INTRODUCTION Patients with chronic renal failure treated with hemodialysis represent a high risk group for the development of tuberculosis (TB) in comparison to general population. AIM The aim of the study was to evaluate clinical presentation, biochemical parameters and outcome of tuberculosis in patients attending the Center for Hemodialysis, Sarajevo University Clinical Center. PATIENTS AND METHODS The study conducted during the 2000-2005 period included four patients with tuberculosis that were already treated with chronic hemodialysis. Three of these four patients had pulmonary type and one had extrapulmonary type (bone type) of tuberculosis diagnosed by bone biopsy. Miliary TB diagnosis was verified with radiographic lung imaging and appropriate bacteriologic and biochemistry tests. RESULTS The mean age of the study patients was 66.5 +/- 59.6 years and mean hemodialysis duration 6.7 +/- 4.5 years. During the study period, we diagnosed four cases of active tuberculosis in 200 patients receiving hemodialysis therapy (2%). Tuberculin test was performed in all four patients and was negative. Clinical presentation was predominated by inappetence, feebleness and elevated body temperature. Biochemical tests revealed anemia (Htc 0.25 +/- 0.15), hypoalbuminemia (36.0 +/- 28.5) and extremely raised sedimentation raste (86 +/- 30). Increased transaminases were present in two of four patients; the culture of Mycobacterium tuberculosis was found in patients with pulmonary type of TB. Radiographic tests revealed miliary changes in two patients and pleural effusion in one patient. All patients were administered tuberculostatic drugs and six-month treatment resulted in full recovery. CONCLUSION Negative PPD test does not exclude the occurrence of TB in hemodialysis patients and the existence of pulmonary infiltrate and pleural effusion on radiographic chest images suggests the presence of the TB.

Interleukin 1 (IL-1) contains two proteins, which are the products of distinct genes, but which recognize the same cell surface receptors. In the liver, IL-1 initiates the acute phase response resulting in an increase in hepatic protein synthesis and decreased albumin production IL-1 also plays an important role in immune functions, having effects on macrophages/monocytes, T lymphocytes, B lymphocytes, NK cells, and LAK cells. Interleukin-6 (IL-6) is a cytokine that regulates immune responses. We analyzed total 160 serum specimens of patients from Clinical Center University of Sarajevo with different inflammatory diseases by ELISA method on interleukins: IL-1alfa and IL-6. Tests that we performed with IL-lalfa and IL-6 by ELISA method confirmed that serum specimens with IL-6 ELISA showed increased values of tested specimens, than the lowest standard and blank. We had average levels of IL-1alfa 3.7 pg/ml which was below the level of the lowest standard. All obtained results were in accordance with the results in IBL protocol for blank and lowest standard values, as well as the average levels of serum specimen values.

Botulinum neurotoxin (BoNT) is produced by Clostridium botulinum as a complex of proteins containing the neurotoxin itself and other nontoxic proteins. Activation of the neurotoxin occurs upon proteolytic cleavage into the heavy and light chains. This di-chain moiety is essential for neurotoxin and each chain is playing a unique role; the heavy chain mediates neurospecifics cell binding and entry, whereas the light chain, a protease, catalyzes the cleavage and inactivation of neuronal proteins that mediate neurotransmitter release. There are seven BoNT serotypes (A,B,CI,D,E,F, and G), all of which inhibit acetylcholine release, though their intracellular target proteins, the characteristics of their actions, and their potencies vary substantially. BoNT type A has been the most widely studied and applied serotype for therapeutic purposes. It has been a mainstay in the treatment of cervical dystonia, blepharospasm, and hemifacial spasm for years. BoNT has more recently emerged as an increasingly important therapeutic option in the clinical management of a broad array of conditions, including other focal dystonias, spasticity, cerebral palsy, equinovarus, gastrointestinal (GI) and urogenital disorders, hypersecretory disorders, facial lines due to hyperfunctional facial muscles and recently, musculoskeletal pain disorders and headache.

