Volumen 40 (2019): Heft 3 (December 2019)

The Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) was established in Ohrid, Republic of Macedonia on October 9, 1993 during the First Congress of the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO).

The idea of the founders was that such Society would have a clear impact on several aspects of practice and research in nephrology and artificial organs in the Balkans, firstly, by increasing its international visibility and potential collaborative work, and recognition by international organizations. Secondly, such a society would facilitate the exchange of experience and knowledge between experts in our area. In addition, it would be a very positive symbolic act showing that collaborative work for the betterment of life is possible and desirable in our area and that coming together will bear better fruits at the human and cultural levels. It will also send a very clear signal to the outside world that the Balkans can be a place of collaboration and mutual understanding. Several international bodies such as the International Society of Artificial Organs and the International Faculty of Artificial Organs have signaled their interest in and support for the creation of such a society. Despite the turbulent times in the Balkan Peninsula, the First BANTAO Congress was held in Varna from September 22 to 24, 1995, which was an impressive event. F. Valderrabano, Chairman of the EDTA–ERA registry reported on that event with a lot of sympathy in the paper entitled “Nephrologists of the Balkan countries meet across political frontiers and war fronts – an example to politicians. The foundation of and the Second Congress of BANTAO were also well accepted by the colleagues nephrologists from Russia. The Second Congress was held on September 6-10, 1997 in Struga, the Third BANTAO Congress was held on September 18-20, 1998 in Belgrade, the Fourth Congress of BANTAO was held in Izmir on November 14-16, 1999, the Fifth Congress of BANTAO was held in Thessaloniki on September 30 – October 3, 2001, the 6th BANTAO Congress was held in Varna, on October 6-9, 2003, the 7th BANTAO Congress was held in Ohrid, on September 8-11, 2005, the 8th BANTAO Congress was held in Belgrade, on September 16-19, 2007, the 9th BANTAO Congress was held in Antalya, November 18-22, 2009, the 10th BANTAO Congress was held in Chalkidiki, October 13-15, 2011, the 11th BANTAO Congress was held from 26 to 29 September 2013 in Timisoara on the 20th Anniversary of the foundation of BANTAO, the 12th BANTAO Congress was held on October 15-18, 2015 in Opatija, the 13th BANTAO Congress was held on 4-8 October, 2017 in Sarajevo, the 14th BANTAO Congress was held on September 20-23, 2018, in Budva and the 15th BANTAO Congress was held in Skopje, 26-29 September 2019.

Another milestone in the life of BANTAO was the appearance of the BANTAO journal in 2003, which has been published biannually since then. In the past 17 years there have been 33 editions of the journal and seven supplements reporting BANTAO congresses. The editors of the journal past and present are: 2003–2005 (Dimitar Nenov); 2005–2009 (Ali Basci); 2009–(Goce Spasovski). Up to date, more than 400 papers have been published. The BANTAO journal is registered on EBSCO, DOAJ, SCOPUS, and has become a strong ‘glue’ among nephrologists from the Balkan cities. The BANTAO congresses and the BANTAO journal have succeeded in elevating nephrology knowledge and thus increased the standards of nephrology patient care throughout the Balkans. Standing above the divisive forces of politics, language and war, BANTAO gives a living example that collaboration and humility are feasible in times of maddening destruction, and are transformative.

The traditional chronic kidney disease (CKD) biomarkers (eGFR based on serum creatinine, sex and age and albuminuria) cannot predict a patient’s individual risk for developing progressive CKD. For this reason, it is necessary to identify novel CKD biomarkers that will be able to predict which patients are prone to develop progressive disease and discriminate between disease processes in different parts of the nephron (glomeruli or tubules).

A good biomarker should change before or simultaneously with lesion development and its changes should correlate strongly with lesion development. Also, there should be a close relationship between severity of injury and amount of detectable biomarker and its levels should decrease with diminishing injury.

Among the large number of molecules under investigation, we have reviewed the most promising ones: NGAL and KIM-1, MCP-1, MMP-9, clusterin, MMP-9, TIMP-1, Procollagen I alpha 1 and suPAR. All these, have been studied as biomarkers for prediction of CKD progression in cohorts of patients with chronic kidney disease of different stages and various aetiologies (proteinuric and non-proteinuric, glomerulonephritides, diabetic, hypertensive and polycystic kidney disease). There is evidence that these molecules could be useful as biomarkers for progressive chronic kidney disease, however, the available data are not enough to draw final conclusions. Further studies with large cohorts and long follow-up are required to identify appropriate biomarkers, that will be able to accurately and reliably define the risk for progressive chronic kidney disease.

