[41imsc] book of abstracts issu

41st International Medical Scientific Congress 12th -15th of May 2018 Ohrid, Macedonia

BOOK OF ABSTRACTS

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COPYRIGHT & PUBLISHER MACEDONIAN MEDICAL STUDENTS’ ASSOCIATION

MMSA Circulation: 250

Technical editors: Miljana Stojanovska Aleksandra Karanfilska Aleksandra Boneva Filip Stojanovski

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CONTENTS 

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CONTENTS:

Contents Honorary & Scientific Advisory Board Scientific Board Organizing committee & Scientific program committee Awards Preface Programme Lectures Workshops Oral session Poster session Case reports sponsors & partners About Index authors & index abstracts

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HONORARY & SCIENTIFIC ADVISORY BOARD

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Honorary Board Prof. D-r Nikola Jankulovski, Rector of the Ss Cyril and Methodius University in Skopje, Macedonia Prof. D-r Sonja Topuzovska, Dean of the Medical Faculty in Skopje Prof. D-r Igor Kaftandjiev, Vice-Dean for specializations and subspecializations Prof. D-r Beti Zafirova Ivanova, Vice-Dean for Teaching Prof. D-r Zlatko Jakjovski, Vice-Dean for Finances Prof. D-r Rozalinda Popova, Vice-Dean for Science

Scientific Advisory Board Chief Scientific Advisor: Prof. D-r Viktorija Caloska Scientific Advisory Board Members: Prof. D-r Oliver Karanfilski Prof. D-r Dejan Trajkov Prof. D-r Violeta Vasilevska Nikodinovska Prof. D-r Goran Dimitrov 

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SCIENTIFIC BOARD

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Scientific Board Members:

Prof. D-r Oliver Karanfilski

Prof. D-r Daniela Chaparoska

Prof. D-r Viktorija Caloska

Prof. D-r Goran Dimitrov

Prof. D-r Dragana Petrovska Cvetkovska

Prof. D-r Milena Petrovska

Prof. D-r Velibor Tasic Docent D-r Igor Spiroski Prof. D-r Jorgo Kostov D-r Dance Gudeva Nikovska Prof. D-r Fimka Tozija Docent D-r Ana Doneva Prof. D-r Daniela Pop-Gjorcheva Assist. Prof. D-r Sanja Manchevska Assoc. Prof. D-r Suzana Nikolovska

Prof. D-r Dejan Trajkov Prof. D-r Liljana Milenkova Prof. D-r Nevena Kostovska Asst. Prof. D-r Slavica Arsova Prof. D-r Rubens Jovanovikj Prof. D-r Arben Taravari Prof. D-r Katarina Stavrikj Prof. D-r Gabriela Kostova Prof. D-r Zoran Guchev Prof. D-r Igor Kaftandziev

Prof. D-r Violeta Vasilevska Nikodinovska

Prof. D-r Nikola Jankulovski

Prof. D-r. Sonja Genadieva Stavrikj

Prof. D-r Sonja Topuzovska

Asst. D-r Sinisha Stojanoski

Prof. D-r Daniela Miladinova 

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ORGANIZING COMMITTEE & SCIENTIFIC PROGRAM COMMITTEE

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Organizing Committee

President

Logistic Coordinator

Onur Dika

Milan Klimkarov

Secretary General

Registration Coordinator

Simona Nikolovska

Jovana Topencharova

Treasurer

Accommodation Coordinator

Blagorodna Kjoseva

Emilija Mitreska

Fundraising Coordinator

Transport & VISA Coordinator

Michel Naydenov

Pamela Arsova

Public Relations

Social Program Coordinator

Tamara Pejoska

Vedran Markovski

Scientific Program Committee Chair Miljana Stojanovska Members: Aleksandra Karanfilska Aleksandra Boneva Filip Stojanovski 

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AWARDS 

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AWARDS The best oral and poster presentations will be rewarded with the following prizes: Oral Session: Award certificate for best oral presentation at the oral session Poster Session: Award certificate best poster presentation Case report presentations Award certificate best oral presentation at the case reports session Final Session The two best presentations from the Oral and Case report Sessions will be invited to present their work in front of a wide audience at the Congress Closing ceremony and will be rewarded with the following prizes: 1st place: free participation fee for the next International Medical Scientific Congress plus publication of the research work in the “in extenso” form in the Macedonian Medical Review, Journal of the Macedonian Medical Society; 2nd place: Abstract publication in Vox Medici – Journal of the Macedonian Medical Chamber;Abstract publication in Acta morphologica – Macedonian Journal of Macedonian Association of Anatomists and Morphologists;

Best poster presentation: publication of the research work in the “in extensor” form in the Physioacta, Journal of Macedonian Association of Physiologist and Anthropologist.

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PREFACE

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DEAN’S WELCOME NOTE: Dear students, respected guests, dear colleagues, It is my great honor and pleasure as Dean of the Faculty of medicine at the University “Ss. Cyril and Methodius” on behalf of the all employees to extend my greetings to the participants of the 41st Congress of medical students and young doctors that traditionally takes place at the coast of the wonderful Ohrid lake.

The Faculty of medicine at the University “Ss. Cyril and Methodius” has a long history, from 1947 when on 17of March the decision was announced for the beginning of the studies of medicine in Socialist Republic of Macedonia.

The first lecture was on 3 of November 1947. We are aware of the 71 years old tradition of the oldest, largest, and owing to our nuptial permanent endeavour, the best faculty of medicine in our country.

The centre for continuous medical education has been founded to allow continuous education for young doctors and doctors specialized in different disciplines. I would like to point out that it is a great pleasure to be a member of this big medical family to belong to the most human and respectful profession, at the same time it is a great challenge to follow the permanent development and achievements in contemporary medicine.

If you would like to be good students, and especially to be good doctors, you have to work very hard. On this congress there will be many presentations, few workshops and seminars will be organized and all these activities will be of great importance for your future professional development and for most of you I hope in the scientific research career. At the end I would like to wish you successful work, to express my gratitude to the invited speakers and all the guests wishing them pleasant stay in our beautiful country, and to all of you wonderful event that will stay in good memories for the years ahead.

Regards, Prof. Sonja Topuzovska MD Dean of the Faculty of Medicine in Skopje, University “Ss. Cyril and Methodius”

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41st International Medical Scientific Congress 12th -15th of May 2018 Ohrid, Macedonia Dear respected professors, guests and colleagues, Imagine yourself contributing to build a better and healthier future for people all over the world and waking up during these hard days by the lake side and feeling the lake breeze warming your soul and boosting your spirit.

It is my great honor and pleasure as a President of the Organizing Committee to welcome you to the 41st International medical scientific congress for medical students and young doctors which is traditionally held along the beautiful coast of the Ohrid Lake, May 12-15, 2018.

Over the years, this Congress has been an irreplaceable part of many students’ continuous medical development and of utmost importance for the extension of their medical and professional knowledge. This year as well, we have prepared for you an exciting programme with rich scientific contents that will leave you with a remarkable educational and professional experience. Apart from the scientific component, this event offers you the opportunity to meet great new people from many diverse cultures and make lifelong friendships.

Finally, on behalf of the entire Organizing Committee, I would like to express our gratitude to all our professors, sponsors and the management of our Medical Faculty without whose moral and material support the realization of this congress would not be possible.

Kindest Regards, Onur Dika President of the Organizing Committee 

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41st International Medical Scientific Congress 12th -15th of May 2018 Ohrid, Macedonia Dear professors, guests and colleagues, On behalf of the Macedonian Medical Students’ Association, we are honoured and delighted to welcome you to the 41st International Medical Scientific Congress in Ohrid, Macedonia, from 12-15 of May 2018.

This congress is for all medical educators with undergraduate or postgraduate responsibilities and interests. It is an opportunity to report and discuss themes, research and initiatives with colleagues from all over the world. The congress traditionally continues to offer excellent opportunities for delegates to discuss innovations in medical education as well as offering excellent networking opportunities. This year’s programme includes a variety of workshops, keynote presentations, oral sessions, poster sessions and case report sessions, awards and social events. We encourage you to explore and participate in the various offerings of the congress.

We want to express our gratitude for the generosity and steadfast support of all our sponsors, professors, speakers and the management of the Medical Faculty in Skopje. Without their help we could not have managed to arrange all this to the fullest.

We hope you may really enjoy the 41st edition of the International Medical Scientific Congress, the culture of Macedonia and take the opportunity to visit the Ohrid surroundings.

