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Vesna Lazarovska, Mira Jovanovska
Archives of Public Health, Volume 13, pp 49-56;

The cochlear implant has been approved as a method of treating bilateral deep deafness since the 1980s, and since then candidate selection methods have changed several times. Initially, the candidates were only adult patients, and in 1990 the cochlear implant was approved for the first time in children under 2 years of age by the US Food and Drug Administration. In 2000, the same US Administration reduced the limit to one year. The aim of this study was to determine the effect of age at cochlear implantation on speech recognition abilities. Concerning the age groups in which the subjects were assigned to, the best results on the tests were achieved by the group who underwent cochlear implantation at the youngest age. In conclusion, the benefit from cochlear implant in subjects with pre-lingual hearing impairment of the most severe degree has to be stressed and it is much bigger in comparison to individual amplifying hearing aids. If cochlear implant is placed at the youngest age, the results might lead to even 100% of active involvement in the social life of individuals with this kind of impairment.
Aferdita Kurti-Karameta, Fimka Tozija
Archives of Public Health, Volume 13, pp 5-16;

The current pandemic of corona virus disease 2019 (COVID-19) is an infectious disease caused by a newly discovered severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). Global COVID-19 burden is characterized by a high variability in death rate across countries. Several possible explanations have been proposed, but it is not clear whether this variability is due to a single predominant factor or instead to multiple causes. The aim of this paper was to present and analyze the epidemiological situation and burden of the COVID-19 pandemic in Kosovo compared to other countries in Europe and the world. Material and methods: Public health approach and desk review were applied to present and analyze the trends over time of selected epidemiological indicators for COVID-19 based on multiple sources of data as well as WHO epidata and literature review. The assessment of the epidemiological situation in EU/EEA member states was done using the surveillance data routinely collected by ECDC. Official medical records from the National Institute of Public Health, other relevant health institutions; State Statistical Office and Ministry of Health in Kosovo were used. Results: According to ECDC as of 11 February 2021, 106,472,660 cases of COVID-19 (in accordance with the applied case definitions and testing strategies in the affected countries) have been reported, including 2,323,103 deaths. COVID-19 cases have been reported from: Africa: 3,673,181 cases, Asia: 20,438,608 cases, Europe: 34,681,426 cases, America: 47,620,931 cases; Oceania: 57,809 cases, Others: 705 cases. Deaths have been reported from: Africa 95,128 deaths, Asia 343,886, America 1,107,066, Europe 775,883, Oceania 1,210 and Other 6 deaths. In Kosovo from 13 March 2020 until 15th February 2021 there have been 64,298 cases of COVID- 19 with 1534 deaths. Absolute values of the indicators remain high in all countries in Europe, including those with stable or decreasing trends in these indicators, suggesting that transmission is still wide spread. The epidemic trajectory over the next months will be determined by the balance of four factors, with many different outcomes possible: the continued scale-up of vaccination, declining seasonality, the spread of new variants and increased behaviors that favor COVID-19 transmission. Conclusion: Findings from this paper can help to develop evidence-based policy interventions in Kosovo for risk assessment of COVID-19 and protection of general population and especially vulnerable groups with higher risk from COVID 19.
Antonio Gavrilovski, Ilir Shabani, Vilijam Velkovski, Teodora Todorova, Shaban Memeti
Archives of Public Health, Volume 13, pp 91-95;

The aim of the study was to investigate the influential factors for hidden blood loss after a total knee arthroplasty and their relationship with the total blood loss. Total knee arthroplasty (TKA) is a crucial treatment of late-stage knee osteoarthritis. Measured blood loss is significantly inconsistent with the hemoglobin (HB) drop postoperatively. Fifty-four patients, 20 males and 34 females, were retrospectively analyzed. The preoperative blood loss and therefore the hidden blood loss following TKA were calculated by the Gross formula. The typical perioperative blood loss was found to be 780±220 ml and therefore the average hidden blood loss was 280±180 ml. No significant differences were found in hidden blood loss for males compared to females. Hidden blood loss may not be reduced by hemostasis during operation with a deflated tourniquet.
Gani Ceku, Mile Petrovski, Shaban Memeti, Nexhmi Hyseni, Sejdi Statovci, Blerim Berisha
Archives of Public Health, Volume 13, pp 110-119;

The main objective of this retrospective study was to evaluate the value of surgical approach in the treatment of children with vesicoureteral reflux (VUR). Material and method: The study was conducted in the period from January 2006 to December 2014, and included children with symptomatic VUR, who were surgically treated. A total of 72 children were treated, of whom 56 were females and 16 were males, aged between 2 and 16 years. They were treated with IV and V grade reflux ureters. Thirty-two of the unilateral refluxes were left-sided, 18 right-sided and 22 both-sided. VUR was diagnosed with Voiding cystourethrography (VCUG). Cohen technique was performed in 64 (90%) patients, Politano-Lead better technique in 4 (5%) patients and Lich-Gregoir technique in 4 (5%) patients. Results: Out of the 72 treated patients, 69 had a postoperative negative finding of VUR on the performed VCUG, indicating a high 95% success rate. In three girls, persistent postoperative reflux was found in postoperative VCUG. In the first patient persistent VUR was unilateral, of V grade. In the second patient, a third-degree VUR was found and the third patient was diagnosed with II grade VUR. Postoperatively, non-febrile UTIs (urinary tract infections) were diagnosed in 23 patients (20 female children and 3 male children) out of 72 patients in total. One female child was hospitalized with febrile UTI and 8 patients or 10% developed febrile UTI within one year of the operative treatment. Conclusion: Open surgery, despite excellent results, is used for more complicated cases, VUR grade IV – V or in previously failed cases, and it does not appear to provide definitive correction of VUR in all patients and does not prevent certain low incidence of UTI postoperatively. Non-febrile UTIs can occur several years after a surgical correction. Endoscopic treatment is an alternative treatment for VUR
Andrej Nikolovski, Aleksandar Otljanski, Rexhep Seljmani, Svetozar Antovic, Nikola Jankulovski
Archives of Public Health, Volume 13, pp 96-100;

Laparoscopic appendectomy is the preferred operative method for acute appendicitistreatment. In terms of complicated appendicitis it can be effective in hands of an experiencedlaparoscopist that overwhelmed the learning curve for the method. Aim: Тhis retrospectivestudy examines whether the operative time for laparoscopic appendectomy for complicatedappendicitis is shortened after mastering the learning curve. Material and methods: A totalnumber of 196 patients were operated for the diagnosis of acute appendicitis, of whom 77were diagnosed with complicated appendicitis. They were subsequently divided in two groups(laparoscopic and open). Operative time in both groups was measured and the conversionand postoperative complications were noted. Results: Conversion rate was 2.3%. Operativetime was shorter in the laparoscopic group (67.4 ± 22.9 vs. 77.9 ± 17.9 minutes; p = 0.033).Overall postoperative morbidity was 25.97% with wound infection present only in the opengroup (p = 0.018). Intraabdominal abscess occurred in one patient from the laparoscopicgroup (0.38%). Length of hospital stay was shorter in the laparoscopic group (4.3 ± 2.2 vs. 5.7 ± 2.1, p = 0.0052).
Marina Krstevska-Konstantinova, Konstandina Kuzevska-Maneva, Hristijan Nestorov, Daniela Georgieva
Archives of Public Health, Volume 13, pp 144-148;

Poland syndrome (PS) is a rare congenital malformation, most commonly characterized by absence of chest wall muscles on one side of the body. It may be accompanied with other deformities of the extremities. We present the case of a 10-year-old girl with Poland syndrome and hypertrichosis of the back of the trunk and extremities. The clinical examination did not reveal the etiology of the syndrome, such as familial predisposition or some event that led to interrupted blood flow during the early embionic growth. The pregnancy was concieved with in vitro fertilization (IVF); triplets were born and our patient is one of these three girls. The hypertrychosis appeared at 8 years of life, without evidence of previous familial occurance, medications or hormonal disbalance. Other malformations that were found were: a mild form of kyphoscoliosis and mitral valve prolapse. The child was evaluated using a multidisciplinary approach, with further follow-up planned with surgical correction of the chest wall and breast augmentation.
Mira Jovanovska, Mirjana Petrovikj-Lazikj, Vesna Lazarovska
Archives of Public Health, Volume 13, pp 30-38;

Children with cleft palate/lip are exposed to risk for verbal communication disorders that include resonance, articulation, voice disorders, and expressive language. The aim of this paper was to evaluate the changes in the voice quality of the children with cleft palate in relation to children without anomaly. The study included 52 participants, 26 with previously corrected cleft palate / lip, and 26 respondents without anomaly who are between 3 and 6 years old. Subjective assessment of voice quality was performed by using the GRBAS scale. Perceptual scales are important in assessing the voice quality, determining the degree and severity of voice disturbance, and deciding on further clinical procedures. Although the instrumental approach to voice examination is relevant because it provides objectivity, the subjective impression in assessing voice quality is crucial. Statistical processing was performed by groups, group structure (gender and age), a certain highest value, as well as percentage participations. The results showed that 50% of the participants were diagnosed with certain changes in the voice. Children aged 3-5 years have a 2.25 times higher incidence of voice changes than children aged 6-8 years. The largest number of participants belong to group 0 - There is no change in voice quality which represents as much as 50% of the total number of patients in the first group. While "3 - Pronounced changes in the voice" were not identified in the respondents aged 3-5 years. In 50% of the total number of participants there is no change in voice quality and these are located in girls aged 3-5 years.
Stefan Pandilov, Suzana Klenkoski, Elena Jovanovska Janeva, Gazmend Mehmeti, Dragan Mijakoski, Sasho Stoleski, Hristian Duma, Dejan Dokic
Archives of Public Health, Volume 13, pp 130-143;

