Quality of Life and Mental Health in Multiple Sclerorsis Patients in Bosnia and Herzegovina Measured by Generc and Disease-Specific Questionaire.

BACKGROUND: Multiple sclerosis (MS) as chronic neurodegenerative disease significantly impact patients' quality of life (QoL). QoL instruments can be generic (EQ-5D, SF-36) and disease-specific like MSQoL-54. Use of disease-specific instruments is preferred since it captures broader symptoms related to MS than generic instruments. Mental health is impacted by MS and different psychiatric conditions significantly impact QoL. We have conducted prospective non-interventional study among MS patients. Aim was to measure and compare MS patients QoL by generic and disease-specific instrument at baseline and after one year and to identify potential correlation between these two types of measurements and to assess mental health scores among MS patients in Bosnia and Herzegovina (B&H) and other countries. SUBJECTS AND METHODS: Study included 62 patients diagnosed with MS and treated at Neurology clinic in Sarajevo from April 2016 to May 2017. Study was approved by Ethical Committee. QoL has been measured by EQ-5D and MSQoL-54. Measurement has been performed at baseline and after 12 months. RESULTS: Average utility score measured by EQ-5D at the baseline and end of the study were 0.688 and 0.639 respectively with no significant difference (p=0.850). EQ-5D utility and MSQoL-54 score showed high correlation at baseline; rho=0.873 p=0.0001 for physical health and rho=0.711 p=0.0001 for mental health. At the end of the study no significant correlations have been found (p>0.05). High negative correlation found between EDSS and scores measured by EQ-5D and MSQoL-54; at baseline (rho=-0.744 p=0.0001) and at the end of the study (rho=-0.832 p=0.0001). Similar MS impact and loss of QoL found in B&H and other countries. CONCLUSIONS: Both instruments can be used in measuring QoL but disease-specific are preferred since they capture broader symptoms impacting MS patient QoL. Using QoL instruments could drive clinician decision and patient-centric care as well as reimbursement and policy decision by recording treatment outcomes.

Is 64-Row Multi-Detector Computed Tomography Angiography Equal to Digital Subtraction Angiography in Treatment Planning in Critical Limb Ischemia?

BACKGROUND: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II). SUBJECTS AND METHODS: The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall's tau-b statistics. RESULTS: Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option. CONCLUSION: 64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.

Validation of the Disease-specific Questionnaire MSQoL-54 in Bosnia and Herzegovina Multiple Sclerosis Patients Sample.

INTRODUCTION: The purpose of this study was to validate Bosnian translation of disease specific quality of life measure MSQoL-54 which is widely used in practice. MATERIAL AND METHODS: Previously translated and culturally adopted MSQoL-54 questionnaire used in this study has been provided and licensed by Optum Inc. The questionnaire was validated in 62 MS patients seen at Neurology clinic at University Clinical Center Sarajevo, during April 2016 until May 2016. Internal reliabilities of Bosnian version MSQoL-54 were assessed for multiple item scales by using Cronbach's alpha coefficient. Clinical validity was assessed comparing means of the two summary MSQoL-54 scores by the EDSS score. Pearson's (r) correlation coefficient was used to investigate the relationship between the composite scores and the main clinical and demographic variables. RESULTS: Patients' participation was satisfactory and all scales fulfilled the usual psychometric standards. Highly significant inverse relationship was found between both composite scores and clinical characteristics of the disease and the EDSS. The lowest internal consistency reliability is found on social function scale (0.743), overall quality of life (0.782) and pain (0.833). The highest internal consistency reliability is found on role limitations due to physical problems (0.959), physical health (0.962) and role limitations due to emotional problems (0.966). The mean value of MSQoL-54 PHC (Physical Health Composite) and MHC (Mental Health Composite) were 49.82±18.90 (36.05-61.38) 51.84±22.22 (34.93-70.20) respectively. Our study has shown that the Bosnian version of MSQoL-54 is easy to administer and well accepted by patients and may be useful as clinical outcome measures in patients with MS.

Expression IRF/MUM1>25% Predictor to Three-year Survival of Diffuse Large B Cell Lymphoma in the Immunochemotherapy Era.