Michel Naydenov Vice President for Internal Affairs at Macedonian Medical Students’ Association

Miljana Stojanovska Vice President for External Affairs at Macedonian Medical Students’ Association

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PROGRAMME 

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AGENDA 

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Sunday, 13.05.2018 Oral Session I 10:00 -11:00h Oral Presentations Chairperson: Daniela Caparoska Jury: Dragana Petrovska Cvetkovska, Slavica Arsova, Igor Spiroski, Coskun Kerala, David Ritchie, Miljana Stojanovska

1. Simultaneous vs. Non-Simultaneous Bilingualism (A casecontrol study) Fjola Hyseni, Ineida Boshnjaku, Sueld Hyseni, Dorina Ylli 2. Hyperthyreosis and autoimmunity, effects on prognosis and remission Bojan Janevski, Sinisha Stojanoski 3. Screening of Female Athlete Triad among Balette Dancers in one of the Cracovian Ballet School Mari Minasyan, Marta Biedrawa, Katarzyna Chłopaś, Alicja Kapusta, Alicja Pietraszek, Kinga Suchoń, Anna Wedrychowicz 4. The evolution of peripancreatic necrotic collections Ana Leben, Rok Dežman, Popovič Peter

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Sunday, 13.05.2018 Oral Session II 12:30 -13:00h Oral Presentations Chairperson: Goran Dimitrov Jury: Dragana Petrovska Cvetkovska, Coskun Kerala, Daniela Caparoska, Katerina Madjunkova, Marko Kostovski, Aleksandra Karanfilska

1. Comparation between Ravitch and Nuss procedure as surgical treatment options for Pectus Excavatum Doruntina Klenja, Anila Bellcishta, Risto Colanceski 2. Evaluation of pregnancy outcomes at advanced maternal age Beata Adrianowicz, Magdalena Płonka, Paulina Danił, Klaudia Gądkowska, Małgorzata Radoń-Pokracka 3. Characteristic of injuries in pediatric patients admitted to emergency room – study from single pediatric centre Alicja Pietraszek, Kornelia Kukla, Patrycja Molek, Malgorzata Pankowska, Anna Peterko, Grzegorz Slota, Zuzanna Zakrzewska, Piotr Wojciechowski

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Monday, 14.05.2018 Case Report Session 10:00 -11:00h Case Report Presentations Chairperson: Violeta Vasilevska Nikodinovska Jury: Mitevska Elida, Sinisha Stojanoski, Suzana Nikolovska, Daniela Caparoska, Marko Kostovski, Miljana Stojanovska

1. Lingua villosa nigra: a novel treatment aproach with propolis tincture Jovan Pop-Stefanija, Andrej Petrov 2. Joubert syndrome coexisting with combined pituitary hormone defficiency in infant boy – case report Alicja Pietraszek, Karolina Rutkowska, Anna Wędrychowicz, 3. Clinical presentation, diagnosis and management of a patient with Transthyretin Familial Amyloid Polyneuropathy (TTR-FAP) Filip Stojanovski, Katerina Gudeva, Gabriela Novotni 4. Assisting in surgery: Overlooked but an essential topic Stefan Arsenkov MD

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Monday, 14.05.2018 Poster Session 11:15 -12:15h Poster Presentations Chairperson: Suzana Nikolovska Jury: Elida Mitevska, Sinisa Stojanoski, Violeta Vasilevska Nikodinovska, Daniela Caparoska, Irena Kostadinova-Petrova, Filip Stojanovski

1. Subacute Budd - Chiari syndrome - case report Frosina Markoska, Andreja Nusdorfer, Miha Bartolič 2. Nutrition of children in elementary school Danijela Knežević, Tijana Brandmajer, Ljaljević Agima 3. Giant bilateral vertebral artery aneurysms Hristina Ilievska, Boro Ilievski 4. The effects of smoking, alcohol and coffee consumption and physical activity on the Body Mass Index (BMI) among medical students attending the Faculty of Medicine at Ss. Cyril and Methodius University in Skopje Katerina Gudeva, Filip Stojanovski, Biljana Bojadzieva Stojanoska

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LECTURES 

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Food Marketing To Children - Public Health Challenge Lecturer: Igor Spiroski MD Date: Sunday, 13.05.2018

There is strong evidence from independent systematic reviews that

marketing of food with high content of saturated fats, trans-fatty acids, free sugars, or salt (HFSS) contributes to childhood overweight and obesity.

Food marketing to children is now a global phenomenon and tends to be pluralistic and integrated, using multiple messages across multiple media.

Traditional advertising, via television, but also billboards, packaging, in-store promotions and sponsorship arrangements, is gradually being complemented by a multifaceted mix of marketing communications which focuses on branding and building relationships with consumers via digital media, not least the internet and smar tphones. As the WHO Recommendations on the marketing of HFSS food to children explicitly acknowledge, governments are best placed to protect the public interest and avoid conflicts of interest. 

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Priorities For Cancer Prevention In Europe: Special Focus On Cancer Screening Programmes Lecturer: David Ritchie Date: Sunday, 13.05.2018

The cancer burden is projected to grow worldwide over the next 30 years. At the same time, the costs associated with treating and caring for cancer are increasing at an alarming rate. This context demands that health systems must implement all reasonable efforts to prevent or detect at an early stage those cancers that are amenable to preventative strategies.

Organised screening programmes have been one of the key pillars of the prevention and early detection plans of many developed health systems.

The 2003 Council of the European Union Recommendation urged countries in Europe to implement quality-assured cancer programmes for breast, cervical and colorectal cancer.

Over the past 15 years, this recommendation has been steadily put into practice by EU member states and associated countries in Europe.

This presentation will provide an overview of the current status of cancer screening in Europe, indicating future trends for cancer screening, and emphasising the role played by civil society.

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When Elite Athlete May Return To Play After Muscule Injury – Imaging With US & MRi Lecturer: Prof. Violeta Vasilevska Nikodinovska MD PhD MSc Date: Monday, 14.05.2018

After clinical examination the best imaging modalities for diagnosis of muscle injuries are MRI and US. Imaging based grading system and the imaging patterns for both, MRI and US will be presented.

Muscle Injury mechanisms can be from direct trauma or excessive eccentric contraction along muscle-tendon-bone axis. Direct trauma may cause mild, moderate or severe contusion. Indirect trauma is not grading.

Other mechanism of injury is eccentric contraction which represent tearing of muscle fibers at myotendinous junction or myofascial interface. Delayed onset muscle soreness may appear 12-24 hours after strenuous exercise, with soreness peaks 24-72 hours, subsides by 5-7 days and US is normal or hyperechogenicity in more than 1 compartment.

Risk for re-injury is highest in hamstring muscles, and strain in one muscle increases risk in other muscles due to altered biomechanics.

When the elite athlete may return to play after muscle injury is important question to be answered for player and for the club managers.

Player's ability to return to full competition depends on many factors. some players showed larger injuries 2 weeks after their acute assessment, evident on both MRI and US, possibly due to insufficient rehabilitation and premature return to training. Complications after muscle injuries are myositis ossificans, Usually associated with blunt trauma and hematoma, than scar tissue which alters in vivo contraction mechanics of the muscle, fatty atrophy and increased risk of re-injury.

Conclusion: Return to play currently based mostly on clinical factors, as imaging resolution appears to lag behind clinical improvement. Imaging has a role as adjunct to clinical assessment for prognosis and return to play and to diagnosis of complications of muscle injury.

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WORKSHOPS 

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Basic life support for medical students, hands-on workshop Workshop leaders: Marko Gjorgon1 MD; Vesna Naumoska1 MD, Emil Stoicovski1 MD; Date: Sunday, 13.05.2018 1Specialized Hospital for Surgical Diseases ZAN MITREV Skopje BACKGROUND: Basic life support (BLS) is a level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by qualified bystanders. Current studies show that there is a significant lack of knowledge regarding the typical signs and risk factors associated with serious medical conditions among medical students. Basic life support consists of a number of medical procedures provided to patients with life threatening conditions of the body that cause pain or dysfunction to the person.

AIM: The aim of this workshop is to train the participants to be able to perform basic life support in situations when it is needed.

METHODS: BLS workshop is conducted by the Department of Anesthesia at Zan Mitrev Clinic. Teaching learning methods are lecture, demonstration, and hands-on practice on mannequin in small groups. The evaluation is done by direct observation procedural skill. The lecture has two parts, history of BLS and procedure of basic life support according to the newest guidelines (2015) from European Resuscitation Council. The hands-on practice includes the participants into performing the skills explained in the previous lectures.

CONCLUSION: Understanding BLS courses and practicing these techniques is by far the most challenging task confronting first aid. Taking everything into consideration, an adequate education in first aid and basic life support should be considered an essential aspect of the medical curriculum.

Keywords: Basic life support, reanimation.

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Parkinsonism Workshop leaders: Prof. Arben Taravari MD ; Coskun Kerala MD Date: Sunday, 13.05.2018

Parkinsonism is an umbrella term that covers clinical syndromes that

exhibit extrapyramidal disturbances, such as tremor, bradykinesia, rigidity of motion and postural instability. This umbrella term covers broad spectrum of diseases, of which the most common is Parkinson disease (PD). Parkinson disease is the second most prevalent neurodegenerative disorder, affecting 7 million people globally.

This disease has insidious onset, it affects males almost equally as

females, and it can produce significant comorbidity which are not contained only to the central nervous system. Although PD has classic presentation, it can remain diagnostic challenge in patients younger than 50 years, because there are no clear cut diagnostic criteria. The pharmacological approach to this syndrome is central in managing the patients with PD, although new nonpharmacological approaches are emerging. The aim of the present workshop is to introduce the participants to the spectrum of Parkinsonian disorders and their presentation and to familiarize the students with the principles of diagnostics and treatment options available for these patients.

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Diagnosis And Treatment Of Precancerous Changes Of Uterine Cervix Workshop leaders: ASST Prof. Goran Dimitrov MD, PhD; Katerina Madjunkova MD MSc Date: 13.05.2018

The workshop is intended to last two hours and after theoretical

presentations with duration of 20min. each, the participants shall get “hands-on” quick training of procedures that are common in the field of colposcopy and treatment of cervical intraepithelial neoplasia: *Cervical biopsies, HPV and PAP collections *Performance of colposcopy *LLETZ (loop) treatment *Short moves about technique of cold-knife conisation, CO2 laser vaporisation and conisation.

