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Deveti dani BHAAAS-a u BiH – Teslić2017. “Most znanja“

OrganizatoriBosanskohercegovačko-američka akademija nauka i

umjetnosti u saradnji sa Sektorom za iseljeništvo Ministarstvaza ljudska prava i izbjeglice BiH

Datum i mjesto održavanjaČetvrtak, 25.5.2017 - nedjelja, 28.5. 2017.

Hotel Kardial Teslić

Organizacioni odbor “Dana BHAAAS u BiH – Teslić2017.” :

Dušica BabovićNirvana

PištoljevićMirsad

Hadžikadić EmirFestić SlavicaHrnkaš Adnan

Karaiković

OFICIJELNI JEZICI KONFERENCIJE SU BOSANSKI I

ENGLESKIPresentations titled in English will be presented in English /

Prezentacije sa nazivima na engleskom, biće prezentovane naengleskom.

SRIJEDA24.05.2017.

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ČETVRTAK25.05.2017.

INTERNACIONALNI SIMPOZIJ OINOVATIVNIM IINTERDISCIPLINARNIMAPLIKACIJAMASAVREMENIHTEHNOLOGIJA (IAT) I

VODITELJI SIMPOZIJA: Mirsad Hadžikadić (Charlotte, USA/

BHAAAS), Samir Avdaković (Sarajevo,BiH / BHAAAS)

Svi radovi iz tehničkihsimpozija dostupni na:

https://www.springer.com/gp/book/9783319713205

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INTERNACIONALNI SIMPOZIJ IZMULTIDISCIPLINARNE ONKOLOGIJE,DAN I

PROGRAM DAN IGordan Srkalović: New designs of clinical trials in oncology

Oncology of CRC

Emir Pinjo (Oslo, Norveška): Mucinous epithelialneoplasms of the appendix / Pseudomyxoma peritonei

Pseudomyxoma peritonei (PMP) is a rare, malignant conditioncharacterized by accumulation of mucinous ascites andperitoneal inplants within the peritoneal cavity. Estimatedincidence is approximately one per million per year.This most often occurs because of the peritoneal spread of amucinous neoplasm from the appendix.Considerable controversy exists on their pathologicalclassification and nomenclature. The 2010 WHO classificationdivided PMP into the two groups: low-grade PMP and highgrade PMP; and the mucinous neoplasms of appendix into thethree categories: mucinous adenoma, low-grade appendicealmucinous neoplasms (LAMNs) and appendicealadenocarcinoma.Treatment depends on the stage of disease and histology gradeas well as clinical presentation.Combained modality treatment of PMP consists of cytoreductivesurgery (peritonectomy with resection of involved viscera) withhypertermic intraperitoneal chemotherapy (HIPEC) and post-operative systemic chemotherapy.

Amer Odobašić, Faris Odobašić, AdemirOdobašić (Tuzla, BiH): Parastomal herniain colorectal cancer: to prevent or when and

how do the surgery?

Parastomal hernia (PSH) is a protrusio of abdominal contentsthrough a weakness in the abdominal wall at thesite of the previous hole made for delivering the stoma. Ostomycomplications, including skin irritation andleakage, dehydration from high output stomas, bowel obstruction,prolapse, and parastomal hernia, are quiteprevalent. Of these problems, parastomal hernia is the mostcommon and significant issue that patients face with. Parastomalhernia occurs in 35%-50% of patients who have had a stomaformed, whether for the digestive tract or the urinary tract. Thereare many repair techniques including primary repair and repairusing different types of mesh prosthesis, and the surgical approachmay be open or laparoscopic. A high index of hernia recurrence isdisadventage common for all techniques.With such a high incidence of PSH and recent success with meshrepair, much attention has been given to prophylactic meshplacement at the time of primary stoma formation, especially forpermanent colostomy after an abdominoperineal resection (APR).Hernia prevention with prophylactic mesh placement at the time ofstoma creation may be the continued focus of future research.

Ibrahim Edhemović (Ljubljana, Slovenija): Kakopoboljšati rezultate liječenja nakon abdominoperinealneekscizije rektumaI

Abdominoperinealna ekscizija rektuma (APE) je kirurški zahvat zaliječenje nisko-ležećeg raka rektuma sa kojim se odstranjuju imišići odgovorni za kontinentnost. Zato se na kraju te operacijeuvijek napravi terminalna, trajna kolostoma. Rezultati liječenjaovom metodom niso tako dobri kao što su rezultati liječenja nakonniskih prednjih resekcija. Razlozi i moguća rješenja za to sumnogobrojni. Možemo ih podijeliti u tri grupe:1. Pogrešno (nepotrebno) indicirana APE, kada je operacijumoguće izvesti bez resekcije zdjeličnog dna. Pravilnu indikaciju zaoperaciju sa ilibez žrtvovanja zdjeličnog dna je moguće postaviti samo na osnovudobrih MRI snimaka, učinjenih po protokolu za rak rektuma. Samotako možemo ocijeniti ev. Zahvaćenost sfinketrnog kopleksa ipotrebu za APE.2. Neadekvatno izvedena sama operacija. Klasična APE bezekscizije levatorne muskulature, često vodi u perforaciju preparatai/ili pozitivne radialne rubove, što predstavlja vrlo slab prognostički

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faktor. To možemo izbjeći tako da u preparat uključimo ilevatornu muskulaturu kroz tzv. ekstralevatorni pristup. S timedobivamo dodatni radialni sloj sa kojimpoboljšavamo radialne rubove i smanjujemo mogućnostperforacije. 3. Septične komplikacije kao poslijedica slabogcijeljenja perinealne rane poslije operacije, koje, ako se pojave,kompromitiraju imunološki sistem i s tim preživljavanjebolesnika. Te komplikacije možemo izbjeći sa odgovarjućimrežnjevima sa kojim u perinealnu ranu dovedemo zdravo tkivo,koje jako ubrzava proces cijeljenja.Sve navedene mjere mogu poboljšati preživljavanje, smanjitibroj nepotrebnih APE i smanjiti broj lokalnirecidiva.

Hasan Osmić, Šefik Hasukić (Tuzla,BiH): Postoperative conformal radiationtherapy of gastric cancer

Background. Based on computer tomography we can see allthe lymph nodes that belong to the stomach and is the clinicaltarget volume lymph nodes need to determine the appropriatemargin around the associated blood vessels. Higher margin willcertainly address all the lymph nodes or the therapeutic dose ofhealthy organs) while the lower margin safer but a big risk forunder dosage of lymph nodes. The aim of this study was todetermine and compare the radiation doses to the organs of therisk for clinical target volumes lymph nodes of 5 mm, 7 mm and10 mm in patients with gastric cancer treated with three-dimensional conformal radiotherapy after gastrectomy.

Patients and methods. Research will be conducted onCT images of patients who are treated for cancer of thestomach by using trans cutaneous radiotherapy atDepartment of Radiotherapy Department of Oncology,Hematology and Radiotherapy, University ClinicalCenter Tuzla in the 2012th-2015th year. The study willinclude 40 patients. To test the statistical significanceof differences among the examined groups will be usedANOVA test. Statistical hypothesis will be tested at thelevel of significance of ά= 0.05, ie. the differencebetween the examined groups shall be consideredsignificant if P<O.O5.

Results. The expected results of this study are thatthere will be significantly lower radiation doses to theorgans of risk planning based on three-dimensionalconformal radiotherapy for trans cutaneous margin of 7

mm CTV lymph nodes around the associated blood vesselscompared to a margin of 10 mm, but not significantly higher thanthe margin of 5 mm.

Conclusions: The dose of radiation, to the authorities of the riskand, coverage of the target volume containing the clinical targetvolume lymph nodes of 7 mm is the most sensitive in the treatmentof gastric cancer after gastrectomy.

Muhamed Topčagić (Tuzla, BiH): Reduction ofSystematic Set-up Errors in Conformal RadiationTherapy (CRT) Using BackgroundElectronic PortalImaging Device (EPID)

Background: The main goal of conformal radiation therapytreatment is to deliver maximum radiation dose to targetvolumewith no compromise of normal tissue tolerance. This goalcan be compromised by geometric set-up errors that occur in theplanning and delivery of radiationtherapy treatment. Set-up errorsare defined as discrepancy between planned and actual treatmentposition. Two types of errors, systematic and random, causevariations from the treatment plan to the actual dailytreatment.Geometric set-up errors can be compensated by application ofgeometrical margins to target volume. If the standard deviation ofthe systematic errors and random errors are known, then themargin can be calculated. Since systematic error requires 3–4times larger margins than random, reduction of systematic errorsshould be an effective approach to better target coverage andpotentially margin reduction.

Methods: The portal imaging studies for each tumor site wereconducted on 20 patients divided into control andoperating group.Portal images were acquired in two orthogonal or oppositeprojections. Measurements of geometric accuracy were made inthe longitudinal, transverse and vertical direction with respect toreference bone marks. Detection, analysis and correction of set-uperrors were performed according to off-lineno action level (NAL)protocol.

Results: The results show a smaller dispersion individual systemerror within the operating group, significant reductionof the overallpopulation mean set-up error and reduction of the populationsystematic error in each direction inoperating group, andconsequent reduction of safety margin to planning target volume(PTV).

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Conclusion: Electronic portal verification with off-line NALprotocol is a valuable method in improving of thegeometricaccuracy in 3D conformal radiotherapy. Eachradiation therapy department should develop site specificprotocol for verification of geometric accuracy, set-up errorsreduction and safety margins optimization based on their ownmeasurements.

Key words: conformal radiation therapy, electronicportal verification, geometric accuracy, set-up error.

Hematology

Dragan Jevremović (Rochester, USA):WHO 2016 Lymphoma Updates

WHO periodically publishes classification of neoplasticprocesses. The last edition for the classification ofhematopoieticneoplasms was published in 2008. A 2014 meeting of theClinical Advisory Committeecomposed of WHO-recognizedexperts initiated the revision of the WHO 2008 classification,based on newlyacquired knowledge. The resulting consensuswas published in the journal Blood (2016), in two reviewarticles(myeloid and lymphoid). The clinicians and pathologists areencoureged to use these reviews to guidediagnostic approachand terminology, while waiting for the new full WHO edition,planned for later 2017 or2018. The differences from WHO 2008classification and new diagnostic entities will be highlighted inthe presentation.

Nurija Bilalović (Sarajevo, BiH):WHO 2016 Myeloproliferative disease

Azra Jahić, Ermina Iljazović, Samira Hasić,Aida Čustović, Damir Sabitović, SemirMešanović, Haris Šahović, Vlastimir

Simendić (Tuzla, BiH): Prognostic parameters of acutemyeloid leukaemia at presentation

Introduction: The treatment response and outcome in acutemyeloid leukaemia (AML) is heterogeneous. Aim:To analyze theprognostic parameters of AML at presentation. Methods: Thetotal sample of 44 AML patientswas analyzed on the basis of age<55 and ≥55 years, sex, WBC count <50x109/l and ≥50x109/l,the Hbconcentration <100 g/l and ≥100 g/l, PLT count<100x109/l and ≥100x109/l, Karnofsky score <60% and>60%,cytogenetics, CD56 expression, morphological type and types oftreatment (standard and reducedinduction chemotherapy, high–dose chemotherapy/stem cell transplantation – autologous andHLA matched,related, allogeneic, together and separately).Results: The age <55 years, Karnofsky score >60% andstandardinduction chemotherapy statistically correlated with the higherCR rates, longer RFS, lower RR andlonger OS (p<0.01). Thedifference in terms of CR and RR between the sexes were notstatistically significant(p<0.05), however women had statisticallylower OS comparing to men (9.71 }4.54 months vs.38.03 }9.17months) (p<0.01). WBC count ≥ 50x109/l and theHb concentration <100 g/l statistically correlated withshorter OS(p<0.05), while the WBC count ≥50x109/l statistically correlatedwith shorter RFS (p<0.05). ThePLT count <100x109/l and≥100x109/l was not found as prognostically significant for CR,RR, RFS and OS(p<0.05). In comparison to the standardinduction chemotherapy, both types of high dosechemotherapy/stemcell transplantation (HDT/SCT) (10/22),together and separately, resulted in longer RFS, lower RR, andlongerOS (p<0.05). The frequency of cytogenetic risk wasintermediate 81.6%, unfavorable 13.2% and favorable5.3%,respectively. CD56 + expression statistically correlated with thelower PLT count, higher RR, shorterRFS and shorter OS(p<0.05). Conclusions: Female sex, the WBC count >50x109/l,the concentration of Hb<100 g/l, and CD56 + expression, atpresentation of AML, should be considered as parameters ofadverserisk, especially in latter decisions considering post-remission treatment with HDT/SCT.Keywords: acute myeloidleukaemia, prognostic parameter, prognosis.

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Damir Sabitović(Tuzla, BiH): ZAP-70 andCD38, by ow cytemetry, as a prognosticmarkers in CLL

B Chronic lymphocytic leukemia (CLL) is a clonal diseasecharacterized by B-lymphocytic infiltration of thebone marrowand peripheral blood, with a variable degree of infiltration of thelymph nodes, spleen and otherorgans. This is the mostcommon single type of leukemia in Europe and the USA, andaccounts for about 30%of all leukemias.Some of the patientsare living with the disease for several decades, and die with,rather than from thedisease, while others develop aggressivedisease soon after diagnosis and require specific therapy.Effortsare made to find new indicators of disease progressionthat would allow prediction of its flow in eachpatientindividually.Expression of CD38 and ZAP-70 positivityidentifies a group of patients with chronic lymphocyticleukemia(CLL) who have aggressive clinical presentation andpoor outcome of the disease.Most of the patients with theaggressive form of CLL have significantly higher percentage ofCD38 expressionand ZAP-70 positivity as opposed to thepatients with stabile form of the disease.Clinical stagingaccording to Rai and Binet still remains base for disease follow-up and for adequate therapydecisions, however new laboratorytechniques (detection of CD38 and ZAP-70 by flow cytometry)can be ofsignificant importance in early detection of patientswith high risk of the disease progression who willrequirefrequent follow-ups and early therapy.Key words: CLL,CD38, ZAP-70

Zoran Todorović, Marija Simić, Dragana Makić,Dragana Protić, Maja Kosanović (Beograd, Srbija):Platelet-derived microvesicles as biomarkers of theincreased prothrombinase activity and thrombotic adverseevents in pediatric patients subjected to bone marrowtransplantation

Trombotic complications and adverse events are common inpatients subjected to hematopoietic stem celltransplantation(HSCT). The incidence of sinus-obstructive syndrome(SOS)/veno-occlusive liver disease(VOD), the most common andmost significant thrombotic complication after HSCT ranges from10% and 60%depending on the intensity of preconditioningregimen, type of transplant, and the presence of risk factors.Themortality rate in patients with SOS/VOD and multi-organdysfunction is high (up to 84%). A reliable and rapidbiomarker isneeded for the early detection of SOS/VOD since the effectivetreatment exists if applied at the early stages of the disease(defibrotide). Unfortunately, current Seattle and Baltimorediagnostic criteria areneither sufficiently sensitive nor specific forthe early diagnosis of SOS/VOD. The possible role ofplateletderivedmicrovesicles (PDMVs) as early biomarkers ofSOS/VOD in pediatric patients subjected to HSCT will bediscussed.

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INTERNACIONALNI SIMPOZIJ IZ KARDIOLOGIJE

PROGRAM DAN I

SESIJA 1

Enver Raljević (Sarajevo, BiH), Emir Fazlibegović (Mostar,BiH, BHAAAS): Kretanje kardiovaskularnih bolesti u BiH isvijetu

Mustafa Hadžiomerović, Emir Fazlibegović (Mostar, BiH,BHAAAS): Aterosklerotske osnove koronarnog plaka i ACS

Samra Međedović, Danijel Pravdić EmirFazlibegović (Mostar, BiH): Genetske osnovekoronarne bolesti

Goran Čuturilo, Jelena Ruml, Marija Mijović,Aleksandra Miletić, Nikola Borlja, Mina Lukić,Brankica Dimitrijević (Beograd, Srbija): Currentstate of pediatric cardiogenetics in Serbia

Emir Fazlibegović, Danijel Pravdić, Diana Zelenika,Danijela Ćuk, Omer Manov (Mostar, BiH): EORP-ispitivanje srčane slabosti u Bosni i Hercegovini

Enes Abdović (Zenica, BiH) Noninvasive markersof predisposition to atrial fibrillation: age,gender,Interatrial block and left atrial enlargement

Adis Muslibegović (Mostar, BiH): Alirocumab utretmanu ateroskleroze

SESIJA 2

Goran Imamović (Tuzla,BiH), Vesna Tovilović(Doboj, BiH), Alma Imamović (Tuzla, BiH), DamirSabitović ( Tuzla, BiH): Pre-Dialysis Blood Pressureand Left Ventricular Hypertrophy – Is There anAssociation?

Introduction. There is no association between predialysis bloodpressure (BP) readings and patients’ survival and left ventricularhypertrophy (LVH), which increases the risk of hypertensionmisdiagnosis in chronic hemodialysis patients. However, for practicalreasons the pre-dialysis BP measurement remains the most

frequently utilized value to characterize hemodialysispopulation, despite the shortcomings, such as: it represents thepeak of the 48- to 72-h dialysis cycle and overestimates theaverage BP; it induces white coat hypertension, but it may alsobring about masked hypertension, which underestimates thetrue BP reading. Guided by the statistical law of large numbers,we hypothesized that the reproducibility of pre-dialysis BPmeasurement could be increased by using an average value of2 month-BP recordings. Therefore, we conducted this study toevaluate whether the average of 2-month BP readings maypredict LVH in patients on chronic hemodialysis better thanconventionally utilised single reading obtained prior tohemodialysis session.

Methods. The cross-sectional study was performed in dialysiscentre of Doboj (Bosnia and Herzegovina) and the data sinceAugust, 2010 till February 2016 were collected. LVH wasassessed by echocardiography.

Results. 123 patients were initially enrolled, but 97 met eligibilitycriteria. Linear regression coefficient of determination (R2) forsingle values of systolic BP (SBP) and diastolic BP (DBP) were0.02 (p>0.05) and 0.01 (p>0.05), respectively. R2 for average 2month-SBP recording was 0.06 (p<0.05), whereas for average2 month-DBP recording it was 0.03 (p>0.05). After theadjustments for age, volume overload and hemoglobin, multiplecorrelation coefficients for single values of SBP and DBP were0.29 (p>0.05) and 0.32 (p>0.05), respectively, whereas foraverage 2 month-SBP recording it was 0.42 (p<0.05) and foraverage 2 month-DBP recording it was 0.41 (p>0.05).

Conclusion. Average 2 month-SBP recording predicts LVHunlike average 2 month-DBP and single SBP and DBPrecordings.

Key words: blood pressure, left ventricular hypertrophy,hemodialysis

Daniela Lončar, Edin Jašarević, Denis Mršić,Indira Karamujić (Tuzla,BiH): Valvular heartdisease after kidney transplantation

INTRODUCTION: Cardiovascular diseases are the greatest cause

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of morbidity and mortality in patients after kidney transplantation.Valvular heart disease is a common occurrence in patients on chronicdialysis. Abnormalities include valvular and annular thickening andcalcification of any of the heart valves, causing regurgitation and/orstenosis. Valvular thickening or sclerosis in patients on chronic dialysistreatment most commonly affectingthe aortic and mitral valve. Currentknowledge of valvular heart disease in patients after kidneytransplantation are scarce.

AIM:To determine the prevalence of valvular heart disease in kidneytransplant patients and patients treated with hemodialysis. Todetermine whether there is a difference in the prevalence of valvularheart disease among kidney transplant patients and patients treatedwith hemodialysis.

PATIENTS AND METHODS: We conducted a prospective study thatincluded 90 patients. All patients had their history data taken,electrocardiogram, complete physical examination andechocardiography. The diffeence in frequency of the observedparameters was tested by chi-sqyare test.

RESULTS:Patients were divided into two groups: kidney transplantpatients (60 patients) and patients treated with hemodialysis (30patients). In the group with kidney transplant patients was 42 (70%)men and 18 (30%) women. In the group with patients treated withhemodialysis was 15 (50%) men and 15 (50%) women. Theaverageage inkidney transplant patients was 42.22 } 1.71 years, in the groupwith patients treated with hemodialysis was 52.97 } 2.98 years. Themean duration of dialisys before kidney transplant in the group withkidney transplantpatients was 43.00 } 9.19 months. The averagekidney graft survival was 9,1 }9,68 years. The mean duration ofdialisys in the group with patients treated with hemodialysis was 87.00

} 15.6 months. Tricuspidal regurgitation had 20 (33.33%) kidneytransplant patients and 12 (40%) patients treated with hemodialysis; pvalue 0.1988. Mitral regurgation had 20 (33.33%) kidney transplantpatients and 17 (56.67%) patients treated with hemodialysis; p value0.0294. Aortic regurgitation had 9 (15%) kidney transplant patients and10 (33.33%) patients treated with hemodialysis; p value 0.0435.Pulmonary valve regurgitation had 0 (0%) kidney transplant patientsand 3 (10%) patients treated with he -modialysis; p value 0.0346.Mitral stenosis had 1 (1.67%) kidney transplant patients and 4(13.33%) patients treated with hemodialysis; p value 0.0407. Aorticstenosis had 1 (1.67%) kidney transplant patients and 2 (6.67%)patients treated with hemodialysis; p value 0.2567.

CONCLUSION: We find statistically significant differences in thefrequency of valvular heart disease between kidney transplant patients

and patients treated with hemodialysis.

Edin Begić, Zijo Begić (Sarajevo, BiH): Theclinical diagnosis of congenital heart defect -coarctation of the aorta

Aim: Display of diagnosing the coarctation of the aorta (CoA) byconventional clinical examination.Case report: Patient, 6 year oldfemale, reported to the emergency center because of headaches,epistaxis,and disturbance of consciousness. Mother stated that thechild has easier fatigue for a long time, persistentdizziness,tinnitus, headache, and that the she complains of irregularheartbeat. Physical examination showedthe following: upper part ofthe body with broad shoulders, narrow waist and underdevelopedlowerextremities, increased blood pressure 150/110 mmHg andelectrocardiographic finding was left axis deviationwith left-ventricular hypertrophy. Enalapril, 10mg was prescribed, and shewas instructed to performlaboratory findings. Next day, the motherappeared with the laboratory findings, which were in order. Thechildsaid that her heart was beating fast again. She was intachycardia and physician touching the pulse of thelowerextremities, saw the lack of it. Chest X-ray was immediatelyperformed, which showed enlarged leftventricle, with a narrowmediastinal waistline.Edin Begic 04/20/2017The physiciansuspected the diagnosis of CoA, which was confirmed byechocardiography(echocardiographic diagnosis of postductal(adult) CoA - clinical triad - hypertension, impairment offemoralartery pulse and systolic heart murmur - loudestintrascapular - on the back).Conclusion: CoA has characteristicclinical features and diagnosis can be set up by physicalexamination.Keywords: Coarctation of the aorta, physicalexamination, congenital heart defect.

Tomica Božić, Jure Pupić Bakrač, Vesna Brkić, DarinkaŠumanović Glamuzina, Marijana Jerković Raguž,Marija Bošnjak, Antonija Mustapić, Ana Pupić Bakrač(Mostar, BiH): Intensive Care of a Newborn with EdwardsSyndrome – Case Report

Introduction: Edwards syndrome is the second most common

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autosomal chromosome anomaly in humans,with a prevalence of 1: 6,000-1: 8,000 in live births. The syndrome includes a recognizable pattern ofmajor and minor anomalies, and prominent psychomotor and cognitiveimpairments. It carries an increased risk of neonatal and infant mortality.More than 50% of children die in the first week of their life, and less than10% of them survive until the age of one year. The approach to thetreatment of such patients has so far caused many controversies amongpediatricians. Whereas some believe that the use of intensive therapyprolongs survival, others believe that it has no long-term effect and due tothe severe psychomotor and cognitive impairment itsapplication is notjustified.

Case report: A female newborn, born on January 11th, 2014, immediatelyafter birth, was transferred to Neonatal Intensive Care Unit of Departmentof Pediatrics, University Clinical Hospital Mostar, because of hypotonia,pale-grayish color of the skin, deficient spontaneous motor skills andrespiratory insufficiency. Clinically, the newborn showed phenotypiccharacteristics typical of Edwards syndrome. Immediately upon receipt thepatient was intubated and connected to mechanical ventilation. The sameday diaphragmatic hernia was diagnosed and a corresponding surgerywas performed. Cytogenetic findings confirmed complete trisomy 18. Heartechography showed VSD input type (size 8 mm), ASD II (5 mm), PDA (3mm). Further diagnostic examination showed other congenitalmalformations with less clinical importance. After stabilization, the patientcontinued post-intensive treatment with cardiac therapy and physiatrictreatment. After being discharged, the patient was repeatedly hospitalized,among other things due to the development of pulmonary hypertensionand its complications. The child died in June 2016 of heart failure at theage of two years and six months.

Conclusion: The application of intensive treatment had a certain impact onour patient's survival. It has also been shown that intensive care isfollowed by cardiovascular events as major mechanisms of death, asopposed to non-invasive approach where high percentage of deaths areassociated with central apnea.

Keywords

Edwards syndrome, intensive care, survival

Ognjen Marinković, Igor Dumanović, DraženkoVuković (Teslić,BiH): Cardiovascular rehabilitation

Cardiovascular rehabilitation is group of activities and interventionswhich are necessary for achieving better physical, mentaly and socialcondition, so that the patients with chronical and postacutecardiovascular diseases can lead active life. It includes : medicalevaluation, physical training, modification of cardiovascular risk factorsand education. There are three phases of cardiovascularrehabilitation. The first is intrahospital phase after heart infarction oroperation. The second phase is cardiovascular rehabilitation in one ofthe centres for rehabilitation. The third phase is longlife and includesregularly doctors controles, using medical therapy and correction ofcardiovascular risk factors. The aims of cardiovascular rehabilitationare: improving weaken physical condition, stabilisation of cardiologicalstatus of patient and reducing risk of progression disease, educatingpatients and their families how to reduce risks for coronary andhypertensive heart disease, reduceing depression which followscardiovascular diseases and preventing invalidity. Indications forcardiovascular rehabilitation are : heart infarction, aortocoronarybypass, PCI with implantation stent, implantation artefitial heart valve,heart transplantation, impl. of pacemaker or ICD and disease ofperipheral blood vessels. Contraindications: congestive heartinsufficiency, malignant arrythmias, atrioventricular block grade II andIII, aneurysma of aorta, myocarditis, endocarditis and pericarditis,pulmonary hypertension, thromboembolic complications, difficultaortas and mitral valve diseases, cerebral diseases, respiratory, liverand kidney insufficiency. Methods of cardiovascular rehabilitation are:physical training, psychotherapy, correction of risk factors,balneotherapy and hyperbaric oxygenotherapy. Interval training istype of training which characterized with periods of extensive activitiesand periods of active resting. Number of cardiovascular patients whichrehabilitated in our hospital in period from 2006 - 2015 years is 8115.Most of them are patients after acute heart infarction. Conclusion:Cardiovascular rehabilitation is part of complex treatment of cardiologypatients. The main method of cardiovascular rehabilitation is physicaltraining. Rehabilitation programme begins very early after heartinfarction of heart operation, lead continualy and lasts longlife.The main words: cardiovascilar rehabilitation, physical training,prevention.

Mirsad Hadžikadić (Charllote,USA, BHAAAS):Kompleksni informacioni sistemi u kardiologiji–

PETAK26.05.2017.

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INTERNACIONALNI SIMPOZIJ IZ PORODIČNEMEDICINE

PROGRAM DAN I

SESIJA 1

Mašić Izet, FatimaGondža (Sarajevo, BiH): The pictureof usage information technologies in the educational process – thesituation at Faculty of Medicine, University Sarajevo, BiH

Eldina Nizamić (Washington, USA/BHAAAS): Diabeticfoot infection

Diabetic foot infection, defined as soft tissue or bone infection belowthe malleoli, is the most common complication of diabetes mellitusleading to hospitalization and the most frequent cause ofnontraumatic lower extremity amputation. This presentation willreview the current recommendations for the diagnosis, treatment,management and prevention of the diabetic foot infection.Preventative efforts directed toward prevention of the foot infectionare much more likely to meet with success than is a therapy of theestablished foot infection.

