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.

Introduction  Uremia is associated with different endocrinologic abnormalities, which in some cases induce polyendocrinopathia. Female patients on dialysis are often subject to menstrual disorders that are variously manifested. The aim of our paper is to evaluate the etiology of menstrual dysfunctions in female dialysis patients. Material and methods  Anamnesis, clinical and hormonal tests were performed on 25 female patients that were in chronic dialysis programs 4 hours, 3 times per week. Oligomenorrhea is considered as menstrual interval between 35 and 90 days and amenorrhea as cease of menstruation in the last six months. Results All patients had had normal menstrual cycles before the dialysis. Mean age of patients was 42.7 ± 9.96 years and mean dialysis duration was 75.5 ± 62.41 months. Out of the 25 patients, 10 developed amenorrhea when beginning dialysis and 5 of them regained regular menstrual cycle after one year. Seven patients had oligomenorrhea and 8 patients had an early menopause. Prolactin concentration was significantly higher in the group which developed menopause (N = 8), cpr = 1222.3 ± 1013.4, amenorrhea (942.2 ± 1061.2), oligomenorrhea (860.4 ± 897.2), compared to the group with a regular menstruation cycle (444.8 ± 299.7). The luteinizing hormone (LH) level in serum was increased in all groups. FSH was insignificantly higher in groups with oligomenorrhea and amenorrhea and amounted to 51.1 ± 69.9, while β-estradiol and progesterone were in normal ranges. Hemodialysis duration influenced the prolactin level and after one year of follow up prolactin level significantly decreased in the group with amenorrhea that regained regular menstruation (cpr = 596.2 ± 297.2). Conclusion  Different menstrual disorders are developed in dialyzed patients. Hyper prolactinemia was present in our dialysis population. Significant lowering of prolactin level in 20% of patients led to normalization of menstrual cycle.

GOAL The patients with the chronical programm for haemodialisys have the higher risk from getting ill virus hepatitis C in the realtion to the rest population. AIM OF THE WORK Was the evaluation of the prevalence and incidence of hepatitis C at the Center for Haemodialisys CCU Sarajevo and the effect of the prevalentive measures on the incidence of the serum conversion of hepatitis C, in the period from 2002 till 2004 year. MATERIAL AND METHOD By the examening is comprehended 155 patients aged 54,58 +/- 14,797 years, with the aproximative length of the haemodialisys 58,9 +/- 53,9 months. Patients at the chronic programm of the bicarbonite haemodialisys taree times per week, and antibodies on the hepatitis C were determined III generation. Also was determined PCR. RESULTS During the periiod of examination the dialized population was increased also 2002 year the prevalence of hepatitis C was 23,87% (37/155), in 2003 year 29,29% (46/157) and 2004 year the pregalence amounted 26,28% (46/175). Incidence of hepatitis C was significantly decreased in the course of the period of followup and in 2002 year was 16,21%, in 2003 year 13,04%, that in 2004 year would amount 4,34%, that is only in two patients occurred the serum conversion on hepatitis C. CONCLUSION By applying of the corresponding protocoles and their strict realization (desinfection of the hands, wearing of gloves, apparatus desinfection) and separation of the dialyzed monitors for anti HCV positive and anti HCV negative patients dicreased significantly the hepatitis C incidence in our dialyzed population. The strict application of the preventive measures can completely prevent the speading occurrence of hepatitis C on haemodialisys.

