zmc_piksel_dev, Author at Zan Mitrev Clinic

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

Posted on October 16, 2020April 17, 2024 by zmc_piksel_dev

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

Posted on October 8, 2020April 17, 2024 by zmc_piksel_dev

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

Posted on October 8, 2020April 17, 2024 by zmc_piksel_dev

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″

Posted on October 8, 2020April 17, 2024 by zmc_piksel_dev

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.

World Heart Day is celebrated every year on 29 September

Posted on September 22, 2020April 17, 2024 by zmc_piksel_dev

In May 2012, world leaders committed to reducing global mortality from non-communicable diseases (NCDs) by 25% by 2025. Cardiovascular disease (CVD) is accountable for nearly half of all NCD deaths making it the world’s number one killer. World Heart Day is, therefore, the perfect platform for the CVD community to unite in the fight against CVD and reduce the global disease burden.

Created by the World Heart Federation, World Heart Day informs people around the globe that CVD, including heart disease and stroke, is the world’s leading cause of death claiming 17.9 million lives each year, and highlights the actions that individuals can take to prevent and control CVD. It aims to drive action to educate people that by controlling risk factors such as tobacco use, unhealthy diet and physical inactivity, at least 80% of premature deaths from heart disease and stroke could be avoided.

World Heart Day is a global campaign during which individuals, families, communities, and governments around the world participate in activities to take charge of their heart health and that of others. Through this campaign, the World Heart Federation unites people from all countries and backgrounds in the fight against the CVD burden and inspires and drives international action to encourage heart-healthy living across the world. We and our members believe in a world where heart health for everyone is a fundamental human right and a crucial element of global health justice.

After two weeks on mechanical ventilation and after 4 cycles of hemofiltration, our 61-year-old patient from Berovo goes home with a negative SARS-CoV-2 test

Posted on September 16, 2020April 17, 2024 by zmc_piksel_dev

After a month stay in our Clinic, or more specifically, in the Department where patients tested positive for the SARS-CoV-2 virus are treated, a patient who has gone through a difficult yet successful treatment process goes home.

The patient was treated in our Clinic for a month and was admitted in extremely severe general condition, positive for Coronavirus, with his body temperature above 38 degrees Celsius.

Immediately after admission, the patient was placed on non-invasive monitoring where we could monitor the patient’s vital parameters and the required laboratory, microbiological and genetic analyses were performed.

The analyses results showed elevated levels of inflammatory markers, leukocytes, CRP, procalcitonin as well as elevated D-dimer, LDH and interleukin 6 levels.

Applying our medical knowledge and following the latest recommendations for treatment of patients positive for Covid-19, we base part of the treatment of critically ill patients on blood purification that is based on the method of chemosorption of cytokines and other inflammatory mediators.

The patient was placed on veno-venous hemofiltration using an Oxiris filter and due to inversion of the gas analyses, low peripheral saturation as well as the X-ray findings of acute respiratory distress syndrome, the patient was intubated and placed on mechanical ventilation.

The patient underwent 4 cycles of hemofiltration. After the fourth cycle of hemofiltration, an improvement in his overall general condition and all the findings could be noticed.

After spending almost two weeks on a mechanical ventilator, the patient was extubated, or removed from the machine. The patient leaves our Clinic with a negative Coronavirus test and in a good and stable condition.

Zan Mitrev Clinical Hospital with the most modern Centre for Women’s Health in the region

Posted on September 16, 2020April 17, 2024 by zmc_piksel_dev

Zan Mitrev Clinical Hospital has opened its Complete Breast Treatment Centre, which is the most modern centre for women’s health in the region, offering a wide range of medical services and state-of-the-art technology to assist in breast cancer diagnosis and surgery.

With the purchase of the latest Mammomat, the Zan Mitrev Clinical Hospital completes the equipping of its Centre for Women’s Health. The Selenia Dimensions 6000 Mammomat with ergonomic design provides comfortable and painless imaging and gives a clear view of the breast, which reduces the number of unnecessary biopsies.

With its superior 3-D technology, the Mammomat provides a scan time of 3.7 seconds and a minimal radiation dose to patients. At the same time, a large number of projections are provided from all angles, which gives a comprehensive and accurate view of the breast. 3D mammography increases the capability of early detection of cancers by 20-65%.

3D mammography – tomosynthesis reduces the number of false-positive findings, it is especially useful in women with dense breast tissue, allows early detection of cancer with a clear view of the lesion and reduces the number of unnecessary biopsies through the guided biopsy system.

The new Centre for Women’s Health in the Zan Mitrev Clinical Hospital is equipped with the latest technology for diagnostics, mammography and breast surgery and operates in synergy with all other departments that perform surgical interventions on various types of cancer.

In anticipation of October, the breast cancer awareness month, we offer a 30% discount from the regular price of 3D mammography.

For the first time in our country, an ECMO intervention was performed on a patient infected with COVID-19

Posted on September 9, 2020April 17, 2024 by zmc_piksel_dev

To save another life, for the first time in our country, ECMO (Extracorporeal Membrane Oxygenation) was performed on a critically ill patient with COVID-19 infection, using a CytoSorb filter.

Extracorporeal membrane oxygenation (ECMO) is a modified type of cardiopulmonary bridging used as temporary support for patients with impaired respiratory or cardiac function. The main components of an ECMO machine are a membrane oxygenator, through which blood is diffused through a semipermeable membrane to remove carbon dioxide.

The patient was admitted to the Zan Mitrev Clinical Hospital in an extremely severe general condition with acute respiratory distress syndrome, with low peripheral saturation, shortness of breath and fever up to 39C. The patient was immediately intubated and placed on mechanical ventilation. Due to the inversion of the gas analyses with high pCO2 value, despite the high respiratory support and the maximum oxygen concentration, the patient was placed on extracorporeal membrane oxygenation – ECMO additionally using a CytoSorb filter.

Continually expanding our medical knowledge and following the latest recommendations for the treatment of COVID-19 patients we have started another type of blood purification based on the method of chemoabsorption of cytokines and other inflammatory mediators using a CytoSorb filter (FDA approved for the treatment of critically ill patients with COVID-19 infection) in a combination with extracorporeal membrane oxygenation (ECMO).