rss_2.0PRILOZI FeedSciendo RSS Feed for PRILOZI Feed Hyperplasia of Tubal Mucosa Associated With Chronic Salpingitis – Clinical And Pathological Challenge: A Case Report<abstract> <title style='display:none'>Abstract</title> <p>Pseudocarcinomatous hyperplasia of the tubal mucosa is a rare, reactive response to an underlying inflammatory or neoplastic process. We present a case of pseudocarcinomatous hyperplasia in a 26-year-old woman with clinical symptomatology of pelvic inflammatory disease, and a normal serum Ca 125-level (30 U/ml). The ultrasound finding showed presence of hydrosalpinx characterized with unilateral tubal enlargement in sausage-like shape that arose from the upper lateral margin of the uterus. The young age of the patient, presence of chronic inflammation, epithelial hyperplasia with unremarkable nuclear atypia and mitosis facilitated the right diagnosis. Pseudocarcinomatous hyperplasia can mimic neoplastic processes clinically and pathologically. Differential morphological and clinical features should be considered to ensure accurate diagnosis and proper management.</p> </abstract>ARTICLEtrue the Outcome of Periradicular Therapy is Based on Strict Inclusion/Exclusion Critera and Co-Medication in Patients with Liver Cirrhosis: A Prospective Study<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: The differences in the survival time of cirrhotic patients reported by different studies are probably caused by the influence of many contributing factors. The aim of the study was to evaluate the survival over a one-year period, to register the occurrence of acute decompensation (AD) and to determine the most frequent causes of death.</p> <p><bold>Material and methods</bold>: Out of 71 patients enrolled in the study, 63 completed the prospective one-year follow-up. During the follow-up, we evaluated the occurrence of AD, the causes of death, and we registered three-month, six-month and one-year survival regarding the AD status at presentation.</p> <p><bold>Results</bold>: Of the 63 patients, 24 (38.09%) died before the end of the study (14 patients before the end of three months, 6 before the end of six months and 4 patients before the end of one year). The overall survival was 38.09% and the mean survival time was 108 ± 98.53 days. The most prevalent cause of death was bleeding from esophageal varices (5 patients, 20.83%). AD patients had a significantly shorter survival than patients without AD (97±90.54 vs. 229±138.59) and 78.57% of them died during the follow-up. The estimated six-month and one-year median survival time were 272.8 [95% CI (238.4–307.2)] and 267.1 [95% CI (232.9–301.2)] days, respectively. The six-month and one-year survival were significantly shorter in AD patients (p&lt;0.0001).</p> <p><bold>Conclusion</bold>: The etiology, stage of liver disease and the presence of AD are important factors that influence on the survival in cirrhotic patients.</p> </abstract>ARTICLEtrue The Neuropathology Tumour Landscape: 10-Year Statistical Analysis With Global Comparison – Single Centre Experience<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Central nervous system (CNS) tumours represent a significant public health issue worldwide, and their incidence and distribution vary across different populations. Although studies on CNS tumours have been conducted in various countries, there is a lack of information regarding their patterns in Macedonia. Therefore, this study is aimed at investigating the distribution, histopathological types and subtypes and demographic features of CNS tumours in our country.</p> <p><bold>Materials and Methods</bold>: A cross sectional study was conducted using the electronic database of the Institute of Pathology – Medical Faculty, University “Ss. Cyril and Methodius” in Skopje which contains data from 3286 received and analysed surgical specimens, mainly from the University Clinic of Neurosurgery in Skopje, and a smaller number of surgical specimens from the University Surgical Centre “St. Naum Ohridski” in Skopje between 2012 and 2022. The collected and analysed data includes patient age, sex and histopathological types and subtypes of the tumours.</p> <p><bold>Results</bold>: The majority of CNS tumours were diagnosed in adults aged between 50-70, with a male to female ratio of 1.5:1. The most common location of the tumours was the cerebrum, followed by the pituitary gland and cerebellum. The most frequent histological groups were gliomas, with glioblastoma as the most common diagnosis, followed by meningiomas.</p> <p><bold>Conclusion</bold>: Following a detailed and thorough review of the CNS tumours in our study, we can conclude that the R. of Macedonia follows global statistics and trends regarding brain tumours.