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)
THE ASSOCIATION BETWEEN PERCEIVED STRESS AND EATING PATTERNS AMONG UNIVERSITY STUDENTS
Background: Psychological stress is known to significantly influence health associated behaviors, especially in student population. The challenges of academic life and the transition to adulthood often contribute to the development of poor dietary habits during university years. Objective: This study aimed to examine the association between the levels of perceived stress and eating behaviors in university students. Methods: A cross-sectional survey was conducted among 200 students enrolled at the Law Faculty and the High Medical School of the University “St. Kliment Ohridski” – Bitola. Data were collected using three tools: a demographic questionnaire, the Perceived Stress Scale (PSS-10), and the Weight-Related Eating Questionnaire (WREQ). Statistical analyses included chi-square tests, correlation assessments, and ANOVA. Results: The majority of participants reported moderate levels of stress, with female students exhibiting significantly higher stress scores (p = 0.0125). A positive correlation was observed between stress levels and disordered eating patterns, particularly emotional eating (p = 0.0082). Conclusion: The findings indicate that emotional eating is a prevalent coping mechanism among distressed university students, with a stronger expression observed in males. Student-centered support programs that focus on stress reduction and healthy nutrition should be implemented as essential tools for promoting university student health and well-being. Keywords: Perceived stress, emotional eating, university students.
SOMATOTYPES IN THE ADOLESCENT PERIOD – A REVIEW ARTICLE
Growth and development in children and adolescents are dynamic, interrelated processes that reflect both genetic and environmental influences. Anthropometric assessment and somatotype classification are essential tools for evaluating these processes, offering insights into body composition, health risks, and physical performance. Somatotype, defined by three components: endomorphy (fat), mesomorphy (muscle), and ectomorphy (linearity) provides a standardized method to describe physique and its variations across age and sex. This paper reviews growth patterns, the historical development of somatotyping methods, and their application in children and adolescents. Evidence shows that somatotype characteristics vary significantly during puberty: endomorphy tends to increase in females, while mesomorphy predominates in males, particularly in late adolescence. Ectomorphy peaks during periods of rapid height growth, then declines with advancing age. These shifts are influenced by hormonal changes, nutrition, physical activity, and socio-economic factors. Understanding somatotype development has clinical and applied relevance. It assists in monitoring population health, identifying risks of obesity and related metabolic conditions, and guiding individualized approaches in sports and physical education. While somatotype is strongly determined by genetic factors, lifestyle interventions especially balanced nutrition and regular physical activity can improve body composition and overall health outcomes. Keywords: growth, adolescence, somatotype, anthropometry, body composition, puberty.
NEUROLOGICAL PROFILE IN PATIENTS WITH STROKE: POSITIVE AND NEGATIVE FOR SARS-COV-2 INFECTION - A RETROSPECTIVE OBSERVATIONAL STUDY
Sars-CoV-2 infection is linked to an increased risk of both ischemic and hemorrhagic strokes, influenced by factors such as inflammation, coagulopathy, and endothelial dysfunction. This study aimed to evaluate the prevalence of different types of stroke, assess the severity of initial neurological deficits using the National Institutes of Health Stroke Scale (NIHSS), and examine neurological disability or dependence on daily activities after treatment using the Modified Rankin Scale (MRS) in patients both positive and negative for Sars-CoV-2. Additionally, the study sought to compare the types of strokes and the degree of neurological deficits and disabilities between these two groups. This retrospective observational cohort study included 91 stroke patients hospitalized in the Department of Neuropsychiatry at the General Hospital of Ohrid during the period from January 1, 2021, to December 31, 2021, which corresponds to the post-COVID period. The findings revealed that Sars-CoV-2 positive patients were generally younger than those who tested negative. Most patients admitted with an initial diagnosis of stroke were classified within the ischemic stroke group, regardless of their COVID-19 status. A significant number of Sars-CoV-2 positive patients exhibited severe to moderate strokes based on the NIHSS classification. Following treatment, the majority of these patients experienced moderate to severe disabilities. The results of this study enhance our understanding of the relationship between stroke incidence and current or prior infections with SARS-CoV-2.
