Depression and Anxiety in Adolescents and their Caregivers: A Cross-Sectional Study from North Macedonia.

Introduction: Mental health problems have increased internationally during the COVID-19 pandemic. Adolescents and their caregivers form a vulnerable group for the development of mental health problems. However, most data stems from high-income countries, and there is a clear lack of prevalence rates and potential risk factors from Balkan countries. No data is available on the impact of the COVID-19 pandemic on mental health in adolescents and their caregivers in North Macedonia. Materials and methods: A cross-sectional study was conducted on adolescents and their caregivers in a school setting in rural and urban areas of North Macedonia. Survey items assessed symptoms of depression, anxiety, and respondents' fear of COVID-19, as well as a number of risk factors, such as gender and living environment. Results: 506 adolescents and 492 caregivers completed the survey. Symptoms of depression and anxiety were mild to moderate in adolescents and their caregivers. Women and girls generally scored higher than men and boys, and adolescents in high school scored higher than those in elementary school. Prevalence rates for depression were 29.2% for adolescents and 10.4% for caregivers, while rates of anxiety were 23.7% for adolescents and 6.1% for caregivers. Conclusion: This study provides a first insight into the mental health of adolescents and their caregivers after the COVID-19 pandemic in North Macedonia. Further research is required to investigate the relatively low rates of caregivers' mental health problems compared to data from other countries.

Incidence and prevalence of epilepsy in the Republic of North Macedonia: Data from nationwide integrated health care platform.

PURPOSE: This study aimed to evaluate the incidence and period prevalence of epilepsy in the Republic of North Macedonia, an upper-middle-income country with universal access to healthcare, based on a nationwide healthcare platform (NHP). METHODS: NHP contains reports from all inpatient and outpatient medical encounters and procedures, and all electronic medical records are linked together with a unique patient number. We performed the analysis of the data maintained at the Macedonian Ministry of Health, concerning the five years of the study (2014 through 2018). Population and demographic data for each year were obtained from the State Statistical Office. RESULTS: The period prevalence was 6.67 per 1,000 inhabitants. There were 6383 (46.2%) females and 7435 (53.8%) males; the gender difference was significant: 6.17 per 1,000 females and 7.16 per 1,000 males (p = 0.0000). Between 2015 and 2018 the median annual incidence of epilepsy was 68 new epilepsy patients per 100,000, with an upward trend over time. The age-specific incidence was high in childhood and adolescence, was constant (and low) in the adult years, and gradually increased in each successive age group after the age of 50 years. The greatest incidence was found in group 70-79 years of age. The incidence in childhood and adolescence tends to gradually decrease from 2015 to 2018, while it progressively increased in population over 50 years of age, which may explain a rise in overall incidence. We found a statistically significant higher incidence in males than in females, a ratio consistently being 1.2: 1. CONCLUSION: The data from the study provides accurate findings on the prevalence and incidence of epilepsy in the upper-middle-income Southeastern European country.

Patients' attitude toward AED withdrawal: A survey among individuals who had been seizure-free for over 2 years.

OBJECTIVE: The study aimed to evaluate the attitudes of seizure-free patients toward the antiepileptic drug (AED) withdrawal and to highlight the factors that affect their perspectives. METHODS: The study participants were recruited among the individuals attending the epilepsy outpatient clinic of a university hospital in Skopje between January 2018 and April 2019. Patients with epilepsy who had been seizure-free for at least 2 years on stable monotherapy were included. RESULTS: Among the 90 participants, 43 were female, and the mean age was 36.3 years. The mean duration of active epilepsy before remission was 7.9 years, and the length of the seizure-free period at the time of evaluation was 2-20 years. Forty-four percent of participants aimed to taper their antiseizure medications because of concerns about the potential long-term side effects and teratogenicity, the burden of taking medication daily, stigma, as well as the impression of no longer having a chronic disease after withdrawal. The majority of them preferred slow versus rapid withdrawal. On the other side, 55% of patients choose to continue AED treatment, mainly feeling well-adjusted to it and being concern about possible seizure recurrence after withdrawal and subsequent loss of driving license or even their jobs. Previous unsuccessful attempts to discontinue AED together with previously uncontrolled seizures were additional motives against withdrawal. The patients' views toward stopping or withholding AED were significantly associated with their gender and marital status (male patients as well as single ones favored medication withdrawal). Patients' age to some extent, though not significantly, affected their viewpoints (younger participants tended to question the further necessity of AEDs and were more concerned about the potential adverse consequences). No other demographic or epilepsy-related data considerably predisposed the decisions. CONCLUSIONS: More than half of the patients with epilepsy preferred to continue their AED after 2 years of seizure freedom. Male gender, being single, and somewhat younger age were associated preferences to withdraw AED.

