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.

Inflammatory bowel disease in Tuzla Canton, Bosnia-Herzegovina: A prospective 10-year follow-up.

BACKGROUND: The incidence and prevalence of inflammatory bowel disease (IBD) vary between regions but have risen globally in recent decades. A lack of data from developing nations limits the understanding of IBD epidemiology. AIM: To perform a follow-up review of IBD epidemiology in the Tuzla Canton of Bosnia-Herzegovina during a 10-year period (2009-2019). METHODS: We prospectively evaluated the hospital records of both IBD inpatients and outpatients residing in Tuzla Canton for the specified period of time between January 1, 2009 and December 31, 2019. Since all our patients had undergone proximal and distal endoscopic evaluations at the hospital endoscopy unit, we used the hospital's database as a primary data source, alongside an additional cross-relational search of the database. Both adult and pediatric patients were included in the study. Patients were grouped by IBD type, phenotype, age, and gender. Incidence rates were calculated with age standardization using the European standard population. Trends in incidence and prevalence were evaluated as a 3-year moving average and average annual percentage change rates. RESULTS: During the 10-year follow-up period, 651 patients diagnosed with IBD were monitored (of whom 334, or 51.3%, were males, and 317, or 48.7%, were females). Of all the patients, 346 (53.1%) had been diagnosed with ulcerative colitis (UC), 292 (44.9%) with Crohn's disease (CD), and 13 (2%) with indeterminate colitis (IC). We observed 440 newly diagnosed patients with IBD: 240 (54.5%) with UC, 190 (43.2%) with CD, and 10 (2.3%) with IC. The mean annual crude incidence rates were found to be 9.01/100000 population for IBD [95% confidence interval (CI): 8.17-9.85], with 4.91/100000 (95%CI: 4.29-5.54) for UC and 3.89/100000 (95%CI: 3.34-4.44) for CD. Calculated IBD prevalence in 2019 was 146.64/100000 (95%CI: 128.09-165.19), with 77.94/100000 (95%CI: 68.08-87.70) for UC and 65.77/100000 (95%CI: 54.45-74.1) for CD. The average annual IBD percentage change was 0.79% (95%CI: 0.60-0.88), with -2.82% (95%CI: -2.67 to -2.97) for UC and 6.92% (95%CI: 6.64-7.20) for CD. During the study period, 24,509 distal endoscopic procedures were performed. The incidence of IBD was 3.16/100 examinations (95%CI: 2.86-3.45) or 1.72/100 examinations (95%CI: 1.5-1.94) for UC and 1.36/100 examinations (95%CI: 1.17-1.56) for CD. CONCLUSION: Trends in the incidence and prevalence of IBD in Tuzla Canton are similar to Eastern European averages, although there are significant epidemiological differences within geographically close and demographically similar areas.

Nephrology in Bosnia and Herzegovina: impact of the 1992-95 war.

It has now been more than two decades since the end of the 1992-95 war in Bosnia and Herzegovina. This may well be the proper time to provide the nephrology community with an appraisal of the care of patients with chronic kidney disease in the pre-war, war and post-war periods in the European transitional country. This report on nephrology in Bosnia and Herzegovina draws attention to the hurdles faced for three turbulent years on that burdensome path of providing quality care, and the chance it offered in developing a successful transplant programme while facing the dreadful chaos of war and a migrant crisis. The perception of war and natural disasters is quite different, from the victim's point of view, from the standardized and well-arranged healthcare systems in the developed world. The guidelines, written in peace, are extremely useful, but are often hard to follow during natural disasters or barbarous wars. Each of the periods described had its specificities as well as its good and bad sides. Despite the unquestionable destructive nature of the war, it was a catalyst for nephrology in Bosnia and Herzegovina to move forward.

Belching After Biliary Pancreatitis and Laparoscopic Cholecystectomy.