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Drowning treatment: First aid information Workshop leaders: Marija Ristovska ; Hristijan Grozdanoski Date:13.05.2018

Giving first aid in drowning stages SURPRISE –The victim assumes a near-vertical position in the water, with little or no leg movement. The head will be tilted back with the face turned up. After saving, first aid is given if needed.

INVOLUNTARY BREATH HOLDING – The victim has now dropped below the static water line and the body, in an attempt to protect itself initiates involuntary breath holding. Water has entered the mouth and causes the epiglottis to close over the airway. Without oxygen, the victim will lose consciousness.Victim must be put in recovery position, if needed CPR will be performed.

UNCONSCIOUSNESS –In this stage, the victim will be motionless. The victim will remain unconscious unless breathing is reestablished. CPR must be performed.

HYPOXICCONVULSION –The victim’s skin turns blue, especially in the lips and fingernail beds, and the body may appear rigid. There may be violent jerking of the body and frothing (foaming saliva). CPR must be performed.

CLINICAL DEATH – The final stage in the drowning process is death. The victim is in cardiac arrest. The heart stops pumping blood. The organs are no longer receiving oxygen rich blood. The lack of oxygen causes the skin to turn blue.

Keywords: Water Safety, Lifeguard, Drowning, First Aid

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12 ways to reduce your cancer risk: translating the science of the European Code against Cancer into practical action Workshop leaders: David Ritchie - European Cancer Leagues Date: 13.05.2018

The latest edition of the European Code against Cancer states that

about half of cancer deaths could be prevented if the 12 recommendations of the Code were followed by the general population. Yet many factors restrict the ability of individuals to adopt the messages of the Code.

This workshop will introduce the evidence behind the European

Code against Cancer, discuss the actions required to support individuals to adopt the recommendations in their daily lives, and consider actions that have been taken to translate the 12 recommendations into practical action.

During the workshop, participants will be encouraged to brainstorm

and evaluate public health interventions or campaigns designed to promote the recommendations of the European Code against Cancer.

At the end of the workshop, participants will be familiar with the

science behind the European Code and will appreciate the necessary steps to take to develop a cancer prevention intervention or campaign based on the evidence of the Code.

 

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Clinical skills Workshop leaders: Monika Jaric MD; Katerina Andreeska MD; Makedonka Zeroska MD Date: Sunday, 13.05.2018

Workshop Purpose: The aim of this workshop is to get knowledge and skills for clinical examinations that are common in practice of the family doctor.

Workshop description: The workshop is organized in a way to get practical skills. Clinical examination of breast, taking swab of the throat-strep test, use of glucometer and vein puncture are common skills that the family doctor practice daily in his practice.

Clinical examination of breast is a part of

preventive examinations of female. Strep test is used as a diagnostic test and is important for rational prescription of antibiotics; Glucometer is used to screen or follow up patients with diabetes. Vein puncture is a common procedure to take blood for laboratory investigations. The students will have the opportunity to learn from one experienced family doctor educators in the Center. Each student can try to do the clinical skills on models. 

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Psychodrama Workshop leader: Asst. Prof. Slavica Arsova MD Date: 13.05.2018

The aim of this workshop is to present psychodrama, a specific kind of

group psychotherapy, which is of humanistic and holistic type. Founded by Jacob Levi Moreno more than one hundred years ago, with the idea to be counterpoint of psychoanalyses, where trough methods of spontaneity and creativity one individual resolves personal issues ‘’here and now’’. Certain phases of psychodrama will be explained like ‘’warming up’’ - exploring for protagonist (a student with specific emotional issue) personal psychodrama or vignette where this issue is enacted trough methods of drama, shearing (individual emotional perspective of enacted drama) and process (what kind of psychological and psychotherapeutic techniques and means were used during the drama method.

Many techniques, unique and specific for psychodrama will be presented like “role playing” ; “hot chair” ; “mirroring” ; “auxiliary ego” and others, which will show the diversity and the richness of this psychotherapy.

Students who will participate on this workshop can freely try to come

in contact with inner emotional conflicts and issues and explore them through this group psychotherapeutical process.

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Multiple sclerosis Workshop leaders: Dragana Petrovska Cvetkovska MD, PhD ; Coskun Kerala MD Date: 13.05.2018

Multiple sclerosis is a demyelinating disease of the central nervous

system, where the pathological processes attack the insulating cover of the nerves in both the brain and the spinal cord. Multiple sclerosis is the commonest demyelinating disease of the central nervous system, affecting approximately 2.5 million people worldwide; despite that, limited therapeutic options are available. This disease has variable presentation early in the course and it can produce almost any neurological deficit. The course of the disease is variable and 4 subtypes are characterized.

The importance of early detection and treatment is crucial; early

recognition of the type of MS and application of therapy can modify the disease course and improve substantially the quality of life. The aim of present workshop is to introduce briefly the pathological processes behind this disease and to familiarize the student with the diagnostic procedures and the modern approach in managing patients with multiple sclerosis.  

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Human Sperm and Semen Evaluation Workshop leaders: Prof. Dr. Mitevska Elida MD, PhD; Kostadinova-Petrova Irena MD; Kostovski Marko MD; Date: 14.05.2018 Aim: To enable students to gain initial skills for performing basic semen analysis and understand the findings of the analysis.

Abstract: It is estimated that almost 40-50% of the infertility cases are due to male factor alone. What is more important is that sperm parameters of approximately 2% of all men have been considered to be suboptimal.

Therefore, semen analysis represents an essential part of male infertility testing.

This workshop will include human semen samples, examples, and scenarios related to the topic. Attendees will be given short assignment and will work in small groups in order to better understand how an accurate semen evaluation should be performed. During the workshop, each student will have an exclusive opportunity to take a part in the process of human semen analysis. This will entail macroscopic and microscopic evaluation of human semen samples. Moreover, participants will be given examples from routine practice and will have the chance to interactively discuss the results with workshop instructors and other participants.

Macroscopic analysis will involve the evaluation of semen: liquefaction, viscosity, volume and pH. Microscopic evaluation will specifically involve the determination of: • • • •

Total sperm number/count Sperm concentration Sperm motility Sperm Vitality

• • •

Sperm aggregation or agglutination Sperm Morphology Cells other than spermatozoa

At the end of the workshop participants should be able to: • carry out basic macroscopic and microscopic evaluation of human semen samples • understand semen analysis results Workshop Interactivity: The workshop will be hands-on, practical and interactive with examples and group exercises.

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Ultrasonographic And Scintigraphic Characteristics Of Thyroid Nodules Workshop leader: Stojanoski Sinisa MD, PhD Date: 14.05.2018

The term thyroid nodule refers to an abnormal growth of

thyroid cells that forms a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign (noncancerous), small proportion c o n t a i n c e l l s t h a t h a ve u n d e r g o n e m a l i g n a n t t ra n s f o r m a t i o n (thyroid cancer). Small, asymptomatic nodules are common, and many people who have them are unaware of them.

Ultrasound imaging is useful as the first-line, non-invasive

investigation in determining the size, texture, position, and vascularity of a nodule, accessing lymph nodes metastasis in the neck, and for guiding fine needle aspiration cytology (FNAC) or biopsy.

When further imaging is required, a radiolabelled iodine-131

or technetium-99 uptake scan may take place. This can determine the size and shape of lesions, reveal whether nodules or goitres are metabolically active, and reveal and monitor sites of thyroid disease or cancer deposits outside the thyroid.

During this workshop, all participants will aquire the following knowledge: • •

Ultrasonographic features of benign tyroid nodular lesions; Ultrasonographic features of suspicious/malignant tyroid nodular

•

lesions; Scintigraphic features of thyroid nodular lesions;

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Basic thyroid gland ultrasonography course;

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How to write and publish scientific paper Workshop Lecturers: Prof. Dejan Trajkov MD, PhD; Asst. Meri Kirijas, MD; Teodora Brnjarcevska MD;

Workshop Purpose: The aim of this workshop is to give practical advice to the participants on how to write and publish their work.

Workshop Description: Scientific researc h ar ticles represent a communication method that scientists use to communicate and discuss their findings not only with their colleagues, but also with the general public.

Much of the value of a scientific communication lies in it being formulated according to a widely accepted, standard structure. This workshop was first held in 2003 and every year since then.

It consists of two parts, in the first of which participants will be taught how to use traditional and advanced online tools to research the existing literature with regard to the their topic of interest.

The second part will then focus on what a scientific paper is, followed by indepth descriptions of the different types thereof and their structuring.

Each part will be supplemented with a practical work session in which participants will be guided through thesis writing and the preparation of a scientific paper and an accompanying oral presentation. At the end, all participants will be awarded a certificate which is part of elective subject "Basics of scientific work".

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Cutaneous manifestations of internal diseases Workshop leader: Prof. Suzana Nikolovska MD Data: 14.05.2018

As the largest organ in the body, the skin may reveal the first manifestations of internal disease. The astute general physician, internist or dermatologist who is asked to help in the diagnosis of obscure internal disease can often use dermatologic findings to diagnose an underlying systemic disease.

In this workshop, case reports of cutaneous manifestations of internal malignancy, endocrinological disease, gastrointestinal and renal disease as well signs of nutritional disturbances will be discussed in terms of clinical features, presentation, pathogenesis, diagnostic methods and treatments.  

