Faculty of Medicine

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    METABOLIC VARIATIONS AMONG WOMEN WITH POLYCISTIC OVARY SYNDROME ACCORDING TO BODY MASS INDEX
    (Македонско лекарско друштво = Macedonian medical association, 2025-12)
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    Naumova, Rosa
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    Introduction. There is a two-way relationship between obesity and polycystic ovary syndrome (PCOS). Although most individuals with PCOS are overweight or obese, a notable number maintain a normal body mass index (BMI). The conventional diagnostic approach to PCOS, based on phenotypic characteristics, categorises patients according to ovulatory function and androgen levels. This study aimed to compare clinical, metabolic, and endocrine parameters in lean and obese women diagnosed with PCOS. Methods. This cross-sectional study enrolled a total of 89 women, aged between 18 and 40 years, diagnosed with PCOS based on the Rotterdam criteria. Participants were stratified into groups according to their BMI. Anthropometric measurements and venous blood samples were obtained for the evaluation of glucose metabolism, lipid profile, and selected endocrine parameters. Calculated indices included BMI, waist-to-height ratio (WHR), and the homeostasis model assessment of insulin resistance (HOMA-IR). Results. Among the 89 women with PCOS included in the study, 39.3% were classified as lean, while 60.7% were categorised as obese. Regardless of phenotypic variation, obese PCOS patients exhibited significantly elevated BMI and WHR, alongside increased levels of luteinizing hormone (LH), LH/FSH ratio, and free androgen index (FAI), higher insulin concentrations, insulin resistance, and dyslipidemia. Conversely, lean women with PCOS maintained normal insulin levels, lacked clinically relevant insulin resistance, and presented with normal lipid profiles. Conclusion. The results indicated significant differences in metabolic profiles between lean and obese patients with PCOS, regardless of phenotypic classification. Metabolic abnormalities were particularly pronounced in women with increased body weight, emphasising the need for focused care and implementation of preventive measures aimed at reducing the risk of long-term health complications. These findings highlight the importance of early metabolic screening in all PCOS patients, along with a personalised approach to management based on individual characteristics.
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    THE ROLE OF OBESITY AS NONOCCUPATIONAL RISK FACTOR IN PATIENTS WIT CARPAL TUNNEL SYNDROME
    (Macedonian Association of Physiologists and Anthropologists, 2020)
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    Antevski, Spaso
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    Zaevska, Zorica
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    THE IMPACT OF OBESITY AND FAT DISTRIBUTION ON ENDOMETRIAL CANCER RISK IN POSTMENOPAUSAL PATIENTS
    (Macedonian Association of Anatomists, 2023)
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    Endometrial cancer (EC) is the fourth most common cancer in women worldwide, with rising incidence partly due to changing reproductive trends and ever increasing obesity. Obesity, especially central adiposity, is linked with endometrial adenocarcinoma, possibly due to elevated estrogen and decreased sex hormone-binding globulin levels. The study aims to evaluate the impact of obesity on endometrial malignancy and to determine whether central adiposity (measured by the waist-to-hip circumference ratio) serves as a better indicator of endometrial cancer risk than BMI. In this cross-sectional study, we studied 164 postmenopausal patients from the University Clinic of Obstetrics and Gynaecology in Skopje. Patients were admitted to the hospital for histopathological examination of endometrial layer because of vaginal bleeding with endometrial thickness >4mm, or other sonographic endometrial abnormalities. Histopathological findings subdivided them into two categories: with malignancy (group I) or benign abnormality (group II). Standard examinations and measurements, including BMI and waist-to-hip ratio, were performed. A significant association was observed between endometrial malignancy and obesity as measured by waist-to-hip ratio. In the distribution of data related to BMI and histopathological findings from the endometrial biopsy for Pearson Chi-square=8.35 and p<0.01(p=0.004) there is a significant difference. For Odds Ratio=2.71 (95.%CI:1.36-5.38), patients who had a BMI ≥ 30 kg/m2 were 2.71 times more likely to have endometrial malignancy than patients who had a BMI <30 kg/m2, (p<0.01). There is a significant difference in the shown distribution of data related to waist circumference/hip circumference and histopathological findings of endometrial sampling Pearson Chi-square=79.22 and p<0.001(p=0.000). For Odds Ratio=40.89 (95.% CI:15.23-109.78), patients who had waist circumference/hip circumference ≥ 0.85 were 40.89 times more likely to have endometrial malignancy than patients who had waist circumference/hip circumference <0.85, (p<0.001). Upon analysing the contribution of central obesity determined by waist-to-hip ratio, it was found to have a more substantial impact (Wald = 37.76, p < 0.001) compared to BMI (Wald = 0.97, p= 0,32). Our study confirms that obesity is a risk factor for endometrial malignancy. Furthermore, fat distribution proves to be a more crucial and accurate indicator of endometrial cancer risk than overall obesity. The statistical significance of the waist circumference to hip circumference ratio exceeded that of BMI. Therefore, even if a patient has a normal BMI, but a waist-to-hip circumference ratio greater than 0,80, she should be considered at increased risk for endometrial malignancy and should be closely monitored in the future in order to detect any malignant changes.
