Open Access Macedonian Journal of Medical Sciences

395-403

Authors: Samiha M. Gawish, Amina A. Gamal El Din, Hanaa H. Ahmed, Abdel Razik H. Farrag, Amira Abou-El Kheir

AIM: The present work aimed to investigate the effect of the antimicrobial nano Ag/polypropylene (PP\Ag) dressing on incisional wound healing on the experimental level. MATERIALS AND METHODS: Male albino rats were divided into, control, PP/Ag dressing, Silver Sulfadiazine (Ag-SD) cream, blank PP dressing and undressed groups. Animals were sacrificed after 5, 10 and 15 days of incisional wound event. RESULTS: Reduction was found in incision wound length in PP/Ag dressed rats, Ag-SD cream treated rats, and blank PP dressed rats after 5, 10 and 15 days compared to undressed rats. Skin of PP/Ag group showed less adverse histopathological changes, enhanced granulation tissue formation, enhanced angiogenesis, accelerated re-epithelialization and quick complete healing; compared to all other groups. Significant decrease in TGF-β level was recorded in PP\Ag and Ag-SD cream groups as compared to blank PP group on day 5. While, significant decrease in TGF-β level was detected in PP\Ag group when compared with undressed and blank PP groups on day 10. TGF-β showed significant in PP\Ag group as compared to undressed, Ag-SD cream and blank PP groups on day 15. CONCLUSION: The present results suggest that PP/Ag dressing enhances, promotes and plays an important role in wound healing.

408-414

Authors: Olaoluwa S Olukiran, Rufus O Akomolafe, Kayode O Bamitale, Akande O Ajayi, Raphael E Okonji, Ronald A Bejide

AIM: This study was to assess the prophylactic and curative effects of Essentiale forte (ESF) on carbon tetrachloride (CCl4) induced liver damage in Wistar rats. MATERIALS AND METHODS: Twenty-four adult Wistar rats were randomly divided into four groups of six rats each. Group I (control group) received 0.3 ml/kg/day of propylene glycol for one month; group II (toxic control) was given 0.7 ml/kg/day of CCl4 dissolved in olive oil (1:1,v/v) orally for 7 days; group III (prophylactic group) received 4.3 mg/kg/day of ESF for one month followed by CCl4 for one week; group IV (curative group) was treated with CCl4 for one week and subsequently received ESF (4.3 mg/kg/day) for one month. Half of the rats were sacrificed at active period, the other half after a 2-week recovery period. RESULTS: The activities of serum AST, ALT, ALP, total bilirubin level were significantly higher, total protein and GSH levels were significantly reduced in the toxic control group compared to the control group. Group III had significantly higher AST and ALT activities compared to the control rats at active period, whereas after the recovery period no significant differences were observed in almost all the parameters. Moreover, no significant differences in the parameters mentioned above were observed in group IV compared to the control rats at active and recovery period. CONCLUSION: The results of this study showed that Essential forte was better as a curative agent rather than a prophylactic agent in rats.

421-423

Authors: Anel Mehinović, Eldar Isaković, Jasmin Delić

OBJECTIVE: Anomalies of vertebrobasilar vessels arise as early embryonal developmental deteriorations. The majority of them concern the position, origin and shape of the basilar artery. Therefore the present study was carried out to find out the variations in position and shape of the basilar artery using Magnetic Resonance Imaging and CT Angiography. MATHERIAL AND METHODS: The study included 130 consecutive patients, adults of both sexes, treated in UKC Tuzla. Patients were divided into two groups. In one group (100) were patients without aneurysm in the vertebrobasilar tree, and in the second group (30) patients with aneurysm. RESULTS: Three types of variations in the shape of basilar artery were recorded: those with arched course, S-shaped course, and the straight course type. All the three types are approximately of the same percentage prevalence in the group of subjects without aneurysm in the vertebral-basilar tree, as well as in the group with aneurysm. Basilar artery at 89.33% of respondents was located in medial or in paramedial position. CONCLUSION: Attention is drawn to the practical importance of such variations as a possible source of diagnostic errors during cerebral arteriography. We highlight the morphological aspects of the basilar artery, the knowledge of which would help neurosurgeons safely diagnose, as well as plan and execute vascular bypass and shunting procedures for the treatment of stenosis, aneurysms and arteriovenous malformations.