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Substances Abuse And Addiction Workshop leader: Prof. Daniela Chaparoska MD Date:14.05.2018

Diagnosed clinically as a substance use disorder, addiction is a recognized condition involving compulsive use of a substance despite negative consequences. Drug abuse is the inappropriate use of substances – including alcohol, prescription medication, or illegal drugs – for purposes such as pleasure, to feel or perform better in certain situations, or to change one’s perception of reality.

Abusing substances creates both changes in behaviour and in the way the brain works, specifically in the areas governing judgment and reward. Continued abuse of substances can be a warning sign that an individual is beginning to lose control over their drug use.

Key wards: substances abuse, addiction, brain changes

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Mediation in medicine Workshop leader: Prof. d-r Dejan Trajkov, Ass. Ilija Manasiev, PhD candidate and mediator Date: 14.04.2018

Workshop purpose: The aim of this workshop is to give theoretical and practical knowledge to the students concerning mediation in medicine.

Mediation is a legal and out of court procedure for settling various disputes among different parties with the help of a licensed mediator. It is quite useful to use mediation, for preserving good communication among the subjects that have disputes. Also mediation is very diverse in its practical implication on disputes concerning torts, inter personal disputes, consumer disputes etc.

This is a regular workshop of this type for the students in medicine in Macedonia, and it will be useful to inform and to stimulate the students to use the methods of mediation to improve their communication with the other colleagues, as well as with their patients. This could be very helpful in developing high level of ethical and personal skills in the area of mediation.

The first part of the workshop concerns the basics of the legal norms related to mediation in healthcare disputes.

The second part of the workshop will be a practical application of the presented material and knowledge in the first part. Every student will be able to test and practice their personal skills, to settle a dispute in the role of mediator or one of the parties in a mediation procedure.

At the end of the workshop all of the participants, will be awarded a certificate for their participation of the workshop.  

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Acute abdomen clinical and radiological diagnosis and treatment Workshop leaders: Prof.Vasilevska Nikodinovska Violeta MD PhD MSc ; Ljuben Arsenkov MD Date: 14.05.2018

Acute abdominal pain is one of the most common conditions in patients presenting to the hospital emergency department. It is syndrome characterized by the sudden onset of severe abdominal pain which require early medical or surgical treatment.

Radiologic signs of acute abdomen Prof.Vasilevska Nikodinovska Violeta MD PhD MSc Medical Faculty, University “Ss.Cyril and Methodius”, Skopje, Macedonia

Radiography is useful tool to the clinician for making diagnosis. In the lecture will be discussed about of imaging technique and importance of good quality radiography.

Will be presented radiological signs for pneumoperitoneum, acute bowel obstruction, sigmoid volvulus, and acute gastritis and acute gastric dilatation. In cases with acute inflammatory abdominal conditions like appendicitis, cholecystitis, diverticulitis radiography may give valuable information for diagnosis.

Clinical diagnosis of acute abdomen and differential diagnosis Ljuben Arsenkov – abdominal surgeon University Surgical Clinic “St.Naum Ohridski”, Skopje, Macedonia

The clinical examination of the patient is the first step of management of all medical conditions and diseases. Being a skilled clinician is a combination of knowledge, experience and skill. The aim of this lecture is to talk about the clinical diagnosis of the most common conditions presenting with acute onset of abdominal pain. Although there are hundreds of reasons for abdominal pain, asking the right questions, looking for the relevant signs and doing the

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Ultrasound diagnosis of acute appendicitis Prof.Vasilevska Nikodinovska Violeta MD PhD MSc Medical Faculty, University “Ss.Cyril and Methodius”, Skopje, Macedonia

Clinical diagnosis of acute appendicitis most of the time is clear for experienced surgeons. Ultrasound (US) is an excellent tool in patients suspected for acute appendicitis after clinical diagnosis. Histologically may be predicted the type of appendicitis in most of the cases. This method is good for making differential diagnosis as well. But the limitation is that it is highly operator dependent.

In lecture will be discussed the US technique and US signs for acute appendicitis with case presentation of appendicitis and differential diagnosis.

Case presentation – practical approach and discussion Ljuben Arsenkov, Vasilevska Nikodinovska Violeta University Surgical Clinic “St.Naum Ohridski”, Skopje, Macedonia

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ORAL SESSION 

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Simultaneous vs. Non-Simultaneous Bilingualism (A case-control study) Abstract ID: #41-1/007 Author(s): INEIDA BOSHNJAKU, Fjola Hyseni, Sueld Hyseni Institution: University of Medicine, Tirana Background: Simultaneous bilingualism refers to the experiences of a child who receives language input from two different languages simultaneously beginning either at birth or typically very early on in infancy.

A number of research and studies, aiming to investigate the neurocognitive performance differences between bilinguals and monolinguals have been performed in the last decades. Some of these researches contradict one another; most are done without differentiating simultaneous bilinguals from successive bilinguals and generally are performed on specific groups of bilinguals (Chinese/English, Spanish/English).

Objective: Our aim was to investigate some areas of the neurocognitive performance and linguistic skills through a number of different tests, specifically designed for this research. Our hypothesis is that bilinguals will show a better performance in logic tests, in short-term memory testing exercises and a faster understanding of gestures and sign language (new language perception skills).

Materials and methods: The structure of our study is case-control, with 11 simultaneous bilinguals and 11 non-simultaneous bilinguals. We gathered demographic data on the subjects, calculated their test results- means for each group and performed t- tests to control for the differences in performance between cases and controls.

Results: The mean age for the case group is 22.1 and for the control 22.4, all are medical students, coming from similar socio-economic backgrounds, criteria chosen to avoid confounding factors that may affect cognitive performance. Simultaneous bilinguals showed a slightly better performance in logic test and short- term memory and a significantly faster understanding of sign language compared to the control group.

Conclusion: The results are similar to the previous studies with some minor differences. This study claims how important the exposure of a child to two different languages is to his neurocognitive performance. Cohort studies would be advised to calculate the long- term success of simultaneous bilinguals.

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Hyperthyreosis and autoimmunity, effects on prognosis and remission Abstract ID: #41-1/005 Author(s): Bojan Janevski, Sinisa Stojanoski Institution: Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, Skopje Introduction: The aim of this study is to analyze the autoimune profile of hyperthyroid patients and correlate the autoimune status with the prognosis of the disease.

Material and methods: This is a retrospective study. Data have been analyzed in the last 5 years. All hyperthyroid patients were divided into 3 groups: with autoantibodies (aTpo and aTg) data, without autoantibodies data and patients with TRab levels. Duration of the disease, duration of remission and recidivant disease were correlated with the autoimune status of the patient.

Results: In the period from 2012 to 2016 (5 years), 350 patients (71 males, 279 females, mean age 51 +/- 18) were analyzed with a diagnosed hyperthyroidism (struma difuza toxica) retrospectively. Positive thyroid autoantibodies were detected in 162 (42%) patients, which correlated statistically significant with the duration of remission in these patients (p <0.001). PTU vs Thyrozol did not show a statistically significant correlation with remission length (p <0.4). The value of TSH prior to termination treatment showed a statistically significant correlation with the remission length (p <0.05). The value of TRab showed a statistically significant correlation, as with the length of the remission, and with the recurrence phenomenon (p <0.002).

Conclusion: the autoimune status of the patient correlated with the disease outcome.

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Screening of Female Athlete Triad among Balette Dancers in one of the Cracovian Ballet School Abstract ID: #41-1/013 Author(s): MARI MINASYAN, Marta Biedrawa, Katarzyna Chłopaś, Alicja Kapusta, Alicja Pietraszek, Kinga Suchoń Institution: Pediatric and Adolescent Department of Endocrinology, Medical School, Jagiellonian University Background: The Female Athlete Triade (FAT) is a complex disturbance of health among women training very hard with low Energy Availability (EA) comparing to the demands. It consists of inappropriately low EA, menstrual disturbances and low Bone Mineral Density (BMD).

Objectives: The aim of our study was to evaluate existence of FAT issue in ballet dancers by using the FAT Coalition Screening Tool.

Materials and methods: We obtained a permission of FAT Coalition to use the questionnaire in our study. It consists of 12 initial and 20 more detailed questioners, which refer to components of FAT. The study group consists of 77 ballet dancers in one of the Cracovian balette schools (mean age 14.44+/-2.39) and the control group was 190 students of primary, secondary and high schools (mean age 14.41+/-2.37). The Statistica13.0 program was used to compare the groups.

Results: The comparison of groups shows statistically significant (p< 0.05) lower BMI in ballett dancers than in control group (18.34kg/m2+/-2.11vs 19.18kg/m2+/-3.14), as well as more time spent on training (8.19h/ week+/-11.19 vs 1.81h/week +/-2.61). Mean difference between ideal body weight and current body weight is -2.67kg+/-3.67 in a ballet group vs +5.13kg+/-9.17 in control group. 5.19% of ballet dancers use laxatives to loose weight vs 1.58% in a control group. Irregular periods were reported among 32.1% of ballet dancers vs 19.47% in a control group. 8.16% ballet dancers vs 1.79% of a control group had less than 3 menses last year.

7.89% of a ballet dancers vs 5.79% of a control group had stress fractures.

Conclusions: Our study showed existence of FAT components among ballet dancers, which is detrimental for reproductive, bone and cardiovascular health. Initially, the symptoms are poorly pronounced, so implementation of screening tool among ballet dancers could be useful for early intervention.