RADIOLOGICAL FINDINGS OF MEDIASTINAL LYMPHADENOPATHY IN SARCOIDOSIS: IMPACT OF COUGH AND SMOKING HISTORY
Sarcoidosis is a systemic granulomatous disease with heterogeneous clinical manifestations, most commonly affecting the pulmonary system. The most typical manifestation include symmetric hilar and mediastinal lymphadenopathy. The aim of the study is is to evaluate the patterns of mediastinal lymphadenopathy in sarcoidosis detected on HRCT and correlate the nodes involvement in patients with cough and smoking history. Material and Methods: A total of 50 patients with confirmed sarcoidosis were evaluated at the University Clinic of Pulmonology and Allergology-Skopje. All patients underwent conventional chest radiography, followed by high-resolution computed tomography (HRCT). The HRCT scans were acquired using a 1 mm slice thickness and imaging was performed on a PHILIPS INCISIVE CT scanner. Results: According to the obtained results, lymphadenopathy did not present as a statistically significant difference in HRCT findings between smokers and non-smokers. In both groups, bilateral hilar lymphadenopathy was the predominant finding, observed in 66.67% of smokers and 70% of non-smokers. Calcified lymph nodes were detected exclusively in patients presenting with cough. A statistically significant difference was confirmed between the four disease stages regarding the prevalence of bilateral hilar lymphadenopathy (p = 0.003). Conclusion: Mediastinal lymphadenopathy, as identified through radiological imaging, is considered a hallmark in the detection of pulmonary sarcoidosis. HRCT remains the gold standard for identifying subtle pulmonary parenchymal abnormalities as well as for the accurate detection of mediastinal lymphadenopathy. Further clinical studies are necessary to clarify the potential association between cough, smoking history and lymphadenopathy in sarcoidosis. Key words: sarcoidosis, HRCT, lymphadenopathy, smoking, cough
TACROLIMUS VARIABILITY FACTORS AND INTERPLAY WITH KIDNEY GRAFT FUNCTION
Introduction: This study aimed to evaluate the association between tacrolimus pharmacokinetic variability and graft function and survival during a one-year follow-up period. Materials and Methods: A prospective study was conducted with 32 kidney transplant patients. Intra-individual variability (CV > 30%) was defined as high. Patients were categorized as slow or fast metabolizers based on the concentration-to-dose ratio (Co/D). The clinical outcome, measured by the change in eGFR, was assessed over a one-year follow-up period. Results: CV > 30% was found in 12.5% of patients, and low Co/D was observed in 15.6%. Both fast metabolizers and patients with high tacrolimus pharmacokinetic variability (IPV) showed higher creatinine levels after 6 and 12 months, along with lower eGFR values. However, these differences did not reach statistical significance (e.g., 135.11 ± 50.89 vs. 158.29 ± 68.33, p = 0.499; 126.36 ± 45.60 vs. 150.80 ± 58.60, p = 0.322). The reduction ratio of eGFR ranged from -64% to +40%, with a mean reduction of -1.26 ± 20.60%. Fast metabolizers did not show a higher frequency of reduction ratios >20% compared to others (3 [15%] vs. 0 [0%], p = 0.585),nor did those with high tacrolimus variability (3 [14.3%] vs. 0 [0%], p = 0.657). In the predictive model, age remained sole significant factor for tacrolimus variability. Conclusion: Further follow-up is needed to fully understand the impact of tacrolimus pharmacokinetic variability on kidney graft function. Keywords: kidney transplant, tacrolimus, pharmacokinetic variability, graft outcome
SHORT REVIEW OF DIRECT ANTERIOR APPROACH VS. LATERAL APPROACH IN TOTAL HIP ARTHROPLASTY - ONE MONTH AFTER SURGERY
The direct anterior approach (DAA) is gaining use in total hip arthroplasty (THA), while the lateral approach (LA) remains standard. This study compared operative time, blood loss, implant positioning, and early complications in 200 patients (100 DAA, 100 LA). All procedures used cementless implants and tranexamic acid. Mean operative time was longer with DAA (87 vs. 76 minutes), but blood loss and transfusion rates were lower. Radiographs showed similar acetabular positioning; however, varus stem alignment and trochanteric fractures occurred more often with DAA. Early complications included one infection in DAA and three infections plus one dislocation in LA. At one month, Harris Hip Scores favored DAA (94 vs. 81). DAA facilitates faster recovery but requires careful technique and patient selection. Keywords: direct anterior approach, lateral approach, total hip arthroplasty, postoperative X-ray, rehabilitation.
IMPACT OF TIME-TO-TREATMENT AND THROMBECTOMY TECHNIQUE ON OUTCOMES IN ACUTE ISCHEMIC STROKE: A SINGLE-CENTER COHORT ANALYSIS
Introduction: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). Time-to-reperfusion is the most critical determinant of patient outcome. This study aimed to conduct a comprehensive analysis of key time metrics and the efficacy of MT at our institution, evaluating their impact on both angiographic and clinical results to identify areas for process optimization. Methods: We conducted a retrospective analysis of a cohort of 17 consecutive patients treated with MT for LVO stroke. We analyzed demographics, baseline clinical status (mRS), occlusion location, detailed time-to-treatment intervals, procedural techniques, and outcomes. The primary angiographic endpoint was successful reperfusion, defined as an extended Thrombolysis in Cerebral Infarction (eTICI) score of 2b or greater. Clinical endpoints included functional outcome at 3 months, measured by the mRS, and the rate of symptomatic intracranial hemorrhage (sICH). Results: The mean patient age was 60.9 years, with a significant male predominance (70.6%). All patients presented with severe stroke (initial mRS 4-5), indicating a high-acuity cohort. The mean time from symptom onset to final reperfusion was prolonged at 505 minutes (8 hours 25 minutes). Despite this, a high rate of successful reperfusion (eTICI 2b or greater) was achieved in 85.7% of patients, with complete reperfusion (eTICI 2c or 3) in 57.1%. However, this technical success did not fully translate to clinical recovery, as a good functional outcome (mRS 0-2) at 3 months was achieved in only 30.8% of patients. The rate of sICH was 15.4%. Conclusion: Our center achieves high rates of technical success in reperfusion (85.7% eTICI 2b or greater), comparable to international benchmarks. However, prolonged treatment delays are significantly attenuating clinical outcomes, with only 30.8% of patients achieving functional independence. This analysis underscores that procedural excellence alone is insufficient; optimizing system-wide time-to-treatment protocols is the critical next step to improve patient recovery. Keywords: NAT, blood safety, transfusion-transmissible infections, residual risk.
