Academic Medical Journal

INTOXICATION WITH ATROPA BELLADONNA L. AND SEVERE ANTICHOLINERGIC SYNDROME

Andon Chibishev — 2024-07-09

Atropa belladonna L., family Solanaceae, or also known as a deadly nightshade, is a plant which foliage and berries contain a high concentration of alkaloids and is extremely toxic. When these substances are being accidentally ingested, they tend to block the postganglionic parasympathetic fibers and muscarinic receptors in the central nervous system, thus causing an emergency clinical state known as anticholinergic toxic syndrome. In this article we present two cases of this rare clinical syndrome.

RUPTURED HEPATIC ARTERY ANEURYSM SUCCESSFULLY TREATED WITH DUAL-LAYER STENT ENDOVASCULAR TREATMENT: CASE REPORT AND LITERATURE REVIEW

Elena Curakova Ristovska — 2024-07-09

Spontaneous rupture of a hepatic artery aneurysm into the peritoneal cavity is a serious life-threatening complication related to hemodynamic instability and high mortality rate. We present a case of a hepatic artery aneurysm complicated with intraperitoneal bleeding and successfully treated with endovascular stent insertion. A 78-year-old male patient was admitted to a tertiary care center due to an abdominal pain and a large amount of free fluid in the peritoneal cavity. The diagnostic paracentesis confirmed hemoperitoneum. The CT scan revealed an aneurysm of the common hepatic artery that was successfully treated with an insertion of a dual-layered carotid stent. Endovascular stent insertion of a ruptured aneurysm of the common hepatic artery is an effective therapeutic procedure that can provide a definitive curative treatment in some patients.

ADVANCEMENTS IN IMAGING TECHNIQUES FOR COMPREHENSIVE ASSESSMENT OF PARTIAL ANOMALOUS PULMONARY VENOUS RETURN

Sonja Nikolova — 2024-07-09

Partial anomalous pulmonary venous return (PAPVR) poses a complex diagnostic challenge due to its varied presentations and intricate vascular anatomy. This article explored the advancements in imaging modalities, particularly computed tomography angiography (CTA) in delineating the diverse manifestations of PAPVR with precision. By a detailed analysis of four clinical cases, this study elucidated the pivotal role of advanced imaging techniques in enhancing diagnostic accuracy and guiding therapeutic interventions for patients with PAPVR.

THE ROLE OF MATRIX METALLOPROTEINASE-1 AND ENDOTHELIAL NITRIC OXIDE SYNTHASE GENE POLYMORPHISMS IN DEVELOPMENT OF CORONARY ARTERY DISEASE

Marjan Boshev — 2024-07-09

Coronary artery disease (CAD) is one of the major causes of morbidity and mortality worldwide. The main pathophysiological processes involved in the development of CAD include impaired lipid metabolism, coagulation and chronic inflammation of the coronary vessel wall. There are many well-known traditional or conventional risk factors that may contribute to development of CAD like smoking cigarettes, lack of physical activity, diabetes, obesity, arterial hypertension, dyslipidemia (hypercholesterolemia), psychosocial stress etc. Nevertheless, over the last two decades there has been a significant progress in the field of genetic research and enlightening of the genetic basis of development of CAD. Certain genetic polymorphisms have been found to be linked not only to lipid metabolism and coagulation but also to inflammation and response, tissue maintenance, remodeling and degradation of the extracellular matrix. In this review article we discuss some of the most frequently studied gene polymorphisms in the development of CAD – matrix metalloproteinase-1 (MMP-1) and endothelial nitric oxide synthase (eNOS) gene polymorphisms.

