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Table of contents:
EDITORIAL: The autumn brings the fruits
DIJANA AVDIC. . . . . . . . . . . . . . . . . . . . . . . . . 99
RESEARCH ARTICLES
Etiological factors as predictor of rehabilitation in
patients after carebrovascular insult
EDINA TANOVI, DAMIR CELIK . . . . . . . . . . 100-103
Risk factors for long term complications among patients
of endocrine clinic in Hospital Penang, Malaysia
SYED WASIF GILLANI, SYED AZHAR SYED
SULAIMAN, SHAMENI SUNDRAM, SITI
MAISHARAH SHEIKH GHADZI, SABARIAH
NOOR HAROON, NUR HAFZAN MD
HANAFIAH . . . . . . . . . . . . . . . . . . . . . . . . . . . 104-117
Dietary calcium intake and osteoporosis in
postmenopausal women living in Sarajevo area
AMILA KAPETANOVI, DIJANA AVDI . . . . . 118-121
Analysis of lipid status, body mass index and waist-hip
ratio in post-menopausal women
LEJLA MEALI, EDHEM HASKOVI . . . . . . 122-126
Does wound infiltration of tramadol reduce
postoperative pain in laparoscopic or open
herniorrhaphy?
REMZIYE SIVACI, EROL EROGLU,
LUTFI YAVUZ, FUSUN EROGLU,
YAAR SIVACI . . . . . . . . . . . . . . . . . . . . . . . . 127-131
Smoking and BMI as a risk factor of cardiovascular
disease at a doctors in Tuzla canton
MERISA IMAMOVI-KULUGLI,
FATIMA JUSUPOVI . . . . . . . . . . . . . . . . . . . 132-137
The possible role of tumor antigen CA 15-3, CEA and
ferritin in malignant and benign disease
NAFIJA SERDAREVI,
SAMIRA MEHANOVI . . . . . . . . . . . . . . . . . . 138-143
CASE REPORTS
Minimally invasive treatment of iatrogenic complete left
ureter obstruction after hysterectomy
YIGIT AKIN, ISIL BASARA,
ALISEYDI BOZKURT . . . . . . . . . . . . . . . . . . . 144-147
Lebers hereditary optic neuropathy - case report
MIRJANA A. JANICIJEVIC-PETROVIC,
TATJANA SARENAC VULOVIC, NENAD PETROVIC,
SUNCICA SRECKOVIC, SVETLANA PAUNOVIC,
KATARINA JANICIJEVIC, DEJAN VULOVIC,
DRAGAN VUJIC . . . . . . . . . . . . . . . . . . . . . . . 148-152
Endocarditis lenta-patient survived septic shock: a
case report
AMRA MACI-DANKOVI, NINA BURINA,
MEHMED KULI, SNJEANA MEHANI . . . . 153-158
INSTRUCTIONS TO AUTHORS
Instructions and guidelines to authors for the
preparation and submission of manuscripts
in the Journal of Health Sciences . . . . . . . . . . 159-162
www.jhsci.ba
Editorial
99
www.jhsci.ba
Abstract
Introduction: Cerebrovascular insult (CVI) is acute or sub-acute occurrence of symptoms which signal death
of cerebral cells caused by localized disruption of arterial circulation in the brain. The goal of this study is to
investigate whether ischemic or hemorrhagic CVI can be used as predictor of rehabilitation.
Methods: A retrospective study was conducted in the period from January 2009 to the December 2009 and
as a source of data we used medical records. The study included 89 patients who had CVI and who were
hospitalized at the Clinic for Physical medicine and rehabilitation, Clinical Center University of Sarajevo
(KCUS). We analyzed socio-demographic variables such as gender and age and clinical variables: the diagnosis, the length of stay in hospital (LOH), and Barthel index (BI) at admission and discharge from hospital.
Results: Out of 89 patients, 78/89 (87.6%) were patients with ischemic CVI (group A), and 11/89 (12.4%)
with hemorrhagic CVI (group B). There was not a significant association between the gender and type of CVI
[(2(1)= .041, P> .05]. There was a statistically significant difference in median of length of hospitalization
(LOH) between two groups (U=186.5; z=-3,025; P= .002). There was not a statistically significant difference
in median of BI at admission (U=317.0; z=-1,399; P= .162) and discharge (U=319.0; z=-1.374; P= .169)
between two groups.
Conclusion: Patients with hemorrhagic CVI have a longer stay in hospital and consequently more expensive
cost of treatment.
2012 All rights reserved
Keywords: cerebrovascular insult (CVI), etiology, rehabilitation, length of stay in hospital (LOH)
Introduction
Cerebrovascular insult (CVI) is acute or subacute occurrence of symptoms caused by localized occlusion in arterial circulation in the brain
(1). Acute form of this disease is marked as stroke,
apoplexy or brain attack. It is the third cause of illness and mortality as well as leading cause of disability in the world (1, 2). Etiological classification
explains the causes that led to this condition, and
the most common causes are vascular lesions in
the brain that can generally be divided to hemorrhagic lesions and ischemic CVI which can be
consequence of embolism and thrombosis (1, 3).
Sequelae of CVI are: clinical paralysis affect* Corresponding author: Edina Tanovic,
Clinic for Physical medicine and rehabilitation,
Clinical Center Universitiy of Sarajevo,
Bosnia & Herzegovina,
E-mail: tanovicedina@hotmail.com
Submitted: 7 July 2012 / Accepted: 24 August 2012
100
EDINA TANOVI, DAMIR CELIK: ETIOLOGICAL FACTORS AS PREDICTOR OF REHABILITATION IN PATIENTS AFTER CAREBROVASCULAR INSULT
Methods
A retrospective study was conducted in the period
from January 2009 to the December 2009 and as a
source of data we used medical records. The study
included 89 patients who had CVI and who were
Results
hospitalized at the Clinic for Physical medicine Out of 89 patients, 78/89 (87.6%) were paand rehabilitation, Clinical Center University of
tient with ischemic CVI (group A), and 11/89
Sarajevo (KCUS). We analyzed socio-demograph- (12.4%) with hemorrhagic CVI (group B). In
ic variables and clinical variables: the diagnosis, group A, the frequency of males was 40/78
the length of stay in hospital (LOH), and Barthel (51.3%), in group B was 6/11 (54.5%). There
index (BI). The Barthel scale or Barthel ADL index was not a significant association between the
is an ordinal scale used to measure performance in gender and type of CVI [(2(1)= .041, P> .05].
activities of daily living (ADL). Each performance The median age was 66 years (IQR=59 to 73
item is rated on this scale with a given number years) in group A, and 69 years (IQR=64 to
of points assigned to each level or ranking (7). It 74 years) in group B. There was not a statistiuses ten variables describing ADL and mobility. A cally significant difference in median age behigher number is associated with a greater likeli- tween two groups (U=367.0; z=- .774; P=
hood of being able to live at home with a degree of .439). The highest number of patients in both
independence following discharge from hospital. groups was between 60-80 years of age (Fig. 1).
The measuring was performed at admission and In group A, the median of LOH was 32 days
discharge from the KCUS. The inclusion crite- (IQR=23.8 to 40.3 days), in group B was 46 days
ria were: patients aged over 18, patients who had (IQR=39.0 to 69.0 days). There was a statistiCVI followed by neurological deficit, patients who cally significant difference in median of LOH becompleted acute treatment with medications at tween two groups (U=186.5; z=-3,025; P= .002)
Neurological Clinic, patients who started rehabili- (Fig. 2). In group A, the median of BI at admistation at the Clinic for Physical
medicine and rehabilitation not
more than one month after cerebrovascular insult. The exclusion criteria (following the use of
therapeutical possibilities) were:
rapid regression of neurological
symptoms, gastrointestinal or
urinary bleeding within last 21
days, myocardial infarct within
last three months, evidence of
active bleeding, acute trauma or
fracture and patients who died
or transferred to another clinic.
FIGURE 1. Distribution of patients age in both groups
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
101
EDINA TANOVI, DAMIR CELIK: ETIOLOGICAL FACTORS AS PREDICTOR OF REHABILITATION IN PATIENTS AFTER CAREBROVASCULAR INSULT
TABLE 1. Descriptive statistics of patients with CVI who were hospitalized at the Clinic for Physical medicine and rehabilitation,
Clinical Center University of Sarajevo, 2009, (n=89)
Variables
Age (years)
LOH (days)
BI *
BI **
CVI
Min.
Max.
0
1
0
1
0
1
0
1
78
11
78
11
78
11
78
11
38
29
7
19
0
0
2
4
82
78
74
84
20
12
20
17
25-th
59.0
64.0
23.8
39.0
2.0
2.0
8.0
8.0
Percentiles
50-th
66.0
69.0
32.0
46.0
8.0
5.0
14.0
11.0
75-th
73.0
74.0
40.3
69.0
15.0
9.0
18.0
14.0
P-value
.439
.002
.162
.169
0 ischemic; 1 hemorraggic; BI* Brathel index at admission; BI** Barthel index at discharge;
FIGURE 3. Box plot of Barthel index at admission and discharge in both groups (BI* Brathel index at admission; BI**
Barthel index at discharge)
102
EDINA TANOVI, DAMIR CELIK: ETIOLOGICAL FACTORS AS PREDICTOR OF REHABILITATION IN PATIENTS AFTER CAREBROVASCULAR INSULT
References
(1) Kantardi D. Klinika neurologija. Sarajevo: Svjetlost, 2001: 263-73.
(2) Tanovi E. Evaluacija vrijednosti
funkcionalne elektrine stimulacije
u rehabilitaciji hoda kod pacijenata
sa motornom lezijom nakon cerebrovaskularnog inzulta. Magistarski rad. Sarajevo 2002.
(3) Poeck K. Neurologija. Zagreb:
kolska knjiga, 1994: 151-84.
(4) Majki M. Klinika kineziterapija,
Zagreb: Inmedia, 1997: 3-83.
(5) Ferrucci L, Bandinelli S, Guralnik
JM, Lamponi M, Bertini C, Falchini
M, et al. R Recovery of functional
status after stroke. A postrehabilitation follow-up study. Stroke 1993:
24: 200-5.
(6) Randall LB. Physical medicine and
rehabilitation. Philadelphia: W.B.
(10) Volpe BT, Krebs HI, Hogan N, Edelstein L, Diels C, Aisen M. A novel
approach to stroke rehabilitation.
The American Academy of Neurology 2000; 1938-43.
(11) Tanovi E, Tanovi H. Functional
electric stimulation on walking
rehabilitation on patients with
hemiplegia after stroke. NEUROL
CROAT: 2007; 56(Suppl.1): 188-94.
(12) Tanovi E. ET- test a new valorization results of the rehabilitation.Folia Medica 2008;43 (suppl 2): 84-8.
(13) Tanovi E, Tanovi H. A new valorization by ET-test in the rehabilitation after cerebro vascular insult.
Edicioni Minerva Medica: 2010;
269-271.
103
www.jhsci.ba
Abstract
Introduction: The prevalence of diabetes is on the increase and an estimated 239 million people worldwide
are expected to have the condition by the year 2020 (1). Diabetes mellitus (DM) represents a serious health
care challenge. The aim of the study was to evaluate the patient clinical characteristics and risk factors for
long term complications in the endocrine clinic of Hospital Penang, Malaysia.
Methods: Descriptive Prospective cross-sectional study design was chosen. To achieve a power of 0.7 with
alpha set at 0.05, 186 subjects were required for the study but researcher increase the sample to 297 in case
of drop out. Self-developed data collection form was used to collect the patient information.
Results: 297 (100%) patients were enrolled from OPD diabetic clinic of Hospital Palau Pinang. Among the
sample 150 (50.5%) were males and rest 147 (49.5%) females. Malay males mean weight at the time of diagnosis significantly higher (p<0.001,) as compared to other ethnics, same results found among Malay females
(p<0.001). Findings suggested increased number of risk factors among the study population. Finding also
showed that hypertension found among all the classes of diagnosis. Significant variable are diagnosis class
and medication consideration.
Conclusion of the study suggested that majority of patients are at high risk of long-term complications and
comorbidies. It has been found that increased rate of risk factors have been found among the study population and non-significant to sociodemographic differences.
2012 All rights reserved
Keywords: diabetes mellitus, risk factors, long term complications, endocrine clinic, clinical health.
Introduction
The prevalence of diabetes is on the increase and
an estimated 239 million people worldwide are
expected to have the condition by the year 2020
(1). Diabetes mellitus (DM) represents a serious
health care challenge. It is a heterogeneous disorder characterized by varying degrees of insulin resistance and insulin deficiency, which leads to disturbances in glucose homeostasis. It is commonly
associates with prolonged ill health and premature
death (2). The mortality rate in patients with DM
* Corresponding author: Syed Wasif Gillani
School of Pharmaceutical Sciences, Universiti Sains
Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
Phone: +60174203027; Fax: +604-6570017
e-mail: wasifgillani@gmail.com
Submitted: 13 May 2012 / Accepted: 23 July 2012
104
may be up to eleven times higher than in persons without the disease (3, 4). DM is the leading
cause of blindness, renal failure and foot and leg
amputations in adults in developed countries (1).
The World Health Organization (WHO) classification system of DM recognized two major
forms of diabetes (5); Type 1 diabetes mellitus
(DM), formerly known as insulin dependent diabetes mellitus (IDDM; patient is dependent on
exogenous insulin for survival) and Type 2 DM,
formerly known as non-insulin dependent diabetes mellitus (NIDDM; patient is not necessary
dependent on exogenous insulin for survival).
