BIOMEDICINSKA ISTRAŽIVANJA

Volume 9, No 2, December 2018.

EDITORIAL

Screening for chronic kidney disease

Nada Dimković

Biomedicinska istraživanja 2018; 9(2):131-133 doi:10.7251/BII1802131D

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ORIGINAL SCIENTIFIC ARTICLES

High-sensitivity C-reactive protein as biomarker of inflammation in children with asthma and allergic rhinitis

Dragana Malčić-Zanić, Olivera Ljuboja, Gordana Bukara-Radujković, Snežana Petrović Tepić

Biomedicinska istraživanja 2018; 9(2):134-142 doi:10.7251/BII1802134M

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Abstract


High-sensitivity C-reactive protein as biomarker of inflammation in children with asthma and allergic rhinitis

Dragana Malčić-Zanić, Olivera Ljuboja, Gordana Bukara-Radujković, Snežana Petrović-Tepić
University Clinical Center of the Republic of Srpska, Children’s Hospital, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Recent researches have shown that a high-sensitivity C-reactive protein (hs-CRP) can be the marker of chronic inflammation. The aim of the study is to investigate whether the serum hs-CRP concentration can be used as biomarker of inflammation in children with acute asthma attack and allergic rhinitis, as well as whether the monitoring of hs-CRP concentration can be an indicator of therapy success in children suffering from asthma.
Methods. The study included 60 patients (30 of them with asthma and 30 with allergic rhinitis), both sexes, aged 7 to 14 years. Apart from being questioned about personal and family history, all patients underwent lung function and serum hs-CRP tests. The concentration of hs-CRP was measured by the latex particle immunoturbidimetric assay. In the group of children with asthma, measuring was performed before and three days after the therapy.
Results. Patients with asthma had statistically significant higher levels of allergic sensitization, other associated allergic diseases, higher serum IgE concentrations, and lower levels of lung functions compared with those with allergic rhinitis. The values of hs-CRP (0.43 mg/l) were significantly higher in asthma patients than in those with allergic rhinitis (0.21 mg/l) (p= 0.002). 26.67% of patients with asthma had the hs-CRP values above the reference range, while all patients with allergic rhinitis had hs-CRP in the reference range. After a three-day therapy, the hs-CRP values were still maintained above the reference interval in four patients with asthma (13.33%)
Conclusion. The research has showed that hs-CRP can be used as a biomarker of acute allergic inflammation in children with asthma and thus be a therapeutic response indicator.
Keywords: children, asthma, allergic rhinitis, hs-CRP

Chronic kidney disease biomarkers in populations at risk: results of
screening study carried out in Priboj

Svetlana Krsmanović

Biomedicinska istraživanja 2018; 9(2):143-150 doi:10.7251/BII1802143K

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Abstract


Chronic kidney disease biomarkers in populations at risk: results of
screening study carried out in Priboj

Svetlana Krsmanović
General Hospital Priboj, Hemodialysis Department, Priboj, Serbia