Surgical site infections after cesarean sections at the University Clinical Center of Kosovo: rates, microbiological profile and risk factors.

BACKGROUND: Surgical site infections (SSI) are a common complication after a cesarean section (C-section) and mainly responsible for increased maternal mortality and morbidity, dissatisfaction of patients, longer hospital stays as well as higher treatment costs. The aim of this study is to determine the incidence rate and risk factors of surgical site infections in women undergoing caesarean section at the University Clinical Center of Kosovo (UCCK), in the Clinic for Obstetrics and Gynecology. METHODS: We conducted a prospective observational cohort study involving 325 women who underwent labor and scheduled C-sections from January, 2018 to September, 2018 at the University Clinical Center of Kosovo, Clinic for Obstetrics and Gynecology. Each woman was followed for 30-postoperative days. Data analysis included descriptive statistics, univariate and multivariate logistic regression analysis. Culture-based microbiological methods were used to identify causal agents in postoperative wounds. RESULTS: Overall the SSI rate was 9.85% and the median time to SSI was the 7th postoperative day. The mean age of the patients was 31.3 ± 5.5 years (range from 17 to 46 years). The average length of stay was 4.2 ± 3.4 days. Several factors reduced the risk of SSI. These included: age less than 35 years (RR 0.25; 95% CI; 0.199-0.906 and P = 0.027) preoperative use of antibiotics (RR 0.232; 95% CI; 0.107-0.502 and P = 0.000) and duration of the operation less than 1 h (RR 0.135; 95% CI; 0.054-0.338 and P = 0.000). Previous cesarean section and one or more co-morbidity were associated with 7.4 fold and 8 fold increased risk of SSI, respectively. We found a statistically significant association between SSI and co-morbidity, preoperative antibiotic use, duration of operation, age and history of previous cesarean section (P = 0.000; 0.000; 0.0001; 0.023; 0.000; respectively using chi-square test). Multivariable logistic regression analysis confirmed that one or more co-morbidity, previous C-section, preoperative antibiotics and duration of the surgery < 1 h are predictors of SSI. CONCLUSION: The high incidence rate of SSIs after C-sections in this study highlight the need for prioritizing SSI control and surveillance. Patient demographics, procedures utilized and surgical factors must be incorporated in programs to reduce the infection rate. Additionally, an effort must be given to decrease number of the C-sections performed for the first time through assuring optimal care for the mother and child. The National Committee for Prevention and Control of Nosocomial infection in Kosovo should provide updated guidelines for control and prevention of the nosocomial infections.

Early-onset neonatal infection in pregnancies with prelabor rupture of membranes in Kosovo: A major challenge.

OBJECTIVE: Prelabor rupture of membranes (PROM) is a common event in obstetrics that has a major impact in pregnancy outcome. This condition is linked to a number of pregnancy and birth complications with early-onset neonatal infection (EONI) being one of the major threats. This study was undertaken to determine the rate of neonatal infection in newborn infants with a maternal history of PROM and to evaluate the association of risk factors with neonatal infection following PROM. MATERIALS AND METHODS: A cross-sectional descriptive design was used to analyze a population of 200 pregnant women presenting to the Obstetrics and Gynecology Tertiary Center in Kosovo (between 2013 and 2015) with PROM who gave birth to single newborns. Data including demographic characteristics, neonatal outcome, and risk factors for infectious neonatal morbidity were recorded and analyzed. RESULTS: The study included 200 pregnant women with PROM and their newborns. Participant demographics included: the majority were young, aged between 20 and 29 years (67%), primiparous (67.5%), unemployed (92%), completed secondary level of education (83%), and with middle socioeconomic status (86%). Overall, 13% of the newborns had early-onset neonatal infection, and sepsis was proven in 5% of cases. Newborns of mothers with risk factors such as preterm (<37 weeks) PROM, low gestational weight at birth, prolonged rupture of membranes, maternal colonization, and low Appearance, Pulse, Grimace, Activity, Respiration score at birth had higher rates of infection compared with newborns of mothers without these risk factors. CONCLUSION: The rate of EONI in pregnancies complicated with PROM continues to be a global challenge in perinatology, and as this study reports, also a major challenge for Kosovo. Future research, revision and improvement on prenatal care and practices, timing of delivery, medical treatment, and prophylactic use of antibiotics in PROM are needed to reduce rates.

