UNLABELLED The objective of this study is the assessment of the association of burnout syndrome with adrenal exhaustion specific symptoms and signs among 116 patients who were exposed to violence or mobbing at workplace and who were treated during 2005 to 2008 in Department of Occupational Pathology and Toxicology Tuzla; to detect symptoms and signs of adrenal exhaustion differences between patients who were exposed to act of violence as acute catastrophic event and patients who were long-term exposed to mobbing or chronic distress at workplace. MATERIAL AND METHODS Data of 86 employees who were exposed to mobbing > 1 years (chronic distress syndrome) and data of 30 employees who were exposed to act of violence as acute traumatic crisis situation (evaluation in first week after acute stress situation and post control observation 6 months later). TOOLS FOR ASSESSMENT WERE CLINICAL EXAMINATION AND QUESTIONNAIRES: Occupational stress questionnaire (OSQ short version), self-constructed Questionnaire about symptoms and signs of Adrenal exhaustion; self-constructed mobbing questionnaire; and Maslach--Burnout Inventory. RESULTS The patients expressed their traumatic experiences during exposure to stress more than 1 year (long-term exposure) which were compared with acute stress experiences (mostly high level of stress intensity. CONCLUSION when workers constant expose to repeat mobbing behavior or have perception of extended distress reaction after act of violence at workplace they are suffering of Syndrome burnout and clinical picture of adrenal fatigue.

Background. Disorder of hemostasis in hemodialysis patients is focused in two directions, towards the development of thrombosis and bleeding. Both complications make it difficult to treat and are life-threatening for the patient.  Monitoring of hemostatic parameters, it is possible to detect the first changes in the coagulation system and correct the factors that lead to changes and thus prevent or stop the further development of complications. Aim. To determine the hemostatic and dialysis parameters and their influence on the occurrence and development of complications. Patients and methods. From a total of 175 patients, 46 had signs of hemorrhagic syndrome and 16 of them had thrombosis. Parameters of primary and secondary hemostasis were determined and vascular access of ultrasound was examined. Results. In the patients with thrombosis D-dimer level was significantly higher and amounted to 4.18 mg / l, while AT III levels were decreased for 54%. Elevated level of APTT was significant for the patients who had bleeding. In 86% of patients with thrombosis, ultrasound findings correlated with findings of D-dimer. Both complications were more pronounced in the older age group above 46 years. Conclusion. Hemorrhagic syndrome is a frequent complication of thrombosis. The level of D-dimer is directly correlated with ultrasound detection of thrombotic formation. Elevated levels of APTT was in direct correlation with bleeding. The development of complica-tions are affected by other factors, such as: age, access type, type of dialysis membrane, the blood flow. Frequent control of hemostatic parameters is essential for early detection of complications. In the event of changes in coagulation system, type and dose of anticoagulant should be corrected and introducing additional oral anticoagulants should be considered.

INTRODUCTION AND AIM The aim of this study was to quantitatively evaluate serum concentration of alpha 1-antitrypsin (A1AT) in patients undergoing surgery of head and neck malignant tumors. PATIENTS AND METHODS Fifty patients undergoing surgery because of head and neck tumors in the years 2007-2008 were analyzed. Serial determinations were performed in all patients in three times: preoperative day--A1AT1; first postoperative day--A1AT2, and thirtieth postoperative day--A1AT3. Concentrations of A1AT were determined by nephelometry method. RESULTS The patients' age varied from 39 to 86 years, 46 male and 4 females. Serum values of A1AT in patients with stage III and IV are statistically significant elevated after operation (and after one month), but in patients with lower stages (I and II) there were not. In patients with laryngeal malignancies recorded statistical significant elevation of serum values of A1AT postoperatively (and after one month). Other tumor locations did not recorded the same results. CONCLUSION The above results suggest that measurements of A1AT may have an ancillary role in the diagnosis and monitoring of head and neck tumors.

