Faculty of Medicine
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Item type:Publication, РИЗИК ФАКТОРИ ЗА ПАТОЛОШКИ ПРОМЕНИ НА ЕНДОМЕТРИУМОТ И НИВНА АСОЦИЈАЦИЈА СО ЕНДОКРИНИТЕ НАРУШУВАЊА, МЕТАБОЛИЧЕН СИНДРОМ И ОСТЕОПОРОЗА(2022)Introduction: The International Federation of Gynecology and Obstetrics (FIGO) has defined a classification system for abnormal uterine bleeding, called PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disfunction, endometrial dysfunction, iatrogenic causes, unclassified reasons). Dysfunctional uterine bleeding is often during the menopausal transition as a result of hormonal changes during this period. In postmenopause there should be no uterine bleeding, the thickness of the endometrium should be less than 5 mm, and if it is above 5mm, the presence of polyp, hyperplasia or cancer is possible. Postmenopausal bleeding occurs in approximately 90% of patients with endometrial cancer, but only 9% of women with postmenopausal bleeding have endometrial cancer. Endometrial hyperplasia and endometrial polyps are associated with development of endometrial cancer and therefore these changes can be called premalignant. Atypical endometrial hyperplasia is a preneoplastic condition that precedes the most common malignant tumor of the uterus, endometrioid adenocarcinoma. Risk factors such as obesity, chronic anovulation, nulliparousness, late menopause, unopposed estrogen (without progesterone), hypertension and diabetes, all increase the risk of endometrial hyperplasia and endometrial cancer. Objectives: To determine the histopathological changes of the endometrium that occur during the period of perimenopause and postmenopause; to determine their association with the presence of diabetes, hypertension, metabolic syndrome, thyroid disorders, glycosylated hemoglobin levels, Vitamin D levels, and to determine the dynamics of bone markers in the peri and postmenopausal period. Material and methods: The study was a prospective observational cohort, involving a total of 160 respondents. The study group consisted of 120 patients who underwent fractionated explorative curettage due to a medical indication (abnormal bleeding or ultrasound-diagnosed endometrial abnormality). They were divided into two subgroups: perimenopausal and postmenopausal. The control group consisted of 40 healthy women without fractionated explorative curettage. Anamnestic data were taken from all respondents. Blood pressure, body weight, height, waist circumference, anteroposterior diameter of the uterus and endometrial thickness were measured. This laboratory analyses were performed: Glycemia, glycosylated hemoglobin (HbA1c), Hormonal Status - FSH, LH, Estradiol, Serum insulin, Thyroxine (fT4), Parathormon (PTH), lipid status, ionized calcium, serum iron, bone markers (Osteocalcin, β-Cross Laps), vitamin D (25-Hydroxyvitamin D). Results: The most common pathological change of the endometrium was an endometrial polyp, and it was present in 45% of the respondents. Endometrial hyperplasia without atypia was present in 23.3% of perimenopausal and 15% of postmenopausal women. Endometrial adenocarcinoma was present in 3% of perimenopausal and in 5% of postmenopausal women. Patients with endometrial pathology were older than healthy women and had significantly more frequently: greater endometrial thickness, higher blood pressure, body mass index, waist circumference, glycemia, triglycerides, serum insulin and metabolic syndrome. Vitamin D levels were lower in women with explorative curettage than in healthy women, and significantly lower in those with organic changes compared with those with functional pathological changes of the endometrium. Women with organic changes of the endometrium, compared with those with functional changes, had significantly higher: body mass index, waist circumference and endometrial thickness. Perimenopausal women, compared with those in postmenopause, had significantly longer duration and intensity of bleeding, larger anteroposterior diameter of the uterus and thickness of the endometrium. Postmenopausal women had higher body mass index, waist circumference, blood pressure, glucose, HbA1c, serum iron and bone markers (osteocalcin and β Cross Laps), than those in perimenopause. Postmenopausal duration in patients with explorative curettage was significantly positively correlated with serum values of bone markers osteocalcin and β Cross Laps. Conclusions: Fractionated explorative curettage is an effective method for timely and effective diagnosis of pathological changes of the endometrium in women with abnormal uterine bleeding or ultrasound-diagnosed abnormal endometrial findings. 