UMBILICAL CORD CORTISOL LEVELS IN TERM AND LATE-PRETERM NEWBORNS
Cortisol, a glucocorticoid hormone secreted by the adrenal cortex, plays a pivotal role in human physiology, particularly in stress response regulation, immune function, and metabolic homeostasis. In the perinatal period, cortisol becomes a critical determinant of neonatal outcomes, as it drives the maturation of key fetal organs and facilitates the transition from intrauterine to extra uterine life. A surge in fetal cortisol levels during late gestation is integral to the development of the lungs, liver, and brain, which are essential for postnatal survival. Moreover, the umbilical cord, as the primary channel of maternal-fetal exchange, provides an invaluable window into the hormonal state of the fetus at birth. An observational prospective study analyzing umbilical cord blood cortisol levels, focusing on their associations with gestational age, was conducted at the Mother Teresa Hospital in Skopje, and 88 samples were obtained for analysis. The aim was to compare cortisol levels in healthy and appropriate for gestational age (AGA) newborns, depending on their gestational age. The results showed a mean cortisol level of 93.41 [95%CI 82.72 – 104.10]. In term infants the mean cortisol level was significantly higher, with a mean value of 100.60 [95%CI 88.940 – 112.259], than in preterm ones where mean cortisol level was 51.91 [95%CI 40.528 – 63.301], with a statistically significant difference (p<0.0012). The significant associations between cortisol levels and gestational age highlight the potential utility of umbilical cord blood cortisol as a biomarker for assessing neonatal stress and adaptation. Keywords: cortisol,newborn,umbilical cord,delivery, gestational age, term, preterm.
THE ROLE OF MR SPECTROSCOPY AND CONTRAST ENHANCED MRI IN PROSTATE CANCER DIAGNOSIS
In patients with increased prostate-specific antigen, the next diagnostics tool is transrectal ultrasound-guided biopsy. The biopsy can cause pain, bleeding and infection. Multiparametric magnetic resonance imaging (mp MRI) as non-invasive diagnostics tool is used as a triage test to avoid biopsy, as well as to improve the diagnostics. The aim of this study was to examine the value of MR spectroscopy and dynamic post-contrast series in the diagnosis of prostate cancer. This cohort prospective study included 100 patients from CGH “September 8th” with increased levels of PSA. The MRI equipment used was Siemens Essenza 1,5T with body coil. The results obtained by MR spectroscopy analysis were correlated with the post-contrast series, whereby by mapping suspicious areas, patients underwent biopsy according to the PIRADS (prostate imaging and reporting data system) classification. Of the 100 patients, 96 were biopsied according to the PIRADS (prostate imaging and reporting data system) classification. The MRI results and pathohistological findings were then compared. On MR postcontrast series, a malignant lesion was detected in 52% of patients, in 33% of patients the lesion was suspicious for malignancy. On MR spectroscopy, a choline+creatinine/citrate ratio of 0.8 to 2 indicating a possible malignant lesion was confirmed in 33% of patients, this ratio was greater than 2 in 33% of patients, indicating a lesion highly suspicious for malignancy. MR spectroscopy combined with contrast enhanced MRI is a powerful tool for non-invasive differentiation of benign prostatic hyperplastic nodule and prostatitis from a malignant nodule. Key words: prostate, carcinoma, spectroscopy, IV contrast.
THE ROLE OF PALLIATIVE RADIOTHERAPY IN THE TREATMENT OF METASTATIC MELANOMA
Objective: To demonstrate the role and effectiveness of palliative radiotherapy in patients with metastatic melanoma, especially in the context of combination therapy with immunotherapy and/or targeted therapy. Methodology: Four patients with metastatic melanoma, treated at the University Clinic for Radiotherapy and Oncology – Skopje are presented. All patients had a performance status (ECOG 0.1) and were treated with palliative radiotherapy due to pain and/or local progression. Different doses and techniques were used according to clinical indication combined with systemic therapy. Results: All patients showed clinical improvement after radiotherapy: pain reduction, regression of local metastases, improvement of functional status and continuation of systemic therapy without interruption. There were no significant side effects of radiotherapy. Conclusion: Palliative radiotherapy is an important tool in the multimodal approach to the management of metastatic melanoma and allows for a rapid palliative effect and potential synergism with immunotherapy and targeted therapy. Keywords: metastatic melanoma, palliative radiotherapy, immunotherapy, targeted therapy, multimodal treatment.
ASSOCIATION BETWEEN MUSCLE STRENGTH, GAIT SPEED AND QUALITY OF LIFE IN OLDER ADULTSA WITH SARCOPENIA:A CROSS-SECTIONAL STUDY
Introduction: Sarcopenia is a progressive and generalized skeletal disorder that is associated with increased likelihood of adverse outcomes, including falls, fractures, physical disability, and mortality. Muscle strength is now considered more important than muscle mass in diagnosing sarcopenia. Material and methods: This is a cross-sectional study with 75 patients in total. The patients included are from nursing homes in the Republic of North Macedonia and outpatients, aged 60 and over. The patients included were diagnosed with sarcopenia through assessment of muscle mass (bioimpedance analysis), physical performance (gait speed), muscle strength (handgrip strength), and a SARC-F score equal to or over 4. Patients diagnosed with sarcopenia fulfill the - 36 questionnaire for assessment of quality of life. Results: In terms of Muscle Strength (MS), the patient group without sarcopenia (Z = 3.27) and p = 0.001 has statistically significantly higher Muscle Strength (handgrip strength) compared to the patient group with sarcopenia. Participants with sarcopenia have a significantly lower gait speed compared to those without sarcopenia (Z = -5.83, p < 0.001). Conclusion: If Muscle Strength is increased by only 1kg, the quality of life in patients with sarcopenia increases on average. The test result shows a significant difference — people with sarcopenia walk more slowly. Routine handgrip and gait speed assessments in older adults can identify at-risk individuals before major functional decline occurs. Improvements in either measure indicate effective intervention and reduced sarcopenia-related risk. Key words: sarcopenia, muscle strength, gait speed, quality of life.