Introduction. Chronic kidney diseases are global health problem and thus close attention is devoted to their prevention and early detection. The aim of the study was to assess the prevalence of chronic kidney disease biomarkers in three groups at risk.
Methods. The study included 77 persons divided into three groups: (1) 31 patients with hypertension that had lasted for five years; (2) 30 patients with type 2 diabetes diagnosed five or more years ago and (3) 16 examinees, aged ≥ 60, without hypertension and diabetes. All patients participated in the survey, after which blood pressure, body mass index, glucose serum level and urea and creatinine serum level were measured. Urine albumin and protein were determined by urine dipstick test and urine sediment was analyzed as well. Glomerular filtration rate (GFR) was estimated by Modification of Diet in Renal Disease (MDRD) equation 4.
Results. These three groups were matched for gender and more than a half of patients with hypertension and diabetes were aged ≥ 60 years. Among patients with diabetes, 26 patients (86.6%) had hypertension, while overweight was found in 67.7% of patients with hypertension, 76.7% of those with diabetes and 25% of examinees aged ≥ 60 years. Normal blood pressure range had more than two-thirds of patients with hypertension and diabetes, and ACEI was used by 74.2% of patients with hypertension and 80% of patients with diabetes. Fasting serum glucose level was above 6.1 mmol/L in 23 (76.6%) of patients with diabetes. GFR below 60 ml/ min/1.73m2 had 7 (22.6%) patients with hypertension, 14 (46.7%) patients with diabetes and 3 (18.8%) persons aged ≥ 60 years. Pathologic albuminuria (≥ 20 mg/L) had 22 (61%) patients with hypertension, 25 (83.4%) patients with diabetes and 10 (62.5%) examinees aged ≥ 60 years.
Conclusion. Although the applied screening methods could overestimate the frequency of examined biomarkers for chronic kidney disease, the results of the study confirmed the importance of regular control of kidney function in population at risk for chronic kidney disease.
Keywords: chronic kidney disease biomarkers, hypertension, diabetes, aged 60 years

Screening for chronic kidney disease in Belgrade Primary Health Care Centers

Ljubica Djukanović and Višnja Ležaić

Biomedicinska istraživanja 2018; 9(2):151-160 doi:10.7251/BII1802151DJ

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Abstract


Screening for chronic kidney disease in Belgrade Primary Health Care Centers

Ljubica Djukanović and Višnja Ležaić
University of Belgrade, School of Medicine, Belgrade, Serbia

Introduction. Academy of Medical Science of Serbian Medical Society introduced collaboration between Belgrade nephrologists and general practitioners with the aim of examining the prevalence of chronic kidney disease (CKD) in populations at risk as well as of checking whether collaboration with general practitioners contributed
to implementation of regular CKD screening.
Methods. The research encompassed two studies carried out in four Belgrade Primary Health Care Centers. The screening study involved 619 patients at risk for CKD (348 with hypertension, 206 with diabetes, 65 persons aged > 60 years without hypertension/diabetes) in whom glomerular filtration rate (eGFR) was estimated by MDRD formula, while urine dipstick test was used for detection of proteinuria and albuminuria (Micral-test® strips).The second study was retrospective analysis of medical records of 450 patients who were examined in the screening study and whose blood pressure and eGFR recording were analyzed during three-year period.
Results. In screening study, eGFR below 60 ml/min/1.73m2 was detected in 121 (19.55%) and albuminuria in 242 (39.10%) patients. During three-year retrospective study, percentage of patients whose blood pressure and eGFR were recorded decreased from 42% to 22% and from 42% to 18%, respectively. Multivariate regression analysis selected health center, systolic blood pressure and hypertension as the variables significantly associated with the number of years in which blood pressure was recorded, while male gender, health center, hypertension and basal eGFR as variables associated with the number of years in which eGFR was recorded.
Conclusion. Despite collaboration between nephrologists and general practitioners in screening study, the retrospective threeyear study revealed insufficient recording of blood pressure and eGFR in patients’ medical records.
Keywords: chronic kidney disease, screening, primary health care

Effect of type of sport, weekly physical exertion and body mass index on values of bone turnover markers in elite female athletes

Nenad Ponorac, Tanja Šobot, Nela Rašeta

Biomedicinska istraživanja 2018; 9(2):161-168 doi:10.7251/BII1802161P

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Abstract


Effect of type of sport, weekly physical exertion and body mass index on values of bone turnover markers in elite female athletes

Nenad Ponorac1, Tanja Šobot1, Nela Rašeta2
1University of Banja Luka, Faculty of Medicine, Department of Physiology, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
2University of Banja Luka, Faculty of Medicine, Department of  athophysiology, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina


