Some of the conditions which occur in maintenance hemodialysis (MHD) patients with a high incidence resulting in a decline in their quality of life, include malnutrition, renal osteodystrophy, refractory hypertension and chronic systemic inflammation. In developing countries, due to the low level of economic development, low-flux dialysis is the main means of extracorporeal blood purification therapy. But it can hardly remove the middle and large molecule uremic toxins and protein-bound toxins; as a result, the patients suffer from long-term complications and poor quality of life. In this study, we attempted to investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the clearance rate of middle and large molecule uremic toxins so as to improve their uremic complications. A total of 54 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into two groups: Group 1 (27 patients) received combined treatment of HD with hemoperfusion (HP) in this regimen: HD 2 times a week with HD+HP once a week two times in a row, then after two weeks, and afterwards once a month as a maintenance treatment. Group 2 (27 patients) was only undergoing maintenance HD 3 times a week. The clinical and laboratory properties of both groups were followed up for 18 months, whereas the primary outcomes included normal clinical data, high sensitive C-reactive protein (hsCRP), immunoreactive parathyroid hormone (iPTH), phosphorus (P04), calcium (Ca), albumin, iron (Fe), total iron binding capacity (TIBC), hemoglobin, Epo doses and types of hypertensive drugs. At the end of the 18-month observation, the serum concentration of albumin, P04, hsCRP, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower with Group 1 than with Group 2 (p<0.05). Whereas, higher levels of iPTH were noticed in group 1, but when the laboratory and clinical data are analysed of the group 1 alone a statistically significant lower values after the observational period are noticed especially in the serum values of iPTH (p<0.05), P04 (p<0.001), CRP (p<0.011), SBP and DBP (p<0.05). HD+HP was superior to HD in regularly eliminating middle and large molecule uremic toxins accumulated in the body which is mostly shown through reducing the values of iPTH and hsCRP. These findings suggest a potential role for HD+HP in the treatment of inflammation and renal osteodystrophy as well, because lowering these values of iPTH leads to a normalization of other minerals which is expected and therefore leads to a stabilization of this long-term uremic complications, which can improve the overall general condition of the MHD patient.

Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at a high risk of acquiring SARS-CoV-2 and of developing severe COVID-19 and death. The possibility of being reinfected with this virus is poorly understood. To date, there are a small number of reports of reinfections in COVID-19 patients, especially in HD patients, with only four cases described so far. The aim was to show the possibility of reinfection and developing severe acute respiratory syndrome in HD patients. We describe a 69-year-old ESRD patient who had been on HD treatment for three years, with diabetes mellitus and a history of ischemic cardiomyopathy. The patient was tested for SARS-CoV-2 by a nasopharyngeal polymerase chain reaction (PCR) test because of a positive cluster at his dialysis unit and initially diagnosed with COVID-19 in July 2020. In this period, he had mild symptoms for a few days and remained asymptomatic afterwards. Four months later, he presented to the hospital with fatigue, high fever and shortness of breath, and was COVID-19 positive again. This case points to the possibility of reinfection, lack of immune response after an asymptomatic or mild infection, or even the possibility of the fi rst false-positive PCR test. Future longitudinal studies are needed to evaluate the potential reinfections, recurrence, and duration of antibody detection.

Abstract Introduction. Present study was performed to verify red blood cell distribution width-to-platelet ratio (RPR) level in rheumatoid arthritis (RA) patients and to examine its correlation with clinical and biochemical indicators of disease activity status. Methods. In this cross-sectional analytical study, 67 patients with RA and 34 age- and gender-matched healthy control subjects were enrolled. Based on the disease activity score 28-ESR (DAS28-ESR), RA patients were divided into subgroups: low disease activity (n = 20), moderate disease activity (n = 22) and high disease activity (n = 25). Laboratory tests included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count (PLT), red blood cells count (RBC), red blood cells distribution width (RDW) and fibrinogen concentration. Statistical analyses were carried out using SPSS 13 software. Statistical significance was set at a p-value less than 0.05. Results. There was statistically significant difference (p = 0.006) between RPR in RA patients with different stages of disease activity, with higher values in patients with low disease activity. The RPR showed statistically significant negative correlations with ESR (rho = –0.309; p = 0.012), CRP (rho = –0.421; p = 0.001), swollen joint count – SJC (rho = –0.368; p = 0.002) and tender joint count – TJC (rho = –0.355; p = 0.003), DAS28-ESR (rho = –0.409; p = 0.001), DAS28-CRP (rho = –0.422; p < 0.0005) and Visual analogue scale – VAS (rho = –0.260; p = 0.033) in RA patients. Conclusion. The present study provided evidence that the lower RPR values in RA patients are significantly associated with the disease activity indicators.

BACKGROUND Cerebrospinal levels of isoprostanes (IsoPs) have been established as biomarkers of oxidative stress in Alzheimer's disease (AD) and vascular dementia (VD). The value of peripheral levels in the diagnostics of these diseases is less conclusive. The aim of this study was to determine serum 8-iso-prostaglandin-F2alpha (8-iso-PGF2α) levels in Bosnian AD and VD patients and to establish whether there is an association between 8-iso-PGF2α serum concentration and cognitive impairment (CI) in patients with dementia. SUBJECTS AND METHODS Serum levels of 8-iso-PGF2α were measured by enzyme immunoassay method in AD (n=30) and VD patients (n=30) and control subjects (CG, n=30). The AD and VD group were further stratified according to the level of CI. RESULTS The serum 8-iso-PGF2α levels were significantly higher in the AD (74.00 pg/mL) and VD groups (38.00 pg/mL) compared to the CG (17.50 pg/mL). A significant difference in serum 8-iso-PGF2α levels between patients with moderate and severe CI was not established in either AD or VD. CONCLUSION Serum 8-iso-PGF2α proved to be a good biomarker in AD and VD, however it cannot be recommended for the differentiation of moderate and severe CI.

