[CIGARETTE SMOKING AMONG SCHOOL ADOLESCENTS IN THE BRCKO DISTRICT OF BOSNIA AND HERZEGOVINA: A CROSS-SECTIONAL STUDY]. / PUSENJE CIGARETA MEDU ADOLESCENTIMA U DISTRIKTU BRCKO U BOSNI I HERCEGOVINI: PRESJECNA STUDIJA.

Objective: The objective of the study was to determine the prevalence of cigarette smoking in adolescents in public schools of the Brcko District of B&H in relation to their gender, age and place of residence. Participants and ­Methods: A cross-sectional study, based on the ESPAD (European School Survey Project on Alcohol and Other Drugs) questionnaire adapted to this research comprised 4,188 respondents who attended primary and secondary schools. Data were collected using a questionnaire prepared for each respondent. Results: Significantly fewer respondents smoke cigarettes compared to those who do not (p < 0.001), while in relation to gender male adolescents smoke more often than female adolescents (p = 0.012). In relation to their place of residence it is established that a significantly higher number of respondents from rural areas smoke cigarettes compared to those from the city (p < 0.001). More than half of the respondents, who smoke regardless of their gender, had their first cigarette before the age of 13. Male adolescents often begin smoking before the age of thirteen compared to female adolescents (p < 0.001), while female adolescents often begin smoking between the ages of 15 and 16 in relation to male adolescents (p <0.001). Every second respondent who smokes cigarettes irrespective of his/her place of residence did so at the age of 13. However, the respondents from rural areas smoke more often (p < 0.0001). Out of 895 respondents who smoked during the last month, 259 of or 30.3 % smoked only one cigarette a week, 162 or 18.1 % smoked 1-5 cigarettes a day, 168 or 18.8 % of the respondents smoked 6-10 cigarettes a day, 146 or 16.3 % smoked 11 to 20 cigarettes a day, and 160 or 17.9 % of the respondents smoked every day. Conclusion: Although 42.8 % of the respondents who had ever smoked cigarettes is significantly less compared to 57.2 % of the respondents who do not smoke, that number is disturbing since we talk about the vulnerable population group and the fact that every second adolescent started smoking at the age to 13.

Should the practice of double blastocyst transfer be abandoned? A retrospective analysis.

As multiple pregnancy is now considered to be an adverse event of an IVF procedure, reducing the multiple pregnancy rates has become the goal of many IVF centres. A large number of double blastocyst transfers in non-selected patients were performed in the author's institution over recent years, and a retrospective analysis was conducted to investigate if multiple pregnancy rates in such a population are still unacceptably high. In addition, the factors determining the birth of singletons or multiple births following the transfer of two blastocysts was analysed. The live-birth rate per cycle was 35.7%, and the multiple-birth rate was 44.2% of all births. When clinically important variables that performed significantly in univariate analysis were analysed in the multiple regression model, age was negatively correlated with singleton and multiple births, and the transfer of two optimal blastocysts was positively correlated. Based on these results, abandoning the transfer of two blastocysts at least in patients younger than 37 years is recommended, regardless of embryo quality, as even the transfer of two non-optimal blastocysts results in almost 20% multiple births.

Evaluating the effects of amantadin, modafinil and acetyl-L-carnitine on fatigue in multiple sclerosis--result of a pilot randomized, blind study.

OBJECTIVE: Fatigue affects more than 60% of multiple sclerosis (MS) patients and is one of the most troublesome symptoms of the disease. Current treatment options for MS fatigue include amantadine, modafinil and acetyl-l-carnitine (ALCAR). The aim of our study was to compare efficacy of amantadine, modafinil and ALCAR with placebo in patients with MS. METHODS: Patients with MS and a disability level ≤ 5.5 on the Kurtzke Expanded Disability Status Scale (EDSS) and fatigue were included in the study. Patients were assigned to a one month treatment with either amantadine 200mg, ALCAR 2g, modafinil 200mg or placebo. Efficacy of the treatment was evaluated by using the modified fatigue impact scale (MFIS). RESULTS: Sixty patients were included in the study (39 females). The mean age of patients was 38 ± 6.7 years and the mean disease duration was 6.6 ± 1.2 years. Contrast analysis showed significantly lower mean MFIS score after one month in patients on amantadine compared to placebo (mean difference=17.3, p=0.001). There was also a trend of a lower MFIS score in ALCAR group in comparison to placebo (mean difference=12.4, p=0.05, with Keppel-corrected alpha of 0.046). The quality of life measured as SF 36 - PCS and SF 36 - MCS proved to be significantly influenced by treatment. CONCLUSION: One month treatment with amantadine improved fatigue in patients with relapsing-remitting MS as evaluated by MFIS. No or only a trend of improvement was seen in patients treated with modafinil or ALCAR, respectively.

Catheter aspiration in ST-elevation myocardial infarction and different extent of coronary thrombus.

