Introduction: The small intestine is a challenging organ for clinical and radiological evaluation, and by introducing imaging radiological techniques, not significantly disturbing the comfort and safety of patients, it attempts to obtain adequate diagnosis and valuable information. Aim: The research was conducted with the aim of checking the comparability and potential of diagnostic modality of ultrasound and dynamic contrast enhanced MR Enterography (DCE-MR) in patients with Crohn’s disease. Methods: 55 patients were examined prospectively, and ultrasound examination of the abdomen was performed for all patients before the MR enterography. They were subsequently endoscopically examined or treated surgically, which was taken as a reference. Four parameters characterizing the disease itself were analyzed: bowel wall thickening, presence of abscess, fistula and lymphadenopathy. Results: Comparing the accuracy of the results of ultrasound findings and findings of MR enterography, it was found that there is a significant difference in the results obtained. The study found that the sensitivity for MR enterography for bowel wall thickening was 97.8%, and the specificity was 70%, while the sensitivity for ultrasound for the bowel wall thickening was 51% and the specificity was 100%. In the diagnosis of abscess, there was no significant difference between the results obtained by ultrasound and magnetic resonance imaging (MRI) findings, while in fistula and lymphadenopathy there was a significant difference. Conclusion: Conventional ultrasound is a good orientation method in the initial evaluation of patients with Crohn’s disease, while contrast enhanced MR enterography provides an excellent assessment for disease activity as well as the complications that accompany it.

Abstract Granulysin is a recently discovered cytolytic protein of natural killer (NK) cells and cytotoxic T lymphocytes. Studies of healthy and immunocompromised patients with primary or recurrent varicella-zoster infections demonstrate the importance of virus-specific cellular immunity in controlling viral replication, but also some studies presented granulysin as a molecule that can play a role in chickenpox immunopathogenesis. This study investigated possible correlation between serum granulysin levels and clinical course of chickenpox. A total of 69 patients with chickenpox were included in the study. We measured the levels of granulysin and percentage count for CD4+, CD8+ and NK cells in serum for all patients and healthy controls. For detection and quantification of granulysin in sera, we performed ELISA test and flow cytometry for detection, identification and percentage measurement of T and B lymphocytes. Descriptive methods, analysis of variance and multivariate logistic regression were used for statistical data analysis. We found respective correlation between serum granulysin level and severity of clinical presentation. These findings can be a good input for further studies, since there is no relevant prognostic parameter of chickenpox in everyday clinical practice. Granulysin, as a therapeutic, also deserves to be a point of interests in the future. If we prove its potential to stop dissemination of human herpes viruses, possibilities to use it in some life-threatening forms of viral disease can be very valuable.

Objective: To investigate possible prognostic values of CD4+, CD8+ T-lymphocytes, CD4/CD8 ratio to clinical course of chickenpox in immunocompetent hosts. Materials and methods: We performed a prospective study which included 69 immunocompetent patients with chickenpox who were addmited to Clinic for infectious disease, Clinical Center University of Sarajevo, in a 18 month period. All patients were divided into two groups depending on clinical presentation on admission. Patients with mild clinical form were dedicated to „outpatient” group, and patients with moderate, severe or life-threatening clinical forms were dedicated to „hospitalized” group. Also 30 healthy volunteers are included in study as a control group. We analyzed values of CD4+, CD8+ percentage, CD4/CD8 ratio with comparison to clinical course of chickenpox. All specimens were taken in acute phase of illness. Results: Values of CD4+ percentage were significantly declined in a group of hospitalized patients, compared to group of outpatients and control group. Values of CD8+ percentage were higher in a group of hospitalized patients, while CD4/CD8 values were lower in comparison to a group of outpatients and control group. Conclusion: We found significant correlation between these parameters and clinical course of chickenpox.

There are differences with respect to the commonly isolated Malassezia species, not only between healthy individuals and the patients with various skin diseases, but also between different countries. We investigated the species composition of Malassezia microflora on the skin of patients with Malassezia-associated diseases and of healthy subjects (HS). Two hundred and fifty skin scrapings from patients with pityriasis versicolor (PV), seborrheic dermatitis (SD), atopic dermatitis (AD), psoriasis (PS), and healthy subjects (HS), fifty each, were inoculated into Sabouraud dextrose agar and into modified Dixon agar and identified using conventional culture-based methods. In PV and PS lesions, the most common species was M. globosa (62% and 52%, respectively), while M. restricta was predominant in SD lesions (28%). M. sympodialis was the most common species recovered from AD (52%) and healthy trunk skin (30%). Fewer cultures were positive for Malassezia growth in patients with AD than in patients with other skin conditions, and even in controls. Our data are in agreement with other studies and suggest that the pathogenic species of PV is M. globosa. The evidence that any given species is clinically important in the pathogenicity of SD, AD and PS is still lacking.

