Open Access Macedonian Journal of Medical Sciences

557-561

Authors: Nayera E. Hassan, Sahar A. El-Masry, Rokia A. El-Banna, Mohamed S. El Hussieny

BACKGROUND: Several tools such as, dual X-ray absorptiometry (DXA), quantitative computed tomography (QCT) and self-assessment tool (OST), are being used for diagnosis of osteoporosis. OBJECTIVE: to compare the sensitivity and specify detection rate of bone mineral density (BMD) changes for DXA versus QCT and OST among a sample of Egyptian adults of both sexes. SUBJECTS AND METHODS: This study is a cross sectional one, which included 62 Egyptians, aged 20-65 years. Each individual was assessed for BMD using DXA at femur and spine sites; QCT and OST which take into account body weight and age. Accordingly they were diagnosed as either osteoporotic/osteopenic or normal. RESULTS: The highest prevalence of osteopenia or osteoporosis was diagnosed among menopause women. DXA at femur has diagnosed more cases of osteoporosis (both osteopenic and osteoporotic) as compared to spine DXA or QCT, but OST is out of rang; as it failed to diagnose any case. CONCLUSION: DXA has been found to be more efficacious than QCT scan in the diagnosis of osteoporosis. DXA in femur is better than DXA-spine and QCT. Generally, DXA is the "gold standard" when assessing osteoporosis. Further studies are needed to modify the equation of OST and confirm its efficiency in Egyptians population.

567-572

Authors: Nayera E. Hassan, Ahmed El-Kahky, Mona Atteya Hana, Mones M. Abu Shady, Essam M. Galal, Aya Khalil

BACKGROUND: Type 1 Diabetes Mellitus (T1DM) is one of the most common chronic endocrine disorders of childhood. Data on growth parameters of diabetic children is scarce. AIM: To assess growth and body composition in a group of diabetic children. SUBJECTS AND METHODS: 427 T1DM children (age 2-10 years) were recruited from Diabetic Paediatric Unit, outpatients' clinic of Abou El-Rish Hospital. Anthropometric and body composition parameters were taken and HbA1c was measured for all subjects. RESULTS: Highly significant difference was detected between controlled and uncontrolled groups as regard to weight/age z-score, height/age z-score, BMI z-score, triceps skin fold thickness, subscapular skin fold thickness, midupper arm circumference, fat mass, fat %, lean mass, and body water (p < 0.001). All values are higher in the controlled group than in the uncontrolled group. Uncontrolled subjects were significantly more at risk of being underweight and short, with odds ratio of 15.131 and 16.877 and 95% confidence interval 1.972-116.130 and 3.973-71.694 respectively. However, controlled subjects were significantly more at risk of being obese than the uncontrolled with an odds ratio 0.116 and 95% confidence interval 0.045-0.302. CONCLUSION: Growth was compromised in uncontrolled T1DM children. This is of utmost importance since most of the clinical features are reversible with better glycemic control and appropriate insulin management.

579-584

Authors: Nayera E. Hassan, Sahar A. El-Masry, Rokia El-Banna, Salwa M. Elshebini, Muhamed Al-Tohamy, Salwa El-Batrawy, Nihad H. Ahmed, Dalia Adel, Enas Abdel Rasheed, Mohamed Selim, Mohamed S. El Hussieny, Aya Khalil, Manal Mouhamed Ali

AIM: To evaluate body composition changes after use of three different types of obesity management protocols: dietary measures and physical activity; acupuncture or laser acupuncture with healthy diet; aiming at achieving stable weight loss among obese Egyptian females. METHODS: A randomized longitudinal prospective study included 76 obese adult females; aged 26 up to 55 years. Anthropometric, body composition, ultrasonographic and biochemical assessments were done. RESULTS: The three types of obesity management protocols showed significant improvement in body composition (decrease in fat% and increases in FFM and TBW) and visceral fat by US. However, nutritional intervention showed highly significant improvement in the skin fold thickness at triceps and biceps sites and peripheral adiposity index. Acupuncture intervention showed highly significant improvement in fasting blood glucose (decreased) and lipid profile (decreased triglycerides, total cholesterol and LDL, and increased HDL). Laser intervention showed highly significant improvement in all the skin fold thickness and some parameters of lipid profile (decreased total cholesterol and LDL). CONCLUSIONS: The three obesity management protocols have significant effect on body composition, but acupuncture has the best effect in improving the lipid profile and fasting blood sugar. In addition, Laser intervention was recommended to improve skin fold thickness and subcutaneous fat.

595-600

Authors: Tamar Zerekidze, Shota Janjgava, Ketevan Asatiani, Elene Giorgadze

BACKGROUND AND AIM: Leptin was assessed to play a coordinating role in obesity and its cardio-vascular complications, however the findings are conflicting and further clinical investigation is required. The aim of the present study was to evaluate the association of serum leptin with cardio-vascular risk factors in different body mass index and age groups. MATERIALS AND METHODS: One hundred and forty nine female patients were enrolled in the study and divided into groups according to body mass index (BMI) and age. Following measurements were carried out: height, weight, BMI, waist circumference, blood pressure. Venous blood sample was obtained for plasma leptin, insulin, glucose and lipid profile analysis. Insulin resistance index was calculated for each patient. Body fat distribution was measured using Dual energy X-ray Absorbtiometry. RESULTS: The lowest leptin concentration was observed in overweight patients, the highest concentration was seen in obese patients. The difference between leptin levels were not observed in age groups. Leptin positively correlated with high density lipoprotein cholesterol levels in obese and elder patients. CONCLUSION: Leptin might act as a preventive measure for cardiovascular complications only in the presence of sufficient amount of fat mass. Further studies are warranted in order to support these results.

608-612

Authors: Oyebola O. Adekola, Ibironke Desalu, John O. Olatosi, Olushola T. Kushimo, Godwin O. Ajayi

BACKGROUND: Metabolic and hormonal changes are noticed within the first few hours after surgical injury. These changes are influenced by the intensity, duration, type of injury, and the anaesthetic techniques. AIM: To investigate the effects of anaesthesia on cortisol, insulin and glucose concentrations during major gynaecological surgeries. METHODS: Forty patients were randomly allotted to receive either balanced general anaesthesia (n=20) or combined spinal epidural anaesthesia extending from T5 to S5 (n=20). Blood samples were collected for cortisol and glucose at preinduction, 1, 3 and 4 hours, and for insulin at preinduction and 24 hours after incision. RESULTS: The mean cortisol concentration was significantly lower 4 hours after incision with combined spinal epidural anaesthesia (19.96 ± 11.32) μg/dl than with balanced general anaesthesia (38.94 ± 10.6) μg/dl, p = 0.018. The mean insulin concentration, 24 hours after incision decreased with combined spinal epidural anaesthesia, but increased with balanced general anaesthesia p = 0.403. The mean glucose concentrations were significantly lower with combined spinal epidural anaesthesia than with balanced general anaesthesia during the 4 hour study period p ≤ 0.05. CONCLUSION: combined spinal epidural anaesthesia extending from T5 to S5 resulted in lower cortisol, insulin and glucose concentrations during major gynaecological surgeries. This may be of benefit in patients scheduled for surgical operations below the umbilicus.

618-621

Authors: Nikola Fatic, Nemanja Radojevic, Jelena Obadovic, Aleksandar Juskovic

In the presented case report, we evaluated mechanism of axillary artery thrombosis in cases of repeated fracture of the shoulder. A 73-year-old female fell down on an outstretched hand. Radiographs demonstrated a Neer’s 2-part displaced fracture of the proximal humerus and open fracture of the acromion. Forty years ago, in a car accident, fractures of the same proximal humerus and clavicle occurred and were surgically treated. Two hours after fixation with Kirschner wires, thrombosis of the axillary artery was quickly diagnosed and rapid treatment allowed revascularisation of the arm without any consequences.

626-631

Authors: Douaa M. Mosalem, Abeer M. El Shabrawy, Aziz Alfeeli, Ayyoub B. Baqer, Mohieldin M. Ahmed

BACKGROUND: Posture and gait instability may cause of morbidity in individuals with progressive supranuclear palsy (PSP). OBJECTIVE: To quantitatively measure balance control by using computerized dynamic posturography (CDP) and to assess gait analysis in early PSP. CASE REPORT: She was evaluated for Berge balance scale, Functional Independence Measure (FIM) and postural stability using CDP device in early PSP with still able to walk or stand unassisted. Also, Gait analysis was conducted using an 8 M-camera Vicon 612 data capturing system set. Berge balance scale improved from 41/56 to 48/56. The score of FIM improved from 71/126 points to 95/126 points in early PSP. In CDP analysis, there was a decrease of composite equilibrium score (38 %). There was an increase of composite equilibrium score (59%) after three months of treatment. In gait analysis, there was no difference of gait parameters after three months of treatment in early PSP. CONCLUSIONS: Both CDP and gait analysis are important quantitative tools in the assessment of posture and gait instability as well as allow for early disclosure of the failure of the postural control system in early PSP.

