Introduction: To present results of MicroTese procedure in treatment of male infertility in patients with azoospermia at Bahçeci BIH IVF Center during two-year period of 2013-2014. Methods: In the stated time-period, 55 MicroTese surgeries were performed. In 52.7% of the cases, sperm cells were isolated after MicroTese surgery, and in 47.3% of the cases, there was a negative outcome of the procedure. Obtained sperm cells were subjected to cryopreservation. Furthermore, ICSI procedure was performed by use of the obtained sperm cells. Results: Of 29 positive MicroTese surgeries, 21 (72.4%) resulted in clinical pregnancies. Biggest percentage of negative MicroTese procedures happened in patients with cryptorchidism and orchidopexy. Conclusion: MicroTese is the most precise and successful method of retrieving sperm cells surgically in men with azoospermia. Our results are within scope of results in referent world centers.

Introduction: Infertility or sterility or barrenness is defined as a state of inability to conceive after a year of unprotected intercourse. Ovulation problems, uterine tube problems, endometriosis, uterine etiology problems, chromosomal problems which are not so rare, spermatogenesis disorders and azoospermia are stated as the most common causes of infertility. Objective: Main objective of this research is to present most common causes of marital infertility in Bosnia-Herzegovina population. Material and methods: Retrospective, descriptive- epidemiological study has been published at Bahceci IVF center in Sarajevo (Bosnia and Herzegovina). The research covered a time-period of two years. During the time-period in question, 826 marital couples from Bosnia and Herzegovina diagnosed with marital sterility approached the Center. Results: Analysis of female patients as per age groups determined that the largest number of respondents belonged to the 36 – 39 age group with a total number of 293 patients, followed by 30 – 35 age group with a total number of 245 patients, and the third most frequent age group included those of ≥ 40 years of age with 179 patients in total, followed by 25–29 age group with 98 respondents. In 42% (n=350) of the couples diagnosed with marital infertility, female sterility was established as the reason, while in 36 % (n=294) of the couples, male sterility was the reason. Both marital spouses were infertile in 11% of the couples (n=92), while in remaining 11% of the couples, no diagnosis was determined and they belonged in the group of unexplainable sterility. The most common cause of sterility in women is diminished ovarian reserve (DOR), as was the case in 38.57% of respondents. This diagnosis is in direct correlation with the age of a woman. Among causes of sterility of organic and functional origin, the most common is ovarian tube problem – in 31.4% of the cases, then ovulatory problems – in 12.86% of the cases, and polycystic ovary syndrome in 6% of the cases. Other causes such as endometrioma, endometriosis and genetic factors are present in less than 2% of respondents. Regarding male sterility, problems with spermatogenesis are prevailing (decreased number and mobility of sperm cells and problems with morphology of sperm cells), oligoasthenoteratozoospermia in 81.61% of the patients. In 14.19% of the cases, azoospermia was present. Conclusion: All of this contributes to the negative demographic trend in Bosnia and Herzegovina. In 2008, European Parliament warned of importance of infertility treatment. In collaboration with ESHRE (European Society of Human Reproduction and Embryology), main guidelines to alleviate this problem were provided.

Aim: The main goal of this research is to correlate anthropometric characteristics of newborns in pregnant women who consume cigarettes during pregnancy. The study was conducted at the Obstetrics Clinic of the Clinical Center, University of Sarajevo. Methods: The retrospective study covered a period of two years. Main inclusion criteria for the study was that pregnant women consume cigarettes during pregnancy. The research included respondents who had a singleton pregnancy, without pathological conditions that can affect the outcome and duration of pregnancy. Results: At the Obstetrics Clinic, Clinical Center University of Sarajevo in the period from January 1, 2012 to December 31, 2013. In that period 393 pregnant women completed labor who in the personal history had data on smoking during pregnancy. Of the total number of subjects enrolled in this study 38.17% smoked up to 10 cigarettes a day, 33.08 % smoked up to 20 cigarettes a day, while up to 30 cigarettes per day smoked 28.75 % of respondents. Conclusion: There was a significant difference in the average values of all anthropometric parameters, in relation to the number of cigarettes consumed by the subjects during the day. We also found negative correlation in the average values of anthropometric measures and the number of cigarettes consumed (p <0.05).

