Open Access Macedonian Journal of Medical Sciences

377-381

Authors: Esmail RS, Sharaf WM, Helmy NA, Farrag ARH, Badawi MA, Eldin AAG

Background: Cancer colon is one of the most prevalent cancers in Egypt. Sporadic cancer colon is much more common than familial type; the latter accounting for not more than 30% of the reported cases in different registrations. BRCA1 is a tumor suppressor gene which is proved to be mutated in many cancer types. Limited studies tried to screen its mutation in cancer colon. Aim: This work is aimed to screen BRCA1 mutations using C-terminal antibody in sporadic non familial colonic carcinoma. Subjects and Methods: Fifty colectomy specimens were collected. Sections of paraffin blocks were cut (μm thickness), then stained with Hematoxylin and eosin and evaluated for tumor type and its nuclear grade and its stage. Immunohistochemical studies for BRCA1 were performed. Results: positive nuclear immunostaining of BRCA1 staining was detected in 84% of the cases, with insignificant correlation with both the grade and the stage p ~ 0.42, p ~ 0.31 respectively. Conclusion: This type of staining denies a direct role of BRCA1 axon 11 mutations in sporadic colonic cancer - unlike some sporadic ovarian and breast cancers - and may point to that BRCA1 may share in the early tumorogenesis in a way other than the usual mutation of exon 11.

389-396

Authors: Yasser S, Nagy N, Marei MK

Stem cells from human exfoliated deciduous teeth (SHED) provide a new attractive source for stem cells; in this study we further characterize SHED. SHED were isolated, differentiated using osteogenic/ odontogenic differentiation media, characterized using light microscope, SEM and immunocytochemistry using CD44. Also, Immunohistochemistry using CD44 was performed on extirpated pulp tissues. We found that a naturally exfoliated human tooth contains a population of stem cells that attain morphological homogeneity after the first passage, on adding the osteogenic/odontogenic medium, sporadic nodule-shaped structures were observed after two weeks that were positively stained with alizarin red and von Kossa stains. SHED stained with H& E showed a basophilic, eccentric nucleus with an eosinophilic cytoplasm in which two differently stained areas were clearly distinguishable. Also we found using SEM that SHED spread on the UBM scaffolds surfaces showing multiple filopodia and formed collagen-like structures by the seventh day. After three weeks, seeded scaffolds incubated in osteogenic/odontogenic media showed many mineralized nodules in the ECM. Cultured SHED revealed positive immunoreactivity when treated with CD44. Also, sections of pulp tissue treated with CD44 depict positively stained cells situated mainly in the perivascular areas reinforcing the hypothesis that pericytes may be the origin of SHED.

404-410

Authors: Petlichkovski A, Stojanoski Z, Djulejic E, Georgievski B, Spiroski M

Aim: The aim of this study was to examine the gene frequencies of 16 KIR genes and pseudogenes and KIR genotypes in Macedonian patients with transplanted bone marrow and their sibling donors in treatment of haematological malignancy, and to analyse eventual association of the gene content with the occurrence of a graft versus host disease (GVHD). Material and Methods: The study was performed on 24 patients and their HLA-matched sibling donors. Results: Comparison of KIR gene frequencies between the total 24 donors and healthy Macedonians reveals statistically significant difference for KIR2DS1 (F= 0.481 in the controls group, and 0.76 in the patients group, p=0.004). This significance is even higher when the frequency of KIR2DS1 in controls is compared with the frequency in donors from pairs with GVHD (F= 0.923, P= 0.002). Another significant difference was observed for the frequency of the full-length allele of KIR2DS4*001-002, present in 25.2% of the control individuals, but in as much as 81.8% of the recipients of haematopoietic stem cell (P=0.0005). We did not see any statistically significant difference in distribution of the C1/C1, C1/C2 and C2/C2 groups among GVHD pairs. Conclusion: Our results address the difference between the haematopoietic stem cell transplantation settings with sibling and unrelated donors and suggest that the KIR2DS4*001/002 might be a predisposing factor for severe GVHD in sibling HSCT.

