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.

Cut-off value of mantoux induration in tuberculous children in R. Macedonia and their nutritional status.

INTRODUCTION: The interpretation of the Mantoux test, as well as knowledge of factors that affect the test's induration size, is significant for the early diagnosis of tuberculosis in children. AIMS: To determine the Mantoux test induration cut-off size which distinguishes between positive and negative results in Macedonian children suffering from tuberculosis. To find whether there is any correlation between the nutritional status (malnutrition) and the Mantoux induration size. MATERIALS AND METHODS: A retrospective and descriptive study was carried out in 270 patients up to 14 years old with diagnosed tuberculosis, treated during the period of 2003-2007 in the Pediatric Tuberculosis Department at the Kozle Institute for Respiratory Diseases in Children, Skopje, Macedonia. The cut-off value of the Mantoux test induration size was determined by analysis of the test results distribution. The nutritional status was calculated as the weight for age standard (z-score). Correlation between the TST results and the nutritional status was calculated with Pearson's coefficient of correlation. RESULTS: Two hundred and seventy (270) children with tuberculosis were included in the study. The lung form of tuberculosis was present in 87.8% of the children. 53.7% of the patients were male, and 46.3% were female. The age group of 1-2 years was the most numerous (15.2%), followed by the group aged 7-8 years (10.4%). 33 children (12.2%) were undernourished (z-score<-2). The Mantoux test induration size was in the range of 0 to 32 mm, with an average of 13.4 mm. The distribution of the frequencies of the indurations had a bimodal form, with the primary mode at 0 mm, the secondary 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%. Pearson's coefficient of correlation (r) of 0.175 showed a weak positive correlation between the results of TST (induration size) and the nutriational status. CONCLUSIONS: The cut-off value of the induration which distinguishes negative from positive Mantoux reaction was 5 mm. The interpretation of the test is recommended to be carried out depending on the risk factors for TB development, which surround the children. The Mantoux test in malnourished children should be interpreted with caution.

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.

The epidemiology of tuberculosis in Latvia.

An increase in the number of outbreaks of tuberculosis (TB) has been reported during recent years in many parts of the world, including the countries of Eastern Europe and the former USSR. This study was performed with the aim of assessing the current epidemiological situation with respect to TB in Latvia, one of the three Baltic States, in comparison to the previous decades (since 1950), and to evaluate trends in the incidence of TB during recent years. Data on the incidence of TB were obtained from the Tuberculosis Registers and the Information Department of the State TB and Lung Diseases Centre of Latvia. The results of this study show that, in Latvia, a deterioration in the epidemiological situation with respect to TB occurred from 1990 onwards. The incidence of TB and TB mortality rates virtually doubled from 1991 to 1995: from 28.7 to 50.4 and from 6.4 to 14.1 per 100,000 population, respectively. The majority of new TB cases occurred in persons from the economically productive age group, i.e. 25-54 yrs. In 1995, 61% of pulmonary TB patients were found to be sputum and/or culture positive, the rate of primary drug resistance was 19%, and of total drug resistance was 38%. In order to prevent a further deterioration in the epidemiology of TB in Latvia, it is vital to revise the National TB Control Programme according to the recommendations of the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD).