Faculty of Medicine

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ASSESSMENT OF ENZYMURIA FROM PROXIMAL RENAL TUBULE IN INFLAMMATORY SERONEGATIVE RHEUMATOID ARTHRITIS
(Macedonian Medical Association/De Gruyter, 2022)
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Ana Vasilevska
Introduction. To determine the effects of non-treated seronegative rheumatoid arthritis (RA) on proximal renal tubule, sensitivity of alanine aminopeptidase (AAP), -glutamyltransferase (--GT), β2 microglobulin in urine β2M), as well as to determine the relation with rheu-matoid factor (RF) and C-reactive protein (CRP), DAS 28 - disease activity score. Methods. RF was determined by agglutination test (latex RF test, while kinetic methods were used for determination of alanine aminopeptidase (AAP) and -glutamyltransferase (-GT), as well as MEIA (micro-particle enzyme immunoassay) to determine β2 micro-globulin in urine. Samples (serum and urine) of 70 participants were examined (35 RA not treated, 35 healthy control group of patients). Results. In 35 RF negative RA, AAP enzymuria was present in 12 (34.28%) patients, -GT was present in 7 patients (20%), while β2 microglobulin was present in 3 patients (8.57%). In the healthy control group, 4 patients showed AAP positivity (11.42%), 2 patients -GT positivity (5.71%) and 1 patient showed presence of 2 microglobulin in urine (2.85). RF was not detected in any patient (0%). Conclusion. AAP has a higher sensitivity of -GT and β2 microglobulin in the detection of asymptomatic renal lesions in non-treated seronegative RA.
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C-REACTIVE PROTEIN - THE MOST USEFUL REACTANT OF ACUTE PHASE IN RHEUMATOID ARTHRITIS
(Macedonian Association of Anatomists, 2023)
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Ljindita Djemaili Jakupi
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Ana Vasilevska
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Abstract The aim of the study was to determine the most useful biochemical marker of the acute phase reactants for the evaluation of disease activity in rheumatoid arthritis (RA). Sixty patients with RA were included, 27 of whom were treated with non-steroid antiinflammatory drugs (NSAIDs) and methotrexate (MTH). The control group consisted of 33 patients treated only with NSAIDs due to irregular control. In the first group, disease activity was evaluated at four-week intervals and in the control group at threeweek intervals, following the scores of the articular indices, complete blood count (CBC), elevated sedimentation rate (ESR), and C-reactive protein (CRP) in every patient. In the first group of patients, decreased activity of RA was found in every subsequent control, with a consecutive decrease in the mean values of the scores of the articular indices and statistically significant differences in the four-time intervals. Considering laboratory parameters, there were statistically significant differences in the mean values of haemoglobin (Hb), erythrocytes (Er), platelets (Plt), and ESR (p=0.0462, p=0.0076, p= 0.0058, p= 0.0003). The mean values of CRP did not show statistically significant differences, but the number of patients who were CRP negative increased (the standard deviation also increased). In the group of patients treated only with NSAIDs, there were statistically significant differences in the mean values of the scores of the articular indices, with increases in every subsequent control (in favor ofdisease progression). There were no statistically significant differences considering CBC, ESR, and CRP (in favor of a permanently active disease). CRP is the most useful marker in the prospective evaluation of patients with rheumatoid arthritis.
