Open Access Macedonian Journal of Medical Sciences

219-226

Authors: Trojacanec J, Zafirov D, Jakjovski K, Gjorgjievska K, Trojacanec P, Labacevski N

Background: Diabetic nephropaty (DN) occurs in approximately 40% of patients with diabetes mellitus, and is the most common cause of end-stage renal disease. The combination of ACE inhibitors with ARB could lead to a more effective inhibition of rennin angiotensin aldosterone system (RAAS). Aim: The present study was undertaken to evaluate the effects of dual RAAS blockade with ARB (candesartan) and ACE inhibitor (perindopril) in streptozotocin induced diabetic nephropathy versus ACE-inhibitor or ARB alone. Materials and Methods: Wistar rats (n=125), were used in this investigation. Diabetes was induced by streptozotocin (STZ) 60 mg/kg. The diabetic rats (n=100) were randomly assigned to receive vehicle, ARB-Candesartan (5 mg/kg/per d), ACE inhibitor-Perindopril (6 mg/kg/per d), or a combination of low dose Can+Per (2.5 mg/kg/per d and 3 mg/kg/per d) respectively, from weeks 4-12. Results: Treatment with candesartan or perindopril as monotherapy, although significantly, only partially prevented the symptoms and signs of DN. Candesartan and perindopril were equally effective in treatment of DN. Combination therapy was more effective than monotherapy with either drug. Conclusion: The results from this study demonstrate that combination treatment with both ACE and ARB in low doses may offer synergistic blockade of the RAAS, not obtainable with either drug alone.

232-237

Authors: Sarry El Din A, Hassan N, El-Masry S, Al-Tohamy M

Background: Neck circumference (NC) is a simple screening measure for identifying overweight and obesity. Aims: To determine whether a single measure of NC might be used to identify overweight and obesity, and to define NC cutoff levels for Egyptian overweight and obesity according to existing BMI and WC cutoff levels. Settings and Design: A prospective cross-sectional study from upper and lower Egypt. Materials and Methods: Main indicators included NC, weight, height, waist and hip circumferences (WC) and body mass index (BMI). Results: Pearson’s correlation indicated a significant positive association between changes in NC and changes in body mass index and WC in both men and women. ROC analysis showed that the area under the curve (AUC) for NC and BMI >25 kg/m² was 0.80 for men, 0.69 for women, respectively, while that for BMI>30 kg/m² was 0.88 for men, 0.75 for women, respectively. NC ≥ 38 cm for men and ≥ 36 cm for women were the best cut-off points for determining subjects with overweight. Conclusion: NC measurement is simple and timesaving screening measure that can be used to identify overweight and obesity. Patients with NC >38 cm for men and >36 cm for women require additional evaluation of overweight or obesity.

244-250

Authors: Iric-Cupic V, Milanov S, Davidovic G, Zdravkovic V, Vuckovic-Filipovic J, Vucic R, Simic I

Background: Ischemic heart disease IHD is a most common manifestation of generalised atherosclerosis. Hyperlipidemia is one of the most significant risk factors causing atherosclerosis. Becouse of this, statin therapy is the guideline in therapy of hyperlipoproteinemia. Aim: The aim of this study was to show the hypolipemic effect of statins. Material and Methods: The research included 74 patients with hyperlipoproteinemia type II and III, with (59 patients) or without (15) coronary disease diagnosis. All patients have been treated with statins. In all patients, we analizing statins hypolipemic effects, and the research was carried out: before therapy, after 2 and 6 weeks, 3 months, and than every 3 months during 2 years of treatment. Results: Target value of lipoprotein profile parameter is achieved after 3-6 months of statin treatment. According to the results HDL-cholesterol was changed with the statins for 12.5% average; the highest average value change of 27.5% was recorded at the end of follow-up, and the minimal mean change, observed 2 weeks after therapy initiation was 4.59%. Conclusion: The statin therapy has significant effect on lipoprotein profile and atherogenic index. That effect is the most intensive after 3 month therapy, and target level of lipoprotein parameter are achieved after 3-6 months of statin treatment.

255-260

Authors: Akanmu ON, Soyannwo OA, Sotunmbi PT, Lawani-Osunde AS, Desalu I, Adekola OO, Oridota SE

Background: Intrathecal opioids as adjuvants to local anaesthetics during spinal anaesthesia have been used to augment the analgesia produced by local anaesthetic agents. The aim of this study is to determine the duration of analgesia following addition of fentanyl to 0.5% hyperbaric bupivacaine during open reduction of lower limb fractures. Material and Methods: This prospective randomized study is comparing the effect of addition of 25μg of fentanyl to 10 mg of 0.5% hyperbaric bupivacaine intrathecally on sixty consecutive ASA I and II patients scheduled to undergo elective open reduction and internal fixation of lower limb fractures (ORIF) at the UCH, Ibadan. The patients were randomized into their either bupivacaine saline (SB n=30) 10 mg (2 ml) 0.5% hyperbaric bupivacaine or bupivacaine-fentanyl combination (FB n= 30) through a 25-guage Whitacre spinal needle. Quality and duration of analgesia as well as any sequelae were recorded. Result: Socio-demographic as well as operating data were comparable between the two groups. Fentanyl provided significantly longer duration of complete (239.97 ± 28.58 vs 129.17 ± 11.61), p<0.001 and effective (276.23 ± 26.21 vs 150.80 ± 10.33) analgesia than bupivacaine alone (p<0.001). The pain intensity (visual analog scale [VAS]) at the time to first post-operative analgesic dose in the Fentanyl-Bupivacaine (FB) groups was significantly lower than in the group BS (p<0.001). Eight of the patients in the control group BS (26.67%) group had hypotension whereas six patients (20%) in FB groups had hypotension that required rapid infusion of crystalloid. There was no statistical difference in the level of shivering in the two groups. No patient in either group developed respiratory insufficiency. Conclusion: Addition of 25 μg of fentanyl to 10 mg of 0.5% hyperbaric bupivacaine intrathecally for open reduction and internal fixation of lower limb fractures significantly prolonged the duration of complete analgesia as well as effective analgesia thereby reducing the need for early postoperative analgesic use without increase in severe adverse effect.