Aims: Determine health effects of programmed physical activities on blood fats in peripheral arterial disease of lower limbs or in examinees on medication therapy and examinees performing programmed physical activities along with the medication therapy. Methods: Overall research has been carried out at the Clinic for Vascular Disease CCUS. Before involvement into the study, examinees had to meet the inclusion criteria. Research was carried out as randomized controlled trial including 100 patients with arterial disease of lower limbs, who meet inclusion criteria: control group (CG, n=50) and test group (TG, n=50). Total level of cholesterol was used for effects assessment of 28 weeks of applied programmed activity in patients. Results: Values of total cholesterol (tCh) and triglycerides before and after treatment in patients of CG and TG showed statistically significant change of its mean values. Significant decrease were marked in tCh and triglycerides levels in TG compared to CG. Conclusion: Adequate programmed physical activities in patients with peripheral vascular disease appeared as very successful in treated patients. Results indicate statistically significant decrease of the cholesterol and triglycerides after the treatment. Physical activity used in the treatment made partial regression of arterial diseases and saved patients for undergoing to surgery. Lower level of total cholesterol represents a ten year period prevention of initial stage in progress of arterial diseases.

Objective: To present the epidemiological features of bronchiolitis in a one-year period in patients of Pediatric Clinic, Clinical Centre of Sarajevo University. Introduction: Bronchiolitis is the most common respiratory infection of early infant age. The disease is one the most common reason for hospitalization of children under the age of six months. The disease is characterized by occurrences in the winter season November–March. For daily diagnosing of severe forms of bronchiolitis as a clinical syndrome, often sufficient are the knowledge of the epidemiological data, age of the patient, clinical examination and insight into the risk factors. Patients and methods: The history of the disease in 155 infant patients, who were clinically treated because of bronchiolitis in the period from February 2013 to February 2014 in the Department of Pediatric Pulmonary Clinic in Sarajevo was retrospectively analyzed. Results: The majority of patients were aged less than 6 months (87.7%). The monthly distribution of bronchiolitis had a peak in January and February. Almost 50% of patients had a risk factors for the development of severe forms of bronchiolitis out of which the most common were artificial diet (53.5%), low birth weight below 2500g (17%), prematurity (16.1%), congenital heart anomalies (14.2%), bronchopulmonary dysplasia (1.9%). 46,5% of patients were on natural nutrition. 46 patients (29.6%) were serologically or by respi-strip test in nasopharyngeal lavage positive on respiratory syncytial virus (RSV). There were no patients who required mechanical ventilation. Conclusion: During the one-year period, bronchiolitis was the most common diagnose in the early infantile period up to 6 months, with a peak incidence in January and February. Risk factors such as prematurity, low birth weight, congenital heart anomalies and bronchopulmonary dysplasia have been less present in the studied period compared to the period before the introduction of RSV chemoprophylaxis. The epidemiological data obtained have facilitated the diagnosis, and accordingly the timely and appropriate treatment of bronchiolitis.

A mumps outbreak reported from the Federation of Bosnia and Herzegovina involved 7,895 cases between December 2010 and September 2012. This was the largest outbreak in the country since the introduction of the measles, mumps and rubella vaccine in 1980. The highest disease incidence was found among 15 to 19 year-olds. About 39% (3,050/7,895) of cases reported to be unvaccinated; the vaccination status of 31% (2,426/7,895) was unknown. A seroprevalence study among 150 asymptomatic contacts to mumps cases showed that about one third (45/150) were susceptible to mumps. Among 105 clinically suspected mumps patients hospitalised at the Clinical Centre of the University of Sarajevo, orchitis (60% of all males: 51/85) and meningitis (9%: 9/105) were the most common complications. Among 57 outbreak sequences obtained for the small hydrophobic gene, eight different variants of genotype G viruses were identified. The outbreak affected mainly age groups comprising individuals who were not vaccinated during or after the Bosnian war, as well as cantons with single dose immunisation policies until 2001. In addition to issues related to vaccination of individuals, differential responses to vaccines and vaccine strains, waning of antibodies and potentially also the genetically diverse variants of genotype G may have compounded the size and duration of the outbreak. Our report emphasizes the need for supplementary immunisation programmes in particular for adolescents and young adults.

The clinical utility of serum procalcitonin (PCT) levels continues to evolve. PCT is regarded as a promising candidate marker for making a diagnosis and antibiotic stewardship in patients with systemic infections. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and to discuss the reliability of this marker when used with validated diagnostic algorithms.

