- Journal Details
- First Published
- 08 Sep 2014
- Publication timeframe
- 2 times per year
- Open Access
Centenary of the Birth of Academician Prof. Dr. Isak Tadzer, Founder of the Pathophysiology and Nuclear Medicine in Macedonia
Page range: 9 - 17
Academician Prof. Dr. Isak Tadzer was born a hundred years ago on December 24, 1916 in Sofia. He completed the primary and secondary education at the German College in Sofia. In 1935 he began his studies at the Medical Faculty in Vienna, which he had to stop because of the annexation of Austria to Germany in 1938. He returned to Bulgaria where he continued his studies and graduated from the Medical Faculty in Sofia in 1941. During the War, 1941-1944, he was forcedly mobilized and he worked as a doctor in several villages. He was twice interned in camps in Bulgaria. In 1944 he joined the National Liberation Army and the Partisan Groups of Yugoslavia. After the liberation in 1945 he started specialization in internal medicine at the famous clinic of Prof. Chilov in Sofia. In 1946 he applied to the call by the Yugoslav government to the doctors in Bulgaria to come in aid of temporary work in our country. On the advice of the current Federal Minister of Public Health Dr. Dimitar Nestorov, Dr. Tadzer came to Skopje and was assigned to work in the Country hospital. He started specialization in internal medicine at the famous professor Ignjatovski, he established a family and decided to stay in Skopje. In 1949 Prof. Tadzer ended his specialization and he was elected an Assistant at the Department of Internal Medicine.
In 1951 he left the Internal Clinic and he was elected an Assistant, and in 1952 he was elected a Docent in the subject of Pathological Physiology. In 1959 he was elected, and in 1964 he was re-elected as an Associate Professor, and in 1967 he was elected a Professor of pathophysiology at the Medical Faculty in Skopje. In the period from 1952 to 1978 he was Head of the Department and Director of the Institute of Pathophysiology.
He was elected a Corresponding Member of the Macedonian Academy of Sciences and Arts in 1969, and a Full Member in 1974. In the period from 1984 to 1988 he was a Secretary of the Department of Medicine and Biology of the Academy.
Prof. Tadzer has published over 300 scientific papers in the field of clinical medicine and pathological physiology, of which about 200 in journals in English, French, German and Serbo-Croatian, as well as 15 books, which include him among the most prolific pathophysiologists on the territory of former Yugoslavia and beyond. In the period from 1950 to 1966 several times he was on a vocational training in similar institutions and centers in Europe, and in 1972 he was on a study stay at many nuclear and medical laboratories in the USA.
In addition to his great research activities his contribution as a teacher was of substantial influence and importance to the faculty. He was one of the greatest lectures at the Medical Faculty, the Faculty of Stomatology and the Pharmaceutical Faculty.
Prof. Tadzer co-authored in most of the textbooks on pathophysiology for students of medicine, stomatology and pharmacy. He was an extraordinary physician, one of the pillars of the Macedonian medicine, he possessed universal, encyclopedic knowledge and is one of the most renowned medical workers in the second half of the 20th century in Macedonia.
In addition to the scientific, medical and educational work Prof. Tadzer has especially rich social activity. He was President of the Faculty Council in 1975-76, he was Vice Dean of the Medical Faculty in 1958-60, Dean of the Faculty from 1963 to 1965, Dean of the Pharmaceutical Faculty and Vice Rector of the University from 1965 to 1967. Especially it should be noted his long-lasting activity at the Macedonian Medical Association of more than 50 years. Also, significant is his creative work within the Editorial board of the journal “Macedonian Medical Review”, where for more than 15 years he was Editor in Chief or member of the Editorial board.
For his complete activity Prof. Tadzer has won numerous diplomas, plaques and awards, and among them the following are emphasized: National Award of October 11, Order of Labor of Second Degree, the Award of the City of Skopje – November 13, the Charter of Dr. Trifun Panovski and the Certificate of Acknowledgement awarded by the Macedonian Medical Association for the outstanding results in advancing the medical science, practice and development of the health care and the long-term contribution and promotion of the MMA.