635-639

Authors: Zakerihamidi Maryam, Hosseini Tabaghdehi Moniralsadat, Khakbazan Zohreh, Mohammadi Zeidi Banafsheh, Salehpour Amir

OBJECTIVE: Globally less than 40% of infants less than six months of age are exclusively breastfed. Adequate breastfeeding support for mothers and families could save many young lives. This study aimed to determine knowledge and attitudes of mothers toward breastfeeding in Tonekabon, Iran. METHODS: This study was a descriptive-analytical cross sectional study with convenience sampling. The sample consisted of 200 nursing mothers who have including criteria of the study. Data was collected by a questionnaire including demographic data and questions about knowledge and attitude toward breastfeeding. Data analysis performed by using of SPSS (11.5) and appropriate statistical tests. RESULTS: Most of them (73.5%) were 21-30 age group. 50.5% of them had a diploma education. 46% of them reported the essential information about breastfeeding obtained from medical- health centers. 5% of them had poor and 42% had a medium knowledge about breastfeeding while 53% of them had good knowledge about it. Most of the mothers (79.5%) had positive attitude regarding breast feeding. CONCLUSION: According to most of the mothers had good knowledge and positive attitude about breastfeeding, with proper planning to increase awareness and promote a positive attitude towards breastfeeding can be tried for child survival.

645-649

Authors: Marina Danilova, Saso Stoleski, Dragan Mijakoski

AIM: To assess the effect of occupational exposure on respiratory symptoms and ventilatory capacity in never-smoking male workers exposed to mineral or organic dusts. MATERIAL AND METHODS: We performed a cross-sectional study including 138 never-smoking male workers exposed to mineral or organic dust (34 construction workers, 32 furniture manufacturers, 37 agricultural workers, and 35 bakers) and 35 unexposed controls (office workers). Evaluation of all study subjects included completion of a questionnaire and spirometric measurements. RESULTS: The prevalence of the overall respiratory symptoms in the last 12 months was higher in dusty occupation workers than its prevalence in office workers. Statistically significant difference was found between the prevalence of cough in construction workers, agricultural workers and bakers, as well as between the prevalence of phlegm in construction workers, furniture manufacturers and agricultural workers as compared to its prevalence in office workers. The mean values of spirometric parameters were lower in all groups of exposed workers as compared to their mean values in office workers with statistical significance for all measured parameters in construction workers and furniture manufacturers, as well as for small airways indices in agricultural workers and bakers. CONCLUSION: Our findings indicate significant effect of occupational exposure on respiratory symptoms and ventilatory capacity impairment in workers exposed to mineral or organic dusts.

655-661

Authors: Rositsa Dimova, Donka Dimitrova, Maria Semerdjieva, Ilian Doikov

BACKGROUND: Self-medication with antibiotics is a major concern worldwide because of the high risks of antimicrobial resistance which may result in complicated courses of treatment, increased risk of death and excess costs to the healthcare systems. AIM: The aim was to study the attitudes and self-medication patterns as related to the use of antibiotics among the general Bulgarian population and their determinants. MATERIALS AND METHODS: A questionnaire-based survey was performed among the patients in two randomly selected municipalities. The questionnaire was mailed to 50 randomly selected adult patients by each of the 33 responding GPs thus addressing a total of 1650 participants. RESULTS: A total of 1050 patients completed and returned the questionnaire. The observed self-medication rate was 43%. The women and the younger employees and students tended to have a higher self-medication rate. Fever (22%), sore throat and cough (12.7%) and discomfort when urinating (8.2%) were the most frequent patterns related to the practice of self-medication. CONCLUSION: This analysis reported an extensive use of self-medication with antibiotics in the study population before the changes in the Bulgarian legislation. Younger age and social status (students, employed) were the most important socio-demographic patterns that had probably led towards self-medication with antibiotics.

404-407

Authors: Syed S. Haque

OBJECTIVES: Typhoid fever an important causes of illness and death, particularly among children and adolescents in south-central and Southeast Asia, where enteric fever is associated with poor sanitation and unsafe food and water. Cell-mediated immunity (CMI) plays an important role for the survival of the host in experimental salmonellosis. Nitric oxide (NO) is the one of the product of macrophages activated by cytokines, microbial compounds or both, is derived from the amino acid L-arginine by the enzymatic activity of inducible nitric oxide synthase (iNOS or NOS2) which acts as antimicrobial molecule. AIM: The aim was to examine the induction of DTH reaction in the animals treated with L-Arginine, ciprofloxacin and their combination followed by immunization with S. typhimurium cell lysate as assessed by the footpad swelling test. RESULTS: The results of the present study showed that the induction of DTH reaction in the animals treated with L-Arginine, ciprofloxacin and their combination followed by immunization with S. typhimurium cell lysate using an antigen revealed that the treatment with combination increased foot pad swelling significantly as compared to saline treated control animals at 48 hour which was followed by a decrease of the swelling at 72 hour. CONCLUSIONS: Animal treated with L-arginine, ciprofloxacin and their combination showed increased cell mediated immune responses as evident by DTH response whereas groups (B+S) shows decreases CMI responses.

415-420

Authors: Amany A. Abdel Aal, Samar S. Attia, Nihal A. Hanafy, Abeer S. Al-Antably, Marwa A. Hassan, Walid El-Sherbiny, Aml S. Nasr

BACKGROUND AND AIM: Infection with the protozoan parasite Toxoplasma gondii has a worldwide distribution. Congenital infection is the most important part of the disease burden due to Toxoplasma infection in humans. Early diagnosis of maternal infection helps to prevent severe complications of toxoplasmosis. In the present study, three PCR assays (conventional, nested & quantitative) were evaluated for diagnosis of recent toxoplasmosis based on detection of Toxoplasma B1 gene. MATERIAL AND METHODS: The present study was carried out on 150 pregnant females who were serologically negative for anti-Toxoplasma IgG and IgM antibodies. RESULTS: The results revealed that out of 12 true positive cases (by 2 out of the 3 PCR protocols), 8 cases were positive by cPCR, 11 cases were positive by nPCR and 12 cases were positive by qPCR. Accurate estimation of genomic Toxoplasma DNA in positive samples was achieved by qPCR. In general, PCR assays offer a sensitive alternative of serological methods for diagnosis of recent maternal toxoplasmosis. In addition, qPCR decreases the risk of contamination of PCR products being a closed tube method and helps in estimation of infection load. CONCLUSIONS: We recommend screening of high-risk pregnant women by qPCR for early diagnosis of toxoplasmosis and proper management.

424-430

Authors: Osama M. Abo-Salem

BACKGROUND: Diabetic neuropathic pain (DNP) is one of the most difficult types of pain to treat. Many studies emphasized on the role of microglial cells, oxidative stress (OS) and inflammatory cytokines (IC) in the development of diabetic neuropathy (DN). AIM: Present study was designed to evaluate the effect of kaempferol in attenuation of DN in mice. METHODS: Diabetes was induced in mice by i.p. injection of a single dose of streptozotocin (STZ) (200 mg/kg). Cold allodynia, thermal hyperalgesia and chemical hyperalgesia were assessed, as well as markers of inflammation and OS. RESULTS: Diabetic mice (DM) showed an increased pain sensation, IC and OS accompanied with reduced body weigh gain. Treatment of DM with kaempferol (25, 50 and 100 mg/kg/day/orally) attenuated the development of DN and reduced pain sensation. Moreover, it reduced interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), lipid peroxidation and nitrite, concomitant with the improvement of antioxidant defense and body weight gain. In contrast, kaempferol (100 mg/kg) had no effects on the behavioral and biochemical parameters. Our results strongly suggest that activated microglia, IC and OS are involved in the development of DN. CONCLUSIONS: Kaempferol attenuates the development of DNP in mice probably by inhibition of neuroimmune activation of microglia and, partly mediated by reducing IC and OS.

439-443

Authors: Amina A. Gamal el Din, Reham Sh. E. Esmail, Amal A. Hareedy

BACKGROUND: Colon cancer is one of the most common malignancies worldwide. Colonic adenoma and ulcerative colitis (UC) are important precancerous lesions. Vascular Endothelial Growth Factor (VEGF) is a well-known pro-angiogenic factor plays important role in physiologic and pathologic conditions and in neovascularization in cancer and hence becomes a potential target for anti-angiogenic cancer therapy. AIM: This study investigated VEGF immunohistochemical expression in colon cancer and its precancerous lesions. MATERIAL AND METHODS: Paraffin blocks from two hospitals were collected in a year: Colon cancer: 20 cases, colonic adenoma: 15 cases, UC: 15 cases and 5 controls from normal mucosa. VEGF was assessed immunohistochemically using a primary anti-VEGF antibody (VG1, Dako, Denemark). RESULTS: Median age was 49 years (range 31-52) in cancer, 40 years (range 31-52) in adenomas and 33 years (range 27-43) in UC. VEGF expression was negative in control, significantly strongly positive in 90% of colonic adenocarcinoma (p= 0.001), significantly positive in adenomas (p= 0.002) - the weak positivity significantly seen in mild dysplasia (p= 0.001) - and significantly positive in 73.3% of UC cases (p=0.022). CONCLUSION: The significant increase in positivity of VEGF in precancerous to cancerous lesions may point to its potential role in the pathogenesis and progression of colonic neoplasia.

