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Introduction/Objective. Buprenorphine appears generally similar to, and in some cases superior to, methadone in terms of maternal, fetal, and neonatal outcomes. The objective of the study was to assess some physical birth outcomes in neonates prenatally exposed to buprenorphine. Methods. During a seven-year period, nine patients have been treated with buprenorphine during their pregnancy. All women underwent interview, clinical investigations, biochemical analysis, toxicological screening, viral markers for hepatitis B, C, HIV, with regular check-ups by an obstetrician and a psychiatrist. Newborn outcomes included: birth weight in grams, birth length in centimeters, physical anomalies, head/chest circumference in centimeters, Apgar score at 1 minute / 5 minutes, gestational age (weeks), newborn length of hospital stay in days, breast-feeding, the newborn’s need for pharmacologic treatment after delivery. Results. The mean birth weight was 2,991.11 ± 37 g; birth length was 49.44 ± 2.29 cm; head circumference was 33.11 ± 0.78 cm; chest circumference was 32.33 ± 1 cm; first minute Apgar score was 8.22, fifth minute 9.22; age at delivery was 38.77 ± 1.09 weeks; hospitalization after delivery 4.44 ± 1.13 days. None of the newborns had physical anomalies. Six of the newborns were breastfed. Conclusion. Buprenorphine is a safe and important part of a complete comprehensive treatment approach in pregnant women with opioid use disorder. Buprenorphine treatment of maternal opioid use disorder indicated a low risk of preterm birth, normal birth weight and length, head and chest circumference, Apgar score, short hospitalization after delivery.

Background/Aims: The aim of this study was to investigate all-cause and cardiovascular mortality in chronic hemodialysis patients (CHP) and to identify the determinants of mortality predictors. Methods: In this study with 3 years of follow-up period, we studied a cohort of 80 CHPs. Mean age at entry was 59.3 ± 11.8 years (duration of dialysis 5.47 ± 5.16 years). At entry, together with standard clinical and biochemical analyses, pulse wave velocity (PWV) was determined from time diversity propagation of the common carotid artery and common femoral artery flow signals by Doppler ultrasound. Results: The mean PWV (m/s) was presented at entry: in survived (12.5 ± 2.01) and deceased (13.13 ± 1.70) patients. The PWV cutoff point (by ROC curves) was 11.8. The regression coefficients (b) and Exp (b) hazard ratio coefficients of covariates in Cox-regression survival analysis in all-cause and CV outcomes was: PWV ( b = 0.2617, Exp[ b] = 1.2992, p = 0.0027; b = 0.3569, Exp[ b] = 1.4289, p = 0.0005), CRP ( b = 0.0776, Exp[ b] = 1.0807, p = 0.0001; b = 0.0832, Exp[ b] = 1.0868, p = 0.0001) and albumin ( b = −0.1302, Exp[ b] = 0.8779, p = 0.0089; b = −0.1881, 0.8285, p = 0.0030), respectively. Relative risk for exposed groups according to all-cause and CV events was 4.2976 (95% CI = 1.6051-11.5071) and 14.3590 (95% CI = 1.6051-11.5071), p = 0.0037, respectively. Conclusions: We conclude that PWV, CRP and serum albumin are strong independent predictors of overall and CV mortality in patients undergoing dialysis. [ABSTRACT FROM AUTHOR]

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Aim: The purpose of this study was to determine the prevalence of oral habits (nail biting, finger sucking) among the pre-elementary children in Bitola. Methods: In the observational average, (cross-sectional) study were covered 890 children 3 and 5 years old, who came to regular medical checkups during the period from January to December 2009, in the Health Centre in Bitola. During the research the following methods were applied: psychological testing (Chuturik Test), clinical paediatric examination, interview with the parents and applying the Questionnaire on Children’s Behaviour, Child Behaviour Checklist-Achenbach, 1981, in Hill R., & Castrol E. (2002): Getting rid of Ritalin, Hampton Roads Publishing Company, Inc. Results: The research included 890 children, of whom 401 were three yeas old and 489 five years old, and 51.6% male and 48.4% female. The prevalence of oral habits among the subjects was 35.39%. Statistical analyses showed that these habits can be found (p < 0.05) among 3-year-old children, but the tested difference concerning the gender was statistically insignificant (p > 0.05). Children who live in a rural environment, who do not have their own room and do not use a computer, statistically significantly manifested oral habits more often (p < 0.05). Tested differences in the frequency of oral habits according to the number of family members were statistically insignificant (p > 0.05). Children whose parents have primary education and whose mothers are working and have minimal incomes manifested a significantly more frequent presence of oral habits for the level of p < 0.01 and p < 0.05. Conclusion: These oral habits have a prevalence of 35.39% among the preelementary children in Bitola and should be viewed as a major public health problem. Because of their influence on the development of the orofacial system, the responsibility primarily of paediatrist and children's dentists is great for their prevention, early diagnosis and treatment in collaboration with other specialists, the child and parents. [ABSTRACT FROM AUTHOR]