</p> </abstract>ARTICLEtrue Conditions in a Cohort of Inpatients with SARS-CoV-2 and their Association with In-Hospital Mortality During the Early Phases of the Pandemic<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Studies determined that age and associated comorbidities are associated with worse outcomes for COVID-19 patients. The aim of the present study is to examine previous electronic health records of SARS-CoV-2 patients to identify which chronic conditions are associated with in-hospital mortality in a nationally representative sample.</p> <p><bold>Materials and Methods</bold>: The actual study is a cross-sectional analysis of SARS-CoV-2 infected patients who were treated in repurposed hospitals. The study includes a cohort of patients treated from 06-11-2020 to 15-03-2021 for COVID-19 associated pneumonia. To examine the presence of comorbidities, electronic health records were examined and analyzed.</p> <p><bold>Results</bold>: A total of 1486 in-patients were treated in the specified period, out of which 1237 met the criteria for case. The median age of the sample was 65 years. The overall in-hospital mortality in the sample was 25.5%, while the median length of stay was 11 days. From whole sample, 16.0% of the patients did not have established diagnoses in their electronic records, while the most prevalent coexisting condition was arterial hypertension (62.7%), followed by diabetes mellitus (27.3%). The factors of age, male gender, and the number of diagnoses showed a statistically significant increase in odds ratio (OR) for in-hospital mortality. The presence of chronic kidney injury was associated with the highest increase of OR (by 3.37) for in-hospital mortality in our sample.</p> <p><bold>Conclusion</bold>: The study reaffirms the findings that age, male gender, and the presence of comorbidities are associated with in-hospital mortality in COVID-19 treated and unvaccinated patients. Our study suggests that chronic kidney injury showed strongest association with the outcome, when adjusted for age, gender, and coexisting comorbidities.</p> </abstract>ARTICLEtrue of Ropeginterferon Alfa-2B in High-Risk Patients with Philadelphia Chromosome Negative Myeloproliferative Neoplasms– Evaluation of Clinicohaematologic Response, and Safety Profile: Single Centre Experience<abstract> <title style='display:none'>Abstract</title> <p><bold>Background: Treatment of Philadelphia chromosome negative myeloproliferative neoplasms (Ph – MPNs)</bold> requires individualized approach depending on multiple factors. Novel pegylated Interferon (IFN) formulations have become an attractive therapeutic option in young Ph- MPN patients associated with better patient compliance.</p> <p><bold>Methods</bold>: In this retrospective observational study a total of 16 high-risk Ph- MPN patients treated off-label with ropeginterferon alfa-2b given twice monthly, were included. Median follow-up was 24 months. High-risk patients were defined using the IPSET score. Response to treatment was evaluated using ELN, IWG-MET EUMNET standardized criteria and occurrence of side effects was documented.</p> <p><bold>Results</bold>: 11 patients were female (68.8%) and 5 male (31.2%); average age at diagnosis was 36 years (17-51); 12 patients (75%) had ET, one (6.2%) PV and three (18.8%) hypercellular phase of PMF. JAK2V617F mutation was detected in 10 patients (62.5%), CALR in three (18.8%), and three (18.7%) were triple-negative cases. In 7 patients (43.7%), ropeginterferon alfa-2b was used in first-line, and 9 (56.3%) were previously treated with HU and/or standard IFN. Among initially ropeginterferon alfa-2b treated patients, complete haematological response was observed in 4/7 (57.1%), partial in 2/7 (28.6%) and suboptimal in one (14.3%). Complete haematological response was observed in 8/9 (88.9%) among previously treated patients. Average time to blood count normalization was 8 weeks, at a dose ranging between 100mcg and 300mcg. Side effects were observed in one patient (6.2%).</p> <p><bold>Conclusion</bold>: Our experience is in support of previous studies regarding ropeginterferon alfa-2b efficacy and safety profile in the treatment of young patients with Ph- MPNs.</p> </abstract>ARTICLEtrue Calculous Cholecystitis Diagnosed with Abdominal CT in a Diabetic Female Patient – Case Report<abstract> <title style='display:none'>Abstract</title> <p>Emphysematous cholecystitis is reported to have a low incidence of less than 1% in all cases of acute cholecystitis and yet a high mortality rate of up to 15%. It is most commonly seen in male diabetic patients with advanced age. The diagnosis is established with the presence of gas in the gallbladder lumen and/or within its wall which can be seen on plain abdominal radiography, abdominal ultrasound, and abdominal computerized tomography. The clinical presentation refers to one of acute cholecystitis, but the treatment requires prompt cholecystectomy since the patient’s condition can deteriorate due to the possibility of gallbladder perforation. We present a case of a 71-year-old female diabetic patient with calculous emphysematous cholecystitis treated with emergency open cholecystectomy.