Introduction. The aim of the study was to determine the level of bone turnover markers (serum middle fragment of osteocalcin and β-CrossLaps) in young female athletes involved in different sports, as well as to determine the relation between bone turnover markers (BMT) and type of sports activity, weekly physical exertion and body mass index.
Methods. Out of a total of 111 female participants, 78 of them were elite athletes while the control group consisted of 33 female students of the faculty of medicine, of a similar age. Athletes with any kind of menstrual irregularity (N=18) were excluded from the study. Therefore, the sample was comprised of 27 basketball and handball players, 11 middle- and long-distance runners and 22 dancers.
Results. Athletes belonging to ball game group had significantly greater body mass index and sport experience compared to the other two groups, while the dancers had the lowest weekly physical exertion. There was a statistically significant difference in serum level of osteocalcin bone markers (49.55 ± 16.83 vs. 36.13 ± 7.26; p = 0.001) and β-CrossLaps (0.75 ± 0.25 vs. 0.53 ± 0.14; p=0.001) between female athletes and the control group respondents. Ball game players had a greater osteogenic effect compared to runners and dancers (p < 0.05). Furthermore, the results revealed significant connection between weekly physical exertion and body mass index on the one hand and BMT level on the other hand.
Conclusion. Chronic physical activity exerts an osteogenic effect, which is made evident by the concentration
of serum level of osteocalcin significantly connected with weekly physical exertion.
Keywords: bone turnover markers, osteocalcin, β-CrossLaps, sport

Analysis of connection between criminal behavior and psychological traits of perpetrators of criminal offences

Dragan Jovanović

Biomedicinska istraživanja 2018; 9(2):169-177 doi:10.7251/BII1802169J

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Abstract


Analysis of connection between criminal behavior and psychological traits of perpetrators of criminal offences

Dragan Jovanović
University of East Sarajevo, The Faculty of Medicine, Foča, The Republic of Srpska, Bosnia and Herzegovina
University Hospital Foča, The Republic of Srpska, Bosnia and Herzegovina

Introduction. The aim of the study paper is to examine the relationship between the criminal behavior and psychological traits of perpetrators of criminal offences. 
Methods. The survey included the prisoners from several Detention and Rehabilitation Centers in the Republic of Srpska as well as from the Judicial Department of the Sokolac Psychiatric Clinic. The sample consisted of 118 offenders ivided into two groups: the first group including 60 prisoners who committed the murder and the second group of 58 prisoners who committed other crimes. The second group was further classified into 3 subgroups: robbery perpetrators (N=21), theft perpetrators (N=17) and other criminal offences (N=20). The MMPI-201 (Minnesota Multiphasic Personality Inventory) personality test was used for the purpose of exploring the underlying problem as well as research objectives.
Results. The high average scores (>60) were found on the scales of psychopathy, hysteria, schizophrenia, depression and paranoia in the homicide group, while high average values (> 60) were noticed only on psychopathy scale in the non-homicide group. The research showed that mental ilnesses and conditions were more present in the homicide group than in the non-homicide group: antisocial personality disorder  as diagnosed in 31.66% of homicides and in 25.86% of non-homicides, which made 28% out of the total number of examinees. Histrionic personality disorder was found in 8.33% of prisoners within the homicide group and in 6.89% of prisoners in the non-homicide group. Schizophrenia was diagnosed in 16.66% of prisoners from the homicide group and in 6.89% of the non-homicide group. Depression was diagnosed in 20% of homicides and in 8.69% of non-homicides. Depression was encountered in comorbidity, usually with antisocial personality disorder.
Conclusion. There is a connection between psychological traits and criminal behavior. In homicide group, psychopathological and deviant personality traits are more pronounced, compared with the non-homicide group. Due to this, the former is more likely to develop mental illnesses and conditions.
Keywords: psychological traits, personality, homicides, non-homicides, prisoners

