KNOWLEDGE - International Journal https://ikm.mk/ojs/index.php/kij <p>KNOWLEDGE - International Journal is an international, high quality, peer-reviewed, open access journal publishing the newest research and good practices on the basis of their originality, importance, interdisciplinarity and impact. The journal publishes research papers in all fields covered by the Frascati classification - Social sciences, Humanities, Medical sciences and health, Biotechnical sciences, Technical and technological sciences and Natural and mathematical sciences.</p> Institute of management and knowledge en-US KNOWLEDGE - International Journal 1857-923X ANALYSIS OF HOSPITAL MORBIDITY AND MORTALITY IN THE AREA OF THE CITY OF SHTIP FOR YEAR 2021 https://ikm.mk/ojs/index.php/kij/article/view/5448 <p>The aim of the research of this scientific paper is to present the situation with hospital morbidity and<br>mortality in the area of the city of Shtip for year 2021.<br>Research methodology: Data on hospital morbidity and mortality are obtained from the Report on inpatient<br>treatment, Exemplar no. 3 -21 61A from hospital health care. The method of work is statistical - informative with a<br>descriptive analysis.<br>Research results: In 2021, 9,212 people were treated in the hospital wards of the PHI Clinical Hospital Shtip. Of<br>these, 4,486 are male and 4,726 are female. A total of 48,263 hospital days were completed. The average length of<br>treatment was 5.2 days. A total of 117 doctors were hired, of which 71.7% are specialists. In first place are "Diseases<br>of the circulatory system" with a total number of 1,610 treated patients who spent 5,277 hospital days or 3.3 days<br>average duration of treatment. The specific morbidity rate of circulatory system diseases is 181.8/10,000 inhabitants.<br>The "Certain infectious and parasitic diseases" group follows with a total number of registered patients for all age<br>categories of 14.6%, who completed 12,065 hospital days with an average length of treatment of 9.0 days. The<br>specific morbidity rate for this group of diseases is 152.2/10,000 inhabitants. The third place in hospital morbidity<br>belongs to "Diseases of the digestive system" with a total number of 774 treated patients or 8.4% of the total treated<br>patients, who spent 4,371 hospital days with an average length of treatment of 5.6 days. The rate of specific<br>morbidity in diseases of the digestive system is 87.4/10,000 inhabitants. During year 2021, there are the most<br>deceased persons from "Certain infectious and parasitic diseases" and their number is 59 persons, of which 71.1%<br>are men, while 28.9% are women. "Diseases of the circulatory system" followed with 40 deceased persons, and<br>"Diseases of the digestive system" is in third place with a total number of 17 deceased persons.<br>Conclusions: The largest number of treated patients who required hospitalization during 2021 were "Diseases of the<br>circulatory system" with 17.5% of the total number of hospitalized patients who spent 5,277 days of hospitalization<br>or the average duration of treatment was 3.3 days.<br>Recommendations: The recommendations resulting from this scientific paper are aimed at highlighting the<br>importance of these "social diseases" which in the largest percentage lead to the hospitalization of the population.<br>The prevention of "Diseases of the circulatory system" leads to a reduction in the costs incurred during the treatment<br>of the same, and also reduces the number of people who need medical treatment.</p> Valentina Simonovska Biljana Cekova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 511 516 IMPACT OF THE ONCOLOGICAL DISEASE ON THE QUALITY OF LIFE AMONG THE ELDERLY https://ikm.mk/ojs/index.php/kij/article/view/5461 <p>Oncological diseases are a large group of social significant diseases. They can occur in any organ or<br>tissue of the human body. Cancer is the second leading cause of death in the world. Estimates are that in 2040 the<br>number of deaths will increase significantly with the greatest increase occurring in low- and middle-income<br>countries where more than two-thirds of concentrated. Cancer accounts for about 30% of all premature deaths from<br>chronic non-communicable diseases in adults aged 30-69. The growth of the epidemic of chronic non-communicable<br>diseases, including oncology, has a negative impact on quality of life. Cancer mortality is a function of morbidity<br>and survival. Worse access to health care in countries with low human development index (HDI) reflects on greater<br>mortality and vice versa – mortality reduction is greater in countries with a high HDI. A large part of countries with<br>low and middles incomes of the population started to pay attention to this health problem later. The incidence of<br>oncological diseases in Bulgaria is lower compared to other countries of South-Eastern Europe but the trends in<br>individual locations are similar. The mortality: morbidity ratio is one of the lowest in the region with a persistent<br>downward trend and is lower than the probability of death for individual locations. Lung cancer is the most common<br>in men and breast cancer in women. Adult survivors are at greater risk of complications from the disease and<br>therapy. It is no coincidence that they report poor health already during or after therapy and this accordingly affects<br>their quality of life. Early diagnosis is the best alternative for many oncological diseases that cannot be prevented<br>and those that occur despite preventive measures. Pain in cancer patients regardless of whether it is caused by the<br>disease itself or by the side effects of the applied therapy is a problem that significantly worsens the quality of life.<br>In a global aspect, it is of particular importance to emphasize the control, prevention, diagnosis, treatment and<br>monitoring of these patients. The approach to oncological diseases is much more complex compared to other<br>diseases. A multidisciplinary approach is needed. The multidisciplinary teams include surgeons, pathologists,<br>radiation therapists, medical oncologists and clinical psychologists. It is necessary to include rehabilitators,<br>occupational therapists, art therapists. It is not by chance that the National Program for the Prevention of Chronic<br>Non-Communicable Diseases sets the strategic goal of improving the health of the population and increasing the<br>quality of life.</p> Sonya Nencheva Varvara Pancheva Copyright (c) 2022 2022-08-15 2022-08-15 53 4 517 522 HEALTHCARE-ASSOCIATED INFECTIONS ON THE TERRITORY OF RUSE DISTRICT IN THE CONTEXT OF PANDEMIC https://ikm.mk/ojs/index.php/kij/article/view/5462 <p>The COVID-19 pandemic is proving to be one of the greatest challenges in modern history. The global<br>nature of the world economy, which is based on the free movement of people between different countries, intensive<br>economic, transport links and tourism contribute to the spread of the infection around the world. In this situation,<br>medical facilities should create an organization for hospitalization of patients with COVID-19, as well as conditions<br>for providing the necessary hospital treatment for patients with other infectious and non-infectious diseases. A basic<br>requirement for all structures is strict compliance with anti-epidemic measures and preventing the occurrence of<br>infections related to medical care.<br>Due to the fact that nosocomial infections do not exist at the time of hospitalization, but develop subsequently, they<br>lead to adverse consequences affecting patients, medical staff and individual structures of medical institutions.<br>Significant losses of an economic, social and moral nature are caused, sufferers arise, treatment becomes more<br>expensive, and the quality of life of patients and their families decreases. The hospital stay is prolonged, the<br>indicators for the effectiveness of the bed base are violated, as well as for achieving a positive final result of the<br>treatment.<br>This specific group of infections is caused by a variety of microflora - from species with pathogenic properties to<br>representatives of the own, resident bacterial flora, including external microorganisms found in the hospital<br>environment.<br>This paper examines the frequency of healthcare-associated infections in the context of a coronavirus infection<br>pandemic. Their etiological and clinical structure was studied in medical facilities for hospital care in 2021. Data<br>were used from the automated information system of the National Center for Public Health and Analyzes (NCPHA),<br>reports on registered HAIs of the Regional Health Inspectorate (RHI) - Ruse and own observations. A documentary<br>method was mainly used, and the data were processed statistically through mathematical and graphic analysis.</p> Preslava Zhekova Nikola Sabev Copyright (c) 2022 2022-08-15 2022-08-15 53 4 523 528 DYNAMICS OF QUANTITATIVE STUDIES ON THE ANTIBODIES TO COVID-19 DURING A PANDEMIC https://ikm.mk/ojs/index.php/kij/article/view/5463 <p>In recent years, the population's incidence of nosological units requiring accurate and high-tech clinical<br>laboratory research have witnessed a significant increase. Such researches are a crucial component of the healing<br>process of each patient as the results obtained from them help to make a real assessment of the health status of the<br>body. Without the results of the clinical and laboratory analysis, it is impossible to achieve an accurate diagnosis and<br>to take effective decisions regarding the health of patients.