COVID-19 is an infectious disease that can manifest quite differently. In this study we examined the relationship between the value of serum CRP(C-reactive protein) andneutrophil-lymphocyte ratio (NLR) as predictor factors for the development of a severe clinical manifestation in COVID19 patients. Materials and methods: We followed 95 COVID-19 positive patients who were hospitalized at the University Clinic for Eye Diseases - COVID Center. We analyzed the initial laboratory parameters of white blood cells and CRP on admission of the patients and the results of laboratory analyses performed before they left the Clinic, or the last parameters before the lethal outcome in those patients who died. Several models of logistic regression were tested to analyze the predictive value of these markers of inflammation for lethal outcome in patients hospitalized for COVID-19. Results: Bivariate analysis demonstrated that the length of hospital stay was significantly shorter in patients with lethal outcome (p=0.001). The NLR was significantly higher in patients with lethal outcome at both times (p=0.005; and p=0.017). Leukocyte’s count (p=0.046, and p<0.001) and CRP (p=0.013,and p=0.005) were also significantly higher in patients with lethal outcome at both times. The increase on the NLR scale both at hospitalization and at discharge (or the last analysis before death) leads to increase in the odds of lethal outcome (T1:40.4% increased odds; T2:36% increased odds). Conclusion: CRP and NLR are laboratory parameters that can predict the severity of the clinical manifestation in patients with COVID-19.
Blazho Janevski, Fimka Tozija, Gordana Ristovska, Vladimir Mikikj, Vasilka Poposka-Treneska
Archives of Public Health, Volume 13, pp 39-48;

Zoonoses have a different impact on public health, determined by geographical and socio-economic factors, which requires their prioritization for prevention and control purposes to be performed at the national level. Prioritization of zoonoses is a mechanism used in policy-making, primarily in allocating available resources. Aim of the paper is to compare two different methods used for prioritization of zoonoses by Institute of public health (IPH) and Food and Veterinary Agency (FVA). Material and methods: IPH used a method prepared by the U.S. Centers for Disease Control and Prevention (CDC), - One Health Zoonotic Disease Prioritization (OHZDP) tool, adapted to national conditions (2019). FVA used a standardized semi-quantitative method based on the OIE Methodological Manual (List and Categorization of priority diseases in animals including and those transmitted to humans). A total of 21 zoonoses have been selected, based on their importance for the human and veterinary sector. These diseases are ranked according to the stated criteria of the two previously conducted prioritizations and their comparison is performed. Results: With the prioritization conducted by IPH and FVA the first 5 ranked zoonoses are: Hemorrhagic fevers with renal syndrome, Leishmaniasis, Tularemia, Brucellosis and Listeriosis. With the prioritization carried out by the FVA the first 5 ranked zoonoses are: Bovine brucellosis, Bovine tuberculosis, Salmonellosis, Avian influenza and West Nile fever. A Cumulative Annual Incidence is taken as a control parameter. Regarding this, the 5 first ranked zoonoses are Echinococcosis, Brucellosis, Lyme fever, Leishmaniasis and Tularemia. Conclusions: A comparative analysis of the separate lists of priorities for human and veterinary medicine shows that only a certain percentage overlap. Also, the presence of a number of zoonoses with endemic character, but also a more pronounced risk of new emergent diseases, determines the need to provide consensus on the methodology of prioritization of zoonoses, and its formalization and institutionalization, as a crucial step towards identification and prioritization of zoonoses that would be the subject of joint programs and interventions.
Valentina Koevska, Erieta Nikolic-Dimitrova, Biljana Mitrevska, Cvetanka Gjerakaroska-Savevska, Marija Gocevska, Biljana Kalcovska
Archives of Public Health, Volume 13, pp 78-90;

Osteoarthritis is a rheumatic disease characterized by degeneration and decay of cartilage in the joints. As the disease worsens, the joint space narrows causing numbness and pain, which often impairs movement. In addition to pharmacological therapy, low-intensity laser (LILT), high-intensity laser (HILT) and exercise are used to treat osteoarthritis (OA) of the knee. HILT is a new modality in our country and the experience from its application is small, especially in the treatment of OA of the knee. Aim of the paper was to compare the effect of HILT with LILT in the treatment of OA of the knee. Material and methods: This was a randomized comparative unilateral blind study involving 72 patients divided into two groups. The first group was treated with HILT, the second group treated with LILT. Outcome measure was the visual analogue scale (VAS) for pain, which was made on the first and tenth day of treatment. Statistical significance was defined as p <0.05. Results: We found a significant difference between the two groups in terms of VAS score after 10 therapies in favor to a significantly lower score, that is, less pain in the HILT group (p = 0.0035). The comparison of the VAS score between the two times in the two groups separately showed that in both, the HILT and the LILT groups, the VAS score after 10 days of therapy was significantly lower compared to thatat 0 time, for consequently p = 0.00001vsp = 0.00001. Conclusion: Treatment with HILT and LILT significantly reduces pain and stiffness in patients with OA. Patients treated with HILT had better results, i.e., had a significant reduction in pain than patients treated with LILT. HILT was more effective than LILT.
Jansun Bukovetz, Kristina Shuntova, Igor Spiroski, Shaban Memeti
Archives of Public Health, Volume 13, pp 17-29;

Walking as a form of physical activity has immense health benefits, but it also has economic benefits. Walking is a very efficient activity that prevents certain diseases and enables better quality of life of people who already have some disease.A considerable contribution of walking is detected in cardiovascular diseases, type 2 diabetes, obesity and chronic pulmonary diseases.The aim of this study was to make a health and economic assessment of the benefits of walking in the Republic of North Macedonia by using the Health and Economic Assessment Tool (HEAT).Materials and methods:Health Economic Assessment Tool is a relatively new tool, developed by WHO experts whose expertise is in the field of Public health and is able to calculate the health effects of regular walking and/or cycling. This study was based on using this tool for walking mode for the first time in the Republic of North Macedonia in a population group of 191 participants between the age of 20 to 73 years, with the average age of 35 years.Results:Besides the aforementioned health benefits, HEAT calculates the economic benefits of walking. The tool applied to 191 participants resulted in a total economic value of 108 808.8€ for one yearas well as reduction in mortality rate. Conclusion: We found that less than one fifth of our assessed population spends time in walking according to the WHO, CDC and AHA recommendations. The rest of them, more than four fifths are not following these recommendations. Our assessed population was relatively young, the average age being 35 years old, and the population was healthy, but still the results from this survey were not satisfying.
Ivan Pangovski
Archives of Public Health, Volume 13, pp 57-61;

Diabetes mellitus is an increasingly common public health problem and affects the population health. In many studies, DM is very often in a close correlation with many cardiovascular diseases and brain hemorrhage in general. The aim of the paper was to determine whether the presence of diabetes mellitus has influence on the occurrence of cerebral hemorrhage. Material and methods: The study included 61 patients diagnosed with hypertensive intracerebral hematoma in the hemispheres of the brain. Results: The prevalence of diabetes in the group of survivors of intracerebral hemorrhage was 26.67%, while in the group of subjects in whom the disease ended lethally diabetes had an insignificantly higher prevalence of 43.75% (Chi-square: 1.61df = 1, p = 0.21). Analysis of the prevalence of diabetes regarding the mobility of the respondents showed that there were no respondents with diabetes in the group of patients who could function independently, while there were 7 (24.14%) respondents with diabetes in the group who required help or aid for accomplishing their daily activities, and 5 (50%) in the group of respondents who were completely dependent on someone else in performing the everyday functioning. Statistical analysis showed these differences as insufficient to be statistically confirmed as significant (Fisher exact test, p = 0.105). Conclusion: In patients who have had cerebral hemorrhage with lethal outcome diabetes mellitus is a very common phenomenon, as well as in patients who have survived but subsequently have decreased mobility. But these differences are not statistically significant. Measures for reduction of the incidence of diabetes mellitus are needed. These measures include early detection of the disease, treatment and prevention of disability.
Ilir Shabani, Milan Samardziski, Viktor Kamnar, Neron Popovski, Antonio Gavrilovski, Shaban Memeti
Archives of Public Health, Volume 13, pp 69-77;

Loss of periprosthetic bone tissue in primary hip endoprostheses is common in clinical practice. This loss can be progressive and in extreme conditions can jeopardize the longevity of the prosthesis. In order to monitor the function of Alendronate therapy for bone maintenance, the study included 50 patients with implanted total cement-free hip endoprosthesis (TPH). The first group of 25 patients received Alendronate, calcium and vitamin D3 orally postoperatively. The second group of 25 patients were examined postoperatively without therapy. Patients were followed by radiographic and dual-energy X-ray absorptiometry (DXA) at 6 and 12 months. The study showed that in patients with TPH there was a difference in the X-ray findings as well as occurrence of osteolysis in certain Gruen zones, which was confirmed by changes in the state of bone mineral density (BMD) and bone mineral content (BMC) in the interval between 6 and 12 months using the DXA method. Alendronate therapy after TPH implantation allows reduction of periprosthetic bone mass loss, maintenance of bone mineralization and implant hardening.
Fana Lichoska-Josifovikj, Kalina Grivcheva-Stardelova, Beti Todorovska, Magdalena Genadieva Dimitrovа, Lidija Petkovska, Meri Trajkovska
Archives of Public Health, Volume 13, pp 101-109;