INTRODUCTION: Non Hodgkin lymphoma-Diffuse large B cell lymphoma (DLBC) is composed of more varieties of one disease. Analysis and understanding of a wide range of characteristics of the disease, which include: clinical, immunohistochemical, cytogenetic and molecular characteristics may improve treatment results. AIM: achieving the estimated three-year survival and influence of IRF/MUM1 expression to three-year survival. MATERIAL AND METHODS: A study was retrospective-prospective, patients were followed for seven years a period of dine. The study included 60 patients de novo DLBCL. Age was 18-72 years old, the average age 45 years, male 31 (51,7%) and female 29 (48.3%). Median follow-up was 47 months (3-91 months). To determine differentiation immunophenotype antibodies those were used anti-CD20, anti-CD10, anti-Bcl-6, IRF-4/MUM1, CD 138. RESULTS: Included the GCB type was 65%. Impact prognostic index IPI>2 GBC vs non GBC p=0,038 X2. Statistically significant difference was confirmed compared to the IPI> 2 to 3 year OS p<0,0005 X2. Significantly longer three-year survival was provided in the group GCB 36 (92,3%) vs. non GCB 8 (38,1%) p=0,003 X2. Clinical and immunohistochemical factors showed a significant impact to three-year survival by univariate: LDH p=0,005, MUM1 p=0,003, while CD10 p=0,069 was confirmed on the level of borderline impact. Using multivariate analysis, expression MUM1 has the greatest impact p<0.0005 OR=0.083 (95% CI 0.23-0.303) on the disease outcome - three-year survival. CONCLUSION: expression MUM1 >25% has the greatest impact on the disease outcome - three-year survival.

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

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

Descriptive review of the patients suffering from tuberculosis in the past 10 years treated at pediatric clinic of clinical center of sarajevo university.

INTRODUCTION: Due to the geographical position of Bosnia and Herzegovina and its socio economic momentum even though the standard vaccination program is carried out, the child population continues to suffer from pulmonary tuberculosis in significant percentage. MATERIAL AND METHODS: The study was retrospective and included patients who were in the period from January 1, 2004 to December 31, 2013 (or the 10 years period) hospitalized at the Department of Pulmonology Pediatric Clinic dually diagnosed with lung TB and start treatment. Data were adopted from available medical records (history of disease). GOAL: The aim of the study was to determine the epidemiological and clinical characteristics of tuberculosis of the lungs in children who were hospitalized at the Pediatric Clinic. RESULTS: In the period from January 1, 2004 to December 31, 2013 there were hospitalized a total of 50 children with a proven active infection with MBT, where it was initiated treatment with a specific therapy. From this number 44% of patients were aged from 5 to 10 years, 22% of patients were aged younger than 5 years. Peak incidence was in 2009. About 66% of patients had a positive history of sick close relative, while 10% of them had a history of contact with other sick person. From baseline 28% of patients were referred to the Department with suspicion of a specific process. From the total 70% of respondents were regularly vaccinated, and 29% of them had a visible BCG scar. In 55% of cases there was anamnestic information - decresed body weight, in 82% of cases the presence of cough, of which 52% of the occurrence of expectoration. In 78% of cases we had positive auscultatory findings of the lungs. In 14% of cases on X-ray of the lungs was noticed changes in terms of the primary complex positive. In this material we had one cavernous and one miliary TB of the lungs. Sputum or gastric lavage was positive in 62% of cases, and Quantiferon because of the lack of the same (in the past) was positive in 34% of cases. All subjects at the time of discharge were classified as recovered. In that period we had proven resistant TB. CONCLUSION: Bosnia and Herzegovina belongs to the group of countries with still present and evident TB. In the investigated period of ten years from the pediatric pulmonary TB, usually have suffered small children and adolescents. At moment of discharge, all patients were classified as recovered. In the teste material we did not have proven resistant TB.

Cutaneous silent period in the evaluation of small nerve fibres.