The aim of this study is to improve 3-years survival rates and functional outcome in high-grade osteosarcoma patients treated with amputations and limb-sparing surgery, introducing Scandinavian Sarcoma Group chemotherapy protocol (SSG XVI). Patients and methods: During the period 2000-2005, thirty seven patients with high-grade, non-metastatic osteosarcoma on the extremities were treated at the Clinic for Orthopaedic Surgery in Skopje. Mail patients were 21 (57%) and female were 16 (43%). Patients age varied from 8 to 63 years (mean 18 ± 13). Seven patients (7/37) did not comply with including criteria and were excluded from the study. The rest 30 patients were introduced to two courses of pre-operative chemotherapy (high doses of Methotrexate, Cisplatin and Adriamycin). Surgical treatment was in 9-th week of the protocol. In 27/30 (90%) of the patients limb-sparing surgery was done, and in 3/30 (10%) amputations were performed. Histopathological assessment of the tumour after the neo-adjuvant chemotherapy divided the patients into group with bad and group with good response. All the patients had 3 more courses of chemotherapy after surgery (same as the preoperative). Patients with bad response were introduced to 3 more cycles of 5 days with high-dose of Ifosfamide. Follow-up was from 2 to 8 years, mean-51 months. Results: Histopathological assessment showed that 57% of the patients had bad response to neo-adjuvant chemotherapy, but there was no statistical significance in the survival time of the groups (p = 0.06). Three-years survival time was 40% of the patients with local recurrence in comparison with 80% of the patients with no local recurrence. Three-years survival time was 20% of the patients with distant metastases in comparison with 92% of the patients with no metastases. Overall survival time (OS) was 80%. After 3 years 60% of the patients were disease-free (DFS). Conclusion: High-grade osteosarcoma of the extremities treated with modem chemotherapy protocols enables limb-sparing in the same time with improved survival time of the patients. Introducing high-dose Ifosfamide in treatment of patients with bad response after neo-adjuvant chemotherapy improves their functional results as well as the survival time. [ABSTRACT FROM AUTHOR]

The purpose of the investigation was to determine the existence of the probable causal associations between cigarette smoking and the development and distribution of lung cancer. Material and methods: The research was conducted as a case-control study. It included 101 patients with lung cancer (investigated group-IG) and the same number of persons without this malignant disease (control group-CG). The members of both groups 'were interviewed within the period May 2006-May 2007. Risk analyses were done using unconditional logistic regression, which provides results in the form of a crude odds ratio. The odds ratios and their 95% confidence intervals (CI) were computed. Results: The habit of cigarette smoking was particularly wide-spread among men with lung cancer (68.8%), while in the CG this percentage was 40.3%. In IG, among the females, current smokers and nonsmokers are represented equally. Smokers and ex-smokers have a 4.05 (95%CI 1.78 < OR < 9.19) times significantly higher risk of becoming ill compared to the non-smokers. The risk of becoming ill increases significantly in smokers who smoke > 20 cigarettes per day (c/d) (p < 0.01) and is 9.33 (95%CI 3.56 < OR < 24.48) compared to nonsmokers. The risk of developing lung cancer is 4.55 (95%CI 1.86 < OR < 11.12) times greater in persons smoking > 15 years (y) > 20 c/d, compared to those who smoke < 1J y < 20 c/d. Conclusion." Our study supports the statement that cigarette smoking is by far the most important risk factor for lung cancer. Concerted control of smoking appears to be an urgent priority in lung cancer prevention, including efforts to prevent adolescents from starting to smoke. [ABSTRACT FROM AUTHOR]

Abstract Background Concurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours. The aim of this study was to analyse the results of three-dimensional conformal radiotherapy given with concomitant weekly cisplatin in patients with advanced oropharyngeal carcinoma and to identify prognostic factors influencing outcomes of this patients category. Methods Sixty-five patients with stage III or IV squamous cell carcinoma of the oropharynx who underwent concurrent radiochemotherapy between January 2005 and December 2010 were retrospectively analyzed. All patients received radiotherapy to 70 Gy/35 fractions/2 Gy per fraction/5 fractions per week. Concurrent chemotherapy consisted of weekly cisplatin (30 mg/m2) started at the first day of radiotherapy. Results Median age was 57 years (range, 36 to 69 years) and 59 (90.8%) patients were male. Complete composite response was achieved in 47 patients (72.3%). Local and/or regional recurrence was the most frequent treatment failure present in 19 out of 25 patients (76.0%). At a median follow-up of 14 months (range, 5 to 72 months), 2-year local relapse-free, regional relapse-free, locoregional relapse-free, disease-free, and overall survival rates were 48.8%, 57.8%, 41.7%, 33.2% and 49.7%, respectively. On multivariate analysis the only significant factor for inferior regional relapse-free survival was the advanced N stage (p = 0.048). Higher overall stage was independent prognostic factor for poorer local relapse-free survival, locoregional relapse-free survival and disease-free survival (p = 0.022, p = 0.003 and p = 0.003, respectively). Pre-treatment haemoglobin concentration was an independent prognostic factor for local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, disease-free survival, and overall survival (p = 0.002, p = 0.021, p = 0.001, p = 0.002 and p = 0.002, respectively). Conclusions Poor treatments results of this study suggested that introduction of intensity-modulated radiotherapy, use of induction chemotherapy followed by concurrent radiochemotherapy, accelerated radiotherapy regimens, and molecular targeted therapies could positively influence treatment outcomes. The incorporation of reversal of anaemia should be also expected to provide further improvement in locoregional control and survival in patients with advanced squamous cell carcinoma of the oropharynx.