431-438

Authors: Bassem M. Alsawy, Magdi A. El-Damarawi

AIM: This work was done to study the effect of both types of diabetes mellitus (DM) on myocardial contractility in rats. Also, we investigated the role of treatment of DM with insulin and rosiglitazone (used as treatment for type 1 and type 2 DM respectively) in improvement of myocardial dysfunction in diabetic rats. METHODS: The study included 50 male Wistar albino rats, divided into 5 groups: control (group I), streptozotocin induced type 1 DM (group II), fructose induced type 2 DM (group III), insulin treated type 1 diabetic rats (group IV) and rosiglitazone treated type 2 diabetic rats (group V). At the end of the study, retro-orbital blood samples were withdrawn and blood glucose, plasma triglyceride (TG), total cholesterol (TC) and thyroid hormones levels were measured. Rats were then anesthetized and their hearts were excised and connected to Langendorff apparatus to perform mechanical cardiac performance tests including heart rate (HR), left ventricular developed pressure (LVDP) and maximum rate of pressure rise (+dp/dt). RESULTS: Data of the study showed that relative to control group, there was significant increase in blood glucose, plasma TG and TC levels while, thyroid hormones and myocardial performance parameters showed significant decrease in both type 1 and type 2 diabetic rats. Treatment of type 1 diabetic rats with insulin and type 2 with rosiglitazone resulted in significant decrease in blood glucose, plasma TG and TC levels associated with significant improvement in thyroid hormones and myocardial performance parameters. The results also showed that insulin treatment of type 1 was more effective in ameliorating all parameters than treatment of type 2 by rosiglitazone. CONCLUSION: We concluded that the induction of both types of diabetes resulted in decreased myocardial performance parameters. The treatment of type 1 and type 2 diabetes by insulin and oral rosiglitazone respectively improved to a great extent the altered metabolism and mechanical myocardial parameters, with more improving effect of insulin in type 1 than rosiglitazone in type 2 DM.

444-447

Authors: Kumaresan Ramanathan, Giri Padmanabhan

BACKGROUND: It is unclear whether the glycated hemoglobin (HbA1c) assay accurately reflects glycemic control in patients with chronic kidney disease (CKD). AIM: To evaluate the usefulness of glycated albumin (GA) in diabetic CKD population with reference to glycemic control in comparison to HbA1c. MATERIALS AND METHODS: Totally 194 Diabetic CKD (Male: 126, Female: 68) patients who attended a private nephrology clinic, were taken for the study. The age ranged between 18 to 87 years. Blood samples were collected in fasting state in all the patients and all biochemical estimations were done using fully automated analyzer. RESULTS: The mean estimated GFR levels were 82.47, 44.32, 24.13 and 10 ml/min/1.73 m2 in Group I, II, III & IV respectively. The GA levels were significantly increased when the eGFR levels have been decreased. Also the GA: HbA1c ratio differed significantly when compared between the groups I & II, I & III and group I & IV of CKD patients. CONCLUSION: GA estimation is a useful marker in assessment of short term glycemic control in stage III & IV (< 30 ml/min/1.73m2) diabetic CKD patients. GA: HbA1c ratio if routinely done may also become a useful marker in Diabetic CKD population in future.

