Month: October 2020

Uncle Vancho was cured of coronavirus and underwent a leg peripheral bypass afterwards

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  • I am Cholkov Vancho from Skopje and I came to the Zan Mitrev Clinic about a month ago. Before coming here, I had chest pain, a cold, and I was hospitalized in one of the state hospitals. After a few days in the state hospital, I realized that my condition was not improving and I was feeling even worse. It was clear to me that I had to find another solution and go to a private hospital. I told my wife that I wanted to be transferred to the Zan Mitrev Clinic and I was immediately brought there – this is how Mr. Cholkov began his story.

He was brought to our clinic in a serious condition and Covid 19-positive. Dr. Dragica Vezenkova Vuchkova, anesthesiologist and specialist in intensive care, talks about how his treatment started and what was its course.

  • The patient Vancho Cholkov came to our clinic at night in a severe, critical condition with peripheral saturation 40 and a diagnosis of Covid 19 pneumonia. We immediately took him to the intensive care unit at the Covid 19 Center and started the process of hemofiltration by CytoSorb and Oxyris filter. All laboratory parameters indicated this viral condition. The patient was also immediately placed on non-invasive mechanical ventilation with a Cipap mask, which he tolerated well. However, due to his difficult general condition proved by the serious chest X-ray finding, even with the Cipap mask he achieved a saturation of 70 to 75 – explains Dr. Vuchkova.

She adds that it is truly a wonder how the patient tolerated that saturation and how he performed all physical and recovery activities.

After the fourth day, a slight improvement in the patient’s clinical picture was observed. Uncle Vancho, as we called him during his stay in our hospital, continued the treatment in a good mood. He received 3 consecutive cycles of hemofiltration, and after 22 days of intensive care and treatment he went home Covid 19-negative in stable and good condition.

However, Uncle Vancho returned to our clinic after only two weeks, but this time to solve the problem with the blood flow in his legs. He immediately underwent a leg peripheral bypass, and after a short recovery, he went home.

We wish Uncle Vancho good health and a successful complete recovery.

 

 

Inflammation of the heart muscle after recovery from infection with COVID-19

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Infection with Covid-19 is a major health problem because it affects not only the lungs but also other organs such as the heart muscle. The virus has been shown to cause inflammation of the heart muscle, or myocarditis.

It is not yet clear whether Covid-19 causes myocarditis more frequently and whether this myocarditis has a more severe clinical presentation than the myocarditis caused by other viruses. The virus triggers an immune response in the body in an unconventional way. Survivors may be at increased risk of heart muscle inflammation. The heart is prone to inflammation from Covid-19 because of the angiotensin-converting enzyme 2 (ACE2) receptor found on the surface of heart muscle cells to which the virus binds. For this reason, several studies have been conducted with patients who had recovered from Covid-19 several months earlier and had a mild to moderate clinical presentation.

Magnetic resonance imaging (MRI) scan of the heart was performed, as the most accurate non-invasive technique for diagnosing inflammation of the heart muscle. The MRI scans showed heart involvement in 78 out of 100 patients. It is interesting to note that 60 out of 78 patients showed signs of acute inflammation 71 days after their infection with Covid-19. The study concludes that even a mild course of Covid-19 in relatively healthy people can leave a mark on the heart.

Another study examines competitive athletes. 4 out of 26 athletes from Ohio State University, USA, who recovered from Covid-19 had myocarditis.

Myocarditis can lead to cardiac arrhythmia, sudden death (during intense training), and heart failure. Therefore, cardiac examination, echocardiography, and cardiac magnetic resonance imaging are recommended 3 months after infection with Covid-19.

The recommendations of the European Society of Cardiology for patients recovered from myocarditis are to avoid strenuous physical activity for 3-6 months.

In the future, a frequent question of cardiologists will be whether you have been infected with the Covid-19 virus.

The last 8 months of life in a pandemic caused by the Coronavirus, has greatly changed our normal life and introduced new rules.

For better control of the pandemic and for your own health, taking into account all possible consequences of the Coronavirus, we recommend that you wear protective masks everywhere, and wash your hands frequently.

In addition, if you have recovered from Covid-19 infection, we recommend at least one cardiac examination, regardless of your age or the severity of your clinical presentation.

