Faculty of Medicine

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    Stereological study of the Wistar rats` thymus after application of high therapeutic doses of dexamethasone and medroxyprogesterone acetate
    (Macedonian Association of Anatomists and Morphologists, 2017)
    ;
    Aim: The aim of our study was to evaluate the eventual immunosuppressive effect of high therapeutic dose of medroxyprogesterone acetate (MPA), to determine morphological and stereological thymic tissue characteristics and to compare them with the morphological characteristics induced by the high therapeutic dexamethasone (Dex) dose. Material and Methods: A total of 36 female Wistar rats were divided into three groups. The control group of rats were administered physiological solution, whereas the experimental groups received Dex at a dose of 3 mg/kg bw and MPA at a dose of 150 mg/kg bw. Drugs were administered intramuscularly every day, in a period of 7 days. Thymus paraffin sections were stained according to the following methods: hematoxylin-eosin, periodic acid-Schiff and elastica-van Gieson. The stereological measurements were performed by using the Weibel’s multipurpose test system (M-42). Results: Histological analysis in the drug-treated rats showed disrupted thymic cytoarchitecture, lymphocyte density reduction which in some areas was to a degree of lymphocyte depletion, presence of Hassal’s corpuscles in thymic lobules medulla and abundant presence of interstitial connective tissue. Stereological analysis showed a significant reduction in the thymic parenchyma volume density, which was due to the more pronounced decrease in the thymic lobules cortex volume density and a significant increase of the interstitial connective tissue volume density. Conclusion: Our results showed that the high therapeutic dose of MPA provoked a marked reduction in immunocompetent lymphoid tissue, which led in changing the proportion of thymic structural components. These resulted in an immunosuppressive effect. Almost identical changes were caused by the high therapeutic dose of Dex, but thymic parenchyma was significantly more sensitive substrate for Dex than for MPA.
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    EPINEPHRINE AND DEXAMETHASONE AS ADJUVANTS IN UPPER EXTREMITY PERIPHERAL NERVE BLOCKS IN PEDIATRIC PATIENTS
    (Macedonian Academy of Sciences and Arts, 2021)
    Ljubica Mikjunovikj-Derebanova
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    ;
    ;
    Ljupcho Donev
    ;
    Albert Lleshi
    ABSTRACT Introduction: Regional anesthesia in children in recent years has been accepted worldwide. The increased interest in it is partly due to the use of ultrasonography which provides confidence and accuracy to the anesthesiologic team. Adjuvants are used to extend the duration of the sensory and motor blocking, limiting the cumulative dose of local anesthetics. The use of adjuvants in peripheral nerve blocks in the pediatric population is still under research. Aim: To observe the effect of epinephrine and dexamethasone as adjuvants to local anesthetics in peripheral upper extremity nerve blocks in pediatric patients. Materials and methods: The study included 63 patients, aged group 4-14 years, admitted to the University Clinic of Pediatric Surgery for surgical treatment of upper limb fractures in the period of January 2020 until March 2021. Patients were randomized into three groups, and all patients in the groups received analgo-sedation prior to peripheral nerve block. Patients in group 1 (21 patients) received supraclavicular, or interscalene block with 2 ml lidocaine 2% and bupivacaine 0.25% (max 2mg/kg) with a total volume of 0.5ml/kg. In group 2, the patients (21) received 25 μg of epinephrine in 2 ml of 2% solution of lidocaine and 0.25% bupivacaine (max 2 mg/kg) with a total volume of 0.5 ml/kg, and in group 3, the patients (21) received 2% lidocaine 2ml and 0.25% bupivacaine (max 2mg/kg) in combination with 2mg dexamethasone with a total volume of 0.5ml/kg. Results: Results showed that in patients in group 1, the average duration of the sensory block was 7 hours, while the duration of the motor block was 5 hours and 30 minutes. In group 2 (epinephrine), the durations of both sensory and motor block were prolonged for about 30 minutes on average compared to the first group. In group 3 (dexamethasone) the duration of the sensory and motor block was significantly longer compared with the first two groups (p<0.0001). Conclusion: Epinephrine and dexamethasone prolong the duration of action of local anesthetics in pe- ripheral nerve blocks of the upper extremity in pediatric patients and thus reduce the need for analgesics in the postoperative period.