Macedonian Journal of Medical Sciences   

Institute of Immunobiology and Human Genetics, Faculty of Medicine, University “Ss Kiril and Metodij”, Skopje, Republic of Macedonia

We present English abstracts of MSc theses defended in 2010 at the Faculty of Medicine, University “Ss Cyril and Methodius”, Skopje, Republic of Macedonia. English summaries are published as they are translated by authors and included in the final version of defended MSc. Macedonian Medical Master of Sciences (MSc) theses are deposited in the Central Medical Library and National and University Library “St. Kliment Ohridski” in Skopje.

At the Faculty of Medicine in Skopje 13 MSc theses there were defended in 2010, eight MSc are without abstracts (61.5%), nine MSc are without Key words (69.3%), and five MSc are without declared mentors (38.5%). Editorial Board does not take any responsibility either for the content, nor the quality of the abstracts.

We have to repeat again and again that primary responsibility for the quality of the MSc theses belongs to the mentors, to the institutions they are representing, and to the Vice-Dean of science. All of them should be more actively involved in the preparation of Master of Sciences theses in order international standards to be achieved.

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Abstract not available.

Key words: Not available.

Defended: January 11, 2010.

Mentor: Prof. Dr. Pavle Filjanoski

Introduction: The interpretation of the Mantoux test, as well as knowledge of the factors that affect the test’s induration size is significant for early diagnosis of tuberculosis in children and preventing its progression into heavier disease forms.

Goals: To determine the Mantoux test induration cut-off value that distinguishes between positive and negative results. To determine the effects of exposure to source of infection, as well as age, nutritional status, social status and clinical forms of tuberculosis to the induration size of the Mantoux test in children with tuberculosis.

Materials and methods: A retrospective and descriptive study has been carried out, in patients up to 14 years old with diagnosed tuberculosis, who had been treated during years 2003 to 2007, in the department for child tuberculosis at the ,,Institute for Respiratory Diseases in Children-Kozle”, Skopje, Macedonia. Demographic, epidemiological, socioeconomical and clinical characteristics were evaluated. The cut-off value of Mantoux test induration was determined through the analysis of the test results distribution. The factors that independently associate with a positive Mantoux test were determined through group comparative analysis of the diseased, according to the value of the Mantoux test (<5 mm and >5 mm) in a multivariate logistic regression.

Results: Two hundred and seventy children with tuberculosis were included in the study. The lung form of TB was present in 87.8% of the children. 53.7% of the diseased were male, and 46.3% were female. The age group of 1 to 2 years was the most prominent (15.2%), followed by the group of 7 to 8 years (10.4%). The weight-for-age z-value of <-2.00 was present in 12.2% of the diseased children. The Mantoux test’s induration size was in the range of 0 to 32 mm, with the average of 13.4 mm. The distribution of the frequency of the indurations has a bi-modal form, with the primary mode at 0 mm, the second mode at 15-19 mm and antimode at 5-9 mm. The Mantoux test had a sensitivity of 82.5%, specificity of 62%, positive predictive value of 68.46% and negative predictive value of 78.61%. In a multivariate logistic regression it has been established that a known source of infection, age less than 24 months and poor living conditions independently statistically significantly associate with a positive Mantoux test value (p<0.05).

Conclusion: The cut-off value of the induration which distinguishes negative from positive Mantoux reaction is 5 mm. The interpretation of the test is recommended to be carried out depending on the risk factors for TB development which surround children, i.e. for positive to consider induration >5 mm in children with close contact with a person that has infective TB, children with clinical signs and radiological findings suggestive of TB, children with immunosuppressive state, children younger than 24 months and children from families with poor living conditions. The Mantoux test in malnourished children should be interpreted with caution.

Key words: tuberculosis; children; Mantoux test; induration distribution; cut-off value.

Defended: January 21, 2010.

Mentor: Not avialable.

Abstract not available.

Key words: Not available.

Defended: April 13, 2010.

Mentor: Prof. Dr. L. Kamchevska.

