OBJECTIVE The purpose of this study was to evaluate the efficiency of the anticholinergic therapy with oxybutynin and the effects of daily transcutaneous tibial nerve stimulation (TTNS) on the quality of life of patients with an overactive bladder (OAB) and multiple sclerosis (MS). PATIENTS AND METHODS The study was designed as a randomized controlled trial. The patients who suffer from MS underwent urodynamic tests which showed that they had an OAB. The tests used to assess symptoms and quality of life were Overactive Bladder Questionnaires (OAB-q) SF. Patients were divided into 2 groups of 30 patients each. The first group received a 5 mg oxybutynin tablet twice a day for 3 months and the second group had TTNS every day for 3 months. RESULTS The anticholinergic therapy showed a statistically significant improvement in all symptoms and quality of life (P<0.001). Side effects such as dry mouth were observed in about 35% of patients. The results of the study TTNS daily therapy showed good performance in the reduction all clin ical symptoms of the bladder and improved quality of life, with statistical significance (P<0.05) and with no side effects. It was found that the improved quality of life parameters and the reduced symptoms were more statistically significant in the treatment with oxybutynin tablets than TTNS therapy (P<0.001). CONLCUSION Our recommendation for the treatment of OAB is oxybutynin in doses of 2x5 mg. If a patient can not tolerate anticholinergic drugs, daily TTNS is recommended to reduce OAB symptoms and improve quality of life, without side effects.

Objective: To determine the incidence of systemic inflammatory response of the organism in surgical patients and its impact on the outcome of treatment. Methods: A prospective study was conducted on 60 patients undergoing abdominal surgical procedures, between January 2014 and December 2015 in the Surgery Clinic at the University Clinical Center Tuzla. Two groups of thirty were formed by the method of consecutive sampling. The first group consisted of subjects who were prepared for elective abdominal surgery (laparoscopic cholecystectomy), and the second group subjects underwent an emergency surgery due to acute abdomen (laparoscopic cholecystectomy). Results The body temperature difference was statistically significant between the two investigated groups in all stages (c2: t0=3,486; t1=3,098; t2=2,453, t: t0=-11,210; t1=-7,360; t2=-4,927, p < 0,05). Non-elective surgery group had a statistical significant difference of the heart rate at all stages (c2: t0=3,873; t1=3,357; t2=3,227, t: t0=-16,524; t1=-10,407; t2=-9,842, p < 0,05). There is a statistically significant difference in the pCO2 values in all stages between groups (c2: t0=2,582; t1=1,678; t2=1,162, t: t0=4,323; t1=2,653; t2=2,229, p < 0,05). The SIRS score has a good positive correlation with the length of treatment, while the correlation with the outcome of treatment has no statistical significance. Conclusion Inflammation scores monitoring in surgical patients is important for the surgical treatment success analysis. By modifying the therapy and influencing the inflammatory response, the results of treatment are improved.

Introduction: This research was to follow characteristics of breakthrough pain caused by cancer (BTcP) and other most common sympthoms (ESAS) at patients in advanced stage of cancer disease in palliative care. Patients and methods: Prospective study included 433 patients which were treated in Palliative Care Centre in UKC Tuzla, Bosnia and Herzegovina. Group 1 was consisted of 353 patients whose basal cancer pain of intensity 4-7 NRS was treated weak opiates (basal analgetic- fixed combination of tramadol/paracetamol (37.5 mg/325 mg) in initial dose 3x1tbl for pain intensity 4, to 4x2tbl (for pain intensity 7). In Group 2 (80 patients) basal pain of intensity 8-10 was treated strong opiates as basal analgetic (oral morphine and transdermal fentanil). If the previous day were 2 or more breakthrough pain that required ‘’rescue dose’’ of analgetics (tramadol 50-100 mg orally in group 1 ie. Oral morphine 8-12 mg in the group 2), the dose of basal analgetic was increased. Results: The total number of reported breakthrough pain in all 433 patients for 10 days of treatment was 3 369 (0.78 BTcP /per patient/day), where at Group 1 patients showed significantly lower BTcP (0.56 BTcP/patient/day). The average intensity of BTcP was 5.91 where in the Group1 was 4.51 while in the Group 2 8.04. 582 (17.28%) was rated grade 7, of which 539 were successfully coupled by strong and 43 (7.39%) successfully coupled by weak opiates. From 556 BTcP who were rated with 8, 540 of them were coupled strong and only 16 successfully coupled by weak opiates. 1967 (58.39 %) of breakthrough pain has occured in the evening hours (18-06 h), while 1402 (41.62%) BTCP occured during day hours (06-18h). Most (1290 or 38.29%) of breakthrough pain lasted less than 10 minutes, 882 (26.18%) between 16 and 20 minutes, 752 (22.32%) between 11 and 15 minutes, 407 (12.8%) between 21 and 30 minutes and 38 (1.13%) lasted longer than 20 minutes. Conclusion: Duriong our study, we noted a relatively large number of breakthrough pain with lower intensity (3-6) in patients treated with weak opiates, which are also adversely affected patients satisfaction with pain treatment and required additional doses of analgetics. In the small percentage is possible the breakthrough pain of stronger intensity (7-8) treat by maximum doses of weak opiates.