- nuclear medicine
- Medical Faculty in Skopje
- Open Access
Fibroblast Growth Factor-23: A Novel Biomarker for Cardiovascular Disease in Chronic Kidney Disease Patients
Page range: 19 - 27
Fibroblast Growth Factor (FGF)-23 increase is considered one of the earliest biochemical abnormalities in chronic kidney disease-mineral bone disorder (CKD–MBD). Furthermore, accumulating data have provided evidence of a link between increased FGF-23 levels and cardiovascular morbidity and mortality in CKD patients as well as in several other populations including cardiology patients and general population. The cellular and molecular mechanisms underlying the deleterious effect of FGF-23 on the cardiovascular system are not yet completely defined and are the focus of intense research. However, animal and human studies have demonstrated important actions of FGF-23 in the heart and vessels through which could promote the development of cardiovascular complications in uremia. Moreover, significant interactions have been reported between FGF-23 and other well recognized cardiovascular risk factors such as renin-angiotensin system and inflammation which could account, at least in part, for the observed associations between FGF-23 and adverse clinical outcomes. Further studies are needed to clarify the mechanisms responsible for the pleiotropic actions of FGF-23 and moreover to identify whether it is a modifiable risk factor and a potential target of therapeutic interventions which could probably help to reduce the unacceptably high cardiovascular morbidity and mortality of CKD patients.
- Fibroblast Growth Factor-23
- chronic kidney disease
- Open Access
Page range: 29 - 33
There are two points of interplay of chronic kidney (CKD) and peripheral arterial disease (PAD): CKD has been recognized as one of the main factors for presence of PAD, and PAD has been defined as a useful tool for risk stratification of CKD population.
Peripheral arterial disease in patients with CKD is a frequent finding, even in those without symptoms.
This review tends to describe determinants for occurrence of arterial disease in chronic kidney disease patients and necessity for its screening.
- peripheral arterial disease
- chronic kidney disease
- risk factors
- Open Access
Prevalence of Depression, Anxiety and Insomnia in Chronic Kidney Disease Patients and their Co-Relation with the Demographic Variables
Page range: 35 - 44
- Chronic kidney disease
- Open Access
Page range: 45 - 53
Anorexia nervosa is a disorder of feeding behavior associated with distortion of body image, mood disturbance and a wide variety of hormonal and metabolic abnormalities. It is supposed that the disease could be the consequence of a combination of cultural-social, psychological and biological factors.
Our study confirmed that anorexia mentalis is a serious, life threatening disorder which in our country appears earlier than it was expected and that is strongly related to environmental factors (family, school, fashion, society).
We showed that specific personality traits are characteristic for both, young patients and mothers. Sublimation of emotional stress by exceptional performances, accompanied by food restrictive consumption together with hypersensitivity, oppositional behavior and aggression are specific for this disorder. High levels of self-imposed standards increase the risk for psychological distress, especially for eating disorder symptomatology.
Both genders could be involved as patients. Boys must be especially followed for possible psychiatric manifestation.
We confirmed that the biofeedback as additional therapeutic modality is very useful.
- mental disorder
- Open Access
Normal Values of Tissue-Muscle Perfusion Indexes of Lower Limbs Obtained with a Scintigraphic Method
Page range: 55 - 61
Muscle perfusion is a physiologic process that can undergo quantitative assessment and thus define the range of normal values of perfusion indexes and perfusion reserve. The investigation of the microcirculation has a crucial role in determining the muscle perfusion.
The study included 30 examinees, 24–74 years of age, without a history of confirmed peripheral artery disease and all had normal findings on Doppler ultrasonography and pedo-brachial index of lower extremity (PBI).
99mTc-MIBI tissue muscle perfusion scintigraphy of lower limbs evaluates tissue perfusion in resting condition “rest study” and after workload “stress study”, through quantitative parameters: Inter-extremity index (for both studies), left thigh/right thigh (LT/RT) left calf/right calf (LC/RC) and perfusion reserve (PR) for both thighs and calves.