INTRODUCTION: High intensity cutaneous stimulus transiently suppresses tonic voluntary muscle activity resulting in cutaneous silent period (CSP). AIM: The aim of our study was to evaluate the normal values of an onset latency L1, a late latency L2 and a duration of CSP after stimulating sensory fibres of the median nerve. MATERIAL AND METHODS: This prospective study was performed at the Neurology Department, Clinical Center of Sarajevo University in period from January 1st 2013 to December 1st 2013. In our study we examined 61 subjects. The group included our relatives, coworkers and friends. The informed consent from testing subjects was obtained. RESULTS: The origin of silent period is stimulation of small A-delta nerve fibres. The pre-synaptic or post-synaptic interruption of the electrical volley to motor neurons is discussed. Median values of muscle activity suppression in healthy female is 55.0 ms (45.0-74.0) and 59.0 ms (52.0-67) male subjects. There is a correlation between the onset latency L1 and the late L2 latency (p < 0.03). In the on-going study it seems that delay of L1 and shorter muscle activity suppression might provide a sign of small nerve fibres involvement. CONCLUSION: The use of CSP improves the value of neurophysiology examination.

Left atrial stiffness is in correlation with left atrial reservoir strain in pediatric patients with mitral regurgitation.

BACKGROUND: Left atrial stiffness index (LASI), defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') to peak atrial strain, reflects reduced left atrial (LA) compliance and represents an emerging marker that can be used for noninvasive measurement of fibrosis of LA in patients with mitral regurgitation (MR). OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on the remodeling and function of the LA, quantified through strain parameters and diastolic function. METHODS: The study included fifty patients (n= 50) diagnosed with primary and secondary chronic MR lasting at least 5 years. The echocardiographic recordings were performed by a third party, two cardiologists actively engaged in echocardiography on a daily basis. RESULTS: Older participants had higher values of the LASI (r= 0.467, p= 0.001). Participants with higher LASI values had a smaller LA reservoir (r= 0.784, p= 0.0001) and smaller LA conduit values (r=-0.374, p= 0.00). Participants with higher LASI values had a larger LA diameter (r= 0.444, p-value= 0.001) and higher average E/e' ratio (r= 0.718, p= 0.0001). There was a significant difference (p= 0.04) in the LASI among participants based on the MR jet area (< 20.85% ⩾ 20.85%), LASI was higher in participants with an area greater than 20.85%. Differences in other parameters such as LA reservoir, LA conduit, LA contractile were not statistically significant. CONCLUSION: Increased LA stiffness is associated with diminished atrial compliance and reservoir capacity, and LASI has a potential to as an early marker for assessing disease severity and progression in pediatric MR.

A New Scale for Rating Oral Health-Related Quality of Life in Denture Wearers.

PURPOSE: When carrying out prosthetic rehabilitation of edentulous and partially edentulous patients, great attention is paid to the personal attitude of the patients, their satisfaction with oral health and psychosocial interaction due to tooth loss, as well as the treatment of the resulting disorders. This attention has led to the development of various instruments for examining the quality of life related to oral health. The aim of this study was to develop and validate a reliable instrument in the Serbian language suitable for measuring oral health-related quality of life in patients who have been rehabilitated with complete or partial dentures. Мaterials and Methods: The study was unicentric and cross-sectional, and assessed the reliability and validity of a newly developed instrument for measuring the oral health-related quality of life in denture wearers (OHRQoL-DW). It was conducted on a sample of 200 adults from Serbia, wearers of various types of dentures, with a mean age 66.9 ± 10.3 years and male/female ratio of 86/114 (43%/57%). RESULTS: The definitive version of the OHRQoL-DW scale with 28 items showed very good reliability, with Cronbach's alpha = 0.938. Good temporal stability of the questionnaire was demonstrated, and satisfactory results were obtained for divergent and convergent validity tests. Exploratory factorial analysis revealed four domains of oral health-related quality of life in denture wearers: physical, psychosocial, environmental and aesthetic. CONCLUSIONS: The OHRQoL-DW scale is a reliable and valid generic instrument for measuring the oral health-related quality of life in patients wearing dentures, which is one of the most important outcomes of oral health in prosthetic treatment.