Background: The impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients., Methods: This longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m 2 for men and women, respectively. The patients were followed during a 60-month period., Results: The mean FA-UA level was 425 ± 59 µmol/L (range 294-620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02-2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38-7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16-6.88,); P = 0.002]., Conclusions: Low serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research., (© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.)

Adipose tissue is a major store of energy for the human body. Polycystic ovary syndrome (PCOS) patients are more prone to abnormal production of some regulatory proteins secreted from the adipose tissue. This study aims to investigate serum levels of adiponectin and their correlation with metabolic and endocrine indices in PCOS., Patients and Methods: This study was conducted on 61 women with PCOS and 17 healthy women whose age and body mass index (BMI) were matched. Adiponectin serum levels were assessed and correlated with parameters of metabolic and hormonal disturbances., Results: In PCOS women, serum levels of insulin, HOMA-IR, testosterone, LH, and LH/FSH were significantly higher, while SHBG was lower than in healthy women. Lower adiponectin was observed in both PCOS groups compared to the control group. Serum levels of adiponectin correlated inversely with BMI (r=- 0.56; p<0.001),WC(r = -0.452;p<0.001), insulin levels (r= - 0.409; p<0.001), HOMA-IR (r= -0.368; p<0.001), and free androgen index (FAI) (r= - 0.53; p<0.001). A positive correlation was found between adiponectin and LH (r= 0.35; p<0.001), LH/FSH ratio (r= 0.33; p<0.001) and SHGB (r= 0.51; p<0.001). Serum adiponectin levels are decreased in women with PCOS compared to the control group. The decrease in adiponectin concentration indicates its potential role in metabolic disorders in the pathogenesis of PCOS, as well as in the development and progression of insulin resistance in PCOS patients., Competing Interests: The authors declare that they have no conflict of interest.

Introduction: The aim of this prospective study was to evaluate the association between serum magnesium (Mg) and mortality, in particular the cause-specific mortality of Mg and other risk factors in hemodialysis (HD) patients., Methods: We studied a cohort of 185 HD patients receiving thrice-weekly HD treatment, on a dialysate Mg concentration of 0.5 mmol/L. We stratified 3 patient groups according to the level of Mg: lower (<1.1 mmol/L), intermediate-reference (1.1 to <1.3 mmol/L), and higher (Mg >1.3 mm/L)., Results: During the 5-year follow-up, 60 patients died, with cardiovascular (CV) disease as the predominant cause (73.3%). Hazard ratio (HR) for all-cause and CV mortality were 2.55 and 2.67 in the lower versus intermediate Mg group, but there was no significant association between the higher and intermediate Mg group. Univariate Cox regression analysis showed that Mg <1.1 versus 1.1-1.30 mml/L with HR 2.34, was a significant univariate predictor for increased mortality in addition to the Hb <110 g/L, Alb <40 g/L, C-reactive protein (CRP) ≥10 mg/L and brain natriuretic peptide >1,200 pg/mL. However, in the multivariate analysis only CRP ≥10 mg/L with HR 3.89 was a significant predictor of mortality. Subgroup analyses showed that among patients with CRP >10 mg/L, HR for all-cause and CV mortality of the lower versus intermediate Mg group were 1.96 and 2.39, respectively, not reaching significance for the higher versus intermediate Mg group. Conversely, there was no association between Mg level and all-cause and CV mortality within these 3 groups among patients with CRP <10 mg/L., Conclusions: Lower serum Mg level was significantly associated with an increased all-cause and cardiovascular mortality in HD patients, especially in inflamed patients.

Introduction: The success of the antiviral treatment in patients with chronic hepatitis C depends on the factors related to the virus and the host. The aim of the study is the analysis of the antiviral therapy which is a combination of pegylated interferon and ribavirin, considering various factors that will identify the predictors of the sustained virological response., Material and Methods: This retrospective study included 226 patients, divided in two groups. Patients with sustained virological response and patients without sustained virological response were compared in terms of the following factors: genotype, viral load, gender, age, inflammatory and fibrotic changes in the liver, metabolic abnormalities, obesity and fatty liver., Results: The rate of the sustained virological response is 83.6%, more frequently in patients with genotype 3, with evidenced statistical significance (90.54%). The factors that significantly contribute to sustained virological response are related to the age (p = 0.0001), genotype (p = 0.002), mode of transmission (p = 0.005), inflammatory changes in the liver (p = 0.028), body mass index (p = 0.022) and insulin resistance (p = 0.039). The high rate of sustained virological response is related to the younger age of the patients which indirectly means short Hepatitis C Virus infection duration, absence of advanced liver disease and lack of significant co-morbid conditions. Single confirmed independent predictors of sustained virological response are the age (OR 0.928, p = 0.0001) and genotype (OR 3.134, p = 0.005)., Conclusions: Factors that are related to the virological response are the age, genotype, mode of transmission, inflammatory changes in the liver, body mass index and insulin resistance, but still, independent predictors of sustained virologic response are the age and the genotype.

