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Four Year Results of Conservative Treatment of Benign Strictures of the Esophagus with Savary Gilliard Technique of Bougienage: Cross-Sectional Study Representing First Experiences in Republic of Macedonia

Abstract

Background: Benign esophageal strictures are complications resulting from various causes. They can be structurally categorized in two groups: simple and complex. Treatment is similar in most cases that require dilatation and means use of three general types of dilators that are currently in use. However, despite the last guidelines on esophageal dilatation, the therapeutic response, optimal timing of treatment and interval between sessions may vary and there is no strong consensus in the literature regarding this fact.

Aims: To analyzethe first 4 year experience of Digestive Endoscopy Unit at the University Clinic of Gastroenterohepatology of the Medical Faculty, Skopje, Republic of Macedonia in treating benign esophageal strictures, since the Savary-Gilliard technique of “bougienage” was introduced for the first time in Republic of Macedonia, at our Institution, in December 2013, by assessing etiology, length of stricture, number of dilations required to achieve satisfactory therapeutic response, as well as the relationship between the type, extent of stenosis and therapeutic response.

Methods: One hundred and forty five dilations, during a period from 20th December 2013, until March 2017, have been analyzed in 31 patients

Results: The caustic strictures were the most prevalent, occurring in 15 (48%) of patients, followed by peptic stenosis presenting 26% of patients. The long and corrosive strictures needed more sessions to the absence of dysphagia. Peptic and short stenoses best respondedon treatment and needed fewer dilatation sessions per patient.

Conclusion: Caustic stricture is the most common type of benign esophageal stenosis and the most refractory to treatment, especially the long one. Peptic stenosis is the second cause of benign esophageal strictures and responded well to endoscopic therapy. The higher the extent of stenosis, the greater the number of sessions required. Short strictures have good prognoses in most cases. The number of dilations depended directly on the cause and extent of stenosis. Bouginage using Savary-Gilliard or American type of technique, irrespective of the type and the extent of esophageal stenosis, is safe and purposeful procedure.

Open access
in PRILOZI
Growth Hormone Treatment in Children Born Small for Gestational Age (SGA)

Abstract

Introduction: Growth failure is a common consequence in small for gestational age (SGA) children.

Patients and Methods: The growth patterns and serum insulin like growth factor 1 (IGF1) concentrations before and after the 1st year under growth hormone treatment of 32 short stature SGA born children have been evaluated. In addition, we investigated the insulin like growth factor 1 receptor (IGF1R) exon 2 as a hotspot for IGF1R genetic alterations. It is of note that no dysmorphic features were observed in this group of children.

Results: The tests for pituitary reserve were within normal ranges for all 32 patients. Growth hormone (GH) treatment (0.037 mg/kg/day) was initiated at the mean age of 9.32±3.19 years. Growth velocity increased yearly from −1.80 SDS after the first year to −0.03 SDS in the sixth year of treatment. Their IGF1 serum concentrations before treatment were age and sex appropriate, while during treatment a significant increase was observed fitting in the upper third of the normal range: before the treatment IGF1 SDS was 0.84±1.78 after 1st year the concentrations increased to IGF1 SDS 0.94±2.23. No genetic alterations were found in the IGF1R exon 2 by PCR analysis.

Conclusions: Herein we present 32 short stature SGA children with no dysmorphic features treated with GH. They all had increased growth velocity and entered the normal growth range on their growth charts. No side-effects were observed. GH treatment in children with no genetic alterations on the IGF1R exon 2 is safe and efficient in treating SGA children with short stature.

Open access
in PRILOZI
Homeostasis Model Assessment - Insulin Resistance and Sensitivity (HOMA-IR and IS) Index in Overweight Children Born Small for Gestational Age (SGA)

Abstract

Introduction: Children born small for gestational age (SGA) have increased prevalence of metabolic syndrome, diabetes mellitus type 2 (DM2), hypertension and cardiovascular and cerebrovascular events in adulthood.

