rss_2.0PRILOZI FeedSciendo RSS Feed for PRILOZI 's Cover’s Response to Letter to the Editor: Is Opioid-Free General Anesthesia More Superior for Postoperative Pain Versus Opioid General Anesthesia in Laparoscopic Cholecystectomy? Thrombotic Thrombocytopenia and Covid-19 Vaccines: Case Series<abstract> <title style='display:none'>Abstract</title> <p>Vaccine-induced thrombotic thrombocytopenia (VITT) is a condition similar to heparin-induced thrombocytopenia (HIT), but it is associated with prior administration of COVID-19 vaccines without prior exposure to heparin. The incidence of VITT is not certain, but it appears to be extremely rare. Reports of unusual and severe thrombotic events, including cerebral and splanchnic venous thrombosis and other autoimmune adverse reactions, such as immune thrombocytopenia or thrombotic microangiopathies in connection with some of the SARS-CoV-2 vaccines, have caused a great deal of concern within the population and the medical community. We would like to present 4 clinical cases of VITT, hospitalized and treated in intensive care unit (ICU) of University clinic of cardiology in Skopje.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Antioxidative Effects of Rosuvastatin in Low-to-Moderate Cardiovascular Risk Subjects<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: Although vast clinical evidence supports the oxidative CVD hypothesis, little is known on the effects of statins on LDL/HDL oxidative functionality. Therefore, the aim of this study was to evaluate the antioxidative effects of rosuvastatin by monitoring the susceptibility of LDL to oxidation and the antioxidative HDL potential in low-to-moderate CV risk subjects.</p> <p><bold>Methods</bold>: 40 adult ambulatory patients (aged 53.8±10.9 years, 27 women and 13 men) were included in the study. Data was collected from patients’ records, physical examination, and blood sampling. Subjects were prescribed rosuvastatin at 20mg/day. Traditional risk-factors/indicators, lipid parameters, inflammatory/immune markers, LDL susceptibility to oxidation and HDL antioxidative potential were monitored and statistically analyzed with t-test, Chi-square test, one-way ANOVA, Mann-Whitney, and Kruskal-Wallis tests. Multivariate logistic regression analyses were made. Results were considered significant when p≤0.05.</p> <p><bold>Results</bold>: 67% of the patients showed lower susceptibility of LDL to oxidation after rosuvastatin treatment (p=0.03), with no significant effect on baseline LDL oxidation and lag time. All three LDL oxidative indices were seen to be dependent on the subjects’ lipid profile, hemoglobin levels and the IL-1α and IL-8 pro-inflammatory marker levels. 53% of the patients showed higher HDL antioxidative capacity after treatment, but without statistical significance (p=0.07). Increased antioxidative potential of HDL with rosuvastatin treatment was more likely in males (OR=9.350; p=0.010), and subjects achieving lower post-treatment CV relative risk levels (higher CV risk reduction) (OR=0.338; p=0.027).</p> <p><bold>Conclusions</bold>: This study suggests the need of a comprehensive approach when investigating oxidative stress and LDL/HDL functions, especially in low-to-moderate CVD risk subjects.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Hypoxic Ischemic Encephalopathy (HIE) in Term and Preterm Infants<abstract> <title style='display:none'>Abstract</title> <p>Hypoxic-ischemic syndrome (HIS) and Hypoxic-ischemic encephalopathy (HIE) are conditions that affect term and premature babies, with different pathophysiology and different brain disorders. HIE appears in 1-6 / 1000 live births and 26/1000 live births in developing countries. 15-20% die in the early neonatal period, while surviving babies have severe neurological impairment, including cerebral palsy, epilepsy, visual and hearing impairment, cognitive impairment, intellectual, behavioural, and social disorders. The hypoxic-ischemic event occurs before, during or after birth. The reasons may be related to the mother, the way of birth, the placenta, and the newborn. The criteria for diagnosis of HIE include a combination of perinatal factors, the need for resuscitation, standard neurological examinations, neurophysiological monitoring, neuroimaging methods and biochemical markers. The most effective treatment for HIE is hypothermia in combination with pharmacological therapy. HIE and HIS are problem that still persist in developing countries due to inadequate obstetric care, neonatal resuscitation, and hypothermia. Current and emerging research for HIE examines new markers for early recognition, treatment, and appropriate neuroprotection of high-risk term and premature infants.