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

Journal Details
Format
Journal
eISSN
1857-8985
ISSN
1857-9345
First Published
08 Sep 2014
Publication timeframe
2 times per year
Languages
English

Search

Volume 36 (2015): Issue 3 (December 2015)

Journal Details
Format
Journal
eISSN
1857-8985
ISSN
1857-9345
First Published
08 Sep 2014
Publication timeframe
2 times per year
Languages
English

Search

20 Articles
Open Access

Steroid Resistant Nephrotic Syndrome-Genetic Consideration

Published Online: 14 Apr 2016
Page range: 5 - 12

Abstract

Abstract

Nephrotic syndrome is defined as the association of massive proteinuria, hypoalbuminaemia, edema, and hyperlipidemia. It is separated to steroid-sensitive or steroid-resistant (SRNS) forms in respect to the response to intensive steroid therapy. SRNS usually progresses to end-stage renal failure. According to the North American Pediatric Renal Trials and Collaborative Studies SRNS constitutes the second most frequent cause of ESRD in the first two decades of life. Unfortunately, there is no curative treatment for majority of patients. Majority of the SRNS patients have the histologic picture of focal segmental glomerulosclerosis. Interestingly, the risk of recurrence in the kidney graft in patients with hereditary SRNS is lower than in those who do not have genetic background. The etiology and pathogenesis of SRSN has remained enigma for decades. The discovery of 39 dominant or recessive SRNS genes enabled better understanding of the function of the glomerular podocytes and slit membrane. Hildebrandt′s group has shown that 85% of the SRNS cases with onset by 3 months of age and 66% with onset by 1 year of age can be explained by recessive mutations in one of four genes only (NPHS1, NPHS2, LAMB2, or WT1). The same group used modern diagnostic techniques such as the next generation sequencing and tested a large international cohort of SRNS patients (n = 1783 families). The diagnostic panel included 21 genes with a recessive mode of inheritance and 6 genes with a dominant mode of inheritance. Single-gene cause was detected in 29.5% (526 of 1783) of the families with SRNS that manifested before 25 years of age. The identification of causative single-gene mutations may have important therapeutic consequences in some cases. This is very important for patients who carry mutations in a gene of coenzyme Q10 biosynthesis (COQ2, COQ6, ADCK4, or PDSS2). In these patients the treatment with coenzyme Q10 may be indicated. Also, patients with recessive mutations in PLCE1 may respond fully to the treatment with steroids or cyclosporine A. The patients with CUBN may benefit the treatment with vitamin B12. The detection of causative mutations may also be very important for familial genetic counseling and for prenatal diagnosis.

Keywords

  • nephrotic syndrome
  • steroid-resistant
  • genetics
  • children
Open Access

Changes of Spleen in Wistar Rats Exposed to Therapeutic Doses of Dexamethasone and Medroxyprogesterone Acetate Evaluated by Stereological Parameters

Published Online: 14 Apr 2016
Page range: 13 - 25

Abstract

Abstract

The aim of our investigation was to evaluate the immunosuppressive effect of medroxyprogesterone acetate (MPA) determining the volume densities of the structural components of the spleen. The volume densities of the same structural components of spleen were determined after administration of dexamethasone too, in order to see whether the morphological changes induced by MPA are in the same line with the changes caused by dexamethasone.

60 female Wistar rats were divided into 5 groups. The control group of rats was administered physiological solution. The remaining, 4 experimental groups were administered: dexamethasone at a therapeutic daily dose of 0.6 mg/kg bw and maximal therapeutic dose of 3 mg/kg bw, and MPA at a therapeutic dose of 30 mg/kg bw and maximal therapeutic dose of 150 mg/kg bw. The drugs were applied intramuscularly for 7 days. Spleen paraffin sections were stained according to the methods: hematoxylin-eosin, Masson and Elastica van-Gieson. Stereological measurements were performed by using the Weibl′s multipurpose test system (M-42).

The histological analyses of the structural components of the spleen in rats treated with dexamethasone and MPA have shown reduction of the white pulp and the marginal zone and an apparent decrease of the cellular density of the lymphocyte component of the pulp. The stereological analysis of the spleen showed significant decrease of the splenic pulp volume density and significant increase of the connective tissue volume density. Reducing the presence of splenic pulp was mainly due to the decrease in the volume density of all structural components of the white pulp. Changes were observed in all drug treated groups of rats.

Our results have shown that the MPA provoked changes suggested atrophy of the spleen lymphoid tissue. Although the atrophic changes of the spleen were significant after the application of both dexamethasone and MPA, the white pulp was significantly more sensitive substrate for dexamethasone than for the MPA.

Keywords

  • spleen
  • Wistar rats
  • stereological analysis
  • dexamethasone and medroxyprogesterone acetate
Open Access

Laparoscopic Adrenalectomy: First Single-Center Experience in the Balkans

Published Online: 14 Apr 2016
Page range: 27 - 33

Abstract

Abstract

Introduction: Laparoscopic adrenalectomy has become the preferred approach for removal of the adrenal gland for the management of benign or malignant functioning or nonfunctioning adrenal masses. We aimed to present our initial experience with this procedure. In addition, we compare the clinical outcomes of laparoscopic (LA) vs. the open adrenalectomies (OA) performed at our institutions. Also we report a case of successful laparoscopic treatment of splenic artery aneurism involving laparoscopic splenectomy.

Patients and Methods: A retrospective analysis of the data of all patients who underwent adrenalectomy at three institutions, over the last 12-year period, since the laparoscopic adrenal surgery was introduced in our country. All patients were assessed regarding the demographic data, hormonal status, operative time, estimated blood loss, complications, size of the tumor, number of patients requiring blood transfusion, hospital stay and conversion to open surgery for LA.

Results: Thirty five consecutive patients, aged from 33 to 67 (average age 54 years) underwent unilateral LA adrenalectomy during the study period including 14 right and 21 left sided. The laparoscopic procedure was successfully completed in all except 4 cases, which were converted to open surgery to control bleeding from the avulsed adrenal veins. LA proved superior to OA, resulting in less estimated blood loss, shorter operating time, shorter time to resumption of oral intake, shorter postoperative hospital stay and less analgesic requirements. During the follow-up of 3 to 36 months no tumor recurrence and/or metastasis developed.

Conclusions: Our results concur with other retrospective reviews comparing laparoscopic and open adrenalectomy, demonstrating unequivocal advantages in terms of reduced length of hospital stay, blood loss, return of bowel function, functional recovery and post-operative morbidity.

Keywords

  • adrenal gland
  • laparoscopy
  • surgery
Open Access

Effect of Adding Dexamethasone as a Ropivacaine Adjuvant in Ultrasound-Guided Transversus Abdominis Plane Block for Inguinal Hernia Repair

Published Online: 14 Apr 2016
Page range: 35 - 41

Abstract

Abstract

Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone.

Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours.

Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points - 2hr, 4hr, 6hr, 12hr and 24hr. (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001).

Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).

Keywords

  • Unilateral open inguinal herniotomy
  • US-TAP block
  • Ropivacaine
  • Dexamethasone
Open Access

Severe Endothelial Damage in Chronic Kidney Disease Patients Prior to Haemodialysis Vascular Access Surgery

Published Online: 14 Apr 2016
Page range: 43 - 49

Abstract

Abstract

Background: Hemodialysis as an efficient therapy for advanced CKD is the most used treatment modality all over the world. Even though primary AVF is widely accepted as a best permanent vascular access in hemodialysis patients, up to 60% of all fistulas fail to mature. The pathogenesis of early fistula failure is not very well understood. Many general and local factors are involved: patient′s age, sex, primary renal disease, small vessel′s diameter, presence of accessory veins, prior venipunctures, surgical skill, genetics, etc. Histological investigations have confirmed the neointimal venous hyperplasia as a major pathological finding in stenotic lesions of AVF failure, due to local inflammation, oxidative stress and migration and proliferation of myofibroblasts, fibroblasts and endothelial cells.

