The Association of Obesity and Microvascular Complications with Glycemic Control in Patients with Type 2 Diabetes Mellitus.

INTRODUCTION: According Type 2 diabetes mellitus is a chronic metabolic disease with a high prevalence characterized by elevated blood glycemic values and with progressive development of micro and macrovascular complications. Glycemia control is a very important factor in the process of "delaying" the onset of complications by glycated hemoglobin (HbA1c) analysis. AIM: The aim of the study is to determine the association of obesity, microvascular complications with glycemic control in patients with type 2 diabetes. METHODS: The study was prospective, involving 105 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska from January 2016 to January 2018. The patients were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was evaluated based on a target HbA1c value of 7%. RESULTS: Out of the 105 patients in the study, 45.8% were male, 54.2% female. The mean age of the patients was 68.3%±10.7 years. The mean HbA1c level was 8.32±1.57%. Of the total number of patients, in 25.7% the HbA1c levels were ≤7.0%, while in 74.3% the HbA1c were ≥7.0% (p<0.001). There were 57.1% of obese patients, of whom 37.0% had HbA1c ≤7.0%, and 64.1% had HbA1c ≥7.0% (p<0.014). Depending on the duration of diabetes, the study found that ≥7.0% HbA1c was more present in patients with an diabetes duration over 20 years (24.4%) compared with those who had had the diabetes for less than 20 years (3.8%) (p<0.037). Microvascular complications were present in 58 patients (55.2%), of which 33.3% had normal HbA1c values, while unregulated glycemia had 62.8% (p<0.008). Retinopathy was present in 40.9%, polyneuropathy 37.1% and nephropathy 32.4% from which the unregulated glycemia (HbA1c ≥7.0%) was present in 39.7% of patients compared to normal glycemic values in 11.1 % of respondents (p<0.006). In 88 patients, certain diseases were present: hypertension in 76.2% of patients, cardiovascular disease 58.0% and hyperlipidemia 35.2%. CONCLUSION: Glycemia control in obese patients with type 2 diabetes mellitus is important especially for the prevention of serious microvascular complications that significantly affect the quality of life of patients.

Guidelines for Editing Biomedical Journals: Recommended by Academy of Medical Sciences of Bosnia and Herzegovina.

BACKGROUND: Enormous number of medical journals published around the globe requires standardization of editing practice. OBJECTIVE: The aim of this article was to enlist main principles of editing biomedical scientific journals adopted at annual meeting of Academy of Medical Sciences of Bosnia & Herzegovina (AMSB&H). METHODS: The evidence for writing this Guideline was systematically searched for during September 2020 in the PUBMED and GOOGLE SCHOLAR databases. The inclusion criteria were: original studies, systematic reviews, invited expert opinions, guidelines and editorials. The exclusion criteria were narrative reviews and uninvited opinion articles. The retrieved evidence was analyzed by members of the AMSB&H, then discussed at 2020 annual meeting of the AMSB&H and adopted by nominal group technique. RESULTS: In total 14 recommendations were made, based on A to C class of evidence. The editors should educate potential authors and instruct them how to structure their manuscript, how to write every segment of the manuscript, and take care about correct use of statistical tests. Plagiarism detection softwares should be used regularly, and statistical and technical editing should be rigorous and thorough. International standards of reporting specific types of studies should be followed, and principles of ethical and responsible behavior of editors, reviewers and authors should be published on the journal's web site. The editors should insist on registration of clinical studies before submission, and check whether non-essential personal information is removed from the articles; when essential personal information has to be included, an article should not be published without signed informed consent by the patient to whom these information relate. CONCLUSIONS: Principles of editing biomedical scientific journals recommended in this guideline should serve as one of the means of improving medical journals' quality.

Balkan Clinical Research Registry: Established by Academy of Medical Sciences of Bosnia and Herzegovina.

BACKGROUND: From 2013 the World Medical Association's Declaration of Helsinki explicitly requires pre-registration of a study involving human subjects. The registration gives a chance for improvement of design and avoidance of bias. OBJECTIVE: The aim of this article was to describe process of bearing decision to create regional registry of clinical studies for Balkan countries. METHODS: After finding relevant studies about research registries and designing the concept and structure of future regional registry an article was published in IJBH journal. The article was than used as basis for discussion at 2020 meeting of Academy of Medical Sciences of Bosnia and Herzegovina (AMSBH), and final decision was made by the Academy to create the research registry. RESULTS: Regional registry of clinical studies will be under the auspices of AMSBH and web-based, with the option of online registration of new studies. The data required to be entered in the moment of registration relate to key elements of research plan: topic, variables, sample, type of the study and the study population. After applying for registration of a clinical study, the authors will soon receive the review made by the AMSBH expert committee. The application could be accepted, rejected or returned for major or minor revision. After an application is accepted, it will be deposited in the searchable database and given the registration number. CONCLUSION: The AMSBH's decision to create the regional registry of clinical studies will satisfy needs of researchers from Balkan countries in the first place, who share cultural and lingual similarities. It will also help with increasing standards of clinical research in the region.