Myasthenia Gravis and Associated Diseases.

BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease caused by the action of specific antibodies to the postsynaptic membrane of the neuromuscular junction, leading to impaired neuromuscular transmission. Patients with MG have an increased incidence of other autoimmune diseases. AIM: to determine the presence of other associated diseases in patients with MG. METHOD: A group of 127 patients with MG followed in 10 years period, in which the presence of other associated diseases has been analysed. RESULTS: The sex ratio is in favour of the female sex, the average age of the initial manifestation of the disease is less than 50 years, 65.4% of the patients with MG have another disease. 15.0% patients have associated another autoimmune disease. Thyroid disease is the most common associated with MG, rarely rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and other autoimmune diseases. Other diseases include hypertension, heart disease, diabetes, respiratory diseases, dyslipidemia. 10.2% of the patients are diagnosed with extrathymic tumours of various origins. CONCLUSION: Associated diseases are common in patients with MG, drawing attention to the possible common basis for their coexistence, as well as their impact on the intensity and treatment of the disease.

Seizure outcome following medical treatment of mesial temporal lobe epilepsy: Clinical phenotypes and prognostic factors.

OBJECTIVE: Surveys on mesial temporal lobe epilepsy (MTLE) repeatedly demonstrate that seizures are commonly resistant to antiepileptic drugs (AED), but patients usually came from third-level epilepsy centers, making the medically refractory population larger. The aim of our study is to evaluate patterns of seizure control and prognostic factors of general population of MTLE patients observed in clinical practice. METHODS: Sixty five MTLE patients were evaluated for demographic data, family history, febrile convulsions, detailed descriptions of auras and seizures, presence of secondarily generalized seizures, age at seizure onset, duration of epilepsy, epileptiform discharges in EEG, neuroradiological findings and AED schedules with therapeutic response. According to seizure frequency, patients were divided into three groups: (1) seizure-free (SF) patients at the time of evaluation, (2) patients considered as having infrequent seizures (IS) if they presented only auras or up to three dyscognitive (complex partial) seizures per year and (3) patients with higher rate were regarded as having frequent seizures i.e. being drug-resistant (DR). For each clinical parameter, the three groups were compared statistically. In addition, following the patterns of evolution over time, patients were categorized into two groups: continuous pattern, with no period of remission, and intermittent pattern, in which patients had at least one period of remission. RESULTS: Ten patients (15.4%) were seizure free, 19 (29.2%) had infrequent seizures, while 36 patients (55.4%) had frequent uncontrolled seizures. Ten (52.6%) IS patients and ten (27.7%) DR patients had a intermittent i.e. relapse-remitting pattern with at least one period of two years without seizures. Female patients dominated SF group and the gender difference with other groups reached statistical significance (p=0.02). Comparing the groups, DR group had longer seizure duration than IS group (12.6±10.9years vs. 22.8±10.6years, p=0.006). Number of tried AEDs (p<0.00006) was significantly lower in the seizure-free patients. Other variables are not related to course of the epilepsy. CONCLUSION: MTLE is a heterogeneous syndrome, 45% of patients in our series were having either rare auras or seizures or were seizure-free. The factors associated with drug resistance were longer duration of epilepsy, higher number of previously tried AED and male gender.

Relationship between ADHD and depression among university students in macedonia.

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.

Prelabour Rupture of Membranes: Mode of Delivery and Outcome.

BACKGROUND: Pre-labour Rupture of Membranes (PROM) is an important cause of maternal and fetal morbidity and increased rate of cesarean section delivery. AIM: The aim of this study is to investigate the clinical characteristics, PROM-delivery interval, mode of delivery, and early maternal neonatal outcome among pregnant patients presenting with pre-labour rupture of membranes. MATERIAL AND METHODS: This prospective case control study is implemented at the Obstetric and Gynecology Clinic of the University Clinical Center of Kosovo. The study included 100 pregnant patients presenting with prelabour rupture of membranes of which 63 were primigravida and 37 patients were multigravida. RESULTS: The incidence of cesarean section in this study is 28 % and the most common indications for cesarean delivery were fetal distress, malpresentation, cephalopelvic disproportion, and failed induction. The most common maternal complications in this study are chorioamnionitis, retained placenta and postpartum hemorrhage. Neonatal infectious morbidity was present in 16 % of cases. CONCLUSION: PROM is a significant issue for obstetricians and an important cause of maternal and neonatal morbidity and increased rate of cesarean section delivery.

