Introduction: Chronic kidney disease (CKD) is a significant public health problem. The aim of this study was to determine the presence of early stages of renal disease in hypertensive and diabetic outpatients without previously diagnosed renal damages. Methods: In this cross-sectional study we studied a random sample of outpatients with essential hypertension and/or diabetes mellitus type 2 in the general practice ambulance of city Sarajevo. Renal function was evaluated by using MDRD (Modification of Diet in Renal Disease) equation and with measurement of renal biomarkers. K/DOQI classification was used to define the stages of CKD. Results: The study included 200 patients, of whom 75 (37.5%) were females, mean age of 54.81 ± 6.1 years, and 125 (62.5%) male, mean age 52.46 ± 8.2 years. More than half of respondents (54.0%) were hypertensive during the follow up period. Early CKD was detected in 52% respondents. Higher prevalence of early CKD was verified in the group of patients who had hypertension associated with diabetes mellitus type 2 (59.6% vs. 47.2% in hypertension group vs. 54,0% in diabetic group, p<0.05). Significant negative correlation was found between estimated glomerular filtration rate and presence of albuminuria (p<0.001), duration of hypertension (p=0.003), duration of type 2 diabetes mellitus (p=0.021), stages of hypertension (p=0.012), female gender (p<0.001) and older age of subjects (p=0.040). Conclusion: Our results confirmed high prevalence of CKD and the importance of early detection of CKD in high risk groups of patients in order to prevent the progression of the same. Prevention of chronic kidney disease in our country is still not carried out satisfactorily. Required is a much greater collaboration between primary care health givers and nephrologists.

Background: the most widely used tumor marker in ovarian cancer, often considered the ‘gold standard’ is CA125 but reliable clinical evidence demonstrates that human epididymis protein (HE4), used alone or in combination with CA125, substantially improves the accuracy of screening and/or disease monitoring. Aim: to evaluate the reliability of the determination a tumor marker HE4 in comparison with CA125 on the Elecsys analyzer 2010 in epithelial ovarian cancer, benign ovarian cyst and healthy controls. Methods: we prospectively determined CA125 and HE4 serum levels in the Biochemical-Immunological-Haematological “Medical Laboratory” Ilidza, Sarajevo, B&H between June 1st and December 31st 2011. Electro-chemiluminescence immunoassay (ECLIA) methods for quantitative determination in vitro were performed on the Roche/Hitachi Elecsys 2010 Immunoassay Analyzer. Standard methods of descriptive statistics were performed for the data analysis. Results: univariate statistical analyze of tumor marker control serum revealed a high reliability for both CA125 and HE4 determination (p>0.05). Levey-Jennings charts of quality control data show that the target and the obtained values of both markers control sera do not differ significantly in relation to the ideal value. In a total number of 60 patients compared values of tumor markers show a high correlation (r=0.85). This study confirmed higher sensitivity and specificity of HE4 tumor marker compared with CA125. ROC-AUC values show that the diagnostic performance of HE4 was significantly higher compared with CA125. Conclusion: We concluded that HE4 was better than CA125 as a single tumor marker.

Objectives: Aim of the present study was to investigate serum concentration of leptin and its association with values of body mass index (BMI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in hemodialysis (HD) patients. Methods: This cross-sectional study included 60 HD patients (34 male, 26 female) and 30 age- and sex-matched (4 males, 26 females) apparently healthy subjects. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA). Serum CRP concentration was measured by means of particle-enhanced immunonephelometry. ESR value was determined by Western Green method. BMI was calculated as weight (kg) divided by height squared (m2). Results: Results have shown that median serum leptin concentration (30.65 ng/mL; 12.48-86.40 ng/mL) was statistically significantly higher in HD patients compared to median serum leptin concentration (15.75 ng/mL; 9.15-30.65 ng/mL) in the control group of healthy subjects (p<0.05). Likewise, median serum CRP concentration (5.5 mg/L; 1.93-8.9 mg/L) and median ESR value (57.5 mm/h; 40.5-77.0 mm/h) were significantly higher in HD patients compared to median serum CRP concentration (0.8 mg/L; 0.38-1.43 mg/L) (p<0.001) and median ESR value (10.0 mm/h; 6.5-14.0 mm/h) (p<0.001) determined in the control group. Statistically significant positive correlation was found between BMI values and serum leptin concentration in HD patients (rho=0.434; p<0.001). Positive, although not significant, correlation was observed between serum CRP and leptin levels in HD patients (rho=0.171; p>0.05). Negative correlation between ESR values and serum leptin concentrations in HD patients was determined but it was not statistically significant (rho= -0.029; p>0.05). Conclusions: Increased serum concentration of leptin as pro-inflammatory cytokine as well as elevated serum values of CRP and ESR indicate presence of systemic micro inflammation in HD patients. Results of the present study point to possible use of serum leptin concentration as an indicator of nutritional status in HD patients based on observed significant positive correlation between serum leptin concentrations and BMI values. However, absence of significant association between serum leptin and CRP levels as well as between serum leptin concentrations and ESR values in HD patients requires further investigation and clarification.