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. According to our study, some of them are related to the occurrence of changes in the endometrium and the need for fractionated explorative curettage for timely diagnosis, especially of premalignant and malignant changes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, RISK FACTORS FOR URINARY INCONTINENCE IN WOMEN(Institute of Knowledge Management, 2020)Urinary incontinence is defined as involuntary loss of urine. The most common types of urinary incontinence are: stress, urgent and mixed urinary incontinence. The aim of the study was to detect potential risk factors for urinary incontinence in women. The study is a retrospective cohort study. Material is represented by 192 patients aged 20 to 80 years, divided into two groups: examined and control. The study was conducted in the approach from September 2019 to February 2020 at the Department of Urogynecology of the University Clinic for Gynecology and Obstetrics in Skopje. In all women we performed: urinary status with urinary sediment, urine culture, cystoscopy, ultrasound, urodynamic tests, Marshall's tests, questionnaire containing questions on the risk factors of urinary incontinence and the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). Stress incontinence was detected in 40.8% of women, urgent incontinence in 32.2% of women, and mixed urinary incontinence in 27.0% of women. Data analysis showed an association between urinary incontinence and patients over sixty years of age (chi-square test = 4.9377, p = 0.0262, p<0.05, with a relative risk of 2.29); patients with a body mass index above 35 (chi-square test = 5.2667, p = 0.0127, p<0.05, with a relative risk of 2.59; vaginal delivery (chi-square test = 5.7351, p = 0.0166, p<0.05, with a relative risk of 2.18); multiparity (chi-square test = 17.0288, p = 0.0001, p<0.05, with a relative risk of 4, 05); macrosomia (chi-square test = 5.5385, p = 0.0186, p<0.05 with a relative risk of 3.00); postmenopause (chi-square test = 4.7643, p = 0.0291 , p˂0.05, with a relative risk of 2.14); cigarette smoking (chi-square test = 8.1702, p = 0.0043, p˂0.05, with a relative risk of 2.45) and drinking alcohol (chi-square test = 4.1739, p = 0.0411, p<0.05, with a relative risk of 2.11). Our study found that age 60, obesity, vaginal delivery, multiparity, macrosomia, postmenopausal period, cigarette smoking and alcohol consumption are potential risk factors for urinary incontinence in women. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, LIFESTYLE HABITS AS RISK FACTORS FOR SQUAMOUS CELL ABNORMALITIES OF THE UTERINE CERVIX(Institute of Knowledge Management, 2021)Studies have shown a positive correlation between cervical cancer and some lifestyle habits, such as cigarette smoking, alcohol consumption, drug use, and dieting. These risk factors basically increase the likelihood of exposure to a high-risk HPV genotype. The aim of our study was to detect the most common lifestyle habits as risk factors for squamous intraepithelial lesions and squamous invasive cervical cancer. The study is a case-control study. Material is represented by 192 patients aged 20 to 59 years, divided into two groups: examined and control. The study was conducted in the period from March 2019 to September 2020 at the University Clinics for Gynecology and Obstetrics and Radiotherapy and Oncology in Skopje. All women underwent: a survey with a specific questionnaire, and as an indication, all women in the study group and colposcopic cervical biopsy with endocervical curettage for histopathological analysis. The relative risk of squamous intraepithelial lesions and squamous invasive cervical cancer was assessed by calculating the odds ratio (OR, Odds Ratio) with a 95% Confidence Interval (CI, Confidence Interval), using logistic regression. Data analysis showed an association between cigarette smoking (chi-square test = 8.1702, p = 0.0043, p<0.05, with a relative risk of 2.45), diet (chisquare test = 4.1739, p = 0.0411, p<0.05, with a relative risk of 2.11) and squamous cell abnormalities of the cervix. Our study found that smoking and dieting were potential risk factors for cervical squamous cell abnormalities. