In the context of new coronavirus COVID-2019 infection spread, many students in numerous higher education institutions have undergone the transition to education applying distance learning technology while medical students undergo partially remote education. It is worth noting that in the setting of the COVID-19 pandemic, remote education is the best prevention measure for decrease in incidence of the new coronavirus infection among students.
The article presents results of a concise analysis of domestic and foreign literature addressing the problem of determining of distinctive diagnostic features in patients with Clouston syndrome as an orphan disease rarely encountered in clinical practice of dentistry. A clinical case of effective orthopaedic rehabilitation of a 10-years-old patient with Clouston syndrome and congenital edentulism using minimally invasive orthopaedic dentistry measures: removable dentures application using shape memory materials is presented. Technological peculiarities and advantages of the chosen approach to treatment are described. Photographic documents of orthopaedic dental treatment results including long-term results within the follow-up period of 10 years are presented providing strong evidence of effective aesthetic, functional and social rehabilitation of the patient. Detailed analytical conclusion is drawn according to the study results.
Hypomimia is a common symptom of Parkinson’s disease. At the present time, issues related to existence of interrelations between hypomimia and manifestations of common hypokinesia remain under-investigated in aspects of both clinical manifestations and rehabilitation efficacy. An objective method for facial muscle movement diagnostics is necessary to achieve this goal. The article presents novel experience in application of a proprietary method using objective facial expression assessment video analysis on the example of a healthy female subject and a female patient with Parkinson’s disease. The Parkinson’s female patient had objective symptoms of hypomimia: a decrease in velocity and amplitude of eyebrow and mouth movement, slow winking. Therefore, application of this method creates prerequisites for more in-depth study of theoretical and clinical aspects in facial expression of Parkinson’s disease patients.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major multidrug-resistant nosocomial pathogen. This class of MRSA, first reported in the early 1960s and now termed healthcare-associated MRSA (HA-MRSA), was followed by a newer class of MRSA, community-associated MRSA (CA-MRSA). The unique feature of the initial CAMRSA included Panton-Valentine leukocidin (PVL), an abscess-associated toxin and also S. aureus spread factor. CA-MRSA usually causes skin and soft-tissue infections, but occasionally causes invasive infections, including (necrotizing) pneumonia, sometimes preceded by respiratory virus infections. The most successful CA-MRSA USA300 (ST8/SCCmecIVa) caused an epidemic in the United States. In Russia, we first detected PVL-positive CAMRSA (ST30/SCCmecIVc) in Vladivostok in 2006, but with no more PVL-positive MRSA isolation. However, we recently isolated four lineages of PVL-positive MRSA in Krasnoyarsk. Regarding chemotherapy against invasive MRSA infections, vancomycin still remains a gold standard, in addition to some other anti-MRSA agents such as teicoplanin, linezolid, and daptomycin. For resistance, vancomycin-resistant MRSA (VRSA) with MICs of ≥16 μg/mL appeared in patients, but cases are still limited. However, clinically, infections from strains with MICs of ≥1.5 μg/mL, even albeit with susceptible MICs (≤2 μg/mL), respond poorly to vancomycin. Some of those bacteria have been bacteriologically characterized as vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA), generally with HA-MRSA genetic backgrounds. The features of the above PVL-positive Krasnoyarsk MRSA include reduced susceptibility to vancomycin, which meets the criteria of hVISA. In this review, we discuss a possible new trend of PVL-positive hVISA, which may spread and threaten human health in community settings.