Introduction: Psoriasis is a chronic skin ailment which can be connected with an increased occurrence of other illnesses, including the metabolic syndrome. Examinees and methods: A prospective study has been conducted which included 70 patients affected by psoriasis, both genders, older than 18 years. Average age being 47,14 (SD=±15,41) years, from that there were 36 men or 51,43 and 34 women or 48,57%. The average duration of psoriasis was 15,52 (SD= ±12,54) years. For purposes of diagnosing the metabolic syndrome, the criteria of National Cholesterol Education Program Adult Treatment Panel III, (NCEP ATP III) were used. For purposes of detecting the severity and spread of psoriasis, Psoriasis Area and Severity Index (PASI) was used. Results: The incidence of metabolic syndrome in patients with psoriasis was 38,57%. Average values of PASI score were 16,65. The increase in values of PASI score and metabolic syndrome were statistically highly connected. (r=0,3, p=0,0001). Conclusion: Psoriasis is connected with metabolic syndrome, there is a positive correlation between the severity of psoriasis and frequency of metabolic syndrome.

It is my great pleasure to introduce to you this special issue of the journal Materia Socio-Medica on the occasion of the 4th Congress of Nephrology of Bosnia and Herzegovina with international participation that will be held in Sarajevo from 22nd to 25th April 2015. The Association of Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina has organized congress under the auspices of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) and the International Society of Nephrology (ISN). This scientific meeting covers the most recent discoveries in the fields of acute kidney injury, chronic kidney disease, cardiovascular diseases, hypertension, diabetes mellitus, dialysis and kidney transplantation. Gathering a large number of national and international nephrologists as well as many distinguished international speakers will certainly contribute to the knowledge transferring and quality of this meeting. There will be more than 200 participants, submitted presentations from more than 20 countries.

Introduction: Information Technologies, taking slow steps, have found its application in the teaching process of Faculty of Medicine, University of Sarajevo. Online availability of the teaching content is mainly intended for users of the Bologna process. Aim: The aim was to present the level of use of information technologies at the Faculty of Medicine, University of Sarajevo, comparing two systems, old system and the Bologna process, and to present new ways of improving the teaching process, using information technology. Material and methods: The study included the period from 2012 to 2014, and included 365 students from the old system and the Bologna Process. Study had prospective character. Results: Students of the old system are older than students of the Bologna process. In both systems higher number of female students is significantly present. All students have their own computers, usually using the Office software package and web browsers. Visits of social networks were the most common reason for which they used computers. On question if they know to work with databases, 14.6% of students of the old system responded positively and 26.2% of students of the Bologna process answered the same. Students feel that working with databases is necessary to work in primary health care. On the question of the degree of computerization at the university, there were significant differences between the two systems (p <0.05). When asked about the possibility of using computers at school, there were no significant differences between the two systems. There has been progress of that opportunity from year to year. Students of Bologna process were more interested in the introduction of information technology, than students of old system. 68.7% of students of the Bologna process of generation 2013-2014, and 71.3% of generation 2014-2015, believed that the subject of Medical Informatics, the same or similar name, should be included in the new reform teaching process of the Faculty of Medicine, University of Sarajevo. Conclusion: Information technologies can help the development of the teaching process, and represent attractive and accessible tool in the process of modernization and progress.

Charles Edwin Molnar (1935–1996) was a codeveloper of one of the first minicomputers and a pioneer in cochlear modeling research (1, 2). As a young researcher at the Lincoln Laboratory of the Massachusetts Institute of Technology in 1962, Molnar with another engineer, Wesley A. Clark — led a team of designers in developing the Laboratory Instrument Computer, or LINC. The machine, which was one of the few unclassified projects a the laboratory in the early 60s, was intended for doctors and medical researchers. Although it would be considered of insignificant power compared to modern personal computers, it was a self-contained machine that had a simple operating system and a small display and stored its programs on a magnetic tape. The LINC originated decades before the advent of the personal computer. Its development was the result of a National Institutes of Health (NIH) program that placed 20 copies of an early LINC prototype in selected biomedical research laboratories nationwide. Later, the LINC was produced in greater numbers by Digital Equipment Corp. and other computer manufacturers Molnar received a bachelor’s degree (1956) and a master’s degree (1957) in electrical engineering from Rutgers University, and received a doctoral degree (1966) from MIT in electrical engineering. His dissertation topic was the mechanics of the inner ear and how it translates auditory signals into neural responses. After leaving MIT, he established the Institute for Biomedical Computing at Washington University in St. Louis, where he worked from 1965 until 1995, when he became a senior research fellow at Sun Microsystems in California. Molnar earned a worldwide reputation for his work in selftimed computer system theory, a design approach for ultrafast computers. While the operations of commercial computers are controlled by a single clock, most researchers in the field believe that significant speed breakthroughs await the advent of systems whose components can operate independently. At Sun, Molnar was continuing his work in this area. Molnar was known as an intensely curious researcher whose talents and interests ranged from physiology and bioengineering to electrical engineering and computers, music and furniture building, and hiking and canoeing. He started practice of sending computer programs by cable technology with his colleague Clark. In the 1960s, Molnar and Clark obtained a patent for sending computer programs over cable television lines to communicate data from central computers, which were expensive at the time, to less expensive bed side terminals in intensive-care units. The patent, which is now expired, turned out to be ahead of its time. Some companies are now starting to employ the cable technology, which allows users to send data much faster than by the more common telephone lines. Charlie Molnar was also well known as a pioneer in the modeling of the auditory system, especially numerical models of the function of the cochlea (the inner ear). Before death in 1996, he was working at Sun Microsystems on asynchronous circuits with Ivan Sutherland. He died December 13, 1996 at home, at the age of 61 from the complications of diabetes. After his death, his body was donated to the University of California, San Francisco Medical Center. He will be the most remembered by his pioneer work in making numerical models of cochlea function.

