Journal of Morphological Sciences is an official journal of the Macedonian Association of Anatomists . Its main objective is to contribute to the development of morphological sciences by publishing scientific papers created by researches all over the world. The journal seeks to publish original research, clinical reviews, case reports and opinion papers on all aspects of medicine All medical scientists are invited to submit papers to this journal.
Macedonian Association of Anatomists (MZA)
EARLY AND LATE COMPLICATIONS OF NASAL FRACTURES IN THE PEDIATRIC POPULATION
This statistic reflects the high incidence of nasal trauma compared to other facial fractures. Nasal injuries can also be associated with head injuries, and can often lead to nasal obstruction as well as various nasal deformities. Post-traumatic early and late complications can occur. The aim was to show the importance of traumatic injuries to the nasal pyramid and analyze it with part of our experience . In this retrospective study, we present 100 patients with history of nasal fracture who required hospitalization. In all patient complete history and clinical examination were preformed. External inspection and palpation as well as internal examination were requered. CBS analysis and Neurosurgical investigations on all patient have been done. CT scan of the nose and PNS were also preformed. More than 37 patients or 37% have fractures with dislocation that occurred around 7 days during which a closed reposition with an elevator was realized. The remaing 63 patient had history of previous nasal injury that developed septal deviation. So mosty septal deviation happends in 53 patient or 88%, 16% or 10 patient in patient develop subluxation. Of these, 7 cases septal hematoma formation (5%) and 2 cases subperichondrial abscess (1%). It is essential to know: the severity of the fracture, the direction of the impact and the physical type of the fracture line are of great importance for the predisposition to what kind of nose defect can develop. In order to ensure a better quality of life by improving the functionality and the aesthetic component of traumatic injuries to the nose, it is necessary to know the seriousness of the injury and its possible complications. Keywords: complications, nasal fracture, treatment, development, side effects.
THE AIR POLLUTION IMPACT ON PULMONARY EXACERBATIONS AND RESPIRATORY FUNCTION IN PATIENTS WITH CYSTIC FIBROSIS
Pulmonary exacerbation in cystic fibrosis (CF) contribute to the burden of disease, with a negative impact on quality of life, treatment cost, but most significantly affect lung function. Data regarding the impact of environmental factors, especially air pollution, on CF are limited. This study aimed to assess the impact of air pollutants on pulmonary exacerbations and lung function in CF. The study included 25 patients with CF. Air quality parameters 5 days before and on the day of hospitalization were provided by measuring stations in cooperation with the State Automatic Monitoring System for Ambient Air Quality. Concentration of PM2.5 and PM10 above the maximum allowed concentration five days before and on the day of exacerbation in almost all patients were determined, with their significant mutual association (highest OR 16.33, p<0.001 on the day of exacerbation for PM2.5 and OR 7.0, p<0.01 on the third day before exacerbation for PM10). A significant difference was found in the patients' lung function during periods with and without air pollution (p<0.001), with lower values during the periods with air pollution. Air pollution with PM2.5 and PM10 particles was associated with an increased risk of pulmonary exacerbations and reduced lung function in patients with CF. Keywords: air pollution, cystic fibrosis,exacerbation, lungs function.
CLINICAL CHARACTERISTICS AND PROGNOSIS OF PATIENTS WITH CANCER-ASSOCIATED THROMBOSIS
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (BE), is a very common and potentially fatal disease. The incidence of VTE in cancer patients is about 4–7 times higher compared to healthy individuals and appears to increase over time. The aim of this study is to evaluate the clinical characteristics and prognosis of patients with cancer-associated thrombosis. Material and methods: This prospective observational single-center clinical study enrolled 20 patients with active cancer, divided into 3 groups, according to the location of thrombosis: deep vein thrombosis (DVT), pulmonary embolism (PE), and DVT with PE. Clinical characteristics between these three groups and their prognosis were compared. Results: The study included 20 patients, of whom 9 (45%) were women and 11 (55%) were men, with a mean age of 54 ±13.7 years. The prevalence of risk factors and comorbidities was determined:10 patients had hypertension (50%), 6 patients had chronic kidney disease (30%), 3 patients had diabetes (15%), 2 patients had hepatic lesion (10%). Smoking was observed in 8 patients (40%).Uurogenital carcinoma was predominantly present in 4 patients, with ovarian cancer and 1 patient with cervical uterine carcinoma (25%). In men, prostate cancer was present in 3 patients (15%), while testicular cancer in 1 patient (5%). Kidney cancer had 2 patients (10%). Breast cancer accounted for 15% (3 patients), 3 patients or 15% were with colon cancer and 2 patients or 10% with pancreatic cancer and lung cancer in 1 patient (5%). PTE was diagnosed in 13 patients (65%), DVT alone was detected in 9 patients (45%), and combined DVT with PTE was reported in 2 patients (10%). DOACs were administered as home therapy in 55% (11 patients). 7 patients (35%) were treated with LMWH, and only 4 patients (20%) were prescribed with VKA. Conclusion: The use of DOACs is an effective and safe treatment option for VTE in selected cancer patients. LMWH remain a treatment option in patients with cancer at high risk of bleeding, such as patients with gastrointestinal and genitourinary cancer, patients with chemotherapy-induced thrombocytopenia, patients receiving anticancer therapies with potential interactions with DOAC and those with brain metastases. Keywords: venous thromboembolism, cancer, DOAC.
