Values of Alpha 1 Microglobulin Does Not Differ between Individuals with and without Family History of Balkan Endemic Nephropathy.

Aim. The aim of this study was to compare urinary alpha 1 microglobulin (A1MG) in healthy individuals with and without family burden for Balkan endemic nephropathy (BEN) in an endemic village. Methods. Otherwise healthy inhabitants with microalbuminuria or proteinuria were divided into two groups: with (n = 24) and without (n = 32) family BEN burden and screened for urinary A1MG and A1MG/urine creatinine ratio. Results. Average value of urinary A1MG was 10.35 ± 7.01 mg/L in group with and 10.79 ± 8.27 mg/L in group without family history for BEN (NS, P = 0.87). A1MG was higher than 10 mg/L in eight (33.33%) inhabitants with family history and in 12 (37.5%) without (NS, P = 0.187). Average values of urinary A1MG/creatinine ratio were 1.30 ± 1.59 and 0.94 ± 0.78 in group with and group without family BEN history (NS, P = 0.39, resp.). Elevated values of this ratio were found in 13 (54.17%) inhabitants with and 14 (43.75%) without family history for BEN (NS, P = 0.415). Conclusion. We did not find statistically significant difference in the examined markers between healthy individuals with and without family burden for BEN. We concluded that these markers are not predictive of risk for BEN.

Hypersensitivity to aeroallergens in children with atopic dermatitis.

Atopic dermatitis (AD) is a chronically relapsing, inflammatory skin disease characterized by severe itch, rash and dry skin. Hypersensitivity to aeroallergens is found in 40%-50% of children with AD and it is the cause of intensive skin lesions. The aim of the study was to assess the presence of hypersensitivity to aeroallergens in AD children. The study included 114 children (56 boys and 58 girls), median age 27.5 months, who had been diagnosed with AD according to Hanifin and Rajka criteria. The severity of the disease was assessed by the SCORAD index. To recognize hypersensitivity to aeroallergens, the following parameters were analyzed: medical history, values of absolute eosinophil count, total IgE antibodies, specific IgE antibodies to aeroallergens, and results of the skin prick test for aeroallergens. A moderate form of the disease was present in 61.4% of study children, with a median SCORAD index score of 28.5 points; 12.3% of study children showed hypersensitivity to aeroallergens (history of hypersensitivity to aeroallergens in 27.2%, increased absolute eosinophil count in 53.5%, increased total IgE antibodies in 56.1%, positive skin prick test in 20.2%, and positive specific IgE antibodies to aeroallergens in 12.3% of children). The most common aeroallergens responsible were house dust in 6.1% and Dermatophagoides pteronyssinus in 3.5% of children with AD. Hypersensitivity to aeroallergens was recorded in the same number of children with mild and severe forms of the disease and in 5.7% of children with a moderate form. In conclusion, the presence of hypersensitivity to aeroallergens in children with AD is significant. By discovering and removing the aeroallergens responsible, it is possible to achieve reduction in the intensity of skin lesions and frequency of exacerbations.

Glomerular filtration rate in examined population of Bosnian Posavina - region of Balkan Endemic Nephropathy.

Balkan endemic nephropathy (BEN) is chronic tubulointersticial nephritis of unknown aetiology characterized by an insidious onset and gradual progression to end stage renal disease (ESRD). Endemic regions of Bosnia and Herzegovina are Posavina and Semberija, sited at basin of Sava River. In BEN, just like in other chronic renal diseases (CKD), glomerular filtration rate (GFR), is assumed a marker of overall renal function. The aim of this study was to compare GFR in examinees of endemic and non-endemic region for BEN, and between examinees with and without risk factors for BEN within endemic region. Study included 603 inhabitants of Bosnian Posavina, out of whom 386 (65%) from endemic (Domaljevac) and 217 (36%) from non-endemic (Svilaj) village, and it was performed in two phases. The first phase encompassed obtaining anamnestic data (demographic, personal and family history), measurement of arterial blood pressure, and urine dipstick testing (specific gravity, pH, proteins, leukocytes, glucose, ketones, and microalbuminuria). In the second phase, besides repeated urine dipstick test, laboratory blood testing and abdominal ultrasound, with special attention to urinary tract, was also performed. We have compared GFR between examinees of endemic and non-endemic regions for BEN, and between examinees with and without family burden for BEN within endemic region, using MDRD formula for calculating GFR, with cut-off value (5th percentile) based on result of studies performed in European Caucasians in screening for CKD and for establishing stages of CKD in BEN. Medical was used for statistical testing. Out of total number of examined inhabitants (603), 145 examinees were included in the second phase. After exclusion of 17 diabetic patients, 94 (73%) examinees from endemic and 34 (27%) examinees from non-endemic region remained. In the endemic region there were 46 (49%) examinees with and 48 (51%) without family burden for BEN. Overall GFR in examined groups was within physiologic range. There was not statistically significant difference in calculated GFR between examinees of endemic and non-endemic regions for BEN (Mann-Whitney test p=0.104; Fisher's test p=1), neither between examinees with and without family burden for BEN within endemic region (Mann-Whitney test p=0,7393; Fisher's test p=0,263). Overall GFR in examined groups was within physiologic range. There wasn't statistically significant difference in calculated GFR between examinees of endemic and non-endemic regions for BEN, neither between examinees with and without family burden for BEN within endemic region. GFR, no matter how accurately calculated and estimated, does not represent significant biomarker for diagnosis, especially early diagnosis, of BEN, until maybe its overt advanced form.

