rss_2.0Social Sciences FeedSciendo RSS Feed for Social Sciences Sciences Feed Among Opioid-Based, Low Opioid and Opioid Free Anesthesia in Colorectal Oncologic Surgery<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Opioids are the “gold standard” for pain treatment during and after colorectal surgery. They can inhibit cellular and humoral immunity and it is assumed that can promote cancer cell proliferation and metastatic spread. Adequate pain management can be achieved not only with opioids, but also with non-opioid drugs, which can be used together in small doses, i.e., multimodal analgesia, and can lower the need for opioids during and after surgery. Opioid free anesthesia (OFA) is part of multimodal analgesia, where opioids are not used in the intraoperative period.</p> <p><bold>Materials and methods</bold>: In this prospective and randomized clinical study 60 patients scheduled for open colorectal surgery were enrolled. They were between the ages of 45 and 70 with the American Association of Anesthesiologists (ASA) classifications 1, 2 and 3, divided in three groups. The first group of patients, or Opioid-based anesthesia group (OBAG), received the following for induction to anesthesia: lidocaine at 1 mg/kg, fentanyl 100 at µgr, propofol at 2mg/kg and rocuronium bromide at 0.6 mg/kg. They intermittently received 50-100 µgr fentanyl intravenously and 0.25 % bupivacaine 2-3 ml every 30-45 minutes, given in the epidural catheter during surgery. The second group of patients, or Low opioid anesthesia group (LOAG), received the following for induction to anesthesia: lidocaine at 1 mg/kg, fentanyl at 100 µgr, propofol at 2mg/kg and rocuronium bromide at 0.6 mg/kg. Prior to surgery, 50 µgr of fentanyl with 5 ml 0.25% bupivacaine was given into the epidural catheter, and the same dose was received at the end of surgery. The third group, or Opioid free anesthesia group (OFAG), received the following before the induction to general anesthesia: dexamethasone at 0.1 mg/kg and 1 gr of paracetamol. Induction to general anesthesia was with lidocaine at 1 mg/kg, propofol at 2mg/kg, ketamine at 0.5 mg/kg and rocuronium bromide at 0.6 mg/kg. After intubation, intravenous continuous infusion with lidocaine was at 2 mg/kg/h, ketamine 0.2 mg/kg/h and magnesium 15 mg/kg/h loaded on and intermittently 0.25 % bupivacaine 2-3 ml every 30-45 minutes given in the epidural catheter during surgery. The primary goal was to measure the patients’ pain after the first 72 postoperative hours in all three groups (2, 6, 12, 24, 36, 48 and 72 hours after surgery). The secondary goal was to measure the total amount of morphine given in the epidural catheter in the postoperative period in all three groups. Other secondary goals were: to compare the total amount of fentanyl given intravenously during surgery in the first and second groups, determine if there was a need to use rescue analgesia in the postoperative period, measure the occurrence of PONV, and to measure the total amount of bupivacaine given in the epidural catheter during operation in all three groups.</p> <p><bold>Results</bold>: Visual Analogue Scale (VAS) score comparisons between groups showed patients from the OBA and LOA groups had significantly higher VAS scores, compared to the patients from the OFA group 2, 12, 24 and 48 hours after operation. After 6 hours postoperatively, patients from the LOA group had significantly higher VAS scores, compared to patients from the OBA and OFA groups. After 36 hours postoperatively, patients from the OBA group had significantly higher VAS scores compared to patients from the LOA and OFA groups. At the last follow-up point, 72 hours after the intervention, the patients from the OBA and LOA groups had significantly higher VAS scores compared to the patients from the OFA group. All patients from the OBA and LOA groups, and only 9 from the OFA group received morphine in the postoperative period via epidural catheter. Patients from the Opioid group received significantly higher amounts of fentanyl during surgery. Additional administration of another analgesic drug in the postoperative period was prescribed in 55% of patients in the OBAG, in 50% in the LOAG and in 35% of the OFA group. PONV was registered in 60% of patients from the OBAG and in 40% of patients from the LOAG. In the OFA group did not register PONV in any of the patients. The biggest amount of bupivacaine given during surgery was in the OBAG (26.37 ± 2.6 mg), in LOAG was 25.0 ± 0 and the less in OFAG group (24.50 ± 4.3).