Open Access Macedonian Journal of Medical Sciences

Dietary exposure to aflatoxin B1 and ethanol from homemade and industrial fermented beverages in South Kivu, Democratic Republic of the Congo

Aladin Ombeni Mahano — 2024-06-15

BACKGROUND: The prevalence of AFB1 contamination in agricultural products used to produce fermented alcoholic beverages is increasing, raising concerns for human health.

AIM: The aim of this study was to investigate dietary exposure to AFB1 and ethanol through homemade and industrial fermented beverages commonly consumed in South Kivu, DR Congo.

METHOD: AFB1 and ethanol were measured using reverse-phase HPLC with a fluorescence detector and a refractive index detector, respectively. Data on fermented beverage consumption were collected from 847 adults using a food frequency questionnaire (FFQ).

RESULTS: The findings revealed that industrial sample Man 8 had the highest exposure to AFB1 (77.8 ± 45.0 ng/kg b.w/day) and Man4 had the highest ethanol exposure (4.83 ± 2.40 mg/kg b.w/day); while among homemade samples, Kasiksi had the highest exposure to both AFB1 (8.8 ± 6.6 ng/kg b.w/day) and ethanol (2.46 ± 1.85 mg/kg b.w/day). The margin of exposure (MOE) for AFB1 was 1011.7 or less, and for ethanol, it was 818.2 or less. Men are more likely to be exposed.

CONCLUSION: Increased consumption of homemade and industrial fermented beverages raises the risk of developing hepatocellular cancer (HCC) because the levels of AFB1 and ethanol MOE drop below the safe limit of 10000. Further research is needed to investigate the connection between AFB1, ethanol, and HCC, especially in regions where alcohol misuse is common.

Efficiency of Immunoblot While Determination of Antibodies to Treponema Pallidum in Cerebrospinal Fluid

Glib Bondarenko — 2024-06-15

BACKGROUND: A decrease in the incidence of syphilis has been observed in the world and in Ukraine in recent years. At the same time, an increase in cases of neurosyphilis is recorded. Diagnosis of neurosyphilis is quite difficult and based on the correct interpretation of the complex of various diagnostic tests.

OBJECTIVES: The paper is aimed to determine diagnostic potential of treponemal tests (TTs) and evaluate effectiveness of Treponema pallidum immunoblot (TPI) while research on cerebrospinal fluid (CSF) in differential diagnosis of neurosyphilis.

MATERIALS AND METHODS: The research object was CSF of patients with late forms of syphilis. The regulated serological and immunological methods in accordance with current guidelines and orders of the Ministry of Healthcare of Ukraine were used for laboratory diagnosis of neurosyphilis: Enzyme immunoassays (EIA), fluorescent treponemal antibody (FTA), T. pallidum hemagglutination assay (TPHA), and TPI.

RESULTS: Effectiveness of TTs in the diagnosis of neurosyphilis while research on 23 samples of CSF was carried out by the following methods: EIA (Immunoglobulin [Ig]M + IgG), FTA, andTPHA. The above-mentioned TTs used in serological diagnosis of CSF do not always meet the problem of confirming neurosyphilis diagnosis. According to these investigations, both positive and false positive results were obtained. In order to verify the diagnosis, a study on positive and false positive samples of CSF by TPI method was carried out. Positive results were obtained in 13 samples with the established duration of the disease.

CONCLUSIONS: TPI is an optimal treponemal immunological method of examination of CSF to diagnose neurosyphilis with a high degree of reliability. The use of TPI while research on CSF makes it possible to verify the diagnosis of neurosyphilis by differentiated detection of antibodies to the most immunogenic antigens of T. pallidum eliminating the subjective factor of the reaction and simplifies diagnostic procedure.

Herbal Bioactive Compounds for Skin Infections and Inflammatory Conditions

Michael Tirant — 2024-06-15

Skin microbiota is an integral part of the human immune system. Staphylococcus aureus is one of the essential components of the normal flora. Approximately 20–30% of healthy individuals are persistently colonized with S. aureus, whereas the remainders are considered low-level intermittent carriers. Despite these natural aspects of existence, S. aureus can be a major opportunistic human pathogen. This versatile microorganism can infect a variety of anatomical sites, causing a broad spectrum of pathologies ranging from superficial to invasive infections. It developed a variety of strategies to adopt to a changing microenvironment. This attributed to the emergence of resistance to antibiotics of different classes during the past six decades. Methicillin-resistant S. aureus (MRSA) was originally confined to health-care settings (health-care-associated MRSA). Later on, community-acquired MRSA was identified as another source of infections. Recent figures indicate that MRSA strains have been associated with approximately 75% of all S. aureus infections worldwide. Several guidelines have been published to establish an adequate treatment of skin and soft tissue infections (SSTIs) caused by MRSA strains. In the first part of this review, we focus on current treatment guidelines with a focus on medical drug therapy, but drug therapy has its own limitations. Recently, the interest in herbal remedies has greatly increased. There is growing evidence of antimicrobial activity of medicinal plants and their extracts. The second part of this review is dedicated to herbal compounds to circumvent antibiotic resistance. Herbal compounds may potentiate the action of antibiotics and restore the activities of antibacterial agents against which S. aureus has developed a drug resistance. Part 2 focuses on the role of S. aureus in pathology of the two major inflammatory skin diseases, i.e., atopic dermatitis (AD) and psoriasis. Finally, Part 3 provides an overview on natural compounds with antimicrobial activity against S. aureus and possible use in the treatment of SSTIs,

Photosensitizing Herbs as Potential Therapeutics: A Prospective Insights into their Mechanisms for the Development of Novel Drug Leads in War with Cancer and Other Human Diseases

