PREVALENCE OF CORONARY ARTERY ANOMALIES DETECTED BY CORONARY CT ANGIOGRAPHY IN CANTON SARAJEVO, BOSNIA AND HERZEGOVINA

Background: Coronary artery anomalies (CAAs) are congenital variations of one or more of the coronary arteries and they are an uncommon but important cause of chest pain and, in some cases, sudden cardiac death. Anomalies of coronary arteries may be found incidentally in 0.3-1% of healthy individuals. The three types of coronary artery anomalies are anomalies of origin, anomalies of course and anomalies of termination. The purpose of our study was to estimate the frequency of CAAs in Canton Sarajevo, B&H, and to deteremine the prevalence of origin, course and termination anomalies of coronary arteries. Subject and methods: This was a retrospective analysis of 919 patients who underwent Coronary CT Angiography to determine CAAs in the period from 2013 to 2017. Results: In our study, total number of CAAs have been found among the 130 patients (14.12%) out of which anomalies of origin are found at 14 patients (1.52%), anomalies of course at 115 patients (12.5%) and anomaly of termination in 1 patient (0.1%). Out of 14 cases in total anomalies of origin, anomalies of origin of the left coronary artery are observed among 11 patients (1.2%), and anomalies of origin of the right coronary artery among 3 patients (0.3%). From mentioned 14 cases of the anomalous origin of the coronary arteries, anomalies with clinical significance (interarterial, malignant course) of the coronary arteries are found among 6 patients (0.65%) and anomalies without clinical significance are found among 8 patients (0.87%). Coronary artery anomalies of origin with malignant course are devided in two groups: LMA from right sinus of Valsalva with interarterial course observed in 4 patients (0.43%) and RCA from left sinus of Valsalva, also with interarterial course in 2 patients (0.21%). We found 4 patients (0.43%) with separated origin LAD and LCX, without LMA. The preavlence rates of separate origin of RCA and conus artery, anomaly origin of the LCX from right coronary sinus, anomaly origin of the LMA from posterior coronary sinus and LMA from right coronary sinus without interarterial course were seen in 0.1% of patients. Among 115 cases of anomalies of course 111 cases (12.07%) belongs to bridging (37 cases to LAD; 25 cases to D1 and D2 and 49 to ramus intermedius), and 4 cases (0.43%) belongs to intraatrial course of RCA. Anomaly of termination presented with fistula between LCX and coronary sinus was found only in 1 case. Conclusion: Coronary CT angiography is an excellent tool for diagnosis of CAAs regarding origin, course and termination of the coronary arteries

Fenestration of the vertebral artery presented by computed tomography angiography of the neck's blood vessels: A case study

Vertebral artery fenestration is a rare vascular anomaly. It most commonly occurs in extracranial segments of the vertebral artery. This congenital anomaly can occur during the various stages of embryonic development of the vertebral artery. This usually does not have clinical significance, but the possibility of associated anomalies such as saccular aneurysms and arteriovenous malformations should be noted. Awareness of vascular anomalies is key to avoiding iatrogenic injury during endovascular diagnostic and therapeutic interventions. Here, we present incidental findings of vertebral artery fenestration in a 46-year-old woman evidenced by CT angiography of the neck's blood vessells after I .V. contrast medium applications

Perfusion magnetic resonance neuroimaging

The clinical appliance of perfusion is being continuously developed and it is closely related to technology development. The role of perfusion neuroimaging in the management of acute stroke has been to prove reduced regional blood flow and to give the contribution in the identification of ischemic areas, respectively the regions of hypoperfusion that can be treated by thrombolytic and/or endovascular recanalization therapy. There are two main approaches to the measurement of cerebral perfusion by magnetic resonance. The aim of this article is to compare different measuring approaches of MR perfusion neuroimaging

Assessment of Lumbar Spine Disc Degeneration in Coherence to Pfirrman Grades and Oswestry Disability Index