Oxidative stress is one of the most important mechanisms of cardiovascular diseases, especially in heart failure. Mitochondrial dysfunction and inflammation play a major role in formation of free radicals and antioxidants. The association between oxidative stress, telomere biology and cell senescence plays the key role in cardiovascular pathology development. The paper considers role of pro-oxidant and antioxidant enzymes in heart pathology development. Specifically, the role of such antioxidant enzymes as glutathione peroxidase 3, catalase, and superoxide dismutase is described. The role of gamma-glutamyl transferase is emphasized as its activity increases significantly in cases of heart failure, coronary heart disease, stroke, arterial hypertensions, and arrhythmias. This article is a literature review of the effect of such antioxidants as alpha-tocopherol, ubiquinone, uric acid, and triiodothyronine on development of heart failure and myocardial infarction. A decrease in triiodothyronine concentration is a risk factor for coronary heart disease. High uric acid values in patients with myocardial infarction upon admission to the hospital are associated with a high risk of sudden death. The influence of such minerals such as zinc, copper, magnesium, selenium, potassium, sodium, calcium, and iron on heart failure development has been analyzed. The role of ceruloplasmin as an independent predictor of acute and chronic cardiac disorders cardiac events, mortality, and bad prognosis in patients with heart failure and myocardial infarction is examined. The authors demonstrate the influence of inflammation on heart failure development as well as association of inflammation with oxidative stress.
Artificial Organs 2000 Satellite Symposium of European Society for Artificial Organs (ESAO) was organized by the Macedonian Society for Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO) and the Macedonian Academy of Sciences and Arts (MASA) on November 25-26, 2000 on the occasion of the 25th Anniversary of the Department of Nephrology of the Ss. Cyril and Methodius University, Skopje, R. Macedonia.
The main topics of this symposium were: Blood-purification techniques, Artificial Kidney, Metabolic- and Cardiac-Assist Systems as well as Biomaterials to be used for Artificial Organs.
H. Klinkmann (Glasgow, United Kingdom), D. Falkenhagen (Krems, Austria), U. Baurmeister (Wuppertal, Germany), V. Bonomini, S. Stefoni (Bologna, Italy), R. Vanholder (Ghent, Belgium), S. Stiller (Aachen, Germany), H. Mann, H. Melzer (Aachen, Germany), J. Pop-Jordanov, N. Pop-Jordanova (Skopje, R. Macedonia), B. Stegmayr (Umea, Sweden), M. Mydlik, K. Derzisova, O. Racz, A. Sipulova, J. Boldizsar, E. Lovasova, M. Hribikova (Kosice, Slovak Republic), A. Jörres (Berlin, Germany), M. Polenakovic (Skopje, R. Macedonia), J. Vienken (Bad Homburg, Germany), S. Bowry (Bad Homburg, Germany), E. Piskin (Ankara, Turkey), J. Klinkmann, W. Schimmelpfennig, H. Lantow, W. Rigger. (Teterow, Germany), A. Sikole (Skopje, R. Macedonia), A. Oncevski, P. Dejanov, V. Gerasimovska, M. Polenakovic (Skopje, R. Macedonia), J. Wojcicki (Warsaw, Poland), K. Affeld (Berlin, Germany), G. Rakhorst et al. (Groningen, The Netherlands), Z. Mitrev (Skopje, R. Macedonia), S. Kedev, G. Guagliumi, O. Valsecchi, M. Tespili (Skopje, R. Macedonia, Bergamo, Italy) have presented their papers at the Symposium. The presentations provoked a fruitful discussion and it was concluded that they should be published.
The papers were published in the International Journal of Artificial Organs of the European Society for Artificial Organs (ESAO) as a special issue on “Artificial Organs 2000 ESAO Satellite Symposium -Skopje, R. Macedonia”, Guest Editors: M. H. Polenakovic, Skopje and J. Vienken, Bad Homburg; Vol. 25, No. 5, 2002.
Cat scratch disease (CSD) is the main clinical manifestation caused by Bartonella henselae in immuno-competent patients. The bacterium is transmitted to humans from cats via scratches or bites. In this case report, we are presenting to our knowledge the first etiologically confirmed case of CSD in our country. Here we describe the case of a previously healthy adult female patient presenting with fever and axillar lymphadenopathy over 1-month period. She underwent numerous clinical and paraclinical investigations for potential etiologies associated with lymphadenopathy and fever. Finally, serological testing for B.henselae was performed with titers for IgG 1:1024 and 1:160 for IgM, which confirmed the diagnosis. Five-day treatment with azithromycin resulted with good clinical response and complete recovery. We proved that CSD is a reality in our country and this report should raise awareness in medical doctors, especially infectious disease specialist. Also, CSD should be included in differential diagnosis in patients with fever of unkown origin (FUO), who are presenting with regional lymphadenopathy, with or without history of cat contact.
Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall survival. The incidence is variant, 7.7/100,000 in Europe, 7.6/100,000 in the USA, 2.2/100.000 in Africa. The only real benefit for cure is surgery, duodenopancreatectomy. The key points for this procedure are radicality, low morbidity and low mortality, the follow up and the expected overall survival. The benchmark of the procedure is the pancreaticojejunoanastomosis, with its main pitfall, postoperative pancreatic fistula B or C. Subsequently, the manner of creation of pancreaticojejunoanastomosis defines the safety, thus the postoperative morbidity and mortality. Finally, this issue remarkably depends on the surgeon and the surgical technique creating the anastomosis. We used 2 techniques with interrupted sutures, dunking anastomosis and duct-to-mucosa double layer technique. The objective of the study was to compare these 2 suturing techniques we applied, and the aim was to reveal the risk benefit rationale for dunking either duct to mucosa anastomosis.
Material and method: In our last series of 25 patients suffering pancreatic head carcinoma we performed a standard dodenopancreatectomy. After the preoperative diagnosis and staging with US, CICT, tumor markers, they underwent surgery. Invagination-dunking anastomosis was performed in 15, whereas, duct-to-mucosa, double layer anastomosis was performed in 10. In the first group with dunking anastomosis, we had 6 patients with soft pancreas and 8 with narrow main pancreatic duct, less than 3 mm. In the duct-to-mucosa group there were 5 patients with soft pancreas and 4 with narrow main pancreatic duct. All other stages of surgery were unified, so the only difference in the procedure remained on the pancreatojejunoanastomosis. The onset of the postoperative pancreatic fistula was estimated with revelation of 3 fold serum level of alfa amylases from the third postoperative day in the drain liquid.
Results: In the duct to mucosa group there wasn’t a clinically relevant postoperative pancreatic fistula, while in the dunking anastomosis group we had 4 postoperative pancreatic fistula B, 26 %. One of these 4 patients experienced intraabdominal collection – abscess, conservatively managed with lavation through the drain. Comparing the groups, there was no significant difference between the groups concerning the appearance of postoperative pancreatic fistula: p>0.05, p=0.125. From all 25 patients, in 21 patients biliary stent was installed preoperatively to resolve the preoperative jaundice. All 21 suffered preoperative and postoperative reflux cholangitis, extending the intra-hospital stay.
Conclusion: So far, there have been many trials referring to opposite results while comparing these 2 techniques in creation of the pancreticojejunoanastomosis. In our study, the duct to mucosa anastomosis prevailed as a technique, proving its risk benefit rationale. However, further large randomized clinical studies have to be conducted to clarify which of these procedures would be the prime objective in the choice of the surgeon while creating pancreatojejunoanastomosis.
Predicting the outcome of neonatal critical patients remains elusive. The multiple factors of maternal state of health (infections, diabetes, gestosis), the placental situation (premature rupture of membranes) as well as multiple factors from the baby (small for gestational age, low Apgar score, low birth infections, mechanical ventilation, hypoglycaemia hyperglycamiea) render the approach to treatment of each patient individual and the outcome uncertain. Several approaches and scales are developed in order to assess the mortality risk in those rather complicated situations.
We used the CRIB-II scale to assess the mortality risk in 80 patients delivered in a large tertiary level hospital with more than 4,000 deliveries yearly. The patients were stratified according to all the neonatal risk factors and comorbidities. The CRIB-II scale identified well the mortality rates, but not the outcomes. A large and well-balanced cohort of patients followed for a longer period is required to discern in detail the importance of CRIB-II scale in predicting outcomes in high-risk new-borns. This could serve as an assistance to personalized approach to severely sick children. In addition, it is a valuable method in comparing outcomes in different NICUs and outcomes in different times in the same NICU, thus rendering possible improvements in the same unit and among several NICU departments.