89 - KCUS

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89 - KCUS

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PUBLISHER
Editor-in-Chief
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EDITORIAL OFFICE
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Clinical Center University of Sarajevo,
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Contents
ORIGINAL ARTICLE
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RELATIONSHIP BETWEEN UROTHELIUM REACTION VERIFIED WITH ULTRASOUND AND VOIDING
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THE MOST COMMON RISK FACTORS AND CO-MORBID CONDITION AMONG PATIENTS
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PAROXYSMAL ATRIAL FIBRILLATION AND OUTCOME IN CRITICALLY ILL PATIENTS WITH SEPSIS
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INFORMATION
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Original article
COMPARING OF NEUROPSYCHOLOGICAL PERFORMANCE IN BIPOLAR DISORDER AND SCHIZOPHRENIA
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*Corresponding author
ABSTRACT
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Earlier comparisons of cognitive impairment
among patients with bipolar disorder and schizo
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cits, but results have varied between studies. This
study is current attempt of another such compari
son.
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try Department Clinical Center, University of Sara
jevo. They were compared with 30 healthy controls
on several neuropsychological tests including the
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Both bipolar disorder and schizophrenia patients
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executive function, memory and perceptuomotor
functions as compared to healthy controls.
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formed worse than patients with bipolardisorder,
but none of the differences between schizophre
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ophrenia may have more severe impairments.
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tant implications for the etiology and treatment of
both disorders.
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Key words: bipolar disorder, schizophrenia, cog
nitive testing, neuropsychology
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INTRODUCTION
Despite the historical and current nosological
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that these conditions might share some genetic
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certain phenomenological characteristics, they
also have similar ages of onset, sex distributions,
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disease overlap, possibly related to the presence
of psychosis, brain imaging studies reveal similari
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separate category, and that we ought to conceptu
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ous distinctions between SZ and BD, including dif
ferences in their clinical course, associated levels
of functional impairment, and response to medica
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One obstacle to elucidating susceptibility genes in
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determining whether SZ and BD are character
ized by similar or different neuropsychological pro
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Cognitive impairment in BD has lately come un
der increasing scrutiny. Several earlier studies of
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These demonstrate impairments in visuospatial
memory, verbal learning, executive functions, and
sustained attention among remitted patients with
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of executive function and verbal memory among
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However, such as state or trait origins of cogni
tive impairment, effect of medications on cognitive
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impairment in SZ is considered a core feature of
the disorder. It is reliably present in the majority
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largely stable over intervals ranging for months to
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Also previous research has shown that individuals
with SZ demonstrate impaired to controls perfor
mance across a broad range of neuropsychologi
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impairments of complex attention, psychomotor
speed, memory, abstraction or executive function
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cits that can be as severe as those seen in SZ
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shown to demonstrate mild, selective impairments
of verbal learning and memory and sustained at
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have shown impairments of psychomotor speed,
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ligence, motor function, praxis, selective attention,
or language.
Systematic review of studies comparing cogni
tive functions in SZ and BD concluded that the
two patient groups share impairments in several
cognitive domains including attention, memory
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appeared to have more severe and widespread
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areas such as psychotic symptomatology, genetic
vulnerability and structural brain abnormalities
has prompted some authors to propose that SZ
and BD lie on a continuum of cognitive dysfunc
tion, and that cognitive impairment in both these
disorders may be based on similar or converging
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Such speculations, however, can be considered
only tentative, particularly because the same re
view also highlighted several methodological
problems affecting the studies that have com
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Aim
The present study aimed to compare the cogni
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bipolar disorder relative to healthy adults.
MATERIALS AND METHODS
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with schizophrenia disorder were recruited from
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of Sarajevo.
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characteristics were derived from retrospective life
charts constructed from patient interview and hos
pital medical records. Also 30 healthy controls with
no history of psychiatric disorder, based on SCID
interview, were recruited from the community. The
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jects.
Subjects admitted to the psychiatric hospital with a
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somatic disease with no history of psychiatric dis
orders were approached.
After obtaining written informed consent which
were approved by Ethic Committee Clinical Cent
er University of Sarajevo, sociodemographic and
SCID I interview were assessed. For all subjects,
interview, ratings and neuropsychological testing
was carried out in the afternoon. The complete as
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The neuropsychological test battery included tests
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speed. Tests used to evaluate these neuropsycho
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was computed for each neuropsychological test.
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group.
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es between bipolar patients and controls as well
as between schizophrenic patients and controls in
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7DEOHT test results for BD versus controls.
7DEOHT test results for SZ versus controls.
RESULTS
Table 1 shows the descriptive statistics for patients
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chological tests healthy controls achieved better
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Table 1. 'HVFULSWLYHVWDWLVWLFVIRUSDWLHQWVZLWK6=%3
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and healthy controls.
7DEOH T test results for BD versus SZ.
DISCUSSION
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ence between all three participants groups for the
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Cognitive impairment in Bipolar Disorder
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is considerably less compared to that on schizo
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thymic patients have convincingly demonstrated
impairment in aspects of executive function, ver
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EDO PHPRU\ DQG VXVWDLQHG DWWHQWLRQ %' SDWLHQWV LQ WKH SUHVHQW VWXG\ 7DEOH VKRZ
impaired cognitive function in information process
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chomotor performance compared to healthy con
trols. So this impairments involving a broad range of
cognitive functions. There are only isolated reports
of disturbed perceptuomotor function in bipolar dis
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of that particular study, however, were based on
symptomatic, and not euthymic, BD patients. Thus,
comparisons with the current study are perhaps not
wholly appropriate
Cognitive impairment in schizophrenia
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spread cognitive impairments involving several do
mains, when compared with normal controls. Com
pared to healthy controls SCZ patients showed
impaired cognitive function on in information pro
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motor function within the executive function domain
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psychomotor performance compared to healthy
controls.
This was in agreement with the extensive body of
literature that exists in this area, which suggests
that most patients with SZ have prominent cogni
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Bipolar Disorder versus schizophrenia
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and BD have usually suggested that the differences
are more in the extent and degree of impairments,
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7KHSUHVHQWUHVXOWVIXUWKHUVXSSRUWWKLVQRWLRQ
They show that although both patient groups were
impaired on several neuropsychological tests com
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GLIIHUHQFHVLQWKHFRJQLWLYHSUR¿OHVRI6=DQG%'
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patients with SZ performed worse than patients
with BD on almost all the neuropsychological tests,
but none of these differences between the two pa
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SDWWHUQ RI QRQVLJQL¿FDQW GLIIHUHQFHV EHWZHHQ WKH
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performing somewhat better than those with SZ in
declarative memory.
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has been reported in a number of previous stud
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WKRVH SUHYLRXV FRPSDULVRQV VFKL]RSKUHQLD
patients and euthymic subjects with BD both exhib
ited extensive cognitive impairments and patients
with BD seemed to be slightly less impaired than
schizophrenic patients, particularly in the areas of
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verbal memory. However, differences between the
disorders are minimal and cognitive impairment
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the pattern of cognitive impairment is similar, sug
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DUH QRW GLDJQRVLV VSHFL¿F 'LIIHUHQFHV LQ WKH
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The similarities in cognitive performance across BD
and schizophrenia found in the present, as well as
earlier, studies, have several possible implications
for both disorders. First, this resemblance is not en
tirely unexpected given the epidemiological, phe
nomenological, genetic and neurobiological overlap
EHWZHHQWKHWZRGLVRUGHUV,QGHHGLWKDVEHHQ
suggested that SZ and BD exist on a continuum
of cognitive dysfunction, and that impaired cogni
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FRPPRQWRERWKWKHVHFRQGLWLRQV7KHRYHUODS
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mon or converging neurobiological origins of these
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IXQFWLRQDSSHDUVWREHWKHPRVWOLNHO\PHFKDQLVP
that could account for the similarities in cognitive
impairment apparent among schizophrenia and bi
polar disorder. The memory dysfunction common
to both disorders could also indicate shared tempo
ral lobe pathologies.
A second implication of the similar cognitive impair
ments found in SZ and BD in present and previous
VWXGLHVUHODWHVWRGLVHDVHRXWFRPH7KHUHOD
tionship between cognitive impairment and func
tional disease outcome has been extensively docu
mented in SZ; now there is emerging evidence of
a comparable association between cognitive dys
IXQFWLRQDQGFOLQLFDOVRFLDORXWFRPHLQ%'DVZHOO
,QFRQWUDVWWRWKDWIRUVFKL]RSKUHQLDKRZHYHU
research in the area of cognitive impairment in bi
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WREHGRQHWRUHVROYHLVVXHVVXFKDVVWDWHWUDLWHI
IHFWVORQJLWXGLQDOFRXUVHRIFRJQLWLYHGH¿FLWVDQG
effect of medications etc.
In summary, the patterns of cognitive impairment
DUHVLPLODULQ6=DQG%3,WQHHGVWREHHPSKDVL]HG
that early diagnosis and active treatment of these
cognitive impairments could potentially reduce the
FRJQLWLYHPRUELGLW\RIERWKGLVRUGHUV7KLVSRVVL
ELOLW\ DORQH VKRXOG EH VXI¿FLHQW UHDVRQ IRU IXUWKHU
exploration of this area.
CONCLUSION
Some earlier comparisons of cognitive impairment
among patients with bipolar disorder and schizo
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cits, but results have varied between studies. This
study was attempt of another comparison.
This study show that patients with bipolar disorder
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VFKL]RSKUHQLD LQ WHUPV RI WKHLU SUR¿OH DOWKRXJK
patients with schizophrenia may have more se
vere impairments. The resemblance in cognitive
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and treatment of both disorders.
&RQÀLFWRILQWHUHVWnone declared.
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tients with schizophrenia and bipolar psychoses. Schiz
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Original article
TYPES AND FREQUENCY OF MEDICAL COMPLICATIONS DURING STROKE
REHABILITATION
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ABSTRACT
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tial barriers to an optimal recovery. The aims of
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retrospective study included 101 patients with pri
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a source of data we used medical records. De
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medical conditions, medical complications that oc
curred during inpatient rehabilitation, the length of
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admission and discharge from hospital were ana
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one or more medical complications. The most
common complications were: urinary tract infec
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associated with the following factors which were
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INTRODUCTION
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RESULTS
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Table 1. 'HPRJUDSKLFDQGVWURNHFKDUDFWHULVWLFV
The most common preexisting medical condi
tions among the patients are heart disease history
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or more medical complications. The most com
mon complications were: urinary tract infections
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associated with the following factors which were
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tions.
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in patients without medical complications it was
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median of BI at admission between two groups
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medical complications, the median of BI at dis
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Figure 1. Box plot of the length of stay in hospital
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median of BI at discharge between two groups
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admission and discharge in patients with medical
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DISCUSSION
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enced one or more medical complications during
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studies urinary tract infection was the most com
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medical complications and the most common
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pneumonia during rehabilitation process is around
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patients undergoing rehabilitation needed acute
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this study had complication, venous thromboem
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sure ulcers during rehabilitation process is around
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Hung et al. reported that there is statistically sig
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and BI at admission and discharge between two
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factors which were presented at admission: fre
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or more stools daily, coronary artery disease and
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complications can prolong length of stay in hos
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cal complications may lead to prevention and im
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REFERENCES
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Original article
ANTIOXIDANT ACTIVITY OF WATER EXTRACTS AND ESSENTIAL OIL OF Artemisa Dracunculus L., Asteraceae
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VRSTE Artemisia dracunculus L., Asteraceae
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Faculty of Sciences, Department of Biology, University of Sarajevo, Zmaja od Bosne 8b, 71000 Sarajevo,
1
ABSTRACT
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Tarragon is herbaceous plant belonging to the
Asteraceae family. It is mainly used as a culinary
herb in oil, sauces, vinegars, mustard and spices
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ent in plant materials are usually responsible for
the antioxidant and antiradical activity. The aim
of this study was to determinate total phenolic
content and antioxidant activity of water extracts
and essential oil of tarragon leaves, Artemisiae
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nolic content was determined in water extracts,
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activity of the water extracts and essential oil of
tarragon was determined using four methods:
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water extract of leaves showed the highest phe
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other methods and it is not possible to compare
their results. Antioxidant activity of tarragon leaf
measured by ORAC method showed following re
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7(J DQG 25$&DJDLQVW SHUR[\O UDGLFDO PPRO7(J$QWLR[LGDQW FDSDFLW\ RI WDUUDJRQ HV
sential oil showed modest activity.
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Key words: tarragon, antioxidant capacity, phe
nols, essential oil
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INTRODUCTION
The potentially reactive derivatives of oxygen, en
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generated inside the human body. Homeosta
sis of normal organism considered existence of
symmetry between the ROS generated and the
antioxidants present. Under normal state of af
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antioxidants nearby in the body. However due to
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ROS gain that culminates in oxidative hassle. The
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to various biomolecules including proteins, lipids,
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a lot of chronic human diseases such as diabe
tes mellitus, cancer, atherosclerosis, arthritis, and
neurodegenerative diseases and also in the age
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which have been reported to exert multiple effects
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stantial attention has been directed towards cre
dentials of plants with antioxidant ability that may
be used for human expenditure. In recent years
one of the areas, which attracted a great treaty
of attention, is antioxidant in the control of degen
erative diseases in which oxidative dent has been
implicated.
Due to the fact that some species of Asteraceae
family have proven antioxidant capacities, present
study was designed to evaluate antioxidant ca
pacity of water extracts of tarragon leaf, Artemisae
dracunculus folium, Asteraceae. This plant spe
cies is widely present in every day domestic and
industrial uses. As conservant and spice, tarragon
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and as garnishes for meat dishes and in vegetable
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aration of beef; in Hungary, Georgia, and Azerbai
jan it is used in the preparation of mutton as well
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following properties: source of vitamins, anticon
vulsant activity, spasmolytic, carminative, appetite
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ceutical products it would be good to examine its
effect in terms of antioxidant capacity, which is the
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Plant materials
The leaves of tarragon were collected from the
plants cultivated in Sarajevo, Bosnia and Herze
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Department of Biology, Faculty of Sciences, Uni
versity of Sarajevo, Bosnia and Herzegovina
Extracts preparation
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extracts of leaves of plant species Artemisia dra
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made.
