Reasons for Referring Patients for Determining the Hormonal Status of the Thyroid Gland From the Level of Primary Health Care in Sarajevo Canton.

Background: Thyroid dysfunction includes hyper- and hypofunction of the thyroid gland (hyperthyroidism and hypothyroidism). The spectrum encompasses both subclinical and clinical disease presentation. The etiology is vast and varied, as are the risk factors and simptoms. Objective: The main aim of the research is to indicate the leading symptom for initial thyroid hormone status evaluation, as well as to identify the distribution of positive and negative test results, and specific disorders according to sex and age groups. Methods: The research is designed as a retrospective, clinical, descriptive study. There were 500 participants included, 355 female and 145 male. Patients were referred to the Department of endocrinology by their primary care physicians. The data was collected through patient documentation. Results: The study included 500 participants, 71% of diagnostic requests made were for women. 80% of subjects had normal thyroid hormone status, p<0.001. Most requests were made for the 41-60 age group, p<0.001. Women had similar number of positive and negative test outcomes, as well as men. When it comes to the age groups, outcomes were similar in all of them, 15-23% positive and 77-85% negative. There were significant differences in the type of symptom expressed in both men and women, as well as all the age groups. Men reported high blood pressure as the most common symptom (30.3%), while women reported weight gain (22.3%). In the 18-25 and 26-40 age groups most common symptom belongs to the category of other. Age group of 41-60 reported weight gain as the most common symptom, while in participants older than 60, high blood pressure is proven to be the most common. Hypothyroidism is the most common disorder in both men and women, as well as in all age groups. Conclusion: It is statistically proven that there were more requests made for women, and older age groups. Leading symptom for initial thyroid hormone status evaluation is high blood pressure. There is no statistically significant difference in distribution of thyroid disorders according to sex or age groups.

IDegLira Improves Metabolic Control in Patients with Type 2 Diabetes Previously Treated with Premix Insulin.

Background: IDegLira( fixed combination of GLP 1 receptor agonist and insulin) has been shown to be effective in improving the glucoregulation in patients previously treated with oral therapy as well as individual components, GLP-1 receptor agonist or basal insulin. Objective: The aim of this study is to examine the parameters of metabolic control in patients treated with IDegLira who were previously treated with premix insulin in several daily doses and to compare them with patients whose premix insulin dose was increased. Methods: The study included 100 patients who had been previously treated with two or three daily doses of premix insulin. Half of the patients were switched to IdegLira( group I), and half (group II) had their insulin dose increased according to the clinical assessment of the physician. Fasting glucose, 2h postprandial glucose, HbA1c, BMI and insulin dose were determined at baseline and at follow-up after 6 months. Results: Patients treated with IDegLira compared to patients whose insulin dose was increased achieved significantly lower fasting glucose (p <0.001), postprandial glucose (p <0.001), HbA1c (p <0.001), BMI (p <0.001) with a significantly lower insulin dose (p <0.001). Comparison of the same parameters within the groups of patients at the beginning and after 6 months showed that patients who were switched from insulin premix to IDegLira achieved significantly lower fasting blood glucose (p <0.001), postprandial glucose (p <0.001), HbA1c (p < 0.001), BMI (p <0.001) with significantly lower insulin dose within the fixed combination (p <0.001). Patients with gradually increased insulin dose achieved significant reduction in fasting glucose (p = 0.021) and postprandial glucose (p = 0.036),but with a significantly higher insulin dose (p = 0.005). There was also a slight increase in BMI that was not statistically significant (p = 0.267). Conclusion: The obtained data suggest that switching patients from a complex insulin regimen to a fixed combination of basal insulin and GLP 1 receptor agonist in comparison to increases in insulin dose results in a significant improvement in fasting glucose, postprandial glucose, HbA1c, and BMI. The results were achieved with a significantly lower daily insulin dose.

CLINICAL EFFECTS OF HYPERBARIC LIDOCAINE AND BUPIVACAINE IN SPINAL ANESTHESIA - OUR EXPERIENCE.

