Search

Introduction: Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD).

Aim: To analyze prevalence and type of psychic changes in primary and secondary brain tumors consideringage, gender, location of the tumor, neurologic status and treatment of patients.Patients and method: In this retrospective study medical records of 101 patients with brain tumor treatedat the Department of Neurology, Clinical Center University of Sarajevo in the period 2000 – 2005were analyzed: 58 males and 43 females with age mean of 62.60 ± 1.28 years; the number of patientsaccording to neoplasm origin was equal (51 primary and 50 secondary tumors).Results: Psychic changes appeared more often in patients with primary tumors (54.2%) as comparedto patients with metastases (45.8%), but the difference was not significant. Mental status changes werealmost equally distributed according to gender. Significantly more often disturbances occurred amongolder patients as compared to the younger and middle age patients (p=0.0074). The most frequent tumorlocation was in the right hemisphere in patients with altered mental state (40.7%). Leading mental statusabnormality in patients with primary tumors was bradyphrenia, and disorientation in patients withmetastases (p=0.0038).Conclusion: Psychic changes in cases of brain tumors are unspecific and mostly manifest in elderly patients.Detailed examination of the psychic status is indispensable for all the suspect cases to neoplasmin order for timely diagnosis of the disease.

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: hypokalemia is a common electrolyte disorder presented in 20% of hospitalized patients. In dialysis patients, potassium<4.4, mmol/L is frequent finding while diuresis is maintained. It is very important to know the concentration of potassium in the dialysate due to the process of diffusion. Aim of the study is to evaluate prevalence of hypokalemia in patients on hemodialysis, in order to prevent complications (occurrence of malignant arrhythmias and increase mortality in dialysis) and introduce the appropriate therapy. Material and methods: out of total number of patients (n= 270) at our Clinic, in the period from December 2012 to June 2013 we found 25 diagnosed with hypokalemia. All patients were on chronic standard hemodialysis for four hours three times a week. All patients included in this study were analyzed by age, gender, duration of hemodialysis, serum potassium values before and after hemodialysis treatment, bicarbonate values before and after dialysis, residual diuresis, diuretics therapy, and values of serum magnesium with parenteral losses. Potassium values in the dialysate during dialysis was the same for all patients (potassium=2.0mmol/L). The retrospective study included two groups of patients on chronic standard hemodialysis treatment: experimental group (n=25), comprising patients with hypokalemia and control group (n=25), comprising patients without hypokalemia but with similar characteristics in terms of gender, age and duration of hemodialysis treatment. Results: the prevalence rate of hypokalemia was 9.3% or 93 cases per 1.000 dialysis patients. Out of total number of patients diagnosed with hypokalemia (n=25), eighteen had preserved diuresis, with an average of 500-1,000 ml/per day. Of these 18 patients six (33.3%) were using diuretics during the study. The mean age of patients was 61.1'}12.1 years in the experimental group and 57.9'}13.9 years in the control group, respectively. The median duration of hemodialysis treatment in the experimental group was 48 months (IQR=12 to 96 months) and 36 months (IQR=18 to 72 months) in the control group. Three patients in the experimental group had sinus tachycardia, with heart frequency .120/min. Mean level of serum magnesium in the experimental group was 0.95'}0.11 mmol/L and 1.08'}0.13mmol/L in the control group. Our study did not detect patients with hypomagnesemia, which could be considered as a cause for renal hypokalemia. Conclusion: hypokalemia was presented in 9.3% of patients on hemodialysis. Taking into account the total number of patients (n=270) we may conclude that hypokalemia was not a common electrolyte disorder at our Clinic. There were no recorded episodes of malignant arrhythmias and sudden deaths during the dialysis treatments. [ABSTRACT FROM AUTHOR]

