Helicobacter pylori resistance to clarithromycin and quinolones in patients with dyspepsia in Tuzla Canton, Bosnia and Herzegovina.

Aim To evaluate Helicobacter pylori (H. pylori) resistance to clarithromycin and quinolones in patients with dyspepsia in Tuzla Canton, Bosnia and Herzegovina, a region with no data on clarithromycin or quinolones resistance. Methods A prospective cross-sectional study was conducted at the Department of Gastroenterology and Hepatology at University Clinical Centre Tuzla between January 2021 and June 2022. The study included 99 patients who underwent esophagogastroduodenoscopy (EGDS) due to dyspepsia. In all patients biopsies were taken for rapid urease test (RUT) and histology findings, concomitantly with blood samples for IgG serology. All RUT positive patient samples were tested for clarithromycin and quinolones susceptibility with GenoType HelicoDr, a PCR method which detects point mutations in 23S rRNA and mutations in the gyrA gene. Results Out of 99 dyspeptic patients, 67 (67.7%) were serologically positive to H. pylori, 46 (46.4.%) were RUT positive, and 19 (19.2 %) had a positive histology finding. Antibiotic (AB) resistance was tested in the total of 46/99 (46.4%) patients. Resistance to clarithromycin was detected in 28.26% (13/46), quinolones resistance in 36.96% (17/46) , and resistance to both AB was detected in 8.69% (4/46) tested biopsies. Conclusions Due to high clarithromycin and quinolones resistance rates, we recommend the use of bismuth quadruple or non-bismuth concomitant quadruple therapy for H. pylori eradication in Tuzla Canton, Bosnia and Herzegovina.

Comparative Analysis of Transradial and Transfemoral Arterial Approach When Performing Diagnostic Coronary Angiography.

Background: The transfemoral (TF) arterial approach is still the most commonly used approach for performing diagnostic coronary angiography in most centers in the world as well as in Bosnia and Herzegovina. Recently, the transradial (TR) arterial approach has gained more and more supporters among interventional cardiologists. Objective: The aim of the study was to compare the duration of the procedure, the amount of delivered ionizing radiation, the amount of applied contrast agent, the frequency of procedural complications and patient comfort during coronary angiography performed via TR and TF arterial approach. Methods: The total sample of 240 respondents was divided into two groups in such a way that the first group consisted of 121 respondents who underwent coronary angiography using TR arterial approach, and the second group consisted of 119 respondents who underwent coronary angiography using TF arterial approach. The Mann-Whitney U test was used to verify the research objective. Results: The obtained research results showed that the duration of coronary angiography and the amount of radiation was greater when using TR arterial approach compared to TF approach. There is no statistically significant difference in relation to the amount of applied contrast medium and the frequency of complications between the two approaches. Periprocedural and postprocedural comfort was better in patents who underwent TR approach. Conclusion: The findings of this study show that diagnostic coronary angiography performed via the TR arterial approach is as safe for the patient as diagnostic coronary angiography performed via the TF arterial approach. With both approaches, there is no significant difference in the amount of contrast agent used nor in the frequency of complications. Procedure duration and radiation exposure are shorter when TF arterial approach i used, while patient comfort is better when the TR arterial approach is used.

Silence pancreatitis in systemic lupus erythematosus.

We present here a systemic lupus erythematosus (SLE) related biochemically silent pancreatitis which was assessed via computed tomography in a 35-year-old woman. A patient with a twelve-year history of SLE presented with exacerbation of symptoms of the basic disease, with SLE Disease Activity Index > 15. She was referred to inpatient care. Dosage of corticosteroid and azathioprine for SLE was increased; subclinically and biochemically silent pancreatitis had developed, and was not diagnosed within an appropriate time. On the 15th hospital day, the patient died due to multisystem organ failure, which was defined as a consequence of clinically and biochemically silent pancreatitis in systemic lupus erythematosus.

Risk factors for post-colectomy adhesive small bowel obstruction.

OBJECTIVE: The purpose of this study was to assess the risk factors for adhesive small bowel obstruction (SBO) following colectomy for colorectal cancer. PATIENTS AND METHODS: In this retrospective study we analyzed 284 patients who underwent surgery for colorectal cancer at the Department of Surgery University Clinical Center Tuzla in the period from 1st January 2009 until 31st December 2014. All patients underwent open colectomy. The length of follow up was from 6 months to 6 years (median follow up 3 years and 6 months). The study included all patients who underwent surgery due to colon cancer. The study excluded patients with postoperative small bowel obstruction after colon cancer surgery with different comorbidities. RESULTS: In the analyzed sample of 284 patients, a small bowel obstruction occurred in 13.7% patients after surgery for colon cancer. The highest correlation of risk factors and the occurrence of postoperative small bowel obstruction after colectomy for colorectal cancer in multivariate regression analysis was found to be for Tumor-Node-Metastasis ≥3 (or =3.680), and postoperative complications (or =30.683). CONCLUSIONS: Postoperative SBO have many causes, but in this study the highest risk factors were the Tumor-Node-Metastasis ≥3, and postoperative complications.