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Inflammatory Bowel Diseases in Renal Transplantat Recipients: A Case Series and Review of the Literature<abstract> <title style='display:none'>Abstract</title> <p>Inflammatory bowel diseases are autoimmune disorders affecting the gastrointestinal tract and producing a wide variety of extraintestinal manifestations. Kidneys are a rare target organ of their extraintestinal activity, but if affected, renal function could deteriorate to end-stage kidney disease, which is curable only by organ transplantation. Renal calculi are the most common pathological kidney manifestation in IBD patients, followed by tubulointerstitial nephritis, glomerulonephritis, and other kidney pathologies.</p> <p>The liver is the most commonly transplanted organ in IBD patients (primary sclerosing cholangitis and autoimmune hepatitis), and a scarcity of literature on kidney recipients is present to date regarding the incidence of renal insufficiency, kidney transplantations, post-transplant IBD course and further complications such as graft rejection or infections in this specific group of patients. De novo IBD is a paradoxical entity in the setting of rigorous post-transplant immunosuppression.</p> <p>In this case series, we present three patients who underwent kidney transplantation with a history of an IBD and one patient who developed de novo Crohn’s disease after the deceased donor organ transplant was performed.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Prophylactic Regenerative Peripheral Nerve Interfaces in Elective Lower Limb Amputations<abstract> <title style='display:none'>Abstract</title> <p>Regenerative peripheral nerve interface (RPNI) is a relatively new surgical technique to manage neuromas and phantom pain after limb amputation. This study evaluates prophylactic RPNI efficacy in managing post-amputation pain and neuroma formation in amputees compared with patients in which lower limb amputation was performed without this procedure. We included 28 patients who underwent above the knee amputation (AKA) or below the knee amputation (BKA) for severe soft tissue infection from July 2019 till December 2020. All patients had insulin-dependent diabetes. The patients were divided into two groups, 14 patients with primary RPNI and 14 patients without. We analyzed the demographic data, level of amputation, number of RPNIs, operative time, postoperative complications and functional outcome on the defined follow up period. The mean patient age was 68.6 years (range 49–85), 19 (67.9 %) male and 9 (32.1 %) female patients. In this study 11 (39.3 %) AKA and 17 (60.7 %) BKA were performed. Overall, 37 RPNIs were made. The mean follow-up period was 49 weeks. PROMIS T-score decreased by 15.9 points in favor for the patients with RPNI. The VAS score showed that, in the RPNI group, all 14 patients were without pain compared to the group of patients without RPNI, where the 11 (78.6 %) patients described their pain as severe. Patients with RPNI used prosthesis significantly more (p &lt; 0.005). Data showed significant reduction in pain and high patient satisfaction after amputation with RPNIs. This technique is oriented as to prevent neuroma formation with RPNI surgery, performed at the time of amputation. RPNI surgery did not provoke complications or significant lengthening of operative time and it should be furthermore exploited as a surgical technique.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Chronic Abdominal Pain, an Overlooked Diagnosis of Median Arcuate Ligament Syndrome (MALS)<abstract> <title style='display:none'>Abstract</title> <p>Median arcuate ligament syndrome (MALS) is a rare condition that is often overlooked as a result of its nonspecific symptoms. It is usually presented with nausea, bloating, abdominal postprandial pain, and weight loss. The diagnosis of MALS is usually delayed and made by excluding other causes for the symptoms. The diagnosis of this syndrome is based on clinical presentation and radiological findings on computer tomography angiography (CTA) or magnetic resonance angiography (MRA). Surgery is treatment of choice, with promising results from laparoscopic surgery.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Continuous Peripheral Block as a Pain Treatment for Redressment and Physical Therapy in a 7-Year-Old Child – A Case Report<abstract> <title style='display:none'>Abstract</title> <p>Continuous peripheral nerve block, also known as “local anesthetic perineural infusion,” refers to percutaneous placement of a catheter near a peripheral nerve or plexus followed by administration of a local anesthetic through a catheter to provide anesthesia, or analgesia for several days, in some cases even for a month.