Iskra Bitoska - Academia.edu (original) (raw)

Papers by Iskra Bitoska

Research paper thumbnail of P-21 Maturity onset diabetes of the young 7: Case report

JCEM Case Reports, Dec 31, 2023

Research paper thumbnail of A Rare Case of a Patient with Hyperthyroidism After Hypothyroidism

PubMed, Oct 7, 2023

Primary hypothyroidism caused by an underlying autoimmune thyroiditis disease is very common in c... more Primary hypothyroidism caused by an underlying autoimmune thyroiditis disease is very common in clinical practice, while one of the most commonly seen types of hyperthyroidism states is Graves' disease. In hypothyroidism, patients are thought to be lifelong treated with substitution therapy with the lacking levothyroxine hormone. Usually due to the started autoimmune process that progressively destroys the thyroid tissue, the doses of levothyroxine increase in a different period of time during the follow ups. Rarely, the doses need to be tapered down, and that is the exact moment when the physician should be suspicious of a possible conversion from a hypothyroid state to a hyperthyroid one. We describe a case of a woman who was diagnosed with hypothyroidism and treated with suitable doses of levothyroxine, and then gradually the levothyroxine doses were tapered and eventually discontinued because of the clinical and laboratory confirmed state of hyperthyroidism- requiring a treatment with thiamazole. To our knowledge, this case is one of rarest worldwide so far published cases that illustrate the shortest time interval between the diagnosis of hypothyroidism and its switch to a hyperthyroid state.

Research paper thumbnail of Once-weekly semaglutide use in glucagon-like peptide-1 receptor agonist naïve patients with type 2 diabetes in North Macedonia: Real-world data from the MIRAGE study

Diabetes Research and Clinical Practice, Nov 30, 2023

Research paper thumbnail of Assessment of Prevalence and Risk Factors for Diabetic Retinopathy in Patients with Type 1 and Type 2 Diabetes Examined at a Tertiary Care

Prilozi - Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki, Jul 1, 2023

Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and ... more Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and the leading cause of visual impairment and blindness. The aim of the study was to estimate and compare the prevalence of DR and to determine an association between DR and systemic risk factors in hospitalized type 1 (DMT1) and type 2 (DMT2) diabetic patients. Material and methods: We analyzed 260 patients with diabetes, 43 with DMT1 and 217 with DMT2. The following data were collected: age, gender, type and duration of diabetes, glycemic control, blood pressure, estimated glomerular filtration rate, ophthalmologic examinations and routine biochemical parameters. Results: Out of the total number of 260 patients, 77 (29.6%) had non-proliferative DR (NPDR), 21 (8.1%) had proliferative DR (PDR), 29 (11.1%) had diabetic macular edema (DME), and 69 (23.5%) had diabetic cataracts. Forty-three (16.5%) patients were previously diagnosed with DMT1 and 217 (83.5%) with DMT2. The duration of diabetes was not significantly longer in DMT1 (12.8±11.2 years) in comparison to DMT2 (11.07±8.1 years). The prevalence of NPDR and PDR did not differ statistically in either groups. DME was more prevalent in DMT2 than in DMT1 (P<0.05). Diabetic cataract was found in 26.7% vs. 6.7% of patients with DMT2 and DMT1, respectively (p<0.01). The duration of diabetes significantly correlated with NPDR and PDR in DMT1 (r=o.31, p<0.05; r=0.55, p<0.001, respectively). In DMT2, significant correlations were found between the duration of diabetes and cataract, NPDR, PDR and DME (r=0.31, p<0.001; r=0.43 p<0.01, r=0.16 p<0.05 and r=0.20 p<0.01, respectively). Fasting plasma glucose (FPG) significantly correlated with PDR (r=0.258, p<0.05), while HbA1c with DME (r= 0.15 p<0.05). Conclusion: The duration of diabetes and hyperglycemia were associated with DR in both types of diabetes.