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carefully decanted with micropipette and splits
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Isolation of the essential oil
The leaves of A. dracunculus were subjected to
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was dried over anhydrous sodium sulphate and
stored in a sealed glass vial at low temperature
until analysis.
Determination of total phenolic content
Total phenol content of A. dracunculus folium
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pared to a gallic acid calibration curve. Total phe
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sented as means of triplicate analyses.
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and incubated for 10 minutes at room tempera
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High pressure liquid chromatography with
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Determination of gallic acid, chlorogenic acid, caf
feic acid and sinapic acid was based on a com
parison of retention times of its standard solution
and retention time of every single acid obtained
from extracts.
Antioxidant capacity tests
1.Evaluation of antioxidant activity using
DPPH method
The ability of phenol derivatives to donate hydrogen
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Decrease in absorbance of tested mixtures was
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trophotometer. Anhydrous ethanol was used to
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as a positive probe.
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The reducing power test is based on the reduc
tion of ferric to ferrous cation by the potent anti
oxidant. In the presence of cyanide ions, adding
a new amount of Fe3+, develops a blue color of
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The reducing power of leaves extracts was de
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ferricyanide. The mixtures were thermostated at
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acetic acid was added to the mixture, which was
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then centrifuged at 3000 rpm for 10 min. Upper
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and the absorbance was measured at 700 nm.
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positive control.
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oxidants in the test sample when ABTS incubates
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methanol until a solution absorbance was between
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were used as standards.
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oxygen radical absorbance capacity method
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The ORAC values of the tested samples were de
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describes below:
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droxy radicals was induced by adding the solution
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peroxy radicals was induced by adding the solu
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ried out in triplicate.
RESULTS
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phenolic compounds.
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Table 1. 6HSDUDWHFRPSRQHQWVRIWKHDTXHRXVH[WUDFW
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7DEOH Contents of single phenolic compounds sepa
rated from tarragon leaves.
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7DEOH Results of analysis of antioxidant activity of
extracts using four different methods.
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DISCUSSION
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of a pure substance or a complex chemical mix
ture to slow or prevent the oxidation of other sub
stances when both are simultaneously exposed
to free radicals that cause their oxidation. There
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ance toward effects of free radicals, which may
be expressed in different ways, and it is mostly
converted to the amount of a standard antioxidant,
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to the data from Table 4, which shows the results
of antioxidant activity of three different extracts of
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tarragon hot extraction, showing minimal values
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ing the highest antioxidant potential of compounds
in this sample. This sample also has the highest
content of total phenolic compounds, where it can
be inferred that the antioxidant activity depends
on the content of phenolic compounds in the sam
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method, which suggests that it is harder to reduce
the stable ion of free radicals, which would other
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From these data we can see that the values of
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effects of the substrate radical.
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cantly from the previously mentioned methods, so
their results cannot be compared, especially since
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the results of this method can be attributed to the
different structures of the phenolic compounds
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oxidant effectiveness of phenolic compounds de
pends on the reactivity of the phenol toward the
chain holder of peroxyl radicals and stability of
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action mechanism is mainly based on the transfer
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drogen atoms provides alternative means of the
occurrence, because it happens slowly in strong
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methanol and ethanol. As it happens in other tests
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the pH value of the reaction. Steric availability of
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reaction, since small molecules that have better
access to radical site, have relatively higher anti
oxidant activity. On the other hand, many complex
antioxidant compounds which rapidly react with
radicals may react slowly or may even be inert in
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correlation between phenol content and antioxi
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CONCLUSION
From the above it can be said that the plant spe
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macognostic standpoint, because it gives the
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phenolic content. The pharmacological effects of
pronounced antioxidant activity justify the idea on
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cine. Since the tarragon has many uses as herb
and positive results of the antioxidant activity
could be the basis for its use as dietary supple
ment and production of special recipe prepara
tion in the prevention of cardiovascular disease,
thrombosis, strengthen the immune system, par
ticularly in terms of the stress of everyday life.
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prevention of chronic disease. Crit Rev Food Sci Nutr.
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$VWHUDFHDH
ZLWKUHVSHFWWRPRGXODWLRQRI&DSXPSIXQFWLRQ,QWHUGLV
FLS7R[LFRO±
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FKDUDFWHULVWLFDQGXVHIXOSURSHUWLHVRIWDUUDJRQ$UWHPL
VLDGUDFXQFXOXV/3KDUPDFHXWLFDO&KHPLVWU\-RXUQDO
/RSH]/XW] '$OYLDQR '6$OYLDQR &6 .RORG]LHMF
]\N336FUHHQLQJRIFKHPLFDOFRPSRVLWLRQDQWLPLFUR
bial and antioxidant activities of Artemisia essential oils.
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bial and antioxidant activities of Artemisia essential oils.
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sorbance capacity assay for antioxidants. Free Radic
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activity of various extracts of Artemisia dracunculus
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Address:
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University of Sarajevo
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71000 Sarajevo
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Original article
RELATIONSHIP BETWEEN UROTHELIUM REACTION VERIFIED WITH ULTRASOUND AND
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Herzegovina; 3HGLDWULF&OLQLF&OLQLFDO&HQWHU8QLYHUVLW\RI6DUDMHYR6DUDMHYR%RVQLDDQG
Herzegovina; 3Academy of Sciences and Arts of Bosnia and Herzegovina, 71000 Sarajevo, Bosnia
and Herzegovina
ABSTRACT
The goal of this study was to analyze the useful
ness of urothelium reaction as ultrasound criteria
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history of the disease had data on urinary infec
tion. Ultrasound examination included the evalu
ation of the urinary tract, while mandatory part of
the examination was to evaluate the appearance
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dard protocol with the use of ultrasound contrast
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three stages. The largest number of patients was
referred with a diagnosis Infectio tracti urinarii re
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LQ RI SDWLHQWV ZKLOH LQ RI SDWLHQWV
it was pathological. Statistical analysis revealed
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indicated that these ultrasound criteria cannot be
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present in case of recurrent urinary tract infections
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Conclusion: The presence of urothelium reaction
proven by routine ultrasound, as an independent
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tion with other criteria, can be used for selection of
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INTRODUCTION
Urinary tract infections are a common and sig
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methods is to establish the existence of this type
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anomalies of the urinary tract are abnormalities
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The average age of patients was 4.4±3.9 years: the
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found that the majority of patients had the diagnosis
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admission diagnoses were represented in less than
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Figure 1. Admission diagnoses.
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Ultrasound examination
Ultrasound examination was made according to
the standard protocol in supine and prone position,
which included examination of the urinary bladder,
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datory part for examination was an assessment
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pathological. Urothelium reaction was considered
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RESULTS
1.8
In this prospective study conducted during the pe
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in the history of the disease had data on urinary
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ter University of Sarajevo. All ultrasound exami
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experienced radiologist at the Clinic of Radiology,
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were sterile urine culture, not older than seven
days and signed consent for examination by at
least one parent.
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on the age, the expected capacity of the bladder is
assessed by following formula: expected bladder
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with saline in amount corresponding to half of the
expected bladder capacity, the contrast agent is
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der. Ultrasound contrast agent used in this study
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sound contrast agent of second generation con
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lipids wrapper. Its application has to be careful and
slow to minimize the destruction of microbubble
contrast and reduce the deposition of the suspen
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on visualization of microbubble in the ureter and
pyelon or collecting system. After that the exami
nation is continued during miction to assess active
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elon dilatation up to 10mm, without dilated calix;
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widened collecting system, compression on renal
parenchyma.
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According to the NICE guidelines the ultrasound
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ation of children with diagnosed urinary infection,
since it allows simultaneous detection of morpho
logical changes that occur during the urinary infec
tion and possible urinary tract abnormalities, while
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which involves the use of ionizing radiation, lately
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cording to leading experts it is characterized as
practical, safe, relatively inexpensive, highly sen
sitive method, which does not use ionizing radia
tion, or as a method which is closest to the ideal
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Aim of this study was to analyze the predictive
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on the day of examination and one day after the
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catheter into the lumen of the bladder and its dis
charge, after which the lumen of the bladder under
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often in the group of patients diagnosed with ac
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action.
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lium reaction is response to urinary tract infec
tion. For that reason in our study we statistically
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with the diagnosis of Infectio tracti urinarii or In
fectio tracti urinarii recidivans. Statistical analysis
showed that the ultrasound parameter of urothe
lium response cannot be designated as a charac
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admission diagnosis Infectio tractii urinari and
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of diagnosis Infectio tractii urinari recidivans and
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ITU.
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DISCUSSION
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used in developed countries in everyday clinical
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zegovina introduced this method in routine clini
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PDGH H[FOXVLYHO\ E\ 9&8* D PHWKRG WKDW LQ
volves the use of ionizing radiation. Due to the fact
that ionizing radiation has accumulation effect and
is used predominantly in the pediatric population,
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Numerous recent studies have demonstrated high
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becoming the primary imaging modality in the
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females and the predominance of bilateral and left
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ing method used in the algorithm for urinary tract
infections examination in the pediatric population
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sound criteria of urothelium reaction diagnosed
during a routine ultrasound examination of the uri
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By the review of the available literature we could
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tween this ultrasound parameter and the existence
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cal analysis showed that the ultrasound parameter
of urothelium reaction cannot be designated as a
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CONCLUSION
According to the results of our study the presence
of urothelium reaction as an independent criteri
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criteria it can be used for selection of patients for
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possibility of simultaneous evaluation of the up
per urinary tract and due to its high sensitivity and
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dren. II. Comparison with radiological examinations.
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REFERENCES
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Address:
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Clinic of Radiology
Clinical Center of University of Sarajevo
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Original article
THE MOST COMMON RISK FACTORS AND CO-MORBID CONDITION AMONG
PATIENTS WITH PULMONARY TUBERCULOSIS
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71000 Sarajevo, Bosnia and Herzegovina
ABSTRACT
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public health concern, mainly affecting poor and
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tion among patients with pulmonary tuberculo
sis. This prospective study was carried out in the
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culosis and Health facilities for lung diseases and
tuberculosis in the Sarajevo area. The sample
consisted of 300 new tuberculosis patients. Be
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Conclusion: Among patients with pulmonary tuber
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diabetes melitus.
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bolesno stanje je diabetes mellitus.
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bolesno stanje
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INTRODUCTION
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public health concern, mainly affecting poor and
vulnerable populations. Every year, more than 9
million people diseased from this infectious dis
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distribution of TB in populations, and on TB trends
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represent a larger attributable fraction for TB dis
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tered and a tuberculosis incidence amounted to
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diseases in the Federation of Bosnia and Herze
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To reduce the annual number of new tuberculosis
cases and the number of people with tuberculosis
in such countries, it may be necessary to identify
and the target factors that increase an individual
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Therefore, the aim of this study was to determine
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dition among patients with pulmonary tuberculo
sis.
Socioeconomic status scale contemplates three
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A case of sputum smear positive pulmonary tuber
culosis is a patient with at least two initial positive
sputum smears, or one sputum smear positive
plus radiographic abnormalities consistent with
active pulmonary tuberculosis as determined by
a clinician; or one sputum specimen positive plus
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berculosis.
A sputum smear negative pulmonary tuberculosis
case is a patient diagnosed with pulmonary tuber
culosis by a clinician not meeting the above crite
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Statistical analysis
All statistical analyses were conducted using the
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calculated.
RESULTS
Characteristics of Participants
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Of the total 300 patients, were somewhat more
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factors reported among TB patients.
This prospective study was carried out in the
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culosis and Health facilities for lung diseases and
tuberculosis in the Sarajevo area.
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presented for the treatment in the aforementioned
medical facilities during the period of the study
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losis patients.
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tients were interviewed according to a structured
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velopment of pulmonary TB.
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The percentage of diabetic patients was sig
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Figure 1. %LRORJLFDOULVNIDFWRU
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Diabetes mellitus
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of TB cases.
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Out of 31 TB patients who consume alcohol 11
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for TB.
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patients.
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DISCUSSION
In this descriptive prospective study, we have
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condition was diabetes mellitus.
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Numerous studies suggest that in many develop
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ing rate in many studies is higher than the national
average among the general adult population. One
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twice as high as among control household mem
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among patients with TB compared with controls
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produce an excess of 18 million tuberculosis cases
and 40 million deaths from tuberculosis between
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to delay the millennium development goal target
to reduce tuberculosis mortality by half from 1990
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towards reducing tobacco use among TB patients
due to its negative impact on TB treatment out
comes.
Diabetes is a common comorbidity in people with
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tributable to diabetes amount to more than 700 000
cases per year worldwide—cases that would not
have occurred in the absence of diabetes. In eight
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culosis, diabetes accounts for a great proportion
of tuberculosis cases. Of eight countries, some
are heavily populated—Russia where diabetes
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but incidence remains high in countries that have
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malnutrition and crowded living conditions. At the
same time, diabetes mellitus prevalence is soar
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There is growing evidence that diabetes mellitus is
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affect disease presentation and treatment re
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TB is not exclusively a disease of the poor but the
association between poverty and TB is well estab
lished.
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patients.
Economically poor and vulnerable groups are at
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culosis compared with the general population be
cause of overcrowded and substandard living or
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ease. Evidence from various researches strongly
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poverty. In Norway and USA prevalence of TB
was higher among poor populations than nation
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higher than national average. In China, in preva
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than the population average in areas surveyed. In
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greater among refugee camp residents than for
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CONCLUSION
Evidence indicates that rates of TB are higher in
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ing than in the general population. In our study
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condition was diabetes mellitus. Early diagnosis
and good management of diabetes, as well as
efforts to minimise the harmful use of tobacco in
people diagnosed with tuberculosis would help to
strengthen general care for TB patients in the fu
ture.