Correlation Between Extracutaneous Microvascular Complications and Diabetic Foot Ulcers in Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Diabetes is a metabolic disease that is taking an epidemic proportion around the world. The occurrence of microvascular complications and diabetic foot ulcer is associated with an increased mortality and morbidity incidence, which is the most serious complication of this disease, which significantly reduce the quality of patient life. OBJECTIVE: The aim of the study was to determine the correlation of extracutaneous microvascular complications with diabetic foot ulcer in patients with type 2 diabetes. METHOD: The study was prospective, and included 160 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska in the period from January 2016 until December 2019. The respondents were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was established based on a target HbA1c value of 7%. RESULTS: Of the 160 patients in the study, 53.8% were men and 46.2% were women. The average age of the patients was 70.11%±10.05 years. Extracutaneous microvascular complications were present in 85 patients (53.1%); of which 30.2% had well-regulated glycemia (HbA1c≤7.0%), while 61.5% (p<0.001) had unregulated glycemia (HbA1c≥7.0). Polyneuropathy was present in 23.3% of patients with HbA1c≤7.0%, while 41.0% of patients had HbA1c≥7.0% (p<0.043). Nephropathy with HbA1c≤7.0% was present in 36.8% of cases compared to patients with HbA1c≥7.0 in whom the prevalence was 36.8% (p<0.004). Out of total, 25.6% had retinopathy with HbA1c≤7.0%, while in 41.9% of patients with HbA1c≥7.0% (p <0.067). Diabetic ulcer foot was present in 13 patients with HbA1c≥7 (11.1%) compared to patients with HbA1c≤7.0% where there was no occurrence of this complication 0.0% (p<0.021). At the same time, 5.6% of patients had a diabetic foot ulcer with polyneuropathy (p=0.010), 4.4% had neuropathy (p=0.058) and 5.6% had retinopathy (p=0.014). CONCLUSION: The high incidence of extracutaneous microvascular complications and diabetic foot ulcer in patients with type 2 diabetes requires a multidisciplinary approach of medical professionals that includes prevention of risk factors and good regulation of glycemia.

The Influence of Non-preventable Risk Factors on the Development of Osteoporosis in Postmenopausal Women.

INTRODUCTION: Scientific studies show that many genetic factors can significantly contribute to the onset of osteoporosis in women. AIM: The aim of our study was to determine whether non-preventable risk factors (certain genetic predisposition - positive parameters of family and personal history, i.e. family history of osteoporosis, family history of fractures, osteoporotic fractures, previous fractures, menopause duration) can affect the occurrence of osteoporosis in women in postmenopausal age. METHODS: The study was performed as matched case and controls study. A group of cases consisted of 100 female postmenopausal women in whom by the DEXA method was newly diagnosed osteoporosis at the Clinic for Endocrinology, Diabetes and Metabolism of the University Clinical Center of Republic Srpska during 2015-2016, while the control group consisted of 100 female postmenopausal women without diagnostic signs of osteoporosis. Groups were matched by age (± 2 years). In order to collect demographic data and data on risk factors for osteoporosis and life habits of patients, the Bone Mineral Density Questionnaire for females of the Irish Society for Osteoporosis was used. RESULTS: The results of the univariate logistic regression in our study did not show that early loss of the menstrual cycle before 50 years of age was a significant factor for osteoporosis in postmenopausal women (p=0.421, OR=0.966, 95% CI=0.889-1.051). The analysis of the data of a positive family history of osteoporosis as a risk factor by the model of the multivariate of logistic regression shows that the presence of osteoporosis in close relatives (usually the mother) represents a significant and independent risk factor for the development of osteoporosis (p=0.003, OR=4.567, 95% CI=1.674- 12.460). The results of the study show that the presence of earlier fractures in the tested subjects is a significant independent risk factor for osteoporosis (p=0.015, OR=2.464, 95% CI=1.195-5.084). CONCLUSION: The results of our study show that the presence of osteoporosis in close relatives (usually the mother) and the existence of previous fractures are significant risk factors for the occurrence of osteoporosis. The presence of these factors may be the reason for the selection of patients for further preventive or curative procedures.