Teamwork and collaboration are essential components of successful DM management, both to
prevent complications and maintain the patients
health-related quality of life (HRQOL) over a
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
Methods
Study design
This study aimed to describe the risk factors and
association among sociodemographics, hence
Descriptive Prospective cross-sectional study design was chosen. Managing diabetes is a lifelong
process and requires total commitment from individuals with diabetes. Hence the framework of
this study was based on the principle of eight risk
factors (RF). RF1-Diabetes, RF2- Hypertension,
RF3- Hyperlipidemia, RF4- Smoking, RF5-Male >
45years, RF6=Female > 55years, RF7- Hypoglycemia, RF8- No exercise (3x/week > 20min). RF1Diabetes, since all the patients are from endocrine
clinic so the rational effect of this variable is 100%.
Setting
As 70% of people with diabetes in Malaysia receive treatment in the government healthcare
system, (21) data was collected from government healthcare settings. The general hospital
is the main government hospital in the Penang
state and is situated within the city area offering tertiary care. Subjects were not recruited
from private clinics and hospitals due to problems with accessibility and differences in socioeconomic status which could bias the outcomes.
Sample Size
The required sample size was calculated with
power analysis using the procedure provided by
the Polit and Hungler (22). The power was set at
0.80 with alpha being set at 0.05. Since the value
of the effect size (Gamma), was unavailable from
previous similar studies and the pilot study sample size was small (19 subjects), the investigator
chose to use the conversion based on the effect
size convention table in Polit and Hungler (22).
Polit and Hungler (22) advise to use medium effect size ranging from 0.2-0.3 for nursing studies.
This provided a range of sample size from 88-197
subjects. For logistical reasons the study had to
be a manageable size within the period of study,
so the investigator chose the sample size using
the medium effect size of Gamma y = 0.25. To
achieve a power of 0.7 with alpha set at 0.05, 186
subjects were required for the study but researcher increase the sample to 297 in case of drop out.
105
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
Inclusion criteria. Subjects who met the following criteria were recruited: non-pregnant adults
with either Type1 or Type 2 diabetes regardless
of gender and ethnicity, 18 years and above (legal
age for consent), diagnosed with diabetes with
year of more, speaking and understanding either
English, Bahasa Malaysia, Mandarin, Chinese
dialects (Cantonese, Hokkien, Teow-chew) because these were the languages used during the
interview, having poor diabetes control during the
last one year. Even though glycated haemoglobin
(HbA1c) is the gold standard for glycaemic assessment, it was not consistently measured for all
diabetic patients in the healthcare system where
the study was done. Therefore for the purpose of
this study, poor diabetes control was defined as
the mean of minimum of three fasting blood glucose (FBG) readings of more than 7 mmol/L in
the last year. Prior studies have shown that FBG of
more than 7 mmol/L is associated with increased
micro-and macro-vascular complications (23-26).
Exclusion criteria. The following subjects were excluded: Were adults 18 years of age and more with
either Type 1 of Type 2 diabetes unable to answer
the questionnaires independently, such as having
unstable medical condition, mental illness, and senility or hearing impairment. This was to avoid assistance from family members to cares that could
introduce bias in the data collection; had poor vision and unable to assess visually the portion sizes
of their carbohydrate food intake during dietary
assessment; were women who were pregnant or
had gestational diabetes due to different criteria on
standard of control; had record of random blood
glucose only because the definition of poor control was based on fasting blood glucose readings.
Research Tool
Self-developed data collection form was used to
collect the patient information.
Ethical issues
The Research Ethics Committee of hospital and the Malaysian Medical Research
and Ethics Committee approved the study.
Written consents which included information to
access the subjects medical records were taken
from all participants before the interviews. For
those who were illiterate and not able to give
106
F (%)
150 (50.5)
147 (49.5)
297 (100.0)
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
Female
Total
Ethnic
Malay
Chinese
Indian
Total
Malay
Chinese
Indian
Total
Malay
Chinese
Indian
Total
Mean
53.20
62.10
55.03
58.23
54.03
63.43
58.30
59.04
53.61
62.75
56.53
58.64
N (%)
Std. Deviation
40 (26.7)
12.831
77 (51.3)
8.612
33 (22)
9.600
150 (50.5)
10.771
36 (24.49)
8.013
81 (55.10)
11.090
30 (20.41)
9.063
147 (49.5)
10.414
76 (25.59)
10.627
158 (53.20)
9.959
63 (21.21)
9.422
297 (100.0)
10.581
Female
Total
Ethnic
Malay
Chinese
Indian
Total
Malay
Chinese
Indian
Total
Malay
Chinese
Indian
Total
Mean
79.17
66.64
69.19
70.34
69.38
60.53
59.95
62.37
74.74
63.31
64.96
66.29
N (%)
Std. Deviation
40 (26.67)
18.936
77 (51.33)
13.003
33 (22)
11.314
150 (50.5)
15.185
36 (24.49)
14.896
81 (55.10)
12.766
30 (20.41)
11.069
147 (49.5)
13.382
76 (25.59)
17.761
158 (53.20)
13.184
63 (21.21)
12.019
297 (100.0)
14.815
Yes
N (%)
No
N (%)
Total N
(%)
pvalue
88 (58.7)
93 (63.2)
44 (57.9)
102 (65.4)
36 (55.4)
32 (42.1) 76 (100.0)
54 (34.6) 156 (100.0) 0.296*
29 (44.6) 65 (100.0)
3 (100.0)
3 (100.0)
8 (9.0)
81 (91.0) 89 (100.0) 0.000*
101 (100.0) 101 (100.0)
69 (66.3)
3 (50.0)
1 6 (66.7)
4 (22.2)
156 (63.4)
2 (66.7)
3 (50.0)
8 (33.3)
14 (77.8)
90 (36.6)
1 (33.3)
6 (100.0)
24 (100.0) 0.013*
18 (100.0)
246 (100.0)
3 (100.0)
Chi-square (*Pearson)
FIGURE 1. Clinical risk factors founds among enrolled patients. (RF1 = Diabetes, RF2 = Hypertension, RF3 = Hyperlipidemia,
RF4 = Smoking, RF5 = Male >45years, RF6=Female>55years, RF7 = Hypoglycemia, RF8 = No exercise (3x/week>20min)).
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
107
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
RF3-hyperlipidemia
Yes N (%) No N (%)
Total N
(%)
pvalue
RF4-Smoking
Yes N (%) No N (%)
Total
N (%)
pvalue
Gender
Male
Female
43 (28.7)
52 (35.4)
Gender
Male
Female
28 (18.7)
4 (2.7)
Ethnic
Malay
Chinese
Indian
20 (26.3)
55 (35.2)
20 (30.8)
56 (73.7) 76 (100.0)
101 (64.8) 156 (100.0) 0.258
45 (69 .2) 65 (100.0)
Ethnic
Malay
Chinese
Indian
6 (8.0)
13 (8.3)
12 (18.5)
70 (92.0) 76 (100.0)
143 (91.7) 156 (100.0) 0.441*
53 (81.5) 65 (100.0)
1 (33.3)
2 (2.2)
4 (4.0)
2 (66.7)
87 (97.8)
97 (96.0)
3 (100.0)
89 (100.0) 0.000*
101 (100.0)
1 (33.3)
8 (9.0)
8 (7.9)
2 (66.7)
81 (91.0)
93 (92.1)
3 (100.0)
89 (100.0) 0.096*
101 (100.0)
88 (84.6)
16 (15.4)
104 (100.0)
Diagnosis
IDDM
Diabetes
Diabetes and HPT
Diabetes and other
complication
13 (12.5)
91 (87.5)
104 (100.0)
6 (100.0)
24 (100.0)
18 (100.0) 0.274*
246 (100.0)
3 (100.0)
Medication
consideration
Insulin
Insulin and oral
BIDS
Oral
Diet and exercise
1 (16.7)
3 (12.5)
1 (5.5)
20 (8.1)
-
5 (83.3)
21 (87.5)
17 (94.5)
226 (91.9)
3 (100.0)
6 (100.0)
24 (100.0) 0.552*
18 (100.0)
246 (100.0)
3 (100.0)
Diagnosis
IDDM
Diabetes
Diabetes and HPT
Diabetes and other
complication
Medication
consideration
Insulin
Insulin and oral
BIDS
Oral
Diet and exercise
3 (50.0)
6 (25.0)
3 (16.7)
83 (33.7)
-
3 (50.0)
18 (75.0)
15 (83.3)
163 (66.3)
3 (100.0)
Chi-square (*Pearson)
108
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
N (%)
p-value
27 (23.7)
65 (57.0)
22 (19.3)
0.000
Diagnosis
IDDM
Diabetes
Diabetes and HPT
Diabetes and other complication
1 (0.9)
27 (23.7)
43 (37.7)
43 (37.7)
Medication consideration
Insulin
Insulin and oral
BIDS
Oral
Diet and exercise
1 (0.9)
12 (10.5)
5 (4.4)
94 (82.5)
2 (1.7)
0.000
0.000
RF4-Hypoglycaemia
N (%)
p-value
16 (17.8)
58 (64.4)
16 (17.8)
0.000
Diagnosis
IDDM
Diabetes
Diabetes and HPT
Diabetes and other complication
1 (11.1)
15 (16.7)
32 (35.5)
42 (46.7)
Medication consideration
Insulin
Insulin and oral
BIDS
Oral
Diet and exercise
3 (33.3)
6 (6.7)
1 (1.1)
79 (87.8)
1 (1.1)
0.000
0.000
RF8-No Exercise
(3x/week>20 min)
Gender
Male
Female
14 (9.3)
8 (5.4)
Gender
Male
Female
41 (27.3)
38 (25.9)
Ethnic
Malay
Chinese
Indian
7 (9.2)
7 (4.5)
8 (12.3)
69 (90.8) 76 (100.0)
149 (95.5) 156 (100.0) 0.317
57 (87.7) 65 (100.0)
Ethnic
Malay
Chinese
Indian
21 (27.6)
38 (24.4)
18 (27.7)
55 (72.4) 76 (100.0)
118 (75.6) 156 (100.0) 0.032
47 (72.3) 65 (100.0)
2 (66.7)
9 (10.1)
7 (6.9)
1 (33.3)
80 (89.9)
94 (93.1)
33 (37.1)
18 (17.8)
3 (100.0)
56 (62.9)
83 (82.2)
3 (100.0)
89 (100.0) 0.001*
101 (100.0)
4 (3.8)
Diagnosis
IDDM
Diabetes
Diabetes and HPT
Diabetes and other
complication
27 (26.0)
77 (74.0)
104 (100.0)
4 (66.7)
20 (83.3)
17 (94.4)
233 (94.7)
3 (100.0)
Medication
consideration
Insulin
Insulin and oral
BIDS
Oral
Diet and exercise
3 (50.0)
4 (16.7)
4 (22.2)
63 (25.6)
-
3 (50.0)
20 (83.3)
14 (77.8)
183 (74.4)
3 (100.0)
6 (100.0)
24 (100.0)
18 (100.0) 0.037*
246 (100.0)
3 (100.0)
Diagnosis
IDDM
Diabetes
Diabetes and HPT
Diabetes and other
complication
Medication
consideration
Insulin
Insulin and oral
BIDS
Oral
Diet and exercise
2 (33.3)
4 (16.7)
1 (5.6)
13 (5.3)
-
3 (100.0)
89 (100.0) 0.016*
101 (100.0)
6 (100.0)
24 (100.0)
18 (100.0) 0.033*
246 (100.0)
3 (100.0)
109
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
Discussion
The World Health Organization projects that by
the year 2025 more than 5% of the world population, i.e. 300 million people will suffer from diabetes. A patient who suffers from type 2 diabetes has
a 24 times greater risk of death from cardiovascular causes than the patient without diabetes (27).
The most Hypertension and Diabetes 83 common
cause of dying in the diabetic patient is heart disease. In addition, peripheral vascular disease, endstage renal disease, blindness and amputations
are common co-morbidities in diabetic patients.
Hypertension has been identified as a major risk
factor for the development of diabetes. Patients
with hypertension are at a 23 times higher risk
of developing diabetes than patients with normal
blood pressure (28). Hypertension by itself is, of
course, a powerful risk factor for cardiovascular
morbidity and mortality as established by data
from the Framingham cohort more than three
decades ago. For any given level of systolic blood
pressure, the occurrence of diabetes distinctly
increases cardiovascular mortality. Stamler et
al. (29) have documented that diabetes in the
normotensive patient confers greater risk than a
systolic blood pressure between 160 and 170mm
Hg. This observation provoked Haffner and Cassells (30) observation that the prognosis of diabetes is just as grim as the one of a patient who
has suffered an acute myocardial infarction. Of
note, while this is true for overall cardiovascular mortality, it does not necessarily mean that
diabetes and hypertension are synonymous in
affecting the individual components of cardiovascular system. Also, it does by no means follow that specific cardiovasculardrugs are equally
protective in diabetes and coronary artery disease.
Blood pressure control remains unacceptably low
in the general population, but is even lower in the
diabetic hypertensive patient (31). Although con-
110
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
dl (50). However, in the U.K. Prospective Diabetes Study, despite a high frequency of modestly elevated baseline triglyceride levels (mean baseline
159 mg/dl), a multivariate analysis showed that
triglyceride levels did not predict CHD events.
LDL cholesterol was the strongest independent
predictor of CHD followed by HDL cholesterol,
(51) supporting current national guidelines in
which LDL lowering is the primary lipid target.