SESIJA 2

Biljana Ćurguz(Banjaluka, BiH): Dijabetesno stopalo – odsuhe kože do amputacije

UVOD: Dijabetesno stopalo je jedna od mnogobrojnih komplikacijašećerne bolesti i predstavlja skup koštanih i mekotkivnih promjena nastopalu dijabetesnih bolesnika. Prema definiciji Svjetske zdravstveneorganizacije; „dijabetesno stopalo je ono stopalo koje je narušenogfunkcionalnog integriteta zbog infekcije, rana i razaranja tkiva, teoštećenja živaca i bolesti krvnih sudova nogu“. Pojava čireva(ulceracija) na stopalu, zatim nastanak gangrene i posljedičneamputacije su značajni uzroci morbiditeta i invalidnosti kod osobaobolelih od dijabetesa. Ove komplikacije predstavljaju velikimedicinski, socijalni i ekonomski problem i značajno smanjuju kvalitetživota dijabetesnom bolesniku. Liječenje dijabetesnog stopala je

složen i mukotrpan proces i može se obaviti na primarnom nivouzdravstvene zaštite.CILJ RADA: Prikazati na slučajevima iz prakse proces zdravstvenenjege pri prevenciji i liječenju dijabetesnog stopala, identifikovatibarijere i dati prijedlog za prevazilaženje istihMETODOLOGIJA: Slikovni prikaz težih oblika dijabetesnog stopala uambulantama porodične medicine uz deskripcijuDISKUSIJA I ZAKLJUČAK: Hronične rane zauzimaju većinsko mjestou opisu posla medicinskih sestara na primarnom nivou.Njihovozarastanje je dugotrajno i znatno opterećuje zdravstveni sistem.Posljednjih godina se posvećuje dosta pažnje edukaciji medicinskogosoblja i pacijenata, ali su i dalje prisutni problemi usljednepravovremenih edukacija, manjka osoblja,izostanakmultidisciplinarnog sistema, neadekvatnog pristupa pacijentu,pogrešne procjene rane.U praksi je prisutna različitost u pristupuliječenju dijabetesnog stopala,od uslova rada, edukacije osoblja domotivisanosti zdravstvenog kadra. Potrebno je napraviti centar ilislužbu za dijabetes u kojoj će se medicinske sestre baviti samoedukacijom stručnog kadra, edukacijom pacijenata, kućnim posjetamaza pacijente u riziku i pacijente sa već nastalim komplikacijama,previjanjem hroničnih rana, debridmanom,i biti karika izmeđupacijenata i zdravstvenih radnika na svim novoima( primarni-sekundarni, centar za mentalno zdravlje, centar za socijalni rad,laboranti, psihijatri, nutricionisti,endokrinolozi, fizioterapeuti).Samo naovakav način će svi pacijenti imati istu priliku za dobijanje uslugavezanih za dijabetesnu njegu, te će se moći prevenirati veliki brojkomplikacija bolesti, što će finansijski rasteretiti zdravstveni sistem ipoboljšati kvalitetu pacijentovoga života.

Jelena Dobrovoljski, Kosana Stanetić (Banjaluka,BiH):Edukacija o pravilnoj ishrani pacijenata sa dijabetesmelitusom

Diabetes mellitus tip 2 (DM tip 2) je hronični poremećaj metabolizma,koji od pacijenta zahtijeva stalnu brigu o zdravlju. Osim farmakološketerapije, pacijenti oboljeli od tip 2 DM moraju biti edukovani oprovođenju nefarmakoloških mjera jer samo kombinacijafarmakološkog i nefarmakološkog liječenja može dovesti do postizanjadobre glikoregulacije.Nefarmakološko liječenje obuhvata pravilnu ishranu, redovnu fizičkuaktivnost i pravilnu samokontrolu. Tim porodične medicine ima velikuulogu u edukaciji pacijenata o svim aspektima nefarmakološkogtremana.Edukacija o pravilnoj ishrani i postizanju ili održavanju normalnetjelesne težine su obavezni u svakodnevnom radu tima porodične

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medicine. Tokom edukacija pacijenti se moraju obučiti o principimapravilne ishrane. Oboljeli od tip 2 dijabetesa bi trebali da unosenamirnice u slijedećem omjeru: 50% ugljikohidrata, 30% masti, 20%bjelančevina. U ishrani treba da koriste što više namirnica bogatihvlaknima (zeleno povrće, žitarice od cijelog zrna, mahunarke). Pacijentibi trebali da smanje unos soli, a posebno oni koji pored dijabetesaimaju i hipertenziju. Pacijentima se treba naglasiti da ograniče unosvoća, jer sadrži velike količine ugljenih hidrata, a da u potpunostiizbace iz ishrane brzu hranu (fast food), grickalice i gazirana pića.Takođe se savjetuje redovna ishrana, bez preskakanja obroka.Osim ovih opštih pravila, mogu se koristiti i specifični načini edukacije opravilnoj ishrani. ADA (eng. American Diabetes Association) je napravilatablice namirnica kako bi pacijentima sa dijabetesom olakšalo pravljenjejelovnika. Namirnice su prema ADA podijeljene u šest grupa: hljeb i zamjene,mlijeko i zamjene, meso i zamjene, voće, povrće masnoće. Edukacijapacijenata o pravilnoj ishrani se može provoditi obukom pacijenata da koriste„model tanjura“ ili po modelu „porcija“.Edukakciju pacijenata oboljelih od dijabetesa tip 2 o ishrani može provoditimedicinska sestra ili ljekar iz tima, a može biti individualno savjetovanje,savjetovanje u malim ili velikim grupama.Ključne riječi: diabetes mellitus tip 2, edukacija, ishrana, tim porodičnemedicine

Nedim Begić., Edin Begić, Amra Dobrača, EdinNislić, Emin Grbić (Breza, Sarajevo BiH): Falsenegative results of anti-tTG and EMA in celiacdisease diagnosis

Aim: To show diagnostic issues in celiac disease diagnosis from theprism of primary health care level.

Case report: The patient (30 year old female), came to primaryhealthcare unit with symptoms such as pain in the stomach,dyspepsia, constipation and meteorism that lasted for days. Shestated that she had similar problems already, and that after the dayof constipation, she regularly has explosive diarrhea. Appetite isweak, she lost weight, she reported skin problem and also problemswith dental enamel. In anamnesis, she is already diagnosed withchronic gastritis. She had done laboratory tests and test for H. pylori.Laboratory findings were in order, H. pylori test was negative. Aftershe took pantoprazole, stomach pain stopped. She was instructed todo anti-tissue transglutaminase antibody (anti-tTG) and anti-endomysial antibodies (EMA) tests, which were also negative.Patient was instructed to remove gluten from the daily nutrition, and

after ten days, on new examination, patient said that her generalcondition was much better, and that her appetite returned. After thatthe patient was advised to do a biopsy. Biopsy was done and fourpieces of the mucosa of the duodenum were taken. Histologically inall four pieces was seen that the mucosa was largely leveled andwithout villi, which were only partially preserved; crypts wererenewed and coated with cubic epithelium that exhibited lightreactive dysplasia. Inflammatory lymphocyte and plasma cells werepresent in stroma. After the arrival of the pathohistological finding,the patient was diagnosed with celiac disease.

Conclusion: Anti-tTG and EMA test in patients with celiac disease,can be negative, while biopsy is positive. Immunoglobulin Adeficiency (occurs more frequently in patients with celiac disease)can lead to falsenegative results, so the intestinal (duodenal) biopsyis considered to be a gold standard in celiac disease diagnosis.

Keywords: celiac disease, anti-tTG, anti-endomysial antibodies,duodenal biopsy.

SESIJA 3

Jasminka Popović, Biljana Ćurguz (Banjaluka,BiH):Upotreba upitnika za psihološko praćenje pacijenataoboljelih od dijabetesa

UVOD Upitnici WHO5 i PAID, za pacijente oboljele od dijabetesa kaoinstrumenti za psihološko praćenje ovih pacijenata, su međunarodnovalidni i široko korišteni u Evropi i svijetu , uzimaju se i kao standardkorišten na godišnjoj kontroli za pacijente oboljele od dijabetesa. WHO5je upitnik koji pomoću pet pitanja procjenjuje psihološku dobrobit , dokPAID zahvata emocionalni distres uslovljen šećernom bolesti. Za obaupitnika postoje norme koje omogućavaju smještanje pacijenata ukategorije (depresivno,sniženo ili pozitivno raspoloženje; prosječan,iznadprosječan ili visok distres) a time i efikasnu trijažu.Tri su mogućaishoda ovakvog probira i prikladnih intervencija:

(1) pacijentov psihosocijalni status je zadovoljavajući, u kojem slučaju senastavlja uobičajeno liječenje;

(2) pacijent ima simptome povišenog distresa i/ili sniženo raspoloženje(ali na subkliničkom nivou), pri čemu osnovni medicinski tim služi kaoizvor podrške i daljnjeg praćenja, uz konsultaciju sa psihologom popotrebi;

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(3) pacijent doživljava izrazit distres i/ili depresivne simptome, u kojemslučaju se upućuje na psihološku ili psihijatrijsku procjenu, na temeljukoje se upućuje prema prikladnim oblicima psihološkog ili psihijatrijskogliječenja.

Ovakav sistem, koji je usklađen sa svjetskim smjernicama, ističe važnostmedicinskog tima u psihosocijalnoj procjeni i praćenju,kao i u pružanjupsihosocijalne podrške. Ovo naglašava ulogu psihologa kaoravnopravnog člana tima, čija je uloga prvenstveno savjetovati i popotrebi dodatno edukovati medicinski tim za prikladnu komunikaciju i štoefikasniji pristup psihosocijalnim teškoćama pacijentu.

CILJ Prikazati rezultate istraživanja upotrebe WHO5 I PAID upitnika natimu porodične medicine

METODOLOGIJA Pacijenti oboljeli od dijabetesa su pozivani u ambulantiradi intervjua, tj popunjavanja dva upitnika .Popunjavanje je dobrovoljnoali sa imenom i prezimenom pacijenta , jer je pretpostavka da će seispitivanje ponavljati za 6 mjeseci,te je potrebno imati početne upitnikeradi poređenje stanja.Korišteni su upitnici WHO5 i PAID,preporučeni posvjetskim smjernicama.

Diskusija i rezultati Iz rezultata se jasno vidi značaj praćenjapsihosocijalnog statusa pacijenata oboljelih od dijabetesa.Diopacijenata je već u riziku,ali sa većim dijelom je moguće raditi naedukaciji i saradnji sa centrom za mentalno zdravlje kako bismopovećali nivo prihvatanja bolesti, spriječili komplikacije i smanjilitroskove u zdravstvenom sistemu.Ovo stavlja radnike iz Centra zamentalno zdravlje na važno mjesto u timu za prevenciju iprihvatanje dijabetesa za pacijente i edukacinog dijela za medicinskeradnike.

Fatima Topčić, Larisa Gavran, Branka Gajanović(Zenica, BiH): Samoevaluacija kvalitete njege pruženeoboljelim od dijabetes mellitusa u timu porodične medicine:uloga sestre

Uvod Sestrinske intervencije u njezi oboljelih od dijabetesa uobiteljskoj medicini treba da se sastoje se od: mjerenja (tjelesnetežine-TT, visine-TV, obima struka, indexa tjelesne mase-BMI);pregleda stopala i edukacije o: šećernoj bolesti, ishrani, primjeniinzulina, tjelesnoj aktivnosti, samokontroli šećera krvi,prepoznavanja simptoma hipo i hiperglikemije, njezi stopala idokumentiranja pronađenog na listi za sestrinske intervencije.

Cilj ove studije bio je procijeniti kvalitet učinjenih sestrinskihintervencija kod oboljelih od dijabetesa u tri uzastopne godine od2014-2016.

Metode Urađen je audit prakse, slučajnim odabirom 30 kartona izregistra pacijenata oboljelih od dijabetesa od 2014-2016. Ispitivalismo koliko je pacijenata bilo po spolu te koliko je pacijenata imaloevidentirano i izmjereno: TT, TV i BMI (unutar 12 mjeseci); pregledstopala; urađen monofilamnt test; edukaciju o dijabetesu isamokontroli glukoze u krvi-GUK (unutar 12 mjeseci).

Rezultat Revizija prakse urađena je za 2014, 2015 i 2016 godinu,pregledom 90 kartona po 30 svake godine. Bilo je 19(63%) vs.18(60%) vs. 15(15%) osoba ženskog spola; 11(36%) vs. 12(40%)vs.15(50%) osoba muškog spola. Izmjerenu i evidentiranu TT i TVimalo je 30 (100%) vs. 13 (43%) vs. 20 (66%), a BMI 30(100%)vs.13 (43%) vs. 20 (66%) osoba. Pregled stopala 14 (46%) vs. 7(23%) vs. 12 (40%); urađen monofilamntni test 0 (0%) vs. 5 (16%)vs. 8 (26%). Evidentiranu edukaciju o dijabetesu imalo je 30 (100%)vs. 30 (100%) vs. 23 (76%), a samokontrolu GUKa 29 (96%) vs.17(50%) vs. 15(50%) osoba.

Zaključak Samoevaluacija je pokazala pad u evidenciji ivrijednostima izmjerenih parametara u 2015 godini u odnosu na2014 godinu kao i poboljšanje u 2016 godini. I dalje ima prostora dase poboljša kvaliteta rada od strane timske sestre da se dostigne80% evidentiranih parametara preporučenih od strane Agencije zaakreditaciju FBiH.

Ključne riječi: kvalitet njege, oboljeli od dijabetesa, sestrinskeintervencije

Mersiha Migalo (Travnik, BiH): Diabetes Melitus - revizija prakseUvod:U ambulanti “Kalibunar” koja broji oko 2000 pacijenata uzet jeuzorak od 100 pacijenata koji boluju od DM i koji su praceni ambulantnoi u savjetovalištu za DM. Utvrđeno je da je samo 50 pacijenata urađenHbA1c i od tih 50 je urađen kontrolni kod njih samo 30, zbog nedostatkareagensa,i lošeg viđenja pacijenata. Od 100 pacijenata 18 ih je nainzulinu a glikemije se uglavnom redovno prate (ŠUK, ŠUM i ACETONu urinu) tako se kod pacijenata na inzulinu krece oko 8-12mmol, a kodpacijenata na oralnim hipoglikemicima od 7-8 mmol/L.Metode:Retrospektivno i prospektivno su praćeni pacijenti i njihovevrijednosti ŠUK-a, način ishrane, fizičke aktivnosti i pridržavanjeuzimanja terapije. Nakon utvrđenih podataka došlo se do zakjučka dase HbA1c dosta povećao kod mojih pacijenata što je prethodilouvođenju inzulinske terapije i mjerenju BMI. Starost pacijenata je od 45-65 godina, s tim što se sve više pojavljuje kod mlađe populacije shodnogenetici i načinu života.

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RezultatiBez obzira na način rada i praćenja pacijenata mogu reći da su ŠUK,HbA1c i BMI kod pacijenata slabo kontrolisani. Edukacija pacijenata jejako slaba i nedovoljna. Zbog nedostatka sredstava HbA1c nije urađenkod svakog pacijenta. Rezultati su pokazali da je 45% pacijenata podkontrolom dok su ostali nedovoljno kontrolisani s obzirom na njihovuposjetu ljekaru i ne pridžavanja uputa liječnika.Zaključak: U ambulanti “Kalibunar” 85% pacijenata je na oralnoj terapiji, 15%je na inzulinskoj terapiji koja je pod kontrolom dijabetološkog savjetovališta.BMI i način ishrane se skoro nikako ne prate kao i nedovoljno savjetovanje iedukacija pacijenata kao i psihološka podrška pacijenata koji bi bilipotencijalni kandidati za inzulinsku terapiju.

Inga Marković (Doboj, BiH): Dijetoterapijski pristup ne-inzulinske i inzulinske terapije diabetes melitusa

Uvod i cilj: Dijabetes mellitus je metabolički poremećaj višestrukeetiologije koji karakteriše hiperglikemija izazvana poremećajem u sekrecijiinsulina ili u dejstvu insulina ili oba ova poremećaja zajedno.To jeoboljenje sa poremećajem metabolizma osnovnih makronutrijenata hraneugljenih hidrata,masti i bjelančevina.To je oboljenje koje zahtjevacjeloživotno liječenje uz osnovne principe: dijabetesnu dijetoterapiju samogućim modifikacijama , svakodnevnu fizičku aktivnost i kontinuiranaterapijska edukacija.Kada osnovni principi liječenja nedaju očekivanirezultat, poseže sa za farmakološkim liječenjem.Da bi se postigla dobraglikoregulacija uz farmakološko liječenje moraju biti zastupljeni i osnovniprincipi liječenja.Farmakološka terapija zahtjeva individualandijetoterapijski pristup koji se temelji na karakteristikama lijeka izdravstvenog stanja pacijenta sa ciljem dobre kontroleglikemije.Dijetoterapijski pristup se mora individualizirati te sedijabetesna dijetoterapija mora modifikovati u odnosu na komorbiditeteoboljelog.

Cilj: Prikazati uticaj edukacije i dijetoterapije na kontrolu glikemije

Metode i istraživanja:Istraživanje je obuhvatilo hospitalizovane iambulantne pacijente koji su prošli edukativni serijal u Savjetovalištu zadijabetes i ishranu JZU Bolnica Doboj.Primjenjivan je modernizovaninačin edukacije o dijabetesnoj dijetoterapiji kao i dijetoterapije različitihkalorijskih vrijednosti.Antropometrijske analize vršene su na InBodyanalizatoru kojim se dobijaju podatci o stanju uhranjenosti,količini irasporedu mišićne mase i masnog tkiva,količini visceralnihmasnoća,balansu gornjih i donjih ekstremiteta,ukupnoj količini proteina iminerala,prisutnosti edema,itd.Dijetoterapijska intervencija sprovođena jeuz praćenje laboratorijskih nalaza (KS,ŠUK,HbA1c,ukupniholesterol,HDL,LDL,TRG,UREA,KREATININ,ALT,AST,URIN), dnevnika

samokontrole i dnevnika prehrane.

Rezultat: Pacijenti koji su prošli kompletnu dijetoterapijsku intervencijuimali su mnogo bolje kontrolne nalaze uz dobru regulaciju glikemije isniženje HbA1C bez epizoda hiperglikemije i hipoglikemije.

Zaključak: U liječenju osoba oboljelih od dijabetes mellitusa neophodan jeindividualan dijetoterapijski pristup, praćenje metaboličkog odgovora tijelana pojedinu vrstu namirnice ,prilagođena edukacija, a sve u cilju dobreglikoregulacije.

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SESIJA 4Niki Caggiano: Understanding new oral anticoagulants

As primary care physicians we deal with anticoagulation on a dailybasis. Some of our most commonly seen diagnoses such as afib,TIA and DVT/PE require the use of anticoagulants. In years pastCoumadin was the only oral anticoagulant available. Recently therehave been several new oral drugs released into the pharmaceuticalmarket. We will compare and contrast the oral agents in terms ofbasic pharmacology, mechanism of action, dosing considerations,monitoring concerns, reversibility, bleeding risk and transitioningfrom one agent to another. We will discuss several real life scenariosto decide which drug would be best for the patient.

Mahira Tanović (New York/USA/BHAAAS): Vještinadijagnostike melanoma u ambulanti porodične medicine

SESIJA 5

Suzana Savić, Gordana Tešanović, Kosana Stanetić,Snježana Popović Pejčić, Aleksandra Grbić: Uticajpromjene životnog stila na parameter glikemijske kontrole utipu 2 dijabetesa

Uvod: Rizik od nastanka tipa 2 dijabetes može da se smanjiuvođenjem pravilnog režima ishrane i povećanjem fizičke aktivnosti(Finish Diabetes Prevention Study).

Cilj: Utvrditi postizanje ciljnih vrijednosti glikoliziranog hemoglobina(HbA1c), krvnog pritiska i lipida, kod ispitanika sa tipom 2 dijabetesa,koji su primjenjivali pravilnu prehranu i kontrolisanu fizičku aktivnost.

Metod: Istraživanje je prospektivna studija, provođena u 60 timovaporodične medicine na ispitanicima sa tipom 2 dijabetesa, od 01.oktobra 2012. do 31. oktobra 2013, u Domu zdravlja Banja Luka. Sviispitanici su na početku studije imali individualno savjetovanje opromjeni načina života, navikama u ishrani, regulaciji tjelesne težine iprekidu pušenje.

Rezultati: Istraživanjem je obuhvaćen 591 ispitanik sa tipom 2dijabetesa. Pravilan način ishrane, na početku studije (oktobar 2012)primjenjivalo je 295 (49.92%) ispitanika, a na kraju studije (oktobar2013) 453 (76.65%) ispitanika (Pχ2:p<0.001). Ispitanici koju su

primjenjivali pravilan način ishrane, ciljnu vrijednost HbA1c ≤ 6.5% napočetku studije postiglo je 61.70%, a na kraju studije 86.62%(Pχ2:p<0.001); ciljnu vrijednost krvnog pritiska (≤130/80) na početkustudije postiglo je 56.21%, a na kraju studije 79.91% (Pχ2:p<0.002);ciljnu vrijednost ukupnog holesterola na početku studije postiglo je59.61%, a na kraju studije 81.91% (Pχ2:p<0.003). Najveći procenatispitanika 60.24% je na početku istraživanja imao fizičku aktivnost 1 do2 puta sedmično, dok je bilježen porast fizičke aktivnosti više putasedmično (sa 20.14% na 47.55%), na kraju studije (Pχ2:p<0.001).Ciljnu vrijednost HbA1c imalo je 51.06% ispitanika koji su na početkuistraživanja imali fizičku aktivnost 1 do 2 puta sedmično, a na krajustudije kod 58.53% ispitanika sa fizičkom aktivnosti više puta sedmično(Pχ2:p<0.001), dok su ispitanici sa primjenom fizičke aktivnost 1 do 2puta u najvećem procentu postizali ciljne vrijednosti krvnog pritiska iholesterola. Pušača je na početku studije bilo 102 (17.26%), a na krajustudije 68 (11.51%) (Pχ2:p=0.005). Na početku studije najveći procenatpušača je imao HbA1c > 8.5%, a na kraju studije HbA1c od 7.1 do8.5%. Pušači su imali više vrijednosti krvnog pritiska i holesterola uodnosu na nepušače.

Zaključak: Individualno savjetovanje oboljelih od tipa 2 dijabetesa opromjeni načina života pomaže u postizanju optimalne vrijednostiHbA1C, krvnog pritiska i lipida.

Ključne riječi: Promjena životnog stila, individualno savjetovanje,metabolička kontrola, tip 2 dijabetesa.

Bojan Savić, Suzana Savić, Gordana Tešanović , KosanaStanetić (Banja Luka, BiH): Prevencija u radu porodičnogljekara sa osvrtom na otkrivanje povišene glikemije kod gojaznihbolesnika

Uvod: Dijabetes melitus tip 2 ima karakteristike savremene epidemije.Pored genetskih faktora rizika izuzetno značajan uticaj, kod osobaiznad 45 godina, imaju negenetski faktori rizika (gojaznost, fizičkaneaktivnost, ishrana bogata mastima, pušenje). Preventivne mjere jepotrebno usmjeriti na smanjenje navedenih faktora rizika.Cilj: Utvrditi uticaj povišene tjelesne težina na porast vrijednostiglikemije, lipida i krvnog pritiska, tokom dvogodišnjeg provođenjepreventivnih pregleda.Metode: Studija je provedena u jednom timu porodične medicine,JZU Doma zdravlja Banja Luka. Obuhvatila je 619 ispitanika, kojima

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je u periodu od 01.01.2015. do 31.12.2016. urađen preventivnipregled. Praćen je uticaj povišene tjelesne težina na porastvrijednosti glikemije, lipida i krvnog pritiska, te pušački status uodnosu na pol, životnu dob i godine istraživanja. Statistička analizaje deskriptivnog i numeričkog karaktera.Rezultat: Kod 619 ispitanika je obavljen preventivni pregled: 320ispitanika u 2015. i 299 ispitanika u 2016. Tokom 2015. kod 26 (8.1%)ispitanika sa prvim stepenom gojaznosti glikemija ≥ 7.0 mmol/l jeotkrivena kod 6 (23.0%) ispitanika, kod 17 (65.3%) holesterol ≥ 5.0mmol/l, kod 13 (50.0%) krvni pritisak ≥140/90 mmHg, a 2 (7.7%)ispitanika su bila pušači. Kod 4 (1.2%) ispitanika utvrđen je drugi stepenugojaznosti sa povišenom glikemijom kod 2 (50.0%) ispitanika, povišenholesterol kod 4 (100%), dok povišen krvni pritisak nije zabilježen, a 1(25.0%) ispitanik je bio pušač. Treći stepen gojaznosti utvrđen je kod 1(0,3%) ispitanika sa povišenom glikemijom i holesterolom. Tokom 2016.kod 30 (10.0%) ispitanika sa prvim stepenom gojaznosti povišenaglikemija je otkrivena kod 7 (23.3%) ispitanika, kod 17 (56.6%) povišenholesterol, kod 6 (20.0%) povišen krvni pritisak, a 5 (16.6%) ispitanika subila pušači. Kod 8 (2.6%) ispitanika utvrđen je drugi stepen gojaznosti sapovišenom glikemijom i holesterolom kod 5 (62.5%) ispitanika, povišenkrvni pritisak kod 2 (25.0%), a 3 (37.5%) ispitanika su bila pušači. Trećistepen gojaznosti utvrđen je kod 1 (0,3%) ispitanika sa povišenimvrijednostima glikemije, holesterola i krvnog pritiska.Zaključak: Povišena tjelesne težina značajno uče na porast vrijednostiglikemije, lipida i krvnog pritiska. Potrebno je kontinuirano provođenjeindividualnih mjera prevencije, koje se odnose na promjenu načina životai medikamentni tretman.

Snežana Milutinović Matić, Brankica Udovčić (Banja Luka,BiH): Dijabetički ulkus-prikaz slučaja

Uvod: Infekcije stopala spadaju među najčešće i vrlo ozbiljnekomplikacije šećerne bolesti i javljaju se 21,0% učestalije kod osobaobolelih od dijabetesa u odnosu na opštu populaciju [1,2]. Dijabetesnepromene na stopalu, po tipu ulkusa, predstavljaju važan kliničkiproblem, koji dovodi do infekcije i konačno gubitka ekstremiteta [1].

Cilj: rada je analiza dijagnostikovanog slucaja, analiza faktorarizika,kao i uspesnosti lecenja.

Metodologija: deskriptivna studija.

Rezultati:Pacijentkinja M.J. 41 godište, dvadeset godina je slabopokretna/pokretljivot uz tuđu pomoć i kolica/. Promena na halluxvalgusu korena palca desnog stopala, pogorsala se nakon ocekivanog

smirivanja i prestanka kucnih poseta pacijentkinji.

Zaključak: Češće posete patronažnih sestara, u ovakvim situacijama biimale smisla, u cilju rasterećenja porodice i njihovih odluka /a nisuzdravstveni radnici/ šta uraditi. Lakše bi se došlo do lekara i saveta zadalje i na kraju trebalo bi postojati educirano osoblje za rešavanje ulkusana primarnom nivou, što bi rasteretilo zdravstveni sistem, skratilo danebolničkog tretiranja rana i eventualnog rizika za sekundarnu infekciju.

Kljucne reci (dijabeticki ulkus, tretman, menadzment)

SESIJA 6

Edin Begić, Mensur Mandžuka, Amra Dobrača, NedimBegić (Sarajevo, Maglaj): Display of use of mobileapplication at Primary Health Care Level

Introduction: Mobile applications, applications that are part ofclinical decision support systems in particular, are becomingmore and more popular, even at primary health care level.

Aim: A display of a mobile application whose purpose is toconvert equivalent doses of antihypertensive agents in dosingand titrating patient’s therapy.

Material and methods: The application was developed using themobile development kit Apache Cordova (sometimes usedunder the name Phone Gap), which is distributed under theApache 2.0 license (for development of application JavaScript,HTML and CSS were also used).

Results: In the basis of the application, there are mathematicalformulas (supported by evidence based medicine) that enable ahigh quality and accurate conversion of pharmacologicallyactive substances (ACE inhibitors, beta blockers, Ca blockers,angiotensin receptor blockers (ARBs)). The application enablesthe conversion of equivalent doses within the same group ofACE inhibitors, beta blockers, Ca blockers and ARBs, as wellas the conversion of ACE inhibitors to ARBs. The applicationprovides information on the indication of use of certainpharmacological agent, contraindications and warnings oncertain drug interactions, and it indicates a permissibility ofcombining certain substances. The application also offers aninformation about side effects of certain substances.

