Breaking habits: safety and efficacy of elective electrocardioversion of atrial fibrillation and atrial flutter in the setting of day hospital.

Aim To examine safety and efficiency of electrocardioversion (EC) in elective treatment of atrial fibrillation and atrial flutter in the setting of Day Hospital by determining success rate, frequency of adverse events and possible cost benefit compared to admitting a patient into hospital. Methods This prospective observational cohort study was performed in Day Hospital and in Intensive Care Department of Internal Medicine Clinic, University Clinical Centre Tuzla from January 2019 to December 2022 and included 98 patients with a persistent form of atrial fibrillation (AF) or atrial flutter. The patients who were divided in two groups, 56 hospitalized and 42 patients accessed in Day Hospital. In all patients, medical history, physical examination, electrocardiogram (ECG) and transthoracic echocardiogram (TTE) evaluation was performed in addition to laboratory findings. Electrocardioversion was performed with a monophasic General Electric defibrillator in anterolateral electrode position with up to three repetitive shocks. Results In hospital setting group overall succes rate of electrocardioversion was 85%, with average 2.1 EC attemps, there was with one fatal outcome due to stroke, one case of ventricular fibrillation (VF) due to human error, and 6 minor adverse events; with average cost of was 1408.70 KM (720.23 €) per patient. In Day Hospital setting succes rate was 88%, with average 2 EC attempts, no major adverse events, 8 minor adverse events; and average cost was of 127.23 KM (65.05 €) per patient. Conclusion Performing elective electrocardioversion in Day Hospital setting is as safe as admitting patients into hospital but substantially more cost effective.

Single-centre experience with the treatment of high-prevalence metabolic syndrome in kidney transplant patients in Bosnia and Herzegovina.

Aim To analyse prevalence of metabolic syndrome (MS) in kidney transplant recipients at the University Clinical Centre Tuzla in Bosnia and Herzegovina (B&H), and determine effects of a modern drug therapy in achieving target metabolic control in kidney transplant patients. Methods A single-centre prospective study that included 142 kidney transplant patients over one year follow-up period was conducted. Patient data were collected during post-transplant periodical controls every 3 months including data from medical records, clinical examinations and laboratory analyses. Results Out of 142 kidney transplant patients, MS was verified in 85 (59.86%); after a pharmacologic treatment MS frequency was decreased to 75 (52.81%). After a one-year period during which patients were receiving therapy for MS, a decrease in the number of patients with hyperlipoproteinemia, decrease in average body mass index (BMI), glycemia and haemoglobin A1C (HbA1C) were observed. Hypertension did not improve during this period, which can be explained by transplant risk factors in the form of immunosuppressive drugs and chronic graft dysfunction. Conclusion A significant reduction in components of the metabolic syndrome after only one year of treatment was recorded, which should be the standard care of kidney transplant patients.

Risk factors associated with the development of secondary hyperparathyroidism in dialysis patients.

Aim To determine risk factors associated with the development and severity of secondary hyperparathyroidism in dialysis patients. Methods A cross-sectional study at the Clinical Centre of the University of Tuzla (March 2022) included 104 adult patients (males 51.9%, females 48.1%) with chronic kidney diseases under dialysis treatment. Based on parathyroid hormone (PTH) values, patients were divided into two groups: study group (45/104, PTH >792pg/mL) and control group (59/104, PTH 176-792 pg/ mL). The analysis aimed to resolve whether there was a connection between the duration of dialysis, the type of therapy treatment administered, the underlying kidney disease, and the presence of comorbidities with the values of PTH, and a wide spectrum of monitored laboratory parameters. Results The most common causes of chronic renal failure were undefined kidney diseases (32.7%), followed by diabetic nephropathy (18.3%) and chronic glomerulonephritis (16.3%). In the examined biochemical parameters, a significant difference was found in mean values of alkaline phosphatase (p<0.001). The correlation was proved between the duration of dialysis (p=0.028), the values of phosphorus (p=0.031), and alkaline phosphatase (p<0.001) with absolute values of PTH. The most common present comorbidity was hypertension (78.8%), followed by cardiovascular diseases (40.4%) and diabetes (22.1%). Conclusion A number of factors contribute to the development and severity of SHPT. Modulation of therapy and better control of risk parameters can prolong and reduce the frequency of SHPT in dialysis patients, as well as the occurrence of comorbidities.

