rss_2.0PRILOZI FeedSciendo RSS Feed for PRILOZI Feed Between Membranoproliferative Glomerulonephritis and Colorectal Cancer – A Case Report<abstract> <title style='display:none'>Abstract</title> <p>Membranoproliferative glomerulonephritis (MPGN) is a rare glomerular disease characterized by mesangial hypercellularity and thickening of the glomerular basement membrane (GBM). MPGN can be idiopathic or associated with malignancy, systemic immune complex disorders and chronic infections. It has rarely been associated with solid organ tumors, such as lung, gastric, breast or prostate cancer. We report a patient with MPGN and coexisting colorectal carcinoma.</p> <p>A 48-year-old man presented with anemia, loss of weight, hypertension, and nephrotic syndrome. The renal biopsy findings were compatible with type 1 MPGN. The antineutrophilic cytoplasmic antibodies, antinuclear antibodies, anti-GBM, serologic markers of hepatitis B and hepatitis C and tumor markers were negative. After ruling out the secondary causes of MPGN, the patient was treated with pulse doses of methylprednisolone and a single dose of cyclophosphamide. However, due to the worsening anemia and rectal bleeding, a colonoscopy was performed, which established a diagnosis of adenocarcinoma of the descending colon. The patient was treated with left hemicolectomy and oral corticosteroids. Within a year after the cancer treatment, the patient experienced a complete resolution of the proteinuria and improvement of the kidney function.</p> <p>Although rare, MPGN can be associated with hematologic malignancies and solid organ tumors. The most common causes of secondary MPGN should be ruled out before starting specific treatment. In our patient, cancer treatment has led to a subsequent remission of the nephrotic syndrome, which indicated that this association was not coincidental but rather causal. In patients with a tumor and concomitant glomerulopathy which is suspected to be paraneoplastic in etiology, the treatment of the underlying malignancy should be prioritized.</p> </abstract>ARTICLEtrue and Immuno-Histologic Changes in Early Arteriovenous Fistula Failure in Patients with Chronic Kidney Disease<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Hemodialysis is a prevalent treatment for the end-stage chronic kidney disease (CKD) worldwide. The primary arteriovenous fistula (AVF), widely considered the optimal hemodialysis access method, fails to mature in up to two-thirds of the cases. The etiology of the early AVF failure, defined as thrombosis or inability to use within three months post-creation remains less understood, and is influenced by various factors including patient demographics, surgical techniques, and genetic predispositions. Neointimal hyperplasia is a primary histological finding in stenotic lesions leading to the AVF failure. However, there are insufficient data on the cellular phenotypes and the impact of the preexisting CKD-related factors. This study aims to investigate the histological, morphometric, and immunohistochemical alterations in the fistula vein, pre-, peri-, and post-early failure.</p> </sec> <sec><title style='display:none'>Materials and Methods</title> <p>Eighty-nine stage 4-5 CKD patients underwent standard preoperative assessment, including the Doppler ultrasound, before a typical radio-cephalic AVF creation. Post-failure, a new AVF was created proximally. The vein specimens were collected during the surgery, processed, and analyzed for morphometric analyses and various cellular markers, including Vimentin, TGF, and Ki 67.</p> </sec> <sec><title style='display:none'>Results</title> <p>The study enrolled 89 CKD patients, analyzing various aspects of their condition and AVF failures. The histomorphometric analysis revealed substantial venous luminal stenosis and varied endothelial changes. The immunohistologic analysis showed differential marker expressions pre- and post-AVF creation.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>This study highlights the complexity of the early AVF failures in CKD patients. The medial hypertrophy emerged as a significant preexisting lesion, while the postoperative analyses indicated a shift towards neointimal hyperplasia. The research underscores the nuanced interplay of vascular remodeling, endothelial damage, and cellular proliferation in the AVF outcomes.