Early diagnosis of myocarditis can prevent the development of serious complications.

* Myocarditis finding using cardiac magnetic resonance (CMR) imaging

 

Dr. Milka Klincheva

Cardiologist

Children are not immune to COVID-19

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What are the first COVID-19 symptoms?

The new coronavirus infection can cause, among other things, fever, cough, and muscle aches. These symptoms can also occur with other viral infections that are characteristic of this autumn period.

What should we pay attention to?

One of the parents’ tasks, given the start of school, is to measure the temperature of their children in the morning before taking them to school / kindergarten.

This is very important because if their temperature is higher than 37.5°C, then they should not enter the classroom / kindergarten and will have to stay at home. In fact, one of the first signs for alert is fever, and a child with a fever may have COVID-19.

Symptoms may appear 2 to 14 days after making contact with an infected person. They may be: temperature higher than 37.5°C, cough, fever, muscle aches, headache, sore throat. Other less common symptoms are gastrointestinal symptoms such as nausea, vomiting or diarrhoea. Some patients lose taste or smell (children may not be able to communicate this feeling). In any case, a temperature higher than 37.5°C, which cannot be reduced by using antipyretics, is the first sign, followed by a cough that is usually dry, persistent and without catarrh.

The earliest symptoms of the new coronavirus are very similar to those of the seasonal flu. Cough, fever and body aches are present in all diseases caused by various respiratory viruses. Among other things, during the flu season, the infection is very common in school / kindergartens, especially among the youngest ones, because the children spend a lot of time together in the same room.

In general, with flu there is a sudden temperature rise of more than 38°C accompanied by at least one general symptom (malaise and fatigue, headache and muscle aches) and at least one respiratory symptom (cough, sore throat and shortness of breath). In fact, it is impossible to distinguish the symptoms of COVID-19 from the flu symptoms.

The only way to get a definite diagnosis of COVID-19 is to take a swab.

How to behave in case of suspicious contacts?

If there is a suspicion that the child has made a close contact with a confirmed or probable case of COVID-19 in the previous 14 days after the onset of the first symptoms, it is important to stay home and contact a pediatrician who will identify the symptoms and if necessary perform the necessary tests (nasopharyngeal swab). It is essential to follow the network of contacts: classmates, teachers, anyone the child contacted.

By probable COVID-19 case we mean:

  • a person living together with someone with COVID-19
  • a person who has had a direct physical contact with someone with COVID-19
  • a person who has had a direct unprotected contact with secretions from someone who has COVID-19
  • a person who has had a direct contact (face to face) with someone who has COVID-19, at a distance of less than 1-2 meters, for more than 15 minutes, without a mask
  • a person who has been indoors (for example, a classroom, a meeting room, a hospital waiting room) with someone with COVID-19 for at least 15 minutes, at a distance of less than 1-2 meters, without a mask.

What should parents do if the child is tested positive?

With the start of schools / kindergartens, the child may be tested positive for the new coronavirus. If this happens, do not panic. It is important to know the duration and characteristics of the COVID-19 disease.

This disease in children usually lasts shorter. This is based on previous experiences with this infection as well as the fact that in many children the infection has not caused any symptoms (it is asymptomatic), but even when it causes a disease, the symptoms are usually mild or moderate such as cold, cough and mild fever. If present, the symptoms tend to disappear within a week or two. On average, the disease lasts four or five days.

However, very often the symptoms are underestimated and this leads to a delayed diagnosis. Sure, with the start of school, children will have episodes of fever and cough, and it will be difficult to tell right away if it is COVID-19 or some other seasonal infection.

It is important for the parents to contact a pediatrician who will identify the symptoms and, depending on their severity, make the necessary tests, especially a nasopharyngeal swab. At our hospital, we have tests for detection of the most common viral infections this season, including the coronavirus. If a child is diagnosed with COVID-19, all previous contacts should be traced to stop the transmission. After the child is examined and a swab is taken, the doctor will assess whether hospitalization is needed or the child can be monitored at home through a special COVID-19 monitoring platform that our hospital has. After a 14-day home isolation, the child can safely return to school without symptoms and with negative test.

How long does it take to be COVID-19 negative?

