Aim To determine risk factors associated with the development and severity of secondary hyperparathyroidism in dialysis patients. Methods A cross-sectional study at the Clinical Centre of the University of Tuzla (March 2022) included 104 adult patients (males 51.9%, females 48.1%) with chronic kidney diseases under dialysis treatment. Based on parathyroid hormone (PTH) values, patients were divided into two groups: study group (45/104, PTH >792pg/mL) and control group (59/104, PTH 176-792 pg/ mL). The analysis aimed to resolve whether there was a connection between the duration of dialysis, the type of therapy treatment administered, the underlying kidney disease, and the presence of comorbidities with the values of PTH, and a wide spectrum of monitored laboratory parameters. Results The most common causes of chronic renal failure were undefined kidney diseases (32.7%), followed by diabetic nephropathy (18.3%) and chronic glomerulonephritis (16.3%). In the examined biochemical parameters, a significant difference was found in mean values of alkaline phosphatase (p<0.001). The correlation was proved between the duration of dialysis (p=0.028), the values of phosphorus (p=0.031), and alkaline phosphatase (p<0.001) with absolute values of PTH. The most common present comorbidity was hypertension (78.8%), followed by cardiovascular diseases (40.4%) and diabetes (22.1%). Conclusion A number of factors contribute to the development and severity of SHPT. Modulation of therapy and better control of risk parameters can prolong and reduce the frequency of SHPT in dialysis patients, as well as the occurrence of comorbidities.

Background: The coronavirus disease (Covid 19) is caused by the SARS-CoV-2 virus. The virus has spread globally, causing millions of deaths.Aim: This study was made with the aim of revealing the clinical features of corona virus infection, as well as assessing the prevalence of comorbidities in patients infected with coronavirus 2 (SARS-CoV-2).Methods: In this analysis the data was obtained from the hospital information system, involving patients who were treated for Covid-19, in the period January 1 until April 8, 2021.Results: 400 infected patients were included in the study, 86.2% of whom had comorbidities, and 8.8% without comorbidities. The results showed that the most common clinical symptom is fever in 62%, followed by difficulty breathing in 53%, and cough in 42%. The most prevalent comorbidities were cardiac 68.3%, then endocrinological 33.8%, surgical 16.5%, neurological 15%, oncological 12%, nephrological 11%, and pulmonary 10%. The existence of a significant association between the presence of comorbidities and the patients suffering from COVID-19 on mechanical ventilation due to treatment complications was determined, p=0.000 (p<0.05) at the 95% significance level.Conclusion: We assessed the prevalence of comorbidities in patients with COVID-19 and found that underlying disease, including cardiac and endocrinological diseases, may be a risk factor for severe forms of the disease.Key words: Covid-19, clinical features, comorbidities

Aim To evaluate clinical and epidemiological characteristics and outcome of patients with COVID-19, and impact of vaccine against COVID-19 on them. Methods This retrospective study included 225 patients treated from COVID-19 in the period from 1 to 30 September 2021 at the Clinic for Infectious Diseases, University Clinical Centre Tuzla (UCC Tuzla). For the diagnosis confirmation of Covid-19, RTPCR was used. Patients were divided in two groups: fully vaccinated with two doses of vaccine, and non-vaccinated or partially vaccinated. Results Of 225 patients, 120 (53.3%) were females, and 105 (46.7%) males. Mean age was 65.6 years. There were 26 (11.6%) fully vaccinated patients. Most common symptoms in unvaccinated patients were fatigue (70.9%), cough (70.4%) and fever (69.8%), and in vaccinated fever (76.9%), fatigue (69.2%) and cough (46.2%). Cough was more common in unvaccinated patients (p=0.013). Fatal outcome happened in 84 (37.3%) patients. Transfer to the Intensive Care Unit (ICU) and older age had a higher risk of death (p<0.001). Older age patients were more likely to have comorbidities like atrial fibrillation (p=0.017), hypertension (p<001) and diabetes mellitus (p=0.002). Atrial fibrillation (p<0.001), hypertension (p<0.001), diabetes mellitus (p=0.009) and history of stroke (p=0.026), were related to fatal outcome in unvaccinated patients, also did a shorter duration of illness prior to hospitalization (p<0.001) and shorter length of hospitalization (p=0.002). Conclusion Older patients with comorbidities, as well as those who were not vaccinated against COVID-19, were at higher risk for severe form of the disease and poor outcome.