266-272

Authors: Davidovic G, Iric-Cupic V, Milanov S, Simic I, Zivic Z, Janicijevic-Petrovic M

Background: Many cardiovascular diseases are associated with obesity, but, despite this fact, obese people live longer than their normal-weight counterparts do. This phenomenon is called the „obesity paradox“. Aim: Purpose was to investigate the impact of obesity on the final outcome; determine the connection between obesity and heart rate > 80 beats per minute and other risk factors, and presence of „obesity paradox“. Material and Methods: Research included 140 patients with anterior wall acute STEMI treated in Coronary Unit, Clinical Center Kragujevac form January 2001-June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission. Body mass index was calculated as the ratio of body weight in kilograms and body height in squared meters, and classified according to the WHO recomendations. Results: More than 75% obese patients were in both groups, survivors and those who died. In the subgroup with heart rate > 80 results were similar. Obesity had no significant effect on mortality despite the fact that the large number of patients with fatal outcome was obese. Conclusion: Correlation with acute myocardial infarction and elevated heart rate is evident, but obesity was not independent predictor for mortality which can only partly confirm presence of „obesity paradox“.

278-280

Authors: Louai OB, Igala M

Background and Objective: The congenital factor V deficiency, known as Owren's disease or parahemophilia is a rare autosomic recessive haemorrhagic disease of coagulation, identified for the first time in Norway in 1943. In Morocco, there is no national registry including cases of congenital coagulopathy. This study highlights the rarity of inherited factor V deficiency deficiency and the importance of coagulation testing in the diagnosis of condition. Patients and Methods: We report twelve cases of factor V deficiency at our institution. Results: Of the 12 cases, seven were followed at the haematology department; the remaining five were discovered during a family survey. The average age of our patients is 16 years old [1 - 40 years], with a female dominance (Sex ratio F/M: 2). Parental consanguinity was found in three patients, bleeding family history were found in 5 patients. The concept of bleeding was found in 6 of 7 cases of patients followed, in 1 patient’s case the discovery was fortuitous. Conclusion: Inherited factor V deficiency is a rare inherited disorder. The diagnosis is mainly based on coagulation tests; however, the bleeding tendency may be severe and occurs early in life with immeasurable factor II levels.

285-295

Authors: Kirijas M, Spiroski M

Major histocompatibility complex class 1 chain-related genes (MIC) are part of the non-classical MHC genes located on the short arm of chromosome 6. MICA comprises of approximately 11 kb DNA and encodes polypeptide of 383 amino acids. The expression of MICA is limited to the surface of the epithelial cells, fibroblasts, keratinocytes and monocytes, but not on the surface of CD4+, CD8+ and CD19+ lymphocytes. It manifests its role by binding with the NK cell receptor NKG2D. There are 84 different alleles for MICA due to discovered polymorphisms in the exons 2 to 5. The aim of this review is to present the data known so far about the association of MICA with different diseases and the role of anti-MICA antibodies in organ and stem cell transplantation. The frequency of different MICA alleles and their association with different HLA-B alleles, as well as the association of MICA with different inflammatory diseases, infection diseases and tumors was determined. Post- and pre-transplant anti-MICA antibodies are associated with antibody-mediated rejection in kidney and heart transplantation. Patients with hematopoietic stem cell transplantation, which have MICA mismatch, have higher frequency of graft versus host disease episodes. In spite of lack of conclusive data about the role of anti-MICA antibodies in organ and stem cell transplantation, there is still clinical relevance for investigation of the polymorphisms of the MICA gene and anti-MICA antibodies.

299-327

Authors: Macedonian Journal of Medical Sciences

We present abstracts of published papers in international journals deposited in PubMed. Search details were: ((Macedonia[Affiliation] NOT Greece[Affiliation]) NOT "Prilozi"[Journal]) AND ("2012/01/01"[PDAT] : "2012/12/31"[PDAT]), dated September 01, 2013. A total number of 88 papers were selected in PubMed during 2012 year, two of which were not from Republic of Macedonia (one from Greece and one from Kosovo) and were excluded. A total number of 86 papers are included in 2012 year in Pubmed from Republic of Macedonia from which one paper (Mile B, Valerija K, Krsto G, Ivan V, Ilir D, Nikola L. Doxycycline-rifampin versus doxycycline-rifampin-gentamicin in treatment of human brucellosis. Trop Doct. 2012 Jan;42(1):13-7.) was indexed with the names instead of surnames. Authors of this paper should contact Editoarial Board of the Journal Trop Doct in order to correct the errors. Six papers are deposited in the PubMed without abstracts. Editorial Board does not take any responsibility for neither the content, nor the quality of the abstracts.