</p> <p><bold>Conclusion</bold>: Patients from OFA group, compared with patients from OBAG and LOAG, have the lowest pain score in first 72 hours after open colorectal surgery, received fewer opioids via an epidural catheter in the postoperative period, had less need for rescue analgesia, no occurrence of PONV, and less need for bupivacaine via an epidural catheter in the intraoperative period.</p> </abstract>ARTICLEtrue Birth Trauma in Macedonian Women<abstract> <title style='display:none'>Abstract</title> <p>Although the childbearing is perceived as a normal and happy event, new research shows that psychological birth trauma is, however, a universal and not so rare phenomenon.</p> <p>Traumatic birth experiences can cause postnatal mental health disturbances, fear of childbirth in subsequent pregnancies and disruption to mother-infant bonding, leading to possible impaired child development.</p> <p>The purpose of this research was to evaluate collected data from several obstetric clinics, as well as from primary paediatric settings related to ‘Birth Trauma’ in order to review women with symptoms of post-traumatic stress disorder (PTSD) following childbirth.</p> <p>The study is prospective, starting from January 2021 and ending in December 2022. The psychological instrument used in this research is the Intersect Questionnaire, composed of 59 questions grouped in 8 parts.</p> <p>The obtained results from our study confirmed that birth trauma is not a rare phenomenon in our country. Symptoms correlated with PTSD were present as follows: unpleasant memories (2.7%), anxiety (38.54%), panic (6.47%), trying not to remember the delivery (4.04%), self-accusation (2.16%), negative emotions (1.89%), alienation (4.31%), irritation/aggression (1.89%), self-destruction (1.89%), impulsiveness (4.31%), problems with concentration (3.23%), and sleeping problems (21.88%). These results are alarming. It is imperative to better understand this vulnerable period in a woman’s life.</p> <p>As a general conclusion, we must highlight the importance of perceived birth trauma in women, phenomena which has been confirmed worldwide and which must be overcome as quickly and as successfully as possible.</p> </abstract>ARTICLEtrue Approach to Renal Transplantation Candidates and Potential Donors with Viral Hepatitis<abstract> <title style='display:none'>Abstract</title> <p>Renal transplantation is the most beneficial treatment in patients with chronic kidney disease (CKD), increasing life expectancy and improving quality of life. A better understanding of organ and tissue functions, the development of surgical techniques, and new and effective immunosuppressive and antimicrobial drugs increase the success of transplantation. However, the number of renal transplantations from living and cadaveric donors is not at the desired frequency. Among the leading causes of the restrictions for transplantation are both the recipients’ and donors’ chronic diseases. While hepatitis B and C infections are a significant problem affecting the number and success of renal transplantations, the innovation of hepatitis C virus treatments has improved outcomes. Thus, the recipient and donor hepatitis B and C virus infections are no longer considered as relative contraindications for renal transplantation. This review discusses the management of patients and donors with hepatitis B and hepatitis C in renal transplantation.</p> </abstract>ARTICLEtrue of Supplemental Antioxidant-Based Therapy on the Oxidative Stress Level in COVID-19 Patients<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: COVID-19 is a disease in several stages starting with virus replication to dysregulation in immune system response, organ failure and recovery/death. Our aim was to determine the effect of Ganoderma lucidum, lycopene, sulforaphane, royal jelly and resveratrol extract on markers of oxidative stress, inflammation, routine laboratory analyses and duration of symptoms in COVID-19 patients.</p> <p><bold>Methods</bold>: The oxidative stress parameters and interleukines 6 and 8 (IL-6, IL-8), tumor necrosis factor alpha (TNF-α) were determined in order to estimate the antioxidant and the anti-inflammatory effect of the product using a spectrophotometric and a magnetic bead-based multiplex assay in serum of 30 patients with mild form of COVID-19.