Outcome Assessment of the Marshall Coughing Test during Cervix Reposition Maneuver in Women with Urinary Stress Incontinence with/without Genital Prolapse

Objectives. Outcome assessment of the Marshall coughing test (MT) during cervix reposition maneuver (CRM) in women with urinary stress incontinence (USI) with/without genital prolapse (GP). Study Design. 268 patients, divided into USIg (n = 132) with isolated USI and USIGPg (n = 136) with USI and GP stage I/II, additionally divided into USIGP(A) (n = 78) with USI and GP stage I and USIGP(B) (n = 58) with USI and GP stage II, were evaluated with pelvic organ prolapse quantification (POPQ), MT, and CRM. Results. (a) 7.58% had (+) MT with CRM in USIg; (b) in up to 96.15% MT became negative during CRM in USIGP(A); (c) in 51.72% MT became positive only during CRM, as a sign for occult USI in USIGP(B); (d) point Aa (POPQ), which is bladder neck(BN) projection on the anterior vaginal wall, was situated higher in rest position (RP), but moved lower during the Valsalva maneuver (VM) in USIg versus USIGPg (P < 0.05). Conclusion. CRM could be useful arm in selection of (1) patients with isolated USI and great chance for postoperative failure; (2) patients with USI+GP stage I, who need GP repair during antistress surgery; (3) patients with USI + GP stage II, who need antistress procedure during vaginal hysterectomy

Assessment of the current energy and price crisis impact on the Macedonian business sector

In the past few years the world economy has faced with several serious economic crises, which have overlapped with each other. Firstly, the crisis determined by the Covid-19 pandemic, that has begun in 2020 as a health crisis in a short time has been recognized as a biggest economic shock of the 21st century on a global scale. Secondly, the period of economic recovery that took place in 2021, in the same time with the economic growth brought an increase in energy prices, especially oil and natural gas prices, as well as in food prices. Such tendencies have significantly intensified with the beginning of the war in Ukraine in February 2022, and plunged the world economy into a new energy and price crisis. All these subsequent crises dealt a heavy blow to the world population from an economic and social aspect and made it difficult for companies to operate normally on global scale. All these circumstances from the world economic scene have been quickly spilled over into the Macedonian economy, plunging the country into several overlapping crises. The aim of the paper is to provide more in-depth inside into the impact of the energy and price crisis on the performance of the Macedonian business sector. To fulfil this goal, we conduct a survey for the business sector. The paper is organized as follow. At the beginning of the paper an overview of the economic impact of Covid-19 crisis and energy and price crisis on the global scale is given. Further in the paper the economic implication of the pandemic and the current energy and price crisis in North Macedonia are elaborated. Analyzes of the economic impacts of the crises is based on the movement of the key macroeconomic indicators as: GDP growth rates, inflation, industrial production, gross debt, etc. Within the paper is also analyzed the impact of the current energy and price crisis on the Macedonian business sector based on the results of our own survey, conducted by the Center for Strategic Research “Ksente Bogoev” of MANU. The questionnaires used as an instrument for data collection were distributed electronically to the respondents (enterprises). The data collection period was one week (from 1 to 7 March, 2023). The survey was responded by 38 enterprises. The survey results give us a more comprehensive picture about the situation in the country, referring to the economic implications of the energy and price crisis on the business sector and satisfaction of the business sector with the implemented government measures

Economic and social impact of Covid-19 pandemic on global scale and in the case of the Republic of North Macedonia

The COVID-19 pandemic has affected about 220 countries with more than 178 millionconfirmed cases and over 3.8 million mortalities worldwide. North Macedonia belongs amongthe severely affected countries by the COVID-19 pandemic, which by the mid-June 2021,resulted with over 155 thousand confirmed cases or 7.470 cases per 100.000 inhabitants and263 mortalities per 100.000 inhabitants. The crisis caused by the COVID-19 pandemic, thatbegan as a health crisis in a short time has grown into an economic and social crisis, whichled to the strongest short term decline in the global economic activity in the past 150 years.This crisis besides the health and economic implications has also contributed to socialinstabilities. Economic and social implications of the COVID-19 crisis on global scale and inthe case of the Republic of North Macedonia are further analyzed within the paper. Analyzesof the economic impacts of the crises is based on the movement of the key macroeconomicindicators as: GDP growth rates, unemployment rates, Gross debt, etc. Analyzes of the socialimpacts of the crises is focused on the reduced incomes, increased inequality in incomedistribution and poverty growth. At the end of the paper is given summery overview of socioeconomicimpacts caused by COVID-19 pandemic in the country and there are designed someproposals to policy makers applicable in the later stages of the crisis and in the period ofeconomic recovery. This proposals are aimed to support the process of reaching the forecastgrowth rates and to increase the investment process and private consumption in the country,in direction of achieving sustainable growth in future