Patients with either type 1 or type 2 diabetes mellitus (DM) carry a risk of developing chronic diabetic complications. The aim of the study was to establish the prevalence of diabetic neuropathy in 300 patients with type 1 and 2 diabetes evaluated at two time points 5 years apart. The study included 300 patients with clinically diagnosed and laboratory verified diabetes. Initial examination, questionnaire and laboratory testing were performed in all patients in 1999 (type 1 diabetes 62 patients and type 2 diabetes 238 patients). Final examination, questionnaire and laboratory testing were performed in 2004 in 278 patients (type 1 diabetes 58 (20.9%) patients and type 2 diabetes 220 (79.1%) patients). Additional history taken on 2004 examination placed two female patients previously classified as type 2 diabetes to another specific diabetes type group. Twenty patients died in the period between March 31, 2000 and final examination taken on February 1, 2004. In 1999, 51.1% of patients had diabetic neuropathy; in 2004, symptoms and signs of diabetic polyneuropathy were recorded in 84.2% of the same diabetic population. The increase in the number of patients with diabetic neuropathy recorded during the 5-year period was statistically significant. The average duration of diabetes was 13 years at initial examination and 18 years at final examination. In conclusion, diabetic neuropathy was significantly more common in 2004 than in 1999 in the same group of patients (p<0.01). The risk of developing diabetic neuropathy increased with longer duration of diabetes (p<0.05). Therefore, a more aggressive approach is necessary in the treatment of our diabetic patients, including education, physical activity and use of appropriate medication.

Concentration of serum cystatine C primarly dependes on the glomerular filtration rate (GFR), and cystatin C concentration in serum can be used as an endogenous marker of kidney function. Use of cystatin C in the assesment of GFR in elderely, childern and pre dialysis patients could be usful. The aim of the study was to evaluate the use of cystatin C as a renal marker of the glomerular filtration rate (GFR) in patients with various degrees of kidney failure. The study icluded the total of 104 patients (various etiology of kidney disease) with different degrees of kidney failure. All of them were on conservative tretmant and 10 healtly patients will comprised the control group. Mean values of cystatin C and creatinine in serum hes been measured and compared to endogeneus cretainine clearense. There were 104 patients testid in total with various etiology of kidney disease. Mean age of patients receiving conservative treatment was 68, 4 ± 5, 06 years and controls 69 ± 3, 66 years. Significant correlation have established between creatinine clearence and creatinine r = 0, 663 p < 0, 001, and between creatinine clearence and cystatin C r = 0, 765, p < 0, 001 in patients will different degrees of chronic kidney failure (CKF). Correlation between creatinine clearence and cystatin C was significantly better than between serum creatinine p < 0, 05. According to results from our study the level of cystatin C in serum is better marker of kidney function than the level of creatinine in serum. Hering in mind that this is faster and cheaper method it could find wider application in every day clinical practtise, especially in elderly where is often impossible to accurately collect 24 hour urine (inconontinence)

Prevalence of arterial hypertension increases with the advancement of chronic renal failure (CRF). In terminal stage of CRF arterial hypertension is present in 80-90% of patients. Cardiovascular and cerebrovascular diseases are the most frequent cause of death in patients on hemodialysis. Cardiovascular mortality rate is three to twenty times higher in patients on hemodialysis compared to general population. In the beginning of the treatment with hemodialysis blood pressure lowers in certain number of patients who had used three, four or more blood pressure lowering medications during the pre-dialysis period.