416-422

Authors: Sofijanova A, Piperkova K, Jordanova O

Background: The aim was to investigate whether S100 in serum is a prognostic marker of cerebral injury in term newborn infants with hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia. Material and Methods: All risk neonates with severe asphyxia, admitted to the neonatal and Pediatric Intensive Care Unit at the University Pediatric Hospital in Skopje-Macedonia within 24h of injury were eligible for inclusion in the study. One serum blood sample was obtained from each patient at the 24h post-injury time-point, than day 3 and day 7. S100B levels were measured using ECLIA method (Electro-Chemil-Luminiscence Immuno Assay-Elecsys 2010-Roche Diagnostic). Results: One hundred and nineteen neonates were recruited. The avarage serum S100B levels for the control group (N=48) was 0.12 microgL(-1) (cut-off point). S100B levels were significantly higher in asphyxiated term neonates N=29; M= 0.64. Infants with moderate and severe HIE had significantly higher S100 levels on postnatal day 1 (p = 0.031) and day 2 (p = 0.008) than infants with mild or no HIE. Increased S100 levels were significantly inversely correlated with perinatal pH in the infants and associated with abnormal CTG at admission to the labor ward. Conclusion: Early determination of serum S100 may reflect the extent of brain damage in infants with HIE after asphyxia.

428-433

Authors: El Dayem SMD, El Sheikh EAB, Abdou SS, Agaibyi MH, Mahmoud M

Objective: To investigate whether advanced glycosylation end products (AGE) and oxidative stress are augmented in young patients with type 1 diabetes at early clinical stages of the disease. Patients and Methods: The study included 50 patients with type 1 diabetes among those attending the endocrine clinic in National Research Centre and 30 healthy volunteers in the control group. Serum glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, serum creatinine concentrations, glycosylated hemoglobin (HbA1c), urinary albumin/ creatinine ratio, malondialdehyde and pentosidine were assessed. Results: No significant difference was found between age of patients (12.0 ± 3.2 ) and controls (11.0 ± 1.2), P > 0.05. Blood glucose, HbA1c, urinary albumin / creatinine ratio, pentosidine and malondialdehyde were significantly higher in diabetic patients than controls. Pentosidine and malondialdehyde had a significant positive correlation with blood glucose, HbA1c and urinary albumin/creatinine ratio. Conclusion: The present study indicates that accumulation of AGEs, whose formation is closely linked to oxidative stress, and resultant endothelial dysfunction may start early in the course of type 1 diabetes. This means that the risk of vascular complications may be present at an early age and that the best possible glycemic control should be emphasized from the diagnosis of diabetes.

437-443

Authors: Lazarevik V, Kasapinov B

Objective: To determine medical doctors’ attitudes towards the implementation of the new pay-for-reporting system in the public hospital sector. Data Source: An electronic survey was conducted among 303 medical doctors in the Republic of Macedonia using the database of Healthgrouper.com, an online provider of information for healthcare providers. Principal Findings: Majority (61.9%) of all surveyed doctors are against the proposed pay-for-reporting (P4R) reform. Disapproval is much higher among the doctors employed at the public hospitals where 79% consider that pay-for-reporting project has to be abandoned. Doctors are against the proposed P4R system that only measures quantity of the work. According to majority of the doctors current model is subjective; it opens possibilities for bias and missconduct, and puts the clinical teamwork at jeopardy. Conclusions: Massive support against the implemented P4R reform was expressed by the Macedonian doctors employed in the public sector. The model should integrate parameters such as quality and complexity of delivered services to patients. Better integration and engagement of doctors is essential to assure support and smooth implementation of P4R reform as sound policy in practice. The Ministry of Health should set key parameters to be monitored by hospitals to evaluate the success of the P4R system.

