The influence of gastronomic identity factors on food tourism development in the Republic of Serbia and Bosnia and Herzegovina.

Background and aims: The gastronomic identity of an area is the key factor in tourism development, attracting numerous tourists and generating significant income. Numerous economic actors participate in its use and proper placement, and their perception of the gastronomic potential significantly affects its distribution and use in tourism. The main aim of this study is to investigate the factors of gastronomic identity that influence the development of tourism, observed at two tourist destinations in Southeast Europe [the Republic of Serbia (RS) the city of Novi Sad with Fruska Gora Mountain, n = 305 and Bosnia and Herzegovina (BIH) the city of Sarajevo with Jahorina Mountain, n = 301]. Methods: In order to define the factors that are relevant to food tourism development, a custom-made GastroIdentity scale was created. A survey was conducted among employees in the hospitality and tourism industry as well as employees in educational institutions in the field of hospitality and tourism. Results: The research results show that employees from the RS area acknowledge the importance of organizing gastronomic events where local products are presented and that they understand that dishes and beverages with unique and recognizable tastes can characterize their area. Employees from the BIH area pointed out that the nutritional quality of their local agricultural and gastronomic products represents an advantage when compared to mass-produced ones and that the local gastronomic culture and tradition are authentic representatives of the culture of the region. Conclusion: The GastroIdentity scale proved to be dependable, highlighting gastronomic culture and tradition as extremely crucial factors in tourism, using the input provided by the employees from the investigated areas. Noteworthy results were also recorded regarding the need for incentives for food tourism development in the investigated regions.

Correlation of kidney size with kidney function and anthropometric parameters in healthy subjects and patients with chronic kidney diseases.

BACKGROUND/AIM: Echosonography is a simple, noninvasive method of kidney visualization. The objective of this study was to compare the kidney echosonograpic characteristics with the kidney function and anthropometric characteristics in healthy subjects and patients with the chronic kidney disease (CKD). METHODS: The study involved 49 patients (21 men; 46.02 ± 14.27 years) with CKD and the control group of 46 healthy persons (20 males; 45.45 ± 18.48 years). Physical examination, kidney echosonography and laboratory analyses including creatinine clearance (Ccr; 24 h and calculated by Cockroft--Gault (C--G) formula) were done in all persons. RESULTS: There was no significant difference in age and sex between two groups but serum creatinine concentration was significantly higher (218.8 vs. 84.5 µmol/L) and Ccr significantly lower (66.44 vs. 94.20 mL/min, C--G) in patient group. The left kidney was larger in both groups, but the only significant difference was in kidney depth (p < 0.01). There was significant correlation between all measured kidney dimensions, volume, parenchymal thickness and serum creatinine concentration and Ccr (C--G) in patient group. In the controls, there was no significant correlation between the kidney size and function, but there was a significant correlation between the kidney width, depth, volume and patients' age and anthropometric parameters. On the contrary, all analyzed parameters of kidney size, except volume, did not correlate significantly with the anthropometric parameters of patients. CONCLUSION: Kidney size of patients with CKD correlated significantly with kidney function, while correlation with anthropometric parameters, which is otherwise present in healthy subjects, was lost in patients with CKD.

[A patient with systemic lupus erythematosus and lupus nephritis: a 12-year follow-up].

INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic immunological disease causing a significant morbidity and mortality in younger women and involving several organs and systems, most often the kidneys, being consequently the incidence of lupus nephritis (LN) about 60%. CASE REPORT: We reported a 57 year-old patient with the diagnosed SLE in 1995. Pathohistological analysis of kidney biopsy revealed LN type V. The patient was treated with corticosteroid pulses and azathioprine during one year. A remission was achieved and maintained with prednisone, 15 mg daily. Nephrotic relapse was diagnosed in 2006 and the second kidney biopsy revealed recent kidney infarction due to extensive vasculitis. Soon, a cerebrovascul insult developed and CT-scan revealed endocranial infarctus. The patient was treated with corticosteroids and cyclophosphamide pulses (totally VI monthly pulses), and also with low-molecular heparine, anticoagulants and salicylates because of the right leg phlebothrombosis. After the pulses, the patient was adviced to take prednisone 20 mg daily and azothioprine 100 mg daily, and 6 months later mycophenolate mofetil because of persistent active serological immunological findings (ANA 1:320) and nephrotic syndrome. Mycophenolate mofetil was efficient in inducing and maintaining remission of nephrotic syndrome. CONCLUSION: The aim of LN treatment is to achieve and maintain remission, improve patients' outcome, reduce the toxicity of immunosuppressive drugs and the incidence of relapses.Mycophenolate mofetil was shown to be efficient in inducing and maintaining remission of nephrotic syndrome in the frame of LN.