Mental health and traffic behavior among drivers in Republic of Srpska

Jelena Niškanović, Sladjana Šiljak, Slobodan Stanić

Biomedicinska istraživanja 2018; 9(2):178-186 doi:10.7251/BII1802178N

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Abstract


Mental health and traffic behavior among drivers in Republic of Srpska

Jelena Niškanović1, Sladjana Šiljak1, Slobodan Stanić2
1Institute of Public Health, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
2Agency for Development of Higher Education and Quality Assurance, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Mental health is related to risky driving behavior and traffic accidents.  he aim of this study is to investigate both social and demographic characteristics of drivers, as well as the connection between mental health and risky driving behavior among drivers in the Republic of Srpska, Bosnia and Herzegovina.
Methods. The study was part of the population health survey conducted in the Republic of Srpska in 2010. The survey included 1866 households and a total of 4178 adults were interviewed (1688 drivers and 2490 non-drivers). The Chi-square test and independent samples t-test were used for data analysis.
Results. Among 4178 respondents, 59.6% were non-drivers and 40.4% were drivers. There were significantly higher percentage of male drivers (73.3%), adults aged 25-54 years (66.1%), who lived in rural areas (55.3%) and were in employment  50.1%). Significantly higher percentage of drivers (58.2%) were present in the category with score values 58 to 78 on the mental distress scale, while most non-drivers were found in the category with mental distress score values 58 and lower (43.2%), p < 0.001. Also, a significantly higher percentage of nonrivers (91.5%) were found in the category with the lowest level of mental vitality (≥ 62.5), while the percentage of drivers increased in categories with higher scores on the mental vitality scale (p < 0.001). Persons driving under the influence of alcohol had lower values on the mental distress scale (p <0.05, eta square = 0.005), while those who tended to use mobile phones while driving achieved higher scores on the mental vitality scale (p < 0.001, eta square = 0.15).
Conclusion. Study results have revealed significant differences in the level of mental health between drivers and non-drivers. People who drive under the influence of alcohol have a lower level of mental health, taking into account the results on the mental distress scale, while those who use mobile phones while driving have a higher level of mental vitality. In subsequent research, it is necessary to thoroughly examine the influence of mental health on tendency towards risky driving behavior.
Keywords: mental health, traffic behavior, drivers, health survey, Republic of  rpska

Status of orofacial musculature and articulation in children who stutter

Nada Dobrota Davidović, Sladjana Ćalasan

Biomedicinska istraživanja 2018; 9(2):187-195 doi:10.7251/BII1802187D

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Status of orofacial musculature and articulation in children who stutter

Nada Dobrota Davidović1, Sladjana Ćalasan2
1University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia
2University of East Sarajevo, Faculty of Medicine, Foča, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Orofacial musculature dysfunction in children is one of the causes of articulation disorders, however, articulation disorders associated with stuttering make communication particularly difficult. The aim of the study is to compare the state of oral praxis and voice articulation in primary school children who stutter with the state of oral praxis and voice articulation in children of the same age who do not stutter.
Methods. The sample consisted of experimental and control group, The experimental group included 31 patients belonging to the Institute for Psychophisiological Disorders and Speech Pathology “Prof. dr Cvetko Brajović”. On the other hand, the control group comprised 31 primary school children who do not stutter. The instruments used in this research are the following: Global test of articulation, Oral praxis test (TOP) and Test for functional examination of orofacial musculature. In statistical analysis, the Chi-square test, Fisher’s exact test, Kruskal–Wallis test and Spearman Rho coefficient were used.
Results. The distribution of patients according to the degree of stuttering was not uniform but in the majority of patient intermediate degree of stuttering was recorded (χ2 = 6.4516; p = 0.0397). The Oral praxis test revealed a statistically significant difference between the groups concerning the marks given for items such as licking the lips in circle and fans (p < 0.05). The comparison of TOP results with the degree of stuttering showed that none of the variables examined by TOP depended upon the degree of stuttering. The result of the Test for functional examination of orofacial musculature showed a statistically significant difference in only one item – licking the lips in circle (χ2 = 3.72; p ≈ 0.05). The Global test of articulation indicated a statistically significant difference between the two groups where the pronunciation of speech sounds /d/ and /r/ was concerned.
Conclusion. In primary school children who stutter as well as in those who do not stutter, there is a certain degree of difficulty where the proper execution of movements of oral praxis and incorrect articulation are concerned. It has not been shown that orofacial musculature dysfunction significantly affects the occurence of stuttering.
Keywords: stuttering, oral praxis, sound articulation