<br>At the beginning of 2020, an outbreak of pandemic was declared due to the novel virus being so far unknown,<br>namely SARS-COV2, which causes the coronavirus disease (COVID-19) – an infectious and systemic disease of the<br>respiratory tract. COVID-19 has challenged the global health system, the specialists from all fields of medicine, with<br>an effect on both public health and social and economic activities. The number of patients with COVID-19 has been<br>accelerating extremely dramatically and exposed health workers to exhaustion. This infection with a Severe Acute<br>Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is becoming a major topic of medicine and all world<br>organizations, causing millions deaths worldwide. Unlike some better known variants, such as e Alpha, Beta,<br>Gamma, Delta, the new Omicron variant (first reported on 24 November 2021) and even more recent versions of<br>Omicron B4 and Omicron B5, have shown a higher infectivity and a lower efficacy of monoclonal antibody therapy<br>due to mutations of the receptor-binding domain of the Spike protein. As a result of the global COVID-19 pandemic,<br>a huge human and financial resource is being used for the purpose of studying this disease – numerous therapeutic<br>approaches have been studied, the improvement of its diagnosis has been achieved with highly specific, reliable and<br>affordable clinical laboratory tests. The rapid and accurate diagnosis of the causative agent SARS-CoV-2 in the<br>situation of COVID-19 pandemic is paramount in the control of the infection both among asymptomatic carriers and<br>among the sick. The performance of quantitative studies on the creation of antibodies against the virus gives a clear<br>picture of the immunity achieved after re-illness or vaccination. Despite the efforts made by medical professionals<br>worldwide, the COVID-19 pandemic will probably accompany Humanity for an indefinite period of time. COVID-<br>19 is an example of a disease, which requires a multidisciplinary approach for its prevention, diagnosis and<br>treatment, in which the Clinical Laboratory Discipline and the Clinical Laboratory Research play a core and<br>important role.</p> Denitsa Trancheva Kiril Panayotov Copyright (c) 2022 2022-08-15 2022-08-15 53 4 529 533 CASE REPORT ON PNEUMOMEDIASTINUM, PNEUMOTHORAX AND PNEUMONIA COMPLICATING THE CORONA VIRUS DISEASE (COVID-)19 INFECTION https://ikm.mk/ojs/index.php/kij/article/view/5464 <p>The main purpose of this report is to present and provide a view of patient with COVID 19 and<br>Pneumomediastinum.The significance of pneumomediastinum in relation to the SARS-CoV-2 (COVID-19) disease<br>and its harmful effect are crucial factors here. The COVID 19 is already known to have serious consequences for the<br>lungs and the associated quality of life, some more severe and fatal than others. In view of this, we would like to<br>discuss this relationship in more detail, precisely the viral infection with Coronavirus 19 and the<br>pneumomediastinum, present it with potential risk factors and evaluate obvious recommendations for a better quality<br>of life.<br>The ascertainment and diagnosis of pneumomediastinum is performed according to the following diagnostic tools: a<br>plain thorax radiograph or chest computed tomography (CT).<br>The chest radiograph, also acquainted as chest X-ray (CXR) is a specific projection radiograph of the thorax utilized<br>conditions that affect the chest, its important content and the adjacent structural tissues. The computer tomography<br>(CT) belongs also to the X-ray examination methods, which use images created layer by layer to visualize the<br>structure of the mesenchymal tissue of the body. In addition, it provides more reliable illustrations than the X-ray.<br>Individuals that suffer, due to infection, by the specific beta coronavirus severe acute respiratory syndrome (SARScoV-<br>2 – COVID 19) have a higher risk of developing a pneumomediastinum and this is proven by the fact that even<br>the younger population can be affected.<br>Pneumomediastinum is a rare complication of Coronavirus disease 2019 and there is an inadequate amount of<br>published literature that show sufficient data about the exact pathogenetic mechanism and assessment of COVID 19<br>in relation to the development of pneumomediastinum.<br>The connection between COVID 19 and complications like pneumothorax and pneumomediastinum should be<br>investigated further in order to provide faster and better treatment fort he patients COVID 19 is generally treated by<br>physicians with internal or infectious diseases and the surgeon society should be more aware that the COVID 19<br>infection can lead to surgica complications.<br>Additional data on these cases is still relatively small and the need to be collected more data is crucial..Many<br>physicians still don`t know the connection between these diseases .</p> Nikoleta Dimitrova Svetlan Dermendzhiev Hessin Musannar Copyright (c) 2022 2022-08-15 2022-08-15 53 4 535 539 STUDY OF THE IMPACT OF ONCOLOGICAL DISEASES ON PRODUCTIVE ACTIVITIES https://ikm.mk/ojs/index.php/kij/article/view/5480 <p>Little is said about people with oncological diseases. Their problems remain somewhere aside in space.<br>The number of victims of malignant diseases in Bulgaria grows with each passing year. According to data from the<br>Ministry of Health for 2020 registered diseases from malignant neoplasms numbered 300 580 people with more than<br>30 000 newly discovered ones. Leading are melanoma and other malignant neoplasms of the skin – 62 863 people of<br>which 4 648 newly discovered, followed by the mammary gland – 54 758 people, 3 333 newly discovered, in third<br>place – of the female genital organs – 44 648 people, 2 773 newly discovered. Registered malignant neoplasms in<br>children up to 17 years of age are 1 096 of which 60 are newly discovered. Burgas was assigned the fourth place in<br>the distribution by regions (16 860 people) after Sofia-city (59 639 people), Plovdiv (34 788 people) and Varna<br>(20 222 people). Neoplasms are the second cause of death among the country's population (267.2 per 100 000<br>people) after diseases of the circulatory system (1 090.1 per 100 000 people) with the relative share being higher in<br>men than in women. They are the second cause of disability in the population (24.5%) after diseases of the<br>circulatory system (32.3%). A large part of people suffering from these diseases are to some extent distanced from<br>society and lead a closed lifestyle. Some of them are unable to return to the activities performed before or return to<br>an environment that they feel is foreign and cannot adapt. Activities give meaning to human life. Occupational<br>therapy aims to provide opportunities to engage in activities that are valuable and meaningful to people. She<br>considers activities in three main areas – self-care, productive activities and activities related to hobbies and<br>entertainment. Productive activities occupy most of people's daily lives. They are no less important than self-care<br>activities and leisure activities. Globally a third even a half of all cancers can be prevented. This can happen by<br>controlling smoking, obesity, alcohol consumption, air pollution, vaccination against infections such human<br>papilloma virus, hepatitis B which are proven carcinogens. Effective control includes prevention, screening and<br>early diagnosis, multidisciplinary treatment, survival and palliative care. In the current study, a group of people with<br>oncological diseases in the territory of the city of Burgas, housed in a hospital and those who are outside it and<br>particular how the disease has its impact on productivities, are studied.</p> Sonya Nencheva Copyright (c) 2022 2022-08-15 2022-08-15 53 4 541 546 PROBLEMS IN MALIGNANT TUMORS STAGING AND INNOVATIVE SURGICAL TECHNIQUES https://ikm.mk/ojs/index.php/kij/article/view/5465 <p>Innovations in medicine affect everyone. The question to what extent a given innovation can be<br>reconciled with the disease itself and its course so as to obtain a positive result of the treatment remains open. The<br>aim of the study is to determine at what stage of development of the oncological disease in gynecology surgical<br>intervention is carried out by means of robot-assisted surgery. A statistical method was used. The data were<br>processed using the Microsoft Excel program. A total of two hundred and five cases of robot-assisted gynecological<br>surgery were studied, divided into two groups according to the location of the tumor - the body of the uterus and the<br>cervix. One hundred and thirty-eight cases were found to be malignant neoplasms of the body of the uterus and<br>sixty-seven cases to be malignant neoplasms of the cervix, over a one-year period. Based on the staging of the tumor<br>according to the TNM classification, it was reported at what stage of the disease the surgical intervention was<br>carried out through robot-assisted surgery. The ratio by localization of a malignant neoplasm in gynecology is sixtyseven<br>percent for endometrial carcinoma and thirty-three percent. Of the thirty-eight cases of carcinoma of the<br>uterine body, one hundred and three patients or seventy-five percent were registered in the T1a stage, twenty-six<br>cases or nineteen percent in the T1b stage, and eight patients or six percent in the T2 stage . Of the sixty-seven cases<br>of carcinoma of the cervix, fifteen patients or twenty-three percent were registered in the T1a stage, forty cases or<br>sixty in the T1b stage, and twelve patients or eighteen percent in the T2 stage. Discussion: In carcinoma of the body<br>and cervix, robot-assisted surgery has been found to operate in patients with stage II carcinoma as well as sarcoma.<br>It follows that the treatment strategy was determined based on clinical staging, namely: examination, biopsy and<br>imaging studies. With the technology, it would not be able to accurately assess the presence of nearby metastases, a<br>prerequisite for desemination. The thesis is supported by the fact that some patients undergo chemotherapy.<br>Establishing precise criteria for the application of robot-assisted surgery in oncological diseases is of urgent<br>importance for patient survival and cure. Conclusion: Currently, the main problems facing robot-assisted surgery in<br>gynecology are: Tumor staging; The participation and commitment of the oncology commissions in determining the<br>treatment strategy for cancer patients; Costing and cost-benefit analysis. There is a need for: Determination of the<br>exact criteria at which stage robot-assisted surgery should be applied in gynecology (for example - first).