Duplex System with Ectopic Ureter Opens into the Posterior Urethra: Case Report.

INTRODUCTION: Duplicated ureter or Duplex Collecting System is a congenital condition in which the ureteric bud, the embryological origin of the ureter, arises twice, resulting in two ureters draining a single kidney. This congenital anomaly is rare, and even rarer when the duplex system with ectopic ureter is present. This type of congenital anomaly is even more rarely diagnosed and surgically treated in adulthood. CASE REPORT: This case report presents a case of a 32-year-old male, who had a duplex collecting system with two ureters on the left side. Ectopic ureter, draining the upper pole of the left kidney, opened into the posterior urethra. In our patient, taking into account the clinical perspective, the renal tissue damaging of the upper pole which was not functional, partial nephrectomy and ureterectomy was successfully performed.

Myometrium Invasion, Tumour Size and Lymphovascular Invasion as a Prognostic Factor in Dissemination of Pelvic Lymphatics at Endometrial Carcinoma.

OBJECTIVE: The aim of this work is to show the importance of the depth of myometrium invasion, tumour size and lymphovascular invasion as prognostic factors in dissemination of lymphatic nodes at endometrial carcinoma (CE). MATERIALS AND METHODS: In the period from 2010 to 2015 at the University Clinic for Gynecology and Obstetrics in Banja Luka, 221 endometrial cancer surgeries were done (laparatomy 184-83%, laparascopy 37-16,74%). Patients who had uterus bleeding in peri/postmenopause or those whose endometrium thickness was bigger than 5 mm which was established by ultrasound, or those who had in their cavum uteri pathological (PH) diagnosis, underwent fractional curettage (FC) or hysteroscopy in order to obtain pathohistological endometrium diagnosis. Substances which were removed by fractional curettage, biopsy or by surgery were sent to patohystological analysis. We analysed the following factors: age (5 groups), histological grade (G) of tumour, depth of myometrial invasion (DIM), whether it is more or less than 50%, the size of the tumour (if it is bigger or smaller than 2 cm), positive or negative lymphovascular invasion (LVI), positive or negative pelvic lymph nodes (PLN). RESULTS: Within histological type the endometrioid type CE 166 (75,11%) was most dominant. Adenocarcinoma of endometrium was present 25 (11,31%), serous CE 11 (4,97%) and clear cell KE 2 (0,90%). Dominant population with CE was over 60 years old 127 (57,46) of female patients. At G3 where DIM was <50% positive PLN were present 2 (3.92%), whereas if DIM was>50%, 6 (26,73%) patients with positive PLN were registred. Tumour size < 2 cm was found with 57 (25,79%) female patients with positive PLN 8 (14,03%), while 164 (74,20%) patients had tumours > 2 cm who had 21 (12,80) PLN metastases. At G1 when tumour was <2 cm, positive PLN had 3 patients (5,88), while when tumour was >2 cm, positive PLN were found at 6 patients (9,69%). At G3 whose size was <2 cm, positive PLN were found at 2 patients (16,66%), but when tumour was >2 cm, PLN metastases were more frequent, 6 (25,00%). Negative LVI was found with 168 patients (76,01%) whose PLN were positive 16 (9,52%), while positive LIV was with 53 patients (23,99%) of whom 14 had PLN metastases (26,41%). At G1 two patients had positive PLN (2,32%) with negative LVI, while with positive LVI, positive PLN were found at 3 patients (11,11%). At G3 having negative LVI positive PLN were found with 6 patients (24,00%), while if LIV was positive, the number of positive PLN were 6 (54,54%). CONCLUSIONS: With low risk for lymphatic spread (DIM less than 50%, tumour size smaller than 2 cm and lack of LVI at G1 CE) we also encounter low metastasis rate of PLN. Diagnoses of this kind have an aim to lower the number of pelvic lymphadenectomies. With patients who have a high risk of lymphatic spread (myometrium invasion >50%, tumour size > 2cm, LVI present at G2 and G3) metastasis rate of PLN is high, therefore it is necessary to perform pelvic and paraaortic lymphadenectomy which lowers the mortality rate for more than 50% and at the same time patients get an absolute chance of 5-year survival period.

Correlation of Oxidative Stress Markers with Ultrasound and Cardiotocography Parameters with Hypertension Induced Pregnancy.