Clinical Manifestations of European Borreliosis on the Skin in Acute, Subacute and Chronic Disease.

Background: Lyme borreliosis is a multisystemic infection caused by the spirochete Borrelia burgdorferi. Erythema migras is the main clinical marker of the disease. Objective: This study aimed was to investigate the frequency and clinical manifestations of European borreliosis on the skin, and to determine the significance of these findings for diagnosis and therapy. Methods: A retrospective-prospective clinical study of outpatients treated and monitored in a private clinic of an infectologist was conducted over nine years from to 2013-2021. The study was clinical, descriptive and analytical in nature. Results: In the investigated period, 509 (30.8%) patients with borreliosis symptoms were treated. EM in our patients occurred under the following conditions: a) ringed redness, b) redness of target cels and d) continuous round or oval redness of different sizes of individual redness, or multiple occurrences with primary dissemination. Skin changes with multiorgan chronic symptoms of borreliosis occurred in 67.7% of cases the including: walking redness of different shapes and sizes, pink borreliosis stretch marks, white borreliosis stretch marks, borreliosis palms and soles, psoriatic changes, Acrodermatitis chronica atrophicans, Scleroderma circumscripta-morphae, Erythema nodosum, Granuloma anulare and Lichen striatus et atrophicans. Of the 509 patients treated for borreliosis, 32.3% with multi-organ symptomatology had no skin changes. Conclusion: The skin manifestations of European borreliosis are multi-layered and Erythema migrans are basic, but not the only markers of the disease. 'Pink borreliose stretch marks, "white borreliosis striae", "borreliosis palms or soles", and intermittent redness accompanied by itching are unique markers for the diagnosis of chronic borreliosis, if they are manifested.

Staphylococcal bacteraemia/sepsis-characteristics of laboratory parameters.

INTRODUCTION: While determining a diagnosis and during a disease follow-up, laboratory, or non-specific inflammatory parameters in particular, platelets reference values, nitrogen matters, and liver enzymes play a significant role because their values may indicate multiple organ failures. GOALS: To analyse laboratory parameters in patients diagnosed with the staphylococcal bacteraemia/sepsis. PATIENTS AND METHODS: Analysed patients have been treated at the Clinic for Infectious Diseases through the period often years. RESULTS: Differences in average CRP values, leucocytes, neutrophils and platelets among the patients diagnosed with the sepsis and bacteraemia are not statistically relevant p > 0,05. Difference in the average sedimentation values of the erythrocytes between the patients diagnosed with the sepsis and the patients diagnosed with the bacteraemia are statistically relevant p = 0,035. Differences between the average INR values between the patients diagnosed with sepsis and the patients with bacteraemia are not statistically significant, but indicative p = 0,051. Differences in the average blood sugar values, urea, creatinine, bilirubin and ALT between the patients diagnosed with bacteraemia and sepsis are not statistically significant p > 0.05. CONCLUSION: The results have showed that even in the course ofa bacteraemia, there is a significant increase in the non-specific inflammatory parameters indicating the gravity ofbacteraemia as well, with a constant risk of developing sepsis and septic shock. The importance of running and following-up the laboratory parameters herewith is emphasised for the purpose of detecting sepsis in a timely manner and administering an adequate therapy.

Serum level of tumor marker carbohydrate antigen-CA125 in heart failure.

