Open Access Macedonian Journal of Medical Sciences

551-556

Authors: Nagwa A. Meguid, Hazem M. Atta, Laila A. Rashed, Amr S. Gouda, Rehab O. Khalil, Adel F. Hashish

BACKGROUND:Autism and Fragile X syndrome are intertwined. This study aimed at assessing Serotonin, Glutamate, and Gama Amino Butyric Acid (GABA) in autism and Fragile X syndrome patients and to detect possible neurochemical similarities between the 2 disorders that can be used as metabolic biomarkers. DESIGN AND METHODS: Eighty subjects divided into four groups, two diseased groups (20 male patients with Autism and 20 males with Fragile X syndrome) and two control groups (20 neurotypical male controls and 20 Down syndrome male patients) were included. Estimation of Serotonin, Glutamate and GABA were done using Enzyme linked Immunosorbent Assay (ELISA), Tandem Mass Spectrometry and high-pressure liquid chromatography (HPLC), respectively. RESULTS: Serotonin was, exclusively, significantly low in autistic children. GABA was significantly high in both autistic and Fragile X children only, but not in Down syndrome children. Glutamate was significantly high in children with autism, Fragile X and Down syndrome Children. CONCLUSIONS: Autism and Fragile X syndrome share some neurochemical similarities with regards of high Glutamate and GABA levels while Serotonin was significantly different in the 2 disorders and may be used a unique biomarker for autism.

562-566

Authors: Nayera E. Hassan, Sahar A. El-Masry, Rokia A. El Banna, Mones M. Abu Shady, Muhammad Al-Tohamy, Manal Mouhamed Ali, Mehrevan M. Abd El-Moniem, Mona Anwar

BACKGROUND: Association between vitamin D, adiponectin and obesity is a matter of debate, as they play important role in linking obesity with different cardio metabolic risk factors. AIM: Evaluation of association between metabolic risk factors with both adiponectin and 25-Hydroxy vitamin D [25(OH) D] levels and that between adiponectin and [25(OH) D] among obese Egyptian children. SUBJECTS AND METHODS: This case-control cross sectional study consisted of 65 obese and 30 healthy children, aged 8-11 years. 25(OH) D, serum adiponectin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol were measured. RESULTS: The mean 25(OH)D and adiponectin levels in the obese were lower than that in control group (

573-578

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

BACKGROUND: The relation between fat distribution and bone mass is still being debated in children and adolescents. AIM: To verify the influence of both visceral and subcutaneous fat on bone mass among Egyptian children and adolescents. SUBJECTS AND METHODS: The study involved 78 (38 boys and 40 girls) individuals from children (42) and adolescents (36), aged 8-17 years. They were divided into 2 age groups: children group (20 boys and 22 girls) aged 8-12 years and adolescent group (18 boys and 18 girls) aged 13-17 years. Anthropometric measurements, visceral and subcutaneous fat (measured by ultrasound), body composition, BMD and BMC (Measured by DXA), were attempted. RESULTS: Among children, significant positive correlations between visceral fat; in males; and subcutaneous fat; in females; with total BMC, BMD and its Z-score were revealed. After exclusion of age effect, the association between visceral fat in females with total BMD and its Z-score and lumbar BMD-Z-score became significant. For adolescents, no correlation was observed between either visceral or subcutaneous fat with any parameter of bone mass. CONCLUSIONS: Visceral and subcutaneous fat had significant positive association with bone mass in children; males and females respectively. On the contrary such association disappeared during adolescence.

585-594

Authors: Sonia L. Elsharkawy, Wafaa E. AbdEl-Aal, Reham S.E. Esmal, Hanan H.M. Ali, Soheir M. Mahfouz, Ahmed El-Habashi