Materials and methods: A total of 89 patients with stadium 4-5 of CKD are involved in the study. A typical radio-cephalic AVF is created in all patients. Part of the fistula vein was taken for histological, immunohistochemical (Vimentin, TGF β and KI67) and morphometric analysis. Appriopriate statistical method was applied.

Results: Up to 80% of the patients showed some degree of endothelial changes at the time of creation of AVF, among them 19 pts with substantial intimal hyperplasia, 51 with medial hypertrophy and 19 pts with normal histology. Almost two thirds of the patients did not have expression of TGFβ. More than 95% had some expression of Vimentin. None of the patients had expression of the marker KI 67.

Conclusion: Medial hypertrophy is predominant preexisting pathohistological lesion prior the AVF creation, despite the presence of neointimal hyperplasia. The absence of TGFβ expression in majority of our patients could suggest that inflammation and oxidative stress are developing later, after vascular access surgery. The dominant cells within the stenosis in the veins are myofibroblasts. Their increased presence maybe a reason why some patients are prone to developing venous endothelial changes as a results of exaggerated vascular endothelial response to the effect of uremia, hypertension and other insults.

Keywords

  • Fistula Failure
  • CKD
  • Intimal Hyperplasia
  • Vimentin
  • TGF- β
Open Access

Non-Tumor Cystic Lesions of the Adrenal Gland

Published Online: 14 Apr 2016
Page range: 51 - 59

Abstract

Abstract

Adrenal cystic lesions are uncommon but due to the improved radiologic imaging techniques their appearance seems to increase.

Material and Methods: We analyzed the clinical and radiological findings of 10 patients with adrenal cysts and the pathological features of the operative material. Standard dissection procedure and paraffin embedded tissue sections were made, stained by HE and immunohistochemically with CD34, CD 31, Factor 8, Podoplanin, CKWS and AE1/AE3

Results: The mean age of the patients was 40.6 years; female to male ratio was 2.3:1. All the cysts were diagnosed as cystic lesions radiologically except one. The most present clinical symptom was abdominal pain.

The diameter of the cysts measured from 2 to 7 cm. Four of the cysts were diagnosed as pseudocysts and six as endothelial. Six cysts were lined by CD34+ and CD31+ cells, four were lined by Factor 8+ and podoplanin+ cells and four had no lining.

Conclusion: Endothelial cysts were more common cysts in our study and the immunohistochemical results suggested common vascular origin to all endothelial cysts and supported additional separation of angiomatous and lymphangiomathous adrenal vascular cysts.

Keywords

  • adrenal cysts
  • pseudocysts
  • CD 34
  • CD 31
  • podoplanin
Open Access

Insulin Resistance, Glycemia and Cortisol Levels in Surgical Patients who Had Preoperative Caloric Load with Amino Acids

Published Online: 14 Apr 2016
Page range: 61 - 70

Abstract

Abstract

Introduction: Surgical stress response, results in elevated levels of anti-insulin hormones and reduced insulin secretion. This hormonal state may be detrimental for surgical patients due to the presence of insulin resistance and hyperglycemia. Additionally, pre-operative fasting favors this conditions. The aim of this study is to analyze the impact of pre-operative caloric load, with 440kJ from amino acid infusions on the levels of glucose, cortisol and insulin resistance in surgical patients.

Material and Methods: The study included 20 female patients scheduled for mastectomy, aged 30-60 years without diabetes and BMI < 30 m2, divided into two groups. The study group A, the evening before the surgery, received 1000 ml amino acid infusions, while the control group B didn′t receive any infusion. In both groups glucose, C-peptide and cortisol levels were determinate preoperatively and postoperatively. From the obtained C-peptide and glucose values, with the help of computer model (HOMA2*), the insulin resistance (IR), functionality of beta cells (BETA) and insulin sensitivity (IS) were calculated.

Results: Postoperative values of insulin resistance (0.94 ± 0.12 vs 1.13 ± 0.2; p = 0.02) and glucose (4.79 ± 0.5 vs 5.77 ± 0.6; p = 0.002) were lower in the study group compared to control group. Postoperative cortisol levels in both groups were higher than the preoperative, but no significant difference was found. The study group showed higher values for BETA and IS. Percentage changes between the groups were significant for all parameters.

Conclusion: Pre-operative caloric load (amino acids) reduces the level of insulin resistance and glucose in the presence of elevated cortisol levels.

Keywords

  • Insulin resistance
  • blood glucose
  • cortisol
  • preoperative fasting
  • amino acid
Open Access

Adenoid Vegetations – Reservoir of Bacteria for Chronic Otitis Media with Effusion and Chronic Rhinosinusitis

Published Online: 14 Apr 2016
Page range: 71 - 76

Abstract

Abstract

Introduction: Otitis media and rhinosinusitis are commonly encountered illnesses in pediatric population. Literature reports have documented the association between the occurrence of these two conditions and even their almost identical microbiological findings. Until recently, the key factor in the association of these two conditions was considered to be the hypertrophic adenoid tissue, but within the past few years there have been evidences in the literature about the presence of bacterial biofilms on the adenoids suggesting biofilms to be also responsible for both conditions, chronic otitis media with effusion and chronic rhinosinusitis.

Aim: The aim of this study was to make a microbiological analysis of the adenoid tissue specimens taken from patients with chronic otitis media with effusion and chronic or recurrent rhinosinusitis and to determine their potential for biofilms formation.

Methods: After the surgical intervention, adenoidectomy, microbiological evaluation and analysis of the adenoid tissue specimens taken from 20 patients were made. Having in mind the disease history, chronic otitis media with effusion was diagnosed in all 20 patients and chronic rhinosinusitis in 9 patients.

Results: The results obtained from the microbiological analyses showed many potentially pathogenic bacteria in the adenoids that were almost identical with the most common organisms incorporated in the etiopathogenesis of both conditions, in chronic otitis media with effusion and in chronic rhinosinusitis. In 7 (35%) patients Haemophylus influenzae was isolated, in 6 (30%) Streptococcus pneumoniae, in 4 (20%) Moraxella catаrrhalis, in 2 (10%) patients Staphylococcus aureus and in 1 (5%) patient Streptococcus pyogenes - group A was isolated. One bacterium was isolated from all adenoid vegetations, except in one case when two bacteria (Haemophylus influenzae and Staphylococcus aureus) were concurrently isolated.

Conclusion: Our results have shown that the key role in adenoid vegetations in chronic otitis media with effusion and chronic rhinosinusitis is not only the mechanism of rhinopharyngeal obstruction, but also the presence of bacterial strains with a large potential for formation of biofilms adhered to their surface, especially in cases with symptoms of chronic otitis media with effusion and chronic rhinosinusitis that were resistant to antibiotic therapy.

Keywords

  • adenoid vegetations
  • bacterial reservoir
  • chronic otitis media with effusion
  • chronic rhinosinusitis
Open Access

The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm

Published Online: 14 Apr 2016
Page range: 77 - 82

Abstract

Abstract

Vasospasm and re-bleeding after subarachnoid hemorrhage from ruptured intracranial aneurysm are devastating complication that can severely affect the outcome of the patients. We are presenting a series of total number of 224 patients treated and operated at our Department due to subarachnoid hemorrhage, out of which certain number developed vasospasm and re-bleeding. We are evaluating the effect of these complications on the outcome of the patients according to the Glasgow Outcome Scale at the day of discharge. In our experience both vasospasm and ReSAH can significantly influence the outcome of patients with subarachnoid hemorrhage from ruptured intracranial aneurysm.