<br>Conducting a cohort study for Bulgaria, regarding survival and quality of life in patients treated by robot-assisted<br>surgery. Study of the "Cost-Benefit" ratio in the given type of carcinomas</p> Darina Mineva Copyright (c) 2022 2022-08-15 2022-08-15 53 4 547 551 РOINT-OF-CARE DIAGNOSIS OF INFECTIOUS DISEASES BY VARIOUS LABORATORY DEVICES AND SYSTEMS https://ikm.mk/ojs/index.php/kij/article/view/5466 <p>We live in an unusual epidemic situation that no one has ever anticipated. The COVID-19 pandemic has<br>shown us how vulnerable we are when it comes to different disasters and has created serious challenges for the<br>healthcare systems. The early detection, early isolation, and early treatment, which will limit the spread of the virus<br>in the population, are directly related to the diagnostic methods, especially the quick, accessible, and inexpensive<br>ones, as well as those near the patient (рoint-of-care diagnostics). Instead of the usual methods of detection and<br>confirmation of viruses used in laboratory diagnostics, various modified polymerase chain reaction (PCR) devices<br>are being introduced. The focus of this article is microfluidics in combination with the microelectromechanical<br>system technology, which allows miniaturization of PCR processes using a lab-on-a-chip device with the potential<br>advantages being ultrafast speed, low cost and low sample volumes, portability, high output, and integration and<br>automation options.</p> Emilia Georgieva Yordanka Mihaylova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 553 555 ANALYSIS OF HOME CARE NEEDS IN CHILDREN WITH CEREBRAL PALSY https://ikm.mk/ojs/index.php/kij/article/view/5467 <p>Children's cerebral palsy (CCP) is a disease leading to serious disability in children, which also<br>determines its great social significance. The disease from CP is 2.1 - 2.5 per 1,000 newborn children in Bulgaria.<br>The parents and society face a number of problems, leading to increased and specific health care requirements for<br>them. CP is a multimodal condition requiring early and polyvalent diagnostics, and complex and multistage<br>rehabilitation. Well-planned and proactive health care is a prerequisite for better outcomes and improved quality of<br>life for children with CP. Continuity between institutional care and home care is needed.<br>Home care has three elements: technological care, physical care (home care in a narrow sense), and nursing<br>(stabilization and prevention of loss of function), and contributes to stabilizing the individual’s social<br>participation.Family-centered care improves the well-being of children with GPs. They put both the child and his<br>family at the center of care. The partnership is mutually beneficial for health care providers, children, their families,<br>and society. Health, education, and social systems must strive to strengthen and modernize services for children with<br>disabilities by providing high-quality care at an affordable price, and ensuring support through an effective set of<br>tools to do so.<br>The necessary care is determined on the basis of an individual assessment of the disability.<br>During the period 01.11.2021 - 10.07.2022, an anonymous survey was conducted, which aims to analyze the state of<br>health care for children with CP in the Republic of Bulgaria and to justify the need to expand their scope through a<br>complex of home care. The need of children with CP and their families has been explored, and the opinion of their<br>parents has been sought.<br>The primary analysis of the received results of the survey shows unequivocally the need for this type of care.</p> Iliyanka Georgieva Ivanka Stambolova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 557 564 ANALYSIS OF THE HEALTH CONDITION AND HEALTH PROTECTION OF THE POPULATION OF SKOPJE REGION FOR 2020 https://ikm.mk/ojs/index.php/kij/article/view/5449 <p>The aim of the research of this scientific paper is to show the health status of the population of the Skopje<br>region for 2020 and to propose measures to improve health and the quality of health services.<br>Methodology of the research: For the realization of the research, the following materials were used: individual<br>statistical reports for a person treated inpatient by hospital health care, that is, form no. 3-21-61A and summary<br>statistical reports from primary health care that refer to the identified diseases and conditions in the ambulatory<br>polyclinic activity. The method of work is statistical - informative with descriptive analysis of health data.<br>Research results: According to the processed data, the first place in hospital health care is occupied by the "group of<br>Neoplasms (C00-D48)" and has a total number of 9,338 registered diseases with a specific morbidity rate of 14.7<br>patients per 1,000 inhabitants. In the activity of general medicine from primary health care, the most sick people are<br>from the group "Diseases of the circulatory system (I00-I99)", that is, 131,687 registered with a specific morbidity<br>rate of 278.4 sick people per 1,000 inhabitants. In the activity of health care of school children and youth and health<br>care of children from primary health care, the first place is occupied by the group "Diseases of the respiratory<br>system (J00-J99). From these diseases suffered 43,592 children aged 0-6 with a specific morbidity rate of 793.3 per<br>1,000 inhabitants. While school children and youth have 48,483 patients with a specific morbidity rate of 232.8 per<br>1,000 inhabitants.<br>Conclusions: In the outpatient-polyclinic activity for Skopje region during 2020, "Respiratory diseases and<br>circulatory system diseases" are in first place, while "Neoplasms and circulatory system diseases" dominate in<br>hospital health care. The high ranking of these diseases in the morbidity of the population of Skopje region indicates<br>the seriousness of this health problem, which we expect to remain one of the priority public health problems.<br>Recommendations: The recommendations resulting from this scientific paper are aimed at continuous and detailed<br>monitoring of risk factors and preparation of programs for their elimination, as well as development and<br>implementation of screening programs for chronic non-communicable diseases. Prevention of diseases with greater<br>awareness of the population about its benefits is necessary for the promotion of public health.</p> Valentina Simonovska Biljana Cekova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 565 570 THE TASKS ОF THE PATRONAGE NURSES WHEN CONDUCTING A POLYVALENT PATRONAGE HEALTH SERVICE DURING COVID-19 https://ikm.mk/ojs/index.php/kij/article/view/5450 <p>Polyvalent patronage health is organized at a level of a primary health care as a part of the public health<br>home or a medical facility. The tasks of the patronage health service have to do with promotion, improvement and<br>saving health, as well as prevention from diseases, and they are conducted through planned activities given by the<br>preventive program for protection of the population. The polyvalent patronage health care is the only service in the<br>primary health care protection which deals preventively with the health and its improvement as well as a medical<br>branch dealing with an active health and social treatment of the individual or the family in the home or within health<br>institutions. One of its goals is to prepare the individual, the family or the community, to which health, except the<br>biological, there are many other factors such as social, cultural, hygienic and so on It strives to create healthy<br>lifestyles which would improve the basis for better health, life quality and prevention of development of chronic<br>diseases.</p> Gordana Panova Sanja Mitreva Copyright (c) 2022 2022-08-15 2022-08-15 53 4 571 575 COMPETENCIES OF THE NURSE FOR EDUCATION OF PATIENTS WITH A DIAGNOSIS OF DIABETIC FOOT https://ikm.mk/ojs/index.php/kij/article/view/5468 <p>Diabetes mellitus is a chronic, endocrine and socially significant disease in which blood sugar is higher<br>than normal as a result of insufficient production of insulin in the body. One of the most serios complications of the<br>disease is the so-called “diabetic foot”, manifested by injury to the limb and subsequent gangrene, amputation and<br>high mortality. This causes permanent disability to the patient, associated with additional complications, reduced<br>duration and quality of life. Treatment requires a multidisciplinary approach, and the team should include –<br>endocrinologist, vascular surgeon, orthopedist, hydropodist, rehabilitator and nurse. Early diagnosis and limiting the<br>influence of risk factors slows down the development of the disease and improves the prognosis of the patient's<br>condition. Nurses carry out continuous monitoring and communication with the patient and his relatives. They must<br>carry out control and training to limit the risk factors and exact compliance with the doctor's prescriptions, which<br>helps to preserve the full lifestyle of the patient, both in the hospital setting and at home and in his social<br>environment. In this context, the nurse's competencies are essential for the early detection and limitation of the<br>factors for the development of the diabetic foot. Her full participation in the treatment team and proper training of<br>patients and their relatives requires her certain knowledge and professional skills. The purpose of this work is to<br>study the competencies of nurses in their participation in a team for the treatment of diabetic foot and to provide<br>training to patients and their relatives to limit risk factors and maintain a normal lifestyle.<br>The study was conducted through an anonymous survey among 32 nurses working in a vascular surgery unit. The<br>research is aimed at analyzing their competencies for providing quality health care to patients with a diagnosis of<br>diabetic foot, as well as their ability to properly educate the patient and his relatives to slow down the development<br>of the disease and maintain a normal lifestyle.<br>The majority of nurses are familiar with the disease diabetes and its complication "diabetic foot". The main<br>guidelines in health care to limit risk factors include: diet, hygienic care and periodic examinations. To provide<br>quality care and maintain a normal lifestyle for patients with a diagnosis of "diabetic foot", it is necessary to develop<br>a health care algorithm in accordance with the specifics of the disease and the needs of the patient. Its successful<br>implementation in practice depends on the competencies of the nurses and the ability of the medical institution to<br>provide conditions for their development.</p> Tatiana Slavkova Ralica Eredanska Copyright (c) 2022 2022-08-24 2022-08-24 53 4 577 582 PHYSIOTHERAPY IN FRACTURE OF THE SURGICAL NECK OF THE BONE-LATE POST-MOBILIZATION PERIOD https://ikm.mk/ojs/index.php/kij/article/view/5469 <p>Fractures in the humerus are about 6% of all fractures, with approximately 1/3 of them in each part of the<br>bone: proximal part, diaphysis, distal end.