Background: The use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased siginificantly in recent years. Many additives to local anesthetics to prolong the duration of analgesia for peripheral nerve blocks have been studied. Dexamethasone has been studied as an effective adjuvant to prolong the analgesia duration of local anesthetics in peripheral nerve block. However, the route of action for dexamethasone and its potential neurotoxicity are still unclear. The aim of this study is to determine possible toxic effects of dexamethasone on peripheral nerve tissue and the dependence of these effects on the place of intraneural applications. Methods and Materials: A rat sciatic nerve block model was used.  The study was conducted in accordance with the principles of laboratory animal care and was approved by the Laboratory Animal Care and Use Committee. Fifty adult Wistar rats (300 g) both sexes were studied. After induction of general anesthesia, the sciatic nerve was exposed bilaterally. Sciatic nerves were randomly assigned by the method of sealed envelopes to recive: intraneural, intrafascicular 2 mL of lidocaine with dexamethasone  (n=25), intraneural, extrafascicular injection  2 mL of lidocaine with dexamethasone (n=25),  perineural 2 mL of lidocaine with dexamethasone  (n=25) and perineural 2 mL of saline 0.9%  (n=25). Injection pressure was continuosly recorded using an in-line digital manometer. Increased injection pressure was used to distinguish intrafascicular from extrafascicular inrtaneural injections. After injection, the rats were awakened and subjected to serial neurologic examinations. Neurologic examination protocol was followed to determine proprioception by tactile placement response, motor function by extensor postural thrust and nociception by withdrawal reflex. On day 3 of the experiment, the animals were sacrificed and the neural tissue histologically examined. Results: Intraneural injections (intrafasciculary and extrafasciculary) of lidocaine in combination with dexamethasone caused neurological deficits and severe pathohistological damage to nerve fibers. All perineural injections (independent of the tested solution), combined with low injection pressure showed a uniform changes, with minimal histological deviation of the normal structure of the nerve fiber. Conclusions: When applied intraneuraly dexamethasone in combination with lidocaine caused nerve fiber damage. However, future studies are required to elucidate the most effective route and optimum dosing range for dexamethasone’s use in this field.

Grazyna ADLER*, Anna PAWIŃSKA-MATECKA, Agnieszka GARSTKA, Nermin Nusret SALKIC, Amina VALJEVAC, Beata KARAKIEWICZ 1 Department of Gerontobiology, Pomeranian Medical University, Szczecin, Poland 2 Central Laboratory, Regional Hospital, Szczecin, Poland 3 Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina 4 Laboratory for Molecular Medicine, Center for Genetics, Medical Faculty, University Sarajevo, Sarajevo, Bosnia and Herzegovina 5 Public Health Department, Pomeranian Medical University, Szczecin, Poland

Introduction: Renalase is a protein secreted in kidneys and considered as a blood pressure modulator. High rates of hypertension and its regulation in patients on hemodialysis demands search for potential cause and treatment. The aim of this study was to determine the genotype and allele frequencies of renalase gene rs2576178 polymorphism in population from Bosnia and Herzegovina. Also, the objective of present study was to find the possible association between renalase gene rs2576178 polymorphism and hypertension in patients on hemodialysis. Material and Methods: The genotype of renalase gene rs2576178 polymorphism was determined in 137 participants (100 patients on hemodialysis and 37 controls), using polymerase chain reaction (PCR) and subsequent cleavage with MspI restriction endonuclease. Genotype and allele frequencies were assessed for Hardy-Weinberg equilibrium using a Chi-squared test. The value of P<0.05 was considered as statistically significant. Results: Comparison of genotype distribution and allele frequency in participants on hemodialysis with and without hypertension, and healthy control showed no statistical difference. Conclusion: The results of the study suggest that renalase gene rs2576178 polymorphism is not a factor that influences blood pressure in patients on hemodialysis.

