Sinisa Ristic

Screen viewing, body mass index, cigarette smoking and sleep duration in Belgrade University student population: results of an observational, cross-sectional study

BACKGROUND Subjects that spend more time working on computers or watching television could have a higher body mass index. AIM To assess the relationship between time spent in front of a screen and studying, body mass index (BMI), smoking, and sleep duration among university students. MATERIAL AND METHODS A cross-sectional study of 734 randomly selected students aged 21 ± 2 years (450 females) that responded an anonymous, structured questionnaire about time spent watching television or in front of a computer, time spent studying, number of daily hours of sleep, smoking habits and number of daily meals. Body mass index was also calculated for all subjects RESULTS Among males, the number of daily sleep hours, time spent working with computers and number of daily meals were significantly higher and time spent studying was significantly lower than females. Nonsmokers ate a significantly higher number of meals and spent less time watching television. No association was observed between time spent in front of a screen and number of sleep hours of body mass index. CONCLUSIONS Men and smokers spend more time working in computers. There is no association between body mass index and time spent in front of screens.

High Prevalence of Risk Factors for Chronic Kidney Disease in Balkan Endemic Nephropathy Foci

Background/Aims: The aim of this study was to find out the prevalence of the most frequent risk factors for chronic kidney disease (CKD) and the prevalence of urinary abnormalities in adult inhabitants of three Balkan endemic nephropathy (BEN) villages near Bijeljina, Bosnia and Herzegovina. Methods: The survey consisted of an interview, blood pressure measurement, and urine dipstick test for proteinuria, hematuria, and glycosuria. Results: The study involved 1625 (739 males, aged 51 ± 16 years) subjects: 319 (19.6%) with positive family history for BEN, 585 (36%) with hypertension, 604 (37.2%) above 60 years, 146 (9%) with diabetes, and 566 (34.8%) with none of these risk factors. Proteinuria was present in 6.2–7.1% of the subjects with risk factors for CKD but in 3.4% of those without risk factors. Systolic blood pressure and BEN in brother/sister were found to be significant variables associated with proteinuria, but female gender and history of kidney disease with hematuria. Conclusion: In addition to a family burden for BEN, other risk factors for CKD were highly prevalent in BEN villages of the Bijeljina municipality. The frequency of proteinuria was higher in the at-risk group than in the group without risk factors and increased with the number of risk factors.

Quality of diabetes care in family medicine practices in eastern Bosnia and Herzegovina

OBJECTIVES In the present study, the audit of medical files of patients with diabetes, followed in family medicine practices in the eastern region of Bosnia and Herzegovina (BiH), was carried out in order to investigate the frequency of the use of screening tests for early diagnosis of diabetes complications. METHODS The audit was conducted in 32 family medicine practices from 12 primary health care centers in the eastern part of BiH over one-year period (March 2010 to March 2011). A specially established audit team randomly selected medical files of 20 patients with diabetes from the Diabetes Registry administered by each family medicine team database. Screening tests assessed are selected according to the ADA guidelines. RESULTS Frequency of the individual screening test varied between 99%, found for at least one blood pressure measurement, and 3.8% for ABI measurement. When the frequency of optimal use of screening was analyzed, only 1% of patients received all recommended screening tests. CONCLUSION The frequency of the use of screening tests for chronic diabetes complications was found to be low in the eastern part of Bosnia and Herzegovina. Multivariate linear regression analysis showed that longer duration of diabetes and a larger number of diabetics per practice were associated with a smaller number of screening tests, but specialists in family medicine provided a higher number of screening tests compared to other physicians.

Differences in Risk Factors and Prevalence of Vascular Calcification between Pre-Dialysis and Hemodialysis Balkan Nephropathy Patients

Aims: The aim of this study was to compare the risk factors and prevalence of vascular calcification (VC) in pre-dialysis and hemodialysis (HD) patients with Balkan endemic nephropathy (BEN) or other kidney diseases (non-BEN). Materials and Methods: The study involved 115 patients, 32 pre-dialysis and 83 HD patients, separated into groups of BEN and non-BEN patients. In addition to interviews, objective examinations and laboratory analyses, VC was assessed using Adragao score. Results: Patients with BEN were significantly older in both groups, while pre-dialysis BEN patients had significantly lower systolic blood pressure, serum cholesterol and phosphorus levels, but higher urinary excretion of phosphorus than non-BEN patients. These differences were lost in HD groups. In pre-dialysis patients, prevalence of VC was lower in BEN than in non-BEN group and mean VC score differed significantly between them (2.8 (1.7) vs. 4.6 (1.8); p = 0.009). No significant difference in VC score was found between BEN and non-BEN patients on HD. Multivariate analysis showed that in pre-dialysis patients VC score >4 was associated with lower iPTH and higher serum cholesterol level, but in the HD group with higher serum triglyceride level and longer HD vintage. Conclusions: Lower prevalence of risk factors for VC in the BEN than non-BEN patients was found in pre-dialysis but not in HD group and this was reflected in the prevalence and severity of VC in the groups. Prevalence of VC and mean VC score were significantly lower in pre-dialysis BEN than in non-BEN patients but not for those on HD.