Diabetes management
Improving glycemic control in individuals with
moderate to severe hyperglycemia regardless of
type of treatment is associated with improvement
in lipid values. Among the available oral therapeutic options for type 2 diabetes, treatment with
metformin and thiazolidinediones has been associated with beneficial effects on lipids. Metformin has been associated with modest reduction
in triglyceride levels in hyperlipidemic and hypertensive patients (52). In a head-to-head comparison study, (53) pioglitazone was associated with
significant triglyceride reduction, whereas there
was no net triglyceride change with rosiglitazone.
Although both agents increased HDL cholesterol
and LDL cholesterol, pioglitazone was associated
with a greater increase in HDL cholesterol and
less LDL cholesterol increase than rosiglitazone.
Smoking
Smokers with Type 1 and Type 2 diabetes are at increased risk of illness and premature death, mostly
through development of cardiovascular disease,
but other disease processes associated with diabetes may also be made worse by smoking (5455). Smokers with Type 1 diabetes in particular
may have a higher risk of developing kidney disease, and possibly eye and nerve damage as well,
whereas smokers with Type 2 diabetes are more
likely to increase their risk of coronary heart disease, stroke and peripheral vascular disease (56).
Evidence is also accumulating that shows that
smoking is associated with an elevated risk of developing Type 2 diabetes (57-62). A major review
and meta-analysis of published data has found
that current smokers are more likely to develop
diabetes than ex-smokers and never smokers, and
that smokers of 20 or more cigarettes a day are
at greater risk than lighter smokers (63). Overall,
112
current smokers are estimated to have a 44% greater risk, and ex-smokers a 23% greater risk of developing Type 2 diabetes than people who have never
smoked (63). Plausible biological mechanisms for
this association include increased insulin resistance, altered insulin secretion and other impairments to pancreatic function noted in smokers
(63). According to the authors of this review, 'the
relevant question should no longer be whether
this association exists, but rather whether this established association is causal.'(63 p2660) If further research proves a causal relationship between
smoking and Type 2 diabetes, it can be expected
to have a major impact on future estimates of tobacco-caused morbidity and mortality in Australia and globally. Smokers experience a poorer level
of overall general health than non-smokers (64).
Taking into account possible confounding factors
such as alcohol use, socioeconomic background,
age and gender, smokers also report higher levels of tiredness or fatigue, reduced wellbeing and
satisfaction with life, slightly lower self-reported
measures of mental wellbeing, and increased incidence of psychological symptoms such as depressed mood and anxiety. In the elderly, smoking is associated with accelerated declines in
physical function, and increased levels of clinical
illness and physical and cognitive impairment
(64). Smokers are also more likely to report a
history of pain during health examinations (65).
It is understood that the circulation throughout
the body of toxic constituents of tobacco smoke
causes a number of diseases of many organs, as
detailed in the preceding sections. The widespread
distribution of tobacco smoke components may
also be responsible for a more general decrement
in health, through altered inflammatory/immune
processes, oxidative stress and subclinical organ
injury (64). Smokers are also more likely to experience sleep disturbances, including taking longer to
fall asleep, being less likely to stay asleep, and having less total sleep time than non-smokers (66-67).
Smoking and absence from work due to illness.
Smokers are more likely to miss work due to illhealth, have longer duration of absence from work,
and access all levels of medical care more frequently. Work absences are reportedly higher in smokers resulting from a broad range of symptoms,
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
unresponsive to external stimuli and may need assistance breathing and ingesting nutrients. Comas
may last between a few hours to several months.
Treating the hypoglycemic disorder usually
brings the patient back to a conscious state (71).
Death
Without sugar, or glucose, the body is unable to
function. Glucose provides much of the energy
the body needs to survive. As blood sugar levels
fall, multiple organs, especially the brain, begin
to fail, warns MayoClinic (71). If left untreated, this condition may lead to death. Patients
must recognize the early signs of hypoglycemia in order to avoid this dreaded outcome (72).
Physical Activity
The possible benefits of physical activity for the
patient with type 2 diabetes are substantial, and
recent studies strengthen the importance of longterm physical activity programs for the treatment
and prevention of this common metabolic abnormality and its complications. Specific metabolic effects can be highlighted as follows (73).
Glycemic control several long-term studies have
demonstrated a consistent beneficial effect of
regular physical activity training on carbohydrate
metabolism and insulin sensitivity, which can
be maintained for at least 5 years (74-75). These
studies used physical activity regimens at an
intensity of 5080% Vo2max three to four
times a week for 3060 min a session (74).
Improvements in HbA1c were generally 1020%
of baseline and were most marked in patients with
mild type 2 diabetes and in those who are likely
to be the most insulin resistant (76). It remains
true, unfortunately, that most of these studies suffer from inadequate randomization and controls,
and are confounded by associated lifestyle changes
(77). Data on the effects of resistance exercise are
not available for type 2 diabetes although early
results in normal individuals and patients with
type 1 disease suggest a beneficial effect (73, 75).
It now appears that long-term programs of regular physical activity are indeed feasible for patients with impaired glucose tolerance or uncomplicated type 2 diabetes with acceptable
adherence rates (79). Those studies with the
best adherence have used an initial period of su113
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
SYED WASIF GILLANI ET AL.: RISK FACTORS FOR LONG TERM COMPLICATIONS AMONG
PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
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PATIENTS OF ENDOCRINE CLINIC IN HOSPITAL PENANG, MALAYSIA
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117
www.jhsci.ba
Abstract
Introduction: Osteoporosis is a multifactorial polygenetic disease of which the genetic determinants are
modulated by hormonal, environmental and nutritional factors. Identification of the risk factors for osteoporosis related to nutrition is important in the prevention and treatment of this disease, considering that these
factors can be modified. The aim of this study was to examine influence of dietary calcium intake on bone
mineral density in postmenopausal women who hadnt a deficit of estrogen in their menstrual history.
Methods: A total of 100 postmenopausal women living in Sarajevo area, aged 50-65 years, without estrogen
deficiency in menstrual history were included in the study. Mineral bone density was measured at the lumbar
spine and proximal femur by DualEnergy Xray Absorptiometry using Hologic QDR-4000 scanner. Examination and control group were formed based on mineral bone density values. The women in the examination
group had osteoporosis. The women in the control group had osteopenia or normal mineral bone density.
Estimates of daily dietary calcium intake were performed based on a Food Frequency Questionnaire.
Results: The average daily intake of dietary calcium among women who had osteoporosis was 967.32 mg,
and in women who hadnt osteoporosis 1195.12 mg. The difference between two groups was statistically significant (p<0.001). There was registered significant correlation between intake of dietary calcium and mineral
bone density in examination (p<0.01) and in control group (p<0.01).
Conclusion: The results of this study have shown that adequate daily intake of dietary calcium in postmenopausal women aged 50-65 years living in Sarajevo area, which hadnt estrogen deficiency in their menstrual
history (in the group of women without osteoporosis amounted to 1195.12 mg) has a positive impact on bone
mineral density.
2012 All rights reserved
Keywords: dietary calcium intake, osteoporosis
Introduction
Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural
deterioration of bone tissue with a consequent
increase in bone fragility and higher fracture risk
(1). It is considered a multifactorial polygenetic
disease of which the genetic determinants are
modulated by hormonal, environmental and nutritional factors (2). Postmenopausal osteoporosis is related to the loss of gonadal function. The
* Corresponding author: Amila Kapetanovi
Medical Rehabilitation Center Fojnica,
Fojnica, Bosnia and Herzegovina
E-mail: nermin1a@bih.net.ba
Tel: +387 30 838 800; Fax: +387 30 838 848
Submitted: 10 July 2012 / Accepted: 20 August 2012.
118
AMILA KAPETANOVI, DIJANA AVDI: DIETARY CALCIUM INTAKE AND OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN LIVING IN SARAJEVO AREA
tures, in contrast to some populations (Scandinavian countries) where average calcium intakes are
high, have a high incidence of osteoporosis (5, 6).
The recommendations for calcium intake vary
widely among regional agencies. Variability in
calcium intake recommendations can be explained partly by the discrepant results obtained
in observational and interventional studies (7).
Identification of the risk factors for osteoporosis
that are related to nutrition is important in the prevention and treatment of this disease, considering
that these are factors that can be modified. In addition to differences in the incidence of osteoporosis
and osteoporotic fractures among racial groups,
differences within the same race have also been determined as well as differences in conjunction with
age and gender (8-13). Therefore, the importance
of conducting research on osteoporosis within
certain population groups has been confirmed.
The aim of this study was to examine influence
of dietary calcium intake on bone mineral density in postmenopausal women who hadnt a
deficit of estrogen in their menstrual history.
Methods
A total of 100 postmenopausal women living in
Sarajevo area (Sarajevo Canton), aged 50-65 years,
without estrogen deficiency in menstrual history
were included in the study. Examination and control group were formed based on mineral bone density values. The women in the examination group
had osteoporosis. The women in the control group
had osteopenia or normal mineral bone density.
Mineral bone density was measured at the lumbar
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
Results
The average age of women without estrogen deficiency in their menstrual history, in the examination group was 58.64 years, and in the control group
was 57.9 years. There was no statistically significant
differences between these two groups, t = 0.746.
Average daily intake of dietary calcium among
women without estrogen deficiency in menstrual history was, in the examination group
967.32 mg, and in the control group 1195.12
mg. The difference in the average daily intake of dietary calcium between the two
groups was statistically significant, p < 0.001
The coefficient of linear correlation between
T scores and daily intake of dietary calcium
among women without estrogen deficiency
in menstrual history in the examined group
was statistically significant, r = 0.677, p < 0.01.
The coefficient of linear correlation between
T scores and daily intake of dietary calcium
among women without estrogen deficiency
in menstrual history in the control group was
statistically significant, r = 0.615, p < 0.01.
119
AMILA KAPETANOVI, DIJANA AVDI: DIETARY CALCIUM INTAKE AND OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN LIVING IN SARAJEVO AREA
Examination group
Control group
r = 0.677
p < 0.01
r = 0.615
p < 0.01
Discussion
The female reproductive system plays a major role
in regulating the acquisition and loss of bone by the
skeleton from menarche through senescence (14).
Estrogen deficiency (e.g., after menopause) increases the rate of remodeling and the volume of
bone that is resorbed and decreases the volume of
bone that is formed resulting in bone loss and structural decay after menopause (15). Kapetanovi
et al. found a significant association between
menstrual factors (years between menarche and
menopause, years since menopause) and bone
mass loss in Bosnian postmenopausal women (16).
Research results regarding the effect of calcium
intake on bone mineral density and on the risk of
bone fractures are not consistent. Park et al. found
in their research that a high intake of dietary calcium, especially calcium from plant foods reduces
the risk of osteoporosis and increase bone mineral
density in Korean postmenopausal women (17).
Napoli et al. studied the importance of sources of
calcium intake on estrogen metabolism and bone
mineral density in healthy postmenopausal women of white race. Intake of calcium form dietary
sources was associated with higher bone mineral
density than suplement calcium intake. The authors concluded that calcium from dietary sources
may produce more favorable effects in bone health
in postmenopausal women than will calcium from
supplements (18). Ilic et al. have shown that there is
significant correlation between bone mineral density in healthy Caucasian postmenopausal women
and certain nutrients including calcium (19).
Although the antifracture effect of calcium alone
120
AMILA KAPETANOVI, DIJANA AVDI: DIETARY CALCIUM INTAKE AND OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN LIVING IN SARAJEVO AREA
References
(1) World Health organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a
WHO Study Group. WHO Technical Report Series 843; 1994.
(2) Gennari L, Merlotti D, De Paola V,
Calabro A, Becherini L, Martini G,
et al. Estrogen receptor gene polymorphisms and the genetics of osteoporosis: a HuGE review. Am J
Epidemiol. 2005;161(4):307-20.
(3) Delaney MF. Strategies for prevention and treatment of osteoporosis during early postmenopause.
Am J Obstet Gynecol, 2006;194(2
Suppl):S12-23
(4) McClung MR. The menopause and
HRT. Prevention and management
of osteoporosis. Best Pract Res Clin
Endocrinol Metab, 2003;17(1):5371
(5) Gueldner SH, Grabo TN, Newman
ED, Cooper DR. Osteoporosis
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(8) Barrett-Connor E, Siris ES, Wehren
LE, Miller PD, Abbott TA, Berger
ML, et al. Osteoporosis and fracture risk in women of different
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(9) Kanis JA, Johnell O, De Leat C,
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(11) Nelson HD, Morris CD, Kraemer
DF, et al. Osteoporosis in postmenopausal women: diagnosis
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Rockville, MD: Agency for Healthcare Research and Quality. January
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(12) Looker AC, Orwoll ES, Johnston
CC, Jr., Lindsay RL, Wahner HW,
Dunn WL, et al. Prevalence of low
femoral bone density in older U.S.
adults from NHANES III. J Bone
Miner Res. 1997;12(11):1761-8.
(13) Looker AC, Melton LJ 3rd, Harris TB, Borrud LG, Shepherd JA.
Prevalence and trends in low femur bone density among older US
adults: NHANES 2005-2006 compared with NHANES III. J Bone
Miner Res. 2010;25(1):64-71.
(14) Clarke BL, Khosla S. Female reproductive system and bone. Arch Biochem Biophys. 2010;503(1):118-28.
(15) Seeman E, Delmas PD. Bone quality--the material and structural basis of bone strength and fragility. N
Engl J Med. 2006;354(21):2250-61.
121
www.jhsci.ba
Abstract
Introduction: Menopause is the absence of menses in the period longer that one year. It is widely accepted
that menopause leads to changes in hormonal status, metabolism and lipid profile. The aim of this study was
to analyze the influence of menopause on the concentrations of lipids, lipoproteins and also the influence of
body mass index (BMI) and waist-hip ratio (WHR) on lipid profile in post-menopausal women.