448-451

Authors: Teodor Garnizov, Vangeliya Atanasova, Mariela Filtcheva

OBJECTIVE: The aim of this study was to provide data about the course and outcome of pregnancy in the women with aortic stenosis (AS) with special attention to complications in pregnant with severe AS, which was asymptomatic prior to conception. METHODS: Eleven pregnant women with different grades of AS were monitored in ambulatory and clinical conditions during pregnancy, childbirth and the post-partum period. The Apgar scores of the neonates born by mothers with AS were compared to those of neonates born by healthy mothers, using the variation statistical analysis. RESULTS: In the group with severe AS, asymptomatic prior to conception, aggravation of the NYHA functional class (FC) with left ventricular heart failure was observed. Pregnancy, childbirth and post-partum period were normal in the group with moderate aortic stenosis and in those with ventricular defects, corrected prior to conception. The sums of the Apgar scores for the whole group did not differ from those for the neonates, born by healthy mothers. CONCLUSION: The results suggest that there is a need of consensus for the complex of examinations, enabling diagnostic differentiation of pregnant women with severe AS requiring urgent defect correction and, the prognosis of pregnancy in women with asymptomatic severe AS.

456-460

Authors: Emilija Velkova

AIM: Prompt discovery of allosensibilisation to RBC’s antigens during pregnancy and successful management of HDFN in Republic of Macedonia, in order to decrease morbidity and mortality of the fetus and the newborn. MATERIALS AND METHODS: The study comprises in total 23,800 patients, 14,858 pregnant women and 8,842 newborn babies. RESULTS: The screening and identification of anti RBC’s antibodies detected in total 216 alloantibodies, out of which 81% (175) had a clinical significance. Out of the above mentioned 164 alloantibodies (65.9%) belong to the Rh system. The most often reason for a severe hemolytic disease is the anti-D antibody. The HDFN symptoms of mild and moderate degree demonstrated 32.5%, and 18.9% had symptoms of severe fetal suffering, and almost half of them (48%) were with or with mild HDFN and had no need of therapy. In 15% it was about alloantibodies of other Rg antigens: anti-C, anti-E and anti-c, at which in most cases there were no signs of HDFN, or it showed weak symptoms (89%), just one case of anti-c ended with intrauterine death. CONCLUSIONS: Anti D antibody represents the most often reason for severe HDFN and displays a need of intrauterine transfusion and exsangvino transfusion. Anti-c is the only antibody that demonstrated the same potential for severe HBN as the anti-D. The most often reason for alloimmunisation of the mother is the lack of RhIG prophylaxis (97.8): postnatal, antenatal and in case of possible sensible conditions during pregnancy. Thus, there is a need and an outmost importance of elaboration and adoption of the National programe for RhIG prophylaxis in Republic of Macedonia.

464-466

Authors: Adrian Kristo, Evin Dani

OBJECTIVE: The study is conducted to evaluate the relationship between testicular volume measured by ultrasound and conventional sperm parameters (volume, concentration, total count, motility and morphology) in Albanian subfertile males and to determine a normal limit value of the testicular volume. MATERIALS AND METHODS: A total of 500 males were observed for this study. The testicular volumes of all subjects were measured by ultrasonography. The semen samples were collected by the process of masturbation after 3-5 days of ejaculatory abstinence and were analyzed according to WHO criteria 2010. RESULTS: Testicular volume has a strong positive correlation with sperm count, total count and motility and a positive correlation with semen volume. CONCLUSION: Testicular volume has a direct correlation with semen parameters and the critical total testicular volume indicating normal testicular function is approximately 26.6 ml (the mean testicular volume 13.3 ml). The measurement of testicular volume can be helpful for assessing fertility at the initial physical examination.

472-473

Authors: Allma Koçinaj, Antigona Gërçari, Mybera Ferizi, Edlira Lashi, Lorela Gjunkshi, Monika Fida

Erythema migrans is a ring like erythema, with a few centimeters in diameter. Usually it occur solitary, days to weeks after an infected tick bite. According to skin changes it can be manifested acutely such as erythema migrans in Lyme Borreliosis, borrelial lymphocytoma (subacute), or as a late Lyme disease with acrodermatitis chronica atrophicans. All stages of this disease can be treatable with antimicrobial agents. As a first case in our department with multiple lesions, we describe a 14-year-old female and review the patient’s clinical and laboratory features, the causes of the disease, diagnosis as well as treatment.

479-482

Authors: Slavcho Stojmenski, Dejan Dimitrovski, Igor Merdzanovski

AIM: The aim of this paper was to present application of the first expert arthrodesis nail in our clinic to a patient with previous performed arthrodesis according to Ulrich Holz. CASE REPORT: Patients A.M. on the age of 22 (1992) have a motor vehicle injury, (fall from a motor bike) with diagnosis polytrauma, shock, supra and transcondyar open fracture of the right femur III degree, open fracture of the right tibia and fibula. We perform reposition and fixation of supra and transcondyar femoral fracture with “cobra” plate. Also we perform reposition and fixation of right cruris with external fixation. After the operation we found fistula in the place of operation of the right crural regia. During the time the infection goes worse and the patient develop osteomyelittis on the right crural regia. After 5 months with therapy the situation become calm. We remove the external fixation. The patient develops severe “pes equinus” on the right leg and he cannot walk. We try to reduce this equines situation with elongation of the Achilles tendonin the first step, and because we didn’t solve the problem we continue with complete section of the Achilles tendon and after that we perform osteotomy of the right talocrural joint simultaneous to tibia plafond and talus and resection of fibula 2sm.above the syndesmosae tibiofibularis and we fixed the talocrural joint with two screws according the technique of Ulrich Holz. CONCLUSION: So we received fixed position on of the food on 110 degrees which was steel unacceptable for normal walking. At last we remove the screws, make once again osteotomy with positioning of the food in maximal dorsiflexion and perform the Experf Hindfood arthrodesis nail so with this method we achieve correction of dorsiflexion on 95 degrees, and the patient become satisfied because he can walk without support.

488-490

Authors: Jasna Pavicic-Astalos, Zoran Vatavuk, Goran Bencic, Biljana Andrijevic-Derk, Krunoslav Kuna

BACKGROUND: Pre-eclampsia is one of the most important causes of a rare cliniconeuroradiological entity called posterior reversible encephalopathy syndrome. The syndrome is characterized by headacke, visual disturbances, seizures, altered mental status and radiological findings of edema in the white matter of the brain areas perfused by the posterior brain circulation. CASE REPORT: Here we present a patient with sudden bilateral visual loss and deafness in early postnatal period without any other neurological deficits, but with affiliated ophthalmological pathology. The correct diagnosis was made 3 days after the Cesarean section.The patient was diagnosed with posterior reversible encephalopathy syndrome and bilateral choroidal detachment. CONCLUSION: Vascular changes in posterior reversible encephalopathy syndrome can cause visual disturbances not only by brain edema, but combined brain and ocular pathology.

494-498

Authors: Marija Knezevic-Pogancev, Nebojsa Jovic, Aleksandra Stojadinovic

AIM: Purpose of the study was to recognize specific migraine triggers in adolescents. MATERIAL AND METHODS: Study was conducted on 20,917 adolescents in Serbia. RESULTS: Lack of sleep, passive tobacco smoking, alcohol intakes, and "not eating in time" are triggers that provoke migraine in adolescents. CONCLUSION: Avoiding migraine triggers in 68% of adolescents reduced drug therapy for 75%.

506-509

Authors: Rada M. Grubovic, Emilija Velkova, Primoz Rozman, Henk W. Reesink

The Safety of the Blood Supply in any country is of utmost importance to safeguard patients from serious adverse events of blood transfusion. Implementation of a Quality System in the Blood Transfusion Service, with support of Government and Ministry of Health is a key element to guarantee safe blood. The IPA TAIB 2009 project - Strengthening of the Blood Safety System executed in 2013/14 provided the means to start implementing a Quality System in the Institute for Transfusion Medicine of the Republic of Macedonia. This project aimed to ultimately bring the Blood Transfusion Service to European Union standards, allowing the exchange of blood components and all other types of collaboration with other European Union countries in future. The project put the basis for unification of blood transfusion standards and operating procedures in the whole country as well as set up essential education of blood transfusion personnel.

