This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI), absolute values as well as pattern of its release. There are two different patterns of BNP release in AMI; monophasic pattern--concentration in the first measurement is higher than in the second one, and biphasic pattern--concentration in the first measurement is lower than in the second one. We observed significance of biphasic and monophasic pattern of BNP release related to diagnostic and prognostic value. We included in this prospective observational study total of 75 AMI patients, 52 males and 23 females, average age of 62.3 +/- 10.9 years with range of 42 to 79 years. BNP was measured and pattern of its release was evaluated. In AMI group BNP levels were significantly higher than in controls (462.88 pg/mL vs. 35.36 pg/mL, p < 0.001). We found statistically significant real negative correlation (p < 0.05) between BNP concentration and left ventricle ejection fraction (LVEF) with high correlation coefficient (r = -0.684). BNP concentrations were significantly higher among patients in Killip class II and III compared to Killip class I; Killip class I BNP = 226.18 pg/mL vs. Killip class II 622.51 pg/mL vs. Killip class III 1530.28 pg/mL, p < 0.001. BNP concentrations were significantly higher in patients with; (i) myocardial infarction vs. controls; (BNP 835.80 pg/mL vs. 243.03 pg/mL); (ii) in pts with positive major adverse cardiac events (MACE) vs. negative MACE (BNP 779.08 pg/mL vs. 242.28 pg/mL, p < 0.001); (iii) in pts with positive compared to negative left ventricle (LV) remodelling (BNP 840.77 pg/mL vs. 341.41 pg/mL, p < 0.001). Group with biphasic pattern of BNP release had significantly higher BNP concentration compared to monophasic pattern group. In biphasic pattern group we found significant presence of lower LVEF, Killip class II and III, LV remodelling and MACE. We found that BNP is strong marker of adverse cardiac events in patients presenting with a myocardial infarction. In our AMI group we found significant elevation of BNP and it is suspected that second peak secretion is not only due to systolic dysfunction and subsequent remodeling of LV but also due to impact of ischaemia. Patients with biphasic pattern probably have worse prognosis due to severe coronary heart disease. Besides its diagnostic role as a simple blood marker of systolic function, BNP is also important prognostic marker who helps making clinical decision about early invasive vs. conservative management.

= 5.53, p <0.001. AcT/RVET r = -0.896, SEE = 6.96, p <0.001; b) while positive correlation was found in variables PEP/AcT r = 0.915, SEE = 6.36, p <0.001 and PEP/RVET r = 0.917, SEE = 6.26, p <0.001; c) MPAP obtained by echocardiography (calculated by applying Mahan’s equation) V.S. MPAP obtained by right heart catheterization r = 0.936, SEE = 5.53 mmHg; d) SPAP obtained by echocardiography (calculated by applying Berger’s equation) V.S. SPAP obtained by right heart catheterization r = 0.971, SEE = 5.72 mmHg; e) RVSP obtained by echocardiography (calculated by applying a modified Bernoulli’s equation) V.S. RVSP obtained by right heart catheterization r = 0.882, SEE = 9.399 mmHg; f) RVSP obtained by echocardiography (calculated by applying a modified Bernoulli’s equation) V.S. SPAP obtained by RHC r = 0.972, SEE = 5.60 mmHg. Conclusion: Significant correlation has been found between the haemodynamic parameters obtained by noninvasive echocardiographic examination and those obtained by right heart catheterization.

Objectives: The aim of this Study is to examine the development of ischaemic heart disease and occurrence of segmental wall motion abnormalities in men and women during Dobutamine stresss echocardiography in order to establish the impact of gender and other risk factors in development of coronary artery disease and the role of Dobutamine stress echocardiography in detecting and assessing the degree of myocardial ischemia and coronary stenosis in patients with suspected coronary artery disease in order to justify its wider application as a non-invasive diagnostic method. Research aim and purpose: Ischemic heart disease (IHD) causes more deaths, disability and economic loss in developed and developing countries than any other disease. Cardiovascular disease is the leading cause of ddath for women in western socitew. The epidemiology of the ischemic heart disease depends on fixed risk factors, such as sex, age and genetic predisposition, and on multiple risk factors that can be addressed, such as elevated lipid levels, arterial hypertension, diabetes mellitus, obesity, lifestyle (physical inactivity and stress), smoking, and alcohol consumption. Cardiovascular diseases are the leading cause of morbidity and mortality in B&H and, considering the exposure profile of the B&H population to risk factors (unhealthy diet, ubiquitous smoking and alcohol drinking habits, inadequate physical activity, inadequate culture of health), further growing trend of cardiovascular diseases can be expected. Patients and methods: The research study covered 86 adult subjects of both sexes with cardiac risk factors, referred to dobutamine stress echocardiography test as part of their cardiological evaluation. The patients for whom invasive cardiac diagnostics was indicated following the dobutamine stress echocardiography were subjected to left heart catheterization: ventriculography and coronary angiography. The parameters obtained and results of each method applied were statistically processed. Results: The study results obtained indicate a high degree of sensitivity, specificity and accuracy of the dobutamine stress echocardiography as a non-invasive diagnostic method compared to invasive diagnostics i.e. coronary angiography, which is the gold standard for the detection and evaluation of coronary artery diseases. Dobutamine stress test, may play a key role in the optimal identification of high risk groups of patients with hypertension, diabetes mellitus, obesity, lifestyle (physical inactivity and stress), smoking, and alcohol consumption. Conslusion: Echocardiographic measures of inducible wall motion abnormalities and global and regional left ventricular function are highly accurate in detecting CAD in women and men alike. The safety and cost-effectiveness of the dobutamine stress echocardiography as a diagnostic procedure has been proved. In modern cardiology, the DSE occupies a significant place in the evaluation of patients with known or suspected coronary artery d