452-455

Authors: Kristin Grigorova-Petrova, Daniela Lubenova, Antoaneta Dimitrova, Dimo Baldaranov, Julia Lozeva

BACKGROUND AND PURPOSE: Clinical practice guidelines for patients with stroke recommend early stroke rehabilitation at acute stroke unit care. The purpose of the study is to determine the feasibility of the application of feedback breathing device for respiratory training during the acute period in patients with ischemic cerebral stroke and appropriate program of physical therapy. MATERIAL AND METHODS: Seven patients in acute period – not later than 48 hours after the accident with light to moderate stroke severity under the NIHSS scale. The applied study methods are the following: functional respiratory evaluation, inspiratory capacity with incentive spirometer device, assessing diaphragmatic movement by ultrasonography. RESULTS: Better results in Forced Vital Capacity, Peak Expiratory Flow, inspiratory capacity and ultrasonography have been observed. CONCLUSION: An early targeted impact on respiratory disorders in patients with ischemic cerebral stroke is applicable. To determine the clinical significance larger studies are needed.

461-463

Authors: Zlatica Goseva, Angelko Gjorcev, Elena Jovanovska-Janeva, Suzana Arbutina

BACKGROUND: It is known that there is some relation between airways obstruction and gastroesophageal reflux symptoms (GER) symptoms in patients with chronic obstructive pulmonary disease (COPD). AIM: The aim was to determine frequency of GER symptoms and correlation with pulmonary function tests in patients with COPD. MATERIAL AND METHODS: The study included 58 patients. First group had 20 patients with mild COPD, second group had 18 patients with moderate COPD and third group had 20 patients with severe COPD. We had also a control group with 12 healthy subjects. All subjects completed their self-reported questionnaire about symptoms like: acid-regurgitation, heartburn, dysphagia, dyspnea and chronic cough. RESULTS: COPD patients with airways obstruction and significant GER symptoms had their respiratory symptoms associated with reflux events. More of COPD patients had significant GER symptoms defined as regurgitation and dysphagia once or more per week. Patients with FEV1 less than 50% showed more prevalent GER symptoms compared to those with values of FEV1 grater then 50%. CONCLUSION: GER symptoms are more prevalent in patients with severe airways obstruction when compared to less airways obstructed group and controls. We could suggest an association between the degree of airways obstruction in patients with COPD and the increased rate of GER symptoms.

467-471

Authors: Salih Gulsen

Patients with multiple myeloma suffer from bone pain, and spontaneous spinal and appendicular bone fractures due to osteoporosis. Osteoporosis occurs as a result of the following 2 factors: 1. Plasma cells secrete macrophage inflammatory protein-1 alpha, which induces osteoclastic activity; 2. Use of corticosteroids. The incidence of osteoporotic fractures and other complications of multiple myeloma are well described in the literature, but the management of cervical disc herniation and its associated complications has not been reported to date. Herein we present a case that we think exemplifies the management of cervical disc herniation and its complications. Consecutive multilevel cervical discectomy and placement of PEEK cages between the intervertebral cervical disc spaces may cause compression fracture of the vertebrae located between the PEEK cages in osteoporotic patients under continuous corticosteroid treatment¾whether or not they have MM; therefore, we recommend use of an anterior plate to prevent this complication.

474-478

Authors: Salih Gulsen

Restrictive cardiomyopathy (RCM) in children is associated with a greater risk of embolic stroke than are other congenital heart diseases. After diagnosis, 50% of children with RCM die within 2 years without heart transplantation. As such, all RCM patients are placed on the heart transplantation list and must wait for an appropriate heart for transplantation. Every type of embolic stroke can occur while waiting for a donor heart; therefore, the cardiovascular team must initiate antithrombotic therapy at time RCM is diagnosed. Some pediatric RCM patients experience embolic stroke (50% are the cerebral type) despite antithrombotic therapy, including acetylsalicylic acid, warfarin, and heparine. Neurosurgeons working in hospitals that perform organ transplantation expect to see RCM cases with restrictive large cerebral infarct. We think that decompressive craniectomy should be performed as soon as possible after determining the clinical condition of any patient with RCM and a large right middle cerebral artery (MCA) infarct.

