AIM To evaluate HbA1c level for diabetic type 2 patients after the implementation of guidelines for diabetes mellitus (GDM) in primary health care settings. According to recommendations of the European Society of Cardiology and European Association for the Study of Diabetes, HbA1c ≤ 6.5 % is considered as optimal level. METHODS A retrospective analysis randomly selected medical records of DM type 2 patients who were older than 18 before and after the review. Nineteen Family Medicine Teams (FMT) reviewed every second record (46 per FMT) in the family medicine facilities in Zenica two years prior and after the introduction of the Diabetes Mellitus 2 Guidelines. All noted values of HbA1c and all FMTs have been divided to those which reached an optimal level of HbA1c ≤ 6.5 % and those with an inadequate level (non-optimal level of HbA1c p< 6.5 %). RESULTS Records of 853 patients with type 2 diabetes were analyzed. A total number of HbA1c recorded in the FMT medical records increased significantly after the GDM implementation from 103 (12.1%) to 318 (37.3%). A significant improvement towards an optimal level of HbA1c was noted after the implementation GDM by all FMTs together (7 vs. 92; 6.7% vs. 28.9%; p<0.0001). Only FMT 4 and FMT 14 (2 vs.19; P < 0.05) reached the optimal level of HbA1c. CONCLUSIONS Family medicine teams improved the level of HbA1c according to the recommended guidelines for diabetes mellitus after their application. Quality variations of care extended to diabetics have been noted in individual family medicine teams.

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.

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 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.

The aim of this study was to evaluate the incidence, clinical data and patterns of mediastinal lymph node metastasis (pN2) in non-small-cell lung cancer patients who underwent systematic mediastinal lymph node dissection (SMLND). We retrospectively studied 140 consecutive patients [125 male and 15 female, mean ages 54.61 +/- 9.23 years (range, 21-75)], underwent SMLND and major lung resections due to non-small lung cancer (NSCLC), from January 2005 till December 2009. Preoperative clinical staging for mediastinal lymph node metastasis was negative (cN0) in all patients. SMLND was defined as a complete removal of mediastinal lymph nodes. Clinicalpathological data were compared according to the pN stage. Lymph node metastasis to the mediastinum was confirmed in 13 (9.28%) patients. In squamous cell cancer pN2 were in 8 (5.71%) cases out of 82 cases with cN0. On the other side in the adenocarcinomas pN2 were in 5 (3.57%) cases out of 48 with cN0. Unvaried analysis revealed central tumor site as predictive factor for mediastinal lymph node involvement. The upper mediastinal compartment was infiltrated in 12 (8.57%) cases, middle in 8 (5.71%) and lower in 3 (2.14%) cases. Pneumonectomy was the most performed surgical procedure in pN2 patients. We concluded that SMLND improves pTNM staging in lung cancer patients who underwent major lung resections with central location of the tumour.

The aim of this study was to analyze (i) ratios between pro-inflammatory cytokines interleukin 6 (IL-6), interleukin 1 (IL-1), tumour necrosis factor alpha (TNF-alpha) and anti-inflammatory cytokine interleukin 10 (IL-10) in patients with acute myocardial infarction (AMI) and stable angina pectoris (ii) as well as correlation between IL-6 and IL-10 in AMI and (iii) correlation between IL-6 and lipoproteins in AMI.The total of 71 patients were enrolled in this study, 41 of them with AMI (study group) and 30 with stable angina pectoris (control group). The concentrations of cytokines and lipoproteins were measured from blood samples. Pro-inflammatory to anti-inflammatory cytokine ratios were calculated by dividing concentrations of pro-inflammatory cytokines with IL-10. In statistical analyses we used descriptive statistics, normality tests and analysis of correlation.IL-6: IL-10 ratio is significantly higher in AMI than in stable angina (P < 0,001), TNF-alpha: IL-10 is also higher in study group but the difference is not significant. We found positive linear correlation between IL-6 and IL-10 (r =0,43; p = 0,015) and negative linear correlation between IL-6 and high density lipoprotein HDL (r = -0,47; p= 0,008) in AMI.IL-6: IL-10 ratio is higher in AMI than in stable angina. There is linear correlation between IL-6 and IL-10 and IL-6 and HDL in AMI.

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.