CORRELATION OF DEMOGRAPHIC AND ANTHROPOMETRIC FACTORS WITH PULMONARY ARTERIAL OBSTRUCTION INDEX AND IMAGING MARKERS OF RIGHT HEART STRAIN IN PATIENTS WITH ACUTE PULMONARY EMBOLISM
Background: Acute pulmonary embolism is a potentially life-threatening condition often accompanied by right heart strain. Computed tomography pulmonary angiography is the preferred imaging modality for assessing both vascular obstruction and cardiac involvement. The impact of demographic and anthropometric factors on imaging biomarkers of right heart strain, such as the pulmonary arterial obstruction index, remains insufficiently investigated. Methods: This prospective study included 119 patients with confirmed acute pulmonary embolism who underwent computed tomography pulmonary angiography and follow-up echocardiographic evaluation. Demographic (age, sex) and anthropometric (body weight) variables were analyzed in relation to the obstruction index and computed tomography indicators of right heart strain. Results: The cohort was nearly gender-balanced, with a mean age of 57.8 years. While male patients had higher mean obstruction index and ventricular diameter ratios, these differences were not statistically significant. Significant sex-based differences were observed in aortic and inferior vena cava diameters. Increasing age was significantly associated with larger vessel diameters and a higher prevalence of contrast reflux in the inferior vena cava. Higher body weight correlated with increased vessel dimensions, but not with the obstruction index or ventricular ratios. Conclusions: Age and body weight are significantly associated with selected imaging markers of right heart strain in acute pulmonary embolism. These results highlight the importance of adjusting computed tomography interpretation based on patient characteristics. Keywords: acute pulmonary embolism, computed tomography pulmonary angiography, pulmonary arterial obstruction index, right heart strain, ventricular diameter ratio, inferior vena cava reflux
COMPARATIVE ANALYSIS OF SEROLOGICAL AND MOLECULAR TRANSFUSION TRANSMISSIBLE INFECTIONS SCREENING
Introduction. Transfusion Transmissible Infections (TTIs) remain a major concern in ensuring the blood safety. Nucleic acid testing (NAT) improves detection by shortening the window period (WP) and identifying occult infections. This study aims to determine the significance of NAT through a comparative analysis of the chemiluminescent serological technique (CMIA) and the molecular technique (NAT). Methods. This retrospective study analyzed TTI testing data from 167979 blood donations (93,390 donors) between 2022 and 2024. Screening included HBV DNA, HCV RNA, and HIV RNA (Procleix UltrioPlex E, Panther System) and serological markers (HBsAg, anti-HCV, anti-HIV/p24) using the Architect 2000 platform. Repeatedly seroreactive samples underwent confirmatory testing (HBsAg neutralization, HCV/HIV immunoblot), while NAT-reactive samples were individually tested using the Procleix Ultrio Elite discriminatory assay. Results. Serological testing identified 237 (0.25%) confirmed TTI cases, while NAT detected 245 (0.26%), including 22 (0.023%) NAT-only positive cases. Among these, 21 were HBV DNA-positive/HBsAg-negative. Follow-up samples from 11 donors showed seroconversion in 7 (33.3%), while 4 (19.0%) were identified as potential occult HBV infections (OBI). One HIV NAT-only case was detected. The NAT yield was 1 per 4,245 donations, decreasing over time. Residual risk per 100,000 donations declined from 10.55 to 4.59 for HBV, while remaining low for HCV and HIV (0.12 in 2024). Conclusion. NAT enhances blood safety by detecting early and occult infections missed by serology. The declining NAT yield and residual risk emphasize improved screening efficiency. Integrating NAT with serological methods is crucial for reducing transfusion-transmitted infections. Keywords: NAT, blood safety, transfusion-transmissible infections, residual risk
SURGICAL APPROACH IN THE TREATMENT OF A LARGE RADICULAR CYST WITH PROMINENCE TOWARDS THE MAXILLARY SINUS
A cyst is defined as an epithelial lined pathologic cavity that may contain fluid or a semisolid material. The radicular cyst is an inflammatory odontogenic cyst seen at the root apex of dead pulp. These cysts are most common among other odontogenic cyst, may be because of high incidence of pulpal pathology in the oral cavity. Rarely the cyst can grow slowly to larger size causing destruction of adjacent vital structures. The aim of this paper is to present the surgical management of a large radicular cyst communicating with the maxillary sinus. This paper describes a case of a 42-year-old woman, where a radicular cyst was diagnosed clinically and radiographically. During the intervention, in addition to the removal of the cyst in toto, a sinus plasty was also performed, due to the prominence of the cyst in the maxillary sinus. The treatment of large radicular cysts is a problem that requires a serious approach in diagnostics, planning and performing the treatment. Pathohistological analysis is key in the correct diagnosis of odontogenic cysts. Key words: radicular cyst, maxillary sinus, sinus plasty, pathohystology.
KNOWLEDGE, ATTITUDES AND PRACTICES OF MEDICAL DOCTORS AND DENTISTS REGARDING MEDICAL ERRORS IN THE HEALTHCARE SYSTEM OF THE REPUBLIC OF NORTH MACEDONIA
Introduction: Medical errors represent a major global public health concern with significant implications for patient safety, healthcare quality, and professional accountability, and remain insufficiently studied in transitional healthcare systems such as the Republic of North Macedonia. Aim of the study: The aim of this study was to evaluate and compare the knowledge, attitudes, and practices of medical doctors and dentists concerning medical errors in the healthcare system of the Republic of North Macedonia. Material and Methods: A cross-sectional, questionnaire-based study was conducted among 200 licensed clinicians (100 medical doctors and 100 dentists) working in public and private healthcare institutions in Skopje. A structured, anonymous, 14-item questionnaire adapted from validated international instruments was used to assess exposure to information on medical errors, perceptions of error frequency and significance, contributing factors, and self-reported experiences. Data was analyzed using SPSS v24, with group differences evaluated using Chi-square tests (p < 0.05). Results: Most participants reported encountering medical error information “sometimes” (41.0%, p < 0.05). Medical errors were considered a very significant problem by 53.5% and quite significant by 36.5%. Serious errors were perceived as not very likely in hospital (47.0%) and specialist care (42.0%). Hospital-acquired infections and diagnostic errors were viewed as most likely, while surgical, medication, and device-related errors were judged less probable. Workload and stress (55.0%) and inadequate communication/teamwork (50.0%) were the most frequently cited contributing factors. A total of 19.5% self-reported having committed a medical error, with medical doctors reporting errors nearly twice as often as dentists (26.0% vs. 13.0%, p < 0.05). Conclusion: Macedonian clinicians acknowledge medical errors as a significant issue yet perceive serious events as relatively infrequent. These findings highlight the need for system-level improvements in teamwork, diagnostic safety, workload management, and a supportive, non-punitive reporting culture. Keywords: medical errors, patient safety, medical doctors, dentists, attitude of health personnel.