Conclusion: Mobile applications, as a tool of modern life, haveits own purpose at the primary level of health care, which allowsthe doctor to find the most optimal mode of treatment of the

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patient.

Keywords: mobile application, antihypertensive therapy,mobile decision support systems.

Emir Hondo (Tešanj, BiH): Choosing Wiselyinicijativa vrijedna I za nas ili možda, nismo jošdovoljno bogati?

Choosing Wisely incijativa ima za cilj promovirati razgovora izmeđukliničara i pacijenata, pomažući pacijentima izabrati zdravstvenuzaštitu koja je: potkrijepljena dokazima, nije dupliciranje drugihispitivanja ili postupaka koji su već urađeni, slobodna od neželjenihpojava, zaista je potrebna. Kao odgovor na ovaj izazov, nacionalneorganizacije u USA koje predstavljaju liječnike specijalista , pitale susvoje članove da „izaberu mudro” identificirajući testove ili postupkekoje obično koriste u svom specijalističkom području odgovornosti čijaupotreba je upitna ili treba biti precizirana. Nastale liste „Stvari okojima se davaoci usluga i pacijenti trebaju zapitati” imaju za ciljpotaknuti raspravu o primjenjivanim testovima ili tretmanima kakonjihovim neophodnostima tako i nedostacima . Ova incijativa seproširila i na područje Kanade, Austrralije i Novog Zelanda. I kod naszbog tehnologizacije medicine, zdravstvenog sistem koji jenekonzistentan, podfinanciran,rasparčan, neracionalan, sapopulacijom koja je sve starija, sa sve kompleksnijom lliničkom slikom,ova incijativa je neophodna kako bi se sa trenutnim zdravstvenimbuđetima pružila što bolja zdravstvena zaštita tj postigla što boljajavna zdravstvena korist.

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INTERNACIONALNI SIMPOZIJ IZ ORTOPEDIJE ITRAUMATOLOGIJE

PROGRAM DAN II

SESIJA: OPŠTA ORTOPEDIJA

Maksim Kovačević (Foča, BiH): NEM u lečenju artroza -činjenice zasnovane na dokazima

UVOD: Atroze u velikoj mjeri utiču na kvalitet života oboljelih ipredstavljaju sve značajniji zdravstveni problem.

CILJ RADA: Analiza literature koja se odnosi na djelovanje Nemtableta kod pacijenata koji se liječe od artroze.

MATERIJAL I METODE: Urađeno je pretraživanje dosadaobjavljene literatura koja se odnosi na Nem tablete odnosnoderivate membrane jajeta.

REZULTATI: Nađeno je devet radova objavljenih u vodećimsvjetskim časopisima koji se odnose na Nem tablete ili naderivate membrane jajeta.U njima se navodi da ovi preparatiimaju efikasnost u liječenju bola i ukočenosti kod gonartroze ikoksartroze, što se obješnjava u radovima gdje se navode senjihovi efekti na produkciju citokina u kulturi mononuklearapri čemu je uočena supresija tumor nekrosis faktora alfa,aktiviranje nuklearnog faktora kapa b in vitro te redukcijaproinflamatornih citokina kod pacova koji su primali ovederivate.

ZAKLJUČAK: Nem tablete su efikasne u smanjenju bolova iukočenosti zglobova kod pacijenata oboljelih od artroza. Sobzirom na to preporučuje se njihova upoterba kodpacijenata sa artrozama kao efikasne dopune ostalihterapeutskih metoda.

Ključne riječi: Nem, artroza,membrane jajeta

Ismet Gavrankapetanović, Sanja Marić (Sarajevo, Foča, BiH):Multimodalna analgezija nakon ortopedskih operacija

Inadequate treatment of postoperative pain after orthopedicsurgical procedures can lead to secondary organ dysfunction in thepostoperative period. Regardless of the progress of medicine

science, postoperative pain is still not adequately treated. Over 40%of patients in hospitals around the world describing the severe painafter various surgical interventions. In order to satisfactorypostoperative analgesia multimodal analgesia administered over twodecades with various modalities adapted to each patient and the typeof surgical intervention. Multimodal analgesia of a mixed analgesicdrugs and methods which aim to create a synergisti mode of pain,which efficiently protects patients from pain management. Anadjuvant psychotropic medications or coanalgesics are drugs that donot have primary analgesic effect, but in certain doses and in certainconditions exhibit a very effective analgesic effect. Coanalgesics canhave undesirable side effects or low potency, or in combination withopioids, opioid-sparing indicating this effect, enable the application oflower doses of the opioid, less side effects and better analgesia. Nowthere is scientific evidence and recommendations for effectiveapplication in the treatment of perioperative pain:antiepileptics,NMDA receptor antagonists, alpha-2-adrenergic agonists, topicalagents. Due to non-noxious component coanalgesics can be used inthe postoperative pain therapy after orthopedic interventions.

Svemir Čustović, Sahmir Šadić, Alen Kamerić (Tuzla, BiH):Tumorozna promjena distalne metafize tibije kod djeteta starog 19mjeseci. Prikaz slučaja.

Hajrudin Kačar, Adnan Kesetović (Tuzla, BiH):Operativno liječenje previdjene luksacije glavice radiusa saplastičnom deformacijom ulne. Prikaz slučaja.

Ismet Gavrankapetanović, Adnan Papović, AdnanaTanović-Talić,Belma Aščić - Buturović, Fuad, Džanković, Mehmed Zahirović(Sarajevo, BH): Učestalost amputacija ekstremiteta kao posljedicakomplikacija diabetesa

INTRODUCTION: Diabetes mellitus represents a state of chronic hyperglycemia,characterized by impaired metabolism of carbohydrates, proteins and fats. It canoccur due to genetic predisposition, but the occurrence is greatly influenced byexternal factors. In fact, diabetes mellitus is diagnosed due to absolute or relativeinsulin deficiency, insulin resistance, increased glucose production and increasedaction of the hormones thathave counteracting effect of insulin. Since the chronic complications areresponsible for most of the morbidity and mortality associated with diabetes, thereare three possible assumptions about the emergence of chronic complications:increased blood glucose leads to the increased formation of the final products ofglucolyse causing faster atherosclerosis and induces endothelial degeneration;

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Chronic hyperglycemia leads to increased production of sorbitol that leads tocell dysfunction; hyperglycemia leading to increased formation of diacylglycerolthat activates some forms of protein kinases that participate in metabolicprocesses causing diabetic complications. Chronic complications of diabeteslead to the development of diabetic neuropathy and angiopathy because ofwhich such patients have 15 times higher incidence of amputation than the rest ofthe population.OBJECTIVE: The aim of this research is to show the number of limb amputations(at any level) that were done at the Clinic of Orthopedics and Traumatology,Clinical Center of the University of Sarajevo in the last 3 years and that wereindicated because of bad treatment of complicated diabetes mellitus.MATERIALS AND METHODS: This study was conducted at the Clinic ofOrthopedics and Traumatology, Clinical Center of the University of Sarajevo.Factors of inclusion in the study were all patients hospitalized because of limbsurgical treatment in last 3 years.RESULTS: The results show that the majority of patients that were hospitalized forlimb amputation are males, belong to elderly age group and are on a long-terminsulin therapy.CONCLUSION: Modern aspects of treatment of diabetic complications requiremulti-disciplinary approach and patient cooperation in order to improve theirgeneral status. If treatment begins on time, it is possible to avoid surgical treatmentin terms of limb amputation. Adequate surgical intervention can also lead to therehabilitation of soft tissue lesions.

SESIJA: REKONSTRUKCIJA – ARTROPLASTIKA ODRASLIH

Željko Jovičić (Banja Luka, BiH): Izbor implantata uprimarnoj artroplastici kuka

Slavko Manojlović (Banja Luka, BiH): Kratkibezcementni femoralni stem u našoj praksi

Zdenko Ostojić (Mostar, BiH): 50 totalnih protezakuka sa prednjim pristupom

Slavko Manojlović (Banja Luka, BiH): Modernatehnika cementiranja u artroplastici kuka i koljena -devet godina iskustva

Enes Kanlić, Benjamin, Geer, Amr Abdelgawad(Chandler, Chandler, El Paso, USA): “Pelvicdissociation” – prikaz slučaja

SESIJA: KIČMA, KARLICA, NOVE TEHNIKE

Aleksandar Vujadinović, Mahir Jašarević, Asmir Hrustić(Tuzla, BiH): Mlada djevojka sa rotirajućom atlanto-aksijalnom subluksacijom kod preloma densa

Enes Kanlić, Benjamin Geer, Amr Abdelgawad(Chandler, Chandler, El Paso, USA): Prelomi karlice iacetabuluma kod starijih osoba

Eldin Karaiković (Chicago, USA): Treatment options for theSacroiliac Joint Pathology

The SI joints allows for some movement and acts as a shock absorberbetween the ilium and sacrum. When this cartilage is damaged or wornaway, degenerative arthritis (osteoarthritis) occurs. This is the mostcommon cause of SI joint dysfunction, just like any other weight-bearingjoints of the body. Other frequentcauses of the SI joint disfuction arepregnancy, lumbar spinal fusion and trauma. We will discuss the etiology,clinical signs, radiology tests and non-operative and operative treatmentoptions for the SI joint dyscussion,giving the emphasis on the newminimally invasive techniques.

Enes Kanlić, Benjamin Geer, Amr Abdelgawad(Chandler,Chandler, El Paso, USA): Primjena “thight rope -endobutton” kod lakta i skočnog zgloba

SESIJA: PRELOMI...

Enes Kanlić, Benjamin Geer, Amr Abdelgawad (Chandler,Chandler, El Paso, USA): Otvoreni prelomi, protokolizasnovani na dokazima i odlukama udruzenja ljekara

Mirza Bisčević (Sarajevo, BiH): Intramedularna fiksacijapreloma dijafize femura

Šadić Sahmir, Čustović Svemir, Kamerić Alen (Tuzla, BiH):Prelomi intramedularne fiksacije kod pseudoartroza nadkoljenice

Senail Sivro (Amsterdam, Holland): Tretman koštanihdefekata u traumatologiji

SESIJA: EDUKACIJA, KAKO BISTE RIJEŠILI “OVAJ” KLINIČKIPROBLEM!?

Marko Ostojić (Mostar, BiH): Ustrojstvo moderne koštane banke

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na Klinici za ortopediju i traumatologiju SKB Mostar – Našaiskustva i planovi

Aleksandar Vujadinović, Nedim Smajić (Tuzla, BiH):Ponovna dislokacija skočnog zgloba nakon odstranjenjafiksacionog materijala

Enes Kanlić, Benjamin Geer, Abdelgawad Amr(Chandler, Chandler, El Paso, USA): Edukacijaspecijalizanata ortopedije i traumatologije u SjevernojAmerici

Senail Sivro (Amsterdam, Holland) : “Propuštenesanse” - klinički slučajevi za diskusiju!

INTERNACIONALNI SIMPOZIJ IZMULTIDISCIPLINARNE ONKOLOGIJE, DAN II

PROGRAM DAN IIDermatology / Malignant melanoma

Munevera Bečarević, Nejra Bećarević,Izet Hasanović (Banovići, BiH): Prevention, screeningand early diagnosis of the most frequent malignantdiseases from a Family doctor’s point of view

Malignant diseases are one of the largest healthy problems today,despite the progress of understanding mechanisms, therapeutic anddiagnostic procedures. The most frequent malignant diseases arelung, prostate, colon, breast, cevical, pancreatic cancer and malignantmelanoma. Only 10% of cancers are caused by genetical factors,which means that the environment and lifestyle have the significantinfluence. Risk factors can be specific and non-specific. Some cancersbeside non-specific, also have specific risk factors. What a familydoctor can do to fight cancers? Patients education about healthylifestyle, and about the specific symptoms could eliminate, prevent, orreduce risks and rate of the illnesses. Knowing and implementation ofthe screening methods for early cancer diagnosis, especially for thepatients with high predisposition, increase a number of the curedpatients. Regular mammography and colposcopy with PAPA test candrastically increased percentage of the cured patients and the years ofsurviving forpatiens with breast and cervical cancer. Digitorectal cexamination andPSA ratio are controversial screening prostate cancer methods, andcolonoscopy and occult blood in a stool test are colon cancerscreeningmethods. All of the procedures are quite available. BiH currentlydoesn't have a cancer cases register neither national cancer screening

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program. According to that, family doctor, considering the riskgroups, is the first and frequently the only one place that implementscreening programs in their teams. Recognizing cancer symptomsand early diagnosing increase patients years of surviving. A familydoctor can reduce rate of the illness by patients educations andpromotion of the health, and also can increase healing percentageand years of surviving by early diagnosing.

Irdina Drljević (Sarajevo, BiH): Dermoscopy and earlymelanoma detection vs small diameter melanoma

Background: Melanoma is a leading cause of death from skindiseases due to potentially lethal nature. Thus, early diagnosis ofmelanoma cannot be overemphasized because thin melanomashave an excellent prognosis. Special difficulties in early detection ofmelanoma lie in melanocytic lesions whose diameter is below 6 mm,hypopigmented and non-pigmented lesions, and regular and ratherclearly defined papular and nodular lesions regardless of their color(differential diagnosis: desmoplastic melanoma, Spitz nevus, Bluenevus). Briefly, there are many reasons to miss the diagnosis ofsmall-diameter melanoma, particularly because melanoma is anexcellent imitator of benign skin tumors. On the other hand, we canalways use clinical, wellknown ABCDE acronym for small-diametermelanomas, and the dermoscopy as an additional diagnostic testoften prevents the application and questions the “excellence” ofknown dermoscopic algorithms.

Method: We have demonstrated several interesting clinical-dermoscopic cases of pathohistologically verified melanoma with thediameter below 6 mm, including a rare naevoid malignantmelanoma. We analyzed gender, age, anatomic localization,dermoscopic structures and pathohistological parameters, especiallyin terms of prognostic factors.

Aim: Emphasize and pay attention to this diagnostic challenge ineveryday clinical and dermoscopic practice. Conclusions: In order torecognize very small melanoma total body skin examination (TBSE)needs to be performed, detailed family and personal anamnesisneeds to be obtained, the clinical ABCDE acronym is to be followedas much as possible and the classical algorithm, so called patternanalysis, should be applied in dermoscopic analysis of a suspiciouslesion. Timely diagnosis and excision of the suspicious lesion withpathohistological verification are crucial for the prognosis, i.e.patient’s survival.

Nermina Hadžigrahić, Azra Hadžigrahić,Emir Bećirević (Tuzla, BiH): Clinical characteristics ofmelanoma and precursors lesion

Malignant melanoma (MM) is derived from neural crest melanocytesand develops mostly from the skin, but also from other tissuescontaining melanocyte such as mucosa, eye and meninges.Cutaneous melanoma is a tumor with poor prognosis and early localand distant metastasis, which incidence has shown a significantincrease for the last few decades around the world. Geneticvulnerability is known to prime certain individuals formelanomagenesis. Moreover, sun exposure, nevi count, and a fairpigmentation phenotype can increase susceptibility to melanoma.Precursor lesions associated with an increased risk of MM are:dysplastic nevus (DN), familiar atypical multiple-mole melanoma(FAMMM) and congenital melanocytic nevus (KN). A metaanalysis ofcase-control studies found that the relative risk of melanoma is.45 inpatient with one dysplatic nevus vs. none, and this increases to 6.36 inthose with five atypical moles. Persons with FAMMM syndrome havea 10-year risk of melanoma of 10.7%, which is 17.3 times higher thanin those without the syndrome. Melanoma is subdivided into foursubtypes, with the most common being superficial spreadingmelanoma (SSM), nodular melanoma (NM), lentigo malignamelanoma (LMM), and acral lentiginous melanoma (ALM). Thesubtypes are important for aetiological and diagnostic purposes, butnot necessarily for prognosis. Superficial MM account for 70% of allmelanomas. They are mostly located in the trunk in males and thelegs in females. Nodular MM is the second most common type with15-30%, mostly at the age of 50-60 years. It is the type with thepoorest prognosis, mostly located in the trunk, head, and neck. It isgenerally diagnosed in the advanced stage. Lentigo MM accounts for5-15% of melanomas and it is usually seen at the age of 60-80 years.Acral lentiginous MM is a very rare type (2-3%) and seen at the age of60-70 years.

Ermina Iljazović (Tuzla, BiH/BHAAAS): Pathology ofskin melanoma and mimics

Today, more than half a century after the first description of Spitznevus (SN) and despite the presence ofmore refined criteria andmolecular diagnostic tools, the distinction between SN with atypical

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features andSpitzoid malignant melanoma (SMM) remains difficult attimes, and prediction of the biological behavior ofthese lesions isoften utterly impossible.Spitz naevus may pose great diagnosticdifficulty due to clinical, dermatoscopic and histologicfeaturesresembling melanoma. Spitz nevi are uncommon nevi thatcan present with a variety of histologicappearances and can occurat any age, although they are most common in children, adolescentsand youngadults. The most common types of Spitz nevi include theclassic spindled and epithelioid Spitz nevus,pigmented spindle cellnevus (Reed’s nevus), spitzoid dysplastic or Spark’s nevus, anddesmoplastic Spitznevus. The angiomatoid variant of Spitz nevuscan be particularly difficult to diagnose. Spitz nevus may beadmixedwith other types of nevi to form a combined nevus. Varioushistologic diagnostic criteria exist (majorand minor criteria), whichcan help differentiate Spitz naevi from melanoma.Assimilation of theclinical presentation, histology, and immunohistochemical andmolecular studies may helpto clarify the diagnosis. When theselesions are misdiagnosed as benign Spitz nevi, there is a riskforundertreatment. Further studies are needed to expand moleculardiagnostics, as well as to confirm whethermolecular findings, suchas homozygous loss of CDKN2A, are sufficient to guide diagnosisand managementof these challenging lesions.

Amra Osmančević (Gothenburg, Švedska):Malignant Melanoma and VitaminD

Vitamin D produced in the skin after exposure to UVB (290-315nm) is a potent molecule important for cellgrowth, cell proliferation,cell differentiation and cell apoptosis. Vitamin D acts throughvitamin D receptors(VDRs), which are expressed in almost all celltypes including cancer cells. VDRs are expressed inkeratinocytes,melanocytes and melanoma cells indicating the potential role ofvitamin D in pathogenesis andprogression of skin cancer. VitaminD can reduce and prevent keratinocytic carcinoma via inhibition ofthehedgehog signaling pathway and upregulation of nucleotideexcision repair enzymes. The incidence ofcutaneous malignantmelanoma (MM) is constantly increasing, which might be due tofrequent intermittentand excessive sun exposure. UVB, but alsoUVA, have carcinogenic effects on skin cells throughdifferentmechanisms involving direct and indirect DNA damages(cyclobutane pyrimidine dimers, 6-4 photoproductsand reactiveoxygen spaces), which activates oncogenes, inactivates tumoursuppressor genes and inducesskin carcinogenesis. Modern life

style implies increasing exposure to UVA which might be moredangerousthan UVB exposure. Moreover UVA can destroy alreadyproduced vitamin D and UVA ant-mutagenicresponses are not aseffective as those induced by UVB (thickening of the skin andinduction of p53 and p16).Although sun-related hypothesis cannotbe directly connected to extra-cutaneous types of MM, thepotentialrole of vitamin D insufficiency due to strict sun avoidingbehavior has been discussed. Some epidemiologicalstudies showthat higher levels of vitamin D are correlated with reduced melanomarisk and improved survival.Considering current knowledge onbiological effects of the sun on vitamin D synthesis, skincarcinogenesis,cell damage repair mechanisms and health ingeneral, short and sensible sun exposure between 11–12 a.m.mightbe most beneficial.

Gordan Srkalović (Lansing, USA/BHAAAS): Role of testingfor BRAFmutation and Tumor Mutational Burden (TMB) in thetreatment of metastatic melanoma

Treatment of metastatic malignant melanoma significantly changedin last few years. Introduction ofimmunotherapy including CTLA-4inhibitors (Ipilimumab) and PD-1/PDL-1 inhibitors(Nivolumab,Pembrolizumab, Atezolizumab, Avelumab) revolutionizedtreatment of B-Raf wild type malignant melanomas.Combinationtreatment involving drugs that produce immune checkpoint blockadethrough different pathwaysproduced patterns of response differentfrom those with molecularly targeted agents andcytotoxicchemotherapy requiring introduction of new nomenclatureand even new response criterias (immune-relatedresponse criterias).Multiple studies such as Keynote-002, Check-Mate 066 and 037showed significantactivity of these drugs in the treatment ofmetastatic melanoma bringing them to the frontline of thetherapy.However, markers of treatment activity are still elusive.Multiple attempts to promote predictive value of PD-1receptorsexpression gave very mixed results. Analysis of human gutmicrobiome could be of value, but itseems it is still too early for anymajor conclusions. Recently was found that tumor mutational burden(TMB)calculated from deep gene sequencing results correlates withresponse to check point inhibitors. Additionalstudies are ongoing andhopefully we will be able to identify tests or set of tests that wouldidentify bestcandidates for immune check point inhibitors treatment.Much more clear is situation with metastaticmelanoma patients whohave BRAF V600E somatic gene mutation. Roughly 40-50% ofpatients will have thisactivating mutation that stimulates growth of the

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malignancy through MAP-kinase/ERK signalingpathway.Medications blocking mutant BRAF kinase such asvemurafenib or dabrafenib showed to produceimprovement inoverall survival when compared to cytotoxic chemotherapy. In thepresentation effects of single drugs and combinations will bediscussed.

Jasmina Alidžanović (Tuzla, BiH): New approaches in thetreatment of metastatic melanoma

Metastatic melanoma is highly malignant disease with a very poorsurvival rate. A long-term survival in patients with distant metastaticmelanoma has been less than 10%. Melanoma expresses veryaggressive biological behavior and rapidly develops treatmentresistance, which makes melanoma responsible for 80% ofmortality of all skin tumors. Therapeutic options for metastaticmelanoma are constantly increasing with the recent developmentof novel agents, which demonstrate better efficacy thanconventional chemotherapy. The first generation of novel targetedand immunotherapy agents (ie. vemurafenib, dabrafenib,ipilimumab) yielded significantly improved response rates andoutcomes compared with standard chemotherapy. Subsequently, anumber of ongoing or recently completed phase II and phase IIItrials with new immunotherapies, targeted therapies andcombination regimens provided noticeable effective agents andcombined protocols, which are now available for treatment ofadvanced metastatic or unresectable melanoma. Unfortunately, inFederation of Bosnia and Herzegovina, the only treatment financedby the social health care system includes traditional chemotherapyregimens. The goal of this presentation is to demonstrate results ofnew clinical trials with innovative drugs, in order to emphasize theneed to include such treatments in our daily practice and offerthese patients better treatment strategies.

Inga Marijanović (Mostar, BiH): Adjuvant therapy of malignantmelanoma

Oncology

Lina Rayan Duranović, Alma Ćupina, Edin Bećiragić(Sarajevo, BiH): Significance of platelets and neutrophilto lymphocyte ratio in patients with small cell lung cancer

Background: Increased platelet number has been shown as agood indicator of neoplastic disease. There is evidence thattumour cells secrete humoral actors which may lead tothrombocytosis which could be related to metastasis. The

neutrophil to lymphocyte ratio (NLR), representing a combination ofcirculating neutrophil and lymphocyte counts, can reflect theimbalance between neutrophils and lymphocytes in patients withtumors and serves as a representative index of systemicinflammation. NLR, calculated from peripheral blood tests, wasidentified as an independent prognostic biomarker related to poorsurvival in numerous cancers (e.g.colorectal, breast, gastric andesophageal cancer). Objective of this study is to evaluate usefulnessof platelet counts and neutrophil to lymphocyte ratio in patients withSCLC at the moment of diagnosis as an indicator stage of disease.

Method: We retrospectively reviewed 130 patients who werediagnosed with SCLC between 2012.to 2014. In Clinic for lungdiseases, University Clinical Centre Sarajevo.Results: SCLC was more common in male patients (78.5%) thanfemale patients (21.5%). Most had extended stage disease at themoment of diagnosis (55.38%), while the rest had limited stage(44.6%). Mean platelet number was slightly increased in patientswith extended stage - 324.44 (+/-134.52), while in patients withlimited stage mean platelet number was 295.58 (+/- 100.5). Thereweren't statistically significant differences in platelet number in eitherstage (T test 1.362, p=0.087). We found that difference in neutrophilto lymphocyte ratio (NLR) in extensive and limited disease wasstatistically significant (t test=-1.9, p=0.025).Conclusion: According to this results, platelet number is not useful asprognostic indicator in patients with SCLC. NLR could be significantindicator of disease stage in patients with SCLC. Limitations of thisstudy are: the sample size was relatively small and there are severallimitations inherent to its design, including the retrospective datacollection.

Alma Mekić Abazović, Hakija Bečulić,Senad Dervišević (Zenica, BiH), BranislavaJakovljević (Banjaluka, BiH): Accidentalnodijagnosticiran timoma

Timur Cerić (Sarajevo, BiH): Uloga CDK 4/6 inhibitora ulijecenju karcinoma dojke

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INTERNACIONALNI SIMPOZI IZ INTENZIVNEMEDICINE

PROGRAM DAN IITematski dio (Intenzivna medicina u neurologiji)

Nataša Milivojevič (SLO): Liječenje intrakranijalnogpritiska: Dekompresivna kraniotomija – našaiskustva

Igor Antončić (HR): Monitoring intrakranijalnogpritiska: Naša iskustva

Alma Šakušić (BiH): Kognitivne promjene nakonboravka u ICU

Lauren K. Ng (USA): Menadžment krvnog pritiskakod bolesnika sa povišenim intrakranijalnimpritiskom PROBLEMI JAVNOG ZDRAVLJA

25. Majski pulmološki daniOpšti dio I

Ognjen Gajić (USA): Prakticni pristup pacijentu sarefraktornom akutnom hipoksicnom respiratornominsuficijencijom

Emir Festić (USA): Dodatna terapija kod teskogARDS-a

Vladimir Krajinović (HR): ECMO u liječenjunajtežih formi ARDS-a – naša iskustva

Aida Mujaković - Evaluation of PreoperativePulmonary and Cardiac Risk for NoncardiothoracicSurgery

Postoperative pulmonary complications are defined as the secondmost common postoperative complication in general surgery whilepostoperative cardiovascular and cerebrovascular complicationsappear with 3% incidence, according to recent ten-year patientfollow-up in USA. The achievement of adequate preoperativeevaluation of pulmonary risk reduces such complications classifiedas major and minor and thus consequently the perioperativemorbidity and hospital stay. Age over 60 years, pre-existing lungdisease, smoking and previous spirometric changes (FEV1) areassociated with high pulmonary risk. Currently, there are no

validated stratification models of pulmonary risk in general surgery.However, the American College of Physicians adopted some scalesfor assessing the risk of specific respiratory complications, such asacute respiratory failure and pneumonia. The American Society ofAnesthesiologists has developed a risk score for prediction ofrespiratory complications in patients with OSAS. Cardiac risk modelsestimate the risk based on information obtained from the history,physical examination, electrocardiogram and type of surgery. Forassessment of preoperative cardiac risk, we use either the revisedcardiac risk index (RCRI), also referred to as the Lee index or theAmerican College of Surgeons’ National Surgical QualityImprovement program risk (ACS-NSQIP) model calculator. TheGupta MI or cardiac arrest (MICA) calculator is defined as a simplerNSQIP database tool. Preoperative evaluation and patientsassessment represents important doctor-patient interaction, leaving aclear pathway to a surgeon for overall healthcare status assessmentmaking optimal plans for the best optional surgical procedure.Thereby patient acquires realistic access to the planned surgicalprocedure reviewing alternatives of the treatment and becomingaware of the possible postoperative complications.

Daniela Lončar - Kardioverzija–defibrilacijaistosmjernom strujom: jedini uspješan modalitetliječenja kod smrtonosnog trovanja Propafenonom.