Introduction: Caesarean section is obstetrical surgery by which through incision of the abdominal wall and the lower uterine segment performs extraction of the fetus in the advanced stages of pregnancy and childbirth ends by abdominal myomectomy. Because of its significance it is one of the most important surgical procedures performed in gynecology and obstetrics. Material and methods: The goal of this study is to show the incidence of cesarean section in the Public Hospital in Travnik during 2012, and the most frequent indications for surgical completion of delivery. During 2012 at the Department of Gynecology and Obstetrics of Cantonal Hospital Travnik there was 927 deliveries. Results: Of the total number of births, in 115 (12.41%) of cases a caesarean section was performed, while in 812 (87.59%) delivery was completed vaginally. Descriptive analysis reveals that 55 (5.93%) women had repeated cesarean section after a previous cesarean section, while in 60 (6.47%) cases in 2012 for the first time underwent cesarean section. As the most common indications in 7.33% of the women was reported cefalopelvinea disproportion and breech presentation. At 6.67% of the women caesarean section was performed due to asphyxia and 4% due to preeclampsia. The incidence of other indications such as abruption, placenta previa, multiple pregnancy and other was less than 3%. Conclusion: On the basis of the data we conclude that in the maternity hospital Travnik vaginal birth is most common. However, although the percentage of cesarean sections was much lower than in the regional maternity hospitals, we cannot ignore that the rate of caesarean sections is slowly increasing and requires that obstetricians in their practice make professional triage when setting indications for cesarean section so that a trend of surgically completed births should not reach epidemic proportions.

ABSTRACT Among the priority basic human rights, without a doubt, are the right to life and health-social protection. The process of implementation of human rights in the everyday life of an ordinary citizen in the post-war recovery of Bosnia and Herzegovina faces huge objective and subjective difficulties. Citizens need to be affordable adequate healthcare facilities that will be open to all on equal terms. The term hospital activity implies a set of measures, activities and procedures that are undertaken for the purpose of treatment, diagnosis and medical rehabilitation of patients in the respective health institutions. Principles of hospital care should include Comprehensiveness (Hospital care is available to all citizens equally); Continuity (Provided is continuous medical care to all users); Availability (Provided approximately equal protection of rights for all citizens). Education of health professionals: The usual threats to patient safety include medical errors, infections occurred in the hospital, unnecessary exposure to high doses of radiation and the use of the wrong drug. Everyday continuing education in the profession of a doctor is lifelong.

Introduction: The goal of this article is to present that innovating in health care begins to become an imperative in present time. Innovating will enable the achievement of the highest quality health care results and the patients' satisfaction with the least amount of financial resources.Methods: The thorough literature review of multifaceted sources was conducted including: studies, books, monographies and peer – reviewed journals with the goal of achieving the clearer picture of today's modern challenges in the complex fi eld of health care innovation.Discussion: Theoretical and empirical studies clearly indicate that the innovation is one of the key factors in the competitiveness of the organization and its survival in the market. Developed countries of the world today are making significant efforts in order for innovation to become a national priority, with special emphasis placed on measuring innovation performance. Results of theoretical and practical studies show that in the future, treatment of the most diffi cult and complex diseases of our time, through the entirely new discoveries and results, derived from the process of innovation, will project entirely new positive forms and outcomes in the health care.Conclusion: There is no doubt that the humanity and medical science will through innovation succeed to win the battles against the majority of the most complex contemporary diseases. Malignant neoplasm of tomorrow, through the application of a new, innovative approaches to research, processes and treatments will become a chronic diseases. Among many, the particular problem in the process of innovation will represent the cost of research and development (R&D), production and the safety of prescription drugs.