In our investigated group we assessed the normal values of quantitative parameters of perfusion indexes. Indexes ranged for LT/RT in rest study 0.91-1.05, in stress study 0.92-1.04. LC/RC in rest 0.93-1.07 and in stress study 0.93-1.09. The examinees older than 50 years had insignificantly lower perfusion reserve of these parameters compared with those younger than 50, LC (p=0.98), and RC (p=0.6).
This non-invasive scintigraphic method allows in individuals without peripheral artery disease to determine the range of normal values of muscle perfusion at rest and stress condition and to clinically implement them in evaluation of patients with peripheral artery disease for differentiating patients with normal from those with impaired lower limbs circulation.
- muscle perfusion
- 99mTc-MIBI scintigraphy
- lower limbs
- perfusion reserve
- Open Access
Page range: 63 - 68
The increased use of antibiotics for acute tonsillitis is a public health problem. 80% of the antibiotic prescriptions for acute tonsillitis are done in the Primary Care practice (PCP). The inappropriate use of the antibiotic causes bacterial resistance and treatment failure. Only patients with acute tonsillitis caused by Group A beta-hemolytic streptococcus (GAS) have benefit of the antibiotic treatment, which is a predict cause in 5-20%. In order to assess the antibiotic prescribing for acute tonsillitis by the doctors in the PCP in Macedonia we use the data from the national project about antibiotic prescribing for acute respiratory tract infections which was conducted in November 2014 during a period of 4 weeks as part of the E-quality program sponsored by the IPCRG. 86 general practitioners from Macedonia have participated. The group of 1768 patients, from 4 months to 88 years of age, with diagnosis of acute tonsillitis was analyzed. The antibiotic prescriptions according to the Centor score criteria were compared to the Cochran’s guidelines which are translated and recommended as national guidelines. 88.8% of the patients with acute tonsillitis were treated with antibiotics, of which 52.9% with Centor score 0 to 2 were treated inappropriate. The diagnosis is mostly made based on the clinical picture and the symptoms. Only (23.6%) of the patients were treated with antibiotics (Penicillin V and cephalexin) according to the guidelines.
We concluded that there is a low adherence to the national guidelines. The clinical assessment is not accurate in determining the etiology. Also, there is a high nonadherence in prescribing the first choice of antibiotics. We emphasize the need to change the general practitioners’ prescription behavior according to the guidelines.
- Centor score
- acute tonsillitis
- irrational antibiotic prescribing
- antibiotic prescribing
- Open Access
Page range: 69 - 78
- acute myocardial infarction PCI
- Open Access
Page range: 79 - 84
241 mothers (32.61%) have had an infection during pregnancy, 82 preeclampsia or eclampsia (11.09%), 20 diabetes mellitus (2.70%), 78 placental situations (placenta previa, abruption) (10.55%). In this study 47 babies (6.35%) with HG and co-morbidities died.
There was a significant positive correlation between HG birth weight (p<0.01), gestational age (p<0.05), and the lowest Apgar score (p<0.01). Neonatal deaths were significantly correlated with GA (р>0,01), co-morbidities of the mothers (р>0,05) but not with the birth weight (р>0,05). In contrast, a significant positive correlation was found between convulsions and body weight (р<0.05). The lowest Apgar score was positively correlated with the gestational age (0.01), but not with the birth weight (0.05).
- neonatal hypoglycaemia
- Open Access
The Importance of Perioperative Prophylaxis with Cefuroxime or Ceftriaxone in the Surgical Site Infections Prevention after Cranial and Spinal Neurosurgical Procedures
Page range: 85 - 97
Surgical site infections pose a significant problem in the treatment of neurosurgical procedures, regardless of the application of perioperative prophylaxis with systemic antibiotics. The infection rate in these procedures ranges from less than 1% to above 15%. Different antibiotics and administration regimes have been used in the perioperative prophylaxis so far, and there are numerous comparative studies regarding their efficiency, however, it is generally indicated that the choice thereof should be based on information and local specifics connected to the most probable bacterial causers, which would possibly contaminate the surgical site and cause infection, and moreover, the mandatory compliance with the principles of providing adequate concentration of the drug at the time of the anticipated contamination.