</p> </sec> </abstract>ARTICLEtrue Budding as a Prognostic Marker in Primary Colon Cancer – A Single Center Experience<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Tumor budding (TB) is considered to be a morphological and prognostic factor relevant to colon cancer (CC). The aim of our study is to assess the TB and to evaluate its relationship to clinicopathological findings within stage II and III CC patients as a single center experience.</p> <p><bold>Materials and methods</bold>: A total of 120 CC patients operated between 2018 and 2021 at the University Clinic of Digestive Surgery in Skopje, the Republic of North Macedonia were included in this retrospective, single center study. TB was evaluated by the magnification of 200x along the invasive front of the primary tumor on H&amp;E and CKAE1/AE3 immunohistochemically stained sections. Two grades were used: low grade (TB1, 0-4 TBs) and high-grade, which includes intermediate (TB2, 5-9 TBs) and high grade (TB3 ≥10TBs) of TBs.</p> <p><bold>Results</bold>: A statistically significant correlation has been identified between high-grade TB and age (p=0.05) of the patients. There was also a significantly higher occurrence of high-grade TB in patients within stage III CC. Statistically significant correlations were also found in lymph node status (p&lt;0.01), vascular invasion (p&lt;0.05), lymphatic invasion (p&lt;0.01), postoperative relapse (p&lt;0.01), and death (p&lt;0.01). Tumor relapse and death were significantly more frequent in patients with high-grade TB than those with low-grade TB. Patients with registered high-grade TB demonstrated significantly lower relapse-free survival (RFS) and overall survival (OS) rates than patients with low-grade TB over the observation period (RFS: 53.8% vs. 98.5%, p&lt;0.001; OS: 65.4% vs. 97.1%, p&lt;0.001, respectively). Patients with lung and liver postoperative relapses had higher percentage of cases with high-grade TB (94.1%).</p> <p><bold>Conclusion</bold>: Our results are highly suggestive that TB should be included as a histological biomarker in the pathology report of patients with stage II and stage III CC, because of its prognostic value.</p> </abstract>ARTICLEtrue to Use Artificial Intelligence in Medicine<abstract> <title style='display:none'>Abstract</title> <p>Over the past period different reports related to the artificial intelligence (AI) and machine learning used in everyday life have been growing intensely. However, the AI in our country is still very limited, especially in the field of medicine.</p> <p>The aim of this article is to give some review about AI in medicine and the related fields based on published articles in PubMed and Psych Net. A research showed more than 9 thousand articles available at the mentioned databases.</p> <p>After providing some historical data, different AI applications in different fields of medicine are discussed. Finally, some limitations and ethical implications are discussed.</p> </abstract>ARTICLEtrue Kidney Transplantation Using Elderly Living Donor with Extremely Large Renal Cyst and Double Arteries<abstract> <title style='display:none'>Abstract</title> <p>The authors describe a kidney transplant procedure using a living donor with a large cyst and double arteries. Due to the lack of regular transplant activity from a deceased donors, we decided to use the, so called, expanded criteria living donors, which means older age (more than 65 years), hypertension, some structural anomalies of the kidneys (cysts, multiple renal arteries), ABO incompatible kidney transplant, etc. The surgical procedure was the unroofing of a large cyst and wadding with perirenal fat. The 10 years survival rate is quite successful and we can recommend it.</p> </abstract>ARTICLEtrue Thromboembolic Events in Young Patient with Homozygous T-786C Mutation in the Endothelial Nitric Oxide Synthase Gene (ENOS)<abstract> <title style='display:none'>Abstract</title> <p>Thromboembolic events are a common cause of morbidity and mortality with significant socioeconomic impact especially when young patients are affected. They are a rare medical event in young people and their clinical presentation can be mild or asymptomatic. The manifestation of symptoms and thrombotic events depends on both: the genetic mutations and the external risk factors that will induce the process. We present a case of a 34-year old young female, with three consecutive cerebrovascular insults in a period of ten years, and an acute myocardial infarction. There is a combination of gene mutations and polymorphism, with a predisposition to thromboembolic events. We emphasized the role of e-NOS (Endothelial nitric oxide synthase 786 T&gt;C mutation) and the connection with smoking. The dual effect of the prolonged smoking and dysfunctional nitric oxide synthase in our young patient led to several thrombotic events. We discussed the various diagnostic tests and possible therapeutic and prophylactic strategies.