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Pregnancy is a unique state of the female organism in which occur physiological changes that are necessary to maintain the pregnancy. To be able to respond to the increased metabolic needs of pregnancy and to maintain an adequate level of thyroid hormones in the blood, the thyroid gland responds with changes in its function and anatomy as well. Changes in thyroid function are mainly associated with increased levels of thyroxine-binding globulins in the blood. Their level increases as a result of estrogen stimulation in pregnancy and they are synthesized in the liver. Changes in the physiology of the thyroid gland during pregnancy also occur as a result of stimulation of the TSH receptors of the gland by the human chorionic gonadotropin hormone (hCG) which is secreted by the placental trophoblast. Due to the difference in the physiology of the thyroid gland in and outside of pregnancy, a special interpretation of the results of functional thyroid tests is required. Changes in hormone values are transitory, especially expressed in the first trimester of pregnancy. A healthy pregnant patient without thyroid pathology or disease compensates for those changes and a sufficient amount of thyroid hormones is produced. The presence of thyroid hormones in an optimal concentration in the blood maintains a successful pregnancy and secures normal neurological development of the fetus. Diseases of the thyroid gland lead to a decrease its compensatory ability during pregnancy and the contributes to the inability to respond to the increased metabolic needs that follow. The motive for this paper are the pregnant patients with undiagnosed or unrecognized thyroid gland diseases before pregnancy, where we encounter conditions when the thyroid gland cannot respond to the physiological changes that occur. One of the negative outcomes of this condition can be spontaneous pregnancy loss in the first trimester. Therefore, a special interpretation of the thyroid status in pregnancy is needed and the introduction of constant reference values that will apply only to pregnancy. World recommendations designate reference values for TSH and thyroid hormones respectively for each trimester of pregnancy, the so-called trimester-specific reference values. In case of absence of trimester-specific reference values, there are recommendations regarding the special interpretation of thyroid function tests and reference values; as well as recommendations for using adjusted values according to demographic characteristics that will apply to all trimesters. This review of literature recommendations would help in the management of patients in order to achieve an optimal serum level of thyroid-stimulating hormone and achieve a successful pregnancy, thus imposing the need to introduce recommendations in our laboratories for thyroid analysis values specific to pregnancy, which will differ from those for the non-pregnant population. Keywords: thyroid gland, thyrostimulating hormone, trimester-specific reference values

Background: External human ear is considered to be a highly variable structure showing different morphological and individualistic features in The uniqueness of the ear may be useful in establishing the identity of individuals by direct examination, during the examination of CCTV footage or analysis of the ear prints. Considering the forensic significance of the human ear and ear prints encountered at the scene of the crime, the present study is an attempt to evaluate various morphological characteristics of the ear . Methodology: The sample for the present study comprises of 90 males and 87 females aged of the 19 years. characteristics such as overall shape of the ear, size and shape of the tragus. Results: The oval-shaped ear was present among 40% of the males and 44.8% of the females in the study sample. The other types of the ear such as oblique, rectangular, round, and triangular were also found in both sexes. Bilateral asymmetry was observed in the shape of the ear. The shape of the tragus also varied with respect to the left and right sides as well as sexes. Conclusion: The present study shows that the individualistic characteristics of the ear can provide very useful information for personal identification in forensic examinations. The shape of the ear and tragus, show a variety of structures and individuality. The importanceand variability of the human ear may encourage the researchers in conducting further studies and solving the forensic cases pertaining to the investigation of CCTV footage and in examination of dead in airplane crashes, intentional mutilation and dismemberment, explosions, or other mass disasters. Keywords: Forensic science, Forensic anthropology, Personal identification, Human ear, Morphological variations .

Anesthesia for caesarean section can be general and regional. General anesthesia is a state of unconsciousness and loss of protective reflexes as a result of administering one or more anesthetics by intravenous infusion. Regional caesarean section anesthesia can be spinal and epidural. Today with new local anesthetics, spinal anesthesia is an anesthesia of choice for caesarean section. The principle is to apply a local anesthetic to the spinal cord with reversible loss of nerve conduction resulting in muscle relaxation and analgesia. Apgar test is a method of assessing the health of a newborn immediately after birth that is done in the first and fifth minutes after birth and the result is called the Apgar score. The purpose of this paper is to compare the first-minute Apgar score in neonates delivered by caesarean section in terms of the type of anesthesia that has been used, general or spinal. The different types of anesthesia, the possibility for the patient to choose the type of anesthesia or that decision should be left to the anesthesiologist, are just some of the questions that arise at a time when the number of cesarean births is increasing. In this study is used data from the documentation of the Department of Anesthesiology and Resuscitation at PHI Strumica General Hospital on the type of anesthesia applied at each caesarean section and Apgar score of neonates born with these caesarean sections. Data have been collected since 2015, when general anesthesia was more prevalent and 2018, when spinal anesthesia is on the rise. 533 patients were included for 2015 and 496 for 2018. Inclusion Criteria - Indication of caesarean section: fetopelvic disproportion, hypertension, diabetes, preeclampsia, eclampsia, obesity. Exclusion criteria: fetal distress, placental abruption. Of all caesarean deliveries in 2015, 93.06% (496) had general anesthesia, the remaining 6.9% (37) were with spinal anesthesia. First-minute Apgar scores in infants born with caesarean section under general anesthesia were Apgar score -10 at 0.8%, 9 at 44.47%, 8 at 37.22% and lowest notched Apgar score 4 at 0.4%. First-minute Apgar score in infants delivered in spinal anesthesia was 10 in 10.81%, 9 in 70.27% 8 in 13.51%. In 2018, 13.9% (69) of the total number deliveries were done under general anesthesia and 86.08% (427) under spinal anesthesia. In neonates who underwent caesarean section under general anesthesia, the following values for Apgar score were obtained: There is no newborn with 10, 9 was at 20.29%, 8 at 56.52%. In neonates with spinal anesthesia, Apgar score in the first minute after delivery was 10 at 0.47%, 9 at 63.7%, 8 at 25.29% and lowest score- 5 at 0.47%. The improvement of anesthesiology practice, the new local anesthetics and informing the mothers about the safer type of anesthesia are important in the process of choosing the type of anesthesia during a caesarean section. The results only confirm that spinal anesthesia is safer for the mother and plays a role in higher Apgar score in the first minute in the newborn. The choice depends on many factors, and there is also the possibility for the mother to choose the type of anesthesia Keywords: Caesarean section, Spinal Anesthesia, General Anesthesia, Apgar Score