<br>We present a 42-year-old female patient with a diagnosis of status post frctura colli humeri sinistra. He was admitted<br>to the diagnostic center for kinesitherapy in the late post-immobilization period. The aim of the applied<br>kinesitherapy was to restore the functional gestures of the upper limb, with a view to performing the activities of<br>daily life. The tasks of kinesitherapy were reduced to reducing pain symptoms, improving trophic, overcoming<br>muscle imbalance, increasing the range of motion in the left shoulder joint and eliminating compensatory<br>movements. Means of kinesitherapy included treatment from the position, passive and passive-active exercises,<br>suspension, stretching, PIR, pendulum exercises, active exercises to increase the volume of movement, PNMU,<br>successive induction, analytical exercises for all affected muscle groups, exercises with and on devices and<br>breathing exercises. At the end of the late postimmobilization period, we included exercises for sensory-motor<br>reprogramming of the left upper extremity.<br>After the comprehensive rehabilitation, a significant improvement in the strength of the motor muscles of the left<br>shoulder joint was observed. Range of motion deficits were observed in rotator cuff movements, but the patient<br>achieved functional independence in performing activities of daily living.</p> Maria Becheva Nina Belcheva Rayna Petrova Penka Кrushkova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 583 586 ANALYSIS OF THE EFFECTIVENESS OF SHOCK WAVE THERAPY AND OTHER STANDARD PROCEDURES OF PHYSICAL THERAPY ON DAILY LIFE ACTIVITIES OF PERSONS WITH PAINFUL SHOULDER SYNDROME https://ikm.mk/ojs/index.php/kij/article/view/5451 <p>The purpose of the work was to analyze the sociodemographic characteristics of the subjects (age,<br>gender), and to analyze the effects of shock wave therapy on shoulder function and daily life activities of subjects<br>with painful shoulder syndrome with the help of the DASH questionnaire<br>Material and methods: In this retrospective, descriptive, analytical study we included 30 subjects with a diagnosis of<br>pain shoulder, treated at MHS - a private practice for physical therapy and rehabilitation in Sarajevo. The DASH<br>questionnaire was used to assess the condition of the subject's upper extremity before and after the rehabilitation<br>treatment. As part of the rehabilitation treatment of the subjects included in the study, shock wave therapy was<br>applied, along with other modalities of physical therapy for ten days.<br>Results: The analysis of the average values of the DASH index shows a statistically significant difference between<br>the values at admission and the values at discharge. The value of the mentioned index at discharge was significantly<br>lower than at admission, which shows improvement (a lower score suggests a lower disability and vice versa).<br>Conclusion: Shock wave therapy is the method of choice that is very effective in the treatment of painful shoulder<br>syndrome, in terms of improving activities of daily life, and improving reduced shoulder function, which we have<br>proven on the example of our respondents.<br>Recommendations: Use shock wave therapy as an effective method of choice in combination with other modalities<br>of physical therapy in the treatment of painful shoulder syndrome, in terms of improving activities of daily life, and<br>improving reduced shoulder function</p> Vanda Zovko Omeragić Sanel Nuspahić Copyright (c) 2022 2022-08-15 2022-08-15 53 4 587 592 IMPACT OF PRIMARY CAREGIVER’S KNOWLEDGE ON GLYCEMIC CONTROL PEDIATRIC PATIENTS WITH TYPE 1 DIABETES MELLITUS IN CANTON SARAJEVO, BOSNIA AND HERZEGOVINA https://ikm.mk/ojs/index.php/kij/article/view/5452 <p>Aim To evaluate primary caregiver’s knowledge and impact knowledge on glycemic control in<br>children/adolescents. Methods and participants The research was cross-sectional study conducted from October 23,<br>2021 year to February 28, 2022 year, in the Canton of Sarajevo. 50 primary caregiver’s of pediatric patients up to 18<br>years old was involved. The Diabetes Knowledge Test was used to assess primary caregiver’s knowledge of<br>diabetes. Results Knowledge of the primary caregiver’s whose children achieve HbA1c values&lt;7.5% is significantly<br>better than those whose children have HbA1c value &gt;7.5% in general knowledge (p=0.003*), total (p=0.014*),<br>while knowledge of insulin did not differ (p=0.865). Conclusion Continuous education of nurses who are key in<br>educating patients and diabetes specialist nurses, especially pediatric specialist nurse is needed to provide effective<br>health care. It would also be of paramount importance to recognize the need for health professionals in the field of<br>nutrition who would provide health services to these patients, as part of the diabetes health care team. Health service<br>providers should regularly assess the knowledge of pediatric patients and their parents about diabetes and self-help<br>management skills, especially in patients who do not achieve optimal HbA1c values, in order to improve knowledge<br>levels and improve skills for disease management.</p> Elmedina Mrkulić Jasmina Mahmutović Suada Branković Hadžan Konjo Anes Jogunčić Copyright (c) 2022 2022-08-15 2022-08-15 53 4 599 606 INTENSITY OF DENTAL CARIES AND LEVEL OF CALCIUM AND MAGNESIUM IN SALIVA IN 12-YEAR-OLD CHILDREN https://ikm.mk/ojs/index.php/kij/article/view/5453 <p>Motivated by new challenges and insights, our paper represents an attempt to recognize the complexity of<br>the etiology of dental caries in children, where the specific goals and focus of the research are aimed at the effects of<br>saliva and its constituent components, therefore we directed the investigations to the following components: is there<br>a significant inverse relationship between the intensity of dental caries and the level of calcium and magnesium in<br>saliva and whether the examined salivary parameters and their optimal concentrations can be used as a diagnostic<br>tool for caries activity. The research included 71 respondents, 26 female and 45 male aged 12 years. For the<br>determination of calcium values in saliva we used ready-made tests - from BioTek Instruments, Inc. headquartered<br>in Winooski, VT, USA. The principle of the methodology of the colorimetric test for the determination of calcium in<br>saliva is based on the fact that calcium ions from the sample, saliva, in an alkaline environment react with the Ocresolphthalein<br>complex, forming a complex with a purple color that absorbs light at 570 nm-578 nm. The intensity<br>of the color was proportional to the concentration of calcium ions in the sample. For the determination of<br>magnesium values in saliva we used ready-made tests - from BioTek Instruments, Inc. headquartered in Winooski,<br>VT, USA. The principle of the method is with a photometric colorimetric test for the determination of magnesium in<br>saliva, where in an alkaline environment magnesium ions from the sample, saliva, react with xylidyl blue,<br>diazonium salt and form a complex with a purple-red color that maximally absorbs light at 520-546 nm. The<br>intensity of the color is proportional to the concentration of magnesium ions in the sample. The examined<br>relationship between the values of calcium and magnesium in the saliva of children with permanent dentition and the<br>presence of the dental has a distinctly low negative insignificant correlation (p&gt;0.05). The increase in the values of<br>calcium in the saliva of children with permanent dentition decreases with the presence of dental caries in children,<br>distinctly insignificant. The examined relationship between the values of magnesium in the saliva of children with<br>permanent dentition and the presence of the dental has a distinctly low negative non-significant correlation (p&gt;0.05).<br>The increase in magnesium values in children with permanent dentition is followed by a drop in the occurrence of<br>dental caries in children, which is clearly insignificant.</p> Sanja Nashkova Cena Dimova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 611 616 DYNAMIC POSTUROGRAPHY IN PATIENTS WITH ORTHODONTIC AND VESTIBULAR DISORDERS https://ikm.mk/ojs/index.php/kij/article/view/5470 <p>Posture of human body corresponds to a certain stable relationship between head, torso and limbs, where<br>a minimal amount of energy is needed for its support. Although clinicians in the field have studied the connection<br>between the muscle chains, maintaining balance of the body, and the musculature in the maxillofacial area (cervical,<br>masticatory), more can be studied and proven in the area. If there is a change of the center of gravity of the body, it<br>is certain that a negative change of posture has been diagnosed. Postural disorders are increasingly common<br>nowadays. The prevalence of musculoskeletal disorders is increasing as well, along with temporomandibular<br>disorders (TMD), vertigo, dizziness, tinnitus, memory loss and others.<br>The present study aims to demonstrate the need for complex examination of patients with symptoms from the audiovestibular<br>system, stomatognathic and other anatomical systems in the head and neck area.<br>In the present study, 40 (20 male and 20 female) patients who have passed through the Audio-vestibular and Sleep<br>laboratory of the University Medical and Dental Center at the Faculty of Dental Medicine of Medical University –<br>Varna in the period February – June 2022 were included. All of them were invited to fill out an informed consent<br>form. They were also given questionnaires to describe the symptoms, concerning audio-vestibular and<br>stomatognathic systems. Thorough examinations were performed by an ENT-specialist and a physician in dental<br>medicine. All patients were examined on a dynamic stabilometric platform, under different modalities – with eyes<br>open/closed, teeth clenched/relaxed, head tilted left and right, for fixed amount of time – 20 sec. Posturographic<br>platform is not a source of ionizing radiation.