Aim. The aim of this study was to compare urinary alpha 1 microglobulin (A1MG) in healthy individuals with and without family burden for Balkan endemic nephropathy (BEN) in an endemic village. Methods. Otherwise healthy inhabitants with microalbuminuria or proteinuria were divided into two groups: with (n = 24) and without (n = 32) family BEN burden and screened for urinary A1MG and A1MG/urine creatinine ratio. Results. Average value of urinary A1MG was 10.35 ± 7.01 mg/L in group with and 10.79 ± 8.27 mg/L in group without family history for BEN (NS, P = 0.87). A1MG was higher than 10 mg/L in eight (33.33%) inhabitants with family history and in 12 (37.5%) without (NS, P = 0.187). Average values of urinary A1MG/creatinine ratio were 1.30 ± 1.59 and 0.94 ± 0.78 in group with and group without family BEN history (NS, P = 0.39, resp.). Elevated values of this ratio were found in 13 (54.17%) inhabitants with and 14 (43.75%) without family history for BEN (NS, P = 0.415). Conclusion. We did not find statistically significant difference in the examined markers between healthy individuals with and without family burden for BEN. We concluded that these markers are not predictive of risk for BEN.

Introduction: Diabetic nephropathy is a chronic complication in patients with diabetes melli- tus typ 1, which leads to kidney disfunction. Aim: The aim of this study was to compare the metabolic control and albuminuria with ultrasound fin- dings of morphometric measurements and registration Doppler signals of kidneys between children and youth with diabetes mellitus type 1 according to the duration of illness. Material and Methods: The retrospective-pro- spective study included 69 patients of both genders, that got diabetes mellitus type 1 when they were in the age from 2. to 25. years. Patients were divided into two groups according to the length of diabetes mellitus type 1: the first group was those whose illness had la- sted for more than 10 years, and second group with du- ration of diabetes mellitus typ 1 less than 10 years. Results: No significant difference was registered between the groups regarding frequency of albuminu- ria, but the chance of it occurring are greater in patients with longer duration of diabetes mellitus type 1. Pati- ents with albuminuria and diabetes mellitus type 1 du- ration over 10 years had higher glycated hemoglobin A1C, blood pressure, body mass index followed by en- larged volume of both kidneys. Patients with albumi- nuria and diabetes mellitus type 1 for less than 10 years had a higher creatinine clearance. Conclusion: Ultrasound dimensions and volume of the kidneys in patients with metabolic control para- meters are useful for monitoring especially in the early

Background. Diabetic neuropathy is a clinical or sub-clinical disorder in type 1 diabetes mellitus (T1DM) in the absence of any other causes for peripheral neuropathy. Methods. This one-year study comprised 69 subjects, children and adolescents with T1DM. The metabolic control of the illness was assessed on the basis of the glycaemia, glycosylated haemoglobin, lipid status, blood pressure, body weight and height and body mass index of the subjects. The data from a questionnaire assessed the frequency of clinical signs of diabetic neuropathy. Results. The clinical manifestations of diabetic neuropathy were muscular weakness, cramps, paraesthesia, insensitivity to pain, vomiting, diarrhoea, urinary disorders. The subjects with neuropathy had glycaemia of 9.8±1.8 mmol/L and HbA1C 10.6 ± 2.2%, with statistically significantly increased triglyceride levels (t=1.8, p=0.04), systolic and diastolic blood pressure (t=5.4, p 10 years had significantly more frequent pathological findings of the back of the eye (X2=3,2, p=0,02), with no statistically significant difference in albumin/creatinine (urine). The ROC curve with an analysis of age at the beginning of neuropathy was 11.7 years, with 55% sensitivity and 82% specificity. Conclusion. Our analysis suggests that there is a significant connection between the metabolic condition and the duration of the illness and the increased frequency of neuropathy in children and adolescents with T1DM. Aim. To test the hypothesis that metabolic control and length of illness are connected with an increased frequency of neuropathy in children and adolescents with T1DM.

