Academic Medical Journal

EVALUATION OF BENEFITS FROM OZONE THERAPY IN PATIENTS WITH CHRONIC PERIODONTITIS

Emilija Stefanovska — 2023-12-27

Aim: The study evaluated the effects of subgingival application of ozonated olive oil as adjuvant therapy to classic non-surgical conservative periodontal treatment.

Material and methods: Sixty patients with moderate and advanced periodontal disease were divided into two groups: group 1, in which only conservative periodontal treatment (scaling and root planning) was applied, and group 2, in which, in addition to the conservative treatment, ozonated olive oil (Ozone Gold-Germany, GmbH, 80 mg) was also applied. The subgingival application of ozonated olive oil was performed right after the conservative treatment and also, on days 7, 14 and 21. Clinical parameters included DPI, IGI, GBI, CAL. BANA test was performed to detect the presence of the three anaerobic periopathogenic bacterial species (T. denticola, T. forsythia, P. gingivalis) in subgingival dental plaque. Clinical parameters and BANA test were recorded at the beginning, before starting conservative treatment and 1 month afterwards.

Results: The results indicated an improvement in all clinical parameters in both groups, with a statistical significance in the group in which ozonated olive oil was applied in addition to conservative periodontal treatment. The combined treatment showed a significantly greater success than the conservative one in terms of the presence of the three anaerobic periopathogenic bacterial species (T. denticola, T. forsythia, P. gingivalis).

Conclusion: Topical application of ozonated olive oil in addition to conservative periodontal treatment may serve as a potential atraumatic, promising antimicrobial agent in the non-surgical treatment of periodontal disease.

LIGASURE HEMORRHOIDECTOMY (LH) WITH “NEAR BASE“ TECHNIQUE

Senol Tahir — 2023-12-27

Aim: In this study we evaluated the use of Milligan-Morgan hemorrhoidectomy with LigaSure vessel sealing using “near base” techniques.

Materials and methods: Grades 3 and 4 hemorrhoidal nodules were operated with LigaSure (LH) by coagulation and cutting of the hemorrhoidal nodules at positions 5, 7 and 11 o’clock. Under anesthesia, the patient was placed in a modified lithotomy position. By using an anoscope and light retraction, a 5 mm "V" incision was made with a surgical scalpel at the border of the anal canal to the skin. The nodule was raised with a surgical instrument and the LigaSure was placed on the base of the nodule, coagulated and incised without additional suture sutures. Revision of hemostasis was made and vaseline gauze was placed without a stopper. A control of the wound was done within 24 hours. Subsequent check-ups were made on 7, 14 and 28 days.

Results: A total of 52 patients undergoing surgery were operated with LH. The average surgical intervention lasted 17.0+4.1 minutes. The average postoperative pain (Visual Analog score- 1-6) was 3. There was postoperative minor bleeding in 5.76% of patients that was resolved with conservative treatment, pruritus in 5.76%, flatus incontinence at one month in 7.69% of patients. No stenosis or incontinence were observed.

Conclusion: According to our results and the results from the comparative literature, LH is an effective and safe method in the surgical treatment of grades 3-4 hemorrhoidal nodules, and it should be used as a routine.

CORRELATION BETWEEN MICROVESSEL DENSITY AND MORPHOLOGICAL FEATURES IN SKIN SQUAMOUS CELL CARCINOMA

Ljubica Tasheva — 2023-12-27

Introduction: Abnormal angiogenesis is described in tumor growth and it facilitates its metastatic spread. Tumors with high angiogenic activity belong to the category of aggressive tumors with a poor prognosis for patients.

The aim of this study was to determine neovascularization at the invasive front of the tumor stroma in skin squamous cell carcinoma (SCC) in relation to the healthy skin and the ratio of blood vessel density in the skin SCC with a different depth of invasion and different degree of histological differentiation.

Materials and methods: The material consisted of surgical specimens obtained from 30 patients with skin SCC, who underwent surgery at the University Clinic for Plastic and Reconstructive Surgery and University Clinic for Maxillofacial Surgery. Samples were analyzed by standard paraffin technique stained by hematoxylin-eosin and immunohistochemically with antibodies against smooth muscle actin (SMA) and CD34.

Results: The difference found in the neovascularization density in neoplasms with different degree of differentiation (G1, G2, G3) was statistically significant. The differences in the depth of stromal invasion in skin SCC registered in neoplasms with different degree of histological differentiation (G) showed a statistical significance for G1, G2, G3. The density of neovascularization in skin SCC was in a positive correlation with the depth of invasion.

Conclusion: The increased vascularization at the invasive front of a neoplasm in SCC with deeper invasion and higher grade has pointed out to its possible role in neoplasm progression.