INTRODUCTION: Pregnancy induced hypertension (PIH), especially preeclampsia, is a state of extremely increased oxidative stress (OS), due to decrease of antioxidant capacity in comparison to normotensive pregnant women. The consequences of increased state of oxidative stress with hypertension disorder in pregnancy are disorder of placental blood flow, intrauterine hypoxia of the fetus and disturbance in transfer of O2 manifested as pathological ultrasound (US) parameters (amount of amniotic fluid and biophysical profile of fetus) and cardiotocography parameters (CTG). AIM: The aim of this research is to analyze correlation of TBARS oxidative stress markers with ultrasound parameters of pregnancy course and cardiotocography parameters in pregnant women with PIH. PATIENTS AND METHODS: Research has been performed at the Clinic of Gynecology and Obstetrics, University Clinical Centre of the Republic of Srpska. It covered 200 pregnant women, 100 of them with PIH and 100 healthy pregnant women, at gestational age from 28 to 40 weeks. All pregnant women were analyzed for US parameters of pregnancy course and CTG records as well as oxidative stress biomarker, values of Thiobarbituric Acid (TBARS). RESULTS: Pregnant women with PIH had high statistical significant (pre)pathological CTG records and US- biophysical profile, less amount of amniotic fluid and delivered in lower gestation compared to healthy pregnant women. TBARS high values are statistical high significant frequent with pregnant women with PIH, who had pathological and pre-pathological biophysical profile and CTG records, as well as with US less amount of amniotic fluid (p<0.01). The highest TBARS values were presented with PIH pregnant women and US of less amount of amniotic fluid 42.3 µmol. CONCLUSION: There is statistical strong connection between TBARS values, being used as oxidative stress markers, and diagnostic methods used in PIH diagnostics, ultrasound (amount of amniotic fluid, fetus biophysical profile) and cardiotocography recording. TBARS could also be significant in clinical application for assessment of pregnant women with PIH in order to make decisions on pregnancy termination period.

Risk Factors for Osteoporosis in Postmenopausal Women.

INTRODUCTION: Scientific studies show that many factors related to lifestyles affect the reduction of bone mineral density and osteoporosis in postmenopausal women. GOAL: The goal of this study was to determine whether smoking, drinking coffee and alcohol in menopausal women contribute to the reduction of bone mass and osteoporosis, as well as the impact of physical activity on bone mass. MATERIAL AND METHODS: The study was carried out as case study and matched controls. The group of cases consisted of 100 females in postmenopausal age, in which by the DEXA method was newly diagnosed osteoporosis at the Clinic of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center of RS during 2015-2016, while the control group consisted of 100 females in a postmenopausal age without diagnosed osteoporosis. The groups were matched by age (±2 years). In order to collect demographic data and information on risk factors for osteoporosis and lifestyle of patients was used the questionnaire Bone Mineral Density Questionnaire- Female of the Irish Association for osteoporosis. RESULTS: Testing the significance of differences in terms of smoking showed that the studied groups are statistically significantly different in terms of smoking (χ2=24.025, p=0.000). In terms of consumption of coffee, a statistically significant difference was found between the group of cases and control group (χ2=0.615, p=0.735). When observing the obtained information about the consumption of alcohol, we find that this preventable risk factor in the present study did not show as significant for osteoporosis in postmenopausal women (χ2=4.35, p=0.114). Statistical analysis shows that there are significant differences between the group of cases and control group in terms of physical activity (χ2=7.30, p=0.026). Analysis of the data of our study by univariate logistic regressions showed that smoking (p=0.000) was statistically significantly associated with osteoporosis, while physical activity is a protective factor for bone mass (p=0.036). Results of multivariate logistic regression showed that the independent risk factors for osteoporosis in postmenopausal women is smoking (OR=1.665; p=0.006). CONCLUSION: The results of our study show that smoking is an independent risk factor for osteoporosis in postmenopausal women, and physical activity is a protective factor for bone mass retention. Through education and certain preventive measures should be stressed the importance of these factors on bone health from the earliest period.

Correlation of Subjective Symptoms in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction.

INTRODUCTION: Epidemiological studies suggest a link between the symptoms of lower urinary tract (LUTS) caused by benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Increasing expected period of life, justify the interest of establishing correlations LUTS / BPH and ED in order to find more efficient ways of treating these pathologies. GOAL: The objective was to evaluate the correlation of symptoms in LUTS/BPH with the degree of ED. PATIENTS AND METHODS: The study was conducted as a prospective study which involved males aged 40-60 yr with present symptoms of LUTS/BPH. All study subjects underwent quantification of subjective symptoms through the International Prostate Symptom Score-IPSS and International Index of Erectile Dysfunction- IIEF-5. The first group of respondents had IPSS 0-8, second group IPSS 9-19 and the third group IPSS 20 to 35. RESULTS: The results of ANOVA (F = 112.492, p = 0.000) showed that there was a statistically significant difference (p <0.05) between groups in degree of erectile function (IIEF). Tahmane test showed that there was a statistically significant difference between the first and second group (p = 0.000 <0.05), the first and third group (p = 0.000 <0.05) and the second and third group (p = 0.000 <0.05). Mean degree of ED correlates with IPSS. The results of Fisher's exact test (p = 0.000) confirmed that there was a statistically significant relationship (p <0.05) between the IPSS score and degree of erectile dysfunction (IIEF). CONCLUSION: Elderly patients have a significantly higher value of IPSS score compared to younger patients. The degree of erectile dysfunction is correlated with symptoms of IPSS score. Severity of symptoms of LUTS/BPH and higher IPSS score, worsens the ED. Results of IIEF-5 score are inversely proportional with symptoms of IPSS score, and increase in IPSS score comes to a decline in IIEF score.

