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 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.

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.

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.

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/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.