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tobacco addiction in countries with high tuberculosis in
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and mortality from tuberculosis and other diseases in
India: retrospective study of 43000 adult male deaths
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Original article
EARLY POSTOPERATIVE AND CHRONIC PAIN IN PATIENTS UNDERGOING PREPERITONEAL OR PREFASCIAL INGUINAL HERNIA REPAIR
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postoperativna bol
ABSTRACT
In surgical practice it is always topic issue which
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obtain less postoperative complications includ
ing postoperative pain. The aim of this study was
to evaluate and compare the occurrence of early
postoperative pain and development of postherni
orraphy pain after open inguinal hernia repair by
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clinical study was conducted at the Clinic for Gen
eral and Abdominal Surgery, CCUS in period from
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which 30 patients were operated by Rives tech
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during the follow up to one year were evaluated in
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lower rate of pain was found in the early postop
erative period in patients treated by Rives tech
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One year after surgery persistent postoperative
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sults of this study indicate that hernia repair with
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postoperative pain and groin discomfort compare
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stein, postoperative pain
INTRODUCTION
Inguinal hernias are the most common pathology
on surgical departments worldwide. At the groin
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only occur is of great importance to surgeons.
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are applied in modern surgical practice, are divid
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and nontension procedure, which may be endo
scopic procedures and classical open procedure
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PXPHI¿FDF\DQGHI¿FLHQF\IRUWKHVHWHFKQLTXHV
is inguinal hernia repair with fewer complications,
LQFOXGLQJHDUO\SRVWRSHUDWLYHDQGFKURQLFSDLQ
7KHUH LV VXEVWDQWLDO JRRGTXDOLW\ HYLGHQFH WKDW
mesh repair for primary inguinal hernia, compared
with nonmesh methods, can be performed with
less postsurgical pain and lower recurrence rate
)UHTXHQF\RISXEOLVKHGSRVWRSHUDWLYHSDLQDI
ter inguinal hernia repair varies in trials around the
ZRUOG /RRV DQG DVVRFLDWHV IROORZHG RYHU patients one year after inguinal hernia repair and
IRXQGPRGHUDWHWRVHYHUHSDLQLQRISDWLHQWV
ZLWKIXQFWLRQDOLPSDLUPHQWLQRIDOOFDVHV
,Q DQRWKHU ODUJH VWXG\ %D\1LHOVHQ ZLWK DVVRFL
DWHVKDVLGHQWL¿HGFKURQLFLQJXLQDOSDLQLQRI
WUHDWHG SDWLHQWV RQH \HDU DIWHU KHUQLD UHSDLU Although the incidence of many complications, in
cluding infection rate, intestinal obstruction, post
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applying mesh compared with nonmesh materials
UDLVHV WKH QDWXUDO TXHVWLRQ RI ZKHWKHU SODFH
setting mesh may contribute in appearing either
of the early postsurgical or chronic inguinal pain.
Aim of this study was to compare postsurgical
pain and chronic postherniorraphy pain in patients
XQGHUJRLQJSUHSHULWRQHDO5LYHVRUSUHIDVFLDO/L
FKWHQVWHLQUHSDLURISULPDU\LQJXLQDOKHUQLD
7KLV SURVSHFWLYH FRPSDUDWLYH VWXG\ LQFOXGHG SDWLHQWV DJH ± \HDUV ZLWK SULPDU\ LQJXL
nal hernia, operated in the Clinic for General and
Abdominal Surgery of Clinical Centre University of
6DUDMHYR EHWZHHQ -DQXDU\ DQG 'HFHPEHU
7KH H[FOXVLRQ FULWHULD ZHUH VHYHUH FRPRU
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tive lung disease, uncontrolled diabetes, ischae
PLF KHDUW GLVHDVH SUHYLRXV ORZHU DEGRPLQDO RU
retropubic surgery that might interfere with place
ment of the mesh, previous contralateral hernia
repair with preperitoneal prosthetic material, re
current hernia, incarcerate inguinal hernia, proven
abdominal neoplasms with a short term survival,
refused surgical treatment. The patients were di
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consents of all patients were obtained.
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and medially for transversal muscular arch. All
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general anaesthesia and done by a team of sur
geons who have undergone the same education
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performed in all patients of both groups with cefo
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phylactically to all patients during hospitalization.
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RI SDLQ 9LVXDO $QDORJ 3DLQ 6FDOH 9$63 ZDV
used as a useful diagnostic tool in assessing the
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by the Ethics Committee of Clinical Centre Univer
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the normal distribution of the studied variables
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comparison of mean values of the variables with
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test was used to determine the existence of dif
ferences in categorical variables between groups.
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the effect of surgery procedures on incidence of
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data were analysed using the statistical program
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RESULTS
The characteristics of the patients are shown in
Table 1. All subjects in both groups were male.
The average age of the patients surgically treated
E\/LFKWHQVWHLQJURXSZDV\HDUV
while the second group of subjects underwent
5LYHV KHUQLRSODVW\ JURXS ZDV \HDUV
2IDWRWDOKHUQLDUHSDLUVGRQH
ZHUH ULJKWVLGHG LQ /LFKWHQVWHLQ JURXS DQG LQ RI5LYHVJURXSZKLOHOHIWVLGHGRILQJXLQDO
KHUQLD ZHUH LQ SDWLHQWV IURP WKH ¿UVW
DQGLQSDWLHQWVIURPWKHVHFRQGJURXS
Both groups were well balanced with respect to
baseline characteristics.
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Tabela 1. 3DWLHQWV¶FKDUDFWHULVWLFV
7KH¿UVWGD\SRVWRSHUDWLYHO\SDLQLQWKHRSHUDWLYH
incision was expressed in both groups of patients,
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SDWLHQWVLQWKH/LFKWHQVWHLQJURXSZKLOH
in the same postoperative period in Rives group
most represented were pain intensity +4, found in
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Figure 1. 7KHIUHTXHQF\DQGLQWHQVLW\RISDLQWKH¿UVW
DVHFRQGEDQGWKLUGSRVWRSHUDWLYHGD\F
7KHVHFRQGSRVWRSHUDWLYHGD\LQWKH/LFKWHQVWHLQ
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had pain intensity +8. In the same postoperative
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DQG RQO\ SDWLHQWV KDG SDLQ LQWHQVLW\ )LJXUHE7KHWKLUGSRVWRSHUDWLYHGD\LQWKH/L
FKWHQVWHLQJURXSSDWLHQWVKDGSDLQLQWHQ
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patient had pain intensity +8. At the same time
SRVWRSHUDWLYHO\ LQ 5LYHV JURXS SD
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tergroup differences in the intensity of pain in the
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and the third postoperative days in the monitored
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Neuralgic postoperative pain in the inguinal region
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FKWHQVWHLQ JURXS DW WKH ¿UVW PRQWK DIWHU VXUJHU\
ZLWKWKHKLJKHVWIUHTXHQF\RISDLQLQWHQVLW\LQ
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no postoperative neuralgia, while the remaining 7
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of discomfort. After six months of operative inter
vention, postoperative neuralgia was present in 14
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ZKLFK SDWLHQWV KDG SDLQ LQWHQVLW\ ZKLOHLQRISDWLHQWVZHUHSDLQLQWHQVLW\
)LJXUHE$OOSDWLHQWVIURP5LYHVJURXS
ZHUHDV\PSWRPDWLFLQWKDWIROORZXSSHULRG2QH
year after surgery persistent postoperative neural
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not present in any of the patients from Rives group
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111
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DDQGVL[PRQWKVDIWHUVXUJHU\E
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VLJQL¿FDQWLQWHUJURXSGLIIHUHQFHVLQWKHLQWHQVLW\RI
SDLQLQWKHJURLQDIWHURQHPRQWKSDVZHOO
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chtenstein method was an independent predic
tor of chronic postoperative pain in patients with
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chtenstein hernia repair done.
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DISCUSSION
The results of this study indicate that the groin pain
in the early postoperative period was expressed
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TXHQF\DQGLQWHQVLW\RISDLQDIWHU/LFKWHQVWHLQSUR
cedure compared to patients after Rives hernio
SODVW\S7KLVFDQEHH[SODLQHGE\WKHIDFW
that the pain is caused by swelling and tissue reac
tion to the mesh, which is in the place of funiculus
LQ/LFKWHQVWHLQWHFKQLTXH7KHUHLVQRUHVSRQVHLQ
5LYHVWHFKQLTXHGXHWRSUHSHULWRQHDOPHVKSRVL
tion and separation mesh from funicular elements
in the inguinal canal, so the intensity of early post
operative pain is less in that group of patients. Sig
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LVDOVRFRQ¿UPHGDIWHUWKHVHWZRRSHUDWLYHSURFH
GXUHV,QWKH/LFKWHQVWHLQJURXSLQWKH¿UVWPRQWK
DIWHUVXUJHU\JURLQSDLQZDVH[SUHVVHGLQRI
SDWLHQWVDQGDIWHUVL[PRQWKVLQRISDWLHQWV
One year after hernia repair done, chronic postop
HUDWLYHSDLQZDVIRXQGLQRIWKHSDWLHQWV
RIWKH/LFKWHQVWHLQJURXS6L[DQGWZHOYHPRQWKV
after procedure of Rives the patients did not have
signs of the potherniorraphy pain.
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DWHVZKLFKFRPSDUHGUHVXOWVRISDWLHQWVZLWK
XQLODWHUDOLQJXLQDOKHUQLDSDWLHQWVZLWK/LFKWHQ
VWHLQKHUQLDUHSDLUDQGSDWLHQWVZLWK5LYHVKHU
QLD UHSDLU LQGLFDWHG WKDW WKH SRVWRSHUDWLYH SDLQ
was lower in Rives group, with shorter time of re
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also found on a sample of 70 patients with ingui
nal hernia repair that 34 patients with preperito
QHDOVHWWLQJPHVK5LYHVKDGORZHUVFRUHVSDLQ
FRPSDUH WR SDWLHQWV WUHDWHG E\ /LFKWHQVWHLQ
WHFKQLTXHZLWKSUHIDVFLDOVHWWLQJPHVK,QWKH
VWXG\ RI )ULFDQR DQG DVVRFLDWHV WKUHH GD\V
DIWHU LQJXLQDO KHUQLD UHSDLU ZLWK PLQRU PRGL¿FD
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PRGHUDWH SDLQ DQG RQO\ WKUHH SDWLHQWV had a slight pain after six months of operation. In
comparison with a group of patients operated by
RULJLQDO/LFKWHQVWHLQSURFHGXUHWKH\IRXQGVLJQL¿
FDQWGLIIHUHQFHVLQWKHLQWHQVLW\DQGIUHTXHQF\RI
SDLQ LQ WKH ¿UVW GD\V DQG LQVLJQL¿FDQW GLIIHU
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cation of operating procedures in this study con
VLVWHGRI¿[LQJPHVKHVRQ&RRSHU¶VOLJDPHQWDQG
apart from this only to the inguinal ligament, thus
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REOLTXHPXVFOH,QWKLVZD\DYRLGVWKHIRUPDWLRQRI
granulomas around the suture, and the absence
of tension, because the mesh can be reduced in
RQO\RQHGLDPHWHUZLWKRXWWUDFWLRQLQWHUQDOREOLTXH
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FDSWXUHQHUYHVRILQJXLQDOFDQDODQGFRQVHTXHQWO\
OHVVFKURQLFSRVWRSHUDWLYHSDLQ0RQLWRULQJRISD
tients in this study was six months after surgery.
Chronic pain after hernia repair or postherniorra
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VHTXHQFHRIWKHQHUYHOHVLRQRUGLVHDVHDIIHFWLQJ
WKH VRPDWRVHQVRU\ V\VWHP¶¶ LQ SDWLHQWV ZKR KDG
no pain in the groin before surgery or in whom
pain is different compared to the prior experience
of operation and present six or more months after
WKHVXUJHU\$OWKRXJKWKHGH¿QLWLRQLVFRPSOH[
the concept of postherniorraphy pain separates
chronic pain from normal postoperative pain,
which reduces the healing of surgical wounds.
Nerve damage during surgery is the most com
mon cause of this pain, because the sensory
GLVRUGHUV RIWHQ VHHQ LQ WKHVH SDWLHQWV DQG
are usually present in the distribution of affected
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pain is ilioinguinal nerve, then genitofemoral and
iliohipogastric nerve, and rarely the lateral femo
UDOFXWDQHRXVQHUYHRUIHPRUDOQHUYH1HUYH
damage is multifactorial nature and involves me
chanical or thermal damage during surgical dis
section and reparation, trapping nerve by suture,
PHVK RU DGKHVLRQ RU RFFXUV DV D UHVSRQVH
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mesh and compression of neural structures in the
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persistent for years after surgery, with possible
SURJUHVVLRQ,Q\HDU3RREDODQDQGDVVRFL
ates were reported that the incidence of chronic
SDLQDIWHULQJXLQDOKHUQLDYDULHV$VV
YDQJ DQG .HKOHW SXEOLVKHG D VLPLODU UDQNLQJ RI
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that the overall prevalence of chronic pain after in
guinal hernia repair with the use of mesh varies
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ent with recent published literature.