Mohamed Ali Seyed — 2024-06-15

In recent years, photodynamic therapy (PDT) has been accepted as an alternative option for the treatment of a wide spectrum of human ailments. It is a minimally invasive treatment that involves the interaction of a non-toxic photosensitizer. In PDT, combining photosensitizing (PS) agent that absorbs specified wavelength of light, which in turn produces free radical molecules to eliminate unwanted cells and tissues. The photosensitization process is activated by the light-induced excitation of molecules within the tissue. Bioactive principles acquired from plants documented as nature-inspired potential photosensitizers with varied properties against microbes, insects, or tumor cells. PDT is a promising method for removing diverse types of cancers but needs to be recognized in therapy as conventional chemotherapy. At present, natural compounds with PS properties are being continuously unearthed and identified. As of now, hundreds of photosensitive drugs or drug leads identified from natural sources with reduced or no toxicity to healthy tissues and no side effects encourage investigators to pursue natural PS for PDT. Although existing PS was developed years back, only a handful of them are engaged in human clinical applications. The main classes of natural photosensitizers discussed in this review are chlorophylls (hypocrellin A and B), hypericin, chlorins (Chlorin e6), and other emerging ones such as curcumin. Hence, the present review aimed to explore the efficacious PS properties of a few herbal-derived PS, preferably the potential ones in terms of specificity, and mechanism of action, inducing less or no toxicity to normal cells but their other medicinal applications.

Dynamic Single-Leg Balance Tests of Physiotherapy Students: A Comparison of Body-Active Weight Shift Test and Two Sudden Disturbance Tests

Blanka Koščak Tivadar — 2024-06-15

BACKGROUND: Balance is essential to maintain and stabilize the transition from static to dynamic posture. The human body can maintain the center of gravity within the base of support and to process input from vision, the vestibular apparatus, and the somatic senses.

AIM: The research aimed to check the correlation of the active body-weight shift test (Y balance test [YBT]) and two sudden perturbation tests in physiotherapy students.

METHODS: In a cross-sectional study, a descriptive research design was used. Twenty-nine healthy adults (14 men and 15 women) with a mean age of 23.6 ± 6.3 were tested using the active body-weight shift test and two sudden perturbation tests. A descriptive statistical analysis using correlation coefficients was performed.

RESULTS: Our subjects’ average values of the test results meet the normative values. There is a correlation between the YBT test and the crossover hop test in the anterior (p < 0.01), posterior-medial, and posterior-lateral directions (p < 0.05), and the triple-hop test forward in the posterior-medial and posterior-lateral directions (p < 0.05), and anterior direction (p < 0.01) for the left extremity, except for the anterior direction to the right. With the right extremity, there is a correlation between the YBT test and the crossover hop test and triple-hop test forward in the posterior medial (p < 0.05), the crossover hop test in the posterior medial and posterior lateral to the left (p < 0.05), and the right (p < 0.01), but no correlation in the anterior direction in either of them.

CONCLUSION: The data of all physiotherapy students in our study meet the normative data, and no difference due to gender has been observed. There is a correlation between the active body-weight shift test and sudden perturbation tests with or without lateral movement for the left extremity, but not for the right extremity. We can assume better results when standing on an undominant limb, which can lead to insufficient support when standing on a dominant limb. What should not be the case in providing patient safety.

Biomechanical Parameters of Implants Placed with Osseodensification Versus Implants Placed with Under-drilling Osteotomy Techniques in Posterior Maxilla: A Comparative Clinical Study

Darko Veljanovski — 2024-06-15

BACKGROUND: To facilitate better implant survival rates in areas with clinically low bone density, osteotomy techniques that provide higher implant stability and improve bone quality are often recommended. The most widely used are under-drilling (UD) and osseodensification (OD). In the UD technique, the diameter of the final osteotomy drill is narrower that the diameter of the placed implant, whereas in the OD technique, special drills that rotate counter-clockwise to condense and densify the bone are used.

AIM: The aim of this study was to evaluate the effect of two different implant osteotomy methods – UD versus osseodensification (OD) in terms of implant stability during the period of osseointegration in the posterior maxillary region.

MATERIAL AND METHODS: This prospective randomized clinical study included 22 patients who received a total of 37 implants in the posterior maxillary region. They were divided into two groups: In 11 patients, 18 implants were placed using the under-drilling method (UD), while the other 11 patients received 19 implants using the osseodensification method (OD). Within the OD group, 10 implants were placed in areas with the initial height that was insufficient to accommodate implants with a minimal length of 8 mm. In these areas, crestal sinus elevation without bone graft use was performed simultaneously with implant placement, according to the osseodensification protocol proposed by the manufacturer. All implants were placed in a dual-stage manner – completely covered with soft tissue and uncovered 4 months later, at the time of second-stage surgery. The implant stability was determined by measurement of implant stability quotient (ISQ) with instrument that utilizes the method of resonance frequency analysis (RFA) to discover implant stability. The ISQ represents a value on a scale between 0 and 100, with values above 65 indicating high implant stability. ISQ values were measured at two timepoints: At the time of implant placement and at the time of their uncovery. Statistical analysis was performed with Prism 9 statistical program for Mac. The data were analyzed using one-sample t-test, Wilcoxon, and paired two-way ANOVA test. The significance level was set at p ≤ 0.05.

RESULTS: The differences between the primary implant stability ISQ values in the UD and osseodensification (OD) groups were not statistically significant. The secondary implant stability was statistically significantly higher in the osseodensification group (p < 0.001) There were no statistically significant differences between secondary implant stability values in implants placed with and without crestal sinus floor lift within the osseodensification group.