453-461

Authors: Petrushevska T

The aim of this review is to give new emphasis to key aspects of the proposed treatment of drug addiction. Surveys for so called “second-line” treatment of drug addiction, with heroin (diacetylmorphine) as a pharmaceutical preparation, started since 1990, but this issue is becoming particularly popular in the last period. Drug addiction according to WHO and International Classification of Diseases (ICD10) is chronic, relapsing disease characterized by compulsive drug seeking and use despite harmful consequences as well as neurochemical and molecular changes in the brain. Drugs generate crime, violence and other social problems that are damaging society as a whole. Drug addiction is medical disorder to which contributes more factors and it is necessary to implement the treatment in multi disciplinary manner - from pharmacological, psychiatric, and social aspect. In recent periods studies are carrying out in several countries in the European region, to provide justification, with the scientific medical evidence, for use of heroin as a pharmaceutical dosage form, for treatment of drug addictions for previously unresponsive group. This review paper is focused on maintenance treatment with heroin, retention of the patients into treatment, whether the dose that is expected to be effective at the same time is safe, which organ (systems) are involved in eliminating the drug from the body, whether the injection is the best way for application of the drug. Purpose of this review paper is not to be supporter or opponent, but to inform, transparently to discuss all aspects and to set conclusions about this type of treatment, within national strategy context.

472-481

Authors: Macedonian Journal of Medical Sciences

We present English abstracts of MSc theses defended in 2011 at the Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Republic of Macedonia. English summaries are published as they are translated by authors and included in the final version of defended MSc. Macedonian Medical Master of Science (MSc) theses are deposited in the Central Medical Library and National and University Library “St. Kliment Ohridski” in Skopje, Republic of Macedonia. At the Faculty of Medicine in Skopje twenty three (23) MSc theses were defended in 2011, eleven (11) MSc are without abstracts (47.8%) and eleven (11) MSc are without Key words (47.8%). Two MSc are not deposited in the Central Medical Library (Kristina Pavlovska, Defended: November 04, 2011 and Igor Kostov, Defended: November 16, 2011) and should be treated as none legally defended MSc. Editorial Board does not take any responsibility either for the content, nor the quality of the abstracts. We conclude that the qualities of the Master of Sciences theses defended in 2011 at the Medical Faculty, Ss Cyril and Methodius University of Skopje, Republic of Macedonia are drastically lower than in the previous year.

263-268

Authors: Kirijas M, Mishevska-Perchinkova S, Karadzova-Stojanoska A, Efinska-Mladenovska O, Petlichkovski A, Trajkov D, Spiroski M

Aim: The aim of this study was to determine the association of HLA-A, -C and -B genes with ankylosing spondylitis in patients from the Republic of Macedonia. Material and Methods: This study included 307 subjects (250 healthy individuals and 57 patients with ankylosing spondylitis who were diagnosed at the University Clinic of Rheumatology in Skopje). The HLA typing of class 1 (HLA-A, HLA-C and HLA-B) genes was performed using the method of Reverse Line Strip, after isolation of DNK from the blood leucocytes with the standard phenol-chloroforme method. The HLA sub typing of HLA-B*27 was performed with high resolution single-strand polymorphism. Results: We found negative association between HLA-A*03, HLA-A*24, HLA-C*04, and HLA-B*18, as well as positive association between HLA-C*01, HLA-C*02, and HLA-B*27 group specific alleles and patients with ankylosing spondylitis. Both HLA-B*27:02 and HLA-B*27:05 alleles have shown positive association with ankylosing spondylitis. Conclusion: Group specific alleles HLA-A*03, HLA-A*24, HLA-C*04, and HLA-B*18 are significantly more frequent in healthy individuals than in patients with ankylosing spondylitis which suggests their protective role. HLA-C*01, HLA-C*02, and HLA-B*27 group specific alleles (HLA-B*27:02 and HLA-B*27:05) have strong positive or susceptible association with ankylosing spondylitis.