VENOUS THROMBOEMBOLISM IN MALIGNANT HEMATOLOGIC DISEASES (PILOT PROJECT)
Introduction:Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a very common and potentially fatal disease. The incidence of VTE in cancer patients is about 4-7 times higher than in healthy individuals. Aim: The motive for conducting this prospective cohort clinical study is to gain our experience regarding the incidence of VTE in malignant hemopathies, the association of VTE with the stage of the underlying disease, the possible impact of primary treatment on the incidence of VTE and the clinical outcome of the underlying disease. Material and methods: This is a prospective cohort study involving 20 consecutive outpatients with malignant haemopathies. We conduct screening for deep vein thrombosis with Echo Color Doppler sonography. Results: The study included 20 patients with a mean age of 58.35 years, of whom 13(65%) were male and 7(35%) female.18 patients were diagnosed with lymphoma and two were diagnosed with multiple myeloma. In 8 patients (45%) DVT was found, with occlusion of femoral vein in 4 (45%) , popliteal vein in 3 (33%), 1 (11%) patient had DVT of the subclavian vein, and 1 (11%) of the cerebral vein (confirmed by CT). Conclusion: deep vein thrombosis is highly prevalent in patients with malignant haemopathies. Hospitalization, malignancy activity, and reception of therapy all contribute to the occurrence of venous thrombosis. Compressive ultrasound is a solid and sensitive tool for screening and diagnosis of deep vein thrombosis. Keywords: malignant hemopathies, venous thromboembolism, anticoagulant therapy.
BRENTUXIMAB VEDOTIN AS A BRIDGE TO TRANSPLANT IN HODGKIN LYMPHOMA PATIENTS. EXPERIENCE FROM TREATED PATIENTS IN NORTH MACEDONIA
The treatment of Hodgkin lymphoma (HL) has evolved significantly since the discovery of monoclonal antibodies (mAbs), which have been promising in improving outcomes, particularly in relapsed/refractory cases. Brentuximab vedotin (BV), an antibody-drug conjugate (ADC) targeting the CD30 antigen, has emerged as an effective treatment for HL, demonstrating improved survival outcomes in patients who have failed conventional chemotherapy regimens. Objective: This study aims to evaluate the efficacy and clinical outcomes of BV-based salvage therapy followed by autologous stem cell transplantation (auto-PBSCT) in patients with relapsed or refractory Hodgkin lymphoma (R/R HL) in North Macedonia. Methods: A retrospective analysis was conducted involving 47 patients treated with BV at the Clinic of Hematology in Skopje starting from the drug's approval in December 2022 to the latest review of patient histories in December 2024. The study primarily focused on patients initially treated with the ABVD regimen, followed by BV-based salvage therapy and subsequent auto-PBSCT. Results: Out of the 47 patients, 53% were male and 47% were female, with a median age of 36 at diagnosis. The most common histopathological subtype was nodular sclerosis HL (60%), consistent with national data. Most patients (87%) received the ABVD regimen as initial treatment. In 5 patients (10.6%) a subsequent second-line salvage BV-DHAP therapy with following auto-PBSCT was applied, and in these patients, no detectable PET/CT progression was observed and the treatment was continued with a BV maintenance therapy. In 12 patients (25.5%), BV-DHAP was used as a second-line therapy, with failure to achieve remission, which was the reason to switch the regimen to BEGEV followed by auto-PBSCT in three of the patients, whereas the rest of the patients were treated with augmented ICE, BV-ICE or escalated to the escalated BEACOPP regimen. Most of these patients are currently being administered a maintenance therapy with BV or Nivolumab. Only one of the patients that was given an augmented ICE protocol had a fatal outcome due to refractoriness of the disease. In 9 patients (19%), the escalated BEACOPP protocol was used as a second-line therapeutic regimen. All of them achieved clinical remission and afterwards were subjected to salvage therapy with BV-DHAP/BV-BEGEV and subsequent auto-PBSCT. The treatment outcomes, including progression-free survival (PFS), are consistent with global studies demonstrating the benefit of BV in R/R cases of HL. Conclusion: BV-based salvage therapy followed by auto-PBSCT is an effective treatment strategy for R/R HL, with promising outcomes in patients who fail ABVD. Our findings support the growing evidence for BV as a key component in the treatment of R/R HL, particularly in the case of high-risk patients. Further studies are needed to explore optimal dosing regimens and long-term survival outcomes. Keywords: brentuximab vedotin, CD30, CD30 targeting.
