Academic Medical Journal https://amj.mk/index.php/amj <p>The <strong>Academic Medical Journal</strong> is published by the Faculty of Medicine, University Ss. Cyril and Methodius in Skopje as a peer-reviewed, open-access, international journal, issued twice a year.</p> Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia en-US Academic Medical Journal 2671-3853 METASTATIC EXTRAOSSEOUS ACCUMULATION OF 99MTC-MDP IN A PATIENT WITH GIANT CELL TUMOR OF THE HUMERUS – A CASE REPORT https://amj.mk/index.php/amj/article/view/217 <p> </p> <p><strong>Introduction</strong><strong>: </strong>Proposed mechanisms for extraosseous 99mTc - MDP uptake are extracellular fluid expansion, enhanced regional vascularity and permeability, and elevated tissue calcium concentration. It can be due to nonmalignant causes, such as parathyroid adenoma, vitamin D intoxication or Paget disease or can be of malignant origin. Malignant conditions are sometimes associated with a life-threatening hypercalcemia and metastatic calcifications.</p> <p><strong>Case report</strong><strong>: </strong>We report a case of a 50-year-old female complaining of back pain and pain in the right leg. CT and MRI scan of the thorax showed a soft tissue mass at the level of the proximal metadiaphysis of the left humerus, with osteolysis of the bone, as well as a penetration of the cortex in multiple spots. Giant cell tumor of the humerus was confirmed by core biopsy. Bone scan showed increased uptake of the tracer in facial bones and mandibula, in the head of the left humerus, both iliac bones and the right acetabulum. Also, extraosseous accumulation of the tracer was found in both lungs, in the heart, and in the stomach, consistent with metastatic calcifications. The patient was diagnosed with a multicentric giant cell tumor, and was treated with monoclonal antibody therapy with Denosumab for two months. Six months later, he passed away. There are many differential diagnoses regarding extraooseous tracer uptake on bone scintigraphy. Careful work-up is necessary because the treatment planning might be completely different once the etiology is elucidated.</p> Nevena Manevska Teodora Todorova Tanja Makazlieva Sinisa Stojanoski Milan Samardziski Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 60 66 REVERSED PROXIMAL HUMERUS INTERNAL LOCKING SYSTEM (PHILOS) PLATE TECHNIQUE AS ALTERNATIVE OSTEOSYNTHESIS METHOD IN THE MANAGEMENT OF BIFOCAL MIDDLE AND DISTAL THIRD DIAPHYSEAL HUMERUS FRACTURE https://amj.mk/index.php/amj/article/view/223 <p><strong>Introduction: </strong>Humeral shaft fractures account for 2% of all fractures in adults with approximately 30% of them being located in the distal third. AO OTA 12.C2 type(s) fractures are rare injuries usually caused from high-energy trauma. Stable and rigid osteosynthesis is suggested with consequent early mobilization and rehabilitation protocol thus outweighing the conservative treatment complication rates, particularly elbow contracture. Multiple implants, approaches and techniques have been published in the literature with reversed (upside-down) "Proximal Humerus Internal Locking System"(PHILOS) plate technique as a new and alternative osteosynthesis method, which is presented in this article.</p> <p><strong>Case report:</strong> A 37-year-old female patient was presented to our emergency department by the emergency medical services (EMS) after motor-vehicle collision (MVC) as unrestrained front passenger with right zygomatic arch, right maxillary, sphenoidal and ethmoidal sinus fractures, nasal bones fracture, bilateral lung contusions, open grade IIIA right patellar multifragmentary fracture as well as right bifocal middle and distal third diaphyseal humerus fractures. An urgent open reduction and internal fixation (ORIF) with cerclage wire technique of the open multifragmentary right patellar fracture grade IIIA according to Gustilo-Anderson classification was done, followed by ORIF of the right bifocal middle and distal third diaphyseal humerus fracture using reversed (upside-down) "Proximal Humerus Internal Locking System" (PHILOS) plate technique. </p> <p><strong>Conclusion: </strong>The reversed PHILOS plate technique in the management of middle and distal humeral extra-articular diaphyseal fractures is feasible and should be further investigated.