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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SEASONAL VARIABILITY OF (25OH) VIT D IN OBESE WOMEN IN NORTH MACEDONIA
(Македонско лекарско друштво = Macedonian medical association, 2023)
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Sonja Panovska
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Petrit Izairi
Introduction. Every year, 15 million infants are born prematurely, and 1 million of them surrender to preterm birth complications, accounting for 1 in every 3 neonatal deaths. Globally, about 28.5 premature births occur per minute, resulting in approximately 4 fatalities, with 2 of these attributed to respiratory distress syndrome (RDS). This study aimed to investigate how betamethasone affects fetal lung development by assessing fetal lung volume and its association with neonatal RDS. The study received ethical approval by the Ethics Committee of the Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia. Methods. This prospective clinical observational-interventional study involved 100 patients, including 50 with a history of preterm birth (study group) and 50 full-term cases (control group). The study was conducted at the University Clinic for Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia. Fetal lung volume was measured before and after betamethasone therapy, and its relation to neonatal RDS was evaluated. Patients were categorized into five groups based on gestational weeks. Results. Significant differences in total fetal pulmonary volume were observed before and after betamethasone treatment. Additionally, the measurement of total fetal lung volume has proved to be effective in predicting neonatal respiratory distress syndrome. Conclusion. Total fetal pulmonary volume measurement is a highly sensitive and specific method for predicting fetal lung maturity. This non-invasive, cost-effective, and easily accessible technique can be routinely employed in hospitals equipped with suitable ultrasound devices and adequately trained staff.
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Safety and Feasibility of Retrograde Recanalization of Radial Artery Occlusion in Patients with Need for Repeated Wrist Procedures
(Scientific Foundation SPIROSKI, 2022-11-25)
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AIM: The purpose of the study was to present a new technique of retrograde recanalization of radial artery (RA) occlusion (RAO) in patients with need for repeated wrist access percutaneous angiographic procedures. MATERIALS AND METHODS: During a 10-year period from March 2011–May 2021, 53 000 patients were referred for percutaneous coronary intervention (PCI) in a high-volume transradial center. RAO on angiography was documented in 1165 patients. Retrograde recanalization of RAO was attempted in 70 patients. The selected patients were with multiple previous bilateral wrist interventions (n = 3–9). Ipsilateral ulnar artery was usually rudimented or occluded and contralateral wrist approach could not be used. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and procedural success of retrograde recanalization of RAO. Visual analog scale (VAS) score forearm pain assessment was performed after procedure. Technique: All patients had palpable pulse distal of previous puncture site due to collaterals from ipsilateral ulnar and interosseous artery. The RA was punctured with an inner metallic needle with a plastic cannula. Using retrograde radial angiography performed by injecting contrast through the plastic cannula, the occluded segment was visualized and crossed with different types of hydrophilic chronic total occlusion guide wires. After sheath insertion, balloon dilatation of the occluded RA segment, successful catheterization, and/or percutaneous coronary intervention was performed. Final RA angiography was performed on all patients. RESULTS: Successful retrograde opening of RAO was achieved in 65 out of 70 patients (92%). PCI was performed in 56% of patients through the opened RAO and 5 patients underwent CAS. Procedural success through opened RA was achieved in all 65 patients. Forearm pain during procedure was present in all cases (VAS score 3 ± 2.1). Access site bleeding EASY score 3 and 4 occurred in 6 patients (8.5%). One patient had discharge of embolic material up the arm without clinical consequences. In one patient, we observed dissection of the interosseous artery. Clinical and duplex long-term follow-up with a median of 4.1 years showed patent RA in only 20 patients. There were no registered cases of hand ischemia. About 61% of patients underwent subsequent PCIs, through other alternative access sites. CONCLUSION: Retrograde recanalization of RAO is successful and safe in patients with need of repeated coronary angiography procedures and inability to use other wrist access sites. Puncturing the collateral and performing retrograde radial angiography through the cannula is a key factor in successful opening of the RAO.
