Author: zmc_piksel_dev

After one month stay at the Intensive Care and Therapy Unit, the first premature baby that was taken care of in the Clinical Hospital “Zan Mitrev”, was dismissed home.

It is a matter of a newborn who has been transferred from a birthing center with a weight of 1.400 grams and serious cardio-respiratory complications. After appropriate 30-day treatment at the Intensive Care Unit, the baby was dismissed home today. He weighs just over two kilograms and he is well adapted.

His parents are overjoyed just like our doctors who have successfully completed this happy story.

– We can not wait to take our little Kiril home. Everyone is eagerly waiting for him. As his mother, I was here with him every day, and I am grateful to the entire team from your clinic who showed immense love, care and knowledge to help the youngest, the most fragile, the most gentle … to help the babies who are prematurely born and have health problems. Our baby was in safe hands and now everything is fine – stated the mother of the little Kiril, while leaving our hospital.

 

Develop good hygiene habits and take impeccable care of your intimate area

 

What problems do you usually encounter in your gynecological practice?

– Annually about 300 million women in the world are diagnosed with some kind of urogenital infection. Usually it is a matter of an inflammation of the vagina with symptoms that are rapidly manifested after the infection and every woman recognizes them (as a change of the normal vaginal secretion). Most common infections include bacterial vaginosis, vaginal candidiasis or trichomoniasis. However, in addition to these, there are also infections of the genital organs that are often not accompanied by symptoms, such as chlamydia infection, which is sometimes diagnosed for the first time once the problems are already present. If the infection is not treated, it can lead to complications such as: infertility, inflammation of the pelvic organs, pregnancy problems (such as premature birth, spontaneous abortion), etc.

Is there a natural barrier that increases the resistance to genital infections?

– The development of medicine and new techniques for mapping the genes of the human organism have come to the realization that out of 100 trillion cells present in and on the human body, only about 1/10 of them are actually human The remaining 90% of them belong to microorganisms – bacteria, viruses and other microbes. To maintain our overall health, we need a delicate balance of microbes that live in and on our bodies. This also applies to the balance between microorganisms and the maintenance of good health of the genital organs. The main cause for the emergence of some vaginal infections is the disbalance of microorganisms in the vagina. The balance is disturbed due to a reduction in the number of good bacterial species or due to excessive growth and proliferation of “bad” bacteria or fungi. These are two processes that occur simultaneously.

What is a normal vaginal flora and how does it work?

– A healthy vagina is populated by a large amount of “good”, useful bacteria, lactobacilli. These bacteria are considered a sort of guardians of vaginal health – they can inhibit the growth of potentially harmful bacteria/fungi through the production of lactic acid and hydrogen peroxide, preventing colonization of the vagina with “bad bacteria”. Lactic acid helps to maintain the acidic environment, the pH of the vagina, which in turn allows the growth and development of good bacteria for the vaginal health, while hydrogen peroxide helps to eliminate “bad” Lactobacilli also form a protective biofilm of the vaginal mucosa, which does not allow harmful microorganisms to stick to it.

When is the normal vaginal flora disturbed?

– Between “good and bad” bacteria there is a constant competition in maintaining a delicate balance. There are many factors that can disrupt it, some of which include: poor hygienic habits, wearing synthetic and tight underwear, swimming in a swimming-pool, antibiotic therapy, heavy menstrual bleeding, diabetes, reduced immunity, stress, inappropriate hygiene, irritants present in cosmetic products, hormonal changes, pregnancy, etc. If the vaginal flora is compromised, the protective role of lactobacilli is reduced. Due to the reduced number of lactobacilli, less lactic acid is produced and the protective vaginal pH is changed, which allows the “bad bacteria” to multiply and lead to bacterial imbalance. When harmful microorganisms multiply above a certain concentration, symptoms that are characteristic of vaginal infections begin to occur. In case the following symptoms emerge, typical of vaginal infections, such as: increased vaginal secretion, changed color or unpleasant odor, burning sensation, redness and itching of the external genitalia, frequent urination, painful and unpleasant sexual intercourse, it is necessary to consult a gynecologist.

What are the most common vaginal infections that you usually encounter in your practice?

