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Lidushka Vasilevska, Elena Kjosevska, Tanja Lekovska-Stoicovska
Archives of Public Health, Volume 13, pp 1-18; doi:10.3889/aph.2021.5992

Abstract:
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.
Nada Pop Jordanova, Jovanka Ristova, Sofija Loleska
Archives of Public Health, Volume 13, pp 1-10; doi:10.3889/aph.2021.5825

Abstract:
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.
Savetka Paljoskovska-Jordanova
Archives of Public Health, Volume 13; doi:10.3889/aph.2021.5993

Abstract:
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.
Snezana Ivic-Kolevska, Andreja Arsovski
Archives of Public Health, Volume 13, pp 1-8; doi:10.3889/aph.2021.5936

Abstract:
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.
Andreja Gavrilovski, Aleksandra Gavrilovska-Dimovska, Goran Aleksovski
Archives of Public Health, Volume 13, pp 1-6; doi:10.3889/aph.2021.5723

Abstract:
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.
Aleksandra Jovanovska, Kata Martinova
Archives of Public Health, Volume 13, pp 1-16; doi:10.3889/aph.2021.5732

Abstract:
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.
Aleksandra Gavrilovska-Dimovska, Andreja Gavrilovski, Venko Filipce
Archives of Public Health, Volume 13, pp 1-5; doi:10.3889/aph.2021.5722

Abstract:
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.
Snezana Palchevska, Beti Gjurkova, Elena Shukarova, Katarina Stavrikj, Jana Jovanovska, Natasha Aluloska
Archives of Public Health, Volume 13, pp 1-6; doi:10.3889/aph.2021.5767

Abstract:
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.
Ana Stamatova, Stojka Fustic, Lidija Spirevska, Snezana Mojsova, Viktor Tonevski
Archives of Public Health, Volume 12, pp 1-5; doi:10.3889/aph.2020.5610

Abstract:
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.
Sandra Kosteska, Dragan Gjorgjev
Archives of Public Health, Volume 12, pp 1-15; doi:10.3889/aph.2020.5654

Abstract:
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.
Emilija Gjoshevska-Dashtevska, Natasha Trpevska-Shekerinov, Maja Ivanova
Archives of Public Health, Volume 12, pp 1-12; doi:10.3889/aph.2020.5636

Abstract:
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.
Sanja Prosheva, Elena Kjosevska, Vesna Velikj Stefanovska
Archives of Public Health, Volume 12, pp 1-5; doi:10.3889/aph.2020.5418

Abstract:
It is important for the health of the children who go to primary school to have clean drinking water, appropriate toilets, healthy food available for all and a safe place to learn and play within the school. The aim of this paper was to assess the physical environment of the primary schools across the country, taking into account the current situation of the schools and the priorities they have for improving the school physical environment. Material and methods: Home and foreign literature deposited in PubMed, Scopus and other scientific basses was used. A cross-sectional study covering 320 primary schools in RNM was conducted. The data were collected using the Rapid Assessment Tool, and they were statistically analyzed using the SPSS software package, version 22.0 for Windows (SPSS, Chicago, IL, USA). Qualitative analysis was performed by determining coefficients of relationships, proportions, and rates. Quantitative series were analyzed using central tendency measures as well as dispersion measures. Results: The current situation was rated as the best (75.31%) by the statement - "All buildings of the school maintain a pleasant temperature, lighting and ventilation". The lowest rated (36.56%) was the current status statement - "School canteen, store and appliances offer healthy food and drink at reasonable prices." Priority (83.44%) was the statement - "School buildings are tailored to students, they are safe, clean and promote hygiene for all students". We can see that better conditions in terms of physical environment are observed among students who attend classes in Macedonian language or are multiethnical, compared to students who attend classes in Albanian language, as well as that the urban schools compared to village schools have better conditions for work. Although the situation in the Southwest region is among the worst at the moment, the schools in this region are still striving to improve. Conclusion: According to the current situation, there is a lack of school canteens, shops and appliances near the schools that would offer healthy food and drinks. The highest priority is for school facilities to be adapted to students, to be safe, clean and to promote hygiene for all students and school staff.
Darijan Trajanov, Elena Kjosevska, Beti Zafirova Ivanovska
Archives of Public Health, Volume 12, pp 1-13; doi:10.3889/aph.2020.5613

Abstract:
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.
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; doi:10.3889/aph.2020.5608

Abstract:
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.
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; doi:10.3889/aph.2020.5612

Abstract:
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
Archives of Public Health, Volume 12, pp 1-5; doi:10.3889/aph.2020.5416

Abstract:
There is a growing body of scientific evidence on the impact of metabolic syndrome (MetS) on the progression of atherosclerosis, imposing the need for research of the association of MetS with carotid artery disease (CAD) as a significant risk factor for cerebrovascular insult (CVI) and transient ischemic attack (TIA). The aim of the study was to determine the prevalence of CAD as a risk factor for CVI and TIA in subjects with MetS. Material and methods: A cross-sectional study was performed including a total of 118 subjects, 65 men, 53 women, with MetS according to NCEP ATP III criteria that were analyzed clinically, biochemically and ultrasonographically in the City General Hospital "8th September" - Skopje in the period from January 2017 to January 2018. Waist circumference, blood pressure, glycemia, triglycerides, and HDL cholesterol were determined according to standard routine protocols. The evaluation of the extracranial carotid trunk was done with a Color Doppler Duplex sonography with a linear probe of 7.5MHz. CAD assessment was performed using Ultrasound Consensus Criteria for Carotid Stenosis. An objective neurological assessment of the existence of CVI and TIA was performed by a standard protocol for neurological examination and brain CT results from medical history were reviewed. Results: The prevalence of CAD in this study was 77 subjects (65.25%), of which 35 subjects (29.66%) had symptomatic CAD, 17 subjects (48.57%) had CVI, 18 subjects (51.43%) had TIA. Regarding the degree of carotid artery stenosis (CAS) in the total number of subjects with MetS and CAD, no subjects with normal findings were registered, 16 subjects had stenosis
Таtjana Jakovska Mareti, Angelcho Andonovski, Eli Stojanova, Biljana Kakaraskoska-Boceska
Archives of Public Health, Volume 12, pp 1-5; doi:10.3889/aph.2020.5413

