UTILISATION ANALYSIS OF ANTIHYPERTENSIVE DRUGS IN BOSNIA AND HERZEGOVINA FOR THE TIME-PERIOD 2013-2015.

Objective: Expenditures for drugs are increasingly burdening already insufficient funds for health protection. This is especially evident in less developed European countries such as Bosnia and Herzegovina. The question is whether such analyses can help save funds for financing treatment for diseases, with an emphasis on a more rational choice of drug for appropriate indication, whereby clinical complications of hypertension would be prevented and patients would have quality of their lives improved.

Prognostic Significance of Ascites and Serum Sodium in Patients with Low Meld Scores.

Objective: to determine ascites and serum sodium significance in short term mortality prediction in patients with advanced liver cirrhosis.

Methods: a cohort of 115 cirrhotic patients referred to our Department were followed up for 6 months in non-transplant settings. The c index equivalent to the area under the receiver operating curve (ROC) was calculated and compared to estimate the short-term prognostic accuracy of the following parameters: ascites, serum sodium and MELD score.

Use of serum levels of proinflammatory cytokine IL-1α in chronic hepatitis C.

Immunoregulatory cytokines influence the persistence of hepatitis C virus chronic infection and the extent of liver damage. Interleukin-1 plays an important role in the inflammatory process. Some studies have demonstrated that IL-1 production was impaired in patients with chronic infections of hepatitis C virus, implying that IL-1 may play a role in viral clearance.

Protein C Deficiency in Chronic Hepatitis C: Correlation With Histological Extent of Liver Fibrosis.

There is accumulating evidence that the coagulation system is involved in the process of fibrogenesis in chronic liver disease. Recent studies postulated a possible connection between plasmatic hypercoagulability and progression of fibrosis. The aim of the study was to investigate disorders of the coagulation system in patients with chronic hepatitis C having different extent of hepatic fibrosis well defined by liver histology.

Nutrition in cancer patients.

Cachexia is defined as an unintended loss of stable weight exceeding 10%. Patients with advanced cachexia express anorexia, early satiety, severe weight loss, weakness, anemia, and edema. Anorexia represents the result of a failure of the usual appetite signals whereas cachexia is the debilitating state of involuntary weight loss.

Endoscopic diagnostic of chronic pancreatitis.

Chronic pancreatitis is defined as a continuous inflammatory pancreatic disease, one characterized by irreversible morphological changes, often associates with pain and sometimes with the loss of endocrine and exocrine function. As a histological confirmation of chronic pancreatitis is often unavailable, the diagnosis is traditionally based on imaging methods such as computerized tomography (CT) or endoscopic retrograde cholangiopancreatography (ERCP), and recently magnetic resonance cholangiopancreatography (MRCP) as a noninvasive alternative to ERCP. Developments in the classification system of CP include the Marseille classification of 1963 which offered histopathologic criteria for CP, the Cambridge classification of 1984 which introduced imaging features of computed tomography (CT), transabdominal ultrasound (TUS) and endoscopic retrograde cholangiopancreatography (ERCP) for classification of CP as well as Rosemont classification system of 2007 which presented the endoscopic ultrasonography diagnosis of CP.

Gastric cancer staging: EUS and CT.

Introduction: Gastric cancer is the fourth most common cancer and the second leading cause of death from cancer. Only complete resection of all gross disease with negative microscopic margins (R0 resection) provides a long-term survival benefit, and the overall 5-year relative survival rate is approximately 20%. To improve survival and quality of life, new therapeutic approaches have been introduced.

Prognostic markers in patients with decompensated cirrhosis.

Aim: To evaluate the easily available laboratory and clinical markers in patients with decompensated cirrhosis and compare their prognostic value.

Methods: The study sample included a group of 80 patients with an established diagnosis of decompensated cirrhosis, hspitalizsed at the Department of Gastroenterohepatology, Clinical Center of the University of Sarajevo, between 2009 and 2011, followed up for 6 months either as outpatients or through repeated hspitalizsation. It was estimated that the accuracy (c-index) of the six variables, laboratory (serum bilirubin, creatinine, International Normalised Ratio (INR) and albumine) and clinical variables (hepatic encephalopathy and ascites) reflect the function of the liver in their ability to predict 6-month mortality.

