Background: Myocardial surgical revascularization in patients with low left ventricular ejection fraction (LVEF) is accompanied by a high rate of morbidity and mortality. Objective: The aim of this study was to investigate and eliminate the reasons for the most common perioperative and postoperative complications. Methods: A total of 64 were analyzed. of patients during 2019 who underwent coronary artery bypass grafting (CABG), average age 61.29±9.12 years. Results: Out of the total number of operated patients, there were 16 women and 48 men. Patients were divided into two groups. The first group consisted of patients who underwent surgery with the use of cardiopulmonary bypass (cCABG-CPB) and the second group those who underwent surgery without the use of cardiopulmonary bypass (OPCAB). In 41 patients, myocardial infarction was previously recorded. Critical stenosis of the main trunk of the left coronary artery was present in 14 patients. The incidence of postoperative complications was higher in the cCABG-CPB 16/10 group (p0.030). Conclusion: In our study, we confirmed that myocardial revascularization is justified, especially in the case of multivessel coronary disease. In the long term, it significantly improves the systolic function of the left ventricle, and thus and quality and length of life.

Background: The negative symptoms of schizophrenia are less known aspects of the illness although they often mark its course and outcome. Negative symptoms refer to loss of function, and they are associated with poor outcomes. It is considered that they are more prominent with the longer duration of illness. Objective: To determine the negative symptoms in the patients with schizophrenia with regard to the duration of illness. Methods: A cross-sectional study was conducted in 60 consecutive outpatients with schizophrenia. Two groups were formed regarding the duration of illness (⩽2 years, and >3 years). The negative symptoms were established with the Brief Negative Symptom Assessment – BNSA. Results: Average score of negative symptoms in the group with the shorter duration of illness was 8.37±2.94, and in the group with longer duration was 10.73±2.86. Independent Samples Test was significant p=0.003, t-2.367, and therefore the difference between scores on BNSA within groups was significant. Moderate size effect was found (p = 0.69). Conclusion: Negative symptoms of schizophrenia are more prominent with the longer duration of illness.

Background: A significant number of patients who underwent surgical myocardial revascularization (CABG) have various comorbidities, including left ventricular diastolic dysfunction (LVDD). Objective: The aim of this paper is to show that patients with preoperative LVDD are at an increased risk of postoperative adverse events and have a worse prognosis compared to patients without LVDD. Methods: The study included 116 patients who underwent myocardial revascularization (CABG) performed at Medical Institute Bayer in Tuzla over a period of 1 year. None of the patients had previously undergone CABG or valvular surgery, or undergone stent implantation (PCI). The presence of LV diastolic dysfunction was detected by echocardiography, and the patients were divided into two groups: with and without LVDD, and further classified into three degrees of LVDD. Results: Of the total number of subjects who underwent surgical revascularization of the myocardium without echocardiographically detected LVDD, 24.1% were patients, and 75.9% were patients with LVDD. In the group with LVDD, the range of days spent in the intensive care unit (ICU) is significantly higher compared to patients without LVDD. Also, patients with LVDD had a significantly higher number of hours of inotropic support, a significantly higher number of cases of tachycardia, predominantly atrial fibrillation (POAF). In this group of patients, a greater number of other adverse events were observed, such as myocardial infarction, cardiac or renal failure, TIA or CVI. Of the total number of patients in the study, 107 patients survived surgical myocardial revascularization and had a satisfactory recovery while 9 (7.8%) survived, all from the group with LVDD. Conclusion: Patients with preoperative diastolic dysfunction of the left ventricle, especially with III degree of dysfunction, are exposed to a higher postoperative risk of adverse events such as: atrial fibrillation, prolonged stay in the intensive care unit, the need for longer-term support with inotropes, and the fatal outcome was recorded exclusively in patients with LV diastolic dysfunction.