Research paper thumbnail of Effects of Hormone Replacement Therapy on Insulin Resistance in Postmenopausal Diabetic Women

Open Access Macedonian Journal of Medical Sciences, Feb 1, 2016

BACKGROUND: Insulin resistance (IR) is closely associated with diabetes mellitus. On the other ha... more BACKGROUND: Insulin resistance (IR) is closely associated with diabetes mellitus. On the other hand, increased visceral fat in menopause is also associated with IR, which makes postmenopausal diabetic women in a big risk for cardiovascular diseases. There are conflicting reports about the effects on hormone replacement therapy (HRT) on IR. AIM: The aim of the study was to investigate the effects of HRT on IR. METHODS: A total of 40 postmenopausal women with type 2 diabetes were enrolled and followed for 12 months. Half of them were assigned to take HRT, while the other half made the control group. Fasting plasma glucose (FPG) and insulinemia were measured in both groups at baseline and after 12 months. IR was represented by Homeostatic model assessment for IR (HOMA-IR). RESULTS: HRT was associated with significant decrease in HOMA-IR, FPG and insulinemia in the examined group. There was no significant reduction in FPG and no significant increase in insulinemia levels and HOMA-IR values in control group after 12 months. CONCLUSION: HRT was associated with statistically signifficant increase of insulin sensitivity. Larger clinical trials will be necessary to understand whether HRT may improve insulin resistance and glucose homeostasis in women with diabetes, especially when given shortly after entering menopause.

Research paper thumbnail of Successful Pregnancy Outcome in Patient with Congenital Adrenal Hyperplasia

Journal of Morphological Sciences, Dec 27, 2018

The term congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorder... more The term congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorders, which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. There are two forms of CAH: classic, devided into salt-waisting and simple virilizing, and nonclasic form. Fertility is relative in CAH, but the incidence of spontaneous miscarriage is higher. We present а patient with simple virilising form of CAH and pregnancy. Our patient was admitted in the hospital in 2014 when we diagnosed simple virilisng form of CAH. She came with history of two unsuccesfull IVF's, in 2013 and 2014. Dexamethason therapy was introduced. In preparation for conception, the steroid replacement was changed to Prednisolon. There was one more IVF performed, in 2016, again without succes. Our patient concieved naturally in august 2017. The screening conducted at the first visit of 14 weeks of gestation was normal and further tests conducted at gynaecologist were also normal. During pregnancy, she continued to take prednisolone (minimum dose 7.5 mg/day to maximum dose 20 mg/day). Check ups were done each two months. She delivered female, weighs 2.9 kg by elective cesarean section at 38+1 week of gestation. The baby exhibited normal Apgar score. The external genitalia were normal. After the delivery, the patient had taken prednisolone (15 mg/day) consistently for theCAH. Choosing the appropriate type and dose of steroid replacement is quite challenging in the treatment of women with classical CAH desiring pregnancy.Succesfull management of CAH in pregnancy requires a firm knowledge of endocrine changes that occur during gestation. From a fetal and neonatal standpoint, accurate prenatal diagnosis alows good prenatal treatment in an attept to minimize clinical problems in the neonates.

Research paper thumbnail of Case report on a switch from hypothyroidism to hyperthyroidism

JCEM Case Reports

Introduction Hashimoto's thyroiditis and Graves’ disease are the most common autoimmune thyro... more Introduction Hashimoto's thyroiditis and Graves’ disease are the most common autoimmune thyroid conditions and are more common in women than in men. Thyrotropin receptor (TSHR) antibodies that stimulate the thyroid (TSAb) cause Graves’ hyperthyroidism and TSHR antibodies which block thyrotropin action (TBAb) are occasionally responsible for hypothyroidism. Unusual patients switch from TSAb to TBAb (or vice versa) with concomitant thyroid function changes. The most common scenario is the evolution from Graves’ disease (GD) to Hashimoto's thyroiditis (HT), whereas the switch from HT into GD seems to be less common. Clinical Case 53-year-old woman presented with a several month's history of tiredness, cold intolerance and hoarseness in October 2020. She was diagnosed with autoimmune hypothyroidism and achieved euthyroid status following treatment with Tbl. Levothyroxine a 50 mcg S. 1×1. This almost stable status was interestingly interrupted after 9 months (January 2021) wh...

Research paper thumbnail of Patients with type 2 diabetes mellitus and diabetic nephropathy have higher risk for foot ulceration

Endocrine Oncology and Metabolism, 2017

Background and Aims: The primary aim of this study was to analyze the association between renal p... more Background and Aims: The primary aim of this study was to analyze the association between renal parameters and the risk for the presence of diabetic foot by using the International Working Group on the Diabetic Foot (IWGDF) classification in patients with type 2 diabetes mellitus (T2DM). Subjects and Methods: We conducted a prospective, cross-sectional study, which included 107 consecutive hospitalized patients with T2DM, aged 35-65 years, over the 6-month period. Patients were examined and tested for diabetic foot and classified according to the IWGDF into four groups. The presence of kidney disease was assessed based on clinical practice guideline for diabetes and chronic kidney disease and classified into grades [1-5] based on the estimated glomerular filtration rate (eGFR) calculated with Cockcroft-Gault and modification of diet in renal disease formula. The patterns of proteinuria were assessed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Results: Only 4 (3.7%)...

