Aim To determine the prevalence rate and resistance profile of Streptococcus agalactiae (S. agalactiae) in vaginal swabs of pregnant and adult non-pregnant women in the Tuzla region, Bosnia and Herzegovina (B&H), as well as its association with other aerobic bacteria. Methods This prospective study included 200 women, 100 pregnant and 100 adult non-pregnant. The research was conducted at the Institute of Microbiology, University Clinical Center Tuzla from October to December 2015. Standard aerobic microbiological techniques were used for isolation and identification of S. agalactiae and other aerobic bacteria. Antimicrobial susceptibility was determined by the disk diffusion and microdilution method(VITEK 2/AES instrument). Results Among 200 vaginal swabs, 17 (8.50%) were positive for S. agalactiae, e. g., 7% (7/100) of pregnant and 10% (10/100) of adult non-pregnant women. In the pregnant group, 71.4% (5/7) of S. agalactiae isolates were susceptible to clindamycin and 85.7%(6/7) to erythromycin. In the adult non-pregnant group, only resistance to clindamycin was observed in one patient (1/10; 10%). S. agalactiae as single pathogen was isolated in 57.14% (4/7) of pregnant and 60% (6/10) of adult non-pregnant S. agalactiae positive women. In mixed microbial cultures S. agalactiae was most frequently associated with Enterococcus faecalis and Escherichia coli. Conclusion The rate of S. agalactiae positive women in the population of pregnant and adult non-pregnant women of Tuzla Canton, B&H is comparable with other European countries. Large studies are needed to develop a common national strategy for the prevention of S. agalactiae infection in B&H, especially during pregnancy.

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency disease (PID) among adults. CVID consists of two phenotypes – one in which infections are the characteristic and another in which impressive inflammatory and/or hematological complications also develop, including lymphadenopathy, splenomegaly, autoimmune cytopenias, enteropathy, and granulomatous disease. These phenotypes appear to be stable, are related to immunological and inflammatory markers, and are predictive of outcomes. Both subcutaneous immunoglobulin (SCIG) and intravenous immunoglobulin (IVIG) are equally effective for replacement therapy. No data are available about specific factors affecting the quality of life related to switching from IVIG to SCIG in the Arabian Gulf area. We present the case reports of three adult CVID patients, who were shifted from IVIG to SCIG by the US conversion method (1 : 1.5). We followed-up patients for clinical outcomes, side-effects, immunoglobulin G (IgG) trough levels, annual infection rate, and quality of life using questionnaires (RAND-36) over a 3-year period. Three patients (two females and one male), with a mean age of 26 years, had received IVIG [Gamunex-C (Grifols Therapeutics Inc., NC, 27709 USA) 10%; Grifols] treatment for an average duration of 4 years and had average IgG trough levels of 7.7±2.9 g/dl. Patients were shifted to SCIG [Subcuvia (Baxalta Innovation GmbH, Vienna, Austria) 10%; Baxter] for different reasons. SCIG was administered, using an infusion pump, under medical supervision at the hospital, on a weekly basis. The average IgG trough level on SCIG was 10.4±1.5 g/dl. The annual infection rate of pneumonias, sinusitis, otitis media, and others significantly declined after switching to SCIG in all three patients. However, while on IVIG treatment, some patients reported headache and malaise, but when on the SCIG treatment the reactions were mild and infusion site-related such as erythema, swelling, and itching. Remarkably, all patients were successfully switched to SCIG with significant decrease in the annual rate of infections and a favorable steady-state of serum trough levels of IgG. The use of SCIG was generally associated with notable improvement in physical, emotional, and social health.

