Microalbuminuria as an independent risk factor for heart failure in the elderly patients with type 2 diabetes mellitus

Introduction:The study evaluated of microalbuminuria as a predictor of heart failure in patients with diabetes mellitus type 2.Materials and methods:The prospective study conducted in a period of time from 01-Feb-2007 to 01-Feb-2010.The study included 100 patients with type 2 diabetes, who had diabetes longer than 5 years. All subjects (average age 66 ± 10 years, 33% male, 67% female) were tested for the presence of microalbuminuria, and 50 patients had microalbuminuria. The second group comprised 50 patients without of microalbuminuria with diabetes mellitus type 2.Results:In the patients with microalbuminuria and diabetes mellitus were found 22% of heart failure and 6% in the second group. Average time to the occurance of heart failure in the first group was 32,5 months, in the second group was 35,3 months.Conclusions:The results show that microalbuminuria is an independent risk factor for heart failure in patients with diabetes mellitus type 2 and microalbuminuria. Patients without microalbuminuria had 3,7 less likely to development heart failure compared to patients with microalbuminuria and diabetes mellitus.

Children vs elderly in orthopedic surgery site of infection. Are there difference? Experience of a high volume plastic surgeon consultant.

Introduction: Prevention of surgical site infection in surgery and bone trauma has some hallmarks not shared with other surgical disciplines. The surgeon is not always able to open the pathogen and a key to correct therapy. The aim of our work is to verify if there are differences between pathogens, and treatment between the two groups most susceptible to skin infections by means of synthesis such as children and the elderly. Materials and Methods: From January 2011 to december 2018, we perform 3189 consultancies in various departments of orthopedics and traumatology. From the exclusion criteria we recruited 168 patients with superficial infection of the surgical site after orthopedic surgery. A group represented by children (under 12 years old) and a group of older people over 65. The evaluation criteria between the two groups were: the infectious bacterial flora; the type of antibiotic, the duration of antibiotic therapy; the type of medications used in the post-operative period, the complications.Results:The results showed that elderly patients are more likely to be bacterial superinfection due to poor hygiene. Therapy in children is shorter and has minor complications. Proper management of the surgical site showed a rapid resolution of the infection in both groups. Conclusion: The correct management and hygiene of the surgical site allows its rapid recovery from infection. The plastic surgeon management of the fracture site infection can be a winning weapon in the treatment of this problem both in the child and in the elderly.

Quality of life in patients with mental and behavioural disorders after application of group therapy

Background: People with mental and behavioural disorders have low satisfaction of quality of life, due to numerous symptoms, as well as poor interpersonal relations, communications skills, low tolerance on frustration.Aim: The aim of this paper was to evaluate whether there has been an improvement in satisfaction with the quality of life after the application of group therapyMethods: The study included 100 patients who attended group therapy, for a period of 6-12 weeks. The instruments used at the beginning and at the end of the treatment were Outcome Questionnaire-45 which measured symptoms distress, interpersonal relations, and social roles, and MANSA questionnaire that measured satisfaction with the quality of life. Results: In total sample (N = 100) there was approximately equal number of women and men (51% vs. 49%). The average age of the subjects was 48.11 ± 7.91. Majority of respondents had depressive disorder (45%). Measuring the mean values obtained on the OQ-45 questionnaire, it was found that after the application of group therapy a significant reduction of the level of dysfunction was achieved. A statistically significant difference was found in the areas of satisfaction with physical and mental health, and the overall score of the MANSA questionnaire.Conclusion: Results show that patients reported lower symptoms distress and higher satisfaction with quality of life after attending group therapy, better interpersonal relations, lower risk of suicidal behaviour and substance abuse. Group therapy is successful intervention which helps patients improve quality of life.