OBJECTIVE: To assess serum levels of tumor marker carbohydrate antigen 125 (CA125) in patients with heart failure (HF) and to investigate possible correlation with echocardiographic parameters and level of brain natriuretic peptide (BNP). PATIENTS AND METHODS: We included 76 patients with different cardiac symptoms hospitalized at Clinic for heart disease and rheumatism. Control group (n = 26) was consisted of patients without signs and symptoms of HF, normal left ventricle ejection fraction (LVEF) and normal BNP level. Patients with diagnosis of HF (n = 50) were subdivided into 2 group depending on signs and symptoms of fluid overload: compensated (compHF, n = 10) and decompensated group (decompHF, n = 40). Serum CA125 and BNP were measured on admission and all patient underwent ECG recording and trans thoracic echocardiographic examination. RESULTS: The median CA125 level in HF group was significantly higher compared to control group (71.05 [30.70-141.47]U/ml vs 10.75 [8.05- 14.32] U/ml, p < 0.0005). Higher CA125 levels were found in decompHF group compared to compHF group (94.90 [49.75-196.75]U/ml vs 11.90 [10.25-15.80]U/ml, p < 0.0005). In decompHF group 13 of patients had pleural and/or pericardial effusion- their CA125 levels were significantly higher compared to patients without serosal effusion (n = 27) (205.10 [106.50-383.90]U/ml vs. 71.50 [47.30-109.55] U/ml, p < 0.002). We found significant difference in CA125 levels between patients with atrial fibrillation and sinus rhythm (98.40 [48.20-242.70] U/ml vs. 47.30 [12.95-99.05] U/ml, p = 0.015). There was no significant difference in CA125 levels in group with enlarged left atrium compared to normal sized atrium (p = 0.282), as well as in group with moderate/severe mitral regurgitation compared to group with no/mild mitral regurgitation (p = 0.99). Finally, levels of serum CA125 positively correlated with serum level of BNP (r = 0.293, p = 0.039), but not with LVEF (p = 0.369) and left atrium diameter (p = 0.636). CONCLUSION: Serum CA125 is elevated in decompensated HF patients: more pronounced elevation was found in patients with pleural and/or pericard effusion compared to patients with no serosal effusion. CA125 level correlated with BNP, but not with left atrium diameter nor with LVEF. Tumor marker CA125 could be used as a marker of systemic congestion and volume overload in decompensated HF. We hypothesized that high CA125 level indicates that measured high BNP is actually wet BNP.

Long-term outcomes in refractory status epilepticus.

INTRODUCTION: Refractory status epilepticus (RSE) is a diagnosis that can be made when tonic-clonic status epilepticus (SE) and focal SE cannot be stopped by at least two anti-seizure medications after 30 and 60 minutes, respectively, from the time of commencement. It could result in mortality, loss of functionality, neurological deficiency, and other serious short- and long-term effects. AREAS COVERED: This narrative review covers original clinical studies of any design and case series investigating long-term outcomes of RSE recorded after at least a year from the SE onset. EXPERT OPINION: The future of a patient with RSE rests mostly on the long-term effects of this severe pathological condition, which may be accompanied with systemic complications like hyperthermia, hyperkalemia, acidosis, and/or stress cardiomyopathy. Younger patients with less severe RSE of shorter duration, particularly of the convulsive kind, are reported to have better long-term outcomes. Previous studies on the factors influencing the long-term outcomes of RSE, however, did not link the outcomes to treatment options for the condition. Such circumstances currently prevent making any definitive recommendations on the treatment of RSE until future research with adequate statistical power is completed.

Psoriasis Area and Severity Index (PASI) Objectivisation by Flow Cytometry Analysis of Major Lymphocytes Subsets.

Background: Psoriasis as an immune-mediated inflammatory skin disease. The basis of the pathogenesis of psoriasis is the dysregulation of immune cell function in genetically predisposed individuals. The characteristic dysfunction of the immune system in patients with psoriasis is manifested as a variation in the cellular phenotypic profile in accordance with the disease status. Objective: The aim of this study was to evaluate the immunophenotypic profile of lymphocytes obtained by flow cytometry as an auxiliary diagnostic tool in the objectivization of the PASI score. Methods: The study group included 40 patients with psoriasis, hospitalized and treated at Dermatology Clinic of Clinical center University of Sarajevo and 30 healthy individuals as controls. After venepunction, the blood samples for determining the immune profile were prepared following standard laboratory procedures using conjugated monoclonal antibodies and BD FACSCanto II flow cytometer. T-lymphocytes (CD3, CD4, CD8), B lymphocytes (CD19), Natural killer cells (NK), and activatet T-cells (CD3HLA) were determined for all patients. Based on the PASI score, the severity and area of the disease was assessed for all psoriasis patients by dermatology specialist. Results: Our data shows no significant difference in any of the lymphocyte subpopulations between psoriasis patients and healthy controls, except CD3HLA. CD3HLA has higher values in patients with psoriasis, p=0.015. Of all the parameters, only NK cells were significantly correlated to the PASI score (rho -0.279; p=0.048). ROC curve analysis revealed a statistically significant difference for the proportion of CD3 lymphocytes (AUC 0.799; p=0.004), CD8 lymphocytes (AUC 0.733; p= 0.023), NK cells (AUC 0.722; p=0.008) and CD3HLA activated T lymphocytes (AUC 0.347; p=0.034). Conclusion: Profile of major lymphocyte subsets in patients with psoriasis is similar to that of healthy controls. The values of CD3, CD8, NK, CD3HLA were defined as biomarkers capable of distinguishing psoriasis according to the severity of the disease. Immunophenotyping of peripheral blood lymphocytes can play an important role as an auxiliary diagnostic method in differentiating the clinical stages of psoriasis and objectifying the PASI score.