</p> <p><bold>Results</bold>: Statistically significant differences were obtained for all investigated parameters between the treated patients and the control group. Moreover, significant differences were observed for leukocytes, neutrophil to leukocyte ratio and iron. The average duration of the symptoms was 9.4±0.487 days versus 13.1±0.483 days in the treatment and the control group, respectively (p=0.0003).</p> <p><bold>Conclusion</bold>: Our results demonstrated the promising effect of Ge132+Natural<sup>TM</sup> on reducing the oxidative stress and the IL-6, IL-8 and TNF-α levels, and symptoms duration in COVID-19 patients. The evidence presented herein suggest that the combination of Ganoderma lucidum extract, lycopene, sulforaphane, royal jelly and resveratrol could be used as a potent an adjuvant therapy in diseases accompanied by increased oxidative stress and inflammation.</p> </abstract>ARTICLEtrue a Catheter for Hemodialysis Placed in the Inferior Vena Cava for the First Time in N. Macedonia - Translumbar Approach<abstract> <title style='display:none'>Abstract</title> <p>Maintenance of vascular access for hemodialysis remains a challenge for every doctor. Exhausted conventional vascular access is the cause for the placement of the central venous catheter in unconventional sites such as enlarged collateral vessels, hepatic veins, hemiazygos, azygos, renal veins, and the inferior vena cava. The percutaneous translumbar catheter for hemodialysis in the inferior vena cava was described over 20 years ago. In this article, we report on the procedure and complications arising from the percutaneous translumbar approach of a hemodialysis catheter. This was done for the first time in N. Macedonia. This approach is a potential option in adults and children when conventional approaches are limited.</p> </abstract>ARTICLEtrue of Lung Cancer Patient Characteristics and Treatment Strategies in the Pandemic Covid-19 Year<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: It is estimated that delays in diagnosis due to the COVID-19 pandemic in North Macedonia could result in significant reductions in the number of potentially curative stages in lung cancer patients.</p> <p><bold>Purpose</bold>: The aim of this study was to review patient characteristics and treatment strategies of lung cancer patients treated at the University Clinic of Radiotherapy and Oncology (UCRO), during the pre-pandemic year (from 1 of March 2019 to the end of February 2020) and the pandemic year (from 1 of March 2020 to the end of February 2021).</p> <p><bold>Material</bold>: We analyzed eligible patients in the course of these two years according to patient characteristics and treatment strategies.</p> <p><bold>Results</bold>: We have a record increasing in number of undefined lung cancer patients without any pathological or histological conformation (11% pandemic year compared to 7% in the previous year), and an increased number of stage III and IV NSCLC patients in the pandemic year 449 (87%), in comparison to the pre-pandemic year of 403 (74%) patients. We have found a decreasing number of stage II NSCLC patients in the pandemic year 82 (13%) compared to 141 (26%) patients in the pre-pandemic year. We also note a decreasing number of patients with NSCLC operated on from 218 to 123 in the pandemic group. Due to frequent check-ups for COVID-19, we report an increasing number of early stage IA and stage IB patients, treated only by surgery.</p> <p><bold>Conclusions</bold>: The strict screening and admittance criteria put in place by hospitals during the pandemic might have improved the oncology treatment course of lung cancer patients.</p> </abstract>ARTICLEtrue Cochlear Nerve Canal as a Predictor for Cochlear Nerve Status in Prelingually Deaf Children<abstract> <title style='display:none'>Abstract</title> <p><bold>Objectives</bold>: The presence of a functional cochlear nerve is a key issue in the preoperative evaluation of pediatric candidates for cochlear implants. Correlations between cochlear nerve deficiency (CND) and bony abnormalities of the labyrinth or bony canal of the cochlear nerve are not yet well understood. The aim of this study was to determine whether the width of the bony cochlear canal (BCNC) can serve as a reliable predictive factor for the existence of a CND.