</p> </abstract>ARTICLEtrue Features of Diagnostic and Treatment Tactics in Patients with Crushed Abdominal Hernias Without Resection of a Hollow Organ<abstract> <title style='display:none'>Abstract</title> <p><bold>The purpose of the work</bold> is to analyze the results of the use of optimized diagnostic and therapeutic tactics in patients with strangulated abdominal hernias without resection of the hollow organ.</p> <p><bold>Materials and methods</bold>: The work is based on the analysis of the results of surgical treatment of 665 patients with strangulated abdominal hernias without resection of the hollow organ, who were divided into 2 groups depending on the features of the diagnostic and treatment tactics. Unlike the patients of group 1, the following diagnostic tactics were used in group 2: substantiated laparoscopic diagnosis of abdominal organs; mandatory biochemical assessment of hernia water; mandatory intraoperative instrumental assessment of the state of the strangulated organ; expansion of indications for the use of laparoscopic interventions and components of the comprehensive Fast track program; substantiated complex prevention of malignancy. The clinical diagnostic algorithm included laboratory, instrumental and biochemical research methods.</p> <p><bold>Results</bold>: The use of priority diagnostic and therapeutic tactics in the patients of group 2 allowed to increase the number of laparoscopic hernioplasty by 49.34%, the number of allohernioplasty by 18.62%, among which the “Sublay” technique was preferred for strangulated ventral hernias. This was accompanied by a decrease in the pain syndrome on the VAS scale during the four days of observation, both during coughing and at rest, and amounted to only 2.21 ± 0.29 points on the fourth day when at rest. In addition, and after 12 months, the patients of group 2 observed a better recovery according to the SF-36 questionnaire, which amounted to 76.77±6.63 points for the assessment of the general state of health, 70.81±5.86 points for the assessment of physical functioning, 68.88±5.37 points for the assessment of role functioning due to physical condition, 68.03±5.92 points for the assessment of role functioning due to emotional state, and social activity was characterized by 72.82±5.52 points.</p> <p>Conclusions: 1. The proposed diagnostic and treatment tactics in the patients of group 2 with strangulated abdominal hernias without resection of a hollow organ, in contrast to patients in group 1, made it possible to increase the number of laparoscopic operations to 227 (66.37%) in contrast to 55 (17.03%) in the first group, which was accompanied by a decrease in pain syndrome on the VAS scale on the fourth day when coughing from 4.35 ± 0.38 points to 2.97 ± 0.43 points.</p> <p>2. The expansion of indications for the use of laparoscopic operations in patients of group 2, in contrast to patients of group 1, led to a decrease in the postoperative complications by 10.48% and the postoperative mortality by 2.29% and was characterized by better postoperative rehabilitation according to the assessment of the patients’ condition after 12 months according to the SF-36 questionnaire..</p> </abstract>ARTICLEtrue Resistance and Ischemic Stroke<abstract> <title style='display:none'>Abstract</title> <p><bold>Objective</bold>: Acetylsalicylic acid (ASA) is the most widely used antiplatelet agent in treating ischemic strokes. ASA resistance varies between the populations, from 5% to 60%. We aimed to determine the prevalence of ASA resistance in our population, its association with demographic characteristics, risk factors, and the occurrence of recurrent ischemic stroke (IS). (IST).</p> <p><bold>Methods</bold>: One hundred consecutive patients with primary or recurrent IS were prospectively included. Strokes were diagnosed with computed tomography (CT) or magnetic resonance imaging (MRI). In all patients a detailed history of cardiovascular risk factors and fasting blood analyzes (blood count, glycemia, HbA1c, degradation products, lipid profile) were taken, and the ASA resistance was examined with the Innovance PFA 200 system. The ASA resistance was examined after a minimum of 1 month of regular use of ASA 100 mg per day.