Keywords

  • vasospasm
  • rebleding
  • intracranial aneurysm
Open Access

Acute Kidney Injury in Newborns

Published Online: 14 Apr 2016
Page range: 83 - 89

Abstract

Abstract

Objective: Acute kidney injury is common condition in the neonatal intensive care unit and it is associated with poor outcome. The incidence of neonatal AKI is the highest one followed by adults and children, depending on different factors such as the gestational age, birth weight, contributing conditions and the facilities of the neonatal intensive care unit. The aim of the study was to determine the incidence, risk factors and the outcome of the neonatal acute kidney injury.

Subjects and Methods: This was a clinical, prospective study that was performed in a referent NICU at the University Children′s Hospital in Skopje. All neonates admitted from January 2012 to December 20014 with documented acute kidney injury were included. The medical data records of the admitted neonates with AKI were analyzed. The material was statistically processed using methods of the descriptive statistics.

Results: During the study period 770 newborn infants were admitted to the NICU and 50 (6.5%) infants developed acute kidney injury. The male to female ratio was 2.1:1. Most of the neonates involved in the study were neonates born at term (62%). Oliguric AKI was found in 28 cases (56%) and no oliguric in 22 cases (44%). The prevalence of prerenal, renal and post renal AKI were 78.5%, 19.5% and 2.0% respectively. Perinatal asphyxia was the most common predisposing factor for AKI and was evaluated in 38% of the cases with predominance of term infants and male. The mortality rate was 32% and was significantly higher in the group of patients with congenital heart diseases.

Conclusion: AKI is a life threatening condition with still high mortality rate. Early recognition of the risk factors and the rapid effective treatment of the contributing conditions will reduce AKI in the neonatal period.

Keywords

  • acute kidney injury
  • newborns
  • predisposing factors
Open Access

Neonatal Hypoglycemia: A Continuing Debate in Definition and Management

Published Online: 14 Apr 2016
Page range: 91 - 97

Abstract

Abstract

Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Maintaining glucose homeostasis is one of the important physiological events during fetal-to-neonatal transition. Transient low blood glucose concentrations are frequently encountered in the majority of healthy newborns and are the reflections of normal metabolic adaptation processes. Nevertheless, there is a great concern that prolonged or recurrent low blood glucose levels may result in long-term neurological and developmental consequences.

Strikingly, it was demonstrated that the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia, did not find association between repetitive low glucose concentrations and poor neurodevelopmental outcomes. On the contrary, NH due to hyperinsulinism is strongly associated with brain injury.

Fundamental issue of great professional controversy is concerning the best manner to manage asymptomatic newborns NH. Both, overtreating NH and undertreating NH are poles with significant potential disadvantages.

Therefore, NH is one of the most important issues in the day-to-day practice. This article appraises the critical questions of definition (widely accepted blood glucose concentration: < 2.6 mmol/l or 47 mg/dl), follow-up ad management of NH.

Keywords

  • Hypoglycemia
  • definition
  • management
  • neonates
Open Access

Compound Galactosylceramidase Gene (GALC) Heterozygosity in a Boy with Infantile Krabbe Disease (KD)

Published Online: 14 Apr 2016
Page range: 99 - 101

Abstract

Abstract

Krabbe disease (KD) (globoid cell leukodystrophy) is a degenerative, lysosomal storage disease, caused by a severe loss of galactocerebrosidase (GALC) enzymatic activity. The inheritance is autosomal recessive. KD affects the white matter of the central and peripheral nervous systems.

We present a 3 year old boy in whom the disease had an ‘infantile’ or ‘classic’ presentation, with spasticity, irritability, and developmental delay. In addition the boy showed progressive severe motor and mental deterioration, difficulties in swallowing and decerebration.

Molecular analysis revealed that the child is a compound heterozygote: p.Asp187Val (c.560A>T) and p.Ile250Thr (c.749T>C). The father was the carrier of p.Asp187Val (c.560A>T), while the mother was the carrier of the p.Ile250Thr (c.749T>C) in exon 6 of the GALC gene.

The clinical course in this compound heterozygote is severe and the patient passed away at the age of 3 years. Genotype-phenotype relations are discussed in this Macedonian patient with KD.

Keywords

  • Krabbe disease
  • infantile form
  • compound heterozygote
Open Access

Brain Topography of Emf-Induced Eeg-Changes in Restful Wakefulness: Tracing Current Effects, Targeting Future Prospects

Published Online: 14 Apr 2016
Page range: 103 - 112

Abstract

Abstract

Introduction: Covering a handful of decades but spanning across two centuries, mobile phones announced the dawn of the technological revolution, standing at the forefront as its′ most prominent symbol. Over the course of their sovereign dominance, human generations born with the birth of the mobile phone reached the age of maturity, while scientific community started reaching for experience-based perceptivity.

Aim: The following review serves as a short-cut across a half-decade old research gap, and a clear-cut analysis on the cutting-edge knowledge of the EMF induced EEG changes.

Material and Methods: The selection covers 28 articles about mobile phone effects on resting wakeful EEG in humans conducted over the last two decades, across three continents and 12 countries, of which 75% had positive findings.

Conclusions: At present, the general protocol of a typical study includes investigations on adults (20-60 yrs) grouped in smaller samples and exposed to shorter intervals of GSM-like pulse-modulated signal (10-30 subjects/minutes). The assessment usually involves linear methods for quantitative analysis, while the results mostly revolve around posterior increase in alpha and beta frequency range. The qualitative variations, however, remain open to interpretation. Future research may benefit from multiplication of sub-specific studies leading to replication of more consistent results. The long-term and large-size epidemiologic studies, stratified by age and gender, may also improve the expected outcomes. Regarding the interpretation, non-linear methods could be employed for assessment of individual variations. The emphasis should be placed on theories/measures for better understanding of the subtle interplay between the spectral individualities and mobile phone radiation specifics.

Keywords

  • Mobile phones
  • electromagnetic fields
  • pulse-modulated and continuous-wave signal
  • human wake resting electroencephalogram
Open Access

Some Psychological Aspects of T1DM in Children and Adolescents

Published Online: 14 Apr 2016
Page range: 113 - 118

Abstract

Abstract

Diabetes mellitus type 1 (T1DM) is a chronic disease with long term consequences dictating daily struggle to maintain a good metabolic control.

Children and adolescents with T1DM seem to have inferior psychological adjustment to their normal counterparts, which might be associated with glycemic control and disease duration.

The aim of this study is to evaluate the psychological characteristics of children and adolescents with T1DM treated last year in the University Children Hospital in Skopje, Macedonia and to propose some response measures. For psychological evaluation we used CBCL (Child Behavior Check List), GAS (General Anxiety Scale), EPQ (Eysenck Personality Questionnaire) and MMPI-201 (Minnesota Multiphasic Personality Inventory).

The results confirmed the following psychological characteristics: mild depression and anxiety, emotional instability, need for social acceptance, as well as the possible psychopathic traits. Suffering for a complex metabolic and chronic illness, these patients need psychological evaluation and intervention in the management.

Keywords

  • diabetes mellitus
  • children
  • adolescents
  • psychology
  • management
Open Access

Influence of Climate Changes on Health (Review)

Published Online: 14 Apr 2016
Page range: 119 - 125

Abstract

Abstract

Although climate changes are one of the most serious public health risks for all nations, it appears that the medical society in the East European countries is not too much concerned.

The aim of this paper is to point out the main treats on health provoked by climate changes.

The literature review was the source of information. Based on the PubMed where in 2015 more than 65,000 papers were dedicated to different aspects of the influence of the climate changes on the human health, as well as 3,500 articles for the pediatric population, we present a review of the main health risks. Especially, the impact of the climate changes on the children′s health is overviewed.