CONCLUSION: Within the limitations of the study, the conclusion is that osseodensification method of implant osteotomy (OD) results in higher secondary implant stability values that the under-drilling method (UD), which has clinical relevance regarding long-term implant survival. It should be a preferred method of choice for osteotomy in areas with clinically low density of bone due to its predictability and effectiveness.

Real-world Observational Multi-center Study: Retrospective Analysis of Diagnostic and Treatment Patterns for Stage III–IV Melanoma in Ukraine from 2018 to 2020

Mariia Kukushkina — 2024-06-15

BACKGROUND: Despite open-access sources with information about cancer patients (National Cancer Registry of Ukraine), there are considerable gaps about actual diagnostic methods and specific treatment patterns or any details on how different regimens are applied for melanoma treatment in Ukraine.

OBJECTIVES: This non-interventional, multicenter, retrospective medical chart review study aims to describe real-world therapeutic strategies and characterize the profile of patients with melanoma Stage III–IV in real-life clinical practice in Ukraine.

METHODS: Anonymized data were collected from medical records of 747 patients in 9 oncology centers in Ukraine - four private and five public. The data variables were retrieved, captured in electronic case report forms, and analyzed with descriptive statistical methods.

INCLUSION CRITERIA: Subjects were not enrolled unless they met all the following criteria: (1) Age >18 years at the time of being diagnosed with III–IV stage melanoma. (2) Morphologically (including cytology) confirmed diagnosis of III–IV stage melanoma. Sufficient available medical records for data abstraction to meet the objectives of the study, that is, the patient has been under the medical care of the participating site for the entirety of the patient observation period or the patient’s detailed historical data on their disease course, and clinical management are otherwise available at the participating site consent has been granted by the Institutional Review Board/Ethical Committee of the study site.

EXCLUSION CRITERIA: Subjects were not enrolled if they met any of the following criteria: (1) The patient has received treatment with anticancer systemic therapy for reasons other than melanoma. (2) Primary cancer other than melanoma. (3) The patient is participating (or was participating) in any investigational program/clinical trial with interventions outside of routine clinical practice. All the statistical tests were two sided and performed at a 0.05 significance level. p-values were rounded to three decimal places. p < 0.001 were reported as <0.001 in tables.

RESULTS: Most melanoma cases (95.05%) were diagnosed histologically, although information about the primary tumor’s characteristics and treatment are heterogeneous. Most individuals (51.05%) diagnosed with Stage III undergo surgical treatment without additional therapy. Chemotherapy constitutes the primary form of systemic therapy for Stages III and IV, accounting for 33.3% and 45.65%, respectively.

CONCLUSION: It is crucial to tackle the problems associated with diagnosing and treating melanoma in Ukraine. This involves creating a unified registry for melanoma patients, establishing uniform methods for staging and re-staging, and standardizing medical records. Nevertheless, the most critical issue is the absence of access to modern therapy, which should be addressed at the state level.

Do Laparoscopic Colorectal Procedures Need Fluid Optimization?

Matej Jenko — 2024-06-15

BACKGROUND: Goal-directed fluid therapy (GDFT) with hemodynamic monitoring may not be of benefit to all elective patients undergoing major abdominal surgery, particularly those managed in enhanced recovery after surgery protocols (ERAS) setting.

AIMS: We predicted different fluid and vasoactive drug consumption during the procedure and less complications in the group of patients, where invasive hemodynamic monitoring was used.

METHODS: Two groups of patients undergoing elective laparoscopic colorectal surgery were compared: A control group (CG), with standard hemodynamic monitoring, and a study group, (SG) with invasive hemodynamic monitoring and appropriate intraoperative interventions. We compared differences in intraoperative fluid consumption, length of hospital stay (LOS) and post-operative morbidity.

RESULTS: A group of 29 patients in SG had similar average intraoperative fluid balance (+438 mL) as 27 patients in CG (+345 mL) p = 0.432. Average LOS was 8 days (±4) in SG and 6 days (±1) in CG (p = 0.124). Acute renal failure, anastomotic dehiscence, and indication for antibiotic treatment were predictors of statistically significant prolongation of hospital stay 3^rdday after surgery, but independent of SG.

CONCLUSION: Since no differences between the groups were shown in overall fluid and vasoactive drug consumption, we conclude that GDFT is not needed in laparoscopic colorectal surgery, when ERAS is followed.

Effects of Adding Dexamethasone Plus Ketamine to Bupivacaine for Ultrasound-guided Serratus Plane Block as Analgesia in Major Breast Surgery: A Randomized, Double-blind Trial

Ahmed Hussein Bakeer — 2024-06-15

BACKGROUND: Post-operative pain after mastectomy is associated with poor recovery, prolonged hospital stays, and increased liability for chronic persistent pain.

AIM: This work aimed to test the analgesic efficacy of adding ketamine to a dexamethasone bupivacaine combination in ultrasound-guided serratus anterior plane block (SAPB) in patients undergoing modified radical mastectomy (MRM).

METHODS: This randomized, double-blind trial included 60 females aged 20–60 undergoing MRM. They were randomized into two groups: Group DB (n = 30) received SAPB using 30 ml of bupivacaine 0.25% and dexamethasone 4 mg. Group KD (n = 30) received the same block with the addition of ketamine 50 mg.

RESULTS: The time to the first analgesic request was significantly delayed in Group KD than in Group DB (p < 0.001). The number of patients requiring morphine and its total consumption during the first 24 post-operative hours in Group KD were significantly less than in Group DB (p = 0.001 and p < 0.001, respectively). Visual Analog Scale scores at rest and movement at 4, 6, 8, 10, 12, and 18 h were significantly lower in Group KD than in Group DB.

