Faculty of Medicine

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CHRONIC RESPIRATORY SYMPTOMS AND SPIROMETRIC PARAMETERS AMONG PROFESSIONAL DRIVERS - THE IMPACT OF OCCUPATIONAL EXPOSURE AND WORK TENURE
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2026-06-18)
Andonov, Goran
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Aim. To assess the prevalence of chronic respiratory symptoms, spirometric parameters and the effects of occupational exposure among professional drivers. Material and methods. A cross-sectional epidemiological study was conducted including 70 male professional drivers and 70 administrative staff matched by age, work tenure, occupational exposure and smoking status. Data on respiratory symptoms, smoking status, occupational exposure to harmful agents and work tenure were collected using a standardized questionnaire. Spirometry was performed to assess lung function. Results. Professional drivers had a significantly higher prevalence of respiratory symptoms compared to controls, including any respiratory symptom (81.4% vs. 58.6%, p=0.003), nasal symptoms (35.7% vs. 8.6%, p<0.001), cough (61.4% vs 34.3%, p=0.002), cough with phlegm (37.1% vs. 20.0%, p=0.040), dyspnea (31.4% vs. 17.1%, p=0.049) and wheezing (25.7% vs. 7.1%, p=0.006). All spirometric parameters were significantly lower in drivers, indicating involvement of both large and small airways (p<0.05). Drivers with ≥ 20 years of work tenure exhibited a significantly higher prevalence of symptoms and lower spirometric values. Multivariable logistic regression identified exposure to gases as the strongest independent predictor of respiratory symptoms (adjusted OR up to 12.4, p<0.01), followed by exposure to smoke (adjusted OR up to 6.31, p<0.05). Dust exposure showed a non-significant trend, while vapors were not associated with respiratory symptoms. Conclusion. Professional drivers are at increased risk of developing respiratory symptoms and lung function impairment compared to the control group. Occupational exposure to gases and smoke represents the main independent risk factor, while longer work tenure suggests a cumulative adverse effect.
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DERMATOGLYPHIC PATTERNS AMONG STUDENTS IN NORTH MACEDONIA
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2026-03-24)
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Introduction: Dermatoglyphics is a scientific discipline that studies the epidermal ridge patterns present on the palmar surfaces of the hands, the toes and the plantar surfaces of the feet. Aim. An analysis of individual dermatoglyphic characteristics in healthy medical students of Macedonian and Albanian ethnicity was conducted. Material and methods: The study included 234 healthy students; palm prints were obtained and dermatoglyphic parameters were read, classified and compared with data reported in the dermatoglyphic literature. Imprinting was done by the Cummins and Midlo ink method. The reading and classification of dermatoglyphic patterns were performed according to Henry's system. Results: Ulnar loops were the most prevalent patterns, followed by circular, arcuate and complex patterns, which were present in a small percentage in both genders; radial loop was present only on the second finger in both genders. There were differences on the right hand for the second, fourth and fifth finger, and on the left hand for the third, fourth and fifth finger between males and females. Also, significant differences were found in the third and fourth interdigital spaces and hypothenar area. The triradii distribution formula in females was: a > b > d > c > t; whereas in males it was: a > t > b > c = d. Additional triradii were rare in both genders. The atd angle was within the range of 32ᵒ -55ᵒ in females and 33ᵒ -50ᵒ in males, most often 40ᵒ in both groups. Conclusion: This population-based study have shown similarities and differences in the prevalence of some dermatoglyphic features in males and females among healthy students.
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Pathophysiology, prevention, and management of coronary microvascular obstruction
(Oxford University Press (OUP), 2026-05-26)
Cenko, Edina
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Badimon, Lina
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Vadalà, Giuseppe
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Merkus, Daphne
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Antoniades, Charalambos
Abstract Although prompt primary percutaneous coronary intervention (PCI) reduces mortality in patients with ST-elevation myocardial infarction (STEMI), the burden of post-infarction heart failure remains considerable and is expected to increase. A major contributory factor is suboptimal myocardial reperfusion, which persists in up to 60% of cases even with timely revascularization. This is largely driven by microvascular obstruction and ischaemia–reperfusion injury, culminating in the no-reflow phenomenon, a critical prognostic factor associated with impaired infarct healing, adverse left ventricular remodelling, and increased risk of heart failure and death. No-reflow is a complex and heterogeneous phenomenon, identifiable through different invasive and noninvasive technologies. When observed post-PCI, after excluding residual epicardial stenosis, it indicates poor microvascular perfusion and necessitates urgent management. Identifying patients at high risk and implementing early targeted interventions are essential to improving outcomes. Pharmacological therapies, including intracoronary adenosine and nitroprusside, have shown unclear benefit in improving microvascular flow. Non-pharmacological strategies, such as ischaemic postconditioning, intracoronary supersaturated oxygen therapy, stent-retriever thrombectomy, and mechanical left ventricular unloading, have demonstrated promise but require further validation in large-scale clinical trials. This clinical consensus statement summarizes current strategies for the prevention and treatment of no-reflow and underscores the need for improved risk stratification and novel microvasculature-targeted therapies. Addressing this persistent and significant unmet clinical need is crucial for improving care for STEMI patients and for mitigating its long-term complications, including heart failure and mortality.