In separate parts, the thermal stress, extreme weather events, changes of infection′s pattern, how to measure health risks as well as some mitigation measures are discussed.

Keywords

  • climate changes
  • health risks
  • review
Open Access

Influence of the Ethnic Affiliation, Level of Education and Place of Living on Oral Health at Geriatric Population with Total and Partial Dentures in Republic of Macedonia

Published Online: 14 Apr 2016
Page range: 130 - 137

Abstract

Abstract

Introduction. Health is the main component of the quality of life, while oral health is component of the general health. The socio-demographic characteristics are one of the important factors for perception of the oral health and the quality of life. The main purpose of this study was to perform an evaluation of the quality of life of geriatric patients (older than 65) with built-in oral prosthetic dentures depending on the ethnic affiliation, level of education and place of living, as socio-demographic characteristics.

Materials and methods. The survey was a prospective transversal (cross-sectional) study conducted among 165 institutionally sheltered patients at the Gerontology Institute (inspected group - IG) and 170 patients from the dental specialist clinics (control group CG) at the age of 65 and older. The statistical program SPSS for Windows ver. 13.0 was used for statistical processing.

Results and discussion. Patients with upper and lower total dentures dominated (43.6% vs. 26.5%). The highest GOHAI score had the other ethnicities of IC (32.08) and Roma of IG (31.00), while the lowest was in the Albanians of CG (25.91). The highest value of 30.15 had the IG of patients living in urban areas.

Conclusion. The quality of life and oral health of the geriatric patients are at unsatisfactory level, with significant influence of the place of living and insignificant influence of the ethnic affiliation and level of education.

Keywords

  • GOHAI indicator
  • quality of life
  • ethnic
  • education
  • place of living
Open Access

Comparative Analysis of the Mechanical Properties between the Fiber-Reinforced Composite and Zirconium Posts

Published Online: 14 Apr 2016
Page range: 138 - 149

Abstract

Abstract

Objectives: To make a comparative analysis of the mechanical properties between FRC and zirconium posts

Methods: The patients with FRC and zirconium posts were divided in two groups with three subgroups, each of them composed of 10 samples. Subgroup I with 1.2 mm; Subgroup II with 1.35 mm and Subgroup III with 1.5 mm post diameter. The fracture force, bending and tensile strength of each group were measured with Shimadzu Universal Testing Machine.

Results: The fracture force for the first group measured in the first, second and third subgroup was 34.80900N; 67.15390N; 46.53100N and for the second group, first, second and third subgroup was 34.80900N; 46.53100N; 67.15390N correspondingly. The bending strength for the first group measured in the first, second and third subgroup was 401.4420N; 444.6425N; 333.6828N and for the second group, first, second and third subgroup was 307.9352N; 289.1030N; 304.1649N correspondingly. The tensile strength for the first group measured in the first, second and third subgroup was 5.442267N; 4.350545N; 2.943465N and for the second group, first, second and third subgroup was 4.224141N; 3.751466N; 3.168756N correspondingly.

Conclusions: The longest diameter of the posts significantly increases the resistance to fracture in relation to the two smaller diameters. The larger diameter, the higher values of the bending strength, as well as the lowest values of the tensile strength of the material contribute to improved mechanical properties of the fiber and zirconium posts.

Keywords

  • FRC posts
  • zirconium posts
  • fracture
  • strength
  • bending
  • elasticity
Open Access

First Case of Endovascular Treatment of Ruptured Internal Carotid Artery Aneurysm Using Stent Assisted Coiling at the Department of Neurosurgery in Skopje

Published Online: 14 Apr 2016
Page range: 150 - 153

Abstract

Abstract

The management of intracranial aneurysms has changed dramatically in recent years. The science and technology advancement have resulted in new therapeutic options for their treatment. There is an increased interest among neurosurgeons to perform endovascular procedures for intracranial aneurysms. This has become a part of the neurosurgical residency in the US. We are presenting our first experience of ruptured aneurysm coiling using stent assisted technique.

Keywords

  • ruptured cerebral aneurysm
  • stent assisted coiling
Open Access

4th Rare Disease South Eastern Europe (See) Meeting Skopje, Macedonia (November 14th, 2015)

Published Online: 14 Apr 2016
Page range: 154 - 159

Abstract

Abstract

The 4th meeting on rare diseases in South Eastern Europe (SEE) was held in Skopje, at the Macedonian Academy of Sciences and Arts (MASA) on the 14th of November 2015. The focuses were metabolic, rare brain diseases as well as the rare dysmorphic syndrome. The authors of the report are particularly keen on stating that one of the main goals of the meeting, namely to help the treatment of patients with rare disease has begun to bear fruits. The talk on an iminosugar-based pharmacological chaperone compound as a drug candidate for the treatment of GM1-gangliosidosis and mucopolysaccharidosis IVB (Morquio disease type B) was enlightening. To date, there is no treatment available to be offered to patients, but chaperones lead mutated proteins to adopt a native-like conformation and to successfully traffic to their normal cellular destination. DORPHAN is developing an iminosugar-based pharmacological chaperone compound for the treatment of GM1-gangliosidosis and mucopolysaccharidosis IVB.

A talk on recent developments in the laboratory diagnosis of mucopolysaccharidoses (MPS) was particularly interesting, covering the laboratory diagnosis of the MPS diseases by a strategy of clinical examination, biochemical analysis of urine samples, enzyme tests and genetic characterization of underlying mutations. New techniques were developed, including analysis of urinary glycosaminoglycans with tandem mass spectrometry, miniaturized enzyme tests or novel synthetic substrates for enzyme assays using mass spectrometry detection of products using dried blood spots. Feasibility and cost-effectiveness of these methods in newborn screening programs have been demonstrated.

Neuromuscular RDs, and especially familial amyloid polyneuropathy (FAP) were a topic of the Bulgarian colleagues. Diagnosis, screening and the role of microglia were also topics of particular interest. In summary, this year RD meeting was exciting and productive on a wide range of diseases and on a novel insights on diagnosis and treatment. New methods are expanding our capabilities for a fast and precise diagnosis. Novel knowledge offers better distinction on whom to treat with which medications (e.g. steroid dependent nephrotic syndrome). Novel diseases or variants are published (segmental overgrowth). The authors of the report are particularly keen on stating that one of the main goals of the meeting, namely to help the treatment of patients with rare disease has begun to bear fruits. Namely, the Health Fund of Macedonia for the first time treats the patients with Gaucher′s disease. We are hopeful that the number of patients treated for Gaucher′s disease and the number of treated patients with other treatable RDs diseases will continue to grow.

Keywords

  • Rare diseases
  • Macedonian Academy of Sciences and Arts
  • mucopolisaccharidoses
  • segmental overgrowth
  • steroid dependant nephrotic syndrome
  • neuromuscular RDs
  • familial amyloid polyneuropathy (FAP)
  • phenulcetonuria
  • Pompe
Open Access

5. Uro-Oncology Winter Congress

Published Online: 14 Apr 2016
Page range: 160 - 163

Abstract

Abstract

The 5th Uro-oncology Winter Congress was held in Skopje, at the Macedonian Academy of Sciences and Arts on January 30 - February 03, 2013. The Congress was co-organized by the Macedonian Academy of Sciences and Arts, the Istanbul University, the Turkish Urology Association, Macedonian Society of Urology and the Ministry of Health of the Republic of Macedonia. Topics of the Congress were tumors of urinary tract (kidney, vesica urinaria) and prostate. The latest achievements in the diagnosis and treatment of the above-mentioned disease were presented. Around 300 participants from the Balkans took part at the meeting. There were simultaneous sessions on different uro-oncological issues with around 60 presentations. In addition, there were poster presentations and training courses. It is important to point out that we had a session with participation of Balkan uro-oncologists - Balkan Urology Session, which is the first time in recent years.