Methods: Sixty post-menopausal women of average age of 52.82 years were compared to a group of 34
pre-menopausal women average age of 47.92 years.
Results: Post-menopausal women had higher, but non significant (p>0.05) concentrations of total cholesterol, very low density lipoproteins (VLDL), low density lipoproteins (LDL) and triglycerides than pre-menopausal women. The concentration of high density lipoproteins (HDL) was significantly lower in post-menopausal
women than pre-menopausal (p<0.05). The concentration of apolipoprotein B was also significantly higher
in post-menopausal women (p<0.05), but the concentrations of apolipoprotein and lipoprotein (a) were lower
but without significance (p>0.05). There was no difference between body mass index (BMI) and waste-hip
ratio (WHR), but the WHR has shown as a significant predictor of the LDL and cholesterol concentrations in
post-menopausal women.
Conclusion: We can conclude that menopause leads to changes in lipid profile by lowering of HDL and
increasing the levels of apolipoprotein B, that increases the risk for cardiovascular disease. The WHR is the
significant predictor of cardiovascular risk in post-menopausal women.
2012 All rights reserved
Keywords: menopause, lipid status
Introduction
Menopause is cessation of menstruation in a period longer than one year, and begins with changes
in ovarian function. After menopause, changes in
lipid profile of a woman occur, but not all of those
mechanisms have been explained. One of the important factors in that mechanism is change in adipose tissue distribution. Higher levels of cholesterol, triglycerides, LDL, apolipoprotein B and lower
levels of HDL and apolipoprotein A are characteristic in menopause. The increase of LDL level
is not the only indicator; the composition of LDL
molecules also changes. Participation of low density lipoproteins in menopause rises for 30-40% (1).
* Corresponding author: Lejla Meali, Women and pregnant
women health protection service Health center Tuzla
Albina Herljevia 1, 75000 Tuzla, Bosnia and Herzegovina
Phone: +38761 146 698; Fax: +38735 282 161;
E-mail: lejlamesalic@yahoo.com
Submitted: 15 May 2012 / Accepted: 1 August 2012
122
During menopause, concentration of triglycerides also increases, which is linked to abdominal fat amount increase and insulin resistance.
Menopause causes decrease of HDL concetration
and also changes in HDL structure. The concentration of HDL2 decreases and concentration
of HDL3 increases. HDL concentration is in inverse proportion with level of abdominal fat (2).
Adipose tissue is not just a passive depot of fat
which contains energetic balance and termoregulation, but is also an important endocrine
organ (3). According to contemporary knowledge, adipose tissue cells adipociytes are
multiplying and proliferating during lifetime.
Aside from having different kinds of receptors
and participating in processes of lipogenesis and
lipolysis, adipocytes have high levels of P 450
aromatase enzyme and 17--hydroxysteroid
dehydrogenase, which catalyze processes of
aromatization of androgens into estrogens.
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
LEJLA MEALI, EDHEM HASKOVI: ANALYSIS OF LIPID STATUS, BODY MASS INDEX AND WAIST-HIP RATIO IN POST-MENOPAUSAL WOMEN
LEJLA MEALI, EDHEM HASKOVI: ANALYSIS OF LIPID STATUS, BODY MASS INDEX AND WAIST-HIP RATIO IN POST-MENOPAUSAL WOMEN
pausal women , but the difference isnt statistically important (p>0.05). Apolipoprotein
B concentration was significantly higher in
post-menopausal women (p=0.003). Lp(a) concentration in post-menopausal women was
higher than in pre-menopausal women, but statistical difference was not significant (p>0.05).
In group of post-menopausal women BMI
values were 2.55 0.38, and in group of premenopausal women 2.47 0.30, which wasnt
statistically significant difference (p>0.05).
15 women (25%) in menopause had a BMI from
25 to 29.9kg/m2 (which reflects increased risk of
cardiovascular diseases) and 4 women (6.67%)
had BMI from 30 to 34.9 kg/m2 (high risk of cardiovascular diseases). In group of pre-menopausal
women , 11 women (18.33%) had BMI from 25 to
29.9kg/m2. Different adipose tissue distribution
and centripetal weight gaining are characteristic
somatic changes in menopause and are recognized
risk of cardiovascular diseases in women (11).
WHR in post-menopausal women was 0,78
0,05, while in pre-menopausal women it was
0,81 0,07, so there wasnt a significant difference between the groups (p>0,05). In the group
of women in menopause, 2 (3,33%) had WHR
bigger than 0,85 and in the group of women with
regular menstruation, 4 (6,66%) women. Sultan
and associates stated that WHR can be used as
screening for identification of postmenopause
women with increased cardiovascular risk (14).
There wasnt a significant correlation between BMI
and lipid and lipoprotein concentration, as well
as apoilipoprotein and Lp(a), while there was a
Cholesterol
Triglyceride
LDL
HDL
VLDL
POST-MENOPAUSE
mmol/L SD
6.08 1.14
1.64 0.68
4.12 1.11
1.44 0.41
0.69 0.68
CONTROL
mmol/L SD
5.99 1.44
1.56 0.74
3.99 1.46
1.69 0.50
0.58 0.39
Apolipoprotein A
Apolipoprotein B
Lp(a)
124
POST-MENOPAUSE
g/L SD
1.52 0.27
1.24 0.33
0.28 0.30
CONTROL
g/L SD
1.61 0.28
1.02 0.17
0.24 0.23
LEJLA MEALI, EDHEM HASKOVI: ANALYSIS OF LIPID STATUS, BODY MASS INDEX AND WAIST-HIP RATIO IN POST-MENOPAUSAL WOMEN
125
LEJLA MEALI, EDHEM HASKOVI: ANALYSIS OF LIPID STATUS, BODY MASS INDEX AND WAIST-HIP RATIO IN POST-MENOPAUSAL WOMEN
References
(1) Carr MC, Kim KH, Zambon A,
Mitchell ES, Woods NF, Casazza CP,
Purnell JQ, Hokanson JE, Brunzell
JD, Schwarz RS. Changes in LDL
density across the menopausal
transition. J Invest Med 2000; 48:
245-250.
(2) Lamarche B,Moorjani S, Cantin B,
Dagenais GR, Lupien PJ, Despers
JP. Association of HDL2 and HDL3
subfractions with ischemic heart
disease in men. Prospective results
from the Qubec cardiovascular
study. Arterioscler Thromb Vasc
Biol 1997; 17: 1098-1105.
(3) Yen SSC, Jaffe RB, Barbieri RL. Reproductive endocrinology. Philadelphia 1999: WB Saunders.
(4) Onat A, Yazici M, Can G, Sniderman A. Evidence for a complex risk
profile in obese postmenopausal
Turkish women with hypertriglyceridemia and elevated apoliptoprotein B. Clin Sci (Lond) 2004; 107(1):
97-104.
(5) Ikenoue N, Wakatsuki A, Okatani
Y. Small low- density lipoprotein
particles in women with natural or
surgically induced menopause. Obste Gynecol 1999; 93(4): 566-570.
126
(12)
(13)
(14)
(15)
www.jhsci.ba
Abstract
Introduction: The laparoscopic approach may be associated with more postoperative pain initially. The aim
of this study was to evaluate the effects of administered tramadol at wound closure on postoperative pain
and analgesic requirements under spinal anesthesia in laparoscopic inguinal herniorrhaphy (LH) or tension
free open inguinal herniorrhaphy (TFOH).
Methods: Twenty patients were randomly divided into two groups (n= 10 in each) as LH or TFOH. Patients
received infiltration of 200 mg tramadol with 40 mL of 0.9% saline solution at wound closure procedure.
Postoperative pain was assessed with a Visual Analog Scale (VAS) at 3, 6, 12, and 24 hours postoperatively.
Additional requirements of tramadol for postoperative pain releif were registered.
Results: VAS scores at postoperative 12 and 24 hours were significantly higher according to 3rd hour VAS
scores in both groups. The VAS scores at 12 hours after operation significantly lower in LH group than in
TFOH group (1.5 0.97 vs 5.1 0.99). Additional requirements of tramadol for postoperative pain releif were
significantly lower in LH group.
Conclusion: We conclude that wound infiltration of 200 mg tramadol reduce postoperative pain in LH group.
2012 All rights reserved
Keywords: laparoscopy herniorrhaphy, postoperative pain, tramadol
Introduction
Pain after laparoscopic surgery may vary in quality
and localization and is reported in several studies
to be incisional, intraabdominal, or referred (1).
The etiology is complex, including damage to abdominal wall structures, the induction of visceral
trauma and inflammation and peritoneal irritation
because of CO2 entrapment beneath the hemi diaphragms. Pain after laparoscopic procedure is significantly less and shorter than that caused by the
same surgical procedure made possible by open
surgery (2). Compared with open procedures, laparoscopic surgery, a minimally invasive technique,
* Corresponding author: Remziye Sivaci, MD.
Dumlupinar Mh. Turabi Cd. Tutuncu Apt.
B Blok NO: 2/1 D:9 03200 AFYON- TURKEY
Tel: + 90 272 2145511; Fax: + 90 272 2158281
E-mail: remziyesivaci@gmail.com
Submitted 18 May 2012 / Accepted 15 July 2012
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
terior aspect of the rectus muscle and the peritoneum. A space-maker balloon trochar apparatus
was then introduced and inflated with isotonic
sodium chloride solution (1000 mL) before deflation. The dissection exposed the hernial defect
and allowed placement of the mesh. At the end of
surgical procedure, Tramadol 200 mg in 40 mL of
0.9% saline was injected to the wound locally by
the surgeon. The patients were placed in a 30o sitting position to keep the injected volume in the
ilioinguinal dependent area of the fascial plane.
Data collected that included to time intervals
(minute) duration of spinal anesthesia (bupivacain injection to loss of sensorial level of L2) and
duration of surgery (incision to end of surgery).
Patients were transferred to the recovery room and
observed by nursing staff and have not received
any other analgesics during the study. Postoperative pain was assessed by using a VAS during unassisted mobilization at 3, 6, 12 and 24 hour after
operation. When VAS value was 3, tramadol was
given intramuscularly for postoperative analgesia
and total amount of tramadol were documented
for each patient. Postoperative complications
included nausea and vomiting were also noted.
Statistical analysis
The results were expressed as mean values standard deviation. Mann-Whitney-U was used to
compare VAS scores and total amounts of tramadol as additional analgesic postoperatively
for each patient between two groups. Friedman
test and Wilcoxon test were used for repeated
and related measures. P values less than 0.05 was
considered as statistically significant. The study
was conducted in accordance with the ethical
standards of the Helsinki Declaration of 1975.
Results
Age, height, weight, duration of anesthesia and
surgery were similar in two groups (Table 1).
VAS scores on postoperative periods in the groups
and levels of statistical significance changes according to 3th hour VAS scores were shown in
Table 2. VAS scores at postoperative 12 and 24
hours were significantly higher in both groups.
The significant is greater in TFOH group. The
VAS scores were reduced significantly in LH
group than in TFOH group at 12 hours after
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
TABLE 1. Patients demographic data and duration of anesthesia and surgery in two groups
Age (yr)
Height (cm)
Weight (kg)
Duration of anesthesia (min)
Duration of surgery (min)
LH (n=10)
49.3 9,8
168.9 7.0
71.2 5.2
80.7 9.1
64.4 8.2
TFOH (n=10)
49.6 8.3
169.1 3.8
75.7 4.9
78.6 9.5
62.6 8.2
TABLE 2. Visual analog scale (VAS) scores on postoperative periods in two groups and levels of statistical significance
changes according to 3th hour VAS scores.
Hours
3
6
12
24
LH (n=10)
TFOH(n=10)
VAS
p
VAS
p
0.8 0.78 (1 [0-2])
1.0 0.94 (1 [0-3])
1.0 0.81 (1 [0-2]) 0.317 1.3 0.67 (1 [0-2]) 0.429
1.5 0.97 (2 [0-3]) 0.020 5.1 0.99 (5 [4-7]) 0.005
5 1.33 (4.5 [3-6]) 0.005 6.4 1.34 (6 [5-9]) 0.005
LH
n
5
5
0
0.001
TFOH
n
0
3
7
62.6 8.2
Never
Nausea
Vomiting
p
LH
n
9
1
0
0.218
TFOH
n
6
1
3
62.6 8.2
130
References
(1) Brooks DC. A prospective comparison of laparoscopic and tensionfree open herniorraphy. Arch Surg.
1994; 129: 361-366.
(2) Alexander JI. Pain after laparoscopy.
Br J Anaesth.1997;79:369-378.
(3) Ger R, Monroe K, Duvivier R,
Mishrick A. Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac.
Am J Surg. 1990;159:370-373.
(4) Naguib M, Attia M, Samarkandi AH. Wound closure tramadol administration has a
short-lived analgesic effect. Can J
Anaesth.2000;47:815-818.
(5) Saff GN, Marks RA, Kuroda M,
Rozan JP, Hertz R. Analgesic effect
of bupivacaine on extraperitoneal
laparoscopic hernia repair. Anesth
Analg. 1998;87:377-381.
(6) Fitzgibbons RJ Jr, Camps J, Cornet
DANguyen NX, Litke BS, Annibali R, Salerno GM. Laparoscopic
inguinal herniorraphy: Results
of a multicenter trial. Ann Surg.
1995;221:3-13.
(7) Joris J, Thiry E, Paris P, Weerts J,
Lamy M. Pain after laparoscopic
cholecystectomy: characteristics
and effect of intraperitoneal bupivacaine. Anesth Analg. 1995;81:379384.