Cyclosporine versus azathioprine therapy in high-risk idiopathic membranous nephropathy patients: A 3-year prospective study.

There is no consensus regarding the modality of therapy for idiopathic membranous nephropathy (IMN), especially for patients who did not react to treatment with cytotoxic drugs. This study followed prospectively for 3-year IMN patients who did not react to Ponticelli protocol comparing effects of 2-year course of cyclosporine (CsA) with azathioprine (Aza) treatment both with small doses of prednisolone. Twenty-three patients were randomly assigned to receive either cyclosporine at 3mg/kg per day (10 patients) or azathioprine at 1.5 to 2mg/kg (13 patients). Both groups were comparable regarding age, sex and renal function, except for proteinuria, which was significantly greater in CsA group (P=0.003). Similar rate of remission of nephrotic syndrome (NS) have been noted at the end of treatment (80% CsA versus 93% Aza). During last year, follow-up relapses of NS were more frequent in Aza group (5 versus 1). A fall in proteinuria was recorded in both groups during treatment, but it rose significantly in Aza group (1.5g/day versus 3.1g/day, P=0.04) and remained unchanged in CsA group (3.9g/day versus 4.1g/day) after treatment cessation. Renal function deteriorated in Aza group (sCr 120.5 versus 269.8µmol/L; P<0.01) and was stable in CsA group. In conclusion, CsA and steroids may be a very important option in the management of high-risk IMN patients. Long-term treatment is necessary for achievement of full therapeutic effect. Treatment with Aza did not have long-term benefits particularly regarding renal function preservation.

Renal biopsy registry from a single centre in Serbia: 20 years of experience.

BACKGROUND: There is not enough epidemiologic data of biopsy proven renal diseases. This is the first report of clinicopathologic correlations over a period of 20 years from central Balkan country-Serbia. METHODS: A retrospective review of reports of 2 362 native renal biopsies performed on patients at the leading nephrology unit in Serbia from 1987 to 2006 was undertaken. Patients were divided in two groups according to age: younger (<60 years old) and older (>or=60 years old). RESULTS: The annual incidence of renal biopsies increased from 3.9 p.m.p./year in 1987 to 12.5 p.m.p/year in 2006. The most common clinical syndrome as an indication for renal biopsy was nephrotic syndrome (NS) (53.6%). Membranous nephropathy was the most frequent cause of NS (21.6%). Primary glomerulonephritis (PGN) accounted for about two thirds of all performed biopsies. Non-IgA mesangioproliferative GN was the most frequent primary GN accounting for almost 25% of all PGN in our whole population, while the prevalence of IgA nephropathy was only 12%. Lupus nephritis was the most frequent secondary glomerulonephritis (75.6%). CONCLUSIONS: This report represents epidemiological overview on biopsy proven renal disease coming from one specific Balkan country, which was under economic sanctions for almost half the studied period. We are hoping that this register will be the basis for developing not only a national register but also a register that will encompass all Balkan countries.

Comparison of kidney size between patients with Balkan endemic nephropathy and other kidney diseases.