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PROXIMAL RENAL TUBULES ENZYMURIA AS A SCREENING TEST IN PATIENTS WITH SERONEGATIVE SPONDYLOARTHROPATIES
(Macedonian Association of Anatomists and Morphologists, 2023)
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Ana Vasilevska
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Ljindita Xhemaili Jakupi
The aims of this study are: to compare diagnostic values and laboratory variables of alanine aminopeptidase (microsomal AAP), γ-glutamyl transferase (γ-GT), β2-microglobulin (β2-M), CReactive Protein (CRP), and the index for disease activity (PASI) in the early diagnosis of previously untreated psoriatic arthritis (Psa) and to see how untreated psoriatic arthritis affected tubular function and the sensitivity of the brush border region, together with the diagnostic value of enzymes originating from the proximal renal tubules. From the standard methods of the International Federation for Clinical Chemistry (IFCC), we used the kinetic method for the determination of alanine aminopeptidase (microsomal AAP), γglutamyl transferase ((γ-G) and MEIA (Microparticles Enzyme Immunoassay (Abbott Axsym system)) for determination of β2microglobulin in the urine. We examined samples (serum and urine) from 70 participants (35 Psa untreated, 35 healthy control group). RF and CRP were determined with the latex agglutination test in the same participants. Of the 35 examined patients with Psa, 12 (34.28%) showed presence of APP enzymuria, 8 patients (22.85%) showed presence of γ-GT, and a low percentage (0% showed presence of β2microglobulin in urine. AAP has a higher sensitivity thanγ-GT and β2-M in asymptomatic renal lesions in untreated Psa.
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Continuous effect of migrant crisis on smoking status among migrants
(European Respiratory Society, 2020)
Monika Tushevska Mitkovska
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Nikola Chamurovski
Introduction: Acknowledging the specific problems of smoking prevalence and cessation in specific high risk populations in 2018, we have conducted a pilot research among migrants in the transitional refugee camps in Bosnia and Hercegovina, to evaluate their smoking habits, showing that migrants crisis has a negative impact on their smoking status. Objective and Method: We aimed to compare and follow the continuous effect of the crisis on the smoking habits, in order to provide data for developing a strategy that can be implemented as an continuous measure in the smoking cessation. From November untill December 2019 we interviewed a total of 368 randomly selected, migrants accommodated in the transitional camps, average length of stay of 70 days. We interwieved 333 men (90%), and 35 women (10%), age of 14-57 with the same questionnaire from the pilot study. Results: 60% were active smokers and 40% were nonsmokers.110 migrants(50%) responded that they have increased the amount of smoked cigarettes since they left they homeland, 65(20%) are smoking less cigarettes compared to the period before they left their homeland, 8(4%) have no difference in the number of smoked cigarettes, 36(16%) have started smoking since they left their homeland. None of the migrants had answered that they quit smoking since they left their homeland. Conclusion: Our data confirmed that the migration crisis has negative impact on the smoking habits of migrants. There was increase of the smoking prevalence and worsening of the smoking status true the migration crisis. We emphasize the need for organizing education and support in the process of quitting smoking for this vulnerable group.
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Inflammatory markers in peripheral blood in patients with asthma
(2020-12)
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Dejan Todevski
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Monika Tushevska Mitkovska
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Nikola Chamurovski
Asthma is one of the most common chronic diseases all over the world, resulting from a state of persistent sub-acute inflammation of the airways. The main attribute of asthma is inflammation, which leads to airway remodeling, bronchial hyper-reactivity and reversible or partly reversible airway obstruction. Asthma is a chronic inflammatory disorder of the airways in which many cells and inflammatory mediators play a role. (GINA). Many cells and mediators take part in creating the asthmatic inflammatory reaction, but eosinophils play a central role. All of the inflammatory cells and mediators can be detected in the airflow tissue. Some of them can be detected in the asthmatics peripheral blood too. This study includes 30 patients of the Pulmology and Allergy Clinic, Skopje, with confirmed bronchial asthma, treated with ICS. In all of the patients we followed Eo count, ECP and IL-5 in peripheral blood at the beginning of the study, after 2 and 6 months treatment. Following the parameters during treatment with ICS we registered changes in all of the tested parameters. Our conclusion is that the ICS objectively suppress the inflammatory reaction in asthma and the biologic markers (IL-5, Eo and ECP), which we have followed, can measure the accomplished effect. They could be used in every day practice, not only as diagnostic parameters but also as valid therapeutic guides in the treatment of asthma
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Management of tobacco dependence
(2018-10-27)
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Dejan Todevski
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Suzana Arbutina