519-524

Authors: Jordan Minov, Jovanka Karadzinska-Bislimovska, Tatjana Petrova, Kristin Vasilevska, Sasho Stoleski, Dragan Mijakoski, Snezhana Risteska-Kuc

BACKGROUND: Bacterial infections are considered as the most important cause of exacerbations in patients with chronic obstructive pulmonary disease. AIM: To compare the efficacy and tolerability of eight antibiotics empirically administered for outpatient treatment of exacerbations of COPD. METHODS: We performed an observational study including 343 COPD patients with probable bacterial exacerbation (Group A and Group B COPD patients) managed in an outpatient setting. Eight antibiotic regimens each used 10 days were evaluated: amoxicillin/clavulonic acid, doxycycline, cefuroxime, cefixime, clarithromycin, roxithromycin, ciprofloxacin, and moxifloxacin. All patients were followed up for 30 days, with an intermediate visits at 5, 7 and 10 days at which the duration of symptoms and the side-effects of the drug were evaluated. RESULTS: The clinical success rate varied from 69.8% with doxycycline to 80.9% with moxifloxacin. The mean time to relief of symptoms varied from 5.6 days with moxifloxacin to 6.3 days with amoxicillin/clavulonic acid. Significant increase of the post-treatment FEV1value was registered in all treatment groups. Relapse within the first 20 days was registered in the group receiving doxycycline, clarithromycin, and ciprofloxacin. The prevalence of the adverse events was low varying from 6.7% with cefuroxime to 11.3% with ciprofloxacin. CONCLUSION: Our findings suggest high clinical success rate and high safety of all studied regimens.

529-531

Authors: Marjan Dzeparoski

Chronic anal fissure is one of the most frequent anorectal disorders. Symptoms vary but typically include bright red rectal bleeding, itching and discomfort or pain during and after defecation. Treatment has undergone a transformation in recent years from surgical to medical, all approaches sharing the goal of reducing the spasm. According to the researched treatment guidelines and the experience at the “University Clinical Center Mother Teresa” (Clinic of Gastroenterohepatology and Clinic of Abdominal Surgery) in Skopje, Macedonia, we propose the following algorithm for treatment of chronic anal fissure in three steps: from topical nifedipine + lidocaine cream (first-line) to second course of nifedipine + lidocaine cream or digital anal dilatation or botulinum toxin type A injection (second-line) to lateral internal sphincterotomy (third-line). The proposed treatment algorithm allows patients to start with the least invasive treatment. There is no doubt that patients are willing to try less invasive modalities with the hope of avoiding surgery, with its risk of permanent disability. It should be up to the patients to decide which treatment they prefer. Although chemical sphincterotomy is less successful from lateral internal sphincterotomy, the algorithm allows feasibility, efficacy and cost-effectiveness, as well as risk reduction for surgical morbidity.

536-543

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

OBJECTIVE: To evaluate the prevalence of respiratory symptoms, lung function and bronchial hyperresponsiveness in farmers, with emphasize to their severity and work-relatedness due occupational risk factors and farming characteristics. METHODS: A cross-sectional survey was performed including 60 cow breeders aged 21 to 65 years, compared to an equal number of agricultural farmers matched by age, job exposure duration, and smoking status. We have used a questionnaire to record the chronic respiratory symptoms, detailed work history, specific farming activities and tasks performed, and smoking history. Evaluation of examined subjects also included lung function spirometry tests, and bronchial hyperresponsiveness testing. RESULTS: We found higher prevalence of work related respiratory symptoms in the last 12 months in cow breeders with significant difference for phlegm (P = 0.039), and wheezing (P = 0.026). Mean values of all spirometric parameters were lower in cow breeders, reaching significance for MEF50 (P = 0.001) and MEF75 (P = 0.000). Significant difference was found for mild bronchial hyperresponsiveness among cow breeders with job exposure of more than 15 years. The risk of developing work-related respiratory symptoms increased significantly with full-time farming, exposure to gases and vapors, and keeping more than 10 cows. CONCLUSION: Our data suggest that workplace exposure in farmers may cause respiratory impairment which is closely related to its duration, characteristics, and intensity. The results suggest that cow breeders in general have higher rates of work-related respiratory symptoms and bronchial hyperresponsiveness than agricultural farmers, whereas their severity increases with an increase in frequency and duration of animal contact.

191-197

Authors: Hassan NE, El-Masry SA, Elshebini SM, Al-Tohamy M, Ahmed NH, Rasheed EA, El-Saeed GSM, Hassan NM, Zikri EN, El Hussieny MS

AIM: The aim of this study was to compare efficiency of three types of obesity management protocols: dietary measures and physical activity; acupuncture or laser acupuncture with healthy diet among obese females. SUBJECTS AND METHODS: Randomized longitudinal prospective study, carried out on 76 adult females. Blood pressure, anthropometric, ultrasonographic and biochemical assessments were done. RESULTS: Females undergo nutritional intervention showed highly significant improvement in the anthropometric measurements, visceral fat at umbilicus by US and diastolic blood pressure (decreased), and insignificant differences in fasting blood sugar and lipid profile. Female undergo acupuncture intervention showed highly significant improvement in visceral fat by US, lipid profile (decreased triglycerides, total cholesterol and LDL, and increased HDL), and decreased fasting blood sugar, and insignificant differences in the anthropometric measurements. Those undergo laser intervention showed highly significant improvement in all anthropometric measurements under study, visceral fat at umbilicus by US, blood pressure and some parameters of lipid profile (decreased total cholesterol and LDL). CONCLUSIONS: Nutritional intervention alone could be used to reduce weight if the lipid profile within normal range, but if it is impaired, acupuncture should be used beside. To strength the reduction in body anthropometry, laser intervention was recommended beside the nutritional intervention.

209-214

Authors: Hameed ERA, El-Alameey IR, Sherif LS, Khairy SA, Megawer AS, Youness ER, El-Shiemy AM

BACKGROUND: Obesity is associated with an increased risk of developing hyperinsulinemia, dyslipidemia, hypertension, premature atherosclerosis, and coronary artery disease in the future. AIM: This study is designed to assess the relationship between serum adiponectin, asymmetric dimethylarginine (ADMA), and lipid profile among Egyptian overweight and obese children. METHODS: This cross sectional case control study included 40 selected pre-pubertal overweight and obese children, 24 girls (60%) and 16 boys (40%) aged between 5 to 13 years (8.85 ± 2.7 years), from new cases attending the National nutrition institute clinic during 2013. Forty apparently healthy children of matched age and sex were recruited as a control group. RESULTS: Obese group showed highly significant higher levels of serum ADMA, triglycerides, and total cholesterol compared with healthy controls (P < 0.000 in all). However, serum adiponectin levels were highly significant lower in obese children compared to healthy controls (P < 0.000). Serum ADMA showed significant positive correlations with height, serum total cholesterol and serum triglycerides levels and significant negative correlation with the body mass index and weight for age z score. Serum adiponectin showed significant negative correlations with BMI, weight, and weight for age z score and significant positive correlation with serum triglycerides. By linear regression analysis; serum adiponectin, and serum triglycerides levels were significant predictors of high serum ADMA level (p =0.045 and 0.015 respectively). BMI, weight, height and serum triglycerides were significant predictors of low serum adiponectin levels (p = 0.005, 0.022, 0.026 and 0.015 respectively). CONCLUSIONS: Our results revealed that ADMA, Adiponectin and lipid profile can be considered as predictive biomarkers in prediction and prevention of atherosclerotic risk in the future among overweight and obese Egyptian children.

219-223

Authors: Peric V, Jaric D, Ketin S, Konicanin A, Biocanin R

In the last 20 years in medical laboratories, numerous activities regarding quality and accreditation system were taken. Approach to this problem in European countries is different, so the task of the Accreditation Work Group of the Confederation of European societies for clinical chemistry (EC 4) to help the efforts to harmonize this issue. External quality control in clinical-chemical laboratories imposed the need for the implementation of quality management system. »Good laboratory practice« and its principles were adopted by nominated bodies, both international and national. In the beginning, the standard ISO 9001 was applied for certification and for accreditation EN 45001 and ISO Guide 25, which are prepared for testing and calibration laboratories. Standard ISO 17025 is the successor of the previous documents and for now it is a reference for mentioned laboratories. Accreditation Work Group of the Confederation of European societies for clinical chemistry (EC 4) made an amendment of the requirements for medical laboratories, which this standard describes. Standard draft ISO 15189 was adopted on February 2003 as a final version with requirements for medical laboratories.

229-233

Authors: Kaftandziev I, Trepeski S, Arsovski O, Spasov M

INTRODUCTION: An important feature of distal tibia fractures is the relevance of the soft tissue coverage. In order to maintain good functional outcome, several operative techniques have been established. Among them, percutaneous screw fixation has the advantage of causing less biological damage of the soft tissues with lower rates of complications. MATERIAL AND METHODS: We reviewed 16 patients with distal tibia fracture. Operative treatment consisted of indirect reduction and percutaneous fixation of the tibia followed by cast immobilization for approximately 3-4 months. Minimum follow up period was 12 months. Functional outcome was evaluated using Olerud-Molander Ankle Score (OMAS) and American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS). RESULTS: Twelve out of 16 fractures healed within 6 months of the injury. In 3 cases, delayed union was evident, but the fractures healed in less than nine months. There was one case of malunion, two cases of superficial skin infections, two cases of DVT and two cases of gross swelling. According to OMAS score, the functional result was excellent in 7 (43.75%), good in 5 (31.25%) and fair in 4 (25%) patients. CONCLUSION: Percutaneous screw fixation can be a safe and effective method for operative treatment of distal tibia fractures.

