Faculty of Medicine

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Epidemiology and impact of frailty in patients with atrial fibrillation in Europe
(Oxford University Press (OUP), 2022-08)
Proietti, Marco
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Romiti, Giulio Francesco
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Vitolo, Marco
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Harrison, Stephanie L
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Lane, Deirdre A
Background: Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Methods A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Epidemiology of Thyroid Carcinomas in North Macedonia (1999-2015)
(SAGE Publications, 2021)
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Epidemiology of Community-Acquired Sepsis in Adult Patients: A Six Year Observational Study
(Macedonian Academy of Sciences and Arts/Sciendo, 2018-07-01)
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Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection and it is a major cause of morbidity and mortality worldwide. The aim of this study is to describe epidemiology of community-acquired sepsis in the Intensive care unit (ICU) of the Macedonian tertiary care University Clinic for Infectious Diseases. A prospective observational study was conducted over a 6-year period from January, 2011 to December, 2016. All consecutive adults with community-acquired sepsis or septic shock were included in the study. Variables measured were incidence of sepsis, age, gender, comorbidities, season, source of infection, complications, interventions, severity indexes, length of stay, laboratory findings, blood cultures, 28-day and in hospital mortality. Of 1348 admissions, 277 (20.5%) had sepsis and septic shock. The most common chronic condition was heart failure (26.4%), and the most frequent site of infection was the respiratory tract (57.4%). Median Simplified Acute Physiology Score (SAPS II) was 50.0, and median Sequential Organ Failure Assessment (SOFA) score was 8.0. Blood cultures were positive in 22% of the cases. Gram-positive bacteria were isolated in 13% and Gram-negatives in 9.7% of patients with sepsis. The overall 28-day and in hospital mortality was 50.5% and 56.3% respectively. The presence of chronic heart failure, occurrence of ARDS, septic shock and the winter period may influence an unfavorable outcome. Mortality compared to previous years is unchanged but patients that we have been treating these last 6 years have had more severe illnesses. Better adherence to the Surviving Sepsis guidelines will reduce mortality in this group of severely ill patients.
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Antibiotics use in relation to asthma in children
(Wiley Blackwell, 2018-05)
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Kimovska, M
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Seckova, L
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Background: Early-life antibiotic exposures have been reported to increase the risk of allergic diseases. The aim of the study was to examine the impact of current antibiotics use on asthma in schoolchildren in The Republic of Macedonia, as developing country with a high rate of antibiotics use and low prevalence of asthma. Method: Data from 2310 schoolchildren aged 5-15 years obtained through a parental-completed questionnaire in randomly selected primary schools in Skopje, the capital of Macedonia, in 2015/2016 was used. The frequency of antibiotics intake ≥3 and <3 times yearly vs never antibiotics intake for respiratory infections, in the last 12 months was correlated to current asthma-like symptoms and ever-diagnosed asthma after adjustment for confounding factors using multiple logistic regression. Results: 50.9% of the children used antibiotics currently and 21.0% out of them used antibiotics ≥3 times yearly. Current wheeze (W) was established in 6.5%, sleep-disturbing W in 3.6%, exercised-induced W in 1.7%, dry night cough apart from a cold in 12.2% and asthma in 2.3%. Current antibiotics use ≥3 times yearly was positively associated with current W (aOR: 13.37; 6.14-29.11; p < 0.001), sleep-disturbing W (aOR: 7.87; 3.34-18.57; p < 0.002), dry night cough (aOR: 3.80; 2.29-6.29; p <0.001), and diagnosed asthma (aOR: 5.68; 1.96-16.50; p = 0.001) while antibiotics use <3 times yearly was positively associated only with current W (p = 0.003) and dry night cough (p = 0.011). Conclusion: The results suggest an aggravating role of antibiotics use on asthma in school age thus further supporting the recommended restriction of antibiotics exposure.
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Standardized Map of Iodine Status in Europe
(Mary Ann Liebert Inc, 2020-05-28)
Ittermann, Till
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Albrecht, Diana
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Arohonka, Petra
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Bílek, Radovan
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Dahl, Lisbeth
Background Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine related population studies can be improved by standardization, which was one of the goals of the EUthyroid project. The aim of this study was to establish the first standardized map of iodine status in Europe by using standardized UIC data. Methods We established a gold-standard laboratory in Helsinki measuring UIC by inductively-coupled plasma-mass spectrometry. A total of 40 studies from 23 European countries provided 75 urine samples covering the whole range of concentrations. Conversion formulas for UIC derived from the gold-standard values were established by linear regression models and were used to post-harmonize the studies by standardizing the UIC data of the individual studies. Results In comparison to the EUthyroid gold-standard, mean UIC measurements were higher in 11 laboratories and lower in 10 laboratories. The mean differences ranged from -36.6% to 49.5%. Of the 40 post-harmonized studies providing data for the standardization, 16 were conducted in schoolchildren, 13 in adults and 11 in pregnant women. Median standardized UIC was < 100 µg/L in 1 out of 16 (6.3%) studies in schoolchildren, while in adults 7 out of 13 (53.8%) studies had a median standardized UIC < 100 µg/L. Seven out of 11 (63.6%) studies in pregnant women revealed a median UIC < 150 µg/L. Conclusions We demonstrated that iodine deficiency is still present in Europe, using standardized data from a large number of studies. Adults and pregnant women, particularly, are at risk for iodine deficiency, which calls for action. For instance, a more uniform European legislation on iodine fortification is warranted to ensure that non-iodized salt is replaced by iodized salt more often. In addition, further efforts should be put on harmonizing iodine related studies and iodine measurements to improve the validity and comparability of results.
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An international comparison of risk factors between two regions with distinct differences in asthma prevalence
(Elsevier BV, 2018)
Madani, K
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Rennie, D C
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Sears, M
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Lawson, J A
Investigation of the geographic variation in asthma prevalence can improve our understanding of asthma etiology and management. The purpose of our investigation was to compare the prevalence of asthma and wheeze among adolescents living in two distinct international regions and to investigate reasons for observed differences.

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