The most common clinical sign in pediatric cardiology is heart murmur, which can often be unchara... more The most common clinical sign in pediatric cardiology is heart murmur, which can often be uncharacteristic. The aim of this research was to present the results of development of a classifier based on machine learning algorithms whose purpose is to classify organic murmur that occur in congenital heart defect (CHD). The study is based on the data collected at Pediatric Clinic, Clinical Center University of Sarajevo during three-year period. Totally, 116 children aged from 1 to 15 years were enrolled in the study. Input parameters for classification are parameters obtained during basic physical examination and assessment of patient. First, analysis of relevance of the feature for classification was done using InfoGain, GainRatio, Relief and Correlation method. In the second step, classifiers based on Naive Bayes, Logistic Regression, Decision Tree, Random Forest and Support Vector Machine were developed and compared by performance. The results of this research suggest that high accura...
The aim of the paper was to examine the effect of noise on the blood flow velocity through a peri... more The aim of the paper was to examine the effect of noise on the blood flow velocity through a period of three years on workers who work on press machine. It was proven that continuous exposure to noise affects the blood flow velocity through the aorta and increases the diameter of ascending aorta and this, consequently, leads to an increase in cardiovascular risk. Prevention of changes in the cardiovascular system is considered to be imperative, and the limitation of noise levels and the length of exposure to noise must be established as factors that must be planned during the construction of the work environment.
1 Department for Architectural Structures and Building Technologies, Faculty of Architecture, Uni... more 1 Department for Architectural Structures and Building Technologies, Faculty of Architecture, University of Sarajevo, Patriotske lige 30., 71 000 Sarajevo, Bosnia and Herzegovina 2 Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Patriotske lige 81., 71 000 Sarajevo, Bosnia and Herzegovina, email: [email protected] 3 Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Kranjčevićeva 12., 71 000 Sarajevo, Bosnia and Herzegovina, email:[email protected] 4 Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, 71 000 Sarajevo, Bosnia and Herzegovina, email:[email protected] 5 Faculty of Medicine, University of Tuzla, Univerzitetska 1., 75 000 Tuzla, Bosnia and Herzegovina, email: [email protected] 6 Department for Pathophysiology, Faculty of Medicine, University of Sarajevo, Čekaluša 90, 71 000 Sarajevo, Bosnia and Herzegovina, email:[email protected]
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2021
Aim To investigate the benefit of high-dose lipophilic statin therapy on cardiac remodelling, fun... more Aim To investigate the benefit of high-dose lipophilic statin therapy on cardiac remodelling, function and progression of heart failure (HF) in patients with ischemic heart disease. Methods A total of 80 patients with ischemic HF diagnosis were followed during 6 months, and they were divided in two groups. First group (n=40) was treated by high-dose lipophilic statin therapy (atorvastatin 40 mg) and conventional therapy for HF, while the second group (n=40) had no atorvastatin in the therapy. Results In the beginning of study, from all of the observed parameters, only the ratio of flow rates in early and late diastole (E/A ratio) differed between the test groups (p=0.007). After six months, a statistically significant increase in left ventricular end-diastolic diameter (LVIDD) in patients who had not been treated with atorvastatin was found. In the patients treated with atorvastatin, there was a significant reduction in basal right ventricle diameter in diastole and systole (p<0....
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2019
Aim To identify short-term effects of extracorporeal shock wave lithotripsy (ESWL) on renal funct... more Aim To identify short-term effects of extracorporeal shock wave lithotripsy (ESWL) on renal function in children and adolescents with single kidney stones. Methods In a 4-year period 30 children (15 boys and 15 girls) from 10 to 18 years of age were treated for unilateral renal stones with ESWL. Inclusion criteria were: up to 18 years of age, kidney stone (from 4 to 20 mm in diameter) visible on X-ray, first ESWL treatment, unilateral lithotripsy treatment without previous kidney surgery, patients without infravesical obstruction, patients without proven urinary infection, repeated use of one (the same) analgesic, patients without anticoagulant and antihypertensive therapy, patients without use of nephrotoxic drugs prior to and during the treatment, normal blood pressure, non-pregnancy patients with normal renal function. Serum enzymes (alkaline phosphatase, lactate dehydrogenase), cystatin C, serum and urine electrolytes (sodium, potassium, chloride), and urine neutrophil gelatinas...
Periodicals of Engineering and Natural Sciences (PEN), 2020
Background: The use of trolleys for transporting the patients and lifting and lowering them in th... more Background: The use of trolleys for transporting the patients and lifting and lowering them in the trolley is a repeated activity in the daily work of a nurse, and a very common cause of the load of the lumbosacral part of the spine and the consequent pathological deformity, and the onset of clinical symptomatology of painful lumbo-sacral syndrome. The high level of excessive biomechanical stress is associated with the established practice of using standard medical wheelchairs to move patients inside the hospital. The process itself depends on the characteristics of the patient, his or her weight, as well as his/her cooperativeness, but primarily depends on the nurse's mobility. Although nurses strive to be in a position that reduces the load on the lumbosacral part of the spine during practice, this is often impracticable due to the patient's inconsistency. Objective: To present the ergonomic analysis of the medical nurse's workplace while lifting the patient into the w...
Results: After 247 ± 53 seconds (4 minutes and 11 seconds) in average patients developed NSVT, an... more Results: After 247 ± 53 seconds (4 minutes and 11 seconds) in average patients developed NSVT, and were referred for coronary angiography. Of total number, 4 had a significant finding on coronary angiography; 3 patients had single-vessel coronary disease (one received a stent on right coronary artery (RCA), two on left anterior descending artery (LAD)), and one had triple-vessel coronary disease (received a stent on circumflex artery (CX) and LAD).