Objective The association between the neck circumference (NC) and components of metabolic syndrome in different countries and ethnic groups has been insufficiently investigated. The aim of the present study was to assess the impact of gender on NC values and to determine whether NC correlates with standard anthropometric measures and blood pressure values in Bosnian young adults. Materials and Methods Study participants were recruited by the snowball method. The NC, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured by trained personnel. Differences between the means were assessed by a Student's t-test. Coefficients of correlation were determined by Pearson's test. Results In young men (n=49), the value of NC was 37.71±1.79 cm, while in young women, (n=62) the value of NC was 32.23±1.83 cm (p<0.001). A significant positive correlation in both genders between the NC and BMI (r=0.70, p<0.001 in men; r=0.53,p<0.001 in women), and between the NC and WC (r=0.48, p<0.001 in men; r=0.38, p=0.01 in women), was found. A significant correlation between the NC and SBP (r=0.08, p=0.57), and DBP (r=0.20, p=0.17), in young men was not determined. Likewise, in young women, a significant correlation between the NC and SBP (r=0.08, p=0.54), and DBP (r=0.09, p=0.49), was not observed. Conclusion Our results suggest that the NC measurement can be used as a valid method in obesity assessment in young adults. A lack of association between the NC and blood pressure requires additional investigation.

Introduction: The main aim of the study was to examine the interdependence of values of the nutrition index, the use of medicaments, and alcohol consumption in the group of subjects with post-traumatic stress disorder (PTSD) and in control group without PTSD. Methods: To determine the interdependence of different indices of nutrition and the alcohol and drug consumption in both groups, the crosstab model was used. Results: In both of the tested groups, medicament users had higher average values for nutritional indexes compared to the subjects that are not the consumers of medicaments, but the confirmed differences were not statistically significant. The subjects with PTSD who consume alcohol had lower average values for nutritional indexes compared to the subjects who do not consume alcohol. In the control group, subjects who consumed alcohol had higher mean values for nutritional indexes than those who did not consume alcohol. Differences in the values of the nutrition index between alcohol and non-alcohol subjects were not statistically significant either in the PTSD group or in the control group. The subjects with PTSD had less average values of all the used nutrition indexes compared to the control group subjects, but the confirmed differences were not statistically significant. Conclusion: Our results indicate that medicaments use and alcohol consumption do not exert a statistically significant effect on the values of the nutrition index in any of the study groups. Possible concomitant use of drugs with the opposite effect on the monitored parameter (nitrazepam and amitriptyline vs. SSRI and bupropion) can lead to findings like this. We recommend further research to eliminate influence of pharmacodynamic effects of alcohol, drugs, and stress on the development of weight gain or loss.

Background: The femur is supplied princially by the diaphyseal nutrient artery which enters the bone throught the nutrient foramen. This supply is essential during the growing period, the early phases of ossification, and in different surgical procedures. The aim of present study was to examine the morphology and topography of the femur nutrient foramen to provide detalied data on such features.Methods: This was a cross-sectional-descriptive study in which we observed 50 femurs. We analysed the number and location of nutrient foramina, the length of the bone, the position of the nutrient foramen regarding to values of FI, correlation between number of nutrient foramen and length of femur, correlation between position of nutrient foramen and side of extremity to which femur belongs.Results: The double foramina were common in right (57.1%) and left (42.1%) femur, mostly located in medial lip of aspera line in right (64.3%) and on the lateral lip in left femur (68.4%), with statistically significant correlation, χ = 4.85; p = 0.03, p <0.05.  The foramina in left (89.5%) and right (96.4%) femur were commonly observed at their middle third, with no statistically significant correlation between position of foramen accordingly to Foraminal Index value and side of extremity on which femur belongs (p=0.56; p>0.05). There is positive correlation between length of right and left femur and number of foramina.Conclusions: The study provides data of the nutrient foramina on femur, which is helpful for clinicians to help preserve bone vascularization during surgery.

Aim To assess triglyceride - to high-density lipoprotein cholesterol (TG/HDL)-C ratio in patients with acute coronary syndrome (ACS) and to verify its association with renal dysfunction. Methods A cross sectional study included 85 ACS patients divided in two groups with (ACS - RD) and without (ACS-nRD) presence of renal dysfunction, and 35 healthy subjects. Blood pressure, blood glucose, C-reactive protein, urea, creatinine, eGFR and serum lipids levels (total cholesterol, triglycerides, LDL-C, HDL-C) was measured in all participants. Based on the values of the measured lipid fractions TG/HDLc ratio was calculated. Results Patients in ACS group had significantly lower HDL-C level (p<0.0005) but significantly higher TG level (p=0.046) and TG/HDL-C ratio (p<0.0005) than controls. There was a significant increase (p<0.0005) in TG/HDL-C ratio in ACS-RD group compared to ACS-nRD group. The ACS-RD group had significantly higher level of TG (p=0.001), serum urea (p=0.02) and creatinine (p<0.0005) compared to the ACS-nRD group. With a cut-off level of 1.135 TG/HDL-C ratio had a sensitivity of 77.6% and a specificity of 62.9% in distinguishing between ACS patients and healthy subjects. With cut-off value of 1.905 TG/HDL-C ratio had a sensitivity of 75.9% and a specificity of 78.6% in distinguishing between ACS patients with and without renal dysfunction. Conclusion This study confirms the reliability of the TG/HDLC ratio as a simple, low cost and useful marker in distinguishing between patients with ACS and healthy subjects and ACS patients with and without renal dysfunction.

AN IMPACT OF DIABETES DURATION ON SERUM ASYMMETRIC DIMETHYLARGININE CONCENTRATION