Comparative study of Pterygium surgery

Aim: To compare and evaluate the success rates of various surgical techniques of pterygium excision, including pterygium excision with complete suture of conjunctivae (PESC), pterygium excision with conjunctival auto-graft transplantation with graft from the inferior temporal bulbar conjunctiva (ITBC) and pterygium excision with conjunctival auto-graft transplantation with graft from the superior temporal bulbar conjunctiva (STBC). Material and methods: 120 cases with primary unilateral nasal pterygium were evaluated. Outcomes were evaluated in terms of complication and recurrence after pterygium excision. The patients were divided into 3 groups: 1.Group of 40 patients with primary pterygium (pterygium length over the cornea 1.0 mm and more) treated by the technique of pterygium excision with complete suture of conjunctiva (PESC). 2.Group of 40 patients with primary pterygium (pterygium length over the cornea 1.0 mm and more) treated by the technique of pterygium excision with the conjunctival auto-graft transplantation with graft from the inferior temporal bulbar conjunctivae(ITBC). 3.Group of 40 patients with primary pterygium (pterygium length over the cornea 1.0 mm and more) treated by the technique of pterygium excision with conjunctival auto-graft transplantation with graft from the superior temporal bulbar conjunctivae(STBC). Results: Mean follow-up time after the surgery was 15 months (6 to 24 months).12 out of 40 (30%) recurred after the pterygium excision with complete suture of conjunctivae (PESC). Three out of forty (7.5%) pterygium recurred after the modified surgical techniques of pterygium excision with conjunctival auto-graft transplanttation wit

A Case Report of Intraoperatively Diagnosed Cholangiocarcinoma after Unsuccessful Conservative Treatment of ERCP Complicated with Hemorrhage

[full article, abstract in English; abstract in Lithuanian] Background Cholangiocarcinoma is a malignant tumor arising from the epithelium of the bile ducts. Most of these tumors are adenocarcinomas [1]. Intrahepatic cholangiocarcinoma accounts for 10% of all cholangiocarcinomas, hilar cholangiocarcinoma for 25%, and extrahepatic cholangiocarcinoma for 65% [2, 3]. Cholangiocarcinoma can develop in any part of the extrahepatic duct, occurring in 50–75% of reported cases in the upper third of the duct including the hepatic hilum, in 10–25% in the middle third, and in 10–20% in the lower third [4–6]. Approximately 95% of cases show extrahepatic obstruction at the time of diagnosis [7]. In a meta-analysis of 21 prospective trials, the rate of hemorrhage as a complication of ERCP was 1.3% (95% CI, 1.2%–1.5%) with 70% of the bleeding episodes classified as mild [8]. Hemorrhagic complications may be immediate or delayed, with recognition of occurring up to 2 weeks after the procedure. The risk of severe hemorrhage (ie, requiring >5 units of blood, surgery or angiography) is estimated to occur in fewer than1 per 1 000 sphincterotomies [9]. Despite new and advanced diagnostic methods, sometimes this type of tumor is finally diagnosed from pathological findings on excised tissue. Case report We present one case with cholangiocarcinoma diagnosed after surgical treatment of hemorrhage as post procedural complication from ERCP. With MRCP intraluminal stenosis of the upper part of common bile duct has been noticed and suspicious presence of substrate with consecutive dilatation of the upper billiary tract. ERCP was performed and sphincterotomy have been made without evacuation of any intraluminal substrate from common bile duct. Insufficient ERCP cholangiography was made and biopsy of the part with stenosis could not be taken due to permanent bleeding from performed sphincterotomy. Despite all attempts for conservative treatment of the hemorrhage, patient was still with permanent decreases of hemoglobin levels and with persistent hemorrhagic anemia. With decision from medical council the patient has been transferred to the Department of abdominal surgery for further immediate surgical treatment. Conclusion Patient with extrahepatic bile duct carcinoma initially diagnosed as a calculus in the common bile duct. Looking back, the patient had symptoms which differential diagnosis for bile duct cholangiocarcinoma should be established. Clinical symptoms such as right hypochondrium pain, itchy skin, vomiting and diarrhea. The laboratory findings showed constantly elevated bilirubin and liver enzymes also elevated tumor markers as CA19-9 and CEA. Hemorrhage that occurs after ERCP sphincterotomy and attempt for biopsy could not been controlled with conservative measures. Patient with consequently caused hemorrhagic anemia has been transferred for surgical treatment, which stopped the bleeding, made final diagnosis and treatment of proximal stenosis of common bile duct

