Open Access Macedonian Journal of Medical Sciences

185-190

Authors: Abdel-Moaty MIA, El-Shebini SM, Ahmed NH, Hussein AMS, Mohamed MS, Tapozada ST, Hanna LM

AIM: To investigate the association between the circulating vaspin concentration and both of glucose homeostasis and insulin resistance in metabolic syndrome (MetS) patients, and also to evaluate the metabolic impact of two different dietary therapies on such conditions. MATERIALS AND METHODS: Fifty eight obese female volunteers suffering from MetS, followed a specially designed dietary therapy consists of a low caloric balanced diet, accompanied by either 30% doum biscuits (group A), or whole wheat biscuits (group B) for four weeks (phase 1). During the next four weeks, they were continued on the hypocaloric diet alone (phase 2). RESULTS: The health effects of two dietary therapies were more prominent in improving the biochemical markers of the MetS than in the body weight reduction. The lower levels of serum vaspin were significantly increased at the end of the 1st phase in both groups especially group (A). Sustained negative correlations were detected between vaspin level and both of C-peptide and insulin resistance expressed as modified homeostatic model assessment (M.HOMA). CONCLUSION: The effect of the dietary supplements may play a role in alleviating the impact of the components of the MetS and may also sustain the level of the vaspin in the sensitization of the C-peptide in order to attain glucose homeostasis.

198-208

Authors: Gulsen S, Cokeliler D, Goktas H, Kucukturhan A, Ozcil B, Caner H

Delaying of bone fusion in osteoporotic patients underwent spinal stabilization surgery leads to screw loosening, and this causes pseudoarticulation, mobility and fibrosis at vertebral segments. To prevent these complications, the screws coated with recombinant bone morphogenetic protein-2 (rhBMP-2) could be used. To verify this hypothesis, we coated 5 Titanium screws with rhBMP-2 using plasma polymerization method, and also used 10 uncoated screws for making comparison between coated and uncoated screws in different groups. And 15 skeletally mature white New Zealand female rabbits were assigned into three different groups: Group 1(N = 5): No osteoporosis induction and insertion of uncoated Titanium screw into right sacrum of each rabbit in group 1; group 2 (N = 5): Osteoporosis induction and insertion of uncoated Titanium screw into right sacrum of each rabbit in group 2; group 3 (N = 5) rhBMP-2 coated Titanium screw inserted into right sacrum of each rabbit in group 3. In summary, using of these coated screws provides new bone formation, but causes less fibrosis and less inflammation than uncoated screws at the interface between the coated screw and bone. Then the plasma polymerization technique provides controlled releasing of rhBMP-2 from the screw to the bone tissue in osteoporotic rabbits.

215-218

Authors: Ilhami Gok, Fahri Ucar, Orhan Ozgur, Altay Celebi, Omer Sentürk, Sadettin Hulagu

BACKGROUND: The role of the CARD15 gene 3020insC frameshift mutation in the pathogenesis of inflammatory bowel diseases (IBD) investigated without a definitive conclusion. The incidence of this mutation in Turkish patients with Crohn’s disease is not known. OBJECTIVE: We investigated whether the CARD15/NOD2 3020insC frameshift mutation is a risk factor for patients with inflammatory bowel disease in Black Sea Region population in Turkey. METHODS: We studied 3020insC mutation of CARD15/NOD2 gene by allele-specific multiplex PCR in 69 patients with IBD (18 Crohn’s disease [CD] and 51 ulcerative colitis [UC]) and 101 ethnically matched healthy controls. RESULTS: CARD15/NOD2 3020insC frameshift mutation was positive in 7/18 (38.8 %), 13/51 (25.5 %), and 4/101 (4 %) of CD, UC, and healthy control groups, respectively. None of the controls or patients with Crohn’s disease and ulcerative colitis was homozygous for this mutations. CONCLUSION: This study is to investigate a relation between CARD15/NOD2 3020insC frameshift mutation and in patients with IBD in the Turkish Population. C-insertion frameshift mutation is a major contributor to the susceptibility to both CD and UC, but it is not specific to patients with CD in Turkish population.