</p> <p><bold>Materials and methods</bold>: A total of 11 children with a confirmed diagnosis of prelingual, severe sensorineural hearing loss were included in this study. In all patients, indication for CI was confirmed and according to the preoperative protocol, high-resolution CT and MR were performed. Reconstructions at a distance of 0.6 mm of the axial plane and images from the HRCT of temporal bones were used for measuring the width of the BCNC. The cochlear nerves were evaluated on axial and sagittal – oblique T2 – MRI images and classified as normal, hypoplastic or aplastic. Two factors were reviewed retrospectively: the presence of inner ear anomalies and the relationship between BCNC stenosis and the existence of CND.</p> <p><bold>Results</bold>: From a total of 22 temporal bones analyzed (22 ears in 11 patients), inner ear malformations were detected in 6 ears from 3 patients (27.27%). All three children had a bilateral malformation, in one it was Michel deformity and in two it was IP2 (incomplete partition 2). The BCNC diameter ranged from 0.1mm to 2.33mm with a mean value of 1.46±0.6mm. CND was recorded in 4 of 22 ears and all were associated with stenosis of the BCNC. In a total of three ears with a stenotic canal, we obtained a normal finding for the cochlear nerve on MR.</p> <p><bold>Conclusion</bold>: Children with BCNC stenosis have a high incidence of CND. A narrowed BCNC on CT can be an indicator for the selection of children with sensorineural hearing loss who will need to be additionally referred for MRI in order to definitively assess the status of the cochlear nerve.</p> </abstract>ARTICLEtrue Evaluation of Arthroscopic Resection of Dorsal Wrist Ganglia<abstract> <title style='display:none'>Abstract</title> <p><bold>Goals</bold>: Arthroscopic ganglionectomy has become an increasingly popular surgical option for dorsal wrist ganglia. The aim of this study was to describe our technique for the arthroscopic treatment of dorsal wrist ganglia and to evaluate the clinical results as well as the recurrence rate in our patients.</p> <p><bold>Methods</bold>: In a prospective study, 48 patients who underwent arthroscopic treatment of dorsal ganglion of the wrist were included. Patients were evaluated preoperatively and 3 and 24 months post arthroscopy. A presence of recurrence at 24 months was recorded. The subjective outcome was evaluated with The Patient-Rated Wrist Evaluation (PRWE) and the Visual analog scale (VAS). Objective outcomes included grip strength and range of movement measurements.</p> <p><bold>Results</bold>: The mean age was 36 years; the majority were women (36/48). Mean grip strength and the average flexion and extension in the wrist showed improvement after 3 months. The total PRWE score improved from 26.7 preoperatively to 10.2 at three months and 2.4 two years after surgery. After 24 months follow-up, there were only two patients with recurrence (4.2%).</p> <p><bold>Conclusion</bold>: The arthroscopic resection of the dorsal wrist ganglia is a procedure with a low recurrence rate and lowest scaring and stiffness; it should be considered as a golden standard for operative treatment of the dorsal wrist ganglia.</p> </abstract>ARTICLEtrue of Left Atrial Enlargement According to Different Modes of Indexing in Overweight and Obese Individuals<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: Current guidelines recommend indexing left atrial volume (LAV) by body surface area (BSA). However, in overweight and obese individuals this may result in the underestimation of left atrial enlargement (LAE). The aim of our study was to assess whether alternative LAV indexing to height and/or height-squared better identifies individuals with LAE among those who are overweight and/or obese.</p> <p><bold>Methods</bold>: LAV was indexed to BSA (LAVI), height (LAVh), and height-squared (LAVh2) in 127 individuals with a mean age of 45.7 years and a mean body mass index (BMI) of 34.9 kg/m2 who underwent outpatient echocardiography at the University clinic of cardiology in Skopje.</p> <p><bold>Results</bold>: LAVI, LAVh, and LAVh2 showed a progressive increase of respective values with the extent of BMI showing the most enlarged LA size in individuals with Class III obesity. There was a progressive significant increase in the prevalence of LAEh and LAEh2 in obese groups with the highest prevalence among those with class III obesity (p=0.002, p=0.002, respectively), on the contrary of LAEBSA where we could not find any significance in its distribution among obese classes. The greatest degree of reclassification occurred when indexing for height-squared, having relatively less reclassification when indexing for height (p=0.0001). The degree of reclassification varied depending on BMI with the greatest impact among the Class III obese patients, where as many as 76.5% and 88.2% of individuals were reclassified according to height or height-squared, respectively.