CONCLUSION
7KLVVWXG\VKRZHGWKDW/LFKWHQVWHLQSURFHGXUHDF
FRPSDQLHG ZLWK VLJQL¿FDQWO\ VWUHQJWKHQV SRVWRS
HUDWLYHSDLQFRPSDUHGWR5LYHVWHFKQLTXH&KURQLF
pain after inguinal hernia repair or postherniorra
SK\ SDLQ RFFXUUHG RQO\ DIWHU /LFKWHQVWHLQ KHUQLD
UHSDLUGXHWR¿EURVLVRIWLVVXHVWKDWDUHLQFRQWDFW
ZLWK WKHPHVK QHUYHV DQG IXQLFXODU HOHPHQWV
which is not the case with Rives hernia repair,
where the same separate from mesh by repaired
transversal fascia. These results indicate that the
ORFDWLRQRIPHVKLQRSHQQRQWHQVLRQPHWKRGVRI
LQJXLQDOKHUQLDUHSDLUPD\LQÀXHQFHRQWKHRFFXU
rence and intensity of postoperative pain.
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,QJXLQDO +HUQLRSODVW\ 9HUVXV $PEXODWRU\ /LFKWHQVWHLQ
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mesh methods of open groin hernia repair: system
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6FRWW1:0F&RUPDFN.*UDKDP3
HWDO2SHQPHVKYHUVXVQRQPHVKIRUUHSDLURIIHPR
ral and inguinal hernia. Cochrane Database Syst Rev.
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open mesh and sutured repair of indirect inguinal hernia
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of primary inguinal hernia: postoperative discomfort
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erative chronic pain following inguinal hernia surgery.
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outcome following ilioinguinalneurectomy for chronic
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after mesh repair of inguinal hernia: a systemic review.
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Address:
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Clinic for General and Abdominal Surgery
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Original article
PRACTICE AND KNOWLEDGE OF CONTRACEPTION IN THE STUDENT POPULATION
,6.8679$ , =1$1-$ 2 .2175$&(3&,-, 0(Ĉ8 678'(176.20 3238/$&,JOM
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1
)DFXOW\RI+HDOWK6WXGLHV8QLYHUVLW\RI6DUDMHYR%ROQLþND6DUDMHYR%RVQLDDQG+HU]HJRYLQDObstet
ULFV*\QHFRORJ\&OLQLF&OLQLFDO&HQWHU8QLYHUVLW\RI6DUDMHYR3DWULRWVNHOLJH6DUDMHYR%RVQLDDQG+HU
zegovina; 3&OLQLFDOFKHPLVWU\DQGELRFKHPLVWU\&OLQLFDO&HQWHU8QLYHUVLW\RI6DUDMHYR%ROQLþND6DUDMHYR
Bosnia and Herzegovina; 4&OLQLFIRU,QIHFWLRXV'LVHDVHV&OLQLFDO&HQWHU8QLYHUVLW\RI6DUDMHYR%ROQLþND
Sarajevo, Bosnia and Herzegovina
ABSTRACT
First steps in education about reproduction and
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measures begin with early sexual activity. This
age group coincides with adolescence, and stu
dent life. Student days are full of surprises, many
VWXGHQWVDUHDZD\IURPKRPHIRUWKH¿UVWWLPHDQG
the whole life comes down to the enjoyment. This
new freedom of student life can lead to actions that
may create a certain amount of complication to ev
ery student. One of these complications is an un
LQWHQGHGSUHJQDQF\$OWKRXJKLQLWLDOWDONLQJDERXW
contraception is somewhat uncomfortable for both
partners, contraception is the only way to avoid
pregnancy. Each student must not forget that sex
is still a nice and comfortable living experience.
But this experience easily underestimates the im
pact of unintended pregnancy for the student and
partner, and contraceptive methods in preventions
of unintended pregnancies are recommended as
the most effective.
Research goals: To investigate the method and
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WLRQDPRQJVWXGHQWVWRLQYHVWLJDWHWKHIUHTXHQF\
RI FRQVHTXHQFHV RI XQSURWHFWHG VH[XDO LQWHU
FRXUVH DQG WR GHWHUPLQH WKH OHYHO RI NQRZOHGJH
DERXW WKH HIIHFWLYHQHVV DQG ULVNV RI FRQWUDFHS
tives in student population.
Results and conclusions: Of the total number of
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<RXQJPHQDUHPRUHVH[XDOO\DFWLYHWKDQWKHJLUOV
As a reliable contraceptive method for protection,
girls consider oral contraceptives, boys consider
condoms. One third of sexually active students
enter into unprotected sex. Abortion, as a conse
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traceptive protection of students was estimated
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survey responses were correct, and there was no
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incorrect responses. The most common source
of information about contraceptive methods was
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of the response was not true; students are poorly
informed about contraception, way of protection
and its application.
Kay words: student, sexual activity, contracep
tion.
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njenoj primjeni.
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cepcija
INTRODUCTION
Contraception involves a set of measures, pro
cedures and methods to prevent unintended
pregnancy. Contraception should not be the only
method. Each contraceptive method must meet
several conditions: it must be effective in provid
ing protection against unwanted pregnancy, not
to interfere into the normal sexual relations, or to
diminish sexual pleasure of sexual partners at the
same time. It must be safe, cheap and accessible
to everyone, simple and understandable, and that
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conceptions of spouse or sexual partner. Today
there is still no ideal, absolutely secure resource or
FRQWUDFHSWLRQPHWKRG0HWKRGVDQGPHDQVRI
contraception according to the mode of operation
FDQ EH FODVVL¿HG LQWR PHFKDQLFDO FKHPLFDO DQG
hormonal. These methods can also be combined.
Family planning implies the right of couples to de
cide about pregnancy and the number of children
they want to have. It aims to achieve substantive
HTXDOLW\RIZRPHQDVZHOODVWRSURYLGHRSSRUWX
nities to the circumstances and the situation, as
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es, preserving their health and ability to mother
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7KH ¿UVW VWHSV RI HGXFDWLRQ DERXW UHSURGXFWLRQ
and reproductive health and contraception must
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activity. This age group coincides with adoles
cence and student life. Student days are full of sur
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home. This new freedom of student life may lead
to procedures that can create a certain amount of
complication to every student. One of these com
plications is an unplanned pregnancy. Although
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easy for partners, contraception is the only way
to avoid pregnancy. Each student must not forget
that sex is still a beautiful and comfortable living
experience. But this experience easily underes
timates the impact of unplanned pregnancy the
student and partner, and contraception is recom
mended as the most effective method of prevent
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are probably the most important factors, but their
convenience, availability and price are also impor
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be informed about its advantages and disadvan
tages, possible side effects and effectiveness of
protection against pregnancy and sexually trans
mitted infections, and about the proper usage. It
LVQHFHVVDU\WRWDNHFDUHDERXWWKHDJHVWDWHRI
health, how often an individual has sexual rela
tions, and personal attitudes. Consultation with a
physician is of great help in deciding the choice of
contraception, and some methods for the obliga
tory medical examination. Certain methods of con
traception in addition to its primary purpose protect
against sexually transmitted diseases. Sexually
transmitted diseases are common among adoles
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nerable to sexually transmitted diseases. Sexually
transmitted diseases are not trivial. They cause
severe damage to fertility and health, and some
are even deadly. Often there are no symptoms,
especially at the beginning of infection, or they are
very mild and remain unnoticed, so the illness is
discovered and treated too late when they have
already caused permanent damage to the general
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to these problems and timely action can reduce
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provide security to sexually active student popula
tion in order to conduct normal sexual life.
Aim
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traceptive use among students in the Faculty of
Health Studies, University of Sarajevo, and to
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population
The authors promote consumer survey among
students of the Faculty of Health Studies, Univer
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sity of Sarajevo. Gender structure is not crucial in
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does not violate the ethical and moral principles
of the research or the privacy of the respondents.
The research is based on an anonymous survey,
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7KHVXUYH\TXHVWLRQQDLUHLVSHUVRQDOO\PHWE\WKH
student, on a voluntary basis without disclosing
personal information. The study was designed as
a prospective epidemiological and observational.
After the formulation of the problem and deter
mination of the instruments for data collection, a
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University of Sarajevo.
to become pregnant, and have regular sexual re
lations should have a permanent contraceptive
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WKH WRWDO QXPEHU RI UHVSRQGHQWV Q PDOHDQGQ RIIHPDOHUHVSRQGHQWV
said they completely agree that the partner, who
does not plan to become pregnant, and have
regular sexual relations should have a permanent
FRQWUDFHSWLYHSURWHFWLRQRUDOFRQWUDFHSWLYHV,8'
SDWFKHV&KLVTXDUHWHVWVKRZHGWKDWWKHUHZDV
QRVWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHLQWKHDQVZHUV
EHWZHHQPDOHDQGIHPDOHȤ S .
)LJXUH Attitude in relation to continuous contracep
tive protection.
RESULTS
The average age of respondents for males was
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in the average number of years of males and fe
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that they are in full agreement that the partners,
who do not plan to become pregnant, during ev
ery sexual relationship, need to use some form of
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male respondents said that they are in full agree
ment that the partners who do not plan to become
pregnant, during every sexual relationship, need
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cant difference in the answers between males and
IHPDOHVȤ S Figure 1. The difference in attitudes between males
and females in relation to the use of contraceptive dur
ing every sexual relationship who do not plan to stay
pregnant.
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VZHUHG WKDW WKH\ DUH LQ IXOO DJUHHPHQW somewhat agree that partner, who does not plan
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are the best choice for the purposes of permanent
contraception. Of the total number of male
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choice of permanent contraception. However, for
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are the best choice of permanent contraception.
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difference in the answers between male and
IHPDOHȤ S )LJXUH Attitude in relation to condoms as the best
choice of contraception.
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there is no intercourse. Of the total number of
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WKDWWKHUHLVQRLQWHUFRXUVHZKLOHQ of female respondents answered that there is
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&RQWUDFHSWLYHSURWHFWLRQLVXVHGE\Q of respondents who have sexual intercourse. Of
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ference in contraceptive use, and that the largest
number of respondents who have sex used some
form of contraceptive protection. Smaller percent
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S of contraceptive surveyed respondents who have inter
course.
7DEOH Type of contraceptive.
Of the total number of respondents who use con
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age use condoms as a contraceptive protection of
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form of contraceptive.
Table 1. 7KHIUHTXHQF\RIVH[XDOLQWHUFRXUVH
The largest number of respondents who have
intercourse responded that they chose a contra
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responded about their chosen contraceptive
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tive method selection in relation to sex, and that
the largest number of respondents who have sex
, FKRVH D FRQWUDFHSWLYH PHWKRG Ȥ S 0.338.
7DEOHThe manner of contraceptive election.
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pregnancy when using a condom.
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of pregnancy when using oral contraceptives is
Ȥ S 7DEOH 7KHUDWLRRIFRUUHFWDQVZHUVRQWKHNQRZOHGJH
about contraception.
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using a condom.
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GLIIHUHQFH LQ NQRZOHGJH DERXW WKH ULVN RI SUH
gnancy when using a condom, and that the lar
gest number of female respondents answered
correctly, and the largest number of male partici
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contraceptives. Analyzing the responses of males,
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using oral contraceptives.
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about contraception. Of the total number of re
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QRWJLYHWKHFRUUHFWUHVSRQVHS DISCUSSION
This study included 100 students from the Faculty
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from the Faculty of Health Studies, University of
Sarajevo had sexual intercourse, and those who
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of sexual subjects and sexual activity it was deter
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are sexually active. Research conducted in Italy
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tive. Respondents who were sexually active indi
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in that time began to use some form of contracep
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active students do not use contraceptive protec
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although this difference was not statistically signif
icant. Research in Italy showed that the respond
ents indicated that they usually used condoms
as contraceptive protection, and have used oral
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sexually active students did not use a condom
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of sexually active respondents said they did not
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spondents answered that the action of emergency
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study showed that the STUDENT population of
Faculty of Health Studies, University of Sarajevo
is in full agreement that the partners who do not
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relation should use some form of contraceptive
protection, either hormonal or mechanical. Among
students today in Bosnia and Herzegovina there
is a lot of prejudice against the use of modern
contraceptives during sexual intercourse, and as
a result many are faced with an unwanted preg
nancy and different sexually transmitted diseases.
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concerned about reproductive health, because
it is still a large number of abortions among girls
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nication with parents one of the problems is the
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European countries, where young people through
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in our country there is no such education, nor is
it in the plan. There is also under development
of health services to young people who provided
assistance and advice in solving problems in the
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cal analysis of information about contraceptive
methods led to the information that females are
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of Health Studies somewhat agree that condoms
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form of contraception, but also partly agree that
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other studies have shown that condoms protect
against most sexually transmitted diseases, hor
monal contraception is one of the most effective
forms of family planning. Combination of both
these methods is recommended as the safest pro
tection. Some women use hormonal contraception
during the reported side effects, and if they de
termine the reasons for particular symptoms, it is
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tive methods vary in their effectiveness in preven
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they do not agree that oral contraceptives protect
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regular sex, and do not use contraceptives, there
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achieved compared to 1990, when the average
number of pregnant women in this age group was
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ducted at the Faculty of Health Studies showed
that students surveyed had no birth or abortion,
or that partner, surveyed students had never be
come pregnant. There were divided opinions
about the complications after abortion among the
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respondents had accurate information about the
appropriate time for an abortion. The highest per
centage of respondents said that abortion can oc
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about contraception and sexual habits, was con
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to contraceptive methods, respondents indicated
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did not have any information about contraceptives.