Background: Allergic rhinitis (AR) related to local weeds pollen sensitization (Chenopodiaceous family) is the most common cause of respiratory allergy in Kuwait. Local nasal accumulation of different cells typical of allergic inflammation is responsible for clinical symptoms of AR. Although nasal smear for Eosinophils (NSE) is one of the earliest included valuable test in diagnosis of AR, with time is underestimated. Aim: Explore possible correlation of natural pollen allergen stimulation with appearance and quantity of Eosinophils in nasal smear. Methods: A group of randomly selected patients with clinical history suggestive for seasonal AR (SAR), who came to Al Rashed Allergy Center in period from October 2014 to October 2015, obtain Nasal Smear for Eosinophils as a screening test before further diagnostic evaluation. Nasal samples were collected by passing a sterile swab, from each nasal cavity, along the medial surface of the inferior turbinate 2 to 3 times and the specimen smeared on a clear glass slide. Nasal smears were examined by light microscopy after staining with hematoxylin and eosin stain. Skin prick test is performed in all symptomatic patients with a battery of inhalant allergens that include local pollens. The control group was recruited, with their voluntary consent, from the medical stuff with a negative history of any allergic nasal symptoms. In this group we performed only nasal smear for Eosinophils. Air Biology Laboratory Kuwait provided us with daily pollen count. Results: From total 158 study participants, 132 had SAR symptoms and are divided in four groups. Fifth, control, group is non symptomatic. For 38.6% of symptomatic patients NSE were positive, while 45% of these patients have negative SPT. From 62.1% NSE negative patients, 37.8% have negative SPT. Our results showed expected positive correlation of NSE positive patients with pollen season in Kuwait, in SPT positive group. However, presence of Eosinophils in nasal smear was moderate to high also in patients with negative SPT during the highest peak of season, in contrast to control group. Conclusion: NES showed moderate sensitivity, relatively high specificity and importance as screening test in SPT negative patients. Evaluation of AR demand wide and improved diagnostic approach due to significant number of SPT negative patients with positive NSE based on natural allergen stimulation. Our results emphasize locale allergic response of nasal mucosa and importance of target organ diagnostic approach.

Introduction: The finding of reduced value of immunoglobulin A (IgA) in children is frequent in daily medical practice. It is important to correctly interpret the findings as adequate further diagnostic evaluation of the patient in order to make the determination on the significance of such findings. In children younger than 4 years always consider the transient impairment of immunoglobulins, maturation of child and his immune system can lead to an improvement in the clinical picture. In older children decreased IgA may lead to serious illnesses that need to be recognize and acknowledge through the appropriate diagnostic methods. At the University Clinical Center Tuzla, children with suspected deficient immune response due to reduced values of IgA, goes through further diagnostic evaluation at the Polyclinic for Laboratory Medicine, Department of Immunology and Department of Microbiology, as well as the Clinic of Radiology. Material and methods: Our study followed 91 patients, for the year 2013, through their medical charts and made evaluation of diagnostic and screening tests. Conclusion: The significance of this paper is to draw attention to the importance of diagnostic approach to IgA deficient pediatric patient and relevance of knowledge of individual diagnostic methods as well as to the proper interpretation of the results thereof.

Introduction: The finding of reduced value of immunoglobulin A (IgA) in children is frequent in daily medical practice. It is important to correctly interpret the findings as adequate further diagnostic evaluation of the patient in order to make the determination on the significance of such findings. In children younger than 4 years always consider the transient impairment of immunoglobulins, maturation of child and his immune system can lead to an improvement in the clinical picture. In older children decreased IgA may lead to serious illnesses that need to be recognize and acknowledge through the appropriate diagnostic methods. Material and methods: Research was realized at the University Clinical Center Tuzla. Children with suspected deficient immune response due to reduced values of IgA observed and, goes through further diagnostic evaluation at the Polyclinic for Laboratory Medicine, Department of Immunology and Department of Microbiology, as well as the Clinic of Radiology. In the period of year 2013, there were a total of 91 patients with reduced values of IgA, age up to 13 years, of which 55 boys and 36 girls. Results: Our study followed 91 patients, for the year 2013, through their medical charts and made evaluation of diagnostic and screening tests. The significance of this paper is to draw attention to the importance of diagnostic approach to IgA deficient pediatric patient and relevance of knowledge of individual diagnostic methods as well as to the proper interpretation of the results thereof.