Pregnant women with chronic kidney disease have a poor adaptation to gestational increase in blood flow through the kidneys, which accelerates the decline in renal function and leads to poor pregnancy outcomes. Women who get pregnant with the values of serum creatinine above 124 mmol / L have an increased risk of accelerated decline in renal function and poor pregnancy outcomes. This paper presents a patient with advanced pregnancies (29 gestational weeks) in the fifth stage of chronic kidney disease (creatininemia - 623 nmol / l) before dialysis. This pregnancy on hemodialysis is the first case from 1972, when hemodialysis was introduced in Bosnia and Herzegovina. Hemodialysis treatment lasted 4 weeks and was uneventful; but preeclampsia occurred, so it was decided to perform a cesarean section. A male child, weighing 1,400 kg, was born and died five days later. Pregnancy is indeed a real challenge for women with kidney disease, especially for patients who are treated by dialysis. However, impressive improvements in maternal-fetal care and continuous improvements in the effectiveness of dialysis, with frequent hemodialysis and improved therapy enabled the realization of goals, which sometimes were unattainable. [ABSTRACT FROM AUTHOR]

Hepatitis C in dialysis patients is a "silent" nature of chronic infection that often can be the initial stage and go unnoticed. Start of viremic phase is usually associated with the activity of ALT (up to 70-74 U / L) and precedes seroconversion. This is followed by a constant viraemia, normal ALT activity and anti-HCV positivity. Past research and experience show that about 25% of patients with HCV infection have normal ALT values, not just of patients with hemodialysis, while 40% have a minimum deviation from the normal ALT values. In the treatment of hepatitis C in patients with end stage, renal failure indicated the application of recombinant interferon alfa-2a or pegylated interferon. 1. Involve group in dialysis patients with chronic hepatitis C infection, which is the indication for treatment according to the protocol of treatment of chronic hepatitis C in hemodialysis patients. 2. Involve dialysis patients with a positive qualitative and quantitative HCV RNA PCR, 3. Provide special monitoring of dialysis patients who were included in the therapeutic protocol, to follow regular treatment, side effects of treatment and outcome of treatment. The target population for treatment was 13 patients in the terminal stage of renal failure on chronic hemodialysis treatment, age group between 32 and 63 years, with chronic hepatitis C infection (12 patients had anti-HCV positive for more than a year and more). One patient had only antigenemia HBs positive and one patient was with dual infection. Patients have a different genotypes of virus C, only one patient had genotype 1a of hepatitis C, one patient had genotype 3, five patients had genotype 1b, four patients had genotype 4, one patient had not determine genotype of virus C. All patients had treated with pegylated interferon alfa -2a Pegylated interferon alfa -2a with reduced dose a 135 ug or 90 ug one time on week. All treatments last 48 weeks. Only three patients after the therapy had a negative PCR after six months and a year of control remained negative. Three PCR negative patients were infected with genotype 1b. (23,07 %). Mean age was 49,23± 8,82 years, and mean hemodialysis duration 144,92± 55,74 months. Conclusion: Treated patients showed heterogeneity in their study of group (different genotypes of hepatitis C). During of the treatment the patients have not demonstrated any major complications. The clinical picture of chronic hepatitis is usually mild, with slight variations in the values of biochemical parameters. Treatment of chronic hepatitis gives perspective and better patient candidates for kidney transplantation. [ABSTRACT FROM AUTHOR]

In recent years, the focus is increasingly on the early treatment of patients to prevent organs damage. Microalbuminuria is an important intermediary end-point that correlates strongly with future advanced renal disease, retinopathy and mortality. The aim of study was to determine the correlation between microalbuminuria, serum creatinine (SCr), glomerular filtration (GFR) and haemoglobin (Hb) in type 2 diabetics. 125 diabetics type 2 (75 women and 50 men, aged 27-85 years) were included in study. At all of them we determined urinary albumin, SCr, Hb and GFR. Urinary albumin excretion rate was measured on morning samples by 'micral test'. Normoalbuminuria, as defined, in the absence of contaminated urine, was found in 15 patients, microalbuminuria (AER below 200 mg/l) in 110 patients. Values of SCr and GFR were at referral level. Hb was at the lower level of its referral values. There was positive and significant correlation between microalbuminuria and duration of disease (r=0.21; p<0.05). Microalbuminuria was significantly correlated with Hb (r=-0.20;p<0.05) and stage of chronically kidney disease (r=0.21;p<0.05). Significant and negative correlation between microalbuminuria and GFR (r=-0.31 ;p<0.01) was found. Similar correlation was found between SCr and Hb (r=-0.29;p<0.01). GFR significantly correlated with Hb (r=-0.20;p<0.05). Screening programmes for microalbuminuria and early intervention can substantially modify natural course of diabetic renal involvement and disease and possibly reduce the incidence of end-stage renal failure. [ABSTRACT FROM AUTHOR]

