ADIPONECTIN AS A SERUM MARKER OF ADIPOSE TISSUE DYSFUNCTION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME: CORRELATION WITH INDICATORS OF METABOLIC DISTURBANCES.

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.

Aortic pulse wave velocity is a strong predictor of all--cause and cardiovascular mortality in chronic dialysis patients.

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.

Prognostic factors in patients with advanced hypopharyngeal squamous cell carcinoma treated with concurrent chemoradiotherapy.

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.

Tobacco use and the risk of lung cancer in Macedonia.

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.

Limb-sparing in patients with non-metastatic high-grade osteosarcoma.

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.

Joint incidence of asthma and rhinitis in macedonia.

The concept of "united airways disease", based on many similar features and mutual interactions in the pathogenesis of asthma (A) and rhinitis (R), has led to an integral approach to their management. We conducted this study to determine the quantity of the problem of joint incidence of A and R in R. Macedonia, and, perhaps to obtain information on a potential causative effect of the two diseases. Three hundred eighty six patients, who presented with wheezing and/or upper respiratory symptoms at the Pulmology and Allergy Clinic, Skopje, were included during a period of 48 months. The presence of bronchial hyperreactivity - BHR (positive histamine challenge), atopy (prick test to seasonal or perennial inhaled allergens), rhinitis symptoms (such as nasal secretion and obstruction) and X-ray of paranasal sinuses was registered by a specially designed questionnaire. R was diagnosed in 106 of the subjects (27.5%), and A in 280 (72.5%). Among the patients with A, co-incidence with R was found in 219 (76.5%). Including X-ray of paranasal sinuses to the diagnostic protocol increased this percentage to over 90% (256 patients). From the 219 patients with A and R together, 127 (57.99%) had positive atopy. On the other hand, 19 (18.0%) of the rhinitis-only patients had positive BHR without asthma symptoms. The follow up of the rhinitis patients with positive BHR revealed 4 patiets who developed asthma within 36 months, but this was also the case with 2 of the subjects with R and negative BHR. In conclusion, the co-incidence of A and R in our material is 78.21%, or 91.4% (including sinusitis); a greater co-existence of A and R is found in atopic patients. The patients with allergic R are at high risk for developing A and should be monitored in the future and the R symptoms should be adequately treated in order to minimize the risk for developing asthma.

Oral habits among pre-elementary children in Bitola.

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.

Predictors of sentinel lymph node status and onset of regional lymph nodes metastases in melanoma.

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.

Clinical and radiographic analysis of the operative procedure results according to the method of Mitchell and Keller used for correction of hallux valgus deformities.

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.

Socio-demographic predictors and reasons for vitamin and/or mineral food supplement use in a group of outpatients in Skopje.

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.

Are there any gender differences in the QEEG power spectrum in patients with schizophrenia?

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.

Lung cancer and the smoking habit - case control study.

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.

Treatment of non-metastatic high-grade osteosarcoma (study of 30 cases treated with Scandinavian osteosarcoma protocol XIV and surgery).

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.