Hypoglycemia in Non-diabetics During Development of Acute Coronary Ischemia.

INTRODUCTION: The occurrence of hyperglycemia in non-diabetics during development of acute coronary ischemia (ACI) indicates latent glucose metabolism disorder, or is a case of newly discovered diabetes mellitus (DM) as a result of stress. Acute coronary syndrome refers to a group of clinical syndromes caused by a sudden circulatory disorder in coronary arteries, resulting in the corresponding myocardial ischemia. It covers range from unstable angina and myocardial infarction (MI) without Q wave in the electrocardiogram finding (NSTEMI) up to myocardial infarction with Q wave in the electrocardiogram finding (STEMI). GOAL: To determine the incidence of hyperglycemia in non-diabetics immediately after the occurrence of acute coronary ischemia and assess its risk factors. RESULTS: The sample included 80 respondents. Men dominated with a total prevalence of 77.5%. The respondent was at mean age of 62.8±13.8 years. During the first measurement, immediately after hospital admission, 50% of respondents had increased blood glucose value and during the second measurement 62%. Hypertension as a risk factor has 54% and 56% smoking. The incidence of stress diabetes after ACI does not depend on the diagnosis of hypertension, χ(2)=0.050; p=0.823. The differences of mean values (median) BMI between examined persons with/without stress DM are not statistically significant p=0.402. Independent t-test showed that there was no statistically significant difference in the average values of HDL and LDL in patients with stress diabetes than in patients without diabetes stress after ACI p>0.05. For each year of age odds ratio for "stress diabetes" increases by 7% and 95% CI is 2% -12%. CONCLUSION: The incidence of stress diabetes ACI is not dependent on the working diagnosis (MI or angina pectoris). As risk factors we set hypertension and current smoking. There were no statistically significant associations between active smoking and hypertension as a risk factor in relation to occurrence of stress diabetes.

Spermiogram part of population with the manifest orchitis during an ongoing epidemic of mumps.

INTRODUCTION: Incidence mumps infection has declined since the introduction of the inevitable MRP vaccination during the stage of childhood. In Bosnia and Herzegovina (BIH), from a period of February 2011 until today, there is an evident inclination of the recorded cases of the mumps infection. Orchitis usually occurs in between 3 to 10 days after the parotitis and is found with the post-puberty population. AIM: The aim of the study is to confirm the changes that occur during an early stage of the spermiogram and hormonal status, and after treated mumps orchitis, the patients treated in the Clinic for the Infectious Diseases. PATIENTS AND METHODS: Retrospectively, the analysis of 54 historical diseases was undertaken. During the research stage, the patients after being discharged have made an inquiry to our clinical consultancy units with final results of the spermiogram and hormone-FSH, LH and testosteron. The data analysis was processed with the SPSS program for Windows. RESULTS: the average length of the hospitalization period was in between 8 (medium) days, and average age M (mean) = 21,9 +/- 5,4 years. The speriogram of the treated patients was undertaken one month after the acute phase of the disease and has shown the following results: azoospermia with 14 patients (25,9%), oligospermia with 30 patients (55,6%) and normospermia with 10 patients (18,5%). During the hormonal status with 11 patients (20,4%), the results have shown the inclination of the value in FSH hormons, with 11 patients (20,4%), have shown the lesser value of the testosterons. CONCLUSION: The current study suggests that post-orhitis atrofia is expected within a period of 2-3 months after the infection, and thus, the monitoring on the patients' treatment would continue. The male infertility as a result of mumps ocrhitis is controversial and continues to be the thematic issue as well as the effect of orchitis on testicular endocrine function. Key words: epidemic, mumps

Importance of quick test for screening of former drug users.

INTRODUCTION: Most frequent mode of transmission of HCV today is with intravenous drug use. Former intravenous (IV) drug users present population group more exposed to HCV infection. Longer period of substance abuse, common syringe, more sexual partners (drug users) represent independent, statistically significant risk factors in this population. Diagnosis of HCV infection is based on history, epidemiological data, and clinical presentation, blood tests, histopathological and virology investigation. Hepagnost C is fast immunochromatography test for qualitative detection of HCV antibodies in blood, serum or plasma. Sensitivity of this test compared to EIA is >99% and relative specificity 98,6%. MATERIAL AND METHODS: At Clinic for Infectious diseases (Hepatology Department) voluntary testing with Hepagnost C test was done for 22 former drug users. Results of this cross-sectional study are processed with SPSS program for Windows. RESULTS: Most of the subjects were male (95,5%), average age of 33 +/- 3,5 years with average length of drug usage of 10 (7-12,5) years. All positive (9/22) were tested with EIA test and HCV infection was confirmed (9/9), therefore positive predictive value for Hepagnost C is 100%. We investigated relative risk (RR) with IV drug usage. Higher risk for infection (1,7 times) was among IV. drug users. Odds ratio was 2,4 (chance for HCV in iv. drug users group is 2,4 times higher). Common syringes increase relative risk for 4,5 times, and Odds ratio for infection 9 times. CONCLUSIONS: Hepagnost C test of high sensitivity and specificity showed 100% prediction. It is simple, inexpensive and comfortable test with results within 15 minutes. Demographic characteristics of tested persons as well as statistical results do not deviate significantly from results in available literature.