THE ROLE AND THE DEVELOPMENT OF CONTEMPORARY SCHOOL

School is the most beautiful place and institution in the life of a child and its purpose is to provide conditions of security and development for the time he will spend there. School is a long journey on the path of raising the intellectual, cultural, educational and health of the child. This study ventures to explore theoretical problems of educational process, which are changing school, methodology of changing school, models , models of planning the changes in school. It is suggested that school must be changed , and the change its means progress. So, if we have to change the school, firstly we have to change the teachers, students. Article visualizations

HORMONSKO NADOMJESNO LIJEČENJE CLIMENOM© I NJEGOV UČINAK NA TKIVO DOJKE

Objective. To evaluate the effect of the hormone replacement therapy on breast changes in postmenopausal women. Material and methods. The study includes 35 women with natural or surgical menopause who were treated with sequential estrogen/progestogen hormone replacement therapy (E/P HRT) during one year. The therapeutic program consisted of three weeks treatment with estradiol valerate 2 mg/day orally, combined with ciproterone acetate 1 mg/day in the last 10 days (Climen© – Schering) followed by one week pause. Before the start with E/P HRT basic mammography and ultrasound examination of the breast tissue was performed in all patients. At the end of the study after 12 therapeutic cycles, control mammography and ultrasonographic examination were done. Results. In the short-term study 18 patients (51.43%) showed regression of the finding, 15 (42.86%) stagnation, and only 2 (5.71%) progression of the finding (D=0.27, p<0.01). Conclusion. A clear consensus regarding the relationship between HRT and breast cancer risk cannot yet be drawn.Cilj rada je bio vrednovati učinak hormonskog nadomjesnog liječenja na promjene dojke u 35 žena u post¬menopauzi. Bolesnice i način istraživanja. 35 žena u prirodnoj ili kirurškoj postmenopauzi je kroz jednu godinu liječeno sekvencijskom hormonskom nadomjesnom terapijom (HNL). Terapijska shema je bila tri tjedna estradiol valerijanat 2 mg/dan peroralno, kombinirano s ciproteron acetatom 1 mg/dan posljednjih 10 dana (Climen© – Schering) te nakon toga sedam dana stanke. Prije početka HNL svima je pacijenticama učinjena mamografija i ultrazvučni pregled dojki. Na kraju studije, nakon 12 terapijskih ciklusa, učinjeni su kontrolna mamografija i pregled ultrazvukom. Rezultati. U kratkoročnoj studiji u 18 pacijentica (51,43%) nastupila je regresija nalaza, u 15 (42,86%) stagnacija i u 2 (5,71%) pacijentice progresija nalaza (D=0,27, p<0,01). Zaključak. Jasni dogovor u pogledu odnosa između hormonskog nadomjesnog liječenja i raka dojke još se ne može donijeti

Androgen Secreting Steroid Cell Tumor of the Ovary Represented with Postmenopasal Bleeding and Extensive Hirsutism

Introduction: Steroid cell tumors of the ovary present less than 0.1% of all ovarian tumors and belong in the group of sex cord-stromal tumors.Case description: We present a case of 69-year-old woman investigated because of postmenopausal bleeding, a 5-year history of excessive hirsutism, baldness and acne. The evaluation revealed elevated serum testosterone, but ultrasound detected a 2 cm-mass of the left ovary. The patient underwent hysterectomy and bilateral adnexectomy. The histopathology diagnosis was steroid cell tumor, not otherwise specified. Postoperative chemotherapy was administered at the discretion of the radio-oncologist. At the last follow-up 48 months after surgery, the hirsutism was completely resolved, the serum testosterone was within the normal range and there was no evidence of recurrence.Conclusion: In adult patients with hirsutism and elevated serum testosterone a possibility of a presence of an ovarian steroid cell tumor should be considered. Surgery is the main treatment of such patients