239-243

Authors: Vera Ilanković, Andrej N. Ilanković, Nikola N. Ilanković

Movement disorders and motor deficiency is highly represented among patients in Schizophrenia – residual type (DSM IV): 37% of patients examined in our research had psycho‑motor disturbances. Dominant disturbances are the following: disturbed tonus among 65% of patients, abnormal postural reactions among 90%, abnormal voluntary movements among 75%, disturbed speech among 85%, disturbed static and dynamic postures among 90%. Involuntary movements are present among 20% of patients. Classic neurological diagnostics offers general assessment of the motor status. Standardized clinical motor scales only register the presence and intensity of the motor disturbance. Rehabilitation treatment requires individual and up to date functional diagnostics of the motor deficiency. We would like to stress that psychiatric patients in psychotic, (prepsychotic) and postpsychotic states, besides being mentally ill, also suffer from serious movement disorders (psychomotor disturbances and deficits) which put them into the category of disabled persons, who besides requiring psychiatric (neuropsychiatric) treatment, also require systematic psychomotor and speech rehabilitation.

249-252

Authors: Bogdan Arsic, Momcilo Pavlovic, Karolina Berenji

AIM: The aim of the present paper was to identify prognostic factors for relapse and mortality in patients with hospital-acquired infections caused by Clostridium difficile. MATERIAL AND METHODS: This study included 133 patients with healthcare facility-associated disease caused by C. difficile. The medical records of all patients with their clinical history and laboratory data were analyzed. RESULTS: Patients with one onset of disease were 105 (78.9%), 28 (21.1%) experienced a relapse and seven (5.2%) patients not survived infection. The average age in our patients was over 65 years (64.5 years in the survived patients and 78.8 in patient who died, p = 0.01). All of patients had received antibiotic treatment (cephalosporins – 83.4%, aminoglycosides – 21.5% and penicillins – 20.3%) and 40.6% of patients received acid-reducing therapy. There was no difference between patients with one onset of disease/patients with relaps; and survived/died in number of administered antibiotics, duration of administration, administration of acid-reducing treatment or length of hospital stay (p > 0.05). CRP levels were significantly higher in the group of patients who died compared with recovered (p < 0.001). CONCLUSION: C. difficile-associated diarrhea is a common nosocomial disease with high relapse, and significant mortality rate particularly in the elderly.

257-260

Authors: Mila Lubomirova, Rejina Djerassi, Boris Bogov

AIM: Previous studies showed that patients with chronic kidney disease (CKD) > 2 dergee had increased intima-media thickness (IMT). We evaluate the relationship between IMT and parameters for renal function. METHODS: 130 subjects were examined – 66 with CKD, 44 without CKD, as well as 20 healthy volunteers. The first group- patients with CKD were with creatinine clearance (CrCl) over 20 ml/min and below 90 ml/min. The second group included 44 pts. with normal renal function, CrCl > 90 ml/min. All examined patients with and without CKD had hypertension. The two groups were streamed into two subgroups: with and without vascular disease. To evaluate the renal function creatinine clearance was calculated in ml/min. IMT was measured in both common carotid artery (CCA) using high resolution sonography in all examined subjects. RESULTS: CCA IMT increased in pts. with CKD and was > 0.75 ( 0.76 ± 0.14 v.s contols 0.59 ± 0.10) Patients with vascular disease (VD) had higher IMT which increased significant when CKD with GFR < 90 ml/min was included (0.77 ± 0.06/0.81 ± 0.10, p < 0.05). Multiple regression analysis proved that renal function deterioration directly affected CCA IMT (R2=0.208, p=0.022). CONCLUSION: Increased IMT is presented in mild renal dysfunction. CKD –GFR< 90 ml/min could be an independent vascular risk factor.

265-270

Authors: Suzette I. Helal, Ahmad Hegazi, Khaled Al-Menabbawy

AIM: Multiple sclerosis (MS) is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged. We Study the effect of Apitherapy in treatment of MS. MATERIAL AND METHODS: Fifty patients with MS, their ages ranged between 26-71 years, were subjected to complete clinical and neurological history and examination to confirm the diagnosis. All cases were under their regular treatment they were divided into two main groups, Group I received honey, pollen, royal jelly and propolis and were treated with apiacupuncture 3 times weekly, for 12 months, in addition to their medical treatment, while group II remains on their ordinary medical treatment only. Apiacupuncture was done by bee stings for regulating the immune system. RESULTS: Results revealed that 4 patients showed some improvement regarding their defects in gait, bowel control, constipation and urination, while 12 cases, showed some mild improvement in their movement in bed, and better improvement in bed sores, sensation, and better motor power, only two cases of them were able to stand for few minutes with support. CONCLUSION: Although Apitherapy is not a curable therapy in MS, but it can be used to minimize the clinical symptoms of MS, and can be included among programs of MS therapy.

277-282

Authors: Katerina Katerina Kasapinova, Viktor Kamiloski

AIM: The aim of this study was to analyze the frequencies of these soft-tissue injuries and to describe the arthroscopic technique used for their diagnosis. METHODS: The prospective study included 85 patients with operatively treated distal radius fracture. Wrist arthroscopy was used to identify the associated lesions of triangular fibrocartilage complex (TFCC), scapholunate ligament (SL) and lunitriquetral ligament (LT), extrinsic ligaments, and chondral lesions. RESULTS: Wrist arthroscopy identified TFCC injury in 72.9%, SL injury in 65.9%, LT injury in 17.7%, extrinsic ligaments in 49.4% and chondral lesion in 30.6% of the patients. 87.1% of the patients had at least one of the major structures injured (TFCC, SL or LT). The presence of the ulnar styloid fractures significantlly correlated with with the associated LT lesion, with the LT lesion type, and with the lesion of both SL and LT ligament. If the distal radius fracture was intraarticular there was no correlation with the finding of any associated soft-tissue lesion. CONCLUSIONS: The frequency of the associated soft-tissue lesions in distal radius fractures is high. Ulnar styloid fracture was identified as risk factor for associated LT lesion, as well as combined lesion of both scapholunate and luntriquetral ligament.

289-292

Authors: Slavica Arsova, Stojan Bajraktarov, Ivan Barbov, Kadri Hadzihamza

INTRODUCTION: Patients with schizophrenia have severe problems with self-care which affects their quality of life. OBJECTIVE: The aim of the paper was to monitor self-care in patients with schizophrenia and to find out the differences regarding socio-demographic characteristics and ambulatory and day hospital treatment. METHOD: The investigation included 120 subjects each with diagnosis F20 according to ICD 10 criteria; divided in two groups of 60 patients regarding their actual treatment (the first group received ambulatory care whereas those from the second group had a day hospital treatment). Patients were of different age and gender, receiving regular antipsychotic therapy. They were included in individual and group psychosocial therapeutic procedures during the day hospital treatment. The investigation utilized the following diagnostic instruments: standardized clinical interview and Personal and social performance scale (PSP scale), non-standardized questionnaire of socio-demographic data, family support and existence of mental disorder in other family members. RESULTS: The results have shown better personal and social functioning in patients who had family support, in those who are employed, in those with no mental disorder in other family members and in patients on day hospital treatment against patients receiving ambulatory care. CONCLUSION: Day hospital treatment, family support and social support improve self-care of patients with schizophrenia.

299-302

Authors: Salih Gulsen

Arachnoid cysts are congenital and non-tumorous intra-arachnoid fluid accumulations that make up about 1% of all intracranial space. occupying lesions. We report a patient with a fourth ventricle arachnoid cyst extending to the upper border of the dens of the axis. This patient progressively developed walking difficulty and stiffness in his legs together with difficulty in grasping objects with his hands within one year. The cyst was totally excised and the patient's symptoms improved in the early postoperative period, but he developed intraventricular and intracisternal air which was followed-up conservatively and resolved spontaneously.

309-312

Authors: Salih Gulsen, Aysen Terzi, Ozlem Isiksacan Ozen, Ali Ayhan

High-grade endometrial stromal sarcoma is a rare uterine malignancy. The cells of these tumors resemble endometrial cells in the proliferation stage, with many small plexiform arterioles. Herein we present a patient with endometrial stromal sarcoma that metastasized to the brain, along with the CT and MRI findings and a discussion of the surgical and histopathological features of the metastatic tumor. Immunohistopathological examination of the metastatic tumor showed a high mitotic rate and strong immunopositivity for CD10 and vimentin (as a mesenchymal marker); therefore, the lesion was considered to be high-grade endometrial stromal sarcoma. Due to the rarity of reported cases of metastatic brain tumors of high-grade endometrial stromal sarcoma, there isn’t a standard treatment protocol; however, metastatic tumors of high-grade endometrial stromal sarcoma match the same general concepts of brain metastasis. In addition, endometrial stromal sarcomas may be associated with hemorrhagic metastasis to the brain due to their pathologic characteristics.