</p> <p><bold>Results</bold>: The prevalence of ASA resistance was 32%. ASA-resistant patients were statistically significantly older (69.9±7.5 vs, 61±1 y., p&lt;0.05), and of male gender (75 vs, 45.6%, p&lt;0.05). Previous cardiovascular diseases were statistically significantly more common in the ASA-resistant patients compared to the ASA-sensitive patients (46.8 vs 26.5%, p&lt;0.05). The presence of recurrent stroke in the ASA-resistant versus ASA-sensitive patients was statistically significant (75% vs. 22.05%, p&lt;0.0001). There was no statistically significant difference in the investigated laboratory parameters and the risk factors between the ASA-resistant and the ASA-sensitive patients.</p> <p>Conclusion. The prevalence of ASA resistance in our population is high. According to our results, ASA resistance testing should be done in the older male individuals with a previous burden of cardiovascular diseases.</p> </abstract>ARTICLEtrue Dysplasia as the Major Anatomic Risk Factors for Patellofemoral Joint Instability: An Infographic as a Visual Learning Tool<abstract> <title style='display:none'>Abstract</title> <p>Patellofemoral instability (PFI) is a common condition in children and adolescents, ranging from mild discomfort and mal-tracking to lateral patellar dislocation [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_001">1</xref>]. A number of anatomical risk factors have been described in the literature, such as trochlear dysplasia, patella alta, excessive tibial tuberosity to trochlear groove (TT-TG) distance, patellar tilt and soft tissue alterations [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_002">2</xref>]. Among them, TD has been identified as the main anatomical risk factor with the strongest association with PFI [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_001">1</xref>, <xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_002">2</xref>]. In the study by Dejour et al. [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_002">2</xref>] radiographically observed TD was identified in 96% of patients with a history of patellofemoral dislocation [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_001">1</xref>, <xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_002">2</xref>]. Patients with Dejour Type D dysplasia are characterized by a prominent and convex lateral facet with a vertical connection to a hypoplastic medial facet (Figure 1), which provides inadequate tracking of the patella in the trochlea during flexion leading to patella subluxation [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_002">2</xref>]. Non-operative treatment of lateral patellar dislocation presents a rate of re-dislocation up to 70% within 24 months of the first episode [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_003">3</xref>]. Sulcus deepening trochleoplasty is indicated for Type B and D dysplasia, in order to improve patella tracking, reduce the rate of re-dislocation and achieve good functional outcomes [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_002">2</xref>, <xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_004">4</xref>]. Trochlea dysplasia is defined as a shallow or flattened groove with decreased resistance to lateral patellar translation. TD can be assessed on computed tomography (CT) and magnetic resonance imaging (MRI) with the use of overlapping axial images and are able to show perfectly the global shape of the femoral trochlea [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_002">2</xref>]. The thresholds for identifying trochlear dysplasia are established based on the sulcus angle ≥ 145°, medial/lateral trochlea facet asymmetry &lt; 40%, trochlear depth &lt; 3 mm and lateral trochlear inclination ≤ 11° and therefore it can be used in young adolescents [<xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_004">4</xref>, <xref ref-type="bibr" rid="j_prilozi-2024-0017_ref_005">5</xref>]. A deep knowledge of anatomic variations and abnormalities of the patellofemoral joint, which may predispose to PFI, is crucial in order to choose the appropriate treatment for each patient.</p> </abstract>ARTICLEtrue Distress Syndrome (RDS) in Newborns with Hypoxic-Ischemic Encephalopathy (HIE)<abstract><title style='display:none'>Abstract</title> <p>Respiratory distress syndrome (RDS) and hypoxic-ischemic encephalopathy (HIE) are frequent causes of death and disability in neonates. This study included newborns between January 2021 and July 2022 at the University Clinic for Gynecology and Obstetrics, Skopje. Up to date criteria for HIE/RDS for term and for preterm infants as well for the severity of HIE/RDS were used in a comprehensive analysis of cranial ultrasonography, neurological status, neonatal infections, Apgar score, bradycardia and hypotension, X-ray of the lungs, FiO2, acid-base status, assisted ventilation and use of surfactant.