INTRODUCTION: Belching is often reported symptom. It is rarely an isolated disorder and mainly occurs within various gastroduodenal diseases. AIM: The aim is to show the great breadth of clinical symptoms of postcholecystectomy syndrome which should have a multidisciplinary therapeutic approach taking into account all aspects of patient's life. CASE REPORT: We report a case of excessive belching within postcholecystectomy syndrome which disturbs the general psycho-physical condition of the patient, with symptoms of depression and anxiety, and social isolation, which significantly reduces the quality of his life.

Inflammatory Markers and Procoagulants in Chronic Renal Disease Stages 1-4.

INTRODUCTION: Starting from the point that the chronic kidney disease (CKD) is chronic, inflammatory and hypercoagulable state characterized by an increase in procoagulant and inflammatory markers high cardiovascular morbidity and mortality in these patients could be explained. AIM: The aim of the research was to monitor inflammatory markers and procoagulants in various stages of kidney disease (stage 1-4). MATERIALS AND METHODS: The research included 120 subjects older than 18 years with CKD stages 1-4 examined and monitored in Clinic of Nephrology, University Clinical Centre Sarajevo over a period of 24 months. The research included determining the following laboratory parameters: serum creatinine, serum albumin, C-reactive protein, leukocytes in the blood, plasma fibrinogen, D-dimer, antithrombin III, coagulation factors VII (FC VII) and coagulation factor VIII (FC VIII). RESULTS: With the progression of kidney disease (CKD stages 1-4), there was a significant increase of inflammatory and procoagulant markers: CRP, fibrinogen and coagulation factor VIII, and an increase in the average values of leukocytes and a reduction in the value of antithrombin III, but without statistical significance. Also, there were no significant differences in the values of D-dimer and coagulation factor VII. CONCLUSION: The progression of kidney disease is significantly associated with inflammation, which could in the future be useful in prognostic and therapeutic purposes. Connection of CKD with inflammation and proven connection of inflammation with cardiovascular risk indicates the potential value of some biomarkers, which could in the future identify as predictors of outcome and could have the benefit in the early diagnosis and treatment of cardiovascular disease in CKD.

Serum cystatin C - marker of inflammation and cardiovascular morbidity in chronic kidney disease stages 1-4.

AIM: The aim of the research was to compare the relationship between inflammatory biomarkers and procoagulants with kidney function assessed by using cystatin C, serum creatinine, and eGFR and determine the sensitivity of cystatin C, serum creatinine and eGFR to total cardiovascular morbidity in patients with CKD stages 1-4. METHODS: The research included 120 patients older than 18 years with CKD stages 1-4 monitored over a period of 24 months. RESULTS: Serum cystatin C correlates with fibrinogen (p<0.01), serum albumin (p<0.01), D-dimer (p<0.05), antithrombin III (p<0.01) strongly in relation to the evaluation of kidney function based on serum creatinine and eGFR. By following cystatin C, creatinine and eGFR with comparison of ROC to total cardiovascular morbidity, the highest sensitivity in relation to the presence of cardiovascular morbidity shows cystatin C, then eGFR and the lowest, creatinine, with a significant difference between cystatin C and serum creatinine (p<0.05). CONCLUSION: Serum cystatin C is more strongly correlated with some biomarkers (fibrinogen, serum albumin, D-dimer, antithrombin III), while simultaneously showing a stronger sensitivity in relation to total cardiovascular morbidity compared with the assessment of kidney function based on serum creatinine and eGFR.

Influence of surgical complications on graft and patients' survival after a kidney transplantation according to donors' age.

The aim of this study was to determine a frequency and a type of early and late surgical complications in kidney transplantation, their impact on renal graft survival among 80 patients, 54 (67.5%) males and 26 (32.5%) females who had undergone a living and cadaveric kidney transplant at the Surgery Center in Tuzla in the period from 15.09.1999 until 31.12.2008. The subjects were divided into two groups according to donor age, younger and older than 55. A significantly higher incidence of early rather than late surgical complications was observed in an experimental group (p=0.001, and p=0.77, respectively). There was a statistically significant difference in the length of graft survival (p=0.004) and the number of deaths (p=0.038). Older age of kidney graft donor had an impact on the occurrence of early surgical complications and no influence on the occurrence of late surgical complications. Fatal outcome after kidney transplantation was significantly higher in patients who received grafts of elderly people.

