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Volume 35 (2014): Issue 2 (October 2014)

Journal Details
Format
Journal
eISSN
1857-8985
First Published
08 Sep 2014
Publication timeframe
2 times per year
Languages
English

Search

Volume 35 (2014): Issue 2 (October 2014)

Journal Details
Format
Journal
eISSN
1857-8985
First Published
08 Sep 2014
Publication timeframe
2 times per year
Languages
English

Search

22 Articles
Open Access

Use of Expanded Criteria in Living Kidney Donors – the Crucial Factor for Improvement of the Kidney Transplant Programme in Republic of Macedonia

Published Online: 01 Dec 2014
Page range: 5 - 7

Abstract

Abstract

Renal transplantation is surely the best treatment for Chronic Kidney Disease (CKD) patients in both developed and developing countries. Due to the tragic events in former Yugoslavia at the beginning of the nineties, it was not possible to develop a really good clinical practice in the field of transplantation. Facing the lack of Deceased Donor Donation Transplantation and any organ-sharing among the Balkan countries, we introduced a large and very ambitious living donor transplant programme including what were called expanded criteria living donors. In the period of the past 20 years elderly (above 65 years), unrelated (emotionally related), marginal and ABO incompatible living donors were accepted. Due to the skilled surgical team, powerful immunosupression and HLA compatibility testing, the results were promising and the number of complications very low. The authors concluded that use of an expanded criteria living donor is fully acceptable, especially in developing countries, and could ameliorate the severe organ shortage in the region.

Key words:

  • kidney transplant
  • living expanded criteria donors
  • graft and patients survival rate
  • complications
Open Access

Protocol for Performing Nephrological Activity in the Republic of Macedonia

Published Online: 01 Dec 2014
Page range: 9 - 23

Abstract

Abstract

The fast development of nephrology in the world, especially in the second half of the 20th century demanded protocol (guidelines) for nephrological activity for all levels of medical care, of doctors and specialists. The International Society of Nephrology, the European Renal Association and other national associations created their own protocol (guidelines) for nephrological activity. The Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO) proclaimed the First Protocol for Performing Nephrological Activity in the Republic of Macedonia at the First Congress of the MSNDTAO, held in Ohrid 1993, and it was published in the Macedonian Medical Review, 1994; Supplement 14: 397–406 [1]. The update of the Protocol for Performing Nephrological Activity in the Republic of Macedonia was proclaimed at the Fourth Congress of MSNDTAO, held in Ohrid 2012 and it presented in this text.

Key words:

  • nephrological protocol
  • guidelines
  • national society
  • Macedonian Society of Nephrology
  • Dialysis
  • Transplantation and Artificial Organs (MSNDTAO)
Open Access

Methods for Molecular Surveillance of Influenza Used in Macedonia

Published Online: 01 Dec 2014
Page range: 25 - 30

Abstract

Abstract

The aim: To present and compare different Nucleic Acid Testing assays used for laboratory diagnosis of influenza virus infection in our country.

Materials and methods: Respiratory samples used were nose and throat swabs. The RNA extraction was performed with a QIAamp viral RNA kit. During the season 2009–2010 the first 25 samples were tested with: conventional gel-based RT-PCR and CDC rtRT-PCR using published specific matrix and HA gene primers and probes for influenza virus typing and subtyping.

Results: Of 25 samples tested with conventional RT-PCR 7(28%) were positive for influenza A, but negative for A/H1seasonal and A/H3. Retested with rtRT-PCR 9(36%) were positive for influenza A, 8(32%) were positive for A/H1pdm and 1(4%) was A/H3. Two samples positive with rtRT-PCR for influenza A were negative with RT-PCR. The sensitivity of the RT-PCR in comparison with rtRT-PCR is 100% and the specificity is 88.89%. Positive predictive value for RT-PCR is 77.78%, and negative predictive value is 100%. RT-PCR is a four-step and rtRT-PCR a one-step procedure. The turn-around time of RT-PCR is 6 hours and for rtRT-PCR it is 2 hours.

Discussion and conclusion: For surveillance purposes nose and throat swabs are the more easy and practical to collect. It was proved that RT-PCR is too laborious, multi-step and time-consuming. The sensitivity of both assays is equal. The specificity of rtRT-PCR is higher. NAT assays for detection of influenza viruses have become an integral component of the surveillance programme in our country. They provide a fast, accurate and sensitive detection of influenza.

Key words:

  • influenza
  • molecular surveillance
Open Access

Genotypes of Esbl Producing Escherichia Coli and Klebsiella Pneumoniae in Relation to Resistance to Antimicrobial Drugs

Published Online: 01 Dec 2014
Page range: 31 - 38

Abstract

Abstract

The aim of the study was to evaluate the association of drug resistance with β-lactamase gene types in ESBL positive E. coli and Klebsiella pneumoniae-Kp.

Material and methods: A total of 251 ESBL-positive E. coli and Kp isolates obtained from urine, tracheal aspirate, wound swab and blood from patients hospitalised at the University Clinics in Skopje were detected using the ESBL set and automated Vitek 2 system. Vitek was also used for susceptibility testing (determination of MIC of 17 antimicrobial agents). Multiplex PCR was used to identify genes for different types of ESBLs in a 100 randomly selected, ESBL positive strains.

Results: More of the 87 ESBL typeable isolates (61%) harbour two or more bla genes and the frequency of antibiotic resistance was high in these isolates, compared to those with a single gene. Isolates with ≥ 3 genes were highly resistant to beta-lactams and non-beta lactams used. The degree of resistance to 3rd generation cephalosporins was also high in these isolates (MIC ≥ 64). More of the ESBL-positive isolates showed higher resistance to cefotaxime than to ceftazidime.

Conclusion: Identification of the genes is necessary for the surveillance of their transmission in hospitals. Surveillance of antibiotic resistance patterns are crucial to overcome the problems associated with ESBLs.

Key words:

  • ESBL
  • antibiotic resistance
Open Access

Correlative Study Between Serum Matrix Metalloproteinase 9 Values and Neurologic Deficit in Acute, Primary, Supratentorial, Intracerebral Haemorrhage

Published Online: 01 Dec 2014
Page range: 39 - 44

Abstract

Abstract

One of the essential characteristics of intracerebral haemorrhages (ICH) is the occurrence of brain oedema (BE). Matrix metalloproteinase-9 (MMP-9) belongs to the family of proteolytic enzymes connected with zinc, which in brain bleeding or a stroke can induce matrix proteolyse into the neurovascular unit, and increase the BE. The aim of the study was to determine the MMP-9 values in serum, and to assess the degree of correlation with neurological deficit in patients with acute, primary and supratentorial ICH.

Materials: The study was prospective and included 62 patients with ICH. The neurological deficit of the patients was evaluated by the National Institute Health Stroke Scale (NIHSS). Serum MMP-9 level was determined by enzyme-linked immune sorbent assay (ELISA). Patients were evaluated in three phases: 1st, 3rdand 7th day following the ICH.

Results: The mean age of the patients was 64.5 ± 9.4. Within the follow-up period, there was a significant rise of the NIHSS score in the first three days: 11.48 ± 3.7; 13.21 ± 3.78, and a significant rise of serum MMP-9, with greatest values in the third day: 134.7 ± 26.1 ng/ml (p = 0.000). There was a positive, significant correlation (r = 0.886, p = 0.000) between the serum MMP-9 concentration and the NIHSS score.

Conclusion: Our study showed that in the first three days of ICH, serum MMP-9 values were rising as well as the neurological deficit and the BE. Determination and evaluation of the MMP-9 in serum is an easy, non-invasive, routine laboratory procedure for the detection and follow-up of BE, and also determines further therapeutic strategy as well as prognosis in these patients.

Key words:

  • intracerebral haemorrhage
  • brain oedema
  • matrix metalloproteinase-9
Open Access

Symptomatic Epileptogenic Lesions

Published Online: 01 Dec 2014
Page range: 45 - 52

Abstract

Abstract

Background and objectives: The main aim of this study is to prove the association of seizure types with the MRI findings of the brain (etiological factor). Also, to prove which type of lesion is mostly represented in which age-group, and with which type of seizure.

Methods: A total of 100 patients with symptomatic epilepsy, aged from 16 to 80 years, were hospitalized at the Neurology Clinic or in its Outpatient Unit, in the period from 2009 to 2012. They were neurologically examined and the seizure type registered. All patients underwent MRI of the brain.

Results: (56%) men and 44 (44%) women were examined. The represented type of epileptic seizures were 41.0% with SPC + CPC, followed by 15.0% GTCC, and 14.0% CPC with secondary generalization, 12,0% CPC, 10,0% SPC and 8.0% with absences. The epileptic lesions of 25.0% were hippocampal sclerosis, 20.0% post-traumatic injuries, 19.0%, post-vascular and brain tumours, and the lowest percentage of 17.0% with post-infectious lesions.

