Faculty of Medicine

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    Bilateral near-total calcification of vas deferens in young male
    (Macedonian Medical Association, 2024-04)
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    Arsenkov, Stefan
    Bilateral calcification of vas deferens is an uncommon condition, particularly in young males. Only a few case reports are published for this condition in young males, and what they have in common is diabetes mellitus. A 33-year old man presented with dull pain in the right inguinal region. The patient has had history of insulin dependent diabetes mellitus type I for thirty years. He complained of dull pain in the right inguinal region. The pain started about ten years ago, but it has grown stronger and more frequent in the last two months. CT scan was performed which confirmed the presence of calcification along almost the entire length of the vas deferens, starting from testes to the prostate with prostatic calcification. Androflor Screen test was made to detect the total bacterial DNA, and pathological levels of Bacteroides spp./Porphyromaonas spp./Prevotella spp. were detected and antibiotic treatment was prescribed. Calcification of the vas deferens is relatively specific to DM and 70% of males who had vas calcification also had diabetes. There are other etiologies associated with the calcification of vas deferens such as chronic infections and inflammations, but it can also be seen as a manifestation of aging. The calcification may also be associated with infertility. Pathologically, diabetic vas deferens calcification can be differentiated from the chronic inflammatory type. Chronic inflammatory calcification is usually intraluminal which may be unilateral and segmental, while the calcification seen in diabetes is usually mural and symmetrical. Unfortunately, currently there are no available curative treatment option for this condition. Diabetes is the primary cause of bilateral calcification of the vas deferens in young males, which can lead to infertility. Bearing this in mind, it's important to inform patients about the associated risks and advise them to take necessary precautions.
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    Association Between Hormone Replacement Therapy and Glycemic Control in Postmenopausal Women with Type 2 Diabetes
    (Македонско лекарско друштво = Macedonian medical association, 2015-01)
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    Markovik-Temelkova, Snezhana
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    Jovanovska-Misevska, Sasa
    Introduction. In women with diabetes, the changes that accompany menopause may further diminish glycemic control. Little is known about how hormone replacement therapy (HRT) affects glucose metabolism in diabetes. The aim of this study was to examine whether HbA1C levels are influenced by current HRT among postmenopausal women with type 2 diabetes. Methods. A total of 40 postmenopausal women with type 2 diabetes were enrolled. All of them fulfilled the criteria of natural menopause, with intact uterus, low estrogen levels (E2) and high follicle-stimulating hormone (FSH) levels. Half of them (20 women) were assigned to take HRT (DM-HRT group). The other half (20 women) were assigned to the control group, those who did not take HRT (DM-non HRT group). HRT consisted of 17 β-estradiol (E2) 1 mg and drospirenone (DRSP) 2 mg. Fasting plasma glycemia, insulinemia and HbA1C were followed in both groups throughout 12 months. Results. The mean age was 49 years (SD±3,3) and 48,5 (SD±3.1), respectively. HRT was associated with statistically significant decrease in serum fasting glucose, HbA1C and insulinemia levels in the DM-HRT group. There was no significant reduction in glucose levels and HbA1C together with no significant increase in insulinemia levels in the DM non-HRT group throughout 12 months. Conclusion. HRT was associated with statistically significant decrease of plasma glucose levels and HbA1C level. Larger clinical trials are necessary to understand whether HRT may improve glycemic control in women with diabetes, especially when it is given shortly after entering menopause.