Introduction: The aim of prenatal diagnosis is to detect fetal structural and genetic abnormalities. Used are different medical methods, procedures, processes and techniques. For this reason we can speak about the prevention and detection of hereditary diseases and congenital anomalies in the unborn fetus. Material and methods: The authors analyzed the results of early amniocentesis tests performed during 2009 in Institute for Gynecology, Infertility and Perinatology “Mehmedbasic” in Sarajevo. Performed is 299 analysis of amniotic fluid after amnion puncture done in the Institute or at the Clinic of Gynecology and Obstetrics (GAK) Sarajevo. Results and Discussion: Indications for the performance of early amniocentesis were: age greater over 35 (84.9%), positive ultrasound markers (1.6%), positive biochemical markers (5.6%) and positive family history for hereditary diseases (7.9%). Detected was 19 pathological cariograms or very high 7% of the total annual number of amniocentesis. An analysis of the distribution of pregnant women in relation to the indication of the result of cytogenetic analysis for each table made positive predictive value (PPV). For indicator age PPV was 0.11, 0.66 for ultrasound markers, for biochemical markers 0.13, for other indications–0.04. The logistic regression model (odds -ratio 11.234 ) indicate a positive ultrasound findings in relation to the year indicates that the risk to gain abnormal fetal karyotype 13 times higher when using only age as an indication for early amniocentesis. Of the 19 pathological cariogram largest number refers to M.Down (10), Sy. Edwards was detected in 2 patients, Sy. Klinefelter in 3, mosaicism in 3 and translocation gene in two of the fetus. Conclusion: The authors would like to acknowledge a very high percentage of pathological cariogram risk groups, the extension of indications for RAC indicate the value of ultrasound markers as a good screening methods and the need for social incentives to perform screening tests and early amniocentesis in B&H in order to prevent genetic abnormalities.

ABSTRACT Introduction: Postmenopausal uterine bleeding is a „cancer until proven otherwise”. Endometrial cancer is a typical disease among postmenopause woman, because every bleeding in this age etiology associated with endometrial cancer (10-30%). The lifespan of women today has been extended and post menopause today last one third of a woman’s life. Early diagnosis of endometrial cancer has a very high cure rate. Screening for this cancer has limits in practice and is necessary given the definition of high-risk groups would be subject to primary and secondary prevention. Goal: Primary to evaluate the leading causes of postmenopausal uterine bleeding among patients at risk for endometrial cancer (diabetes, obesity, nulliparity, late menopause (after 55 years) and compared them with the causes of postmenopausal uterine bleeding patients without this risk. Material and methods: A retrospective, descriptive study with a targeted sample of 50 consecutive patients who had registered postmenopausal uterine bleeding in high-risk groups (cohorts) and the same number of patients with postmenopausal uterine bleeding that does not belong to the risk group (control group). Each patient underwent clinical examination, then fractionated curettements and its histopathological verification and assessment of treated clinical stage of disease with PH analysis of the resected specimens. Results: The patients of the studied risk group were significantly affected by endometrial cancer compared with the control group (RR=2.45, 95% CI 1.2 4.6, p=0.005). Endocervical pathology did not differ between groups. Clinical forms of bleeding: for those that are profuse bleeding cancer was present in 54.6% of cases. With intermittent bleeding cancer is verified in the 33.3% of patients. Risk patient groups with cancer frequently suffer from clinically more advanced stages of histologically aggressive endometrial cancer (serous adenocarcinoma–type II, low differentiated cancer).

ABSTRACT At the Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo there is a trend of increasing number of cesarean deliveries in the last 15 years. Material and methods: During the 2012 percentage of Caesarean sections was 35 %, which represents a true pandemic in obstetrics profession and all scientific postulates are threatened by these practices. Of the total number of vaginal births only 48 deliveries were after previous cesarean section. Of the total number of subjects in which the delivery is completed vaginally after a previous cesarean delivery in 5 (10.42 %) was used vacuum extraction, forceps was not used, while manual exploration of the uterus in order to check the condition of the scar of a previous cesarean section was performed in 32 (66.67%) cases. Results and discussion: The largest number of respondents who were surveyed were at age from 31 – 35 years (n=25), followed by group between 26-30 years (39.58%). The analysis of complications of vaginal birth after Caesarean delivery revealed that 93.75 % of the patients did not have any complications, at 4.17 % occured postpartum hemorrhage and in one patient febrile condition. Birth after cesarean delivery can be successfully completed vaginally, with a careful application of prostaglandins, with a good estimate of an experienced obstetrician, and adequate conditions to complete delivery by caesarean section if a vaginal birth is not going in the right direction and as planned.