Objective: The incidence of autoantibodies may be associated with the duration of drug use. In this study, we assessed the association between the duration of heroin dependence and various humoral immunologic indicators, including IgA, IgG, IgM, complement component 3, complement component 4, rheumatoid factor, anti-β2-glycoprotein 1 (IgA, IgG, IgM), antinuclear antibody, circulating immune complexes, and cryoglobulins., Methods: A total of 363 patients with heroin dependence were enrolled in this cross-sectional and prospective study over a 3.5-year period. Depending on the duration of heroin use, participants were divided into 3 groups: up to 3 years, 4 to 7 years, and more than 7 years of heroin dependence. All patients were analyzed for the indicators., Results: There was a significant difference between the duration of heroin dependence and increased concentration of IgA (P = 0.0000), IgG (P = 0.0000), IgM (P = 0.0001), complement component 3 (P = 0.042), rheumatoid factor (P = 0.0001), anti-β2-glycoprotein 1 (IgA, P = 0.0098; IgG, P = 0.0000; IgM, P = 0.0000), the presence of antinuclear antibody (P = 0.01) and cryoglobulins (P = 0.0000), and decreased concentration of complement component 4 (P = 0.002). There was no significant difference in circulating immune complex concentration (P = 0.097)., Conclusions: A longer duration of heroin dependence was associated with increased concentrations of IgA, IgG, IgM, complement component 3, rheumatoid factor, anti-β2-glycoprotein 1 (IgA, IgG, IgM), presence of antinuclear antibodies and cryoglobulins, and decreased concentrations of complement component 4, but there was no influence on circulating immune complex values.

Aim: The aim of the study was to investigate the prevalence of diabetes mellitus in privies diagnosed chronic obstructive pulmonary disease (COPD) patients with severe and very severe disease, which ware stable., Methods: We investigated 100 subjects, all of them smokers, with smoking status >10 years. They were stratified in two groups. It was clinical, randomized, cross sectional study. Besides demographic parameters, functional parameters, BMI, cholesterol, LDL and HDL, and the level of blood sugar was measured., Results: The prevalence of diabetes mellitus in our survey in total number of COPD patients with severe and very severe stage was 21%. In the very severe group were recorded significantly higher average values of glycaemia compared with severe group (7.67 ± 3.7 vs. 5.62 ± 0.9, p = 0.018). In the group with severe COPD, it was not confirmed any factor with significant predictive effect on the values of glycaemia. As independent significant factors that affect blood glucose in a group of very severe COPD were confirmed cholesterol (p <0.0001) and HDL (p = 0.018)., Conclusion: These results suggest that the presence of the COPD in patients itself is a factor that results in the clinical presentation of diabetes mellitus Type 2.

Background: High blood cholesterol is part of metabolic syndrome and can be caused by medical conditions or bad dietary habits., Aim: The aim of the study was to investigate the prevalence of hypercholesterolemia in privies diagnosed patients with the severe and very severe stage of COPD, which were stable., Material and Methods: We investigated 100 subjects, all of them smokers, with smoking status >10 years, stratified into two groups: with severe and very severe stage of the disease. It was clinical, randomized, cross-sectional study. Besides demographic parameters and functional parameters, body mass index, cholesterol, LDL, and HDL were investigated., Results: In the group of patients with very severe COPD were recorded significantly higher average values of cholesterol (6.16 ± 1.5 vs. 5.61 ± 1.1, p = 0.039). As independent significant factors influencing cholesterol in the group with a very severe COPD were confirmed the age of the patients (p = 0.005), LDL (p = 0.004) and HDL (p = 0.002). In the group with severe COPD, only LDL was confirmed as an independent significant factor that has an impact on cholesterol (p < 0.0001)., Conclusion: The results of our survey demonstrated a high level of blood cholesterol and LDL, and low level of blood HDL in both investigated group's patients with COPD.