135-140

Authors: Spiroski M

Aim: The aim of this study was to analyze semantically medical abstracts from the Republic of Macedonia indexed in the PubMed database with GoPubMed. Material and Methods: The analysis was performed with GoPubMed on March 18, 2013 in order to identify indexed papers affiliated with the country Macedonia in the PubMed database. A total number of 1469 abstracts were identified for analysis. Results: Macedonian medical scientists published papers in a total of 400 different journals which have been indexed in PubMed database. The largest number of published papers was in the domestic journal Prilozi. Top twenty Macedonian authors published 72.4% of the total number of abstracts indexed in PubMed. A significant increase of abstracted papers during the period of 1989-2012 was recorded (from 50 abstracts to 180 abstracts, respectively) and a significant increase of relative research interest (from 0.00006 to 0.00018, respectively). Top author networks of the Macedonian scientists have shown that the largest group was composed of scientists working in the field of nephrology and related disciplines. Conclusion: Requirements for at least one paper to be published and indexed in PubMed before a candidate approaches to the Philosophy Doctor Degree defence at the Faculty of Medicine, Ss Cyril and Methodius University of Skopje was a trigger for an increased number of publications indexed in PubMed in the last decade. A larger number of Macedonian medical journals should be indexed in PubMed in order to increase the impact of Macedonian medical scientists in the world.

146-152

Authors: Egwu O, Njoku C, Ukoha U, Eteudo A, Elem B

Objective: The thickness of the triceps surae muscle complex was assessed by ultrasound in a young adult Nigerian population. Its relationship with some anthropometric variables and sexual dimorphism was also assessed. Subjects and Methods: Sixty young adults (30 males and 30 females) between the ages of 19 and 30 years were recruited for the study. Anthropometric protocols for height, weight, foot length (FL) lower leg length (LLL) and mid calf circumference (MCC) were observed. Results: Results show that the mean thickness of the calf muscle complex (CMT) was 81.65 ± 8.92 mm for all the subjects; 83.70 ± 8.73 mm for males; 79.95 ± 8.56 mm for females. The mean mid calf circumference (MCC) was 35.26 ± 2.61 cm for all subjects; 36.41 ± 3.56 cm for males; 34.10 ± 3.33 cm for females. Pearson’s correlation coefficient showed that CMT correlated positively with height, weight, BMI and BSA in the sample subjects. However, such correlations were not observed among the male subjects. MCC also correlated with some anthropometric parameters (height, weight, BMI, BSA, FL) measured. Conclusion: The findings from this study will form the bases for further research on relationships of the calf muscle complex. It also indicates that males have thicker Calf muscles and CMT has a positive relationship with height, weight, BMI and BSA especially among the female subjects.

158-161

Authors: Kopacheva-Barsova G, Nikolovski N, Kirjas M, Avramovski A

Background: Nasal tip projection has been defined as the distance along a perpendicular line from the vertical facial plane to the most anterior projecting point of the nasal tip. The tripod concept, although an oversimplification of nasal tip dynamics, highlights the intimate relationship between projection and rotation. Aim: The aim of the study was to evaluate the rate of nasal tip irregularities after the medial crura overlay procedure, and following the Tripoid concept. Methods: We completed a retrospective review of patients who have been admitted at ENT Clinic, Skopje from the period of 2008-2012. Operative technique rhinoplasty was prepared in 36 patients. Procedures included full-transfixion incision, release of tension septum, lateral crural overlay (LCO), dome truncation, medial crural overlay (MCO), and combinations of them. We reviewed major and minor secondary revision procedures that patients underwent, postoperative complications, and any functional complaints. Results: Of the remaining 36 patients: one (2.5%) required minor revision of dorsal irregularities, 3 (3.0%) required tip revision, 33 patients (93.3%) were satisfied without qualification, 3 patients (3.5%) were not satisfied and wont for revision surgery. Three patients (2.5%) underwent radix grafts. 5 (13.3%) of the patients had had previous rhinoplasty performed by another physicians. Seven patients (18.3%) were classified as having tension nose. One patient had postoperative epistaxis, and there were no cases of postoperative functional complaints. Conclusion: Our revision rate of 4.2% for tip irregularity and our finding that no patients had postoperative functional complaints allows us to feel confident that this algorithmic paradigm can be used to accomplish tip deprojection in almost any circumstance.

168-173

Authors: Jeje E, Olajide T, Akande B

Aim: This study aims to document the indications and common findings in UGI endoscopy and evaluate the relationship between H pylori and endoscopic findings. Methods: The indications for UGI endoscopy and findings detected over a 3-year period were analyzed. Results: The commonest symptoms were epigastric pain, other upper abdominal pain, and dyspepsia while common signs were epigastric and right upper quadrant tenderness, and epigastric mass. Complete data was obtained in 172 patients of which 114 had abnormal findings. The commonest were duodenal ulcer, gastritis and duodenitis. Less common findings were gastric ulcer, gastric cancer and oesophageal cancer. There was no significant difference in the frequency of H. pylori infection between those with normal and abnormal endoscopic findings. Conclusion: The commonest indication for UGI endoscopy in Lagos, Nigeria is dyspepsia while the commonest endoscopic abnormalities are duodenal ulcer, gastritis and duodenitis.

178-181

Authors: Singh A, Coppock M, Mukaetova-Ladinska EB

The diagnosis of Munchausen by Proxy (MbP) is well recognised with children as the victims, but remains infrequently reported in later life. Older frail adults may also become victims of this syndrome. In this study we report a case of an older adult with a diagnosis of dementia and her son being the perpetrator. We discuss the diagnosis of MbP in older adults and review the available literature on MbP for this population. We also highlight the clinical features that should alert the clinicians to this diagnosis as it has considerable impact on the victim’s health and consumes disproportionately large health care resource.

186-188

Authors: Alushani M, Kasa E

Gestational trophoblastic disease is a spectrum of trophoblastic diseases that includes: Complete molar pregnancy (CMP), partial molar pregnancies (PMP), invasive mole (IM), chorioncarcinoma (CHC), and placental site trophoblastic tumors (PSTT). Hydatidiform moles are abnormal gestations characterized by the presence of hydropic changes affecting some or all of the placental villi. Hydatidiform moles arise as a result of an abnormal fertilization. In this report, the patient was a 28 year old Albanian woman who had induction of ovulation with Clomid. The majority of molar gestations arise within the uterine cavity. The occurrence of a hydatidiform mole within ectopic gestational tissue is rare. It is important to differentiate a hydatidiform mole from an ectopic pregnancy, particularly in infertile women who have a history of ovulation induction.

