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    General anesthesia: Is it safe for newborns, infants and young children?
    (Association of medical doctors "Sanamed" Novi Pazar, 2016)
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    Nancheva, Andrea
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    The exposure of neonates, infants and small children to general anesthesia is becoming a common occurrence. Accumulating preclinical data indicate that exposure to commonly used general anesthetic agents during key periods of brain development in this population(between late gestation and 3 to 4 years of age,) can lead to apoptotic neurodegeneration, synapse loss, and cognitive and neurobehavioral deficits that persist as the organism matures. New work suggests that infants and small children undergoing some types of surgery could have better recovery if they receive regional anesthesia rather than general anesthesia. In response to this concerns, the Food and drug administration (FDA) and the International Research Society in anesthesia (IARS) started an initiative called Smart Tots (Strategies for Mitigating Anesthesia- related neuro Toxicity in Tots) which examine the effects of anesthesia on brain development. Also another two major prospective studies are ongoing in children : PANDA (Pediatric Anesthesia Neurodevelopment assessment Study )project is a large, multi-center study based at the Morgan Stanley Childrens Hospital of New York at Columbia University, and another one is GAS study which is a multisite randomized controlled trial comparing neurodevelopment outcomes in infant receiving general anesthesia compared to spinal and other regional anesthetics to the stress response to surgery. The findings from these studies will help researches to design the safest anesthetic regimens and to develop the new and safer anesthetic drugs for use in pediatric medicine.
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    Trochlear dysplasia - congenital anomaly or biomechanical development
    (National Library of Serbia, 2018)
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    Introduction. The aim of this study was to investigate the appearance of the trochlear groove in infants and to present the possible causes for the development of trochlear dysplasia as one of the most severe pathologic findings in patients with patellar instability. Material and Methods. Knee ultrasonography was performed in 200 infants, 3 to 6 months of age. The measurements were made at 30 and 60 degrees of knee flexion, in order to measure the trochlear bone and cartilaginous sulcus angle on the patellar surface of the femur and to determine the degree of trochlear dysplasia. A 7-megahertz probe was used for measurements, which was tangentially placed with the reference to the posterior femoral joint. Results. A completely flat trochlear bony sulcus angle was registered in all infants aged 3 to 6 months. The mean cartilaginous sulcus angle was between 149 ? 5.4? and 19 infants had a sulcus angle over 159?. Eleven infants with trochlear dysplasia were in breech presentation at birth. Conclusion. Our study showed that the cartilaginous part of the trochlear groove was already well developed at birth. Breech presentation of the fetus could be a predisposing factor for dysplasia of the cartilaginous part of the trochlear groove. The bony part of the trochlear groove is dysplastic in infants and it gradually gets deeper, later getting a shape of the overlying articular cartilage. The influence of the Delpech law, with lower pressure in the trochlear groove, could be the possible mechanical theory explaining the development of the trochlear dysplasia in the later stage of the childhood.
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    Results of Arthroscopic Treatment of Chronic Patellar Tendinopathy
    (Walter de Gruyter GmbH, 2020-09)
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    Background: The surgical treatment of chronic patellar tendinopathy could be open or arthroscopic. A general agreement on the best surgical treatment option is still lacking. Purpose: The aim of our study was to evaluate the clinical results after a minimally invasive arthroscopic treatment of chronic patellar tendinopathy including a resection of the lower patellar pole. Methods: The study included 14 patients with a mean age of 26 years and chronic patellar tendinopathy refractory to non-operative treatment of more than 6 months. All patients underwent arthroscopic debridement of the adipose tissue of the Hoffa’s body posterior to the patellar tendon, debridement of abnormal patellar tendon and resection of the lower patellar pole. Preoperative and postoperative evaluation was undertaken using clinical examination, magnetic resonance imaging (MRI) and the Lysholm and Victorian Institute of Sport Assessment-Patella (VISA-P) scores. Return to sports and postoperative complications were also assessed. The mean follow-up was 12.2 ± 0.9 months. Results: All 14 patients continued with sport activities, but only 12 of them (85.7%) achieved their pre symptom sporting level. The median time to return to preinjury level of activity was 3.9 ± 0.8 months. Patients showed a major improvement in the mean Lysholm score from 51.1 ± 3.8 to 93.4 ± 4.2 (p=0.001) and in the mean VISA-P score from 42.1 ± 3.5 to 86.7 ± 8.4 (p=0.001) There were no postoperative complications. Conclusion: We found that this arthroscopic technique gives reduced morbidity and satisfactory outcome resulting in significantly faster recovery and return to sports in patients with chronic patellar tendinopathy.
