PONOVNA INFEKCIJA COVID-19 U BOLESNIKA SA ZAVRŠNIM STADIJEM KRONIČNE BOLESTI BUBREGA NA KRONIČNOJ HEMODIJALIZI: JE LI TO MOGUĆE ILI SE RADI O DIJAGNOSTIČKOM PROPUSTU?

Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at a high risk of acquiring SARS-CoV-2 and of developing severe COVID-19 and death. The possibility of being reinfected with this virus is poorly understood. To date, there are a small number of reports of reinfections in COVID-19 patients, especially in HD patients, with only four cases described so far. The aim was to show the possibility of reinfection and developing severe acute respiratory syndrome in HD patients. We describe a 69-year-old ESRD patient who had been on HD treatment for three years, with diabetes mellitus and a history of ischemic cardiomyopathy. The patient was tested for SARS-CoV-2 by a nasopharyngeal polymerase chain reaction (PCR) test because of a positive cluster at his dialysis unit and initially diagnosed with COVID-19 in July 2020. In this period, he had mild symptoms for a few days and remained asymptomatic afterwards. Four months later, he presented to the hospital with fatigue, high fever and shortness of breath, and was COVID-19 positive again. This case points to the possibility of reinfection, lack of immune response after an asymptomatic or mild infection, or even the possibility of the fi rst false-positive PCR test. Future longitudinal studies are needed to evaluate the potential reinfections, recurrence, and duration of antibody detection.Bolesnici s terminalnom bubrežnom bolešću koji su na hemodijalizi (HD) pod visokim su rizikom od zaraze virusom SARSCoV-2 i od razvijanja teške kliničke slike bolesti COVID-19. Mogućnost ponovne zaraze ovim virusom još je uvijek većinom nepoznata. Do danas je opisan manji broj COVID-19 reinfekcija, pogotovo kod bolesnika na HD gdje su dosad opisana samo četiri slučaja. Prikazujemo mogućnost reinfekcije virusom SARS-CoV-2 i razvoja teškog akutnog respiracijskog sindroma kod bolesnika na HD. Prikaz bolesnika: Bolesnik u dobi od 69 godina je na kroničnom programu HD tri godine zbog bubrežnog zatajenja tijekom dijabetičke nefropatije s anamnezom ishemijske kardiomiopatije te dvostrukim CABG zbog trožilne koronarne bolesti. U srpnju 2020. godine bolesnik je testiran pozitivno metodom PCR na SARS-CoV-2 zbog kontakta s pozitivnim bolesnikom u zajedničkom prijevozu na dijalizu. U tom je razdoblju imao blage simptome, umor nekoliko dana, nakon čega je postao asimptomatičan. Nakon četiri mjeseca javlja se u bolnicu s visokom tjelesnom temperaturom, teškom zaduhom i lošim općim stanjem te je opet COVID-19 pozitivan. Zaključak: Ovaj slučaj ukazuje na mogućnost reinfekcije, slabog imunosnog odgovora nakon asimptomske ili blage infekcije ili čak prvog lažno pozitivnog PCR testa. Da bi se evaluirao potencijalni mehanizam reinfekcija, eventualnih recidiva i trajanje imunosnog odgovora potrebne su buduće longitudinalne studije

Analysis of variables of the nutrition index alcohol and medicament use and PTSD

Introduction: The main aim of the study was to examine the interdependence of values of the nutrition index, the use of medicaments, and alcohol consumption in the group of subjects with post-traumatic stress disorder (PTSD) and in control group without PTSD. Methods: To determine the interdependence of different indices of nutrition and the alcohol and drug consumption in both groups, the crosstab model was used. Results: In both of the tested groups, medicament users had higher average values for nutritional indexes compared to the subjects that are not the consumers of medicaments, but the confirmed differences were not statistically significant. The subjects with PTSD who consume alcohol had lower average values for nutritional indexes compared to the subjects who do not consume alcohol. In the control group, subjects who consumed alcohol had higher mean values for nutritional indexes than those who did not consume alcohol. Differences in the values of the nutrition index between alcohol and non-alcohol subjects were not statistically significant either in the PTSD group or in the control group. The subjects with PTSD had less average values of all the used nutrition indexes compared to the control group subjects, but the confirmed differences were not statistically significant. Conclusion: Our results indicate that medicaments use and alcohol consumption do not exert a statistically significant effect on the values of the nutrition index in any of the study groups. Possible concomitant use of drugs with the opposite effect on the monitored parameter (nitrazepam and amitriptyline vs. SSRI and bupropion) can lead to findings like this. We recommend further research to eliminate influence of pharmacodynamic effects of alcohol, drugs, and stress on the development of weight gain or loss