SALIVARY UREA AND pH OF NON-STIMULATED SALIVA IN CORRELATION WITH DENTAL CARIES INTENSITY

Meri Pavlevska — 2023-12-27

Aim: The aim of our study was to determine and compare hydrogen ions (pH) and urea in non-stimulated saliva in patients with varying caries intensity.

Material and methods: The study involved 109 subjects from both sexes, from 12 to 15 years of age, which were divided into 3 groups according to their caries intensity: group with very low and low caries intensity involving 31(28.44%) subjects, group with moderate caries intensity involving 30(27.52%) subjects, and group with high and very high caries intensity involving 48(44.04%) subjects. We took saliva samples from the subjects and analyzed the pH and urea concentrations, using the spectrophotometric method.

Results: The average concentration of salivary urea was highest in the subject group with very low and low caries intensity (9.13±3.8 mmol/L), followed by the group with moderate caries intensity (7.57±2.9 mmol/L) and the group with high and very high caries intensity (7.22±3.3 mmol/L). The post-hoc analysis for intergroup comparisons showed that this total significance was due to a significantly higher concentration of urea in the group with low and very low caries intensity as opposed to the group with high and very high caries intensity.

The caries intensity did not significantly affect the pH value of non-stimulated saliva.

Conclusion: The concentration of urea had significantly lower values in the subject group with high and very high caries intensity, compared to the subject group with very low and low caries intensity. During our study we recorded statistically significant differences among the study groups with different caries intensity.

COPING STYLES AND MENTAL HEALTH IN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC

Ivo Kunovski — 2023-12-27

Introduction: There is limited research on the factors influencing mental health of healthcare workers during the COVID-19 pandemic. Studies show that coping styles variably influence the severity of mental health symptoms. However, no data is available on the effects of coping styles on mental health of healthcare workers in North Macedonia and the wider region of Southeast Europe.

Materials and methods: A cross-sectional web-based study was conducted with 342 participants during the early period of the COVID-19 pandemic. Participants provided sociodemographic data and were assessed in regard to coping styles, and symptoms of depression, anxiety and stress. Associations between the variables were examined using nonparametric tests, and their additive effects were tested using generalized linear models.

Results: Identifying as a woman, single, and of younger age was associated with higher levels of mental health symptoms. The coping styles that contributed to poor mental health outcomes included the use of active coping, instrumental support, substance use, venting, behavioral disengagement, self-blame, and the low use of emotional support and humor.

Conclusion: The findings help identify vulnerable populations, and add to the growing research on gender differences in the impact of COVID-19 on healthcare workers. The study may help in the development of mental health prevention programs for populations at risk during health crises.

CORRELATION BETWEEN QUALITY OF LIFE AND DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH VITILIGO IN NORTH MACEDONIA

Natasa Teovska Mitrevska — 2023-12-27

Many skin conditions affect patients in a multidimensional way, ranging from emotional to social interaction, symptoms, and functional impairment.

Aim: The aim of the study was to measure the QL of patients with vitiligo, expressed through the Dermatological Quality of Life Index (DLQI), as well as the correlation between, disease activity and demographic characteristics.

Materials and methods: This cross-sectional study was realized in a period of 1 year. Two questionnaires were used in the study: the first questionnaire contains data from the DLQI, which measures the QL. The second contains demographic characteristics of patients (age, gender, place of residence, marital status, education), disease activity, comorbid diseases, and size of BSA. DLQI was used for comparison of patients with newly diagnosed vitiligo and also, a comparison was made in terms of disease spread and stability. Data analysis was performed using the Statistica 7.1 for Windows and SPSS Statistics 23.0.

Results: Among 70 subjects included in the study, the total score for the DLQI ranged from 0 to 28 and the average was 11.70±5.7. The QL was significantly worse in the studied group of 16-30 years (13.85±5.3) compared to the population of 51-60 and over 60 years (6.75±5.7, and 7.0±2.3) in terms of daily activities and leisure activities and treatment. As the age of patients with vitiligo advanced, the QL improved. Subjects with higher education had a higher DIQS score (14.41±6.6; p=0.001).

DETECTION OF LYNCH SYNDROME IN ENDOMETRIAL CANCER PATIENTS

Katerina Kubelka Sabit — 2023-12-27

Lynch syndrome (LS) is an autosomal dominant inherited disease defined by germline mutations in mismatch repair (MMR) genes, leading to a defective DNA MMR system. Patients with LS have predisposition to a spectrum of cancers, primarily colorectal cancer, but LS-associated endometrial cancer (LS-EC) is the most common extraintestinal cancer and occurs in 2% of LS patients. The most frequently mutated MMR genes are MLH1, MSH2, MSH6 and PMS2. Clinico-pathologic features of LS-EC are: early age of onset, lower body mass index, endometrioid type of carcinoma and lower uterine segment involvement.