Comparing the protective effect of two perioperative prophylactic antibiotic regimes using cefuroxime (second generation cephalosporin) and ceftriaxone (third generation cephalosporin) in the prevention of postoperative surgical site infections after elective and urgent cranial and spinal neurosurgical procedures at the University Clinic for Neurosurgery in Skopje in the period of the first three months of 2016.
Prospective randomized comparative study.
Establishing the clinical outcome represented as prevalence of superficial and deep incision and organ/space postoperative surgical site infections.
We analyzed prospectively 40 patients who received parenteral antibiotic prophylaxis with two antibiotic regimes one hour before the routine neurosurgical cranial and spinal surgical procedures; the patients were randomized in two groups, according to the order of admission and participation in the study, alternately, non-selectively, those persons who fulfilled inclusion criteria were placed in one of the two programmed regimes with cefuroxime in the first, and cefotaxime in the second compared group. All relevant demographic and perioperative patient data were analyzed for both comparative groups, especially the factors known to cause disposition (predisposition) to infections. The prevalence of postoperative infections was evaluated as the primary outcome in both comparative groups, while the secondary outcome was the postoperative infection rate after cranial and spinal neurosurgical procedures at the Neurosurgical clinic in Skopje (having in consideration that so far no data have been published in this context), as well as the prevalence of the risk factors for occurrence of postoperative infections, pre-surgically in patients undergoing neurosurgical interventions locally in the Republic of Macedonia.
A total of three cases of postoperative infections were registered, two of which classified as superficial incisional, while one case organ/space infection – meningitis (elective intervention) without etiological confirmation. Both comparative groups were statistically similar, without any statistically significant differences in the basic demographic and perioperative characteristics, especially in relation to the incidence of the factors, which, regardless of the antibiotic prophylaxis, show predisposition to postoperative infections. All three cases with infections were registered in the group of persons who received prophylaxis with ceftriaxone preoperatively, with isolated etiological S. aureus agent (elective intervention) in one of them, and methicillin resistant staphylococcus aureus (MRSA) in another (urgent intervention) with superficial incisional SSI. There was no case of SSI in the group of patients who received cefuroxime before surgery.
Administration of parenteral antibiotics before surgery reduces the incidence of postoperative infections after neurosurgical procedures, especially in cases with increased risk factors for SSI, such as ACA score of ≥ 2/3, the duration of the surgical intervention ≥ 4 hours, contaminated wound and comorbidities. Perioperative antibiotic prophylaxis should be directed to better coverage of the S.aureus arrays.
- Surgical site infections
- Antibiotic prophylaxis
- Open Access
Page range: 99 - 105
Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery - decortications or thoracoplasty. Early recognition of the parapneumonic effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally invasive, is possible not to prograde the process and not to become empyema.
- pleural empyema
- thoracic drainage
- Open Access
Comparative Analysis of Ultrasound Guided Central Venous Catheterization Compared to Blind Catheterization
Page range: 107 - 114
Central venous catheterization is performed by the landmark method and ultrasound guided method. The purpose of the study was to compare the success, average number of attempts, average time to return of blood, and complication rate between the two methods.
This was a prospective study done in the Intensive Care Unit of the Acibadem Sistina Clinical Hospital, in Skopje. There were 400 patients in need of central venous catheter and they were prospectively randomized in two groups. The patients randomized in the examined-ultrasound group underwent real-time ultrasound-guided catheterization and the patients randomized in the control-landmark group were catheterized using the landmark method. Internal Jugular, Subclavian and Femoral vein were catheterized in both groups. The Overall success, success on the first attempt, time to the return of blood, number of attempts and complications at the moment of catheterization such as arterial puncture, pneumothorax and hematoma formation were the main outcome measures.
