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Biljana Ivanovska Adjievska,1 Salih Boskurt,1 Nikola Orovcanec,2 Vesna Dimovska-Jordanova3 1Department for Posterior Segment, European Eye Hospital, Skopje, Republic of Macedonia; 2Department for Medical Statistics, Institute for Epidemiology and Medical Statistics, Medical Faculty, Skopje, Republic of Macedonia; 3Department for Retinal Diseases, University Clinic for Eyes Diseases, St Cyril and Methodius University, Skopje, Republic of Macedonia Aim: We aimed to evaluate the 1-year efficacy and safety of low-frequency intravitreal bevacizumab in the treatment of macular edema due to retinal vein occlusions (RVOs).Methods: The study comprised an interventional prospective study of patients with macular edema due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion, followed for 12 months. Treatment-naïve patients with reduced best-corrected visual acuity (BCVA) and central macular thickness (CMT) of at least 250 µm received intravitreal injection of bevacizumab. After 1 month, BCVA and optical coherence tomography (OCT) images of the macula were recorded. In patients with 0.3 log of the minimum angle of resolution [logMAR] units) with average number of injections of 1.98. Improvement of mean BCVA in CRVO was significant (P=0.001) from baseline (1.2±0.95 logMAR units) to 1 year (0.75±0.6 logMAR units). Significant improvement of mean BCVA (P

Introduction: Fabry disease is a rare X-linked lysosomal storage disorder caused by α-galactosidase A (α-Gal A) deficiency. Reduced or absent enzyme activity causes progressive lysosomal accumulation of globotriaosylceramide (Lyso-Gb3) in various cells throughout the body to trigger inflammation and fibrosis., Case Description: We present the first familial case of Fabry Disease in North Macedonia identified based on clinical manifestations and confirmed through enzyme, biomarker, and genetic tests. The index case in the family was a 45-year-old male undergoing hemodialysis therapy. He has had chronic burning uncontrolled limb pain since childhood, intermittent abdominal cramps, anhidrosis, and hypertension. The constellation of clinical presentations accompanied by similar symptoms in close family members prompted the enzyme, biomarker, and genetic analyses for Fabry disease. Genetic testing identified a known pathogenic GLA missense variant c.443G>A or p.(Ser148Asn) in the hemizygous state. Subsequent family studies allowed identification of another hemizygous male and five heterozygous female carriers affected by this X-linked disorder., Conclusion: We report identification of the first familial case of Fabry disease in North Macedonia and describe the phenotype associated with the Ser148Asn GLA variant. Greater awareness of this rare disease linked to continuous medical education is crucial for timely diagnosis and treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gjorgjievski, Karanfilovski, Arsov, Vidimliski, Andreevska, Selim, Dejanov, Jordanova, Marinova, Paskalev and Nikolov.)

The validity of dementia diagnostic criteria depends on their ability to distinguish dementia symptoms from pre-existing cognitive impairments. The study aimed to assess inter-rater reliability and concurrent validity of DSM-5 criteria for neurocognitive disorder in Down syndrome. The utility of mild neurocognitive disorder as a distinct diagnostic category, and the association between clinical symptoms and neurodegenerative changes represented by the plasma biomarker neurofilament light were also examined. 165 adults with Down syndrome were included. Two clinicians independently applied clinical judgement, DSM-IV, ICD-10 and DSM-5 criteria for dementia (or neurocognitive disorder) to each case. Inter-rater reliability and concurrent validity were analysed using the kappa statistic. Plasma neurofilament light concentrations were measured for 55 participants as a marker of neurodegeneration and between group comparisons calculated. All diagnostic criteria showed good inter-rater reliability apart from mild neurocognitive disorder which was moderate (k = 0.494). DSM- 5 criteria had substantial concurrence with clinical judgement (k = 0.855). When compared to the no neurocognitive disorder group, average neurofilament light concentrations were higher in both the mild and major neurocognitive disorder groups. DSM-5 neurocognitive disorder criteria can be used reliably in a Down syndrome population and has higher concurrence with clinical judgement than the older DSM-IV and ICD-10 criteria. Whilst the inter-rater reliability of the mild neurocognitive disorder criteria was modest, it does appear to identify people in an early stage of dementia with underlying neurodegenerative changes, represented by higher average NfL levels.

