INTRODUCTION Laboratory diagnosis of medical biochemistry activity plays a significant role in the Primary Health Care Center (PHCC), dominated by Family medicine and diagnostic services. Medical biochemical diagnosis has a visible place at all levels of health care, which shows the number of requests for laboratory diagnosis, number and type of required laboratory tests. MATERIALS AND METHODS The study included 1000 requests for laboratory tests at the PHCC in Gracanica in primary health care units. We made an analysis of the most common laboratory tests in the requests by doctors from primary health care based on requests for laboratory diagnosis. RESULTS The requests of primary health care units in PHCC laboratory tests are required at all levels of service: urine, WBC, SE, glucose, total bilirubin, ALT, AST, AF, CK, cholesterol, HDL cholesterol, triglycerides, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requirements are the most common laboratory tests with 94% representation: urine, WBC, glucose, cholesterol, triglycerides, aminotransferases, creatinine, and urea. In 1000 requires was required total of 5333 laboratory tests. Test requirements of a general practice make 44, 1%; FM doctors account for 40% and the requirements of other specialists (pediatricians, gynecologists and specialists of occupational medicine) are 15, 3%. The doctors in family practice most often required: glucose, urine, WBC, SE, TGL., Chol., ALT, AST, creatinine and urea. General practitioners are demanding more cholesterol and triglycerides, a family medicine doctors are demanding lower cholesterol and triglycerides and higher CRP, fibrinogen, total bilirubin, ALT, AST, and other specialists the most demanded urine and WBC. DISCUSSION Laboratory diagnosis is a common diagnosis, which shows the representation of required number and type of laboratory tests. In requirements of PHC units in PHCC laboratory tests are required at all levels of service: urine, WBC, SE, glucose, bilirubin, ALT, AST, AF, CK, cholesterol, HDLchol., triglycerides, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requirements are the most common laboratory tests at the primary level: urine, WBC, glucose, cholesterol, urea, and found the secondary level of triglycerides, index levels and did not clear the number of searches required by the standards and norms of PHC.

Problem: Laboratory medicine, medical-biochemical diagnosis in primary health care is much represented. By organization of family medicine medical-biochemical diagnosis is defined as a branch of diagnostic services in primary health care. For these actions is necessary in the morning prior to admission of users and their demands that all jobs are properly prepared. On previous day should be provided and prepared: accessories, reagents and machines. Morning daily routine work of preceding control and calibration equipment, methods and process quality control of work in the laboratory. Only after the fulfillment of the procedures followed overview of search control of samples. After validating the results of daily quality control and after they met the criteria can be analytically examined samples from users. These procedures are not sufficiently familiar to users and doctors, for that are very often necessary the direct telephone communication between them. To make the results of laboratory tests needed are huge material resources. This is evident in the economic analysis where laboratory tests are valued with a score of: search by type and material resources expended for analytical examination. These technical and financial performances of laboratory medicine are not appropriately classified as blatant as that in other industries, technology and other primary health care (PHC) and family medicine (FM). Goal: The overall objective of the research is to define a model of efficiency (or effectiveness) of medical-biochemical diagnosis for users with the requirements of units of family medicine (FM), in a representative sample of patients in the unit for the laboratory diagnosis of the Primary Health Care Center Gracanica. Confirm what is the usefulness of the application of laboratory diagnosis in family medicine. Determine the frequency of the need for laboratory tests in the therapeutic treatment of major diseases. Evaluate the need for using laboratory diagnostics to try to prevent major diseases. Material and methods: The study included a total of 1000 respondents. All subjects were users of primary health care in Primary Health Care Center Gracanica (Tuzla Canton) in primary health care units have received requests for laboratory diagnosis. This paper is an analysis of the representation requirements for the laboratory diagnosis by doctors in primary health care and the most frequent diseases in primary care. An analysis is made of laboratory test results, based on requests for laboratory diagnosis by doctors and illnesses in primary care. Made is analysis of the presence of normal and pathological laboratory test results from the request for the laboratory diagnosis by doctors in primary health care. Made is an analysis of the most common laboratory tests requests, and based on requests for laboratory diagnosis by doctors in primary health care and the most frequent diseases in primary health care. Incorporated is the economic analysis of labor