(8) Golianu B, Krane EJ, Galloway KS,
(9)
(10)
(11)
(12)
(13)
(14)
1991;27:7-17.
(15) Cashman JN, Jones RM, Foster JM,
Adams AP. Comparison of infusions of morphine and lysine acetyl
salicylate for the relief of pain after
surgery. Br J Anaesth. 1985;57:255258.
(16) Mkinen MT, Yli-Hankala A.
Respiratory
compliance
during laparoscopic hiatal and inguinal hernia repair. Can J Anaesth.1998;45:865-870.
(17) Chauvin M. State of the art pain
treatment following ambulatuar
surgery. Eur J Anaesthesiol. 2003;20
(28):3-6.
(18) Naguib M, el Gammal M, Elhattab
YS, Seraj M. Midazolam for caudal
analgesia in children: comparison
with caudal bupivacaine. Can J Anaesth. 1995;42:758-764.
(19) Yndgaard S, Holst P, Bjerre-Jepsen
K, Thomsen CB, Struckmann
J, Mogensen T. Subcutaneously
versus subfascially administered
lidocaine in pain treatment after inguinal herniotomy. Anesth
Analg.1994;79:324-327.
(20) Anatol TI, Pitt-Miller P, Holder Y.
Trial of three methods of intraoperative bupivacaine analgesia for pain
after paediatric groin surgery. Can J
Anaesth. 1997;44:1053-1059.
131
www.jhsci.ba
Smoking and BMI as a risk factor of cardiovascular disease at a doctors in Tuzla canton
Merisa Imamovi-Kulugli1*, Fatima Jusupovi2
Health Centre Tuzla, Albina Herljevia 2, 75000 Tuzla, Bosnia and Herzegovina. 2 Faculty of Health Studies, University in
Sarajevu, 71000 Sarajevo, Bosnia and Herzegovina
Abstract
Introduction: Cardiovascular diseases are becoming the leading social and medical problem of civilization,
given the trend indicates an increase of morbidity, disability and mortality from this diseases. The aim of
our study was to determine the frequency of smoking and increased BMI, as a risk factor for cardiovascular
disease in doctors in the Tuzla Canton and correlate values of BMI by the doctor smokers and nonsmokers.
Methods: The study was conducted in 13 medical centers in the area of Tuzla canton in the second quarter
of 2009. Two groups were formed by randomization of 150 doctors non-smokers and 150 doctors smokers
from a total of 366 doctors of both sexes, age over 25 years. The study involved doctors who smoke tobacco
5 or more years. The methods of anthropometric measurements and questionnaires were used in study.
Results: The results showed that the total number of doctors surveyed, 44.81% were smokers, with more
women smokers (28.7%) than men (21.3%) smokers (p=0.011). We found that there is a significant statistical difference between subjects with BMI higher than 25 and subjects with normal weight, in the group of
smokers (p = 0.0001).
Conclusion: It can be concluded that the frequency of smoking in the total number of surveyed doctors, is
significant. The increased value of BMI (over 25) is present in large number of subjects (with the larger percentage subjects of smokers).
2012 All rights reserved
Keywords: smoking, BMI, cardiovaskcular disease.
Introduction
Chronic non-infectious diseases, including the
cardiovascular and cerebrovascular diseases are
the leading cause of morbidity and mortality, in
addition to cancer (1). They are a significant cause
of invalidity, loss of working ability, early death
(before 65 years of age) and increasing health care
costs, especially in countries where a high percentage of the population is represented by older
people (2). For these the trend of increasing morbidity, mortality and invalidity from diseases of
circulatory system, it is clear that these diseases
are becoming major public health problem of civilization. According to the World Health Organization, cardiovascular diseases cause 16.7 million
deaths annually (29% of all deaths), more than one
* Corresponding author: Merisa Imamovi-Kulugli,
Health Centre Tuzla, Albina Herljevia 2, 75000 Tuzla,
Bosnia and Herzegovina; Phone: +38761785549
E-mail: merisa.k@bih.net.ba, fatimajusupovic@yahoo.com
Submitted 2 May 2012 / Accepted 28 June 2012
132
Methods
The research was conducted in 13 health centers
in Tuzla Canton in second quarter of 2009. From
a total of 366 doctors of both sexes, aged over 25
years, method of free chose formed group from
150 doctors smokers and 150 doctors nonsmokers.
In the study involved doctors who smoke tobacco
5 years and over, every day a certain number of
cigarettes (at least 10 cigarettes a day), and excluded doctors who smoke tobacco occasionally,
every second or third day, two to three cigarettes.
The research was a prospective, cross-sectional.
Risk factors were evaluated: smoking and overweight - obesity. It was processed with questionnaire and anthropometric measurements.
Data on risk factors were obtained by the survey. A modified questionnaire referred in part
to general directories, and second part consisted of general information, general relation for smoking, smoking duration, number of cigarettes smoked per day (17, 18).
Body height (cm) was measured by anthropometry,
three times and was calculated as the mean value.
Body weight (kg) was measured by the decimal
scale (100 grams of tolerance), which calibrated before the measurement. The measurement was done
with minimum clothes, three times and calculated
the mean value. Body mass index (BMI) was calculated based on the relation measured body mass
(kg) and body height (cm), as follows: BMI = BW
(kg) / TV (m) 2, whereby as the increased body
weight taken BMI value equal to or greater than
25.0 according to the World Health Organization.
After the survey, made is appropriate encryption
and controls to ensure proper data entry. Data
were entered into the table in Excel, and then
transported into the statistical software package
SPSS17.0. where the after definition of the variables were statistically processed data, and with
the help program Arcus QuickStat completed.
For testing the statistical significance between
groups, we used proportions, Chi square test,
Student's t-test. Statistically significant results we considered those in which the p <0.05.
Results
Of the total number of surveyed doctors
(366) them 202 or 55.19% were non-smokers, and 164 or 44.81% were smokers, a sta133
age group over 65 years (5 or 1.7%). The highest number doctors of smokers in the age group
between 36 and 45, it is 49 or 16.3% of all respondents doctors of smokers, a statistically
significant difference compared to nonsmokers of the same age group (p = 0.0001) (Table 2) .
The mean age of smokers is about 42 (+ -9)
years. The youngest doctor is a smoker aged 25 years and the oldest 73 years.
The total number subjects of smokers largest
number of them is a smoker for 20 years and
TABLE 1. The gender structure of subjects in the sample of
over, in the age group between 46 and 55 years
smokers and nonsmokers
(19 or 12.7%), while at the same age group of 3
or 2% smoked 5 years. Of the total number of
GENDER
smokers, 37 subjects or 24.7% is a smoker 10
Women
Men
Total
years and 33 or 22% is smoke 20 or more years,
Nonsmokers N 90
60
150
% 30.0%
20.0%
50.0%
no statistically significant difference (p = 0.58).
Smokers
N 86
64
150
The total number subjects of smokers most of
% 28.7%
21.3%
50.0%
them women with smoking period of 10 years (30
Total
N 176
124
300
or 20%), and the smallest number of men with
% 58.7%
41.3%
100.0%
smoking period of 10 years (7 or 4.7%), a statistically significant difference (p = 0.0001). Of the
Statistically significant differences by gender in subjects smokers
total number women who smoke 20 or more
(p = 0.011).
years, 19 of them or 12.7% and men
14 or 9.3%, while in the group who
TABLE 2. Age structure in a sample of smokers and nonsmokers
declared to smoked 20 years, women 12 or 8%, while men 19 or 12.7%.
AGE OF SUBJECTS
Th
e total number subjects of smokers
25-35 36-45 46-55 56-65 over 65 No data TOTAL
most
them, in the age group between
Non
N 28
22
53
10
4
33
150
25 and 35 years old, smokes 10 cigasmokers % 9.3% 7.3% 17.7% 3.3% 1.3%
11.0% 50.0%
rettes a day (23 or 15.3%). Of the total
Smokers N 40
49
45
6
1
9
150
number subjects of smokers, them 63
% 13.3% 16.3% 15.0% 2.0% .3%
3.0%
50.0%
or 42% smoked an average of 10 cigaTotal
N 68
71
98
16
5
42
300
% 22.7% 23.7% 32.7% 5.3% 1.7%
14.0% 100.0%
rettes a day and 2 or 1.3% smoked 40 or
more cigarettes a day, which is statistically significant difference (p = 0.0001).
TABLE 3. Distribution of cigarettes smoked per day by sex subjects
A statistically significant difference in
the number subjects who smoked an avwomen men
TOTAL
erage of 10 cigarettes a day (63 or 42%)
not has pleaded N 19
2
21
% 12.7%
1.3%
14.0%
compared to subjects who smoked an av10
N 37
26
63
erage of 40 cigarettes per day (2 or 1.3%)
% 24.7%
17.3%
42.0%
(p = 0.0001), while there was no statisti20
N 28
29
57
cally significant differences among sub% 18.7%
19.3%
38.0%
CIGARETTES
jects who smoked an average of 10 (63 or
PER DAY
40
N 2
5
7
42%) and 20 cigarettes a day (57 or 38%)
% 1.3%
3.3%
4.7%
(p = 0.47). Among subjects who smoke
40 and more
N 0
2
2
an average of 10 cigarettes a day more
% .0%
1.3%
1.3%
is a woman, 37 or 24.7% (men 26 or
TOTAL
N 86
64
150
17.3%), which was significantly higher
% 57.3%
42.7%
100.0%
134
Discussion
Analyzing, in our study, the frequency of smoking and increased BMI values as risk factors for
cardiovascular disease in 366 doctors in primary
care, both sexes, aged over 25 years, we have found
that smoking among doctors is present in a significant percentage (44.81% ). By Masironu (9) from
50's to 90's of the 19th century in many European
countries, the rate (%) doctors of smokers has
constantly decreased. In the study group of health
workers in the department of pediatrics, gynecology, community health services, and home treatment in Belgrade, smokers were more than in the
our study (58.5%), and 23% nonsmokers (19). In
the total investigated sample of smokers in our
study, it was found that there are more women
smokers (28.7%) than men (21.3%) smokers (p =
0.011), the larger the percentage of survey frequency of smoking in late last century in the
northern countries of Europe (9). In this
TABLE 4. BMI values of doctors smokers and doctors of non-smokers
study characterized the low frequency of
smoking among doctors, an average of
SUBJECTS
7-23% men and 3-15% women doctors
NONSMOKERS SMOKERS TOTAL
of smokers, while the values in the gen17-20
N 5
4
9
eral population ranged between 30-45%.
% 1.7%
1.3%
3.0%
By the same study, the countries of Cen20-25
N 60
53
113
tral Europe is characterized by the rate
% 20.0%
17.7%
37.7%
doctors of smokers slightly higher (2025-30
N 64
67
131
28% men and women 16-25%), which
% 21.3%
22.3%
43.7%
is close to our study, while the countries
30-35
N 13
19
32
BMI
of eastern and north-eastern Europe
% 4.3%
6.3%
10.7%
have had higher rate doctors of smok35-40
N 3
4
7
ers, which is greater than our study and
% 1.0%
1.3%
2.3%
was 30-54% men and 40% women docThere is not N 5
3
8
% 1.7%
1.0%
2.7%
tors of smokers. According to statistical
TOTAL
N 150
150
300
data British Heart Foundation (20) in
% 50.0%
50.0%
100.0%
England in 2004 were 26% men and 23%
of women aged 16 years and over who
(According to WHO BMI over 25 = obesity)
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
135
smoke cigarettes, which is also similar to our results. Testing that was done in Croatia, in the general population group, it was found that smoking is
more frequent among men than in women, which
is different from our study where a larger percentage of smokers among women (21). Results of
our study confirm that most patients who smoke,
with smoking period of 10 years (24.7%), including more women than men, less is subjects with
smoking period of 20 years and over (20 %). From
the aspect of the amount of cigarettes smoked per
day, we found that most subjects smokers (42%)
smoked 10 cigarettes a day, significantly more
women, slightly less (38%) smoked 20 cigarettes a
day, and 1.3% of those smoking 40 or more cigarettes a day , which is worrying from the aspect
unwanted effects on cardiovascular disease, which
depends on the amount of cigarettes and smoking
period, as showed De Backe et al (6) Manson and
colleagues (22). Among subjects who smoked 20
cigarettes a day slightly leading men than women,
which was not statistically significant difference (p
= 0.85), and is risk of negative effects is present for
both population groups. Our study shows that the
largest number of smokers in the older age group
between 36 and 45 years, which is different from research Kovacic and colleagues (21) which was carried in Croatia in which smoking is most common
in the younger age group between 18 and 25 years.
Results of ATTICA study, conducted in Greece,
confirmed earlier research that obesity is connected with various cardiovascular risk factors such
as diabetes, hypertension and hipercholesteronemia (23), and we have the purpose of estimating
potential risk to our subjects wanted to look and
value BMI. In our study, the increased values of
BMI (over 25) are present in a significant number
subjects (56.7%). In the study in Slovenia, ZaletelKragelj and Fras (24) showed that among the subjects was 40.1% overweight and 38.5% were normal
weight, which is slightly smaller than our results.
Increased levels of BMI in the subjects were smokers in the percentage of 30% and in nonsmokers
26.7%, which is not a significant difference between groups. There was no connection between
the frequency of obesity-BMI (CHI2 = 0.86, p =
0.35) in the investigated group. Values of BMI over
30, in our study had 13% subjects, which is less
than the research was conducted in Croatia by
136
Conflict of interest
Authors declare no conflict of interest.
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www.jhsci.ba
Department of biochemistry, Clinical Center University of Sarajevo, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina.
Faculty of health sciences, University of Sarajevo, Zmaja od Bosne 33, 71000 Sarajevo, Bosnia and Herzegovina.