224-228

Authors: Ilanković AN, Ilanković V, Ilanković NN

Movement disorders and psychomotor deficiency is highly represented among patients in Schizophrenia – residual type. Our therapeutic work and the results we are herewith presenting, reveal that the psychomotor deficiency by Schizophrenia residual conditions represent new and significant indication fields for specific rehabilitation treatment in psychiatry. Evaluation of efficacy after 6 weeks specific rehabilitation treatment with the Vilan method showed: very satisfactory results in correction of involuntary movements of the torso, bradykinesia of the hands, praxia and the simple simultaneous movements; satisfactory correction of involuntary movements of the extremities, walking and the facial gestures. No correction was in: involuntary movement of mouth and face, tremor, ideation, ideo motor series and in complex simultaneous movement.

234-238

Authors: Yamamah GA, Meguid IEA, Fatouh AA, Shaaban HH, Kantoush NA, Beharrey SF

BACKGROUND: Cytokines including Interleukin-5 play a key role in orchestrating the chronic inflammation of asthma. We aimed to determine the level of serum IL-5 in partly controlled atopic asthma in children and to assess the effect of different therapies on their levels. METHODS: The study included 40 children aged 6-12 years with partly controlled asthma. Cases were randomly divided into two groups; group ‘A’ receiving Leukotriene modifiers and group ‘B’ receiving inhaled corticosteroids; each for two months. They were compared to 20 healthy non-asthmatic, matched controls. Serum IL-5 was measured for cases on the first visit and two months after therapy. Absolute eosinophilic count and serum Ig-E were determined. Pulmonary function testing was performed using spirometer at the beginning and two months after regular therapy. RESULTS: Serum Interleukin-5 was significantly increased in asthmatic children during exacerbation and was significantly decreased after treatment. ROC curve analysis showed significant difference of IgE and PEFR after treatment with leukotriene modifier only. CONCLUSION: Serum IL-5 seems to have a role in asthma pathogenesis. Efficiency of the two therapies (ICs & LTA) was similar in this group of patients. Both treatments led to significant decline in serum IL-5, IgE levels and eosinophilic count.

244-248

Authors: Daniela Lubenova, Ekaterina Titianova, Dance Vasileva

AIM: The purpose of the study was to assess the effect of a structured physical therapy (PT) programme on the orthostatic reactivity in patients with diabetic neuropathy (DNP). MATERIAL AND METHODS: The study was performed in 90 patients with DNP (34 male and 56 female, mean ages 60.8 ± 7.8 years) of lower extremities. The orthostatic autoregulation was evaluated using an active orthostatic test. The arterial blood pressure and the heart rate were determined after 10 minutes of rest in lying position before and after 1, 5 and 10 minutes of active standing. RESULTS: At the start of the study a normotonic orthostatic reactivity (NOR) was observed in 32 patients. Abnormal sympathicotonic type of orthostatic reactivity (SOR) was found in 18 patients and asympaticotonic type of orthostatic reactivity (AOR) was established in the remaining 40 patients. After the PT treatment a significant improvement of the orthostatic autoregulation in the groups with SOR and AOR was not found – NOR was observed in 66 patients with DNP (80.3%) at 6 weeks after the start of PT. CONCLUSION: The applied structured PT, later continued as a home exercise programme, significantly improved the orthostatic reactivity in patients with orthostatic dysregulation due to DNP.

253-256

Authors: Mobolaji Oludara, Olufemi Idowu, Nasiru Ibrahim, Ibrahim Mustafa, Abdulwahab Ajani, Rufai Balogun, Babatunde Solagberu

BACKGROUND: This study sets out to establish a database of BID patients presenting at the Lagos State University Teaching Hospital (LASUTH). METHOD: A retrospective study of consecutive ‘’Brought in Dead‘’ (BID) patients seen from April to November 2011 at the surgical emergency room of the Lagos State University Teaching Hospital (LASUTH) was done using a validated questionnaire. RESULTS: A total of 144 BID patients were seen during the study period. There were 112 males or 78% and 32 females or 22% of the total (M:F=3:1). The age group with the largest number of victims was the 31-40 age groups; and there were 37 patients (30.8% of 120 cases captured under age group). Trauma also accounted for 104 patients (72.2%) with 52 (36.1%, 50% of trauma cases) of these caused by Road traffic injuries (RTI), and Gunshot injuries accounting for 21 (14.6%, 20.2% of trauma cases). Among the Trauma BID cases from RTI, 4-wheeled vehicles accounted for 20 cases (19.2%, 40% of RTI), whilst motor cycle injuries accounted for 12 cases (11.5%, 24% of RTI). CONCLUSION: The study shows that road traffic injuries and gunshot injuries, accounted for 70% of BID cases presenting at LASUTH. Majority of cases of RTI are from 4 wheeler vehicles (40%) and motorcycles (24%).