Specifičnost i senzitivnost biomarkera balkanske endemske nefropatije

Uvod. Posljednjih godina posvecuje se posebna pažnja definisanju kriterijuma za dijagnozu balkanske endemske nefropatije (BEN). Cilj rada je ispitivanje senzitivnosti, specificnosti i granicnih vrijednosti biomarkera koji se koriste za dijagnozu BEN. Metode. Ispitivanje je obuhvatilo 103 odrasle osobe podijeljene u dvije grupe: 1. grupa od 60 bolesnika sa BEN (35 muskaraca, starosti od 48 do 82 godine) i 2. grupa od 43 zdrave osobe (23 muskarca, starosti od 23 do 78 godina). Svim ispitanicima je pored detaljne anamneze urađen objektivni pregled, laboratorijske analize seruma i urina, i pregled bubrega ultrazvukom. Pored rutinskih laboratorijskih analiza urađeno je i mjerenje koncentracije albumina, alfa1-mikroglobulina i KIM-1 u urinu. Rezultati. Bolesnici sa BEN bili su znacajno stariji, imali znacajno visi sistolni i srednji krvni pritisak, nižu koncentraciju hemoglobina, manju jacinu glomerulske filtracije (JGF) i tubulsku reapsorpciju fosfata od zdravih osoba. Izlucivanje alfa1-mikroglobina (2,56 mg/mmol kreatinina vs. 0,09 mg/mmol kreatinina; p=0,004), albumina (6,5 mg/mmol kreatinina vs. 1,87 mg/mmol kreatinina; p=0,018) i proteina (26,7 mg/mmol kreatinina vs. 11,5 mg/mmol kreatinina; p<0,0001) urinom bilo je znacajno vece kod bolesnika sa BEN nego kod zdravih osoba. Nije utvrđena statisticki znacajna razlika u ekskreciji KIM-1 između dvije grupe. Dužina bubrega je bila znacajno manja kod bolesnika sa BEN nego kod zdravih osoba (97,8 mm vs.105,8 mm). Alfa1-mikroglobulin u urinu ima najvecu specificnost (100%) i senzitivnost (81,1%) (granicna vrijednost: 1,08 mg/mmol kreatinina) za razlikovanje BEN od zdravih. Logisticka regresiona analiza je izdvojila proteinuriju i JGF kao znacajne prediktore za dijagnozu BEN. Zakljucak. Alfa1-mikroglobulin u urinu ima pri granicnoj vrijednosti od 1,08 mg/mmol kreatinina visoku senzitivnost i specificnost za razlikovanje BEN od zdravih osoba, pa se može smatrati optimalnim testom za dijagnozu BEN.

Reversion of methacholine induced bronchoconstriction with inhaled diazepam in patients with asthma

BACKGROUND Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. AIM To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. PATIENTS AND METHODS Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progressive doses of methacholine. After the last dose, when at least a 20% drop of the initial forced expiratory volume in the first second (FEV1) was achieved, vital capacity (VC) and FEV1 were measured at 7, 15 and 30 minutes after provocation. On the second day a diazepam aerosol was inhaled by the patients prior to the same protocol with methacholine. RESULTS In the first day of testing, methacholine inhalation (6 mg/mL) led to a significant drop in FEV1 from 2.98 to 1.69 L. On the second day of study, in the same patients, previous inhalation with diazepam reduced the changes of FEV1 after inhalation of methacholine. This parameter decreased from 2.48 to 2.21 L. CONCLUSIONS Inhalation of benzodiazepines reduce bronchoconstriction after a methacholine challenge in patients with asthma.

Magnetna rezonanca dojke

Karcinom dojke je najcesci maligni tumor u ženskoj populaciji. Mamografija i ultrazvuk su osnovni vizuelizacioni modaliteti za dijagnostiku karcinoma dojke, a istraživanja su pokazala da magnetna rezonanca ima vecu osjetljivost u njegovoj detekciji u odnosu na njih. Magnetna rezonanca dojke je ukljucena u dijagnosticki algoritam karcinoma dojke, mada jos uvijek nakon mamografije i ultrazvuka i u korelaciji s njima. Ipak, niska specificnost magnetne rezonance dojke i visoka cijena njenog izvođenja ogranicavaju njenu siru upotrebu. U radu su prikazane savremene mogucnosti i znacaj primjene magnetne rezonance u dijagnostici, skriningu, određivanju rasirenosti bolesti karcinoma dojke, kao i postterapijskom pracenju ovih bolesnica. Magnetna rezonanca dojke se odlikuje velikom osjeljivoscu ali slabijom specificnoscu koja se povecava primjenom kontrastnih sredstava (dinamicka magnetna rezonanca dojke). Jedna od njenih prednosti je sto omogucava i izvođenje ciljanih biopsija.