CONCLUSIONS: Adding ketamine to bupivacaine plus dexamethasone in ultrasound-guided SAPB is associated with better analgesic outcomes in patients undergoing MRM, including prolonged duration of analgesia and decreased post-operative morphine consumption and pain scores at rest and movement.

Studying the Specific (Adaptogenic and Anabolic) Activity of the Supramolecular Complex of 20-Hydroxyecdysone Triacetate with β-Cyclodextrin

B. I. Tuleuov — 2024-06-15

BACKGROUND: A supramolecular complex of ecdysterone triacetate with β-cyclodextrin (β-CD) was synthesized to obtain new potentially bioactive substances and study the effect of bulky pharmacophore-functional groups on the preservation of the specific activity of 20-hydroxyecdysone. The adaptogenic and anabolic activities of the resulting water-soluble inclusion complex were studied. It was established that with the introduction of 3 acyl-pharmacophore groups in the form of encapsulated and hydrophilic supramolecular forms to experimental animals at a dose of 10 mg/kg, the studied complex has anabolic and adaptogenic effects, including increased stress resistance, increased physical endurance, as well as slightly increased weight of the heart and gonads compared to the control.

AIM: Study of the specific activity of the supramolecular complex of ecdysterone 3-acetate with β-CD.

METHODS: During the experimental study of the adaptogenic and anabolic effects of the supramolecular complex of ecdysterone 3-acetate with β-CD, the “open field” and “free swimming” tests were used. Statistical processing of the results was carried out using the Statistica 8 software package. Intergroup differences were assessed using the non-parametric Mann–Whitney U-test. For unpaired related groups, the non-parametric Wilcoxon test was used.

CONCLUSIONS: It has been established that physical activity (swimming) simultaneously has a significant stressor effect on animals and is characterized by an increased supply of glucose into the blood and the breakdown of blood proteins. It was revealed that the supramolecular complex of ecdysterone 3-acetate with β-CD at a dose of 10 mg/kg has anabolic and adaptogenic effects, in particular increased stress resistance and physical endurance of animals, as well as a slightly increased weight of the heart and gonads compared to the control.

Aesthetic Palpebral Reconstruction Following the Excision of Basal Cell Carcinoma (BCC): A Case Report

Smilja Tudzarova-Gjorgova — 2024-06-15

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin malignancy, and when considering its predilection for the face – it is most commonly found on the eyelids.

CASE PRESENTATION: In our patient’s case, the BCC was located on the left lower eyelid exemplifying the classic macroscopic appearance of a nodular basalioma. We took into account all of the patient’s variables (particularly the lesion’s difficult location) to choose the best surgical approach for excision of the tumor, as well as the reconstructive strategy that would result in the most functional and aesthetic outcome.

CONCLUSION: In this report, we present a case of our patient with BCC on the lower eyelid, our surgical method for excision and palpebral reconstruction using an autologous auricular cartilage graft, and the final outcome, which we consider was the best option for the patient in question.

Spontaneous Caecal Perforation in a Male Neonate: A Case Report

Syahar Banu — 2024-06-15

BACKGROUND: Spontaneous perforation of the colon in full-term neonates is a rare case, with perforation of the cecum being rarely reported.

CASE PRESENTATION: We present a rare case of spontaneous perforation of the cecum in a term neonate who presented with vomiting and flatulence on the second day of life. Surgical intervention revealed full-thickness perforation in the caecum. Histopathologically, there was no necrotizing enterocolitis and Hirschsprung’s disease.

CONCLUSION: Clinica diagnosis and hopefully prompt surgical management.

Exploring Disparities in Life Satisfaction among LGBTQ+ Older Adults in different Living Environments: The Case of Slovenia

Mihael Nedeljko — 2024-06-15

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults are an overlooked minority of the population who face discrimination, stigma, and homo-, bi-, or transphobia. We have not found any research in the European area that examines differences in life satisfaction among LGBTQ+ older adults according to the living environment.

AIM: The aim of the research was to determine differences in life satisfaction according to different living environments (big cities, small cities, and rural areas) among LGBTQ+ older adults.

METHODS: We selected a non-random purposive sample size of 318 units of LGBTQ+ older adults for the quantitative survey. In the first phase, we used exploratory factor analysis. To ascertain the normality of data distribution, the Kolmogorov–Smirnov and Shapiro–Wilk tests were used. To test the hypothesis, we used a one-way analysis of variance (ANOVA) with a post hoc analysis, with which we determined the existence of differences in the perception of life satisfaction according to the living environment.

RESULTS: We find statistically significant differences at p < 0.05, which occur in all items except the item. So far, I have gotten the important things I want in life (p = 0.150). Since there are statistically significant differences between the ratings of satisfaction with life according to the living environment, we confirm the hypothesis. With a post hoc analysis, we determined even more precise differences between the three living environments of the interviewed persons, regarding which we found that life satisfaction increases with the size of the place where they live.

DISCUSSION: As with studies from other countries, we also note that differences exist between rural and urban living environments for LGBTQ+ older adults in Slovenia in terms of life satisfaction. Further research is needed on the factors that account for these disparities among LGBTQ+ older adults.

CONCLUSION: LGBTQ+ older adults in urban settings report higher life satisfaction than those in rural areas, possibly due to factors like community support and acceptance. Further research is needed to understand the needs of LGBTQ+ older adults, especially in countries where they are hidden due to political or religious influences, to ensure optimal conditions for their life satisfaction in old age.

Avascular Necrosis of the Hip Joint and Femoral Head Related with Long COVID-19 or Post-COVID-19: Case Report Study

Sanja Petrusevska-Marinkovic — 2024-06-15

BACKGROUND: Post-COVID conditions can include a wide range of ongoing health problems. As a consequence of long COVID-19 or post-COVID-19 an increase in osteonecrosis has been detected in different series of patients.

