Urinary tract infections (UTI) cause a great number of morbidity and mortality. These infections are serious complications in pregnancy, patients with diabetes, polycystic kidneys disease, sickle cell anaemia, kidney transplant and in patients with functional or structural anomalies of the urinary tract. The aim of this investigation was to determine a dominant causative agents of UTI and some of the clinical and laboratory characteristics of acute community-acquired UTI in adult hospitalised patients. We studied 200 adult patients with acute community-acquired UTI hospitalised in the Clinic for Infectious Diseases Tuzla from January 2006 to December 2007. The patients were divided into two groups: a group of patients with E. coli UTI (147) and a group of patients with non-E. coli UTI (53). In these two groups, the symptoms and signs of illness, blood test and urine analysis results were analysed. Our results have shown that the patients with E. coli UTI frequently had fever higher than 38,5 degrees C (p<0,0001), chills (p=0,0349), headache (p=0,0499), cloudy urine (p<0,0001), proteinuria (p=0,0011) and positive nitrite-test (p=0,0002). The patients with non-E. coli UTI frequently had fever lower than 38,5 degrees C (p<0,0001) and urine specific gravity <1015 (p=0,0012). There was no significant difference in blood test results between patients with E. coli and non-E. coli UTI. These clinical and laboratory findings can lead us to early etiological diagnosis of these UTI before urine culture detection of causative agents, which takes several days. Early etiological diagnosis of the E. coli and non-E. coli UTI is necessary for an urgent administration of appropriate empirical antibiotic treatment. This is very important in prevention of irreversible kidney damage, prolonged treatment, complications, as well as recidives and chronicity of the illness.

Increasing gap between demand and availability of human kidneys for transplantation has forced a re-evaluation of the limits on donor age acceptability. The present study included 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. In an observational cohort study we assessed impact of donor age on post transplant renal function by analyzing following parameters: 24 hour urine output, creatinine clearance (Cr Cl) and glomerular filtration rate (GFR). Depending on donor age recipients were allocated in to two groups. Group I included patients who received renal graft from donors age up to 55 years, and Group II encountered recipients who received renal graft from donors older than 55 years. Our goal was to determine whether donor age over 55 years significantly diminishes renal graft function in first seven post transplant days. No statistically significant difference was found between Group I and II regarding 24 hour urine output. From second to fifth postoperative day creatinine clearance values were higher in the group of patients who received kidney from donors older than 55 years (47+/-19, 1 vs. 44, 4+/-20, 8). On the fifth, sixth and seventh post operative day GFR was significantly higher in patients who received renal graft from donors age up to 55 years (p<0, 0161). Our data showed no significant difference in observed variables between the two groups, thus indicating that utilization of renal grafts from donors' age > 55 years is acceptable and may considerably expand the donor pool.

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.

Urinary tract infection (UTI) is one of the most common infections in children, and usually it appears in early childhood. The aim of this study was to find out the incidence and distribution of urinary tract infections in childhood, and to analyze clinical presentation of urinary tract infections in children. In the retrospective study were included 164 children, of both genders, who were treated in Primary Health Centre. Medical history were analyzed from all children who have presence of bacteria in urinary sediment. Urinary tract infection was found in 7.74% (164/2118) children, 11.26% (115/1021) of girls and 4.47% (49/1097) of boys. The biggest frequency was found in age group 3-6 years were UTI was found in 9.80% (74/755) of all children. Some of non-specific symptoms were found in 73.18% (120/164) children, and specific symptoms for UTI were found in 35.98% (59/164) children. The most common symptom was fever, which was found in 54.9% (90/164) children. UTI is common bacterial infection causing illness in children. It may be difficult to recognize UTI in children because the presenting symptoms and/or signs are non-specific, particularly in younger children.