</p> <p><bold>Conclusions</bold>: The use of height, and especially height-squared, in comparison to BSA-based indexing methods are more successful in identifying the LAE prevalence in each class of obesity. Using allometric indexation leads to the significant reclassification of LA size from normal to dilated, especially in women and those with severe obesity, thereby providing an opportunity to identify more individuals at increased risk of adverse events.</p> </abstract>ARTICLEtrue of Inflammatory Markers with Disease Severity and Outcome in Covid-19 Patients<abstract> <title style='display:none'>Abstract</title> <p><bold>Objectives</bold>: The coronavirus pandemic was associated with a high mortality rate in the Republic of North Macedonia. Finding early markers of the disease’s severity may predict outcomes and guide the treatment of the disease. The aim of our study was to evaluate the role of inflammatory markers in predicting the outcome of COVID-19 in hospitalized patients.</p> <p><bold>Methods</bold>: The study included 104 PCR-confirmed COVID-19 patients who underwent hospital treatment at the Institute of Lung Diseases and Tuberculosis in Skopje, North Macedonia, between November 2020 and May 2021. Inflammatory markers were assessed in all patients and correlated with the disease severity and outcome in terms of survival or death.</p> <p><bold>Results</bold>: IL-6 and LDH at admission were significantly elevated in patients with a severe or critical form of the disease and among non-survivors. In addition, IL-6 showed 87.9% of sensitivity and 61.8% of specificity for distinguishing non-survivors from survivors with a cut-off value of 21.7 pg/ml in the receiver operator curve (ROC). Procalcitonin was significantly increased in non-survivors. Parallel to the increase of disease severity, the values of CRP and LDH increased significantly during hospitalization.</p> <p><bold>Conclusion</bold>: The results of the study indicate that a significant association exists between the highly increased levels of CRP, LDH, IL-6 and procalcitonin and the severity of the disease and mortality in COVID-19 patients. Their measurements and follow-up during the course of the disease could be used as predictors for prognosis and outcome but also as a subject for targeted therapy.</p> </abstract>ARTICLEtrue and Anxiety in Adolescents and their Caregivers: A Cross-Sectional Study from North Macedonia<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Mental health problems have increased internationally during the COVID-19 pandemic. Adolescents and their caregivers form a vulnerable group for the development of mental health problems. However, most data stems from high-income countries, and there is a clear lack of prevalence rates and potential risk factors from Balkan countries. No data is available on the impact of the COVID-19 pandemic on mental health in adolescents and their caregivers in North Macedonia.</p> <p><bold>Materials and methods</bold>: A cross-sectional study was conducted on adolescents and their caregivers in a school setting in rural and urban areas of North Macedonia. Survey items assessed symptoms of depression, anxiety, and respondents’ fear of COVID-19, as well as a number of risk factors, such as gender and living environment.</p> <p><bold>Results</bold>: 506 adolescents and 492 caregivers completed the survey. Symptoms of depression and anxiety were mild to moderate in adolescents and their caregivers. Women and girls generally scored higher than men and boys, and adolescents in high school scored higher than those in elementary school. Prevalence rates for depression were 29.2% for adolescents and 10.4% for caregivers, while rates of anxiety were 23.7% for adolescents and 6.1% for caregivers.</p> <p><bold>Conclusion</bold>: This study provides a first insight into the mental health of adolescents and their caregivers after the COVID-19 pandemic in North Macedonia. Further research is required to investigate the relatively low rates of caregivers’ mental health problems compared to data from other countries.</p> </abstract>ARTICLEtrue Diseases in Children as a Challenge for Parenting<abstract> <title style='display:none'>Abstract</title> <p>To be a parent or a caregiver in a modern society is a very difficult task, including multiple demands and expectations. Parenting imposes a special role in the life of any couple, especially for the mother, roles which must be learned through personal education, enriched by transgenerational experience.