Abstract
Introduction: Serum CA15-3 has been one of the most reliable tumor markers used in monitoring of breast
cancer patients. To increase its sensitivity, the combined measurement of other tumor markers (CEA and ferritin) with CA15-3 was investigated. The aim of this study was determination of CA 15-3, CEA and ferritin in
female patients with breast cancer, lung cancer and mastitis
Methods: 300 patients with carcinoma, hospitalized at Department of Gynecologic Oncology and Department for Oncology at the University Clinics Center of Sarajevo and 200 healthy subjects were compared.
Results: In patients with breast cancer the mean value of tumor markers were CEA 155.61 ng/mL, CA 15-3
106.38 U/mL and ferritin 197.03 ng/mL. In patients with lung cancer CEA was 58.97 ng/ml, CA 15-3 40.62 U/
mL and ferritin 544.16 ng/mL. Patients with mastitis had CEA 5.17 ng/mL, CA 15-3 112.67 U/mL and ferritin
174.92 ng/mL. The control group had values of tumor markers CEA 1.62 ng/mL, CA 15-3 11.72 U/mL and ferritin 85.35 ng/mL. We found good correlation between CA 15-3 and CEA correlation coefficient was r = 0.750.
There was a low correlation between CA 15-3 and ferritin with correlation coefficient r = 0.274.
Conclusions: The CA 15-3 and CEA are useful markers in patients with confirmed diagnosis of breast and
lung cancers. The ferritin concentration has not increased in patients with breast cancer but it increased in
lung patients. The future study has to make investigations of tumor markers and ferritin in different stage of
breast cancer.
2012 All rights reserved
Keywords: CA15-3, CEA and ferritin
Introduction
Although the measurement of tumor markers
in breast cancer has been studied for nearly 20
years, their usefulness remains unclear. In patients with metastatic breast carcinoma, tumor
markers appear to be useful during follow-up,
but a wide range in rates of marker positivity has
been reported: 50%80% (1-3). Breast cancer is
the most common malignancy in women. Successful treatment of breast cancer relies on a better understanding of the molecular mechanisms
involved in breast cancer initiation and progres* Corresponding author: Nafija Serdarevi
Department of biochemistry, Clinical Center University of Sarajevo,
Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina,
Tel: +387 33 29 70 00; Fax: +387 33 44 18 15
E-mail: serdarevicnafija@yahoo.com
Submitted 14 June 2012/ Accepted 8 August 2012
138
NAFIJA SERDAREVI, SAMIRA MEHANOVI: THE POSSIBLE ROLE OF TUMOR ANTIGEN CA 15-3,
CEA AND FERRITIN IN MALIGNANT AND BENIGN DISEASE
Methods
Patients
The investigation included patients (n= 500) in period from February till October in 2011. It was retrospective study ant we included female patients
with diagnosis breast cancer, lung cancer or with
diagnosis of mastitis. All of 300 patients were hospitalized at Department of Gynecologic Oncology
and Department for Oncology at the University
Clinics Center of Sarajevo and 200 healthy subjects. The mean age of patients with cancer was
45.32-/+ 9.23, patents with mastitis 35.24 +/- 5.64
and mean age of control group was 43.45 -/+ 2.85.
The patient samples of blood were collected in
serum separation Vacutainer test tubes (Beckton
Dickinson, Rutherford, NJ 07,070 U.S.) in volume of
3.5 mL. We used test tubes with gel. Serum samples
were obtained by centrifugation at 3000 rpm using
centrifuge (Sigma 4-10). After centrifuging, serum
concentration of CEA, CA 15-3 and ferritin was
determined. The investigation was done respecting ethical standards in the Helsinki Declaration.
Chemiluminescent microparticle immunoassay
CMIA
All immunoassays require the use of labeled material in order to measure the amount of antigen or antibody. A label is a molecule that will
react as a part of the assay, so a change in signal
can be measured in the blood after added reagent solution. CMIA is noncompetitive sandwich assay technology to measure analytes. The
amount of signal is directly proportional to
the amount of analyte present in the sample.
Architect ferritin, CEA and CA 15-3 assay is twostep immunoassay to determine the presence
antigen in human serum using CMIA technology. In the first step, sample, assay diluent and
anti-antibody-coated paramagnetic particles are
combined. Ferritin, CEA or CA 15-3 present in
the sample binds to the anti-coated micro particles. After incubation and wash, anti-acridiniumlabeled conjugate is added in the second step. Following another incubation and wash, pre-trigger
and trigger solutions are then added to the reaction mixture. The pre-trigger solution (hydrogen peroxide) performs the following functions:
Creates an acidic environment to prevent
139
NAFIJA SERDAREVI, SAMIRA MEHANOVI: THE POSSIBLE ROLE OF TUMOR ANTIGEN CA 15-3,
CEA AND FERRITIN IN MALIGNANT AND BENIGN DISEASE
Results
The CA 15-3 is cancer antigen that is used in the
management of some patients with breast cancer. It is most effective at monitoring metastatic
breast cancer, but has not had high success at
detecting early stage breast cancers. Many studies are still conducted with the purpose of finding markers that could be used for early diagnosis and/or serve as possible reliable prognostic
or predictive parameters, but with conflicting
results. At present, no markers are available for
an early diagnosis of breast cancer. The surveillance of patients with diagnosed breast cancer
the most widely used serum markers are CA 15-3
and CEA which, in combination with other clinical parameters, could have clinical significance.
The raised of serum ferritin concentrations in
breast carcinoma patients might be attributed to
stromal reaction rather than to tumor synthesis.
In our study we have a female patients with diagnosis of breast and lung cancer. The patients with
lung cancer have a primary cancer in breast. The
140
patients with cancer were hospitalized in Department of Gynecologic Oncology and Department
for Oncology at the University Clinics Center of
Sarajevo. The patients with mastitis were hospitalized in Department of Gynecologic at the
University Clinics Center of Sarajevo. The percent of patients in our study is show in Figure 1.
Abnormal CEA (>5 ng/mL) or CA 15.3 (>30 U/
mL) serum concentrations were found in 15.4%
and 27.2 % of the patients studied, respectively. In
patients with breast cancer the mean value of tumor
markers were CEA 155.61 ng/mL, CA 15-3 106.38
U/mL and ferritin 197.03 ng/mL. Our study have
got results in patient with lung cancer CEA 58.97
ng/ml, CA 15-3 40.62 U/mL and ferritin 544.16
ng/mL. The results of our study have shown that
the patients with mastitis have CEA 5.17 ng/mL,
CA 15-3 112.67 U/mL and ferritin 174.92 ng/mL.
The control groups have value of tumor markers
CEA 1.62 ng/mL, CA 15-3 11.72 U/mL and ferritin 85.35 ng/mL. Serum levels for the three tumor
markers in patients with metastatic diseases were
significantly higher than those in patients without
metastasis. This suggests that serum CA15-3 is the
most reliable monitoring marker in patients with
metastatic diseases. The CEA and ferritin were
high in patients with lung cancer then CA 15-3 and
it could be explain that CEA is more specific for
lungs then CA 15-3. The raises serum ferritin in tumors might be due to tumor synthesis because the
ferritin is reactant of acute phase. The mean value
of tumor marker in our study is shown in Figure 2.
We compared CA 15-3 and ferritin in patients with
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
NAFIJA SERDAREVI, SAMIRA MEHANOVI: THE POSSIBLE ROLE OF TUMOR ANTIGEN CA 15-3,
CEA AND FERRITIN IN MALIGNANT AND BENIGN DISEASE
FIGURE 3. Comparison of CA 15-3 and ferritin in serum measured by Architect CMIA. The correlation coefficient r = 0.274.
FIGURE 4. Comparison of CA 15-3 and CEA in serum measured by Architect CMIA. The correlation coefficient r = 0.75.
141
NAFIJA SERDAREVI, SAMIRA MEHANOVI: THE POSSIBLE ROLE OF TUMOR ANTIGEN CA 15-3,
CEA AND FERRITIN IN MALIGNANT AND BENIGN DISEASE
Discussion
The results of this study indicate that of the three
tumor markers tested, serum CA15-3 is the most
sensitive and specific in terms of the detection of
breast cancer metastases. In our study the average
concentration of CEA and CA 15-3 was higher
in patients group with primary breast cancer, a
results are shown in Figure 2. The CA 15-3 was
higher in breast cancer but lower than CEA in
lung cancer. The patients with mastitis diagnosis the have higher concentration of CA 15-3 but
normal concentration of CEA. Serum CA15-3
has been one of the most reliable tumor markers used in monitoring breast cancer patients. It
has been reported that the sensitivity and specificity of serum CA15-3 for detecting metastatic
diseases are higher than those of CEA (12,13).
In our study the concentration of CEA was mostly
elevated in patients with breast and lung carcinoma. The recent study has reported that serum
levels of CEA were high at patients with adenocarcinoma and squamous carcinoma (14). The
other investigator has shown that CEA is significantly related to differential degree of lung
cancers (15). The different staining patterns and
positive rates and intensities of CEA may be
helpful for the pathological classification of lung
cancers. The CEA concentration was in reference rage in patients with mastitis and controls.
In this study patients with cancer particularly with
lung cancer have higher concentration of ferritin. This might be due to the potential additional
regulators involved in ferritin synthesis. Iron is
the main, but not the only regulator of ferritin
expression. Hypoxia, often present in neoplastic tissue, is also one of the factors that promote
ferritin increase independently of the iron status
References
(1) Molina R, Barak V, van Dalen A,
Duffy MJ, Einarsson R, Gion M, et
al. Tumor markers in breast cancer.
European Group on Tumor Markers Recommendations. Tumour
Biol 2005;26:281-293.
(2) Sturgeon CM, Duffy MJ, Stenman
UH, Lilja H, Brnner N, Chan DW,
et al. National Academy of Clinical
142
NAFIJA SERDAREVI, SAMIRA MEHANOVI: THE POSSIBLE ROLE OF TUMOR ANTIGEN CA 15-3,
CEA AND FERRITIN IN MALIGNANT AND BENIGN DISEASE
(11)
(12)
(13)
(14)
143
www.jhsci.ba
Abstract
The iatrogenic ureter injuries are rare complications and may have serious consequences. The treatment options depend on situations. Pelvic surgeons, keep in mind that this kinds of complications, is very important
for diagnosis and treatment, during the surgery. This report presents a case of a patient with iatrogenic left
ureteral injury during hysterectomy. The patient visited emergency department of our hospital with the chief
complaints of left lomber pain on the 17th day of hysterectomy. After evaluation in emergency clinic, the patient had an endoscopic treatment for iatrogenic ureter injury. The patient is still in follow-up period. We also
review the literature and discuss diagnose, treatment, prognosis of iatrogenic ureter injuries. The treatment
options are still developing by technology.
2012 All rights reserved
Keywords: hysterectomy, minimally invasive, surgical procedures, ureteral obstruction, wounds, injuries.
Introduction
The iatrogenic ureteral injuries are rare; this
complication is the one of the most important
complication in gynecological surgery (1). The
injuries almost locate in the distal part of ureter
(2). Quick diagnosis and treatment decrease complication rates (3). Also early diagnosis provides
the best results for treatment (3). There are a lot
of treatment options. When this rare complication applies our clinics, we may prefer minimally invasive treatment options (4-6). Herein, we
present a 62-year-old woman with a complete
left ureter obstruction which was formed by a suture in her ureter with a previous hysterectomy.
Case report
On April 2011, a 62-year-old woman with complaints of abdominal pain was admitted to our hospital. She was evaluated in gynecology outpatient
* Corresponding author: Yigit Akin,
Department of Urology, School of Medicine,
Erzincan University, Erzincan/Turkey
Tel: +90-506-5334999
e-mail: yigitakin@yahoo.com
Submitted: 15 May 2012/ Accepted: 4 August 2012
144
FIGURE 1. In gray scale US examination, there are dilatations in all calyx system. The level of dilatation is grade 2-3
hydronephrosis.
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
YIGIT AKIN ET AL.: MINIMALLY INVASIVE TREATMENT OF IATROGENIC COMPLETE LEFT URETER OBSTRUCTION AFTER HYSTERECTOMY
YIGIT AKIN ET AL.: MINIMALLY INVASIVE TREATMENT OF IATROGENIC COMPLETE LEFT URETER OBSTRUCTION AFTER HYSTERECTOMY
surgery is approximately 1%, with a higher percentage of injuries occurring during abdominal hysterectomies and partial vaginectomy
(1). Nevertheless, when a ureteral injury occurs,
quick recognition of the problem and a working
knowledge of its location and treatment are essential in providing patients with optimal care.
Ureter lies on anterior of psoas muscle and crosses
over the iliacs and also crosses anteriorly by the
gonadal vessels. Most of the iatrogenic injured
cases do not have any identifiable risk factors.
Endometriosis, uterus size larger than 12 weeks
gestation, ovarian cysts 4 cm or larger, pelvic radiation therapy, anatomic anomalies of urinary
tract, ovarian masses, inflammation of pelvis, pelvic malignancy are the some of the risk factors
which may disrupt of normal pelvic anatomy (2).
The reasons of iatrogenic ureter injury are, misapplication of a clamp, ligation with suture,
transection of ureter, ureteral ischemia form
electrocoagulation, resection of segmental ureter, secondary obstruction of ureter by angulation. Also the combination of all of these reasons may lead the iatrogenic ureter injury (5).