Atopic dermatitis (AD) is a chronically relapsing, inflammatory skin disease characterized by severe itch, rash and dry skin. Hypersensitivity to aeroallergens is found in 40%-50% of children with AD and it is the cause of intensive skin lesions. The aim of the study was to assess the presence of hypersensitivity to aeroallergens in AD children. The study included 114 children (56 boys and 58 girls), median age 27.5 months, who had been diagnosed with AD according to Hanifin and Rajka criteria. The severity of the disease was assessed by the SCORAD index. To recognize hypersensitivity to aeroallergens, the following parameters were analyzed: medical history, values of absolute eosinophil count, total IgE antibodies, specific IgE antibodies to aeroallergens, and results of the skin prick test for aeroallergens. A moderate form of the disease was present in 61.4% of study children, with a median SCORAD index score of 28.5 points; 12.3% of study children showed hypersensitivity to aeroallergens (history of hypersensitivity to aeroallergens in 27.2%, increased absolute eosinophil count in 53.5%, increased total IgE antibodies in 56.1%, positive skin prick test in 20.2%, and positive specific IgE antibodies to aeroallergens in 12.3% of children). The most common aeroallergens responsible were house dust in 6.1% and Dermatophagoides pteronyssinus in 3.5% of children with AD. Hypersensitivity to aeroallergens was recorded in the same number of children with mild and severe forms of the disease and in 5.7% of children with a moderate form. In conclusion, the presence of hypersensitivity to aeroallergens in children with AD is significant. By discovering and removing the aeroallergens responsible, it is possible to achieve reduction in the intensity of skin lesions and frequency of exacerbations.

Objectives. We examined association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status in Tuzla Canton during 1992–1995 war in Bosnia and Herzegovina. Methods. The present study covers a 22-year period (1988–2009), including the war period (1992–1995), and we retrospectively collected data on a total of 108 316 liveborn infants and their mothers from three different socioeconomic periods: before (1988–1991), during (1992–1995), and after the war (1996–2009). Association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status were determined for each study period. Results. There were 23 194 live births in the prewar, 18 302 during the war, and 66 820 in the postwar period. Among the liveborn infants born during the war, 1373 (7.5%) had birth weight of <2500 g, which is significantly more in comparison with 851 (3.6%) liveborn infants in this birth weight group born before and 1864 (2.8%) after the war. We found the number of examinations during pregnancy was 1.8 per pregnant woman in the war period, which was low in comparison with the number of examinations before (4.6 per pregnant woman) and after (7.1 per pregnant woman) the war (P<.001 for both). Prewar perinatal mortality LBW infants of 6.2 per 1000 live births increased to 10.8 per 1000 live births during the war (P<.001), but after the war, perinatal mortality LBW infants (5.2‰) and early neonatal mortality (2.4‰) decreased. Conclusions. We found statistically significant association between low-birth-weight and maternal sociodemographic status in Tuzla Canton during 1992–1995 war in Bosnia and Herzegovina.

Balkan endemic nephropathy (BEN) is chronic tubulointersticial nephritis of unknown aetiology characterized by an insidious onset and gradual progression to end stage renal disease (ESRD). Endemic regions of Bosnia and Herzegovina are Posavina and Semberija, sited at basin of Sava River. In BEN, just like in other chronic renal diseases (CKD), glomerular filtration rate (GFR), is assumed a marker of overall renal function. The aim of this study was to compare GFR in examinees of endemic and non-endemic region for BEN, and between examinees with and without risk factors for BEN within endemic region. Study included 603 inhabitants of Bosnian Posavina, out of whom 386 (65%) from endemic (Domaljevac) and 217 (36%) from non-endemic (Svilaj) village, and it was performed in two phases. The first phase encompassed obtaining anamnestic data (demographic, personal and family history), measurement of arterial blood pressure, and urine dipstick testing (specific gravity, pH, proteins, leukocytes, glucose, ketones, and microalbuminuria). In the second phase, besides repeated urine dipstick test, laboratory blood testing and abdominal ultrasound, with special attention to urinary tract, was also performed. We have compared GFR between examinees of endemic and non-endemic regions for BEN, and between examinees with and without family burden for BEN within endemic region, using MDRD formula for calculating GFR, with cut-off value (5th percentile) based on result of studies performed in European Caucasians in screening for CKD and for establishing stages of CKD in BEN. Medical was used for statistical testing. Out of total number of examined inhabitants (603), 145 examinees were included in the second phase. After exclusion of 17 diabetic patients, 94 (73%) examinees from endemic and 34 (27%) examinees from non-endemic region remained. In the endemic region there were 46 (49%) examinees with and 48 (51%) without family burden for BEN. Overall GFR in examined groups was within physiologic range. There was not statistically significant difference in calculated GFR between examinees of endemic and non-endemic regions for BEN (Mann-Whitney test p=0.104; Fisher's test p=1), neither between examinees with and without family burden for BEN within endemic region (Mann-Whitney test p=0,7393; Fisher's test p=0,263). Overall GFR in examined groups was within physiologic range. There wasn't statistically significant difference in calculated GFR between examinees of endemic and non-endemic regions for BEN, neither between examinees with and without family burden for BEN within endemic region. GFR, no matter how accurately calculated and estimated, does not represent significant biomarker for diagnosis, especially early diagnosis, of BEN, until maybe its overt advanced form.