DEMOGRAPHIC AND LIFESTYLE RISK FACTORS FOR SMALL ADENOMATOUS COLORECTAL POLYPS
Introduction: Adenomatous colorectal polyps are well-recognized precursors of colorectal cancer. Identification of risk factors associated with their development remains essential for effective prevention and early detection strategies. Aim: To assess demographic and lifestyle-related risk factors associated with small adenomatous colorectal polyps, including sex, age, smoking, and positive family history of colorectal cancer. Materials and Methods: This cross-sectional study included 205 patients with a total of 346 histologically confirmed adenomatous colorectal polyps sized 4–10 mm. All polypectomies were performed at a single center by one experienced endoscopist over a two-year period. Data on sex, age, smoking status, and family history of colorectal cancer were analyzed. Results: Adenomas were more frequently detected in male patients (54.1%) than in females (45.9%). The mean age was 53.8 years for males and 56.9 years for females. Smoking was reported in 38.5% of patients and was significantly associated with adenoma presence (OR=1.58; 95% CI: 1.07–2.34; p<0.05). A positive family history of colorectal cancer was present in 19.5% of patients and showed a statistically significant association with adenoma detection (p<0.05). Conclusion: Male sex, smoking, and family history of colorectal cancer are important risk factors for small adenomatous colorectal polyps. These findings support current prevention and screening concepts. Keywords: colorectal polyps, adenomas, colorectal cancer, risk factors.
QUANTIFICATION OF THE RISK OF CERTAIN PARAMETERS FOR CATARACT IN PATIENTS WITH GLAUCOMA
Cataract and glaucoma are among the most common ophthalmological diseases that lead to reduced visual acuity in the elderly population. These diseases often coexist, and their interrelationship is the subject of numerous studies. This study aimed to quantify the risk of cataract development in patients with glaucoma, stratified by age, gender, diabetes, prior glaucoma surgery, and corticosteroid use. This research was designed as a cross-sectional study, with a prospective approach, and was conducted in 2025 at the Clinic for Eye Diseases. The study included 415 patients with glaucoma. The mean age was 67.84±10.84 years. Binary logistic regression was used to analyze factors associated with cataract occurrence. Cataract was registered in 192 (46.3%) patients. The results showed that age (OR=1.122; p<0.001) and diabetes (p=0.045) were statistically significant factors associated with the cataract occurrence. Gender, previous glaucoma surgery, and corticosteroid use did not showanystatistically significant relationship. The area under the ROC curve was 0.765 (p<0.001), indicating good discriminative ability of the model. Age and diabetes are significant factors associated with the occurrence of cataracts in patients with glaucoma. Keywords: Cataract, glaucoma, risk factors, diabetes, logistic regression.
EVALUATION OF BIOFILM PRODUCTION IN PSEUDOMONAS AERUGINOSA FROM CYSTIC FIBROSIS PATIENTS
Introduction: Cystic fibrosis is a multisystemic autosomal recessive disease causing viscous secretions that predispose patients to chronic infections. Pseudomonas aeruginosa, a common pathogen in CF patients, possesses the ability to form biofilms, a key factor contributing to antimicrobial resistance and persistence. Aim of the study: This study aimed to phenotypically analyze and compare biofilm formation in 48 P. aeruginosa isolates from CF and non-CF patients. Material and Methods: Material and Methods: Isolates were identified using conventional methods and the Vitek-2 system. Biofilm production was assessed using a quantitative colorimetric assay. Results: Biofilm production was confirmed in 46% (22/48) of isolates. Among biofilm producers, 86% (19/22) originated from CF patients versus 13.6% (3/22) from controls, though this difference was not statistically significant (p=0.466), likely due to limited sample size. Mucoid strains comprised 28% of CF isolates; 73% (8/11) of these produced biofilm compared to 39% (11/28) of non-mucoid strains (p=0.145). Biofilm strength was distributed as strong (13%), moderate (36%), and weak/non-producer (51%), with no significant difference between groups (p=0.804). Conclusion: Despite the lack of statistical significance, the high proportion of biofilm producers among CF isolates, particularly mucoid phenotypes, aligns with established literature on P. aeruginosa pathogenesis. These findings underscore the clinical relevance of biofilm production in CF infections and support the need for larger studies to confirm these associations. Keywords: Biofilm, Pseudomonas aeruginosa, mucoid, non-mucoid, CF.
