Academic Medical Journal <p>The <strong>Academic Medical Journal</strong> is published by the Faculty of Medicine, University Ss. Cyril and Methodius in Skopje as a peer-reviewed, open-access, international journal, issued twice a year.</p> Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia en-US Academic Medical Journal 2671-3853 DO FIRST-YEAR STUDENTS NEED ASSISTANCE IN ADOPTING HIGHER LEVEL OF LEARNING STRATEGIES? <p><strong>Introduction</strong><strong>:</strong> This study aimed to estimate the level to which the students at the beginning of medical studies are familiarized with strategies for learning in order to explore where and how to assist at the very beginning of their learning.</p> <p><strong>Methods:</strong> A total of 368 1st to 6th year medical students at Ss. Cyril &amp; Methodius University, Skopje, (North Macedonia) filled out the Motivated Strategies for Learning Questionnaire. In this questionnaire-based, cross-sectional, observational study emphasis was given to the first-year students (n=109). Cohort distribution was determined according to scores expressing the level of practicing instruments of each learning strategy. Percentiles and lo­west scores were used for tracing the least adopted strategies.</p> <p><strong>Results: </strong>Majority of the first-year students (52.49%) use learning strategies at medium level, 26.60% at high and 20.89% at low level. For three subscale areas the percentile of students practicing at low level is especially high (39.45% for critical thinking, 40.36% for peer learning and 36.69% for help seeking). For these subscales also students’ scores have the lowest values.</p> <p><strong>Conclusion:</strong> Our first-year students use a different level of learning strategies. As 20.89% of students practice less than 55% of the instruments of each learning strategy and critical thinking, peer learning and help seeking (shown to be less adopted) are basic instruments for deeper and effective learning, the need to assist the first-year students in better adopting lear­ning strategies is obvious.</p> Liljana Milenkova Mile Srbinovski Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 11 21 NON-METRIC VARIATIONS OF THE AXIAL SKELETON BONES IN MEDIEVAL SKELETONS FROM VINICA FORTRESS (VINICHKO KALE) <p>The majority of researchers use cranial and infracranial non-metric traits as separate entities in their investigations of the past populations. We decided to focus our investigation on the axial skeleton non-metric traits, consisting of components such as cranial and vertebral column skeleton. The main goal of our study was to gain some insight into the expression of axial skeleton non-metric traits in a medieval population sample. We investigated 72 well preserved skeletons from the medieval period documented collection (11-12 century AD) in order to examine axial skeleton non-metric traits. The skeletons belonged to individuals aged 20 to 65 years, of both sexes, exhumed from the necropolis Vinichko Kale.</p> <p>Analysis of cranial non-metric traits in our population sample showed a high prevalence of occipital bone cranial traits, such as os apicis (13.9%) and torus occipitalis (20.8%). Among vertebral column non-metric traits, a high prevalence of cervical spine traits, such as ponticulus posterior atlantis (11%), foramen transversarium partitum - FTP (33.3%), foramen transversarium apertum - FTA (13.9%) and cervical ribs (13.9%) was noted. Our findings of skeletal non-metric traits in the medieval population can provide additional knowledge in the skeletal growth and development in general.</p> <p> </p> Niki Matveeva Fanica Veljanovska Julija Zhivadinovik Biljana Zafirova Elizabeta Chadikovska Ace Dodevski Biljana Trpkovska Biljana Bojadzieva Stojanoska Copyright (c) 2021 Academic Medical Journal 2022-01-10 2022-01-10 1 2 22 34 EFFECTS OF RAMADAN FASTING ON SOME BIOCHEMICAL PARAMETERS <p><strong>Introduction:</strong> Holy month Ramadan lasts for about 29-30 days. It is mandatory for all adult individuals of the Islamic faith to fast during the holy month of Ramadan. During this period, healthy Muslims do not eat or drink (i.e., total abstinence from food and fluids) and refrain from tobacco, daily from pre‑dawn until dusk.