Introduction: Ankle fractures are common injuries. Since the recognition of the importance of syndesmotic injury in ankle fractures, much of the scientific work has been focused on concomitant syndesmotic injury. Despite the invention of novel devices for restoration and maintenance of the congruent syndesmosis following syndesmotic injury, the metallic syndesmotic screw is still considered to be the "gold standard". The aim of this study was to compare the clinical results in patients who retained the syndesmosis screw with those in whom the screw was removed following open reduction and internal fixation of the malleolar fracture associated with syndesmosis disruption., Materials and Methods: This was a retrospective study of 82 patients. Minimum follow-up was 12 months. Clinical evaluation included American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analogue Scale (VAS) for patient general satisfaction. The condition of the screw (removed, intact or broken), presence of radiolucency around the syndesmotic screw and the tibiofibular clear space were recorded using final follow-up radiographs., Results: Three cortices were engaged in 66 patients (80%) and quadricortical fixation was performed in the remaining 16 patients (20%). The number of engaged cortices did not correlate with the clinical outcome and screw fracture. A single syndesmotic screw was used in 71 patients (86%. The mean AOFAS score in the group with intact screw (I) was 83; the scores in the group with broken screw (B) and removed screw (R) were 92.5 and 85.5, respectively. There was a statistically significant difference between the three groups: this was due to the difference between groups I and B; the difference between groups I and R and groups B and R were not statistically significant. There were no statistically significant differences in VAS results., Conclusion: There were no statistically significant differences in clinical outcome between the group with the screw retained and the group in which the screw was removed; however, the group with broken screws had the best clinical outcome based on AOFAS score. Widening of the syndesmosis after screw removal was not evident. We do not recommend routine syndesmosis screw removal., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder usually diagnosed in children, with appearance of the first symptoms before the age of seven years. The disorder is characterized by inattention and/or impulsivity and hyperactivity that can seriously affect many aspects of behavior and performance at school. ADHD can be associated with comorbidities, such as oppositional defiant disorder, conduct disorder, anxiety or depression., Material and Methods: The study was done on a sample of 500 university students. For the measurement of ADHD symptoms, the ADHD Adult Self-report Scale was used and for depression measurement DASS., Results: The results of this screening study showed that ADHD is highly significant associated with gender (p = 0.0004). Men more often than women have this kind of disorder. Female students have attention subtype deficit, while man student have often hyperactivity/impulsivity disorder and combined subtype due to psychological, temperament and character gender differences among boys and girls. Female examinees are significantly (p=0.028) more often depressed compared to male examinees., Conclusion: The examined correlations are positive ones or direct, meaning that by increasing the values of the scores from both subscales from the Evaluation ADHD Scale one also increases the scores from the Depression Scale, and vice versa. For a value of p=0.001 and p=0.004 these correlations are statistically highly significant, in other words highly important.

Background: A consensus about the optimal timing of dialysis initiation is still controversial. Thus, the goal of this analysis was to compare outcomes in patients with early and late referral with early and late initiation of hemodialysis (HD)., Methods: We studied 190 patients (mean age 52.03±14.22) who were initiated on HD between 1994 and 2004. Patients who received regular nephrology care during 12 months before HD initiation were categorized as early referrals (ER) and those without nephrology care were late referrals (LR). The early start (E-start) was defined by the estimated GFR (eGFR) at start of HD≥7.5 mL/min/1.73 m2, and the late start (L-start) by eGFR of <7.5 mL/min/1.73 m2. The four groups of patients (ER with E-start and L-start; LR with E-start and L-start) were prospectively followed in the next 60 months after HD initiation., Results: During the follow-up, 43.3% of E-start and 43.2% of L-start patients died, without significant difference in survival between the groups [HR for L-start vs. E-start=1.06 (95% CI 0.69-1.62); p=0.797]. When survival between ER and LR groups was compared (28.1% patients in the ER and 53.2% in the LR died), there was significant difference in survival [HR for LR vs. ER=2.16 (95% CI 1.28-3.65); p=0.004]. Compared with patients with ER and L-start, higher mortality was observed among those with LR and L-start [HR 3.51 (95% CI 1.48-8.35); p=0.004] and LR with E-start [HR 2.79 (95% CI 1.16-6.7); p=0.022]. There was no significant difference between patients in ER with L-start and ER with E-start., Conclusions: Our study showed that ER above 12 months before HD initiation and L-start of dialysis was associated with a reduced mortality risk in HD patients.

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder usually diagnosed in children, with appearance of the first symptoms before the age of seven years. The disorder is characterized by inattention and/or impulsivity and hyperactivity that can seriously affect many aspects of behavior and performance at school. Specific sociodemographic characteristics seem to contribute to the appearance of ADHD., Material and Methods: The study was done on a sample of 500 university students. For the measurement of ADHD symptoms, the ADHD Adult Self-report Scale was used and a specifically designed questionnaire for collecting sociodemographic data., Results: The results of this screening study showed that in 184 (48.7%) respondents the symptoms of the disorder in the activity and attention were registered. ADHD is highly significant associated with gender (p = 0.0004). Men more often than women have this kind of disorder. Our results also showed that living and material conditions were not associated with a higher prevalence of ADHD.