Factor V Leiden, Prothrombin and MTHFR Mutation in Patients with Preeclamsia, Intrauterine Growth Restriction and Placental Abruption.

BACKGROUND: Factor V Leiden, Prothrombin and MTHFR gene mutation, could have an influence in pregnancy with adverse outcome Preeclamsia, IUGR and Placental abruption. AIM: The aim of this study is to investigate the presence of above mentioned inherited thrombophilias and its statistical significance, distribution among the complicated and normal pregnancy, and relative risk for carrier of mutation to develop preeclampsia, IUGR and placental abruption. MATERIAL AND METHODS: Prospective cohort study is implemented at University Clinic for Obstetric and Gynecology in Skopje, Republic of Macedonia. The study included 109 delivered patients: 40 with preeclapmsia, 22 with IUGR, 17 with placental abruption and 30 as control group with normal pregnancy. The amount of 3 ml venous blood has been used for detection of these point mutations using ThromboStrip -Opegen, QIAGEN kit manufactured for thrombotic risk. RESULTS: The highest frequency was found: in the group with preeclampsia 35% were MTHFR homozygous, IUGR -MTHFR heterozygous 45%, Placental abruption- 52.9% MTHFR heterozygous, and in the control group without thrombophilia 56.7%. There were combined thrombophilia in 3 patients. There aren`t statistical significance in presence of thrombophilia among groups (p > 0.05). Statistical significance (p < 0.05) was found between carriers of MTHFR homozygous in preeclampsia and group with placental abruption and control group. Relative risk in IUGR group for MTHFR homozygous was 5.54 (1.37

Prevalence, gender distribution and presence of attention deficit hyperactivity disorder by certain sociodemographic characteristics among university students.

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.

Tissue expansion in limbs vs other body regions.

INTRODUCTION: The development of tissue expansion technique as an important routine procedure in plastic and reconstructive surgery in the past two decades reflects the tendency of getting quality skin that would replace the defect. The aim of this study was to present our experience in the application of tissue expanders in the limbs, and to compare the complications of this procedure in limb and non-limb sites. MATERIAL AND METHODS: This retrospective study included 16 expanders in 14 patients. Indications for tissue expansion were post burn scarring and contractures, post mastectomy reconstruction and before excision of giant nevus. The expanders were placed in the following sites: scalp, breast, abdomen, leg and arm. RESULTS: Despite the fact that there were complications in 3 out of the 16 expanders used, failure occurred in 1 expander, which was removed. The remaining complications were managed either by immediate delivery whenever expansion approached full size or by salvage of the expander by exteriorizing the buried part in cases of infection.

Epidemiological analysis of progression-free survival (PFS) and overall survival (OS) in non-small-cell lung cancer patients in Republic of Macedonia.

Lung cancer represents the leading cause of cancer mortality worldwide, accounting for ~1.2 million deaths each year. Improving survival in lung cancer is a major challenge for modern oncology considering that 5-year survival remains < 15%, across all stages of the disease with < 7% of patients alive 10 years after diagnosis. About 85% to 90% of lung cancers are non-small-cell lung cancer (NSCLC). Lung cancer is the leading cause of cancer-related mortality in Macedonia with more than 900 newly diagnosed lung cancer patients per year. The motive for undertaking the study was precisely the lack of adequate statistical data on treatment outcomes and survival rates of non-smal-cell lung cancer patients in the country. The main goal was to provide an assessment of progression-free survival and overall survival in NSCLC patients treated at UCRO-Skopje, over the past three years: 2009-2011. The research represents a follow-up study. The study was based on filling in forms for an epidemiological analysis of PFS and OS in NSCLC patients. These forms contain demographic, clinical and histological data, as well as dates of diagnosis, treatment initiation and outcomes. Data were collected from patient files for a period of three years (2009-2011), collected through the registration of each NSCLC patient treated in the period of the investigation. The statistical series were analysed by determining the ratio, proportions, chi-square and Student t-test and survival analysis. The study included 1002 patients with NSCLC treated at the UCRO, of whom 859 were males and 137 were females, and 0.6% missing data for gender. The average age of patients was 60.4 ± 9.0 y., min. of 19 y., max. of 85 y. Most of the patients were smokers- 86.9%. The dominant stage in NSCLC was stage IV, with 36.3%, followed by IIIA 17.5%, stages IIIB and IIB with 13.6% and so on. In the examined group of patients the most common subtype was 56.9% with planocellular, 28.2% with adenocarcinoma, large-cell with 7.7% and missing / no closer subtype 7.2%. Median survival from diagnosis to the last check-up/death was 6.2 m. 25% of patients with NSCLC from diagnosis to the last check-up/death died in the first 2.5 m and 25% survived more than 11.1 m. Median survival from treatment outset to the last check-up/death was 5.4 m. 25% of patients with NSCLC survived for two months from the outset of treatment to the last check-up/death and 25% survived for more than 10.8 m. In the course of the study we found that the median survival in 2009, 2010 and 2011 differed from the diagnosis to the last control/death. In 2009, median survival was 7.5 m and we registered a statistically significantly longer survival compared to 2010 - 6.1 m, and 2011 - 5.4 m. Similar data and conclusions were received in calculating the survival from therapy to the last check-up/death. Median survival in 2009 was 6.2 m and this is a statistically significant longer survival compared with 2010 (5.9 m) and 2011 (4.6 m). The results indicate that compared with international data patients with NSCLC had a shorter life of survival.We hope that this study will help to improve the future treatment of non-small-cell lung cancer patients through optimizing the treatment for every single patient, which will help in longer patient survival. Precise determination of these data provides for a proper selection of the best treatment option and optimized therapy for every patient.