INTRODUCTION Hepatic resection is the accepted treatment for various liver tumors. Increasing evidence suggests that two factors significantly influence outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis. There are liver function recovery and the degree of inflammation during early postoperative period. OBJECTIVE Aim of this study was to determine whether probiotic use influences on liver function recovery, degree of inflammation during early postoperative period, intraoperative risk, type and frequency of intraoperative and postoperative complications, morbidity, intraoperative and early postoperative mortality and a one-year survival rate in patients who have been used probiotic, and underwent the hepatic resection due to HCC in cirrhosis. PATIENTS AND METHODS Study was conducted on 120 patients underwent the hepatic resection due to HCC in cirrhosis. This study has been done in University Clinical Centers Tuzla, Maribor and Strasbourg from October 2006 till February 2008. Patients were divided into 2 groups: 1) patients with liver cirrhosis and histologically verified HCC whom underwent liver resection surgery (segmentectomy/ bisegmenctetomy, right and left hemihepatectomy/extended hemihepatectomy) that used preoperatively and postoperatively probiotics (n = 60), 2) a control group of patients with liver cirrhosis and HCC, which did not use preoperative and postoperative probiotics (N = 60). Treatment with probiotics was conducted 3 days preoperatively and postoperatively with 7 day's oral supplementation. RESULTS This study have shown next: patients underwent to the hepatic resection due to HCC in cirrhosis who have been used preoperatively and postoperatively probiotic had liver function recovery better and faster, acute immune response better, serum level of tumor markers lower, intraoperative and postoperative complications were less frequent, and morbidity and mortality rates were lower than in those who have not been using probiotic. CONCLUSION Probiotic use may make liver function recovery better and increases immune response in early postoperative period and positively influences outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis.

Introduction: Laparoscopic cholecystectomy is a method of choice in the treatment of calculous gallbladder. There is a clear evidence of changes in hemostatic parameters during this surgical procedure, which can result in thromboembolic complications. The aim of the study was to evaluate changes in D-dimer values, as a marker of hypercoagulability in patients treated with laparoscopic cholecystectomy. Patients and methods: The study included total of 60 patients, divided into two groups, one treated with classic (open) and other with laparoscopic method. Blood samples were taken from all patients before, during the surgery and 24 hours and 5 days after the procedure with consequent determination of D-dimer levels. Results: Blood samples of patients in both groups manifested higher values of D-dimer during the operation, 24 hours and 5 days after the procedure. We have found elevated values of D-dimer 5 days after the surgery in the group of patients treated with laparoscopic cholecystectomy with 2.5 times higher levels compared to values measured preoperatively. Conclusion: Our results suggest that there is an increased fibrinolytic activity after laparoscopic cholecystectomy, which demands more detailed and complete study on tromboembolism prophylaxis.

All conventional immunosuppressive tree drugs-protocols are based on Cyclosporine; consisting of low doses of Cyclosporine (CsA), Azathioprine (AZA) or Mycophenolate Mofetil (MMF) and Prednisolone. AZA has been used in clinical transplantation for more than 30 years and was the first immunosuppressive agent to achieve widespread use in organ transplantation. MMF was introduced in clinical practice in 1995 after several clinical trials proved that it was more efficient than AZA for prevention of acute rejection episodes. Our aim was to evaluate influence of AZA and MMF on renal graft function in early post-transplant stage. Study recruited 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. All patients received CsA and corticosteroid-based immunosuppression, as a part of triple immunosuppressive regiment, 40 patients received AZA and 34 MMF. In order to assess renal graft function, following parameters were evaluated: glomerular filtration rate GFR (ml/min) creatinine clearance (CrCl) (ml/min), 24 h urine output (ml/day), and from the serum potassium, sodium, urea and creatinine (mmol/dm3). Significantly higher average values of 24 hour urine output were recorded during first seven postoperative days in patients receiving MMF compared to those treated with AZA. Serum creatinine values showed statistically significant decrease, starting with the second postoperative day, in MMF vs. AZA group (168,7+/-70,5 vs. 119,9+/-42,6; p<0,0007). GFR was significantly higher in MMF compared to the AZA group of patients. On the first post-transplant day CrCl was higher in AZA group (24,3+/-10 vs. 17,5+/-7,3; p=0,01), next six days situation is reversed CrCl is significantly higher in the MMF group (43,7+/-15 vs. 53, 4+/-22, 8 p=0,006). MMF vs. AZA therapy was associated with protective effect against worsening of renal function in first seven post-transplant days.

Introduction: Cardiac output is the amount of blood pumped out from left ventricle into systemic circulation within one minute, i.e. product of stroke volume and heart rate. Coronary artery disease occurs as a consequence of reduced blood flow to heart muscle due to partial or total coronary artery obstruction by atherosclerosis or coronary thrombosis. Surgical revascularization of myocardium is performed with or without the use of cardiopulmonary bypass. Goal: to find the values of cardiac output, cardiac index, stroke volume, and heart rate before and after surgical revascularization of myocardium. Patients and methods: research was conducted as a retrospective study in Cardiovascular Clinic of University Clinical Centre in Tuzla on a sample of 60 patients subjected to surgical revascularization of myocardium. The first group consisted of 30 patients in which the revascularization was performed without the use of cardiopulmonary bypass, and the second group consisted of 30 patients in which the revascularization was performed witht the use of cardiopulmonary bypass. Haemodynamic parametres were measured and analyzed in all patients before and after the revascularization procedure. Results and Discussion: cardiac output after revascularization of myocardium without the use of cardiopulmonary bypass was increased by 13.62% (p .05), and cardiac index was decreased by 9.25% (p> .05) compared to preoperative values. Conclusion: values of haemodynamic parametres after revascularization of myocardium without the use of cardiopulmonary bypass are significantly better compared to the ones after revascularization of myocardium with the use of cardiopulmonary bypass.

