Case report : Severe mitral regurgitation due to rupture of the chordae tendineae and mitral valve pro-lapse (Barlow’s disease), with a left atrial volume of 37.6 mL/m 2 was verified in 43-year old patient. He was admitted for an examination due to frequent palpitations and fast and irregular heartbeats. In the anamnestic data, thrombosis of the veins of the right leg was verified (thrombosis of popliteal, posterior tibial and great saphenous vein during previous years). He carries mutations: heterozygote of factor V Leiden, with MTHFR C677T heterozygote (CT), PAI- 1 heterozygote (4G⁄5G) and MTHFR A1298C heterozygote. The surgical treatment was done, and mechanical valve was implanted. In the follow-ing months, the patient complained on frequent dizziness, with crises of consciousness, and a short-ness of breath. He was not suitable for beta-blocker therapy, as well as propafenone and amiodarone, which had been prescribed in therapy in the meantime. The 24-hour ECG Holter monitoring described various arrhythmias, most of the time AV block of the first degree with PQ interval up to 320 msec, oc-casionally second-degree atrioventricular block Mobitz II, polymorphic ventricular extrasystoles and one attack of non-sustained ventricular tachycardia (6 ventricular extrasystoles in row), with intermit-tent nodal rhythm, junctional tachycardia and atrial flutter with AV ratio 2:1. An electrophysiological study was performed, and the cavotricuspid isthmus (CTI) dependent atrial flutter was verified, and radiofrequent ablation was done. After the procedure patient was in sinus rhythm. During the next follow up visits, the patient was in sinus rhythm, on therapy with a low dose of nebivolol (inability to tolerate beta blockers) and ivabradine, along with vitamin K antagonists. Conclusion

AIM To analyze a change of level of nautriuretic peptide (NT pro- BNP) caused by stress distension of myocardial wall in cases of acute myocardial infarction (AIM), as a possible predictor of early heart failure. METHODS Patients with myocardial infarction were followed up. Standard clinical and laboratory examination, including NT pro- BNP, and other laboratory analyses, were performed on the day of admission, the next day and on the eighth day of hospitalization. Statistical analyses included variance for repeated measurement (ANOVA), factorial multivariate analysis and test of multiple correlations. RESULTS The most important predictors of early heart failure in acute myocardial infarction were age, diastolic blood pressure, creatin kinase (CK) on admission, larger field of infarction zone and so on. Multiple correlations showed statistically significant correlation of age, diastolic pressure and larger zone of myocardial infarction with an increase of NT pro-BNP concentration. The activity of CK on the day after admission was higher than on admission (p=0.02) and myocard-binding CK (CK-MB) the next day after admission was higher than on admission (p=0.016). A statistically significant increase was found on the next day for NT pro-BNP in comparison with the value on admission (p=0.0049), but the level of activity of CK was markedly decreased on the eighth hospital day. CONCLUSION The significant increase of the concentration of NT pro-BNP during myocardial infarction is an important predictor of early heart failure, therefore, in case of a significant increase of NT pro-BNP in the early phase of the infraction a therapy that could prevent clinically relevant heart failure should be administered .