INTRODUCTION Vascular access failure remains a significant problem in haemodialysis. Complications of dialysis access represent major cause of morbidity in dialysis patients. The aim of our study was to correlate the AV-fistula adequacy with clinical and demographic factors. MATERIAL AND METHODS The survey encompassed 40 patients followed up in one-year period. AV-fistula adequacy was graded if the blood flow rate was higher or equal to 300 ml/ min. AV-fistula adequacy was correlated with clinical and demographic factors. Following data were gathered: age, gender, diabetic status, body mass index (BMI), serum parathyroid hormone (PTH), and serum albumin. RESULTS The study included 40 patients (25 males and 15 females), average age of 46.3 +/- 12.65 years and haemodialysis duration of 3.16 +/- 2.39 years. 40% of AV-fistulas were created in patients older then 65 years. Diabetes was present in 30% of patients. 45% of patients were overweighed (BMI > or = 27 kg/m2). The mean concentration of intact PTH was 418.867 +/- 320.44. Serum PTH was higher then 500 pg/mol in 35% of patients. The mean serum albumin concentration was 40.129 +/- 3.509 g/l. AV-fistula adequacy was lower in older patients (age > or = 65) then in younger patients (age < 65). The difference in AV fistula adequacy between patients with BMI > or = 27 kg/m2 was statistically highly significant (p < 0.001). Lower overweighed patients had better AV-fistula adequacy. Serum albumin, as well as the PTH level did not influence AV-fistula adequacy, while age and BMI significantly correlated with AV-fistula adequacy. CONCLUSION Predictors of AV-fistula malfunction in our dialysis population were age, diabetes and overweight, while other clinical and demographical factors did not influence AV-fistula adequacy.

INTRODUCTION Patients suffering from chronic kidney failure and patients on haemodialysis are characterized with numerous biochemical abnormalities, including hyperlipidemia. Hyperlipidemia is one of the risk factors that contribute to increased incidence of cardiovascular diseases among haemodialysed patients. The aim of our paper is to evaluate high flux effect in patients on haemodialysis. MATERIAL AND METHODS 49 patients receiving dialysis treatment were included in this study (28 males and 21 females). 28 patients were on high flux (13M/15F) and 21 on low flux (8M/13F). All of them were followed up for one year. Lipid profile included testing of cholesterol, T6, VLDL, LDL, HDL, HDLC and atenogenic index. RESULTS Mean age of our dialysed population (N=49) is 56.8+/-10.1 years and mean dialysis duration is 3.7+/-1.26 years. Mean cholesterol level in patients on high flux was 5.42+/-1.26 at the beginning of the study. Female patients (N=15) showed significant decrease of cholesterol level (5.80+/-1.20), which after one year was 5.11+/-1.28, p<0.05. In 21 patients on low flux cholesterol was in normal range (4.72+/-0.94). Triglyceride (T6) level was significantly higher in female (3.13+/-1.33) on low flux than in males (2.35+/-1.25). Female patients have also shown a significant decrease of T6 level (2.31+/-1.33) at the end of the study. In 21 patients on low flux, mean values of T6 were 2.24+/-1.18 and there was no significant T6 decrease (2.51+/-1.20). HDL fraction of lipoproteins was lowered in both groups (0.188+/-0.074); HDL normalized in high flux group (0.2863+/-0.2394). Atenogenic index was significantly higher in low flux group (3.247+/-2.025) compared to high flux group. CONCLUSION Our dialyzed population showed an improvement of T6 level in patients that were on high flux. Female patients showed significant improvement in comparison to patients receiving conventional dialysis treatment. The mechanism responsible for different lipid profiles in dialyzed patients, with special emphasis on gender, should be explored further.