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    Oral Health Status in Diabetic and Non-Diabetic Patients on Maintenance Hemodialysis Treatment
    (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2022)
    Emilija Rambabova
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    Gjorgjievska, Gordana
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    Vasiliki Krecova
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    Introduction. Uremic toxins and inflammation influence the oral health in patients on maintenance hemodialysis treatment. The presence of diabetes additionally aggravates the oral status. The aim of the study was to compare the oral health status in diabetic and non-diabetic patients on chronic hemodialysis program. Methods. Observational, cross-section, monocentric study was conducted in 72 hemodialysis (HD) patients divided into two groups regarding the presence of Diabetes mellitus (DM). Demographic characteristics as patients age, dialysis vintage, laboratory inflammatory markers as C-reactive protein (CRP), albumin and Interleukin 6 (IL-6) were measured at the start of the study. Also, uremic small and middle molecules as blood urea nitrogen (BUN), creatinine, β2-microglobilin (β2M), myoglobin, albumin, free light chains kappa (FLC-k), and free light chains lambda (FLC-λ) were analyzed. Patients were examined by a dentist specialist scoring the oral hygiene index (OHI) by Greene Vermillion as good, fair and poor. Presence of hyperkeratosis, periodontal disease, erosions, ulceration, erythema, pigmentations, tongue coating and uremic fetor were notified. Gingival hyperplasia (GH) was scored (1-3) with 3 for the worst score. Data was presented as mean and standard deviation for continuous and percentages for nominal values. X squared Fisher exact and Mann Whitney test were used for statistical analysis. P<0.05 was considered as significant. Results. The patients from group 1-with DM (N=26) didn’t differ from the non-diabetic group (N=46) in respect of gender, age but had significantly shorter dialysis vintage (48.68±37.45 vs. 88.13±63.29, p=0.02, respectively). From the inflammatory markers only Il6 was significantly higher in DM patients (p=0.03). All the analyzed uremic toxins-small and middle molecules also didn’t differ between the two groups. Diabetic patients were at 3 fold risk for manifestation of fissure, 4 fold risk for pigmentations and 7 fold risk for erythema (OR 3.58; CI:1.017-12.380, p= 0.003; OR 4.12; CI:0.684-22.870; p=0.02, OR 4.84; CI:1.343-17.498, p=0.000), (OR 7.25; CI:1.123-46.880, p=0.000), respectively. GH was more likely to be present in diabetic patients (35%, 54%, 11% vs 83%, 15, 0%, p=0.000, respectively). The presence of hyperkeratosis, periodontal disease, erosions, didn’t differ between the groups. Patients with DM were found with higher percentage of bad oral hygiene index (38% vs 20%), but the overall comparison of OHI showed no significant difference. Conclusion. Oral health is significantly deteriorated in dialysis patients, especially in those with inflammation. Diabetic patients are at higher risk of developing changes in the oral health status.
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    Role of education in prevention and delay of complications in type 2 diabetic patients
    (bioscientifica, 2012)
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    Lumani, Sedat
    Aim: To assess the impact of education of people with T2DM and complications. Patients and methods. Observational study, 100 T2DM patients of age 35–75 years, both sex, duration of DM >1 year.Results. From 100 T2DM 47% were male sex and 53% female. Mean age 60.45±8y, duration of DM 10.45y±3 y. Average A1c 8%±0.6, BMI 27%, systolic BP 140±6 mmHg, TG 2.2±0.3 mmol/L, LDL 4.0±0.6 mmol/L. Education (diet, physical activities, drug compliance) for DM was 67% for male and 54% for female. Education for diabetic foot care (inspection, foot hygiene, appropriate shoes) 51% for male and 49% for female. Conclusion: Metabolic risk factors are poorer in no educated than in educated T2DM, People who had not satisfactory education for foot care have higher risk for foot ulceration.
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    Design of a Non-invasive ECG-based Glucose Measurement System
    (IEEE, 2020-09-28)
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    Gusheva, E
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    Diabetic patients have to pay for each glucose reading with a blood drop and a small fortune. In addition, routine finger pricking is troublesome for diabetic patients because it can lead to scarring. It is no surprise then that the idea that glucose measurement can be done cheaply and in a non-invasive way surpasses the wildest dreams of diabetic patients. The goal of this paper is to present the design of a new technology solution for non-invasive glucose measurement based on processing the electrocardiogram obtained via a light easy-to-wear ECG monitor. We present details on how to develop a service that tracks glucose levels based on real-time ECG monitoring, and using sophisticated machine learning and related technologies. Our initial analysis shows that no similar solution is present on the market today, although several research initiatives are ongoing.