Conclusions: Post-traumatic lesions occur more frequently in the elderly population with the accent on the male, while hippocampal sclerosis occurs in the adolescent and younger population with higher frequency in the female.

Key words:

  • symptomatic epilepsy
  • epileptic seizures
  • epileptic lesions
Open Access

Depression in Ophthalmological Patients

Published Online: 01 Dec 2014
Page range: 53 - 58

Abstract

Abstract

Introduction: Vision is the most important sensorial part of the human information system. Visual loss leads to reduced ability to perform routine activities of daily living and can be a risk for stable mental health.

Aim: The aim of this cross-sectional study is to assess the incidence of depression in patients treated in an ophthalmological outpatient clinic. To our knowledge this is the first study of its kind in our country.

Subjects and method: The number of evaluated patients was a hundred; mean age 41.6 ± 15.9 years, with different educational levels and common ophthalmological disorders. For the assessment of the level of depression the Beck Depression Inventory was used. Patients were divided into two groups: serious ophthalmological diagnoses where we expected psychological problems (N = 65) and the simplest ones (N = 35) as a control.

Results: Obtained results show that the levels of depression correlate with the diagnoses. Patients in the first group (serious ophthalmological diagnoses) showed moderate depression in 12% and severe in 13% of patients. It was shown that the most depressed were the patients suffering from age-related macular degeneration and proliferative diabetic retinopathy, as well as glaucoma and cataract. The second group showed BDI scores of normal values. The level of depression is positively correlated with age and the level of education (p < 0.05).

Conclusion: Depression is an important mental problem in ophthalmological practice. It is usually unrecognized and untreated. Depression could be the risk factor for treatment and prognosis of eyes diseases. Some measures for mitigation of psychological problems are proposed.

Key words:

  • depression
  • ophthalmology
  • outpatients
  • mitigation
Open Access

Emotional Intelligence and Big-Five Personality Factors in Female Student Sample

Published Online: 01 Dec 2014
Page range: 59 - 66

Abstract

Abstract

The aim of this study is to figure out possible connectedness between emotional intelligence and five big personality factors in female students selected from social sciences faculties.

The evaluated sample comprised 66 healthy students, of Macedonian nationality, mean age 18.9 ± 0.63 years. As psychometric instruments, we used the EI-test and NEO-PI-R, both with eligible metric characteristic and already used in the Republic of Macedonia. Statistical analysis was performed using Sta17, both descriptive and inferential statistics including medians, standard deviations, and two-tailed Pearson's correlation.

The obtained results for emotional intelligence showedn average anxiety level (M = 77.35), extraversion (M = 50.91) and a realistic outlook on life (M = 81.64), high self-confidence (M = 44.44) and generally satisfactory empathy (M = 85.39). Personality characteristics obtained with NEO-PI-R showed high extroversion (M = 123. 70), low agreeableness (M = 105.82) and consciousness (M = 104.67), as well as mild neuroticism (M = 91.33) and openness (M = 117.45). The results confirmed a high positive correlation between anxiety, optimism, and empathy; and between self-confidence and empathy within the EI test. Within NEO-PR-R there was a positive correlation between factors Extroversion and Openness to Experience and a negative correlation between the factors Extroversion and Agreeableness. However, just one negative correlation is noted, between Extroversion from EI and Openness to experience from NEO-PR-R (-0,25; p < 0.05).

We concluded that similar facets measured with different psychometric instruments have different basic concepts. The obtained results, although they figure out some support from other research, also differ from other studies. It is important for us to follow the obtained results and to provoke further research on a bigger and more diverse sample.

Key words:

  • personality traits
  • emotional intelligence
  • students
Open Access

The Prevalence of High Anxiety and Substance Use in University Students in the Republic of Macedonia

Published Online: 01 Dec 2014
Page range: 67 - 74

Abstract

Abstract

Aim: The aim of the study was to determine the prevalence of high anxiety and substance use among university students in the Republic of Macedonia.

Material and methods: The sample comprised 742 students, aged 18–22 years, who attended the first (188 students) and second year studies at the Medical Faculty (257), Faculty of Dentistry (242), and Faculty of Law (55) within Ss. Cyril and Methodius Universityin Skopje. As a psychometric test the Beck Anxiety Inventory (BAI) was used. It is a self-rating questionnaire used for measuring the severity of anxiety. A psychiatric interview was performed with students with BAI scores > 25. A self-administered questionnaire consisted of questions on the habits of substance (alcohol, nicotine, sedative-hypnotics, and illicit drugs) use and abuse was also used. For statistical evaluation Statistica 7 software was used.

Results: The highest mean BAI scores were obtained by first year medical students (16.8 ± 9.8). Fifteen percent of all students and 20% of first year medical students showed high levels of anxiety. Law students showed the highest prevalence of substance use and abuse.

Conclusion: High anxiety and substance use as maladaptive behaviours among university students are not systematically investigated in our country. The study showed that students show these types of unhealthy reactions, regardless of the curriculum of education. More attention should be paid to students in the early stages of their education. A student counselling service which offers mental health assistance needs to be established within University facilities in R. Macedonia alongside the existing services in our health system.

Key words:

  • anxiety
  • BAI
  • substance use
  • student counselling service
Open Access

Continuous Versus Patient-Controlled Epidural Analgesia for Labour Analgesia and Their Effects on Maternal Motor Function and Ambulation

Published Online: 01 Dec 2014
Page range: 75 - 83

Abstract

Abstract

Background and objectives: The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades.

The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA.

Method: Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus − 5 ml, lockout interval − 15 minutes, basal rate − 0 ml) with bupiva-caine 0.08% and fentanyl 2 μg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded.

Results: Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambu-lation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034).

Conclusion: Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.

Key words:

  • epidural analgesia
  • continuous
  • patient-controlled
  • motor block
Open Access

Continuous Femoral Nerve Block Versus Fascia Iliaca Compartment Block as Postoperative Analgesia in Patients with Hip Fracture

Published Online: 01 Dec 2014
Page range: 85 - 93

Abstract

Abstract

Introduction: Systemic postoperative analgesia is inefficient in most patients with hip fracture, which is the reason for pain, especially during leg movement. Peripheral and plexus nerve blocks are an efficient option for postoperative pain relief.

The aim of this study was to compare the effect and duration of continuous FNB versus a single FIC block as a postoperative analgesia in patients with hip fracture.

Methods: Sixty patients with hip fracture were included and were randomly assigned to two groups of 30 patients: FNB group – patients with continuous femoral nerve block; and FIC group –patients with a single fascia iliaca compartment block. In all patients, pain intensity was measured at rest and in passive leg movement by using VDS (0–4) at several intervals: 1, 2, 12, 24, 36 and 48 hours after intervention. The amount of supplemental analgesia was measured, together with the time when the patient needed it for the first time, as well as the side effects.

Results: The values of VDS were significantly lower in patients with FNB block versus patients with FIC block in rest and movement at the 24-hour intervals (46.67% vs 0% felt moderate pain), after 36 hours (43.33% vs 0% felt moderate pain) and 48 hours after intervention (46.67% vs 3.33% felt moderate to severe pain) for p < 0.05. Patients with FNB block received a significantly lower amount of supplemental analgesia, 23.3% of the FNB group vs 50% of the FIC group (p < 0.05). Registered side effects were were nausea, dizziness and sedation, and they were statistically significantly more frequent in the FIC group (p < 0.05).

Conclusion: Pain relief in the postoperative period was superior in the FNB group versus the FIC group at rest and in movement in patients with hip fracture.

Key words:

  • postoperative analgesia
  • regional anaesthesia
  • fascia iliaca compartment block
  • femoral nerve block
  • hip fracture
Open Access

Influence of Hysteroscopic Metroplasty on Reproductive Outcome in Patients with Infertility and Recurrent Pregnancy Loss

Published Online: 01 Dec 2014
Page range: 95 - 103

Abstract

Abstract

Introduction: Patients with congenital uterine anomalies (CUA) have decreased reproductive potential and an unfavourable reproductive outcome compared to the population with normal uterine cavity. Patients with untreated CUA have a higher abortion rate, higher foetal loss rate and decreased live birth rate. Hysteroscopic metroplasty is a standard, safe and minimally invasive method for the treatment of correctible types of congenital uterine anomalies.

The aim of the study was to analyse the reproductive outcome in certain groups of patients with CUA and infertility, before and after hysteroscopic metroplasty.

