Faculty of Medicine

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Echocardiographic Heart Changes in Pregnancies Complicated with Gestation Hypertension and Preeclampsia
(International Scientific Invention Journals, 2019-02-13)
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Milkovski, Daniel
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Introduction: Echocardiography as an imaging method is increasingly being used in obstetrics in the management of hemodynamic changes which occur in normal but also in pregnancies with gestational hypertension/preeclampsia. Aim: The aim of the study is to show that some of the heart changes in pregnancies complicated with gestational hypertension and preeclampsia are abnormal and further follow up of these patients is needed. Methods: A total of 81 patients were enrolled in the study. The patients were further divided in two groups. Pregnant women with gestational hypertension or preeclampsia (51) and a control group of normotensive pregnancies (30). A total of 3 echocardiograph exam were made, the first upon entry in the study (28 -34 g.w), the second 2 weeks after delivery and the last 6 months after delivery. Results and discussion: We found several statistically significant results that involve the IVS, PWLV, LKM, left chamber hypertrophy and diastolic function. Diastolic dysfunction usually shows up before systolic dysfunction in the evolution of ischemic/hypertensive cardiovascular disease and is of prognostic value in predicting long term cardiovascular morbidity. The changes seen 6 months after delivery on our last control mean that those changes are permanent and need further prevention strategies. Conclusion: From the noninvasive methods echocardiography is the most favorable method in identifying structural changes and functional changes in pregnancies with hypertension. Echocardiography allows fast, reproducible information and is both safe for mother and fetus.
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African L0a mtDNA haplogroup in Republic of Macedonia
(Elsevier B.V., 2017-12)
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Mitochondrial DNA analysis from individuals from Republic of Macedonia as one of the south-eastern European countries showed that the phylogenetic characteristics of Macedonian population are similar as in other Europen countries, sharing west Eurasian haplogroups, predominantly European haplogroup H. Macedonian population is multiethnic and some of this ethnic groups have specific mtDNA haplogroup traced to their origin. In this article we present first finding of an African haplogroup L0a in orthodox Macedonian. From the published data it is evident that most likely L lineages arrived in Europe in rather recent historical times, what for today’s Republic of Macedonia from historical point of view could be in the last 2500 years.
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Some Aspects of Women’s Health in Republic of Macedonia
(Scientific Foundation SPIROSKI, 2022-10-12)
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INTRODUCTION: Sex and gender “matters” in terms of the health status as well as a result of both biological and gender-related differences. Thus, sex must be considered in all aspects and all levels of biomedical research.AIM: This study aims to analyze sex- and gender-based differences in Republic of Macedonia through analysis of some aspects of mortality, the knowledge, and attitudes related to women’s health.METHODS: Analysis of the general and age-standardized mortality patterns and computer-assisted personal interview composed on different topics including women’s health for the period of 2017–2020 were used.RESULTS: Age-standardized mortality rates (all-causes of death, circulatory and respiratory diseases, and neoplasms) are prevalent and higher in the male population in Republic of Macedonia. A significantly higher all-cause mortality trend for both sexes was found in 2020 making this year hardly comparable with the previous years. A decreasing trend of malignant neoplasms rate of female genital organs and an increasing trend of breast cancer mortality is observed. The majority of the respondents (50.6%) rated their current health status as excellent with a statistically significant difference between the age and ethnical groups. One-third of the respondents reported regular physical activity, mostly on a daily basis. The majority (39.3%) are overweight and 27.5% belongs to the obesity Class I without a significant difference in terms of ethnicity. Respondents (27%) reported that have high blood pressure, 20.2% vaginal infections, 19.9% allergies, heart issues 15.1%, anemia 11.7%, while diabetes and cancer 8.5% and 2.5%, respectively. The youngest and oldest age groups of Albanian women are the least informed about the early detection procedures of malignant compared to Macedonian women and other ethnic groups.CONCLUSIONS: Analyzing some aspects of women’s health in Republic of Macedonia through the mortality and knowledge and attitudes of Macedonian women, we provide some further evidence for the development and implementation of targeted interventions and policies aimed to reduce the sex- and gender-based health inequalities in the country.