INTRODUCTION Secondary lack of iron in patients on hemodyalisis is the main cause of inadequate answer on therapy of recombinant human erythropoietin (rHuEPO). Therefore, it is very important to follow the status of iron in these patients. OBJECTIVES The objectives of our study were to define the value of hemoglobin content in reticulocytes as predictor of functional iron deficiency on hemodialyzed treated patients with erythropoietin (rHuEPO) then evaluate the eficiency of using the value of hemoglobin content in reticulocytes in administration of iron HD (Patients on hemodialyzed ). PATIENTS AND METHODS It is a prospective study which included 53 patients treated on chronical hemodialysis and continuing hospital peritoneal dialysis (CAPD), all patients were given additional iron therapy intravenously in order to keep the level of ferritin between 300 microg/l and 500 microg/ and transferrin saturation over 20%. The patients were both male and female randomly chosen. The following parameters conected to iron deficiency were compared in this study. The study was taken in the period from august to december 2008 at University Clinical Centar Tuzla. RESULTS AND DISCUSSION The study included patients from chronical HD programme in therapy with rhEPO, iron intravenously, than patients on CAPD also in therapy with rh EPO and intravenously iron and patients on chronical HD with intravenously iron without rh EPO therapy. There wasn't any significant difference between numbers of male and female patients that were examined and in control group. In this study the following parameters conected to iron deficiency were compared. There wasn't any significant difference in values of seruum ferritin, Ret-he and hemoglobin between the examined and control group. Still, it's clear that members of the examined group had higher values of these parameters comparing to the control group. If we would use criterias like the saturation transferrin and the level of ferritin as referent standard we would have 26/53 (49.1%) patients with iron deficiency in the whole sample. CONCLUSION Following chematological and biochemic parameters in examined patients on HD are giving us essential information for planing and leading an adequate erythropoietin therapy. For the maximum effect of rhEPO therapy, an adequate compensation of iron is necessary.

Urinary tract infection (UTI) is one of the most common infections in children, and usually it appears in early childhood. The aim of this study was to find out the incidence and distribution of urinary tract infections in childhood, and to analyze clinical presentation of urinary tract infections in children. In the retrospective study were included 164 children, of both genders, who were treated in Primary Health Centre. Medical history were analyzed from all children who have presence of bacteria in urinary sediment. Urinary tract infection was found in 7.74% (164/2118) children, 11.26% (115/1021) of girls and 4.47% (49/1097) of boys. The biggest frequency was found in age group 3-6 years were UTI was found in 9.80% (74/755) of all children. Some of non-specific symptoms were found in 73.18% (120/164) children, and specific symptoms for UTI were found in 35.98% (59/164) children. The most common symptom was fever, which was found in 54.9% (90/164) children. UTI is common bacterial infection causing illness in children. It may be difficult to recognize UTI in children because the presenting symptoms and/or signs are non-specific, particularly in younger children.

Introduction: Laparoscopic cholecystectomy is a method of choice in the treatment of calculous gallbladder. There is a clear evidence of changes in hemostatic parameters during this surgical procedure, which can result in thromboembolic complications. The aim of the study was to evaluate changes in D-dimer values, as a marker of hypercoagulability in patients treated with laparoscopic cholecystectomy. Patients and methods: The study included total of 60 patients, divided into two groups, one treated with classic (open) and other with laparoscopic method. Blood samples were taken from all patients before, during the surgery and 24 hours and 5 days after the procedure with consequent determination of D-dimer levels. Results: Blood samples of patients in both groups manifested higher values of D-dimer during the operation, 24 hours and 5 days after the procedure. We have found elevated values of D-dimer 5 days after the surgery in the group of patients treated with laparoscopic cholecystectomy with 2.5 times higher levels compared to values measured preoperatively. Conclusion: Our results suggest that there is an increased fibrinolytic activity after laparoscopic cholecystectomy, which demands more detailed and complete study on tromboembolism prophylaxis.

Introduction: Chronic obstructive pulmonary disease (COPD) is a disorder characterized by maximal expiratory flow decrease and slow forced lung exhalation, which are significantly unchanged over several months. Subjects and Methods: Our study included 100 patients, 50 males and 50 females, diagnosed COPD who have been tested by functional lung tests: spirometry, body plethysmography and blood gas analysis. Patients have been analyzed at Clinic for pulmonary diseases and TBC, University Clinical Center Tuzla. All tests have been done at Department for Cardiorespiratory Diagnostics. Results: In this study have shown highly significant correlation among following parameters: FEV1 and VC, FEV1 and FEF 25, FEV1 and FEF75/25, FEV1 and FEF75, FEF25 and FEF75/25, FEF75 and FEF75/25. In males FEV1, VC and FEV1/VC have been significantly decreased comparing to females. Our results have shown no significant deference among spirometry, plethysmography and blood gas analysis parameters in male smokers with COPD comparing to female smokers. It has been found significant difference for pCO2 in male comparing to female nonsmokers. Conclusion: According to the results we recommend that all individuals having chronic cough, dyspnea and wheezing, and who are smokers or ex-smokers, aged >45 years, considering BMI, should be tested by spirometry.