Clinic for Gynecology and Obstetrics, Clinical Center University of Sarajevo represents a tertiary level of health care with more than 3,000 births during one year. The aim of this article is to present the operation of the birth room at the Clinic for Gynecology and Obstetrics in 2012. Data were obtained on the basis of protocol of deliveries from the birth room. Material and Methods: Analyzed are the total number of births, the incidence of obstetric surgeries and other manual interventions. Results: Over the study period, there were a total of 3216 births, of which by Caesarean section was, completed 1115. The highest number of births was in September (n=305). The largest number of women who gave birth was nulliparous. Also among primiparous is performed the majority of cesarean sections (n=731). In the study period, multiple births were recorded in a total of 60 (59 twins, 1–triplets). Number of premature births was 370, and the perinatal mortality was 7.12 ‰. Number of newborn with birth weight below 2500g was 271. Among manual interventions in the delivery room mostly was used manual exploration of the uterus followed by the manual lysis of the placenta.

Introduction: Hemolytic disease of the newborn was first described in the medical literature 1609, when it was diagnosed in one French housewife. In 1932 Diamond and colleagues described the mutual relationship of fetal hydrops, jaundice, anemia and erythoblastosis, which was later called fetal erytroblastosis. Hemolytic disease of the newborn (HDN) in the strict sense is considered disease whose basis is accelerated immune destruction of fetal/child erythrocytes that are bound to IgG antibodies of maternal origin. These antibodies are directed against antigens of father’s origin, which are present in the fetal/children’s erythrocytes and that the mother’s immune system recognizes them as foreign antigens. Goal: The goal is that in the period from January 1st 2011 to October 23st 2013 determine the frequency of ABO and Rh D incompatibilities in our sample of pregnant women/mothers, and to underscore the importance of regular check of ABO Rh D negative pregnant women and application specific Rh D protection. Material and methods: In the General Hospital “Prim. Dr. Abdulah Nakas” in Sarajevo by retrospective study are followed several relevant variables. Immune alloantibodies were detected in vivo by indirect Coombs test (ICT) with serum mother and O test erythrocytes, by direct Coombs test (DCT) with erythrocytes of a newborn. Results: The total number of births ABO Rh D negative was 596 (14%) and ABO Rh D positive mothers 4261 (86%). Of the total number of Rh D negative mothers there was A Rh D: negative mothers 42%; O Rh D negative 33%; B Rh D: negative 17% and AB Rh D: negative 8%. Most of immune antibodies appear in mothers with O Rh D: negative blood type. The emergence of immune antibodies in the Rh D negative mothers was 1%, the appearance of ABO incompatibilities amounted to 2.3% of our sample. Conclusion: In order to reduce the occurrence of alloimmunization of the mother to erythrocyte antigens of the newborn that can lead to major complications in subsequent pregnancies of Rh D: negative mothers and HDN constant monitoring in order to prevent them is necessary. Prevention is essential because once immunized mother will remain immunized for life.

Background: Prevention of diseases in gynecology can be improved by better understanding of health promotion and management of diseases. Management is “the art of performing jobs by or with other people” Mary Parker Follet. Methods: A descriptive analysis was performed on scientific studies in several published articles in medical journals and books. Results: There are five primary functions of management as: Anticipate and plan, organize, command, coordinate and control. If we introduce the following definition in the sense of medical science and apply it to the medical practice that would mean way of recognizing, managing and resolving issues of diagnosis and therapy of diseases (in this case gynecology diseases) according to certain guidelines and treatment algorithms. Treatment of family doctors is an important aspect in the quality-of-life of women and their reproductive health as well as a significant issue in public, environmental and social problems. Conclusions: It is very important to deal with it on the primary care level and in addition to promote the primary and secondary prevention of diseases, which is sometimes more important than the curative procedures. The primary prevention involves regular gynecological examinations and screening. The doctors have also a duty to educate women about the risk factors for malignant diseases, as well as proposing some of the qualitative preventive measures.

