Overweight and obesity prevalence: a pilot implementation of the ?COSI" methodology in the Republic of Srpska.

OBJECTIVES: Childhood obesity has become a worldwide public health concern over the past decade, counting Bosnia and Herzegovina (BiH). The Childhood Obesity Surveillance Initiative (COSI) was established by the World Health Organization (WHO) to address the lack of standardized surveillance data on childhood obesity. However, BiH and its entity, Republic of Srpska (RS), are failing inclusion in such initiative, which hinders efforts to monitor and address the issue. Henceforth, the objective of this nationally funded study was to gather and analyse data on the prevalence of overweight and obesity among primary-school children in RS by implementing the COSI methodology. METHODS: Weight, height, and BMI of first, second, and third grade children (aged 6-8), from 11 schools (N = 2,030) in the RS region was analysed according to the standardized COSI protocol. RESULTS: The prevalence rates of overall overweight (OW) and obesity (OB) observed were 14.37% (OW 9.09%, OB 5.21%). No gender-related differences were noted (boys 14.36%, girls 14.88%). CONCLUSIONS: These findings highlight a concerning trend of increasing overweight and obesity prevalence with age among primary-school children in the RS.

Kinematic parameters and metabolic power in elite soccer players: A small sided a large sided games comparison.

Introduction: The goal of this paper is to determine what happens in one minute (on average) in kinematic parameters and metabolic power in small sided games (SSG) (3v3; 5v5) and large sided games (LSG) (10v10) and in which games kinematic parameters and metabolic power are best developed. Methods: The participants of this study were 22 professional football players, height 182.95±6.52 cm, mass 77.17±8.21 kg, body mass index (BMI) 22.97±1.47 kg/m2, body fat 9.85±2.55 %, aged 27.1±5.4 yrs, who played in the Premier League of Bosnia and Herzegovina. Data total distance (TD), maximum speed (MS), number of accelerations (nAcc), number of decelerations (nDec), number of sprints (nS), high intensity distance (Z4≥19.8 km/h), sprint distance (Z5≥25.2 km/h) and movements requiring a certain metabolic power (Pmet), were collected using a 20 Hz Global positioning system (GPS) system Pro2 (GPEXE, Exelio srl, Udine, Italy), on a total of 307 individual observations. Results: The results showed that the average total distance was significantly higher in the 5v5 (135.16±18.78 m) and 10v10 (133.43±20.06 m) games (F=64.26, p<0.001) compared to the 3v3 (108.24±11.26 m). Furthermore, the values of the variables Z4 (8.32±3.38 m, F=97.59), Z5 (1.84±1.53 m, F=123.64), nS (0.13±0.10 n, F=96.14) as well as Maxspeed (27.06±1.90 km/h, F=139.33), are statistically significantly higher (p<0.001) in the 10v10 game compared to the other two game formats. The average number of nAcc (0.40±0.32 n, F=9.86, p<0.001) and nDec (0.62±0.36 n, F=6.42, p<0.001) is statistically significantly higher in the 5v5 game. The results showed that the 5v5 game is significantly more metabolically demanding Pmet (2.76±0.67 W•kg-1, F=66.08, p<0.001) compared to the other two game formats. Discussion: The data presented in this paper can be used as a basis for the construction of specific exercises based on kinematic and physiological requirements, and for planning and programming microcycles in football.

Hepatic Epithelioid Hemangioendothelioma and Adult Liver Transplantation: Proposal for a Prognostic Score Based on the Analysis of the ELTR-ELITA Registry.

