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Atrial Flutter as the First Manifestation of Progressive Cardiac Conduction Disease in a Young Apparently Healthy Patient: А Case Report

Abstract

We reported a case of a twenty-one-year-old man with an atrial flutter as the first manifestation of progressive cardiac conduction disease. The patient was admitted to the cardiology department due to complaints of shortness of breath and a decrease in exercise tolerance, which had happened after physical exercises (running). During ambulatory ECG monitoring persistent AFL was observed with atrial rate 262-297 bpm and ventricular rate 26-136 bpm (average 56 bpm). AV conduction was very variable – 4:1-14:1. The results of ambulatory ECG monitoring during the whole period of recording indicated signs of atrioventricular conduction disturbances. After cardioversion sinus rhythm was restored additional rhythm and conduction disorders were revealed. Ambulatory ECG monitoring was performed two weeks after the initial one, and throughout this recording were registered sinus rhythm on the background of first-degree AV block; transient Mobitz I AV block; and type 2 second-degree sinoatrial block. Trans-esophageal electrophysiology study was performed. During pharmacological denervation of the heart, signs of slowing of the atrioventricular conduction and sinus node recovery time persisted. These changes along with right bundle branch block were regarded as a progressive cardiac conduction disease with an apparently hereditary cause.

Open access
The Incidence of Depression and the Decrease of Quality of Life in Patients with Moderate-Severe Inflammatory Acne

Abstract

Objective: to know the prevalence of depression in patients with moderate-severe acne vulgaris.

Hypothesis: the incidence of depression increases in patients with moderate-severe acne vulgaris and will therefore decrease the quality of life.

Background: acne is a very frequent dermatosis in the outpatient clinic, it is not considered a life-threatening disease. It has been associated with negative emotional status. Also, suffering from it for a long time has been associated with depression, anxiety and frustration. The complications of acne in the psychosocial aspect are related to academic or vocational performance, self-esteem and adolescents’ quality of life.

Materials and Methods: the type of study was retrospective cross-sectional descriptive observational study. The sampling was carried out at the facilities of the Popular Autonomous University of the State of Puebla, taking into account any person within the institutional organisation within the range of 12-20 years of age, with a total of 50 participants. The Hamilton assessment scale of depression and the Cardiff Acne disability index were applied to all patients with dermatological diagnosis of moderate-severe vulgar acne in a period between February-October 2019. Results: a total of 50patients were analysed, of which 28 were women aged 12 to 20 years and 22 men (28 women and 13 men) and severe acne in 9 patients, all over 17 years of age and male. According to the degree of depression, 28% (n = 14) of the patients were obtained without some degree of depression; 60% (n = 30) with minor depression; 12% (n = 6) with moderate depression. Regarding the quality of life: 40% (n = 20) of the patients showed good quality of life, 46% (n = 23) regular quality of life and 14% (n = 7) showed poor quality of life.

Conclusion: orderly study of the psychic impact of acne and other skin diseases on people suffering them is recent and is carried out through questionnaires that try to measure the impact the diseases have on the patients’ quality of life.

Open access
Methicillin-Resistant Staphylococcus Aureus in Community Settings: Spread of Drug Resistance and Uncontrollable Infections

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a major multidrug-resistant bacterial pathogen. The evolution of MRSA is dynamic posing an ongoing threat to humans. The evolution of MRSA includes horizontal gene transfer, which is mediated by mobile genetic elements, plasmids, and bacteriophages, and also mutations. In this review, we clarify the recent trends in MRSA from the perspectives of drug-resistance transfer and uncontrollable infections, particularly those occurring in community settings. We first address the role of MRSA as a disseminator of multidrug resistance. We have studied the cell-to-cell transfer of drug resistance, in which transfer frequencies range from 10-3 to 10-8. The mechanisms of drug-resistance transfers include the self-transmission of large plasmids, the mobilization of small nonconjugative plasmids, the generalized transduction of phages, and the transfer of transposons with circular intermediates. We then discuss uncontrollable infections. Although several anti-MRSA agents have been developed, uncontrollable cases of MRSA infections are still reported. Examples include a case of uncontrollable sepsis arising from a community-associated MRSA (CA-MRSA) with the ST8/SCCmecIVl genotype, and a relapsing severe invasive infection of ST30/SCCmecIVc CA-MRSA in a student athlete. Some of these cases may be attributable to unique adhesins, superantigens, or cytolytic activities. The delayed diagnosis of highly adhesive and toxic infections in community settings may result in CA-MRSA diseases that are difficult to treat. Repeated relapse, persistent bacteremia, and infections of small-colony variants may occur. To treat MRSA infections in community settings, these unique features of MRSA must be considered to ensure that diagnostic delay is avoided.