Aim: To present a therapeutic modality of peripartum cardiomyopathy (PPCM). Case report: A 24-yea... more Aim: To present a therapeutic modality of peripartum cardiomyopathy (PPCM). Case report: A 24-year-old female patient, with no prior known diagnosis, was admitted to the Department of Cardiology with signs of acute heart failure. A 45 days prior to admission she delivered a healthy baby (first pregnancy) via cesarean section, while 20 days before hospitalization she developed symptoms like dyspnea, orthopnea, fatigue, weakness and extremely low tolerance to effort. Upon admission on X-ray, heart shadow was enlarged and, while on electrocardiogram (ECG) there was a sinus tachycardia with negative T waves from V1-V5. Echocardiography on admission showed initial dilatation of cardiac chambers, reduced ejection fraction of left ventricle (EFLV; estimated about 25%) with global hypokinesia, signs of moderate to severe mitral and tricuspid regurgitation with mild pulmonary hypertension, along with hemodynamically nonsignificant circumferential pericardial effusion (diastolic separation of 8mm). Laboratory findings were as follows: NT-pro BNP 1810.0 pg/mL; signs of anemia, while inflammatory parameters, cardiac necrosis markers, urea, creatinine, D-dimer and thyroid hormones values remained in reference values. Testing for known cardiotropic viruses was not positive and PPCM was diagnosed. The patient was treated with cardio selective beta blocker (metoprolol), angiotensin-converting enzyme (ACE) inhibitor (ramipril), diuretics (furosemide), spironolactone, and digoxin along with supportive therapy. After twelve days of hospital treatment, there was significant improvement of the clinical status of our patient. Her symptoms were notably ameliorated. EFLV before discharge improved to 40%, heart chambers dimensions were in referral values, while mitral and tricuspid regurgitation were significantly reduced into a mild grade, while pericardial effusion was also in regression. Follow-up examination after two and six months showed further improvement of patients' conditions while after six months only beta-blocker and acetylsalicylic acid were prescribed in therapy. Conclusion: PPCM can occur during the end of pregnancy or within five months after delivery with no determinable etiology and with absence of cardiac disease in anamnesis. 1
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2020
Özet-Kalsifiye lezyonların dilatasyonu ve perkütan koroner girişimi girişimsel kardiyologların gü... more Özet-Kalsifiye lezyonların dilatasyonu ve perkütan koroner girişimi girişimsel kardiyologların günlük pratiğinde sık karşılaştığı bir zorluktur. Koroner kalsifikasyon, aterosklerotik sürecin ilerlemesinin bir göstergesidir. Kalsifiye lezyonların varlığı, daha kötü klinik sonuçları öngörür ve artmış mortalite ve işlem sonrası majör olumsuz kardiyovasküler olaylar ile ilişkilidir. Altmış̧ bir yaşındaki erkek hasta, daha önce suboptimal genişletilmiş̧ stentte gelişen stent trombozunun neden olduğu kardiyak arrest ile komplike olan ST yükselmeli miyokart enfarktüsü (STYME) tanısı ile hastaneye kabul edildi. Lezyon, non-kompliyan (NC) balonların dilatasyonuna yanıt vermezken, süper yüksek basınçlı NC balonun (OPN NC) ultra yüksek basınçta şişirilmesiyle lezyonun dilatasyonunda optimum sonuç elde edilmiştir. Kalsifik, sert lezyonlara girişim kapsamlı ve dikkatli bir yaklaşım gerektirir. OPN NC balonları bu tip lezyonların tedavisinde yer edinmiştir. İşlemden sonra optimize edilmiş tıpsal tedavi de olumsuz kardiyovasküler olayların önlenmesi için vazgeçilmezdir.
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2020
Aim: The aim of the paper is to present prenatal diagnosis of Holt-Oram syndrome (HOS), pregnancy... more Aim: The aim of the paper is to present prenatal diagnosis of Holt-Oram syndrome (HOS), pregnancy management, out-of-hospital birth in the 33rd week of gestation, and postnatal treatment. Case description: The following fetal malformations were detected by ultrasound on the 30th week of gestation: bilateral upper lip and palate cleft, bilateral upper limb mesomelia with bilateral ulnar deviation of the wrist with absent thumb, ventricular septal defect, and distension of the colon. The amniotic fluid index was 23. Holt-Oram syndrome was suspected. During the ultrasound examination, a Kurjak antenatal neurodevelopmental test (KANET) was scored to be 8. At home, at the 33rd week of pregnancy, a premature rupture of the amniotic membranes occurred, followed by uterine contractions, and the patient was urgently transported to the hospital. During the transportation attended by the midwife, premature baby was delivered in the car not far from the hospital, where the baby was admitted at the age of 7 minutes. The baby was admitted to the neonatal intensive care unit with all prenatally detected congenital malformations present during the first checkup. The baby was in the life-threatening condition and died at the age of 48 hours. Conclusion: Holt-Oram syndrome should be prenatally detected in order to enable better prenatal counseling with the possibility of the interruption of pregnancy, which may be the option in severe cases, or if parents opt for continuation of pregnancy to discuss with the all possible options of pregnancy and postnatal outcome.