Renal osteodistrophy is one of the most common complications of chronic renal failure and one of the risk factors of increased mortality among chronic haemodialysis patients. Aim of the study was to evaluate frequency of renal osteodistrophy in our dialysis population and to identify demographic, clinical and laboratory parameters associated with poor phosphorus and PTH control. Research included 100 patients on chronic haemodialysis program three times weekly for four hours with programmed ultrafiltration. Average age was 52,6 years and there were 55 males and 45 females in total, with average haemodialysis length of six years. Average calcium value was 2,19±0,190 mmol/L, 10% of patients had hypercalcaemia Ca>2,4 mmol/L. 58 patients (60,5%) involved in study had hyperphosphataemia and calcium-phosphorus product >4,4 mmol2/L2. Secondary hyperparathyroidism was found in 64 patients (64%), respectively to PTH>300 pg/ml. There was no significant correlation between patients' age, haemodialysis length, levels of PTH and phosphorus in tested dialysis population. Parathyreoidectomy was performed in 10 patients (16%), with significant lowering of PTH (959,7 pg/ml vs. 163,3 pg/ml). Conclusions: Our study has shown poorly controlled levels of phosphate in blood. In our dialysis population 60,5% of patients had P04 >1,8 mmol/L and 49% of the patients had calcium-phosphorus product >4,4 mmol2/L2, with the levels of PTH>300pg/ml. In 10% of our patients parathireidectomya was done because of SHP. Results show the need for intensive education of patients in restricting phosphorus intake as a preventive measure in reducing bone diseases in patients on haemodialysis. Multidisciplinary approach in treating secondary hyperparathyroidism includes doctor, nurse, dietitian, patient and his/her family, because renal osteodistrophy relates to increased morbidity and mortality of haemodialysis patients. [ABSTRACT FROM AUTHOR]

The contact of blood with dialysis membranes elicits organized inflammatory response, especially complement activation via alternate pathway and leucopenia. The inflammatory response leads to numerous longterm clinical sequels, which are in part determined by the degree of the membrane biocompatibility. The aim of this study is to analyze the biocompatibility of different dialysis modalities in our patients. Our survey included 42 patients, divided in four groups based on the hemodialysis treatments. I -group - bicarbonate hemodialysis on a low-flux polysulfone membrane (N -10) II-group - bicarbonate hemodialysis on a high-flux polysulfone membrane (N -12) III -group postdilution on-line hemodiafiltration (l\l -10) IV -group - bicarbonate hemodialysis on cuprofan membrane (N -10). Biocompatibility is assessed based on the reduction of leukocyte count in first 15 minutes of hemodialysis, activation of complement components (C3 and C4) which were determined at the beginning of hemodialysis, after 30 min, 180 minutes, 240 minutes. The survey included 42 patients: 22 males and 20 females mean age 51.4±7.6 and mean hemodialysis duration of 54 months. In the first 15 minutes the leukocyte count decreased by 14.47±8,35% in group I; by I2.43±9.45% in group II; by 10.54±6.36% in group III and by 45.42+15.31% in group IV. The decrease of the leukocyte count was significantly higher in group four (cuprophan), compared to other three groups (p<0.001). Opposite to the number of leukocytes, activation of complement components was at its peak when the leukocyte count had been lowest. In first three groups there was no statistically significant difference in complement components' values. Group I C3 O.88±0.25g/L, C4 0.61 ±0.43g/L, group II C3 0.68±0.16g/L, C4 0.4±0.15g/L, and group III C3 0.53±0.13g/L, C4 0.26±0.08g/L. In the fourth group there was a significant increase in complement components values at the end of hemodialysis C3 1.26±0.43g/L,C4 0.75±0.57g/L(p<0.05). The use of on-line hemodiafiltration and high-flux dialysis provides higher degree of biocompatibility than cuprofan dialysis. It is based on the use of synthetic dialysis membranes and ultra pure dialysis fluid. [ABSTRACT FROM AUTHOR]