CASE PRESENTATION: We present two patients diagnosed with COVID-19 and pneumonia, one with moderate and the other with severe clinical picture. They were treated with corticosteroid equivalent to prednisolone 993.5 mg (400–1587 mg) which correlates with steroid dose documented in the literature as causative for avascular necrosis (ANV) in patients with COVID-19. After the mean time of 65 days, due to pain in the groin and difficulty in movement, magnetic resonance imaging (MRI) was performed in both patients and AVN was diagnosed. Compared to our results, the literature records a longer time required for the development of AVN in patients without COVID-19, which is 6–36 months. This indicates the potency of the virus itself to cause disturbances in the microcirculation, and thus the development of AVN. The bone damage correlates with the degree of inflammation and the severity of the clinical picture.

CONCLUSION: After a course of COVID-19 as part of a long COVID-19, ANV should be considered a possible complication, especially in patients who have clinical manifestations. Early detection of AVN and diagnosis using MRI on clinical suspicion would help early intervention with bisphosphonate therapy in patients with osteonecrosis of the hip. If the disease is detected in the more advanced stage, it is necessary to perform a surgical intervention and even a possible hip replacement.

A Rare Case of Gastric Metastasis from a Rare Case of Mucosal Malignant Melanoma

Zaim Gashi — 2024-06-15

BACKGROUND: Malignant melanoma (MM) is the deadliest form of skin cancer and the most common carcinoma to metastasize into the gastrointestinal tract (GI). While the jejunum, ileum, colon, and rectum are common gastrointestinal sites of metastasis, metastatic melanoma in the stomach is rare and usually not detected until late in the disease.

CASE PRESENTATION: We report a patient who presented with hematemesis, epigastric pain, and weight loss. In the second esophagogastroduodenoscopy, after 8 months from the first endoscopic assessment, a double ulcerative gastric mass was found, and histopathology confirmed metastatic malignant melanoma. The complete surgical resection of GI metastatic MM in carefully selected patients not only provides symptom control but has also been associated with an increase in overall survival in the absence of other metastatic sites. At present, the overall survival of patients with advanced metastatic MM who have been treated with a combination of immunotherapeutic agents reaches 52% at 5 years.

CONCLUSION: The role of surgery for patients with metastatic involvement of the GI tract with MM is evolving in the era of effective systemic treatments.

Incidental Finding of Parathyroid Adenoma in a Patient with Breast Carcinoma Detected by PET/CT 18F -FDG Examination and Confirmed by 99 mTc -Terofosmin SPECT/CT

Albena Botushanova — 2024-06-15

BACKGROUND: Primary hyperparathyroidism (PHPT) is due to the overproduction of PTH by one or more abnormally altered parathyroid glands and leads to the development of hypercalcemia.

CASE PRESENTATION: We present a case of a 69-year-old female patient who was diagnosed with carcinoma of the right mammary gland in 2010. She underwent surgical treatment (right sided mammectomy) and follow-up hormone therapy with Letrozole until cancer remission in 2020. The patient was sent for a positron emission tomography-computed tomography (PET/CT) scan for restaging in May 2022. The patient underwent a whole- body PET/CT 18F-Fluorodesoxyglucosae (18F-FDG) examination on a “SIEMENS” hybrid PET/CT device, model “Biograph mCT64.” During the processing of the hybrid PET/CT images, a rounded lesion suspicious for a parathyroid adenoma of the lower right parathyroid gland was visualized with a slightly increased metabolic activity of SUVmax-2.91. The neck ultrasound revealed a solid, hypoechoic, rounded formation with peripheral blood supply suspicious for a lower right parathyroid adenoma. Blood tests revealed primary hyperparathyroidism osteoporosis of the proximal femur. To diagnostic clarification of the area caudal to the right lobe of the thyroid gland, after 1 month, a single isotope two-phase scintigraphy with 99 mTc-tetrofosmin combined with an early single-photon emission CT (SPECT/CT) technique was performed on a SPECT/ CT gamma camera “Siemens,” model “Symbia Intevo 6.” In the early phase (20 min.) and on the early SPECT/CT images, a hyperfixing zone accumulating the radiomarker, suspicious for a parathyroid adenoma, was visualized under the right lobe of the thyroid gland. The patient underwent surgery, during which a parathyroid adenoma was histologically proven.

CONCLUSION: This case shows that PET/CT 18F-FDG examination can be useful in discovering parathyroid adenomas.

Musculoskeletal Disorders in the Workplace of Physiotherapists: Occupational Risk Factors and Their Role in Prevention and Management: A Systematic Review

Petra Kotnik — 2024-06-15

BACKGROUND: Since musculoskeletal disorders at work (MSDW) are very common among physiotherapists, we must introduce strategies that could help reduce their prevalence. The main objective of this study was to determine the prevalence of MSDW among physiotherapists, which parts of the body are most often affected, what are the ergonomic risk factors for MSDW among physiotherapists and what are strategies to reduce them.

METHODS: In the systematic literature review, involving a total of 2127 physiotherapists, search terms such as occupational musculoskeletal disorders, physiotherapists, and occupational risk factors were used in the SCOPUS (n = 24), MEDLINE (n = 2), ScienceDirect (n = 103), PEDro (n = 0), Cumulative index of the nursing and allied health literature (n = 3), and PubMed (n = 30) databases in February 2024. The search included only original studies published in English, cross-sectional studies published in thepast 10 years, studies that included the prevalence of MSDW, and studies that included risk factors for MSDW. In the end, we included eight studies in the systematic review.