Manual catheter aspiration appears to be a useful adjunct to primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction. We investigated effects of catheter aspiration during primary PCI in patients with different extents of coronary thrombus. The study included 46 patients with no or possible thrombus (thrombus scale [TS] grades 0 to 1) and 135 patients with angiographic evidence of obvious thrombus (TS grades 2 to 5). Reference vessel diameter, which was significantly larger in the group with TS grades 2 to 5 (3.4 vs 3.2 mm, p = 0.004), was the only independent predictor of angiographically visible thrombus (odds ratio 3.3, 95% confidence interval 1.3 to 8.7, p = 0.015, per millimeter increase). Aspiration catheter was successfully advanced across the lesion in 89% of patients with TS grades 0 to 1 and 96% of those with TS grades 2 to 5 (p = 0.115). Number of aspirations varied from 1 to 5 and was significantly larger in patients with TS grades 2 to 5. Visually observable aspirate was obtained in 90% of patients with TS grades 2 to 5 and in 67% of patients with TS grades 0 to 1 (p <0.001) with more patients with TS grades 2 to 5 having aspirate >5 mm in length (49% vs 11%, p <0.001). Final Thrombolysis In Myocardial Infarction grade 3 flow (89% vs 92%), residual TS (0.2 vs 0.1), frequency of distal embolization (2% vs 6%), and early complete ST resolution (65% vs 70%) were comparable between groups with TS grades 0 to 1 and 2 to 5. In conclusion, although the amount of aspirate is larger in patients with angiographically obvious thrombus, visually observable aspirate can be obtained in most patients without definite signs of thrombus. Extent of coronary thrombus does not influence primary PCI result if manual aspiration is used.

A prospective, randomized trial on the effect of atmospheric versus reduced oxygen concentration on the outcome of intracytoplasmic sperm injection cycles.

OBJECTIVE: To assess whether the embryo cultivation at different oxygen tensions had any effect on intracytoplasmic sperm injection (ICSI) outcome. DESIGN: Prospective randomized trial. SETTING: University clinical center. PATIENT(S): Women undergoing ICSI (n = 647). INTERVENTION(S): Culturing of embryos, either at 6% CO(2), 5% O(2), 89% N(2), or at 6% CO(2) in air. MAIN OUTCOME MEASURE(S): The primary outcome was ongoing pregnancy rates (PR). SECONDARY OUTCOMES: cumulative PRs, implantation, and embryo quality, for both treatment groups and clinical outcomes for subgroups (optimal cycles, poor responders, older women). RESULT(S): Although low oxygen resulted in a higher proportion of good day 2 embryos (0.547 +/- 0.021 vs. 0.39 +/- 0.019) and optimal blastocysts (0.162 +/- 0.199 vs. 0.083 +/- 0.128), the ongoing PRs (31.6% vs. 27.1%) and implantation rates (28.8% vs. 25.2%) were similar in both oxygen groups. Low oxygen caused a higher cumulative PR (38% vs. 28.3%) in the main group and a higher PR in the poor responder subgroup (23% vs. 9.8%) with embryo transfers performed mostly on day 3. CONCLUSION(S): The use of reduced oxygen in IVF is reasonable, irrespective of the duration of embryo culture. It improves embryo development and cumulative PR and is also recommended in poor responding cycles.

Impact of insulin resistance on the developmental potential of immature oocytes retrieved from human chorionic gonadotropin-primed women with polycystic ovary syndrome undergoing in vitro maturation.

In a homeostasis model assessment-insulin resistance (HOMA-IR)-positive group of women with polycystic ovary syndrome undergoing in vitro maturation (IVM), the maturation rate of immature oocytes was significantly lower compared with a HOMA-IR negative group of women (47% vs. 59%). The results of our study showed that IR and hyperinsulinemia have an adverse effect on the developmental potential of immature oocytes retrieved in the IVM procedure.

Results of intracytoplasmic sperm injection of single oocyte in 362 unstimulated cycles.

PURPOSE: The purpose was to test the adequacy of unstimulated cycles for intracytoplasmic sperm injection (ICSI) and to evaluate implantation and pregnancy rates in three different age groups. METHODS: ICSI was performed in 362 unstimulated cycles in women up to 45 years old. All cycles were monitored by serum estradiol, urinary LH, and ultrasound. RESULTS: The delivery rate per started cycle was higher in patients younger than 36 (9.4%) than in cycles with patient's age between 36 and 39 years (4.8%) or older than 40 (4.6%) but the difference was not statistically significant. In all groups, the fertilization rate was similar (70.4, 77.6, and 84.8%, respectively). The pregnancy rate per cycle and the pregnancy rate per puncture was similar in the group of patients in age between 36 and 39 years (8.3 and 9.7%) and those older than 40 (7.7 and 9.3%). CONCLUSIONS: Unstimulated cycles monitored by serum estradiol, urinary LH, and ultrasound can produce an acceptable pregnancy rate after ICSI procedure only in patients younger than 36.