Metastasis of Prostate Adenocarcinoma to the Testis.

INTRODUCTION: Prostate carcinoma is the most frequently diagnosed carcinoma in the male population. The most typical places of the metastases are pelvic lymphatic glands, bones and lungs, and very rarely it metastasizes into a testis. The prognostic importance of testicular metastasis of prostate cancer is not yet well-known, due to a very few published cases. According to the known facts, it is certain that a metastasis of the prostate carcinoma into a testis is a sign of an advanced disease. CASE REPORT: This work presents a 48-year-old patient, to whom an adenocarcinoma of the prostate has been proven by the pathohistological finding of transrectal biopsy, performed due to the elevated level of prostate-specific antigen (PSA). Nine years after the initial diagnosis, due to a gradual rise of PSA and tumorous enlargement of the left testis, left inguinal orchectomy and right orchectomy were performed. Metastatic dissemination of prostate adenocarcinoma into a testis was determined by a pathohistological analysis of the left testis. CONCLUSION: The metastasis of the prostate carcinoma into a testis, as a rare localization of the metastatic dissemination, after additionally performed orchectomy along with further oncological therapy, can provide a continuation of a good life quality as well as a control of the disease in a longer time period.

Correlation of Osteoporosis and Calcium Urolithiasis in Adult Population.

INTRODUCTION: Scientific studies indicate that there is a correlation between decreased bone mineral density and the age of the patient, especially in post menopausal women. GOAL: The aim of our study was to assess the connection between osteoporosis and the age of respondents, based on the DEXA findings in patients with calcium urolithiasis. MATERIAL AND METHODS: The study was prospectively and conducted in University Clinical Center Banja Luka, at the Urology Clinic and Clinic of Internal Medicine. In this study the respondents were divided into two groups: experimental group-subjects with calcium urolithiasis and control group without calcium urolithiasis. The study included 240 patients, in both groups of 120 patients who were divided into three age groups: 20-40 years, 40-60 years and more than 60 years. In both groups of respondents was conducted determination of bone mineral density in L2-L4 vertebra lumbar spine and hip by DEXA method. RESULTS: Observing the whole sample of the experimental group, according to age groups it can be noticed that DEXA results are at 72.5% normal, 27.5% below expected value, more in women within older subgroups, 20% show signs of osteopenia and osteoporosis in 7.5 %. Share of patients with osteoporosis is statistically different (p<0.05) only between sub-groups 20-40 years and over 60 years. Although appears absolute difference in the participation of patients with osteopenia by age groups, the differences are not statistically significant (p>0.05). The share of patients with normal DEXA values was significantly lower in the group over 60 years compared to the other two age groups (p<0.05). At age subgroups of the control group, the youngest group of respondents share with normal DEXA finding is 95% and among the oldest group (over 60 years) this share is much lower and is 60%, which represents a statistically significant difference, and confirms the relationship (p<0.01). Normal DEXA findings decreases with increasing years, the share of those who do not have normal findings is higher in the elderly population. CONCLUSION: Our study has just shown that in adult patients with calcium urolithiasis osteoporosis is more prevalent in older patients and more pronounced in patients with calcium urolithiasis in relation to the population without the same.

Correlation of the Lipid Profile, BMI and Bone Mineral Density in Postmenopausal Women.