POSTOPERATIVE PAIN MANAGEMENT AFTER HYPOSPADIAS SURGERY IN CHILDREN
Introduction: Postoperative pain after hypospadias surgery in children causes discomfort and may delay recovery. Effective pain management shortens hospital stays and improves satisfaction. Guidelines recommend a multimodal approach combining pharmacologic therapy, local or regional anesthesia, and nonpharmacologic strategies. Objective: To evaluate postoperative pain management in children undergoing hypospadias repair at the Department of Pediatric Surgery, University Clinical Center of Kosovo, and assess the effectiveness of different analgesic strategies. Materials and Methods: A prospective study included 60 children over 1 year old undergoing hypospadias repair between February and October 2023. Children with prior penile surgery were excluded. Pain was measured using the Faces Pain Scale. Analgesia included opioids, nonsteroidal anti-inflammatory drugs, caudal or penile blocks, or combinations, with supplemental acetaminophen or diclofenac for pain above mild. Results: Postoperative pain was reported in 42 children (70%), with some reporting multiple episodes. Nonsteroidal anti-inflammatory drugs alone were mostly associated with mild pain (15 reports) peaking at 2-6 hours. Caudal and penile blocks (n=10 each) produced mild to moderate pain within 2-6 hours. Penile block combined with nonsteroidal anti-inflammatory drugs (n=11) caused mainly mild pain. Caudal plus nonsteroidal anti-inflammatory drugs (n=2) and opioids plus nonsteroidal anti-inflammatory drugs (n=2) produced few scattered reports between 2-12 hours. Conclusions: All analgesic methods relieved pain, with modest benefit for caudal block. Multimodal strategies, though limited, provided high-quality analgesia. Broader use may reduce opioid reliance, improve comfort, and enhance recovery and satisfaction in pediatric patients. Key words: Analgesia, caudal block, NSAIDs, opioids, penile block, postoperative pain.
SAFETY AND EFFICACY OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY VERSUS PERCUTANEOUS NEPHROLITHOTOMY FOR THE TREATMENT OF MODERET SIZE KIDNEY STONES IN THE MIDDLE AND UPPER POLE
Introduction: Given the high incidence and recurrence of nephrolithiasis, technological advances have been made to dramatically improve minimally invasive techniques for treatment of kidney stone, such as extracorporeal shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL). SWL is the standard method in the treatment of kidney stones smaller than 10 mm while PCNL methods of choice in the treatment of kidney stones larger than 20 mm. But for the choice of method for the treatment of 10 to 20 mm, upper and middle calices stones still there are conflicting opinions. Objectives: The aim of the study was to evaluate the efficacy and safety of SWL and PCNL in the treatment of 10-20 mm kidney stonei in the middle and upper pole and to choose the optimal procedure. Material and methods: The clinical study was designed as a randomized prospective study and conducted in GH "8th of September" - Skopje in the period from December 2023 to Januar 2025. During the study for both methods were analysed success rate, rate of re-treatment, the need for additional procedures, the degree of complications and the duration of the intervention and the hospital stay. Results: The study included 81 patients randomized into two groups. The first group included 41 patients treated with SWL, and the second group included 40 patients treated with PCNL. SWL vs. PCNL success rate was 90% vs. 82.9% (p = 0.29); the rate of re-treatment of SWL was 39.02% versus 0% of PCNL. (p = 0.00001). The additional procedures were equally present in the two treatment groups 14.64% in SWL and 15% in PCNL (p = 0.96). PCNL was associated with a significantly longer duration of treatment versus SWL, 110.2 ± 17.7 minutes versus 47.1 ± 3.3 minutes respectively (p = 0.00000). Complications were less frequently detected in patients treated with SWL compared to patients treated with PCNL, 17.1% versus 32.5% respectively. (p = 0.11) The mean length of hospital stay was significantly shorter in patients treated with SWL compared to PCNL, 1.1 ± 0.4 versus 6.0 ± 1.7 days (p <0.0001). Conclusion: This study shows that PCNL and up to three SWL treatments are safe and comparatively effective in treating patients with stones in the upper and middle calices ranging 10–20 mm. Key words: urolithiasis, nephrolithiasis, extracorporeal lithotripsy, percutaneous nephrolithotomy, kidney.