Purpose: The aim of this study was to evaluate different prognostic factors affecting response to treatment, locoregional control (LRC) and survival in patients with advanced hypopharyngeal squamous cell carcinoma (HPSCC)., Methods: A retrospective analysis of 41 patients with advanced HPSCC who had undergone definitive concurrent chemoradiation treatment between January 2006 and October 2009 was performed., Results: Complete composite response (CCR) was achieved in 27 patients (65.9)). Significant prognostic factors for CCR were T stage, technique of radiation, and gross tumor volume (GTV). Unfavorable prognostic factors for CCR in multivariate analysis were higher T stage and radiation technique with electron-photon fields. The 2-year LRC rate was 51.3%. The 2-year disease-free survival (DFS) and overall survival (OS) rates were 29.3% and 32.8%, respectively. Significant prognostic factors for LRC, DFS, and OS in univariate analysis were T stage, overall stage, and GTV. OS was also significantly influenced by N stage. In multivariate analysis T stage was found to be the only significant independent prognostic factor for LRC (p=0.003), DFS (p=0.01), and OS (p=0.005)., Conclusion: Revealing the significant prognostic value of T stage for CCR, LRC, DFS, and OS in the multivariate analysis, we consider that the implementation of intensity modulated radiotherapy (IMRT) and the adoption of intensified concurrent chemoradiotherapy (CCRT), sequential therapy, and targeted therapy should be strongly advocated in order to improve outcome in patients with locally advanced HPSCC.

Aim: The purpose of this study was to determine the prevalence of oral habits (nail biting, finger sucking) among the pre-elementary children in Bitola., Methods: In the observational average, (cross-sectional) study were covered 890 children 3 and 5 years old, who came to regular medical checkups during the period from January to December 2009, in the Health Centre in Bitola. During the research the following methods were applied: psychological testing (Chuturik Test), clinical paediatric examination, interview with the parents and applying the Questionnaire on Children's Behaviour, Child Behaviour Checklist-Achenbach, 1981, in Hill R., and Castrol E. (2002): Getting rid of Ritalin, Hampton Roads Publishing Company, Inc., Results: The research included 890 children, of whom 401 were three yeas old and 489 five years old, and 51.6% male and 48.4% female. The prevalence of oral habits among the subjects was 35.39%. Statistical analyses showed that these habits can be found (p<0.05) among 3-year-old children, but the tested difference concerning the gender was statistically insignificant (p>0.05). Children who live in a rural environment, who do not have their own room and do not use a computer, statistically significantly manifested oral habits more often (p<0.05). Tested differences in the frequency of oral habits according to the number of family members were statistically insignificant (p>0.05). Children whose parents have primary education and whose mothers are working and have minimal incomes manifested a significantly more frequent presence of oral habits for the level of p<0.01 and p<0.05., Conclusion: These oral habits have a prevalence of 35.39% among the pre-elementary children in Bitola and should be viewed as a major public health problem. Because of their influence on the development of the orofacial system, the responsibility primarily of paediatrist and children's dentists is great for their prevention, early diagnosis and treatment in collaboration with other specialists, the child and parents.

Introduction: Several clinico-pathological characteristics such as age, sex, tumour localization, Breslow thickness, ulceration, mitotic count, vessel invasion and the presence of tumour-infiltrating lymphocytes have been identified as independent prognostic factors for relapse and overall survival of patients with skin melanoma. The aim of this study was to identify characteristics of primary melanoma which predict sentinel lymph node (SLN) positivity and the onset of regional lymph nodes metastases., Material and Methods: A total of 60 patients who underwent surgery for malignant skin melanoma, divided into examined and control group, were analyzed. In the patients from the examined group SLN were marked with 1% solution of methylene blue, removed and histologically examined. The radical lymphadenectomy was performed as a separate procedure in the patients with SLN positive for metastasis. We analysed the differences in age, sex, tumour location, tumour area, primary tumour thickness, Clark levels of invasion, lymphocytic infiltration and presence of ulcerations in patients in the examined group and the control group and the correlation of the examined variables with the onset of metastases in the SLN., Results: The results showed that the differences between the groups were statistically significant only for the primary melanoma thickness and the Clark level of invasion. There was a significant difference in the intensity of the lymphocytic infiltration between the SLN negative patients and the patients from the control group. A statistically significant correlation with SLN positive status was found only with the Clark level of invasion.

Unlabelled: The aim of this study is to make a correlation of the clinical and radiographic results after performing two different surgical procedures for correction of hallux valgus deformity., Material and Methods: The study included 70 patients having hallux valgus deformity of the foot, and they were divided into two groups. The first group (Group 1) was composed of 35 patients who were treated by osteotomy of the I-st metatarsal bone according to Mitchell, while the second group (Group 2) was also composed of 35 patients who were treated by resectional arthroplasty according to Keller. Clinical (pain and metatarsalgia, as well as most dominant symptoms) and radiographic examinations (I metatarsophalangeal angle and I intermetatarsal angle) were analysed comparatively during the evaluation. The analysis of the clinical and radiographic results was performed pre-operatively and post-operatively for the two groups., Results: According to their sex, the patients were 5 men and 65 women. Using the method of Mitchell, pain as a clinical symptom post-operatively was found in only 3 patients out of the 35 with operated feet, while in the other group of patients treated by the method of Keller, there was no presence of pain in any of the patients. Comparatively, this does not present a statistically significant difference (p>0.05). Nor do, the differences in the distribution of metatrsalgia incidence show a statistical significance between the two groups (p>0.05). There is no significant difference (p>0.05) in the patients of the two groups concerning the pre-operative mean dimension values of the I metatarsophalangeal angle and I intermetatarsal angle. However, the radiographic analysis of the same angles in both groups, one year post-operatively, showed a high statistically significant difference (p<0.001)., Summary: Mitchell's operative technique could be recommended as an effective procedure for the correction of hallux valgus and metatarsus primus varus in young and middle-aged patients, while the resection arthroplasty according to the method of Keller is recommended for older patients with arthrotic changes.