Rytmonorm (generički naziv: propafenon) je lijek koji se umedicini najčešće koristi za prevenciju supraventrilularnihtahikardija, poput fibrilacije atrija, tahikardije iz AV čvora, Wolf-Parkinson-Whiteovog sindroma, paroksizmalnih fibrilacija atrijate za liječenje teških ventrikulskih tahikardija ako premamišljenju ljekara ugrožava život. Ritmonorm pripada IC klasiantiaritmika a djeluje na način da blokira Na+ kanaleusporavajući influks natrijevih iona u stanice sprovodnogsistema srca. Međutim, poslije primjene većih doza djeluje i naspore Ca2+ kanale, usporavajući tako transport iona kroz obatipa kanala, što dovodi do usporenja provođenja kroz sprovodnisistem srca, ali i redukcije provođenja i produžavanjarefrakternog perioda eventualnih akcesornih puteva.Propafenon se dobro resorbuje iz GIT-a (oko 95%), ali jebiološka iskoristivost mala, tek 12%. Gotovo sva metabolizacijalijeka odvija se u jetri, a u krvnom optoku se 95% lijeka vezujeza proteine plazme, zbog čega hemodijafiltracija u liječenjueventualnog predoziranja nema nikakvog efekta. Početna doza

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koju kliničaripropisuju bolesnicima uglavnom je 150 mg lijeka,dva do tri puta dnevno, dok bi maksimalna doza bila dva putaveća. Lijek se isključuje ukoliko se QRS kompleks na EKG-uproširi preko 20% u odnosu na prvobitno stanje. Propafenon,kao i svaki drugi lijek, ima svoje nusefekte, a koji se najčešćeispoljavaju na kardiovaskularni, centralni nervni igastrointestinalni sistem. Bitno je istaći da i male, terapijskedoze lijeka mogu dovesti do intoksikacije. Propafenon je ustanju da, kao i svaki drugi antiaritmik, napravi komplikaciju uvidu nove aritmije. Najčešća neželjena dejstva lijeka su:

- gastrointestinalni sistem: metalni okus lijeka, suhoća usta,smanjenje apetita, mučnina, nadutost, povraćanje, diareja ikonstipacija,

- kardiovaskularni sistem: poremećaji provođenja kao što suPQ prolongacija, proširenje QRS kompleksa, ventrikularnatahikardija, smanjenje kontraktilnosti (negativni inotropskiefekat), hipotenzija i druge, te na

- CNS: glavobolja, zamućen vid, parestezije, vrtoglavica.Konvulzije, somnolencija, koma i respiratorni arest teži susimptomi trovanja propafenonom.

Do 2009. godine opisano je oko 60 slučajeva namjernog ilinenamjernog trovanja lijekom. Jedna retrospektivna studijapokazala je da je smrtnost predoziranja propafenonom 23%.Najraniji simptominintoksikacije propafenonom javljaju se polasata po ingestiji velikih količina lijeka, a u vidu mučnine,povraćanja i gubitka svijesti. Veoma je bitno pravovremenodijagnostikovati i zbrinuti bolesnika. Najvažnija dijagnostičkametoda kod trovanja propafenonom jeste elektrokardiografija,na kojoj se najčešće nađe proširenje QRS kompleksa,prolongacija QT intervala i atrioventrikularni blok. U slučajuprolongacije QT intervala potrebno je uraditi i nalazeelektrolita u serumu. Razina lijeka u serumu može se utvrditiali nije od izuzetne pomoći prilikom zbrinjavanja bolesnika.Bitno je pratiti krvni tlak i funkcionalni status jetre.

Liječenje Pokušaji eliminacije hemoperfuzijom su ograničenedjelotvornosti. Zbog izrazitog vezanja za proteine plazme (>95%) i velikog volumena distribucije, hemodijaliza nijeučinkovita. Dodatno je, uz opće hitne mjere, potrebno pratitivitalne pokazatelje bolesnika u jedinici intenzivne skrbi te ihpo potrebi regulirati. Za kontrolu srčanog ritma i krvnog tlakaučinkovita je defibrilacija, kao i infuzija dopamina iizoproterenola. Intravenska primjena diazepama ublažavakonvulzije. Mogu biti potrebne opće potporne mjere, kao što

su mehanička pomoć pri disanju (upotreba respiratora) ivanjska masaža srca.

PRIKAZ SLUČAJA: Pacijentica životne dobi 19 godina liječenaje u Klinici za interne bolesti od 2.1. do 4.1.2016. godine zbognamjernog trovanja Propafenon (Rythmonorm) tabletama.

Iz anamneze: Bolesnica hospitalizirana zbog suicidalnogtrovanja tabletama Propafenona (Rythmonorm), popila 32 tbl.Prethodno pregledana od strane neurologa (zbog poremećajastanja svijesti po tipu somnolencije). Po prijemu u Odjeljenjeintezivne terapije i njege odmah se pristupi kardiopulmonalnojreanimaciji zbog bezpulsne srčane aktivnosti i dispneje, tebizarnih QRS kompleksa na monitoru, što se protumači kaoproaritmogeno dejstvo Rytmonorma. Pacijentica tokomreanimacije primila u više navrata ampule Adrenalina i Atropina,a elektrokonverzija zbog ventrikularne fibrilacije rađena 30-takputa.Tokom slijedeća dva dana dolazi do postepenestabilizacije kliničkog stanja nakon čega bolesnica postajeuznemirena i navodi da će ponovo pokušati suicid, te sekonsultuje psihijatar i indicira premještaj u Psihijatrijsku kliniku.

Iz statusa:Bolesnica pri pregledu svjesna, teže komunikativna,verbalni kontakt se nakratko uspostavlja ali se ne održava uželjenom pravcu, eupnoična, afebrilna. Srednjeosteomuskularne građe i uhranjenosti. Koža tamnijeg kolorita,očuvanog turgora i elasticiteta. Vidljive sluznice dobroprokrvljene. Dostupni limfni čvorovi nisu uvećani. Odaje utisakteškog bolesnika. U predjelu desnog gornjeg očnog kapkahematom (1x1 cm) smeđkaste boje i stara ekskorijacija 2 cm.Lice u miru i pri mimici simetrično.

Thorax :Srednje velik, pravilno sveden. Respiratorno simetričnopokretan.Pulmo: Perkutorni plućni zvuk sonoran. Auskultatornonormalan disajni šum. Cor: po prijemu akcija srca ritmična,tonovi tihi bez pat.šumova. CP: filiforman puls 90/min. TA:50/20 mmHg. Abdomen: u nivou grudnog koša, mekan.Palpatorno nije bolno osjetljiv na duboku i površnu palpaciju.Jetra i slezena se ne

palpiraju. Bubrežne lože nisu bolno osjetljive na sukusiju.Extremiteti:prisutni, simetrični, pokretni bez otoka, deformiteta ivarikoziteta. EKG (prilikom prijema): sinusni ritam, fr. 60/min.,široki QRS kompleksi. Kontinuirani EKG monitoring: asistolija,VT, VF. Kontrolni EKG (sljedeći dan): sinusni ritam, fr. 70/min,.Bez znakova za aktuelnu ishemiju miokarda Kontrolni pregled:EKG, UZ srca, lab. nalazi: uredni.

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Senita Beharić – Pediatric Thoracic Anesthesia -Case Report

Introduction: Surgical interventions, including video-assistedthoracoscopic surgeries, are increasingly being performed in theneonatal and pediatric populations. Pediatric thoracic proceduresprovide an enormous challenge for even the most experiencedpediatric anesthesiologist. These include assessment of thepatient’s clinical condition, obtaining and maintaining single lungventilation (SLV), and maintaining adequate ventilation andoxygenation while the surgery is in progress.

Background: The common infectious causes for thoracic surgicalinterventions in children are: empyema, lung abscess andbronchiectasis. Pneumonia often leads to the development of aparapneumonic effusion, which in less then 5% of cases fails toresolve and subsequently evolves into a located collection of pusorempyema. General anesthesia is often necessary for theinsertion of the initial chest tube and may subsequently benecessary for open thoracotomy and decortication, if tubedrainage and intravenous antibiotics fail to resolve the empyema.The indication for SLV and the airway management shouldalways be discussed thoroughly with the surgeon in order totailor the effort, complexity and risk of airway management to theneeds of the patient.

Results: We present the case of a 4-year old boy withpleuropneumonia, who required general anesthesia forthoracotomy, decortication and atypical lung resection.Perioperative and postoperative care of such patients is reviewedand strategies for intraoperative anesthesia are discussed.

Discussion and conclusion: Patients are often small and mayhave significant respiratory disease, surgery is

technically difficult and may compromise both the cardiovascularand respiratory systems, and the procedures may result insevere postoperative pain. Ensuring adequate monitoring,intravenous access and blood replacement, and constantcommunication with the surgeon about developing situations areessential to success.

Key words: Pediatric thoracic anesthesia, SLV in children

Opšti dio IIAlan Šustić (HR) – Ultrazvuk pluća

Cassie Clements (USA): Sepsa - rano prepoznavanjei tretman u službi hitne pomoći

Guillaume Thiery (FRA): Ekonomicna intenzivnanjega u uslovima limitovanih resursa; Šta je zaistavažno?

SUBOTA27.05.2017.

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INTERNACIONALNI SIMPOZIJ IZNEUROHIRURGIJE I SPINALNE HIRURGIJE

PROGRAM DAN III

Bruno Splavski (Osijek, Hrvatska): Djela umjetnosti umedicini i neurohirurgiji

Physicians have used visual art to teach anatomy and understandthe workings of the human body for millennia. Medicine and artswere jointly connected throughout the ages having a mutual purposeof better understanding and explaining diseases. Illustrations ofdifferent medical conditions were frequently found in the works of artmade by artist from the antic times to the modern art. Much of themedical information in the middle ages was derived fromcommentaries on Hippocrates, Aristotle, and Galen written byIslamic scholars and illustrated by renowned artists of the time. Yet,not before the renaissance the misconceptions about therelationship between structures and function of the human bodywere corrected away due to practical anatomical work of Vesaliuswho was the greatest scholar of his time and beyond, as well asfamous artists such as Leonardo and Michelangelo. Surgery ingeneral, as well as neurosurgery in particular were exceptionallybeneficial from the detailed anatomical drawings dating back to thevery beginning of civilization, continuing through the middle agesand renaissance up to nowadays. Surgeons have successfullyutilized art to comprehend the human body functions for millennia.Therefore, the legacy of art in modern medicine includingneurosurgery is well documented and dutifully confirmed. Art is stillvery much involved in improved understanding of the human bodyinfluencing up-to-date medical knowledge. The works of visual arthave always set out to lay the knowledge of the human body whichis derived from anatomy and subjected to medical science that issuitable to a manual procedure.

Jacob Bergsland (Tuzla, BiH / Oslo, Norveška):Izazovi u razvoju Centara izvrsnosti u BiH

With a population of 4 million, BIH has a population large enoughto develop expertise in all major medical specialties. In a number

of areas, for example transplantation, successful programs have not beenaccomplished, due to fragmentation of society in both the political andmedical arenas. Factors that could drastically improve advanced medicalservices in the country include: 1) Strengthening of BIH Medical Societiesand weaken political influence, 2) Analysing and defining needs andgeographical distribution, 3) Reorganise hospital organisational models,4) Transparent publication of clinical results, 5) Improved opportunities forprivate sector, 6) Free patient choice of provider, 7) Eliminate corruptionand create a favorable economic situation for highly specializedpersonnel. BIH has educated high quality medical staff before, during andafter the last Balkan wars. Many of the best have left due to economical,organisational and political issues. The profession overall is weak andimproperly controlled by politicians. It is necessary for leaders within themedical profession to mobilize to ensure proper balance between thedifferent forces within the medical care system.

SESIJA: TUMORI MOZGA 1

Mustafa Baskaya (Madison, WI, SAD): Ulogatopografske anatomije u tretiranju tzv. inoperabilnihtumora mozga

Tarik Mašić (Sarajevo, BiH): Transfacijalni pristup bazilobanje

Janez Ravnik (Maribor, Slovenija): Operacije tumoracentralne baze lobanje: endoskopski, mikroskopski ilikombinirano

Mirsad Hodžić, Zlatko Ercegović, Mirza Moranjkić,Harun Brkić (Tuzla, BiH): “Benigni” tumori baze lobanje:uspostavljanje dijagnoze i tretman

Background: Skull base tumors arise from the cranial base or reach it,either from an intracranial or extracranial origin. These tumors presentunique management challenges because of their relative rarity, typicallydeep location, close proximity to critical neurovascular structures, andextension beyond classically taught anatomic and specialty boundaries.Management outcomes for skull base tumors are maximized when theirtreatment is approached in a multidisciplinary fashion, utilizing theknowledge base of varied medical, surgical, and radiotherapeuticspecialists.Methods: The study population consisted of the patients underwent surgery

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for skull base tumors identified retrospectively from January 2012 toJanuary 2017. Of the 571 patients surgicaly treated for intracranialtumors, 146 underwent surgery for skull base tumors.Patohistological diagnosis and treatment wereevaluated.Results: The average age of the patients was 37 years, between 20and 75. Most of the patients (64 or 44%) were treated formeningiomas and for pituitary adenoma (62 or 42%). The rest of theskull base tumors were schwannoma (5 or 3.5%), epidermoid tumors(5 or 3.5%), craniopharyngioma (5 or 3.5%) and metastasis (5 or3.5%).Conclusion: Whereas location is the most important consideration forsurgical planning, the tumor’s biologic behavior dictates the need forthe various available therapies needed to optimize patient outcome.The outcome of surgery for basal tumors depends on the type, size,and location of the neoplasm, patient’s age and general medicalstatus, and extent of preoperative neurologic disability.Key words: skull base tumors, diagnosis, treatment

Goran Lakičević, Bruno Splavski, MarijanaKarlović- Vidaković, Marko Bošnjak (Mostar,BiH): Pouzdanost visoko-intenzivnog 3T MRInalaza mozga u procjeni gradusa glioma

Aim. Glioma is predominant adult primary brain tumor havingvarious malignancies ranging from low-to highgrade.Currentradiological brain imagining techniques like multi-sliced computedtomography (MSCT) andhigh-field 3Tesla magnetic resonanceimaging (3T MRI) are recently becoming more accurate indetectionand classification of such tumors. Nevertheless, tumorhistopathology still remains customary for gliomagrading. Thepurpose of this article was to estimate reliability of theseradiological techniques in contemporarybrain glioma diagnosticsand grading.Methods. A diagnostic protocol for brain gliomapatients was established in a pilot single-institution study.Itincluded conventional, high-resolution MSCT, and high-field3Tesla whole brain T1 and T2-weighted nonenhancedand post-contrast MR brain scanning. The tumors were allocated into low-grade versus high-gradečević 04/04/2017glioma groups accordingto the two-tier imaging grading system based on analyzingdifferent parameters(intracranial mass effect, tumor borders,perifocal edema, signal intensity heterogeneity, and tumortissuecontrast enhancement, hemorrhage and central necrosis).The difference between the glioma groups wasstatistically

analyzed.Results. A high-field 3T MRI differentiated infiltrating gliomafrom surrounding perifocal edema and/or normaltissue better,distinguishing increased tumor cell density and vascularity withinenhancing lesions. A highresolutionMSCT brain scanning did notdiscriminate malignant glioma from other glioma grades accurately,due toits reduced sensitivity and specificity.Conclusion. Considering our results,a high-field brain 3T MRI is a reliable diagnostic method to estimatetumormalignancy grades. Introducing 3T MRI method in daily clinical practicemay provide gliomamanagement with valuable diagnostic informationpreceding surgery.

SESIJA: TUMORI MOZGA 2

Kenan Arnautović (Memphis, TN, SAD):Parasagitalni meningeomi: paradigma tretmana

Zulejha Merhemić (Sarajevo, BiH): Extra-axialni tumornimozga

Extra-axial brain tumors are the lesions that not extend from the brainparenchima. Extra-axial tumors are responsible for approximately half ofall intracranial neoplasms in the USA. Meningeal tumors are the largestcategory of extra-axial CNS tumors divided into menigiomas andmesenchymal tumors. Meningiomas are the most common extra-axialbrain tumor (approximately one-third of all intracranial neoplasms) andtypically present as slowly growing dural-based masses. Second largescategory are tumors of cranial nerves: schwannoma and neurofibromas.Pituitary tumors, Pineal tumos and tumor like lesions mostely cyst belongto extra-axial masses. Understanding of the radiological anatomy andanatomical relationship of the lesion is essential for differential diagnosisand tretmant planning.Magnetic resonace imaging (MRI) has become thegold standard bicause of its capability of tissue characterisationComputed tomography (CT) allows evaluation of bony anatomy and bonyinvolvement.. We present an overview of the most relevant MRI and CTcharacteristics together with clinical findings of extraxial brain tumors.

Rosanda Ilić, Mihailo Miličević, Dragan Savić, AleksandarStanimirović, Danica Grujičić (Beograd, Srbija): Tretmandifuznog nisko-gradusnog glioma: naša iskustva

We present the series of patients operated in Department ofNeurooncology, Clinical Center of Serbia between January 1st 2008 toDecember 31st 2012. The number of patients with available follow updata was 68. Average age at the time of diagnosis was 36 years, with

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equal gender distribution. Most frequent presenting symptom wasepilepsy, in 50% of patients and average time from symptomsbeginning to diagnosis was 4,2 months. Radical resection wasachieved on 47% of entire number of patients. In group of thepatients where radical resection was attempted, it was successfulin 69% of patients. Biopsy was performed in 6% of patients.Worsening of existing neurogical deficit or new deficit was presentin 12,5 %. All patients were with ECOG PS 0-2. Mortality was 0%.Radiotherapy was performed in 44% of the patients, because ofresidual tumor in 33% and in 11 % after progression. 21% ofpatients were reoperated, 8% because of residual tumor, and 13%at the time of progression. Progression to higher grade wasproven in 10% (all the patients progressed to glioblastoma). Meantime to progression in higher grade was 3,9y. Overall 2-yearsurvival was 98,3% and 5-year survival was 88,4%. Maximal saferesection is the gold standard in low grade glioma treatment.Radical resection was predictor for longer survival. Reoperationshould be performed for residual tumor, if radical resection couldbe expected. Radiotherapy is reserved for the patients withresidual tumor that cannot be resected without neurologicaldamage.

Mirza Pojskić1, Kenan Arnautović2

(1Marburg, Nejmačka; 2Memphis, TN, SAD):Intrakranijalni zahvati u prone poziciji

The prone position is commonly used for approaches to the posteriorfossa, pineal and suboccipital regions, posterior parietal and occipitalregions, and posterior approaches to the upper cervical spine.Because of the relatively high complication rate and disadvantagesof the sitting and semi-sitting positions, especially the risk of venousair embolism, the prone position and its modifications (Concorde andarm-down Concorde) are becoming more important for everydaysurgical practice. In this work we discuss the physiology of the proneposition and its general and specific considerations for positioningthe patient for lesions of the posterior fossa and pineal region, aswell as complications.

Bruno Splavski, Vjenčeslav Vrtarić, Irina Bagić,Marko Kovačević (Osijek, Hrvatska): Simpletumor localization scale as a prognostic tool inintracranial meningioma surgery

Aim. The overwhelming majorities of intracranial meningiomas,

which are primary tumors located extracerebrally and generated fromarachnoid cup cells, are surgically well manageable. However, thesurgical outcome still stays heavily interconnected with the extent ofsurgical resection (Simpson Grading), as well as the tumor’s endocraniallocation. The purpose of this study was to investigate the correlationbetween tumor location and outcome and to validate the prognostic valueof the proposed simple localization scale in intracranial menigiomasurgery.

Methods. During the last couple of years, 243 single-institution patientswith intracranial meningiomas were operated on and their data wasanalyzed in a cross-section review. Depending on the location of thetumor, the patients were divided into the group with peripheral and thegroup with central tumor position. Karnofsky Performance Scale (KPS)and Glasgow Outcome Scale (GOS) were employed as the outcomemeasures at hospital discharge, and at one year follow-up, respectively.

Results. The correlation between tumor location and both measures ofoutcome was statistically significant (p<0.001).

Conclusion. Considering the results of this study, it seems that peripheraltumor location is more favorable in comparison to central one which isunfavorable due to the nearness of vital neurovascular structures. Simpletumor localization scale may be proposed as a prognostic tool inintracranial meningioma surgery.

Ibrahim Omerhodžić, Salko Zahirović, Almir Džurlić, AdiAhmetspahić, Dino Lisica, Bekir Rovčanin, EldinBurazerović (Sarajevo, BiH): Hirurški pristup rijetkim lezijama ustražnjoj lobanjskoj jami

The posterior fossa is a tight intracranial space cradled by bone and by thetentorium. Expansion of a mass in this infratentorial area occurs at theexpense of the normal structures in the region and may result in brainstem or cerebellar dysfunction. The majority of lessions there are eithermedulloblastomas, cerebellar astrocytomas, brain stem gliomas, orependymomas. Other tumor types, which may arise less frequently,include choroid plexus papillomas, germ cell tumors, and dermoid lesions.Surgical treatment of rare tumors as subependymomas, dermoid tumors orepithelioid hemangioendothelioma etc. will be presented.

SESIJA: CERBROVASKULARNA HIRURGIJA

Mustafa Baskaya (Madison, WI, SAD): Uloganeuroanatomije u tretiranju kompleksnih neoplazmi ivaskularnih lezija

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Mehmet Tonge (Istanbul, Turska): Šta je novou Deep Brain Stimulation?

Mirza Moranjkić (Tuzla, BiH):Endovaskularni menedžement AVmalformacija CNS-a: neurohirurškaperspektiva

Cerebral arteriovenous malformations (AVMs) and dural AV fistulas(dAVFs) are complex high-flow lesions that can result in devastatingneurological injury when they cause hemorrhage. Endovascularembolization is a critical component in the management of manypatients with cerebral AVMs. Embolization may be used as anindependent curative therapy or in an adjuvant fashion prior to eithermicro- or radiosurgery. Even though recent randomized trials haveshed some light on natural history and treatment morbidity forpatients with unruptured AVMs, treatment protocols for these patientscontinue to vary considerably between institutions. We present asingle-center experience with endovascular AVM treatment.

Adisa Kuršumović (Deggendorf, Njemačka):Sadašnji trendovi u endovaskularnom tretiranjuakutnog ishemijskog moždanog udara

Feridun Acar (Denizli, Turska): Trendovi uGamma Knife radiohirurgiji

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SESIJA: SPINALNA HIRURGIJA

Eldin Karaiković (Chicago, IL, SAD): IntraoperativeStereotactic Navigation and Robotics in Spine Surgery

We will discuss the latest advancements in intraoperative navigationusing computer guided systems andapplications of the robotics in thespinal surgery. The need for the accuracy in placement of the pediclescrewsand other devices in spinal surgery in order to avoidcatastrophic complications in patients is the primarymotivation indevelopment contemporary advanced computer guided systems.Although the idea of usingimaging to guide to help placement ofspinal implants is not new the explosion of the new very accurateandapplicable systems on the market is recent. Technology, benefits,risks, complication and costs of thesesystems will be discussed.

Matjaž Voršić (Maribor, Slovenija): Minimalno invazivnastražnja međupršljenska fuzija kod degenerativne bolestilumbalne kičme

Mirza Biščević (Sarajevo, BiH): Operativni tretmanhemivertebri

Salko Zahirović, Ibrahim Omerhodžić,Adi Ahmetspahić, Almir Džurlić, Dino Lisica (Sarajevo,BiH): Unilateralni mikrohirurški pristup sa centralnom ibilateralnom dekompresijom i foraminotomijom u tretmanustenoze lumbalnog dijela kičme

OBJECT: The authors studied a consecutive series of patients withspinal stenosis in whom surgery was performed by a single surgeonwho used a microscope and high speed drill. Patients underwentprospective evaluation involving radiography, CT and magneticresonance (MR) imaging. The objective was to assess the feasibilityand surgery-related efficacy of performing unilateral-approachbilateral and central decompression in patients with spinal stenosis.METHODS: This is a short report of our large prospective studywhich we started one year ago. Thirteen consecutive patients withspinal stenosis underwent central and extensive bilateraldecompression followed with foraminotomy of both nerve roots.Surgery was performed using the unilateral approach techniquewith utilization of microscope and high speed drill. The procedureswere performed after induction of general anesthesia. Preoperativeradiographs and CT were obtained. Preoperative and earlypostoperative MR imaging was also performed. Nineteen levels

were surgically decompressed. The mean operative time was 50 minutesper level. All patients had improved low back pain and the distance thatpatient can walk in first days after surgery. Early (3-month) postoperativeMR imaging shows no evidence of progression in any case.CONCLUSIONS: Minimally invasive bilateral and central decompressioncan be successfully performed via a unilateral approach in patients withacquired spinal stenosis. The procedure can be undertaken on aninpatient basis with short stay in hospital (24-48 hours), reasonableoperative times, minimal blood loss, costbenefit and acceptable morbidityrates.

Adi Ahmetspahić1, Ibrahim Omerhodžić1, Edin Hajdarpašić1,Salko Zahirović1, Almir Dzurlić1, Kenan Arnautović2(1Sarajevo, BiH; 2Memphis, TN, SAD): Four levels ACDF formultiplelevel degenerative disc disease:safe and surgicalprocedure 1. Semmes Murphy Clinic, Memphis Tennessee, USA2. Clinic of Neurosurgery, Clinical Center of University inSarajevo, Bosnia and Herzegovina

Introduction: Degenerative disc disease (DDD) is a spine abnormalitiywhich includes discs degeneration, osteophyte formation, spinal andneural foramen stenosis resulting in neck pain and variety of neurologicalAdi Ahmetspahić 04/15/2017 deficits. Since surrounding structures outsideof the disc are ussually also involved, the term degenerative spine diseasemay be more preferable (DSD). Anterior cervical discectomy and fusion(ACDF) is a surgery designed to relieve spinal cord and nerve rootcompression by removing the anterior and posterior longitudinal ligaments,i.v. disks, osteophytes and deompressing the spinal cord and spinalnerves. Most commonly one, two or three levels standardized proceduresare utilized.Patient and methods: In this article we present 2 patients with four levelsACDF treated for degenerative disc disease combined with degenerativekyphosis in mid-age patients who presented with cervical spondyloticmielopathy. We performed 4 levels discectomy including removal ofanterior and posterior longitudina ligaments, partial drilling of endplatesand decompression of spinal cord and neural foramina at all 4 levels. Theintervertebral fusion was achieved with cortico-cancellous allografts. Asthe final phase of procedure the long cervical plate was placed on anteriorportion of spine with bilateral screw fixation in all 5 vertebraea. Kyphosiswas corrected back into lordosis. Results: Postoperative C spine x raysconfirmed good decompression, acceptable position of allografts, plateand screws with cervical spine corection to lordosis. The patient wasdischarged from hospital second day after surgery. They werw fully

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mobilized, neurologically intact with immediate improvement ofmyelopathic symptoms.Coclusions: ACDF is a standardized procedure for 1-3 levels inDDD. However, four level ACDF is safe and routine surgicalprocedure as well carring little or no morbidity or mortality. Itprovides appropriate decompression of spinal cord and spinalnerves and optimal restauration of cervical lordosis.

Mirza Pojskić, Barbara Carl, Miriam Bopp,Christopher Nimsky (Marburg, Njemačka): Aplikacijaekspandibilnog cervikalnog cage-a, retrospektivnakonsekutivna serija 33 pacijenta

Introduction. Expandable cages are frequently used to reconstructthe anterior spinal column after a corpectomy. In this retrospectivestudy we evaluated the perioperative advantages and disadvantagesof cervical corpectomy reconstruction with a distractable cage in ashort time follow-up.

Methods. 33 patients, (17 male and 16 female patients, medium age60.9 years) that are treated with expandable titanium cages for avariety of indications in 2012 and 2013 were analysedretrospectively. The mean follow-up was 5.21 months. Outcome wasmeasured by clinical examination and Visual Analogue Scale (VAS);myelopathy was classified according to the EMS (EuropeanMyelopathy Scale) Radiographic analysis comprised measurementof subsidence and cervical C2-C7 angle.

