Association of Inflammatory Markers with Disease Severity and Outcome in Covid-19 Patients.

Objectives: The coronavirus pandemic was associated with a high mortality rate in the Republic of North Macedonia. Finding early markers of the disease's severity may predict outcomes and guide the treatment of the disease. The aim of our study was to evaluate the role of inflammatory markers in predicting the outcome of COVID-19 in hospitalized patients. Methods: The study included 104 PCR-confirmed COVID-19 patients who underwent hospital treatment at the Institute of Lung Diseases and Tuberculosis in Skopje, North Macedonia, between November 2020 and May 2021. Inflammatory markers were assessed in all patients and correlated with the disease severity and outcome in terms of survival or death. Results: IL-6 and LDH at admission were significantly elevated in patients with a severe or critical form of the disease and among non-survivors. In addition, IL-6 showed 87.9% of sensitivity and 61.8% of specificity for distinguishing non-survivors from survivors with a cut-off value of 21.7 pg/ml in the receiver operator curve (ROC). Procalcitonin was significantly increased in non-survivors. Parallel to the increase of disease severity, the values of CRP and LDH increased significantly during hospitalization. Conclusion: The results of the study indicate that a significant association exists between the highly increased levels of CRP, LDH, IL-6 and procalcitonin and the severity of the disease and mortality in COVID-19 patients. Their measurements and follow-up during the course of the disease could be used as predictors for prognosis and outcome but also as a subject for targeted therapy.

Tuberculosis in the Prisons in the Republic of Macedonia, 2008-2017.

BACKGROUND: Tuberculosis (TB) is a major health problem in penitentiary institutions (prisons), and its prevalence was reported to be multiple times higher compared to that of the general population. Conditions such as overcrowding, malnutrition and limited access to medical care which often exist in prisons increase the risk of reactivation, transmission and poor prognosis of tuberculosis disease among inmates. AIM: The main objective of this study was to present the epidemiological situation of TB in the prisons from 2008 till 2017 in the Republic of Macedonia (RM). PATIENTS AND METHODS: There are 13 different penitentiary institutions in the RM with a total capacity to house 2600 prisons inmates. Management of TB in the prisons is part of the National TB program in RM, and the Institute for Lung Diseases and Tuberculosis in Skopje is in charge of it. All prisoners with TB in the RM are registered in the Central Register for TB within this Institute. We use the data from the Central Register, and with the method of description, we present the epidemiological data and clinical characteristics of the prisoners about TB in prisons in RM for 10 years' period. RESULTS: From 2008 till 2017 there were 58 TB cases registered in prisons in total. The absolute number of TB cases in the prisons is not big, but the incidence rate is higher than 100/100,000 population, or several times bigger than in the general population (except in 2012 and 2016). In 2017 there were 10 TB cases registered in the prisons with an incidence rate of 323.9/100,000 population which is many times higher than in the general population in RM. The majority of inmates with TB were young men with risk factors for TB infection or TB disease before incarceration such as drug abuse, alcohol, smoking, but there was no association with HIV infection. The most of the patients diagnosed in prison were new cases (54), secondary TB due to reactivation from the latent TB infection or secondary TB due to the environment. From 2008-2017 there were 82.75% successfully treated TB cases in the prisons, and there were no cases of multi-drug resistant tuberculosis (MDR-TB). CONCLUSION: The results from our study showed that the TB control in the prisons in RM is good with satisfactory treatment outcome. On the other hand, the high incidence rate showed that the prisons in RM provide conditions for TB transmission and with other additional risk factors present place for high TB prevalence. The study findings can be used for planning more effective TB control interventions for the prison population in RM.

Evaluation of the Directly Observed Treatment's Acceptance by Tuberculosis Patients in the Republic of Macedonia.

BACKGROUND: Directly observed therapy (DOT) is a specific strategy endorsed by the World Health Organization in 1994 to improve adherence by requiring health workers, community volunteers or family members to observe and record tuberculosis (TB) patients for taking each dose. The implementation of DOT strategy in the National Tuberculosis Programme (NTP) in Macedonia was introduced in 2006 and was realised by 6 nurses engaged through the Project of Global Fund against HIV/AID and TB. AIM: This study aimed to evaluate how these visits conducted by the DOT nurses engaged through the GF were accepted by TB patients and to evaluate the impact on the treatment outcomes. PATIENTS AND METHODS: In this prospective study 105 TB patients who started treatment in 2016 and who were supposed to be visited by DOT nurses at their homes were included. All of these patients filled out a questionnaire compiled of 6 questions related to their opinion about the efficacy and usefulness of the visits managed by the nurses when they would come for check-ups at the Institute for Lung Diseases and Tuberculosis. The assessment of the efficacy of the work of DOT nurses was performed by analysis of the answers received by TB patients. The data were analysed with the method of description and was statistically prepared in the program SPSS for Windows, 17.0. RESULTS: The results from the analyses showed that the number of visited patients were not satisfied, because 29.52%% were never visited by a DOT nurse at their homes. A lot of patients (61.91%) were not willing to take medicines under the observed control by nurses. Those TB patients who were visited by DOT nurses thought that this type of visit is useful for them: they were satisfied by the attitude of the nurses during the visits, and they received enough explanations regarding TB. CONCLUSION: We can conclude that the DOT visits to TB patients are useful, contribute patients to complete the therapeutic regime without interruption, take care for every individual patient effectively, and protect the rest of society by preventing the development and spread of TB, including drug-resistant strains.

Evaluation of C-Reactive Protein in Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is associated with evidence of systemic oxidative stress, activation of circulating inflammatory cells and increased plasma level of proinflamatory cytokines which include C-reactive protein (CRP). CRP is one biomarker of extrapulmonary or systemic consequences of COPD that can be detected. AIM: The aim of this research is to determine whether the level of CRP statistically significantly correlates with the level of bronchial obstruction and the accompanying co-morbidities in patients with COPD. MATERIAL AND METHODS: This study included 80 patients with exacerbation of COPD, hospitalised at the Institute for Lung Diseases and Tuberculosis in Skopje. We measured the level of CRP in the blood in all of these patients in fasting conditions. The classification of COPD patients by the severity of airflow limitation was made according to the actual version of the Global initiative for chronic Obstructive Lung Disease (GOLD). The Student's Independent Samples t-test was used for the statistic analysis of the data. RESULTS: In 52 (65%) of the patients with exacerbation of COPD we detected an increase of the mean value of CRP. The statistical analysis using the Student's t-test showed statistically significant differences in the mean value of CRP in patients with different level of bronchial obstruction. Hypertension, heart failure, diabetes mellitus, hyperlipidemia, coronary disease, and CVI were confirmed as co-morbidities in 45 (73.1%) of the patients, hypertension being the most frequent one (40%). The statistical analysis using the Student's t-test showed statistically significant difference of the mean value of CRP (p< 0.01) depending on the number of co-morbidities. CONCLUSION: In 52 (65%) of the patients with exacerbation of COPD, were detected an increase of the mean value of CRP. The mean values of CRP statistically significantly correlate with the level of bronchial obstruction and the number of co-morbidities in patients with COPD.