Prevalence and determinants of smoking initiation among school students in Bosnia and Herzegovina

Abstract Background: Tobacco smoking amongst the young is a matter of public health concern because of the immediate and long-term health consequences associated with tobacco use, such as asthma, cancers, and cardiovascular diseases. The purpose of this study was to identify the determinants of smoking initiation among a sample of high school students in Bosnia and Herzegovina. Methods: The study was conducted among 198 high school students in Zvornik, Bosnia and Herzegovina, during April 2013. A self-administered, pre-tested, structured, close-ended questionnaire was used for data collection. Results: Fourth grade students mainly initiated smoking in high school (45%), while the majority of third and second grade students initiated smoking in primary school. Among students who smoke, an average duration of the smoking habit was <2 years. A multivariate analysis showed that males were 5.27 times more likely to have initiated smoking. For every unit increase in pro-smoking attitude towards smoking, students were 5.3 times more likely to have initiated smoking. Those with parents and friends who are smokers were 6.106 and 5.175 times, respectively, more likely to have initiated smoking. Conclusion: This study indicates that a high proportion of 15–18 year olds in the town of Zvornik are current smokers. Gender, age, and parent and peer influence were identified as important associations with smoking. Interventions should not only be confined to the secondary school environment but they should also extend to their places of residence so that influences in the home environment and social surroundings that contribute to tobacco use are also tackled.

The role of the psychiatrist in obtaining informed consent from patients with somatic and mental comorbidity: Report of one case

The nature of mental disorders, the attitudes and prejudices of the social community towards psychiatric patients, the behavior and treatment of mental patients, all bring about numerous dilemmas and prejudices. When a patient is diagnosed with a mental disorder, he may suffer restrictions in the field of general human rights. However, the biggest problems in clinical practice occur in the treatment of patients who, besides their mental disorder also have a somatic disease. We report a 56-years-old female with a severe renal failure who refused to undergo dialysis. Following the patients refusal to sign an informed consent, a psychiatrist was called in for consultation and diagnosed an acute psychotic reaction. To manage the delusions and acute psychotic reactions, risperidone in the dose of 2 mg was started. After 22 days, the patient still had marked psychotic symptoms. A psychiatrist, a nephrologist and an anesthesiologist, in the presence of the spouse on the grounds of her life-threatening condition, decided to apply the necessary medical procedures even without the patients consent. A day after the start of dialysis the patient still had delusional ideas, but without the presence of anxiety, and the patient no longer offered resistance to dialysis. Four days after the first dialysis, the patient was calm, had vague memories about the entire previous period, and signed the informed consent concerning her further treatment.

Poređenje rezultata skrininga hronične bolesti bubrega u neendemskom i endemskom naselju

Uvod. U radu su prikazani rezultati skrininga hronicne bolesti bubregasprovedenih u Foci i endemskom selu Brodac (Bijeljina). Poređenje dobijenihrezultata urađeno je sa ciljem da se utvrdi ucestalost faktora rizika za bolestibubrega i ucestalost markera bubrežnog ostecenja u zavisnosti od prisutnihfaktora rizika.Metode. Skriningom je obuhvaceno 449 osoba iz Foce (180 muskaraca, starosti56,5±17,9 godina) i 402 osobe iz Broca (182 muskaraca, starosti 50,6±16,6godina). Od svih ispitanika su anketom dobijeni osnovni podaci, licna i porodicnaanamneza i podaci o faktorima rizika za bolesti bubrega. Svima jeizmjeren krvni pritisak i urađen pregled urina test trakama.Rezultati. Faktori rizika za hronicnu bolest bubrega bili su znacajno cescezastupljeni u grupi ispitanika iz Foce u odnosu na one iz Broca: hipertenzija– 52,3% vs. 36,6%; dijabetes – 12,7% vs. 8,4%; broj osoba starijih od 60 godinau ispitivanoj grupi – 47,4% vs. 33,3%; koriscenje analgetika – 28,3% vs. 21,7%i pozitivna licna anamneza o prethodnoj bolesti bubrega – 21,8% vs. 9,8%.Porodicna opterecenost endemskom nefropatijom zabilježena je samo kodbolesnika iz Broca (21,9%). Proteinurija (4,2% vs. 4,3%) i glikozurija (2,4%vs. 1,7%) su bile podjednako ucestale kod ispitanika iz Foce i Broca, dok jehematurija (7,3% vs. 1,2%; p=0,0001) bila cesca kod stanovnika Foce. Mnogiod ispitanika su imali vise od jednog faktora rizika, a ucestalost proteinurijese znacajno povecavala sa brojem faktora rizika.Zakljucak. Visoka opterecenost faktorima rizika za hronicnu bolest bubregaotkrivena je u obje ispitivane grupe ali znacajno vise kod ispitanika iz Foce.Vise od jednog faktora rizika imalo je 71,2% ispitnika, a ucestalost proteinurijese znacajno povecavala sa povecanjem broja faktora rizika.