One hundred kidney transplantations in Tuzla.

INTRODUCTION: Kidney transplantation assures considerably better quality of life than the treatment of end-stage renal disease patients with dialysis. GOAL: Authors intended to present results of kidney transplantations that were performed for over 13 years in UCC Tuzla. EXAMINEES AND METHODS: Total of 100 transplantations have been done over 13 years. The gender and age structure have been presented, as well as number of transplantations per year, type of transplantation (living related donor, living unrelated donor, deceased donor), number and percentage of donors and results of transplantations expressed as survival of both the patient and transplanted kidney/ renal graft. We also wanted to presented other important events such as dates of introduction of certain drugs, dates of first cadaver transplantation, transplantation with desensitization protocols and dates of first living unrelated (spousal/emotional) transplantation. RESULTS: The survival of patients and renal grafts were demonstrated by Kaplan-Meier curve, and obtained results were fully in range of results recommended in other literature and by other authors. One-year survival of graft is 94%, with five-year survival being 75%. One-year survival of patients is 95%, and five-year survival of patients was 84%. DISCUSSION: Our results have been compared to those from other studies, gaining suggestions for transplantation improvement. CONCLUSION: Among all modifications of renal replacement therapy transplantation is by far the method of choice because, its well known advantages aside, it also has an economical advantage over chronic treatment with dialysis and it should therefore become interesting to healthcare systems.

[Hypertension and age of the donor in living-related kidney transplantation]. / Hipertenzija i dob darivatelja u zivoj srodnoj transplantaciji bubrega.

INTRODUCTION: Post-transplantation hypertension is one of the most important factors with negative influence on survival of a graft and a patient. The objective of this study was to evaluate the influence of donor's age on hypertension and the outcome in living-related transplantation of the kidney. METHODS: The research included 52 recipients of the graft, 30 women and 22 men who received living-related kidney graft in the time period of 1999 to 2004. In the while control group consisted of recipients of graft who's donors were younger than 55. Age and sex of the donor, glomerular filtration rate of the donated kidney, dialysis treatment, kidney disease and number of months after transplantation were monitored. Blood pressure was measured once a day and average monthly value was assessed. Creatinine clearance was evaluated once in six months period. Functional kidney graft after 60 months was considered the one with serum creatinine < or = micromol/l. Statistical analysis included t test, Fisher's exact test, chi-square test, Kaplan - Meier curve and multivariate logistic regression. RESULTS: Experimental group included 23 examinees who received grafts from donors 55 years old and above (18 men and 5 women, average age 34.86 +/- 6.54, who have been treated for 35.33 +/- 37.59 months) while control group included 29 examinees (16 men and 13 women, average age 31.69 +/- 10.5, who have been treated for 21.03 +/- 25.59 months). Average age of the donors in the experimental group was 62.43 +/- 4.10 and 45.31 +/- 5.24 in control group. Mean creatinine clearance of the donated kidneys was 47.87 +/- 10.5 ml/min in experimental group and 51.19 +/- 10.1 ml/min in the control (p = 0.005). Sixty months after transplantation graft was functional in 32.69% recipients of the experimental group and in 82.75% recipients of the control group. The average systolic blood pressure in test group was 146 +/- 20 mm Hg, and in the control 129 +/- 16 mm Hg (p < 0.001). Average diastolic blood pressure was 90 +/- 11 mm Hg in experimental group, and 83 +/- 10 mm Hg in the control (p < 0.03). CONCLUSIONS: Age of the donor has significant influence on long-term survival of the kidney graft in the living-related transplantation. Survival of the graft in examinees without hypertension is significantly longer. Treatment of post-transplantation hypertension is one of the most important tasks in the treatment of patients with transplanted kidney.

Comparison of the effects of Puumala and Dobrava viruses on early and long-term renal outcomes in patients with haemorrhagic fever with renal syndrome.

