Publications

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    ABSTRACT: Background There is a large variability in clinical practice and in the literature, and no controlled trial with adequate sample size for performing pneumatic balloon dilation (BD) for achalasia. We aimed to evaluate the efficacy and safety of pneumatic BD for achalasia over a 12-year period. Methods We undertook a retrospective review of the medical records of 45 patients who underwent BD for achalasia at a single institution between 2000 and 2013. The primary objectives were the efficacy and safety of BD, patients were followed up every 6 months and the secondary goal was the evaluation of the epidemiological characteristics of achalasia. Results A total of 45 patients were analysed, of whom 25 (55.6 %) were female. The mean age (SD) of the sample was 54 years. Out of 66 dilations, we were successful in 62 dilations (93.94 %); three were unsuccessful due to perforation of the oesophagus, and one dilation was declared unsuccessful. Of the total patients, three (6.6 %) needed more than two BDs. Conclusion Endoscopically controlled BD based on the free choice of the diameter of a balloon and duration of dilation is an effective and safe therapeutic modality of achalasia.
    Esophagus 09/2014; · 0.83 Impact Factor
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    ABSTRACT: Backgrounds and aims: We aimed to asses the diagnostic accuracy of artificial neural network (ANN) model based on routinely used biochemical and ultrasound parameters in the assessment of chronic hepatitis B (CHB) related liver fibrosis and to and compare it against other noninvasive scores. Methods: we included 270 patients. Age, platelets count, AST, ALT, GGT, LDH, albumin, cholesterol level, INR, portal vein and longitudinal spleen diameters were used to devise an ANN model and compare it against liver histology. Results: there were 154 (57.0%) of patients having significant fibrosis (>F2) and 34 (12.6%) having cirrhosis (F4). The AUC for significant fibrosis and cirrhosis for ANN model were 0.89 (95% CI 0.85-0.93) and 0.94 (%95 CI 0.91-0.98), respectively. ANN probability scores (range 0-1.0) <0.20 and >0.90 had negative and positive predictive values of 97% and 92%. Restricting the liver biopsy in patients with intermediate scores may prevent liver biopsy in 39% of patients with >95% accuracy. The areas under the ROC curve for significant fibrosis for AAR, APRI, GUCI, FORNS, HALT-C, HUI and FIB-4 scores were 0.67, 0.87, 0.84, 0.80, 0.80, 0.78 and 0.84 respectively. Correspondingly, AUCs for cirrhosis or AAR, APRI, GUCI, FORNS, HALT-C, HUI and FIB-4 scores were 0.75, 0.84, 0.86, 0.80, 0.85, 0.79 and 0.87. Conclusion: ANN model based on routinely available biochemical and ultrasound parameters is an accurate and cheap option for prediction of significant liver fibrosis and cirrhosis in chronic hepatitis B with favorable diagnostic accuracy in comparison with other free noninvasive scores.
    Journal of Hepatology 04/2014; 60(1):S410. · 9.86 Impact Factor
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    Article: Response.
    Nermin N Salkic, Ervin Alibegovic, Predrag Jovanovic
    Gastrointestinal endoscopy 12/2013; 78(6):963. · 6.71 Impact Factor
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    Nermin N Salkic, Ervin Alibegovic, Predrag Jovanovic
    Gastrointestinal endoscopy 03/2013; · 6.71 Impact Factor
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    ABSTRACT: A case of a 45-year-old Caucasian male initially reported with symptoms of acute intestinal obstruction was presented. Diagnostic tests revealed presence of eosinophilic ascites with marked peripheral eosinophilia, a signiicant thickening of stomach and intestinal wall and iniltration of gastric and duodenal mucosa with eosinophiles. Findings were conclusive with subserosal type of eosinophilic gastroenteritis and the patient's treatment started with a combination of parenteral methylprednisolone and oral loratadine. A prompt clinical response was encountered after 5 days of treatment with complete resolution.