Keywords

  • Uro-oncology
  • prostate
  • urinary tract
  • Balkan Urology Session
20 Articles
Open Access

Steroid Resistant Nephrotic Syndrome-Genetic Consideration

Published Online: 14 Apr 2016
Page range: 5 - 12

Abstract

Abstract

Nephrotic syndrome is defined as the association of massive proteinuria, hypoalbuminaemia, edema, and hyperlipidemia. It is separated to steroid-sensitive or steroid-resistant (SRNS) forms in respect to the response to intensive steroid therapy. SRNS usually progresses to end-stage renal failure. According to the North American Pediatric Renal Trials and Collaborative Studies SRNS constitutes the second most frequent cause of ESRD in the first two decades of life. Unfortunately, there is no curative treatment for majority of patients. Majority of the SRNS patients have the histologic picture of focal segmental glomerulosclerosis. Interestingly, the risk of recurrence in the kidney graft in patients with hereditary SRNS is lower than in those who do not have genetic background. The etiology and pathogenesis of SRSN has remained enigma for decades. The discovery of 39 dominant or recessive SRNS genes enabled better understanding of the function of the glomerular podocytes and slit membrane. Hildebrandt′s group has shown that 85% of the SRNS cases with onset by 3 months of age and 66% with onset by 1 year of age can be explained by recessive mutations in one of four genes only (NPHS1, NPHS2, LAMB2, or WT1). The same group used modern diagnostic techniques such as the next generation sequencing and tested a large international cohort of SRNS patients (n = 1783 families). The diagnostic panel included 21 genes with a recessive mode of inheritance and 6 genes with a dominant mode of inheritance. Single-gene cause was detected in 29.5% (526 of 1783) of the families with SRNS that manifested before 25 years of age. The identification of causative single-gene mutations may have important therapeutic consequences in some cases. This is very important for patients who carry mutations in a gene of coenzyme Q10 biosynthesis (COQ2, COQ6, ADCK4, or PDSS2). In these patients the treatment with coenzyme Q10 may be indicated. Also, patients with recessive mutations in PLCE1 may respond fully to the treatment with steroids or cyclosporine A. The patients with CUBN may benefit the treatment with vitamin B12. The detection of causative mutations may also be very important for familial genetic counseling and for prenatal diagnosis.

Keywords

  • nephrotic syndrome
  • steroid-resistant
  • genetics
  • children
Open Access

Changes of Spleen in Wistar Rats Exposed to Therapeutic Doses of Dexamethasone and Medroxyprogesterone Acetate Evaluated by Stereological Parameters

Published Online: 14 Apr 2016
Page range: 13 - 25

Abstract

Abstract

The aim of our investigation was to evaluate the immunosuppressive effect of medroxyprogesterone acetate (MPA) determining the volume densities of the structural components of the spleen. The volume densities of the same structural components of spleen were determined after administration of dexamethasone too, in order to see whether the morphological changes induced by MPA are in the same line with the changes caused by dexamethasone.

60 female Wistar rats were divided into 5 groups. The control group of rats was administered physiological solution. The remaining, 4 experimental groups were administered: dexamethasone at a therapeutic daily dose of 0.6 mg/kg bw and maximal therapeutic dose of 3 mg/kg bw, and MPA at a therapeutic dose of 30 mg/kg bw and maximal therapeutic dose of 150 mg/kg bw. The drugs were applied intramuscularly for 7 days. Spleen paraffin sections were stained according to the methods: hematoxylin-eosin, Masson and Elastica van-Gieson. Stereological measurements were performed by using the Weibl′s multipurpose test system (M-42).

The histological analyses of the structural components of the spleen in rats treated with dexamethasone and MPA have shown reduction of the white pulp and the marginal zone and an apparent decrease of the cellular density of the lymphocyte component of the pulp. The stereological analysis of the spleen showed significant decrease of the splenic pulp volume density and significant increase of the connective tissue volume density. Reducing the presence of splenic pulp was mainly due to the decrease in the volume density of all structural components of the white pulp. Changes were observed in all drug treated groups of rats.

Our results have shown that the MPA provoked changes suggested atrophy of the spleen lymphoid tissue. Although the atrophic changes of the spleen were significant after the application of both dexamethasone and MPA, the white pulp was significantly more sensitive substrate for dexamethasone than for the MPA.

Keywords

  • spleen
  • Wistar rats
  • stereological analysis
  • dexamethasone and medroxyprogesterone acetate
Open Access

Laparoscopic Adrenalectomy: First Single-Center Experience in the Balkans

Published Online: 14 Apr 2016
Page range: 27 - 33

Abstract

Abstract

Introduction: Laparoscopic adrenalectomy has become the preferred approach for removal of the adrenal gland for the management of benign or malignant functioning or nonfunctioning adrenal masses. We aimed to present our initial experience with this procedure. In addition, we compare the clinical outcomes of laparoscopic (LA) vs. the open adrenalectomies (OA) performed at our institutions. Also we report a case of successful laparoscopic treatment of splenic artery aneurism involving laparoscopic splenectomy.

Patients and Methods: A retrospective analysis of the data of all patients who underwent adrenalectomy at three institutions, over the last 12-year period, since the laparoscopic adrenal surgery was introduced in our country. All patients were assessed regarding the demographic data, hormonal status, operative time, estimated blood loss, complications, size of the tumor, number of patients requiring blood transfusion, hospital stay and conversion to open surgery for LA.

Results: Thirty five consecutive patients, aged from 33 to 67 (average age 54 years) underwent unilateral LA adrenalectomy during the study period including 14 right and 21 left sided. The laparoscopic procedure was successfully completed in all except 4 cases, which were converted to open surgery to control bleeding from the avulsed adrenal veins. LA proved superior to OA, resulting in less estimated blood loss, shorter operating time, shorter time to resumption of oral intake, shorter postoperative hospital stay and less analgesic requirements. During the follow-up of 3 to 36 months no tumor recurrence and/or metastasis developed.

Conclusions: Our results concur with other retrospective reviews comparing laparoscopic and open adrenalectomy, demonstrating unequivocal advantages in terms of reduced length of hospital stay, blood loss, return of bowel function, functional recovery and post-operative morbidity.

Keywords

  • adrenal gland
  • laparoscopy
  • surgery
Open Access

Effect of Adding Dexamethasone as a Ropivacaine Adjuvant in Ultrasound-Guided Transversus Abdominis Plane Block for Inguinal Hernia Repair

Published Online: 14 Apr 2016
Page range: 35 - 41

Abstract

Abstract

Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone.

Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours.

Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points - 2hr, 4hr, 6hr, 12hr and 24hr. (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001).

Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).

Keywords

  • Unilateral open inguinal herniotomy
  • US-TAP block
  • Ropivacaine
  • Dexamethasone
Open Access

Severe Endothelial Damage in Chronic Kidney Disease Patients Prior to Haemodialysis Vascular Access Surgery

Published Online: 14 Apr 2016
Page range: 43 - 49

Abstract

Abstract

Background: Hemodialysis as an efficient therapy for advanced CKD is the most used treatment modality all over the world. Even though primary AVF is widely accepted as a best permanent vascular access in hemodialysis patients, up to 60% of all fistulas fail to mature. The pathogenesis of early fistula failure is not very well understood. Many general and local factors are involved: patient′s age, sex, primary renal disease, small vessel′s diameter, presence of accessory veins, prior venipunctures, surgical skill, genetics, etc. Histological investigations have confirmed the neointimal venous hyperplasia as a major pathological finding in stenotic lesions of AVF failure, due to local inflammation, oxidative stress and migration and proliferation of myofibroblasts, fibroblasts and endothelial cells.