CASE REPORT

Thyroglossal cyst with oropharyngeal propagation in 40 year-old patient

Miroslav Obrenović, Siniša Šolaja, Siniša Kojić, Vekoslav Mitrović, Mirjana Ćuk, Borko Davidović

Biomedicinska istraživanja 2018; 9(2):196-201 doi:10.7251/BII1802196O

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Abstract


Thyroglossal cyst with oropharyngeal propagation in 40 year-old patient

Miroslav Obrenović1,2, Siniša Šolaja1,2, Siniša Kojić2,3, Vekoslav Mitrović1,2, Mirjana Ćuk1,2, Borko Davidović1
1
University Hospital Foča, The Republic of Srpska, Bosnia and Herzegovina
2University of East Sarajevo, The Faculty of Medicine, Foča, The Republic of Srpska, Bosnia and Herzegovina
3Clinic „Varis“, Belgrade, Serbia

Introduction. Thyroglossal cyst represents the most common congenital anomaly of the neck and it occurs in approximately 7% of the overall population. It develops as a consequence of obliteration failure of ductus thyreoglossus during migration of thyroid gland in embryogenesis. It is usually diagnosed during the first decade of life by clinical examination, echosonography, multislice computed tomography (MSCT) and/or magnetic resonance imagining (MRI) of the brain and neck, fine needle aspiration (FNA) and cytological analysis of the FNA content. Treatment is surgical using the Sistrunk procedure.
Case report. The 40 year-old patient was hospitalized for the diagnostics and treatment of the tumor of submental and submandibular region as well as of oral cavity, with right-sided dislocation of the tongue followed by difficulties in swallowing and speech. In his early childhood, the patient detected a subcutaneous formation under the chin that expanded gradually. Clinical examination revealed the subcutaneous tumor mass that affected submental and both submandibular regions, predominantly left-sided with the intraoral presentation of submucosal tumor that completely filled oropharynx and dislocated the tongue to the right side. MSCT of the mouth and neck floor indicated an irregularly oval tumor of 120 x 95 x 90 mm, with its upper pole reaching the hard palate. The tumor filled the oral cavity and descended anterolaterally and more to the left side into the neck region to the hyoid bone, dislocating the tongue, eosophagus as well as pharyngeal and laryngeal structures to the right side. Cytological analysis of the FNA content confirmed the presence of thyroglossal cyst. Under nasotracheal intubation, the operation using the Sistrunk procedure was performed, with the removal of cystic tumor, and medial portion of hyoid bone, as well as with the tongue reposition. There were no complications during post-operative period. Speech and swallowing functions were completely rehabilitated. The results of pathohistological analysis confirmed the presence of thyroglossal cyst.
Conclusion.Thyroglossal cysts are the most common congenital anomalies of the neck and the treatment is surgical with satisfying outcome, low complication rates and small percentage of recidives.
Keywords: thyroglossal cyst, diagnostics, surgical procedure



CURRENT TOPIC

Gut microbiota and uremic toxins produced in intestines in patients with chronic renal failure

Miloš Mitrović, Nada Dimković

Biomedicinska istraživanja 2018; 9(2):202-206 doi:10.7251/BII1802202M

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Abstract


Gut microbiota and uremic toxins produced in intestines in patients with chronic renal failure

Miloš Mitrović1, Nada Dimković1,2
1
Zvezdara University Medical Center, Clinical Department of Renal Diseases and Metabolic Disorders with Dialysis “Prof. dr Vasilije Jovanović”, Belgrade, Serbia
2University of Belgrade, School of Medicine, Belgrade, Serbia