EXTRACTS FROM THE HISTORY OF CANNABIS

Biljana Bauer — 2024-07-09

Cannabis (Cannabis sativa L. Fam. Cannabinaceae) has been cultivated and used for millennia for industrial purposes, as food, for recreational and religious purposes, but also as a medicine in the treatment of various pathologies or symptoms. This paper traces the cultural and medicinal history of Cannabis use, from the earliest human contact with the plant to its subsequent global expansion. The discovery of the endocannabinoid system in the 20th century started a new era of renewed scientific interest in the pharmacological properties of Cannabis, which enabled the successful integration of Cannabis into modern clinical practices. Due to the new evidence-based research of its potential therapeutic value, in the last few decades the support for its decriminalization and legalization for medicinal purposes has also been revived.

CHRONIC WOUNDS - MICROBIOLOGY AND BIOFILM FORMATION

Julija Mitrova Telenta — 2024-07-09

Introduction: Chronic wounds are wounds that do not heal for more than 4 weeks. Among the most important causes of wound chronicity are wound infection, biofilm formation with microbial agents that are resistant to antimicrobial agents.

Aim: To investigate microbial agents in chronic wounds, their potential to form biofilm.

Material and methods: This was a prospective study involving 24 patients from the University Clinic for in Skopje. Microbiological swabs were taken from patients with chronic wounds on the lower extremities, and were analyzed at the Institute of Microbiology and Parasitology, Faculty of Medicine in Skopje. The biofilm formation potential in isolates was determined using the tissue culture plate (TCP) biofilm detection method.

Results: In 17 patients, at least one microorganism was isolated from 23 wounds, a total of 36, and in 7 patients there was no positive isolate from 7 wounds. Eighteen wounds (60%) had an isolate with the potential to form a biofilm. The following microorganisms from the wound samples were recorded: 17 (47%) isolates of the genus Staphylococcus, 4 (11%) isolates each from the genera Proteus and Pseudomonas, 3 (8%) isolates each from Enterococcus and Escherichia, 2 (6%) isolates from Streptococcus, 1 (3%) each isolate from the genera Acinetobacter, Enterobacter and Candida albicans.

Conclusion: In 60% of the isolates, a biofilm formation with different degrees was confirmed. A statistically significant association was found between the degree of wound healing and isolates with low potential for biofilm formation, as well as the type of isolate.

METABOLIC SYNDROME IN ANTIRETROVIRAL THERAPY TREATMENT EXPERIENCED BY PEOPLE LIVING WITH HIV

Biljana Petreska — 2024-07-09

Introduction: Metabolic syndrome (MS) constitutes a group of risk factors that significantly affect the quality of life and life expectancy of people living with HIV.

Aim: To estimate the prevalence of MS among people living with HIV who receive antiretroviral therapy (ART) in the Republic of North Macedonia (RNM).

Material and methods: A study was conducted on 53 adult patients with confirmed HIV infection at the University Clinic for Infectious Diseases and Febrile Conditions, who are receiving ART. In all patients, the presence of MS was determined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel ATP III (NCEP ATP III), defined by at least three of five risk factors including: low values of HDL - high density lipoprotein cholesterol, elevated waist circumference, hypertriglyceridemia, increased values of fasting glucose and hypertension. The statistical analysis was made by utilizing the statistical program SPSS 23.0.

Results: The average age of patients was 35.7 ± 8.3, with a male predominance of 90.57%. All patients had undetectable values of HIV RNA viral load in serum and 79.25% had achieved immune reconstitution with a CD4 count above 350 cells/ml. The prevalence of MS among people living with HIV in RNM was 7.55%, or out of 53 respondents 4 had MS.

Conclusion: People with HIV infection in RNM who regularly receive ART have a low prevalence of metabolic syndrome.

MRI EVALUATION OF BIOLOGICALLY ENHANCED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Alan Andonovski — 2024-07-09

Introduction: Platelet-rich plasma (PRP) and anterior cruciate ligament (ACL) residual remnant preservation are used today as biologic therapies aimed at stimulating graft healing process after ACL reconstruction, but their synergism has not been established yet. The aim of our study was to investigate the combined influence of PRP and ACL remnant preservation on graft healing after ACL reconstruction and evaluate the results with MRI.