Materials and methods: A total of 89 patients with stadium 4-5 of CKD are involved in the study. A typical radio-cephalic AVF is created in all patients. Part of the fistula vein was taken for histological, immunohistochemical (Vimentin, TGF β and KI67) and morphometric analysis. Appriopriate statistical method was applied.

Results: Up to 80% of the patients showed some degree of endothelial changes at the time of creation of AVF, among them 19 pts with substantial intimal hyperplasia, 51 with medial hypertrophy and 19 pts with normal histology. Almost two thirds of the patients did not have expression of TGFβ. More than 95% had some expression of Vimentin. None of the patients had expression of the marker KI 67.

Conclusion: Medial hypertrophy is predominant preexisting pathohistological lesion prior the AVF creation, despite the presence of neointimal hyperplasia. The absence of TGFβ expression in majority of our patients could suggest that inflammation and oxidative stress are developing later, after vascular access surgery. The dominant cells within the stenosis in the veins are myofibroblasts. Their increased presence maybe a reason why some patients are prone to developing venous endothelial changes as a results of exaggerated vascular endothelial response to the effect of uremia, hypertension and other insults.

Keywords

  • Fistula Failure
  • CKD
  • Intimal Hyperplasia
  • Vimentin
  • TGF- β
Open Access

Non-Tumor Cystic Lesions of the Adrenal Gland

Published Online: 14 Apr 2016
Page range: 51 - 59

Abstract

Abstract

Adrenal cystic lesions are uncommon but due to the improved radiologic imaging techniques their appearance seems to increase.

Material and Methods: We analyzed the clinical and radiological findings of 10 patients with adrenal cysts and the pathological features of the operative material. Standard dissection procedure and paraffin embedded tissue sections were made, stained by HE and immunohistochemically with CD34, CD 31, Factor 8, Podoplanin, CKWS and AE1/AE3

Results: The mean age of the patients was 40.6 years; female to male ratio was 2.3:1. All the cysts were diagnosed as cystic lesions radiologically except one. The most present clinical symptom was abdominal pain.

The diameter of the cysts measured from 2 to 7 cm. Four of the cysts were diagnosed as pseudocysts and six as endothelial. Six cysts were lined by CD34+ and CD31+ cells, four were lined by Factor 8+ and podoplanin+ cells and four had no lining.

Conclusion: Endothelial cysts were more common cysts in our study and the immunohistochemical results suggested common vascular origin to all endothelial cysts and supported additional separation of angiomatous and lymphangiomathous adrenal vascular cysts.

Keywords

  • adrenal cysts
  • pseudocysts
  • CD 34
  • CD 31
  • podoplanin
Open Access

Insulin Resistance, Glycemia and Cortisol Levels in Surgical Patients who Had Preoperative Caloric Load with Amino Acids

Published Online: 14 Apr 2016
Page range: 61 - 70

Abstract

Abstract

Introduction: Surgical stress response, results in elevated levels of anti-insulin hormones and reduced insulin secretion. This hormonal state may be detrimental for surgical patients due to the presence of insulin resistance and hyperglycemia. Additionally, pre-operative fasting favors this conditions. The aim of this study is to analyze the impact of pre-operative caloric load, with 440kJ from amino acid infusions on the levels of glucose, cortisol and insulin resistance in surgical patients.

Material and Methods: The study included 20 female patients scheduled for mastectomy, aged 30-60 years without diabetes and BMI < 30 m2, divided into two groups. The study group A, the evening before the surgery, received 1000 ml amino acid infusions, while the control group B didn′t receive any infusion. In both groups glucose, C-peptide and cortisol levels were determinate preoperatively and postoperatively. From the obtained C-peptide and glucose values, with the help of computer model (HOMA2*), the insulin resistance (IR), functionality of beta cells (BETA) and insulin sensitivity (IS) were calculated.

Results: Postoperative values of insulin resistance (0.94 ± 0.12 vs 1.13 ± 0.2; p = 0.02) and glucose (4.79 ± 0.5 vs 5.77 ± 0.6; p = 0.002) were lower in the study group compared to control group. Postoperative cortisol levels in both groups were higher than the preoperative, but no significant difference was found. The study group showed higher values for BETA and IS. Percentage changes between the groups were significant for all parameters.

Conclusion: Pre-operative caloric load (amino acids) reduces the level of insulin resistance and glucose in the presence of elevated cortisol levels.

Keywords

  • Insulin resistance
  • blood glucose
  • cortisol
  • preoperative fasting
  • amino acid
Open Access

Adenoid Vegetations – Reservoir of Bacteria for Chronic Otitis Media with Effusion and Chronic Rhinosinusitis

Published Online: 14 Apr 2016
Page range: 71 - 76

Abstract

Abstract

Introduction: Otitis media and rhinosinusitis are commonly encountered illnesses in pediatric population. Literature reports have documented the association between the occurrence of these two conditions and even their almost identical microbiological findings. Until recently, the key factor in the association of these two conditions was considered to be the hypertrophic adenoid tissue, but within the past few years there have been evidences in the literature about the presence of bacterial biofilms on the adenoids suggesting biofilms to be also responsible for both conditions, chronic otitis media with effusion and chronic rhinosinusitis.

Aim: The aim of this study was to make a microbiological analysis of the adenoid tissue specimens taken from patients with chronic otitis media with effusion and chronic or recurrent rhinosinusitis and to determine their potential for biofilms formation.

Methods: After the surgical intervention, adenoidectomy, microbiological evaluation and analysis of the adenoid tissue specimens taken from 20 patients were made. Having in mind the disease history, chronic otitis media with effusion was diagnosed in all 20 patients and chronic rhinosinusitis in 9 patients.

Results: The results obtained from the microbiological analyses showed many potentially pathogenic bacteria in the adenoids that were almost identical with the most common organisms incorporated in the etiopathogenesis of both conditions, in chronic otitis media with effusion and in chronic rhinosinusitis. In 7 (35%) patients Haemophylus influenzae was isolated, in 6 (30%) Streptococcus pneumoniae, in 4 (20%) Moraxella catаrrhalis, in 2 (10%) patients Staphylococcus aureus and in 1 (5%) patient Streptococcus pyogenes - group A was isolated. One bacterium was isolated from all adenoid vegetations, except in one case when two bacteria (Haemophylus influenzae and Staphylococcus aureus) were concurrently isolated.

Conclusion: Our results have shown that the key role in adenoid vegetations in chronic otitis media with effusion and chronic rhinosinusitis is not only the mechanism of rhinopharyngeal obstruction, but also the presence of bacterial strains with a large potential for formation of biofilms adhered to their surface, especially in cases with symptoms of chronic otitis media with effusion and chronic rhinosinusitis that were resistant to antibiotic therapy.

Keywords

  • adenoid vegetations
  • bacterial reservoir
  • chronic otitis media with effusion
  • chronic rhinosinusitis
Open Access

The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm

Published Online: 14 Apr 2016
Page range: 77 - 82

Abstract

Abstract

Vasospasm and re-bleeding after subarachnoid hemorrhage from ruptured intracranial aneurysm are devastating complication that can severely affect the outcome of the patients. We are presenting a series of total number of 224 patients treated and operated at our Department due to subarachnoid hemorrhage, out of which certain number developed vasospasm and re-bleeding. We are evaluating the effect of these complications on the outcome of the patients according to the Glasgow Outcome Scale at the day of discharge. In our experience both vasospasm and ReSAH can significantly influence the outcome of patients with subarachnoid hemorrhage from ruptured intracranial aneurysm.

