Sanamed

2016; 11(1): 21–27

Authors: Lyapina Maya, Dencheva Maria, Krasteva Assya, Tzekova Mariana, Deliverska Mariela, Kisselova Angelina

Introduction: Occupational allergic contact sensitization is common in dental personnel. Some of the most common occupational allergens in dental practice are some formaldehyde-releasers, formaldehyde and glutaraldehyde. Aim: The aim of the present study was to evaluate the rate of contact sensitization to formaldehyde, quaternium-15, imidazolidinyl urea, diazolidinyl urea, and to glutaraldehyde in students of dental medicine and dental patients. Material and methods: A total of 50 participants were included in the study: 40 students of dental medicine exposed to formaldehyde-releasers, formaldehyde and glutaraldehyde during the course of their education; 10 dental patients without occupational exposure to the latter substances served as a control group. All of them were patch-tested with the studied allergens. Results: The sensitization rate to formaldehyde was significantly higher in the group of dental patients if compared to the one of dental students (χ2=5.37; p=0.021). Positive skin patch test reactions to quaternium-15 and to imidazolidinyl urea were observed only in the group of dental students. A significantly higher rate of sensitization to diazolidinyl urea, if compared to the one to imidazolidinyl urea (χ2=5.4; p=0.02) and to quaternium-15 (χ2=6.76; p=0.009), as well as to glutaraldehyde, if compared to the one to quaternium-15 (χ2=3.96; p=0.04) for the whole studied population was established. For the whole studied population, significantly increased rate of concomitant sensitization to formaldehyde and glutaraldehyde (χ2=6.18 p=0.013), as well as to diazolidinyl urea and to glutaraldehyde was established (χ2=9.12 p=0.003). Conclusions: We consider the importance of exposure to diazolidinyl urea, quaternium-15, imidazolidinyl urea and glutaraldehyde during the course of practical education in dentistry for the onset of sensitization. The exposure to formaldehyde is ubiquitous and is difficult to distinguish the roles of environmental and occupational exposures. The promotion of proper personal protection as well as adequate information on occupational chemical hazards should start as early as during the first years of education in dentistry. Key words: contact sensitization, students of dental medicine, formaldehyde, formaldehyde-releasing preservatives, glutaraldehyde

2016; 11(1): 35–38

Authors: Borislavova Marinova-Takorova Mirela, Anastasova Radostina, Panov Vladimir

Background: Bleaching has gradually became a popular procedure for people searching for aesthetic improvement. The aim of this in vitro study was to investigate the effect of bleaching with 45% carbamide peroxide on the level of mineralization of enamel, using laser fluorescence. Materials and methods: Sixty extracted human teeth were treated with 45% carbamid peroxide (Opalescence, Ultradent), 4 consecutive days for one hour each day. The effect of the bleaching agent on the level of mineralization of enamel was measured with DIAGNO dent pen. The statistical method we use was descriptive analysis. Results: The average values, measured before the applications of the carbamid peroxide were 6.33. On the first day they were 5.41, on the second 5.38, on the third 5.11 and 5.35 on the forth. Conclusion: There was observed a slight remineralization effect due to the incorporated Ca2+ and F- ions in the bleaching agent that we have used. Key words: bleaching, DIAGNO den pent, carbamide peroxide

2016; 11(1): 47–52

Authors: Georgieva Daniela, Poposka Anastasika, Bozinovski Zoran, Samardziski Milan, Dzoleva-Tolevska Roza, Nanceva Jasminka