Laparoscopic Management of Adhesive Small Bowel Obstruction.

INTRODUCTION: Adhesions are the reason for bowel obstruction in 80% of the cases. In well selected patients the adhesive ileus laparoscopic treatment has multiple advantages which include the shorter hospitalization period, earlier food taking, and less postoperative morbidity rate. CASE REPORT: Here we have a patient in the age of 35 hospitalized at the clinic due to occlusive symptoms. Two years before an opened appendectomy had been performed on him. He underwent the treatment of exploration laparoscopy and laparoscopic adhesiolysis. Dilated small bowel loops connected with the anterior abdominal wall in the ileocecal region by adhesions were found intraoperatively and then resected harmonically with scalpel. One strangulation around which a small bowel loop was wrapped around was found and dissected. Postoperative course was normal.

Influence of Prognostic Factors for Recurrence of Adenocarcinoma of the Stomach.

INTRODUCTION: Gastric cancer is the second most important neoplasm in the world. Surgical resection is the treatment of choice for gastric cancer, and recognized by the International Union against Cancer (International Union Against Cancer - UICC) TNM classification of the parameters of the tumor and lymph node. Prognostic factors related to characteristics of the tumor by histopathologic findings have an impact on the planning of the operation. According to the results of most studies it is possible to predict survival and recurrence based on histological type and TNM classification of tumors on the one hand and the surgical procedure on the other. AIM: The aim of the research was to analyze prognostic factors that influenced the frequency of recurrence in gastric surgery patients. PATIENTS AND METHODS: The five year study covered a population of 100 treated patients of adenocarcinoma of the stomach at the Department of Surgery, University Clinical Center Tuzla. The first group were characteristics of tumors in patients with gastric adenocarcinoma. Lymphadenectomy and splenectomy, types of surgery were the second group of prognostic factors. RESULTS: Histological type and TNM stage of tumor as prognostic factors had a significant impact on local tumor recurrence. The type of surgery had no statistically significant value for tumor recurrence (p = 0.7520). CONCLUSION: Statistical analysis of prognostic factors related to histopathologic characteristics of tumors and the type of surgery gave the results that had an impact on recurrence in gastric surgery patients. The most important prognostic factors were TNM stage of tumor and histological type of tumor that influenced the incidence of recurrence.

Laparoscopic Wedge Resection of Gastric Stromal Tumor (GIST).

INTRODUCTION: Laparoscopic treatment in general, in recent age has proven that it is well associated with low morbidity, mortality, fast recovery, less pain and sound oncologic outcomes. Recent reports from the National Comprehensive Cancer Network (NCCN) GIST Task Force and the GIST Consensus Conference under the auspices of The European Society for Medical Oncology (ESMO) show that laparoscopic resection may be used for small gastric GISTs (< 2 cm in size). CASE REPORT: We report, all the benefits of laparoscopic approach which include short hospitalization, less pain, better cosmetic effect and good oncological outcome, in this case report of 60 year old female patient with gastric GIST larger than 2 cm.

Education and Training for Major Incidents Through Medical Response to Major Incidents-MRMI course.

Incidence of major incidents nowadays is in constant growth, especially in last decade. Main goal of all health systems is to minimize and prevent tragic outcomes of major incidents, thus reducing morbidity and mortality and psychological and physical suffering. Lessons learned from Major Incidents throughout the World point out that tragical outcomes could be avoided through adequate preparation and planning. Necessity to plan and to educate to response to Major incident is greater than ever. Finally it is legal obligation that every hospital has plan in case of Major Incident. Effective planning must incorporate: identification of risks, methods of prevention, identification of all recourses, anticipation of errors and detailed protocol of response for each participant. Knowledge and skills needed for Major incident situations must be adopted through interactive training and practical exercise ("learning by doing"). That can be achieved by field exercises and by simulation model. Simulation model has many advantages and enables simultaneous education and training of all participants; scene, transport, hospitals, communication and command which than can be evaluated through objective outcomes. The goal is to train medical staff in real time, on position they are assigned to, with available resources in conditions of Major incident.

Use of a circular stapler for Billroth I anastomosis after distal gastrectomy.

Staplers are widely used in gastrointestinal surgery. We used a circular stapler to establish gastroduodenal anastomosis after distal gastrectomy in a recent case. After separating the stomach from the duodenum, we anastomosed the posterior wall of the stomach to the duodenum by introducing the circular stapler through the part of the stomach that was to be resected. Then we separated the distal part of the stomach with a linear stapler, and so completed the distal gastric resection. The advantages of this technique are that it is simple and safe.