ABSTRACT Aim of the work: Examine clinical characteristics of aerobic vaginitis and mixed infection for the purpose of better diagnostic accuracy and treatment efficiency. Materials and methods: Prospective research has been conducted at Clinic for Gynecology and Obstetrics, Department for Microbiology and Pathology at Polyclinic for laboratory diagnostic and Gynecology and Obstetrics Department at Health Center Sapna. Examination included 100 examinees with the signs of vaginitis. Examination consisted of: anamnesis, clinical, gynecological and microbiological examination of vaginal smear. Results: The average age of the examinees was 32,62±2,6. Examining vaginal smears of the examinees with signs of vaginitis in 96% (N-96) different microorganisms have been isolated, while in 4% (N-4) findings were normal. AV has been found in 51% (N-51) of the examinees, Candida albicans in 17% (N-17), BV in 15% (N-15), Trichomonas vaginalis in 13% (N-13). In 21% (N-21) AV was diagnosed alone while associated with other agents in 30% (N-30). Most common causes of AV are E. coli (N-55) and E. faecalis (N-52). AV and Candida albicanis have been found in (13/30, 43%), Trichomonas vaginalis in (9/30, 30%) and BV (8/30, 26%). Vaginal secretion is in 70,05% (N-36) yellow coloured, red vagina wall is recorded in 31,13% (N-16) and pruritus in 72,54% (N-37). Increased pH value of vagina found in 94,10% (N-48). The average pH value of vaginal environment was 5,15±0,54 and in associated presence of AV and VVC, TV and BV was 5,29±0,56 which is higher value considering presence of AV alone but that is not statistically significant difference (p>0,05). Amino-odor test was positive in 29,94% (N-15) of associated infections. Lactobacilli are absent, while leukocytes are increased in 100% (N-51) of the examinees with AV. Conclusion: AV is vaginal infection similar to other vaginal infections. It is important to be careful while diagnosing because the treatment of AV differentiates from treatment of other vaginitis.

Aim: The prognostic value of circulating antibodies to oxidized low-density lipoprotein (anti-oxLDL) in patients with coronary heart disease is not completely clear. We aimed to investigate the association between levels of anti-oxLDL in three groups of patients with different grades of severity of coronary heart disease. Patients and methods: The study included 101 patients classified into three groups: one (N=35) with acute myocardial infarction (AMI), a group (N=35) with angiographicallly proven coronary artery disease (APCAD), and a group without angiographicallly proven coronary artery disease (N=31) designated as a control group. Levels of IgG anti-oxLDL antibodies were meausured by enzyme-linked immunosorbent assay. Results: Mean anti-oxLDL value was significantly higher in patients with AMI than in patients with APCAS (1342.1±581.5 mIU/ml vs. 553.0±183.3 mIU/ml, p<0.001), as well as compared with control group (1342.1±581.5 mIU/ml vs. 246.5±114.3, p<0.001). Similarly, significant difference in anti-oxLDL levels was found between the patients with APCAS and control group (p<0.001). Conclusions: The present study showed that elevated levels of anti-oxLDL are positively related with a severity of coronary artery disease. Hence, elevated levels of anti-oxLDL may identify patients with unstable coronary heart disease. Oxidized LDL in circulating plasma could serve as a marker of cardiovascular events.

The aim of the study was to determine serum levels of matrix metalloproteinase 9 (MMP-9) and high sensitivity C reactive protein (hsCRP) in patients with diagnosis of acute coronary syndrome (ACS). The study included 150 patients divided in three groups: patients with significant coronary artery disease (CAD), patients without significant coronary artery disease and patients with acute myocardial infarction (MI). Method used for determination of coronary artery disease significance is coronary angiography, and CAD is determined as significant if level of stenosis is > 50%. The group without significant CAD had lower MMP-9 serum concentrations than group with significant CAD, which has lower MMP-9 than group with acute MI. Difference in levels of MMP-9 serum concentration between groups with and without CAD is statistically significant. Level of serum hsCRP in group with MI is significantly higher than in other two groups. There is no significant difference in hsCRP serum level between group of patients with significant CAD and without significant CAD. Our results demonstrate the significance of MMP-9 and hsCRP level determination in assessment of acute coronary syndrome patients in the future as a biomarker of plaque instability.