It is very important for patients with spontaneous bacterial peritonitis (SBP) to assess the length of survival and the risk of death, primarily because of the wide range of potential complications that can lead to multisystem organ failure and fatal outcome. The aim of this study was to determine the predictive potential of MELD and Child-Turcotte-Pugh II score for SBP in patients with cirrhosis and ascites. Material and methods: The study was designed as a prospective-analytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje for a period of one year. The study population included 70 hospitalized patients with established liver cirrhosis, regardless of etiology, divided into two groups, 35 patients with SBP and 35 non-SBP. Prognostic scores in patients with liver cirrhosis and ascites: MELD score, according to the formula: MELD = [(0.957 x Ln Creatinin) + (0.378 x Ln Bilirubin) + (1.12 x Ln INR) + (0.643) x 10]. The Child-Turcotte-Pugh II score includes 6 parameters: serum albumin and bilirubin, amount of ascites, degree of encephalopathy ( HE), prothrombin time (PT) and serum creatinine, and assessment of the degree of hepatic encephalopathy according to the West Haven criteria. Results: The average value of the MELD score in patients with SBP was 22.6 ± 8.27 and in non-SBP the average value was lower - 17.83±5.87. According to the Mann-Whitney U test, the difference between the mean values ​​was statistically significant for p <0.05 (z = 2.41; p = 0.015). A score of 30 to 39 was registered in 25.7% of patients with SBP, and only in 2.9% in non-SBP; the percentage difference was statistically significant for p <0.05 (Difference test, p = 0.0064 ). Patients with SBP had an average Child-Pugh score of 13.09 ± 2.48 or 100.0% C-class points. In patients with non-SBP, an average child-Pugh score of 9.63 ± 1.62 was recorded, or class B in 65.7% and class C in 34.3%. The percentage difference was statistically significant for p <0.05 (Difference test, p = 0.000000). According to the Mann-Whitney U test, the difference between the mean values ​​was statistically significant for p <0.05 (z = -5.44; p = 0.00001). ROC analysis indicated that the Child-Turcotte-Pugh II score contributed to the diagnosis of SBP - 90.7% (p = 0.000) (excellent predictor), closer to the ideal value of 1.0 and above the worst value of 0.5. ROC analysis indicated that the MELD score did not contribute to the diagnosis of SBP - 66.7% (p = 0.017) (weak predictor), closer to the worst value of 0.5. Conclusion:Our research confirmed that SBP occurs in patients with severe hepatic dysfunction calculated according to the CTP II score and MELD score. Mean value of the MELD score in patients with SBP was higher then in patients with non-SBP. On the other hand all patients with SBP had an average CTP II score, C-class points, while the largest percentage of patients with non-SBP were class B-class points. MELD score is a weak predictor of SBP. The best predictor for predicting SBP is the CTP II score (rank C).
Dushanka Grujoska-Veta, Daniela Georgieva, Nenad Atanasov, Ilir Shabani, Liljana Angeleska, Antonio Georgiev, Jasna Bogdanska
Archives of Public Health, Volume 13, pp 120-129;

Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies caused by chronic compression of the median nerve in the area of the carpal tunnel and its etiology is multifactorial. Trigger fingers and de Quervain’s disease are common disorders of the hand related to CTS in adults.Theaim of this study was to present the most common disorders of the hand such as stenosing tenosynovitis in adults with surgically treated CTS and to evaluate their demographic data.Material and methods: A total of 116 surgically treated patients with established diagnosis of CTS (clinically and by electrophysiological examination) were included in this prospective study, which was conducted at the University Clinic for Orthopedic Diseases in Skopje. Demographic data, findings of history of the disease and clinical examination were recorded and analyzed.Results: Participants with CTS included in the study were with a mean age of 55.41±10.7 years (age range 29-75). 75% of them were female. 63.8% of participants suffered from one or more comorbid chronic diseases. On admission to hospital, disorders such as trigger fingers and de Quervain’s disease were concomitantly diagnosed in 15.51% on ipsilateral hand with CTS. All disorders were surgically treated following open carpal tunnel release, as “one stage procedure”, under local anesthesia.Conclusion: Our findings have determined concomitant existence of CTS and stenosing tenosynovitis (trigger fingers and de Quervain’s disease) on ipsilateral hand, which suggests common etiological factors. Female gender and age range 40-60 years are major common factors related to these three disorders.
Marija Neskovska-Sumenkovska, Aspazija Sofijanova, Rozana Kacarska, Konstandina Kuzevska-Maneva, Beti Gjurkova Angelovska, Valentina Jovanovska
Archives of Public Health, Volume 13, pp 62-68;

Juvenile idiopathic arthritis (JIA) is the most common chronic disease in childhood. It manifests a heterogenic group of symptoms of arthritis, lasting at least 6 weeks and it appears before the age of 16. Patients who had no good therapeutic response to conventional therapy with Methotrexate were treated with biological therapy. The aim of this paper was to evaluate 9 patients who were receiving Tocilizumab at the Department of Rheumocardiology, University Clinic of Pediatric Diseases in Skopje. Materials and methods: Our study included 9 patients treated at our Department with biological therapy with Tocilizumab. Prior to initiation of the biological therapy, all patients underwent laboratory investigations, purified protein derivative (PPD) skin test for tuberculosis, X ray of the lungs and heart, and analysis of hepatitis markers. All patients were treated with amp. Actemra (tocilizumab) 8 mg/kg/tt i.v. Two of the patients had a severe form of the disease (one with severe systemic form and one with severe oligoarticular form of JIA). All presented patients had clinical remission of the disease. Conclusion: Therapy with tocilizumab in patients with juvenile idiopathic arthritis is a good therapeutic choice. The results obtained in our study have shown a significant therapeutic effect of tocilizumab even in severe forms of the disease.
Aspazija Sofijanova, Sonja Bojadzieva, Silvana Naunova- Timovska, Hristina Mandzukovska, Elizabeta Shuperliska, Olivera Jordanova
Archives of Public Health, Volume 13, pp 39-47;

Sepsis in newborns with RDSy and asphyxia is essential; it is a life-threatening condition and still represents an important cause of mortality and morbidity. The aim of this study was to evaluate the predictive values of procalcitonin (PCT) as an early diagnostic and prognostic biochemical marker for sepsis in newborns with RDS and asphyxia. Material and methods: The study was designed as prospective and we examined 110 newborns with proven sepsis admitted in the Intensive Care Unit at the University Clinic of Pediatrics – Skopje in the period between December 2018 and Јanuary 2021. Procalcitonin levels were measured by using the immunoassay system Vidas based on the ELFA principles. The newborns with proven sepsis were divided into two groups. The first group comprised 55 newborns with RDS and proven sepsis and the second group included 55 newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in first group of newborns with RDS and proven sepsis, p<0.001. The highest average values (40.37±53.79) ​​were measured on admission with a high level of peak compared to the second group of newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in the first group of newborns with RDS and proven sepsis with mechanical ventilation (MV) and bubble continuous positive airway pressure (BCPAP) compared to the second group of newborns with asphyxia and proven sepsis, p<0.001. PCT is a promising sepsis marker in newborns with RDSy, capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection at the time of ICU admission.
Ana Kaftandzieva, Marko Kostovski, Blerta Mehmeti, Gordana Mirchevska
Archives of Public Health, Volume 13, pp 77-90;

Aim: The aim of our study was to determine the most common bacteria isolated from wound samples and tо compare the frequency of the resistant bacteria isolated over a 3-year period. Material and methods: During a three years period (2017-2019) a total of 11 863 wound samples (wound swabs, punctuates, exudates, tissue, etc.) were obtained from the hospitalized patients in the University Clinics of the ,,Mother Theresa” campus, the City hospital ,,8th September” and the University Clinic for surgical diseases ,,St. Naum Ohridski” in Skopje. All samples were processed at the Institute of Microbiology and Parasitology, Faculty of Medicine, Skopje. They were examined by standard microbiology techniques. Identification and susceptibility of microorganisms were done by both standard methods and automatized Vitek 2 system. Results: Out of a total number of samples, which was 3 463 in 2017, 4 127 in 2018 and 4 273 in 2019, positive were 2 068 (60%), 2 302 (55.8%) and 2 387 (55.9%), respectively. From the total of aerobes/facultative anaerobes (2 758, 2 949 and 3 279 in three consecutive years, 2017, 2018 and 2019, respectively), Staphylococcus aureus was the most predominant isolate (19.5%, 16.6%, 16.9%) followed by Enterococcus spp (16%, 16%, 16.7%), Pseudomonas aeruginosa (12%, 13%, 12.7%) and E. coli (10%, 10.4%, 10.7%). Considering anaerobic bacteria, the percentage of Gram positive anaerobes (Peptostreptococcus) has decreased from 33% to 18% out of a total number of anaerobes, unlike Gram negative anaerobes in which the increasing percentage was mostly observed in bacteria of the genus Bacteroides (from 39% to 45%). The percentage of the resistant strains of MRSA, CNS-MR and VRE was almost the same in that period. In Gram-negatives the percentage of ESBL-positive isolates of E. coli and Enterobacter spp. increased consecutively from 2017 to 2019. The increase in the percentage of resistant strains was more noticeable in ESBL-positive isolates of Klebsiella pneumonia between 2017 and 2018, but in 2019 a percentage decrease can be observed. Considering carbapenem-resistant (CR) Enterobacterales, an increase in the resistance was noticeable in K. pneumonia. The increase in the percentage of resistant strains in Enterobacter spp. between 2017 and 2018, as well as the decrease between 2018 and 2019 was statistically significant. The percentage of CR-isolates of Pseudomonas aeruginosa was from 30% to 38% and for Acinetobacter spp. this percentage was from 81% to 85%. Conclusion: The knowledge of the most commonly isolated bacterial pathogens, especially the presence of resistant bacteria, is crucial and should be continuously monitored in order to understand, construct and update effective treatment algorithms and guidelines.
Igor Spiroski, Vladimir Mikik, Natalija Miloradovska, Marjan Veljanovski, Jeton Shaqiri, Aleksandra Petrova, Biljana Dzikovska, Blerta Shahini, Julijana Kitanovska Spasev
Archives of Public Health, Volume 13, pp 5-13;

