CENTER FOR CYSTIC FIBROSIS

The Cystic Fibrosis Center diagnoses, treats and controls children, adolescents and adults with cystic fibrosis in the Republic of Northern Macedonia.

The center consists of:

Hospital part (8 isolations) where patients with cystic fibrosis (CF) who need hospital treatment due to:

1. Worsening (exacerbation) of lung disease
2. Eradication therapy of pulmonary prim infection with CF pathogen
3. Acute gastrointestinal problems: abdominal pain, vomiting, distal intestinal obstructive syndrome (DIOS), biliary colic (calculosis, cholangitis) or intestinal bleeding (haematemesis and melena)
4. Appearance of symptoms and signs related to other organs and systems: diabetes, rheumatic problems (chronic inflammatory disease), nephrological problems, cardiac problems, bone disease, etc.
5. Newly diagnosed patients with cystic fibrosis or patients with suspected cystic fibrosis:

1. With respiratory disorders (respiratory distress, bronchopneumonia, bronchiolitis, obstructive bronchitis)
2. In malnutrition (non-progression, malabsorption symptoms, malnutrition syndrome: edema, hypoproteinaemia, and anemia)
3. With metabolic disorders suspected of cystic fibrosis (hyponatremic / hypochloremic dehydration, metabolic alkalosis, etc.)
4. For research or training in physical therapy; replacement therapy with pancreatic enzymes

Consultative clinic for regular monitoring of cystic fibrosis patients, Patients have access to the Cystic Fibrosis Center every day, in case of deterioration, as well as the opportunity for telephone consultation. The following work within the consulting clinics:

• Nutritionist, monitors the growth of children and the nutritional status of patients; advice is given on nutrition and achieving a hypercaloric diet; tips for pancreatic enzyme replacement therapy are given depending on the type of meal.
• Physiotherapist, for physical therapy, where training for pulmonary physical therapy is performed, the effectiveness of physical therapy is monitored in individual patients, training for inhalation therapy is performed, as well as the manner of maintenance of inhalation and physical therapy devices.
• functional diagnostics (spirometry)
• Genetic counseling
• Psychologist

Services offered by the department

1. Diagnosis and treatment of patients with cystic fibrosis
2. Regular follow-up, every 2 months, of patients with cystic fibrosis: history, physical examination, assessment of nutritional status, pulse oximetry, spirometry, taking material for microbiological examination of sputum.

3. Annual evaluation of the patients’s condition (according to the protocol), when in addition to the regular procedures blood is taken for complete laboratory tests, monitoring of vitamin D status, glucose metabolism, the patient is referred for radiography or CT of the chest, ultrasound examination of abromen, DEXA et al. as needed
4. Monitoring the growth and nutritional status of patients (weight, height, weight percentages and height for age and sex, Z-score for weight, height and weight for height, body mass index-BMI, impedance).

5. Training and monitoring of the effectiveness of physical therapy in patients. Methods of pulmonary physical therapy for airway clearance that are used are the following: postural drainage / percussion, active cycle of respiratory techniques, PEP mask / system, Flutter, autogenous drainage, as well as physical exercises.
6. Training for inhalation therapy, as well as the way of maintaining the devices for inhalation and physical therapy, for prevention of infections.
7. Functional diagnostics (spirometry), in outpatients and inpatients, to monitor the effect of therapy.

Team of doctors and medical staff

The Cystic Fibrosis Center employs 6 specialist doctors, 3 pediatricians and 3 internist-pulmonologists:

• Prof. Dr. Tatjana Jaqovska, pediatrician, CF doctor, head of the Center for Cystic Fibrosis
• Assistant Dr. Ivana Arnaudova Danevska, pediatrician, PhD
• Dr. Elena Gjinovska Tasevska, pediatrician, doctor
• Prim. Dr. Ani Vidoevska, internist, pulmonologist
• Dr. Sonja Momcilovic, internist, pulmonologist
• Dr. Tanja Savin, internist

The team includes a psychologist, nutritionist, clinical pharmacist, physiotherapist, dietitian, cf nurses trained on all issues in the field. The team of nurses consists of experienced nurses, with education and training for cystic fibrosis, inhalation therapy, spirometry and prevention of nosocomial infections. The trained nurses participate in the training of patients and parents for various therapeutic procedures, necessary for maintaining the health of patients.

PROFESSOR DR. TATJANA JAJOVSKA

• Position: Head of the Cystic Fibrosis Center

VOCATIONAL EDUCATION: 1983-1989 Faculty of Medicine, University “St. Cyril and Methodius ”Skopje; 1992-1996 Specialization in Pediatrics – Faculty of Medicine, University “St. Cyril and Methodius ”Skopje; 2003 Master of Pediatrics – Faculty of Medicine, University “St. Cyril and Methodius ”Skopje; 2014 Doctor of Medical Sciences in the field of pediatrics – Faculty of Medicine, University “St. Cyril and Methodius ”Skopje, 2015 – Assistant Professor of Medical Sciences, 2020 – Associate Professor of Medical Sciences.

WORK EXPERIENCE: Employed at the Clinic for Children’s Diseases – Skopje since 1990 From 1996-1998 specialist doctor in the Department of Pulmonology 1998-2018 doctor specialist in the Department of Infant and Metabolism and Cystic Fibrosis.2018- currently, Head of the Center for Cystic Fibrosis .

MAIN ACTIVITIES AND RESPONSIBILITIES: Diagnosis, treatment and monitoring of children with cystic fibrosis Diagnosis, treatment and monitoring of pulmonary diseases in children

PROFESSIONAL TRAINING: 2015 Trainer in workshops for education of family doctors in Macedonia 2014 Trainer in workshops for education of family doctors in Macedonia 2012 Trainer for pediatricians in Macedonia in workshop “Anemia and nutrition in pregnant women and children till 5 years, health and clinical aspects ”, Sponsored by Ministry of health and UNICEF – 2011 Trainer for pediatricians in Macedonia in“ Teaching end education in capacity building for prevention against violence and child abuse ”(TEACH VIP), sponsored by World Health Organization 2011 Certified Training in Bone Densitometry, the International Society for Clinical Densitometry (ISCD) 2010 Clinical fellowship in pediatrics at the University Pediatric Clinic in Salzburg, Austria 2009 National coordinator in Ministry of Health for prevention of violence and child abuse 2008 Attendance and contribution in TR02-1 05 Study (American research study ) 2008 Certified Training in Clinical Healthcare Management 2008 Clinical Fello wship at the Department for Pediatric liver pre and post transplant, University Clinic St. Luc, Brussels, Belgium (mentor: Prof. E. Sokal) 2004 Chief of Department for Infections in infants 1997 Assistant-Professor in Pediatric 1996 Clinical Fellowship in Pediatric Respiratory Medicine at Institute of Child Health, Great Ormond Street, London, UK, sponsored by the British Government (mentor: Prof. R.Dinwiddie)