AKTIVNOST SUPEROKSID DISMUTAZE I LIPIDNI PROFIL U SERUMU PACIJENATA S HEMODIJALIZOM

Objectives/Aim: Hemodialysis (HD) is associated with a number of biochemical abnormalities including dyslipidemia and oxidative stress. The aim of this study was to evaluate the relationship between serum superoxide dismutase (SOD) activity and lipid profi le in HD patients with different duration of HD treatment. Material and Methods: This cross-sectional study included 100 HD patients that were divided into two subgroups based on the duration of HD therapy: patients on HD for more than three months but less than fi ve years (HD <5 years; n=48) and patients on HD for fi ve years or more (HD ≥5 years; n=52). Control group (n=50) consisted of age- and gender-matched, apparently healthy individuals without subjective and objective indicators of any renal disease. Blood samples were obtained for determination of SOD, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Serum SOD concentration was determined by ELISA method using a commercial kit. Results: Serum concentration of SOD was increased in HD patients when compared to healthy controls. SOD concentration was signifi cantly higher in HD <5 year group compared with control group [12.29 (10.85-14.15) vs.11.04 (9.42 -12.99) U/mL; p<0.05]; however, there was no signifi cant difference in SOD concentration between HD≥5 year group [12.97 (10.27-14.56) U/mL] and healthy control subjects. In addition, there was no significant difference in serum SOD concentration between HD patients with different duration of dialysis therapy. The levels of TC, LDL and HDL were significantly decreased in both groups of HD patients as compared with control subjects (p<0.0005); however, serum TG levels did not differ significantly between the study groups. According to the ROC analysis, serum levels of TC, LDL and HDL had higher sensitivity than serum SOD concentration in differentiating HD patients from healthy subjects. Conclusions: According to our results, it is concluded that increased serum SOD concentration together with alterations in the lipid profi le enhances the risk of atherosclerosis and favors higher incidence of cardiovascular complications in HD patients.Uvod/cilj: Hemodijaliza (HD) je povezana s brojnim biokemijskim abnormalnostima uključujući dislipidemiju i oksidativni stres. Cilj istraživanja bio je ispitati aktivnost i utvrditi povezanost enzima superoksid dismutaze (SOD) s parametrima lipidnog profi la kod bolesnika na HD. Metode: Presječnom studijom obuhvaćeno je 100 HD bolesnika koji su podijeljeni u dvije skupine: bolesnici koji su bili liječeni pomoću HD više od tri mjeseca, ali manje od pet godina (HD <5 godina, n=48) i bolesnici koji su bili liječeni pomoću HD pet godina i više (HD ≥5 godina, n=52). Kontrolnu skupinu (n=50) činile su po dobi i spolu odgovarajuće zdrave osobe bez subjektivnih i objektivnih pokazatelja bubrežne bolesti. Uzorci krvi služili su za određivanje koncentracija SOD, ukupnog kolesterola, triglicerida (TG), lipoproteina male gustoće (LDL) i lipoproteina velike gustoće (HDL). Serumska koncentracija SOD određena je metodom ELISA upotrebom komercijalnog kita. Rezultati: Serumska koncentracija SOD bila veća kod HD bolesnika u usporedbi sa zdravim kontrolnim osobama. Koncentracija SOD u skupini bolesnika na HD <5 godina bila je značajno veća u odnosu na kontrolnu skupinu ispitanika [12,29 (10,85-14,15 prema 11,04 (9,42-12,99) U/mL (p<0,05)], ali nije utvrđena značajna razlika u koncentraciji SOD između skupina bolesnika na HD ≥5 godina [12,97 (10,27-14,56) U/mL] i zdravih ispitanika kontrolne skupine. Uz to, nije bilo značajne razlike u serumskoj koncentraciji SOD između HD bolesnika koji su bili liječeni pomoću HD <5 godina i ≥5 godina. Utvrđeno je značajno smanjenje koncentracija TC, LDL i HDL u objema skupinama HD bolesnika u odnosu na kontrolnu skupinu (p<0,0005), ali razine serumskih TG nisu se značajno razlikovale između promatranih skupina. Rezultati dobiveni ROC analizom pokazali su da su serumske razine TC, LDL i HDL u odnosu na serumsku koncentraciju SOD osjetljivije u razlikovanju HD bolesnika i zdravih osoba. Zaključak: Na osnovi naših rezultata može se zaključiti da povišena serumska koncentracija SOD, zajedno s promjenama lipidnog profi la, povećava rizik od ateroskleroze i kardiovaskularnih komplikacija kod HD bolesnika

