1University Clinical Center Sarajevo, Sarajevo School of Science of Technology, Sarajevo, Bosnia and Herzegovina 2University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina KeYWORdS: prosthetic valve thrombosis, thrombolytic drug. citAtiON: Cardiol Croat. 2019;14(3-4):47. | https://doi.org/10.15836/ccar2019.47 *AddReSS FOR cORReSPONdeNce: Behija Hukeljić Berberović, Klinički centar Univerziteta u Sarajevu, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina. / Phone: +387-33-297941. Fax: +387-33-298-522 / E-mail: behijaberberovic@yahoo.com ORcid: Behija Hukeljić Berberović, https://orcid.org/0000-0001-9583-4523 • Nermir Granov, https://orcid.org/0000-0002-6228-6230 Zina Lazović, https://orcid.org/0000-0002-0285-9631 • Lejla Divović, https://orcid.org/0000-0002-7953-9601 Omer Perva, https://orcid.org/0000-0003-2645-1558

Background Postoperative bleeding in patients who underwent elective coronary artery bypass surgery (CABG) may increase due to preoperative anticoagulant therapy indicative of their disease - acute coronary syndrome or implanted coronary artery stent. Increased bleeding in many cases requires the use of blood and blood derivatives, and sometimes even reoperation. Their use poses the risk of complications, may extend the hospitalization. Methods Our observation retrospective study included 131 patients, 41 treated with aspirin and 90 treated with aspirin and clopidogrel. All underwent for the first time elective on-pump isolated CABG surgery at Clinic for cardiovascular surgery of Clinical Center University of Sarajevo, in period June 2016 to September 2017. The data were collected from patient’s records. Results Out of 131 patients,73.3% were male. The average age was 62. The average total drainage during the first 48 postoperative hours in ASA group was 1027.4±404.9ml and 1049.8±371.3ml in DAPT group. The mean number of whole blood transfusions in the DAPT group washigher compared to ASAgroup. The average number of fresh frozen plasma were higher in the DAPT group 0.84±0.51 compared to the group ASA 0.39±0.07, as well the average thrombocytes transfusions were slightly higher in the DAPT group. Statistical analysis suggests that there is no significant difference between the observed groups (p>0.05). Also, our study did not show a statistically significant difference between arrhythmia onset, the length of mechanical ventilation, use of protamineand tranexamic acid. Reoperation due to postoperative bleeding was recorded in 2 cases in the DAPT group as well as 2 lethal cases. Conclusion In our study, we could not demonstrate less postoperative bleeding and use of blood and blood products in a group of patients who were preoperatively treated with aspirin compared to patients with dual antiplatelet therapy in the elective isolated CABG surgery.

Introduction Excess dilatation of the left atrium >65 mm is known in the literature as gigantic atrium. This dilation is most commonly encountered in the mitral insufficiency of rheumatic etiology, but also in severe prolapses of the mitral valve, permanent atrial fibrillation, and at the left right shunt with cardiac insufficiency. Case report In this paper is presented a case study of echocardiographically verified giant thrombus in left atrium in a 50 years old female patient aged 50 hospitalized because of tiredness, choking, heartburn and urinary tract symptoms. The patient had rheumatic fever at age of 18 years. At age of 35, she was diagnosed with mitral stenosis. In permanent atrial fibrillation with anamnestic data on the previous cerebrovascular stroke (CVI) and the repeated transitional ischemic seizures. Echocardiographic examination confirmed severe mitral stenosis with moderate aortic insufficiency and gigantic left atrium (LA) with gigantic thrombus. Invasive diagnostics were indicated and performed, followed by an acute cardiac surgery including left atrial thrombectomy and implantation of the mechanical aortic and mitral valve. The surgical course was without complications. Conclusion On eleven postoperative day, after mobilization, the patient experiences stroke with motor aphasia. She was clinically recovering from stroke consequences, and remains cardiollogically stable.