The catheterization using the landmark method was successful in 90.5% of patients, 60.5% of which during the first attempt. The cannulation using real-time ultrasound guidance was successful in 98% of patients with a first pass success of 77%. The complication rate with the landmark method was 14.5% versus 4% with real-time ultrasound guidance p<0.05(p=0.0008).
Real-time ultrasound guidance improves success, decreases number of attempts, decreases average time to the return of blood and reduces mechanical complications rate.
- central venous cauterization
- Open Access
Hemodynamic and Bispectral Changes During Pin Insertion in Craniotomy – Effect of Locally Infiltrated Bupivacaine
Page range: 115 - 121
- cranial pin
- local infiltrative anesthesia
- bispectral index
- Open Access
Page range: 123 - 129
An increasing tendency has recently emerged for the use of phytotherapeutic agents as alternative to commercial pharmacological agents for the treatment of benign prostate hyperplasia (BPH). The purpose of this study is to evaluate the effects of
The study was performed on 70 men aged 40 - 79 years (mean 60.58) with symptomatic BPH that were divided into a group of 40 patients treated with
The patients in the SRT group showed a statistically significant increment of the average MFR and AFR values and reduction of PV relative to the control group (
The mild improvements of the urine flow, prostate size and IPSS score during 12 months treatment with the
- benign prostate hyperplasia
- Open Access
Dimensional Stability and Accuracy of Silicone – Based Impression Materials Using Different Impression Techniques – A Literature Review
Page range: 131 - 138
A quality-made dental impression is a prerequisite for successful fixed-prosthodontic fabrication and is directly dependent on the dimensional stability, accuracy and flexibility of the elastomeric impression materials, as well as on the appropriately used impression techniques. The purpose of this paper is to provide a literature review of relevant scientific papers which discuss the use of various silicone impression materials, different impression techniques and to evaluate their impact on the dimensional stability and accuracy of the obtained impressions. Scientific papers and studies were selected according to the materials used, the sample size, impression technique, storage time, type of measurements and use of spacer for the period between 2002 and 2016. In the reviewed literature several factors that influence the dimensional stability and accuracy of silicone impression molds, including the choice of the type of viscosity, impression material thickness, impression technique, retention of the impression material on the tray, storage time before the casting, number of castings, hydrophilicity of the material, release of byproducts, contraction after polymerization, thermal contraction and incomplete elastic recovery were presented. The literature review confirmed the lack of standardization of methodologies applied in the research and their great diversity. All findings point to the superiority of the addition silicone compared to the condensation silicone.
- silicone impression material
- impression technique
- fixed partial dentures
- dimensional stability
- Open Access
Page range: 139 - 145
The authors present a rare case of giant mediastinal cyst which arises from the thymus gland, and goes down in both pleural spaces, especially in the right chest cavity where a dominant part of the cyst was present. The cyst was full with 2.5 liters of transparent fluid, and compressed surrounding structures – heart and both lungs, especially the right one which was partially collapsed.
The patient was a 52 years old woman, without any clinical symptoms. Accidentally, on the screened chest X-ray a shading in the distal third of the right chest was detected.
The case was well documented with a CT of the chest, and an indication for surgical treatment was made. The surgery was done successfully in general anesthesia according to the small right anterior thoracotomy from which a giant part of the cyst was mobilized, which was in the right pleural cavity, but, also, the thymus with the origin of the cyst in the anterior and superior mediastinum was completely removed. In the end, a part of the cyst which was in the left pleural cavity was removed.
- mediastinal cyst
- thymic cyst
- surgical treatment
- Open Access
Page range: 147 - 151
Bananas have enormous health benefits as a food for both animals and humans. They have been used as a complimentary medicine to treat pathological conditions since ancient times. Recently, there has been increased interest in the scientific validity of the beneficial effects of bananas in alleviating and treating disease conditions including, ulcers, infections, diabetes, diarrhea, colitis and blood pressure. Herein, we write on the potential therapeutic and functional benefits of certain species of bananas when consumed green as well as considering the properties of extracts from the non-fruit parts of the plant. We conclude that green bananas appear to deliver an array of health and therapeutic benefits
- Green banana
- Musa paradisiacal