Effects of the Covid-19 pandemic on the visits frequencies in Emergency Service Skopje

Abstract: The pandemic caused by the COVID -19 virus has affected human health, consequently the health system and health services, both worldwide and in the Republic of North Macedonia. The idea for this research was therefore to examine the impact of the conditions imposed by the pandemic on the visits of the Emergency medical service in Skopje.For this purpose, the frequencies of visits with transport to hospital and just visits, as well as the frequencies of emergency calls and calls only for transport in the periods: before the pandemic (March 2019-February 2020) and during the pandemic (March 2020 to February 2021) were analyzed. The overall number of visits was further analyzed by categories: age and gender.In the period from March 2019 to March 2021, a total of 49,930 visits were performed, of which 24,115 were performed during the pandemic and 25,815 before. In the same period, a total of 13,835 emergency calls were answered, of which 6,434 were during the pandemic and 7,401 before; a total of 9780 calls for transport of patients were carried out, during the pandemic 5602 and 4178 before the pandemic. The analysis showed that the number of transports was increased and the number of emergency calls decreased during the pandemic compared to the pre-pandemic period, while the number of visits during and before the pandemic did not differ significantly. Concerning age and gender, the analysis showed that the number of visits to children, men aged 20 to 40 and women over 60 years was significantly reduced compared to pre-pandemic visits, while there was no difference in other age groups. The contributions of visits related to certain diagnostic and a particular age group are discussed in this paper.We found that the pandemic has not influenced the pace of work, apart from the conditions, only the association between the kind of calls and the diagnoses for which the visits were made has practically changed. During the pandemic, most visits for males and females over 40 were related to COVID diagnosis, while for children, men and women under 40, accidents were the most common caus

Antibacterial Activity of Selected Silver Nanoparticles Coatings - Our Initial Experience

Nanoparticles exhibits chemical and physical properties significantly different to their macro-scale counterparts composed of the same substance (due higher surface/volume ratio, colour, solubility, diffusivity,material strength, toxicity, thermodynamic, magnetic, optical and other properties) and may have unique impacts on health and environment. Extremelly small size (1-100 nm) enables them to enter the human body through usual or unusual routes, pass through cell membranes, or cross the blood-brain barrier. Gravity loses impact and importance, surface tension and Van der Waals constants has more importance in system of nano particles. Nanotechnology is already used in various applications, with potential tobe applied at any stage in food industry: production, preservation, processing, packaging,transport, nanobarcodes for food authenticity and tracing, labelling, keeping the quality of food products, extend the products shelf-life, removal of undesirable tastes, flavours or allergens from food products, nano (bio)sensors for food safety, water filtration. Risks of nanotechnology are still unknown and unpredictable. Initial scientific studies showed negative effects on living organisms and a potential for serious threat to human health. Authorities of the most developed countries, have set up, guidance documents and procedures for nanoenabled products based on existing regulations, appropriate in vitro and in vivo ADME studies (absorption, distribution, metabolism and excretion) and requirements for standardised and harmonised analytical test methods for proper risk assesments, clear identification and characterization of nano-hazards. Nanotechnology in medicine (Nanomedicine) apply for rapid and sensitive detection of pathogenic bacteria and low levels of viruses, in small sample volumes, at lower costs than current in-use technologies. This advance in early detection enables accurate and prompt treatment. Nano-robots to make repairs at the cellular level are under development. Rapid and sensitive detection methods, based on nano (bio) senzors, are developed for food-borne pathogens E. coli, especially E. coli O157:H7, S. aureus, S. typhimurium, C. jejuni, E. cloacae, B. subtilis, L. monocytogenes. Detection sensor to detect bacterial biofilm formation on surfaces are under development. New strategies to combat multydrug resistant microorganisms (MDR) are urgently needed and nanomaterials are very promising approach. Small size provides large surface of nanoparticles and at least 50% of molecules will react to the microorganisms. Metal nanomaterials (silver, gold, copper, titanium, zinc, magnesium,cadmium, and alumina) possess advantage of unique antimicrobial activities. Scientists offers also new complex antibacterial and antiviral nano systems on the basis of metal oxides or intermetallic oxide compounds (such as TiO2, ZrO2, SnO and SiO2). Inside the human body ionic silver quickly combines with chloride to form an insoluble compound called silver chloride which is far less reactive than metallic silver nanoparticles. Some studies established that silver ions has strongest bactericidal effect, cooper and gold weaker one. In our preliminary study on antibacterial activity of several different compositions of nanoparticle coatings (titanium, inox and silver), we found antimicrobial activity of silver, double composition of titanium and silver against Staphylococcus aureus and Staphylococcus epidermidis, but not for E. coli, Pseudomonas aeruginosa, Listeria monocytogenes and Candida albicans. More extensive studies will follow. Key words: Nanoscience, nanoparticles, silver, ions, biofilm, antimicrobial, antibiotic, resistance