Introduction: Various side effects and complications in the perioperative period can occur with the use of hyperbaric lidocaine and bupivacaine. Goal: Comparative presentation of the occurrence of side effects and complications of hyperbaric lidocaine and bupivacaine during spinal anesthesia in our patients. Methods: The study was retrospective and included 178 patients of both sexes. Patients were divided into two groups. In Group I (n-98) hyperbaric lidocaine 5% was used for spinal block. Group II (n-80) was divided into 2 subgroups, A- where hyperbaric Markain 0.5% was used (n-51), and B (n-29) where hyperbaric Sensorkain 0.75% was used. In the study, we analyzed gender, age, block onset, and complications. Results: There were 98 patients in Group I, 79 males and 19 females. There were 80 patients in Group II, 69 males and 11 females. The mean age of patients in Group I was 44.96 and in Group II 48.16 years. There was no statistically significant difference in the age of patients in both groups p> 0.05 (p = 0.2321). The occurrence of spinal block occurred significantly faster in Group I compared to group II (p <0.0001), and in subgroup B faster than in subgroup A (p <0.005). The clinical occurrence of complications and side effects during spinal anesthesia is somewhat more common in spinal block with 5% lidocaine. Conclusion: The compared incidence of adverse perioperative clinical effects and complications after administration of hyperbaric lidocaine and bupivacaine in spinal anesthesia was not statistically significant.

Frequency of Ventilator Associated Pneumonias in Patients in the Intensive Care Unit.

INTRODUCTION: Ventilator associated pneumonia (VAP) is defined as nosocomial pneumonia in patients who have mechanical ventilation (MV) for more than 48 hours. The diagnosis of VAP is based on radiological-microbiological examinations. In the United States, the Centers for Disease Control and Prevention (CDC) and the National Health Care Network (NHSN) have an incidence of VAP of 5.8% per 1,000 days on mechanical ventilator. AIM: In this study, we had an aim to determine the occurrence of ventilator-associated pneumonia (VAP) in patients with MV who were hospitalized in the intensive care unit. METHOD: The study was retrospective, clinical, conducted in the period from January 1, 2016 until December 31, 2016. In a one-year period, 719 patients of both sex, aged 14 to 91, were hospitalized in the intensive care unit of the Clinic for Anesthesia and Resuscitation of the University Clinical Center in Sarajevo. The study included 250 patients of both sex who had respiratory support with mechanical ventilator. No patient was excluded from the study. As a confirmation of VAP, we used microbiological reports from the patient history documentation. The results were presented statistically through tables and graphs, numerically, by a percentage, and by a mean value with standard deviation. RESULTS: Out of the 719 hospitalized patients, 250 or 34.8% underwent controlled ventilation. In 103 or 41.2% of patients some form of pneumonia was confirmed microbiologically. An average patient age on controlled ventilation was 60.4 ± 16.8 years. The mean age of a female patients who were on controlled ventilation was 63.2 ± 16.7, higher than that of male patients, which was 57.8 ± 16.6 years. The most frequent patients were over 60 years of age (52.8%). The shortest hospitalization of patients on controlled mechanical ventilation was 1 day and the longest was 120 days. Average duration of mechanical ventilation was 6.9 ± 10.5 days. CONCLUSION: VAP is a relatively common complication in patients with MV that can increase morbidity and mortality, as well as treatment costs. It is more frequent in females and in the elderly. Medical staff should provide normal maintenance of respiratory functions to a patient who is on MV, which will reduce the risk of VAP.

The preemptive effect of tramadol and metamizole on the intensity of postoperative pain.

Aim To demonstrate the analgesic effect of preemptively administered tramadol and metamizole on the postoperative pain severity, after an elective operative hysterectomy with adnexectomy. Methods There were three groups with 30 patients in each group. Patients included in the study were between 45 to 67 years old. They were all in the ASA group II. Randomization was performed in random order according to the regular elective operating program. Patients in Group I received i. m. tramadol 1mg/kg, and in Group II 30mg/kg of metamizole, five minutes before anaesthesia induction. Patients did not receive preemptive analgesia in Group III (control). All patients underwent the same induction anaesthesiology procedure with propofol, fentanyl, tracrium, supplemented with O2, N2O, and sevoflurane at an appropriate dose until MAC 1 was reached. Surgeries lasted for 80-120 minutes. Every patient performed a resting pain assessment 30 minutes after an extubation by Numerical Pain Scale (NPS). Results We found out that tramadol had a better effect in preemptive analgesia and that the average pain score for Group I was 6.10 (p=0.043). In Group II, it was 7.93 (p=0.022). There is significant difference in pain intensity between patients in the control group, (pain intensity was 9.16), and those who received tramadol and metamizole. There was no significant difference in the intensity of pain when using these two analgesics (p=0.733). Conclusion The effect of preemptively administered tramadol prior to the introduction of general anaesthesia in postoperative pain is significantly more favourable than the effect of metamizole.