ER: YAG Application and its benefits before and during prosthodontic treatment

Background: Prosthodontic cases usually include all concepts of dentistry and integrates ef¬fective comprehensive treatment planning. The practice will necessarily include a wide variety of patients seeking a diverse range of care. Lasers have become an integral part of treatment in variety of indications in prosthodontics. Material and method: In this presentation we will present 5 different clinical cases and indications, typically present in every day prosthodon¬tic practice. We followed the results and post laser treatment healing of Er: Yag removal of Epulis fissuratum, Er: Yag crown lengthening procedure and gingival re-contouring, Er: Yag gum depigmentation and uncovering submerged implants with Er:Yag. We have applied two different types Erbium lasers and compared the results. Results: During the laser treatment most of the patients didn’t require infiltrative anesthesia, the laser procedure is comfortable and nearly painless. The gingival bleeding is diminished and controlled due to the coagulation effect of the laser and the following prosthodontic treatment was applied much faster. Conclu¬sion: There are many clinical, aesthetic and psychological reasons to use lasers in all aspects of dentistry, including the reduction or elimination of anesthetics. The laser is not merely just a ‘‘hightech’’ gadget: it is an extremely useful piece of equipment for the dental practice and gives us series of benefits comparing to the traditional tools and methods

Ovarian Strumal Carcinoid Tumour: Case Report

BACKGROUND: Ovarian strumal carcinoid is a germ cell tumour characterised by a mixture of thyroid tissue and carcinoid. Ovarian struma is a very rare occurrence with 0.3-1% incidence of all ovarian tumours and 3% of mature teratomas. Primary carcinoid ovarian tumours are still uncommon as a part of mature teratoma or mucinous cystadenoma. There are four major variants of a carcinoid tumour: insular, trabecular, strumal and mucinous. A strumal carcinoid is an unusual form of ovarian teratoma composed of an intimate admixture of thyroid/carcinoid tissues.CASE REPORT: This is a case report of a 59-year old woman with a 5-year clinical history of perimenopausal uterine bleeding and three explorative curettages. Gynaecological and ultrasound examinations revealed ovarian enlargement with a diameter of 50 mm with hypoechoic zones suspected of benign teratoma. The diagnostic test such as Ca-125, AFP, free-T4 and TSH was in normal range. A smooth, solid right ovarian 50 an mm-size tumour, as well as small amount of fluid in the Douglas pouch, was found during the total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging biopsy.  The histopathology revealed teratoma with strumal carcinoid tumour IA stage according to AJCC 2010 of the right ovary and negative cytopathology of the fluid from the Douglas pouch. On the postoperative 2-year control, the patient was tumour free, and Ca-125, free-T4 and TSH were in normal range.CONCLUSION: We would like to point out those specific diagnostic tools, such as ultrasound and Ca-125 have low specificity and sensitivity in detection of this rare ovarian malignancy

Endometrioid Adenocarcinoma Arising in Adenomyoma in a Woman with a Genital Prolapse - Case Report

BACKGROUND: Endometrial cancer is the third-ranked genital malignancy in women and includes 3% of cancer deaths. There is a 2.8% chance of a woman developing endometrial cancer during her lifetime. Low-grade endometrioid adenocarcinomas are often seen along with endometrial hyperplasia, but high-grade endometrioid adenocarcinomas have more solid sheets of less-differentiated tumour cells, which are no longer organised into glands, often associated with surrounded atrophic endometrium.CASE REPORT: We present an unusual case of endometrial adenocarcinoma arising in adenomyoma in 74-year old woman presented with genital prolapse, without other clinical symptoms. Ultrasound evaluation revealed endometrium with 4 mm-thickness and atrophic ovaries. The cervical smear was normal. The patient underwent a total vaginal hysterectomy. The histopathology of the anterior uterine wall revealed an intramural adenomyoma of 4 mm in which some endometrial glands with malignant transformation of well-differentiated endometrioid adenocarcinoma without infiltration in surrounding myometrium and lymphovascular invasion were present. The endometrium lining the uterine cavity was predominantly atrophic, and only one focus of simplex and complex hyperplasia was found, with cell-atypia. According to AJCC/FIGO 2010, the tumour was classified: pTNM = pT1B pNX pMX G1 R0 L0 V0 NG1, Stage I. On dismiss, the near-future oncological consultation was recommended.CONCLUSION: We would like to point out the rare occurrence of such type of malignancy and the importance of meticulous histopathology evaluation, even after reconstructive surgery for genital prolapse

Analyses of the Spirits Market and Possible Implications for Marketing Strategy in Macedonia

Although mostly associated with the harmful consequences of alcohol abuse over the public health, the industry of distilled spirits represents a very important and substantial part of the economy. Nowadays, the spirits industry does not only consist of alcoholic beverages; but it is part of many cultures, creates a certain image, and provides additional incomes for the economy in the form of taxes and excises, as well as job creation. The main aim for writing this paper on this topic was to analyze the Macedonian spirits market and to suggest a marketing strategy through making parallel comparisons between specifics in different spirits markets in the world and the spirits industry in Macedonia. Working in the spirits market industry requires careful execution of the company's strategies and policies, while respecting all the legislation procedures. That is why when entering the spirits market; a good and essential analysis is necessary