Clinical recovery in children is very fast, except in rare cases. However, it takes more time for the child’s body to get rid of the virus (so-called viral excretion). In some cases, the virus triggers a very rapid immune response that allows children to get rid of the virus quickly. In other children, the immune system is not able to recognize the virus so quickly and their immune response is not as efficient and fast and therefore the virus tends to persist in the body for a long time.

What if children are tested positive but are asymptomatic?

Children (but adults too) can be asymptomatic, i.e., infected with the virus, but not showing any symptoms, and thus they can transmit the disease to others.

The situation becomes complicated schools / kindergartens, a place where children and young people have to spend several hours together. Having a potential source of infection in the classroom and not being able to identify it is a risk for all students to get sick. Such cases are rare but should not be ignored.

How to protect ourselves?

It is currently impossible to detect asymptomatic adults and children unless a nasopharyngeal swab is taken repeatedly.

It is therefore necessary to try to limit the infection in children and at the same time allow them to return to school, their everyday life and games as safely as possible by adhering to the recommended protection measures – keep distance, wash hands and wear masks where recommended.

Prim. Blagica Mancheva, MD
Specialist in pediatrics

Breast cancer is curable if diagnosed early

Breast cancer is the second most commonly diagnosed cancer in women, after skin cancer, and the second most common cause of cancer death, after lung cancer.

Statistics show that the incidence of the disease in the last 30 years is growing globally, i.e., 3.1% per year, and mortality varies.

Studies show that on average, 1 in 8 women will develop breast cancer in their lifetime. About two-thirds of women are over 55, and the rest are between 35 and 54.

Postmenopausal women are twice as likely to develop cancer if they have obesity problems.

WHAT IS BREAST CANCER

The direct cause for a normal cell to become malignant has not yet been fully elucidated, but the genes involved in cell development, growth, and death are responsible for that change. There is a balance between cell’s growth and death. With the loss of this balance, uncontrolled proliferation of biologically altered cells occurs. If these cells travel to places where they are not usually found, we say that the cancer is metastatic.

Breast cancer usually starts in a limited region of the milk-producing glands (lobular carcinoma) or in the ducts (ductal carcinoma) that carry milk to the nipple. It can grow in the breast and spread to nearby lymph nodes or through the bloodstream to other organs.

Men can get breast cancer, but only 1% of all cases are of this type.

Symptoms

What are the early symptoms of breast cancer?

  • Changes in the nipple shape
  • Chest pain, especially after menstruation cycle
  • A lump that does not disappear after menstruation cycle
  • Red or brown nipple secretion
  • Unexplained redness, swelling, inflammation of the skin, itching or rash
  • Swelling or lump around the armpits or at the end of the breast.

Risk factors

There are several factors that increase the risk of this disease. Unfortunately, we cannot influence the most important ones:

Age group – the older the woman, the greater the risk

Family medical history – women whose sister, mother or daughter have already had the disease

Hereditary factor – about 5 to 10% of all breast diseases are caused by a hereditary factor

First menstruation at the age of 12 and last after the age of 55

Women who did not give birth, or gave birth after the age of 30

Hormone therapy

Excessive alcohol consumption

Overweight.

 

 Prevention

Pay more attention to a healthy and varied nutrition

Physical activity

Avoid hormonal preparations.

 

Early detection of the disease

Self-examination

Mammography of patients over 40 years or earlier – by  decision of a specialist radiologist

Breast echotomography

Breast MRI.

Month dedicated to the importance of women’s physical, sexual, reproductive and mental health

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Pregnancy, breast self-exam, menopause and related osteoporosis, prevention of cervical cancer, infertility, are just some of the topics covered by the phrase “female health”. However, talking about women’s health is much more than determining a high-risk or non-risk pregnancy, infertility, breast cancer, an urgent need for a mastectomy, a hysterectomy, etc.

Women’s health is more than that, not because of some presumed (and by the way, often infertile) “political correctness” for the needs of the public, but because neither health nor women are homogeneous terms outside the biological discourse, and even in it, not entirely because of the functional nature of health. This is necessary to emphasize because October is dedicated to women’s health and requires a consideration that covers, but also transcends the range of examples related to the female reproductive system.