– Every woman at least once in her life has experienced a vaginal infection of a different type. The most common infection is bacterial vaginosis, 50% of women in the world have had this type of infection, and it is a disorder of the vaginal flora with the predominance of anaerobic bacteria, primarily Gardnerella vaginalis. The presence of this infection increases the risk of pelvic inflammatory disease, especially after curettage, hysteroscopy, and during pregnancy it increases the risk of premature birth. One of the symptoms may be a grayish secretion with a specific smell of rotten fish, while usually there are no other symptoms such as itching and a burning sensation. An exception to this are cases of mixed infection, where fungi proliferate along with Gardnerella, mainly Candida albicans, which easily proliferate in conditions of reduced acidity and pH of the vagina, higher than 4.5. The second most common infection is a fungal infection, which occurs in cases of reduced immunity, after the use of antibiotics or oral contraceptives, due to increased intake of sugars, diabetes, pregnancy. The first symptoms are observable with the increase in the number of fungi: curd-like secretion whose smell is similar to the smell of yeast, as well as itching and redness.

How do infections affect pregnancy?

– During pregnancy, the amount and variety of vaginal lactobacilli often decreases, under the action of hormones, by putting pregnant women at greater risk of infection.

Infections in pregnancy can go unnoticed, while damaging both the fetus and the health of the mother. If some of the infections in pregnancy are not detected, they may lead to miscarriage, premature rupture of the membranes, discharge of the amniotic fluid and premature delivery, infections and sepsis of the fetus. Some of them can harm the organogenesis, acting on the development of the fetal organs, leading to congenital anomalies. The number of infections during pregnancy that can harm both the fetus and the mother is really high, and therefore regular gynecological examinations before and during pregnancy are necessary to reduce their occurrence and to timely prevent problems that may affect the health of the mother and the fetus.

How are these infections being treated?

– The treatment of these conditions involves the administration of antibiotics and/or antifungals, which are very efficient. However, specifically due to the disturbed vaginal microflora, the disease very often returns. In the first three months after the treatment, bacterial vaginosis is repeated in 15-30% of cases, and after a longer period, almost 50% of women will have the same symptoms as before the treatment. While in case of vaginal candidiasis, the inflammation in 20% of the patients repeats, four to six weeks upon completion of the therapy. For this reason, after the treatment of the acute infection, it is important to normalize the vaginal flora. Today, for this purpose we have products that contain lactic acid or probiotics (bacteria useful for our organism). The balance of the vaginal flora can be restored by using the product Vagisan, vaginal tablets with lactic acid, necessary for maintaining the normal vaginal flora and rapid establishing of the vaginal acidity. Vaginal tablets with lactic acid can be administered after antibiotic therapy, or preventively in order to prevent the occurrence of a vaginal infection.

What is your advice on maintaining good vaginal health?

– A balanced vaginal flora helps to prevent bacterial and fungal infections and is crucial for good vaginal health. In order to reduce the risk of imbalance in the vaginal flora, develop good hygiene habits and follow the general recommendations on how to take care of your intimate area. You can also use a product that contains ingredients that support the growth of good bacteria to prevent possible infections and promote recovery if the symptoms are already developed.

Folic acid or vitamin B9 is a necessary supplement in the diet of pregnant women, however not only for pregnant women, this vitamin is indispensable to every individual, for normal health and life.

Folic acid is essential for the human body, having a role in many metabolic processes. The organism can not produce it itself, and it can not be stored in the organism for a long time, so it is necessary to take the required amount through the diet, and in case of an increased need of folic acid, it should be taken through supplements. Folate is the form of the B9 vitamin contained in food, and folic acid is a form of B9 vitamin in vitamin supplements.

Folic acid is significant for many important processes in our organism, especially in the division, differentiation and growth of the embryo and the fetus. It is important for the synthesis of DNA and the functioning of the cells in the body. It participates in the metabolism of nerve cells, and together with vitamin B12 it is necessary for the creation of red blood cells or the creation of DNA. It also has a significant role in the conversion of amino acids that our body needs, thereby reducing the level of homocysteine ​​in blood. An elevated level of homocysteine ​​leads to occlusion of blood vessels acting thrombogenically. The consumption of folic acid gives energy to the organism.