Material and methods: We analyzed 115 patients on whom 129 hysteroscopic metroplasty interventions were performed at the University Clinic of Obstetrics and Gynaecology in Skopje over a one-year period, between 01.01.2011 and 31.12.2011. Patients and their reproductive outcome were monitored over a two-year period and the same group served as a control group, taking into account their previous reproductive history before and after metroplasty. Statistical analysis was performed using the Chi-square test and p < 0.05 was considered to be statistically significant.

Results: The most common CUA were types 5b and 6, represented by 83.3%. In a follow-up period of two years, there were 55 patients with previous foetal loss treated by hysteroscopic metroplasty, and 31 of them had pregnancies. There was a statistically significant decrease of abortion rate from 88.5% to 19.3%, and a significant increase in term delivery rate from 2.3% to 71%.

Conclusion: Hysteroscopic metroplasty significantly improves the reproductive outcome in patients with previous foetal loss.

Key words:

  • hysteroscopy
  • reproduction
  • infertility
  • pregnancy
Open Access

Minimally Invasive Surgery for Stress Urinary Incontinence – Mesh Complications

Published Online: 01 Dec 2014
Page range: 105 - 110

Abstract

Abstract

Currently, the most commonly performed surgeries for stress urinary incontinence (SUI) are mesh midurethral slings (MUS). They are minimally invasive outpatient procedures, and they are as effect-tive as traditional suburethral slings, open retropubic colposuspension (Burch, Marshall-Marchetti), and laparoscopic retropubic colposuspension. They have a short operative time and fewer postoperative complications. In the paper we present results from a prospective study of 214 patients with SUI who underwent midurethral sling placement: 68 patients with retropubic slings (TVT) and 146 patients with transobturator slings (TVT-O) followed over 12 months. The operations were performed at the Department of Obstetrics and Gynaecology at the Medical Faculty, Skopje, R. Macedonia and at the Department of Obstetrics and Gynaecology, General Hospital, Sibenik, Croatia. All MUS placements (TVT and TVT-O) were performed by one surgeon (urogynaecologist) using the standard surgical technique and operative and postoperative protocol for those procedures. TVT and TVT-O meshes are polypropylene macroporous meshes produced by “Ethicon” We evaluated mesh complications related to the procedure (Table 1) and complications specific to the mesh (Table 2). In the article are presented the data from up-to-date literature related to the evaluated topic parallel to our results. We can conclude that all our findings on the evaluated groups are comparable with the data from competent literature. Instead of a conclusion we would like to suggest continuous follow-up of all minimally invasive procedures with midurethral slings placement for collecting experience of side-effects and complications and improving those procedures which are gold standard today in the treatment of SUI.

Key words:

  • mesh
  • complication
  • stress incontinence
  • retropubic
  • transobturator
Open Access

Analysis of the Results of Implantation of Total Hip Endoprothesis in Severe Dysplastic Coxarthrosis

Published Online: 01 Dec 2014
Page range: 111 - 116

Abstract

Abstract

Background: The aim of this study is to affirm the importance of operative treatment of severe dysplastic coxarthrosis through analysis of the results of implantation of total cementless endo-prothesis in patients with DDH Crowe types III and IV.

Patients and methods: This retrospective study involved 28 patients (30 hips) with dysplastic coxart-hrosis, in whom an implantation of cementless total hip endoprothesis was performed at the University Clinic for Orthopaedic Surgery in Skopje. In 26 of the patients the involvement was unilateral and in two patients it was bilateral. The inclusion criterion was radiographically proved severe hip dysplasia Crowe types III and IV. Twenty-one of the patients were female and 7 male, and age distribution was in an interval from 30 to 65 years. The ingrowth of the implant was evaluated using the clinical method, native radiographs and radioisotopic examination with Tc99m. The follow-up period lasted 5 years, and the results were evaluated using the Harris hip score system.

Results: 19 of the patients presented an excellent result of the operative treatment, there were 8 good results with persistent local pain 6 months postoperatively, in one case a surgical revision and reimplantation of the acetabular cup was performed, while one patient underwent a surgical revision and reimplantation of the femoral stem and in another patient there was nonunion at the place of the subtrochanteric osteotomy. Full weight-bearing without the use of crutches was achieved 3 months postoperatively, and no serious early postoperative complications were registered in our patients.

Discussion and conclusions: In the majority of cases in whom a total hip replacement with cemen-tless endoprothesis is performed because of dysplastic coxarthrosis, a sufficient primary fixation both of the acetabular and the femoral component is achieved, unless one-third of the acetabular cup is left uncovered with bone stock. The problems of decreased muscle strength and limping are usually solved by means of physical therapy in a time period of 45 months.

Key words:

  • Developmental Dysplasia of the Hip
  • Crowe Classification
  • Cementless Total Hip Replacement
  • Harris Hip Score
Open Access

Partial Caecal Necrosis – a Rare Cause of Right-Sided Inferior Abdominal Pain and Tenderness

Published Online: 01 Dec 2014
Page range: 117 - 121

Abstract

Abstract

Introduction: Non-occlusive caecal infarction is a rare condition that has been described in association with a variety of clinical entities, generally due to a low-flow state, and has been reported to occur in association with chronic heart disease, open-heart surgery, certain drugs, and haemodialysis. The aim of this article is to describe the presentation, diagnosis and management of this unusual clinical problem.

Case presentation: We report on an 84-year-old female with known chronic heart disease presenting with right lower abdominal quadrant pain, tenderness and leukocytosis. Although initial clinical findings were highly suggestive of acute appendicitis, CT revealed marked circumferential wall thickening of the caecum. Intraoperatively, caecal necrosis was confirmed, while the appendix and the remainder of the intestine appeared normal. There was no evidence of major vascular occlusion or embolization. The right hemicolectomy was performed with ileo-transverse anastomosis. Histopatho-logic analysis demonstrated isolated transmural caecal necrosis with marked infiltration of the caecal wall by numerous bacteria and neutrophils as a consequence of nonocclusive ischaemic colitis. The patient recovered completely and was discharged from the hospital on the tenth postoperative day without any surgical complications.

Conclusion: Partial caecal necrosis should be included in the differential diagnosis of acute right lower quadrant pain, especially in elderly patients with chronic heart disease.

Key words:

  • partial caecal necrosis
  • ischemic colitis
  • chronic heart disease
Open Access

Congenital Hydronephrosis: Disease or Condition?

Published Online: 01 Dec 2014
Page range: 123 - 129

Abstract

Abstract

The aim of this paper is to address the dilemmas of the paediatric surgeon when facing an isolated, unilateral, congenital hydronephrosis and discuss the strategic options for the management of this condition.

Congenital hydronephrosis, the most commonly diagnosed uropathy in children, is usually a benign and self-resolving condition. Nonobstructive hydronephrosis does not require operative treatment, while timely treatment is imperative for obstructive hydronephrosis before significant renal damage ensues. Managing congenital hydronephrosis is a challenging task.

Thirty-two children with unilateral, isolated hydronephrosis and nonobstructed renography curves were followed up for 3 years.

On the initial evaluation according to the grade of hydronephrosis: 22.6% were grade I, 54.8% grade II and 22.6% grade III. After 12 months of follow-up: 30% were grade I, 51.5% grade II and 18.5% grade III, respectively. After the three-year follow-up, there were no hydroneproses greater than grade II. The mean value of the separate GFR of the affected kidney at initial evaluation was 42.83%, and 40.33% after three years. In three children the treatment was converted from conservative to surgical. Nonobstructive, congenital hydronephrosis is a benign condition not requiring any medical treatment, but aggressive observation is indicated.

Key words:

  • congenital hydronephrosis
  • management
  • child
Open Access

Effect of Lipid Parameters on Foetal Growth In Gestational Diabetes Mellitus Pregnancies

Published Online: 01 Dec 2014
Page range: 131 - 136

Abstract

Abstract

Introduction: Women with gestational diabetes mellitus (GDM) often deliver newborns large for their gestational age (LGA). The aim of the study was to evaluate the effect of lipid parameters in the second half of pregnancy on foetal growth in GDM pregnancies.

Material and methods: In two hundred consecutive women with GDM the age, body mass index before pregnancy, body mass index before delivery, gestational week of GDM diagnosis, lipid parameters after 24 weeks of pregnancy, fasting glycaemia, HbA1c in the second and third trimester of pregnancy, gestational age at delivery, mode of delivery, and baby birth weight were analyzed.