275-279

Authors: Eseyin O, Ebong A, Ubobre A, Ekarika J, Udo I

Effect of Gnetum africana on the pharmacokinetic parameters of chloroquine was investigated. Chloroquine phosphate (200 mg/Kg) was concurrently administered to overnight fasted albino rats. Blood samples were collected 15, 30, 60, 120, 240 and 480 minutes after administration through cardiac puncture. Serum concentration of chloroquine was evaluated spectrophotometrically. The results indicated that the extract significantly decreased Cmax (9.17%), Ka (3.06%), Ke (45.38%), Cl (48.46%) and AUC (0-8) (16.90%). The extract also increased the values of t1/2 (83.11%), tmax (100.00%). The LD50 of the extract was 5.25 g/Kg. Phytochemical screening revealed the presence of steroids, tannins, flavonoids and traces of phlobatanins and alkaloids. Proximate and elemental analyses showed that the plant contained Sodium (26.37 + 0.01ppm), Potassium (32.84 + 0.02 ppm), Copper (0.01 + 0.00 ppm), Calcium (6.53 + 0.01ppm), Magnesium (7.58+ 0.02 ppm), Iron (2.01 + 0.02 ppm), Zinc (0.93 + 0.03 ppm), Lead (0.02 + 0.01 ppm), Moisture (10.90 + 0.91 mg/100 g), Crude protein (15.31 + 1.12 mg/100g), Crude fibre (4.20 + 0.21 mg/100 g), Crude fat (10.60 + 0.65 mg/100 g), Ash (5.40 + 0.30 mg/100g), Carbohydrate (74.49 + 0.23 mg/100 g) and Energy (407.80 Kcal). The results of this work showed that concurrent administration of the extract of Gnetum africana affected some of the pharmacokinetic parameters of chloroquine. Malaria patients on chloroquine therapy should therefore be advised to beware of consuming Gnetum africana.

288-295

Authors: Petlichkovski A, Milenkovic Z, Djulejic E, Jefremovska B, Babacic H, Ivanovski LJ, Kondova Topuzovska I, Spasovska K, Spiroski M

Background: Infection by the pandemic influenza A (H1N1)pdm09 virus results in significant pathology disease in many cases in different populations worldwide. The natural killer (NK) cells are among the major effectors important in early innate immune responses to viral infections, interacting with host cells through their activating or inhibiting receptors. Aim: The aim of this study was to analyze Killer Ig-Like Receptor (KIR) gene polymorphisms in critically ill Macedonian patients with pandemic influenza A (H1N1)pdm09 infection. Material and Methods: The studied sample consists of 63 critically ill Macedonian patients with pandemic influenza A (H1N1)pdm09 infection. The population genetics analysis package, Arlequin, was used for analysis of the data. Results: We found that all 16 KIR genes were observed in the studied individuals and framework genes (KIR3DL3, KIR3DP1, KIR2DL4, and KIR3DL2) were present in all individuals. The results of tested linkage disequilibrium (LD) among KIR genes demonstrated that KIR genes present a wide range of linkage disequilibrium. Comparison of KIR gene frequencies between critically ill H1N1/09 Macedonian patients and healthy subjects reveals statistically significant difference for frequency of KIR2DL1 (F=1 in the patients group, and 0.94 in the control group, p=0.045). Conclusion: We did not found any significant association of all 16 KIR genes or KIR genotypes with critically ill (H1N1)pdm09 Macedonian patients, except for the KIR2DL1.

302-312

Authors: Jani Y, Spiroska V

Aims: To test the hypothesis that: the potential of type 2 diabetes, in precipitation of the sub clinical left ventricular diastolic dysfunction at the female sex, in absence of high blood pressure disease, coronary disease and other known heart disease, is different in comparison to the male sex. Material and Methods: Prospectively, 180 people with type 2 diabetes were tested, at the ages between 45 and 55, divided into 2 groups: 1) Control group- was comprised of 60 patients (30 male and 30 female), without diabetes, with similar epidemiological-demographic characteristics; 2) Diabetes group - was comprised of 120 patients (60 women and 60 men) with type 2 diabetes. The estimation of the diastolic function of the left ventricular was made by Doppler echocardiograph analysis of the diastolic time intervals, as well as analysis of the model of ventricular filling, shown with a transmitral flow-velocity profile, acquired with a conventional pulsed-wave Doppler. Results: Significant changes between the groups in clinical variables were observed regarding body mass index, low density cholesterol and triglycerides, the variables gotten with the pulsed-wave Doppler of the transmitral flow, and the duration of the isovolumetric relaxation time. Conclusions: In this study, we do not prove the hypothesis that the type 2 diabetes potential in the precipitation of the sub clinical left ventricular diastolic dysfunction at the female sex, in absence of coronary disease, blood pressure disease and other well known heart diseases, is different in comparison to the male sex.