INTRODUCTION: To the reduction of bone density and osteoporosis in postmenopausal women contribute elevated lipid parameters and Body Mass Index (BMI). GOAL: The goal of our study was to determine the correlation between lipid parameters, BMI and osteoporosis in postmenopausal women. MATERIAL AND METHODS: The study was carried out by matched type between experimental group and controls. The experimental group consisted of 100 females at postmenopausal age, in which by the DEXA method was diagnosed osteoporosis at the Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center of RS during 2015-2016, while the control group consisted of 100 females in a postmenopausal age but without diagnosed osteoporosis. The groups were matched by age (± 2 years). To all participants of the study were carried out biochemical analysis of blood, or the analysis of the lipid profile that included total cholesterol, LDL cholesterol, triglycerides (TG) and HDL cholesterol, and was determined the values of BMI and waist circumference (WC). RESULTS: Analysis of the data of our research shows that by the univariate logistic regression the values of lipid parameters total cholesterol (p=0.000), LDL (p=0.005) and TG (p=0.033) were significantly associated with osteoporosis, while in multivariate logistic model only total cholesterol (p= 0.018) was found as an independent risk factor for osteoporosis in postmenopausal women. BMI values were not statistically significantly associated with osteoporosis (p=0.727). CONCLUSION: On the decrease in bone mineral density and osteoporosis in postmenopausal women influence many risk factors whose identification has the aim to develop more effective prevention of this disease in the elderly.

The Correlation Between Prostate Volume in Patients with Benign Prostatic Hyperplasia in Relation to Erectile Dysfunction.

INTRODUCTION: The exact etiology of lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH) has not yet been determined, and the etiology of erectile dysfunction (ED) is often multicausal and includes organic and/or psychogenic causes, as well as their combinations. Although the relation of BPH, and thus the volume of the prostate (VP) with ED is indisputable, precise mechanisms of integration are still under examination. GOAL: The objective was to evaluate the correlation between prostate volume and degree of erectile dysfunction in patients with symptoms of lower urinary tract caused by benign prostatic hyperplasia. Material and Methods. 150 subjects with BPH, and before starting the BPH treatment, which can affect the sexual function, were divided into three groups: 50 patients with prostate volume of 30 to 40 ml (group A), 50 patients with a volume of 40 to 60 ml (group B) and 50 patients with prostate volume above 60 ml (group C). Quantification of erectile function is performed in all respondents by International Index of Erectile Function with five questions (IIEF-5). RESULTS: The mean IIEF-5 in group A was 20.52 points with a standard deviation of 3.22, in group B 17.08 points with a standard deviation of 4.10, while in group C 10.78 points, with a standard deviation of 3.29. Comparing the results of a statistical analysis from all three groups of patients with the degree of ED, Group A had the highest value of IIEF-5, group C the lowest mean value of IIEF-5. The results of ANOVA (F=96.375, p=0.000) indicated that there was a statistically significant difference (p<0.05) between groups at high values of IIEF-5. Additional analysis by Turkey test revealed that there was a statistically significant difference between the first and second groups (p=0.000 <0.05), the first and third groups (p=0.000 <0.05) and the second and third groups (p=0.000 <0.05). Results of Fisher's exact test (p=0.000) confirmed that there was a statistically significant relationship (p<0.05) between prostate volume and the degree of erectile function. Results of Spearman correlation (ρ=-0.720; p=0.000) showed that prostate volume is negatively correlated with IIEF-5 score with a reliability of 99% (p<0.05), or that increase in the volume of the prostate reduces the IIEF score. CONCLUSION: Results of IIEF-5 score are inversely proportional to the volume of the prostate or the prostate volume increase, the more severe erectile dysfunction, because the increase in prostate volume leads to a decline in IIEF score.

Gender Representation of Osteoporosis in Patients with Urolithiasis.

INTRODUCTION: A great number of clinical studies has indicated that the patients with calcium urolithiasis have a reduced mineral bone density. AIM: The aim of our research was to establish representation of osteoporosis, by measuring mineral bone density using the DEXA method, in patients with calcium urolithiasis, by gender. MATERIAL AND METHODS: The research was a prospective one, performed at the University Hospital of the Clinical Center of Banja Luka, at the Urology Clinic and Clinic for Endocrinology, Diabetes and Metabolic Diseases. The material in this research were the patients divided into two groups: a working group (the patients suffering from calcium urolithiasis) and a control group (the patients without calcium urolithiasis). One hundred and twenty (120) patients were included in both these groups, divided in three age subgroups: 20-40, 40-60 and over 60. The total working group consisted of 63 men (52.2%) and 57 (47.5%) women. In the control group, the number of women was 72 (60%) and 48 (40%) of men. Establishing of mineral bone density at L2-L4 of lumbal spine vertebrae and hip was done for the patients in both these groups, using DEXA method. RESULTS: Analysis of mineral bone density using DEXA method in patients by gender of working and control groups has shown that osteoporosis and osteopenia in patients of the working group is significantly more present in women (14% and 22.8%) compared to men (1.6% and 17.5%). When compared by gender in the control group, osteoporosis was present a lot more in women (36.1%) compared to men (2.1%). When observed for the total sample of both the working and control group, there was a statistically significant difference (p<0,01) related to gender structure, where the share of women with osteoporosis/osteopenia was significantly higher (36.1%) compared to men (4.2%). CONCLUSION: Representation of osteoporosis in women with urolithiasis, particularly of older age, is very expressed and this is why prevention measures should start as soon as possible, so as to avoid severe complications of this illness.

