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.

Cervical cancer is the second most common cancer in the world and the leading cause of death. Frequency and mortality are significantly reduced thanks to cytological Papanicolau test (PAP). Regular PAP test can reduce approximately 80% of cases of this cancer Aim of the study: To examine frequency of cervical cancer and changes of cervix, the age of risk for the changes and effect of frequency of PAP test. Materials and methods: 3383 PAP (cytological) findings have been retrospectively ana lysed in three Health Centres of Tuzla Canton: Tuzla, Srebrenik and Sapna. During 2010 and 2011 protocols of Health Centers have been analyzed. Results: Analysis of 3383 smears detected the following: abnormal PAP tests in 20.8% (705) and without abnormalities in 79.1% (2678). Normal findings in 9.1% (311), inflammatory changes in 69.6% (2357), ASCUS in 12.9% (438), ASC-H in 0.3% (11), LSIL in 5.4% (183), HSIL in 1.4% (49) and Squamous cell carcinoma in 0.7% (24). Cervical cancer has mostly been found in women from Srebrenik 1.1% (15) and least in women from Tuzla 0.3%(4).The highest number of abnormal findings (ASCUS, ASC-H , LSIL, H SIL and Cc) was also found in women from Srebrenik 39.5% (279). The average age of the examinees with the cancer was 41.7. In 62.5% (15) of women PAP test was performed for the first time and they were diagnosed with cervical cancer. Cervical cancer hasn’t been found in women who had PAP test once a year or more. Conclusion: Women with the abnormal findings in their first PAP test and should be persuaded to accept the treatment in order to prevent development of cervical cancer.

GOAL To determine frequency of HPV infection, aerobic vaginitis and bacterial vaginosis in respondents with squamous intraepithelial lesion of lower grade comparing to respondents with normal PAP test results. MATERIAL AND METHODS Prospective research of 100 respondents has been conducted at University-Clinic Center Tuzla and Gynecology and Obstetrics Department at Primary Health Care Center Tuzla in period from May 2011 untill January 2012. Examination program included: anamnesis, clinical gynecological examination, HPV typization, microbiological examination of vaginal and cervical smear and PAP test. RESULTS High risk HPV group has been found more frequently among the respondents with LG SIL 46% (23) than in those with normal PAP result 14% (7) p < 0.05. Aerobic vaginitis has been found in the respondents with LG SIL in 28% (14) and there is statistically significant difference of this vaginitis comparing to the respondents with normal PAP result (p < 0.05). Bacterial vaginosis has been found in 12% (6) of the respondents with LG SIL and in 4% (2) of those with normal PAP result which is not statistically significant. In women with LG SIL and aerobic vaginitis in 9 cases E. coli has been isolated, in 4 E. faecalis and in 1 Staphylococcus aureus, while in women with normal PAP test results 3 cases of E.coli have been isolated. Examining changes in pH value of vaginal environment, higher measured values have been found in the respondents with LG SIL- 5.26 while in the respondents with normal PAP test result was 4.94 (p < 0.05). There is also statistically significant increase in the number of leukocytes in the respondents with LG SIL in relation to those with normal result. CONCLUSION In women with LG SIL aerobic vaginitis is very common but is not an indicator of HPV infection. An adequate treatment of aerobic vaginitis would decrease the frequency of LG SIL and number of precancerous lesions which may

UNLABELLED AIM OF THIS STUDY was to examine the frequency of cervical cancer and cervical intraepithelial lesions of a different degree in women, corelation between cytologically diagnosed CIN I, CIN II and CIN III lesions and colposcopic findings and corelation between cytologic and pathohistologic findings of CIN III lesion. MATERIAL AND METHODS Cytologic and colposcopic findings have been analysed retrospectively in 2652 women who went through systematic examinations in Women's Health Care Department at Health Center "Dr.Mustafa Sehovic" Tuzla in period 2008-2011. For 93.2% (N = 2475) cytology results were normal. Abnormal cytology result was found in 6.71% (N = 178): CIN I in 5.54% (147), CIN II in 0.67% (18) and CIN III in 0.49% (13) of women examined. RESULTS AND DISCUSSION Colposcopy in women with cytology results CIN I, CIN II and CIN III showed abnormal result in women with CIN I in 29.9% (44/147), CIN II in 61.1% (11/18) and CIN III in 61.5% (8/13). Significant association between abnormal colposcopic and abnormal cytologic findings (Chi2 = 36.30, p < 0.0005). Abnormal colposcopic result is twice as often with CIN II and CIN III changes on cervix in relation to CIN I. Byopsy of cervix in 13 women with CIN III pathohistologicaly confirmed the diagnose in 46.1% (4/13), cervix lesion was of higher degree in 30.8%, and in 23.0% (3/13) lesion of cervix was of a lower degree. Abnormal colposcopic image is an indicator for the abnormal cytological result. CONCLUSION Systematic examination of women represents an efficient way of organized screening and prevention of cervical cancer.