Abstract:
The aim of the paper was to evaluate clinical characteristics of COVID-19 in children and the success of the treatment. Material and methods: The study included 218 pediatric patients suspected for COVID-19 hospitalized at the Institute for Pulmonary Diseases in Children-Skopje, during the period from 16th of March to 19th of June 2020. All patients were tested for presence of SARS-CoV-2 virus in nasopharyngeal swab with real-time reverse transcription polymerase chain reaction (RT-PCR) in the Institute of Public Health of Republic of North Macedonia. Clinical symptoms, X-ray and laboratory findings were included in the study. Results: From 218 hospitalized patients, only 9 (4.13%) were positive for COVID-19 and 59% of them were males. Infants, with moderate pulmonary disease were 44.4% of the patients. Fever and gastrointestinal symptoms were present in 66.6% and 22.2% of the children, respectively. Macrolides were therapy of choice in 88% of the treated patients, 77% received intravenous therapy, 33% were on inhaled bronchodilator. Conclusions: A small number of children had COVID-19. All infected children were with mild to moderate pulmonary symptoms and reacted satisfactory to the treatment. However, the importance of transmitting the virus and influence over children’s health remains uncertain.
Nada Pop-Jordanova, Sofija Loleska
Archives of Public Health, Volume 12, pp 1-11; doi:10.3889/aph.2020.5635

Abstract:
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.
Cvetanka Gjerakaroska-Savevska, Erieta Nikolikj-Dimitrova, Valentina Koevska, Biljana Mitrevska, Marija Gocevska, Daniela Gecevska
Archives of Public Health, Volume 12, pp 1-10; doi:10.3889/aph.2020.5609

Abstract:
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.
Emilija Lazarova Trajkovska
Archives of Public Health, Volume 12, pp 32-36; doi:10.3889/aph.2020.5192

Abstract:
Bleeding is a common side effect of anticoagulant use. However, the majority of bleeding events are not life-threatening and can be managed conservatively. The first step in managing any significant bleeding event is to temporarily stop using the anticoagulant. The aim of this review was to determine the appropriate management strategy for an acutely bleeding patient on DOACs. Direct oral anticoagulants (DOACs) are now widely used in treatment of venous thromboembolism (VTE) and are recommended first-line over vitamin K antagonists (VKAs) in non-cancer associated VTE. Until recently, supportive measures and infusion of clotting factors were the only available options for reversal of DOACs. Within the last 4 years, approval of specific antidotes has led to hopes for improved outcomes in DOAC-related acute bleeding, however limitations remain including cost, availability and "real-world" data. In severe and life-threatening bleeding events, use of non-specific (e.g. PCC) or specific (e.g. idarucizumab, andexanet alpha) reversal agents are recommended. However, further data is needed to compare outcomes between these two management strategies and identify the cost-effectiveness of these various strategies.
Dimitar Petreski, Natalija Cokleska, Lazar Todorovic, Marjan Kamiloski, Shaban Memeti, Ljupco Donev, Ljubica Mikjunovikj
Archives of Public Health, Volume 12, pp 71-80; doi:10.3889/aph.2020.5194

Abstract:
(Spontaneus) Rectus sheath hematoma ((S)RSH) is an accumulation of blood in the sheath of the rectus abdominis muscle, secondary to rupture of an epigastric vessel or muscle tear. It is defined as spontaneous in patients without history of abdominal trauma. It can be located supra- or infraumbilically. Although the exact incidence is unknown, Klingler et al. observed 23 cases (1.8%) of rectus sheath hematoma among 1257 patients evaluated by ultrasound for acute abdominal disorders. Ultrasonography can help in the diagnosis, but CT scan is most accurate in its ability to define the lesion. When diagnosed clinically, a conservative therapeutic program can usually be instituted. Only in cases of supportive management failure, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated. Case presentation: We present two cases of SRSH in patients using oral anticoagulant agent (acenocoumarol). Their chief complaint was sudden onset of acute abdominal pain. On admission they were haemodynamically stable. After thorough clinical evaluation a suspicion for SRSH diagnosis was made and then confirmed by ultrasonography and CT. Both of them were successfully treated conservatively and discharged home in a good general condition. Conclusion: These two cases illustrate the accurate diagnosis of SRSH treated conservatively leading to optimal patient outcomes.
Bisera Velkovska, Natasha Trpevska Shekerinov, Emilija Gjoshevska Dashtevska, Maja Ivanova
Archives of Public Health, Volume 12, pp 64-70; doi:10.3889/aph.2020.5195

Abstract:
Goldenhar's syndrome (GS) is a complex syndrome characterized by a combination of abnormalities: hemifacial macrosomia, mandibular hypoplasia, ocular dermoids, ear abnormalities, and vertebral disorders. The incidence of GS is about 1 in 5000 to 25,000 live births. The male to female ratio is 3: 2.The etiology of this rare disease is not fully understood. The treatment protocol depends on the age of the patient and systemic clinical presentations. This paper presents a case of a 46-year-old woman with Goldenhar syndrome, which manifested with facial asymmetry, epibulbar dermoid, hearing loss, and scoliosis. Because it is a congenital syndrome, these people's lives are complex from an early age. There is a need for timely recognition of this syndrome and a multidisciplinary approach in treating these patients, with a team of specialist physicians, to enable them as much optimal functioning as possible in the environment. By presenting this case report, we would like to attract the attention of GS, which would be of educational significance for all physicians, primarily ophthalmologists, as well as otolaryngologists and orthopedists.
Marija Sholjakova, Biljana Kuzmanovska, Vesna Durnev, Adrijan Kartalov, Rozalinda Isjanovska
Archives of Public Health, Volume 12, pp 15-24; doi:10.3889/aph.2020.5198