</p> Dimitar Petrevski Antonio Andonovski Iljasa Veseli Andrijan Arapinovski Simon Trpeski Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 67 71 UNCOMMON BILATERAL TRICEPS TENDON TEAR https://amj.mk/index.php/amj/article/view/69 <p>Triceps tendon tear is one of the least commonly recognized major tendon traumatic tears. A bilateral triceps tendon tear is an especially rare and uncommon entity. In this paper, we present the case of a 42-year-old man, with a suspect history of anabolic steroid use, presented to an urgent surgery facility at the day of injury. The pain was present after lifting weight (approximately 210 kg). On physical examination, mild tenderness and a palpable defect over each olecranon was present. He had almost full strength on extension; however, he complained of weakness and pain in both arms, especially on the medial part of the distal triceps tendon. We excluded first a possible fracture of the bones, after making an X-ray of the injured areas. After making an ultrasound on both triceps' tendons, we admitted the patient to the hospital. At the left triceps tendon, we revealed partial rupture of the medial head of the triceps muscle. At the right triceps tendon, the rupture was complete. A subsequent fat-saturated proton-density-weighted MRI of the right confirmed the diagnosis, with extensive oedema and surrounding hemorrhage. Surgery on the right triceps tendon was then performed.</p> Maja Nedelkovska Aleksandar Saveski Aleksandar Trajanovski Bojan Budic Eren Sejfula Kornelija Gjorgjieska Simon Trpeski Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 72 74 PREPAPILLARY VASCULAR LOOP IN A GIRL WITH VENTRICULAR SEPTAL DEFECT – CASE REPORT https://amj.mk/index.php/amj/article/view/239 <p>A prepapillary vascular loop is a congenital variant of normal retinal vessels that is present on and/or around the optic disc. It is a rare vascular entity, with a prevalence of 1:2000 to 1:9000 eyes.</p> <p>The aim of this paper was to describe a case of a 10-year-old girl in whom a unilateral prepapillary vascular loop was observed during a routine ophthalmological examination. Because of the anamnestic data of congenital heart anomaly, we performed a literature search of data available in several major medically relevant databases, but we did not come across another case where correlation of these two conditions was made. Considering that, this is the first case, known to us, where the following are present in the same patient: prepapillary vascular loop, eyelid ptosis and ventricular septal defect. A larger number of such patients is needed to draw a conclusion whether it is a systemic syndrome or a coincidental simultaneous presentation of multiple entities in the same patient.</p> Igor Isjanovski Stefan Pandilov Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 75 79 THE ROLE OF ULTRASOUND-GUIDED POPLITEAL NERVE BLOCK IN OPIOID-FREE ANESTHESIA FOR AN OSTEOSYNTHESIS MATERIAL EXTRACTION AFTER BILATERAL CALCANEAL FRACTURE https://amj.mk/index.php/amj/article/view/220 <p>Peripheral nerve blocks (PNBs) for intraoperative and perioperative pain management are often part of the anesthetic plan for foot and ankle surgery. Usage of peripheral nerve blocks may limit occurrence of general anesthesia related complications by decreasing the amount of intraoperative anesthetic medications usage. Decreased postoperative opioids use and earlier time to discharge were encountered when peripheral nerve blocks were used. This case presentation is about a 38-year-old male patient with bilateral calcaneal OSM extraction and left calcaneal osteotomy, who refused spinal anesthesia, as well as refused to be awake during the procedure. Avoiding opioids was possible with usage of bilateral ultrasound-guided popliteal nerve block with 10 ml of 2% Lidocaine on each side. The purpose of this case report is to present the role of PNBs in intraoperative and postoperative decrease of opioids usage, as well as the absolute hemodynamic stability met during the procedure and pain-free extubated and awakened patient.