Snježana Popović-Pejičić

Introduction: Respiratory manifestations of ANCA vasculitis (manifestations of the upper and lower respiratory tract) are a common clinical presentation of this type of vasculitis. The aim: Show the frequency and type of respiratory manifestations in 3 clinical presentations of ANCA vasculitis as well as the impact on patient survival (1-year, 3-year and 5-year) for all patients together as well as the differences in survival in 3 clinical presentations of ANCA vasculitis. Methods: Retrospective analysis of 27 patients with ANCA vasculitis who were admitted to the nephrology department of the Internal Medicine Clinic of the University Clinical Center in the period from 2007-2023. The clinical presentations of ANCA vasculitis, differences in the involvement of individual organ systems between the 3 most important clinical presentations, respiratory manifestations of the disease and their impact on patient survival were analyzed. Results: There were 27 patients, 14 men and 13 women, the average age of patients at the time of diagnosis of the disease was 57. 8 years. The follow-up time was from 8 months to 16 years. The clinical presentation of patients with ANCA vasculitis was microscopic polyangiitis (MPA) in 17 patients, granulomatosis with angiitis (GPA) in 7 patients and isolated renal vasculitis in 4 patients. 13 patients had respiratory manifestations of the disease, 3 with manifestations of the upper respiratory tract, 10 with pulmonary manifestations, 3 with the most severe clinical picture of pulmonary syndrome. Fatal outcome because there were 4 patients, all with MPA. Cumulative 1-year, 3-year and 5-year survival times were 96. 3%, 92% and 88. 2%. Conclusion: Respiratory manifestations of the disease at the time of diagnosis of ANCA vasculitis did not have a statistically significant effect on patient survival. There was no significant difference in survival in the 3 clinical presentations of ANCA vasculitis.

Background/Objectives: Dobutamine stress echocardiography (DSE) is a non-invasive diagnostic technique commonly employed in routine clinical practice to identify coronary artery disease. Emerging echocardiographic methods, including strain and strain rate imaging, quantify alterations in myocardial contractility and may improve the diagnostic accuracy of DSE. The main aim of this study was to assess the correlation between visual interpretation and longitudinal strain during dobutamine stress echocardiography. Methods: Our study was observational and was conducted at the Cardiology Clinic of the University Clinical Center of the Republic of Srpska. It included 70 patients who underwent dobutamine stress echocardiography. The patients were divided into two groups (diagnostic and viable study). A visual assessment of segmental contractility of the left ventricle was performed, as well as an assessment of contractility with longitudinal strain (LS) during the test. Results: The median baseline LS of segments without impaired contractility in the diagnostic study was −20% (−21 to −18) and, at the peak of the test, −22% (−23 to −21), which was statistically significant (p < 0.05). The median baseline LS in the segments with impaired contractility was −17% (−18 to −16) and, at the peak of the test, −13% (−15 to −12), which was statistically significant (p < 0.05). In the viability study, the average baseline LS in the segments with improved contractility was −8% (−11 to −7) and, at the peak of the test, −14% (−17 to −13), which was statistically significant (p < 0.05). The average baseline LS in the segments without improved contractility was −6% (−5 to −7) and, at the peak of the test, −2% (−3 to −0), which was statistically significant (p < 0.05). Conclusions: Our study indicates a good correlation between a visual assessment of left ventricular segment contractility and longitudinal strain during dobutamine stress echocardiography.