In recent years, academic publishing excited a considerable interest in gut microbiota and its role in human health maintenance. In patients with chronic renal failure, gut microbiota is altered due to increased blood urea nitrogen and metabolic acidosis, specific diet and therapy, as well as prolonged intestinal transit time. Protein-fermenting bacteria such as E. coli, Bacteroides and Ruminicoccus spp dominate gut microbiota in patients with chronic renal failure. Therefore, the key nephro- and cardiovascular toxins, such as indoxyl-sulfate (IS) and p-cresyl-sulfate (PCS) are produced in the gut mucosa. The important impact of increased serum levels of IS and PCS on cardiovascular comorbidity and further deterioration of renal function has been witnessed by numerous observational and animal studies. There are several therapeutic strategies for lowering serum levels of IS and PCS as well as  heir toxic effect. The use of synbiotics, pre- and probiotics, in order to modulate gut microbiota is the most optimal solution currently used. Probiotic cultures of Bifidobacter and Lactobacillus have presented themselves as the ones with the greatest potential to limit the growth of protein-fermenting bacteria responsible for the production of uremic toxins. Nevertheless, there is still a need for more well- designed prospective interventional studies, as well as for controls with well-defined diet restrictions, in order to establish definitive value of this kind of therapy in patients with chronic renal failure.
Keywords: gut microbiota, chronic renal failure, uremic toxins



REVIEWS

Contemporary knowledge of typical and atypical development of verbal communication

Sladjana Ćalasan, Nadica Jovanović

Biomedicinska istraživanja 2018; 9(2):207-216 doi:10.7251/BII1802207C

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Abstract


Contemporary knowledge of typical and atypical development
of verbal communication

Sladjana Ćalasan1, Nadica Jovanović2
1University of East Sarajevo, Faculty of Medicine, Foča, The Republic of Srpska, Bosnia and Herzegovina
2University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia

Communication can generally be defined as an exchange of messages between the sender and recipients. When analyzing the characteristics of communication, the classification into verbal and non-verbal communication is often referred to in literature. Typical child development includes the stages of pre-intentional, intentional pre-symbolic and intentional symbolic communication. Every child goes through the same phases of communication development, but the time at which he or she enters certain stage as well as its duration is not always the same for each and every child. Some children exhibit atypical development of communication. Due to this, some periods of communication development last longer compared to those children going through the stages of typical development. Communication disorders represent a serious and common problem faced by the child, parents and the wider community where the child grows up, because if there are communication difficulties at an early age, additional problems concerning insufficiently adopted speech- language system may appear. Speech and language delays recorded at an early age often appear throughout the developmental period and have negative consequences for academic achievements in school, as well as for the overall communication and social functioning of children in older age.
Keywords: verbal communication, communication development, atypical communication development

Model of self-esteem during adolescence period

Olivera Kalajdžić, Ranka Perućica

Biomedicinska istraživanja 2018; 9(2):217-223 doi:10.7251/BII1802217K

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Model of self-esteem during adolescence period

Olivera Kalajdžić, Ranka Perućica
University of East Sarajevo, Faculty of Medicine, Foča, The Republic of Srpska, Bosnia and Herzegovina

In contemporary psychological literature, there is a huge amount of research concerning self-esteem as well as the importance of high or low level of it for the adaptive and maladaptive behavior of a person. Self-esteem is defined as the result of one’s self-conception and self-evaluation, respectively. It is extremely important during adolescence when the changes in experience and behavior are often crucial for future life, personal self-satisfaction, relationships with other people, as well as for the success in the activities and roles they are taking. Researchers within this field claim that behavior, as well as the adolescents’ abilities, are always consistent with their self-image. Self-esteem is an important component of healthy adolescent’s development and of a successful transition to the adult world. For this reason, in this paper we will define the notion of self-esteem, explain the dimensions and importance of it, and outline the results of recent research concerning the adolescent population.
Keywords: self-esteem, adolescence, development of self-esteem, importance of self-esteem