We plan extending of our study among ballet dancers from more restrictive ballet schools.

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The evolution of peripancreatic necrotic collections Abstract ID: #41-1/004 Author(s): ANA LEBEN, Rok Dežman Institution: Institute of Radiology, University Medical Center Ljubljana, Slovenia Background: Pancreatic fluid collections are seen in up to 50% of cases of acute pancreatitis. Acute necrotic collections (ANC) consist of inhomogeneous mixture of liquefied necrotic fatty tissue, solid pancreatic and extra- pancreatic debris. They may gradually resolve or persist as walloff necrosis – homogeneous well- demarcated fluid collections. However, quantification of changes in these collections has never been performed. We propose a texture analysis of these collections as a quantitative description of changes in ANC. Aim: The aim of this study was to evaluate the evolution of ANC and its meaning for clinical intervention.

Materials and methods: This retrospective study included all patients with acute necrotizing pancreatitis hospitalized at Department of Abdominal surgery, University medical center Ljubljana from January 2016 until October 2017. Patients with two or more successive CT examinations and ANC present on those were included. Two blinded radiologists analyzed and determined heterogeneity of peripancreatic collections with LIFEx software system at the Institute of Radiology, UMC Ljubljana. Periodic change of the heterogeneity was determined with paired samples t-test.

Results: We included 19 patients, 13 men (68%) and 6 women (32%). 50 CT examinations were performed (mean 2.6 per patient, range 2-4 per patient). The median difference between the first and the last examination was 22 days (range 3-190 days). A texture analysis of one collection per examination was performed, altogether 19 fluid collections were analyzed (1 per patient). The mean change in entropy was 7% (3.90 vs 3.62, p<0,001).

Conclusions: Texture analysis of ANC is a feasible method capable of quantitative description of an evolution of ANC with decrease in entropy and increase in homogeneity. This finding has a potential role to help clinicians decide about further treatment options and finding the right timing for interventional or surgical procedure. Further studies with bigger sample size are needed to confirm this data.

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Comparation between Ravitch and Nuss procedure as surgical treatment options for Pectus Excavatum Abstract ID: #41-1/008 Author(s): Doruntina Klenja Institution: Thoraco-vascular Clinic, Faculty of Medicine, Skopje Background: Pectus excavatum (PE) is the most common congenital chest wall anomaly. The deformity is reported to occur more frequently in males than females. PE is sporadic and generally asymptomatic. The Haller index is a mathematical relationship that exists in a human chest section observed with a CT scan and describes the extent/depth of the pectus: mild, moderate or severe. The two most common types of surgeries used to correct pectus excavatum is the open repair (Ravitch) or the minimally invasive repair with a metal bar (Nuss) procedure.

Objectives: Aim of this study is to compare the postoperative results between Ravitch and Nuss procedure.

Material and Methods: A comparison of patients that underwent repair of a pectus excavatum during a 10-year period from 2005 to 2015 was performed.

Results: The cases were divided into two groups, group I operated with Ravitch procedure and group II with Nuss procedure. In our cohort the inclusion criteria were CT chest with moderate HI > 3.25, bony deformity distressing the patient psychologically, progressive bone abnormality, bony deformity with progressive symptoms secondary to compression either cardiac or pulmonary with positive finding in EKG, Echocardiography or pulmonary function study With Ravitch procedure are operated 19 patients and with Nuss procedure 11 patients. Only 45% from Ravitch and 55% patients operated with Nuss procedure that shows better results.

Conclusion: There was no significant difference in terms of satisfaction degree between the Nuss and Ravitch operation in this study. The Nuss procedure had several advantages over the Ravitch procedure in the immediate postoperative period.â&#x20AC;Š

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Evaluation of pregnancy outcomes at advanced maternal age Abstract ID: #41-1/011 Author(s): BEATA ADRIANOWICZ, Magdalena Płonka, Paulina Danił, Klaudia Gądkowska Institution: Jagiellonian University Medical College Background: Advanced maternal age at childbirth has been associated with adverse perinatal and neonatal outcomes. As delayed childbearing has become increasingly common in the recent decades, the issue of pregnancy outcomes among older patients seems to be of utmost importance, especially to women considering postponing pregnancy or expanding their families.

Aim: The objective of this study was to compare maternal, perinatal and neonatal outcomes depending on maternal age and parity.

Material and methods: We retrospectively analysed 950 women who gave birth in the University Hospital in Kraków during a six-month period (between 1st January and 30th June 2017). The patients were divided into 3 groups according to their age (30-34 years old, 35-39 years old and over 40 years old). Each of these groups was subsequently subdivided into 2 subgroups depending on parity (primiparae and multiparae). Pregnancy outcomes were compared between the groups and the subgroups.

Results: Comparison of the 3 age groups revealed that the risk of adverse pregnancy outcomes begins to increase after the age of 35, but becomes significant in women aged ≥40. Advanced maternal age constitutes a predisposing factor for caesarean delivery (OR=2.03, p=0.02) and large for gestational age (OR=2.17, p=0.04). In addition, it dramatically increases the risk of postpartum haemorrhage (OR=6.43, p=0.03). At the same time, older women had a lower incidence of lack of progress of labour (OR=0.29, p=0.02). Furthermore, there is a negative correlation between maternal age and gestational age at delivery (R= -0.106, p<0.05).

Conclusion: Advanced maternal age can undoubtedly be associated with several perinatal complications. Therefore, obstetricians should be especially cautious for adverse effects in this group of the patients, particularly as trends of postponing childbearing continue.

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Characteristic of injuries in pediatric patients admitted to emergency room – study from single pediatric centre Abstract ID: #41-1/009 Author(s): ALICIJA PIETRASZEK, Kornelia Kukla, Patrycja Molek, Malgorzata Pankowska, Anna Peterko, Grzegorz Slota, Zuzanna Zakrzewska Institution: Department of Children Surgery, Jagiellonian University Medical College, Cracow, Poland Background: Injuries are leading causes of children’s hospitalization and mortality. Many children suffer from disabilities due to injuries. Prevention of injuries is one of the most important issues to introduce in daily life.

Aim: The purpose of the study was to analyze the characteristic of injuries among children admitted to emergency room (ER) and injuries’ preventive methods introduced by parents.

Materials and methods: We interviewed 100 parents who admitted with their child (50 girls), to ER due to injury. We focused on patients’ age, sex, type of injury, place were injury occurred, parents’ age, level of education, material standing, presence of adult at the time of injury and introduced preventive methods.

Results: The most common injury while presenting at ER was sprained joint (25%) followed by hurt (18%), fall (16%), burn (14%), bruising (13%), fracture (9%), other reason (4%), choking (1%), poisoning (0%). Girls constituted 84% of the group of children with sprained joint, while only 21% in the group of burns and 33% in hurts. Younger children experienced burns more often (mean age 1,9), older sprained joint (10,7 yrs) and fracture (8,4 yrs). Most injuries happened in living room (28%), followed by school (21%), kitchen (13%), yard (11%), bathroom (0%), other (27%). Children of younger parents (mean age 30,5) experienced burns more often. 59% of parents had higher, 38% secondary and 3% elementary education. 71% of parents asses their material standing as good, 29% as average. Adults were presents when the injury happened in 75%. The most common preventive method introduced by parents was drug storage in an inaccessible place (99%).

Conclusions: The most common injury in our group of children was sprained joint. Young children were more likely to experience burns while older fractures and sprained joint. The majority of injuries happened in living room. Adults were usually present at the time of the injury.

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Customers' Satisfaction With Chosen Doctor Study Abstract ID: #41-1/015 Author(s): Maja Kalac Institution: Medical Faculty Podgorica, Montenegro Introduction: Customers’ satisfaction is a significant indicator of quality of the health care system, therefore regularly measurement of it is emphasized.

Patient’s satisfaction is his/her basic right because the quality of health care and services at all levels should be ensured.

Aim: To identify users’ satisfaction with a chosen doctor in the Primary Health Centre Stari Aerodrom and Primary Health Centre Bijelo Polje and to compare results acquired at these two primary health centres.

Method: The survey was conducted during the month of October 2015 in respective two institutions. The sample consisted of 97 patients who visited the centres in order to meet their medical needs. The survey instrument was anonymous questionnaire consisted of 17 closed questions purposed to detect subjective satisfaction. Methods of descriptive statistics were used to process the results.

Results: The study composed of 97 users. The survey showed that users are very satisfied with the services provided in terms of the relationship between medical workers and users, a sense of trust towards the selected doctor, examinations and treatments explanation, waiting for an appointment with the selected doctor and other aspects through which one could perceive the quality of the chosen doctor.

Conclusion: The main conclusion of this survey is that users are very satisfied with provided services of the chosen doctor on the primary health care level and that there is no significant difference between the two covered primary health centres.

Key words: primary health centre, satisfaction, user, chosen doctor, health care system

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Significance of prognostic factors in patients with non-Hodgkin lymphoma (DLBCL) of gastrointestinal tract Abstract ID: #41-1/001 Author(s): Srdjan Nikolovski Institution: Clinic for Hematology, Lymphoma Center, Clinical Center Serbia, Belgrade Background: Gastrointestinal non-Hodgkin lymphomas are the most frequent form of all extranodal lymphomas. The most significant risk factors whic h ha ve influence on t heir occur rence are age, gender, immunosupression, autoimmune and immunodeficient conditions, microorganisms, exposition to toxic chemicals, lifestyle and genetic factors.