Abstract:
Intractable cancer pain is a chronic severe pain, affecting patient’s quality of life and presents aheavy health, social and family problem in many countries. Different methods for pain relief are proposed by the WHO. Epidural analgesia with opioids is one of the proposed methods. Aim of the study was to determine the effects of morphine, fentanyl and butorphanol used for epidural analgesia in intractable pain and to comment our experiences over a five-year-period, with regard to its actuality nowadays. Material and methods: Retrospective longitudinal observational study was carried at the University Clinic for Anesthesiology, Reanimation and Intensive Care in Skopje, Macedonia, between 2005-2010 and evaluated in 2017-2018. A total of 116 patients suffering from intractable pain were enrolled in the study. Exclusion criteria were: infective and metastatic processes in the spine, allergy to opioids, psychological problems and language barrier. After the pretreatment evaluation of the pain, patients were randomly assigned to receive three different opioids through epidural catheter placed from Th8-10 or L2-3. Results: There were no differences in pretreatment pain scores between the three groups (p>0.05). A significant onset of analgesia after 15 minutes was found for butorphanol, 20 minutes for fentanyl and 30 minutes for morphine group (p
Ana Lazarova, Andrej Nikolovski, Violeta Vasilevska-Nikodinovska
Archives of Public Health, Volume 12, pp 25-31; doi:10.3889/aph.2020.5197

Abstract:
MRI is a basic tool in patient selection for preoperative neoadjuvant treatment of rectal carcinoma, with assessment of stage reduction. The aim of the paper was to evaluate chemoradiotherapy effects in advanced stage rectal carcinoma by comparison of MRI findings before and after chemoradiotherapy. Material and methods: Prospectively, MRI findings of 15 patients with rectal carcinoma confirmed at colonoscopy, were evaluated. In all patients preoperative neoadjuvant treatment was done and MRI restaging was performed after 6 to 8 weeks. MRI standard protocol was done on 1.5T machine, sagital T2WI, axial T1WI, T2WI and DWI. On MRI was assessed tumor and nodal stage, presence of extra-mural vascular invasion (EMVI), tumor localization within the rectum (low, medium, high rectum, recto-sigmoid junction). Computer tomography was performed in all patients for distant metastases assessment. Results: Out of 15 patients, 12 (66.7%) were male, and 3 (33.3 %) were female, with a mean age of 65 years (range 50 to 80years). Six cases had middle rectum localization, 6 cases in low rectum, and 3 patients had recto-sigmoid localization. At initial MRI, 7 cases (46.6%) had MR signs for T3 stage, and 8 cases (53.3%) had T4 stage. Comparison of MRI results before and after chemoradiotherapy showed stage decreasing in 5(33.3%), from T4 to T3 stage. In 11 patients (73.7%), EMVI after therapy became negative with a statistically significant difference before and after chemoradiotherapy. All patients before therapy had different numbers of metastatic lymph nodes in mesorectum, with number reduction in all cases after therapy and two patients were without metastatic lymph nodes. Conclusion: MRI has a significant value in pre- and post-neoadjuvant therapy assessment of resection margins involved by tumor, positive extramural vascular invasion, and metastatic lymph node around resection margins. This is important for operative planning in order to avoid extensive resection with surgery techniques that preserve the anal sphincter.
Jadranka Georgievska, Igor Samardziski, Ana Daneva, Goran Kocoski
Archives of Public Health, Volume 12, pp 81-85; doi:10.3889/aph.2020.5193

Abstract:
Twin pregnancies are high-risk pregnancies accompanied with multiple complications, such as: spontaneous abortion, preterm rupture of the membranes, preterm delivery, intrauterine death of one or both twins etc. There is no consensus about the management of twin pregnancies complicated with preterm rupture of the membranes of one twin and risk of preterm delivery. These cases are rarely found in the literature. We present a case of a 35 years old patient, hospitalized in a tertiary level institution, because of a diamniotic dichorionic twin pregnancy complicated with preterm rupture of the membranes of the first twin at 19 weeks of gestation. She had one delivery with Caesarean section 16 years ago. In consultation with the patient induction of labor was done with delivery of the first twin, a death male fetus. After that, antibiotics and tocolytic therapy were administrated and the patient remained in the hospital about one week. The patient was discharged at home with regular control of her condition and condition of the fetus. The patient was again hospitalized at 33 weeks of gestation with uterine contractions on cardiotocography. After administration of corticosteroid therapy for fetal lung maturation she delivered spontaneously the second twin in a good condition and she was discharged from hospital after 16 days. In twin pregnancies clinicians must think about delayed interval delivery of the second twin, after delivery of the first twin, with an aim to increase chances for survival, especially for pregnancies less than 30 weeks of gestation.
Marko Naumovski, Ivamaria Jovanovska, Kakja Popovska, Vesna Velikj Stefanovska, Gordana Mirchevska
Archives of Public Health, Volume 12, pp 56-63; doi:10.3889/aph.2020.5272

Abstract:
In recent years, snakes have become suitable pets for people with little spare time. By buying these animals people ignore the fact that they carry many microorganisms that are pathogenic for humans. The idea of ​​this study was to identify the microorganisms from the oral cavity of exotic snakes kept as pets in the Republic of North Macedonia, which can help in the treatment of bite infections if they occur. The study comprised 30 snakes of 9 species, from 3 families of non-venomous snakes: Pythonidae, Boidae and Colubridae. Snakes are part of the 5 largest collections of exotic snakes in the Republic of North Macedonia. Only one swab from the oral cavity was taken from each snake. The brushes were cultured and microscopically analyzed at the Institute of Microbiology and Parasitology at the Faculty of Medicine in Skopje. From 59 isolated microorganisms from the oral cavity of 30 exotic snakes, 37.3% were Gram-positive bacteria, 61.01% were Gram-negative bacteria and 1.69% were fungi. Of the total number of microorganisms, Pseudomonas aeruginosa was predominant with 27.11%, Providencia rettgeri / Proteus vulgaris with 18.64% and KONS / Micrococcus luteus with 16.94%. Pseudomonas aeruginosa was present in all three snake families, with 62.5% of the snake in the fam. Pythonidae; 50% in the fam. Boidae and 50% in the fam. Colubridae. The isolate Providencia rettgeri / Proteus vulgaris was most frequently found in the fam. Colubridae with 71.43%, followed by fam. Pythonidae with 12.5%, but was not isolated in any specimen of the fam. Boidae. The microbiome of the non-venomous snakes is composed of Gram-positive bacteria in healthy snakes, but also in snakes kept in inadequate hygienic conditions. Gram-negative bacteria were predominant, of which the most significant was the presence of multiple drug resistance Pseudomonas aeruginosa. Snakes as pets require proper knowledge of terms and conditions.
Vesna Micevska, Tatjana Jakovska Mareti, Ilija Kirovski, Olivera Jordanova
Archives of Public Health, Volume 12, pp 37-45; doi:10.3889/aph.2020.4069