</p> <p><strong>Materials and Methods:</strong> The present study included healthy adult male and female Muslim volunteers from different towns in the Republic of North Macedonia. The number of subjects in the study was 195. Blood samples from all subjects were collected twice during the study - once 2-3 days prior to the beginning of Ramadan and then again, the last day of Ramadan fasting. The following biochemical parameters were taken into consideration: total cholesterol, triglycerides, HDL cholesterol, glucose, insulin, total proteins, albumin, total and direct bilirubin, urea, creatinine and uric acid.</p> <p><strong>Results:</strong> It was observed that compared to pre‑fasting levels, total cholesterol (TC) and triglycerides (TG) were significantly decreased (P=0.000) and high‑density lipoprotein cholesterol (HDL‑C) level had significantly increased (P=0.000); total proteins were significantly increased (P=0.000); albumins were significantly increased (P=0.004); urea was significantly increased (P=0.004); total and direct bilirubin were significantly increased (P=0.000), glucose was significantly increased (P=0.000); there was no change in insulin levels (P&lt;0.1)</p> <p><strong>Conclusion:</strong> This study showed that Ramadan fasting has an effect on biochemical parameters. We can conclude that reduction in total cholesterol and triglycerides along with a rise in levels of HDL‑C have beneficial effects on lipid profile post-Ramadan fasting period.</p> Katerina Tosheska-Trajkovska Melda Emin Irena Kostovska Ampova Hristina Elena Petrushevska-Stanojevska Coshkun Kerala Dragan Cibrev Natasha Toseska-Spasova Ognen Kostovski Svetlana Cekovska Jasna Bogdanska Sonja Topuzovska Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 35 45 COMPARATIVE ANALYSIS OF PREOPERATIVE AND POSTOPERATIVE DIAGNOSIS IN SKIN MELANOMA <p><strong>Introduction:</strong> Taking into account the increase in incidence and high mortality in advanced stages, early diagnosis is a prerequisite for successful treatment of melanoma.</p> <p><strong>The aim</strong> of this study was to determine the concordance between dermatological (with dermoscopy), surgical and pathohistological diagnosis in patients with a suspicious finding of skin melanoma.</p> <p><strong>Material and methods:</strong> A comparison between the clinical and pathohistological diagno­sis of patients of both sexes, of all ages, with a referral diagnosis of skin melanoma was made.</p> <p><strong>Results:</strong> Out of a total of 535 analyzed cases, 469 (87.5%) had preoperative dermato­lo­gical findings. In 329 of these patients the referral diagnosis was in favor of melanoma. In 140 cases with a dermatological finding other than melanoma, a pathohistological finding of melanoma was obtained, 30% with a dermatological finding.</p> <p>In addition to melanoma, in 289 cases out of 329 cases with dermatological findings a pathohistological finding for melanoma was obtained, and in 40 cases a pathohistological finding other than melanoma was obtained.</p> <p>Of 66 cases without dermatological findings, 27 patients with a surgical diagnosis other than melanoma were operated on, with a pathohistological finding for melanoma - 41%. With a diagnosis of melanoma without prior dermatological examination, 39 cases were operated on, of which in 12 cases the pathohistological finding was in support of melanoma.</p> <p>Of 58 patients who underwent dermoscopy, 78% had a matching dermoscopic and pa­thohistological diagnosis.</p> <p><strong>Conclusion:</strong> The results of this study showed a high percentage of erroneous pre­ope­ra­tive diagnoses.</p> Lazo Noveski Boro Dzonov Elizabeta Mirchevska Margarita Peneva Vladislav Gruev Jasmina Dobrevska Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 46 53 FUNGI IN SKIN AND SOFT TISSUE INFECTIONS - A THREE-YEAR STUDY <p><strong>Introduction: </strong>Exposure of subcutaneous tissue following a loss of skin integrity provides a suitable environment for microbial colonization and proliferation, which contributes to delayed healing and infection of the wound. The aim of this study was to retrospectively investigate the spectrum of fungi responsible for skin and soft tissue infections over a 3-year period, and to compare the results with those from other parts of the world.