Surveyed students at the University of Sarajevo
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sponded that oral contraceptives do not protect
against sexually transmitted diseases. Respond
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state of affairs when, in the use of oral contracep
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of combined hormonal contraception. There was
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age of correct responses at the level of the en
tire sample, and there is a greater percentage of
those respondents who gave the correct response
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group with the highest percentage of unintended
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LQNQRZOHGJHDERXWFRQWUDFHSWLYHSURWHFWLRQ2UDO
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they did not use any contraceptive protection in
WKHODVWPRQWKVZKLOHRIUHVSRQGHQWVVDLG
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Students of the Faculty of Health Studies, despite
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not enough and fully informed of the importance
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tives. A large number of students in the period
when started sex life did not actively start using
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CONCLUSION
The students at the Faculty of Health Studies, Uni
versity of Sarajevo believe that sex partners, who
do not plan pregnancy, need to use some form of
contraceptive. Boys are more sexually active com
pared to girls. The most reliable method of con
traceptive is oral contraceptives for girls and con
doms for young men, and in most cases, sexually
active girls use oral contraceptives. Girls are more
VDWLV¿HGZKHQXVHGFRQWUDFHSWLYHPHWKRGVFRP
SDUHG WR ER\V RI VH[XDOO\ DFWLYH VWXGHQWV
enter into unprotected sex. Abortion, as a result
of unwanted pregnancy, has not experienced by
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SRVWFRLWDO FRQWUDFHSWLRQ KDG D VH[XDOO\
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contraceptive protection rated on the basis of cor
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WR KDYH D PLQLPXP RI UHTXLUHG NQRZOHGJH 7KH
most common source of information about con
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true, and that students are less informed about
contraceptive protection and its application.
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REFERENCES
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0LKDLORYLü$*LQHNRORJLMDLDNXãHUVWYR%HRJUDG=DYRG
]DXGåEHQLNHLQDVWDYQDVUHGVWYDVWU
%UDQNRYLF6$YGLü'5XGLF$8QDSUHÿHQMH]GUDYOMD
L]GUDYVWYHQRREUD]RYDQMH7X]OD%RVDQVNDULMHþ
7DIXUL60DUWLQHOOL'*HUPLQDULR&3UDWR5$VWXG\
on the sexual and contraception behaviours of the preu
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+\J
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Guttmacher Institute; 1999.
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sexuality among college students in Beijing, China.
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Address:
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Faculty of Health Studies
University of Sarajevo
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Original article
PREDICTORS OF PATIENT MORTALITY IN INTENSIVE CARE UNIT
PREDIKTORI MORTALITETA PACIJENATA NA ODJELU INTENZIVNE NJEGE
$]UD%XUHNRYLü1*$PHOD'L]GDUHYLü%RVWDQGåLü1, Amer Iglica, Amina Godinjak1
1
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71000 Sarajevo, Bosnia and Herzegovina; 0HGLFDO,QWHQVLYH&DUH8QLW&OLQLFDO&HQWHU8QLYHUVLW\RI6DUDMHYR
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ABSTRACT
In the Intensive care unit of the Clinic of Endo
crinology, acute metabolic disorders overlap with
other emergencies in internal medicine, and fatal
outcome in these patients is caused by numerous
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identify general patient characteristics who had a
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ratory parameters on admission to the intensive
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To compare the diagnoses on admission with the
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Intensive care unit of the Clinic for Endocrinology,
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were not diabetics, therefore 48 diabetic patients
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fatal outcome. In all patients with fatal outcome,
the following data was recorded: gender, age; di
agnosis upon admission; time of fatal outcome
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reference limits. The values of urea and creati
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creased in patients with fatal outcome compared
with recovered patients. The most common cause
of mortality in patients with hyperglycemia was
cardiovascular incident: myocardial infarction and
cerebrovascular insult, and respiratory failure.
The most common causes of mortality in patients
in hypoglycemia were: cerebrovascular insult and
acute myocardial infarction. Conclusion: Of all
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tal outcome. The most common cause of mortality
in patients with hyperglycemia was major cardio
vascular events and respiratory failure. The most
common causes of mortality in patients in hypo
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Further reduction in mortality among patients can
be achieved by optimal detection and treatment of
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Key words: DFXWH PHWDEROLF GLVRUGHUV FRPRU
bidity, fatal outcome.
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to severe alteration of consciousness until coma
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cemic agents, compared to the amount of food
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diabetics are particularly prone to severe hypogly
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not produce normal glucagon, and adrenal glands
do not produce hormones which prevent hypo
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diabetes is higher if cardiovascular incidents pre
cede the metabolic decompensation. On the other
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have fatal outcome due to myocardial infarction or
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its branches. It usually occurs suddenly due to
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its branches. Cerebrovascular insult is a sudden
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function caused by cerebrovascular disease,
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terrupts the circulation, or due to vessel rupture
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Aim
1. To identify the general characteristics of pa
tients in Intensive care unit with fatal outcome.
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upon admission to the Intensive care unit in pa
tients with fatal outcome.
3. To compare the admission diagnosis with the
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INTRODUCTION
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to the ICU of the Clinic for Endocrinology, Diabetes
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outcome. Six patients were not diabetic, so there
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the intensive care unit who had fatal outcome. The
following data were recorded in all patients with
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e. other acute endocrine or metabolic disorder,
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RESULTS
)LJXUH State of consciousness on admission in pa
tients with fatal outcome.
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who had a fatal outcome and in patients who have
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Figure 1. Diagnoses upon admission of patients with
fatal outcome.
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Hyperglycemia, Hypoglycemia, followed by other
diagnoses. Total of 48 patients were admitted be
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ues at admission of patients with fatal outcome
compared with patients who eventually recovered.
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within the reference limits. The values of urea and
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ed in patients with fatal outcome compared with
recovered patients.
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7DEOH Enzyme values upon admission.
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tory acidosis with metabolic acidosis contributed
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admitted with hypoglycemia.
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fatal outcome compared with recovered patients.
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cose on admission of patients with fatal outcome
compared with recovered patients. Of the total of
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outcome in these two admission diagnoses are
shown Figure 3 and 4.
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mitted with hyperglycemia.
with hyperglycemia were: acute myocardial infarc
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tients. In the patients admitted with diagnosis of
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the most commonly associated diagnoses were:
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in hypoglycemia were: cerebrovascular accident
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with hypoglycemia.
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DISCUSSION
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In recent years, mortality in acute complications
of diabetes in developed countries ranges from
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mortality in these patients. Older age and infec
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The advantage of our study is that the clinical and
laboratory parameters on admission in these pa
tients were thoroughly documented and analyzed.
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altered state of consciousness, elevated potassi
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Regarding comorbidity, Chen and colleagues
found that myocardial infarction led to death in
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In our study, acute myocardial infarction was the
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Concerning two young patients in the group aged
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myocardial infarction, and in the second bronho
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leads to death, such as myocardial infarction and
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In patients with admission diagnosis of hypoglyce
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cular insult or myocardial infarction preceded the
fatal outcome. In earlier studies, these were also
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gardless of whether the patient is diabetic or not,
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It should be noted that a certain number of pa
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radiological examinations, especially those who
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information, one can expect a higher percentage
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CONCLUSION
Based on our study, we reached the following con
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tered consciousness on admission was present
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evated, but within the reference limits. The values
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fatal outcome compared with recovered patients.
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tality in patients with hyperglycemia were: acute
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most common causes of mortality in patients in hy
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argued that in the intensive care unit, acute meta
bolic disorders overlap with other emergencies in
internal medicine, and fatal outcome in these pa
tients is caused by a number of complex events
in the organism. Further reductions in mortality in
patients can be achieved by optimal detection and
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REFERENCES
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parsion of patient characteristics, clinical presentations
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term case fatality rate and associated factors among
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hyperosmolar state: a hospital based analysis over a
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Original article
PAROXYSMAL ATRIAL FIBRILLATION AND OUTCOME IN CRITICALLY ILL PATIENTS WITH SEPSIS AND/OR SEPTIC SHOCK IN MEDICAL INTENSIVE CARE
UNIT, CLINICAL CENTER UNIVERSITY OF SARAJEVO
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ABSTRACT
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rhythmia in intensive care units, and its effects on
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The objective of this study was to evaluate the
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its development.
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Intensive Care Unit, Clinical Center University of
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Campaign, international guidelines for manage
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probably within septic cardiomyopathy. Comorbid
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analysis showed strong association between se
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come. Duration of hypotension, before introducing
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verity of illness. According to that, duration of hy
potension has been shown to be the basic predic
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care unit and improving the outcome.
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tional guidelines for management of severe sepsis
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roidism, and other metabolic disorders. Other fac
tors potentially involved in the induction or main
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nervous system activity, atrial ischemia, atrial
dilatation, anisotropic conduction, and structural
changes associated with aging. It has been pos
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conditions are common in critically ill patients, in
cluding mentioned, potentially involved factors.
AF is one of the most common arrhythmias among
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of patients with severe sepsis develop paroxys
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mortality and prolonged hospitalization during se
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velopment, as well as their clinical characteristics
and outcomes, including mortality, length of stay
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INTRODUCTION
Sepsis is a systemic, deleterious host response
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dysfunction secondary to documented or suspect
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care problems, affecting millions of people around
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are treated in the ICU.
AF is the most common arrhythmia in clinical prac
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pitalizations for cardiac rhythm disturbances, with
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men, and its prevalence increases with age. The
mortality rate of patients with AF is about double
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of paroxysmal AF occur in younger patients with
out demonstrable underlying disease. AF may
be related to acute, temporary causes, including
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embolism or other pulmonary diseases, hyperthy
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to ICU. This ICU is located in Clinical Center Uni
versity of Sarajevo and provides care to critically
ill medical patients. The study was approved by
the institutional review board and the ethics com
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The following data were analyzed for all included
patients: demographics, reason for ICU admis
sion, medical history of cardiovascular diseases,
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diseases, and malignancy. The lowest and high
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natrium, calcium, creatinine, lactates, use and
dosage of catecholamines, were registered the
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in all patients.
In all patients admitted to the ICU, cardiac rhythm
was continuously monitored and the diagnosis of
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tivity and chaotic atrial activity with no apparent
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onset AF included direct and pharmacological
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decision of the responsible intensivist.
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Their differences were determined by using the T
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exact test was used for comparison of categorical
variables. A logistic regression model was created
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the development of new onset of AF as predictor
variables to determine the independent associa
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RESULTS
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graphic and mortality data for all septic patients
are presented in Table 1.
Table 1. &KDUDFWHULVWLFV RI SDWLHQWV ZLWK VHSVLV
DQGRUVHSWLFVKRFN
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in age, gender, underlying comorbidities, sever
ity of illness at admission to the ICU between
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chanical ventilation duration, was not statistically
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PRUWDOLW\ UDWH ZDV VLJQL¿FDQWO\ KLJKHU LQ SDWLHQWV
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7DEOH Comparison of baseline characteristics be
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without AF.
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tients.
A multiple logistic regression model that included
severity of illness at ICU admission measured by
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tion and severity of illness at ICU admission with mortal
ity in ICU.
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mined in age, severity of illness at admission to
the ICU and length of ICU stay between survival
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7DEOH Comparison of baseline characteristics and
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Analysis of clinical and laboratory parameters be
tween survivors and nonsurvivors showed statis
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els, duration of hypotension before admission to
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7DEOH Differences in clinical and laboratory param
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The group association of independent variables in
prediction of lethal outcome through multiple logis
tic regression model that included age, severity of
illness, creatinine levels, duration of hypotension,
comorbidities and showed that basic predictive in
dependent variable in this model is duration of hy
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7DEOH The Association of independent variables in
prediction of lethal outcome.
DISCUSSION
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been well described. In this prospective observa
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medical critically ill patients have shown the inci
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Although advanced age, higher severity of illness
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this study did not show advanced age and higher
severity of illness, neither comorbidities to be the
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VWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHVRIVHYHULW\RILOO
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between the serum creatinine level and the devel
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lamines used to support the hemodynamic insta
bility of patients may also be contributing to high
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$OWKRXJK WKH PHFKDQLVP RI 3$) LQ VHSVLV LV QRW
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Recent studies have shown that atrial structural
remodeling is important contributor for initiation
and persistence of AF, with mitochondrial dysfunc
tion and apoptosis also playing a role in the de
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of this dysfunction.
The actual ICU length of stay was no longer in pa
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WKDW SDWLHQWV ZKR GHYHORSHG QHZRQVHW DWULDO DU
rhythmia had higher mortality rate and ICU length
RIVWD\
In a recent study of medical and surgical patients
admitted to a general ICU, Goodman et al have
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clinical outcome in patients with sepsis. There was
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day mortality.
The most important predictive variable for the le
thal outcome was duration of hypotension, implify
ing the severity of illness. This study has several
limitations. It is a single center study with small
number of patients. Due to the design of the study,
we were unable to perform echocardiography
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unable to assess the effect of the treatment on
clinical outcome because of the small number of
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CONCLUSION
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without major effect on mortality, than mortality
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sion has been shown to be the basic predictive
independent variable for the lethal outcome. Early
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essential for improving the treatment outcome.
REFERENCES
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Original article
RISK FACTORS CAUSING DEVELOPMENTAL DYSPLASIA OF THE HIP IN PRETERM INFANTS
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ABSTRACT
6$ä(7$.
Developmental dysplasia of the hip is the most
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European countries, Bosnia and Herzegovina
is the one with the highest prevalence of some
form of developmental dysplasia of the hip. The
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the developmental hip dysplasia in relationship to
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companying morbidity in mechanically ventilated
preterm infants.
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ER\VGLDJQRVHGZLWKGHYHORSPHQWDOKLSG\VSODVLD
by means of clinical examination, ultrasound and
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JXVWLQWKHRXWSDWLHQWIDFLOLW\DQG'HSDUWPHQW
RI1HRQDWDO,QWHQVLYH&DUHDWWKH3HGLDWULF&OLQLF
Sarajevo.
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diagnosed with some form of developmental dys
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infant patients who did not need ventilatory sup
port but were diagnosed with some form of devel
opmental disorder of the hip.
Among ventilated preterm infants, developmental
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unventilated preterm infants there was only one
with some form of developmental disorder of the
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lesions, static body position during prolonged me
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ical course prolonged and complicated.
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Key words: preterm birth, mechanical ventilation,
ULVNIDFWRUVSHULQDWDOK\SR[LDLQWUDFUDQLDOKHPRU
rhage, developmental hip dysplasia.
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INTRODUCTION
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births etiology is uncertain.