INTRODUCTION This survey aims to assess knowledge, attitude and stigma towards HIV patients, among medical students in Tuzla, Bosnia and Herzegovina. We also aimed to assess potential risk factors for HIV infection among fourth year medical students. METHODOLOGY Data were collected from specific questionnaire that was completed by 171 students of the Faculty of Medicine, University of Tuzla. A multivariable logistic regression was performed. RESULTS Majority of students (79%) had a good knowledge of HIV, (median value of correct answers was 9 (95%) with at least 6 correct responses). Also, majority of students (73.6%) had a positive attitude towards HIV patients and the median positive value was 6 (95% CI: 6-7). More than a third of students considered that all hospitalized patients should be tested for HIV. Total of 81% of students considered that they should inform the sexual partner of HIV positive patient, although she/he disagrees. 61.4% of students had a discriminatory attitude towards HIV, with the median values of 3 (95% CI: 3-3). Multivariate regression analysis identified positive attitude towards HIV patients as an independent predictor for a non-discriminatory attitude. Moreover, an overall attitude towards HIV patients defines student`s determination to work with AIDS population. Male gender, and older age, were identified as predictors of risky behavior. CONCLUSIONS Preventive measures, including better HIV education, are crucial. Knowledge can increase awareness of HIV infection, decrease the incidence and reduce stigma towards HIV patients.

Introduction: Cytomegalovirus (CMV) infection is ubiquitous. It affects all age groups, and its clinical picture ranges from mild to severe, especially as a congenital infection in neonates. Aim: To determine frequency of CMV infection in pregnant women in Tuzla Canton (TC) and the risk factors that lead to the infection. Methods: This prospective study included 300 pregnant women from TC aged 18 to 42 years. CMV serology was performed on all participants, and in case of acute infection additionally IgG avidity test. Participants also completed the questionnaire on the risk factors for CMV infection. Results: The median age of the 300 women was 28 ±4.97 years. There were 161participants (53.6%) who classified their environment as urban and 295 (98.33%) were married. More than half of the women had completed secondary school 168 (56%). Positive IgG antibodies to CMV had 280 (93.0%) women. Positive IgM and IgG antibodies had 9 (3.0%) participants, but all of them had high IgG avidity, which indicates reinfection or recurrent CMV infection. There was a statistically significant higher number of seropositive participants living in rural areas than those living in urban areas (p= 0.048). Also, there was significantly higher percentage of positive anti-CMV IgG in pregnant women with lower education (p=0.04). Conclusion: In our region there is high seropositivity rates of IgG antibodies to CMV in pregnant women. No case of primary CMV infection was proven. The risk factors for CMV infection have been proven to be rural environment and lower level of education.

Introduction: The main route of acquiring infectious blood and body fluids in hospital conditions is accidental exposure to stinging incidents. Aim: The aim of this study was to determine the epidemiological characteristics of accidental exposures to blood-borne pathogens among different professional groups of health care workers (HCWs). Materials and Methods: A cross-sectional study was conducted using the “Questionnaire on the HCWs exposure to blood and blood transmitted infections” at the University Clinical Centre Tuzla, Bosnia and Herzegovina, from the 1st of March to the 31st of December 2014. Study sample consisted of 1031 participants (65% of total employees) stratified into three occupational groups: doctors, nurses and support staff. Results and Discussion: Exposure incident was recorded in 1231 participants (54.8%) at least once in the last 12 months. An average number of exposure incidents per HCWs in total years of service was 7.07± 8.041. Out of total sample, 70% reported at least one type of exposure incident. Nurses had a higher frequency of multiple contacts compared to doctors and support staff (χ2=37.73; df=4; p<0.001). The frequency of reported incidents among nurses at the surgical departments was almost two times higher (1.7). 75.5% (778/1031) of the participants, reported not having been exposed to these incident. Doctors were significantly less likely to report exposure incidents than nurses and support staff. There were significant differences in reporting rate (χ2=32,66; df=4; p<0.001). Conclusion: HCWs in hospitals have a high prevalence of occupational exposure to blood-borne infections. Seventy percent of the HCWs is periodically or constantly exposed to or contact related to blood. Nurses are most frequently exposed occupational group among HCWs, while the lowest reporting rate on an exposure incident is among doctors.