Introduction: Hallux valgus represents a complex progressive deformity of the front part of the foot, with the most distinguished malformation as lateral deviation of the toe. Radiography is extremely important in the decision of the surgical procedure for the best correction of this deformity. Aim:The aim of this work is to show the significance of radiographic examinations in operated patients with Hallux Valgus deformityaccording to Mitchell and Keller techniques. Material and methods: The study included 70 patients having hallux valgus deformity of the foot, and they were divided to two groups. The patients were grouped according their sex, age, the degree of deformity (moderate or severe degree of deformity) and according to radiographic findings. The first group (Group 1) was composed of 35 patients who were treated by osteotomy of the 1st metatarsal bone according to Mitchell, while the second group (Group 2) was also composed of 35 patients who were treated by resectional arthroplasty according to Keller. Radiographic examinations (Method of Hardy and Clapham, Piggott classification, presence and absence of the secondary arthritic and reactive changes of the first metatarsophalangeal joint) were analyzed comparatively during the evaluation. The analyses of the radiographic results were performed pre-operatively and post-operatively for the two groups. Results: According to their sex, the patients were 5 men and 65 women. The average age of the patients in group 1 was 42 years, while for group 2 it was 56 years. There is no significant difference (p>0.05) in the patients of the two groups concerning the pre-operative mean dimension values of the I metatarsophalangeal angle and 1st intermetatarsal angle. However, the radiographic analysis of the same angles in both groups, one year post-operatively, showed a high statistically significant difference (p<0.001). The patients operated by Mitchell’s technique, according to Piggott classification, have deviation significantly more often on the 1st metatarsophalangeal joint of 51.43% as a result of their hallux valgus deformity. Significantly more often, there is a subluxation of 77.14% on the 1st metatarsophalangeal joint in the patients treated by Keller’s technique. The radiographic analysis of the 1st metatarsophalangeal joint (presence and absence of the secondary arthritic and reactive changes) in both groups, pre-operatively (p<0.01) and one year post-operatively (p<0.001), showed a high statistically significant difference. Conclusion: Radiographic analyses were of enormous benefit as in the choice of the decision on the type of the operative procedure and also for the evaluation of the postoperative results. Key words: radiographic analysis, Mitchell, Keller, hallux valgus

2016; 11(1): 57–6

Authors: Bozinovski Zoran, Jakimova Marija, Georgieva Daniela, Dzoleva-Tolevska Roza, Nanceva Jasmina

The patient TK, 7 years old, had sustained a supracondylar fracture of the left elbow after fall on the left hand with elbow extended. She was admitted in local hospital where the clinical examination and X ray were made and they confirmed the diagnosis of supracondylar fracture of the left elbow (Gartland Type III). She was treated with closed reduction (without anaesthesia) and cast immobilization for four weeks. With poor to no function of the left hand she was send to physical therapy for duration of 10 days, but she did not gain her function of the left hand, almost all active movements of the left hand were impossible and the muscles of the left under arm were hypothonic. Due to loss of left hand function,EMG was made and the EMG result showed acute lesion of the nerves of the left forearm caused by possible nerve compression (n.ulnaris, n.medianus, n. radialis). After four months she was admitted in our Clinic were we perform operation of the left elbow with removing callus formation in which we find entrapped median and ulnar nerves. We also did an osteotomy of the humerus for correction of the angular deformity and fixation with K wire. The patient was put in cast immobilisation after surgery for four weeks. After the removal of the cast and K wire she was sent to intensive rehabilitation. One year after surgery she regain almost all of hand and elbow function with satisfying range of motion. She is now able to fullfil every day function without any help or support.

5

Authors: Glazar Irena, Pezelj-Ribaric Sonja, Abram Maja

Background: Different antimicrobial drugs inhibit functions of the microbial cells but, unfortunately, some of these drugs can also affect the host cells, including macrophages. Since these cells represent the baseline defense against microbial agents, it is important that they are fully activated. Materials and Methods: In the present study we investigated the effect of amphotericin B and fluconazole on the functions of peritoneal macrophages from Balb/c mice treated with these antimycotics. For each antimycotic the therapeutic dose used in clinical practice (calculated on the mouse body weight) and two-fold higher doses were administered intraperitoneally once a day for three consecutive days. The control group was treated with saline in the same way. Four different tests, candidacidal assay, nitroblue tetrazolium test, adherence capability and phagocytic capability, were used to determine macrophage functions. Results: Our results confirmed positive effect of high dose amphotericin B on phagocytic capability (31.00±4.46 %), metabolic changes (27.93±6.63 %) and adherence capacity (59.24±8.67 %). Lower doses of drug amphotericin B (2 mg/kg) significantly increased the adherence index of macrophages (71.99±5.55 %) and intensity of the NBT intracellular reduction (30.20±3.83 %). Maximum dose of fluconazole expressed significantly higher phagocytic index (30.77±2.17 %), metabolic changes (24.00±4.07 %) and candidacidal activities (27.73±6.73 %), while lower doses of fluconazole (15 mg/kg) significantly increased the adherence index of macrophages (75.58±5.47 %) as well as the phagocytic index (29.23±2.40 %). Other results were similar as in control group. Conclusion: Positive immunomodulatory effects of fluconazole and amphotericin B may be clinically relevant especially in compromised patients who are predisposed to opportunistic fungal infections and require a long-term antimycotic therapy. Synergistic action of macrophages and antimycotics can influence the course of disorders related to immune suppression. Key words: Amphotericin B, fluconazole, macrophage functions

5

Authors: Glisic Selimir, Jovanovic Milos, Gakovic Aleksandar, Dacic-Krnjaja Bojana

Cataract surgery and intraocular lens power calculation is challenging in patients with anterior megalophthalmos and cataract, with postoperative refractive surprise frequently reported. Deep anterior chamber in these patients substantially influence effective lens position. To minimize possibility of refractive surprise, we used Haigis formula that takes into account anterior chamber depth in the lens power calculation for our patient. Cataract was managed by phakoemulsification with standard intraocular lens implanted in the capsular bag. Postoperatively, satisfying refractive result was achieved and refractive surprise was avoided.