Introduction: Postoperative Atrial Fibrillation (POAF) is associated with a higher rate of postoperative complications and mortality, as well as with longer hospitalization and increased treatment costs. We have designed and performed a randomized, trial of pharmacological prophylaxis in which the event of interest is POAF. Aim: The aim of this study is to reduce the risk of postoperative, complications associated with this arrhythmia. Methods: We included 240 stable patients with a coronary heart disease, who were referred to elective surgical revascularization of the myocardium. The patients were assigned into three groups of 80 patients each: group A (BB, beta blocker, comparator), group B (BB+ Amiodarone) and group C (BB + Rosuvastatin). The goal was to establish whether intervention by combination therapy was more useful than a comparator. Results: An event of interest (POAF) has occurred in 66 of the total 240 patients. Number of new POAF cases is the lowest in Group B, 14 (17.5%) compared to 25 (31.25%) new cases in the comparator group, and 27 new cases (33.75%) in group C. Absolute risk reduction was 13.75%, ≈14% less POAF in group B compared to comparator. Relative risk reduction was 56% (RR 0.56, p = 0.04). Number Needed to Treat was 7.27. In group C, 33.75% of patients developed POAF. Absolute risk was insignificantly higher in group C (2.5%, NS) compared to the comparator .The number needed to harm was high, 40. Conclusion: The results of our research show that prophylaxis of POAF with combined therapy BB + Amiodarone was the most efficient one.

Introduction Heart rhythm disorders are common in the post-operative period following surgical myocardial revascularization (CABG). The incidence of any type of arrhythmia in the postoperative period can go up to 85%. While most are transient and short-term, it does not lead to deterioration of the postoperative course, in a smaller number of patients they can be predictors of various events that result in fatal outcome. Arrhythmias occur suddenly and need to be recognized and reacted in time. Standard monitoring consists of 12-channel electrocardiogram (ECG), laboratory findings and, if necessary, 24-hour HOLTER monitoring. Persistent arrhythmias increase overall morbidity and mortality, and costs treatments are increasing enormously. Patients and methods The prospective study analyzed patients of all age groups and sexes in whom angiographically coronary arterial disease was confirmed and who underwent surgery CABG. A total of 60 patients were screened during 2016. All age groups of both sexes in whom no rhythm disorders were previously recorded were included in the study. Results A total of 60 patients undergoing CABG were analyzed. The average age of patients was 63.56 8.55 years. The most preoperative factor was hypertension, which was recorded in 53 (88.33%) patients. The higher number of patients was operated using CPB 75.86%. The most commonly performed 3 aorto-coronary by-pass 45 (75%). The most common form of rhythm disorder was POAF, which occurred in 18 (30%) patients. In 24 patients, a change in heart rhythm was observed in the postoperative period in the group of operated ON pump techniques, while in the case of the application of Off pump technique only 5 patients were present, which was statistically significant (p <0.05). Conclusion Preoperative patient preparation and prophylaxis with good anesthesia monitoring and minimal trauma during surgery are the main preconditions for reducing the incidence of postoperative heart rhythm disorders.

Introduction: Dilatation of the left atrium and left ventricular diastolic dysfunction (DDLV) according to recent studies has significance in the occurrence of postoperative atrial fibrillation (AF), stroke and death. Authors of some studies found no relationship between these parameters and atrial fibrillation. Objective: this study is to determine the time of occurrence and duration of atrial fibrillation in patients after surgical revascularization (CABG) due to the presence of left ventricular diastolic dysfunction and left atrium dilatation and identify the most significant predictors of incident AF. Methods: Prospective study included 116 patients undergoing surgical myocardial revascularization followed from admission to discharge. The study was conducted at the Special Hospital “Heart Center BH” Tuzla for a period of one year (March 2011/2012 g.). For all patients was performed preoperative ultrasound examination, especially parameters of diastolic function of the left ventricle and left atrium volume index (LAVi), as the best parameter sized left atrium, and the postoperative occurrence of certain AF and day occurrence, duration in hours, the number of attacks. To assess whether an event occurred or not was used logistic regression, and the effect of time on the event of interest is analyzed by Cox ‘s regression hazard parallel. Results: 75.9 % of patients had DDLV, and 91.4 % were hypertensives, 12.9 % from the previous stroke (ICV) and 42.2 % diabetics (DM), 14 % with COPD. The average age of patients was 61.41 ± 4.69 years. In both groups was 32.8 % women and 67.2 % men. LAVi preoperative values were significantly higher as DDLV greater degree. In patients with DDLV and higher values LAVi risk of AF is higher, the greater the length of AF and significantly higher number of attacks FA. Early occurrence of atrial fibrillation and its longer duration in function with increasing LAVi a marked increase in the value LAVi have the greatest hazard for the early appearance of atrial fibrillation. As a result of analysis of the most significant predictors of AF are DDLV and LAVi. Conclusion: Postoperative atrial fibrillation occurs earlier and lasts longer in patients with DDLV and elevated left atrial volume index especially LAV > 36ml/m2. LAVi has the best explanation of the function of hazard occurrence of atrial fibrillation after CABG.