194-201

Authors: Amzai G, Stojanovic A

Aim: The aim of this article is to provide the health professionals with clear, novel and practical guidelines regarding management of fertility in patients with malignant hematological disorders, with special accent on lymphoma. Also, it aims at raising consciousness of all physicians administering chemotherapy, about the undesired effects of many chemotherapy regimens, on the reproductive ability, about available methods for preserving fertility and regarding many other issues in connection with fertility in patients treated for lymphoma. Materials and methods: Online internet databases and publications have been searched, and a systematic literature review has been performed, using the following keywords: fertility, chemotherapy as well as relevant keywords in connection to the subject. Results: Within the search, reports regarding smaller-sized groups, as well as in series of patients and case reports have been found, but relatively few large randomized studies or actual reports regarding the success rate and the influence of methods for fertility preservation in patients treated for Hodgkin's and Non-Hodgkin's lymphoma. We have managed in summarizing a large proportion of the research studies and transferring it into an integral multidisciplinary text, offering valid and applicable options for fertility preservation in patients treated for lymphoma. We use the term lymphoma in general, since the chemotherapy and radiotherapy approaches for Hodgkin's and for Non-Hodgkin's lymphomas are similar, rendering a major part of the fertility preservation guidelines appropriate for both entities. Recommendations: Hematologists should possess fundamental knowledge regarding the late complications of lymphoma treatment. Besides acknowledging the risk of secondary cancer development as well as of non-neoplastic cardiac and pulmonary complications, they should be prepared to raise the issue of infertility as an integral part of the treatment plan, since that is a complication of significant importance for patients treated with chemotherapy within their reproductive life period. Possible methods for preserving fertility should be presented and discussed, and patients should be referred promptly to a reproductive medicine specialist. Cryopreservation of both sperm and embryos are considered standard practice and are generally available, while other methods are still in investigational phase and performed in specialized centers under mandatory professional surveillance and expertise. Conclusion: It is recommended to utilize treatments that are with as little as possible gonadal toxicity, to consider a wide array of options for fertility preservation as soon as possible, and to practice a decision-making process most beneficial for the patient, based on the latest medical accomplishments and most novel prospects.

5-10

Authors: Spiroski M

Aim: The aim of this study was to analyze medical scientific papers in the Republic of Macedonia indexed in the Scopus database. Material and Methods: A search of the Scopus database was performed on February 23, 2013 in order to identify published papers from the field of medical sciences affiliated with the country Macedonia. A total number of 967 articles were selected for analysis and h-index was calculated from these documents. Results: The papers were published in a total of 160 journals. The largest number of papers has been published in domestic journals. Two scientists are top two with 59-65 published papers, the next group of eight scientists have published 25-44 papers, and the rest of the authors have published less than 25 papers, each. The published papers have been cited 4380 times (mean citation of 4.5 per paper) with the Hirsh index (h-index) of 27. Conclusion: An important factor for increasing the quality of the Macedonian medical journals is validation of the published papers in the journals indexed in the Scopus database by the Scientific Board of the Medical Faculty, which is associated with submission and/or defence of PhD theses. Such policy would trigger Editorial Boards of the Macedonian medical journals to improve the quality of their journals and include them in the Scopus database.

16-23

Authors: Miova B, Dinevska–Kjovkarovska S, Cvetkovska F, Mitev S, Dzimrevska A, Dimitrovska M

In the present work we have estimated the effect of acute heat stress (1 hour to 41±0,5°C) and the different period of recovery at room temperature after the heat stress (0, 30 minutes, 1, 6, 12, 24, 48 and 96 hours) over the hepatic carbohydrate-related enzymes and substrates of rats. The obtained results can be summarized in three phases: up to 6th hour, from 6th to 24th hour and form 24th up to 96th hour of recovery after the heat stress. Acute heat stress (up to 1hour of recovery) caused intensive glycogenolysis, associated with moderate, but non-significant endogenous production of glucose. The period of 6th to 24th hour of recovery after exposure to acute heat stress, is characterized with intensive rebound of glycogen stores, with decreased glucose production, and finally, from the 48th up to 96th hour of recovery, process of glycogenolysis is still evident, even though less intensive than the first hours after the heat stress. Overall, we can conclude that acute heat stress and the period of recovery after the heat stress are followed with dynamic changes of the liver carbohydrate-relates enzymes and substrates in a course of elevated glycogenolysis, but decreased glycolysis and gluconeogenesis.

31-36

Authors: Popova Ramova E, Poposka A, Lazovic M, Ramov L

Aim: Scoliosis is a 3D deformation, in a vast related medical literature, we can find quit a few scoliosis evaluation indices, which are based on back surface data and are generally measured along three planes. The purpose of this study was to assess the usefulness of surface clinical measurements for evaluation of condition by patients with scoliosis in shorter terms. Materials and Method: A total of 40 scoliosis patients, with an average age of 13 years, the average Risser sign 3 and an average angle of curvature of 23.67° according to Cobb were included in this study. In research were looking a correlation between convexity of curve by x-ray picture and asymmetry of measurement distances. Results: the data analyze is showing a correlation between decrease of clinical asymmetry and reduction of curve by treatment with significance p < 0.01. The trunk surface asymmetry is still difficult to objectify and it depended of new examination technique shall be done more. Conclusion: External measurements of some anatomical points can be use in physical therapy practice for evaluation of condition by patients with scoliosis with significant correlation of convexity of curve.