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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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Cardiac structure and functon of elite volleyball players across different playing position
(Edizioni Minerva Medica, 2022)
Alreyami Shihab
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Ebrahim Khosrow
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Sajad Ahmadizad
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Hirofumi Tanaka
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BACKGROUND: Volleyball is a popular Olympic sport but has been little studied. Volleyball players have very distinct roles based on their playing positions. The present study aimed to investigate and compare cardiac functions and structure in elite volleyball players across different playing positions. METHODS: Left ventricular structure and function were measured using echocardiography in 60 male professional volleyball players (30.6±3.6 years) across five playing positions including libero, opposite players, outside hitters, middle blockers, and setters. RESULTS: Significant differences in most echocardiographic variables were observed among different playing positions, including left ventricular (LV) internal dimension, posterior wall thickness, intact ventricular septum, stroke volume, cardiac output, end-diastolic volume, ejection fraction, and fractional shortening (all p<0.01). End-systolic volume was not different among positions (p=0.167). The opposite players demonstrated greater LV dimension and thickness as well as systolic function than players in other positions (p<0.05). Stroke volume in the setters was significantly lower than those of the opposite players and outside hitters (p<0.05). Regression analysis showed that the playing position independently predicted most of the echocardiographic variables (p<0.05). CONCLUSIONS: LV adaptations in volleyball players vary widely according to their playing positions. The opposite players had the most pronounced LV adaptations compared with player in other positions.
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Case Report of Latent Autoimmune Diabetes in Adults - misdiagnosed as type 2 Diabetes Mellitus
(2022-12)
Todorova, Biljana
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Introduction: Latent Autoimmune Diabetes in Adults (LADA) is a form of autoimmune mediated diabetes in adults and a hybrid form of diabetes with features of both type 1 (T1DM) and type 2 diabetes (T2DM). The diagnosis of LADA according to Immunology of Diabetes Society is based on three features: age over 35, Presence at least one of four autoantibodies to pancreatic islet cell antigens and insulin independance at least 6 months after diagnosis. Unfortunately, patients with LADA are often misdiagnosed as having T2DM, shows a sustained poor glycemic control over time and significantly increased risk of microvascular complications. CASE REPORT: We present a fimale patient aged 52. She was diagnosed as T2DM when she was 36. Her past history includes: Rheumatoid Arthritis, family history-son and father diagnosed with type T1DM at the age of 26 and 33 years, respectively. She was treated with basal insulin therapy for seven years and due to poor glycaemic control the therapy was intensified. Several months before the admittance toour hospital she had have a history of frequent urination and hypoglicemic episodes followed by loss of consciousness. Laboratory revealed: HbA1c- 8.03% ; C- peptide 0,314ng/ml (0,53-2,9 ng/ml. The rest of the laboratory was normal. Ophthalmology exam stressed non-proliferative retinopathy. Immunologic analyses revealed positive Glutamic Acid Decarboxylase Autoantibodies (GADA) 65 and Insulin Autoantibodies (IAA). DISSCUSION: Our patient was diagnosed and treated as T2D for 15 years. The susspision for LADA was raised during her last exam. In our patient, there were two antibodies found out of four-GADA65 and IAA. She was already on insulin therapy and there was no need major change of the insulin therapy. CONCULION: Prevalence of LADA is increased in the patients with family history of T1DM. The early recognition of LADA is of utmost importance. Recognizing LADA at early stage will lead to early initiation of insulin, better glycemic control as well as the preservation of residual beta-cell function in adult-onset autoimmune diabetes.
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Insulinoma of the tail of the pancreas
(2023-05)
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Todorova, Biljana
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Pavlevska Elena
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SUBCLAVIAN CRUSH SYNDROME AND INAPPROPRIATE SHOCKS IN PATIENT WITH IMPLANTABLE CARDIOVERTER DEFIBRILATOR
(Macedonian Association of Anatomists, 2022)
Misic, Irena
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Janusevski, Filip
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Risteski, Dejan
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Sleep and sleep disorders in childhood and adolescence
(2022-09)
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Paediatric appendicitis: international study of management in the COVID-19 pandemic
(Oxfor academic, 2022-07-19)
Paul van Amstel
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Ali El Ghazzaoui
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Nigel J Hall
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Tomas Wester
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Francesco Morini

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