Damir Rebić | University of Sarajevo (original) (raw)

Papers by Damir Rebić

Medical Archives, 2015

Aim: Introduction: Starting from the point that the chronic kidney disease (CKD) is chronic, infl... more Aim: Introduction: Starting from the point that the chronic kidney disease (CKD) is chronic, inflammatory and hypercoagulable state characterized by an increase in procoagulant and inflammatory markers high cardiovascular morbidity and mortality in these patients could be explained. Aim: The aim of the research was to monitor inflammatory markers and procoagulants in various stages of kidney disease (stage 1-4). Materials and Methods: The research included 120 subjects older than 18 years with CKD stages 1-4 examined and monitored in Clinic of Nephrology, University Clinical Centre Sarajevo over a period of 24 months. The research included determining the following laboratory parameters: serum creatinine, serum albumin, C-reactive protein, leukocytes in the blood, plasma fibrinogen, D-dimer, antithrombin III, coagulation factors VII (FC VII) and coagulation factor VIII (FC VIII). Results: With the progression of kidney disease (CKD stages 1-4), there was a significant increase of inflammatory and procoagulant markers: CRP, fibrinogen and coagulation factor VIII, and an increase in the average values of leukocytes and a reduction in the value of antithrombin III, but without statistical significance. Also, there were no significant differences in the values of D-dimer and coagulation factor VII. Conclusion: The progression of kidney disease is significantly associated with inflammation, which could in the future be useful in prognostic and therapeutic purposes. Connection of CKD with inflammation and proven connection of inflammation with cardiovascular risk indicates the potential value of some biomarkers, which could in the future identify as predictors of outcome and could have the benefit in the early diagnosis and treatment of cardiovascular disease in CKD.

Medicinski arhiv, 2009

We present a case of 52 year old male with an acute renal failure that took place 4 days after op... more We present a case of 52 year old male with an acute renal failure that took place 4 days after open transabdominal surgery repair of infrarenal abdominal aneurysm along with aneurysm of left common iliac artery and dilatation of left external iliac artery. Patient was subjected to 13 hemodialysis treatments that resulted in satisfactory recovery of renal function. One month after aneurysm repair he developed the right ureteral leak, consequently urinoma and acute renal failure once again. We suppose that ureteral leak was related to segmental ischemic necrosis of right ureter but not to traction or other iatrogenic ureteral injury. Percutaneous nephrostomy and insertion of ureteral stent was resulted in complete recovery of renal function.

Left ventricular (LV) structure and function abnormalities are frequent in patients with chronic ... more Left ventricular (LV) structure and function abnormalities are frequent in patients with chronic uraemia; these disorders increase the risk of cardiovascular (CV) and overall morbidity and mortality in the predialysed population, during dialysis treatment, and in renal transplant recipients. Since the first description of the association between chronic kidney disease (CKD) and heart disease, many epidemiological studies have confirmed and extended this finding. The risk of cardiovascular disease (CVD) is notably increased in patients with CKD. When adjusted for traditional CV risk factors, impaired kidney function increases the risk of CVD 2 to 4-fold. CVD is frequently underdiagnosed and undertreated in patients with CKD. This review will attempt to summarise current knowledge of the prevalence and pathophysiological mechanisms of LV disease in chronic uraemia, and to discuss useful medical strategies in this population.