Effects of extraction solvent/technique on the antioxidant and antimicrobial activity of spring saffron (Crocus vernus (L.) Hill)

Spring saffron (lat. Crocus vernus (L.)Hill) is a perennial from the Iridaceae family. Purple or white coloured flowers bloom in the early spring. Saffron is commonly used in cookery, but because of its healing properties, crocus is also used in medicine for improving blood circulation, treating the cardiovascular diseases, preventing tumour and healing skin diseases. This research aimed to determine the influence of solvents (water, ethanol and acetone) on antioxidative, antimicrobial activity and the content of biologically important compounds, such as phenols and flavonoids in saffron. FRAP and DPPH methods were used to examine antioxidative activity. Antibacterial activity was analysed by using diffusion technique on bacterial strains of Escherichia coli, Enterococcus faecalis, Staphylococcus aureus, Bacillus subtilis, Listeria monocytogenes, and Pseudomonas aeruginosa. Antifungal activity was examined on Candida albicans. The results showed that the ethanol extracts have the highest antioxidant activity and the aqueous extracts have the lowest one. None of the tested extracts showed antibacterial activity, but aqueous extracts and ethanolic extract of saffron, obtained by maceration, showed antifungal activity.

Prevalence of oral health in the area of Tuzla City

Caries is the most widespread oral desease of all age groups, the main oral-health problem as well as the leading cause of teeth loss. Bosnia and Herzegovina has a huge prevalence of caries patients in comparison with a significant decline in developed countries. Postwar state period, inadequate nutrition and neglected care of oral health have reflected on oral health of children in Tuzla City. Aim: to determine prevalence of oral health of children of different age groups in the area of Tuzla City. Methods: physical checkup and education have encompassed 5452 children of different age groups in the period from 2011 to 2017 (5098 of six- year- olds, 114 twelve-year-olds, 120 fifteen-year-olds and 120 eighteen-year-olds). Physical checkups were done in dental practices of Public Health Scientific Institution (hereinafter PHSI) Medical Center Tuzla, children's department, with a dental probe and mirror. CES (caries, extraction, sealed teeth- permanent) and CES (caries, extraction, sealed teeth- dairy) were calculated on the basis of 100 checkups. During the same period there were educations for pregnant women in the first and last quarter of pregnancy organized within the school for pregnant women of the Women Dispensary of PHSI Medical Center Tuzla. Outcomes: the research determined the value of CES index of diary teeth for six-year-olds (6,41) in 2011 that was decreased in 2017 (5,19) what indicates a good effect of educative lectures. CES index of tvelwe-year-olds in 2017 was 3,2. The research proved that high school children (15-year-olds) have a high CES index (8,3) in year 2013/14 and the same group of examinees as graduates (18-year-olds) in 2016/17 had CES index of 7,73.Conclusion: CES of the examinees had very high values, far from the aim of the World Health Organization (1,5).Programs and activities of oral health promotion of the Dental Service of PHSI Medical Center Tuzla have made changes, warned of the importance of preventive action as well as triggered revitalization of preventive detal protection for preschool and school population of Tuzla City.

Chloropyramine and Ranitidine as a combination of H1 and H2- antihistamines in the additive therapy of anaphylaxis

Introduction: Current international guidelines recommend H1 and H2- antihistamines as a second or third- line drugs for the management of anaphylaxis. Aim: To present positive cardiovascular and dermatological effects of Chloropyramine and Ranitidine as the combination of H1 and H2- antihistamines in additive therapy of anaphylaxis. Patients and methods: In a retrospective study two groups of 146 patients who met the NIAID/FAAN criteria for the diagnosis of anaphylaxis were compared. Experimental group consisted of 62 patients who received combination of Chloropyramine H1- antihistamines and Ranitidine H2- antihistamines. Control group consisted of 84 patients who received only Chloropyramine H1- antihistamines. Results: A statistically significant differences of diastolic pressure and central pulse (p< 0.001), a higher values of diastolic pressure, and a lower values of central pulse in the experimental group of patients were recorded at the end of the prehospital treatment of anaphylaxis. The increase in the mean arterial blood pressure at the end of the treatment is higher in the experimental group compared to the initial values, with an average difference of 15 mmHg (%95 CI= 7,95-21,95). Total prehospital time and time recovery of the skin urticaria and itch was shorter in the experimental group for 18 minutes (95% CI= 11,95-25,95). Conclusion: Positive cardiovascular effects and a faster resolving of the skin symptoms justify the use of combination Chloropyramine and Ranitidine as an additive therapy of anaphylaxis that is not life- threatening, and of a rapid progression.

