DOES OBSESSION OF IRRATIONAL STACKING ANABOLIC STEROIDS WITH TRENBOLONE ACETATE OVER DECADES LEADS TO GENERAL, CARDIOVASCULAR OR SOCIAL DEVIATION PROBLEM IN YOUNG ADULTS, OR JUST BIGGEST MUSCLE MASS IS EQUAL HIGHEST SOCIAL REPUTATION IN GYM AND IS THIS ALL PRICE HEALTH WORTH? - CASE REPORT

Inconspicuous epidemic of anabolic steroids application among young recreational athletes contributes to a greater potential damaging of the overall cardiovascular and mental state of obsessed individuals. All of them turn to anabolic steroids without a rational concept and take them in big amounts with unbelievable irrational combinations (stacking) of anabolic steroids of wide spectrum and questionable quality from black market with the aim to satisfy their pathological obsession of subjectivity of muscle mass, strength and appearance. An examinee, 36 years old (with the height of 182 cm and the weight of 168 kg), recreational amateur power lifter comes to doctor because of the subjective hardships in the form of tiredness and occasional pain in chest area with exact location (on the level of sternum and pectoral muscles), denies retrosternal pain. Also, he reports dizziness and occasional leg pain. He suspects that he has insufficiency of artery peripheral circulation. Personally, he also names frequent insomnia, decrease of tolerance levels alongside tolerated aggressiveness and anger attacks with auto mutilation and periodical depression  Article visualizations

CAN THE IRREGULAR ACETYLSALICYLIC ACID (ASA) THERAPY COMBINED WITH INTERVAL TRAINING EXERCISE PROGRAM INCREASE THE CLAUDICATION DISTANCE IN DIABETIC AND NON-DIABETIC PATIENTS WITH FEMORO-POPLITEAL STENOSIS AGE OVER 55

The aim of the study was to estimate the increasing capability of claudications distance in Fontaine's stage IIa of peripheral artery disease by influence of irregular acetylsalicylic acid (ASA) therapy and life style modification, combined with regular physical activity in diabetic and non-diabetic patients age over 55, in order to establish if there were any improvements in claudication distance in the both groups of patients. Method: This study was conducted from beginning of January, 2014 till end of January, 2015 at the Clinic of Vascular Surgery, Clinical Center University of Sarajevo and included 60 patients age over 55 (30 patients who have diabetes mellitus and impellers group consisting of 30 patients who were clinically confirmed not to have diabetes mellitus), male and female, in stadium IIa of peripheral artery disease, with manifestation of mild claudication symptoms. For the testing of statistical significance of differences between the exanimated groups non-parameter and parameter tests were used. The difference at a level of p<0,05 was statistically significant. Results: In all the tested patients, we investigated increasing of claudications distance in diabetic and non-diabetic patients age over 55 years after one year study. Analysis shows the statistically significant influence of antiplatelet therapy (Acetylsalicylic acid) (ASA), combined with physical activity and life style modification on claudications distance over 500 meters in 25 patients without diabetes mellitus in (83% p<0,05), compared to 12 patents with diabetes mellitus (40% p<0,05). Sixteen of non-diabetic patients (53%) were on antiplatelet therapy over 4 years, on permanent treatment, compared to 4 diabetic patients or (3%) (p<0,05). Conclusion: These clinical combined factors appeared to us as being the main strategy of the therapeutic effect on enhancement of claudication distance (Fontaine's stage II) of peripheral artery disease in patients with diabetes mellitus, as well as patients without it.  Article visualizations

PHYSICAL ACTIVITY AND HEALTH: THE BENEFITS OF PHYSICAL ACTIVITY IN THE PREVENTION OF DIABETES MELLITUS AND CARDIOVASCULAR DISORDERS

Public health of people and individuals is the most important resource in the modern world. The sugar epidemic and cardiovascular diseases are linked to the obesity epidemic. As obesity appears at younger and younger ages, it is to be expected that the proportion of people who have been obese for the number of years will increase and that those practicing a "sedentary lifestyle" will move less and less. Diabetes mellitus type 2 (DMT2) and cardiovascular diseases (CD) are among the top ten causes of death in the world. It is observed that the association between DMT2 and CD risk is not the same for both sexes, with the cardiovascular risk associated with DMT2 being greater in women. Among the different strategies for the prevention and treatment of DMT2 and risk factors for CD, physical exercise has been largely recommended because of its positive effects on glycemic control, body mass, blood pressure, and lipid profile. A higher level of daily physical activity significantly reduces the risk of contracting numerous diseases such as: diabetes, diseases of the heart and blood vessels, certain forms of malignant diseases, obesity, asthma, osteoporosis and others.  Article visualizations