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maturely born babies from perinatal brain impair
ments such as perinatal hypoxia, intracranial hem
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Due to their initial developmental impairments,
prematurely born babies, even in the best of con
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WDONRUZDONE\WKHPVHOYHV7KXVHDUO\GLDJQRVLV
of these disorders, among which is developmental
disorder of the hip, by use of reliable and simple
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WLPHO\ DQG DGHTXDWH PXOWLGLVFLSOLQDU\ WKHUDSHXWLF
activities achieve fast and effective therapeutic re
sults and avoid emergence of lasting disabilities.
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borns display some form of neuromuscular disor
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of Obstetrics and Neonatal Intensive Care lead to
dramatically decreasing rate of newborns mortal
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dominantly in prematurely born babies. This is
especially evident in developing countries where
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disorder of the hip in preterm infants belong: peri
natal asphyxia, intracranial hemorrhage, systemic
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Bosnia and Herzegovina has the highest preva
lence of cases relating to some form of develop
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1000 live born infants; Bosnia and Herzegovina
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in outpatient facilities and Department of Neonatal
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Children participating in the research were sepa
rated into two groups.
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Inclusion criteria were: infants born before the 37th
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control group and with mechanical ventilation
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Exclusion criteria were: gestational age above
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medical treatment with terminal outcome.
The collected data was analyzed according to:
gender, age, methods of diagnosis, age of pa
tients at the time of ultrasound diagnosis of de
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ence developmental dysplasia of the hip, typology
of applied medical therapy, and diagrams of thera
peutic results.
Standard statistical analyses were performed for
the study populations characteristics and clinical
outcomes.
RESULTS
Table 1. Gender distributions of preterm infants.
Aim
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tors related to immaturity and accompanying mor
bidity in mechanically ventilated preterm infants.
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hip dysplasia by means of clinical examination, ul
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The study was performed in the period between
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opmental dysplasia of the hip associated with preterm
birth of infants.
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ultrasound comparing to group II, so they were
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neurologists and physical therapists and involved
in early habilitation treatment.
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tors.
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ventricular hemorrhage and necrotizing enteroco
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dysplasia in preterm infants.
Clinical examination and ultrasound detection of
the developmental hip dysplasia were performed
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fecting one or both hips.
Among seven patients in which developmental hip
dysplasia was detected, three of them had left hip
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plasia of the hip type, two have type IIc and one
has type IIa.
All affected patients were treated conservatively
and complete remedial treatment was in 3 cases;
three patients remain with some form of perma
nent disability as part of neurodevelopmental con
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garding result of medical treatment of one patient.
DISCUSSION
This study is focused on problem of early detec
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mental disorder of the hip especially in the group
of preterm babies.
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necrotizing enterocolitis, sepsis, anemia, broncho
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mental disorder of the hip allows timely treatment,
which increases complete and positive outcomes
of medical treatment and decreases occurrences
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whom are preterm infants, into early rehabilita
tive treatment, once they are examined by pedi
atric neurologist, developmental pediatrician, and
infant physiatrist, provides objective possibility for
complete amelioration of minor developmental
disorders, prevention of further development of
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life for the patient and the whole family, and en
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Comparing the results gathered from two groups
of preterm infants we have procured the following
data: among ventilated preterm infants, develop
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among unventilated preterm infants only one was
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diagnosed with some form of developmental dis
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body position during prolonged mechanical venti
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be prolonged and complicated.
Developmental disorder of the hip is more com
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difference. Five patients from the group of ventilat
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have pathological ultrasound of CNS. Similarly,
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tion in combination with necrotizing enterocolitis.
This data highly suggest that not only prematurity,
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From six patients diagnosed with some form of de
velopmental disorder of the hip, two had positive
outcomes of medical treatment. Unfortunately, in
spite of timely diagnosis of developmental disor
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three patients have developed some form of per
manent disability while the results of one patient
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term infant in whom developmental disorder of
the hip was detected and who was independent
of mechanical ventilation had positive outcome of
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CONCLUSIONS
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born babies who develop some form of perma
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developmental dysplasia of the hip.
Thus, we recommend immediate ultrasound ex
amination of hips at every preterm infant or within
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low up.
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mental impairments and need for special education re
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weight outcomes of the Neonatal Institute of Child
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Original article
RISK FACTORS FOR NEW EPISODE OF SCHIZOPHRENIA
FAKTORI RIZIKA NOVE SHIZOFRENE EPIZODE
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ABSTRACT
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factors for new schizophrenic episodes in patients
with schizophrenia after one and after repeated
schizophrenic episodes. The study was prospec
tive, comparative, analytical and descriptive, and
was carried out in the Cantonal Hospital Zenica
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jects. The experimental group patients had more
than one schizophrenic episode, while the control
group had only one schizophrenic episode which
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fect the relapse of schizophrenia, comparison of
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ODSVHRIVFKL]RSKUHQLFHSLVRGHVGHVLJQHGE\WKH
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ordinated antipsychotic therapy, interruption of an
tipsychotic therapy, interruption of psychiatric ex
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of insight into the nature of schizophrenia, age
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ous episodes and the time interval between each
schizophrenic episode. According to the results,
compliance with antipsychotic therapy shows that
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medications more regularly. So they rarely forgot
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According to conventional drug administration
and new antipsychotics there was no statistically
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number of the experimental group patients was
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mination of antipsychotic therapy was registered
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at the control group. The absence of psychoedu
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dents in the control group, on average, later ex
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to the experimental group and this difference was
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antipsychotic therapy, interruption of antipsychotic
therapy, irregular psychiatric examinations, psy
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curring schizophrenic episodes.
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INTRODUCTION
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terized by a distorted perception of reality, loss of
contact with reality, closure into own autistic world,
disorganized behavior and the disintegration of the
personality, with concomitant loss of functionality.
Disorders of thought, observations, and affect with
clear consciousness are present. Small number of
persons with schizophrenia maintained the level
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The course of schizophrenia can be continuous, or
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tions, or it can be one or more episodes with com
plete or incomplete remission. New episodes of
schizophrenia lead to neurodegenerative chang
es in the brain. Numerous studies have demon
strated the extension of lateral cerebral ventricle
and sulcus and increase in the width of the third
ventricle of the brain, indicating the occurrence of
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ysis of 18 studies that there is a bilateral reduc
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showed loss of neurons in certain areas of the
brain, particularly in the hippocampus, frontal and
temporal lobe. Radiological examinations found
that the gray cerebral substance decreases pro
gressively during the schizophrenic process. The
loss is greatest in the frontal and temporal areas.
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areas correlates with the number of psychotic re
lapses. Certain morphological asymmetry of cer
tain regions of the brain, as the left ventricle, and
the inversion of the usual brain asymmetry which
is seen in mentally healthy individuals are also ob
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Negative symptoms of schizophrenia by type
schizophrenic defect states dominate clinical
picture of patients who had greater number of
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of schizophrenia leaves a permanent defect on
the psychic plane and decreased functionality. In
recent years the outcome of schizophrenia has
changed since there are modern methods of treat
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tion have antipsychotic, anxiolytic, antidepressant,
antimanic, antiagressive, antisuicidal and neuro
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Recommended duration of maintenance therapy
LV \HDUV DIWHU WKH ¿UVW HSLVRGH DQG DW OHDVW years after the repeated episode. The importance
of maintenance therapy is to prevent progressive
neurodegenerative changes that are associated
with recurrent episodes, as each new episode re
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possible acute exacerbation of the disorder, iden
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Regular use of antipsychotic therapy prevent re
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extremely important in the prevention of relapse,
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families about the nature of the disorder, in order
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Aim
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rence of schizophrenic episodes in the experimen
tal and control group.
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tors for recurrence of schizophrenic episodes be
tween the experimental and control group.
MATERIAL AND METHODS
The study was prospective, comparative, ana
lytical and descriptive and was conducted at the
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spondents before inclusion in the study signed a
written consent to participate in the research. The
study sample consisted of 100 patients with a di
agnosis of schizophrenia divided into two groups
H[SHULPHQWDO DQG FRQWURO JURXSV HDFK ZLWK respondents. Including criteria for research: Ex
perimental group: The diagnosis of schizophrenia
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schizophrenic episode or multiple schizophrenic
episodes before study started and at least four
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ing symptomatic mental disorders, mental un
derdevelopment and mental and behavioral dis
orders due to use of psychoactive substances.
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except that the control subjects had to have only
one schizophrenic episode and that the episode
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affect the relapse of schizophrenia. Comparison
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ordinated antipsychotic therapy, interruption of an
tipsychotic therapy, interruption of psychiatric ex
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of insight into the nature of schizophrenia, age of
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schizophrenic episodes, the time between each
schizophrenic episode.
RESULTS
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FACTORS THAT AFFECT THE RECURRENCE OF
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Questions about compliance with antipsychotLFWKHUDS\FRQYHQWLRQDORUQHZDQWLSV\FKRWLFV
Analysis of adherence to antipsychotic therapy
shows that the controls comply better with treat
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According to conventional and new antipsychotics
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respondents in the experimental group was on
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Table 1. Adherence to antipsychotic therapy, con
ventional or new antipsychotic.
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Q: Discontinuation of antipsychotic therapy,
interruption of psychiatric controls, lack of
psycho-education, lack of insight into the nature of schizophrenia.
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differences between the control and experimen
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ruptions in psychiatric controls were present in
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controls. The absence of psychoeducation is reg
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insight into the nature of schizophrenia is present
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the control group respondents. All these differenc
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7DEOHAntipsychotic treatment discontinuation, inter
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and insight into the nature of schizophrenia.
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interval between schizophrenic episodes.
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episode shows that the respondents in the control
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perimental group at the average age of 30.4 ±8.03
years. Statistical analysis shows that there are
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schizophrenic episodes observed between the
groups. The time interval between schizophren
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schizophrenic episode until the beginning of the
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months for the experimental group . Statistical
analysis shows that there are no statistically sig
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episodes and the average time between schizo
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Q: The average number of schizophrenic episodes in the experimental group.
Experimental group respondents had an average
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control subjects had only one schizophrenic epi
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7DEOH The average number of episodes of schizo
phrenia in the experimental group.
Q: Number of schizophrenic episodes in the
experimental group.
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in the control group had only one schizophrenic
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7DEOH Number of schizophrenic episodes in the ex
perimental group.
DISCUSSION
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fect on repeated schizophrenic episodes have
noncompliance with antipsychotic therapy use,
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chotics or new antipsychotic did not demonstrated
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perimental and control group. Antipsychotic treat
ment discontinuation, interruption of control psy
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of insight into the nature of schizophrenia show
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the experimental and control group, which proves
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the development of repeated episodes of schizo
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ence between the experimental and control group.
Respondents from experimental group statistically
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schizophrenic episode. The time interval between
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that on average these periods was 18.3±7.8
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months for the experimental group while statistical
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ence between the two groups in terms of the time
interval between schizophrenic episodes. Experi
mental group had an average of 7 schizophrenic
episodes; the highest prevalence was 3 schizo
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control respondents had only one schizophrenic
episode. The studies of patient adherence refer to
the tendency that the patient adheres to the pre
scribed therapy, going to the scheduled control
examinations. Non adherence represents a major
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collaboration not only between doctors and pa
tients, but also their family members, along with
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family attitude towards treatment and thus leads
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tipsychotics discontinuation leads to relapse and
recurrence. According to studies there are several
factors associated with the cessation of the ther
apy, including factors that are related to the dis
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common barriers to adherence to antipsychotic
treatment of persons with schizophrenia. Full ad
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detected causes for discontinuation of therapy.
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illness worsening, or because of the subjective
feeling of improvement. Embarrassment or being
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tors for discontinuation is: if the patient is young,
male, unemployed socially isolated or perhaps
abuse some substance. The most common is a
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has the most chances for a good prognosis, but
it is also a critical period for cooperation due to
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lescence and early adulthood is the most sensitive
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are diagnosed with schizophrenia before the age
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es prodromal phase of the illness can be followed,
which can be detected up to 30 months before
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younger age than in the control group experienced
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the beginning of schizophrenia at a younger age is
characterized by poorer prognosis and tendency
to repeated schizophrenic episodes.
CONCLUSIONS
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antipsychotic therapy, interruption of antipsychotic
therapy, interruption of control psychiatric exami
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for recurring schizophrenic episodes.
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phrenic episodes in the experimental group was
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only one schizophrenic episode.
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and in the experimental group, 30.4 years of age,
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which proves that the beginning of schizophrenia
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of new schizophrenic episode.
4. Analysis of adherence to antipsychotic medica
tion shows that respondents in the control group
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psychotic medication, which prevented the new
schizophrenic episode.
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corded between the control and experimental
group according to administration of new or con
ventional antipsychotics, although a slightly higher
number of respondents in the experimental group
was using conventional and a slightly larger num
ber of controls was on the new antipsychotics.
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episodes relapse.
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sight into the nature of schizophrenia had a statis
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episode, which proves that the psychoeducation
and insight into the nature of the disease are sig
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phrenic episodes.
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Original article
DYSLIPIDEMIA IN PATIENTS WITH DIABETES MELLITUS TYPE 1 AND
HYPOTHYROIDISM
DISLIPIDEMIJA KOD PACIJENATA SA DIABETES MELLITUS TIP 1 I
HIPOTIREOZOM
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ABSTRACT
High blood lipids are important factor in the devel
opment of atherosclerosis, which is the underlying
pathological process for numerous clinical entities
such as ischemic heart disease, cerebrovascular
disease and peripheral vascular disease. There
fore it is important to pay attention to all the dis
eases and conditions that are connected with the
disturbances in lipid metabolism, in order to ad
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the characteristics of dyslipidemia in patients with
two endocrinopathy, type 1 diabetes mellitus and
hypothyroidism, and to compare it with dyslipid
emia in patients with only type 1 diabetes and
with dyslipidemia in patients suffering only from
hypothyroidism. Study included 90 patients, both
males and females: 30 patients with type 1 dia
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and in patients with hypothyroidism with the pre
viously included substitution therapy. All patients
were from the Clinic for Endocrinology, Diabetes
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pare the characteristics of dyslipidemia, following
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hypothyroidism, what this group of patients classi
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development of the atherosclerotic process.