<br>Patients who reported pain and noise from the temporomandibular joints, when examined with the posturography<br>platform, shifted the center of gravity of the body more often backwards and to the right side (especially if the TMD<br>was bilateral). In patients who also had vestibular symptoms (dizziness, vertigo), with or without a disorder in the<br>mandibular joints, the center of gravity of the body was more often shifted back and to the right as well. Most of the<br>patients with the described displacement also had an orthodontic deformity. Based on intraoral dental examination,<br>cephalograms, and analysis, patients with Angle class 2 (distal bite), crossbite in the lateral area, laterognathia were<br>diagnozed, the first being the most common in patients with a shift in the center of gravity. In all studied patients, an<br>increase in the length of the stabilogram curve above the reference values of 150 mm was found. A change in the<br>feet - flat feet - was found in half of the patients, included in the study.<br>Postural problems can worsen existing symptoms from other systems with a disorder. Establishing the direction of<br>the displacement helps to establish the genesis of the disorder and directs the appropriate therapy, according to the<br>specific clinical case.</p> Miroslav Stoykov Mario Milkov Copyright (c) 2022 2022-08-15 2022-08-15 53 4 617 620 STRESS-RELATED BRUXISM IN DENTAL MEDICINE STUDENTS https://ikm.mk/ojs/index.php/kij/article/view/5471 <p>Authors define stress as a negative stimulus and a concomitant reaction that includes components of<br>physiological and psychological type, affecting the normal functioning of the human being. Bruxism is a wellstudied,<br>parafunctional, repetitive activity of the mandible, during which patients unconsciously grind, gnash or<br>clench with their teeth. When teeth are clenched, a static relation between the maxilla and the mandible is observed.<br>When patients grind with their teeth, clinicians find dynamic maxillo-mandibular relationship. Bruxism is classified<br>as awake and sleep, rhythmic and non-rhythmic, primary and secondary. Etiology of bruxism is multifactorial.<br>Contributing factors for the condition are anxiety, depression and stress situations, malocclusions and interferences<br>with occlusion, as well as pathophysiological, psychological and genetic determinants. Diagnosis of bruxism is done<br>through patient’s subjective report, clinical intraoral examination, the usage of trial dental splints (bruxing checkers),<br>electrophysiological tools. Management of bruxism is not a straightforward task to complete, providing the fact that<br>clinical practice lacks a solution which can permanently stop the condition. A variety of methods are known –<br>medications prescription, dental occlusal splints and obstructive sleep apnea mandibular advancement devices<br>(MADs) usage, psychological approaches, changing bad sleep habits and improving sleep hygiene, lowering or<br>cessation of alcohol, tobacco and coffee consumption. Students of dental medicine, irrespective of the country they<br>study in, especially those who are in their clinical cycle, participate in high demand situations that generate states of<br>stress and anxiety. Teams of clinicians have studied the onset and consequences of bruxism in those clinical groups.<br>The aim of the following publication is to study the correlation between anxiety and stress in dental medicine<br>students, the frequency of bruxism events, gender and age distribution.<br>In order to fulfil the aims of the study, a standard questionnaire (American Association of Sleep Medicine), related<br>to bruxism symptoms, was distributed among dental medicine students. All participants signed written informed<br>consent forms and underwent thorough intraoral analysis of occlusion. The results from the questionnaire were<br>analyzed.<br>Stress is one of the main factors for bruxism and has shown a strong correlation with it. Careful and timely measures<br>should be undertaken to alleviate the symptoms. Improper clinical approaches can cause temporomandibular<br>disorders.</p> Elina Todorova Miroslav Stoykov Copyright (c) 2022 2022-08-15 2022-08-15 53 4 621 625 READING, WRITING AND UNDERSTANDING OF WORDS PRESENTED IN REBUS FORM IN DEAF CHILDREN https://ikm.mk/ojs/index.php/kij/article/view/5454 <p>Deaf writing is an inseparable part of linguistic education which, due to the lack of an auditory sensor,<br>has insurmountable difficulty in realization, so this shortcoming is directly reflected in the general literacy of deaf<br>children. Many researches in the world indicate that to become literate, a deaf child must learn the language of their<br>community. He must first learn the letters, learn to write. About 50% of young deaf people after high school read<br>and write worse than a ten-year-old hearing child. The research aims to examine reading, writing, and<br>comprehension of words presented in rebus form in deaf children, and to determine the statistical significance of<br>differences between deaf and hearing children. The research was done on a sample of 140 respondents. The first<br>subsample of respondents, an experimental group consisting of 70 deaf students, and the second subsample, a<br>control group of 70 hearing students, of the same chronological age. The measuring instrument Test of reading,<br>writing, and comprehension of words presented in puzzle form was applied. The frequencies and percentages of<br>respondent's responses to the variables used were calculated. To determine the statistical significance of differences<br>between deaf and hearing subjects was used the F (Fisher) test. Research results have shown, that deaf children do<br>not understand all the words presented in rebus form despite the fact that they successfully read and write them.<br>18.60% of deaf children read and write the words presented in rebus, and 17.10% of deaf children in subordination<br>understand the words read and written presented in rebus form. Of 14.30% of deaf children who successfully read<br>and write 80% of the words presented in rebus, 11.40% of them understand the read and written words. About<br>2.90% of deaf children cannot read and write words presented in rebus form, and 8.60% of deaf children do not<br>understand the words presented in rebus form. There is a statistically significant difference between deaf and hearing<br>children in reading, writing, and understanding rebus-represented words at the statistical level significance of p =<br>0.000.</p> Naim Salkić Copyright (c) 2022 2022-08-15 2022-08-15 53 4 627 633 READING, WRITING AND UNDERSTANDING OF WORDS PRESENTED IN DISTORTED FORM IN DEAF CHILDREN https://ikm.mk/ojs/index.php/kij/article/view/5455 <p>Deaf writing is an integral part of linguistic education, which due to the lack of an auditory sensor has an<br>insurmountable difficulty in implementation, so this shortcoming is directly reflected in the general literacy of deaf<br>children. Many researchers in the world suggest that in order to become literate, a deaf child must learn the language<br>of the community. He must first understand the letters, and learn to write. About 50% of young deaf people after<br>high school read and write worse than a ten-year-old hearing child. The research aims to examine the reading,<br>writing, and comprehension in deaf children of words presented in a distorted form, and to determine the statistical<br>significance of the differences between deaf and hearing children. The research was done on a sample of 140<br>respondents. The first subsample of subjects, the experimental group consisted of 70 deaf students, and the second<br>subsample, a control group of 70 hearing students, of the same chronological age. The measuring instrument Test of<br>reading, writing, and comprehension of words presented in a distorted form was applied. The frequencies and<br>percentages of respondent's responses to the variables used were calculated. The F (Fisher) test was used to<br>determine the statistical significance of the differences between deaf and hearing subjects. The results of the<br>research showed that 35.70% of deaf children fully read and write words presented in distorted form, and 57.20%<br>manage to partially read and write words presented in distorted form, while 7.10% of deaf children cannot read and<br>write words presented in a distorted form. Words presented in a distorted form are fully understood by 34.30% of<br>deaf children. The majority of deaf children (61.40%) partially understand words presented in a distorted form, and<br>4.30% of deaf children do not understand words presented in a distorted form. There is a statistically significant<br>difference between deaf and hearing children in reading, writing, and comprehension of words presented in the<br>distorted form at the level of statistical significance of p = 0.000.</p> Naim Salkić Copyright (c) 2022 2022-08-15 2022-08-15 53 4 635 641 PREGNANCY AND PREGNANCY OUTCOME IN A PATIENT WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA https://ikm.mk/ojs/index.php/kij/article/view/5472 <p>Idiopathic thrombocytopenic purpura, otherwise known as primary immune thrombocytopenia, is an<br>immune-mediated acquired disease that presents with decreased platelet count and associated risk of bleeding. In<br>most cases there are autoimmune antibodies involved in the pathophysiology of the disease. Thrombocytopenia is<br>found during laboratory testing and is defined as platelet count less than 150 000 per microliter per blood whereas<br>higher risk of bleeding complications occurs usually at counts less than 50 x 10^9 /L. In most cases patients stay<br>asymptomatic and the low platelet count is an accidental finding. Furthermore, it is well known that pregnancy is a<br>prothrombotic state and it is hence more likely for thrombocytopenia to stay unrecognized. Most common diagnoses<br>presenting with thrombocytopenia during pregnancy are gestational thrombocytopenia, hypertensive disorders, and<br>immune processes. Case presentation: A thirty-eight-year-old primipara at thirty-three gestational weeks was<br>admitted to Obstetrics Department of MBAL “St. Anna” AD – Varna with diagnosis “Foetus mortus”, blood<br>pressure of 180/100 mmHg, heartbeat of 70 bpm, last menstrual period on 26.01.2018 and estimated delivery date<br>on 02.11.2018. She was previously diagnosed with idiopathic thrombocytopenic purpura. From anamnesis – a<br>pregnant woman with abdominal pain and uterine contractions on tocolytic and spasmolytic therapy showing no<br>significant effect on pain syndrome and shortened cervical length of 25 mm measured with transvaginal ultrasound.