Research paper thumbnail of Rare Case of Ovarian Steroid Cell Tumor Not Otherwise Specified in a Postmenopausal Woman

Journal of Morphological Sciences, 2022

Research paper thumbnail of THE EFFECT OF METHYLPREDNISOLONE VERSUS DEXAMETHASONE IN INCREASING THE DIABETOGENIC EFFECT OF SARS-CoV-2 INFECTION AND THE DEVELOPMENT OF A NEW-ONSET DIABETES MELLITUS

Journal of Morphological Sciences

Research paper thumbnail of Klinefelter Syndrome and Other Sex Chromosomal Aneuploidies in the Republic of North Macedonia

Journal of Morphological Sciences

Research paper thumbnail of Successful Pregnancy Outcome in Patient with Congenital Adrenal Hyperplasia

Journal of Morphological Sciences, Dec 27, 2018

Research paper thumbnail of Association Between Hormone Replacement Therapy and Glycemic Control in Postmenopausal Women with Type 2 Diabetes

Macedonian Medical Review, 2015

Introduction. In women with diabetes, the changes that accompany menopause may further diminish g... more 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), resp...

Research paper thumbnail of Role of education in prevention and delay of complications in type 2 diabetic patients

Research paper thumbnail of Evaluation of Sex-Specific Differences of Anthropometric Variables That Were Used as Indicators of Nutritional Status in Macedonian Children

The aim of this study was to evaluate sex-specific differences of anthropometric varibales that w... more The aim of this study was to evaluate sex-specific differences of anthropometric varibales that were used as indicators of nutritional status in Macedonian children aged 5. The study included 226 (113 boys and 113 girls) Macedonian children aged 5. We selected 5 anthropometrical parameters to measure (body weight, height, mid upper arm circumferences-MUAC, skinfolds thickness triceps–SFTr and subscapular-SFSc) and in addition according to the standard formulas we calculated: weight-for-age (BW), height-for-age (BH), body mass index-for-age (BMI) midupper-arm circumference-for-age (MUAC) and skifolds thikness (SFTr-for-age, SFSc-for-age). In general results have shown sex-specific differences in the examined parameters (BH, BW, BMI) in favour of the boys, with exception of skin-folds thickness that were higher in girls. Values of the 50th percentile in boys were as follows: 21 kg for BW, 115cm for BH, 15.48 kg/m2 for BMI, 15.5 cm for MUAC, 7mm for SFTr and 4.1mm for SFSc. The values ...

Research paper thumbnail of Growing Prevalence and Incidence of Diabetes in Republic of Macedonia in the Past 5 Years Based on Data from the National System for Electronic Health Records

Open Access Macedonian Journal of Medical Sciences, 2020

Introduction. Diabetes is a chronic metabolic disease characterized with a rapid progression of p... more Introduction. Diabetes is a chronic metabolic disease characterized with a rapid progression of prevalence in last 3 decades, especially in countries with low and middle income. Next three decades this number of diabetes in the world is expected to be doubled. Early diagnosis and appropriate management of diabetes is the primary way to prevent and delay cardiovascular complications. Patients and methods. In this retrospective study, we used the data from National electronic system e-health which was performed in late 2014, wich gives us nearly precise data, and we made statistical analysis for diabetes in last 5 years (2015-2019). Results. In 2015 we have registered 103480 patients with DM, in 2016 108130 patients, in 2017 114408, in 2018 119999 and in 2019 124450 patients with DM. 95% of patients are with T2DM and 4, 1% with T1DM. According the data from State statistical office for population of Republic of Macedonia, the prevalence of T2DM for the years 2015-2019 is as follows: 5...

