this paper, we present our center first experience with INO bridging treatment in R/R ALL before haploidentical stem cell transplantation.

Case presentation: We present a case of a 24-year-old female patient diagnosed as B-ALL during July 2021 at the University Clinic of Wurzburg, Germany where she initiated treatment according to German multicenter study group protocol for adult ALL (GMALL) regimen. She had disease relapse early during maintenance treatment. INO was administered in two cycles as monotherapy bridge to haploidentical transplant. The patient achieved MRD negativity and continued conditioning with thiotepa, busulfan and fludarabine. Immunosuppression was provided with posttransplant cyclophosphamide (PTCy), mycophenolate mofetil (MMF) and cyclosporine. Chimerism analysis on +1, +3, +6, +9 and +12 months post-transplant showed full chimerism with negative MRD.

Conclusion: Bridging patients safely to HSCT is the primary goal of post-relapse ALL treatment, but allo-HCT is associated with considerable treatment-related morbidity and mortality. Salvage with inotuzumab ozagamicin can provide a bridge to transplant in relapsed/refractory ALL.

INEFFECTIVE ERYTHROPOIESIS IN PATIENT WITH BETA-THALASSEMIA AND MYELODYSPLASTIC SYNDROME - CASE REPORT

Sanja Trajkova — 2024-12-11

Ineffective erythropoiesis and associated anemia are hallmarks of two hematological diseases - myelodysplastic syndromes and thalassemia, treated with regular blood transfusions. Erythropoiesis is a highly regulated process where functional erythrocytes are produced from hematopoietic stem cells, and defects can adversely affect the proliferation, differentiation, and survival of erythroid precursors. Treatments that directly mark the ineffective erythropoiesis are limited. There is unmet requirement for treatments that can restore effective erythropoiesis. Herein, we present a case report of a patient with beta-thalassemia and development of myelodysplastic syndrome with 5q deletion.