Influence of Gender and Age on Average Dimensions of Arteries Forming the Circle of Willis Study by Magnetic Resonance Angiography on Kosovo’s Population

BACKGROUND: Circulus arteriosus cerebri is the main source of blood supply to the brain; it connects the left and right hemispheres with anterior and posterior parts. Located at the interpenducular fossa at the base of the brain the circle of Willis is the most important source of collateral circulation in the presence of the disease in the carotid or vertebral artery.AIM: The purpose of the research is to study the diameter and length of arteries and provide an important source of reference on Kosovo’s population.METHODS: This is an observative descriptive study performed at the University Clinical Center of Kosovo. A randomised sample of 133 angiographic examinations in adult patients of both sexes who were instructed to exploration is included.RESULTS: The diameters and lengths measured in our study were comparable with other brain-cadaver studies especially those performed by MRA. All dimensions of the arteries are larger in male than female, except the diameter of PCoA that is larger in female (p < 0.05) and length of the ACoA (p < 0.05). Significant differences were found in diameters of arteries between the younger and the older age groups.CONCLUSION: Knowing the dimensions of the arteries of the circle of Willis has a great importance in interventional radiology as well as during anatomy lessons

Overview of the Regulatory Framework for Radiopharmaceuticals

Radiopharmaceuticals are products that have the particularity of combining two very restrictive regulatory requirements depending on two different authorities: that of the drug in the pharmaceutical sense and that of a radioactive source linked to a specific authorization system. Radiopharmaceuticals are a new reality in the pharmaceutical industry and are considered to be an indicator of modern medicine and the technological industry. The exponential increase in their use is attributed to their dual use as diagnostic and therapeutic agents. They represent a group of pharmaceutical preparations, which contain radionuclides with short half-lives and are mainly administered intravenously. Maximum care should be taken during their production, distribution, storage, and disposal because their radiant nature is a concern for both patients and medical staff. All stages of production must be done by the requirements of Good Manufacturing Practice. Therefore, radiopharmaceuticals must meet the requirements of the pharmaceutical regulator, the same as those of the nuclear regulator. The largest number of regulatory bodies in the world have different perspectives in terms of their production, distribution, transportation, storage, and disposal. However, in developed countries, the regulator of radiopharmaceuticals is in its infancy. In this article, we will shed light on the various regulatorylimitationsimposedbythesestatutes, emphasizing that these regulations are therefore likely to evolve in the years to come and to demonstrate the importance of their development, proper use, and perspective

medication-overuse headache (MOH)

Migraine is a common headache disorder that causes significant disabilities. Headache developed or significantly worsened during medication overuse (for simple analgesics and combination acute medications, intake must be 15 days or more per month for triptans, ergotamines, opioids, and combination analgesics; 10 days per month sufficient to get a diagnosis of Medication-overuse headache-MOH). A recent epidemiologic study on drug-induced disorders demonstrated that excessive drug use can lead to nephrotoxicity. Microalbuminuria was common in patients under the influence of nephrotoxic drugs. Subclinical renal damage cannot be identified by routine tests (serum creatinine), and microalbuminuria is a more sensitive indicator of renal dysfunction. The aim is to confirm the sensitivity of certain biomarkers when comparing patients treated with NSAIDs in combination with other drugs (analgesics, triptans and antidepressants) with patients treated with monotherapy by NSAIDs Besides conventional markers of renal functioning (serum/urine creatinine determined by Jaffe methods), enzymatic assay for urea serum and Jon selective electrode (ISE) are used fordetermination of electrolite in serum. Imunoturbodimetric assay for determination of urinary albumin, microalbuminuria and β2- microglobulin will be used. In the case of combination therapy (analgesics, triptans and antidepressants) a significant effect on the increase of microalbuminuria has been demonstrated. Keywords: Medication-overuse headache, Nephrotoxicity, Microalbuminuria

Comparison of the sensitivity of several biomarkers in patients with medication overuse headache (MOH)

Migraine is a common headache disorder that causes significant disabilities. Headache developed or significantly worsened during medication overuse (for simple analgesics and combination acute medications, intake must be 15 days or more per month for triptans, ergotamines, opioids, and combination analgesics; 10 days per month sufficient to get a diagnosis of Medication-overuse headache-MOH). A recent epidemiologic study on drug-induced disorders demonstrated that excessive drug use can lead to nephrotoxicity. Microalbuminuria was common in patients under the influence of nephrotoxic drugs. Subclinical renal damage cannot be identified by routine tests (serum creatinine), and microalbuminuria is a more sensitive indicator of renal dysfunction. The aim is to confirm the sensitivity of certain biomarkers when comparing patients treated with NSAIDs in combination with other drugs (analgesics, triptans and antidepressants) with patients treated with monotherapy by NSAIDs Besides conventional markers of renal functioning (serum/urine creatinine determined by Jaffe methods), enzymatic assay for urea serum and Jon selective electrode (ISE) are used for determination of electrolyte in serum. Imunoturbodimetric assay for determination of urinary albumin, microalbuminuria and β2-microglobulin will be used. In the case of combined therapy with NSAIDs and other medications (analgesics, triptans and antidepressants), a significant effect on the increase of microalbuminuria has been demonstrated, which signals us for a more sensitive indicator in compared to β2M which as specific bioindicator did not show a measured sensitivity for the detection of early changes in the tubular level. Significant glomerular damage has been reported in patients with combination therapy than patients treated with NSAID monotherapy. Following the levels of specific biomarkers, we can use them as signals for early detection of nephrotoxicity, especially in patients treated with combination therapy requiring special attention when administering them