Background: Pulmonary hypertension (PH) is a haemodinamic and pathophysiological condition defined as increase in mean Pulmonary Artery Pressure (PAP) ≥ 25mmHg at rest as sessed by right heart catheterization (RHC). Objective and purpose: The objective of this study is to determine, by investigating haemodynamic parameters of the pulmonary hypertension in congenital and left heart diseases, the linkage and diagnostic value of echocardiography in detecting the pulmonary hypertension in heart diseases and assessing its degree, as well as to warrant a wider application of this non-invasive diagnostic method. Patients and methods: The research covered 56 adult subjects of both genders, who were subjected to echocardiography as part of the clinical cardiological examination. The patients were examined on an ultrasound machine ATL HDI-3000 and 5000, equipped with a cardiologic probe for adults 2.25 MHz and a multi-plan transoesophageal probe ATL MPT7-4 TEE. The patients, for whom invasive cardiologic diagnostic methods were indicated following evaluation by echocardiography, were subjected to cardiac catheterization. RHC was performed in all patients and diagnosis of pulmonary hypertension was established by measuring mean PAP ≥ 25mmHg at rest, also left heart catheterization was performed in order to define the underlying heart disease. The haemodynamic parameters, obtained for each method applied, have been statistically processed. Results: By the statistical processing of the echocardiographic parameters a correlation ratio has been found, which shows significant correlation between the non-invasive variables (AcT, Act/RVET, PEP/AcT, PEP/RVET and RVSP according to modified Bernoulli equation. MPAP according to Mahan’s equation, SPAP according to Berger’s equation) and the variables obtained by right heart catheterization (RHC): (RVSP, MPAP, SPAP): a) In AcT and AcT/RVET variables, a negative correlation was found AcT r = -0.936, Standard Estimation Error (SEE) = 5.53, p

BACKGROUND Ischemic heart disease (IHD) causes more deaths, disability and economic loss in developed and developing countries than any other disease. Our country belongs to the group of countries in transition, and it has seen a continuous growth in mortality and morbidity rates caused by cardiovascular diseases. An early, accurate and fast diagnosis of the myocardial ischemia is the main step toward reducing patient morbidity and mortality, and hospital costs. It also reduces prolonged diagnostic observation, defines the strategy of approach and etiological treatment in order to prevent serious complications. OBJECTIVES The aim of this study is to examine the occurrence of segmental wall motion abnormalities during pharmacological stress and measurement of coronary flow reserve in order to establish the diagnostic value of Dobutamine stress echocardiography in detecting and assessing the degree of myocardial ischemia and coronary stenosis in patients with suspected coronary artery disease, and to justify its wider application as a non-invasive diagnostic method. METHODS The research study covered 86 adult subjects of both genders, referred to dobutamine stress echocardiography test and assessment of coronary flow reserve as part of their cardiological evaluation. RESULTS The study results obtained indicate a high degree of sensitivity (97%), specificity (83%) and accuracy (95%) of the dobutamine stress echocardiography as a non-invasive diagnostic method compared to invasive diagnostics i.e. coronary angiography. Measurement of coronary flow reserve represents a strong diagnostic and prognostic tool in evaluation patients with suspected CAD. CONCLUSIONS The Dobutamine stress echocardiography (DES) has come a long way as a diagnostic tool, from detecting myocardial ischemia, viability, and prognostics to problems underlying the coronary artery diseases. The safety and cost-effectiveness of the Dobutamine stress echocardiography as a diagnostic procedure has been proved. In modern cardiology, the DSE occupies a significant place in the evaluation of patients with known or suspected coronary artery disease, which has contributed to its accessibility and availability in a great number of centers.