EFFECT OF THE RECTUS SHEATH BLOCK ON HEMODYNAMIC CHANGES IN TOTAL ABDOMINAL HYSTERECTOMY AS A PART OF MULTIMODAL ANESTESIA
Background: Total abdominal hysterectomy (TAH) is associated with substantial postoperative pain and discomfort. Rectus sheath block (RSB) is used to block the sensory nerves of the anterior abdominal wall and thereby contribute to pain relief after lower abdominal surgeries. Aim of Study: The aim of this study is to evaluate the effect of bilateral Ultrasound (US)-guided RSB on hemodynamic changes after TAH. Patients and Methods: This prospective randomized study was carried out on 10 females, ASA I or II, presented for elective TAH under general anesthesia (GA) and randomly classified into 2 equal groups R and C of 5 patients each; patients in Group R received RSB with 40 ml ropivacaine 0.375% (20ml each side) before surgery and standard endotracheal anesthesia and patients in Group C received only standard general endotracheal anesthesia. Mean arterial Blood pressure (MAP) and Heart rate (HR) were measured as baseline, after induction of GA, every 15 min till end of surgery, immediately after recovery, at 6h, 12h and 24 h postoperatively. Conclusion: Patients in group R with bilateral US-guided RSB and standard general anesthesia had higher values of systolic and diastolic blood pressure, mean arterial pressure, and heart rate at the start and during the hysterectomy, compared to the control group C, which had a calm hemodynamic initial course. Postoperative measurements showed stable parameters, with a decrease in hemodynamic values in group R compared to group C, demonstrating an approximation to the values of group C. Key Words: hemodynamic changes, Rectus Sheath Block, Total Abdominal Hysterectomy
CORRELATION BETWEEN ROOT COMPLEX MORPHOLOGY AND SURGICAL EXTRACTION OF MANDIBULAR THIRD MOLARS
Introduction: An impacted tooth is a tooth that has not erupted in the oral cavity, that is, its eruption is prevented for some reason. These are teeth that, throughout their development and under the influence of biological, dynamic and mechanical factors of genetic and phylogenetic origin, show variations in their number, size and degree of development. Material and methods: This paper included 80 patients who were divided into 2 groups of 40 patients each according to the degree of impaction and analyzed how the morphology of the root complex is affected by the surgical technique used during extraction. Results: The results show that the easiest surgical intervention is when the morphology of the root complex is a single conical root or the roots are joined in a conical shape, or even distally bent, because it is not necessary to separate them to extract the impacted tooth in its entirety and at the same time the possibility of apical fracture is avoided. Conclusion: The oral surgical procedure for extraction of impacted mandibular molars is not correlated with the morphology of the root complex but rather depends on the experience of the surgeon. Key words: impacted mandibular third molar, root complex morphology, operative surgical procedures, flap, separation.
THE IMPACT OF MATERNAL OBESITY ON PREGNANCY – A REVIEW ARTICLE
Maternal obesity has been estimated as a global epidemic, affecting 40% of pregnant women in developed nations. The weight of females that are pregnant has become one of the most concerning points in the modern obstetrics. For this matter after consulting the most accurate literature from academic books in the field and from internet sources from the year 2020 until the year 2025 available on PubMed, Scopus, Data of Science, Google Scholar, ResearchGate, Academia and others we have created a review article that takes in consideration the impact of maternal obesity on the pregnancy itself. Women may have been obese before becoming pregnant or they may have rapidly gained weight during pregnancy and the types of maternal obesity have their challenges for the pregnancy outcome. The maternal obesity must be carefully treated since it is directly responsible for the impact on gestational diabetes mellitus (GDM), hypertensive disorders, and various perinatal complications. By analyzing the types of maternal obesity and complications that occur during pregnancy we take care not only for the current health of the pregnant mothers and their babies but also of their future to take preventive measures, lifestyle changes and thus to improve their health and the health of their babies. Key words: maternal obesity, pregnancy outcome, diabetes mellitus, hypertension, perinatal complications.
KNOWLEDGE, ATTITUDES AND PRACTICES OF MACEDONIAN MOTHERS REGARDING PROBIOTIC USE IN CHILDREN
Introduction: Probiotics are live microorganisms with documented benefits in preventing and treating pediatric illnesses, particularly those related to gastrointestinal health. Objective: To assess the level of knowledge, attitudes, and practices among Macedonian mothers regarding probiotic use in children. Methods: A cross-sectional study was conducted using a structured online questionnaire distributed to 527 Macedonian mothers through social media parenting groups. Results: 89.9% of respondents knew what probiotics are. 56% understood that probiotic formulations differ. 89.2% breastfed their babies and knew breast milk contains beneficial bacteria. 97.3% reported administering probiotics to their children. 64.1% gave probiotics after birth; 46.5% during breastfeeding. 71.6% administered probiotics concurrently with antibiotics. 65.1% noticed improvement in the child's health following probiotic use. Conclusion: Macedonian mothers exhibit a good level of awareness and engagement regarding probiotics. Their attitudes and practices align with current recommendations for the use of probiotics in pediatric care. Keywords: Probiotics, maternal knowledge, children, health behavior, Macedonia.
THE ROLE OF THE FAECAL SAMPLES CULTIVATION IN THE DIAGNOSTICS OF CLOSTRIDIOIDES DIFFICILE INFECTION
Introduction: Clostridioides difficile is one of the most important intra-hospital pathogens. A few years ago, a new diagnostic algorithm for Clostridioides difficile infection (CDI) was introduced by ESCMID, stating that cultivation of the bacteria is not necessary for the diagnosis of CDI. Aim: We aimed to explore the role of the cultivation of faecal samples in the diagnosis of CDI. Materials and Methods: In 4 years, we have cultivated 80 different strains of C. difficile from as many patients. Initially, 1380 faecal samples from CDI-suspected patients were planted on selective and non-selective blood agar media and were accordingly incubated in order to isolate the strains. Quick immuno-chromatographic tests were performed on each faecal sample for detection of GDH (glutamate dehydrogenase) and C. difficile toxins A and B as well as on each confirmed C. difficile isolate (from one colony-toxins detection only). Results: In 14 of the 80 faecal samples from which the isolates originated, toxins A and B have not been detected. In 8 of these 14 strains, toxins A and B were detected only from the culture. Only 6 strains were confirmed as non-toxigenic. Conclusions: Although there was no statistical significance, the detection rate of C. difficile toxins A and B was higher from the culture than from the faecal samples by up to 10%. Cultivation of the samples for C. difficile could reduce the rate of false negative findings for CDI. Keywords: Clostridioides difficile infection, ESCMID diagnostic algorithm, toxigenic culture.