261-264

Authors: Hassan Boskabadi, Shahin Mafinezhad, Fatemah Bagher, Yasaman Bozorgnia

Background: Hyperbilirubinemia is the most common reason for admission during the neonatal period and may develop serious complications. Thrombocytopenia is defined as platelet count <150,000/mm3 and has not been conclusively reported as a complication of hyperbilirubinemia in any of the standard paediatric textbooks. The aim of this study was to find the incidence of thrombocytopenia in neonates with idiopathic jaundice and the relationship between hyperbilirubinaemia and platelet count. Methods: This was a descriptive-analytic study accomplished on 878 newborns. After a detailed history, clinical examination and baseline investigations,185 babies with idiopathic hyperbilirubinemia were tested for platelet counts and then categorized in two groups namely group A (n=65) and group B (n=120) showing the presence and absence of thrombocytopenia, respectively. Newborns data were recorded and Statistical analysis was carried out, using SPSS 11.5. Results: The incidence of thrombocytopenia was seen in 65 (12%) newborns admitted due to jaundice. The mean serum bilirubin in group A and B was defined as 19.7 (± 6) and 20.4 (± 5), respectively (P = 0.362).There was no significant difference in Laboratory variables likeTSH, T4, coombs test, reticulocite count, serum sodium and hematocrit values between two groups. Conclusion: This study determines higher rate of thrombocytopenia among idiopathic hyperbilirubinemic neonates (36%) and helps the practitioner to be aware of this association and avoid unnecessary investigations.We did not find a significant correlation between serum bilirubin values and thrombocytopenia.

271-276

Authors: Mohieldin M. Ahmed, Douaa M. Mosalem, Wafaa A. Tarshouby, Aziz K. Alfeeli, Ayyoub B. Baqer, Mohamed H. Mohamed

BACKGROUND: Diabetic peripheral neuropathy (DPN) often has reduced stability during standing conditions. AIM: To compare balance control in diabetic patients and normal subjects using computerized dynamic posturography and to assess effect of visual feedback-based balance training in DPN. MATERIALS AND METHODS: A total of 57 patients of type 2 diabetes mellitus and 30 age-matched normal control subjects were recruited. The sensory organization test was done before and after the training program. RESULTS: There was a significant decrease of mean (± SD) of composite equilibrium score and somatosensory ratio score between subgroups of DPN and control healthy group (p < 0.05). There was a significant increase of mean (± SD) of composite equilibrium score and the somatosensory ratio score after treatment as compared to results before training (p < 0.05) in mild DPN. Moreover, there were a significant correlation between composite equilibrium score and disease duration before training in the severe DPN (r = 0.368, p < 0.05). CONCLUSIONS: Computerized dynamic posturography is an important quantitative tool in the assessment of posture instability and allows for early disclosure of the failure of the postural control system. Visual feedback-based balance training was shown to be a promising method for fall prevention among early diabetes mellitus with peripheral neuropathy.

283-288

Authors: Yusr I. Kazem, Maha I. A. Moaty, Salwa M. El-Shebini, Salwa T. Tapozada, Laila M. Hanna