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Neonatal Mortality Trend at the University Clinic of Gynecology and Obstetrics- SKOPJE in the period of 2011-2017
(International Organization of Scientific Research (IOSR), 2020-05)
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Jasna Bushinoska
Abstract: INTRODUCTION: Neonatal mortality is the percent of neonatal (infant) mortality of the live- born neonates per thousand live births, in the neonatal period from 0-28 days after delivery, or those born after 22 gestation weeks of pregnancy with birth weight more than 500 g. The neonatal mortality can be divided into early neonatal mortality, which covers the period of 0-7 days after delivery (168h), regardless of the stage of pregnancy, and late neonatal mortality that includes the mortality of live-born infants in 8 until before 28 days after delivery. RESEARCH PURPOSE: The purpose of this paper is to show the percentage of neonatal mortality among live- born neonates at the UCGO-Skopje from 0-28 days after delivery, and the trends of movement of the mortality in the period 2011-2017 year. MATERIAL AND METHODS: This retrospective analysis elaborates on neonatal mortality or mortality in live- born neonates in the period 0-28 days after delivery at the UCGO-Skopje, in the period of 7 years (from 2011 to 2017), in relation to the total number of births in that period. The data is collected from the Info Centre and the histories of the disease of women that gave birth and the newborns at UCGO-Skopje during this period. RESULTS: During this period of 7 years at UCGO-Skopje, there were 36,733 live- born newborns, out of which 912 newborns died in the neonatal period after delivery, from 0-28 days after delivery. The results show that the number of early neonatal deceased newborns, 0-7 days after birth, is higher and is especially significant in the first 24 hours after delivery. The number of late neonatal deaths from 8 until before 28 days after delivery is also high. The total neonatal mortality of UCGO- Skopje in this 7 year period is 24.82 ‰, or 24.8 neonatal deaths in the neonatal period after delivery (0-28 days) per thousand live births. The highest neonatal mortality rate of 33.81‰ was recorded in 2017, while the lowest rate was 17.19 ‰ , recorded in 2015. CONCLUSION: The neonatal mortality rate in Macedonia is quite high, higher than in the countries in our surroundings, the Balkan countries and the mid- developed countries of the world.
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Particulate matter measurements in Macedonia for health impact assessment
(Book of abstracts of the 22nd European Aerosol Conference, France Tours 2016, 2016)
Rumrich, Isabell Katharina
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Lappi, Sari
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Stefanovska, Aneta
Solid fuel combustion is a common heating source in Macedonia. Small scale combustion in combination with lacking legislation for other emissions lead to high air pollution levels in the Skopje valley. It is suspected that current air quality has significant impact on the population health. To investigate this topic further, risk assessment investigations have been introduced within the EU-funded Twinning project “Further strengthening the capacities for effective implementation of the acquis in the field of air pollution” (MoE 2016). Measured monthly mean concentration of particulate matter (PM) will be used in a pilot study on health impact assessment. The aim of the present work was to assess the correlations between the measured monthly particulate matter mass concentrations (PM2.5 and PM10) from different air quality monitoring stations, in order to evaluate their usability in the health impact assessment study. Method Monthly PM data were available from the national air quality monitoring network for the period of January 2012 to February 2016. PM2.5 was measured at two stations only (both within the city of Skopje) and PM10 at nine stations (4 Skopje city, 1 Skopje region, 4 outside Skopje region). Missing monthly values were imputed using the average PM2.5 or PM10 concentration calculated from measurements in the corresponding month of the other years at the same monitoring station. In addition, the average monthly ratios PM2.5:PM10 were calculated for the two stations in Skopje having parallel measurements of these two PM parameters with continuously acting instruments. Results The PM2.5:PM10 ratios at the two stations within Skopje city ranged between 0,61 in spring and 0,67 in autumn. Overall, the correlations in PM data between the different monitoring stations were high. The correlation in PM2.5 between the two stations in Skopje was excellent (R2>90%): The same applied to the PM10 stations within the city of Skopje, where only one monitoring station showed correlation lower than 90% with the others (Gazi Baba; R2>80%). all the Skopje region monitoring stations as well as the monitoring stations outside Skopje region showed generally intercorrelations higher than 70%. Only PM10 data from the station of Kavadarci, correlated poorly with the other stations. The rural background station of Lazaropole, located on a mountain, showed an inverse correlation with all the other monitoring stations. Conclusions. The limited size of the newly started national air quality monitoring programme in Macedonia poses challenges for air pollution exposure assessment. High PM2.5 and PM10 intercorrelations, however, suggest that the PM10 data can be used to improve spatial coverage of PM exposures. Most likely due to same sources, PM pollution levels have similar monthly profiles to those in Skopje city also at the three urban monitoring sites outside Skopje.
