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BACKGROUND: Thanks to modern methods of assisted reproduction (ART), parenthood has become an attainable goal for couples in which the male partner has experienced spinal cord injury (SCI). OBJECTIVE: The aim of our study was to determine the success of the treatment of infertile patients with SCI with intracytoplasmic sperm injection (ICSI) of cryopreserved sperm obtained by the testicular sperm aspiration (TESA) procedure. METHODS: In this retrospective study 156 infertile couples were included, in which the male partner is primarily infertile due to azoospermia. Infertile couples were divided into two groups. The first group (n = 82) includes men with SCI, and the second (n = 74) men with obstructive azoospermia (OA) as the cause of infertility. All infertile men were examined and processed in the diagnostic procedure, and based on the urological findings, surgical extraction of sperm from the testicles was indicated. Exclusion criteria were the age of women over 40 and men over 45. RESULTS: We found that the quality of sperm was worse in the group with SCI, compared to the group with OA, but without statistical significance. Zenica and Johnsen score (p = 0.001; p = 0.000) showed worse semen characteristics in the group with SCI. There were no significant differences in the average number of embryos (p = 0.698), pregnancy rates per cycle (p = 0.979) and pregnancy rates per embrio transfer (ET), clinical pregnancy rates per ET (p = 0.987) and delivery rates per ET (p = 0.804) in couples with SCI, compared to couples with OA. CONCLUSION: Based on the results of this research, the TESA and ICSI procedures can be recommended as a successful method in the treatment of male infertility caused by azoospermia due to SCI. [ABSTRACT FROM AUTHOR]

BACKGROUND: Metabolic syndrome (MetS) is a group of comorbidities related to regulating hyperglycemia and acute cardiovascular incidents and complications. With the increasing prevalence in individuals with type 2 diabetes mellitus (T2DM), MetS represents an increasing public health problem and clinical challenge, and early diagnosis is necessary to avoid the accelerated development of diabetic complications. OBJECTIVE: To investigate the role of Complete Blood Count-derived Inflammation Indexes (CBCIIs) in predicting MetS in T2DM individuals. METHODS: The study was designed as a two-year prospective study and included 80 T2DM individuals divided into MetS and non-MetS groups based on MetS development over two years. The sera samples were analyzed for complete blood count parameters and C-reactive protein (CRP). Based on the laboratory test results, 13 CBCIIs were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy. RESULTS: There were significant differences between T2DM participants with Mets and those without MetS concerning Neutrophil to Platelet Ratio (NPR) values (p < 0.001), Neutrophil to Lymphocyte and Platelet Ratio (NLPR) (p < 0.001), Platelet to Lymphocyte Ratio (PLR) (p < 0.001), Lymphocyte to C-reactive protein Ratio (LCR) (p < 0.001), C-reactive protein to Lymphocyte Ratio (CRP/Ly) (p < 0.001), Systemic immune inflammation index (SII) (< 0.001), and Aggregate Index of Systemic Inflammation (AISI) (p = 0.005). The results of ROC curve analysis have shown that the LCR (AUC of 0.907), CRP/Ly (AUC of 0.907) can serve as excellent predictors, but NPR (AUC of 0.734), NLRP (AUC of 0.755), PLR (AUC of 0.823), SII (AUC of 0.745), and AISI (AUC of 0.688) as good predictors of MetS in T2 DM individuals. CONCLUSION: This study confirms the reliability of the CBCIIs as novel, simple, low cost and valuable predictors of MetS developing in T2DM. [ABSTRACT FROM AUTHOR]

Aim To assess morphological characteristics of carotid blood vessels in uremic patients before to the initiation of the dialysis treatment, and corelate data with various dialysis therapy modules. Methods The study included 30 patients with end-stage renal disease (ERDS) prior to commencing dialysis, 30 patients treated with haemodialysis and 30 patients treated with continuous ambulatory peritoneal dialysis. The control group consisted of 15 subjects with normal kidney function (eGFR>60ml/min). Carotid intima-media thickness (CIMT), as well as lipid status values (cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), apolipoprotein A, apolipoprotein B) were evaluated. Results The significant difference in CIMT was detected between the control and haemodialysis groups (p<0.001), and between the control and the peritoneal dialysis group (p=0.004). In patients in the predialysis group, CIMT was influenced by cholesterol (p=0.013), HDL (p=0.044), LDL (p=0.001) and ApoB (p=0.042) values. A significant difference in CIMT was proved between the haemodialysis and predialysis group of patients (p<0.001). The only variable from the patient's lipometabolic profile significantly associated with the change in IMT in uremic patients was HDL. A significant difference was found in the average value for systolic blood pressure (p<0.001) and diastolic blood pressure (p=0.018) in patients before starting the dialysis treatment compared to patients treated with other dialysis methods. Conclusion Patients on haemodialysis treatment had a significantly greater CIMT, which is in relation with a higher cardiovascular risk. [ABSTRACT FROM AUTHOR]