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2020
Introduction: Congenital heart defects (CHDs) are the most common congenital anomalies in the ped... more Introduction: Congenital heart defects (CHDs) are the most common congenital anomalies in the pediatric population, representing about one-third of all congenital anomalies in infants. Modern pediatric cardiology deals mainly with CHD. Echocardiography is a well-established diagnostic method in fetal and pediatric cardiology. The paper aimed to show the importance of early diagnosis of CHD in Bosnia and Herzegovina by fetal and pediatric echocardiography to foster the treatment if necessary and to present the outcome of children with early prenatal screening and postnatal diagnosis of CHD. Material and methods: In a retrospective study, we investigated all patients with prenatally detected CHDs at the
Introduction: Aim of article was to present perspectives of telemedicine in the field of cardiolo... more Introduction: Aim of article was to present perspectives of telemedicine in the field of cardiology in Bosnia and Herzegovina. Material and methods: Article has descriptive character and present review of literature. Results: Information technology can have the application in the education of students, starting from basic medical sciences up to clinical subjects. Information technologies are used for ECG analysis, 24h ECG Holter monitoring, which detects different rhythm disorders. By developing software packages for electrocardiogram analysis, which can be divided and interpreted by mobile phones, and complete the whole of the patient in the ambulance, specialist, experienced specialists, or even consultations in various illnesses and cities. Image segmentation algorithms have significance in the quantization and diagnostics of anatomic and pathological structures, and 3D representation has an important role in education, topography and clinical anatomy, radiology, pathology, as well as in clinical cardiology itself, especially in the sphere of coronary arteries identification in the multislice computerized angiography of coronary arteries. Interactive video consultations with subspecialists from the state and the region in adult cardiology, adult interventional cardiology, cardiovascular surgery, pediatric invasive and non-invasive cardiology enable better access to heart specialists and subspecialist, accurate diagnosis, better treatment, reduction of mortality, and a significant reduction in costs. Conclusion: Telemedicine by slow steps in entering the soil of Bosnia and Herzegovina, but the potential exists. It is necessary to educate the medical staff, as well as to provide a tempting environment for software engineers. Investing in infrastructure and equipment is imperative, as well as a positive climate for the its implementation.
This study aims to investigate whether the high sensitive C-reactive protein (hsCRP) is associate... more This study aims to investigate whether the high sensitive C-reactive protein (hsCRP) is associated with an ejection fraction of left ventricle (EFLV) in the early phase of ST-elevation myocardial infarction (STEMI), treated with the primary percutaneous intervention (pPCI), and to establish whether there exists a relationship between its values and the presence of major adverse cardiovascular events (MACE) within six months of pPCI. Materials and Methods: In this prospective study, 357 patients who were diagnosed with STEMI and who underwent pPCI within 24 hours of pain onset were included. The following were monitored and recorded: 1) hsCRP values, which were measured between 24 and 48 hours of pPCI, 2) EFLV values, which were measured five days after the pPCI, and 3) MACE, which was established within six months of pPCI. Results: The EFLV values measured five days after the pPCI were significantly lower with increasing hsCRP values (rho=-0.384, p<0.0001). There was a significant difference in hsCRP values between patients who had MACE and those without it (38.35 [98.10] vs. 12.97 [23.80], p=0.0001). In addition, hsCRP values were significantly increased in patients who died during the first six months after the pPCI compared with patients who survived (115.00 [202.80] vs. 15.84 [31.5], p=0.001). Conclusion: The hsCRP values in patients with STEMI who were treated with the pPCI are related to systolic function in the early phase of STEMI, as well as MACE during the first six months of follow-up.
Periodicals of Engineering and Natural Sciences (PEN), 2019
Background: The aim of the article was to create an appropriate computer model based on the real ... more Background: The aim of the article was to create an appropriate computer model based on the real status of the mortar operator's workplace and to analyze the workplace. After that, for any possible exceedances from the aspect of the organism's load and safety, the aim is to redesign the workplace and bring it within the limits of the permissible load, and therefore the required safety. The aim is also to identify the characteristic work movements performed by the soldier and to carry out an ergonomic analysis of the soldier's efforts and to propose appropriate improvements. Methods: The analysis is performed on a total of 20 soldiers, from which is determined an average model of the following characteristics: 180 cm in height and 85 kg in weight. The task is to take a mine from the shell containing the mines, then transfer it to the mortar and fill the mortar barrel. The weight of the 120 mm mortar grenade is 14.8 kg. The average soldier is 26 years old and his military exercise lasts 4 hours. The CATIA software package (Dassault Systèmes, Vélizy-Villacoublay, France) is used for analysis. By knowing the anthropometric and work environment data, with ergonomic design and analysis, the following analyses were made: biomechanical analysis, rapid upper limb assessment (RULA) and carry analysis (option from CATIA software). Results: The proposed modification of the position resulted in a decrease in the L4/L5 torque from 316 Nm to 154 Nm along with decreasing of the compression force on the L4/ L5 from 5,779 N to 3038 N (the compression force allowed is 3,400 N), and while the RULA analysis is from the red color position 1 (score 7; maximum load requiring rapid repositioning of such position), revised final score 4 made in yellow (a solution acceptable for this work place). Conclusions: By ergonomic analysis, obtained proposal will lead to less chance of injury, prevention of burn out syndrome, fewer chances of illness, decreasing the fatigue, greater safety, less energy spent and better preparedness for all necessary tasks.
Objective: Demonstration of idiopathic dilated cardiomyopathy with unusual flow, unpredictable cl... more Objective: Demonstration of idiopathic dilated cardiomyopathy with unusual flow, unpredictable clinical picture and complex therapy. Case report: Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed. Conclusion: The clinical course of dilated cardiomyopathy is extremely unpredictable and therapy is very complex and demanding.
This study aimed to show the spontaneous rupture of the stomach in a 3-year-old girl. The patient... more This study aimed to show the spontaneous rupture of the stomach in a 3-year-old girl. The patient was admitted to the pediatric clinic due to poor general condition that occurred suddenly with severe abdominal pain, vomiting, and the development of hypovolemic shock (blood pressure was unmeasurable, in acidosis), and after the ultrasound and abdominal X-ray, she was operated by the pediatric surgeon within 6 h of admission. During surgery, multiple defects of stomach mucosa with transmural bleeding without pathohistological changes in the muscle layer were found in the large stomach blood vessels. Treatment was continued in the pediatric intensive care unit with the development of life-limiting complications: peritonitis, sepsis, intracranial hemorrhage, and outcome of death. Rupture of the stomach caused by acute distension is rarely seen outside the neonatal period with fast clinical course and high mortality rate. Early diagnosis and rapid surgical procedures are a prerequisite to avoid the development of life-limiting complications that lead to a fatal outcome.