Results: Of the 200 GDM pregnancies, 50 (25%) women delivered LGA newborns, 135 (67.5%) women delivered newborns appropriate for gestational age (AGA), and 15 (7.5%) women delivered newborns small for gestational age (SGA). Maternal triglyceride levels and HbA1c in the second trimester were higher, and HDL-C was significantly lower, in the LGA group than in the AGA group (3.8 ± 1.8 vs. 3.1 ± 1.1 mmol/L, 6.1 ± 1.1 vs. 5.5 ± 0.8%, and 1.3 ± 0.4 vs. 1.6 ± 0.4 mmol/L, p < 0.05). Also, maternal triglyceride levels and HbA1c in the second trimester were significantly higher in the SGA group than in the AGA group (3.8 ± 1.9 vs. 3.1 ± 1.1 mmol/L and 6.8 ± 0.8 vs. 5.5 ± 0.8%, p < 0.05). Maternal triglycerides were independent predictors for delivering LGA newborns in GDM women.

Conclusion: In GDM pregnancies, maternal triglycerides in the second half of pregnancy may indentify women who will deliver LGA newborns. Thus, with good regulation of lipid profile, we can avoid macrosomia from GDM pregnancies.

Key words:

  • lipid parameters
  • triglycerides
  • gestational
  • large for gestational age newborns
Open Access

Echocardiographic Predictors of Chronotropic Incompetence to Exercise in Patients with Heart Failure with Preserved Ejection Fraction

Published Online: 01 Dec 2014
Page range: 137 - 145

Abstract

Abstract

Objective: Exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF) is most often attributed to diastolic dysfunction (DD); however, chronotropic incompetence (CI) could also play an important role. We intended to examine whether there are predictive echocardiographic parameters of DD for impaired chronotropic response to exercise.

Methods and Results: Patients (n = 143) with unexplained dyspnea and/or exercise intolerance who fulfilled clinical and echocardiographic criteria of HFpEF presence underwent a symptom-limited exercise test using a treadmill (ETT) according to the Bruce protocol. CI was defined as an achieved heart rate reserve (HRR) of ≤ 80%. Comparison of the groups with (n = 98) and without CI (n = 45) did not show any statistically significant difference regarding demographic and clinical character-ristics except for use of beta blockers (BB) that were more frequently present (p = 0.012) in patients with CI in comparison with those without. Patients with CI had a higher mean E-wave velocity, E/A ratio, increased E/E‵ septal, lateral as well as average ratio and abnormal IVRT/TE-e‵ index all consistent with elevated LV filling pressures. E/E‵ average ratio > 15 was statistically insignificantly more frequently present in patients with CI. In addition, by multivariate stepwise regression analysis value of E‵ septal (β = 3.697, 95%CI 0.921–6.473, p = 0.009) along with use of BB, current smoking and basal heart rate appeared as statistically significant independent predictors of lower HRR %.

Conclusion: Patients with HFpEF frequently have chronotropic incompetence to graded exercise which may partly be predicted with echocardiographic parameters that are consistent with elevated LV filling pressures.

Key words:

  • heart failure with preserved ejection fraction
  • diastolic dysfunction
  • left ventricular filling pressure
  • chronotropic incompetence
Open Access

Anthropometric Parameters in National Footballers in the Republic of Macedonia

Published Online: 01 Dec 2014
Page range: 147 - 154

Abstract

Abstract

Objectives: The focus of this study is on anthropometric characteristics of footballers in the Republic of Macedonia, and the aim is to provide normative data for selected anthropometric parameters for adult male footballers in our country.

Material and method: The study included eight hundred (800) adult male footballers, aged 24.06 ± 4.8y (age range 18–35y), who have undertaken routine sport medical examinations over a ten-year period. The football players were divided into six age – specific subgroups (“up to 20”; “up to 22”; “up to 24”; “up to 26”; “up to 28” and “over 28” years). Anthropometric measurements were made by Matiegka's protocols and body composition components were determined.

Results: Average values of body height (178.8 ± 6.7 cm), body weight (77.72 ± 7.9 kg), lean body mass (66.21 ± 6.36 kg), body components (MM% = 53.04; BM% = 17.15; FM% = 14.7%) and a large series of anthropometric measurements which define the footballers' anthropometric dimensions were obtained. The distribution of the adipose tissue regarding the body and limbs showed that the skinfolds were thickest on the lower limbs and thinnest on the arms.

Conclusions: The adult football players in Republic of Macedonia were insignificantly variable in height and body mass from their counter parts from European and American teams. The football players up to 20 year, who played in the senior national football league were lighter and smaller than their older colleagues. The football players aged from 20 to 35 years were insignificantly variable in height, body mass, and anthropometric dimensions of limbs and trunk.

Key words:

  • football
  • adult
  • anthropometry
  • body composition
  • skinfolds
  • diameters
Open Access

T-Scan III System Diagnostic Tool for Digital Occlusal Analysis in Orthodontics – a Modern Approach

Published Online: 01 Dec 2014
Page range: 155 - 160

Abstract

Abstract

Introduction: This systematic literature review was performed to establish the mechanism, methodology, characteristics, clinical application and opportunities of the T-Scan III System as a diagnostic tool for digital occlusal analysis in different fields of dentistry, precisely in orthodontics.

Methods: Searching of electronic databases, using MEDLINE and PubMed, hand searching of relevant key journals, and screening of reference lists of included studies with no language restriction was performed. Publications providing statistically examined data were included for systematic review. Results: Twenty potentially relevant Randomized Controlled Trials (RCTs) were identified. Only ten met the inclusion criteria. The literature demonstrates that using digital occlusal analysis with T-Scan III System in orthodontics has significant advantage with regard to the capability of measuring occlusal parameters in static positions and during dynamic of the mandible.

Conclusion: Within the scope of this systematic review, there is evidence to support that T-Scan system is rapid and accurate in identifying the distribution of the tooth contacts and it shows great promise as a clinical diagnostic screening device for occlusion and for improving the occlusion after various dental treatments. Additional clinical studies are required to advance the indication filed of this system. Importance of using digital occlusal T-Scan analysis in orthodontics deserves further investigation.

Key words:

  • Orthodontic treatment
  • skeletal orofacial anomalies
  • T-Scan III system
  • digital occlusal analysis
Open Access

White Spot Lesions: Prevention and Management During the Orthodontic Treatment

Published Online: 01 Dec 2014
Page range: 161 - 168

Abstract

Abstract

The formation of white spot lesions, or enamel demineralization, around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which marks the result of a successfully completed case. This article is a contemporary review of the risk factors and preventive methods of these orthodontics scars. Preventive programmes must be emphasized to all orthodontic patients. The responsibility of an orthodontist is to minimize the risk of the patient having decalcification as a consequence of orthodontic treatment by educating and motivating the patients for excellent oral hygiene practice. Prophylaxis with topical fluoride application should be implemented: high-fluoride toothpastes, fluoride mouthwashes, gels and varnishes during and after the orthodontic treatment, especially for patients at high risk of caries.

Key words:

  • white spot lesions
  • oral hygiene
  • topical fluorides
Open Access

The Influence of Etiological Factors in the Occurence of Diastema Mediana

Published Online: 01 Dec 2014
Page range: 169 - 177

Abstract

Abstract

Even from the distant past the aesthetic perception in an individual was diminished by the presence of gap between the central incisors. This condition is found under the term “dents du bonheur” or “lucky teeth” and is encountered even among world famous figures including Brigitte Bardot, Eliah Wood, Madonna, Zac Efron, Amy Winehouse and Elton John. The teeth gaps are still considered main reasons for dissatisfaction of the dental patients and reasons for the requirement of aesthetic treatment.

The purpose of this study is to exhibit the influence of the etiological factors in the occurrence of dia-stema mediana classified according to the dominance of their occurrence expressed in percentage values. Materials of this investigation were 100 patients with diastema mediana from the following factors: inheritance, disproportion in the dental arches, inborn or acquired missing teeth, harmful oral habits, high insertion of the labial frenulum as well as mesiodens. After the diagnosis and evaluation of the etiological factor for diastema mediana was performed, a decision regarding the course of treatment was made in direction of the removal of the etiological factor at an early age and orthodontic treatment. The end of the orthodontic treatment in a group of the patients was the beginning of prosthodontic reconstruction.

From our clinical investigation we came to the realization that in 49 patients (49%) the hereditary influence was a dominant factor, next followed disproportions and discrepancies in the dental arch in 14 (14%), inborn or acquired missing teeth in 11 patients (11%), harmful oral habits in 10 (10%), high frenulum insertion in 4 (4%), and pathological objects between central incisors, mesiodens, iatrogenic factors and periodontal disease, in 3 of the clinical cases (3%) each.

We concluded that the occurrence of diastema mediana is multi-causal. The dominant place is occupied by the hereditary factors. With regard to the mutual relationship between the multitudes of factors in the occurrence of diastema mediana, the diagnosis should be made conciliary and the clinical treatment should be interdisciplinary including a prosthodontist, orthodontist and oral surgeon.