Aim: To determine the morphological features of mental foramen in population to provide guidelines for forensic scientists and dentists. Methods: 50 adult male and female human mandibles were obtained. Size, incidence, shape,location and number of mental foramina were recorded. Incidence of accessory mental foramina was also noticed. Distance from anatomical landmarks and size was recorded using vernier caliper. Results: Shape of mental foramen was oval in 6% of mandibles and rounded in 94% on the right side and on left it was oval in 13% of mandibles and rounded in 87%. The average size of mental foramen was 2.79 mm on right side and 2.7 mm on the left side. Mental foramen was most commonly found below the apex of second premolar tooth i.e. in 70% of the mandibles. The mean distances of mental foramina from upper border were 1.3 cm and 1.2 cm and from lower border were 1.4cm and 1.5 cm on right and left sides respectively. The average distances from symphysis menti were 2.9cm and 3 cm and 7.2cm and 7.3cm from posterior margin of ramus of mandible on the right and left sides respectively. Conclusion: Comprehensive knowledge of the mental foramen and it’s variations in different population is essential for dental surgeons, anesthetists, anatomists and forensic scientists. Keywords: Mental Foramen, Vernier Caliper, mandibular

Nowadays, in the diagnosis of the extensive endocranial processes, major significance is attributed to the dary changes in the skull that appear also in the X-Rays. Despite some successes in the development of the X-anatomy of the skull and in the study of secondary changes, there are major difficulties in reading the X-rays. This is explained by the fact that the variability in the construction of the various parts of the skul I is more frequent, ially at its base and in the area of the great occipital opening. the literature it can hardly be found how the variations in the shape of the great occipital opening are described IKl peculiarities in the construction of its rear end. fn healthy persons, the semi-axial X-rays of the great occipital opening have an oval shape, a clear and smooth back end, surrounded by a solid bone cylinder that passes toward -.Cmidd\e in the vertically set ridge of the occipital bone. When tumors in the posterior cranial fossa are described, many authors note changes in the great occipital opening a the form of osteoporosis, atrophy, and slinging the sku!J at the posterior end of the opening, with local cleavers aid leveling of the corresponding part of the occipital bone, known as the Bapcin symptom. The anatomical variation of the form of the fora men occipital magnum was axsarnioed on 80 ca\varials. With detail malysis we identified three normal variations of the form of the foramen occipital magnum: the oval (48 cases), the IOUlld (21 cases) and the anomalous form ( l l cases). Also the dorsal end and osseous configuration of the occipital m was examined. The importance of this study is it's prognostic and diagnostic application in the clinical and roentgengratic research. (ireatest difficulties arise in the malignant brainstem process, especially when the invasive process goes to the lliddleofthe back of the great occipital opening. Knowledge of foramen occipital magnum variations is important for surgeons in pereforming many procedures and &may help to avoid clinical coplications, especially, during radiological examination .

Činjenica je da su anesteziolozi najkompetentniji stručnjaci za stabilizaciju i održavanje vitalnih funkcija bolesne i povrijeđene. Transport vitalnih ugroženih bolesnika iz regionalnim bolnicama u većim kliničkim bolnicama je dodatni rizik faktor za ishod liječenja i je sastavni dio rada anesteziologa.

Терминот АИА-аспирин индуцирана астма е најдобриот опис на агресивното и континуирано воспалување на дишните патишта, комбинирано со егзацербација на астма и ринитис по апликација на аспирин и повеќето нестероидни анти-инфламаторни лекови (NSAIDs). Разбирањето на аспиринската интолеранција од медицинска гледна точка е многу важно во случаи кога пациентот треба да се лекува со некој лек од оваа група, на пример при ревматоиден артритис.

Methadone is a relatively safe and efficient synthetic opioid analgesic with long lasting effect which is particularly useful in the treatment of pain in terminal patients . To draft pharmacodynamics , pharmacokinetics , drug interactions , clinical use , dosage rules , the negative effects of methadone and its advantages over morphine . A review of relevant literature on the use of methadone in the treatment of terminal patients' pain and meta- analyzes were conducted .