</p> <p>This report describes the case of a 7 year old boy with left elbow contracture with limited flexion and extension who was admitted to the Clinic of Pediatric Surgery for redressment of the elbow and physical therapy. An ultrasound-guided axillary brachial plexus block was performed, with placement of a non-tunneled perineural catheter. Redressment of the left elbow was performed twice and before each redressment boluses of local anesthetic were applied through the perineural catheter. Physical therapy was performed painlessly with continuous perineural infusion. On the 5th day of catheter placement, the perineural catheter was removed without any prior complications such as hematoma, infection, catheter dislocation or leakage of local anesthetic.</p> <p>Our goal is to minimize the psychological and physical trauma to the patient, no matter how immature the patient is. Continuous regional anesthesia in children is a safe technique in postoperative pain management that facilitates early mobilization due to its sufficient analgesia and better comfort. It can provide in-home treatment, with adequate education for patients and parents, and improve rehabilitation in children.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00The Effects of CNI and Mtori-Based Regimens on Bone Mineral Density After Renal Transplantation<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: Since glucocorticoids are used in low maintenance doses today, the relationship between calcineurin inhibitors (CNI) and osteoporosis has become clinically significant in osteoporosis after solid organ transplantation. However, there is evidence that the mammalian target of rapamycin inhibitors (mTORi) may be beneficial via osteoclast inhibition.</p> <p><bold>Objective</bold>: The bone mineral density (BMD) changes are investigated in renal transplant patients under CNI or mTORi-based maintenance regimens during the first five-year post-transplant course.</p> <p><bold>Methods</bold>: This study consists of thirty-three renal allograft recipients with less than one year of dialysis history. The exclusion criteria were: being older than 50 years old, history of bisphosphonate use, parathyroidectomy, CNI-mTORi switch after the post-transplant third month, diuretic use, and history of malignancy. First and fifth-year BMD scores and simultaneous laboratory parameters were evaluated.</p> <p><bold>Results</bold>: CNI (n=21) and mTORi group (n=12) had similar demographics, dialysis vintages, first and fifth-year serum parathormone, calcium, phosphate, magnesium, alkaline phosphatase, and 25-OH-vitamin D levels. The femur neck scores of the CNI group decreased from -0.82 (±0.96) to -1.52 (±0.92) (p=0.020). We observed a significant decrease in the CNI group compared to the mTORi group [-0.70 (±0.68) and 0.30 (±0.36), respectively; p&lt;0.01] when the BMD score changes were evaluated among years. The mean femur neck score of the mTORi group increased insignificantly from -1.13 (±0.65) to -0.82 (±0.56) at the fifth-year DXA scan (p=0.230). Similar trends were also observed in L1-4 scores.</p> <p><bold>Conclusion</bold>: Our study suggests that CNI-based treatment is associated with decreased femur neck BMD scores, and mTORi-based treatment tends to be beneficial in the post-transplant five-year follow-up.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Correlation Between the Different Types of Antipsychotics and Serum Cortisol, Dehidroepiandrosterone Sulfat and their Ratio in Schizophrenia<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: Evidence for disturbances in HPA activation and abnormal HPA regulatory mechanisms in schizophrenia is accumulating.</p> <p><bold>Aim</bold>: To compare serum levels of cortisol, DHEA-S and their ratio between patients with schizophrenia and healthy controls and among patients before and after treatment with different types of antipsychotics.</p> <p><bold>Material and methods</bold>: In this clinical prospective study, 60 patients with schizophrenia and 40 healthy age and sex matched control subjects were included. All patients experienced an acute exacerbation of the illness (PANSS: P1 and P3 ≥ 4). Clinical evaluation of patients was performed using the Positive and Negative Symptom Scale. A questionnaire for socio-demographic and clinical data collection was used. Serum levels of cortisol, DHEA-S and their ratio were measured at baseline in all participants and after 3 and 6 weeks, respectively, of the antipsychotic treatment with different types of antipsychotics in patients with schizophrenia.</p> <p><bold>Results</bold>: Patients with schizophrenia had significantly higher serum cortisol and DHEA-S levels in comparison to the control group. There was no significant difference in serum levels of cortisol, DHEA-S and their ratio between patients treated with different types of antipsychotics (typical/atypical). Serum levels of the analyzed hormones significantly reduce during the 6-week period of examination in both subgroups treated with different types of antipsychotics.