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    BODY COMPOSITION RELATED TO BODY MASS INDEX AMONG YOUNG ELITE FOOTBALL PLAYERS
    (Medical faculty, Ss Cyril and Methodius University in Skopje, 2017)
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    Abstract Introduction. Body composition is extremely important for athletes’ performance, thus assessment tools may be used to clarify their sports condition. The aim of the study was to investigate body composition measurements and maximal oxygen consumption related to body mass index (BMI) in young elite football players. Material and methods. A total of 29 young football players were divided into 3 groups related to the value of BMI: I group (n=8); II group (n=13); and III group (n=8). The subjects were submitted to the sub-maximal pulse approach on treadmill method (SchillerAg, MTM-1500 Bear, Switzerland) to measure VO 2max (ml/kg/min). A body composition analyzer (InBody720, Biospace Co, Seoul, Korea) was used to determine the body fat - BF (%), skeletal muscle - SM (%) and total body water – TW(L) including intracellular body water – ICW(L) and extracellular body water – ECW(L). For the statistical analysis, a t-test was performed upon which the significance for p<0.05 was considered. Results. The football players showed the highest VO 2 max value in the II group (p<0.05). BF showed increased value in the III group (p<0.02). SM did not show any significant difference between the groups. Body water composition showed no statistical significance. Conclusion. Due to our results, we may conclude that certain parameters may determine the condition of young athletes in order to select appropriate training procedures, proper diet, and personalized performance. Key words: football; body mass index; body composition.
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    OBESITY PARAMETERS IN FEMALE MEDICAL STUDENTS
    (Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, 2021)
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    Abstract Introduction.The behavioral patterns, eating habits and participation in physical activities of university students have important influence on body composition of this young population group. The aim of this study was to determine the level of overweight and obesity in female medical students and level of physical activity. Material and methods. A descriptive cross-sectional study was conducted at Faculty of Medicine, Ss. Cyril and Methodius University in Skopje between December 2019 and April 2020. A total of 308 girls, students of the 1st and 2nd year of study, underwent body composition testing with InBody 720 bioimpedance analyzer. International physical activity questionnaire (IPAQ) was used for determining the level of physical activity. Results. The average age of participants was 19.4  1.1 years, and the mean values for obesity parameters were as followed: BMI = 22.5  4.3 kg/m2 ; BF% = 28.3  8.5; WHR= 0.87  0.07. One third of students had normal body fat percentage (34.5%) and waist-to-hip ratio (33.3%). Two thirds of students showed normal BMI, and 14.6% of girls were overweight while 6% were obese according to BMI. The greatest percentage of students, 60% of girls, showed BF% and WHR higher than normal values. Conclusion. Analysis of obesity parameters derived from bioimpedance analyzer – (BIA) showed that BMI parameter was less sensitive to level of obesity than BF% and WHR. The findings revealed that more than half of the young female medical students were overweight and/or obese. Key words: obesity, body mass index, body fat, waist to hip ratio, students
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    Leptin, obesity parameters and atopy among children with asthma
    (Macedonian Academy of Sciences and Arts / De Gruyter, 2021-10-26)
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    Leptin, as a major adipokine, positively correlates with the body’s fat, while atopy is an important feature in the development of childhood asthma. We aimed to evaluate the relationship between leptin, parameters of obesity, and atopy in children with asthma. The study included 112 children (73 boys, 39 girls, mean age 11.1±2.4). 41 were overweight, 38 had asthma and a normal body mass index (BMI), and 33 were overweight asthmatics. Serum leptin levels, BMI, waist circumference (WC), and waist to hips ratio (WHR) were measured. Skin prick test (SPT)/CAP, total serum IgE, fractional exhaled nitric oxide (FeNO), and pulmonary function tests were performed. In asthmatic children, serum leptin median level was 9.2±16.2 ng/ml, in overweight children was 30.6±21.6 ng/ml, and in overweight asthmatics was 31.1±20.3 ng/ml with a significant difference between the groups (p=0.0374), yet with a significantly lower median level in the group of children with asthma compared to the overweight children: with asthma (p=0.00001) and without asthma (p=0.00001). In the three groups of patients, BMI and WC displayed a significant positive correlation with leptin (for BMI r=0.652 vs. r=0.530 vs. r=0.563, respectively and for WC r=0.508 vs. r=0.426 vs. r=0.527, respectively). No significant correlations of leptin within atopy parameters (Eo, IgE, SPT/CAP, FeNO) in all three analyzed groups (p>0.05) was detected.Conclusion: Atopy was not confirmed as an underlying mechanism of the association between asthma and being overweight. Leptin had a significant linear correlation as a parameter of central obesity with BMI and WC in all three groups, but not with WHR.