316-318

Authors: Raildo Coqueiro, Kleyton Santos, Ludmila Schettino, Aline Barbosa, Rafael Pereira, Marcos Fernandes

AIM: The aim of this study was to investigate the association between fall and performance in the “chair stand” test; and evaluate this test as a predictor of community-dwelling Brazilian elderly men fallers. MATERIAL AND METHODS: This was a study based on secondary data derived from a population-based epidemiological study involving 143 elderly men. The association between fall and performance in the “chair stand” test was tested with the Poisson regression technique (robust model adjusted by age). The discriminatory power of the “chair stand” test was determined by the ROC curve. In all analyses the level of significance adopted was 5% (α = 0.05). The data were analyzed in the IBM SPSS and MedCalc. The participants’ age ranged from 60 to 105 years (73.4 ± 9.4 years). The time for performing the test ranged from 6 s to 31 s (13.2 ± 5.0 s) and 17.7% (n = 25) reported having suffered at least one fall in the last 12 months. RESULTS: The Poisson multiple regression model (adjusted by age) showed that the spent time to perform the “chair stand” test was positively associated (PR = 1.08; CI95% = 1.02 - 1.14; P = 0.009) with the occurrence of fall in the last 12 months. The power of the “chair stand” test to discriminating the elderly who suffered fall may be visualized by means of the ROC curve parameters. The value of AUC indicates that the “chair stand” test was able to discriminate individuals who suffered and those who did not suffered fall. The cut-off point of 12 s was the one that best discriminated the occurrence of fall, presenting sensitivity = 68.4% and specificity = 60.0%. CONCLUSIONS: The results indicated that the “chair stand” test was associated with fall and presented predictive potential for elderly men fallers.

320-326

Authors: Jordan Minov, Jovanka Karadzinska-Bislimovska, Engin Tutkun, Kristin Vasilevska, Snezana Risteska-Kuc, Saso Stoleski, Dragan Mijakoski

AIM: Textile workers in their work environment are exposed to airborne particulate from natural and synthetic origin. In the present study we aimed at assessment of prevalence and characterstics of COPD in never-smoking female workers employed at cotton weaving sector in textile manufacture. MATERIAL AND METHODS: In order to assess chronic prevalence and characteristics of chronic obstructive pulmonary disease (COPD) in textile industry we performed a cross-sectional study including 47 never-smoking female cotton workers (aged 36 to 56 years) and an equal number of never-smoking female office workers studied as a control. Evaluation of examined subjects consisted of completion of a questionnaire, baseline spirometry, and bronchodilator reversibility testing. RESULTS: We found higher prevalence of respiratory symptoms in cotton workers with significant difference for phlegm and dyspnea. Majority of the chronic respiratory symptoms in cotton workers were work-related. With exception of the mean value of forced vital capacity (FVC), the mean values of all other measured spirometric parameters in cotton workers were significantly lower than in office workers. The prevalence of COPD was significantly higher in cotton workers than in office workers (11.4% vs. 2.3%, P = 0,027). COPD in cotton workers was significantly associated with age higher than 45 years and with duration of exposure longer than 20 years. CONCLUSION: Our findings support data about relationship between occupational exposure to organic dust in textile workers and persistent airflow limitation.

335-343

Authors: Tatjana Petrushevska, Vesna Velik Stefanovska

AIM: The aim of the survey is to analyze national data from opioid substitution treatment (OST) medical records and to compare it with the data from EU countries. MATERIAL AND METHODS: The survey is quantitative analytical cross-sectional study conducted in the period September - December 2013. Medical records from all patients on OST at national level during the year 2012 were analyzed. EMCDDA questionnaire from treatment protocol 3.0 was used. Data for OST patients on MMT was take from all 12 public treatment facilities, three private centers and 3 prisons. Data for OST patients on buprenorphine was taken from public clinic as the only one responsible for this type of treatment. RESULTS: A comprehensive network, diverse models of treatment intervention exists in the MKD. Total number of OST patients in 2012 in all treatment facilities was 1857 (1356 are in public, 141 in private, 360 in prison settings) 10% are on Buprenorphine and 90% are on Methadone, 52% in age group 20-34. Ratio of male to female heroin clients is 9:1; 162 are female (9 %); 107(66%) are in treatment in the age group 20-34. Average number of OST patients is 0.1% of the total population in each of the 10 cities analyzed. The mean age at first heroin use is 18 years. 40% of patients haven’t high school. With their family lives 65% of OST patients; 487 patients (36%) have children; 80% of patients use of benzodiazepines. CONCLUSION: Although treatment network of drug addiction is quite developed, perceived need for further capacity building and increase the quality of medical care implies increasing the availability, diversification in terms of sensitivity to cultural differences, gender, age, ethnicity, as well as the treatment of dependence of different types of psychoactive substances.

350-352

Authors: Dinesh Sethi, Dimitrinka Jordanova Peshevska

AIM: To describe the burden of interpersonal violence, risk factors and discuss the need for evidence based action to reduce the public health threat of interpersonal violence. METHODS: Global Health Estimates data were used to describe the mortality and meta-analyses from previous reports were used to describe the prevalence of the different types of interpersonal violence and to discuss the options for evidence informed prevention programmes. RESULTS: In the 53 countries of the WHO European Region, violence kills about 160,000 people each year, and of these around 31,000 die from interpersonal violence, 123,000 from self-inflicted violence and 2,000 from war. Deaths are just the tip of the iceberg and for every death there are numerous admissions to hospital and emergency departments. Interpersonal violence is thought to be one of the most frequently experienced yet commonly overlooked forms of violence. Based upon data from meta-analyses of population surveys in Europe: the prevalence in children under 18 years of sexual abuse is 9.6% (13.4% in girls and 5.7% in boys); physical abuse is 22.9% and 29.1% for emotional abuse; the prevalence of intimate partner violence (physical and or sexual violence) is 19.3% in high-income countries and 25.6% in low- and middle-income countries, suggesting that about 49 million women aged 14-49 years have been abused. Surveys of older people over 60 years, suggest that the past year prevalence of physical abuse is 2.7%, sexual abuse 0.7%, emotional abuse 19.% and financial abuse 3.8%, suggesting the numbers experiencing elder maltreatment in Europe run into the tens of millions CONCLUSION: Community surveys can play an important role to better understand the scale and risk factors of different types of interpersonal violence. Readers are called upon to support a coordinated public health response to prevent this societal and health threat.

360-366

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

OBJECTIVES: The first Macedonian National Prevalence study of elder maltreatment in private settings was conducted in 2011 and 2012. This article provides an overview of the risk factors on individual level regarding the ecological model of human development. METHOD: The study involved 960 respondents who provided answers to a face-to-face survey questionnaire and a Geriatric Depression Scale. The Mini-Mental State Examination test was used as a pre selection criterion. The achieved sample was weighted to be representative on the Macedonian population aged 65 and over. RESULTS: Being women, being married, with elementary school education, suffering from certain chronic diseases, sensory impairment, are potential risk factors on individual level for elderly Maltreatment. CONCLUSION: The findings support the previous quantitative data obtained in other countries, as well as the concept of ecological framework.

373-378

Authors: Marijana Markovik, Dimitrinka Jordanova Peshevska

BACKGROUND: National prevalence study of elderly abuse in Macedonia intended to explore prevalence and risk factors of elder abuse and neglect. This paper is focused on influence of the gender as individual risk factor, according to ecological model, on elderly abuse and neglect. METHODS: Culturally validated questionnaire and Geriatric Depression scale was used for data collection. Mini Mental State Examination (MMSE) test, was used for sample selection. Cutting score was 20. The research was conducted through face-to-face interviews on the sample of 960 respondents aged 65 and over. RESULTS: Evidenced were 32% abused and neglected from representative sample, living in private households, 19% of abused was female. In Macedonian study women are 1.6 times often victims of abuse than man. Only female respondents reported sexual abuse. CONCLUSION: Being female is risk factor for being exposed on any type of abuse and neglect, excluding financial abuse.

384-389

Authors: Dimitrinka Jordanova Peshevska, Marija Raleva, Izabela Filov, Dinesh Sethi, Tamara Jordanova, Kadri HazdiHamza, Fimka Tozija, Vesna Damchevska Ilievska

OBJECTIVES: One of the main objectives of this paper is to analyze the associations between physical abuse and neglect and health risk behaviours among young adolescents in the country. METHOD: A representative sample consisted of total 1277 students (58.6% female and 41.6%), aged 18 and above. About 664 of them are in last (fourth) year of secondary school and 613 respondents are 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: Physical abuse (21.1%) and physical neglect (20%) were reported with similar prevalence rates. Disciplining children by spanking or corporal punishment was presented with very high rate of 72.4%. CONCLUSION: The results demonstrated a relationship between physical abuse and later manifestation of health risk behaviours such as: smoking and early pregnancy. Physical neglect increased the chances for drug abuse, drink-driving, having early sex, having more sexual partners.