INTRODUCTION Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of antihyperglycemic drugs that block degradation ofincretin hormones. GOAL To assess the effects oftreatment with DPP-4 inhibitors on glucoregulation and body weight in obese patients with type 2 diabetes mellitus. PATIENTS AND METHODS The study included 9 females and 9 males with type 2 diabetes (n=18), BMI=31.24 +/- 2,26 kg/m2, mean age 58 +/- 6,8 years. The patients have been thoroughly evaluated before treatment, and 6 months after treatment with DPP-4 inhibitor (sitagliptin) in combination with metformin. RESULTS After 6 months of treatment with DPP-4 inhibitors in combination with metformin HbAlc (-1,49%)., FBG (-3.75 mmol/L) and PBG (-5.79 mmol/L) significantly reduced (p=0.000). Mean body weight also significantly reduced (-12.5%; p=0.000). Reduction of mean fasting insulin was 5.46 mIU/L or 27% (p=0.000). Mean HOMA-IR change was -1.64 (p=0.000). Also there was significant decreasing of systolic blood pressure (p=0.001), cholesterol (p=0.004), triglycerides (p=0.001), LDL (p=0.002) and increasing of HDL (p=0.002). Hypoglycaemia was not registered in any of the patients. CONCLUSION These results show that in obese patients with type 2 diabetes, DPP-4 inhibitors treatment in combination with metformin was associated with improvements in glycaemic control, and a reduction in body weight.

INTRODUCTION This study represents a new approach to the extended analysis of correlation of findings of oligoclonal bands on gels and the level of intrathecal synthesis of immunoglobulin G in the central nervous system. Previous studies have shown that there is no correlation at this level as well as the number of tape or finding does not correlate with the forecast effect of therapy or patient outcome. AIMS OF THE STUDY To determine the correlation of level of immunoglobulins IgG in CSF with the number of oligoclonal bands on the gel. MATERIAL AND METHODS The retrospective study based on data processed in Clinical Immunology Clinical Center University of Sarajevo. Patients were assumed of multiple sclerosis according to clinical findings and magnetic resonance imaging. All CSF and serum samples were processed by nephelometry, isoelectric focusing on the gel. Statistical analysis of results was also performed by using SPSS statistical analysis program. RESULTS Analyses were performed on 254 samples of cerebrospinal fluid and serum of patients from neurological clinic, suspected of multiple sclerosis. We concluded that there is no correlation between the level of intrathecal synthesis obtained by Reibergram with the number of oligoclonal bands on gels. We think that the reason could be a small sample of patients analyzed and it leaves room for future analysis on a larger sample. DISCUSSION AND CONCLUSION For most patients with established MS we found intrathecal humoral response, type two, and the number and arrangement of IgG bands generally does not change during the disease, because they reflect long-term non-specific immune stimulation rather than a specific immune response that during infectious disease changes (quantitatively and qualitatively).

Defining normal and abnormal fetal neurological function in utero in order to better predict antenatally which fetuses are at risk for adverse neurological outcome has remained a great challenge in perinatal medicine. Fetal behavioral patterns have been considered as indicators of fetal brain development. It has been suggested that the assessment of fetal behavior in different periods of gestation may make possible the distinction between normal and abnormal brain development. Advances in ultrasound technology and particularly the introduction of real time four-dimensional (4D) ultrasonography, allowed direct observation of in utero life and offered a new insight for the assessment of fetal behavior. Fetal behavioral movements, the full range of facial expressions and mobility of fetal upper and lower extremities and fingers can be clearly visualized with 4D ultrasound. A new scoring system for the assessment of fetal neurobehavior based on prenatal assessment of the fetus with 4D sonography has been developed based on the same technique that neonatologists assess newborns during the first days of their postnatal life. This overview focuses on the study of fetal behavior and neurological assessment with 4D ultrasound.