Introduction: The aim of the study was to determine the most frequent early and late complication... more Introduction: The aim of the study was to determine the most frequent early and late complications in diff erent types of ileal urinary diversions. Patients and methods: The study was conducted in a fi ve-year period, on 106 patients who were diagnosed with invasive urinary bladder cancer and who had indication for radical cystectomy with one of the investigated types of urine derivation. They were divided into 2 groups, based on the type of ileal urinary diversions. Results: The colonization of bacteria was more prominently present in the ileal conduit urinary diversion group (97%) compared to Ghoneim (25%) and Hautmann (10%) group, Ureteral stenosis was slightly less represented in the conduit group (9.1%). Wound infections were signifi cantly more represented in the conduit (21.2%) than in the Ghoneim group (5%) Nighttime incontinence was present in 20% of patients in both groups or 4 patients in each group. Daytime incontinence in the Ghoneim group was present in 3 patients (15%) and in the Hautmann group 2 patients (10%). Late complications correlate signifi cantly negative with the type of surgery and slightly negative with the grade, and signifi cantly positively with the examined group and T stage, and slightly correlate positively to the N and R stages. Early complications correlate slightly negative with the type of surgery, slightly negative with the grade, and signifi cantly positively with T stage, and slightly positively correlates with the N and R stage. Conclusion: The most commonly reported complications in ileal conduit are: prolonged ileus, stoma infection, wound dehiscence and bacterial colonization, followed by peristomal skin complications and complications related only to the stoma, such as stenosis and stoma retraction, and prolaps of ileostoma and ileointestinal stenosis. The ileus rate in orthotopic derivation was signifi cantly lower than that of the ileal conduit group, which led to the conclusion that the neomybladder position does not disturb the anatomic abdominal structure.
International Journal of Applied and Basic Medical Research, 2019
Introduction: Renal vasculature is extremely sensitive to vasoconstrictor effects of endothelin (... more Introduction: Renal vasculature is extremely sensitive to vasoconstrictor effects of endothelin (ET), while nitric oxide (NO) has special role in several pathological renal conditions. Aim: The aim of this study to examine the presence, character, and degree of changes in NO and ET levels in the serum of extracorporeal shock wave lithotripsy (ESWL)-treated patients with nephrolithiasis. Patients and Methods: This study included a total of 60 patients that were divided in two groups: Group I (n = 24), in which a total of 2000SWs were administered; 0–2 units; (0.5 units per each 500SWs), and Group II (n = 36), in which a total of 4000SWs were administered; 0–4 units; (0.5 units per each 500SWs). Results: In the Group I median NO serum concentration increased in relation to pretreatment levels (39.04 ± 8.29 μmol/L) specifically 30 min, 60 min, and 24 h following the treatment (39.11 ± 12.60), (41.80 ± 6.89), and (46.33 ± 9.03), where concentration growth after 24 h was statistically significant P < 0.01. The NO serum concentration in the Group II increased in relation to pretreatment levels (38.90 ± 10.33 μmol/L) after 30 min (48.71 ± 30.09), 60 min (54.57 ± 39.76), and 24 h (97.95 ± 72.07). The NO concentration increase after 60 min and 24 h is statistically significant, respectively, P < 0.03 and P < 0.0001. Conclusion : NO and ET serum levels are changing under the influence of ESWL, and that the NO and ET changes are directly correlated with the number of administered shock waves and administered energy.
Alzheimer's disease represents the most common age-related neurodegenerative disorder and a leadi... more Alzheimer's disease represents the most common age-related neurodegenerative disorder and a leading cause of progressive cognitive impairment. Predicting cognitive decline is challenging but would be invaluable in an increasingly aging population which also experiences a rising cardiovascular risk. In order to examine whether plasma measurements of one of the established biomarkers of heart failure, brain natriuretic peptide (BNP), reflect a decline in cognitive function, associated with Alzheimer's disease neurodegeneration, BNP levels were analysed, by using a novel assay called a SOMAscan, in 1. cognitively healthy, control subjects; 2. subjects with mild cognitive impairment, and 3. subjects with Alzheimer's disease. The results of our study show that the levels of the BNP were significantly different between the three types of diagnoses (p < 0.05), whereby subjects with mild cognitive impairment had the lowest mean BNP value, and healthy subjects had the highest BNP value. Importantly, our results show that the levels of the BNP are influenced by the presence of at least one APOE4 allele in the healthy (p < 0.05) and in the Alzheimer's disease groups of subjects (p < 0.1). As the levels of the BNP appear to be independent of the APOE4 genotype in subjects with mild cognitive impairment, the results of our study support inclusion of measurements of plasma levels of the BNP in the list of the core Alzheimer's disease biomarkers for identification of the mild cognitive impairment group of patients. In addition, the results of our study warrant further investigations into molecular links between Alzheimer's disease-type cognitive decline and cardiovascular disorders.
The most common clinical sign in pediatric cardiology is heart murmur, which can often be unchara... more The most common clinical sign in pediatric cardiology is heart murmur, which can often be uncharacteristic. The aim of this research was to present the results of development of a classifier based on machine learning algorithms whose purpose is to classify organic murmur that occur in congenital heart defect (CHD). The study is based on the data collected at Pediatric Clinic, Clinical Center University of Sarajevo during three-year period. Totally, 116 children aged from 1 to 15 years were enrolled in the study. Input parameters for classification are parameters obtained during basic physical examination and assessment of patient. First, analysis of relevance of the feature for classification was done using InfoGain, GainRatio, Relief and Correlation method. In the second step, classifiers based on Naive Bayes, Logistic Regression, Decision Tree, Random Forest and Support Vector Machine were developed and compared by performance. The results of this research suggest that high accura...