Candida is a yeast and common cause of the opportunistic mycosis, it is usually destructive and collonizes the skin and mucous membranes i.e. the regular microflora of the mouth cavity, the skin, the vagina and the colon. In the cases of human infections most commonly isolated are: Candida albicans (50-60%) which is one of the most significant pathogen species as well as the group of Candida non-albicans species: Candida non-albicans: Candida tropicales (6-12%), Candida glabrata (15-20%), Candida parapsilosis (10-20%), Candida lusitaniae, Candida krusei (1-3%), Candida kefyr (<5%), Candida guilliermondi (<5%), Candida lusitaniae (<5%), Candida dubiliniensis (<1%). The usual risk factors of local and systemic Candida infections are alteration of the imune system and various yatrogenic factors (for exemple irrational use of various antibiotics and the changes inthe endocrine and methabolic ballance cause the fungal collonization which primarily causes disorder in the internal ecology and reduced imune response of the host.

Infections with Candida which appear to be endogenic are usually a result of thw developing yeast cells i.e the candida which was part of the normal flora in the organism now has expanded, However, the causes for these infections may be of egzogenic sources as well (after the application of prothesis or cateters or transmision from the patients).

The pathogeneses of the Candida breed is determined by the ability of adhering of the mucous membranes and the tissues of the host and forming of the so called biofilm, it is also determined by the production of the secretary aspartil prosthesis and the production of phosphorilaza enzymes and by the ability of transformation from yeast phase to hive phase.

With the massive empiric use of the antifungal measures we are exposing to a risk of changes in the yeast population via suppression or eradication of the sensitive species the survival of the less sensitive species and the possibility of their reproduction and expansion to the level of the predominant yeast (selection of the mutant resistant yeast cells). There may appear many resistance determinates in a single yeast breed so it is almost impossible to determine the significance of every separate mechanism at the whole level of resistance. However, the resistance may appear secondarily as a result of the accumulation of many resistance factors in the same time. In the last decade in the world and in the Republic of Macedonia it’s noticed the increased number of infections with Candida and with it it’s imposed the necessity of the monitorung of the antifugal sensitivity of the Candida isolates. The poorness of acknowledgment in the field of Candida resistance towards antifugal measures in the Republic of Macedonia is imposing the possibility of the contribution in the correct choice of the antifugal therapy of the local infections with this yeast.

The goals of this prospectiv i.e. retrospective examination research are getting information of the presence of the different types of Candida non albicans in local micotic infections in the Ohrid and Struga regions, distinguishing the differences of the antifugal sensitivity on Candida albicans and Candida non albicans species and with it identification of the common resistance types which are present in the local micro ecology in the area. Swabs of Candida isolated from the swabs of oropharyngeal membrane, swabs taken from a tongue and egzocervix were used as material. All in all 85 breeds of Candida albicans and 50 breeds of Candida non albicans were examined. Cultivation, isolation, identification and visual diferentiation of the Candida breed were examined by a CALB (Chromogen Candida Albicans - Oxoid) medium. ID 32 C Mini Api (BioMerieux) was used in the identification of various non albicans Candida breed as a standard identification system of the yeasts. The antifungal sensitivity of the Candida breeds was distinguished by a standard disk - diffusion method (NCCLS/CLSI). According to the criteria of the manufacturer Liofilhem antifugal sensitivity of the Candida isolates towards the following antimicotics was visually detected: Amphotericin-B, Clotrimazole, Econazole, Fluconazole, Flucitosin, Itraconazole, Ketoconazole, Miconazole, Nystatin. The results ot the this examination are referring of the presence of statistically significant difference in the appearance of Candida albicans (63%) and Candida non albicans (37%) isolated from local infections. Candida albicans and non albicans were mostly present in the swabs of the egzocervix (63.5% and 68%) and also of the mucous membrane (11.8% and 10.0%). From the various breeds of Candida non albicans mostly isolated were Candida glabrata (30%) and Candida kefyr (20%). 43 isolates (31.9%) showed resistance on Itraconasole and 11 (8.1%) showed intermediate sensitivity on the same medicine. 6 (4.4%) showed resistance on Nistatin and 1 (0.7%) showed intermediate sensitivity. Candida albicans isolates were resistant on Fluconasol and 10(7.4%) showed intermediate sensitivity whereas Candida non albicans breeds showed resistance of 3 (6.0%) and intermediate sensitivity of 10 (20.0%). Out of 135 isolates of Candida albicans and Candida non albicans 27 (20.0%) were resistant, 7 (5.2%) showed intermediate sensitivity and 101 (74.8%) showed resistance on Flucitosin. In vitro resistance is not noticed in none of the 135 isolates of Candida albicans and Candida non albicans on the following antifugal medicine: Ketoconasol, Miconasol, Econasol, Amphotericin B and Clotrimasol 34 (25.2%). The resistance type (RR) was significantly more present in Candida albicans 24 (28.0%) isolates than in Candida non albicans isolates. Out of 50 isolates of Candida non albicans the resistance type (PP) was present only in 3 (6.0%) isolates. The resistance type (RS) was found in 7 (8.2%) Candida albicans isolates, whereas (RS) resistance type was not detected in the 50 Candida non albicans isolates. Although the sensitivity towards the antifugal medicines is not an everyday especially in every particular patient, still it’s very important issue in distinguishing the sensitivity on particular medicine (IHI-isolate). The temporally and periodically testing of the amtifugal sensitivity will help in selection of the adequate empirical dozing regime and will warn in time about the shanges of the antifugal sensitivity of the different types of the Candida breed. And even though there is on widely present antifugal resistance in our environment we must be careful towards the variability of the senssitivity in particular breeds and also must be careful for their distribution and resistance.