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Monika Tushevska Mitkovska
Tobacco is the leading cause of premature death and disability in Europe. Each year, more than 700,000 Europeans die from tobacco-related illness. In Macedonia, 46.6% of the male and 26.8% of the female population are active smokers. These numbers acertain Macedonia to the high place in Europe by smoking rates. There is nothing more important we can do for patients who smoke than help them stop! Doctors and health professionals must take into account that tobacco dependence is a medical condition and not a habit, vice, pleasure, or life-style choice and it must be diagnosed and treated in the same way as other chronic diseases. Most smokers are not able to stop on their own (without help). Nicotine dependence is a chronic relapsing condition and has two components: physical dependence and psychological dependence. The tenacity of nicotine addiction means that many smokers who attempt to quit will relapse. Relapse is most common within the first few weeks of quitting. The ENSP Tobacco Treatment Guidelines recommend five strategies for addressing tobacco use in clinical settings. Known as the “5As” these strategies are: Ask all patients about smoking status and document in medical record; Advise patients who smoke to quit; Assess readiness to quit; Assist with making a quit attempt, including providing behavioral counselling and prescribing first-line smoking cessation medications; and Arrange follow-up. Behavioral support (Motivational interviewing) is the keystone of tobacco dependence treatment. It is generally matched to the patient’s motivation to quit smoking also known as the patients “stage of change”. There are five stages of change. Pre-contemplation, Contemplation. Preparation, Action and Maintenance. Tobacco dependence may need persistent and repeated therapeutic interventions, as well as long- term follow-up until it is cured. In order to give our contribution to the reduction of tobacco consumption in Macedonia, we are implementing a program for education of doctors and health workers for smoking cessation. The project represents partnership between the Medical faculty in Skopje and the Henry Ford Health System from Detroit, Michigan, USA.
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Total Eosinophyls, ECP and IL-5 in Peripheral Blood During Treatment with Inhaled Cortikosteroids in Patients with Asthma
(Turkish Thoracic Society, 2019)
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Dejan Todevski
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Monika Tushevska Mitkovska
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Nikola Chamurovski
Objectives: The main attribute of asthma is inflammation, which leads to airway remodeling, bronchial hyper-reactivity and reversible or partly reversible airway obstruction. According to GINA, asthma is a chronic inflammatory disorder of the airways in which many cells play a role, in particular mast cells, eosinophils (Eo), and T lymphocytes (GINA). Many cells and mediators take part in creating the asthmatic inflammatory reaction, but eosinophils play a central role. Methods: This study includes 30 patients of the Pulmology and Allergy Clinic, Skopje, with confirmed bronchial asthma, treated with ICS. In all of the patients we followed Eo count, ECP and IL-5 in peripheral blood at the beginning of the study, after 2 and 6 months treatment. Results: At the beginning of the study in all 30 (100 percent) of the patients the serum level of IL-5, Eo count and ECP were increased. Following the parameters during treatment with ICS we registered statistical significant changes in all of the tested parameters. Conclusion: Our conclusion is that the ICS objectively suppress the inflammatory reaction in asthma and the biologic markers (IL-5, Eo and ECP), which we have followed, can measure the accomplished effect. They could be used in every day practice, not only as diagnostic parameters but also as valid therapeutic guides in the treatment of asthma.
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Strategy for Developing a Smoking Cessation Program in Macedonia
(E-Cronicon, 2020)
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Arben Rexhepi
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Macedonia has one of the highest smoking rates in Europe and ranks among the top ten globally. Although there is a moderately strict anti-smoking legislation, tobacco free policies are not financially supported and smoking cessation activities are not included in the regular educational process of health workers in the country. Smoking cessation is not considered a medical intervention, there is no consistent access to nicotine replacement therapy or other cessation medications, nor are they covered by health insurance. The goal of the partners from Henry Ford Health System and the University St Cyril and Method in Skopje was to develop and adapt a Certified Tobacco Treatment Specialists program (aCTTS). A team of physician champions was created to facilitate implementing the program and to educate respiratory and internal medicine specialists, as well as general practitioners who proceeded treating patients for tobacco dependence. During the first four months of the intervention 64,668 patients visits were registered, 25,710 (40%) of them for tobacco-related diseases. Of the latter, 18,558 (72%) included smoking cessation counseling, which by itself is a great progress to reaching a striving population of smokers.

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