Results. Indications for corpectomy and reconstruction with anexpandable cervical cage included zervikal spinal canal stenosiswith myelopathy (24 or 75.8%), spondylodiscitis (2), metastaticcancer (4 or 12.1%) and one patient each with aneurysmatic bonecyst and traumatic fracture. Paresis of biceps muscle and spinalataxia were the most common deficits. 16 patients or 48.4% wereoperated only with a ventral approach, 13 of these had only astandalone cage, in 17 or 51.6% additional dorsal stabilization (360◦fusion) was performed. In 3 patients (9%) revision operations wereperformed due to hardware failure, in one patient adjacent segmentdisease with fracture of the adjacent vertebral body occured.Improvement of pain symptoms, myelopathy and gait after surgerywere statistically significant (p<0.05), with medium preoperative VAS6.67 and postoperative score of 2.7, medium EMS Scorepreoperative: 12.29 vs. postoperative: 14.55. Radiographic analysisshowed in 26 of 29 Patients (89,65 %) successful fusion, subsidencewas evident only in the single patient with adjacent segment

disease. As shown in previous studies, correction of C2-C7 angle didn’tcorrelate to improvement of neurological symptoms.

Conclusion. Our results show that expandable titanium cages are a safeand useful tool in anterior cervical corpectomies for providing adequateanterior column support and stability.

ODABRANE KRATKE PREZENTACIJE

Mirza Moranjkić (Tuzla, BiH): Dvostruko educiranivaskularni neurohirurg – pomicanje standarda

By the dawn of the 21st century endovascular techniques have assumed asignificant role in treatment of cerebrovascular disorders. Supported by theresults of recent randomized controlled trials and novel technologicalsolutions, endovascular techniques are striving to assume dominant role infor intracranial aneurysm management. In many regions of the world(particularly North America and Japan), the bulk of endovascularprocedures are performed by neurosurgeons, trained in both endovascularand neurosurgical techniques. Dualism and multidisciplinary integration ofboth microsurgical and endovascular strategies has become a hallmark ofmature cerebrovascular programs. Reluctance of European neurosurgeonsto embrace this new paradigm shift might lead to deleteriousconsequences, with interventional radiologist gaining a dominant role inaneurysm treatment in Europe. We present a single-center experience witha dual-trained neurosurgeon paradigm and we suggest that this is not onlypreferred, but also necessary path to follow.

Mirza Pojskić1, Kenan Arnautovic2 (1Marburg,Germany; 2Memphis, TN, USA): Međunarodnastipendija za neurohirurgiju u Memphisu, Tenneessee

The author is a chief resident in Department of Neurosurgery, University ofMarburg, Germany. He emigrated from Bosnia after working one year inDeparment of Neurosurgery, Cantonal Hospital Zenica. After experiencingneurosurgical residency and education in two european countries, theauthor had an opportunity to visit Semmes-Murphey Clinic in Memphis,Tennessee, USA, as a fellow of Professor Kenan I.Arnautovic. During theperiod of four weeks he was allowed to observe different cranial and spinalprocedures, to work in a cadaver laboratory and to visit two prestigeneurosurgical courses. He engaged in social life as well, got acquiantedwith faculty and residents in Memphis and had a close and profoundexperience of life of a neurosurgeon in the USA. This presentation is anattempt to show the author's experience from the fellowship in Memphis.

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Hakija Bečulić, Rasim Skomorac, AnesMašović, Alma Mekić-Abazović, MelicaImamović, Alma Efendić (Zenica, BiH):Spontana hernijacija mozga i arahnoideje uduralne venske sinuse: rijetka anatomskavarijacija ili klinički entitet?

Brain and/or arachnoidal herniation into the venous sinus are a rarecondition. The mechanism of brain or arachnoidal herniation is notclear. Progressive dural thinning secondary to elevated intracranialpressure, inflammation, aging and erosive arachnoid granulation areamong the aetiologies thought to be responsible. The clinicalsignificance of this herniation is questionable. According to theliterature some patients have symptoms such as headache,dizziness, walking disorders, epilepsy and etc. The research wasdesigned as a retrospective-prospective study. This researchincluded 990 patients who submitted to Magnetic ResonanceImaging (Siemens Magnetom Avanto 1,5 T, Erlangen, Germany) atthe Department of Radiology of the Cantonal Hospital in Zenica inthe period from January to December 2016. In all patients with brainof arahnoid herniation the MRI was revieved two times by aneurosurgeon and neuroradiologist. The MRI scans were evaluatedin Impax system Cantonal Hospital Zenica. To analysed brain orarachnoidal herniation we used T1 and T2 sequences in axial,sagittal and coronary section. In this research we evaluatedpresence, type and localisation of herniation. The clinicalcharacteristis of patients with brain or arachnoidal herniation wereevaluated, too. The methods of descriptive and comparativestatisticswere used (χ2 and p-test) and the results are presented intables and expressed by relative values and mean value. Statisticallysignificant difference was set to p<0.05.

Key words: venous sinus, herniation, clinical significance

Rosanda Ilić, Biljana Seha, GordanaGligorijević, Miodrag Stojsavljević, DanicaGrujičić (Beograd, Srbija): Gamma Knifecentar u Beogradu - prvi rezultati

Gamma Knife Center in Belgrade was opened in November 2015th.The number of treated patients was 919, and number of procedureswas 1038. The most frequent diagnosis was metastatic tumor (501),followed by 181 meningiomas, 124 vestibular schwannomas, 68

trigeminal neuralgias, 20 arteriovenous malformations, 20 pituitaryadenomas, 10 gliomas, 1 hordoma, 4 craniopharyngeomas, 1hemangioblastoma, 5 other, rare tumors. The time of follow up was tooshort to see results for meningioma and schwannoma treatment, also forpituitary adenomas and AVMs. Complication rate in benign tumors was low,most frequently edema that was successfully resolved with corticosteroidtherapy. The success rate was high in trigeminal neuralgia. The percent ofretreatment was 10%. Results were worse in patents with multiple sclerosis.Good results were achieved in treatment of metastatic tumors. The numberof treated metastasis was between 1-18. Retreatment was performed in22,4%, because of newly diagnosed metastasis. The cause of death inpatients with metastatic disease was systemic progression in most of thepatients.

Fahrudin Alić, Anes Mašović, Rasim Skomorac, AldinJusić, Hakija Bečulić (Zenica, BiH): Neurosurgicalmanagement of uncommon penetrating brain injury of lowand high velocity: Case Reports

Aim: to present two unusual cases of intracranial injury. One caused byspontaneous fall on knife and theother caused by shrapnel after activationof explosive device in a case of domestic violence Case report 1 This casereports a 6-years-old Caucasian who was admitted to the Department ofEmergency Medicine due to injury of the right eye caused by a knife. Thepatient was fully conscious, oriented,hemodynamically stable and withoutany neurological deficit. X-Ray and Computed Tomography (CT) showedaknife entering the orbit through medial part of right superior eyelid. The CTalso showed that the knife hadpassed through the right orbital roof into themedial part of the right frontal lobe with underlying tracthematoma. Afterdiagnostics the patient was cleared for emergency surgery. Case report 2This case reports intracranial shrapnel injury in 48-year-old Caucasiancaused by the shrapnel after activation of explosive device in a case ofdomestic violence. There were no signs of impairment of consciousness,focal neurological deficit or lateralizing. The local status showed supraciliarypunctiform wound with minimal edema of soft tissue. X-ray of the skullshowed a stray shrapnel in the cranial cavity and computed tomography(CT) frontal bone defect parasagittal left as a place of shrapnel entry,intraparenchymalcorridor of passing and parietal left, along the sagittal line,metal density with diameter of 3.5 mm. Prophylacticantibiotic therapy wasadministered and after neurosurgical consultation patient underwentsurgical intervention. No complications related to the wound or theoperation treatment occurred. Conclusion It is important to evaluate theoptimal neurosurgical treatment for rare penetrating brain injuries. Althoughintracranial penetrating injury usually tends to lead to extensive brain tissuedamage, it does nothave to necessarily be a rule of thumb as is confirmed

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by our cases.Key words: penetrating brain injury, neurologicalimpairment, radiological evaluation.

Mirza Pojskić, Barbara Carl, Miriam Bopp,Christopher Nimsky (Marburg, Njemačka):Retrospektivna studija 229 hirurški tretiranihpacijenata sa metastazama na mozgu: prognostičkifaktori, ishodi i komparacija između RPA i DS-GPAklasifikacije

Objectives. Metastases are the most frequent tumors in the brain.Most often used scoring systems to predict the outcome are RPA(Recursive partitioning analysis) Classification and DS-GPA(Diagnosis-Specific Graded Prognostic Assessment) Score. The goalof our study was to determine prognostic factors which influenceoutcome in patients who undergo surgery for brain metastases and tocompare different outcome scores.

Methods. 229 patients who underwent surgery for brain metastasesin our institution between January 2005 and December 2014 wereincluded in the study. There were 114 male and 115 female patients.Patient age ranged from 26 to 86 years, medium age 59.7 years. Themost common primary tumors were lung cancer (SCLC and NSCLC,86 or 37.5 %) followed by breast cancer (50 or 21.9%). The patientdata was evaluated retrospectively.

Results. The mean survival time of the whole group was 14.7 months(median survival time MST 8 months), for patients with a singlemetastasis (n=149) 14.2 months and for patients with multiplemetastases (n=80) 14.9 (median survival time MST 8 months each).Significant influence on median survival time had age<65 years (9months vs 5 months, p=0.002), female sex (10 months vs. 6 months,p<0.001), primary tumor (breast cancer 8 months vs. SCLC andNSCLC, melanoma and renal 7 months each vs. gastrointestinaltumors 6 and CUP 2 months, p=0.030), RPA Class I and II (11months vs. 4, p<0.001), Karnofsky >70% (11 vs. 4 months, p<0.001)and postoperative radiotherapy (8 vs.5 months, p<0.002) Number ofmetastases and presence of extracranial metastases were nosignificant factors. In order to evaluate the diagnostic power of DS-GPA and RPA score in respect of survival, two Cox regressions weremodeled. In both models the predictive power of two gradings ishighly significant (p<0.005), RPA classification showed betterpredictive power (-2 Log Likelihood = 1117.322 and χ2 =22.855).

Conclusions. Prognostic favourable factors for prolonged survivalwere KPS > 70%, RPA Class I and II , age<65 years, female sex, and

adjuvant radiotherapy. Patients with breast cancer metastases had thelongest median survival time. RPA Classification was more accurate inpredicting the outcome than DS-GPA score.

Hakija Bečulić, Rasim Skomorac, Aldin Jusić, AlmaMekić-Abazović, Anes Mašović, Fahrudin Alić, MelicaImamović, Hana Štimjanin - Jović (Zenica, BiH):Rezultati neurohirurškog tretmana gigantskihmijelomeningocela u Kantonalnoj bolnici Zenica

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INTERNACIONALNI SIMPOZIJ IZ PORODIČNEMEDICINE IIPROGRAM DAN III

SESIJA 1

Zaim Jatić, (Mahir Bogdanić): Correlation of glycemiccontrol and control of arterial pressure in patients withdiabetes mellitus and hypertension

Džanana Jatić, (Asmir Lepuzanović, Zaim Jatić):Diabetes Mellitus and Dementia

SESIJA 2

Larisa Mešić Ðogić, Hajrudin Đogić, E. Hodžić,S. Fazlagić (Tešanj, BiH): Infekcija cervikalnog kanalakao prediktor prijevremenog porođaja

Ispitati povezanost infekcije cervikalnog kanala i prijetećegprijevremenog porođaja. Prospektivna studija provedena je uginekološko-akušerskim ambulantama Doma zdravlja iUniverzitetskog kliničkog centra u Tuzli te Općoj bolnici u Tešnju, uperiodu od oktobra 2013. do maja 2014. godine. Ispitivanu skupinučinilo je 50 zdravih trudnica s jednoplodnom trudnoćom, gestacijskedobi između 28. i 37. nedjelje, kod kojih je na osnovu ultrazvučnebiometrije i modificiranog Bishop skora utvrđeno stanje prijetećegprijevremenog porođaja, dok je kontrolnu skupinu činilo 30 zdravihtrudnica s jednoplodnom trudnoćom, gestacijske dobi između 28. i 37.nedjelje, kod kojih nisu prona- đene promjene koje bi upućivale nastanje prijetećeg prijevremenog porođaja. Kod svih pacijentica jeutvrđeno stanje čistoće cervikalne sluzi uzimanjem brisa cervikalnogkanala i izolovanjem mikrobiološkog agensa. Prisustvo infekcije ucervikalnom kanalu dokazano je kod 35 (70%) ispitanica i 4 (13%)pacijentice kontrolne skupine. Najčešće su otkrivane Ureaplasma kod7 (20%), Mycoplasma kod 7 (20%) i E. coli kod 5 (14%) ispitanica(p=0.001). Infekcija porođajnog kanala udružena je s pojavompromjena na cerviksu i prijevremenim prskanjem plodovih ovojnica,odnosno s prijevremenim porođajem i prijetnjom prijevremenogporođaja. Vodeći zadatak porodičnih liječnika, kao i ginekologa,morao bi biti probir na infekcije cervikalnog kanala prije nastankatrudnoće. Ključne riječi: cervicitis, komplikacije u trudnoći, prijevremeniporođaj

Emina Spahić, Damira Kadić, Sabaheta Hasić, MuamerDervišević (Zenica, BiH): Inflammation based scores in Diabetesmellitus type 2 patients

Chronic hyperglycemic state leads to an increase in subclinical systemicinflammatory response in Diabetes mellitus type 2 (DMT2) patients.Inflammation-based scores, neutrophil to lymphocyte ratio (NLR), plateletto lymphocyte ratio (PLR) and red blood cell distribution width to plateletratio (RPR) are biomarkers able to quantify systemic inflammation. Theaim of the study was to investigate association of the inflammation-basedscores with short- and long-term glycemic control markers, and whetherthey could be used as indicators of glucoregulation in DMT2 patients. Thecross-sectional study included 92 DMT2 patients, treated at the PrimaryHealth Care Centre Zenica from December 2015 to April 2016, distributedinto groups according to glycated hemoglobin (HbA1c) values: A (n=59,HbA1c ≤7.0%) and B (n=33, HbA1c>7.0%). Complete blood cell count,fasting blood glucose (FBG)and HbA1c measurements were determined atthe Primary Health Care Centre Zenica and at the Department ofLaboratory Diagnostics, Cantonal Hospital Zenica by standard laboratorymethods. All statistical tests were performed using SPSS 19.0. P values<0.05 were considered statistically significant. Fasting blood glucose andHbA1c were significantly higher in the group B compared to the group A(p<0.0005). There was no significant difference of NLR, PLR and RPRbetween the groups (p=0.50; p=0.220; p=0.525, respectively). Significantcorrelation of inflammation-based scores with FBG and HbA1c was foundonly between PLR and HbA1c in the group A of DMT2 patients (r=0.328,p=0.011). Inflammation-based scores could gather meaningful clinicalinformation, either diagnostic or prognostic, on a variety of hyperglycemic,inflammatory, cardiovascular and thrombotic disorders. Since there wasnostatistically significant difference of NLR, PLR and RPR between DMT2patients with good and poor glycemic control, we conclude that thesescores could not be used as indicators of glucoregulation in DMT2patients.

Slađana Cvijanović Benke, Dejan Nedić, Zagorka Pavlović,Andrea Tomić , Marina Tomanić, Radoslav Nikolić: Praćenjeoboljelih od DM kroz ambulantu u DZ Doboj

Okolnosti:Od juna 2011. godine u JZU DZ Doboj radiAmbulanta zadijabetes u kojoj rade: doktor specijalista porodične medicine i medicinskitehničar. Ambulanta radi 2 sata dnevno.Svaki doktor ima definisan radnidan i zakazane pacijente koje prati. U ambulantu se upućuju oboljeli odDM sa HbA1c> 8 %uz odgovarajuče nalaze. Medicinski tehničar uradiantropometrijska mjerenja, mjerenje šećera u krvi, monofilament test,

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edukuaciju o upotrebi glukometra i načinu aplikacije insulina.Doktor provede edukaciju o bolesti daje savjete o ishrani i fizičkojaktivnosti , prati koriguje ili mijenja terapiju. Doktori održavajusastanke 1x sedmično i diskutuju o načinu liječenja pojedinihpacijenata. Za komplikovanije slučajeve se konsultujeendokrinolog.Cilj:Predstaviti rezultate praćenja oboljelih od DM kroz Ambulantu zadijabetes.Metodologija: Analizirani kartoni oboljelih od DM koji su praćeni krozambulantu za dijabetes od juna 2011. do juna 2013. Godine. Praćenesu vrijednosti HbA1c u momentu javljanja, nakon 6 i 12 mjeseci, kao ibroj pacijenata koji su, kroz ambulantu, prevedini na insulinskuterapiju.Rezultat: U periodu juni 2011- juni 2013. godine na I konsultaciju sejavilo 299 oboljelih od DM; I kontrolu HbA1c uradilo 98 oboljelih odDM (32,8%) a II kontrolu 30 pacijenata (10%). Prosječna početnavrijednost HbA1c 9,20%; I kontrolni 8,11%,II kontrolni 7,20%. Ukupanbroj prevedenih na insulin je26 pacijenata .Zaključak: Pad vrijednosti HbA1c za 1% na I kontrolnom pregledupotvrđuje značaj timskog savjetovanja oboljelih od DM. S obzirom jedijabetes hronična bolest neophodno je stalna podrška pacijenata teedukacija kako pacijenata tako i ljekara Porodične medicine,kako bipostigli da što veći broj naših pacijenata bude blizu zlatnog standarda–vrijednosti HbA1c 7,5% . Prevođenje na insulinsku terapiju pravidodatne uštede kako za pacijente tako i za zdravstveni sistem uopšte.

SESIJA 3

Zarema Obradović (Sarajevo, BiH): Medicinskiturizam-izazovi

Zdravstveni turizam je putovanje ljudi u druge zemlje iz zdravstvenihrazloga, odnosno zbog ostvarivanja medicinskog tretmana. Broj ljudi kojiputuju zbog zdravstvenog turizma je veoma značajan pa se globalni profitod ove djelatnosti procjenjuje na oko 60 milijardi $. Zdravstveni turizamraste iz godine u godinu sa godišnjim rastom oko 20% i predstavlja globalniizazov za cijeli svijet. Razlozi za zdravstveni turizam su različiti i gotovo danema oblasti medicine zbog koje se danas ne putuje iz jedne zemlje udrugu. U zdravstveni turizam su uključene sve zemlje svijeta, bilo da se iznjih putuje ili da se u njih putuje zbog ostvarivanja neke zdravstveneusluge. Nekada se putuje iz nerazvijenih zemalja u razvijene kako bi seobezbijedili tretmani koji se zbog nerazvijenosti tehnologija i nedostupnostiaparature ne mogu provesti u vlastitoj zemlji. Međutim, nekada se putuje izveoma razvijenih zemalja u nerazvijene zemlje zbog nižih cijena usluga ililiberalnijih zakona. U radu će biti prikazane različite vrste zdravstvenogturizma, zakonodavne i etičke dileme te rizici koji su sa njima povezani

Ključne riječi: zdravstveni turizam, izazovi, rizici

Mirsad Rahimić, Majda Trebinjac, Melida Hasanagić (Mostar,BiH):Farmakoekonomika pacijenta sa dijabetesom

Melida Hasanagić, Nađa Hasanagić, Aida Ćupina Jonuz,Ajdinović, Malina Fočić (Mostar, BiH): Dijabetes u ambulantiporodične medicine

-------------------------------------------------------------------POSTER SESIJE------------------------------------------------------------------------------

MILKA MIRNIĆ - DIJABETES I FIZIČKA AKTIVNOST

UVOD Ishrana i fizička aktivnost su od najvećeg značaja za prevenciju iliječenje dijabetesa. Fizička aktivnost djeluje tako da snižava nivo šećera ukrvi, smanjuje potrebu za insulinom, povoljno djeluje na srce i krvne sudovei doprinosi održavanju i kontroli tjelesne težine. Takođe doprinosi jačanjukoštano-zglobnog i mišićnog sistema i oslobađanju od svakodnevnogstresa.Odabir fizičke aktivnosti zavisi od zdravstvenog stanja i fizičke

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sposobnosti, o čemu pacijenta može edukovati medicinska sestra,koja i sama mora biti upoznata sa dobrobitima i komplikacijamafizičke aktivnosti , te pripremi pacijenta kako bi je kasnije mogaosam sprovoditi.

CILJ Utvrditi vrstu fizičke aktivnosti koju mogu sprovoditi pacijentioboljeli od dijabetesa, njihovu spremnost za saradnju pri edukativnimaktivnostima medicinskih sestara, te potrebu za edukacijommedicinskog kadra o važnosti motivisanja pacijenata i edukaciju okineziologiji uz dijabetes.

METODOLOGIJA Deskriptivna metoda, intervjui sa pacijentima kojisame dolaze u ambulantu

DISKUSIJA I ZAKLJUČAK Fizička aktivnost povoljno utiče na: 1.Nametaboličke procese-kod zdravih ljudi tokom mirovanja ili laganefizičke aktivnosti koncentracija glukoze u krvi se neznatno mijenja.2.Sprečava vaskularne ishemije-dijabetičare prate i specifičnadegenerativna oboljenja kardiovaskularnog i nervnog sistema. 3.Naposljedice psihičkih stresova-dijabetes je teška i dugotrajna bolestkoja utiče na modalitete ponašanja i organizaciju življenja bolesneosobe. Potrebno je razviti svijest kod pacijenata i medicinskih radnikao značaju fizičke aktivnosti za zdravlje čovjeka, a posebno za značajkod oboljelih od šećerne bolesti. Do izražaja dolazi potreba zaprovođenje organizovanih programa vježbanja, posebno za žene kojezbog prevelikog broja obaveza nemaju vremena za tjelesnu aktivnostkod kuće tj. samostalno, te za starije osobe koji se sve manje i manjekreću. U tu svrhu potrebna je edukacija medicinskih sestara od stranestručnjaka, fizioterapeuta..., koji bi provodili individualne i grupneprograme sportsko-rekreativnih sadržaja. U liječenju šećerne bolestivažan je timski rad koji čine bolesnik, doktor ,medicinskasestra,terapeut,psiholog koji bi uz dokazanu dobro razvijenu svijest ofizičkoj aktivnosti pridonio prevenciji, kontroli i liječenju oboljelih.

ALEKSANDAR KLJAJIĆ - PRIJAVAPACIJENATA OBOLJELIH OD DIJABETESA

UVOD Dijabetes se nalazi među pet vodećih uzroka smrti u većinizemalja sveta.Glavni izvor podataka je nacionalni registar hroničnihnezaraznih bolesti.Opterećenje kroničnim nezaraznim bolestima kojeutiče na stanje mentalnog zdravlja osjeća se svugdje u svijetu,posebno zbog prevelikog izostajanja s posla i odsutnosti tokom rada iličinjenice da radnik gubi produktivnost rada koja se spušta na nivoispod normalno.Kako bi se pratila učestalost pojavljivanja bolestipotrebno je reagovati na primarnom nivou u smislu pravovremenihprijava pacijenata oboljelih od dijabetesa i ostalih hroničnih nezaraznih

bolesti.

CILJ Obnoviti znanje o važnosti uniformnog prijavljivanja dijabetesa

METODOLOGIJA Deskriptivna metoda

DISKUSIJA I ZAKLJUČAK Potrebno je napraviti/revidirati nacionalne vodiče iregistre za dijabetes , a to je jedino moguće na osnovu podataka o oboljelojpopulaciji.Da bi se napravio plan prevencije dijabetesa i prevencijekomplikacija dijabetesa, potrebno je da porodični ljekari na isti način i poistom tipu prijavljuju novootkrivene pacijente sa dijabetesom.Prijave ovjeravai statistički dokumentuje medicinska sestra u porodičnoj medicini i šalje uHigijensko-epidemiološku službu gdje se pravi baza podataka koji seprosljeđuju u Institut za zaštitu zdravlja Republike Srpske.Preko ovihpodataka se mogu formirati standardi za unapređenje zdravstvene zaštite,formirati registar visokorizičnih pacijenata, korigovati plan prevencije zaefiksnije aktivnosti, planirati resurse za edukaciju medicinskih radnika ipacijenata.

DARIJA JOVIĆ - KOMPLIKACIJE DIABETESMELLITUSA-DIJABETIČKO STOPALO

Prema definiciji SZO:Dijabetično stopalo je stopalo koje je narušenogfunkcionalnog integriteta zbog infekcije rana i razaranja tkiva te oštećenjaživaca i bolesti krvnih sudova nogu.Javlja se kod svakog 4 ili 5 pacijentaoboljelog od DM a amputacija se izvede kod skoro 15-30 % bolesnika saranom na stopalu. Oboljeli od DM osim kontrole nivoa GUK treba redovno dapregledaju svoja stopala prema datim smjernicama . Loša njeg adovodi doniza komlikacijai problema a na kraju i do amputacija . Ukoliko je već došlodo pojave rane na stopalu primarni cilj je da se dovede do zarastanja rane ušto kraćem periodu u čemu veliku ulogu ima medicinska sestra.Ukolikonekroza doseže dublje slojeve prvo se radi hirurško zbrinjavanje rane .Dobra inspekcija sprečava stvaranje rane na stopalu a dobra njegapostojeće rane sprečava širenje iprodubljivanje rane i amputaciju.

RADA BUBIĆ - RANA DETEKCIJADIJABETESA KAO PREVENCIJAKOMPLIKACIJA

UVOD

Hronična bolest koju karakteriše višak glukoze (šećera) ukrvi i njen nedostatak u ćelijama organizma. Uzodgovarajuće liječenje moguće je izbjeći komplikacije takoda osoba može voditi normalan život, karijeru i imatipotomstvo.

„V.V. muškarac 65 godina života, ima dijabetes tip 2

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unazad 12 godina. Pridružene bolesti:hipertenzija, angina pektoris. Pušač od 30.godine, puši 15 cigareta dnevno. Alkoholkonzumira rijetko, na nekim slavljima 3-4 stand.pića .TM 87,5kg; TV 167cm; BMI 31,37kg/m2;Obim struka: 107cm“

CILJ

Prikazati pravilan tretman pacijenta sa dijabetesomu praksi s ciljem sprečavanja ili usporavanjarazvoja komplikacija

REZULTATI

Laboratorijske analize: KKS u referentnimvrijednostima; GUK 6,94mmol/L; HbA1c5,74%;HOL uk. 3,21; TG 0,95; HDL 0,84; LDL 1,94; urea3,1; kreatinin/s 68; URIN : alb. neg; sediment-2-4L, malo sluzi.TA 130/80mmHgPregled očnog dna – retinopatija dijabetika.Pregled stopala – uredan nalaz

ZAKLJUČAK

Ako se dijabetes na vrijeme otkrije i ostvari dobrasaradnja sa pacijentom tako da on prihvati savjeteo promjeni životnog stila i obavlja redovnekontrole, bolest se može držati pod kontrolom inastanak komplikacija se može spriječiti ili usporiti.

JASMINKA GRANOLIĆ - PATRONAŽNAPOSJETA PACIJENTU OBOLJELOM ODDIJABETESA

UVOD Patronažna sestrinska njega je djelatnost medicinskih sestarau zajednici uz maksimalnu saradnju pacijenta i porodice.Medicinskasestra mora znati prepoznati edukacijske potrebe pacijenata teprovoditi edukaciju kako bi osposobila pacijenta za samozbrinjavanjei samopomoć s ciljem odgađanja komplikacija,invalidnosti, smrti ismanjenja patnji.Edukacija za samozbrinjavanje podrazumijevausvajanje znanja i vještina do nivoa samostalnosti pacijenta ilinekoga od članova porodice.

CILJ Utvrditi prepreke za edukaciju pacijenta i članova porodice ipronaći efikasno rješenje uz najmanju moguću finansijsku potporuzdravstvenog sistema.