Key words:

  • diastema mediana
  • etiological factors
  • real diastema mediana
  • physiological diastema mediana
22 Articles
Open Access

Use of Expanded Criteria in Living Kidney Donors – the Crucial Factor for Improvement of the Kidney Transplant Programme in Republic of Macedonia

Published Online: 01 Dec 2014
Page range: 5 - 7

Abstract

Abstract

Renal transplantation is surely the best treatment for Chronic Kidney Disease (CKD) patients in both developed and developing countries. Due to the tragic events in former Yugoslavia at the beginning of the nineties, it was not possible to develop a really good clinical practice in the field of transplantation. Facing the lack of Deceased Donor Donation Transplantation and any organ-sharing among the Balkan countries, we introduced a large and very ambitious living donor transplant programme including what were called expanded criteria living donors. In the period of the past 20 years elderly (above 65 years), unrelated (emotionally related), marginal and ABO incompatible living donors were accepted. Due to the skilled surgical team, powerful immunosupression and HLA compatibility testing, the results were promising and the number of complications very low. The authors concluded that use of an expanded criteria living donor is fully acceptable, especially in developing countries, and could ameliorate the severe organ shortage in the region.

Key words:

  • kidney transplant
  • living expanded criteria donors
  • graft and patients survival rate
  • complications
Open Access

Protocol for Performing Nephrological Activity in the Republic of Macedonia

Published Online: 01 Dec 2014
Page range: 9 - 23

Abstract

Abstract

The fast development of nephrology in the world, especially in the second half of the 20th century demanded protocol (guidelines) for nephrological activity for all levels of medical care, of doctors and specialists. The International Society of Nephrology, the European Renal Association and other national associations created their own protocol (guidelines) for nephrological activity. The Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO) proclaimed the First Protocol for Performing Nephrological Activity in the Republic of Macedonia at the First Congress of the MSNDTAO, held in Ohrid 1993, and it was published in the Macedonian Medical Review, 1994; Supplement 14: 397–406 [1]. The update of the Protocol for Performing Nephrological Activity in the Republic of Macedonia was proclaimed at the Fourth Congress of MSNDTAO, held in Ohrid 2012 and it presented in this text.

Key words:

  • nephrological protocol
  • guidelines
  • national society
  • Macedonian Society of Nephrology
  • Dialysis
  • Transplantation and Artificial Organs (MSNDTAO)
Open Access

Methods for Molecular Surveillance of Influenza Used in Macedonia

Published Online: 01 Dec 2014
Page range: 25 - 30

Abstract

Abstract

The aim: To present and compare different Nucleic Acid Testing assays used for laboratory diagnosis of influenza virus infection in our country.

Materials and methods: Respiratory samples used were nose and throat swabs. The RNA extraction was performed with a QIAamp viral RNA kit. During the season 2009–2010 the first 25 samples were tested with: conventional gel-based RT-PCR and CDC rtRT-PCR using published specific matrix and HA gene primers and probes for influenza virus typing and subtyping.

Results: Of 25 samples tested with conventional RT-PCR 7(28%) were positive for influenza A, but negative for A/H1seasonal and A/H3. Retested with rtRT-PCR 9(36%) were positive for influenza A, 8(32%) were positive for A/H1pdm and 1(4%) was A/H3. Two samples positive with rtRT-PCR for influenza A were negative with RT-PCR. The sensitivity of the RT-PCR in comparison with rtRT-PCR is 100% and the specificity is 88.89%. Positive predictive value for RT-PCR is 77.78%, and negative predictive value is 100%. RT-PCR is a four-step and rtRT-PCR a one-step procedure. The turn-around time of RT-PCR is 6 hours and for rtRT-PCR it is 2 hours.

Discussion and conclusion: For surveillance purposes nose and throat swabs are the more easy and practical to collect. It was proved that RT-PCR is too laborious, multi-step and time-consuming. The sensitivity of both assays is equal. The specificity of rtRT-PCR is higher. NAT assays for detection of influenza viruses have become an integral component of the surveillance programme in our country. They provide a fast, accurate and sensitive detection of influenza.

Key words:

  • influenza
  • molecular surveillance
Open Access

Genotypes of Esbl Producing Escherichia Coli and Klebsiella Pneumoniae in Relation to Resistance to Antimicrobial Drugs

Published Online: 01 Dec 2014
Page range: 31 - 38

Abstract

Abstract

The aim of the study was to evaluate the association of drug resistance with β-lactamase gene types in ESBL positive E. coli and Klebsiella pneumoniae-Kp.

Material and methods: A total of 251 ESBL-positive E. coli and Kp isolates obtained from urine, tracheal aspirate, wound swab and blood from patients hospitalised at the University Clinics in Skopje were detected using the ESBL set and automated Vitek 2 system. Vitek was also used for susceptibility testing (determination of MIC of 17 antimicrobial agents). Multiplex PCR was used to identify genes for different types of ESBLs in a 100 randomly selected, ESBL positive strains.

Results: More of the 87 ESBL typeable isolates (61%) harbour two or more bla genes and the frequency of antibiotic resistance was high in these isolates, compared to those with a single gene. Isolates with ≥ 3 genes were highly resistant to beta-lactams and non-beta lactams used. The degree of resistance to 3rd generation cephalosporins was also high in these isolates (MIC ≥ 64). More of the ESBL-positive isolates showed higher resistance to cefotaxime than to ceftazidime.

Conclusion: Identification of the genes is necessary for the surveillance of their transmission in hospitals. Surveillance of antibiotic resistance patterns are crucial to overcome the problems associated with ESBLs.

Key words:

  • ESBL
  • antibiotic resistance
Open Access

Correlative Study Between Serum Matrix Metalloproteinase 9 Values and Neurologic Deficit in Acute, Primary, Supratentorial, Intracerebral Haemorrhage

Published Online: 01 Dec 2014
Page range: 39 - 44

Abstract

Abstract

One of the essential characteristics of intracerebral haemorrhages (ICH) is the occurrence of brain oedema (BE). Matrix metalloproteinase-9 (MMP-9) belongs to the family of proteolytic enzymes connected with zinc, which in brain bleeding or a stroke can induce matrix proteolyse into the neurovascular unit, and increase the BE. The aim of the study was to determine the MMP-9 values in serum, and to assess the degree of correlation with neurological deficit in patients with acute, primary and supratentorial ICH.

Materials: The study was prospective and included 62 patients with ICH. The neurological deficit of the patients was evaluated by the National Institute Health Stroke Scale (NIHSS). Serum MMP-9 level was determined by enzyme-linked immune sorbent assay (ELISA). Patients were evaluated in three phases: 1st, 3rdand 7th day following the ICH.

Results: The mean age of the patients was 64.5 ± 9.4. Within the follow-up period, there was a significant rise of the NIHSS score in the first three days: 11.48 ± 3.7; 13.21 ± 3.78, and a significant rise of serum MMP-9, with greatest values in the third day: 134.7 ± 26.1 ng/ml (p = 0.000). There was a positive, significant correlation (r = 0.886, p = 0.000) between the serum MMP-9 concentration and the NIHSS score.

Conclusion: Our study showed that in the first three days of ICH, serum MMP-9 values were rising as well as the neurological deficit and the BE. Determination and evaluation of the MMP-9 in serum is an easy, non-invasive, routine laboratory procedure for the detection and follow-up of BE, and also determines further therapeutic strategy as well as prognosis in these patients.

Key words:

  • intracerebral haemorrhage
  • brain oedema
  • matrix metalloproteinase-9
Open Access

Symptomatic Epileptogenic Lesions

Published Online: 01 Dec 2014
Page range: 45 - 52

Abstract

Abstract

Background and objectives: The main aim of this study is to prove the association of seizure types with the MRI findings of the brain (etiological factor). Also, to prove which type of lesion is mostly represented in which age-group, and with which type of seizure.

Methods: A total of 100 patients with symptomatic epilepsy, aged from 16 to 80 years, were hospitalized at the Neurology Clinic or in its Outpatient Unit, in the period from 2009 to 2012. They were neurologically examined and the seizure type registered. All patients underwent MRI of the brain.

Results: (56%) men and 44 (44%) women were examined. The represented type of epileptic seizures were 41.0% with SPC + CPC, followed by 15.0% GTCC, and 14.0% CPC with secondary generalization, 12,0% CPC, 10,0% SPC and 8.0% with absences. The epileptic lesions of 25.0% were hippocampal sclerosis, 20.0% post-traumatic injuries, 19.0%, post-vascular and brain tumours, and the lowest percentage of 17.0% with post-infectious lesions.