Recent studies support LS screening in every EC patient since MMR status is also part of the molecular subclassification of endometrial cancers. Screening methods include traditional clinical criteria and molecular techniques, such as MMR-immunohistochemistry (MMR-IHC), microsatellite instability (MSI) testing, MLH1promoter methylation testing and gene sequencing. MSI can also be detected in sporadic tumors, through epigenetic events inactivating the MMR system.

Patients with diagnosed LS and their affected relatives should be closely monitored in order to prevent the development of other types of cancer. Patients with advanced recurrent microsatellite instability-high (MSI-H)/mismatch repair-deficient (dMMR) endometrial cancer can also benefit from immunotherapy.

We describe our 3-year experience in screening of Lynch syndrome in EC patients.

SERTOLI-LEYDIG CELL TUMOR OF THE OVARY AS AN INCIDENTAL FINDING IN A PATIENT UNDERGOING HYSTERECTOMY DUE TO RECURRENT ABNORMAL UTERINE BLEEDING

Sasho Stojchevski — 2023-12-27

Sertoli-Leydig cell tumor (SLCT) of the ovary is a rare neoplasm that accounts for only 0.5% of all primary ovarian neoplasms. Clinical and histopathological presentations of the tumor are different, which makes diagnosis and treatment difficult. We present a case of a 67-year-old female patient, who presented at the University Clinic for Gynecology and Obstetrics with abnormal uterine bleeding. Explorative curettage was performed for the second time after 1 year, with a histopathological finding of endometrial hyperplasia. The patient underwent an excision of a lung tumor 2 years ago, with a histopathological finding of synovial sarcoma of the lungs, after which she received adjuvant chemotherapy. On transvaginal ultrasonography, the patient had no suspicious pathological findings on the uterus and ovaries. Laboratory tests of tumor markers did not show any elevation. Due to recurrent abnormal bleeding from the uterus, the patient underwent an abdominal hysterectomy with bilateral adnexectomy. Histopathology: Sertoli-Leydig tumor of the right ovary with retiform histoarchitectonics, stage IA and atypical endometrial hyperplasia.

Sertoli-Leydig cell tumors have a relatively good prognosis, but their management, surgical treatment and postoperative follow-up due to their rarity is a challenge even today.

UNUSUAL PRESENTATION OF BECKWITH-WIEDEMANN SYNDROME IN AN INFANT

Rexhep Memedi — 2023-12-27

Beckwith-Wiedemann syndrome affects 1 in approximately 14000 newborns.

Here we present an atypical case of an infant with Beckwith-Wiedemann syndrome with mild facial dysmorphia, macroglossia, hypotonia, respiratory and feeding difficulties, without lateralized overgrowth, without abdominal wall defects, no organomegaly, hypoglycemia or embryonal tumors.

MISDIAGNOSIS OF CERVICOBRACHIAL SYNDROME WITH SUBOCCLUSION OF THE LEFT SUBCLAVIAN ARTERY

Antonio Georgiev — 2023-12-27

Introduction: Cervical spondylosis (degenerative osteoarthritis) and subclavian occlusion, mostly caused by atherosclerosis, share similar symptoms. Both are diseases of the advanced age. Thus, there are similarities of overlapping or misdiagnosis of both diseases.

The aim of this case report was to present diagnosis and treatment of subclavian subocclusion and possibility of misdiagnosis with cervicobrachial syndrome.

Case report: We present the case of a 71-year-old woman with noncontrolled hypertension. For many years she complained of occasional pains and tingling in her neck, left shoulder, and hand, coolness in the fingers of the left hand, headache and occasionally dizziness. An x-ray finding of the cervical spine was in favor of spondyloarthrosis on the neck vertebrae, and after consulting an orthopedic specialist, she was diagnosed and treated as cervicobrachial syndrome for many years without success. Cardiology examination detected different high blood pressure readings in both arms and that induced us to perform a computerized angiography (CT). CT showed subocclusion on the left subclavian artery after which our patient underwent angiography and stent implantation. After the procedure, the blood pressure difference decreased and the symptoms disappeared.

Conclusion: Due to similar symptoms, whenever cervicobrachial syndrome is diagnosed, the blood pressures in both arms should be measured. In case of their difference, subclavian stenosis should also be considered and appropriate investigations should be made, especially if the difference in pressures is high.

