Parenteral application of drugs, uretheral catheterization

Obtaining parenteral application of drugs and urethral catheterization are essential skills for all physicians. Peripheral intravenous access is one of the simplest invasive procedures, but mastering this potentially lifesaving intervention requires refined skills and experience. It is required in a broad range of clinical applications, including intravenous drug administration, intravenous hydration, and transfusions of blood or blood components, as well as during surgery, during emergency care, and in other situations in which direct access to the bloodstream is needed

COST Action “Harmonizing clinical care and research on adrenal tumours in European countries” (HARMONISATION) CA20122

Adrenal tumours affect more than 3% of the population aged > 50 years, and their absolute prevalence is increasing due to population aging. Most of these tumours are benign and hormonally inactive. However, 2-10% of them are at risk of malignancy, and 20-40% present hormone over-secretion, leading to significant morbidity. Management of adrenal tumours is quite heterogeneous, and this leads to substantial inequality in patient care throughout Europe. In this context, the goal of HARMONISATION is to constitute a multidisciplinary network to harmonize clinical care and research on adrenal tumours throughout Europe. Our focus will be on COST Inclusiveness Target Countries (ITCs). In addition, this collaborative network will establish a modern framework to develop a new generation of real-time and real-life randomized clinical trials, which will be federated and registry-based. For this purpose, HARMONISATION will be organized in five Working Groups: 1. Harmonizing clinical practice for adrenal tumours; 2. Harmonizing adrenal tumour research and -omics practice; 3. Harmonizing Information Technology (IT)/Artificial Intelligence (AI) tools towards a standardized registry; 4. Harmonizing the ethical and legal framework required for federated European trials; and 5. Communication, dissemination, and inclusiveness. The successful execution of HARMONISATION’s goals is guaranteed by the collaboration of clinicians, researchers, and experts from other relevant fields, including artificial intelligence, data science data protection, legal and ethical issues, and patients’ representatives

COST Action “Network for Research in Vascular Ageing” (VascAgeNet) CA18216

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, regardless of gender, ethnicity or income. The concept that vascular age, as opposed to chronological age, is better related to the prognosis of CVD is rapidly evolving. Arterial stiffness is an important component of vascular ageing and a potent CVD risk predictor, and as such is emerging as an appealing therapeutic target. Despite recent technological advances for the measurement of vascular ageing in clinical practice, unmet needs remain including: complexity of use and heterogeneity of approaches, insufficient validation in clinical settings, fragmentation of expertise, and lack of research driven studies regarding treatment and head-to�head comparisons between different techniques

Influence of the Subclinical Hypothyroidism on the Left Ventricular Systolic and Diastolic Function (pilot study)

Introduction: The clinically manifested hypothyroidism is associated with systolic and diastolic dysfunction. Studies investigating the left ventricular function in subclinical hypothyroidism (ScH) have shown controversial results. The aim of the study was to assess whether ScH is associated with the left ventricular systolic and diastolic dysfunction. Material and methods: Seventeen consecutive patients with newly diagnosed ScH and 20 healthy euthyroid patients as controls were analyzed. The two groups were appropriate by: age, sex, and body mass index. Laboratory analyses were performed in all patients - determination of TSH, free thyroxin (FT4), free triijodothyronine (FT3), antibodies directed to thyroid peroxidase (TPOAb) and antitiroglobulin antibodies (TgAb), and the assessment of left ventricular systolic and diastolic function by M-mode, two-dimensional echocardiography, pulse, continuous and color-Doppler, advanced echocardiographic modalities Tissue Doppler (TDI) and two-dimensional speckle tracking. Results: ScH patients had statistically significant lower ejection fraction, smaller ratio s/d (where s is the systolic velocity and d is the diastolic velocity through the pulmonary veins) and lower negative longitudinal global strain compared with the control group (62.1 ± 2.1 vs. 58.7 ± 6.2%, p<0.05, 1.27 ± 0.12 vs. 1.06 ± 0.20, p<0.001, -0.21 ± 0.01 versus -0.19 ± 0.01%, p<0.05, respectively). There was a statistically significant negative correlation of TSH with s/d and S/ TDI (r = 0.43 and r = 0.26, p<0.05, respectively). There was a statistically significant negative correlation of free thyroxine with myocardial performance index (r = -0.17, p<0.05), and a positive correlatin with s/d (r =0.48, p<0.05). Conclusion: ScH was associated with a statistically significant reduction in global systolic and global longitudinal systolic function of the left ventricle

Comparison of Diet, Metformin and Insulin in the Treatment of Gestational Diabetes Mellitus