Laparoscopic cholecystectomy: summary of five years results

In the Republic of Macedonia, laparoscopic cholecystectomy has been introduced early. In GOB 8 September, laparoscopic cholecystectomy has been in 1993. During the last decade, from September 2009 to October 2014, 1352 operations were performed. In 49 cases (3,62 %) surgeons decided on conversion procedure. 40 (82 %) of these conversions were so called elective and on the other hand, 9 (18 %) of them were caused by complications. Complications were found in 75 (5,54 %) cases. They have been classified in four groups, and have been analyzed by the period in which they occurred: period A, 274 patients until 2010, period B, 551 patients until 2012, and period C, 527 patients until 2014. There was a significant decrease of complications rate (p0,05) in all four groups (kinds) of complications. Laparoscopic cholecystectomy provides many advantages in comparison to other procedures treating cholecystolythiasis, however, it is characterized by some limited possibilities and complications, some of which closely related to the laparoscopic procedure

Практикување на медицина и стоматологија базирана на докази

Медицина/стоматологија базирана на докази претставува совесно, експлицитно и одговорно користење на моментално најдобриот доказ што ќе помогне да се донесе одредена одлука при лекувањето и грижата за индивидуален пациент (Sackett DL,BJM,1996). Доказите се делат на внатрешни и надворешни. Внатрешните докази се темелат на знаењето на лекарот/стоматологот стекнато при неговото образование и континуирано усовршување, како и на искуството од секојдневната практика. Надворешните докази се информации добиени од литературата – во прв ред примарната литература. Постојат различни видови на надворешни докази во зависност од тоа со која методологија, односно, со кој тип/ дизајн на студија се добиени, а достапни се при користење на се поголемиот број на биомедицинските бази на податоци. Практикување на медицина/стоматологија базирана на докази претставува интегрирање на индивидуалното знаење и клиничкото искуство, со моментално најдобриот доказ според светската литература при индивидуалниот пристап кон пациентот. Корист од ваквото практикување имаат и пациентите и лекарите и целиот здравствен систем. Во трудот ќе бидат презентирани епидемиолошките методи кои се основа во научно-истражувачката работа, можните дизајни на студии и прашањата на кои тие треба да одговорат, како и стратегијата за пребарување на литература при практикување на медицина/стоматологија базирана на докази