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    QUALITY OF LIFE, FORCED EXPIRATORY VOLUME IN ONE SECOND AND BODY MASS INDEX IN PATIENTS WITH COPD, DURING THERAPY FOR CONTROLLING THE DISEASE
    (Macedonian Academy of Sciences and Arts, 2009)
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    Stevcevska G.
    Abstract: Patients with chronic obstructive pulmonary disease (COPD) are characterized by an impaired lung function and limited exercise tolerance. Medication and rehabilitation programmes are generally directed towards relief of symptoms and improvement of lung function and exercise tolerance. 130 patients were included in the examination with diagnosed chronic obstructtive pulmonary disease, stable form, 114 male and 16 female, of whom 121 were smokers and 9 were non-smokers. Inclusive criteria were FEV1 < 50% from predicted (with moderate and severe level of the disease), the relation FEV1/FVC < 70%, the test of reversibility with β2-agonist < 15%. The patients were followed up for 18 months. They were evaluated at the start, and then at the end of the study. During the examination 9 patients were excluded because they did not obey recommendations of the examination, and three patients died during the examination. At the end of our study 77 patients in group I, 66 male and 11 female, were evaluated, and 41 patients, 35 male and 6 female, in group II. The patients were divided on the basis of BMI (body mass index), group I with BMI from 21 to 28 kg/m2 and group II with BMI < 21 kg/m2 . The mean age of the patients was 63 ± 7.2 years in group I, and 68 ± 8.3 in group II. The values of FEV1 at the start were 1.33 ± 0.35L (43 ± 8.1%) in group I, and 0.89 ± 0.27 L (28 ± 7.9%) in group II. Both were significantly lower in group II (p < 0.001). At the end of the study the values of FEV1 were lower in both groups than at the start (Fig. 1). At the start of the study SGRQ scores in group I were significantly lower (p < 0.001) than in group II. This indicated a better quality of life in patients with BMI from 21 to 28 kg/m2 . The SGRQ scores at the end of the study were also significantly lower in group I (p < 0.001). And they were lower than at the start in both groups, indicating a better quality of life in patients with COPD after18 months’ regular use of therapy (Fig. 2). The values of Pearson’s coefficient r = -0.49 (p < 0.05) in group I and r = -0.35 (0.05) in group II, shows that between these two variables there is an indirect, or negative correlation; lower values of FEV1 are associated with higher SGRQ total scores. It can be concluded that regular use of therapy for controlling the disease leads to improved quality of life in COPD patients, which is not associated with improvement in lung function. Patients with malnutrition (BMI < 21kg/m2 ) have lower values of FEV1, and they have higher SGRQ scores of quality of life. High levels of SGRQ scores are associated with lower values of FEV1. Key words: COPD, therapy, quality of life, forced expiratory volume in one second, body mass index.