</p> <p>Three groups were created: HIE with RDS (42 babies), HIE without RDS (30 babies) and RDS without HIE in 38 neonates. All newborns with severe (third) degree of HIE died. Intracranial bleeding was found in 35.7% in the first group and 30% in the second group, and in the third group in 53.3%. The need for surfactant in the HIE group with RDS is 59.5%, and in the RDS group without HIE 84.2%. DIC associated with sepsis was found in 13.1-50% in those groups. In newborns with HIE and bradycardia, the probability of having RDS was on average 3.2 times higher than in those without bradycardia.</p> <p>The application of the surfactant significantly improved the pH, pO2, pCO2, BE and chest X-ray in children with RDS. An Apgar score less than 6 at the fifth minute increases the risk of RDS by 3 times. The metabolic acidosis in the first 24 hours increases the risk of death by 23.6 times. The combination of HIE/ RDS significantly worsens the disease outcome. The use of scoring systems improved the early detection of high risk babies and initiation of early treatment increased the chances for survival without disabilities.</p> </abstract>ARTICLEtrue PCR in Diagnosing Respiratory Tract Infections in Hospitalized Children<abstract><title style='display:none'>Abstract</title> <sec><title style='display:none'>Objectives:</title> <p>To elaborate the utility of multiplex quantitative polymerase chain reaction (multiplex qPCR) for the accurate diagnosis of severe respiratory tract infections (RTIs) in hospitalized children. </p> </sec> <sec><title style='display:none'>Methods:</title> <p>In two separate periods during 2022, 76 respiratory specimens (combined throat/nasopharyngeal swabs) were submitted for multiplex qPCR regarding 26 respiratory pathogens. The specimens were obtained from children with severe RTIs hospitalized in the Institute for Respiratory Diseases in Children, Skopje.</p> </sec> <sec><title style='display:none'>Results:</title> <p>Multiplex qPCR detected at least one respiratory pathogen in all examined specimens (76/76), with 83% (63/76) rate of co-infections. Considering that positive results are only the ones with Ct value below 28, the rates of detected pathogens and co-infections decrease to 75% and 22%, respectively. The most commonly detected pathogens during the spring period were Parainfluenza type 3 (PIV3) followed by Adenovirus (AdV) and Respiratory syncytial virus type B (RSVB) with frequency rate of 23%, 19% and 19%, respectively. During the autumn period, the most common were RSVB and <italic>Streptococcus pneumoniae</italic> with frequency rate of 31% and 17%, respectively.</p> </sec> <sec><title style='display:none'>Conclusion:</title> <p>Multiplex qPCR is a powerful tool for diagnosing RTIs. Semi-quantification of the viral load by reporting Ct values added higher level of evidence for accurate diagnosis. Seasonal detection of the examined viruses was notable with higher prevalence of PIV3 in spring and RSVB in autumn period.</p> </sec> </abstract>ARTICLEtrue – A Rewiev of 438 Cases<abstract><title style='display:none'>Abstract</title> <p>The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under <italic>postauricular, endaural and transcanal approach </italic>with <italic>overlay, underlay and inlay methods</italic>. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P&gt;0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.</p> </abstract>ARTICLEtrue Gaming: The Relevance of a New Phenomenon in the Youth<abstract><title style='display:none'>Abstract</title> <p>The high level of technological growth in contemporary society, beside benefits, provokes different kinds of damages, especially among the worldwide youth population. World statistics have recognized that video and internet game addiction is a growing problem. In this context, it is supposed that 0.3 to 1.0 percent of the general population might be qualified as a potential sufferer of internet gaming disorder. However, youth between 18-34 years are the highest risk population.