Research paper thumbnail of Is There a Difference in Pregnancy and Glycemic Outcome in Patients with Type 1 Diabetes on Insulin Pump with Constant or Intermittent Glucose Monitoring? A Pilot Study

Diabetes Technology & Therapeutics, 2011

Background: The aim of the study is to describe glycemic and insulin outcomes by trimester and ma... more Background: The aim of the study is to describe glycemic and insulin outcomes by trimester and maternal and fetal outcome in patients with type 1 diabetes using an insulin pump with constant or intermittent continuous glucose monitoring (CGM). Methods: Twenty-five women with type 1 diabetes with newly diagnosed pregnancy were treated with insulin pump therapy (Medtronic 722, Medtronic Minimed, Northridge, CA) for at least 1 year. Insulin pump and CGM (Medtronic Paradigm Real-Time) were implemented at least 3 months before conception. Patients were randomized in two groups: constant CGM group, 12 patients on insulin pump with glucose sensor, 24 h/day; and intermittent CGM group, 13 patients on insulin pump with intermittent glucose sensor, 14 days/month. The following parameters were analyzed: glycosylated hemoglobin (HbA1c), mean blood glucose, insulin requirement (in IU/kg/day), weight gain, severe hypoglycemic events, diabetic ketoacidosis, macrosomia, cesarean section, and neonatal hypoglycemia. Results: Both groups achieved good glucose control during their pregnancies (P < 0.05): 6.78-1.3% and 6.92-0.9% at the beginning of the study compared with 6.14-0.9% (constant CGM group) and 6.23-0.6% (intermittent CGM group) at the end of the study (last HbA1c before delivery). There was no significant decrease of HbA1c between the two groups. The constant CGM group had a significantly lower A1c in the first trimester compared with the intermittent CGM group. Maternal and fetal outcome did not show a significant difference between the two groups. Conclusions: Insulin pump therapy together with constant or intermittent CGM can improve diabetes control and pregnancy outcome in type 1 diabetes. The quality of the glucose profile at conception was the important factor for pregnancy outcome.

Research paper thumbnail of Successful desensitization in patient with type 2 diabetes with an insulin allergy using insulin pump and glargine

Research paper thumbnail of Malnutrition cause of Secondary Osteoporosis after surgical operation of Glucagonoma

Endocrine Abstracts, 2013

Research paper thumbnail of A primary adrenal adenomatoid tumor in a young woman

Endocrine Abstracts, 2014

Research paper thumbnail of P-21 Maturity onset diabetes of the young 7: Case report

JCEM Case Reports, Dec 31, 2023

Research paper thumbnail of A Rare Case of a Patient with Hyperthyroidism After Hypothyroidism

PubMed, Oct 7, 2023

Primary hypothyroidism caused by an underlying autoimmune thyroiditis disease is very common in c... more Primary hypothyroidism caused by an underlying autoimmune thyroiditis disease is very common in clinical practice, while one of the most commonly seen types of hyperthyroidism states is Graves' disease. In hypothyroidism, patients are thought to be lifelong treated with substitution therapy with the lacking levothyroxine hormone. Usually due to the started autoimmune process that progressively destroys the thyroid tissue, the doses of levothyroxine increase in a different period of time during the follow ups. Rarely, the doses need to be tapered down, and that is the exact moment when the physician should be suspicious of a possible conversion from a hypothyroid state to a hyperthyroid one. We describe a case of a woman who was diagnosed with hypothyroidism and treated with suitable doses of levothyroxine, and then gradually the levothyroxine doses were tapered and eventually discontinued because of the clinical and laboratory confirmed state of hyperthyroidism- requiring a treatment with thiamazole. To our knowledge, this case is one of rarest worldwide so far published cases that illustrate the shortest time interval between the diagnosis of hypothyroidism and its switch to a hyperthyroid state.

Research paper thumbnail of Once-weekly semaglutide use in glucagon-like peptide-1 receptor agonist naïve patients with type 2 diabetes in North Macedonia: Real-world data from the MIRAGE study

Diabetes Research and Clinical Practice, Nov 30, 2023

Research paper thumbnail of Assessment of Prevalence and Risk Factors for Diabetic Retinopathy in Patients with Type 1 and Type 2 Diabetes Examined at a Tertiary Care

