Open Access Macedonian Journal of Medical Sciences

11-15

Authors: Zaki M, Kamal S, El-Bassyouni H, Kholoussi S, El-Gammal M

Background: Body composition changes with age are of interest. They related to various health problems, excess accumulation of fat increases the risk of diseases such as diabetes mellitus, hypertension, osteoarthritis, and cardiovascular disease. Objective: The aim of this study was to determine age differences in body composition among Egyptian obese females. Design: A cross-sectional study was conducted in 600 obese females, 300 young (median age=19 yr) and 300 older (median age=40 yr). Body weight, height, waist and hip circumferences and body composition were measured. Results: Older obese females had a significantly higher values of waist to hip ratio, fat mass (FM) and body fat mass percentage (FM%) than younger obese females. On the other hand, they had a significantly lower values of fat free mass (FFM) and basal metabolic rate (BMR) as compared to younger females. Conclusions: The study showed that proportion of fat mass is different between young and older obese females, although they had similar BMI. The greater decrease in FFM in older obese females might suggest loss of skeletal muscle mass.

24-30

Authors: Petlichkovski A, Stojanoski Z, Cibrev D, Spiroski M

Aim: The aim of this study was to examine the gene frequencies of 16 KIR genes and pseudogenes (KIR2DL1, KIR2DL2, KIR2DL3, KIR2DL4, KIR2DL5, KIR3DL1, KIR3DL2, KIR3DL3, KIR2DS1, KIR2DS2, KIR2DS3, KIR2DS4, KIR2DS5, KIR3DS1, KIR2DP1, and KIR3DP1) and KIR genotypes in Macedonian patients with haematological malignancies, to compare them with the corresponding frequencies of healthy Macedonians and to analyse eventual association of specific genes or genotypes with the studied haematological diseases. Material and Methods: The study included 63 patients of which 40 had acute myeloblastic leukaemia (63.5%), 11 (17.5%) had chronic myeloid leukaemia, 8 (12.7%) acute lymphoblastic leukaemia, 2 (3.17%) non-Hodgkin Lymphoma, 1 (1.59%) aplastic anemia, and 1 (1.59%) chronic lymphocytic leukaemia. Results: Comparison of KIR gene frequencies between the 63 patients and healthy Macedonians reveals statistically significant difference for KIR3DL2 (F= 1 in the control group, and 0.95 in the patients group, p=0.001). Another statistically significant difference was observed for the frequency of Bx3 and Bx439 genotypes both found more often in patients group (P=0.017 and P= 0.009, respectively). Conclusion: Further analysis, involving larger series of patients and targeted at the ligands of the KIRs are needed in order to determine a certain KIR gene and/or genotype as either predisposing, or protecting factor for haematological malignancy in patients from Republic of Macedonia.

37-40

Authors: Yamamah GAE, El Dayem SMA, Salam E, Salama H, Shoman M

Objective: To evaluate prevalence of urinary crystals among Egyptian children in selected 6 localities of South Sinai. Subject and Methods: It is a cross sectional, observational study, included 1918 children from six localities of South Sinai. History of any previous renal problems was taken and urine samples were collected from all patients to search for the presence of any type of crystals. Results: Prevalence of urinary crystals was found to be 28.99 %. The most frequent urinary crystals were oxalate (15.64 %). Oxalate crystals were the highest in EI-Tur, Uric acid crystals were the highest in Abo Redeis, Triple phosphate crystals were the highest in Saint Katrin. Uric acid crystals were significantly higher in children of bedouin area and in children with positive consanguinity. Conclusion: high prevalence of urinary crystals (which predispose to stone formation) among children in South Sinai. City was the most frequent risk factor for the three crystals and oxalate crystals were the most common crystal followed by uric acid.