AIM: This study aimed to investigate the value of DNA ploidy and galectins-3 immunostain in the preoperative evaluation of thyroid epithelial lesions. MATERIAL AND METHODS: Sixty patients presenting with thyroid enlargement were included in this study and referred by clinicians for FNA. Routine cytological evaluation was done on PAP stained slides according to the WHO criteria and at least three slides were prepared for routine cytological examinations. The nuclear DNA analysis was performed at the Pathology Department, National Research Center using the Leica Qwin 500 Image Analyzer (LEICA Imaging Systems Ltd, Cambridge, England). Galectin-3 expression was investigated in all tissues using streptavidin-biotin technique. RESULTS: Conventional Fine needle aspiration cytology (FNAC) of 60 cases could diagnose malignancy with a sensitivity of 60%, negative predictive value (NPV) 71.4%, and overall diagnostic accuracy of 80%. The aneuploidy was significantly associated with malignancy, with sensitivity 90.9%, specificity 83.3% and accuracy 88.3%. On using galectin-3 immunocytochemichal stain on cell blocks prepared from FNA the values were improved, sensitivity 93.3% specificity 86.7% and overall accuracy 90% and it was noticed that galectin-3 over expression was significantly associated with malignancy. CONCLUSIONS: From the results of this study we can consider that DNA ploidy and Galectin-3 could refine the FNA results and increase its sensitivity as a screening test from sensitivity(60%) to reach sensitivity (93.3%), thus decreasing the false negative cases. From this study, it is concluded that the application of ancillary techniques as galectin-3 immunocytochemical markers may become a reliable indicator for surgical intervention, DNA ploidy measurements on the other hand may be of value in galectin-3 negative cases to determine the behavior of the lesion in such cases & refine the preoperative assessment by out ruling false negative cases.

601-607

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

INTRODUCTION: Multiple epidemiological studies have shown that low testosterone levels are associated with and predict the future development of T2DM. AIM: The aim of study was to show the influence of testosterone replacement therapy on anthropometric characteristics, glycosylated hemoglobinlevel level, blood pressure and dyslipidemia in patients with T2DM and Androgen deficiency. MATERIALS AND METHODS: From 125 male patients with T2DM were randomized 85 subjects with age 49.8 ± 6.74 and BMI from 35.83 ± 3.65 kg/m2 in placebo-controlled study. We divided patients into two groups: 1) Treatment group, where was used testosterone replacement therapy. 2) Placebo group, where was used placebo. In both groups was added Life style modification, but Antidiabetic therapy was unchanged. RESULTS: After six months of treatment we repeated the diagnostic assessments: lipid profile was improved in both groups but in group I it was statistically significant. Free testosterone level increased in all groups but in group I it was statistically significant. HbA1c decreased in both group but in group I we had the best result. Blood pressure was reduced in both groups, results were similar. CONCLUSION: Our study demonstrated that it is possible to regulate blood pressure, lipid profile, HbA1c, BMI - by raising testosterone in diabetic men with androgen deficiency.

613-617

Authors: Vladimir Vukomanović, Milovan Matović, Vesna Ignjatović, Branislav Belić

Hereditary hemorrhagic telangectasia (HHT) or Rendu-Osler-Weber syndrome, is a rare genetic disorder with autosomal dominance and variable penetrance. The typical findings of the disease are telangiectasias in skin and mucous membranes, and arteriovenous malformations presenting in the organs like lung, intestine, brain and liver. It is characterized by the classic triad of recurrent epistaxis, mucocutaneous telangiectasias and visceral hemorrhages, with familial occurrence. This article describes a case of HHT of an adult patient, associated with multiple angiodysplasic injuries in the nasal mucosa, upper gastrointestinal tract, lungs and who presents continuous blood loss, resulting iron deficiency anemia. Based on clinical and diagnostic findings, we diagnosed this case as HHT, which has rarely been reported in our literature.

622-625

Authors: Marija Karakolevska-Ilova, Elena Simeonovska Joveva, Marija Dimitrovska Ivanova

BACKGROUND: Leptomeningeal metastases are diagnosed in 1% to 8% of patients with cancer. The most common histology is leukaemia, lymphoma, breast carcinoma, lung carcinoma and melanoma. The aim of this study is to show the appearance of leptomeningeal metastases in lung and breast cancer with specific biological features. AIM: The study is a review of two cases - breast and lung carcinoma with specific biological features who eventually have developed leptomeningeal metastases. CASE PRESENTATION: Although CNS metastasis most commonly occurs in those with known systemic metastases, our patient had biological indolent disease (nor hormone negative or HER 2 positive and no metastatic disease) and still LM did occur. LM remains a devastating complication of cancer with classic presentation with multifocal neurologic signs and symptoms (like the case with lung cancer), but many patients also have evidence of impaired CSF flow, and hydrocephalus may be the only presenting manifestation of LM. CONCLUSION: The prognostic factors associated with survival in patients with LM metastasis are not certain as well as right treatment for these patients which is still a big challenge. Due to the lack of randomized studies and especially of studies referring to one specific primary tumor, there is currently no generally accepted standard of care in the treatment of LM metastases.