Objective – The aim of this paper is to present the epidemiological and clinical characteristics of a measles outbreak in children age 0-18 years, who were hospitalized at the Clinic for Infectious Diseases of the University Clinical Center, Tuzla in the 2014/2015 period. Patients and methods – The target population of this retrospective study were patients in the 0-18 year age group, who were hospitalized at the Clinic for Infectious Diseases during the measles outbreak in 2014/2015. Results – At the Clinic for Infectious Diseases in Tuzla, 341 patients with the clinical characteristics of measles were hospitalized during the period of the measles outbreak in 2014/2015. Of all hospitalized patients 74.7% (255/341) belonged to the age group from 0 to 18 years. Most of hospitalized children, 146 (57.2%) of them, were in the age group from 0 to 6 years, next was the group of children aged 11 to 18 years, 69 (27.1%) of them, followed by the group of children aged from 6 to 10 years, 40 (15.7%) of them. Complications were present in 176 (69.02%) of the hospitalized children. Among the hospitalized children suffering from measles, 92.5% were unvaccinated or incompletely vaccinated, or their vaccination status was unknown. Conclusion – The youngest population is susceptible to a much higher risk of measles. To reduce the incidence of measles in children a high level of immunization is required.

Introduction: More than three decades after recognition of acquired immunodeficiency syndrome (AIDS) in the United States, the pandemic of human immunodeficiency virus (HIV) infection has dramatically changed the global burden of disease. Aim: The main goal of this research is retrospective analysis of epidemiological and clinical characteristics of 28 HIV infected patients, who were diagnosed and treated at the Clinic for Infectious Diseases in University Clinical Center Tuzla in the period from 1996 until the end of 2013. Subjects and Methods: Retrospective analysis was performed using the medical records of 28 HIV-infected persons. Two rapid tests were used for HIV testing: OraQuick Advance test, Vikia HIV1/2, Elisa combo test, HIV RNA test. AIDS disease was determined by using the criteria from WHO. Results: Among a total of 28 HIV-infected persons, 23 (82.14%) were males and 5 (17.86%) were females, with the male: female ratio of 4,6:1. In terms of the transmission route, a large proportion of cases were infected through heterosexual contact 19 (67.86%). At the time of the first visit, 16 (57.15%) patients showed asymptomatic HIV infection, 4 (14.28%) HIV infection with symptoms other than the AIDS defining diseases, and 8 (28.57) had AIDS. At the time of first hospital visit, the CD4 + cells count ranged from 40 to 1795/µl (conducted in 19 patients), and mean value of CD4 + cells was 365,31/µl, and mean HIV RNA titer was 287 118 copies/ml³. Of 28 HIV-infected persons 39 cases of opportunistic diseases developed in 12 patients (42.9%). In terms of the frequency of opportunistic diseases, tuberculosis (12 cases, 42.9%). Among a total of 28 HIV-infected patients, 6 (21.4%) of them died. Conclusion: This study characterizes the epidemiological and clinical patterns of HIV–infected patients in Tuzla region of Bosnia and Herzegovina to accurately understand HIV infection/AIDS in our region, in the hope to contribute in the establishment of effective HIV guidelines in the Tuzla region of B&H in the future.

AIM To determine the prevalence and antimicrobial resistance of dominant causes of urinary tract infections (UTI) in patients treated at the Clinic for Infectious Diseases, University Clinical Center Tuzla during the period January 2010 to June 2011. METHODS This prospective study included 438 patients divided into three groups: hospital-treated patients group (H-T), outpatient- treated group (O-T) and patients with hospital-acquired (H-A) UTI. Identification of UTI causes completed using standard microbiological methods; antimicrobial susceptibility was done by disc-diffusion method according to the CLSI. RESULTS E. coli was significantly more commonly isolated in females H-T, 111 (68-1%) (p=0.012) and O-T, 148 (82.7%) (p=0.006) groups, as well as in females less than 65 years from the H-T, 87 (84.5%) (p=0.000) and H-A, four (40%) (p=0.044) groups. Klebsiella pneumoniae and Pseudomonas aeruginosa were significantly more commonly isolated in male H-T, 11 (29.7%) (p=0.000) and five (13.5%) (p=0.009), and O-T UTI, two (9.5%) (p=0.009) and three (14.3%) (p=0.000) groups. E. coli showed significantly higher prevalence of resistance to amoxycillin, coamoxiclav, cefuroxime, ceftriaxone, gentamicin and co-trimoxazole in the H-A group comparing to other two groups (p less than 0.05), as well as to ampicillin, amoxycillin and cefixime in the O-T comparing to H-T group (p less than 0.05). CONCLUSION Empirical antimicrobial therapy should include coamoxiclav, nitrofurantoin, cefepime, and ceftazidime for females less than 65 years old in both H-T and H-A, cefalosporines, co-amoxiclav and nitrofurantoin in O-T UTIs; for females more than 65 years old, cefalosporines, aminoglicosides, and ciprofloxacin, in H-T and O-T UTIs. For H-A UTI in females more than 65 years as well as for all male patients antimicrobial susceptibility testing should be performed.