The aim of the paper was to examine the effect of noise on the blood flow velocity through a peri... more The aim of the paper was to examine the effect of noise on the blood flow velocity through a period of three years on workers who work on press machine. It was proven that continuous exposure to noise affects the blood flow velocity through the aorta and increases the diameter of ascending aorta and this, consequently, leads to an increase in cardiovascular risk. Prevention of changes in the cardiovascular system is considered to be imperative, and the limitation of noise levels and the length of exposure to noise must be established as factors that must be planned during the construction of the work environment.
1 Department for Architectural Structures and Building Technologies, Faculty of Architecture, Uni... more 1 Department for Architectural Structures and Building Technologies, Faculty of Architecture, University of Sarajevo, Patriotske lige 30., 71 000 Sarajevo, Bosnia and Herzegovina 2 Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Patriotske lige 81., 71 000 Sarajevo, Bosnia and Herzegovina, email: [email protected] 3 Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Kranjčevićeva 12., 71 000 Sarajevo, Bosnia and Herzegovina, email:[email protected] 4 Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, 71 000 Sarajevo, Bosnia and Herzegovina, email:[email protected] 5 Faculty of Medicine, University of Tuzla, Univerzitetska 1., 75 000 Tuzla, Bosnia and Herzegovina, email: [email protected] 6 Department for Pathophysiology, Faculty of Medicine, University of Sarajevo, Čekaluša 90, 71 000 Sarajevo, Bosnia and Herzegovina, email:[email protected]
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2021
Aim To investigate the benefit of high-dose lipophilic statin therapy on cardiac remodelling, fun... more Aim To investigate the benefit of high-dose lipophilic statin therapy on cardiac remodelling, function and progression of heart failure (HF) in patients with ischemic heart disease. Methods A total of 80 patients with ischemic HF diagnosis were followed during 6 months, and they were divided in two groups. First group (n=40) was treated by high-dose lipophilic statin therapy (atorvastatin 40 mg) and conventional therapy for HF, while the second group (n=40) had no atorvastatin in the therapy. Results In the beginning of study, from all of the observed parameters, only the ratio of flow rates in early and late diastole (E/A ratio) differed between the test groups (p=0.007). After six months, a statistically significant increase in left ventricular end-diastolic diameter (LVIDD) in patients who had not been treated with atorvastatin was found. In the patients treated with atorvastatin, there was a significant reduction in basal right ventricle diameter in diastole and systole (p<0....
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2019
Aim To identify short-term effects of extracorporeal shock wave lithotripsy (ESWL) on renal funct... more Aim To identify short-term effects of extracorporeal shock wave lithotripsy (ESWL) on renal function in children and adolescents with single kidney stones. Methods In a 4-year period 30 children (15 boys and 15 girls) from 10 to 18 years of age were treated for unilateral renal stones with ESWL. Inclusion criteria were: up to 18 years of age, kidney stone (from 4 to 20 mm in diameter) visible on X-ray, first ESWL treatment, unilateral lithotripsy treatment without previous kidney surgery, patients without infravesical obstruction, patients without proven urinary infection, repeated use of one (the same) analgesic, patients without anticoagulant and antihypertensive therapy, patients without use of nephrotoxic drugs prior to and during the treatment, normal blood pressure, non-pregnancy patients with normal renal function. Serum enzymes (alkaline phosphatase, lactate dehydrogenase), cystatin C, serum and urine electrolytes (sodium, potassium, chloride), and urine neutrophil gelatinas...
Periodicals of Engineering and Natural Sciences (PEN), 2020
Background: The use of trolleys for transporting the patients and lifting and lowering them in th... more Background: The use of trolleys for transporting the patients and lifting and lowering them in the trolley is a repeated activity in the daily work of a nurse, and a very common cause of the load of the lumbosacral part of the spine and the consequent pathological deformity, and the onset of clinical symptomatology of painful lumbo-sacral syndrome. The high level of excessive biomechanical stress is associated with the established practice of using standard medical wheelchairs to move patients inside the hospital. The process itself depends on the characteristics of the patient, his or her weight, as well as his/her cooperativeness, but primarily depends on the nurse's mobility. Although nurses strive to be in a position that reduces the load on the lumbosacral part of the spine during practice, this is often impracticable due to the patient's inconsistency. Objective: To present the ergonomic analysis of the medical nurse's workplace while lifting the patient into the w...
Results: After 247 ± 53 seconds (4 minutes and 11 seconds) in average patients developed NSVT, an... more Results: After 247 ± 53 seconds (4 minutes and 11 seconds) in average patients developed NSVT, and were referred for coronary angiography. Of total number, 4 had a significant finding on coronary angiography; 3 patients had single-vessel coronary disease (one received a stent on right coronary artery (RCA), two on left anterior descending artery (LAD)), and one had triple-vessel coronary disease (received a stent on circumflex artery (CX) and LAD).