<br>She was previously hospitalized once to Department of pathological pregnancy in SBAGAL – Varna. On physical<br>examination she showed hemorrhagic rash on extremities with eyelid, lower leg, and ankle edema. From observation<br>– centripetal type of fat distribution. From laboratory - : Hemoglobin 131g/L; Hematocrit 0,405 L/L; Erythrocytes<br>4,66 T/L; Leukocytes 17,80 G/L; Platelets 22 x 10^9/L; Fibrinogen 4,61 g/L; Total proteins 60 g/L; Urea 2,8<br>mmol/l; ASAT – 26,4 U/I; ALAT 33,0 U/I; Blood glucose – 5,4 mmol/L; Bleeding time – 150 sec; Blood clotting<br>time – 420 sec. Induction of labour with 10 IU/ml oxytocin in 500 ml 0,9% NaCl solution was initiated by reason of<br>the unfavourable cervical score. Magnesium tocolysis and antihypertensive drug chlophazolin were also included in<br>the plan of action due to the high blood pressure. On the 16th hour from induction of labour a non-vital macerated<br>fetus with sign of Spalding was delivered. Episiotomy was not performed due to the higher risk of bleeding. During<br>the third stage of labour total blood loss accounted for 150-200 ml. Conclusion: Despite the advances in medical<br>sciences, immune thrombocytopenia could have a significant impact on both fetal and maternal life and there is<br>always a chance of unfavourable progression of the disorder.</p> Nikolay Kolev Nikoleta Tabakova Maria Marinova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 643 646 APPLICATION OF THREE-DIMENSIONAL (3D) AND FOUR-DIMENSIONAL (4D) ULTRASOUND DIAGNOSTICS IN OBSTETRICS IN NORMALLY RUNNING PREGNANCY https://ikm.mk/ojs/index.php/kij/article/view/5473 <p>Three-dimensional (3D) and four-dimensional (4D) ultrasound are a natural evolution of technology in<br>medicine and were first demonstrated nearly 25 years ago. The development of modern medicine and the<br>introduction of technologies in the diagnosis and treatment of patients determines the relevance of the application of<br>3D and 4D ultrasound in obstetrics as a primary or additional diagnostic tool. Purpose: The purpose of the study is to<br>analyze and evaluate the effectiveness of application of three-dimensional and four-dimensional ultrasound<br>diagnostics in the different stages of pregnancy by using clinical data compared with literature sources. Material and<br>methods: Documentary and historical methods were used, as well as own clinical observations during the follow-up<br>of 121 pregnancies, through which a comparative analysis was made and the positive role of the application of<br>3D/4D ultrasound for early monitoring of fetal behavior and development processes was proven. normal pregnancy<br>in different gestational periods. Results and discussion: The present study, conducted by 3D ultrasound in 121<br>fetuses from all stages of normal pregnancy, showed an increasing frequency of different movement patterns, such<br>as isolated arm and leg movements, stretching, as well as head movements, during the first trimester. From 14 to 19<br>weeks of gestation, the fruits are very active and the longest period between movements lasts only 5-6 minutes. The<br>application of 4D sonography in the study of fetal facial movements reveals the existence of a full range of facial<br>expressions, including smiling and crying, similar to emotional expressions in adults, in the 2nd and 3rd trimester. In<br>the second quarter, there was a steady increase in the frequencies of almost all facial motor patterns. No statistically<br>significant differences were found in either the quality or the quantity of fetal hand or facial movements between<br>term and preterm infants. Conclusion: A good understanding of the relationship between fetal behavior and<br>developmental processes at different gestational periods can provide an important distinction between normal and<br>abnormal development and enable early diagnosis of structural or functional abnormalities.</p> Mario Davidkov Tatyana Atanasova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 647 654 EARLY DIAGNOSIS OF FETUS MALFORMATIVE INJURIES THROUGH THE APPLICATION OF 3D/4D ULTRASOUND IN OBSTETRICS https://ikm.mk/ojs/index.php/kij/article/view/5474 <p>3D data is an interpretation of two-dimensional (2D) planes and is an extension of conventional<br>technique. In this way, 3D does not replace 2D, but rather expands its capabilities. 3D provides a number of imaging<br>modes and image processing techniques that are used in diagnosis depending on the specific problem, and 4D<br>ultrasound allows the display of fetal movements in surface and film-like transparent modes. As a result, 3D/4D<br>technology has become a valuable additional method to conventional 2D ultrasound in the diagnosis of<br>malformations and can be used in clarifying suspicious objects. Objective: To propose guidelines for improving the<br>efficiency of the diagnostic process in obstetrics by analyzing the application of 3D/4D ultrasound diagnostics.<br>Material and methods: Using a computer database, articles on three-dimensional and four-dimensional ultrasound<br>diagnostics in obstetrics and gynecology were reviewed. Our own clinical experience over the past 15 years has also<br>been used. On the basis of the collected information, the present study was conducted, in which we will prove the<br>positive role of 3D/4D ultrasound in the daily practice in the field of obstetrics and the possibility of early diagnosis<br>of structural or functional anomalies requiring significant decision-making. Results and discussion: Introduction of<br>three- and four-dimensional apparatus, combined with the transvaginal approach, gives more objective and accurate<br>information about embryonic and early fetal development. For the first time, parallel analyzes of structural and<br>functional parameters during the first 12 weeks of pregnancy are possible. 3D and 4D ultrasound play an important<br>role in early demonstration of normal and abnormal structures in the first, second and third trimesters. Embryonic<br>and fetal circulation can be demonstrated by applying Glass body mode, a combination of 3D ultrasound in gray<br>scale and color, respectively power Doppler. With the interactive display of 3D images, all types of visible<br>anomalies can be observed in the most appropriate mode, showing the size of the object of interest in all dimensions.<br>Conclusion: 3D/4D ultrasound in prenatal diagnosis represents an important milestone in ultrasound history. The<br>correct use of 3D ultrasound requires technical training, spatial thinking and continuous training of the specialists<br>who use this technology.</p> Mario Davidkov Copyright (c) 2022 2022-08-15 2022-08-15 53 4 655 661 ABORTION ON REQUEST - TOPICAL HEALTH, MORAL AND DEMOGRAPHIC PROBLEM https://ikm.mk/ojs/index.php/kij/article/view/5475 <p>The problem of performing abortionson request is topical even today, significant for the reproductive<br>health of the Bulgarian woman. On the background of the unfavorable demographic situation, it should be set as a<br>priority to be solved with follow-up measures not only by medical specialists but also by specialists in the field of<br>population, environment, education, socialservices, media etc.<br>This report presents the dynamics of the number of abortions in Bulgaria over the last three years, 2019, 2020, 2021.<br>The focusis on abortionson request and the need for pre-abortion prevention.<br>The abortionon request is still practiced as a means of regulating children in the family, contraceptive methods and<br>means are not sufficiently known. Decisions to terminate a pregnancy are made under the influence of cultural and<br>material criteria, of emotional factors, different for different individuals. The medical prevention lacks a clear vision<br>of midwives and nurses as important health care specialists for the health of girls and women. The hospital is not the<br>most appropriate place for consultations, especially immediately after experiencing an abortion on request. In the<br>organized training campaigns, which are rare, they are not included.<br>Every woman should be given the opportunity to prevent unwanted pregnancy by providing information, training,<br>consultations, accessible contraceptive services with a wide variety of reliable, safe, acceptable methods. A set of<br>measures and legislative initiatives which aim at popularizing contraceptive means and methods needs to be taken,<br>increasing the health and sexual culture of the population, introduction of specialized training in schools, provision<br>of medical information on the optimal method of contraception. The public should be more actively directed to the<br>problems of abortion and reproductive health, health behavior in the conditions of a deepening demographic crisis<br>and on their basis to develop effective strategies to improve the situation.<br>With adequate medical prevention and care, with the support of public and state decisions, the number of abortions<br>on request can be significantly reduced and this will lead to an increase in the birthrate, as well as a decrease in<br>infantmortality.<br>The conclusions were made that the midwife and the nurse can prevent the problem in the medical institutions of the<br>out-of-hospital care. The preparation of a training program for students of different age groups and its<br>implementation is one of the important preventive activities.</p> Tsveta Hristova Teodora Todorova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 663 668 DIETARY PATTERNS AND THEIR IMPACT ON MALE INFERTILITY https://ikm.mk/ojs/index.php/kij/article/view/5486 <p>Infertility is an inability to achieve a clinical pregnancy after regular, non-protected sexual intercourse for<br>a period of 12 months. Unfortunately, the global rate of both male and female infertility is racing within the last few<br>years. It is estimated that it affects 15% of reproductive age couples, and male infertility factors contribute in 45-<br>50% of the cases. Male infertility evaluation is important not only for defining infertility treatment strategies, but<br>also for men’s health itself as male infertility could be a predictor of future morbidity. The evaluation of infertile<br>men is by conventional semen analysis (sperm concentration, motility, and morphology). Sperm DNA fragmentation<br>is a specific analysis that can occur even though other sperm parameters are within normal limits. While genetic,<br>endocrine, congenital, intrauterine (e.g. maternal smoking), and demographic factors – such as age, smoking, and<br>heavy alcohol use – are risk factors for decreased sperm quality, there is increasing evidence that nutrition could also<br>play an important role.