Bosnian Journal of Basic Medical Sciences, 2010

Lupus nephritis (LN) is an immune infl ammation of kidneys caused by systemic lupus erythematosus... more Lupus nephritis (LN) is an immune infl ammation of kidneys caused by systemic lupus erythematosus (SLE), a chronic infl ammatory disease that aff ects the body' s immune system. Aim of this study was to analyze clinical manifestation and treatment results of patients with LN. Forty one patients with clinical signs of LN were included in the study. Mean age of patients was ,±, years in the moment of fi rst diagnosis of LN, with female-male ratio :. Renal disease was pathohistologically (PTH) verifi ed in , of patients ( pts with class III,  pts with class IV, one pt with class V of lupus nephrites). Patients with high nephrotic proteinuria were treated with pulse dose of methylprednisolone and pulse doses of cyclophosphamide (CYC) in induction therapy. Corticosteroid and CYC were continued according to treatment protocol. e other group of LN patients with lower nephrotic proteinuria was treated with mycophenolate mofetil (MMF) in induction therapy at a dose of x g/day for six months, and than in maintenance x, g/day. e patients with non-nephrotic proteinuria and normal renal function were treated with oral prednisolone ,- mg/kg/day in a single morning dose, and then gradually reduced to the dose of maintenance. e mean time of patient' s follow-up was ,±, years. Partial renal remission was accomplished in , pts, and complete remission in , pts for period of ,±, months from the beginning of the treatment. Duration of complete renal remission was ,±, months. During the period of follow-up, , pts developed at least one nephritic fl are and were treated again. ese results confi rmed that the aggressive form of lupus nephritis should be treated associating cyclophosphamide with corticosteroids therapeutical regiment. MMF is a new promising immunosuppressive drug for a treatment of this serious disease.

Bosnian Journal of Basic Medical Sciences, 2012

We present the case of a -year-old female patient with microscopic polyangiitis presented with ... more We present the case of a -year-old female patient with microscopic polyangiitis presented with polyneuropathy of lower extremities and rapidly progressive glomerulonephritis. Disease had started as a pain and weakening of muscular strength fi rst in the left and than in the right leg. Electromiography has shown that a mainly dominant neurological aff ection was paresis of peroneal nerve in both lower extremities. In laboratory examination the titer of anti-myeloperoxidase anti-neutrophilic cytoplasmic antibodies (p-ANCA) was elevated. Due to renal involvement presented as a microscopic haematuria and decreasing of renal function, patient undergone kidney biopsy. It confi rmed the immune vasculitis microscopic polyangiitis type with ANCA-associated glomerulonephritis. Th is is one of rare case of microscopic polyangiitis without lung simptomatology, fi rst presented with asymmetrical polineuropathy of lower extremities. Th e patient was treated with methylprednisolone and cyclophosphamide in dosis adjusted to the level of disease severity and the renal function (methylprednisolone  mg/kg of body weight for two months with gradually tapering to the minimum eff ective dose and cyclophosphamide  mg/kg of body weight). Th is treatment lead to the partial remission of disease. In maintenance therapy azathioprin was introduced instead of cyclophosphamide.

Central European Journal of Public Health, 2019

Objectives: Staphylococcus aureus (SA) represents one of the most important microorganism that is... more Objectives: Staphylococcus aureus (SA) represents one of the most important microorganism that is part of the normal microflora of humans, but in certain conditions can cause very serious infections. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for a wide spectrum of nosocomial and community associated infections worldwide. The aim of this study was to determine community acquired MRSA (CA-MRSA), as well as the frequency of Panton-Valentine leukocidin (PVL) genes and staphylococcal cassette chromosome mec (SCCmec) types in isolates obtained from outpatients in the region of 700,000 people (Canton Sarajevo, Bosnia and Herzegovina) Methods: Our investigation included phenotypic and genotypic markers such as antimicrobial resistance, pulsed-field gel electrophoresis (PFGE), SCC typing, and PVL detection. Results: Antimicrobial susceptibility: all MRSA isolates were resistant to the β-lactam antibiotics tested, and all isolates were susceptible to trimethoprim sulphamethoxazole, rifampicin, fusidic acid, linezolid, and vancomycin. After the PFGE analysis, the isolates were grouped into five similarity groups: A-E. The largest number of isolates belonged to one of two groups: C-60% and D-27%. In both groups C and D, SCCmec type IV was predominant (60% and 88.8%, respectively). A total of 24% of the isolates had positive expression of PVL genes, while 76% showed a statistically significantly greater negative expression of PVL genes. Conclusions: Using combination techniques, we were able to investigate the origin and genetic background of the strains. PFGE analysis revealed two large, genetically related groups of strains consisting of 87 isolates. Our results suggest failure to apply the screening policy, and a lack of knowledge about multiresistant MRSA strains. This study showed the local epidemiological situation which should be the basis of antimicrobial empiric therapy for non-hospitalized patients.