EFFECT OF CUMULATIVE EXPOSURE TO SILICA DUST ON RESPIRATORY SYMPTOMS IN UNDERGROUND MINERS
Introduction. Occupational exposure to silica dust may lead to respiratory symptoms, lung function decline, morbidity, disability and mortality. Aim of the study. To assess the impact of estimated cumulative exposure to silica dust on respiratory symptoms in underground miners. Methods: A cross-sectional study included 320 male underground miners divided in two groups by their work tenure (<15 and >15years). Study protocol included completion of a questionnaire on demographics and respiratory symptoms (cough, phlegm, dyspnea, wheezing and chest tightness) in the last 12 months and grade of sypnea, measurements of respirable dust and crystalline silica and calculation of cumulative exposure to silica dust. Results. Mean estimated cumulative exposure to silica dust in the underground miners with work tenure equal or less than 15 years was 0.06±0.03 mg/m3, whereas mean estimated cumulative exposure to silica dust in the underground miners with work tenure longer than 15 years was 0.15±0.04 mg/m3. A significant association was found between the work tenure (<15/ >15 years) and the presence of respiratory symptoms (15.83% vs. 36.11%, p=0.00001). A significant linear positive correlation was found between the presence of respiratory symptoms and the work tenure (p=0.00001) and the estimated cumulative exposure to silica dust (p=0.00001). Conclusion. We found significant impact of cumulative exposure to silica dust on respiratory symptoms, indicating a need of improvement of preventive measures and activities in order to protect respiratory health of underground miners. Key words: crystalline silica, estimated cumulative exposure, respiratory symptoms in the last 12 months, underground miners, work tenure.
BIOMARKERS IN OBESITY-RELATED METABOLIC SYNDROME: FROM PATHOPHYSIOLOGY TO CLINICAL APPLICATION
Obesity-related metabolic syndrome (MetS) represents a complex, multifactorial disorder characterized by central obesity, insulin resistance, dyslipidemia, hypertension, and chronic low-grade inflammation. Its rising global prevalence underscores the urgent need for comprehensive understanding and early detection strategies. While traditional clinical and biochemical parameters provide insight into overt metabolic dysfunction, they often fail to capture upstream molecular disturbances. Recent research has identified a spectrum of novel biomarkers that reflect the pathophysiological mechanisms underlying MetS, including inflammatory mediators (high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, monocyte chemoattractant protein-1, plasminogen activator inhibitor-1), adipokines and hormonal regulators (adiponectin, leptin, resistin, visfatin, ghrelin, glucagon-like peptide-1), oxidative stress and endothelial dysfunction markers (malondialdehyde, 8-isoprostane, oxidized LDL, asymmetric dimethylarginine, paraoxonase-1), thyroid function indicators (TSH, free thyroxine, anti-thyroid peroxidase antibodies), vitamin D, and genetic/epigenetic modulators (microRNAs and DNA methylation patterns). This review summarizes current evidence on these biomarkers, highlighting their roles in elucidating disease mechanisms, enabling early risk assessment, guiding therapeutic interventions, and supporting precision medicine approaches. Future research directions are proposed to standardize assays, validate findings across diverse populations, and develop integrated multi-marker panels to optimize the management of obesity-related MetS. Key words: Obesity, Metabolic syndrome, Adipokines, Inflammation, Insulin resistance,
COMPARISON OF ENDOSCOPIC AND CONSERVATIVE MANAGEMENT IN PEDIATRIC VESICOURETERAL REFLUX: A RETROSPECTIVE STUDY
Background: Vesicoureteral reflux (VUR) is a prevalent congenital urinary tract anomaly in children, often associated with recurrent urinary tract infections (UTIs), renal scarring, and long-term complications such as hypertension and chronic kidney disease. The optimal management of primary VUR—particularly in intermediate grades—remains debated, with both conservative and endoscopic treatments widely used. Objective: To compare clinical and functional outcomes of endoscopic injection therapy versus conservative management in pediatric patients with primary VUR, focusing on reflux resolution, UTI recurrence, renal scarring, and renal function. Methods: This retrospective study included 70 pediatric patients with primary VUR treated at a tertiary center between 2015 and 2018. Thirty-five patients underwent endoscopic subureteric injection with dextranomer/hyaluronic acid copolymer, and 35 received conservative management with antibiotic prophylaxis. Comparative analysis assessed changes in VUR grade, recurrence of UTIs, renal scarring (via technetium-99m dimercaptosuccinic acid [DMSA] scintigraphy), renal function by kidney side, and serum creatinine levels. Results: Endoscopic treatment achieved complete reflux resolution in 74.3% of cases. A significant reduction in reflux grade and improvement in right kidney function were observed in the intervention group (p < 0.001). The conservative group showed higher rates of recurrent febrile UTIs and no significant improvement in renal function. Renal scarring was present in both groups but slightly less frequent following endoscopic therapy. Post-treatment left kidney function was significantly higher in the conservative group (p = 0.020), likely reflecting baseline differences. Conclusions: Endoscopic injection therapy is a safe and effective treatment for moderate-to-high-grade VUR in children, associated with superior reflux resolution and better infection control compared to conservative management. Conservative therapy remains appropriate for select low-grade cases but may confer higher risk for recurrent infections and limited renal recovery. Individualized treatment selection is essential to optimize pediatric VUR outcomes. Keywords: vesicoureteral reflux, endoscopic therapy, urinary tract infection, renal scarring, pediatric urology, reflux resolution
RADIO-GUIDED PARATHYROIDECTOMY USING Tc-99m MIBI FOR ECTOPIC PARATHYROID ADENOMA : A CASE REPORT
Ectopic parathyroid adenomas pose diagnostic and therapeutic challenges. Preoperative Tc-99m sestamibi SPECT/CT scan and radio-guided surgical technique enhance intraoperative accuracy enabling precise detection of an ectopic parathyroid gland. Case presentation: We present a case of a 54-year-old female patient with PHPT due to an ectopic parathyroid adenoma located in the suprasternal region. Neck ultrasonography showed a normal-sized thyroid with a cystic nodule in the right lobe and a hypoechoic mass in the suprasternal region, raising suspicion of an enlarged parathyroid gland. Dual-phase SPECT parathyroid scintigraphy with Tc-99m sestamibi revealed homogeneous uptake in both thyroid lobes and intense accumulation below the right thyroid lobe, suggesting hyperfunctional ectopic parathyroid tissue. The patient successfully underwent a minimally invasive radio-guided parathyroidectomy using a handheld gamma probe. Conclusion: The management of ectopic parathyroid adenomas requires a multidisciplinary approach, utilizing advanced imaging and minimally invasive techniques such as parathyroid scintigraphy with SPECT/CT and intraoperative gamma probes for the safe and precise removal of these hyperfunctional glands. Keywords: Ectopic parathyroid adenoma, 99mTc-sestamibi scintigraphy,SPECT/CT, radio–guided surgery.