Presence of Type 1 Diabetes-Related Autoantibodies in Pediatric Population in Bosnia and Herzegovina.

Background: Diabetes mellitus type 1 (T1D) is an autoimmune organ-specific disease with a wide range of clinical manifestations, in which the ß cells of the pancreatic islets of Langerhans are destroyed by the action of autoreactive T lymphocytes and the formation of autoantibodies against ß cell components. Among used serological markers of T1D, anti-glutamic acid decarboxylase antibodies (GAD65), anti-tyrosine phosphatase antibodies (IA2), islet cell antibodies (ICA), insulin autoantibodies (IAA) and anti-zinc transporter antibodies (Zn-T8) are of great significance. Objective: This study aimed to analyze presence of type 1 diabetes-related autoantibodies (GAD65, IA2, ICA, IAA and Zn-T8 and effects of age and gender on their occurrence in pediatric population. Methods: Sixty seven (N=67) T1D pediatric patients were included in the study. The levels of immunological parameters such as anti-glutamic acid decarboxylase antibodies (GAD-Ab), anti-tyrosine phosphatase antibodies (IA2-Ab), islet cell antibodies (ICA) and insulin autoantibodies (IAA) were determined by chemiluminescence immunoassay (CLIA) and anti-zinc transporter antibodies (Zn-T8-Ab) were determined by enzyme-linked immunosorbent assay (ELISA). For statistical analysis, we used SPSS statistical program. Results: Our study revealed that among 67 patients with T1D (40 male and 27 female), with an average age of 12,1±3,9 years. The average age of diabetes diagnosis was 6,15±3,29 years. 24 (35,8%) cases were positive for GAD65, 15 (22,4%) for ICA, 34 (50,7%) for IAA, 16 (23,9%) for IA2 and 36 (53,7%) for Zn-T8. The largest number of patients had single positive antibody, the most dominated among them was IAA dominated (40,9%), then Zn-T8 (31,8%). According to Spearman correlation test Zn-transporter shows a significant positive correlation with age of the participants (p=0.027) and disease duration (p=0.006). Anti IA2 shows significant negative correlation with HbA1c (p=0.043). Zn-transporter is associated with patients age and duration of T1D. Conclusion: In most cases, patients with T1D are positive for at least one of the specific autoantibodies. Zn-T8 is the most frequently detected and is an important serological marker of type 1 diabetes mellitus. Gender effects on autoantibodies seems to be insignificant, while age alongside disease duration shows important effects.

Triglyceride level as a potential marker of residual cardiovascular risk and its relation to HeartScore.