483-487

Authors: Salih Gulsen

Various complications including air embolism have been discussed in large clinical series regarding the parasagittal meningioma. We presented and discussed the patient suffering from persistent hypotension after excision of parasagittal meningioma. A 47-year-old man was admitted to our hospital with complaints of headache and frontal region swelling. His cranial MRI showed a bilaterally located parasagittal meningioma at the anterior one third of the sagittal sinus. Conspicuously, he had large frontal sinus and its length was about totally 7 cm in sagittal and transverse part. During cranitomy, we had to open frontal sinus because of its large size and open the sagittal sinus while removing of the tumor. So coincidental opening of the superior sagittal sinus and/or emissary veins located within diploe of the cranium and frontal sinus may cause hypotension after extubation due to normal respiration led to air escaping from the frontal sinus to the emissary veins placed next to the frontal sinus. Bilateral application of the tamponade embedded with vaseline inside to the nose prevents air escaping from the frontal sinus to the emissary veins.

491-493

Authors: Mehmet Hoxha, Albana Deliu, Elida Nikolla, Gjustina Loloci, Tritan Kalo

Food-dependent exercise-induced anaphylaxis (FDEIA), is a severe form of allergy for which the ingestion of a specific food, usually before physical exercise induces symptoms of anaphylaxis. Patients typically have IgE antibodies to the food that triggers the reactions; however, the symptoms appear only if the co-factors act together. The most common reported cause of these reactions seems to be wheat. In some cases FDEIA is displayed even when the food is eaten immediately after exercise, showing that in FDEIA, not the sequence but rather the coincidence of triggering factors use, is of crucial importance. The risk to develop anaphylaxis in these patients depends on the presence and, in some cases, on the amount of cofactors of anaphylaxis. There are lots of evidences about the role of NSAIDs as cofactors of anaphylaxis.

499-505

Authors: Zsuzsanna Jakab, Agis D. Tsouros

AIM: To present contemporary major public health challenges and comprehensive policy framework and strategic vision of the "Health 2020" for improving population health and well-being in Europe. METHODS: Retrospective study based on the available indicators of the health status of the population in Europe, social determinants of health and health-related behavior, health systems and public health services, and analysis of the WHO policy documents, reports and commitments leading to the new coherent approach and strategic vision "Health 2020". RESULTS: The 21st-century health landscape is shaped by growing global, regional and local interdependence and an increasingly complex array of interlinking factors that influence health and well-being. Most of today’s major public health challenges, including non communicable diseases, antimicrobial resistance, health inequalities and the health effects of austerity measures in some countries, cannot be addressed effectively without inter sectoral and coordinated action at supranational, national and local levels. The 53 countries of the WHO European Region developed and adopted a European policy framework and strategy for the 21st century (Health 2020) as a common, evidence-informed policy framework to support and encourage coordinated action by policy-makers at all levels and in all sectors to improve population health and well-being. CONCLUSION: This article presents the development process of Health 2020 and its main strategic goals, objectives and content. Further, it describes what is needed to successfully implement Health 2020 in countries and how WHO can provide technical assistance to countries that embark on developing health policy aligned with the Health 2020 policy framework. The development and implementation of Health 2020 is a powerful vehicle for concerted inter-sectoral action across the WHO European Region for improving health and well-being of present and future generations. Successful implementation of Health 2020 needs providing technical assistance by WHO to the countries to embark on developing health policy aligned with the Health 2020 policy framework.