Material and methods: The study included 52 patients (45 men and 7 women, mean age 28) divided into 2 groups: group I (control group) - 28 patients in whom after the removal of ACL residual bundle, a standard single bundle ACL reconstruction was made, and group II (examined group) - 24 patients in whom remnant preserving ACL reconstruction with addition of PRP was performed. The results were assessed 6 months after surgery by MRI evaluation of the graft healing process.

Results: Patients in the examined group had more frequently a light hyperintense signal of the intra-articular part of the graft (75% vs. 35.7%, p=0.0046) and absence of synovial fluid at tunnel-graft interface (45.8% vs. 21.4%, p=0.06), average 0.98 cm²less surface of bone edema around the graft (p=0.009) than those from the control group.

Conclusion: Combined use of PRP and ACL remnant preservation has a positive influence on graft healing after ACL reconstruction leading to faster ligamentization and osteoligamentous integration of the graft.

THE QUALITY OF DRINKING WATER FROM NATURAL PUBLIC WATER TABS IN THE MUNICIPALITY OF VELES FROM A PUBLIC HEALTH ASPECT

Ivana Gjorgjievska — 2024-07-09

Introduction: In many urban areas worldwide, drinking water from public water tabs is a widespread practice. However, the water quality of these sources has been questioned by some experts and authorities.

The aim of this paper was to assess the prevalence of unsafe water samples consumed by the citizens of Veles, despite prior notifications regarding their compromised safety.

Materials and methods: The water quality was examined in accordance with the national program for public health. A total of 261 water samples were meticulously tested, encompassing both physical-chemical and microbiological analyses, according to parameters in the Regulation on drinking water safety.

Results: A total of 40 (15%) samples were unsafe in relation to the physico-chemical parameters, because of contamination with nitrates, and 200 (76%) samples were unsafe because of microbiological contamination with E. coli.

Conclusions: The city's natural public water tabs have poor and variable water quality, which makes them unsuitable for human consumption and are a public health hazard. Nevertheless, the residents continue to use them in summer, ignoring the expert opinion that the water is not safe for human consumption. It is advisable to perform hygiene maintenance and disinfection procedures on a regular basis, and to entrust the water supply to a qualified and licensed entity, which would ensure its availability as a backup source in case of emergencies. These findings are useful for local authorities to remove the source of the contamination of the water sources and to integrate them into the municipal water supply network.

PARENTAL PERCEPTIONS ON THEIR CHILD'S WEIGHT STATUS IN NORTH MACEDONIA

Aleksandra Stamenova — 2024-07-09

Introduction: Obesity is a growing crisis, with onset in early childhood.

Aim: The purpose of this study was to explore parental perceptions of their child’s weight among a nationally representative sample of children living in North Macedonia.

Materials and Methods: From October to December 2022, a cross-sectional study was conducted including children and their parents/caregivers who were living in North Macedonia. The study was a part of the 6^th round of the WHO Childhood Obesity Surveillance Initiative (COSI). Parental perceptions were assessed through record forms and compared in relation to objectively measured weight status using anthropometric standardized procedures. WHO 2007 cut-off definitions on overweight/obesity were used. Wald χ²-tests were used to explore relations between objectively measured weight status (i.e., body mass index - BMI) and parental perceptions of their child’s weight status. Statistical significance was set at p<0.05 a priori.

Results: The sample was composed of 2613 school children with equal male to female representation and majority living in urban areas, whilst 31.8% of the children were living with overweight (including obesity). Parents underestimated their child’s weight status, especially regarding children with overweight and obesity.

Conclusion: To the best of our knowledge, this is the first study in North Macedonia to explore parental perceptions of school children’s weight status and compare accuracy with objective measured children’s weight status. Our study further compliments previous evidence of parental underestimation of children living with overweight and obesity, which is a crucial factor in understanding and addressing childhood obesity.

CHARACTERIZING FOOD, DAIRY, AND BEVERAGE AVAILABILITY IN PRIMARY SCHOOL PREMISES IN NORTH MACEDONIA - COSI STUDY

Katerina Mihajlova — 2024-07-09

Introduction: Childhood obesity remains a global public health challenge.

