Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) can be diagnosed in the absen-ce of histology with typical echocardiographic fi ndings and skeletal scintigraphy showing grade 2 or 3 myocardial tracer uptake, when clonal plasma cell dyscrasia is excluded. Aim: To present a patient diagnosed with ATTR-CM, who was hospitalized with clinical signs of congestive heart failure. Case Report: An 84-year-old man was hospitalized with clinical signs of heart failure. Echocardiography showed concentric left ventricular hypertrophy (LVH) with reduced systolic function, along with impaired LV global longitudinal strain (GLS) with apical sparing (-9.9%). Serum and urine protein electrophoresis with immunofi xation were obtained and were negative for plasma cell dyscrasia. Bone scintigraphy showed similar radiotracer uptake in the myocar-dium and ribs (Perugini grade 2). The diagnosis of ATTR-CM was confi rmed. Conclusion: ATTR-CM is an underdiagnosed condition and should be suspected in patients with heart failure and unexplained LVH.

Introduction: Aorto-pulmonary

The aim of this article was to present a summary of the current resources available in the literature regarding the role of inflammation in anal cancer development. Anal cancer is relatively uncommon, accounting for about 2.7% of all reported gastrointestinal cancers in the United States. However, the importance of understanding the pathogenesis and risk factors for anal cancer has been recognized over the last several decades due to a noticed increase in incidence worldwide. Infections, autoimmune diseases, and inflammatory diseases of unknown etiology cause chronic inflammation that promotes tumorigenesis. The association between chronic inflammation and cancer development is widely accepted. It is based on different pathophysiological mechanisms that lead to cellular transformation and changes in immunological response, allowing tumor cells to avoid apoptosis and immune surveillance. However, there are still many molecular and cellular mechanisms that remain largely unexplored. Further studies on this topic could be of tremendous significance in elucidating anal cancer pathogenesis and developing immunotherapeutic approaches for its treatment.

Background/Aim. For the first time, we evaluated and presented the socio-demographic characteristics, clinical manifestations and laboratory findings of hospitalized coronavirus disease 2019 (COVID-19) patients from Canton Sarajevo, Bosnia and Herzegovina. Methods. This retrospective, single-centre study included 159 RT-PCR verified COVID-19 patients (92 mild/moderate; 67 severe/critical) consecutively hospitalized at the General Hospital "Prim. dr Abdulah Nakaš" in Sarajevo, Bosnia and Herzegovina. Socio-demographic, clinical, and laboratory data on admission were retrospectively obtained from each patient's electronic medical record and patient files by two experienced physicians. Results. 43.4% of the patients belonged to the age range of 46-65 years; 71.1% were men, and 68.6% had comorbidities; hypertension was the most prevalent comorbidity (100%), followed by diabetes (91.7%) and ischemic heart disease (35.8%). The leading clinical symptoms were fever (87.44%), tiredness (77.8%), and body/muscle aches (70.3%). There was significant reduction of blood oxygen saturation (p = 0.005), and significant elevation of D-dimer (p = 0.003), CRP (p = 0.044), and fasting plasma glucose (p = 0.047) in the severe/critical patients group compared to mild/moderate group. Conclusion. Older age, the male gender, confirmed comorbidities, decreased blood oxygen saturation, increased levels of CRP, D-dimer, and fasting plasma glucose, together with symptoms of chest pain/shortness of breath and/or diarrhea occurred more frequently in severe/critical than mild/moderate COVID-19 patients.

ACCEpTED: December 18, 2020 Aim: To present a therapeutic modality of rhabdomyolysis after acute myocardial infarction (AMI). Case report: A 45-year-old patient was admitted to Urgent Care Center due to chest pain. Due to repeated attacks of ventricular fibrillation (11 direct-current cardioversion defibrillation was done), and after successful cardiopulmonary resuscitation (CPR) he was intubated. Computed tomography (CT) of the head was without pathological findings. At admission laboratory findings were as follows: urea 17.5 mmol/L, creatinine 143 μmol/L, AST 584 IU/L, ALT 162 IU/L, creatine kinase 6220 IU/L, C-reactive protein 249.5 mg/L, troponin I 0.12 ug/L (in two days increased to 6.31 ug/L). In the resuscitation procedure, gastric contents were aspirated, and shadowing of the right lung was radiographically verified. Patient from admission was febrile up to 40° Celsius despite received therapy (positive finding on Haemophilus influenzae B was received subsequently). Ejection fraction of left ventricle was reduced (estimated about 30-35%) along with anteroseptal medioapical akinesia, while stroke volume was 46 mL. Hypokinesia of right ventricular free wall was verified. Tricuspid annular plane systolic excursion was 15mm, along with moderate tricuspid regurgitation. On the fourth day deep vein thrombosis of the left leg was verified. On the ninth day of hospitalization, a high increase in creatine kinase was verified (up to 127.100 IU/L) with consecutive renal failure (urea 38.1 mmol/L, creatinine 620 μmol/L) and rhabdomyolysis with acute renal failure was diagnosed. The patient was included in the acute hemodialysis program (six hemodialysis were performed, diuresis was up to a maximum of 250 mL/day). The patient’s condition gradually stabilized, and the patient was taken of mechanical ventilation after 16 days. During next twenty days, kidney function was improving, and the patient was discharged home. Follow-up examination after two months verified anteroseptal and medioapical akinesia of left ventricle, with satisfactory renal function. Percutaneous coronary intervention was indicated.