Open access
Mobile Ultrasound Systems as a Modern Tool for the Doctor

Abstract

Miniaturisation of ultrasound equipment in the form of a tablet- or smartphone-sized scanner is the result of rapid development of modern medical technology. Availability of mobile ultrasound devices has changed our approach to diagnostics of many cardiovascular diseases. Mobile visualisation can be performed at the patient’s bedside and is simple in use. The information obtained from mobile visualisation, despite being incomplete, is of undoubtable value for rapid diagnosis which leads to early treatment onset. These devices possess unique characteristics: low cost, wide availability, safety, and precision. These characteristics make them usable in different clinical scenarios by operators of different specialties and expertise. Visualisation and interpretation of the images is done fast and provides useful diagnostic, prognostic and treatment data for each situation. This review devotes main attention to the regulation of application of mobile ultrasound devices, the notion of “focus cardiac ultrasound” and its differences from emergency and elective expert echocardiography protocols as well as limitations and numerous advantages related to usage of mobile ultrasound systems.

Open access
Possible Deleterious Impact of Glyphosate and its Commercial Formulation in Reproductive Health of Fishes

Abstract

Glyphosate (GLY) is the active ingredient of Roundup® and it is the most utilized herbicide worldwide in the maintenance of conventional agricultural crops, and lawns in parks. A growing number of studies have associated environmental GLY to different pathologies such as obesity, diabetes, heart disease, Alzheimer’s disease, depression, and autism. Different fish species have been used for a long time as experimental biological models to measure the environmental impact of different substances. Therefore, the present study approached the possible association between the exposure to GLY / Roundup® and the ecotoxicological impact on fish reproductive health. With this goal, we performed a comprehensive analysis of the literature and its content by systematic review of international databases. Two independent electronic searches were performed on Medline / PubMed and Scielo for identifying relevant studies published in English up to September 2019. The application of inclusion / exclusion criteria settled the boundaries for this systematic review and after qualitative analysis of the data; we found evidences that suggest a link between the exposure to GLY / Roundup® with deleterious effects on reproductive health in eight different species of fish.

Open access
Acad. Prof. Yucel Kanpolat, Distinguished and Internationally Recognized Neurosurgeon and Friend of the Republic of Macedonia

Abstract

The sad news about the death of Acad. Yucel Kanpolat (September 17, 2016), a famous scholar, a pioneer in the field of neurosurgery, and a friend of the Republic of Macedonia, saddened the members of the Editorial Board of the journal PRILOZI of the Department of Medical Sciences of the Macedonian Academy of Sciences and Arts, of which he was a member, as well as the other members of the Academy. Yucel Kanpolat was an international figure, linking Turkey to almost every country in the world. Neurosurgery has lost a very special surgeon, scientist and humanitarian. During the visit to the Macedonian Academy of Sciences and Arts in 2011, we discussed the cooperation between the Turkish Academy of Sciences and the Macedonian Academy of Sciences and Arts, which he respected very much, as well as the role of the academies. He delivered a lecture on The Mission of Academia in the Age of Science, PRILOZI, MASA, XXXII, 2, p. 7-10 (2011), which we reprint in addition.

