Abstract Aim: The study aimed to evaluate the acute effect of ultrafiltration on the mechanical properties of the aorta using brachial-ankle pulse wave velocity (PWV) before and after hemodialysis (HD). Patients and Methods: This study included 80 patients who were on a long-term HD program. The input variables were anamnestic data, body composition monitor (BCM) parameters, and echocardiography findings. The assessment of hydration status was determined by BCM, whose work is based on the principle of multifrequency bioimpedance spectroscopy. Another diagnostic procedure was the use of an arteriograph apparatus to assess PWV and Augmentation Index (AIx). All measurements were performed before and after dialysis on the middle dialysis day of the week. Results: The participants were divided into two groups based on hydration status: the experimental group consisted of 40 overhydrated participants and the control group consisted of 40 normovolemic participants. Statistically, the following BCM parameters correlated significantly positively with PWV: total body fat (r = 0.222; P < 0.05), overhydration (r = 0.290; P < 0.001), and relative overhydration (r = 0.290; P < 0.001). From echocardiography findings, only left atrial diameter correlated statistically significantly positively with PWV (r = 0.359; P < 0.001). Comparison of the mean PWV values within the experimental group before and after HD showed a statistically significant decrease from 14.32 ± 2.34 m/s to 8.72 ± 1.52 m/s (Z = 3.254; P = 0.0001). Mean PWV values within the control group did not decrease significantly from 13.39 ± 1.32 m/s to 10.39 ± 1.18 m/s (Z = 0.524; P = 0.742). If we compare the mean values of PWV between groups, then before HD treatment, there was no statistically significant difference between groups with PWV values in the experimental group of 14.32 ± 2.34 m/s and the control group of 13.39 ± 1.32 m/s (Z = 0.762; P = 0.852). According to the results of univariate regression analysis before and after HD treatment, only overhydration showed an absolute effect on PWV before and after HD. Conclusion: Overhydration showed an effect on brachial-ankle PWV before and after HD, and brachial-ankle PWV should be followed in HD patients.

The use of anticoagulant therapy is a part of the daily work of clinicians and a reason for fear, primarily due to the risk of bleeding. The use of anticoagulant drugs in rheumatology remains a challenge. first, a large number of clinicians consider rheumatic conditions as a hypercoagulable state, which often leads to wrong decisions. second, the use of drugs in the treatment of rheumatic diseases may be associated with an increased risk of venous thromboembolism (vte), and they can have effect on dose of anticoagulant agent. The aim of this paper is to present the properties of anticoagulant therapy through the prism of rheumatological pathology.

BACKGROUND: Prosthetic mechanical valve endocarditis (PVE) can be manifested as early PVE (acquired perioperatively) and late PVE (resulting from infections unrelated to the valve operation). Causes of both are similar but are late PVE are more prone to less virulent microbes. PVE resulting with paravalvular abscess is confirmed through echocardiography (transthoracic or transesophageal), it results with a high mortality rate especially if it is not early recognized. The aim of article was to present a patient with heart failure symptoms caused by PVE. CASE PRESENTATION: Male patient, 44 years old, was admitted because of dyspnea and swelling of lower extremities. The patient is a long-standing heroin addict who had aortic valve replacement done 8 years ago due to endocarditis. The implanted valve was a mechanical aortic valve – Edwards MIRA bi-leaflet valve No 32 (Edwards Lifesciences; Irvine, California). He also was already diagnosed with hepatitis C years before. In multiple occasions were hospitalized on the Department of cardiology due to signs and symptoms of heart failure. On transthoracic echocardiography, dilatation of all heart chambers was found. The left ventricular systolic function was moderately reduced with an ejection fraction of left ventricle of 42% according to Simpson with restrictive filling pattern. Hypoechoic mass along the right side of the mechanical aortic valve was noted measuring 3.57 × 1.03 cm. CONCLUSION: Paravalvular abscess of mechanical heart valves is a very serious complication with a high mortality rate. It is essential to recognize this type of pathology as early as possible, so aggressive parenteral antibiotic therapy could be started, while in many cases, surgical reoperation is needed.

Aim

Aim: The aim of article was to present a patient with heart failure symptoms caused by prosthetic mechanical valve endocarditis. Case presentation : 44-years-old male patient was admitted because of dyspnea and swelling of lower extremities. The patient is a long-standing heroin addict who had an aortic valve replacement done 8 years ago due to endocarditis. The implanted valve was a mechanical aortic valve – Edwards MIRA bi-leaflet valve No 32 (Edwards Lifesciences; Irvine, California). He also was already diagnosed with hepatitis C years before. At admission the patient had heart failure signs with sinus tachycardia on the electrocardiogram. During physical examination

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Abstract Hypertensive syndrome in pregnancy complicates up to 15% of pregnancies, and preeclampsia (PE) occurs in about 3–10% of pregnant women. Inadequate prenatal care is associated with higher mortality from PE, possibly due to reduced monitoring, detection, and missed opportunities for early intervention. The imperative of the clinician’s work is to monitor the symptoms and clinical signs of PE, and stratification of patients in relation to the risk of PE is essential. PE represents a multisystem inflammatory response, and the consequences can be expected in all organs. The question of the effect of PE on long-term maternal health is raised. The aim of the paper is to present the effect of PE on the patient’s health through the prism of low-income countries.