Key words: Not avialable.

Defended: April 14, 2010.

Mentor: Prof. Dr. Kakja Popovska - Jovanovska.

Abstract not available.

Key words: Not available.

Defended: April 20, 2010.

Mentor: Prof. Dr. Mirche Simeonov.

Nephrotoxicity in heroin users is associated with the nephrotic syndrome, acute glomerulonephritis, amyloidosis, interstitial nephritis and rhabdomyolysis. Clinically kidney disorders are often revealed by asymptomatic proteinuria and very rarely with manifested nefrotic syndrome.

The cross section study included 60 heroin addicts, in which an estimation of kidney function was preformed and incidence of the asymthomatic proteinuria was established. Biochemical-labaratory analysis for function of renal estimation were determineted: albumin/creatinin ratio, KKK, creatine/s, 24h proteinuria, total protein (albumin, globulins), blood differential, electrolytes, toxicology analysis, renal ultrasonography, test for viral infection (hepatitis, HIV).

Results imply that values of creatinine in serum and KKK among heroin users varies in normal limits, however values of KKK are significantly lower regarding those from the control group. Significant connection between heroin application and occurrence of renal failure was not reported. Dependence duration did showe significant correlation with occurrence of renal disease. In the examinated group of patients macroalbuminuria was not detected. In half of the respondents microalbuminuria was detected. The usage of heroin increases the risk of occurrence of microalbuminuria twice, and break down the usage of heroin more then tow years increases the risk for occurrence of microalbuminuria seven times. Albumin/creatinine ratio is more superior method for early detection of microalbuminuria in heroin users compared to 24h proteniuria. In the examined population the described changes are result of the toxic effects of heroin on the kidneys. Among multiorganic toxicity associated with heroin use, mild disorders of renal function are present.

Key words: Heroin; proteinuria; nephrotoxicity.

Defended: April 16, 2010.

Mentor: Not available.

Abstract not available.

Key words: Not available.

Defended: April 28, 2010.

Mentor: Prof. Dr. Nikola Siljanovski.

According to neurodevelopmental hypohesis schizophrenia results from a neurodevelopmental abnormality during the prenatal period. Empirical support for the neurodvelopmental model of schizophrenia is difficult to be obtained because the period of interest (prenatal) is hard to be assessed directly. One approach to studying neurodevelopmental factors has been to look for neurodevelopmental markers-valid biological indicators in adult schizophrenic patients. Two of the most commonly studied markers are dermatoglyphic signs and minor physical anomalies (MPA).