</p> </abstract>ARTICLEtrue Heterozygosity in Cerebellar Ataxia, Mental Retardation, and Disequilibrium Syndrome Type 4<abstract> <title style='display:none'>Abstract</title> <p>Cerebellar ataxia, mental retardation, and disequilibrium syndrome (CAMRQ) is a genetically and clinically heterogeneous disorder with four described subtypes. Autosomal recessive syndrome of cerebellar ataxia, mental retardation, and disequilibrium type 4 (CAMRQ4) is caused by mutations in the <italic>ATP8A2</italic> gene. We report an 8-year-old boy with choreoathetosis, hypotonia, without the ability to keep his head up and profound mental retardation. There was quadrupedal locomotion, as well. MRI of the brain revealed a hypotrophy of the corpus callosum, diffuse white matter reduction, widespread delayed myelination and ventriculomegaly. Trio whole-exome sequencing revealed compound heterozygosity in the <italic>ATP8A2</italic> gene consisting of a known variant c.1756C&gt;T (p.Arg586*) inherited from the mother and a novel variant c.691_701delCTGATGAAGTT (p.Leu231fs) inherited from the father. CAMRQ type 4 has been found in about 50 patients. To the best of our knowledge, this is the first reported patient with CAMRQ4 with these gene variants. The clinical presentation is severe.</p> </abstract>ARTICLEtrue Incidence of Lymphovascular and Perineural Invasion and their Impact on Survival in Patients with Rectal Cancer<abstract> <title style='display:none'>Abstract</title> <p><bold>Aim</bold>: Lymphovascular Invasion (LVI) and Perineural Invasion (PNI) represent undesirable but still realistic pathological features of rectal cancer, associated with poor prognosis and worse survival. The aim of this study is to assess the incidence of LVI and PNI in patients treated for rectal cancer and the impact of LVI and PNI on patient survival.</p> <p><bold>Material and Methods</bold>: This retrospective single center observational study, conducted in the period of 2016-2019, includes patients with rectal cancer treated with/without long-course neoadjuvant chemoradiotherapy (nCRT). Data collection encompassed demographics, tumor characteristics, type of surgery (abdominal perineal rectal resection - APR and low anterior rectal resection - LAR), and LVI/PNI presence. Survival during follow-up was estimated and compared for patients with/without LVI and PNI involvement.</p> <p><bold>Results</bold>: A total number of 234 patients (77 females and 157 males) with mean age of 61.3 enrolled in the study. Neoadjuvant CRT was conducted in 170 patients. APR procedure was performed in 67 of them and LAR in 167. LVI presence was noted in 55 (24.4%) and PNI in 77 (34.2%) patients. Mean survival during follow-up was 42.07 months. The use of nCRT influenced on survival (p &lt; 0.033). Patients treated with LAR had better survival outcomes (p = 0.001). Presence of LVI and PNI was associated with a worse prognosis (p &lt; 0.001).</p> <p><bold>Conclusion</bold>: PNI was more frequent than the LVI in this study. Patients with nCRT conduction had better overall survival. LVI and PNI presence was associated with poor prognosis in terms of overall survival in patients with rectal cancer.</p> </abstract>ARTICLEtrue Current State of Nuclear Nephrology in Modern Medicine<abstract> <title style='display:none'>Abstract</title> <p>Glomerular filtration rate (GFR) is the most reliable parameter of renal function. Regarding the complexity of the gold standard inulin clearance, different estimating equations have been developed with CKD-EPI creatinine equation recommended as the most reliable one. In some clinical situations where creatinine based equations might not be valid, alternative methods are needed. Nuclear medicine methods for measuring GFR with 51Cr EDTA and 99mTc DTPA have been widely used for decades. There are different methodologies for the measurement of kidney function with radiopharmaceuticals: urinary clearance, plasma clearance, multiple plasma sampling, slope intercept, single sample plasma equation, slope only, and the gamma camera-based method. Greater precision of measuring GFR is needed in certain clinical situations. The most common are diagnosis and follow up of chronic kidney disease and definition of the beginning of replacement therapy. The assessment of renal function is also important for potential kidney donors. In recent years, with the introduction of new chemotherapeutic drugs and targeted therapy, oncologic patients treated with nephrotoxic drugs have become more commonly referred for measuring GFR. The monitoring of renal function is important during treatment in order to detect the transformation from reversible acute kidney injury to irreversible chronic kidney disease as well as in the cases of renal insufficiency reduce the dosage and prevent accumulation of the drug and avoid dosage related toxic effects. Assessment of kidney function using measured mGFR will be an important milestone in the creation of more accurate and expanding personalized medicine principle in current onconephrology practice.