COMPARISON OF PLEXUS BRACHIAL BLOCKADE EFFECT BY SUPRACLAVICULAR AND AXILLARY APPROACH - OUR EXPERIENCE.

INTRODUCTION: Brachialis plexus block is a frequently used method of regional anesthesia that can be performed in several ways and locations. It has been successfully performed to provide good anesthesia and analgesia lasting several hours for operative procedures on hands. It can be performed by paresthesia technique or by ultrasound that has almost pushed out the old conventional technique since it allows the visualization of the blockade performance. TARGET: In the paper we use our sample to try to determine which of the two locations of the blockageis more favorable for the patient, and which one gives a higher percentage of success or a better sensory blockade. METHOD: This is a retrospective study and includes 40 patients of both sexes that were operated on at the Clinic for Traumatology and the Clinic for Plastic Surgery of the University Clinical Center in Sarajevo in the period from 30 August 1993 to 30 August 1994. Patients were divided into two groups. Group I were patients who had an axillary approach to plexus brachialis (n-21) ASA I-II. Group II were patients who had supraclavicular access to plexus brachialis (n-19) ASA I-II. All patients received 0.5 ml / kg Bupivacaine 0.5%. In the study, we analyzed sex, age, duration of blockade and complications. Analgesia and motor block were evaluated 20 minutes after the local anesthetic injection. The complete block is defined as analgesia in all dermatomes (C5-Th1) 20 minutes after injection. THE RESULTS: Group I had 20 male and 1 female patients while group II had 17 male and 2 female patients. The supraclavicular block enabled complete blockade in 18 patients (95.23%), and the axillary approach had a successful blockade in 17 patients (80.95%). In both groups the corresponding motor block was similar. The start of the engine block was similar in both groups. There were no significant complications in either group. CONCLUSION: Regarding clinical efficacy, both brachial plexus blocking approaches provided a good motor block, anesthesia and analgesia for the forearm or hand surgery. Supraclavicular approach proved to be more favorable.

The Effect of Prophylactic Doses of Reviparin on the Postoperative Value of Platelets.

INTRODUCTION: Low molecular weight heparin (LMWH) is used as anticoagulant in diseases characterized by possible thrombosis, as well as for thromboprophylaxis in surgery. The administration of LMWH preoperatively and postoperatively allows satisfactory thromboprophylaxis of patients undergoing surgery. Their application can reduce the number of platelets. AIM: To determine what effect Reviparin has on platelet values postoperatively in patients undergoing open cholecystectomy. METHODS: The study was conducted at the Clinic for Anesthesia and Resuscitation of the Clinical Center of the University of Sarajevo. A retrospective study was performed that included data analysis for 33 patients undergoing open cholecystectomy over a two-year period. There were 22 male and 11 female patients out of a total of 33 patients. Platelet values from laboratory findings of patient's medical history were monitored for 5 days. The values found were recorded in a table containing the patient's first and last name, gender, age and platelet value. All patients had the same endotracheal anesthesia with Propofol, Fentanyl, and Atracurium supplemented with oxygen and nitric oxide at the appropriate dose. All of the patients received same dose of 0.25ml (1432 IU) Reviparin (Clivarin) from Abbott GmbH & Co.KG, preoperatively and postoperatively. Patients undergoing laparoscopic surgery as well as patients receiving other low-molecular-weight heparin or receiving higher doses of Reviparin were excluded from the study. Statistical analysis was performed using the MedCalc v12.7 statistical package for biomedical research. RESULTS: An analysis of gender representation in the total sample shows that there was 22 or 66.7% of males while there was 11 or 33.3% of female patients. Analysis of platelet values indicates that there is no statistically significant correlation with gender, but that there is a statistically significant correlation between platelet values between samples, ie. that patients who had higher preoperative values retained more platelet values even during postoperative measurements. CONCLUSION: Platelet values do not change significantly postoperatively with the use of prophylactic doses of Reviparin, after an open cholecystectomy.

Complications in preserving the airway in intensive care unit patients.

