Severe Encephalitis in Infant with COVID-19: A Case Report

BACKGROUND: Encephalitis is a serious condition that contains neurological dysfunction cause by inflammation of the brain tissue. Etiological factors for the occurrence of this condition include infectious and non-infectious causes. CASE REPORT: We are presented 9-month-old infant referred to our clinic in convulsive status, fever, and disturbed consciousness. From anamnestic information, the infant has been febrile for 2 days with profuse vomiting initiating just before admission at the clinic. At the moment of admission in the clinic, the infant looked intoxicated with generalized tonic-clonic seizures, with shortness of breath and fever with a weakened reaction to painful stimuli. It was admitted in the Isolation Unit by the protocol of the clinic. Laboratory investigations were done. Due to the persistence of convulsive status, a computed tomography scan of the brain was performed with the finding of enlargement of the lateral ventricles, with intraventricular masses and pronounced internal hydrocephalus. The results of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) from the infant were positive as well as the grandmother. The infant was intubated immediately and put on mechanical ventilation SIPPV. CONCLUSION: Our case report could suggest that SARS-CoV-2 infection may cause severe clinical symptoms, neurological manifestations, and encephalitis in infants

Централна дебелина: oбем на половина, однос обем на половина и колкови, однос обем на половина и висина кај 13-годишни деца

Obesity in children is a growing worldwide health problem, with a tenfold increase over just four decades. The aim of this study was to determine the prevalence of obesity and to identify central obesity in children aged 13 years from southwestern part of North Macedonia. Materials and methods: This cross-sectional study included a total of 178 healthy children of both sexes (boys 98, girls 80) aged 13 years living in Tetovo, North Macedonia. Results: The prevalence of categorized BMI according to CDC in all 13-year old children (n=178) was 4.5% underweight, 20.2% overweight and 16.3% obese. Among boys, the total prevalence of underweight, overweight and obese was consistently 4.1% vs. 19.4 %vs. 15.3%, while girls had statistically insignificant higher prevalence of underweight, overweight and obese 5% vs. 21.2% vs. 17.5%. At a comparison of the central obesity parameters like WC,WHR, WHtR showed statistically significant differences between sexes (p<0.003, p<0.0001, p<0.011).In the entire sample, the prevalence of high risk for waist-to-hip ratio (WHR) was 34.3% and the prevalence of high risk for waist-to-height ratio (WHtR) was 31.5%. In boys, the prevalence of high risk for WHR was 51% and for WHtR was 35.7% while in girls for WHR was 13.8 % and for WHtR 26.2%. A significant association of male gender with high risk for WHR (X2=27.161; df=1; p=0.0001) was found while for WHtR (X2 =1.830; p=0.176) there was no statistically significant sssociation. It is important to underline that in boys the risk of central obesity was 6.53 times higher compared to girls of the same age [OR=6.53 (3.08–13.83) 95% CI. Conclusions: In our study girls had a higher BMI prevalence of general overweight and obesity vs. boys, and a significant association of male gender with high risk for WHR was detected. Additionally, healthcare professionals should always consider assessing the measurements and risk of central obesity in obese or overweight children, and seek for the unique risk factors associated with each type of obesity and tailor interventions accordingly.Дебелината во детска возраст е сè поголем јавноздравствен проблем глобално, со десеткратно зголемување во текот на последниве четири децении. Целта на оваа студија беше да се процени преваленцијата на дебелината и да се идентификува централната дебелина кај децата на возраст од 13 години во северозападниот дел на Р.С. Македонија. Материјали и методи: Во оваа студија на пресек беа вклучени вкупно 178 здрави деца од двата пола (момчиња 98, девојчиња 80) на 13-годишна возрастод Тетово, Северна Македонија. Резултати: Преваленцијата на катагоризираниот БМИ според CDC кај сите 13-годишни деца (n=178) беше 4,5% потхранети, 20,2% натхранети и 16,3% дебели. Кај момчињата вкупната преваленција на потхранети, натхранети и дебели беше 4,1%; 19,4%; 15,3%,  додека кај девојчињата имаше статистички незначителна поголема преваленција на потхранети, натхранети, и дебели 5%; 21,2%; 17,5%. При споредбата на параметрите за централна дебелина како WC, WHR, WHtR истите покажаа статистички значајни разлики помеѓу половите (p<0,003, p<0,0001, p<0,011). Кај целиот примерок, преваленцијата на висок ризик за WHR беше 34,3%, додека преваленцијата на висок ризик за WHtR беше 31,5%. Кај момчињата, преваленцијата на висок ризик за WHR беше 51%, а заWHtR беше 35,7% додека кај девојчињата за WHR беше 13,8%,а за WHtR 26,2%. Утврдивме статистички сигнификантна поврзаност на машкиот пол со висок ризик за WHR (X2=27.161; df=1; p=0,0001), додека за WHtR (X2 =1.830; p=0.176) не постои статистички значајна поврзаност. Важно е да се нагласи дека кај момчињата ризикот од централна дебелина беше 6,53 пати поголем во споредба со оној кај девојчињата на истата возраст [OR=6,53 (3,08-13,83) 95% CI]. Заклучок: Оваа студија покажа дека девојчињата во споредба со момчињата имаа повисока преваленција на БМИ, потхранетост и дебелина, а беше регистрирана значајна поврзаност на машкиот пол со висок ризик за WHR. Здравствените работници треба секогаш да размислуваат за проценка и на ризикот од централна дебелина кај дебели и натхранети деца, како и идентификување  на факторите на ризик поврзани со секој тип на дебелина и соодветно приспособување на понатамошните интервенции