11-17

Authors: Edagha IA, Davies KG, Akpan BC, Mbadugha CC, Udoiso WU

Aim: This study was designed to investigate the effect of ethanolic extracts of the leaves of Emilia sonchifolia on the haematological parameters and histomorphology of the liver of male Swiss albino mice infected with Plasmodium berghei berghei (Pbb). Material and Methods: 35 mice were divided into; Group 1 (control) given normal saline 0.3 ml, Group 2 passaged with Pbb only, Group 3 passaged with Pbb, and then treated with Coartem®, Group 4 treated with E. sonchifolia 325 mg/kg only, Group 5 treated with E. sonchifolia 650 mg/kg only, Group 6 passaged with Pbb then treated with E. sonchifolia 325 mg/kg, while Group 7 was passaged with Pbb then treated with E. sonchifolia 650 mg/kg. Pbb was passaged intraperitoneally, while the test drug and extracts was given via orogavage once daily. Results: The result showed significantly (P<0.001) reduced RBC parameters at in Group 5 treated with 650 mg/kg similar with Group 2 compared to Group 1, while there was significant (P<0.01) increased WBC and differentials in Parasitized groups compared with Group 1. The micrographs showed slightly inflamed nuclei in Group 4, with few nuclei shrinkage Group 5, whereas in the parasitized groups treated with the extract there appeared to be hepatoprotection compared to Group 2. Conclusion: In conclusion, the extract promotes erythropoiesis at 325 mg/kg, but was haemolytic at 650 mg/kg, and exerts its effect possibly through an agonistic and a synergistic activity of its rich bioactive ingredients. It showed mild toxic effect in the histomorphology of the non-parasitized mice at 325 mg/kg and 650 mg/kg, and also appeared to offer hepatoprotection in parasitized mice compared to the parasitized group that had no treatment.

23-28

Authors: Nurul Syazana MS, Wan Sulaiman WA, Halim AS, Sarina S

Cleft lip palate is a human congenital disorder worldwide and the study of this genetic disease requires molecular genetic analysis. This analysis required the use of nucleic acid and protein, thus good quality and quantity of its extraction is important. We are comparing RNA and protein extractions from tissue biopsy of cleft lip palate in both fresh and stabilized condition. Tissue morphology was also captured using Scanning Electron Microscopy (SEM) for any morphology differences. Tissue homogenization may destroy nucleic acid stability but not its morphology. Low RNA concentration from stabilized tissue was found. However, there was no crucial issue of protein extraction, degradation or concentration. Tissue morphology was slight different between normal and CL/P tissue.

34-39

Authors: Petrovic S, Cegar S, Barisic N

Background: Lower respiratory tract infections are frequent and often serious diseases in children. Wide number of microorganisms may cause lower respiratory tract infections, and sometimes it could be very difficult to determine the exact causative. Aim: The aim of this study was to assess the reliability of specimens obtained by bronchial lavage in determining the etiology of childhood pneumonia. Methods: This is prospective study conducted during four years period, in a group of 60 children aged from 6 months to 18 years. All patients included in this study underwent bronchoscopy when they fulfilled criteria of routine clinical protocol, in order to set correct diagnosis of lower respiratory tract disease. Results of bacteriological analysis of PLA samples were compared against the results of bacteriological analysis of BL samples of the same patient. Results: In majority of subjects - 41 (68.32%), the bacteria isolated from the bronchial lavage samples was not identified in pharyngolaryngeal aspirate and was considered as the cause of infection. Haemophilus influenzae was the most frequently isolated pathogen in bronchial lavage samples. Conclusion: Findings based on analysis of bronchial lavage samples may be used as reliable criterion for etiological diagnosis in cases of pneumonia when initial empirical treatment failed.

46-50

Authors: Teferici D, Qirko S, Petrela E, Bara P

Background: Strain imaging (SI) has been shown to quantify regional myocardial function in both acute ischemic myocardium and infarcted myocardium. The aim of this study is to determine the diagnostic value of SI for the detection of coronary lesions in pts with chest pain, but without apparent wall motion abnormalities. Methods: SI for advanced wall motion analysis was performed in 59 pts with suspicious stable angina (SA) and in 57 pts with suspicious unstable angina (UA), prior to coronary angiography (CAG). Longitudinal strain was measured in 3 apical views. For the identification of ischemia a magnitude parameter, being defined as a reduction of the peak systolic strain, was used. A homogenous pattern of strain was defined as relatively uniform distribution of the peak systolic strain. Heterogeneity of strain was considered abnormal; these segments were called strain (+) and the rest were called strain (-). Results: Out of the 59 SA patients, 28 had >70% stenosis (ischemic-SA) and 31 had normal coronary anatomy or 50% stenosis (normal-SA). Of the 28 patients in the ischemic-SA group, 9 patients (32%) showed a homogeneous pattern of peak systolic strain throughout the wall (strain negative) and 19 patients (67%) showed heterogeneity of strain (strain positive). 31 patients with normal coronary anatomy or <50% stenosis (normal-SA), 6 patients (19%) showed heterogeneity of strain (strain positive) and 25 patients (80%) showed a homogeneous pattern of peak systolic strain throughout the wall (strain negative). The positive predictive value of strain was 76% in the SA group. In the group of 57 UA patients, 32 had >70% stenosis (ischemic-UA), and 25 had normal coronary anatomy or 50% stenosis (normal-UA). From the 32 patients in the ischemic-UA group, 7 patients (22%) were determined to be strain negative, and 25 patients (78%) were determined to be strain positive. Out of 25 patients with normal coronary anatomy or 50% stenosis (normal-UA), 25 patients (80%) showed a homogeneous pattern of peak systolic strain throughout the wall (strain negative) and 6 patients (19%) showed heterogeneity of strain (strain positive). The positive predictive value of strain was 80.6% in the UA group. Sensitivity and specificity of 2D strain was evaluated using diagnostic test. The results were: 68% and 80.6% respectively in the stable angina group and 78% and 76% respectively in the unstable angina group. Conclusion: Ultrasound-based SI demonstrates a strong correlation with CAG and it has potential as a non-invasive diagnostic tool for detecting CAD in pts with chest pain and without wall motion abnormalities.

56-61

Authors: Żuber Z, Kania U, Król-Zdechlikiewicz A, Morawska A, Pilch B, Rajska E, Turowska-Heydel D, Sobczyk M, Chudek J, Rutkowska-Sak L

Background: Juvenile idiopathic arthritis (JIA) is a heterogenic group of chronic inflammatory connective tissue diseases of unknown aetiology in children up to 16 years of age. Aim: The aim of this study was to analyse the incidence, clinical presentation and laboratory findings in children with JIA in Malopolska region. Materials and methods: A retrospective analysis included all children with JIA (N=251) hospitalized in the two reference rheumatology centres covering Malopolska region (Poland), between July 2007 and December 2010. Results: The annual incidence of JIA in Malopolska region was estimated at 9.5 per 100 000 children. Oligoarthritis (54.9%) was the most common category in all age groups with a tendency to decrease with age; from 71.4 % in children aged 1-6 years; 55.7% in aged 7-12 years to 39.3 % in aged 13-16 years. The frequency of polyarthritis and enthesitis-related arthritis was greater in adolescents (29.2 % and 22.5 %, respectively). HLA-B27 antigen and uveitis were most frequently found in children with enthesitis-related arthritis (58% and 18.5 %, respectively). Conclusions: The study suggests the improvement of diagnostic capacity of JIA during the last decade in Poland. In accordance with the existing data diverse clinical presentation of JIA categories and laboratory characteristics were proven.

68-73

Authors: Salah ON, Abdelraouf ER, Abdelhameed MH, Dawood AA, Hashish AF, Kilany A, Helal SI

Febrile seizure is one of the most common neurological problems during childhood. The etiology and pathogenesis of febrile seizure remain unknown. However, several factors such as vitamin B6 deficiency, electrolyte disturbances, and reduction in serum zinc, selenium, magnesium levels, and low gamma - aminobutyric acid (GABA) levels are thought to play a role in the pathogenesis of febrile seizure. The present study included twenty children from 10 families, 11 were male and 9 were female. Each family has at least 2 members with a history of febrile convulsion. All cases were subjected to the following: Determination of serum levels of copper, zinc, magnesium, selenium level in serum, and plasma level of γ-aminobytaric acid (GABA). Serum levels of selenium and GABA were statistically significantly low in comparison with controls. Serum copper was statistically significantly higher in cases than controls, while serum zinc showed no significant changes in the cases of febrile convulsion compared with the control group. The mean Zn level in the serum of febrile convulsion was found to be at lower level than in the control group. The serum magnesium was significantly low in cases than controls. The logistic regression model in our study shows that Selenium and Magnesium have protective effects, while Copper has causative effect.