AIM: The clinical course and outcome of patients with haemorrhagic fever with renal syndrome (HFRS) caused by Puumala (PUUV) and Dobrava viruses (DOBV) were analyzed and whether it left long-term consequences on kidney function after 10 years was evaluated. METHODS: Cross-sectional studies were conducted to test the kidney function and blood pressure of HFRS-affected patients and to follow them up 10 years after. Eighty-two PUUV- and 53 DOBV-induced HFRS patients and 14 and 31 participants 10 years after having contracted PUUV- and DOBV-related diseases, respectively were evaluated. RESULTS: Serum creatinine concentrations were 279.5 and 410 mcmol/L in PUUV and DOBV groups, respectively (P = 0.005). There were six and 13 anuric (P < 0.05), none and seven dialysis-dependant (P < 0.05), and nine and 18 hypotensive patients (P < 0.05) in PUUV and DOBV groups, respectively. After 10 years, glomerular filtration rates were 122.1 + or - 11.1 and 104.7 + or - 20.2 mL/min (P < 0.05) in PUUV and DOBV groups, respectively. CONCLUSION: During the acute phase, DOBV causes more severe renal impairment than PUUV infection. After 10 years follow up, renal function was found within normal limits, although after DOBV infection glomerular filtration rate (GFR) was significantly lower than after PUUV infection.

[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.

Mortality at the Clinic of Internal Medicine of University Clinical Center in Tuzla during 2008.

INTRODUCTION: Accurate information about the cause of death is given by expert teams based on pathological or forensic expertise. Reliable information can be obtained from doctors from clinical-hospital institutions if the deceased person was treated in such an institution and with previously diagnosed disease (hospital mortality). Analysis of hospital mortality provides a lot of data that can be used in planning the hospital beds capacities, the amount of drug procurement, purchasing equipment, organization and creation of highly specialized medical teams (medical team for resuscitation), the number of reanimation techniques, the number of pathologists who are required for autopsy procedures, etc. GOAL was to determine the total number of deaths, the most common causes of death and the 10 leading diagnoses of deceased patients at the Clinic for Internal Medicine of Clinical Center in Tuzla during 2008. MATERIAL AND METHODS: We used the material from the archive (medical records and reports on deceased patients, delivered by physicians working at the Clinic for Internal Medicine of Clinical Center in Tuzla). RESULTS: During 2008 at the Clinic for Internal Medicine 368 patients died. According to the analyzed data leading cause of death and leading diagnosis as cause of death at the Clinic for Internal Medicine in 2008 were as follows: cardiogenic shock in 73 (19.84%), cerebrovascular stroke in 46 (12.50%), coma due to stroke in 32 (8.70%), coma not classified as cerebral in 25 (6.79%) (metabolic 13 (3.53%) and hepatic 12 (3.26%), cardiomyopathy in 22 (5.98%), malignant neoplasm of the abdomen in 17 (4.62%), respiratory insufficiency in 17 (4.62%), acute myocardial infarction and myocardial infarction with rupture in 17 (4.62%), pulmonary edema in 16 (4.35%), and cardiorespiratory arrest in 13 (3.53%) deaths. CONCLUSION: During 2008 at the Clinic for Internal Medicine of Clinical Center in Tuzla died a total of 368 patients. The most common cause of death of patients at the Clinic for Internal Medicine of Clinical Center in Tuzla are cardiovascular disease (n = 175; 47.55% of deaths), in second place was cerebrovascular disease (n = 76; 20.65% of deaths) for a total of 251 (68.20%) of deaths from cardiovascular and cerebrovascular disease.

[Acute rejection in kidney transplantation]. / Akutno odbacivanje u transplantaciji bubrega.

