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Sabina Nuhbegović

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Sunita Ćustendil-Delić, S. Nuhbegović, S. Brkić, F. Ljuca, A. Žabić, D. Tulumović

Background. Disorder of hemostasis in hemodialysis patients is focused in two directions, towards the development of thrombosis and bleeding. Both complications make it difficult to treat and are life-threatening for the patient.  Monitoring of hemostatic parameters, it is possible to detect the first changes in the coagulation system and correct the factors that lead to changes and thus prevent or stop the further development of complications. Aim. To determine the hemostatic and dialysis parameters and their influence on the occurrence and development of complications. Patients and methods. From a total of 175 patients, 46 had signs of hemorrhagic syndrome and 16 of them had thrombosis. Parameters of primary and secondary hemostasis were determined and vascular access of ultrasound was examined. Results. In the patients with thrombosis D-dimer level was significantly higher and amounted to 4.18 mg / l, while AT III levels were decreased for 54%. Elevated level of APTT was significant for the patients who had bleeding. In 86% of patients with thrombosis, ultrasound findings correlated with findings of D-dimer. Both complications were more pronounced in the older age group above 46 years. Conclusion. Hemorrhagic syndrome is a frequent complication of thrombosis. The level of D-dimer is directly correlated with ultrasound detection of thrombotic formation. Elevated levels of APTT was in direct correlation with bleeding. The development of complica-tions are affected by other factors, such as: age, access type, type of dialysis membrane, the blood flow. Frequent control of hemostatic parameters is essential for early detection of complications. In the event of changes in coagulation system, type and dose of anticoagulant should be corrected and introducing additional oral anticoagulants should be considered.

S. Delic, S. Nuhbegović, F. Ljuca, S. Hasukić, Jasmina Petrov-Rasljic, S. Jović

Introduction: Laparoscopic cholecystectomy is a method of choice in the treatment of calculous gallbladder. There is a clear evidence of changes in hemostatic parameters during this surgical procedure, which can result in thromboembolic complications. The aim of the study was to evaluate changes in D-dimer values, as a marker of hypercoagulability in patients treated with laparoscopic cholecystectomy. Patients and methods: The study included total of 60 patients, divided into two groups, one treated with classic (open) and other with laparoscopic method. Blood samples were taken from all patients before, during the surgery and 24 hours and 5 days after the procedure with consequent determination of D-dimer levels. Results: Blood samples of patients in both groups manifested higher values of D-dimer during the operation, 24 hours and 5 days after the procedure. We have found elevated values of D-dimer 5 days after the surgery in the group of patients treated with laparoscopic cholecystectomy with 2.5 times higher levels compared to values measured preoperatively. Conclusion: Our results suggest that there is an increased fibrinolytic activity after laparoscopic cholecystectomy, which demands more detailed and complete study on tromboembolism prophylaxis.

Introduction: Chronic obstructive pulmonary disease (COPD) is a disorder characterized by maximal expiratory flow decrease and slow forced lung exhalation, which are significantly unchanged over several months. Subjects and Methods: Our study included 100 patients, 50 males and 50 females, diagnosed COPD who have been tested by functional lung tests: spirometry, body plethysmography and blood gas analysis. Patients have been analyzed at Clinic for pulmonary diseases and TBC, University Clinical Center Tuzla. All tests have been done at Department for Cardiorespiratory Diagnostics. Results: In this study have shown highly significant correlation among following parameters: FEV1 and VC, FEV1 and FEF 25, FEV1 and FEF75/25, FEV1 and FEF75, FEF25 and FEF75/25, FEF75 and FEF75/25. In males FEV1, VC and FEV1/VC have been significantly decreased comparing to females. Our results have shown no significant deference among spirometry, plethysmography and blood gas analysis parameters in male smokers with COPD comparing to female smokers. It has been found significant difference for pCO2 in male comparing to female nonsmokers. Conclusion: According to the results we recommend that all individuals having chronic cough, dyspnea and wheezing, and who are smokers or ex-smokers, aged >45 years, considering BMI, should be tested by spirometry.

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