Background/Aim: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease, characterized by the production of numerous pro-inflammatory cytokines, such as tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β), which lead to pathophysiological changes in innate and acquired immunity. The existing evidence shows that pro-inflammatory cytokines in rheumatoid arthritis impact monoaminergic neurotransmission, neurotropic factors, and synaptic activity, which may lead to the development of depression. Materials and Methods: In our study, we explored the association between TNF-α and IL-6, disease activity, and the degree of depression in patients with RA. The association between TNF-α and IL-6 and the Beck and Hamilton depression scales was analyzed in a group of 116 RA patients with depression. We investigated the same correlation in 45 patients with primary depression who represented the control group. Results: A Spearman test showed that IL-6 levels had a positive association with the Beck and Hamilton scales (p < 0.05) and that TNF-α had a positive association with the Hamilton scale (p < 0.05). Also, the Hamilton depression scale was the more sensitive scale in the detection of depressive symptoms. Conclusions: Our study indicates that elevated values of pro-inflammatory cytokines are associated with the degree of depression in patients with RA. Future preclinical and clinical studies will contribute to a better understanding of the pathophysiological mechanism of depression in patients with RA and may serve as the basis for new treatment modalities. By detecting depression promptly, with the help of the HAM-D as the more sensitive scale, we could influence the future modality of treatment, and with a multidisciplinary approach, we could ensure an improvement in the quality of life of patients with RA.

Background/Objectives:Dobutamine stress echocardiography (DSE) is a non-invasive diagnostic method frequently used in daily practice to detect coronary artery disease. New echocardiographic techniques such as strain and strain rate quantify changes in myocardial contractility and can increase the accuracy of DSE. The primary objective of this study was to examine the correlation between visual assessment and longitudinal strain during dobutamine stress echocardiography. Methods: Our study was observa-tional and was conducted at the Cardiology Clinic of the University Clinical Center of the Republic of Srpska. It included 70 patients who underwent dobutamine stress echocar-diography.The patients were divided into two groups (diagnostic nd viable study). A visual assessment of segmental contractility of the left ventricle was performed, as well as an assessment of contractility with longitudinal strain (LS) during the test. Results:The median baseline LS of segments without impaired contractility in the diagnostic study was -20% (-21 to -18), and at the peak of the test -22% (-23 to -21). That was statistically significant (p< 0,05). The median baseline LS in the segments with impaired contractility was -17% (-18 to -16), and at the peak of the test, it was -13% (-15 to -12). That was statis-tically significant (p < 0,05). In the viability study, the average baseline LS in the segments with improved contractility was -8% (-11 to -7) and the peak of the test was -14% (-17 to -13). That was statistically significant (p < 0,05). The average baseline LS in the segments without improved contractility was -6% (-5 to -7), and at the peak of the test, it was -2% (-3-0). That was statistically significant (p < 0,05). Conclusion: Our study indicates a good correlation between a visual assessment of left ventricular segment contractility and lon-gitudinal strain during dobutamine stress echocardiography.

Introduction. Psoriatic arthritis is an inflammatory arthritis with a complex clinical presentation. The aim of this study was to assess the correlation between clinical features and bone density in patients with psoriatic arthritis, and to compare bone densitometry results with those of healthy controls. Material and Methods. The study included 20 patients with psoriatic arthritis and 14 healthy controls. Demographic and clinical data were collected, including nail changes and the Psoriasis Area and Severity index. All participants underwent dual-energy-X-ray absorptiometry and evaluation using the Fracture Risk Assessment Tool. Results. The mean age of participants was 58 ?} 9.1 years, with 55% being male. Rheumatoid factor was positive in 30% of patients, nail lesions were present in 60%, and the mean Psoriasis Area and Severity Index score was 10.37 ?} 10.13. A significant correlation was observed between rheumatoid factor positivity and reduced bone density (p = 0.002), as well as between nail lesions and higher fracture risk (p = 0.005). Higher psoriasis index scores were significantly associated with increased fracture risk (p = 0.03). No other statistically significant correlations were identified. Although differences were found in bone mineral density and Fracture Risk Assessment Tool scores between patients with psoriatic arthritis and controls, these did not reach statistical significance. Conclusion. This study demonstrated an association between reduced bone density and rheumatoid factor positivity, as well as a high fracture risk in psoriatic arthritis patients with nail lesions. These findings support the consideration of routine bone density assessment in diagnostic algorithm for psoriatic arthritis, particularly in patients with rheumatoid factor positivity and nail involvement.

