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Incidence of hospital mortality in polytrauma patients in a tertiary center in Bosnia and Herzegovina
Get PDFIntroduction: In the late 70s of the last century, the mortality rate due to polytrauma amounted to 40%. This led to a new approach to this patient category with the goal of improving the treatment outcome. According to the German trauma register, the rate of mortality in polytrauma at the end of the last century was 18.6%. The goal of this study is to determine the incidence of hospital mortality in polytrauma patients in a tertiary institution in Bosnia and Herzegovina.Methods: We analyzed patient medical records from the Intensive Care Unit of the Clinic of Orthopedics and Traumatology at University Clinical Center Sarajevo, from January 1, 2012 to December 31, 2012.Results: There were 70 polytrauma patients in 2012, with average age 47.55 (range 8-77) years. Half of the patients were younger than 50 years. Age groups most frequently affected were 61 and older (25.7%), 51-60 years (24.3%), and 31-40 years (21.4%). Lethal outcome occurred in 10 patients (14.3%), while 60 patients (85.7%) survived and were treated until discharge or transfer to a different department. The average Injury Severity Score (ISS) in patients with lethal outcome was 71.50, while in survivors was 37. The largest percentage of lethal outcomes was recorded in cases of traffic accidents.Conclusion: The mortality rate among hospitalized polytrauma patients in the tertiary institution in Bosnia and Herzegovina is similar to reported mortality rates in other countries with developed healthcare system.
Cytogenotoxic effects of two potential anticancer Ruthenium(III) Schiff Bases complexes
Get PDFIntroduction: Treatment of cancer has been subject of great interest. Researchers are continuously searching for new medicines. In this sense, ruthenium complexes have big potential. Some evidences suggest that ruthenium compounds possess anticancer activities. We synthesized two recently published ruthenium(III) complexes with bidentate O,N and tridentate O,O,N Schiff bases derived from 5-substituted salicylaldehyde and aminophenol or anilineare. These compounds showed affinity for binding to the DNA molecule, however, insufficient data are available regarding their possible toxic effects on biological systems.Methods: In the present study we evaluated genotoxic, cytotoxic, and cytostatic effects of Na[RuCl2(L1)2] and Na[Ru(L2)2], using the Allium cepa assay.Results: Different toxic effects were observed depending on the substance, tested concentration, and endpoint measured. In general, the tested compounds significantly lowered the root growth and mitotic index values as compared to the control group. Additionally, a wide range of abnormal mitotic stages, both clastogenic and non-clastogenic were observed in the treated cells. Na[RuCl2(L1)2] significantly increased the frequency of sticky metaphases, chromosome bridges, micronuclei, impaired chromosome segregation, as well as number of apoptotic and necrotic cells over the controls. In contrast, Na[Ru(L2)2] did not show significant evidence of genotoxicity with regard to chromosome aberrations and micronuclei, however, significant differences were detected in the number of apoptotic and necrotic cells when the highest concentration was applied.Conclusions: In this study we demonstrated antiproliferative effects of Na[RuCl2(L1)2] and Na[Ru(L2)2]. At clinical level, these results could be interesting for further studies on anticancer potential of the ruthenium(III) complexes using animal models
Screening needs and expectations of patients with vascular access due to chronic hemodialysis
Get PDFThere is a lack of data about daily difficulties and life quality, especially among young patients having arteriovenous fistula (AVF) affected by (pseudo)aneurysm. In this retrospective cohort study, 195 patients with AVF were followed up from May to June 2015. An unstandardized questionnaire was used for the evaluation of patients’ screening needs and expectations. Retired married men in their sixties, with completed secondary education, represented the majority of patients with AVF in this study. The patients had a positive attitude towards the disease and AVF, and they received the majority of information related to the care and treatment of AVF from the medical personnel and doctors in selected dialysis centers. Employed, well-educated single men, aged between 21 and 40 years, had the highest interest in having an aesthetic correction of AVF, especially due to the formation of (pseudo)aneurysm at the AVF site. Establishment of rules for reconstructive procedures of AVF, once circulatory and hemodynamic stability is achieved after renal transplantation, is suggested in addition to establishing criteria for determining vascular access affected by (pseudo)aneurysm
Prevalence and antimicrobial resistance of beta-lactamase-producing Gram-negative isolates from outpatient clinical and environmental samples in the Zenica-Doboj Canton, Bosnia and Herzegovina