Folic acid is one of the essential vitamins that is recommended if a woman is pregnant or planning to get pregnant

Folic acid has the highest value in pregnant women, for normal growth and development of the fetus: in the period before pregnancy, during pregnancy and during breastfeeding. Folic acid acts on the development of the fetal system of the fetus, preventing 50 to 70% of the occurrence of neural tube defects in the fetus. Neural tube defects are serious congenital anomalies of the spinal cord (such as spina bifida) or anomalies of the head and the central nervous system, such as anencephaly in the fetus.

However, although these reasons are significant, they are not the only ones for folic acid intake before and during pregnancy. There are studies that show that it can reduce the risk of other congenital defects in newborns. In addition, a particular group of pregnant women who have an inborn deficiency of MTHFR (methylenetetrahydrofolate) reductase, an enzyme whose deficiency significantly impairs the conversion of folates to folic acid, in consultation with a gynecologist, should make sure that they receive a sufficient dose and an appropriate form of this vitamin through supplements.

Previous pregnancy with a neural tube defect, or a known history of such a defect in one of the partners, is of particular importance, where the supplementation should be initiated with appropriate doses of folic acid several months before the planned pregnancy.

In the human diet, folic acid is mostly contained in fruits and vegetables

It is present in all dark green leafy vegetables (spinach, beta, cabbage leaves …), asparagus, beans, beets, broccoli, kale, cauliflower, corn, peas, green beans … Fruits rich in folic acid include: avocado, orange, lemon, banana, melon, grapefruit … In addition to fruits and vegetables, folic acid is also found in brewer’s yeast, eggs and liver.

When is it necessary to add a folic acid supplement in your diet?

Folic acid supplements are usually recommended to women who intend to conceive (several months before pregnancy), to women during pregnancy and nursing. Of course, a doctor should be consulted before use.

A large number of associations of gynecologists and perinatologists recommend that women in the reproductive age receive 400 mcg of folic acid daily, because the neural tube closes by the 28^th day of pregnancy, when maybe the pregnant woman does not know she is pregnant yet. It is therefore important that women who are planning to get pregnant start to take folic acid three months before and at least during the first 12 weeks of gestation.

However, folic acid intake is not necessary only for pregnant women. Its intake through supplements is beneficial for the body in case of other health problems as well such as: anemia, heart and blood vessel diseases, increased pressure, depression, prevention of colon cancer, infertility, neuroses, insomnia, immunodeficiency, metabolism problems, infections, poor memory, stress, and chronic fatigue.

Folic acid deficiency is usually experienced by people who have problems with the digestive system, kidneys, liver or who consume alcohol. Symptoms that may suggest folic acid deficiency include: anemia, depression, insomnia, irritability, loss of concentration, loss of appetite, muscular weakness.

In fact, the use of folic acid supplements is beneficial to many processes in the organism, keeping us healthy, protecting our offspring during pregnancy and helping us create healthy generations.

Dr. Irena Andonova

Specialist in Gynecology – Obstetrician

Zan Mitrev Clinic

From today, Dr. Jasna Anastasovska, a specialist pediatrician cardiorheumatologist, started to work in our clinic. Dr. Anastasovska has a 30-year experience in the field of pediatric cardiorheumatology. She was educated in Croatia, Serbia and Bulgaria and she has participated in numerous professional European and world congresses in the field of pediatric rheumatology and cardiology.

Dr. Jasna Anastasovska will be a part of the team at the pediatric cardiosurgery which started to operate within the Clinical Hospital Zan Mitrev from February 1.

Her outpatient clinic will be open for all children with heart problems, completely financially covered by the Health Insurance Fund of Macedonia.

“We implanted for the first time a Syncardia “Total Artificial Heart” (TAH) in a 38-year-old male patient at Zan Mitrev Clinic (ZMC).

The implantation of a TAH is approved for use in end-stage biventricular heart failure as a bridge to heart transplantation.

Our patient is awake, and in stable condition, he is currently receiving intensive postoperative care.

The implantation of the TAH mimics a standard heart transplant procedure. The ZMC TAH team consists of Dr. N. Hristov, Dr. D. Vuckova, Dr. T. Angjuseva, Mrs A. Temelkovska and is led by Dr Mitrev.