RADIOLOGICAL CHARACTERISTICS OF OSTEOLYSIS IN CEMENTED VS. CEMENTLESS TOTAL HIP ARTHROPLASTY: A COMPARATIVE STUDY OF OSTEOLYTIC PATTERNS
Background: Even though THA is a highly effective surgical procedure, its long-term success is frequently compromised by periprosthetic osteolysis and subsequent aseptic loosening of the implant. This study aims to: 1) compare the radiological features of osteolysis in cemented versus cementless THA, 2) locate the osteolytic zones using standard X-rays and 3) calculate the precise volume of these lesions using advanced CT scans. Methods: This is a comparative retrospective analysis of prospectively collected imaging data with primary concern on providing important information about the radiological patterns of osteolysis using objective and quantitative ways to measure the severity and the progression related to the fixation method (cemented vs. cementless). Osteolytic lesions were identified and quantified according to the Gruen zones on the femoral side and the DeLee and Charnley classification on the acetabular side, with volumetric CT-based measurements used to characterize patterns of bone degradation. Results: In this comparative analysis of 60 revised total hip arthroplasties, we found that cementless implants exhibited a distinctly more aggressive osteolytic phenotype than cemented implants, despite being in situ for markedly shorter durations. Cemented THA were revised later (median 20 vs 13 years) and predominantly in older patients, yet demonstrated substantially lower volumetric osteolysis across both the femoral and acetabular sides. Cementless hips showed nearly threefold greater total osteolytic burden (median 72.8 vs 23.9 cm³), with disproportionately high involvement of proximal femoral Gruen zones (1–3) and the superolateral acetabular zone (DeLee–Charnley zone 1). Conversely, cemented constructs exhibited relatively greater osteolytic involvement in distal femoral zones, consistent with endosteal cement–bone interface remodeling. Scatterplot analyses reinforced these patterns: cementless components accumulated significantly larger osteolytic volumes earlier in their lifespan, indicating a fundamentally different—and more rapid—biologic response to wear and fixation type. Conclusion: These findings suggest that fixation method exerts a powerful influence on the magnitude, tempo, and topographic distribution of osteolysis, with important implications for surveillance strategies, implant selection, and revision planning. Keywords: Total hip arthroplasty; Cemented hip prosthesis; Cementless hip prosthesis; Periprosthetic osteolysis; Polyethylene wear; Computed tomography; Volumetric imaging; 3D Slicer.
THE SIGNIFICANCE OF INTERFEROMETRY IN PATIENTS WITH EVAPORATE TYPES OF DRY EYE DISEASE AS A RESULT OF MEIBOMIAN GLAND DYSFUNCTION
Abstract Interferometry is a modern method for assessing the thickness of the lipid layer of the tear film, which through its analysis may lead to the diagnosis of the evaporative type of dry eye disease in patients suffering from Meibomian Gland Dysfunction. The aim of this study was to determine the significance of interferometry and the relationship of interferometric values with clinical findings and dry eye tests in patients with Meibomian Gland Dysfunction. Material and methods: The study included 50 subjects suffering from Meibomian Gland Dysfunction in whom examination of the eyelids of both eyes was performed, the clinical stage of the disease was determined, and TBUT, Schirmer II test, meniscometry, Oxford score and interferometry were performed. Results: Statistical analysis of 100 eyes showed a significant correlation of interferometric values with the clinical grade (r -0.9574, p 0.001), with TBUT (r 0.7858, p 0.001) and with Oxford score (r -0.7496, p 0.001), while Schirmer II test and meniscometry showed a weak statistically insignificant correlation with interferometric values. Conclusion: The thickness of the lipid layer of the tears has an important role in the diagnosis and grading of evaporative type dry eye disease in patients suffering from Meibomian Gland Dysfunction, which may allow easier and faster diagnosis, monitoring and treatment of these patients. Keywords: meibomian gland dysfunction, interferometry, lipid layer thickness, TBUT, Schirmer II test, meniscometry, Oxford score.