Prilozi - Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki, Jul 1, 2023

Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and ... more Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and the leading cause of visual impairment and blindness. The aim of the study was to estimate and compare the prevalence of DR and to determine an association between DR and systemic risk factors in hospitalized type 1 (DMT1) and type 2 (DMT2) diabetic patients. Material and methods: We analyzed 260 patients with diabetes, 43 with DMT1 and 217 with DMT2. The following data were collected: age, gender, type and duration of diabetes, glycemic control, blood pressure, estimated glomerular filtration rate, ophthalmologic examinations and routine biochemical parameters. Results: Out of the total number of 260 patients, 77 (29.6%) had non-proliferative DR (NPDR), 21 (8.1%) had proliferative DR (PDR), 29 (11.1%) had diabetic macular edema (DME), and 69 (23.5%) had diabetic cataracts. Forty-three (16.5%) patients were previously diagnosed with DMT1 and 217 (83.5%) with DMT2. The duration of diabetes was not significantly longer in DMT1 (12.8±11.2 years) in comparison to DMT2 (11.07±8.1 years). The prevalence of NPDR and PDR did not differ statistically in either groups. DME was more prevalent in DMT2 than in DMT1 (P<0.05). Diabetic cataract was found in 26.7% vs. 6.7% of patients with DMT2 and DMT1, respectively (p<0.01). The duration of diabetes significantly correlated with NPDR and PDR in DMT1 (r=o.31, p<0.05; r=0.55, p<0.001, respectively). In DMT2, significant correlations were found between the duration of diabetes and cataract, NPDR, PDR and DME (r=0.31, p<0.001; r=0.43 p<0.01, r=0.16 p<0.05 and r=0.20 p<0.01, respectively). Fasting plasma glucose (FPG) significantly correlated with PDR (r=0.258, p<0.05), while HbA1c with DME (r= 0.15 p<0.05). Conclusion: The duration of diabetes and hyperglycemia were associated with DR in both types of diabetes.

Research paper thumbnail of Effects of Hormone Replacement Therapy on Insulin Resistance in Postmenopausal Diabetic Women

Open Access Macedonian Journal of Medical Sciences, Feb 1, 2016

BACKGROUND: Insulin resistance (IR) is closely associated with diabetes mellitus. On the other ha... more BACKGROUND: Insulin resistance (IR) is closely associated with diabetes mellitus. On the other hand, increased visceral fat in menopause is also associated with IR, which makes postmenopausal diabetic women in a big risk for cardiovascular diseases. There are conflicting reports about the effects on hormone replacement therapy (HRT) on IR. AIM: The aim of the study was to investigate the effects of HRT on IR. METHODS: A total of 40 postmenopausal women with type 2 diabetes were enrolled and followed for 12 months. Half of them were assigned to take HRT, while the other half made the control group. Fasting plasma glucose (FPG) and insulinemia were measured in both groups at baseline and after 12 months. IR was represented by Homeostatic model assessment for IR (HOMA-IR). RESULTS: HRT was associated with significant decrease in HOMA-IR, FPG and insulinemia in the examined group. There was no significant reduction in FPG and no significant increase in insulinemia levels and HOMA-IR values in control group after 12 months. CONCLUSION: HRT was associated with statistically signifficant increase of insulin sensitivity. Larger clinical trials will be necessary to understand whether HRT may improve insulin resistance and glucose homeostasis in women with diabetes, especially when given shortly after entering menopause.

Research paper thumbnail of Successful Pregnancy Outcome in Patient with Congenital Adrenal Hyperplasia

Journal of Morphological Sciences, Dec 27, 2018

The term congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorder... more The term congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorders, which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. There are two forms of CAH: classic, devided into salt-waisting and simple virilizing, and nonclasic form. Fertility is relative in CAH, but the incidence of spontaneous miscarriage is higher. We present а patient with simple virilising form of CAH and pregnancy. Our patient was admitted in the hospital in 2014 when we diagnosed simple virilisng form of CAH. She came with history of two unsuccesfull IVF's, in 2013 and 2014. Dexamethason therapy was introduced. In preparation for conception, the steroid replacement was changed to Prednisolon. There was one more IVF performed, in 2016, again without succes. Our patient concieved naturally in august 2017. The screening conducted at the first visit of 14 weeks of gestation was normal and further tests conducted at gynaecologist were also normal. During pregnancy, she continued to take prednisolone (minimum dose 7.5 mg/day to maximum dose 20 mg/day). Check ups were done each two months. She delivered female, weighs 2.9 kg by elective cesarean section at 38+1 week of gestation. The baby exhibited normal Apgar score. The external genitalia were normal. After the delivery, the patient had taken prednisolone (15 mg/day) consistently for theCAH. Choosing the appropriate type and dose of steroid replacement is quite challenging in the treatment of women with classical CAH desiring pregnancy.Succesfull management of CAH in pregnancy requires a firm knowledge of endocrine changes that occur during gestation. From a fetal and neonatal standpoint, accurate prenatal diagnosis alows good prenatal treatment in an attept to minimize clinical problems in the neonates.