BACKGROUND Simplification of APACHE II scoring system in the prediction of the outcome in critically ill patients with perforative peritonitis can be a useful and a cheaper model than the standard APACHE II system. We tested APACHE II and SAPS I scoring systems and variables of arterial pH, pO2, pCO2 and HCO3, cholesterol and albumin in the prediction of the outcome in these patients. PATIENTS AND METHODS The prospective study involved 145 patients of both sexes with perforative peritonitis. The main outcome of this study was peritonitis-related death. APACHE II and SAPS I scoring systems were calculated on the admission (during the first 24 hours). Cutoff points were specified and all values greater than the cut-off points were taken to predict death. Sensitivity and specificity are graphically shown for the different values of cut-off points. They are presented with the ROC curve. Variables of arterial pH, pO2, pCO2 and HCO3 were tested with Feed-Forward Artificial Neural Network which had 4 hidden layers with 8 neurons in the layer. We used Levenberg-Marquardt method for training, and 16 variables for the entrance in the network. We tested correlation between cholesterol and albumin levels with the patient outcome. RESULTS APACHE II ROC curve demonstrated that its discriminatory ability was better than the SAPS ROC curve. The area under the curve was 0.86 for APACHE II score in comparison to 0.83 for SAPS score. This illustrated that APACHE II is significantly better (P < 0.01) at determining of outcome. Use of FeedForward Artificial Neural Network (ANN) for analysis of variables such as arterial pH, pO2, pCO2 and HCO3, showed that withdrawal of these variables lead to the decreased power of prediction of APACHE II scoring system. Measurement of the correlation between the cholesterol and albumin levels and the patient outcome revealed that there was no significance between these parameters, as the level of correlation for cholesterol and albumin was -, 1, and -, 14, respectively. CONCLUSION APACHE II has better prognostic power than SAPS scoring system. Withdrawal of variables such as arterial pH, pO2, pCO2 and HCO3, reduces the prognostic power of APACHE II system.

BACKGROUND Blood pressure (BP) is one of the important parameters for controlling Diabetes Mellitus (DM). European Society of Cardiology recommended optimal level for DM BP < 130/80 mmHg. AIM We wanted to assess the level of BP for our DM patients after using specific guidelines for DM. METHODOLOGY Retrospective medical record (audit) has been conducted among 853 DM patients older then 18 years. We checked patient charts among 19 FM teams two years before (May 2003-May 2005) and two years after (May 2005-May 2007) implementation of the DM guidelines in Family Medicine (FM) clinic in Zenica. We divided FM teams based on their patients BP values; optimal level of BP < 130/80 mmHg; suboptimal level when systolic BP 130-140mmHg and diastolic 85-90 mmHg and that with inadequate level with BP>140/90mmHg. RESULTS 853 DM patient charts were analysed, 46 per FM team. Average age of DM patients was greater than 60 years and average age of doctors was 46.6. Percentage of BP inadequate level was smaller after implementation of DM guidelines in most of FM teams. For optimal level BP < 130/80 mmHg, significant improvement was seen after implementation of DM guidelines for: 6/19 teams (p < 0.0001), 2/19 teams (p < 0.001) and 2/19 teams (p < 0.01). CONCLUSION After implementation of BP guidelines for DM patients, BP can be improved in patients treated by FM teams and guidelines should be used.