Childhood obesity is growing as one of the most important public health issues that affects individual and population health but also puts heavy burden on the health systems. It is frequently associated with immediate adverse consequences, such as psychological problems, and a higher risk of many harmful comorbidities later in life, such as type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease, hypertension, and coronary heart disease. Comparability of anthropometric data is crucial to track the changes over time. The aim of this paper was to present prevalence of thinness, overweight, and obesity in 7-year-old schoolchildren in North Macedonia in 2010 and 2019, and the changes in their nutritional status during thatperiod. Material and methods: Anthropometric measurements of body height and body weight were performed to the nationally representative sample of 7-year-oldchildren in school years 2010/2011 and 2018/2019. Measurements followed the Childhood Obesity Surveillance Initiative (COSI) protocol and data collecting procedures. In total, 2737 children (1317 girls and 1420 boys) in 2010 and 2059 children (1045 girls and 1014 boys) in 2019 were measured. WHO Growth references were used to determine the growth and nutritional status of children. Results: The average height of children in the observed period has increased by 1.7 cm, weight for 1.2 kg and the BMI for 0.3 kg/m2. As for the weight classification, thinness prevalence is significantly increased for 0.3%. Overweight (including obesity) significantly increased (p=0.0377) from 34.4% (95% CI 32.6%-36.2%) in 2010 to 37.3% (95% CI 35.2%-39.5%) in 2019. Obesity significantly increased (p=0.040) from 16.3% (95% CI 14.9%-17.7%) in 2010 to 18.4% (95% CI 16.7%-20.1%) in 2019. The main driver of that increase was the highly significant (p=0.0004) increase of almost 7% of overweight (including obesity) in girls. Conclusion: There is unfavorable rising trend which indicates deterioration of the situation with childhood obesity in the country. Focused and more comprehensive public health nutrition actions are needed to plateau or reverse the trends. The childhood obesity national monitoring system is well established and should continue to beone of the key public health monitoring systems that provide evidence for actions.
Olga Kokoceva-Ivanovska
Archives of Public Health, Volume 13, pp 91-102;

Early childhood caries occurs immediately after the eruption of deciduous teeth. During this period, children are too young to be able to properly implement oral hygiene. Consequently, it is at a negligible level, with plenty of soft plaque on the deciduous tooth surfaces. The objective of this investigation was to determine the correlation between oral hygiene (shown with the OHI index) and the initial stages of early childhood caries: initial lesion (white spot) and superficial form, before and after local fluoride treatment. Material and methods: For determining the OHI index among our examinees we used the method of Green-Vermillion. It was determined in 117 examinees twice, during the first visit and immediately before physiological replacement of deciduous teeth. Patients were two to three years of age, diagnosed with initial stages of early childhood caries and fluoride preparate (amino fluoride solution) was applied once a week, for 6 months. Results: In 30 subjects treated with local fluoride treatment from both basic groups (with initial and superficial lesions), just before the physiological change of the teeth, we received a statistically significant improvement in the OHI index (p = 0.000038; p = 0.00006) at the end from the examination. Conclusion: From the conducted analysis of the obtained results, we can conclude that the level of oral hygiene is correlated with the progression of changes in the enamel. Oral hygiene and fluoride treatment significantly reduce soft tissue levels and improve the OHI index.
Ilir Shabani, Antonio Gavrilovski, Vilijam Velkovski, Nenad Atanasov, Shaban Memeti, Anila Belchishta
Archives of Public Health, Volume 13, pp 32-38;

The development of aloarthroplasty of the hip is continuously rising. After implantation of a total cement-free hip endoprosthesis, often there is a periprosthetic femoral bone loss. Alendronate has been shown to be a potent inhibitor of bone resorption activity; it inhibits osteoclastic bone resorption, increases bone mass, and plays a significant role in post-implantation stabilization of the femur. The aim of this study was to determine the effect of alendronate on osteointegration of hip endoprosthesis.Material and methods: The study analyzed 10 patients operated on with implantation of a total cement-free hip endoprosthesis (THP). The included patients were examined by a radiographic method at 6 and 12 months and DXA method at 6 and 12 months. Results: The study showed differences in the values of bone mineral density and bone mineral content in the interval between 6 and 12 months in patients undergoing THP, and hence we can conclude that alendronate therapy after THP implantation reduced periprosthetic loss of bone mass and implant stiffening. Alendronate is a proven inhibitor of periprosthetic bone loss that occurs after prirmary impantation of a total cement-free hip endoprosthesis.
Savetka Paljoskovska-Jordanova
Archives of Public Health, Volume 13;

Carotid artery disease most commonly manifests as atherosclerotic carotid artery disease, which can lead to an ischemic stroke. Our aim was to present the epidemiological aspects of carotid disease and to demonstrate the association of risk factors with carotid disease. For that purpose, we prospectively followed 1031 patients at the University Clinic for Cardiology in Skopje, who were examined for carotid stenosis and its correlation with risk factors such as hypertension, smoking, hyperlipidemia, diabetes, obesity and peripheral arterial disease. Results: Carotid stenosis was correlated with arterial hypertension, hyperlipidemia, diabetes mellitus, smoking, and peripheral arterial disease. Conclusions: Our study found that conventional risk factors such as hypertension, diabetes, smoking, and dyslipidemia were independently associated with significant carotid artery disease and peripheral arterial disease.
Nada Pop Jordanova, Jovanka Ristova, Sofija Loleska
Archives of Public Health, Volume 13, pp 1-10;

Ophthalmological problems have a great influence on the quality of life, employment and everyday activities. In this context they are an important issue in the public health. The aim of this study was to evaluate the level of anxiety, depression as well as type-A personality in a sample of 40 ophthalmological patients. The results obtained showed moderate anxiety, moderate depression, as well as different type of personality related to the diagnosis. Scores obtained for psychometric tests are related to the age, but not to the gender. Research confirmed that depressive symptoms and anxiety may not only aggravate symptoms of eye disease, but also affect other psychological systems forming a vicious circle. With a change of the medical model, medical professionals are placing an increasing emphasis on the mental health of patients. It is an imperative to introduce social measures for improvement of the health. These findings highlight an important mental health issue in eye disease patients.
Lidushka Vasilevska, Elena Kjosevska, Tanja Lekovska-Stoicovska
Archives of Public Health, Volume 13, pp 1-18;

The COVID-19 pandemic is an unprecedented global crisis in public health. Professionals in dental institutions, dental associations and regulatory bodies face various challenges in providing dental care and prevention of oral health of the population, as well as protection of patients and practitioners from the health threat of SARS-CoV-2 virus. The aim of this paper is to present the current findings and views regarding the information on the epidemiological and clinical characteristics of the SARS-CoV-2 virus and the need to implement protocols to protect patients and dental practitioners from the health threat posed by the virus, in compliance with medically relevant regulations.Material and methods: References from WHO, FDI and published papers in international scientific journals in this relatively short period were consulted and they presented: updated epidemiological and seroepidemiological information, review of response measures implemented in EU countries / EEA, UK and countries around the world and response options to minimize the risk of recurrence of COVID-19. Results: Viral pneumonia that appeared on February 11, 2020, was named "Coronavirus (COVID 19)" by the WHO, while the International Committee on Taxonomy of Viruses (ICTV) proposed the name "SARS-CoV-2" for phylogenetic and taxonomic analysis of this corona virus. Dentists/doctors of dental medicine should be familiar with transmission of SARS-CoV-2, how to identify patients with SARS-CoV-2 infection and what measures should be taken for protection during the intervention in order to prevent its transmission. There are recommendations for infection control measures that should be followed by the dentists/doctors of dental medicine. The fact that aerosols and drops have been considered for major SARS-CoV-2 propagation routes has been emphasized. If these measures are not undertaken, then the dental office can potentially expose patients to cross-infection. Conclusion: The epidemiological situation around the world is changing dynamically, but patients should not be left without urgent medical help. Oral health team members are required to update their knowledge and skills regarding the prevention, diagnosis and management of communicable diseases that can be transmitted in a clinical setting and to stick to the standard precautions to protect patients from infections as well as protect themselves.
Aleksandra Jovanovska, Kata Martinova
Archives of Public Health, Volume 13, pp 1-16;