</p> <p>Chronic disease is recognized as a large stressor that affects the current situation of a child and a child’s family. In this difficult situation, the family must go through a process of learning how to cope with it. In the family, where a child has a long-term health problem, there are certain behaviours that hinder the normal functioning of family relationships.</p> <p>According to the experience of many researchers, including my own, there is an indication that a child’s illness often leads to the divorce of the parents. The fathers of sick children are often the initiators of such decisions.</p> <p>The purpose of this article was to find if there are differences in parenting between mothers and fathers of chronically ill children.</p> <p>The methodology is comprised of a review of published articles in PubMed over the last two decades related to parenting when there is chronic illness in children. More than 500 articles related to the topic were found. Obtained results were discussed.</p> </abstract>ARTICLEtrue of Oxidative Stress Levels in Healthy Children and Children with Allergic Rhinitis<abstract> <title style='display:none'>Abstract</title> <p><bold>Background/aim</bold>: Allergic rhinitis (AR) is characterized by chronic inflammation of the nasal mucosa. Under the influence of exogenous factors - allergens, reactive oxygen species (ROS) are released during cellular metabolism. They induce a series of pathological changes in the mucosa. Oxidative stress is а result of an imbalance between the production of ROS and the ability to neutralize them. The aim of this study is to compare the levels of oxidative stress between healthy children and children with allergic rhinitis.</p> <p><bold>Material and methods</bold>: A total number of 60 children were included (30 healthy children and 30 children with AR). The oxidative stress index was determined by using the FRAS 5 (Free Radical Analytical System) Bravo system. Demographic characteristics, medical history, children’s living conditions and eating habits were obtained from the questionnaire. Anthropometric measurements and the absolute number of eosinophils in the peripheral smear were performed on each child.</p> <p><bold>Results</bold>: This study showed high oxidative stress index and a significantly higher value of the absolute number of eosinophils in the peripheral smear in children with AR in comparison to healthy children (p&lt;0.05). The group of children with AR had more atopic characteristics and was more exposed to passive smoking than healthy children.</p> <p><bold>Conclusion</bold>: Compared to healthy children, children with AR have a high index of oxidative stress, despite of the very high mean value of the concentration of water-soluble antioxidants in serum (PAT test) in the group of children with AR.</p> </abstract>ARTICLEtrue Memoriam Acad. Prof. Dr. Ljubiša Rakić (1931-2022) of Results After Surgical Application of Bone Marrow Aspirate Stem Cell Concentrate in the Treatment of Avascular Necrosis of the Femoral Head<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Avascular necrosis or osteonecrosis of the femoral head is defined as a pathological process that results in a critical reduction in the blood supply to the hip head with increased intraosseous pressure. Avascular necrosis is a multifactorial disease. The treatment used so far consists of transosseous decompression of the femoral head and is the most commonly used method in the early stages of osteonecrosis.</p> <p><bold>Aim</bold>: The aim of this study was to evaluate the results after application of bone marrow stem cells obtained from the pelvic ridge, which was applied to the necrotic zone after previous decompression.</p> <p>Material and methods. The study is of prospective character and included 30 patients with first, second, and third degrees of AVN according to the Ficat classification, determined with X-ray. The range of motion in the hip was examined preoperatively by using a goniometer, a radiological evaluation of the degree of AVN was performed, according to the Ficat classification, and the VAS scale and the Harris Hip Score were examined preoperatively and postoperatively.