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    Demographic, Clinical and Biochemical Characteristics of Pediatric Obesity: Interim Analysis of a Larger Prospective Study
    (Medical University of Plovdiv, 2020-12)
    Tankoska Maja
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    Stamatova Ana
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    Murtezani Avni
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    Maneva Elita
    Introduction: Pediatric obesity is a common nutritional disorder that affects more than a third of the young population and predisposes individuals to greater future morbidity and mortality. Materials and methods: Sixty-two children were recruited in the study. Demographic and clinical information regarding the patients and their parents was collected. Data about the weight, height, systolic (SP) and diastolic (DP) blood pressure, lipid metabolic profile, thyroid hormone levels, glucose and insulin levels before and after oral glucose tolerance test (OGTT) of participants were also collected. Body mass index (BMI) was calculated and patients were classified into groups according to the International Obesity Task Force criteria. Descriptive, comparative parametric, non-parametric tests and Spearman’s ranked correlations were used in the statistical analysis. Results: The study sample consisted of 34 males and 28 females aged 11.6 and 11.8 years, respectively (p=0.781). The mean BMI was 30.5 (SD 5.5): 8 of participant had normal weight (≤25 BMI), 22 were overweight (25-30 BMI), and 32 were obese (≥30 BMI). The children’s BMIs were significantly associated with parental BMIs (r=0.395, p=0.004). Both SP and DP were significantly different between BMI subgroups (p=0.005 and p=0.001, respectively) with the obese group having the highest values (post-hoc Benjamini, p=0.004). Obese children had lower average T4 levels when compared to the comparators (7.5 μg/dL vs. 9.9 μg/dL, p=0.021). Obese children had significantly lower baseline glucose levels and higher insulin levels when compared to the overweight/normal BMI children (73.8 mg/ dL vs. 86.4 mg/dL, p<0.001 and 21.8 μgU/mL vs. 132 μgU/mL, p=0.003). Obese children had the greatest numerical increase in glucose levels during the OGTT (Δ63.0 mg/dL vs. Δ43.2 mg/dL, p=0.063) and numerically smaller absolute insulin response (Δ86.1 μIU/mL vs. Δ125.7 μIU/mL, p=0.307). Conclusions: Pediatric patients demonstrate familial type of obesity and premorbid asymptomatic endocrine impairments. In order to maintain normal glucose levels, obese pediatric patients demonstrate high levels of resting insulin levels and diminished response after OGTT load
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    Metabolic Syndrome and Myocardial Infarction in Women
    (Bentham Science Publishers, 2021-04-29)
    Djuro Macut
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    Sanja Ognjanovic
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    Milka Ašanin
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    Gordana Krljanac
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    Abstract: Metabolic syndrome (MetS) represents a cluster of metabolic disorders that arise from insulin resis-tance (IR) and adipose tissue dysfunction. As a consequence, there is an increased risk for type 2 diabetes melli-tus and atherosclerotic cardiovascular disease (CVD). MetS is associated with a 2-fold increase in cardiovascu-lar outcomes. Earlier population analyses showed a lower prevalence of MetS in women (23.9%) in comparisonto men (27.8%), while later analyses suggest significantly reduced difference due to an increase in the preva-lence in women aged between 20 and 39. However, the prevalence of MetS in specific populations of women,such as in women with polycystic ovary syndrome, ranges from 16% to almost 50% in some geographical re-gions. Abdominal fat accumulation and IR syndrome are recognized as the most important factors in the patho-genesis of MetS. After menopause, a decline in insulin sensitivity corresponds to an increase in fat mass, circu-lating fatty acids, low-density lipoproteins, and triglycerides. Prevalence of MetS in acute coronary syndrome(ACS) is significantly more present in women (55.9%-66.3%) than in men (40.2%-47.3%) in different cohorts.Younger women with ACS had a higher mortality rate than younger men. Acute myocardial infarction (AMI)remains a leading cause of death in aging women. Women with AMI had significantly higher rates of prior con-gestive heart failure, hypertension history, and diabetes. The role of androgens in CVD pathogenesis in womenhas not yet been clarified. The current review aims to provide an insight into the role of MetS components andinflammation for the development of atherosclerosis, CVD, and AMI in women.