Research paper thumbnail of Case report on a switch from hypothyroidism to hyperthyroidism

JCEM Case Reports

Introduction Hashimoto's thyroiditis and Graves’ disease are the most common autoimmune thyro... more Introduction Hashimoto's thyroiditis and Graves’ disease are the most common autoimmune thyroid conditions and are more common in women than in men. Thyrotropin receptor (TSHR) antibodies that stimulate the thyroid (TSAb) cause Graves’ hyperthyroidism and TSHR antibodies which block thyrotropin action (TBAb) are occasionally responsible for hypothyroidism. Unusual patients switch from TSAb to TBAb (or vice versa) with concomitant thyroid function changes. The most common scenario is the evolution from Graves’ disease (GD) to Hashimoto's thyroiditis (HT), whereas the switch from HT into GD seems to be less common. Clinical Case 53-year-old woman presented with a several month's history of tiredness, cold intolerance and hoarseness in October 2020. She was diagnosed with autoimmune hypothyroidism and achieved euthyroid status following treatment with Tbl. Levothyroxine a 50 mcg S. 1×1. This almost stable status was interestingly interrupted after 9 months (January 2021) wh...

Research paper thumbnail of Patients with type 2 diabetes mellitus and diabetic nephropathy have higher risk for foot ulceration

Endocrine Oncology and Metabolism, 2017

Background and Aims: The primary aim of this study was to analyze the association between renal p... more Background and Aims: The primary aim of this study was to analyze the association between renal parameters and the risk for the presence of diabetic foot by using the International Working Group on the Diabetic Foot (IWGDF) classification in patients with type 2 diabetes mellitus (T2DM). Subjects and Methods: We conducted a prospective, cross-sectional study, which included 107 consecutive hospitalized patients with T2DM, aged 35-65 years, over the 6-month period. Patients were examined and tested for diabetic foot and classified according to the IWGDF into four groups. The presence of kidney disease was assessed based on clinical practice guideline for diabetes and chronic kidney disease and classified into grades [1-5] based on the estimated glomerular filtration rate (eGFR) calculated with Cockcroft-Gault and modification of diet in renal disease formula. The patterns of proteinuria were assessed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Results: Only 4 (3.7%)...

Research paper thumbnail of Rare Case of Ovarian Steroid Cell Tumor Not Otherwise Specified in a Postmenopausal Woman

Journal of Morphological Sciences, 2022

Research paper thumbnail of THE EFFECT OF METHYLPREDNISOLONE VERSUS DEXAMETHASONE IN INCREASING THE DIABETOGENIC EFFECT OF SARS-CoV-2 INFECTION AND THE DEVELOPMENT OF A NEW-ONSET DIABETES MELLITUS

Journal of Morphological Sciences

Research paper thumbnail of Klinefelter Syndrome and Other Sex Chromosomal Aneuploidies in the Republic of North Macedonia

Journal of Morphological Sciences

Research paper thumbnail of Successful Pregnancy Outcome in Patient with Congenital Adrenal Hyperplasia

Journal of Morphological Sciences, Dec 27, 2018

Research paper thumbnail of Association Between Hormone Replacement Therapy and Glycemic Control in Postmenopausal Women with Type 2 Diabetes

Macedonian Medical Review, 2015

Introduction. In women with diabetes, the changes that accompany menopause may further diminish g... more 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), resp...