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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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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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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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Nt-probnp as a Prognostic Marker in Different Gold Classes in Patients with Chronic Obstructive Pulmonary Disease (COPD)
(2023-01-05)
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Background: Chronic obstructive pulmonary disease (COPD) was the fifth leading cause for early death and disability in 2020 with approximately 2.75 million deaths per year, which was 4.8%in total from the general mortality. Right ventricular hypertrophy with preserved systolic function is the most common finding in patients with COPD. The development of pulmonary hypertension leads to DV (right ventricle) dilatation and DV heart failure during the course of the disease. Material and methods: The design of the research was a prospective-clinical cross-sectional study as we analyzed 94 patients with COPD. All patients were divided in groups according to the degree of obstruction and classified by the GOLD classification system into four groups from GOLD 1 – GOLD4. All of our patients were analyzed thoroughly on admission and during hospital stay. ECG was made, Nt-proBNP analysis and basic and advanced echocardiography evaluation. Natriuretic peptides were measured and processed by commercially available assays with excellent precision where cut-off value was 125pg/ml. Echo analysis was done by Vivid 7 echo machine with a special feature to right heart chamber characteristics. Results: In terms of risk factors, hypertension, diabetes mellitus and hyperlipidemia were examined in all 94 patients in our study. Arterial hypertension was present in half of the patients, 51.06%. Diabetes mellitus was present in 19.15% of analyzed patients. The analysis of Nt-proBNP level in our study showed that the average value of this natriuretic peptide was above reference range and it was 236.27pg/ml. The highest average values of NT-proBNP were registered in GOLD class 3, while the lowest average and maximum value of NT-proBNP was found in GOLD class 2. According to the results of the Tukey post-hoc test, there was a statistically significant difference in Nt-proBNP levels between GOLD class 2 and GOLD class 3. The average values of Nt-proBNP in the group of patients with acute exacerbation was far higher than in the group of chronically stable patients. The difference between the two groups was 3.5 times in GOLD class 3 and approximately 2 times in GOLD class 4. Conclusion: BNP and NT-proBNP are natriuretic peptides that are secreted under conditions of cardiac stress and weakness. They are established biomarkers and are listed in the guidelines for chronic heart failure as they are quantitative markers used for diagnosis and risk stratification. Still, more studies with a larger number of patients are needed to confirm the role of Nt-proBNP in patients with COPD in different stages of GOLD and progression of the disease.
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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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REVIEW OF LUNG CANCER PATIENT CHARACTERISTICS AND TREATMENT STRATEGIES IN THE PANDEMIC COVID-19 YEAR Treated at the University Clinic of Radiotherapy and Oncology in Skopje
(Macedonian Academy of Sciences and Arts, 2023-01)
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Dragan Jakimovki
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Vladimir Ristovski
Introduction: It is estimated that delays in diagnosis due to the COVID-19 pandemic in North Macedonia could result in significant reductions in the number of potentially curative stages in lung cancer patients. Purpose: The aim of this study was to review patient characteristics and treatment strategies of lung cancer patients treated at the University Clinic of Radiotherapy and Oncology (UCRO), during the pre-pandemic year (from 1 of March 2019 to the end of February 2020) and the pandemic year (from 1 of March 2020 to the end of February 2021). Material: We analyzed eligible patients in the course of these two years according to patient characteristics and treatment strategies. Results: We have a record increasing in number of undefined lung cancer patients without any patho logical or histological conformation (11% pandemic year compared to 7% in the previous year), and an increased number of stage III and IV NSCLC patients in the pandemic year 449 (87%), in comparison to the pre-pandemic year of 403 (74%) patients. We have found a decreasing number of stage II NSCLC patients in the pandemic year 82 (13%) compared to 141 (26%) patients in the pre-pandemic year. We also note a decreasing number of patients with NSCLC operated on from 218 to 123 in the pandemic group. Due to frequent check-ups for COVID-19, we report an increasing number of early stage IA and stage IB patients, treated only by surgery. Conclusions: The strict screening and admittance criteria put in place by hospitals during the pandemic might have improved the oncology treatment course of lung cancer patients.

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