DEFINING SEISMIC PARAMETERS FOR AN ESSENTIAL ELECTRIC POWER FACILITY

For the purpose of building a new electric power facility a project to determine seismic potential and seismic parameters for design is produced. Multiple in-situ geophysical investigations have been performed and soil samples have been taken to the laboratory where simple shear tests are done to determine the dynamic parameters of the soil layers. As a result, the dynamic shear modulus and damping ratio vs shear strain relationships of characteristic soil materials were defined. The response analysis was done using these curves, where the effects of the sub-surface local soil medium have a dominant influence upon the amplitude and frequency modification of the expected ground motion. Finally, the seismic design parameters, maximum accelerations at foundation level for design and maximum earthquake site-specific response spectrum have been obtained

Surgical Treatment of a Seven-Year-Old Boy with Refractory Epilepsy Due to Focal Cortical Dysplasia, Case Report

The most common developmental malformation encountered in patients with refractory epilepsy is Focal Cortical Dysplasia (FCD). Malformations of cortical development, in particular FCDs are identified in 20–25% of patients with focal epilepsy, and approximately 76% of these patients are supposed to suffer from drug-resistant epilepsy. A promising therapy option for these patients could be surgical treatment. We present a seven-year-old child with drug-resistant epilepsy, who underwent surgical treatment that had an excellent outcome. Throughout the period of five years, the index patient was admitted several times to the Department of Neurology at the University Pediatrics Clinic-Skopje. He was initially admitted at the age of two years, because of his first episode of febrile seizures accompanied by diarrhea. In the following period, during the hospitalization, febrile seizures also developed. CT findings showed a slight degree of front parietal cortical reduction, while the first MRI showed a slight dysmorphia at the frontal gyri, yet no focal abnormalities. The initial EEG revealed a bihemispheric epileptogenic focus. The reason for constant treatment alterations was drug-resistance. Although some encephalographic stabilization had been achieved, a full clinical response had never been obtained for a prolonged period. At the age of seven years, a pediatric epilepsy surgical team at the University School of Medicine–ACIBADEM, Turkey, evaluated the patient. The conclusion of the team was that the child is a candidate for surgical treatment of epilepsy. The child underwent surgery at the age of eight years and has been seizure free since.Keywords: Focal Cortical Dysplasia, Epilepsy, Surgery

Outcomes of ultrasound-monitored treatment of divelopmental dysplasia of the hip graf type II

Introduction: The management of developmental dysplasia of the hips (DDH) type Graf IIa is still controversial. This study aims to examine the outcomes of ultrasound-monitored Pavlik harness treatment, as well as the effects of associated factors, such as gender, side of DDH, the age at the treatment start, and laterality on the treatment outcomes in different Graf type II subtypes. Methods: A cohort retrospective investigation was performed on 88 ultrasound-screened infants or 125 hips diagnosed with Graf type II dysplasia during a six-month period at a single institution, the University Clinic for Orthopedic Surgery, Skopje. Subsequently, 47 infants (18 boys, 29 girls) or 73 hips who underwent Pavlik harness treatment with at least one follow-up throughout treatment monitoring were included in this study. Results: The treatment success rate of the right DDH Graf type IIa (-) was higher (70.8%) compared to the rate of success (50%) in the treatment of left Graf type IIa (-) hips. The mean age of the infants at the treatment start in successfully treated Graf type IIa (-) hips was lower (9.12 ±2.27 weeks) compared to the age of the infants with treatment failure at the last follow-up (11.33 ±3.06 weeks), P= 0.04. Conclusion: The age of treatment initiation and the side of DDH were the most relevant factors related to the treatment outcome. Infants with maturational deficit hips, Graf type IIa (-), should undergo early initiated, carefully guided, and monitored Pavlik harness treatment

Achalasia of the cardia - a pediatric case report

Introduction: Achalasia is an esophageal motor disorder characterized by aperistalsis of the esophageal body and lack of relaxation of the lower sphincter in response to swallows. It affects both sexes and all age groups. The exact etiology of this degeneration is unclear though many theories have been proposed. Possible etiology of achalasia can be familial, infection or autoimmune. Patients often present with progressive dysphagia to solids and liquids, heartburn, chest pain, regurgitation, and varying degrees of weight loss or nutritional deficiencies. Case report: In January 2020, a 10 years old boy was admitted to our hospital due to vomiting, chest pain during swallowing, and prolonged cough. A lot of investigations were performed. Fyberbronchoscopy showed that the trachea, the right main bronchus and the left main bronchus were with anteroposterior narrowed lumen. Computed tomography of thorax and abdomen showed dilated esophagus with largest diameter of 45 mm subcarinal with retained content.There is a compression of the right hillus. The finding indicates achalasia of the cardia. One month after the hospital stay, the child was admitted at the Clinic for pediatric surgery. Laparoscopic Heller Myotomy (LHM) with antireflux Dor fundoplication was performed. The following period the boy has no gastric or respiratory symptoms. Conclusion: We can conclude that it is worth to suspect achalasia in a pediatric patient with prolonged cough and recurrent respiratory infections refractory to conventional treatments such as bronchodilators, especially if the patient also has a history of vomiting and dysphagia