Aim: To present a therapeutic modality of peripartum cardiomyopathy (PPCM). Case report: A 24-yea... more Aim: To present a therapeutic modality of peripartum cardiomyopathy (PPCM). Case report: A 24-year-old female patient, with no prior known diagnosis, was admitted to the Department of Cardiology with signs of acute heart failure. A 45 days prior to admission she delivered a healthy baby (first pregnancy) via cesarean section, while 20 days before hospitalization she developed symptoms like dyspnea, orthopnea, fatigue, weakness and extremely low tolerance to effort. Upon admission on X-ray, heart shadow was enlarged and, while on electrocardiogram (ECG) there was a sinus tachycardia with negative T waves from V1-V5. Echocardiography on admission showed initial dilatation of cardiac chambers, reduced ejection fraction of left ventricle (EFLV; estimated about 25%) with global hypokinesia, signs of moderate to severe mitral and tricuspid regurgitation with mild pulmonary hypertension, along with hemodynamically nonsignificant circumferential pericardial effusion (diastolic separation of 8mm). Laboratory findings were as follows: NT-pro BNP 1810.0 pg/mL; signs of anemia, while inflammatory parameters, cardiac necrosis markers, urea, creatinine, D-dimer and thyroid hormones values remained in reference values. Testing for known cardiotropic viruses was not positive and PPCM was diagnosed. The patient was treated with cardio selective beta blocker (metoprolol), angiotensin-converting enzyme (ACE) inhibitor (ramipril), diuretics (furosemide), spironolactone, and digoxin along with supportive therapy. After twelve days of hospital treatment, there was significant improvement of the clinical status of our patient. Her symptoms were notably ameliorated. EFLV before discharge improved to 40%, heart chambers dimensions were in referral values, while mitral and tricuspid regurgitation were significantly reduced into a mild grade, while pericardial effusion was also in regression. Follow-up examination after two and six months showed further improvement of patients' conditions while after six months only beta-blocker and acetylsalicylic acid were prescribed in therapy. Conclusion: PPCM can occur during the end of pregnancy or within five months after delivery with no determinable etiology and with absence of cardiac disease in anamnesis. 1
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2020
Özet-Kalsifiye lezyonların dilatasyonu ve perkütan koroner girişimi girişimsel kardiyologların gü... more Özet-Kalsifiye lezyonların dilatasyonu ve perkütan koroner girişimi girişimsel kardiyologların günlük pratiğinde sık karşılaştığı bir zorluktur. Koroner kalsifikasyon, aterosklerotik sürecin ilerlemesinin bir göstergesidir. Kalsifiye lezyonların varlığı, daha kötü klinik sonuçları öngörür ve artmış mortalite ve işlem sonrası majör olumsuz kardiyovasküler olaylar ile ilişkilidir. Altmış̧ bir yaşındaki erkek hasta, daha önce suboptimal genişletilmiş̧ stentte gelişen stent trombozunun neden olduğu kardiyak arrest ile komplike olan ST yükselmeli miyokart enfarktüsü (STYME) tanısı ile hastaneye kabul edildi. Lezyon, non-kompliyan (NC) balonların dilatasyonuna yanıt vermezken, süper yüksek basınçlı NC balonun (OPN NC) ultra yüksek basınçta şişirilmesiyle lezyonun dilatasyonunda optimum sonuç elde edilmiştir. Kalsifik, sert lezyonlara girişim kapsamlı ve dikkatli bir yaklaşım gerektirir. OPN NC balonları bu tip lezyonların tedavisinde yer edinmiştir. İşlemden sonra optimize edilmiş tıpsal tedavi de olumsuz kardiyovasküler olayların önlenmesi için vazgeçilmezdir.
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2020
Aim: The aim of the paper is to present prenatal diagnosis of Holt-Oram syndrome (HOS), pregnancy... more Aim: The aim of the paper is to present prenatal diagnosis of Holt-Oram syndrome (HOS), pregnancy management, out-of-hospital birth in the 33rd week of gestation, and postnatal treatment. Case description: The following fetal malformations were detected by ultrasound on the 30th week of gestation: bilateral upper lip and palate cleft, bilateral upper limb mesomelia with bilateral ulnar deviation of the wrist with absent thumb, ventricular septal defect, and distension of the colon. The amniotic fluid index was 23. Holt-Oram syndrome was suspected. During the ultrasound examination, a Kurjak antenatal neurodevelopmental test (KANET) was scored to be 8. At home, at the 33rd week of pregnancy, a premature rupture of the amniotic membranes occurred, followed by uterine contractions, and the patient was urgently transported to the hospital. During the transportation attended by the midwife, premature baby was delivered in the car not far from the hospital, where the baby was admitted at the age of 7 minutes. The baby was admitted to the neonatal intensive care unit with all prenatally detected congenital malformations present during the first checkup. The baby was in the life-threatening condition and died at the age of 48 hours. Conclusion: Holt-Oram syndrome should be prenatally detected in order to enable better prenatal counseling with the possibility of the interruption of pregnancy, which may be the option in severe cases, or if parents opt for continuation of pregnancy to discuss with the all possible options of pregnancy and postnatal outcome.
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2020
Introduction: Congenital heart defects (CHDs) are the most common congenital anomalies in the ped... more Introduction: Congenital heart defects (CHDs) are the most common congenital anomalies in the pediatric population, representing about one-third of all congenital anomalies in infants. Modern pediatric cardiology deals mainly with CHD. Echocardiography is a well-established diagnostic method in fetal and pediatric cardiology. The paper aimed to show the importance of early diagnosis of CHD in Bosnia and Herzegovina by fetal and pediatric echocardiography to foster the treatment if necessary and to present the outcome of children with early prenatal screening and postnatal diagnosis of CHD. Material and methods: In a retrospective study, we investigated all patients with prenatally detected CHDs at the
Introduction: Aim of article was to present perspectives of telemedicine in the field of cardiolo... more Introduction: Aim of article was to present perspectives of telemedicine in the field of cardiology in Bosnia and Herzegovina. Material and methods: Article has descriptive character and present review of literature. Results: Information technology can have the application in the education of students, starting from basic medical sciences up to clinical subjects. Information technologies are used for ECG analysis, 24h ECG Holter monitoring, which detects different rhythm disorders. By developing software packages for electrocardiogram analysis, which can be divided and interpreted by mobile phones, and complete the whole of the patient in the ambulance, specialist, experienced specialists, or even consultations in various illnesses and cities. Image segmentation algorithms have significance in the quantization and diagnostics of anatomic and pathological structures, and 3D representation has an important role in education, topography and clinical anatomy, radiology, pathology, as well as in clinical cardiology itself, especially in the sphere of coronary arteries identification in the multislice computerized angiography of coronary arteries. Interactive video consultations with subspecialists from the state and the region in adult cardiology, adult interventional cardiology, cardiovascular surgery, pediatric invasive and non-invasive cardiology enable better access to heart specialists and subspecialist, accurate diagnosis, better treatment, reduction of mortality, and a significant reduction in costs. Conclusion: Telemedicine by slow steps in entering the soil of Bosnia and Herzegovina, but the potential exists. It is necessary to educate the medical staff, as well as to provide a tempting environment for software engineers. Investing in infrastructure and equipment is imperative, as well as a positive climate for the its implementation.