INTRODUCTION The prevalence of MRSA (Methicillin Resistant Staphylococcus Aureus) in haemodialysis patients has increased dramatically during recent years. The aim of our study is to determine the prevalence of MRSA colonization among haemodialysis patients and medical staff. MATERIAL AND METHODS This prospective study included 235 patients undergoing haemodialysis therapy and 60 medical staff members, in the Center for Haemodialysis Sarajevo. Nasal and throat samples were taken (identification of MRSA was performed using standard microbiological methods). A total of 474 nasal and throat cultures from patients' samples and 120 cultures from medical staff samples were obtained. RESULTS AND DISCUSSION The total number of sampled patients was 235 and colonies were found in 36 of the samples (15.3%). Among medical staff nasal carriage rate of MRSA was 11.6% (7/60). The mean age of haemodialysis patients with MRSA was 52.94:1:5.3. The patients aged between 55 and 64 had the highest prevalence of MRSA (11/36, 30.55%). Those aged 45-54 had the next highest prevalence of nasal carriage (10/36, 27.77%). Patients aged 65 years had middle prevalence of MRSA (6/36, 8.33%). Patients aged 25-34 had the lowest prevalence of nasal carriage. We did not have possibilities to isolate MRSA positive dialysis patients, and we used intensive antibacterial prophylaxis. We treated our patients with mupirocin ointment (three times a day for 5-14 days) and gained decolonization in 34 patients (94.4%). In the treatment period, positive medical staff did not come to work. CONCLUSION The overall prevalence of MRSA colonization in our dialysis patients was higher (15.3%). Implementation of adequate strategies for prevention of MRSA with application of mupirocin among carriers, reduced prevalence of MRSA in our dialysis units.

Neuropathic pain is result of damage or dysfunction of periphery or central nervous system. There is no adequate adaptation and produce suffering without biological helpfulness. The aim of treatment of patient with neuropathic pain is soothing of pain and suffering and prevention of further development of pathological process. Periphery mechanisms of neuropathic pain include hyperexcitability of cell membrane and periphery sensibilization. Central mechanism includes central sensibilization, central reorganization of alphabeta fibers and loss of inhibition mechanisms. The main symptoms of neuropathic pain are described as lancinating, stabbing, or shooting pain. Hyperalgesia and allodynia are special kind of neuropathic pain that is provoked by mechanic or thermal stimuli. Mononeuropathy, plexopathy, radiculopathy, and myelopathy, lesions of thymus, cortex or brain stem are real cause of neuropathic pain. In the treatment of neuropathic pain drug such as opioid, nonsteroid antirheumatics, analgetics, tricyclic antidepressant and antiepileptic are used. The most successful treatment is with antiepileptic drugs of second generation. Carbamazepin was the drug of choice till ten years ago. Since then the leader position in treatment has belong to gabapentin in dose from 900-2400 mg daily. Currently the new drug is tested, antiepileptic pregabaline. The first experiences are promising.

Data from the World Health Organization show that there is an increase in the morbidity and mortality caused by ischemic coronary disease. Diabetes has been confirmed as an independent risk factor in the development of coronary disease. The aim of this study was to determine the effect and role of diabetes mellitus in patients suffering from acute myocardial infarction (AMI). The study included 506 patients treated for AMI at Department of Medicine, Cantonal Hospital in Zenica during 1991, 1993 and 1996. In total, there were 94 diabetic patients with AMI: 36 in 1991; 31 in 1993; and 27 in 1996. In the same years, 412 nondiabetic patients were treated for AMI: 127 in 1991; 143 in 1993; and 142 in 1996. The percentage of patients with AMI was significantly higher in the group of diabetics than in nondiabetics (p<0.01). The percentage of women with AMI was significantly higher among diabetics than among nondiabetics in all three study years (1991 and 1993, p<0.01; 1996, p<0.05). Among nondiabetics, the percentage of AMI was significantly higher in men as compared with women in all three study years (p<0.001). The percentage of diabetics with AMI did not change significantly among the three study years.