INTRODUCTION: Transplantation of kidneys (TK) is the best way of curing patients with terminal kidney disease. Unfortunately, right after the operation, different kinds of complications are possible and might happen to transplant. The worst and the most often complication is acute rejection (AR). PURPOSE: The aim of work is to find the most often clinical signs and symptoms of AR. The aim of research is to value the influence of AO on function of graft and to find the influence of AR on surviving patients and graft. METHODS: This study has been done on 91 patients, 62 male and 29 female patients in the age of 38.58 +/- 11.4. Patient are divide in two groups: experimental group which includes 29 patients that have had one or more episodes of acute rejection. We used serum concentration of creatinine defined by Cocroft-Gault curve to measure function of transplant. Time of patients and graft survival is estimated by Caplan-Meier curve. RESULTS: In a group of patients with acute rejection we registered 42 episodes of dysfunction of graft which are treated as AR. The average creatinine in a group of patients with acute rejection was 183.42 +/- 65.39 micromol/L. Clearance of creatinine of group patient without AR is much bigger (p < 0.0001) than average clearance of creatinine of patients with acute rejection. Average serum creatinine in this group of patients is 147.59 +/- 62.57 and it is quite smaller (p < 0.002) than average creatinine at patients with acute rejection. Survival of all patients after five years is 91%, survival of patients without acute rejection is 96%, and with acute rejection is 80% (p < 0.014). Five year survival of graft is 78%, at the patients without acute rejection is 96% and at the patients with acute rejection is 64% (p < 0.0001), which is quite shorter. DISCUSSION: Clinical image of acute rejection is unspecific. There is not arranged values of serum creatinine although in some research those values are 130-170 micromol/L. This values includes patients which did not have an acute rejection. Five year survival patients and graft in our patients that did not have an acute rejection is same as in the results of relevant centers. But survival of patients and grafts in patients that had an acute rejection is little bit lower than it is in the results in relevant centers. CONCLUSION: There is no clinical picture than can help you to recognize an acute rejection because many other dysfuncion look the same. Acute rejection reduces function of transplant. Survival of patients and graft is mutch longer in the patients without acute rejection.

[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.

[Evaluation of diabetic nephropathy in older patients with diabetes mellitus type 2]. / Evaluacija dijabetesne nefropatije u starijih bolesnika sa dijabetes mellitus-om tip 2.

INTRODUCTION: Diabetes currently affects more than 170 million people world-wide, but the World Health Organization (WHO) expects that the number of patients will double within the next 20 years. Diabetic nephropathy (DN) is the leading cause of kidney disease in patients who need renal replacement therapy. It is defined by increased urinary albumin excretion in the absence of other renal diseases. The goal of the study is evaluation of DN in older patients with diabetes mellitus (DM) type 2. PATIENTS AND METHODS: Prospective study has been used to analyze 182 patients of old age with DM type 2 according to the criteria of WHO. According to the concentration of albumin in urine the patients were divided in 2 groups: the patients who have confirmed type 2 DM with DN and patients who have confirmed type 2 DM without DN. The following parameters were determined and compared in both groups of patients: age, sex, duration of diabetes, concentration of glucose in blood, microalbuminuria, blood pressure, smoking, obesity, and family history with kidney disease. Albumin/ creatinine ratio was calculated and concentration of albumin in urine was tested by specified albumin straps. RESULTS: The prevalence of type 2 DM in the health care center is 3.64% and prevalence of DN is 24.72%. Results show that duration of DM type 2 is significantly longer in patients with DN (p<0.0001) and concentration of albumin in urine is inreased (p<0.0001), and that significantly higher concentration of HbA1c (p=0.005) and increased creatinine in serum (p=0.04) is present when compared with patients without DN. This study did not find evidence of age, sex, blood pressure, smoking, obesity and family history with kidney disease as risk factors in genesis of DN. CONCLUSION: Duration of DM type 2, increased concentration of glycosyllated HbA1c, and increased creatinine in blood are the risk factors in genesis of DN in older patients with DM type 2.

[Permanent double-lumen central venous catheters--replacement for arteriovenous fistula]. / Trajni dvoluminalni centralni venski kateter--zamjena za arteriovensku fistulu.