This is the first study performed in population from Bosnia & Herzegovina (BH), in which we analysed a significance of genetic variations in drug-metabolising enzyme, cytochrome P450 (CYP), in pathogenesis of Type 2 diabetes. We have determined allele frequencies for CYP2C9*2, CYP2C19*2, and CYP2D6*4 in diabetic patients and nondiabetic controls. Genomic DNA was extracted from blood samples collected from 37 diabetic and 44 nondiabetic subjects. A real-time polymerase chain reaction was used for the detection of specific CYP polymorphisms, with the application of the specific TaqMan® SNP genotyping tests (Applied Biosystems). Interestingly, results from this study have demonstrated that frequencies of CYP2C19*2 and CYP2D6*4 variants were in line, while frequency of CYP2C9*2 polymorphism seemed to be lower in this sample of BH population as compared to the Caucasians genotype data. Furthermore, no significant difference in allele frequencies for CYP2C9*2, CYP2C19*2, and CYP2D6*4 was demonstrated between diabetic and nondiabetic subjects. Thus, results form this study seem to indicate no relationship between CYP2C9, CYP2C19, and CYP2D6 genotype and diabetes susceptibility in Bosnian population. This in part may reflect a limited study population included in our study and would require larger cohorts to reveal potential relationships between analysed CYP genetic variants and diabetes risk. In addition, it would be pertinent to further explore possible effects of CYP genetic variations on therapeutic and adverse outcomes of oral antidiabetics, which might be the key in optimising therapy for individual patient with Type 2 diabetes.

Th is is the fi rst study performed in population from Bosnia & Herzegovina (BH), in which we analysed a signifi cance of genetic variations in drug-metabolising enzyme, cytochrome P (CYP), in pathogenesis of Type  diabetes. We have determined allele frequencies for CYPC*, CYPC*, and CYPD* in diabetic patients and nondiabetic controls. Genomic DNA was extracted from blood samples collected from  diabetic and  nondiabetic subjects. A real-time polymerase chain reaction was used for the detection of specifi c CYP polymorphisms, with the application of the specifi c TaqMan® SNP genotyping tests (Applied Biosystems). Interestingly, results from this study have demonstrated that frequencies of CYPC* and CYPD* variants were in line, while frequency of CYPC* polymorphism seemed to be lower in this sample of BH population as compared to the Caucasians genotype data. Furthermore, no signifi cant diff erence in allele frequencies for CYPC*, CYPC*, and CYPD* was demonstrated between diabetic and nondiabetic subjects. Th us, results form this study seem to indicate no relationship between CYPC, CYPC, and CYPD genotype and diabetes susceptibility in Bosnian population. Th is in part may refl ect a limited study population included in our study and would require larger cohorts to reveal potential relationships between analysed CYP genetic variants and diabetes risk. In addition, it would be pertinent to further explore possible eff ects of CYP genetic variations on therapeutic and adverse outcomes of oral antidiabetics, which might be the key in optimising therapy for individual patient with Type  diabetes. ©  Association of Basic Medical Sciences of FBIH. All rights reserved

Spirometry is the widely used method in clinical practice in different levels of medical care. Sometimes it is use as the screening method in general practice, bus very often as the method in diagnostic procedures for asthma diagnosis, chronic obstructive pulmonary diseases, and restrictive pulmonary syndromes and so on. Very often spirometry is used as the part of diagnostic protocols for asthma treatment follow up, and many other respiratory diseases. Diagnostic procedures for asthma diagnosis sometimes include bronchoprovocation testing using methacholine or some other chemical bronchoconstrictive agents. Patients own experience for diagnostic procedures may influence to results of procedure. Experienced patients could have very well results, but they could perform very worse result so. Inexperienced patients perform worse results and that result should not be considered for diagnosis of therapeutic follow up. Medical staff, involved in spirometric procedures can influence so much, by explanation of spirometric procedures and giving support for the patients. How to assess the quality control we discuss in this paper.