317-323

Authors: Palchevska S, Krstevska M, Shukarova E, Aluloska N, Jakimoska M, Kocevski D, Kocova M

Introduction: Serum adipocytokines concentration, their mutual relationship and correlations with anthropometric data could be indicators of fetal and neonatal growth maturity level in term and preterm infants. Objectives: Study was designed to assess the correlation of the anthropometric parameters with leptin and adiponectin levels in healthy preterm and term newborns. Design and Methods: A cohort of 110 neonates of both sexes, born pre term (PT) (n=36) or at term (AT) (n=74, additionally classified as AT-AGA (n=36), AT-SGA (n=18), AT-LGA (n=20) and PT-AGA (n=24), PT-SGA (n=12), according to the Lubchenco curves Mother Body Mass Index-MBMI, Birth Weight-BW, Birth Length-BL, Body Weight/Body Length ratio-BW/BL, Body Mass Index-BMI, Ponderal Index-PI, was recorded after birth. Results: Sex has no influence on mean serum leptin and adiponectin level. However, differences between AT and PT groups were highly (p<0.01) significant (2.20 ± 1.02; 30.77 ± 22.64 and 1.24 ± 0.35; 9.44 ± 4.82 ng/mL, respectively). Significant difference was found in adiponectin levels between AT-AGA and AT-LGA compared to AT-SGA subgroup (32.8 ± 25.41 and 43.40 ± 16.98 vs 12.67 ± 2.45 ng/mL, respectively, (p<0.01; p<0.01). There was a significant difference between leptin levels (1.93 ± 0.70; 1.71 ± 0.53 vs 3.12 ± 1.27 ng/mL) in AT-AGA and AT-SGA compared to AT-LGA newborns, respectively, (p<0.01; p<0.01). No significant differences were found in leptin and adiponectin levels neather between PT subgroups (1.30 ± 0.38 ng/mL) nor between PT group and AT-SGA (1.71 ± 0.53 ng/mL) subgroup. Leptin and adiponectin levels were positively correlated with all anthropometric parameters: BW, BL, BW/BL, BMI, and PI (p<0.05). Conclusion: These results indicate that the stage of body growth maturity is positively correlated to adipocytokines involved in fetal growth regulation.

328-335

Authors: Dodevski A, Tosovska-Lazarova D

The vertebral artery and its branches are target of arteriographic investigations, ultrasound and Doppler visualization, MRI and CT imaging in many contemporary diagnostic procedures. The big horizon of procedures in the interventional and diagnostic radiology, orthopedic and surgery opens new avenues for the study of anatomy and especially variations of the vertebral artery and its branches. The aim of the present report is to give a summary of the vertebral artery anatomy as well as its variations, and to emphasize there clinical importance.

346-355

Authors: Damjanovska G, Labacevski N

Background: Desmoid tumor lately referred as aggressive fibromatosis (AF) is rare clinically heterogeneous and unpredictable disease with prevalence < 0.03% of all malignancies. The current standard treatment is: radical surgical treatment with tumour excision accompanied by radiotherapy and/or systemic approaches. The potential morbidity and the high local recurrence rates leaded investigators to assess the role of pharmacological approaches. The purpose of this review was to overview effectiveness of treatment options for AF and the role of imatinib mesylate (Glivec™; Novartis), in AF that has been published over the past decade. Material and Methods: Published clinical trials, studies, case reports and case series literature review, was carried out using the electronic databases PubMed/Medline from 2002 to 2012. Results: Reviewed literature included case reports, case series, retrospective studies and several small phase II trials. According to the review NSAIDs treatment performed positive response range of 37%-57%, COX 2 treatment (Meloxicam) up to 90% response, treatment with hormonal agents response ratio between 40%-50, positive responses for chemotherapy against AF of almost 50% and response rate for Imatinib ~10%. However several questions need to be answered: which is the most suitable treatment at certain AF condition, what is the optimal dose and duration of treatment since the lack of sufficient patient numbers and randomized trials compromises the validity of the reported results. Conclusions: Reviewed literature presents evidence that citotoxic and non-citotoxic systemic therapies other that surgery are effective against AF. Main issue that has to be processed is stronger validation of results by further investigation with precisely designed prospective studies with larger patient numbers and, with main end points that include tumor respones rate and survival as well as quality of life.