Conclusions: Post-traumatic lesions occur more frequently in the elderly population with the accent on the male, while hippocampal sclerosis occurs in the adolescent and younger population with higher frequency in the female.

Key words:

  • symptomatic epilepsy
  • epileptic seizures
  • epileptic lesions
Open Access

Depression in Ophthalmological Patients

Published Online: 01 Dec 2014
Page range: 53 - 58

Abstract

Abstract

Introduction: Vision is the most important sensorial part of the human information system. Visual loss leads to reduced ability to perform routine activities of daily living and can be a risk for stable mental health.

Aim: The aim of this cross-sectional study is to assess the incidence of depression in patients treated in an ophthalmological outpatient clinic. To our knowledge this is the first study of its kind in our country.

Subjects and method: The number of evaluated patients was a hundred; mean age 41.6 ± 15.9 years, with different educational levels and common ophthalmological disorders. For the assessment of the level of depression the Beck Depression Inventory was used. Patients were divided into two groups: serious ophthalmological diagnoses where we expected psychological problems (N = 65) and the simplest ones (N = 35) as a control.

Results: Obtained results show that the levels of depression correlate with the diagnoses. Patients in the first group (serious ophthalmological diagnoses) showed moderate depression in 12% and severe in 13% of patients. It was shown that the most depressed were the patients suffering from age-related macular degeneration and proliferative diabetic retinopathy, as well as glaucoma and cataract. The second group showed BDI scores of normal values. The level of depression is positively correlated with age and the level of education (p < 0.05).

Conclusion: Depression is an important mental problem in ophthalmological practice. It is usually unrecognized and untreated. Depression could be the risk factor for treatment and prognosis of eyes diseases. Some measures for mitigation of psychological problems are proposed.

Key words:

  • depression
  • ophthalmology
  • outpatients
  • mitigation
Open Access

Emotional Intelligence and Big-Five Personality Factors in Female Student Sample

Published Online: 01 Dec 2014
Page range: 59 - 66

Abstract

Abstract

The aim of this study is to figure out possible connectedness between emotional intelligence and five big personality factors in female students selected from social sciences faculties.

The evaluated sample comprised 66 healthy students, of Macedonian nationality, mean age 18.9 ± 0.63 years. As psychometric instruments, we used the EI-test and NEO-PI-R, both with eligible metric characteristic and already used in the Republic of Macedonia. Statistical analysis was performed using Sta17, both descriptive and inferential statistics including medians, standard deviations, and two-tailed Pearson's correlation.

The obtained results for emotional intelligence showedn average anxiety level (M = 77.35), extraversion (M = 50.91) and a realistic outlook on life (M = 81.64), high self-confidence (M = 44.44) and generally satisfactory empathy (M = 85.39). Personality characteristics obtained with NEO-PI-R showed high extroversion (M = 123. 70), low agreeableness (M = 105.82) and consciousness (M = 104.67), as well as mild neuroticism (M = 91.33) and openness (M = 117.45). The results confirmed a high positive correlation between anxiety, optimism, and empathy; and between self-confidence and empathy within the EI test. Within NEO-PR-R there was a positive correlation between factors Extroversion and Openness to Experience and a negative correlation between the factors Extroversion and Agreeableness. However, just one negative correlation is noted, between Extroversion from EI and Openness to experience from NEO-PR-R (-0,25; p < 0.05).

We concluded that similar facets measured with different psychometric instruments have different basic concepts. The obtained results, although they figure out some support from other research, also differ from other studies. It is important for us to follow the obtained results and to provoke further research on a bigger and more diverse sample.

Key words:

  • personality traits
  • emotional intelligence
  • students
Open Access

The Prevalence of High Anxiety and Substance Use in University Students in the Republic of Macedonia

Published Online: 01 Dec 2014
Page range: 67 - 74

Abstract

Abstract

Aim: The aim of the study was to determine the prevalence of high anxiety and substance use among university students in the Republic of Macedonia.

Material and methods: The sample comprised 742 students, aged 18–22 years, who attended the first (188 students) and second year studies at the Medical Faculty (257), Faculty of Dentistry (242), and Faculty of Law (55) within Ss. Cyril and Methodius Universityin Skopje. As a psychometric test the Beck Anxiety Inventory (BAI) was used. It is a self-rating questionnaire used for measuring the severity of anxiety. A psychiatric interview was performed with students with BAI scores > 25. A self-administered questionnaire consisted of questions on the habits of substance (alcohol, nicotine, sedative-hypnotics, and illicit drugs) use and abuse was also used. For statistical evaluation Statistica 7 software was used.

Results: The highest mean BAI scores were obtained by first year medical students (16.8 ± 9.8). Fifteen percent of all students and 20% of first year medical students showed high levels of anxiety. Law students showed the highest prevalence of substance use and abuse.

Conclusion: High anxiety and substance use as maladaptive behaviours among university students are not systematically investigated in our country. The study showed that students show these types of unhealthy reactions, regardless of the curriculum of education. More attention should be paid to students in the early stages of their education. A student counselling service which offers mental health assistance needs to be established within University facilities in R. Macedonia alongside the existing services in our health system.

Key words:

  • anxiety
  • BAI
  • substance use
  • student counselling service
Open Access

Continuous Versus Patient-Controlled Epidural Analgesia for Labour Analgesia and Their Effects on Maternal Motor Function and Ambulation

Published Online: 01 Dec 2014
Page range: 75 - 83

Abstract

Abstract

Background and objectives: The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades.

The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA.

Method: Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus − 5 ml, lockout interval − 15 minutes, basal rate − 0 ml) with bupiva-caine 0.08% and fentanyl 2 μg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded.

Results: Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambu-lation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034).

Conclusion: Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.

Key words:

  • epidural analgesia
  • continuous
  • patient-controlled
  • motor block
Open Access

Continuous Femoral Nerve Block Versus Fascia Iliaca Compartment Block as Postoperative Analgesia in Patients with Hip Fracture

Published Online: 01 Dec 2014
Page range: 85 - 93

Abstract

Abstract

Introduction: Systemic postoperative analgesia is inefficient in most patients with hip fracture, which is the reason for pain, especially during leg movement. Peripheral and plexus nerve blocks are an efficient option for postoperative pain relief.

The aim of this study was to compare the effect and duration of continuous FNB versus a single FIC block as a postoperative analgesia in patients with hip fracture.

Methods: Sixty patients with hip fracture were included and were randomly assigned to two groups of 30 patients: FNB group – patients with continuous femoral nerve block; and FIC group –patients with a single fascia iliaca compartment block. In all patients, pain intensity was measured at rest and in passive leg movement by using VDS (0–4) at several intervals: 1, 2, 12, 24, 36 and 48 hours after intervention. The amount of supplemental analgesia was measured, together with the time when the patient needed it for the first time, as well as the side effects.

Results: The values of VDS were significantly lower in patients with FNB block versus patients with FIC block in rest and movement at the 24-hour intervals (46.67% vs 0% felt moderate pain), after 36 hours (43.33% vs 0% felt moderate pain) and 48 hours after intervention (46.67% vs 3.33% felt moderate to severe pain) for p < 0.05. Patients with FNB block received a significantly lower amount of supplemental analgesia, 23.3% of the FNB group vs 50% of the FIC group (p < 0.05). Registered side effects were were nausea, dizziness and sedation, and they were statistically significantly more frequent in the FIC group (p < 0.05).

Conclusion: Pain relief in the postoperative period was superior in the FNB group versus the FIC group at rest and in movement in patients with hip fracture.

Key words:

  • postoperative analgesia
  • regional anaesthesia
  • fascia iliaca compartment block
  • femoral nerve block
  • hip fracture
Open Access

Influence of Hysteroscopic Metroplasty on Reproductive Outcome in Patients with Infertility and Recurrent Pregnancy Loss

Published Online: 01 Dec 2014
Page range: 95 - 103

Abstract

Abstract

Introduction: Patients with congenital uterine anomalies (CUA) have decreased reproductive potential and an unfavourable reproductive outcome compared to the population with normal uterine cavity. Patients with untreated CUA have a higher abortion rate, higher foetal loss rate and decreased live birth rate. Hysteroscopic metroplasty is a standard, safe and minimally invasive method for the treatment of correctible types of congenital uterine anomalies.

The aim of the study was to analyse the reproductive outcome in certain groups of patients with CUA and infertility, before and after hysteroscopic metroplasty.

Material and methods: We analyzed 115 patients on whom 129 hysteroscopic metroplasty interventions were performed at the University Clinic of Obstetrics and Gynaecology in Skopje over a one-year period, between 01.01.2011 and 31.12.2011. Patients and their reproductive outcome were monitored over a two-year period and the same group served as a control group, taking into account their previous reproductive history before and after metroplasty. Statistical analysis was performed using the Chi-square test and p < 0.05 was considered to be statistically significant.