MR rectum imaging with ultra sound gel as instrumental contrast media in tubulovillous adenoma Bacground. Colorectal polyps are frequent and can be found in 10% of adults, most common in elderly with prevalence of 20% in age group of 60. Over 90% cases of cancer are being developed from benign adenomas. Colorectal cancer (CRC) is a significantly large cause of death right after bronchial cancer in males, and breast cancer in women. Therefore, a standpoint was adopted that the removal of polyps as precursor will prevent the development of colorectal area cancer. Polyps can occur as peduncular or sessile. Adenomas are grouped in three subtypes based on histological criteria: tubular, tubulovillous and villous. Villous adenomas are larger than others and show a higher level of dysplasia. The prevalence of adenomas increases with the patient's age. Having in mind that the risk of malign adenoma transformation is 10 years average, and that small lesions have no clinical potential to turn into cancer, their removal would lead to unnecessary complications and additional costs. CRC risk grows both with the size and the number of adenomas. In patients who refuse polypectomy, we can expect cancer development in average of 5 years 4% and in 10 years 14%. Case report. We present a patient with a years long history of rectal polyp. She has refused any treatment of polyp removal up so far. Due to stool problems, mostly constipation, occasional bleeding and falling out feeling, she has decided to remove the polyp. The polyp has been detected through colonoscopy and described as very risky for polypectomy due to its suspected malign appearance. We did rectum MR on 1.5T Siemens, so that the patient came with clean lumen into which we applied ultra sound gel with huge 60 ml syringe (no needle) simply and pain free with three fillings (total 180 ml of gel). We have concluded that the polyp was of uneven outline and stretched partially along the inner rectum wall without extra rectal infiltration into mesorectal area. After that, we performed endoscopic polypectomy according to peace meal method resection up to real muscular layer after adrenalin undermining. Pathohistological finding which was done in HE technique showed tubulovillous adenoma. Conclusions. Rectal MR is a new, very reliable method of contemporary radiological imaging that gives better characterization of polyp tissue and of other tumours. It is currently the best imaging modality enabling very accurate evaluation and topographic ratio of tumour growth within the rectum wall and outside the wall, especially compared to mesorectal fascia. In addition, it is a very comfortable procedure without radiation. The application of ultra sound gel as intra luminal rectal contrast agent can distend the lumen and make an excellent contrast of lumen against the rectum wall and thus can better show polyps and tumours.

Gall disease and gall tract diseases, except anamnesis characteristics, physical examination and biochemical findings, require application of modern visual technology which with its high sensitivity and specificity allows quick, accurate and verifiable diagnosis and favorable outcome of disease, a false positive and false negative findings are reduced to a very low percentage. Data from the literature shows the sensitivity of Transabdominal ultrasound (TUS) up to 90% and specificity from 20 to 85%, while CT shows sensitivity up to 87% and specificity up to 90%. In our research, which included 366 patients with gall and gall tract pathology and 147 of them were treated surgically, shows TUS sensitivity up to 87.5%, but the low specificity of 28.5%, mainly caused by a large number of patients with gall tract pathology. CT shows high sensitivity of 100% and 100% specificity, which diverge from data from the literature because CT was done after TUS and with the selection of diagnostically complicated cases. In all these complicated cases surgical findings have confirmed CT diagnosis. From this we can conclude that the application of image technology allows fast and accurate diagnostic and treatment of gall and gall tracts.

OBJECTIVES In order to assess diagnostic value of prolactin (PRL) in breast cancer (BC), we examined its serum levels and frequencies of its increase in breast cancer patients (BCP), and compared them to those in two controls. We also determined circulating levels of PRL in localised and advanced BC and calculated sensitivity and specificity of PRL in BC. PATIENTS AND METHODS The main experimental group consisted of 47 female patients with histologically confirmed diagnosis of BC. The obtained results were compared to those in two control groups: clinically healthy women, and female patients with other types and locations of cancer. Serum levels of PRL were measured by means of radioimmunoassay. Results were processed by means of t-test and two way analysis of variance. RESULTS The serum levels of PRL before treatment, as well as the frequencies of its increase, were significantly higher in BCP in comparison to controls (p<0.01, 0.02). The average circulating levels of PRL in patients with advanced BC were significantly higher (p<0.0001) in comparison to patients with localised disease. Sensitivity for PRL in BC was 50%, and specificity was 100%. CONCLUSIONS Increased levels of PRL can be detected in the majority of patients with advanced BC. PRL has high specificity for BC, especially for metastatic BC, which leads to its diagnostic and prognostic importance in this disease.