This study aims to investigate whether the high sensitive C-reactive protein (hsCRP) is associate... more This study aims to investigate whether the high sensitive C-reactive protein (hsCRP) is associated with an ejection fraction of left ventricle (EFLV) in the early phase of ST-elevation myocardial infarction (STEMI), treated with the primary percutaneous intervention (pPCI), and to establish whether there exists a relationship between its values and the presence of major adverse cardiovascular events (MACE) within six months of pPCI. Materials and Methods: In this prospective study, 357 patients who were diagnosed with STEMI and who underwent pPCI within 24 hours of pain onset were included. The following were monitored and recorded: 1) hsCRP values, which were measured between 24 and 48 hours of pPCI, 2) EFLV values, which were measured five days after the pPCI, and 3) MACE, which was established within six months of pPCI. Results: The EFLV values measured five days after the pPCI were significantly lower with increasing hsCRP values (rho=-0.384, p<0.0001). There was a significant difference in hsCRP values between patients who had MACE and those without it (38.35 [98.10] vs. 12.97 [23.80], p=0.0001). In addition, hsCRP values were significantly increased in patients who died during the first six months after the pPCI compared with patients who survived (115.00 [202.80] vs. 15.84 [31.5], p=0.001). Conclusion: The hsCRP values in patients with STEMI who were treated with the pPCI are related to systolic function in the early phase of STEMI, as well as MACE during the first six months of follow-up.
Periodicals of Engineering and Natural Sciences (PEN), 2019
Background: The aim of the article was to create an appropriate computer model based on the real ... more Background: The aim of the article was to create an appropriate computer model based on the real status of the mortar operator's workplace and to analyze the workplace. After that, for any possible exceedances from the aspect of the organism's load and safety, the aim is to redesign the workplace and bring it within the limits of the permissible load, and therefore the required safety. The aim is also to identify the characteristic work movements performed by the soldier and to carry out an ergonomic analysis of the soldier's efforts and to propose appropriate improvements. Methods: The analysis is performed on a total of 20 soldiers, from which is determined an average model of the following characteristics: 180 cm in height and 85 kg in weight. The task is to take a mine from the shell containing the mines, then transfer it to the mortar and fill the mortar barrel. The weight of the 120 mm mortar grenade is 14.8 kg. The average soldier is 26 years old and his military exercise lasts 4 hours. The CATIA software package (Dassault Systèmes, Vélizy-Villacoublay, France) is used for analysis. By knowing the anthropometric and work environment data, with ergonomic design and analysis, the following analyses were made: biomechanical analysis, rapid upper limb assessment (RULA) and carry analysis (option from CATIA software). Results: The proposed modification of the position resulted in a decrease in the L4/L5 torque from 316 Nm to 154 Nm along with decreasing of the compression force on the L4/ L5 from 5,779 N to 3038 N (the compression force allowed is 3,400 N), and while the RULA analysis is from the red color position 1 (score 7; maximum load requiring rapid repositioning of such position), revised final score 4 made in yellow (a solution acceptable for this work place). Conclusions: By ergonomic analysis, obtained proposal will lead to less chance of injury, prevention of burn out syndrome, fewer chances of illness, decreasing the fatigue, greater safety, less energy spent and better preparedness for all necessary tasks.
Objective: Demonstration of idiopathic dilated cardiomyopathy with unusual flow, unpredictable cl... more Objective: Demonstration of idiopathic dilated cardiomyopathy with unusual flow, unpredictable clinical picture and complex therapy. Case report: Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed. Conclusion: The clinical course of dilated cardiomyopathy is extremely unpredictable and therapy is very complex and demanding.
This study aimed to show the spontaneous rupture of the stomach in a 3-year-old girl. The patient... more This study aimed to show the spontaneous rupture of the stomach in a 3-year-old girl. The patient was admitted to the pediatric clinic due to poor general condition that occurred suddenly with severe abdominal pain, vomiting, and the development of hypovolemic shock (blood pressure was unmeasurable, in acidosis), and after the ultrasound and abdominal X-ray, she was operated by the pediatric surgeon within 6 h of admission. During surgery, multiple defects of stomach mucosa with transmural bleeding without pathohistological changes in the muscle layer were found in the large stomach blood vessels. Treatment was continued in the pediatric intensive care unit with the development of life-limiting complications: peritonitis, sepsis, intracranial hemorrhage, and outcome of death. Rupture of the stomach caused by acute distension is rarely seen outside the neonatal period with fast clinical course and high mortality rate. Early diagnosis and rapid surgical procedures are a prerequisite to avoid the development of life-limiting complications that lead to a fatal outcome.
Introduction: The aim of the study was to determine the most frequent early and late complication... more Introduction: The aim of the study was to determine the most frequent early and late complications in diff erent types of ileal urinary diversions. Patients and methods: The study was conducted in a fi ve-year period, on 106 patients who were diagnosed with invasive urinary bladder cancer and who had indication for radical cystectomy with one of the investigated types of urine derivation. They were divided into 2 groups, based on the type of ileal urinary diversions. Results: The colonization of bacteria was more prominently present in the ileal conduit urinary diversion group (97%) compared to Ghoneim (25%) and Hautmann (10%) group, Ureteral stenosis was slightly less represented in the conduit group (9.1%). Wound infections were signifi cantly more represented in the conduit (21.2%) than in the Ghoneim group (5%) Nighttime incontinence was present in 20% of patients in both groups or 4 patients in each group. Daytime incontinence in the Ghoneim group was present in 3 patients (15%) and in the Hautmann group 2 patients (10%). Late complications correlate signifi cantly negative with the type of surgery and slightly negative with the grade, and signifi cantly positively with the examined group and T stage, and slightly correlate positively to the N and R stages. Early complications correlate slightly negative with the type of surgery, slightly negative with the grade, and signifi cantly positively with T stage, and slightly positively correlates with the N and R stage. Conclusion: The most commonly reported complications in ileal conduit are: prolonged ileus, stoma infection, wound dehiscence and bacterial colonization, followed by peristomal skin complications and complications related only to the stoma, such as stenosis and stoma retraction, and prolaps of ileostoma and ileointestinal stenosis. The ileus rate in orthotopic derivation was signifi cantly lower than that of the ileal conduit group, which led to the conclusion that the neomybladder position does not disturb the anatomic abdominal structure.