</p> Marina Chavkoska Filip Naumovski Marija Cvetkovа Mladenovska Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 80 83 CIRCULATING OXIDIZED LOW-DENSITY LIPOPROTEIN LEVELS IN AN EARLY STAGE OF ACUTE ISCHEMIC STROKE https://amj.mk/index.php/amj/article/view/240 <p><strong>Introduction:</strong> Atherosclerosis remains the most common cause of coronary artery disease (CAD) and cerebral or peripheral artery disease. At present, lipid peroxidation is considered one of the basic mechanisms involved in the initiation and progression of many diseases. An oxidative stress resulting in lipid peroxidation and protein modification is involved in the pathogenesis of atherosclerosis and cardiovascular diseases.</p> <p><strong>Aim:</strong> The primary aim of this study was to determine the circulating levels of oxidized low-density lipoprotein (ox-LDL) in patients with acute stages of ischemic stroke. The secondary aim was to evaluate if there was an association between ox-LDL concentration and conventional lipid risk factors for cardiovascular diseases (CVD).</p> <p><strong>Material and methods:</strong> Seventy-five patients with acute ischemic stroke (AIS) and ninety control subjects without cardiovascular risk factors were included in the study. Total cholesterol, triglycerides, HDL-cholesterol, and LDL-cholesterol were measured in patients as well as in control subjects by enzymatic methods on Roche C311 Cobas Analyzer. Ox-LDL was measured by the sandwich ELISA technique.</p> <p><strong>Results: </strong>There was no significant difference in BMI, total cholesterol, triglycerides, HDL-c, and LDL-c between the two groups. There was a significant difference between patients with AIS and the control group regarding ox-LDL concentrations (p=0.03). We did not find any significant correlation between plasma ox-LDL concentration and lipid parameters.</p> <p><strong>Conclusions:</strong> Levels of circulating ox-LDL were elevated in patients with acute ischemic stroke. Ox-LDL levels were not statistically correlated with major lipid risk factors for CVD. Therefore, ox-LDL levels may represent a novel risk marker of CVD. </p> Katerina Tosheska Trajkovska Melda Emin Hristina Ampova Coskun Kerala Irena Kostovska Sonja Topuzovska Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 1 7 EARLY CHANGES IN LEFT-VENTRICULAR EJECTION FRACTION AND LONGITUDINAL DEFORMATION IN PATIENTS WITH BREAST CANCER AT ANTHRACYCLINE CONTAINING REGIMENS https://amj.mk/index.php/amj/article/view/232 <p><strong>Background:</strong> Anthracyclines (ATs) are the most frequent used anti-cancer drugs in breast cancer (BC) patients. Certain demographic parameters and risk factors are closely linked to anthracycline-induced cardiotoxicity manifestation as the most feared adverse effect. </p> <p><strong>Aims: </strong>The study aimed to assess the differences in selected echocardiographic parameters related to LV systolic function including longitudinal strain (LS%) according to cardiovascular (CV) risk factors and demographic characteristics and their relations in BC patients treated with ATs.</p> <p><strong>Methods</strong><strong>:</strong> Thirty patients with newly diagnosed BC scheduled to receive ATs were examined. The following demographic parameters and risk factors were evaluated: age, body mass index, obesity, hypertension, diabetes, physical activity and total AT dose. The echocardiographic evaluation consisted of parameters for LV systolic function estimation, including LV ejection fraction (LVEF%) and LS%. Statistical analysis was done with the SPSS, v.25.0.</p> <p><strong>Results:</strong> LVEF%, GLS%, and LS% in two/four chamber view (A4c/A2c) statistically significantly decreased at the control evaluation (p=0.036, p=0,002, p=0,031, p=0,019). Correlation between the differences in LVEF% between two visits showed a significant relation with the absence of physical activity (p=0,029), while a significant correlation of the LS% decrease was also found in A4c view with diabetes (p=0.024).</p> <p><strong>Conclusion:</strong> ATs initiate frequent echocardiography changes in BC patients. Close monitoring and regular surveillance ensure early diagnosis of serious cardiotoxic complications. Cancer therapy-related cardiac dysfunction (CTRCD) is a broad spectrum of possible presentations, and serial LVEF% and LS% measurement are ideal tools to identify the disease in early, asymptomatic stage and guide further therapeutic strategies.