CLINICAL AND ANATOMICAL FACTORS ASSOCIATED WITH OBSTRUCTIVE SLEEP APNEA SEVERITY IN CHILDREN: A PROSPECTIVE PRELIMINARY STUDY
Abstract Introduction: Pediatric obstructive sleep apnea (OSA) is a multifactorial disorder characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxia and sleep fragmentation. Although adenotonsillar hypertrophy is the primary anatomical risk factor, disease severity may be influenced by additional variables including age, obesity and allergic status. Objective: To evaluate the association between adenotonsillar hypertrophy, age, body mass index (BMI), allergic status and OSA severity measured by the apnea-hypopnea index (AHI). Methods: A prospective analytical study was conducted in a preliminary cohort of 26 children aged 3-14 years with suspected OSA. Participants underwent overnight cardiorespiratory polygraphy, otorhinolaryngological assessment including Brodsky tonsillar grading and endoscopic adenoid grading, anthropometric evaluation, allergy history assessment and completion of the Pediatric Sleep Questionnaire (PSQ). Associations between clinical variables and AHI were analyzed using nonparametric statistical methods. Results: Mild OSA predominated (88.5%). No significant associations were observed between AHI and adenotonsillar hypertrophy grade, age, BMI or allergic status. A significant positive correlation was identified between PSQ total score and AHI (p 0.023). Conclusion: In this preliminary cohort, OSA severity was not significantly associated with anatomical hypertrophy, age, obesity or allergic status. Symptom burden assessed by PSQ correlated with objective disease severity, supporting its value as a screening tool. Larger studies are required to clarify the multifactorial determinants of pediatric OSA severity. Keywords: pediatric OSA, adenotonsillar hypertrophy, BMI, allergy, AHI
BLOOD TRANSFUSION IN EMERGENCY SITUATIONS INCLUDING CONDITIONS OF MASSIVE BLEEDING, URGENT AND MASSIVE TRANSFUSION
In situations involving major blood loss, early diagnosis and effective intervention are essential in preventing the development of hypovolemic shock and its consequences. Rapid provision of blood and blood components may be of vital importance. Key prerequisites include efficient interdisciplinary communication, documentation and investigation of all events associated with massive blood loss, implementation of clinical and laboratory protocols for the management of major hemorrhage, and appropriate pretransfusion testing including determination of ABO blood group and RhD antigen as well as cross matching including the anti human globulin phase. In emergency situations, the following may be administered: O RhD negative uncrossmatched blood, ABO and RhD specific uncrossmatched blood, or ABO and RhD specific blood with incomplete crossmatch. Keywords: blood grouping and cross matching, emergency treatment, blood group incompatibility, blood component transfusion, hemorrhagic shock
THE IMPACT OF INFLUENZA A ON BLOOD DONATION
Abstract Numerous elements affect the body's and the provided components' safety. The primary factor that guarantees safe transfusion is the management of a steady stream of voluntary, frequent, unpaid, and willing contributions. Through quantitative analysis of the total number of blood donors, voluntary blood donors, multiple blood donors, age structure, social structure, and unresolved blood donors, this paper aims to present the impact of influenza A on blood donation and the issuance of units in clinical service during the period from 2024 to 2025. By enabling the safe and efficient conveyance of the necessary components, transport medicine plays a crucial role in contemporary healthcare. Healthcare workers can use blood transfusions to save lives, restore life-support capacity, and assist the life support system. Blood transfusions are a medical procedure that can save lives. Optimal transfusion therapy necessitates knowledge of components and natural cross-matching, blood sources and donor selection, blood collection and delivery techniques, component therapy, transfusion responses, and red cell replacements. Keywords: blood, components, transfusion, drugs, donors
COMPARATIVE, RANDOMISED, SINGLE-DOSE, CROSSOVER BIOAVAILABILITY STUDY OF TWO FORMULATIONS OF AZITHROMYCIN 500 mg FILM-COATED TABLETS IN HEALTHY VOLUNTEERS UNDER FASTING CONDITIONS
Abstract Bioequivalence studies are clinical studies for determining bioavailability of investigated medicinal products and are conducted in accordance with EU Directive 2001/20/ EMA - Note for Guidance on the Investigation of Bioavailability and Bioequivalence (CPMP/EWP/QWP/1401/98 Rev. 1/Corr**), Objective: The objective of this study was to compare the rate and extent of absorption of single dose of 500mg AZITHROMYCIN (as test or reference preparation) in two periods of treatment with 28 days wash out between them, administered to healthy volunteers in a single-dose, randomized, 2 way cross-over study under fasting conditions. Material and methods: Clinical study included forty-four male healthy volunteers with fulfilled inclusion criteria and signed Informed consent in accordance with the Clinical Study Protocol approved by Ethical Committee for clinical and other investigations related to medicines and medical devices at the Agency for Medicines and Medical Devices of Republic of North Macedonia. Validated HPLC-MS/MS method for AZITHROMYCIN form plasma determination was used, and with pharmacokinetic analysis, pharmacokinetics variables were determined: Primary Variables:Cmax; AUC0-72h Secondary Variables:Tmax; AUC0-.Statistycal analysis:An analysis of variance (ANOVA) was used to evaluate treatment, sequence and period effects. Safety:Descriptive statistics were calculated for demographic data and for adverse events. Results:Pharmacokinetic:A total of 44 subjects had pharmacokinetic samples, 43 of them were included in the pharmacokinetic statistical analysis Safety:Both treatments (A and B) appear to be safe and well tolerated after single oral dose. No severe adverse events, serious adverse events or deaths Conclusion:Both products are bioequivalent based on the results of main analysis (equivalence of AUC0-72h and Cmax using ln-transformed data).