Anaemia and inflammatory bowel disease.

Background: Anaemia has been recognised as a key symptom of IBD. Although efficient therapeutic options have been developed for the treatment of IBD associated anaemia, treating anaemia often has a low priority for gastroenterologists. Compared with other manifestations of the disease, such as arthritis or osteopathy, anaemia in IBD has been given scant attention.

Predictive value of endoscopic ultrasound in diagnosis and staging of primary gastric lymphoma.

The aim of the paper is to investigate significance of the endoscopic ultrasound (EUS) in diagnostic and staging of gastric lymphoma. Retrospective clinical study was conducted at the Clinic for Hematology and Clinic for Gastroenterology of the University Clinical Center of Sarajevo in the period of years 2002 to 2009. Patients (N = 40) with diagnosis of gastric lymphoma confirmed by pathohistological diagnosis were included in the study.

Impact of sustained virus elimination on natural anticoagulant activity in patients with chronic viral hepatitis C.

Previous studies have reported reduced synthesis of various hemostatic factors in patients with chronic liver disease. Whether changes in plasma levels of these proteins reflect recovered liver synthetic function following virological eradication therapy has not been approved yet. The aim of the study was to determine the impact of sustained viral suppression achieved with pegylated interferon alpha and ribavirin on hemostatic parameters including natural anticoagulants in patients with chronic hepatitis C.

Association between high D-dimer plasma levels and ascites in patients with liver cirrhosis.

Objective: The aim of the study was to investigate plasma D-dimer concentration in patients with liver cirrhosis with and without ascites and to evaluate the impact of ascites depletion on circulating plasma D-dimer levels.

Methods: Sixty patients with liver cirrhosis were recruited and categorized into two groups: cirrhotic patients without ascites in group 1 (n = 30) and patients with liver cirrhosis and ascites in group 2 (n = 30). D-dimer levels were measured on day of admission, in patients with ascites D-dimer concentration levels were repeated measured after ascites resolution cofirmed by ultrasonography.

Percutaneous endoscopic gastrostomy (PEG): retrospective analysis of a 7-year clinical experience.

Aims: Since its description in 1980, percutaneous endoscopic gastrostomy has become the modality of choice for providing enteral access to patients who require long-term enteral nutrition. This study aimed to evaluate current indications and complications associated with PEG feeding.

Methods: We conducted a retrospective analysis of all patients who referred to our endoscopic unit of the Department of Gastroenterology and Hepatology of the Medical Center University of Sarajevo for PEG tube placement over a period of 7 years.

Non-invasive liver fibrosis markers: use of serum levels of cytokines IL 1α and TGF ß1 in management of chronic liver diseases.

Aim: To analyze the usefulness of specified immunological parameters, proinflammatory IL-1α and profibrogenic, antiinflammatory TGF-β1, along with routinely used laboratory tests, in the differential - diagnostic procedure of chronic hepatitis of infectious and noninfectious etiology.

Methods: A total of 150 subjects were divided into two groups, depending on the infectious or noninfectious etiology of liver damage, and the control group. Apart from standard laboratory tests, the analysis included serum levels of cytokines: IL-1α and TGF-β1.

Etiology and oncogenesis of pancreatic carcinoma.

Pancreatic cancer is the fourth leading cause of cancer death overall. The factors that favor the development of pancreatic cancer can be divided into hereditary and acquired. Cancerogenesis is best explained by a "multi-hit" hypothesis, charcterized with the developmental sequence of cellular mutatitions, forcing mutant cell to inappropriate proliferation and preventing its repair and programmed cell death (apoptosis).

Clinical significance of haemostatic tests in chronic liver disease.

Objective: To determine different haemostatic tests in patients with various degrees of liver parenchymal damage and to rule out their role in assessing parenchymal hepatocyte dysfunction.

Methods: Seventy-five patients with chronic liver disease were included and due to their degree of liver damage categorized into three groups: group one patients with chronic viral hepatitis and early stage of fibrosis (n=30), group two patients with compensated cirrhosis (n=17) and group three patients with decompensated liver cirrhosis (n=28). The following haemostatic tests were measured: activated partial thromboplastin time, prothrombin time, plasma fibrinogen, antithrombin III and protein C and plasma D-dimer.