MPA are slight deviations in the external physical characteristics without medical or cosmetic repercussion per person. The pathogenesis of these anomalies would appear to be the result of inherited genetic defects, chromosomal aberration and environmental teratogenic agents interacting through unknown mechanisms.

A total of 146 patients satisfying ICD-10 criteria for schizophrenia and 114 mentally healthy subjects were evaluated for MPAs. Anomalies were assessed by the method proposed by Waldrop et al., as the average number of minor anomalies per individual, and as the weighted score of minor anomalies. Variables were grouped into 6 regions (head, eyes, ears, hands, feet), and we calculated regional scores, a score for the craniofacial region (MPA-CF), a score for the periphery (MPA-P) and a total score (MPA-T) according to the Waldrop scale. The aim of the study was to investigate the rate and topographical pattern of MPAs in schizophrenic patients and normal control subjects. The study was conducted to evaluate the relevance of MPAs –T score to sex, age of onset of the disease and season of birth. The logistic regression analysis was performed to determine the MPAs that best predict patient – control status. Schizophrenics showed a higher rate for almost all examined anomalies. The patients have significantly higher MPA-T score (mean score 3.97±1.82) v.s 1.66 ± 1.37 for control group (p< 0.001).

Defended: May 3, 2010.

Mentor: Prof. Dr. Vesna Malevska-Ivanovska.

Abstract not available.

Key words: Not available.

Defended: June 9, 2010.

Mentor: Prof. Dr. Ilija Todorov

Glomerulonephritis is a heterogenic group of diseases where pathological process is presumably localized in the glomerules.

The aim of this study is to present the epidemiological characteristics of glomerulonephritis, documented with renal biopsy, in children in Republic of Macedonia in the period from 1996 to 2008.

This study was performed in Clinic of Child Disease and Department of pathology. We analyzed 82 children in the age from 1 to 15 years, who had diagnosis of glomerulonephritis. The data from the history and the renal biopsy findings were analyzed.

The mean age of patients was 8.59+3.9 with predominance of male gender. The two most frequent national groups (Macedonian/Albanian) were equal registred.

Primary glomerulonephritis was registred in 65(79.27%) patients and secondary glomerulonephritis was registred in 17(20.73%) patients.

The most frequent clinical presentation in the group of primary glomerulonephritis was nephrotic syndrome found in 56.80% of cases, and the most frequent clinical presentation in the group of secondary glomerulonephritis was acute nephritic syndrome combine with nephrotic syndrome found in 64.70% of cases.

The most frequent pathohistological finding in the group of primary glomerulonephritis was minimal change disease found in 35.38% of cases, and the most frequent secondary glomerulonephritis was Hoenoch Schonlein mesangioproliferative nephritis in 58.82% of cases.

The most frequent clinical presentation in the group of minimal change disease was nephrotic syndrome. In the same time, nephrotic syndrome was the most frequent clinical presentation in focal segmental glomerulosclerosis, membranous glomerulonephritis and mesangioproliferative glomerulonephritis.

The most frequent clinical presentation in the group of IgA nephropathy was haematuria recidivas found in 80.0% of cases, and the most frequent clinical presentation in the Hoenoch Schonlein nephritis and lupus nephropathy was acute nephritic syndrome combine with nephrotic syndrome.

Our results were compared with the data published in the medical literature. They were similar concerning in sex distribution, but different with reference to distribution of separate types of glomerulonephritis.

This difference probably is result of different selection of the groups or different criteria for realization of renal biopsy as well as of different genetic background of the patients.

Key words: epidemiology; glomerulonephritis; renal biopsy; child.

Defended: June 15, 2010.

Mentor: Not available.

Abstract not available.

Key words: Not available.

Defended: December 02, 2010.

Mentor: Not available.

Abstract not available.

Key words: Not available.

Defended: June 14, 2009.

Mentor: Prof. Dr. Branislav Stefanovski.

Abstract not available.

Key words: Not available.

Defended: December 7, 2010.

Mentor: Prof. Dr. Nikola Orovchanec.

Abstract

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