</p> <p><bold>Conclusion</bold>: Elevated serum cortisol and DHEA-S in schizophrenic patients might be associated with their role in the pathophysiology of the disorder. There is no significant difference in serum levels of cortisol, DHEA-S and their ratio among the patients treated with different types of antipsychotics.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Childbirth-Related Psychological Trauma<abstract> <title style='display:none'>Abstract</title> <p>Traumatic childbirth is an international public health problem because it is supposed that currently up to 45% of new mothers have reported such an experience. International rates of PTSD due to birth trauma range between 1.5 and 9 percent of all births.</p> <p>Birth trauma is defined as an event occurring during the labour and delivery process that involves actual or threatened serious injury or death of the mother or her infant.</p> <p>A traumatic event or situation creates psychological trauma when it overwhelms the individual’s ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed.</p> <p>The aim of this article is to present a review of published data for childbirth trauma over various periods of time, as well as in different regions of the world. Studies were identified through a comprehensive search of PubMed, PsycInfo, ProQuest and PILOTS (Published International Literature of Traumatic Stress) over the last 20 years.</p> <p>More than 8000 articles were found. In this article we present and discuss some important findings.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00The Personality Profiles for Contemporary Macedonian Actors<abstract> <title style='display:none'>Abstract</title> <p>Theatre is one of the higher cultural activities that characterise us as imaginative, creative and truly human. In general, theatre is an arena in which participants can mentally play, acting out their own fears and fantasies in an experimental way.</p> <p>The purpose of this study is to investigate the psychological personal characteristics, using the MMPI questionnaire, applied in a sample of Macedonian professional actors.</p> <p>MMPI is used as an older form of the questionnaire, standardised in ex-Yugoslavia, and then translated into Macedonian. This is all done with a computer.</p> <p>This research confirms that our (Macedonian) contemporary actors are normal people who function normally in everyday life and generally do not deviate from what in the psychology of personality are denotes as normal/abnormal. Small exceptions are still a rarity!</p> <p>Some indexes of interest are included in this analysis of personal characteristics of actors.</p> </abstract>ARTICLE2022-04-22T00:00:00.000+00:00Grief: Aetiology, Symptoms and Management<abstract> <title style='display:none'>Abstract</title> <p>Grief is a process provoked as a response to different losses, such as death, loss of job, relationship breakdown, some unexpected life events and changes, etc. The experiences of loss and bereavement are very individual. Even though loss is expected, the person feels traumatized, especially if death is provoked by violence, natural disasters, or war. This pandemic, like other disasters (wars, tsunami, earthquakes, floods, etc.) has provoked intensive reactions of grief, reactions that could persist for years. The core symptoms of grief are described in the ICD-11 and DSM-5 manuals.</p> <p>The term “complicated grief” in the medical sense refers to a superimposed process that alters grief and modifies its course for the worse. Prolonged grief disorder (PGD) is characterized by normal grief symptoms, but these are symptoms that remain too intense for too long of a period.</p> <p>This article is a review of the manifestations and duration of grief in different occasions, and it is based on over 50 published papers, and discoveries in the Medline and Psych-Net databases.</p> <p>Commonly described reactions to grief are: shock, disbelief or denial, a high level of anxiety, distress, anger, sadness, insomnia, and a loss of appetite. As predictors for a high/slow decreasing trajectory of grief process are: female gender, reported symptoms of depression before the traumatic event, and higher scores on avoidance. However, grief is transient, even as we are is in the midst of its clutches. People should expect to fluctuate between moments of sadness and mourning, and moments of acceptance, or even happiness for being alive. Researchers suppose that when a crisis passes; most people will be able to bounce back and move on with their lives.