Experience of nurses in assessing postoperative pain in hip fracture patients suffering from dementia in nursing homes.

Aim To explore the experiences of registered nurses in assessing postoperative pain in hip fracture patients suffering from dementia in nursing homes. Methods The study was designed as a qualitative study using data from a self-reported questionnaire form. Data were collected through the self-administered questionnaire with 23 questions, mainly addressing demographic and social data, information about communication and pain assessment. Results All nurses reported that large part of verbal communication with dementia patients was lost, and non-verbal communication was very important to optimize the care of these patients in postoperative situations. An assessment of pain in patients with dementia and hip fractures was a complex process because cognitive ability of these patients was reduced. Conclusion Registered nurses need to know various and different forms of evaluation and tools to assess the experience of pain in patients with dementia who had undergone surgery for hip fractures. This is a complicated task, which requires a great deal of time, and means that nurses must work together with other medical staff, using a holistic approach.

Recent Pattern of Acute Kidney Injury in Bosnia and Herzegovina.

INTRODUCTION: Acute kidney injury (AKI) is one of the major public health issues with constantly increasing incidence, with epidemiology and outcomes that vary substantially across the world. AIM: Aim of our study was to determine epidemiological characteristics and causes of AKI and to provide a comparison of our findings with data from other low and middle income countries. METHODS: This retrospective observational study conducted during an 18-month period included 84 patients. Data were collected from hospital information system and patients' medical records. All data were analyzed using descriptive statistics. RESULTS: More than two-thirds of patients were older than 56 years. Most cases of AKI (54,76%) were hospital-acquired and predominantly developed in intensive care units (32,14%). Dominant risk factor was underlying chronic kidney disease (48,81%) and chronic heart failure (45,24. In majority of patients (73,81%) were identified multiple factors that may have contributed to AKI: infection (90,48%), prerenal factors (77,38%), nephrotoxic agents (69,05%), and sepsis (28,57%). Multiple organ failure was identified in 94,05% of patients: cardiovascular (64,56%), respiratory (58,23%) and hematological (56,96%) system. Half of all patients were alive at last observation day. Leading cause of death was infection/sepsis (21,43%), followed by cancer (16,67%) and shock (14,28%). CONCLUSION: Data on AKI show great variation, but general picture of AKI resembles more that from high income countries. The need for dialysis and overall mortality remains high. This highlights the importance of early recognition of AKI, timely referral to nephrologist and need for national guidelines and standardized protocols for AKI.

Posterior reversible encephalopathy syndrome (PRES) as a complication of immunosuppressive therapy in renal transplantation in children.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

Posterior Reversible Encephalopathy Syndrome (PRES) as a Complication of Immunosuppressive Therapy in Renal Transplantation in Children.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

Pregnancy in renal transplantation.

UNLABELLED: Pregnancy in kidney transplantation is, considering its numerous complications, listed in category of high-risk pregnancies. Complications occur as consequence of action of immunosuppressant drugs and mutual interactions of graft on pregnancy and pregnancy on graft. To asses conception it is necessary for female patient to fulfill conditions after which planning and management of pregnancy are carried out. Planning means a list of actions which altogether have as a goal to decrease risk factors for future mothers and for babies as much as possible. Pregnancy management is also procedural, including numerous hospitalizations, in which pregnancy, fetus and renal function are controlled, on-time identifying potentially dangerous complications and solving ones that might have already occurred. With all given precautions there is still no guarantee for successful pregnancy termination, although given measurements significantly improve possibilities of normal childbirth, like those in general population. KEYWORDS: renal transplantation, pregnancy.