The Republic of Srpska (RS), as a part of the Western Balkans (WB) region, has a higher diabetes prevalence than the EU. This study aims to assess the cost-effectiveness of early treatment of high-risk patients with pre-diabetes and undiagnosed diabetes in our setting. We designed a Markov chain Monte Carlo (MCMC) model which reflects the current International Diabetes Federation (IDF) three-step plan for the prevention of T2DM in those at increased risk. The model captures the evolution of the disease in FINDRISC high-risk patients from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and then to T2DM and its complications. We developed two MCMC models, in order to follow the progression of the disease in high-risk cases, ie, when early treatment is undertaken or when it is not undertaken. The health costs and quality adjusted life years (QALY) were discounted at an annual rate of 3%. The key model parameters were varied in one-way and probabilistic sensitivity analysis. Early treatment resulted in increased life expectancy, postponement of the onset of diabetes and increased QALY for all patients. The discounted incremental cost-effectiveness-ratios (ICER) in NGT, IFG, IGT, and T2DM patients were -289.9, 9724.03, -1478.59 and 4084.67 €. In high-risk IGT patients, ICER was the most favorable, being both a cost saving and QALY gaining, with the consistent results confirmed by the sensitivity analysis. The results recommend the acceptance of a new health policy of identifying IGT patients with the use of FINDRISC questionnaire and plasma glucose measurements; providing them with a lifestyle change program; and implementing intensive diabetes treatment, as their disease progresses. Our results are especially significant for the Western Balkan countries, since this was the first cost-effectiveness study of T2DM prevention in this region.

Introduction. Systemic sclerosis (SS) is a complex autoimmune disease characterized by chronic progressive organic sclerosis. The aim of this paper is to show the correlation of ultrasound (US) parameters with Rodnan skin score (mRSS), as well as the clinical involvement of other organ systems. Methods. Our study included 24 patients diagnosed with SS and 24 healthy controls. We included demographic, clinical and laboratory parameters, individually and included in the European Scleroderma Trial and Research Disease Activity Index (EUSTAR-DAI) score. To measure skin involvement, we used the modified mRSS and skin ultrasound.Results. The skin thickness of patients and healthy controls measured by ultrasound showed statistically significant differences (p<0.001). Correlations between mRSS and anti-Scl-70 antibody (p=0.02) and between mRSS and diffusion capacity for carbon monoxide (DLCO) (p=0.03) were shown.Conclusion. In recent years, the importance of using skin ultrasound in patients with systemic sclerosis has been increasing, due to the fact that this technique can detect skin involvement in the early stages of the disease. The advantages of the method are availability and non-invasiveness, unlike skin biopsy. By standardizing ultrasound skin measurement, it would be possible to implement the method in daily clinical practice.

Background/Aim: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystemic involvement. Almost 50 % of patients who suffer from systemic lupus erythematosus have lupus nephritis (LN) as well. Mycophenolate mofetil (MMF) or intravenous cyclophosphamide (CYC) are recommended as preferred therapy. The aim of this study was to see how MMF and CYC, when compared, are efficient in dealing with LN. Methods: Study included 53 SLE patients with biopsy-proven class III and class IV LN. Twenty-two patients (42 %) were treated with MMF (dosage 2-3 g/day) and 31 patients (58 %) were treated with CYC (0.5 to 1.0 g/m2 in monthly pulses) in a 24-week induction study. Outcome of interest was the improvement in serum creatinine, proteinuria and creatinine clearance. Primary end point included complete renal remission defined as serum creatinine within 25 % of baseline before flare and proteinuria < 0.5 g/24 h. Secondary end point included complete renal remission in follow-up period. Results: The results revealed that response between two groups was not notably different (X2 = 0.151, p = 0.697). Four out of 22 patients (18.2 %) in MMF group and 7 out of 31 patients (22.6 %) in CYC group had complete renal remission. Most patients from both groups showed improvement from the clinical point of view. Secondary end point was also similar between treatment groups. Conclusion: The study showed same efficiency between these treatment groups, MMF and CYC as induction for LN. No crucial differences were identified between MMF and CYC groups in terms of renal remission.