Introduction: Asymptomatic hypoglycaemia has been reported in both diabetic and non-diabetic patients on haemodialysis. Uremic symptoms as inadequate appetite, nausea and vomiting worsen the risk of hypoglycaemia at dialysis initiation. As a standard therapeutic approach for decreasing this risk and dis-equilibrium syndrome at our dialysis unit, a continuous venous 5% glucose solution is applied during the glucose-free dialysate (GFD) dialysis. In this interventional study we sought to assess the glycaemic control during standard initiating dialysis protocol versus novel approach with glucose-rich dialysis fluid (GRD).

Material and methods: Twenty-one dialysis patients with chronic renal failure were dialyzed alternatively using GRD (5.6 mmol/l) and GFD fluid. They were not taking any hypoglycaemic medication prior and food during dialysis session. Blood was sampled at regular intervals during dialysis. The dialysis prescription consisted of ultrafiltration (UF) of up to 1 L, membrane surface (MS) up to 1.4 square meters and duration time of 2-2.5 hours. Intra-patient glycaemic variability was defined by Coefficient of variation (CV). In paired analysis t-test was used to determine the glucose control differences in both therapeutic approaches in each patient. For the whole group t-test was used to assess the glucose variability as CV.

Results: The mean age of study participants was 62.95±11.73 years; 7 (33%) had diabetes. The two dialysis approaches did not differ in respect of initial blood pressure, UF and MS. Only two episodes of hypoglycaemia occurred in both types of dialysis. The mean glucose level was higher during GRD (8.15±1.89 vs. 6.29±1.33, p=0.001), respectively. The glucose CV was lower in GRD dialysis when pared t-test was applied, without significant difference (16.97± 8.86 vs. 21.05±11.99, p=0.151). When only diabetic patients were analysed, there was no significant glucose CV difference as well (p=0.151). For the whole cohort glucose variability was significantly higher in glucose-free dialysate dialysis (p=0.0001).

Conclusion: The GRD approach for initiating dialysis sessions is non-inferior to standard GFD care. Dialysate rich in glucose obtains better glucose control during dialysis compared to glucose-free dialysate.

Introduction: Cytomegalovirus (CMV) is the most common opportunistic infective pathogen in kidney transplant recipients. Valganciclovir (VAL) is commonly used for prophylaxis, especially in high-risk recipients. Generic VAL formulations have become available, but the data about their safety and efficacy are lacking.

Methods: Consecutive de novo kidney transplant patients were randomized to generic VAL Valganciklovir Teva® (VT group)(24 patients) or Alvanocyte® (A group), Alvogen (19 patients) or to Valcyte® (V group), Roche (23 patients) in a 18-month open-label study. Universal prophylaxis was used for 6 months after the transplantation. CMV DNA levels were measured at 1,3,6,9,12 and 18 months after the transplantation. All positive measurements of CMV DNA were recorded.

Results: Groups did not differ regarding the clinical characteristics or the risk for developing CMV infection in the post-transplant period. CMV replications were most common at 9 months after the transplantation with rates of 9% for the V, 13% for the VT and 26% for the A group (p=0.26). At 12 months, positive CMV DNA was recorded in 22%, 8% and 11 % of patients taking V, VT and A, respectively (p=0.37). Rates of biopsy-proven acute rejection, adverse events, and serious adverse events were similar for all formulations. Lymphocele occurred most commonly in the V group (35%) compared to 17% in VT and 17% in the A group (p=0.23). One patient from each of the A and VT groups developed CMV disease. Additionally, they were the only two patients with CMV DNA copies above 656 IU/ml. Glomerular filtration rates were similar in all groups at all time points, while proteinuria was significantly higher at 12 months in patients who received V 0.32 g/day (0.18 – 0.42), compared to patients on VT 0.2 (0.1 – 0.2), or A 0.2 (0.2 – 0.3), p=0.04.

Conclusion: Valgancyclovir efficacy and safety in this limited data set is similar with early administration of V, VT and A after kidney transplantation. Additional studies aimed at elucidating the effectiveness of this treatment regimen in patients who are at high risk for developing CMV infection are necessary to draw further conclusions.

Borderline personality disorder is a clinically important psychiatric diagnosis that is distinct from major depressive, bipolar and posttraumatic stress disorders, despite the overlapping symptoms. The diagnosis is mainly clinical and must follow the DMS 5 (or ICD 10) characteristics.

The most common age at first presentation is in late adolescence, but the disorder frequently can be stay as misdiagnosed.

Our study is concerned to QEEG characteristics, as well as coherence in borderline patients compared with healthy group, matched by number, gender and age and selected randomly.

Our obtained results showed that electrophysiological characteristics for borderlines are fairly without statistical differences, except in low bands (delta and theta), which showed significantly lower frequencies and coherence compared to a healthy group.

Future research in this filed with more patients is highly recommended.