</p> <p><bold>Results</bold>: The average value for the Harris Hip Score (HHS) preoperatively was: for Ficat I -66.32±5.1, for Ficat II - 49.19±3.4 and for Ficat III - 33.71±2.1. At the 3-month postoperative follow-up, the average HHS values were: 87.92±4.3 for Ficat I, 78.64±6.6 for Ficat II and 76.48±2.6 for Ficat III. The same values for HHS were obtained in the control examinations at the 6th and 12th month postoperatively, indicating the fact that good bone regeneration was achieved and the progression of the condition was prevented. A decrease in the HHS value was observed at the control examination at 1 year after the surgical treatment, in 3 patients according to the Ficat classification of grade III, in whom a total hip replacement surgery was performed.</p> <p><bold>Conclusion</bold>: The use of stem cells in the treatment of avascular necrosis of the femoral head has achieved good functional results and reduced pain in operated patients. Radiographically, good bone regeneration was achieved and the progression of necrosis to a higher degree was prevented.</p> </abstract>ARTICLEtrue and Safety of Empagliflozine and Semaglutide (Once Weekly) in T2DM Patients in Shtip<abstract> <title style='display:none'>Abstract</title> <p><bold>Objective</bold>: The efficacy and safety of the following new treatment agents were analyzed: once weekly semaglutide (OWSem) and the empagliflozine (Empa). This was done with patients with type 2 diabetes mellitus (T2DM) at the Clinical Hospital in Shtip, R.N. Macedonia.</p> <p><bold>Material and methods</bold>: One-hundred-twenty-one diabetic patients were treated for the first time with OWSema or Empa and were retrospectively analyzed. Glycemic control, serum creatinine, decrease in weight, co-morbidities, and hospitalization during treatment were recorded.</p> <p><bold>Results</bold>: Among the 61 patients treated with OWSema and 60 patients treated with Empa, there were not any statistically significant differences in age, sex, BMI, duration of diabetes, and a number of patients treated with insulin. Both agents (OWSema and Empa) achieved statistically significant HbA1c reduction after 6, 12, and 18 months (9.2; vs. 7.6; 6.7; 6.6, and 9.3; vs. 7.5; 7.2, 7.5%, respectively) treatment. There were not any differences in the value of creatinine between the visits in both groups. During the period of 2 years, 3 patients (5%) from the Empa group died, all with multiple comorbidities. One patient from Empa group was hospitalized because of acute pulmonary edema and two from the OWSema group because of TIA and acute coronary syndrome. The median decrease in weight was more pronounced in the OWSema group (6.0 vs. 4.0kg). Five patients stopped the treatment with Empa because of a simple urinary infection, and one stopped the OWSema because of GIT intolerance. Eight patients did not tolerate the dose of 1mg, and they therefore continued with 0.5mg of OWSema.</p> <p><bold>Conclusion</bold>: Once weekly treatment with semaglutide and empagliflozine achieves a great reduction in HbA1c, and as such are safe for treatment of T2DM.</p> </abstract>ARTICLEtrue Quality of Life of Women in the Perinatal Period: A Post Covid-19 Pandemic Exploration in North Macedonia<abstract> <title style='display:none'>Abstract</title> <p>Subjective quality of life could be considered one of the indicators of health behavior and wellbeing of women in the perinatal period. Accordingly, the aim of this paper was to examine how women in perinatal period perceive quality of life in various domains. Its relationship to age, number of pregnancies, course of pregnancies, and method of delivery and experience with Covid-19 pandemic was investigated, as well. Our sample consisted of 366 pregnant women in any period of pregnancy who came in for regular outpatient examinations and control, those who were hospitalized due to pathological pregnancy or due to the need for intensive care, as well as women in their postnatal period, one year after delivery, who were seeking professional advice from a gynecologist. The majority were aged 20 to 30 years (53.8%). The findings showed that assessed domains of subjective quality of life were related to a variety of experiences with the Covid-19 pandemic. The results are presented and discussed in detail. Implications and limitations are given, as well.