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    Insulin resistance in patients with chronic hepatitis C
    (Македонско лекарско друштво = Macedonian Medical Association, 2016)
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    Introduction: Insulin resistance is the most common extrahepatic manifestation associated with hepatitis C virus, which leads to developing more pronounced fibrosis and liver steatosis. The aim of the study was to assess the prevalence of insulin resistance in non-diabetic, treatment naive patients with chronic hepatitis C and to analyze the relation of insulin resistance with genotype, viral load, gender, age, laboratory parameters, inflammatory and fibrotic changes in the liver, body mass index (BMI) and the presence of steatosis. Material and methods: In this cross sectional study, 224 patients with hepatitis C viral infection were included. The patients were divided into two groups. The first group was with no insulin resistance and the second one with present insulin resistance. They were compared in terms of genotype, viral load, gender, age, inflammatory and fibrotic changes in the liver, BMI and liver steatosis. Results: Insulin resistance was present in 45.5% of patients. The following factors were associated with insulin resistance: age (p = 0.0022), inflammatory and fibrotic changes in the liver (p = 0.001, p = 0.006, respectively), steatosis (p = 0.015) and transaminase activities (for AST, p = 0,002, for ALT, p = 0.001). Conclusion: In the Republic of Macedonia, high percentage of 45.5% among non-diabetic and treatment naïve patients with chronic viral hepatitis C, had insulin resistance. Insulin resistance was more prevalent in older patients, in those with more pronounced inflammatory and fibrotic changes in the liver, in patients with steatosis and in those with higher transaminase activity.
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    The association between BMI, vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema in children and adolescents: ISAAC Phase Three
    (Wiley, 2013-01)
    Mitchell, E A
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    Beasley, R
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    Björkstén, B
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    Crane, J
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    García-Marcos, L
    Background: Several studies have observed an association between obesity and asthma, but whether or not there is an association with rhinoconjunctivitis or eczema is unclear. Aims To examine the relationship between body mass index categories (underweight, overweight and obesity), vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema. Methods: As part of International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, parents or guardians of children aged 6–7 years completed written questionnaires about symptoms of asthma, rhinoconjunctivitis and eczema, and several potential risk factors, such as vigorous physical activity and television viewing, and other information such as the child’s height and weight. Adolescents aged 13–14 years self-completed the questionnaires on these symptoms and potential risk factors and reported their own height and weight. For 28% of children and 24% of adolescents, the height and weight was objectively measured. Results: A total of 76 164 children aged 6–7 years (from 29 centres and 17 countries) and 201 370 adolescents aged 13–14 years (from 73 centres and 35 countries) provided data meeting the inclusion criteria. There were associations between overweight and obesity, but not underweight, and symptoms of asthma and eczema but not rhinoconjunctivitis. Vigorous physical activity was positively associated with symptoms of asthma, rhinoconjunctivitis and eczema in adolescents, but not children. Viewing television for five or more hours/day was associated with an increased risk of symptoms of asthma, rhinoconjunctivitis and eczema in adolescents and symptoms of asthma in children. Conclusions and Clinical Relevance: This study has confirmed the association between overweight and obesity and symptoms of asthma. It has extended these observations to include significant associations with symptoms of eczema, but not rhinoconjunctivitis. There are complex relationships between obesity, vigorous physical activity and sedentary behaviour and the symptoms of asthma, rhinoconjunctivitis and eczema in children.
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    Maternal post-natal tobacco use and current parental tobacco use is associated with higher body mass index in children and adolescents: an international cross-sectional study
    (Springer Science and Business Media LLC, 2015-12-24)
    Braithwaite, Irene
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    Stewart, Alistair W
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    Hancox, Robert J
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    Beasley, Richard
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    Murphy, Rinki
    Background: We investigated whether maternal smoking in the first year of life or any current parental smoking is associated with childhood or adolescent body mass index (BMI). Methods: Secondary analysis of data from a multi-centre, multi-country, cross-sectional study (ISAAC Phase Three). Parents/guardians of children aged 6–7 years completed questionnaires about their children’s current height and weight, whether their mother smoked in the first year of the child’s life and current smoking habits of both parents. Adolescents aged 13–14 years completed questionnaires about their height, weight and current parental smoking habits. A general linear mixed model was used to determine the association between BMI and parental smoking. Results: 77,192 children (18 countries) and 194 727 adolescents (35 countries) were included. The BMI of children exposed to maternal smoking during their first year of life was 0.11 kg/m2 greater than those who were not (P = 0.0033). The BMI of children of currently smoking parents was greater than those with non-smoking parents (maternal smoking: +0.08 kg/m2 (P = 0.0131), paternal smoking: +0.10 kg/m2 (P < 0.0001)). The BMI of female adolescents exposed to maternal or paternal smoking was 0.23 kg/m2 and 0.09 kg/m2 greater respectively than those who were not exposed (P < 0.0001). The BMI of male adolescents was greater with maternal smoking exposure, but not paternal smoking (0.19 kg/m2, P < 0.0001 and 0.03 kg/m2, P = 0.14 respectively). Conclusion: Parental smoking is associated with higher BMI values in children and adolescents. Whether this is due to a direct effect of parental smoking or to confounding cannot be established from this observational study.