SUCCESS RATE OF STRABISMUS SURGERY IN ADULT PATIENTS

Background ̸Purpose. Adults as well as children may have problems with strabismus, which can significantly affects on quality of social and professional life. Strabismus surgery in adults are not conditioned for years of a patient, and the main goal of this kind of surgery is to improve motoric-senzorial relationship of eyes, and to improve esthetic moment of a patient. Patients&Methods. A surgical review was performed on 35 adult patients with strabismus in period between January 2016 - May 2018 years. The type of strabismus, preoperative measurements, and indications for surgery were obtained from the patient notes, as were all final outcomes. Final measurements, on average, were 3 to 6 weeks postoperatively, and patients were asked to comment subjectively on their outcome. Results. In total number 35 of adult strabismic patients, were 12 (34,3%) male and 23 (65,7%) female, mean age 34,15±13 ( 20 to 67 years), 17 patiens (48,6%) were exotropic, esotropic 11 (31,4%) patiens, and hypertropic 7 (20%) patients. Indication for surgery in the most cases were aesthetic 28 (80%). The success rate is measured by number of orthophoric patients with less than 10 prism diopters 31 (88,6%), stereoacuity 22 (62,9%) and patient satisfaction 30 (85,7%). Conclusion. Adult strabismus surgery is very successful and provides patients with a good level of satisfaction. Many patients seek surgical correction for cosmetic and psychosocial benefits.Keywords; adult, strabismus, success, surgery

Distribution of hepatitis C virus genotypes and subtypes in a group of patients with chronic hepatitis C from Canton Sarajevo, 2012-2018

Background: Hepatitis C virus (HCV) genotypes and subtypes exhibit significant geographic variations.Aim: To analyse the distribution of genotypes/subtypes of HCV in a group of patients with chronic hepatitis C from Canton Sarajevo during 2012-2018.Material and methods:The study enrolled 247 human plasma samples of HCV-RNA positive patients with available results of HCV genotyping test.Results: During 2012-2018, the domination of subtypes 1a (34.01%), 1b (28.34%) and genotype 3 (23.89%) was registered. In 2012 and 2013, HCV subtype 1a was the most common (27/63; 42.86% and 17/40; 42.50%, respectively). In 2014, the leading HCV genotype/subtype were 3 and 1b (17/57; 29.82%). In 2015, the dominance of HCV genotype 3 (14/39; 35.90%) continued, while in 2016, the same number of HCV subtypes 1a and 1b (11/30; 36.67%) was recorded. Although in a small number of tested, during 2017, HCV subtype 1b was the most prevalent (7/14; 50.00%), and in 2018, it was replaced by a HCV subtype 1a (3/4; 75.00%). Distribution of HCV genotypes/subtypes by age group of patients varied significantly (p=0.000). The largest number of patients (71/247; 28.74%) belonged to the age category 30-39 years and HCV genotypes/subtypes 1, 3, 4, 1a and 1b were identified. Except in 2017, male gender significantly dominated (p=0.000). In males, HCV subtype 1a (68/170; 40.00%) was the most common, while in women it was HCV subtype 1b (44/77; 57.14%).Conclusion: This six-year retrospective study showed the time variations of the circulating HCV genotypes/subtypes among patients with chronic hepatitis C in Canton Sarajevo. Genotyping of the HCV has an important implications for diagnosis and treatment of the patients.