147-151

Authors: Popovska K, Zdravkovska M, Blazevska B, Icev K, Eftimovski G

Background: Hand hygiene has a fundamental role in the prevention of one of the most challenging problems in the management of modern hospitals: nosocomial infections and occupational diseases. Aim: This survey presents the experience of laboratorians in the Microbiology Department in the Clinical Center in Skopje in promoting proper hand hygiene by participating in a training course and implementation of WHO guidelines among laboratory staff. Material and Methods: The group of 36 Health Care Workers (HCW) has been divided in to seven different groups, based on their specific work in the Institute of Microbiology. The investigation was conducted in two phases: phase-1 was before the training course and phase-2 immediately after taking the training course. During phase-2, hand samples were taken with the technique of the moist swab on the left hand and the fingertips touch method on the right hand. Results: It was found that 17% of the cultures from the left hand detected pathogenic bacteria and 39% on the samples taken from the right one (there is significant difference (p = 0.041). Conclusion: The Touch Method appears to be the more sensitive method than swabbing the critical areas of the palms. It is also evident (significant) that awareness of the problem of the staff, obtain some changes in their attitude and practice.

152-158

Authors: Hassan NE, El-Masry SA, Soliman NL, El-Batran MM, Al-Tohamy M, El-Batrawy SR, Elmoniem MMA

Background: Childhood obesity increases risk for developing cardio-metabolic diseases. Objectives: to investigate the relation of some anthropometric parameters with cardio-metabolic disease risk factors in obese children and adolescents. Subjects and Methods: Cross sectional study, comprised of 139 obese pupils; aged 8 to 16 years (classified to 3 age groups). Each pupil underwent complete physical examination, anthropometric and laboratory assessment (fasting blood sugar and lipid profile). Results: Boys had significantly higher values of abdominal skin fold thickness in the age groups II and III and in central adiposity, waist circumference, waist/hip ratio and sub scapular skin fold thickness in adolescents. For boys, fasting blood sugar correlated with most of the anthropometric measurements in young age, and with skinfold thickness in the three age groups. While lipid profile correlated with skinfold thickness particularly at subscapular area in the age groups I and II. For girls, none of the parameters under study showed any significant correlation except subscapular skinfold thickness which had significant correlations with lipid profile in age groups I and II. Conclusion: Skin fold thickness particularly subscapular; is important indicator for cardio-metabolic complications in obese children of both sexes. Obese boys are more liable to cardio-metabolic complications.

164-168

Authors: Kirijas M, Hristomanova S, Trajkov D, Pajkovska M, Kostov B, Spiroski M

Aim: The aim of this study was to determine the serum concentrations of immunoglobulin classes (IgA, IgM and IgG) and subclasses (IgG1, IgG2, IgG3 and IgG4) in elderly individuals from the Republic of Macedonia. Material and Methods: This study included elderly persons from the Gerontology Department “13 Noemvri”, Skopje, Republic of Macedonia between the ages of 65 and 101 years, previously screened with the SENIEUR protocol. We investigated the serum concentration of immunoglobulin classes (IgA, IgM and IgG) and subclasses (IgG1, IgG2, IgG3 and IgG4) in these two groups by immunonephelometry. Results: The results have shown significantly higher concentration in the NON-SENIEUR group for the IgA, IgG, IgG1, and IgG2. Serum concentration of immunoglobulin classes and subclasses in the SENIEUR group have shown significantly higher values in males for IgG, IgG1, and IgG2 and in the NON-SENIEUR group significantly higher values in females for IgG, and IgG1. Conclusion: Macedonian elderly people from NON-SENIEUR group have shown significantly higher serum concentration of IgA, IgG, IgG1, and IgG2 but without differences in IgM, IgG3 and IgG4. There was gender difference in the serum immunoglobulin concentration between SENIOUR and NONSENIOR elderly group.