Variation of pupillary distance: Republic of Macedonia case study

Pupillary distance (PD), the horizontal distance between the centers of pupils in each eye, is very important parameter used due the preparation of prescription eye glasses. As well in Republic of Macedonia the PD is measured on potential user of prescription eye glasses before its making. Although regular every day practice, there is no any investigation related to PD of the population for the country. This fact motived as to perform small case study in order to obtained preliminary results for population PD for the country as well as to investigate its variation due to gender and age. The survey was done in Tetovo municipality (Republic of Macedonia) in 2013. A totally 98 participants (34 female and 64 male) in age from 9 to 90 were observed. The participant observation was included: the monocular pupillary distance near measurements for both eyes using millimeter ruler as well determination of PD in mm. The obtained results of PD were with in the range from 44 to 70mm with mean value of 63mm. The analysis of variance confirmed PD dependence of gender and age at 95% confidence level (ANCOVA, p<0.0001). The mean female PD value of (61±4) mm was lower than mean male PD value of (63±4) mm (Fisher LSD test, p=0.005). Due the linear regression analysis female PD and male PD dependence of age was modeled with linear function. Although the sign if I cant correlation between the quantities, the model was with relatively low coefficient of determination (R2=0.26) indicating possibility of another parameters influence on the PD results

Questionnaire study of use of emergency contraception among teenagers

Aim of the study is to get the information and frequency of emergency contraception use, as well as sexual activity, among teenagers in ages 15 to 18 in Skopje. Material and Methods: Study design included questioning 638 teenagers, females, at the ages between 15 and 18 years, in four secondary schools in the area of Skopje in 2010. The authors used the anonyme questioning for real responses obtaining. The results were analysed with descriptuve and analytical epidemiologicall method. Results: The paper presents the results for girls in secondary schools from the cohort 1995 (mean age of 15,8 yrs., range 15,3-16,2) and 1994 (mean age of 16,6 and range 16,3-17,4), as well as for girls in upper secondary schools from the cohort 1993 (mean age 17,9 with range 17,5-18,8 yrs.Only 33% of the 15-16 years olds and 27,5% of the 17-18 years olds didn’t know what emergency contraception is. The proportion of girls who had used emergency contraception increased with age from 2,1% to 15,1%. Two thirds of all girls who had used emergency contraception had used it only once. In secondary schools 7,3% of 15 year olds (cohort 1995) and 16,8% of 16 year olds (cohort 1994) had sexual intercourse, while among 17 – 18 year olds (cohort 1993) this percent was 41,5%. Information about the usage of contraception and consultations with gynecologist about that have had only 57 (8,9%) from the girls that were included in the survey and most of them searched for the information on the internet. Conclusions: Emergency contraception is a part of primary health care in local health centers and family planning clinics in many European countries (Finland, Denmark, Sweden, Norway). Sexual education in schools includes adequate informationing and consulting of teenagers about the sexual problems including emergency contraception. In our country the sexual education is not imposed inthe schools and consultations with gynecologist about using contraceptive methods confirmed only low percentage of the girls in age from 15 to 18 years. Keywords: teenagers, education, emergency contraception, sexual intercourse

Prediction of Long-Term Indoor Radon Concentration Based on Short-Term Measurements

We present a method for the estimation of annual radon concentration based on short-term (three months) measurements. The study involves results from two independent sets of indoor radon concentration measurements performed in 16 cities of the Republic of Macedonia. The first data set contains winter and annual radon concentration obtained during the National survey in 2010 and the second, contains only the radon concentration measured during the winter of 2013. Both data sets pertain to radon concentration from the same cities and have been measured applying the same methodology in ground floor dwellings. The results appeared to be consistent and the dispersion of radon concentration was low. Linear regression analysis of the radon concentration measured in winter of 2010 and of the 2010 annual radon concentration revealed a high coefficient of determination R-2 = 0.92, with a relative uncertainty of 3%. Furthermore, this model was used to estimate the annual radon concentration solely from winter-term measurements performed in 2013. The geometrical mean of the estimated annual radon concentration of the 2013: radon concentration (A-2013) =98 Bqm(-3) was almost equal to the geometrical mean of the annual radon concentration from the 2010, radon concentration (A-2010) = 99 Bqm(-3). Analysis of the influence of building characteristics, such as presence/absence of a basement in the building, or the dominant building material on the estimated annual radon concentration is also reported. Our results show that a low number of relatively short-term radon measurements may produce a reasonable insight into a gross average obtained in a larger survey