Introduction: Syndrome of difficulties in breathing has an important position in pathology of childhood. It is manifested as in diseases of respiratory tract so in series of diseases and pathological conditions linked to other organs and systems. Patients and Methods: Patient with difficulties in breathing develops clinical presentation of respiratory distress, which is characterized with many different clinical symptoms and signs. Acute respiratory failure with discrepancy between utility of oxygen and produces of carbon dioxide is the last point of respiratory distress, so the primary care of clinician is quickly recognition of abnormal blood gasses values. Early identification and appropriate treatment of incoming respiratory failure is essential for good prognosis and decreasing long term complications. The aim of this paper was to analyze retrospectively histories of diseases of children treated at the Department of Intensive care Pediatrics clinic in Tuzla and to establish type and frequency of diseases characterized with syndrome of difficult breathing, frequency of non-respiratory diseases in etiology of this syndrome, and to estimate correlation of clinical findings in admission with pulse oximetry and blood gases findings. Analysis was based on population of patients treated at the Department of Intensive care unit Pediatrics clinic in Tuzla with recorded, clinically manifested syndrome of difficult breathing. Patient selection was performed consecutively from January 1st till 31st December 2006. All selected patients were from Tuzla Canton. Source of data for this investigation was Admission protocol for Pediatric Clinics and Intensive care unit protocol and personal histories of children treated at the Intensive care unit of Pediatric Clinics January 1st till 31st December 2006. Method of work was retrospective study which analyzed anamnestic data, clinical and laboratory findings, therapeutical procedures and length of hospitalization at the Intensive care unit and outcome of the treatment. Results: The results of investigation demonstrated that in anlized period (from January 1st till 31st December 2006) in Pediatric Clinic, Tuzla a total number of 3932 children were treated, out of them 767 (19.5%) children were treated at the Department of Intensive care unit. Syndrome of difficulties in breathing was recorded in 608 patients (79.3%). The biggest number of children in this group were treated for syndrome of broncho-obstruction, total of 332 children (54.6%). Other large group was neurological disorders: convulsions and epilepsy, total number of 125 patients (20.6%). Out of total number of patients 11 (1.8%) suffered from complete failure of breathing and required mechanical ventilation support. Out of this number 10 of them were chronic ill patients. The most common causal factor for respiratory insufficiency in strict meaning of this word and endangering respiratory arrest was epileptic attack and recidivated pneumonia. Discussion: Clinical findings, pulse oximetry and blood gases analysis were in correlation and in favor of hypoxemic type of respiratory insufficiency. Results of gas analysis for group of neurological disorders and poisoning spoke in favor of acute hypercapnic respiratory insufficiency. Clinical parameters for dyspnea were absent and finding of pulse oximetry monitored isolated for these disorders demonstrated partly unreliable.

INTRODUCTION The prevalence of broncho-obstruction in children is in permanent increase at any age and in global. According to many studies, about 50% of children have at least one episode of broncho-obstruction in the first six years of life. Risk factors for broncho-obstruction in children include not only intrinsic, but a lot of extrinsic factors which could accelerate beginning of early symptoms. Globally, there is increase in first hospitalization with broncho-obstruction and many authors described decrease in rehospitalizations, thanks to therapy improvements. There is evidence of seasonal distribution of children treated for broncho-obstruction. Depending on country and author, different periods of year are related to increased number of patients, which could be explained by seasonal agents. Many studies described geographic variation in incidence and prevalence of respiratory diseases, which could also be explained by seasonal agents. PURPOSE The aim of this paper is to establish frequency of broncho-obstructive syndrome, comparing the age, gender, place of inhabitance and seasonal agents in children treated at the Department of Intensive care at the Pediatrics Clinic in Tuzla trough analysis of their personal histories, clinical, radiography and laboratory findings. METHODS Analysis was based on population of patients treated at the Department for Intensive care of Pediatrics Clinic in Tuzla with broncho-obstructive syndrome, from January 1st to 31st December 2006. All selected patients were from Tuzla Canton. Source of the data for research were Admission protocol for Pediatric Clinics, Intensive care unit protocol and personal histories of children treated. Method of work was retrospective study which analyzed anamnesis' data, clinical, radiography and laboratory findings, therapeutic procedures and length of hospitalization at the Intensive care unit and outcome of the treatment. RESULTS AND DISCUSSION Total number of 767 children were treated during the investigated period at the Intensive care unit. Out of this number 332 children (43,3%) were treated for syndrome of broncho-obstruction. The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was most common at nursing age (40,0%) and 76,5% patients were under age of five. Boys dominated at all age groups except for repeated admissions of school age where this relation was equal. Spatial distribution demonstrated that the highest number of children treated for broncho-obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Season distribution demonstrated that the highest numbers of children were treated in December, and lowest in July and August. Number of treated children was statistically significant higher during winter months. Broncho-obstructive syndrome in 67,5% patients was with radiography confirmed pneumonia and in 13,8% with lung athelectasis. The most common isolated agents were Staphylococcus, Klebsiella and Pseudomonas. CONCLUSION The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was found in 67,5% patients with radiography confirmed pneumonia.

Influence of perinatal complications on serum levels of alpha 1-antitrypsin was investigated in preterms newborns. Investigation was performed on two groups of newborns: first group consisted of 40 preterm newborns (gestation below 37 weeks) with perinatal complications, and second group consisted of 40 newborns without perinatal complications (gestation 37-42 weeks). Values of al-AT in serum preterm newbornswere 1,76+/-0,48 g/l, and in health newborns 1,88+/-0,31 g/l. Statistically significant difference was noted between two investigated serum values (p<0,0008). There was not a statistically significant influence of sex of investigated newborns in serum levels of alpha1-AT. From all investigated perinatal complications (RDS, brain damage, infection, deviation of intrauterine growth, ruptura vela filamentorum, vitium cordis congenita and more complications) variable "infection" has had only statistically significant influence on serum levels alpha1-AT (p< 0,02). T he opinion o f authors of th is investigation is that serum levels of this protein could be usefull in a diagnostic purposes, even if antibiotic treatment was started, and it will be a usefull as an early marker of pure treatment some of diseases.