Research paper thumbnail of Role of education in prevention and delay of complications in type 2 diabetic patients

Research paper thumbnail of Evaluation of Sex-Specific Differences of Anthropometric Variables That Were Used as Indicators of Nutritional Status in Macedonian Children

The aim of this study was to evaluate sex-specific differences of anthropometric varibales that w... more The aim of this study was to evaluate sex-specific differences of anthropometric varibales that were used as indicators of nutritional status in Macedonian children aged 5. The study included 226 (113 boys and 113 girls) Macedonian children aged 5. We selected 5 anthropometrical parameters to measure (body weight, height, mid upper arm circumferences-MUAC, skinfolds thickness triceps–SFTr and subscapular-SFSc) and in addition according to the standard formulas we calculated: weight-for-age (BW), height-for-age (BH), body mass index-for-age (BMI) midupper-arm circumference-for-age (MUAC) and skifolds thikness (SFTr-for-age, SFSc-for-age). In general results have shown sex-specific differences in the examined parameters (BH, BW, BMI) in favour of the boys, with exception of skin-folds thickness that were higher in girls. Values of the 50th percentile in boys were as follows: 21 kg for BW, 115cm for BH, 15.48 kg/m2 for BMI, 15.5 cm for MUAC, 7mm for SFTr and 4.1mm for SFSc. The values ...

Research paper thumbnail of Growing Prevalence and Incidence of Diabetes in Republic of Macedonia in the Past 5 Years Based on Data from the National System for Electronic Health Records

Open Access Macedonian Journal of Medical Sciences, 2020

Introduction. Diabetes is a chronic metabolic disease characterized with a rapid progression of p... more Introduction. Diabetes is a chronic metabolic disease characterized with a rapid progression of prevalence in last 3 decades, especially in countries with low and middle income. Next three decades this number of diabetes in the world is expected to be doubled. Early diagnosis and appropriate management of diabetes is the primary way to prevent and delay cardiovascular complications. Patients and methods. In this retrospective study, we used the data from National electronic system e-health which was performed in late 2014, wich gives us nearly precise data, and we made statistical analysis for diabetes in last 5 years (2015-2019). Results. In 2015 we have registered 103480 patients with DM, in 2016 108130 patients, in 2017 114408, in 2018 119999 and in 2019 124450 patients with DM. 95% of patients are with T2DM and 4, 1% with T1DM. According the data from State statistical office for population of Republic of Macedonia, the prevalence of T2DM for the years 2015-2019 is as follows: 5...

Research paper thumbnail of Is There a Difference in Pregnancy and Glycemic Outcome in Patients with Type 1 Diabetes on Insulin Pump with Constant or Intermittent Glucose Monitoring? A Pilot Study

Diabetes Technology & Therapeutics, 2011

Background: The aim of the study is to describe glycemic and insulin outcomes by trimester and ma... more Background: The aim of the study is to describe glycemic and insulin outcomes by trimester and maternal and fetal outcome in patients with type 1 diabetes using an insulin pump with constant or intermittent continuous glucose monitoring (CGM). Methods: Twenty-five women with type 1 diabetes with newly diagnosed pregnancy were treated with insulin pump therapy (Medtronic 722, Medtronic Minimed, Northridge, CA) for at least 1 year. Insulin pump and CGM (Medtronic Paradigm Real-Time) were implemented at least 3 months before conception. Patients were randomized in two groups: constant CGM group, 12 patients on insulin pump with glucose sensor, 24 h/day; and intermittent CGM group, 13 patients on insulin pump with intermittent glucose sensor, 14 days/month. The following parameters were analyzed: glycosylated hemoglobin (HbA1c), mean blood glucose, insulin requirement (in IU/kg/day), weight gain, severe hypoglycemic events, diabetic ketoacidosis, macrosomia, cesarean section, and neonatal hypoglycemia. Results: Both groups achieved good glucose control during their pregnancies (P < 0.05): 6.78-1.3% and 6.92-0.9% at the beginning of the study compared with 6.14-0.9% (constant CGM group) and 6.23-0.6% (intermittent CGM group) at the end of the study (last HbA1c before delivery). There was no significant decrease of HbA1c between the two groups. The constant CGM group had a significantly lower A1c in the first trimester compared with the intermittent CGM group. Maternal and fetal outcome did not show a significant difference between the two groups. Conclusions: Insulin pump therapy together with constant or intermittent CGM can improve diabetes control and pregnancy outcome in type 1 diabetes. The quality of the glucose profile at conception was the important factor for pregnancy outcome.

Research paper thumbnail of Successful desensitization in patient with type 2 diabetes with an insulin allergy using insulin pump and glargine

Research paper thumbnail of Malnutrition cause of Secondary Osteoporosis after surgical operation of Glucagonoma

Endocrine Abstracts, 2013

Research paper thumbnail of A primary adrenal adenomatoid tumor in a young woman

Endocrine Abstracts, 2014