BACKGROUND: The aim of this study was to assess the relationship between kidney dimensions and creatinine clearance (Ccr) in patients with Balkan endemic nephropathy (BEN), nephrosclerosis (NSc), glomerulonephritis (GN), diabetic nephropathy (DN) and in healthy persons. The main objective was to find out at which stage of BEN the kidneys start to shrink. METHODS: The study involved 84 patients with BEN, 39 with NSc, 56 with GN, 55 with DN, and 52 healthy subjects, allocated to group 1 (n = 28) sex- and age-matched with BEN/NSc patients, or group 2 (n = 24) sex- and age-matched with GN/DN patients. Based on Ccr, patients were classified according to the NKF/DOQI guidelines. RESULTS: The kidney dimensions of BEN patients in all stages of the disease were significantly shorter than those of healthy controls and patients with GN and DN. In stages 3-5, BEN patients had significantly smaller kidneys than patients with NSc. Patients with NSc had smaller kidney dimensions than controls and GN/DN patients but all of these differences were not significant. CONCLUSION: BEN patients had significantly smaller kidneys than sex- and age-matched healthy persons and patients with GN and DN in all stages of the disease and patients with NSc in stages 3-5 of the disease.

[Therapy of lupus nephritis with standard therapeutic protocols and cyclosporine]. / Terapija lupusnog nefritisa standardnim protokolima lecenja i ciklosporinom.

The study carried out was at the Department of Nephrology, Military Medical Academy, over the period from 1996 to 2001. Different types of lupus nephritis were documented in 42 patients and were treated with standard therapeutic protocols (corticosteroids, the pulse dose of cyclophosphamide + corticosteroids) and cyclosporine in the target serum concentration of 100-120 ng/ml along with pronisone of 15-20 mg per day. The different degree of damaged renal function was observed. Renal biopsy was performed in 13 patients and in one patient rebiopsy was done. Twenty one patients were treated only with corticosteroids (remission in 23.8% of cases), with cyclophosphamide + corticosteroids 33 patients (remission in 42.4% of cases) and cyclosporine + corticosteroids 12 patients (remission in 91.7% of cases). The pulse therapy with cyclophosphamide in combination with corticosteroids, and cyclosporine in combination with lower doses of corticosteroids was statistically more successful in comparison with corticosteroids monotherapy (p < 0.01). Remission was found in 73.8% of patients, terminal renal weakness was observed in 7 patients, and fatal outcome in 4 patients. We recommend the pulse therapy of cyclophosphamide in combination with corticosteroids in the treatment of severe clinical forms of lupus nephritis, and in refractive forms cyclosporine in combination with low doses of corticosteroids.

[Comparison of various cyclophosphamide treatment regimens on the course and outcome of lupus nephritis ]. / Poredjenje dejstva razlicitih rezima lecenja ciklofosfamidom na tok i ishod lupusnog nefritisa.