5

Authors: Karganov Mikhail, Eskina Erika, Stepanova Maria

The method of laser correlation spectroscopy (LCS) is based on the analysis of the spectrum of quasielastic light scatter during coherent monochromatic laser irradiation of micro-particles in biological fluids (blood serum, urine, oropharyngeal washout fluid, tear fluid etc.). Spectrum provides information on dynamic processes in the analyzed system: translation motion of scattering particles and their orientation and conformation dynamics. Special procedures of cluster analysis make it possible to find out to which linkage group a particular spectrum belongs. LCS allows evaluation of sub-fractional composition of biological fluids in a wide range of molecular sizes (from 1 to 10,000 nm), which determines principal novelty of this approach in ophthalmology.

6

Authors: Janicijevic Katarina, Kocic Sanja, Todorovic Dusan, Sarenac Vulovic Tatjana

Introduction/Aim: The goal of our study was to analyze the epidemiological`s characteristics of ocular hypertension, as well as the influence of chronic risk factors on glaucoma development (conversion in glaucoma). We tried to make some entries for solving this complex ophthalmological problem. Material /Methods: From 2009 to 2015, a retrospective control study was performed on 121 patient with diagnoses of bilateral ocular hypertension and without disease progression/conversion of glaucoma (by standard protocols of diagnosis and basic procedures) on tertiary level at Clinic of Ophthalmology, Clinical Centre of Kragujevac, Serbia.. The authors analyzed epidemiological characteristics: sex, age groups, positive/negative family history and personal history with chronic risk factors (one and/or two) of ocular hypertension. The data obtained from this study were statistically analyzed in SPSS program, version 20.00. Results: As for the patients, 69 of them (57.02%) were male and 52 female (42.98%). Dominant age group was between 40-49 (42.15%) and then group between 50-59 (40.50%) years of age. Anamnesis data indicated the absence of family anamnesis 71 (58.68%). Risk factors for ocular hypertension were presented in 103 (85.13%) patients, 18 of them (14.87%) did not respond. One risk factor - cardiovascular disease was noted in 83 (68.59%), with two risk factors - cardiovascular diseases and diabetes mellitus in 20 patients (16.53%) and with PEX syndroma at other respondents. Conclusion: Ocular hypertension is not a common disease, but with risk factors, such as older age, positive family history, and chronic risk factors syndicated, represents a serious clinical and social problem, so the question remains for ophthalmologists - pro or against therapy? Those in favor of therapy would state the safety and protection from conversion/progression of glaucoma; but those against therapy would only mention adequate monitoring of patients.

8

Authors: Milisavljevic Slobodan, Spasic Marko, Milosevic Bojan

Introduction: Pneumothorax is defined as the presence of air in the pleural cavity, ie, the space between the chest wall and the lung itself. Pneumothorax is classified ethiologically into spontaneous pneumothorax and traumatic pneumothorax. Spontaneous pneumothorax is further classified into primary and secondary. Traumatic pneumothorax may result from either blunt trauma or penetrating injury to the chest wall. It can also be caused by iatrogenic injuries. Spontaneous pneumothorax is a significant health problem because of the high recurrence rate (this is so called recurrent pneumothorax). The aim of the study: the review of modern diagnosis and surgical management of pneumothorax Methodology: This is a review article. We used Medline and Pubmed databasis for retrieving the literature. Conclusion: Pneumothorax, either spontaneous or traumatic, demands urgent intervention in order to normalize lung function and save life of the patie

3

Authors: Sekulic Stojan, Sekulic-Frkovic Aleksandra, Milankov Andrijana

Introduction: Meckel's diverticulum is a congenital anomaly of the small intestine and remnant of omphalomesenteric duct. It can be found in about 2% of the population. The diagnosis of Meckel's diverticulum is mostly established during surgical intervention. Case report: Our research is based on the 22 years old female patient, who has been admitted to the clinic with all the features of acute appendicitis. After the completion of 20 hours of observation, intestinal permanence ileus, was diagnosed. The patient was operated after a brief reanimation and anesthetic preparation. During the surgical intervention, we have found a normal appendix, without signs of inflammation. Further exploration of the abdomen fortified Meckel's diverticulum at a distance of 75 cm from the ileocecal valve of the ileum. Diverticulum was completely filled in with peanuts, and wreathed around its axis, causing the ileus. We have performed diverticulectomy and appendectomy. The patient had a rapid and successful postoperative course. Conclusion: Apart from the acute appendicitis, when patient complains on pains in ileocecal region, Meckel's diverticulum should also be taken into a consideration.