The use of screening tools is an effective and practical approach within the clinical diagnostic assessment of attention deficit hyperactivity disorder (ADHD) in adults. Existing screening measures for adult ADHD have focused on a younger population. Subsequently, the current study aimed to evaluate the utility and general usability of an adapted four-item screening tool for adult ADHD: a brief version of the Wender Utah Rating Scale (WURS-brief), within a middle-aged population. The sample consisted of 69 adults, aged between 30 and 63 (age M= 45, SD=6.95), who had been referred to a specialist adult ADHD outpatients clinic. Using factor analysis, the WURS-brief screening measure was compared to existing ADHD diagnostic tools that were used as reference measures within the analysis. The WURS-brief had respectable sensitivity when compared with existing diagnostic tools. This study highlights the importance of validating brief screening measures for middle-aged adults with ADHD within clinical settings and offers suggestions for future research.

People with autism spectrum disorder (ASD) experience reading comprehension difficulties, often misinterpreting complex texts, metaphors, and idioms. We have developed and tested a new assistive technology tool for adaptive, personalized text simplification, called Open Book. This tool is an open-sourced, online platform that uses Natural Language Processing with the specific aim of assisting reading and aiding understanding of written text for people with ASD. The accessibility and effectiveness of Open Book was tested by examining the differences in text comprehension scores between the original texts and texts that were simplified by Open Book tool, randomly allocated to study participants. Two hundred forty-three participants (153 adults and 90 adolescents) with high-functioning ASD were recruited in the UK, Spain, and Bulgaria. Regarding the primary outcome, results showed that both adults and adolescents with ASD gave more correct answers for the simplified ( M = 11.2, SD = 4.1) than original texts ( M = 10, SD = 4.1; p < 0.001). This finding was consistent across age groups and countries. Regarding the secondary outcome, when participants were asked to blindly rate how easy was to understand each text, simplified texts were rated as easier ( M = 7.6, SD = 2.4) to understand than the original texts ( M = 8.7, SD = 2.6; p < 0.001). The Open Book software seems to have the potential to be a useful tool in assisting reading among people with ASD. Our findings support our primary hypothesis that texts simplified through Open Book were easier to comprehend compared to original texts.

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Although the impact of discrimination on mental health has been increasingly discussed, the effect of religious discrimination has not been examined systematically. We studied the prevalence of perceived religious discrimination and its association with common mental disorders in a nationally representative population-based sample in England., Methods: We used data from the Adult Psychiatric Morbidity Survey 2007 that represents all adults age 16 years and over living in private households in England. Common mental disorders were ascertained using the Revised Clinical Interview Schedule. Experience of discrimination was assessed by a computer-assisted self-report questionnaire and potential paranoid traits by the Psychosis Screening Questionnaire., Results: From the total of 7318 participants, 3873 (52.4%) reported adhering to religion. 108 subjects (1.5%) reported being unfairly treated in the past 12 months due to their religion. Non-Christian religious groups were more likely to report perceived religious discrimination compared to Christians (OR 11.44; 95% CI 7.36-17.79). People who experienced religious discrimination had increased prevalence of all common mental disorders. There was a two-fold increase in the risk of common mental disorders among people who reported experience of religious discrimination independent of their ethnicity, skin colour or suspected paranoid traits., Conclusions: The impact of perceived religious discrimination on mental health should be given more consideration in treatment and future preventative policies.

Purpose of Review: Pathways-to-care studies represent a valid and cost-effective tool to provide information on patients' access to psychiatric care. However, no direct comparison of data concerning the pathways to mental healthcare, at the world level, is available yet., Recent Findings: Data obtained from different countries of the world may offer a global perspective on psychiatric pathways to mental healthcare, highlighting the strengths and weaknesses of different mental health systems and reflecting cultural, economic, social and political differences. We evaluated all studies that used a standardized methodology to describe pathways to mental healthcare of all adult patients, presenting for the first time to psychiatric services., Summary: Our findings highlight that considerable variations of pathways to mental healthcare across different countries still exist. A consensus on the quality standards of psychiatric care should be reached and actions to ensure their implementation in low-middle income countries should be taken in the near future. The role of primary care doctors and social networks still represent an unsolved issue for psychiatric care worldwide. Stigma and discrimination towards patients with mental illnesses may still represent a relevant limiting factor for equal delivery of mental healthcare.