Get PDFIntroduction: Infections due to extended-spectrum beta-lactamase (ESBL)-producing isolates in patients are hard to treat and cause high morbidity and mortality. ESBL-producing bacteria have been increasingly detected in environmental samples in different countries since 2002, and have gained considerable attention worldwide.Methods: Antibiotic susceptibility of all isolates was determined using the disk diffusion method. The production of ESBLs was determined by the double-disk synergy test.Results: Among the outpatient clinical samples, out of 2857 Gram-negative bacteria, 184 (6.5%) ESBL-producing bacteria were isolated. In this group, 143 (77.7%) were from urine samples, 26 (14.1%) from surgical wounds, 6 (3.3%) from umbilical swabs, and 9 (4.9%) from other patients sites (upper respiratory tract, cannula, eyes, genital swabs). Escherichia coli was isolated in 62 (33.7%), and Klebsiella spp. in 50 (27.8%) cases. Among the environmental samples, out of 381 Gram-negative bacteria, 52 (13.6%) were ESBL-producing isolates. In this group, 37 (71.2%) were sampled from water, 7 (13.5%) from food, and 8 (15.4%) from environmental surfaces. The most prevalent ESBL-producing bacteria isolated from the environmental samples were E. coli (isolated from 26 samples), Klebsiella spp. (10), non-fermenters (9), and other bacteria isolated from 7 samples. The clinical outpatient ESBL-producing isolates showed resistance to all cephalosporins, ranging from 25% (cefepime) to 100% (cefuroxime). The environmental ESBL-producing isolates showed resistance to cefuroxime, aztreonam, cefpodoxime, amoxicillin/clavulanate, and cefoxitin in the range of 65-100%.Conclusions: Prevalence of antibiotic resistance of ESBL-producing strains is high and requires routine detection of ESBL-producing isolates in the laboratories, designing of appropriate antibiotic prescribing policies and control of the risk factors
Gastric adenocarcinoma with choriocarcinomatous differentiation in the remnant stomach, 54 years after Billroth II partial gastrectomy
Get PDFThe gastric remnant cancer is defined as a cancer that has developed 5 or more years after distal gastric resection for benign diseases of the stomach. The choriocarcinomatous differentiation of adenocarcinoma in the stomach is a very rare tumor. A 75-year-old woman underwent resection of remnant stomach which she had operated for benign gastric pathology 54 years ago. Pathologic examination of the resection revealed areas of choriocarcinomatous differentiation in addition to classical adenocarcinoma. In the literature on English language, this report presents the first case of adenocarcinoma associated with choriocarcinomatous differentiation in the gastric remnant. The treatment of these patients depends on the clinical setting, and early diagnosis is an important factor for the treatment strategies. Therefore, due to the probability of arising adenocarcinoma in the remnant stomach, the patient should be investigated with endoscopic examination periodically, despite the long postoperative period
Comparison of the performance of three cancer antigen (CA) 15-3 immunoassays
Get PDFIntroduction: In the present study we investigated the performance, precision, and recovery of three different automated methods in determining cancer antigen (CA) 15-3 levels.Methods: Serum samples were obtained from 60 hospitalized female patients. As controls, commercially available samples were used. Cancer antigen (CA) 15-3 levels were measured using ARCHITECT CA 15-3, Elecsys® CA 15-3, and Vitros CA 15-3 immunoassays. A comparison of the results between the three methods was conducted, and the precision and recovery were analyzed.Results: Coefficient of variations (CVs), determined with low- and high-level-CA 15-3 control samples, and reproducibility values were: 2.56-2.80% and 3.10-4. 20% for ARCHITECT i2000SR immunoassay analyzer; 3.50-5.55% and 4.88-6.47% for Cobas E 601 analyzer; 3.30-4.0% and 4.30-4.80% for VITROS 5600 Integrated System, respectively. The percent recoveries were 95-98% for Elecsys® CA 15-3 assay, 93-105% for Vitros CA 15-3 assay, and 92-95% for ARCHITECT CA 15-3 assay. Method comparison results demonstrated correlation coefficient (r) in range from 0.994 to 1. The average CA 15-3 concentrations measured by Vitros, ARCHITECT, and Elecsys® were 157.24 +/- 329.75 U/mL, 100.91 +/-213.75 U/mL, and 80.93 +/- 173.29 U/mL, respectively.Conclusions: Tumor marker CA 15-3 in individual patients should be monitored using the same immunoassay method, reagents, and analyzer. Different immunoassays tested on different analyzers, often show large discrepancies in reported values for individual patients. Different immunoassay technologies quantify analytes of clinical interest using monoclonal or polyclonal antibodies. Thus, the usage of antibodies with different specificities could explain the differences in CA 15-3 serum values between different methods
The attitudes of pharmacists and physicians in Bosnia and Herzegovina towards adverse drug reaction reporting
