Faculty of Medicine

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Prevalence and Characteristics of Allergic Asthma in a Sample of Dairy Farmers
(Scientific Foundation Spiroski, 2024-01)
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Atanasovska, Aneta
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Bislimovska, Dragana
AIM: The objective of the study is to evaluate the prevalence characteristics of allergic asthma in a sample of dairy farmers. METHODS: We performed a cross-sectional study including 83 dairy farmers (mean age: 52.6 ± 8.7 years; mean exposure duration: 23.7 ± 7.6 years) compared to 80 office controls (mean age: 52.7 ± 8.2 years) matched for age, smoking habits, and socioeconomic status. Methods of evaluating examined subjects included a questionnaire on respiratory symptoms in the past 12 months, baseline spirometry and histamine challenge, and skin prick tests to standard inhalant and occupational allergens. RESULTS: The frequency of asthma was non-significantly higher in dairy farmers than in controls (7.2% vs. 5%). The frequency of allergic asthma was non-significantly higher in dairy farmers than in controls (6% vs. 3.8%). The frequency of allergic asthma was significantly higher compared to non-allergic asthma in both groups, while the frequency of subjects with allergic asthma who are sensitized to occupational allergens (wheat, corn, rye, cow hairs, molds) was similar in dairy farmers and controls. The risk of sensitization to occupational allergens was non-significantly higher among dairy farmers with allergic asthma (OR = 1,39 [0,18–12,28] CI 95%), compared to office controls. The risk for asthma development was non-significantly higher in subjects sensitized to occupational allergens compared to those who are not sensitized to them both in dairy farmers (OR = 2.00 [0.11–40.60] CI 95%) and office controls (OR = 3.00 [0.00–197.11] CI 95%). The risk for asthma development was about 4 times higher in subjects with atopy compared to those without atopy among dairy farmers (OR = 4.00 [0.22–104.88] CI 95%), while in office controls was almost identical (OR = 1.00 [0.00–39.77] CI 95%). Having in mind sensitization to certain inhalant allergens, asthma was significantly associated with sensitization to Dermatophagoides pteronyssinus both in dairy farmers (p < 0.01) and office controls (p < 0.05). CONCLUSION: The results suggest that occupational exposure among dairy farmers was associated with a higher prevalence respiratory symptoms, lung function impairment, and allergic asthma development. Study findings also can contribute in the detection of critical points for action, predict asthma development, and indicate the need for reduction of adverse occupational exposures by appropriate preventive measures, use of respiratory protective equipment, and implementation of engineering controls.
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Work Ability in Patients with COPD: Sick Leave Frequency and Duration
(International Journal of Clinical Studies and Medical Case Reports, 2023-09-04)
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Atanasovska, Aneta
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Panajotovic-Radevska, Maja
Introduction: Findings of several studies indicated that chronic obstructive pulmonary disease (COPD) affects patients’ work ability and everyday life activities. Aim of the study: To compare frequency and duration of absence from work in workers with COPD and non-COPD controls. Methods: We performed a cross-sectional study including 114 workers with COPD (63 males and 51 females, mean age 53.2 ± 3.7) and an equal number of non-COPD controls (60 males and 54 females, mean age 52.7 ± 3.1), classified by skill level in four occupation groups. Evaluation of the study subjects consisted of completion of a questionnaire, baseline spirometry, and bronchodilator reversibility testing. Results: Frequency of the sick leave episodes was significantly higher in workers with COPD than in non-COPD controls (44.7% vs. 20.1%; P = 0.004). In addition, frequency of sick leave episodes was higher in all occupation groups of workers with COPD than in non-COPD controls with significant difference for the workers performing physical or manual tasks (48.3% vs. 21.2%; P = 0.045). In regard to duration of sick leave episodes, the frequency of episodes lasting equal or less than 15 days and more than 15 days was higher in workers with COPD being significantly higher for episodes longer than 15 days (50.9% vs. 26.9%; P = 0.045). Conclusion: Our findings indicated significantly higher frequency of sick leave episodes, as well as significantly higher frequency of sick leave episodes lasting more than 15 days, in workers with COPD than in non-COPD controls.