</p> <p><strong>Material</strong> <strong>and</strong> <strong>methods:</strong> The study was performed during a 3-year period (2017-2019) and included analysis of 11,863 wound samples, which were obtained from patients hospital­lized at the University Clinics of the “Mother Theresa” campus, City hospital ”8<sup>th</sup> September” and University Clinic for Surgical Diseases “St. Naum Ohridski” in Skopje. All specimens were analyzed by standard mycological methods at the Institute of Microbiology and Parasitology.</p> <p><strong>Results: </strong>Growth of fungi was confirmed in 5.5%, 5% and 6.2% of the positive speci­mens, during a 3-year period, respectively. <em>C</em><em>. </em><em>albicans</em> was a predominant yeast (67.6%, 63%, 63.2% in 2017, 2018 and 2019, respectively). Molds were represented by <em>Aspergillus </em>confirmed in 3, 4 and 5 specimens, and <em>Fusarium</em> was confirmed in 2, 3 and 3 specimens during the 3-year period, respectively. <em>Mucor </em>was detected in 3 patients, in 2019 only.</p> <p><strong>Conclusion:</strong> Species identification of fungal microbes in wound specimens revealed that <em>Candida</em> species was the most predominant species, followed by <em>Aspergillus</em> and non-<em>Aspergillus</em> molds. It is crucial for every institution that treats patients with wounds to be aware of fungi as possible etiological agents of wound infections.</p> Gordana Mirchevska Ana Kaftandzieva Marko Kostovski Blerta Mehmeti Marija Stojanova Zorica Zafirovik Vesna Kotevska Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 54 63 SAPS 2 SCORE VALID PARAMETER FOR OUTCOME IN SEVERE INFLUENZA <p>The <strong>aim</strong> of study was to identify the<strong> </strong>significance of SAPS 2 score admission values on outcome in severe influenza.</p> <p><strong>Materials and methods:</strong> The investigation was prospective, group comparison, con­duc­ted at the University Clinic for Infectious Diseases, Skopje in a three-year period. The study included adult patients with severe influenza divided in two groups, survived and deceased. Demographic, clinical and biochemical data were noted on admission. The variables of the univariate analysis that showed a significant difference in terms of the outcome were used for creating multivariate logistic and regression analysis of the outcome as dependent factors. The independent predictors for lethal outcome in severe cases of influenza were identified by using logistic regression.</p> <p> <strong>Results:</strong> The study included 87 patients with clinical and laboratory confirmed severe influenza divided in two groups: survived (n=75) and deceased (n=12). The overall mortality was 13.79%. Multivariate analysis conducted on admission identified SAPS II score (p=0.048) as independent predictor of the outcome in severe influenza. The increase of the SAPS II score in one point increased the chance of death in patients with influenza by 1.2% (OR=1.12 95% CI 1.01-2.976).</p> <p><strong>Conclusion:</strong> In our study the SAPS II score has been identified as an independent va­riab­le, which has predicted the outcome in patients with severe influenza on hospital admission. The early identification of the outcome predictors in patients with severe influenza will ensure implementation of adequate medical procedures, and also, it will contribute to decreasing the mortality of this disease.</p> Marija Cvetanovska Ilir Demiri Krsto Grozdanovski Katerina Spasovska Vlatko Cvetanovski Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 64 69 BONY COCHLEAR NERVE CANAL IN CHILDREN WITH BILATERAL PROFOUND SENSORINEURAL HEARING LOSS – A PILOT STUDY <p><strong>Introduction:</strong> The aim of this study was to evaluate the width of the bony cochlear nerve canal (BCNC) in children with congenital sensorineural hearing loss (SNHL) and "normal" findings on thin section temporal bone CT.</p> <p><strong>Material and methods: </strong>The width of the BCNC was retrospectively evaluated in two groups of patients. The study group included 11 children (22 bone canals) aged 2-12 years, with congenital, bilateral SNHL who underwent cochlear implantation (CI) from July to De­cember 2019 and no abnormalities of the inner ear were detected on their preoperative CT scans. Eleven patients (22 bone canals), aged 3-10 years, in whom no sensorineural hearing loss had been diagnosed were taken as controls and CT scan of the temporal bone was perfor­med for another reason - suspected acute mastoiditis, chronic otitis media, or perforation of the tympanic membrane. Axial sections of their CT scans were used to measure the width of the BCNC.