METODOLOGIJA Anketiranje pacijenata i članova porodice u ambulanti ikućnim uslovima po sistemu slučajnog uzorka iz grupe pacijenata kojima jepostavljena dijagnoza „šećerna bolest tip 2“ , te anketiranje medicinskihsestara iz tima porodične medicine kojem pripadaju navedeni pacijenti

REZULTATI Najveći problem nađenih prepreka je vezan za komunikacijupacijenta sa članovima porodice , te prihvatanjem bolesti, a sa stranemedicinskih sestara najveći problem je organizacionog karakterazdravstvenog sistema

DISKUSIJA I ZAKLJUČAK Pacijenti kojima članovi porodice dolaze uambulantu po terapiju nemaju priliku ni razgovarati sa medicinskim radnikompa se oslanjaju na članove porodice.U tom slučaju se mora edukovatiporodica kako bi mogli prenijeti pacijentu znanje , ali i kako bi mogli prenijetimedicinskoj sestri ili doktoru probleme sa kojima se susreće pacijent usmislu mogućih komplikacija bolesti. Ukoliko komunikacija između pacijenta iporodice izostane pacijent je u velikom riziku od invalidnosti,patnje ismrti.Opravdanost odlaska patronažne sestre u preventivnu posjetu leži utome da je jedino tako sigurna u sposobnost pacijenta da se nosi sabolešću te uslovima života i ne mora se oslanjati na riječi članaporodice.Porodice koji nisu dovoljno finansijski stabilne ne mogu i porednajbolje volje pacijentu obezbijediti kvalitetnu ishranu , te ih treba u kućiobučiti o minimumu ishrane i higijene koja je neophodna pacijentu oboljelomod dijabetesa.Znatan broj pacijenata je starije populacije koji žive sami ukući, a članovi porodice ih povremeno posjećuju, te je potrebno damedicinska sestra utvrdi da li je pacijent obučen o načinu uzimanja lijekova ,njihovom djelovanju, te povezanosti sa drugim bolestima ako su utvrđenekod pacijenta.

Evidentna je i potreba medicinskih sestara za edukacijom o procjeni potrebaza zdravstvenom njegom kod pacijenata oboljelih od dijabetesa, što se možeizvesti kratkotrajnim povremenim radionicama,seminarima, uz periodičnoprovjeravanje usvojenog znanja.

Medicinske sestre naglašavaju važnost vraćanja patronažne službe usistem, jer većina timova porodične medicine ima samo jednu medicinskusestru koja nije u mogućnosti raditi istovremeno u ambulanti i izdvojitikvalitetno vrijeme za pacijente u kućnim posjetama, što može samo dovestido komplikacije postojeće bolesti što šteti i pacijentu i zdravstvenomsistemu.

PREDRAG PETROVIĆ - PSIHOLOŠKA PODRŠKAPACIJENTU OBOLJELOM OD DIJABETESA

Cilj rada je ukazati na neophodnost promjene životnog stila osoba sadijabetesom. Obzirom da u tretmanu dijabetesa ključnu ulogu igra spremnostpacijenta na promjena životnih navika, te promjene su često ključne u

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uspostavljanju poželjnog nivoa glikoregulacije. Centralno mjestozauzimaju izmjene navika u sferi aktivnosti samozbrinjavanja.Promjena navika i rutina nije laka za pacijenta. Pacijentu je stoganeophodna psihološka podrška-motivacija. To podrazumjeva holističkipristup pacijentu, razumjevanje tipologije ličnosti mehanizamaprihvatanja bolesti, principa komunikacije na liniji zdravstveni radnik-pacijent, motivacionog intervju (William R. Miller), promjene navika (pomodelu Prochaska i DiClemente). U radu je dat i kratak osvrt naznačaj takozvane LIEZON-KONSULTATIVNE PSIHIJATRIJE(franc.liaison-povezanost, veza, udruživanje) koja se bavipsihopatološkim fenominima koji prate somatska oboljenja u tretmanudijabetesa, sa posebnim osvrtom na pojavu dijabetes distresa kodosoba sa dijabetesom i njegovog uticaja na nivo HbA1C.

IRENA NIŠIĆ - PREVENCIJA I TRETMANDEKUBITUSA

UVOD Dekubitus se javlja kod bolesnika sa ograničenompokretljivošću. Dekubitus je komplikacija koja nastaje usljedprodužene hospitalizacije (ortopedski odjel, jedinice intenzivne njege,neurološki odjel, gerontološki centri), ali sve češće se javlja i uuslovima kućne njege. Promjene na koži se javljaju na dijelovimatijela koji su najviše izloženi pritisku težine tijela, a bitan faktor jehipoestezija, odnosno anestezija. U razvoju kliničke slike razlikuju sepet stadija, na osnovu kojih se određuje tretman u procesu liječenja.Najčešće komplikacije kod dekubitalnih ulceracija: infekcije,dehidratacija, anemije, gubitak proteina, sepsa (u lll i lV stadiju),malignizacija ulceracija. Liječenje dekubitusa može biti konzervativnoi hiruško, i spada u najskuplja liječenja u medicini.

CILJ Podići nivo znanja kod medicinskog osoblja i pacijenata ouzrocima nastanka dekubitusa.

ZAKLJUČAK Liječenje dekubitusa je veoma složen, dugotrajan i skupproces koji zahtjeva multidisciplinaran pristup (angažovanje velikogbroja ljekara različite specijalnosti, fizioterapeuta, psiho – socijalneslužbe i sestrinskog kadra).Važnu ulogu u liječenju ima medicinskasestra koja pruža njegu i provodi mjere prevencije da bi spriječilanastanak dekubitusa.

NINA RADOJKOVIĆ LUNIĆ - ULOGAMEDICINSKE SESTRE U DIJABETESNOJ

KETOACIDOZI

UVOD Svjetske smjernice za liječenje dijabetesa preporučuju uz redovnopraćenje pacijenta i uključivanje redovne psihosocijalneprocjene.Međunarodna dijabetička federacija –IDF daje smjernice zapsihološku brigu za osobe sa dijabetesom na na trinivoa:standardnom,minimalnom i proširenom.Takođe uključuju i tri aspekta:komunikaciju ,psihosocijalnu procjenu i savetovanje.Smjernice Američkogdijabetičkog udruženja -ADA navode da je prilikom redovnekontrole,potrebno procjenjivati stavove o bolesti, očekivanja od medicinskogtretmana, raspoloženje, opštu kvalitetu života i kvalitetu vezanu uz bolest, tepsihijatrijski morbiditet.Kod procjene psiholoških tegoba je potrebno obratitipažnju na depresiju, anksioznost, poremećaj prehrane, kognitivne smetnje.Kanadske smjernice uključuju uz psihosocijalnu procjenu pacijenta iprocjenu njihove porodice,koja treba uključivati izvore stresa i i socijalnepodrške, štetna ponašanja, stavove o bolesti i budućnosti, uticaju bolesti nasvakodnevni život, te procjenu rizika za depresiju i anksioznost.Ovesmjernice navode važnost edukacije pacijenta kao preventivnu mjeru zarazvoj komplikacija bolesti. Sve navedene smjernice se zasnivaju na jačanjukomunikacije zdravstvenih radnika sa pacijentom, rutinsko praćenjepsihosocijalnih potreba, te uključivanje stručnjaka iz domena mentalnogzdravlja.

CILJ RADA 1.edukacija medicinskih radnika i pacijenata, 2.uvođenjerutinskih upitnika i intervjua za praćenje psihosocijalnog statusa kod osobaoboljelih od dijabetesa

METODOLOGIJA Deskriptivna metoda

DISKUSIJA I ZAKLJUČAK U komunikaciji sa pacijentom zdravstveni radniktreba zauzeti kompletan pristup osobi sa dijabetesom gdje će pacijent zauzetisredišnju ulogu u svojem liječenju, uz napomenu neosuđujuće i neutralnekomunikacijske prakse.Zdravstveni tim svojim pristupom može djelovati nazdravstvene navike i uticati na faktore za rizik od nastanka psihosocijalnihpoteškoća, ukoliko pravovremeno razviju odnos povjerenja. Medicinskesestre na sekundarnom nivou mogu uticati samo na prvobitnu kratkoročnuedukaciju kod pacijenata hospitalizovanim po otkrivanju bolesti ili pacijenatakod kojih su se već razvile komplikacije .Nakon otpusta pacijenta sa Klinikeza endokrinologiju, medicinska sestra više nije u mogućnosti pratiti pacijenta,jer se daljni pregledi obavljaju u ambulantama i u Porodičnoj medicini. Izovoga proizilazi zaključak da treba prevenstveno jačati porodičnu medicinu,edukovati medicinske sestre uz upotrebu nacionalnih vodiča , te obaveznouvesti psihosocijalnu procjenu pacijenta i porodice uz upotrebu zvaničnihformulara i protokola , kako bi se identifikovale prepreke za kvalitetan život isamozbrinjavanje i uklonile prije nego počnu imati štetan uticaj na život izdravlje pacijenta.

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MIODRAG ĐAJIĆ - ULOGA MEDICINSKESESTRE-TEHNIČARA U PREVENCIJIMETABOLIČKOG SINDROMA

Metabolički sindrom je skup metaboličkih poremećaja koji se očitujukao inzulinska rezistencija, nakupljanje masnog tkiva u područjutrbuha (abdominalna ili centralna pretilost), visoka razina holesterola ipovišen krvni pritisak. Za sve spomenute tegobe karakteristična jerezistencija na inzulin, a poremećaji su učestaliji u starijoj životnojdobi. Svaki od navedenih zdravstvenih problema povećava opasnostpojave bolesti poput dijabetes mellitus i bolesti srca. Budući daspomenuti problemi imaju tendenciju pojavljivanja u kombinaciji,smatra se da zajednički tvore ovaj sindrom. Izloženost stresu,neredovita i nepravilna prehrana, fizička neaktivnost i nedostatak snapridonose sve većoj učestalosti metaboličkog sindroma. Metaboličkisindrom najčešće je uzrokovan pogrešnim načinom života.. Smatra seda upravo takav životni stil pridonosi sve većoj učestalostimetaboličkog sindroma u "zapadnjački orijentiranoj" populaciji.Smanjenje tjelesne mase, odnosno smanjen energetski unos, prva jemjera u liječenju metaboličkog sindroma protiv kojega se treba boritiistodobno na više razina. Smanjenje tjelesne mase u gojaznih osobakoje nemaju dijabetes poboljšava iskoristivost glukoze a ujednopoboljšava regulaciju glukoze u krvi u gojaznih bolesnika sdijabetesom tipa II. Tjelesna aktivnost sastavni je dio borbe protivmetaboličkog sindroma. Zadatak medicinskih tehničara/ sestara uprevencij metaboličkog sindroma bio bi rad sa pojedincem, manjim ilivećim grupama kroz savjete, edukaciju kao i projekte.Pronalaženjerizične skupine, kao i pronalaženje motiva koji bi pokrenuo rizičnuskupinu da počnu razmišljati i voditi brigu o svom zdravlju. Raditi sveviše na edukaciji i mlade populacije koja je sve više nažalost gojazna ifizički neaktivna.

Ključne riječi : metaboličkisindrom,hipertenzija,holesterol,gojaznost,fizička aktivnost

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SAŠA BIJELIĆ - DIJABETES I SPORTDijabetes mellitus nastaje kao posljedica poremećaja stvaranjainzulina u pankreasu ili kao blokada inzulina u cirkulaciji krvi. Javlja seu svakoj životnoj dobi. Učestalost bolesti u odrasloj populaciji iznosi 2- 3 % dok se u 4% slučajeva bolest javlja u djetinjstvu s tendencijomstalnog rasta. Postoje 2 osnovna tipa: diabetes mellitus tip 1(dijabetesovisan o inzulinu) i diabetes mellitus tip 2 (dijabetes neovisan oinzulinu). Ključni elementi liječenja za sve bolesnike sa dijabetesom sudobra edukacija, savjetovanje o dijeti i fizičkoj aktivnosti te pravilnaupotreba lijekovi. Svi bolesnici tipa 1 trebaju inzulin. Kod oboljelihpacijenata od diabetes mellitus tipa 2 s blago povišenom vriednostimaglukoze u krvi provodi se preporuka o dijeti i fizičkoj aktivnosti uzdodatak jednog peroralnog lijeka. Fizičkom aktivnošću se procjenjujeda mišićni rad može povećati potrošnju glukoze do 20-ak puta višenego u stanju mirovanja tijela pogotovo kod gojaznih osoba te osoba spozitvnom porodičnom anamnezom nastanka inzulin neovisnogdijabetesa. Redovita fizička aktivnost ne može spriječiti nastanakinzulin ovisnog dijabetesa, ali smanjuje kardiovaskularne rizičnefaktore koji u kombinaciji sa dijabetesom dovode do aterosklerotskebolesti srca i krvnih sudova. Isto tako smanjuje razinu serumskihlipida, te smanjuje stres. Vježbanje ima velik pozitivan psihološkiefekat. Uspostava kontrole nad šećernom bolesti reflektira se i nadruga područja života. Povećava se samopouzdanje sportaša, manjaje ovisnost o lijekovima. Kontrola nad svojom bolesti jest zapravokontrola nad jednim važnim dijelom svakodnevnog života. Oboljeli oddiabetes mellitus koji se profesionalno bave sportom,bolest neprestavlja kočnicu upravo iz razloga što drže bolest pod kontrolom,postižu vrhunske rezultate.Ključne riječi: dijabetes mellitus, šećerna bolest tipa 2, tip 1, inzulinovisni, inzulin neovisni, ,fizička aktivnost, dijabetičari u sportu

DRAGO TOMAŠEVIĆ - LIJEČENJE DIJABETESAKOD STARIJIH OSOBA

UVOD: Poslije pedesetih godina života, nivo šećera u krvipostepeno se povećava kod svih osoba. Samo manji diostarijih osoba sa dijabetesom drži koncentraciju šećera u krvipod kontrolom.Makar i mala odstupanja od normalnihvrijednosti šećera mogu uticati na učestalost oboljenja srca ikrvnih sudova. Slaba kontrola dijabetesa je povezana sdugoročnim povećanjem rizika za oštećenja nerava, gubitakvida i oštećenja bubrega, te amputacija.Nakon postavljanjadijagnoze i dodjeljivanja medikamentozne terapije od stranedoktora, medicinska sestra može pristupiti procjeni pacijenta(

sposobnost i interes pacijenta, finansijske,motoričke ,socijalnemogućnosti),planu zdravstvene njege, edukaciji pacijenta i njegoveporodice.Kod pacijenata koji nemaju porodicu ,svakodnevno prisustvomedicinske sestre je od krucijalnog značaja.CILJ RADA:Prikazati procedure i dokumentaciju koja se koristi tokomzdravstvene njege starijih korisnika sa dijabetesom u Gerontološkomcentru BanjalukaMETODOLOGIJA:Deskriptivna metodaDISKUSIJA I ZAKLJUČAK: Gerontološki centar Banjaluka je osnovan1946.godine i od samih početaka koristi multidisciplinaran pristuppacijentu.Zadnjih godina je evidentan povećan broj pacijenata sadijabetesom te se na tom polju sve više radi na edukaciji medicinskihradnika i pacijenata.U zadnjih šest mjeseci nije bilo mjerenja nivoaglukoze u krvi većeg od 6 mmol/l , što možemo zahvaliti iskusnom imotivisanom osoblju i dobroj saradnji sa pacijentom.Velika pažnja seposvećuje ishrani( planiranje vrste i rasporeda obroka).Fizičkaaktivnost je u najvećem broju slučajeva šetnja ,a za pacijente koji jene mogu zbog invaliditeta upražnjavati postoji individualni rad safizioterapeutom.Većina pacijenata koji koriste inzulin su slabijeg vida ipamćenja te je donešena odluka da bez obzira na edukaciju pacijentaterapiju aplicira medicinsko osoblje. U planu za poboljšanje kvalitetau budućnosti ostaje uspostavljanje vodiča za medicinske sestre zaprevenciju i zdravstvenu njegu dijabetesa , te povezivanje sa drugimzdravstvenim radnicima na nivou grada i Republike,što bi se moglouraditi kroz osnivanje Centra za dijabetes ili Centra za prevenciju iliječenje dijabetesa, edukaciju profesionalaca i pacijenata.

DRAGANA ALEKSIĆ – DIJABETES I NEPLODNOSTUvod: Istraživanja pokazuju da je neplodnost povezana sa dijabetesom. Toznači da će jedan od šest parova koji pokušavaju da ostvare potomstvo imatiprobleme sa neplodnošću. Neplodnost je problem s koji ima otprilike 15%parova.Cilj: Uticaj dijabetesa na žensku i mušku plodnostRezultati: Od 2000 do 2017. g. pojava dijabetesa u žena u dobi od 30-39godina povećana za 70%. Dijabetes može uticati na: kasne menstruacije ,rane menopauze i prijevremenu insuficijencije jajnika. Povećana glukozaznačajna je kod dijabetes tipa 2, što može promijeniti okolinu jajnika i uticatina sposobnost pravilnog razvoja jajne ćelije. Šećerna bolest može zahvatitimušku reproduktivnu funkciju na više načina: endokrina kontrolaspermatogeneze, sama spermatogeneza ili poremećaj erektilne funkcije iejakulacije. U dijabetičara : prevalencija neplodnosti 35-52 % .Zaključak: Savremene tehnike liječenja neplodnosti omogućavaju većinineplodnih parova sa dijabetesom dobivanje željenog potomstva. Postići

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dobru regulaciju glikemije s HbA1c ispod 7%, učiniti potrebne pretragei posavjetovati se sa ginekologom i endokrinologom o planiranojtrudnoći.

SANDRA KUSONJIĆ

SESIJA 4

Niki Caggiano: Zika virus and what you need toknow as a primary care physician

Zika virus is getting a lot of mainstream coverage in the UnitedStates. This Arbovirus has been around since 1947 but it is just nowgetting attention in the news and at the American CDC because of itsteratogenic effects. These teratogenic effects are not reversible anddistinct to Zika virus. Having an easily contracted disease on thecoasts of the US is striking fear in the heart of young healthy peopleof childbearing age. The symptoms are much like that of any othervirus—Chikungunya, dengue or ebola. Infection may or may not besymptomatic. The symptoms range from fever, muscular aches,headaches and rash. The most serious effects are on an unborn fetuswhich leads to microcephaly and permanent brain damage if not stillbirth. Zika is blood borne illness that can be transmitted by bothmosquito-bites and sexual contact. Diagnosis is made with eitherblood or urine testing typically 2 or more weeks after exposure. Thispresentation will discuss the most common areas were breakoutsoccur, how to diagnose it, how to prevent them and what to do whenit is contracted.

Larisa Mešić Đogić, Hajrudin Đogić, EnesHodžić, Seid Fazlagić (Tešanj, BiH): IGFBP-1marker cervikalnog sazrijevanja i prediktorprijevremenog porođaja

Istražiti korelaciju između pozitivnih vrijednosti IGFBP-1 (>10 mg/l,Actim Partus Test, APT) i preranog sazrijevanja grlića kod prijetećegprijevremenog poroda. Prospektivna studija, provedena u Domuzdravlja u Tuzli, Ginekološko-akušerskoj klinici Univerzitetskogkliničkog centra Tuzla i Općoj bolnici Tešanj, obuhvatila je 50 trudnica(ispitanice) (jedno čedo, 28-37 gestacijskih sedmica), kojima jedijagnosticiran prijeteći prijevremeni porod ultrazvučnomcervikometrijom i modificiranim Bishop-skorom, i 30 trudnica(kontrolna skupina) (jedno čedo, 28-37 gestacijskih sedmica) bezznakova prijetećeg prijevremenog poroda. Testirano je prisustvo

IGFBP-1 u cervikalnom sekretu između 28. i 37. sedmice, sve dok test nijebio pozitivan. IGFBP-1>10 mg/L bio je pozitivan kod 43 (86%) ispitanice i 6(20%) pacijentica iz kontrolne skupine (p=0.001). Kod 31 (62%) ispitaniceAPT je bio pozitivan u periodu 28-30. sedmice, kod 9 (18%) ispitanica drugotestiranje bilo je pozitivno u periodu 31-33. sedmice i kod 3 (6%) ispitanicetreće testiranje je bilo pozitivno u periodu 34-37. sedmice. U kontrolnojskupini kod 3 (10%) pacijentice test je bio pozitivan između 31-33. sedmice ikod 3 (10%) između 34-37. sedmice. Pri prvom testiranju (28- 30. sedmica)APT je statistički signifikantno češće bio pozitivan kod ispitanica u odnosu nakontrolnu skupinu ( p< 0,05). Testiranjem u kasnijoj gestacijskoj dobi nije sestatistički razlikovala učestalost pozitivnih nalaza između kontrolne iispitivane skupine ( p=0.08). Povećane vrijednosti IGFBP -1 u cervikalnomsekretu jako su povezane s prijevremenim porođajem. Probir pomoću IGFBPmogao bi pomoći u preveniranju prijevremenog porođaja i njegovihkomplikacija.Ključne riječi: inzulinu slični proteini koji vezuju faktor rasta , privremeniporod, cervikalna sluz

Omar-Vedran Ćizmić, Edin Begić, Haris Bradarić,Mirela Ćizmić (Maglaj, BiH): An un-expected Sideeffect of ibuprofen Use in Patients on DesloratadinTreatment

Aim: To show an unexpected side effect of Ibuprofen in patients who havebeen receiving desloratadine treatment for several days.

Case report: The patient came to the emergency centre because of aheadache and mild uncontrollable movements of her tongue. The doctoradministered a 10% infusion of mannitol (500ml). After the infusion, theheadache stopped, however, the uncontrolled movements of the tongueintensified (i.e. she twisted and stuck out her tongue more). She developed afever and diarrhoea. Additionally, pouting of lips was present. She stated thatshe had had a headache in the occipital part of the head that evening, afterwhich she took 400 mg of ibuprofen. At the time she was on her fourth day ofa 5 mg desloratadine treatment. She stated that she had no drug or foodallergies and that she had used Ibuprofen previously. She was cardio-respiratory compensated and normotensive. Except for the orofacialdyskinesia (uncontrollable tongue movements and pouting of the lips), otherneurological findings were normal. The patient was transferred to theCantonal Hospital in Zenica, where she was diagnosed with Dyskinesiafaciei. She was prescribed the following treatment: dexamethason 4mg/mLi.v., NaCl 500 ml i.v., ranitidin, amp, 50mg with diazepam, amp, 10mg /2 ml,i.m. After the treatment the symptoms ceased completely and theneurological findings were normal.

Conclusion: The literature does not mention the existence of an interaction

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between ibuprofen and desloratadine, and the patient is not aware ofbeing allergic to either and has used both in the past. Therefore, it isnecessary to distinguish whether there is a real interaction betweenthe two substances, or whether this is an isolated case.

Keywords: ibuprofen, desloratadine, drug interaction, allergy reaction.

SESIJA 5

Igor Dumanović, Ognjen Marinković,Draženko Vuković (Teslić): Risk factors forcardiovascular disease in patients withmyocardial infarction

Introduction:Cardiovascular diseases are the leading cause ofpremature death and disability in world, especially in developingcountries. The most specific cause of cardiovascular death is IHDwhich counts for 45% global cardiovascular deaths and 54,6%European cardiovascular deaths and is the leading cause of death bythis date.

Objectives: Estimate presence of individual risk factors for CVD inpatients who had myocardial infarction, and estimate most commonrisk factors in this population. Suggest actions for secondaryprevention of risk factors for CVD.

Methods: A cross-sectional study was conducted in Hospital forrehabilitation of patients with cardiovascular diseases Banja Vrućica,Teslić, in 2016. Research included patients who had myocardialinfarction and were admitted in hospital in 2016. A data about age,gender, BMI index, total cholesterol, triglycerides, glicaemia,diabetes, smoking habits, blood pressure, duration of hypertensionand history of acute cardiovascular event (previous IM, PCI, CABG,valve replacement and stroke) were collected from patient’s medicalrecords.

Results: Of total 337 patients with MI, 78,04% were men and 21.96%were women. Only 29,08% of patients were older than 65. The mostcommonly joined with myocardial infarction as risk factor is obesity(84,87%), followed by smoking (76,56%), hypertension lasting forlonger than 10 years (55,19% ), diabetes (20,77%) andhyperlipidaemia (12,76%) . Majority had joined 3 risk factors. For22,85% patients, IM was the first manifestation of CVD, recurrencesof IM had 6,28% of patients , IM followed with PCI and stent had83,09% patients and IM followed with CABG had 16,91% patients.

Conclusion: In order to prevent future acute cardiovascular events itis important to reduce number of risk factors. That is the big task and

great challenge both for health care professionals and patients . Many riskfactors, even if they exist, can be minimized with good management andtreatment.

Key words: myocardial infarction, risk factors, obesity, smoking,hypertension ,diabetes, hyperlipidaemia.

Mladen Tepić, Miroslav Živković, Suzana Savić(Banjaluka, BiH): Studentski osvrt na porodičnumedicinu sa fokusom na dijabetes melitus

Kao student Medicinskog fakulteta, studijskog programa Medicina, na 6.godini studija sam se prvi put susreo sa predmetom „Porodična medicina“,karakteristikama i načinom rada primarne zdravstvene zaštite, te njenimspecifičnostima u odnosu na druge grane medicine. Ono što je na meneostavilo dobar utisak jeste sama organizovanost rada Katedre, predavanja,praktičnog dijela nastave, susretljivost pojedinih članova Katedre i adekvatnaliteratura za učenje. U toku dosadašnjeg školovanja rijetko sam imao prilikuda potpuno samostalno pristupim radu sa pacijentom, od njegovog dolaskau zdravstvenu ustanovu pa do napuštanja iste, što na ovom predmetu nijebio slučaj. Tokom praktičnog dijela nastave obučen sam da prepoznam itretiram najčešće probleme u zajednici, sa posebnim osvrtom na masovnenezarazne bolesti, te prevenciju bolesti i promociju zdravlja. Posebno moramistaći nesebično podučavanje mog asistenta da što bolje naučim liječitioboljele od diabetes mellitus-a. Mnogo sam sigurniji u komunikaciji sa ovimpacijentima, jer sam savladao osnove liječenja ovih pacijenata pridržavajućise novih dijagnostičkih kriterijuma i smjernica (ADA/EASD 2017.). Naučiosam: edukovati pacijente o promjeni životnog stila (pravilana ishrana i fizičkaaktivnost), uključivati metformin kao lijek prvog izbora (modifikovati dozu),osnove insulinske terapije , raditi skrining riziko faktora (fizička neaktivnost,ishrana bogata mastima, gojaznost, upotrebom alkohola...), prevenirati mikroi makrovaskularne komplikacije. Posebno ističem moj prvi susret i pozitivnoiskustvo u dijagnozi neuropatije, pomoću Semmes Weinstein-ovimmonofilamenta i zvučne viljuške. Zaključak: Katedra porodične medicine, pomeni, je jedna od bolje organizovanih Katedri na Medicinskom fakultetu sadobrim predavanjima, praktičnom nastavom, adekvatnom i razumljivomliteraturom, te dobrim načinom polaganja ispita.

Belma Pojskić, Štimjanin E., Pojskić L.,Selimović H., Berberović-Mulahalilović S:Rezistentna hipertenzija - prikaz slučaja i mogućnostnefarmakološke terapije u bosanskohercegovačkimuslovima

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Pacijentica stara 60 godina, BMI 22, ne puši, dugogodišnjihipertoničar dolazi na pregled zbog jakih bolova u grudima zadnjih 10dana praćenih vrijednostima sistolnog tlaka preko 220 mmHg,dijastolnog preko 110 mmHg ( jednom izmjeren tlak 280/ 140 mmHg).Svakodnevno uzima više od 10 antihipertenziva u više doza, javlja seu SHP i ne želi bolnički tretman.Na pregledu uznemirena, TA 260/140mmHg, ostali fizikalni nalaz neupadan. EKG pokazuje hipertrofijulijeve komore, koja se potvrdi na UZ srca, uz manje sklerotičnepromjene na zaliscima,urednu sistolnu funkciju LV, uredne dimenzijeascendentne aorte. Uradjena koronarografija i CT angiografija aortesu uredni, kao i doppler renalnih arterija i UZ abdomena. Svibiohemijski parametri, endokrinološke analize su uredni. Našojpacijentici smo uključili terapiju koju do sada nije koristila: peridonpril8mg/indapamid 1,25 mg ujutro, perindopril 8mg / amlodipin 10 mguveče, uz ranije ordinran metoprolol 100 mg . Nakon 5 dana bolovi ugrudima su se smanjili a onda i prestali, vrijednosti tlaka se kreću od130/80 do 160/90 mmHg.Preporučili smo po potrebi furosemid ,nitroglicerin sublingvalno. Nije se dobro osjećala prilikom uzimanjaspironolaktona, tako da je taj lijek isključen iz terapije. Rezistentnahipertenzija je ona gdje je TA≥140/80 kod uzimanja kombinacije trilijeka uključujući diuretike u maksimalnoj dozi. Prevalenca seprocjenjuje n a oko 5% hipertenzija u svijetu.Opcije nefarmakološkogtretmana su renalna simpatička denervacija RDN, barostim terapija,arteriovenska anastomoza. Studije o RDN pokazuju različite ishodeove metode, a meta analiza 7 sudija je pokazala da ne snižavasignifikantno tlak ali da je sigurna metoda. Druga meta analiza jepokazala da dodatak spironolaktona u terapije je efikasnijiod RDN u tretmanu rezistentne hipertenzije. Nefarmakološke metodetretmana rezistentne hipertenzije nisu dostupne u Bosni iHercegovini. Dosadašnje studije su pokazale da ove metode nisudovoljno efikasne i da je potrebno razvijanje novih tehnologija ipristupa u tretmanu rezistentne hipertenzije.

