Faculty of Medicine

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THE IMPACT OF MATERNAL OBESITY ON PREGNANCY – A REVIEW ARTICLE
(Macedonian Association of Anatomists and Morphologists, 2025-11)
Maternal obesity has been estimated as a global epidemic, affecting 40% of pregnant women in developed nations. The weight of females that are pregnant has become one of the most concerning points in the modern obstetrics. For this matter after consulting the most accurate literature from academic books in the field and from internet sources from the year 2020 until the year 2025 available on PubMed, Scopus, Data of Science, Google Scholar, ResearchGate, Academia and others we have created a review article that takes in consideration the impact of maternal obesity on the pregnancy itself. Women may have been obese before becoming pregnant or they may have rapidly gained weight during pregnancy and the types of maternal obesity have their challenges for the pregnancy outcome. The maternal obesity must be carefully treated since it is directly responsible for the impact on gestational diabetes mellitus (GDM), hypertensive disorders, and various perinatal complications. By analyzing the types of maternal obesity and complications that occur during pregnancy we take care not only for the current health of the pregnant mothers and their babies but also of their future to take preventive measures, lifestyle changes and thus to improve their health and the health of their babies.
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Diabetes and arterial stiffness, our experiences
(Македонско лекарско друштво = Macedonian medical association, 2021)
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Cibrev, Dragan
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Angelovska, Makedonka
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Introduction. The incidence and prevalence of diabetes mellitus (DM) has increased worldwide but also in the Republic of Macedonia, Diabetes is a high-ranking a cause of death, primarily as a cause of cardiovascular death. In the United States, 42% of diabetic patients have diabetic nephropathy, with a 20-fold increased risk of cardiovascular mortality. Arterial rigidity is another independent risk factor for CV death, which is a degenerative process of remodeling the large arteries wall. There is increased arterial rigidity in both: diabetic patients and in patients with arterial hypertension, but studies that address these issues do not have consistency in the results, which was our motive for this study. Methods. This was a cross-sectional study that comprised 62 patients with diabetes mellitus type 2, aged over 38 years, followed at the University Clinic for Nephrology for diagnosis of, or already diagnosed hypertension. The control group consisted of 22 healthy subjects who had not been diagnosed with either DM type 2 or arterial hypertension. We examined pulse wave velocity, and analyzed hypertension with data obtained from 24-hour ambulatory blood pressure monitoring. The obtained data were statistically processed. Results. The results were displayed in tables. Conclusion. Arterial stiffness (measured by PWV) was higher in patients with DM compared to the control group of healthy subjects. In our study HgA1c had impact on PWV which can serve as a tool for assessing CV risk and arterial rigidity. Keywords: diabetes mellitus, arterial hypertension, arterial rigidity, pulse wave velocity
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Rare Case Of Deep Neck Infection
(2020-11-10)
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Milceska, E
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Sulejmani, S
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Arnautovska, B
Introduction: Deep neck infections are a serious but treatable group of infections affecting the deep cervical space and characterized by rapid progression and life-threatening complications. These infections remain an important health problem with significant morbidity and potential mortality. These infections most frequently arise from the local extension of infec - tions from tonsils, parotid glands, cervical lymph nodes, and odontogenic structures. They classically present with symptoms related to local pressure effects on the respiratory, nervous, or gastrointestinal tract (particularly neck mass/swelling/ induration, dysphagia, dysphonia, and trismus). The specific presenting symptoms will depend on the deep neck space involved (parapharyngeal, retropharyngeal, prevertebral, submental, masticator, etc) Objectives: To present a successful management of a 68 year old patient with severe deep neck infection, despite the unknown origin of the infection focus. Material and Methods: A 68 year old male patient visited ENT Clinic on day 1 without specific pain, only with slight neck edema in front of the laryngeal box. The edema was non painful and soft, without affection of lateral neck lymph nodes. Oropharyngoscopy - there were no pathologic findings. Fibernasolaryngoscopy - sufficient breathing canal, without specific pathological signs. The patient had diabetes mellitus, treated with oral antidiabetic drug for more than 5 years. The patient was set on double course –antibiotic per -os therapy (3rd gen. cephalosporin and macrolide), corticosteroids and painkiller. On day 3 the patient condition was getting worse so on his second visit to the ENT specialist his neck was swelled, red, warm and painful with severe edema spreading towards jugulum, and immediate hospitalization was required. The patient was set on double Antibiotic I.V therapy, I.V corticosteroids, and insulin injections. His biochemistry results showed severe raise of inflammatory parameters. Second day after the hospitalization his breathing was affected, led by fibernasolaryngoscopy evaluation that showed hyperemia of hypopharyngeal and laryngeal structures affecting the breathing space. Urgent tracheostomy and neck incision were performed under endotracheal anesthesia. During the neck incision massive purulent secretion was drained. The patient was left with an open wound for daily treat - ment and inspection. In the next days the patient’s neck incision was locally treated with antibiotic, and drained from pus. CT scan and microbiological swab and aspiration were performed during the next 5 days. The patient was switched to vancomycin after the microbiology results (Enterococcus). Results: After 15 days of constant care, twice daily local treatment of the wound, the inflammatory parameters started set - tling to normal values, and the local finding was improved. The larynx and hypopharynx inflammation was resolved. The patient was stable and subjective feeling was well. The main problem left was the intermediate skin defect due to prolonged treatment and skin necrosis. Conclusion: Deep neck infection can be capricious condition in which the time and reaction in treatment can be of life essence. Many other conditions and comorbidity can affect the course and the outcome of the treatment. Hospital treatment and constant follow up of the patient can give the healthcare professionals position to react accordingly.