78-82

Authors: Ilanković NN, Ilanković AN, Ilanković V

Aim: The aims of the study were: 1. revealing the new indicator(s) in internal organization of sleep in psychotic states; 2. constitution of new neurophysiologic and statistical models of sleep perturbation in psychotic states and/or altered states of consciousness based on experimental data. 3. Introduction of new sleep marker as biological marker for distinction of sleep organization by different psychotic states. 4. Established new hypothesis and theories in functions of sleep and dreams. Methods: The clinical neurophysiologic test (Polysomnography - PSG) were performed on 90 drug-free patients - 60 with depression (30 patients with reactive depression F32.0, F32.1, and 30 patients with depression with psychotic future F32.3); and 30 patients with Acute schizophrenia and schizophrenia-like states F23.1, F23.2 (all according to the DSM-IV criteria). Polysomnography was used for two nights, sleep staging (according to the criteria of Rechtschaffen & Kales, 1968) and statistical analysis of 130 sleep parameters with logistic regression (discriminative analysis “step by step”). All patients were drug-free in 3 days (1st adaptation night and 2 nights sleep investigation). The bigger part of investigation was performed in “Zentrum fuer Chronomedizin“in Wuerzburg (Germany) and one part at Psychiatric Clinic in Belgrade (Serbia). Results: 1. The results of our investigations demonstrate that the ratio between REM and NREM time in the first period of sleep (index of endogenous perturbation of sleep or IEP-P1=REM-1/NREM-1) is statistically the most significant chronobiological marker of internal sleep organization (through maturation and in different pathological states); 2. IEP-P1 is a highly reliable indicator of the development of endogenic perturbation of sleep in depression, mania, schizophrenic and other psychotic states, and in organic brain syndromes. Conclusion: IEP-P1 could be a new biological marker to distinction of sleep organization in different psychotic states and other states of altered consciousness. The developed statistical models could be the basis for new hypothesis and theories about functions of sleep and dreams.

89-94

Authors: Sarry El Din AM, Zaki ME, Kandeel WA, Mohamed SK, Wakeel KH

Background: Obesity, particularly abdominal adiposity, is closely associated with premature atherosclerosis and many metabolic modifications including insulin resistance dyslipidemia hypertension and diabetes. Cut-off values for abdominal obesity predicting future cardiovascular disease are known to be population specific. Objective: To identify cut-off points of some anthropometric measurements (BMI, WC, WHR and WHtR) that associated with hypertension in a sample of Egyptian adults. Subjects and Methods: This is a cross-sectional analysis. The blood pressure of 5550 Egyptian adults was measured (2670 females – 2880 males).The subjects represented different geographic localities and different social classes. Anthropometric measurements including height, weight, waist circumferences, and hip circumferences were also measured by practitioners. Results: The cut-off values to detect hypertension in females were 30.08 for BMI, 87.75 for WC , 0.81 for WHR and 0.65 for WHtR, and the corresponding sensitivity and specificity were 69.1; 60.7- 80.9; 48.6 -65.3; 53.4 and 61.4; 58.9, respectively. The cut-off values to detect hypertension in males were 27.98 for BMI, 95.75 for WC, 0.92 for WHR, and 0.57 for WHtR and the corresponding sensitivity and specificity were 62.8; 59.9 -71.9; 51.9 -64.6; 55.8 and 59.7; 55.8, respectively. Conclusion: The BMI, Waist circumference, WHR and WHtR values can predict the presence of hypertension risk in adult Egyptians.

103-108

Authors: Tofoski G, Georgievska J

Introduction: Reproductive outcome can be negatively affected in patients with congenital uterine anomalies (CUA), increasing the number of unsuccessful pregnancies and obstetric complications. Compared with the population with normally formed uterus, patients with CUA have higher abortion rate, higher fetal loss rate and decreased live birth rate. Hysteroscopic metroplasty (HM) is a standard, safe and minimally invasive method for the treatment of correctible types of congenital uterine anomalies. Aim: The aim of the study was to analyze the reproductive outcome in group of patients with infertility and recurrent pregnancy loss and present CUA, before and after hysteroscopic metroplasty. Material and Methods: We analyzed 67 patients to whom 78 interventions hysteroscopic metroplasty were performed at the University Clinic of Obstetrics and Gynecology in Skopje during a two year period, between 01.01.2010 and 31.12.2011. Their reproductive outcome was monitored during a two-year period and the same group served as a control group, taking into account their previous reproductive history. Statistical analysis was performed using Chi-square test and p < 0.05 was considered to be statistically significant. Results: Most common CUA were types 5b and 6 represented by 88 %. In a follow up period of two years, 33 of the patients become pregnant. There was a statistically significant decrease of abortion rate from 92% to 21.2%, as well as an increase in the term delivery rate from 0% to 69.7%. Conclusion: Treatment with hysteroscopic metroplasty is significantly improving the reproductive outcome in patients with CUA and previous fetal loss.

114-118

Authors: Fayed SB, Abd El Dayem SM, Khalil E, Abd El Kader M, Abd El Halim E

Objective: To evaluate H. pylori infection and virulent strain in diabetic children. Patients: In this study 53 type 1 diabetics and 53 of normal volunteers were included. Methods: All studied children were subjected to assessment of glycosylated hemoglobin (HbA1), Anti H. pylori antibodies (IgA, IgG, IgM), Anti-cytotoxin associated gene A antibodies (Anti Cag A IgG). Results: Anti H. pylori antibodies IgA, IgG, total antibodies and anti Cag A IgG were significantly higher in diabetics. Diabetic patients with positive anti Cag A IgG had a lower age of onset of diabetes, higher age of patients, body mass index (BMI) and HbA1. Conclusion: High prevalence of infection with the virulent strain of H. pylori among diabetic children with older age, large BMI, high HbA1 and younger age of onset of disease. The screening for the virulent strain in diabetic patients with poor metabolic control is mandatory. Control of diabetes is essential to present the infection with H. pylori.

124-127

Authors: Nasser ME, Younes KM, Sany DH, Youssef SS, Mahmoud M, El-Sayed BS

Background: Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality in end stage renal disease (ESRD) patients on hemodialysis (HD). Routine HCV viremia screening is recommended in those patients but it is not applied. Aim: To evaluate the seroconversion rate in HD patients based on viremia detection compared to antibody (Ab), and to assess the role of isolation on the rate of seroconversion in those patients. Materials and Methods: One hundred ESRD patients from two HD units using same infection control criteria were enrolled in the study; only one unit was applying isolation for HCV patients. Patients were followed up for 12 month; HCV positivity was tested at the begining of the study and after 12 month of HD. HCV Ab and viremia were detected by third generation ELISA and PCR respectively. Results: The seroconversion rate was 0% based on HCV Ab detection by ELISA, compared with the 16 % seroconversion rate based on viremia detection by PCR. Notably, viremia seroconversion was seen only in the HD unit lacking the isolation system. Conclusion: HCV screening in HD units should be based on viremia detection; isolation in HD units prevents HCV spreading.

132-134

Authors: Ruci V, Serani D

Osteopoikilosis is a rare bone anomaly usually benign which may be confused with other severe primary diseases or dangerous metastatic bone lesions. We present one new case describing typical radiological findings with no clinical signs or other associations. No malignant transformation or other complications happened in the last ten years. Osteopoikilosis is found in most cases incidentally, and in most cases is not associated with other serious medical complications. Screening of family members may be considered.

141-146

Authors: Saad-Hussein A, Abdalla MSh, Shousha WGh, Moubarz G, Mohamed AH

Aim: The study aimed to estimate oxidative role of aflatoxin B1 (AFB1) on the liver in wheat milling workers. Materials and Methods: Case-control study was conducted to compare between the levels of AFB1/albumin (AFB1/alb), liver enzymes (ALT, AST, GGT, and ALP), P53, MDA, GST, SOD, zinc and vitamin C in 35 wheat milling workers and 40 control subjects. Results: Statistical analysis revealed that ALT, AST, GGT, ALP, P53, MDA, GST and SOD in workers were significantly elevated compared to their controls. In the milling workers, there were significant correlations between MDA levels and the levels of AST, GGT, and P53, while, P53 was inversely correlated with GST and SOD activities. There were significant correlations between Zn levels and GGT, GST and SOD activities, between vitamin C and GST activities, and vitamin C inversely correlated with MDA. Conclusion: The present study concluded that the oxidative stress of AFB1 elevated the MDA and the liver enzymes in wheat milling workers. GST has a crucial role in the detoxification of aflatoxin and SOD as a scavenger antioxidant increased in the workers to overcome the oxidative toxic effects of AFB1 on the liver of the workers, and roles of Zn and vitamin C were significant in activation of these processes.

154-179

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 ("2013/01/01"[PDAT] : "2013/12/31"[PDAT]), dated March 01, 2014. A total number of 138 papers were selected in PubMed during 2013 year, 23 of which were not from Republic of Macedonia and were excluded. A total number of 105 papers are included in 2013 year in Pubmed from Republic of Macedonia Four papers are deposited in the PubMed without abstracts. Editorial Board does not take any responsibility either for the content, nor the quality of the abstracts.