Tanja Zlatković Zanin, Ajlina KaramehićMuratović (St. Louis/USA): Influenceof Income and Education on Health Outcomesof Bosnian Refugees in the United States

Background Little is known about long-term health outcomes ofrefugees in the United States (U.S.). Beyond the initial resettlementperiod there are no coordinated surveillance mechanisms thatdistinguish refugees from other immigrant groups or provide any dataon outcome metrics. Understanding the health status of refugees inthe decades after resettlement is critical to developing appropriate

and effective current refugee health policy.Purpose/Objectives Focusing on social determinants of health, we aim toinvestigate the influence of income and education level on long-term healthoutcomes of Bosnian refugees resettled in the U.S.Methodology We utilized the validated PROMIS Health Measure in individualsurveys of 250 Bosnian adults living around the U.S. We used the one-wayANOVA to assess the mean difference in PROMIS scores across reportedincome groups and education levels. Through multiple linear regressions wewill model the relationship between these variables while controlling forconfounders, such as age and gender.Results Preliminary data on 250 respondents shows a normal distribution.Although our study population is younger than the average U.S. population,their mean PROMIS scores in the physical and mental health domains arelower than the U.S. 50th percentiles. Our preliminary data does not showdiscernible trends between income at resettlement or current income andPROMIS scores. There is a slightly positive relationship between educationlevels and PROMIS scores.Discussion Economic stability and education are two key social determinantsof health. Our data on Bosnian refugees suggests poorer self-reportedphysical and mental health compared to the U.S. average population. Whencompared with income, education is a stronger determinant of healthoutcomes among Bosnian refugees.

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INTERNACIONALNI SIMPOZIJ IZ PEDIJATRIJE

PROGRAM DAN III

SESIJA: MALIGNE BOLESTI KOD DJECE

Biljana Djurdjević Banjac (Banja Luka,BIH): Toxic Complications in Children withAcute Lymphoblastic Leukemia TeatedwithProtocol ALL IC BFM 2002

Acute lymphoblastic leukemia (ALL) is the most common childhoodmalignancy. With the advent of aggressive multimodality therapy, ALLhas become a curable disease for majority of pediatric patients.However, the morbidity and toxicity associated with current intensivetreatment protocols for acute lymphoblastic leukemia in childhoodbecome even more important as the vast majority of children can becured and become long-term survivors.

METHODS: In this retrospective study analyzed all children withacute lymphoblastic leukemia who were diagnosed and treated at theUniversity Childrens Hospital in Belgrade and the Clinic for Children'sDiseases in Banja Luka, in the period from December 2002 to May2010. The study included children aged 0 months to 18 years with thediagnosis of ALL treated for the same protocol - ALLIC BFM 2002.The frequency and characteristics of toxic complications in all phasesof treatment and for all risk groups are analyzed.

RESULTS: A total of 123 children, 74 boys (60.16%), girls 49(39.84%), middle age 7.11 years. The frequency of toxiccomplications was high, 98.37% of patients had at least onecomplication during treatment with average 4.8 complications perpatient. The most frequent complications were infections (48.53%), ofwhich 87.19% were infections associated with neutropenia. The mostcommonly documented clinical infection was pneumonia (35.17%). Inpatients with high risk (HR), statistically significant incidence ofinfections was observed in all treatment phases (p <0.001). Non-infectious complications were one-third of complications, withmucositis and vomiting most commonly (39.60%, 23.83%). Therewas also a high incidence of neurological complications (11.34%).The total mortality of toxic complications was 4.8% of patients, in 80%of cases of infection were the cause of death.

CONCLUSION: We concluded that the frequency and clinical characteristicsof toxic complications as well as total mortality from complications of therapyin our patients are similar to the toxicity characteristics that are mentioned instudies in the developing country.

Dragana Malčić-Zanić, Lidija Krivokapić Dokmanović,Dragana Janić, Jelica Samardžic Predojević, NadaKrstovski, Biljana Djurdjević Banjac, Jelena Lazić,Predrag Rodić, Goran Milošević (Banja Luka, BIH):Influence of time to diagnosis on risk group and survival ofchildren with the acute lymphoblastic leukemiaduring twenty years

INTRODUCTION: Early diagnosis of cancer is still a fundamental goal inoncology because it allows anopportunity for timely treatment while diseaseburden is in its earliest stages. Unfortunately, delayed diagnosis which couldto be associated with advanced stage of disease and poorer treatmentoutcome remains aproblem.AIM: The aim of this study was to identify the timeto the diagnosis of acute lymphoblastic leukemia in childrenand the clinicaland sociodemographic factors associated with this latency.METHODS: All patients diagnosed with acute lymphoblastic leukemiabetween 1993 and 2013 at UniversityChildren’s Hospital Belgrade andChildren’s Hospital Banjaluka were retrospectively evaluated. Clinicalanddemographic variables were analyzed to assess their association with thetime to diagnosis.RESULTS: A total of 292 patients younger than 18 years of age were includedin the study, and 175 of thesubjects were males (59.93%) while 117 werefemales (40.07%). The median age of patients was 5.7 years(interquartilerange [IQR], 3.56–10.14),. High risk group was present in 87 (29.79%) cases,intermedium riskgroup in 156 (53.42%) and standard risk group in 49(16.78%) caeses. The median time to diagnosis was 15days (interquartilerange [IQR], 7.00–30.00). Overall survival rate was 76%. Gender, age, firstphysician seen(pediatrician/general practitioner), area of residence,socioeconomic status did not significantly affect time todiagnosis. There wasno significant differences between time to diagnosis and risk group and withsurvival ofpatients at the end on observed period.CONCULSION: Median time to diagnosis in children with acute lymphoblasticleukemia was shorter thandescribed in developing countries and wascomparable to data from developed ones, where the index ofsuspicion forchildhood malignancies is high.

Dalibor Tomić (Banja Luka, BIH):Electroencephalographic Findings in Children with AcuteLymphoblastic Leukaemia

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The goal of the study was to evaluate changes inelectroencephalogram (EEG) recordings during the courseof acutelymphoblastic leukemia (ALL) in children. This study enrolled 20children with ALLwho underwent atotal of 47 EEGs at various stages ofthe disease. The medical files were reviewed for relevant clinicaldata.Changes in EEG activity was noted in 4 of the EEGs done beforebegining of the treatment and during theinduction phase and in 10EEGs of those done during the consolidation phase of treatment. Themain findingof this study is the higher rate of EEGs changes during thelater stage of ALL (about 21%) than during theearly stage (about 8%).EEG changes, by themselves, are not an indicator of central nervoussysteminfiltration nor the predictor of seizures in children with ALL. Themain role of EEG in children with ALL is as adiagnostic tool forneurological complications of leukemia or its treatment.

SESIJA: HRONIČNE BOLESTIAmira Peco-Antić (Beograd, Srbija):Growing up with chronic kidney disease(Kako odrasti sa hronicnom bolestibubrega)Diana Milojević (Boston,USA/BHAAAS): Auto-inflammatorydisease in children )Dušica Babović-Vuksanović(Rochester, USA/ BHAAAS):Neurofibromatosis type 1 management

SESIJA: KONGENITALNE ANOMALIJE I AKUTNA TERAPIJA

Jelica Predojević-Samardžić (BanjaLuka, BiH): Kongenitalne anomalije uRepublici Srpskoj- rezultati dvogodišnjegskrininga (The registry of congenitalanomalies in RS, two years experience)

Congenital anomalies (CA) are structural defects and functionaldisorders that are present and visible at birth. They are significantmedical and public health problem and important cause ofmiscarriages, stillbirths, morbidity and mortality in neonates andinfants, and very often permanent anatomical and / or functionaldamage, with serious consequences on the quality of life of theindividual and his family.CA cause of 260,000 deaths per year (7% inthe neonatal period). Where is the overall mortality rate is lower, theproportion of KA in infant mortality is higher ; in Europe is 25%. It is

expected that the number of children born with congenital anomalies in ourcountry ( RS) is higher than he average in Europe with regard to: lownational standard, an increasing number of non-vaccinated population in,insufficient awareness of women of reproductive age, uncontrolled use ofdrugs, an increasing number of older pregnant women,war developments inthe recent past Therefore, consideration of the epidemiological situation asregards congenital anomalies in our country and preventive action are ofgreat importance and positive impact on the birth rate and the health of thechild population in the Republic Srpska. Conclusions and observations :Theresults represent a cross-section of the current situation, saying that theprevalence of CA in our country is higher(426 CA :10.000 deliveries) thanthe average prevalence indicated by the EUROCAT (234,4:10.000deliveries). -Significantly higher incidence CA of heart , urinary system andextremities relative to EUROCAT; -Significantly smaller proportion ofprenatally detected cases CA (10,3%) compared to EUROCAT(31%); -Thesmaller the number of registrations in the regions of the Eastern part of RS; -The problem of different prevalence CA (Heart) between different regions ofthe RS (teratogenic factors?). -The problem of incomplete registration (lackof data on the teratogenic factors and family history); It is important that theregister CA becomes mandatory in clinical practice to obtain a well-documented database that would allow to establish control of CA in ourcountry, detect risk factors, consider and improve prevention measures andthus improve health care for children and populations at all.

Tomica Božić, Jure Pupić- Bakrač, VesnaBrkić,Darinka Šumanović – Glamuzina, MarijanaJerković – Raguž, Marija Bošnjak, AntonijaMustapić, Ana Pupić -Bakrač (Mostar, BIH):Intensive care of a newborn with EdwardsSyndrome-a case report

Introduction: Edwards syndrome is the second most common autosomalchromosome anomaly in humans, with a prevalence of 1: 6,000-1: 8,000 inlive births. The syndrome includes a recognizable pattern of major and minoranomalies, and prominent psychomotor and cognitive impairments. It carriesan increased risk of neonatal and infant mortality. More than 50% of childrendie in the first week of their life, and less than 10% of them survive until theage of one year. The approach to the treatment of such patients has so farcaused many controversies among pediatricians. Whereas some believe thatthe use of intensive therapy prolongs survival, others believe that it has nolong-term effect and due to the severe psychomotor and cognitive impairmentits application is not justified.

Case report: A female newborn, born on January 11th, 2014, immediatelyafter birth, was transferred to Neonatal Intensive Care Unit of Department ofPediatrics, University Clinical Hospital Mostar, because of hypotonia, pale-grayish color of the skin, deficient spontaneous motor skills and respiratory

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insufficiency. Clinically, the newborn showed phenotypiccharacteristics typical of Edwards syndrome. Immediately upon receiptthe patient was intubated and connected to mechanical ventilation.The same day diaphragmatic hernia was diagnosed and acorresponding surgery was performed. Cytogenetic findings confirmedcomplete trisomy 18. Heart echography showed VSD input type (size8 mm), ASD II (5 mm), PDA (3 mm). Further diagnostic examinationshowed other congenital malformations with less clinical importance.After stabilization, the patient continued post-intensive treatment withcardiac therapy and physiatric treatment. After being discharged, thepatient was repeatedly hospitalized, among other things due to thedevelopment of pulmonary hypertension and its complications. Thechild died in June 2016 of heart failure at the age of two years and sixmonths.

Conclusion: The application of intensive treatment had a certainimpact on our patient's survival. It has also been shown that intensivecare is followed by cardiovascular events as major mechanisms ofdeath, as opposed to non-invasive approach where high percentageof deaths are associated with central apnea.

Keywords Edwards syndrome, intensive care, survival

Dušica Babović-Vuksanović(Rochester, MN, USA/ BHAAAS):Facial clefts, etiology and genetics

Amina Selimović, Ermina Mujičić,Selma Milišić, Zuvdija Cecunjanin,Snježana Hasanbegović,Edo Hasanbegović (Sarajevo, BiH):Assessment of hematological parameters,acid-base status and arterial blood gastest before and after treatment of acutebronchiolitis in children.

Objective: The purpose of our retrospective study was to investigatethe necessity of some laboratory testing in patients with acutebronchiolitis before and after treatment.Methods: We have taken blood samples of all children puncturing thecubital vein, and analyzed it using the Colter appliances-automaticcounter blood count, for analyzes of a number of erythrocytes,leukocytes, platelets, differential blood count, Hct, Hb. CRPconcentration in serum of patients determined by laser nephelometrywith CardioPhase® high sensitivity C-reactive protein (hsCRP). Forassessment of acid-base status and arterial blood gas analysis wereused ABL5 and ABL700 Radiometer Copenhagen. We monitored the

following parameters: pH, pCO2, HCO3-, total CO2, base excess, pO2,SpO2.Results: There was a significant improvement of hypoxemia aftermanagement of acute bronchiolitis in the form of a significant increase inaverage values of pO2 and SpO2 after treatment of acute bronchiolitis. Theaverage value of the number of leukocytes and value of CRP in childrenwere significantly decreased before and after management of acutebronchiolitis. There was no significant difference in duration of hospitalizationin term and preterm newborns.Conclusion: No routine diagnostic tests are used routinely. however, there isan improvement of hypoxemia after management of acute bronchiolitis inchildren.

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SESIJA: RAZVOJNA PEDIJATRIJA

Nirvana Pištoljević (New York,USA/BHAAAS; Sarajevo, BiH): Ulogapedijatrijske službe u praćenju i skrininguranog rasta i razvoja: Koncept ranedetekcije i intervencije u BiH

Nirvana Pištoljević, Eldin Džanko,Stanislava Majušević (New York,USA/BHAAAS, Sarajevo, BiH): Efektinaučno zasnovanog koncepta ranedetekcije i intervencije pri pedijatrijskimslužbama u BiH – pilot studija

Nirvana Pištoljević, StanislavaMajušević (New York, USA/BHAAAS;Sarajevo BiH):Uspostavljanje naučno zasnovanogsistema rane detekcije i intervencije pripedijatrijskim službama u SoP – replikacijaBiH modela

Lejla Buturović, Zumreta Jeina (NewYork, USA/ BHAAAS; Sarajevo BiH):Sistematski pristup edukaciji roditelja djecesa poteškoćama u ravoju u EDUSprogramu – prvi nivo intervencije sa djecom

Nirvana Pištoljević, Džana Hrvić (NewYork, USA/ BHAAAS; Sarajevo BiH):Analiza uspješnosti EDUS programa raneintervencije – studija slučaja

Emira Švraka, Berka Klinić (Sarajevo,BiH): Slobodno vrijeme djece i mladih srazvojnim teškoćama

Djeci s razvojnim teškoćama potrebna je pomoć u razvijanju opcijaslobodnih aktivnosti i prilagođavanja okruženja za izvođenje slobodnihaktivnosti prema mogućnostima. Rezultati istraživačkog ProjektaSaveza udruženja osoba s cerebralnom paralizom FBiH dali supodršku inkluziji osoba s cerebralnom paralizom.

Cilj: upoznati osobe s razvojnim teškoćama, članove porodice izajednicu s mogućnostima korištenja slobodnog vremena, kako bi sepoboljšao kvalitet života ove populacije.

Metod rada: Individualni rad roditelja – radni list i grupni rad roditelja nahamer papiru.

Rezultati: U radionicama je učestvovala 121 osoba s cerebralnom paralizom,52 (42,98 %) iz Sarajeva, 14 (11,58 %) iz Goražda, 29 (23,97 %) iz Zenice, 9(7,43%) iz Sapne i 17 (14,05%) iz Centra „Koraci nade“ iz Tuzle. Od ukupnoguzorka (121 učesnik) dnevno 1 sat sluša muziku 29 (23,97%) učesnika, 2sata 26 (21,49%), 3 i više sati 59 (48,76%) i ne sluša muziku 7 učesnika(5,78%). Dnevno 1 sat gleda TV i koristi internet 20 (16,53 %) učesnika, 2sata 35 (28,92%), 3 i više sati 60 (49,59 %) i ne gleda TV i ne koristi internet6 (4,96 %) učesnika istraživanja. Od ukupnog uzorka, 37 (30,58%) učesnikadnevno 1 sat „ne rade ništa“, 2 sata „ne radi ništa“ 29 (23,97%), 3 i više sati25 (20,66 %) i cijeli dan/potpuno „ne rade ništa“ 30 (24,79%) učesnikaistraživanja.

Zaključak: Navedene željene slobodne aktivnosti trebalo bi da se nađu unarednim planovima i programima svih subjekata koji su zaduženi zapružanje podrške inkluziji osoba s cerebralnom paralizom. Takođe,preporučuje se da sastavni deo svih terapijskih pristupa osobama s razvojnimteškoćama bude i obuka ovih osoba za adekvatno korištenje slobodnogvremena. Potrebno je sistemsko razvijanje metodologije istraživanjaslobodnog vremena i interdisciplinarno sinergijski stvaralački pristup ovomvitalnom problemu.

Ključne riječi: slobodno vrijeme, cerebralna paraliza, radionice za roditelje

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INTERNACIONALNI SIMPOZIJSESTARA/TEHNIČARA INTENZIVNENJEGE

PROGRAM DAN III

SESIJA: SLOBODNE TEME IZ SESTRINSTVA

Mevludin Babajić (Tuzla, BIH): Anestezija isedacija izvan operacione sale

Poslednje dvije decenije bilježi se napredak u razvojumedicinske tehnologije, koja omogućava liječenje pacijenataneinvazivnim ili minimalno invazivnim procedurama. Pacijentikod kojih je, do prije nekoliko godina, liječenje podrazumijevalovelike hiruške intervencije, sada se mogu liječiti efikasnije,ekonomičnije i komfornije nehirurškim intervencijama koje seizvode van operacione sale. Mnoge od ovih procedura se izvodiu opštoj intravenskoj anesteziji ili proceduralnoj sedaciji ianalgeziji koja se sve češće koristi, a radi obezbjeđivanjaoptimalnih uslova rada za ljekara, uz maksimalni komfor ibezbijednost po pacijenta. Izvođenje različitih oblika anestezijeu uslovima van operacione sale, doveo je do razvoja jedne novesubspecijalnosti: Non-Operating Room Anaesthesia Care(NORA) Anestezija van operacione sale Rezultati istaživanja uAmerici pokazuju da je oko 30% anestezija u najvećimbolnicama izvedeno van operacione sale. Cilj izvođenjaanestezija van opercione sale: bezbjednosti pacijenta,smanjenja bola i uznemirenosti kod pacijenta koje su posljedicaizvođenja same procedure, omogućava da pacijent bude miran,bez pokreta tokom izvođenja procedure, maksimalnogobezbjeđivanja uslova za uspješno izvođenje procedure, brzoporavak pacijenata. Pacijenti koji se podvrgavaju ovakvimintervencijama, u sve većem broju su sa ozbiljnimkomorbiditetima zbog čega se rješavanju njihovog zdravstvenogproblema pristupa manje inavzivnim metodama.

Valentin Zupan (Slavosnki Brod, BiH):Projekti proširene edukacije laika izpodručja hitne pomoci i njihov utjecaj nakvalitetu rada hitne medicinske službe

Proširena edukacija laika – sastavnice, BLS/AVD edukacija laika, utjecajedukacije na kvalitetu zbrinjavanja pacijenata, projekti edukacije –međunarodna suradnja i projekti.

Elmedin Dubravac (Sarajevo, BiH): IntrahospitalInfections in ICU

During my lengthy career as a Registered Nurse I have encountermany patient cases that acquired nosocomial infections whilebeing hospitalized. In this paper I will be presenting commoncauses of intra-hospital infections among patients in critical caresetting. Also, the best practices in prevention strategies worldwide.Will also present mortality rates among ICU patients in industrialversus developing countries. Additionally is important to discusseducation of medical and non-medical staff in infection preventionand what strategies are best to decrease rates of these infectionsamong patient population. In conclusion we can say that it is veryimportant to discuss this matter among all medical and health careproviders, because this way we can decrease unnecessaryprolongation of hospitalization and possible complications.

Keywords: Intrahospital infections, prevention, education

Mirsada Čustović (Sarajevo, BiH): Terapija kisikomUVOD:Pacijentu je potrebna terapija kiseonikom kada jehipoksemija rezultat poremećene funkcije disanja ili srca icirkulacije, ili usljed povećannja metaboločkih funkcija.U slučaju hitnog respiratornog stanja, primjena kiseonikaomogućava pacijentu da smanji svoj ventilacioni napor.Kadastanja kao što je atelektaza ili adultni respiratorni distres sindrompogoršaju difuziju ,ili kada su smanjeni plućni volumeni zbogalveolarne hipoventilacije , ova procedura podiže nivo alveolarneoksigenacije.U slučaju hitnog kardiološkog stanja, kiseonička terapija pomažeda se postigne povećani rad srca kojim srce pokušava dakompenzuje hipoksemiju.Oksigenoterapija je praktično važna za pacijenta kada je miokardveć kompromitovan, možda zbog infarkta miokarda ili srčanearitmije.Adekvatna kiseonička terapija se procjenjuje na osnovu analizegasova u arterijskoj krvi (ABS), osimetar – monitoringa i kliničkog

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pregleda.Pacijentova bolest, fizičko stanje i godine, pomažu da seodredi najbolji mogući tretman.

MATERIJAL I METODE:Bolesnik, prikaz slučajaCILJ RADA: Prikazati ulogu medicinske sestre -

tehničara kod primjene oksigenoterapije, ciljeve ievaluaciju zdravstvene njege i terapije pacijenata naoksigenoterapiji.ZAKLJUČAK: Medicinska sestra – tehničar jezadužena za namještanje, održavanje i rukovanjeopremom.Potreban pribor zavisi od tipa sistema zanapajanje kiseonikom.Potrebno je radno iskustvo za medicinske sestre –tehničare koji rukuju sa opremom za primjenuoksigenoterapije.KLJUČNE RIJEČI:pacijent, oksigenoterapija,medicinska sestra – tehničar, kiseoničkaoprema,indikacije i kontraindikacije.

SESIJA: NEUROHIRUSKA OBOLJENJA (OPERATIVNI,FARMACEUTSKI I DRUGI OBLICI TRETMANA)

Jasmina Dervišević (Sarajevo, BiH): Prisustvo iprevencija epileptičnih napada kod tumora mozga

UVOD:Epilepsija je poremećaj koji se pojavljuje u čitavom svijetu i jedanje od najstarijih poznatih čovječanstvu. Karakterizira je sklonostponavljanim napadima koji mogu dovesti do gubitka budnosti ili svijesti,poremećaja kretanja, osjeta (uključujući vid, sluh i okus), autonomnihfunkcija, raspoloženja i mentalnih funkcija. Epilepsija uključuje bilo kojestanje kod kojeg postoje ponavljane epizode napada bilo kojeg tipa.Epilepsija (idiopatski poremećaj s napadima) termin je koji se koristi kadporemećaj s napadima nema uzrok koji se može otkriti kao što je bolestmozga. Epilepsija pogađa oko 0.5% stanovništva. Uzrok napada je uodređenoj mjeri u korelaciji s dobi kod pojave bolesti. Mogu se pojavitipromjene u mentalnom statusu (kao što su budnost i svijest) i/ili fokalnineurološki simptomi (lokalizirani simptomi promjena u funkciji mozga)povezani s napadima. Tip napada koji se pojavljuje varira ovisno o lokacijii vrsti problema koji izaziva napad i individualnom odgovoru naporemećaj. Napadi se mogu pojaviti u generaliziranom obliku (kojizahvaća cijeli ili veći dio mozga) ili parcijalnom obliku (koji zahvaća samodio mozga). Tipovi napada: petit mal napadi, grand mal napadi,jednostruki fokalni napadi, parcijalni kompleksni napadi. Tumoromuzrokovane epilepsije. Kardinalni znaci ekspanzivnog intrakranijalnogprocesa su glavobolja i povračanje, epileptični napadi, progresivnafokalana lezija, zamračenje vida, poremećaji svijesti, progresivna sporaEEG dizritmija, papila stagnans na pregledu očnog dna. Glavobolja jenekada lokalizovana iznad mjesta tumora ali je česće frontalna, potiljačnaili difuzna. Često se javlja noću. Epileptični napadi između 35 i 55 godineživota uvijek zahtijevaju pažljivo ispitivanje i isključenje tumora. Oni suprvi simptom tumora mozga u oko 25-40%. U spororastućih tumora odjavljanja epileptičnih napada do neuroloških ispada može proći 15 do 25godina.

Ciljevi istraživanja su: 1. Utvrditi učestalost epilepsije kod pacijenata satumorom na mozgu, 2.Utvrditi učestalost epilepsije kod tumora mozga,ovisno polu, dobi i vrstama tumora, 3.Utvrditi korelaciju izmeđulokalizacije tumora, vrste tumora, i vrste epileptičnih napada, 4.Utvrditiprincipe profilakse i liječenja epilepsije kod tumora mozga

Materijal i metode istraživanja: Istraživanje je provedeno na Klinici zanerohirurgiju, UKCS-a.

KLJUČNE RIJEČI:Epilepsija, tumori, epileptični napadi,liječenje.

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Edisa Jakupović (Sarajevo, BiH): Tumorihipofize, operacija i uloga medicinske sestre

UVOD: Hipofiza je kod ljudi velika oko 1 cm i smještena jeispod dijela mozga koji zovemo hipotalamus, namjestu kojezovemo tursko sedlo (sella turcica). Ona ima glavnu ulogu uhormonskoj regulaciji u tijelu i jednaje od najbolje proučenihžlijezda. Njeno je djelovanje usko povezano sa hipotalamusom.Odnos"hipotalamus -hipofiza" predstavlja jedan od najboljeproučenih kontrolnih mehanizama u tijelu i odličan je primjerzameđudjelovanje i saradnju nervnog i endokrinog sistema.Tumori hipofize mogu se osnovnom podjelomsvrstati u nekolikogrupa: Obzirom na hormonsku aktivnost razlikuju se:funkcionalni i nefunkcionalni adenom.Prema veličini adenomimogu biti veći (makroadenomi) ili manji od 10 mm(mikroadenomi); locirani suintraselarno (s mogućim širenjeminfraselarno ili lateralno) ili ekstraselarno; Po ponašanju suneinvazivni iliinvazivni i tada govorimo o njihovom malignomponašanju usprkos histološkim osobinama benignihtumoraLiječenje tumora može biti:Medikamentozno liječenje(agonisti dopamina, analozi somatostatina, inhibitoristeroidogeneze)Operativno liječenje (transsfenoidni,transkranijski i endoskopski pristup) Iradijacijska terapija(konvencionalniizvori zračenja, brahiterapija, radiokirurškemetode -“Gamma knife”, stereotaktičko zračenjelinearnimakceleratorima)KemoterapijaHormonalna nadomjesnaterapijaGenska terapijaPostoperativna zdravstvena njega je:Pratiti vitalne i neurološke znakove, staviti bolesnika u povišenpoložaj ,monitorirati satnu diurezu i specifičnutežinu urina,zabilježiti bolesnikove pritužbe na žeđ ,kontrolirati elektrolite iosmolarnosti po odredbi liječnika,pomoći bolesniku u/s toaletomusne šupljine.Uloga medicinske sestre je upozoriti bolesnika dane ispuhuje nos, nakon što su šavi omogućiti obavljanjehigijenekao što je kupanje, češljanje kose i rezanje noktiju ,pomoćibolesniku prilikom ustajanja kako bi seprevenirao pad i ozljede,osigurati tekuću ili kašastu dijetu ,nuditi tekućinu često,održavati hidraciju ,vlažitimukozne membrane usne šupljine •osigurati njegu očiju ,stavljati obloge na periokularnu regijuukolikonastane edem ,pripremiti i provoditi edukacijskiplan.KLJUČNE RIJEČI:hipofiza,tumori hipofize,zdravstvenanjega.