Key words: dyslipidemia, diabetes mellitus type
1, hypothyroidism
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INTRODUCTION
Atherosclerosis is a complex process of blood
vessels damage, which is supported by the dis
order of blood lipids. Hypercholesterolemia as
sociated with elevated levels of atherogenic lipo
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with proteoglycans, or incorporation into immune
complexes and are considered the main cause of
damage to the endothelium and smooth muscle
that lie beneath the endothelium. High density li
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effect. The basis of this action is the inverse cho
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also antioxidant enzymes that degrade oxidized
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in the structure of cell membranes and activation of
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of oxidative stress in endothelial cells, monocytes
and lymphocytes. It also stimulates platelet aggre
gation and adhesion and proliferation of smooth
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type 1 diabetes is hypertriglyceridemia that occurs
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ally associated with poor metabolic control of the
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thyroidism in patients with hypercholesterolemia is
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development of hypercholesterolemia in hypothy
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of the study was to examine the characteristics of
dyslipidemia when these two entities combined, in
patients who have both diabetes mellitus type 1
and hypothyroidism and to compare lipid levels in
a group of patients with both diseases with groups
of patients who are suffering from diabetes only
and from hypothyroidism only.
Study included 90 patients, both males and fe
males: 30 patients with type 1 diabetes and hypo
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ism with the previously included substitution ther
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patients were from the Clinic for Endocrinology, Di
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was conducted based on the usual approach to
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RESULTS
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ues for both groups were higher than the target
value for the population with diabetes.
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were higher than the recommended target range
for people with diabetes. The difference was sta
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somewhat worse, but the difference was not sta
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lated diabetes.
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Table 1. HbA1cSDUDPHWHU RI GLDEHWHV PHOOLWXV
control.
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groups were higher than the laboratory reference
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the target values for triglycerides in the population
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of triglycerides were found in this group compared
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p=0.014
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DISCUSSION
REFERENCES
Characteristic of dyslipidemia in patients with both
endocrinopathies, diabetes mellitus type 1 and
hypothyreoidismus is a combination of poor gly
cemic control and associated characteristics of
dyslipidemia of two single entities resulting in sig
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diabetes mellitus type 1. Elevated levels of total
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literature well documented characteristic of hypo
thyroidism. Studies have also shown that hypothy
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poprotein that increases its atherogenicity. Althaus
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in hypothyroidism compared to euthyroid controls,
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type 1 diabetes, it may also be explained by the
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factor is associated with atherogenic potential of
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mellitus and hypothyroidism is worse in compari
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veloping atherosclerosis. Intensive treatment of
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prevention of macrovascular complications.
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Diseases,
Clinical Center University of Sarajevo,
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Original article
DURIE-SALMON SYSTEM AND INTERNATIONAL STAGING SYSTEM IN DE NOVO
MYELOMA PATIENTS
DURIE-SALMON SISTEM I INTERNACIONALNI STAGING SISTEM U NOVOOTKRIVENIH PACIJENATA SA MIJELOMOM
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ABSTRACT
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cording to available registration of the patients
from Clinic of Hematology Clinical Center Univer
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cases of myeloma patients per year at this Clinic.
There are several systems in use that character
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The Durie Salmon System and the International
Staging System are commonly used. Staging sys
tems are used in an attempt to predict outcome in
myeloma patients, so they have prognostic value
as well. The aim of this study was compared two
staging systems regarding agreement of estima
tion clinical stage and overall survival in myeloma
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QRYRP\HORPDSDWLHQWVIHPDOHVDQG
males who have been diagnosed and treated at
Clinic of Hematology Clinical Center University of
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7KH DYHUDJH DJH RI SDWLHQWV ZDV \HDUV
Follow up was 48 months. All of patients included
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study showed agreement in stages between the
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at diagnosis. Statistical comparison between DSS
and ISS on patients OS did not show statistical
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Key words: myeloma, DSS, ISS
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i agresivnost bolesti. Durie Salmon Sistem i In
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da predvide ishod bolesti u pacijenata sa mijelo
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pacijenata je iznosio 48 mjeseci.
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Analizirane su vrijednosti parametara ISS, u grupi
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.OMXþQHULMHþL mijelom, DSS, ISS
INTRODUCTION
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plasma cells, a type of white blood cells normally
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myeloma is the second most common hematologi
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tion of patients who have been diagnosed and
treated at Clinic of Hematology Clinical Center
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new cases of myeloma per year at this Clinic. It
is more common in older people, in men, and for
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cause many organs can be affected by myeloma,
the symptoms and signs vary greatly. On the other
hand some patients are asymptomatic and have
been diagnosed by accident. Diagnosis of myelo
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multiple myeloma. There are several systems in
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Salmon System. International Staging System has
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to the DSS to gain wide acceptance. Staging sys
tems are used in an attempt to predict outcome
in myeloma patients at diagnosis, so they have
prognostic value as well. Stage of disease is one
of the most powerful prognostic factors in myelo
ma. The DSS predicts tumor mass and estimates
survival by using levels of immunoglobin proteins
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globin and calcium concentrations, and number
of bone lesions. The ISS, on the other hand, is
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myeloma patients into 3 prognostic groups with
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included into DSS and ISS system: level of he
moglobin, serum calcium, serum creatinine, beta
PLFURJOREXOLQVHUXPDOEXPLQQXPEHURIRVWH
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imunoelectrophoresis of serum proteins and urine
in de novo myeloma patients.
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eloma regarding agreement of estimation clinical
stage and overall survival in myeloma patients at
diagnosis.
Statistical analysis used in this study included de
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RESULTS
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and serum albumin, parameters of ISS in group 1,
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The median value of serum albumin was the high
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Figure 1. 0HGLDQYDOXHRIVHUXPDOEXPLQLQP\HORPD
patients stage I, II, III by DSS respectively.
:H DQDO\]HG GH QRYR P\HORPD SDWLHQWV IHPDOHV DQG PDOHV ZKR KDYH
been diagnosed and treated at Clinic of Hematol
ogy Clinical Center University of Sarajevo from
-DQXDU\ WR 'HFHPEHU 7KH DYHUDJH
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Included criteria: all patients with de novo myelo
ma, previously not treated. All included patients
KDYHEHHQVSOLWHGLQWRJURXSVE\'66DQG,66
as follows:
Group 1: de novo myeloma patients in stage I by DSS;
*URXSGHQRYRP\HORPDSDWLHQWVLQVWDJH,,E\'66
Group 3: de novo myeloma patients in stage III by DSS;
Group 4: de novo myeloma patients in stage I by ISS;
*URXSGHQRYRP\HORPDSDWLHQWVLQVWDJH,,E\,66
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in myeloma patients stage I, II, III by DSS respectively.
Statistical analysis of parameters included in DSS
in de novo myeloma patients staged by ISS, i.e.
JURXSDQGVKRZHGVWDWLVWLFDOVLJQL¿FDQWGLI
ference between these groups in haemoglobin
level, serum creatinine and number of ostelytic
bone lesions as follows:
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eloma patients stage I, II, III by ISS respectively.
tients who underwent autologous stem cell trans
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were classed by two staging system, DSS and
ISS at diagnosis. The study showed agreement
EHWZHHQ WKH WZR VWDJLQJ V\VWHPV WR EH SHU
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Our results showed that value of serum albumin
DQGEHWDPLFURJOREXOLQZHUHVLJQL¿FDQWO\FRUUH
lated with DSS stage. The median value of serum
albumin was the highest in group 1, the median
YDOXHRIVHUXPEHWDPLFURJOREXOLQZDVWKHORZ
est in group 1, respectively.
Statistical analysis of parameters included in DSS
LQJURXSDQGVKRZHGVWDWLVWLFDOVLJQL¿FDQW
difference between these groups in hemoglobin
level, serum creatinine and number of ostelytic
bone lesions showed: the median value of haemo
globin level was statistically the highest in group
4, the median value of serum creatinine and num
ber of bone lesions were the lowest in group 4,
respectively.
0HGLDQYDOXHRIVHUXPFUHDWLQLQHZDVWKHORZHVW
LQ JURXS KLJKHU LQ JURXS DQG WKH KLJKHVW LQ
JURXSS)LJXUH
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ma patients stage I, II, III by ISS respectively.
The differences between value of parameters in
DSS I, DSS II and DSS III and ISS I, ISS II and
ISS III suggest that the both staging systems are
important for clinical practice and have to be used
concurrently, what is the conclusion study of Hotta
DQGDVVRFLDWHVDVZHOO
Statistical comparison between DSS and ISS on
patients overall survival in our study did not show
VWDWLVWLFDOO\ VLJQL¿FDQW GLIIHUHQFH $LODZDGKL 6
and associates analyzed prognostic value of ISS
and DSS of 170 patients who suffered of myelo
ma. Statistical comparison between two systems
showed that ISS was able to predict mortality
FOHDUO\WKDQ'66
DISCUSSION
The aim of this study was to compare two staging
systems regarding agreement of estimation clini
cal stage and overall survival in myeloma patients
at diagnosis.
The study showed agreement between the two
VWDJLQJV\VWHPVLQFDVHVU S
GLVDJUHHPHQWLQRIP\HORPDSDWLHQWVDWGL
agnosis. For instance, among the 18 patients des
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ZHUHLQ'66VWDJH,JURXSLQ'66VWDJH,,
JURXSDQGLQ'66VWDJH,,,JURXS+DUL
and associates analyzed the outcomes of SD
Conte and associates compared prognostic im
pact of DSS and ISS in 81 patients with myeloma
and showed that both staging systems have prog
nostic value, but ISS is more simple and effective
PHWKRG RI SURJQRVWLF FODVVL¿FDWLRQ RI P\HORPD
SDWLHQWV
Hungria and associates concluded that ISS is
more powerful than DSS, and ISS has to be used
IRU%UD]LOLDQSDWLHQWVZLWKPXOWLSOHP\HORPD
Hari and associates modeled the predictive value
of both staging systems and analyzed the results
RQP\HORPDSDWLHQWV1HLWKHUVWDJLQJV\VWHP
was strongly predictive of outcome. The authors
DFNQRZOHGJH WKDW IRU D ELRORJLFDOO\ FRPSOH[ GLV
HDVHVXFKDVPXOWLSOHP\HORPDLWLVXQOLNHO\WKDW
any one clinical staging system can fully accom
PRGDWHDOOIDFWRUVWKDWDIIHFWRXWFRPH
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CONCLUSION
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ing System are compatible in staging and predic
tion of overall survival in de novo myeloma pa
tients. The differences between value of DSS and
ISS parameters suggest that the both staging sys
tems are important for clinical practice and have to
be used concurrently.
REFERENCES
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ULD IRU WKH FODVVL¿FDWLRQ RI PRQRFORQDO JDPPRSDWKLHV
multiple myeloma and related disorders: a report of the
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myeloma patients undergoing autologous transplant.
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Stagin System Is Superior to Durie Salmon Staging in
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the new international staging system in multiple myelo
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Address:
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Clinic of Hematology
Clinical Centre University of Sarajevo
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Our contribution in reduction of cardiovascular disease !
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Original article
CYTOCHEMICAL MYELOPEROXIDASE STAINING IN INITIAL DISTINCTION OF
ACUTE LEUKEMIAS
CITOHEMIJSKO BOJENJE NA MIJELOPEROKSIDAZU U INICIJALNOJ DISTINKCIJI AKUTNIH LEUKEMIJA
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vina; &OLQLFIRU,QIHFWLRXV'LVHDVHV&OLQLFDO&HQWHU8QLYHUVLW\RI6DUDMHYR%ROQLþND6DUDMHYR%RVQLD
and Herzegovina
1
ABSTRACT
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plasms characterized by uncontrolled, excessive
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Given on high mortality, fast and accurate identi
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critical importance. Optimal diagnostics of acute
OHXNHPLDV WRGD\ GRHV LQFOXGH F\WRPRUSKRORJ\
and cytochemistry, immunophenotyping, as well
as genetic and molecular testing.
The aim of study was to analyze results obtained
by cytochemical staining with myeloperoxidase
032 DQG HVWDEOLVK LWV XWLOL]DWLRQ LQ GLDJQRVWLF
SURFHHGLQJRIDFXWHOHXNDHPLDV
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SDWLHQWVZLWKGLDJQRVLVRIDFXWHP\HORLGOHXNHPLD
$0/ DQG DFXWH O\PSKREODVWLF OHXNHPLD $//
established in 4 years period, respecting inclusion
and exclusion criteria.
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showed satisfactory results in initial diagnostic dis
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PLDV±$0/DQG$//
Conclusions: Cytological examination of bone
marrow supplemented by cytochemical staining is
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Although cytomorphological and cytochemical
stainings are available for initiation of treatment in
PRVWFDVHVRIDFXWHOHXNHPLDVDGGLWLRQDOQHZHU
diagnostic methods are now an integral and indis
pensable part of diagnosis of these diseases, es
pecially in cases of poorly differentiated and rarer
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Key words: DFXWHOHXNHPLD$0/$//F\WRPRU
phology, myeloperoxdase
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analize.
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INTRODUCTION
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of hematopoietic tissue which is characterized
by uncontrolled proliferation and accumulation of
abnormal blast cells, principally in bone mar
row and impaired production of normal blood
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0HGLFLQVNLåXUQDO
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as exposure to ionizing radiation and number of
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of hematological precursor cells and their inabil
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KLVWRU\ DSSURSULDWH FODVVL¿FDWLRQ RI DFXWH OHXNH
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account various criteria. During recent decades,
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HG WK \HDU E\ WKH )UHQFK %ULWLVK DQG 86
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logical and cytochemical characteristics of blast
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resulting in impaired production of normal blood
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toms that occur as a result of anemia, thrombocy
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disease is fatal and lethal outcome occurs within
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depends of age, performance status and comor
bidities, as well immunological, cytogenetic and
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peripheral blood and bone marrow smear is used
to set the hematologic diagnosis. According to
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cells in peripheral blood or bone marrow. Immuno
phenotyping is today essential part of diagnostics.