SURGICAL INFECTIONS OF STERNAL WOUND IN CARDIAC SURGERY PATIENTS TREATED WITH WAX AND VANCOMYCIN PASTE: A SINGLE-CENTER STUDY
Abstract Introduction: Postoperative sternal wound infections are serious and potentially life-threatening complications that are associated with significant morbidity, mortality, and increased health care costs. Although the prophylactic use of topical vancomycin paste to reduce the incidence of deep sternal wound infection, has been repeatedly examined, this method remains controversial. Material and methods: The research is a retrospective-prospective randomized monocentric clinical study that was conducted in 24 months. We report our first experience with 82 patients operated with a complete medial sternotomy, in which the closure protocol applied intra sternal wax paste in 40 patients, and vancomycin paste in 42 patients. All sternum wound infections that were the result of surgery during this period were analyzed. Results: Patients in both groups were compared in terms of demographic data and risk factors. In 7 patients operated on with the application of wax paste out of 40 patients, a sternal wound infection developed (17.50%). The introduction of the new protocol for sternal closure with vancomycin paste application reduced this number to 2 patients with superficial sternal wound infection out of 42 patients (4.76%; p<0.001). Discussion: Topical application of antibiotic agents (vancomycin paste) significantly reduced sternal wound infection. However, the results of this trial need to be confirmed in a randomized trial. Key words: deep sternal wound infection, topical antibiotic, vancomycin paste, wax paste.
PREVALENCE AND CLINICAL IMPLICATIONS OF INCIDENTALLY DETECTED HIATAL HERNIA ON CHEST COMPUTED TOMOGRAPHY
Abstract Background: Hiatal hernia is a common but often underrecognized condition, and although computed tomography (CT) enables reliable detection, data on CT-based prevalence and diagnostic agreement remain limited. Aim: To determine the CT-based prevalence of hiatal hernia, describe demographic characteristics, hernia size distribution and associated symptoms, and assess interobserver agreement. Materials and Methods: This retrospective study analyzed 1045 chest CT examinations performed over a 6-month period from August to January 2026 at the University Clinic of Pulmonology and Allergology, Skopje, using a PHILIPS INCISIVE 128 slice scanner optimized for thoracic imaging. Hiatal hernia prevalence was calculated based on CT findings. Demographic data, hernia size and associated symptoms were analyzed in patients with hiatal hernia. Interobserver agreement was evaluated in a randomly selected subset of 267 CT examinations independently reviewed by two radiologists using Cohen kappa with 95% confidence intervals. Results: Hiatal hernia was identified in 119 of 1045 CT examinations, yielding a prevalence of 11.4%. The mean age of affected patients was 66.3 years, range 31-84 years, with female predominance (73.1%). Small hiatal hernias were most frequent (81.5%), followed by medium (11.8%) and large (6.7%) hernias. Chronic obstructive pulmonary disease was present in 21.0% of patients. Interobserver agreement for CT detection of hiatal hernia was substantial, kappa 0.74, 95% confidence interval 0.59-0.90. Conclusion: Hiatal hernia is a relatively common incidental finding on chest CT, predominantly affecting older female patients, with small hernias being most frequent, while CT demonstrates substantial interobserver agreement, supporting its reliability in detection. Keywords: hiatal hernia, HRCT, incidental chest findings
EFFECT OF BMI AND UNCONTROLLED HYPERTENSION ON LEFT VENTRICULAR DYSFUNCTION IN HYPERTENSIVE PATIENTS WITH PRESERVED EJECTION FRACTION
Abstract Introduction: Hypertension and elevated body mass index (BMI) are established independent predictors of cardiovascular morbidity and mortality. Objective: The aim of this study was to compare the effects of BMI and uncontrolled hypertension on echocardiographically assessed parameters related to left ventricular dysfunction in hypertensive patients with preserved ejection fraction. Methods: This prospective analytical cross-sectional study was conducted between 2024 and 2025 at the Public Clinical Hospital Tetovo, Republic of North Macedonia. A total of 92 patients aged 18 years or older with a clinical diagnosis of arterial hypertension and preserved ejection fraction (EF greater than 50 percent) were included. Results: The presence of uncontrolled hypertension was significantly associated with disease duration greater than 5 years (p 0.0013). No significant association was observed between controlled and uncontrolled hypertension and BMI categories (p 0.2617). Overweight status was significantly associated with duration of hypertension greater than 5 years (p 0.0177). No significant association was found between BMI categories and gender (p 0.6026). Regarding BMI categories, significantly worse echocardiographic parameters were observed in overweight and obese patients compared to normal weight patients, including relative wall thickness (p 0.0403), left ventricular