In BiH, brucellosis (a disease that is transmitted from animals to people in a group of zoonoses) has become endemic disease. Epidemic has not yet been published, although in the past ten years in the constantly growing number of applicants cases. Nearly a thousand patients were reported in 2008. Brucellosis in hemodialysis is described sporadically. We will show the case in our clinic patient who was infected with brucellosis in 2008. In the period June / July 2008 after positive hemocultures series patient was hospitalized at the Clinic for Infectious Diseases due to septicemia and persistant symptoms in the form of malaise, general weakness, arthritis, subfebrility and loss of weight during the last three months. During the first HD treatment of febrile to 39 C, the first series hemoculture was done. B.mellitensis was isolated during the first hemolcultures. On the Clinic for Infectious Diseases the patient was examined and treated according to the protocol of treatment of brucellosis, with some modified therapy for haemodialysis patients.After conducted therapy culturally negative, not febrile patient was dismissed with recommendations for monthly control , laboratory findings and echography of gluteal region, after gluteal abscessus incurred due to the antibiotic therapy applied intramuscularly. [ABSTRACT FROM AUTHOR]

Uremic patients are at greater risk to develop cancer,and the most common type of cancer in these patients is kidney and urinary tract cancer. The aim of our study is to report our experience with malignancy in patients with end stage renal failure receiving dialysis in period 2002-2007. In follow up period 200 patients have been on chronic dialysis treatment 3 times weekly 4 hours,and 31 patients had malignancy.15 patients died in the follow up period. We analysed following data:sex,age,diagnosis of renal disease,duration of dialysis,pathological stage,surgical outcome and the type of the received treatment. Socio-epidemiological investigation with retrospective for data which is connected for the period of the war in Bosnia and Herzegovina was performed. Results:Mean age of 31 dialysis patients with malignancy was 64,4 ±11,16. There was performed 18 males and 13 females. Average duration of the haemodialysis for deceased patients was 4,73±5.1 and for living patients 4.29±3.33,and there was no significant differences in the average time of haemodialysis age and sex.(p-n.s) in these groups. The incidence of prostate cancer is increased (22 %) , renal (8%), ureter or.v.urinaria (8%),ovaria and uterus (12 %), colorectal 8%, otolaryngical -8%, thyroid 8%, bronchopulmonal 8% and other tumors 14%.. In 31 patients 35 tumors were detected and histologically confirmed.50% of tumors located in genitourinary tract.The majority of malignancies was treated with curative intention. Questionnaire analysis:14 patients had been in the war in Bosnia and Herzegovina, 2 patients had been wounded,one patient is a refuge. Conclusion: There is a notable increase of malignancies in general population in Bosnia and Herzegovina in the post war period. Dialysis population has high prevalence of malignancies -10%.Basic cancer screening for patients with CKD or ESRD should be a standard practice. [ABSTRACT FROM AUTHOR]

Epilepsy is a clinical syndrome of primary cerebral origin characterized by recurrent episodes in which there is a disturbance of consciousness, movement, feeling or behavior. Besides stroke it is the most common neurological disease. It is believed that 2-5% of people in the general population have epilepsy. Epilepsy can develop at any age. The goal is to determine the etiology of epileptic crisis of consciousness in people older than 65 years. A retrospective descriptive study of patients with epileptic crises of consciousness over 65 years, who were treated at the Neurology Clinic, Clinical Center University of Sarajevo University was performed in the period from January 1st 2007 to December 31st 2009. In addition to medical history and neurological examination, all patients had laboratory tests, with EEG, brain CT, ECG, and cardiological findings. Within the three-year period the crisis of consciousness was recorded in 85 patients. The average age of respondents was 74.83 years. In 72 cases it was the first epileptic episode in life (84.70%) and in 13 (15.30%) were repeated seizures. The largest percentage was partial seizures (60%). Regarding the etiology of seizures we obtained the following results: CVI was the cause in 65.70% in 13 cases tumors, due to metabolic disorders 11.76%, intoxication 3.53%, trauma 3.53%, infections 1.18% and cortical brain atrophy in 1.18%. Conclusions: epileptic crisis of consciousness are common in elderly. The most common etiologic factor for epileptic crisis of consciousness in patients over 65 years is a stroke, than cancer, infections, drug toxicity, metabolic disorders, and atrophy of the cortex. Prevention of risk factors for stroke is one of the manners of prevention of frequent epileptic crises in the elderly. [ABSTRACT FROM AUTHOR]