We present a case of Wegener granulomatosis in patient 20 years old with characteristic findings on skin, lung, kidney, and positive cytoplasmic-autoantibodies recognising antigens in the cytoplasmic granules of neutrophils (c-ANCA).

UNLABELLED About 50,000 women dead due to result hypertension in pregnancy every year worldwide. Frequency of hypertension in pregnancy is 5-10% and complicate pregnancy. Control of high blood presure in pregnancy and therapy of hypertension are elements that prevent complication as a praeclampsia, eclampsia, abruption of placenta and operation end pregnancy. Aim of work is to establishing frequency of hypertension of controlled group of pregnen women and determinate results of pregnancy in pregnant women with high blood presure. The sample were 230 pregnant women which we controlled in Health Care Sapna. Hypertension was found at 7 pregnant women or 3.04%, at 14.28% was found chronic hypertension and at 87.1% was found gestation hypertension. Pregnant women were controlled, averagely 4 times and pregnant women with hypertension were controlled 8 times. Hypertension was treated with drugs at 6 pregmnant women with hypertension and one pregnant women did not take a medicine. 28.57% pregnant women with hypertension was delivered Caesarean section and 71.42% was vaginal delivery. Pregnancy of one pregnant women with chronic hypertension who did not take medicine was complicated of abruption of placenta and she was delivered Caesarean section. Pregnant women with gestation hypertension did not complicate during delivery. CONCLUSIONS Regular control and therapy of hypertension during pregnancy can significantly reduce perinatal morbidity and mortality. Health educated pregnant women is important for control pregnancy as using advise and regular treating of medicine of pregnant women.

It is generally accepted that inflammation has an important role, not just in the pathogenesis of atherosclerosis, but also in initiation of acute coronary syndrome (ACS). A number of studies showed, that a high concentration of high sensitivity C reactive protein (hsCRP) is an independent risk factor for the development of cardiovascular disease in a healthy person. HsCRP can predict new cardiovascular episodes, including death, in patients with unstable angina and acute myocardial infarction (AMI). Ability of oxidated low densiti lipoprotein (oxLDL) to induce accumulation of holesterol in macrofage was his first described proaterogenic characteristic and it help in hipotesis that oxidation of low densiti lipoprotein (LDL) can be important step in proces of aterogenesis. Framingham study showed that ther is significant corelation between level of total holesterol in blood and coronary artery disease (CAD). Evaluation of bouth hsCRP and LDL levels is superior in detection of CAD. Aims of this study were to determine values of hsCRP in patients with coronary arteries disease verified by coronary angiography (stenosis>70%), and to check if values of hsCRP higher than 3.0 mg/ dL are better predictor of coronary artery disease then lipid status. A prospective study was conducted on 60 patients, who were divided in two groups in compliance with significance of coronary artery disease. All patients have earlier diagnosis of ACS, and from this study excluded patients with acute infection, chronic, systemic or malignant disease. This research shows that patients with significant coronary artery disease, verified by coronary angiography, have higher values of hsCRP than those without disease that have values within the range of the reference values (0-3 mg/dL). Patients with coronary artery disease verified by coronary angiography have values of hsCRP that put them in a group of patients with intermediate to high risk of a future acute cardiovascular event, by classification of American Heart Association. In group of patients with coronary disease there is significant elevation of LDL and total cholesterol. With elevation of HDL values there is reduction in hsCRP values in patients with no significant coronary artery disease.

Celiac disease is intolerance to gluten that classically produces chronic diarrhea with a picture of malabsorption and a total villous atrophy. These elements regress completely in a sequential way under a prolonged gluten-free diet. We describe a case of a 35-year-old woman affected by celiac disease who presented atypically, with features including hypoproteinaemia (38g/L) with dominant hypoalbuminaemia (12g/L), weight loss, strong psychoneurotic component and amenorrhoea. These manifestations for the first time were diagnosed as irritable bowel disease and after immunology diagnostic as celiac disease. Current research on celiac disease has pointed out the biologically significant role of antigliadin antibodies IgG and IgA and antibodies to tissue transglutaminase (tTg).