Aim To examine a relation of thyroid function, neutrophil-lymphocyte ratio (NLR) with left ventricular function measured through the left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction treated with percutaneous coronary intervention (PCI). Methods This prospective research involved 160 consecutive patients with acute myocardial infarction. Patients were divided into those with normal thyroid hormone status (n=80) and those with hypothyroidism (newly diagnosed) (n=80). Inflammatory parameters and parameters of hormonal status were taken for analysis: thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), and free triiodothyronine (FT3). All patients underwent transthoracic echocardiographic examination (TTE) five days upon admission, and left ventricular ejection fraction (LVEF) was analysed. Results Significant difference between the two groups was verified in values of T3, T4, erythrocytes, haemoglobin, haematocrit, neutrophil, lymphocytes, NLR, C-reactive protein (CRP) and sedimentation rate. Patients with euthyroidism had a higher frequency of coronary single-vessel disease (p=0.035) and a significantly lower frequency of triple vessel disease (p=0.046), as well as a higher median value of LVEF (p=0.003). There was a significant correlation between LVEF with haemoglobin values (p=0.002), NLR (p=0.001), and CRP (p=001). Conclusion The altered status of the thyroid gland in acute myocardial infarction is associated with the severity of the coronary blood vessel lesion, LVEF and correlates with inflammatory response. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease (CVD) frequency is high in individuals with human immunodeficiency virus (HIV) infection receiving antiretroviral therapy, mainly because of lipodystrophy and endothelial dysfunction leading to immune activation and chronic low inflammation degree, which in turn promote atherosclerosis. The question arises whether the CD4/CD8 ratio can have an influence on the increase in cardiovascular risk in patients with HIV infection1-3 Aim: To examine whether the CD4/CD8 ratio, as well as C-reactive protein (CRP), can be predictors in monitoring cardiovascular risk changes in HIV-positive patients during two years of combination antiretroviral therapy (cART). Patiens and Methods: The study was designed as a retrospective-prospective, cohort longitudinal and clinical study. The sample size was determined based on the following conditions: 1) alpha value=0.05, 2) study power (1-B)=0.8, and 3) effect size=0.3351 (average therapeutic effect of increasing CD4/CD8 ratio one year after cART administration). With the receiver operating characteristic (ROC curve), we showed whether CRP and the CD4/CD8 quotient (ratio) can be markers for CVD risk that was monitored in different periods, at baseline, and after 3, 6, 12, 18, 24 months. We checked the statistical significance of the regression model with the analysis of variance (ANOVA) test, and the value model (r2) presented as % variance. In HIV-infected patients, the values of CD4 and CD8, and CRP are preferred for cardiovascular risk assessment given the data-collection on adverse effects of anti-HIV drugs (D:A:D score). Results: A total of 76 HIV patients were included in the research, 67 (88.2%) men and 9 (11.8%) women. The average age of the subjects was 35.2+8.7 years. Before the start of cART, CD4/CD8 ratio, CRP, and risk for CVD were not significantly correlated (p>0.05). However, after 24 months of treatment, CRP was positively and strongly correlated with the risk for CVD (rho =0.747; p=0.0001) and was considered a marker of intermediate risk for CVD (p=0.0001; area under a curve (AUC) 0.882). The CD4/CD8 ratio was positively correlated with the risk for CVD (rho -0.409; p=0.0001) after 12 months of therapy and was considered a marker of low CVD risk after 24 months from the start of therapy (p=0.001; AUC -0.762). Finally, after 18 months of cART therapy, the CD4/CD8 ratio was negatively and moderately strongly correlated with both CRP and CVD risk (rho=-0.483 to rho=0.483; p<0.01), which was maintained even after 24 months. Conclusion: CD4/CD8 ratio and CRP have been shown to be significant predictors of CVD risk. CD4/CD8 ratio and CRP were negatively and moderately strongly correlated. The higher the CD4/CD8 ratio, the lower the CRP values and the lower the risk for CVD during 24 months of cART therapy. [ABSTRACT FROM AUTHOR]