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Incidence of Immunological Occupational Asthma in 2015–2022 by Occupation: Macedonian Experience
(Scientific Foundation SPIROSKI, Skopje, Republic of North Macedonia, 2023-05-02)
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Atanasovska, Aneta
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Panajotovic-Radevska, Maja
BACKGROUND: Immunologic occupational asthma (OA), a more prevalent OA type than non-immunologic OA, became an important public health problem in the last decades worldwide.AIM: To present the distribution of new diagnosed cases of immunologic OA in the RN Macedonia in the period 2015–2022 by occupation.METHODS: Immunologic OA was diagnosed by the serial measurement of peak expiratory flow rate (PEFR) at and away from work or by combination of serial PEFR measurement at and away from work and non-specific bronchial provocation at and away from work in workers with diagnosed asthma and work-relatedness of the symptoms. Sensitization to common inhalant and occupational allergens was evaluated by skin prick test.RESULTS: The annual incidence rate of the diagnosed immunologic OA in this period varied from 1.9/100,000 working population in 2015–2.6/100,000 in 2022 with a drop in 2020 and 2021, i.e.in the period of COVID-19 pandemic (0.6 and 0.5, respectively). Cleaning, bakery, cleaning, textile manufacture, wood industry, agriculture, and metal-parts manufacture were the most important occupations for the development of immunologic OA. More than a half of the new diagnosed immunologic OA cases were atopics.CONCLUSION: Our findings indicated the occupations with the highest incidence of immunologic OA that could enable targeting of preventive measures and activities to reduce the occurrence of immunologic OA as well as its adverse health outcomes.
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Efficacy and Safety of Levofloxacin in Outpatient Treatment of Exacerbations of COPD and Bronchiectasis
(European Journal of Respiratory Medicine, 2022-01)
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Petrova, Tatjana
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Atanasovska, Aneta
Introduction: Majority of the exacerbations of chronic obstructive pulmonary disease (COPD) and bronchiectasis could be treated on outpatient basis. Aim of the study: To assess efficacy and safety of levofloxacin as empirical treatment of exacerbations of COPD and bronchiectasis in outpatient setting. Methods: We performed an observational, non-randomized, open-label study including 74 patients with exacerbation of COPD and 34 patients with exacerbation of bronchiectasis of bacterial origin which met criteria for outpatient treatment. The patients were treated with oral levofloxacin 500 mg once daily for 10 days (COPD exacerbations) and 14 days (exacerbations of bronchiectasis). Efficacy of the treatment was assessed by a number of patients with clinical remission of exacerbation, while the safety was assessed by a number of patients with side effects during the treatment. Results: Clinical remission of exacerbation, i.e. complete resolution of clinical symptoms and signs or their return to their baseline severity, was achieved in 87.8% of patients with COPD, as well as in 82.3% of patients with bronchiectasis. In addition, the mean time to clinical remission of exacerbation in patients with COPD and bronchiectasis was 6.2 and 9.6 days, respectively. Incidence of side effects during the treatment with levofloxacin was 9.4% in patients with COPD and 11.7% in patients with bronchiectasis. Registered side effects were mild and self-limited and did not require premature discontinuation of the treatment with levofloxacin. Conclusion: Our findings confirmed high efficacy and good tolerability of levofloxacin in empirical treatment of exacerbations of COPD and bronchiectasis in outpatient setting.
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CEFPODOXIME IN THE OUTPATIENT TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS
(Faculty of Medicine, Skopje, 2021-05-15)
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Petrova, Tatjana
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Introduction. According to the recent data, lower respiratory tract infections (LRTIs), i.e. a broad terminology including acute bronchitis (AB), influenza, community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and acute exacerbation of bronchiectasis (AEBX), represent the fourth most common cause of death at global level. Aim of the study. To assess efficacy and safety of cefpodoxime in the empirical treatment of LRTIs of bacterial origin in an outpatient setting. Methods. We performed an observational, non-randomized, open-label study (a real life-study) including 126 patients with LRTI of bacterial origin, 59 patients with AECOPD, 32 patients with CAP and 35 patients with AEBX, who met criteria for treatment in an outpatient setting. All study subjects were treated with cefpodoxime 200 mg twice daily, and had intermediate visits at 3, 5, and 7 days (patients with AECB) and at 3, 5, 7, and 10 days (patients with CAP and AEBX) at which their symptoms as well as eventual side effects were evaluated. The treatment was considered to be successful if complete resolution of symptoms or their return to the baseline severity was achieved. Results. Percentage of clinical success, i.e., complete resolution of clinical symptoms and signs or their return to the baseline severity, varied from 77.9% in patients with AECOPD, 81.3% in patients with CAP to 77.1% in patients with AEBX. Mean time to clinical remission varied from 6.5  0.3 days in patients with AECOPD, 7.8  0.5 days in patients with CAP to 10.7  1.2 days in patients with AEBX. Incidence of side effects during the treatment varied from 10.2% in patients with AECOPD, 12.5% to 8.6% in patients with AEBX. Registered side effects were mild and self-limited and did not require premature discontinuation of the treatment. Conclusion. Our findings supported the use of cefpodoxime in the treatment of bacterial LRTI due to its high efficacy and good tolerability.