TRANSPLANTATION FOR MANTLE CELL LYMPHOMA: IS IT THE RIGHT TREATMENT OPTION FOR PATIENTS? CASE REPORT
Mantle cell lymphoma is clinically and biologically heterogeneous disease, ranging from the indolent non-nodal leukemic variant to the highly malignant blastoid variant. Despite many recent therapeutic advances, mantle cell lymphoma (MCL) remains a largely incurable disease. The median age at diagnosis of MCL is 60–65 years. MCL usually presents with advanced extra nodal, bone marrow, peripheral blood, spleen, and gastrointestinal involvement. First-line treatment consists of chemoimmunotherapy, which may result in prolonged remission, but relapse should be expected. Sustained long-term remissions are achievable following autologous stem cell transplantation. In this case report, we present a case of MCL in 60-year-old men diagnosed initially presented with an abdominal tumor. The patient underwent autologous stem cell transplantation after achieving first remission. Keywords: MCL, autologous stem cell transplantation, Bruton tyrosine kinase (BTK) inhibitors.
ZERO-P IMPLANTS IN CERVICAL SPINE PROCEDURES-CASE REPORT
Supplementing anterior cervical disectomy and fusion (ACDF) with plates enhances stabilization, increases fusion and reduces failure rates. Zero-P implant for stand-alone anterior interbody fusion procedures of the cervical spine was recently developed to avoid complications associated with anterior cervical plates Key words: ACDF, HDI, pressure, neck pain, parestesis.
MULTIDISCIPLINARY TEAM IN TREATMENT OF HIGH ENERGY TRAUMA OF LEFT LOWER LEG– CASE REPORT
High- energy fractures of lower leg are complex lesions that may be associated with soft tissue damage and severe complications, such as compartment syndrome and infection. This case report interests a professional motocross freestyler with complex tibia and fibular open fracture, with soft tissue damage. Case presentation We report the case of 31-year-old man, presented with injuries resulting from accident, as professional freestyler motorcyclist, including open horizontal multifragmentary fracture with angulation of the proximal and middle part of the left tibia and horizontal fracture with angulation of the proximal and middle part of the left fibula. The initial assessment revealed surgical stabilization of the tibia, intramedullary osteosynthesis with wedge. The open lacero-contused wound of the anterior lower leg after the surgery complicated with infection. Necrectomy and Suprasorb A + Ag dressing was performed for per secondar healing of the wound. Conclusion For mounts later, despite the complexity of the fractures, the gravity of the soft tissue lesion and subsequent complications, the patient healed. This satisfactory result depended on the correct management in terms of type of treatment and timing. It highlights the importance of a multidisciplinary approach, incorporating trauma surgeons, plastic and reconstructive surgeon and intensive care specialist to navigate the intricacies of high energy trauma care. Keywords: injuries, soft tissue damaged, osteosynthesis.
THIERISH SKIN GRAFTING IN COMPLEX PATIENTS- CASE REPORT
We present a patient which is complex patient regarding the risks for skin graft survival. Multidisciplinary management of the risks is the only way of skin grafting survival. Choosing the right time, right donor region, right techniques of harvest the skin grafts, choice and preparation of graft, fixation techniques, good preparation of the recipient region and controlling the chronic diseases which are bringing risks such as Diabetes mellitus, arteriosclerosis, vascular diseases, infection, are the key of surviving the skin graft. Keywords : Autologous skin grafts, complex patient, skin graft survival.
RADIOLOGICAL APPROACH TO NEPHROBLASTOMA IN CHILDHOOD
Abstract Nephroblastoma (Wilms’ tumor) is the most common malignant kidney tumor in children, and the bilateral form occurs in approximately 5–10% of cases. It is an undifferentiated mesodermal tumor, containing a variable amount of embryonic renal elements (blastema, epithelium, and stroma). In this paper, we present a case of a 4-year-old child with bilateral nephroblastoma, who underwent right-sided nephrectomy due to a dominant tumor mass and adjuvant chemotherapy according to the SIOP protocol. After completion of treatment, significant radiological and clinical regression of lesions in the remaining kidney was recorded. During the follow-up of several months after the end of therapy, no signs of relapse or new progression of the disease were observed. The case emphasizes the importance of multimodal treatment and careful monitoring in patients with bilateral nephroblastoma with special emphasis on the current key role that imaging plays in preserving renal function and achieving a favorable outcome. Keywords: nephroblastoma, bilateral, nephrectomy, regression, relapses