632-634

Authors: Nikola Fatic, Nenad Zornic, Nemanja Radojevic, Nikola Bulatovic

In the presented case report, we evaluated the mechanism of the external iliac, the common femoral and the superficial femoral arterial thrombosis secondary to total hip arthroplasty. A 75-year-old female sufferd from 5.5 cm shorter left lower limb and same sade coxarthritis. Next day after arthroplasty and eqalisation of the lower limbs, an acute ishemia of the treated leg was presented. Multyscan CT angiography revealed the presence of the external iliac, the common femoral and the superficial femoral arterial thrombosis. From the best of our knowledge, it seems to be the only case of this arterial segment thrombosis after total hip arthroplasty and equalistaion of the lower limbs reported.

640-644

Authors: Dance Gudeva Nikovska, Fimka Tozija

BACKGROUND: Stigma and discrimination are interrelated and are breaking the fundamental human rights. Both are associated with tuberculosis (TB) disease since ever and have negative influence on activities aimed at TB prevention, treatment and control, both at individual, community and societal level. AIM: To determine the magnitude of TB stigma in Republic of Macedonia, identify root causes and detect main determinants associated with it. MATERIAL AND METHODS: Cross-sectional study was performed on 315 TB patients registered in the period Jul, 2012-Jun, 2013, using selected module from World Health Survey questionnaire. Self-reported data is collected through face to face interview conducted by trained directly observed treatment (DOT) nurses in the patients’ home. RESULTS: 16.7% TB patients have not received any assistance when diagnosed with TB and 8.4% were treated badly by a member of the family or close friends because of the disease, consequences ranging from living the patient completely, refusal to talk or telling other people that the person is infected. An odd for such behavior were higher if the patient is male, married, have no formal education or have completed only primary school, is unemployed and lives in rural area. CONCLUSION: Understanding the origins of TB stigma is integral to reducing its impact on health. Our survey has provided a baseline on the magnitude of existent stigma associated with TB disease and has identified main determinants that trigger stigmatizing behavior.

650-654

Authors: Anthonia Ikpeme, Akintunde Akintomide, Grace Inah, Afiong Oku

BACKGROUND: X-ray and sonomammography constitute a significant option in the early detection and management of breast diseases in the developed world. Unfortunately these modalities became available in Nigeria, only in the past few decades. AIM: The aim of this audit is therefore to document the imaging findings, in the past three years in a developing facility in Nigeria relating them with the demograghic features. METHODS: We prospectively studied the x-ray and sonomammography in all patients, presenting over a three year period, for breast evaluation with the hope of discerning the epidemiologic pattern of breast lesions in this environment. RESULTS: One hundred and forty-five females and four males. Median was 38 years (IQR=30-48). The commonest reason for evaluation was screening. Patients that were below 38 years showed no significant difference in frequency and type of lesion compared with patients over 38 years. The commonest breast pattern was fatty replaced. The upper outer quadrant was the commonest site. CONCLUSION: Patients presenting for breast evaluation in Calabar do so for screening mainly. Patients below 38 are nearly equally affected by malignant breast disease as their older counterparts. The commonest breast pattern was fatty replaced. Digital mammography should be available in all tertiary institutions.

662-667

Authors: Rada Miskovic, Aleksandra Plavsic, Jasna Bolpacic, Sanvila Raskovic, Mirjana Bogic

Vitamin D is a steroid hormone that in addition to its well known role in the metabolism of calcium and phosphorus exerts immunoregulatory properties. Data from animal studies and from prospective clinical trials on patients with rheumatoid arthritis, multiple sclerosis and type 1 diabetes point to the potential role of vitamin D as important environmental factor in the development of autoimmune diseases. Such role of vitamin D in systemic lupus erythematosus (SLE) has not yet been sufficiently studied. This review shows the sources, metabolism and mechanism of action of vitamin D, its effect on the cells of the immune system, prevalence and causes of vitamin D deficiency in patients with SLE, the link between vitamin D status and disease activity as well as recommendations for vitamin D supplementation.