    Medicinski glasnik 02/2013; 10(1):178-82. · 0.20 Impact Factor
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    ABSTRACT: Acute pancreatitis is a rare but life-threatening complication in patients with transplanted kidney. The incidence of acute pancreatitis after kidney transplantation ranges from 2% to 7%, with mortality rate between 50 and 100%. We report a case of a female patient aged 46 years, developing an interstitial acute pancreatitis 8 years following a renal transplantation. The specific aethiological factor was not clearly established, although possibility of biliary pancreatitis with spontaneous stone elimination and/or medication-induced pancreatitis remains the strongest. Every patient after renal transplantation with an acute onset of abdominal pain should be promptly evaluated for presence of pancreatitis with a careful application of the most appropriate diagnostic procedure for each individual patient.
    Case Reports 01/2012;
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    Mithat Tabaković, Ervin Alibegovic, Nermin Salkic
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    ABSTRACT: Hronični virusni hepatitis se, danas, definiše kao zapaljenje jetre koje traje duže od šest meseci, a uzrokovano je nekim od primarno hepatotropnih virusa: virusom hepatitisa B, C, D ili G. U prošlosti, danas, pa i u budućnosti, ovaj klinički entitet je bio i, zasigurno, biće jedan od najvažnijih i najtežih globalnih problema humane medicine jer u značajnom procentu dovodi do razvoja ciroze jetre, hronične hepatocelularne insuficijencije i hepatocelularnog karcinoma (HCC). Pretpostavlja se da oko 700 miliona ljudi (više od 10% svijetske populacije) ima hroničnu infekciju ovim virusima sa, manje ili više, značajnim hroničnim oštećenjem jetre.
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    ABSTRACT: To establish an optimal age threshold for endoscopy referral in patients with simple uninvestigated dyspepsia in the setting of European developing country (Bosnia and Herzegovina) with low availability and high workload of endoscopy units. We reviewed patient information on all upper endoscopies performed during a 6-year period (2000-2005). Different age thresholds were evaluated in terms of their predictive power for absence of malignancy. A total of 82 of 4403 (1.86%) dyspeptic patients had upper gastrointestinal (GI) malignancy. Age cutoffs of 40 years for men and 45 years for women had the best predictive power, without any cases of upper GI malignancies below those thresholds. Age cutoffs of 45 years for men and 50 years for women also had excellent negative predictive values (99.7 and 99.9%, respectively) with 1.45 and 0.98 cases of missed upper GI malignancies per 1000 endoscopies, respectively. A total of 1709 of 4403 (38.8%) of endoscopies might have been avoided in men of less than 45 and women of less than 50 with uninvestigated dyspepsia. (i) Age thresholds for endoscopy referral are lower than in Western countries and should be different for men and women. (ii) Cutoff values of 40 and 45 years for men and women, respectively, are completely safe to use. (iii) Thresholds of 45 years for males and 50 years for females have a small level of risk of missing upper GI malignancy, but are acceptable to use in areas of low availability of endoscopy.
    European journal of gastroenterology & hepatology 02/2009; 21(1):39-44. · 1.66 Impact Factor
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    Muharem Zildzic, Ervin Alibegovic
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    ABSTRACT: Crohn's disease (CD) is a lifelong disease arising from an interaction between genetic and environmental factors, but seen predominantly in the developed countries of the world. The precise etiology is unknown and therefore a causal treatment is not yet available. Fistulating Crohn's disease includes fistulas arising in the perianal area, together with those communicating between the intestine and other organs or the abdominal wall. Non perianal fistulas include fistulas communicating with other viscera (urinary bladder, vagina), loops of intestine (enteroenteral fistulas) or the abdominal wall (enterocutaneus fistulas). The diagnostic approach is a crucial aspect in the management of fistulating CD as the findings influence the therapeutic strategy. Short bowel syndrome caused by extensive bowel resection should be initially treated with nutritional support and can caused serious treatment and reevaluating problems. We review this uncommon manifestation in a high risk patient after multiple operations and severely shortened bowel and also with non perianal fistulating CD.
    Medical Archives 01/2009; 63(6):354-5.