The aim of the study was to compare ultrasound findings of morphometric measurements and registration of Doppler signs of kidneys between children and adolescents with diabetes mellitus type 1 (DMT1) with microalbuminuria, and metabolic control with duration of the disease. Retrospective-prospective study included 80 patients, who got DMT1 in the age from 2 to 16 years. In relation to the duration of the disease, all patients were divided into two groups: the first was whose illness had lasted less than 10 years, the second group was with duration of DMT1 more than 10 years. In patients with duration of DMT1 more than 10 years, the frequency of microalbuminuria, pathological findings of the volume of right kidney, and higher HbA1C were significantly greater. The significant difference was found in the frequency of pathological findings of the resistance index (RI) in the interlobar arteries in both kidneys. Alongside microalbuminuria, monitoring the dimension and volume of the kidneys may indicate the existence of the early phases of diabetic nephropathy.

Summary Computer technology is a reality of our modern world. It gives us a tool which can be used to help us cope with the complexity and efficiency which is often required in many areas of work. It is an erroneous assumption that it robs a situation of its human qualities. No one would deny that the use of a word processor denies the possibility of highly creative writing being produced or that computerized checkouts make the interaction skills of the checkout person irrelevant to the process of struggling with the week’s shopping once more. In many ways, the use of the computer frees the person from the drudgery of repetitive labour to allow more time and effort to be available for the more personal skills to find expression. Recording assessment data using a computer keyboard allows just as much caring communication between nurse and clients as writing it down on a form. The critical factor is not the method of recording but the interpersonal skills and motivation of the nurse. The nursing profession is at last beginning to appreciate the role which the new technology can have in improving the service provided to patients. Only by taking an active role now in the implementation of computers to clinical practice can nurses maintain control of their own professional contribution to the large complex systems at present being implemented in many health care settings. Knowledge based systems are set to become a major component in the nurse’s ability to take on this role.

Balkan endemic nephropathy (BEN) is chronic tubulointersticial nephritis of unknown aetiology characterized by an insidious onset and gradual progression to end stage renal disease (ESRD). Endemic regions of Bosnia and Herzegovina are Posavina and Semberija, sited at basin of Sava River. In BEN, just like in other chronic renal diseases (CKD), glomerular fi ltration rate (GFR), is assumed a marker of overall renal function. [ e aim of this study was to compare GFR in examinees of endemic and non-endemic region for BEN, and between examinees with and without risk factors for BEN within endemic region Study included  inhabitants of Bosnian Posavina, out of whom  () from endemic (Domaljevac) and  () from nonendemic (Svilaj) village, and it was performed in two phases. [ e fi rst phase encompassed obtaining anamnestic data (demographic, personal and family history), measurement of arterial blood pressure, and urine dipstick testing (specifi c gravity, pH, proteins, leukocytes, glucose, ketones, and mycroalbuminuria). In the second phase, besides repeated urine dipstick test, laboratory blood testing and abdominal ultrasound, with special attention to urinary tract, was also performed. We have compared GFR between examinees of endemic and non-endemic regions for BEN, and between examinees with and without family burden for BEN within endemic region, using MDRD formula for calculating GFR, with cut-off value (th percentile) based on result of studies performed in European Caucasians in screening for CKD and for establishing stages of CKD in BEN. Medical was used for statistical testing. Out of total number of examined inhabitants (),  examinees were included in the second phase. After exclusion of  diabetic patients,  () examinees from endemic and  () examinees from non-endemic region remained. In the endemic region there were  () examinees with and  () without family burden for BEN. Overall GFR in examined groups was within physiologic range. [ ere was not statistically signifi cant diff erence in calculated GFR between examinees of endemic and non-endemic regions for BEN (Mann-Whitney test p=.; Fisher’s test p=), neither between examinees with and without family burden for BEN within endemic region (Mann-Whitney test p=,; Fisher’s test p=,). GLOMERULAR FILTRATION RATE IN EXAMINED POPULATION OF BOSNIAN POSAVINA REGION OF BALKAN ENDEMIC NEPHROPATHY Mirna Alečković1*, Enisa Mešić1, Senaid Trnačević1, Želimir Stipančić1, Damir Hamidović1, Evlijana Hasanović3 1 Department of Nephrology and Dialysis, Clinic for Internal Diseases, University Clinical Centre Tuzla, Trnovac bb,  Tuzla, Bosnia and Herzegovina 2 Centre for Dialysis, Regional Hospital Orašje,  Orašje, Bosnia and Herzegovina 3 Pediatric clinic, University Clinical Centre Tuzla, Trnovac bb,  Tuzla, Bosnia and Herzegovina * Corresponding author