Correlation of serum lipid profile and glycemic control parameters in patients with type 2 diabetes mellitus

Introduction: Diabetes mellitus type 2 has become a global health-care problem of modern society due to a pronounced increase of prevalence to pandemic proportions and vascular complications. At present, glycated hemoglobin (HbA1c) is widely accepted as a measure of glycemic control in established diabetes. The aim of this study was to analyze the lipid profile in serum of patients with diabetes mellitus type 2, and its relationship with HbA1c levels. Methods: The observational cross-sectional study included 60 diabetic patients, 30 men, and 30 women, age 32–94 years. Patients were assigned into two groups based on HbA1c values; Group 1: HbA1c ≤ 7% (good glycemic control) and Group 2: HbA1c > 7% (poor glycemic control). We analyzed the concentration of glucose, HbA1c, and lipid profile including total cholesterol levels, triglycerides (TAG), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). Results: Significantly lower values of glucose concentration, TAG and the ratio TAG/HDLc were obtained in the group of patients with good glycemic control. (p 0.005) Our study revealed a significant positive correlation between HbA1c and triglyceride level (r = 0.375; p = 0.003) and HbA1c and ratio triglyceride/HDLc (r = 0.335; p = 0.009). Conclusion: HbA1c can also be used as a predictor of dyslipidemia in type 2 diabetics in addition to as a glycemic control parameter

The serum triglyceride to high-density lipoprotein (HDL) ratio in patients with acute coronary syndrome with and without renal dysfunction

Aim To assess triglyceride – to high-density lipoprotein cholesterol (TG/HDL)-C ratio in patients with acute coronary syndrome (ACS) and to verify its association with renal dysfunction. Methods A cross sectional study included 85 ACS patients divided in two groups with (ACS – RD) and without (ACS-nRD) presence of renal dysfunction, and 35 healthy subjects. Blood pressure, blood glucose, C-reactive protein, urea, creatinine, eGFR and serum lipids levels (total cholesterol, triglycerides, LDL-C, HDL-C) was measured in all participants. Based on the values of the measured lipid fractions TG/HDLc ratio was calculated. Results Patients in ACS group had significantly lower HDL-C level (p<0.0005) but significantly higher TG level (p=0.046) and TG/HDL-C ratio (p<0.0005) than controls. There was a significant increase (p<0.0005) in TG/HDL-C ratio in ACS-RD group compared to ACS-nRD group. The ACS-RD group had significantly higher level of TG (p=0.001), serum urea (p=0.02) and creatinine (p<0.0005) compared to the ACS-nRD group. With a cut-off level of 1.135 TG/HDL-C ratio had a sensitivity of 77.6% and a specificity of 62.9% in distinguishing between ACS patients and healthy subjects. With cut-off value of 1.905 TG/HDL-C ratio had a sensitivity of 75.9% and a specificity of 78.6% in distinguishing between ACS patients with and without renal dysfunction. Conclusion This study confirms the reliability of the TG/HDL-C ratio as a simple, low cost and useful marker in distinguishing between patients with ACS and healthy subjects and ACS patients with and without renal dysfunction

ELEVATED SERUM C-REACTIVE PROTEIN LEVEL IS NOT ASSOCIATED WITH SERUM NITRIC OXIDE IN PATIENTS WITH POSTTRAUMATIC STRESS DISORDER