INTRODUCTION: The adequate vascular access in the patients on chronically hemodialysis treatment is very importance element in patient feel secure, and medical staff in hemodyalisis centre. The aim of this work is to examinee possibility of the use of permanent double lumen central venous catheter (PermCath) in patients with inadequate vascular access. PATIENTS AND METHOD: PermCath has been placed with local anesthesia in chirurgical room. Eight catheters was application in vena subclavia (three of them in links vena subclavia and six in right vena subclavia) and 26 in vena jugularis internal (for of them in links vena jugularis and 22 in right vena jugularis. The catheters were long 19 cm (26 catheters) and 23 cm (nine catheters). The catheters has been placed in 35 patients on chronically hemodialysis program, eight mean and 27 women, average age 56.03 +/- 16.52 (19 to 77 years). The causal chronically kidney disease has been diabetes mellitus in 12 (34.29%) patients, chronically pyelonephritis in eight (22.86%) patients, polycystic kidney disease in five (14.29%) patients, chronically glomerulonephritis in three (8.57%) patients and seven (20%) patients with other diseases. RESULTS: The catheters has been placed average 233.55 +/- 303.58 days (9 to 1256 days). For three catheters have not registered wail the patients was from another hemodialysis centre. In four of patients were registered catheter sepsis episodes. In two of them catheter was treated with adequate doses of antibiotics since we have performed adequate and systemically antibiotics in lumen of catheter. The isolated bacteria from microbiological examination were: Enterococcus species and Pseudomonas species. Van catheter was isolated, and in microbiological examination from blood were registered Acinobacter species and Enterobacter species. A van patient past away and microbiological examination shown Staphylococcus species. CONCLUSION: PermCath is very security permanent vascular access in the patients with loss construction arteriovenous fistula. The catheter in the patients who has been not adequate arteriovenous fistula, and with adequate treatment he has exchange for arteriovenous fistula.

[The renal failure and capillary leak during the acute stage of (Dobrava) DOB and PUU (Puumala) infection]. / Bubrezna slabost i kapilarna propustljivost u akutnoj fazi DOB i PUU infekcije.

The target organ for Puumala (PUU) and Dobrava (DOB) viruses is the kidney, but the impact on renal function seems far more important in DOB infection than in PUU infections. Aim of study was to estimate the renal failure and capillary leak during the acute stage of DOB-infection and PUU-infection. 50 patients with serological conformed diagnosis of acute hantavirus infection were included in the study. Diuresis, serum urea and creatinine were measured. Size of kidneys and presence of ascites was followed by ultrasonography. Enlargement of both kidneys were found in all (100%) patients. Ascites was present in 8/25 (32%) DOB patients; in 1/25 (4%) PUU patient and pleural effusion in four 4/25 (16%) DOB patients. The statistically significant difference in the mean urinary output was during 5th, 6th and 7th day of hospitalization (P<0,05). Serum creatinine and urea levels were at significantly higher levels for DOB than for PUU patients (P<0,05). Acute haemodialysis was needed in 7/25 (28 %) of the DOB patients. One DOB patient died. DOB virus infection is associated with a more severe kidney function disorders than PUU virus infection. Capillary leak, which caused swollen of kidney and ascites is probably the pathogenesis key factor.

[Puumala and Dobrava viruses in the northeastern and central regions of Bosnia]. / Puumala i Dobrava virusi na podrucju sjeveroistocne i srednje Bosne.