Keywords

  • vasospasm
  • rebleding
  • intracranial aneurysm
Open Access

Acute Kidney Injury in Newborns

Published Online: 14 Apr 2016
Page range: 83 - 89

Abstract

Abstract

Objective: Acute kidney injury is common condition in the neonatal intensive care unit and it is associated with poor outcome. The incidence of neonatal AKI is the highest one followed by adults and children, depending on different factors such as the gestational age, birth weight, contributing conditions and the facilities of the neonatal intensive care unit. The aim of the study was to determine the incidence, risk factors and the outcome of the neonatal acute kidney injury.

Subjects and Methods: This was a clinical, prospective study that was performed in a referent NICU at the University Children′s Hospital in Skopje. All neonates admitted from January 2012 to December 20014 with documented acute kidney injury were included. The medical data records of the admitted neonates with AKI were analyzed. The material was statistically processed using methods of the descriptive statistics.

Results: During the study period 770 newborn infants were admitted to the NICU and 50 (6.5%) infants developed acute kidney injury. The male to female ratio was 2.1:1. Most of the neonates involved in the study were neonates born at term (62%). Oliguric AKI was found in 28 cases (56%) and no oliguric in 22 cases (44%). The prevalence of prerenal, renal and post renal AKI were 78.5%, 19.5% and 2.0% respectively. Perinatal asphyxia was the most common predisposing factor for AKI and was evaluated in 38% of the cases with predominance of term infants and male. The mortality rate was 32% and was significantly higher in the group of patients with congenital heart diseases.

Conclusion: AKI is a life threatening condition with still high mortality rate. Early recognition of the risk factors and the rapid effective treatment of the contributing conditions will reduce AKI in the neonatal period.

Keywords

  • acute kidney injury
  • newborns
  • predisposing factors
Open Access

Neonatal Hypoglycemia: A Continuing Debate in Definition and Management

Published Online: 14 Apr 2016
Page range: 91 - 97

Abstract

Abstract

Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Maintaining glucose homeostasis is one of the important physiological events during fetal-to-neonatal transition. Transient low blood glucose concentrations are frequently encountered in the majority of healthy newborns and are the reflections of normal metabolic adaptation processes. Nevertheless, there is a great concern that prolonged or recurrent low blood glucose levels may result in long-term neurological and developmental consequences.

Strikingly, it was demonstrated that the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia, did not find association between repetitive low glucose concentrations and poor neurodevelopmental outcomes. On the contrary, NH due to hyperinsulinism is strongly associated with brain injury.

Fundamental issue of great professional controversy is concerning the best manner to manage asymptomatic newborns NH. Both, overtreating NH and undertreating NH are poles with significant potential disadvantages.

Therefore, NH is one of the most important issues in the day-to-day practice. This article appraises the critical questions of definition (widely accepted blood glucose concentration: < 2.6 mmol/l or 47 mg/dl), follow-up ad management of NH.

Keywords

  • Hypoglycemia
  • definition
  • management
  • neonates
Open Access

Compound Galactosylceramidase Gene (GALC) Heterozygosity in a Boy with Infantile Krabbe Disease (KD)

Published Online: 14 Apr 2016
Page range: 99 - 101

Abstract

Abstract

Krabbe disease (KD) (globoid cell leukodystrophy) is a degenerative, lysosomal storage disease, caused by a severe loss of galactocerebrosidase (GALC) enzymatic activity. The inheritance is autosomal recessive. KD affects the white matter of the central and peripheral nervous systems.

We present a 3 year old boy in whom the disease had an ‘infantile’ or ‘classic’ presentation, with spasticity, irritability, and developmental delay. In addition the boy showed progressive severe motor and mental deterioration, difficulties in swallowing and decerebration.

Molecular analysis revealed that the child is a compound heterozygote: p.Asp187Val (c.560A>T) and p.Ile250Thr (c.749T>C). The father was the carrier of p.Asp187Val (c.560A>T), while the mother was the carrier of the p.Ile250Thr (c.749T>C) in exon 6 of the GALC gene.

The clinical course in this compound heterozygote is severe and the patient passed away at the age of 3 years. Genotype-phenotype relations are discussed in this Macedonian patient with KD.

Keywords

  • Krabbe disease
  • infantile form
  • compound heterozygote
Open Access

Brain Topography of Emf-Induced Eeg-Changes in Restful Wakefulness: Tracing Current Effects, Targeting Future Prospects

Published Online: 14 Apr 2016
Page range: 103 - 112

Abstract

Abstract

Introduction: Covering a handful of decades but spanning across two centuries, mobile phones announced the dawn of the technological revolution, standing at the forefront as its′ most prominent symbol. Over the course of their sovereign dominance, human generations born with the birth of the mobile phone reached the age of maturity, while scientific community started reaching for experience-based perceptivity.

Aim: The following review serves as a short-cut across a half-decade old research gap, and a clear-cut analysis on the cutting-edge knowledge of the EMF induced EEG changes.

Material and Methods: The selection covers 28 articles about mobile phone effects on resting wakeful EEG in humans conducted over the last two decades, across three continents and 12 countries, of which 75% had positive findings.

Conclusions: At present, the general protocol of a typical study includes investigations on adults (20-60 yrs) grouped in smaller samples and exposed to shorter intervals of GSM-like pulse-modulated signal (10-30 subjects/minutes). The assessment usually involves linear methods for quantitative analysis, while the results mostly revolve around posterior increase in alpha and beta frequency range. The qualitative variations, however, remain open to interpretation. Future research may benefit from multiplication of sub-specific studies leading to replication of more consistent results. The long-term and large-size epidemiologic studies, stratified by age and gender, may also improve the expected outcomes. Regarding the interpretation, non-linear methods could be employed for assessment of individual variations. The emphasis should be placed on theories/measures for better understanding of the subtle interplay between the spectral individualities and mobile phone radiation specifics.

Keywords

  • Mobile phones
  • electromagnetic fields
  • pulse-modulated and continuous-wave signal
  • human wake resting electroencephalogram
Open Access

Some Psychological Aspects of T1DM in Children and Adolescents

Published Online: 14 Apr 2016
Page range: 113 - 118

Abstract

Abstract

Diabetes mellitus type 1 (T1DM) is a chronic disease with long term consequences dictating daily struggle to maintain a good metabolic control.

Children and adolescents with T1DM seem to have inferior psychological adjustment to their normal counterparts, which might be associated with glycemic control and disease duration.

The aim of this study is to evaluate the psychological characteristics of children and adolescents with T1DM treated last year in the University Children Hospital in Skopje, Macedonia and to propose some response measures. For psychological evaluation we used CBCL (Child Behavior Check List), GAS (General Anxiety Scale), EPQ (Eysenck Personality Questionnaire) and MMPI-201 (Minnesota Multiphasic Personality Inventory).

The results confirmed the following psychological characteristics: mild depression and anxiety, emotional instability, need for social acceptance, as well as the possible psychopathic traits. Suffering for a complex metabolic and chronic illness, these patients need psychological evaluation and intervention in the management.

Keywords

  • diabetes mellitus
  • children
  • adolescents
  • psychology
  • management
Open Access

Influence of Climate Changes on Health (Review)

Published Online: 14 Apr 2016
Page range: 119 - 125

Abstract

Abstract

Although climate changes are one of the most serious public health risks for all nations, it appears that the medical society in the East European countries is not too much concerned.

The aim of this paper is to point out the main treats on health provoked by climate changes.

The literature review was the source of information. Based on the PubMed where in 2015 more than 65,000 papers were dedicated to different aspects of the influence of the climate changes on the human health, as well as 3,500 articles for the pediatric population, we present a review of the main health risks. Especially, the impact of the climate changes on the children′s health is overviewed.

In separate parts, the thermal stress, extreme weather events, changes of infection′s pattern, how to measure health risks as well as some mitigation measures are discussed.