OBJECTIVE: To evaluate the levels of serum vitamin D (25-hydroxyvitamin D) among obese Egyptian females and search possible association with cognitive functions and insulin resistance. SUBJECTS AND METHODS: This study included 2 groups, Group-1(cases) consists of 120 obese females and Group-2 (controls) consists of 30 non-obese females. The included females were subjected to full clinical examination, anthropometric measurements and Kendrick Battery for evaluation of cognitive functions (short term memory and attention). Evaluation of serum Vitamin D, Parathyroid hormone, C-peptide and fasting blood glucose were done. The obese group was put on a balanced low caloric diet (900-1000 K Calories/day) for 2 months, where reevaluation was performed. RESULTS: Comparing obese group with non-obese control group revealed significant lower mean level of serum vitamin D associated with significant lower cognitive functions test and higher fasting blood glucose. After 2 months of low caloric diet, a significant increase in the serum level of vitamin D, accompanied with improvement in cognitive functions and decrease in fasting blood glucose and improved insulin resistance was seen. A correlation is found between vitamin D serum level and cognitive functions. CONCLUSION: A lower vitamin D serum level could be a modifiable risk factor for obesity, insulin resistance and cognitive impairment in middle age females.

293-298

Authors: George A. Asare, Ruth Tetteh, Elsie Amedonu, Bernice Asiedu, Derek Doku

AIM: The purpose of the study was to determine the levels of Copper (Cu), selenium (Se), Zinc (Zn), Lead (Pb) and Lithium (Li) in patients in Accra and Pantang Psychiatric Hospitals in Ghana since no data exist. SUBJECTS AND METHODS: Simple random sampling of age-matched subjects was used to recruit 81 schizophrenics and 25 mentally healthy controls in 2012. Serum levels of Cu, Se, Zn, Pb and Li were determined by flame atomic absorption spectroscopy (FAAS). RESULTS: Mean levels were as follows: Cut 766 ± 250 µg/L and Cuc 855 ± 270 µg/L (p = 0.168). Set 149 ± 72 µg/L and Sec 108 ± 61 µg/L (p=0.009). Znt 702 ± 438 µg/L and Znc 1007 ± 593 µg/L (p = 0.028). Pbt 1.38 ± 0.05 µg/L and Pbc 0.10 ± 0.05 µg/L (p = 0.000). Li levels for the test group (Lit) was 4077 ± 2567 µg/L, whiles that of the controls was undetectable < 0.02 µg/L. Se, Pb and Li levels were significantly higher in schizophrenic patients compared to controls. While Zn and Cu levels were lower in the same group. CONCLUSION: Trace elements dysmetabolism exist among Ghanaian schizophrenics and monitoring is essential to avoid the adverse effects of metal overload or deficiency.

303-308

Authors: Neeraj Sharma, Hemant Batra, Manjula Mehta, Jagdish Chander

In the maxillofacial skeleton, chronic osteomyelitis is more often observed in the mandible than maxilla. Maxillary osteomyelitis is rare because of its rich blood supply. It is usually seen in individuals with impaired immune response, uncontrolled diabetes and hospitalized patients. It can be caused by bacterial, fungal or viral infections. We report a rare case of maxillary osteomyelitis caused by an emerging mucormycete, Apophysomyces variabilis.

313-315

Authors: Alfred Ibrahimi, Saimir Kuci, Ervin Bejko, Stavri Llazo, Esmerilda Bulku, Diana Dhimitri, Ilir Ohri

Rhabdomyolysis and myoglobinuria are the main cause of the acute renal failure. Hyperkalemia is life threating complication of rhabdomyolisis due to massive cell destruction. We report a case of very severe hyperkalemia treated successfully with high volume hemodiafiltration (CVVHDF).

319

Authors: Mirko Spiroski

The article published by Ilankovic et al., 2013 [1] has been retracted by Editor-in-Chief because corresponding author published the similar paper in Psychiatria Danubina in 2014 [2]. An internal investigation has raised sufficient evidence of the originality in the first paper [1] and self plagiarism in the second paper [2]; as such, we retract this article from the literature on request by corresponding author and in accordance with guidelines and best editorial practices from the Committee on Publication Ethics. We apologize to our audience about this unfortunate situation.