Furosemide is a diuretic and is often used in the treatment of hypertension. This medicine is very good when it comes to lowering the blood pressure, and this is also a drug of choice when it comes to the stage of hypertensive urgencies and emergencies. It can be administered intravenously, and the effects reach a maximum within 30 minutes. Due to the fact that this medicine causes a loss of potassium ions it can also affect the reduction of insulin in the blood, and thus the increase in blood glucose and arrhythmias. A prospective random study was carried out in Emergency Medical Service of Public Health Institution Center “Zivinice’’, where we analyzed 120 patients which were suffering from hypertension heart disease, and diabetes. We included all 120 patient whom suffering from hypertension and diabetes starting February till end of July 2016. Data for analysis: age, gender, bodymass index, analysis of the arterial blood pressure value, characteristic laboratory changes, analysis of electrocardiography. Looking at all the three groups of patients, it can be noticed that the maximum value of arterial blood pressure upon arrival at the Emergency Medical service had patients suffering from hypertension and diabetes, where the average value of arterial blood pressure was 173/113 mmHg. According to analysis for all three observed groups of patients, after treatment with furosemide there is no statistical significance in the incidence of arrhythmias between the groups where. Looking at the summary for all three groups of patients, the average value increase of blood glucose after treatment with furosemide is 0.7 mmol/l. Furosemide is safe for the treatment of hypertension in diabetic patients. It does not cause an increase in blood glucose levels.

pends on the research question and proper selection of the confounders used to adjust for the analysis. Their study was designed to test the probability for the outcomes specified while having hemoglobin excursions outside the target range and not to test the association between them [3] , because the analysis was adjusted for hypertension and coronary artery disease which were by definition not confounders in this design being influenced by the hemoglobin level [4–6] . Thus, if one adjusts the analysis for them, the link between hemoglobin excursions and the outcomes tested may be reduced or even canceled out, thereby not revealing the possible effect of an increased hemoglobin level on the outcomes. In this study, hypertension and coronary artery disease were related to the effect of hemoglobin level [5, 6] . This allowed for only prognostic and not etiological inferences to be made because, in the prognostic model, pathophysiology was not an issue but only probabilities for the outcomes specified [3] . Dear Editor We appreciate the reply of Dr. Handelman to our comment [1] on the paper ‘Hospitalization and mortality in hemodialysis patients: association with hemoglobin variability’, published in your journal [2] . In his reply, Dr. Handelman compares the indication of impending problems secondary to having a hemoglobin level below the target range with the fever and elevated white count as indicators of infection as well as with the association between severe edema and congestive heart failure. However, the inferences made quite often in the paper by using wording such as ‘association’, ‘influence’, etc., did not correspond with the methodology applied in their study, which was the major point of our critique, so that no relation exists between the examples specified above by Dr. Handelman. Even infection may not necessarily be associated with an elevated white count, but with a low white count if it is a septic one and severe edema may not be associated with congestive heart failure, but with liver cirrhosis, so that every conclusion dePublished online: June 5, 2014

Surgical revascularization of the heart (CABG - coronary artery bypass grafting) is one way of treating coronary heart disease. Bleeding is one of the serious and frequent complications of heart surgery and can result in increased mortality and morbidity. Hemostasis disorder may be secondary consequences of surgical bleeding, preoperative anticoagulant therapy, and the use of cardiopulmonary bypass. Tests used for routine evaluation of the coagulation system are activated partial thromboplastin time (APTT) and international normalized ratio (INR). The study encountered 60 patients who were hospitalized at the Clinic for Cardiovascular Diseases, University Clinical Center Tuzla. Patients underwent elective coronary artery bypass heart surgery either with cardiopulmonary bypass (on-pump CABG) or without it (off-pump CABG). The aim of this study was to compare the changes in coagulation tests (APTT, INR) in patients who were operated on-pump and patients operated off-pump. Our study showed that the values of APTT and INR tend to increase immediately after surgery. Twenty-four hours after surgery these values are declining and they are approaching the preoperative values in all observed patients (p <0.05). Comparing APTT between the groups we found that postoperative APTT levels are significantly higher in the group of patients who underwent surgery with cardiopulmonary bypass (p <0.05). Changes in coagulation tests after surgical revascularization of the heart are more pronounced in patients who were operated with on-pump technique compared to patients operated off-pump technique.