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    THE EFFECT OF PLASMA PREPARATION RICH IN GROWTH FACTORS ON PATELLAR STABILITY AFTER MEDIAL PATELLOFEMORAL LIGAMENT REEFING
    (Association of medical doctors "Sanamed" Novi Pazar, 2016)
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    Nanceva, Andrea
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    Introduction: Although more than 100 operative procedures have been described for the treatment of patellar instability, there is no single universally successful procedure. For the most patients with lateral patellar instability medial patellofemoral ligament (MPFL) reefing is recommended. When we perform MPFL reefing we are not aware of the quality and strength of the MPFL tissue. In the presence of recurrent patellar instability,the quality and strength of MPFL tissue is often compromised and it disturbs patellar stability after MPFL reefing. Biomedicine development,recognizing the ligament healing process show us that autologous blood products, particularly PRP can enhance healing in soft tissue injuries. Purpose: The purpose of this study was to determine the potential effect of Plasma preparation rich in growth factorson patellar stability after MPFL reefing. Material and methods: Plasma preparationrich in growth factors was produced from a unit of autologous whole blood using Arthrex ACP double syringe system.Platelet gel was prepared by adding bovine thrombin and 10% solution of calcium chloride.The platelet gel was applied locally into the place where suturing of the MPFL was performed. In this prospective, randomized and double blindstudy12 patients were included:6 patients in the PG group who received platelet gel and 6 patients in the control group who were not treated with platelet gel. Patellar stability was evaluated before surgery and 3 months after surgery with Axial stress radiographs. Results: The calculated 3 month improvement was 12.67 2.51 in the control group and 17.33 1.52 in the PG group, (p=0.064).Although there was greater improvement in patellar stability in PG group comparing to the control group, the difference was not statistically significant (p>0.05).The main reason for this was probably the small number of patients included in the study. Conclusion: Results showed that growth factors from the plasma preparation rich in growth factorshave positive effect on patellar stability after MPFL reefing.We believe that they stimulate and accelerate physiological healing and reparative tissue processes in ligament healing. More studies should be made, including more patients, if we want to get more relevant results.
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    THE INFLUENCE OF NUTRITION ON MUSCLE WASTING IN CRITICALLY ILL PATIENTS – A PILOT STUDY
    (Association of Medical Doctors Sanamed, 2018-12-04)
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    A Rare Case of Superior Gluteal Artery Pseudo Aneurysm after Blunt Trauma
    (Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences/ Sciendo, 2019-10-01)
    Trpeski, Sime
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    Ilieva Mihajlova, Marija
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    Apostolovska, Nina
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    Prevailing over in rotationally unstable pelvic fractures, acetabular fractures or hip dislocations, superior gluteal artery pseudo aneurysm imperceptibly could be found after blunt force trauma of the pelvic region. We present a case of superior gluteal artery pseudo aneurysm after blunt force trauma that became gradually symptomatic in two months following the prime malevolence. Non-resolving gluteal hematoma presented two months after the incident, disregarding standard treatment methods led the diagnosis to plausible entity of pseudo aneurysm. Standard protocol was followed. CT angiography was indicated and it confirmed the suspected diagnosis. Upon indication a treatment plan was established with correspondent angioembolization of the pathologic substrate. Pseudo aneurism of the superior gluteal artery should be considered as differential diagnosis for unexplained hematomas in the posterior pelvic region following a trauma regardless of its nature.
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    Импинџмент синдром: отворена предна акромиопластика - приказ на случај
    (Македонско друштво на ортопеди и трауматолози = Macedonian Association of Orthopedics and Traumatology, 2007)
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    Ilievski, A
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    Hadji Antonovski, Antonije
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    Intracerebral hemorrhage and epileptic seizure : frequency, localization and seizure types
    (Македонско лекарско друштво = Macedonian Medical Association, 2017-07)
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    Taravari, Arben
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    Coskun, Kerala
    Introduction. Among 2.8-18.7% of the patients that suffered from spontaneous intracerebral hemorrhage (ICH) develop seizures. Previous studies suggest that most important contributors to developing subsequent seizures are: volume and localization of hematoma, cortical involvement and age. Aims: To determine the occurrence of new epileptic seizures in patients with spontaneous intracerebral hemorrhage and to analyze it with respect to the patient’s age, gender, presence of premorbid risk factors, localization of the hematoma and the type of the seizures. Methods. This study is retrospective in design, with study population of 308 patients with spontaneous intracerebral hemorrhage admitted to our clinic in the period between 2008 and 2014. Analyzed premorbid risk factors for ICH are: hypertension, smoking, alcohol uptake. According to the computer tomography (CT) of brain findings the patients was divided in two groups: lobar and thalamic (deep). By the time of presents of seizures, they were classified as early (within 1 week of ICH) or late (more than 1 week after ICH). Also we analyzed the seizures type and we divided them in four groups: simple partial, partial complex, secondary generalized and tonic clonic generalized seizures. Results. Arterial hypertension was revealed in 78% of the patients with spontaneous supratentorial ICH. Epileptic seizures developed in 8.2% of analyzed patients, most of them in the first week of brain bleeding. Lobar ICH had 78.6% of the patients, with frontal localization was 44% of patients with lobar ICH, and most of them had simple partial and partial complex seizures. Conclusion. Cortical involvement, large volume of hematoma, may be a factor for provoked seizures, especially in the first days of brain bleeding.
