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Purpose Educational interventions have already been shown to positively affect awareness of clinical trials (CTs) among medical students. We aimed to explore basic knowledge and attitudes about CTs among medical students in terms of educational interventions that should be reflected in their further involvement in performing CTs and their role in raising awareness about CTs. Methods This cross-sectional, self-report anonymous online survey involved undergraduate medical students of the Medical Faculty University of Sarajevo enrolled in classes held within the Department of Pharmacology and Toxicology in the academic year 2015–2016. To include all accessible subjects for better representation of the whole population, consecutive sampling was applied. Results Among 142 students who completed questionnaire, 50% of them expressed partial or full agreement with the questionnaire statement that they were satisfied with the available information on CTs. Only 38% said they would participate in a CT, 21% would not, while 41% were not sure. Positive correlations were detected for composite subscale scores of agreement with questionnaire statements conveying the student’s knowledge about ethical and legal aspects of CTs and their perception about reliability/integrity and impact of CTs on medical practice. Conclusion Students have knowledge of the basic design and ethical aspects of CTs. Positive attitudes toward the impact of CTs on medical practice were shown in students of higher years of study, where educational intervention of additional knowledge of CTs was inserted and those students expressed better knowledge of CTs. However, no significant impact was detected between knowledge and willingness to participate in CTs, irrespective of years of study, reflecting the third of students that would participate in CTs. Changes in medical curricula led to the change in students’ knowledge and attitudes regarding CTs as well as their involvement in CTs.

Aim To evaluate the efficacy (rate of recanalization) of therapy with novel oral anticoagulants (NOAC; rivaroxaban, apixaban) compared to conventional treatment (low molecular weight heparin - LMWH and vitamin K antagonist) in the treatment of deep vein thrombosis (DVT) of the proximal segments of lower extremities. Methods The first group consisted of patients diagnosed with DVT and treated with NOAC (n = 100), while the second group consisted of patients diagnosed with DVT, who were treated by conventional treatment (low molecular weight heparin and vitamin K antagonists) (n = 100). In the first group, NOAC was included in the initial treatment. Patients in the second group were treated with LMWH for four days, and on the fifth day vitamin K antagonist was included in therapy, international ratio (INR) was titrated to therapeutic values (2.0-3.0), and then low molecular weight heparin was excluded from the therapy. Results There was a statistically significant difference in the estimated values of free lumen of the blood vessel between the examined groups after 30 days (p=0.0001), after 90 days (p=0.0001) and after 180 days (p=0.0001). After 180 days, the average free lumen values in the NOAC group were 85% (81-89%), which was significantly higher than the free lumen values in the second group, 73% (69-79%). Conclusion The use of NOAC represents more efficient treatment of DVT comparing to vitamin K antagonists.

BACKGROUND Acute ischemic stroke (AIS) frequently results in the development of cognitive impairment, which quite often persists. The pathophysiological mechanisms involved in the development of cognitive impairment are only partially elucidated. The aim of this study was to evaluate the correlation between interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) serum levels with cognitive impairment in AIS patients. SUBJECTS AND METHODS This hospital-based case-control study was performed during December 2014 - May 2018. A total number of 130 randomly selected patients were prospectively recruited from the Department of Neurology, Clinical Center University of Sarajevo. The study examined 100 first-ever AIS patients, while 30 comprised the non-stroke control group of patients with discogenic lumbosacral radiculopathy. All participants were evaluated using the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Addenbrooke's Cognitive Examination-Revised. Cognitive testing and laboratory analyses were performed within the first three days of admission in all patients while AIS patients were reassessed on the 15thday of hospitalization. RESULTS Female stroke patients with cognitive impairment had significantly higher baseline levels of IL-6 (p<0.017), and TNF-α (p<0.017) than those without cognitive impairment. In the control measurement, a significant difference in IL-6 levels (p=0.037) in male and TNF-α levels (p=0.042) in female stroke patients with cognitive impairment was observed. CONCLUSIONS These findings indicate that pro-inflammatory cytokines are probably implicated in the pathogenesis of cognitive decline in AIS patients.

BACKGROUND Previous studies have indicated that changes in the expression of certain inflammatory biomarkers are associated with cognitive impairment (CI), but only a limited number of studies were conducted in patients with acute ischemic stroke (AIS). The present study aimed to evaluate the potential association between serum levels of several inflammatory markers and cognitive impairment in AIS patients. These markers included interleukin 6 (IL-6), C-reactive protein (CRP), plasma fibrinogen, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count. SUBJECTS AND METHODS All participants were prospectively recruited from the Department of Neurology, Clinical Center University of Sarajevo. A total of 100 patients with first-ever AIS were included in stroke group and 30 in the non-stroke control group. Each patient underwent a comprehensive cognitive assessment and laboratory tests (IL-6, CRP, fibrinogen, ESR and WBC) within the first three days of admission. Cognitive status was assessed using cognitive instruments: the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Addenbrooke's Cognitive Examination-Revised. RESULTS Female stroke patients with CI had higher levels of IL-6 compared to those without CI and controls (p<0.017). AIS patients with CI had significantly higher plasma fibrinogen (p<0.001) and CRP levels (p<0.001) than controls, whereas there was no significant difference in comparison with cognitively intact patients. There were no statistical differences in ESR or WBC count between groups. CONCLUSIONS Of the inflammatory markers, only IL-6 levels were associated with CI in AIS patients. Measuring circulating IL-6 could be used as a screening test to identify all such patients.

OBJECTIVES The aim of this research was to detect the presence of depressive symptoms among the student population at a Faculty of Medicine, as well to determine the correlation between the socio-demographic characteristics and students' lifestyle and depressive symptoms. SUBJECTS AND METHODS Of 800 students enrolled and asked to participate, 412 responded to the survey. The study included students from all 6 years of studies. The degree of depressive symptoms was measured by a 21-item revised form of the Beck Depression Inventory (BDI). We built bivariate logistic regression models to study whether age, gender, housing accommodation, year of medical training, and school success status (Grade Point Average - GPA) were associated with depressive symptoms. The results are reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS The study revealed that almost one third of students reported BDI >16 (30.1%). The present study did not find any association between BDI scores and study year or age difference, but we found that there was an association between housing accommodation and depressive symptoms. Students who lived with their parents had lower BDI scores than those who lived in a dormitory. The results of this study showed there is a negative correlation between physical activity and depressive symptoms in students, as well as that there is a positive correlation between depressive symptoms and substance abuse. CONCLUSION Overall, our study confirms that the factors associated with an increase in medical students' depressive symptoms are housing accommodation, a lack of physical activity and substance abuse. Regarding failing a year of study at the medical school, as well as gender and age differences, we did not find any significant difference between students with higher compared to those with lower depressive symptoms.

Dear Editor, Patients with communication between pancreatic pseudocysts (PPC) and pancreatic duct (PD) require a longer duration of drainage, due to the short-term drainage resulting in very high recurrence rates. However, with prolonged drainage period, the risk of septic complications is also potentially increased.1-3 The aim of the study was to evaluate the results of prolonged percutaneous catheter drainage (PCD) in the treatment of recurrent PPC with PPC-PD communication, including its outcome and complications.