[The ultrasound characteristics of kidneys in children and adolescents with diabetes mellitus type 1]. / Ultrazvucne karakteristike bubrega u djece i adolescenata s dijabetesom melitusom tipa 1.

The aim of the study was to compare ultrasound findings of morphometric measurements and registration of Doppler signs of kidneys between children and adolescents with diabetes mellitus type 1 (DMT1) with microalbuminuria, and metabolic control with duration of the disease. Retrospective-prospective study included 80 patients, who got DMT1 in the age from 2 to 16 years. In relation to the duration of the disease, all patients were divided into two groups: the first was whose illness had lasted less than 10 years, the second group was with duration of DMT1 more than 10 years. In patients with duration of DMT1 more than 10 years, the frequency of microalbuminuria, pathological findings of the volume of right kidney, and higher HbA1C were significantly greater. The significant difference was found in the frequency of pathological findings of the resistance index (RI) in the interlobar arteries in both kidneys. Alongside microalbuminuria, monitoring the dimension and volume of the kidneys may indicate the existence of the early phases of diabetic nephropathy.

Association of Low Birth Weight Infants and Maternal Sociodemographic Status in Tuzla Canton during 1992-1995 War Period in Bosnia and Herzegovina.

Objectives. We examined association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status in Tuzla Canton during 1992-1995 war in Bosnia and Herzegovina. Methods. The present study covers a 22-year period (1988-2009), including the war period (1992-1995), and we retrospectively collected data on a total of 108 316 liveborn infants and their mothers from three different socioeconomic periods: before (1988-1991), during (1992-1995), and after the war (1996-2009). Association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status were determined for each study period. Results. There were 23 194 live births in the prewar, 18 302 during the war, and 66 820 in the postwar period. Among the liveborn infants born during the war, 1373 (7.5%) had birth weight of <2500 g, which is significantly more in comparison with 851 (3.6%) liveborn infants in this birth weight group born before and 1864 (2.8%) after the war. We found the number of examinations during pregnancy was 1.8 per pregnant woman in the war period, which was low in comparison with the number of examinations before (4.6 per pregnant woman) and after (7.1 per pregnant woman) the war (P<.001 for both). Prewar perinatal mortality LBW infants of 6.2 per 1000 live births increased to 10.8 per 1000 live births during the war (P<.001), but after the war, perinatal mortality LBW infants (5.2‰) and early neonatal mortality (2.4‰) decreased. Conclusions. We found statistically significant association between low-birth-weight and maternal sociodemographic status in Tuzla Canton during 1992-1995 war in Bosnia and Herzegovina.

Nursing information systems.

Computer technology is a reality of our modern world. It gives us a tool which can be used to help us cope with the complexity and efficiency which is often required in many areas of work. It is an erroneous assumption that it robs a situation of its human qualities. No one would deny that the use of a word processor denies the possibility of highly creative writing being produced or that computerized checkouts make the interaction skills of the checkout person irrelevant to the process of struggling with the week's shopping once more. In many ways, the use of the computer frees the person from the drudgery of repetitive labour to allow more time and effort to be available for the more personal skills to find expression. Recording assessment data using a computer keyboard allows just as much caring communication between nurse and clients as writing it down on a form. The critical factor is not the method of recording but the interpersonal skills and motivation of the nurse. The nursing profession is at last beginning to appreciate the role which the new technology can have in improving the service provided to patients. Only by taking an active role now in the implementation of computers to clinical practice can nurses maintain control of their own professional contribution to the large complex systems at present being implemented in many health care settings. Knowledge based systems are set to become a major component in the nurse's ability to take on this role.

[Microalbuminuria and ultrasound characteristics of kidneys in children and adolescents with diabetes mellitus type 1]. / Mikroalbuminurija i ultrazvucne karakteristike bubrega u djece i adolescenata sa Dijabetes melitusom tip 1.

The aim of the study was to compare ultrasound findings of kidneys in children and adolescents with diabetes mellitus type 1 (DMT1), establish the association with microalbuminuria, blood pressure values and metabolic control of the disease, and creatinine clearance. In 80 children and adolescents with DMT1, in whom illness occurred in period between 2 and 16 years of age, morphometry measurements with ultrasound were performed. Nephelometric method of three consecutive samples of urine determined microalbuminuria. In patients with microalbuminuria, creatinine clearance was also measured. Demographic data were obtained from the parents and from the patients medical records. In relation to the duration of the disease, all patients were divided into two groups: the first group of patients with illness lasting for less than 10 years, and the second were those whose illness had lasted more than 10 years. In patients with duration of DMT1 of more than 10 years, the frequency of pathological findings of the longitudinal diameter and volume of both kidneys in relation to age and anthropometric standards was statistically significantly greater. Also, the finding of microalbuminuria was more frequent. In the group of patients with DMT1 lasting for more than 10 years, the mean value of HBA1c was statistically significantly higher In patients with microalbuminuria the total mean value of creatinine clearance was within the bounds of the reference values and was statistically significantly higher in patients in whom the illness had lasted less than three years, which indicates hyperfiltration of the kidneys. Alongside microalbuminuria, monitoring of the dimension and volume of the kidneys may indicate the existence of the early phases of diabetic nephropathy and result in its prevention and prevention of illness progression.