</p> <p><strong>Results:</strong> BCNC width values in patients with bilateral, profound sensorineural hearing loss ranged from 1.0 to 2.3 mm and the mean value was 1.5±0.3 mm. In patients with normal hearing, the values for the canal width were higher, with mean value of 2.1±0.3 mm.</p> <p><strong>Conclusion: </strong>The results obtained showed that the width of the BCNC in children with bilateral, profound sensorineural hearing impairment was significantly smaller than in the con­trol group with normal hearing for p &lt;0.05 (t-test=6.62912, p=0.000000).</p> Marija Dokoska Marina Davceva-Chakar Sonja Nikolova Gordana Kiteva-Trencevska Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 70 77 CCNG1 AND FDXR GENE EXPRESSION LEVELS AFTER RADIATION THERAPY IN BREAST CANCER PATIENTS <p><strong>Introduction: </strong>Radiation biomarkers represent parameters which, through their quan­ti­fication, reflect the interaction of the biological system with ionizing radiation (IR) as а physical agent in the environment and are object of study of the biological dosimetry. Of all identified radioresponsive genes that consist “gene signatures” of IR, the gene for ferredoxin reductase, FDXR, is prominent with its promptness and relevance in estimation of exposition to IR. It is also known as adrenodoxin reductase. The gene for CCNG1 represents another <em>in vitro </em>and <em>in vivo </em>validated radiation biomarker involved<strong>. </strong></p> <p><strong>Materials and methods: </strong>In this non-randomized, controlled open-trial clinical study, 57 patients with diagnosed breast cancer and 50 healthy individuals were included. Isolation of RNA from 3 mL peripheral blood and gene expression analysis with qRT-PCR were performed for detection of expression of FDXR and CCNG1 genes.</p> <p><strong>Results: </strong>A statistically significant difference in the threshold cycle was confirmed for FDXR and CCNG1 in the analyzed period between 24 and 48 h after radiation.</p> <p><strong>Conclusion: </strong>Gene expression is emerging as a highly powerful readout for biodosimetry. Exposure to IR leads to many cellular responses including modification of gene expression. Many genes have been reported to be radiation-responsive at the transcriptional level and monitoring of their expression in blood samples can potentially be used for rapid, minimally invasive high-throughput biological dosimetry purposes.</p> Katerina Trenceva Aleksandar Eftimov Aleksandar Petlichkovski Zlatko Jakovski Sonja Topuzovska Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 78 88 HYPOTHYROIDISM AND ITS ASSOCIATION WITH CHANGES IN THE LIPID PROFILE <p><strong>Introduction: </strong>Thyroid gland dysfunction is presented as overt or subclinical hypothy­roidism and has repercussions on patient’s lipid profile.</p> <p><strong>Aims:</strong> To present patients lipid status with hypothyroidism versus a control group and to determine an association of thyroid status elements with lipid parameters.</p> <p><strong>Material and methods:</strong> This case-controlled retrospective study included a sample of 82 patients, examined group (N=56), who were divided into two subgroups according to the established TSH level (ТЅН&lt;4ulU/ml and ТЅН&gt;4ulU/ml) and a control group (ТЅН&lt;4ulU/ml) (N=26). We analyzed the parameters of the thyroid function (TSH, FT4, FT3, anti-TPO) and se­lec­ted lipid status parameters (cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol).</p> <p><strong>Results:</strong> The comparative analysis between the examined and the control group of patients, as well as between the two subgroups, found no significant difference in the lipid pa­ra­meter levels in relation to selected parameters of the lipid status. The performed correlation among the elements of the lipid status with the thyroid parameters determined a significant linear negative weak correlation between the fT4 and cholesterol, and between fT4 and triglycerides.