OBJECTIVE To evaluate the defense mechanisms (DM) in patients with drug-resistant epilepsy and, to determine whether displacement is associated with seizures. SUBJECTS AND METHODS Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humor, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The values were compared with 50 subjects without epilepsy. RESULTS Patients with drug-resistant epilepsy use immature defensive styles significantly more (p=0.0010). Displacement have a positive correlation with frequency of seizure (p=0.0412). CONCLUSION Blaming others is a characteristic of the behavior of patients with drug-resistant epilepsy, especially if they have seizures. As such, they may be less adaptable in a micro social environment.

It has been reported in recent years that elevated thyroglobulin antibody (TgAb) values can be associated with thyroid malignancy. The aim of this study is to determine whether serum TgAb have a predictive role in thyroid cancer in patients with thyroid nodules. The crossed study included 100 patients with scintigraphic cold thyroid nodules divided in two groups. Demographic data, TgAb levels and final histopathological findings were recorded. The first group consisted of 50 patients with histopathological verified malignant nodules and the second group of 50 patients with histopathological verified benign nodules. TgAb were estimated by the radio-immunity assay (RIA) method. The median of TgAb in the group with benign nodules were 14.3 (10-32) IU / mL and in the group with malignant nodules 42.9 (13-156) IU / mL. TgAb values were significantly higher in patients with malignant nodules (p = 0.02 The increase in values of TgAb by 1 IU / mL increased the risk for malignancy by 0.7%. The cut-off for TgAb of > 35 IU / mL discriminates between diagnosis of the malignant and benign thyroid nodule. TgAb of > 35 IU / mL, with a sensitivity of 56% and a specificity of 78%, was found to be a limit value for predicting malignant thyroid lesion. TgAb serum values were predictor of malignant thyroid lesion and their preoperative measurement in combination with other risk factors could assist in preoperative diagnosis in patients with cytological indeterminant thyroid nodules.

Haemodiafiltration (HDF) is a renal replacement modality that combines diffusion and enhanced convection in order to remove smalland middle-molecular-weight com‐ pounds, respectively. They are removed along solvent drag effect of ultrafiltration through increased transmembrane pressure (TMP), whereas the replacement solution is infused intravenously at equal amount minus the desired fluid volume removal for achieving dry weight. Limiting factors for high-volume on-line haemodiafiltration (HV oHDF) are blood flow and viscosity (haematocrit, protocrit), filter performance and technical features of HDF monitor. Most recent advanced technology of dynamic analysis of pressure pulses along the blood flow pathway in the dialyser has enabled optimal ultrafiltration flow performances. HV oHDF offers today the best compromise of cardioprotective option by reducing cardiovascular risk factors in end-stage kidney disease patients. Recent randomised controlled trials (RCTs), individual participant data meta-analyses and a number of observational studies have shown the evidence of survival advantage of HDF over conventional haemodialysis (HD). The convective volume has become the key quantifier for HV oHDF as the measure of dialysis dose. Its cut-off values for better survival have been recognised, but the research is still needed in the years to come to set the required optimal volumes tailored to individual patients’ needs.

Background: Haemodiafiltration (HDF) is the preferred dialysis modality in many countries. The aim of the study was to compare the survival of incident patients on high-volume HDF (HV-HDF) with high-flux haemodialysis (HD) in a large-scale European dialysis population. Methods: The study population was extracted from 47,979 patients in 369 NephroCare centres throughout 12 countries. Baseline was six months after dialysis initiation; maximum follow-up was 5 years. Patients were either on HV-HDF (defined as with ≥21 litres substitution fluid volume per session) or on HD if on that treatment for ≥75% of the 3 months before baseline. The main predictor was treatment modality. Other parameters included country, age, gender, BMI, haemoglobin, albumin and Charlson comorbidity index. Propensity score matching and Inverse Probability of Censoring Weighting (IPCW) were applied to reduce bias by indication and consider modality crossover, respectively. Results: After propensity score matching, 1,590 incident patients remained. Kaplan-Meier and proportional Cox regression analyses revealed no significant survival advantage of HV-HDF. Results were biased by modality crossover: during the 5-year study period, 7% of HV-HDF patients switched to HD, and 55% of HD patients switched to HV-HDF. IPCW uncovered a statistically significant survival advantage of HV-HDF (OR 0.501; CI 0.366-0.684; p < 0.001). A higher benefit of HV-HDF for some subgroups was revealed, for example, non-diabetics, patients 65-74 years, patients with obesity or high blood pressure. Conclusions: This large-scale study supports the generalizability of previous RCT findings regarding the survival benefit of HV-HDF. Sub-group analysis showed that some sub-cohorts appear to benefit more from HV-HDF than others.