Therapeutic approach to chickenpox in children and adults--our experience.

INTRODUCTION: Chickenpox is highly contagious childhood disease which occurs as a result of varicella-zoster virus primary infection. Symptomatic therapy is usually adequate for chickenpox, but in some cases it requires combinations of antiviral drugs and antibiotics. OBJECTIVES: To present our expirience with chickenpox therapy in children and adult patients. MATERIAL AND METHODS: Study included 120 randomly chosen patients, 60 adults and 60 children, with confirmed chickenpox infection, hospitalised at Clinic for infectious diseases in Sarajevo. Observed period was 1st January 2005. to 30th June 2011. We compared used therapy and outcome of disease. RESULTS: We had 333 patients with confirmed chickenpox in mentioned period. Male sex prevailed. Antiviral (acyclovir) therapy was initiated in 8(13.5%) adults and 16(27%) children. Most frequently used antibiotic was Co-Amoxiclav in a group of adults and Ceftriaxone in a group of children. DISCUSSION AND CONCLUSION: We use different terapeutical approaches to chickenpox according to the severity of the clinical picture and the existence of underlying diseases. Symptomatic treatment is indicated in all immunocompetent patients with no signs of complications. Use of corticosteroids remains open dillemma. Our therapeutical approcach followed by actual guidelines proved to be usefull. No death cases were recorded in these

A Questionnaire for Rating Health-related Quality of Life.

BACKGROUND: Translations of instruments for measuring quality of life developed in certain, mostly more developed, parts of the world usually do not cover regionally specific aspects of health-related quality of life, even after transcultural validation. The aim of this study was to develop and validate a reliable questionnaire in Serbian, Croatian, Bosnian, and Montenegrin languages suitable for measuring health-related quality of life in adults. METHODS: The study was of a cross-sectional type, assessing the reliability and validity of a newly developed questionnaire for measuring health-related quality of life (HRQoL) in adults residing in western Balkan states (WB-HRQoL). It was conducted on a sample of 489 adults from Serbia, Croatia, Bosnia & Herzegovina, and Montenegro, with a mean age of 52.2±14.4 years and a male/female ratio of 195/294 (39.9%/60.1%). RESULT: The definitive version of the WB-HRQoL scale with 19 items showed very good reliability, with Cronbach's alpha 0.905. The scale was temporally stable, and satisfactory results were obtained for divergent and convergent validity tests. Exploratory factorial analysis brought to the surface four domains of health-related quality of life, namely the physical, psychical, social, and environmental. CONCLUSION: The WB-HRQoL scale is a reliable and valid generic instrument for measuring HRQoL that takes into account the cultural specifics of the western Balkan region.

Predictive Role of Electroencephalography in Regard to Neurological and Cognitive Sequelae After Acute Central Nervous System Infection.

INTRODUCTION: Electroencephalography can also be used to monitor long-term recovery of the patient after acute phase of the disease. Impaired neurocognitive function after infection, similar to brain injury, may present a transient but also prolonged problem for the functioning of an individual. Some studies have shown that importance of EEG may not be significant in sequel monitoring, because the extensive changes in EEG seen with severe forms of CNS infection do not necessarily imply a longer-term poor outcome. AIM: To examine the predictive potential of electroencephalography (EEG) in regard to the emergence of neurological and cognitive sequelae of acute central nervous system (CNS) infection. METHODS: The study included 62 patients treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, who were diagnosed with acute CNS infection. The EEG record was characterized as: normal, non-specific changes of mild, moderate and severe degree and specific changes. The sequelae (headache, cognitive dysfunction, neurological and neurophysiological disorders, audiological and behavioral disorders) was evaluated by combining neurological, psychiatric, pediatric, otolaryngological, ophthalmic and infectological examination in the Neuroinfective Counseling Department for up to 6 months after discharge. RESULTS: After a treatment of an acute CNS infection 25 (40.3%) patients had no sequelae and 37 (59.7%) were with sequelae. The EEG in the initial stage of the disease (Wald's coefficient = 12.8), followed by the age of the patients (Wald = 6.4), had the greatest influence on the prediction of sequela (p=0.0001). For each additional degree of verified pathological changes in the EEG, the risk of sequelae was increased by 5 degrees (OR = 5.3), respectively. There was no statistically significant association between changes in cerebrospinal fluid (CSF) findings, meningeal symptoms, and signs with sequelae development. CONCLUSION: Younger age, as well as severe clinical status of a patient, which implies a disorder of consciousness and seizures on admission, are associated with irreversible consequences on a previously mentally healthy individual. Pathological changes (Delta and Theta waves, spike slow complex wave) on the EEG finding significantly predicted presence of sequelae. .