Namely, it is quite meaningful and necessary to talk about challenges that affect exclusively women in different periods of life, contexts (work, home, travel), degrees and cultures (policies that exist to protect vulnerable categories, tradition and stereotypes, family values etc.), but their health obviously goes beyond the above-mentioned spectrum by simply asking in what context, with what family and social dynamics, or with what social and personal capacity we see the woman.

Health, for us humans, is above all an experience, or more precisely, a meaningful experience. It is this experience that today is influentially standardized as a state where health is defined positively (not only as the absence of disease, but as a well-being),  holistically or multidimensionally (as a complete well-being that necessarily includes more parameters through physical, mental and social health). This change in the understanding of the term health has very specific, temporal-historical and political roots, which we have no room to address here (we will be silent about the concept of ‘woman’, because it remains a secret), but one benefit is the emphasized awareness of the importance of the personal and emotional-motivational processes in the health dynamics of each individual, and the irreplaceability of social support, cultural identity, context and social challenges that often place the clinical picture in the categories “healthy / sick”.

The opposite of this expanded concept of health is the possibility of pathologisation of all suboptimal conditions, and in part unreality, because “it finds most of us unhealthy most of the time” (Smith, 2008). It seems that we are called not only upon health, but upon multidimensional “perfection” too. But upon what kind, what for or more precisely for whom? The today’s almost ubiquitous narcissistic culture burdened by likability (or, if you will, “likeholism”) tends to normalize and standardize a kind of measurable and public perfection of unrelated or less and less unrelated individuals. Standards are in fact a group phenomenon, which has a powerful regulatory function not only in the individual’s  behavior, but also in the dynamics of occurrence, development and prognosis of health problems. Fortunately, man does not cease to be a community being simply because he lives in such a social climate, but it is necessary to distinguish the “cockle from the grain” – the cockle of sterile perfection, from the grain of creative love for the other as the greatest virtue. If we are a bit perfect, then it is because of the other, through the possibility for giving and, equally important, gratitude.

Giving and gratitude, when both are expressions of the most fundamental human indicator – free will – are in fact the fullness of a healthy woman or man (even when one or the other is sometimes feared). And how would you talk about one without the other? Therefore, no matter how much they are imposed on us in the spirit of the (neo)liberal ideology, days or months dedicated to cluster-covered topics, we are obliged to think about them from the perspective of what connects us and not only intra- and inter-gender, or intra- and inter-culturally, nationally, etc., but as individuals – health as self-giving is the real free space, where our action actually ennobles us. There are numerous examples that support this claim – of the more risky ones (saving the life of a stranger, a parent who donates a kidney for the life of their child) to the less risky ones, and no less important (non-judgment, meek word, singing a lullaby, or a handshake that speaks louder than any word). Living in a time when only brief information holds people’s attention, health today is each of our relationships, which through dedication will in time grow from a seed into a tree on whose branches the birds nest, a space where the other is valued for what he/she is.

May the month dedicated to women’s health be a reminder of what life actually shows us again – by seeking, we lose freedom, and with it love and joy. By giving, we find love and joy and through it we grow creatively even when we suffer because of the losses or unexpected diseases. We must not forget that despite the longer lifespan, cardiovascular diseases are the leading cause of death in women, unipolar depression affects women twice as often as men, female health workers make up 70% of the global workforce, and half their contribution to health is in the form of unpaid care, or that 1 in 3 women worldwide experiences physical or sexual violence, a fact that certainly has a profound effect on woman’s physical, sexual, reproductive and mental health. And facts, like deeds, always speak louder than words.

Docent  Kristina Egumenovska, MD
Psychologist-psychotherapist

Publication of Petar Ugurov, MD: ”Early initiation of hemofiltration – extracorporeal blood purification in Covid-19 patients″

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On 22.09.2020, Zan Mitrev Clinic received a new publication on topic “Early Initiation of Extracorporeal Blood Purification Using the AN69ST (oXiris®) Hemofilter as a Treatment Modality for COVID-19 Patients: a Single-Centre Case Series.

This is our original work and the first publication in the Republic of North Macedonia when it comes to COVID – 19, and it was published in the prestigious Brazilian journal of cardiovascular surgery.

The team that worked on this publication is composed of experienced specialist doctors (cardiologists, anesthesiologists, microbiologists, transfusiologists) from the Zan Mitrev Clinic, led by Petar Ugurov, MD.