327-334

Authors: Saso Stoleski, Jordan Minov, Jovanka Karadzinska-Bislimovska, Dragan Mijakoski

OBJECTIVE: To assess the effect of job exposure and its duration on chronic respiratory symptoms and ventilatory capacity among agricultural workers. METHODS: We performed a cross-sectional study including 120 agricultural workers aged 36 to 53 years, compared to an equal number of office workers matched by age, duration of workplace exposure and smoking status. A questionnaire was used to record the chronic respiratory symptoms, detailed job history, specific job activities and tasks performed, and smoking history. Evaluation of examined subjects also included functional lung testing by spirometry. RESULTS: We found non-significantly higher prevalence of respiratory symptoms in the last 12 months in agricultural workers with significant difference for cough (P = 0.044), and wheezing (P = 0.031). Mean values of all spirometric parameters were lower in agricultural workers, being significantly different for MEF50 (P = 0.001) and MEF75 (P = 0.000). Adverse respiratory effects and lung function deterioration were more expressed in agricultural workers with duration of job exposure more than 20 years than in those exposed less than 20 years. CONCLUSION: Our data suggest that workplace exposure in agricultural workers may lead to respiratory impairment which is close related to its duration.

344-349

Authors: Nurka Pranjić, Ibrahim Gledo, Ljiljana Maleš-Bilić

BACKGROUND: Numerous studies have observed risk factors for breast cancer. We aimed to investigate and assess the relationship between individual, social, occupational and environmental determinants of breast cancer using a questionnaire among 100 newly diagnosed female breast cancer patients and 100 control female subjects without cancer. METHODS: A case-control study using a family ambulatory based survey was conducted among 200 female patients from all municipalities of Zenica - Doboj Canton. New cases of breast cancer among subjects of experimental group (n = 100) were diagnosed between January 1, 2003 and December 31, 2007 using the institutional clinical procedure for breast cancer diagnosis. Data were obtained using a self - rated questionnaire specially designed for this research. The questionnaire contains a group of questions about individual and demographic data, occupational and environment characteristics, reproductive hystory, body mass index, life style and quality life factors. RESULTS: Fifty two percent of our examinees with breast cancer are housewives. There were no significant differences between the two groups and their subgroups except for prevalence of routine physical activity (P = 0.016), unemployment (P = 0.004), history arrival menopause (P = 0.012), and type of occupation/ workplace (P = 0.015) among subjects with breast cancer in relation to control subjects. We found significantly higher prevalence for failure to routine physical activity (P = 0.006), obesity (P = 0.009), unemployment (P = 0.001), unsecure existence (P = 0.015), and low level of education (P = 0.001) in housewives in relationship to others occupation. CONCLUSION: The most common new cases of breast cancer were among housewife. Inverse significantly link between breast cancer and poverty, arrival time of menopause and distant-cousin- degree family history were found. For most women, physical activity may reduce the risk of invasive breast cancer.

353-359

Authors: Dimitrinka Jordanova Peshevska, Marijana Markovik, Dinesh Sethi, Eleonora Serafimovska, Tamara Jordanova

OBJECTIVES: One of the study objectives was to explore the prevalence of elder abuse and neglect in the country. METHOD: Total of 960 respondents aged 65 years and above (44.7% of male and 55.3%) in private households, from all eight statistical regions participated in the study. Respondents were sampled through three staged national representative sampling procedure. Data were collected using a cognitively validated questionnaire for investigating elder abuse and neglect (psychological abuse, physical abuse, physical injury; financial abuse; sexual abuse and neglect) and Geriatric Depression Scale. The MMSE test was used as a pre-selection method. Statistical significance was set up at p < 0.05. RESULTS: Three hundred seven (32.0%) respondents reported experience of any type of abuse and neglect. A single form of abuse was reported by 56.4% of participants, and two types of abuse by 27.4% of participants reporting abuse. Data showed that psychological abuse was the most prevalent form of abuse (25.7%), followed by financial abuse (12.0%), physical abuse (5.7%), physical injury (3.1%) and sexual abuse, and reported only by females (1.3%). Some type of neglect was reported by 6.5% of respondents. CONCLUSIONS: Defining the phenomenon of elder abuse and neglect in the context of our country can facilitate support of abused older people and, most importantly, may help develop policy and programmes based on evidence-based practices, targeting prevention and response.