Neuropathic pain is result of damage or dysfunction of periphery or central nervous system. There is no adequate adaptation and produce suffering without biological helpfulness. The aim of treatment of patient with neuropathic pain is soothing of pain and suffering and prevention of further development of pathological process. Periphery mechanisms of neuropathic pain include hyperexcitability of cell membrane and periphery sensibilization. Central mechanism includes central sensibilization, central reorganization of alphabeta fibers and loss of inhibition mechanisms. The main symptoms of neuropathic pain are described as lancinating, stabbing, or shooting pain. Hyperalgesia and allodynia are special kind of neuropathic pain that is provoked by mechanic or thermal stimuli. Mononeuropathy, plexopathy, radiculopathy, and myelopathy, lesions of thymus, cortex or brain stem are real cause of neuropathic pain. In the treatment of neuropathic pain drug such as opioid, nonsteroid antirheumatics, analgetics, tricyclic antidepressant and antiepileptic are used. The most successful treatment is with antiepileptic drugs of second generation. Carbamazepin was the drug of choice till ten years ago. Since then the leader position in treatment has belong to gabapentin in dose from 900-2400 mg daily. Currently the new drug is tested, antiepileptic pregabaline. The first experiences are promising.

INTRODUCTION Recent studies show that psychological status of HD patients has been changed in terms of an increased score of the called neurotic triad: hypochondria, depression and hysteria. The aim of this study was to evaluate the correlation between the development of psychopathological tendencies in HD patients and the demographic features such as: gender, age, marital status, education level, employment status and HD duration. MATERIAL AND METHODS There were 56 patients on HD. Depending on registered psychopathological tendencies, we compared patients according to the mentioned demographical characteristics. We applied MMPI 201. Previously, all patients were psychologically examined by explorative interview regarding demographical data and the pre-dialysis psychological status. To compare categorical variations, we use 6 multivariant analysis of variance. A p value of <0.5 was considered to be statistically significant. RESULTS The overall profile of psychopathological tendencies of HD patients indicates increase of scores on neurotic triad. Female patients showed significantly higher level of psychosteny than male patients (FPt=4.86, p<0.05): singles showed significantly higher scores on some psychotic subscales--paranoia, schizophrenia, mania--in relation to the group of married patients (FPa=7.21, FSc=6.84, FMa=5.35, p<0.05): patients with only primary school have significantly more expressive paranoia in relation to patients with university education (FPa=3.80, p<0.05); unemployed patients have significantly more expressed paranoia and tendencies to emphasize pathology in relation to employed patients (FF=5.13, FPa=5.94, p<0.05). CONCLUSION Depression could be taken as a a primary psychiatric complication associated with life on haemodialysis. Gender, marital status, education level and employment status significantly influence the differences in occurrences of psychopathological tendencies in HD patients.

INTRODUCTION Central venous catheters (CVC) have become and indispensable form of haemodialysis access and represent, in our centre, about 8,58 % of the permanent vascular access with a total number of more than 957 venous catheters in the past 8 years. We used double-lumen catheters. METHODS The aim of this study was to identify the factors of the catheter dysfunction. We studied prospectively 23 chronic haemodialysed patients with CVC, 14 men and 9 women 63 +/- 14 (51-83), treated with haemodialysis for 3.7 +/- 4 (1-9) years. Catheters were inserted by percutaneous Seldinger techniques in right internal jugular vein. We studied the localization of the catheter tip: superior vena cava, right atrium, the blood pressure before and after haemodialysis, the interdialytic weight gain, and number of symptomatic episodes during 13 last dialysis (one month). The patients were divided into two groups: group I with usual adequate catheter function (n=17) and group II with frequent dysfunction (n=6). RESULTS In group I the catheters tip was in the right atrium, and in group II in the vena cava superior. Blood pressure was not different between the two groups. We found no correlation between central venous pressure, blood pressure, interdialytic weight gain and symptomatic hypotension, but there was a higher frequency of hypotension in the hypovolemic patients. CONCLUSIONS Optimal hemodynamic conditions will be provided by a catheters tip in the rights atrium and a central venous pressure over 5 mmHg, which can be provided with vascular filling or dry body weight.