Body structure of the macedonian population

Establishing the structural components of the body: bone, muscle and fat is of great significance in sport orientation and selection as in entire biophysical development in young people. Nowdays, when there is hypokinetics in the modern world, there is a greater disbalance between active (muscle) and inactive (fat) components, which enlarge the value of “ballast” tissue. The material comprised personal files of 200 Macedonian examinees 14 years old,100 females and 100 males. On the basis of manifested anthropometrical variables, structural components of the body are established, in Macedonian children at age 14 who live in Skopje area, living in approximately equal socio-economic conditions. For quantitative determination of the absolute values of the bone (0 kg), muscle (M kg) and fat tissue (D kg), the dynamic anthropometric method by J. Meteigka was applied. At the age of 14 years, the absolute values of the bone mass (0 kg) was 9.91 (17,04%) in the males and in the females it was 7,83 (14,63%). The muscle mass (M kg) was 31.52 (52,04%) in the males and 27.89 (51.49%) in the females. The fat structural component (D kg) was 7.18 (11.14 %) in males and 7.02 (12.32 %) in females. The difference among sexes in the Macedonian population at the age of 14 years is very significant for the bone mass. At this age in male examinees bone mass is in high correlation with the diameter of the knee joint and in females with the diameter of the elbow, so they can serve as most valid sign in maintaining the bone mass. Muscle mass at 14 year age is in correlation with the circumference of the upper arm in males and with total muscle mass in females. Fat structural component at this age is higher in females then in male examinees, and is in high correlation with the body mass

Baseline Surveillance in Li-Fraumeni Syndrome Using Whole-Body Magnetic Resonance Imaging: A Meta-analysis.

Importance Guidelines for clinical management in Li-Fraumeni syndrome, a multiple-organ cancer predisposition condition, are limited. Whole-body magnetic resonance imaging (WBMRI) may play a role in surveillance of this high-risk population.Objective To assess the clinical utility of WBMRI in germline TP53 mutation carriers at baseline.Data sources Clinical and research surveillance cohorts were identified through the Li-Fraumeni Exploration Research Consortium.Study selection Cohorts that incorporated WBMRI for individuals with germline TP53 mutations from January 1, 2004, through October 1, 2016, were included.Data extraction and synthesis Data were extracted by investigators from each cohort independently and synthesized by 2 investigators. Random-effects meta-analysis methods were used to estimate proportions.Main outcomes and measures The proportions of participants at baseline in whom a lesion was detected that required follow-up and in whom a new primary malignant neoplasm was detected.Results A total of 578 participants (376 female [65.1%] and 202 male [34.9%]; mean [SD] age, 33.2 [17.1] years) from 13 cohorts in 6 countries were included in the analysis. Two hundred twenty-five lesions requiring clinical follow-up were detected by WBMRI in 173 participants. Sixty-one lesions were diagnosed in 54 individuals as benign or malignant neoplasms. Overall, 42 cancers were identified in 39 individuals, with 35 new localized cancers treated with curative intent. The overall estimated detection rate for new, localized primary cancers was 7% (95% CI, 5%-9%).Conclusions and relevance These data suggest clinical utility of baseline WBMRI in TP53 germline mutation carriers and may form an integral part of baseline clinical risk management in this high-risk population

Introducing Team-Based Learning (TBL) at Faculty of Medicine

Background: TBL value in medical education is in promoting individual accountability while developing skills for teamwork. Summary of work: TBL sessions were introduced since 2010 to medical students at UGD. Two TBL sessions were administered for each of the courses ‘Fundamentals in Immunology’ and ‘Clinical Immunology’. Sessions were conducted in collaboration with the E-learning Center. Summary of results: TBL sessions were adjusted to 60 minutes sessions. A total of 544 medical students, 487 in Fundamentals of Immunology and 57 in Clinical Immunology underwent the TBL sessions. Students were divided in groups of 5-6 students and were initially administered a short Readiness Assessment Test followed by case presentations, discussions and teams answers to multiple-choice questions. TBL sessions were not obligatory. Points were awarded for presence and the winning team was awarded extra points. Because of the large number of students, two sets of TBL sessions on the same topic were created and administered. Conclusions: TBL sessions were very well accepted and enjoyed by the students. Students very much preferred this type of interactive, active learning as opposed to classical lecturing. Take-home messages: TBL sessions are a valuable teaching tool that can also be administered in medical schools in developing countries