Introduction: According to the World Health Organization estimates annually in the world die due to CVI every sixth women and 10th man. This paper is the research of the correlation between changes in relative air humidity and stroke (CVA) in the Sarajevo Canton. Included are patients who experienced an acute stroke in the Canton of Sarajevo and treated in the pre hospital phase by the staff of the Institute for Emergency Medicine. Days with stroke and those without cases of stroke were compared within three years and meteorological data for those days were obtained by the Weather Bureau of Federation of Bosnia and Herzegovina. Meteorological data include measurements of average humidity every day at 7, 14 and 21 o’clock in three years. Aim: To evaluate the significance of the influence of humidity on the incidence of CVI’s. Show the trend towards CVI in the reporting period and is it correlated with the trend of change in relative humidity in those days. Correlate the incidence of stroke as determined in relation to gender, age and selected climatic parameter. Material and Methods: This article presents a retrospective study. Subjects were patients of Emergency Medical Care Institute in Sarajevo, which in the period from 2004 to 2006 had a CVI. Included are patients who had a working diagnosis of stroke for the first time or as a repeated stroke. Analysis of cases of stroke was carried out by gender, age, days and seasons by descriptive-analytical epidemiological methods. Results: In total were registered 1930 patients during three years period. According to years of research in 2004–635, 2005-616 and 2006 – 679. It was found that when testing the null hypothesis about the effects of humidity in two months with a maximum stroke in the year and days without CVI and relative humidity only in 2005 had a statistically significant effect on the incidence of stroke, while during the other two years of the study there was no impacts. It turned out that the extreme values of relative humidity of the day whether there was a rapid increase or decrees in humidity increases the incidence of stroke in all three years of research. Conclusion: Patients gender had no effect on the incidence of CVI. Seasons had no effect on the incidence of CVI. Most CVI in all three years of research was in relation to the old age and occurred in the older age group 70-79 (41.35%), where it was shown that the age of the patient influences the incidence of CVI. Extremely low relative humidity and extremely high, influence on the increase in the number of CVI. Determined is a slight correlation between the average relative humidity and CVI in single day.

AIM To analyze the usefulness of specified immunological parameters, proinflammatory IL-1α and profibrogenic, antiinflammatory TGF-β1, along with routinely used laboratory tests, in the differential - diagnostic procedure of chronic hepatitis of infectious and noninfectious etiology. METHODS A total of 150 subjects were divided into two groups, depending on the infectious or noninfectious etiology of liver damage, and the control group. Apart from standard laboratory tests, the analysis included serum levels of cytokines: IL-1α and TGF-β1. RESULTS A high degree of correlation of serum level of IL-1α with viral hepatitis has been found, especially with active replication of genetic material ( HBV-DNA or HCV-RNA-PCR positive), p less 0.01. The highest mean concentration of TGF-β1 was noted in the group of malignant and toxic hepatitis, p less 0.0001. A negative correlation between the concentration of IL-1α and TGF-β1 has been found (-0.18). For IL-1 α significant predictive parameters included a previous infection of hepatitis B, lower serum level of TGFβ, age, use of alcohol, lower MELD and Chilld-Pugh scores. For TGF-β1 significant predictive parameters were age, lower MELD and Child-Pugh scores, history of receiving transfusions, lower serum level of IL-1α, higher serum level of fibrinogen. A predictive model has been delivered MELD = (TGF-β1) x 0,001- (IL-1 α) x 0,085 + CTP x 1,771-2,052; ( ± 2.04, R2=0,61; p less 0,001). CONCLUSION Inflammatory and immune parameters, analyzed together could significantly contribute to the understanding of chronic liver damage and thus differential diagnostic procedure. IL-1α and TGF-β1 are important parameters of inflammatory activity and fibrosis evaluation in chronic liver damage.

Introduction: Life satisfaction involves cognitive component that allows evaluation of the life and accomplishments of life, and emotional component that includes an evaluation of emotions and mood that followed these accomplishments. Goal: To examine the life satisfaction of young people who attend secondary school, examine the level of satisfaction with life according to sex, to academic achievement, the presence of siblings and to examine the relationship between levels of life satisfaction and risk-taking behaviors. Results and Discussion: The results showed that there was no relationship between life satisfaction and preferences of delinquency, as well as life satisfaction and achieved academic success. The results confirmed the relationship between life satisfaction and sex as well as the relationship between life satisfaction and the presence of siblings in the family.