Results: The most common CUA were types 5b and 6, represented by 83.3%. In a follow-up period of two years, there were 55 patients with previous foetal loss treated by hysteroscopic metroplasty, and 31 of them had pregnancies. There was a statistically significant decrease of abortion rate from 88.5% to 19.3%, and a significant increase in term delivery rate from 2.3% to 71%.

Conclusion: Hysteroscopic metroplasty significantly improves the reproductive outcome in patients with previous foetal loss.

Key words:

  • hysteroscopy
  • reproduction
  • infertility
  • pregnancy
Open Access

Minimally Invasive Surgery for Stress Urinary Incontinence – Mesh Complications

Published Online: 01 Dec 2014
Page range: 105 - 110

Abstract

Abstract

Currently, the most commonly performed surgeries for stress urinary incontinence (SUI) are mesh midurethral slings (MUS). They are minimally invasive outpatient procedures, and they are as effect-tive as traditional suburethral slings, open retropubic colposuspension (Burch, Marshall-Marchetti), and laparoscopic retropubic colposuspension. They have a short operative time and fewer postoperative complications. In the paper we present results from a prospective study of 214 patients with SUI who underwent midurethral sling placement: 68 patients with retropubic slings (TVT) and 146 patients with transobturator slings (TVT-O) followed over 12 months. The operations were performed at the Department of Obstetrics and Gynaecology at the Medical Faculty, Skopje, R. Macedonia and at the Department of Obstetrics and Gynaecology, General Hospital, Sibenik, Croatia. All MUS placements (TVT and TVT-O) were performed by one surgeon (urogynaecologist) using the standard surgical technique and operative and postoperative protocol for those procedures. TVT and TVT-O meshes are polypropylene macroporous meshes produced by “Ethicon” We evaluated mesh complications related to the procedure (Table 1) and complications specific to the mesh (Table 2). In the article are presented the data from up-to-date literature related to the evaluated topic parallel to our results. We can conclude that all our findings on the evaluated groups are comparable with the data from competent literature. Instead of a conclusion we would like to suggest continuous follow-up of all minimally invasive procedures with midurethral slings placement for collecting experience of side-effects and complications and improving those procedures which are gold standard today in the treatment of SUI.

Key words:

  • mesh
  • complication
  • stress incontinence
  • retropubic
  • transobturator
Open Access

Analysis of the Results of Implantation of Total Hip Endoprothesis in Severe Dysplastic Coxarthrosis

Published Online: 01 Dec 2014
Page range: 111 - 116

Abstract

Abstract

Background: The aim of this study is to affirm the importance of operative treatment of severe dysplastic coxarthrosis through analysis of the results of implantation of total cementless endo-prothesis in patients with DDH Crowe types III and IV.

Patients and methods: This retrospective study involved 28 patients (30 hips) with dysplastic coxart-hrosis, in whom an implantation of cementless total hip endoprothesis was performed at the University Clinic for Orthopaedic Surgery in Skopje. In 26 of the patients the involvement was unilateral and in two patients it was bilateral. The inclusion criterion was radiographically proved severe hip dysplasia Crowe types III and IV. Twenty-one of the patients were female and 7 male, and age distribution was in an interval from 30 to 65 years. The ingrowth of the implant was evaluated using the clinical method, native radiographs and radioisotopic examination with Tc99m. The follow-up period lasted 5 years, and the results were evaluated using the Harris hip score system.

Results: 19 of the patients presented an excellent result of the operative treatment, there were 8 good results with persistent local pain 6 months postoperatively, in one case a surgical revision and reimplantation of the acetabular cup was performed, while one patient underwent a surgical revision and reimplantation of the femoral stem and in another patient there was nonunion at the place of the subtrochanteric osteotomy. Full weight-bearing without the use of crutches was achieved 3 months postoperatively, and no serious early postoperative complications were registered in our patients.

Discussion and conclusions: In the majority of cases in whom a total hip replacement with cemen-tless endoprothesis is performed because of dysplastic coxarthrosis, a sufficient primary fixation both of the acetabular and the femoral component is achieved, unless one-third of the acetabular cup is left uncovered with bone stock. The problems of decreased muscle strength and limping are usually solved by means of physical therapy in a time period of 45 months.

Key words:

  • Developmental Dysplasia of the Hip
  • Crowe Classification
  • Cementless Total Hip Replacement
  • Harris Hip Score
Open Access

Partial Caecal Necrosis – a Rare Cause of Right-Sided Inferior Abdominal Pain and Tenderness

Published Online: 01 Dec 2014
Page range: 117 - 121

Abstract

Abstract

Introduction: Non-occlusive caecal infarction is a rare condition that has been described in association with a variety of clinical entities, generally due to a low-flow state, and has been reported to occur in association with chronic heart disease, open-heart surgery, certain drugs, and haemodialysis. The aim of this article is to describe the presentation, diagnosis and management of this unusual clinical problem.

Case presentation: We report on an 84-year-old female with known chronic heart disease presenting with right lower abdominal quadrant pain, tenderness and leukocytosis. Although initial clinical findings were highly suggestive of acute appendicitis, CT revealed marked circumferential wall thickening of the caecum. Intraoperatively, caecal necrosis was confirmed, while the appendix and the remainder of the intestine appeared normal. There was no evidence of major vascular occlusion or embolization. The right hemicolectomy was performed with ileo-transverse anastomosis. Histopatho-logic analysis demonstrated isolated transmural caecal necrosis with marked infiltration of the caecal wall by numerous bacteria and neutrophils as a consequence of nonocclusive ischaemic colitis. The patient recovered completely and was discharged from the hospital on the tenth postoperative day without any surgical complications.

Conclusion: Partial caecal necrosis should be included in the differential diagnosis of acute right lower quadrant pain, especially in elderly patients with chronic heart disease.

Key words:

  • partial caecal necrosis
  • ischemic colitis
  • chronic heart disease
Open Access

Congenital Hydronephrosis: Disease or Condition?

Published Online: 01 Dec 2014
Page range: 123 - 129

Abstract

Abstract

The aim of this paper is to address the dilemmas of the paediatric surgeon when facing an isolated, unilateral, congenital hydronephrosis and discuss the strategic options for the management of this condition.

Congenital hydronephrosis, the most commonly diagnosed uropathy in children, is usually a benign and self-resolving condition. Nonobstructive hydronephrosis does not require operative treatment, while timely treatment is imperative for obstructive hydronephrosis before significant renal damage ensues. Managing congenital hydronephrosis is a challenging task.

Thirty-two children with unilateral, isolated hydronephrosis and nonobstructed renography curves were followed up for 3 years.

On the initial evaluation according to the grade of hydronephrosis: 22.6% were grade I, 54.8% grade II and 22.6% grade III. After 12 months of follow-up: 30% were grade I, 51.5% grade II and 18.5% grade III, respectively. After the three-year follow-up, there were no hydroneproses greater than grade II. The mean value of the separate GFR of the affected kidney at initial evaluation was 42.83%, and 40.33% after three years. In three children the treatment was converted from conservative to surgical. Nonobstructive, congenital hydronephrosis is a benign condition not requiring any medical treatment, but aggressive observation is indicated.

Key words:

  • congenital hydronephrosis
  • management
  • child
Open Access

Effect of Lipid Parameters on Foetal Growth In Gestational Diabetes Mellitus Pregnancies

Published Online: 01 Dec 2014
Page range: 131 - 136

Abstract

Abstract

Introduction: Women with gestational diabetes mellitus (GDM) often deliver newborns large for their gestational age (LGA). The aim of the study was to evaluate the effect of lipid parameters in the second half of pregnancy on foetal growth in GDM pregnancies.

Material and methods: In two hundred consecutive women with GDM the age, body mass index before pregnancy, body mass index before delivery, gestational week of GDM diagnosis, lipid parameters after 24 weeks of pregnancy, fasting glycaemia, HbA1c in the second and third trimester of pregnancy, gestational age at delivery, mode of delivery, and baby birth weight were analyzed.

Results: Of the 200 GDM pregnancies, 50 (25%) women delivered LGA newborns, 135 (67.5%) women delivered newborns appropriate for gestational age (AGA), and 15 (7.5%) women delivered newborns small for gestational age (SGA). Maternal triglyceride levels and HbA1c in the second trimester were higher, and HDL-C was significantly lower, in the LGA group than in the AGA group (3.8 ± 1.8 vs. 3.1 ± 1.1 mmol/L, 6.1 ± 1.1 vs. 5.5 ± 0.8%, and 1.3 ± 0.4 vs. 1.6 ± 0.4 mmol/L, p < 0.05). Also, maternal triglyceride levels and HbA1c in the second trimester were significantly higher in the SGA group than in the AGA group (3.8 ± 1.9 vs. 3.1 ± 1.1 mmol/L and 6.8 ± 0.8 vs. 5.5 ± 0.8%, p < 0.05). Maternal triglycerides were independent predictors for delivering LGA newborns in GDM women.