Patients and Methods: In 100 children born SGA, and in second cohort having 32 obese children born in term with normal birth weight and height, anthropometric measurements and biochemical metabolic profiles were analysed. The Homeostasis Model Assessment - Insulin Resistance and Sensitivity (HOMA-IR and IS) were calculated.

Results: Four overweight/obese children (M:F=3:1) with normal height were found among 100 SGA children. The body mass index (BMI) in all 4 children was above the 98th percentile and the mean BMI z-score was (2.04±0.30 SDS). The HOMA-IR index in all four children was increased: 1.26-2.65 (>1). Two teenagers had significant hyperinsulinemia (198.00 uIU/ml and 275 uIU/ml) and were treated with metformin. Two girls needed only a diet and increased physical activity. The mean values of HOMA-IR (1.26-2.65; N< 1) and IS (58 ±17.12) in fo-ur SGA overweight/obese children who caught-up growth had indistinguishable values with the group of 32 (M: F=21:11) obese children (HOMA-IR 1.83±1.2 SDS; IS 82.99±64.53 SDS) born in term with normal birth weight and height.

Conclusions: SGA born children are usually thin; nevertheless we found overweight and obesity in 4% of the patients. Two of those children have metabolic syndrome. Excess weight, obesity and metabolic syndrome in SGA children result with increase of their inherent risk for DM2, cardiovascular and cerebrovascular diseases in adulthood.

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in PRILOZI
The Impact of Glyco-Metabolic Status in Patients Treated for Acute Coronary Syndrome

Abstract

Objective: The aim of the study was to assess the prevalence of newly diagnosed diabetes in patients with acute coronary syndrome and estimate the relationship between stress hyperglycemia, glyco-regulation and newly diagnosed diabetes with hospital morbidity and mortality.

Methods: This was an observational study which included all patients hospitalized due to acute coronary syndrome (January 2015 until April 2017) at the University Clinic of Cardiology in Skopje, Macedonia. We analyzed demographic, clinical, biochemical variables and hospital morbidity and mortality. Five investigated groups were compared using a single biochemical parameter glycated hemoglobin (HgbA1c) depending on the presence of known diabetes before the acute event: 0-without DM (HgbA1c <5.6%), 1-newly diagnosed pre-diabetes (HgbA1c 5.6-6.5%), 2-newly diagnosed diabetes (HgbA1c ≥ 6.5%), 3-known well controlled diabetes (HgbA1c <7%) and 4-known un-controlled diabetes (HgbA1c ≥7%).

Results: 860 patients were analyzed. Impaired glucose metabolism was confirmed in 35% of patients, 9% of which were with newly diagnosed diabetes. Stress hyperglycemia was reported in 27.3% (3.6% were without diabetes). The highest values of stress hyperglycemia were reported in newly diagnosed and known un-controlled diabetes. In-hospital morbidity and mortality were 15% and 5% accordingly and the rate was highest in patients with newly diagnosed and known, but un-controlled diabetes. HgbA1c, stress hyperglycemia, and poor glycemic control have emerged as significant independent predictors of hospital morbidity and mortality in patients with acute coronary syndrome.

Conclusion: High prevalence of newly diagnosed diabetes was observed in patients with acute coronary syndrome. Stress hyperglycemia and failure to achieve glycemic control are independent predictors of hospital morbidity and mortality.

Open access
in PRILOZI
Lecturers from Macedonia Elected for the First Time to the Faculty of Medicine in Skopje in the Period 1961-63

Abstract

Aim: To present a group of young doctors from R. Macedonia who were elected as lecturers at the Faculty of Medicine (FM) in Skopje, R. Macedonia, in the period 1961-63.

Method: A retrospective study based on archive materials, encyclopaedias and jubilee publications of the FM and Faculty of Dentistry in Skopje, other relevant sources of information, and a review of the relevant literature.

Results: The Skopje FM was founded in 1947 and the first meeting of the Teachers’ Council of the Faculty was held on March 17, 1947. The first generation of 153 students was enrolled in the autumn of 1947 and the first lecture was delivered on November 3, 1947.