'LDJQRVWLFVRIDFXWHOHXNHPLDVLVFRPSOHWHGE\
cytogenetic and molecular biology examinations
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other substances in the cells. Basically three type
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According to guidelines International Council for
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set of cytochemical tests in diagnostics of acute
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Aim
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mias
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ducted bone marrow aspiration; Samples of bone
marrow aspirate obtained by puncture of sternum
or posterior iliac crest. Bone marrow smears pre
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od, as well as myeloperoxidase staining, using
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available medical records were excluded from the
study. Results are presented in form of tables and
charts. Statistical analysis performed on personal
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RESULTS
Results of the study are presented in form of ta
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Table 1. 5HSUHVHQWDWLRQRISDWLHQWVZLWK$0/DQG$//
in tested sample.
Figure 1. 3DUWLFLSDWLRQRISDWLHQWVZLWK$0/DQG
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were included in study. The difference was not
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type.
7DEOH Sex distribution of patients. 7DEOH 032
staining in whole sample.
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represented in our sample.
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number of younger patients have also been pre
sent.
)LJXUH Age distribution of patients.
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The results of comparation show considerable dif
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DISCUSSION
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Number of males and females in our study was
virtually the same, with slight predominance of
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According to the literature reviews, average age
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The second most common types were secondary
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with literature data, where acute myelomonocytic
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more than literal data from previously cited sourc
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of cases.
According to relevant literature, the incidence of
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In our sample, mentioned types were not present.
As previously stated, conspicuous and relatively
high percentages of secondary forms of acute my
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nophenotype than cytomorphology hence majority
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CONCLUSION
The results of various diagnostic methods ana
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Age and sex distribution of patients correspond to
the literature data. The most common subtypes in
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cytomorphologic diagnosis supplemented by cy
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gency, and in situations where more sophisticated
analyses are unavailable. Cytological diagnosis is
still basic element of diagnosis of acute myeloid
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now an integral and indispensable part of diag
nosis of these neoplasms. Importance of immu
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particularly emphasized in cases of poorly differ
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pathologic diagnosis and biology of acute myeloid leu
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plastic diseases of the Hematopoietic and lymphoid tis
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Review article
ACUTE KIDNEY INJURY IN PATIENTS WITH CRITICAL ILLNESS
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Sarajevo, Bosnia and Herzegovina
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*Corresponding authoror
ABSTRACT
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patients with syndrome of sepsis and it is associ
ated with considerable morbidity and mortality and
prolonged hospitalization. The aim of this paper is
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with emphasis on the early unraveling and initiation
of early therapeutic measures in patients with un
recognized and overt renal dysfunction. New con
cepts on immunological alterations and apoptotic
changes of nephron cells have appeared as main
events in the series of pathophysiological changes
that lead to renal dysfunction and failure. It is of
paramount importance to enable early recognition
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renal injury that are current in clinical practice are
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of alterations in glomerular, tubular and interstitial
functions have been developed, but the relevance
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antioxidant activities in the situation of established
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therapy and renal replacement therapy stay as
main therapeutic approach in this setting. Recog
nition of renal dysfunction in early stages of acute
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patients with septic syndrome, in the early hours
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replacement therapy have been shown as most
effective preventive and therapeutic measures for
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INTRODUCTION
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nal dysfunction is common in patients in intensive
care units and is associated with substantial in
crease in morbidity and mortality. Epidemiological
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critically ill patients have shown increase of the
incidence in last decades and changes of mortal
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mortality rate of patients who are treated with renal
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scenarios are possible: patients may have already
developed acute renal dysfunction on admission
in ICU or deterioration of renal function may devel
op during the stay in intensive care unit. The num
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terpret the results of the clinical studies and com
pare the results in everyday practice. In addition,
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sively changing from intrinsic renal diseases to
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therapeutic approaches or procedures. After pub
lishing the guidelines of Second International Con
sensus Conference of the Acute Dialysis Quality
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recommendations new criteria for determining the
stage of renal dysfunction have been introduced,
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have given opportunity of easier staging and fol
low up of patients with renal dysfunction.
The spectrum of conditions that can lead to acute
renal dysfunction in patients in intensive care unit
is wide, but most common cause is septic syn
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acute renal dysfunction which can range from mild
disorder to acute renal failure. Development of
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injury is associated with higher morbidity, mortality
and prolonged ICU stay in the case of successful
resuscitation, despite better modalities for organ
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The most important limitations to better under
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tools, few animal models that can mimic human
sepsis, limited histologic information and limited
access of monitoring.
Epidemiology
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spectrum of the syndrome of acute renal dysfunc
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replacement therapy, several clinical trials have
shown clinical relevance of the criteria for diag
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The possibility to monitor epidemiology in a differ
ent way made it clear that the number of patients
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ria have been proposed as a standard graduation
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the group of patients who succeeded to survive
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During last decades, large, cohort studies have
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crease of mortality in patients who develop acute
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results of the largest and most inclusive cohort
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and administration of nephrotoxic agents. The
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Pathophysiology concepts
In the traditional concept on the pathophysiology
of acute renal injury that is believed for more than
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ischemia secondary to decreased cardiac output
and hypoperfusion, which lead to sustained renal
vasoconstriction and in turn exacerbated and sus
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Some of numerous potential causes of acute renal
injury, which are mostly associated to mismatch
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cells of different parts of nephron and energy de
mand of those cells, are presented in Figure 3.
)LJXUH Some of numerous etiological factors of
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But, recent evidence has shown that renal perfu
sion may vary from increased to normal in some
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occlusion of the renal artery does not trigger re
nal vasoconstriction. Findings from experimental
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Recent research highlights that acute apoptosis
could be the main factor in pathogenesis of acute
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little histologic changes present in so called acute
tubular necrosis. The pathogenesis is much more
complex than isolated hypoperfusion caused by
decreased cardiac output and hypotension. In the
case when patient is not resuscitated when car
diac output is low, hypoperfusion could contribute
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injury can develop in the setting of hyperemia in
the absence of hypoperfusion. Alterations in the
microcirculation in the renal cortex or renal me
dulla can occur despite normal or increased global
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ance may represent a pivotal haemodynamic fac
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by sepsis.
Ischemia and reperfusion which are components
of different pathological conditions lead to dynam
ic process that can involve vascular changes with
alterations in oxygenation and delivery of nutri
ents to epithelial cells , which in turn change their
metabolic pathways and start producing factors
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cells and small vessels. The most vulnerable are
highly metabolically active segments of nephron
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renal outer medulla. Complex activation of differ
ent factors and cells results in haemodynamic al
terations, accumulation of immune cells and direct
injury to epithelial cells of tubules which could be
of lethal or sublethal degree. In the situations of ef
fective therapy in the early stages these changes
are followed by a repair process that could restore
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Speculated possible events in pathogenesis of
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)LJXUH Haemodynamic alterations lead to endothe
lial injury and upregulation of adhesion molecules and
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Further studies are needed to explore the time
course of alterations of renal microvascular ele
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injury. Speculated possible mechanisms of patho
genesis of acute renal dysfunction in sepsis are
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Hypoperfusion
Ischaemiareperfusion
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Hypoperfusion and hypoxia
of «outer medulla»
Obstruction of medullary
capillaries
Activation of
vasoconstricting agents
Imbalance between pro and
apoptotic factors
Exogenous
Heme protein
Antibiotics
Contrast media
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hypertension in some
cases
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Recent observations in initial phases of septic
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glomerular hemodynamics and lead to loss of
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vasoconstriction of both afferent and efferent ar
terioles are important factors of the pathogenesis
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Monitoring of renal function/dysfunction
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increase of azotemia and oliguria which are nor
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have no simple alternative as for diagnosis of re
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nal dysfunction. Recognition of early stage of dys
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important role to detect changes in glomerular, tu
bular and interstitial functions, but their relevance
in clinical practice remain to be examined.
Biomarkers of kidney injury
Serum concentrations of creatinine are insensi
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secretion of creatinine and in normal conditions it
accounts for ten percent of creatinine clearance.
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by volume of distribution, so the volume overload
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terpret single time point determination and it may
not manifest as a detectable increase until at least
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may not be associated with elevations in serum
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be a substance that is released immediately in re
sponse to injury, with possibilities to be detected in
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function, which has been mostly assessed in eve
ryday clinical practice by measurement of serum
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clinical relevance.
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or release of tubular cell proteins in response to
ischemic or nephrotoxic injury could be found in
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renal tubular cells and found in urine only after cel
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that are not found in normal conditions in tubular
cells or in urine unless they are produced in dif
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in the condition of injury of proximal tubular
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by immune cells, hepatocytes and renal epithelial
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early postischemic period, particularly in proximal
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ity of the test for diagnosis and prediction of the
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early as one hour postoperatively in comparison
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other study with a hundred patients scheduled for
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relation with the duration and severity of the renal
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mission could be predictive for later development
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gest possibility of differentiating the etiology of
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tance in patients with possible multiple factors that
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mediator of ischemic injury in the heart, brain and
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After numerous experimental studies and clinical
trials that included small number of patients, the
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diac surgery are published from the Translational
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multivariate analysis it was shown that the high
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brane protein is not expressed in tissues of healthy
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publishing of results of trial which revealed that
in seven patients who had ischemic acute tubular
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levels were predictive for development of acute
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tients after renal transplantation was shown in the
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is no tubular secretion. It seems that the rise of
serum cystatin C appears one to two days before
serum creatinine increase in the state of acute
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renal dysfunction.
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sorbed in normal situation in the proximal tubules.
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are promising in the light of possible use of this
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and monitoring of the graft function in patients af
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inantly in the elements of proximal tubule is ex
pressed after heavy metals intoxication.
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proximal tubular cells. In patients with type 1 dia
betes and in patients with chronic renal disease
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monitoring of the values of this protein has been
shown useful in follow up of patients with chronic
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Osteopontin, a multifunctional protein, expressed
by various cell types, has been in focus of research
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jury important for prediction of renal dysfunction
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RI NLGQH\ LQMXU\ XQIROGV SRVVLELOLW\ RI UHPDUNDEOH
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ney injury. Appropriately designed clinical trials of
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recognized and accepted as important indicators
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ney injury in future period, that could be a turning
point in the development of modalities of early rec
ognition and possible early treatment and therapy
for patients with acute renal dysfunction and pre
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Therapeutic measures
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common therapeutic measures are still support
ive. In most cases the patients present with some
stage of change of renal function. Recently, there
have been published guidelines for prevention of
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pressure by vasopressors in vasodilatory circu
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hemodynamic monitoring, sodium bicarbonate for
emergency procedures when administering con
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patients with severe chronic renal failure sched
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trials are focused on new therapeutic approaches
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tory and other pharmacological agents that have
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tive measures are listed in the Table 4.
7DEOH Therapeutic and possible preventive meas
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Delays in starting appropriate antimicrobial ther
apy independently predict development of acute
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have shown in a cohort retrospective study which
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lay in starting of administration of effective antimi
crobial therapy following the onset of hypotension
was a critical therapeutic variable associated with
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sion , rate of survival decreased for an average
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tion of sepsis and appropriate therapy in terms of
haemodynamic stabilization, control of the source
of infection, early initiation of appropriate antibiotic
therapy, fast identifying of the causative agents
may provide best results in prevention of develop
ment of renal dysfunction or exacerbation of previ
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Identification of patients at
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SIRSsepsis
Haemodynimic
Taking cultures and
stabilisation and
initiation of broad spectrum source control
antibiotic therapy
preferably in the first hour
preferably
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of presentation
agents
Timly institution of renal
Appropriate antibiotic
replacement therapy
therapy according to
biogram and antibiogram 3UHYHQWLRQRILQMXU\
attributable to renal
replacement therapy
Restoration of
homeostasis
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nal replacement therapy and some other meas
ures of organ support in critically ill patients could
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Introducing renal replacement therapy, which is in
vasive procedure with numerous possible adverse
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delivered and monitored. Recently, the results of
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normal versus augmented level replacement ther
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shown improvements in patients who had more
intensive renal replacement therapy. According to
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DUDQJHRIPONJKIRUFRQWLQXRXVWKHUDSLHV
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Despite advancements in renal replacement the
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dysfunction on the other organs, phenomenon
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ins the most severe complication with predicted
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on and prevention of all factors that could aggra
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dysfunctions as well. There are also clinical stu
dies on the use of agents that could affect spe
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gical response even after the primary injury had
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of endotoxins, and clinical trials with agents with
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shown promising results, but further clinical trials
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offer immediate and long term improved clinical
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Conclusions
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antibiotic therapy in patients with sepsis in the early
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but also multiple organ dysfunctions.
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onal Society of Nephrology as a part of global cam
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dence based approach in analysis of literature on the
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given to preventive and therapeutic approach, so
that all issues regarding initial therapy, hemodynamic
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uretic therapy, anticoagulation, extracorporeal blood
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recommended for interested readers as a most up
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of administration of diuretics as a possible prevention
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detect changes in earlier stage of renal dysfunc
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the setting of established diagnosis of renal injury,
besides renal replacement therapy, latest research
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antioxidative effects in terms of attenuation of cellular
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TITLE OF THE ARTICLE IN ENGLISH LANGUAGE
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ARTICLE BODY
The main body of the article should be systematically ordered under the following headings:
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- MATERIALS AND METHODS
- RESULTS
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- REFERENCES
INTRODUCTION
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and epidemiological studies the following should be described: sample, protocol and type of clinical
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DISCUSSION
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