Application of nutritional screening tests for determining prevalence of hospital malnutrition.

Introduction And Objective: Many illnesses are related to the loss of appetite or the inability to intake food in a regular fashion. The consequence of long-term or even short-term non-intake of food leads to damaging of organ functions and tissue. Tissue consumption, which is speeded up through metabolic effects of inflammatory mediators, is a characteristic which is identified as clinical malnutrition.

Proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding.

Background: Peptic ulcer bleeding is a common and potentially fatal condition. For patients with bleeding peptic ulcers that display major endoscopic stigmata of recent hemorrhage, a combination of endoscopic and pharmacologic therapy is the current standard management.

Objective: To show our experience with management of peptic ulcer bleeding.

Test for obscure bleeding vs colonoscopy in the prevention of colorectal cancer.

Introduction: Colorectal cancer is one of the most common forms of cancer and its frequency has been on the constant and significant increase over the past 20 years. Prevention aiming for early precancerous detection, results in huge financial savings in the health care system. METHODOLOGY AND TEST SUBJECTS: Prospective randomized clinical research was conducted on 150 randomly chosen asymptomatic persons over the age of 50, with positive family history.

Pretherapeutic staging of the esophageal cancer using endoscopic ultrasound.

Patients with verified early stage of the esophageal carcinoma are presented with a very good prognosis, however all over the world patients present themselves with advanced stages thus minoring the chances for survival. Data obtained form the USA programmes are presenting information about 5 year survival period in 14% of the cases. On the other hand, prospective multi centric European study refers to the same period in 10%.

Portal hypertensive gastropathy (PHG).

Portal hypertenisive gastropathy (PHG) and GAVE syndrome are recently discovered entities who can be associated with bloodloss from gastrointestinal tract at patients with or without liver cirrhosis. PHG will be developed at 65% of patients with portal hypertension caused by liver cirrhosis but it could be developed at portal hypertension which is not caused by the liver cirrhosis. PHG is often assosiated with portal hypertension patients and presence of esofageal and /or gastric varices.

[Clinical effectiveness of omeprazole, azithromycin and amoxicillin in ulcer healing and eradication of Helicobacter pylori infection].

Aim: Prospective clinical investigation efficacy of omeprazole was proved in combination with two antibiotics (azithromicine and amoxycillin) in H. pylori eradication. Efficacy of omeprazole was also followed in gastric and duodenal ulcer healing.

[Enteral and parenteral nutrition in gastroenterology].

Malnutrition is state of organism with import of energy and other nutritional factors lower then consumption, leading in certain period, to deviation from normal, or changes in some functions. Patients with gastrointestinal diseases are prone to malnutrition states because of basic functions in absorption of nutritional substances. Most common causes are inflammatory bowel diseases (ulcerative colitis and Crohns disease especially), different digestive fistulas (proximal parts), chronic pancreatitis, chronic liver diseases and malignant tumors of digestive tube.

[Endoscopy of the lower part of the digestive system].

Examination of lower part of digestive system by colonoscopy is necessity in occult fecal hemorrhage occurrence, hematochesis, unresolved loss of blood iron and suspicious finding of large bowel X-ray barium study. By therapeutical colonoscopy, haemorrhage from neoplasms and angiodysplastic changes are controlled, foreign bodies are removed as well as routine polipectomics. Balloon dilation of large bowel stenosis, and palliative treatment of unoperable stenoses lead to improvement in quality of life with significant cost-benefit effects.

[Proximal endoscopy--from diagnosis to therapy].

Gastroscopy is medical procedure which allows examination of esophagus, stomach and duodenum by flexible instrument named gastroscope. Procedure could be strictly diagnostical, with evidence of current state and interventional/therapeutical, by attempting of prompt action (haemostasis, mucosal resection of cancer "in situ", polypectomy, dilation of benign and malignant strictures of digestive tube, placing endoprosthesis over strictures) Despite of its invasive nature, endoscopy is daily routine, safe and accurate procedure.