Во последните неколку декади е остварен значаен напредок во терапискиот исход кај детската акутна лимфобластна леукемија (АЛЛ), што резултира со денешно 5-годишно вкупно преживување кое достигнува до 90%. Овој импресивен успех се должи на примената на ефикасни, комбинирани хемотераписки режими и прецизна стратификација на пациентите во ризични групи според добро дефинирани прогностички фактори кои ги вклучуваат клиничките карактеристики присутни при дијагнозата, биолошките и генетските карактеристики на леукемиските клетки и раниот одговор на терапија. Пациентите кои се класифицираат во прогностичка група со низок ризик се третираат со помалку интензивна терапија, додека за тие со високо-ризични карактеристики се применуваат поагресивни режими. Минималната резидуална болест (МРБ) во моментов претставува најважен и независен предиктор на терапискиот исход. Во овој ревијален труд се опишани клиничките, биолошките карактеристики и раниот одговор на терапија како и актуелните сознанија кои ја поддржуваат нивната клиничка примена кај детската АЛЛ.
Andreja Gavrilovski, Aleksandra Gavrilovska-Dimovska, Goran Aleksovski
Archives of Public Health, Volume 13, pp 1-6;

Fractures of the talus do not occur frequently, accounting for about 0.1% of all fractures. Failure to achieve anatomic reduction, exponentially increases the risk of postoperative aseptic osteonecrosis and posttraumatic osteoarthritis. The purpose of this study was to evaluate and compare the short-term and medium-term functional outcomes in patients who underwent open reduction and internal fixation of talus fractures. Materials and methods: At the University Clinic for Traumatology in the period between 2017 to 2020, 14 patients with talus fractures were surgically treated. The inclusion and exclusion factors were determined, all patients signed the consent and the study passed the ethics committee. Results: All patients underwent open reduction and internal fixation with screws or reconstructive plate. Follow-up was done on the 14th postoperative day, 1st month, 3rd month and 6th month. At the 6th month follow-up, the functional outcome was tested using the Kitaoka score unified by the American Orthopedic Foot and Ankle Society. This injury is too rare for conclusions to be brought out of and to be compared to larger studies. However, all major studies from reference trauma centers lead to the same conclusions, that the treatment of these fractures is complex Anatomical reduction is mandatory for a better outcome. Conclusion: A protocol for the treatment of posttraumatic osteoarthritis should be introduced, given the high rate of its occurrence despite the satisfactory surgical technique.
Snezana Ivic-Kolevska, Andreja Arsovski
Archives of Public Health, Volume 13, pp 1-8;

Pulmonary actinomycosis is a rare and uncommon invasive bacterial disease. We are presenting a case report of 45 year old male patient with severe acute pneumonia with pleural effusion, presenting with fever, fatigue, productive cough, chest pain, dyspnea and swelling on both legs. Microbiological findings showed an isolation of anaerobic bacterium Actinomyces odontolyticus. The antibiogram showed sensitivity on penicillin and penicillin preparations, cephalosporins and carbapenems. There was an intermediate sensitivity on quinolones and there was a resistance on lincosamins and aminoglycosides. Our patient was treated with operation and received appropriate antibiotic therapy, after which there was a very good improvement, both clinically and on control native lung RTGs. This disease has excellent prognosis with early detection and proper treatment. Penicillin is the drug of choice for treatment of pulmonary actinomycosis.
Snezana Palchevska, Beti Gjurkova, Elena Shukarova, Katarina Stavrikj, Jana Jovanovska, Natasha Aluloska
Archives of Public Health, Volume 13, pp 1-6;

DiGeorge’s syndrome is a 22q11.2 deletion leading to abnormal embryogenesis of pharyngeal arches and it is manifesting in a variety of clinical signs and symptoms. The spectrum of anomalies varies from minor facial dysmorphism and cleft palate to a broad spectrum of cardiovascular anomalies, thymic disfunction and immune deficiencies, hypocalcemia due tohypoparathyroidism,growth and developmental delay and speech disturbances. Cardiovascular anomalies might include right sided aortic arch, aberrant vesiclesand vascular ring. Here we present an atypical case of partial DiGeorge’s syndrome with feeding and swallowing difficulties and laryngeal stridor in the neonatal period. Early presentation in this period is usually due to severe hypocalcemia and cardiac disease. Feeding difficulties in a preterm baby needed clinical assessment skills in order to establish the diagnosis and delineate it from feeding difficulties usually seen in preterm babies. Esophagogram (barium X Ray) showed antero-posterior oblique impression towards the right side, the latero- lateral view showed impression on the rare side, suspected to be esophageal sub stenosis due to vascular anomaly, aberrant right subclavian arteryand suspectedthymic hypoplasia. We report a 9-year follow up periodbya team of subspecialists. The child had two surgeries due to aberrant vessel and velopharyngeal deficiency. Optimal management of patients with DiGeorge’s syndrome requires a multidisciplinary teamwhichshould include a cardiologist, immunologist, geneticist, speech/language therapist, endocrinologist and other subspecialists depending on patient`'s phenotype.
Aleksandra Gavrilovska-Dimovska, Andreja Gavrilovski, Venko Filipce
Archives of Public Health, Volume 13, pp 1-5;

Cerebral venous sinus thrombosis (CVST) is presence of a blood clot in the dural venous sinuses. This is a rare, but dangerous condition. CSVT is characterized by a highly variable clinical spectrum, difficult diagnosis, variable etiologies and prognosis. The International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) determined the frequency of the sites of SCVT. The aim of this case study was to show the clinical presentation, the examination we made, the therapy that was ordinated and the outcome of the treatment. Case study: A 14-year-old male teenager was admitted to the University Clinic for Neurosurgery in Skopje with GCS 10, accompanied with tonic-clonic epileptic seizures. CT examinations by systems were made, and during the time of recording the patient was given Dormicum 2mg overall dose. CT scan of the brain showed hyperdense zones formation around superior sagittal sinus (SSS), the rest of the medical finding was normal. We ran laboratorytests and the test for hemostasisshowed deviation from the normal range. With the ordinated therapy the clinical condition of the patient drastically improved. He was discharged home 12 days after the admission. He was given a recommendation for further check-ups by a transfusiologist and regular visits to our clinic. Occlusion of the cerebral veins and dural venous sinuses may occur on the basis of local trauma, neoplasm or infection. Primary aseptic thrombosis may involve either cerebral veins or dural venous sinuses, or both in combination. The clinical picture and the prognosis of intracranial venous thrombosis probably depend largely on the location, extent, and rapidity of development of the venous occlusion. Conclusion: Superior sagittal sinus thrombosis is a condition that can be manifested with diverse and many symptoms and signs, which often can start unexpectedly and can be life-threatening.
Aleksandra Stambolieva, Mihail Kocubovski, Gordana Ristovska, Aneta Kostova
Archives of Public Health, Volume 11, pp 37-42;

Здравствената стратегија на ЕУ „Заедно за здравје“ ги призна климатските промени како закана за здравјето и ја нагласи улогата на Европската заедница да ги координира и брзо да одговори на заканите по здравјето на глобално ниво и да ги зајакне капацитетите на земјите (Европска комисија, 2008). Целта на трудот беше да се утврди степенот на свесност и информираност на популацијата околу глобалниот проблем со климатските промени и одговорноста на надлежните тела околу мерките за справување со климатските промени. Материјал и методи: Беше спроведено пилот истражување во текот на декември 2018 година во Република Македонија, со применана прашалник кој беше адаптирана верзија од survey questionnaire (‘climate change’, version 1) преведен на македонски јазик и дистрибуиран на интерактивна онлајн платформа. На прашалникот добивме одговори од 130 испитаници. Резултати: Најголем процент (90,2%) од испитаниците одговорија дека аерозагадувањето е првото нешто што го поврзуваат со климатските промени, а потоа следуваат густината на сообраќајот (41,7%) и управувањето со отпадот (41,7%). Кога станува збор за одговорноста околу проблемот, според испитаниците националната влада (33,8%) има највисока одговорност, во однос на меѓународните организации (20%). Заклучок: Истражувањето покажа дека постои одреден степен на информираност кај населението за климатските промени и појавите поврзани со нив како што се: загадувањето на воздухот, густината на сообраќајот, поплавите, пожарите и слично, но исто така потребно е да се спроведат силни кампањи за подигање на јавната свест.
Emilija Gjoshevska-Dashtevska, Natasha Trpevska-Shekerinov, Maja Ivanova
Archives of Public Health, Volume 12, pp 1-12;

The epidemics of COVID-19 started in December 2019 in Wuhan, China, and the World Health Organization (WHO) officially declared a pandemic in March 2020. COVID-19 can also affect the eyes. Ophthalmic manifestations of the virus are not so frequent; the prevalence is about 3% up to now. Recognizing the possibility of ophthalmic transmission and manifestation of the virus is of significant importance for ophthalmologists and health workers. According to published studies, the most common ophthalmic manifestation is follicular conjunctivitis with all the symptoms and signs of viral conjunctivitis. It is usually bilateral, and patients present adenoviral-like symptoms, discomfort, foreign body sensation, redness, or they have no subjective symptoms. The symptoms are more pronounced in patients with a more severe clinical picture of the disease. One of the described non-specific manifestations of COVID-19 as an initial manifestation is keratoconjunctivitis. The effects of the virus on the retina and blood vessels have not been fully investigated, yet. It has been proven that COVID-19 can be isolated from tears and from ocular surface by PCR conjunctival swab. The most common mode of transmission is through direct contact and through aerosols. Through the nasolacrimal system, the eyes can be the entrance for respiratory infection and hematogenous spread of the virus can occur through the lacrimal gland. Early recognition of the ophthalmic symptoms by ophthalmologists as well as the other health workers during this pandemic is necessary because sometimes they can be the only manifestation of COVID-19, and on the other hand, it will lead to greater protection and prevention of the virus spreading. Prevention measures should be focused on the application of administrative protocols, personal protection and environmental control.
Ardita Kerveshi-Sulejmani, Aferdita Selmanaj, Igor Isjanovski, Rozalinda Isjanovska
Archives of Public Health, Volume 10, pp 40-47;