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, OBESITY AND AGE AS A RISK FACTORS FOR URINARY INCONTINENCE IN WOMEN(Institute of Knowledge Management, 2021-10) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, РИЗИК ФАКТОРИ НА СКВАМОЗНИТЕ КЛЕТОЧНИ АБНОРМАЛНОСТИ НА ГРЛОТО НА МАТКАТА(SHMSHM / AAMD, 2017); ; ; ; Duvlis, SotirijaВовед: Целта на нашата студија беше да ги детектираме најчестите ризик фактори на сквамозните интраепителни лезии и сквамозниот инвазивен карцином на грлото на матката. Материјал и методи: Case-control студија, работена на 192 сексуално активни жени, на возраст од 20 до 59 години, поделени во две групи: испитувана и контролна, на Универзитетските клиники за гинекологија и акушерство и радиотерапија и онкологија во Скопје и на Институтот за јавно здравје на Република Македонија, во периодот од Јануари 2016 година до Јуни 2017 година. Кај сите жени се направи: анкета со специфичен прашалник, ХПВ ДНК тестирање, Nugent-ов скор систем, а по индикација, кај сите жени од испитуваната група и колпоскопска цервикална биопсија со ендоцервикална киретажа за хистопатолошка анализа. Резултати: Анализата на податоците покажа асоцијација помеѓу ХПВ ДНК инфекцијата (хи квадрат тест=4.8204, p=0.028125, p<0.05), бактериската вагиноза (хи квадрат тест=4.1906, p=0.040649, p<0.05) и сквамозните клеточни абнормалности на грлото на матката. Нашата студија покажа дека пониското ниво на едукација за 2,29 пати (OR=2.29; 95%CI: 1.093-4.797) го зголемува ризикот за појава на сквамозни клеточни абнормалности на грлото на матката. Релативниот ризик за сквамозни клеточни абнормалности на грлото на матката, кај пациентките со понизок социјален статус беше 2,59 (OR=2.59; 95%CI: 1.137-5.503). Нашата студија покажа дека пушењето цигари за 2,45 пати го зголемува ризикот за појава на сквамозни клеточни абнормалности на грлото на матката (OR=2.45; 95%CI=1.3165-4.5762). Релативниот ризик за сквамозни клеточни абнормалности на грлото на матката, кај пациентките кои употребувале орални хормонски контрацептивни средства подолго од 5 години беше 3,00. Нашата студија покажа дека раниот прв сексуален однос пред 17 година од животот за 2,14 пати го зголемува ризикот за појава на сквамозните интраепителни лезии и сквамозниот инвазивен карцином на грлото на матката (OR=2.14; 95%CI: 1.0723-4.2821). Анализата на податоците од нашата студија покажа и асоцијација помеѓу сквамозните клеточни абнормалности на грлото на матката и диеталната исхрана (OR=2.11; 95%CI=1.0218-4.3832). Заклучок: Анализата на податоците на нашата студија покажа асоцијација помеѓу сквамозните клеточни абнормалности на грлото на матката и ХПВ ДНК инфекцијата, бактериската вагиноза, нередовните гинеколошки контроли, честиот вагинален исцедок, раниот прв сексуален однос, пушењето цигари, долготрајната употреба на хормонски орални контрацептивни средства и диеталната исхрана. Introduction: The purpose of our study was to detect the most common risk factors for squamous cell abnormalities of the uterine cervix. Material and methods: Case-control study, performed on 192 sexually active women aged 20 to 59, divided into two groups: examination and control, at the University Clinics of Gynecology and Obstetrics and Radiotherapy and Oncology in Skopje and the Institute for Public Health of the Republic of Macedonia, in the period from January 2016 to June 2017. All women were made: a questionnaire, HPV DNA testing, Nugent score system, and by indication, in all women in the study group and colposcopic cervical biopsy with endocervical curettage for histopathological analysis. Results: The analysis of the data showed an association between the presence of HPV DNA infection (chi-square test = 4.8204, p = 0.028125, p <0.05), bacterial vaginosis (chi-square test = 4.1906, p = 0.040649, p <0.05) and the occurrence of squamous intraepithelial lesions and squamous invasive carcinoma of the uterine cervix. Our study showed that the lower level of education for 2.29 times (OR = 2.29; 95% CI: 1.093-4.797) increased the risk of squamous cell abnormalities of the uterine cervix. The relative risk of squamous cell cervical abnormalities in patients with lower social status was 2.59 (OR = 2.59; 95% CI: 1.137-5.503). Our study showed that smoking cigarettes by 2.45 times increases the risk of squamous cell abnormalities of the uterine cervix (OR = 2.45; 95% CI: 1.3165-4.5762). The relative risk of squamous cell cervical abnormalities in patients who used oral hormone contraceptives for more than 5 years was 3.00. Our study showed that the first sexual intercourse before the age of 17 years of life for 2.14 times increases the risk of squamous intraepithelial lesions and squamous invasive cervical cancer (OR = 2.14; 95% CI: 1.0723-4.2821). The analysis of the data from our study also showed an association between squamous intraepithelial lesions and squamous invasive cervical cancer and dietary nutrition (OR = 2.11; 95% CI: 1.0218-4.3832). Conclusion: The analysis of the data of our study showed an association between squamous intraepithelial lesions and squamous invasive cervix cancer and HPV DNA infection, bacterial vaginosis, irregular gynecological controls, frequent vaginal discharge, early first sexual intercourse, cigarette smoking, long-term use of hormonal oral contraceptives and dietary nutrition.