Medical Archives, 2018

Introduction: Acinetobacter species is associated with health care associated infections especial... more Introduction: Acinetobacter species is associated with health care associated infections especially in patients on respiratory therapy equipment and indwelling catheters. They are becoming increasingly drug resistant. The knowledge of the prevalence and pattern of antimicrobial susceptibility pattern of Acinetobacter spp. is important. Aims: The study is undertaken to estimate the prevalence rate, risk factors and antimicrobial resistance pattern of isolates. in Acinetobacter spp. from various clinical samples. Material and Methods: The isolates of Acinetobacter species obtained from various clinical specimen. Specimens were processed by standard microbiological techniques. Antimicrobial sensitivity tests of the Acinetobacter isolates were done by modified Kirby-Bauer disc diffusion method. Results: Out of 622 isolates, 399 isolates were from inpatients (62,18%) and 223 were from outpatients (37,82%). More than 90% of isolates displayed resistance to ampicillin, amoxicillin-clavulanic acid, ceftazidime, caftriaxon and amikacin. Resistance to gentamicin, co-trimoxazole and ciprofloxacin were also common. Least resistance was seen to piperacillin-tazobactam and imipenem. A total of 125 Acinetobacter isolates were analyzed, out of which 78.4 % were multi-drug resistant (MDR). Of these MDR isolates, 17.24% were pan-resistant. A. baumannii was the most common species responsible for wound infection (84,8%), pneumonia(96,15%), abscess (72.7%), urinary tract infection (85,7%) and septicemia(89,5%). Conclusion: Multidrug resistant Acinetobacter has emerged as an important nosocomial pathogen. Antibiotic susceptibility testing is critical in the treatment of infections caused by Acinetobacter. Continued surveillance of prevalent organisms in ICUs, combined with preventive measures remains absolutely essential in efforts to prevent or limit the spread of Acinetobacter infection.

Future cardiology, 2018

To assess the utility of gamma-glutamyl transferase (GGT) and C-reactive protein (CRP) in predict... more To assess the utility of gamma-glutamyl transferase (GGT) and C-reactive protein (CRP) in predicting troponin elevation in patients with acute coronary syndrome. The total of 119 patients were divided into troponin-positive (n = 61) and troponin-negative (n = 58) patients. CRP cut-off value ≥13.4 mg/l had the sensitivity of 68.1% and specificity of 62.5%, while the GGT cut-off value ≥61.5 IU/l had the sensitivity of 66.0% and specificity of 62.0% and combined use of both CRP and GGT had 71.4% sensitivity and 69.6% specificity in predicting troponin increase in acute coronary syndrome patients. GGT might be used as an adjuvant marker for risk assessment patients who present with chest pain and are suspected to have acute coronary syndrome.

Some Special Problems in Peritoneal Dialysis, 2016

Research focus: The role of peritoneal dialysis (PD) in the management of acute kidney injury (AK... more Research focus: The role of peritoneal dialysis (PD) in the management of acute kidney injury (AKI) is not well defined, although it remains frequently used, especially in lowresource settings. A review was performed to ascertain its suitability as the "first choice" in AKI patient treatment and to compare PD with extracorporeal blood purification (EBP), such as hemodialysis (HD). Research methods used: Design, setting, participants, and measurements of MEDLINE, CINAHL, and Central Register of Controlled Trials were searched. The review selected eligible adult population studies on PD in the setting of AKI. Results/findings of the research: This paper suggests that PD should be considered as a valuable method for AKI since it offers several advantages over HD, such as technical simplicity, no extracorporeal circuit, and no bleeding risk. It offers good cardiovascular tolerance and less cardiovascular instability, thus reducing kidney aggression by ischemia and hydroelectrolytic imbalance. Main conclusions and recommendations: Finally, not only in developing countries but also in developed countries, PD is relatively simple and inexpensive and is more widely used. Various techniques of PD have been developed, and these have been adapted for use in AKI. There is currently no evidence to suggest significant differences in mortality between PD and HD in AKI. There is a need for further good-quality evidence in this important area.

