BACKGROUND: Diabetic peripheral neuropathy (DPN) means the presence of symptoms and/or signs of peripheral nerve damage that occur to people with diabetes, excluding all other causes of neuropathy. Chronic hyperglycaemia leads to increased secretion of tumour necrotic factor-alpha (TNF-α), with the development of micro and macroangiopathy, damage to nerve fibres and local demyelination. AIM: To determine the role of inflammation in the peripheral nerve damage process concerning people suffering from type II diabetes mellitus. MATERIAL AND METHODS: The study included a total of 80 subjects, men and women, divided into two groups: an examined group (n = 50) consisting of subjects with DPN at the age from 30 to 80 years and a control group (n = 30) of healthy subjects aged from 18 to 45. In the investigated group, a neurological examination was performed using the Diabetic Neuropathy Symptoms (DNS) Score and Electroneurography. All the subjects had the blood plasma concentration of TNF-α by ELISA technique. RESULTS: The average value of TNF-α in the test group was 8.24 ± 2.899 pg/ml, while the control group was 4.36 ± 2.622 pg/ml (p < 0.0001). The average value of TNF-α was correlated with the achieved DNS score in the investigated group (p = 0.005). Concerning the linear association of the concentration of TNF-α with the peripheral nerve velocity in the investigated group, no statistical significance was detected. CONCLUSION: Inflammation can play a role in the pathogenesis of diabetic autonomic neuropathy and cranial neuritis.

CT-guided periradicular therapy (PRT) is a minimally invasive interventional technique for treatment of chronic lumbar pain.Aim: To investigate importance of pain duration before PRT treatment in patients with chronic lumbar pain and radiculopathy, with clinical effectiveness assessment.A prospective follow-up CT guided PRT study was done in 166 patients divided into 4 groups according duration of pain before intervention (<3 months, 4-6months, 7-12months, >1year). Degree of pain intensity was determined according to VAS scale. Improvement degree was excellent, good, moderate, or weak.Good clinical response was defined when improvement is greater or equal to 50% on VAS scale, and functional improvement was equal to 40% in the reduction of the ODI index. Follow-up was done at 2nd weeks, 3 and 6 months.Good response was observed in 51.8% of the cases after 2 weeks, 54.2% after 3 months and 59% after 6 months. ODI index parameters was greater or equal to 40% in 22.2% after 2 weeks, 13.8% after 3 months, and 8.4% after 6 months. After 6 months in patients with pain duration up to 3 months, the improvement was excellent in 41(74.5%), moderate in 3(5.4%), good in 6(10.9%) and weak in 4(7.2%) patients in contrast to patients with pain over one year who showed excellent improvement in only 2(5.7%) patients, moderate in 11(31.4%), good in 6(17.1%) and weak in 16 (45.7%) patients.PRT is clinically effective with better clinical outcomein patients with shorter duration of symptoms.

BACKGROUND: Hantavirus infection is manifested as an urgent, severe and life-threatening disease caused by Hantavirus. The virus affects human endothelial cells. The natural reservoir of the Hantaviruses is chronically infected rodents. Human infection is accidental. Occurs by intake of contaminated food or inhalation of contaminated secretion from infected rodents' excretions have an increased risk of contamination. The most affected persons are people who work in nature. The virus causes haemorrhages, fever and acute renal failure. The disease appears more frequently in endemic regions with the lethality of 6-15%. The disease can surprise doctors with severity, urgency and undefined clinical picture. Fast clinical evaluation, proper and urgent diagnosis and treatment can improve the safe life of these patients. CASE REPORT: We report a case of 45 -year-old male patient worked as a shepherd on mountain Babuna near the city of Veles in the Republic of Macedonia at the end of the summer in the year 2017, presented with prolonged hemorrhagic fever with renal syndrome. The clinical presentation and lab findings support the diagnosis of Hantavirus infection with acute renal failure. CONCLUSION: It is necessary to raise the awareness of the family doctors for the hantavirus disease, especially in countries with sporadic cases, as in our country. It needs for prompt and timely diagnosis, timely hospitalisation and initiation of therapy.

Periradicular therapy (PRT) is a minimally invasive radiological procedurein patients with chronic lumbar pain.The aim of the study is to identify clinical and radiological predictive factors for treatment success after a single PRT treatment in patients with sciatica.The study includes a prospective follow-up of 166 patients treated with PRT. The pain intensity is determined according to the VAS scale and the degree of improvement is presented as excellent (over 75%), good (50-70%), moderate (25-49%), and weak (less than 25%). The follow up of the treated patients was done at 2 weeks, 3 and 6 months. In patients with pain duration up to 3 months, the improvement was excellent in n=32 (58.18%) after 2 weeks, after 3 months n=41 (74.55%) and after 6 months n=41 (74.55%). This stands in contrast to patients with pain over 1 year. The percentage of improvement after 6 months, post-intervention, was highest in patients without nerve root compression (86.25±19.2),and the highest improvement after 6 months was in patients with localization of pain at the L4-L5 level (69.69±29.7), the greatest improvement after six months was in patients with extraforaminal hernia (62.82±34.3), and the lowest in patients with central stenosis (40.21±30.7).Our study results suggest that the shorter a pain duration, low-grade root compression, injection level and type of herniation area predictor the more favourable response patients have to transforaminal epidural steroid injection in patients with sciatica.

Cerebral venous thrombosis is a condition that requires greater clinical and radiological experience due to the significantly wider range of clinical signs and significant radiological variability.When the patient presents with SAH (subarachnoid haemorrhage), the challenge can be great.We present a case of cerebral venous thrombosis that radiologically presented with SAH without initial involvement of the parenchyma, which is why early diagnosis was important.We present a 36-year-old patient, with clinical manifestation of acute headache, elements for SAH on CT (computerised tomography) without initial involvement -haemorrhage of the brain parenchyma.CT angiography and venography using MRI (magnetic resonance imaging) demonstrated extensive thrombosis of the jugular vein, sigmoid and transverse sinus, with no other cause for SAH. Complete recanalization of the venous sinuses and significant improvement of the clinical diagnosis were reached after adequate anticoagulation therapy.The findings indicated that venous sinus thrombosis may initially manifest as unilateral SAH without the involvement of the brain parenchyma.