Do household tobacco smoking habits influence asthma, rhinitis and eczema among 13–14 year-old adolescents?

Background: Although the harmful impact of environmental tobacco smoke on respiratory health in early childhood is well known, its effect in adolescence is still ambiguous. This study aims to examine if parents’ and household tobacco smoking habits influence asthma, rhinitis and eczema in early adolescence in The Republic of Macedonia, as a country with a very high rate of household tobacco smoke exposure despite the smoking cessation campaign, and low prevalence rates of asthma, rhinitis and eczema. Methods: Children aged 13–14 years (n=3026) from randomly selected schools in Skopje, the capital of Macedonia, completed by themselves the standardised International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three written questionnaires on asthma, rhinitis, eczema and potential environmental risk factors. Maternal and paternal tobacco smoking habits and the number of smokers in households were separately correlated to current and ever-diagnosed asthma, rhinitis and eczema by odds ratios (OR, 95% CI) with and without adjustments for potential confounders using binary logistic regression. Results: The maternal smoking habit was significantly positively associated only with current night dry cough apart from chest infection (aOR: 1.26; 1.03–1.54; p=0.026). No significant association was observed in relation to the other studied variables with either parental smoking habits or the number of smokers in the household. Conclusion: Household tobacco smoking habits were not found to have a significant influence on asthma, rhinitis and eczema in young adolescents. The established results point out the dominant influence of maternal smoking on cough as an unspecific asthma symptom (AU)

Do household tobacco smoking habits influence asthma, rhinitis and eczema among 13-14 year-old adolescents?

BACKGROUND: Although the harmful impact of environmental tobacco smoke on respiratory health in early childhood is well known, its effect in adolescence is still ambiguous. This study aims to examine if parents' and household tobacco smoking habits influence asthma, rhinitis and eczema in early adolescence in The Republic of Macedonia, as a country with a very high rate of household tobacco smoke exposure despite the smoking cessation campaign, and low prevalence rates of asthma, rhinitis and eczema. METHODS: Children aged 13-14 years (n=3026) from randomly selected schools in Skopje, the capital of Macedonia, completed by themselves the standardised International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three written questionnaires on asthma, rhinitis, eczema and potential environmental risk factors. Maternal and paternal tobacco smoking habits and the number of smokers in households were separately correlated to current and ever-diagnosed asthma, rhinitis and eczema by odds ratios (OR, 95% CI) with and without adjustments for potential confounders using binary logistic regression. RESULTS: The maternal smoking habit was significantly positively associated only with current night dry cough apart from chest infection (aOR: 1.26; 1.03-1.54; p=0.026). No significant association was observed in relation to the other studied variables with either parental smoking habits or the number of smokers in the household. CONCLUSION: Household tobacco smoking habits were not found to have a significant influence on asthma, rhinitis and eczema in young adolescents. The established results point out the dominant influence of maternal smoking on cough as an unspecific asthma symptom.

Knowledge of HCV infection among nursing students of the Medical College of Bitola.