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Assessing environmental and health risks from chemicals in Republic of Macedonia
(Istituto Superiore di Sanità, Italy, 2016)
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The paper presents the current status of the contaminated sites in Republic Macedonia including policy aspects. Special emphasize has been put on the most dangerous site of the ex chemical plant near the capital city of Skopje. The Republic of Macedonia faces similar problems in the environmental sector to those of many other former command economies in Central and Eastern Europe. In particular, inadequate solid waste management and numerous industrial hotspots (including historical industrial pollution sites) have in some cases led to threatened public health with environmental implications. The lack of suitable infrastructure hampers adequate waste disposal in general and disposal of hazardous waste in particular. There is only one licensed (though not acquiscompliant) landfill in the country compared to around a thousand illegal dumps; there are no incineration (except for medical waste), no composting and few recycling facilities. Hazardous waste is exported in accordance with the Basel Convention. A register and maps for pollutants and polluting substances for solid and hazardous waste and waste waters were completed in September 2005. Decades of industrialization and extensive exploitation of natural resources have left certain number of areas heavily polluted in the country. Since independence no significant concrete investments in this regard have taken place for the protection of the environment. As a result many uncontrolled municipal, as well as industrial landfills and wild dumps proliferated. With regard to economic activities contributing to soil contamination expressed in percentage, the highest share belongs to mining and metallurgy with 31.25%, followed by organic chemical industry with 12.5% and oil refining and leather manufacturing industry with 6.25% (2). There are many barriers in the management of the hot spots such are: no official National Strategy for remediation of contaminated sites; no specific law on soil protection; lack of technical guidelines for investigation of contamination, human health and/or environmental risk assessment and prioritizing the need of actions and management of contaminated sites; insufficient institutional capacity for contaminated site management; no permanent intergovernmental or inter-institutional coordination bodies established for the coordination of contaminated sites management, with the consequence of improper inspection on site
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Assessing Health Impact of Air Pollution in Macedonian Cities
(Biomedical Research Network, LLC, 2018-10-15)
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The Effects of COVID-19 Lockdown on Air Quality in Macedonia
(Scientific Foundation SPIROSKI, 2020-10)
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BACKGROUND: Faced with the novel coronavirus outbreak (2019-nCoV), various urgent and coordinated actions have been taken worldwide to reduce spread of the disease. Slowing down economic activities, transportation, restrictions of the human public gatherings, and interaction resulted with a tremendous decline in air pollutant concentration especially in nitrogen dioxide, registered by National Aeronautics and Space Administration and European Space Agency satellites. AIM: The aim of the study was to assess the impact of COVID-19 lockdown conditions on the air quality in selected cities in Macedonia. METHODS: Daily mean concentration of the particulate matter (PM10 and PM2.5), nitrogen dioxide, ozone, and carbon monoxide measured in the national air quality monitoring network, was analyzed separately comparing following periods: past week of February 2020 to the end of May 2020 with the same period in 2017–2019. Depending on the data distribution, parametric independent-samples t-test or nonparametric Mann–Whitney U-test was run to determine if there were differences in the pollutants concentration during the COVID-19 and non-COVID-19 period. RESULTS: Implementation of strict restrictions of the movement along with reduced economic activities and vehicular transport, led to notable decrement of air pollutant concentrations. We have found an evident decrease in the concentration levels of all pollutants measured during COVID-19 period in 2020, compared to those from 2017 to 2019 with exceptions for PM2.5 in Kumanovo and carbon monoxide in Skopje (7% and 3% higher concentration). The most notable decrement was for NO2, with a concentration 5–31% lower during COVID-19 period. CONCLUSIONS: Although beneficial to human health, there is a need to assess economic implications of the lockdown that could have a negative impact on the health as well.