</p> </abstract>ARTICLE2021-10-26T00:00:00.000+00:00Cancer – Associated Thrombosis – A Study of Cases<abstract> <title style='display:none'>Abstract</title> <p>Research shows that the presence of cancer increases the likelihood of developing venous thromboembolism (pulmonary thromboembolism and deep vein thrombosis) from as much as fourfold up to sevenfold. It is imperative that after early diagnosis we treat cancer-associated thrombosis with grave seriousness in order to reduce its morbidity and mortality.</p> <p>We present 14 case reports of patients with cancer-associated thrombosis including thrombosis related to malignant hemopathies.</p> </abstract>ARTICLE2021-10-26T00:00:00.000+00:00Anti-Factor H Antibody-Associated Atypical Hemolytic Uremic Syndrome: A Case Report<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction</bold>: Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy, caused by dysregulation of the complement alternative pathway. Deletion of the complement factor H–related genes, CFHR1 and CFHR3, together with the presence of CFH autoantibodies are reported in aHUS patients, representing 10% of cases of patients with aHUS.</p> <p><bold>Case presentation</bold>: We report here on a case of 4-year-old girl with anti-CFH antibody-associated aHUS. The measurement of complement factors and anti-factor H antibodies, was the main guideline for making an accurate diagnosis and providing the appropriate therapy, with the patient responding positively to plasma exchanges (PEs) and cyclophosphamide pulses. We then, one year after disease onset, continued with glucocorticoids and mycophenolate mofetil (MMF), as maintenance therapy. There were no complications during the therapy other than neutropenia. Now, one year after the cessation of the immune suppression therapy, she is in remission with normal kidney function, no signs of hemolysis, normal C3 levels, and normal range proteinuria. The anti-factor H autoantibody titer decreased but still remained positive, the factor H antigen values remained low all throughout. Close follow-up is applied with frequent urine testing and complete blood count with an intention for early detection of relapse of the disease.</p> <p><bold>Conclusion</bold>: The purpose of this case report is to emphasize the value of complement factor measurements and also to separate anti-CFH antibody-associated aHUS as an entity, because immunosuppressive therapy provides an excellent response..</p> </abstract>ARTICLE2021-10-26T00:00:00.000+00:00New DXA Diagnostic Indexes of Abdominal Obesity<abstract> <title style='display:none'>Abstract</title> <p><bold>Aim</bold>: Cushing’s syndrome (CS) is associated with weight gain and extreme central, visceral, abdominal obesity which is confirmed with dual-energy X-rays absorptiometric (DXA) diagnostic cut-off point (CP) values of central obesity indexes (COI), determined as an android to gynoid tissue and fat mass ratios. These best differentiate CS from non-CS obese women matched with CS according to their age and BMI. The aim of this study was to determine the CP values of new DXA indexes of central, abdominal obesity as a ratio of android and trunk to legs as well as trunk and legs to total tissue and fat mass that best differentiate CS and matched non-CS obese women in order to confirm central abdominal obesity, and to determine their normal CP values that best differentiate healthy non-obese women from CS and non-CS obese women, and to exclude abdominal obesity completely.</p> <p><bold>Material and Methods</bold>: DXA indexes of abdominal obesity, calculated as а ratio of regional body fat and tissue mass compartments android to legs (A/L), trunk to legs (Tr/L), trunk to total (Tr/To) and legs to total (L/To) values were determined among 4 groups. Each group consisted of 18 women: 1<sup>st</sup> group of CS, 2<sup>nd</sup> group of obese women (O<sub>1</sub>) not different according to their age and BMI from CS, 3<sup>rd</sup> group of obese women (O<sub>2</sub>) with higher BMI of 35 ± 1.2 kg and a 4<sup>th</sup> group of non-obese, healthy women (C) with a normal BMI. Diagnostic accuracy (DG) of CP values of DXA indexes of abdominal obesity and indexes of normal body fat distribution (BFD) were determined.</p> <p><bold>Results</bold>: A/L, Tr/L, Tr/To, and L/To DXA indexes were significantly different between CS and O<sub>1</sub> as well as between non-CS women O<sub>2</sub> compared to O<sub>1</sub> and C. These indexes had a highly significant correlation among each other and also in relation to their BMI (p &lt; 0.0001). A/L-Tm CP value of 0.3 best differentiated the CS from group O<sub>1</sub>, with the highest DG of 100 % and an A/L-Fm CP value of 0.26 differentiated them with a DG of 94.44% and sensitivity of 100 %. An A/L-Tn CP value of 0.23 and an A/L-Fn CP value of 0.25 best differentiated CS and C as well as O<sub>2</sub> and C for the highest DG of 100 %.