Introduction: Cystic fibrosis (CF) is a progressive, life-threatening, genetic disease which mainly damages the lungs and the digestive system. It’s a complex medical condition, with several individual forms and variation in the symptoms severity. Few factors such as age of establishing the diagnosis, the number and the type of infections and their management, best treatment options, comorbid conditions etc. can influence the patient’s overall health, disease progression and quality of life. Many CF patients will reach adulthood, so coping with the chronic disease is very important for the overall health and everyday living.

Aim of the study: To screen the quality of life in CF patients in the Republic of Macedonia, from the parent perspective.

Subjects and methods: In the study we have included 55 parents of CF patients. We have created a questionnaire, specially designed for this survey, with questions related to their everyday coping with CF and quality of life.

Results: The majority of the parents refer to the overall typical social and emotional life of their children, addressing some difficulties concerning the financial aspect of the disease and still significantly having fear from the stigma in the society.

Conclusion: CF patients and their families in the Republic of Macedonia must overcome many obstacles on daily basis. Despite that, they can still have full and meaningful lives.

Approaching to the maturity the adolescent population are living in continuous process of changes. They are faced with intermediated contact of the surroundings. As a consequence, the support of the social environment is necessary for the healthy development of the personality.

The aim of this research is to investigate the relationship between the psychological support system and psychosomatic tendencies among adolescents named as “generation Z” in our country. The sample is composed of 106 (Nm=81, Nf=25) participants that accepted and filled in the on-line questionnaires. The students, especially those studying art and social and humanistic sciences, were more interested in participating in the research.

Two psychological instruments (BOL-110 and HI test form the KON-6 battery) via Google form were applied.

Based on the results gained from the complex interplay of the basic supports (Proactivity, Body, Thinking, Belonging) with psychosomatics, among generation Z, we have figured out three profiles of personality: a) healthy, b) with high tendencies to psychosomatics and c) with high tendencies to develop severe mental health disorders. The suggestions how to sustain health are final recommendations of this work.

Background: From the conception onward, certain parameters associated with maternal health may affect foetal body composition, growth and bone mineral content.

The objective of the study was to determine the association between maternal vitamin D and adiponectin status with the anthropometrical measures of newborns, and bone health status measured by Quantitative Ultrasound (QUS) at birth.

Methods: Circulating 25OHD and adiponectin concentration were measured in 73 pregnant women. Correlations with the anthropometrical measures and bone health status in their infants were studied. Bone health was evaluated using QUS with the measurements of speed of sound (SOS, in m/s) and Z score on the right tibia.

Results: There was no significant association between maternal 25OHD and newborn’s anthropometrical measures at birth (weight p=0.35, length p=0.59 and head circumference p=0.47). There was a significant negative correlation between a maternal serum adiponectin and a) weight of infants at birth (R= -0.37, p=0.002); b) birth length (R= -0.31, p=0.008) and c) head circumference (R= -0.29, p=0.014). There was no significant correlation between maternal 25OHD blood levels during pregnancy and SOS in newborns (p=0.48). Additionally, a correlation between maternal adiponectin concentration during pregnancy and SOS in newborns was not significant (p=0.82).

Conclusion: Although a high prevalence of low 25OHD level among pregnant women was found, maternal vitamin D status did not influence growth and bone health of their offspring at birth. Maternal adiponectin levels in plasma showed an inverse relationship with anthropometrical measures of infants at birth, while no correlation with the newborn’s bone health was found.

Introduction: Epidural analgesia is considered a gold standard in obstetric anaesthesia and analgesia. However, in situation when it is contraindicated, unwanted by the patient or simply unavailable, remifentanil can be an excellent alternative. The goal of our study is to analyse the side effects of intravenous patient-controlled analgesia (IV PCA) with remifentanil compared with epidural analgesia during delivery.

Material and methods: This study included 155 pregnant women in term for birth, divided into 2 groups: a remifentanil group (RG), and an epidural group (EG). Patients in the RG received intravenous PCA with remifentanil, while patients in the ЕG received epidural analgesia with programmed intermittent bolus dosing. Our primary outcome was maternal safety; the secondary outcome was neonatal safety.

Results: The results present a significantly lower SaO2 value of the parturients in the RG (96.95 ± 1.4 vs 98.22 ± 0.6), and a significantly higher respiratory rate per minute in the EG at all time points after the onset of analgesia (20.85 ± 1.4 vs 18.67 ± 0.9). There was more frequent sedation, nausea and vomiting in the RG, while in the EG there was a more elevated temperature, itching and irregularities in the CTG record. Regarding the newborn, there was no significant difference between the two groups in the Apgar scores, pH, pCO2, pO2, and bicarbonate, while there was a significantly lower value of the base excess in the RG group.

Conclusion: PCA with remifentanil is safe for the mother, foetus and the newborn, with minimal side effects. Continuous respiratory monitoring, oxygen supply and following of all consensus recommendations are mandatory.