<br>There are many studies that are focused on isolated nutrient or a few nutrients or foods. However, diet and nutrition<br>are complex and multiple approaches are needed to examine the relationship between them and the risk for<br>infertility. Dietary pattern analysis is the approach that considers overall eating. Obesity and nutrition poor with<br>nutrient-rich food, resulting from an unhealthy lifestyle, negatively affect sperm quality and male fertility, as well as<br>a diet rich in saturated fatty acids and low in polyunsaturated fatty acids. The healthy dietary models, the<br>components of the diet, and nutrients have been studied as factors that clearly correlate with better sperm quality and<br>a lower risk of abnormalities in sperm parameters, such as sperm count, sperm concentration, motility, and lower<br>sperm DNA fragmentation. There is a direct association between antioxidant status and the production of reactive<br>oxygen species (ROS) in spermatozoa because the high concentration of ROS negatively affect sperm DNA, sperm<br>motility, and concentration.<br>The purpose of this review is to discuss the role of nutrient-dense foods and healthy dietary patterns on sperm<br>quality and male fertility. The food components that provide an antioxidant role, such as certain vitamins and<br>minerals are considered.<br>Understanding the biochemical mechanisms responsible for sperm quality will lead to more targeted and effective<br>therapeutic for male infertility. Therefore, it is advisable to have a varied and balanced diet based on vegetables and<br>fruit, fish and seafood, nuts, seeds, whole-grain products, poultry, and low-fat dairy products.</p> Biljana Markovska Copyright (c) 2022 2022-08-15 2022-08-15 53 4 669 674 3D AND 4D SONOGRAPHY IN OBSTETRICS AND GYNECOLOGY AS AN ADDITIONAL METHOD TO 2D EUCHOGRAPHY IN CASE SOLUTION https://ikm.mk/ojs/index.php/kij/article/view/5476 <p>The development of modern medicine and the introduction of technologies in the diagnosis and treatment<br>of patients determines the relevance of the application of 3D and 4D ultrasound in obstetrics and gynecology, as a<br>primary or additional diagnostic tool. In practice, ultrasound is now a routine part of every examination. Thanks to<br>it, normal physiological changes during the menstrual cycle can be evaluated (for example, ovulation and changes in<br>the thickness of the uterine lining during infertility research), to see abnormalities and tumors of the uterus and<br>ovaries, to guess with a high degree of probability whether a tumor is benign or malignant, to establish pregnancy,<br>as well as the location and (inside or outside the uterus) and to follow the development of the fetus throughout<br>pregnancy, looking for developmental deviations or the presence of malformations. Objective: To investigate the<br>development of sonoechography in the field of gynecology and to present the application of 3D/4D ultrasound<br>examination as an additional diagnostic method to 2D ultrasound when solving casuistic cases. Research material<br>and methods: Using a computer database, articles on three-dimensional and four-dimensional ultrasound diagnostics<br>in obstetrics and gynecology were reviewed. An analysis of the literature sources and a comparison with the<br>accumulated clinical experience over a period of 15 years has been made, the effectiveness in diagnosing<br>pathological findings in the area of the small pelvis through the application of 3D and 4D sonography has been<br>proven. Results and discussion: 3D and 4D sonography is a specialized ultrasound examination of the pelvic organs<br>for the diagnosis of congenital anomalies of the uterus (bicornuate, unicornuate, double, septate uterus, etc.), polyps,<br>submucous fibroids, uterine fibroids, endometriosis, adenomyosis , ovarian cysts, etc. Screening and diagnosis of<br>neoplasia of the uterus and ovaries, folliculometry (ultrasound monitoring of the ovarian cycle in sterility and<br>infertility), diagnosis of ectopic pregnancy and molar pregnancy. The main advantage of transvaginal 3D/4D<br>ultrasonography is the ability to generate cross-sections of the pelvis in addition to conventional sagittal and coronal<br>planes. This makes it possible not only to determine the maximum size of an abnormal object, but also to define the<br>exact location of the lesion in all three planes. The ability to visualize all three orthogonal planes simultaneously on<br>the monitor also allows for accurate volumetric analysis. This is important in determining tumor volume. In<br>reproductive medicine, hysterocontrast sonography is used, which is the main procedure for evaluating the uterine<br>cavity and fallopian tubes. 3D ultrasound can also be used to obtain an image of a normal and abnormal pelvic floor.<br>Conclusion: Pelvic scanning with a transvaginal 3D/4D probe opens up new diagnostic possibilities. Using 3D for<br>gynecological applications requires an additional investment of time.</p> Mario Davidkov Tatyana Atanasova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 675 681 THE ROLE OF CANNABIS FLOWER SAMPLING IN QUALITY CONTROL IN MEDICAL CANNABIS INDUSTRY: A REVIEW https://ikm.mk/ojs/index.php/kij/article/view/5456 <p>The purpose of cannabis flower sampling is to apply good practices for sampling cannabis that is strictly<br>regulated, for analysis in order to examine the quality of the product. Every company involved in the production of<br>cannabis has standard operating procedures for managing operations, sampling and testing. More than 500 bioactive<br>components have been identified in the cannabis plant. The distribution and concentration of these compounds also<br>depends on environmental conditions such as soil, water and light. A sample is a small part of something which<br>represents a larger whole or grouping. It is important to look at sampling from the grow through to the laboratory to<br>examine where the focus and perspective should be to ensure that cannabis sampling at every stage of the process<br>represents the whole we are trying to characterize. For the cannabis industry, the population or sampling frame could<br>be as large as an entire crop, just one variety within an operation, or as small as selected trimmed buds from specific<br>plants, varieties, or just areas of growth, depending on the purpose for the sampling. There are two basic types of<br>sampling: probability sampling (random) and nonprobability sampling. Probability sampling is when each unit of a<br>population or a whole has the same chance of being selected to make up a sample and the probability of being<br>selected can be calculated. Nonprobability sampling is when samples are collected in a process where some samples<br>are purposely selected and the selection processes do not give all the possible samples an equal chance of selection.<br>Dry plant material is not completely homogeneous. In sampling methods, sample size is very important, and<br>laboratories often have to prepare smaller samples to meet all testing requirements. The most common method for<br>obtaining a homogeneous sample is grinding. Grinding the samples increases the homogeneity, their surface area<br>and reduces the particle size, which improves the extraction efficiency. In the end, the development of sampling<br>plans-sample preparation methods that understand the importance of these concepts-will ultimately be the most<br>important step in achieving good analyses.</p> Slavica Angelova Biljana Gjorgjeska Copyright (c) 2022 2022-08-15 2022-08-15 53 4 683 686 REDUCED STABILITY STUDY DESIGN FOR HERBAL PRODUCT „DRY CANNABIS FLOSS“ https://ikm.mk/ojs/index.php/kij/article/view/5457 <p>Stability of the final product, independently whether it is an active substance or a drug of herbal, mineral<br>or other origin, according to the guide of the International Conference for Harmonization (ICH): "Stability testing of<br>new drug substances and products Q1A(R2)" is defined as the ability of the final product to keep the quality<br>(physical-chemical and microbiological) prescribed in the specification for quality within the expiry date if it is<br>stored in the proposed packaging. Stability testing enables the establishment of recommended storage conditions,<br>retesting period, or expiry date for the product. When it comes to determining the stability of a herbal product, the<br>procedure is more complex, taking into account the inhomogeneity of herbal preparations, which depends on many<br>factors. This is also the case with cannabis-based preparations, especially dried cannabis flowers, which can be very<br>heterogeneous depending on the variety. Therefore, it is necessary to test the stability of such products with a<br>precisely defined protocol, a properly selected series of flowers, properly selected parameters to be monitored and<br>the justification of the choice of parameters. In such cases, the guide provides accurate guidance for developing a<br>stability protocol using a reduced design that simultaneously provides more information about the quality of the<br>product packaged in several different packages, while significantly reducing the number of analyzes performed. In<br>this way, the manufacturer using this design has an advantage in terms of reduced financial burden, reduced time<br>constraints for obtaining data and rapid scientific expertise for decision making. In this direction, the aim of our<br>research was to develop a protocol for monitoring the stability of dried cannabis flowers in different sizes from the<br>same package using a reduced design, according to the guidelines of the International Council for Harmonization for<br>the preparation of this type of stability study. During creating the protocol, the following topics were taken into<br>account: specifications and certificates on the quality of the materials used for the final packaging of the herbal<br>product, technological files for each produced batch of flowers that are tested for stability, as well as procedures and<br>instructions for the process of growing and processing the flower . The stability study included batches of the final<br>plant product - dried cannabis flower, with the same potency, or uniform content of the active component with<br>proven therapeutic activity (tetrahydrocannabinol), so that the results would be comparable. The final product, dried<br>cannabis flower, was packaged in multi-layer aluminum packaging in three different sizes. A stability protocol was<br>developed in a way to includ different sampling frequencies from different packaging size, using bracketing and<br>matrix principles. When carrying out the reduced design of the stability study, it was considered that the deviation of<br>any parameter at any point of the test would mean a further extension of the test to obtain more relevant data to<br>support the proposed packaging in the appropriate shelf life.