BACKGROUND The transient left ventricular apical ballooning syndrome, also known as takotsubo cardiomyopathy was first described in Japan approximately 20 years ago (Satoh and coworkers, 1991). It was later described elsewhere as well and is being increasingly recognized. Takotsubo Cardiomyopathy characterized by transient apical and midventricular LV dysfunction in the absence of significant coronary artery disease that is triggered by emotional or physical stress. Its name refers to a contraption used for catching octopuses and suggests the aspect assumed by the ventricle during the systole due to the typical regional wall motion abnormalities that occur after onset. Takotsubo cardiomiopathy occurring mainly in post-menopausal women, echocardiography in the Takotsubo cardiomyopathy reveals during its acute phase a ballooning resembling the octopus trap configuration--the apex and lateral ventricular segments are hypokinetic while the base is hyperkinetic--along with reduced ejection fraction. Ventricular function will usually recover within a few days/weeks. OBJECTIVE AND PURPOSE The objective of this study is to determine the role of echocardiography in detecting and establishing the diagnosis of Takotsubo cardiomiopathy in patients with suspect acute coronary syndrome and during the follow up period. PATIENTS AND METHODS The study covered 12 adult patients the majority are women (92%) who were subjected to echocardiography evaluation as part of the clinical cardiological examination due to suspect acute coronary syndrome or Takotsubo Stress Cardiomyopathy. The patients were examined on an ultrasound machine Philips iE 33 x Matrix, ATL HDI and GE Vived 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated clinical characteristics, LV systolic function, biomarkers, and prognosis in all patients. RESULTS Among all the patients referred for Echocardiographic evaluation for left ventricle motion abnormalities with suspect acute coronary syndrome, the echo exam revealed 12 patients with acute apical ballooning which involving the left ventricular apex and med-ventricle. The triggering factors were physical stress in 4 patients (33%) and emotional stress in 8 patients (67%). The initial symptom was chest pain (n = 8, 67%) rather than dyspnea (n = 4, 33%). An initial electrocardiogram (EKG) presented ST-elevation (n = 10, 83%) and T-wave inversion (n = 2, 17%), other data are shown on Table 2. Among the all patients 8 of them (66%) had normal EF by the 1st follow up (47 +/- 51 days), and the rest 4 patients (34%) had normal EF by 68 +/- 96 days. CONCLUSION Widespread uses of echocardiography has contributed to more frequent recognition of Takotsubo stress cardiomyopathy and highlight the central role of this noninvasive method from an echocardiographers' perspective.

Objectives: An open-label prospective, combined basic and clinical controlled study was done to investigate the effects of biological therapy using rituximab, and cytotoxic drug treatment with methotrexate on morphology and quantifitiation of chromosomes in rheumatoid arthritis patients. Methods: This study is follow-up of a prior publication, with new observations in comparison with control subjects. A total of 16 subjects were divided into two groups. Group Ⅰ comprised 8 seropositive rheumatoid arthritis patients who were analysed for the primary end point of possible cytotoxic effects of rituximab and methotrexate. Group Ⅱ included 8 healthy individuals who served as controls. Assessment was done before treatment with rituximab, and 4 weeks after initiation of therapy. Patients were randomly assigned to receive infusion of rituximab in a full dose of 2.0 g divided into two doses of 1.0 g on days 1 and 15. The lymphocytes from periphereal blood was cultured by the Moorhead method. Results: Normal male and female Karyograms were observed after full courses of therapy with rituximab. In one female patient who had been receiving longstanding cytotoxic therapy with methotrexate, 2% of chromosomal mitosis showed structural abnormalities. Following the discontinuation of methotrexate and the administration of rituximab, her karyogram became normal. Conclusion: The results from this study indicated that rituximab therapy was safe for the number and structure of human chromosomes, while methotrexate showed chromosomal aberration in one female RA patient. After discontinuation of this longstanding treatment, the karyogram of the same patient returned to normal.

The open prospective combined cytogenetic and clinical study investigated the impact of biological therapy Rituximab on number and structure of chromosomes in Rheumatoid arthritis patients. The purpose of this study was to investigate safety of Rituximab on chromosomes as well as cytotoxic therapy Methotrexate. A total of 8 seropositive Rheumatoid arthritis patients were analyzed for primary end point of eventual cytotoxic effect of Rituximab. Assessment was done before and 1 month later, actually 2 weeks after the administration of full course of Rituximab in infusion. Patients suffering from active Rheumatoid arthritis were randomly assigned according to established protocol to receive infusion of Rituximab in a full dose of 2.0 grams divided in a two doses of 1.0 gram on days 1 and 15. The lymphocytes from peripheral blood were cultured according to Moorhead method. The results obtained from this investigation showed that normal male and female karyogram was found after the full therapy of Rituximab. The results from this study, that was done on a rather small number of subjects, indicate that Rituximab does not express either clastogenic or aneugenic effects. But, co-finding of this study was that Methotrexate had a side effect on chromosomal aberration in one female RA patient, and after discontinuation of this treatment the normal karyogram was observed.