Keywords

  • climate changes
  • health risks
  • review
Open Access

Influence of the Ethnic Affiliation, Level of Education and Place of Living on Oral Health at Geriatric Population with Total and Partial Dentures in Republic of Macedonia

Published Online: 14 Apr 2016
Page range: 130 - 137

Abstract

Abstract

Introduction. Health is the main component of the quality of life, while oral health is component of the general health. The socio-demographic characteristics are one of the important factors for perception of the oral health and the quality of life. The main purpose of this study was to perform an evaluation of the quality of life of geriatric patients (older than 65) with built-in oral prosthetic dentures depending on the ethnic affiliation, level of education and place of living, as socio-demographic characteristics.

Materials and methods. The survey was a prospective transversal (cross-sectional) study conducted among 165 institutionally sheltered patients at the Gerontology Institute (inspected group - IG) and 170 patients from the dental specialist clinics (control group CG) at the age of 65 and older. The statistical program SPSS for Windows ver. 13.0 was used for statistical processing.

Results and discussion. Patients with upper and lower total dentures dominated (43.6% vs. 26.5%). The highest GOHAI score had the other ethnicities of IC (32.08) and Roma of IG (31.00), while the lowest was in the Albanians of CG (25.91). The highest value of 30.15 had the IG of patients living in urban areas.

Conclusion. The quality of life and oral health of the geriatric patients are at unsatisfactory level, with significant influence of the place of living and insignificant influence of the ethnic affiliation and level of education.

Keywords

  • GOHAI indicator
  • quality of life
  • ethnic
  • education
  • place of living
Open Access

Comparative Analysis of the Mechanical Properties between the Fiber-Reinforced Composite and Zirconium Posts

Published Online: 14 Apr 2016
Page range: 138 - 149

Abstract

Abstract

Objectives: To make a comparative analysis of the mechanical properties between FRC and zirconium posts

Methods: The patients with FRC and zirconium posts were divided in two groups with three subgroups, each of them composed of 10 samples. Subgroup I with 1.2 mm; Subgroup II with 1.35 mm and Subgroup III with 1.5 mm post diameter. The fracture force, bending and tensile strength of each group were measured with Shimadzu Universal Testing Machine.

Results: The fracture force for the first group measured in the first, second and third subgroup was 34.80900N; 67.15390N; 46.53100N and for the second group, first, second and third subgroup was 34.80900N; 46.53100N; 67.15390N correspondingly. The bending strength for the first group measured in the first, second and third subgroup was 401.4420N; 444.6425N; 333.6828N and for the second group, first, second and third subgroup was 307.9352N; 289.1030N; 304.1649N correspondingly. The tensile strength for the first group measured in the first, second and third subgroup was 5.442267N; 4.350545N; 2.943465N and for the second group, first, second and third subgroup was 4.224141N; 3.751466N; 3.168756N correspondingly.

Conclusions: The longest diameter of the posts significantly increases the resistance to fracture in relation to the two smaller diameters. The larger diameter, the higher values of the bending strength, as well as the lowest values of the tensile strength of the material contribute to improved mechanical properties of the fiber and zirconium posts.

Keywords

  • FRC posts
  • zirconium posts
  • fracture
  • strength
  • bending
  • elasticity
Open Access

First Case of Endovascular Treatment of Ruptured Internal Carotid Artery Aneurysm Using Stent Assisted Coiling at the Department of Neurosurgery in Skopje

Published Online: 14 Apr 2016
Page range: 150 - 153

Abstract

Abstract

The management of intracranial aneurysms has changed dramatically in recent years. The science and technology advancement have resulted in new therapeutic options for their treatment. There is an increased interest among neurosurgeons to perform endovascular procedures for intracranial aneurysms. This has become a part of the neurosurgical residency in the US. We are presenting our first experience of ruptured aneurysm coiling using stent assisted technique.

Keywords

  • ruptured cerebral aneurysm
  • stent assisted coiling
Open Access

4th Rare Disease South Eastern Europe (See) Meeting Skopje, Macedonia (November 14th, 2015)

Published Online: 14 Apr 2016
Page range: 154 - 159

Abstract

Abstract

The 4th meeting on rare diseases in South Eastern Europe (SEE) was held in Skopje, at the Macedonian Academy of Sciences and Arts (MASA) on the 14th of November 2015. The focuses were metabolic, rare brain diseases as well as the rare dysmorphic syndrome. The authors of the report are particularly keen on stating that one of the main goals of the meeting, namely to help the treatment of patients with rare disease has begun to bear fruits. The talk on an iminosugar-based pharmacological chaperone compound as a drug candidate for the treatment of GM1-gangliosidosis and mucopolysaccharidosis IVB (Morquio disease type B) was enlightening. To date, there is no treatment available to be offered to patients, but chaperones lead mutated proteins to adopt a native-like conformation and to successfully traffic to their normal cellular destination. DORPHAN is developing an iminosugar-based pharmacological chaperone compound for the treatment of GM1-gangliosidosis and mucopolysaccharidosis IVB.

A talk on recent developments in the laboratory diagnosis of mucopolysaccharidoses (MPS) was particularly interesting, covering the laboratory diagnosis of the MPS diseases by a strategy of clinical examination, biochemical analysis of urine samples, enzyme tests and genetic characterization of underlying mutations. New techniques were developed, including analysis of urinary glycosaminoglycans with tandem mass spectrometry, miniaturized enzyme tests or novel synthetic substrates for enzyme assays using mass spectrometry detection of products using dried blood spots. Feasibility and cost-effectiveness of these methods in newborn screening programs have been demonstrated.

Neuromuscular RDs, and especially familial amyloid polyneuropathy (FAP) were a topic of the Bulgarian colleagues. Diagnosis, screening and the role of microglia were also topics of particular interest. In summary, this year RD meeting was exciting and productive on a wide range of diseases and on a novel insights on diagnosis and treatment. New methods are expanding our capabilities for a fast and precise diagnosis. Novel knowledge offers better distinction on whom to treat with which medications (e.g. steroid dependent nephrotic syndrome). Novel diseases or variants are published (segmental overgrowth). The authors of the report are particularly keen on stating that one of the main goals of the meeting, namely to help the treatment of patients with rare disease has begun to bear fruits. Namely, the Health Fund of Macedonia for the first time treats the patients with Gaucher′s disease. We are hopeful that the number of patients treated for Gaucher′s disease and the number of treated patients with other treatable RDs diseases will continue to grow.

Keywords

  • Rare diseases
  • Macedonian Academy of Sciences and Arts
  • mucopolisaccharidoses
  • segmental overgrowth
  • steroid dependant nephrotic syndrome
  • neuromuscular RDs
  • familial amyloid polyneuropathy (FAP)
  • phenulcetonuria
  • Pompe
Open Access

5. Uro-Oncology Winter Congress

Published Online: 14 Apr 2016
Page range: 160 - 163

Abstract

Abstract

The 5th Uro-oncology Winter Congress was held in Skopje, at the Macedonian Academy of Sciences and Arts on January 30 - February 03, 2013. The Congress was co-organized by the Macedonian Academy of Sciences and Arts, the Istanbul University, the Turkish Urology Association, Macedonian Society of Urology and the Ministry of Health of the Republic of Macedonia. Topics of the Congress were tumors of urinary tract (kidney, vesica urinaria) and prostate. The latest achievements in the diagnosis and treatment of the above-mentioned disease were presented. Around 300 participants from the Balkans took part at the meeting. There were simultaneous sessions on different uro-oncological issues with around 60 presentations. In addition, there were poster presentations and training courses. It is important to point out that we had a session with participation of Balkan uro-oncologists - Balkan Urology Session, which is the first time in recent years.

Keywords

  • Uro-oncology
  • prostate
  • urinary tract
  • Balkan Urology Session

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