Besides 15 doctors from R. Macedonia - faculty staff, who had been appointed in the period from 1947-54, and a group of 24 lecturers from R. Macedonia who had been elected assistant professors in the period from 1955-60, an additional group of 17 Macedonian lecturers had been elected for the first time in the period from 1961-63. Those 56 pioneers and coryphaei of medicine in R. Macedonia played important roles in the establishing and/or initial and further development of a number of the faculty departments/chairs, institutes and clinics within the newly established FM in Skopje in 1947 and in the first 15-20 years of its initial development, until 1960s and later.

Conclusion: The Skopje FM, founded in 1947, played a crucial role in the education of medical professionals, in improving the poor health status of the population and the overall further development of the health system and provision of health care to the population of R. Macedonia. The contribution of the third group of 17 lecturers from R. Macedonia in furthering the development of the Skopje FM, during the 1960s and later, was very important.

Open access
in PRILOZI
Low Molecular Weight Proteinuria in Children with Distal Renal Tubular Acidosis

Abstract

Distal renal tubular acidosis (dRTA) (MIM #267300, #602722 and #179800) is a rare inherited tubulopathy characterized by the inability of the distal tubule to acidify the urine with consecutive systemic acidosis. The clinical features include polyuria, polydipsia, poor appetite, failure to thrive, short stature and rickets. Prominent biochemical features are hypokalemia, hypercalciuria and hypocitraturia. There are reports on patients who presented with unusual biochemical features such as low molecular proteinuria, hypophosphatemia, hypouricemia, generalized hyperaminioaciduria, hyperoxaluria and other making diagnostic confusion to the clinicians. In this work, we report on a series of 8 children with clinically, biochemically and genetically proven dRTA who present with low molecular proteinuria at the disease onset. With metabolic compensation of the disease, there was complete resolution of the low molecular weight protenuria and other proximal tubular abnormalities in all children. Late recognition of the disease with long standing hypokalemia and acidosis may result in abnormal expression and function of the transporters in the proximal tubules. Sodium dodecyl sulphate polyacrylamide gel electrophoeresis is an accurate method for detection and follow up of patients with low molecular weight proteinuria.

Open access
in PRILOZI
Nt-ProBNP Discriminatory Role Between Symptomatic and Asymptomatic Patients with Severe Valvular Aortic Stenosis

Abstract

Background: The aim was to evaluate the Nt-proBNP discriminatory role between symptomatic and asymptomatic patients with severe aortic stenosis.

Methods: 187 patients with severe valvular aortic stenosis, with normal EF > 50%, were included, 61 asymptomatic and 126 symptomatic. We used clinical, laboratory (Nt-proBNP) and echocardiographic parameters. Endpoints of monitoring (occurrence of event) were: the onset of symptoms in asymptomatic patients and death in both groups.

Results: The symptomatic group with severe AS had a significantly higher means of Nt-proBNP, in comparison with the asymptomatic group. Nt-proBNP was a significant predictor for the risk of event occurrence (HR 1.4). In the group of severe AS without CAD (n = 101), the subgroup with Nt-proBNP above the cut-off value, took significantly higher percentage of patients with chest pain, fatigue and syncope. In the group with Nt-proBNP above the cut-off value, we had a significantly higher percentage of patients with severe AS without CAD, compared to those with CAD (n = 142). Nt-proBNP was negatively correlated with AVA and LVEF, whether the positive correlation was expressed for: LVEDd, LVEDs, IVSd, AV_Vmax, AV_MaxGrad, LVM and LA. Patients with Nt-proBNP above the cut-off, had a significantly lower event free survival, compared to patients with Nt-proBNP below the cut-off (n = 187; n = 101).

Conclusion: The Nt-proBNP cut-off> 460 pg/ml was confirmed as a useful tool in the determination of event free survival in patients with severe AS. Nt-proBNP not only had relevance in the assessment of the severity of the disease, but also was a significant predictor for the risk of event occurrence.

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in PRILOZI
Originally Adapted Mobile Application Used for Neuropsychiatric Patients

Abstract

The potential use of modern mobile devices for medical purposes is huge. Digital mental health tools have mostly tended to use psycho-educational strategies based on treatment orientations developed and validated outside digital health.