BACKGROUND The degree of spreading of Hodgkin's lymphoma (HL) is usually estimated according to An Arbor classification system and its modifications. Some laboratory parameters are routinely determined at diagnosis and their abnormal values tries to correlate with disease activity or extension. OBJECTIVES of the research were to identify relationship between common laboratory parameters used in patients with HL, with focus on Serum copper level (SCL) and the degree of spreading of disease expressed through clinical stage (CS). MATERIALS AND METHODS Research was carried out through retrospective analysis of medical records of 47 previously untreated HL patients. The study evaluated descriptive statistical parameters, mean, median, standard deviation, minimum and maximum values, ANOVA, X2 test, Man-Whitney test and Spearman's correlation. Statistical analyzes performed using SPSS statistical software v.13.0. Results have presented in form of tables and graphs. Significance level less than 0.05 considered significant. RESULTS The results of study shown good sensitivity of SCL (61,9%), and very high specificity (95,3%) in diagnosis of HL. PPV of SCL in our study was 92,9%, and NPV-- 71,9%. On the other hand, the results did not confirm correlation between serum copper level and spreading of disease. Serum levels of albumin, gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) showed good correlation with clinical stage. CONCLUSION Our results did not confirm significance of serum copper level in term of staging of HL. Sensitivity and significance of serum copper in HL was very good and real prognostic impact of its elevated level in these patients should be assessed, and the research conducted on a larger number of subjects. Key words: Hodgkin's

UNLABELLED Analyzing data in the literature, it is noted that in-hospital acquired infections are an increasing problem even in more developed countries. This increasing trend is related to the progress of medical science and introduction of new invasive diagnostic-therapeutic methods, as well as increase of multiresistant types of bacteria, including staphylococci in big percentages. GOALS To analyze frequency of in-hospital acquired staphylococcus bacteremia/sepsis. PATIENTS AND METHODS Anamneses of patients who were diagnosed with staphylococcus bacteremia/sepsis were analyzed within a ten-year period. RESULTS Within the analyzed period from 2001 to 2011, there were 87 patients with diagnosis of staphylococcus bacteremia/sepsis, out of which (20) 77% were diagnosed with sepsis, and (67) 23% with bacteremia. In-hospital outcome was present with 32 (36.8%) patients, while 55 (63.2%) were out of hospital. The chi-square test for independence showed that the diagnosis of bacteremia/sepsis and the place of the infection origin (in hospital/ out of hospital) were independent chi2 = 1.951 df= 1 p=0.162. The cause isolated from hemoculture depends on the place of the infection origin (out of hospital/in hospital); larger percentage of methicillin-resistant types was presented in in-hospital acquired infections chi2 11.352 df=1 p=0.001. And the chi-square test for independence showed both dependence of the preceding antibiotic treatment and the place of the infection origin in both categories of patients. Sepsis: chi2 = 22.92 df=1 p<0.0005; Bacteremia: chi2 = 9.89 df=1 p= 0.005. CONCLUSION The results showed larger percentage of methicillin-resistant types in in-hospital acquired infections, as well as significantly larger percentage of hospital infections with the preceding antibiotic therapy, which puts in focus possible rationalization of including antibiotic therapy.

Introduction: Chickenpox is very contagious childhood disease, which occurs due to varicella-zoster virus (VZV) primary infection. Disease in healthy children resolves usually without complications, but risk of complication is much higher in adults and immunocompromised hosts. The goal of this study was to determine different clinical and epidemiological characteristics, laboratory features, clinical course, and outcome of chickenpox in children and adults. Material and methods: The descriptive study was conducted at the Department of Infectious Diseases, Clinical Center in Sarajevo, Bosnia-Herzegovina. The study included 120 patients chosen randomly. We compared their clinical and epidemiological characteristics, laboratory investigations, complications and the outcome of the disease. Results: Age of patients was in range from one to 48 years. Male patients prevailed in both groups (65% in adults, 52% in children). Hospitalization rate was 10.7/100,000 inhabitants. Positive contact with chickenpox was confirmed in 80% adults and 82% children. Dominating symptoms were fever, rash and muscle aches. Levels of C-reactive protein, erythrocyte sedimentation rates (ESR) and fibrinogen levels were elevated in both groups, while thrombocytopenia was presented in 33% of adults and 3% of children. Adults had complications in 83.3% and their hospitalization rate was longer compared to children (11.5 days vs. 9.5 days, p<0.001). Conclusions: Chickenpox is a potentially severe illness in adult patients. Introduction of active immunization in BosniaHerzegovina should be considered to prevent severe forms of chickenpox. J Microbiol Infect Dis 2012; 2(2): 64-67

SUMMARY CONFLICT OF INTEREST: none declared. Introduction Brucella endocarditis (BE) is a rare but severe and potentially lethal manifestation of brucellosis. Pre-existing valves lesions and prosthetic valves (PV) are favorable for BE. Case report We represent the case of a 46-year-old man who was treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, as blood culture positive (Brucella melitensis) mitral and aortic PV endocarditis. He was treated with combined anti-brucella and cardiac therapy. Surgical intervention was postponed due to cardiac instability. Four months later he passed away. Surgery was not performed.