Elmedin Dubravac (Sarajevo, BiH):Sevoflurane versus Propofol in NeuroAnesthesia

Both inhalational and intravenous anaesthetic agents are being used forneuroanaesthesia. Clinical trialscomparing “propofol and sevoflurane” and“desflurane and sevoflurane” have been published. However,thecomparison of all the three anaesthetics in neurosurgical patients hasnot been done. A randomised clinicalstudy was carried out comparingpropofol, sevoflurane and desflurane to find the idealneuroanaestheticagent. The practice of neuroanesthesia is unique in thatthe target organ of both the surgeon and theanesthetist is one and thesame. Thus, the surgical goals have a profound impact on the constraintsthat theanesthesiologist must work within. In order to appropriatelyanesthetize the patient for neurosurgery, anunderstanding of theinterrelationships of neurophysiology, pathophysiology and pharmacologyis important.Sevoflurane or propofol–remifentanil-based anaestheticregimens represent modern techniques forneurosurgical anaesthesia.Nevertheless, there are potential differences related to their activity onthecerebrovascular system. The magnitude of such difference is notcompletely known. Volatile anesthetics affectcerebral blood flow bothindirectly and directly. When cerebral metabolism is decreased,vasoconstrictionoccurs to appropriately reduce cerebral blood flow.However, direct vasodilation also occurs in a dosedependent fashion butmay not manifest as increased CBF except at higher concentrations.Propofol,barbiturates and etomidate are potent cerebral vasoconstrictorsreducing cerebral blood flow secondary todecreasing cerebralmetabolism. The effect on cerebral blood flow is greater with propofol andthiopental thanetomidate. Propofol and thiopental do not alterautoregulation.

Aida Žujović (Sarajevo, BiH): Procedure antisepse iasespse u operacionoj sali pri ugradnjiventrikuloperiotonealnog santa kod hidrocefalusa

Uvod: Hidrocefalus predstavlja nakupljanje likvora u komoramamozga.Likvor je moždana tečnost koja se nalazi u šupljinamamozga(komorama) i oko cijelog mozga i kičmene moždine. On se stvarau komorama i ukoliko postoji prepreka njegovom oticanju iz mozga,

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nakuplja se u istim dovodeći do širenja komora i pritiska namoždano tkivo, što može izazvati velika i trajna oštećenjavegetativnih, motoričkih i psihičkih funkcija mozga. Na prostrimabivše Jugoslavije, prvu operaciju VPŠ izveo je prof. dr. PetarMilenković, 1960. godine u Beogradu. Hidrocefalusi se dijele na:Komunikativni (kada su sve likvorske komore spojene) iNekomunikativni(opstruktivni). Komunikativni hidrocefalus jehidrocefalus kod kojeg su sve komore spojene i on se hiruškirješava ugradnjom Ventrikuloperitonealnog šanta (VPŠ) i nemože se rješavati endoskopski. Nekomunikativni hidrocefalusse rješava endoskopski. Klinički se razlikuju hidrocefalus koddjece i hidrocefalus kod odraslih. Hidrocefalus kod djece u prvoji drugoj godini života se manifestuje povećanjem glave, naočima se vidi beonjača izmeni dužice i kapaka (što nijenormalno), dijete povraća,ima napetu fontanelu i ne napreduje.Hidrocefalus u odraslih se manifestuje u početku psihičkimpropadanjem, otežanim hodom i nekontroliranim mokrenjem(Hoakimov trijas). Pored ovih kao simptomi mogu se javitinestabilnost , glavobolja i druge tegobe. Ukoliko je hidrocefalusuzrokovan nekim oboljenjem ( tumorom ili krvarenjem), mogudominirati znaci te bolesti i maskirati znakehidrocefalusa.Dijagnoza se postavlja na osnovu CT i MRImozga. Hidrocefalus u odraslih se manifestuje u početkupsihičkim propadanjem, otežanim hodom i nekontroliranimmokrenjem (Hoakimov trijas). Pored ovih kao simptomi mogu sejaviti nestabilnost , glavobolja i druge tegobe. Ukoliko jehidrocefalus uzrokovan nekim oboljenjem ( tumorom ilikrvarenjem), mogu dominirati znaci te bolesti i maskirati znakehidrocefalusa.Dijagnoza se postavlja na osnovu CT i MRImozga. Oboljenje hidrocefalus kako kod djece tako i kododraslih,se liječi operativno, postavljanjem sistema cjevčica kojivišak likvora odvodi u neku od tjelesnih šupljina (najčešćetrbušnu duplju ) odakle se vraća u krvotok.Sistem tih cjevčica senaziva VENTRIKULOPERTONEALNI ŠANT. VPŠ je implantat,ugradbeni, neresorptivni,materijal koji pacijent nosi u organizmucijeli svoj život, te kao takav ne bi ni u kojem slučaju smioizazvati infekciju, jer su ovakvi pacijenti ovisni o njemu. Sobzirom da je ugradnja VPŠ-a veoma invazivna hiruškametoda, gdje se implantatom punktiraju likvorske komore ipritom se prolazi iz vanjske sredine kroz mozgovinu, bitno jesprovesti stroge kriterije antisepse i asepse. Ako na područijuoperativnog polja nastane infekcija u periodu od 30 danapostoperativno takva se smatra hiruškom infekcijom. Ako jepostavljen implantat hiruškom infekcijom se smatra infekcijakoja je nastala u tom području od roku od 1 godine.

Cilj rada: Prikazati metode sprječavanje hiruške infekcije kojepodrazumijevaju: pripremu pacijenta, operativnog polja,hiruškog tima,operacione sale, instrumentarija i opreme, te postoperativnu njegupacijenta. Metoda rada:Retrospektivna studija operacije VP šanta naKlinici za neurohirurgiju u Sarajevu.

Zaključak: Antisepsa je postupak kod kojeg se hemijskim sredstvimauništavaju svi oblici mikroorganizama smanjuje njihov broj, spriječavanjihov rast, i razmnožavanje. Asepsa je takav način rada kod kojeg jeisključena mogućnost infekcije tj. svedena na najmanju moguću mjeru.Izvori infekcije mogu biti: Egzogeni - zrak u operacijskoj sali, hiruški stol,instrimentarij, hirški tim, komprese, tuferi, hiruški veš za pokrivanjeoperativnog polja. Endogeni - sam pacijent zbog bakterija prisutnih nakoži.

Ključne riječi: Hidrocephalus, VPŠ ventrikuloperitonealni šant, infekcija,operacija, antisepsa,asepsa, sterilizacija.

Amela Redžepović (Sarajevo, BiH):Baklofenska pumpa

Samela Zelić (Sarajevo, BiH): Enteralnaprehrana pacijenata sa karcinomom usnešupljine

Prema podacima SZO karcinom je vodeći uzrok smrti u svijetu sa 7,9miliona smrtnih slučajeva (oko 13% svih umrlih) u 2007. godine. Predviđase da će ovaj broj iznositi oko 12 miliona smrtnih slučajeva u 2030.Godine Karcinom izaziva 20% smrtnih slučajeva u Evropskom regionu.Karcinom usne šupljine je jedan od najčešćih karcinoma glave i vrata.Čini 3% od svih karcinoma kod čovjeka (4% M i 2% Ž) i 10 puta je češćikod muškaraca. Ujedno jedan je od deset najučestalijih uzroka smrti usvijetu. Hirurško odstranjenje opsežnih tumora glave i vrata neizbježnoima za posljedicu gubitak vitalnih funkcija kao što su gutanje, govor iosjet okusa i mirisa. Enteralna prehrana je prehrana putem probavnogtrakta. Ima brojne prednosti i manje komplikacija u odnosu naparenteralnu prehranu. Najčešći oblici umjetnog hranjenja enteralnimputem su: putem nazogastrične sonde (NGS) i prekutanomgastrostomom (PEG). Metode hranjenja kojima se može obavljatihranjenje i putem nazogastrične sonde i putem perkutane gastrostomesu iste: gravitacijska metoda, metoda putem pumpe i bolus metoda. PEGje najprihvatljivija i najsigurnija metoda za duže hranjenje, osobito nakonopsežnih hirurških zahvata u svrhu liječenja oboljelih od karcinoma usnešupljine i orofarinksa, radio i kemoterapije ili pak svega navedenogazajedno. Prednost je u tome da su usta slobodna od kontaminacije urazdoblju cijeljenja operacijske rane i omogućena je nutritivna podrškakada pacijent nije u stanju uzimati dovoljno hrane. Ključne riječi:

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enteralna prehrana, nazogastrična sonda, PEG

Amira Hasanović (Sarajevo, BiH):Prisustvo stresa kod zdrastvenih radnikana radnom mjestu

Uvod: Zdravstveni radnici su izloženi profesionalnom stresuprirodom svog posla, naročito u kliničko-bolničkoj praksi.Učestvuju u poslovima koji se duboko tiču ljudi i njihovih života,na šta se nikada do kraja ne mogu profesionalno adaptirati,često razmišljajući da bi bilo najbolje da postanu neosjetljivi, ato ne bi bilo dobro ni za bolesnika, ni za njegovu po¬rodicu.

Radna hipoteza: Postoje razlike u učestalosti stresa na poslu uodnosu na profil zdravstvenih radnika u bolničkoj zdravstvenojzaštiti.

Ciljevi istraživanja: Ispitati količinu stresa na radnom mjestu,korištenjem anketnog upitnika kod 40 zdravstvenih radnikahirurških disciplina i 40 zdravstvenih radnika nehirurškihdisciplina. Utvrditi najčešće faktore stresa na radnom mjestu.Na osnovu dobivenih rezultata, predložiti mjere za prevencijuprofesionalnog stresa kod zdravstvenih radnika svih profila.

Ispitanici i metode istraživanja: Istraživanje je retrospektivnastudija presjeka, koja je sprovedena na uzorku od 80 ispitanikapodijeljenih u 2 grupe u odnosu na profil zdravstvenog kadra.Ispitivanje je sprovedeno pomoću standardizovanog anketnogupitnika koji se sastoji od upitnika za ispitivanje socio-demografskog statusa SEF upitnika i prilagođenogstandardizovanog anketnog upitnika „Stres na radnom mjestubolničkih zdravstvenih radnika“.

Rezultati istraživanja: Prosječna starosna dob ispitanikahirurških disciplina je iznosila 42.02±9.57 godina, a ispitanikanehirurških disciplina 43.90±11.77 godina. Neadekvatnaosobna primanja i materijalna sredstva za primjeran rad, temogućnost napredovanja se nisu statistički značajno razlikovaliu odnosu na ispitivane skupine te predstavlja ponekad stresnoza ispitanike obje skupine, p>0.05. Zbog nedostatnog brojauposlenih ispitanici hirurških disciplina se osjećaju stresno, doknehirurških disciplina ponekad stresno, (p=0.034).Preopterećenost poslom stresno utiće na obje ispitivaneskupine (p=0.141). Kod ispitanika hirurških disciplina stresnoutiču noćni rad, smjenski rad, prekovremeni rad i dežurstva,dok kod ispitanika nehirurških disciplina utiče ponekad stresno,što je i statistički značajno različito (p<0.05). Uvođenje novih

tehnologija predstavlja rijetko stresno za ispitanike nehirurških disciplina,dok je za ispitanike hirurških disciplina uvođenje novih tehnologijaponekad stresno (p=0.041).

Zaključak: Količina stresa u skupini hirurških disciplina je veća i iznosilaje 3.30±0.68, a u skupini nehirurških disciplina bila je 2.93±0.62.

Ključne riječi: zdravstveni radnici, stresogeni faktori, stres na poslu.

Nurudin Salkanović (Tuzla, BiH): Endotrahealnaintubacija

Endotrahealna intubacija je postupak zbrinjavanja disajnog puta gdjeplasiramo endotrahealni tubus direktno u traheju. To je krajnja alternativakad treba hitno uspostaviti prohodnost disajnih puteva pacijenata bezsvijesti: kod operacija na glavi i vratu, da bi se oslobodilo operativno poljeza nesmetan rad hirurga; kad je potrebno kontrolisati intrapulmonalnipritisak u toku operacija u - pacijenti sa respiratornim ikardiorespiratornim arestom; grudnom košu; kod svih hirurškihinetrvencija koje se izvode u nepovoljnom položaju, kao sto supolusedeći, potrbušni, leđni ili bočni; da se spriječi aspiracija povraćenogili regurgitiranog želudačnog sadržaja u disajne puteve anesteziranogpacijenta; da spriječi naduvavanje želudca kada se asistirani ilikontrolisano disanje otežano izvodi; da obezbijedi i zaštiti disajni put upacijenta bez svijesti; da se odloži ili izbegne traheotomija u pacijenta saporemećajem disanja, koji mogu trajati nekoliko dana; Pribor koji jepotreban za izvođenje endotrahealne intubacije: laringoskop;endotrahealni tubus različite veličine; uvođač; lokalni anestetik; šprice;Magilova hvataljka; materijal za fiksaciju tubusa; aspirator i sukcionikateter; stetoskop, kapnometar; rukavice; kiseonik i prateća oprema;oprema za oksigenaciju i ventilaciju prije postupka za intubaciju. Nikadane ukidati mogućnost spontanog disanja pacijenta ako se predhodnonismo uvjerili da je ventilacija intermitentnim pozitivnim pritiskom namasku moguća. U nekim slučajevima mora se odustati od intubacije ioperacija. Bolje je da je pacijent razočaran, nego mrtav .

INTERNACIONALNI SIMPOZIJ IZ HIRURGIJEI PLASTIČNE HIRURGIJE

PROGRAM DAN IIIBilal Imširović, Anesa Čengić, MuhamedĐedović, Emir Gušo, Aida Bilajac, IbrahimOmerhodžić, Zulejha Merhemić (Sarajevo, BiH):

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Primarna aorto - enteralna fistula –prikaz slučaja

Aorto - enteralna fistula je uzrok po život opasnoggastrointestinalnog krvarenja, a može biti primarna (povezanasa aneurizmom abdominalne aorte) ili sekundarna (običnonastala kao posljedica operativnog zahvata). Prema dostupnojliteraturi incidenca pojavljivanja primarne aorto – enteralnefistule je izrazito mala i iznosi 0,007 na milion stanovnika, doksu sekundarne nešto češće. Primarna aorto - enteralna fistulanastaje kao posljedica dugotrajnog bliskog kontakta crijevnevijuge, obično trećeg ili četvrtog segmenta dvanaestopalačnogcrijeva, sa aneurizmom abdominalne aorte pri čemu dolazi doerozije zida i komunikacije krvnog suda i lumena crijeva.Smrtnost je izrazito visoka. U radu je prikazan slučaj pacijentastarog 65 godina sa povremenim gastrointestinalnimkrvarenjima bez jasnog uzroka, kod koga je, i pored negativnihnalaza endoskopije i CT angiografije, pri MRI obradi postavljenasumnja na aorto – enteralnu fistulu, a što je naknadno hirurškidokazano.

Ključne riječi: Aorto – enteralna fistula, krvarenje, MRI

Dražan Erić, Nikola Baroš, Sanja Marić,Siniša Kojić, Maksim Kovačević, MiladaSimeunović (Foča, BiH) IsmetGavrankapetanović (Sarajevo, BiH):Rekonstrukcija defekata prstiju i šake

Uvod: Mekotkivni defekti šake i prstiju najčešće nastaju zbogtraume, radikalne ekscizije malignih tumorakože i mekih tkiva,kongenitalnih anomalija, opekotinskih povreda i hirurškogliječenja Dupuytren-ovekontrakture.Materijal i Metod: Uperiodu od januara 2010. godine do decembra 2016. godinena Odjeljenju za plastičnu irekonstruktivnu hirurgijuUniverzitetske bolnice Foča kod 118 pacijenata je urađenaneka od rekonstruktivnihDražan Erić 04/12/2017metoda urješavanju defekata na šaci i prstima. Kod pacijenata smoevidentirali demografske podatke(godine, pol, zanimanje),lokaciju, uzrok defekta, veličinu defekta te rekonstruktivnetehnike i komplikacije.Rezultati: Kod 82 pacijenta uzrokmekotkivnih defekata šake je trauma, kod 23 pacijenatauzrok je radikalnaekscizija malignih tumora kože i mekihtkiva, kod 7 pacijenata Dupuytren-ova kontraktura i kod 6pacijenatapostopekotinske kontrakture prstiju. Kod 98pacijenta nismo imali komplikacija, kod 5 pacijenta smoimaligubitak režnja, kod 7 pacijenata smo imali marginalnu

nekrozu a kod 8 pacijenta smo imali tranzitornu venskukongestijurežnja.Zakljucak: Značaj lokalnih, direktnih i indirektnih petaljkastihrežnjeva je, obzirom na složenost funkcije šake,veliki a primarni cilj jefunkcionalna rekonstrukcija. Izbor režnjeva zavisi od lokalizacijedefekta, veličinedefekta, dobrog poznavanja hirurške anatomije,preciznog planiranja i iskustva hirurga.Ključne riječi: rekonstrukcija,šaka, prsti.

Edin Bećiragić, Vesna Čengić,Dragiša Đogović, LinaDuranović Rayan (Sarajevo, BiH): A case of giantpseudocyst of the anterior abdominal wall after openventral hernia repair

A case of giant pseudocyst of the anterior abdominal wall after openventral hernia repairEdin Bećiragić1, Vesna Čengić2, Dragiša Đogović1,Lina Duranović Rayan31Department of general surgery, General Hospital“Prim Dr Abdulah Nakaš”, Sarajevo, Bosnia andHerzegovina2Departmentof anaesthesia and intensive care, General Hospital “Prim Dr AbdulahNakaš”, Sarajevo, Bosniaand Herzegovina3Clinic of Pulmonary Diseasesand TB, University Clinical Center of Sarajevo, Sarajevo, BosniaandHerzegovinaGiant pseudocyst of the anterior abdominal wallrepresents a very rare complication of the ventral herniaEdin Bećiragić04/14/2017repair. It is defined as an encapsulated cyst without anepithelium layer on its own. Pseudocyst formation cantake months oryears to form. This complication of the ventral hernia repair is oftenoverlooked andunderreported in a clinical settings. In this case report wepresent a case of giant pseudocyst in an olderobese female, with ahistory of multiple ventral hernia repairs and numerous comorbidities. Hermaincomplaints on admission were abdominal pain and swelling, whatdiffers from the typical clinical presentationof giant pseudocysts inliterature which usually are not painful. She was admitted at the hospitalunderdiagnoses of recurrent ventral hernia two months after her lastventral hernia repair with polypropylene mesh.An abdominal ultrasoundwas performed in an effort to establish the diagnosis. Although itdescribed thenature of the pseudocyst correctly, it did not steer thedecision making process toward the correct diagnosis.Most probably thisis due to the rarity and somewhat unusual clinical presentation of thiscomplication. Truediagnosis and definitive treatment of giant pseudocystof the anterior abdominal wall was made during thesubsequent surgicalexcision. A large pseudocystic formation with colliquative haematoma andnumeroussepta was found.Key words: ventral hernia, abdominal wallrepair, giant pseudocyst, complication, and seroma

Muhamed Djedović, Amel Hadžimehmedagić, Bilal

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imširović, Dragan Totić, Haris Vranić, HarisVukas (Sarajevo, BiH): Hronična rupturaaneurizme abdominalne aorte (Chronic rupturedabdominal aortic aneurysm)

Ruptura aneurizme abdominalne aorte (RAAA) može se odvijatina jedan od 4 slijedeća načina: 1. „Otvorena ruptura”- ruptura uperitonealnu šupljinu; 2. „Zatvorena ruptura” ruptura uretroperitonealni prostor uz tvorbu retroperitonealnoghematoma; 3. Ruptura u okolne šupljine strukture, kao što suvena i crijeva (primarna aorto-kavalna ili aorto-enterična fistula);4. U rijetkim slučajevima ruptura u retroperitonealni prostor kojaje učinkovito „zapečaćena” reakcijom okolnog tkiva i uz„hroničan“ retroperitonealni hematom. Dijagnoza RAAA se lahkouspostavlja kada je prisutna trijada simptoma: hipotenzija saznacima šoka, jak bol u trbuhu ili leđima i pulsirajuća tumefakcijau trbuhu.Klinička dijagnoza može biti teška kada su izostalinavedeni simptomi i kada su dominantan simptom dugostajnabol u donjem dijelu leđa uz propagaciju boli u bedro i širenje niznogu, uz hemodinamsku stabilnost pacijenta i normalnevrijednosti HTC. Prvu hroničnu RAAA je opisao Szilagyi isuradnici 1961.god. Cilj ovog rada je prikazati 4 pacijenta sahroničnom RAAA u periodu januar 2015- decembar 2016 na„Klinici za Vaskularnu hirurgiju“ UKC Sarajevo.Svi pacijenti subili muškarci,prosječne životne dobi 69.25± 4.35 godine, urasponu od 63 do 73 godine. Prosječna dužina tegoba je bila3.0±2.4 mjeseca u rasponu od 1 do 6 mjeseci. Prosječan najvećidijametar AAA je bio 79.25±22.23 mm, u rasponu od 52 do 106mm. Dva pacijenta su imala eroziju trupa jednog ili višelumbalnih kralješaka koji nije zahtijevao tretman ortopeda. Svipacijenti su operisani transperitonalnim pristupom, kod dvapacijenta je vaskularnorekonstruktivni zahvat urađenbifurkacionim protezom a kod dva tubularnom.Svi su rađeni uuslovima poluhitnosti. Sva četiri pacijenta su nakon vaskularno-rekonstruktivnog zahvata otpuštena kući 10-tog dana.

Zaključak: Svaku bol u leđima, kod starijih bolesnika, trebaozbiljno shvatiti i isključiti postojanje AAA.

Muhamed Djedović, AmelHadžimehmedagić, Bilal imširović, DraganTotić, Haris Vranić, Haris Vukas (Sarajevo,BiH): Hirurški tretman stečene (post-traumatske) arteriovenske fistule / (Surgicaltreatment stretch (Posttraumatic) fistula

AVF predstavlja abnormalnu komunikaciju između arterija i venakoja zaobilazi kapilarnu mrežu. Može biti kongenitalna ili stečena ,također se može hirurški konstruisati za potrebe hemodijaliznog(HD) tretmana. Stečene AVF nastaju kao posljedica ozljede krvnogsuda. Najčešće su uzrokovane penetrantnom ozljedom -90%slučajeva (rane od metka, gelera, ali ubodne rane i jatrogeneozljede ,također, mogu objasniti njihov nastanak), tupa trauma jerijetko uzrok i odgovorna je (10%).Vaskularne lezije nakon tupe ilipenetrantne povrede su značajan uzrok morbiditeta i mortaliteta.Zbog nedostupnosti adekvatnog vaskularo-hirurškog tretmana kodvaskularnih lezija dolazi do pojave post-traumatske AVF.AVFmalog promjera pa su često asimptomatske. Velike i razvijenepost-traumatske AVF se mogu klinički manifestirati nekim odslijedećih simptoma: povećanjem obima ekstremitata, blagompromjenom boje, izraženim venama te auskultatorno, a ipalpatornoprisutnim „thrill-om“, slabo punjenim distalnim arterijskeimpulzacijama, klaudokacijskim tegobama, otežano disanje. Ciljovoga rada je prikazati 3 postraumatske AVF gdje su bili zahvaćenirazličiti krvni sudovi ( P1 segment a.popliee, tibiofibularni trunkus ia.tibialis posterior) koje su hirurški tretirane. Sve povrede suizazvane gelerom. Od tri pacijenta, 2 su bila muškarci (66.7%) ijedna žena (33.3%), prosječne životne dobi 49.0±22.0 godina urasponu od 27 do 71 god. Prosječno vrijeme koje je poroteklo odpovrede je bilo 22.0±3.6 godina u rasponu od 18 do 25 godina. Kodjednog pacijenta je urađena vaskularna rekonstrukcija bypass-om,kod drugog TT rekonstrukcijom arterije, a kod trećeg resekcijomAVF između arterije i vene te njihovom primarnom suturom. Svipacijenti su nakon vaskularno-rekonstruktivnog zahvata otpuštenikući 10-tog postoperativnog dana. Zaključak: Liječenje ovog stanjaostaje izazov. Hirurški pristup i dalje ostaje zlatni standard uodnosu na endovaskularne procedure u siromašnim zemljama,zbog rijetke dostupnosti endovaskularnog tretmana - Coveredstentova, zbog njihove cijene.

Nikola Baroš, Branko Despot, Zoran Dimitrijević,Srđan Veselinović, Miljan Petković, Dražan Erić,Siniša Kojić, Aleksandar Guzijan (Banjaluka, BiH): LDand TRAM for secondary breast reconstruction in Clinicfor plastic and reconstructive surgery, UCC RS BanjaLuka

Secondary breast reconstruction in our Clinic is being done by LD, TRAMflap and TISSUE EXPANDER with implant, two stage reconstruction. Aprospective database maintained at the University Clinical Centre of The

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Republic of Srpska, patients with secondary breastreconstruction between 2008 and 2016. Avarage age ofpatients was 48 yo. Technique used in secondary breastreconstruction were LD (66%), TRAM (21%) and Expander(13%). Tumor relaps were 6,7 %. Complications in secondarybreast reconstruction were breast assimetry (17%), partial flapnecrosis (11%), full flap necrosis (8%) and swelling,seroma, haematoma, infection, hypertrophic scarring andcapsular contracture (less than 6%) at a median follow-up of 36month. The results show that were no statistically significantpostoperative complications which would demand revision ingeneral anesthesia and this is an acceptable treatment optionfor secondary breast reconstruction. Key Words LD, TRAM,Tissue Expander, secondary breast reconstruction,complications

Hajrudin Đogić, Larisa Mešić-Đogić, EnesHodžić, Škiljo H., Denjalić A, SeidFazlagić , Kovač R., BrkićE., Hadžić E., Nikić B., Jukić J., KalabićM., BegunićE. (Tešanj, BiH): Trychobesoar kao uzrokacutnog perforiranog ulcusa želuca iacutnog abdomena (prikaz slučaja)

Hajrudin Đogić, Mešić-Đogić L., HodžićE., Škiljo H., Denjalić A., Fazlagić S.,Kovač R., Brkić E., Hadžić E., Nikić B.,Jukić J., Kalabić M.,Begunić E.: Spontana ruptura muskulusrectus abdomis kao uzrok akutneabdominalne boli (prikaz slučaja)

Hajrudin Đogić, Mešić-Đogić L., HodžićE., Škiljo H., Denjalić A., Fazlagić S.,Kovač R., Brkić E.,Hadžić E., Nikić B., Jukić J., Kalabić M.,Begunić E.: Plica ileocecalis kao uzrokstrangulacionog ileusa i acutnog abdomena(prikaz slučaja)

Hajrudin Đogić, Mešić-Đogić L., Hodžić E.,Škiljo H., Denjalić A., Fazlagić S., Kovač R.,Brkić E., Hadžić E., Nikić B., Jukić J.,Kalabić M.,Begunić E: Trychobesoar želuca kao uzrok

hronične anemije (prikaz slučaja)

Mahira Tanović (New York/USA/BHAAAS): Melanomaincidence, awarnes, prevention and treatment

Melanoma occurs when the pigment-producing cells that give color to theskin become cancerous. Symptoms might include a new, unusual growthor a change in an existing mole. Melanomas can occur anywhere on thebody. Treatment may involve surgery, radiation, medications, or in somecases chemotherapy.

Srđan Babović (Rochester, USA/BHAAAS):Balancinprocedures in breast reconstruction

Balancing procedures are integral part of breast reconstruction inbreast cancer treatment. Designed to obtain balancedappearance as well as long lasting symmetric result. Thoseprocedures are usually executed at a time of the second stage ofthe breast reconstruction. Most commonly performed procedureswill be discussed: 1. Breast reduction, 2. Mastopexy, 3.Augmentation, 4 combination techniques. In addition to those roleand indications for fat grafting in improving reconstructed andnative breast will be discussed.

ORGANIZACIONIPARTNERI

KOORGANIZATORI INTERNACIONALNI SIMPOZIJUM IZPORODIČNE

MEDICINE: Udruženje doktora porodične medicine RS BiH,Udruženje doktora porodične / obiteljske medicine i USAID

KOORGANIZATORI INTERNACIONALNI SIMPOZIJUM IZNEUROHIRURGIJE I SPINALNE HIRURGIJE: Udruženje

neurohirurga Jugoistočne Evrope (SeENS) i Udruženjeneurohirurga u Bosni i Hercegovini (UNUBIH)

KOORGANIZATORI INTERNACIONALNIH TEHNIČKIHSIMPOZIJUMA

SPONZORI 9. DANA BHAAAS-a u BiH, TESLIĆ 2017

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