</p> Tanja Ivanova Tijana Serafimovska Marija Darkovska Serafimovska Copyright (c) 2022 2022-08-15 2022-08-15 53 4 687 691 APPLICATION OF MEDIATION IN HEALTHCARE- RESEARCH OF THE ATTITUDES OF MEDICAL SPECIALISTS https://ikm.mk/ojs/index.php/kij/article/view/5477 <p>Introduction: Conflict situations are inevitable in everyday work, even more in emotionally charged<br>professions that require self-sacrifice and empathy. In extreme cases, conflict can lead to burnout with adverse<br>consequences for patients such as: inadequate healing process, delayed diagnosis, redundant diagnostic tests,<br>iatrogenic complications, dissatisfaction in patients and practitioners, risky decision making.<br>Aim: The aim of this study is to determine the attitude of medical specialist regarding the application of mediation in<br>the resolution of conflict situations in medical practice.<br>Material and Methods: The survey was conducted online between August 2021 and October 2021. A total of 163<br>medical professionals (physicians, nurses, midwifes, laboratory assistants and other) were enrolled. An original<br>questionnaire was developed for the purposes of the study.<br>The following methods were used:A documentary method for researching and analyzing the literature available on<br>application of alternative dispute methods in healthcare and medical practice; Questionnaire method: Anonymous<br>online direct individual questionnaire among medical professionals practicing on the territory of Sofia municipality;<br>Statistical methods: The statistical data package SPSS (Statistical Package for Social Sciences) version 19.0 was<br>used to process the survey data. A wide range of descriptive and analytical methods were used. The results are<br>described by tables, graphs and numerical indicators for structure, frequency, averages, correlation coefficients, etc.<br>Results: 69,3% of the participants report that they have been in a conflict situation with patients. According to<br>mediation as alternative dispute resolution method 25,2% respond they are familiar with this method and another<br>41,1%- answer “Yes, partly”. About 1/4 think they are aware of the benefits of mediation. When asked about the<br>potential benefits of additional training in communication skills and mediation, 77,3% of health professionals<br>believe that it would be useful for their practice<br>Conclusion: Mediation is an alternative dispute resolution method based on "conciliatory" communication and is<br>considered a good choice in the field of healthcare. Mediation is a structured, interactive process in which a neutral<br>third party (mediator) assists disputants in resolving the conflict through the application of specialized<br>communication and negotiation techniques. Medical specialists need to be aware of the benefits of mediation and<br>consider the application of this approach as a first choice in resolving disputes in their practice.</p> Radostina Shtereva Copyright (c) 2022 2022-08-15 2022-08-15 53 4 693 696 THE CRIMINAL LIABILITY OF MEDICAL PROFESSIONALS https://ikm.mk/ojs/index.php/kij/article/view/5478 <p>Human life and health are the highest values in any legal and democratic state, which is why legal<br>guarantees for their protection are regulated in all legal systems. The most effective of these guarantees is criminal<br>legal responsibility, which is expressed in the elevation of those socially dangerous acts that threaten or damage<br>human life or health to crimes. These criminal acts can be committed by all criminally liable natural persons,<br>including medical specialists during or on the occasion of exercising the medical profession. From the jurisprudence<br>of the Bulgarian courts, it is established that most often the criminal liability of doctors and other medical specialists<br>is committed for two types of crimes, namely: criminal professional negligence causing death<br>e under Art. 123 of the Criminal Code of the Republic of Bulgaria and criminal professional negligence causing<br>personal injury under Art. 134 of the Criminal Code of the Republic of Bulgaria. The object of the specified crimes<br>are public relations that ensure the inviolability of human life and the inviolability of human health and the physical<br>integrity of the person, i.e. human life and health. The Bulgarian criminal law also regulates other types of crimes<br>that are related to the criminal liability of medical specialists, but they affect other public relations. Such are, for<br>example: the crime under Art. 126, paragraph 1 of the Criminal Code - the so-called "criminal abortion", the abuse<br>under Art. 141, paragraph 1 of the Criminal Code, passive and active bribery under Art. 301, paragraph 1 and art.<br>304 of the Criminal Code, exercising a profession or trade without the corresponding legal capacity under art. 324,<br>paragraph 1 of the Criminal Code and other crimes. This report will present an analysis of the main characteristics of<br>the crimes of criminal professional negligence causing death and criminal professional negligence causing personal<br>injury, for the commission of which the criminal liability of medical professionals most often arises. The main,<br>qualified and privileged compositions of the specified types of crimes, their features and specifics were examined.<br>The purpose of the report is to acquaint not only the public, but also medical specialists, with the elements of the<br>targeted crimes, which will contribute to increasing their legal culture and conforming their behavior to criminal law<br>norms. In this sense, the good awareness of legal entities about the current criminal legislation is an important<br>prerequisite for limiting crime in any country.</p> Momchil Mavrov Mariya Hristozova Copyright (c) 2022 2022-08-15 2022-08-15 53 4 697 701 KNOWLEDGE AND ATTITUDES TOWARDS HACCP SYSTEM AMONG FOODHANDLERS EMPLOYED IN RESTAURANTS WITH AND WITHOUT IMPLEMENTATION OF HACCP SYSTEM https://ikm.mk/ojs/index.php/kij/article/view/5458 <p>The implementation and effectiveness of the HACCP system is one of the most important legal<br>obligations and a public health instrument that prevents the possibility of food contamination and the consequent<br>occurrence of food-borne diseases among the population. The aim of this study was to examine knowledge and<br>attitudes towards HACCP system among food-handlers, employed in restaurants with and without HACCP<br>system.This cross-sectional study included 197 respondents. The study was conducted anonymously using a<br>purpose-built questionnaire created as a result of searching literature and similar studies. Only 10.2% of respondents<br>in both observed groups knew the meaning of the word HACCP. Slightly more than half of the respondents from<br>restaurants with HACCP knew that HACCP system is mandatory according to current B&amp;H legislation, comparing<br>to respondents employed in restaurants without HACCP system, where the respondents in 36.0% of cases answered<br>incorrectly. Food handlers employed in restaurants without HACCP in 57,3% cases considered HACCP system<br>exclusively as an administrative-technical measure of inspection bodies, while 27.8% of respondents from<br>restaurants with HACCP system did not have affirmative attitudes or they were unsure of the stated statement<br>(18.5%).45.3% of respondents employed in restaurants with HACCP considered that HACCP documentation is too<br>complicated. More than two-thirds of respondents had opinion that keeping records reduces the effectiveness of<br>employees' work. Recognizing the importance and benefits of HACCP principles as well as developing affirmative<br>attitudes towards HACCP system by employees is essential for ensuring the food safety production and preventing<br>the occurrence of food-related diseases.</p> Eldina Smječanin Zarema Obradović Arzija Pašalić Ema Pindžo Amar Žilić Jasmina Hrnjica Bajramović Dino Ćemić Copyright (c) 2022 2022-08-15 2022-08-15 53 4 703 709 ATTITUDES AND PRACTICES OF CONSUMERS REGARDING FOOD LABELS https://ikm.mk/ojs/index.php/kij/article/view/5479 <p>Food labels are the only objective link between food business operators and consumers and present a<br>crucial public health instrument. Food labels help consumers make better food choices, especially with regard to<br>health, dietary, or other cultural and social issues. However, the frequencies of use and consumer attitudes toward<br>food labels depend on various demographic and socioeconomic characteristics of consumers. This cross-sectional<br>study, which included 400 respondents, was designed to assess the frequency of use and attitudes toward food labels<br>among consumers in Sarajevo Canton as well as to determine barriers that hinder consumer use of food labels. An<br>anonymous survey questionnaire based on previously conducted studies was used as a research instrument. The<br>habit of reading information on food labels depends on the gender of the respondent. Respondents who “always” or<br>“sometimes” read food label information were mostly female (72.4% and 63.1%). The level of education had<br>statistical significance. Respondents with a high level of education used food labels more often than respondents<br>who only had primary or high school education. Information on food label that respondents (81.3%) most often read<br>and give highest priority was the expiration date. The most common reasons for not reading food label information<br>were small lowercase letters and poor legibility of the text (47.3%) and lack of time during shopping (44.0%).<br>Consumer education (56.7%), bigger letters (50.7%), more information for consumers (32.5%), and better legibility<br>(30.3%) were the respondents' suggestions on how to improve the frequency of food label use. Barriers to the use of<br>food labels indicated a need for better harmonization of food labels in terms of legibility, as well as the need to<br>improve the level of nutritional literacy through educational approaches as well as various promotional programs<br>adapted to consumer needs.</p> Eldina Smječanin Kenan Čaklovica Ema Pindžo Amar Žilić Zarema Obradović Neira Fazlović Copyright (c) 2022 2022-08-15 2022-08-15 53 4 711 717