Frequency and antimicrobial susceptibility pattern of hospital isolates of Escherichia coli and Klebsiella pneumoniae in urine samples

Objectives/Aim: Urinary tract infections (UTI) are a serious public health problem and caused by many pathogens, most often by Escherichia coli and Klebsiella pneumoniae.Aim of this study was to show the frequency and antimicrobial susceptibility pattern of E. coli and K. pneumoniae in hospital isolates, following the GLASS methodology.Methods: This is a retrospective study that was conducted in the Laboratory for Urinary Infections OU Clinical Microbiology CCUS in the period from January till December 2018.A total of 13760 urine samples were processed, using standard laboratory methods, in which significant bacteriuria was detected in 3218 (23.4%) of specimens.Results: Out of the total number of positive samples, E. coli was isolated in 1166 (36.2%) and K. pneumoniae at 341 (10.6%) patients. The presence of E. coli and K. pneumoniae isolates is dominant in females (1103/73.2%) and age group 60 and older (812/54.7%). Out of the total E. coli isolates, the ESBL strain was presented with 79 (6.8%) and K. pneumoniae with 145 (42.5%). The proportion of carbapenemase (CPE) produced by K. pneumoniae isolates was 8 (2.4%). The ESBL strain distribution analysis on clinics showed the highest prevalence of both isolates at the Clinic for Nephrology: K. pneumoniae 26/17,9%; E. coli: 12/15.4%. Isolated E. coli showed the highest resistance to ampicillin 673/1166 (57,7%), trimethoprim-sulfamethoxazole 454/1166 (38.9%) and ciprofloxacin 253/970 (26.1%), while K. pneumoniae to ciprofloxacin and trimethoprim-sulfamethoxazole with 151/285 (53.0%) and 164/341 (48.1%), respectively.Conclusions: Our study has shown that the most common cause of urinary infections in hospital settings are E. coli and K. pneumoniae. Data analysis showed that the presence of ESBL isolates was significantly higher in K. pneumoniae than E. coli. CPE isolates of K. pneumoniae were also detected.

Prevalence and susceptibility pattern of anaerobic bacteria isolated from wound swabs in Clinical Centre University of Sarajevo

Objectives: Anaerobic bacteria may cause numerous infections in different locations through human body. Those infections can be life-threatening with significant mortality. Wounds represent a suitable habitat for colonization of anaerobic bacteria. Their proliferation contributes to moist and warm environment, hypoxic and necrotic tissue.Methods:A retrospective study was conducted at the Clinical Centre University of Sarajevo from 2015-2017. The study involved wound swab samples, sampled from hospitalized patients. The anaerobic bacteria were isolated using standard procedures.Results: During the period from 01.01.2015. to 31.12.2017, 8386 samples were analyzed on anaerobic bacteria and 872 (10.4%) of specimen were positive. In 2015, 332 (15%) specimens were positive, while during 2016 and 2017, 244 (7,8%) and 296 (9.9%) respectively. Bacteroides spp. was the most common isolate during three year period: 2015-227 (55.5%); 2016-139 (48%); 2017-161 (42,5%). It was followed by Peptococcus spp.: 2015-70 (17.1%); 2016-40 (13.9%); 2017-66 (17.4%), Clostridium spp.: 2015 – 32 (7.8%); 2016-21 (7.3%); 2017- 35 (9.2%), Fusobacterium spp.: 2015 – 49 (11.9%); 2016-32 (11.1%); 2017- 45 (11.9%).VITEK 2 Compact has identified to the level of species 48 isolates which were in pure culture.The largest number of anaerobic bacteria were isolated from the samples received from the Abdominal surgery. The overview of antimicrobial sensitivity showed highest sensitivity to metronidazole (99,9%) and carbapenems (99,9%), respectively.Conclusions The most commonly isolated anaerobic bacteria was Bacteroides spp.Highest number of positive isolates was from abdominal surgery since intra-abdominal infections reflect the microflora of the resected organ. Metronidazole remains the antibiotic of choice in the treatment of anaerobic infections.