Objectives: Postmenopausal period is associated with the decline in antioxidant levels due to gradual loss of estrogen, increased body weight and central adiposity. The present study aimed to evaluate association of adiposity and regional fat distribution with total antioxidant capacity in postmenopausal women. Methods: This cross-sectional study included 90 apparently healthy postmenopausal women. We measured anthropometric indices including body mass index (BMI), waist circumference (WC) and waist-hip ratio (W/H ratio). Total fat mass (TFM), total lean mass (TLM), percentage fat mass (%FM), visceral fat diameter (VFD) and subcutaneous fat diameter (SFD) were measured using ultrasound. Serum total antioxidant capacity (TAC) was measured by quantitative colorimetric determination using Total antioxidant Capacity -QuantiCromAntioxidant Assay Kit (BioAssay systems, USA; DTAC-100). Results: Out of 90 postmenopausal women, 35.9% were overweight and 25.0% obese, while 60.9% had central obesity. Postmenopausal obese women had significantly lower median TAC level [308.3 (283.0-375.1)] mM Trolox equivalents compared to overweight [383.38 (356.5-389.4) mM Trolox equivalents; p<0.001] and normal weight women [376.3 (318.0-388.7) mM Trolox equivalents; p<0.005]. Serum logTAC level was inversely associated with BMI, TFM, TLM and WC in postmenopausal women. However, when stratified by central obesity, inverse associations between serum logTAC level and BMI (r=-0.503; p<0.001), TFM (r=-0.383, p=0.004) and WC (r=-0.408; p=0.002) were observed only in postmenopausal women with central obesity. Conclusion: Our results provide evidence that obesity and central obesity during postmenopausal period are associated with decreased total antioxidant capacity and depleted antioxidant defenses possibly due to elevated oxidative stress. Larger prospective studies are needed to evaluate whether obese postmenopausal women might benefit from antioxidants supplementation for the prevention of obesity related diseases. Keywords: total antioxidant capacity, oxidative stress, obesity, overweight

Abstract Background: Venous thrombosis (VT) affects 1–2 out of 103 individuals each year. Mutations of 1691G > A FV gene, 20210G > A PT gene and 677C > T gene MTHFR are common in Europe and increase the risk of venous thrombosis. To the authors’ knowledge, this is the first report on the prevalence of these mutations in the general population of Bosnia and Herzegovina. Aim: The aim of this study was to simultaneously analyse main VT associated polymorphisms and compare the results with those published for other European populations. Data sources: Electronic databases including Medline and Embase were searched from 1995 to December 2013. Subjects and methods: The subjects of the study consisted of 100 unrelated healthy people from Bosnia and Herzegovina (82 female and 18 male). The mean age of the cohort was 58.8 (±10.7) years. PCR-RFLP was used for measurement of allele frequencies. Results: All three SNPs were found to be polymorphic, with allele frequencies of 6.0%, 6.0% and 37.5% for 1691A FV, 20210A PT and 677T MTHFR, respectively. Conclusion: Further studies on larger cohorts with an adequate female-to-male ratio are necessary to confirm a high prevalence of hereditary thrombophilia in the Bosnian population.

The endothelial cell layer is responsible for molecular traffic between the blood and surrounding tissue, and endothelial integrity plays a pivotal role in many aspects of vascular function. Cardiovascular disease (CVD) is the main cause of death in patients with chronic kidney disease (CKD) and its incidence and severity increase in direct proportion with kidney function decline. Non-traditional risk factors for CVDs, including endothelial dysfunction (ED), are highly prevalent in this population and play an important role in cardiovascular (CV) events. ED is the first step in the development of atherosclerosis and its severity has prognostic value for CV events. Several risk markers have been associated with ED. Reduced bioavailability of nitric oxide plays a central role, linking kidney disease to ED, atherosclerosis, and CV events. Inflammation, loss of residual renal function, and insulin resistance are closely related to ED in CKD. ED may be followed by structural damage and remodelling that can precipitate both bleeding and thrombotic events. The endothelium plays a main role in vascular tone and metabolic pathways. ED is the first, yet potentially reversible step in the development of atherosclerosis and its severity has prognostic value for CV events. Therefore, evaluation of ED may have major clinical diagnostic and therapeutic implications. In patients with CKD, many risk factors are strongly interrelated and play a major role in the initiation and progression of vascular complications that lead to the high mortality rate due to CVD.