The aim of this study was to test the availability of our own original app named “Neuro-game” for evaluation of reaction time in different neuropsychiatric patients. Reaction time is strongly related to the executive brain functions.

The examined sample comprised of 135 neuropsychiatric patients (with epilepsy, depression, general anxiety, psychosis and ADHD) compared with matched 50 healthy persons.

We showed that the average reaction time in neuropsychiatric patients compared with healthy people is not notably different. However, we found significant differences in total hits, total misses and total tries in the performances of ill persons.

The crucial differences in obtained scores are confirmed for age and gender issues.

The most important differences are found in the number of hits, misses and tries in the group of depressed, followed by psychotic and ADHD patients, while anxious ones showed pretty normal parameters.

All tested parameters are remarkably different for the epileptic group vs. healthy people.

The T-test for epileptic vs. healthy people showed noteworthy differences for total tries, total misses, and total hits, but the average time reaction did not differ significantly.

In comparison with other psychometric assessments, this approach by using mobile phones seemed more practical, available anywhere (not only in medical settings), less time consuming and quite interesting for all ages.

Open access
in PRILOZI
Parameters of Metabolic Syndrome in Obese Children and Adolescents

Abstract

Background: Obesity is the most common chronic metabolic disease in children and adolescents. It has reached epidemic ranges and is a significant global problem.

Objective: This study aimed to investigate the possible metabolic disturbances in children and adolescents with obesity and severe obesity.

Subjects and methods: This cross-sectional study included 158 (82 boys, 76 girls) obese children and adolescents between ages of 0 and 17years (10.43 ± 3.11 years). The obesity was defined according to the sex- and age-specific growth charts proposed by the Centers for Disease Control and Prevention as BMI ≥ 95th percentile. Severe obesity was classified as 120% of the 95th percentile for age and sex. Study participants underwent medical assessment and analysis of: ALT, AST, fasting serum triglycerides, total serum cholesterol, fasting plasma glucose and plasma glucose from oral glucose tolerance test.

Results: The majority of study participants were severely obese (69.92%). The highest distribution of abnormal biochemical results was seen in elevated ALT (53.91%) followed by elevated triglycerides (34.75%). The prevalence of abnormal total cholesterol level was significantly higher (p=0.04) in the group of obese children compared to the severely obese children. The levels of total cholesterol were also statistically higher in the group of adolescents compared to preadolescents (p=0.02). An important number of obese patients (2.5%) and even higher number of severely obese patients (5.26%) had carbohydrate intolerance.

Conclusion: There was a significant elevation of ALT, total serum cholesterol and triglycerides in all study participants. High serum lipids and high hepatic enzymes (as introduction in non-alcoholic fatty liver disease) are alarming. Strikingly, there was carbohydrate intolerance in an important number of patients. Treatment and education of patients and parents is mandatory. Preventive measures in the society concerning childhood obesity are necessary.

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Personality Typology in Patients with Traumatic Limb Fractures

Abstract

The notion that personality impacts health is not new. According to Grossarth-Maticek and Eysenck’s theoretical approach, the main factor for health is the ability for self-regulation, which seems to moderate the effects of some physical risk factors.

The aim of this study was to evaluate personality characteristics of patients hospitalized for traumatic limb’s fractures which have been operatively treated. To our knowledge, it is the first study of this type in the region.

The evaluated sample comprises two groups of examinees: patients hospitalized at the Traumatology Clinic for surgery after fractured limbs (N=30) and healthy people (N=120) as control, previously examined. Two psychometric tests were used: Grossarth-Maticek questionnaire and Eysenck Personality Questionnaire (EPQ).

Obtained results showed that the personality characteristics of patients with traumatic limb fractures belong generally to the “healthy type 4” of Grossarth-Maticek typology, similarly as the control. It correlates to the low N (neuroticism) and moderate E (extraversion) scales in the Eysenck typology.

We showed that gender and age highly influence the scores obtained from the questionnaire.

The type of personality could influence reactions in life situations, coping with stress and consequently to be a trigger for any disorder, even traumatic fractures

Open access
in PRILOZI