BACKGROUND: Atherosclerotic cardiovascular diseases (ASCVD) are still the leading cause of morbidity and mortality in Bosnia and Herzegovina. Elevated LDL-cholesterol is established as a strong marker of cardiovascular risk. Some researchers believe that measuring triglyceride levels gives a good assessment of the residual risk for ASCVD besides the measurement of LDL-cholesterol. OBJECTIVE: The aim of this study was to evaluate the overall prevalence of major risk factors for ASCVD, lipid profile and 10-year fatal cardiovascular risk using the HeartSCORE scoring system. Further, we want to evaluate the prevalence and relationship between elevated triglyceride levels and high 10-year fatal cardiovascular risk calculated as a HeartSCORE. METHODS: This is a cross-sectional study conducted on 832 volunteers aged between 40 and 65 years without a diagnosis of diabetes and without known preexisting cardiovascular disease, as a part of the preventive program conducted at the Family Medicine office. Data were collected for ASCVD risk factors and lipid panel (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides). 10-year fatal cardiovascular risk was calculated using the HeartSCORE scoring system for countries with high CV risk. RESULTS: Among 832 participants included, 565 (67.9%) were female, and 267 (32.1%) were male. We found high prevalence of hypertension (27.7%), obesity (32.2%), and smoking (36.2%). All lipid parameters, except HDL-C, were not optimal. Only 17.4% of participants had normal estimated HeartSCORE risk, while more than one-third (33.9%) had high or very high estimated HeartSCORE risk. Although we found a higher percentage of participants with elevated triglycerides in groups with higher HeartSCORE, there was a very weak positive correlation between values of triglycerides and the 10-year risk of a fatal cardiovascular event (r= 0.249, p= 0.000). CONCLUSION: The high prevalence of major known risk factors and high estimated HeartSCORE risk indicate a high overall risk for ASCVD in the sample. The proportion of participants with elevated triglycerides was increased in patients with high HeartSCORE risk what implicates importance of triglyceride measurement.

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

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

Importance of quick test for screening of former drug users.

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

Serratia marcescens meningitis following spinal anaesthesia and arthroscopy.

We present case of nosocomial bacterial meningitis, caused by Serratia marcescens (ESBL), occurred following spinal anaesthesia. Although very rare bacterial meningitis is serious complication of spinal anaesthesia and early diagnosis as well as effective treatment is extremely important. Previously healthy individual, admitted to Orthopaedic Department for routine arthroscopy, approximately within 24 hours after operation was performed complained of headache and fever. Infectious Diseases physician was consulted, lumbar puncture was performed and purulent meningitis was confirmed. Cerebrospinal fluid and blood cultures of patient confirmed Serratia marcescens (ESBL), resistant pathogen and important nosocomial agent. Patient was successfully treated. Cases of spinal meningitis caused by Serratia marcescens are rare. Local resistance pattern is important and should be always considered when starting therapy. Infection control team was appointed because of similar case of meningitis one month before in the same Department, and after investigation discovered Serratia in anaesthetic vial used in procedures. New measures and recommendations regarding infection control were implemented at Orthopaedic Department. Meningitis as a complication should always be considered as a possible differential diagnosis with patients after spinal anaesthesia complaining on headache and fever. Early diagnosis and early treatment is extremely important. Knowledge and practice of infection control measures is mandatory and should be always emphasized to performing staff.

Recanalization rate of proximal deep venous thrombosis related to therapeutic modality during six months follow-up.

Aim To evaluate the efficacy (rate of recanalization) of therapy with novel oral anticoagulants (NOAC; rivaroxaban, apixaban) compared to conventional treatment (low molecular weight heparin - LMWH and vitamin K antagonist) in the treatment of deep vein thrombosis (DVT) of the proximal segments of lower extremities. Methods The first group consisted of patients diagnosed with DVT and treated with NOAC (n = 100), while the second group consisted of patients diagnosed with DVT, who were treated by conventional treatment (low molecular weight heparin and vitamin K antagonists) (n = 100). In the first group, NOAC was included in the initial treatment. Patients in the second group were treated with LMWH for four days, and on the fifth day vitamin K antagonist was included in therapy, international ratio (INR) was titrated to therapeutic values (2.0-3.0), and then low molecular weight heparin was excluded from the therapy. Results There was a statistically significant difference in the estimated values of free lumen of the blood vessel between the examined groups after 30 days (p=0.0001), after 90 days (p=0.0001) and after 180 days (p=0.0001). After 180 days, the average free lumen values in the NOAC group were 85% (81-89%), which was significantly higher than the free lumen values in the second group, 73% (69-79%). Conclusion The use of NOAC represents more efficient treatment of DVT comparing to vitamin K antagonists.