181-188

Authors: Kamberi B, Kamberi G

Background: Meal with high-fat content represents a common and increasing habit in general population in the Macedonia. Contribution of homocysteine and meal with high-fat content in the acute phase of first-ever ischaemic stroke (AFIS) due to the different dietary habits remains unclear. Aim: Our aims/hypothesis was comparison of serum total homocysteine (tHcy) level and dietary habits in patients with AFIS and in controls due to non-consuming (non-users) or consuming (users) meat with high content of fats that can be regarded as traditional eating habits influenced by religion dietary restrictions from Lower Pollog populations. Materials and Methods: From initially 847 patients hospitalized from September 2008 to August 2010in neurology department, only 231 patients with diagnostic entity-AFIS and 194 healthy subjects were evaluated in this study. Serum tHcy was measured on admission and dietary history was noted. Results: In the overall pooled estimate, for all included study participants, serum tHcy level in the acute phase of disease and frequency of users are similar in patient with AFIS and in controls, but non-users mostly was dispose to AFIS and hyperhomocysteinemia. Conclusion: Meat with high-fat content is very often combined with tHcy-increasing effects at users. Because the regression coefficient of linear regression model with users as variable, adjusting for age, gender and serum tHcy of patients with AFIS was not confirmed the statistical significance of previous pretesting factors by cross tabulation model our research could not confirm that hyperhomocisteinemia and meat with high-fat content are the only reason for cause of AFIS.

194-196

Authors: Lazarevik V

An email survey was conducted among general practitioners in the Republic of Macedonia to assess their self reported administrative workload and communication with specialists. More than 56% (55.8%) of the surveyed physicians reported that they spent over 40% of the time with patients to administrative procedures, follow by poor communication with specialists after the referral. Urgent reforms are needed to advance the work of GP’s and improve referral communication with specialists in order to upgrade the quality of the services they provide to their patients.

202-204

Authors: Tahiri Z, Toçi E, Rrumbullaku L, Pulluqi P, Roshi E, Burazeri G

Our survey conducted in 2011 aimed to assess the socio-economic correlates of primary health care personnel satisfaction in Kosovo, the newest country in Europe which is undergoing a difficult socioeconomic transition. In a sample of 142 primary health care professionals in Gjilan region, a significantly lower satisfaction level was reported among nurses compared with physicians. Overall, satisfaction level was positively related to work experience and work conditions.

215-221

Authors: Atanasovska-Stojanovska A

In global terms, periodontitis is the leading cause of tooth loss, and causes serious aesthetic and functional problems. There are numerous scientific evidence that power periopathogenic microorganisms may have influence on some systemic conditions and diseases. If we add the fact that periimplantitis are caused by identical periopathogenes, management or effective identification and elimination of periodontal inflammation set as imperative in successful periodontal treatment and possible complications locally or systemic, as well as resistance and lifetime of the implants. As a method for quantifying and classification of bacterial species are recommended monitoring of the bacterial micro flora through PCR (polymerase chain reaction) technique. Laser therapy as a supplementary method to classic treatment is strongly emphasized as a new therapeutic option that uses the photo-thermal effect to fight bacterial infection. Air flow - an original method that uses water, air and powder help to destroy the biofilm and remove plaque. Oral application of LAD (Light activated disinfection) therapy influence nascent oxygen breaks down the interaction in biofilm and makes the microorganisms more sensitive to further damage. Finally, the role and use of probiotics as a link between the beneficial oral bacteria species and inflammation.