AIM To determine a predictive potential of biochemical and clinical parameters, including independent predictors of the therapeutic outcome in patients with H1N1 influenza. METHODS In this retrospective study, 119 patients treated at the Clinic for Infectious Diseases in Tuzla in the period July 2009 to February 2010 were included. They were at the age of 1 month up to 80 years. The patients showed clinical, epidemiological and biochemical parameters of the pandemic flu and they had also been positive for the virus A (H1N1), which was confirmed by the real time polymerase chain reaction (RT-PCR). RESULTS One hundred and nineteen patients were positive to the virus A (H1N1), 60 (50.4%) were male, and 59 (49.6%) female patients. The average age of the patients was 26.74 years. The number of patients with co-morbidity was 53 (44.5%). There were 71 (59.7%) patients who had been admitted to the Intensive Care Unit. The complications of the flu had appeared in 45 (37.8%) patients. Pneumonia was recorded in 108 (90.8%), and reduced saturation in 62 (52.1%) patients. The highest number of cured patients was in the group of patients who had received the oseltamivir within 48 hours after the outbreak of the disease. CONCLUSION The age, reduced saturation with oxygen, duration of the hospitalization, pregnancy and overweight were independent predictors of the severe form of the disease/lethal outcome. For an optimal therapeutic outcome, it is important to apply antiviral therapy as soon as possible.

Introduction: Hospital-acquired Urinary tract infections make 35% of all the hospital-acquired infections, and about 80% of them are related to the catheterization of the urinary bladder Purpose: To determine clinical characteristics and dominant etiologic factors of Urinary Tract Infections associated with urinary catheter (C-UTIs). Methods: Determined clinical characteristics of C-UTIs were prospectively analyzed on 38 hospitalized patients in the Clinic for Infectious Diseases at the University Clinical Centre Tuzla, from January 1st 2011 to December 31st 2011. The control group constituted of 200 patients with community-acquired Urinary Tract Infections (Co-UTIs) hospitalized in the same period. Results: It was registered on 22 (57.89%) of symptomatic infections, 14 (36.84%) asymptomatic bacteriuria and 2 (5.26%) other C-UTIs. Dominant etiologic factors were: E. coli, caused 14 (36.84%), Extended-Spectrum Beta-lactamase producing (ESBL) Klebsiella pneumoniae 7 (18.42%), Enterococcus faecium and Candida spp. 3 (7.89%) of C-UTIs. E. coli was significantly most common etiologic factor of C-UTIs in younger women (p=0.04). E. coli from C-UTIS showed significantly higher resistance to antimicrobial drugs. Inadequate antimicrobial therapy was significantly more common prescribed to patients from C-UTIs. Lethal outcome was significantly most common associated with certain clinical and laboratory findings. Conclusion: Initial antimicrobial therapy of those serious infections should be based on data from those research.

AIM To determine the etiology of peritonitis, as well as the sensitivity of isolated bacteria to antibiotics. METHODS Study was performed at the Surgical Clinic, Department of Anesthesiology and Reanimation, Department of Microbiology, Department of Clinical Pharmacology of University Clinical Centre (UCC) Tuzla. In a prospective study, starting from 1.6.2009. to 30.6.2010., was 60 patients analyzed who underwent surgery for acute peritonitis in the Surgical Clinic, UCC Tuzla. RESULTS After microbiological processing of the content of the operative field, wound swabs and smears of drainage, we isolated Gram positive coccid bacteria: Coagulase-negative Staphylococcus in 18.36%, Staphylococcus aureus in 12.6%, while Enterococcus faecalis and Enterococcus faecum were found in 3.44% isolates. In the group of Gram-negative bacteria we isolated: Escherichia coli in 15.51%, and Pseudomonas aeruginosa and Klebsiella pneumoniae in 10.34% of the cases. The sensitivity of coagulase-negative Staphylococcus was largest to vancomycin (100%), and lowest to penicillin (10%) and Staphylococcus aureus sensitivity was largest to vancomycin and amoxicillin-clavulanate (100%) and lowest to penicillins (3.7%). Sensitivity of the facultative anaerobic Gram-negative bacilli was highest to carbapenems 95-100%, and lowest to penicillin preparations 0-56%. CONCLUSION Based on the results of microbiological findings of 83.33% patients empirical antibiotic therapy was appropriately involved, and in 16.67% was inadequate and later changed, following the results of microbiological findings. This study indicates the importance and validity of microbiological diagnostics to determine the etiology of peritonitis and appropriate selection of antibiotics to treat these infections, with the required surgical treatment.