Abstract:
Asthma is a chronical disease of the airways characterized by reversible obstruction of the bronchi and airway inflammation. In recent decades, the scientific interest of the vitamin D system and its role in development of asthma and other alergic diseases has been increased. Aims of this study are to mesure and compare the serum level of 25 OHD in asthmatic and healthy children and corelate the level of 25OHD and total IgE in asthmatic children. This prospective study includes 70 children at age 2 to 14, of which 32 are children with diagnosed asthma and 38 healthy children. In both of the groups the serum level of 25 OHD was measured and by the results 18 % of the healthy children (C) and 28% of the asthma children (E) had 25OHD deficiency, 45% of C and 50% of E were insufficient and 37 % of C / 22% of E were with normal 25 OHD serum level. The mean level of 25OHD in C was 27,83 +/- 10,24 and in E 20,9 ng/ml +/- 10,72. The mean levels in both groups had statistic significant difference with p-value < 0,05. According to age no statistic significant difference was found in both of the groups. There was a statisticaly significant decreased serum level of 25 OHD in asthmatic females.In the examined group (children with asthma) there was a negative linear correlation (association) of the level of 25OHD and total IgE serum level with r=- 0,55 Vitamin D serum level measurements in asthma patients gives the possibility for discovering the connection between its deficiency and development of asthma symptoms.
Marija Gjerakaroska Radovikj, Elizabeta Srbinovska Kostovska, Cvetanka Gjerakaroska Savevska, Sasko Jovev
Archives of Public Health, Volume 12, pp 5-14; doi:10.3889/aph.2020.5219

Abstract:
Atrial fibrillation (AF) is the most common type of arrhythmia following open heart surgery and it contributes to prolonged hospital stay, increased prevalence of thromboembolic complications and overall increased postoperative morbidity and mortality. The aim of this prospective observational follow-up study was to determine the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass surgery, to identify predisposing risk factors for its occurrence in the immediate preoperative period and to assess its effect on the postoperative outcome in patients at the University Clinic for Cardiac Surgery in Skopje, North Macedonia. Material and methods: The study included patients at the University Clinic for Cardiac Surgery in Skopje, North Macedonia undergoing coronary artery bypass surgery. The experimental group included patients developing POAF, whereas the control group those who did not develop the primary outcome. All patients were followed up for a period of 30 days postoperatively. Results: POAF was registered in 38% of the patient population and more frequently in the elderly. Patients developing POAF had significantly higher left atrial volume index, as well as higher CHADS2-VASC2, HATCH and Euroscore I values. Average time to POAF occurrence was 48-72 hours postoperatively. There were death outcomes, thromboembolic events, longer hospital stay, need for antiarrhythmic and oral anticoagulant therapy in the POAF group. Conclusion: POAF significantly increases postoperative morbidity and mortality in patients undergoing coronary artery bypass surgery. Age, higher CHADS2-VASC2, HATCH and Euroscore I values and left atrial volume were found to be significant predictors of POAF after coronary artery bypass surgery.
Olga Kokoceva Ivanovska
Archives of Public Health, Volume 12, pp 46-55; doi:10.3889/aph.2020.5218

Abstract:
In the early childhood, at the age of 1 to 1.5 year, immediately after teeth eruption, a special form of caries which spreads only over the primary teeth, often appears. The aim of this study was to determine local factors that affect the occurrence of this dental disease in early childhood.Materials and methods: Our examinees were children 1.5-3.5 years old, where during the standard check-ups we diagnosed starting phases of circular caries: initial lesion (white spot) and superficial form. The mothers of children with diagnosed circular caries were provided with a pre-prepared questionnaire containing data on: the length of the breastfeeding period, the infant's feeding with a bottle and the most commonly consumed contents, oral hygiene habits after feeding the infant, and tooth brushing. Results: Only 30% of mothers breastfed (children) by the 6-th month and 40% by the third month and shorter. About 15% of mothers received fluoride prophylaxis during pregnancy and lactation. The largest percentage of respondents (48%) were fed with a baby bottle, over a prolonged period of time, up to three or more years, mostly with industrial juices (48%). They were mostly consumed at night (40%). Oral-hygiene measures after bottle feeding were observedonly in 16%. The daily frequency of tooth brushing in young children is at most once a day (32%). Conclusion: The analysis of the results showed that circular caries is more common in children who have been breastfed for shorter period and who used the bottle in their daily diet. The most commonly consumed are industrial juices, which are considered "cariogenic drinks" because they are potentially dangerous to primary teeth, especially when consumed at night (pH of saliva drops to 0).
Marina Krstevska-Konstantinova, Konstandina Kuzevska-Maneva, Elena Sukarova-Angelovska, Ana Stamatova, Velibor Tasic, Zoran Gucev, Julia Hã¶efele
Archives of Public Health, Volume 12, pp 58-61; doi:10.3889/aph.2020.4476

Abstract:
Micromastia or breast hypoplasia is described as underdevelopment of a woman’s mammary tissue. We present the case of a 15-year-old girl with unilateral micromastia, with familial predisposition. Ultrasound, hormonal, dysmorphic, cardiologic, genetic examinations and testing were performed. No mutation in the whole- exome sequencing was found, nor novel mutation. Some of these cases have been reported to be related to breаst cancer so further follow-up is mandatory. Therapy consists of surgical reconstruction of the affected breast. This is a rare condition and it requires a multidisciplinary approach.
Maja Tankoska, Avdi Murtezani, Konstandina Kuzevska-Maneva, Marina Krstevska €“ Konstantinova
Archives of Public Health, Volume 12, pp 62-65; doi:10.3889/aph.2020.4477