AIM Aim of the research was to analyze clinical characteristics and most important risk factors of uremic pruritus. PATIENTS AND METHODS A total of 151 patients on chronic hemodialysis (CHD) during at least 12 months were analyzed. Thorough history was taken for pruritus, its presence and localization, sleep disorder and neuropathic symptoms. On physical examination, attention was focused on the skin. Laboratory tests includes blood cells count, serum urea, creatinine, electrolytes, aminotransferases, alkaline phosphatase and proteins. The dose of dialysis was followed by Kt/V. On statistical analysis, t-test and chi2 test were used. RESULTS Pruritus was present in 85 (56%) patients, 41 women and 44 men, mean age 53.56+/-13.36 (26-81) years, mean time on CHD 78.36+/-55.02 (12-268) months. There were 66 (44%) patients without pruritus, 32 women and 34 men, mean age 50.35+/-13.76 (22-73) years, on CHD for 58.64+/-50.40 (12-187) months. Although the patients with pruritus were somewhat older and longer on CHD, there was no significant difference either in sex structure or distribution according to primary renal disease. In the group with pruritus there were significantly more anuric patients (43 vs. 22) (p<0.01). The patients with pruritus had a higher rate of sleep disorder (NS), calcium deposits in soft tissues and blood vessels (NS) and clinical neuropathy (p<0.01). Skin changes were found in almost all patients with pruritus (93%), which differed significantly from the patients without pruritus (48%) (p<0.005). The mean value of Kt/V was 1.23+/-0.35 in patients with pruritus, and 1.34+/-0.41 in those without pruritus (NS). Kt/V higher than 1.4 was significantly less frequently recorded in patients with pruritus than in those without pruritus (55%) (p<0.005). The red cell and white cells count, serum hemoglobin, calcium, phosphorus and their products, aminotransferases, bilirubin, alkaline phosphatase and proteins were approximately the same in both groups of patients. CONCLUSION The loss of residual renal diuresis, Kt/V below 1.4, presence of calcium deposits and neuropathy were the most common risk factors for the extent of uremic pruritus in our CHD patients.

INTRODUCTION Correction of anemia in haemodialysed patients by recombinant human erythropoetin (R-Hu Epo) has been reported to improve sexual functions and hormonal disturbances. The purpose of this study was to evaluate how levels of sexual hormones and sexual function differ before and during a 12 month R-Hu Epo therapy. MATERIALS AND METHODS Thirty six male patients, mean age 47.5 +/- 12.78 and thirty six female patients, mean age 53.0 +/- 10.14, were included in this study. All patients were dialyzed 3 times per week with haemodialysis mean duration of 4.56 +/- 3.84 years. In order to evaluate sexual activities, the questionnaire was presented to all patients. The levels of prolactin, testosterone, FSH, LH were measured at the beginning of the study and every forth month during the study. RESULTS During twelve month therapy with Epo, serum hemoglobin significantly increased from 96.0 +/- 13.3 g/dl to 104.0 +/- 17.2 g/dl (p < 0.005), and hematocrit value rose from 0.284 +/- 0.046% to 0.308 +/- 0.052% (p < 0.05). Prolactin was not significantly decreased: at the beginning of the study was 540.3 +/- 302.2 and at the end 537.4 +/- 297.1 microIU/ml. Testosterone concentrations were in normal range in male patients (18.26 +/- 8.61 microIU/ml). There was significant difference in value of LH in female patients which increased from 57.68 +/- 62.58 to 73.79 +/- 68.52 IU/L. Improvement of sexual function was remarkable in female patients. In male patients sexual desire, frequency of sexual intercourse was strengthen after R-Hu epo therapy. CONCLUSION Better sexual functions in our patients after treatment with R-Hu Epo did not correlate with hormonal disturbances except changes of LH that increased at the end of the therapy.

– Stroke is the leading cause of mortality and the main cause of disability in adults in Europe. According to the American Heart Association, “the profile of apoplectic personality is determined by systolic blood pressure greater than 160 mm Hg, diastolic blood pressure higher than 95 mm Hg, family history of cardiovascular diseases, hypercholesterolemia, smoking, alcohol abuse and diabetes mellitus”. The aim of this retrospective study was to assess the correlation between early and late epileptic seizures during and after stroke, and some heart diseases associated with hypertension. Ten-year records (January 1, 1989 till December 31, 1998) of the University Department of Neurology, Sarajevo University Clinical Center, were examined. There were 7001 stroke patients (53.6% with cerebral thrombosis, 17.35% with embolic etiology, 21.96% with intracerebral hemorrhage, and 1.17% with subarachnoid hemorrhage), with a 3.38% incidence of symptomatic epileptic seizures. The following cardiac diseases were considered relevant for the study purpose: absolute arrhythmia, subdecompensated heart state, well treated cardiac decompensation, angina pectoris, postmyocardial infarction state, and extrasystoles. Results revealed a statistically significant difference in the correlation with cardiac diseases between patients with early and late epileptic seizures. The patients with early epileptic fits had severe heart problems compared to those with late seizures. The former suffered from angina pectoris, heart decompensation and chronic subdecompensated state, yielding a ratio of 1.1 to 0.6. There was no statistically significant difference between the groups according to absolute arrhythmia. Study results suggested the patients with cerebrovascular disease and early epileptic fits to have a significantly higher rate of heart problems compared to stroke patients with late epileptic fits, in whom the morphological changes of the brain appeared neurophysiologically to act as an epileptogenic focus.