RESULTS: A systematic review of eight studies highlighted the prevalence and risk factors associated with MSDW among physiotherapists. The studies were conducted on samples ranging in size from 75 to 501 individuals and focused on determining the prevalence of MSDW and identifying the associated risk factors. The prevalence rates differ, with the lower back region being the most affected region in all studies (38–68.8%), followed by the neck (10–59.2%) and the shoulder girdle (7–51.7%). Risk factors included back strain, awkward posture, prolonged posture, frequent bending/turning of the trunk, performing manual therapy techniques, patient lifting, repetitive tasks, work environment, and psychosocial issues. Reported coping strategies included changing one’s working posture, improving one’s body mechanics, and taking more breaks during the workday.

CONCLUSION: Our systematic review of the literature revealed a high prevalence of MSDW among physical therapists (up to 92%) and highlighted the urgent need for strategies to mitigate this widespread problem. These findings highlight the multifaceted nature of the etiology of MSDW and point to the interplay of physical demands, ergonomic challenges, and psychological stressors that characterize the profession of a physical therapist.

Association Between Inflammatory Markers and Cognitive Impairment in Patients with Asymptomatic Carotid Stenosis

Elena Joveva — 2024-06-15

BACKGROUND: Certain inflammatory mechanisms are involved in the carotid atherosclerotic process, and determining the inflammatory activation can be useful in the assessment of cognitive impairment in patients with asymptomatic carotid stenosis (ACS).

AIM: This study aimed to correlate these markers of inflammation with the degree of asymptomatic carotid stenosis (ACS) and the degree of cognitive impairment.

MATERIALS AND METHODS: One hundred and twenty patients with carotid stenosis and 60 patients without carotid stenosis were enrolled in the study. Clinical, neurological, and laboratory evaluations (C-reactive protein [CRP], fibrinogen, tumor necrosis factor alpha [TNF-α]) were performed, as well as evaluation of intima-media thickness (IMT) and carotid stenosis degree. Cognitive functions were assessed with the Addenbrooke’s Cognitive Examination test. Neuroimaging tests were included.

RESULTS: There was no significant correlation in the asymptomatic group between TNFα and IMT and between fibrinogen, CRP, and IMT both on the left and the right side. In the same group, there was a statistically significant association between the degree of carotid stenosis and low-to-moderate degree of cognitive impairment on the right side (p < 0.05) and left side (p < 0.05). A moderately weak negative statistically significant correlation between the severity of cognitive impairment and the degree of stenosis in the asymptomatic group was reported. A high degree of carotid stenosis (≥70%) on the right increased the chance of a moderate degree of cognitive impairment by 6 times compared to the low degree of carotid stenosis in the asymptomatic group. The high degree of carotid stenosis (≥70%) on the left increased the chance of a severe degree of cognitive impairment by 20 times compared to the low degree of stenosis in the asymptomatic group.

CONCLUSIONS: ACS increases the risk of cognitive impairment.

Febrile Infection-Related Epilepsy Syndrome (FIRES), a Possible Cause of Super-Refractory Status Epilepticus: A Case Report

Houssam Eddine Sahraoui — 2024-06-15

BACKGROUND: Febrile infection-related epilepsy syndrome (FIRES) is a subset of NORSE that requires a febrile infection between 24 h and 2 weeks before the onset of refractory status epilepticus (SE), with or without fever at the onset of SE, and with no restriction to the age of the patient. The literature on FIRES is scarce.

CASE PRESENTATION: This article reports a case of a patient of 8 years old without relevant family, psychosocial, prenatal or perinatal, or pathological history and normal neurodevelopment. The child consulted on a pediatric emergency with convulsive SE preceded 8 days before by otitis with acute fever managed with cephalosporin. Subsequently, seizures appeared in the following 48 h, characterized by generalized tonic-clonic seizures lasting 5–6 min. The seizures became more frequent until consciousness deteriorated, and motor SE appeared. In consequence, a coma was initiated, and the patient was hospitalized for emergency pediatric reanimation, where multifocal clonic and myoclonic seizures continued. A lumbar puncture with polymerase chain reaction was done twice and returned negative. Two magnetic resonance imaging scans were performed: the first was normal and the second, after 20 days in the hospital, showed cortical damage with SE. Different anticonvulsant treatments were used for 4 weeks: Valproic acid, clobazam, ketamine, levetiracetam for 24 days, and relay to, brivaracetam used in the treatment of epilepsy to control focal seizures; propofol, midazolam, and some antiepileptic drugs were used simultaneously and at maximum recommended doses, achieving a poor initial response, but eventually leading to total crisis control. The patient receives immunoglobulin for 2 days 1 g/kg/J. A ketogenic diet aimed at therapy and known antiepileptic properties, rich in lipids, and low in sugars, causing ketonemia in non-surgical drug-resistant epilepsies, was used for our patient with an efficacy that proved to be remarkable on the frequency of undergoing seizures, his tolerance was good. The diet can be maintained for 20 days without incident, in particular, with no episode of hypoglycemia. Electroconvulsive therapy (formerly called sismotherapy, electronarcosis, or shock therapy) is a therapeutic tool used in several psychiatric illnesses was also used with different frequencies for our patients twice a week with no favorable response. The evolution was marked by the aggravation of the patient following diffuse cerebral edema resulting in cardiac arrest and non-response to resuscitation measures, the patient declared at 07 AM on February 27, 2023.

CONCLUSION: FIRES is a rare epilepsy syndrome of unclear aetiology in which children, usually of school age, suddenly develop very frequent seizures after a mild febrile illness. Seizures in FIRES are typically difficult to treat, and the prognosis is poor.