41-43

Authors: Ayesh MH, Bataineh AM, Rababeih M, Momani SM, Alawneh K

Objectives: To study the effect of intravenous iron in the management of anemia in erythropoietin (EPO) treated hemodialysis patients with poor response to treatment with oral iron. Methods: Thirty-six patients (27 men and 9 women) with serum hemoglobin of less than 10 g/dl and a serum ferritin level of less than 500 mcg /l were included in the study. Each patient received 100 mg of intravenous iron at end of dialysis for 10 consecutive dialysis treatments, and once weekly of regular intravenous iron supplementation for another 13 weeks included in the study. All patients were receiving oral iron supplements (ferrous sulphate 325 mg twice daily), and were all also receiving EPO, a total dose of 8000 units per week, given subcutaneous as 4000 unit twice weekly throughout the study. The primary end point of this study was hemoglobin level at 4 months of starting intravenous iron supplementation. Results: The mean hemoglobin increased from 8.88 g/dl to11.18 g/dl over the period of the study (4 months) (p<0.0001). The mean serum ferritin increased from 179 mcg/l to 444 mcg/l over the same period (P<0.0001). Conclusion: Intravenous iron supplementation is very effective in correcting a poor response to EPO in hemodialysis patients on oral iron supplements.

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.

56-58

Authors: Vukmirovic F, Vukmirovic M, Vukmirovic I

Introduction: Melanoma is the primary tumor of melanocytes with gastrointestinal metastases which ocurs in about 2% of the patients. Aim: The aim of this paper is to present a patient with multiple simultaneos metastases of melanoma in the gastrointestinal tract and draw attention to the occurrence of gastrointestinal symptoms in patients with melanoma. Patients and Methods. We report a case of 74 years-old male with previously removed skin melanoma three years ago, and with symptoms such as anemia, weight loss and abdominal pain. Results: On gastroscopy two tumours sized 3 cm and 3,5 cm, on the front and rear stomach wall was detected. On colonoscopy, tumor size 3 cm was detected in sigmoid colon. During surgical operation in addition to these were found three more tumors on small intestine sized from 3 cm to 6 cm. Microscopicaly the diagnosis of metastatic melanoma was made. Conclusion: Gastrointestinal metastases of malignant melanoma are rare but it should be considered in any patient with a history of melanoma who develops gastrointestinal symptoms.

65-69

Authors: Spiroska V, Hristova E, Kedev S

Background: Noncompaction of the ventricular myocardium is a rare, unclassified cardiomyopathy due to an arrest of myocardial morphogenesis. The characteristic echocardiographic findings consist of multiple, prominent myocardial trabeculations and deep intertrabecular spaces communicating with the left ventricular cavity. Aim: The aim of this report was to present the first case of noncompaction cardiomyopathy with bicuspid aortic valve in Republic of Macedonia. Case Report: A 19-year-old male with the diagnosis of syncope, tachycardia with arrhythmia, and chest pain was referred to the University Clinic of Cardiology for the echocardiography. Transthoracic echocardiography showed bicuspid aortic valve with normal left ventricular (LV) dimensions and normal systolic function. Mild thickening of the aortic valve cusps and mild aortic regurgitation was found. In addition to these echocardiographic findings, prominent muscular trabeculations and deep intertrabecular spaces communicating with the ventricular cavity were observed in the infero-postero-lateral region, apical and septal portion of the LV chamber. Conclusion: We described first case of combination of left ventricular noncompaction and bicuspid aortic valve in 19-year-old male in the Republic of Macedonia.

74-78

Authors: Kaftandzieva A, Peneva M, Petrovska B, Cekovska Z

Pasteurella spp are the first organisms to consider in any patient who presents with a soft tissue infection following cat scratches, or cat or dog bites or licks. Pasteurella canis is most common isolate of dog bites. A case of a 55- year- old woman with symptoms of infected right leg after a dog bite was described. Microbiological examination of the wounds was performed. The collected specimen was used for Gram stain and culture. No bacteria were detected on a direct gram-stained smear from wound specimens. Both aerobic and anaerobic cultures were performed. After 24 hours, growth of smooth, greyish-white colonies was observed only on Columbia agar. Another Gram stained slide was performed from those colonies and Gram-negative cocobacilli to short rodshaped morphology with bipolar staining was observed. They demonstrate positive catalase and oxidase positive reaction. The bacterium was susceptible to all tested antimicrobial agents. Although systemic forms of Pasteurella are possible, cutaneous infections from animal bites is the most common presentation. Most animal-bite injuries can be treated with oral antimicrobials on an outpatient basis. This patient had been managed aggressively at the very early stage, including surgical debridement and peroral antibiotic, which most likely contributed to the absence of further complications.

1-5

Authors: Jakjovski K, Labachevski N, Petlichkovski A, Senev A, Trojacanec J, Atanasovska E, Kostova E, Spiroski M

Background: Distribution of CYP2C9 and VKORC1 gene polymorphisms may vary significantly among different ethnic groups, and eventually influence the variation in drug metabolism or even failure. Objective: The aim of this study was to evaluate the prevalence of CYP2C9 and VKORC1 alleles in the healthy population of Republic of Macedonia compared to the global geographic data reported from different ethnic populations. Also, to genotype CYP2C9 and VKORC1 genes and eventually to divide individuals in poor, extensive, or intermediate metabolizer. Material and Methods: Blood samples were collected after signing written consent, DNA was isolated from peripheral blood, and CYP2C9 and VKORC1 genes were typed (n=124). Genotyping was performed by commercially available kits (GeneID GmbH, Strassberg, Germany, AID Diagnostica), based on the method of polymerase chain reaction with a subsequent hybridization. The population genetics analysis package, PyPop ver. 0.6.0, was used for analysis of the data. Results: The frequency of alleles varies from 0.931 for CYP2C9*3 to 0.109 for CYP2C9*2 indicating common “wild type” allele in those genes. The frequency ranges spanned ~50% for each allele of VKORC1 gene, indicating no common “wild type” allele in this gene. Test of neutrality showed significant negative value for VKORC1 polymorphism that indicates balancing selection operating on the alleles at that locus. All polymorphisms of CYP2C9*2, CYP2C9*3 and VKORC1 showed a good fit with Hardy-Weinberg expectations. Conclusion: The results of polymorphic alleles of CYP2C9 and VKORC1 genes in Macedonian population can be used for the variation in drug metabolism studies as well for adapting dosage regimes for oral anticoagulant therapies.