Introduction: Intervertebral disc (IVD) degeneration (IDD) is one of the main causes of low back pain (LBP). Standardized diagnostic algorithms for adequate estimation and classification of changes of lumbar discs are mandatory before starting with therapy.Methods: One hundred patients who were indicated for lumbar magnetic resonance imaging (MRI) were included in the study. Pfirrmann grading system was used for the determination of IDD, while the visual analog scale (VAS) is used for evaluation of the intensity of LBP. To quantification of disability for LBP, we used the Oswestry Disability Index (ODI).Result: Results showed higher Pfirrmann grades II and III for L2/L3 and L3/L4 lumbar levels and lower scores at L4/L5 and L5/S1. The analysis also showed low scores at the L2/3 and L3/4 lumbar level for Pfirrmann grades IV and V, and there was an increased at more inferior lumbosacral levels L4/5 and L5/S1. There was a significant correlation between Pfirrmann grades and ODI (p = 0.24) as well as VAS (p = 0.16).Conclusion: Higher Pfirrmann grades correlated with increased ODI and VAS. Therefore, MRI can be used as a strong indicator of clinical appearance, but it is important to take into consideration that LBP should be correlated with clinical features. By summing Pfirrmann grades of all lumbar intervertebral levels in each patient, we can get more accurate insight for the status of the lumbar spine

Effects of axial loaded magnetic resonance imaging of lumbar spine on dural sac and lateral recesses

Introduction: Axial-loaded magnetic resonance imaging (MRI), which can simulate an upright position of the patient may cause a significant reduction of the dural sac cross-sectional area (DCSA) compared with standard MRI, thus providing valuable information in the assessment of the lumbar spinal canal. The purpose of this study was to investigate excessiveness of the change in DCSA and depth of lateral recesses (DLRs) before and after axial-loaded imaging in relation to body mass index (BMI) of the subjects.Methods: Twenty patients were scanned to evaluate DCSA and DLR at three consecutive lumbar spine intervertebral disc levels (L3/4, L4/5, and L5/S1) on conventional-recumbent MRI, and after axial loading were applied.Results: Axial-loaded MRI demonstrates a significant difference of DSCA in comparison to conventional MRI. Furthermore, results show a significant correlation between the DCSA and BMI on level L3/L4, both before and after axial loading MRI. With axial loading, there is a reduction of DSCA of 12.2%, 12.1%, and 2.1% at the levels L3/L4, L4/L5, and L5/S1, respectively. After axial loading has been applied, the depth of the neural foramen has been reduced by an average of 10.1%.Conclusion: Axial-loaded MRI reduces DCSA and DLRs in comparison to standard MRI. Information obtained in this way may be useful to explain the patient’s symptomatology and may provide an additional insight that can influence the treatment decision plan accordingly

Benefits of low-dose carotid CT angiography in stroke patients

Introduction: Computed tomography angiography (CTA) represents the gold standard as a method for the diagnosis of carotid artery diseases. The current topic is the use of CTA for the evaluation of carotid arteries with a reduction in the dose of contrast agent and dose of ionizing radiation, which, with adequate preparation, would enable the use of this method in some risk groups. The aim of this study was to evaluate the feasibility and image quality of a new low-dose CTA protocol in comparison with a standard protocol. Methods: Forty patients with recumbent ischemic stroke were included in the study, twenty of whom underwent lowdose CTA, and the remaining twenty underwent a standard CTA protocol of the carotid arteries. Results: No significant difference was found between the mean values of CT number (Hounsfield unit), signal-to-noise ratio, contrast-to-noise ratio, and subjective assessment of image quality in the comparison of the control and experimental groups. CT dose index, volume, and dose length product were significantly lower in patients who underwent lowdose carotid CTA. There was no significant difference in the degree of carotid stenosis between color Doppler and CTA. Conclusion: The use of the low-dose protocol for carotid CTA allows the application of this method in risk groups, in which it was previously not possible to perform, with the same image quality in comparison with the standard protocol

The SARS-CoV-2 Delta (B.1.617.2) variant with spike N501Y mutation in the shadow of Omicron emergence