INTRODUCTION Balkan Endemic Nephropathy (BEN) is still dominant cause of the end stage renal disease (ESRD) in North-Eastern Bosnia. The aim of this paper was to analyze the patients with BEN diagnosis on chronic dialysis treatment in Bosnia and Herzegovina. METHODS In this study we used data from individual questionnaires which we collected for Renal Registry. Individual questionnaires include: sex, age, place of birth and address, primary renal disease, data of the first dialysis treatment, type of dialysis, kidney transplantation, co-morbid diseases, erythropoietin therapy and outcome. For patients with BEN diagnosis we gathered additional data: history of urothelial tumor and family history of similar kidney diseases and renal replacement therapy. We compared these data with data about others dialysis patients in Bosnia and Herzegovina. STATISTICAL ANALYSIS descriptive statistical analysis. RESULTS Prevalence of the chronic dialysis patients in Bosnia and Herzegovina in 2003 was 474 pmp, 70 pmp for patients with BEN and 54 pmp for patients with diabetic nephropathy. In North-Eastern Bosnia prevalence of chronic dialysis patients was 844 and of patients with BEN 520 pmp. Incidence of the new chronic dialysis patients in Bosnia and Herzegovina in 2003 was 113 pmp, 11 pmp for BEN, and 19 pmp for diabetic nephropathy. Mortality of the chronic dialysis patients in Bosnia and Herzegovina in 2003 was 11.24 %, and mortality of the BEN patients 10.75 %. CONCLUSION From the total number of the chronic dialysis patients in Bosnia and Herzegovina 14.7 % are BEN patients and 11.3 % are patients with diabetes. BEN is still big medical and social problem in Bosnia and Herzegovina, especially in the North-Eastern Bosnia. There are certain indicators that the incidence of the BEN patients is in decrease such as decreased difference between the prevalence of the patients with BEN and diabetic nephropathy; as well as increase of average age of patients with BEN.

Disturbances in mineral and bone metabolism are common in patients with chronic kidney disease (CKD). Patients with CKD almost always develop secondary hyperplasia of the parathyroid glands, resulting in elevated blood levels of parathyroid hormone (PTH). The processes causing disordered mineral metabolism and bone disease have their onset in the early stages of CKD, continue throughout the course of progressive loss of kidney function and may be influenced beneficially or adversely by various therapeutic approaches used. It is should be emphasized that the care of CKD patients with bone disease requires frequent assessment of the various parameters (levels of calcium, phosphorus, vitamin D, PTH) and frequent evaluation of the therapies.

Objectives  Hepatitis C virus (HCV) infection is spread worldwide with significant geographical differences in the prevalence and genotypes. The aim of this study was to analyse HCV infection in hemodialysis (HD) units in Bosnia and Herzegovina (BH), through genotypes and routes of transmission. Design and Methods  We analysed data from Renal Registry of BH for the years 2002 and 2003 in order to estimate prevalence and incidence of anti-HCV positive patients in 23 HD units in BH (ELISA III). Then we tested 88 anti-HCV positive patients from Tuzla for HCV RNA using reverse transcription polymerase chain reaction (Amplicor Roche diagnostic commercial test) and genotype with method of reverse hibridization of amplified sample material (Innolipa HCV II commercial test). Results  In 2002 we registered a prevalence of 39.1 and an incidence of 3.1% of anti-HCV positive HD patients in 23 HD units, and in 2003 a prevalence of 29.3 and an incidence of 2.04% in 24 HD units. Prevalence of anti-HCV positive patients was significantly different in HD units, from 14.3 to 69.1%. From 88 tested anti-HCV positive HD patients in Tuzla HD unit, we found 76 HCV RNA positive patients (87.36%). The genotype of HCV was analysed in 59 of these patients and we found, unusual for Europe, genotype 4 in 37 (62.7%), genotype 1b in 17 (28.8%) and 1a in five patients (8.5%). A total of 61% of seroconversions happened in 1999, 2000 and 2001. In 2001, we separated dialysis machines for anti-HCV positive and anti-HCV negative patients, and in 2003 we had nine seroconversions (genotype 4 in five patients). These patients had no blood transfusions. Conclusions  Prevalence and incidence of anti-HCV positive hemodialysis patients is still high in BH and origin of genotype 4 HCV is not clear. Nosocomial spreading of HCV plays a significant and probably the most important role in transmission of HCV in HD units.