Introduction: Chronic obstructive pulmonary disease (COPD) is a disorder characterized by maximal expiratory flow decrease and slow forced lung exhalation, which are significantly unchanged over several months. Subjects and Methods: Our study included 100 patients, 50 males and 50 females, diagnosed COPD who have been tested by functional lung tests: spirometry, body plethysmography and blood gas analysis. Patients have been analyzed at Clinic for pulmonary diseases and TBC, University Clinical Center Tuzla. All tests have been done at Department for Cardiorespiratory Diagnostics. Results: In this study have shown highly significant correlation among following parameters: FEV1 and VC, FEV1 and FEF 25, FEV1 and FEF75/25, FEV1 and FEF75, FEF25 and FEF75/25, FEF75 and FEF75/25. In males FEV1, VC and FEV1/VC have been significantly decreased comparing to females. Our results have shown no significant deference among spirometry, plethysmography and blood gas analysis parameters in male smokers with COPD comparing to female smokers. It has been found significant difference for pCO2 in male comparing to female nonsmokers. Conclusion: According to the results we recommend that all individuals having chronic cough, dyspnea and wheezing, and who are smokers or ex-smokers, aged >45 years, considering BMI, should be tested by spirometry.

The common complication after stroke is pain and dysfunction of shoulder of paralyzed arm, as well as the swelling of the hand. The aim of this study was to determine the effects of LASER therapy and to correlate with electrotherapy (TENS, stabile galvanization) in subjects after stroke. We analyzed 70 subjects after stroke with pain in shoulder and oedema of paralyzed hand. The examinees were divided in two groups of 35, and they were treated in the Clinic for Physical Medicine and Rehabilitation in Tuzla during 2006 and 2007. Experimental group (EG) had a treatment with LASER, while the control group (CG) was treated with electrotherapy. Both groups had kinesis therapy and ice massage. All patients were examined on the admission and discharge by using the VAS, DASH, Barthel index and FIM. The pain intensity in shoulder was significantly reduced in EG (p<0,0001), swelling is lowered in EG (p=0,01). Barthel index in both groups was significant higher (p<0,01). DASH was significantly improved after LASER therapy in EG (p<0,01). EG had higher level of independency (p<0,01). LASER therapy used on EG shows significantly better results in reducing pain, swelling, disability and improvement of independency.

Introduction: Renal graft function in the immediate posttransplant period is directly associated with patients hemodynamic condition during graft revascularization and early postoperative period. Our aim was to evaluate correlation between average daily value of central venous pressure (CVP) and renal perfusion, in first seven posttransplant days. Patients and methods: We recruited 74 patients, who underwent renal transplantation. We evaluated the influence of CVP and 24 h urine output on renal graft function. In order to assess the renal graft function, following parameters were evaluated: glomerular filtration rate (GFR), creatinine clearance, 24-hour urine output, and from the serum levels of K+, Na++, urea and creatinine. Results: Statistically significant positive correlation between mean values of CVP and 24 h urine output was found on the first (r=0.5422; p=0.0001) but not on the third postoperative day (r=0.1116; p=0.344). Statistically significant inverse correlation between mean values of creatinine and diuresis was found on the first (r=-0.2824; p=0.015) and third (r=-0.2976; p=0.01) postoperative day but on the seventh postoperative day a positive statistically significant correlation between these parameters was registered (r=0.4114; p=0.0001). There is a statistically significant difference between GFR and urine output on the first (r=0.2771; p= 0.017) and seventh day (r=0.4114; p=0.0001). We have not found any significant correlation between mean values of creatinine clearance and diuresis on the first posttransplant day (r=0.1760; p=0.134), but when same parameters were examined on the seventh day a positive statistical significance was found (r=0.4248; p=0.0001). Conclusion: Renal graft survival in early postoperative period is largely influenced by recipient hemodynamic condition. This study proved that 24-hour urine output directly depended on CVP level; it also proved existence of statistically significant correlation between mean values of diuresis, creatinine clearance, GFR and serum creatinine.

A pathologic fracture is every fracture caused by minimal trauma of the bone weakened by some process (osteoporosis, tumor, etc.). Most common pathological spine fractures are compressive fractures of thoracolumbal vertebras in geriatric patients. Considering the fact that geriatric population often have numerous comorbidities, weakened bone quality, and that instrumented spondylodeses have increased surgical risk, minimally invasive procedures are treatment of the choice for described fractures. Principle of the minimally invasive treatment of compressive spine fractures is to inject bone cement percutaneously into the collapsed vertebral body through transpediculary placed cannulas, under the X-ray control. After this ambulatory procedure, patient has prompt lack of pain, full mobility; risks of surgery are lower then one promil. In this article we describe first Bosnian experiences after those surgeries (vertebroplasty, kyphoplasty, percutaneus biopsy of spine metastasis) performed at the Department for Orthopedics and Traumatology of Clinical Centre University of Sarajevo.

The prevalence of bronchial obstruction in children is continuously increasing at any age. Many studies have found associations between increase of respiratory diseases and air pollution. The aim of this paper was to establish possible connection between children hospital admission trends for bronchial obstruction and levels of measured concentration of air pollution agents in Tuzla Canton area. The results of investigation demonstrated that the distribution of hospital admissions of children with bronchial obstruction was different regarding place of inhabitants and season. Spatial distribution demonstrated that the highest number of children treated for bronchial obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Seasonal distribution of hospital admissions of children with bronchial obstruction was different for single municipalities of Tuzla Canton and for different seasons. Air pollutants, sulfur oxide and dust deposition were significantly higher for heating season compared to season without heating. There is a link between frequency of hospital admission for bronchial obstruction and level of measured air pollutants.

Background: Accurate estimations of hepatitis B virus transmission risk for any region in Bosnia and Herzegovina are not clearly established. We aimed to determine levels of risk associated with intrafamilial transmission of hepatitis B infection within families in our region. Patients and Methods: Family members of 81 chronic carriers of hepatitis B surface antigen (>6 months positive and considered as index case) were tested for hepatitis B markers. For family members, we recorded their age, sex, and family relationship to the index case, and vaccination status. Results: The proportion of HBsAg positive family members was 25/207 (12.1%), while the proportion of family members with evidence of exposure to HBV was 80/207 (38.6%). Only 17/207 (8.2%) family members had evi--dence of past HBV vaccination. Age was found to be a significant predictor of HBV exposure of family members (odds ratio 1.05, 95% CI 1.03-1.07, P< .001). In a multivariate analysis, HBsAg positivity was associated with a female index case (odds ratio 11.31, 95% CI 3.73-34.32, P< .001), HBeAg positivity in the index case (odds ratio 5.56, 95% CI 1.80-17.23, P< .005) and being a mother of the index case (odds ratio 9.82, 95% CI 2.43-39.68,P< .005). A female index case (odds ratio 4.87, 95% CI 2.21-10.72, P< .001), HBeAg positivity in the index case (odds ratio 3.22, 95% CI 1.15-9.00, P< .05) and being a mother of the index case (odds ratio 3.72, 95% CI 1.19-11.64, P< .05) were also risk factors for HBV exposure among family members. The combination of HBeAg positivity and female index case was a significant predictor for HBsAg positivity of family members (odds ratio 70.39, 95% CI 8.20-604.61, P< .001). Conclusions: Children of HBeAg positive mothers are at highest risk for becoming chronic carriers them--selves and generally, the combination of female sex and HBeAg positivity dramatically increases the chances of HBV transmission within the family.

Aim of this study was to estimate how knee osteoarthritis (OA) affects the shape of femoral condyles by comparing the radiuses of condylar curves between healthy and OA knees. Seventeen female and five male patients with established diagnosis of knee OA were included in the study. Radiuses of medial and lateral condylar curves were calculated from the side view knee X-ray by original mathematical equation and compared to referent values of healthy knees, after adjusting to body height. The average radiuses of condylar curves were between 52.6 +/- 6.2 and 17.6 +/- 3.5 mm medially, and between 43.3 +/- 8.4 and 15.4 +/- 3.7 mm laterally for 0 degrees and 90 degrees femoral flexion contact points, respectively The OA knees had longer curve radiuses medially and laterally at 0 degrees, 10 degrees, and 20 degrees femoral flexion contact points in comparison to the healthy sample (P < 0.001; t-test). Our results suggest that the shape of the femoral condyles in OA knees is changed. It should be aware not only in researching of OA etiology, but also in designing of knee endoprostheses, in a manner to achieve better individual sizing.