AIM The Carcinoembryonic antigen (CEA) is used as a tumor marker for breast cancer (BC). In order to better define clinical usefulness of CEA in breast cancer patients (BCP) we determined its baseline pre-treatment levels and correlated them with main parameters of primary tumor and metastases. PATIENTS AND METHODS The main experimental group consisted of 47 female patients with histologically confirmed diagnosis of BC. The obtained results have been compared with those of two control groups: clinically healthy women, and patients with other types and locations of cancer. In both cancer groups the parameters of primary tumor (size, grade) and metastases (time interval to metastases, location, size) have been determined. Circulating levels of CEA were measured by the means of immunoradiometric assay. Results were processed by means of t-test, two way analysis of variance in F-test, and logistic general linear model with calculations of Pearson's correlation coefficient. RESULTS Baseline levels of CEA in BCP were significantly higher than in healthy women (p < 0.0001), and in patients with other types and locations of cancer (p < 0.007). There also was significant difference (p < 0.001) between serum CEA in other cancer patients and healthy women. Baseline CEA levels were in significant positive correlation with the size of primary tumor both in all BCP (p < 0.03) and in hyperCEA BCP (p < 0.002), while in other cancer patients such a correlation did not exist. There was no correlation between CEA and degree of differentiation of primary tumor either in BCP or in other cancer patients. The average circulating levels of CEA in metastatic BCP were significantly higher (p < 0.03) in comparison to non-metastatic patients, while in other cancer patients such a difference did not show up. There was significant correlation (p < 0.0001) between circulating CEA and the size of metastases in all BCP and in subgroup of hyperCEA BCP, while in other cancer patients it was not a case. There was no correlation between serum CEA and other two metastatic parameters either in BCP or in other cancer patients. CONCLUSIONS CEA does not have high tumor specificity for BC since its baseline levels may be elevated in other types of cancer. Circulating levels of CEA in BCP are directly dependable on the size of both primary and metastatic tumor. CEA is a tumor antigen of less differentiated cancer cells. Circulating CEA is a good prognostic marker for patients with metastatic BC.

The objective of the research were consolidate the correlation the greatest values ALT and AST, and the recovery from hepatitis infection. To the group of 237 adolescents, male sex of 18, 19 and 20 years is measured the activity of ALT and AST. The examinees are questionnaired to the recovery from hepatitis infection. Had to the significant increased values AST, and only mildly increased values in relation to the upper referent values.

Importance of establishing quality control in health care system was given in this paper. It is necessary to standardize the protocols in any kind of medical treatment. Only main protocols and guidelines allow us to compare its usefulness in everyday practice doctors, medical teams and medical institutions. First, it is necessary to calculate life expectancy tables for population to whom health care system is established. Than, collecting of the data should be systematically performed by health care providers. So, if we use guidelines and standardized protocols in everyday practice we could compare medical work and with other countries which are in our interest.

BACKGROUND We frequently observed allergic skin reactions in patients with documented history of alcoholic liver disease (ALD). To assess the potential association between alcohol-induced liver damage and urticaria a prospective randomized trial investigating immunologic parameters in various stages of alcoholic liver disease was designed. Fifty patients were available for analysis. METHODS By means of a multivariate discriminant analysis seven out of a number of laboratory and clinical parameters (level of serum proteins, serum globulins, gamma globulins, albumin/globulin ratio, and immunoglobulins A, E, and G) have been found important for analysis. They were compared with age, general clinical status, degree of progression of alcoholic liver disease, and frequency of appearance of type I skin reactions. Results were further processed by means of logistic general linear models, Chi-square test, and summarized in a structural equation model. RESULTS Alcoholic liver disease does not influence IgA, IgG, and A/G Index directly, but it increases levels of IgE. About 13% of variance of IgA, IgG, and A/G Index are affected by group membership only in non-alcoholic liver disease, and 27% of variance of IgE can be explained by alcoholic liver disease. There were striking differences in IgE content between alcoholic liver disease and control groups. Degree of liver disease had a negative impact on A/G Index, and on IgA, and a positive on IgG. About 16% of variance can be explained by degree of liver disease. IgE is not degree related. Alcoholic liver disease as a disease was found as the most important predictor of skin reactivity (p = 0.0046). Of all immunologic parameters investigated IgE followed by A/G Index was found as the most significant predictor of allergic skin reactions. The extent of alcoholic liver disease plays not a role in allergic skin manifestations. Alcoholic nature of liver disease itself is a significant factor causing allergic skin reactions (p = 0.0002), but alcoholism itself as an independent factor contributes to increased incidence of skin allergies. CONCLUSIONS Alcoholic liver disease plays an important role in development of type I allergic skin manifestations. This effect has a direct mechanism through alcohol itself, and an indirect through elevation of IgE. Alcohol in liver disease and not liver disease causes immunologic abnormalities and accounts significantly for increased appearance of allergic skin reactions regardless of the extent of underlying liver disease.

The objective of this study to consolidate the correlation between BMI with the values of ALT and AST of the healthy adolescents in age of 18, 19 and 20 years. To the group of 237 examinees of the healthy adolescents is determined BMI, and is measured the activity of ALT and AST. In the sample of the examinees we had 22% examinees had the increased BMI > or = 25. The examinees who had the increased BMI (> or = 25), had the significant increased values ALT, and only mildly increased values AST in relation to the upper referent values. On the basis of the simple linear regression was confirmed the positive correlation between the of body mass indexes and activities ALT i AST.