Healthcare workers are at risk of occupationally-acquired viral infections such as human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV). HCV is parenterally transmitted and has been found in every part of the world. This cross-sectional study was conducted to establish the awareness and attitude about HCV infections among 210 full-time and part-time nursing students of the Medical College in Bitola, Macedonia from May to June 2009. For this purpose we used a self-administered questionnaire which consisted of three parts. The first included demographic data, the second included questions about causes of infection, mode of transmission, symptoms, acute and chronic hepatitis, and prevention, and the third questions about students' attitude toward patients with suspect or confirmed HCV infection. Full-time students showed higher HCV awareness (84 %) than part-time students (69 %). 58 % of the full-time and 79 % of the part-time students said they would not avoid professional contact with suspect or HCV infected patients. Our study has shown that even though both groups of students have a sufficient knowledge about HCV to face future challenges, they need further education on the subject. Practical recommendations would help to reduce stigmatising behaviour still further.

Acetaminophen intake and risk of asthma, hay fever and eczema in early adolescence.

A positive association between acetaminophen intake and allergic diseases has recently been reported in developed countries with impaired oxidant/antioxidant balance and promotion of atopy as proposed underlying mechanisms. The aim of the study was to explore the relationship between acetaminophen intake and asthma, hay fever, and eczema in The Republic of Macedonia as a country with acetaminophen intake not physician-controlled, high passive smoke exposure and dietary antioxidant intake, and moderately low prevalence of allergic diseases. Self-reported data obtained through the standardized International Study of Asthma and Allergies in Childhood Phase Three written questionnaires of 3026 adolescents aged 13/14 years from randomly selected schools in Skopje, the capital of Macedonia, were used. The frequency of current acetaminophen intake--both unadjusted and adjusted for confounding factors--was correlated to current and ever-diagnosed asthma, hay fever and eczema by odds ratios (OR, 95% CI) in binary logistic regression. Use of acetaminophen at least once monthly increased the risk of current wheeze (adjusted OR 2.04, 1.31-3.20 p = 0.002), asthma 'ever' (adjusted OR 2.77, 1.06-7.26 p=0.039), current allergic rhinoconjunctivitis (adjusted OR 2.95, 1.79-4.88 p=0.000) and hay fever 'ever' (adjusted OR 2.25, 1.36-3.70 p=0.002). A significant association between frequent acetaminophen intake and atopic eczema and also between infrequent acetaminophen intake and investigated allergic diseases was not established. The findings suggest an increased risk of asthma and hay fever, but not atopic eczema associated with frequent acetaminophen use in a developing country.

Frequency distribution of apoprotein(a) isoforms in patients with diabetes mellitus and healthy subjects.

AIM: To determine the frequency distribution of apoprotein(a) isoforms in patients with insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus and healthy subjects. METHOD: We separated and visualized 5 apo(a) isoforms in 40 patients with IDDM (12 men aged 48.00-/+4.59 and 28 women aged 52.37-/+8.21), 65 patients with NIDDM (26 men aged 61.88-/+9.25 and 39 women aged 60.15-/+7.98), and 182 healthy subjects, using 3-15% gradient sodium dodecyl sulfate polyacrylamide gel electrophoresis, followed by immunoblotting. RESULTS: The frequency distribution of apo(a) isoforms was very similar in patients with diabetes mellitus and the control group. Atherogenic low molecular weight (LMW) S1 apo(a) isoform was more frequent in patients with IDDM (7.5%) and NIDDM (6.15%) than in the control group (0.78%). LMW S1 apo(a) isoform in patients with IDDM (relative risk [RR], 6.86; 95% confidence interval [CI], 1.19-25.21; p<0.001) and patients with NIDDM (RR, 7.04; 95% CI, 1.40-35.40; p=0.0057) as well as high molecular weight >S4 apo(a) isoform in patients with NIDDM (RR, 2.39; 95% CI, 1.28-5.21; p=0.0067) significantly increased the risk for the development of atherosclerosis. Mean molecular weight of S3, S1, and B apo(a) isoforms was higher in patients with IDDM and NIDDM than in the healthy subjects carriers of the same isoforms, but this difference was not statistically significant. We estimated high inverse statistical correlation between apo(a) size (kDa) and plasma lipoprotein(a) concentration in all study groups, patients with IDDM (p<0.001), patients with NIDDM (p<0.001), and healthy subjects (p<0.01). CONCLUSION: Not only the increased plasma Lp(a) levels, but also apoprotein(a) isoforms may play an important role as a risk factor for the development of atherosclerosis in patients with diabetes mellitus.