Implementation of a Culturally Sensitive Caring-Based Nursing Service Model Increasing Patient Satisfaction in Hospitals

Aemilianus Mau — 2024-06-15

BACKGROUND: Culturally sensitive caring-based nursing services yield numerous benefits for patients, nurses, and hospitals. One of the advantages hospitals derive is enhanced patient satisfaction and loyalty, leading to financial benefits.

AIM: The aim of this study was to assess the impact of culturally sensitive caring-based nursing services on patient satisfaction in hospitals.

METHODS: Quasi-experimental pre-post-test control group design. The sample consisted of inpatients that were purposefully selected. The formula for the difference in proportions between the two groups was used to determine the sample size, yielding a total sample of 360 people, 180 in the intervention group and 180 in the control group. The intervention group received model socialization, module books, and 2 months of assistance with model implementation practices, while the control group only received module books without socialization and assistance. Data collection utilized a patient satisfaction questionnaire developed from the Swanson caring instrument, validated for reliability. Data analysis involved independent sample t-tests to ascertain differences in patient satisfaction between the intervention and control groups, and the general linear model repeated measure (GLM-RM) test to assess the development of patient satisfaction during the intervention and the model’s contribution to its increase.

RESULTS: The independent t-test yielded a p = 0.0001 <0.05, signifying a significant difference in patient satisfaction between the intervention and control groups. The GLM-RM test demonstrated a Partial Eta Squared value of 0.715, indicating that the model contributed to a 71.50% increase in patient satisfaction, with the remainder influenced by other variables.

CONCLUSION: Culturally sensitive caring-based nursing services enhance patient satisfaction in hospitals. Suggestion: This model can be implemented across hospitals.

Navigating the Patient with Heart Failure through the Health-care System – The Perspective of Hospital Nurses

Tamara Štemberger-Kolnik — 2024-06-15

BACKGROUND: Navigating the complex health-care system requires the patients to have comprehensive knowledge, active participation, and self-efficacy in health management to effectively engage in planned activities that include diagnosis, treatment, and rehabilitation, to ensure a high quality of life and successfully prevent disease-related complications.

AIM: This study aims to investigate which activities nurses in hospital settings perform to support patients with heart failure to increase health literacy and navigate effectively through the health-care system.

METHODS: Based on qualitative research, the data were collected through semi-structured interviews with 11 nurses from hospitals where patients with heart failure are treated. After reviewing and analyzing the transcribed interviews, a qualitative content analysis of the text followed.

RESULTS: Based on an inductive approach, we first identified coding units, which were grouped into 10 subcategories, and these into five categories: General health literacy, digital literacy, communication health literacy, interprofessional collaboration, and navigation through the health-care system. We found that the treatment of patients with heart failure varies in Slovenian hospitals.

CONCLUSION: Inequality in the treatment of patients between different hospitals highlights the need for a coordinated approach in the Slovenian health-care system. It is crucial to establish uniform national guidelines that would define treatment standards, ensure evidence-based patient care, and thus reduce the disparity in the quality of treatment between different medical institutions.

A Comparative Evaluation of the Sealing Ability, Adaptability and Antibacterial Effect of Nano MTA Plus Versus Conventional MTA Fillapex: An In-Vitro Study

Marina S. Fahmy — 2024-06-15

AIM: To compare nano-mineral trioxide aggregate (MTA) Plus with MTA Fillapex sealers regarding their sealing ability, adaptability, and antibacterial effect.

METHODS: Forty freshly extracted sound single-rooted permanent maxillary central incisors were used. Following access cavity preparation and root canal preparation. All the samples (n = 40) were randomly and equally categorized into two groups (n = 20 each) according to the sealer employed: group I, in which MTA Fillapex was utilized, and group II, in which nano-MTA Plus was applied. Obturation of root canals was accomplished using the lateral compaction technique. Decoronation of all teeth was performed for standardization of the root length at 12 mm. Roots were submerged in a 2% methylene blue dye solution for 72 h. The roots were divided lengthwise. Linear apical dye penetration and gaps between gutta-percha and dentin were measured under a stereomicroscope at 30× magnification to determine the sealing ability and adaptability, respectively. While the antibacterial activity against Enterococcus faecalis was tested using the Agar Diffusion Test (ADT). Data were statistically estimated utilizing the Mann-Whitney test, Spearman’s correlation coefficient examination, and the independent T-test.

RESULTS: Although Nano-MTA Plus showed higher sealing ability and lower antibacterial action than MTA Fillapex, we didn’t record any statistically substantial variation (2.05 ± 1.43 mm and 11.00 ± 9.42 mm, respectively), (2.10 ± 1.17 mm and 14.25 ± 6.70 mm, respectively). While statistical significance was reported in adaptability, Nano-MTA Plus showed a statistically significant lower adaptability compared with MTA Fillapex (57.89 ± 23.45 μm and 26.82 ± 16.55 μm, respectively).

CONCLUSION: Nano-MTA Plus and MTA Fillapex have comparable sealing abilities, and antibacterial effects. While MTA Fillapex was superior to Nano-MTA Plus regarding adaptability.

Effect of Chitosan Nanoparticle as an Antioxidant Material on Shear Bond Strength of Composite Resin to Enamel after External Bleaching

Diatri Nari Ratih — 2024-06-15

BACKGROUND: If composite resin restoration is required following external bleaching treatment, a waiting period of between 1 and 3 weeks is needed to avoid restoration failure. However, patients usually need faster treatment.

AIM: This study aimed to investigate the effect of chitosan nanoparticles as an antioxidant material on the shear bond strength (SBS) of composite resin restorations to enamel after external bleaching.