Ureteral injury may be divided as recognized or
unrecognized during surgery. When the iatrogenic injury was diagnosed during the surgery,
the time of urologist starts-up in operation. The
injury may be treated best by urologist with ureteral repair during the same operation. Unilateral
ureteral injuries are occurred nearly 75% of the
cases after the operation (7). If the injury of ureter has occurred and has not been recognized, it
may cause flank pain, chronic ureteral obstruction or formation of fistulas. In our case, the iatrogenic injury had occurred after the surgery.
Then, the injury was diagnosed quickly and it was
treated endoscopic minimally invasive surgery.
As a result of developing technology, laparoscopic and robotic-assisted surgery have been
included to the surgery modalities. Same as
open pelvic surgery, in laparoscopic and robotic-assisted surgery, surgeons should keep
in their minds the iatrogenic ureter injury (8).
If the ureteral injury can be diagnosed intraoperative, intravenous administration of indigo
carmine or methylene blue with furosemide may
help to localize a ureteral injury (1). Extravasation
of blue dye indicates ureteral discontinuity. Also
146
fluoroscopy may help us by administration of contrast substance in ureter and show us the injury or
obstruction zone in ureter. If the ureteral injury
has occurred after surgery, laboratory studies including complete blood count, a electrolyte panel
with serum creatinine and blood urea nitrogen
are needed to distinct for possible infection and
renal failure. In radiological evaluation, renal US,
if the patients serum creatinine levels are normal
IVU, abdominal and pelvic computed tomography
with intravenous contrast may be used. Although
renal US is the best non-invasive method to visualize the kidney and shows hydronephrosis it
cannot be used to assess kidney function or the
continuity of the ureter. Urologists use the IVU
to evaluate for continuity of the ureter in cases of
ureteral injury. Unlike renal ultrasonography and
a retrograde ureteropyelography, IVU is used to
assess for function of the ipsilateral kidney and
the drainage of the ureter in a series of sagittal
images. Hydronephrosis, ureteral integrity, and
any extravasation may usually be seen with IVU.
CT scan can also be used to assess for both function of the ipsilateral kidney and drainage of the
ureter. CT scanning has the advantage of imaging
for concomitant conditions at the same time (5).
The treatment options depend on situation of the
cases. There is no exact medical treatment options
for iatrogenic ureter injuries but some conditions
such as infection, renal failure which belongs to
ureteral injury should be treated medically. The
surgical treatments may range from minimally
invasive treatments to ureteroneocystostomy. The
most common open, laparoscopic or roboticassisted surgical treatments for ureteral injury
are simple removal of a ligature, ureteral stenting, ureteral resection and ureteroureterostomy,
transureteroureterostomy, and ureteroneocystostomy (9-11). Wolf et al. (12) reported long term
excellent results of endoureterotomy. In our case,
we simply removed the ligated suture by endouretetomy and put ureteral stent. If the patients
situation is not suitable for treatment of ureteral
injury the urinary diversion should be perform
by percutaneous nephrostomy catheter. This provides decompression of closed urinary system.
If the obstruction or injury is managed by minimally invasive endoscopic surgery and additionally ureteral stent is put in to ureter, the stent may
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
YIGIT AKIN ET AL.: MINIMALLY INVASIVE TREATMENT OF IATROGENIC COMPLETE LEFT URETER OBSTRUCTION AFTER HYSTERECTOMY
genic ureter injury which occurred after surgery. Also this case emphasizes the significance
of ureteroscopy which is a minimal invasive
and effective method in the diagnosis and treatment. In the future, the use of new minimally
invasive technologies will be able to change
the management of iatrogenic ureter injuries.
Competing interests
Authors declare no conflict of interest.
References
(1) Selzman AA, Spirnak JP. Iatrogenic
ureteral injuries: a 20- year experience in treating 165 injuries. J Urol
1996;155(3): 878-881.
(2) Payne CK. Ureteral injuries in the
female: fistulas and obstruction. In:
Raz S (ed). Female Urology. 2nd ed.
Philadelphia: W.B. Saunders, 1996.
pp. 507-20.
(3) Gilmour DT, Dwyer PL, Carey MP.
Lower urinary tract injury during
gynecologic surgery and its detection by intraoperative cystoscopy.
Obstet Gynecol 1999; 94(5): 883889.
(4) Mate-Kole MO, Yeboah ED, Affram
RK, Ghosh TS. Anuric acute renal
failure due to bilateral accidental
ureteric ligation during abdominal
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
147
www.jhsci.ba
Abstract
Lebers hereditary optic neuropathy is a neuro-ophthalmological entity characterized by acute or subacute
bilateral, not simultaneous visual loss with centro cekal scotoma and occasional further visual improvement.
This rare ophthalmological disease can be accompanied with dyschromatopsia. It is associated with a matrilineal inheritance pattern. Its diagnosis used to be solely clinical, aided by imaging and neuro-physiological
studies, until the advent of descriptions of mitochondrial biochemical abnormalities and genetic testing. We
describe a case of 24 year old male with progressive painless deterioration of visual acuity and positive family
history.
2012 All rights reserved
Keywords: optic neuropathy, Leber, visual acuity
Introduction
Lebers hereditary optic neuropathy is a neuroophthalmological entity characterized by acute
or subacute bilateral, not simultaneous visual
loss with centro cekal scotoma and occasional
further visual improvement. This rare ophthalmological disease can be accompanied with dyschromatopsia. It is associated with a matrilineal
inheritance pattern. Its diagnosis used to be solely
clinical, aided by imaging and neuro-physiological studies, until the advent of descriptions of
mitochondrial biochemical abnormalities and
genetic testing. Primary point mutations occur
at nucleotide positions 3460, 11778 and 14484
of the mitochondrial genome coding for protein
subunits of the respiratory chain complexes. The
11778 mutation is most frequently observed, accounting for 80-90% of described cases.2 Young
males are primarily affected (80-90%), usually in their third decade of life. Females, carriers of the disease, rarely express the symptoms.
* Corresponding author: Mirjana A. Janiijevi-Petrovi
Kneza Miloa 3-1, 34000 Kragujevac, Srbija
Phone: +38166013691
Fax:+38134370073
e-mail:mira.andreja@yahoo.com
Submitted 20 June 2012/Accepted 26 July 2012
148
Case report
A young man adult of 24 experienced a sudden
progressive, painless decreasing of visual acuity of
the right eye. The condition deteriorated over a few
days. He also noticed that the colors when viewed
with the right eye, were extremely pale. The left
on the first examination was with normal visual
acuity. For 22 days visual acuity of the left eye decreased. He had a healthy younger brother, with
no visual disturbances. His mother remembered
that his uncle (her brother) was 23 years old and
had similar problem The patient did not smoke,
nor did he consume any alcohol and was well
nourished. He was not exposed to heavy metals.
At the time of the referral, two months after the
onset of the disease, visual acuity was 0.01 in the
right eye, and 0.1 in the left. During visual field
testing, centrocoecal scotoma on the right eye and
central scotoma on the left eye were found (Figure
1). Subjectively present profound dyschromatopsia could not be objectively proved due to very low
central vision. Pupillary responses were normal,
and relative afferent pupillary defect could not be
detected. There were no signs of intraocular inflammation and intraocular pressure was normal.
Fundoscopic appearance was not impressive. The
only thing that could be seen was slightly tortuous
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
papillary capillary network and very discrete dilatation and tortuosity of small peripapillary vessels,
more pronounced on the right eye. On fluorescein
angiography, the vessels were intact, with no leakage (Figure 2). Pattern visual evoked potentials
149
FIGURE 3. Bilateral profound optic atrophy with empty, pale discs on ophthalmoscopy
References
(1) Kerrison JB. Hereditary optic neuropathies. Ophthalmol Clin North
Am. 2001;14(1):99-107.
(2) Riordan-Eva P, Sanders MD, Govan GG, Sweeney MD, Da Costa J,
Harding AE. The clinical features of
Lebers hereditary optic neuropathy
defined by the presence of a pathogenic mitochondrial DNA mutation. Brain. 1995;118(Pt 2):319-37.
(3) Huoponen K. Leber hereditary
optic neuropathy: clinical and molecular genetic findings. Neurogenetics. 2001;3(3):119-25.
(4) Yamada K, Mashima Y, Kigasawa K,
Miyashita K, Wakakura M, Oguchi
Y. High incidence of visual recovery
among four Japanese patients with
Lebers hereditary optic neuropathy
with the 14484 mutation. J Neuroophthalmol. 1997;17(2):103-7.
151
152
www.jhsci.ba
Abstract
Infective endocarditis is defined as an infection of the endocardial surface of the heart. Its intracardiac effects
include severe valvular insufficiency, which may lead to intractable congestive heart failure and myocardial
abscesses. This disease still carries a poor prognosis and a high mortality.
A severe case of infective endocarditis with its complications is presented. A man with aortic prosthetic
valve due to earlier aortic stenosis and corrected aortal coarctation and implanted pacemaker presented
with prolonged unexplained fever, malaise, sweating, weight loss (15 kg/4 months) and lumbar pain. He
was treated with broad-spectrum antibiotics prior IE diagnosis was considered. Echocardiogram showed
aortic vegetations and possible periaortal abscess formation. Nonspecific inflammation parameters were
high positive. Cultures were constantly negative. His condition had deteriorated suddenly, and he had presented with worsening of cutaneous vasculitis, subacute glomerulonephritis and subsequent acute respiratory distress syndrome and septic shock. This patient survived with residual bilateral necrosis of the feet and
toxic peroneal paresis. At the end transthoracic echocardiogram showed enlarged heart chambers, LV mild
dilated and concentric hypertrophy with ejection fraction about 40%, degenerative postinflammatory mitral
valve changes, mild mitral regurgitation and tricuspid regurgitation, postinflammatory aortic root fibrosis and
moderate aortic valve stenosis (AVPG max 50,9 mmHg, AVPG mean 24 mmHg) with no pericardial effusion.
Initial suspicion of Q fever was definitely excluded by serological testing showing nonspecific IgM positivity,
probably rheumatoid factor related.
2012 All rights reserved
Keywords: Endocardtitis lenta, prosthetic valve infection, septic shock, false positive Q-fever
Introduction
Infective endocarditis (IE) is an interesting disease because of its constant incidence and mortality rate despite advances in both diagnostic and
therapeutic procedures. The diverse nature and
evolving epidemiological profile of IE ensure it
remains a diagnostic challenge (1). Despite improvements in medical and surgical therapy, IE
is still associated with a severe prognosis and remains a therapeutic challenge (2). Different sets
of diagnostic criteria have been used to direct and
standardize case definitions both in clinical practice and in scientific work (3). The clinical history
of IE is highly variable according to the causative
* Corresponding author: Amra Maci Dankovic,
Department of of Internal medicine, General Hospital
Prim. Dr Abdulah Naka, Kranjevieva 12,
71000 Sarajevo, Bosnia and Herzegovina
Tel.: 061/177-743 E-mail: ifsa@bih.net. ba
Submitted: 14 June 2012 / Accepted: 1 August 2012
JOURNAL OF HEALTH SCIENCES 2012; 2 (2)
microorganism, the presence or absence of preexisting cardiac disease, and the mode of presentation. Thus, IE should be suspected in a variety of
very different clinical situations. It may present as
an acute, rapidly progressive infection, but also as
a subacute or chronic disease with low grade fever and nonspecific symptoms which may thwart
or confuse initial assessment. The current in-hospital mortality rate for patients with IE is 15% to
20% with 1-year mortality approaching 40% (3).
Once a disease of young adults with mostly
rheumatic valve disease, IE now has new predisposing factors valve prostheses, degenerative
valve sclerosis, intravenous drug abuse associated with increased risk for bacteriemia, resulting in health care-associated IE. Leading causative organism shifted from predominantly
streptococci to predominantly staphylococci.
According to microbiological findings, the following categories are proposed:
153
AMRA MACI-DANKOVI ET AL.: ENDOCARDITIS LENTA-PATIENT SURVIVED SEPTIC SHOCK: A CASE REPORT
AMRA MACI-DANKOVI ET AL.: ENDOCARDITIS LENTA-PATIENT SURVIVED SEPTIC SHOCK: A CASE REPORT
atrial side of the anterior leaflet of the MV. Cardiosurgeon did not suggest any surgical treatment.
However, his condition deteriorated suddenly, and
he presented with worsening of cutaneous vasculitis, subacute glomerulonephritis and subsequent
acute respiratory distress syndrome (ARDS) and
septic shock. Chest auscultation was significant for
basal bilateral fine crackles. Chest x-ray showed
progressive bilateral infiltrative changes. He was
intubated and mechanically ventilated for six
days. Antibiotic therapy was changed to Doxicyclin 2x100 mg, Tienam 3x1 g, Funzol 1x400 mg
and finally Linezolid 2x600 mg. Third serologic
testing results showed F2-IgM positive, F1-IgG
i F2-IgG negative. It was concluded that it was a
false positive reaction and Q fever was deffinitely
exc luded. In addition our patient developed left
femoral vein thrombosis and lymphoedema in his
right arm with possible superficial vein thrombosis. TEE showed vegetation on artificial valve
but patient was hemodinamically insufficient
and no definitive surgical therapy was indicated.
After stabilization he was discharged from Intensive Care Unit and sent back to Heart Center. Subsequent laboratory investigation showed
high cytoplasmic (classical) antineutrophil cytoplasmic antibodies (c-ANCA) which led to
suspect Wegener's granulomatosis and corticosteroid therapy was administrated (Medrol
1x12 mg). It was not conclusive because of no
evidence of upper respiratory involvement.