Objectives : Alternations in adipokines secretion associated with obesity could play an important role in diet-induced diabetes. The aim of our study was to estimate the impact of high-fat diet on serum adiponectin and leptin levels in streptozotocin (STZ) induced type 2 diabetes mellitus (T2DM). Methods : The study included 40 adult male Wistar rats were divided into four groups: Standard food control group (C-Non-HF)(n=10), standard food STZ group (STZ-NonHF)(n=10), high-fat diet control group (C-HF)(n =10) and high-fat diet STZ group (STZ-HF)(n =10). C-NonHF and STZ-NonHF group was fed with regular chow, and other two groups were given high-fat diet for 5 weeks. Type 2 DM was induced by single intra-peritoneal STZ injection (60 mg/kg). All the rats were fasted for 12 hours; when blood samples were taken for the measurement of serum leptin and adiponectin level by ELISA. Results : Mean serum adiponectin level was significantly lower in STZ-HF (1.34±0.57 ng/mL) compared to STZ-NonHF (2.61±0.79 ng/mL), C-NonHF (3.13±0.74 ng/mL) and C-HF group (3.04±0.63 ng/mL) (p<0.01). Mean serum leptin level was significantly higher in STZ-HF (1792.0}1378.8 pg/mL) compared to STZ-NonHF (634.0}149.1 pg/mL), C-NonHF (671.5}164.0 pg/mL) and C-HF group (593.8}200.8 pg/mL) (p<0.05). In STZ-HF group, a significant positive correlation between leptin and glucose level was observed (r=0.71; p=0.048). Conclusion : Our study results show that high fat diet induces an increase in serum leptin and the decrease in adiponectin levels in STZ diabetic rats and suggests that high fat diet impairs glucose control by increasing leptin secretion. Key words: Diabetes mellitus, leptin, adiponectin, obesity

Recent evidence has demonstrated the role of CCR5Δ32 in a variety of human diseases: from infectious and inflammatory diseases to cancer. Several studies have confirmed that genetic variants in chemokine receptor CCR5 gene are correlated with susceptibility and resistance to HIV infection. A 32-nucleotide deletion within the CCR5 reading frame is associated with decreased susceptibility to HIV acquisition and a slower progression to AIDS. Mean frequency of CCR5Δ32 allele in Europe is approximately 10%. The highest allele frequency is observed among Nordic populations (about 12%) and lower in the regions of Southeast Mediterranean (about 5%). Although the frequency of CCR5Δ32 was determined in numerous European populations, there is a lack of studies on this variant in the Bosnia and Hercegovina population. Therefore, the aim of our study was to assess the frequency of CCR5Δ32 allele in the cohort of Bosniaks and compare the results with European reports. CCR5Δ32 was detected by sequence-specific PCR in a sample of 100 healthy subjects from Bosnia and Herzegovina (DNA collected 2011-2013). Mean age of the cohort being 58.8 (± 10.7) years, with 82% of women. We identified 17 heterozygotes and one mutant homozygote in study group, with mean ∆32 allele frequency of 9.5%. CCR5∆32 allele frequency among Bosniaks is comparable to that found in Caucasian populations and follows the pattern of the north-southern gradient observed for Europe. Further studies on larger cohorts with adequate female-to-male ratio are necessary.

Studies that investigated an association between asymmetric dimethylarginine (ADMA) and glycated haemoglobin (HbA1c) in type 2 diabetes mellitus (T2DM) have given discordant results. The aim of this study was to determine and compare serum ADMA concentration in patients with T2DM and healthy controls, and to assess correlation between ADMA and HbA1c in patients with T2DM. Serum ADMA concentration was determined by ELISA method with the use of ADMA ® - ELISA kit (DLD Diagnostics, Hamburg, Germany) and HbA1c levels were determined by an immunoturbidimetric method in 60 patients with T2DM and 60 healthy individuals matched for age and sex. Results have shown that mean serum ADMA concentration was significantly higher in T2DM patients (1.54±0.06 μmol/L) compared to mean serum ADMA concentration (0.62±0.02 μmol/L; p<0.0001) in healthy subjects. A significant, positive, correlation between serum ADMA concentration and HbA1c levels was observed (r=0.494; p<0.01) in T2DM patients. Our results suggest that there is an association between endothelial dysfunction and glycaemic control in type 2 diabetes mellitus. Possible explanation for obtained results may be oxidative stress that is increased in conditions of hyperglycaemia and it also promotes endothelial dysfunction. Larger, longitudinal studies are required that will evaluate relation between metabolic abnormalities and increased ADMA levels in patients with type 2 diabetes mellitus.

The aim of the study was to detect prevalence of MBL2 exon 1 (codons 52, 54 and 57) genetic polymorphism in postmenopausal women in Bosnia and Herzegovina and its possible role as genetic risk factor for susceptibility to occurrence of osteoporosis in this study group. Also, we investigated association between MBL serum concentrations and osteoporosis in postmenopausal women. Genetic codons' variations were determined by PCR-RFLP and MBL in serum was measured by ELISA method in 75 postmenopausal women (37 with osteoporosis and 38 apparently healthy, non-osteoporotic women serving as a control). Serum MBL levels were not significantly different between osteoporosis and control group (492 (37-565.1) and 522.6 (477-559.4) ng/mL respectively, p=0.206). Genotype frequencies were not significantly different (p=0.997) between the studied groups of postmenopausal women. Genotype frequencies A/A, A/0 and 0/0 in osteoporosis group were 0.576; 0.405; 0.018 and in control group 0.562; 0.412; 0.026, respectively. Frequencies of A and 0 allele were 0.78 and 0.22 in osteoporosis and 0.77 and 0.23 in control group. The results do not suggest association of functional polymorphism of MBL2 gene and MBL serum concentration with osteoporosis in postmenopausal females.