</p> </abstract>ARTICLEtrue Procedure for the Treatment of Bilobar Multiple Liver Metastasis from Colorectal Cancer: First Case in RN Macedonia<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy), is a recently developed procedure, first performed by HJ Schlitt in Regensburg, Germany. The technique developed two stages of hepatectomy. The ALPPS procedure has been introduced to increase the volume of future liver remnant, much more than the other technique, such as PVE (portal vein embolization). The first ALPPS in our country was introduced and performed by our team on May 15th, 2018.</p> <p><bold>Results</bold>: The 60-year-old patient was previously operated on for rectal cancer in 2017 at another institution. The operation was performed with anterior resection and the patient was in long term adjuvant chemotherapy. One year after surgery, the patient has multiple bilobar liver metastases and increased tumor markers that led to instant admission to our institution for liver resection. In the first stage, we performed four metastasectomies on the left lobe with right portal vein ligation and transection on the Cantlie line. The second stage was performed after a CT evaluation on the eighth day, with significant hypertrophy on the left lobe. Pathological findings reported ten metastases on the right lobe with a diameter 1-3 cm. The patient was on the long-term chemotherapy, and after one year he had other MS in the IVa segment of the liver. We also performed a metastasectomy. The patient died 32 months after ALPPS.</p> <p><bold>Conclusion</bold>: ALPPS is a safe and feasible procedure for the treatment of bilobar liver metastasis from colorectal cancer. It could provide long-term survival for patients.</p> </abstract>ARTICLEtrue Admission Risk Factors, Clinical Features and Kidney Outcomes in Covid-19 Hospitalised Patients with Acute Kidney Injury<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients.</p> <p><bold>Methods</bold>: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days.</p> <p><bold>Results</bold>: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 – 0.958, p = 0.000; OR 0.987; 95%CI: 0.885–0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009).</p> <p><bold>Conclusion</bold>: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself.</p> </abstract>ARTICLEtrue Chalenges And Managment In Patient With Ataxia- Telangiectasia<abstract> <title style='display:none'>Abstract</title> <p>Louis-Bar Syndrome is a synonym for a very rare complex neurodegenerative disorder ataxia-telangiectasia (A-T). This is an autosomal recessive inherited disease that encompasses abnormalities in the cerebellum, multisystem degeneration, immunodeficiency, increased risk for malignancy and consecutive respiratory insufficiency. Most of the patients are radiosensitive and any exposing to ionization may lead to progression of the disease. Potential risks from anesthesia, mechanical ventilation, and postoperative complications in these patients have been insufficiently discussed in the literature. We present a successful anesthetic and respiratory management with one-lung ventilation in a patient with Louis-Bar Syndrome who underwent video assisted thoracoscopy (VATS) for recurrent pleural effusion.</p> </abstract>ARTICLEtrue Alienation and Feeling of Self-Efficiency in Young Male and Female Adults<abstract> <title style='display:none'>Abstract</title> <p>In psychology, alienation is a condition of being separated or marginalized from other individuals or some larger segment of society. Self-efficacy is an individual’s belief in their capacity to act in ways necessary to reach specific goals.</p> <p>This study was conducted to investigate the possible connectivity between psychological alienation and feelings of self-efficiency among young male and female adults. The study was conducted in April 2023, among 167 young people, aged 18-25 (M=22.28 ± 1.7SD). For this purpose, we used the Scale for psychological alienation and General self-efficacy.