Introduction: Cephalea from orofacial origin is a diffuse, mild to moderate pain that appears as a bandage around the head. There are many different etiological causes of dental origin that contribute to the appearance of cephalea.

Purpose: The purpose of our research is dental treatment of patients with traumatic occlusion, bruxism and loss of occlusal support, which have a pathological condition - cephalea from orofacial origin.

Material and methods:For the purposes of this paper, 15 patients with cephalea from orofacial origin were analysed, diagnosed and treated. The control group consisted of 15 patients without etiological factors. A butterfly deprogrammer and a stabilization splint were made depending on the indication.

Results and discussion: According to our patient study results, it appears to be a link between inadequately made prosthetic devices, bruxism and loss of occlusal support with cephalea. The therapy should help the patient urgently and continue to relieve the cephalea symptoms from orofacial origin. The results show an improvement in 86.7% of the examinees.

Conclusion: The butterfly deprogrammer and stabilization splint are new methods that can contribute along with other therapeutic modalities in improving the quality of life in a patient with cephalea from orofacial origin.

In the period from 26^th until 29^th of September 2019, the 15th BANTAO Congress (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs) in conjunction with the 6th Congress of the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO) was held in Skopje, Republic of North Macedonia, hosted by the Macedonian Academy of Sciences and Arts (MASA). MSNDTAO was created in 1992 and the First Congress of the MSNDTAO was held on 9^th October 1993 in Ohrid when, also, the Balkan Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) was established, as the only professional association of this kind in the Balkans and Southern Europe. Since then, MSNDTAO has been very active in education and collaboration with BANTAO, the European Renal Association (ERA-EDTA) and the International Society of Nephrology (ISN). The 15^th BANTAO and the 6^th MSNDTAO Congress were highly professional events in honor of the 80th anniversary of Academician Momir Polenakovic from the Republic of North Macedonia, one of the founders of BANTAO and MSNDTAO, who was unselfishly dedicated to the education and guidance for many generations of young doctors in this region. This year’s Congress was endorsed by the ERA-EDTA, and supported by the ISN. On the first day of the Congress, a European Renal Best Practice (ERBP) session was held, in which the Chair of the ERBP Working Group, Prof. Dr. Jonathan Fox gave a comprehensive insight of the purpose and aims of ERBP, the methods used for their achievement, and an overview of the recently produced and guidelines in development. The second day was organized in four sessions: Clinical nephrology and renal registries; CKD Diagnosis, comorbidities and treatment; Kidney transplantation and Acute and chronic renal failure management. On the third congress day, the ISN CME Course with ERA-EDTA endorsement was held. The course was entitled “Possibility of diagnosis and treatment of the CKD progression and complications/Possibility of diagnosis and treatment of the CKD progression – current perspective” and was chaired by Prof. Dr. Caskey Fergus and Prof. Dr. Serhan Tuglular. On the last Congress day, before the official closure and the best wishes from the President of the Congress, Prof. Dr. Goce Spasovski, a session about CKD and the renal replacement therapy complications was held. This event was of an exceptional importance for the region, considering the charred international achievements and the most up-to-date methods used in the Nephrology field, bringing out continuous quality improvement in the treatment of patients with renal diseases.

PhD. Anastas Kocarev (Kotzareff in French) is one of the most prominent Macedonian doctors and experts, prolific contributor to the cancer research in Switzerland and France in the first decades of the 20^th century. He was born in Ohrid on May 5^th, 1889. He graduated from the Faculty of Medicine in Geneva where he defended a doctorate in medicine in 1915. In 1916 he was elected Assistant Professor (Private Docent) at that Faculty. He was a prominent scientist and professor of experimental medicine at the Faculty of Medicine in Geneva and the Sorbonne University in Paris, with a wide reputation in Europe and the United States. PhD. A. Kocarev is one of the pioneers of oncology and radiology in the world, a forerunner of modern nuclear medicine and positron emission tomography. He was a close associate of Nobel laureate in chemistry and physics Maria Sklodovska-Curie and at her invitation moved to Paris in 1925 to continue the research on the diagnosis and treatment of cancer using radium. He was fully devoted to science and published numerous scientific papers and books with high citations and dissemination in many medical libraries in Europe and beyond. In addition to his professional teaching and scientific work as a top oncologist-radiologist, he was a great patriot with advanced political ideas. He founded the Academic Society “Macedonia” in Geneva, in 1915, and united it with other Macedonian political associations from Zurich and Lausanne, in 1918, into a joint “Alliance of Macedonian Societies for Independent Macedonia”, with commitments, activities and initiatives to the Society of Nations, based in Geneva, Switzerland, for the proper resolution of the Macedonian national issue by creating a united and independent state “Macedonia” or the formation of a “Balkan Federation”. He died suddenly in Paris on March 29, 1931.