Objectives: Determination of significance and influence of basic prognostic factors in survival of patients with diffuse large B-cell lymphoma of gastrointestinal tract.

Material and methods: The survey included 97 patients treated against non-Hodgkin lymphoma of gastrointestinal tract in the period 2001-2013 on Clinic of Hematology, Clinical Center Serbia. We analyzed clinical caracteristics in these patients (sex, age, course of the disease, clinical stadiums by Ann Arbor classification, stadiums by Lugano classification, ECOG performance status, international prognostic index, thrombocyte blood count, serum levels of lactat-dehidrogenase and C reactive protein, and presence and frequency of “B“ symptoms) which are compared with the lenght of survival time. Used statistical methods were univariate and multivariate analysis.

Results: There was significant difference in relation between five year overall survival and Ann Arbor stadium ≥ 2, ECOG performance status ≥ 2, international prognostic index ≥ 2, high levels of thrombocytes and C reactive protein, hypoalbuminemia and newly defined inflammatory stagemodified international prognostic index (p<0,05).

Conclusion: Patients with non-Hodgkin lymphoma of gastrointestinal tract have ECOG performance status, international prognostic index, thrombocytosis, high levels of C reactive protein and hypoalbuminemia as main predictors of overall survival. We have defined new inflammatory stage-modified international prognostic index as the best prognostic factor.

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POSTER SESSION

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Subacute Budd - Chiari syndrome - case report Abstract ID: #41-2/003 Author(s): FROSINA MARKOSKA, Andreja Nusdorfer Institution: General Hospital Dr. Franca Derganca Nova Gorica Introduction: Budd-Chiari syndrome (BCS) is defined as hepatic venous outflow tract obstruction, independent of the level or mechanism of obstruction, provided the obstruction is not due to a cardiac disease, pericardial disease or sinusoidal obstruction syndrome (veno-occlusive disease).

Case presentation: A 35-years old healthy woman was referred to our hospital with epigastric pain and ascites of one-month duration. On physical examination patient had palpatory abdominal pain in right upper quadrant.

Blood analysis showed abnormal hepatogram. We tested our patient for viral hepatitises, autoimmune diseases, metabolic liver diseases where all of them were negative. Result of computed tomography of abdomen with contrast showed thrombosis of all three hepatic veins and partial thrombosis of inferior vena cava above hepatic veins inflow. With further examinations the patient was diagnosed BCS caused by protein C deficiency. We started a treatment with paracentesis and anticoagulant therapy. For further treatment we sent our patient to Clinical department of gastroenterology (KOGE) UKC Ljubljana. She was hospitalized two months later because of worsening of symptoms on KOGE. Medicamentous treatment was not enough and esophageal varices were confirmed by gastroscopy. Thatâ&#x20AC;&#x2122;s why transjugular intrahepatic portosystemic shunt (TIPS) was done. Doppler ultrasound controls show normally passable TIPS. Conclusion: Clinical manifestation of BCS can be extremely diverse, ranging from completely asymptomatic patients, classic triad of hepatomegaly, abdominal pain and ascites to fulminant liver failure. The diagnosis is made

by Doppler ultrasonography, computer tomography and magnetic resonance imaging. Treatment includes supportive care, specific care that consists of anticoagulation and decompressive methods, as well as liver transplantation in extreme cases.

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Nutrition of children in elementary school Abstract ID: 41-1/016 Author(s): DANIJELA KNEZEVIC, Tijana Brandmajer Institution: Medical University of Montenegro The aim of this study is to examine the nutrition of children in elementary school, their eating habits and attitudes towards personal appearance. In children, obesity is particularly important, because obese children as a rule, grows into a man with a higher risk of developing many diseases and onethird of overweight children is adults was such in childhood.

Objective: To determine the nutritional status of students in grades primary school, their eating habits and attitudes towards personal appearance.

Methodology: The survey instrument is specially designed questionnaire containing 20 questions.

Results: Most of the respondents have (51%) three meals during the day, a smaller number (29%) have four meals a day, two meals a day has all (10%), the smallest number of respondents have only one meal per a day (1%). In most of respondents, sweets do not replace the meal (41%), while few respondents (33.3%) rarely replace a meal with sweets. Meat and meat products 2-3 times a week consumes 43.8% of the respondents, 5-6 times a week 25.7% of the respondents, while only 1.9% never consume meat and meat products. Most respondents never induced self-deliberate vomiting after eating (83.8%), while rarely makes up 11.4%. Of the 11.4% of respondents who rarely induce deliberate vomiting on the statistic, make up 8.57% of girls and only 2.85% of boys.

Conclusion: The causal relationship of malnutrition as a lifestyle and the resulting obesity as a risk factor for the development of many chronic diseases is one of the leading public health issues. Attention must be paid to girls because of imposed unattainable ideals of beauty and consequently greater dissatisfaction with their appearance.â&#x20AC;Š

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Giant bilateral vertebral artery aneurysms Abstract ID: 41-1/016 Author(s): DANIJELA KNEZEVIC, Tijana Brandmajer Institution: Medical University of Montenegro

Background: Giant cerebral aneurysms are ones that measure >25 mm in greatest dimension and account for ~5% of all intracranial aneurysms.

Case presentation: A 61-year-old male died at Department of Infective disease with a clinical diagnosis for bilateral bronchopneumonia, cerebral aneurism, fibro muscular dysplasia, CVI, HTA, chronic CMP, cardiac arrest. Gross examination of the brain at the autopsy showed saccular giant bilateral vertebral artery aneurysms that measured 58 mm on the right and 40 mm on the left artery. They were tumor- like and compressed the medulla and pons. Both were thrombosed. The right was ruptured with subacute subarachnoid bleeding. Sections of the cerebral vessels exhibited minimal atherosclerotic plaques, with mild stenosis (focally up to 10%) of the left internal carotid artery. We found mild dilatation on ventricles and minimal cortical atrophy of the brain.

During the microscopic examination angiodysplasia with abnormally dilated blood vessels on visceral organs, predominantly on brain and heart was detected. The cause of death was central type of cardiopulmonary insufficiency with pulmonary edema.

Coclutions: We presented an extremely rare case with bilateral giant vertebral aneurysms. Giant cerebral aneurysms are ones that measure >25 mm in greatest dimension and account for ~5% of all intracranial aneurysms. They occur in the 5th-7th decades and are more common in females. Vertebral artery aneurysmsâ&#x20AC;Š

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The effects of smoking, alcohol and coffee consumption and physical activity on the Body Mass Index (BMI) among medical students attending the Faculty of Medicine at Ss. Cyril and Methodius University in Skopje Abstract ID: #41-1/014 Author(s): KATERINA GUDEVA, Filip Stojanovski Institution: Faculty of Medicine, University Ss. Cyril and Methodius, Skopje Background: Often, medical students tend to lead a sedentary lifestyle and acquire unhealthy habits due to the demands and stress that studying this field brings. Smoking, coffee and alcohol consumption and the lack of physical activity have all been tied to the Body Mass Index (BMI). Increased BMI is a risk factor for developing various metabolic disorders.

Aim: To evaluate the correlation between the BMI and other lifestyle factors among medical students.

Material and Methods: A cross – sectional study was performed on 47 male students and 137 female students. The information from the participants was gathered in 2018 through an anonymous, online questionnaire. A univariate data analysis was preformed using SPSS 19 statistical software.

Results: The study comprised 184 students. Overall, current smokers had a higher BMI than non-smokers. Highest BMI was observed in male students that smoke 5 – 10 cigarettes a day. Female non-smokers and those that smoke 0-5 cigarettes a day had similar BMI. Furthermore, coffee and alcohol consumption too affect the BMI. Students that do not drink coffee, but drink 3-7 alcoholic drinks a week tend to have the highest BMI, whereas the lowest BMI was measured in those students that drink 3+ cups of coffee a day and 7+ alcoholic drinks a week. Students that exercise one to three times a week and smoke 0-5 cigarettes a day had the lowest BMI, while those that are not physically active and smoke 10-20 cigarettes a day had the highest BMI. Conclusion: Although there was a measurable difference in BMI between smokers and nonsmokers, no statistical significance was found (p > 0.05).

Moreover, different alcohol and coffee consumption rates affect the BMI, but again with no statistical significance (p > 0.05).

Key words: Alcohol, body mass index, cigarette smoking, coffee, lifestyle, physical activity

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CASE REPORTSâ&#x20AC;Š

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Lingua villosa nigra: a novel treatment approach with propolis tincture Abstract ID: #41-2/006 Author(s): Jovan Pop-Stefanija Institution: Faculty of Medicine, University Goce Delchev, Stip

Background: Lingua villosa nigra is a disorder with chronic character, with occasional remissions and exacerbations. Itâ&#x20AC;&#x2122;s characterized with hyperkeratosis, hypertrophy and multicolor discoloration of the filiform papillae of the tongue. Etiological factors include chronic irritation of endogenous (bacterial infection, C. albicans infection, ect. ) or exogenous ( chemical or physical irritants ) origin. Although benign in its nature, due to the presentation and frequent association with halitosis, it can cause significant stress to the patients suffering from this disorder.

Case presentation: We present the case of a 22-year old woman (student, non-smoker, does not consume alcohol) who noticed the changes on her tongue one year prior to her doctor visit. At the moment of clinical examination, she presented with the classical symptoms of Lingua villosa nigra. The patient was treated with commercially available propolis tincture three applications twice per day half an hour before a meal for a period of ten days. During the treatment the discoloration of the tongue completely subsided. Exacerbation of the condition on her six-month check-up was not noted.