Introduction: The intention of this work is to research whether the link between the barometer pressure and the cerebrovascular insult (CVI) exists. The stroke is the first cause of non-traumatic disability and third illness by mortality in the majority of available relevant literature. Goals: Goal of the sudy was to research all the cases of the patients who suffered from the acute stroke in the Canton of Sarajevo and those who were treated in the pre-hospital phase by Emergency Medical Institute staff and their working diagnosis was established as CVI ac. Material and methods: The criteria in the research were established for inclusion and exclusion of cases. The days with and without CVI cases were compared with the meteorological data obtained from the Hydro-meteorological Institute of Federation of Bosnia and Herzegovina . Since the approval was requested and obtained from the Hydro-meteorological Institute, all the meteorological data could be compared. The meteorological data comprise the barometer pressure measuring every day at 7 h, 14 h and 21 h. Results and discussion: In the retrospective study, there will be followed, during three years (2004, 2005 and 2006), the cases of the patients who suffered from the stroke, and, the emergency medical care was offered to them by the side of the Emergency Medical Institute of Canton of Sarajevo staff. All the cases in the Canton of Sarajevo were followed regardless of the place of incidence: whether the help was offered in Institute’s outpatient departments, patient’s flat or at public place. Due to the extensiveness of data (in the analysis comprising three years, there was the total of 1930 cases), the test of normal distribution was used. Since it was about the pre-hospital research, the acute stroke was looked at generally without division by types. The certain diagnostics by types can only be established in the hospital. Conclusion: The results in the research indicate that the extreme values of barometer pressure, regardless of their being increased ones or decreased ones, influence the increase of CVI incidence, while by comparing the average values in the days with CVI and without CVI, they did not have any influence on the CVI incidence.

Aim: To study correlation of IgE level and C-reactive protein (CRP) for exacerbation of the disease in asthmatic patients. Methods: Asthmatic subject were examined for achieving of asthma control according to GINA recommendation. Numbers of exacerbation of asthma during one month were analyzed. The patients were followed in six month period (since first January to 30th of Jun. Average monthly days of exacerbations was calculated. IgE level in the blood was measured using Enzyme-linked Immunoassay (ELISA), and CRP was measured by immunotubidimetry. Assessment of asthma control was considered using Asthma Quality of Life Questionnaire (AQLQ). Results: The study includes 63 patients with asthma. Average level of IgE was 674 IU/mL (SD 167), range 56-3785 IU/mL, 1 IU=3,2 ng; average level of CRP was 16,4 mg/mL (SD 6,3), range 5-48; Average number of days in exacerbation during one month was 3,6 (SD 2,4), and varied from zero, patients with no exacerbation, to 21. Using test of multiple correlation it was shown statistical significant correlation (level p Conclusion: In this study CRP was shown as stronger predictor of asthma exacerbation and worse quality of life than total IgE level in asthmatic subjects.

AIM To analyze usefulness of measurement amino-terminal pro-B type natriuretic peptide of (NT pro-BNP) as the one of parameters of water overload in patients with chronic kidney diseases. METHODS A total number of 277 patients with chronic kidney diseases (CKD) were followed up in the period often years between January 2000 and July 2010. Patients with creatinine clearance of 60 ml/min or less were included in the study. Changes of creatinine clearance, and in last five years changes of NT pro-BNP were followed. Water overload was analyzed using chest x-ray in relation with concentration of NT pro-BNP in the blood. RESULTS Decrease of clearance of creatinine ranged from average 54.7 ml/min in the first year to 14.6 ml/min in the fifth year of the monitoring. Average NT pro-BNP level in patients without any sign of water overload was 94 pg/ml (SD 21), mean value in those with Kerley lines was 231 pg/ml/L (SD 64), in those with clear signs of water overload but without pleural effusion it was 525 pg/ml (SD 223), and in those with water retention including pleural effusion it was 1606 pg/ml (SD 1134). Using test of multiple correlation a statistically significant correlation between X-ray signs of water overload and NT pro-BNP concentration was shown, p < 0.05. CONCLUSION Measurement of NT pro-BNP was increased in the beginning of water overload in patients with CKD. Increased value of NT pro-BNP may be found earlier than any other signs of water overload. NT pro-BNP was a useful parameter in estimation of water overload in these patients.

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.