The aim of the study was to compare ultrasound findings of kidneys in children and adolescents with diabetes mellitus type 1 (DMT1), establish the association with microalbuminuria, blood pressure values and metabolic control of the disease, and creatinine clearance. In 80 children and adolescents with DMT1, in whom illness occurred in period between 2 and 16 years of age, morphometry measurements with ultrasound were performed. Nephelometric method of three consecutive samples of urine determined microalbuminuria. In patients with microalbuminuria, creatinine clearance was also measured. Demographic data were obtained from the parents and from the patients medical records. In relation to the duration of the disease, all patients were divided into two groups: the first group of patients with illness lasting for less than 10 years, and the second were those whose illness had lasted more than 10 years. In patients with duration of DMT1 of more than 10 years, the frequency of pathological findings of the longitudinal diameter and volume of both kidneys in relation to age and anthropometric standards was statistically significantly greater. Also, the finding of microalbuminuria was more frequent. In the group of patients with DMT1 lasting for more than 10 years, the mean value of HBA1c was statistically significantly higher In patients with microalbuminuria the total mean value of creatinine clearance was within the bounds of the reference values and was statistically significantly higher in patients in whom the illness had lasted less than three years, which indicates hyperfiltration of the kidneys. Alongside microalbuminuria, monitoring of the dimension and volume of the kidneys may indicate the existence of the early phases of diabetic nephropathy and result in its prevention and prevention of illness progression.

Type 1 diabetes mellitus (DM1) is diagnosed in children worldwide in between 15% and 67% of cases at the stage of diabetic ketoacidosis (DKA). This complication of new onset DM1 is characterized by hyperglycemia (blood glucose >11 mmol/1), acidosis (venous pH <7.30 and/or bicarbonate <15 mmol/1) and glycosuria, ketonuria and ketonemia. In Bosnia and Herzegovina, data on DKA at DM1 onset are not yet available. The aims of the present study were to describe the frequency and patterns of the clinical and laboratory characteristics of DKA at onset of DM1 in children who were hospitalized at the Department of Pediatrics in Tuzla, Bosnia and Herzegovina, during the past 16 years.

The aim of the study was to determine the epidemiology of type 1 diabetes mellitus in the 0 to 14 years age group on the territory of the Tuzla Canton. Primary case identification was based on the data from the local register of Type 1 diabetes, which is held at Department of pediatrics, University Clinical Center in Tuzla. Secondary independent sources were data from 13 public health centers in the Tuzla Canton. The ascertainment was based on the capture-recapture method and was estimated to be 100%. Medical records of the children with diabetes were retrospectively reviewed. In the Tuzla Canton the prevalence of the disease on December 31st of 2005 was 0.56 per 1000. The prevalence was the highest in AŒeliA‡ (1.43) and Tuzla (1.01), and the lowest (0.13) in Srebrenik. A prevalence higher than average (0.56) was found in AŒeliA‡ (1.43), Tuzla (1.01), Kalesija (0.84) and Lukavac (0.66). The highest number of patients was diagnosed in January, March, October and December and the lowest in May and June. According to age the highest incidence was found at ages 10 and 12. The mean yearly incidence in the period 2001 – 2005 was 10.5 per 100 000. In conclusion, the results of our research provide means for adequate consideration of epidemiological indicators of type 1 diabetes in children in the Tuzla Canton, which may be useful for planning preventive, organizational, and therapeutic programs in pediatric health care in the Tuzla Canton.

Several criteria are necessary to meet in order to have the diagnosis of Balkan endemic nephropathy established. One of them is tubular proteinuria type that may be found, but not in the early stage of the disease. Beta 2 microglobulin may be found in the early stage, but its determination is rather cumbersome and not suitable for a daily routine. Therefore, urinary albumin/creatinine ratio was determined in 8 patients (all females, aged 58,37±4,37 years) from the town of aamac region (Bosnia and Herzegovina) as a measure of albumin excretion in order to establish useful marker in the early stage of the disease. Increased urinary albumin/creatinine ratio, was found in 50% of BEN patients. According to these preliminary results, microalbuminuria could be used as the reliable marker for the early detection of BEN.