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Are diabetes mellitus and lipoprotein(a) independently or causally associated with an increased cardiovascular risk?
(Kare (Turkey), 2017-03-17)
Serum Lp(a) and diabetes mellitus increase the risk of cardiovascular diseases (CVD). However, the relationship between serum Lp(a) and diabetes is poorly characterized, and it is a subject of debate as to whether they are independently or causally associated (1). One of the atherogenic mechanisms in hyperglycemia is based on enhanced inflammation. Diabetes is associated with increased vascular production of reactive oxygen species (ROS), which causes premature cell apoptosis via reduction of endothelial nitric oxide (NO), resulting in decreased smooth muscle relaxation and antiatherogenic properties, including decreased platelet aggregation and adhesion inhibition (1).
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Newly Diagnosed Diabetes and Stress Glycaemia and Its' Association with Acute Coronary Syndrome
(Scientific Foundation SPIROSKI, 2015-12-15)
Kamceva, Gordana
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Kitanoski, Darko
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Diabetes is diagnosed in 10-20% of patients with acute coronary syndrome (ACS) not known to be diabetics. Elevated blood glucose is an independent risk factor for cardiac events, regardless of presence of diabetes.
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DEPRESSION AND DIABETES
(Institute of Knowledge Management, 2020)
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Janicevic Ivanovska Danijela
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Mitic Zore
Introduction: Some researchers suggest that people with depression are more likely to develop diabetes. The AIM of this study is determinate the effects of SSRIs antidepressant in depressive patients with diabetes mellitus . Methods: The study was designed as observation cross-section including 80 depressive patients with diabetes, observed as two groups. The first group was presented patients without antidepressant medication in them (the patients who starting in the treatment), and the second group were patients with antidepressant therapy (sertraline). Depression status was assessed using BDI. Quantitative determination of glucose level in serum was performed with enzymatic reference method with hexokinase. Results : There was significant differences in distribution on according the level of blood glucose in observed groups. . In the first group 58% of patients have high level of blood glucose but in second group only 20% of them.. Data obtained in the first groups show significant positive correlation between score of BDI and blood glucose level. P=0,003. The results in examination groups show positive correlation between blood glucose level and socio-demographic and clinical parameters. Conclusion : The results obtained in our study showed high blood glucose levels in depressant patients but treatment with sertraline was diminished this level. So screening this condition is important, because that patients shoved be treated differently.
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Evaluation of the role of left atrial strain using two-dimensional speckle tracking echocardiography in patients with diabetes mellitus and heart failure with preserved left ventricular ejection fraction
(SAGE Publications, 2016-07-12)
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Planinka Zafirovska
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Zarko Hristovski
Abstract Objective: To evaluate additional role of left atrial two-dimensional speckle tracking echocardiography in patients with diabetes mellitus type 2, 218 patients with heart failure with preserved left ventricular ejection fraction divided according to the presence of diabetes mellitus (108 with and 110 without) were enrolled in the study. Methods: Traditional parameters using two-dimensional echocardiography and Doppler imaging were measured as expressions of left ventricular diastolic function as well as peak atrial longitudinal strain and peak atrial contraction strain were measured using two-dimensional speckle tracking echocardiography. Results: Global average peak atrial longitudinal strain and peak atrial contraction strain were significantly lower in patients with diabetes mellitus (p = 0.002 and p = 0.001, respectively) and its reduced values were significantly associated with higher prevalence of diabetes mellitus (p=0.002 and p=0.001, respectively), its greater severity (p=0.002 and p=0.016, respectively) and longer duration only for global average peak atrial longitudinal strain (p=0.030). Multiple linear regression analysis demonstrated that the presence of diabetes mellitus appeared as independent predictor of reduced global peak atrial longitudinal strain [B=−2.173; 95% confidence interval: −3.870 to (−0.477); p=0.012] as well of reduced global peak atrial contraction strain [B=−1.30; 95% confidence interval: −2.234 to (−0.366); p=0.007]. Conclusion: Two-dimensional speckle tracking echocardiography appeared as a useful additional tool for detection of left atrial dysfunction in patients with heart failure who have preserved left ventricular ejection fraction and diabetes mellitus who are especially prone to develop cardiovascular complications.

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