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Strategy for Developing a Smoking Cessation Program in Macedonia
(E-Cronicon, 2020)
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Arben Rexhepi
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Macedonia has one of the highest smoking rates in Europe and ranks among the top ten globally. Although there is a moderately strict anti-smoking legislation, tobacco free policies are not financially supported and smoking cessation activities are not included in the regular educational process of health workers in the country. Smoking cessation is not considered a medical intervention, there is no consistent access to nicotine replacement therapy or other cessation medications, nor are they covered by health insurance. The goal of the partners from Henry Ford Health System and the University St Cyril and Method in Skopje was to develop and adapt a Certified Tobacco Treatment Specialists program (aCTTS). A team of physician champions was created to facilitate implementing the program and to educate respiratory and internal medicine specialists, as well as general practitioners who proceeded treating patients for tobacco dependence. During the first four months of the intervention 64,668 patients visits were registered, 25,710 (40%) of them for tobacco-related diseases. Of the latter, 18,558 (72%) included smoking cessation counseling, which by itself is a great progress to reaching a striving population of smokers.
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EP1073 The prevalence of squamous intraepithelial lesions according to ethnic affiliation in Macedonia
(BMJ Publishing Group Ltd, 2019-11)
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Dimitrov, Gligor
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Introduction/Background To determine the prevalence of abnormal Pap smears in different ethnic population in women from Macedonia. In our country, Pap smear test is included in the prevention program against cervical cancer to be performed every year in women aged 18 to 65. Methodology We analyzed 1145 female patients, 129 with abnormal Pap smear and 1016 controls. The study was performed in 2015 in women aged 18–65, at the University Clinic for Gynecology and Obstetrics, Private General Hospital Re-Medika, Clinical Hospital ‘Dr. Trifun Panovski’ and in the Primary Health Institution ‘Dr. Emilija Trajkovska’. Results From 1145 analyzed female patients and 129 (11.3%) abnormal Pap smears, we found 9 patients (6.97%) with cell changes from viral infection, 50 (38, 76%) HPV positive patients on cytology test, CIN 1 in 34 patients (26.35%), CIN 2 in 9 patients (6.97%), ASC in 19 patients (14.72%), ASC-H in 6 patients (4.65%), and CIS in 2 patients (1.55%). Furthermore, from all Pap test positive patients, 15 patients had previous cervical conisation and following re-infection. The distribution of ethnicity among abnormal Pap smear women was as following: 107 (82.94%) were Macedonians, 12 Serbians (9.30%) with all types of cervical intraepithelial lesions, 5 Roma ethnicity (3.87%), 3 (2.32%) Albanians, 1(0.77%) Bosnian and 1(0.77%) Turkish ethnicity all with CIN1 lesion. Conclusion Our study showed that the Macedonian population as the predominant population in Republic of Macedonia, was the most prevalent ethnicity with cervical intraepithelial lesions.

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