THE VALUES OF FITNESS INDEX AND VO2max OF STUDENTS USING INDIRECT METHOD AEROBIC TESTS

Aerobic fitness, endurance, and cardiovascular endurance are synonyms for work capacity, which itself is an important prerequisite for the health and life of every man. A very common way of assessing the state of aerobic fitness of a particular population are diagnostic tests on the basis of which we receive the necessary information when it comes to general physical condition of a defined population. This diagnostic evaluation is usually performed in the laboratory (direct methods), however, available and reliable data are about high reliability in the performance of some field tests (indirect methods). Depending on the field conditions, very often these measurements are performed using estimates of general ability (test UKK 2km). To perform this test data about body height, body weight, BMI, the values of the pulse rate and walking time during the test must be contained in it. Based on testing using the UKK 2km are obtained Fitness Index values (FINDEX) and maximal oxygen consumption (VO²max) of 35 male students of the Faculty of Physical Education and Sport, University of East Sarajevo (BIH) in order to determine and define the physical condition of respondents. The results showed that the fitness index (103.22) in the upper zone average (103.22) and VO²max = 49.12 reflects good shape, but still the results indicate toward decreasing trend in students' aerobic fitness, and  have fitness index values below the standard norms of the Swedish population. The general trend of decreasing aerobic fitness of the population can be seen in the sport and physical education students, as a consequence of lifestyle in which there is not enough adequate physical activity.  Article visualizations

The effects of recreational cardio fitness programs on the body composition of young women

Background and study aim. Group fitness programs are a form of programmed physical exercises with the aim of improving health, aesthetic appearance, satisfying the motivation to preserve health and reduce body weight. The aim of this study was to determine the effects of an experimental cardio fitness program on the morphological status of female subjects aged 21.5 ± 3.5 years. Material and methods. The experimental program was implemented over a period of three months (12 weeks), with a weekly frequency (3 x 20-60 min). Initial and final measurements were performed and Body weight, Body fat percentage, Body fat mass, Free fat mass, Body muscle mass, Body mass index and Basal metabolism rate were analyzed. All test subjects have their doctor's confirmation that they are healthy and can undergo training loads in a planned and clearly defined cardio program. Results. The exercise program on cardio equipment caused changes in all body composition parameters between the initial and final measurements t-test (except for muscle mass). The total average Body weight at the initial-final measurement (66.45 vs. 64.70kg; t= 5.225, p<0.000), which represents a difference of -1.75kg after the program. Conclusions. The assumption is that a controlled and monitored program with a special focus on nutrition would lead to even more precise results on the effects on body composition. Continuous application of the content of this program throughout the entire one-year macrocycle with a higher weekly frequency would certainly give even more significant results

Whether exercises and testosterone replacement therapy support a treatment for cardiovascular and atherosclerotic patients with iliac artery stenosis and low total testosterone and high-density lipoprotein cholesterol after endovascular procedure?

Serum levels of testosterone (ST) and high-density lipoprotein (HDL) are generally associated with atherosclerosis in male patients over 50 years with critic iliac stenosis (TASC II A and B) and cardiovascular disease with significant changes in HDL and low-density lipoprotein (LDL). In addition to the standard therapy, combined medicamentous therapy and adequate model of exercise are also important factors as medicines can improve HDL levels and primary bypass and endovascular potency impacting positively on improvement of ST or it can be the following testosterone replacement therapy (TRT) comprising cardiovascular disease prevention and vascular treatment as adjunct therapy options after endovascular and vascular surgical procedures. The aim of the study is to identify the association between HDL and ST after surgical and endovascular intervention on the iliac segment (TASCII A and B), as well as cardiovascular risk factors with modified medium activity (MET) 6 (MET), with total duration of 30–60 minutes. It also attempts to remodel a patient behavioral pattern, optimize ST levels and link them to outcomes and patency of vascular procedures on the iliac segment. Materials and methods. 108 selected male patients with cardiovascular disease combined with metabolic syndrome and critical iliac artery stenosis (TASC II A and B) were examined during 2014–2018, 4 years after invasive and minimal invasive treatment (54 patients were treated with surgical Dacron reconstruction and 54 patients – with endovascular treatment on short segment of critical iliac artery stenosis (TASC II A and B). Results. In the total population, no difference was observed in changes of constraint-induced movement therapy between the standard exercise group and the control one after 4 years from baseline. However, there was no significant interaction between the effect of exercise trainings and primary bypass potency within 4 years. Conclusions. Primary effects of endovascular procedure and Dacron bypass revascularization raise the risk of elevated testosterone levels after 4 years of group training but does not provide adequate answers to questions as to whether higher levels of ST have any major influence on primary bypass potency preventing further progression of cardiovascular disease and general symptomatic and asymptomatic atherosclerosis. However, exercise and TRT can be potential adjunctive therapeutic options for a future supporting postsurgical and endovascular illiac treatment in cardiovascular patients with low testosterone levels