The book “Clinical Aspects of Hemodialysis” contains 19 chapters: 1. Chronic renal disease; 2. Epidemiology; 3. Uremic syndrome; 4. Cardiovascular disease in dialysis patients; 5. Hemodialysis in elderly patients; 6. Mineral-bone disease in hemodialysis patients; 7. Gastrointestinal diseases in dialysis patients; 8. Hepatitis virus infection in patients on chronic dialysis program; 9. Malnutrition in patients on chronic dialysis; 10. Amyloidosis; 11. Neurological complications in dialysis patients; 12. Skin lesions in chronic hemodialysis patients; 13. Pruritus in chronic hemodialysis patients; 14. Pregnancy and chronic renal disease; 15. Ethical problems in dialysis; 16. Psychological preparation of patients for hemodialysis; 17. Nutrition of dialysis patients; 18. Exercises for hemodialysis patients; 19. The general principles of medications dosage in patients with chronic renal disease. This book represents a comprehensive material in the field of advanced renal disease study by the most contemporary approach. The book clearly and systematically elucidated factors for occurrence kidney disease as well as their distribution and frequency of occurrence in this population. In current elaboration of this problem the authors suggest that there is no tissue and organ system that cannot be affected by changes, or the final consequences, i.e. terminal renal impairment. In a meaningful and clear manner are presented the problems of cardiovascular diseases in hemodialysis which are the leading cause of death in this group of patients. Because of the high incidence of these diseases Cardionephrology is being developed as a separate medical discipline. All other important aspects of uremic syndrome events in certain systems of human pathology are described and explained in this book. Separately are presented the directions for resolving the dilemmas in hemodialysis among elderly patients, the problems of malnutrition, inflammation, pregnancy, ethical problems and problems of patient’s rehabilitation and physical exercises. All terms in the text are aligned in the presentation of these issues with the regulations of European and global recommendations for the overall management of patients on hemodialysis. Book chapters are written systematically and transparently, their contents are clear and written in understandable manner, accompanied by the most current data from the world literature in this field. Literature is listed at the end of each chapter. Text is by its content designed and innovated with new essential material from the world’s leading recommendations for monitoring patients on hemodialysis. The authors of the book, using their rich scientific and expert experience, created the content and presented the recommended guidelines in their own way and make it appropriate and acceptable for experts in this field of medicine, as well as all other common specialty, family physicians whose task is to identify as early as possible the potential kidney disease patients and send them for treatment at higher or inpatient levels of health care. The book is both a textbook for students in all three cycles of study by the Bologna concept of education, because it was written by a multidisciplinary team of experts and content of the described chapters in the book may be of assistance to specialists and residents from all fields of internal medicine, as well as resuscitation medicine, vascular surgery and infectious diseases. By retrieval of the contents of this book in biomedical databases, in particular aspect of the approach to solving the current problem of hemodialysis patients in clinical practice, especially in Bosnia and Herzegovina, which is described in this book - textbook, I came to the conclusion that this approach is somewhat unique and therefore is attractive and instructive and it should be used in practice for more efficient treatment of hemodialysis patients. Sarajevo, March 2015

Introduction: The basic principle of non-surgical fracture treatment is to restore the original anatomical position of fractured fragments by different techniques, without direct access to the bone and without further traumatizing of tissues. Intramedullary nailing is synthesis and consolidation of fracture fragments with the main goal to gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment. Aim: The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results. Material and methods: The study was conducted at the Clinic for Orthopaedics and Traumatology, Clinical Center University Sarajevo from January 2004 to June 2009. The study was retrospective-prospective, manipulative, controlled and it was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B, with different segments of bone, regardless of sex and age structure, with the exception of children under 14 years of age. Results: Precisely there were 47 patients with femoral fractures and 82 patients with tibial fractures. The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382). The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978). We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus. Conclusion: Static intramedullary osteosynthesis resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.

This paper addresses different aspects of practical interventions with regard to education and rehabilitation of children with intellectual disabilities which can take place in schools or other rehabilitation settings. The outlined approach is based on the Bruner’s concept of so-called growth sciences which include both the special education and the rehabilitation. The focus is on the theoretical, diagnostic, and rehabilitation strategy, based on the implementation of educational and treatment activities with this population of children. In the light of applied research we try to define interventions in education and rehabilitation of the children with mild intellectual disabilities. The sample was formed of 124 participants in school settings with regard to their cognitive and school achievement. With respect of these results we propose the educational and treatment strategies for these children.