Open access
in PRILOZI
Acute Thyroiditis Associated with Brucellosis: A Case Report

Abstract

Brucella thyroiditis represents an extremely rare focal form of brucellosis. In this case report we describe a 55 years old male, diagnosed with brucellosis and peripheral arthritis with subsequent development of acute thyroiditis. The symptoms duration consistent with brucellosis started two weeks before establishing the diagnosis. Only a day after diagnosis and initiation of antibrucellar treatment, acute non-suppurative thyroiditis suddenly manifested. Thyroiditis was diagnosed with clinical inspection and confirmed by ultrasound investigation. With the appropriate antibrucellar treatment, complete cure of thyroid affection was reached in ten days and the patient remained well during the follow-up period of two and a half years. In conclusion, in brucellosis endemic regions brucellosis should be included in the diagnostic consideration in patients with acute non-suppurative thyroiditis. Early recognition and adequate treatment of brucella thyroiditis results in favorable outcome.

Open access
in PRILOZI
Antimicrobial Susceptibility of Campylobacter isolates in the Capital of North Macedonia

Abstract

Background: Campylobacter infections are typically self-limited, but in cases with severe enteritis, immuno-compromised system and bacteremia, an appropriate antimicrobial treatment is demanding. Our study aim was to determine the isolation rate of Campylobacter among patients with acute enteritis in the capital of North Macedonia and its antimicrobial susceptibility.

Material and methods: A total number of 3820 patients clinically diagnosed as acute enteritis, were included in the study. Stool samples were collected and Campylobacter was isolated and identified by classical microbiological methods. Antimicrobial susceptibility of all isolates to Ceftriaxone, Amoxicillin-clavulonic acid, Erythromycin, Ciprofloxacin, Tetracycline and Gentamicin was determined by disc-diffusion technique. Additionally, minimal inhibitory concentrations of all Campylobacter isolates against erythromycin, ciprofloxacin and tetracycline were determined by Epsilon gradient tests.

Results: Campylobacter species was isolated in 97 patients. Although the mean isolation rate of Campylobacter spp. during the whole study period was 2.53%, a statistically significant increase was detected in 2016 and 2017, in comparison with the data from previous four years of the study. The isolation rate of Campylobacter spp. didn’t reveal statistically significant difference between males and females (p > 0.05). 46.4 % of patients with Campylobacter enteritis were children at the age under 15 years. Forty-three C. jejuni isolates were susceptible to all six antibiotics, but the remaining 44 isolates revealed resistance to at least one antibiotic. C. coli isolates were resistant to 3 antibiotics simultaneously. Two C. coli isolates only, were susceptible to all 6 antibiotics. 40.90% of C. jejuni and 50% of C. coli isolates were resistant to beta-lactams, fluoroquinolones and tetracyclines, simultaneously.

Conclusion: The increase of the isolation rate of Campylobacter from patients with acute enteritis indicates the need for permanent isolation and identification of Campylobacter from every clinically diagnosed patient, as acute enteritis. Erythromicin is the most effective antibiotic for treatment of Campylobacter enteritis in our patients. The high level of Campylobacter resistance to beta-lactams, fluoroquinolones and tetracyclines requires more rational approach in the treatment of Campylobacter enteritis

Open access
in PRILOZI
Association of Systemic Inflammatory Response Syndrome with Bacteremia in Patients with Sepsis

Abstract

The aim of this study was to evaluate the usability of systemic inflammatory response syndrome (SIRS) and commonly used biochemical parameters as predictors for positive blood culture in patients with sepsis. The study included 313 patients aged ≥18 years with severe sepsis and septic shock consecutively admitted in the Intensive Care Unit (ICU) of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia. The study took place from January 1, 2011 to December 31, 2017. We recorded demographic variables, common laboratory tests, SIRS parameters, site of infection, comorbidities and Sequential Organ Failure Assessment (SOFA) score. Blood cultures were positive in 65 (20.8%) patients with sepsis. Gram-positive bacteria were isolated from 35 (53.8%) patients. From the evaluated variables in this study, only the presence of four SIRS parameters was associated with bacteremia, finding that will help to predict bacteremia and initiate early appropriate therapy in septic patients.

Open access
in PRILOZI