Aim: Using WHO COSI-6^th round data, the aim of this study was to depict availability of select foods, dairy and beverages in a nationally representative sample of primary schools across North Macedonia.

Material and methods: Data were drawn from the WHO COSI-6^th round conducted in North Macedonia in 2022. A designated official (n=111) at the respective primary school reported availability of the following: (1) food (fruits, vegetables, ice cream, sweet snacks, and savory snacks), (2) dairy (milk, yogurt, and/or ayran), (3) beverages without added sugar (water, tea, and fruit juices), and (4) beverages with added sugar (non-carbonated fruit juices, carbonated drinks, hot drinks [e.g., cocoa], and flavored milk). Additionally, the designated school official reported whether their primary school had a canteen and/or shop/cafeteria where foods or beverages could be purchased.

Results: Across primary schools in North Macedonia, availability of healthy options (i.e., fruits and vegetables) was lower as compared to energy-dense selections (i.e., sweet and savory snacks). Overall, 18.3% of schools offered dairy products (including milk, yogurt, and ayran). Water was the most commonly available (69.0%) beverage. No significant differences emerged in availability of food, dairy, beverages without added sugar or beverages with added sugar across primary school enrollment (small versus large). Less than one-fifth of primary schools had a canteen (17.4%) and/or shop/cafeteria (14.4%) where foods or beverages could be purchased.

Conclusion: In conclusion, access to food, dairy, and beverages for primary school children in North Macedonia was limited.

SMOKING HABIT AS A RISK FACTOR ASSOCIATED WITH OCCURRENCE OF LUNG CANCER

Ljubica Dimitrievska — 2024-07-09

Lung cancer is one of the most common causes of mortality in the world, right after cardiovascular diseases.

The motivation for conducting this study was the fact that the number of newly diagnosed and death cases from lung cancer has been constantly growing, especially in the last few years.

The aim of the study was to present lung cancer (LC) as a public health problem today at the global level as well as in the Republic of North Macedonia.

This is an analytical case-control study. It included all patients with a confirmed diagnosis of lung cancer (LC) with histopathological analysis (examined group) and patients who have not had any history of malignancy (control group), in a period of six months. Survey data were collected using a specially designed questionnaire.

The study included a total of 82 respondents in both, the examined and the control group. Regarding the habit of cigarette smoking, the largest percentage of examined respondents (56%) were current smokers, compared to the control group where the largest percentage (56%) were non-smokers. The results obtained showed that the two groups differed significantly with regards to the habit of cigarette smoking.

This study confirmed the association of cigarette smoking habit and lung cancer, where several variables related to smoking were examined (age at which cigarette smoking started, number of cigarettes smoked per day, duration of smoking status, type of cigarettes).

RISK ASSESSMENT OF MUSCULOSKELETAL DISORDERS IN NURSES USING THE WERA QUESTIONNAIRE

Maja Panajotovikj Radevska — 2024-07-09

Introduction: Ergonomic factors are one of the most significant factors that occur in various specific work processes in the healthcare sector and different workplaces, resulting in side effects on health workers’ health.

Aim: The aim of this study was to present a risk assessment of musculoskeletal disorders in nurses using the WERA questionnaire for ergonomic risk assessment at the workplace.

Materials and methods: A total of 160 nurses in three categories (primary, secondary, and dentistry fields) were surveyed. This study employed the Standard Nordic questionnaire for analyzing musculoskeletal symptoms and the WERA questionnaire for ergonomic risk assessment at the workplace.

Results: According to the results of the WERA questionnaire, 57.5% of nurses had a moderate degree of risk that required corrective measures, and 30% had a high level of risk that was unacceptable and required immediate improvements. Musculoskeletal issues occurring within the last 12 months were most common in the lower back (63.8%), neck (32.5%), and knees (24.9%). Musculoskeletal problems in the recent seven days were most common in the lower back, found in 40.6% of nurses.