Comparative Study of Operative Tretmant of Varicose Veins According to The Klapp and Smetana Method Versus Myers Method

Venous abnormalities in lower extremities are among the most frequent disorders that affects general population with significant morbidity and mortality. Usually, the problem consists of a mild form of varicose veins and teleangiectasis. Treatment in this stage of disease is highly recommended since progression can lead to chronic venous insufficiency and chronic disability with very few effective treatment options. The most effective and popular treatment of varicose veins is operative treatment; specifically two different operative procedures: method according to Myers and method according to Klapp and Smetana. We designed this study in order to determine which method is superior based on clinical parameters and patients satisfaction. Our evidence strongly support clinical superiority, as well as patient satisfaction, of Klapp and Smetana method

Femoro-Popliteal Bypass Above Knee with Saphenous Vein vs Synthetic Graft

There is still debate whether sintethic graft (polytetrafluoroethylene or Dacron) is equivalent to vein as bypass graft material for the above-knee femoropopliteal bypass. Therefore, we performed prospective randomized trial to compare vein with polytetrafluoroethylene/dacron for femoropopliteal bypasses with the distal anastomosis above the knee. Between January 2000 and June 2003, 121 femoropopliteal bypasses were performed. The indications for operation were severe claudication in 96 cases, rest pain in 16 cases, and ulceration in 9 cases. After randomization, 60 reversed saphenous venous bypasses and 61 polytetrafluoroethylene/ dacron bypasses were performed. No perioperative mortality was seen, and 5% of the patients had minor infections of the wound, not resulting in loss of the bypass, the limb, or life. After 5 years, 37% of the patients had died and 7% were lost to follow-up. Only once saphenous vein was necessary for coronary artery bypass grafting. Primary patency rates after 5 years were 76,6% for venous bypass grafts and 59,1% for polytetrafluoroethylene/dacron grafts (p=0,035). Secondary patency rates were 83,3% for vein and 69,2% for polytetrafluoroethylene/dacron bypasses (p = 0,036). In the venous group, 10 bypasses failed, leading to four new bypasses. In the polytetrafluoroethylene group, 22 bypasses failed, leading to 12 reinterventions. After 5 years of follow-up, we conclude that a bypass with saphenous vein has better patency rates at all intervals and needs fewer reoperations. Saphenous vein should be the graft material of choice for above-knee femoropopliteal bypasses and should not be preserved for reinterventions. Polytetrafluoroethylene/dacron is an acceptable alternative if the saphenous vein is not available

Classical surgical approach and treatment with clips of extracranial internal carotid artery berry aneurysm

Introduction: We can define extracranial carotid artery aneurysm (ECAA) as bulb dilatation greater than 200% of the diameter of the internal carotid artery (ICA) or in a case of common carotid artery (CCA) greater than 150% of the diameter. Surgical intervention is required for the treatment of this disease.Case report: This study presents an open vascular surgical procedure to resolve ECAA. We report a case of 61 years old woman with an extracranial internal carotid artery berry aneurysm, presented with a headache and dizziness when turning the head aside. Classic open surgery was performed and the lumen of berry aneurysm was separated with three clips from the lumen of ICA.Conclusions: The open surgical approach is the method of choice for the treatment of extracranial internal carotid artery pathological conditions

Дія тривалих тренувань помірної інтенсивності на мікроциркуляторні порушення та товщину інтима-медіа сонної артерії в пацієнтів після ендоваскулярного та класичного шунтування