INTRODUCTION: Immunosuppressive drugs, particularly cyclophosphamide, are widely accepted as the treatment of choice for severe, proliferative lupus nephritis. However, there is no consensus with regard to: 1) the dose required for achieving control of disease activity; 2) duration of cyclophosphamide therapy after the achievement of treatment response; 3) treatment of lupus nephritis relapses [1-5]. In the Institute of Rheumatology, Belgrade, two regimens of intravenous cyclophosphamide have been introduced in the treatment of lupus nephritis patients years ago. The first has comprised the so called "small pulses" that have been used since 1985, and the second has been standard protocol with high doses of cyclophosphamide, accepted in 1990. Results of these follow-up studies were published previously [6-8]. AIM: The aim of this study was to compare the efficacy of two regimens of intravenous pulse cyclophosphamide in the treatment of patients with severe lupus nephritis. METHODS: We analyzed the results of two follow-up studies comprising patients with lupus nephritis, treated with cyclophosphamide: 1) 41 females treated with "small pulses", consisting of 400 mg of cyclophosphamide weekly at treatment onset, followed by the same dose fortnightly for the next three months, and finally on monthly basis for several months or years; 2) 33 patients (29 females and 4 males) treated with standard protocol consisting of "induction phase" with 6 monthly pulses of high doses (0.5-0.75 g/m2 body surface), followed by "maintenance phase" with quarterly pulses for additional 1-2 years. The evaluation of long-term treatment effects was based on remission/response rate [9], number of patients with renal failure, end-stage renal disease and death outcome. RESULTS: Groups of patients were quite comparable with respect to their demographic and clinical data (Table 1). The only difference was much higher frequency of renal biopsy in "high dose" cyclophosphamide pulse (85% versus 32%), confirming the presence of proliferative lupus nephritis. Cummulative dose of cyclophosphamide and treatment duration were not significantly different between treatment groups. At the end of the follow-up, distributions of favorable (remission/response) and unfavorable outcome was similar (p = 0.831; Mann-Whitney U test), as well as dynamics of remission achieving (p = 0.068; Log-rank test), cummulative renal survival (p = 0.129; Log-rank test) and patient survival (p = 0.577; Log-rank test). DISCUSSION: Similar efficacy of two different cyclophosphamide regimens in our patients with lupus nephritis was not surprising considering that cummulative cyclophosphamide doses and treatment duration were similar obtaining similar control of disease. During induction phase of treatment, patients on small pulses have received even higher cummulative dose of cyclophosphamide. Aggressive immunosuppressive treatment with cyclophosphamide has significantly ameliorated the outcome of lupus nephritis. In different studies, rate of assessed clinical response is 60-80 [13-17]. Significant proportion (42%) of patients who achieved partial remission, as well as complete remission, developed flare of renal disease several months after the end of the treatment, necessitating restarting of pulse cyclophosphamide therapy. The results of our study were in accordance with those results, especially with results of Mosca et al. [18] who have applied the duration of treatment similar to ours in high pulse regimen. CONCLUSION: Treatment response did not differ between two different cyclophosphamide regimens (small pulses and standard high doses protocol), but standard protocol seemed to be more comfortable for patients. We recommend standard protocol for patients with biopsy proved proliferative lupus nephritis as a gold treatment standard. However, sustained remission of proliferative lupus nephritis is a goal that still remains to be achieved.

[Lupus nephritis: retrospective analysis of the course of the disease]. / Lupusni nefritis: retrospektivna analiza toka bolesti.

INTRODUCTION: Systemic lupus erythematosus is a multisystemic autoimmune disease characterized by various clinical manifestations, as well as unpredictable course and therapy response. Lupus nephritis is a severe manifestation of the disease, significantly influencing its prognosis. Since the pathogenesis of lupus nephritis has not been elucidated, optimal therapeutic approach is still subject of numerous studies. AIM: A retrospective study was undertaken with the aim to analyze clinical features of different types of lupus nephritis, their therapy response as well as their course and outcome. PATIENTS AND METHODS: The retrospective study included 67 patients who were regularly followed-up for 36-188 months after renal biopsy at the Department of Nephrology, Clinical Centre of Serbia or at the Department of Nephrology, Clinical Centre of Montenegro. Systemic lupus erythematosus was diagnosed according to the ARA criteria, while pathomorphological classification was based on WHO recommendations. RESULTS: The studied group was mostly composed of patients with proliferative lupus nephritis (21 with diffuse and 9 with focal) followed by 20 patients with membranous, 14 with mesangioproliferative (type IIb) and only one patient with type I, IIa and VI lupus nephritis each. Age distribution of the patients and incidence of extrarenal complications was equal in patient groups with different types of lupus nephritis. Only four patients were males. Choice of therapy depended on the morphological characteristics of lupus nephritis, presence and severity of extrarenal complications and renal function. At the time of analysis, 10/14 patients with lupus nephritis type IIb were in remission, as well as 14/30 type III/IV patients and 15/20 patients with type V lupus nephritis. The outcome was the worst in patients with proliferative lupus nephritis, and thus, at the time of analysis four of 30 patients had chronic renal failure, 7 were on regular haemodialysis, while 3 patients decreased. With respect to the renal function, the most favorable outcome was recorded in IIb patients, while mortality was not dependent on lupus nephritis type but on extrarenal manifestations of systemic lupus and associated diseases. Five- and ten-year patients' survival rates were 100% and 86%, respectively. Cardiovascular and cerebrovascular diseases were the most frequent causes of death. CONCLUSION: Persistent and controlled treatment using a combination of different immunosuppressive drugs along with close follow-up of patients and possibility of dialysis treatment have significantly improved prognosis of patients with lupus nephritis, even in those with diffuse proliferative changes.