Circulation of the Omicron variant with the reemergence of the N501Y mutation along with many others in the spike protein has once again stirred the academic community. Interestingly, tracing the genetic diversity of SARSCoV- 2 shed light on a less frequent N501Y þ Delta variant which has been in the global circulation for some time before the Omicron appearance. This paper aims to present the molecular characteristics of the SARS-CoV-2 Spike_N501Y þ Delta variant detected in Bosnia and Herzegovina. The study was conducted during November and December 2021. All patients were tested using real-time RT-PCR for detection of SARS-CoV-2. A representative number of SARS-CoV-2 positive samples was pre-screened using VirSNiP SARS-CoV-2 Spike N501Y kit. The characterization of the viruses was carried out with Illumina RNA Prep with enrichment and the Respiratory Virus Oligo Panel kit. Among the analyzed sequences, we found two isolates of the Delta variant that differ from their most related clade- GK AY.4.3 in additional mutations N501Y and L54F. In this study, we described the presence of a rare form of Delta variant with Spike_N501Y mutation in the shadow of the Omicron emergence. Despite the set of mutations in the Spike protein, this form of Delta variant does not indicate the large-scale consequences for the general population. Further functional studies of this form could provide more information about its antigenicity and infectivity

Relationship between ultrasonographically determined kidney volume and progression of chronic kidney disease

Aim To investigate a correlation between calculated creatinine clearance as a measure of kidney’s functional abilities and ultrasonographically determined kidney volume, which represents actual size of the kidney, in fact residual renal mass in chronic kidney disease, in order to determine possibilities of ultrasound as a diagnostic method in diagnosing and follow up of chronic renal disease. Methods Prospective study included 150 patients with registered demographic and anthropometric data, and also with relevant laboratory tests of renal function. Longitudinal diameter, thickness and width of the kidney and renal volume calculated according to the Dinkel’s formula were measured by ultrasound. A correlation between the measured volume of the kidneys and calculated creatinine clearance was done by the Spearman method, with statistical significance of p<0.05. Results Statistically significant correlation between the estimated creatinine clearance values and the average of the calculated values of kidney volume was found (p<0.01). Average value of the kidneys’ volume showed a linear decrease with the progression of chronic kidney disease: the kidney volume in the control healthy group was 171.7 ± 32.6 mL (95.22- 229.59 mL), and in the subjects classified in stage IV it was 74.7 ± 24.6 mL (43.22-165.65 mL). Conclusion Calculated volume of kidney well correlated with creatinine clearance as a measure of functional ability of the kidneys and with the stage of chronic renal disease. It can be used in clinical practice for monitoring of chronic kidney disease in conjunction with other clinical and laboratory parameters

Age, gender and hypertension as major risk factors in development of subclinical atherosclerosis

<strong>Introduction</strong>: Intima-media thickness (IMT) measurement of the common carotid artery (CCA) is considered as useful indicator of carotid atherosclerosis. Early detection of atherosclerosis and its associated risk factors is important to prevent stroke and heart diseases. The aim of the present study was to investigate which risk factors are better determinants of subclinical atherosclerosis, measured by common carotid<br />artery intima media thickness (CCA-IMT).<br /><strong>Methods</strong>: A total of 74 subjects were randomly selected in this cross – sectional study. Information on the patient’s medical history and laboratory fi ndings were obtained from their clinical records. Risk factors relevant to this study were age, gender, cigarette smoking status, diabetes, hypertension and dyslipidemia. Ultrasound scanning of carotid arteries was performed with a 7,5 MHz linear array transducer (GE Voluson<br />730 pro). The highest value of six common carotid artery measurements was taken as the fi nal IMT. Increased CCA-IMT was defi ned when it was > 1 mm.<br /><strong>Results</strong>: Our data demonstrated higher CCA-IMT values in male patients compared with female patients. Increased CCA-IMT was the most closely related to age (P<0.001), followed by systolic blood pressure (P=0.001), diastolic blood pressure (P=0.003) and glucose blood level (P=0.048).<br /><strong>Conclusion</strong>: Age, gender and hypertension are the most important risk factors in development of carotid atherosclerosis. Early detection of atherosclerosis among high-risk populations is important in order to prevent stroke and heart diseases, which are leading causes of death worldwide