Renal replacement therapy (RRT) had been establishedin Bosnia and Herzegovina before the war in 1992–1995.During the war, the activity of the dialysis centres couldonly continue because of donations of supply providedby Medicine Du Monde and the European Union [1].Since 1997, the expenses of dialysis treatment are againmet by the government of Bosnia and Herzegovina.In 1997, the Society of Nephrology, Dialysis andTransplantation of Bosnia Herzegovina was foundedand continues to receive organizational and financialhelp from Medicine Du Monde. In 1999, the societyfounded the renal registry of Bosnia and Herzegovina.Complete data reporting was achieved in 2001, coveringall 20 dialysis centres in Bosnia Herzegovina, with areturn rate of 100%. In the following, we report some ofthe data concerning this part of Europe, which continuesto struggle with political and economical difficulties.The data were obtained using a questionnaire andcovering the years 2000 and 2001. We asked for detailsconcerning the centre (premises, equipment, number ofstaff, type of water treatment), the number and charac-teristics of patients (age, gender, primary renal disease,type of renal replacement therapy, mortality, transplan-tation). We respected the ‘rule of 90 days’, i.e. we inclu-ded only patients who had been on dialysis treatment formore than 3 months [2].

INTRODUCTION Patients on hemodialysis belong to a high risk group of patients that are exposed to viral hepatitis. The aim of the study was to evaluate the prevalence and incidence of HCV infection seroconversion in this high risk group of patients. PATIENTS AND METHODS Patients were followed up from January 1997 until January 2002. During this five-year period, the dialysis population increased. There were 99 patients (58 m/41 f) in January 1997, 43 of them seropositive. Out of 186 patients recorded in January 2002, 44 had anti-HCV antibodies. The following parameters were recorded: sex, age, hemodialysis duration, number of blood transfusions, and hepatitis markers. HCV antibodies were determined by third--generation ELISA method (Behring). RESULTS The study included 164 patients (75 f/92 m), mean age 47.2 +/- 4.2 years, and mean hemodialysis duration 6.2 +/- 4.2 years. In January 1997, HCV antibodies were detected in 43/99 patients with a prevalence of 43.51%. During five-year follow-up, the highest prevalence of hepatitis C was 44% in 1998, with an extremely high incidence of 40% (8 patients became seropositive). In the first three years of the follow-up, the number of blood transfusions and duration of hemodialysis were the main risk factors for HCV transmission. The mean length of hemodialysis of seropositive patients was 6.92 +/- 4.23 in seropositive patients and 2.44 +/- 1.82 in seronegative patients (p < 0.001). Anti-HCV positive patients received significantly more blood transfusions (8.2 +/- 4.36) as compared to seronegative patients. Upon the introduction of preventive measures in 2000 and 2001, which included strict disinfection of monitors and working surfaces, connecting anti-HCV positive and anti-HCV negative patients to different machines, and use of erythropoietin, the incidence rate decreased, and in January 2002, it was 11% with a prevalence of 25%. CONCLUSION HCV infection is frequent among hemodialysis patients. The number of blood transfusions and duration of hemodialysis as well as sharing the same dialysis machines were the main risk factors of transmission of HCV infection. The use of erythropoietin and preventive measures, along with the use of appropriate protocols and separation of HCV positive from HCV negative patients led to a decrease in the prevalence and incidence of hepatitis C in our hemodialysis population.