BACKGROUND To establish the prevalence of metabolic syndrome and its parameters in group of patients with schizophrenia in polypharmacy - receiving first generation antipsychotics versus clozapine alone treated group. SUBJECTS AND METHODS 48 outpatients with schizophrenia divided into two groups: the first group of 21 patients in polypharmacy with first generation antipsychotics, and the second group of 27 patients treated with clozapine alone were assessed for the presence of metabolic syndrome. We used logistic regression models to assess the relationship between metabolic syndrome and antipsychotic therapy, gender and age. RESULTS Metabolic syndrome was found in 52.1% of all subjects. Compared to first generation antipsychotics polypharmacy, the monopharmacy with clozapine was associated with elevated rates of metabolic syndrome (28.6% vs. 70.4%, p=0.004). With regard to particular parameters of metabolic syndrome, the elevated plasma triglycerides were significantly more present in subjects within Clozapine group (p=0.03). Logistic regression analysis showed that female gender (p=0.004), and clozapine treatment (p=0.005) were significantly associated with metabolic syndrome. CONCLUSION Compared to polypharmacy with first generation antipsychotics, the higher prevalence of metabolic syndrome is found in patients treated with Clozapine alone. The most prevalent metabolic disorder is dyslipidemia.

Introduction: Cigarette smoking among students is greatly widespread. Smoking prevalence ranges from 28% to 67% for students, respectively, from 19% to 34% for female students. Aim: The aim of this survey was to investigate the smoking habits of students, who are studying at three faculties at the University of Tuzla in academic Year 2012/2013 and to investigate whether there is a difference in smoking habits of students from different faculties and observed by gender. Patients and Methods: The study included a total of 254 students, 170 females (66.93%) and 84 male patients (33.07%). A representative sample consisted of students of three faculties of the University of Tuzla. Results: The conducted analyzes have shown that in this sample 22.8% of current smokers, and 7.8% are former smokers who now no longer smoke. Due to the adopted smoking habits, which some students began to adopt in the age of 13, in 47.5% part of students occasionally was observed some symptoms (cough, etc.) which are attributed to smoking. The analysis showed no statistically significant gender difference in smoking habits. Although the trend of smoking in the population students progression, one and the same quantity was well as male colleagues. We did not find any statistically significant difference in onset of adopting smoking habits. Conclusion: The analyzes have shown that in this sample 22.8% of current smokers, and 7.8% were former smokers who now no longer smoke. The analysis showed no statistically significant gender difference in smoking habits of all students. There were no statistically significant differences in the daily consumption of cigarettes between faculty.

Introduction: The aortic valve replacement is a standard operating procedure in patients with severe aortic stenosis. Structure of patients undergoing surgery ranges from young population with isolated mitral valvular disease to the elderly population, which is in addition to the underlying disease additionally burdened with comorbidity. One of the most commonly present factors that further complicate the surgery is coronary heart disease that occurs in, almost, one third of patients with aortic stenosis. The aim is to compare the results of surgery for aortic valve replacement with or without coronary artery bypass graft (CABG). Patients and Methods: From August 2008 to January 2013 in our center operated on 120 patients for aortic stenosis. Of this number, 75 were men and 45 women. The average age was 63.37 years (16-78). Isolated aortic valve replacement was performed in 89 patients and in 31 patients underwent aortic valve replacement and coronary bypass surgery. Implanted 89 biological and 31 mechanical valves. Results: Patients with associated aortic stenosis and coronary artery disease were more expressed symptomatic symptoms preoperatively to patients with isolated aortic stenosis who were on average younger age. Intra-hospital morbidity and mortality was more pronounced in the group of patients with concomitant aortic valve replacement and coronary bypass surgery. Morbidity was recorded in 17 patients (14.3%) in both groups, while the mortality rate in both groups was 12 patients (10.1%). Conclusion: Evaluation of preoperative risk factors and comorbidity in patients with aortic stenosis and coronary artery disease contributes to a significant reduction in intraoperative and postoperative complications. Also, early diagnosis of associated coronary artery disease and aortic stenosis contributes to timely decision for surgery thus avoiding subsequent ischaemic changes and myocardial damage.