BACKGROUND: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor which has an intermediate aggressive behavior. Although the value of liver transplantation (LT) is well established, its place in the management of HEHE is still unclear. The aim of this study is to confirm, based on a very large patient cohort, the value of LT in the management of HEHE and to identify risk factors for post-LT recurrence. METHODS: The outcome of 149 transplant recipients with HEHE recorded in the European Liver Transplant Registry during the period November 1984 to May 2014 was analyzed. Median post-LT follow-up was 7.6 years (interquartile range, 2.8-14.4). RESULTS: Cox regression analysis showed that macrovascular invasion (hazard ratio [HR], 4.8; P < 0.001), pre-LT waiting time of 120 days or less (HR, 2.6; P = 0.01) and hilar lymph node invasion (HR = 2.2; P = 0.03), but not pre-LT extrahepatic disease, were significant risk factors for recurrence. These findings, which were also confirmed in a propensity score analysis, allowed the development of a HEHE-LT score enabling stratification of patients in relation to their risk of tumor recurrence. Patients with a score of 2 or less had a much better 5-year disease-free survival compared to those having a score of 6 or higher (93.9% vs 38.5%; P < 0.001). CONCLUSIONS: The analysis of this (largest in the world) HEHE adult liver recipient cohort clearly confirms the value of LT in the treatment of this rare disorder and also permits identification of patients at risk of posttransplant recurrence. Posttransplant follow-up should take the HEHE-LT score into account. Extrahepatic disease localization is reconfirmed not to be a contraindication for LT.

CD19+ in intestinal mucosa predict the response to infliximab in Crohn's disease.

BACKGROUND/AIMS: Infliximab is an effective treatment for Crohn's disease, yet about 30% of patients have a weak or no response. The aim of the study was to determine if the likelihood of a patient achieving complete remission 3 months after treatment with infliximab can be predicted from immunological parameters measured in peripheral blood and inflamed intestinal mucosa before the treatment. METHODOLOGY: 25 patients with Crohn's disease resistant to conventional therapy underwent treatment with infliximab. Samples of peripheral blood and inflamed intestinal mucosa were analyzed by flow-cytometry before infliximab administration. The clinical response was evaluated after 3 months. RESULTS: At 3 months post-treatment, 11 (44%) patients were in complete remission, while 14 (56%) had no remission. Logistic regression analysis revealed that 50% of patients having 2.29% of CD19+ cells in inflamed intestinal mucosa may be expected to achieve complete remission. If the proportion of CD19+ cells in the inflamed mucosa is 5%, the probability of the patient achieving complete remission following treatment rises to 85%. CONCLUSIONS: This is the first study which found that a high percentage of CD19+ cells in the inflamed intestinal mucosa of a patient with Crohn's disease may predict long remission after infliximnab therapy.

The effects of physical training on cardiovascular parameters, lipid disorders and endothelial function.

BACKGROUND/AIM: [corrected] Regular physical activity is widely accepted as factor that reduces all-cause mortality and improves a number of health outcomes. The aim of this study was to investigate the effects of aerobic exercise training on cardiovascular parameters, lipid profile and endothelial function in patients with stable coronary artery disease (CAD). METHODS: The study included seventy patients with stable CAD. All the patients were divided into two groups: the group I--33 patients with CAD and with regular aerobic physical training during cardiovascular rehabilitation program phase II for 3 weeks in our rehabilitation center and 3 weeks after that in their home setting, and the group II (control)--37 patients with CAD and sedentary lifestyle. Exercise training consisted of continual aerobic exercise for 45 minutes on a treadmill, room bicycle or walking, three times a week. We determined lipid and cardiovascular parameters and nitric oxide (NO) concentration at the beginning and after a six-week of training. RESULTS: There were no significant differences in body weight, waist circumference and waist/hip ratio at the start and at the end of physical training program. Physical training significantly reduced body mass index after six weeks compared to the initial and control values. Physical training significantly reduced systolic and diastolic blood pressure and heart rate after a six-week training period (p < 0.05). Heart rate was significantly lower after a training period as compared to the control (p < 0.05). A significant reduction of triglyceride and increased high density lipoprotein cholesterol (HDL-C) concentration after cardiovascular rehabilitation were registered (p < 0.05). The concentration of triglycerides was significantly lower while NO and HDL-C were higher after six weeks in the exercise training group (p < 0.05). CONCLUSION: Dynamic training can improve blood pressure in patients with moderate to severe hypertension and reduce the need for medication. Exercise programs induced favorable adaptations on lipoproteins profile, cardiovascular parameters and endothelial function which are clinically desirable in primary and secondary prevention of CAD.

Acute biliary pancreatitis: detection of common bile duct stones with endoscopic ultrasound.