Bosnian journal of basic medical sciences / Udruženje basičnih mediciniskih znanosti = Association of Basic Medical Sciences, 2010

The metabolic syndrome (MS) is a multi-factorial disorder which includes a main risk factors asso... more The metabolic syndrome (MS) is a multi-factorial disorder which includes a main risk factors associated with the development of cardiovascular, neurologic, renal and endocrine diseases, especially type 2 diabetes. This study has been conducted to estimate the prevalence of the MS in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and its association with cardiovascular morbidity. The study included 37 patients (25 type 2 diabetic patients and 12 non-diabetic patients), who had been on peritoneal dialysis for > 3 months. At the beginning of CAPD treatment (baseline) and at the end of follow-up, we measured: body mass index (BMI), blood pressure, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (HDLC) and defined the prevalence of the MS using the modified National Cholesterol Education Program (NCEP; Adult Treatment Panel III) for peritoneal dialysis patients. The overall prevalence of the MS was 89.2%. The metabolic syndrome was e...

Journal of Renal Injury Prevention, 2016

Female acute kidney injury (AKI) hospital survivors with increasing burden of comorbidities, diag... more Female acute kidney injury (AKI) hospital survivors with increasing burden of comorbidities, diagnosis of sepsis and acute decompensated heart failure (ADHF) seem to be at high-risk for poor postdischarge outcome. Close monitoring of high-risk hospital AKI survivors after discharge should be done, preferably by a nephrologists, aiming to reduce mortality and prevent adverse outcome of kidney function in this patient population.

International Journal of Applied and Basic Medical Research

< e metabolic syndrome (MS) is a multi-factorial disorder which includes a main risk facto... more < e metabolic syndrome (MS) is a multi-factorial disorder which includes a main risk factors associated with the development of cardiovascular, neurologic, renal and endocrine diseases, especially type diabetes. < is study has been conducted to estimate the prevalence of the MS in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and its association with cardiovascu-lar morbidity. < e study included patients ( type diabetic patients and non-diabetic patients), who had been on peritoneal dialysis for> months. At the beginning of CAPD treatment (baseline) and at the end of follow-up, we measured: body mass index (BMI), blood pressure, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (HDLC) and defi ned the preva-lence of the MS using the modifi ed National Cholesterol Education Program (NCEP; Adult Treatment Panel III) for peritoneal dialysis patients. < e overall prevalence of the MS was ,. < e metabolic syndrome was estimated in all () type diabetic patients (vs. patients on the beginning of CAPD treatment). In non-diabetic peritoneal patients, the MS was estimated in cases, ac-cording to , at the beginning CAPD treatment. Development of the MS was signifi cantly higher in the type diabetic patients in compared with non-diabetic patients until the end of follow-up examination (p=,). < e prevalence of LVH in type diabetic pa-tients with the MS was signifi cantly higher (p=,) than in non-diabetic peritoneal patients with the MS. We didn’t found statistical signifi cantly diff erence in the prevalence of ischemic heart disease between this two category of peritoneal dialysis patients (p=,). < e results indicate that the metabolic syndrome is presented in high percentage in peritoneal dialysis patients, and it’s also important