Treatment of Bone Defects in War Wounds: Retrospective Study.

INTRODUCTION: Results of the treatment of open fractures primarily depend on the treatment of connected soft tissue injuries. OBJECTIVE: The aim was to present the experience and methods gained during the treatment of diaphyseal bone defects as a consequence of gunshot fracture soft war trauma. PATIENTS AND METHODS: The study consisted of 116 patients with the diaphyseal bone defect who were treated with the usage of primary and delayed autotransplantation of bones, transplants of the fibula and Ilizarov distraction osteogenesis. RESULTS: The results of compensation of bone defect less than 4 cm and conducted by an early cortico-spongioplastics were as follows: good in 8 respondents (45%), satisfactory in 6 (34%) and poor in 4 respondents (21%). In cases of delayed cortico-spongioplastics, the above mentioned results were: good in 36 (41%) respondents, satisfactory in 24 (34%) and poor in 16 (25%) respondents. The results of compensation of bone defect greater than 4 cm with the usage of fibular transplant were as follows: good in 3 (38%) respondents, satisfactory in 3 (38%) and poor in 2 (24%), and with the usage of using the Ilizarov method, the results were as follows: good in 8 (57%) respondents, satisfactory in 3 (21.5%) and poor in 3(21.5%) respondents. CONCLUSION: The results showed that, in cases of compensation of bone defects less than 4 cm, the advantage is given to the primary spongioplastics over the delayed one. In cases of compensation of bone defects greater than 4 cm, the advantage is given to the Ilizarov distraction osteogenesis when compared to the fibular transplant.

Encrustation of the Ureteral Double J Stent in Patients with a Solitary Functional Kidney - a Case Report.

INTRODUCTION: The efficacy of ureteric stents in the management of various urological conditions causing the upper urinary tract obstruction has been extensively proven, and their contribution to urology remains enormous. The clinical use of ureteric stents is associated with several complications. "Stent syndrome," encrustation, migration and urothelial hyperplasia are the most common problems related to long-term ureteral stenting. CASE REPORT: This work presents an interesting case from our practice: a complete encrustation of a classical polyurethane double J stent two and a half months after its initial instillation, in a 70 year old man, with a solitary functioning kidney, as well as successful removal of it by using a simultaneous treatment of extracorporeal lithotripsy and ureteroscopy with a contact disintegration of encrustations and with percutaneous nephrostomy, as an auxiliary procedure for providing of additional urine derivation. CONCLUSION: These problems can be overcome by the introduction of new advanced ureteral stent designs and biomaterials.

Correlation of Parathormone and the Serum Values of Acidum Uricum with Calcium Nephrolithiasis Examined by Three Different Methods of Diagnostics.

INTRODUCTION: Urolithiasis is a multifactorial disease. Changes in social and economic living conditions have generated changes in chemical composition of urolith too. Although calcium is a predominant crystalline constituent of kidney stones in 80% of cases, metabolic disorders are not the main reason for their formation. Hyperparathyroidism may be a cause of occurrence of calcium lithiasis, however, the biggest number of its occurrence is not a consequence of elevated values of parathormone. Acid uric has a pervasive presence in all body fluids. The serum level of acid uric is determined by its rate of synthesis, rate of excretion by kidney and gastrointestinal tract, and metabolism. GOAL: The goal of our study is to determine a correlation of calcium lithiasis of the upper part of the urinary tract with the parathormone values and the concomitant values of acidum uricum. MATERIAL AND METHODS: The study was prospective and included 120 patients with calcium lithiasis of the upper part of urinary tract, divided in three age categories, 20-40 years, 40-60 years and older than 60 years. The diagnosis of calcium lithiasis of the upper part of the urinary tract was made on the basis of urinary tract ultrasonography, and kidney-ureter-bladder radiography (KUB) /intravenous urography (IVU), urine culture and chemical analysis of stone with patients who had a spontaneous emission of stone or following some of the methods for active removal of stone; with some patients non-contrast (NCCT) was carried out too. All patients were subjected to the laboratory analysis of the serum level of acidum uricum and parathormone. RESULTS: With observed 120 patients suffering from calcium urolithiasis, who belonged to adult population, no patient had an elevated value of parathormone, while three patients (2.5%) had the values of acidum uricum higher than the reference values. The average value (for both parameters) was the lowest with the youngest patients and vice versa, and only in the group of 40 to 60 years of age there were patients whose values of the acidum uricum parameter was outside the interval of reference values; the other age groups did not have such values. Based on the analysis of the variance, as a statistical method, it was determined that the average values of acidum uricum in different age groups were statistically significantly different, which is not the case for the parameter parathormone. (p>0,05). CONCLUSION: The biggest number of nephrolithiasis is not a consequence of elevated values of parathormone. Hyperuricosemia may be present with calcium urolithiasis, without participation in forming kidney stones, most probably as an indirect sign of the existence of the initial insulin resistance and metabolic disease.