</p> <p><strong>Conclusion: </strong>These three examined groups did not differ in lipid status, although dyslipidemia is an expected finding in untreated hypothyroidism. The statin therapy influenced on reduction of lipid fraction values ​​in all groups. Therefore, in newly diagnosed patients with hypothyroidism and dyslipidemia, before starting statin therapy, levothyroxine is recommended to be initially administered. Even under conditions of concomitant use of statins, cholesterol and triglyceride levels showed a negative correlation with fT4 and anti-TPO.</p> Maja Jazheva Davchevska Vesela Maleska Ivanovska Vesna Velic Stefanovska Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 89 99 IMPACT OF COVID-19 RELATED STRESSORS ON MENTAL HEALTH IN JUNIOR MEDICAL STUDENTS <p><strong>Introduction: </strong>Concern for mental health consequences in general population world­wide has been apparent since the start of the actual pandemic. <strong> </strong></p> <p><strong>Aim of the study</strong> was to assess the impact of COVID-19 related stressors on mental health in junior medical students during December 2020 COVID-19 related lockdown.</p> <p><strong>Material and methods:</strong> The investigation included 275 second-year medical students aged 19-28 years, from the Faculty of Medicine, Ss. Cyril and Methodius University in Skopje during December 2020. Self-administered questionnaire containing standardized instruments for assessment of parameters of psychological distress (BAI, BDI and PSS) were used. COVID-19 related attitudes questionnaire for assessment of status of COVID-19 testing and infection, self-perceived levels of concerns related to academics [COVID-19-AA (academic apprehensions)] and those related to the self and family/friends [COVID-19-GA (general apprehensions)] were included.</p> <p><strong>Results: </strong>The prevalence of anxiety, depression and stress was 74.9%, 43.3% and 78.9%, respectively. Almost 29% of students reported high anxiety, 6.2% had severe depression and 21.45% reported high levels of perceived stress. There was a significant positive correlation between COVID-19 GA score and BAI, BDI и PSS scores (p&lt;0.05). Correlations between the COVID-19 AA scores and scores on BAI, BDI and PSS scales were also statistically significant (p=0.0000). Academic apprehension was found a predictive factor for high anxiety, depression and high stress (<em>R</em><sup>2</sup> = .12, <em>F </em>(1,273) = 38.79, <em>p</em> &lt; .001. β = 1.12, <em>p</em> &lt; .001).</p> <p><strong>Conclusion:</strong> General and academic apprehension related to COVID-19 have negative effects on mental wellbeing in second year medical students. </p> Sanja Manchevska Jasmina Pluncevic Gligoroska Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 100 111 METHODS FOR PHYSICAL ACTIVITY EVALUATION AMONG THE WORKING POPULATION <p>The high incidence of physical inactivity in the last decades increases the need for development and use of lifestyle interventions that promote physical activity, especially among the working population.</p> <p>The levels of occupational and leisure time physical activity differ and are specific among workers form different occupations, often creating opposing health effects or the so called “physical activity health paradox”.</p> <p>The aim of this paper is to present different methods for physical activity evaluation, and to determine the best methodological approach for the evaluation of the physical activity and its domains among the working population.</p> <p>Through literature review, the most common methods for physical activity evaluation among the working population are shown: subjective (interview, self-reported questionnaires and physical activity logs), objective (measurement of energy expenditure, physiological measurements, use of motion sensors) and combined methods (subjective-objective).</p> <p>Criteria for selection of corresponding methodological approach for physical activity evaluation among the working population are discussed, including the characteristics of the examined population and the used methods (quality, objectivity, level of work load, cost-effectiveness, specific limitations).</p> <p>The obtained data will help create recommendations for interventions for health promotion among the working population.</p> Dragana Bislimovska Copyright (c) 2021 Academic Medical Journal 2021-12-30 2021-12-30 1 2 1 10