Faculty of Medicine

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A CASE OF A LYME DISEASE IN THE SECOND TRIMESTER OF PREGNANCY
(Македонско лекарско друштво = Macedonian medical association, 2025-09)
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Anamarija Shpishikj Pushevska
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Pranvera Izairi
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Arta Islami Zulfiu
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Bekim Dika
Introduction: Lyme disease is the most common tick-borne disease in North America and Europe and it is caused by spirochetal bacteria Borelia burgdorferi. Early symptoms of infection include a characteristic rash (erythema migrans), fever, headache and lethargy. If untreated, the disease may affect the heart, nervous system and joints. Regardless of whether maternal exposure to B. burgdorferi occurs before conception or during pregnancy, it does not appear to be associated with fetal death, prematurity or risk of congenital malformations. Even documented infection of the placenta with B. burgdorferi has not been linked to adverse pregnancy outcomes. Also, there have been no reported cases of transmission of B. burgdorferi via breast milk. Antibiotics used during pregnancy are amoxicillin or cephalosporins, 14-21 days. Case report: A 24-year-old primigravida, at 23 weeks of gestation, reported that 3 weeks earlier she had been bitten by a tick that had not been removed by a surgeon. A change appeared as a red ring of about 10 cm in the gluteal region on the right, as well as joint pain, without fever. She was examined by an infectious disease specialist. Serological tests were performed and a high titer of IgG and IgM antibodies for Borelia burgdorferi sensu lato were detected. Antibiotic therapy Amp. Ceftriaxone 2gr/day was administered for 14 days, which prevented further complications in mother or fetus. Conclusion: With this case, we want to point out that Lyme borreliosis is present, that a tick bite is serious and requires an examination by a surgeon and an infectious disease specialist, in order to properly remove the tick and prevent the occurrence of this disease, which is possible even during pregnancy. It is also important to be aware of its symptoms, in order to start antibiotic therapy before more serious complications arise.
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Hormonal changes in women with abnormal endometrial bleeding in peri and postmenopause
(European Society of Endocrinology, 2022-05)
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Bashkim Ismaili
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Dimitar Georgiev
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SHpishikj Pushevska, Anamarija
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BONE MARKERS IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING
(International Osteoporosis Foundation, 2022-03-24)
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Biljana Jovanoska Todorova
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Bashkim Ismaili
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Pranvera Izairi
Objectives: To determine the histopathological changes of the endometrium that occur during the period of perimenopause and postmenopause and to determine their association with the presence of obesity and the levels of bone markers for bone resorpition and bone formation, serum parathormone, vitamin D and calcium levels. Material and methods: This study involved 120 patients with fractionated explorative curettage due to abnormal uterine bleeding. The examined group was divided in two subgroups: 60 women in perimenopausis and 60 women in postmenopausis. Anamnestic data were taken from from all respondents. Body height and weight were measured. This laboratory analyses were performed: Serum Osteocalcin, beta CTX, parathormone, Vitamin D and calcium levels. Results: The most common pathological change of the endometrium was an endometrial polyp. History of previous bone fractures was significantly more common in postmenopausal women than in perimenopausal women. Postmenopausal women were older than perimenopausal and had significantly higher Body Mass Index, higher levels of serum osteocalcin and beta CTX in serum. Postmenopausal duration significantly positively correlated with Osteocalcin and β Cross Laps serum values. Higher serum Osteocalcin and β Cross Laps values were measured in patients with longer postmenopause duration. There was not significant difference in the levels of vitamin D and calcium between the groups. Conclusions: In the period of perimenopause and postmenopause, there are changes in the genital organs, but also there are internal disorders (obesity, metabolic syndrome, diabetes, thyroid disorders, cardiovascular disease, osteoporosis), which should be timely prevented, diagnosed and treated. Estrogen deficiency in postmenopausis is the most common cause of postmenopausal osteoporosis.
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THE CORELATION BETWEEN FETO-PLACENTAL UNIT, FETAL BIOMETRY AND AMNIOTIC FLUID IN PREGNANT WOMEN WITH PREECLAMPSIA IN SECOND TRIMESTER
(2020)
Pranvera Izairi
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Nevenka Velickova
Abstract: Preeclampsia is a pregnancy complication, characterized by high blood pressure, that exceeds 140/90mmHg, documented in two occasions, at least four hours appart and proteinuria 0.3 g or more proteins in urine for 24 hours. It usually begins after 20 gestational weeks, in normotensive women. The incidence is approximately 3-8% of all pregnant women, worldwide. Etiology of preeclampsia is not known yet, but there are theories that explain it: immunologic, genetic, placental ischemia, etc., and all of them contribute to abnormality of spiral arteries, placental site trophoblastic cell dysfunction, inadequate trophoblastic invasion, that finally results with placental hypoperfusion and ischemia. The study is prospective, proceeding at the Department of Pathologic and High Risk Pregnancy, SHGO "Mother Theresa" in Skopje. The data are estimated from March-December 2019. It was done measurment of doppler values of a. uterine dex. et sin., between 20-24 g.a., fetal biometry measurments and the index of amniotic fluid. From all 150 pregnant women included in the study, in 20 of them was found high doppler values and in four of the same group, presence of notch. In 16 pregnant women with high doppler values, it was found intrauterine growth retardation, while in three of them decreased levels of amniotic fluid. All 20 women were followed up by regulary measuring arterial tension and hospitalisation at the beginning of third trimester for doing analizes of presence of proteins in the urine and given adequate therapy. From 20 pregnant women that had high doppler values, hypertension and other changes in ultrasound parameters, in 11 of them was found preeclampsia. Also, it was found positive correlation between high doppler values of a. uterine and notch in second trimester, and appearance of preeclampsia, later in pregnancy and also a correlation between the values of a. uterine, notch, fetal biometry and index of amniotic fluid.
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ASSOCIATION BETWEEN FIRST TRIMESTER OBESITY AND SOME MATERNAL CHARACTERISTICS
(Македонско лекарско друштво = Macedonian Medical Association, 2020)
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Pranvera Izairi
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Abstract Introduction. Obesity in pregnant women has substantial negative impact on both pregnancy and labor/delivery. The aim of this article was to determine first trimester obesity-frequency, and its association with some maternal history data. Methods. In this cross-sectional study, 809 first trimester pregnant women were evaluated for obesity defined as BMI ≥30. The data were collected via a questionnaire. Results. BMI ≥30 had17.3% of all participants, 17.0% of them were Macedonian and 17.5% Albanian. BMI ≥30 had 23.9%of those with completed primary school, 16.4% of those with completed high school, and 14.8% of those with university degree; 18.7% of those with total family income less than 350 euros, 14.9% of those with total family income between 350-700 euros, and 14.8% of those with total family income above 700 euros. BMI ≥30 had 13.2% of nulliparous, and 20.6% of parous women. Among smokers, BMI ≥30 had 28.8%, but only 15.3% in nonsmokers. Regarding the IPI (interpregnancy interval), 26.2% in those with IPI ≤12 months had BMI ≥30, and 19.6% of those with IP I>12 months. Women aged40 years and over had BMI ≥30 in 40% of casesversus 16.8% of pregnant women younger than 40 years. Conclusion. Obesity showed statistically significant negative association with level of education (p=0.010), positive correlation with smoking (p=0.003), age of the mother (p=0.019) and parity (p=0.006); obesity showed negative, but statistically insignificant association with IPI and family wealth, and showed no association with nationality.

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