METHODS: Thirty premolars were used in this study and randomly assigned into four groups of six samples, Group 1, no bleaching – no antioxidant, Group 2, bleaching – composite restoration, Group 3, bleaching – waiting 2 weeks – composite restoration, Group 4, bleaching – sodium ascorbate – composite restoration, Group 5, bleaching – chitosan nanoparticles – composite restoration. The SBS was tested with a universal testing machine. One-way analysis of variance and the Turkey’s test were used for statistical data analysis (p < 0.05).

RESULTS: The group that applied chitosan nanoparticles to the teeth previously bleached and then restored with composite resin resulted in similar SBS as the other groups (p > 0.05), except for the group that was bleached and directly restored with composite resin (p = 0.000).

CONCLUSION: The chitosan nanoparticle has the potential as an antioxidant material since it produces similar SBS to composite resin restorations on enamel after external bleaching than the other groups.

Clinical Importance of Evaluating the Results of Excused Perianal Lesions

Sümeyra Emine Bölük — 2024-06-15

BACKGROUND: Perianal and anal region lesions are mostly benign, typically polypoid formations seen adjacent and distal to the anal canal. Fibroepithelial anal polyps are benign lesions commonly found in the perianal region, composed of squamous epithelium and subepithelial connective tissue. Despite their benign nature, excision may be necessary in cases where they cause pain, progressively increase in size, or give rise to suspicion of an infectious or malignant disease, as well as during treatment for accompanying perianal conditions. Follow-up of the pathology results for all removed lesions is important, as the patient’s follow-up and treatment process may vary based on the pathology results. Based on this perspective, patients who underwent excision of perianal lesions during surgery for a preliminary diagnosis of benign anorectal diseases were retrospectively evaluated in our clinic. The importance of the excision and pathological examination of these lesions was discussed based on the results.

AIM: The study retrospectively evaluated patients who underwent surgery for anal fistula, anal fissure, or palpable lesions in the anal or perianal area and had accompanying lesions that were pre-diagnosed as sentinel tags excised.

MATERIALS AND METHODS: The patients who underwent surgery due to anal, perianal lesions, anal fistula, or anal fissures in the general surgery clinic were retrospectively evaluated between January 2017 and February 2022. Their medical history, surgical notes, and pathology results were reviewed. Patients who underwent excision of lesions from the perianal and anal regions were evaluated. The age, gender, pathology results, pre-operative diagnoses, number and size of polyps, and the presence of concomitant hemorrhoids, anal fissures, and fistulas were recorded. The Number Cruncher Statistical System (NCSS) 2020 Statistical Software (NCSS LLC, Kaysville, Utah, USA) program was used for statistical analysis for the evaluation of the findings obtained in the study.

RESULTS: A total of 49 patients were evaluated. Three patients were excluded from the study as their pathology results were not recorded, even though a lesion excision was mentioned in their surgical notes. One patient who underwent surgery for an incisional biopsy was also evaluated separately. Of the patients, 20 were female and 25 were male. The average age of the patients was 41 (ranging from 21 to 86 years old). The average diameter of the excised polypoid lesions was 1.29 cm. When the final pathology results of the cases were reviewed, it was found that 37.8% (n = 17) had anal condyloma, 35.6% (n = 16) had fibroepithelial polyp, 8.9% (n = 4) had pyogenic granuloma, 4.4% (n = 2) had hemorrhoid, 4.4% (n = 2) had inflammatory polyp, 2.2% (n = 1) had multiple squamous papilloma, 2.2% (n = 1) had basal cell carcinoma, 2.2% (n = 1) had hypertrophic anal papilla, and 2.2% (n = 1) had pilonidal sinus. One notable result was that, despite the pre-operative diagnosis not being malignant, one patient had a pathology result of basal cell carcinoma. In addition, it is important to note that low-grade dysplasia was also detected in a patient with anal condyloma.

CONCLUSION: While perianal and anal lesions are generally benign, it is noteworthy that malignant cases can still occur, although rarely. Therefore, it is important to subject every excised perianal and anal lesion to pathological evaluation, as it is crucial for the proper follow-up and treatment of patients.

Risk Factors in Adult Myopia in Macedonia

Antonela Ljubic — 2024-06-15

AIM: In our case–control study of the Caucasian Macedonian myopia population of adults aged over 40 years, to analyze the environmental risk factors such as education level and outdoor activity levels in hours.

MATERIALS AND METHODS: We included 53 patients with myopia and 64 control subjects. The following demographic characteristics were evaluated using questionnaires: Age, gender, level of education, outdoor activities (hours), and parental myopia. Ophthalmic examination was performed with slit-lamp biomicroscopy and parameters: best corrected visual acuity, cycloplegic autorefraction, and corneal curvature radius were recorded.

RESULTS: About 54.7% of the myopia study population were male, and most of the subjects had high education (58.5%). About 43.4% of the myopia subjects did have parental myopia in the family history. The mean age of onset of myopia was 22.5 years, and the mean age when myopia stopped was 37.1 years. The mean value of near tasks (screen time, reading, etc.) time in hours, in the myopia group was 5.6, whereas in the emmetropia group 4.9. The mean value of outdoor activity in hours per day (prior 26 years of age, recent years, and today) was: 5.1 h, 4.2 h, 3.9 h in the myopia group versus 4.8 h, 3.8 h, 3.3 h in the emmetropia group, respectively.

CONCLUSION: The prevalence of male gender in myopia group was higher. Near task time in hours was higher in myopia group versus emmetropia group. Parental history of myopia was significantly more present in patients with myopia. Environmental risk factors such as outdoor activities in hours and level of education did not differ significantly among the groups.