mass index (p 0.0001), left atrial volume index (p 0.0101), and Tei index (p 0.0301). Global longitudinal strain, ejection fraction and E to e prime ratio were non-significantly worse in overweight and obese patients compared to normal-weight patients. Significantly worse global longitudinal strain (p 0.00001) and Tei index (p 0.00005) values were observed in patients with uncontrolled hypertension compared to those with controlled arterial hypertension. No significant differences were found between controlled and uncontrolled hypertension groups regarding ejection fraction, relative wall thickness, left ventricular mass index, left atrial volume index and E to e prime ratio. Conclusion: Larger prospective cohort studies are needed to clarify causal relationships and to better understand the impact of controlling established and emerging risk factors. Keywords: echocardiography, hypertension, left ventricular dysfunction, preserved ejection fraction, BMI, obesity
SUBGLOTTIC STENOSIS AFTER PROLONGED INTUBATION: CASE REPORT AND MANAGEMENT
Abstract Subglottic stenosis represents abnormal narrowing of the airway below the vocal cords, most commonly resulting from prolonged endotracheal intubation. This condition can cause significant respiratory difficulties and requires timely recognition and treatment. This paper presents a clinical case of a young patient with subglottic stenosis and discusses the selection of an appropriate treatment method. We report the case of a 23-year-old patient with a history of prolonged intubation and tracheostomy. The patient underwent endoscopic evaluation followed by CO2 laser therapy combined with airway dilation. Surgical treatment with CO2 laser resection and dilation resulted in significant improvement of respiratory symptoms and airway patency. The patient recovered successfully and continued with regular postoperative follow-up without complications. Subglottic stenosis is a frequent complication after prolonged intubation and requires early recognition. Endoscopic CO2 laser therapy combined with dilation represents an effective treatment method. Early detection, appropriate treatment selection, and long-term follow-up are crucial for a successful outcome. Keywords: subglottic stenosis, intubation, CO2 laser, dilation, tracheostomy
WHEN MITE ALLERGY MIMICS HELMINTH SENSITIZATION: CROSS-REACTIVE IGE TO ASCARIS LUMBRICOIDES IN A HIGHLY ATOPIC CHILD
Sensitization to helminth antigens detected by specific IgE assays may occasionally reflect immunological cross-reactivity rather than true parasitic infection, particularly in highly atopic individuals. A 5-year-old boy was hospitalized for the fourth time because of severe bronchial obstruction and recurrent wheezing. Laboratory findings showed mildly elevated leukocyte count without eosinophilia. Specific IgE testing revealed strong sensitization to house dust mites (Dermatophagoides pteronyssinus and D. farinae, both class 6) and elevated Ascaris lumbricoides–specific IgE (class 4). Stool examination for intestinal parasites was negative. A previous Enterobius vermicularis infestation treated months earlier was reported, with no clinical or laboratory evidence of current or past Ascaris infection. Given the strong dust mite sensitization and absence of evidence for ascariasis, the detected Ascaris-specific IgE was interpreted as a result of IgE cross-reactivity, most likely mediated by shared pan-allergens such as tropomyosin. Prior Enterobius infestation was considered an unlikely contributor to the observed IgE profile. This case highlights the risk of overinterpreting helminth-specific IgE results in highly atopic children and underscores the importance of clinical correlation. In the context of severe house dust mite sensitization, Ascaris lumbricoides–specific IgE positivity most likely reflected allergen cross-reactivity rather than true parasitic infection. This case highlights the importance of interpreting helminth-specific IgE results within the clinical context to avoid diagnostic error and inappropriate management. Keywords: Asthma, IgE cross-reactivity, Ascaris lumbricoides, Dermatophagoides pteronyssinus, Dermatophagoides farinae.
LUMBAR DISC SEQUESTRATION ON TWO LEVELS MIMICKING A EXTRADURAL TUMOR - CASE REPORT
Sequestered intervertebral disc herniation represents an advanced and severe form of disc pathology in which a fragment of the nucleus pulposus becomes completely separated from the parent intervertebral disc and migrates into the spinal canal. This condition can lead to significant compression of neural structures, resulting in acute back pain, radiculopathy, sensory deficits, and motor weakness. Magnetic resonance imaging (MRI) is the diagnostic modality of choice, enabling precise localization of the sequestered fragment and assessment of its relationship to adjacent neural elements. Treatment approaches vary depending on symptom severity and neurological involvement, ranging from conservative management to surgical intervention, particularly in cases of progressive neurological deterioration or intractable pain. Keywords: disc herniation, spinal canal, MRI.