5

Authors: Detanac A. Dzenana,Jancic Snezana,Rakocevic Milena,Ceranic Merima

There has been significant progress made in the diagnosis and treatment of the primary uveal melanoma during the past decades and despite that, survival rate of uveal melanoma patients is still stable. Treatment options for uveal melanoma include phototherapy, brachytherapy, proton beam therapy, stereotactic radiotherapy, local resection, anti-angiogenic therapy, immunotherapy, and enucleation. Genetic analysis of tumors provides us with valuable prognostic information although effective therapies are lacking at this moment. It is not established yet whether prolonged survival is the result of treatment or whether it merely reflects earlier detection of metastases. Also, there are indications that survival after treatment of uveal melanoma probably does not depend on the method of treatment but rather on many clinical, histological and genetic risk factors. New studies are needed to provide a better understanding of ocular treatment impact on survival in patients whose prognosis can be estimated according to the clinical stage, histological grade and genetic type. Therefore, the patients should be treated in experienced multi-disciplinary teams that must include these patients in clinical trial.

7

Authors: Andjelic Ivana,Matijevic Snezana,Andjelic Jasminka

Introduction. Caries or tooth decay regardless of the good knowledge of the nature of the disease and the possibility of its effective prevention is still the most widespread disease in our population. It also very often threatens the functions of organs and even the entire organism. Health culture is an integral part of general culture and health education plays an important role in maintaining health of individuals. Aim. The main objective of this study is to determine the influence of oral health behavior of schoolchildren aged 12 to 14 on their oral health. The schoolchildren attended the seventh and eight grade at Drago Milovic Elementary School in Tivat. Method. The survey was conducted during the period from the end of January to April 2015 at Drago Milovic Elementary School in Tivat. It comprised all seventh and eight-graders that were at school those days. The survey instrument was a questionnaire specially designed for this study and it consisted of 36 closed-ended questions. Clinical examination of oral health in children was used as an additional research instrument. Assessment of oral health was carried out under natural light with dental mirror and probe according to WHO recommendations. The parameter used to assess the state of oral health was DMFT index - the number of carious, extracted and filled teeth. In addition, the assessment of oral hygiene was conducted using soft debris index according to Green-Vermillion which determines absence or presence, quantity and distribution of dental plaque and other soft deposits. Results. The majority of students stated that they lack knowledge regarding the effectiveness of fluoride toothpaste (69.4%). It was found that the lowest incidence of caries occurred among those students who think that teeth should be brushed after every meal, and the highest incidence of this diagnosis occurred in respondents who think that teeth should be brushed once a day. Half of the surveyed students believe that teeth should be brushed most of- ten after every meal and more than half of excellent students (55.6%) believe so. DMFT index for study population was 1.87 while Green-Vermillion soft debris score of oral hygiene was 2 in largest number of students (49.5%). Conclusion. Looking at the results it can be concluded that dental care in this area does not significantly affect the improvement of oral health in children. Therefore a greater attention should be paid to continuous education programmes and gaining knowledge about oral health and hygiene of the mouth and teeth.

4

Authors: Zhelyazkov Christo , Davarski Atanas, Kitova Tanya, Kehayov Ivo, Kitov Borislav

Objective: To analyze and present cases of tandem compression of medulla spinalis and cauda equina. Material and Methods: The subjects of observation were four patients with simultaneous compression of medulla spinalis and cauda equina, admitted to the Neurosurgery Clinic of the St George University Hospital, Plovdiv, Bulgaria during the period March 2012 - March 2014. The average age of the patients was 60.5 years (47-72). In one case, left-sided paramedian herniated discs were found at levels L1-2 and L4-5 combined with a concomitant stenosis, in another case - right-sided paramedian herniated discs on the level of Th12-L1 and a degenerative stenosis at level of L3-4, in the third case - pronounced degenerative compression at level Th7-8 and a central stenosis at level of L4-5, and in the last case- degenerative stenosis at level L3-5 and spinal meningioma at level Th9-10. Results: The clinical signs of the simultaneous compression of the spinal cord and cauda equina have been examined. These signs may mislead the physician in the diagnosis of the spinal lesion, thus, resulting in inappropriate surgical strategy. Conclusion: The involvement of the spinal cord must be clinically confirmed to rule out lesions in the thoracic region. When the lumbar imaging examinations are inconclusive or cannot explain the clinical symptoms of a certain patient, it is advisable to perform a magnetic resonance imaging of the entire spine.