</p> <p>Results showed that there is a significant negative correlation between alienation and self-efficacy, meaning that the higher psychological alienation is, the lower self-efficacy is (t=−0.627; &lt;0.001). There is a statistically significant difference between young male and female adults regarding alienation (t=−5.592; &lt;0.001) e. g. males are reporting to be more alienated than females. Also, there is a statistically significant difference between young male and female adults regarding feeling of self-efficacy (t=4.692; &lt;0.001) e.g. males feel less effective than females and in the scale for measuring meaninglessness (t=−2.966; 0.003) e. g. males feel more meaninglessness than females.</p> <p>In conclusion, psychological alienation and self-efficacy are correlated and there are gender differences regarding the two measured variables, in favor of the females.</p> </abstract>ARTICLEtrue Wall Endometriosis at the Cesarean Section Scar<abstract> <title style='display:none'>Abstract</title> <p>Abdominal wall endometriosis is atypical localization of the extra-pelvic endometriosis with non-specific symptoms and is difficult for diagnosis. Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis, which usually develops after obstetric operations. We report a case of a 33-year-old woman who had two previous cesarean sections presented with a mass in the subcutaneous tissue of the abdominal wall, approximately 4 cm superior to the Pfannenstiel incision, 5 years after her second lower segment caesarean section. The classic clinical presentation, imaging findings on ultrasonography and computed tomography are analyzed. Treatment with local surgical excision of the mass is discussed. The diagnosis was confirmed with histopathological analysis of the surgical sample. When it comes to the limited painful lesion in the subcutaneous tissue at the cesarean scar, with a pain intensifying during menstruation, the physician should consider cesarean scar endometriosis in women of reproductive age with a history of cesarean section.</p> </abstract>ARTICLEtrue of the Dynamics of Salmonellosis in the Republic of North Macedonia<abstract> <title style='display:none'>Abstract</title> <p>The main goals of this research are to determine the developmental tendency of salmonellosis in the Republic of North Macedonia and to determine the index of dynamics and the rate of decline/increase of salmonellosis in the Republic of North Macedonia. The research covers the period from 01.01.2012 until 31.12.2022. The data used to implement this study were obtained from the Institute of Public Health of the Republic of North Macedonia. The research included 2711 subjects who were sick with salmonellosis from 2012 to 2022. The following statistical methods of work are used: linear trend, dynamic index with a constant base, dynamic index with a variable base (chain index), rate of decline, and rate of increase. The results of the study suggest that in the period 2012-2022, the highest number of patients (n=373) and the highest incidence (18/100000) of salmonellosis were registered in 2018, and the lowest in 2020 (n=119, I=5.8/100000). From the linear trend values, it can be concluded that salmonellosis in the Republic of North Macedonia shows a decreasing tendency. The biggest increase in salmonellosis in the Republic of North Macedonia was in 2015 by 71% compared to 2014. The biggest decrease in salmonellosis in the Republic of North Macedonia was in 2020 by 48% compared to 2019. From the study, it can be concluded that food operators and manufacturers are observing the procedures of the HACCP control system for food safety, leading to a possible decrease in salmonellosis.</p> </abstract>ARTICLEtrue of Prevalence and Risk Factors for Diabetic Retinopathy in Patients with Type 1 and Type 2 Diabetes Examined at a Tertiary Care<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and the leading cause of visual impairment and blindness. The aim of the study was to estimate and compare the prevalence of DR and to determine an association between DR and systemic risk factors in hospitalized type 1 (DMT1) and type 2 (DMT2) diabetic patients.</p> <p><bold>Material and methods</bold>: We analyzed 260 patients with diabetes, 43 with DMT1 and 217 with DMT2. The following data were collected: age, gender, type and duration of diabetes, glycemic control, blood pressure, estimated glomerular filtration rate, ophthalmologic examinations and routine biochemical parameters.</p> <p><bold>Results</bold>: Out of the total number of 260 patients, 77 (29.6%) had non-proliferative DR (NPDR), 21 (8.1%) had proliferative DR (PDR), 29 (11.1%) had diabetic macular edema (DME), and 69 (23.5%) had diabetic cataracts. Forty-three (16.5%) patients were previously diagnosed with DMT1 and 217 (83.5%) with DMT2. The duration of diabetes was not significantly longer in DMT1 (12.8±11.2 years) in comparison to DMT2 (11.07±8.1 years). The prevalence of NPDR and PDR did not differ statistically in either groups. DME was more prevalent in DMT2 than in DMT1 (P&lt;0.05). Diabetic cataract was found in 26.7% vs. 6.7% of patients with DMT2 and DMT1, respectively (p&lt;0.01). The duration of diabetes significantly correlated with NPDR and PDR in DMT1 (r=o.31, p&lt;0.05; r=0.55, p&lt;0.001, respectively). In DMT2, significant correlations were found between the duration of diabetes and cataract, NPDR, PDR and DME (r=0.31, p&lt;0.001; r=0.43 p&lt;0.01, r=0.16 p&lt;0.05 and r=0.20 p&lt;0.01, respectively). Fasting plasma glucose (FPG) significantly correlated with PDR (r=0.258, p&lt;0.05), while HbA1c with DME (r= 0.15 p&lt;0.05).