Get PDFIntroduction: Adverse drug reactions (ADRs) are threat to the patient’s safety and the quality of life, and they increase the cost of health care. Spontaneous ADR reporting system mainly relies on physicians, but also pharmacists, nurses, and even patients. The aim of this study was to explore attitudes, barriers, and possible improvements to ADR reporting practices in Bosnia and Herzegovina.Methods: A self-reported questionnaire was developed to collect data on the perception of pharmacovigilance practice and ADR reporting. The survey was conducted in the period between September, 2014 and October, 2014.Results: The response rate was 73% (44 of 60) and 93% (148 of 160) among the pharmacist and family medicine physician groups, respectively. Regarding the attitudes to pharmacovigilance practice and reporting, both the pharmacists and physicians found the practices important. The majority of pharmacists and physicians in year 2014 did not report any ADR, while 18% of the pharmacists and 12% of the physicians, who participated in this study, reported one ADR. Reporting procedure, uncertainty, and their exposure were the main barriers to reporting ADRs for the pharmacists. The physicians claimed lack of knowledge to whom to report an ADR as the main barrier. A significant number of the respondents thought that additional education in ADR reporting would have a positive impact, and would increase the ADR reporting rate.Conclusions: Despite the overall positive attitude towards ADR reporting, the reporting rate in Bosnia and Herzegovina is still low. Different barriers to the ADR reporting have been identified, and there is also the need for improvements in the traditional education in this field
Comparison of magnetic resonance diffusion-weighted imaging characteristics between cystic lesions and normal pancreatic parenchyma
Get PDFIntroduction: Diffusion weighted imaging (DWI) is a form of magnetic resonance imaging (MRI) based on measuring the random Brownian motion of water molecules within a tissue. The aim of this study was to show the significance of diffusion-weighted imaging (DWI) in differentiating pancreatic cystic formations from normal pancreatic parenchyma using MRI 1.5 T.Methods: A total of 52 patients were included in the study (25 with pancreatic cystic formations and 27 with normal MRI findings of the pancreas). DWI technique was used with b values of 0.500 and 1 000 mm2/s at 1.5 T. The signal intensity was measured, as well as apparent diffusion coefficient (ADC). Visual estimation of the signal intensity of detected cystic lesions was performed and compared to the normal appearance of pancreas.Results: The highest signal intensity of the cystic lesions with hyper-signal was observed with DWI b0 value in the pancreatic head (M 185.1 ± 47.205, p < 0.05). Similarly, the highest apparent diffusion coefficient (ADC) value of the cystic formations with hyper-signal was observed in the pancreatic head (2.09 x 10-3 mm2/s, p < 0.05). In the group with healthy pancreas, the highest signal intensity was observed with DWI b0 value (M 76.40 ± 18.28, p < 0.05). The observed ADC value in this group was 1.21 x 10-3 mm2/s in the head, 1.24 x 10-3mm2/s in the neck, 1.21 x 10-3mm2/s in the body, and 1.06 x 10-3mm2/s in the tail; p > 0.05.Conclusions: Differences in signal intensity and ADC values have an important diagnostic value in differentiating the cystic formations from normal pancreatic parenchyma in MRI examination
Effects of individual or combined use of alpha-lipoic acid and methylprednisolone on malondialdehyde, superoxide dismutase, and catalase levels in acute spinal cord injury in rats
Get PDFIntroduction: Recent studies have demonstrated that alpha-lipoic acid (ALA) has a strong antioxidant property and it exerts neurotrophic effects on the peripheral nerves. In this study, we investigated potential effects of ALA on secondary injury mechanisms as well as on apoptosis.Methods: Forty Sprague-Dawley rats were equally divided into 5 groups, as follows: laminectomy (control), laminectomy + trauma (Trauma), laminectomy + posttraumatic methylprednisolone [MP] (Trauma + MP), laminectomy + posttraumatic ALA (Trauma + ALA), laminectomy + posttraumatic MP and ALA (Trauma + MP + ALA). Yasargil aneurysm clip method was used to induce the spinal cord injury. Twenty-four hours after the procedure the rats were sacrificed. Spinal cord samples were harvested to analyze malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) levels, as well as histopathological characteristics.Results: The Kruskal-Wallis test (95% confidence level, p < 0.05) showed a statistically significant difference between the groups in MDA (p = 0.006), CAT (p = 0.000), and SOD (p = 0.001) levels. Pairwise comparisons, with Bonferroni correction, of control and Trauma group with the other groups, revealed a significant difference in CAT and SOD levels. Overall, our results showed that ALA administration significantly decreased MDA levels in Trauma + ALA compared to the same effect of MP in Trauma + MP group. Furthermore, ALA administration increased SOD and CAT levels in Trauma + ALA group. The combined use of ALA and MP demonstrated synergistic effects and yielded even more significant results.Conclusions: A combined use of ALA and MP might provide a benefit in patients exposed to spinal cord injury. However, at present, further studies are required to confirm these results
A gastric stump cancer with unusual appearance
No full textA 60 year old man was referred to our hospital with the chief complaints of abdominal pain and vomiting. He underwent a distal gastrectomy with a Billroth II gastrojejunostomy for a peptic ulcer 13 years ago. Esophagogastroduodenoscopy (EGD) did not reveal any gross lesion in the stomach but depigmented areas were seen in the anastomosis line. The histopathology of the anastomotic area revealed poorly differentiated adenocarcinoma. Gastric stump cancers can be polypoid, fungating, ulcerated and diffusely infiltrating tumors respectively. In our case, the appearance of adenocarcinoma was quite different from that described in the classification system