PRIMARY POORLY DIFFERENTIATED SQUAMOUS CELL CARCINOMA OF THE GALLBLADDER: RARE CLINICAL PRESENTATION
Abstract Squamous cell carcinoma of the gallbladder (SCC) is a rare histological subtype, accounting for less than 2% of all gallbladder carcinomas. It is most often diagnosed in an advanced stage due to non-specific symptoms, infiltrative growth, and early locoregional invasion. Early recognition of infiltration and biliary obstruction is crucial for surgical planning. We present a patient with right upper quadrant abdominal pain for a couple of months. Contrast-enhanced CT of the abdomen revealed an irregularly thickened gallbladder wall with a mass formation and pronounced pericholecystic infiltration. Loss of the boundary towards segment VI of the liver was noted, suggesting local invasion. The patient underwent surgical treatment. Intraoperatively, extensive tumorous infiltration was identified, tumour mass within segment VI of the liver and compressing the extrahepatic bile ducts. A radical cholecystectomy with wedge hepatic excision and dissection of the hepatoduodenal ligament was performed. Due to the involvement of the choledochus, it was ligated, and a hepatojejunostomy T-L was performed with a smooth operative and postoperative course. Pathological examination is the gold standard for the diagnosis of squamous cell carcinoma. Tumor tissue showed specific microscopic features of squamous differentiation, which are distinct from the more common adenocarcinoma. Immunohistochemistry is the technique that uses specific markers to confirm the diagnosis and rule out other types of cancer. In our case, the tumor cells were positive for CKAE1/AE3 and p63. Keywords: gallbladder carcinoma, CT diagnostics, squamous cell carcinoma, immunohistochemistry, biliary obstruction.
NEGATIVE PRESSURE WOUND THERAPY IN THE TREATMENT OF SEVERE LEG INJURY IN 2-YEAR-OLD CHILD - CASE REPORT
Background: Negative pressure wound therapy (NPWT) is used for treatment of different type of acute and chronic wounds. This technique is commonly used for management of extremity soft tissue injuries. Sub-atmospheric pressure, from 75 to 125 mmHg is used in order to increase the blood flow and granulation tissue formation, to decrease the risk of infection by improving the bacterial clearance. Case report: We report a case about 2-year old girl, a victim in a high-energy motor vehicle accident. Despite other injuries, the most important was a severe wound on left popliteal region. The wound underwent detailed exploration. There were evident signs of skin ischemia. There was partial laceration of biceps femoris muscle and lacerated subcutaneous blood vessels. Debridement for the necrotic tissue and reconstruction of the injured muscle were performed. Up to the 15th post injury day, there was a complete demarcation of necrotized zone of left popliteal region and proximal part of the lower leg. A wide skin, subcutaneous tissue and deep soft tissue structures surgical excision was performed. After the surgical debridement, VAC wound dressing was used for wound closure. After nine cycles of NPWT the wound was ready for skin grafting. Conclusion: NPWT is successful and safe treatment for child injuries. This type of treatment shows many advantages, such as decreased morbidity, pain, cost, duration of hospitalization, antibiotic usage, analgesics usage, risk of infection, while, the patient comfort, esthetic and functional result are highly increased. Keywords: Vacuum assisted closure, Negative pressure wound therapy, Sub-atmospheric pressure dressing
SCHWANNOMA OF THE BREAST MIMICKING A FIBROEPITHELIAL TUMOR: A CASE REPORT
Schwannomas are benign peripheral nerve sheath tumors that most often occur as solitary lesions in the extremities and head and neck region. Involvement of the breast is rare and can mimic more common breast neoplasms on imaging. We report a 55-year-old woman with a one-year history of painful, palpable right breast lump. Ultrasound demonstrated a well-circumscribed, round, solid, hypoechoic nodule with diameter of 2 cm and regular margins, raising suspicion for a fibroepithelial tumor. The patient underwent tumorectomy without preoperative needle biopsy. On gross inspection, the lesion was encapsulated and tan-white. Histologic examination revealed a benign spindle cell neoplasm with alternating hypercellular Antoni A and hypocellular Antoni B areas. Tumor cells showed strong, diffuse positive immunohistochemical signal for S-100 and Vimentin, supporting the diagnosis of schwannoma. This case highlights breast schwannoma as an important, though uncommon, consideration in the differential diagnosis of well-defined breast masses. Because breast schwannomas show no specific mammographic or ultrasonographic features, definitive diagnosis relies on histopathologic evaluation and immunohistochemistry. Awareness of this entity may help prevent misclassification of lesions such as fibroadenoma, phyllodes tumor, or breast carcinoma. Keywords: breast, schwannoma, peripheral nerve sheath tumor, S-100, spindle cell neoplasm