AIM To assess macular and optic nerve head characteristics in patients after kidney transplantation using noninvasive optical coherence tomography (OCT) imaging. METHODS The study had a prospective character and was performed during period from November 2019 to November 2020 at the University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina, and included 59 patients with renal graft who underwent OCT. The obtained OCT images, pathologic changes on the fundus, including macula and optic nerve, were analyzed by reviewing nonparametric measures such as scanning laser ophthalmoscope, B-scan, 3D display, as well as parametric measurements such as central macular thickness, optic nerve head excavation, and retinal nerve thickness fiber (RNFL). RESULTS There is a statistically significant difference in RNFL values (P = 0.031) and cup to disc (P = 0.002) ratio in relation to duration of graft. The highest average values of RNFL was in patients with creatinine clearance <30 mL/min, while average cup to disc ratio was lowest in patients with creatinine clearance >60 mL/min. Optic nerve head edema was bilateral in 9 and unilateral in 5 patients. Fundus examination also revealed changes on posterior segment, including retinal detachment (1 patient), bilateral macular edema (9 patients), unilateral macular edema (3 patients), central serous chorioretinopathy (2 patients), and macular pseudo hole (3 patients). CONCLUSIONS Different retinal pathology is present in high incidence in patients secondary to renal transplant. Immunosuppressive therapy, older age, and comorbidities are the usual causes of these changes.

Objective. To identify the type of the non-invasive ventilatory treatment for patients diagnosed with chronic obstructive pulmonary disease (COPD), with respiratory status deteriorated by COVID-19 pneumonia, and in need of treatment in the Intensive Care Unit (ICU). Materials and Methods. This cross-sectional study was conducted over a one-year period in the medical intensive care units of two hospitals. As the patients’ clinical condition deteriorated and the parameters of the arterial blood gas (ABG) analysis worsened, oxygen support was applied via a high flow nasal cannula (HFNC) or by non-invasive positive pressure ventilation (NPPV). According to the control values of the arterial oxygen saturation (SaO2) and the parameters of ABG, the patients were enabled to be transferred between the two types of non-invasive ventilatory support. The primary outcome was the length of hospital stay, while secondary outcomes were the rate of intubation, the mortality rate, and respiratory support-free days. Results. Out of 21 critical patients with COPD and COVID-19, 11 (52.4%) were initially treated with NPPV and 10 (47.6%) with HFNC. The ages (67±9.79 in NPPV group vs. 70.10±10.25 in HFNC group) and severity of illness (SOFA score 5 (3.5) in NPPV group vs. 5 (2.8) in HFNC group) were similar between the two groups. Switching the mode of respiratory support was more common in NPPV (58.3% in survivor group vs. 41.7% in non-survivor group). Patients treated with NPPV compared to HFNC had a nominally longer length of stay (15 (11) vs. 11.5 (4.25)), and higher risk of intubation (66.7% vs. 33.3%) and mortality (66.7% vs. 33.3%), but the comparisons did not reach statistical significance. Survivors had significantly longer Medical Intensive Care Unit and hospital stays, but significantly lower FiO2 (0.60 vs.1) and higher values of PaO2/FiO2 (78(32.4) vs. 56.3(17.8)) than non-survivors. All patients were treated with corticosteroids, and the duration of treatment was similar between groups. Conclusion. In critically ill patients with COPD and COVID-19, both HFNC and NPPV were commonly used as the initial mode of ventilation. Switching to a different mode and adverse patient outcomes were more frequent in patients initially treated with NPPV. Survivors had higher values of PaO2/FiO2 than non-survivors.

INTRODUCTION Bosnia and Herzegovina (B&H) belongs to the countries of the Western Balkan located in Southeast Europe with an area of 51 129 km. The country is located in the continental part of Europe and extends to the Adriatic Sea. B&H is bordering Croatia in the north, west, and south; in the east, the country is bordered by Serbia, in the southeast by Montenegro, and in the southwest by the Adriatic Sea (Figure 1). According to the 2013 population census, B&H has 3 531 159 inhabitants, which is significantly less than in the 1991 census when the country counted 4 377 033. There are 2 219 220 people living in the Federation of B&H and 1 228 423 in the Republic of Srpska, and 83 880 people live in the Brčko District.

Aim To evaluate the efficacy (rate of recanalization) of therapy with novel oral anticoagulants (NOAC; rivaroxaban, apixaban) compared to conventional treatment (low molecular weight heparin - LMWH and vitamin K antagonist) in the treatment of deep vein thrombosis (DVT) of the proximal segments of lower extremities. Methods The first group consisted of patients diagnosed with DVT and treated with NOAC (n = 100), while the second group consisted of patients diagnosed with DVT, who were treated by conventional treatment (low molecular weight heparin and vitamin K antagonists) (n = 100). In the first group, NOAC was included in the initial treatment. Patients in the second group were treated with LMWH for four days, and on the fifth day vitamin K antagonist was included in therapy, international ratio (INR) was titrated to therapeutic values (2.0-3.0), and then low molecular weight heparin was excluded from the therapy. Results There was a statistically significant difference in the estimated values of free lumen of the blood vessel between the examined groups after 30 days (p=0.0001), after 90 days (p=0.0001) and after 180 days (p=0.0001). After 180 days, the average free lumen values in the NOAC group were 85% (81-89%), which was significantly higher than the free lumen values in the second group, 73% (69-79%). Conclusion The use of NOAC represents more efficient treatment of DVT comparing to vitamin K antagonists.