Abstract:
There is a small number of studies that have reported abnormalities in endocrine function after a long-term gonadotropin-releasing hormone agonist (GnRHa) treatment in girls. This treatment is considered as safe and effective by most authors. We report our second case of unusual outcome of long-term GnRHa therapy in a girl with central precocious puberty (CPP) of idiopathic or familial etiology. She has received monthly depot of injections of triptorelin for a time period of 4 years. We have examined thyroid function by measuring serum levels of thyrotropin (TSH), thyroxine (T4), thyroid antibodies and ultrasound of thyroid gland. At the age of 11 years she developed a mild goiter and presented with autoimmune thyroiditis, having elevated thyroid antibodies and ultrasound of thyroid gland typical for Hashimoto thyroiditis. Having in mind these two cases, we suggest a closer monitoring of thyroid function in girls with CPP, before and during therapy with GnRH agonist.
Katerina Nikoloska, Iva Malahova- Gjoreska, Ivi Kaev, Aleksandar Petlickovski
Archives of Public Health, Volume 12, pp 5-13; doi:10.3889/aph.2020.4472

Abstract:
Цитокините (IL-1, IL-6, IL-8, TNF- Alfa) се од исклучително значење во бременоста и тие се продуцираат од страна на постелката во амнионската течност и се зголемени доколку постои интраутерина инфламација. Целта на студијата беше да се докаже соодносот на покаченото ниво на IL-8 во амнионската течност во почетокот на раниот втор триместар (16-22 г.н.) и предвременото породување (< 37 г.н.). Материјал и методи: Во оваа проспективна студија беа вклучени 150 гравидни пациентки, каде постоеше медицинска индикација за изведување на амниоцентеза (напредната мајчина возраст, висок ризик на PRISCA I, суспектни...
Mare Stevkovska, Violeta Nikodinovska Vasilevska
Archives of Public Health, Volume 12, pp 33-39; doi:10.3889/aph.2020.4484

Abstract:
Тумесцентната техника е техника на инфилтрација во супкутаното ткиво на голем волумен пуфериранфизиолошки раствор во кој е потопена мала концентрација лидокаин заедно со адреналин. Овој раствор лесно и безболно се инфилтрира и доведува до анестезија на поткожното ткиво од одредени телесни регии како абдоменотили натколеното,обезбедува помало крвавење за време на интервенциите изведувани на кожата и поткожното ткиво. Тумесцентната локална анестезија (ТЛА) е многу лесна и сигурна процедура, која широко се употребува во многу хируршки гранки. Целта...
Fana Lichoska-Josifovikj, Meri Trajkovska, Kalina Grivceva-Stardelova, Viktoria Caloska-Ivanovska, Rozalinda Popova-Jovanovska, Lidija Petkovska, Emilija Petrovska, Sefedin Biljali
Archives of Public Health, Volume 12, pp 23-32; doi:10.3889/aph.2020.4475

Abstract:
Спонтаниот бактериски перитонитис (СБП) кај пациентите со црнодробна цироза е новонастаната, спонтана бактериска инфекција на стерилна асцитна течност, во отсуство на интраабдоминални извори на инфекција или малигнитет. Најсензитивен показател за поставување на дијагнозата е бројот на полиморфонуклеарни клетки (ПМНК) ≥250 во 1 мл асцитна течност (рачно микроскопско или автоматизирано пребројување) и/или кога во микробиолошката култура биде изолиран еден бактериски вид. Цел на трудот е да се одреди концентрацијата на калпротектин во асцит кај...
Valenitina Koevska, Biljana Mitrevska, Erieta Nikolic-Dimitrova, Dragana Petrovska-Cvetkovska
Archives of Public Health, Volume 12, pp 14-22; doi:10.3889/aph.2020.4468

Abstract:
Parkinson's disease is one of the most common neurodegenerative diseases. Given the progressive course and numerous motor and motor symptoms, this disorder can significantly affect person's functional status, quality of life, and disability. Possibility of treatment and prevention of parkinsonism varies depending on the type of Parkinson's disease. Medication, physical therapy and surgical treatment are used. Effective pharmacologic therapy includes comprehensive physical therapy and rehabilitation, starting at the time of diagnosis. It can prevent and treat complications, slow the progression of symptoms, and enhance adaptation to the newly acquired condition. It is necessary to stimulate mechanisms of compensation and neuroplasticity. Experiences show that kinesiotherapy and physical agents are effective in the treatment of pain, walking disorders, postural instability and risk of falls. There are also alternative techniques such as yoga, tai chi, acupuncture, dance therapy, music therapy that have a positive impact on the disease. The efficacy of neurofeedback, art therapy in improving and maintaining cognitive functions has been demonstrated. Occupational therapy is of great importance for empowering the patient with activities of daily living, especially for self-care. Education and support from family and carers, as well as home and workplace adaptation, play an important role in rehabilitation. Rehabilitation and physical therapy for this disease is carried out systematically and for a lifetime. A multidisciplinary approach in treating patients with Parkinson's disease enables the maintenance of quality of life.
Lidushka Vasileska, Elena Kosevska, Tanja Lekovska Stoicovska, Vjosa Rechica
Archives of Public Health, Volume 12, pp 49-57; doi:10.3889/aph.2020.4372

Abstract:
Dental care prevention involves prophylactic oral health practices and strategies that are primarily targeted to diseases of the oral tissues with the focus on prevention of certain conditions. Not enough attention has been given to the communication between the dentist and the patient as well as the ability or the inability to understand patient's health information. The aim of this paper is to present the current practices and regulations related to the effective communication between oral healthcare professionals and patient population, and their representation and influence in improving and raising the profile of the oral health on a national level. Materials and method:A systematic literature search was conducted including published scientific articles between 1977 and 2018. Studies discussing the improvement of oral health in the function of general health and well-being in the patient population of all ages were analyzed. The main focus was put on the commitment of the oral health community in the global agenda and the importance of integrating multifactorial approaches to prevention. Particular attention was paid to the representation of the skills for effective communication between health care professionals and patient population, and the medical education (health education), which should result in the individual's health literacy. Results: During the global struggle to improve the oral health, efforts are being made to enhance current practices and share knowledge about preventive care and treatment in oral health science and education in order to ensure the general health and well-being of the patient population of all ages. Unfortunately, the commitment to take action in raising effective communication and oral health literacy is minimal. Conclusion: Improving the communication between the oral health care professionals and the patient population in the direction of an interactive, dynamic and flexible process, as well as raising the level of oral health literacy among the population through targeted and carefully developed medical education should be the first step in any preventive program for raising the level of oral health.
Mihail Kocubovski, Aleksandra Stambolieva, Aneta Kostova, Elena Chibisheva, Zarko Karadzovski
Archives of Public Health, Volume 12, pp 40-48; doi:10.3889/aph.2020.4324