12-17

Authors: Ruhullah M, Shah S, Singh HR, Shrestha D

Introduction: Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. We compared primary hip spica with closed reduction and fixation with retrogradely crossed Rush pins for diaphyseal femur fracture in 25 children of age group 3 to 13 years randomly distributed in each group. Methods: Fifty children with femoral fractures were evaluated; 25 of them underwent conservative treatment using immediate hip spica (group A) and 25 were treated with crossed retrograde Rush pins (group B). The patients ages ranged from 3 to 13 years (mean age 5.6±3.57 yrs). Results: Mean clinico-radiological consolidation was within 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing 7 weeks in group B and 14 weeks in group A. Mean hospital stay were 8 days in group B and 4 days in group A. Mean follow up period in group A was 16 months and group B was 17 months. Complications like angulation, shortening, infection were compared. Bursitis and penetration of pins at the site of Rush pin insertion is complication associated with this method of treatment. Conclusions: Intra-medullary crossed Rush pinning is an effective method of paediatric diaphyseal femur fracture fixation as compared to primary hip spica in terms of early weight bearing and restoration of normal anatomy.

21-26

Authors: Ezzat WM, Ragab HM, El Maksoud NA, Abdulla NA, Elhosary YA

We aimed to detect the validity of serum ATX as a diagnostic marker for liver fibrosis. Forty-eight males and 16 females were enrolled in the current study. Their ages ranged from 29-57 years with mean of 45.09, all were chronically HCV infected. Laboratory assessment was done for all subjects in form of complete blood picture; liver function test; lipid profile and serum detection of ATX. Patients were grouped according to the stage of fibrosis into group 1: fibrosis score 0, 1, 2, 3; group 2: fibrosis score: 4, 5, 6.The mean values of ATX in all studied patients with chronic HCV infection was 63.02 ± 36.29 while that of healthy controls was 65.31 ± 12.24 without any significant difference. Surprisingly, mean values of ATX were higher among patients with group 1 but it did not reach the significant level. In each group of them, the differences between mean values of ATX among different grades of liver fibrosis were insignificant. It was also noticed that the mean values of ATX were higher among men than in women .It was concluded that Autotoxin might not be used as a useful diagnostic marker for liver fibrosis in Egyptian chronic HCV patients.

32-37

Authors: Zisovska E, Lazovska B

Background: A phenotype is the composite of the observable characteristics, and in some cases it is not representative for identification of recognized genetic structure. Aim: The aims of the study were to present the incidence and clinical features of dismorphia in newborn children, and to investigate the prevalence of phenocopies among them. Material and Methods: Newborns born at the University Clinic for Gynecology & Obstetrics, having at least 3 minor anomalies (mm) specific for Down syndrome were investigated. Patients’ histories, observation, cytogenetic analysis of peripheral blood samples were analysed. Results: Among 17835 liveborns during 5 years’ period, 128 were detected having at least 3 mm, calculated incidence of dysmorphia 0.83% (1:139). Cytogenetic analysis was not performed in 3.1% (4/128) due to immediate death or transfers elsewhere, 30.5% (39/128) were confirmed Down syndrome. Cytogenetic analysis showed trisomy 21 in 97.4%; Robertsonian translocation had one newborn (2.6%); normal cytogenetic structure had 66.4% (85/128) of the newborns. Conclusons: Other studies didn’t highlight the proportion of phenocopies of Down syndrome in unselected population of newborns, mainly investigating sick children, disabled, or older-aged. As more the critical role of phenocopy emerges, the more the initial difficulty in detecting gene-gene interactions is amplified. Neglecting the possible presence of phenocopies in complex traits, heavily affects the analysis of their genetic data.

45-49

Authors: Janicijevic-Petrovic MA, Petrovic M, Vujic D, Janicijevic K, Popovic A

Aim: To evaluate success rate (efficacy, safety) in treatment of post-chemical injuries and corneal defects using autologous serum eye drops. Material and Methods: Authors reviewed 93 patients (116 eyes) hospitalized in Clinic of ophthalmology from 2010 to 2013, who had post-causoma corneal defects that were nonresponsive to conventional treatment and were treated with serum therapy. Authors correlated time of epithelialization of defects with rate of epithelial healing. Results: Authors investigated 93 patients (52 males, 41 females; aged 18 - 74) for treatment of corneal defects. Application of autologous serum therapy 56 (48.28%) of 116 eyes was healed in an average time of 4 weeks. Among 116 eyes, epithelial defects healed in 4 (3.45%) within 1 week, in additional 17 (14.65%) in 1-2 weeks, totalling 31 (26.72%) within 3 weeks. Five eyes (4.31%) completely healed at 5 week; three eyes (2.59%) had subsequent healing of epithelial defect at 6 week; 56 eyes completely healed within one month, and the remaining eight eyes healed within 1.5 month. Conclusion: Using serum therapy, it was managed to reduce time of healing from eleven weeks, which were necessary just couple years ago (before 2010) to four (maximum six) weeks to complete healing which are necessary today.