Objective: The aim of the study was to compare maternal and neonatal outcomes in patients with gestational diabetes mellitus (GDM) treated with metformin versus those with insulin, or diet alone. Material and methods: The study included 24 GDM women treated with metformin, 21 treated with insulin, and 17 women only on diet. All patients were from Outpatient Department of Endocrinology in the period from May, 2008 to October, 2010. Results: The three groups were comparable with respect to age, pre-pregnancy body mass index (BMI), weight gain during pregnancy, gestational week at enrolment, smoking cigarettes and positive family history for diabetes. Mean glycosylated haemoglobin (HbA1c) at 37 gestation week was lower in diet and metformin groups than insulin group (4,5±0,9, 5,3±0,7, and 6,1± 1,3 %, respectively, p< 0,01). Postprandial glycaemia (PPG) statistically significant differed in diet from metformin group (6,2±2,1 v.s. 7,5±1,1 mmol/L, p< 0,05) and in diet as to insulin group (6,2±2,1 v.s. 8,3±2,3 mmol/L, p< 0,01). There were statistically significant difference in mean gestational age at delivery, between the three (diet, metformin and insulin) groups (39,1±2,2; 38,7±1,6 and 37,3±2,4 gestation week, respectively, p< 0,05). The incidence of neonatal hypoglycemia was higher in the insulin group (52,4%) than in the metformin (33,3%) and diet group (17,6%), but there was statistically difference between insulin and diet group (p=0,04). No differences between the groups were observed in mode of delivery, birth weight, and incidence for large or small for gestational age. Conclusion: Metformin is effective, easy and safe in controlling GDM. Author Keywords: Gestational diabetes mellitus, metformin, insulin, glycaemia

AV block type2 as a cardiovascular complication of COVID-19

Introduction: COVID 19 is a serious disease which has symptoms that range from asymptomatic to moderate and severe pain symptoms including fever, cough, and dyspnea due to pneumonia. Cardiac complication includes: acute myocardial infarction, arrhythmias, heart blocks and cardiomyopathies. Objective: To present a case in a patient with AV block type 2 (Mobitz II) as a complication of COVID 19 infection. Material and methods: The patient was admitted to our hospital with fatigue, palpitations, anxiety and heaviness in the chest during exertion in the last two weeks. PCR test for COVID 19 was positive from the beginning of the symptoms, but for the entire period without worsening of the condition. Results: His blood pressure was 130/80 mmHg, heart rate was 42 beats/min, respiratory rate was 14 breaths/min, oxygen saturation was 96%. Cardiac markers are not specific. His ECG findings are shown in Figures 1 and 2. Echocardiographic findings had a left ventricular ejection fraction of 47%. Coronary angiographic findings without significant features. After a consultation, the patient was referred for implantation of a permanent pacemaker at the Clinic of Cardiology-Skopje. Conclusion: Identifying heart blocks as a potential complication of COVID-19 will help health professionals better manage the condition in this pandemic by shortening hospital stays and improving patient prognosis. Key words: Covid 19, AV block, cardiovascular complication

The Impact of Mastitis Pathogens on Antioxidant Enzyme Activity in Cows’ Milk

The beginning of lactation in dairy cows is a challenging period when cows experience oxidative stress followed by an increased risk of mastitis. This study aimed to establish a correlation between mastitis pathogens and the activity of antioxidant enzymes – superoxide dismutase (SOD) and glutathione peroxidase (GPX) – in milk collected from cows with mastitis compared with their healthy counterparts. During the two-year survey, the udder health status was followed and the changes in SOD and GPX activity in milk were assessed in the period to 42nd day of lactation. The quarter milk samples were screened for detection of abnormal milk secretion (AMS) and intramammary infections (IMI). The spectrophotometric methods were used for detection of antioxidant enzyme activity in milk serum. The prevalence of IMIs from AMS was 43.83% while the isolated mastitis pathogens were grouped as contagious: Streptococcus agalactiae (19.14%) and Staphylococcus aureus (6.17%); or environmental: Enterococcus spp. (8.02%), Pseudomonas aeruginosa (7.41%), Escherichia coli (1.85%), and Aspergillus niger (1.23%). IMI showed statistically significant influence on SOD and GPX activity in milk serum (p<0.05). Contagious bacteria lead to increased activity of GPX, while environmental pathogens more drastically increase SOD activity. Providing a balanced diet with adequate antioxidants and managing environmental stressors can help reduce oxidative stress during the transition period and decrease the risk of mastitis in early lactation. Key words: glutathione peroxidase, superoxide dismutase, mastiti