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Lung Function Impairment in Construction Workers – Influence of Smoking and Exposure Duration
(Scientific Foundation SPIROSKI, 2021-05-08)
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Bislimovska, Dragana
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Atanasovska, Aneta
AIM: The objective of the study was to assess the influence of exposure duration and smoking on ventilatory impairment among construction workers. METHODS: A cross-sectional study was performed, including 83 construction workers aged 18–64 years, compared to equivalent number of office controls matched by age, workplace exposure duration, and smoking status. Data on chronic respiratory symptoms, work history, and smoking status were collected by standardized questionnaire, while lung functional testing of the examined subjects was performed by spirometry. RESULTS: Mean values of spirometric parameters were lower in construction workers compared to controls with statistical significance registered for maximal expiratory flow (MEF25), MEF50, and MEF75. Lung functions of construction workers have been found to decrease in relation to exposure duration but reached significance only for small airways changes. There was a significant difference in detected ventilatory impairment between exposed workers and controls for any type of ventilatory impairment, as well as obstructive and combined ventilatory pattern and obstructive ventilatory pattern in small airways. Obstructive ventilatory impairment was significantly associated with life-time smoking in construction workers, while obstructive ventilatory pattern in small airways was significantly associated with life-time smoking. The combined effect of daily smoking, life-time smoking, and number of cigarettes smoked daily was shown to have a significant influence in their development. The risk for obstructive ventilatory pattern in small airways among exposed subjects was about 4 fold higher in those exposed more than 20 years (odds ratio [OR] = 3.68 [1.01–14.59] confidence interval [CI] 95%), and about 2.5 fold higher in smokers (OR = 2.57 [0.92-7.25] CI 95%). Exposure duration, smoking and age had independent effect only on small airways changes and force expiratory volume in the 1st s/force vital capacity %. CONCLUSION: Our data suggest the importance of the joint effect of job exposure in construction and daily smoking on the development of lung function impairment and airflow limitation, being dominant, especially on small airways.
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Specific work activities and exposure to respiratory hazards - predictors of lung function impairment among crop farmers
(ID Design Press/Scientific Foundation SPIROSKI, 2020-04-25)
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Atanasovska, Aneta
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Bislimovska, Dragana
The objective of the study was to evaluate the specific work activities and occupational exposure to respiratory hazards as predictors of chronic respiratory symptoms development, lung function decline, and respiratory health impairment among crop farmers. METHODS: A cross-sectional survey was performed, including 87 crop farmers (mean age: 53.4 Â± 7.8 years; and mean exposure duration: 22.9 Â± 7.8 years) and 80 office workers as a control group (mean age: 52.7 Â± 8.2 years) matched for age, smoking habits, and socioeconomic status. Subjects were evaluated by a questionnaire on respiratory symptoms in the past 12 months and spirometry testing. RESULTS: Crop farmers had a significantly higher prevalence of cough (41.4), phlegm (28.7%), and dyspnea (21.8%), than controls (p < 0.05). All mean baseline spirometric parameters were lower in crop farmers, but statistical significance was confirmed only for MEF25, MEF50, and MEF75 (p = 0.003, p = 0.000, and p = 0.001, respectively). Most of the respiratory symptoms were significantly associated with common work activities of crop farmers and all-day exposure to certain respiratory hazards. Age, exposure duration, and their combined effect with smoking habit had a significant effect on forced expiratory volume in one second FEV1 and FEV1/forced vital capacity. CONCLUSION: The results confirm that occupational exposure among crop farmers is associated with higher prevalence of respiratory symptoms and lung function decline and, together with specific workflow activities, may not only be a predictors of respiratory health impairment, but also a key tool in the creation of preventive strategies.</jats:p>

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