The metabolic syndrome (MS) is the main clinical and public health challenge in the world, in the wake of urbanization, excess energy intake, increased obesity, sedentary lifestyle and habits. MS leads to a 5-fold increase the risk of diabetes mellitus type 2 (T2DM) and 2 times the risk of cardiovascular disease (CVD) over the next 5 to 10 years. The aim of the research is to determine the prevalence of metabolic syndrome syndrome in the Pech District according to NCEP ATD III / 2001. Material and methods: Cross sectional study was carried out at the General Hospital in Pec, which represents a regional hospital for the Pec District. A total of 1667 patients from the Pech district were interviewed for a period of one year. Results: In the group, MS was present in 506 patients. In the majority of cases, we found the systolic blood pressure condition ≥ 130 mmHg -99.4%, followed by diastolic blood pressure ≥ 85 mmH-96.4%, elevated triglycerides ≥ 1.7 mmol / l- 94.7%, waist circumference> 88 cm in women-94.0% , increased glycemia ≥ 6.1mmol / L in 80.0%, waist circumference > 102cm in men-65.5%, HDL values ​​
Ana Stamatova, Stojka Fustic, Lidija Spirevska, Snezana Mojsova, Viktor Tonevski
Archives of Public Health, Volume 12, pp 1-5;

Benign transient hyperphosphatasemia (BTH) is a condition which occurs in children younger than five years, characterized by a complete absence of specific clinical and laboratory findings of bone or liver diseases and a five or even 20–70-fold increase in serum of alkaline phosphatase levels(ALP). The aim of this case report was to point out that elevated levels of ALP are not always related to serious bone and liver diseases. We described three healthy patients, which were referred to our out-patient clinic by their primary care physicians because of markedly elevated levels of ALP. The diagnosis of BTH was based on a thorough physical exam, a wide range of laboratory and imaging tests, which excluded liver or bone disease as a cause for elevated ALP. BTH is not very well-known and managed in daily clinical practice. Primary care physicians should consider this diagnosis in cases with elevated ALP in otherwise healthy infants and toddlers, refrain from unnecessary tests, prescribing higher doses of vitamin D3 or referral to tertiary level pediatric institutions.
Elena Trajkovska-Dokic, Kiril Mihajlov, Katja Popovska, Gordana Mircevska, Andrijan Kartalov, Biljana Kuzmanovska
Archives of Public Health, Volume 10, pp 12-18;

Механизмите за адаптација со кои располагаат микроорганизмите од цревниот микробиом го одредуваат нивното квалитативно и квантитативно присуство. Еден од најзначајните фактори кои значајно го нарушуваат цревниот микробиом, овозможувајќи им на условно патогените бактерии да предизвикаат инфекции, е употребата на антибиотиците во терапија на голем број инфекции. Токму таква е инфекцијата која ја предизвикува C. difficile. Целта на нашата студија беше да се испита дали пробиотикот „Диастоп пробио” може да ја превенира колонизацијата и инфекција со C. difficile кај хоспитализирани пациенти. Материјал и методи: Во студијата беа вклучени вкупно 32 пациенти, кои беа третирани истовремено со два од наведените антибиотици: Ceftriaxon, Clindamycin, Ciprofloxacin, Imipenem, Meropenem и Amikacin. Шеснаесет пациенти ја сочинуваа групата на испитаници, кои го примаа и пробиотикот „Диастоп пробио”, а другите 16 пациенти од контролната група не добиваа пробиотик. Од сите пациенти беа добивани по два примерока за детекција на колонизација или инфекција со C. difficile, со класични микробиолошки техники. Истовремено беше проценувана и квалитативната застапеност на нормалната цревна флора. Резултати: Кај пациентите од групата испитаници, процентот на детектираните токсични соеви на C. difficile беше 3 пати повисок во однос на пациентите од контролната група (p
Vlatko Kokolanski, Suzana Trajkovikj -Jolevska, Rozalinda Isjanovska, Kiro Ivanovski, Katarina Dirjanska
Archives of Public Health, Volume 11, pp 20-30;

Materiovigilance is a system applied for the purpose of detecting, gathering, monitoring, assessing and responding to new data on safety of medicinal products and related to the use of medical device related to possible incidents during use. The aim of this paper was to show the characteristics of the system of materiovigilance in the Republic of Macedonia compared to four other jurisdictions (US, EU, Japan and China), the recognition of the advantages and disadvantages of the systems and their impact on public health. Material and methods: For the realization of the aim of the study, we conducted an analysis of data published on the web pages of regulatory authorities related to the existing legal framework and review of the literature available on the network for scientists and researchers ResearchGate. General dialectical method as well as legal methods (dogmatic and normative method) were used in this study in order to determine the content, the meaning and the importance of the legal norms which regulate the system of materiovigilance. Results: The five systems of materiovigilance have several features that include monitoring of adverse events caused by medical device that have been granted a marketing authorization. Globally, these systems provide different, shared responsibility of all stakeholders. Thus, the scope of responsibilities of producers is significantly higher in Japan and China, opposed to the EU and Macedonia, where the responsibility is passed on to distributors, health professionals and other for-profit entities. United States is in the middle between these two extreme systems of materiovigilance, where the FDA has the responsibility to protect the public health forecasting responsibilities to the industry. Conclusion: There are significant variations in the regulation system of materiovigilance in the Republic of Macedonia and the analyzed legal systems. To date, there is no empirical evidence that one system is better than another, but it is indisputable that each system has its advantages and disadvantages regarding the protection of public health. Within the analyzed systems of materiovigilance three best practices can be seen that contribute to the improvement of public health: transparency, repeating the examination of medical device and central versus local control.
Cvetanka Gjerakaroska-Savevska, Erieta Nikolikj-Dimitrova, Valentina Koevska, Biljana Mitrevska, Marija Gocevska, Daniela Gecevska
Archives of Public Health, Volume 12, pp 1-10;

Urinary incontinence is the inability to control urination with spectrum of disturbances from periodical urinary leaks to complete inability to retain urine. It occurs more often in elderly and in women. Urinary incontinence has a great impact on general health and may reduce the quality of life. There are several types: stress urinary incontinence, urgent urinary incontinence, neurogenic urinary incontinence, overflow urinary incontinence. Stress urinary incontinence is the most frequent one and is due to pelvic floor muscle weakness. For assessment and treatment of these patients the individual approach is warranted. The treatment of these patients includes medications, behavioral therapy, biofeedback, pelvic floor muscle training, electrical stimulation, magnetic stimulation and surgery. Non-surgical treatment might be effective to prevent surgery. Rehabilitation treatment with pelvic floor exercises and physical modalities for patients with urinary incontinence is important for recovery of the urinary continence and improvement of quality of life in these patients.
Nada Pop-Jordanova, Sofija Loleska
Archives of Public Health, Volume 12, pp 1-11;

Science cannot achieve its purpose without some practical applications. The aim of this article is to inform our colleagues about some practical uses of the methodology named biofeedback in the general population. It is important for the staff, especially for those employed in the public health service, because this method is not useful only for treating some disorders, but also for obtaining some health attitudes, performances and mental relaxation in the general population.
Biljana Kakaraskoska Boceska, Dugagjin Osmani, Branka Petrovska Basovska, Verica Kakaraskoska Petreska, Kata Martinova, Zorica Antevska Trajkova, Aleksandra Jovanovska, Svetlana Kocheva
Archives of Public Health, Volume 12, pp 1-8;

Rhizobium radiobacter is a Gram-negative rod-shaped bacterium usually associated with diseases in plants. Infections due to R. radiobacter in humans are strongly related to the presence of foreign plastic materials, immunocompromised and chronically debilitated hosts with underlying conditions such as malignancies, human immunodeficiency virus as well as bone marrow transplant recipients. The aim of this paper was to present a rare blood infection with Rhizobium radiobacter in North Macedonia in a pediatric patient with underlying conditions. The treatment was successful with appropriate cephalosporin and aminoglycoside therapy without removing the central venous catheter
Nadica Todorovska, Suzana Dinevska-Kjofkarovska, Orce Popovski, Elisaveta Stikova
Archives of Public Health, Volume 10, pp 58-63;