The aim of this work is to show our experiences in eye injury care in children. The case involved a 24-hour-old eye injury with traumatic cataract. Immediately after having been admitted in hospital, surgery was performed, under complete anaesthesia, using the phacoemulsification method by implanting an IOL in the posterior chamber. The postoperative development was regular. The sight definition, after the first day of surgery, was 0.4 accompanied by normal intraocular pressure without pathological changes in the posterior eye segment. Two months later, the sight definition was 0.8, with the presence of iridolental synechia (iris-IOL) and pupil irregularity. We decided to perform surgery once more to correct the pupil and prevent secondary glaucoma development. After corneal paracentesis, pupil synechiosis was performed with an iris manipulator and the pupil in central projection. The postoperative period was regular with 0.8 sight definition in the first post-operative week, and 0.9 and 1.0 three months following surgery. The patient's sight definition prognosis was good and control tests were regular, due to the possibility of posterior lens capsule opacification and eventual secondary glaucoma. Eye injuries relate to serious injuries, due to the unpredictability of trauma consequences. Child eye injuries are a particular problem, considering the socioeconomic aspect that determines their future importance. The surgical approach in child injury care is frequently individual, and it depends on the experience and skill of the surgeon himself.

The retrospective study included 250 patients, treated at Clinic for cardiovascular diseases of Tuzla Clinical center, between 30.08.2003. and 15.11.2004. In the coronary disease group there were 145 men, 55 women, with diagnosed coronary artery stenosis of 50% or more. The control group had 150 patients, 35 men and 15 women, medium age of 58.2. The control group had coronary artery stenosis of 50% or less. Coronarography was done using AXIOM ARTIS DFC (SIEMENS). Lipoproteins were determined on the Clinic for biochemistry of Tuzla Clinical Center using automatic analyser DIMENSION LxR (DADE BOEHRING). In the coronary artery disease (CAD) group elevated triglycerides were found in 38.5%, total cholesterol in 88% and LDL 55.5% of patients. The concentration of HDL cholesterol was elevated in 52.5% of patients. In the control group elevated values of triglycerides were found in 28%, total cholesterol 46%, LDL cholesterol 16%, and lower values of HDL in 10% of patients. Statistically significant differences of lipide profile of CAD patients in relation to the control group was defined. Using regresional analysis it was established that decide elevated values of total and LDL cholesterol, low values of HDL were also significant.

INTRODUCTION Spinal muscular atrophies (SMA) are group of neuromuscular disorders characterized by degeneration of motorneurons in anterior column of medulla spinalis, and sometimes in motoneurons of cranial nerves and the brain. Causes of SMAs are mutations in genes encoding for SMN, SIP and NAIP that are very low in motorneurons of these patients. Ribonucleases (RNases) are enzymes that depolimerize RNA and may destabilize DNA. AIM The objective of this study was to determine ribonuclease activity in serum and urine of SMA patients. METHODS RNases were purified by anion-kation-exchange chromatographies, and HPLC, and their activity was measured by immunodetection using specific antibodies against rinonucleases in presence of RNA as a substrate. RESULTS Eosinophil-derived neurotoxin (EDN) activity iin serum of SMA patients was 5.6, 3.8 and 2.6 higher in type I, II and III comparing with control group. RNase inhibitor activity in serum of the same patients was 3.0 and 2.4 lower in type I and II vs. Control group, but in type III was unchanged. Similar results are found in urine of the same patients. CONCLUSION Increased serum and urin EDN activities in SMA patients could be used as a new additional clinical marker in their diagnosis.

Arterial hypertension is a common finding in patients with end stage renal disease (80% patients are hypertensive). Cardiovascular diseases are the main cause of death in haemodialysis. The present study was performed to asses' successful treatment in hypertensive chronic haemodialysis patients by ultra filtration only and ultra filtration combined with medics. We studied 80 hypertensive adult patients who had been on regular haemodialysis treatment for at least 12 months (average duration of 41 months). All subjects were divided in two different antihypertensive treatment groups including 40 subjects each. The first group of patients were treated with trandolapril and ultra filtration, and the second group of patients were only treated with ultra filtration (control group). Blood pressure measurements before and after HD sessions were performed for each patient. Blood pressure control was defined using World Health Organization criteria 140/90 mm Hg. Average systolic blood pressure levels, after haemodialysis, were in the first group of patients 146.33 +/- 9.7 mm Hg, and in the control group 157,86 +/- 10.33 mm Hg. Average diastolic blood pressure was 87.83 +/- 8.11 mm Hg in the first group of patients and, in the control group it was 91.03 +/- 10.67 mm Hg. There were significant differences between systolic blood pressure level in the first group of patients and the control group of patients as well as in diastolic blood pressure (p < 0.05). We conclude that an antihypertensive therapy by trandolapril is more effective than ultra filtration alone in hypertensive patients on chronic haemodialysis.