International Journal of Applied and Basic Medical Research, 2019
Introduction: Renal vasculature is extremely sensitive to vasoconstrictor effects of endothelin (... more Introduction: Renal vasculature is extremely sensitive to vasoconstrictor effects of endothelin (ET), while nitric oxide (NO) has special role in several pathological renal conditions. Aim: The aim of this study to examine the presence, character, and degree of changes in NO and ET levels in the serum of extracorporeal shock wave lithotripsy (ESWL)-treated patients with nephrolithiasis. Patients and Methods: This study included a total of 60 patients that were divided in two groups: Group I (n = 24), in which a total of 2000SWs were administered; 0–2 units; (0.5 units per each 500SWs), and Group II (n = 36), in which a total of 4000SWs were administered; 0–4 units; (0.5 units per each 500SWs). Results: In the Group I median NO serum concentration increased in relation to pretreatment levels (39.04 ± 8.29 μmol/L) specifically 30 min, 60 min, and 24 h following the treatment (39.11 ± 12.60), (41.80 ± 6.89), and (46.33 ± 9.03), where concentration growth after 24 h was statistically significant P < 0.01. The NO serum concentration in the Group II increased in relation to pretreatment levels (38.90 ± 10.33 μmol/L) after 30 min (48.71 ± 30.09), 60 min (54.57 ± 39.76), and 24 h (97.95 ± 72.07). The NO concentration increase after 60 min and 24 h is statistically significant, respectively, P < 0.03 and P < 0.0001. Conclusion : NO and ET serum levels are changing under the influence of ESWL, and that the NO and ET changes are directly correlated with the number of administered shock waves and administered energy.
Alzheimer's disease represents the most common age-related neurodegenerative disorder and a leadi... more Alzheimer's disease represents the most common age-related neurodegenerative disorder and a leading cause of progressive cognitive impairment. Predicting cognitive decline is challenging but would be invaluable in an increasingly aging population which also experiences a rising cardiovascular risk. In order to examine whether plasma measurements of one of the established biomarkers of heart failure, brain natriuretic peptide (BNP), reflect a decline in cognitive function, associated with Alzheimer's disease neurodegeneration, BNP levels were analysed, by using a novel assay called a SOMAscan, in 1. cognitively healthy, control subjects; 2. subjects with mild cognitive impairment, and 3. subjects with Alzheimer's disease. The results of our study show that the levels of the BNP were significantly different between the three types of diagnoses (p < 0.05), whereby subjects with mild cognitive impairment had the lowest mean BNP value, and healthy subjects had the highest BNP value. Importantly, our results show that the levels of the BNP are influenced by the presence of at least one APOE4 allele in the healthy (p < 0.05) and in the Alzheimer's disease groups of subjects (p < 0.1). As the levels of the BNP appear to be independent of the APOE4 genotype in subjects with mild cognitive impairment, the results of our study support inclusion of measurements of plasma levels of the BNP in the list of the core Alzheimer's disease biomarkers for identification of the mild cognitive impairment group of patients. In addition, the results of our study warrant further investigations into molecular links between Alzheimer's disease-type cognitive decline and cardiovascular disorders.
The future of pharmacogenomics/pharmacogenetics - the study of the effect of genes on a person's ... more The future of pharmacogenomics/pharmacogenetics - the study of the effect of genes on a person's drug response - does not wait for us in the distance. With the establishment of the Dutch Pharmacogenetics Working Group (DPWG) in 2005, and the Clinical Pharmacogenetic Implementation Consortium (CPIC) in 2009, pharmacogenetics became a reality. Based on peer-reviewed, evidence- based studies, the CPIC guidelines on gene(s)-drug interactions are published in the journal of the American Society for Clinical Pharmacology and Therapeutics titled Clinical Pharmacology and Therapeutics and posted on the CPIC's website (https://cpicpgx.org). Their main aim is to provide clinicians with recommendations on how an individual patient's genotype translates into specific phenotype which affects his/her drug sensitivity or resistance. They are the most important step forward towards the so-called personalised medicine. The main aim of this book, which includes a practicum, is to provide medical degree students with an introduction to pharmacogenomics/pharmacogenetics, by presenting a protocol for characterisation of two genes that are responsible for an individual's response to the most commonly prescribed anticoagulant drug, a vitamin K antagonist, warfarin. This is the first drug for which the Food and Drug Administration (FDA) has issued a specific genotype-phenotype-drug dosing recommendation in 2007, thereby implementing the knowledge of pharmacogenetic data in its drug label.
International Atherosclerosis Symposium organized by The Working Group for Atherosclerosis of Ass... more International Atherosclerosis Symposium organized by The Working Group for Atherosclerosis of Association of Cardiologists in Bosnia and Herzegovina
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Papers by Edin Begic
The main aim of this book, which includes a practicum, is to provide medical degree students with an introduction to pharmacogenomics/pharmacogenetics, by presenting a protocol for characterisation of two genes that are responsible for an individual's response to the most commonly prescribed anticoagulant drug, a vitamin K antagonist, warfarin. This is the first drug for which the Food and Drug Administration (FDA) has issued a specific genotype-phenotype-drug dosing recommendation in 2007, thereby implementing the knowledge of pharmacogenetic data in its drug label.