Exercise training may increase production of free radicals and reactive oxygen species in different ways. The training type and intensity may influence free radicals production, which leads to differences in oxidative stress status between athletes, but the results of the previous studies are incosistent. The aim of our study was to estimate oxidative stress status in elite athletes engaged in different sport disciplines. The study included 39 male highly skilled professional competitors with international experience (2 Olympic players): 12 wrestlers, 14 soccer players and 13 basketball players in whom we determined the levels of advanced oxidation protein products (AOPP) and malondialdehyde (MDA), as markers of oxidative stress and the total antioxidative capacity (ImAnOX) using commercially available assay kits. The mean AOPP concentration was not significantly different between soccer players, wrestler and basketball players (60.0 ± 23.0 vs. 68.5 ± 30.8 and 80.72 ± 29.1 μmol/L respectively). Mean ImAnOX concentration was not different between soccer players (344.8 ± 35.6 μmol/L), wrestlers (342.5 ± 36.2 μmol/L) and basketball players (347.95 ± 31.3 μmol/L). Mean MDA concentration was significantly higher in basketball players (1912.1 ± 667.7 ng/mL) compared to soccer players (1060.1 ± 391.0 ng/mL, p=0.003). In spite of this fact, oxidative stress markers levels were increased compared to referral values provided by the manufacturer. Type of sports (soccer, wrestler or basketball) have no impact on the levels of oxidative stress markers. Elite sports engagement is a potent stimulus of oxidative stress that leads to the large recruitment of antioxidative defense. Oxidative stress status monitoring followed by appropriate use of antioxidants is recommended as a part of training regime.

Objectives: The purpose of this study was to determine endothelin (ET)-1 and nitric oxide (NO) serum concentration levels at baseline and after 1 year of peritoneal dialysis (PD) treatment. A further aim was to evaluate the association between ET-1 and NO with parameters of echocardiography and the common carotid artery (CCA) ultrasound, and to assess their impact on cardiovascular remodeling. We also aimed to evaluate the influence of dialysis adequacy and residual renal function (RRF) on cardiovascular remodeling. Methods: This study included 40 PD patients in whom we measured serum ET-1 and NO concentrations, echocardiography and CCA ultrasound parameters. Results: ET-1 decreased and NO serum concentration levels increased (p < 0.01) after 12 months of PD treatment compared to baseline values. Left ventricular (LV) hypertrophy was observed in 77.5% of patients at baseline with significant reduction in LV mass index (LVMI), CCA intima media thickness (IMT) and plaque score after 12 months of PD treatment (p < 0.001). The dialysis adequacy and RRF were significantly associated with LVMI and CCA IMT after 12 months on PD. Conclusion: In our study, ET-1 significantly decreased while NO increased during PD treatment and both were independently related to the cardiovascular remodeling parameters in PD patients.

The aim was to examine the predictive value of two different equations for glomerular filtration rate (GFR) assessment: Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) in patients with chronic kidney diseases(CKD). We also aimed to compare sensitivity and specificityof the predictive equations in renal function assessment. Thestudy included 75 patients with CKD who were further dividedinto four groups according to the stages of disease (CKDStage 1-4) and 25 healthy subjects. The GFR was estimatedusing CG and MDRD equations. The estimated GFR valuesusing the MDRD equation in all groups were lower comparedto those calculated using the CG equation. In patientswith CKD stage 1, GFR was significantly lower as estimatedby MDRD compared to CG equation (p=0.032). The ROC curves for estimated GFR using CG and MDRD equations in CKD patients vs healthy subjects were significant (AUC for CG 0.839 and for MDRD 0.923; p<0.0005). The optimal cutoff value for GFR estimated by CG equation was 62.86 mL/min (sensitivity 81.25%; specificity 76%) and for estimated GFR using MDRD equation 57.2 mL/min/1.73° m2 (sensitivity91.3%; specificity 81%). MDRD equation yields higher sensitivity and specificity in predicting GFR in patients with CKD compared to CG equation. Key words: chronic kidney disease, glomerular filtration rate, Cockcroft-Gault equation, modification of diet in renal disease (MDRD) study equation