Безбедноста на житата и житните производи е од големо нутритивно и токсиколошко значење, бидејќи житната индустрија и нејзините производи имаат голема економска и социјална важност на светско ниво. Во ова пилот истражување е испитана концентрацијата на токсичните елементи во траги арсен, кадмиум и олово, во три мостри од различни производители на ориз: 11,67+5,69mg/kg, 25,67+6,43mg/kg, 47,67+18,01mg/kg, пченично брашно: 7+5mg/kg, 9+1,73mg/kg, 69,92+16,92mg/kg за As, Cd и Pb, соодветно, и производи од брашно (леб: 9,33+2,08mg/kg, 6,67+0,58mg/kg, 36+3,6mg/kg, тестенини: 1,61+1,15mg/kg, 2,67+2,08mg/kg, 30+7mg/kg и чајни колачи: 4,67+4,04mg/kg, 1,33+0,58mg/kg, 53+9,64mg/kg за As, Cd и Pb, соодветно) од македонскиот пазар, со употреба на хидридно генерирачка и електротермичка атомска апсорпциона спектрометрија со мокра дигестија. Извршена е пресметка на учеството во просечниот дневен внес за токсични елементи внесени преку дневна консумација на жито и производи од жито (20% од целодневниот оброк). Придонесот на As (9,86%), Cd (10,02%) и Pb (11,39 %) спореден со просечниот дневен внес и прифатливиот толериран дневен внес, PTDI, беше низок, што покажува дека овие производи се безбедни за употреба во однос на испитаните токсични елементи. Нивоата на токсичните елементи во мострите на македонскиот ориз, пченично брашно и производи од брашно се споредливи со резултатите добиени од различни делови од светот и нивниот внес не претставува здравствен ризик за потрошувачите.
Sandra Kosteska, Dragan Gjorgjev
Archives of Public Health, Volume 12, pp 1-15;

Considering complicity in ecological health and social aspects of industrial contaminated sites (ICSs), the methodologies and approaches of health impact assessments are very heterogeneous. ICSHNet together with WHO recommend two main methodological approaches: health risk assessments and epidemiological studies. Some countries have necessary experience for impact assessment of ICSs, but others have limited resources and less intensity studies. In the Republic of North Macedonia, 16 ICSs are identified, but one of them, lindane dumpsite in OHIS Plant is characterized as the most ecological and public health risk. The general aim: Systematic review of literature data about methodological approaches for health risk assessment of ICSs on international and national level in order to make comparative analysis of current methodological approaches in the Republic of North Macedonia using the case study of ICS OHIS PLANT SKOPJE. Material and methods: The review of scientific and grey literature was performed. The selected scientific studies were searched in the PubMed and Medline databases from 2000-2017, in English and Macedonian. The selected studies and data were analyzed by required information for identification of hazards, exposure assessment and risk characterization. Additionally, the review was performed on published reports of risk assessment of OHIS Plant. Results: A total of 14 original papers were investigated. Continuous monitoring systems for gathering environmental data related to ICSs were used only in two cases and in other studies the concentrations of contaminants in the source were calculated or several ad hoc monitoring campaigns were performed. Exposure assessment was conducted according to qualitative definition for the presence/absence of a source, distance to a source and biomonitoring in the study. Mortality, cancer incidence, congenital abnormalities and hospitalizations were used health data. The study of risk assessment of OHIS Plant has ecological design and indirect quantitative exposure assessment model was used. Conclusion: All investigated studies used three main methodological approaches for exposure assessment: measurement of hazard concentration, distance from source and biomonitoring. Comparable, conducted risk assessment of OHIS Plant follows the recommendations of US EPA and ATSDR with weakness of no existing continual monitoring process and also deficiency of health data and this is the reason for limitation of health impact assessment and setting up EPHT or other public health surveillance system.
Igor Isjanovski, Viktor Isjanovski
Archives of Public Health, Volume 10, pp 64-70;

Прематурната ретинопатија (РОП) е главна причина за слепило кај предвремено родените бебиња. Инциденцата на РОП се зголемува во земјите во развој и се должи на зголемување на преживување на предвремено родените деца. Прематурната ретинопaтија (РОП) е сериозна компликација кај предвремено родени деца која може да доведе до слепило, освен ако се дијагностицира и се третира рано. Цел на оваа студија е да се проучат мајчините и акушерските фактори на ризик за РОП. Материјал и методи: Истражувањето преставува аналитичка “Case control” студија во периодот 2015-2016г. Во студијата се вклучени 163 предвреме родени деца кои не ги исполнуваат критериумите на Американската академија за офталмологија (ААО), со родилна тежина се над 1500 г и гестациска старост над 30 недела. Мајките се поделени во две групи во однос на новородените со РОП и без. За оставрување на целите се користеше дводелен анкетен прашалник, првиот дел од прашалникот се однесува на прашања за мајката. Резултати: ИВФ (ин витро фертилизациа) ја зголемува веројатноста за РОП повеќе од два пати OR=2.1256 (1.1133-4.0585). Како независни фактори мултипната бременост ја зголемува веројатноста за РОП за два и пол пати. Прееклампсијата делува протективно, ја намалува веројатноста за настанување на РОП. Начинот на породување, возраста на мајката, број на бремености, број на раѓања, консумирање на алкохол, пушење, наркотици не претставувaат ризик фактори. Треба да се обрне големо внимание на дефинирањето на ризик факторите, нивната комплексност, развојот и прогресијата на прематурната ретинопатија и нејзината превенција кои се само еден дел од прашањата со кој се соочуваат офталмолозите и неонатолозитe во текот на својата работа. Во студијата се потврдија истите ризик факори кои се регистрираат на кај прематурусите според ААО (родилна тежина под 1500 г и под 30-та гестациска недела). Заклучок: протоколите за скрининг на РОП да се модифицираат, покрај инклузионите критериуми на ААО да се вклучат и прематуруси според препораката на неонатолозите за зголемен ризик за развој на прематурна ретинопатија, а се со родилна тежина над 1500 г и над 30-та гестациска недела.
Elizabeta Zisovska
Archives of Public Health, Volume 10, pp 71-81;

The importance of recognition of the social determinants and the degree to which they influence the perinatal health is of utmost significance for the reproductive epidemiology and therefore they are important causes of the health inequalities within and between the countries. These facts have implied the aims of this study, to evaluate four frequent social determinants (level of education, employment status, parity and antenatal controls) and their influence on the two adverse perinatal outcomes – preterm/near term newborn of 35-37 gestational weeks, and small for gestational age baby (SGA). The research is a part of very extensive study, and by design it was prospective cohort study during which validated Questionnaire was used and extracted data from the maternal and neonatal history. As very relevant, the statistical parameters Relative Risk and Numbers Needed to Treat (NNT) were used for risk analysis. The Results have shown strong influence of the maternal education on the both perinatal outcomes. The Relative risk for preterm delivery in 35-37th gestational week in mother of uneducated mother is 14,963 (95%CI 4,54-49,27) compared to mother of academic level of education; the relative risk for SAG newborn is 3,204 (95%CI 2,12-4,84); in unemployed mother, the relative risk for preterm delivery is 4,585 of that in mother of academic level (95%CI 2,27-9,28), whereas for SGA baby is 4,799 (95%CI 3,17-7,26). No antenatal control in pregnancy is high risk for bad outcome, but in this study the Relative risk for preterm delivery was 1,293 (95%CI 0,67-2,47), and for SGA babies it was very low compared to full control in pregnancy, and was 1,041 (95%CI 0,84-1,29). According to these findings, it is obvious that the understanding of the social determinants of health priorities are the first and the most important step towards their gradual reduction, and this action is an entry point for global action to reach the health goals. Therefore, it is recommended such types of research studies to be conducted in extensive sample size, considering as much as possible social determinants, and performing multivariate analysis, in order to get higher statistical significance, which will help in creating strategies and activities for reduction of the most influential social determinants and improvement of the perinatal outcome of the newborns.
Maja Bojadzioska, Petar Dejanov, Irena Kafedziska, Mimoza Nikolovska-Kotevska, Andzelika Karadzova-Stojanoska, Viktor Isjanovski, Sasha Jovanovska-Mishevska, Filip Gucev, Igor Isjanovski, Elena Curakova Ristovska
Archives of Public Health, Volume 12, pp 1-8;

Osteoporosis (OP) is a serious extracorporeal manifestation that occurs in patients with rheumatoid arthritis (RA). One of the risk factors is long-term use of glucocorticoids (GC). Osteoporosis together with the increased risk of vertebral (VF) and non-vertebral fractures (non-VF) in particular has a negative impact on quality of life in patients with rheumatoid arthritis. The aim of the study was to detect the occurrence of OP and VF in postmenopausal patients with RA and their association with long-term use of small doses of glucocorticoids. Material and methods: A total of 46 patients were analyzed. All respondents underwent imaging for osteoporosis evaluation with a DXA scanner (Lunar iDXA, GE) and VF with incorporated Vertebral Fracture Assessment (VFA). Results: The values of bone mineral densities (BMD) were significantly smaller in the group that received glucocorticoids. According to VFA, 37,0% of patients were registered to have a fracture of middle degree, a mild fracture was registered in 19.6% of patients, and severe fractures were registered in 3 patients (6.5%). Conclusion: In postmenopausal patients with RA receiving GC therapy, a more common occurrence of osteoporosis and vertebral fractures was reported compared with the remaining group of RA patients. All patients with RA in menopause need to be screened for timely detection and treatment of osteoporosis and prevention of its complications.
Darijan Trajanov, Elena Kjosevska, Beti Zafirova Ivanovska
Archives of Public Health, Volume 12, pp 1-13;