The team underwent extensive training in Berlin, Germany to adequately prepare for the complicated surgery; the successful procedure signifies a huge accomplishment for our clinic and considerable advancement in the treatment of end-stage heart failure in Macedonia.”

Chronic Obstructive Pulmonary Disease – COPD is a group of chronic respiratory diseases, which are characterized by breathing difficulties i.e. airway obstructions in patients who have previously been diagnosed with chronic bronchitis and/or emphysema.

COPD is characterized by obstruction of the respiratory tract which is not completely reversible. The respiratory obstruction does not change significantly and usually it is a long-term progressive condition. The disease is usually caused by cigarette smoking, but other factors have influence as well, such as the occupational exposure to toxic gases and vapors. This disease occurs in 34 cases of 1000 people, and usually in people over 65 years of age. Currently, COPD is the world’s fourth leading cause of death worldwide, however it is estimated that by 2020 it will be ranked first according to the World Health Organization.

In scientific studies in many countries it has been found that people living in large cities are more likely to suffer from COPD compared to people in rural areas. One of the main symptoms in COPD patients is a cough, which is actually a defensive mechanism of the airways, and protects the airways from unwanted inhaled particles, and simultaneously it is an important method of cleansing the produced mucus in them. A cough in patients with COPD usually occurs in the morning. The other major symptom is dyspnoea (shortness of breath), which is considered the most significant sign of this disease. Patients with an advanced form of COPD often develop respiratory failure, which is manifested by the occurrence of cyanosis of the mucous membranes and the skin, as a result of lack of oxygen in the blood. Excess carbon dioxide in the blood causes headache, drowsiness or cramps. Another complication of an advanced COPD are heart changes known as chronic pulmonary heart which are a result of its increased function, that is, due to the greater effort to pump blood into the painfully changed lung pathways. A gold standard for the diagnosis of COPD is spirometry which confirms the possible presence of airway obstruction, however the clinical assessment, based on a combination of the patient’s history and the physical examination, also has a part in making a diagnosis.

COPD produces symptoms, disabilities and impaired quality of life that may react to pharmacological therapy, however its effect is insignificant if it is not combined with a respiratory physiotherapy. A respiratory physiotherapy with pharmacological support increases the effect of the treatment of airway obstruction. In the treatment of COPD, intravenous therapy with bronchodilators, mucosecretolytics, decongestants and antibiotics may be used, but it is important to point out that this treatment is not complete unless it is combined with a respiratory physiotherapy.

The application of these pharmacological solutions can be both more diverse and more effective if the patient receives the medications through an inhalation therapy with appropriate inhalers whereby the therapy itself acts locally and their action is improved and accelerated. An inhalation therapy with aerosols combined with breathing and expectoration exercises helps to effectively insert aerosol particles into the airways and their deposition, whereby the bronchial secretion softens i.e. a local pharmacodynamic effect is caused, and it helps to improve the airways passage by evacuation of the accumulated pulmonary secretion, thereby causing dyspnoea reduction.

In the treatment of patients who have experienced a respiratory failure, which are actually patients in the fourth stage of the disease, and the values ​​of the partial pressure and oxygen saturation are low, oxygen therapy should be used. The oxygen therapy is recommended to last more than 15 hours during the day, with low flow rates of 1.5 to 2 liters per minute. The oxygen therapy is a part of respiratory physiotherapy that also contains respiratory exercises for deep inhalation, exhalation, and expectoration with the help of postural drainage and inhalation therapy.

All of these elements of respiratory physiotherapy have a leading role in the treatment of COPD given their effectiveness immediately after their implementation. The physiotherapist and the patient are partners in this process, and usually patients who live with the disease for a long time and are aware of their condition, are educated on an independent and regular implementation of the respiratory exercises for correcting the respiratory mechanics and appropriate physical activity, thus they directly influence their quality of life. In the period of exacerbation of the condition in these patients, non-invasive mechanical ventilation (NIV) with different modes of ventilation of CPAP or BIPAP should be used, which can affect the resolution of the patient’s critical condition and avoid the consequences.

The treatment of patients with COPD is complex and specialists should be involved in their treatment (pulmonologist, physiotherapist, and nutritionist) who should directly cooperate in the individual treatment of the patient. Only the appropriate combination of treatments and advice from different specialists can influence the success of the treatment of patients with COPD.