Low Molecular Weight Heparins (LMWH) in the Treatment of Recurrent IVF-ET Failure

Implantation failure is common in assisted reproductive technology. LMWH can alter the hemostatic response to the controlled ovarian stimulation and modify the risk of thrombosis. It can also modulate many of the fundamental physiological processes required for blastocyst apposition, adherence, and implantation, as well as trophoblast differentiation and invasion due to its similarities with heparan sulfates and has the potential to improve pregnancy rates and outcomes.Our study, represents a retrospective study, which was undertaken during 01 January 2012 – 31 December 2013, in the Department of Gynecology and Obstetrics, at Clinical Hospital in Tetova. The patient demographic: date, month and week of pregnancy; diagnosis; drug details; which include name of the drug, dosage form, dose frequency were recorded.During the period of two years, the number of patiens which received anticoagulation therapy after in viro focundation was 14. The age group with the highest attendance was \u3e35, 6 patients (42.85 %). For 7 patients (50 %), this was their fourth pregnancy. The majority of patients 9 (64.28 %) were treated with Clexane (enoxaparin) 4000 IU anti-Xa in 0.4mL. Despite in vivo and in vitro evidences in favor of the alleged beneficial effect wholesale adoption of this strategy into routine practice will not become a gold standard until further research confirms the presence of such an effect and reveals its exact mechanism of action

Internal Audit as a Management Tool in Pharmaceutical Industry

The internal audit is an important control function within a pharmaceutical industry. It ensures a thorough analyses and evaluation of the company activities and informs the management on the effectiveness of the company quality controls of their processes and products. These audits ensure compliance with Good Manufacturing Practice (GMP) requirements. A well designed checklist is a key tool to assist in conducting an internal audit. It consists of several series of questions that will help verifying if the control system maintains GMP compliance and to find and address any violations or critical items. Although, internal audit is not a regulation requirement, the information obtained from it, can play a valuable role in production, process performance and quality monitoring as outlined in ICH Q10

The importance of compression elastography in the evaluation of thyroid nodule malignancy

Introduction/Objective. Compression, also called strain elastography imaging techniques, represent new echotomographic modality, which is a promising method for the differentiation of benign from malignant lesions, not only in the thyroid gland but also in other organs. The objective of this study is to evaluate the importance of compression elastography in the differentiation of benign and malignant thyroid nodules. Methods. We performed echotomographic examinations in B mode, and examinations using compression elastography in a total of 186 persons (152 females and 34 males, with the average age of 45.3 ± 13.5 years), with 264 nodules in the thyroid gland. Elastography was done in two steps: the first one through scoring elastographic figures, and the second one through the determination of the resistance index (strain ratio – SR). Results. Using elastography scores by Fukunari, 44 of 60 malignant nodules had a score of 3–4, while 152 of the 204 benign nodules had a score of 1–2. Using the receiver operating characteristic (ROC) analysis, the best cut-off point obtained using elastography scores was 2, with a sensitivity of 73.3% and specificity of 74.5%. Using the software-calculated SR we found that out of 89 nodules with SR ≥ 2.5, 52 were malignant nodules, while out of 175 nodules with SR 2.5, with a sensitivity of 86.7%, and specificity of 81.9%. Conclusion. As a follow-up of standard echotomographic examination in B mode, compression elastography is a newly developed and promising technique in the differentiation of benign from malignant lesions. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175030

The importance of patient compliance with medicines storage recommendations

Proper storage and handling of medicines throughout the distribution chain to the consumer/patient is an important process that affects the quality of medicines as a prerequisite for the effectiveness and safety of medicines. The patient, as the user, the end in that chain, has a very important role, because every person usually stores in their home medicines for the treatment of certain diseases or incidental use. All medicines should be stored in compliance with the storage recommendations/instructions that are determined by the manufacturing drug company, marked on the medicine packaging, and on the patient information leaflet. Non-compliance and non-implementation of these recommendations cause significant changes in the quality of the medicines, which may result in decreased efficiency or problems with the safety of the medicines. Therefore, the purpose of this paper is to analyze the importance of patient compliance with medicines storage recommendations and the consequences of non-compliance with them

Anatomical and MRI relations of the cerebral aqueduct to the adjacent parts of the brain and calvaria

Introducton/Objective. Insufficiency of relevant anatomic data and great neurological and neurosurgical significance were the reasons for this study with scientific and practical implications. The purpose was to determine, at the transverse in situ section of the head, the position and relations of the sylvian aqueduct of the mesencephalon by measuring its distances from particular brain and calvaria structures. Also, the aim was to determine the same distances according to axial sections by using MRI. Methods. The material consisted of twenty autopsy human heads. The section of the head was made at the level of the tentorial hiatus and the midbrain. After that, we measured the distances between the cerebral aqueduct and a) posterior border of the optic chiasm, b) upper border of the dorsum sellae, c) terminal bifurcation of the basilar artery, d) beginning of the straight sinus, e) internal occipital protuberance, f) tentorial edge (lateral from the aqueduct), and g) internal surface of the calvaria (lateral to the aqueduct). We determined the same distances by the MRI system. The measurements were made in 37 subjects. Results. The numerical data obtained by this study will be of benefit to neurosurgeons in choosing a surgical approach to the contents of the incisural space, and to neurologists for the exact localization of the lesion and interpretation of certain signs and symptoms. Conclusion. The results of a detailed examination of the sylvian aqueduct position and relations have shown that the use of MRI is the morphometric method of choice, because it is more precise for all the parameters monitored than in situ measurements. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175030