5

Authors: Haritonov Dimitar, Kalevski Svetoslav, Peev Nikolay

Aim: There are different surgical techniques for massa lateralis screw instrumentation of subaxial cervical spine-those of Roy-Camille, Magerl, Anderson, and An. Each has different starting point and trajectorys of screw implantation. For each technique there is a potential risk to affect vascular and neural structures.In this paper we share our experience in using a modified Magerl's technique for stabilization of subaxial cervical spine. Method: We present a retrospective study and clinical follow-up of 27 patients operated on the occasion of cervical injury that we have used the modified technique of Magerl. In 8 patients was carried and an anterior decompression and stabilization. Results: In these patients was carried posterior or combined - posterior and anterior stabilization. The posterior fixation was massa lateralis with this modified technique of Magerl with multiaxial screws. With this technique were inserted 160 multiaxial screws and the most common length of the implants were 108 mm (108 from 160 or 67.5%). Conclusion: Based on world literature, experience and analysis of clinical cases, we believe that this modified technique for subaxial cervical fixation is effective (the pull-out strength approach to the strength of pedicle screw instrumentation) and is much safer.

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Authors: Hadzic Devleta, Zulic Evlijana

Introduction: Pneumonia is the most serious inflammatory disease of the lower respiratory system caused by various microorganisms. It occurs in all age groups, more often in children aged 5 years and below, in children with chronic diseases and impairments of the immune status. The aim of this study was to present the epidemiological, etiological and clinical characteristics of pneumonia in hospitalized children. Patients and methods: We analyzed the epidemiological, etiological and clinical characteristics of pneumonia in 224 children hospitalized at the Pediatric hospital Tuzla during one year period with radiologically proven pneumonia. Results: Almost half of children with pneumonia (46.4%) were infants, and 82.1% of patients were under five years of age. The boys were leading in all age groups. Asignificant number of children had one or more predisposing risk factors. Clinical signs, gas analyses and pulse oximetry well correlated with hypoxemic type of respiratory failure. The most frequently isolated pathogens were Staphylococcus aureus, Klebsiella sp. and Pseudomonas aeruginosa. The average length of intensive treatment was 2.8 days and the average total length of treatment was 9.5 days. Conclusion: Pneumonia hospitalizations of children at the Pediatric Clinic Tuzla, showed the usual age and gender distribution. A significant number of children had underlying chronic diseases. Etiological characteristics emphasizing severity of disease and immune status of children. The management of pneumonia in children has to follow general pediatric principles, and special attention should be given to risk categories.

9

Authors: Kalevski Svetoslav, Peev Nikolay

Introduction: A multitude of underlying reasons result in hydrocephalus (HC), and its classification remains controversial. The current study looks at patients with the Syndrome of Hydrocephalus in Young and Middle-Aged adults (SHYMA) through a case series. Patients and methods: We report 35 patients with HC referred to St. Anna Multiprofile Hospital during the period 2008-2012. Inclusion criteria were decompensated congenital hydrocephalus, (DCH), acquired hydrocephalus (AHC), or idiopathic hydrocephalus (IHC) in the age range of 16-55 years, treated with a ventriculo-peritoneal shunt (VPS)- 17 patients were treated with Strata Adjustable Delta Valve ('Strata' group) and 18 patients had Medtronic Orbis Sigma valves inserted ('Orbis Sigma' group). Results: Eight patients (22.86%) had DCH, 14 (40%) had AHC, and 13 (37.14%) had IHC. Regardless the underlying cause for HC, all the patients had similar symptoms, mainly related to gait in 26 (74.3%), cognition in 30 (85.7%), bladder control in 20 (57.14%) and chronic headaches in 24 patients (68.57%). Symptomatic improvement was achieved in 34 of the shunted 35 patients (97.14%), but the postoperative complications rate was found to be significantly lower in the 'Strata' group. Conclusion: The clinical presentation of hydrocephalus in the age 16-55 years has common features presenting with syndrome of hydrocephalus in young and middle-aged adults as separate clinical entity. VPS is a feasible treatment option in SHYMA. Due to the excessive, long standing ventriculomegaly, thus sensitive compliance of brain parenchyma and high tendency to develop subdural hematomas, adjustable VPS are advisable option.