Objective: It is well known that coronary artery bypass grafting (CABG) is often the cause of non-thyroidal illness syndrome (NTIS). Nonthyroidal illness syndrome (NTIS) is a state characterized by low levels of tri-iodo-thyronine (T3) and high levels of reverse T3 (rT3), with normal or low levels of thyroxin (T4) and normal, low-normal, or low levels of thyroid-stimulating hormone (TSH). Today, there are two main techniques of CABG: CABG with the use of cardiopulmonary bypass (on-pump coronary artery bypass - ONCAB) and CABG without the use of cardiopulmonary bypass (off-pump coronary artery bypass OPCAB), or ’beating-heart surgery.’ The OPCAB technique is considered to be less invasive. We prospectively investigated the influence of these surgical techniques on the occurrence of NTIS. Methods: Serum levels of free fractions of thyroid hormones (FT3 and FT4) and TSH were analyzed in 70 consecutive patients subjected to CABG surgery, using the ONCAB technique in 36 patients and OPCAB technique in 34 patients. The measurements of hormone levels were performed prior to surgery and 12 hours and 14 days after surgery. Results: The basic, the early, and the late postoperative serum levels of FT3 (p=0.458, p=0.632, p=0.869, respectively), FT4 (p=0.664, p=0.301, p=0.417, respectively), and TSH (p=0.249, p=0.058, p=0.324, respectively) were similar in both groups. The levels of FT3 and TSH were significantly lower 12 hours after surgery (p<0.0001, p<0.0001, respectively), and the FT4 levels rose at the same time (p<0.0001). The third measurement showed the return of all investigated parameters back to physiological levels, although they were still not precisely within the initial values. Conclusion: NTIS occurs significantly in patients subjected to CABG. Although the OPCAB technique is considered to be less invasive, its impact on the occurrence of NTIS does not differ significantly from the ONCAB technique.

Cardiologia CROATICA Objectives: The aim of this article is to investigate the relationship between the degree of the common carotid artery (CCA) atherosclerosis and the degree of complexity of the coronary artery disease (CAD) expressed with SYNTAX score. It is known that the existence of the CCA disease indicates with high probability the existence of CAD, but few studies have examined the relationship between CCA ultrasound findings and complexity, not just the presence of CAD. Patients and Methods: We included a total of 106 consecutive patients referred to the BH Heart Center for elective coronary angiography. In order to measure and calculate the mean intima-media thickness (IMT) we performed three measurements in predefined segments of CAA for both carotid arteries, the values are converged, and divided by the number of measurements. Plaque score (PS) was measured on the basis of maximum thickness of plaque in four clearly defined segments of both CCA. The final value of PS score is obtained by adding the thickness of plaques found in all segments of CCA. The complexity of coronary artery lesions is evaluated by using the SYNTAX score. The middle and high SYNTAX scores are associated with an increased risk of cardiac death and major cardiac events. Results: Data collection and statistical analysis is in progress and preliminary results indicate that IMT values and PS score significantly correlate with SYNTAX score >18 (r=.0,64, p 27 (r=.0,79, p<0,01). It is expected that final results will show that there is a significant correlation between the degree of CCA atherosclerosis measured by two methods — IMT and PS, and the degree of complexity of coronary artery lesions. Conclusion: Preliminary results show that carotid ultrasound examination has sufficient sensitivity and specificity in the detection of patients with high risk of significant CAD and it is an argument for broader use of CCA ultrasound for the evaluation of patients who are considered for coronary angiography. Besides, we are going to improve algorithm of patients selection for coronary angiography, so, our limited material and human resources and efforts will be directed towards the treatment of patients i.e. net clinical benefit will be improved.

Background and Objectives: Currently, there is no consensus about immunosuppressive therapy following kidney transplantation. Acute rejection rates and allograft survival rates are the clinical outcomes traditionally used to compare the efficacy of various immunosuppressive regimens. Therefore, we conducted this study to evaluate whether patient survival rates improved in the era of modern immunosuppressive treatment during living-related kidney transplantation. Design and Setting: Retrospective cohort study in a university-based tertiary internal medicine teaching hospital performed between 1999 and 2009 and patients followed up to 7 years. Patients and Methods: Survival rates were assessed in 38 patients receiving basiliximab and mycophenolate mofetil (regimen A) and 32 patients receiving antithymocyte globulin and azathioprine (regimen B). The rest of the regimen (cyclosporine A and steroids) remained the same. A secondary end point was acute rejection episode. Results: Seven-year survival rates were 100% and 72% (P=.001) and 7-year acute rejection-free survival rates were 82% and 53% (P=.03), in groups A and B, respectively. Conclusion: Long-term survival after living-related kidney transplantation has improved in the era of modern immunosuppressive treatment.