Introduction: In individuals with chronic obstructive pulmonary disease (COPD), evaluating the severity of hypercapnia and/or acidosis following the start of non-invasive ventilation (NIV) is a key predictor of NIV failure. This study sought to investigate how arterial hypertension affects the treatment outcomes of patients admitted for COPD exacerbation. Patients and Methods: This prospective study involved 80 patients who were divided into two groups of 40, based on the mode of non-invasive ventilation (NIV): CPAP (continuous positive airway pressure) and BiPAP (bilevel positive airway pressure). A 1:1 randomization approach was employed to determine the NIV mode for each patient. The research took place at the General Hospital “Prim. Dr Abdulah Nakaš” in Sarajevo and included patients admitted to the Non-surgical Intensive Care Unit with a history of chronic hypercapnic respiratory failure (HRF) related to one of the three COPD phenotypes. Results: The average age of patients on BiPAP was 66.6 ± 8.6, while for CPAP it was also 66.6 ± 8.6. There were no significant differences in the use of ACE inhibitors, beta-blockers, diuretics, or vasodilators between the two patient groups. In the BiPAP group, the impact of arterial hypertension on the reduction of pCO2 compared to admission was not observed. The chi-square test demonstrated that in the CPAP group, arterial hypertension did influence the reduction of pCO2 compared to admission (p=0.019). Conclusion: Arterial hypertension significantly affects the efficacy of both NIV modalities concerning a single outcome – the reduction of pCO2. The absence of hypertension enhances the positive effect of BiPAP on lowering pCO2. In the BiPAP group, the influence of arterial hypertension on the reduction of pCO2 compared to admission was not evident. In the CPAP group, arterial hypertension significantly correlated with a more frequent reduction of pCO2 compared to patients without arterial hypertension. [ABSTRACT FROM AUTHOR]

Introduction: Obstruction of the pulmonary artery and its branches increases the pulmonary vascular resistance, resulting in pulmonary hypertension and right ventricular (RV) dysfunction.1,2 Aim: To analyze the correlation between the pulmonary artery obstruction index (PAOI) score obtained from quantifying obstruction in pulmonary embolism (PE), inflammatory markers, coagulation parameters, and echocardiographic findings. Patients and Methods: This retrospective study included 59 patients hospitalized with PE at the Department of Internal Medicine, General Hospital “Prim.dr. Abdulah Nakaš” in the period from 2022 until 2024. PE was confirmed on CT angiography and the PAOI score was calculated using the Qanadli index. Echocardiography was performed during hospitalization. Inflammatory and coagulation parameters were obtained. Results: The PAOI score significantly correlated with the right ventricular systolic pressure (RVSP) (p=0.03) and with the presence and degree of the tricuspid regurgitation (p=0.03). No correlation was found between the PAOI score and other echocardiographic parameters. Strong correlation was found between the PAOI score and D-dimer values (p<0.001). No significant correlation was found between the PAOI score and C-reactive protein, hemogram and hemogram-derived ratios. Conclusion: The PAOI score on admission in patients with PE is in correlation with RV function and coagulation parameters. [ABSTRACT FROM AUTHOR]

Introduction: Left atrial (LA) remodeling is a complex anatomical and functional process in response to electrical, mechanical and metabolic disturbances. LA remodeling is usually a consequence of LA volume overload, left ventricular systolic dysfunction and physiological aging process. LA remodeling directly correlates with atrial fibrillation occurrence.1-3 Aim: To analyze left atrial strain parameters for the purpose of prediction of atrial fibrillation (AF) after the electrical cardioversion. Patients and Methods: Analysis included 31 patients, who underwent electrical cardioversion due to AF at the Department of Cardiology, General Hospital “Prim. Dr. Abdulah Nakaš” in the period from May 2023 until May 2024. Transthoracic and transesophageal echocardiogram was performed in all patients, regardless of the previous anticoagulation therapy. Results: There was a statistically significant correlation between the recurrence of AF three months and six months after the electrical cardioversion and the following echocardiographic parameters: LA reservoir strain (p<0.001; p=0.001), LA conduit strain (p<0.001, p=0.001), LA contractile strain (p<0.001; p<0.001), E/e’ ratio (p<0.001, p=0.001), and left atrial stiffness index (p<0.001; p=0.004). Left atrial volume index did not significantly correlate with AF recurrence within three and six months after the cardioversion. Conclusion: Patient risk stratification for AF recurrence could be made based on LA strain parameters. [ABSTRACT FROM AUTHOR]