Parathyroid adenoma and angina pectoris

Introduction. A parathyroid adenoma (PA) is a benign tumor ; the most common reason of primary hyperparathyroidism (PHPT) is PA . Aim . To showed a male patient with PA without typical symptoms of PHPT, presented with chest pain and positive coronary stress test (CST), but normal coronary arteriography. Case presentation.A 44 year old man with positive CST, after normal coronary arteriography was transferred to the endocrinologist because of a nodule found in the left lobe of the thyroid gland. Nifedipine relieved the angina. On the neck ultrasound , the patient had two hypoechoic nodules (1.1 х 1.4 х 1.7 and 0.7 х 0.8x10cm) under the left lobe of the thyroid gland without symptoms of primary hyperparathyroidism (Picture 1 4). Clinical investigations showed: osteoporosis Tscore on the L1 L4 vertebrae= 3.1, and left distal radius = 4.4SD) (Picture 5 6), high total and jonizated serum calcium ( 3.0 and 1.57 mmol /L, respectivelly ) and intact PTH (320 pg /mL). Sesta mibi scaning revealed PA of the left inferior parathyroid gland (Picture 7). After conservative management, PA was surgically excided, and serum calcium and intact PTH normalized. Patohystologic result showed PA (0.6x1.2x1.6cm ) with attached parathyroid gland on the periphery of the PA. During 2 years, follow up, postoperative controls of calcium and neck ultrasound were normal and he has had no angina. Conclusion.Hypercalcemia due to PHPT may be reason for chest pain and ECG changes resulting with positive CST. Physicians should evaluate electrolyte and consider PHPT in patients presented with chest pain, EKG changes, positive CST but normal coronary arteriography

Effect of lipid parameters on fetal growth in type 2 diabetes mellitus and gestational diabetes mellitus pregnancies

Background: During pregnancy,complex changes occur in lipid profiles. The aim of the study was to evaluate the effect of lipid parameters on fetal growth in type 2 diabetes mellitus (D.M) and gestational diabetes mellitus (GDM) pregnancies. Material and methods: In forty three type 2D.M. and two hundred GDM women pregnancies were analyzed: age, body mass index (BMI), lipid parameters, HbA1c in first, second and third trimester of pregnancy, preeclampsia, and baby birth weight. Results: D.M. tip 2 and GDM group were statistically significant different in the following variables: total lipids, triglycerides, total cholesterol, BMI, age, baby birth weight, and incidence of SGA (9.4±2,3 vs. 11,0±2,3mmol/L, 2,4±1,4 vs. 3,4±1,6mmol/L, 5,5±1,2 vs. 6,4±1,4mmol/L, 30,6±5,4 vs. 26,9±5,2 kg/m2, 34±7,8 vs. 31,5±5,6 years, 3183±972 vs. 3533±699 g., 20% vs. 7,5%, respectively, p<0,05). Statistically significant correlations were found between triglycerides and HbA1c (r=0,18, p<0,05), HDL-C and HbA1c (r=-0,19, p<0,05), HDL-C and large for gestational age (LGA) (r=-0,17, p<0,05), small for gestational age (SGA) and Hba1c (r=0,29, p<0,05). LinearmultipleregressionanalysisdemonstratedthatLDL-C,triglycerides, and total cholesterol were independent predictors of LGA (p<0,05). Conclusion:LDL-C and triglycerides are predictors for macrosomia in type 2 D.M and GDM pregnancies.Thus, with good regulation of lipid profile we can avoid macrosomia from type 2 D.M and GDM pregnancies. Key words: lipid parameters, gestational diabetes mellitus, type 2 diabetes mellitus, macrosomia

Maternal and Neonatal Outcomes in Pregnant Women with Gestational Diabetes Mellitus Treated with Diet, Metformin or Insulin

AIM: Aim of the study was to compare outcomes of pregnancy in gestational diabetes mellitus (GDM) treated with metformin, insulin, or diet.MATERIAL AND METHODS: The study included 48 women with GDM treated with metformin, 101 with insulin, and 200 women on a diet from the Outpatient Department of Endocrinology and University Clinic of Obstetrics and Gynecology in Skopje.RESULTS: The groups were comparable in age, smoking cigarettes and positive family history of diabetes. Mean glycosylated haemoglobin (HbA1c) at 37 gestation week, mean fasting, postprandial glycaemia, and gestational age at delivery were lower in diet and metformin than insulin group. No differences in mode of delivery were observed between the metformin and insulin group. Women in metformin group had a significantly lower incidence of LGA newborns than diet and insulin groups. The percent of SGA new-borns was higher in insulin group than diet and metformin groups. The incidence of neonatal hypoglycemia was statistically significantly higher in the insulin group than in the metformin and diet group.CONCLUSION: Metformin in women with GDM can improve maternal and neonatal outcomes compared with those treated with diet or insulin