Maintaining the airway in patients in intensive care unit (ICU) is often a vitally important issue for successful treatment of patients. The aim of the study was to identify the complications as the most common causes of difficult ventilation in ICU patients. This retrospective study included 12 patients with difficult pulmonary ventilation, aged 12-70 years, 8 male and 4 female. All patients were intubated for a period of 7-14 days on mechanical ventilation. Due to the need of prolonged mechanical ventilation, the patients underwent surgical tracheotomy and tracheal cannula was placed in five patients. Patients with unilateral atelectasis of the lung underwent bronchoscopy and airway lavage. All patients underwent regular intensive clinical observation and diagnosis, x-ray, CT and MRI. They all were administered antibiotic therapy as well as symptomatic and supportive therapy. Five patients underwent tracheotomy. In one patient with Down syndrome, tracheal rupture occurred two hours after general anesthesia. He developed massive pleural, mediastinal and subcutaneous emphysema. Seven patients with unilateral atelectasis of the lung underwent bronchoscopy and airway lavage. In two patients, therapeutic bronchoscopy with lavage was repeated twice, and in one patient bronchoscopy was repeated 4 times over a 6-month period. Eight patients died and four patients survived. Of the patients with polytrauma, two were in vigil coma, one survived for 6 months, while the other died from respiratory failure. In conclusion, it is important to promptly recognize and appropriately treat complications while maintaining airway in ICU patients, especially those with multiple trauma or conditions after extensive surgery. Preventing hypoxemia as a result of hypoxia has a far-reaching significance for the clinical course and success of patient treatment.

Insulin resistance and lipid accumulation product in corelation to body mass index in women with polycystic ovary syndrome.

INTRODUCTION: Women with Polycystic Ovary Syndrome (PCOS) are at increased risk for cardiovascular morbidity and metabolic disorders including: dyslipidaemia, hypertension, insulin resistance, gestational diabetes, type 2 diabetes, systemic inflammation and endothelial dysfunction. The prevalence of obesity and insulin resistance in women with PCOS is significantly higher compared to the general population. Lipid accumulation product is a new, cheap and easily available predictor for metabolic syndrome both in general population and in women with PCOS. MATERIALS AND METHODS: The study included 50 patients at the Clinic of Endocrinology, Diabetes and Metabolic Disorders, Clinical Center University of Sarajevo. All patients were diagnosed with PCOS according to the Rotterdam ESHRE criteria and were divided into two groups according to their body mass index (BMI). A prospective study established the following parameters: anthropometric measurements (waist circumference, height, weight), BMI, and serum triglycerides and insulin resistance. LAP was calculated using the formula: LAP (women) = [waist circumference (cm)-58] x [triglycerides (mmol/L)]. RESULTS: Waist circumference in women with BMI < or = 24.9 kg/m2 was 31 cm lower than waist circumference in women with a BMI > 25 kg/m2. Mean triglyceride value of the patients in group BMI < or = 24.9 kg/m2 was 1.15 mmol/l lower than the mean value of triglycerides in women with a BMI > 25 kg/m2. Insulin resistance was present in 66.7% in group with BMI < or = 24.9 kg/m2, and in 75.0% in the group with BMI > 25.0 kg/m2. LAP was shown to be a marker for the differentiation of insulin-resistant and nonresistant patients with a cut-off value of 17.91. CONCLUSION: Patients with PCOS and BMI < or = 24.9 kg/m2 were significantly different from those with BMI > 25 kg/m2 in the values of body weight, waist circumference and triglycerides. There was no statistically significant difference in insulin resistance. LAP values were higher in patients in the group with BMI > 25 kg/m2. LAP was a marker for differentiation of insulin--resistant and non-resistant women with PCOS.

[Vaccine for prevention of type 1 diabetes mellitus]. / Vakcina za prevenciju diabetesa tipa 1.

Diabetes mellitus type 1, known as insulin dependent diabetes mellitus (IDDM), results from a chronic autoimmune destruction of the insulin secreting pancreatic beta cells. This autoimmune process is marked by circulating auto antibodies to beta cell antigens. GAD 65 (Glutamic Acid Decarboxylase) auto antibodies are present in 70-80% of newly diagnosed patients with type 1 diabetes, and it can be detected many years before clinical onset of the disease. New knowledge in the imunopathogenesis have given expectation that imunotherapy will become routine manner for cure of diabetes mellitus type 1.

[LEAP (Lantus Early Access Programme) in Sarajevo]. / LEAP (Lantus Early Access Programme)--program za ranu dostupnost Lantusa u Sarajevu.