</p> <p>New research has shown the need of early identification of at-risk young people for internet addiction. Adverse experience in children of different forms of stress, negative life circumstances and especially negative, hostile parenting can lead to depression, social and cultural problems, together with significant boredom and loneliness levels. These are all confirmed to be related with addictive behaviour.</p> <p>Some neural correlates are discussed as the possible background of game addiction. Finally, therapeutic possibilities are presented.</p> </abstract>ARTICLEtrue Treatment of Gonarthrosis: Proximal Fibular Osteotomy<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction:</title> <p>Gonarthrosis is arthrosis of the knee joint, a chronic non-inflammatory disease manifested by progressive destruction of the intra-articular cartilage, accompanied by abnormal formation of the bones form the joint, changes in the synovial membrane and synovial fluid. Gonarthrosis is the most common type of arthrosis. Gonarthrosis can be treated conservatively and operatively. Among well-established surgical options for the treatment of medial gonarthrosis are high tibial osteotomy (HTO), unicompart-mental knee arthroplasty (UKA), and total knee arthroplasty (TKA). Proximal fibular osteotomy (PFO) or superior partial fibulectomy is a relatively recent procedure proposed to reduce knee pain in patients with medial compartment.</p> </sec> <sec><title style='display:none'>Aim:</title> <p>Our study aims to demonstrate an alternative treatment for gonarthrosis with proximal fibular osteotomy and reduced knee pain in patients with medial compartment osteoarthritis of the knee. </p> </sec> <sec><title style='display:none'>Materials and methods:</title> <p>At the Department of Orthopedics and Traumatology at J.Z.U “Borka Taleski” Prilep in the period from 2018 to 2021, 14 cases were treated, of which 11 were female and 3 were male. All patients were aged between 62 and 82 years with a mean age of 71.3 years. Patients had a severe degree of gonarthrosis (III/IV) according to Kellgren-Lawrence classification. Arthroscopy was performed in 2 patients. The fibula osteotomy was 7 cm away from the fibular head, with 1 cm resected bone fragment from the fibula.</p> </sec> <sec><title style='display:none'>Results:</title> <p>The average duration of the surgery was 30 minutes. Patients were followed up on the 7th day, first month, 3 months and 6 months after surgery. The final evaluation of function was done after 6 months by examining the active and passive movements of the knee joint. In all 14 patients we have excellent results with pain reduction, improvement of movement and quality of life.</p> </sec> <sec><title style='display:none'>Conclusion:</title> <p>Proximal fibular osteotomy is an option for medial compartment osteoarthritis of the knee. Current literature is limited to small case series which report good outcomes in pain reduction, including the correction of varus deformity in medial gonarthrosis. Further studies are needed to determine the place of the PFO in the medial gonarthrosis management algorithm before it can be recommended for routine clinical use.</p> </sec> </abstract>ARTICLEtrue of the Effects of Gastro Protect as an Alternative Medicine on Gastritis and Other Gastrointestinal Symptoms<abstract><title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction:</title> <p>The use of herbal medicine as a part of the Complementary and Alternative Medicine is increasing worldwide. Herbal remedies are used to better different conditions including gastritis. </p> </sec> <sec><title style='display:none'>Material and Methods:</title> <p>We conducted a prospective randomized control clinical trial on a total sample of 72 patients with gastritis in order to examine the effects of the commercial herbal product Gastro Protect. After 6 weeks of conventional therapy the patients were divided into two groups with 36 patients each. As a continuation of the treatment, Group 1 received conventional therapy + Gastro Protect and Group 2 received conventional therapy + Placebo.</p> <p>We analyzed 14 selected gastrointestinal symptoms, five related to digestive problems, and nine related to stool and bowel problems. For assessing the selected symptoms we used seven point gastrointestinal symptom rating scale (GSRS).</p> </sec> <sec><title style='display:none'>Results:</title> <p>The Gastro Protect group had a significantly lower GSRS score (better condition) compared to the Placebo group related to all five selected symptoms of digestive problems as: abdominal pain (p=0.0250), hunger pain (p=0.0276), nausea (p=0.0019), heartburn (p=0.00001), and acid reflux (p=0.0017). The Gastro Protect group, also had a significantly lower GSRS score (better condition) compared to the Placebo group related to three out of nine selected bowel symptoms: rumbling (p=0.0022), abdominal distension (p=0.0029), and gas or flatus (p=0.0039).