367-372

Authors: Dimitrinka Jordanova Peshevska, Marijana Markovik, Dinesh Sethi, Eleonora Serafimovska

OBJECTIVES: The objective of the study was to mesaure the 12-months prevalence of elder abuse and neglect in private huousehold and to examine the relationship and community level risk factors for elder abuse and neglect. METHOD: Total of 960 respondents aged 65 years and above in private households, from all eight statistical regions participated in the study. Nationally stratified quota sampling procedure was applied, through four stages. Information was collected in face-to face interview on socio-demographic, healthy life style, physical and mental health, and abuse and neglect types characteristics of elder population. Data were examined using descriptive statistics, binary logistic regression, and odd ratios (OR). Statistical significance was set up at p < 0.05. RESULTS: The respondents reported prevalence of psychological abuse 25.7%, followed by financial abuse 12 %, neglect 6.6%, physical abuse 5.7%, physical injury 3.1%, and sexual abuse 1.3% (reported only in female respondents) in the previous 12-months. Living with close relatives, dissatisfaction with the household income, less equipped households, lacking property of house/flat are associated risk factors for elder maltreatment on relationship level. Living in the northeast, southeast, and Polog region are associated risk for elder maltreatment. CONCLUSION: Study findings emphasized the previous data obtained with regards to the community and relationships risk factors for elder maltreatment.

379-383

Authors: Marija Raleva, Dimitrinka Jordanova Peshevska, Izabela Filov, Dinesh Sethi, Antoni Novotni, Dimitar Bonevski, Kadri Haxhihamza

OBJECTIVES: One of the main objectives of this paper is to analyze the associations between childhood abuse, household dysfunction and the risk of attempting suicide among young adolescents in the country. METHOD: A representative sample consisted of total 1277 students (58.6% female and 41.6% male), aged 18 and above in year four of 664 secondary school and 613 first- and second-year university students. The data were obtained using Adverse Childhood Experiences Study Questionnaires (Family Health History Questionnaire) for collecting information on child maltreatment, household dysfunction and other socio-behavioural factors, applying WHO/CDC-recommended methodology. Statistical significance was set up at p<0.05. RESULTS: Emotional neglect, physical abuse and physical neglect were the most frequent abusive experiences students had. Overall, suicide attempts were reported by 3.1 % of respondents (4.7% by females and 0.8% by males). Those respondents who had been emotionally abused were almost three times as likely to attempt suicide, physical abuse almost doubles the chances of attempting suicide, substance abuse in the family increased the chances 2.3 times for attempting suicide, violent treatment of the mother almost quadrupled them for attempted suicide, having a family member who had been in prison increased the odds of almost 3.5 times for attempting suicide. Attempted suicide was found to be 1.5 times more likely as the number of ACEs reached 3 and 3.4 times more likely as the number of adverse childhood experiences reached four or more. CONCLUSION: Identifying and treating children, adolescents and young adults who have been affected by adverse childhood experiences may have substantial value in our evolving efforts to prevent suicide.

390-394

Authors: Izabela Filov, Marija Raleva, Dimitrinka Jordanova Peshevska, Dinesh Sethi, Gordana Ristevska-Dimitrоvska, Kadri Hazdi Hamza, Ana Poprizova

OBJECTIVES: The aim of the study is to determine the relationship between of the problem of alcohol abuse and child maltreatment. METHOD: The ACE study was administered by the University Clinic of Psychiatry, Department for Child and Adolescent Psychiatry. The ACE study used a representative sample of students in year four of secondary school (aged 18 and above) and first- and second-year university students. The sample consisted of 664 secondary school students (258 males and 406 females.The university student sample consisted of 613 (343 female and 270 male) students from four universities. The data were obtaining by applying ACE Study Questionnaires. RESULTS: Individuals who experience psychological abuse are more prone to develop alcoholism. One of the most serious risk factors for abuse and neglect of children was alcoholism, as a form of household dysfunction. Overall, 13.4% of students lived with someone who misused alcohol. Overall, 10.7% lived with someone who was alcoholic. The association to each ACE was highest among respondents who grew up with two alcohol-abusing parents compared with persons with no alcohol-abusing parents. The health-risk behaviours of most concern included among the others alcohol use (by 82.2% of students). Alcohol use is widespread among students and its prevalence rate is almost 28% by both sexes, and they start drinking at the age of 14–15. CONCLUSION: Among the most frequent household dysfunctions was alcohol use by a family member and about 82% of respondents had ever used alcohol.