Background: The aim of the present study was to evaluate serum nitric oxide (NO) and C reactive protein (CRP) concentration in veterans with and without PTSD. Furthermore, we aimed to assess whether there is a correlation between serum NO and CRP concentrations in tested groups. Subjects and methods: Cross-sectional study included 90 male individuals, with and without experience of direct war combat, divided into three equal groups (n=30): group 1- included war veterans with PTSD, group 2 - included war veterans without PTSD, and control group - 30 apparently healthy volunteers, without experience of direct war combat. The diagnosis of PTSD was assessed according to the guidelines in the 10th revision of the International Classification of Diseases (ICD-10). High-sensitivity CRP was determined by immunonephelometry. The serum NO level was determined by classic colorimetrical Griess reaction. Results: Serum CRP concentration in veterans with (3.54±1.19 mg/L) and without PTSD (3.24±2.04 mg/L), was significantly higher (p<0.05) compared to control group (1.26±1.06 mg/L). Serum NO concentration in veterans with (7.64±4.43 μmol/L) and without PTSD (7.12±2.60 μmol/L) was significantly lower (p<0.05) compared to control group (11.26±7.01 μmol/L). Statistically significant correlation between serum NO and CRP concentration was determined in veterans without PTSD (r=-0.473; p<0.01). No correlation was observed between serum NO and CRP concentration in veterans with PTSD (r=0.118; p=0.534) and in control group (r=-0.067; p=0.727). Conclusion: The present study has showed significant increase of serum CRP and significant decrease of serum NO concentrations in veterans with and without PTSD. Furthermore, statistically significant negative correlation between serum NO and CRP concentration was determined only in veterans without PTSD. Obtained results indicate that the complex mechanism of the pathogenesis of PTSD requires further research

Coagulation factor VIII activity in diabetic patients

Aim To examine coagulation factor VIII activity in plasma, as a risk factor for thrombosis, in the patients with diabetes mellitus (DM). Also, to assess its relationship with ibrinogen and fasting blood glucose concentrations and with body mass index. Methods The plasma coagulation factor VIII activity, plasma levels of ibrinogen and blood glucose concentrations were measured in 30 patients with DM type 1, 30 patients with DM type 2 and in 30 healthy subjects. Body weight and body height were also measured and BMI was calculated.Results The plasma factor VIII activity in patients with DM type 1 and patients with DM type 2 was signiicantly higher than the values measured in healthy subjects. There was no signiicant difference in the factor VIII activity between patients with DM type 1 and type 2. The concentrations of ibrinogen and blood glucose in both groups of patients were signiicantly higher than in the group of healthy subjects. Patients with DM type 2 had a signiicantly higher BMI compared to healthy subjects, as well as compared to patients with DM type 1. There was a signiicant positive correlation between plasma factor VIII activity and plasma level of ibrinogen and a signiicant negative correlation between factor VIII activity and BMI in patients with DM type 2. Conclusion Diabetic patients have the elevated plasma coagulation factor VIII activity and increased ibrinogen concentration thus an increased risk of thrombosis and vascular diseases

Red blood cell distribution width-to-platelet ratio inversely correlates with indicators of disease activity status in rheumatoid arthritis patients

Introduction. Present study was performed to verify red blood cell distribution width-to-platelet ratio (RPR) level in rheumatoid arthritis (RA) patients and to examine its correlation with clinical and biochemical indicators of disease activity status

Average saturated fatty acids daily intake in Sarajevo University students

Introduction: There are wide variations in diet patterns among population subgroups. Macronutrients content analyses have become necessary in dietary assessment. The purpose of this study is to analyze dietary saturated fatty acids intake in students, detect differences between men and women, and compare with nourish status and nutrition recommendations.Methods: A cross-sectional survey of 60 graduate students was performed during the spring 2013, at the Sarajevo University. Food-frequency questionnaire was conducted during seven days. Body mass index was used to assess students' nourish status. Statistical analyses were performed using the Statistical Package for Social Sciences software (version 13.0).Results: Mean age of males was 26.00±2.72, and of females was 27.01±3.93 years. The prevalence of overweight was more common among males compared to females (55.56% vs. 6.06%). Median of total fat average intake for men and women was 76.32(70.15;114.41) and 69.41(63.23;86.94) g/d, respectively. Median of saturated fatty acids average intake for men and women was 28.86(22.41;36.42) and 24.29(20.53;31.60) g/d, respectively. There was significant difference in average intake of total fat between genders (Mann-Whitney U test: p=0.04). Macronutrient data were related to requirement of reference person. Total fat intake was beyond recommended limits in 37.04% of males and 54.55% of females. Saturated fatty acids intake was beyond the upper limit in 55.56% of males and 51.52% of females.Conclusion: Diet pattern of the average student is not in accordance with the recommendations of saturated fatty acids contribution as a percentage of energy