</p> </sec> <sec><title style='display:none'>Conclusion:</title> <p>Gastro protect was effective in treating gastritis and other gastrointestinal symptoms. It was safe for usage and showed almost no side effects. In our study, Gastro Protect reduced the examined gastric symptoms and related examined intestinal symptoms.</p> </sec> </abstract>ARTICLEtrue Nephrostomy as a Procedure in the Treatment of Urinary Tract Obstruction – Experiences in the University Clinic of Urology in Skopje<abstract><title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction:</title> <p>Obstructive uropathy encompasses various urinary tract obstructions, leading to changes in urine flow, kidney pressure, and impaired kidney function. Predicting renal recovery from obstructive uropathy, can be challenging and necessitates treatment, as in percutaneous nephrostomy (PNS) drainage. The choice of drainage method depends on patient-specific factors and local expertise. According to the data for the Republic of North Macedonia, in the register of the European Renal Association, in the last few years, there has been an increase in the percentage of patients with obstructive nephropathy from 7.6% to 8.9% who end up on a chronic hemodialysis program. Prompt relief from urinary tract obstruction is essential to preserve renal function and prevent complications.</p> <p>The aim of this study is to present our initial data analysis of recent experience in the use of nephrostomies as a method for temporary or long-term resolution of obstructive nephropathy, in terms of safety and success in preserving kidney function and reducing the number of patients on hemodialysis.</p> </sec> <sec><title style='display:none'>Materials and methods:</title> <p>This study analyzed the medical records of 24 patients with obstructive uropathy who underwent PNS placement. Data were collected for the type and degree of obstruction from the ultrasonographic examination. A pig tail nephrostomy was used, with a dilator, guided under ultrasound and controlled with contrast and fluoroscope. Obstructive nephropathy was defined as an elevation of the serum creatinine &gt; 109 µmol/L, before the intervention. Glomerular filtration rate (GFR) was calculated according to the formula CKD epi in ml/min. Each placement of the PNS was considered as an individual procedure and the data of 38 placed nephrostomies were analyzed. We compared the laboratory analyses from the day before (D0) PNS placement and on the seventh day (D7) after PNS placement. The reduction of values for red blood cells (RBC) and hemoglobin (Hb) baseline values from D0 to D7 and the need for transfusion after the procedure were defined as a complication-bleeding. The increase in total counts of the white blood cells (WBC) and C-reactive protein (CRP) from the baseline values from D0 to D7 were defined as a complication-infection. Standard statistical methods were used for data processing.</p> </sec> <sec><title style='display:none'>Results:</title> <p>Most patients, 17 (70%), had malignant disease as the cause of obstruction. Unilateral obstruction was more common, detected in 24 (63%) of procedures, with a high degree of hydronephrosis. Obstructive nephropathy, marked by elevated serum creatinine, was observed in 23 (60%) cases before PNS placement. Complications included bleeding and infection but did not result in any fatalities. When comparing the laboratory analysis before PNS placement (D0) and seven days later (D7), a statistically significant decrease in serum creatinine (225±161 vs. 162±145, p=0.005) and an increase in GFR (47±39 vs.59±34, p= 0.005) were observed.</p> </sec> <sec><title style='display:none'>Conclusion:</title> <p>Percutaneous nephrostomy is a safe and effective treatment option for urinary tract obstruction, especially in patients with malignancies. Continuous monitoring is essential to assess long-term complications and the longevity of PNS functionality. This procedure offers a significant benefit in preserving renal function and minimizing the need for hemodialysis in these patients.</p> </sec> </abstract>ARTICLEtrue Outcome Predictors of COVID-19 Requires a Multicentre, Prospective Design and Inclusion of All Determinants 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