At the end TTE showed enlarged heart chambers, LV mild dilated and concentric hypertrophy with ejection fraction about 40%, degenerative postinflammatory MV changes(figure
2), mild MR and TR, postinflammatory aortic
155
AMRA MACI-DANKOVI ET AL.: ENDOCARDITIS LENTA-PATIENT SURVIVED SEPTIC SHOCK: A CASE REPORT
root fibrosis(figure 4) and moderate AV stenosis (AVPG max 50,9 mmHg, AVPG mean 24
mmHg)-(Figure 3) with no pericardial effusion.
Because of bilateral necrosis of the feet plastic surgeon recommended surgical treatment.
The patient was discharged with bilateral toxic peroneal paresis treated with gabapentin.
Discussion
We presented a case of culture-negative IE with
multiple episodes of recurrent fever, vegetation
formation on the prosthetic aortic valve, thromboembolic incidents through the whole body and
subsequent complication development. Initial suspicion of Q fever was definitely excluded by serological testing showing nonspecific IgM positivity,
probably RF related. Later Wegener's granulomatosis diagnosis was dismissed because no evidence
of upper respiratory tract involvement was found.
IE has showed to be a great challenge to diagnose
because of its non-specific symptomatology. Patients may therefore present to a variety of specialists who may consider a range of alternative diagnoses including chronic infection, rheumatologic
and autoimmune disease, or malignancy. Classic
textbook signs may still be seen in the developing world, although peripheral stigmata of IE are
increasingly uncommon elsewhere, as patients
generally present at an early stage of the disease.
However, vascular and immunological phenomena such as splinter hemorrhages, Roth spots, and
glomerulonephritis remain common, and emboli
156
AMRA MACI-DANKOVI ET AL.: ENDOCARDITIS LENTA-PATIENT SURVIVED SEPTIC SHOCK: A CASE REPORT
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AMRA MACI-DANKOVI ET AL.: ENDOCARDITIS LENTA-PATIENT SURVIVED SEPTIC SHOCK: A CASE REPORT
References
(1) European Society of Cardiology.
Guidelines on the prevention, diagnosis, and treatment of infective
endocarditis (new version 2009).
ESC Guidelines. European Heart
Journal.2009; 30:2369-2413.
(2) Botelho-Nevers E, Thuny F, Casalta JP, Richet H, Gouriet F, Collart F et al. Dramatic reduction
in infective endocarditisrelated
mortality with a managementbased approach. Arch Intern Med.
2009;169(14):1290-1298.
(3) Murdoc D, Corey GR, Hoen B,
MiroJM, Fowler VG Jr, Bayer AS
et al. Clinical presentation, etiology,
and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditisprospective cohort study.
Arch Intern Med. 2009;169(5):463473.
(4) Alshukairi AN, Moysheed MG,
158
(5)
(6)
(7)
(8)
www.jhsci.ba
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All authors must sign the submission form. It is necessary that all
authors of confirm with their signature that: they meet the criteria
for authorship in the work, established by the International Committee of Medical Journal Editors; believe the manuscript represents honest work and being able to validate these results. Authors
are responsible for all statements and opinions in their papers.
More information is available at (http://bmj.com/cgi/collection/
authorship).
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INSTRUCTIONS AND GUIDELINES TO AUTHORS FOR THE PREPARATION AND SUBMISSION OF MANUSCRIPTS IN THE JOURNAL OF HEALTH SCIENCES
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www.jhsci.ba
UPUTSTVO AUTORIMA
Upute i smjernice autorima za pripremu i predaju rukopisa u Journal of Health Sciences
Ciljevi i okvir asopisa
The Journal of Health Sciences (JHSci) je internacionalni asopis
na engleskom jeziku, koji objavljuje orginalne radove iz oblasti fizikalne terapije, medicinsko-laboratorijske dijagnostike, radioloke
tehnike, sanitarnog inenjerstva, zdravlja i ekologije, zdravstvene
njege i terapije, te drugih srodnih oblasti.
Vrste znanstvenih radova koje se mogu poslati za objavljivanje
u JHS
Orginalni radovi: orginalne laboratorijske eksperimentalne i klinike studije ne bi trebao prelaziti 4500 ukljuujui tabele i reference.
Prikaz sluajeva: prezentacije klinikih sluajeva koji mogu sugerisati kreiranje nove radne hipoteze, uz prikaz odgovarajue literature. Tekst ne bi trebao prelaziti 2400 rijei.
Pregledni lanci: lanci afirmiranih znanstvenika, pozvanih da ih
napiu za asopis. Redakcija e, takoer, razmatrati i samostalne
aplikacije.
Uvodnici: lanci ili kratki uvodniki komentari koji predstavljaju
miljenja prepoznatih lidera u medicinskim istraivanjima.
Podnoenje rada za objavljivanje
Rad koji se alje u JHSci mora biti u skladu sa propozicijama o sadraju, izgledu i kvalitetu, koje je urnal propisao u ovim instrukcijama za autore i na web stranici urnala, www.jhsci.ba. Propozicije
o sadraju, izgledu i kvalitetu naunog rada u skladu su sa meunarodnim propozicijama i preporukama datim od strane International Committee of Medical Journal Editors. Uniform Requirements
for Manuscripts Submitted to Biomedical Journals New Engl J
Med 1997, 336:309315 (www.icmje.org), te preporuka meunarodnih radnih grupa za standardizaciju izgleda i kvaliteta naunih
radova: STROBE (www.strobe-statement.org) , CONSORT (www.
consort-statement.org), STARD (www.stard-statement.org) i drugih.
Predloci
JHSci je pripremio predloke (engl. template) za izgled i sadraj
naunog rada. Predloci sadre sve neophodne podnaslove i obogaeni su uputama o sadraju svakog poglavlja naunog rada, te e
autorima znatno olakati proces pisanja rada. JHSci preporuuje
koritenje predloaka za pisanje naunih radova koji se nalaze na
web stranici urnala www.jhsci.ba u dijelu Information for authors.
autori ele predstaviti rukopis, pismo ili dijelove koji ne mogu biti
poslani elektronski, ili je to zatraeno od urednitva. Za autore koji
nemaju mogunost elktronskog slanja rada, potrebno je poslati
potom jedan primjerak rada, zajedno s elektronskom verzijom na
CD-u ili DVD-u na sljedeu adresu: za Journal of Health Sciences,
Fakultet zdravstvenih studija Univerziteta u Sarajevu, 71000 Sarajevo, Bolnika 25, Bosna i Hercegovina.
Pravila redakcije
Autorstvo
Svi autori morati potpisati formular za podnoenje rada (Manuscript Submission form). Potrebno je da svi autori potpisom potvrde
da: su zadovoljili kriterije za autorstvo u radu, utvreno od strane
International Committee of Medical Journal Editors; vjeruju da
rukopis predstavlja poteni rad i da su u mogunosti potvrditi valjanost navedenih rezultata. Autori su odgovorni za sve navode i
stavove u njihovim radovima. Vie informacija se moe dobiti na
(http://bmj.com/cgi/collection/authorship).
Plagijarizam ili dupliciranje objavljenog rada
Od autora se zahtjeva da svojim potpisom potvrde da u momentu
podnoenja rad nije objavljen u sadanjem obliku ili bitno slinom
obliku (u tampanom ili elektronskom obliku, ukljuujui i na web
stranici), da nije prihvaen za objavljivanje u drugom asopisu ili
razmatran za objavljivanje u drugom asopisu. Meunarodni odbor urednika medicinskih asopisa dao je detaljno objanjenje ta
jeste, a ta nije duplikat (www.icmje.org). Vie informacija moe se
nai i na stranici www.jhsci.ba.
Formular saglasnosti bolesnika
Zatita prava pacijenta na privatnost je od iznimnog znaaja. Autori trebaju, ako redakcija zahtjeva, poslati kopije formulara Suglasnosti bolesnika iz kojih se jasno vidi da bolesnici ili drugi subjekti
eksperimenata daju doputenje za objavljivanje fotografija i drugih
materijala koji bi ih identificirali. Ako autori nemaju potrebnu saglasnost za istraivanje, moraju je dobiti ili iskljuiti podatke koji
identificiraju subjekte, a za koje nisu dobili saglasnost.
Odobrenje Etikog komiteta
Autori moraju u formularu za podnoenje rada i u dijelu rada
Metode jasno navesti da su studije koje su proveli na humanim
subjektima, odnosno pacijentima, odobrene od strane odgovoarajueg etikog komiteta. Vie informacija moete nai u najnovijoj verziji Helsinke deklaracije (http://www.wma.net/e/policy/
b3.htm). Isto tako, autori moraju potvrditi da su eksperimenti koji
ukljuuju ivotinje provedeni u skladu sa etikim standardima.
Slanje rada
Vri se iskljuivo preko web stranice www.jhsci.ba preko predvienog web formulara. Web formular sadri etiri stranice na kojima
se nalazi: 1. popis stavki koje treba ostvariti prije podnoenja rada;
2. informacije o autoru za korespondenciju; 3. informacije o naunom radu; 4. dio za slanje fajlova. U web formularu autori su duni
ispravno popuniti informacije, unijeti ispravnu e-mail adresu za
korespondenciju, te poslati 2 fajla: 1. Pismo za podnoenje rada;
2. Nauni rad. NIJE POTREBNO slati tampanu verziju, osim ako
Izdavaka prava
U okviru Pisma za podnoenje rada od autora se zahtjeva da prenesu izdavaka prava na Fakultet zdravstvenih studija. Prijenos izdavakih prava postaje punovaan kada i ako rad bude prihvaen
za publiciranje. ira javnost ima prava reproducirati sadraj ili listu
lanaka, ukljuujui abstrakte, za internu upotrebu u svojim institucijama. Saglasnost izdavaa je potrebna za prodaju ili distribuciju
van institucije i za druge aktivnosti koje proizilaze iz distribucije,
ukljuujui kompilacije ili prijevode. Ukoliko se zatieni materijali
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materijala u radu, ili koji bi mogli uticati na nepristranost studije. Ako ste sigurni da ne postoji sukob interesa, navedite to u radu.
Jo informacija se moe nai ovdje: (http://bmj.com/cgi/content/
short/317/7154/291).
Reference
Reference se trebaju numerisati prema redoslijedu pojavljivanja u
radu. U tekstu, reference je potrebno navesti u zagradama, npr. (12).
Kada rad koji citirate ima do 6 autora, navesti sve autore. Ukoliko
je 7 ili vie autora, navesti samo provih 6 i dodati et al. Reference
moraju ukljuivati puni naziv i izvor informacija (Vancouver style).
Imena urnala trebaju biti skraena kao na PubMedu. http://www.
ncbi.nlm.nih.gov/journals
Primjeri referenci:
Standardni rad: Meneton P, Jeunemaitre X, de Wardener HE,
MacGregor GA. Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev.
2005;85(2):679-715
Vie od 6 autora: Hallal AH, Amortegui JD, Jeroukhimov IM, Casillas J, Schulman CI, Manning RJ, et al. Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in
resolving gallstone pancreatitis. J Am Coll Surg. 2005;200(6):86975.
Knjige: Jenkins PF. Making sense of the chest x-ray: a hands-on
guide. New York: Oxford University Press; 2005. 194 p.
Poglavlje u knjizi: Blaxter PS, Farnsworth TP. Social health and
class inequalities. In: Carter C, Peel JR, editors. Equalities and
inequalities in health. 2nd ed. London: Academic Press; 1976. p.
165-78.
Internet lokacija: HeartCentreOnline. Boca Raton, FL: HeartCentreOnline, Inc.; c2000-2004 [cited 2004 Oct 15]. Available from:
http://www.heartcenteronline.com/
Osobne komunikacije i nepublicirani radovi ne bi se trebali nai u
referencama ve biti navedeni u zagradama u tekstu. Neobjavljeni
radovi, prihvaeni za publiciranje mogu se navesti kao referenca sa
rijeima U tampi (engl. In press), pored imena urnala. Reference moraju biti provjerene od strane autora.
Tabele
Tabele se moraju staviti iza referenci. Svaka tabela mora biti na posebnoj stranici. Tabele NE TREBA grafiki ureivati.
Broj tabele i njen naziv pie se IZNAD tabele. Tabela dobija broj
prema redoslijedu pojavljivanja u tekstu, a naziv treba biti jasan i
dovoljno opisan da je jasno ta tabela prikazuje. npr Table 3. Tekst
naziva tabele..... U radu prilikom pozivanja na tabelu treba napisati
broj tabele u zagradi, npr. (Table 3). Za skraenice u tabeli potrebno
je dati puni naziv ispod tabele. Poeljno je ispod tabele dati objanjenja i komentar, koji su neophodni da se rezultati u tabeli mogu
razumjeti. Prikazati statistike mjere varijacije, kao to je standardna devijacija i standardna greka sredine, gdje je primjenjivo.
Slike
Slike staviti iza referenci i tabela (ako postoje). Svaka slika mora biti
na posebnoj stranici. Slika dobija broj prema redoslijedu pojavljivanja u tekstu. Naziv i broj se piu ISPOD slike, npr. Slika 3. Tekst
naziva slike... U radu, prilikom pozivanja na sliku treba napisati
broj slike u zagradi, npr (Slika 3). Neophodno je da slika ima jasan
i indikativan naziv, a u tekstu ipod slike objasniti sliku i rezultat
koji ona prikazuje, sa dovoljno detalja da ona moe biti jasna bez
pretrage teksta koji je objanjava u radu. Slika mora biti kvaliteta
najmanje 250-300 dpi, formata JPG, TIFF ili BMP.
Jedinice mjere
Mjere duine, teine i volumena trebaju se pisati u metrikim jedinicama (meter, kilogram, liter). Hematoloki i biohemijski parametri se trebaju izraavati u metrikim jedinicama prema International System of Units (SI).