Petar Ugurov, MD answered several questions related to this research conducted in our clinic and the importance of its application, especially when it comes to patients’ safety, health and fast and safe recovery.

What was the main reason for starting research in this field and what makes this study so specific and significant?

Petar Ugurov, MD – The main reason for our research work is the SARS-CoV 2 virus itself, a virus that has become a challenge for the whole world.

We already know that COVID-19 is a disease caused by SARS-CoV-2, a virus of the Coronavirus family, which was first discovered in China in December 2019.

Before talking about this study, I would like to explain once again how the virus itself leads to deterioration of the general health condition in patients with SARS – CoV2 virus.

The respiratory dysfunction in COVID-19 patients is associated with changes in the respiration mechanics. Decreased mobility of the diaphragm and chest, decreased contraction of the respiratory muscles, and decreased motor activity of the patient may occur. This leads to impaired pulmonary ventilation and gas exchange.

When COVID-19 patients start coughing and have a fever, it is a sign that the infection has reached the respiratory system.

The protective layer of these respiratory organs is damaged, leading to inflammation, and even the slightest amount of dust can cause coughing.

– What makes this study unique and important is that we are the only clinic in the country and a rare one in the region that managed to show how to prevent the progressive deterioration of the general health condition with early initiation of extracorporeal blood purification in combination with systemic heparinization and respiratory support through a specially designed treatment protocol for SARS CoV2 patients.

How did you come up with the idea to start this study?

Petar Ugurov, MD – The study we started to work on and the very idea of this study is based on our previous experiences and work with patients with elevated inflammatory markers, as well as patients in septic shock.

The main challenge that we posed to ourselves is how to prevent the progressive deterioration of the general health condition of SARS – CoV-2 patients.

  • We based the overall treatment of COVID-19 patients on the fact that if we have control over the inflammatory markers, then we could have control of the general patient condition, as well as the cytokine storm.

Can you tell us more about the study?

Petar Ugurov, MD – Our study included a group of 15 patients positive for SARS – CoV-2 virus. The continuous monitoring of the level of inflammatory markers, cytokines, and differential blood counts along with D-dimers, LDH, and ferritin, is a powerful predictor of when to initiate haemofiltration as part of the treatment in Covid-19 patients.

Treatment consisted of early initiation of extracorporeal blood purification using the AN69ST (oXiris®) Hemofilter, systemic heparinization, and respiratory therapy.

During this period, we became quite interesting to the general population with the haemofiltration we use and I would like to briefly explain how to use these filters and their function.

The filter we use is oXiris®, which uses a modified AN69ST membrane and which has an affinity for both endotoxins and cytokines. This filter has a three times bigger adsorption power for endotoxins and cytokines.

Additionally, the oXiris set is authorized by the US Food and Drug Administration to treat patients with Sars – CoV2 virus.

  • If we go back to our beginnings and to what I mentioned earlier, i.e., how we came up with the idea to start treating patients this way, we will understand that this is actually the way we established control over the inflammatory markers of the cytokine storm.

There has been a lot of talk about the cytokine storm during this period. Can you explain to us what a cytokine storm is and what worries us most about this condition?

Petar Ugurov, MD – Cytokine storm syndrome refers to over-release of cytokines in response to external stimuli and is a major cause of acute respiratory distress syndrome as well as multiorgan failure.

When there is an increased cytokine level, such as of TNF-α, IL-6, IL-1 and IFN, it can cause pathological reactions such as diffuse damage to the alveoli, formation of the so-called transparent membrane and pulmonary fibrosis.

Circulating cytokines can cause widespread endothelial dysfunction with disseminated intravascular coagulation (DIC) and multiorgan failure.

What might be the conclusion of this study and why is it so specific and important?

Petar Ugurov, MD – From the study itself, it can be concluded that early initiation of blood purification using an oXiris® haemofilter may be an effective way to prevent abnormal levels of inflammatory markers in COVID-19 patients.

Also, the continuous monitoring of the vital parameters, biochemical, immune markers as well as coagulation factors and X-rays gives us the opportunity to monitor the severity of the disease and allows us to adjust therapy.

The combination of systemic heparin and extracorporeal blood purification using cytokine-absorbing haemofilters can reduce hyperinflammation, prevent coagulopathy, and support clinical recovery.