REVIVING CRANIAL OUTER TABLE PERFORATIONS AS A MODERN INNOVATION FOR COMPLEX SCALP AVULSION INJURIES RECONSTRUCTION: A CASE REPORT

Boro Dzonov — 2023-12-27

Introduction: Scalp avulsion injuries can present a tremendous challenge for both the patient and the surgeon. The absence of periosteum can limit the reconstruction options. Various surgical techniques are available for scalp reconstruction, including skin grafting, microsurgical scalp replantation or free flaps. A cranial outer table perforation is also a potential treatment since we activate the body’s natural healing processes and within a matter of days the defect is gradually repairing with granulation tissue on which we can use skin grafts for further reconstruction.

Case Report: A 52-year-old patient was brought at our emergency center, due to an injury that occurred as a result of hair entrapment in high-speed rotatory devices, such as agricultural machine. Since the patient refused a potential treatment using free flaps, and microsurgical scalp replantation was not possible due to the condition of the avulsed scalp segment, we made transcortical holes in the outer table of the cranium up to the level of diploe for reconstruction of this defect.

Discussion: For individuals with scalp defects as a result to a trauma, a carefully planned multidisciplinary approach is required. It is crucial to have a comprehensive understanding of scalp anatomy, wound healing principles and physiology. Every reconstructive option should be taken into consideration.

Conclusion: Despite the significant advancements made in the reconstructive field, we are often faced with situations where we have to rely on a valuable historical medical technique. The modern reintroduction of cranial outer table perforations offers a bold, yet practical solution.

INTRA-ARTICULAR MEDIALEPICONDYLE AVULSION FRACTURE ENTRAPMENT FOLLOWING CLOSED REDUCTION ATTEMPT OF POSTERIOR ELBOW DISLOCATION

Dimitar Petrevski — 2023-12-27

Introduction: Pediatric complex elbow dislocations are uncommon injuries as intra-articular medial epicondyle fracture incarceration associated with posterior elbow dislocation occurs in 5-18% of all cases. A high-index of suspicion necessitates a computed tomography (CT) evaluation of the elbow joint as conventional two-plain radiography can be falsely interpreted as normal. The proposed treatment for this type of injury is surgical with multiple techniques being described in the literature.

Case report: A fifteen-year-old male presented to our emergency department with left elbow pain, medial elbow region bruising, valgus deformity and decreased range of motion (ROM) of the affected elbow seven hours post-injury. Unsuccessfully closed reduction maneuver at the local hospital with persistent symptoms was followed by CT of the elbow joint with consequent patient transfer to our institution where another closed reduction under appropriate analgesia failed. Urgent open reduction and internal fixation (ORIF) with two second generation 3.5x30 mm fully threaded headless compression screws of the medial epicondyle fracture incarceration was done. The patient was followed-up for three months resulting in laudable patient satisfaction as a result of the painless full range of motion in everyday and sport activities.

Conclusion: The imperative in diagnosing this type of injuries in pediatric posterior elbow dislocations following closed reduction attempt is to be aware of its existence. A high-index of suspicion should be further evaluated by CT. ORIF with second generation headless compression screws (HCS) fixation provides a satisfactory functional outcome.

OSSEOUS CHORISTOMA OF THE TONGUE: A CASE REPORT

Goran Panchevski — 2023-12-27

Osseous choristoma of the tongue is a rare condition characterized by the appearance of exophytic mature bone tissue in an ectopic site, mostly on the dorsal surface of the tongue. In this study we present a case with lingual osseous choristoma in an 11-year-old girl, treated surgically under local anesthesia. After the treatment, the patient was symptom free, and follow-up showed no recurrence.

OVARIAN DYSGERMINOMA IN PREGNANCY

Deva Petrova — 2023-12-27

Dysgerminoma is a very rare germ cell tumor of the ovary. It constitutes about 1% of all germ cell malignancies and accounts for 1-5% of all ovarian malignancies in the first two decades of life. Approximately 80% of cases are reported in patients younger than 30 years of age (mean age: 21 years), whereas 75% of women with dysgerminomas present with stage I of the disease. Ovarian tumors generally remain asymptomatic, until they are discovered due to their large size or related complications.

Dysgerminomas can occur in pregnant women. Тhe most commonly used diagnostic methods for ovarian tumors in pregnancy are ultrasound and magnetic resonance, not using radiation for ensuring safety of the fetus. Several factors have influence on treatment decisions such as: gestational week of the pregnancy, patient’s expectations, stage of the disease, influence of the diagnostic methods for assessing the stage of the disease on the fetus, as well as the reproductive history of the patient. In stage I of the disease, fertility sparing surgery with unilateral salpingo-oophorectomy can be performed if the patient wants to preserve fertility. No chemotherapy is required for stage I tumors, unless recurrence occurs (9.2% cases).

We present a case of dysgerminoma in a pregnant patient, treated with unilateral salpingo-oophorectomy. After two years of follow-up, the patient remained free of disease.