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Anxiety and perceived stress are increasingly prevalent among youth; however, empirical data from Southeast Europe remain limited. This study examines the prevalence, interrelation, and psychological implications of anxiety and perceived stress in youth from North Macedonia, utilizing validated psycho-metric tools. A cross-sectional study included 204 participants aged 15 and older (mostly under 30), recruited from various educational institutions. Participants completed the Beck Anxiety Inventory (BAI) and the Perceived Stress Questionnaire (PSQ-30) under standardized conditions. Analyses included descriptive statistics, Latent Profile Analysis, k-means clustering, MANOVA, linear regression, and Exploratory Factor Analysis to evaluate symptom patterns and demographic predictors. Additionally, machine learning models (logistic regression and random forest) were employed to predict subgroup membership. High levels of perceived stress and anxiety were observed, with significant gender- and age-related differences. Correlation analyses demonstrated a strong positive association between PSQ-30 and BAI scores. The Pearson correlation coefficient was r = 0.66, confirming the statistical strength of this association. Factor analysis revealed multiple latent dimensions of anxiety, while cluster analysis identified distinct psychological profiles. These findings underscore the co-occurrence and interplay of anxiety and perceived stress in Macedonian youth, emphasizing the need for targeted mental health interventions and region-specific policy development.

Introduction: Alexithymia, defined by difficulty identifying and verbalizing emotions, has emerged as a significant factor influencing emotional regulation and coping behaviors in youth. Adolescents with high levels of alexithymia may be at greater risk of psychological distress due to maladaptive coping mechanisms and reduced social support engagement. Materials and Methods: This cross-sectional study was conducted among 141 high school students aged 15–18 in Skopje, North Macedonia. Participants completed validated instruments including the Toronto Alexithymia Scale (TAS-20) and the Adolescent Coping Orientation for Problem Experiences (COPE-A). Statistical analyses included descriptive statistics, Pearson correlations, to examine associations between alexithymia and coping strategies. Results: The mean TAS-20 score suggested a high prevalence of alexithymic traits in the sample. Approximately 44% of adolescents in the sample scored above the clinical threshold for alexithymia (TAS-20 > 61), highlighting the prevalence of emotional processing difficulties in this population. Significant correlations were found between higher alexithymia and maladaptive emotion regulation strategies such as self-blame, rumination, and catastrophizing. Conversely, positive coping strategies like positive reappraisal and acceptance were negatively correlated with alexithymia levels. Participants with high alexithymia reported a greater tendency to engage in maladaptive coping behaviors. Discussion: Findings underscore alexithymia as a trait associated with emotion dysregulation and diminished coping flexibility in adolescents. The results highlight the interplay between poor emotional awareness and a tendency to adopt dysfunctional cognitive responses to stress, which may exacerbate vulnerability to psychological problems. Conclusion: Early identification of alexithymic traits and the promotion of emotional literacy and adaptive coping in adolescence are crucial. Preventive school-based programs focusing on emotional skill development and peer support may buffer the impact of alexithymia and enhance youth mental health outcomes.

One-lung ventilation (OLV) in children is technically demanding due to small airway calibers, variable bronchial anatomy, and limited pediatric-specific devices. Challenges are greater in resource-limited settings where double-lumen tubes (DLTs) and fiberoptic bronchoscopes are not consistently available. We retrospectively reviewed five consecutive pediatric patients (ages 4-13 years) who underwent thoracic surgery with OLV between 2022 and 2024. Case summaries highlighted device choice, confirmation method, and perioperative challenges. Variables included demographics, diagnosis, surgical side, isolation technique, OLV duration, ventilatory parameters, arterial blood gases, and defined outcomes (desaturation, hypercarbia, hemodynamic instability, device dislodgement, and postoperative complications). Lung isolation was achieved with DLTs in two older patients and bronchial blockers in three younger ones, guided by age and weight. OLV lasted 105-150 min. Two children developed transient desaturation (nadir SpOâ 75%), one experienced hypercarbia (PaCOâ >50 mmHg), and two had hemodynamic instability. No tube dislodgement occurred. Median ICU stay was 17 h (IQR 8-19), and hospital stay 21 days (IQR 15-21). All patients were discharged in stable condition. An age- and weight-based algorithm bronchial blockers for children < 8 years or < 30 kg, DLTs for older/heavier patients enabled safe OLV and preserved oxygenation, even without routine fiberoptic bronchoscopy. Vigilant ETCOâ monitoring, careful device fixation, and close intraoperative assessment compensated for equipment limitations. This pragmatic workflow demonstrates feasibility in resource-constrained environments, provides practical guidance for clinicians, and is hypothesis-generating for future multicenter studies.

Introduction: Venous malformations (VMs) are a prevalent type of congenital vascular disorder, affecting nearly 1% of the population. These low-flow vascular anomalies often lead to chronic swelling, pain, and mobility challenges, often interfering with a child’s daily life. Their development is mostly caused by genetic abnormalities in the TIE2/TEK and PIK3CA pathways, which cause poor venous remodeling and vascular proliferation. This study aims to assess the clinical manifestations, diagnostic methods, and therapeutic alternatives for pediatric venous malformations, emphasizing the effectiveness of different treatment modalities. Recognizing clinical presentations and understanding treatment outcomes are essential for improving early diagnosis and optimizing patient-centered care strategies. Materials and methods: Between 2019 and 2023, the Clinic for Pediatric Surgery in Skopje treated 38 pediatric patients with venous abnormalities. Patient demographics, lesion characteristics, and treatment options (including conservative management, sclerotherapy, and surgical intervention) were examined. Results: The majority of patients (39.5%) received conservative treatment, whereas 23.7% underwent sclerotherapy and 34.2% needed surgical intervention. Sclerotherapy results were evaluated according to lesion size. Treatment was effective for smaller lesions (<5 cm), while bigger or recurring cases required multiple treatment sessions. Conclusion: The results highlight the importance of early identification and individualized treatment strategies for pediatric venous malformations. Sclerotherapy is the primary therapeutic option for minor to moderate lesions, whereas surgical intervention is designated for symptomatic or refractory patients. A multidisciplinary approach is crucial for enhancing patient outcomes, and future research should focus on the advancement of minimally invasive therapeutic techniques and the exploration of targeted genetic medicines.

Abstract Rectal leiomyosarcoma (LMS) is an exceptionally rare malignancy, representing ˂0.5% of all rectal cancers. Even more uncommon are the cases of radiation-induced LMS arising as an independent malignancy following pelvic radiotherapy. We report a case of a 56-year-old female patient with a history of high-grade large cell neuroendocrine cervical carcinoma treated 12 years earlier with radical hysterectomy and adjuvant chemoradiotherapy. The patient presented with rectal discomfort and altered bowel habits. A colonoscopy revealed a near-obstructing polypoid rectal mass, and a biopsy confirmed LMS. Surgical treatment via abdominoperineal resection with total mesorectal excision was performed. Adjuvant chemotherapy was conducted by an oncologist. Given the long latency period and absence of metastases, the tumor was stated as a radiation-induced primary malignancy. This case emphasizes the importance of awareness in cancer survivors previously treated with pelvic radiotherapy and highlights the critical role of surgery in the management of rectal LMS.