</p> <p><bold>Conclusion</bold>: The duration of diabetes and hyperglycemia were associated with DR in both types of diabetes.</p> </abstract>ARTICLEtrue Insulin Edema and Pericardial Effusion in a 12-Year-Old Newly Diagnosed Girl with Type 1 Diabetes<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Insulin induced edema (IIE) is a rare condition, usually found in newly diagnosed diabetes patients, either after insulin treatment initiation or after dose increment. It is a self-limited process, rarely associated with serosal effusions. Teenage girls with type 1 diabetes (T1DM) are most commonly affected.</p> <p><bold>Patient and Methods</bold>: A 12-year-old girl was diagnosed with ketoacidosis (DKA). Seven days after initiation of the insulin treatment, at a stable total daily dose of insulin (TDDI) of 0.55 IU/kg, she came with two kilograms weight gain in only two days and edema of the feet and calves. Ultrasound of the heart found a 7 mm pericardial effusion. The diagnostic workout included clinical examination, biochemical, hormonal, allergen analyses and imaging which excluded other known causes of swelling. <bold>Conclusions</bold>: We describe an adolescent girl with newly diagnosed T1DM and a rare association of peripheral insulin-induced edema and pericardial effusion. Short-term diuretic treatment and salt restriction resolved this rare complication of insulin treatment.</p> </abstract>ARTICLEtrue Markers in Patients with Chronic Kidney Disease<abstract> <title style='display:none'>Abstract</title> <p><bold>Aim of the study</bold>: To determine the possibility of using saliva as a diagnostic and prognostic tool for screening and monitoring kidney function.</p> <p><bold>Methods</bold>: This study included 32 patients with different stages of chronic kidney disease (CKD) and 20 healthy examinees for the control group. Saliva was collected using the spitting method, and on the same day blood was also drawn from the examinees to determine serum concentrations of urea and creatinine. The salivary values of uric acid, urea, creatinine and albumin were determined with a spectrophotometer, as well as the serum concentrations of urea and creatinine.</p> <p><bold>Results</bold>: Our results showed a statistically significant positive correlation between salivary and serum levels of urea and creatinine in patients with CKD (Pearson’s correlation coefficient for urea was r =0.6527, p = 0.000, while for creatinine it was r = 0.5486, p = 0.001). We detected a statistically significant positive correlation between the salivary levels of urea and the clinical stage of CKD (r = 0.4667, p = 0.007). We did not register a significant correlation between the salivary levels of creatinine and the clinical stage of CKD (r = 0.1643, p = 0.369).</p> <p><bold>Conclusion</bold> : Salivary urea is a valid marker for determining kidney function and a potential salivary marker for screening and monitoring kidney function. Salivary creatinine can be used as a qualitative marker, only indicating the existence of a disease.</p> </abstract>ARTICLEtrue of Cardiac Magnetic Resonance in Diagnosis and Treatment of Ball Thrombus in Left Atrium – Trust But Verify! – Case Report<abstract> <title style='display:none'>Abstract</title> <p>Male patient with left atrial cardiac mass was in need of a quick diagnosis for individualized and effective treatment. Transthoracic echocardiography showed presence of а giant left atrial cardiac mass with atypical location for thrombus. Cardiac Magnetic Resonance (CMR) Imaging was performed for histological discrimination, and showed a large cardiac mass wall attached in the left atrium, homogeneous, with diameter of 3.4cm x 3.2cm. Late Gadolinium Enhancement sequences revealed black avascular tissue without signal, confirming the characterization of a thrombus.</p> <p>The patient refused hospital initiation of low molecular weight heparin treatment and started treatment with Rivaroxaban. Six weeks later he presented with NYHA class II, almost complete dissolving of the thrombus on CMR scan. Seven months from the initial CMR scan, echocardiography screen was done showing complete absence of the left atrial mass. With this case report we have demonstrated the significance of the CMR as one step further in the precise diagnostics of cardiac masses, solving critical clinical dilemma.</p> </abstract>ARTICLEtrue