54-58

Authors: Holecki M, Skorupa A, Duława J, Chudek J

Objective: Hypercalcemia as the consequence of an excessive bone resorption is a common complication in patients with cancer. The aim of the study was to analyze the prevalence of hypercalcemia in patients with tumor-induced osteolysis starting therapy with bisphosphonates. Methods: The questionnaire-based survey (data collected during three consecutive examinations within a 3-month period) was conducted among 1,450 patients treated with bisphosphonates for tumor-induced osteolysis. Results: Hypercalcemia was found in 8.7% respondents starting the treatment with bisphosphonates. The most common cause of malignancy-associated hypercalcemia was prostate cancer, multiple myeloma and breast cancer. On the other hand, hypercalcemia was the most prevalent among patients with multiple myeloma, metastatic cancer of an unknown primary origin and bladder cancer. Metastases were reported in 342 patients, while pathological fractures in 37. The normalization of calcium level was obtained in 91.4% of the patients treated with bisphosphonates, mostly clodronate. During the bisphosphonate therapy, pathological fractures occurred in 4.6% of patients and the percentage of the patients reporting bone pain decreased from 79.9% to 30.9%. Conclusion: Multiple myeloma, prostate and breast cancer are the most common causes of hypercalcemia of malignancy in patients with tumor-induced osteolysis starting therapy with bisphosphonates.

66-69

Authors: Barbov I, Arsova S, Taravari A, Petrova V

Background: Silent brain infarctions (SBI) are common findings in advanced age, but their relationship to dementia is still uncertain. Aim: The present study was designed to evaluate whether SBI predict the development of dementia after first clinical ischemic stroke. Methods: We blindly studied admission CT scans of 102 consecutive nondemented patients presenting with ischemic stroke that clinically was their first stroke episode. SBI were defined as CT evidence of infarcts not compatible with the acute event. The patients were subsequently followed for their mental state for 2 years. Survival analysis, wherein onset of dementia was the end point, was performed on the total sample population and conducted separately on those with and without SBI at admission. Results: Dementia developed in 33 patients (32.3%), including 17 of the 37 (45.9%) with SBI and 16 of the 65 (24.6%) without SBI. Thus, dementia was strong related to SBI. Conclusion: Elderly people with silent brain infarcts and stroke have an increased risk of dementia and a steeper decline in cognitive function than those without such lesions.

76-82

Authors: Zohir N, Afifi R, Ahmed A, Aly Z, Elsobekey M, Kareem H, Helmy R

Background: Oral anticoagulant therapy is conditioned by environmental and genetic factors. Objectives: To verify the effect of the calumenin, cytochrome P-450 variants and VKORC1 genetic polymorphisms on the response to warfarin therapy and warfarin dose adjustment. Patients and Methods: We selected fifty warfarin treated patients with dose adjusted at INR value between 2 and 3. PCR-RFLP is used for of calumenin gene polymorphism. Insitu Hybridization was used for identification of VKORC1 promoter and CYP2C9 variants polymorphisms. Results: The warfarin dose in the patients with Calumenin and CYP2C9 genetic polymorphism was lower than the wild type gene. The warfarin dose in the patients with VKORC1 variants was statistically lower compared to that of the wild-type. The presence of combined CYP2C9 genetic variants and VKORC1 polymorphism was associated with lower warfarin dose than that the wild types. Conclusion: Calumenin (CALU) might be a new genetic factor involved in the pharmacogenetics of anticoagulant therapy.

87-89

Authors: Fida M, Kellici S, Hoxha M, Qirko E

Background: Propolis or bee-glue is used as adjuvant in the therapy because of its antiseptic, anti-inflammatory, anesthetic and antibacterial properties. Propolis is found in a number of products such as cosmetics, shampoos, toothpastes, lip balms, creams and ointments. In dermatology propolis has been used for wound healing, treatment of ulcers and eczema, and regeneration of the skin. The sensitizing properties of propolis have been reported in the literature. Aim: The aim of this study was to present a case of allergic contact dermatitis after self-treatment with propolis. Methods: We report a case of 46 years old man who presented severe vesiculo-bullous elements on the leg after the treatment with bee-glue for the eczematous elements. Results: The diagnosis of allergic contact dermatitis to propolis was confirmed due to patch tests. Conclusions: Here we show that allergic contact dermatitis from propolis should be taken in consideration if an allergic reaction is evident. Dermatologists and general physicians should be aware of propolis as an important allergen that can cause Allergic Contact Dermatitis. The therapeutic use of propolis should be performed under medical advisory.

93-98

Authors: Georgievska J, Antovska V, Basheska N, Aleksioska N

Introduction: Steroid cell tumors of the ovary present less than 0.1% of all ovarian tumors and belong in the group of sex cord-stromal tumors. Case description: We present a case of 69-year-old woman investigated because of postmenopausal bleeding, a 5-year history of excessive hirsutism, baldness and acne. The evaluation revealed elevated serum testosterone, but ultrasound detected a 2 cm-mass of the left ovary. The patient underwent hysterectomy and bilateral adnexectomy. The histopathology diagnosis was steroid cell tumor, not otherwise specified. Postoperative chemotherapy was administered at the discretion of the radio-oncologist. At the last follow-up 48 months after surgery, the hirsutism was completely resolved, the serum testosterone was within the normal range and there was no evidence of recurrence. Conclusion: In adult patients with hirsutism and elevated serum testosterone a possibility of a presence of an ovarian steroid cell tumor should be considered. Surgery is the main treatment of such patients.