Conclusion: The pharmacodynamic properties and therapeutic potential of propolis as an active ingredient completely nullifies the effects of all causative factors of the disorder. Therefore, theoretically and in practice the result of the treatment is to be expected. However, it is our conclusion that this approach offers a cheaper, more reliable and available treatment option for patients suffering from this disorder.

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Joubert syndrome coexisting with combined pituitary hormone deficiency in infant boy – case report Abstract ID: #41-2/010 Author(s): ALICIJA PIETRASZEK, Karolina Rutkowska Institution: Jagiellonian University Medical College, Students’ Scientific Group at Department of Pediatric and Adolescent Endocrinology, Cracow, Poland Introduction: Joubert syndrome is a genetic disorder that belongs to ciliopathy group. It is characterized by brain abnormalities, hypotonia leading to ataxia and delayed development. Prevalence of the disease is 1:80.000, but it may be underestimated due to heterogenous manifestation.

Combined pituitary hormone deficiency is a disfunction of at least two of pituitary - organ hormonal axis. It affects 1 out of 100.000 children. Signs and symptoms depend on child age and in infant period include seizures, prolonged jaundice, hypotonia, micropenis and delayed development.

Case presentation: In the thesis there is presented a case of an infant boy with multiple abnormalities in physical examination as well as general clinical picture. After delivery he presented with seizures, multisystem organ failure and improper sucking reflex. On physical exam he presented with asymmetric legs and ears setting, micropenis, hypotonia and prolonged jaundice. Motor development was delayed. Labs showed elevated liver enzymes, CK-MB, D-dimers and troponins and deficiency of growth hormone and thyroid hormones. USG scans of the brain, lungs, abdomen and heart showed only one spleen cyst. Brain MRI revealed deep interpeduncular fossa, mesencephalon and pons hypoplasia which suggested Joubert syndrome. Moreover, ectopy of posterior pituitary and suprasellar cysts were described, what together with hormones abnormalities suggested combined pituitary hormone deficiency. Supplementation of thyroid hormones and growth hormone was introduces as well as complex health care.

Conclusion: Described patient is an example of coexistence of two different syndromes: Joubert syndrome and combined pituitary hormone deficiency. It should remind us that making clinical diagnosis is not only simple matching present symptoms to one illness. The same symptoms may be sign of many different conditions which can co-exist in one patient.

Diagnostic process should not be stopped after finding one possible justification for most of the complaints, but after disqualifying other possible explanations of their existence.

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Clinical presentation, diagnosis and management of a patient with Transthyretin Familial Amyloid Polyneuropathy (TTR-FAP) Abstract ID: #41-2/017 Author(s): FILIP STOJANOVSKI, Katerina Gudeva Institution: Clinic of Neurology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje Introduction: TTR-FAP is a disease in which a protein called Transthyretin dissociates from its tetramer structure to monomers that misfold and aggregate. These aggregations form amyloid-like fibrils which deposit primarily in peripheral and autonomic nerve tissue as well as the heart, liver, eyes and kidneys. The clinical presentation can vary depending on the type of mutation present. There are over 100 different mutations of the TTR gene.

It is inherited in an autosomal dominant manner.

Case Presentation: The patient, a 23 years old male, first hospitalized after complaints of trouble walking and dysesthesia in the hands and feet.

The patient also experienced presyncope episodes after sudden verticalization. Because of a positive family history (father, two uncles, aunt and grandfather) he was genetically tested, and had a positive TTR gene mutation, Phe53Val. The neurological exam noted generalized diminished reflex responses, especially on the lower extremities, as well as peripheraltype changes in the tactile sense of the hands and feet. Laboratory results were normal. Biopsy of the fatty tissue was performed in which the deposits seen correspond with Amyloidosis. Myocardial scintigraphy and E c h o c a r d i o g r a p hy b o t h s h ow s i g n s o f c a r d i a c i nvo l ve m e n t .

Electromyoneurography shows signs of chronic, partially generalized, mostly distal neurogenic lesion with axonal degeneration more pronounced on the lower extremities.

In accordance with the clinical presentation and the paraclinical investigations, he is diagnosed with TTR-FAP. The polyneuropathy is in the first stage. He is discharged with the recommended therapy and consulted to do regular check-ups with a neurologist, cardiologist, gastroenterologist, nephrologist and ophthalmologist.

Conclusion: TTR-FAP is a chronic progressive and fatal disease. While initial symptoms may be mild, they progress steadily, and become more severe over time. The Type of mutation has an impact on life expectancy.

Early diagnosis and treatment, although presently can’t cure the disease, is key to prolonging the onset of symptoms.

Key words: amyloidosis, autosomal dominant, family history, genetic mutation, heart, neuropathy, transthyretin.

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Assisting in surgery: Overlooked but an essential topic

Abstract ID: #41-2/018 Author(s): Stefan Arsenkov MD

Surgery is a major part of medicine that treats numerous diseases and conditions. The focal point of the science of Surgery is the surgical operation. Every surgeon will most likely need an assistant, and most of the time the assistants are residents and students. Although much of the residency is spent assisting in surgical operations, there are no lectures given on how to assist, and just a handful of books are written about it. The goal of this lecture is to familiarize students with some of the general concepts of assisting in surgery, as well as shatter some myths and offer some tips.

The operating room is like a temple, and much like one, each has it’s own set of rules. However, there are a few (un)written laws that must be respected. First and foremost is the sterility, before and in the operating room. How to scrub, what is sterile and what is not - what can you touch - all are important terms for someone entering an OR. Second is the conduct in the operating room - how to behave and who to watch.

Once the assistant is scrubbed and ready for the operation, a whole new set of rules apply. There are a myriad of tasks the assistant must do.

Cleaning the surgical site, improving the surgeon’s view, providing traction on the tissues are just a few. Here some general principles apply too.

Finally, every surgeon teaches the assistant how to assist him/her the best, but only a few talk about assisting in general. Each has their own personal opinion on how an assistant should perform, but a few tips from a resident with more than a thousand operations under his belt, couldn’t hurt.

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SPONSORS & PARTNERS

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Macedonian Medical Association

The Macedonian Medical Association (MMA) is a professional organisation of the medical doctors in Republic of Macedonia.

The Macedonian Medical Association was founded on August 12th, 1945 as an Association of doctors, dentists and pharmaceutical chemists. The later two, the pharmaceutics in 1947 and the dentists in 2004, separated from MMA and formed their own associations.

At the very beginning MMA consisted of only 123 medical doctors and dentists and 96 pharmaceutical chemists. Today, MLD gathers together over 5000 medical doctors of all branches of medicine, of whom approximately 35% are general practitioners and 65% are specialists in various fields. These medical doctors are further assembled in around 70 specialists and sub-specialists associations and 20 local associations according their place of work and living.

Over 70 years, generations of doctors â&#x20AC;&#x201C; MMA members, on an entirely voluntary basis, with enormous enthusiasm, unselfish efforts and selfsacrifice, have been carrying out their mission with great success. Today, MMA is a well established pillar of the healthcare system of the Republic of Macedonia and an extremely significant segment in the overall social development of the country.

MMA was the predecessor of the Medical Faculty as a most relevant source of teaching staff, because many of its members later became professors at the Faculty.

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SUPPORTED BY: â&#x20AC;Š

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41st International Medical Scientific Congress 12th -15th of May 2018 Ohrid, Macedonia â&#x20AC;Š

Our story begins in 1994 as one of the first foreign language schools and we have successfully written the story for 24 years. The persistence, creativity and great dedication of the employees resulted in great success among our listeners, which at the same time are our biggest advertising. Success after successes, the school experienced expansion.

Today it operates in ten locations in Skopje, in the settlements Avtokomanda, Aerodrom, Centar, Kozle, Lisice, Kisela Voda, Rasadnik, Ilinden and Kadino, with more than 20 classrooms equipped with audio-visual equipment, as well as interactive boards for monitoring the teaching.

The year-long successful collaboration with the British Council in preparation for international exams and collaboration with the Cambridge University to organize pre-testing for the following FCE, CAE, BEC, IELTS, TOEFEL exams, as well as preparations for international examinations in German is another confirmation of our successful work. In 2010, the school was certified according to the ISO 9001: 2008 quality standard, and 2015 with ISO 9001: 2015.

The school offers language courses and individual classes in English, German, Italian, French, Albanian and Macedonian for foreigners. We perform an evaluation of knowledge and issue certificates for language proficiency. We also do general, judicial and expert translation.

The professional and professional team of Piccadilly S is expecting you.

Invest in your knowledge and sail with us in the world of languages.

Be part of the story of Piccadilly S.

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ABOUTâ&#x20AC;Š

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REPUBLIC OF MACEDONIA Macedonia (Macedonian: Македонија), officially Republic of Macedonia (Република Македонија), is an independent country on the Balkan peninsula in the heart of southeastern Europe. The country borders Albania to the west, Bulgaria to the east, Greece to the south and Serbia and Kosovo to the north. In 2005, the Republic of Macedonia received official candidate status for the European Union. The capital is Skopje with more than 500,000 inhabitants. It also has a number of other significant cities, notably Bitola, Prilep, Tetovo, Gostivar, Kumanovo, Ohrid, Veles, Štip, and Strumica. The Republic of Macedonia is often called a land of lakes and mountains. There are more than 50 natural and artificial lakes and sixteen mountain ranges higher than 2,000 m (6,562 ft) above sea level.