Background: Vitamins and/or mineral food supplements (VMS) are mono- or multi-component products prepared in different pharmaceutical forms and categorized as food supplements. Numerous researchers have investigated the epidemiological predictors of use of VMS in population. Data of this kind in our setting are limited., Aims: This survey aimed to gain information on the prevalence of use, certain sociodemographic predictors and reasons for VMS use in a group of 256 outpatients in Skopje., Materials and Methods: This study was designed as an open-ended, cross-sectional survey. Data on VMS use were collected by survey method with a specially designed questionnaire as an instrument for this research. Appropriate statistical tests were used to analyse the data., Results: Data from 256 outpatients from Skopje were analysed. Of them, one hundred and five (41.02%) reported using VMS. Female outpatients (p<0.01) and participants of Macedonian ethnicity (p<0.01), with a higher educational level (p<0.01) and those having their own income (p<0.05) reported significantly higher consumption of VMS. We found a statistically significant difference between the group of users and non-users of VMS regarding smoking status (p<0.05), alcohol consumption (p<0.05) and presence of a chronic disease (p<0.01). Physicians, magazines and friends were the most common source of information on VMS while maintaining good health and prevention of disease was the most common reasons for the use of these products. Only 63% of the users had disclosed the information on taking VMS to their physicians., Conclusion: This research provided an insight into VMS in our setting. Predictors on the use of VMS are of interest since these products contribute to total intake of vitamins and minerals in the population and they represent a source of valuable information when planning public health activities.

Unlabelled: The aim of the study was to investigate the gender differences in patients with schizophrenia in age of onset, other demographic and clinical characteristics and their relationship with QEEG power spectrum measures., Material and Methods: Thirty patients with schizophrenia were enrolled in the study, 17 female and 13 male, mean age 34 years. Comprehensive assessment of the symptoms of schizophrenia was performed using PANSS (Positive and Negative Syndrome Scale), BPRS (Brief Psychiatric Rating Scale) and CGI (Clinical Global Impression) scale. The age of onset of schizophrenia and the duration of psychosis was assessed using the medical history and parts of the IRAOS (Interview for Retrospective Assessment of Onset of Schizophrenia)., Results: Female patients had more severe psychopathology with statistically significant differences in PANSS and BPRS scores (larger total scores) and on the positive subscale of PANSS. QEEG power spectrum showed statistical significant difference only for the beta band in female patients. Women were less employed and had longer duration of illness and previous treatment. There were no differences in the mean age of onset of the disease (26 years in male and 25 years in female patients) and in the familiar occurrence., Conclusion: Fast basic activity in beta bands was associated with female patients with schizophrenia who presented more severe psychopathology and had longer duration of the disease and previous treatment. Considering the relatively small sample the current results must be replicated with a larger group of subjects to confirm the findings.

Purpose: To improve survival rates and functional outcome in patients with non-metastatic, high-grade osteosarcoma of the extremities, using the Scandinavian Sarcoma Group XIV neoadjuvant chemotherapy protocol., Patients and Methods: The analysis included 37 patients treated during the period 2000-2005. Age range was 8 to 65 year (median 23). Seven (7/37) patients were excluded from the study. The remaining 30 patients received 2 cycles of preoperative chemotherapy (high dose methotrexate, cisplatin and doxorubicin). Surgery was carried out in the 9th week. Twenty-seven (90%) patients had limb-salvage operation and in the remaining 3 amputation was performed. Based on the histopathological assessment of the removed tumor patients were classified in two groups (regarding good or poor response to chemotherapy). All 30 patients received 3 courses of postoperative chemotherapy with the same regimen. Patients with poor response received 3 more cycles of chemotherapy with high dose ifosfamide. Follow-up was 2-8 years (mean 52 months)., Results: Histopathological assessment showed poor response to neoadjuvant chemotherapy in 57% of the patients but no significant difference in 3-year survival between the 2 groups was noted. Three-year survival of the patients with local recurrence was 40 vs. 88% of those without local recurrence (p=0.013). Three-year survival of the patients with distant metastases was 20 vs. 92% of those without distant metastases (p=0.0002). Three-year overall survival (OS) was 80% and disease-free survival (DFS) 60% for all 30 patients., Conclusion: Neoadjuvant chemotherapy in patients with high-grade osteosarcoma of the extremities gives the opportunity for limb-sparing operation and at the same time improves survival rates.