UNLABELLED: Bosnia and Herzegovina has been known as a highly endemic region for Hantavirus infections for more than 50 years. Previous studies have shown that at least two different hantaviruses, the murine Dobrava (DOB) and avricoline Puumala (PUU) viruses, each carried by a different rodent species, have been circulating in the area. However, there is little information on rodent population density fluctuations in Bosnia over the past years as well as on the ratio of Puumala to Dobrava infection in humans. THE AIMS OF OUR STUDY WERE: to identify the rodent species which may serve as hantavirus reservoirs in the north-east and central Bosnia; to assess the geographical distribution, density and population dynamics of rodent species in the area; to assess the influence of climatic conditions on the size of rodent population; and to determine the ratio of Puumala to Dobrava infection in humans. METHODS: The epidemiologic and epizootic study in the north-east and central Bosnia was conducted during the 8-year period (1995-2003). The average yearly and monthly temperatures, air humidity and precipitation during the study period were analyzed. A total of 381 small rodents were caught during the epidemic years (1995 and 2002), and in-between the epidemic periods (1999 and 2000). The animals were caught by live-traps and identified by morphometric methods. The density of animals was estimated by counting the number of holes per 1000 m2. Sera of 311 patients with clinical signs and symptoms of hemorrhagic fever with renal syndrome (HFRS) were tested for the presence of antibodies reactive to the Dobrava, Puumala and Seoul viruses by using indirect immunofluorescence test (IIF), and IgG and IgM ELIS. Sera of 84 patients were tested using only IIF, and 227 sera were tested by IIF and -capture IgM ELIS tests. RESULTS: During the epidemic years, the average monthly temperatures in February were by 4.3 times higher than the average temperatures during the nonepidemic years, which may have influenced the early reproduction of rodents and development of "mouse years". The rodents were identified as: Apodemus flavicollis (n = 139), Apodemus sylvaticus (n = 89), Apodemus agrarius (n = 4), Clethrionomys glareolus (n = 117), Sorex araneus (n = 5), Pytimus subterraneus (n = 23), Mus musculus (n = 1), Mycrotus arvalis (n = 1) and Rattus norvegicus (n = 2). Clethrionomys glareolus was predominant in the regions with the altitude higher than 1160 meters and Apodemus species in the regions with the altitude lower than 670 meters. The rodent population density changes seasonally and cyclically. During the epidemic years, the rodent population density was marked as very high, whereas during the nonepidemic years it was designated from low to moderate. Well-known natural hosts of Hantaviruses (A. flavicolis and C. glareolus) are most widely spread species of small rodents, and the increase in their population is closely related with outbreaks of epidemics of HVBS-a. Puumala virus caused HVBS-a in 49.84% (155/311); Dobrava virus in 23.15% (72/311) of cases, whereas Hantaviruses serotype was not identified in 27.00% (84/311) of cases. Infections caused by Puumala virus were more frequent than the infections caused by Dobrava virus during both epidemic and nonepidemic periods. The proportion of humans infected with Puumala and Dobrava viruses correlated with the number of natural hosts of Hantaviruses in the areas of HVBS outbreaks. The study of the prevalence of hantavirus antibodies in the populations of rodents and humans, which had been under way, should elucidate these relationships.

[Ultrasound findings on abdominal organs in the acute phase of hemorrhagic fever with renal syndrome]. / Ultrasonografski nalaz na abdominalnim organima u akutnoj fazi hemoragijske vrucice s bubreznim sindromom.

INTRODUCTION: There are significant changes in small blood vessels with increased permeability, edema of abdominal organs and ascites in the acute phase of hemorrhagic fever with renal syndrome (HFRS). We analyzed ultrasound changes of abdominal organs in patients with serologically verified HFRS, in order to assess the value of this method in the diagnosis of acute renal failure (ARF). METHODS: The study included 14 sporadic patients with ARF and suspicion of HFRS, treated in 2002. Ultrasonography of the liver, gallbladder, pancreas, spleen, kidneys, prostate and retroperitoneum was performed on a Toshiba 220 SSA. RESULTS: Parenchymal edema with increased echogenicity, sinus narrowing and enlargement of both kidneys were found in all 14 (100%) patients. Hepatosplenomegaly was found in seven (50%), ascites in four (28.6%), and pleural effusion in two (14.3%) patients. Increased thickness of the bladder wall was found in two (14.3%), gallbladder enlargement in one (7%), and edema of the pancreas in one (7%) patient. CONCLUSION: Ultrasound examination has a very important role in the diagnosis and follow-up of changes in the parenchymal organs in the acute acute phase of the disease.