Abstract:
Healthy and safe drinking water in sufficient quantities provided to consumers improves living conditions, raises health culture at a higher level and promotes the environment as a whole. The aim is to see if there is a correlation between irregular water samples with intestinal infectious diseases related to drinking water. Materials and method. The preparation of the Republic Computer Program (1996) for issuing laboratory findings (RCP) from the analyses of samples of drinking water (physico-chemical and bacteriological), in accordance with the methodology for application of ID numbers in the computer system in the Public Health Centers has created the possibility of complete health records of drinking water supply facilities under health surveillance for the territory of the entire Republic. Evaluation has been made of the results of basic physicо-chemical and bacteriological analyses of drinking water in the settlements of the Republic of North Macedonia and the water-related diseases – waterborne intestinal infectious diseases in the period 2014-2018. Results. Drinking water from city water supply in the examined period in terms of physico-chemical analysis ranged 2.9-4.3%, while in relation to bacteriological analysis 0.9-2.6%.. Waterborne intestinal infectious diseases show a decline in their incidence in 2018. Conclusion. The registered data from the physicо-chemical and bacteriological analysis showed that the drinking water from the city water supply systems in the period 2014-2018 was safe. According to the processed data, access to safe drinking water for the population was 97% by 2018, which ranks the country in the group of countries in the world with the highest access to safe drinking water, and there is no significant connection with drinking water related diseases.
Ilir Ismaili
Archives of Public Health, Volume 11, pp 11-18; doi:10.3889/aph.2019.4189

Abstract:
Карциномот на дојката е меѓу водечките причини за морбидитет и морталитет и е меѓу најчестите малигни неоплазми кај женскиот пол во светски рамки. Адјувантната хемотерапија со комбинација на циклофосфамид и доксорубицин често е проследена со низа токсични ефекти со различен степен на изразеност и клиничка значајност за што клучна улога имаат конститутивните полиморфизми во гените вклучени во детоксификацијата и метаболизмот на хемотерапевтиците. Основната цел на студијата беше да се определи генетската поврзаност на полиморфизмите rs20325282 во генот ABCB1 и rs1695 во генот GSTP1 со појавата на токсични ефекти во текот на хемотерапијата со циклофосфамид и доксорубицин кај пациентките со карцином на дојка. Материјал и методи: определувањето на двата полиморфизма се изврши врз DNA примероците изолирани од 110 случаи со карцином на дојка кои биле третирани адјувантно со циклофосфамид и доксорубицин, по претходно добиена согласност од пациентките. Статистичките анализи беа извршени споредувајќи ги клиничките податоци за токсичните ефекти со фреквенциите на генотиповите и алелите од испитуваните генски полиморфизми. Резултати: анализите покажаа дека полиморфизмите rs1695 во генот GSTP1 и rs20325282 во генот ABCB1 имаат предиктивна вредност во проценката на веројатноста, односно ризикот од појава на неутропенија, леукопенија и на кој било токсичен ефект, со исклучок на гадење и повраќање. Покрај тоа, полиморфизмот rs1695 во генот GSTP1 има предиктивна вредност при идентификација на ризикот од појава на анемија. Заклучок: во иднина овие сознанија можат да се користат за прилагодување и персонализирање на хемотерапијата според индивидуалната генотипска комбинација кај секој поединечен пациент.
, Anita Hristova Dimceva, Rada Grubovic Rastvorceva, Sedula Useini
Archives of Public Health, Volume 11, pp 19-25; doi:10.3889/aph.2019.4195

Abstract:
There are many factors for in vitro fertilization (IVF) failure, and hereditary thrombophilia has been mentioned as one of them in the last few years. Thrombophilia is a condition of predisposition to thromboembolism. The aim of the study was to evaluate the sociodemographic characteristics and to examine the representation of thrombophilic mutations in women with IVF failure. Material and methods: In a retrospective-prospective case-control study we evaluated 52 women, divided in two groups. Twenty-twowomen with at least three IVF failures were included in the examined group (EG). Thirty women, age matched, who gave birth to at least one healthy child without obstetric complications were included in the control group. Presence of gene mutations for factor II Prothrombin (G20210A), factor V Leiden (FVL) and methylentetrahydrofolate reductase (MTHFR C677T) was examined in both groups. Sociodemographic data, data from personal, family and obstetric anamnesis was collected with standard questionnaire. Results: Representation of nationality in both groups roughly corresponds to the national structure in Republic of Macedonia. In both groups the most prevalent age was from 30 to 34 years (40% in the CG and 50% in the EG). According to the degree of education, homogeneity between the two groups was registered. In most of the EG, MTHFR heterozygous was 63.6% vs. 56.7% in the CG, followed by the FV Leiden heterozygous with 13.6% vs. 3.3% in the CG, MTHFR homozygous with 9.1% vs. 6.7% in CG, factor II Prothrombin (G20210A) heterozygous with 4.5% vs. 6.7 in CG. 72.7% of women in the EG and 60% in the CG had one thrombophilic mutation, and 9.1% of women in EG and 6.7% in CG had two thrombophilic mutations. 18.2% of women in EG and 33.3% in CG did not have any mutations. Conclusion: The sociodemographic profile of women with IVF failure is a woman aged between 30 and 34 years with a university degree, with at least one thrombophilic mutation. Thrombophilic mutation has not been registered in only a small percentage of women with failed IVF.
Natasha Petkovikj, Vesna Velikj Stefanovska, Irena Eftimovska Rogach, Natasha Eftimovska Otovikj, Ana Doneva, Natasha Stavreva
Archives of Public Health, Volume 11, pp 26-33; doi:10.3889/aph.2019.4202