510-518

Authors: Dashuri Cela, Loreta Kuneshka, Polikron Pulluqi

AIM: The purpose of this study is: (1) to help monitor the Albanian students’ lifestyle, the way they spend their free time, the weight that studying, networks, screens and sports have in their life; (2) to assess their health risk behaviours, such as tobacco and drug use, weapon carrying and sports betting; (3) to identify differences in behaviour by gender, grade, socioeconomic and demographic status; (4) to understand the influence of parents on their children. METHOD: The study was conducted in May 2013, as a classroom survey of students in urban and rural schools of Elbasan. A questionnaire was distributed to the 8th to 12th grade students to be completed by them anonymously. RESULT: There are a low number of the students that are interested to books and study and meantime, a large number of them spend their free time in front of a screen or hanging out in bars with friends. Moreover, a considerable number of them are engaged in health risk behaviours. CONCLUSION: In students’ lifestyle exist serious problems and these data also provide inside into ways to shape a public health response. We need to change the way society views and treats these problems.

525-528

Authors: Hysaj Vila Brunilda, Shundi Lila, Abazaj Erjona, Bino Silva, Rexha Tefta

BACKGROUND: Hepatitis C is a blood-borne, infectious, viral disease that is caused by a hepatotropic virus called Hepatitis C virus (HCV). AIM: The aim of this study is to determine the prevalence of active HCV infection (HCV–RNA) in the cases that were anti-HCV positive. MATERIAL AND METHODS: Plasma of 301 high-risk for HCV infection consecutive from University Hospital Centre “Mother Theresa” Tirana-Albania, during January 2007 to December 2010 was included in this study. To identify the presence of HCV RNA, the samples were examined by Cobas Amplicor HCV test (qualitative method). RESULTS: From 301 samples analyzed in total, 214 of them resulted positive for the presence of HCV-RNA's, corresponding to a prevalence of 71.1%, with 95% CI interval [65.8 - 75.9] for value of χ2 = 52.7 p value <0.0001. Divide by the sex 56% were males and 44% females, with statistically significant difference between them for value χ2 =4306 p value=0.0380. Among the age groups the highest prevalence was observed in the age groups > 25 years with a significant difference with other age groups for p value <0.001. CONCLUSION: Among tested samples, 71.1 % were confirmed to be positive for HCV –RNA infections. The prevalence of male was highest compared to female. For males and females infected the prevalence was highest in the age group of > 25 years.

532-535

Authors: Thomas Olajide, Justina Seyi-Olajide, Andrew Ugburo, Ezekiel Oridota

BACKGROUND: Procedural tasks are important in patient management, with varying degrees of proficiency expected at different levels of medical training. Little has been done in this region to assess the medical students’ proficiency at performing basic procedures. AIM: The aim of this study is to determine their self-assessed proficiency, degree of participation in performing these procedures and the use of skill-lab training. MATERIALS AND METHODS: The study is questionnaire-based, amongst final year medical students of University of Lagos, Nigeria. RESULTS: One hundred and forty students participated in the study. A significant number (82{58.6%}) self-reported level of proficiency for venepuncture was above average or excellent; for IV line placement it was a little less than half (65{46.4%}) and for urethral catheterisation 44 (31.7%); however it was quite low for the other procedures. Many students self-reported high level of participation for venepuncture (83{59.2%}); sixty one (43.6%) for IV line placement and 30 (21.7%) for urethral catheterization. The correlations between self-assessed levels of proficiency and participation were significant for all procedures. There was no exposure to the use of mannequins. CONCLUSION: Self-reported proficiency is lacking for basic procedures in a significant proportion of students with a low level of participation.

544-549

Authors: Aleksandra Plavsic, Rada Miskovic, Sanvila Raskovic, Mirjana Bogic, Branka Bonaci Nikolic

Antiphospholipid syndrome is an autoimmune disorder defined as association of vascular thrombosis and/or pregnancy complications with presence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin and anti-β2 glycoprotein I). It is the most common cause of acquired thrombophilia, and can occur as an independent entity or in relation with other diseases, especially systemic lupus erythematosus. Presence of antiphospholipid syndrome in systemic lupus erythematosus is additional vaso occlusive factor in already present inflammation, bringing further risk for thrombotic events. Clinical and serological manifestations of antiphospholipid syndrome and systemic lupus erythematosus are very similar, so possible connection for these two autoimmune disorders is assumed.