The epileptic seizures occur as the consequence of THE cerebrovascular insult. The morphologic changes at the brain after cerebrovascular insult are responsible for its occurrence. The pathophysioloogic basis of the late epileptic manifestations (after the second week after CVI) are the epyleptic activities of the morphological brain changes which behave according to the type of the "epileptogene focus". The epileptic seizures which occur during CVI are the result of the moleculary changes which occur in ischemia as the primary, and in haemohagia as secondary ones. The aim of our paper is to see the therapeutic aspects of the early and late epileptic seizures during and after cerebrovascular insult. In the course of the retrospective processed treatment of the patients at our clinic, and in the ten years period (01.01.1989-31.12.1998), we treated 7001 patients with the various types and subtypes of CVI. The incidence of the epileptic seizure moved from 0.65% (1994) till 3.14% (1998). In our sample we had 111 patients with late epileptic seizures, and 56 patients with early epileptic seizures. The early epileptic seizures in most cases were treated by Diazemap intravenously, while in the group of the patients with late seizures, most frequently we applied Fenobarbiton, and later diazepam intravenously. After the seizures and admission at the Clinic and in the future treatment most often we recommended and gave diazemap, phenobarbiton and karabo zepine. The therapeutic effects of the applied therapy were statistically significant. It is significant that there were more patients of the applied therapy statistically significantly. It is significant that there were more patients had no later seizures or of whose the seizures were more rarely (Hi2 = 14.209, n = 2, p < 0.01). On the basis of our research we can conclude that the therapeutic principle of the symptomatic epileptic seizures during and after cerebrovascular insult is the principle of the MONOTHERAPY. On the basis of our material we came to the conclusion that kabazepin optimally antiepileptic for this group of symptomatic epileptic seizures.

INTRODUCTION Glomerular diseases are hybrid group, mostly immunologically related kidney diseases where pathologic changes start in glomerules, but afterwards within their further process they grasp the other kidney structures. The most common clinical manifestation of the primary glomerulonephritis in the adults is nephrotic syndrome. Therefore, this elaboration aims are to estimate the therapy effect onto the different pathohistologic forms of the primary nephrotic syndrome. MATERIAL AND METHODS Study has been conducted on 41 patients having the primary nephrotic syndrome, prior having normal kidney function. Different pathohistological forms of NS were verified by percutaneous kidney biopsy. Depending on the pathohistological finding the different therapeutic protocoles were applied. Each of the monitored patients were treated by giving steroids at least six weeks dosing them 2 mg/kg/bw/48 h, but not higher then 130 mg/48 h. In the cases of the patients having the given therapy, it did not lead them to the nephrotic syndrome remission, cyclophosphamid was induced in the dosage of 1.5-2.0 mg/kg/bw/48 h. According to the therapy reaction the patients were divided in three groups: the patients with the complete remission, with partial remission and the patients resistant to the treatment. THE RESULTS 41 patients have been observed, 28 male and 13 female, aged between 16-69, average 32.3 years old. All patients had normal kidney function, and diseases duration from the moment of the pathohistomorphologic diagnosis had been lasting 0-2 years, from average 6.4 months. According to pathohistological diagnosis the patients were divided into four groups: a) "minimal changes" MCNS (n -11), b) focal--segmental glomerulosclerosis FSGS (n - 10) c) membraneous glomerulonephritis MGN (n-9) d) membranoproliferative MPGN (n-10). The best therapy effect had been resulted within the group with MCNS having 82% cases with the complete remission, while the group with MCNS had reacted the most adversely, 45% were resistant onto the therapy. 18 patients of the total 41 had the complete remission, 14 partial remission, and 9 of them were without remission. CONCLUSION The patient having the minimal changes had the best response onto the steroids therapy, while the patients having the expressive proliferative changes did not respond with the complete remission.