Hypersensitivity to aeroallergens in patients with nasobronchial allergy.

BACKGROUND: Aeroallergens are the most common causes of allergy. AIM: The aim of this study was to determine hypersensitivity to aeroallergens in patients with nasobronchial allergy. METHODS: This retrospective population study included 2254 patients with nasobronchial allergy, from late adolescents to adults. Their response to aeroallergens was assessed by skin prick tests. RESULTS: More patients had rhinitis (72.7%), than asthma (27.6%). Although majority of patients were female, allergy is more common in men than in women (p < 0.05). Both groups of patients had the greatest number of positive skin prick tests for Dermatophagoides pteronyssinus (27.5%) and weed pollens (21.9%), followed by grass (18.3%) and tree pollens (10.1%). Ragweed is the most common positive weed pollen in both groups, more in patients with rhinitis (p = 0.022). The cocksfoot is the most common grass pollen in rhinitis group (15.3%), but meadow grass (12.6%) in asthma patients. Birch is the most common tree allergen in the both groups. CONCLUSIONS: More patients with nasobronchial allergy have rhinitis than asthma. Skin prick tests are usually positive for Dermatophagoides pteronyssinus and weed pollens, followed by grass and tree pollens, and they are more common positive in patients with rhinitis than asthma.

Correlation of serum and ionized calcium in patients with calcium nephrolithiasis.

INTRODUCTION: Pathogenesis of kidney stones includes many factors, whereas uroliths, as a generic term for kidney stones, are of a different composition. In pathogenesis of calcium urolithiasis hypercalcemia/hypercalciuria takes a significant place. Hypercalcemia exists when the serum calcium is of increased values, along with measurement and calculation of physiologically active calcium, when there are differences in the Ph of the blood or albumin. GOAL: the goal of this research is to determine the correlation of values of the serum (CaS) and ionized calcium (Ca++) in patients with the calcium nephrolithiasis, whom have been established not to have hyperparathyroidism and malign diseases. MATERIAL AND METHODS: the research was prospective and implemented at the Clinical Center in Banja Luka, at the Urology Clinic, in the period between 1(st) April 2012 - 1(st) January 2013 and it included 120 patients with the calcium lithiasis of the upper part of the urinary tract, divided into three age categories. Diagnosis of the calcium lithiasis of the upper part of the urinary tract was established on the basis of the ultrasonography of the urinary tract as well as native urinary tract/intravenous urography and chemical analysis of the stone in patients with spontaneous stone emission or after some of the methods for active removal of the stone. Chemical laboratory analysis of the serum and ionized calcium was done for all the patients, with 3ml of blood being taken for establishing the aforementioned parameters (1-2 ml of the serum) in vacuumed test tubes or glass tubes of capillary blood. Increased parathormone values (PHT) and history of malignity were excluding factors. RESULTS: out of the 120 patients observed, Cs(S) had the value in the reference interval with most of them, that is, in 110 patients (91.7%). Those, whose value was out of the interval, are of an older age (all above 40). Average value of this parameter amounted to 2.3017, with an average difference (the standard deviation) of 0.11391. Observing the value of Ca++, the value within the reference interval was found in 106 patients (88.3%). Out of the remaining 14 patients, only two simultaneously had the value of Ca(S) out of the permitted interval. The majority of this group consisted of older patients (a half of those whose values were outside the interval was over 60). Average value of Ca++ amounted to 1.22 mmol/L with an average difference of 0.06454. In the 2 aforementioned patients, who simultaneously had increased values of CaS and Ca++, the blood Ph was within the referential value limits, which suggests that, in line with the hyporcalcemia definition, only 2 patients with nephrolithiasis, in the total sample of 120 patients of our research sample, could have had a true hypercalcemia. CONCLUSION: the biggest number of patients with the calcium urolithiasis, who do not have hyperparathyroidism and history of malign diseases, do not have a real hypercalcemia.