OBJECTIVES: To determine prospectively the sensitivity and specificity of endoscopic ultrasound (EUS) for detecting common bile duct stones (CBS) in patients with acute biliary pancreatitis in whom transabdominal ultrasound was negative for CBS. METHODS: In 38 consecutive patients with acute biliary pancreatitis who were negative for CBS by transabdominal ultrasound, EUS was performed before endoscopic retrograde cholangiopancreatography (ERCP). The endoscopist performing ERCP was blind to the results of EUS. The primary goal of EUS and ERCP was to confirm or exclude CBS. The reference standard for CBS was endoscopic extraction of bile duct stones after endoscopic sphincterotomy. When both procedures, EUS and ERCP excluded CBS, it was assumed that there were no CBS and endoscopic sphincterotomy was not performed. The results EUS and ERCP were compared with the McNemar test. RESULTS: Twenty-five of the 38 patients (66%) had CBS. EUS and ERCP were false negative in one patient each, EUS was false positive in two patients and ERCP in one patient. The sensitivity of both EUS and ERCP was 96%. The specificity of EUS and ERCP was 85 and 92%, respectively. The difference between EUS and ERCP was not significant (P=0.9). CONCLUSION: EUS proved to be as sensitive as ERCP for detection of CBS in patients with acute biliary pancreatitis. Therefore, EUS could be used as the first-line procedure in patients with acute biliary pancreatitis when therapeutic ERCP is not needed. By this approach a substantial number of unnecessary diagnostic ERCP procedures could be avoided.

Infliximab reduces the number of activated mucosal lymphocytes in patients with Crohn's disease.

BACKGROUND: Infliximab is an effective treatment for Crohn's disease in patients with poor prior response to conventional therapy. The mechanism by which infliximab induces clinical improvement is not completely known. AIM: The aim of the study was to investigate the influence of infliximab on immunological parameters in peripheral blood and inflamed intestinal mucosa. METHODS: Twenty-five patients with Crohn's disease (11 with luminal and 14 with fistular form) underwent treatment with infliximab. The lymphocyte populations from the peripheral blood and the inflamed intestinal mucosa were analysed by flow cytometry before treatment and 14 days later. RESULTS: After treatment, the peripheral blood analysis showed a significant increase in the percentage of CD19 cells and the concentrations of CD3, CD4, CD8 and activated (HLA DR positive) T cells, while the percentage of NK cells was reduced. In the inflamed mucosa, a significant decrease in the percentage of activated T cells and expression of HLA I molecules by epithelial cells was noted. CONCLUSIONS: Infliximab profoundly downregulates inflammation in the intestinal mucosa of patients with Crohn's disease. This effect is manifested by a reduction of activated T cells, main producers of proinflammatory cytokines, in the inflamed mucosa.

Bile in the esophagus: a factor in the pathogenesis of reflux esophagitis in children.

OBJECTIVES: Bile reflux has been postulated to be an important factor contributing to gastroesophageal reflux disease in adults. The purpose of this study was to investigate its role in children. METHODS: Sixty-five children with symptoms of gastroesophageal reflux disease were classified on the basis of the endoscopic grade of reflux esophagitis: no esophagitis (n = 26), mild to moderate esophagitis (n = 26), and severe esophagitis (n = 13). Simultaneous 24-hour esophageal pH and bilirubin monitoring with Bilitec 2000 was performed. RESULTS: Both bile and acid reflux increased with the severity of esophagitis. The differences between all groups were significant for the percentage of total (P < 0.0005), upright (P < 0.05), and supine time (P < 0.0005) bilirubin absorbance > or = 0.14, as well as for the percentage of total and supine time pH < 4, and DeMeester score (P < 0.0005). Combined pathologic acid and bile reflux was found in 11% of children with mild esophagitis and in 70% of children with severe esophagitis, while isolated bile reflux was found in 31% and 7.5%, respectively. Combined pH and bilirubin monitoring, compared with ph-monitoring alone, increased the sensitivity from 56% to 79%, and the accuracy from 69% to 83%. CONCLUSIONS: Both bile and acid reflux increase stepwise with the severity of esophagitis. Combined acid and bile reflux is associated with severe esophagitis. Isolated acid or bile reflux is usually present in mild esophagitis. Simultaneous esophageal pH and bilirubin monitoring has a higher sensitivity, as well as predictive values and accuracy than ph monitoring alone.