Introduction: Postponed recuperation from anesthesia can lead to different complications such as apnoea, aspiration of gastric content whit consequent development of aspiration pneumonia, laryngospasm, bradycardia, and hypoxia. Aim of this research was to determine infl uence of propofol, sevoflurane and isoflurane anesthesia on post anesthesia recovery rate.Methods: This was a prospective study; it included 90 patients hospitalized in period form October 2011 to may 2012 year, all patients included in the study underwent lumbar microdiscectomy surgery. Patients were randomly allocated to one of three groups: group 1: propofol maintained anesthesia, group 2: sevoflurane and group 3: isofl urane maintained anesthesia. Assessments of recovery rate were done 1, 5 and 10 minutes post extubation using White fast tracking scoring system.Results: Significant difference was observed only 1 minute after extubation (p=0,025) finding recovery rate to be superior in propofol group. Propofol group compared to inhaled anesthesia with sevoflurane group, shows significantly faster recovery from anesthesia only one minute after extubation (p=0,046). In comparison of propofol group and isofl urane anesthesia group, statistical significance was noticed one minute following extubation (p=0,008). Comparison of propofol group and inhaled anesthesia groups recovery rates were not significantly different at all times measured. When we were comparing sevoflurane and isoflurane anesthesia, recovery rates shoved no signifi cant statistical difference.Conclusions: Recovery rate evaluated by using White fast tracking scoring system was superior and with fewer complications in propofol maintained in comparison to sevoflurane and isoflurane maintained anesthesia only one minute post extubation, while after fifth and tenth minute difference was lost.

Introduction: There is no simple answer to the question as to when the brain function is back to normal after anaesthesia. Research done so far has identified different factors influencing the rate of cognitive function recovery and type of anaesthetic as one of those factors.Methods: This study encountered 90 patients hospitalized in neurosurgical department of University Clinical Centre Tuzla in period from October 2011 to may 2012 year. Aim of the study was to compare influence of three different anesthetics (propofol, isofl urane and sevofl urane) on recovery rate of cognitive performance 1, 5 and 10 minutes following extubation. Assessment of cognitive functions was preformed using the short Orientation-Memory-Concentration (OMC) Test. All patients included in the study underwent lumbar microdiscectomy surgery and were allocated to one of three groups: propofol, sevoflurane and isoflurane.Results: Trough comparison of OMC test values there is obvious superiority in recovery of cognitive functions between propofol group and inhaled anesthetic group, after 1 minute (p = 0.008) and after 5 minutes (p =0.009). Comparison of propofol and isoflurane anesthesia shows significantly faster recovery of cognitive performance in propofol group (after 1 minute p = 0.002, 5 minutes p = 0.004, 10 minutes p = 0.038). Faster recovery of cognitive function is present in sevoflurane compared to isoflurane group only 1 minute after extubation p = 0.049.Conclusions: Fastest recovery of cognitive performance appears after propofol anesthesia, than follows sevofl urane based anesthesia and after that isoflurane anesthesia.

Increasing gap between demand and availability of human kidneys for transplantation has forced a re-evaluation of the limits on donor age acceptability. The present study included 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. In an observational cohort study we assessed impact of donor age on post transplant renal function by analyzing following parameters: 24 hour urine output, creatinine clearance (Cr Cl) and glomerular filtration rate (GFR). Depending on donor age recipients were allocated in to two groups. Group I included patients who received renal graft from donors age up to 55 years, and Group II encountered recipients who received renal graft from donors older than 55 years. Our goal was to determine whether donor age over 55 years significantly diminishes renal graft function in first seven post transplant days. No statistically significant difference was found between Group I and II regarding 24 hour urine output. From second to fifth postoperative day creatinine clearance values were higher in the group of patients who received kidney from donors older than 55 years (47+/-19, 1 vs. 44, 4+/-20, 8). On the fifth, sixth and seventh post operative day GFR was significantly higher in patients who received renal graft from donors age up to 55 years (p<0, 0161). Our data showed no significant difference in observed variables between the two groups, thus indicating that utilization of renal grafts from donors' age > 55 years is acceptable and may considerably expand the donor pool.