LEAP is multicentric study in phase IV. The first aim was to affirm Lantus efficacy and safety in every day practice, in local conditions. The second aims were to verify therapy successful by measuring fast blood glucose (FBG) and HbA1c and to estimate patients' pleasure. Duration of study was 2 months. Lantus was administrated subcutaneously daily. Doses were individual. HbA1c was measured at the begining of therapy and at the last control. Blood glucose was measured every day. The study included patients who did not reach the control of glycemy, or patients with frequent hypoglycemic crysis, older then 6 year. LEAP study in Sarajevo included 114 patients. Fifty four patients (47%) were men, and 60 (53%) were women. 46% diabetics have type 1 of diabetes mellitus and 54% have type 2 diabetes mellitus. The results of study demonstrated statistically significant decreasing of FBG and HbA1c in both groups (I group--patients younger than 18 years and II group--patients older than 18 years), p<0.05. FBG in I group on the start of Lantus therapy was 9.9+/-3.9 mmol/l but on ending control was 8.7+/-4.4 mmol/l (p<0.05). HbA1c on start of therapy was 9.4+/-1.9%, but on end control was 8.0+/-1.8% (p<0.05). FBG in II group on start was 13.6+/-4.7 mmol/l but on finish was 7.3+/-2.9 mmol/l (p<0.01). HbA1c on start was 9.3+/-1.8% and on end was 7.2+/-1.2% (p<0.01). These results showed that the Lantus is very efficacious for good glycoregulation. Just for two months, HbA1c decreased for 2%. Undesirable effects were not registered. We concluded that Lantus is very safe. Most patients (89%) were satisfied with therapy.

[Contemporary methods of prevention and treatment diabetic kidney disease]. / Savremene metode prevencije i tretmana dijabeticne bubrezne bolesti.

The number of people with diabetes is increasing worldwide. Diabetes is the leading cause of end-stage renal disease. Diabetic kidney disease has been reported to occur in 25-40% of people with type 1 or type 2 diabetes. Recent studies have demonstrated that the onset and course of diabetic nephropathy can be significantly improved by intervention in early stage of the development of this complication. In this article we will review the current recommendations regarding the prevention and treatment of diabetic nephropathy.

[Unilateral pheochromocytoma and adrenal gland hyperplasia]. / Unilateralni feohromocitom i hiperplazija nadbubrega.

Woman, forty two years old, has been hospitalized because of frequent headache, palpitation and tremor of lips with paroxysmal increase of blood pressure. The adrenals have examined. The status of the hormones has checked many times but showed increased values of VMA and 17-OH steroids only once. There is no possibility to measure the catcholamines. Analysis of other hormones has showed normal values except of paradoxal hGH increase during suppressive hGH test and hypoglycemia in OGTT test. The changes of the left adrenal, which size was 25x18 and 30x25 mm, have diagnosed by MRI of adrenals. It has been suspected microadenoma by MRI of pituitary gland. The left adrenalectomy has been done. During the surgery hypertension and tachyarrhythmia has occurred and treated by fentolamin and propranolol. No complications have been noticed after the surgery. The status of the adrenals hormones are in the normal range. Patohystological analysis has proved phcochromocytoma and hyperplasy.

[Amylin--a partner hormone to insulin]. / Amylin partner hormon inzulinu.

This article will provide an overview of some of the known functions of a recently discovered hormone, amylin, a partner hormone to insulin. Studies indicate that amylin has a role in the postmeal glucose regulation through effects on glucagon secretion, nutrient delivery and food intake. Three hormones--amylin, glucagon and insulin--are a critical part of postmeal glucose regulation. The interaction of these hormones and their role in the regulation of postmeal glucose concentrations is the subject of this article.

Medical aspects of the mass-scale civilian casualties at Sarajevo Markale market on August 28, 1995: triage, resuscitation, and treatment.

The siege of Sarajevo, which holds an important but tragic position in the history of war, lasted for more than 45 months, from April 6, 1992 to March 19, 1996. Shelling of the Markale city market on August 28, 1995, was the attack with the largest number of civilian casualties. There were 23 persons killed on the spot. Another 104 were injured, of whom 15 died immediately after the explosion or during surgery, and 4 died a week later. Transport to the hospital was provided mostly by other civilians and resuscitation on the spot was not attempted. The triage of the wounded was conducted at the Kosevo University Hospital Center and State Hospital by teams of surgeons and anesthesiologists. Out of 104 wounded, 94 were treated at several different Surgery Departments and the Emergency Department. There were 85 survivors among the wounded. This incident once again illustrates the importance of timely adequate triage and resuscitation after mass-scale injuring, which can increase the chances of survival.