Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za biološki i medicinski nauki = Contributions / Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences
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In the day-to-day practice of answering questions from the area of medicine today, there is a growing need for forensic medical expertise in bodily injuries in criminal procedure. Furthermore, when qualifying a bodily injury, the expert must possess knowledge and experience not only medical, but s/he must also be aware of the legal requirements and norms of the Code of Criminal Procedure and the Criminal Code of R. Macedonia. ⋯ The aim of this paper is to outline the method of performing this forensic medical expertise, i.e. by whom and when can expertise in bodily injuries be sought and, moreover, what is the legal and ethical responsibility of the expert during the execution of the expertise. Additionally, the steps that the expert should follow when preparing a written statement and opinion on the type of the bodily injury are explained. More specifically, emphasis is placed on the expert's requirements after examination of the injured individual; after revision of the medical documentation during expert assessment of bodily injuries in the case of criminal subjects; and providing oral statements and opinions during the criminal procedure.
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Protrusion of the lower eyelid is an aesthetic condition that is influenced by many anatomical features. Aim is to identify and categorize fat pad protrusion under the lower eyelids, and to evaluate the scoring system for determining the anatomical characteristics that will yield optimal surgical results. ⋯ The cumulative contribution score for each anatomic variable show us that prolapsed orbital fat received high score in man as compared to women. The knowledge of the origin of baggy eye lids can aid surgeons in their selection of the correct facial sculpting technique in order to achieve the optimal aesthetic effect.
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Patients with right ventricular myocardial infarction (RVMI) and patients with left ventricular myocardial infarction (LVMI) of the anterior wall with ST-elevation (STEMI), due to the profundity and volume of the necrosis, tend to have a more severe and more complicated clinical outcome as well as a higher mortality level compared to patients with myocardial infarction of inferoposterior localization in the left ventricle (IPILK), without the right ventricle being overtaken. C-Reactive protein (CRP) is a sensitive and reliable indicator of acute inflammation and is in good correlation with creatin kinasis (CK) or the enzymes which indicate necrosis markers in acute myocardial infarction (AIM). Because of this, a common biohumoral answer is of greater importance and more reliable both diagnostically and prognostically; it signifies a more severe and more complicated clinical outcome, especially on the rupture of the myocardium. The main goal of this study was to compare the maximum values of enzymes and CRP in patients with RVMI and LVMI who had first STEMI and who were in the acute phase treated with percutaneous transluminal coronary angioplasty (PTCA). ⋯ Primary PCI should be done whenever it is possible with all patients who have a great volume and depth of necrosis, especially if that is the first manifestation of a coronary disease and the first acute STEMI, as were all of our patients in both groups. Our results show that older patients with RMI, and dominantly women, have a more severe and more complicated clinical outcome in the acute phase of RMI compared to patients with LMI of the anterior wall. In the longer prognosis of this case, they have a quicker and a more complete recovery of the right ventricle due to which they have a better immediate and long term prognosis, but demand careful overseeing and energetic treatment in the acute phase of the myocardial infarction, especially considering that their treatment is often specific compared to patients with an infarction of the left ventricle.
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Randomized Controlled Trial
Spinal anaesthesia for cesarean section with reduced dose of intrathecal bupivacaine plus fentanyl.
The hypotension following spinal anesthesia remains common place in cesarean delivery. The combination of reduced dose of local anesthetics with intrathecal opioids makes it possible to achieve adequate spinal anesthesia with minimum hypotension. We investigate whether this synergistic phenomenon could be used to provide less frequent hypotension while incurring adequate spinal anesthesia for cesarean section. ⋯ Bupivacaine 9 mg plus fentanyl 20 microgr provided spinal anesthesia for cesarean delivery with less hypotension and vasopressor requirements while ensuring excellent perioperative surgical anesthesia.
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Randomized Controlled Trial
Infection as a risk factor in the outcome of patients with acute renal failure assessed by SOFA score.
Acute renal failure (ARF) is a complex syndrome, frequently reported with mortality in 20-80% of the patients. Infection, as a cause or a complication of the syndrome, is a risk factor which unfavourably determines the outcome. A prospective 4-year study was performed of 112 ARF patients in the intensive care unit (ICU), with an evaluation of 68 clinical and laboratory parameters, as risk factors, at admission to the ICU. ⋯ Patients with ARF due to sepsis have a worse prognosis than those with non-septic ARF. Coagulation disorder, liver and cardiovascular dysfunction, as well as the SOFA score itself are independent variable in the outcome prediction. The SOFA score, derived from easily obtained data, is useful for judging survival prognosis in patients with ARF.