Conclusion: Overall, based on the outcomes of this study, there is a need for the establishment of relevant ergonomic programs for professional prevention of the occurrence of musculoskeletal disorders in nurses.

RELATIONSHIP BETWEEN BURNOUT AND DEPRESSION: A CROSS-SECTIONAL STUDY AMONG PUBLIC, PRIVATE EMPLOYEES AND FACTORY WORKERS

Natasha Stancheva-Pargov — 2024-07-09

Introduction: Burnout is one of the most common psychological conditions that modern society is increasingly facing.

Aim. This study aimed to investigate the predictive role of burnout with its dimensions for depression among the specified groups of workers.

Materials and methods: A self-administrated questionnaire was completed by a sample of three groups of workers to assess mental health and burnout with its three dimensions (Patient Health Questionnaire and a Maslach Burnout Inventory - General Survey). Logistic regression models were used to estimate associations between burnout and depression symptoms.

Results: The analysis indicated that the highest average PHQ-9 score had the public group 5.44±5.57 followed by the private 2.72±3.09 and the factory group 2.43±3.314. The total burnout score was 2.55±1.08, which corresponded to a moderate degree of this dimension, and the factory respondents were most affected (2.81±1.03). The multiple logistic regression determined that a low degree of exhaustion reducds the probability of depression by 0.05 times, and a high degree of lack of professional efficacy increased the probability by 10.27 times.

Conclusion: Our study has indicated that depression is predicted by burnout, especially by the lack of professional satisfaction. The use of accurate predictors could prove vital in the early detection and management of affected individuals, especially in high-risk professions. Burnout prevention and burnout reduction interventions should be made to highlight the increasing need for the development and deployment of mental health institutions and professionals respectively around the country in an effort to pay more attention to mental health.

A QUESTIONNAIRE STUDY ON THE KNOWLEDGE OF PHARMACOVIGILANCE AMONG HEALTHCARE PROFESSIONALS IN THE REPUBLIC OF NORTH MACEDONIA

Vlatko Kokolanski — 2024-07-09

Introduction: The higher incidence of adverse drug reactions (ADR) is a global health problem which requires the attention of all stakeholders. Spontaneous ADR reporting system is a global phenomenon, and the cornerstone of pharmacovigilance activities. Therefore, healthcare professionals play a crucial role in the pharmacovigilance system.

The aim of our study was to evaluate the health workers’ knowledge about pharmacovigilance in the Republic of North Macedonia

Material and method: This study included 400 health workers (100 doctors of medicine, 100 doctors of dental medicine, 100 pharmacists and 100 medical nurses/technicians) employed in public and private healthcare institutions in the city of Skopje. The research was conducted using an anonymous survey questionnaire and the collected data were statistically analyzed using SPSS Statistica v23 for Windows.

Results: Our results showed that pharmacists' knowledge was significantly better than that of other healthcare professionals regarding the definition of the term “pharmacovigilance”, the main goal of the pharmacovigilance, the obligations for reporting adverse drug reactions and the function of the system of pharmacovigilance in our country. In our study, doctors of medicine, although with weaker knowledge than pharmacists, showed a good level of knowledge of the pharmacovigilance system, while doctors of dentistry and nurses/technicians had the least knowledge of this system.

Conclusion: We believe that by predicting the curricula on pharmacovigilance and the adverse drug reactions in the undergraduate studies, adequate knowledge of this system will be provided which will contribute to improving the quality of care for patients and reducing the under-reporting of ADRs.

FREQUENCY AND DISTRIBUTION OF LAMBDACISM AND RHOTACISM IN 5-6 YEARS OLD CHILDREN

Tatjana Georgievska Jancheska — 2024-07-09

Introduction: In the child’s speech development, speech sound appears first. Speech sound is the primary means of expression and articulation disorders can hinder the comprehensibility of children’s speech. The improper speech can limit the child’s inclusion in the social and educational environment.