 Research on moderate-intensity continuous training (MICT) is closely connected with primary and secondary cardiovascular protection but also can be associated with primary bypass patency and outcome of endovascular treatment for critical iliac stenosis TASC II A and B. After specific surgical or non-surgical treatment, iliac bypass or endovascular revascularization patency still depends on an individual and is still in the eye of scientific research modalities. Carotid intima-media thickness (CIMT) is an efficient surrogate parameter in detection and prediction of cerebrovascular events and potential marker of generalized atherosclerosis with prognosis of peripheral arterial disease related to prognosis of atherosclerotic coronary hemodynamic pathology.Materials and methods. A total of 139 patients were observed during 4 years of MICT. Ultrasonography of the distal part of the common carotid artery (CCA) was performed to measure CIMT before and after revascularization procedure. The bypass patency and walking distance was also studied.Results. In the total population, no difference in changes of CIMT from baseline was observed between the standard exercise group and controls in 4 years. However, there was a significant correlation between the effect of exercise training and CIMT within 4 years. CIMT was not significantly reduced in the exercise group compared with control non-diabetic patients.Conclusions. Exercise training in both groups did not significantly change carotid intima-media thickness in the four years following endovascular procedure and Dacron bypass revascularization, but significant beneficial effect of moderate-intensity continuous training on bypass patency was observed in patients with mild or without claudication symptoms as well as on subjective and objective health status. Научное исследование продолжительных тренировок умеренной интенсивности коррелирует с первичной и вторичной сердечно-сосудистой терапией, но и связано с исходом первичного обходного шунтирования и лечения эндоваскулярного подвздошного стеноза TASC II A и B. После специфического хирургического и нехирургического лечения результаты шунтирования или эндоваскулярной подвздошной реваскуляризации все еще зависят от пациента, и данные показатели актуальны для медицинских исследований. Толщина интима-медиа сонной артерии – эффективный замещающий параметр в определении и предупреждении инсульта, а также потенциальный маркер рассеянного атеросклероза с прогнозом поражения периферических артерий в связи с прогнозом коронарной атеросклеротической гемодинамической патологии.Материалы и методы. На протяжении 4 лет исследовали 139 пациентов во время длительных тренировок умеренной интенсивности. Проведена ультрасонография дальней части общей сонной артерии для измерения толщины интима медиа сонной артерии до и после реваскуляризации. Также определили проходимость шунта и дистанцию безболевой ходьбы.Результаты. У всех обследованных не наблюдали отличия в изменении толщины интима-медиа сонной артерии между стандартной и контрольной группами на протяжении 4 лет. Однако отмечена значительная взаимосвязь между действием тренировок и толщиной интима-медиа сонной артерии на протяжении 4 лет. Показатели толщины интима медиа сонной артерии незначительно уменьшились в базовой группе по сравнению с контрольной (у пациентов без диабета).Выводы. На протяжении 4 лет после эндоваскулярной процедуры и реваскуляризации дакроновым протезом тренировки, проводимые в обеих группах, незначительно изменили развитие показателя толщины интима-медиа сонной артерии, но наблюдали значительное позитивное действие продолжительных тренировок умеренной интенсивности на проходимость шунта с незначительными симптомами микроциркуляторных нарушений или их отсутствием в субъективном или объективном статусе пациента. Наукове дослідження тривалих тренувань помірної інтенсивності корелює з первинною та вторинною серцево-судинною терапією, але також пов’язане з результатом первинного обхідного шунтування та лікування ендоваскулярного здухвинного стенозу TASC II A та B. Після специфічного хірургічного та нехірургічного лікування результати шунтування або ендоваскулярної клубової реваскуляризації все ще залежать від пацієнта, і ці показники актуальні для медичних досліджень. Товщина інтима-медіа сонної артерії – ефективний заміщальний параметр у визначенні та запобіганні інсульту, а також потенційний маркер розсіяного атеросклерозу з прогнозом ураження периферичних артерій у зв’язку з прогнозом коронарної атеросклеротичної гемодинамічної патології.Матеріали та методи. Протягом 4 років дослідили 139 пацієнтів під час тривалих тренувань помірної інтенсивності. Виконали ультрасонографію дальньої частини загальної сонної артерії для вимірювання товщини інтима-медіа сонної артерії до та після реваскуляризації. Визначили прохідність шунта та дистанцію безбольової ходьби.Результати. У всіх осіб, яких дослідили, не спостерігали відмінності за зміною товщини інтима-медіа сонної артерії між стандартною та контрольною групами протягом 4 років. Однак виявили значущий взаємозв’язок між дією тренувань і товщиною інтима-медіа сонної артерії протягом 4 років. Показники товщини інтима-медіа сонної артерії несуттєво зменшилися в базовій групі порівняно з контрольною (в пацієнтів без діабету).Висновки. Протягом 4 років після ендоваскулярної процедури та реваскуляризації дакроновим протезом тренування, що відбувалися в обох групах, несуттєво змінили розвиток показника товщини інтима-медіа сонної артерії, але спостерігали значущу позитивну дію тривалих тренувань помірної інтенсивності на прохідність шунта з незначними симптомами мікроциркуляторних порушень або їхньою відсутністю в суб’єктивному чи об’єктивному статусі пацієнта.