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    ABSTRACT: Objective: To establish an optimal age threshold for endoscopy referral in patients with simple uninvestigated dyspepsia in the setting of European developing country (Bosnia and Herzegovina) with low availability and high workload of endoscopy units. Methods: We reviewed patient information on all upper endoscopies performed during a 6-year period (2000-2005). Different age thresholds were evaluated in terms of their predictive power for absence of malignancy. Results: A total of 82 of 4403 (1.86%) dyspeptic patients had upper gastrointestinal (GI) malignancy. Age cutoffs of 40 years for men and 45 years for women had the best predictive power, without any cases of upper GI malignancies below those thresholds. Age cutoffs of 45 years for men and 50 years for women also had excellent negative predictive values (99.7 and 99.9%, respectively) with 1.45 and 0.98 cases of missed upper GI malignancies per 1000 endoscopies, respectively. A total of 1709 of 4403 (38.8%) of endoscopies might have been avoided in men of less than 45 and women of less than 50 with uninvestigated dyspepsia. Conclusion: (i) Age thresholds for endoscopy referral are lower than in Western countries and should be different for men and women. (ii) Cutoff values of 40 and 45 years for men and women, respectively, are completely safe to use. (iii) Thresholds of 45 years for males and 50 years for females have a small level of risk of missing upper GI malignancy, but are acceptable to use in areas of low availability of endoscopy.
    European Journal of Gastroenterology & Hepatology 12/2008; 21(1):39-44. · 1.92 Impact Factor
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    ABSTRACT: Bosnia and Herzegovina (B&H) is one of the Eastern European countries with lacking data on Crohn's disease (CD) epidemiology. We aimed to assess incidence of CD in Tuzla Canton of B&H during a 12-year period (1995-2006). We retrospectively evaluated hospital records of both CD inpatients and outpatients residing in Tuzla Canton of B&H (total of 496,280 inhabitants) between 1995 and 2006. Patient that satisfied previously described criteria were included in the study. Incidence rates were calculated with age standardisation using European standard population. Trends in incidence were evaluated as moving 3-year averages. During the observed period, 140 patients met the diagnostic criteria for CD. Mean annual incidence was found to be 2.3/10(5) (95% CI=1.6-3.0) inhabitants ranging from 0.20 to 6.45 per 10(5). Mean annual crude incidence during the last 5 years of study (2002-2006) was 4.15/10(5) (95% CI=3.35-4.95). The prevalence of CD, at the end of the observed period was found to be 28.2/10(5) (95% CI=23.5-32.9). CD incidence increased dramatically from 0.27/10(5) in 1995-1997 to 4.84/10(5) in 2004-2006, as well as did the number of colonoscopies performed; from 29 in 1995 to 850 in 2006. We observed almost constant trend of around three new cases of CD per 100 colonoscopies performed. (1)Our area is the region of moderate incidence of CD with the trend that remains toward continuing increase in the rates of CD, which is most likely a direct consequence of the growing number of performed colonoscopies. (2) We believe that in the future years, CD incidence in our region will probably further increase and stabilise at a level of around five cases per 10(5) inhabitants.
    International Journal of Colorectal Disease 06/2008; 23(10):957-64. · 2.24 Impact Factor
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    ABSTRACT: Colorectal cancer occurs in the familial cancer syndromes in about 2 to 4 percent. The major genetic syndromes are Familial adenomatous polyposis (FAP) and Hereditary nonpolyposis colorectal cancer (HNPCC). FAP is caused by germline mutation of APC gene, and HNPCC is caused by germline mutation in one of five MMR genes. The identification of patients with inherited disease is very important in the management of colorectal cancer. But, it is impractical to test every patient with the disease for these mutations. The clinical and genetical screening programme should be advised for family members at risk and colectomy in affected individuals in purpose to reduce the frequency of colorectal cancer.
    Medical Archives 02/2007; 61(4):256-9.
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    ABSTRACT: To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. Prevalence of hepatitis B surface antigen was higher (P<0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9-5.8; P<0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P<0.001) in exposure existed among family members; exposure increased with age (rhos=0.34; P<0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P<0.005) and among offspring of female index cases (P<0.001). There were more (P<0.001) hepatitis B surface antigen-positive family members among those with mother-children relationship with index case (13/31; 41.9%) than among those with father-children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P<0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P<0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88-65.21; P<0.05). In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.
    European Journal of Gastroenterology & Hepatology 02/2007; 19(2):113-8. · 1.92 Impact Factor

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