</p> </abstract>ARTICLEtrue Sheets in Ghanaian Recording Studios<abstract> <title style='display:none'>Abstract</title> <p>The <italic>split sheet</italic> used at a recording studio is one of the essential means for any creative artist who understands its implementation benefits from the royalties that the creative work generates as it gets commercial merchandise. However, surprisingly, Ghanaian music producers and practitioners are yet to tap into the full potential of this avenue. This paper investigates the awareness and benefits of the <italic>split sheet</italic> among Ghanaian music producers and practitioners in the recording industry and the extent to which they have explored it. Using a mixed-methods mode of inquiry for data collection, we sampled music producers and practitioners (<italic>n</italic> = 218) in Ghana to briefly analyse the moneymaking through <italic>split sheets</italic> of songs available to music practitioners in Ghana’s recording industry. It was noted that 94.9% of respondents were unaware of the <italic>split sheet</italic>, while 92.7% did not know the benefit of the <italic>split sheet</italic>. However, only 4.6% of the respondents had used the <italic>split sheet</italic>. Subsequently, we conclude that the low awareness of the <italic>split sheet</italic> among Ghanaian music producers and practitioners compromises the decorum of the business side of creativity in the Ghanaian recording industry. Therefore, we recommend that more intensive education be undertaken to sensitise Ghanaian music producers and practitioners to the benefit of the <italic>split sheet</italic> in their daily work to enhance revenue generation.</p> </abstract>ARTICLEtrue in Virtual Team Communication in the Context of Virtual Exchange Experience<abstract> <title style='display:none'>Abstract</title> <p>As technology has enabled people across the world to collaborate and create virtual communities, the ability to interact in computer-mediated, cross-cultural environments in a meaningful way has become a necessity. This is particularly true for younger adults who operate in virtual teams during their studies, for instance in virtual exchange projects, and later in their professional life. In this qualitative study, we examined the features and functionality of cross-cultural communication in virtual exchange teams. By analysing three datasets produced by Finnish university and American community college students (n=38) who participated in a virtual exchange, we examined what kinds of challenges emerge in the communication of virtual teams and how students use theories of computer-mediated communication when trying to make sense of those challenges. The results of the reflexive thematic analysis indicated that the challenges in communication of virtual teams stem from cultural and motivational differences. These challenges could be alleviated by increasing the shared work time allocated for social information sharing and for constructing appropriate, team-specific ways to express online social presence and propinquity. The findings highlight the meaningfulness and relationality of virtual team communication and provide insight into motivational factors and the sense of belonging when communication challenges arise.</p> </abstract>ARTICLEtrue of the Project-Based 6E Learning Model<abstract> <title style='display:none'>Abstract</title> <p>This research aims to determine the effectiveness of the Project-based 6E (engagement, exploration, explanation, elaboration, extension and evaluation) Learning Model. The researchers created the model by combining the basic features of project-based learning with an understanding of the learning cycle. The pre-test/post-test semi-experimental design, in which no control group is included, was used in the study. The study group in the research consisted of junior students studying at the Turkish Teaching and English Language Teaching departments of the Faculty of Education, Düzce University, in the fall semester of the academic year 2020–2021. The experimental process was structured according to the Project-based 6E Learning Model. Two different types of data, namely, qualitative and quantitative, were collected to determine the effectiveness of the experimental process. It was concluded that the students found the model efficient, effective and attractive. The model positively changed students’ perceptions of values and values education. It was also seen that the model enables students to realise their values, review and question the values, reinforce them, complete their deficiencies and gain new values. Due to the effect of the learning model, students positively experienced significant changes in their teaching perception.</p> </abstract>ARTICLEtrue