Patients with cancer in developing and low-income countries have limited access to targeted cancer therapies. The transitional nature of these economieshas influencedhealthcare funding,whichhas resulted in the unavailability of targeted cancer treatments. Besides the three studies that will be described here, to our knowledge, no literature exists on the clinical outcome of patients treated with delayed targeted cancer therapy. To raise awareness on the importance of timely targeted cancer treatment, we will discuss three key issues: (1) the low number of targeted cancer therapies for different cancers, (2) thedelay incancer treatment, and (3) the unavailability of cancer diagnostics.

1Travnik General Hospital, Travnik, Bosnia and Herzegovina 2Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina KeYWORdS: patent foramen ovale, management. citAtiON: Cardiol Croat. 2019;14(3-4):92-3. | https://doi.org/10.15836/ccar2019.92 *AddReSS FOR cORReSPONdeNce: Alma Sijamija, J.U. Bolnica Travnik, Kalibunar bb, 72270 Travnik, Bosna and Herzegovina. / Phone: +387-61-780-085 / E-mail: alma.sijamija@hotmail.com ORcid: Alma Sijamija, http://orcid.org/0000-0003-2818-0501 • Nermir Granov, http://orcid.org/0000-0002-6228-6230 Alma Agačević, http://orcid.org/0000-0003-4671-0991 • Omer Perva, http://orcid.org/0000-0003-2645-1558 Nedžad Hadžić, http://orcid.org/0000-0002-7186-7803

Aim: The aim of this study was to examine the impact of antibiotic consumption on development of antimicrobial resistance in Acinetobacter baumannii. Material and Methods: The study was conducted in University Clinical Center of Sarajevo. In our retrospective study Acinetobacter baumannii isolated in period from July 1st 2009 to December 31st 2012. Isolates were detected from different clinical samples including urine, wound swab, blood, bronchial aspirate and other samples which were collected from patients situated on various hospital wards. Clinical isolates belonged to one per patient in a given period of time. Results: Antimicrobial resistance was interpreted according to CLSI breakpoints. Consumption of antibiotics was analyzed according to recommendations of the ESAC-Net and current Acinetobacter baumannii classification. Pearson’s correlation showed a positive correlation between gentamicin consumption and emerging of resistance (p = 0.023). Conclusion: Increase in the antimicrobial use was followed with an increase in resistance of Acinetobacter baumannii isolates. Monitoring of antibiotic resistance and consumption is of a great importance in order to reduce the emergence and spread of antimicrobial resistant organisms in the health care settings.

1Travnik General Hospital, Travnik, Bosnia and Herzegovina 2Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Aim: This study sought to assess whether the volume and osmolarity of contrast media (CM) influences the occurrence of contrast induced nephropathy (CIN) following coronarography procedure. CIN can be defined as an increase in the serum concentration of creatinine greater than a 25% from baseline during the period of 12 to 48 hours after the administration of radiocontrast media. Material and methods: We examined 100 patients without diabetes with serum creatinine concentration from 45 mmol/l to 141 mmol/l and 100 patients with diabetes with serum creatinine concentration from 46 mmol/l to 161 mmol/l who underwent coronary angiography. During procedure they received iso-osmolar contrast medium, Visipaque 320 (iodixanol-320), for group without diabetes from 40 to 340 ml and for group with diabetes from 49 to 310 ml. Results: CIN occurred in 27 (13,5%) of the 200 study patients. There was a trend toward higher prevalence of CIN (16% vs.11%, p = 0.086) in the diabetic group compared with the non-diabetic group. Patient with diabetes received less contrast media, they are younger but number patients with CIN are higher. Conclusion: Increasing contrast media dose is associated with the occurrence of CIN following coronarography. But, another risk factors like diabetes mellitus, old age, male sex and preexisting kidney disease have influence of developing CIN after coronarography.

IntroductIon: Cardiac tumors can be primary (benign or malignant), with incidence from 0.002 to 0.3% according to autopsy reports, and secondary which are more common, found in about 5-10%. The most common primary tumor of the heart is the myxoma. About 75% of all myxomas are located in the left atrium. They occur in all age groups, usually from the third to the sixth decade. They are more common in women, usually solitary, round tumors with a diameter of 10 cm, uneven surfaces.