</p> Irena Gigovska Dimova Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 8 18 BNT162b2 VACCINE ANTIBODY RESPONSE USING THREE ANTIBODY ASSAYS https://amj.mk/index.php/amj/article/view/219 <p><strong>Aim:</strong> The aim of our study was to compare the durability of BNT162b2 antibody response between male and female healthcare workers (HCWs), before vaccination and at 3, 9 and 12 months after administration of the second dose of the Pfizer/BioNTech BNT162b2 vaccine, using three antibody assays: Maglumi® SARS-CoV-2 Neutralizing Antibody (CLIA), Maglumi® SARS-CoV-2 S-RBD IgG (CLIA) and VIDAS® SARS-CoV-2 IgG (ELFA).</p> <p><strong>Material and methods:</strong> This study included 200 HCWs and the gender structure of the participants consisted of 41% males and 59% females. We utilized blood samples collected from HCWs who had not previously been infected with SARS-CoV-2. All procedures strictly followed the manufacturer's instructions.</p> <p><strong>Results:</strong> Male and female HCWs had similar serum anti-S-RBD IgG concentrations before vaccination. Our findings showed the highest concentration of antibodies three months after vaccination in both genders, where females had non-significantly higher serum anti-S-RBD IgG antibodies with all three methods. Nine months after vaccination, females had significantly lower serum anti-S-RBD IgG measured with Maglumi Neutralizing Antibody (median 161 <em>vs</em>. 167 BAU/mL, p=0.017). However, at this time point, the difference between males and females was statistically insignificant regarding the serum values of anti-S-RBD IgG measured with Maglumi RBD (median 171.54 <em>vs.</em> 165.22 BAU/mL, p=0.38) and VIDAS RBD (68.16 <em>vs</em>. 103.3 BAU/mL, p=0.75). The level of anti-spike-RBD antibodies significantly decreased during 12 months after vaccination in males and females, (p&lt;0.0001) determined by all three methods.</p> <p><strong>Conclusion:</strong> Our results demonstrated that there were no significant differences in SARS-CoV-2 IgG antibody concentrations between male and female HCWs.</p> Valdrina Ajeti Emin Melda Katerina Tosheska-Trajkovska Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 19 29 HUMAN PAPILLOMA VIRUS INFECTIONS, VIRAL LOAD AND AGE IN WOMEN WITH CERVICAL CANCER https://amj.mk/index.php/amj/article/view/235 <p><strong>Introduction:</strong> Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of preinvasive and invasive cervical lesions. The study aimed to investigate associations between HPV infections, age, HPV DNA viral load, and cytological abnormalities.</p> <p><strong>Material and methods:</strong> A total of 300 women, aged 18-65, were enrolled in this study as part of a primary cervical cancer screening program, from February 1<sup>st</sup> 2019 to August 30<sup>th</sup> 2023. Participants were referred to the Microbiological Laboratory of the Bitola Public Health Center for HPV genotyping, conducted concurrently with the Pap test. Specimens for HPV genotyping were collected by cervical canal scraping. DNA extraction used the genomic DNA Kit by Life-Technology. HPV genotypes and viral DNA concentration were determined using the HPV Quantitative Real-time PCR Kit, DTlite, Russia.</p> <p><strong>Results:</strong> Participants were categorized into a control group, 97 patients with normal Pap tests, and a study group (119 with low-risk cervical lesions - non-hrCL, and 87 with high-risk cervical lesions - hr-CL). HPV infections exhibited a bimodal distribution, with peaks in women aged 18-34 and 55-64. MT-HPV infection correlated with a higher proportion of hr-CL (54.76%) compared to non-hrCL (41.18%) and normal findings (31.96%). Viral loads for specific HPV types increased linearly with worsening cervical lesions, except for HPV-18, -45, -56, and -59, which exhibited a decrease in viral loads.</p> <p><strong>Conclusion:</strong> Associations between type-specific viral load and cervical pathology severity underscore the significance of enhanced measures for treating and monitoring patients infected with high-risk HPV, particularly those with MT-HPV infections and high viral loads.