Macedonia has a rich cultural heritage in art, architecture, poetry and music. It has many ancient, protected religious sites. Poetry, film and music festivals are held each year.

Macedonian music styles developed under the strong influence of Byzantine church music.

Macedonia belongs to the countries with the best preserved frescoes, many of which date from the period between the 11th and 16th centuries. There are several thousand square meters of preserved frescoes, most of which are in very good condition and are masterpieces of the Macedonian School of ecclesiastical painting.

In Macedonia the past meets the present. Its ageold architecture and monasteries and churches of exquisite beauty make an interesting contrast with the super modern new architecture. Almost all Macedonian monasteries, built in different periods, particularly those built between the 11th and 15th-16th century, is now completely preserved.

Macedonian collection of icons, especially Ohrid is one of the most valuable collections in the world today. After Sinai and the Moscow collection of icons, is third in importance within Orthodoxy. The Byzantine aspect, it is unique.

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OHRID Ohrid, an immortal town, on the mythical Balkan, a magical hill of Macedonia whose primordial pulsation links ancient and modern times forever.

It is the largest city on Lake Ohrid and the eighth-largest city in the country with over 42,000 inhabitants.

Ohrid is notable for once having had 365 churches, one for each day of the year, and has been referred to as a "Jerusalem (of the Balkans)". The city is rich in picturesque houses and monuments, and tourism is predominant.

It is located southwest of Skopje, west of Resen and Bitola, close to the border with Albania. Ohrid has been a living town for two thousand and four hundred years, the legitimate descendant of the shining Lychnida, a town whose achievements were woven into the tapestry of a powerful ancient civilization. The town of Ohrid is indeed the cultural history of the Republic of Macedonia in miniature.

As an Episcopal center in ancient times, and likewise through the widely renowned Ohrid archbishopric, the town has likewise through centuries represented the entire ecclesiastical history of Macedonia. It bears the name “The Balkan Jerusalem”. Through the activity of St. Clement of Ohrid, at the end of 9th and the beginning of the 10th century the first pan Slavonic university in Europe was situate here.

Ohrid was the most important official capital of the first mediaeval Macedonian state, of Samuel`s empire. Ohrid is a literary center of Macedonia in the 19th century with the strong maxim of one of the greatest European intellectuals of that time, the native from Ohrid, Grigor Prlichev, so called “The second Homer”: PERFECTION OR DEATH! Today Ohrid is a cultural, spiritual and tourist center of Macedonia. And finally, as the crowning glory of its values, Ohrid and the lake of Ohrid were declared a cultural and natural heritage site under protection of UNESCO since 1980.

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SKOPJE Vodno is a mountain located in the northern part of the country, to the southwest of the capital city Skopje. In 2002, on Krstovar peak the Millennium Cross was built, is one of the biggest crosses in the world.

The Mother Teresa Memorial House is dedicated to the humanitarian and Nobel Peace Prize laureate Mother Teresa. Inside the house, parts of her relics are preserved. There is a museum and sculptures of Mother Teresa and the members of her family in realistic appearance.

The Stone Bridge rises magnificently over the river Vardar in the central part of Skopje, the capital of Macedonia. The bridge connects the old and the new part of the city, and is the primary element of the daily communication of its inhabitants and visitors. There is no visitor who visited Skopje and did not walk over it. The bridge connection the two part of Skopje not only physically, but also with time.

The Old Bazaar in Skopje is the largest bazaar in the Balkans.

Situated on the eastern bank of the Vardar River the bazaar had been the cityâ&#x20AC;&#x2122;s centre for trade and commerce since at least the 12th century. It rapidly grew and reached its peak during Ottoman rule, evidenced by over 30 mosques, several caravanserais, and other Turkish buildings and monuments.

Kale fortress has the dominant place in Skopje. It was built of stone blocks from the ruins of the city of Scupi, during the rule of the Byzantium Emperor Justinijan the 1st. It originates from the 6th century, while itâ&#x20AC;&#x2122;s presents appearance is from the Ottoman period.

Skopje is small city, but there is plenty of nightlife with many night clubs & bars with different kind of music which are open everyday.

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Macedonian Medical Students’ Association MMSA

The Macedonian Medical Student Association is nongovernmental, a nonprofit organization aimed unifying all students by medicine in the Republic of Macedonia, where we represent one of the largest non-governmental organizations in the Republic of Macedonia with more than 2000 active members.

Our vision is medical students to educate themselves on the highest European level standards for medical education, to be able to cope with latest medical skills, to know their rights as students and to have professional and moral responsibility with medical and ethical principles. We are actively fighting to improve the quality of medical education in Macedonia, by organizing educational and scientific-research activities, congresses, t he realization of professional and research exchanges with the member states of the International Federation of Medical Student Associations-IFMSA.

The very beginning of the MMSA dates from the time of the formation of the first Medical Faculty in Skopje in 1947. MMSA is a member of the International Federation of Medical Student Associations-IFMSA since 1954 as a part from the Yugoslav Medical Student Association, and since 1994 as Macedonian Medical Student Association-MMSA. Although is one of the smallest Member States of IFMSA, MMSA is one of the most prestigious organizations, with quality of work, excellent ideas and ability of it's members, MMSA hosted 3 General Assemblies of IFMSA till now, that were attended by about 1000 medical students from 130 countries of the World.

The constitution of MMSA is composed of an Executive Board that include president, vice-president of foreign affairs, vice-president of interior affairs, secretary general and treasurer. Apart from the Executive Board, MMSA is also composed from standing committees of different areas: standing committee of Public Health, standing committee for Medical Education, standing committee for Human Rights and Peace, standing committee of Reproductive Health including HIV / AIDS, standing committee for professional and research exchanges, standing committee for national project and Erasmus+, standing committee for Cultural Life & Sports, PR & HR, alumni and supervising council. All these committees throughout the year, are organizing scientific events and workshops in order to increase the awareness of the citizens of the Republic of Macedonia, and thus contribute to the improvement of the public health.

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INDEX AUTHORS & INDEX ABSTRACTS

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Index Authors: Adrianowicz B…………………………………………………………………21 Arsenkov S……………………………………………………………………..22 Bartolič M………………………………………………………………………23 Bellcishta A……………………………………………………..………………21 Biedrawa M……………………………………………………..…………….20 Boshnjaku I…………………………………………………………………..…20 Brandmajer T………………………………………………………………..…23 Chłopaś K………………………………………………………………………20 Colanceski R……………………………………………………………..…….21 Danił P…………….…………………………………………………………….21 Dežman R……………………….……………………………………………..20 Gądkowska K…………………………….…………………………….……..21 Gudeva K……………………………………….………………………….22,23 Hyseni F…………………………………………………………………………20 Hyseni S………………………………………..…………………………….…20 Ilievska H………..……………………………………………………..………23 Ilievski B………..………………………………………………………………23 Janevski B…………………………………………………………………..….20 Kapusta A………………………………………………………………………20 Klenja D…………………………………………………………………………21 Knežević D……………………….…………………………………………….23 Kukla K…………………………………..………………………………........21 Leben A……………………………………………………………………..….20 Macedonian Medical Students’ Association

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Ljaljević A………………………………………………………………………23 Markoska F…………………………………………………………………….23 Minasyan M……………………………………………………………………20 Molek P………………………………………………………………………….21 Novotni G………………………………………………………………………22 Nusdorfer A……………………………………………………………………23 Pankowska M………………………………………………………………….21 Peterko A…………………………………………………………………….…21 Petrov A…………………………………………………………………………22 Pietraszek A……………………………………………………………20,21,22 Płonka M………………………………………………………………………..21 Popovič P……………………………………………………………………….20 Pop-Stefanija J………………………………………….……………………..22 Radoń-Pokracka M………………………………………………………..….21 Rutkowska K……………………………………………………………………22 Slota G……………………………………….…………………………………21 Stojanoska B.B. ……………………………………………………………….23 Stojanoski S………………………….…………………………………………20 Stojanovski F……………………..……………………………………….22,23 Suchoń K……………………………………………………………………….20 Wedrychowicz A…………………………………………………………20,22 Wojciechowski P………………………………………………………………21 Ylli D……………………………………………………………………….……20 Zakrzewska Z……………………………………………………………….…21

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Index Abstracts: Abstract ID: #41-1/007………………………………………………………………46 Abstract ID: #41-1/005………………………………………………………………47 Abstract ID: #41-1/013…………………………………………………………..…..48 Abstract ID: #41-1/004………………………………………………………………49 Abstract ID: #41-1/008…………………………………………….…………….….50 Abstract ID: #41-1/011……………………………………………………………….51 Abstract ID: #41-1/009………………………………………………………………52 Abstract ID: #41-1/015………………………………………………………………53 Abstract ID: #41-1/001……………………………………..……………………….54 Abstract ID: #41-2/003…………………………………………..………………….56 Abstract ID: 41-1/016…………………………………………………………………57 Abstract ID: 41-1/016……………………………………………………..…………58 Abstract ID: #41-1/014………………………………………………………………59 Abstract ID: #41-2/006……………………………………………………..……….61 Abstract ID: #41-2/010………………………………………………………………62 Abstract ID: #41-2/017……………………………………………………….……..63 Abstract ID: #41-2/018………………………………………………………….…..64

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