</p> <p><bold>Conclusions</bold>: DXA indexes A/L, Tr/L, Tr/To and L/To values were significantly different among the four groups. These values correlated significantly among them and with their BMI in non-CS groups, thus confirming a BMI increase association with a more pronounced abdominal BFD. An A/L-Tm CP value of 0.3 and an A/L-Fm CP value of 0.26 were discovered as the best DXA diagnostic indexes of extreme abdominal obesity in CS and these could also be used in discovering abdominal BFD in non-CS obese women with metabolic syndrome (MS). An A/L-Tn CP value of 0.23 and an A/L-Fn CP value of 0.25 were discovered as the best DXA diagnostic indexes of normal BFD which completely excluded abdominal obesity.</p> </abstract>ARTICLE2021-10-26T00:00:00.000+00:00Leptin, Obesity Parameters, and Atopy Among Children with Asthma<abstract> <title style='display:none'>Abstract</title> <p>Leptin, as a major adipokine, positively correlates with the body’s fat, while atopy is an important feature in the development of childhood asthma. We aimed to evaluate the relationship between leptin, parameters of obesity, and atopy in children with asthma. The study included 112 children (73 boys, 39 girls, mean age 11.1±2.4). 41 were overweight, 38 had asthma and a normal body mass index (BMI), and 33 were overweight asthmatics. Serum leptin levels, BMI, waist circumference (WC), and waist to hips ratio (WHR) were measured. Skin prick test (SPT)/CAP, total serum IgE, fractional exhaled nitric oxide (FeNO), and pulmonary function tests were performed. In asthmatic children, serum leptin median level was 9.2±16.2 ng/ml, in overweight children was 30.6±21.6 ng/ml, and in overweight asthmatics was 31.1±20.3 ng/ml with a significant difference between the groups (p=0.0374), yet with a significantly lower median level in the group of children with asthma compared to the overweight children: with asthma (p=0.00001) and without asthma (p=0.00001). In the three groups of patients, BMI and WC displayed a significant positive correlation with leptin (for BMI r=0.652 vs. r=0.530 vs. r=0.563, respectively and for WC r=0.508 vs. r=0.426 vs. r=0.527, respectively). No significant correlations of leptin within atopy parameters (Eo, IgE, SPT/CAP, FeNO) in all three analyzed groups (p&gt;0.05) was detected.</p> <p><italic>Conclusion</italic>: Atopy was not confirmed as an underlying mechanism of the association between asthma and being overweight. Leptin had a significant linear correlation as a parameter of central obesity with BMI and WC in all three groups, but not with WHR.</p> </abstract>ARTICLE2021-10-26T00:00:00.000+00:00Potocki-Lupski Syndrome Dup17p11.2 in a Girl with Hypotonia and Early Behavioural Disturbances<abstract> <title style='display:none'>Abstract</title> <p>Potocki-Lupski syndrome (PTLS) is a contiguous gene syndrome caused by duplication of chromosome 17p11.2. PTLS is characterized by hypotonia, failure to thrive, congenital anomalies (particularly of the cardiovascular system), intellectual disability, and behavioural disturbances.</p> <p>The patient was a full-term baby girl, 2,750 grams at birth, delivered via an uncomplicated vaginal delivery with pronounced hypotonia at birth. Nevertheless, there was failure to thrive (weight 7.6 kg; 2.8 SD). Micrognathia, epicanthal skin folds, and megalocornea were noticeable. There was a harsh continuous systolic murmur, and the ultrasound of the heart revealed a persistent arteriosus duct which was surgically closed. At the age of 18 months, the girl could not sit without support, and she could not utter simple words. The girl is often moody, angry, and aggressive. She is hyperactive and unable to establish contacts with family members. A 17p12-p11.2 microduplication was identified via MLPA.</p> <p>Muscle hypotonia, congenital heart malformation, failure to thrive, developmental delay, behavioural disturbances (or autism spectrum disorder), and intellectual disability are early signs of PTLS. The presence of PTLS was proven by an MLPA analysis.</p> </abstract>ARTICLE2021-10-26T00:00:00.000+00:00A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis<abstract> <title style='display:none'>Abstract</title> <p>Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases.</p> <p>Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases.</p> <p>In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up.</p> <p>We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.</p> </abstract>ARTICLE2021-10-26T00:00:00.000+00:00“Life is a Great Illusion, Achievements Stay Forever!” Momir H. Polenakovic (1939–2021)