Abstract:
Морталитетната статистика по причини за смрт е основен показател на здавствената состојба на населението во една земја. Нејзината валидност во целост е базирана на точноста на Лекарските извештаи за причина на смрт (ЛИПС) што претставуваат нејзин основен извор на податици. Цел на ова истражување е да се утврди точноста на лекарските извештаи со впишано КВЗ (I10 - I50) како основна причина за смрт во Градската општа болница „8ми Септември“ во Скопје. Материјал и методи: Истражувањето представува квантитативна аналитичка студија на пресек имплементирана во Градската општа болница „8ми Септември“ - Скопје во периодот од јануари 2015 до декември 2016 година. Во истражувањето беа анализирани ЛИПС-овите кои согласно МКБ10 беа со впишано КВЗ (I10 - I50) како основна причина за смрт. Опфатени беа 121 пациент на возраст од 24 до 84 години кои починале во периодот 0 - 28 дена од хоспитализацијата и тоа независно од полот и другите социо-демографски карактеристики. Анализата на точноста на ЛИПС-овите, беше направена согласно стандардизиран образец од MONICA проектот. Резултати: Просечната возраст на починатите во целиот примерок изнесуваше 72,41±9,14 [95% CI (70.71-74,11)] години. Tочно пополнети ЛИПС-ови биле 67 (56,3%), неточно 22 (18,5%) и делумно точно 30 (25,2%). Нема сигнификантна асоцијација (p>0,05) меѓу полот на испитаниците и точноста на впишување на примарната причина за смрт. Утврдена е сигнификантно (p
Marije Gjetaj Jakovski, , Gordana Ristovska
Archives of Public Health, Volume 11, pp 34-42; doi:10.3889/aph.2019.4203

Abstract:
Цел на трудот беше да се направи компаративна анализа на нутритивниот статус на деца на возраст од 6 до 8 години во градот Скопје во 2010 и 2016 година. Материјал и методи: За спроведување на истражувањето во 2010 и 2016 година беше развиен протокол кој беше усогласен со протоколот на COSI истражувањето. Во двата круга на собирање на податоци во 14 основните училишта на територијата на град Скопје беа одбрани деца од второ одделение. Антропометриските испитувања се вршени според стандардите на СЗО за мерење на висина и тежина. Референците за раст на училишни деца на СЗО од 2007 година беа користени за да се пресметаат z-скоровите на стандардни девијации на индексот телесна маса-за-возраст (БМИ/В), како и за интерпретација на антропометриските индикатори. Финалната обработка на податоците и проценката беше направена со примена на WHO AnthroPlus софтверот. Резултати: Вкупниот број вклучени деца во истражувањето во 2010 година беше 324, од кои 174 машки и 150 женски деца. Во истражувањето во 2016 година беа вклучени 365 деца, од кои 183 машки и 182 женски деца. Индексот БМИ/В кај децата мерени во 2010 година покажа кај 0,3% потхранетост кај сите деца. Индексот БМИ/В покажува дека речиси кај една третина од децата постои зголемена ТТ и дебелина, со тоа што во 2010 година процентот на деца со зголемена ТТ и дебелина е повисок (32,4%) во однос на 2016 година (28,8%). Исто така, поголем процент на дебели деца се измерени во 2010 година (14,5%) во споредба со 2016 година (12,6%). Околу 5% од децата се со екстремна дебелина (% > +3СД) и се евидентирани во 2010 година, додека во 2016 година таа состојба е присутна кај 4,7%. Заклучок: Кривата на дистрибуција е поместена надесно во однос на референтните вредности, односно проблемите со исхраната на децата се поместени кон ризиците од зголемена телесна тежина и дебелина. Според тоа, и јавноздравствените акции треба да бидат насочени во тој правец. Потхранетоста, било умерена или тешка, ретко се среќава и не претставува значаен јавноздравствен проблем кај децата на оваа возраст во Македонија.
, Anita Arsovska, Slagjana Simeonova-Krstevska, Ana Daneva-Markova, Drage Dabeski
Archives of Public Health, Volume 11, pp 5-10; doi:10.3889/aph.2019.3576

Abstract:
The aim of this study was to evaluate the possible reasons for the emergence of endometrial hyperplasia in perimenopause. Material and methods: A total of 71 patients with irregular bleeding were analyzed, at the age of 40-50 years, who should have undergone diagnostic curettage. Depending on the histopathological findings, we divided them into 2 groups: group 1-findings for endometrial hyperplasia, group 2 - atrophic or endometrium with deficient secretory changes. Body mass index (BMI) was determined (obesity defined with BMI >30 kg/m2); we measured blood pressure (cut-off value was 135/90 mmHg), waist circumference (cut-off value was 88 cm) as well as data of anamnesis (age, physical activity, type of diet, smoking cigarettes). All these data were analyzed as etiological factors in the emergence of endometrial hyperplasia.Results: The mean age of patients was 47 years, and the results obtained were very similar in both examined groups. BMI and waist circumference were increased, more than 60% of patients had hypertension, but not all had a statistical significance. Most of them were with completed secondary education, and city living statistically significantly increases the risk of endometrial hyperplasia (p
Vesna Ambarkova, Mira Jankulovska, Mihail Kocubovski, Vladimir Popovski, Mirjana Popovska
Archives of Public Health, Volume 11, pp 58-67; doi:10.3889/aph.2019.2855