SUMMARY The 4th Congress of Infectiologists of Bosnia-Herzegovina with international participation was held in Konjic, on 30. May to 02. June 2012. In addition to the prominent infectious disease experts from almost all university centers in B&H, the teachers at medical schools in Bosnia-Herzegovina, infectious disease specialists who work in health institutions in B&H, this Congress was attended by infectious disease experts from Serbia (12 participants), Turkey (3 participants), Croatia (3 participants), Macedonia (3 participants), Germany (2 participants) and Montenegro (2 participants). Topics included: Infections of the skin, soft tissue and bones, Sepsis and endocarditis, Infectious diseases emergencies and pediatric infectology, Emerging and reemerging infectious diseases, Hospital infections, Sexualy transmitted diseases, Infectious diagnostic and therapeutic protocols. Participating invited speakers were following professors: Salih Hosoglu (Turkey), Hakan Leblebicioglu (Turkey), Resat Ozaras (Turkey), Karsten Plötz (Germany), Ilija Kuzman (Croatia), Bruno Baršić (Croatia), Goran Tešović (Croatia). In addition to experts in infectious diseases at this Congress, their works were presented by experts from other medical disciplines, but with infectious character issues (Professors: Sead Ahmetagić, Ismet Gavrankapetanović, Zora Vukobrat-Bijedić, Senija Rašić, Halima Resić, Adnan Kapidžić, Ivo Curić, Jelena Ravlija, Amela Begić, Izet Mašić, Sadeta Hamzić, and others). Some of the papers that were presented at this Congress have been published in extenso, in the Medical Archives and Materia Socio Medica. One part as abstracts (both journals are indexed in over 10 databases), and will be electronically available to the general scientific community in Bosnia-Herzegovina, Europe and worldwide. In this way, the Bosnian infectious disease experts, as a science and profession, will be worthily represented to the colleagues from other countries in the region and beyond.

Introduction: Pulmonary thromboembolism (PTE) is the most serious manifestation of thromboembolic disease. Objective: To determine the most common risk and etiologic factors of pulmonary tromboembolism in patients treated in Intensive care unit of Clinic for Pulmonary Diseases and TB “Podhrastovi” in three-year- period from 2008. to 2010. Material and methods: We retrospectively analysed patients with PTE treated in Intensive care unit of Clinic for Pulmonary Diseases and TB “Podhrastovi” in three-year period from 2008. to 2010. PTE was diagnosed by high resolute computed tomography, in most of them ventilatory /perfusion scintigraphy (V/P SPECT) was made, with proper laboratory analyses (D-dimmer, platelets , fibrinogen, and if it was needed protein C, S and AT III factor were examined). In all of them echosonography of abdomen and pelvis was done, also the examination by angiologist, and in patients with indications echosonography of the heart and Color Doppler of leg veins was made. We analysed risk and etiologic factors for PTE in each patient. Results: In 222 treated patients with PTE risk factors were found in 124 or 55.86% patients, etiologic factors were found in 31 or 13.96%, and both risk and etiologic factors in one patient were found in 18 or 8.11% patients. Conclusion: PTE is very serious disease that very often has fatal prognosis, and can develop with previously entirely healthy people, and as soon as we become suspicious of its presence we have to made appropriate diagnostic procedures and include appropriate therapy. We can after look for risk and etiologic factors and try to influence them.

Organized by the Association of Infectologists of Bosnia and Herzegovina and the Clinic of Infectious Diseases, Clinical Center of Sarajevo University in the period from 30th May untill 2nd of June in Konjic was held the 4th Congress of Infectologists of B&H with international participation. This was the biggest meeting of infectious disease and allied disciplines specialists in the last six years, with the presence of more than 100 participants. The Congress was held under the auspices of the Clinical Center of Sarajevo University and the Federal Ministry of Health. In addition to infectologists the Congress was attended by a large number of experts from related medical fields: microbiologists, epidemiologists, orthopedists, gastroenterologists, nephrologists, neurosurgeons, pediatricians, audiologists, oncologists. Topics were current and were related to sepsis, endocarditis, osteomyelitis, nosocomial infection, pediatric infectious diseases, emergent and re-emergent diseases, therapeutic protocols for the presentation of new knowledge in these fields. A total of about 90 papers were presented, while participants of the Congress were experts from Bosnia and Herzegovina, neighboring countries (Croatia, Serbia, Montenegro, Macedonia) but also Turkey and Germany. Congress by the participants was rated as very successful and well organized, with arrangements for the continuation and improvement of cooperation and possible joint organization of symposia and seminars with colleagues from abroad