Currently used diagnostic criteria in different endemic (Balkan) nephropathy (EN) centers involve different combinations of parameters, various cut-off values and many of them are not in agreement with proposed international guidelines. Leaders of EN centers began to address these problems at scientific meetings, and this paper is the outgrowth of those discussions. The main aim is to provide recommendations for clinical work on current knowledge and expertise. This document is developed for use by general physicians, nephrologists, urologist, public health experts and epidemiologist, and it is hoped that it will be adopted by responsible institutions in countries harboring EN. National medical providers should cover costs of screening and diagnostic procedures and treatment of EN patients with or without upper urothelial cancers.

pends on the research question and proper selection of the confounders used to adjust for the analysis. Their study was designed to test the probability for the outcomes specified while having hemoglobin excursions outside the target range and not to test the association between them [3] , because the analysis was adjusted for hypertension and coronary artery disease which were by definition not confounders in this design being influenced by the hemoglobin level [4–6] . Thus, if one adjusts the analysis for them, the link between hemoglobin excursions and the outcomes tested may be reduced or even canceled out, thereby not revealing the possible effect of an increased hemoglobin level on the outcomes. In this study, hypertension and coronary artery disease were related to the effect of hemoglobin level [5, 6] . This allowed for only prognostic and not etiological inferences to be made because, in the prognostic model, pathophysiology was not an issue but only probabilities for the outcomes specified [3] . Dear Editor We appreciate the reply of Dr. Handelman to our comment [1] on the paper ‘Hospitalization and mortality in hemodialysis patients: association with hemoglobin variability’, published in your journal [2] . In his reply, Dr. Handelman compares the indication of impending problems secondary to having a hemoglobin level below the target range with the fever and elevated white count as indicators of infection as well as with the association between severe edema and congestive heart failure. However, the inferences made quite often in the paper by using wording such as ‘association’, ‘influence’, etc., did not correspond with the methodology applied in their study, which was the major point of our critique, so that no relation exists between the examples specified above by Dr. Handelman. Even infection may not necessarily be associated with an elevated white count, but with a low white count if it is a septic one and severe edema may not be associated with congestive heart failure, but with liver cirrhosis, so that every conclusion dePublished online: June 5, 2014

Surgical revascularization of the heart (CABG - coronary artery bypass grafting) is one way of treating coronary heart disease. Bleeding is one of the serious and frequent complications of heart surgery and can result in increased mortality and morbidity. Hemostasis disorder may be secondary consequences of surgical bleeding, preoperative anticoagulant therapy, and the use of cardiopulmonary bypass. Tests used for routine evaluation of the coagulation system are activated partial thromboplastin time (APTT) and international normalized ratio (INR). The study encountered 60 patients who were hospitalized at the Clinic for Cardiovascular Diseases, University Clinical Center Tuzla. Patients underwent elective coronary artery bypass heart surgery either with cardiopulmonary bypass (on-pump CABG) or without it (off-pump CABG). The aim of this study was to compare the changes in coagulation tests (APTT, INR) in patients who were operated on-pump and patients operated off-pump. Our study showed that the values of APTT and INR tend to increase immediately after surgery. Twenty-four hours after surgery these values are declining and they are approaching the preoperative values in all observed patients (p <0.05). Comparing APTT between the groups we found that postoperative APTT levels are significantly higher in the group of patients who underwent surgery with cardiopulmonary bypass (p <0.05). Changes in coagulation tests after surgical revascularization of the heart are more pronounced in patients who were operated with on-pump technique compared to patients operated off-pump technique.

tivariate logistic regression analysis using hypertension and coronary artery disease as covariates. However, those covariates do not meet the criteria for confounder’s definition since they are on a causal path between the predictor and the outcome [2] , which means the higher hemoglobin, the higher blood pressure [3] , and the higher hemoglobin, the worse coronary artery disease [4] . Above all, the authors entered in the model all covariates and observed what would come up as the result. Thus, they were testing a prognostic and not an etiological model, so there was no room for the inferences made, but only for the probabilities for the outcomes specified [5] . Dear Editor, I read with great interest the paper published in your journal by Handelman et al. [1] . The authors concluded that the number of excursions below the range appeared to have the most influence on mortality, whereas time below range, area below range, and measures of amplitude have the most effect on hospitalization. They also specified that this variability is linked to outcomes of hospitalization and mortality, with the most impact coming from measures below the target range. However, the observational study design that the authors applied cannot account for such conclusions because it was not a randomized controlled trial to infer causality. The authors performed the epidemiological study instead and applied mulPublished online: February 6, 2014

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

To evaluate the prognostic value of acute fluid collections (AFC) diagnosed by conventional transabdominal ultrasound in the early assessment of severity acute pancreatitis (AP).