Physical activity is one of the key factors in protecting and promoting peoples’ health of all ages around the world.Healthy lifestyle that includes physical activity, healthy food and appropriate health education will creating healthy young people, who will have a healthy and long life. The aim of the paper was to determine if there was a link between socioeconomic status in the family and practicing regular physical activity among young people. Materials and Methods: This was a descriptive-analytical study. It included 316 students in the second and third year of the study program for general medicine at the Faculty of Medicine at UKIM in Skopje. Results and Discussion: Students who practiced moderate physical activity came from families with monthly incomes higher than 30,000 denars or it was 48.4% compared to 34.65% of students who came from families with monthly incomes lower than 30,000 denars. There was a weak positive correlation between the monthly income of students' families and the practice of physical activity, R=0.21, p=0.002. Conclusion: The financial situation in the family has a main role in practicing physical activity. Therefore, with the increase of the family budget, the days when the students are physically active increase, too.
Evgenija Grigorova, Gordana Ristovska
Archives of Public Health, Volume 11, pp 51-57;

Speech communication is complex and is based on the integrity of the central nervous system (CNS) function, as well as the speech mechanisms that are conditioned and controlled by an auditory perception, verbal memory, intellectual activity, but also by the peripheral speech apparatus. If there is a deviation from this integrated complex system in its perfect functioning, speech disorders occur. The aim of the paper was to make a literature review that provides scientific evidence of the most frequent phonological articulation disorders in pre-school children and their public health impact. Materials and Methods: Search in the available databases, such as Pubmed, Google scholar, as well as a review of the references in the papers, doctoral dissertations and master thesis. The following search terms were used: speech, language, disorders, dysphasia, dyslalia, aphasia, public health. Results: A total of 90 abstracts were found, all of them were read and 15 were selected as appropriate for the purpose of our research, as well as in extenso papers that were found and analyzed for this review. Conclusions: According to the available scientific evidence, the development of speech and language is a useful indicator of the overall development of the child, and the cognitive ability is related to the success of the school, and therefore the academic development. This rationale supports pre-school speech and language screening as a part of the basic language routine care for children. Public health impact will be reduced through timely diagnosis, prompt detection, prevention and removal of all factors leading to permanent speech disorders.
, Fimka Tozija
Archives of Public Health, Volume 11, pp 6-19;

Правата на пациентите произлегуваат од општите човекови права и се важен сегмент во процесот на ,,европеизација“ на Република Македонија. Главна цел на оваа студија беше да се анализира легислативната рамка на човековите права во здравствената заштита во Република Македонија и имплементацијата во пракса. Материјал и методи: Студијата е дизајнирана како дескриптивно–аналитичка студија на пресек, во која беше применет јавноздравствен пристап, информатичко-аналитичен метод и метод на синтеза на евиденција (evidence synthesis) за анализа на релевантната легислатива. Беше спроведено анкетно истражување на репрезентативен стратифициран примерок на пациенти во Полошкиот Регион, во период од два месеци, октомври-ноември во 2017 година, во Клиничката болница во Тетово и Општата болница во Гостивар. Резултати: Беше анализиран правниот систем на Република Македонија и беше спореден со 6 држави во транзиција, кои претрпеа низа суштински реформи во последниве години. Легислативната рамка во Република Македонија претставува сеопфатна рамка за заштита на правата на пациентот, со која на пациентот му се загарантирани законски права во процесот на лекувањето, почитувањето и заштитата на неговата личност и интегритет. Во овој труд имплементацијата на правата на пациентите во пракса беше анализирана преку имплементацијата на две права на пациентите, и тоа: право на информираност за препорачаните медицински интервенции и право на прифаќање и одбивање на определена медицинска интервенција. 85,2% од анкетираните пациенти имале информации за правото на информираност за препорачаните медицински интервенции, а 14,8% немале. 72,1% од анкетираните пациенти имале лично искуство за ова право, додека 27,9% немале. Во однос на правото на прифаќање и одбивање на определена медицинска интервенција, 77% од анкетираните пациенти имале информации за ова право, а 23% немале. Значително помало беше личното искуство за ова право, односно само 32,8% од анкетираните пациенти имале лично искуство, а 67,2% немале. Разликите беа сигнификантни во одговорите за двете права, и за информацијата и за личното искуство. Заклучок: Човековите права во здравствената заштита во Република Македонија се рефлектирани во националната легислатива која е хармонизирана со европската и меѓународната. Меѓутоа, потребно е подобрување на имплементацијата на правата на пациентите во пракса, преку подигнување на свеста на граѓаните за познавање на правата на пациентите и поттикнување на медицинскиот персонал за почитување на правата на пациентите
Konstandina Kuzevska-Maneva, Rozana Kacarska, Beti Gjurkova- Angelovska, Valentina Jovanovska, Marija Neshkovska-Shumenkovska, Elita Maneva, Slobodan Ilic, Milan Dukic, Vladimir Cadikovski
Archives of Public Health, Volume 11, pp 104-109;

Cor triatriatum sinister е ретка срцева мана кај која левата преткомора е поделена на два дела со фибромускулна мембрана. Проксималната преткомора ги прима пулмоналните вени заедно со крвта која тие ја носат, а дисталната или (вистинска) преткомора е вообичаено празна и таа е поделена од комората со митралната валвула. Има постојана комуникација помеѓу двата дела на поделената преткомора преку која крвта се пренасочува кон левата комора. Маната е многу ретка, најчесто е изолирана, но може да оди во комбинација со други срцеви мани. Презентираме случаи на две деца на возраст од 8 и 3 години во времето кога е поставена дијагнозата. Кај обете причина за дијагнозата бил замор и чуен срцев шум. За поставување на дијагнозата беа користени анамнезата, клиничките знаци и симптоми, ЕКГ, рендген на срце и бели дробови и златниот стандард - ехокардиографијата. Дефинитивно излекување беше направено со изведување на кардиохируршка ресекција на фибромускулната мембрана со користење на екстракорпорална циркулација. Потребно е регуларно периодично следење на децата со цел откривање на доцни компликации од типот на нарушувања на срцевиот ритам.
, Svetlana Jovevska, Mihail Kocubovski
Archives of Public Health, Volume 11, pp 89-94;

Целта на ова истражување беше да се одреди влијанието на симптомите и ефектите од медикаментозниот третман врз квалитетот на живот на пациентите со бенигна простатична хиперплазија (БПХ). За таа цел направивме евалуација на две групи пациенти преку интернационален прашалник за скорирање на симптомите на долен уринарен тракт, Беков прашалник за депресија и прашање за квалитетот на животот. Првата (контролна) група ја сочинуваа пациенти со БПХ кои беа на терапија со алфаблокатор, додека вторатагрупа (испитувана) пациенти беа на комбинирана терапија со алфаблокатор и 5-алфа-редуктаза инхибитор. При анализа на резултатите дојдовме до заклучок дека пациентите во контролната група имаа подобар квалитет на живот како и психосоцијален статус кои се должат на послабо изразените симптоми на болеста. Пациентите во втората група имаа полош квалитет на живот заради појавата на несакани ефекти од терапијата со 5АРИ: еректилна дисфункција и депресија, како и заради потешко изразените симптоми. Модалитетите во терапевтскиот пристап овозможуваат подобрување на симптомите во втората група и подобрување на квалитетот на живот на пациентите со двојна терапија за БПХ.
, Milena Golubovik Arsovska
Archives of Public Health, Volume 11, pp 110-113;

Tay Sachs-овата болест е ретко нарушување, генетски наследено од родители на дете. Тоа е предизвикано од отсуство на ензим кој помага во разградувањето на масните супстанци. Овие масни супстанции, наречени ганглиозиди, се издигнуваат до токсични нивоа во мозокот на детето и влијаат врз функцијата на нервните клетки. Со напредување болеста, детето губи мускулна контрола. На крајот, доведува до слепило, парализа и смрт.Најчесто новороденчето почнува да покажува симптоми на возраст од околу 6 месеци. Знаци и симптоми на Tay Sachs-овата болест можат да бидат: губење на моторни вештини, губење на способноста за превртување, седење или ползење. Потоа следат напади, губење на слухот и неможност за движење, зголемени реакции кога бебето слуша гласни звуци, губење на видната острина, појава на "Cherry-red" дамки во очите, мускулна слабост
Viktor Isjanovski, Igor Isjanovski
Archives of Public Health, Volume 11, pp 95-103;

Шизофренијата е поврзана со зголемен ризик од кардио-метаболички морбидитет и морталитет. Метаболичкот синдром (МС) e релевантен предиктор за морбидитет и морталитет на кардиоваскуларните заболувања, исто така, се покажа дека е поприсутен кај пациенти со шизофренија. Цел на ова истражување беше да ја утврдиме преваленцијата на МС во примерок од пациенти со шизофренија во Центарот за ментално здравје - "Пролет", Психијатриска болница - Скопје и потенцијалните ризик фактори поврзани со него. Материјали и методи: примерокот се состои од 50 пациенти со шизофренија. Кај сите пациенти е земена венска крв за да се одреди нивото на холестерол HDL, триглицериди и гликоза, измерена е телесна тежина, телесна висина и обемот на половината. МС е дефиниран според критериумите за Национална програма за холестеролска програма за возрасни третман - панели III (NCEP ATP III). Резултати: Преваленцијата на МС кај пациенти со шизофренија изнесуваше 46,0%. Се покажа дека зголемувањето на индексот на телесна маса (BMI) е значително поврзано со преваленцијата на МС. Заклучок: Оваа студија покажала висока преваленција на МС кај пациенти со шизофренија и дека BMI може да биде фактор на ризик во развојот на МС. Оваа информација е клинички релевантна бидејќи BMI рутински се мери во психијатриска пракса и може да се користи за следење на развојот на МС кај пациентите со шизофренија.
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