Background/Aim: Chronic kidney disease (CKD) has seen a rapid increase worldwide in recent decades, now recognised as a global health issue of the 21st century. Optimal, continuous control of hypertension represents a crucial part of treatment capable of slowing the progression of CKD. The aim of this study was to demonstrate that optimal regulation blood pressure control in patients with essential and secondary hypertension, along with CKD, slows the progression of CKD. Methods: The research was conducted at the University Clinical Centre of the Republic of Srpska, Banja Luka, Internal Clinic Nephrology Department. A retrospective-prospective study was blind for patients and lasted for 24 months. It included 97 patients, aged 18 and above, of both genders, hypertensive, in the 3rd or 4th stage of CKD (creatinine clearance of 15-59 mL/min). Assess the outcome of CKD, a "complex (undesirable) clinical outcome" was taken - one of three fundamental clinically undesirable events: double increase in serum creatinine values at the end of 24 months, onset of terminal renal insufficiency, or patient death. Patients were classified into three groups: I group - 30 patients with essential hypertension and CKD with optimally regulated blood pressure; II group - 32 patients with secondary hypertension and CKD with optimally regulated blood pressure; III control group - 35 patients with hypertension of various causes and CKD who did not achieve target blood pressure values. Blood pressure control was measured from month 0 to month 24 - once a month. Laboratory tests were taken every 3 months (red blood cells, haemoglobin, glycaemia, cholesterol, urea, creatinine, uric acid, sodium, potassium in serum and urine). Results: There was a highly statistically significant difference in glomerular filtration rate in the first group compared to the third group and in the second group compared to the third group. No statistically significant difference in glomerular filtration rate between the first and second groups was observed, where good blood pressure regulation was achieved. Conclusion: Optimal blood pressure control in the examined groups, regardless of the cause of CKD, was responsible for slowing the progression of CKD compared to the group with unregulated blood pressure.

Background Macro- and microvascular diseases (MMVDs) in diabetes mellitus (DM) are important clinical and economic burdens. Reimbursement decisions require substantiated information; however, for Central and Eastern European (CEE) countries cost data are lacking. Our aim was to estimate the direct public-payer medical costs of MMVDs in adult DM (regardless of the type of DM) patients in Bulgaria, Lithuania, Poland, Republic of Srpska/Bosnia and Herzegovina, Romania, and Slovenia. Methods The MMVDs considered were diabetic foot, end-stage renal disease (ESRD), heart failure (HF), painful neuropathy, peripheral vascular disease, retinopathy, stable angina pectoris, myocardial infarction (MI), stroke, transient ischemic attack, and unstable angina (UA). They were split into complications (the first seven) and events; prevalence and incidence-based approaches, respectively, were used. Experts in participating countries provided information via a unified questionnaire. Results The total cost of DM-related MMVDs (EUR per annum) amounted to 1,165 million (m) in Poland, 581m in Romania, 103m in Bulgaria, 76m in Slovenia, 47m in Republic of Srpska/Bosnia and Herzegovina, and 29m in Lithuania (some categories omitted). The cost per DM patient was similar for most included countries (range 586–759), and lower in Lithuania (301) and Bulgaria (219). The largest individual contributor was HF (20.9%), followed by 13% for MI, UA, stroke, and ESRD. Conclusions DM-related MMVDs impose a significant financial burden in CEE countries; our results can aid economic assessments of treatments for DM. Collecting data for several countries is challenging as available information differs; however, a unified methodology allow quality checks. The results are consistent between the countries, which supports the credibility.