Conclusion: In GDM pregnancies, maternal triglycerides in the second half of pregnancy may indentify women who will deliver LGA newborns. Thus, with good regulation of lipid profile, we can avoid macrosomia from GDM pregnancies.

Key words:

  • lipid parameters
  • triglycerides
  • gestational
  • large for gestational age newborns
Open Access

Echocardiographic Predictors of Chronotropic Incompetence to Exercise in Patients with Heart Failure with Preserved Ejection Fraction

Published Online: 01 Dec 2014
Page range: 137 - 145

Abstract

Abstract

Objective: Exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF) is most often attributed to diastolic dysfunction (DD); however, chronotropic incompetence (CI) could also play an important role. We intended to examine whether there are predictive echocardiographic parameters of DD for impaired chronotropic response to exercise.

Methods and Results: Patients (n = 143) with unexplained dyspnea and/or exercise intolerance who fulfilled clinical and echocardiographic criteria of HFpEF presence underwent a symptom-limited exercise test using a treadmill (ETT) according to the Bruce protocol. CI was defined as an achieved heart rate reserve (HRR) of ≤ 80%. Comparison of the groups with (n = 98) and without CI (n = 45) did not show any statistically significant difference regarding demographic and clinical character-ristics except for use of beta blockers (BB) that were more frequently present (p = 0.012) in patients with CI in comparison with those without. Patients with CI had a higher mean E-wave velocity, E/A ratio, increased E/E‵ septal, lateral as well as average ratio and abnormal IVRT/TE-e‵ index all consistent with elevated LV filling pressures. E/E‵ average ratio > 15 was statistically insignificantly more frequently present in patients with CI. In addition, by multivariate stepwise regression analysis value of E‵ septal (β = 3.697, 95%CI 0.921–6.473, p = 0.009) along with use of BB, current smoking and basal heart rate appeared as statistically significant independent predictors of lower HRR %.

Conclusion: Patients with HFpEF frequently have chronotropic incompetence to graded exercise which may partly be predicted with echocardiographic parameters that are consistent with elevated LV filling pressures.

Key words:

  • heart failure with preserved ejection fraction
  • diastolic dysfunction
  • left ventricular filling pressure
  • chronotropic incompetence
Open Access

Anthropometric Parameters in National Footballers in the Republic of Macedonia

Published Online: 01 Dec 2014
Page range: 147 - 154

Abstract

Abstract

Objectives: The focus of this study is on anthropometric characteristics of footballers in the Republic of Macedonia, and the aim is to provide normative data for selected anthropometric parameters for adult male footballers in our country.

Material and method: The study included eight hundred (800) adult male footballers, aged 24.06 ± 4.8y (age range 18–35y), who have undertaken routine sport medical examinations over a ten-year period. The football players were divided into six age – specific subgroups (“up to 20”; “up to 22”; “up to 24”; “up to 26”; “up to 28” and “over 28” years). Anthropometric measurements were made by Matiegka's protocols and body composition components were determined.

Results: Average values of body height (178.8 ± 6.7 cm), body weight (77.72 ± 7.9 kg), lean body mass (66.21 ± 6.36 kg), body components (MM% = 53.04; BM% = 17.15; FM% = 14.7%) and a large series of anthropometric measurements which define the footballers' anthropometric dimensions were obtained. The distribution of the adipose tissue regarding the body and limbs showed that the skinfolds were thickest on the lower limbs and thinnest on the arms.

Conclusions: The adult football players in Republic of Macedonia were insignificantly variable in height and body mass from their counter parts from European and American teams. The football players up to 20 year, who played in the senior national football league were lighter and smaller than their older colleagues. The football players aged from 20 to 35 years were insignificantly variable in height, body mass, and anthropometric dimensions of limbs and trunk.

Key words:

  • football
  • adult
  • anthropometry
  • body composition
  • skinfolds
  • diameters
Open Access

T-Scan III System Diagnostic Tool for Digital Occlusal Analysis in Orthodontics – a Modern Approach

Published Online: 01 Dec 2014
Page range: 155 - 160

Abstract

Abstract

Introduction: This systematic literature review was performed to establish the mechanism, methodology, characteristics, clinical application and opportunities of the T-Scan III System as a diagnostic tool for digital occlusal analysis in different fields of dentistry, precisely in orthodontics.

Methods: Searching of electronic databases, using MEDLINE and PubMed, hand searching of relevant key journals, and screening of reference lists of included studies with no language restriction was performed. Publications providing statistically examined data were included for systematic review. Results: Twenty potentially relevant Randomized Controlled Trials (RCTs) were identified. Only ten met the inclusion criteria. The literature demonstrates that using digital occlusal analysis with T-Scan III System in orthodontics has significant advantage with regard to the capability of measuring occlusal parameters in static positions and during dynamic of the mandible.

Conclusion: Within the scope of this systematic review, there is evidence to support that T-Scan system is rapid and accurate in identifying the distribution of the tooth contacts and it shows great promise as a clinical diagnostic screening device for occlusion and for improving the occlusion after various dental treatments. Additional clinical studies are required to advance the indication filed of this system. Importance of using digital occlusal T-Scan analysis in orthodontics deserves further investigation.

Key words:

  • Orthodontic treatment
  • skeletal orofacial anomalies
  • T-Scan III system
  • digital occlusal analysis
Open Access

White Spot Lesions: Prevention and Management During the Orthodontic Treatment

Published Online: 01 Dec 2014
Page range: 161 - 168

Abstract

Abstract

The formation of white spot lesions, or enamel demineralization, around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which marks the result of a successfully completed case. This article is a contemporary review of the risk factors and preventive methods of these orthodontics scars. Preventive programmes must be emphasized to all orthodontic patients. The responsibility of an orthodontist is to minimize the risk of the patient having decalcification as a consequence of orthodontic treatment by educating and motivating the patients for excellent oral hygiene practice. Prophylaxis with topical fluoride application should be implemented: high-fluoride toothpastes, fluoride mouthwashes, gels and varnishes during and after the orthodontic treatment, especially for patients at high risk of caries.

Key words:

  • white spot lesions
  • oral hygiene
  • topical fluorides
Open Access

The Influence of Etiological Factors in the Occurence of Diastema Mediana

Published Online: 01 Dec 2014
Page range: 169 - 177

Abstract

Abstract

Even from the distant past the aesthetic perception in an individual was diminished by the presence of gap between the central incisors. This condition is found under the term “dents du bonheur” or “lucky teeth” and is encountered even among world famous figures including Brigitte Bardot, Eliah Wood, Madonna, Zac Efron, Amy Winehouse and Elton John. The teeth gaps are still considered main reasons for dissatisfaction of the dental patients and reasons for the requirement of aesthetic treatment.

The purpose of this study is to exhibit the influence of the etiological factors in the occurrence of dia-stema mediana classified according to the dominance of their occurrence expressed in percentage values. Materials of this investigation were 100 patients with diastema mediana from the following factors: inheritance, disproportion in the dental arches, inborn or acquired missing teeth, harmful oral habits, high insertion of the labial frenulum as well as mesiodens. After the diagnosis and evaluation of the etiological factor for diastema mediana was performed, a decision regarding the course of treatment was made in direction of the removal of the etiological factor at an early age and orthodontic treatment. The end of the orthodontic treatment in a group of the patients was the beginning of prosthodontic reconstruction.

From our clinical investigation we came to the realization that in 49 patients (49%) the hereditary influence was a dominant factor, next followed disproportions and discrepancies in the dental arch in 14 (14%), inborn or acquired missing teeth in 11 patients (11%), harmful oral habits in 10 (10%), high frenulum insertion in 4 (4%), and pathological objects between central incisors, mesiodens, iatrogenic factors and periodontal disease, in 3 of the clinical cases (3%) each.

We concluded that the occurrence of diastema mediana is multi-causal. The dominant place is occupied by the hereditary factors. With regard to the mutual relationship between the multitudes of factors in the occurrence of diastema mediana, the diagnosis should be made conciliary and the clinical treatment should be interdisciplinary including a prosthodontist, orthodontist and oral surgeon.

Key words:

  • diastema mediana
  • etiological factors
  • real diastema mediana
  • physiological diastema mediana

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