Materials and methods: A retrospective analysis was carried out on a random sample selected from preventive examinations for early diagnosis of impairments of hearing, speech and sounds in children aged 5-6 years. In the selected sample (n=275) of boys and girls, from rural or urban area, the frequency and distribution of lambdacism, rhotacism, or both disorders together were analyzed. The data was statistically and descriptively analyzed, and presented in tables and figures.

Results: In the analyzed sample, greater presence of lambdacism was observed before lambdacism-rhotacism and rhotacism. Most commonly the articulation disorder appearred alone, as lambdacism or rhotacism, followed by lambdacism-rhotacism, i.e., both disorders together. The disorders were more common among boys than among girls.

Conclusion: The study offers useful information about the prevalence of lambdacism, rhotacism and lambdacism-rhotacism in children of different gender and place of residence. The obtained findings can help in better understanding of the situation and establishing timely diagnosis and planning of the rehabilitation that will enable easier and faster integration of the children in the social and educational environment without long-lasting consequences.

THERAPEUTIC DRUG MONITORING OF AMIKACIN: METHODS AND RESULTS IN PATIENTS WITH CYSTIC FIBROSIS

Aleksandar Nikodinkvski — 2024-07-09

Introduction: Therapeutic drug monitoring (TDM) is essential to optimize amikacin therapy, especially in patients with cystic fibrosis (CF), due to a small therapeutic index and significant interpatient variability. This study presents the methods and results of TDM in CF patients treated with amikacin.

Methods: A prospective, open-label clinical study was conducted in CF patients receiving amikacin. Amikacin serum concentrations were measured using a fluorescence polarization immunoassay (FPIA). Peak and trough concentrations were recorded to maintain therapeutic levels and minimize toxicity. Data on patients’ demographics, renal function, and clinical outcome were also collected.

Results: Amikacin serum concentrations were determined in a total of 165 blood samples taken from 33 patients who received amikacin at a dose of 30 mg/kg, but not more than 1.5 g, in the form of an intravenous infusion over 30 minutes once a day. Maximum concentrations of amikacin in patients ranged from 29.6-197.7 µg/ml, while minimum values were always < 2 µg/ml in all patients in the study. No cases of nephrotoxicity and ototoxicity were observed.

Conclusion: According to literature, TDM of amikacin in CF patients is crucial to achieve optimal therapeutic results. Because no dose adjustment was required in any patient in our study, determination of amikacin concentrations in our population is justified only in patients with decreased therapeutic efficacy of the drug or in the case of adverse effects.

EXPLORING RARE INTERSTITIAL LUNG DISEASES: INSIGHTS FROM HIGH-RESOLUTION COMPUTED TOMOGRAPHY

Kristina Dimitrijevikj — 2024-07-09

Interstitial lung diseases (ILDs) pose significant diagnostic and therapeutic challenges due to their diverse and intricate nature. This study investigated rare ILDs, such as cryptogenic organizing pneumonia, eosinophilic pneumonia, lymphocytic interstitial pneumonia, hypersensitivity pneumonitis, and Langerhans cell histiocytosis, identified through high-resolution computed tomography (HRCT) in N. Macedonia.

A cohort of ten patients was recruited from the University Clinic for Pulmonology and Allergology in Skopje over a one-year period. HRCT scans were conducted using a 128-slice PHILIPS INCISIVE CT scanner, while clinical data were gathered from comprehensive medical records and questionnaires.

Analysis revealed a gender distribution of 6 females and 4 males, with ages ranging from 18 to 78 years (mean age: 50±17.2 years), predominantly residing in urban areas. Notably, six patients reported cough symptoms, while dyspnea was present in nine individuals. HRCT findings encompassed reticular shadows, high and low attenuation, and trapped air, exhibiting diverse distribution patterns.

This study contributes to elucidating the radiological patterns and distributions of rare ILDs, thereby enhancing diagnostic accuracy and facilitating effective management strategies.