INTRODUCTION Chronical renal insufficiency is followed by many endocrinological abnormalities which pathogenesis isn't still enough clarified. The hormone level of thyroid gland is often abnormal. It is well known that use of erythropoietin leeds to an improvement of the various endocrine disorders. The aim of this paper was to evaluate the erythropoetin impact on the thyroid function in patients on haemodialysis. MATERIALS AND METHODS This study included patients that were on chronical haemodialysis treatment 4 hours 3 times a week. Acetate or bicarbonate were used as buffers. 32 out of totally 74 patients, received erythropoietin (40-50 IU/kg/HD), and 42 patients did not. FT3, FT4, TSH were taken right before haemodialysis as were albumins, total proteins and hematocrit. FT3 and FT4 were determined by fluorimmunnoassay method, and TSH by immunoradiometric assay (IRMA) method. RESULTS Our survey included 74 clinically crithroid patients, 37 males and 37 females, average age 49.3 +/- 12.3 and duration of the haemodialysis 4.34 +/- 2.846. Thyroid Stimulation Hormone (TSH) was high in 10.8% of patients (8/74), FT3 was low in 38% of patients (28/74), and FT4 in 25% of our patients (18/24). The hormone level of the thyroid gland was similar in both groups, so there was no statistically important difference between them. FT3 in group with erythropoietin was 5.21 +/- 0.93, FT4--12.18 +/- 4.84, TSM -2.02 +/- 1.46 mlU/K, while in group without erythropoetin (non-erythropoietin group) references were FT3-4.81 +/- 0.87, FT4-12.49 +/- 1.98 TSH 2.31 +/- 2.08. No significant correlation was found between Hct, albumin, protein and T3, T4 and TSH in group that received erythropoietin, although there was correction of anemia. CONCLUSION Our results imply that patients on haemodialysis usually have asymptomatic abnormalities of thyroid gland. The use of erythropoietin did not improve their hormonal status, although correction of anemia was gained.

Association between epilepsy and stroke has been known since 1864. The pathophysiological basis of epileptic seizures during and after stroke are molecular changes that occur in ischemia as primary events, and in hemorrhage as secondary events. The aim of the study was to determine the incidence of epileptic seizures during and after stroke, recorded over a 10-year period at the Department of Neurology, Sarajevo University Clinical Center. The study covered the period from January 1, 1989 till December 31, 1998. During the period, 7001 patients were treated at the Department. Cerebral thrombosis predominated (53.6%), whereas there were only 17.25% of patients with cerebral embolism, 21.96% with intracerebral hemorrhage, and 7.17% with subarachnoid hemorrhage. The incidence of symptomatic epileptic seizures for total patient sample according to years ranged from 0.75% to 6.67%. According to type of insult, the incidence of symptomatic epileptic seizures was 1.0%-3.37% for cerebral thrombosis, 1.22%-6.67% for cerebral embolism, 0.65%4.05% for intracerebral hemorrhage, and 1.34%-4.34% for subarachnoid hemorrhage. Associated epileptic seizures, i.e. the seizures accompanying the onset of stroke, were not included in the study. Results of the study showed that there were 75 patients with symptomtic epileptic seizures (47 with late seizures and 28 with early seizures, or 1.998% of total patient sample) during the 10-year period of observation. There were 36 cases of cerebral embolism (23 and 13 in the group of late and early seizures, respectively; 2.980%), 30 cases of intracerebral hemorrhage (23 and seven with late and early seizures, respectively; 1.951%), and seven cases of subarachnoid hemorrhage (four with late and three with early seizures; 1.394%). According to stroke types and subtypes, hemorrhagic stroke was found to be a more common etiologic factor for the occurrence of early and late symptomatic epileptic seizures, whereas cerebral embolism in ischemic stroke was a more common cause of symptomatic epileptic seizures than cerebral thrombosis. During the study period, the years 1993, 1994 and 1995 were characterized by a small number of patients with symptomatic early and late epileptic seizures (9 in total). The incidence of early and late epileptic seizures in the sample of stroke patients during the study period ranged from 1.394% to 2.980%.