Goal: To present protocol for diagnosis and differentiation of cardiac amyloidosis, and to review treatment options for patients with transthyretin amyloid cardiomyopathy (ATTR-CM) in daily clinical practice. Case presentation: 70-year-old man was hospitalized with symptoms consistent with peripheral neuropathy, polyarthralgia, Raynaud syndrome and dyspnea on exertion. His past medical history included hypertension and hypothyroidism. Electrocardiogram (ECG) revealed left axis deviation, low voltage and intermittent atrial fibrillation. Echocardiography showed concentric left ventricular hypertrophy with granular speckling, normal ejection fraction and grade 1 diastolic dysfunction. Moderate aortic stenosis with mild aortic regurgitation was present, as well as moderate mitral regurgitation and mild tricuspid regurgitation. Subsequent analysis of global longitudinal strain (GLS) showed GLS reduction with nonspecific apical sparing pattern (Figure 1). Infiltrative cardiomyopathy was suspected, and we obtained serum and urine protein electrophoresis with immunofixation and the kappa/lambda ratio, which were negative for clonal plasma cell dyscrasia. Bone scintigraphy showed Technetium 99m-methyl diphosphonate uptake in the myocardium which was less/similar to ribs uptake (Perugini grade 1-2). Cardiac magnetic resonance (CMR) was obtained since scintigraphy results were inconclusive, and it confirmed cardiac amyloidosis pattern. Patient had significantly high levels of rheumatoid factor, without specific diagnostic criteria for rheumatological diseases. Electromyoneurography of arms and legs confirmed severe polyneuropathy. Since the patient presented with both cardiomyopathy and neuropathy, disease-specific therapies to consider would be tafamidis and patisiran. Genetic testing should be performed to detect specific mutations and to guide the treatment. Conclusion: Extracardiac manifestations which represent 'red flags' for ATTR-CM, should guide clinicians to perform echocardiography. After establishing the diagnosis, patient should be treated with specific treatment based on the dominant disease phenotype.1-3 [ABSTRACT FROM AUTHOR]

Introduction: Left atrial (LA) mechanical dysfunction due to LA fibrosis, which is common in atrial fibrillation (AF) regardless of LA enlargement, can be assessed by LA strain. Important factor in determining which patients are more likely to experience an AF recurrence following cardioversion is among others the early detection of LA dysfunction. Predicting the likelihood of an AF recurrence prior to electrical cardioversion enables more effective patient selection and avoiding unnecessary risk and treatment costs. In addition, better selection of patients with high probability to FA recurrence enables us to manage more safely further drug treatment.1-3 The main objective of this study was to assess whether LA function estimated by strain echocardiography carries any additional predictive significance for the early AF recurrence after electrical cardioversion. Patients and Methods: In total 36 symptomatic patients (EHRA symptom score ≥3) with permanent atrial fibrillation and preserved systolic function who underwent successful electrical cardioversion were prospectively monitored. Following previous saturation with antiarrhythmic medications, successful electrical cardioversion was performed utilizing synchronized 200J energy to max three times. Mean age of patients was 49.8 ± 5.3 years, 81% of them were male and 19% were female. Prior to cardioversion, a comprehensive echocardiography evaluation was carried out, including measuring the LA volume index and strain. As well TEE evaluation of the LAA was performed in each patient regardless of anticoagulant therapy status. The assessment of rhythm was carried out within the first month following cardioversion (33±3 days). Confirmation of the recurrence of persistent AF at the ambulatory control examination was the main outcome. Results: Regardless of the duration of AF, 12 patients (33,3%) of the total study population experienced an AF recurrence. The greatest incremental predictive value for an AF recurrence was found in patients with peak atrial longitudinal strain (PALS) ≤17% (HR =7.37, 95% CI: 3.12-19.25, p < 0.001). PALS≤17% continued to be an independent predictor of AF recurrence in patients with non-dilated LA (HR = 5.23, 95% CI: 2.32-15.71, p = 0.005). Conclusion: This study showed that LA function assessment using PALS can serve as an additional predictive marker for early recurrence of AF after electrical cardioversion independent of left atrial volume and AF duration. A better prediction of the early AF recurrence after electrical rhythm conversion allows a better selection of patients who undergo invasive treatment and can facilitate the decision of the clinician in tailoring the treatment strategy in terms of rate or rhythm control. [ABSTRACT FROM AUTHOR]

Aim To determine the value of IFN (intzerferon)-α in the patients with systemic lupus erythematosus (SLE) and to correlate IFN-α with values of non-specific biochemical parameters of inflammation (C-reactive protein, leukocytes values, erythrocyte sedimentation rate, albumins and globulins). Methods Research included 55 patients with SLE diagnosis and a control group consisted of 25 healthy subjects (during period 2019-2020). IFN (Interferon)-α and non-specific biochemical parameters of inflammation were obtained using standard protocols. Results IFN-α values were independent of gender (p=0.95). The difference in serum IFN-α values in relation with the age in the SLE group was statistically significant (p=0.036). Only serum globulin was significantly higher (p=0.0023) in IFN-α positive compared to IFN-α negative SLE patients. A statistically significant correlation between the values of IFN-α and globulin was proved (r=0.315; p=0.019). No significant correlation was found between other non-specific biochemical parameters and IFN-α values. Conclusion Increased IFN-α values were observed in younger patients, and the correlation between IFN and globulin was proved. [ABSTRACT FROM AUTHOR]