Introduction: Lung cancer (LC) is one of the most common diseases in the world. Smoking is the most important "lifestyle" risk-factor attributed to the development of LC., Objective: The aim of the study was to determine the existence of a causal association between cigarette smoking and the development and distribution of LC., Material and Methods: The case-control study was conducted in 91 patients with LC (investigated group-IG) and the same number of persons without malignant disease (control group-CG). Both groups were interviewed between 14 July 2005 and 14 July 2006. Risk analyses were done using unconditional logistic regression, which provided results in the form of crude odds ratio. The odds ratios and their 95% confidence intervals (CI) were computed., Results: Cigarette smoking is wide spread among men with LC (68%), while in CG this percent is 40.3%. In IG, among females, current smokers and nonsmokers are represented equally. More than a half of the LC patients smoke between 21-40 c/d (56.8%). Smokers and ex-smokers have 4.05 (95% CI 1.78 < OR < 9.19) times significantly higher risk to become ill compared to the non-smokers. The risk for becoming ill is 9.33 (95% CI 3.56 < OR < 24.48) times higher in smokers who smoke >20 c/d (p<0.01) compared to nonsmokers. The risk for developing LC is 4.55 (95 % CI 1.86 < OR < 11.12) times higher in persons smoking >15 years >20 c/g, compared to those who smoke <15 years <20 c/d., Conclusion: Our study supports the statement that cigarette smoking is by far the most important risk factor for LC. Concerted control of smoking appears to be an important priority in LC prevention, including efforts to prevent adolescents from starting to smoke at an early age (Tab. 2, Fig. 2, Ref. 22). Full Text (Free, PDF) www.bmj.sk.

Unlabelled: THE PURPOSE of the investigation was to determine the existence of the probable causal associations between cigarette smoking and the development and distribution of lung cancer., Material and Methods: The research was conducted as a case-control study. It included 101 patients with lung cancer (investigated group-IG) and the same number of persons without this malignant disease (control group-CG). The members of both groups were interviewed within the period May 2006-May 2007. Risk analyses were done using unconditional logistic regression, which provides results in the form of a crude odds ratio. The odds ratios and their 95% confidence intervals (CI) were computed., Results: The habit of cigarette smoking was particularly wide-spread among men with lung cancer (68.8%), while in the CG this percentage was 40.3%. In IG, among the females, current smokers and nonsmokers are represented equally. Smokers and ex-smokers have a 4.05 (95%CI 1.78 < OR < 9.19) times significantly higher risk of becoming ill compared to the non-smokers. The risk of becoming ill increases significantly in smokers who smoke > 20 cigarettes per day (c/d) (p < 0.01) and is 9.33 (95%CI 3.56 < OR < 24.48) compared to nonsmokers. The risk of developing lung cancer is 4.55 (95%CI 1.86 < OR < 11.12) times greater in persons smoking > 15 years (y) > 20 c/d, compared to those who smoke < 15 y < 20 c/d., Conclusion: Our study supports the statement that cigarette smoking is by far the most important risk factor for lung cancer. Concerted control of smoking appears to be an urgent priority in lung cancer prevention, including efforts to prevent adolescents from starting to smoke.

Unlabelled: The aim of this study is to improve 3-years survival rates and functional outcome in high-grade osteosarcoma patients treated with amputations and limb-sparing surgery, introducing Scandinavian Sarcoma Group chemotherapy protocol (SSG XVI)., Patients and Methods: During the period 2000-2005, thirty seven patients with high-grade, non-metastatic osteosarcoma on the extremities were treated at the Clinic for Orthopaedic Surgery in Skopje. Mail patients were 21 (57%) and female were 16 (43%). Patients age varied from 8 to 63 years (mean 18 +/- 13). Seven patients (7/37) did not comply with including criteria and were excluded from the study. The rest 30 patients were introduced to two courses of pre-operative chemotherapy (high doses of Methotrexate, Cisplatin and Adriamycin). Surgical treatment was in 9-th week of the protocol. In 27/30 (90%) of the patients limb-sparing surgery was done, and in 3/30 (10%) amputations were performed. Histopathological assessment of the tumour after the neo-adjuvant chemotherapy divided the patients into group with bad and group with good response. All the patients had 3 more courses of chemotherapy after surgery (same as the preoperative). Patients with bad response were introduced to 3 more cycles of 5 days with high-dose of Ifosfamide. Follow-up was from 2 to 8 years, mean 51 months., Results: Histopathological assessment showed that 57% of the patients had bad response to neo-adjuvant chemotherapy, but there was no statistical significance in the survival time of the groups (p = 0.06). Three-years survival time was 40% of the patients with local recurrence in comparison with 80% of the patients with no local recurrence. Three-years survival time was 20% of the patients with distant metastases in comparison with 92% of the patients with no metastases. Overall survival time (OS) was 80%. After 3 years 60% of the patients were disease-free (DFS)., Conclusion: High-grade osteosarcoma of the extremities treated with modern chemotherapy protocols enables limb-sparing in the same time with improved survival time of the patients. Introducing high-dose Ifosfamide in treatment of patients with bad response after neo-adjuvant chemotherapy improves their functional results as well as the survival time. Key words: osteosarcoma, neo-adjuvant chemotherapy, limb-sparing.