Objective: Despite advances in the technology of dialysis, cardiovascular morbidity and mortality in patients with end-stage renal disease (ESRD) who are on hemodialysis therapy are still very high. Recent clinical studies have demonstrated a significant correlation between leptin levels and hypertension, hyperlipidemia, perturbed fibrinolysis and chronic inflammation. The aim of this study was to investigate the significance of changes in serum leptin concentrations and relationship of leptin and traditional cardiovascular risk factors in patients with varying duration of hemodialysis therapy. Design and method: The cross sectional study included 60 patients with end stage renal disease, of both sexes, divided into two equal groups (n = 30) based on the duration of hemodialysis treatment: A group of subjects who are on hemodialysis therapy between three months and five years, and group of subjects who are on hemodialysis therapy five and more than five years. The control group (n = 30) consisted of apparently healthy subjects, with no subjective and objective indicators of chronic renal disease. The serum leptin concentration was determined by enzyme-linked immunosorbent assay (ELISA). Results: Serum leptin levels in patients in Group under 5 years was significantly higher from leptin concentrations in serum of patients in Group eqally and more then 5 years and of serum leptin concentrations in the control group. Statistically significant positive correlation was found between serum leptin levels and body mass index (BMI) in subjects of Group eqally and more then 5 years and in the control group. There was no significant correlation between serum leptin levels and C – reactive protein (CRP) in any of the groups of patients. Results showed that the serum leptin value had a poor diagnostic accuracy in distinguish hemodialysis patients from healthy control, as well as, hemodialysis patients at different length of dialysis therapy. Conclusions: In this population of stable HD patients, obtained results do not support the hypothesis that serum leptin and relationship between leptin and traditional cardiovascular risk factors can be used as an independent marker to distinguish between hemodialysis patients than healthy subjects, nor in differentiating hemodialysis patients at different length of dialysis therapy.

Objectives: Aim of the present study was to investigate serum concentration of leptin and its association with values of body mass index (BMI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in hemodialysis (HD) patients. Methods: This cross-sectional study included 60 HD patients (34 male, 26 female) and 30 age- and sex-matched (4 males, 26 females) apparently healthy subjects. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA). Serum CRP concentration was measured by means of particle-enhanced immunonephelometry. ESR value was determined by Western Green method. BMI was calculated as weight (kg) divided by height squared (m2). Results: Results have shown that median serum leptin concentration (30.65 ng/mL; 12.48-86.40 ng/mL) was statistically significantly higher in HD patients compared to median serum leptin concentration (15.75 ng/mL; 9.15-30.65 ng/mL) in the control group of healthy subjects (p<0.05). Likewise, median serum CRP concentration (5.5 mg/L; 1.93-8.9 mg/L) and median ESR value (57.5 mm/h; 40.5-77.0 mm/h) were significantly higher in HD patients compared to median serum CRP concentration (0.8 mg/L; 0.38-1.43 mg/L) (p<0.001) and median ESR value (10.0 mm/h; 6.5-14.0 mm/h) (p<0.001) determined in the control group. Statistically significant positive correlation was found between BMI values and serum leptin concentration in HD patients (rho=0.434; p<0.001). Positive, although not significant, correlation was observed between serum CRP and leptin levels in HD patients (rho=0.171; p>0.05). Negative correlation between ESR values and serum leptin concentrations in HD patients was determined but it was not statistically significant (rho= -0.029; p>0.05). Conclusions: Increased serum concentration of leptin as pro-inflammatory cytokine as well as elevated serum values of CRP and ESR indicate presence of systemic micro inflammation in HD patients. Results of the present study point to possible use of serum leptin concentration as an indicator of nutritional status in HD patients based on observed significant positive correlation between serum leptin concentrations and BMI values. However, absence of significant association between serum leptin and CRP levels as well as between serum leptin concentrations and ESR values in HD patients requires further investigation and clarification.

Anemia refers to a hemoglobin or hematocrit level lower than the age-adjusted reference range in healthy children and adults. Anemia is not a specifi c disease entity but is a condition caused by various underlying pathologic processes. The clinical effects of anemia depend on its duration and severity. When a precipitous drop in the hemoglobin or hematocrit level occurs (eg, due to massive bleeding), the clinical presentation is typically dramatic and can be fatal if the patient is not immediately treated. Even then, mortality risk is very high. We report the case of a 76-year-old woman with clinical symptoms and laboratory confirmation of severe anemia with level of hemoglobin 24 g/l, and hematocrit 0.08. Anemia was a sign of malignoma of the stomach, later patohistologicaly verifi ed gastric adenocarcinoma. Aim of management is to prevent tissue hypoxia by maintaining an adequate circulating volume and oxiform capacity. However, as shown in this case, the very rapid correction of anemia and the circulatory volume does not decrease the risk of fatal outcome