44-49

Authors: Ikpeme IA, Ilori IU, Udosen AM

Dynamic Screw Systems are useful in proximal and distal femoral fractures, and convey advantages over fixed angle devices. Improved proximal fragment fixation, controlled fracture impaction and a “forgiveness” with respect to axial alignment of the side plate to bone are improvements over fixed angle devices. Image intensifiers are often required to aid lag screw alignment when these devices are used. The equipments are expensive and often not available in some regions of the developing world. There is also the risk of radiation exposure to the surgical team. The burden of musculoskeletal trauma is enormous in the developing world and treatment outcomes are influenced by a host of factors. The choice of the best treatment options for patients in these resource-poor regions remains a challenge. Improvisations that aid appropriate treatment while conveying documented advantages is key to patient care in musculoskeletal disease in these regions. We document our experience in a small cohort of patients who accepted treatment of their fractures with Dynamic Screw devices in a setting without image intensifiers. Technical advances and modifications that reduce the cost of fracture care have the potential of reducing the overall cost of care in the developing world and may offer universal benefits.

50-55

Authors: Pavkovic M, Trpkovska-Terzieva S, Sotirova T, Cevreska L, Stojanovic A

Immune thrombocytopenia (ITP) is an autoimmune disease of unknown etiology, characterized by isolated thrombocytopenia and the absence of any underlying cause for thrombocytopenia. Corticosteroids are the standard first line treatment for patients with symptomatic disease, inducing platelet count recovery in 70-80% of patients; but in many cases, steroid tapering or withdrawal is followed by a decrease of platelet count and the need for additional treatment. Splenectomy is still the standard salvage therapy in cases refractory to corticosteroid therapy. In the past decade monoclonal anti-CD20 antibodies (Rituximab) are being increasingly used in patients with refractory ITP and other autoimmune diseases. Recent studies show that Rituximab is useful in the treatment of patients with chronic and refractory ITP. We report two cases with chronic ITP treated with standard dose of Rituximab in four weekly doses and than continue to receive maintenance therapy with Rituximab for 2 years.

59-64

Authors: Nikolikj-Dimitrova E, Gavrilovski A, Dejanova-Ilijevska V

Background: Treatment of hemophilic arthropathy may be conservative and operative. Conservative therapy includes medications and physiotherapy, and surgery includes synovectomy, tendon release, capsulotomy, osteotomy and total joint arthroplasty. During physiotherapy, surgery and postoperative rehabilitation haemophiliacs need to receive clotting factor. Aim: We present our first experience in multidisciplinary treatment of a patient with severe haemophilia A during and after total hip replacement surgery, the patient’s outcome after postoperative rehabilitation treatment and 6 months later. Material and Methods: In a patient, age 28, with severe Haemophilia A, hip replacement surgery with total hip cementless prosthesis on his left hip was undertaken. Prophylaxis was done with concentrate of human coagulation factor VIII. Patient assessment was made with clinical findings, VAS for pain, Harris Hip Score for surgery outcome. Results: The postoperative rehabilitation treatment program consisted of exercise therapy, occupational therapy and education. After the rehabilitation Harris Hip Score was 79 points, and 89 after six months follow-up. Conclusion: The arthroplasty of the hip can be a valuable option in the management of severe hemophilic arthropathy. The successful outcome of replacement surgery in haemophilia depends upon a close collaboration between the orthopaedic surgeon, heamatologist/specialist of transfusion medicine, physiatrist and other team members.

69-73

Authors: Jurkovikj D, Korneti-Pekevska K

Aim: Besides the most frequent-modal type of confluent patterns intrahepatic biliary ducts, there are cases with aberrant type of confluence. The aim of this report is to present a case with aberrant confluence of intrahepatic biliary ducts. Material and Methods: Injection-corrosive method was used to obtain acrylic cast from biliary and portal systems of one human liver. Biliary ducts were followed parallel to the adjoint portal ramification from the initial part of segmental ductules. Results: Nine portal segments of the liver were established. Segmental biliary ducts and their confluence subsequently from IV to I order, were also seen. The right hepatic duct was absent. The posterior and anterior right sectorial ducts joined consecutively the opposite left hepatic duct in front of the portal bifurcation. As to the segmental ducts 2nd segment duct inflow the left hepatic duct, then 3rd segment duct had merging pattern of double medial sector duct as well as three segmental ducts 5th, 6th and 7th had inflow pattern in posterior sector duct. This specimen with aberrant confluence of intrahepatic ducts has been selected to point out the “close” relationship of found aberrant bile ducts in the liver region. Conclusion: The knowledge of the aberrant anatomy of biliary ducts emphasizes the importance in clinical practice of basic information for portobiliary topography.