102-107

Authors: Spiroski I, Gjorgjev D, Milosevic J, Kendrovski V, Naunova-Spiroska D, Barjolle D

Background: The objective of our study was to explore the knowledge, attitudes and practices of Macedonian consumers towards functional foods, to predict future trends and to assess the national public health policies encompassing the functional foods market. Methods: Total of 518 respondents aged 18+, from all regions in the country participated in the study. They were sampled through three-staged national representative sampling procedures. The questionnaire comprised questions regarding the level of information about functional foods, trust in health claims, frequency of consumption and knowledge and attitudes related to those foods. Statistical significance was determined at p<0.05. Results: Respondents aged 18-34 were more informed compared to the total population (22 and 16 % respectively, p<0.05). Most of the consumers consume these products once a day. Employed consumers were willing to increase daily consumption from 3 to 18 % (p<0.05). On average 65.1% of the statements assessing knowledge were answered correctly. On a scale from -3 to +3 functional foods were considered as very healthy (mean=2.03, SD=1.42). Conclusion: On average, Macedonian consumers have a positive attitude and high expectations of functional foods. Public health policies still lag when compared to comprehensive approach of the food industry in market placement of these products.

112-116

Authors: Ahmeti A, Simaku A, Preza I, Bino S

Background: Diarrheal diseases count for a considerable proportion of morbidity, mortality and elevated use of health services and costs, especially in developing countries. In limited resource countries like Albania, it is essential to assess the costs associated with diarrhea, from health provider and social perspective, as a first step toward prioritization of interventions. Materials and Methods: We used the 2011 information by gathering data from primary care, emergency rooms (ER) and hospitals. Average non-medical and medical costs were used. To assess the social costs of diarrhea we interviewed parents of children with diarrhea. Based on this information the total cost of diarrhea in Albania was calculated. Results: The total mean cost per hospitalized, emergency room and outpatient diarrhea case was $228.97, $17.68 and $9.24, respectively. The total social costs per each hospitalized, ER and outpatient diarrhea case were $45.66, $15.22 and $15.22, respectively. The final burden of diarrhea, in terms of costs, in Albania was approximately $3 million in 2011. Conclusion: The high burden of diarrhea associated costs for the Albanian health care system finances dictates the necessity to assess the costs of a potential rotavirus immunization program in order to prioritize the interventions based on scientific evidence.

127-134

Authors: Nanovic Z, Petrovska M

Aim: To establish a review in the current literature and to analyze the relation Legionnaires’ disease – TNF-α inhibitors, in order to estimate the real indications for such connection. Material and Methods: The electronic data for PubMed and Google Scholar have been searched, according to the vocabulary: legionellosis, epidemiology, outbreak, diagnosis, pathogenesis, therapy, TNF-α inhibitors, indications, side effects, risk of infection. The obtained studies have been selected in English, according to the relevance by the topic. Results: Selected papers, consisted of ten studies and eight case reports, yielded 35 cases of Legionnaires' disease associated with the use of TNF- α inhibitor treatment. Discussion: There is a prevailing conclusion for increased risk of serious infections while using TNF-α inhibitors and also a deficiency of studies for an association of Legionnaires’ disease with the use of TNF-α inhibitors. Sub-diagnosing and no-existence of screening before the anti-TNF-α therapy blur the factual profile for the researched relation. The possibility for latent infection has not been sufficiently researched. Conclusion: There are indications that Legionnaires’ disease in the therapy with TNF-α inhibitors is indeed a forthcoming problem. Additional target researches are required in order to establish the position of Legionnaires’ disease in the mosaic of anti - TNF-α therapy.

140-147

Authors: Hasani I, Kaftandziev I, Trpeski S, Nikolov Lj, Saveski A, Velkovski Gj

The ilioinguinal approach (IIA) to the acetabulum has been used as a golden standard for fifty years to treat “anterior” acetabular fractures. Since its introduction by Hirvensalo and Cole, the anterior intrapelvic approach (AIPA) has been adopted by some surgeons, whilst others remain devoted to the IIA. IIA is routinely used in the Republic of Macedonia. The aim of this study is to present a review of literature for two different anterior approaches for the treatment of acetabular fractures used in modern day surgery, focussing on AIPA and its priorities and comparing it to IIA. We performed a search, mainly electronically, and retrospective analysis of existing literature. We have identified and selected two representative and well-systematized papers for IIA, and six for AIPA. We presented the advantages and disadvantages, priorities and weaknesses of both approaches separately, comparing complications, risks and results. Based on the facts presented regarding the advantages of AIPA with a focus on visualization, accessibility and biomechanical justification, the approach should be implemented in our everyday practice and we are comfortable in stating this preference, especially due to the fact that upon comparison of the complication rate there is no significant difference between the two approaches. Introduction The ilioinguinal approach (IIA) to the acetabulum has been used as a golden standard for fifty years to treat “anterior” acetabular fractures. Since its introduction by Hirvensalo and Cole, the anterior intrapelvic approach (AIPA) has been adopted by some surgeons, whilst others remain devoted to the IIA. IIA is routinely used in the Republic of Macedonia. The aim of this study is to present a review of literature for two different anterior approaches for the treatment of acetabular fractures used in modern day surgery, focussing on AIPA and its priorities and comparing it to IIA. We performed a search, mainly electronically, and retrospective analysis of existing literature. We have identified and selected two representative and well-systematized papers for IIA, and six for AIPA. We presented the advantages and disadvantages, priorities and weaknesses of both approaches separately, comparing complications, risks and results. Based on the facts presented regarding the advantages of AIPA with a focus on visualization, accessibility and biomechanical justification, the approach should be implemented in our everyday practice and we are comfortable in stating this preference, especially due to the fact that upon comparison of the complication rate there is no significant difference between the two approaches.

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.