A test included 40 women in the reproductive age with clinical symptoms of vaginitis and microbiological examination. They were treated by combined therapy of vaginal tablets of nifuratel, 500 mg and nistatin 200 000 i. u. during six days, after which they underwent gynaecological reexamination and repeated microbiological examination of vaginal and cervical smears. An analiysis of vaginal secretion found bacterial flora in 34 smears (65%), fungus (Candida albicans) in 15 (24%) and Trichomonas vaginalis in 7 (11%). Local vaginal therapy in vaginitis caused by Trichomonas vaginalis was successfull in all 7 patients, vaginitis caused by Candida albicans was successly treated in 14 (93%) patients. Bacterial vaginitis was cured in 29 (71%) patients during this tharapy. Local vaginal combined therapy of nifuratel and nistatin is eficient in patients with vaginitis caused by fungi and Trichomonas vaginalis too.

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.

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.

Colposcopy and Pap examination in the Primary health care influence on increasing of detection precancerous lesions and cervical cancer. We analyzed 245 women from Sapna region: 90 women who were controled in University clinical centre Tuzla during 3 years period and 155 women who were controled during 9 months in the Primary health care Sapna. The results showed that the introduction of colposcopy and Pap examination in the Primary helath care increased the number controled women. There were found precancerous lesons in 48 cases: Cervical intraepithelial lesions grade 1 (CIN 1) in 38, CIN 2 in 6 and CIN 3 in 4 cases. Cervical cancer was found and confirmed in 2 cases. We concluded that the colposcopy and Pap examination on the Primary health care is most efficacious and the cheapest method for detection and prevention of the cervical cancer.

Normal pH value of vagina from 3.8 to 4.2 has regulatory and protectors mechanisms of vaginal environment. The change in the pH value indicates to presence of disbalance in the ecosystem of vaginal environment. The value of pH above 4.0 is indicator of the decreased number of lactobacillus bacteria and the increased number of other microorganisms in the vaginal environment. This situation is present in the case of developing of bacterial vaginosis. One of the bacteria which is often isolated from vaginal swabs is Enterococcus faecalis. Aims of this study are to examine presence o f Enterococcus faecalis in vagina in healthy women and womenwith signs of bacterial vaginosis, the most often present signs in patients with bacterial vaginosis and isolated Enterococcus faecalis from vaginal swabs, and to determine whether the change of the pH value of vaginal environment could be indicator for bacterial vaginosis associated with Enterococcus faecalis. In this study there were included 90 patients. To all patients there were done: gynecological survey, determined pH of vaginal environment and color of vaginal secret, amino odor test, and taken vaginal swabs for microbiological examination. Enterococcus faecalis was found in the patients with pH 4.0 in 24.05 % cases, but in the patients with signs of bacterial vaginosis it was found in 52.78 %. Positive findings of Enterococcus faecalis was the most often associated with presence of all tree signs of bacterial vaginosis (pH>4.0, changed color of vaginal secret and positive amino odor test) it is in 60.78 6% cases. With two signs of bacterial vaginosis (pH>4.0, changed color of vaginal secret) Enterococcus faecalis was present in 60 % cases. The only presence of change in the pH>4.0 was associated with Enterococcus faecalis in 52.78 %. This study showed that pH change of vaginal environment was associated with Enterococcus faecalis in bacterial vaginosis in high percentage but it can not be used as the sure sign of presence of Enterococcus faecalis in vaginal discharge. Therefore it is necessary to make microbiology examination vaginal discharge.

This investigation had an aim to establish the incidence of Enterococcus faecalis in vaginal smears and its correlation with antibiotics used for the treatment of genital and extragenital diseases, as well. By this prospective study 300 women in reproductive period have been involved. An average age was 34.5 years and 282 of them are married. They have been divided in 4 groups, 75 in every group. First group consisted women who have not been treated by an antibiotic in last 6 months; second group--women who have been treated due to infections of genital tract; third group--women were treated for unspecific colpitis and last one group were women treated for extragenital infections. A special designated questionnaire has been used to collect data from patients. A vaginal smears for microbiology examination has been taken at the Gynecological Clinic and Clinic for Infective diseases of The University Clinical Center Tuzla from patients of group I, II and IV and at the Outpatient Clinic from patients of group III. Enterococcus faecalis has been found in 112 patients (37.33%); in first group in 13 (17.33%) cases, in second group in 26 (34.66%), in third group 39 (52%), and in last group in 34 (45.33%) patients, which significantly different. Investigation on sensitivity showed a minimal sensitivity on Penicillin and Streptomycin and no resistance on Vancomycin. In conclusion, it could be said that Enterococcus faecalis was found in 17.33% patients who has not been treated by antibiotics and in 44% who used antibiotics, which differ significantly (p<0.01).