Cardiovascular diseases (CVD) are a major cause of morbidity and leading cause of mortality in al... more Cardiovascular diseases (CVD) are a major cause of morbidity and leading cause of mortality in almost of patients (pts) with chronic kidney disease (CKD), including kidney transplant recipients. Left ventricular hypertrophy (LVH) is the most common struc-tural alteration and powerful risk factor for cardiovascular complications in the uremic patients. Z e aim of this study is to analyze predictors of the left ventricular remodelling in the fi rst year after kidney transplantation based on comparison of echocardiographic fi ndings, which had been done before and twelve months after transplantation. In fi ve years retrospective study, we followed up kidney transplant patients in the fi rst post-transplant year. All patients data – blood pressure, BMI, ECG, blood haemoglobin, serum protein, calcium, phosphorus, product of calcium and phosphorus, the values of parathyroid hormone, serum creatinine and creatinine clearance were recorded just before kidney transplantation and in one month...

Folia Medica Facultatis Medicinae Universitatis Saraeviensis, 2017

The r enal damage is an emerging complication of excess weight. Aim of this study was to determi... more The r enal damage is an emerging complication of excess weight. Aim of this study was to determine the occurrence of chronic kidney disease (CKD) in subjects depending on their weight and the influence of body mass index (BMI) on glomerular filtration (GF) rate decline in outpatients with hypertension and/or diabetes mellitus type 2. Methods: This observational, cross sectional, pilot study included 200 adult patients suffering from hypertension and/or diabetes mellitus type 2 from March 2012. to March 2013. in the Institute for Occupational Medicine of Canton Sarajevo. Renal function was evaluated by using MDRD equation and measurement of microalbuminuria and proteinuria in 24 - hour urine, using nefelometric method at the Institute of Clinical Biochemistry of the University Clinical Center in Sarajevo K/DOQI classification was used to define the stages of CKD. Results: Of the total 200 patients (62.5% male; mean age of 52.46 ± 8.2 years) most of them had a BMI of 25 - 30 (n=99; ...

Accelerated atherosclerosis and vascular calcifi cation, with oxidative stress, endothelial dysfu... more Accelerated atherosclerosis and vascular calcifi cation, with oxidative stress, endothelial dysfunction, and other factors causing the arterial stiff ness, increases cardiovascular morbidity and mortality in patients on peritoneal dialysis. W e aim of this paper is to assess changes in intima media thickness (IMT) at com-mon carotid arteries (CCA) in patients with stable continuous ambulatory peritoneal dialysis (PD) and examine the relationship of these changes and other risk factors on the occurrence of atherosclerosis. W e study was conducted on stable PD patients ( type diabetic patients), aged , ± , years. CCA-IMT was assessed using ultrasound B-mode technique, bilaterally. Other risk factors for the occurrence of atherosclerosis were monitored through regular laboratory control. One atheromatous plaque was found in patients (,). Among type diabetic patients, vascular calcifi cations were found in patients. In all PD patients, CCA-IMT is , ± ,, in PD patients with vascular calc...

Acta Clinica Croatica, 2021

Folia Medica Facultatis Medicinae Universitatis Saraeviensis, 2014

Objectives: Atherosclerosis is a significant cause of morbidity and mortality in peritoneal dialy... more Objectives: Atherosclerosis is a significant cause of morbidity and mortality in peritoneal dialysis patients. The aim of this study was to measure the intima-media thickness (IMT) and peak systolic velocity (PSV) values on common carotid arteries (CCA) and to assess relationship between CCA parameters and serum nitric oxide (NO) level, traditional and uremic specific risk factors in patients treated with continuous ambulatory peritoneal dialysis (CAPD) with and without type 2 diabetes mellitus (DM2). Methods: Study included 38 patients on CAPD, (mean age 51.32 } 18.03 y) (44.7% DM2 and 55.3% non-DM2 patients). CCAIMT and PSV were determined by B-mode ultrasound and serum NO level was measured by ELISA. Results: Serum NO level in DM2 patients was significantly higher compared to non-DM2 patients (7.09 vs. 5.15 μmol/L). Vascular calcification was found in 94.1% DM2 patients and in 33.3% non-DM2 patients. There were no CCA hemodynamic flow blockages in 11.8% DM2 patients. Mid-signifi...