Abstract:
Целта на оваа студија беше да се утврди корелацијата помеѓу КЕП (Кариес, Екстракција, Пломба) индексот на 12-годишни деца и концентрацијата на флуорот во водата за пиење од населените места каде што децата живеат. Материјал и методи: Во испитувањето беа опфатени 129 ученици од 2 централни и 2 подрачни основни училишта, на кои им се одреди КЕП индексот. Децата живеат во градот Струмица и 3 различни села. Деветнаесет примероци на вода беа земени од испитуваната област за да се одреди концентрацијата на флуор со помош на електрохемиски метод користејќи го јонометарот (pH/ISE meter-Thermo-Orion) со специјална Ф-електрода (Thermo Orion Ion Plus Fluoride Electrode) на Институтот за јавно здравје. За одредување на корелацијата помеѓу одредените варијабли беше користен Spearman-овиот метод. Резултати: Вкупниот број деца во испитуваниот примерок изнесуваше 129, од кои 59 (45,7%) беа од женски и 70 (54,3%) од машки пол. Просечниот КЕП индекс кај оваа група деца изнесуваше 1,94, со стандардна девијација од ±2,5. Максимални концентрации на флуор во водата за пиење од 1,36 ppmF беа утврдени во селото Банско и од 0,36 ppmF во селото Муртино, додека минимални (0,08 ppmF) во градот Струмица. Корелацијата помеѓу вредноста на КЕП индексот кај децата на возраст од 12 години од Југоисточниот регион и концентрацијата на флуорот во водата за пиење постоеше негативна, индиректна корелација, со вредност на коефициентот r =-0,16. Заклучок: Корелацијата помеѓу КЕП индексот и концентрацијата на водата за пиење е негативна, индиректна корелација, и оваа корелација е статистички значајна (p˂ 0,05).
Viktor Isjanovski, Igor Isjanovski, Pavle Nikolovski
Archives of Public Health, Volume 11, pp 43-50; doi:10.3889/aph.2019.2846

Abstract:
Цел на студијата е да се утврдат знаењата и ставовите на студентите по медицина за ХЦВ инфекција. Материјал и методи: истражувањето е аналитичка студија на пресек спроведена на Медицинскиот факултет, на примерок од 360 студенти. Анкетирани се студенти од вториот семестар се до завршната година. Притоа користен е специјално дизајниран прашалник, кој е развиен од страна на истражувачот. Прашалникот е составен од три дела: прашање поврзани со социо-демографски податоци, знаење за ХЦВ инфекции и став на студентите кон ХЦВ-позитивни пациенти. Резултати: Стапката на одговор на анкетата беше 90%. Oваа студија, посочи дека целокупното знаење на студентите по медицина е умерено (многу добро-7-8). Студентите имаат повеќе информации за превенција на хепатит Ц отколку за другите аспекти на болеста, како начин на пренесување и симптоми. Регистрирана е статистички значајна разлика помеѓу знаењето за хепатитис Ц со нивото на образование на студентите. Заклучок: Нашата студија покажа дека студентите по медицина имаат доволно знаење за ХЦВ, но потребно е да се продолжи со едукација на оваа тема.
Archives of Public Health, Volume 11, pp 31-36; doi:10.3889/aph.2019.2844

Abstract:
Цел на трудот: Да се утврди влијанието на консумирањето алкохол во појавата и лекувањето на хипертензивните мозочни крвавења и штетните последици врз морбидитетот и морталитетот на пациентите. Материјал и методи: Беше изведена ретроспективна студија кај 61 пациент на ЈЗУ Универзитетска клиника за неврохирургија од 2011 до 2016 год. со различни манифестации на мозочни крвавења. Пациентите беа поделени во 2 групи: со и без нагласени ризик-фактори.Во групата со нагласени ризик-фактори се утврди дека 15 испитаници консумирале алкохол.Беа испитувани следниве варијабли: пол, возраст, волумен на крвавењето, компресија, исход на лекувањето и функционална мобилност. Резултати: Резултатите укажуваат дека алкохолизмот значително влијае на појавата на мозочните крвавења, особено кај болните што консумираат повеќе од 200 ml алкохол дневно. Најверојатна причина е оштетувањето на црниот дроб и нарушувањето на хемостазата. Заклучок: Алкохолизмот како социомедицински фактор има сигнификантна улога во појавата на мозочните крвавења
, Biljana Shirgoska, Radmila Trajkova, Ivana Klisevska Ilcevska
Archives of Public Health, Volume 11, pp 77-88; doi:10.3889/aph.2019.2859

Abstract:
Хипотензивната анестезија е таква анестезиолошка техника при која средниот артериски при- тисок на пациентот се намалува за повеќе од 20% од неговата предоперативна вредност. Мотив: да се спречи појава на хипооксија на мозокот при употреба на хипотензивна анестезиолошка техника кај пациенти подложни на септо/ринопластика. Цели на трудот: да се утвр Хипотензивната анестезија е таква анестезиолошка техника при која средниот артериски притисок на пациентот се намалува за повеќе од 20% од неговата предоперативна вредност. Мотив: да се спречи појава на хипооксија на мозокот при употреба на хипотензивна анестезиолошка техника кај пациенти подложни на септо/ринопластика. Цели на трудот: да се утврди просечната вредност на мозочната сатурација кај будни пациенти, да се одреди корелацијата на средниот артериски притисок и мозочната сатурација при умерена хипотензија, и да се анализираат постоперативните несакани ефекти. Материјали и методи: во студијата беа вклучени 20 пациенти, АСА 1, водени со умерена хипотензивна анестезија предизвикана со ремифентанил и севофлуран. Во пет временски интервали (Т1-Т5) се следеа параметрите: MAP, HR, rSO2 и се одреди нивната корелација. Резултати: умерена хипотензија се постигна во Т4 (МАР=69,05±7,09). За просечна базална вредност на мозочната сатурација се утврдија: 73,30 ± 5,44% за левата и 75,30±5,18% за десната мозочна хемисфера. Кривата на мозочната сатурација покажуваше нагорен тренд и пик кој се совпаѓаше со воведот во анестезија, а во понатамошниот тек тенденција кон опаѓање. Се најде слаба до умерена позитивна корелација помеѓу MAP и rSO2 во текот на хипотензивната анестезија, а во целиот тек на мерењето rSO2 беше повисоко од базалната вредност. Заклучок: умерената хипотензија и стабилниот среден артериски притисок придонесуваат за стабилна мозочна сатурација.
, Milena Golubovik Arsovska
Archives of Public Health, Volume 11, pp 110-113; doi:10.3889/aph.2019.2863

Abstract:
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
Aleksandra Stambolieva, Mihail Kocubovski, Gordana Ristovska, Aneta Kostova
Archives of Public Health, Volume 11, pp 37-42; doi:10.3889/aph.2019.2845

Abstract:
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.
, Svetlana Jovevska, Mihail Kocubovski
Archives of Public Health, Volume 11, pp 89-94; doi:10.3889/aph.2019.2860

Abstract:
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.
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; doi:10.3889/aph.2019.2862

Abstract:
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.
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