An Instrument for Rating Quality of Life Related to Sore Throat in Patients Suffering from Acute Pharyngitis or Tonsillitis.

INTRODUCTION: Quality of life in patients with acute pharyngitis or tonsillitis is significantly lower than in healthy persons, and it should be taken into account when efficacy of new therapeutic options is investigated. OBJECTIVE: The aim of this study was to develop and validate a reliable instrument that can measure quality of life in adult outpatients with sore throat caused by acute pharyngitis or acute tonsillitis. METHOD: The study was of a cross-sectional type, and assessed reliability and validity of newly developed questionnaire for measurement of quality of life in adult outpatients with sore throat (STQoL) caused by acute pharyngitis or acute tonsillitis. It was conducted on a sample of 282 patients, with mean age 39.0 ± 14.8 years, male/female ratio 104/178 (36.9%/63.1%). RESULTS: Final version of the STQoL scale with 21 items showed excellent reliability, with Cronbach's alpha 0.949. It was temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains, Social/psychic aspects, Physical aspects and Environmental aspects of sore throat related quality of life. CONCLUSIONS: The STQoL scale is reliable and valid specific instrument for measuring sore throat related quality of life, which is an important treatment outcome in patients with acute pharyngitis or tonsillitis.

T-lymphocyte Subsets as a Prognostic Factor in a Clinical Course of Chickenpox.

OBJECTIVE: To investigate possible prognostic values of CD4+, CD8+ T-lymphocytes, CD4/CD8 ratio to clinical course of chickenpox in immunocompetent hosts. MATERIALS AND METHODS: We performed a prospective study which included 69 immunocompetent patients with chickenpox who were addmited to Clinic for infectious disease, Clinical Center University of Sarajevo, in a 18 month period. All patients were divided into two groups depending on clinical presentation on admission. Patients with mild clinical form were dedicated to "outpatient" group, and patients with moderate, severe or life-threatening clinical forms were dedicated to "hospitalized" group. Also 30 healthy volunteers are included in study as a control group. We analyzed values of CD4+, CD8+ percentage, CD4/CD8 ratio with comparison to clinical course of chickenpox. All specimens were taken in acute phase of illness. RESULTS: Values of CD4+ percentage were significantly declined in a group of hospitalized patients, compared to group of outpatients and control group. Values of CD8+ percentage were higher in a group of hospitalized patients, while CD4/CD8 values were lower in comparison to a group of outpatients and control group. CONCLUSION: We found significant correlation between these parameters and clinical course of chickenpox.

Predictive Role of Preventive Measures in Preventing the Progression of Diabetic Foot.

INTRODUCTION: Diabetes mellitus (DM) is one of the most common endocrine disease of modern life. Diabetic foot (DF) is the term for a foot of a patient suffering from DM with the potential risk of a number of pathological sequels, including infection, ulceration and/or destruction of deep tissue. GOAL: To determine the importance of preventive measures to prevent the development of diabetic foot. RESULTS: The gender structure of respondents categorized by the complication of DF (yes/no) was uniform. The average age was 60.15±12.2 years. Respondents without DF, 63% had 2 visits to the doctor a month, while in the group of those with DF, 39% of them had 3 visits to a doctor and 33% four or more times. Wearing comfortable shoes and foot hygiene in relation to the development of the DF are interdependent: c(2)=4,409; c(2) = 12.47 (p <0.0005). Also, recurrent foot injury, and slow healing of sores in comparison to the development of the DF are mutually dependent; c(2)=13,195; c(2)=14 (p <0.0005). CONCLUSION: We found that there is a significant statistical relationship between preventive measures and development of the DF.

[Endocarditis caused by Coxilla burnetii]. / Endokarditis uzrokovan Coxiellom burnetii.

Q-fever is antropozoonosis caused by Coxiella burnetii. The microorganism usually transmitted to humans through the inhalation of infected dust from sub clinical infected mammals. The most common reservoirs for Coxiella burnetii are large numbers domestic and wild animals. The illness can occur by farmers or slaughterhouses, or veterinarian and laboratories workers. In this report we presented case of endocarditic caused by Coxiella burnetii. The patient is driver 43 years old, who lived in the countryside Nahorevo. He hospitalized in May, 2002. He had symptoms of hepatitis, with elevation of transaminases in sera. Endocarditic was diagnosed by echosonografy. The patient is controlled by infectologist, cardiologist by cardio-surgeon, but since disease is in progress and operation treatment will be probably necessary.