INTRODUCTION Atrial myxomas are the most frequent benign tumors of the heart. Left atrial myxomas are about 3-4 times more frequent then right. Clinical findings reveal atrioventricular obstruction symptoms and signs, symptoms and signs of peripheral arteries or pulmonary artery embolisation and/or nonspecific symptoms. AIM Review of atrial myxomas diagnosed at the Clinic of Cardiology in 20 years period and analysis of clinical characteristics, transthoracic echocardiographic (TTE), transesophageal echocardiographic (TEE), and M-mod echophonographic findings. METHODS TTE is performed in all, but TEE in 16 patients. Simultaneous M-mod echophonocardiographic examination were performed in 11 patients, when optional equipment was applicable. RESULTS We found 24 atrial myxomas: 19 (79.2%) in left and 5 (20.810%) in right atrium. 21(87.5%) patients had some of the symptoms, but 3 (12.5%) were asymptomatic. TTE was performed in all patients, but we found 1 (2.4%) false negative result. TEE was performed in 14 (58.3%) patients. Echophonocardiographic recordings showed early diastolic tumor "plop" in 10 patients and unusual late diastolic tumor "plop" in one right atrial myxoma, which has not yet been described. CONCLUSIONS TTE is a reliable method in diagnosis of atrial myxomas, but not in all cases, while TEE has been found as always reliable. Echophonocardiographic recording is useful for confirmation and understanding of auscultatory finding when applicable.

Aim: Detection of Anti-CCP antibodies in rheumatoid arthritis patients using Automated Microreader and Gen5 Software for analysis and data processing. Material and method: Total of 776 blood samples from inflammatory arthritis patients were obtained. Statistical analysis for positive and negative results was calculated and test values were compared. Results: Anti-CCP test was found positive (>25U/ml) in 32,8% of blood samples. The all positive test results were in rheumatoid arthritis patients with 95% specificity. Negative test results was found in 67,2% of blood samples that were drawn from all IgM RF negative individuals, reactive arthritis and osteoarthritis patients as well as in some end-stage rheumatoid arthritis disease. Mean value of positive results was very high: 599,62 U/ml. Conclusion: The anti-CCP test is highly specific test in Rheumatoid arthritis. The positive test in early undifferentiated inflammatory polyarthritis provides new laboratory diagnostic inflammatory marker and helps practitioners to confirm diagnosis of early rheumatoid arthritis. Microplate reader and Genf4 Software using ELISA method is essential automotive tool for extensive on-board data obtained analysis.

Background The Osteoporosis has always been a great problem for the clinicians in every country, since this disorder brings higher morbidity, disability and mortality. The Statins, lipid lowering drugs, have been recently shown to have positive impact on the osteoporosis, i.e. the bone mineral density, where the “T” score has increased in patients taking these drugs for hiperlipidemia. Objectives The objective of this research is to investigate the potential efficiency of Simvastatin (Lipex) on BMD score i.e. T score in patients suffering from postmenopausal osteoporosis. Methods An open randomised Prospective Control Study has been designed. The patients with the postmenopausal osteoporosis have been selected in one group and they received lipex 10 mg plus 500 Calcium at bed time. The other group of potmenopausal women, served as the control one, was assigned to receive only 500 mg of Calcium at the evening meal. Total number of individuals in each group was thirty three. Laboratory test including the risk factor stratifications were detected on baseline and after 3. The statistical analysis was done between two groups. Results The results obtained in this study showed the significant improvement in the group of patients receiving lipex and the score is much higher than those taking calcium only. This BMD result, i.e. T score, has been found to be about 30% higher in simvastatin group. The positive effect on lipid profile has been gained as well. The well-being improvement has also been notified. Conclusion The statins, in our research simvastatin (lipex), has been proven in our study to have a very positive effect on the treatment of osteoporosis. So, beside the primary effect of statins on lowering cholesterol levels, this is the other option and positivity of this drug. These medications can be added to the list of therapy in osteoporosis.

The goal of this paper is to explain hadiths on cardiovascular ills (as they are not well-known in this environment), and to compare them to medical principles. Seven hadiths concerning cardiovascular system recovery were processed. All hadiths were taken from the Collections of Hadiths. A correlative analysis between the directions for cardiovascular system recovery of Holly Prophet and contemporary methods of modern medicine was implemented. Equality of methods used by Holly Prophet and contemporary official medicine is manifested through palpation of heart and blood releasing. It would be necessary to implement an investigation based on-scientific principles, as to make more detailed analysis of Holly Prophet's advises.