</p> Elena Krstevska-Kelepurovska Ana Kaftandzieva Jasmina Nikolovska Angela Delova Emilija Jasovic-Siveska Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 30 40 ANTIBIOTICS: CURE AND RISK FACTOR FOR CLOSTRIDIOIDES DIFFICILE INFECTION https://amj.mk/index.php/amj/article/view/227 <p><strong>Introduction: </strong>The major risk factor for acquiring an infection with <em>Clostridioides difficile</em> (CDI) is a long-term antibiotic treatment. Contrarily, the treatment of severe CDI cases involves application of antibiotics like vancomycin or metronidazole. Our aim was to investigate the percentage of resistance to eight antibiotics (vancomycin, metronidazole, tetracycline, clindamycin, erythromycin, imipenem, ciprofloxacin and moxifloxacin) among <em>Clostridioides difficile </em>isolates, indirectly evaluating the risks of acquiring CDI and the risks of therapeutic failure.</p> <p><strong>Materials and methods:</strong> Eighty isolates of <em>Clostridioides difficile, </em>collected from fecal samples from as many patients during a four-year period, were subject to PCR ribotyping and to antibiotic susceptibility testing by using the E test.</p> <p><strong>Results:</strong> Ribotyping of the 80 isolates of <em>C. difficile</em> showed that they belonged to 20 different ribotypes. The most common one was 001/072, with 40% of the isolates. All 80 of <em>C. difficile</em> isolates in this study showed a good sensitivity towards vancomycin and metronidazole. Resistance percentages towards tetracycline, clindamycin, erythromycin, imipenem, ciprofloxacin and moxifloxacin were 1.25%, 49%, 55%, 57%, 100% and 45%, respectively. The highest antimicrobial resistance percentages were detected in isolates taken from patients hospitalized in surgical clinics and in isolates belonging to the dominant ribotype 001/072 and hypervirulent ribotypes 017 and 027.</p> <p><strong>Conclusions:</strong> Vancomycin and metronidazole should remain the first option therapy for CDI. Therapy with clindamycin, erythromycin, imipenem, ciprofloxacin and moxifloxacin could be a risk factor for CDI. Excessive use of a particular antibiotic plays a major role in selecting and multiplying resistant clones of <em>Clostridioides</em><em> difficile </em>strains.</p> Kiril Mihajlov Elena Trajkovska Dokic Liljana Labachevska Gjatovska Marko Kostovski Radomir Jovchevski Danica Kovacheva-Trpkovska Ivana Ignjatovikj Mihajlova Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 41 47 PERCEIVED PARENTING STYLE AND PERFECTIONISM IN EARLY AND MIDDLE ADULTHOOD https://amj.mk/index.php/amj/article/view/238 <p>The family lays the foundations of the personality and shapes the children from a biological to a social being, and accordingly, the children form their personality. The aim of this study was to test the association of perceived parenting styles with perfectionism in individuals in early and middle adulthood, as well as the association between individual perceived parenting styles and perfectionism subscales and differences between them. The study was conducted on 100 respondents, and a positive relationship was determined between the perceived authoritarian and permissive parenting style and perfectionism, as well as a negative relationship between the authoritative parenting style and perfectionism.</p> Andromahi Naumovska Viktor Isjanovski Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 48 52 MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS OF THE DISTAL TIBIA - COMPARISON OF TWO DIFFERENT IMPLANTS https://amj.mk/index.php/amj/article/view/230 <p class="BodyA" style="margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt; line-height: normal;">Minimally invasive percutaneous locking plate osteosynthesis (MIPLPO) enables widening of indication area for using locking plates in the distal tibia region. Timing of surgery, appearance of deformity on X-ray, postoperative pain and the loss of range of motion were analyzed between two groups of patients. Preliminary results showed statistically significant advantage in shortening the operative time, appearance of deformity on X-ray, as well as improving the range of motion in patients treated with MIPLPO technique. Patients treated with MIPLPO technique showed statistically significantly better results compared to those treated with MIPPO technique.</p> Nebojsha Nastov Krsto Nikolikj Darko Dimitrovski Simon Trpevski Copyright (c) 2024 Academic Medical Journal 2024-04-22 2024-04-22 4 1 53 59