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    Factors Affecting In-Hospital Mortality in Patients with Hip Fracture
    (Albanian Society for Trauma and Emergency Surgery, 2022-01-20)
    Popovska, Danica
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    Dalipi, Rezeart
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    Todorova, Teodora
    Background. The prevalence of hip fractures is steadily increasing, as the population ages. These fractures are associated with significant morbidity and mortality. Most of these fractures are treated surgically. Factors related to surgical intervention can play a significant role in the outcome. This study examines the association of in-hospital mortality with the timing of surgery, sex, and age of patients treated surgically due to a hip fracture at Clinical Hospital Shtip in a 2-year long period. Material and Methods. A total of 348 patients admitted with a diagnosis of hip fracture who were treated surgically were identified. Data about sex and age were collected. The outcome was assessed for groups treated within 24, 48, 72, and more than 72 hours after admission. Descriptive statistical methods, chi-square test, t-test for independent samples, and odds - ratio with 95% confidence interval (CI) were used in statistical analysis. Results. The delay of surgical treatment beyond 24 hours did not increase the risk of death (OR=0.65, 95%CI=0.23-1.73). Delays beyond 48h and 72h increased the risk of death progressively (OR=1.17, 95%CI=0.50-2.75, and OR=1.65, 95%CI=0.69-3.95 respectively). Mortality was significantly higher in the 76-85-years age group. Conclusions. Association between surgical delay and in-hospital mortality in hip fracture patients is disputed. Confounding factors such as age, sex, comorbidities, and type of treatment determine the outcome. Patients with hip fractures, without any additional disease, should be operated on as soon as possible after admission to the hospital. Delay beyond 48 hours may increase the risk for in-hospital mortality.
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    Multidrug resistant infections in intensive care units
    (Association of medical doctors "Sanamed" Novi Pazar, 2020)
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    Background: Intensive care units (ICU) are often the epicentre of development of infections caused by multidrug resistant (MDR) organisms. Purpose: The aim of our study was to determine the prevalence and types of ICU-acquired infections, pathogens associated with such infections and to determine the antibiotic resistance pattern of the presented pathogens. Material and methods: In the study were included 130 patients hospitalized into the surgical ICU of the University Clinic for Anesthesiology and Intensive Care in Skopje in period of 2 months, April -Jun, 2017. who developed infection after at least 72 hours of their hospitalization. In all of them the pathogens and their antibiotic resistance pattern were identified. Results: Twenty of 130 (15.4%) patients developed ICU-acquired infection. Most common infections were pneumonia (50%) and surgical site (30%) infections.Gram-negative organisms were more common isolated than Gram-positive organisms (83% vs.17%). The most common isolated bacteria were Acinetobacter species (30, 41.7%) and Pseudomonas aeruginosa (15, 20.8%). All isolated species were MDR organisms resistant to the most used antibiotics like Cephalosporins, Gentamicin, Ciprofloxacin and Clindamycin. Pseudomonas aeruginosa and Acinetobacter species were sensitive to Colistin, Methicillin-resistant Staphylococcus aureus (MRSA) to Vancomycin and Linezolid and Enterococcus only to Linezolid. Klebsiella pneumoniae and Proteus mirabilis showed low resistance only to Amikacin and Carbapenems. Conclusions: Our study obtained local data about the prevalence and types of ICU-acquired infections, types of pathogens and their antibiotic resistance pattern.Based on this knowledge, clinicians can choose appropriate antibiotics, avoiding antibacterial drug overuse and MDR bacteria development.